Can Too Much Be Bad: Aggressively Lowering LDL Not Associated with Improvement in Maximal Intimal Thickening

Purpose Statins are the only Class I ISHLT recommendation in heart transplantation (HT) as an established therapy to reduce cardiac allograft vasculopathy (CAV) and improve survival. However, the goal LDL is not known with no formal recommendation on targets. We assessed if LDL Methods This was a retrospective study in heart transplant recipients between 01/2012 and 8/2018 at a single institution. All patients were on a statin within discharge of index hospitalization if tolerated. Continuous variables were summarized in terms of median and interquartile range (IQR), and dichotomous and polytomous variables were summarized using frequencies. Between-group differences were assessed using Wilcoxon rank-sum tests for continuous variables and Fisher's exact tests for dichotomous and polytomous variables. Univariable linear regression modeling was used to evaluate the effect of LDL on MIT at 1 year. Results Overall, 89 patients were included with known LDL at 1 year and use of statin therapy. The cohort was predominantly male (74%), Caucasian (55%), with 72% having non-ischemic cardiomyopathy (Table 1). There were 68 patients who had an IVUS at 1 year ± 6 months from transplant. Overall LDL at 1 year was not significantly associated with differences in MIT at 1 year (p=0.90). A LDL Conclusion In this study, lower LDL levels was not associated with improved IVUS findings at 1 year post-transplant. Future studies are warranted to examine the longer-term relationship between low LDL levels and CAV as well as the role of high-intensity statin therapy. Additionally, potential confounders will need to be considered.