Abstract:
BACKGROUND:Coronary artery disease is a major cause of death in transplant recipients. PURPOSE:To review current approaches for the detection, evaluation, and treatment of coronary artery disease in transplant recipients. SUMMARY:Renal transplantation promotes the development of coronary artery disease primarily because immunosuppressant medications accentuate known coronary risk factors such as hypertension, hypercholesterolemia, and hyperglycemia that accelerate the progression of coronary artery disease existing before transplantation. Physicians can monitor a patient's risk status by regular inquiries for symptoms and by simple clinical tools such as the Framingham Study Coronary Heart Disease Risk Prediction Chart in asymptomatic patients. Patients found to be at high risk for coronary artery disease can then undergo dobutamine echocardiography or other noninvasive tests, and patients with positive studies can subsequently undergo angiography. The cost-effectiveness of such an approach is presented. In recent studies at our institution, patients with coronary artery disease had decreased numbers of CD2+ and CD3+ circulating lymphocytes. In addition, in immunosuppressed transplant recipients with coronary artery disease, there was a decrease in CD8+ lymphocytes, whereas in nonimmunosuppressed, nontransplant patients there was a decrease in CD4+ lymphocytes. CONCLUSIONS:A systematic approach to screening patients for coronary artery disease before transplantation can identify those at highest risk and potentially save money and lives. Possible new avenues of research may focus on the role of the lymphocytes in coronary atherosclerosis.
journal_name
Cleve Clin J Medjournal_title
Cleveland Clinic journal of medicineauthors
Braun WE,Marwick THdoi
10.3949/ccjm.61.5.370subject
Has Abstractpub_date
1994-09-01 00:00:00pages
370-85issue
5eissn
0891-1150issn
1939-2869journal_volume
61pub_type
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journal_title:Cleveland Clinic journal of medicine
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