Shah SJ et al. (2008) Intensive lipid-lowering with atorvastatin for secondary prevention in patients after coronary artery bypass surgery. J Am Coll Cardiol 51: 1938–1943

Patients who have undergone CABG surgery are at particularly high risk of atherosclerosis progression, yet these individuals tend not to receive adequate lipid-lowering therapy. Shah et al.'s post-hoc analysis of patients enrolled in the randomized, double-blind Treating to New Targets (TNT) trial has revealed that high-dose atorvastatin after CABG surgery reduces the incidence of cardiovascular events by 27%, and the need for repeat revascularization by 30%, when compared with a low-dose regimen.

The TNT trial enrolled patients aged 35–75 years with coronary heart disease. Exclusion criteria included nephrotic syndrome, liver disease, uncontrolled hypertension or diabetes, and hypersensitivity to statins. Of the 4,654 participants who reported previous CABG surgery, 2,338 were randomly assigned to receive low-dose atorvastatin 10 mg per day and 2,316 to the high-dose regimen 80 mg per day. High-dose atorvastatin was associated with a 51% reduction in LDL cholesterol from baseline, compared with a 38% reduction with low-dose atorvastatin. After a median follow-up of 4.9 years, the incidence of major cardiovascular events was significantly lower in the high-dose group than in the low-dose group (hazard ratio 0.73, 95% CI 0.62–0.87; P = 0.0004) as was the need for repeat revascularization (hazard ratio 0.70, 95% CI 0.60–0.82; P <0.0001). High-dose atorvastatin was generally well tolerated, but was associated with a trend towards an increased incidence of treatment-related adverse events (P = 0.04). The authors recommend that atorvastatin 80 mg per day should be given to all patients who have undergone CABG surgery.