Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials.
Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials.
复制标题
DOI：
10.1016/s0140-6736(09)60503-1
复制
发表时间：
2009-05-30
期刊：
影响因子：
168.9
通讯作者：
Patrono, Carlo
中科院分区：
文献类型：
--
作者：
Collins, Rory;Peto, Richard;Hennekens, Charles;Doll, Richard;Bubes, Vadim;Buring, Julie;Dushkesas, Rimma;Gaziano, Michael;Brennam, Patrick;Meade, Tom;Rudnicka, Alicja;Hansson, Lennart;Warnold, Ingrid;Zanchetti, Alberto;Avanzini, Fausto;Roncaglioni, Maria Carla;Tognoni, Gianni;Chown, Marilyn;Gaziano, Michael;Hennekens, Charles;Baigent, Colin;Barton, Ian;Baxter, Alex;Bhala, Neeraj;Blackwell, Lisa;Boreham, Jill;Bowman, Louise;Buck, Georgina;Collins, Rory;Emberson, Jonathan;Godwin, Jon;Halls, Heather;Holland, Lisa;Kearney, Patricia;Peto, Richard;Reith, Christina;Wilson, Kate;Baigent, Colin;Blackwell, Lisa;Patrono, Carlo
低剂量阿司匹林对许多已经患有闭塞性血管疾病的人有明确和实质性的净益处。我们评估了初级预防的益处和风险。我们对6项一级预防试验（95000例低平均风险患者，660000人-年，3554例严重血管事件）和16项二级预防试验（17000例高平均风险患者，43000人-年，3306例严重血管事件）中的严重血管事件（心肌梗死，卒中或血管性死亡）和大出血进行了荟萃分析，比较了长期服用阿司匹林与对照组。 我们报告在预定治疗期间首次事件的意向治疗分析。在一级预防试验中，阿司匹林的分配使严重血管事件减少了12%（每年0.51%阿司匹林vs 0.57%对照，p= 0.0001），主要是由于非致命性心肌梗死减少了约五分之一（每年0.18% vs 0.23%，p<0.0001）。对卒中的净效应不显著（每年0.20% vs 0.21%，p= 0.4;出血性卒中0.04% vs 0.03%，p= 0.05;其他卒中0.16% vs 0.18%，p= 0.08）。血管死亡率无显著差异（每年0.19% vs 0.19%，p= 0.7）。阿司匹林的使用增加了胃肠道和颅外出血的发生率（每年0.10% vs 0.07%，p<0.0001），冠心病的主要危险因素也是出血的危险因素。在二级预防试验中，阿司匹林分配产生了更大的严重血管事件的绝对减少（每年6.7% vs 8.2%，p<0.0001），出血性卒中无显著增加，但总卒中减少约五分之一（每年2.08% vs 2.54%，p= 0.002）和冠状动脉事件（每年4.3% vs 5.3%，p<0.0001）。在一级和二级预防试验中，男性和女性所有严重血管事件的总体比例降低似乎相似。在无既往疾病的一级预防中，阿司匹林的净价值不确定，因为闭塞事件的减少需要与大出血的增加进行权衡。进一步的审判正在进行中。英国医学研究理事会、英国心脏基金会、英国癌症研究和欧洲共同体生物医学计划。
Low-dose aspirin is of definite and substantial net benefit for many people who already have occlusive vascular disease. We have assessed the benefits and risks in primary prevention. We undertook meta-analyses of serious vascular events (myocardial infarction, stroke, or vascular death) and major bleeds in six primary prevention trials (95 000 individuals at low average risk, 660 000 person-years, 3554 serious vascular events) and 16 secondary prevention trials (17 000 individuals at high average risk, 43 000 person-years, 3306 serious vascular events) that compared long-term aspirin versus control. We report intention-to-treat analyses of first events during the scheduled treatment period. In the primary prevention trials, aspirin allocation yielded a 12% proportional reduction in serious vascular events (0·51% aspirin vs 0·57% control per year, p=0·0001), due mainly to a reduction of about a fifth in non-fatal myocardial infarction (0·18% vs 0·23% per year, p<0·0001). The net effect on stroke was not significant (0·20% vs 0·21% per year, p=0·4: haemorrhagic stroke 0·04% vs 0·03%, p=0·05; other stroke 0·16% vs 0·18% per year, p=0·08). Vascular mortality did not differ significantly (0·19% vs 0·19% per year, p=0·7). Aspirin allocation increased major gastrointestinal and extracranial bleeds (0·10% vs 0·07% per year, p<0·0001), and the main risk factors for coronary disease were also risk factors for bleeding. In the secondary prevention trials, aspirin allocation yielded a greater absolute reduction in serious vascular events (6·7% vs 8·2% per year, p<0.0001), with a non-significant increase in haemorrhagic stroke but reductions of about a fifth in total stroke (2·08% vs 2·54% per year, p=0·002) and in coronary events (4·3% vs 5·3% per year, p<0·0001). In both primary and secondary prevention trials, the proportional reductions in the aggregate of all serious vascular events seemed similar for men and women. In primary prevention without previous disease, aspirin is of uncertain net value as the reduction in occlusive events needs to be weighed against any increase in major bleeds. Further trials are in progress. UK Medical Research Council, British Heart Foundation, Cancer Research UK, and the European Community Biomed Programme.