High rate of metabolic syndrome following heart transplantation
MedWire News: Nearly half of all patients who undergo heart transplantation develop the metabolic syndrome, research suggests.
Among those who developed the metabolic syndrome early after heart transplantation, there was a trend toward reduced survival, report Ignacio Sánchez-Lázaro (Hospital Universitari i Politècnic, La Fe, Valencia, Spain) and colleagues in the journal Transplantation Proceedings.
Despite the increased risk for mortality, investigators do not believe the surgery should be contraindicated in those who already have the metabolic syndrome.
Instead, " it should alert us to this higher risk population that will require closer monitoring and possibly alternative treatment regimens," say the researchers.
Metabolic syndrome among the general population is associated with an increased risk for cardiovascular events. It is typically characterized by vascular endothelium dysfunction.
There is limited data, however, on the impact of developing metabolic syndrome shortly after heart transplantation.
The researchers studied 196 heart transplant patients who survived more than 1 year after surgery.
Among these patients, 96 (48%) were diagnosed with metabolic syndrome within 3 months of heart transplant surgery.
Of these, 54 patients had the metabolic syndrome prior to surgery, while an additional 42 patients developed the syndrome in the first 3 months after surgery.
There was no observed difference in terms of gender, underlying etiology, smoking, pre-transplant diabetes, or immunosuppression between those who developed metabolic syndrome and those who did not.
However, individuals who developed the metabolic syndrome were older and had higher baseline creatinine levels before heart transplantation, as well as higher body mass indexes.
In addition, individuals who developed the metabolic syndrome were significantly more likely to have hypertension and dyslipidemia before transplantation than those who did not.
Long-term survival was higher among the non-metabolic syndrome patients, although the between-group differences did not reach statistical significance.
Mean survival among the metabolic syndrome patients was 2381 days compared with 2900 days in those without metabolic syndrome.
"Although the difference between groups was not significant, there was a clear trend," according to Sánchez-Lázaro and colleagues. "The difference likely would have achieved significance with a larger number of subjects."
The researchers believe that the development of the metabolic syndrome could be related to the use of immunosuppressants.
For example, corticosteroids and calcineurin inhibitors are known to display diabetogenic and dyslipidemic effects.
The causes of death were not evaluated in the study, but the group said the lower survival rate among heart transplant patients with the metabolic syndrome is largely due to cardiovascular causes.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
By MedWire Reporters