Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Lancet. 2019 May 25;393(10186):2155-2167. doi: 10.1016/S0140-6736(19)30541-0.
Aspirin is one of the most frequently used drugs worldwide and is generally considered effective for the secondary prevention of cardiovascular disease. By contrast, the role of aspirin in primary prevention of cardiovascular disease is controversial. Early trials evaluating aspirin for primary prevention, done before the turn of the millennium, suggested reductions in myocardial infarction and stroke (although not mortality), and an increased risk of bleeding. In an effort to balance the risks and benefits of aspirin, international guidelines on primary prevention of cardiovascular disease have typically recommended aspirin only when a substantial 10-year risk of cardiovascular events exists. However, in 2018, three large randomised clinical trials of aspirin for the primary prevention of cardiovascular disease showed little or no benefit and have even suggested net harm. In this narrative Review, we reappraise the role of aspirin in primary prevention of cardiovascular disease, contextualising data from historical and contemporary trials.
阿司匹林是全球应用最广泛的药物之一，通常被认为对心血管疾病的二级预防有效。相比之下，阿司匹林在心血管疾病一级预防中的作用仍存在争议。千禧年之前开展的早期评估阿司匹林用于一级预防的试验提示，该药可降低心肌梗死和卒中等心血管事件（尽管不降低死亡率），但增加出血风险。为了权衡阿司匹林的风险和获益，心血管疾病一级预防的国际指南通常仅建议在存在高 10 年心血管事件风险时应用阿司匹林。然而，2018 年，三项评估阿司匹林用于心血管疾病一级预防的大型随机临床试验显示，阿司匹林的获益很小或几乎没有，甚至可能存在净危害。在本叙述性综述中，我们结合历史和当代试验的数据，重新评估阿司匹林在心血管疾病一级预防中的作用。
