Effect of Statin Intensity in the Prevention of Cardiac Allograft Vasculopathy

Goehring, Kimberly C.; Kuan, William; Sieg, Adam; Dawson, Kyle L.; Kołodziej, Adam

doi:10.1016/j.healun.2020.01.839

The Journal of Heart and Lung Transplantation

2020

DOI: 10.1016/j.healun.2020.01.839

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Effect of Statin Intensity in the Prevention of Cardiac Allograft Vasculopathy

Kimberly C. Goehring

William Kuan

Adam Sieg

et al.

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“…[ 18 ] Another report of 131 heart transplant patients found no association between high-intensity statins and the incidence of CAV at 1 or 3 years. [ 19 ] Although statin intensity has been associated with reduction in atherosclerotic cardiovascular disease in non-transplant patients, the effect of statin intensity on CAV reduction in the cardiac transplant population is still unknown. The primary aim of this study is to evaluate the effect of statin intensity on the time to the development of CAV after cardiac transplantation.…”

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Effect of Statin Intensity on the Progression of Cardiac Allograft Vasculopathy

et al. 2021

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Background: In the non-transplant population, hyperlipidaemia has shifted from targeting LDL goals to statin intensity-based treatment. It is unknown whether this strategy is also beneficial in cardiac transplantation. Methods: This single-centre retrospective study evaluated the effect of statin use and intensity on time to cardiac allograft vasculopathy (CAV) after cardiac transplantation. Kaplan–Meier and Cox proportional hazards regression survival methods were used to assess the association of statin intensity and median post-transplant LDL on CAV-free survival. Results: The study involved 143 adults (71% men, average follow-up of 25 ± 14 months) who underwent transplant between 2013 and 2017. Mean CAV-free survival was 47.5 months (95% CI [43.1–51.8]), with 29 patients having CAV grade 1 or greater. Median LDL was not associated with time to CAV (p=0.790). CAV-free survival did not differ between intensity groups (p=0.435). Conclusion: Given the non-statistically significant difference in time to CAV with higher intensity statins, the data suggest that advancing moderate- or high-intensity statin after cardiac transplantation may not provide additional long-term clinical benefit. Trial registration: Not applicable.

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Effect of Statin Intensity on the Progression of Cardiac Allograft Vasculopathy

et al. 2021

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A Systematic Review and Meta-Analysis of the Effects of Statin Therapy on Heart Transplantation

Mardani-Nafchi,

Hashemi Rafsanjani,

Heidari-Soureshjani

et al. 2024

RRCT

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Background: Most of the mortality after Heart Transplantation (HT) is attributed to severe cardiac allograft vasculopathy (CAV) and rejection. Objectives: This meta-analysis aimed to investigate the effects of postoperative statin therapy on outcomes (mortality, rejection, and CAV in HT patients). Methods: This systematic review and meta-analysis was performed on publications between 1980 and October 2023 in Web of Science, Scopus, PubMed, Cochrane, Science Direct, Google Scholar, and Embase databases. Heterogeneity was assessed using Chi-square, I2, and forest plots. Publication bias was evaluated using Begg's and Egger's tests. Analyses were performed in Stata 15 with significance at p < 0.05. Results: This meta-analysis included 17 studies comprising 4,627 participants and conducted between 1995 to 2021. Compared to non-users, the odds of mortality were lower among statin users (OR= 0.49, 95% CI: 0.32–0.75, p < 0.001). The odds of CAV were also reduced with statin use (OR= 0.71, 95% CI: 0.53–0.96, p = 0.027). The odds of rejection were not significantly different (OR= 0.69, 95% CI: 0.41–1.15, p = 0.152). However, rejection odds were lower with statins in RCTs (OR= 0.42, 95% CI: 0.21–0.82, p = 0.012) but not in case-control studies (OR= 0.87, 95% CI: 0.49-1.52, p = 0.615). No publication bias was observed with Begg's test, but Egger's test showed possible bias. Conclusion: This meta-analysis found postoperative statin use associated with lower mortality and CAV, but not overall rejection, though RCT subgroup analysis showed decreased rejection with statins. Statin therapy may improve prognosis in HT patients.

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Effect of Statin Intensity in the Prevention of Cardiac Allograft Vasculopathy

Cited by 2 publications

References 0 publications

Effect of Statin Intensity on the Progression of Cardiac Allograft Vasculopathy

Effect of Statin Intensity on the Progression of Cardiac Allograft Vasculopathy

A Systematic Review and Meta-Analysis of the Effects of Statin Therapy on Heart Transplantation

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