Long-Term Safety and Effectiveness of Statins for Heart Transplant Recipients in Routine Clinical Practice

Grigioni, Francesco; Carigi, Samuela; Potena, Luciano; Fabbri, Francesca; Russo, Antonio; Musuraca, Anna Chiara; Coccolo, Fabio; Magnani, Gaia; Ortolani, Paolo; Leone, Ornella; Arpesella, Giorgio; Magelli, Carlo; Branzi, Angelo

doi:10.1016/j.transproceed.2006.02.071

Cited by 29 publications

(25 citation statements)

References 11 publications

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“…Graft vascular disease (GVD) is a peculiar type of atherosclerosis affecting coronary arteries of HT recipients and a leading risk cause of post-HT mortality (Christie et al, 2008). Several studies showed that GVD -besides immunological risk factors -is favored by the traditional risk factors for atherosclerosis (Winters et al, 1990;Potena et al, 2004Grigioni et al, 2006). Among the latter, the metabolic syndrome plays a pivotal role (Biadi et al, 2007;.…”

Section: Discussionmentioning

confidence: 99%

Changes in exercise capacity induced by heart transplantation: prognostic and therapeutic implications

Grigioni

Specchia

Latessa

et al. 2011

Scandinavian Med Sci Sports

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Survival and exercise performance are key targets of heart transplantation (HT). We designed this study to help in identifying (1) patients with chronic heart failure (CHF) at risk of poor exercise capacity after HT and (2) HT recipients presenting risk factors modifiable with exercise showing a potential impact on outcome. We enrolled 49 HT recipients (age 52 ± 12 years, 84% males) who underwent a cardiopulmonary exercise test before (9 ± 6 months) and after (20 ± 14 months) HT. In the CHF phase, lower peak oxygen consumption (VO(2) ) (odds ratio 0.69, P=0.017) independently predicted peak VO(2) improvement after HT. In the post-HT phase, body mass index (BMI) [adjusted hazard ratio (HR) 1.16, P=0.034] and VE (ventilation)/VCO(2) (carbon dioxide production) slope (adjusted HR 1.07, P=0.031) independently predicted mortality. In conclusion, CHF patients with only a moderate impairment of peak VO(2) are at a risk of failing to achieve a significant improvement of exercise performance after HT. In the post-HT phase, a BMI≥28 and/or a VE/VCO(2) slope ≥47 represent risk factors for death, which are potentially modifiable with exercise. Prospective randomized studies are needed to analyze the effects of training on functional capacity and outcome in the different subsets of HT recipients.

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Section: Discussionmentioning

confidence: 99%

Changes in exercise capacity induced by heart transplantation: prognostic and therapeutic implications

Grigioni

Specchia

Latessa

et al. 2011

Scandinavian Med Sci Sports

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“…There was no change in summary effect size with omitting 1 study at a time or fixedeffects model. The outcomes from studies by Fröhlich et al 9 (5/151) and Grigioni et al 20 (6/186) were not included in the pooled analysis because these 2 studies reported the rates of myopathy only in heart transplant recipients undergoing statin therapy.…”

Section: Myopathymentioning

confidence: 99%

Impact of Statin Use After Heart Transplantation

Vallakati

Reddy

Dunlap

et al. 2016

Circ: Heart Failure

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Background— Although various studies revealed the beneficial effects of statins in post–cardiac transplant patients, these were relatively small and low-powered studies. We performed a meta-analysis of published studies to evaluate the role of statins in post–cardiac transplant patients, specifically examining the effects on hemodynamically significant/fatal graft rejection, coronary vasculopathy, terminal cancer, and overall survival. Methods and Results— We searched PubMed, Cochran CENTRAL, and Web of Science databases using the search terms “cardiac transplant” or “heart transplant,” and “statin” for a literature search. A random-effects model with Mantel–Haenszel method was used to pool the data. We identified 10 studies, 4 randomized controlled trials, and 6 nonrandomized studies, which compared outcomes in heart transplant recipients undergoing statin therapy to statin-naive patients. A pooled analysis of 9 studies reporting mortality revealed that the use of statins was associated with significant reduction in all-cause mortality (odds ratio, 0.26; 95% confidence interval, 0.20–0.35; P <0.0001). Statins also decreased the odds of hemodynamically significant/fatal rejection (odds ratio, 0.37; 95% confidence interval, 0.21–0.65; P =0.0005), incidence of coronary vasculopathy (odds ratio, 0.33; 95% confidence interval, 0.16–0.68; P =0.003), and terminal cancer (odds ratio, 0.30; 95% confidence interval, 0.15–0.63; P =0.002). Conclusions— The evidence from a pooled analysis suggests that statins improve survival in heart transplant recipients. Statins may prevent fatal rejection episodes, decrease terminal cancer risk, and reduce the incidence of coronary vasculopathy. Additional prospective studies are needed to further investigate and explain this association.

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“…Therapeutic targets of cholesterol levels are poorly defined in heart transplant population. Nonetheless, efficacy and therapeutic benefit of statins in heart transplant recipients is established unequivocally [94][95][96][97][98][99][100]. In addition to their lipid lowering effects, statins exert their potential beneficial effects by their pleiotropic effects [101].…”

Section: Dyslipidemiamentioning

confidence: 99%

Cardiac Allograft Vasculopathy: A Review of Risk Factors and Pathogenesis

Munagala¹,

Phancao²

2018

obm.transplant

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Heart transplant remains the gold standard therapy for patients with end stage heart disease and offers improved survival and quality of life. Significant progress has been achieved in improving one-year mortality after heart transplantation. Nonetheless, longterm graft survival has not changed significantly over the past few decades. Long term survival of heart transplant recipients is limited by chronic rejection, cardiac allograft vasculopathy (CAV), and malignancy. CAV is a major contributor for graft failure and mortality after the first year of in heart transplant recipients. CAV is a proliferative vasculopathy characterized by diffuse myointimal hyperplasia and progressive narrowing of the graft vessels. Both immune dependent and independent factors have been shown to contribute to the pathogenesis of CAV. Understanding these risk factors is essential in developing preventative and therapeutic strategies. Angiography with Intravascular ultrasound has become the key diagnostic tool in the early detection of CAV as well as prognostication. Echocardiographic assessment of allograft function in conjunction with coronary angiographic findings are used in assessing the severity of CAV. Adjustment of immunosuppression and statins remain the initial steps in the management of CAV. Retransplantation is the definitive treatment for severe CAV, however, the paucity of organs along with increased mortality associated with retransplantation makes it a less desirable option. Remarkable progress has been achieved in the understanding of pathogenesis, risk factors for CAV and plaque morphology. Nevertheless, significant knowledge gaps persist in scientific understanding of risk factors, pathogenesis, prevention and treatment of CAV. Further research is warranted to fill these gaps, develop diagnostic modalities to facilitate early detection of CAV, and management strategies to Improve graft tolerance and immune modulation. This review focuses on summarizing the pathogenesis and risk factors for CAV.

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Long-Term Safety and Effectiveness of Statins for Heart Transplant Recipients in Routine Clinical Practice

Cited by 29 publications

References 11 publications

Changes in exercise capacity induced by heart transplantation: prognostic and therapeutic implications

Changes in exercise capacity induced by heart transplantation: prognostic and therapeutic implications

Impact of Statin Use After Heart Transplantation

Cardiac Allograft Vasculopathy: A Review of Risk Factors and Pathogenesis

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