The Effects of Lipid-Lowering Therapy on Graft Patency In Coronary Bypass Surgery Patients (original) (raw)
Related papers
Clinical Cardiology, 1994
Vein graft atherosclerosis is a common and serious complication of coronary artery bypass grafbng (CABG). There is mounting evidence that lipoprotein abnormalities play an equally important role in the development of lesions in saphenous vein grafts after CABG as in native coronary vessel disease. The potential benefit of low-dose lipid lowering combination therapy in these patients has not been investigated. In a randomized, double-blind, placebo-controlled study, we compared the efficacy and safety of a lowdose combination of co-lestipol10 g and simvastatin 10 mg/day (CS) to colestipol 10 mg and be&brate 400 mg/day (CB) for 2 months in 33 patients with s e m total cholesterol > 6.5 mmoyl and triglyceride < 4.5 mmoyl who had undergone CABG for severe coronary artery disease. In the CS group, total cholesterol decreased by 29% and low-density lipoprotein (LDL) cholesterol by 42%; similarly, CB reduced total cholesterol by 17%, LDL cholesterol by 23%, triglyceride by 19%, and increased high-density lipoprotein (HDL) cholesterol by 14%. Lipoprotein (a) and hemostatic factors were unaffected by either therapy in this study. Both combination therapies were well tolerated with no si@cant clinical or biochemical side effects. We conclude that low-dose combinations of colestipol and simvastatin or colestipol and bezafibrate are effective and well tolerated in the management of moderate hyperlipidemia in patients who had undergone CABG.
Preoperative Lipid Profile of Patients Operated for Coronary Bypass Surgery
2017
Aims: Dyslipidemia is a major risk factor for atherosclerosis and coronary heart disease. Evidence showed that an atherogenic lipid pattern is characterized by high levels of small, dense low-density lipoprotein, low levels of high-density lipoprotein cholesterol, elevated triglyceride and total cholesterol levels; similar with the lipid profiles of diabetics.Methods: In this study, 91 patients who underwent coronary artery bypass grafting in Trakya University Hospital Department of Cardiovascular Surgery from April 2017 to September 2017 were analyzed retrospectively. As for statistical analysis, Student’s t-test and Mann Whitney U tests were performed.Results: The lipid profiles of patients were not significantly related to their ages and genders. However, when diabetic patients’ lipid profiles were analyzed, their low-density lipoprotein, and total cholesterol values were found to be significantly lower.Conclusion: It is unexpected to see that patients with diabetes had significa...
Hypertriglyceridaemia is associated with early non-patency of coronary bypass grafts
Heart, 2005
C oronary artery bypass grafting (CABG) has prognostic benefit in patients with severe coronary disease and left ventricular dysfunction. It is particularly important in diabetic patients where CABG confers greater long term protection against coronary events than percutaneous angioplasty. However, up to 32% of saphenous vein grafts (SVGs) and 31% of radial artery grafts (RAGs) may be non-patent by one year. 1 Hypertriglyceridaemia is associated with increased mortality after CABG, particularly among diabetics, but its relation to early graft patency is unknown. 2 3 We investigated the association between metabolic risk factors and early graft occlusion by using non-invasive computed tomography (CT) angiography.
BMC Cardiovascular Disorders, 2016
Background: Lipoprotein(a) (Lp(a)) excess is an independent risk factor of coronary artery disease (CAD) and have shown wide ethnic variations. Further, lipid parameters used in the assessment and management of risk factors for CAD may not reflect accurately the disease or severity if the patients are on pharmacological interventions when compared to Lp(a). Lp(a) levels of Sri Lankan CAD patients awaiting coronary artery bypass graft are not documented. Methods: A cross sectional study was carried out with patients (n = 102) awaiting coronary artery bypass graft at a tertiary healthcare institution in Sri Lanka. Lp(a) was determined by immunoturbidimetric method (Konelab 20XT) and information on risk factors collected using a standardized questionnaire. The severity of CAD was determined by Gensini score. Lipid parameters and pharmacological treatment data were obtained from the Medical Records. Data were analysed using independent sample t-test, Pearson and Spearman tests respectively. Results: Total cholesterol (TC), LDL cholesterol (LDLc) and HDL cholesterol (HDLc) of the total study sample (average ± SD) were, 150 ± 36 mg/dL, 92 ± 36 mg/dL and 34 ± 9 mg/dL respectively with no significant difference irrespective of being on pharmacological treatment or not. All lipid parameters were significantly high (p < 0.05) in females. The average Lp(a) was 50 ± 38 (SD) mg/dL with no significant difference in males or females independent of being on treatment (50 ± 39 mg/dL) or not (49 ± 39 mg/dL) and above the cut off value (30 mg/dL). Conclusions: Despite pharmacological interventions 27 % of the study population had high LDLc and majority low HDLc. Mean Lp(a) was in excess irrespective of risk factors or being on treatment or not and is confirmed as an independent, potential marker for assessing the susceptibility for CAD especially in those with other intermediate risk factors but considered non-hyperlipidemic by conventional methods.
Lipoprotein(a) Changes during and after Coronary Artery Bypass Grafting: An Epiphenomenon?
