Intensive Lipid-Lowering With Atorvastatin for Secondary Prevention in Patients After Coronary Artery Bypass Surgery

Sanjiv J. Shah, David D. Waters*, Philip Barter, John J.P. Kastelein, James Shepherd, Nanette K. Wenger, David A. DeMicco, Andrei Breazna, John C. LaRosa

*Corresponding author for this work

Research output: Contribution to journalArticle

68 Scopus citations

Abstract

Objectives: The aim of this post hoc analysis from the TNT (Treating to New Targets) trial is to determine whether patients with previous coronary artery bypass grafting (CABG) surgery achieved clinical benefit from intensive low-density lipoprotein (LDL)-cholesterol lowering. Background: The development and progression of atherosclerosis is accelerated in coronary venous bypass grafts. Methods: A total of 10,001 patients with documented coronary disease, including 4,654 with previous CABG, were randomized to atorvastatin 80 or 10 mg/day and were followed for a median of 4.9 years. The primary end point was the occurrence of a first major cardiovascular event (cardiac death, nonfatal myocardial infarction, resuscitated cardiac arrest, or stroke). Results: A first major cardiovascular event occurred in 11.4% of the patients with prior CABG and 8.5% of those without prior CABG (p < 0.001). In CABG patients, mean LDL-cholesterol levels at study end were 79 mg/dl in the 80-mg arm and 101 mg/dl in the 10-mg arm, and the primary event rate was 9.7% in the 80-mg arm and 13.0% in the 10-mg arm (hazard ratio 0.73, 95% confidence interval 0.62 to 0.87, p = 0.0004). Repeat revascularization during follow-up, either CABG or percutaneous coronary intervention, was performed in 11.3% of the CABG patients in the 80-mg arm and 15.9% in the 10-mg arm (hazard ratio 0.70, 95% confidence interval 0.60 to 0.82, p < 0.0001). Conclusions: Intensive LDL-cholesterol lowering to a mean of 79 mg/dl with atorvastatin 80 mg/day in patients with previous CABG reduces major cardiovascular events by 27% and the need for repeat coronary revascularization by 30%, compared with less intensive cholesterol-lowering to a mean of 101 mg/dl with atorvastatin 10 mg/day. (A Study to Determine the Degree of Additional Reduction in CV Risk in Lowering LDL Below Minimum Target Levels [TNT]; NCT00327691).

Original languageEnglish (US)
Pages (from-to)1938-1943
Number of pages6
JournalJournal of the American College of Cardiology
Volume51
Issue number20
DOIs
StatePublished - May 20 2008

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Shah, S. J., Waters, D. D., Barter, P., Kastelein, J. J. P., Shepherd, J., Wenger, N. K., DeMicco, D. A., Breazna, A., & LaRosa, J. C. (2008). Intensive Lipid-Lowering With Atorvastatin for Secondary Prevention in Patients After Coronary Artery Bypass Surgery. Journal of the American College of Cardiology, 51(20), 1938-1943. https://doi.org/10.1016/j.jacc.2007.12.054