South Asian ethnicity as a risk factor for major adverse cardiovascular events after renal transplantation.
OBJECTIVE
South Asians (SAs) comprise 25% of all Canadian visible minorities. SAs constitute a group at high risk for cardiovascular disease in the general population, but the risk in SA kidney transplant recipients has never been studied.


METHODS
In a cohort study of 864 kidney recipients transplanted from 1998 to 2007 and followed to June 2009, we identified risk factors including ethnicity associated with major cardiac events (MACEs, a composite of nonfatal myocardial infarction, coronary intervention, and cardiac death) within and beyond 3 months after transplant. Kaplan-Meier methodology and multivariate Cox regression analysis were used to determine risk factors for MACEs.


RESULTS
There was no difference among SAs (n = 139), whites (n = 550), blacks (n = 65), or East Asians (n = 110) in baseline risk, including pre-existing cardiac disease. Post-transplant MACE rate in SAs was 4.4/100 patient-years compared with 1.31, 1.16, and 1.61/100 patient-years in whites, blacks, and East Asians, respectively (P < 0.0001 versus each). SA ethnicity independently predicted MACEs along with age, male gender, diabetes, systolic BP, and prior cardiac disease. SAs also experienced more MACEs within 3 months after transplant compared with whites (P < 0.0001), blacks (P = 0.04), and East Asians (P = 0.006). However, graft and patient survival was similar to other groups.


CONCLUSIONS
SA ethnicity is an independent risk factor for post-transplant cardiac events. Further study of this high-risk group is warranted.
Prasad
G V Ramesh
GV
University of Toronto, Renal Transplant Program, St. Michael's Hospital, 61 Queen Street East, 9th Floor, Toronto, ON, Canada M5C 2T2. prasadr@smh.toronto.on.ca
Vangala
Sai K
SK
Silver
Samuel A
SA
Wong
Steven C W
SC
Huang
Michael
M
Rapi
Lindita
L
Nash
Michelle M
MM
Zaltzman
Jeffrey S
JS
D000328:Adult; D000368:Aged; D044466:Asian People; D002318:Cardiovascular Diseases / Q000209:etiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000208:ethnology*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors