Patients are strongly advised to stop smoking. They are encouraged to engage in an exercise program and maintain a low-cholesterol, low-saturated-fat diet. Blood pressure should be checked every four months to be sure that it is not elevated because this may aggravate the problems of blockage in the graft.
Patients must be strongly advised that atherosclerotic disease is not cured by surgery. Coronary thrombosis can still occur. The vein graft can develop atherosclerosis over a period of 10–15 years as veins are not usually subjected to the blood pressure found in arteries. The average pressure found within veins is normally about 5–7 mmHg as compared to the normal pressure in arteries of about 110–150 mmHg. One study showed that at 10 years post surgery more than half of the grafts were narrowed or blocked, particularly in individuals who continued to smoke cigarettes or in those with hypertension and increased cholesterol levels. Clinical trials done from 1994 to 1995 have established that the use of statins to main¬tain LDL cholesterol at less than 80 mg/dl (2.0 mmol/L) prevents the progression of atheroma and reduces the need for angioplasty and repeat bypass surgery (see the chapter Cholesterol).

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