title: Aspirin Use and Incident Cardiovascular Disease, Kidney Failure, and Death in Stable Kidney Transplant Recipients: A Post Hoc Analysis of the Folic Acid for Vascular Outcome Reduction in Transplantation (FAVORIT) Trial.
abstract: BACKGROUND
  Cardiovascular disease (CVD) is the leading cause of death in kidney transplant recipients. Whether aspirin may reduce the risk for CVD, death, and kidney failure outcomes is uncertain.
  
  
  METHODS
  Post hoc cohort analysis of FAVORIT, a randomized trial examining the effect of homocysteine-lowering vitamins on CVD in kidney transplant recipients.
  
  
  METHODS
  Prevalent adult kidney transplant recipients with hyperhomocysteinemia and stable kidney function from the United States, Canada, and Brazil participating in FAVORIT, with no known history of CVD.
  
  
  METHODS
  Aspirin use, with aspirin users matched to nonusers using a propensity score.
  
  
  RESULTS
  Incident CVD events, kidney failure, all-cause mortality, a composite of CVD events or mortality, and a composite of kidney failure or mortality. Cox proportional hazards models with a robust variance to account for the correlation in outcomes within matched pairs were sequentially adjusted for demographic, clinical, and laboratory characteristics to assess the association between aspirin use and events.
  
  
  RESULTS
  981 aspirin users were matched to 981 nonusers. During a 4-year mean follow up, there were 225 CVD events, 200 deaths, 126 kidney failure events, 301 composite kidney failure or mortality events, and 324 composite CVD or mortality events. Adjusted models showed no significant difference associated with aspirin use in risk for CVD events, all-cause mortality, kidney failure, composite of kidney failure or mortality, or composite of primary CVD events or mortality (HRs of 1.20 [95% CI, 0.92-1.58], 0.92 [95% CI, 0.69-1.23], 1.19 [95% CI, 0.81-1.74], 1.03 [0.82-1.31], and 1.11 [95% CI, 0.88-1.38], respectively).
  
  
  CONCLUSIONS
  We did not examine dose or continued use of aspirin after randomization. CVD history is dependent on participant report at baseline. Aspirin use was non-randomly assigned.
  
  
  CONCLUSIONS
  Aspirin use is not associated with reduced risk for incident CVD, all-cause mortality, or kidney failure in stable kidney transplant recipients with no history of CVD.
authors.affiliation: Tufts Medical Center and Tufts University School of Medicine, Boston, MA.
authors.forename: Taimur
authors.initials: T
authors.lastname: Dad
authors.affiliation: Tufts Medical Center and Tufts University School of Medicine, Boston, MA; The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA.
authors.forename: Hocine
authors.initials: H
authors.lastname: Tighiouart
authors.affiliation: Tufts Medical Center and Tufts University School of Medicine, Boston, MA.
authors.forename: Alin
authors.initials: A
authors.lastname: Joseph
authors.affiliation: Rhode Island Hospital, Providence, RI.
authors.forename: Andrew
authors.initials: A
authors.lastname: Bostom
authors.affiliation: University of North Carolina, Chapel Hill, NC.
authors.forename: Myra
authors.initials: M
authors.lastname: Carpenter
authors.affiliation: University of Iowa, Iowa City, IA.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Hunsicker
authors.affiliation: National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD.
authors.forename: John W
authors.initials: JW
authors.lastname: Kusek
authors.affiliation: Brigham and Women's Hospital, Boston, MA.
authors.forename: Marc
authors.initials: M
authors.lastname: Pfeffer
authors.affiliation: Tufts Medical Center and Tufts University School of Medicine, Boston, MA.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Levey
authors.affiliation: Tufts Medical Center and Tufts University School of Medicine, Boston, MA. Electronic address: dweiner@tuftsmedicalcenter.org.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Weiner
mesh_terms: D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000517:prevention & control*; D015331:Cohort Studies; D004311:Double-Blind Method; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality* / Q000517:prevention & control*; D051437:Renal Insufficiency / Q000453:epidemiology* / Q000517:prevention & control*; D014803:Vitamin B Complex / Q000627:therapeutic use*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D014803:Vitamin B Complex; D005492:Folic Acid; D001241:Aspirin
keywords: Kidney transplantation; all-cause mortality; aspirin; atherosclerosis; cardiovascular disease (CVD); chronic kidney disease (CKD); death; dialysis; kidney transplant recipient; renal failure