An update on aspirin in the primary prevention of cardiovascular disease
An update on aspirin in the primary prevention of cardiovascular disease
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DOI：
10.1001/archinte.163.17.2006
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发表时间：
2003-09-22
影响因子：
--
通讯作者：
Hennekens, CH
中科院分区：
文献类型：
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作者：
Eidelman, RS;Hebert, PR;Hennekens, CH
背景：1988年，医生健康研究中的阿司匹林成分被提前终止，这是一项随机、双盲、安慰剂对照试验，对象为22071名表面健康的男性，主要原因是首次心肌梗死(MI)的风险在统计学上极端(P<；0.00001)降低了44%。心脏-肾脏药物咨询委员会建议美国食品和药物管理局批准阿司匹林的专业标签，以防止首次心肌梗死。该机构没有对这一建议采取行动，因为唯一的另一项试验，即英国医生对5139名男性的试验，没有显示出显著的好处。方法：计算机检索1988年至今的英文文献，共发现5个已发表的试验：医生健康研究(22071名参与者)、英国医生试验(5139名)、血栓预防试验(5085名)、高血压最佳治疗研究(18790名)和一级预防项目(4495名)。结果：在55580名随机参与者中，11466名女性)，阿司匹林在统计学上显著降低了首次心肌梗死的风险32%，显著降低了所有重要血管事件的风险15%，但对非致命性中风或血管死亡没有显著影响。结论：目前的全部证据为医生健康研究的初步发现提供了强有力的支持，即阿司匹林降低了首次心肌梗死的风险。根据美国预防服务工作组和美国心脏协会的数据，对于那些10年内首次发生冠状动脉事件的风险在10%或更高的表面健康的人来说，长期服用阿司匹林的好处可能超过任何风险。
Background: In 1988, the aspirin component of the Physicians' Health Study, a randomized, double-blind, placebo-controlled trial of 22071 apparently healthy men was terminated early, due principally to a statistically extreme (P < .00001) 44% reduction in the risk of a first myocardial infarction (MI). The Cardio-Renal Drugs Advisory Committee recommended that the US Food and Drug Administration approve professional labeling of aspirin to prevent first MI. The agency did not act on this recommendation because the only other trial, the British Doctors' Trial of 5139 men, showed no significant benefits. Since that time, 3 additional randomized trials (which included men and women) of aspirin in the primary prevention of MI have been published.Methods: A computerized search of the English literature from 1988 to the present revealed 5 published trials: the Physicians' Health Study (22071 participants), the British Doctors' Trial (5139), the Thrombosis Prevention Trial (5085), the Hypertension Optimal Treatment Study (18790), and the Primary Prevention, Project (4495).Results: Among the 55580 randomized participants 11466 women), aspirin was associated with a statistically significant 32% reduction in the risk of a first MI and a significant 15% reduction in the risk of all important vascular events, but had no significant effects on non-fatal stroke or vascular death.Conclusions: The current totality of evidence provides strong support for the initial finding from the Physicians' Health Study that aspirin reduces the risk of a first MI. For apparently healthy individuals whose 10-year risk of a first coronary event is 10% or greater, according to the US Preventive Services Task Force and the American Heart Association, the benefits of long-term aspirin therapy are likely to outweigh any risks.