Portal de Periódicos da CAPES

GLOBAL CARDIOVASCULAR RISK UNDER EARLY STEROID CESSATION DECREASES PROGRESSIVELY IN THE FIRST YEAR POSTTRANSPLANT.

2004; Wolters Kluwer; Volume: 78; Linguagem: Inglês

10.1097/00007890-200407271-00788

1534-6080

Maurizio Cardi, Christin C. Rogers, Rita R. Alloway, R Boardman, J Trofe, Michael J. Hanaway, J. Wesley Alexander, Prabir Roy‐Chaudhury, Joseph F. Buell, Michael A. Thomas, B. Süßkind, E. Steve Woodle,

Renal Transplantation Outcomes and Treatments

P293 Aims: Cardiovascular disease (CVD) is the leading cause of death with a functioning graft in renal transplant patients. A primary consideration for the minimization/elimination of corticosteroids (CS) and calcineurin inhibitors (CI) is reduction in cardiovascular risk (CV risk). To date, global assessments of CV risk have not been reported or used as an endpoint in clinical trials of CS/CI elimination. The purpose of this study was to determine the 10 yr risk for coronary heart disease (CHD) in patients enrolled in early corticosteroid withdrawal (ECSW) trials and to compare the calculated risk to the actual occurrence of post transplant cardiovascular events. This report substantially updates our previous experience with a doubling of the number of patients with 12 month follow-up Methods: A modified Framingham risk calculation was performed at baseline, 3, 6, 12 months post-transplant on all patients enrolled in ECSW (<7 days of steroids) clinical trials. The total score was based on age, sex, presence of DM, HDL and total cholesterol, and systolic blood pressure. All patients were non-smokers. LVH assessment by EKG criteria was not available at all time points therefore were not included. CHD risk as defined by Framingham criteria includes sudden death, MI or angina. Results: 183 patients were evaluated. 5 (2.7%) of patients experienced a CV event (MI, sudden death or angioplasty with stenting,) post transplant. These events occurred at a median time of 25 (3.6-36.73) months post transplant. 14% of patients had evidence of CHD (prior MI, CABG, PTCA, or significant CVD as evidenced by angiography) prior to transplant. Complete information was available for 160 pts at BL, 132 pts at 1, 3, and 6 mo, and 93 pts at 12 mo. Mean 10 year risk (expressed as %) for developing CHD decreased over time: 8.03 at BL, 8.31 at 3mo, 7.40 at 6 mo, and 7.20 at 12 mo. Conclusions: This analysis indicates that patients undergoing ECSW experience a progressive decline in CHD risk over the first year post transplant. These observations provide the first evidence of a positive impact of steroid free immunosuppression on global CHD risk.