FINAL REPORT ON THE ASPIRIN COMPONENT OF THE ONGOING PHYSICIANS HEALTH STUDY
FINAL REPORT ON THE ASPIRIN COMPONENT OF THE ONGOING PHYSICIANS HEALTH STUDY
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DOI：
10.1056/nejm198907203210301
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发表时间：
1989-07-20
影响因子：
158.5
通讯作者：
HENNEKENS, CH
中科院分区：
文献类型：
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作者：
HENNEKENS, CH
医生健康研究是一项随机、双盲、安慰剂对照试验，旨在确定低剂量阿司匹林（每隔一天325 mg）是否降低心血管死亡率以及β-胡萝卜素是否降低癌症发病率。阿司匹林成分比预定时间提前终止，并发表了初步结果。我们现在对22，071名参与者的心血管成分进行了详细的分析，平均随访时间为60.2个月，心肌梗死的风险降低了44（相对危险度，0.56; 95%可信区间，0.45 ~ 0.70; P<0.00001）阿司匹林组（254.8/100，000/年，安慰剂组439.7/100，000/年）。在服用阿司匹林的人群中，中风风险的轻微增加没有统计学意义;这种趋势主要在出血性中风的亚组中观察到（相对风险，2.14; 95%置信区间，0.96至4.77; P = 0.06）。所有心血管原因的死亡率与阿司匹林无关（相对危险度为0.96，95%可信区间为0.60 ~ 1.54），进一步分析显示，心肌梗死风险的降低仅在50岁及以上人群中明显。这种益处存在于所有胆固醇水平，但在低水平时似乎最大。阿司匹林组发生溃疡的相对危险度为1.22（阿司匹林组为169例，安慰剂组为138例; 95%置信区间为0.98至1.53; P = 0.08），需要输血的相对危险度为1.71。这项阿司匹林用于心血管疾病一级预防的试验表明，心肌梗死的风险，但关于中风和心血管死亡总数的证据仍然不确定，因为这些终点的医生数量不足。（《新英格兰医学杂志》1989; 321：129- 135）
The Physicians' Health Study is a randomized, double-blind, placebo-controlled trial designed to determine whether low-dose aspirin (325 mg every other day) decreases cardiovascular mortality and whether beta carotene reduces the incidence of cancer. The aspirin component was terminated earlier than scheduled, and the preliminary findings were published. We now present detailed analyses of the cardiovascular component for 22,071 participants, at an average follow-up time of 60.2 months.There was a 44 percent reduction in the risk of myocardial infarction (relative risk, 0.56; 95 percent confidence interval, 0.45 to 0.70; P<0.00001) in the aspirin group (254.8 per 100,000 per year as compared with 439.7 in the placebo group). A slightly increased risk of stroke among those taking aspirin was not statistically significant; this trend was observed primarily in the subgroup with hemorrhagic stroke (relative risk, 2.14; 95 percent confidence interval, 0.96 to 4.77; P = 0.06). No reduction in mortality from all cardiovascular causes was associated with aspirin (relative risk, 0.96; 95 percent confidence interval, 0.60 to 1.54).Further analyses showed that the reduction in the risk of myocardial infarction was apparent only among those who were 50 years of age and older. The benefit was present at all levels of cholesterol, but appeared greatest at low levels. The relative risk of ulcer in the aspirin group was 1.22 (169 in the aspirin group as compared with 138 in the placebo group; 95 percent confidence interval, 0.98 to 1.53; P = 0.08), and the relative risk of requiring a blood transfusion was 1.71.This trial of aspirin for the primary prevention of cardiovascular disease demonstrates a conclusive reduction in the risk of myocardial infarction, but the evidence concerning stroke and total cardiovascular deaths remains inconclusive because of the inadequate numbers of physicians with these end points. (N Engl J Med 1989; 321: 129–35.)