Superko H Robert, Sninsky John, Garrett Brenda
Cholesterol, Genetics and Heart Disease Institute (501c3 nonprofit), USA.
Am J Prev Cardiol. 2025 May 21;22:101013. doi: 10.1016/j.ajpc.2025.101013. eCollection 2025 Jun.
The use of daily aspirin in a primary prevention population to reduce cardiovascular disease event risk is a conundrum because the reduction in cardiovascular event risk is balanced by an equal increase in the risk of a serious gastrointestinal bleed. This conundrum can be partially clarified by genetic testing for polymorphisms. A genetic polymorphism in the apolipoprotein (a) component of lipoprotein (a) has been identified that could help identify patients who may benefit the most from daily aspirin in regard to coronary heart disease event reduction. Recent clinical trials have demonstrated that carriers of the variant (rs3798220) have a significantly greater risk for a coronary heart disease event compared to non-carriers. However, in carriers of the variant randomized to aspirin, the incidence of major coronary heart disease events was reduced to the same level as subjects who did not have the variant. This provides a clinically available tool that may allow identification of a subset of primary prevention patients who derive more cardiovascular risk reduction from daily aspirin than the risk of a serious gastrointestinal bleed. This provides an inexpensive treatment options for patients with the variant.
在一级预防人群中使用每日阿司匹林来降低心血管疾病事件风险是一个难题，因为心血管事件风险的降低与严重胃肠道出血风险的同等增加相平衡。通过对基因多态性进行基因检测可以部分阐明这一难题。已鉴定出脂蛋白(a)的载脂蛋白(a)成分中的一种基因多态性，这有助于识别在降低冠心病事件方面可能从每日阿司匹林中获益最大的患者。最近的临床试验表明，与非携带者相比，该变体（rs3798220）的携带者发生冠心病事件的风险显著更高。然而，在随机接受阿司匹林治疗的该变体携带者中，主要冠心病事件的发生率降至与没有该变体的受试者相同的水平。这提供了一种临床可用工具，可能有助于识别一部分一级预防患者，这些患者从每日阿司匹林中获得的心血管风险降低超过严重胃肠道出血的风险。这为具有该变体的患者提供了一种廉价的治疗选择。
