[Cardiovascular disease in kidney transplantation].

Cardiovascular diseases that include atherosclerotic diseases; coronary artery disease, cerebrovascular disease and peripheral vascular disease, and cardiac functional diseases; congestive heart failure, left ventricular hypertrophy and arrhythmias, are very common in the general population and are the first cause of mortality (Wilson &Culleton, 1998, Culleton & Wilson, 1998). Moreover, patients with chronic renal failure have an increased risk of cardiovascular disease compared with the general population, and after stratification by age and gender, cardiovascular mortality is 10 to 20 times more frequent independently of treatment; predialysis, dialysis or after kidney transplantation (Foley et al, 1998). Kidney transplantation is the best therapy of end-stage renal disease by reducing cardiovascular mortality (McDonald &Russ, 2002, Ojo et al, 2000, Wolfe et al, 1999). But even after transplantation, a recipient of 25 to 35 years of age has a 10 times higher risk of cardiovascular mortality than an individual of similar sex and gender without renal failure (Foley et al, 1998). Among the cardiovascular diseases, atherosclerotic diseases are the most frequently studied and are associated with patient outcome. Ischaemic heart disease was the cause of 53% of total mortality in a study performed in Scandinavia 15 years ago (Lindholm et al, 1995) and these findings were still prevalent in a later report (Aakhus et al, 2004). However, several authors have recently emphasized the importance of functional cardiopathies such as congestive heart failure on patient outcome (Rigatto et al, 2002). The high incidence of cardiovacular events and mortality in renal transplant recipients has been attributed to the increased presence of traditional (Ojo, 2006) and nontraditional risk factors (Ducloux et al, 2004, De Mattos et al, 2006). As traditional risk factors do not fully explain the high cardiovascular risk it has been postulated that some of these risk factors, age, diabetes and smoking, could have a higher deleterous impact in transplant recipients than in the general population (Kasiske et al, 2000a). Other authors consider that transplant related (De Mattos et al, 2006) and nontraditional or emergent factors, hyperhomcysteinemia and inflammation, could play a predominant role in the appearance of cardiovascular events (Ducloux et al, 2004). Progressive chronic graft dysfunction and death with functioning graft are the most important causes of graft loss (Matas et al, 2002, Collins et al, 2008) and cardiovascular diseases are the leading cause of mortality in renal transplant recipients dying with a functioning graft (Pilmore et al, 2010). Consequently decreasing