LIPIDS, LIPOPROTEIN (A) AND CORONARY-ARTERY DISEASE IN PATIENTS FOLLOWING CARDIAC TRANSPLANTATION

Cardiac allograft vascular disease (CAVD) is the most important cause of late mortality in cardiac transplant recipients. While the pathogen esis of the disease is believed to be immunological, other factors lik e hyperlipidaemia may contribute. Total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, apolipoprotein Al and B and Lp(a) leve ls were measured in 174 cardiac transplant recipients attending our cl inic for routine followup. Univariate and multivariate logistic regres sion analysis was carried out to assess the relationship of the variab les studied to the presence of CAVD diagnosed with coronary angiograph y. CAVD was present in 42 of the 174 patients. The group with CAVD had a higher total cholesterol (6.8 vs 6.3 mmol/l), lower HDL cholesterol (0.8 vs 0.9 mmol/l), higher triglyceride (2.8 vs 2.0 mmol/l) and high er Lp(a) level (317.5 vs 95 mg/l) than the group without CAVD. In mult ivariate analysis, after adjusting for gender, hypertension, time from transplantation, preoperative diagnosis and lipid-lowering therapy, L p(a), total cholesterol, HDL cholesterol and triglycerides remained si gnificantly correlated with CAVD. The results indicate a significant a ssociation between hyperlipidaemia, Lp(a) levels and allograft vascula r disease. Further studies are needed to show whether treatment of hyp erlidaemia in this population delays the onset or slows the progressio n of CAVD.