Incidence of cardiovascular risk factors and cardiovascular complications after renal transplantation

Background: Cardiovascular disease is a leading cause of death after renal transplantation (RTx), and the incidence is considerably higher than in the general population. Aim of this study was to evaluate the incidence of ath erosclerotic cardiovascular complications after RTx, the prevalence of card iovascular risk factors, prior to and following RTx, and the association be tween the risk factors and complications. Patients and Methods: Analysis of atherosclerotic cardiovascular diseases ( coronary artery disease, cerebral and peripheral vascular disease) and card iovascular risk factors before and after transplantation in 427 renal trans plant recipients between 1987 and 1992 (mean age at transplantation 45 +/- 12 years: 58% male, 7% diabetics) with a mean posttransplant follow-up of 2 8 +/- 20 months. Results: Following RTx 11.7% developed atherosclerotic cardiovascular disea ses, the majority coronary artery disease(9.8%). The comparison of risk fac tors 12 months before and 24 months following transplantation showed: The p revalence of systemic hypertension (from 67% to 86%), diabetes mellitus (fr om 7% to 16%) and obesity with a body mass index > 25 kg/m(2) (from 26% to 48%) had increased significantly whereas the number of smokers halved to 20 %. The triglycerides decreased significantly (from 235 +/- 144 mg/dl to 217 +/- 122 mg/dl). The total and HDL cholesterol rose significantly (from 232 +/- 65 mg/dl to 273 +/- 62 mg/dl and from 47 +/- 29 mg/dl to 56 +/- 21 mg/ dl, respectively). The LDL cholesterol increase was insignificant (from 180 +/- 62 mg/dl to 189 +/- 53 mg/dl). In the univariate analysis, cardiovascu lar diseases were significantly associated with male gender, age over 50 ye ars, diabetes mellitus (DM), smoking, total cholesterol > 200 mg/dl, LDL ch olesterol > 180 mg/dl, HDL cholesterol < 55 mg/dl, fibrinogen > 350 mg/dl, body mass index > 25 kg/m(2), and more than 2 antihypertensive agents per d ay. The Cox proportional hazards model revealed DM with a relative risk (RR ) of 4.3, age > 50 years (RR = 2.7), body mass index > 25 kg/m2 (RR 2.6), s moking (RR = 2.5), and LDL cholesterol > 180 mg/dl (RR = 2.3) as independen t risk factors. Conclusions: The high incidence of cardiovascular disease f ollowing renal transplantation is mainly due to a high prevalence and accum ulation of classical risk factors before a following transplantation. The t reatment of the risk factors must be effective and introduced early in the course of renal failure, furth they must be continued following transplanta tion. Future prospective studies should evaluate the success of treatment r egarding reduction of cardiovascular morbidity and mortality in this high r isk population.