Burden of atherogenic lipids and association with cardiac allograft vasculopathy in heart transplant recipients.

BACKGROUND

Cardiac allograft vasculopathy (CAV) is a leading cause of morbidity and mortality after heart transplantation (HTx). There are limited contemporary studies examining post-transplant lipid management and cardiometabolic health.

OBJECTIVE

We study the burden of cardiometabolic derangements post transplantation and its impact on CAV in a modern cohort of HTx recipients.

METHODS

All HTx recipients between January 2019 and December 2020, with 2 lipid assessments and angiographic surveillance were included. Logistic regression was used to assess association of lipid levels with cardiovascular outcomes and CAV.

RESULTS

Among 87 HTx recipients, atherogenic lipids were significantly elevated after Htx. Median low-density lipoprotein cholesterol increased from a baseline level of 69.5 mg/dL to 86.5 mg/dL, p = .002, non-high-density lipoprotein cholesterol (non-HDL-C) 91.5 mg/dL to 118 mg/dL, p < .001, triglycerides 94.5 mg/dL to 133 mg/dL, p < .001, and remnant cholesterol 19 mg/dL to 27 mg/dL, p < .001. Increases in non-HDL-C, triglycerides, and remnant cholesterol were significantly associated with increased risk of CAV (Stanford Grade 4 and intimal thickness). Increases in triglycerides and remnant cholesterol were associated with increased risk of composite major adverse cardiovascular events (MACE).

CONCLUSION

We demonstrate a significant increase in atherogenic lipids 2 years following transplantation with low use (20%) of high-intensity statin. Increase in atherogenic lipids was associated with increased risk of CAV and increase in triglycerides and remnant cholesterol with increased MACE. Future studies examining cardiometabolic consequences of HTx and optimal treatment strategies to reduce risk of CAV and MACE are needed.