Evaluation of lipid management practices for secondary atherosclerotic cardiovascular disease prevention in abdominal solid organ transplant recipients.

BACKGROUND

High-intensity HMG-CoA reductase inhibitors (statins) are recommended for secondary atherosclerotic cardiovascular disease (ASCVD) prevention. Solid organ transplant (SOT) recipients are at an increased risk of ASCVD events. This study evaluated if abdominal SOT recipients who experienced an ASCVD event prior to transplant received guideline-directed pharmacotherapy for secondary ASCVD prevention posttransplant.

METHODS

Single-center, retrospective, cohort study that evaluated lipid-lowering therapy prescribing practices in SOT recipients transplanted at Duke University Hospital. The primary objective was the percentage of patients receiving a high-intensity statin regimen during the first-year posttransplant. Secondary objectives included reason for change in statin therapy, other lipid-lowering medications prescribed, percentage of patients who had lipid panel(s) drawn, safety of statin therapy, and the incidence of recurrent ASCVD or death secondary to an ASCVD event within the first-year posttransplant.

RESULTS

Sixty-three transplant patients were included, 46 (73%) received a kidney, 12 (19%) a liver, and 5 (7.9%) a multiorgan transplant. Twenty-four patients (38.1%) were maintained on a high-intensity statin during the first-year posttransplant. Reason for statin dose change included elevated lipids (35.3%), statin-related safety event (11.8%), and undocumented reason (52.9%). Statins were well tolerated. Two (3.2%) patients experienced a recurrent myocardial infarction within the first-year posttransplant.

CONCLUSION

Less than half of the abdominal transplant patients were maintained on guideline-directed high-intensity statin therapy for secondary ASCVD prevention at 1 year posttransplant. Our findings demonstrate an opportunity to optimize the prescribing practices of lipid-lowering therapy following abdominal transplant in a high cardiovascular risk population.