Effect of Statin Intensity on Tolerability, Lipid Levels, and Cardiac Function After Transplantation

Statins reduce coronary vasculopathy and mortality after heart transplantation (HT). However, it remains uncertain if intensified statins are tolerated and related to the preservation of cardiac function. We conducted a single-center, retrospective cohort study of all single-organ adult HT recipients between 2012 and 2021. Standard intensity statin was defined as pravastatin ≤20 mg or equivalent doses, while higher doses were defined as intensified statin. Overall, 277 patients met eligibility criteria. The incidence of intolerability was similar between patients on standard and intensified statin (7% vs. 3%; p = 0.56). Similarly, no differences were detected for intolerability with conventional classifications as low- (5%), moderate- (4%), or high-intensity (3%) statin users (p = 0.58). At 1 year after HT, low-density lipoprotein (LDL) increased from 70 (49-88) mg/dl to 82 (66-99) mg/dl (p = 0.01) in standard statin users but remained similar for those on intensified statin from 75 (56-97) mg/dl to 80 (59-97) mg/dl (p = 0.67). Left ventricular global longitudinal strain (n = 53) from 1 to 3 years after HT was lower by -10% in those on standard compared with -2% on intensified statin (p = 0.03). In conclusion, intensified statin is well tolerated after HT, leads to better LDL control, and is associated with greater preservation of myocardial function.