Lipid Management Statins and Low-Density Lipoprotein Management Elevated low-density lipoprotein (LDL) cholesterol levels strongly influence the process of saphenous vein graft disease after CABG, including the development of intimal hyperplasia Kulik et al Secondary Prevention After CABG 933 and atheromatous plaques.75,76 Through lifestyle changes and medications, the treatment of hyperlipidemia reduces adverse cardiovascular events in patients with CAD, and among CABG patients in particular.68,77 79 Statins, the most com- monly prescribed agents for hyperlipidemia, have been shown to improve survival and to reduce the risks of adverse car- diovascular events across a wide range of cholesterol levels. Statins also reduce the progression of native artery atheroscle- Of importance to the CABG population, statins have been demonstrated to inhibit the development of saphe- nous vein graft disease68,83 by reducing neointimal formation and smooth muscle proliferation.84 86 A number of studies have investigated the role of statins for postoperative cholesterol reduction after CABG. In the land- mark Post-CABG Trial, 1351 patients who had previously undergone CABG 1 to 11 years earlier and who had LDL lev- els between 130 and 175 mg/dL were randomized to aggres- sive cholesterol reduction with lovastatin 40 to 80 mg daily or moderate cholesterol reduction with lovastatin 2.5 to 5 mg daily. As measured annually during the study period, mean LDL levels of patients who received aggressive treatment ranged from 93 to 97 mg/dL compared with 132 to 136 mg/ dL for patients who received moderate treatment (P<0.001). 