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Review

Which is the best statin for the postoperative coronary artery bypass graft patient?

Department of Cardiothoracic Surgery, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK

Received 6 October 2008; received in revised form 19 March 2009; accepted 23 March 2009.

^_* Corresponding author. Address: 36 Ash Hill Drive, Shadwell, Leeds, LS17 8JP, UK. Tel.: +44 7734 693090. (Email: allan.m.conway{at}doctors.org.uk).

The progression of atherosclerosis following coronary artery bypass graft (CABG) surgery results in the need for re-vascularisation therapy in a significant proportion of patients. It is well recognised that this risk can be lowered by controlling the level of low-density lipid cholesterol (LDL-C) which can be achieved easily and safely with the use of statins. The choice of which is the best statin in post-CABG patients remains unclear. It has been shown that for milligram-equivalent doses, rosuvastatin provides the greatest LDL-C reduction and greatest number of patients achieving LDL-C targets in comparison with simvastatin and atorvastatin. Rosuvastatin's superiority over other statins in allowing patients to reach LDL-C targets has been maintained in ‘real-world’ observational studies. Rosuvastatin has also been shown to increase high-density lipid cholesterol (HDL-C) by greater proportions in comparison with other statins, providing increased anti-atherogenic effects. There are several statins currently available, some of which are now generic. However, the empirical use of generic statins does not necessarily translate into a cost-effective treatment option. This article reviews the rationale for lipid-lowering therapy in patients following CABG. We also look objectively at which is the best statin for use in the post-CABG patient, discussing effectiveness, cost and tolerability.

Key Words: Coronary artery bypass graft • Lipid • Statin