ABSTRACT
Cardiovascular disease as a determinant of long-term outcome becomes more important as allograft survival continues to improve and the median age of transplant recipients increases. The posttransplant state is characterized by a number of endocrine and metabolic abnormalities, which may contribute to the development or progression of cardiovascular disease. Lung and combined heart-lung transplantation is associated with a proatherogenic milieu and transplant patients are more prone to develop atherosclerotic cardiovascular disease for a variety of reasons. Immunosuppressive agents have a number of atherogenic effects. These agents contribute to the development of hypertension, hyperlipidemia, diabetes mellitus, and post-transplant obesity. Infectious agents, particularly cytomegalovirus, have been implicated in the pathogenesis of atherosclerosis and the development of transplant coronary artery disease in heart transplant recipients. Increased risk of infection following transplantation also places them at risk for developing infective endocarditis or inflammatory myocarditis.
