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Homocysteine-lowering and cardiovascular disease outcomes in kidney transplant recipients: primary results from the Folic Acid for Vascular Outcome Reduction in Transplantation trial.

Publication ,  Journal Article
Bostom, AG; Carpenter, MA; Kusek, JW; Levey, AS; Hunsicker, L; Pfeffer, MA; Selhub, J; Jacques, PF; Cole, E; Gravens-Mueller, L; House, AA ...
Published in: Circulation
April 26, 2011

BACKGROUND: Kidney transplant recipients, like other patients with chronic kidney disease, experience excess risk of cardiovascular disease and elevated total homocysteine concentrations. Observational studies of patients with chronic kidney disease suggest increased homocysteine is a risk factor for cardiovascular disease. The impact of lowering total homocysteine levels in kidney transplant recipients is unknown. METHODS AND RESULTS: In a double-blind controlled trial, we randomized 4110 stable kidney transplant recipients to a multivitamin that included either a high dose (n=2056) or low dose (n=2054) of folic acid, vitamin B6, and vitamin B12 to determine whether decreasing total homocysteine concentrations reduced the rate of the primary composite arteriosclerotic cardiovascular disease outcome (myocardial infarction, stroke, cardiovascular disease death, resuscitated sudden death, coronary artery or renal artery revascularization, lower-extremity arterial disease, carotid endarterectomy or angioplasty, or abdominal aortic aneurysm repair). Mean follow-up was 4.0 years. Treatment with the high-dose multivitamin reduced homocysteine but did not reduce the rates of the primary outcome (n=547 total events; hazards ratio [95 confidence interval]=0.99 [0.84 to 1.17]), secondary outcomes of all-cause mortality (n=431 deaths; 1.04 [0.86 to 1.26]), or dialysis-dependent kidney failure (n=343 events; 1.15 [0.93 to 1.43]) compared to the low-dose multivitamin. CONCLUSIONS: Treatment with a high-dose folic acid, B6, and B12 multivitamin in kidney transplant recipients did not reduce a composite cardiovascular disease outcome, all-cause mortality, or dialysis-dependent kidney failure despite significant reduction in homocysteine level.

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Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

April 26, 2011

Volume

123

Issue

16

Start / End Page

1763 / 1770

Location

United States

Related Subject Headings

  • Vitamin B Complex
  • Stroke
  • Risk Reduction Behavior
  • Risk Factors
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Kidney Transplantation
  • Kidney Failure, Chronic
  • Kaplan-Meier Estimate
 

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Bostom, A. G., Carpenter, M. A., Kusek, J. W., Levey, A. S., Hunsicker, L., Pfeffer, M. A., … Weir, M. (2011). Homocysteine-lowering and cardiovascular disease outcomes in kidney transplant recipients: primary results from the Folic Acid for Vascular Outcome Reduction in Transplantation trial. Circulation, 123(16), 1763–1770. https://doi.org/10.1161/CIRCULATIONAHA.110.000588
Bostom, Andrew G., Myra A. Carpenter, John W. Kusek, Andrew S. Levey, Lawrence Hunsicker, Marc A. Pfeffer, Jacob Selhub, et al. “Homocysteine-lowering and cardiovascular disease outcomes in kidney transplant recipients: primary results from the Folic Acid for Vascular Outcome Reduction in Transplantation trial.Circulation 123, no. 16 (April 26, 2011): 1763–70. https://doi.org/10.1161/CIRCULATIONAHA.110.000588.
Bostom, Andrew G., et al. “Homocysteine-lowering and cardiovascular disease outcomes in kidney transplant recipients: primary results from the Folic Acid for Vascular Outcome Reduction in Transplantation trial.Circulation, vol. 123, no. 16, Apr. 2011, pp. 1763–70. Pubmed, doi:10.1161/CIRCULATIONAHA.110.000588.
Bostom AG, Carpenter MA, Kusek JW, Levey AS, Hunsicker L, Pfeffer MA, Selhub J, Jacques PF, Cole E, Gravens-Mueller L, House AA, Kew C, McKenney JL, Pacheco-Silva A, Pesavento T, Pirsch J, Smith S, Solomon S, Weir M. Homocysteine-lowering and cardiovascular disease outcomes in kidney transplant recipients: primary results from the Folic Acid for Vascular Outcome Reduction in Transplantation trial. Circulation. 2011 Apr 26;123(16):1763–1770.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

April 26, 2011

Volume

123

Issue

16

Start / End Page

1763 / 1770

Location

United States

Related Subject Headings

  • Vitamin B Complex
  • Stroke
  • Risk Reduction Behavior
  • Risk Factors
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Kidney Transplantation
  • Kidney Failure, Chronic
  • Kaplan-Meier Estimate