Zhao Binghao, Wu Qian, Wang Li, Liao Chen, Dong Yifei, Xu Jingsong, Wei Yiping, Zhang Wenxiong
Department of Cardio-Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China.
Departments of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Pharmacol. 2021 Jan 14;11:592116. doi: 10.3389/fphar.2020.592116. eCollection 2020.
Aspirin leads to substantial benefits for the secondary prevention of cardiovascular disease (CVD). We aimed to cast more light on aspirin's role for the primary prevention of CVD. Databases were searched for clinical trials comparing aspirin vs. no aspirin use in this meta-analysis. Efficacy and safety profiles were rigorously investigated. Trial sequential analysis (TSA) was used to determine the robustness of the results. Fourteen studies with 163,840 participants were eligible (mean follow-up 6.2 y). Aspirin intake was found to be associated with 9, 13, and 12% reductions in the risk of cardiovascular events (CV events) (relative risk [RR]: 0.91, 95% confidence intervals [CI]: 0.87-0.96; risk difference (RD): 0.29%; absolute risk percentage (AR%): 7.61%; number needed to treat (NNT): 345), myocardial infarction (RR: 0.87, 95% CI: 0.77-0.97; RD: 0.21%; AR%: 11.11%; NNT: 488) and ischemic stroke (RR: 0.88, 95% CI: 0.80-0.96; RD: 0.21%; AR%: 16.14%; NNT: 476), respectively; aspirin intake was also associated with 40%, 30%, and 57% increases in the risk of major bleeding (RR: 1.40, 95% CI: 1.29-1.53; RD: 0.47%; AR%: 27.85; NNT: 214), intracranial bleeding (RR: 1.30, 95% CI: 1.11-1.52; RD: 0.10%; AR%: 22.99%; NNT: 1,000) and major gastrointestinal bleeding (RR: 1.57, 95% CI: 1.38-1.78; RD: 0.32%; AR%: 36.70%; NNT: 315), respectively. Further, populations with low doses of aspirin intake (≤100 mg), populations <65 y old or populations with body mass index (BMI) ≧ 25 experienced more advantages; high-risk (10-y cardiovascular risk ≧10%) and full diabetic individuals reported hardly clinical benefits. Aspirin intake was associated with a reduced risk of CV events and an increased incidence of bleeding profiles in primary prevention. It is necessary to identify individual's CVD risk using clear examinations or assessments before aspirin intake, and truly realize individualized prescription.
阿司匹林对心血管疾病（CVD）的二级预防具有显著益处。我们旨在进一步阐明阿司匹林在CVD一级预防中的作用。在该荟萃分析中，检索数据库以查找比较使用阿司匹林与不使用阿司匹林的临床试验。对疗效和安全性进行了严格调查。采用试验序贯分析（TSA）来确定结果的稳健性。14项研究共163,840名参与者符合条件（平均随访6.2年）。发现服用阿司匹林可使心血管事件（CV事件）风险降低9%、13%和12%（相对风险[RR]：0.91，95%置信区间[CI]：0.87 - 0.96；风险差[RD]：0.29%；绝对风险百分比[AR%]：7.61%；需治疗人数[NNT]：345），心肌梗死风险降低（RR：0.87，95% CI：0.77 - 0.97；RD：0.21%；AR%：11.11%；NNT：488），缺血性中风风险降低（RR：0.88，95% CI：0.80 - 0.96；RD：0.21%；AR%：16.14%；NNT：476）；服用阿司匹林还分别使大出血风险增加40%、30%和57%（RR：1.40，95% CI：1.29 - 1.53；RD：0.47%；AR%：27.85；NNT：214），颅内出血风险增加（RR：1.30，95% CI：1.11 - 1.52；RD：0.10%；AR%：22.99%；NNT：1,000），主要胃肠道出血风险增加（RR：1.57，95% CI：1.38 - 1.78；RD：0.32%；AR%：36.70%；NNT：315）。此外，低剂量（≤100毫克）阿司匹林摄入人群、年龄<65岁人群或体重指数（BMI）≧25的人群获益更多；高危（10年心血管风险≧10%）和完全糖尿病个体几乎未报告临床获益。服用阿司匹林在一级预防中与降低CV事件风险及增加出血发生率相关。在服用阿司匹林前，有必要通过明确的检查或评估来识别个体的CVD风险，并真正实现个体化处方。
