Traditional and Nontraditional Cardiovascular Risk Factors and Estimated Risk for Coronary Artery Disease in Renal Transplant Recipients: A Single-Center Experience

Abstract

Background/Aims: The prevalence of cardiovascular disease in renal transplant recipients is markedly higher than in the general population due to the high prevalence of traditional cardiovascular risk factors, renal transplant function impairment and treatment with immunosuppressive drugs that affect blood pressure, cholesterol and blood glucose levels. Methods: Cross-sectional analysis using our renal transplant clinic cohort investigating (1) the cardiovascular risk factors present in this cohort, and (2) estimating their impact on the risk of coronary artery disease (CAD) by using the Framingham algorithm. Results: Control of modifiable cardiovascular risk factors in 231 renal transplant recipients is suboptimal, i.e. 47.2% of patients are hypertensive, 10.3% actively smoke, 39.4% have serum cholesterol concentrations >200 mg/dl, and 19.7% have diabetes mellitus. Blood pressure, age, hyperlipidemia, smoking and diabetes modulate the estimated CAD risk in males and females. Furthermore, a short time period (less than 1 year) since transplantation and increased serum creatinine levels negatively influenced the CAD risk in this patient population. Conclusion: According to current guidelines, the control of modifiable cardiovascular risk factors in renal transplant recipients is suboptimal. The decreasing CAD risk over time after transplantation may be due to the reduction of immunosuppressive drugs with time and survival bias.

Contribution of impaired renal function to cardiovascular risk prediction models in renal transplant recipients

“…While literature linking CVD risk scores to event rate is available through both equations (12-14, 16, 17), we could not identify any comparative studies in RTR, which raises several points for discussion. First, the prevalence of traditional and transplant-related CVD risk factors is similar to published reports (23,24). In our cohort of RTR~e ight yr post-transplant, 22% of patients had SBP levels >140, 22% had a previous history of smoking, and 27% had DM.…”

“…In a previous study from Halifax investigating patients seven yr after renal transplantation, 27% of the patients had systolic SBP > 140 mm Hg, 23% smoked, and 30.0% had diabetes mellitus (23). In another single-center analysis of 231 RTR in Canada, 47.2% of patients were hypertensive, 10.3% of patients still smoked, and 19.7% of patients had diabetes mellitus (24). Many of traditional risk factors are potentially treatable, and thus, their prevalence in RTR give hopes to target modifiable CVD risk factors in RTR.…”

Evidence of enhanced systemic inflammation in stable kidney transplant recipients with low Framingham risk scores

“…Furthermore, renal insufficiency is a known risk factor for graft loss and death , and graft loss is an independent risk factor for ACS and cardiac mortality . The lack of association between FRS and eGFR shown in this study, and by others , reinforces the notion that an improved CV risk predictor is needed in the kidney transplant population.…”

Interventions to Reduce Clinical Inertia in Cardiac Risk Factor Management in Renal Transplant Recipients

“…Control of modifiable CVD risk factors was observed to be suboptimal in a study of 231 RTRs. 8 A recent study at the center where the current study was conducted also revealed that a substantial number of RTRs did not achieve treatment goals or missed recommended screening for risk factors. 9 Glycated hemoglobin (HbA1c) was assessed in only 50% to 60%.…”