Does high-density lipoprotein influence the development of saphenous vein graft disease after coronary bypass surgery?: exploratory analysis from the CASCADE trial

Journal of Cardiothoracic Surgery

Alexander Kulik³  Michel R Le May¹  Pierre Voisine²  Marc Ruel¹  Katie Jerzewski³ 

[1] The University of Ottawa Heart Institute, Ottawa, Ontario, Canada;Hôpital Laval, Quebec City, Quebec, Canada;Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA

关键词: Cholesterol;    Graft patency;    HDL;    Vein graft disease;    Coronary artery bypass graft surgery;   

Others  :  824261
DOI  :  10.1186/1749-8090-8-172

 received in 2013-04-05, accepted in 2013-07-08,  发布年份 2013

【 摘 要 】

Background

Low levels of high-density lipoprotein (HDL) purportedly increase the risk after coronary bypass surgery. This may relate to the development of saphenous vein graft (SVG) disease early postoperatively, but this premise has never been evaluated in the context of a prospective trial.

Methods

The CASCADE Trial was a multi-center study of 113 patients evaluating the use of postoperative clopidogrel. Patients received standard lipid management after surgery (96% statins). At 12 months, angiography and intravascular ultrasound was performed to assess SVG occlusion and intimal hyperplasia, respectively. In this exploratory analysis, we evaluated the influence of HDL levels on the development of SVG disease at 12 months, using the established cut-off of <40 mg/dL suggesting increased risk.

Results

While HDL levels increased over the time-period of the trial (P < 0.0001), 51.1% of patients had HDL levels <40 mg/dL 12 months after surgery. Slightly more SVG occlusions occurred amongst patients with HDL levels <40 mg/dL (6.8%), compared to patients with HDL levels >40 mg/dL (4.0%, P = 0.5). With multivariate adjustment, HDL level <40 mg/dL was associated with a trend towards more SVG occlusions (odds ratio: 3.2; P = 0.12). Lower HDL level was also associated with more intimal hyperplasia on ultrasound at 12 months (P = 0.10). Patients who had HDL levels >60 mg/dL had the least amount of intimal hyperplasia, significantly less than the remainder of the cohort (P = 0.01).

Conclusions

Within this population, lower HDL levels were associated with trends towards more graft occlusions and more vein intimal hyperplasia. Modulation of postoperative HDL levels may represent a valuable future strategy for the reduction of SVG disease.

