When should LDL optimization occur relative to CABG?

• A. Lipids are not modifiable around surgery
• B. Only postoperatively matters
• C. Preoperative optimization of LDL is not important
• D. LDL should be optimized pre- and postoperatively

Answer: (D)

LDL management around CABG should occur both before and after the operation. Optimizing LDL preoperatively helps stabilize plaques and reduce perioperative risk, including myocardial injury and inflammatory responses. Continuing lipid lowering after the surgery is essential to protect grafts and native vessels from progressive atherosclerosis and to reduce future cardiac events. The beneficial effects of statins and other lipid-lowering therapies extend across the perioperative period, improving short-term safety and long-term graft patency. So, LDL should be optimized pre- and postoperatively.