The prognostic importance of modifiable risk factors after heart transplantation.
BACKGROUND
It is well established that the treatment of modifiable risk factors can reduce cardiovascular mortality in the general population. However, there is limited data evaluating the importance of modifiable risk factors for survival following heart transplantation (HTx). Hence, we evaluated the prognostic importance of smoking, obesity, hyperglycemia and hyperlipidemia at 1 year after HTx for all-cause and cardiac mortality.


METHODS
We evaluated 381 patients attending their first annual visit post-HTx. Data regarding modifiable risk factors was collected together with other clinical variables. Median follow-up time was 7.4 years.


RESULTS
In total, there were 122 (32%) deaths and smoking and elevated total cholesterol were independent risk factors for all-cause mortality (adjusted HR 1.6 [P = .02] and 1.8 [P = .003], respectively). A significantly higher incidence of cardiac death was noted amongst smokers and patients with elevated total cholesterol. Elevated body mass index and hemoglobin A(1c) did not affect prognosis and elevated total cholesterol was not a risk factor once statin therapy commenced at the time of HTx was instituted as protocol.


CONCLUSIONS
Smoking is a risk factor for all-cause and cardiac mortality, but elevated total cholesterol is a risk factor only in the absence of statin therapy being commenced at the time of HTx.
Arora
Satish
S
Department of Cardiology, Rikshospitalet Medical Center, Oslo, Norway. satish.arora@medisin.uio.no
Aukrust
Pål
P
Andreassen
Arne
A
Simonsen
Svein
S
Gude
Einar
E
Grov
Ingelin
I
Geiran
Odd
O
Fiane
Arnt
A
Gullestad
Lars
L
D002784:Cholesterol / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000601:surgery*; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D006943:Hyperglycemia / Q000150:complications; D006949:Hyperlipidemias / Q000150:complications; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D011379:Prognosis; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000401:mortality
D002784:Cholesterol