There is no evidence to support the use of one statin over another, either before or after CABG, although the administration of generic statins is appealing from a cost point of view because this may improve patient compliance.140 Essentially all patients under- going CABG are candidates for long-term statin therapy in the absence of contraindications such as liver disease. For the occasional subject who cannot take statins, alternative lipid treatments such as bile acid sequestrants, niacin, and fibrates should be considered, as described elsewhere.82,141 High-Density Lipoprotein Management Many patients remain at high risk for adverse cardiovascu- lar events even when their LDL levels have been aggressively reduced by statins.142 Thus, increasing attention has recently been directed to the evaluation of therapies to raise high-den- sity lipoprotein (HDL) levels to further improve cardiovascu- Frequently seen in patients with CAD, a low HDL level has been well described as an independent risk factor for adverse cardiovascular outcomes in several stud- Some of the earliest data on the subject became available from the Framingham Heart Study, in which low HDL was found to be a more potent CAD risk factor than high Recent studies from the current era have shown that HDL levels are inversely related to cardiovascular events, even among patients receiving statin therapy152 and those with LDL levels aggressively treated to <70 mg/dL.151 In addition, mod- erate increases in HDL appear to be associated with regression of coronary atherosclerosis in statin-treated patients.153 Smoking cessation, weight loss, exercise, and moderate alcohol intake all modestly increase HDL. Fibrate therapy can raise HDL levels by 5% to 10%, and niacin increases HDL by 15% to 25%. Statins, on the other hand, have little effect on HDL. 