Cardiovascular disease medications after renal transplantation: Results from the patient outcomes in renal transplantation study

Background: Cardiovascular disease (CVD) is the most common cause of death after kidney transplantation. Nevertheless, the use of potentially protective CVD medications has not been examined in a large international cohort of kidney transplant patients. Methods: Using the Patient Outcomes in Renal Transplantation database, we retrospectively examined CVD medication use in 14,236 kidney transplant patients from 10 centers worldwide at 4 and 12 months posttransplant. Results: Use of CVD medications posttransplant increased between 1990 to 1994 and 2000 to 2006, with a 12-fold increase in the use of statins (odds ratio [OR] 12.28, 95% confidence interval [CI] 10.18-14.80). Use of β-blockers also increased (OR 3.74, 95% CI 3.20-4.38), as did use of angiotensin converting enzyme inhibitors or angiotensin II receptor blockers (OR 3.68, 95% CI 3.07-4.40) and antiplatelet agents (OR 1.93, 95% CI 1.66-2.24). Use of most CVD medications was not higher in patients with diabetes than in patients without diabetes, despite a higher risk of CVD among patients with diabetes. Although use of several CVD medications was higher in patients with previous CVD events than in patients with no previous CVD, less than 75% of patients with previous CVD were using a statin or antiplatelet agent. Conclusion: Although use of CVD medications after kidney transplant has increased in recent years, use of potentially cardioprotective medications may be suboptimal given the high CVD risk in kidney transplant patients.