Plasma atherogenic markers in congestive heart failure and posttransplant (heart) patients

OBJECTIVES We hypothesized that plasma factors important for the developmen t of atherosclerosis play a major role in the occurrence of cardiac allogra ft vasculopathy (CAV). BACKGROUND Cardiac allograft vasculopathy is a major cause of death among h eart transplant recipients, has a poorly understood pathogenesis and has si milarities to atherosclerotic coronary disease. METHODS The study population consisted of 93 postcardiac transplant recipie nts. Thirty-one patients with congestive heart failure (CHF) and 18 healthy individuals served as control subjects. Posttransplant coronary anatomy wa s evaluated by angiography and intravascular ultrasound. Laboratory analyse s of lipids, homocysteine, vitamin B-12 and folate, fibrinogen, von-Willebr and factor antigen (vWFAg) and renin were obtained on all participants. RESULTS Posttransplant patients were found to have elevated serum triglycer ides, total cholesterol/high-density lipoprotein cholesterol ratio, lipopro tein (a), homocysteine, vWFAg, fibrinogen and renin and lower high-density lipoprotein cholesterol. Most of these laboratory atherogenic factors were also elevated to a similar degree in the CHF control population. Although m ost atherogenic markers were elevated, there was little correlation with CA V severity. Cardiac allograft vasculopathy severity varied with time after transplantation, 3-hydroxy-methyl-glutaryl-coenzyme A reductase inhibitor u se and prior cytomegalovirus infection. Even within the normal range, lower RBC folate levels were associated with increased severity of CAV. CONCLUSIONS The posttransplant course is associated with increased clinical and laboratory atherogenic factors, some of which likely contribute to the severity of coronary vasculopathy. Compared with normal control subjects, many of these markers are already increased in pretransplant CHF patients w ith or without occlusive coronary artery disease. (C) 2000 by the American College of Cardiology.