预防心血管疾病和结肠直肠癌的阿司匹林使用:美国预防服务工作组的最新建模研究
Steven P Dehmer1, Lauren R O'Keefe1, Corinne V Evans2
1HealthPartners Institute, Minneapolis, Minnesota.
JAMA
|April 26, 2022
概括
低剂量阿司匹林用于心血管疾病 (CVD) 的初级预防,尤其对心血管疾病风险较高的年轻人有好处. 然而,益处随着年龄的增长而减少,必须考虑出血的风险.
科学领域:
- 预防心血管疾病
- 胃肠道健康
- 预防医学
背景情况:
- 美国预防服务工作组 (USPSTF) 正在更新关于阿司匹林用于心血管疾病 (CVD) 和结直肠癌 (CRC) 的初级预防的指导方针.
- 之前的2016年推要求更新对利益和损害的净平衡的证据.
研究的目的:
- 为初级预防提供基于模型的低剂量阿司匹林净益处和危害的最新估计.
- 提供最新的USPSTF建议.
主要方法:
- 使用微型模拟来估计长期的益处和危害.
- 分析了美国40至79岁男性和女性的假设群体,他们的10年心血管疾病风险有所不同.
- 低剂量阿司匹林 (≤100毫克/天) 的使用是终身模拟的,停用年龄不同.
主要成果:
- 在年龄较小 (40-59岁) 开始服用阿司匹林的人群中,至少有5%的10年心血管疾病风险,在60-69岁的人群中,至少有10%的风险.
- 年轻人和心血管疾病风险较高的人均寿命也呈现出类似的积极趋势.
- 大多数60-79岁开始服用阿司匹林的人的益处减少,QALY为70-79岁的人是负的.
- 停用阿司匹林在65-85岁之间与终身使用相比没有什么好处.
- 敏感性分析表明,如果阿司匹林降低了CRC或心血管疾病的死亡率,则益处可能更高,如果它增加了出血或降低了生活质量,则益处可能更低.
结论:
- 亚司匹林用于初级心血管疾病预防可能有利于特定人群,特别是具有较高心血管疾病发病风险的年轻人.
- 开始服用阿司匹林的决定应仔细权衡潜在的益处与出血风险,特别是在老年人中.
- 这些发现支持基于年龄和个体心血管疾病风险概况的细微建议.
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