The impact of aggressive risk factor modification in renal transplant recipients with impaired glucose tolerance or diabetes on the development of de novo cardiac events

Aim: To assess the impact of aggressive cardiac risk factor modification on cardiac outcomes in renal transplant recipients (RTR) with impaired glucose tolerance or type 2 diabetes.Methods: RTR with either impaired glucose tolerance or diabetes were enrolled in an open label randomized controlled trial and randomized to either standard care or aggressive risk factor modification (targeted blood pressure, dyslipidemia, homocysteine, anti-platelet therapy). Clinical and biochemical parameters and investigations including ECG and dobutamine stress echocardiography were recorded at baseline. DSE was available for 94 subjects at baseline and 70 subjects at follow up. New ischemia was defined as new or worsening wall motion stressat follow up compared to baseline. Patients were followed up for the development of new onset acute coronary syndrome, myocardial infarction and cardiac death.Results: 102 patients were recruited into the study. The mean follow up period was 2.05 p 0.8 years. There was a significant difference in all risk factor target goals favouring the aggressive risk factor modification group at the end of the study period. There was no significant difference in follow up ischemia between the two groups [5(15%) vs. 3(7%), p = 0.07] though the number of new events was small. Independent predictors of new ischemia were prior ischemic events (p l 0.001), older age (p = 0.004), urate (p = 0.08), lghsCRP (p = 0.04), calcium (p = 0.09) and random urine protein creatinine ratio (p = 0.09). There was no significant difference in the development of new clinical cardiac ischemic eventsbetween the two groups (p = 0.7).Conclusion: Aggressive cardiac risk factor management did not result in a significant reduction in new ischemia or cardiac event rates compared to standard care in renal transplant recipients.n