Aspirin for primary prevention of cardiovascular disease in diabetes mellitus.
Aspirin for primary prevention of cardiovascular disease in diabetes mellitus.
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DOI：
10.1038/nrendo.2010.169
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发表时间：
2010-11
期刊：
影响因子：
--
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中科院分区：
文献类型：
--
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阿司匹林对有血管病史的患者的心血管事件的预防是有效的，即所谓的二级预防。在没有心肌梗死或中风病史的一般人群中，阿司匹林似乎也有助于心血管事件的一级预防，尽管绝对益处小于有心血管疾病病史的患者。糖尿病患者发生心血管事件的风险增加，但新的试验对阿司匹林在糖尿病患者一级预防中的益处提出了质疑。本综述全面考察了阿司匹林的基本药理学，并概述了阿司匹林治疗的随机对照试验，其中包括糖尿病患者。根据目前从一级预防试验中获得的证据，估计阿司匹林可使糖尿病患者心肌梗死和卒中的相对风险降低约10%；然而，阿司匹林也会增加胃肠道出血的风险。因此，低剂量阿司匹林治疗（75-162毫克）对于糖尿病患者是合理的，10年心血管事件风险为10%。即将进行的大型试验的结果将有助于更精确地阐明阿司匹林的效果，包括男性和女性之间的益处是否不同。
Aspirin is effective for the prevention of cardiovascular events in patients with a history of vascular disease, as so-called secondary prevention. In general populations with no history of previous myocardial infarction or stroke, aspirin also seems useful for primary prevention of cardiovascular events, although the absolute benefits are smaller than those seen in patients with previous cardiovascular disease. Patients with diabetes mellitus are at an increased risk of cardiovascular events, but new trials have raised questions about the benefit of aspirin for primary prevention in patients with this disorder. This Review comprehensively examines the basic pharmacology of aspirin and provides an overview of the randomized, controlled trials of aspirin therapy that have included patients with diabetes mellitus. On the basis of currently available evidence from primary prevention trials, aspirin is estimated to reduce the relative risk of myocardial infarction and stroke by about 10% in patients with diabetes mellitus; however, aspirin also increases the risk of gastrointestinal bleeding. As such, low-dose aspirin therapy (75–162 mg) is reasonable for patients with diabetes mellitus and a 10-year risk of cardiovascular events >10%. Results from upcoming large trials will help clarify the effects of aspirin with greater precision, including whether the benefits differ between men and women.
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影响因子：
16.2
作者：
American Diabetes Association
通讯作者：
American Diabetes Association
影响因子：
--
作者：
Almdal, T;Scharling, H;Vestergaard, H
通讯作者：
Vestergaard, H
影响因子：
37.8
作者：
Calkin, Anna C.;Drew, Brian G.;Jackson, Shaun P.
通讯作者：
Jackson, Shaun P.
影响因子：
37.8
作者：
Eikelboom, JW;Hirsh, J;Yusuf, S
通讯作者：
Yusuf, S
影响因子：
168.9
作者：
Hansson, L;Zanchetti, A;Westerling, S
通讯作者：
Westerling, S