Raising high-density lipoprotein cholesterol and lowering low-density lipoprotein cholesterol as adjunctive therapy to coronary artery revascularization

Several studies shortly after the advent of coronary artery bypass surgery reported early atherosclerosis in saphenous vein grafts, and an association between dyslipidemia and graft occlusion. Lipid-lowering therapy in a number of trials resulted in reduced progression of atherosclerosis in vein grafts and fewer subsequent revascularization procedures. Presently, however, only a few patients are treated and reach target lipid levels. Percutaneous coronary interventions permit rapid relief of symptoms and ischemia, and return to full activity levels, but may not reduce the risk of death or nonfatal myocardial infarction in patients with chronic stable coronary artery disease. Whether optimal medical therapy, including aggressive lipid control, could decrease the need for some of these procedures is the subject of ongoing debate and research. Despite successful coronary artery revascularization, subsequent ischemic events continue to occur, supporting the requirement for successful secondary prevention interventions. Ultimately, optimal care of revascularization patients should include maximizing lipid profiles.