Burden of atherogenic lipids and association with cardiac allograft vasculopathy in heart transplant recipients .

Autor: Birs AS; Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, La Jolla, CA, USA. Electronic address: abirs@health.ucsd.edu., Kao AS; Univerity of California San Diego School of Medicine, La Jolla, CA, USA., Silver E; Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, La Jolla, CA, USA., Adler ED; Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, La Jolla, CA, USA., Taub PR; Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, La Jolla, CA, USA., Wilkinson MJ; Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, La Jolla, CA, USA. Electronic address: mjwilkinson@health.ucsd.edu.
Jazyk: angličtina
Zdroj: Journal of clinical lipidology [J Clin Lipidol] 2024 Nov 13. Date of Electronic Publication: 2024 Nov 13.
DOI: 10.1016/j.jacl.2024.10.005
Abstrakt: Background: Cardiac Allograft Vasculopathy (CAV) is a leading cause of morbidity and mortality after heart transplantation. There are limited contemporary studies examining post-transplant lipid management and cardiometabolic health.
Objective: We study the burden of cardiometabolic derangements post transplantation and its impact on CAV in a modern cohort of heart transplant recipients.
Methods: All heart transplant (HTx) recipients between January 2019 and December 2020, with two lipid assessments and angiographic surveillance were included. Logistic regression was used to assess association of lipid levels with cardiovascular outcomes and CAV.
Results: Among 87 HTx recipients, atherogenic lipids were significantly elevated after Htx. Median LDL-C increased from a baseline level of 69.5 mg/dL to 86.5 mg/dL, p = 0.002, non-HDL-C 91.5 mg/dL to 118 mg/dL, p < 0.001, triglycerides 94.5 mg/dL to 133 mg/dL, p < 0.001, and remnant cholesterol 19 mg/dL to 27 mg/dL, p < 0.001. Increases in non-HDL-C, triglycerides, and remnant cholesterol were significantly associated with increased risk of CAV (Stanford Grade 4 and intimal thickness). Increases in triglycerides and remnant-C were associated with increased risk of composite major adverse cardiovascular events.
Conclusion: We demonstrate a significant increase in atherogenic lipids two years following transplantation with low use (20 %) of high-intensity statin. Increase in atherogenic lipids was associated with increased risk of CAV and increase in triglycerides and remnant cholesterol with increased MACE. Future studies examining cardiometabolic consequences of heart transplantation and optimal treatment strategies to reduce risk of CAV and MACE are needed.
Competing Interests: Declaration of competing interest MW: Dr. Wilkinson is a consultant to Amarin, Regeneron, Kaneka, and The Kinetix Group; reports advisory board fees from Novartis and NewAmsterdam and speaker fees from Regeneron; has received grant support from Amgen (investigator-initiated study) and support through an institutional consulting agreement with Novartis paid to his institution for advising on research; and has contracted research grants to his institution with Amgen, Novartis, Ionis, and Mineralys, and Lilly. PT: Dr. Pam R. Taub is a consultant for Amgen, Novartis, Esperion, Boehringer Ingelheim, Lilly, Novo Nordisk, Medtronic and Edwards and is a shareholder in Epirium Bio. EA: Chief Medical Officer and Head of Research: Lexeo Therapeutics. Shareholder: Rocket Pharmaceuticals. Scientific Founder: Papillion Therapeutics. Founder, Scientific Board and Shareholder: Corstasis Therapeutics. The other authors have nothing to disclose. Use of AI and AI-assisted Technologies Statement: AI was not used for any aspect of this manuscript preparation or writing.
(Copyright © 2024. Published by Elsevier Inc.)
Databáze: MEDLINE
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