Cardiovascular Risk in the Kidney Transplant Patient
Cardiovascular Risk in the Kidney Transplant Patient
Cardiovascular events are the single greatest cause of death in recipients of kidney transplantation. Patients in the kidney transplant population have an increased incidence of hypercholesterolemia, and more than 60% have elevated total and low-density lipoprotein (LDL) cholesterol levels. This increased incidence of hyperlipidemia also has been linked to decreased graft survival.
Risk factors for heart disease in the general population include age, smoking, diabetes mellitus, obesity, hypertension, hyperlipidemia, and family history. In the transplant community, an additional important factor contributing to risk may be immunosuppressive therapy. Results show that some immunosuppressive therapies, such as cyclosporine (CsA), sirolimus, and corticosteroids, may be independently associated with increased cholesterol levels. Immunosuppressive therapies, particularly cyclosporine and corticosteroids, have also been shown to increase hypertension, which has been associated with an increased risk of both graft failure and cardiovascular events.
Although no controlled studies have been conducted on the benefits of cholesterol lowering in kidney transplant patients, it is recommended that physicians use the National Cholesterol Education Program guidelines as targets. Statins are the therapy of choice for lowering LDL cholesterol levels; however, it is important to control drug levels and to monitor patients for drug-drug interactions between statins and immunosuppressive drugs. Study results also suggest that conversion from CsA to tacrolimus may help reduce hyperlipidemia in some patients and, therefore, reduce the risk of cardiovascular disease and graft loss. General guidelines for management of hyperlipidemias and hypertension are provided in Table 1 , Table 2 , and Table 3 .
Cardiovascular events are the single greatest cause of death in recipients of kidney transplantation. Patients in the kidney transplant population have an increased incidence of hypercholesterolemia, and more than 60% have elevated total and low-density lipoprotein (LDL) cholesterol levels. This increased incidence of hyperlipidemia also has been linked to decreased graft survival.
Risk factors for heart disease in the general population include age, smoking, diabetes mellitus, obesity, hypertension, hyperlipidemia, and family history. In the transplant community, an additional important factor contributing to risk may be immunosuppressive therapy. Results show that some immunosuppressive therapies, such as cyclosporine (CsA), sirolimus, and corticosteroids, may be independently associated with increased cholesterol levels. Immunosuppressive therapies, particularly cyclosporine and corticosteroids, have also been shown to increase hypertension, which has been associated with an increased risk of both graft failure and cardiovascular events.
Although no controlled studies have been conducted on the benefits of cholesterol lowering in kidney transplant patients, it is recommended that physicians use the National Cholesterol Education Program guidelines as targets. Statins are the therapy of choice for lowering LDL cholesterol levels; however, it is important to control drug levels and to monitor patients for drug-drug interactions between statins and immunosuppressive drugs. Study results also suggest that conversion from CsA to tacrolimus may help reduce hyperlipidemia in some patients and, therefore, reduce the risk of cardiovascular disease and graft loss. General guidelines for management of hyperlipidemias and hypertension are provided in Table 1 , Table 2 , and Table 3 .
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