From an era before the rou- tine use of statins after CABG, patients were randomized to receive either slow-release gemfibrozil 1200 mg/d or match- ing placebo. Coronary angiography was performed at baseline and after a mean of 32 months of therapy. Gemfibrozil ther- apy led to significant increases in HDL levels (P<0.001) and slowed the progression of native CAD (P=0.009). Moreover, gemfibrozil significantly reduced the risk of developing new lesions in bypass grafts on follow-up angiography (2% ver- sus 14%, gemfibrozil versus placebo; P<0.001).156 Despite the notable results of LOCAT, gemfibrozil never became incorpo- rated into the routine care of CABG patients. This was likely a reflection of the impressive data published that same year promoting the use of statins after CABG,68 as well as the high risk of side effects associated with gemfibrozil, particularly when combined with statin therapy.167,168 Lower HDL levels are associated with worse long-term sur- vival and higher risk of cardiovascular events after CABG.163,164 Although there is strong evidence supporting the use of statins after CABG, adding gemfibrozil to a patient s medication regimen can increase the risk of side effects such as myopa- thy and rhabdomyolysis. Theoretically, HDL modulation may help slow the process of saphenous vein graft disease, but this concept must be tempered by the absence of data on the administration of fenofibrate or niacin therapy after CABG. Moreover, in the non-CABG population, the administration of these agents on top of statins has proven to be futile in recent Future research may help further explore this possible strategy of administering second-line agents such as fenofibrate to elevate low levels of HDL after surgery, with a view toward improving post-CABG vein graft patency. 