Effect of Statin Potency on Rapid Coronary Intimal Thickening and Rejection in Heart Transplant Recipients.

Background: Statins help prevent cardiac allograft vasculopathy (CAV) and rejection in heart transplant recipients. Whether these adverse outcomes can be further attenuated with higher potency statins is unknown. Methods: In this single-center, retrospective study, we compared outcomes of heart transplant patients who received either a higher dose statin (HDS) or a lower dose statin (LDS) at discharge after transplant. Exclusion criteria were age <18 years old, not prescribed a statin, and any of the following within 1 year: death, loss to follow-up, or incomplete data to determine the primary outcome. The primary outcome was CAV at 1 year, defined as International Society for Heart and Lung Transplantation CAV grade ≥1 on angiography or intravascular ultrasound demonstrating rapid coronary intimal thickening (0.5-mm increase in coronary maximal intimal thickness at 1 year). Secondary outcomes were biopsy-proven acute rejection, treated rejection, hemodynamically unstable rejection, and adverse effects. Results: The study population consisted of 81 patients in the HDS group and 103 patients in the LDS group. The incidence of CAV was not different in the HDS vs LDS group (32.1% vs 31.1%, respectively; P=0.881) despite less biopsy-proven acute rejection (2.5% vs 12.6%, respectively; P=0.013) and less treated rejection (2.5% vs 17.5%, respectively; P=0.001) in the HDS group. All other secondary outcomes were similar between groups. Conclusion: Increasing statin intensity in heart transplant patients appears to be safe and may reduce rejection but did not attenuate CAV at 1 year in our population.