Effects of aggressive cholesterol lowering and low-dose anticoagulation on clinical and angiographic outcomes in patients with diabetes: the Post Coronary Artery Bypass Graft Trial

• Published in: Diabetes (New York, N.Y.) Vol. 48; no. 6; pp. 1289 - 1294
• Main Authors: HOOGWERF, B. J, WANESS, A, KNATTERUD, G. L, WHITE, C, CRESSMAN, M, CANNER, J, CAMPEAU, L, DOMANSKI, M, GELLER, N, HERD, A, HICKEY, A, HUNNINGHAKE, D. B
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01-06-1999
• Subjects: Anticholesteremic Agents - therapeutic use; Anticoagulants; Anticoagulants (Medicine); Anticoagulants - therapeutic use; Associated diseases and complications; Biological and medical sciences; Biomarkers; Cholesterol; Coronary Artery Bypass - adverse effects; Coronary Disease - drug therapy; Coronary Disease - etiology; Coronary Disease - surgery; Coronary heart disease; Diabetes. Impaired glucose tolerance; Diabetic Angiopathies - drug therapy; Diabetic Angiopathies - surgery; Double-Blind Method; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Female; Health aspects; Humans; Hypoglycemic Agents - therapeutic use; Insulin - therapeutic use; Male; Measurement; Medical sciences; Middle Aged; Risk Factors; Sulfonylurea Compounds - therapeutic use; Endocrinopathy; Human; Radiodiagnosis; Angiography; Diabetes mellitus; Treatment efficiency; Cardiovascular disease; Lipids; Anticoagulant; Coronary heart disease; Cholesterol; Chemotherapy; Aortocoronary; Bypass; Complication; Antilipemic agent
• ISSN: 0012-1797; 1939-327X
• DOI: 10.2337/diabetes.48.6.1289

Effects of aggressive cholesterol lowering and low-dose anticoagulation on clinical and angiographic outcomes in patients
with diabetes: the Post Coronary Artery Bypass Graft Trial.
B J Hoogwerf ,
A Waness ,
M Cressman ,
J Canner ,
L Campeau ,
M Domanski ,
N Geller ,
A Herd ,
A Hickey ,
D B Hunninghake ,
G L Knatterud and
C White
Cleveland Clinic Foundation, OH 44195, USA. [e-mail]
Abstract
Diabetic patients have greater risk for coronary heart disease (CHD) events after coronary artery bypass graft (CABG) surgery
than nondiabetic patients. The Post CABG trial studied the effects of aggressive cholesterol lowering and low-dose anticoagulation
in diabetic patients compared with nondiabetic patients. A double-blind, randomized clinical trial in 1,351 patients (1-11
years after CABG), the Post CABG trial consisted of two interventions (aggressive cholesterol-lowering versus moderate lowering
and low-dose warfarin versus placebo) on angiographic end points. Angiographic changes in saphenous vein graft conduits 4.3
years after entry were compared in 116 diabetic and 1,235 nondiabetic patients. Seven clinical centers participated in the
trial, as well as the National Institutes of Health project office (National Heart, Lung, and Blood Institute), the coordinating
center (Maryland Medical Research Institute), and the Angiogram Reading Center (University of Minnesota). Baseline characteristics
of the diabetic patients differed from the nondiabetic patients in the following ways: percentage of women participants, 15
vs. 7%, P = 0.002; mean baseline weight, 87.4 vs. 82.8 kg, P = 0.006; mean BMI, 29.5 vs. 27.6 kg/m2, P = 0.0002; mean systolic
blood pressure, 141.7 vs. 133.6, P < 0.0001; mean triglyceride concentrations, 2.09 vs. 1.77 mmol/l, P < 0.0001; and mean
HDL cholesterol concentrations, 0.93 vs. 1.02 mmol, P = 0.0001. The percentage of clinical events was higher in diabetic than
nondiabetic patients (20.6 vs. 13.4, P = 0.033) and angiographic outcomes were not different. The benefits of aggressive cholesterol
lowering were comparable in diabetic and nondiabetic patients for the angiographic end points. Warfarin use was not associated
with clinical or angiographic benefit. Diabetic patients in the Post CABG trial had more CHD risk factors at study entry and
higher clinical event rates during the study than nondiabetic patients. The benefits of aggressive cholesterol lowering in
diabetic patients were comparable to those in nondiabetic patients for both angiographic and clinical end points. The small
number of diabetic patients provided limited power to detect significant differences between diabetic and nondiabetic patients
or between diabetic patients in the aggressive versus moderate cholesterol treatment strategies.