title: Multicenter retrospective analysis of cardiovascular risk factors affecting long-term outcome of de novo cardiac transplant recipients.
abstract: BACKGROUND
  Previous risk factor studies in cardiac transplant patients have analyzed pre-transplant risk factors as they relate to outcomes. This study is the first in-depth multicenter assessment of ongoing post-transplant risk factors in heart transplant patients and their impact on 5-year outcomes.
  
  
  METHODS
  We reviewed 280 heart transplant patients who survived > 1 year for the impact of post-transplant risk factors (hyperlipidemia, hypertension, diabetes, body mass index [BMI] and renal dysfunction: 8 to 18 possible measurements over 5 years) on outcomes, including death, cardiac allograft vasculopathy (CAV) and non-fatal major adverse cardiac events (NF-MACE).
  
  
  RESULTS
  Upon multivariate Cox regression analysis, significant findings were high total-cholesterol for NF-MACE (relative risk [RR] = 4.34, confidence interval [CI] 1.35 to 13.98, p = 0.01), presence of diabetes for NF-MACE (RR = 3.96, CI 1.24 to 12.65, p = 0.02) and high serum creatinine for graft death (RR = 1.59, CI 1.35 to 1.87, p < 0.001). No covariates were found to be significant for CAV. Other significant risk factors by univariate Cox regression models with time-dependent covariates included BMI > or = 33 for graft death.
  
  
  CONCLUSIONS
  Post-transplant risk factors of hypercholesterolemia and diabetes are associated with NF-MACE, whereas high serum creatinine and BMI > or = 33 are associated with graft death. Risk factor modification, including direct therapy to minimize risk factors, should be considered.
authors.affiliation: University of California at Los Angeles, Los Angeles, California 90095, USA. jonk@mednet.ucla.edu
authors.forename: Jon A
authors.initials: JA
authors.lastname: Kobashigawa
authors.forename: Randall C
authors.initials: RC
authors.lastname: Starling
authors.forename: Mandeep R
authors.initials: MR
authors.lastname: Mehra
authors.forename: Robert L
authors.initials: RL
authors.lastname: Kormos
authors.forename: Geetha
authors.initials: G
authors.lastname: Bhat
authors.forename: Mark L
authors.initials: ML
authors.lastname: Barr
authors.forename: Chris S
authors.initials: CS
authors.lastname: Sigouin
authors.forename: June
authors.initials: J
authors.lastname: Kolesar
authors.forename: William
authors.initials: W
authors.lastname: Fitzsimmons
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D002320:Cardiovascular Physiological Phenomena; D003404:Creatinine / Q000097:blood*; D048909:Diabetes Complications / Q000150:complications*; D005260:Female; D006084:Graft Rejection / Q000209:etiology*; D006331:Heart Diseases; D016027:Heart Transplantation / Q000706:statistics & numerical data*; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications*; D006973:Hypertension / Q000150:complications / Q000503:physiopathology; D007668:Kidney / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D003404:Creatinine