Is aggressive cholesterol control justified? Review of the post-coronary artery bypass graft trial.

The Post-Coronary Artery Bypass Graft (CABG) trial was undertaken to compare the efficacy of aggressive low-density-lipoprotein (LDL) cholesterol lowering (<85 mg/dL) with moderate LDL-cholesterol lowering (130-140 mg/dL) in preventing atherosclerotic progression in saphenous vein grafts. In both the aggressive- and moderate-treatment groups, clinicians titrated lovastatin dosages based on individual patients' LDL-cholesterol levels. Based on angiography performed 4-5 years after enrollment, the rate of disease progression was 31% lower in aggressive-treatment patients than in those who received moderate treatment. Compliance with lovastatin therapy was 85-90%. The results confirm that LDL-cholesterol levels should be decreased to <100 mg/dL in patients with coronary artery disease. The challenge is to ensure that at-risk patients receive drug therapy in adequate, individualized doses.