多基因风险,阿司匹林,以及冠状动脉疾病的初级预防
Chenglong Yu1, Pradeep Natarajan2,3,4, Aniruddh P Patel2,3,4,5
1Sc hool of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia.
European heart journal. Cardiovascular pharmacotherapy
|October 25, 2024
概括
阿司匹林可能有利于冠状动脉疾病 (CAD) 的高遗传风险的个体,通过减少心血管事件而不会增加出血. 这一发现表明基于遗传倾向的个性化预防策略.
科学领域:
- 心血管医学 心血管医学
- 遗传学 是一个遗传学.
- 药理学 药理学是指药理学的学科.
背景情况:
- 最近的阿司匹林初级预防试验没有显示出明显的净益处,原因是出血风险增加.
- 识别可能受益于阿司匹林的子组对于个性化预防心血管疾病至关重要.
研究的目的:
- 调查是否具有高遗传倾向冠状动脉疾病 (CAD) 的个体体从阿司匹林治疗中获得更大的益处,与具有较低遗传风险的个体相比.
- 评估不同遗传风险层中的心血管事件减少与出血风险的平衡.
主要方法:
- 利用遗传风险分层与冠状动脉疾病多基因风险评分 (GPSMult) 在阿司匹林减少老年人事件 (ASPREE) 试验中.
- 分析了12,031名参与者的数据,并按GPSMult五分位数分层.
- 使用Cox模型检查了CAD事件 (心肌梗塞,冠心病死亡) 和出血的风险.
主要成果:
- 总的来说,阿司匹林增加了出血风险 (aHR=1.30),但没有显著减少CAD事件 (aHR=0.84).
- 在最高遗传风险五分之一 (前20%),阿司匹林显著减少了CAD事件的47% (aHR=0.53),没有增加出血风险 (aHR=1.05).
- 在CAD风险方面观察到多基因风险评分和阿司匹林使用之间的显著相互作用,但在出血风险方面没有.
结论:
- 在初级预防中,阿司匹林的净益在对冠状动脉疾病具有较高遗传倾向的个体中更为有利.
- 遗传风险分层可能有助于确定一个可以从阿司匹林治疗中受益的子组,以预防心血管疾病.
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