Aspirin for primary prevention of cardiovascular events
Aspirin for primary prevention of cardiovascular events
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DOI：
10.1046/j.1525-1497.1998.00246.x
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发表时间：
1998-12-01
影响因子：
5.7
通讯作者：
Spann, SJ
中科院分区：
文献类型：
--
作者：
Augustovski, FA;Cantor, SB;Spann, SJ
目的：在一般人群中使用阿司匹林作为心血管事件的一级预防是有争议的。本研究的目的是建立一个通用的模型来评估阿司匹林在不同风险的患者心血管事件的一级预防中的作用。设计：马尔可夫决策分析模型评估了队列未来10年的预期寿命和生活质量，通过服用或不服用阿司匹林的质量调整生存率来衡量。考虑了在初级保健环境中常见的具有一系列风险特征的几个患者队列。考虑的风险因素包括性别、年龄、胆固醇水平、收缩压、吸烟状况、糖尿病和左心室肥大。这些队列被随访了10年。结局包括心肌梗死、中风、胃肠道出血、溃疡和死亡。主要结果：对于所考虑的病例，阿司匹林的作用根据队列的风险状况而有所不同。通过服用阿司匹林，风险最低的队列将受到最大的伤害，服用阿司匹林会损失1.8个质量调整生命日;风险最高的队列将获得最大的益处，获得11.3个质量调整生命日。没有质量调整的结果有利于所有队列服用阿司匹林，增加了0.73至8.04天。这一决定对服用阿司匹林的效用变化以及阿司匹林对心血管死亡率的影响非常敏感。该模型是强大的其他概率和效用的变化在合理的parameters.CONCLUSIONS：决定是否服用阿司匹林作为一级预防心血管事件取决于患者的风险。对于没有危险因素的患者来说，这是一种有害的干预措施，对于中、高危患者来说是有益的。阿司匹林对该人群的益处与其他广泛接受的预防策略相当。它尤其取决于患者的风险状况、患者对阿司匹林不良反应的偏好以及阿司匹林对心血管相关死亡率的有益作用水平。
OBJECTIVE: The use of aspirin for primary prevention of cardiovascular events in the general population is controversial. The purpose of this study was to create a versatile model to evaluate the effects of aspirin in the primary prevention of cardiovascular events in patients with different risk profiles.DESIGN:A Markov decision-analytic model evaluated the expected length and quality of life for the cohort's next 10 years as measured by quality-adjusted survival for the options of taking or not taking aspirin.SETTING: Hypothetical model of patients in a primary care setting.PATIENTS: Several cohorts of patients with a range of risk profiles typically seen in a primary care setting were considered. Risk factors considered included gender, age, cholesterol levels, systolic blood pressure, smoking status, diabetes, and presence of left ventricular hypertrophy. The cohorts were followed for 10 years. Outcomes were myocardial infarction, stroke, gastrointestinal bleed, ulcer, and death.MAIN RESULTS: For the cases considered, the effects of aspirin varied according to the cohort's risk profile. By taking aspirin, the lowest-risk cohort would be the most harmed with a loss of 1.8 quality-adjusted life days by taking aspirin; the highest risk cohort would achieve the most benefit with a gain of 11.3 quality-adjusted life days. Results without quality adjustment favored taking aspirin in all the cohorts, with a gain of 0.73 to 8.04 days. The decision was extremely sensitive to variations in the utility of taking aspirin and to aspirin's effects on cardiovascular mortality. The model was robust to other probability and utility changes within reasonable parameters.CONCLUSIONS: The decision of whether to take aspirin as primary prevention for cardiovascular events depends on patient risk. It is a harmful intervention for patients with no risk factors, and it is beneficial in moderate and high-risk patients. The benefits of aspirin in this population are comparable to those of other widely accepted preventive strategies. It is especially dependent on the patient's risk profile, patient preferences for the adverse effects of aspirin, and on the level of beneficial effects of aspirin on cardiovascular-related mortality.