Hyperlipoproteinemia in renal transplant patients: Effect of hypocaloric diet, exercise and HMG-CoA reductase inhibition

To study the effects of a hypocaloric low-fat diet, aerobic exercise (walking) and lovastatin (20 mg/d) on 24 overweight (BMI 27,5 +/- 2,6) patients (age 51,4 +/- 9, 1 years, post-transplant evolution of 39,3 +/- 20,2 months), with hypercholesterolemia (263,5 +/- 30,3 mg/dl) and serum creatinine 1,3 +/- 0,2 mg/dl. They were randomized after three months of diet to aerobic exercise or lovastatin for three months. Criteria for patient selection were stable renal function (creatinine < 2 mg/dl), post-transplant period > 1 year, proteinuria < 0,5 g/d and normal thyroid function, oral glucose tolerance test, and hepatic function. Patients received treatment with cyclosporin (3,7 +/- 1,0 mg/kg/d) and prednisone (5 mg/d). Diet alone decreased triglycerides (211,8 +/- 74,9 vs 175,0 +/- 68,3 mg/dl; p = 0,0002) and VLDLc (43,5 +/- 23,5 vs 32,2 +/- 18,9 mg/dl, p = 0,01). Exercise did not modify the levels of total cholesterol, LDL or HDL. Lovastatin decreased total cholesterol (258,0 +/- 33,0 vs 207,9 +/- 26,2 mg/dl, p = 0,0001), LDL (154,3 +/- 23,3 vs 102,5 +/- 15,8 mg/dl, p = 0,0001) and increased HDL (52,6 +/- 11,9 vs 67,0 +/- 18,8 mg/dl, p = 0,007). No side effects were observed with lovastatin. We conclude that HMG-CoA reductase inhibitors with hypocaloric low fat diet and aerobic exert ise are the treatment of choice in renal transplant patients with hyperlipoproteinemia.