LIPID TRENDS ON DONOR DERIVED ATHEROSCLEROTIC DISEASE AND ALLOGRAFT VASCULOPATHY IN HEART TRANSPLANT RECIPIENTS AT A LARGE ACADEMIC CENTER
Therapeutic Area: ASCVD/CVD in Special Populations Background: Prior studies demonstrate an association between statins and reduction in mortality and incidence of coronary allograft vasculopathy (CAV) following heart transplant, and while lipid lowering with LDL < 100 mg/dL is associated with re...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-09-01
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| Series: | American Journal of Preventive Cardiology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S266666772300082X |
| _version_ | 1797676579346710528 |
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| author | Antoinette S. Birs, MD Eric D. Adler, MD Pam R. Taub, MD Michael Wilkinson, MD |
| author_facet | Antoinette S. Birs, MD Eric D. Adler, MD Pam R. Taub, MD Michael Wilkinson, MD |
| author_sort | Antoinette S. Birs, MD |
| collection | DOAJ |
| description | Therapeutic Area: ASCVD/CVD in Special Populations Background: Prior studies demonstrate an association between statins and reduction in mortality and incidence of coronary allograft vasculopathy (CAV) following heart transplant, and while lipid lowering with LDL < 100 mg/dL is associated with reduced risk of CAV and delayed time to first CAV diagnosis, little is known about real-world trends in atherogenic lipids following heart transplant. We aim to describe lipid trends and CAV in a contemporary cohort of heart transplant recipients. Methods: Single-center, retrospective study of consecutive heart transplant recipients having received transplant between 01/01/2019 and 12/31/2020. Intravascular ultrasound (IVUS) during coronary angiography was performed and lipid panels were performed annually, starting at one-year post-transplant. Baseline lipids were the closest available results performed prior to transplant. Per site protocol, all patients were initiated on Pravastatin 20mg and Aspirin 81mg prior to discharge unless contraindicated. Two-sample t tests, Wilcoxon, and Kruskal-Wallis tests were performed for statistical analysis. Results: 142 Heart transplants were performed within the designated study period; 87 patients were included in the study. Most patients were male (75.3%), Caucasian (40%), median age 59 years, and median BMI 25.4 kg/m2, 78.8%, had a history of non-ischemic cardiomyopathy. Median atherogenic lipid values two years following transplant were higher when compared to pre-transplant (LDL-C: 69.5 vs 86.5 mg/dL, p=0.03, non-HDL-C:91.5 vs 118, p < 0.001, triglycerides: 94.5 vs 133, p=0.04, and remnant cholesterol 18 vs 27, p< .05). With respect to CAV outcomes two years post-transplant, LDL-C was significantly higher in patients with severe class 4 CAV. Conclusions: There is a significant increase in atherogenic lipids 2 years after heart transplant, and higher levels of LDL-C are seen in those with severe CAV. Thus, there is a clinical need to further lower atherogenic lipids in patients after heart transplant. Limitations: Analysis of confounding variables to confirm these findings and investigate the differences CV outcomes between patients with elevated lipids. |
| first_indexed | 2024-03-11T22:31:16Z |
| format | Article |
| id | doaj.art-cb8baaf375534ec3bff81db542c9493b |
| institution | Directory Open Access Journal |
| issn | 2666-6677 |
| language | English |
| last_indexed | 2024-03-11T22:31:16Z |
| publishDate | 2023-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Journal of Preventive Cardiology |
