Division of Clinical Pharmacy, College of Pharmacy, Ajou University, 206 Worldcup-ro Yeongtong-gu, Suwon, 16499, Republic of Korea.
Drugs Aging. 2020 Jan;37(1):43-55. doi: 10.1007/s40266-019-00723-3.
Aspirin is widely used to prevent cardiovascular diseases (CVDs). However, the balance of its benefits and risks in the primary prevention of CVDs and cancer is unclear, especially in elderly Asians. The present study aimed to evaluate the efficacy of aspirin in the primary prevention of major adverse cardiac and cerebrovascular events (MACCE), bleeding risk, and cancer in elderly Koreans with cardiovascular (CV) risk factors.
This retrospective cohort study used data from the Korean National Health Insurance Service-Senior cohort database (2002-2015). Patients aged 60-90 years with hypertension, type 2 diabetes mellitus (T2DM), or dyslipidemia were identified. Aspirin users were compared with non-users using propensity score matching at a 1:3 ratio. The primary outcome was MACCE, a composite of CV mortality, myocardial infarction, and ischemic stroke. The secondary outcomes were the components of MACCE, all-cause mortality, angina pectoris, heart failure, the incidence and mortality of cancer, and the risks of hemorrhagic stroke and gastrointestinal bleeding. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using a Cox proportional hazard model.
A total of 3366 aspirin users and 10,089 non-users were finally included in the study. During a mean follow-up of 7.8 years, the incidence of MACCE was 15.2% in aspirin users and 22.4% in non-users. The risk of MACCE was significantly lower in aspirin users than in non-users (HR 0.76; 95% CI 0.69-0.85), and this risk was significantly reduced in patients using aspirin over 5 years (HR 0.52; 95% CI 0.46-0.60). Aspirin use was associated with a 21% reduction in the risk of primary cancer (HR 0.79; 95% CI 0.70-0.88) and cancer-related mortality (HR 0.72; 95% CI 0.61-0.84). No significant differences in bleeding risks were observed between the two groups.
Aspirin reduced the risks of MACCE and cancer without increasing the bleeding risk in elderly Koreans with hypertension, T2DM, or dyslipidemia. Moreover, the benefits of the long-term use of aspirin in reducing the risks of MACCE were demonstrated. However, the decision of using aspirin for primary prevention must be carefully made on an individual basis, while estimating the benefit-risk balance of aspirin.
阿司匹林被广泛用于预防心血管疾病（CVD）。然而，其在 CVD 和癌症一级预防中的获益与风险的平衡尚不清楚，尤其是在老年亚洲人群中。本研究旨在评估阿司匹林在伴有心血管（CV）危险因素的老年韩国人群中对主要不良心脑血管事件（MACCE）、出血风险和癌症的疗效。
这是一项回顾性队列研究，使用了韩国国家健康保险服务-老年人队列数据库（2002-2015 年）的数据。纳入年龄 60-90 岁、患有高血压、2 型糖尿病（T2DM）或血脂异常的患者。将阿司匹林使用者与非使用者按照 1:3 的比例进行倾向评分匹配。主要结局是 MACCE，即心血管死亡率、心肌梗死和缺血性卒中的复合结局。次要结局是 MACCE 的组成部分、全因死亡率、心绞痛、心力衰竭、癌症的发生率和死亡率以及出血性卒中和胃肠道出血的风险。使用 Cox 比例风险模型估计风险比（HR）和 95%置信区间（CI）。
最终纳入了 3366 名阿司匹林使用者和 10089 名非使用者。在平均 7.8 年的随访期间，阿司匹林使用者的 MACCE 发生率为 15.2%，而非使用者为 22.4%。与非使用者相比，阿司匹林使用者的 MACCE 风险显著降低（HR 0.76；95%CI 0.69-0.85），且使用阿司匹林超过 5 年的患者风险显著降低（HR 0.52；95%CI 0.46-0.60）。阿司匹林的使用与原发性癌症（HR 0.79；95%CI 0.70-0.88）和癌症相关死亡率（HR 0.72；95%CI 0.61-0.84）风险降低 21%相关。两组间出血风险无显著差异。
在伴有高血压、T2DM 或血脂异常的老年韩国人群中，阿司匹林可降低 MACCE 和癌症风险，且不会增加出血风险。此外，长期使用阿司匹林降低 MACCE 风险的获益得到了证实。然而，在考虑阿司匹林的获益-风险平衡后，必须根据个体情况谨慎决定是否使用阿司匹林进行一级预防。
