Strategy and research progress of lipid management after coronary artery bypass grafting_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Fangzhou ¹ , SU Xiaoting ¹ , ZHANG Heng ^1,2 ,  ZHENG Zhe ^1,2

1. National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Beijing, 100037, P. R. China;
2. Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P. R. China;

Corresponding author：

ZHENG Zhe, Email: zhengzhe@fuwai.com

Keywords：

Coronary heart disease; coronary artery bypass grafting; dyslipidemia; lipid-lowering therapy; secondary prevention; review

DOI：

10.7507/1007-4848.202109017

Video：

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Abstract Full text Figures/Tables Video References Cited by

Patients undergoing coronary artery bypass grafting (CABG) belong to the very high-risk group of atherosclerotic cardiovascular disease. Although CABG gets advantages in relieving symptoms and improving long-term outcomes, a significant risk of cardiovascular adverse events after surgery still exists and standardized secondary prevention is needed. Lipid management plays a critical role as a secondary preventive strategy in CABG. However, lipid management of CABG patients in real clinical setting is inadequate, including lack of standardized lipid-lowering strategy, low goal attainment rate, as well as poor long-term medication adherence. In recent years, a series of clinical trials have provided a lot of groundbreaking new evidence for lipid management in patients with cardiovascular diseases which offers new strategies together with objectives of lipid-lowering and comprehensive management for patients undergoing CABG. This article reviews the strategy and research progress of lipid management after CABG, aiming to provide objective reference for clinical treatment.

Citation： LI Fangzhou, SU Xiaoting, ZHANG Heng, ZHENG Zhe. Strategy and research progress of lipid management after coronary artery bypass grafting. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(11): 1532-1539. doi: 10.7507/1007-4848.202109017 Copy

1.	中国心血管健康与疾病报告编写组. 中国心血管病报告2019. 中国循环杂志, 2020, 35(9): 833-54.
2.	郑哲, 顾大川, 陈斯鹏. 中国冠状动脉旁路移植术医疗质量控制工作报告. 中国循环杂志, 2020, 35(8): 729-38.
3.	Zheng Z, Zhang H, Yuan X, et al. Comparing outcomes of coronary artery bypass grafting among large teaching and urban hospitals in China and the United States. Circ Cardiovasc Qual Outcomes, 2017, 10(6): e003327.
4.	Zhou M, Wang H, Zeng X, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet, 2019, 394(10204): 1145-1158.
5.	Song PK, Man QQ, Li H, et al. Trends in lipids level and dyslipidemia among Chinese adults, 2002-2015. Biomed Environ Sci, 2019, 32(8): 559-570.
6.	Zhang M, Deng Q, Wang L, et al. Prevalence of dyslipidemia and achievement of low-density lipoprotein cholesterol targets in Chinese adults: A nationally representative survey of 163, 641 adults. Int J Cardiol, 2018, 260: 196-203.
7.	Zhang X, Liu J, Wang M, et al. Twenty-year epidemiologic study on LDL-C levels in relation to the risks of atherosclerotic event, hemorrhagic stroke, and cancer death among young and middle-aged population in China. J Clin Lipidol, 2018, 12(5): 1179-1189.
8.	Borén J, Chapman MJ, Krauss RM, et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease: Pathophysiological, genetic, and therapeutic insights: A consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J, 2020, 41(24): 2313-2330.
9.	Ference BA, Ginsberg HN, Graham I, et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease. Ⅰ. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J, 2017, 38(32): 2459-2472.
10.	Ference BA, Graham I, Tokgozoglu L, et al. Impact of lipids on cardiovascular health: JACC health promotion series. J Am Coll Cardiol, 2018, 72(10): 1141-1156.
11.	Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS guidelines for the management of dyslipidaemias: Lipid modification to reduce cardiovascular risk. Eur Heart J, 2020, 41(1): 111-188.
12.	Björklund E, Nielsen SJ, Hansson EC, et al. Secondary prevention medications after coronary artery bypass grafting and long-term survival: A population-based longitudinal study from the SWEDEHEART registry. Eur Heart J, 2020, 41(17): 1653-1661.
13.	Goldman S, Sethi GK, Holman W, et al. Radial artery grafts vs. saphenous vein grafts in coronary artery bypass surgery: A randomized trial. JAMA, 2011, 305(2): 167-174.
14.	Goldman S, Zadina K, Moritz T, et al. Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery: Results from a Department of Veterans Affairs Cooperative Study. J Am Coll Cardiol, 2004, 44(11): 2149-2156.
15.	de Vries MR, Simons KH, Jukema JW, et al. Vein graft failure: From pathophysiology to clinical outcomes. Nat Rev Cardiol, 2016, 13(8): 451-470.
16.	Ezhov MV, Afanasieva OI, Il'ina LN, et al. Association of lipoprotein(a) level with short- and long-term outcomes after CABG: The role of lipoprotein apheresis. Atheroscler Suppl, 2017, 30: 187-192.
17.	Antonopoulos AS, Odutayo A, Oikonomou EK, et al. Development of a risk score for early saphenous vein graft failure: An individual patient data meta-analysis. J Thorac Cardiovasc Surg, 2020, 160(1): 116-127.
18.	Zafrir B, Saliba W, Jaffe R, et al. Attainment of lipid goals and long-term mortality after coronary-artery bypass surgery. Eur J Prev Cardiol, 2019, 26(4): 401-408.
19.	Castañer O, Pintó X, Subirana I, et al. Remnant cholesterol, not LDL cholesterol, is associated with incident cardiovascular disease. J Am Coll Cardiol, 2020, 76(23): 2712-2724.
20.	Johannesen CDL, Mortensen MB, Langsted A, et al. Apolipoprotein B and non-HDL cholesterol better reflect residual risk than LDL cholesterol in statin-treated patients. J Am Coll Cardiol, 2021, 77(11): 1439-1450.