| spelling | doaj.art-cb8baaf375534ec3bff81db542c9493b2023-09-23T05:12:57ZengElsevierAmerican Journal of Preventive Cardiology2666-66772023-09-0115100541LIPID TRENDS ON DONOR DERIVED ATHEROSCLEROTIC DISEASE AND ALLOGRAFT VASCULOPATHY IN HEART TRANSPLANT RECIPIENTS AT A LARGE ACADEMIC CENTERAntoinette S. Birs, MD0Eric D. Adler, MD1Pam R. Taub, MD2Michael Wilkinson, MD3Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, La Jolla, California, USADivision of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, La Jolla, California, USADivision of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, La Jolla, California, USADivision of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, La Jolla, California, USATherapeutic Area: ASCVD/CVD in Special Populations Background: Prior studies demonstrate an association between statins and reduction in mortality and incidence of coronary allograft vasculopathy (CAV) following heart transplant, and while lipid lowering with LDL < 100 mg/dL is associated with reduced risk of CAV and delayed time to first CAV diagnosis, little is known about real-world trends in atherogenic lipids following heart transplant. We aim to describe lipid trends and CAV in a contemporary cohort of heart transplant recipients. Methods: Single-center, retrospective study of consecutive heart transplant recipients having received transplant between 01/01/2019 and 12/31/2020. Intravascular ultrasound (IVUS) during coronary angiography was performed and lipid panels were performed annually, starting at one-year post-transplant. Baseline lipids were the closest available results performed prior to transplant. Per site protocol, all patients were initiated on Pravastatin 20mg and Aspirin 81mg prior to discharge unless contraindicated. Two-sample t tests, Wilcoxon, and Kruskal-Wallis tests were performed for statistical analysis. Results: 142 Heart transplants were performed within the designated study period; 87 patients were included in the study. Most patients were male (75.3%), Caucasian (40%), median age 59 years, and median BMI 25.4 kg/m2, 78.8%, had a history of non-ischemic cardiomyopathy. Median atherogenic lipid values two years following transplant were higher when compared to pre-transplant (LDL-C: 69.5 vs 86.5 mg/dL, p=0.03, non-HDL-C:91.5 vs 118, p < 0.001, triglycerides: 94.5 vs 133, p=0.04, and remnant cholesterol 18 vs 27, p< .05). With respect to CAV outcomes two years post-transplant, LDL-C was significantly higher in patients with severe class 4 CAV. Conclusions: There is a significant increase in atherogenic lipids 2 years after heart transplant, and higher levels of LDL-C are seen in those with severe CAV. Thus, there is a clinical need to further lower atherogenic lipids in patients after heart transplant. Limitations: Analysis of confounding variables to confirm these findings and investigate the differences CV outcomes between patients with elevated lipids.http://www.sciencedirect.com/science/article/pii/S266666772300082X |
| spellingShingle | Antoinette S. Birs, MD Eric D. Adler, MD Pam R. Taub, MD Michael Wilkinson, MD LIPID TRENDS ON DONOR DERIVED ATHEROSCLEROTIC DISEASE AND ALLOGRAFT VASCULOPATHY IN HEART TRANSPLANT RECIPIENTS AT A LARGE ACADEMIC CENTER American Journal of Preventive Cardiology |
| title | LIPID TRENDS ON DONOR DERIVED ATHEROSCLEROTIC DISEASE AND ALLOGRAFT VASCULOPATHY IN HEART TRANSPLANT RECIPIENTS AT A LARGE ACADEMIC CENTER |
| title_full | LIPID TRENDS ON DONOR DERIVED ATHEROSCLEROTIC DISEASE AND ALLOGRAFT VASCULOPATHY IN HEART TRANSPLANT RECIPIENTS AT A LARGE ACADEMIC CENTER |
| title_fullStr | LIPID TRENDS ON DONOR DERIVED ATHEROSCLEROTIC DISEASE AND ALLOGRAFT VASCULOPATHY IN HEART TRANSPLANT RECIPIENTS AT A LARGE ACADEMIC CENTER |
| title_full_unstemmed | LIPID TRENDS ON DONOR DERIVED ATHEROSCLEROTIC DISEASE AND ALLOGRAFT VASCULOPATHY IN HEART TRANSPLANT RECIPIENTS AT A LARGE ACADEMIC CENTER |
| title_short | LIPID TRENDS ON DONOR DERIVED ATHEROSCLEROTIC DISEASE AND ALLOGRAFT VASCULOPATHY IN HEART TRANSPLANT RECIPIENTS AT A LARGE ACADEMIC CENTER |
| title_sort | lipid trends on donor derived atherosclerotic disease and allograft vasculopathy in heart transplant recipients at a large academic center |
| url | http://www.sciencedirect.com/science/article/pii/S266666772300082X |
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