Non-HDL cholesterol is an independent predictor of long-term cardiovascular events in patients with dyslipidemia after renal transplantation

Background Posttransplant dyslipidemia is a common condition in renal transplantation recipients (RTR) and is related to poor cardiac outcomes. We aimed to demonstrate the value of non-high-density lipoprotein cholesterol (non-HDL-C) in predicting long-term major cardiovascular and cerebrovascular events (MACCE) in RTR with dyslipidemia. Methods Patients who had undergone renal transplantation between 2011 and 2019 were retrospectively analysed and were classified as normal non-HDL-C and high non-HDL-C groups based on first year levels. Development of high non-HDL-C levels was used to predict the occurrence of MACCE (a combination of cardiac death, nonfatal myocardial infarction, unstable angina, and nonfatal stroke) and all-cause death during the long-term follow-up. Results Overall, 674 patients were included, of whom 470 (69.7%) were male; the mean age was 43.6 +/- 13.2 years. The mean follow-up duration was 5.5 +/- 2.29 years 1 year after the transplant. MACCE occurred during the follow-up in 102 (61.8%) patients in the high non-HDL-C group and 13 (2.6%) patients in the normal non-HDL-C group (P < .001). High non-HDL-C was a predictor of MACCE in the multivariate analysis (hazard ratio [HR] 1.02, 95% confidence interval [CI] 1.01-1.02, P < .001). Smoking (HR: 1.92, 95% CI 1.16-3.20, P < .001), cadaver graft (HR: 2.55, 95% CI 1.52-4.26, P < .001), and left ventricular ejection fraction (HR: 0.96, 95% CI 0.94-0.98, P < .001) were also predictors of MACCE. Kaplan-Meier analysis revealed that all MACCE components and all-cause mortality were significantly higher in the high non-HDL-C group (P < .001). Conclusion Non-HDL-C was closely related to long-term cardiac outcomes in RTR with dyslipidemia. Non-HDL-C should be among the primary goals in lipid-lowering treatment in post-transplant dyslipidemia.