03431nas a2200373   4500008003900000245014200039210006900181260000800250300001200258490000700270520219000277653007302467653001902540653004402559653003302603653001102636653005402647653004202701653004802743653002002791653001702811100001602828700001702844700001602861700001302877700001702890700001902907700002102926700001502947700001402962700001602976700001602992856004903008       2005                          d00aGlobal cardiovascular risk under early corticosteroid cessation decreases progressively in the first year following renal transplantation0 aGlobal cardiovascular risk under early corticosteroid cessation   cMar  a812 - 30 v373 aA primary reason to eliminate corticosteroids from immunosuppressive regimens in solid organ transplant recipients is improved cardiovascular risk profiles. Although a number of studies have documented that corticosteroid withdrawal (CSWD) regimens reduce hypertension, hyperlipidemia, diabetes, and weight gain, global assessments of cardiovascular risk under CSWD have not been reported. The purpose of this study was to document cardiovascular risk under CSWD using a global risk assessment by Framingham risk assessment. METHODS: Framingham global cardiovascular risk assessments were performed at baseline and 3, 6, and 12 months posttransplant on patients enrolled in prospective, IRB-approved early (<7 days of corticosteroids) CSWD trials. Framingham score was based on age, sex, presence of diabetes, HDL and total cholesterol, and systolic blood pressure. All patients were nonsmokers. Left ventricular hypertrophy assessment by EKG criteria was not available at all time points and therefore were not included. RESULTS: One hundred eighty-three patients were included in the analysis. Fourteen percent of patients had evidence of coronary heart disease (prior MI, CABG, PTCA, or significant cardiovascular disease as evidenced by angiography) prior to transplant. Complete information was available for 160 patients at baseline, 132 at 1, 3, and 6 months, and 93 at 12 months posttransplant. Mean 10-year risk (expressed as percent) for developing coronary heart disease decreased over time: 8.03 at baseline, 8.31 at 3 months, 7.40 at 6 months, and 7.20 at 12 months, indicating that global cardiovascular risk fell at 1 year posttransplant by about 10% in renal transplant recipients undergoing early CSWD. CONCLUSIONS: Estimation of cardiovascular risk by Framingham risk factor assessment allows incorporation of several cardiovascular risk factors into a single estimate, thereby accounting for differential effects of each individual factor on global cardiovascular risk. This experience indicates that global cardiovascular risk decreases by approximately 10% at 1 year posttransplant in renal transplant recipients who undergo early corticosteroid withdrawal (CSWD).10aAdrenal Cortex Hormones / administration & dosage / *therapeutic use10aBlood Pressure10aCardiovascular Diseases / *epidemiology10aDrug Administration Schedule10aHumans10aKidney Transplantation / immunology / *physiology10aLipoproteins, HDL Cholesterol / blood10aPostoperative Complications / *epidemiology10aRisk Assessment10aRisk Factors1 aRogers, C C1 aAlloway, R R1 aBoardman, R1 aTrofe, J1 aHanaway, M J1 aAlexander, J W1 aRoy-Chaudhury, P1 aBuell, J F1 aThomas, M1 aSusskind, B1 aWoodle, E S  uhttps://www.notifylibrary.org/reference/1327