Therapeutic strategies for the treatment of hyperlipidemia in patients after heart transplantation: a systematic review
DOI:
https://doi.org/10.37085/jmmv8.n1.2026.pp.6-11Keywords:
Heart transplantation, Hyperlipidemias, Hydroxymethylglutaryl-CoA Reductase InhibitorsAbstract
Background
Dyslipidemia is a frequent complication after heart transplantation (HT), associated with preexisting metabolic factors, comorbidities, and the use of immunosuppressive agents. This disease is strongly related to graft vasculopathy and increased long-term mortality.
Objective
To evaluate the main pharmacological therapies used in the treatment of post-heart transplant hyperlipidemia.
Methods
A systematic review was conducted in accordance with PRISMA guidelines. The PubMed, Scopus, and Web of Science databases were searched for studies published between 2015 and 2025 in English or Portuguese. Eligible studies addressing pharmacological management of hyperlipidemia after HT were included.
Results
Seven studies met the inclusion criteria. Low-dose statins remain the first-line therapy, particularly pravastatin and fluvastatin, due to their lower risk of myopathy and drug interactions. Early initiation after transplantation is recommended. The combination with ezetimibe showed additional LDL reduction. PCSK9 inhibitors, especially evolocumab, demonstrated efficacy in refractory cases or statin intolerance, although long-term safety evidence in HT patients remains limited.
Conclusion
Statins remain the cornerstone of treatment for hyperlipidemia after heart transplantation. PCSK9 inhibitors represent a promising alternative in selected cases, but further robust studies are needed to establish their long-term safety and clinical impact in this population.
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References
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