For people who already have cardiovascular and cerebrovascular diseases, doctors will advise patients to take low-dose aspirin for a long time to prevent the recurrence of the disease. This is "secondary prevention". Studies have confirmed that secondary prevention can effectively reduce the risk of serious cardiovascular events by 25%, including nonfatal myocardial infarction 1/3, nonfatal stroke 1/4, and all vascular events 1/6. In the treatment of acute myocardial infarction and acute ischemic stroke, after one month of aspirin treatment, 40 and 65,438+000 cases of macrovascular events per 65,438+000 people can be reduced respectively. Therefore, the efficacy of aspirin in acute ischemic diseases and secondary prevention is not controversial.
However, it is still controversial whether the general population without cardiovascular and cerebrovascular diseases should take low-dose aspirin for primary prevention. Recently published data show that aspirin has little benefit in preventing cardiovascular and cerebrovascular diseases in low-risk population, because aspirin will cause bleeding risk, and its beneficial effect is offset by bleeding risk.
Recently, many media at home and abroad are discussing the advantages and disadvantages of taking aspirin for healthy people. The reporter of Life Times interviewed Professor Gao, an academician of China Academy of Engineering, former chairman of Cardiovascular Branch of Chinese Medical Association and professor of cardiology at Fuwai Cardiovascular Hospital of China Academy of Medical Sciences.
Evidence of the benefits of primary prevention
At present, cardiovascular and cerebrovascular events are the leading cause of death in the world, and the incidence of cardiovascular and cerebrovascular diseases in China is also increasing rapidly. Statistics show that every 15 seconds, one China person dies of cardiovascular and cerebrovascular diseases, and every 22 seconds, one China person loses the ability to work. Prevention is the key to reverse the rising trend of cardiovascular and cerebrovascular diseases. Academician Gao said that cardiovascular and cerebrovascular diseases are terrible, but many cardiovascular and cerebrovascular diseases can be prevented as long as we actively pay attention to our own risk factors and prevent them scientifically. A study by Harvard University shows that by improving high-risk factors, the global incidence of stroke can be reduced by 85%, and the incidence of ischemic heart disease can be reduced by 75%. Therefore, primary prevention is the key measure to reduce the burden of cardiovascular and cerebrovascular events, and the concept of prevention must be deeply rooted in people's hearts.
In cardiovascular and cerebrovascular events, platelet activation is the last link, so "no thrombosis, no event". Among antiplatelet drugs, aspirin is not only the basic drug for secondary prevention and acute treatment of cardiovascular events, but also the only antiplatelet drug recommended by the primary prevention guide. Previous research results also proved the preventive effect of aspirin in some people.
Clarify three concepts
Academician Gao said that in order to find out who needs to take aspirin, we need to find out the following three concepts first.
First, the concept of "healthy people". The so-called "healthy people without cardiovascular and cerebrovascular diseases" actually includes two types of people, one is healthy people without cardiovascular and cerebrovascular diseases risk factors, and the other is high-risk people with cardiovascular and cerebrovascular diseases risk factors, including hypertension, diabetes, dyslipidemia, obesity, smoking and so on. That is, people who look healthy on the surface but are actually unhealthy need to focus on the primary prevention of cardiovascular and cerebrovascular diseases. In other words, among healthy people without cardiovascular and cerebrovascular diseases, everyone should pay attention to lifestyle intervention, and some middle-and high-risk groups need drugs for primary prevention.
All drugs have advantages and disadvantages. Whether you should take it or not needs to be weighed. Only when the advantages outweigh the disadvantages can we take them. Recently, the American preventive service expert group pointed out that the primary prevention of aspirin is meaningful only when the benefits of preventing cardiovascular and cerebrovascular diseases obviously exceed the risk of bleeding. The primary prevention guidelines of aspirin in various countries are aimed at the high-risk groups of cardiovascular and cerebrovascular diseases. Therefore, strictly screening the high-risk population of cardiovascular and cerebrovascular diseases and fully evaluating the benefit/risk ratio are the key to realize the primary preventive effect of aspirin.
Second, the concept of "risk stratification". "Generally speaking, it is not recommended to take aspirin regularly for the first healthy population mentioned above. The second category of seemingly "healthy" people, that is, high-risk groups who already have the risk of cardiovascular disease, should take aspirin. " Academician Gao said that the latest guidelines suggest that whether to use aspirin should be decided according to different age groups and different cardiovascular risk levels in 10. The primary prevention of aspirin is meaningful only when the number of cardiovascular events is significantly higher than the risk of bleeding. Generally speaking, patients with moderate or high risk of cardiovascular and cerebrovascular events (i.e. 10 year cardiovascular event risk ≥ 10%-65433).
The simple method to judge the risk of cardiovascular events in patients aged 10 is: male, over 45 years old, with two or more risk factors; Female, over 55 years old, with two or more risk factors. Risk factors include hypertension, diabetes, dyslipidemia, obesity, smoking and family history of coronary heart disease (among first-degree relatives, male relatives are less than 55 years old and female relatives are less than 65 years old and have a history of coronary heart disease).
Third, the concept of "special population". According to statistics, the risk of death from cardiovascular disease in diabetic patients is 2-4 times higher than that in normal people. /kloc-the main cardiovascular events of diabetic patients in 0/0 are in the same state as those of patients with coronary heart disease, so diabetes is called "critical disease such as coronary heart disease". At the same time, diabetes is also the main risk factor of coronary heart disease, so it is suggested that aspirin should be considered when diabetes is complicated with high risk factors. Hypertension is one of the most important risk factors of coronary heart disease, and its risk of coronary heart disease is more than four times that of patients without hypertension. When hypertension is combined with another risk factor, aspirin should also be considered after blood pressure control.
China Cardiovascular Disease Report in 2005 shows that there are 65.438+600 million hypertensive patients, more than 23 million diabetic patients, 60 million obese people and 350 million smokers in China. These people are a huge reserve army of cardiovascular patients, so these people should be more alert to the occurrence of cardiovascular diseases and do a good job in prevention in time.
75- 100mg/ day is the best dose.
"At present, there are many studies on primary prevention of aspirin in the world. These results will further clarify the primary preventive effect of aspirin on cardiovascular diseases in different populations, which is worth our expectation. With the publication of more clinical data, the national first-level prevention guidelines will be continuously revised, and it is believed that the indications will be more clear. " Academician Gao said, "Of course, the dosage of aspirin is also a matter of great concern to everyone. Studies have shown that the average optimal dose of aspirin for long-term application to inhibit platelet function is 100mg/ day; It is generally believed that 75- 100mg/ day is the best dose for long-term use in primary prevention. "
Finally, Academician Gao concluded that combined with the current research results, aspirin should not be advocated for the prevention of cardiovascular diseases in all healthy people, but should be used for the primary prevention of people whose clinical benefits outweigh the risks. National guidelines suggest that people at high risk of cardiovascular disease should consider taking low-dose aspirin for a long time. (Life Times)