CORONARY CALCIFICATIONS IN RENAL TRANSPLANT RECIPIENTS

University Of Pennsylvania, Philadelphia PA

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Abstract

DESCRIPTION (provided by applicant): The R03 candidate has made outstanding progress in the K08 study entitled "Homocysteine, Lp (a), Atherosclerosis and Renal Transplantation" (# 1-K08-DK02626-03). She has enrolled 438 renal transplant recipients (RTR). In the course of these studies, she has identified the importance of determining subclinical atherosclerosis events. The recent availability of Electron Beam Computer Tomography (EBCT) substantially improves the assessment of subclinical atherosclerosis. This method quantitates coronary calcification. The renal transplant recipients studied to date exhibit a high prevalence of adverse lipid profiles, elevated levels of lipoprotein (a) (Lp(a)) and hyperhomocysteinemia. However, long observation periods are required to assess the effect of this risk factors in RTR. Coronary calcification scores as measured with EBCT will allow to identify subclinical atherosclerosis and risk factors for progression of atherosclerosis before they become clinically significant. Therefore, we now propose expanding the current K08 protocol to EBCT measures of coronary calcifications in 100 renal transplant recipients enrolled in the on-going K08 study. The primary hypotheses is that EBCT will describe more accurately the unique effects of adverse lipid profiles, elevated levels of lipoprotein (a) (Lp(a)) and hyperhomocysteinemia on the cardiovascular system The independent contributions of Lp(a) and homocysteine to the development of subclinical atherosclerosis will have important therapeutic implications. This proposed expansion of the K08 will provide the applicant with an effective springboard to a career as a fully independent investigator.