Everolimus only protects against early cardiac allograft vasculopathy

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1. Everolimus treatment is associated with a lower maximal intimal thickness (MIT) increase during first year (OR=0.14, p=.02). 

2. High dose statins have an independently protective effect on MIT increase in early and late cardiac allograft vasculopathy (CAV). 

3. Higher triglyceride levels at baseline are associated with higher late CAV progression. 

Evidence Rating Level: 2 (Good) 

Study Rundown: The data in this observational study suggest that everolimus is effective at limiting the progression of early CAV (< 1 year), but not for late CAV (< 5 years).  Meanwhile, high-dose statins seem to be protective of both early and late CAV.  This information is useful because MIT progression within the first year has been directly tied to the prognosis of heart transplant patients, with lower MIT progression improving prognosis.   One limitation of this study is that it was not randomized, and as an observational trial there are confounding factors that may be difficult to take into account.  Moreover, as the associations between late MIT progression and prognosis after heart transplant are not yet fully known, more research has to be done before the full impacts of everolimus long-term can be understood.

Click to read the study in American Journal of Transplantation

Relevant Reading: From clinical trials to clinical practice: an overview of Certican (everolimus) in heart transplantation.

In-Depth [retrospective cohort]: 143 heart transplant patients were divided into early and late cohorts with 91 and 52 patients each, respectively.  Patients differed in their treatment protocol, with some receiving everolimus and the control group receiving mycophenolate mofetil (MMF).  The early cohort had their 3-6 week and 1 year post-operative intravascular ultrasound (IVUS) evaluated and the late cohort had the 1 year and 5 year IVUS evaluated. Evaluation focused on the measurement of maximal intimal thickness (MIT), which shows the progression of cardiac allograft vasculopathy.  MIT changed less under everolimus than MMF during the first year (0.23 vs 0.37 mm, p=.05).  In patients with high-dose vs. low-dose statins within the first year, progression of MIT was also delayed (0.23 vs. 0.38, p=0.01).  High dose statins continued to be more effective in preventing development of late CAV at the 5 year mark (10% vs. 39%, p=0.02).  Finally, patients with late CAV had higher median triglycerides as recorded at baseline than those without late CAV (210 vs. 153, p=0.01).

By David Mattos and Allen Ho

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