Potential Adverse Effects of Perioperative Statin Therapy The most common adverse effects reported with statin use are myopathy and hepatotoxicity. Muscle aches have been re- ported in about 5% of patients treated with statins, although several pooled analyses of RCTs have shown a similar rate of muscle aches with placebo.577 Myositis, defined as muscle pain with a serum creatine kinase 10 times the upper limit of normal, occurs in 0.1% to 0.2% of statin users, and rhabdomyolysis occurs in 0.02%.578,579 In addition, approxi- mately 2% of patients are observed to have elevated liver enzymes (ie, alanine and aspartate transaminases) in the weeks to months after statin initiation, but no data are available to suggest that these elevations are associated with permanent hepatotoxicity or an increased risk of hepatitis. Nonetheless, the presence of active or chronic liver disease is a contraindication to statin use, and patients initiated on a statin should be monitored for the development of myositis or rhabdomyolosis, either of which would mandate its 4.4. Hormonal Manipulation: Recommendations Class I 1. Use of continuous intravenous insulin to achieve and maintain an early postoperative blood glucose con- centration less than or equal to 180 mg/dL while avoiding hypoglycemia is indicated to reduce the incidence of adverse events, including deep sternal wound infection, after CABG.581 583 (Level of Evi- dence: B) Class IIb 1. The use of continuous intravenous insulin designed to achieve a target intraoperative blood glucose concentration less than 140 mg/dL has uncertain effectiveness.584 586 (Level of Evidence: B) Class III: HARM 1. Postmenopausal hormonal therapy (estrogen/pro- gesterone) should not be administered to women undergoing CABG.587 589 (Level of Evidence: B) 4.4.1. Glucose Control Hyperglycemia often occurs during and after CABG, partic- ularly when CABG is performed on pump. 