Immunosuppressant drugs can contribute to high cholesterol

[okarol]

Our member MiSSis was in Southern California this week from Illinois. Even though we didn't get to meet, we had a great phone conversation. One thing we discussed was high cholesterol and transplant recipients. She got me thinking so I looked up more info. Doctor's seem to downplay this type of thing, I think because Jenna is so young. But the longterm effects need to be monitored to keep her healthy for a long time.
Thanks MISSis - I always learn things from our members!

High Cholesterol
Many immunosuppressant drugs can contribute to high cholesterol. This condition therefore affects many transplant recipients. When a patient develops high cholesterol, blood vessels, including the ones attached to the transplanted organ, become clogged, which affects the flow of blood. This slowing of blood flow can affect the success of your transplant and may even lead to heart disease. It is important to talk to your doctor about how to reduce the risk factors of heart disease, including controlling your cholesterol.

Testing Your Cholesterol Levels
High blood cholesterol itself does not have warning signs or symptoms, and as a result many people are unaware that their
cholesterol level is too high. A lipid profile blood test is recommended to find out your cholesterol numbers. This test gives you information
about your:
•Total cholesterol
•LDL (bad) cholesterol
•HDL (good) cholesterol
•Triglycerides
This info is from: "Staying Healthy With Your New Transplant" http://www.transplantliving.org/afterthetransplant/stayinghealthy/healthconcerns.aspx

News article from 2005:
Statins may help shield organ recipients from heart attack

SATURDAY, Nov. 12 (HealthDay News) -- Giving cholesterol-lowering statin drugs to kidney transplant recipients may reduce their increased risk of heart attack and other cardiovascular events, a Norwegian study found.

"As patients continue to live longer after kidney transplantation, there is an increased need to prevent some of the long-term complications that can develop. One major risk is premature cardiovascular disease, related to high cholesterol levels developing after transplantation," study leader Dr. Hallvard Holdaas of National Hospital in Oslo, said in a prepared statement.

The study included more than 2,100 kidney transplant recipients divided into two groups. One group received the cholesterol-lowering drug fluvastatin for up to eight years, while the other group received a placebo. All the patients in the study had good long-term functioning of their transplanted kidney.

In the group taking fluvastatin, the average level of so-called "bad" low-density lipoprotein (LDL) cholesterol decreased from 159 milligrams per deciliter (mg/dL) to 98 mg/dL. These patients also achieved a 21 percent reduction in their risk of heart attack and other major cardiovascular events, while their combined risk of death from cardiac causes decreased by 29 percent, compared to patients taking the placebo.

Both groups had a similar overall risk of death from all causes and similar rates of long-term survival of the transplanted kidney.

The study was presented Nov. 11 at the American Society of Nephrology annual meeting, in Philadelphia.
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There's an article I posted that discusses the Kidney and Heart http://ihatedialysis.com/forum/index.php?topic=4127.0

[Falkenbach]

Yep, indeed. Sirolimus is particularly guilty.

Statins are hard to tolerate for some people, so you may need to try some different types to find one that suits you.

Lucky for me, I haven't reach the stage where they want to put me on lipid lowering therapy yet. But I AM on sirolimus. 

[stauffenberg]

It is astonishing how few doctors understand this, and how unwilling they are to pay attention to patients who try to convince them that the immunosuppressive drugs they are taking are the cause of the problem, not diet.  My endocrinologist, for example, insists that the reason why my cholesterol doubled from its pre-transplant to its post-transplant level must be because of my high cholesterol diet.  When I explain that immunosuppressive drugs are the cause, and that I eat a very healthy diet with minimal fat content and large amounts of fruits and vegetables, I can see that the explanation goes in one ear and out the other, making no impression at all.

[Falkenbach]

Sounds like he's already made his mind up, and is not even willing to listen to you.

My doctors (nephs) told me up front that Sirolimus puts up the cholesterol. However, by the same token, it was never mentioned with any of my other medications.

[willieandwinnie]

Excellent information okarol.  Our GP keeps real good track of Len's labs, Cholesterol and his liver numbers. He has told us that all immunosuppression drugs raise Cholesterol and mess with the liver. Our transplant hospital doesn't even do a Cholesterol test. Go figure.

[MiSSis]

Sorry I'm so late in replying to this thread, OKarol.  It's been a rather hectic time around here for my husband and me. 

There's no doubt in my mind that my cardiac problems are due to the immunosuppressant drugs that I took while I had my transplant.  I received my 2nd transplant in 1987 when cyclosporine was quite new and not much known about side effects and nothing about long term side effects.  Although I did ask about them, in hindsight I'm fairly certain that I would not have done anything differently.  I had my first heart attack in April '95.  Although I was given an angiogram, nothing much else was said.  No cardiac rehab, no dietary or medical advice.  In fact, because I was such an a-typical patient (female, 40 yrs old, not overweight, non smoker and non drinker with no immediate family history of heart disease other than high blood pressure), it wasn't until the results came back from the cardiac blood work that I was moved from a regular patient room to the cardiac floor.  No one seriously believed at first that I was truly having a heart attack, including me!  I was given a few weeks off work and then back to life as I'd known it.  That all changed in 1998 (11 years post-transplant).  In the space of 9 months, I'd had two more heart attacks and 4 angioplasties with a total of 6 stents placed.  My cardiologist said he never seen anyone with the severity of coronary artery disease that I had and was still walking around.  Although to be truthful, every step hurt my chest and I was eating sublingual Nitro like candy.  My husband, who saw the before and after pictures from my angiogram, said the vessels looked like the linked sausage or hot dogs that you see in a butchers shop, there were so many blockages.  It was only at this point in time that I was finally put on Zocor, was advised to attend cardiac rehab classes and given the education I needed for treatment.

Today I'd like to be considered for a 3rd transplant but my cardiologist is totally opposed to the idea and doesn't want me to even think about it.  He says we'd be back to the same old thing of angioplasties every six months or so because he says there just hasn't been enough advancement in the anti-rejection medications.  I have to respect his opinion since not only would I probably not be here today except for him and his skills but he also has personal experience.  He just lost his father-in-law, following years of providing him cardiac care following his father-in-law's kidney/pancreas transplant.

It's a difficult situation and one my husband and I think about often.  Some days I'm all for going ahead and at least getting the testing and other days like today, when I'm sitting here with minor pains and pressure in my chest, that I think "you know, things really aren't all that terrible right now".  PD is a pain in the ass but at least I'm still here, relatively healthy and we're still able to get out and do the traveling we like to do.  Do I really want to rock the boat?

[Chris]

Just picked up my cholesterol test results today. Seems I am doing ok and haven't taken Lipitor since having my transplant. My LDL is on the low side of normal values. Mine is 44 and the range on the page states normal is between 50 - 149.

[cambonesegirl]

I was informed that my cholesterol and blood sugar might be a little elevated due to the immunosuppressants. When I was discharged from the hospital after my transplant I was prescribed a medicine for my cholesterol but it was put on hold since my lab results were fine. Till this day I'm not taking anything for my cholesterol, yet......that is. However I did have a problem with my blood sugars, but now that my prednisone has been tapered down it's under better control.

[monrein]

It took a long time post-transplant (15 or more years) for my cholesterol to climb and although it still isn't outrageous the triglycerides are on the higher side so I take just 10 mg daily of prevastatin and that's been enough.  I've always been very careful about dietary cholesterol also although my neph is the one who said that the drugs are to blame not diet.