Berger Jeffrey S, Brown David L, Becker Richard C
Duke Clinical Research Institute, Durham, NC 27710, USA.
Am J Med. 2008 Jan;121(1):43-9. doi: 10.1016/j.amjmed.2007.10.002.
Many recommendations for aspirin in stable cardiovascular disease are based on analyses of all antiplatelet therapies at all dosages and in both stable and unstable patients. Our objective was to evaluate the benefit and risk of low-dose aspirin (50-325 mg/d) in patients with stable cardiovascular disease.
Secondary prevention trials of low-dose aspirin in patients with stable cardiovascular disease were identified by searches of the MEDLINE database from 1966 to 2006. Six randomized trials were identified that enrolled patients with a prior myocardial infarction (MI) (n=1), stable angina (n=1), or stroke/transient ischemic attack (n=4). A random effects model was used to combine results from individual trials.
Six studies randomized 9853 patients. Aspirin therapy was associated with a significant 21% reduction in the risk of cardiovascular events (nonfatal MI, nonfatal stroke, and cardiovascular death) (95% confidence interval [CI], 0.72-0.88), 26% reduction in the risk of nonfatal MI (95% CI, 0.60-0.91), 25% reduction in the risk of stroke (95% CI, 0.65-0.87), and 13% reduction in the risk of all-cause mortality (95% CI, 0.76-0.98). Patients treated with aspirin were significantly more likely to experience severe bleeding (odds ratio 2.2, 95% CI, 1.4-3.4). Treatment of 1000 patients for an average of 33 months would prevent 33 cardiovascular events, 12 nonfatal MIs, 25 nonfatal strokes, and 14 deaths, and cause 9 major bleeding events. Among those with ischemic heart disease, aspirin was most effective at reducing the risk of nonfatal MI and all-cause mortality; however, among those with cerebrovascular disease, aspirin was most effective at reducing the risk of stroke.
In patients with stable cardiovascular disease, low-dose aspirin therapy reduces the incidence of adverse cardiovascular events and all-cause mortality, and increases the risk of severe bleeding.
许多关于阿司匹林用于稳定型心血管疾病的推荐是基于对所有剂量的抗血小板治疗以及稳定型和不稳定型患者的分析。我们的目的是评估低剂量阿司匹林（50 - 325毫克/天）在稳定型心血管疾病患者中的获益和风险。
通过检索1966年至2006年的MEDLINE数据库，确定了低剂量阿司匹林用于稳定型心血管疾病患者的二级预防试验。确定了6项随机试验，纳入了既往有心肌梗死（MI）（n = 1）、稳定型心绞痛（n = 1）或中风/短暂性脑缺血发作（n = 4）的患者。采用随机效应模型合并各个试验的结果。
6项研究将9853例患者随机分组。阿司匹林治疗使心血管事件（非致命性MI、非致命性中风和心血管死亡）风险显著降低21%（95%置信区间[CI]，0.72 - 0.88），非致命性MI风险降低26%（95% CI，0.60 - 0.91），中风风险降低25%（95% CI，0.65 - 0.87），全因死亡率风险降低13%（95% CI，0.76 - 0.98）。接受阿司匹林治疗的患者发生严重出血的可能性显著更高（比值比2.2，95% CI，1.4 - 3.4）。对1000例患者平均治疗33个月可预防33例心血管事件、12例非致命性MI、25例非致命性中风和14例死亡，并导致9例严重出血事件。在缺血性心脏病患者中，阿司匹林在降低非致命性MI和全因死亡率风险方面最有效；然而，在脑血管疾病患者中，阿司匹林在降低中风风险方面最有效。
在稳定型心血管疾病患者中，低剂量阿司匹林治疗可降低不良心血管事件的发生率和全因死亡率，并增加严重出血的风险。
