Low HDL-C predicts the onset of transplant vasculopathy in pediatric cardiac recipients on pravastatin therapy.
The levels and protein/lipid compositions of major lipoprotein particles of 19 pediatric cardiac transplant recipients (4-18 yr of age) were studied in this prospective, open clinical follow-up study before and at one yr of pravastatin therapy (10 mg/day). The recipients were grouped into those with (n = 6; group A) and those without (n = 13; group B) angiographically detectable vasculopathy. Twenty-one pediatric non-transplant controls were studied at baseline. At baseline, the group A recipients had 29% lower HDL-C concentrations (p = 0.031) and 29% higher apoB-100/apoA-I ratios (p = 0.034) than the group B recipients. At one yr of pravastatin, the respective figures were 29% (p = 0.013) and 33% (p = 0.005). Compared with the healthy pediatric controls, the transplant recipients had significantly higher serum TG before pravastatin [median (range): 1.3 mmol/L (0.6-3.2) vs. 0.7 mmol/L (0.3-2.4), p = 0.0002] and at one yr [1.3 mmol/L (0.5-3.5) vs. 0.7 mmol/L (0.3-2.4), p = 0.0004]. The baseline apoB-100/apoA1 ratios of the recipients were 33% higher (p = 0.005). In conclusion, low HDL-C and high apoB-100/apoA-I ratio were associated with angiographically detectable vasculopathy. Even though pravastatin effectively lowered the TC and LDL-C and improved compositional properties of LDL and HDL(2) particles, it failed to normalize the elevated TG and, in some patients, to prevent the progression of transplant vasculopathy.
Hedman
Mia
M
Hospital for Children and Adolescents, University of Helsinki, FIN-00029 HUS, Helsinki, Finland.
Pahlman
Raija
R
Sundvall
Jouko
J
Ehnholm
Christian
C
Syvänne
Mikko
M
Jokinen
Eero
E
Jauhiainen
Matti
M
Holmberg
Christer
C
Antikainen
Marjatta
M
D000293:Adolescent; D000924:Anticholesteremic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D008076:Cholesterol, HDL / Q000097:blood / Q000172:deficiency* / Q000187:drug effects; D003124:Colorimetry; D017023:Coronary Angiography; D003327:Coronary Disease / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000097:blood / Q000517:prevention & control; D006333:Heart Failure / Q000601:surgery; D016027:Heart Transplantation; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications; D017035:Pravastatin / Q000009:adverse effects* / Q000627:therapeutic use; D011446:Prospective Studies; D016896:Treatment Outcome; D014461:Ultracentrifugation
D000924:Anticholesteremic Agents; D015415:Biomarkers; D008076:Cholesterol, HDL; D017035:Pravastatin