Abstract 13470: Update on Lipid Profiles and Lipid Modifying Therapies in Heart Transplant Recipients, a Single Center Experience

Abstract

Introduction: Statin use after heart transplant (HT) has been shown to reduce rates of CAV and improve morbidity and mortality regardless of lipid profile. However, drug-drug interactions (DDIs) between statins and immunosuppressive therapies limit their use, particularly at higher doses. Recently, non-statin lipid modifying therapies have also been used in the HT population, despite a lack of outcome trials. Objective: We sought to examine current trends in lipid profiles and lipid-lowering therapy use in the HT population. Methods: We performed a retrospective chart review of 198 HT recipients (average age 53.6 years, 139 males, 59 females) transplanted between 4/8/2016 and 3/24/2020 at a single center. Of those patients, 82 underwent HT for ischemic cardiomyopathy (ICM), and 116 underwent HT for nonischemic cardiomyopathy (NICM). Lipid panels and medications were collected pre-transplant, immediately post-transplant, and 1-year post-transplant. Most recent values were also collected. At each point the 2018 lipid guidelines were used to determine the recommended intensity of statin each patient should ideally be on if they were not transplant patients. Results: Median cholesterol, triglyceride, HDL, and LDL values were reasonably well-controlled post HT. Despite high overall rates of statin use, our data suggest that most HT recipients are on lower than guideline-recommended statin doses due to DDI, particularly in the ICM group. The proportion of patients on non-statin lipid modifying therapies increased over time. Conclusions: There is emerging evidence that non-statin therapies added to statins can further reduce atherothrombotic events in non-transplant patients. These therapies may offer options for additional lipid control in transplant recipients whose statin use is limited by DDIs. However, the pathophysiology of CAV and atherosclerosis are different, and outcome trials of non-statin lipid therapies in HT patients are urgently needed.