More recently, several studies have evaluated the impact of intensive lipid reduction early after CABG. In a cohort study of 418 CABG patients, Ouattara et al128 noted a significant reduction in the incidence of perioperative cardiovascular events (heart failure, malignant arrhythmia, or cardiac death) in patients who received high-dose statin therapy before sur- gery compared with those who were treated with low-dose intracoronary angioscopy 12 to 16 months after CABG, Hata noted yellow plaque and thrombus in the vein grafts of all 11 studied patients who had LDL levels >100 mg/dL (mean, 130 mg/dL). In contrast, in the 10 patients who had LDL levels <80 mg/dL (mean, 64 mg/dL), no yellow plaque or thrombus was seen, suggesting that aggressive lipid-low- ering therapy after CABG may prevent the development of saphenous vein graft disease. In a recent post hoc analysis of the CASCADE trial, 1-year graft patency was notably higher for patients with LDL levels <100 mg/dL (96.5%) compared with those with LDL levels >100 mg/dL (83.3%; P=0.03). However, no improvement in graft patency was noted with further LDL reduction to <70 mg/dL (P=1.00).83 Extensive evidence exists supporting the use of high-inten- sitystatintherapyforsecondarypreventionamongpatientswith clinical atherosclerotic cardiovascular disease.82 Although the data are sparse in the CABG literature, the recent ACC/AHA cholesterol guideline statement recommended high-intensity statin therapy for the majority of patients who have clinical atherosclerotic cardiovascular disease, which would include nearly all patients who have previously undergone CABG.82 The only exception to this recommendation relates to patients >75 years of age, given the potential for drug-drug interactions in this population and because few patients of this age were included in the high-intensity statin trials.82 Notwithstanding the new recommendations, little experience has accrued with the use of high-intensity statin therapy early after CABG as it relates to patient compliance and side effects. 