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Timing of 3‐hydroxy‐3‐methylglutaryl‐coenzyme A reductase inhibitor initiation and allograft vasculopathy progression and outcomes in heart transplant recipients
AIMS: Early studies from the 1990s have shown that statins improve survival and attenuate cardiac allograft vasculopathy (CAV). However, little contemporary data are available on the incremental benefit of statins with the current use of new‐generation immunosuppressive agents and the use of coronar...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6300821/ https://www.ncbi.nlm.nih.gov/pubmed/30019530 http://dx.doi.org/10.1002/ehf2.12329 |
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author | Asleh, Rabea Briasoulis, Alexandros Pereira, Naveen L. Boilson, Barry A. Edwards, Brooks S. Adigun, Rosalyn Maltais, Simon Daly, Richard C. Lerman, Amir Kushwaha, Sudhir S. |
author_facet | Asleh, Rabea Briasoulis, Alexandros Pereira, Naveen L. Boilson, Barry A. Edwards, Brooks S. Adigun, Rosalyn Maltais, Simon Daly, Richard C. Lerman, Amir Kushwaha, Sudhir S. |
author_sort | Asleh, Rabea |
collection | PubMed |
description | AIMS: Early studies from the 1990s have shown that statins improve survival and attenuate cardiac allograft vasculopathy (CAV). However, little contemporary data are available on the incremental benefit of statins with the current use of new‐generation immunosuppressive agents and the use of coronary intravascular ultrasound for assessment of CAV. We sought to investigate the effect of early statin (ES) as compared with late statin (LS) initiation after heart transplantation (HT) on long‐term CAV progression and clinical outcomes in a large contemporary HT cohort. METHODS AND RESULTS: We analysed a cohort of 409 adult HT recipients. CAV progression was assessed by serial coronary intravascular ultrasound volumetric measurements of the differences between baseline and last follow‐up plaque volume (PV) and plaque index (PV/vessel volume ratio). CAV progression and clinical outcomes were compared between the ES (<2 years after HT) and the LS (>2 years after HT) groups. During a median follow‐up of 8.2 years, ES resulted in significantly lower change (Δ) of plaque index (+3.8% ± 1.7% vs. +8.2% ± 3.6%; P = 0.0008) and PV (+0.8 ± 0.3 vs. +1.9 ± 1.2; P = 0.045) compared with LS group. In a Cox proportional hazards regression model and after adjustment for baseline characteristics, ES was associated with a 52% decreased risk of CAV‐associated events (hazard ratio 0.48, 95% confidence interval: 0.27–0.91; P = 0.025) and a 42% decreased risk of the composite endpoint of all‐cause mortality and CAV‐associated events (hazard ratio 0.58, 95% confidence interval: 0.38–0.91; P = 0.019). CONCLUSIONS: Early initiation of statin therapy after HT results in attenuated CAV progression as well as in decreased CAV‐related events and mortality. |
format | Online Article Text |
id | pubmed-6300821 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-63008212018-12-31 Timing of 3‐hydroxy‐3‐methylglutaryl‐coenzyme A reductase inhibitor initiation and allograft vasculopathy progression and outcomes in heart transplant recipients Asleh, Rabea Briasoulis, Alexandros Pereira, Naveen L. Boilson, Barry A. Edwards, Brooks S. Adigun, Rosalyn Maltais, Simon Daly, Richard C. Lerman, Amir Kushwaha, Sudhir S. ESC Heart Fail Original Research Articles AIMS: Early studies from the 1990s have shown that statins improve survival and attenuate cardiac allograft vasculopathy (CAV). However, little contemporary data are available on the incremental benefit of statins with the current use of new‐generation immunosuppressive agents and the use of coronary intravascular ultrasound for assessment of CAV. We sought to investigate the effect of early statin (ES) as compared with late statin (LS) initiation after heart transplantation (HT) on long‐term CAV progression and clinical outcomes in a large contemporary HT cohort. METHODS AND RESULTS: We analysed a cohort of 409 adult HT recipients. CAV progression was assessed by serial coronary intravascular ultrasound volumetric measurements of the differences between baseline and last follow‐up plaque volume (PV) and plaque index (PV/vessel volume ratio). CAV progression and clinical outcomes were compared between the ES (<2 years after HT) and the LS (>2 years after HT) groups. During a median follow‐up of 8.2 years, ES resulted in significantly lower change (Δ) of plaque index (+3.8% ± 1.7% vs. +8.2% ± 3.6%; P = 0.0008) and PV (+0.8 ± 0.3 vs. +1.9 ± 1.2; P = 0.045) compared with LS group. In a Cox proportional hazards regression model and after adjustment for baseline characteristics, ES was associated with a 52% decreased risk of CAV‐associated events (hazard ratio 0.48, 95% confidence interval: 0.27–0.91; P = 0.025) and a 42% decreased risk of the composite endpoint of all‐cause mortality and CAV‐associated events (hazard ratio 0.58, 95% confidence interval: 0.38–0.91; P = 0.019). CONCLUSIONS: Early initiation of statin therapy after HT results in attenuated CAV progression as well as in decreased CAV‐related events and mortality. John Wiley and Sons Inc. 2018-07-17 /pmc/articles/PMC6300821/ /pubmed/30019530 http://dx.doi.org/10.1002/ehf2.12329 Text en © 2018 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. |
spellingShingle | Original Research Articles Asleh, Rabea Briasoulis, Alexandros Pereira, Naveen L. Boilson, Barry A. Edwards, Brooks S. Adigun, Rosalyn Maltais, Simon Daly, Richard C. Lerman, Amir Kushwaha, Sudhir S. Timing of 3‐hydroxy‐3‐methylglutaryl‐coenzyme A reductase inhibitor initiation and allograft vasculopathy progression and outcomes in heart transplant recipients |
title | Timing of 3‐hydroxy‐3‐methylglutaryl‐coenzyme A reductase inhibitor initiation and allograft vasculopathy progression and outcomes in heart transplant recipients |
title_full | Timing of 3‐hydroxy‐3‐methylglutaryl‐coenzyme A reductase inhibitor initiation and allograft vasculopathy progression and outcomes in heart transplant recipients |
title_fullStr | Timing of 3‐hydroxy‐3‐methylglutaryl‐coenzyme A reductase inhibitor initiation and allograft vasculopathy progression and outcomes in heart transplant recipients |
title_full_unstemmed | Timing of 3‐hydroxy‐3‐methylglutaryl‐coenzyme A reductase inhibitor initiation and allograft vasculopathy progression and outcomes in heart transplant recipients |
title_short | Timing of 3‐hydroxy‐3‐methylglutaryl‐coenzyme A reductase inhibitor initiation and allograft vasculopathy progression and outcomes in heart transplant recipients |
title_sort | timing of 3‐hydroxy‐3‐methylglutaryl‐coenzyme a reductase inhibitor initiation and allograft vasculopathy progression and outcomes in heart transplant recipients |
topic | Original Research Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6300821/ https://www.ncbi.nlm.nih.gov/pubmed/30019530 http://dx.doi.org/10.1002/ehf2.12329 |
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