阿司匹林在男性和女性心血管事件初级预防中的作用－随机对照实验中性别特异的Meta分析
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| 发布日期: 2006-01-21 22:14 | 文章来源: 丁香园神经科学讨论版 |
关键词:
阿司匹林
Meta分析
中风
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Aspirin for the Primary Prevention of Cardiovascular Events in Women and Men
A Sex-Specific Meta-analysis of Randomized Controlled Trials
Jeffrey S. Berger, MD, MS; Maria C. Roncaglioni, MD; Fausto Avanzini, MD; Ierta Pangrazzi, MD; Gianni Tognoni, MD; David L. Brown, MD
JAMA. 2006;295:306-313.
ABSTRACT
Context Aspirin therapy reduces the risk of cardiovascular disease in adults who are at increased risk. However, it is unclear if women derive the same benefit as men.
Objective To determine if the benefits and risks of aspirin treatment in the primary prevention of cardiovascular disease vary by sex.
Data Sources and Study Selection MEDLINE and the Cochrane Central Register of Controlled Trials databases (1966 to March 2005), bibliographies of retrieved trials, and reports presented at major scientific meetings. Eligible studies were prospective, randomized controlled trials of aspirin therapy in participants without cardiovascular disease that reported data on myocardial infarction (MI), stroke, and cardiovascular mortality. Six trials with a total of 95 456 individuals were identified; 3 trials included only men, 1 included only women, and 2 included both sexes.
Data Extraction Studies were reviewed to determine the number of patients randomized, mean duration of follow-up, and end points (a composite of cardiovascular events [nonfatal MI, nonfatal stroke, and cardiovascular mortality], each of these individual components separately, and major bleeding).
Data Synthesis Among 51 342 women, there were 1285 major cardiovascular events: 625 strokes, 469 MIs, and 364 cardiovascular deaths. Aspirin therapy was associated with a significant 12% reduction in cardiovascular events (odds ratio [OR], 0.88; 95% confidence interval [CI], 0.79-0.99; P = .03) and a 17% reduction in stroke (OR, 0.83; 95% CI, 0.70-0.97; P = .02), which was a reflection of reduced rates of ischemic stroke (OR, 0.76; 95% CI, 0.63-0.93; P = .008). There was no significant effect on MI or cardiovascular mortality. Among 44 114 men, there were 2047 major cardiovascular events: 597 strokes, 1023 MIs, and 776 cardiovascular deaths. Aspirin therapy was associated with a significant 14% reduction in cardiovascular events (OR, 0.86; 95% CI, 0.78-0.94; P = .01) and a 32% reduction in MI (OR, 0.68; 95% CI, 0.54-0.86; P = .001). There was no significant effect on stroke or cardiovascular mortality. Aspirin treatment increased the risk of bleeding in women (OR, 1.68; 95% CI, 1.13-2.52; P = .01) and in men (OR, 1.72; 95% CI, 1.35-2.20; P<.001).
Conclusions For women and men, aspirin therapy reduced the risk of a composite of cardiovascular events due to its effect on reducing the risk of ischemic stroke in women and MI in men. Aspirin significantly increased the risk of bleeding to a similar degree among women and men.
阿司匹林在男性和女性心血管事件初级预防中的作用－随机对照实验中性别特异的Meta分析。
摘要
连续阿司匹林治疗降低高危成人心血管疾病的风险，然而，在女性是否和男性一样获益目前尚不清楚。
目的
在以性别不同的心血管疾病初级预防中，为确定应用阿司匹林治疗是否获益及其风险，资料来源于 MEDLINE，Cochrane中心对照实验数据库（1966－2005.3），检索书目，和主要学术会议报道。在有关心梗，中风和心血管死亡率的报道资料中，对无心血管疾病行阿司匹林治疗的参与者挑选合适的前瞻性、随机对照实验。在总数95456病人中进行了6次实验，3次只包括男性，1次只包括女性，2次男女都有。对所得资料进行总结来确定随机病人的数目，随访的平均时间及结束时间点（心血管事件的组成[非致死MI、非致死性中风和心血管死亡率]，每一病人的各自特征和主要出血部位）。
资料的综合：在51342名妇女中，有1285次主要心血管事件：625人出现中风、469人发生心梗和364人死亡。阿司匹林治疗与心血管事件降低12％显著相关（OR为0.88；95%可信区间CI为0.79－0.99；P＝0.03），与中风减少17％显著相关（OR为0.83;95%可信区间为0.70-0.97;P=0.02），这也是缺血性中风发生率降低（OR为0.76,95%可信区间为0.63-0.93;P=0.008）的一个反映，在心梗和心血管死亡率方面无明显效应。在44114名男性中，共有2047次心血管事件:597次中风，1023次心梗，776次心血管死亡事件。阿司匹林治疗与14％的心血管事件降低显著相关(OR0.86,95%可信区间为0.78-0.94;P=0.01),与32％的心梗降低显著相关（OR0.68,95%可信区间为0.54-0.86;P=0.001）。在中风及心血管死亡率方面无显著效应。阿司匹林治疗增加了男性和女性出血的风险，女性为（OR1.68,95%CI1.13-2.52;P=0.01），男性为（OR1.72,95%CI为1.35-2.20;P<0.001）.
