The risks and benefits of each agent need to be weighed. Dyslipidemia is unusual EPZ-6438 mouse
in patients with cirrhosis but is common among LT recipients, 45% to 69% of whom develop hyperlipidemia.16, 18 Dyslipidemia is a major risk factor for cardiovascular-related morbidity and mortality. There is a lack of data specific to the LT population, but this risk is at least equal in the transplant population, if not greater (because of the prevalence of additional risk factors). A full understanding of why and how hyperlipidemia is so prevalent in our patients eludes us, but immunosuppression agents certainly contribute to the pathophysiology (Table 2). Comorbidities such as renal insufficiency, frequent in the LT patient, GDC941
also contribute to lipid abnormalities and particularly elevated triglycerides. There are no specific guidelines for the management of hyperlipidemia in the LT population, so the recommendations of NCEP ATP III are suggested. These guidelines recognize conditions that are thought to be equivalent to a previous history of cardiovascular events, such as longstanding diabetes, symptomatic carotid artery disease or peripheral vascular disease, an abdominal aortic aneurysm, and multiple risk factors associated with a 10-year risk > 20% (for the Framingham score calculator, go to http://hp2010.nhlbihin.net/atpiii/calculator.asp?usertype=prof
). Even chronic renal failure with a creatinine level > 1.5 mg/dL or a glomerular filtration rate < 60 mL/minute/1.73 m2 is considered a cardiovascular risk equivalent in some circles. Some transplant physicians believe that a history of any organ transplantation and chronic immunosuppression use should be http://www.selleckchem.com/products/PD-0325901.html
considered a CVD equivalent, but because of the frequency of each of these cardiac risk factors and risk equivalents in our patients, we may not need to lobby for this special status. Goals of cholesterol management are described in Table 3. Another parameter worth discussing is the total cholesterol/high-density lipoprotein (HDL) cholesterol ratio. This ratio is possibly a better predictor of risk: increased risk is identified in men with a ratio higher than 6.4 and in women with a ratio higher than 5.6. Statin medications have been used commonly in solid organ transplant recipients for decades and are well tolerated.25 There has been concern about hepatotoxicity with ezetimibe, particularly when it is used with statins, but a small retrospective study has suggested that it may be safe and effective in combination with statin drugs in LT patients.26 Hypertriglyceridemia with normal cholesterol levels is also very common post-LT. Hypertriglyceridemia responds to fish oil (omega 3) and may be the agent of first choice because very few side effects and drug interactions can be expected.