001) with a trend toward reduced hypertension (RR = 0.84, P = 0.08), but there were no differences in all-cause mortality, graft loss, or infection.38 Fortunately, metabolic syndrome is a cluster of modifiable factors, and early intervention can probably prevent more deleterious consequences. The modification of immunosuppressive regimens according to the specific side-effect profiles of different agents and the early initiation of statins to achieve the targeted low-density lipoprotein level (<130 mg/dL or, in some cases, <100 mg/dL) may have a positive impact on the primary prevention of CV events in the post-OLT population. <a href="http://www.selleck.cn/products/SB-203580.html
">SB203580 The strongest evidence for early statin initiation in patients with PTMS comes from Soveri et al.,39 who reported data from the Assessment of Lescol in Renal Transplantation (ALERT) extension trial. The ALERT trial was a multicenter, investigator-initiated, randomized, double-blind study designed to investigate the effects of fluvastatin on cardiac and renal endpoints in renal transplant recipients. Patients with metabolic syndrome who were randomized to the statin arm had approximately half the risk for CV events (53%, P = 0.015) and CV death (52%, P = 0.03) Selleckchem Linsitinib
in comparison with the placebo arm, whereas no significant effect of the statin treatment was found in renal transplant recipients without metabolic syndrome. The authors concluded that renal transplant recipients with metabolic syndrome are an easily identifiable group of patients who benefit from statin treatment for the primary prevention of CV events. Several potential limitations of our study findings need to be addressed. First, individual patient data were unavailable; we used aggregate data reported in published articles (or provided by their authors). This approach is inherent to meta-analyses and may not detect and cannot solve methodological problems affecting the primary studies. For example, most of the case-control studies did not specifically use age-, sex-, or propensity-matched controls but instead used population-based references. This could have led to overestimation or underestimation in our results. Second, only publications in English were included. The reason for excluding foreign language studies was the difficulty in extracting information accurately from such studies, especially with selleck chemicals llc
various definitions of CV disease. Furthermore, the review of abstracts from our PubMed search for non�CEnglish language articles did not result in any pertinent study in a foreign language. Hence, we do not believe that a significant number of studies were missed in the meta-analysis, so the results are representative. Third, the literature specifically looking at the impact of PTMS on CV outcomes is very limited. The majority of the studies included in our meta-analysis were of average quality, and there was statistical heterogeneity when quantitative pooling was performed.