title: Ischemic heart disease after renal transplantation in patients on cyclosporine in Spain.
abstract: Ischemic heart disease (IHD), more common among transplant recipients than in the general population, accounts for approximately 50% of cardiovascular deaths. Despite its importance, only a few publications have addressed the prevalence of and risk factors for this complication. This was a retrospective cohort study in 2382 cadaver renal transplant recipients who were treated with cyclosporine as initial immunosuppression. Two groups were formed. The first group consisted of 163 patients with IHD, and the second group consisted of 326 patients without IHD. The prevalence of IHD was 6.8%, and the incidence was 15.7/1000 patient-years. Cardiac events presented during the first year in 62 (38%) patients. Multivariate analysis showed that the risk factors for IHD were age at transplant in years (relative risk [RR] 1.054; 95% confidence interval [CI] 1.033 to 1.075; P = 0.000), male gender (RR 1.940; 95% CI 1.221 to 3.081; P = 0.005), body weight at transplant in kg (RR 1.020; 95% CI 1.007 to 1.033; P = 0.002), pretransplantation cardiovascular disease (RR 2.150; 95% CI 1.733 to 3.359; P = 0.001), and a history of pretransplantation hypercholesterolemia (RR 2.032; 95% CI 1.378 to 2.998; P = 0.000). When only ischemic events that occurred 12 mo after transplantation were taken into consideration, the risk factors were age, male gender, body weight, smoking, and pretransplantation and posttransplantation hypercholesterolemia, whereas pretransplantation cardiovascular disease disappeared from the model. IHD affected nearly 7% of transplant recipients. Smoking, hypertension, and hypercholesterolemia constituted the treatable risk factors for IHD in this population. Emphasis should be placed on the need to stop smoking and to control hypertension and pre- and posttransplantation levels of serum cholesterol.
authors.affiliation: Department of Nephrology, Ramón y Cajal, Madrid, Spain. rmarcen.hrc@salud.madrid.org
authors.forename: Roberto
authors.initials: R
authors.lastname: Marcén
authors.forename: José María
authors.initials: JM
authors.lastname: Morales
authors.forename: Manuel
authors.initials: M
authors.lastname: Arias
authors.forename: Gema
authors.initials: G
authors.lastname: Fernández-Juárez
authors.forename: Gema
authors.initials: G
authors.lastname: Fernández-Fresnedo
authors.forename: Amado
authors.initials: A
authors.lastname: Andrés
authors.forename: Emilio
authors.initials: E
authors.lastname: Rodrigo
authors.forename: Julio
authors.initials: J
authors.lastname: Pascual
authors.forename: Beatriz
authors.initials: B
authors.lastname: Domínguez
authors.forename: Joaquín
authors.initials: J
authors.lastname: Ortuño
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000150:complications; D015331:Cohort Studies; D016572:Cyclosporine / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006084:Graft Rejection / Q000378:metabolism / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications; D006973:Hypertension / Q000150:complications; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000453:epidemiology* / Q000209:etiology; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D013030:Spain / Q000453:epidemiology
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine