Continuation of Atorvastatin After CABG

Evidence-Based Rationale for Continuing Atorvastatin

The American College of Cardiology recommends that all patients undergoing CABG should receive statin therapy unless contraindicated, with a Class I, Level of Evidence: A recommendation 1, 2, 3
Discontinuation of statin or other dyslipidemic therapy is specifically not recommended before or after CABG in patients without adverse reactions to therapy, with a Class III: HARM, Level of Evidence: B recommendation 1, 2, 4
An adequate dose of statin should be used to reduce LDL cholesterol to less than 100 mg/dL and to achieve at least a 30% lowering of LDL cholesterol, with a Class I, Level of Evidence: C recommendation 2, 3
For very high-risk patients, it is reasonable to treat with statin therapy to lower the LDL cholesterol to less than 70 mg/dL, with a Class IIa, Level of Evidence: C recommendation 2, 3

For patients already on statin therapy before surgery, it should be continued without interruption, according to the American College of Cardiology 1, 2
For patients undergoing urgent or emergency CABG who are not taking a statin, it is reasonable to initiate high-dose statin therapy immediately, with a Class IIa, Level of Evidence: C recommendation 2, 3

Aspirin (100 mg to 325 mg daily) should be initiated within 6 hours postoperatively if not started preoperatively and continued indefinitely, according to the American College of Cardiology 2, 3
Beta blockers should be reinstituted as soon as possible after CABG in all patients without contraindications, according to the American College of Cardiology 6, 5
ACE inhibitors and ARBs should be reinstituted postoperatively once the patient is stable, according to the American College of Cardiology 6, 5

Discontinuing statin therapy before or after CABG is specifically classified as harmful, with a Class III: HARM recommendation 1, 2
Using inadequate doses of statins that fail to achieve target LDL reductions of at least 30%, according to the American College of Cardiology 2, 3
Failing to reinitiate statin therapy promptly after surgery, according to the American College of Cardiology 5