Prevention and treatment of coronary artery vasculopathy

Abstract

The implementation of measures and lifestyles that help prevent CAV should be a priority of postheart transplantation management. Research should urgently evaluate mTOR inhibitors for the treatment of established CAV.

Transplant coronary heart disease: challenges and solutions

“…64 Regimens utilizing a PSI are appealing because the use is associated with reduced rates of CAV and improved renal function. 55,65,66 Current guidelines do not recommend the use of PSI for immunosuppression immediately after OHT in view of the lack of mortality benefit, fear of higher cellular rejection rates, and other adverse effects, including poor wound healing. 41 Current guidelines suggest adding a PSI to ongoing calcineurin inhibitor therapy in place of azathioprine or mycophenolate for patients with established CAV.…”

“…55 Many of the same treatment options for traditional atherosclerosis have been applied to CAV. Statins are the cornerstone of primary CAV prevention by lowering lipid levels and attenuating the adverse effects of hyperlipidemia on CAV development.…”

“…Statins are the cornerstone of primary CAV prevention by lowering lipid levels and attenuating the adverse effects of hyperlipidemia on CAV development. 3,17,55 In addition, the pleiotropic effects of statins may inhibit alloimmune responses, including CMV replication. Statins are recommended for all OHT recipients regardless of cholesterol levels on the basis of randomized trial data showing reduced rates of CAV, all-cause mortality, and hemodynamically significant rejection with statin treatment.…”

“…The combination of tacrolimus and mycophenolate has become the most popular combination of routine immunosupression due to its efficacy at preventing cellular rejection and the concept that preventing acute rejeciton will lower the risk of CAV. 2,[5][6][7]55 The proliferation signal inhibitor (PSI) drugs sirolimus and everolimus are potent inhibitors of intimal proliferation, and for this reason, they have become the drugs of choice for drug-eluting coronary stents to prevent in-stent restenosis, a process analogous to CAV progression. 64 Regimens utilizing a PSI are appealing because the use is associated with reduced rates of CAV and improved renal function.…”

“…Statins are recommended for all OHT recipients regardless of cholesterol levels on the basis of randomized trial data showing reduced rates of CAV, all-cause mortality, and hemodynamically significant rejection with statin treatment. 3,17,41,[55][56][57][58][59][60] Hypertension control is important for CAV prevention, and both angiotensin converting enzyme (ACE) inhibitors and calcium-channel blockers appear to reduce CAV development and/or progression. 3,16,61 As with traditional CAD, prevention and control of diabetes after OHT likely retards CAV development.…”