Cardiovascular disease in renal transplantation: Management by statins
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- 作者：Bengt Fellströ ; m ; Hallvard Holdaas ; Alan Jardine
- 刊名：Transplantation Reviews
- 出版年：2004
- 出版时间：July 2004
- 年：2004
- 卷：18
- 期：3
- 页码：122-128
- 全文大小：95 K
文摘
The mortality rates for cardiovascular diseases (CVDs) in transplant recipients are greater than those of the general population. CVD is a major cause of both patient and graft loss in renal transplant recipients, and improving cardiovascular health in transplant recipients will presumably help to extend both patient and graft survival. Further studies are needed to better define the risk factors for CVD in the transplant population and to evaluate the effectiveness of risk modification on subsequent CVD morbidity and mortality. As far as we understand, today there is no reason to consider risk factors for CVD such as hyperlipidemia, hypertension, and diabetes mellitus in transplant patients differently from the general population. In addition hereto, there are transplantation specific risk factors such as acute rejection episodes and the use of immunosuppressive drugs. It is obvious that several of the immunosuppressive agents used today have disadvantageous influences on risk factors for CVD such as hyperlipidemia, hypertension, and posttransplant diabetes mellitus, but the relative importance of immunosuppressant induced increases of these risk factors on incidence of CVD is basically uncovered. This may urge for a selective use of and individual tailoring of immunosuppressive regimen. Hyperlipidemia is common after transplantation, and immunosuppression with corticosteroids, cyclosporin A, or sirolimus causes different types of posttransplantation hyperlipidemia. Multiple acute rejection (AR) episodes have also been shown to be a risk factor for CVD, which urges for the use of immunosuppressive drugs reducing the incidence of AR. Graft failure and renal transplant dysfunction also lead to a higher risk for premature patient death. Treatment of renal transplant recipients with fluvastatin has recently been shown to successfully reduce the risk of cardiac death or nonfatal myocardial infarction, without causing any increased risk for disadvantageous side effects, which was reassuring in this population that is at risk for infections, malignancies, and drug interactions.