【 授权许可】

   
2013 Jerzewski et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Motwani JG, Topol EJ: Aortocoronary saphenous vein graft disease: pathogenesis, predisposition, and prevention. Circ 1998, 97:916-931.
• [2]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. The post coronary artery bypass graft trial investigators N Engl J Med 1997, 336:153-162.
• [3]Kulik A, Voisine P, Mathieu P, Masters RG, Mesana TG, Le May MR, Ruel M: Statin therapy and saphenous vein graft disease after coronary bypass surgery: analysis from the CASCADE randomized trial. Ann Thorac Surg 2011, 92:1284-1290. discussion 1290–1281
• [4]Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, Cigarroa JE, Disesa VJ, Hiratzka LF, Hutter AM Jr, et al.: ACCF/AHA guideline for coronary artery bypass graft surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circ 2011, 2011(124):e652-e735.
• [5]Barter P, Gotto AM, LaRosa JC, Maroni J, Szarek M, Grundy SM, Kastelein JJ, Bittner V, Fruchart JC: HDL cholesterol, very low levels of LDL cholesterol, and cardiovascular events. N Engl J Med 2007, 357:1301-1310.
• [6]Barter P: HDL-C: role as a risk modifier. Atheroscler Suppl 2011, 12:267-270.
• [7]Boden WE, Probstfield JL, Anderson T, Chaitman BR, Desvignes-Nickens P, Koprowicz K, McBride R, Teo K, Weintraub W: Niacin in patients with low HDL cholesterol levels receiving intensive statin therapy. N Engl J Med 2011, 365:2255-2267.
• [8]Taylor AJ, Villines TC, Stanek EJ, Devine PJ, Griffen L, Miller M, Weissman NJ, Turco M: Extended-release niacin or ezetimibe and carotid intima-media thickness. N Engl J Med 2009, 361:2113-2122.
• [9]Birjmohun RS, Hutten BA, Kastelein JJ, Stroes ES: Efficacy and safety of high-density lipoprotein cholesterol-increasing compounds: a meta-analysis of randomized controlled trials. J Am Coll Cardiol 2005, 45:185-197.
• [10]Gordon T, Castelli WP, Hjortland MC, Kannel WB, Dawber TR: Predicting coronary heart disease in middle-aged and older persons. The Framington study. JAMA 1977, 238:497-499.
• [11]Seo SM, Choo EH, Koh YS, Park MW, Shin DI, Choi YS, Park HJ, Kim DB, Her SH, Lee JM, et al.: High-density lipoprotein cholesterol as a predictor of clinical outcomes in patients achieving low-density lipoprotein cholesterol targets with statins after percutaneous coronary intervention. Heart 2011, 97:1943-1950.
• [12]Foody JM, Ferdinand FD, Pearce GL, Lytle BW, Cosgrove DM, Sprecher DL: HDL cholesterol level predicts survival in men after coronary artery bypass graft surgery: 20-year experience from The Cleveland Clinic Foundation. Circ 2000, 102:III90-III94.
• [13]Sabik JF 3rd, Blackstone EH, Gillinov AM, Smedira NG, Lytle BW: Occurrence and risk factors for reintervention after coronary artery bypass grafting. Circ 2006, 114:I454-I460.
• [14]Frick MH, Syvanne M, Nieminen MS, Kauma H, Majahalme S, Virtanen V, Kesaniemi YA, Pasternack A, Taskinen MR, Lopid Coronary Angiography Trial (LOCAT) Study Group: Prevention of the angiographic progression of coronary and vein-graft atherosclerosis by gemfibrozil after coronary bypass surgery in men with low levels of HDL cholesterol. Circ 1997, 96:2137-2143.
• [15]Kulik A, Le May M, Wells GA, Mesana TG, Ruel M: The clopidogrel after surgery for coronary artery disease (CASCADE) randomized controlled trial: clopidogrel and aspirin versus aspirin alone after coronary bypass surgery [NCT00228423]. Curr Control Trials Cardiovasc Med 2005, 6:15. BioMed Central Full Text
• [16]Kulik A, Le May MR, Voisine P, Tardif JC, Delarochelliere R, Naidoo S, Wells GA, Mesana TG, Ruel M: Aspirin plus clopidogrel versus aspirin alone after coronary artery bypass grafting: the clopidogrel after surgery for coronary artery disease (CASCADE) trial. Circ 2010, 122:2680-2687.
• [17]Nicholls SJ, Tuzcu EM, Sipahi I, Grasso AW, Schoenhagen P, Hu T, Wolski K, Crowe T, Desai MY, Hazen SL, et al.: Statins, high-density lipoprotein cholesterol, and regression of coronary atherosclerosis. JAMA 2007, 297:499-508.
• [18]Barter PJ, Caulfield M, Eriksson M, Grundy SM, Kastelein JJ, Komajda M, Lopez-Sendon J, Mosca L, Tardif JC, Waters DD, et al.: Effects of torcetrapib in patients at high risk for coronary events. N Engl J Med 2007, 357:2109-2122.
• [19]Ericsson CG, Hamsten A, Nilsson J, Grip L, Svane B, de Faire U: Angiographic assessment of effects of bezafibrate on progression of coronary artery disease in young male postinfarction patients. Lancet 1996, 347:849-853.
• [20]Effect of fenofibrate on progression of coronary-artery disease in type 2 diabetes: the diabetes atherosclerosis intervention study, a randomised study Lancet 2001, 357:905-910.
• [21]Bottorff MB: Statin safety and drug interactions: clinical implications. Am J Cardiol 2006, 97:27C-31C.