title: Gender-associated risk factors for cardiac end points and total mortality after renal transplantation: post hoc analysis of the ALERT study.
abstract: BACKGROUND
  Female gender offers a cardioprotective effect over men in the general population, but is lost in the dialysis population. Whether renal transplantation restores the gender-dependent cardiac protection and whether there is a difference in the impact of risk factors is not known.
  
  
  METHODS
  This is a post hoc analysis of pre-defined end points in the placebo arm in the Assessment of Lescol in Renal Transplantation (ALERT) study, a study in renal transplant recipients. Cox regression was performed to estimate the association between different risk factors at baseline and non-fatal myocardial infarction (MI) or cardiac death and total mortality, and specifically assess whether there are gender differences.
  
  
  RESULTS
  The placebo arm included 1052 patients (mean age 50.1 +/- 11.1 yr, 65.3% males) with a mean follow-up of 65 months. The incidence of non-fatal MI or cardiac death was 10.9% vs. 7.9% (NS) and total mortality 13.3% vs. 12.8% (NS) in men and women. In multivariate analysis, previous coronary heart disease (CHD), diabetes, treatment for rejection and serum triglycerides were predictive for cardiac events in men, and low-density lipoprotein (LDL)/high-density lipoprotein (HDL) ratio only in women. A slightly different risk-factor pattern appeared for total mortality. Diabetes, ECG abnormalities, plasma triglycerides, serum creatinine, time on dialysis and age predicted total mortality in men, while ECG abnormalities, LDL/HDL ratio and age were predictors in women.
  
  
  CONCLUSIONS
  In this relatively low-risk population of renal transplant recipients, no gender difference in cardiac events or total mortality was observed, suggesting that female gender advantage regarding CHD is not restored following transplantation. The predictive value of risk factors differed in men and women.
authors.affiliation: Faculty of Medicine, University of Oslo, Norway. cecilia.oien@stolav.no
authors.forename: Cecilia Montgomery
authors.initials: CM
authors.lastname: Oien
authors.forename: Anna Varberg
authors.initials: AV
authors.lastname: Reisaeter
authors.forename: Ingrid
authors.initials: I
authors.lastname: Os
authors.forename: Alan
authors.initials: A
authors.lastname: Jardine
authors.forename: Bengt
authors.initials: B
authors.lastname: Fellström
authors.forename: Hallvard
authors.initials: H
authors.lastname: Holdaas
mesh_terms: D000328:Adult; D000368:Aged; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000453:epidemiology / Q000401:mortality; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors