Cardiovascular disease in stable renal transplant patients in Norway: morbidity and mortality during a 5-yr follow-up

Background: Although cardiovascular disease is a major cause of death after renal transplantation (Tx), predictors for cardiovascular events have not been well defined. Aims of this cross-sectional study were first to assess cardiovascular morbidity and mortality in stable renal Tx patients, and to identify predictors for cardiovascular events during long-term follow-up. Methods: In all, 406 renal Tx patients (mean age: 47 yr, 60.1% males, 70.9% using cyclosporine A) commenced a baseline registration (median) 48 months after Tx, and 405 was thereafter followed in 5 yr. Kaplan-Meier plots and multivariate regression analysis (Cox proportional hazards model) were used to identify and characterize predictors for cardiovascular events. Results: There were 88 deaths (average annual mortality: 4.4%), and 74% of these were cardiovascular. In age groups 40-49, 50-59, and 60-69 yr, odds ratio for cardiovascular mortality in patients vs. general population was 46.2, 20.1, and 8.0, respectively. Death from ischemic heart disease (IHD) was independently predicted by baseline congestive heart failure (relative risk: RR 5.33), diabetes (RR 2.28), systolic blood pressure (mmHg, RR 1.02), age (yr, RR 1.06), and high-density lipoprotein cholesterol (mmol/L, RR 0.36). Predictors for a major ischemic heart event (death from or onset of IHD) were in addition baseline total cholesterol (mmol/L, RR 1.18) and cerebrovascular disease (RR 2.98). Conclusions: Thus, IHD was the major cause of death late after renal Tx, and a major ischemic heart event was predicted by baseline congestive heart failure, diabetes, age, hypertension, and hypercholesterolemia.