21.	Foody JM, Ferdinand FD, Pearce GL, et al. HDL cholesterol level predicts survival in men after coronary artery bypass graft surgery: 20-year experience from the Cleveland Clinic Foundation. Circulation, 2000, 102(19 Suppl 3): III90-94.
22.	Bittner V, Hardison R, Kelsey SF, et al. Non-high-density lipoprotein cholesterol levels predict five-year outcome in the bypass angioplasty revascularization investigation (BARI). Circulation, 2002, 106(20): 2537-2542.
23.	Caliskan E, de Souza DR, Böning A, et al. Saphenous vein grafts in contemporary coronary artery bypass graft surgery. Nat Rev Cardiol, 2020, 17(3): 155-169.
24.	Post Coronary Artery Bypass Graft Trial Investigators. The effect of aggressive lowering of low-density lipoprotein cholesterol levels and low-dose anticoagulation on obstructive changes in saphenous-vein coronary-artery bypass grafts. N Engl J Med, 1997, 336(3): 153-162.
25.	Hata M, Takayama T, Sezai A, et al. Efficacy of aggressive lipid controlling therapy for preventing saphenous vein graft disease. Ann Thorac Surg, 2009, 88(5): 1440-1444.
26.	Mercer JR, Cheng KK, Figg N, et al. DNA damage links mitochondrial dysfunction to atherosclerosis and the metabolic syndrome. Circ Res, 2010, 107(8): 1021-1031.
27.	Delles C, Dymott JA, Neisius U, et al. Reduced LDL-cholesterol levels in patients with coronary artery disease are paralleled by improved endothelial function: An observational study in patients from 2003 and 2007. Atherosclerosis, 2010, 211(1): 271-277.
28.	Zhu J, Zhu Y, Zhang M, et al. Influence of lipoproteins and antiplatelet agents on vein graft patency 1 year after coronary artery bypass grafting. J Thorac Cardiovasc Surg, 2022, 163(3): 1030-1039, e4.
29.	Kulik A, Abreu AM, Boronat V, et al. Intensive versus moderate statin therapy and early graft occlusion after coronary bypass surgery: The aggressive cholesterol therapy to inhibit vein graft events randomized clinical trial. J Thorac Cardiovasc Surg, 2019, 157(1): 151-161.
30.	Knatterud GL, Rosenberg Y, Campeau L, et al. Long-term effects on clinical outcomes of aggressive lowering of low-density lipoprotein cholesterol levels and low-dose anticoagulation in the post coronary artery bypass graft trial. Post CABG investigators. Circulation, 2000, 102(2): 157-165.
31.	Shah SJ, Waters DD, Barter P, et al. Intensive lipid-lowering with atorvastatin for secondary prevention in patients after coronary artery bypass surgery. J Am Coll Cardiol, 2008, 51(20): 1938-1943.
32.	Eisen A, Cannon CP, Blazing MA, et al. The benefit of adding ezetimibe to statin therapy in patients with prior coronary artery bypass graft surgery and acute coronary syndrome in the IMPROVE-IT trial. Eur Heart J, 2016, 37(48): 3576-3584.
33.	Goodman SG, Aylward PE, Szarek M, et al. Effects of alirocumab on cardiovascular events after coronary bypass surgery. J Am Coll Cardiol, 2019, 74(9): 1177-1186.
34.	Alkhalil M. Effects of intensive lipid-lowering therapy on mortality after coronary bypass surgery: A meta-analysis of 7 randomised trials. Atherosclerosis, 2020, 293: 75-78.
35.	Schwartz GG, Steg PG, Szarek M, et al. Alirocumab and cardiovascular outcomes after acute coronary syndrome. N Engl J Med, 2018, 379(22): 2097-2107.
36.	Sabatine MS, Giugliano RP, Keech AC, et al. Evolocumab and clinical outcomes in patients with cardiovascular disease. N Engl J Med, 2017, 376(18): 1713-1722.
37.	Cannon CP, Blazing MA, Giugliano RP, et al. Ezetimibe added to statin therapy after acute coronary syndromes. N Engl J Med, 2015, 372(25): 2387-2397.
38.	Hu Z, Chen S, Du J, et al. An in-hospital mortality risk model for patients undergoing coronary artery bypass grafting in China. Ann Thorac Surg, 2020, 109(4): 1234-1242.
39.	Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 2019, 139(25): e1082-e1143.
40.	钱海燕, 王征, 刘德平, 等. ≥75岁老年患者血脂异常管理的专家共识. 中国心血管杂志, 2020, 25(3): 201-209.
41.	Gencer B, Marston NA, Im K, et al. Efficacy and safety of lowering LDL cholesterol in older patients: A systematic review and meta-analysis of randomised controlled trials. Lancet, 2020, 396(10263): 1637-1643.
42.	Mortensen MB, Nordestgaard BG. Elevated LDL cholesterol and increased risk of myocardial infarction and atherosclerotic cardiovascular disease in individuals aged 70-100 years: A contemporary primary prevention cohort. Lancet, 2020, 396(10263): 1644-1652.
43.	中国胆固醇教育计划(CCEP)工作委员会, 中国医疗保健国际交流促进会动脉粥样硬化血栓疾病防治分会, 中国老年学和老年医学学会心血管病分会, 等. 中国胆固醇教育计划调脂治疗降低心血管事件专家建议(2019). 中华内科杂志, 2020, 59(1): 18-22.
44.	Jellinger PS, Handelsman Y, Rosenblit PD, et al. American Association of Clinical Endocrinologists and American College of Endocrinology guidelines for management of dyslipidemia and prevention of cardiovascular disease—Executive summary complete appendix to guidelines. Endocr Pract, 2017, 23(4): 479-497.
45.	Lloyd-Jones DM, Morris PB, et al. 2016 ACC expert consensus decision pathway on the role of non-statin therapies for LDL-cholesterol lowering in the management of atherosclerotic cardiovascular disease risk: A report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol, 2016, 68(1): 92-125.
46.	Räber L, Ueki Y, Otsuka T, et al. Effect of alirocumab added to high-intensity statin therapy on coronary atherosclerosis in patients with acute myocardial infarction: The PACMAN-AMI randomized clinical trial. JAMA, 2022, 327(18): 1771-1781.
47.	中国冠状动脉旁路移植术后二级预防专家共识组, 中国医师协会心血管医师分会冠心病外科学组. 中国冠状动脉旁路移植术后二级预防专家共识(2016版). 中华胸心血管外科杂志, 2016, 32(10): 577-583.
48.	中国冠状动脉旁路移植术后二级预防专家共识组, 中国医师协会心血管医师分会冠心病外科学组. 中国冠状动脉旁路移植术后二级预防专家共识(2020版). 中华胸心血管外科杂志, 2021, 37(4): 193-201.
49.	Sengstock D, Vaitkevicius P, Salama A, et al. Under-prescribing and non-adherence to medications after coronary bypass surgery in older adults: Strategies to improve adherence. Drugs Aging, 2012, 29(2): 93-103.
50.	Hlatky MA, Solomon MD, Shilane D, et al. Use of medications for secondary prevention after coronary bypass surgery compared with percutaneous coronary intervention. J Am Coll Cardiol, 2013, 61(3): 295-301.
51.	Pinho-Gomes AC, Azevedo L, Ahn JM, et al. Compliance with guideline-directed medical therapy in contemporary coronary revascularization trials. J Am Coll Cardiol, 2018, 71(6): 591-602.
52.	Li JJ, Liu HH, Wu NQ, et al. Statin intolerance: An updated, narrative review mainly focusing on muscle adverse effects. Expert Opin Drug Metab Toxicol, 2020, 16(9): 837-851.
53.	Vonbank A, Drexel H, Agewall S, et al. Reasons for disparity in statin adherence rates between clinical trials and real-world observations: A review. Eur Heart J Cardiovasc Pharmacother, 2018, 4(4): 230-236.
54.	Zhou Z, Albarqouni L, Curtis AJ, et al. The safety and tolerability of statin therapy in primary prevention in older adults: A systematic review and meta-analysis. Drugs Aging, 2020, 37(3): 175-185.
55.	Gupta A, Thompson D, Whitehouse A, et al. Adverse events associated with unblinded, but not with blinded, statin therapy in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid-Lowering Arm (ASCOT-LLA): A randomised double-blind placebo-controlled trial and its non-randomised non-blind extension phase. Lancet, 2017, 389(10088): 2473-2481.
56.	Wood FA, Howard JP, Finegold JA, et al. N-of-1 trial of a statin, placebo, or no treatment to assess side effects. N Engl J Med, 2020, 383(22): 2182-2184.

