The Impact of Statin Intensity on the Early Progression of Cardiac Allograft Vasculopathy

IF 1.9 4区 医学 Q2 SURGERY Clinical Transplantation Pub Date : 2024-11-18 DOI:10.1111/ctr.70030
Xinyi Huang, Melana Yuzefpolskaya, Paolo C. Colombo, Jason Choe, Tara Shertel, Douglas L. Jennings
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Abstract

Background

Limited research has compared the relative risks and benefits different statins have after heart transplantation (HT).

Method

We hypothesize that higher statin intensity is associated with a smaller degree of allograft intimal thickening on intravascular ultrasound (IVUS) at 1-year post-HT. Allograft intima-media thickness (IMT) on the first annual IVUS was retrospectively compared in patients initiated on a low-intensity statin (pravastatin 20 mg daily) versus moderate-intensity statin (atorvastatin 20 mg daily) post-HT.

Results

A total of 172 adult patients were included (2018–2022, n = 86 in each group). At 1 year, the maximal IMT was lower in the moderate-intensity statin group, but the difference did not reach statistical significance. The LDL levels at 1 year trended lower with moderate-intensity statin therapy, while the rates of adverse reactions were not statistically different. A multivariate analysis of the logistic regression model showed moderate statin intensity at 12 months was protective, while donor-specific antibodies developed within the first-year posttransplant were associated with IMT ≥ 0.5 mm on the first annual IVUS.

Conclusion

This study found that using moderate-intensity statin to prevent the early progression was as safe and possibly more effective than low-intensity statin therapy for the prevention of early cardiac allograft vasculopathy.

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他汀类药物强度对心脏移植血管病早期进展的影响
背景:对心脏移植(HT)后不同他汀类药物的相对风险和益处进行比较的研究有限:我们假设,他汀类药物强度越高,心脏移植术后一年的血管内超声(IVUS)显示的异体移植物内膜增厚程度越小。我们回顾性比较了HT后开始服用低强度他汀类药物(普伐他汀20毫克/天)和中等强度他汀类药物(阿托伐他汀20毫克/天)的患者首次年度IVUS检查的移植物内膜中层厚度(IMT):共纳入172名成年患者(2018-2022年,每组n=86)。1年后,中等强度他汀组的最大IMT较低,但差异未达到统计学意义。使用中等强度他汀类药物治疗一年后,低密度脂蛋白水平呈下降趋势,而不良反应发生率无统计学差异。逻辑回归模型的多变量分析显示,12个月时中等强度的他汀类药物具有保护作用,而移植后第一年内出现的供体特异性抗体与首次年度IVUS检查IMT≥0.5毫米有关:本研究发现,在预防早期心脏同种异体移植血管病变方面,使用中等强度的他汀类药物预防早期进展与低强度的他汀类药物治疗一样安全,甚至可能更有效。
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来源期刊
Clinical Transplantation
Clinical Transplantation 医学-外科
CiteScore
3.70
自引率
4.80%
发文量
286
审稿时长
2 months
期刊介绍: Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.
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