结论：在男性和女性，阿司匹林治疗降低了心血管事件的风险，主要是由于其能降低女性患缺血性中风、男性患心梗的效应。阿司匹林在男性和女性均能同等程度的出血风险。
A Sex-Specific Meta-analysis of Randomized Controlled Trials
Jeffrey S. Berger, MD, MS; Maria C. Roncaglioni, MD; Fausto Avanzini, MD; Ierta Pangrazzi, MD; Gianni Tognoni, MD; David L. Brown, MD
JAMA. 2006;295:306-313.
ABSTRACT
Context Aspirin therapy reduces the risk of cardiovascular disease in adults who are at increased risk. However, it is unclear if women derive the same benefit as men.
Objective To determine if the benefits and risks of aspirin treatment in the primary prevention of cardiovascular disease vary by sex.
Data Sources and Study Selection MEDLINE and the Cochrane Central Register of Controlled Trials databases (1966 to March 2005), bibliographies of retrieved trials, and reports presented at major scientific meetings. Eligible studies were prospective, randomized controlled trials of aspirin therapy in participants without cardiovascular disease that reported data on myocardial infarction (MI), stroke, and cardiovascular mortality. Six trials with a total of 95 456 individuals were identified; 3 trials included only men, 1 included only women, and 2 included both sexes.
Data Extraction Studies were reviewed to determine the number of patients randomized, mean duration of follow-up, and end points (a composite of cardiovascular events [nonfatal MI, nonfatal stroke, and cardiovascular mortality], each of these individual components separately, and major bleeding).
Data Synthesis Among 51 342 women, there were 1285 major cardiovascular events: 625 strokes, 469 MIs, and 364 cardiovascular deaths. Aspirin therapy was associated with a significant 12% reduction in cardiovascular events (odds ratio [OR], 0.88; 95% confidence interval [CI], 0.79-0.99; P = .03) and a 17% reduction in stroke (OR, 0.83; 95% CI, 0.70-0.97; P = .02), which was a reflection of reduced rates of ischemic stroke (OR, 0.76; 95% CI, 0.63-0.93; P = .008). There was no significant effect on MI or cardiovascular mortality. Among 44 114 men, there were 2047 major cardiovascular events: 597 strokes, 1023 MIs, and 776 cardiovascular deaths. Aspirin therapy was associated with a significant 14% reduction in cardiovascular events (OR, 0.86; 95% CI, 0.78-0.94; P = .01) and a 32% reduction in MI (OR, 0.68; 95% CI, 0.54-0.86; P = .001). There was no significant effect on stroke or cardiovascular mortality. Aspirin treatment increased the risk of bleeding in women (OR, 1.68; 95% CI, 1.13-2.52; P = .01) and in men (OR, 1.72; 95% CI, 1.35-2.20; P<.001).
Conclusions For women and men, aspirin therapy reduced the risk of a composite of cardiovascular events due to its effect on reducing the risk of ischemic stroke in women and MI in men. Aspirin significantly increased the risk of bleeding to a similar degree among women and men.
阿司匹林在男性和女性心血管事件初级预防中的作用－随机对照实验中性别特异的Meta分析。
摘要
连续阿司匹林治疗降低高危成人心血管疾病的风险，然而，在女性是否和男性一样获益目前尚不清楚。
目的
在以性别不同的心血管疾病初级预防中，为确定应用阿司匹林治疗是否获益及其风险，资料来源于 MEDLINE，Cochrane中心对照实验数据库（1966－2005.3），检索书目，和主要学术会议报道。在有关心梗，中风和心血管死亡率的报道资料中，对无心血管疾病行阿司匹林治疗的参与者挑选合适的前瞻性、随机对照实验。在总数95456病人中进行了6次实验，3次只包括男性，1次只包括女性，2次男女都有。对所得资料进行总结来确定随机病人的数目，随访的平均时间及结束时间点（心血管事件的组成[非致死MI、非致死性中风和心血管死亡率]，每一病人的各自特征和主要出血部位）。
资料的综合：在51342名妇女中，有1285次主要心血管事件：625人出现中风、469人发生心梗和364人死亡。阿司匹林治疗与心血管事件降低12％显著相关（OR为0.88；95%可信区间CI为0.79－0.99；P＝0.03），与中风减少17％显著相关（OR为0.83;95%可信区间为0.70-0.97;P=0.02），这也是缺血性中风发生率降低（OR为0.76,95%可信区间为0.63-0.93;P=0.008）的一个反映，在心梗和心血管死亡率方面无明显效应。在44114名男性中，共有2047次心血管事件:597次中风，1023次心梗，776次心血管死亡事件。阿司匹林治疗与14％的心血管事件降低显著相关(OR0.86,95%可信区间为0.78-0.94;P=0.01),与32％的心梗降低显著相关（OR0.68,95%可信区间为0.54-0.86;P=0.001）。在中风及心血管死亡率方面无显著效应。阿司匹林治疗增加了男性和女性出血的风险，女性为（OR1.68,95%CI1.13-2.52;P=0.01），男性为（OR1.72,95%CI为1.35-2.20;P<0.001）.
结论：在男性和女性，阿司匹林治疗降低了心血管事件的风险，主要是由于其能降低女性患缺血性中风、男性患心梗的效应。阿司匹林在男性和女性均能同等程度的出血风险。
作者: dhanks 编译
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