Aspirin has both advantages and risks. Aspirin has been widely used in the primary prevention of atherosclerotic cardiovascular diseases. However, when aspirin is used in the primary prevention of atherosclerotic cardiovascular diseases, it can not significantly reduce the mortality of all-cause mortality or cardiovascular diseases.
Its main benefit is to significantly reduce non-fatal ischemic events, including myocardial infarction, transient ischemic attack, ischemic stroke and major cardiovascular events (cardiovascular death, non-fatal myocardial infarction and non-fatal stroke).
The main risk is a significant increase in non-fatal bleeding events, including gastrointestinal bleeding and intracranial bleeding.
Therefore, it is meaningful to use aspirin for primary prevention only when the benefits obviously outweigh the risks.
What are the guidelines for the use of aspirin in the United States? American Heart Association and American Heart Association's 20 19 edition guidelines for primary prevention of cardiovascular diseases also believe that aspirin should not be routinely used for primary prevention of atherosclerotic cardiovascular diseases, otherwise there will be no net benefit.
However, the correct use of aspirin is still one of the main measures for the primary prevention of atherosclerotic cardiovascular diseases, and there are three suggestions:
(1) Adults aged 40-70 who have a high risk of atherosclerotic cardiovascular disease but have no increased risk of bleeding may consider taking low-dose aspirin (75- 100 mg/d) as the primary prevention of atherosclerotic cardiovascular disease.
(2) Adults over 70 years old should not take low-dose aspirin (75~ 100 mg/d) for primary prevention of atherosclerotic cardiovascular diseases.
(3) For the primary prevention of atherosclerotic cardiovascular diseases, adults with increased bleeding risk at any age should not take low-dose aspirin (75~ 100 mg/d).
What does the Chinese guide say about the use of aspirin? Experts in China believe that according to the existing clinical evidence, on the one hand, aspirin must be very cautious when used in the primary prevention of atherosclerotic cardiovascular diseases; On the other hand, it is not yet possible to conclude that aspirin has no primary preventive value.
First of all, the latest summary analysis of all primary prevention clinical trial data shows that aspirin can still significantly reduce major cardiovascular events.
Secondly, patients who cannot implement other primary preventive measures (such as statins) may need aspirin more.
Third, through careful evaluation, individuals with relatively reasonable income-risk ratio can still be found.
The primary prevention of aspirin is mainly suitable for adults aged 40-70 who are still at high risk of ischemia (expected risk 10 years ≥ 10%) and have a low risk of bleeding after active intervention in risk factors, and I am willing to take low-dose aspirin for a long time.
For all patients who intend to use aspirin, we must take four measures (1) to carefully weigh the benefit-bleeding risk ratio before taking aspirin, screen and exclude high-risk groups of bleeding, and evaluate the benefit-bleeding risk ratio regularly or dynamically during use, and deal with problems in time when found.
(2) Take preventive measures to reduce the risk of gastrointestinal bleeding, treat active gastrointestinal diseases (including eradication of Helicobacter pylori) in advance, and use proton pump inhibitors, such as omeprazole and rabeprazole, or H2 receptor antagonists, such as cimetidine and ranitidine, if necessary.
(3) Adhere to a healthy lifestyle (smoking cessation, careful drinking, scientific diet and exercise) and actively control blood pressure, blood sugar and blood lipid levels. Patients with hypertension must control their blood pressure at
(4) Before prescribing aspirin, communicate with doctors and patients, and start using it after the patient agrees.
Low-dose aspirin (75~ 100 mg/d) can be considered for primary prevention in adults aged 40~70 years. At the time of initial risk assessment, the expected risk of atherosclerotic cardiovascular disease is ≥ 10%. After active treatment and intervention, there are still ≥3 main risk factors that are not well controlled or difficult to control.
For the risk assessment of atherosclerotic cardiovascular diseases, please refer to the 20 17 edition of China Guidelines for the Prevention of Cardiovascular Diseases. The main risk factors include:
(1) hypertension;
(2) diabetes;
(3) dyslipidemia, total cholesterol (TC)≥ 6.2 mmol/L or low density lipoprotein cholesterol (LDL-C)≥ 4. 1 mmol/L or high density lipoprotein cholesterol (HDL-C).
(4) smoking;
(5) Family history of early-onset cardiovascular disease (onset age of first-degree relatives)
(6) Fat, body mass index (BMI) ≥ 28kg/m2;
(7) Coronary artery calcification score ≥ 100 or non-obstructive coronary artery stenosis (
Aspirin is not recommended for primary prevention of atherosclerotic cardiovascular disease in the following population (1) Age >; 70 years old or above
(2) People with high risk of bleeding: people who are using other drugs that increase the risk of bleeding (including antiplatelet drugs, anticoagulants, glucocorticoids and non-steroidal anti-inflammatory drugs) and have a history of gastrointestinal bleeding, peptic ulcer or bleeding in other parts, age >; 70-year-old, thrombocytopenia, coagulation dysfunction, severe liver disease, chronic kidney disease stage 4~5, Helicobacter pylori infection not eradicated, hypertension not controlled, etc.
(3) Patients whose risk of bleeding is greater than that of thrombosis.
People who cannot take aspirin (1) are known to be allergic to aspirin and substances containing salicylic acid.
(2) Patients with asthma, urticaria or allergic reaction induced by taking aspirin or other non-steroidal anti-inflammatory drugs.
(3) It is forbidden to treat perioperative pain of coronary artery bypass grafting.
(4) Patients with a history of gastrointestinal bleeding or perforation after NSAIDs.
(5) Patients with active peptic ulcer/bleeding or recurrent ulcer/bleeding in the past.
(6) Patients with severe heart failure.
(7) Patients with hemophilia or thrombocytopenia.