Objectives

To determine the relative effectiveness of moderate versus more aggressive lipid lowering, and of low dose anticoagulation versus placebo, in delaying saphenous vein coronary bypass graft atherosclerosis and preventing occlusion of saphenous grafts of patients with saphenous vein coronary bypass grafts placed 1 to 11 years previously.

Background

Obstructive changes often occur in aortocoronary saphenous-vein bypass grafts because of atherosclerosis and thrombosis. We studied whether aggressive lowering of low-density lipoprotein (LDL) cholesterol levels or low-dose anticoagulation would delay the progression of atherosclerosis in grafts.

Participants

Men and women, aged 18-75 years, between 1 and 11 years post-CABG. Patients had two completely independent saphenous vein grafts that were patent. Patients had an LDL-cholesterol between 130 and 175 with plasma triglycerides below 300mg/dl.

Design

This is a multicenter, randomized placebo-controlled clinical trial, using the double-blind method.

Conclusions

Aggressive lowering of LDL cholesterol levels to below 100 mg per deciliter reduced the progression of atherosclerosis grafts. Low-dose warfarin did not reduce the progression of atherosclerosis. (N Engl J Med 1997;336:153-62.)

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