Systemic Inflammation and Metabolic Syndrome in Cardiac Allograft Vasculopathy

Eugenia Raichlin, Joseph P. McConnell, Amir Lerman, Walter K. Kremers, Brooks S. Edwards, Sudhir S. Kushwaha, Alfredo L. Clavell, Richard J. Rodeheffer, Robert P. Frantz

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Background: Metabolic syndrome and elevation of inflammatory markers is common in transplant recipients. We investigated the role of insulin resistance and C-reactive protein (CRP) in predicting development of angiographic cardiac allograft vasculopathy (CAV). Methods: CRP and lipid profile were measured in 114 cardiac transplant recipients at 4.7 ± 3.1 years post-transplant. A triglyceride/high-density lipoprotein cholesterol (TG/HDL) ratio of ≥3 was considered a marker of insulin resistance. Ninety-seven patients (mean age ± SD: 48.2 ± 16.7 years) subsequently underwent routine coronary angiography at 8.6 ± 3.2 years post-transplantation. Diagnosis of CAV required the presence of stenosis of ≥40% in any major branch, and/or distal pruning of secondary side branches. Coronary artery stenosis ≥70% was defined as severe. Results: Eighty-one percent of patients were treated with statins. Low-density lipoprotein (LDL)-cholesterol level was 98 ± 26 mg/dl at study entry. CRP and TG/HDL were found to be predictors of development of CAV. CAV severity correlated with TG/HDL (p < 0.005), but not with CRP level. Freedom from CAV 5 years after study entry was 9% in patients with TG/HDL >3, CRP >3 mg/liter, as compared with 65% in patients with TG/HDL <3, CRP <3 mg/liter (p = 0.003). The combination of CRP >3 mg/liter and TG/HDL >3 identified a sub-group of patients having a 2.8-fold increased odds ratio for a combined end-point of cardiovascular (CV) events (percutaneous coronary intervention, coronary artery bypass graft, left ventricular ejection fraction <45%) and death (95% confidence interval 0.90 to 8.45, p = 0.07) compared to patients with CRP <3 mg/liter and TG/HDL <3. Conclusions: CRP >3 mg/liter and TG/HDL >3 are cumulative risk factors for angiographic CAV and the combined end-point of CV events and death in transplant patients and these patients should be targeted for intervention.

Original languageEnglish (US)
Pages (from-to)826-833
Number of pages8
JournalJournal of Heart and Lung Transplantation
Volume26
Issue number8
DOIs
StatePublished - Aug 1 2007

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HDL Cholesterol
Allografts
Triglycerides
Inflammation
C-Reactive Protein
Transplants
Insulin Resistance
HDL3 Lipoprotein
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Coronary Stenosis
Percutaneous Coronary Intervention
Coronary Angiography
Coronary Artery Bypass
Stroke Volume
LDL Cholesterol
Pathologic Constriction
Transplantation
Odds Ratio
Lipids
Transplant Recipients

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

Cite this

Raichlin, E., McConnell, J. P., Lerman, A., Kremers, W. K., Edwards, B. S., Kushwaha, S. S., ... Frantz, R. P. (2007). Systemic Inflammation and Metabolic Syndrome in Cardiac Allograft Vasculopathy. Journal of Heart and Lung Transplantation, 26(8), 826-833. https://doi.org/10.1016/j.healun.2007.05.008

Systemic Inflammation and Metabolic Syndrome in Cardiac Allograft Vasculopathy. / Raichlin, Eugenia; McConnell, Joseph P.; Lerman, Amir; Kremers, Walter K.; Edwards, Brooks S.; Kushwaha, Sudhir S.; Clavell, Alfredo L.; Rodeheffer, Richard J.; Frantz, Robert P.

In: Journal of Heart and Lung Transplantation, Vol. 26, No. 8, 01.08.2007, p. 826-833.

Research output: Contribution to journalArticle

Raichlin, E, McConnell, JP, Lerman, A, Kremers, WK, Edwards, BS, Kushwaha, SS, Clavell, AL, Rodeheffer, RJ & Frantz, RP 2007, 'Systemic Inflammation and Metabolic Syndrome in Cardiac Allograft Vasculopathy', Journal of Heart and Lung Transplantation, vol. 26, no. 8, pp. 826-833. https://doi.org/10.1016/j.healun.2007.05.008
Raichlin E, McConnell JP, Lerman A, Kremers WK, Edwards BS, Kushwaha SS et al. Systemic Inflammation and Metabolic Syndrome in Cardiac Allograft Vasculopathy. Journal of Heart and Lung Transplantation. 2007 Aug 1;26(8):826-833. https://doi.org/10.1016/j.healun.2007.05.008
Raichlin, Eugenia ; McConnell, Joseph P. ; Lerman, Amir ; Kremers, Walter K. ; Edwards, Brooks S. ; Kushwaha, Sudhir S. ; Clavell, Alfredo L. ; Rodeheffer, Richard J. ; Frantz, Robert P. / Systemic Inflammation and Metabolic Syndrome in Cardiac Allograft Vasculopathy. In: Journal of Heart and Lung Transplantation. 2007 ; Vol. 26, No. 8. pp. 826-833.
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abstract = "Background: Metabolic syndrome and elevation of inflammatory markers is common in transplant recipients. We investigated the role of insulin resistance and C-reactive protein (CRP) in predicting development of angiographic cardiac allograft vasculopathy (CAV). Methods: CRP and lipid profile were measured in 114 cardiac transplant recipients at 4.7 ± 3.1 years post-transplant. A triglyceride/high-density lipoprotein cholesterol (TG/HDL) ratio of ≥3 was considered a marker of insulin resistance. Ninety-seven patients (mean age ± SD: 48.2 ± 16.7 years) subsequently underwent routine coronary angiography at 8.6 ± 3.2 years post-transplantation. Diagnosis of CAV required the presence of stenosis of ≥40{\%} in any major branch, and/or distal pruning of secondary side branches. Coronary artery stenosis ≥70{\%} was defined as severe. Results: Eighty-one percent of patients were treated with statins. Low-density lipoprotein (LDL)-cholesterol level was 98 ± 26 mg/dl at study entry. CRP and TG/HDL were found to be predictors of development of CAV. CAV severity correlated with TG/HDL (p < 0.005), but not with CRP level. Freedom from CAV 5 years after study entry was 9{\%} in patients with TG/HDL >3, CRP >3 mg/liter, as compared with 65{\%} in patients with TG/HDL <3, CRP <3 mg/liter (p = 0.003). The combination of CRP >3 mg/liter and TG/HDL >3 identified a sub-group of patients having a 2.8-fold increased odds ratio for a combined end-point of cardiovascular (CV) events (percutaneous coronary intervention, coronary artery bypass graft, left ventricular ejection fraction <45{\%}) and death (95{\%} confidence interval 0.90 to 8.45, p = 0.07) compared to patients with CRP <3 mg/liter and TG/HDL <3. Conclusions: CRP >3 mg/liter and TG/HDL >3 are cumulative risk factors for angiographic CAV and the combined end-point of CV events and death in transplant patients and these patients should be targeted for intervention.",
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AU - Raichlin, Eugenia

