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Pharmacotherapy of Hyperlipidemia in Pediatric Heart Transplant Recipients

Current Practice and Future Directions

Abstract

Lipoprotein abnormalities are fairly common after pediatric heart transplantation. Graft coronary artery disease (GCAD) limits long-term survival and has been linked to elevated serum triglyceride levels and decreased high-density lipoprotein levels. Histologically, GCAD represents intimal hyperplasia of the coronary vessel and is best imaged by intravascular ultrasound.

A number of pharmacologic agents are available for the management of lipid disorders but experience with these drugs has mainly been in adults. HMG-CoA reductase inhibitors (statins) are currently used by many adult transplantation centers to alter lipid profiles in the hope of reducing GCAD. The use of statins among pediatric heart transplant centers is more limited. Although rhabdomyolysis is a concern with these agents, the incidence among individuals receiving immunosuppressant therapy is low. Aside from their lipid-lowering properties, statins may also protect against graft failure and rejection.

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Acknowledgements

No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

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Correspondence to Dr Clifford Chin.

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Chin, C., Bernstein, D. Pharmacotherapy of Hyperlipidemia in Pediatric Heart Transplant Recipients. Pediatr-Drugs 7, 391–396 (2005). https://doi.org/10.2165/00148581-200507060-00007

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Keywords

  • Simvastatin
  • Pravastatin
  • Fenofibrate
  • Ezetimibe
  • Mycophenolate Mofetil