Cardiovascular risk profile in nondiabetic renal transplant patients:: Cyclosporine versus tacrolimus

Calcineurin inhibitors (CIs) contribute to cardiovascular risk (CR) in renal transplant (RT) patients. However, the CR profile in RT patients without preexistent diabetes is not well known. We compared CR factors in 191 nondiabetic RT recipients with functioning grafts beyond I year, receivingly either CsA (Neoral; n = 100) or tacrolimus (Tac; n = 91). Clinical data and pretransplant CR profiles were similar in both groups. There were no differences in acute rejection episodes and graft survival rates during follow-up. The overall proportions of posttransplant diabetes (9% versus 6%), and of hypertension (73% vs 63%) were similar in both groups. Hyperlipidemia was more frequent in the CsA group (58% vs 31%; P = .0001). The cholesterol levels in the CsA group showed at 3 months (232 +/- 47 vs 202 +/- 42 m/dL; P = .0001), 6 months (232 +/- 49 vs 205 +/- 41 mg/dL; P = .0001), and 12 months (217 +/- 50 vs 202 +/- 40 mg/dL; P = .028), despite receiving a greater proportion of lipid-lowering drugs (49% vs 15%; P = .0001). Logistic regression analysis showed that CsA was an independent predictor of posttransplant hyperlipidemia (OR: 5.8, CI 95%; 3.3-10.7; P = .0001) as were age, female gender, pretransplant dyslipidemia, and body mass index (BMI). Interestingly, an interaction was observed between pretransplant BMI and CIs: Among pretransplant normal weight patients (BMI < 25 kg/m(2)), CsA produced a greater incidence of hyperlipidemia than tacrolimus (58% vs 23%; P = .0001) while not among patients who were overweight (BMI > 25 kg/m(2): pretransplant 58% vs 42%; P = .341). In conclusion, CsA confers a higher risk of hyperlipidemia after RT in nondiabetic patients, particularly those with normal pretransplant weight.