AU - McConnell, Joseph P.

AU - Lerman, Amir

AU - Kremers, Walter K.

AU - Edwards, Brooks S.

AU - Kushwaha, Sudhir S.

AU - Clavell, Alfredo L.

AU - Rodeheffer, Richard J.

AU - Frantz, Robert P.

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N2 - Background: Metabolic syndrome and elevation of inflammatory markers is common in transplant recipients. We investigated the role of insulin resistance and C-reactive protein (CRP) in predicting development of angiographic cardiac allograft vasculopathy (CAV). Methods: CRP and lipid profile were measured in 114 cardiac transplant recipients at 4.7 ± 3.1 years post-transplant. A triglyceride/high-density lipoprotein cholesterol (TG/HDL) ratio of ≥3 was considered a marker of insulin resistance. Ninety-seven patients (mean age ± SD: 48.2 ± 16.7 years) subsequently underwent routine coronary angiography at 8.6 ± 3.2 years post-transplantation. Diagnosis of CAV required the presence of stenosis of ≥40% in any major branch, and/or distal pruning of secondary side branches. Coronary artery stenosis ≥70% was defined as severe. Results: Eighty-one percent of patients were treated with statins. Low-density lipoprotein (LDL)-cholesterol level was 98 ± 26 mg/dl at study entry. CRP and TG/HDL were found to be predictors of development of CAV. CAV severity correlated with TG/HDL (p < 0.005), but not with CRP level. Freedom from CAV 5 years after study entry was 9% in patients with TG/HDL >3, CRP >3 mg/liter, as compared with 65% in patients with TG/HDL <3, CRP <3 mg/liter (p = 0.003). The combination of CRP >3 mg/liter and TG/HDL >3 identified a sub-group of patients having a 2.8-fold increased odds ratio for a combined end-point of cardiovascular (CV) events (percutaneous coronary intervention, coronary artery bypass graft, left ventricular ejection fraction <45%) and death (95% confidence interval 0.90 to 8.45, p = 0.07) compared to patients with CRP <3 mg/liter and TG/HDL <3. Conclusions: CRP >3 mg/liter and TG/HDL >3 are cumulative risk factors for angiographic CAV and the combined end-point of CV events and death in transplant patients and these patients should be targeted for intervention.

AB - Background: Metabolic syndrome and elevation of inflammatory markers is common in transplant recipients. We investigated the role of insulin resistance and C-reactive protein (CRP) in predicting development of angiographic cardiac allograft vasculopathy (CAV). Methods: CRP and lipid profile were measured in 114 cardiac transplant recipients at 4.7 ± 3.1 years post-transplant. A triglyceride/high-density lipoprotein cholesterol (TG/HDL) ratio of ≥3 was considered a marker of insulin resistance. Ninety-seven patients (mean age ± SD: 48.2 ± 16.7 years) subsequently underwent routine coronary angiography at 8.6 ± 3.2 years post-transplantation. Diagnosis of CAV required the presence of stenosis of ≥40% in any major branch, and/or distal pruning of secondary side branches. Coronary artery stenosis ≥70% was defined as severe. Results: Eighty-one percent of patients were treated with statins. Low-density lipoprotein (LDL)-cholesterol level was 98 ± 26 mg/dl at study entry. CRP and TG/HDL were found to be predictors of development of CAV. CAV severity correlated with TG/HDL (p < 0.005), but not with CRP level. Freedom from CAV 5 years after study entry was 9% in patients with TG/HDL >3, CRP >3 mg/liter, as compared with 65% in patients with TG/HDL <3, CRP <3 mg/liter (p = 0.003). The combination of CRP >3 mg/liter and TG/HDL >3 identified a sub-group of patients having a 2.8-fold increased odds ratio for a combined end-point of cardiovascular (CV) events (percutaneous coronary intervention, coronary artery bypass graft, left ventricular ejection fraction <45%) and death (95% confidence interval 0.90 to 8.45, p = 0.07) compared to patients with CRP <3 mg/liter and TG/HDL <3. Conclusions: CRP >3 mg/liter and TG/HDL >3 are cumulative risk factors for angiographic CAV and the combined end-point of CV events and death in transplant patients and these patients should be targeted for intervention.

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