Management of cardiovascular risk in patients receiving calcineurin inhibitors—a case report

Cardiovascular disease is the main cause of death after renal transplantation. There are few trials evaluating the efficacy of prevention strategies in renal transplant patients on major adverse cardiac events (MACE) and cardiovascular mortality. However, there is general agreement that active prevention strategies can significantly decrease cardiovascular mortality after renal transplantation. Here, we present the case of a 52-year-old male patient who received a first kidney transplant in 1993. He showed a small fixed perfusion defect on thallium scintigraphy before transplant. He was admitted at 13 months due to an antero-lateral myocardial infarction that was complicated with ventricular fibrillation. Despite anti-coagulation with acenocumarol, treatment with statins and angiotensin II receptor blocking agents and an excellent preservation of renal function, the patient presented with a second episode of myocardial infarction at 9 years post-transplant. This case report is discussed in order to highlight the way in which attitudes have been modified in the past decade in order to systematically pursue an early diagnosis of pre-existing coronary artery disease, aggressively treat MACE and actively decrease cardiovascular risk in transplant patients, using all available efficacious treatments as well as individualizing immunosuppression to prolong not only graft but also patient survival.