Cholesterol Lowering After Heart Transplantation is Associated with a Lower Incidence of Transplant Coronary Artery Disease.

Abstract

97 Hypercholesterolemia after heart transplant is common and is seen in 60-80% of patients. HMG-CoA reductase inhibitors (HMG) are reported to be effective for cholesterol lowering and reduce the incidence of transplant coronary artery disease (TCAD) when started immediately after transplant. It is not known if late cholesterol lowering (> 6 months after transplant) will result in lower incidence of transplant coronary artery disease. We reviewed 70 cardiac transplant patients on pravastatin (20-40 mg per day) who were started on these agents an average of 7 ± 13 months after transplant for total cholesterol level > 200 mg/dl and followed for up to 5 years duration. Average cholesterol level at the start of HMG was 258 ± 53 mg/dl and was significantly lower (p < 0.05) in the ensuing 1,2,3,4,5 years after start of HMG (187, 186, 189, 195, 192 mg/dl, respectively). LDL cholesterol and triglyceride levels had similar sustained reduction. HDL cholesterol levels did not significantly change. The incidence of TCAD in these 64 cardiac transplant patients is seen in the graph below and is compared to 88 cardiac transplant patients not on HMG (transplanted prior to the use of pravastatin in our program; between 1984 and 1989). Cholesterol levels for the control group at 1,2,3,4,5 years after transplant were 240,209,203,207,207 mg/dl, respectively. There was a significant benefit of pravastatin over the control group in freedom from TCAD (p < 0.01). There was no significant rise in creatine kinase, SGOT, SGPT in those patients on pravastatin.FigureConclusion: Long-term therapy with HMG in cardiac transplant patients appears safe and effective and is associated with lower incidence of transplant coronary artery disease.