However, the management of this comorbid condi- tion in the perioperative setting has improved substantially, and the specificity of 1 - and 2 -blockers has minimized the cross-reactivity between the cardiac and pulmonary effects of -blockade. Even more recently, the pharmacogenetics of -adrenergic receptor antagonists have become clear, with certain genes being identified that influence the pharmacody- namic and pharmacokinetic effects of -blocker compounds.187 To clearly establish the benefit of -blocker therapy and secondary prevention after CABG, a link to improved mortal- ity is needed. An important study by Goyal et al198 assessed both the use and clinical impact of secondary preven- tion medications after CABG. The use of aspirin, -blockers, ACE inhibitors or angiotensin receptor blockers (ARBs), and lipid therapy was measured in patients enrolled in the Project of Ex-Vivo Vein Graft Engineering via Transfection (PREVENT IV) trial of 3014 patients. In ideal candidates for these therapies, -blocker rates at discharge (88.8%) and 1 year (76.9%) were suboptimal, but in this trial context, the rates of use were substantially higher than in contemporane- ous observational studies. The authors noted a stepwise asso- ciation between medication use at discharge and a lower risk of adverse patient outcomes (death or MI).198 Most recently, a study by Bangalore et al199 evaluated the use of -blocker therapy in stable patients with risk factors for CAD or a history of CAD or MI. This longitudinal, obser- vational registry study demonstrated that the use of -blocker therapy was not associated with a lower risk of cardiovascular events, including cardiovascular death, nonfatal MI, or non- fatal stroke, whether patients had risk factors only, a known prior MI, or known CAD without MI.199 Many patients under- going CABG would likely fall into one of these categories. 