Annals of Clinical Biochemistry: International Journal of Laboratory Medicine, 1998
The lipoprotein(a) (Lp(a)) time course during and after coronary artery bypass grafting was examined in 20 caucasoid patients, in relation to the time courses of serum cholesterol and serum triglycerides. Samples were taken at eight different time points. Baseline geometric means (SD) for Lp(a), cholesterol and triglycerides were 115 (336) mg/L, 5.73 (1.10) mmol/L and 1.73 (1.21) mmol/L, respectively. Up to 10 min after cardiopulmonary bypass (CPB) and after correction for haemodilution, no observable effect of CPB on serum concentrations of Lp(a) could be demonstrated, whereas serum concentrations of total cholesterol and triglycerides showed a progressive and significant decline. Ten minutes after stopping CPB geometric means for cholesterol and triglyceride were 3.90 (0.82) and 0.90 (0.58) mmol/L, respectively. At the third post-operative day geometric Lp(a) and cholesterol means decreased to 62 (90) mg/L and 2.97 (0.84) mmol/L, respectively, while triglycerides went up. It is co...
Atherosclerosis, 1999
The reported results (The Post Coronary Artery Bypass Graft Trial Investigators. The effect of aggressive lowering of low-density lipoprotein cholesterol levels and low-dose anticoagulation on obstructive changes in saphenous-vein coronary-artery bypass grafts. New Engl J Med 1997;336:153-162) of the Post Coronary Artery Bypass Graft (Post CABG) trial have shown that aggressive lowering was more effective than moderate lowering of low density lipoprotein (LDL) cholesterol in reducing the progression of atherosclerosis in saphenous-vein grafts (27 vs. 39%; PB 0.001); low dose warfarin had no effect on the progression of atherosclerosis. The present report describes the effect of long-term (an average of 4.3 years) aggressive treatment with high (40-80 mg/day) and moderate treatment with low (2.5-5 mg/day) doses of lovastatin on lipids, apolipoproteins (apo) and apoAand apoB-containing lipoprotein families. To achieve the target LDL-cholesterol levels (60 -85 mg/dl for aggressive group and 134-140 mg/dl for moderate group), cholestyramine (8 g/day) was given to 25% of subjects on aggressive and 5% of subjects on moderate treatment. Although with both treatment strategies there were significant decreases (P B 0.001) in the levels of total cholesterol, LDL-cholesterol, apoB, LDL-apoB and cholesterol-rich Lp-B family, percent changes in the levels of these variables were greater in the aggressive-than in the moderate-treatment groups. These treatments had only marginal effects in increasing the levels of high density lipoprotein cholesterol, apoA-I and Lp-A-I and Lp-A-I:A-II families. The long-term aggressive treatment exerted no effect on the concentrations of triglycerides, apoC-III, apoC-III in VLDL +LDL and triglyceride-rich Lp-B c families. Neither treatment affected the levels of Lp(a). The potentially modifying influence of warfarin and apoE phenotypes on lovastatin-induced changes in lipoprotein variables was found to be of little significance. It is likely that the beneficial effect of lovastatin in reducing the progression of atherosclerosis in grafts is mediated through its specific lowering effect on cholesterol-rich Lp-B particles.
Heart, 1997
Objective-To examine the association between serum Lp(a) lipoprotein concentration and clinical and angiographic outcomes five years after coronary artery bypass graft (CABG) surgery. Setting-A regional cardiothoracic centre, Freeman Hospital, and the University Clinical Investigation Unit, Royal Victoria Infirmary, Newcastle upon Tyne. Patients and design-353 consecutive patients (56 female, 297 male, mean age 57 2 years) undergoing first time CABG surgery for stable angina were studied prospectively. Main outcome measures-Late cardiac death (beyond 30 days) and non-fatal myocardial infarction; prevalence of angina five years after surgery in 291 (94%) survivors and vein graft patency (evaluated by patient) in 118 survivors five years after surgery. Serum Lp(a) concentration and lipid profiles were measured before operation, and 3, 6, 12, and 60 months after surgery. Lipid profiles were also measured 24 months after surgery. Results-Weighted Lp(a) concentration (by tertile) was not associated with late cardiac death or with the combination of late cardiac death and non-fatal myocardial infarction, with the presence of angina, or with vein graft occlusion. The association remained non-significant if analysis was restricted to the upper tertile of LDL cholesterol (> 4.1 mmoMl) or to patients under the age of 55 years at the time of surgery. Conclusions-Serum Lp(a) concentration did not predict late cardiac death, the combination of late cardiac death and non-fatal myocardial infarction, or the prevalence of angina or vein graft occlusion five years after CABG surgery.
Lipid Control before CABG and Its Association with In-Hospital Mortality
Iranian Red Crescent medical journal, 2011
Controlling risk factors such as dyslipidemia in patients with coronary artery disease, including candidates for coronary artery bypass grafting (CABG), is of great importance and has serious effects on CABG morbidity and mortality. The aim of this study was to evaluate lipid serum levels, comprising TG, LDL, and HDL, before CABG and their relation with in-hospital outcome. The clinical profiles of 3,593 patients in the hospital cardiac surgery databank who underwent isolated CABG between April 2006 and April 2008 were reviewed. Three components of lipid profile, including TG, LDL, and HDL serum levels, were checked at the time of hospitalization in all the patients. Lipid control was evaluated according to the published guidelines. The mean LDL, HDL, and TG serum levels were 103.4±48.5, 40.9±16, and 168±87 mg/dl, respectively. Additionally, 487 (13.6%) patients had entire TG, LDL, and HDL serum levels within the acceptable range and in 668 (18.6%) patients, all of these components ...