Hyperlipidemia after heart transplantation: Report of a 6-year experience, with treatment recommendations

• Published in: Journal of the American College of Cardiology 1992-05, Vol.19 (6), p.1315-1321
• Main Authors: Ballantyne, Christie M., Radovancevic, Branislav, Farmer, John A., Frazier, O.Howard, Chandler, Linda, Payton-Ross, Charlotte, Cocanougher, Beth, Jones, Peter H., Young, James B., Gotto, Antonio M.
• Format: Article
• Language: English
• Subjects: Analysis of Variance; Biological and medical sciences; Drug Therapy, Combination; Follow-Up Studies; General and cellular metabolism. Vitamins; Heart Transplantation - physiology; Heart Transplantation - statistics & numerical data; Humans; Hyperlipidemias - blood; Hyperlipidemias - drug therapy; Hyperlipidemias - epidemiology; Incidence; Lipids - blood; Lovastatin - administration & dosage; Lovastatin - adverse effects; Medical sciences; Pharmacology. Drug treatments; Postoperative Complications - blood; Postoperative Complications - drug therapy; Postoperative Complications - epidemiology; Risk Factors; Texas - epidemiology; Time Factors
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/0735-1097(92)90340-S

Mean plasma lipid values in 100 patients who survived >3 months after heart transplantation increased significantly at 3 months over pretransplantation values: total cholesterol from 168 ± 7 to 234 ± 7 mg/dl, low density lipoprotein (LDL) cholesterol from 111 ± 6 to 148 ± 6 mg/dl, high density lipoprotein (HDL) cholesterol from 34 ± 1 to 47 ± 1 mg/dl and triglycerides from 107 ± 6 to 195 ± 10 mg/dl. There were no significant increases after this time. The LDL cholesterol values remained ≥130 mg/dl in 64% of patients and triglyceride values remained ≥200 mg/dl in 41% of patients 6 months after postoperative dietary instructions. Beginning in 1985, select patients whose total cholesterol values remained >300 mg/dl despite 6 months of dietary intervention were treated with lovastatin given alone in a high dose (40 to 80 mg/day) or in combination with another hypolipidemic agent. Four of the five patients so treated developed rhabdomyolysis; two of the four had acute renal failure. Beginning in 1988, a second protocol—lovastatin at 20 mg/day as monotherapy—was used in patients who despite dietary intervention had total cholesterol > 240 mg/dl (mean follow-up 13 months). In the 15 patients so treated, mean total cholesterol decreased from 299 ± 10 mg/dl before treatment with lovastatin to 235 ± 9 mg/dl during treatment (21% reduction, p < 0.001) and mean LDL cholesterol was reduced from a baseline value of 190 ± 10 to 132 ± 12 mg/dl during treatment (31% reduction, p < 0.001). In this study, lovastatin at a dose of ≤29 mg/day as monotherapy was a well tolerated, effective treatment for hyperlipidemia after heart transplantation. It did not result in rhabdomyolysis and required no alteration in immunosuppressive therapy. However, the dose should not exceed 20 mg/day and combination therapy with either gemfibrozil or nicotinic acid should be avoided, even if the target LDL cholesterol value is not reached.