Predicting coronary heart disease in renal transplant recipients: A prospective study

Background. Current cardiovascular risk calculators, widely used in the general population, have not yet been validated in renal transplant recipients. We conducted a prospective study to determine the incidence and risk factors for ischemic heart disease in renal transplant recipients and to assess the relevance of the Framingham Heart Study risk calculator in this population. Methods. Three hundred and forty four consecutive renal transplant recipients free of vascular disease were enrolled. Coronary events were registered and analyzed with respect to traditional and nontraditional cardiovascular risk factors. The risk of coronary events was assessed through the Framingham Heart Study formula and the relevance of this equation was then analyzed. Results. The patients were followed for a mean duration of 72 +/- 14 months. Twenty seven coronary events occurred in 27 patients (7.8%). In addition to risk factors included in the Framingham Heart Study score, C-reactive protein (CRP) level (P = 0.009), and hyperhomocysteinemia (P = 0.01) were found to be independent risk factors for ischemic heart disease events in renal transplant recipients. The Framingham Heart Study model did not predict absolute ischemic heart disease risk in the transplant population as a whole. Conclusion. Nontraditional cardiovascular risk factors greatly contribute to increased incidence of ischemic heart disease events in renal transplant recipients. They should therefore be considered in preventive care of these patients which relies on reduction of overall absolute risk. Although the Framingham Heart Study score has an excellent predictive value in low-risk renal transplant recipients, it tends to underestimate the real cardiovascular risk in high-risk patients.