Of interest, after CABG, women with high triglyc- eride levels have far worse long-term survival (HR, 1.5; 95% CI, 1.1 2.1) compared with men with high triglyceride levels (HR, 1.1; 95% CI, 0.9 1.3). Other studies also have demon- strated that elevated triglyceride values after surgery predict vein graft occlusion,178 recurrent angina and MI,179 181 and the need for redo CABG.182,183 In a secondary analysis of the Post- CABG Trial, the study investigators demonstrated that a high triglyceride level was a significant prognostic factor for vein graft atherosclerosis progression.165 Although the mechanism by which elevated triglyceride levels increase cardiovascu- lar risk is not entirely clear, triglyceride-rich lipoproteins in the vessel wall may lead to fatty streaks, which are noted in saphenous vein grafts as early as 18 months after CABG.184,185 High triglyceride levels have been shown to be a marker of worse outcomes after CABG. However, very few data are available to support the use of medical therapy to lower tri- glyceride levels after CABG. Before the advent of routine statin therapy, Barbir et al186 performed a small pilot trial of combination therapy with colestipol 10 mg and bezafibrate 400 mg/d for 2 months after CABG, noting a reduction in total cholesterol of 17%, in LDL cholesterol of 23%, and in triglyc- eride levels of 19%. In the previously described LOCAT study in which gemfibrozil reduced the development of new bypass graft lesions, gemfibrozil increased HDL levels and led to a 36% reduction in triglyceride levels (P<0.001).156 To date, no trial has investigated the use of fenofibrate ther- apy to reduce triglyceride levels and to potentially improve outcomes after CABG, highlighting the need for more research on the subject. 