Which is the best statin for the postoperative coronary artery bypass graft patient?
The progression of atherosclerosis following coronary artery bypass graft (CABG) surgery results in the need for re-vascularisation therapy in a significant proportion of patients. It is well recognised that this risk can be lowered by controlling the level of low-density lipid cholesterol (LDL-C) which can be achieved easily and safely with the use of statins. The choice of which is the best statin in post-CABG patients remains unclear. It has been shown that for milligram-equivalent doses, rosuvastatin provides the greatest LDL-C reduction and greatest number of patients achieving LDL-C targets in comparison with simvastatin and atorvastatin. Rosuvastatin's superiority over other statins in allowing patients to reach LDL-C targets has been maintained in 'real-world' observational studies. Rosuvastatin has also been shown to increase high-density lipid cholesterol (HDL-C) by greater proportions in comparison with other statins, providing increased anti-atherogenic effects. There are several statins currently available, some of which are now generic. However, the empirical use of generic statins does not necessarily translate into a cost-effective treatment option. This article reviews the rationale for lipid-lowering therapy in patients following CABG. We also look objectively at which is the best statin for use in the post-CABG patient, discussing effectiveness, cost and tolerability.
Conway
Allan M
AM
Department of Cardiothoracic Surgery, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK. allan.m.conway@doctors.org.uk
Musleh
Ghassan
G
D000368:Aged; D008078:Cholesterol, LDL / Q000097:blood; D001026:Coronary Artery Bypass; D023903:Coronary Restenosis / Q000517:prevention & control*; D016527:Drug Costs / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*
D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors