TY - JOUR
T1 - The Relationship Between Obesity and Atherosclerotic Progression and Prognosis Among Patients With Coronary Artery Bypass Grafts. The Effect of Aggressive Statin Therapy
AU - Wee, Christina C.
AU - Girotra, Saket
AU - Weinstein, Amy R.
AU - Mittleman, Murray A.
AU - Mukamal, Kenneth J.
N1 - Funding Information:
The Post CABG (Coronary Artery Bypass Graft) study was conducted and supported by the National Heart, Lung, and Blood Institute (NHLBI) in collaboration with the Post CABG Study Investigators. This article was prepared using a limited access dataset obtained by the NHLBI and does not necessarily reflect the opinions or views of the Post CABG study or the NHLBI. The authors had full access to the data and take responsibility for its integrity. All authors have read and agree to the article as written.
PY - 2008/8/19
Y1 - 2008/8/19
N2 - Objectives: This study examines whether obesity accelerates atherogenic progression or adverse outcomes after coronary artery bypass graft (CABG) surgery. Background: Obesity is a major risk factor for developing coronary heart disease. Whether obesity accelerates disease progression after CABG is unclear. Methods: We examined how body mass index (BMI) related to atherosclerotic graft progression and a clinical composite outcome of death, nonfatal myocardial infarction, stroke, CABG surgery, or angioplasty among 1,314 participants in the Post CABG trial. Participants who had undergone CABG surgery were randomly assigned in a 2 × 2 factorial design to warfarin versus placebo and aggressive low-density lipoprotein cholesterol (LDL-C) lowering with lovastatin 40 to 80 mg/day (to achieve LDL-C of 60 to 85 mg/dl) versus moderate LDL-C lowering with lovastatin 2.5 to 5 mg/day (to achieve LDL-C of 130 to 140 mg/dl). Angiographic progression was assessed by coronary angiography at 4 to 5 years. Results: Higher BMI was associated with a higher likelihood of angiographic progression (p trend = 0.003) after adjustment for demographic factors, treatment assignment, smoking status, and years since CABG surgery, but not with clinical events (p trend = 0.81). In stratified analyses, higher BMI was associated with angiographic progression in the low-dose lovastatin group (p trend <0.001) but not in the high-dose group (p = 0.03 for test for interaction of BMI and statin treatment). In the high-dose lovastatin group, higher BMI appeared to be protective against clinical events (p trend = 0.06, test of interaction: 0.02). Conclusions: Higher BMI is strongly associated with atherogenic progression after CABG surgery. Aggressive statin therapy may be protective against obesity-related acceleration of coronary heart disease.
AB - Objectives: This study examines whether obesity accelerates atherogenic progression or adverse outcomes after coronary artery bypass graft (CABG) surgery. Background: Obesity is a major risk factor for developing coronary heart disease. Whether obesity accelerates disease progression after CABG is unclear. Methods: We examined how body mass index (BMI) related to atherosclerotic graft progression and a clinical composite outcome of death, nonfatal myocardial infarction, stroke, CABG surgery, or angioplasty among 1,314 participants in the Post CABG trial. Participants who had undergone CABG surgery were randomly assigned in a 2 × 2 factorial design to warfarin versus placebo and aggressive low-density lipoprotein cholesterol (LDL-C) lowering with lovastatin 40 to 80 mg/day (to achieve LDL-C of 60 to 85 mg/dl) versus moderate LDL-C lowering with lovastatin 2.5 to 5 mg/day (to achieve LDL-C of 130 to 140 mg/dl). Angiographic progression was assessed by coronary angiography at 4 to 5 years. Results: Higher BMI was associated with a higher likelihood of angiographic progression (p trend = 0.003) after adjustment for demographic factors, treatment assignment, smoking status, and years since CABG surgery, but not with clinical events (p trend = 0.81). In stratified analyses, higher BMI was associated with angiographic progression in the low-dose lovastatin group (p trend <0.001) but not in the high-dose group (p = 0.03 for test for interaction of BMI and statin treatment). In the high-dose lovastatin group, higher BMI appeared to be protective against clinical events (p trend = 0.06, test of interaction: 0.02). Conclusions: Higher BMI is strongly associated with atherogenic progression after CABG surgery. Aggressive statin therapy may be protective against obesity-related acceleration of coronary heart disease.
KW - atherosclerosis
KW - cardiac surgery
KW - lipid lowering
KW - obesity
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U2 - 10.1016/j.jacc.2008.05.021
DO - 10.1016/j.jacc.2008.05.021
M3 - Article
C2 - 18702964
AN - SCOPUS:48849087044
SN - 0735-1097
VL - 52
SP - 620
EP - 625
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 8
ER -