Attainment of Lipid Targets Following Coronary Artery Bypass Graft Surgery: Can We Do Better?

Objective: Patients undergoing coronary artery bypass graft (CABG) surgery remain at high cardiovascular risk; however, few studies have evaluated lipid management and attainment of lipid targets in these patients. We investigated the proportion of CABG surgery patients who attained low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (HDL-C) targets.
Methods: Data were retrospectively obtained from patients undergoing CABG surgery at an Australian tertiary hospital between February 2015 and August 2020. The most recent lipid profile was recorded (at least 3 weeks post-operatively). We studied patients with electronically available data to ensure accuracy. Target LDL-C was defined as <1.4 (54 mg/dL) and <1.8 mmol/L (70 mg/dL), and target non-HDL-C as <2.2 (85 mg/dL) and <2.6 mmol/L (100 mg/dL), as per the 2019 and 2016 European dyslipidaemia guidelines, respectively.
Results: Follow-up lipid results were available for 484 patients (median post-operative follow-up, 483 days; interquartile range, 177.5-938.75 days). The mean age was 62.7±10.5 years and 387 (80.1%) were male. At discharge, 469 (96.9%) patients were prescribed statins, 425 (90.6%) high-intensity. Ezetimibe was prescribed for 62 (12.8%) patients and a proprotein convertase subtilisin-kexin type 9 inhibitor for 1. LDL-C levels <1.4 and <1.8 mmol/L were attained in 118 (24.4%) and 231 (47.7%) patients, respectively, and non-HDL-C levels <2.2 and <2.6 mmol/L in 140 (28.9%) and 237 (49.0%) patients, respectively.
Conclusion: The use of non-statin lipid-lowering therapies was limited, and many CABG surgery patients did not attain lipid targets despite high-intensity statins. Further studies are required to optimise lipid management in this very high-risk population.
Competing Interests: Conflict of Interest: NSRL has previously received funding and speaker honoraria from Sanofi as part of a Clinical Fellowship and conference support from Boehringer Ingelheim. BBY has received speaker honoraria and conference support from Sanofi, MSD, Boehringer Ingelheim, Lilly, AstraZeneca, Novo Nordisk, and Takeda, and has participated in advisory committees for Sanofi, Lilly, and Novartis. PGF has received speaker honoraria and conference support from Sanofi, MSD, Boehringer Ingelheim, Lilly, AstraZeneca and Novo Nordisk. DAB has received lecture fees from Sanofi and Amgen. The other authors have no conflicts of interest to declare.
(Copyright © 2022 The Korean Society of Lipid and Atherosclerosis.)