With the new recommendations on cardiovascular risk a high proportion of renal transplant patient s will be categorized as high cardiovascular risk (glomerular filtration rate frequently less than 60 ml / min). Consequently, if we follow these recommendations should use drug therapy such as statins. It is expected cardiovascular benefit in the medium to long term ?
No I do not think there is. However the combination statin and ezetimibe (EZ) seems to be of value which was shown in the Sharp study. This might be explained by the fact that in kidney disease there is a lot of remnat lipoprotein particles and that newly syntetized partícles from the intestine migt be decreased by EZ, another explanation might be that EZ also have effects in the liver?!
According to one research paper ahead of print entitled statins use prolong patient survival after renal transplant published by the journal of the American society of Nephrology ......kidney transplant patients should not be denied the likely benefits of statins although the benefits still remain to be rigorously proved
There is no definite evidence of such benefit, although there is a number of papers suggesting potential gain, especially in older recipients. In patients after renal transplantation there is a high incidence of atherosclerosis, thus this group could be considered as high risk of CAD. In addition, cytostatic treatment may promote secondary hiperlipidemia. Decision of the treatment with statins should be individualized, based also on concomitant treatment (i. e. cyclosporine reduces hepatic metabolism, which leads to higher blood concentrations of statins and higher risk of toxicity).
I think they are useful not specially because of the renal transplant but in order that they are high risk cardiovascular patient the statins contributes not only to lower the rate of serum cholesterol but to stabilize the atherome plaque avoiding new CVE.
Regards
Indeed statin therapy may help diminishing CV events in TX patients.
However, due to the immunosuppresive therapy which may induce de nuovo diabetes melitus, one should prescribe only hydrosoluble statis as pravastatin or rosuvastatin while lipophilic statins may decrease insulin due to increased HGM-COA inhibition or direct cytotoxicity* on pancreas (please see link attached) and therefore also increase the risk of onset of DM.
*https://www.utexas.edu/pharmacy/divisions/pharmaco/rounds/chung11-02-12.pdf
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