University of Toledo, Toledo, OH, USA.
The Ohio State University Medical Center, Columbus, OH, USA.
Curr Cardiol Rep. 2020 May 29;22(7):48. doi: 10.1007/s11886-020-01296-z.
To review the clinical evidence of the effect of aspirin as primary prevention for patients with diabetes mellitus and in healthy elderly.
Two trials were performed to study these two patient populations: ASCEND showed that the use of low-dose aspirin in persons with diabetes, who did not have prior cardiovascular disease, led to a lower risk of cardiovascular events than placebo (8.5% vs 9.6%, rate ratio 0.88, 95% CI 0.79-0.97; p = 0.01). However, it showed a similar magnitude of increased risk of major bleeding among the aspirin group compared with placebo (4.1% vs 3.2%, rate ratio 1.29, 95% CI 1.09-1.52; p = 0.003). ASPREE showed that the use of low-dose aspirin in healthy elderly did not prolong disability-free survival (21.5% vs 21.2%, HR 1.01, 95% CI 0.92-1.11; p = 0.79); however, the rate of major hemorrhage was higher in the aspirin group than in the placebo group (3.8% vs 2.8%, HR 1.38, 95% CI 1.18-1.62; p < 0.001). Additionally, further analyses of secondary end points of death, cardiovascular disease, and major hemorrhage were also studied. Higher all-cause mortality was seen among healthy elderly who received aspirin compared with placebo (12.7% vs 11.1%, HR 1.14, 95% CI 1.01-1.29) and was primarily attributed to cancer-related deaths. Similar risk of cardiovascular disease was seen among elderly who received aspirin compared with placebo (10.7% vs 11.3%, HR 0.95, 95% CI 0.83-1.08) and resulted in a significantly higher risk of major hemorrhage (8.6% vs 6.8%, HR 1.38, 95% CI 1.18-1.62; p < 0.001). These studies show that the use of low-dose aspirin as primary prevention in patients with diabetes and in the elderly does not have overall beneficial effect compared with its use in secondary prevention. In patients with diabetes without prior cardiovascular disease, the benefits of aspirin use were counterbalanced by the bleeding risk. Additionally, in healthy elderly, the use of aspirin did not prolong disability-free survival and instead led to a higher rate of major hemorrhage.
评估阿司匹林作为糖尿病患者一级预防和健康老年人一级预防的临床效果。
两项试验研究了这两个患者人群：ASCEND 研究表明，在无心血管疾病既往史的糖尿病患者中，使用低剂量阿司匹林可降低心血管事件风险，低于安慰剂组（8.5% vs 9.6%，率比 0.88，95%CI 0.79-0.97；p=0.01）。然而，与安慰剂组相比，阿司匹林组大出血风险增加幅度相似（4.1% vs 3.2%，率比 1.29，95%CI 1.09-1.52；p=0.003）。ASPREE 研究表明，在健康老年人中使用低剂量阿司匹林并不能延长无残疾生存（21.5% vs 21.2%，HR 1.01，95%CI 0.92-1.11；p=0.79）；然而，阿司匹林组的大出血发生率高于安慰剂组（3.8% vs 2.8%，HR 1.38，95%CI 1.18-1.62；p<0.001）。此外，还对次要终点死亡、心血管疾病和大出血进行了进一步分析。与安慰剂组相比，接受阿司匹林治疗的健康老年人全因死亡率更高（12.7% vs 11.1%，HR 1.14，95%CI 1.01-1.29），主要归因于癌症相关死亡。与安慰剂组相比，接受阿司匹林治疗的老年人发生心血管疾病的风险相似（10.7% vs 11.3%，HR 0.95，95%CI 0.83-1.08），但大出血风险显著升高（8.6% vs 6.8%，HR 1.38，95%CI 1.18-1.62；p<0.001）。这些研究表明，与二级预防相比，糖尿病患者和老年人使用低剂量阿司匹林作为一级预防并没有总体获益效果。在无心血管疾病既往史的糖尿病患者中，阿司匹林的使用益处被出血风险所抵消。此外，在健康老年人中，使用阿司匹林并不能延长无残疾生存，反而导致更高的大出血发生率。
