Management of hypercholesterolemia after heart transplantation in adults

LDL-C: low-density lipoprotein cholesterol; PCSK9: proprotein convertase subtilisin/kexin type 9.

* For most patients after heart transplantation, we prefer initial therapy with pravastatin; rosuvastatin is a reasonable initial therapy or secondary therapy for patients who have an unmet LDL-C goal.

¶ The maximal daily doses of the preferred statins after heart transplantation are pravastatin 40 mg and rosuvastatin 20 mg. Starting doses are pravastatin 20 mg daily and rosuvastatin 10 mg daily. For further information on the management of statin intolerances, refer to UpToDate content on treatment of hyperlipidemia in patients after transplantation.

Δ Diagnoses that may require treatment to a specific LDL-C value include diabetes, peripheral vascular disease, and stroke. For further information on LDL-C management for these and other atherosclerotic risk factors, refer to the relevant UpToDate content.

◊ For patients with heart transplantation, ezetimibe and PCSK9 inhibitors have some evidence of safety. Other therapies for reducing LDL-C may interact with immunosuppressive agents. For further details on interactions between immunosuppression and hyperlipidemia therapies, refer to UpToDate content on cholesterol therapy and organ transplantation and the Lexicomp drug interactions database included with UpToDate.