Dalen J E, Goldberg R J
College of Medicine, University of Arizona, Tucson.
Clin Geriatr Med. 1992 Feb;8(1):119-26.
A wide array of clinical trials over the past two decades has established that aspirin is indicated to prevent myocardial infarction in patients with clinically evident coronary artery disease, and to prevent stroke in patients with a history of stroke or TIAs. The most likely mechanism by which aspirin decreases the incidence of myocardial infarction is by preventing coronary thrombosis in patients with obstructive coronary artery disease. This protective effect of aspirin should occur in patients with both clinically silent and clinically evident coronary artery disease. For this reason, it has been recommended that patients with risk factors for coronary artery disease also should be treated with prophylactic aspirin. Advanced age is one of the strongest risk factors for coronary artery disease, and the mortality of myocardial infarction rises steeply with increased age. A prospective randomized study of US male physicians without a history of myocardial infarction demonstrated a 44% reduction in myocardial infarction in those treated with 325 mg aspirin every other day. The treatment effect occurred only in those aged 50 or older. A prospective study of US nurses aged 34 to 65, without a history of diagnosed coronary artery disease, demonstrated a 32% decrease in those who took one to six aspirin per week. Again, the treatment effect was seen only in those aged 50 or older. Given these findings, the authors believe that prophylactic aspirin is indicated in men and women aged 50 or older who do not have contraindications to its use. The authors recommend a dose of 325 mg of aspirin every other day, a dose with minimal side effects.
在过去二十年中，大量临床试验已证实，阿司匹林可用于预防有明显临床症状的冠状动脉疾病患者发生心肌梗死，以及预防有中风或短暂性脑缺血发作病史的患者发生中风。阿司匹林降低心肌梗死发病率最可能的机制是预防阻塞性冠状动脉疾病患者的冠状动脉血栓形成。阿司匹林的这种保护作用在临床无症状和有明显临床症状的冠状动脉疾病患者中均应出现。因此，有人建议有冠状动脉疾病危险因素的患者也应接受预防性阿司匹林治疗。高龄是冠状动脉疾病最强的危险因素之一，心肌梗死的死亡率随年龄增长而急剧上升。一项针对无心肌梗死病史的美国男性医生的前瞻性随机研究表明，每隔一天服用325毫克阿司匹林的患者心肌梗死发生率降低了44%。治疗效果仅出现在50岁及以上的人群中。一项针对年龄在34至65岁、无确诊冠状动脉疾病病史的美国护士的前瞻性研究表明，每周服用一至六片阿司匹林的护士心肌梗死发生率降低了32%。同样，治疗效果仅在50岁及以上的人群中出现。基于这些发现，作者认为，对于50岁及以上且无使用阿司匹林禁忌证的男性和女性，应使用预防性阿司匹林。作者建议每隔一天服用325毫克阿司匹林，该剂量副作用最小。
