Sehgal Mandi, Wood Sarah K, Ouslander Joseph G, Hennekens Charles H
1 Department of Integrated Medical Science, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA.
J Cardiovasc Pharmacol Ther. 2017 Nov;22(6):511-513. doi: 10.1177/1074248417696820. Epub 2017 Mar 9.
In the treatment or secondary prevention of cardiovascular disease (CVD), there is general consensus that the absolute benefits of aspirin far outweigh the absolute risks. Despite evidence from randomized trials and their meta-analyses, older adults, defined as aged 65 years or older, are less likely to be prescribed aspirin than their middle-aged counterparts. In primary prevention, the optimal utilization of aspirin is widely debated. There is insufficient randomized evidence among apparently healthy participants at moderate to high risk of a first CVD event, so general guidelines seem premature. Among older adults, randomized data are even more sparse but trials are ongoing. Further, older adults commonly take multiple medications due to comorbidities, which may increase deleterious interactions and side effects. Older adults have higher risks of occlusive events as well as bleeding. All these considerations support the need for individual clinical judgments in prescribing aspirin in the context of therapeutic lifestyle changes and other adjunctive drug therapies. These include statins for lipids and usually multiple drugs to achieve control of high blood pressure. As regards aspirin, the clinician should weigh the absolute benefit on occlusion against the absolute risk of bleeding. These issues should be considered with each patient to facilitate an informed and person-centered individual clinical judgment. The use of aspirin in primary prevention is particularly attractive because the drug is generally over the counter and, for developing countries where CVD is becoming the leading cause of death, is extremely inexpensive. The more widespread use of aspirin in older adults with prior CVD will confer net benefits to risks and even larger net benefits to costs in the United States as well as other developed and developing countries. In primary prevention among older adults, individual clinical judgments should be made by the health-care professional and each of his or her patients.
在心血管疾病（CVD）的治疗或二级预防中，人们普遍认为阿司匹林的绝对益处远大于绝对风险。尽管有随机试验及其荟萃分析的证据，但65岁及以上的老年人比中年同龄人更不太可能被开具阿司匹林处方。在一级预防中，阿司匹林的最佳使用存在广泛争议。在首次发生CVD事件的中度至高度风险的明显健康参与者中，缺乏足够的随机证据，因此一般指南似乎为时过早。在老年人中，随机数据更为稀少，但试验正在进行中。此外，老年人由于合并症通常服用多种药物，这可能会增加有害相互作用和副作用。老年人发生闭塞性事件和出血的风险更高。所有这些考虑因素都支持在治疗性生活方式改变和其他辅助药物治疗的背景下，在开具阿司匹林处方时需要进行个体化临床判断。这些包括用于血脂的他汀类药物以及通常用于控制高血压的多种药物。至于阿司匹林，临床医生应权衡其对闭塞的绝对益处与出血的绝对风险。应与每位患者考虑这些问题，以促进明智的、以患者为中心的个体化临床判断。阿司匹林在一级预防中的使用特别有吸引力，因为该药物通常是非处方药，而且对于CVD正成为主要死因的发展中国家来说，极其便宜。在美国以及其他发达国家和发展中国家，在有既往CVD的老年人中更广泛地使用阿司匹林将给风险带来净益处，甚至给成本带来更大的净益处。在老年人的一级预防中，医疗保健专业人员及其每位患者都应做出个体化临床判断。
