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Cardiovascular risk factors and diseases after renal transplantation
1Heinrich-Heine-Universität Düsseldorf, Klinik für Nephrologie und Rheumatologie, Germany.
Insights
Cardiovascular disease is common after renal transplantation due to increased risk factors. Managing these factors is crucial for reducing heart complications in transplant patients.
Area of Science:
- Nephrology
- Cardiology
- Transplantation Medicine
Background:
- Cardiovascular disease (CVD) is a primary cause of mortality post-renal transplantation.
- The incidence of CVD is significantly higher in renal transplant recipients compared to the general population.
Purpose of the Study:
- To determine the incidence of atherosclerotic cardiovascular complications after renal transplantation.
- To assess the prevalence of cardiovascular risk factors before and after transplantation.
- To analyze the association between these risk factors and the development of cardiovascular complications.
Main Methods:
- Analysis of 427 renal transplant recipients (1987-1992).
- Evaluation of atherosclerotic cardiovascular diseases (coronary, cerebral, peripheral vascular) and risk factors before and after transplantation.
- Mean follow-up of 29 months.
Main Results:
- 11.7% developed atherosclerotic cardiovascular diseases post-transplantation, primarily coronary artery disease (9.8%).
- Significant increases in hypertension (73% to 85%), diabetes mellitus (7% to 16%), and obesity (26% to 48%) were observed post-transplantation.
- Independent risk factors identified include diabetes mellitus (RR=4.3), age >50 (RR=2.7), obesity (RR=2.6), smoking (RR=2.5), LDL cholesterol >180 mg/dl (RR=2.3), and uric acid >6.5 mg/dl.
Conclusions:
- High incidence of cardiovascular disease post-renal transplantation is linked to prevalent and accumulating cardiovascular risk factors.
- Further prospective studies are needed to assess interventions aimed at reducing cardiovascular morbidity and mortality in this high-risk group.
Unlabelled:
Cardiovascular disease is a leading cause of death after renal transplantation (tpx), and the incidence is considerably higher than in the general population.
Objective:
To evaluate the incidence of atherosclerotic cardiovascular complications after tpx, the prevalence of cardiovascular risk factors, prior to and following tpx, and the association between the risk factors and complications.
Patients And Methods:
Analysis of atherosclerotic cardiovascular diseases (coronary artery disease, cerebral and peripheral vascular disease) and cardiovascular risk factors before and after transplantation in 427 renal transplant recipients between 1987 and 1992 (mean age at transplantation 45+/-12 years, 58% male, 7% diabetics) with a mean post-transplant follow-up of 29+/-20 months.
Results:
Following tpx 11.7% developed atherosclerotic cardiovascular diseases, the majority coronary artery disease (9.8%). The comparison of risk factors 12 months before and 24 months following transplantation showed: prevalence of systemic hypertension (from 73% to 85%), diabetes mellitus (from 7% to 16%) and obesity with a body mass index >25 kg/m2 (from 26% to 48%) had increased significantly whereas the number of smokers halved to 20%. Triglycerides decreased significantly (from 235 mg/dl to 217 mg/dl). Total and HDL cholesterol rose significantly (from 232 mg/dl to 273 mg/dl and from 47 mg/dl to 56 mg/dl, respectively). LDL cholesterol increase was significant (from 180 mg/dl to 189 mg/dl). In the univariate analysis, cardiovascular diseases were significantly associated with male gender, age over 50 years, diabetes mellitus (DM), smoking, total cholesterol > or=200 mg/dl, LDL cholesterol >180 mg/dl, HDL cholesterol < or =55 mg/dl, fibrinogen > or =350 mg/dl, body mass index >25 kg/m2, serum uric acid >6.5 mg/dl and with more than two antihypertensive agents per day. The Cox proportional hazards model revealed DM with a relative risk (RR) of 4.3, age >50 years (RR=2.7), body mass index >25 kg/m2 (RR=2.6), smoking (RR=2.5), LDL cholesterol >180 mg/dl (RR=2.3) and uric acid >6.5 mg/dl as independent risk factors.
Conclusions:
The high incidence of cardiovascular disease following renal transplantation is mainly due to a high prevalence and accumulation of classical risk factors before and following transplantation. Future prospective studies should evaluate the success of treatment regarding reduction of cardiovascular morbidity and mortality in this high risk population.