Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Am J Cardiol. 2011 Jun 15;107(12):1796-801. doi: 10.1016/j.amjcard.2011.02.325. Epub 2011 Apr 8.
Several meta-analyses have focused on determination of the effectiveness of aspirin (acetylsalicylic acid) in primary prevention of cardiovascular (CV) events. Despite these data, the role of aspirin in primary prevention continues to be investigated. Nine randomized trials have evaluated the benefits of aspirin for the primary prevention of CV events: the British Doctors' Trial (BMD), the Physicians' Health Study (PHS), the Thrombosis Prevention Trial (TPT), the Hypertension Optimal Treatment (HOT) study, the Primary Prevention Project (PPP), the Women's Health Study (WHS), the Aspirin for Asymptomatic Atherosclerosis Trial (AAAT), the Prevention of Progression of Arterial Disease and Diabetes (POPADAD) trial, and the Japanese Primary Prevention of Atherosclerosis With Aspirin for Diabetes (JPAD) trial. The combined sample consists of about 90,000 subjects divided approximately evenly between those taking aspirin and subjects not taking aspirin or taking placebo. A meta-analysis of these 9 trials assessed 6 CV end points: total coronary heart disease, 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. The meta-analysis suggested superiority of aspirin for total CV events and nonfatal MI, (p <0.05 for each), with nonsignificant results for decreased risk for stroke, CV mortality, and all-cause mortality. There was no evidence of a statistical bias (p >0.05). In conclusion, aspirin decreased the risk for CV events and nonfatal MI in this large sample. Thus, primary prevention with aspirin decreased the risk for total CV events and nonfatal MI, but there were no significant differences in the incidences of stroke, CV mortality, all-cause mortality and total coronary heart disease.
几项荟萃分析集中于确定阿司匹林（乙酰水杨酸）在心血管（CV）事件一级预防中的有效性。尽管有这些数据，阿司匹林在一级预防中的作用仍在研究中。有 9 项随机试验评估了阿司匹林在 CV 事件一级预防中的益处：英国医生试验（BMD）、医师健康研究（PHS）、血栓形成预防试验（TPT）、高血压最佳治疗（HOT）研究、一级预防项目（PPP）、妇女健康研究（WHS）、无症状动脉粥样硬化阿司匹林治疗试验（AAAT）、动脉疾病和糖尿病预防进展（POPADAD）试验以及日本糖尿病阿司匹林动脉粥样硬化预防（JPAD）试验。合并样本包括约 90000 名受试者，大致分为服用阿司匹林组和未服用阿司匹林或服用安慰剂组。对这 9 项试验进行的荟萃分析评估了 6 个 CV 终点：总冠心病、非致死性心肌梗死（MI）、总 CV 事件、卒中和 CV 死亡率以及全因死亡率。未进行协变量调整，并且应用了适当的治疗效果、异质性和研究规模偏倚检验。荟萃分析表明阿司匹林对总 CV 事件和非致死性 MI 具有优越性（p<0.05），但对卒中、CV 死亡率和全因死亡率风险降低的结果无统计学意义。没有证据表明存在统计学偏差（p>0.05）。总之，在这个大样本中，阿司匹林降低了 CV 事件和非致死性 MI 的风险。因此，阿司匹林一级预防降低了总 CV 事件和非致死性 MI 的风险，但在卒中和 CV 死亡率、全因死亡率和总冠心病的发生率方面没有显著差异。
