阿司匹林对于心血管疾病一级预防的效果及安全性的系统综述及meta分析

Effect and safety of aspirin for primary prevention of cardiovascular diseases:a systematic review and meta analysis

目的：使用系统综述和meta分析评价阿司匹林在心血管一级预防中的效果及安全性。方法2014年12月利用阿司匹林、一级预防、心血管等作为检索词检索PubMed、EMBASE、Cochrane Library、ClinicalTrials．gov、中国生物医学文献数据库（CBM）、中国生物医学期刊引文数据库（CMCI）、中国期刊全文数据库（CNKI）、中国科技期刊数据库（VIP）及万方数据库等多个数据库。根据纳入排除标准对检索出的文献进行筛选。对纳入的文献进行方法学评价，并提取基本信息、方法学特征、干预措施和结局指标等信息。根据异质性检验选择固定效应模型或随机效应模型对各个研究的结果进行meta分析。数据分析和图表制作使用Stata11．0等软件完成。结果本研究共纳入10项研究，阿司匹林组共纳入59365人，其中发生主要不良心血管事件（MACE）2222件（3．74％）；安慰剂组纳入57720人，发生MACE 2306件（4．00％）。使用固定效应模型的汇总结果显示出MACE风险显著减少10％（RR＝0．90，95％CI：0．85～0．96，P＜0．000）；心肌梗死风险降低16％（RR＝0．84，95％CI：0．72～0．98，P＝0．023）；卒中风险降低了6％（RR ＝0．94，95％CI：0．86～1．04，P ＝0．211）；全因死亡风险降低了5％（RR＝0．94，95％CI：0．90～1．01，P＝0．075）；心血管死亡降低2％（RR＝0．98，95％CI：0．89～1．09，P＝0．776）；大出血风险增加77％（ RR＝1．77，95％CI：1．40～2．22，P＝0．000）。结论阿司匹林不适宜用于心血管疾病的一级预防，虽然可使MACE及心肌梗死事件的发生率降低，但是会增加发生大出血的风险。

Objective To evaluate the role of aspirin in primary prevention of cardiovascular diseases through a systematic review and meta analysis.Methods Computer retrieval was carried out in PubMed , EMBASE, Cochrane Library, China Biology Medicine disc （CBM）, China National Knowledge Infrastructure （CNKI）, VIP database and WanFang Data, etc, in December 2014 for the literatures about aspirin , primary prevention , cardiovascular diseases and other search terms .The obtained literatures were screened according to the eligibility criteria .Then the quality of the literature was assessed with methodological evaluation , and the data such as baseline information, methodological characteristics , interventions and outcomes were extracted .According to the heterogeneity test , a fixed-effect model or a random-effects model was selected to perform meta-analysis in each study .Data analysis and charting were done using Stata 11.0 software.Results There were 10 studies incorporated in this study , including 59 365 cases of aspirin group and 57 720 cases of placebo group .The meta-analyses showed the incidence of major adverse cardiovascular events （MACE） was 3.74%（2222 cases） for the former group and 4.00%（2306 cases） for the latter.The results of the fixed-effect model indicated that aspirin reduced the risk of MACE by 10% （ RR =0.90, 95%CI： 0.85 -0.96, P〈0.000）, the risk of myocardial infarction by 16%（RR=0.84, 95%CI：0.72-0.98, P=0.023）, the risk of stroke by 6% （RR=0.94, 95%CI：0.86-1.04, P=0.211）, the risk of all-cause death by 5% （RR =0.94, 95%CI： 0.90 -1.01, P =0.075）, and the risk of cardiovascular death by 2%（RR=0.98, 95%CI：0.89-1.09, P=0.776）, but increased the risk of hemorrhea by 77% （RR=1.77, 95%CI：1.40-2.22, P=0.000）.Conclusion Aspirin is not suitable for primary prevention of cardiovascular diseases, although it can reduce the incidences of MACE and myocardial infarction , but it will increase the risk of hemorrhea .