title: Prompt impact of first prospective statin mega-trials on postoperative lipid management of CABG patients: a 20-year follow-up in a single hospital.
abstract: BACKGROUND
  The long-term success of coronary artery bypass grafting (CABG) depends on secondary prevention. Vast evidence provided by the results of cholesterol mega-trials over two decades has shown that effective reduction of LDL cholesterol improves the prognosis of patients with coronary heart disease. However, the implementation of these results into the clinical practice has turned out to be challenging. We analysed how the information derived from clinical statin trials and international recommendations affected the local treatment practices of dyslipidaemia of CABG patients during a 20-year time period.
  
  
  METHODS
  The cohort includes all CABG patients (n = 953) treated in Kanta-Häme Central Hospital during the time period 1990-2009. At the postoperative visits in the cardiology outpatient clinic, each patient's statin prescription was recorded, and blood lipids were determined.
  
  
  RESULTS
  During 1990-1994, 12.0 % of patients were on statins and during the following 5-year time periods the proportion was 57.2, 82.2 and 96.8 %, respectively. During the 20-year observation period (1990-2009), the effective statin dose increased progressively during these 5-year periods up to 36-fold, while the mean concentration of LDL cholesterol decreased from 3.7 to 2.1 mmol/l and that of apolipoprotein B from 1.3 to 0.8 g/l. In the very last year of follow-up, the mean concentrations of LDL-C and apoB were 1.83 mmol/l and 0.78 g/l, respectively. The most prominent increase in statin use and dosage took place during 1994-1996 and 2003-2005, respectively.
  
  
  CONCLUSIONS
  Among CABG patients the lipid-lowering efficacy of statin therapy improved dramatically since 1994. This progress was accompanied by significant and favourable changes of lipid and apolipoprotein-B values. This study shows that it is possible to effectively improve lipid treatment policy once the results of relevant trials are available, and that this may happen even before international or national guidelines have been updated.
authors.affiliation: Department of Emergency Medicine, Kanta-Häme Central Hospital, FIN-13530, Hämeenlinna, Finland.|Medical School, University of Tampere, Tampere, Finland.
authors.forename: A
authors.initials: A
authors.lastname: Palomäki
authors.affiliation: Department of Emergency Medicine, Kanta-Häme Central Hospital, FIN-13530, Hämeenlinna, Finland. ville.hallberg@khshp.fi.|Medical School, University of Tampere, Tampere, Finland. ville.hallberg@khshp.fi.
authors.forename: V
authors.initials: V
authors.lastname: Hällberg
authors.affiliation: University of Oulu, Institute of Health Sciences, Computational Medicine and Oulu University Hospital, Oulu, Finland.|School of Social and Community Medicine and Medical Research Council Integrative Epidemiology Unit, Computational Medicine, University of Bristol, Bristol, UK.
authors.forename: M
authors.initials: M
authors.lastname: Ala-Korpela
authors.affiliation: Wihuri Research Institute, Helsinki, Finland.
authors.forename: P T
authors.initials: PT
authors.lastname: Kovanen
authors.affiliation: Medical School, University of Tampere, Tampere, Finland.|Department of Emergency Medicine, Tampere University Hospital, Tampere, Finland.
authors.forename: K
authors.initials: K
authors.lastname: Malminiemi
mesh_terms: D000368:Aged; D001055:Apolipoproteins B / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000097:blood / Q000473:pathology / Q000601:surgery*; D004334:Drug Administration Schedule; D050171:Dyslipidemias / Q000097:blood / Q000473:pathology / Q000517:prevention & control*; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D006761:Hospitals; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D055502:Secondary Prevention
chemical_list: D001055:Apolipoproteins B; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents
keywords: ApoB; CABG; Coronary artery bypass; Extended Friedewald; LDL cholesterol; Lipids; Statin intolerance; Statins