Non-HDL cholesterol is an independent predictor of long-term cardiovascular events in patients with dyslipidemia after renal transplantation.

Abstract

Posttransplant dyslipidemia is a common condition in renal transplantation recipients (RTR) and is related to poor cardiac outcomes. We aimed to demonstrate the value of non-high-density lipoprotein cholesterol (non-HDL-C) in predicting long-term major cardiovascular and cerebrovascular events (MACCE) in RTR with dyslipidemia. Patients who had undergone renal transplantation between 2011 and 2019 were retrospectively analysed and were classified as normal non-HDL-C and high non-HDL-C groups based on first year levels. Development of high non-HDL-C levels was used to predict the occurrence of MACCE (a combination of cardiac death, nonfatal myocardial infarction, unstable angina, and nonfatal stroke) and all-cause death during the long-term follow-up. Overall, 674 patients were included, of whom 470 (69.7%) were male; the mean age was 43.6±13.2years. The mean follow-up duration was 5.5±2.29years 1year after the transplant. MACCE occurred during the follow-up in 102 (61.8%) patients in the high non-HDL-C group and 13 (2.6%) patients in the normal non-HDL-C group (P<.001). High non-HDL-C was a predictor of MACCE in the multivariate analysis (hazard ratio [HR] 1.02, 95% confidence interval [CI] 1.01-1.02, P<.001). Smoking (HR: 1.92, 95% CI 1.16-3.20, P<.001), cadaver graft (HR: 2.55, 95% CI 1.52-4.26, P<.001), and left ventricular ejection fraction (HR: 0.96, 95% CI 0.94-0.98, P<.001) were also predictors of MACCE. Kaplan-Meier analysis revealed that all MACCE components and all-cause mortality were significantly higher in the high non-HDL-C group (P<.001). Non-HDL-C was closely related to long-term cardiac outcomes in RTR with dyslipidemia. Non-HDL-C should be among the primary goals in lipid-lowering treatment in post-transplant dyslipidemia.