Metabolic Syndrome in Heart Transplantation: An Underestimated Risk Factor?

Abstract

<h3>Purpose</h3> Metabolic Syndrome (MS) is a multifactorial condition that increases the risk of cardio-vascular events, it's frequent in Heart transplant (HTx) candidates and worsens with immunosuppressive therapy. Aim of the study was to analyse the impact of MS on long-term outcome of HTx patients. <h3>Methods</h3> MS was defined through the presence of at least 3 of the following factors: • -Triglyceride ≥150mg/dl or drug treatment for hypertriglyceridemia • -HDL <40mg/dl for men and <50mg/dl for women • -Blood glucose ≥100mg/dl or diabetes mellitus • -Arterial pressure ≥130/80 or hypertensive drug treatment • -BMI>30 In 349 HTx patients since 2007, mortality and morbidity predictors were evaluated. <h3>Results</h3> MS was present in 35% of patients pre-HTx and 47% within the first year of follow-up. Five-year survival in patients with pre-HTx MS was worst (65% vs 78%, p<0.01), as well as in those with MS in the first year of follow-up (78% vs 89%, p<0.01). At the univariate analysis, risk factors for mortality were recipient age (HR 1.07, 1.04-1.09, p<0.01), pre-HTx MS (HR 1.86, 1.29-2.69, p<0.01), pre-HTx hypertension (HR 2.46, 1.70-3.55, p<0.01), pre-HTx hypertriglyceridemia (HR 1.50, 1.04-2.18, p=0.03), chronic renal failure (HR 2.95, 2.03-4.27, p<0.01), MS and diabetes at 1-year follow-up (HR 2.00, 1.25-3.19, p<0.01; HR 2.02, 1.27-3.23, p<0.01, respectively). The last two resulted also risk factors for CAV (HR 1.86, 1.16-2.99, p=0.01; HR 1.67, 1.03-2.69, p=0.04, respectively). MS at 1-year follow-up determined a significant higher risk to develop CAV at 5- and 10-year follow-up (25% vs 14% and 44% vs 25%, p<0.01). <h3>Conclusion</h3> MS is an important risk factor for both mortality and morbidity post-HTx, suggesting the need for a strict monitoring of metabolic disorders with a careful nutritional follow-up in HTx patients.