患有脂蛋白升高的患者使用阿司匹林:对心血管事件和出血的影响
Walter Masson1, Leandro Barbagelata1, Juan Patricio Nogueira2
1Department of Cardiology. Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
阿司匹林可能会降低高脂蛋白[Lp[a]水平的个体的心血管风险. 这一系统性审查发现,对于那些Lp (a) 或相关遗传变异升高的人来说,有好处,但出血问题有限.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
- 遗传学 是一个遗传学.
背景情况:
- 在初级心血管预防中阿司匹林的作用是有争议的.
- 升高的脂蛋白 (Lp) 是心血管疾病的危险因素.
- 阿司匹林的抗纤维解质和抗血小板作用可能有利于高Lp的个体.
研究的目的:
- 系统地审查阿司匹林在患有升高Lp (a) 和没有先前心血管疾病的患者的心血管益处和出血风险.
- 评估阿司匹林在高危子组的初级预防中的有效性.
- 评估与阿司匹林使用相关的安全问题,特别是血流事件.
主要方法:
- 在遵守PRISMA指南的基础上进行系统审查.
- 在文献中搜索有关阿司匹林在患有升高Lp(a) 或相关遗传变异 (SNP rs379822) 且没有心血管疾病病史的患者中使用的研究.
- 包括5项涉及49871人的研究,分析基于遗传变异或直接Lp (a) 测量.
主要成果:
- 在使用阿司匹林的阿波利波蛋白 (a) 变体携带者或Lp (a) 水平>50 mg/dL的患者中观察到心血管风险的持续降低.
- 在包括的研究中,没有报告出血事件的显著增加.
- 关于出血风险的数据仍然有限,仅在两项研究中发现了事件.
结论:
- 阿司匹林的使用可能会降低患有升高Lp (a) 水平且没有心血管疾病史的人的心血管风险.
- 需要进一步的研究,以充分确定与阿司匹林相关的出血风险,在这个特定的患者群体.
- 本综述支持探索阿司匹林在高Lp (a) 患者的初级预防中的作用.
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