Bartolucci Alfred A, Howard George
The Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Am J Cardiol. 2006 Sep 15;98(6):746-50. doi: 10.1016/j.amjcard.2006.04.012. Epub 2006 Jul 26.
Until recently, 5 major studies have formed the basis for the use of aspirin (acetylsalicylic acid) in primary prevention of cardiovascular (CV) events. Despite these data, the role of aspirin in primary prevention has not been established firmly. Six randomized trials have evaluated the benefits of aspirin for the primary prevention of CV events: the British Doctors' Trial, the Physicians' Health Study, the Thrombosis Prevention Trial, the Hypertension Optimal Treatment study, the Primary Prevention Project, and the Women's Health Study. The combined sample consists of 47,293 subjects on aspirin and 45,580 not on aspirin or placebo. A meta-analysis of these 6 trials assessed 6 CV end points: total coronary heart disease (CHD), nonfatal myocardial infarction (MI), total CV events, stroke, CV mortality, and all-cause mortality. No covariate adjustment was performed and appropriate tests for treatment effect, heterogeneity, and study size bias were applied. Using odds ratios and confidence intervals, the meta-analysis suggested superiority of aspirin for total CHD, nonfatal MI, and total CV events (p < or =0.001 in each case), with a nonsignificant trend (0.07 < p <0.34) for decreased risk of stroke, CV mortality, and all-cause mortality. There was no evidence of statistical bias (p >0.05). Given the study size and cohort, aspirin decreased the risk of CV events in this large patient sample. In conclusion, primary prevention with aspirin decreased the risk of total CHD, nonfatal MI, and total CV events, but there were no significant differences in the incidences of stroke or CV mortality.
直到最近，五项主要研究构成了使用阿司匹林（乙酰水杨酸）进行心血管（CV）事件一级预防的基础。尽管有这些数据，但阿司匹林在一级预防中的作用尚未得到明确确立。六项随机试验评估了阿司匹林对CV事件一级预防的益处：英国医生试验、医生健康研究、血栓形成预防试验、高血压最佳治疗研究、一级预防项目和妇女健康研究。合并样本包括47293名服用阿司匹林的受试者和45580名未服用阿司匹林或安慰剂的受试者。对这六项试验的荟萃分析评估了六个CV终点：总冠心病（CHD）、非致命性心肌梗死（MI）、总CV事件、中风、CV死亡率和全因死亡率。未进行协变量调整，并应用了治疗效果、异质性和研究规模偏差的适当检验。使用比值比和置信区间，荟萃分析表明阿司匹林在总CHD、非致命性MI和总CV事件方面具有优势（每种情况p≤0.001），中风、CV死亡率和全因死亡率风险降低呈非显著趋势（0.07＜p＜0.34）。没有统计学偏差的证据（p＞0.05）。鉴于研究规模和队列，阿司匹林降低了这个大型患者样本中CV事件的风险。总之，阿司匹林一级预防降低了总CHD、非致命性MI和总CV事件的风险，但中风或CV死亡率的发生率没有显著差异。
