Benefits of statin therapy in patients with special risks: coronary bypass surgery, stable coronary disease, and acute coronary syndromes.

Several major clinical studies have examined the impact of lipid lowering in patients with and without coronary heart disease and have demonstrated that lowering lipid levels can successfully and significantly delay the onset of cardiovascular events. Although epidemiologic studies and small clinical trials have suggested that more aggressive and sustained lowering of low-density lipoprotein cholesterol (LDL-C) to < 100 mg/dl (2.6 mmol/l) can result in reductions in cardiovascular events in these populations, reducing LDL-C to these concentrations has only recently been shown in larger clinical trials. However, few clinical trials have been conducted in patients with certain special high risks, such as those who have had a recent revascularization procedure or have experienced an acute coronary event. Three trials examined the short- and long-term clinical benefits of aggressive lipid lowering in patients who underwent coronary artery bypass surgery (Post-CABG), were candidates for angioplasty (AVERT), or were hospitalized for acute coronary syndromes (MIRACL).