Statins in heart transplantation.

Over the last four decades, cardiac transplantation has become the preferred therapy for select patients with end-stage heart disease. Critical to the success of heart transplantation are the continual investigational efforts to optimize immunosuppressive regimens. One of the major advances over the past few decades has been the use of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (commonly referred to as statins) to reduce the risk of rejection and allograft vasculopathy in heart transplant recipients. This chapter will focus on the advances of statin therapy in the management of heart transplant recipients. Statins are widely used for the primary and secondary prevention of atherosclerotic cardiovascular disease and the benefit is derived not only from lipid lowering, but also through the pleiotropic, cholesterol-independent effects, which include vasculoprotective, antiinflammatory, and immunosuppressive properties. Statin therapy administered to patients after heart transplantation results in a decrease in rejection, cardiac allograft vasculopathy, and an increase in short- and long-term survival. Statins can be considered a feat of translational medicine, where the mechanistic analysis of potential benefit has been realized in an improvement in the quality and quantity of life of heart transplant recipients.