Multicenter retrospective analysis of cardiovascular risk factors affecting long-term outcome of de novo cardiac transplant recipients.
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.
Kobashigawa
Jon A
JA
University of California at Los Angeles, Los Angeles, California 90095, USA. jonk@mednet.ucla.edu
Starling
Randall C
RC
Mehra
Mandeep R
MR
Kormos
Robert L
RL
Bhat
Geetha
G
Barr
Mark L
ML
Sigouin
Chris S
CS
Kolesar
June
J
Fitzsimmons
William
W
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
D003404:Creatinine