title: Impact of Statin Use After Heart Transplantation: A Meta-Analysis.
abstract: BACKGROUND
  Although various studies revealed the beneficial effects of statins in post-cardiac transplant patients, these were relatively small and low-powered studies. We performed a meta-analysis of published studies to evaluate the role of statins in post-cardiac transplant patients, specifically examining the effects on hemodynamically significant/fatal graft rejection, coronary vasculopathy, terminal cancer, and overall survival.
  
  
  RESULTS
  We searched PubMed, Cochran CENTRAL, and Web of Science databases using the search terms "cardiac transplant" or "heart transplant," and "statin" for a literature search. A random-effects model with Mantel-Haenszel method was used to pool the data. We identified 10 studies, 4 randomized controlled trials, and 6 nonrandomized studies, which compared outcomes in heart transplant recipients undergoing statin therapy to statin-naive patients. A pooled analysis of 9 studies reporting mortality revealed that the use of statins was associated with significant reduction in all-cause mortality (odds ratio, 0.26; 95% confidence interval, 0.20-0.35; P<0.0001). Statins also decreased the odds of hemodynamically significant/fatal rejection (odds ratio, 0.37; 95% confidence interval, 0.21-0.65; P=0.0005), incidence of coronary vasculopathy (odds ratio, 0.33; 95% confidence interval, 0.16-0.68; P=0.003), and terminal cancer (odds ratio, 0.30; 95% confidence interval, 0.15-0.63; P=0.002).
  
  
  CONCLUSIONS
  The evidence from a pooled analysis suggests that statins improve survival in heart transplant recipients. Statins may prevent fatal rejection episodes, decrease terminal cancer risk, and reduce the incidence of coronary vasculopathy. Additional prospective studies are needed to further investigate and explain this association.
authors.affiliation: From the Division of Cardiovascular Diseases, The Ohio State University Wexner Medical Center, Columbus (A.V.); Division of Cardiovascular Diseases, Metrohealth Medical Center, Case Western Reserve University, Cleveland, OH (S.R., M.E.D.); and Department of Cardiovascular Medicine, Heart and Vascular Institute Cleveland Clinic, Cleveland, OH (D.O.T.). ajayvhs@gmail.com.
authors.forename: Ajay
authors.initials: A
authors.lastname: Vallakati
authors.affiliation: From the Division of Cardiovascular Diseases, The Ohio State University Wexner Medical Center, Columbus (A.V.); Division of Cardiovascular Diseases, Metrohealth Medical Center, Case Western Reserve University, Cleveland, OH (S.R., M.E.D.); and Department of Cardiovascular Medicine, Heart and Vascular Institute Cleveland Clinic, Cleveland, OH (D.O.T.).
authors.forename: Siddharth
authors.initials: S
authors.lastname: Reddy
authors.affiliation: From the Division of Cardiovascular Diseases, The Ohio State University Wexner Medical Center, Columbus (A.V.); Division of Cardiovascular Diseases, Metrohealth Medical Center, Case Western Reserve University, Cleveland, OH (S.R., M.E.D.); and Department of Cardiovascular Medicine, Heart and Vascular Institute Cleveland Clinic, Cleveland, OH (D.O.T.).
authors.forename: Mark E
authors.initials: ME
authors.lastname: Dunlap
authors.affiliation: From the Division of Cardiovascular Diseases, The Ohio State University Wexner Medical Center, Columbus (A.V.); Division of Cardiovascular Diseases, Metrohealth Medical Center, Case Western Reserve University, Cleveland, OH (S.R., M.E.D.); and Department of Cardiovascular Medicine, Heart and Vascular Institute Cleveland Clinic, Cleveland, OH (D.O.T.).
authors.forename: David O
authors.initials: DO
authors.lastname: Taylor
mesh_terms: D003324:Coronary Artery Disease / Q000453:epidemiology*; D006084:Graft Rejection / Q000453:epidemiology* / Q000401:mortality; D016027:Heart Transplantation; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D015994:Incidence; D009369:Neoplasms / Q000453:epidemiology* / Q000401:mortality; D016017:Odds Ratio; D015996:Survival Rate
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: allograft; graft rejection; hydroxymethylglutaryl-CoA reductase inhibitors