Improve prognosis in patients with type 2 diabetes mellitus

Regulate low-density lipoprotein cholesterol level for those undergoing coronary revascularisation


  • Depending on the revascularisation strategy, LDL-C levels yield a differential influence on cardiovascular (CV) outcomes
    • Compared to patients with 1-year LDL-C <70 mg/dl, patients who had 1-year LDL-C ≥100 mg/dl showed a significant increase in long-term cardiovascular risk
    • Patients randomised to coronary artery bypass grafting (CABG) group had lower rates of major adverse cardiac or cerebrovascular events (MACCE) versus the optimal medical therapy (OMT) alone group


  • Guideline-directed management of patients with coronary heart disease (CHD) and type 2 diabetes mellitus (T2DM) includes intensive lifestyle intervention along with aggressive secondary prevention (OMT) and an appropriate revascularisation strategy
    • This analysis highlights the significance of LDL-C control in the first year post-procedure


  • Pooled analysis: combined individual patient-level information from 3 federally funded trials (BARI 2D, COURAGE, and FREEDOM)
  • 4,050 patients with T2DM (mean age = 62.8 ± 8.8 years; female = 27.0%; median follow-up = 3.9 years [after the index 1-year assessment]) were categorised according to LDL-C levels at 1 year following randomisation
    • Key inclusion criteria: all patients with CHD and T2DM from BARI-2D and FREEDOM trials and only patients with T2DM in the COURAGE trial
    • Key exclusion criteria: patients with LDL-C <20 mg/dl and triglycerides >400 mg/dl both at baseline and 1 year
    • Primary outcome: 4-year rate of the MACCE composite (all-cause mortality, nonfatal myocardial infarction, and nonfatal stroke)
    • Secondary outcomes: subsequent revascularisation


  • Patients with 1-year LDL-C levels ≥100 mg/dl experienced higher 4-year cumulative risk of MACCE
    • 17.2% versus 13.3% (70 to <100 mg/dl) versus 13.1% (<70 mg/dl); p = 0.016
  • Incidence of CV events following a coronary revascularisation procedure or OMT:
    • When comparing CABG with PCI, CABG led to significantly lower rates of MACCE for those with 1-year LDL-C levels:
      • Between 70 and <100 mg/dl: HR: 0.49; 95% CI, 0.31 to 0.79; p = 0.003
      • ≥100 mg/dl: HR: 0.53; 95% CI, 0.30 to 0.91; p = 0.022
    • When compared with both OMT and PCI patients, CABG correlated with lower rates of subsequent revascularisation in all 1-year LDL-C strata
      • No difference in subsequent revascularisation rates were observed when comparing PCI with OMT in any of the 1-year LDL-C strata


  • There may be a possibility of additional confounders influencing the association between cardiovascular outcomes and both the choice of revascularisation procedure and the LDL-C control rate
  • There is a lack of data for adherence to the prescribed therapy
  • A systematic analysis was not pursued for lipid lowering therapy during the first year of follow-up
  • There could be an occurrence of immortal time bias

    Farkouh ME, Godoy LC, Brooks MM, Mancini GBJ, Vlachos H, Bittner VA, et al. Influence of LDL-cholesterol lowering on cardiovascular outcomes in patients with diabetes mellitus undergoing coronary revascularization. J Am Coll Cardiol. 2020;76(19):2197-2207. doi: 10.1016/j.jacc.2020.09.536.

MAT-BH-2100647/v1/Jul 2021