Determinants of post-cardiac transplantation hypercholesterolemia

decreasein blood pressure exceeding 15 mm Hg after hydralazine administration are rare. For these reasons,patients such as those in group A of our study have not been described up to now. Our tindings are consistent with the studies of Goldsmith et al., who observed an impaired response of plasma vasopressin to orthostatic stress in patients with heart failure. However, no decreasein blood pressure in response to orthostasis was observed in their study. The correlation between the decreasein blood pressure and the increase in plasma vasopressin observed in our study1 and in others6,7does not necessarily imply a causalrelation, and we have also not proposed this. However, changes in blood pressure and the corresponding changes in plasma norepinephrine and in plasma vasopressin are highly suggestiveof differential responses of the 2 vasopressor systems to arterial baroreceptor unloading in a subgroup of patients with severeheart failure. Joachim

Manthey,

MD,

Bad Friedrichshall, Germany Wolfgang Kiibler, MD, Heidelberg, Germany 16 October 1992

REFERENCES 1. Manthey J, Dietz R, Opherk D, Osterziel KJ, Leinberger H, Kiibler W. Baroreceptor-mediated release of vasopressin in patients with chronic congestive heart failure and defective sympathetic responsiveness. Am J Cardiol 1992;70:224-228.

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Packer M, Meller J, Medina N, Gorlin R, Herman MV. Dose requirements of hydmlazine in patients with severe chronic congestive heat failure. Am J Cardiol 1986;45:655660. 3. Greenberg BH, Massie BM, Brundage BH, Botvinick EH, Pan&y WW, Chatterjee K. Beneficial effects of hydralazine in severe mitral regurgitation. Circulation 1978;58:273-279. 4. Lii MS, McNay L, Shepherd AMM, K&on TK. Effects of hydralzine and sodium nitroprusside on plasma catecholamines and heat rate. Clin Pharnzzco1 Ther 1983;34:47rc480. 5. Fitch&t DH, Neto JAM, Oakley CM, Goodwin JE. Hydralazine in the management of left ventricular failure. Am J Cardiol 1979;44:3w309. 6. Uretsky BF, Verbalis JG, Generalovich T, Valdes A, Reddy PS. Plasma vasopressin response to osmotic and hemcdynamic stimuli in heart failure. Am J Physiol 1985;248:H396-H402. 7. Borghi C, Magelli C, Boscbi S, Costa N, Capelli M, Varani E, Magnani B, Ambrosioni E. Peripheral hemodynamic and humoral effects of oral zofeno pril calcium (SQ 26,991) in patients with congestive heart failure. .I Clin Pharmacol 1989;29:10771082. 2.

Determinants of Postxardiac Transplantation Hyperche lesterolemia

In the samemonth as the publication of the article by Kubo et al,’ an independent study from Austria on the same topic was published in a surgical journal2 with the sameconclusion; namely, patients with coronary artery disease as the original cardiac pathology and low-dose maintenancesteroids have the greatest risk for the development of hypercholesterolemia after cardiac transplantation. Both studies further suggestthat genetic abnormalities of

THE AMERICANJOURNALOF CARDIOLOGY VOLUME71

MARCH1, 1993

lipoprotein metabolism and dietary factors continue to affect total plasma cholesterol levels after cardiac transplantation.Whereasno successful intervention is currently available to correct the underlying, genetically controlled, lipoprotein abnormality early attention to dietary control, especially in heart transplant recipients with a previous diagnosis of coronary artery disease,may make a difference in reducing the frequency of this dreadful complication. Tsung 0. Cheng,

MD

Washington, D.C. 24 August 1992

REFERENCES 1. Kubo SH, Peters .I, Knutson KR, Hertz MI, Olivari MT, Bolman RM, Hutighake DB. Factors influencing the development of hypercholesterolemia after cardiac transplantation. Am J Cardiol 199270: 520-526. 2. Laufer

G, Gmblowitz V, Laczkovics A, Miolic J, Heinz G, Wollenek G, Schreiner W, Wolfram J, Wolner E. The determinants of elevated total plasma cholesterol levels in cardiac transplant recipients administered low dose cyclosporine for immtmosuppression. J Thorac Cardiovasc Surg 1992; 104:241-241.

Correction

In the December 15, 1992issue of the AJC, on page 1449, “A Comparison of Hospital and CommunityAcquired Infective Endocarditis,” the academicdegreesof Dr. Tania C. Sorrell are incomplete. They should read: Tania C. Sorrell, MD, BS, FRACP