Ballantyne C M, Bourge R C, Domalik L J, Eisen H J, Fishbein D P, Kubo S H, Lake K D, Radovancevic B, Taylor D O, Ventura H O, Yancy C W, Young J B
Department of Medicine, Baylor College of Medicine, Houston, Texas 77030, USA.
Am J Cardiol. 1996 Sep 1;78(5):532-5. doi: 10.1016/s0002-9149(96)00358-x.
Hyperlipidemia occurs frequently after heart transplantation, and accelerated coronary artery disease remains the major cause of morbidity and mortality in patients who survive more than 1 year after heart transplantation. However, the risks and benefits of lipid-lowering therapy after heart transplantation remain poorly defined, and national guidelines for lipid-lowering drug therapy do not specifically address treatment of dyslipidemia in transplant recipients. Since the initial reports in the 1980s of rhabdomyolysis in heart transplant patients receiving high-dosage lovastatin, results of 11 post-transplantation series that used lovastatin, simvastatin, or pravastatin at lower dosages as drug monotherapy have been published. These studies have shown an overall 1% incidence of rhabdomyolysis, defined as creatine kinase > 10 times the upper limit of normal plus muscle symptoms. One randomized, controlled prospective trial has investigated the effects of lipid-lowering pharmacotherapy on patient outcome in cardiac transplant recipients. At 1-year follow-up in this nonblinded, single-center trial, patients treated with pravastatin (20 or 40 mg/day) initiated within 2 weeks of transplantation had a significant reduction in mortality rate and a significantly lower incidence of transplant arteriopathy. A number of important issues remain unanswered regarding treatment guidelines in patients with hyperlipidemia after heart transplantation. In January 1995 we began the Heart Transplant Lipid Registry, with 12 participant centers, to gather data prospectively on the efficacy and safety of lipid-lowering drugs in the treatment of dyslipidemia after heart transplantation.
高脂血症在心脏移植后频繁发生，而加速性冠状动脉疾病仍然是心脏移植后存活超过1年患者发病和死亡的主要原因。然而，心脏移植后降脂治疗的风险和益处仍未明确界定，国家关于降脂药物治疗的指南并未专门涉及移植受者血脂异常的治疗。自20世纪80年代首次报道接受高剂量洛伐他汀的心脏移植患者发生横纹肌溶解以来，已发表了11篇关于移植后使用低剂量洛伐他汀、辛伐他汀或普伐他汀作为单一药物治疗的系列研究。这些研究显示横纹肌溶解的总体发生率为1%，定义为肌酸激酶>正常上限10倍并伴有肌肉症状。一项随机对照前瞻性试验研究了降脂药物治疗对心脏移植受者患者预后的影响。在这项非盲、单中心试验的1年随访中，移植后2周内开始使用普伐他汀（20或40mg/天）治疗的患者死亡率显著降低，移植血管病的发生率也显著降低。关于心脏移植后高脂血症患者的治疗指南，仍有许多重要问题未得到解答。1995年1月，我们启动了心脏移植血脂登记处，有12个参与中心，以前瞻性收集降脂药物治疗心脏移植后血脂异常的疗效和安全性数据。
