Cardiovascular risk factors and diseases after renal transplantation

Aker, Sendogan; Ivens, Katrin; Grabensee, B.; Heering, Peter

doi:10.1007/bf02564867

Cited by 68 publications

(44 citation statements)

References 28 publications

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“…Notably, the HDL cholesterol levels of transplant recipients have been somewhat higher (approximately 55 mg/dL) than the population mean (3,5,26). This is a consequence of the use of corticosteroids, which increase HDL cholesterol levels (27,28).…”

Section: Discussionmentioning

confidence: 99%

“…In particular, several reports indicate that hypercholesterolemia contributes to cardiovascular risk after transplantation, as in nontransplant patients (3,4,25).…”

Section: Discussionmentioning

confidence: 99%

“…The major risk factors for CHD in the general population appear to contribute to the risk in transplant patients (3)(4)(5)(6). These include age, male sex, hypertension, hypercholesterolemia, low high-density lipoprotein (HDL) cholesterol, diabetes mellitus, and cigarette use.…”

Section: Introductionmentioning

confidence: 99%

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Effects of Sirolimus on Lipids in Renal Allograft Recipients: An Analysis Using the Framingham Risk Model

Blum

2002

American Journal of Transplantation

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This report describes the effects of sirolimus on plasma lipids, and uses the Framingham risk model to assess the clinical importance of these effects. Lipid data from two large controlled studies of 1295 renal transplant patients were analyzed retrospectively. Sirolimus 2 mg/day and 5 mg/day were compared with placebo or azathioprine, and administered concomitantly with steroids and cyclosporine over 12 months. Hypercholesterolemia and hypertriglyceridemia occurred in all treatment groups and were maximal at 2-3 months. The sirolimus groups evidenced higher lipid levels than the controls, but the elevations diminished over time. At 1 year, the patients given sirolimus 2 mg/ day had a mean cholesterol level 17 mg/dL greater and a mean triglyceride level 59 mg/dL greater than the controls. Among the patients given sirolimus 5 mg/day, mean cholesterol was 30 mg/dL greater and mean triglycerides were 103 mg/dL greater than the controls. Treatment with statins and fibrates was effective in reducing cholesterol and triglyceride levels, respectively, in the sirolimus-treated patients. The Framingham risk model predicted that the 17 mg/dL elevation in cholesterol would increase the incidence of coronary heart disease (CHD) by 1.5 new cases per 1000 persons per year and CHD death by 0.7 events per 1000 persons per year. Lipid elevations observed in the sirolimus-treated patients were manageable, improved over time, and responded to lipid-lowering therapy. Based on the Framingham risk model, the CHD risks associated with these cholesterol elevations are small compared with the baseline risks of the transplant population.

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Section: Discussionmentioning

confidence: 99%

“…In particular, several reports indicate that hypercholesterolemia contributes to cardiovascular risk after transplantation, as in nontransplant patients (3,4,25).…”

Section: Discussionmentioning

confidence: 99%

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Effects of Sirolimus on Lipids in Renal Allograft Recipients: An Analysis Using the Framingham Risk Model

Blum

2002

American Journal of Transplantation

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“…Tobacco use, which occurs in approximately 25% of RTR, is an independent risk factor for CVD and confers a 30% risk for graft loss as a result of premature CVD (35,36). In fact, smoking has been demonstrated to be a risk for death with a functioning graft as great as that due to diabetes (37).…”

Section: Smokingmentioning

confidence: 99%

Management of Cardiovascular Disease in Renal Transplant Recipients

Shirali¹,

Bia²

2008

Clinical Journal of the American Society of Nephrology

110

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Cardiovascular disease is a major cause of graft loss and the leading cause of death in renal transplant recipients. Although there are robust data on the frequency of risk factors and their contributions to cardiovascular disease in this population, few trials have demonstrated the benefit of modifying these risk factors to reduce cardiovascular events. Nevertheless, it is widely accepted that the clinical acumen filtered through the best available studies in the general population be used to treat individual renal transplant recipients given their high cardiovascular mortality. Transplant task forces and the Kidney Disease Outcomes Quality Initiative have created guidelines for this purpose. This review examines the data available for prevention and treatment of major risk factors contributing to cardiovascular disease in renal transplant recipients. The contribution of immunosuppressive agents to each risk factor and the evidence to support lifestyle modification as well as drug therapy are examined. Reducing cardiovascular risk factors requires an integrative approach that is best accomplished by a team of health care professionals. It creates a significant challenge but one that must be met if allograft survival is to improve.

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“…[2] Cardiovascular disease is the leading cause of death in renal transplant patients accounting for 40-55% of all deaths, and the incidence is considerably higher than in the general population. [3] The main contributing factors leading to atheroma include older age, male gender, hyperlipidemia, smoking, obesity, lack of exercise, hyperglycemia, and hyperhomocysteinanemia. [4] Though renal transplantation eliminates cardiovascular disease risk factors by restoring renal function, it introduces new cardiovascular risks, derived in part from immunosuppressive medications.…”

Section: Introductionmentioning

confidence: 99%

Effects of Immunosuppressive Drugs on Platelet Aggregation and Soluble P-Selectin Levels in Renal Transplant Patients

et al. 2009

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Background/aim. Post-transplant cardiovascular events are associated with increased morbidity and mortality after renal transplantation. Though renal transplantation eliminates cardiovascular disease risk factors by restoring renal function, it introduces new cardiovascular risks derived partly from immunosuppressive medications. In this study, to assess the effects of various immunosuppressive drugs on platelet function of renal transplant patients, we measured soluble P selectin levels (sP-selectin) and performed platelet aggregation studies in patients who have undergone renal transplantation. Methods. sP-selectin levels and platelet aggregation induced by 5 μM adenosine diphosphate (ADP), 5 μM epinephrine, 1.25 mg/mL ristocetin, and 2 μg/mL collagen were studied by whole blood platelet lumiaggregometer in 40 renal transplant patients. Patients in group 1 (n = 24) were treated with cyclosporine/mycophenolate mofetil/ methylprednisolone, and group 2 (n = 16) were treated with tacrolimus/mycophenolate mofetil/methylprednisolone. Effects were compared with those in control groups of hypertensive subjects and healthy subjects. Results. Platelet aggregation values induced by ADP, epinephrine, ristocetin, and collagen were lower in cyclosporine-treated patients than tacrolimus-treated patients, hypertensive subjects, and healthy subjects, though the difference was not statistically significant (p > 0.05). sP-selectin levels were appreciably higher in cyclosporine-treated patients, and statistically significant differences were observed compared with those of tacrolimus-treated patients (p < 0.05), hypertensive subjects (p < 0.01), and healthy subjects (p < 0.05). Conclusion. We conclude that cyclosporine-treated renal transplant patients show enhanced platelet activation in which anti-platelet therapy should be considered, in addition to management of other conventional cardiovascular risk factors, to decrease the cardiovascular morbidity and mortality in this high risk population.

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Cardiovascular risk factors and diseases after renal transplantation

Cited by 68 publications

References 28 publications

Effects of Sirolimus on Lipids in Renal Allograft Recipients: An Analysis Using the Framingham Risk Model

Effects of Sirolimus on Lipids in Renal Allograft Recipients: An Analysis Using the Framingham Risk Model

Management of Cardiovascular Disease in Renal Transplant Recipients

Effects of Immunosuppressive Drugs on Platelet Aggregation and Soluble P-Selectin Levels in Renal Transplant Patients

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