P1769 - Traditional Framingham Risk Score Is Predictive of Atherosclerotic Cardiovascular Events up to 10 Years After Liver Transplant

Ramzi Hassouneh, DO¹, Samarth Patel, MD², Steve Shen, ³, Anh Bui, PhD², Taseen Syed, MBBS, MD⁴, Sean Flynn, MD⁵, Jose Hernandez Roman, MD², Vaishali Patel, MBBS, MD⁴, Chandra Bhati, MBBS, MD⁶, Mohammad Shadab Siddiqui, MD^4
1VCU, Richmond, VA; ²Virginia Commonwealth University Health System, Richmond, VA; ³Virginia Commonwealth University School of Medicine, Richmond, VA; ⁴Virginia Commonwealth University Health Systems, Richmond, VA; ⁵Virginia Commonwealth University, Richmond, VA; ⁶Hume-Lee Transplant Center, Virginia Commonwealth University Health System, Richmond, VA

Introduction: Cardiovascular disease (CVD) is an important cause of long-term mortality in liver transplant (LT) recipients. There are currently no CVD risk-stratification tools that have been validated in LT recipients. This underscores a significant limitation within clinical transplant hepatology. Thus, we aimed to evaluate Framingham Risk Score (FRS) in LT recipients using adjudicated atherosclerotic events.

Methods: Patients receiving LT between 1/2007 to 1/2019 (N=553) were included. Patients who died within 12 months of LT were excluded. Baseline FRS was calculated using the traditional algorithm that incorporates serum lipid profile and nonlaboratory predictors of CVD. Patients were followed up to 10 years post LT. The primary outcome was 3-point major adverse cardiovascular events (MACE-3), which includes myocardial infarction, stroke, or CVD death.

Results: The study cohort consisted mainly of males (74.1%) and non-Hispanic Caucasians (74.9%). The prevalence of diabetes, hypertension, obesity, and dyslipidemia pre-LT was 19.9%, 53.3%, 24.1%, and 36.5%, respectively. The distribution of baseline FRS scores of patients in low-risk, intermediate risk, and high risk was 33%, 32% and 35%, respectively. After median follow up of 74 months (IQR 36,11), 94 (17%) of patients died and 66 (12%) patients experienced MACE-3. The most common MACE-3 was non-fatal MI (5.4%, n=30), followed by cardiovascular death (3.6%, n=20), and non-fatal stroke (2.6%, n=16). A significant longitudinal increase in FRS was noted in patients who were initially in low-risk and intermediate risk categories (Figure A). No patients who were in the high FRS category transitioned to either intermediate or low-risk categories. FRS categories correlated with increased risk of all-cause mortality, but this relationship did not reach significance (Figure B). In time to event analysis, baseline FRS category was independently associated with future risk of MACE-3 (Figure C). In multivariate analysis, the relationship between MACE-3 and baseline FRS (HR 1.04, CI 1.01,1.07, p=0.013) remained significant after adjusting for age, gender, obesity, diabetes, and hypertension.

Discussion: FRS at LT predicts with good accuracy the 10-year risk of atherosclerotic CVD risk. This will allow early identification of patients at high risk for CVD and early intervention to improve traditional risk factors, however, this approach requires further validation in large, prospective trials.



Disclosures:


Ramzi Hassouneh, DO¹, Samarth Patel, MD², Steve Shen, ³, Anh Bui, PhD², Taseen Syed, MBBS, MD⁴, Sean Flynn, MD⁵, Jose Hernandez Roman, MD², Vaishali Patel, MBBS, MD⁴, Chandra Bhati, MBBS, MD⁶, Mohammad Shadab Siddiqui, MD⁴. P1769 - Traditional Framingham Risk Score Is Predictive of Atherosclerotic Cardiovascular Events up to 10 Years After Liver Transplant, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.