BackgroundA proven therapy for nearly 50 years, CABG is the most durable and complete treatment of ischemic heart disease. However, in the months and years that follow surgery, patients who have undergone CABG remain at risk for subsequent ischemic events as a result of native coronary artery disease progression and the development of graft atherosclerosis. Secondary therapies therefore play a key role in the maintenance of native and graft vessel patency and for the prevention of adverse cardiovascular outcomes.Methods and ResultsWe present a Scientific Statement prepared for the American Heart Association (AHA) to expand on two 2011 AHA and American College of Cardiology documents that provided a general overview of secondary prevention and briefly summarized the use of medical therapy after surgical coronary revascularization. Since the writing of those two statements, important evidence from clinical and observational trials has emerged that further supports and broadens the merits of intensive risk-reduction therapies for CABG patients. The present statement, specifically focused on the CABG population, thoroughly evaluates the current state of evidence regarding preventative therapies after surgery. Postoperative antiplatelet agents and lipid-lowering therapy continue to be the mainstay of secondary prevention following coronary surgical revascularization. Other opportunities for improving long-term clinical outcomes after CABG include the aggressive management of hypertension and diabetes mellitus, smoking cessation, weight loss, and cardiac rehabilitation. Select Class I and IIa recommendations are summarized in the Table below.Conclusion BackgroundA proven therapy for nearly 50 years, CABG is the most durable and complete treatment of ischemic heart disease. However, in the months and years that follow surgery, patients who have undergone CABG remain at risk for subsequent ischemic events as a result of native coronary artery disease progression and the development of graft atherosclerosis. Secondary therapies therefore play a key role in the maintenance of native and graft vessel patency and for the prevention of adverse cardiovascular outcomes. A proven therapy for nearly 50 years, CABG is the most durable and complete treatment of ischemic heart disease. However, in the months and years that follow surgery, patients who have undergone CABG remain at risk for subsequent ischemic events as a result of native coronary artery disease progression and the development of graft atherosclerosis. Secondary therapies therefore play a key role in the maintenance of native and graft vessel patency and for the prevention of adverse cardiovascular outcomes. Methods and ResultsWe present a Scientific Statement prepared for the American Heart Association (AHA) to expand on two 2011 AHA and American College of Cardiology documents that provided a general overview of secondary prevention and briefly summarized the use of medical therapy after surgical coronary revascularization. Since the writing of those two statements, important evidence from clinical and observational trials has emerged that further supports and broadens the merits of intensive risk-reduction therapies for CABG patients. The present statement, specifically focused on the CABG population, thoroughly evaluates the current state of evidence regarding preventative therapies after surgery. Postoperative antiplatelet agents and lipid-lowering therapy continue to be the mainstay of secondary prevention following coronary surgical revascularization. Other opportunities for improving long-term clinical outcomes after CABG include the aggressive management of hypertension and diabetes mellitus, smoking cessation, weight loss, and cardiac rehabilitation. Select Class I and IIa recommendations are summarized in the Table below. We present a Scientific Statement prepared for the American Heart Association (AHA) to expand on two 2011 AHA and American College of Cardiology documents that provided a general overview of secondary prevention and briefly summarized the use of medical therapy after surgical coronary revascularization. Since the writing of those two statements, important evidence from clinical and observational trials has emerged that further supports and broadens the merits of intensive risk-reduction therapies for CABG patients. The present statement, specifically focused on the CABG population, thoroughly evaluates the current state of evidence regarding preventative therapies after surgery. Postoperative antiplatelet agents and lipid-lowering therapy continue to be the mainstay of secondary prevention following coronary surgical revascularization. Other opportunities for improving long-term clinical outcomes after CABG include the aggressive management of hypertension and diabetes mellitus, smoking cessation, weight loss, and cardiac rehabilitation. Select Class I and IIa recommendations are summarized in the Table below. Conclusion
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