Center for Preventive Cardiology, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA.
Center for Preventive Cardiology, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA.
J Clin Lipidol. 2019 Mar-Apr;13(2):231-245. doi: 10.1016/j.jacl.2019.01.011. Epub 2019 Jan 30.
Solid organ transplantation (SOT) has revolutionized treatment of end-stage disease. Improvements in the SOT continuum of care have unmasked a significant burden of cardiovascular disease, manifesting as a leading cause of morbidity and mortality. Although several risk factors for development of post-transplant cardiovascular disease exist, dyslipidemia remains one of the most frequent and modifiable risks. An important contributor to dyslipidemia in SOT recipients is the off-target metabolic effects of immunosuppressive medications, which may alter lipoproteins and their metabolism. Dyslipidemia management is paramount as lipid-lowering therapy with statins has demonstrated reductions in graft vasculopathy, decreased rejection rates, and improved survival. Several nonstatin medication options are available, but data supporting their benefit in the SOT population are minimal, typically extrapolated from studies in the general population. Further compounding dyslipidemia management is the complex interplay of drug interactions between lipid-lowering and immunosuppressant medications, which can result in serious toxicity and/or therapeutic failure.
实体器官移植（SOT）彻底改变了终末期疾病的治疗方法。SOT 连续护理的改进揭示了心血管疾病的巨大负担，表现为发病率和死亡率的主要原因。尽管存在多种导致移植后心血管疾病发展的风险因素，但血脂异常仍然是最常见和可改变的风险之一。免疫抑制药物的靶向代谢作用是 SOT 受者血脂异常的一个重要原因，这可能会改变脂蛋白及其代谢。血脂异常的管理至关重要，因为他汀类药物的降脂治疗已证明可减少移植物血管病变、降低排斥反应率并提高生存率。有几种非他汀类药物选择，但支持它们在 SOT 人群中获益的数据很少，通常是从一般人群的研究中推断出来的。进一步使血脂异常管理复杂化的是降脂药物和免疫抑制剂药物之间药物相互作用的复杂相互作用，这可能导致严重的毒性和/或治疗失败。
