Key advances in secondary prevention after coronary artery bypass grafting

PURPOSE OF REVIEW: Coronary artery bypass grafting (CABG) improves prognosis in advanced coronary artery disease but does not halt native-vessel atherosclerosis or prevent graft failure. This review summarizes key advances in secondary prevention after CABG, emphasizing contemporary evidence, treatment shortcomings, and practical implications for long-term care. RECENT FINDINGS: Intensive lipid lowering remains key, with high-intensity statins, ezetimibe, and PCSK9 inhibitors used sequentially to achieve very low LDL-C targets, while triglyceride-lowering therapy may benefit selected high-risk patients. Aspirin remains the cornerstone of antithrombotic therapy, whereas dual antiplatelet therapy should be patient-specific. Routine long-term beta-blocker or renin-angiotensin system inhibitor therapy should be guided by established indications rather than CABG alone, while calcium channel blockers may have a role after radial artery grafting. SGLT2 inhibitors, GLP-1 receptor agonists, cardiac rehabilitation, smoking cessation, obesity management, vaccination, and mental health and cognitive screening have broadened secondary prevention beyond traditional risk-factor control. SUMMARY: Secondary prevention after CABG is a lifelong, multidisciplinary strategy aimed at preserving graft function, slowing disease progression, improving quality of life, and reducing recurrent cardiovascular events. Contemporary care should be individualized according to clinical phenotype, conduit strategy, comorbidity burden, thrombotic and bleeding risk, functional status, and treatment burden. Future studies should clarify persistent evidence gaps in antithrombotic therapy, cardiometabolic treatment, graft-specific outcomes, rehabilitation delivery, adherence, and patient-centered care.