预防心血管疾病使用阿司匹林:美国预防服务工作组建议声明
, Karina W Davidson1, Michael J Barry2
1Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York.
JAMA
|April 26, 2022
概括
低剂量阿司匹林在40至59岁的高心血管疾病风险的成年人中可能对心血管疾病 (CVD) 的初级预防具有很小的益处. 然而,由于没有净益处,不建议60岁及以上的患者开始服用阿司匹林.
科学领域:
- 预防医学
- 心脏病学
- 胃肠病学
背景情况:
- 心血管疾病 (CVD) 是美国的主要死亡原因.
- 据估计,每年有60万5千和61万人患心肌梗塞和中风.
- 阿司匹林通常用于预防心血管疾病,因此需要更新建议.
研究的目的:
- 更新2016年美国预防服务工作组 (USPSTF) 关于阿司匹林用于初级心血管疾病预防的建议.
- 评估阿司匹林在降低心血管疾病,心血管死亡率和全因死亡率方面的有效性.
- 评估阿司匹林对结肠直肠癌 (CRC) 和相关危害的影响,特别是出血.
主要方法:
- 进行了一项系统性审查,以评估阿司匹林对初级心血管疾病预防的有效性和危害.
- 一个微模拟模型研究评估了益处和危害的净平衡.
- 根据年龄,性别和心血管疾病风险水平对结果进行分层分析.
主要成果:
- 在40至59岁的成年人中,使用阿司匹林对初级心血管疾病预防具有很小的净益,其10年心血管疾病风险为10%或更高.
- 在60岁或以上的成年人中,开始服用阿司匹林用于初级心血管疾病预防没有明显的益处.
- 吸食阿司匹林可能会导致出血.
结论:
- 在高风险的40-59岁成年人中,开始使用低剂量阿司匹林进行初级心血管疾病预防的决定应该是个性化的.
- 愿意每天服用低剂量阿司匹林的没有增加出血风险的人可能会体验到小的净益.
- 在60岁及以上的成年人中,USPSTF建议不使用低剂量阿司匹林进行初级心血管疾病预防.
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