Ann Intern Med. 2016 Jun 21;164(12):777-86. doi: 10.7326/M15-2129. Epub 2016 Apr 12.
Evidence indicates that aspirin is effective for the primary prevention of cardiovascular disease (CVD) and colorectal cancer (CRC) but also increases the risk for gastrointestinal (GI) and cerebral hemorrhages.
To assess the net balance of benefits and harms from routine aspirin use across clinically relevant age, sex, and CVD risk groups.
Decision analysis using a microsimulation model.
3 systematic evidence reviews.
Men and women aged 40 to 79 years with a 10-year CVD risk of 20% or less, and no history of CVD and without elevated risk for GI or cerebral hemorrhages that would contraindicate aspirin use.
Lifetime, 20 years, and 10 years.
Clinical.
Low-dose aspirin (≤100 mg/d).
Primary outcomes are length and quality of life measured in net life-years and quality-adjusted life-years. Benefits include reduced nonfatal myocardial infarction, nonfatal ischemic stroke, fatal CVD, CRC incidence, and CRC mortality. Harms include increased fatal and nonfatal GI bleeding and hemorrhagic stroke.
RESULTS OF BASE-CASE ANALYSIS: Lifetime net quality-adjusted life-years are positive for most adults initiating aspirin at ages 40 to 69 years, and life expectancy gains are expected for most men and women initiating aspirin at ages 40 to 59 years and 60 to 69 years with higher CVD risk. Harms may exceed benefits for persons starting aspirin in their 70s and for many during the first 10 to 20 years of use.
Results are most sensitive to the relative risk for hemorrhagic stroke and CVD mortality but are affected by all relative risk estimates, baseline GI bleeding incidence and case-fatality rates, and disutilities associated with aspirin use.
Aspirin effects by age are uncertain. Stroke benefits are conservatively estimated. Gastrointestinal bleeding incidence and case-fatality rates account only for age and sex.
Lifetime aspirin use for primary prevention initiated at younger ages (40 to 69 years) and in persons with higher CVD risk shows the greatest potential for positive net benefit.
Agency for Healthcare Research and Quality.
有证据表明，阿司匹林对于预防心血管疾病（CVD）和结直肠癌（CRC）非常有效，但也会增加胃肠道（GI）和脑出血的风险。
评估常规使用阿司匹林的益处和危害的净平衡，涵盖临床相关的年龄、性别和 CVD 风险组。
使用微模拟模型进行决策分析。
3 项系统证据综述。
年龄在 40 至 79 岁之间、10 年内 CVD 风险为 20%或以下、无 CVD 病史且无升高的 GI 或脑出血风险（这会导致阿司匹林使用禁忌）的男性和女性。
终生、20 年和 10 年。
临床。
低剂量阿司匹林（≤100mg/d）。
主要结果是通过净寿命年和质量调整寿命年来衡量的生命长度和生活质量。益处包括减少非致命性心肌梗死、非致命性缺血性中风、致命性 CVD、CRC 发病率和 CRC 死亡率。危害包括增加致命和非致命性 GI 出血和脑出血。
对于大多数在 40 至 69 岁开始使用阿司匹林的成年人，终生质量调整寿命年是积极的，并且对于大多数在 40 至 59 岁和 60 至 69 岁开始使用阿司匹林且 CVD 风险较高的男性和女性，预期会增加预期寿命。对于 70 多岁开始使用阿司匹林的人以及许多人在使用前 10 至 20 年，危害可能超过益处。
结果对脑出血和 CVD 死亡率的相对风险最为敏感，但也受到所有相对风险估计、基线 GI 出血发生率和病死率以及与阿司匹林使用相关的不良效用的影响。
阿司匹林对年龄的影响尚不确定。中风益处被保守估计。胃肠道出血的发生率和病死率仅考虑年龄和性别。
在年轻年龄（40 至 69 岁）和 CVD 风险较高的人群中开始使用阿司匹林进行初级预防，具有最大的净收益潜力。
美国医疗保健研究与质量局。
