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(Circulation. 1999;99:3241-3247.)
© 1999 American Heart Association, Inc.

Clinical Investigation and Reports

Aggressive Cholesterol Lowering Delays Saphenous Vein Graft Atherosclerosis in Women, the Elderly, and Patients With Associated Risk Factors

NHLBI Post Coronary Artery Bypass Graft Clinical Trial

Lucien Campeau, MD; Donald B. Hunninghake, MD; Genell L. Knatterud, PhD; Carl W. White, MD; Michael Domanski, MD; Sandra A. Forman, MA; James S. Forrester, MD; Nancy L. Geller, PhD; Fredarick L. Gobel, MD; J. Alan Herd, MD; Byron J. Hoogwerf, MD; Yves Rosenberg, MD; Post CABG Trial Investigators¹

From the Montreal Heart Institute and University of Montreal (L.C.), Canada; The Maryland Medical Research Institute (G.L.K., S.A.F.), Baltimore, Md; The National Heart, Lung, and Blood Institute (M.D., N.L.G., Y.R.), Bethesda, Md; University of Minnesota (D.B.H., C.W.W.), Minneapolis; Minneapolis Heart Institute Foundation (F.L.G.), Minn; Cleveland Clinic Foundation (B.J.H.), Ohio; Cedars-Sinai Medical Center (J.S.F.), Los Angeles, Calif; and Baylor College of Medicine (J.A.H.), Houston, Tex.

Correspondence to Dr Lucien Campeau, Research Center, Montreal Heart Institute, 5000 Bélanger Street East, Montreal, Quebec H1T 1C8, Canada.

Background—The NHLBI Post Coronary Artery Bypass Graft trial (Post CABG) showed that aggressive compared with moderate lowering of low-density lipoprotein-cholesterol (LDL-C) decreased obstructive changes in saphenous vein grafts (SVGs) by 31%.¹ Using lovastatin and cholestyramine when necessary, the annually determined mean LDL-C level ranged from 93 to 97 mg/dL in aggressively treated patients and from 132 to 136 mg/dL in the others (P<0.001).

Methods and Results—The present study evaluated the treatment effect in subgroups defined by age, gender, and selected coronary heart disease (CHD) risk factors, ie, smoking, hypertension, diabetes mellitus, high-density lipoprotein cholesterol (HDL-C) <35 mg/dL, and triglyceride serum levels 200 mg/dL at baseline. As evidenced by similar odds ratio estimates of progression (lumen diameter decrease 0.6 mm) and lack of interactions with treatment, a similar beneficial effect of aggressive lowering was observed in elderly and young patients, in women and men, in patients with and without smoking, hypertension, or diabetes mellitus, and those with and without borderline high-risk triglyceride serum levels. The change in minimum lumen diameter was in the same direction for all subgroup categories, without significant interactions with treatment.

Conclusions—Aggressive LDL-C lowering delays progression of atherosclerosis in SVGs irrespective of gender, age, and certain risk factors for CHD.

Key Words: bypass • grafting • atherosclerosis • risk factors

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