If left untreated, about half of bypass vein grafts become occluded within 10 years of surgery. “Both statins and aspirin carry class I indications from the American College of Cardiology and the American Heart Association to be used to keep grafts open over the long term and should be continued indefinitely unless patients have specific contraindications,” says Kevin Curl, MD.
Taking a Deeper Look
Despite guideline recommendations, few studies have explored the long-term usage of statins and aspirin among patients who have undergone CABG. To address this research gap, Dr. Curl and colleagues had a study published in the American Journal of Cardiology that analyzed utilization rates of statins and aspirin among post-CABG patients who were referred for coronary angiography with the purpose being to identify the long-term trends with medication adherence in this high-risk population.
The authors reviewed the electronic health records 381 consecutive patients who received CABG and a cardiac catheterization procedure at Thomas Jefferson University at least 3 years after surgery was performed. Inpatient and outpatient records were analyzed to assess prescribing patterns of these medications and other pertinent clinical and laboratory data.
According to the results, 67% of patients involved in the study were being prescribed a statin, while 75% were prescribed aspirin. “Alarmingly, only 52% were prescribed both of these medications at the time of their catheterization procedure,” says Dr. Curl. CABG recipients who were not taking statins had 22% higher LDL cholesterol levels as well as significantly lower average total cholesterol values. Nearly one-third of study participants (35%) had LDL levels that were 100 mg/dl or higher. Among patients not taking statins, the authors reported that only 43% of saphenous vein grafts remained patent.
The study findings confirm that both aspirin and statins continue to be significantly underutilized among CABG patients during long-term follow up. “Clinicians need to make more concerted efforts to ensure that patients continue taking the appropriate prevention measures after a successful heart surgery,” Dr. Curl says. “Patients need to understand that CABG is not a cure for their heart problems and recognize that they will need to take medications—like statins and aspirin—for the long term after they undergo the surgery.”
Dr. Curl notes that CABG surgery should be viewed by patients as a second chance to extend their life. “We should be clear with our patients about why they need statins and aspirin after they experience a cardiac event in which CABG is required,” he says. “Clinicians should also be vigilant about following current guideline recommendations regarding the long-term care of this high-risk patient population.“
Kevin Curl, MD, has indicated to Physician’s Weekly that he has no financial disclosures to report.
Curl K, LeBude B, Ruggiero N, et al. Frequency of use of statins and aspirin in patients with previous coronary artery bypass grafting. Am J Cardiol. 2016 Apr 19 [Epub ahead of print]. Available at: http://www.ajconline.org/article/S0002-9149(16)30487-8/fulltext.
Curl K, LeBude B, Ruggiero N, et al. CRT-132 under-utilization of statins and aspirin following coronary artery bypass graft surgery. J Am Coll Cardiol Intv. 2014;7:S17-S17.
Brackbill M, Kline VT, Sytsma CS, Call JT. Intervention to increase the proportion of acute myocardial infarction or coronary artery bypass graft patients receiving an order for aspirin at hospital discharge. J Manag Care Pharm. 2010;16:329-336.