Cardiovascular risk, cardiovascular events, and metabolic syndrome in renal transplantation: comparison of early steroid withdrawal and chronic steroids.
BACKGROUND
Cardiovascular disease (CVD) is the leading cause of death with a functioning graft in renal transplant recipients. The purpose of this study was to compare Framingham Risk Score (FRS), metabolic syndrome (MS), and cardiovascular events (CVE) in patients receiving early corticosteroid withdrawal (ECSWD), or chronic corticosteroid therapy (CCS).


METHODS
In all, 251 ECSWD and 146 CCS patients were evaluated. FRS and MS were identified at baseline, six, 12, and 24 months post-transplant. A total of 124 patients with diabetes mellitus prior to transplantation were excluded from MS analysis. CVE were defined as sudden-death, MI, angina, or CVA/TIA. Repeat-measure logistic regression was used for statistical analysis.


RESULTS
Fifty-four patients experienced 72 CVE. Mean follow-up was 755 +/- 312 d and time to CVE was 14.8 +/- 8.3 months. Demographics were similar between groups. FRS was not different between groups. CVE were significantly greater in CCS patients then ECSWD (20% vs. 10%, p = 0.024). New-onset MS occurred more frequently in patients receiving CCS then ECSWD (45% vs. 22%, p < 0.001) and was associated with more CVE (p < 0.015).


CONCLUSIONS
Patients receiving ECSWD regimens have significantly decreased CVE and new onset MS compared with CCS. MS is associated with increased CV risk and CVE.
Rike
Adele H
AH
Division of Transplantation, Department of Surgery, University of Cincinnati, Cincinnati, OH 45219, USA. rikea@ucmail.uc.edu
Mogilishetty
Gautham
G
Alloway
Rita R
RR
Succop
Paul
P
Roy-Chaudhury
Prabir
P
Cardi
Michael
M
Kaiser
Tiffany E
TE
Thomas
Mark
M
Woodle
E Steve
ES
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects*; D000328:Adult; D002318:Cardiovascular Diseases / Q000139:chemically induced*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D024821:Metabolic Syndrome / Q000139:chemically induced*; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors
D000305:Adrenal Cortex Hormones