BackgroundMortality in allograft kidney transplant recipients is high, and cardiovascular disease is the leading cause of death in these patients. They have heightened activity of sympathetic and renin–angiotensin systems. We tested the hypothesis that blockade of sympathetic and renin–angiotensin systems in these patients may offer a survival benefit using a large cohort of patients with long‐term follow up.Methods and ResultsMedical records of 321 consecutive patients from our institution who had received renal transplantation between 1995 and 2003 were abstracted. Survival was analyzed as a function of pharmacological therapies adjusted for age, sex, and comorbidities. The characteristics of the 321 patients were as follows: age at transplant, 44±13 years; 40% male; 89% with hypertension; 36% with diabetes, and mean left ventricular ejection fraction of 60%. Over a follow‐up of 10±4 years, there were 119 deaths. Adjusted for age, sex, diabetes, and coronary artery disease, use of a beta‐blocker therapy (P=0.04) and angiotensin‐converting enzyme inhibitor or receptor blocker (P=0.03) was associated with better survival. This treatment effect was seen across all major clinical subgroups and was supported by propensity score analysis. The propensity score–adjusted 10‐year survival was 95% in those taking both groups of medications, 72% in those taking either of them, and 64% in those taking neither (P=0.004).ConclusionsUse of beta‐blocker and angiotensin blocking therapies is associated with higher survival after renal transplantation, indicating their potential protective role in this high‐risk population.

The syndrome of chest pain, abnormal stress test, and nonflow limiting coronary artery disease (CAD) is common and is attributed to coronary microvascular disease (?VD). It is associated with increased hospital admissions and health care costs. But its impact on long-term survival is not known. Of the 9941 consecutive patients who had an exercise stress test for evaluation of chest pain between May 1991 and July 2007, 935 had both a positive stress test and a coronary angiogram within 1?year of their stress test forming the study cohort. Significant angiographic CAD defined as ?70% stenosis of an epicardial coronary artery or ?50% stenosis of the left main coronary artery was present in 324 patients. Rest (n?=?611) were considered to have coronary ?VD. Compared with patients with significant epicardial CAD, patients with coronary ?VD were younger (63???11 vs. 65???10 years, p?=?0.002), and had lower left ventricular wall thickness (p?

Renal transplantation is the treatment of choice in patients with end-stage renal disease. Major adverse cardiac events (MACE) are common after renal transplant, especially in the perioperative period, leading to excess morbidity and mortality. The predictors and long-term prognostic implications of MACE are poorly understood. We analyzed predictors and implications of MACE in a cohort of 321 consecutive adult patients, who received renal allograft transplantation between 1995 and 2003 at our institution. The characteristics of 321 patients were: age at transplant 44 ± 13 years, 60% male, 36% diabetes mellitus (DM), left ventricular ejection fraction (LVEF) 60 ± 16%. MACE occurred in 21 patients with cumulative rate of 6.5% over 3 years after renal transplant, 57% occurring within 30 days, 67% within 90 days, and 86% within 180 days. MACE was not predicted by any clinical or pharmacological variables including age, gender, hypertension, DM, prior myocardial infarction, smoking, duration of dialysis, LVEF, or therapy with β-blockers (BB), angiotensin converting enzyme inhibitors, or calcium channel blockers. However, a clinical decision to perform a stress test or a coronary angiogram was predictive of higher MACE rate. MACE, irrespective of type, was independently associated with higher mortality over a period up to 15 years and this seemed to be blunted by BB therapy. MACE rate after renal transplantation decreases over time, most occurring in the first 90 days and is not predicted by any of the traditional risk factors or drug therapies. It is associated with higher long-term mortality.

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