Racial Disparities in Receipt of Medications for Secondary Prevention of Cardiovascular Disease in Kidney Transplant Recipients in the FAVORIT Trial
Bibliographic record
Abstract
Background: Cardiovascular disease (CVD) is the most common cause of death with a functioning graft in kidney transplant recipients. Black patients have been shown to have higher prevalence of cardiovascular (CV) risk factors and less intensive risk factor modification. We evaluated racial disparities in receipt of HMG-Co-A reductase inhibitors (statins) and aspirin for secondary prevention of CVD in kidney transplant patients in the Folic Acid for Vascular Outcome Reduction in Transplantation Trial (FAVORIT) trial. Methods: FAVORIT was a multicenter international trial of vitamin therapy to lower homocysteine levels and improve CV outcomes in kidney transplant patients. We identified FAVORIT trial participants from US and Canada who had a self-reported history of established CVD at baseline and/or developed a CVD event during the study. We used parametric interval-censored survival models to evaluate the effect of race on self-reported receipt of statins and aspirin for secondary CV prevention, adjusting for age, gender, ethnicity, and country of enrollment. In addition, we controlled for baseline cyclosporin use in the model assessing statin use and graft vintage in the model assessing aspirin use. Results: Of the 4110 kidney transplant patients enrolled in FAVORIT, 978 met the inclusion criteria (78% White, 17% Black, 6% Other race). Mean age was 55.7±8.9 years, 70% were male, and mean graft vintage was 5.4±4.7 years. Black race was independently associated with lower hazard of receiving statin for secondary CVD prevention compared with White race (aHR=0.77, 95% CI: 0.60-0.97). There was no significant difference in aspirin use by Black race compared with White race (aHR=0.86, 95% CI: 0.67-1.09). Conclusions: Findings from a large multicenter trial showed that Black race was associated with lower hazard of receiving statins for secondary CVD prevention. Underutilization of statins represents a potential target to improve CVD preventive care in Black kidney transplant recipients. Funding: NIDDK Support
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".