阿斯匹靈預防心臟病有爭議 Mounting debate over aspirin use in primary prevention－矯正醫生的狂想曲--- Straight teeth and life

Part I ---

以低劑量阿斯匹靈預防心臟病有爭議

Mounting debate over aspirin use in primary prevention should prompt new talks with patients

雖然2009-03 美國 USPSTF (US Preventive Services Task Force ) 修正服用阿斯匹靈預防心臟病的(年齡)建議,

-- 男性 45 to 79 歲 (預防心肌梗塞) , 女性 55 to 79歲 ( 預防中風stroke) 破碎的心

但在歲末, 由於有新的研究結果,

許多專家學者表示以低劑量阿斯匹靈預防心臟病有爭議;

因為消化道(胃腸)出血的危險大於預防心臟病的優點!!

尤其無症狀的動脈硬化, 第二型(成人)糖尿病, 及 peripheral artery disease反對服用阿斯匹靈!

Dr. Colin Baigent 便認為降血壓藥物(例如statin)更安全,而戒煙一樣能降低心肌梗塞及中風~~ 電燈泡

Oxford, UK - December 9, 2009

Physicians and consumers looking for drug-company information on aspirin need look no further than the Bayer website www.wonderdrug.com: an immodest homepage for a drug that, at least in the primary-prevention arena, has weathered a less-than-wonderful year. The US Preventive Services Task Force (USPSTF) says it stands by its seemingly broad recommendations for aspirin to prevent a first MI in men and stroke in women. But some experts, including regulatory groups abroad, worry that key messages on aspirin's potential harms are just not getting through to physicians and their mostly healthy patients who, for years, have taken an aspirin a day to keep heart attack at bay.

Things looked rosier early this year. In March 2009, the USPSTF issued an update to its 2002 recommendations for aspirin in primary prevention. These stipulated that aspirin was likely of benefit for preventing MI in men age 45 to 79 and preventing stroke in women 55 to 79, when the benefits outweigh the gastrointestinal risks on an individual-patient basis.

But over the ensuing months, a steady stream of studies have warned against aspirin use in some of the key primary-prevention populations, including patients with asymptomatic atherosclerosis, type 2 diabetes, and peripheral artery disease. Most striking of all was the May 2009 meta-analysis, published in the Lancet, from the Oxford Antithrombotic Treatment Trialists (ATT)—the same group that wrote the original 2002 aspirin/primary-prevention meta-analysis, published in the BMJ, credited by many to have been the paper that cemented the role of low-dose aspirin in primary prevention in the first place. The Lancet paper found that while aspirin used for primary prevention may reduce the risk of nonfatal ischemic events, these benefits are offset by higher bleeding, leaving no net effect on vascular mortality.

There is "overwhelming evidence" that safer drugs, such as statins and blood-pressure-lowering drugs, as well as smoking cessation, reduce the risk of MI and stroke. "So the question is not whether to give aspirin for primary prevention, but whether to add aspirin to safer forms of primary prevention, and that's a very important distinction." --ATT investigator Dr Colin Baigent (Oxford University, UK)

Part II---

Recommendation Statement from USPSTF: Aspirin for the Prevention of Cardiovascular Disease. 2009

Summary of Recommendations

The USPSTF recommends the use of aspirin for men age 45 to 79 years when the potential benefit due to a reduction in myocardial infarctions, and for women age 55 to 79 years when the potential benefit due to a reduction in ischemic strokes that outweighs the potential harm due to an increase in gastrointestinal hemorrhage..
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of aspirin for cardiovascular disease prevention in men and women 80 years or older.
The USPSTF recommends against the use of aspirin for stroke prevention in women younger than 55 years and for myocardial infarction prevention in men younger than 45 years.