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[大学生论坛]:阿司匹林在健康老年人的心血管事件和出血中的作用

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XmWu 发表于 2019-1-3 22:41:19 | 显示全部楼层 |阅读模式
Effect of Aspirin on Cardiovascular Events and Bleeding in the Healthy Elderly
阿司匹林在健康老年人的心血管事件和出血中的作用
Abstract
摘要
BACKGROUND
背景
Aspirin is a well-established therapy for the secondary prevention of cardiovascular events. However, its role in the primary prevention of cardiovascular disease is unclear, especially in older persons, who have an increased risk.
心血管事件的二级预防中使用阿司匹林是一种公认的疗法。但其在心血管疾病初级预防中的作用却尚未明确,尤其是在患病风险增加的老年人群体中。
METHODS
方法
From 2010 through 2014, we enrolled community-dwelling men and women in Australia and the United States who were 70 years of age or older (or ≥65 years of age among blacks and Hispanics in the United States) and did not have cardiovascular disease, dementia, or disability. Participants were randomly assigned to receive 100 mg of enteric-coated aspirin or placebo. The primary end point was a composite of death, dementia, or persistent physical disability; results for this end point are reported in another article in the Journal. Secondary end points included major hemorrhage and cardiovascular disease (defined as fatal coronary heart disease, nonfatal myocardial infarction, fatal or nonfatal stroke, or hospitalization for heart failure).
20102014年间,我们招募了澳大利亚和美国各社区中70岁以上,或65岁以上美国黑人和西班牙裔的老年人。他们均未患心血管疾病,痴呆症残疾。我们将参与者随机分配,并让其服用100毫克肠溶阿司匹林安慰剂。主要终点是死亡、痴呆和持续性身体残疾;这一终点结果在此刊另一篇文章中有相应报告。次要终点包括大出血和心血管疾病。心血管疾病在此定义为致命性冠心病,非致命性心肌梗塞,致命或非致命性中风因心力衰竭而住院治疗等疾病或情况。
RESULTS
结果
Of the 19,114 persons who were enrolled in the trial, 9525 were assigned to receive aspirin and 9589 to receive placebo. After a median of 4.7 years of follow-up, the rate of cardiovascular disease was 10.7 events per 1000 person-years in the aspirin group and 11.3 events per 1000 person-years in the placebo group (hazard ratio, 0.95; 95% confidence interval [CI], 0.83 to 1.08). The rate of major hemorrhage was 8.6 events per 1000 person-years and 6.2 events per 1000 person-years, respectively (hazard ratio, 1.38; 95% CI, 1.18 to 1.62; P<0.001).
在参加试验的19114名受试者中分别有9525人服用阿司匹林,9589人则使用安慰剂。经过四年零八个月的随访,得出阿司匹林组的心血管疾病发生率是每年千人中有10.7例,安慰剂组则是每年千人11.3例(风险比0.95;置信区间95%0.83-1.08)。大出血的发生率分别是每年千人8.6例和每年千人6.2例(风险比1.38;置信区间95%1.18-1.62P0.001)。
CONCLUSIONS
结论
The use of low-dose aspirin as a primary prevention strategy in older adults resulted in a significantly higher risk of major hemorrhage and did not result in a significantly lower risk of cardiovascular disease than placebo. (Funded by the National Institute on Aging and others; ASPREE ClinicalTrials.gov number, NCT01038583.)
在老年人中,使用小剂量阿司匹林作为主要预防策略导致大出血的风险明显高于安慰剂,同时阿司匹林没有显著降低患心血管疾病的风险。
Dramatic increases in life expectancy over the past century have led to a substantial demographic shift toward an aging society in many countries. Thus, maintaining good health in older persons is an increasingly important public health aim. Cardiovascular diseases are among the principal causes of disability and death in older persons, and therefore, preventive interventions for such diseases are a high priority.1-3
上世纪以来急剧攀升的平均寿命导致许多国家人口结构趋向老龄化的重大变化。 因此,维护老年人的健康日益成为公共卫生的重要目标。心血管疾病是老年人残疾和死亡的主要原因,所以加强此类疾病的预防性干预对我们来说至关重要。
Low-dose aspirin is among the most widely used agents for the prevention of cardiovascular disease.4-8 Its efficacy has been established in secondary prevention trials, in which the benefits associated with reducing the rates of both myocardial infarction and ischemic stroke have appeared to outweigh the risk of hemorrhage.9,10In primary prevention trials, involving participants in whom the risk of cardiovascular disease was typically lower than the risk seen in secondary prevention trials, the risks and benefits of low-dose aspirin have been more finely balanced. The role of low-dose aspirin as a primary prevention strategy is debated.11-13
小剂量阿司匹林是使用范围最广的预防药物,其功效已在二级预防试验中得以确立,且其对于降低心肌梗死缺血性脑卒中的有效性似乎要大于减少出血的有效性。 在初级预防中小剂量阿司匹林的风险和益处得到了很好的平衡,其患心血管疾病的风险通常低于二级预防试验。使用小剂量阿司匹林作为主要预防策略其实具有争议。
In elderly populations, the risk of cardiovascular disease is higher and the potential benefits of aspirin may accordingly be greater than in younger populations. However, an increased risk of bleeding has also been observed in the elderly age group.10, 14-17Because a limited number of older persons have been included in previous primary prevention trials, the riskbenefit balance in this age group is unknown.18
老年群体患心血管疾病的风险比青年群体更高,阿司匹林因此大有益处。然而老年人出血的风险却在增加。先前参与初级预防试验的老年人数有限,所以这一年龄组的风险收益平衡尚未可知。
In the primary analysis of the Aspirin in Reducing Events in the Elderly (ASPREE) trial, now published in the Journal,19,20 we report that daily use of low-dose aspirin did not prolong disability-free survival among the elderly. Here, we report findings from the ASPREE trial regarding the effect of aspirin on the prespecified secondary end points of cardiovascular disease and major hemorrhage. We also present analyses of the nonprespecified end point of major adverse cardiovascular events.
在目前发表在此杂志上的阿司匹林减少老年人事件(Aspree)试验的初步分析中,我们对每天使用小剂量阿司匹林并不能延长老年人无失能存活时间进行了报告。我们还报告了阿斯匹林对心血管疾病和大出血的预定二级终点的影响的研究结果,并且对主要不良心血管事件的非预定终点进行了分析。

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