1. 中国心血管健康与疾病报告编写组. 中国心血管病报告2019. 中国循环杂志, 2020, 35(9): 833-54.
2. 郑哲, 顾大川, 陈斯鹏. 中国冠状动脉旁路移植术医疗质量控制工作报告. 中国循环杂志, 2020, 35(8): 729-38.
3. Zheng Z, Zhang H, Yuan X, et al. Comparing outcomes of coronary artery bypass grafting among large teaching and urban hospitals in China and the United States. Circ Cardiovasc Qual Outcomes, 2017, 10(6): e003327.
4. Zhou M, Wang H, Zeng X, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet, 2019, 394(10204): 1145-1158.
5. Song PK, Man QQ, Li H, et al. Trends in lipids level and dyslipidemia among Chinese adults, 2002-2015. Biomed Environ Sci, 2019, 32(8): 559-570.
6. Zhang M, Deng Q, Wang L, et al. Prevalence of dyslipidemia and achievement of low-density lipoprotein cholesterol targets in Chinese adults: A nationally representative survey of 163, 641 adults. Int J Cardiol, 2018, 260: 196-203.
7. Zhang X, Liu J, Wang M, et al. Twenty-year epidemiologic study on LDL-C levels in relation to the risks of atherosclerotic event, hemorrhagic stroke, and cancer death among young and middle-aged population in China. J Clin Lipidol, 2018, 12(5): 1179-1189.
8. Borén J, Chapman MJ, Krauss RM, et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease: Pathophysiological, genetic, and therapeutic insights: A consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J, 2020, 41(24): 2313-2330.
9. Ference BA, Ginsberg HN, Graham I, et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease. Ⅰ. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J, 2017, 38(32): 2459-2472.
10. Ference BA, Graham I, Tokgozoglu L, et al. Impact of lipids on cardiovascular health: JACC health promotion series. J Am Coll Cardiol, 2018, 72(10): 1141-1156.
11. Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS guidelines for the management of dyslipidaemias: Lipid modification to reduce cardiovascular risk. Eur Heart J, 2020, 41(1): 111-188.
12. Björklund E, Nielsen SJ, Hansson EC, et al. Secondary prevention medications after coronary artery bypass grafting and long-term survival: A population-based longitudinal study from the SWEDEHEART registry. Eur Heart J, 2020, 41(17): 1653-1661.
13. Goldman S, Sethi GK, Holman W, et al. Radial artery grafts vs. saphenous vein grafts in coronary artery bypass surgery: A randomized trial. JAMA, 2011, 305(2): 167-174.
14. Goldman S, Zadina K, Moritz T, et al. Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery: Results from a Department of Veterans Affairs Cooperative Study. J Am Coll Cardiol, 2004, 44(11): 2149-2156.
15. de Vries MR, Simons KH, Jukema JW, et al. Vein graft failure: From pathophysiology to clinical outcomes. Nat Rev Cardiol, 2016, 13(8): 451-470.
16. Ezhov MV, Afanasieva OI, Il'ina LN, et al. Association of lipoprotein(a) level with short- and long-term outcomes after CABG: The role of lipoprotein apheresis. Atheroscler Suppl, 2017, 30: 187-192.
17. Antonopoulos AS, Odutayo A, Oikonomou EK, et al. Development of a risk score for early saphenous vein graft failure: An individual patient data meta-analysis. J Thorac Cardiovasc Surg, 2020, 160(1): 116-127.
18. Zafrir B, Saliba W, Jaffe R, et al. Attainment of lipid goals and long-term mortality after coronary-artery bypass surgery. Eur J Prev Cardiol, 2019, 26(4): 401-408.
19. Castañer O, Pintó X, Subirana I, et al. Remnant cholesterol, not LDL cholesterol, is associated with incident cardiovascular disease. J Am Coll Cardiol, 2020, 76(23): 2712-2724.
20. Johannesen CDL, Mortensen MB, Langsted A, et al. Apolipoprotein B and non-HDL cholesterol better reflect residual risk than LDL cholesterol in statin-treated patients. J Am Coll Cardiol, 2021, 77(11): 1439-1450.
