小剂量阿司匹林对心血管病一级预防效果及安全性的系统评价

目的 系统评价小剂量阿司匹林在高危人群中一级预防心血管病的有效性和安全性.方法 计算机检索MEDLINE、EMbase、Cochrane图书馆(2008年第3期)、中国生物医学文献数据库、中国学术期刊全文数据库,同时筛检了纳入文献的参考文献.收集小剂量阿司匹林(75～150 mg)一级预防心血管病的随机对照试验(RCT),2名评价员独立评价文献质量和提取资料,并采用RevMan4.2软件对资料进行荟萃分析.结果 共纳入6个研究(TPT,HOT,PPP,WHS,POPADAD,JPAD),72 466例患者.(1)小剂量阿司匹林总的心血管事件的发生率(RR=0.85,95% CI:0.80～0.92)、卒中发生率(RR=0.87,95% CI:0.77～0.98)、非致死性卒中发生率(RR=0.81,95%CI:0.70～0.95)、短暂脑缺血发作发生率(RR=0.76,95%CI:0.64～0.90)均低于安慰剂(均P＜0.05).(2)小剂量阿司匹林非致死性心肌梗死(RR=0.89,95%CI:0.77～1.02)、心血管性死亡(RR=0.98,95% CI:0.86～1.13)、全因死亡发生率(RR=0.95,95%CI:0.88～1.02)与安慰剂比较,差异无统计学意义(P＞0.05).(3)在老年人群中分析显示,小剂量阿司匹林冠心病的发生率低于安慰剂(RR=0.81,95%CI:0.70～0.94,P＜0.01).(4)在安全性方面,与安慰剂比较,小剂量阿司匹林有出血并发症的风险(RR=1.15,95%CI:1.12～1.18,P＜0.01),而在过敏反应方面差异无统计学意义(P＞0.05).结论 小剂最阿司匹林能降低总的心血管事件、短暂脑缺血发作、卒中、非致死性卒中的发生率;对降低非致死性心肌梗死、心血管性死亡、全因死亡方面效果不明显;在老年人群中小剂量阿司匹林能降低冠心病的发牛率;长期应用无明显过敏反应,但存在出血并发症的风险.

Effects of low-dose aspirin on primary prevention of cardiovascular events :a systematic review

Objective To evaluate the effect and safety of low-dose aspirin for primary prevention of cardiovascular events.Methods We searched for randomized controlled trials (RCT) in the following electronic databases:MEDLINE,EMbase,the Cochrane Library (Issue 3,2008),CBM,CNKI.Quality assessment and data extraction were conducted by two reviewers independently.All data were analyzed using Review Manager 4.2.Results Six studies (TPT,HOT,PPP,WHS,POPADAD,J-PAD) involving a total of 72 466 participants met the inclusion criteria.Meta-analysis results showed that:(1) Compared with placebo,the incidences of total cardiovascular events (RR = 0.85,95 % CI:0.80-0.92),stroke (RR = 0.87,95% CI:0.77-0.98),nonfatal stroke (RR = 0.81,95% CI:0.70-0.95) and transient ischemic attack (RR =0.76,95% CI:0.64-0.90) were significantly lower in low-dose aspirin group than those in placebo control group (all P＜0.05).(2) Nonfatal myocardial infarction (RR = 0.89,95 % CI:0.77 -1.02),death from cardiovascular causes (RR =0.98,95%CI:0.86-1.13) and death from any cause (RR =0.95,95%CI:0.88-1.02) were similar between the 2 groups (all P＞0.05).(3) The risk of coronary heart disease was reduced in low-dose aspirin group in the elderly (RR = 0.81,95% CI:0.70-0.94,P＜0.05).(4) The risk of bleeding was higher in low aspirin group compared to placebo group (RR = 1.15,95% CI:1.12-1.18,P＜0.O1).Conclusions low-dose aspirin use could reduce the incidences of total cardiovascular events,stroke,nonfatal stroke and transient ischemic attack but increase the risk of bleeding,the incidence of nonfatal myocardial infarction,death from cardiovascular causes and death from any cause was not affected by low-dose aspirin use.Low-dose aspirin use was also significantly reduced the risk of coronary heart disease in the elderly.