[A strategy to improve the cardiovascular risk factor profile in renal transplant patients].
BACKGROUND
Cardiovascular disease represents the leading cause of morbidity, mortality and graft function loss in renal transplant recipients (RTR). Aggressive treatment of risk factors is strongly advocated. However, there is a gap between recommended evidence-based therapy and effective cardiovascular management in that population.


OBJECTIVE
To establish a cardiovascular risk factor control strategy for RTR.


METHODS
The cardiovascular risk of 300 RTR of a renal transplant unit was assessed using the Framingham criteria. Interventions on modifiable risk factors were suggested to attending physicians by letters attached to patients' charts, including lifestyle modifications, blood pressure control and use of antiplatelet and lipid-lowering therapy. Risk factor profiles were re-evaluated after 6 and 12 months.


RESULTS
Most patients were at high cardiovascular risk (58%). After 12 months, the proportion of patients on antiplatelet, antihypertensive and lipid-lowering therapy was significantly increased (29 to 51%, 83 to 92% and 3 to 46%, p < 0.001, respectively). Total cholesterol and triglyceride levels decreased (237 to 215 mg/dl, p = 0.001 and 244 to 221 mg/dl, p = 0.03). Although a non-significant reduction in LDL levels was observed (136 to 116 mg/dl, p = 0.12), patients starting statins within the first 6 months of the study presented a significant 25% reduction in LDL (159 to 119 mg/dl, p < 0.001). The proportion of patients with complete plasma lipid evaluation was also increased (27% to 49%, p < 0.001).


CONCLUSIONS
Our results suggest that a simple, inexpensive strategy significantly improves the cardiovascular risk profile of RTR, potentially translating into marked benefits for long-term graft function and life expectancy.
Leite
Denise
D
Universidade Federal de São Paulo, SP, Brasil. leitedenise@hotmail.com
Campos
Alexandre Holthausen
AH
D000328:Adult; D001938:Brazil; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D003920:Diabetes Mellitus / Q000517:prevention & control; D005260:Female; D006304:Health Status; D006801:Humans; D006973:Hypertension / Q000517:prevention & control; D016030:Kidney Transplantation / Q000502:physiology*; D008019:Life Style; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D018570:Risk Assessment / Q000706:statistics & numerical data; D012307:Risk Factors; D000074606:Smoking Prevention; D013997:Time Factors; D016896:Treatment Outcome
D008055:Lipids