Key result
Early statin initiation (<2 years) after heart transplantation reduced the risk of all-cause mortality and CAV-associated events compared with late initiation (HR 0.58; 95% CI 0.38-0.91; P=0.019).
Why the study?
Does early statin initiation reduce cardiac allograft vasculopathy progression and clinical events in adult heart transplant recipients?
Cohort (n=409)
Does early statin initiation reduce cardiac allograft vasculopathy progression and clinical events in adult heart transplant recipients?
Hazard Ratio: 0.58 (95% CI 0.38–0.91)
p-value: p=0.019
Early initiation of statin therapy within 2 years after heart transplantation significantly attenuates cardiac allograft vasculopathy progression and reduces related clinical events and mortality.
Supports early statin consideration post-transplant; extends observational data but leaves open need for RCT confirmation.
AIMS: Early studies from the 1990s have shown that statins improve survival and attenuate cardiac allograft vasculopathy (CAV). However, little contemporary data are available on the incremental benefit of statins with the current use of new-generation immunosuppressive agents and the use of coronary intravascular ultrasound for assessment of CAV. We sought to investigate the effect of early statin (ES) as compared with late statin (LS) initiation after heart transplantation (HT) on long-term CAV progression and clinical outcomes in a large contemporary HT cohort. METHODS AND RESULTS: We analysed a cohort of 409 adult HT recipients. CAV progression was assessed by serial coronary intravascular ultrasound volumetric measurements of the differences between baseline and last follow-up plaque volume (PV) and plaque index (PV/vessel volume ratio). CAV progression and clinical outcomes were compared between the ES (<2 years after HT) and the LS (>2 years after HT) groups. During a median follow-up of 8.2 years, ES resulted in significantly lower change (Δ) of plaque index (+3.8% ± 1.7% vs. +8.2% ± 3.6%; P = 0.0008) and PV (+0.8 ± 0.3 vs. +1.9 ± 1.2; P = 0.045) compared with LS group. In a Cox proportional hazards regression model and after adjustment for baseline characteristics, ES was associated with a 52% decreased risk of CAV-associated events (hazard ratio 0.48, 95% confidence interval: 0.27-0.91; P = 0.025) and a 42% decreased risk of the composite endpoint of all-cause mortality and CAV-associated events (hazard ratio 0.58, 95% confidence interval: 0.38-0.91; P = 0.019). CONCLUSIONS: Early initiation of statin therapy after HT results in attenuated CAV progression as well as in decreased CAV-related events and mortality.
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Asleh et al. (2018) conducted a cohort in Heart transplant (n=409). Early statin initiation (<2 years after HT) vs. Late statin initiation (>2 years after HT) was evaluated on Composite of all-cause mortality and CAV-associated events (HR 0.58, 95% CI 0.38-0.91, p=0.019). Early statin initiation (<2 years) after heart transplantation reduced the risk of all-cause mortality and CAV-associated events compared with late initiation (HR 0.58; 95% CI 0.38-0.91; P=0.019).
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