Bugiardini Raffaele, Pavasović Saša, Yoon Jinsung, van der Schaar Mihaela, Kedev Sasko, Vavlukis Marija, Vasiljevic Zorana, Bergami Maria, Miličić Davor, Manfrini Olivia, Cenko Edina, Badimon Lina
Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola Malpighi, Padiglione 11, Via Massarenti 9, 40138 Bologna, Italy.
Department for Cardiovascular Diseases, University Hospital Centre Zagreb, University of Zagreb, Zagreb, Croatia.
EClinicalMedicine. 2020 Sep 20;27:100548. doi: 10.1016/j.eclinm.2020.100548. eCollection 2020 Oct.
Controversy exists as to whether low-dose aspirin use may give benefit in primary prevention of cardiovascular (CV) events. We hypothesized that the benefits of aspirin are underevaluated.
We investigated 12,123 Caucasian patients presenting to hospital with acute coronary syndromes as first manifestation of CV disease from 2010 to 2019 in the ISACS-TC multicenter registry (ClinicalTrials.gov, NCT01218776). Individual risk of ST segment elevation myocardial infarction (STEMI) and its association with 30-day mortality was quantified using inverse probability of treatment weighting models matching for concomitant medications. Estimates were compared by test of interaction on the log scale.
The risk of STEMI was lower in the aspirin users (absolute reduction: 6·8%; OR: 0·73; 95%CI: 0·65-0·82) regardless of sex (p for interaction=0·1962) or age (p for interaction=0·1209). Benefits of aspirin were seen in patients with hypertension, hypercholesterolemia, and in smokers. In contrast, aspirin failed to demonstrate a significant risk reduction in STEMI among diabetic patients (OR:1·10;95%CI:0·89-1·35) with a significant interaction (p: <0·0001) when compared with controls (OR:0·64,95%CI:0·56-0·73). Stratification of diabetes in risk categories revealed benefits (p interaction=0·0864) only in patients with concomitant hypertension and hypercholesterolemia (OR:0·87, 95% CI:0·65-1·15), but not in smokers. STEMI was strongly related to 30-day mortality (OR:1·93; 95%CI:1·59-2·35).
Low-dose aspirin reduces the risk of STEMI as initial manifestation of CV disease with potential benefit in mortality. Patients with diabetes derive substantial benefit from aspirin only in the presence of multiple risk factors. In the era of precision medicine, a more tailored strategy is required.
None.
低剂量阿司匹林在心血管（CV）事件一级预防中是否有益存在争议。我们假设阿司匹林的益处未得到充分评估。
我们在ISACS - TC多中心注册研究（ClinicalTrials.gov，NCT01218776）中调查了2010年至2019年因急性冠状动脉综合征作为CV疾病首发表现而入院的12123名白种人患者。使用倾向评分匹配模型对伴随用药进行匹配，量化ST段抬高型心肌梗死（STEMI）的个体风险及其与30天死亡率的关联。通过对数尺度上的交互作用检验比较估计值。
无论性别（交互作用p值 = 0.1962）或年龄（交互作用p值 = 0.1209）如何，阿司匹林使用者发生STEMI的风险较低（绝对降低：6.8%；OR：0.73；95%CI：0.65 - 0.82）。在高血压、高胆固醇血症患者以及吸烟者中观察到阿司匹林的益处。相比之下，与对照组（OR：0.64，95%CI：0.56 - 0.73）相比，糖尿病患者使用阿司匹林未能显著降低STEMI风险（OR：1.10；95%CI：0.89 - 1.35），存在显著交互作用（p值：<0.0001）。将糖尿病按风险类别分层显示，仅在伴有高血压和高胆固醇血症的患者中阿司匹林有益（交互作用p值 = 0.0864）（OR：0.87，95%CI：0.65 - 1.15），但在吸烟者中无益处。STEMI与30天死亡率密切相关（OR：1.93；95%CI：1.59 - 2.35）。
低剂量阿司匹林可降低作为CV疾病首发表现的STEMI风险，并可能对死亡率有益。糖尿病患者仅在存在多种风险因素时才从阿司匹林中获得显著益处。在精准医学时代，需要更具针对性的策略。
无。
