TREATMENT OF HYPERLIPIDEMIA IN HEART-TRANSPLANT RECIPIENTS WITH GEMFIBROZIL +/- LOVASTATIN

Improvements in the diagnosis and therapy of early rejection and infection have resulted in >80% 1-year survival for heart transplant recipients.1 However, accelerated coronary vasculopathy is a frequent long-term complication and is the cause of death in up to 20% of patients followed >1 year,1-3 with some degree of vasculopathy noted in all autopsy examinations.4,5 Hypercholesterolemia, a frequent complication of heart transplantation, appears to be associated with accelerated coronary disease.3,6-8 Several recent studies have demonstrated that reducing plasma cholesterol can decrease the development and the progression of atherosclerosis in both native coronary arteries and bypass grafts.9-11 Based on these factors, there have been several reports on the use of hypolipidemic drugs in heart transplant recipients. 12,13 These studies usually involved only a small number of patients and only 1 drug. We therefore retrospectively examined changes in lipid values in 71 heart transplant recipients who received drug therapy for hyperlipidemia that was primarily guided by a step-care approach involving gemfibrozil in 2 doses, followed by lovastatin for more resistant cases. © 1993.