*Purpose: Cardiovascular (CV) disease is a leading cause of mortality 1 year after liver transplantation (LT). We aimed to assess the effect of treating CV risk factors on CV events and mortality 1 year after LT.

*Methods: This is a quaternary academic single-center retrospective study of adult LT recipients between 2000 and 2010. The primary outcomes are composite CV events after the 1st year of LT and the cumulative incidence of mortality at 5 years. We used univariate and multivariate logistic regression models. The variables in the multivariate models were selected using the corrected Akaike information criterion.

*Results: 725 patients were included, median follow-up 8 years and median age 54 (IQR 48-60). 65.7% men, 80.7% whites, 41.7% HCV, 23.7% alcohol, and 20.0% NASH or cryptogenic. Prior to LT, 25.2% had diabetes mellitus (DM), 37.9% hypertension (HTN), 9.4% dyslipidemia (HLD) and 5.7% coronary artery disease. After LT, 29.0% had DM, 44.2% HTN, 19.8% HLD and 37.9% CKD and ESRD. 58.0% of DM, 95.0% of HTN and 97.4% of HLD were on medical treatment post LT for their respective CV risks. 26.7% were not adequately treated for DM or HTN or HLD. Patients who were treated for DM or HTN and/or HLD were less likely to have CV events (OR 0.37, CI 0.19 to 0.72, p= 0.003) and less likely to die (OR 0.32, CI 0.21 to 0.49, p= 0.000). Patients without CV risk factors (DM and HTN and HLD), as expected, were less likely to have CV events (OR 0.21, CI 0.06 to 0.58, p= 0.009).

*Conclusions: CV risk factors are variably treated post LT. Adequate treatment of all CV risk factors is significantly associated with improved CV event risks and survival in long-term LT recipients. Post LT follow up care can be further improved if DM, HTN and dyslipidemia are addressed and treated.

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