EFFICACY AND SAFETY OF COMBINED THERAPY WITH ATORVASTATIN AND TACROLIMUS IN HEART TRANSPLANT RECIPIENTS

Introduction: The HMG-CoA inhibitors are part of the standard medication after orthotopic heart transplantation (OHTx), but they could interact with cyclosporin A (CyA). 
Aim: To evaluate the efficacy and safety of combined therapy with atorvastatin and tacrolimus (TAC) in heart transplant recipients with dyslipidemia in spite of fluvastatin therapy.
Method: We followed up a group of 23 OHTx patiens (8 women, 15 men, age range 52,56 ± 11,78) with repeatedly detected levels of total cholesterol above 5,5 mmol/l in spite of fluvastatin therapy. CyA was the main imunosuppression. Subsequently the patients have been switched to TAC and atorvastatin in starting dose of 20 mg. The controls with blood tests was performed one month after conversion and then every three months up to one year. In the time of writing this abstract are evaluated controls one month and four month after conversion. Statistics: pair t-test, ANOVA test.
Results: TAC was tolerated in all patients, no appearance of myalgia or creatinkinase elevation was detected. Total cholesterol levels declined significantly after one month (6,21±0,89 mmol/l before conversion; 4,86±0,70 mmol/l after conversion; p<0,0001), as well as did LDL cholesterol (3,66±0,94 vs. 2,48±0,78; p<0,0001) and apolipoprotein-B (1,11±0,02  vs. 0,78±0,19 g/l; p<0,0001). By contrast levels of HDL-cholesterol, apolipoprotein-A and creatinine changed only non-significantly. The subgroup  of 16 patients underwent the control after four month. Levels of total cholesterol, LDL-cholesterol and apolipoprotein-B  remained decreased in comparison with levels before conversion, but they didn´t change significantly in accordance with the control after first month.
Conclusion: Switching to TAC with subsequent atorvastatin therapy after OHTx resulted in significant decrease of cholesterol, LDL-cholesterol and apolipoprotein-B levels.