阿司匹林用于慢性肾脏病患者的心血管疾病一级预防：一项更新的荟萃分析。

Aspirin for the Primary Prevention of Cardiovascular Diseases in Patients with Chronic Kidney Disease: An Updated Meta-analysis.

机构信息

Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 75, Mikras Asias str., 115 27, Athens, Greece.

Department of Nephrology and Renal Transplantation, Laiko General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.

出版信息

Am J Cardiovasc Drugs. 2024 Mar;24(2):241-253. doi: 10.1007/s40256-024-00630-y. Epub 2024 Feb 1.

DOI:10.1007/s40256-024-00630-y

PMID:38296933

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10973060/

Abstract

AIM

Chronic kidney disease is associated with increased risk of cardiovascular diseases (CVD). This meta-analysis aims to evaluate the efficacy and safety of aspirin administered for primary prevention of CVD in patients with chronic kidney disease.

METHODS

PubMed, Scopus, Web of Science, CENTRAL and Clinicaltrials.gov were systematically searched from inception to 22 June 2023. Randomized controlled trials (RCTs) and cohort studies evaluating aspirin as primary prevention of CVD in chronic kidney disease were included. Meta-analysis was conducted using random-effects models.

RESULTS

Overall, 11 studies (6 RCTs and 5 cohort studies) with 24,352 patients were included. The meta-analysis of RCTs indicated that aspirin was associated with lower risk of major adverse cardiovascular events [hazard ratio (HR): 0.79; 95% confidence intervals (CI): 0.64-0.97] and higher risk of major bleeding [risk ratio (RR): 1.35; 95% CI 1.15-1.58]. Incorporating observational evidence led to statistically non-significant findings in terms of risk of both cardiovascular events (pooled HR: 0.97; 95% CI 0.75-1.25; low certainty) and major bleeding (pooled RR: 1.21; 95% CI 0.99-1.48; moderate certainty). No statistically significant differences between aspirin and placebo were observed in the outcomes of mortality, coronary heart disease, stroke and renal events.

CONCLUSIONS

RCT evidence points to a possible benefit in cardiovascular event reduction from aspirin administration, at the cost of increased major bleeding risk. This finding was not confirmed when the existing observational evidence was incorporated. Further research should determine the most appropriate subpopulation of chronic kidney disease patients that would benefit the most from prophylactic aspirin therapy.

REGISTRATION

The study protocol has been prospectively registered and is publicly available from: https://doi.org/10.17504/protocols.io.261ged63jv47/v1 .

摘要

目的

慢性肾脏病与心血管疾病（CVD）风险增加相关。本荟萃分析旨在评估阿司匹林用于慢性肾脏病患者 CVD 一级预防的疗效和安全性。

方法

系统检索了 PubMed、Scopus、Web of Science、CENTRAL 和 Clinicaltrials.gov 从建库至 2023 年 6 月 22 日的数据。纳入评估阿司匹林用于慢性肾脏病 CVD 一级预防的随机对照试验（RCT）和队列研究。采用随机效应模型进行荟萃分析。

结果

共纳入 11 项研究（6 项 RCT 和 5 项队列研究），共计 24352 例患者。RCT 荟萃分析结果表明，阿司匹林可降低主要不良心血管事件风险[风险比（HR）：0.79；95%置信区间（CI）：0.64-0.97]，但增加大出血风险[风险比（RR）：1.35；95%CI 1.15-1.58]。纳入观察性证据后，心血管事件（合并 HR：0.97；95%CI 0.75-1.25；低确定性）和大出血（合并 RR：1.21；95%CI 0.99-1.48；中等确定性）的风险均无统计学意义。阿司匹林与安慰剂在死亡率、冠心病、卒中和肾脏事件方面无统计学差异。