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	Why is CVD risk greater?		Previous history of CRF
	High prevalence of hyperlipidaemia		High proportion of diabetics
	Hyperhomocysteinaemia		Healthy Heart Sessions
	Medication		Diet
	Exercise

Renal transplant patients are at significantly greater risk of cardiovascular disease (CVD) than are members of the general population.

The incidence of ischaemic heart disease events has been found to be as high as 23% by 15 years post transplantation (1). Another study found that the incidence of CVD was about five times greater than that predicted by the Framingham Heart Study data for patients of comparable age and gender (2).

So, as graft-survival time increases, renal healthcare professionals are becoming increasingly concerned that many of these patients are surviving their renal disease only to develop cardiovascular disease.

On a positive note, professionals have also identified several modifiable risk factors, which can by targeted for intervention.

Why is CVD risk greater?

Many of the risk factors for heart disease identified in renal transplant patients are the same as in the general population but there are additional risk factors specific to chronic renal failure (3).

Some of the main risk factors identified are:

		a previous history of chronic renal failure (CRF);
		high prevalence of hyperlipidaemia;
		high proportion of diabetics; and
		hyperhomocysteinaemia.

Previous history of CRF

Patients on dialysis are at even greater risk of CVD than are transplant patients. CVD mortality is approximately 15-times higher in dialysis patients than in the general population (4). Ideally, suitable patients should be transplanted as soon as possible. All chronic renal failure patients need to be targeted to reduce CVD risk.

High prevalence of hyperlipidaemia

It is generally accepted that total and LDL cholesterol increases the risk of CVD in the general population. The clinical evidence for an association in renal transplant patients is not conclusive but the observational studies undertaken have shown a strong link (5).

High proportion of diabetics

The incidence of post-transplant diabetes has been estimated at 3.6 to 18% (5). Immunosuppressive medication and weight gain post transplant have both been identified as risk factors for diabetes. The increased risk of CVD in diabetics is widely recognised.

Hyperhomocysteinaemia

It has been estimated that renal transplant patients have homocysteine levels twice as high than in the general population when matched for age and gender (5). It is proposed that increased homocysteine increases the risk of CVD (5,6). Many studies have shown that treatment with folic acid in combination with vitamin B6 and B12 can decrease homocysteine levels (6,7).

Healthy Heart Sessions at Brighton

The aim of the Healthy Heart Session is to give patients information about their risk of cardiovascular disease and on how they can reduce this risk through lifestyle changes. The Sessions are multidisciplinary and are designed to be informative and enjoyable.

The multidisciplinary team includes the consultant nephrologist, the renal transplant sister, the dietitian, the pharmacist and the physiotherapist.

During the Session, patients are taught what heart disease is, why transplant patients are at greater risk, and how they can reduce their risk factors. Other topics discussed include medication, diet and exercise.