Statin therapy for preventing cardiovascular diseases in patients treated with tacrolimus after kidney transplantation

Abstract

Nayoung Han,1,* Seung Hee Han,1,2,* Yun-Kyoung Song,1 Myeong Gyu Kim,1 Yon Su Kim,3,4 In-Wha Kim,1,* Jung Mi Oh1,* 1Research Institute of Pharmaceutical Sciences, College of Pharmacy, Seoul National University, Seoul, 2Department of Pharmacy, Asan Medical Center, Seoul, 3Department of Internal Medicine, Seoul National University Hospital, Seoul, 4College of Medicine, Seoul National University, Seoul, Republic of Korea *These authors contributed equally to this work Background: Lipid abnormalities are prevalent in tacrolimus-treated patients. The aim of the study was to evaluate the preventive effects of statin therapy on major adverse cardiovascular events (MACE) in patients treated with tacrolimus-based immunosuppression after kidney transplantation (KT), and to identify the risk factors. Methods: This observational cohort study included adult patients who underwent KT and were treated with tacrolimus. Patients who received any lipid-lowering agents except statins, or had a history of immunosuppressant use before transplantation were excluded. The primary outcome was the adjusted risk of the first occurrence of MACE. The secondary outcomes included the risk of individual cardiovascular disease (CVD) and changes in cholesterol level. Subgroup analyses were performed in the statin-user group according to the dosage and/or type of statin. Results: Compared with the control group (n=73), the statin-users (n=92) had a significantly reduced risk of MACE (adjusted HR, 0.31; 95% CI, 0.13–0.74). In the Cox regression analysis, old age, history of CVD, and comorbid hypertension were identified as independent factors associated with increased MACE. The total cholesterol levels were not significantly different between the two groups. Subjects with higher cumulative defined daily dose of statins had significantly lower risks of MACE. Conclusion: Statin therapy in patients treated with tacrolimus after KT significantly lowered the risk of MACE. Long-term statin therapy is clearly indicated in older kidney transplant recipients for secondary prevention. Keywords: kidney transplantation, tacrolimus, HMG-CoA reductase inhibitors, major adverse cardiovascular events (MACE)

Keywords

• kidney transplantation
• tacrolimus
• HMG-CoA reductase inhibitors
• major adverse cardiovascular events (MACE)