Marquis-Gravel Guillaume, Stebbins Amanda, Wruck Lisa M, Roe Matthew T, Effron Mark B, Hammill Bradley G, Whittle Jeff, VanWormer Jeffrey J, Robertson Holly R, Alikhaani Jacqueline D, Kripalani Sunil, Farrehi Peter M, Girotra Saket, Benziger Catherine P, Polonsky Tamar S, Merritt J Greg, Gupta Kamal, McCormick Thomas E, Knowlton Kirk U, Jain Sandeep K, Kochar Ajar, Rothman Russell L, Harrington Robert A, Hernandez Adrian F, Jones W Schuyler
Duke Clinical Research Institute Durham NC.
Montreal Heart Institute, Université de Montréal QC Canada.
J Am Heart Assoc. 2024 Feb 20;13(4):e026921. doi: 10.1161/JAHA.122.026921. Epub 2024 Feb 13.
In patients with atherosclerotic cardiovascular disease, increasing age is concurrently associated with higher risks of ischemic and bleeding events. The objectives are to determine the impact of aspirin dose on clinical outcomes according to age in atherosclerotic cardiovascular disease.
In the ADAPTABLE (Aspirin Dosing: A Patient-Centric Trial Assessing Benefits and Long-Term Effectiveness) trial, patients with atherosclerotic cardiovascular disease were randomized to daily aspirin doses of 81 mg or 325 mg. The primary effectiveness end point was death from any cause, hospitalization for myocardial infarction, or hospitalization for stroke. The primary safety end point was hospitalization for bleeding requiring transfusion. A total of 15 076 participants were randomized to aspirin 81 mg (n=7540) or 325 mg (n=7536) daily (median follow-up: 26.2 months; interquartile range: 19.0-34.9 months). Median age was 67.6 years (interquartile range: 60.7-73.6 years). Among participants aged <65 years (n=5841 [38.7%]), a primary end point occurred in 226 (7.54%) in the 81 mg group, and in 191 (6.80%) in the 325 mg group (adjusted hazard ratio [HR], 1.23 [95% CI, 1.01-1.49]). Among participants aged ≥65 years (n=9235 [61.3%]), a primary end point occurred in 364 (7.12%) in the 81 mg group, and in 378 (7.96%) in the 325 mg group (adjusted HR, 0.95 [95% CI, 0.82-1.10]). The age-dose interaction was not significant (=0.559). There was no significant interaction between age and the randomized aspirin dose for the secondary effectiveness and the primary safety bleeding end points (>0.05 for all).
Age does not modify the impact of aspirin dosing (81 mg or 325 mg daily) on clinical end points in secondary prevention of atherosclerotic cardiovascular disease.
在动脉粥样硬化性心血管疾病患者中，年龄增长与缺血性和出血性事件风险增加同时存在。目的是确定在动脉粥样硬化性心血管疾病中，阿司匹林剂量对不同年龄患者临床结局的影响。
在ADAPTABLE（阿司匹林剂量：以患者为中心评估益处和长期有效性的试验）试验中，动脉粥样硬化性心血管疾病患者被随机分为每日服用81毫克或325毫克阿司匹林两组。主要有效性终点是任何原因导致的死亡、因心肌梗死住院或因中风住院。主要安全性终点是因出血需要输血而住院。共有15076名参与者被随机分为每日服用81毫克阿司匹林组（n = 7540）或325毫克阿司匹林组（n = 7536）（中位随访时间：26.2个月；四分位间距：19.0 - 34.9个月）。中位年龄为67.6岁（四分位间距：60.7 - 73.6岁）。在年龄小于65岁的参与者中（n = 5841 [38.7%]），81毫克组有226人（7.54%）发生主要终点事件，325毫克组有191人（6.80%）发生主要终点事件（调整后风险比[HR]，1.23 [95% CI，1.01 - 1.49]）。在年龄≥65岁的参与者中（n = 9235 [61.3%]），81毫克组有364人（7.12%）发生主要终点事件，325毫克组有378人（7.96%）发生主要终点事件（调整后HR，0.95 [95% CI，0.82 - 1.10]）。年龄 - 剂量交互作用不显著（P = 0.559）。年龄与随机分组的阿司匹林剂量在次要有效性终点和主要安全性出血终点方面无显著交互作用（所有P>0.05）。
在动脉粥样硬化性心血管疾病二级预防中，年龄不改变阿司匹林剂量（每日81毫克或325毫克）对临床终点的影响。
