Rogers C C, Alloway R R, Boardman R, Trofe J, Hanaway M J, Alexander J W, Roy-Chaudhury P, Buell J F, Thomas M, Susskind B, Woodle E S
Division of Transplantation, University of Cincinnati, Cincinnati, Ohio 45249, USA.
Transplant Proc. 2005 Mar;37(2):812-3. doi: 10.1016/j.transproceed.2005.01.060.
A primary reason to eliminate corticosteroids from immunosuppressive regimens in solid organ transplant recipients is improved cardiovascular risk profiles. Although a number of studies have documented that corticosteroid withdrawal (CSWD) regimens reduce hypertension, hyperlipidemia, diabetes, and weight gain, global assessments of cardiovascular risk under CSWD have not been reported. The purpose of this study was to document cardiovascular risk under CSWD using a global risk assessment by Framingham risk assessment.
Framingham global cardiovascular risk assessments were performed at baseline and 3, 6, and 12 months posttransplant on patients enrolled in prospective, IRB-approved early (<7 days of corticosteroids) CSWD trials. Framingham score was based on age, sex, presence of diabetes, HDL and total cholesterol, and systolic blood pressure. All patients were nonsmokers. Left ventricular hypertrophy assessment by EKG criteria was not available at all time points and therefore were not included.
One hundred eighty-three patients were included in the analysis. Fourteen percent of patients had evidence of coronary heart disease (prior MI, CABG, PTCA, or significant cardiovascular disease as evidenced by angiography) prior to transplant. Complete information was available for 160 patients at baseline, 132 at 1, 3, and 6 months, and 93 at 12 months posttransplant. Mean 10-year risk (expressed as percent) for developing coronary heart disease decreased over time: 8.03 at baseline, 8.31 at 3 months, 7.40 at 6 months, and 7.20 at 12 months, indicating that global cardiovascular risk fell at 1 year posttransplant by about 10% in renal transplant recipients undergoing early CSWD.
Estimation of cardiovascular risk by Framingham risk factor assessment allows incorporation of several cardiovascular risk factors into a single estimate, thereby accounting for differential effects of each individual factor on global cardiovascular risk. This experience indicates that global cardiovascular risk decreases by approximately 10% at 1 year posttransplant in renal transplant recipients who undergo early corticosteroid withdrawal (CSWD).
在实体器官移植受者的免疫抑制方案中停用皮质类固醇的一个主要原因是改善心血管风险状况。尽管多项研究已证明皮质类固醇撤药（CSWD）方案可降低高血压、高脂血症、糖尿病和体重增加，但尚未有关于CSWD下心血管风险的全面评估报告。本研究的目的是通过弗明汉风险评估进行全面风险评估，以记录CSWD下的心血管风险。
对参加前瞻性、经机构审查委员会批准的早期（皮质类固醇使用<7天）CSWD试验的患者，在基线时以及移植后3、6和12个月进行弗明汉全球心血管风险评估。弗明汉评分基于年龄、性别、糖尿病的存在、高密度脂蛋白和总胆固醇以及收缩压。所有患者均不吸烟。通过心电图标准进行的左心室肥厚评估并非在所有时间点都可行，因此未纳入。
183例患者纳入分析。14%的患者在移植前有冠心病证据（既往心肌梗死、冠状动脉搭桥术、经皮冠状动脉腔内血管成形术或血管造影显示的重大心血管疾病）。移植后基线时160例患者、1、3和6个月时132例患者以及12个月时93例患者可获得完整信息。发生冠心病的平均10年风险（以百分比表示）随时间下降：基线时为8.03，3个月时为8.31，6个月时为7.40，12个月时为7.20，表明在接受早期CSWD的肾移植受者中，移植后1年全球心血管风险下降约10%。
通过弗明汉风险因素评估来估计心血管风险，可将多个心血管风险因素纳入单一估计中，从而考虑到每个个体因素对全球心血管风险的不同影响。这一经验表明，在接受早期皮质类固醇撤药（CSWD）的肾移植受者中，移植后1年全球心血管风险降低约10%。
