Supplementary Material for: Analysis of the correlation between hypercholesterolemia and increased Cardiovascular Morbidity and Mortality among Adult Kidney Transplant Recipients

Introduction: The correlation between hypercholesterolemia and cardiovascular disease in kidney transplant recipients (KTR) remains uncertain. We sought to characterize the association between abnormal cholesterol profiles and cardiovascular morbidity and mortality in this unique population. Methods: This retrospective cohort study was conducted at a single center and included all adult KTR, transplanted between January 2005 and April 2014. The primary outcome was Major Adverse Cardiovascular Events (MACE) while the secondary outcome was the composite outcome of MACE and all-cause mortality. Exposure to abnormal cholesterol levels was calculated using a time-weighted average (TWA) calculation. MACE and mortality risk were analyzed using a multivariate time varying Cox model. Results: The final cohort comprised 737 KTR, with a median follow-up of 2920 days. A total of 126 patients (17.1%) experienced MACE. High LDL-C levels and MACE risk were correlated by multivariate analysis (HR 1.008 per mg/dl, 95%CI 1.001 – 1.016), while low HDL-C levels were not significantly associated with MACE (HR 0.992 per mg/dl, 95%CI 0.976 – 1.009). A higher LDL-C/HDL-C ratio was significantly associated with an increased risk of MACE in multivariate analyses (HR 1.502 per unit, 95%CI 1.147-1.968), and also correlated with the composite outcome (HR 1.35 per unit, 95%CI 1.06 – 1.71). Conclusions: A high LDL-C /HDL-C ratio is predictive of an increased risk of cardiovascular morbidity and mortality in kidney transplant recipients. These findings emphasize the significance of the LDL-C/HDL-C ratio as a valuable marker of cardiovascular risk and support current recommendations to improve hypercholesterolemia in this high-risk group.