High HDL Levels are Associated with Survival Benefit after Heart Transplantation.

Hyperlipidemia has been associated with the development of atherosclerotic cardiovascular disease in non-transplant patients. More recently, first-year LDL cholesterol was found to be a significant risk factor for the development of cardiac allograft vasculopathy (CAV) in a paper by Loupy and colleagues. Previous randomized clinical trials have demonstrated that statins can lower LDL cholesterol as well as decrease the development of CAV. Thus, most heart transplant patients are on statin therapy. In the current era with newer immunosuppressive agents, we sought to confirm that first-year lipid levels have an impact on outcome. Between 2010 and 2017 we assessed 260 HTx patients who survived to 1-year, where we assessed first-year lipid levels (where available) to include high vs low levels of total cholesterol (>200 vs <100mg/dl), LDL-cholesterol (>135 vs <70mg/dl), HDL-cholesterol (>60 vs <40mg/dl) and triglycerides levels (>200 vs <150mg/dl). The percent of patients on statin therapy for each group was included. The outcomes included 5-year survival and 5-year freedom from cardiac allograft vasculopathy (CAV: new stenosis ≥30%). High first-year HDL cholesterol levels compared to low levels had significantly greater 5-year survival although there was no significant difference in 5-year freedom from CAV. There was a trend for low LDL-cholesterol levels compared to high levels to have greater freedom from 5-year CAV. There were no significant differences in outcome in high vs low total cholesterol or high vs low triglyceride levels. There were less patients on statins in the high LDL vs low LDL-cholesterol groups. (See Table) HTx patients with high HDL may have survival benefit but CAV remains same. Further studies into the reason for this finding are being pursued. Low LDL levels appear to have benefit in 5-year outcome. [ABSTRACT FROM AUTHOR]