Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida.
Division of Cardiology, A.O.U. "Policlinico-Vittorio Emanuele," University of Catania, Catania, Italy.
Am J Cardiol. 2021 Apr 1;144 Suppl 1:S15-S22. doi: 10.1016/j.amjcard.2020.12.022.
Aspirin (ASA) is the most commonly prescribed antiplatelet agent. Although the evidence for efficacy of aspirin for secondary prevention of ischemic events in patients with established cardiovascular disease is strong, its role in primary prevention has been subject of controversies over the past decades. In fact, historical trials have shown only modest benefit in terms of reduction of ischemic events, mostly myocardial infarction and to a lesser extent stroke, and only at the expense of an increased risk of bleeding. These observations have led to divergent recommendations from professional societies on the use of ASA for primary prevention of cardiovascular disease manifestations. However, recent results from three trials of primary prevention have shown either no benefit or modest benefit on combined ischemic end points, without any impact on hard cardiovascular events such as myocardial infarction or stroke, accompanied by an increased risk of bleeding. Overall, this translated into neutral net benefit or even harm with the use of aspirin in patients with no overt cardiovascular disease. These results have accordingly led to a downgrade in the current recommendations on the use of ASA for primary prevention. This article provides an overview on the current evidence on the use of aspirin for primary prevention of cardiovascular disease.
阿司匹林（ASA）是最常被开的抗血小板药物。虽然阿司匹林在已确诊心血管疾病患者中预防缺血性事件的二级预防中的疗效证据确凿，但在过去几十年中，其在一级预防中的作用一直存在争议。事实上，历史研究仅表明在降低缺血性事件（主要是心肌梗死，其次是中风）方面有适度的益处，而且这是以增加出血风险为代价的。这些观察结果导致专业协会在阿司匹林用于心血管疾病表现的一级预防方面的建议存在分歧。然而，最近三项一级预防试验的结果表明，联合缺血终点无获益或获益甚微，对心肌梗死或中风等严重心血管事件无任何影响，同时出血风险增加。总体而言，这导致在无明显心血管疾病的患者中使用阿司匹林的净获益为中性，甚至有害。这些结果相应地导致了目前关于阿司匹林用于一级预防的建议降级。本文概述了阿司匹林用于一级预防心血管疾病的现有证据。