21. Foody JM, Ferdinand FD, Pearce GL, et al. HDL cholesterol level predicts survival in men after coronary artery bypass graft surgery: 20-year experience from the Cleveland Clinic Foundation. Circulation, 2000, 102(19 Suppl 3): III90-94.
22. Bittner V, Hardison R, Kelsey SF, et al. Non-high-density lipoprotein cholesterol levels predict five-year outcome in the bypass angioplasty revascularization investigation (BARI). Circulation, 2002, 106(20): 2537-2542.
23. Caliskan E, de Souza DR, Böning A, et al. Saphenous vein grafts in contemporary coronary artery bypass graft surgery. Nat Rev Cardiol, 2020, 17(3): 155-169.
24. Post Coronary Artery Bypass Graft Trial Investigators. The effect of aggressive lowering of low-density lipoprotein cholesterol levels and low-dose anticoagulation on obstructive changes in saphenous-vein coronary-artery bypass grafts. N Engl J Med, 1997, 336(3): 153-162.
25. Hata M, Takayama T, Sezai A, et al. Efficacy of aggressive lipid controlling therapy for preventing saphenous vein graft disease. Ann Thorac Surg, 2009, 88(5): 1440-1444.
26. Mercer JR, Cheng KK, Figg N, et al. DNA damage links mitochondrial dysfunction to atherosclerosis and the metabolic syndrome. Circ Res, 2010, 107(8): 1021-1031.
27. Delles C, Dymott JA, Neisius U, et al. Reduced LDL-cholesterol levels in patients with coronary artery disease are paralleled by improved endothelial function: An observational study in patients from 2003 and 2007. Atherosclerosis, 2010, 211(1): 271-277.
28. Zhu J, Zhu Y, Zhang M, et al. Influence of lipoproteins and antiplatelet agents on vein graft patency 1 year after coronary artery bypass grafting. J Thorac Cardiovasc Surg, 2022, 163(3): 1030-1039, e4.
29. Kulik A, Abreu AM, Boronat V, et al. Intensive versus moderate statin therapy and early graft occlusion after coronary bypass surgery: The aggressive cholesterol therapy to inhibit vein graft events randomized clinical trial. J Thorac Cardiovasc Surg, 2019, 157(1): 151-161.
30. Knatterud GL, Rosenberg Y, Campeau L, et al. Long-term effects on clinical outcomes of aggressive lowering of low-density lipoprotein cholesterol levels and low-dose anticoagulation in the post coronary artery bypass graft trial. Post CABG investigators. Circulation, 2000, 102(2): 157-165.
31. Shah SJ, Waters DD, Barter P, et al. Intensive lipid-lowering with atorvastatin for secondary prevention in patients after coronary artery bypass surgery. J Am Coll Cardiol, 2008, 51(20): 1938-1943.
32. Eisen A, Cannon CP, Blazing MA, et al. The benefit of adding ezetimibe to statin therapy in patients with prior coronary artery bypass graft surgery and acute coronary syndrome in the IMPROVE-IT trial. Eur Heart J, 2016, 37(48): 3576-3584.
33. Goodman SG, Aylward PE, Szarek M, et al. Effects of alirocumab on cardiovascular events after coronary bypass surgery. J Am Coll Cardiol, 2019, 74(9): 1177-1186.
34. Alkhalil M. Effects of intensive lipid-lowering therapy on mortality after coronary bypass surgery: A meta-analysis of 7 randomised trials. Atherosclerosis, 2020, 293: 75-78.
35. Schwartz GG, Steg PG, Szarek M, et al. Alirocumab and cardiovascular outcomes after acute coronary syndrome. N Engl J Med, 2018, 379(22): 2097-2107.
36. Sabatine MS, Giugliano RP, Keech AC, et al. Evolocumab and clinical outcomes in patients with cardiovascular disease. N Engl J Med, 2017, 376(18): 1713-1722.
37. Cannon CP, Blazing MA, Giugliano RP, et al. Ezetimibe added to statin therapy after acute coronary syndromes. N Engl J Med, 2015, 372(25): 2387-2397.
38. Hu Z, Chen S, Du J, et al. An in-hospital mortality risk model for patients undergoing coronary artery bypass grafting in China. Ann Thorac Surg, 2020, 109(4): 1234-1242.
39. Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 2019, 139(25): e1082-e1143.
40. 钱海燕, 王征, 刘德平, 等. ≥75岁老年患者血脂异常管理的专家共识. 中国心血管杂志, 2020, 25(3): 201-209.
41. Gencer B, Marston NA, Im K, et al. Efficacy and safety of lowering LDL cholesterol in older patients: A systematic review and meta-analysis of randomised controlled trials. Lancet, 2020, 396(10263): 1637-1643.
42. Mortensen MB, Nordestgaard BG. Elevated LDL cholesterol and increased risk of myocardial infarction and atherosclerotic cardiovascular disease in individuals aged 70-100 years: A contemporary primary prevention cohort. Lancet, 2020, 396(10263): 1644-1652.
43. 中国胆固醇教育计划(CCEP)工作委员会, 中国医疗保健国际交流促进会动脉粥样硬化血栓疾病防治分会, 中国老年学和老年医学学会心血管病分会, 等. 中国胆固醇教育计划调脂治疗降低心血管事件专家建议(2019). 中华内科杂志, 2020, 59(1): 18-22.
44. Jellinger PS, Handelsman Y, Rosenblit PD, et al. American Association of Clinical Endocrinologists and American College of Endocrinology guidelines for management of dyslipidemia and prevention of cardiovascular disease—Executive summary complete appendix to guidelines. Endocr Pract, 2017, 23(4): 479-497.
45. Lloyd-Jones DM, Morris PB, et al. 2016 ACC expert consensus decision pathway on the role of non-statin therapies for LDL-cholesterol lowering in the management of atherosclerotic cardiovascular disease risk: A report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol, 2016, 68(1): 92-125.
46. Räber L, Ueki Y, Otsuka T, et al. Effect of alirocumab added to high-intensity statin therapy on coronary atherosclerosis in patients with acute myocardial infarction: The PACMAN-AMI randomized clinical trial. JAMA, 2022, 327(18): 1771-1781.
47. 中国冠状动脉旁路移植术后二级预防专家共识组, 中国医师协会心血管医师分会冠心病外科学组. 中国冠状动脉旁路移植术后二级预防专家共识(2016版). 中华胸心血管外科杂志, 2016, 32(10): 577-583.
48. 中国冠状动脉旁路移植术后二级预防专家共识组, 中国医师协会心血管医师分会冠心病外科学组. 中国冠状动脉旁路移植术后二级预防专家共识(2020版). 中华胸心血管外科杂志, 2021, 37(4): 193-201.
49. Sengstock D, Vaitkevicius P, Salama A, et al. Under-prescribing and non-adherence to medications after coronary bypass surgery in older adults: Strategies to improve adherence. Drugs Aging, 2012, 29(2): 93-103.
50. Hlatky MA, Solomon MD, Shilane D, et al. Use of medications for secondary prevention after coronary bypass surgery compared with percutaneous coronary intervention. J Am Coll Cardiol, 2013, 61(3): 295-301.
51. Pinho-Gomes AC, Azevedo L, Ahn JM, et al. Compliance with guideline-directed medical therapy in contemporary coronary revascularization trials. J Am Coll Cardiol, 2018, 71(6): 591-602.
52. Li JJ, Liu HH, Wu NQ, et al. Statin intolerance: An updated, narrative review mainly focusing on muscle adverse effects. Expert Opin Drug Metab Toxicol, 2020, 16(9): 837-851.
53. Vonbank A, Drexel H, Agewall S, et al. Reasons for disparity in statin adherence rates between clinical trials and real-world observations: A review. Eur Heart J Cardiovasc Pharmacother, 2018, 4(4): 230-236.
54. Zhou Z, Albarqouni L, Curtis AJ, et al. The safety and tolerability of statin therapy in primary prevention in older adults: A systematic review and meta-analysis. Drugs Aging, 2020, 37(3): 175-185.
55. Gupta A, Thompson D, Whitehouse A, et al. Adverse events associated with unblinded, but not with blinded, statin therapy in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid-Lowering Arm (ASCOT-LLA): A randomised double-blind placebo-controlled trial and its non-randomised non-blind extension phase. Lancet, 2017, 389(10088): 2473-2481.
56. Wood FA, Howard JP, Finegold JA, et al. N-of-1 trial of a statin, placebo, or no treatment to assess side effects. N Engl J Med, 2020, 383(22): 2182-2184.

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