Retrospective analysis of hyperlipidemia management in a transplant population.

Study Objectives: To determine the prevalence of hyperlipidemia and the effectiveness of hyperlipidemia management in a large population of transplant recipients. A secondary objective was to assess the effect of the National Cholesterol Education Program (NCEP) Adult Treatment Panel III guidelines on hyperlipidemia management compared with the effect from earlier guidelines.

Design: Retrospective review of computerized records.

Setting: University-affiliated transplantation center.

Patients: Three thousand four hundred fourteen patients with liver, kidney, or pancreas transplants.

Measurements And Main Results: To determine a diagnosis of hyperlipidemia and the effectiveness of treatment, we assessed the patients's lipid levels. Hyperlipidemia was defined as a total cholesterol level above 200 mg/dl and/or the use of antihyperlipidemic drugs. Of the 3414 patients in the study, 1638 (48%) had hyperlipidemia. Of these, 711 (43%) were receiving antihyperlipidemic drugs; 227 (32%) of the 711 patients had achieved the total cholesterol goal of 200 mg/dl or below. Low-density lipoprotein cholesterol (LDL) levels were available for 1953 (57%) patients. Of these, 537 patients were receiving cholesterol-lowering drugs, and 384 (72%) of the 537 patients achieved the LDL goal of less than 130 mg/dl.

Conclusion: Although NCEP guidelines recommend monitoring LDL, only slightly more than half of these transplant recipients were monitored. In addition, the patients identified as having hyperlipidemia were not effectively treated to lower their cholesterol levels. Clinicians must be aggressive in diagnosing, monitoring, and treating hyperlipidemia to decrease the rate of cardiovascular disease and to prolong patient survival after transplantation.