Timing of Statin Use and CABG Outcomes As noted, the benefits of post-CABG LDL lowering with statins have been reported previously, but no prospective studies of the impact of preoperative LDL cholesterol lower- ing on post-CABG outcomes are available. One small ran- domized comparison of preoperative placebo and a statin (initiated 1 week before CABG) showed a reduction in elevated perioperative cardiac biomarkers with statin ther- apy.554 Several nonrandomized, retrospective studies have noted an association between preoperative statin use and reduced rates of postoperative nonfatal MI and death.553,555,557 559 In addition, preoperative statin use has been associated with reduced rates of postoperative atrial fibrillation (AF),571,572 neurological dysfunction,555,573,574 re- nal dysfunction,575 and infection.576 Untreated hyperlipidemic patients have been shown to have a higher risk of post-CABG events than that of treated hyperlipidemic patients and those with normal serum lipid concentrations.567 In patients under- going CABG who are not on statin therapy or at LDL goal, it seems reasonable to initiate intensive statin therapy preoper- atively (ie, no later than 1 week before surgery). Postoperatively, statin use should be resumed when the patient is able to take oral medications and should be continued indefinitely. Patients in whom statins were discon- tinued after CABG have been shown to have a higher mortality rate than those in whom statins were continued 4.3.1.1. Potential Adverse Effects of Perioperative Statin Therapy The most common adverse effects reported with statin use are myopathy and hepatotoxicity. 