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Link Between Cardiac Allograft Vasculopathy and Metabolic Syndrome: A Systematic Review and Meta-Analysis

Patavee Pajareya1, Watsapon Chuanchai1, Noppachai Siranart1

  • 1Division of Cardiovascular Medicine, Center of Excellence in Arrhythmia Research, Cardiac Center, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand.

Metabolic Syndrome and Related Disorders
|June 17, 2025
PubMed

Insights

Metabolic syndrome (MetS) significantly increases the risk of cardiac allograft vasculopathy (CAV) after heart transplants. Managing MetS components like obesity and dyslipidemia is crucial for improving outcomes in heart transplant recipients.

Area of Science:

  • Cardiology
  • Transplantation Immunology
  • Metabolic Diseases

Background:

  • Metabolic syndrome (MetS) is a growing global health concern associated with cardiac inflammation.
  • Cardiac allograft vasculopathy (CAV) is a major inflammatory complication and cause of graft failure post-orthotopic heart transplantation (OHT).
  • The link between MetS and CAV is not well-established.

Purpose of the Study:

  • To investigate the association between metabolic syndrome (MetS) and cardiac allograft vasculopathy (CAV) in patients undergoing orthotopic heart transplantation (OHT).
  • To identify specific components of MetS that contribute to CAV development.
  • To understand the prevalence of MetS before and after OHT.

Main Methods:

  • A comprehensive literature search was performed up to September 2024.
  • Included studies analyzed the association between MetS or its components (obesity, hypertension, dyslipidemia, diabetes mellitus) and CAV development post-OHT.
  • Results were synthesized using odds ratios (OR) and hazard ratios (HR) with 95% confidence intervals (CI), employing random and fixed-effect models.

Main Results:

  • 16 studies with 3,366 patients were analyzed.
  • MetS prevalence was high pre-OHT (32%) and post-OHT (37%).
  • MetS significantly increased CAV risk (OR=1.99). Obesity (OR=1.54) and dyslipidemia (OR=1.87) were key contributors. New-onset diabetes post-transplant also raised CAV risk (HR=1.71).

Conclusions:

  • High prevalence of MetS before and after OHT is linked to increased CAV risk.
  • Components of MetS, particularly obesity and dyslipidemia, are significantly associated with CAV.
  • Targeted interventions for MetS management are essential for heart transplant recipients to reduce CAV.

Keywords:
cardiac allograft vasculopathyheart transplantationmeta-analysismetabolic syndromemortalityrenal failure

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