Second Line Options for Hyperlipidemia Management after Cardiac Transplantation

Abstract

SUMMARYDespite widespread statin therapy, 91% of cardiac transplant patients have hyperlipidemia within 5 years from cardiac transplantation. The implications of this are profound, particularly given that coronary allograft vasculopathy is a leading cause of death. Unfortunately the solution is not easy, with problems of toleration at higher statin doses and a lack of good quality evidence for second line agents. We review the literature and discuss some of the key issues transplant physicians are faced with when considering alternatives to statin therapy.

Opportunistic Genetic Screening for Familial Hypercholesterolemia in Heart Transplant Patients

“…On this basis, statins are already recommended for heart transplant recipients in routine treatment [52]. Unfortunately, side effects and interactions with immunosuppressants sometimes limit their optimal use in such patients [53]. Therefore, it may be informative to include in the genetic study of FH in pretransplant screening in order to identify individuals at higher risk, such as Patient 1.…”

Cholesterol lowering with EVOLocumab to prevent cardiac allograft Vasculopathy in De‐novo heart transplant recipients: Design of the randomized controlled EVOLVD trial

“…Inhibitors of this enzyme, commonly known as statins, reduce cholesterol levels and mitigate CAV 9 . Statins are recommended in the routine treatment of heart transplant recipients, 10 but side effects and interactions with immunosuppressants limit the degree to which optimum lipid levels can be achieved with statin therapy alone in these patients 11 . The prevalence of hyperlipidemia reaches 88% five years after heart transplant 2 .…”

“…The prevalence of hyperlipidemia reaches 88% five years after heart transplant 2 . On the other hand, there have been no randomized controlled trials to show whether second‐line lipid‐lowering drugs improve outcomes in these patients 11 …”