Related Experiment Video
Updated: Jun 20, 2026
Cardiac Loading using Passive Left Atrial Pressurization and Passive Afterload for Graft Assessment
Published on: August 2, 2024
The prognostic importance of modifiable risk factors after heart transplantation
Satish Arora1, Pål Aukrust, Arne Andreassen
1Department of Cardiology, Rikshospitalet Medical Center, Oslo, Norway. satish.arora@medisin.uio.no
Insights
Smoking significantly increases mortality risk after heart transplantation (HTx). Elevated cholesterol is a risk factor unless patients receive statin therapy at the time of HTx.
Area of Science:
- Cardiology
- Transplantation Medicine
- Cardiovascular Risk Factor Management
Background:
- Modifiable risk factors are known to reduce cardiovascular mortality in the general population.
- Limited data exists on the impact of modifiable risk factors on survival after heart transplantation (HTx).
- This study investigates the prognostic significance of smoking, obesity, hyperglycemia, and hyperlipidemia one year post-HTx.
Purpose of the Study:
- To determine the prognostic importance of modifiable risk factors (smoking, obesity, hyperglycemia, hyperlipidemia) for all-cause and cardiac mortality in heart transplant recipients.
- To assess the long-term impact of these risk factors on patient survival following HTx.
Main Methods:
- A cohort of 381 patients was evaluated at their first annual visit post-HTx.
- Data on modifiable risk factors and other clinical variables were collected.
- Median follow-up was 7.4 years.
Main Results:
- Smoking and elevated total cholesterol were independent risk factors for all-cause mortality (adjusted HR 1.6 and 1.8, respectively).
- Smokers and patients with elevated total cholesterol had a higher incidence of cardiac death.
- Elevated body mass index and hemoglobin A1c did not impact prognosis.
- Elevated total cholesterol ceased to be a risk factor when statin therapy was initiated as protocol at the time of HTx.
Conclusions:
- Smoking is a significant risk factor for both all-cause and cardiac mortality after heart transplantation.
- Elevated total cholesterol is a risk factor for mortality post-HTx, but this association is mitigated by concurrent statin therapy initiated at the time of transplantation.
Background:
It is well established that the treatment of modifiable risk factors can reduce cardiovascular mortality in the general population. However, there is limited data evaluating the importance of modifiable risk factors for survival following heart transplantation (HTx). Hence, we evaluated the prognostic importance of smoking, obesity, hyperglycemia and hyperlipidemia at 1 year after HTx for all-cause and cardiac mortality.
Methods:
We evaluated 381 patients attending their first annual visit post-HTx. Data regarding modifiable risk factors was collected together with other clinical variables. Median follow-up time was 7.4 years.
Results:
In total, there were 122 (32%) deaths and smoking and elevated total cholesterol were independent risk factors for all-cause mortality (adjusted HR 1.6 [P = .02] and 1.8 [P = .003], respectively). A significantly higher incidence of cardiac death was noted amongst smokers and patients with elevated total cholesterol. Elevated body mass index and hemoglobin A(1c) did not affect prognosis and elevated total cholesterol was not a risk factor once statin therapy commenced at the time of HTx was instituted as protocol.
Conclusions:
Smoking is a risk factor for all-cause and cardiac mortality, but elevated total cholesterol is a risk factor only in the absence of statin therapy being commenced at the time of HTx.
