Metabolic Abnormalities Characteristic of Dysmetabolic Syndrome Predict the Development of Transplant Coronary Artery Disease

Abstract

These data suggest that insulin resistance plays a role in TXCAD:

The Role of Viruses in Cardiac Allograft Vasculopathy

“…Of all evaluated pathogens, only IgG seropositivity to HSV-2 (p = 0.05) and IgA seropositivity to EBV (p = 0.001) as well as H. pylori (p = 0.002) revealed an independent significant association with future cardiovascular death. However, when infectious burden was evaluated, patients seropositive to > 5 pathogens compared with those seropositive to <4 pathogens had a 5.1 (1,(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) higher risk of future cardiac death. This result was mainly driven by the pathogen burden of seropositivities to Herpes viridae (p < 0.0001).…”

“…The propensity for CAV to remain clinically silent until presentation with sudden death or cardiac failure, underscores the importance of identifying its major risk factors, with the goal of developing effective prevention strategies. The body of literature suggests that multiple factors are involved in the pathophysiology of CAV, including ischemia (3), acute rejection (4), and the metabolic abnormalities associate with insulin resistance induced by immunosuppressive drugs (5). There is also accumulating data suggesting that infections play a role in atherosclerosis in the general population (herein termed native atherosclerosis or CAD), and in CAV.…”

Cardiac Allograft Vasculopathy: An Ongoing Challenge in the Care of Heart Transplant Recipients

“…Patients with high plasma glucose or insulin concentrations after oral glucose intake have greater intimal thickness and are less likely to be free of CAV and have significantly lower survival during 5 years of follow up than patients with low glucose and insulin levels (Valantine et al, 2001). Specific therapies shown to be effective in correcting insulin resistance, such as the thiazolidinediones, offer potential new therapeutic targets for CAV prevention, however the clinical studies are lacking.…”

New Onset Diabetes After Solid Organ Transplantation

“…Clinical studies evaluating the impact of NODAT on patient and allograft outcomes after non-renal solid organ transplantation have yielded variable results (Baid et al, 2001;John & Thuluvath, 2002;Valentine et al, 2001). In a study consisting of 66 heart transplant recipients, post-transplant insulin resistance or post-transplant hyperglycemia (glucose levels > 8.9 mmol/L 2 hours after a standard oral glucose tolerance test) was found to be a predictive factor for transplant coronary artery stenosis (p < 0.01) and death (p < 0.005) during a 5-year post-tarnsplant follow-up period (Valentine et al, 2001).…”