Application of US guidelines in other countries: Aspirin for the primary prevention of cardiovascular events in Japan
Application of US guidelines in other countries: Aspirin for the primary prevention of cardiovascular events in Japan
复制标题
DOI：
10.1016/j.amjmed.2004.04.017
复制
发表时间：
2004-10-01
影响因子：
5.9
通讯作者：
Matsui, K
中科院分区：
文献类型：
--
作者：
Morimoto, T;Fukui, T;Matsui, K
目的：美国制定的临床指南在其他国家经常使用，但没有评估其在非美国人群中的适当性。我们探讨了最近美国关于在日本人群中使用阿司匹林一级预防心血管事件的指南的相关性。方法：通过对已发表数据的系统搜索，得出了日本人群和具有不同危险因素的亚组的冠心病、出血性中风和严重胃肠道出血的发生率的估计。Meta分析得出的优势比被用来评估使用阿司匹林的潜在益处和风险。结果：日本中年男性冠心病的估计发病率低于美国(每1000人年发病率为1.57比6.0)，而出血性中风的发病率更高(每1000人年发病率为1.14比0.37)。由于出血性疾病的基线比率较高，使用阿司匹林预期减少的心血管事件将被日本女性和大多数男性出血性并发症的更大增加所抵消，高血压和糖尿病患者除外。为了达到美国指南中3%的5年必然疾病风险阈值所暗示的避免冠心病事件与导致出血事件的2：1比率，日本患者推荐使用阿司匹林的风险阈值似乎是6%至14%，具体取决于患者的年龄。结论：亚洲人群的抗血小板治疗阈值应比美国人群高2至5倍，因为出血并发症的风险更高。在其他国家使用之前，应评估美国指南的假设和影响。
PURPOSE: Clinical guidelines developed in the United States are used frequently in other countries without assessment of their appropriateness in non-U.S. populations. We explored the relevance of recent U.S. guidelines for the use of aspirin for the primary prevention of cardiovascular events in the Japanese population.METHODS: From a systematic search of published data, estimates were derived for rates of coronary heart disease, hemorrhagic stroke, and major gastrointestinal bleeding for the Japanese population and for subgroups with different risk factors. Odds ratios derived from meta-analyses were used to assess the potential benefits and risks of aspirin use.RESULTS: The estimated incidence of coronary heart disease in middle-aged men in Japan is lower than in the United States (1.57 vs. 6.0 per 1000 person-years), while that of hemorrhagic stroke is higher (1.14 vs. 0.37 per 1000 person-years). Because of higher baseline rates of hemorrhagic diseases, the expected reduction in cardiovascular events with aspirin use would be offset by a greater increase in hemorrhagic complications for women and most men in Japan, except for those with both hypertension and diabetes. To achieve the same 2:1 ratio of coronary heart disease events avoided to hemorrhagic events caused that is implied by the 3% threshold for 5-year corollary disease risk in U.S. guidelines, a 6% to 14% risk threshold, depending on patient age, seems appropriate for recommending aspirin in Japanese patients.CONCLUSION: The thresholds of antiplatelet therapy for Asian populations should be two to five times higher than those for the U.S. population because of higher risks of hemorrhagic complications. The assumptions and implications of U.S. guidelines should be evaluated before use in other countries.