Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York.
Harvard Medical School, Boston, Massachusetts.
JAMA. 2022 Apr 26;327(16):1577-1584. doi: 10.1001/jama.2022.4983.
IMPORTANCE: Cardiovascular disease (CVD) is the leading cause of mortality in the US, accounting for more than 1 in 4 deaths. Each year, an estimated 605 000 people in the US have a first myocardial infarction and an estimated 610 000 experience a first stroke. OBJECTIVE: To update its 2016 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review on the effectiveness of aspirin to reduce the risk of CVD events (myocardial infarction and stroke), cardiovascular mortality, and all-cause mortality in persons without a history of CVD. The systematic review also investigated the effect of aspirin use on colorectal cancer (CRC) incidence and mortality in primary CVD prevention populations, as well as the harms (particularly bleeding) associated with aspirin use. The USPSTF also commissioned a microsimulation modeling study to assess the net balance of benefits and harms from aspirin use for primary prevention of CVD and CRC, stratified by age, sex, and CVD risk level. POPULATION: Adults 40 years or older without signs or symptoms of CVD or known CVD (including history of myocardial infarction or stroke) who are not at increased risk for bleeding (eg, no history of gastrointestinal ulcers, recent bleeding, other medical conditions, or use of medications that increase bleeding risk). EVIDENCE ASSESSMENT: The USPSTF concludes with moderate certainty that aspirin use for the primary prevention of CVD events in adults aged 40 to 59 years who have a 10% or greater 10-year CVD risk has a small net benefit. The USPSTF concludes with moderate certainty that initiating aspirin use for the primary prevention of CVD events in adults 60 years or older has no net benefit. RECOMMENDATION: The decision to initiate low-dose aspirin use for the primary prevention of CVD in adults aged 40 to 59 years who have a 10% or greater 10-year CVD risk should be an individual one. Evidence indicates that the net benefit of aspirin use in this group is small. Persons who are not at increased risk for bleeding and are willing to take low-dose aspirin daily are more likely to benefit. (C recommendation) The USPSTF recommends against initiating low-dose aspirin use for the primary prevention of CVD in adults 60 years or older. (D recommendation).
重要提示：心血管疾病（CVD）是美国的主要死亡原因，占死亡人数的四分之一以上。每年，美国估计有 60.5 万人首次发生心肌梗死，估计有 61 万人首次发生中风。
目的：为更新其 2016 年的建议，美国预防服务工作组（USPSTF）委托对阿司匹林在无心血管疾病史人群中降低 CVD 事件（心肌梗死和中风）、心血管死亡率和全因死亡率风险的有效性进行系统评价。该系统评价还调查了阿司匹林在初级 CVD 预防人群中对结直肠癌（CRC）发病率和死亡率的影响，以及与阿司匹林使用相关的危害（特别是出血）。USPSTF 还委托了一项微观模拟建模研究，以评估阿司匹林用于 CVD 和 CRC 初级预防的获益和危害的净平衡，按年龄、性别和 CVD 风险水平分层。
人群：40 岁或以上无 CVD 迹象或症状或无已知 CVD（包括心肌梗死或中风史）且无出血风险增加的成年人（例如，无胃肠道溃疡史、近期出血、其他医疗状况或使用增加出血风险的药物）。
证据评估：USPSTF 以中等确定性得出结论，在 40 至 59 岁 CVD 风险为 10%或更高的成年人中，使用阿司匹林进行 CVD 事件的初级预防具有较小的净获益。USPSTF 以中等确定性得出结论，在 60 岁或以上的成年人中开始使用阿司匹林进行 CVD 事件的初级预防没有净获益。
建议：在 10 年 CVD 风险为 10%或更高的 40 至 59 岁成年人中开始使用低剂量阿司匹林进行 CVD 的初级预防应是个人决定。证据表明，该组人群使用阿司匹林的净获益较小。没有出血风险增加且愿意每天服用低剂量阿司匹林的人可能会获益更多。（C 级推荐）USPSTF 建议不要在 60 岁或以上的成年人中开始使用低剂量阿司匹林进行 CVD 的初级预防。（D 级推荐）
Gynecol Oncol Rep. 2025-8-5
Zotero 插件