最新证据！每天服用阿司匹林降低心脏病风险、预防癌症、延长寿命
3 小时前
来源：生物探索
11月30日，发表在PLOS ONE杂志上的一项研究中，南加州大学（USC）的研究人员发现，对具有高心脏病风险的老年美国人来说，每天服用低剂量的阿司匹林能够降低心脏病发作的风险，预防某些癌症和癌症相关死亡，并延长寿命，挽救患者的生命。 此外，研究估计，在2016-2036年期间，增加阿司匹林的使用将为美国人口产生6920亿美元的净效益。 争议 今年，每天服用低剂量阿司匹林的长期益处受到了质疑。4月12日，美国预防服务工作组（USPSTF）发布了更新版的阿司匹林指南，声明了阿司匹林的临床益处。该指南对2009年USPSTF关于阿司匹林用于预防心血管疾病的推荐以及2007年关于阿司匹林和非甾体类抗炎药物用于预防结直肠癌的推荐进行更新。而这似乎与FDA的意见并不一致。 今年6月，FDA针对消费者常用于心痛、胃酸、消化不良、阵痛等疗效的非处方药——含有阿司匹林的抗酸药物发布了警告信。FDA担心，一些病人（特别是≥60岁的病人），如果每天服用阿司匹林会，可能会引发中风和出血（胃肠道和大脑中）风险增加。 参与该研究的étienne Gaudette表示，这让大家对阿司匹林的使用感到很困惑。通过我们的研究，我们希望让每个人能更容易理解阿司匹林的长期效益是什么。 进展
Increased Aspirin Use Would Prevent Heart Disease and Extend Life. 为了评估阿司匹林的长期效应，USC的研究人员开展了两个方案。第一个方案为指南依从性性的（Guideline Adherence，详细解释见上图）。结果发现，遵照指南将能在每1000名51-79岁的美国人中预防11例心脏病以及4例癌症的发生。预期寿命将增加0.28岁。不过，研究发现，中风的发生率没有显著降低。同时，消化道出血比率将增加25%。 第二个方案（Universal Eligibility）旨在评估，如果所有≥51岁的美国人不按照指南，而是每天服用阿司匹林，将会带来的全部潜在益处和不利。结果发现，该方案比第一种方案显示出了略大的健康益处。 论文结论指出，在接下来的二十年里，心血管疾病风险升高的老年美国人增加阿司匹林的使用能够产生实质性的健康益处。领导该研究的David B. Agus强调：“我们的研究表明，这一简单的、低成本的措施具有多种健康益处，且能够减少医疗保健开支，应该被考虑作为适当患者护理的标准部分。” 参考资料： Medicalxpress：Aspirin regimen for older adults has long-term benefits PLOS ONE：The Long-Term Benefits of Increased Aspirin Use by At-Risk Americans Aged 50 and Older 推荐阅读： 参考文献
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 The Long-Term Benefits of Increased Aspirin Use by At-Risk Americans Aged 50 and OlderBackground The usefulness of aspirin to defend against cardiovascular disease in both primary and secondary settings is well recognized by the medical profession. Multiple studies also have found that daily aspirin significantly reduces cancer incidence and mortality. Despite these proven health benefits, aspirin use remains low among populations targeted by cardiovascular prevention guidelines. This article seeks to determine the long-term economic and population-health impact of broader use of aspirin by older Americans at higher risk for cardiovascular disease. Methods and Findings We employ the Future Elderly Model, a dynamic microsimulation that follows Americans aged 50 and older, to project their lifetime health and spending under the status quo and in various scenarios of expanded aspirin use. The model is based primarily on data from the Health and Retirement Study, a large, representative, national survey that has been ongoing for more than two decades. Outcomes are chosen to provide a broad perspective of the individual and societal impacts of the interventions and include: heart disease, stroke, cancer, life expectancy, quality-adjusted life expectancy, disability-free life expectancy, and medical costs. Eligibility for increased aspirin use in simulations is based on the 2011–2012 questionnaire on preventive aspirin use of the National Health and Nutrition Examination Survey. These data reveal a large unmet need for daily aspirin, with over 40% of men and 10% of women aged 50 to 79 presenting high cardiovascular risk but not taking aspirin. We estimate that increased use by high-risk older Americans would improve national life expectancy at age 50 by 0.28 years (95% CI 0.08–0.50) and would add 900,000 people (95% CI 300,000–1,400,000) to the American population by 2036. After valuing the quality-adjusted life-years appropriately, Americans could expect $692 billion (95% CI 345–975) in net health benefits over that period. Conclusions Expanded use of aspirin by older Americans with elevated risk of cardiovascular disease could generate substantial population health benefits over the next twenty years and do so very cost-effectively. 展开 |
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