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.
The 2026 American College of Cardiology/American Heart Association multisociety guideline on the management of dyslipidemia provides a comprehensive update to the 2018 cholesterol guideline. With the prevention of ASCVD (atherosclerotic cardiovascular disease) as its central goal, the new guideline emphasizes earlier identification, earlier intervention, and long-term management of dyslipidemia to reduce lifetime exposure to atherogenic lipoproteins. The PREVENT-ASCVD equations are recommended to replace the previous Pooled Cohort Equations for 10-year and 30-year cardiovascular risk assessment. Low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol treatment goals are re-emphasized in clinical decision-making, and apolipoprotein B and lipoprotein(a) are assigned more important roles in risk refinement. In terms of treatment, statins remain the foundation of lipid-lowering therapy, while the roles of ezetimibe, proproteinconvertase subtilisin/kexin type 9 monoclonal antibodies, bempedoic acid, inclisiran, and apolipoprotein C3 inhibitors are further clarified. This article interprets the background, key updates, primary and secondary prevention strategies, use of special lipid biomarkers, management of hypertriglyceridemia, and positioning of novel lipid-lowering therapies in the 2026 guideline, and discusses their implications for dyslipidemia management in China.