The metabolic syndrome is defined as the coexistence of several interrelated conditions, including central obesity, hyperglycemia, elevated systemic BP, hypertriglyceridemia, and decreased HDL. The presence of 3 of these abnormali- ties establishes the diagnosis of metabolic syndrome based on the Adult Treatment Panel III consensus.397 The metabolic syn- drome has been associated with numerous pathophysiological mechanisms that can lead to cardiovascular disease, includ- ing insulin resistance, increased oxidative stress, endothelial dysfunction, and atherogenic lipid patterns. The presence of metabolic syndrome increases the risk for cardiovascular events Kulik et al Secondary Prevention After CABG 947 from 2- to 4-fold independently of the presence of diabetes mel- litus. As a well-established cardiovascular risk factor, the meta- bolic syndrome is common among patients undergoing CABG, with some studies reporting the prevalence as high as 50%.398 The metabolic syndrome has been associated with increased in-hospital mortality in subjects undergoing CABG. In a study of 5304 consecutive CABG patients, those with metabolic syn- drome had a 2.7-times higher in-hospital mortality than those without metabolic syndrome, a risk that was independent of the presence of diabetes mellitus.399 Moreover, patients with metabolic syndrome also have an increased risk for long-term mortality. Angeloni et al398 noted that all-cause mortality was 50% higher in those patients with metabolic syndrome com- pared with those without in a long-term follow-up study of 1726 CABG patients. 