Purpose Hypercholesterolemia is seen in approximately 80% of heart transplant patients. Statins are the therapy of choice to lower cholesterol and are reported to have survival benefits in both transplant and non-transplant patients. However, at times statins are not adequate to achieve new National Cholesterol Education Program guidelines, and dosing is limited by concerns for significant drug interactions (with immunosuppressive agents). Therefore, additional cholesterol lowering therapy may be needed. Ezetimibe is a selective cholesterol absorption inhibitor that can be used effectively with statin therapy with potentially a lower risk of adverse effects in heart transplant recipients.
Methods Between 12/02 and 8/04, 12 heart transplant patients on statin therapy were started on ezetimibe at 10 mg p.o. q.d. for cholesterol lowering therapy. Lipid levels, adverse effects, immunosupression drug interactions, and changes in other cholesterol lowering therapy were reviewed at 3 months post start date.
Results The 12 patients were an average of 55 years old at the time of transplant, were 50% male, and were on the average 56.5 months post transplantation at the time of initiating ezetimibe. Three of the 12 patients discontinued ezetimibe during this follow-up period due to muscle pains, nausea/vomiting and diarrhea. Of the remaining 9 patients, between baseline and 3 months follow-up, average cholesterol and triglyceride levels were significantly lower at 3 months (280.11±58.7 to 207.78±57.6, p≤0.001 and 341±208.2 to 234.1±123.1, p=0.026, respectively). There was no change in SGOT, SGPT, alkaline phosphatase, CPK levels or immunosuppression dosage (tacrolimus, cyclosporine, rapamycin, azathioprine, everolimus or prednisone) during this 3-month follow-up period.
Conclusion Ezetimibe appears to be safe and effective for cholesterol lowering therapy in heart transplant patients, however not all patients are able to tolerate the medication. A larger cohort of patients and a longer follow-up period is needed.