Therapy and prevention 619 Statin therapy is associated with reduced total and cardiovascular mortality after coronary artery bypass grafting surgery Athanasios Papathanasiou a , Ioannis K. Toumpoulis a , Haralampos J. Milionis b , Kallirroi Kalantzi a , Christos S. Katsouras a and John Goudevenos a Objective In an observational study, we evaluated the association between postoperative statin therapy and long-term mortality among patients undergoing a first-ever coronary artery bypass grafting (CABG) surgery. Methods In an outpatient clinic setting, we assessed 1869 consecutive patients (age 58.7 ± 9.6 years; 1657 men), who survived the 1st month after a first-ever CABG, within a 17-year period. Cox proportional hazard analysis was used to calculate the adjusted hazard ratios (adjusting for age, smoking, the presence of hypertension, diabetes mellitus, lipid profile at the time of the procedure, vessel disease, number and kind of grafts used, and concomitant treatment) for patients receiving statin treatment during follow-up and adjusted Kaplan–Meier survival curves were constructed. Results During a 9345 patient-years follow-up, 48% of the patients were on a statin. In a total of 222 deaths, 80.6% were because of cardiovascular causes. Total and cardiovascular mortality were significantly reduced in patients receiving statin therapy [adjusted hazard ratio, 0.48 (95% confidence interval, 0.28–0.82); P = 0.007), and 0.43 (95% confidence interval, 0.23–0.80); P = 0.007, respectively]. The estimated 16-year Kaplan–Meier survival curves diverged at 2 years and thereafter. Conclusion Taking into account the potential limitations of observational data, statin treatment postoperatively is associated with a 50% reduction in total and cardiovascular mortality in patients undergoing a first-ever CABG. Coron Artery Dis 19:619–625  c 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins. Coronary Artery Disease 2008, 19:619–625 Keywords: cardiovascular disease mortality, coronary artery bypass grafting surgery, statin therapy, total mortality Departments of a Cardiology and b Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece Correspondence to Haralampos Milionis, MD, Assistant Professor of Internal Medicine, Department of Internal Medicine, School of Medicine, University of Ioannina, 451 10 Ioannina, Greece Tel: + 30 2651097516; fax: + 30 2651097016; e-mail: hmilioni@uoi.gr Received 20 May 2008 Revised 5 August 2008 Accepted 5 August 2008 Introduction Aortocoronary saphenous vein bypass grafts (SVGs) are effective in the relief of angina and, in certain patient subsets, in prolonging life [1]. The development and progression of atherosclerosis, at least after the 1st year following the procedure, however, limits the duration of SVG usefulness [2]. Even after complete revasculari- zation, long-term clinical outcomes are still determined by recurrence of atherosclerosis in the vein graft and progression of the disease in the native coronary arteries [3]. Risk factors associated with SVG occlusion and mortality in patients undergoing coronary artery bypass grafting surgery (CABG) include smoking [4], dyslipide- mia [5,6], and diabetes mellitus [7,8]. Statin therapy has been shown to reduce mortality in patients with established coronary artery disease and CABG [6,9]. The benefits of statin therapy have been attributed to plaque stabilization, owing to their lipid- lowering capacity as well as to a series of pleiotropic effects, such as anti-inflammatory and antioxidant actions on vessel wall of either SVGs or native arteries [3,10]. Aggressive lipid-lowering therapy [11–13] in CABG patients has been shown to be associated with reduced progression of vein grafts atherosclerosis or the formation of new lesions in native vessels and bypass grafts [11–13]. Recent studies suggested that preoperative statin therapy is associated with reduced early [14,15], or 1-year mortality [16], whereas discontinuation of statin therapy just after the procedure was associated with increased in-hospital mortality [14]. Whether these beneficial effects of statin therapy influence long-term mortality, however, remains uncertain. The aim of this study was to assess the association between postoperative statin therapy and long-term mortality among patients undergoing a first-ever CABG. 0954-6928  c 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins DOI: 10.1097/MCA.0b013e3283142607 Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.