In the absence of contraindications, it is reasonable to add an aldosterone antagonist (on top of -blocker and ACE inhibitor therapy) after CABG for patients with LV dysfunction (EF <35%) who have class NYHA class II to IV heart failure symptoms (Class IIa; Level of Evidence B). 4. Among patients with LV dysfunction (EF <35%), ICD therapy is not recommended for the prevention of sudden cardiac death after CABG until 3 months of postoperative goal-directed medical therapy has been provided and persistent LV dysfunction has been confirmed (Class III; Level of Evidence A). Diabetes Mellitus The effects of diabetes mellitus and the metabolic syndrome on the development and progression of cardiovascular disease are well established. Indeed, diabetes mellitus is associated with increased mortality and morbidity after cardiac surgery in general and CABG specifically.268 Diabetes mellitus is classified as type 1 if it results from -cell destruction or as type 2 if it results from a progressive insulin secretory defect and insulin resistance, but other causes of diabetes mellitus exist, including genetic defects in insulin secretion, drug- induced diabetes mellitus, and gestational diabetes mellitus.269 Traditionally, the diagnosis of diabetes mellitus has been based on a fasting plasma glucose >126 mg/dL, a 2-hour plasma glu- cose >200 mg/dL after oral administration of 75 g glucose, or a random plasma glucose of >200 mg/dL in a patient with the classic symptoms of diabetes mellitus.270 In 2009, however, an International Expert Committee recommended the use of the ) test be added, with a threshold >6.5% as a diagnostic criterion for diabetes mellitus.271 Because it is not always known whether a patient has dia- betes mellitus or glucose intolerance before surgery, it is reasonable for all patients undergoing CABG to have pre- operative fasting plasma glucose and HbA1c measurements. 