It is generally believed that it takes decades to develop a complicated atherosclerotic plaque. This view is challenged by the present case describing a hyperlipidemic patient who died of vein graft atherosclerosis less than 4 years after otherwise successful coronary bypass surgery. Although the atherogenesis may be accelerated in autogenous coronary vein grafts compared with native coronary arteries, the present case illustrates that complicated atherosclerosis may develop in the course of only a few years if appropriate conditions prevail.