“神药”阿司匹林预防心脏病和中风?柳叶刀称:没有定论!
2018/09/02
作为医药史上三大经典药物之一,阿司匹林从最初的镇痛消炎到抗血栓、抗癌,展现出多个潜能。但是,对于这一“神药”能否将作为心血管疾病的一级预防措施,一直存在争议。近日,顶级医学期刊《柳叶刀》发表的一项最新研究给出了“没有定论”(the jury is still out)的答案。


图片来源:网络

文章作者、布列根和妇女医院的研究员J. Michael Gaziano表示:“在这项研究中,阿司匹林并没有减少主要心血管疾病发生的概率。而且,真正发生疾病的概率比预期要少,这表明,这实际上是一个低风险人群。这可能是因为一些参与者通过服用药物来控制血压和脂肪,从而保护了他们。”

不可否认,阿司匹林对于预防心脏病或者中风患者的第二次发病有着积极的作用。但是,该药物对于第一次生病的预防效果却一直有争议,过往的研究揭示了相互矛盾的结果。其中,反对使用阿司匹林的研究指明,该药物会增加出血的风险。


效益有限

在最新的研究中,科学家们评估了每日服用阿司匹林对心血管疾病中等风险人群第一次发生心脏病和中风概率的影响。其中,中等风险(moderate risk)被定义为10年内发生心血管疾病的风险为20-30%。

该研究招募了12546名没有心血管病史的参与者,其中男性至少55岁,有2-4个心血管危险因素,女性至少60岁,有3个或以上危险因素(包括吸烟、血脂升高和高血压)。

这些参与者(平均年龄位63.9岁,女性占29.7%)被随机分成两组——每天服用100mg的阿司匹林肠溶片(6270人)或者安慰剂(6276人),中位随访60个月,主要终点是首次出现心血管死亡、心肌梗死、不稳定性心绞痛、中风或短暂脑缺血发作。

在意向性分析中,阿司匹林组共有269名参与者发生了主要终点中的疾病(4.29%),而对照组生病人数为281人(4.48%)。在按方案分析中,阿司匹林组共有129名参与者达到主要终点(3.40%),而安慰剂组生病人数为164名(4.19%)。

阿司匹林组出现61例胃肠道出血(0.97%),对照组为29例(0.46%)。与对照组相比,阿司匹林组发生药物相关的不良反应更为常见,包括消化不良、流鼻血、胃食管反流和上腹痛。

结果分析

服用阿司匹林的人发生心脏病的风险较小,特别是50-59岁的人。但是该药物对于中风并没有积极影响。” J. Michael Gaziano表示道,“正如预期的那样,阿司匹林组胃肠道出血和其他一些轻微出血的发生率较高,但两组之间致命性出血事件没有差异。”

他强调:“是否使用阿司匹林来预防心血管疾病?这需要咨询医生,因为要权衡潜在的风险和益处。”

责编:悠然

参考资料:

Jury still out on aspirin a day to prevent heart attack and stroke

所有文章仅代表作者观点,不代表本站立场。如若转载请联系原作者。
查看更多
  • Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a randomised, double-blind, placebo-controlled trial

    Background The use of aspirin in the primary prevention of cardiovascular events remains controversial. We aimed to assess the efficacy and safety of aspirin versus placebo in patients with a moderate estimated risk of a first cardiovascular event. Methods ARRIVE is a randomised, double-blind, placebo-controlled, multicentre study done in seven countries. Eligible patients were aged 55 years (men) or 60 years (women) and older and had an average cardiovascular risk, deemed to be moderate on the basis of the number of specific risk factors. We excluded patients at high risk of gastrointestinal bleeding or other bleeding, or diabetes. Patients were randomly assigned (1:1) with a computer-generated randomisation code to receive enteric-coated aspirin tablets (100 mg) or placebo tablets, once daily. Patients, investigators, and others involved in treatment or data analysis were masked to treatment allocation. The primary efficacy endpoint was a composite outcome of time to first occurrence of cardiovascular death, myocardial infarction, unstable angina, stroke, or transient ischaemic attack. Safety endpoints were haemorrhagic events and incidence of other adverse events, and were analysed in the intention-to-treat population. This study is registered with ClinicalTrials.gov, number NCT00501059. Findings Between July 5, 2007, and Nov 15, 2016, 12 546 patients were enrolled and randomly assigned to receive aspirin (n=6270) or placebo (n=6276) at 501 study sites. Median follow-up was 60 months. In the intention-to-treat analysis, the primary endpoint occurred in 269 (4·29%) patients in the aspirin group versus 281 (4·48%) patients in the placebo group (hazard ratio [HR] 0·96; 95% CI 0·81–1·13; p=0·6038). Gastrointestinal bleeding events (mostly mild) occurred in 61 (0·97%) patients in the aspirin group versus 29 (0·46%) in the placebo group (HR 2·11; 95% CI 1·36–3·28; p=0·0007). The overall incidence rate of serious adverse events was similar in both treatment groups (n=1266 [20·19%] in the aspirin group vs n=1311 [20·89%] in the placebo group. The overall incidence of adverse events was similar in both treatment groups (n=5142 [82·01%] vs n=5129 [81·72%] in the placebo group). The overall incidence of treatment-related adverse events was low (n=1050 [16·75%] vs n=850 [13·54%] in the placebo group; p<0·0001). There were 321 documented deaths in the intention-to-treat population (n=160 [2·55%] vs n=161 [2·57%] of 6276 patients in the placebo group). Interpretation The event rate was much lower than expected, which is probably reflective of contemporary risk management strategies, making the study more representative of a low-risk population. The role of aspirin in primary prevention among patients at moderate risk could therefore not be addressed. Nonetheless, the findings with respect to aspirin's effects are consistent with those observed in the previously published low-risk primary prevention studies.

    展开 收起
发表评论 我在frontend\modules\comment\widgets\views\文件夹下面 test