Secondary Prevention After Coronary Artery Bypass Graft Surgery A Scientific Statement From the American Heart Association Alexander Kulik, MD, MPH, FAHA, Chair; Marc Ruel, MD, MPH, FAHA, Co-Chair; Hani Jneid, MD, FAHA; T. Bruce Ferguson, MD, FAHA; Loren F. Hiratzka, MD, FAHA; John S. Ikonomidis, MD, PhD, FAHA; Francisco Lopez-Jimenez, MD, MSc, FAHA; Sheila M. McNallan, MPH; Mahesh Patel, MD; V ronique L. Roger, MD, MPH, FAHA; Frank W. Sellke, MD, FAHA; Domenic A. Sica, MD, FAHA; Lani Zimmerman, PhD, RN; on behalf of the American Heart Association Council on Cardiovascular Surgery and Anesthesia The recommendations listed in this document are, when- ever possible, evidence based. Writing group members per- formed these relevant supplemental literature searches with key search phrases, including but not limited to coronary artery bypass graft surgery; tobacco, smoking, and smoking cessation; blood pressure control and hypertension; choles- terol, hypercholesterolemia, lipids, lipoproteins, and dyslipid- emia; physical activity, exercise, and exercise training; weight management, overweight, and obesity; type 2 diabetes melli- tus management; antiplatelet agents and anticoagulants; renin, angiotensin, and aldosterone system blockers; -blockers; influenza vaccination; clinical depression and depression screening; and cardiac rehabilitation. These searches were limited to studies, reviews, and other evidence conducted in human subjects and published since 1979. In addition, writ- ing group members reviewed documents related to the subject matter previously published by the AHA, the ACCF, and the National Institutes of Health. Antiplatelet Therapy Aspirin First discovered in 1897, aspirin irreversibly inhibits platelet cyclooxygenase-1. By decreasing thromboxane A2 produc- tion, aspirin prevents platelet aggregation, reducing the risk of stroke, myocardial infarction (MI), and vascular death Table. Applying Classification of Recommendation and Level of Evidence A recommendation with Level of Evidence B or C does not imply that the recommendation is weak. 