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Management of Cardiovascular Disease in Renal Transplant Recipients

Division of Nephrology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut

Correspondence: Dr. Margaret J. Bia, Renal Section, Department of Medicine, Yale University School of Medicine, FMP 107, P.O. Box 208029, New Haven, CT 06520. Phone: 203-785-4184; Fax: 203-785-7068; E-mail: margaret.bia{at}yale.edu

Cardiovascular disease is a major cause of graft loss and the leading cause of death in renal transplant recipients. Although there are robust data on the frequency of risk factors and their contributions to cardiovascular disease in this population, few trials have demonstrated the benefit of modifying these risk factors to reduce cardiovascular events. Nevertheless, it is widely accepted that the clinical acumen filtered through the best available studies in the general population be used to treat individual renal transplant recipients given their high cardiovascular mortality. Transplant task forces and the Kidney Disease Outcomes Quality Initiative have created guidelines for this purpose. This review examines the data available for prevention and treatment of major risk factors contributing to cardiovascular disease in renal transplant recipients. The contribution of immunosuppressive agents to each risk factor and the evidence to support lifestyle modification as well as drug therapy are examined. Reducing cardiovascular risk factors requires an integrative approach that is best accomplished by a team of health care professionals. It creates a significant challenge but one that must be met if allograft survival is to improve.