Dia- betic status did not influence the effects of hyperglycemia.585 In short, until additional information is available, extremely tight intraoperative glucose control is not recommended. Although the management of blood glucose before surgery in patients with and without diabetes mellitus is not well studied, an increased incidence of adverse outcomes has been noted in patients with poor preoperative glycemic con- trol.593,595 As a result, most centers now attempt to optimize glucose control before surgery, attempting to achieve a target glucose concentration 180 mg/dL with continuous intrave- nous insulin. Measuring preoperative hemoglobin A1c con- centrations may be helpful in assessing the adequacy of preoperative glycemic control and identifying patients at risk for postoperative hyperglycemia.596 4.4.2. Postmenopausal Hormone Therapy Postmenopausal hormone therapy was shown previously to reduce the risk of cardiac-related death. However, more contemporary published RCTs have suggested that it may have adverse cardiovascular effects. The Women s Health Initiative randomly assigned 16 000 healthy postmeno- pausal women to placebo or continuous combined estrogen progestin therapy. Hormone therapy was discontinued early because of an increased risk of breast cancer in those receiving it. Additionally, subjects receiving it had an in- creased incidence of cardiac ischemic events (29% increase, mainly nonfatal MI), stroke, and venous thromboembo- lism.588 A secondary prevention trial, HERS (Heart and Estrogen/Progestin Replacement Study), randomly assigned 2763 postmenopausal women with known CAD to continu- ous estrogen/progestin or placebo, after which they were followed up for a mean of 4.1 years.587 No difference in the primary endpoints of nonfatal MI and CAD death was noted, but those receiving hormone therapy had a greater incidence of deep venous thrombosis and other thromboembolic events. This predisposition to thrombosis has raised concerns that hormone therapy may cause adverse events at the time of CABG. 