title: Impact of lipid-lowering medications and low-density lipoprotein levels on 1-year clinical outcomes after coronary artery bypass grafting.
abstract: BACKGROUND
  Studies investigating lipid-lowering medication (LLM) use and LDL levels in coronary artery bypass grafting patients are limited.
  
  
  METHODS
  The Veterans Affairs Randomized On/Off Bypass Trial's patient records were analyzed for LLM use and 1-year LDL levels. Mortality, acute MI (AMI), and repeat revascularization rates were compared at 1 year between patients with and without LLM at discharge. In addition, AMI, repeat revascularization, and graft patency were compared between patients that did and did not achieve a 1-year LDL target level of <100 mg/dL.
  
  
  RESULTS
  The LLM data were available for 86.4% (1,904 of 2,203) of patients. Rates of LLM use were 83.4% (1,316 of 1,577) at discharge and 90.0% (1,713 of 1,904) at 1 year. Patients discharged after coronary artery bypass grafting on LLMs had a significantly lower 1-year mortality rate (1.9% vs 5.4%; p < 0.01) than those not discharged on LLM, and 1-year AMI and repeat revascularization rates were not significantly different. Of the patients with 1-year LDL measurements, 69.4% (1,200 of 1,729) achieved an LDL target level of <100 mg/dL. No differences were seen in AMI, revascularization, or graft occlusion rates between patients who achieved target LDL levels and those who did not.
  
  
  CONCLUSIONS
  Rates of LLM use among veterans post-coronary artery bypass grafting are high. Discharge on LLM might be associated with improved intermediate-term survival. Patients who achieved an LDL target of <100 mg/dL at 1-year did not experience improved 1-year clinical outcomes or graft patency. Longer-term follow-up might reveal differences in cardiac outcomes related to achievement of target LDL levels.
authors.affiliation: VA Boston Healthcare System, West Roxbury, MA 02132, USA. jacquelyn.quin@va.gov
authors.forename: Jacquelyn A
authors.initials: JA
authors.lastname: Quin
authors.forename: Brack
authors.initials: B
authors.lastname: Hattler
authors.forename: Muath
authors.initials: M
authors.lastname: Bishawi
authors.forename: Janet
authors.initials: J
authors.lastname: Baltz
authors.forename: Sandeep
authors.initials: S
authors.lastname: Gupta
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Collins
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Grover
authors.forename: Gerald
authors.initials: G
authors.lastname: McDonald
authors.forename: A Laurie W
authors.initials: AL
authors.lastname: Shroyer
mesh_terms: D002318:Cardiovascular Diseases / Q000097:blood* / Q000401:mortality*; D016009:Chi-Square Distribution; D008078:Cholesterol, LDL / Q000097:blood*; D001026:Coronary Artery Bypass / Q000401:mortality; D005260:Female; D006083:Graft Occlusion, Vascular / Q000097:blood / Q000401:mortality / Q000517:prevention & control; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood / Q000401:mortality; D012086:Reoperation; D015996:Survival Rate; D016896:Treatment Outcome; D014654:Vascular Patency; D014728:Veterans
chemical_list: D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: AMI; CABG; IMA; LLM; MACE; OR; ROOBY; Randomized On/Off Pump Bypass; VA; Veterans Affairs; acute MI; coronary artery bypass grafting; internal mammary artery; lipid-lowering medication; major adverse cardiac events; odds ratio