日本6年半的研究： 阿司匹林对心脏并无保护作用

文中提到亚裔比其他族裔更易有出血性中风，可是亚裔用阿司匹林的研究很少。
JAMA文章link在此， 要有account喔
http://jama.jamanetwork.com/article.aspx?articleid=1936801

哈佛医学院新闻解读贴在这里
http://www.intelihealth.com/print-article/japanese-study-no-heart-protection-from-aspirin

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Japanese Study: No Heart Protection from Aspirin

November 17, 2014

News Review From Harvard Medical School -- Japanese Study: No Heart Protection from Aspirin

In a study from Japan, taking daily low-dose aspirin did not reduce the risk of early death for people who had a high risk of developing heart disease. The study included 14,464 people, ages 60 to 85. All of them had high blood pressure, high cholesterol or diabetes. They did not have known heart disease, however. They were randomly assigned to take a daily low-dose aspirin or no aspirin. Researchers kept track of people for up to 6½ years. An expert panel then decided to end the study early. They concluded that the treatment was not helping. That's because the risk of death from heart attack, stroke or related events was no different between the 2 groups. The risk of nonfatal stroke also was the same in both groups. The rates of nonfatal heart attack and transient ischemic attack ("mini-stroke") were reduced by half in the aspirin group. But the aspirin group was more likely to have major bleeding problems than the no-aspirin group. The Journal of the American Medical Association published the study.

 

By Lori Wiviott Tishler, M.D.
Harvard Medical School

                  

What Is the Doctor's Reaction?

One of the most common questions that healthy men and women over 50 ask me is "Should I start taking an aspirin?" Patients know about the good effects of aspirin in preventing heart disease and stroke. We learned about this effect from well-done and well-publicized studies dating back to the early 1990s.  

Patients want to hear: "Yes, you should take an aspirin," or "No, you shouldn't." Doctors want to be able to give a clear, straightforward answer. In truth, the answer has become less clear over time. To answer the question, doctors have to really understand the person in front of them. Is the patient male or female?  What is his or her specific risk, based on race, gender and medical history?     

This study is an important addition to the data. It was presented at the American Heart Association Scientific Sessions in Chicago. Conducted in Japan, the study enrolled almost 15,000 people. Their ages ranged from  60 to 85. All of them had health factors that increased their risk of heart disease. These included high blood pressure, high cholesterol or diabetes. People  took their regular medicines. Half of them also took a daily low-dose aspirin. 

This study was stopped early. The group of experts keeping track of the data felt that aspirin was unlikely to be of any major benefit to those who were taking it. Everyone had fewer heart attacks and strokes than expected. Yet, in this study, taking aspirin did not seem to have a role in decreasing that risk. The data suggested some benefit in decreasing the risk of heart attacks and transient ischemic attack (sometimes called "mini-stroke"), but the study was not designed to measure this specifically. 

In this entirely Japanese population, the risk of all kinds of bleeding did increase.

This study is particularly interesting to us for several reasons:

• We know that Asian people are more likely to have hemorrhagic (bleeding) strokes than other populations. But so far there has been little research on aspirin use among Asians.
• This study also highlights the importance of gathering robust data in non-white populations.
• The study shows that, over time, it has become much harder to do research on the role of aspirin in preventing heart attack and stroke. This is likely because other medicines, such as statins for cholesterol, have so much benefit as well. 
• Many people in the study stopped their aspirin. Others in the non-aspirin group started to take an aspirin during the study. An editorial explains that this was unlikely to affect overall results. But it does point out the challenges of doing long-term research in the 21st century, when people are mobile and have so much access to medical information.

In summary, this study will help doctors to help our patients decide whether or not an aspirin a day is a good idea. It doesn't allow for an easy yes or no. But it does contribute to a more nuanced view that will help make the safest, best decision for each person.

 

What Changes Can I Make Now?

If you are over 50 and considering taking an aspirin a day, discuss it with your doctor. He or she will likely review your:

• Risk of heart disease in the next 10 years
• Risk of stroke
• Risk of bleeding

Together, you can decide whether the benefits of a daily, low-dose aspirin outweigh the risks.

Whether your doctor suggests aspirin or not, it's important to change factors that may increase your risk of heart and blood vessel disease. Here's what you can do to protect your heart and brain:

• Maintain a healthy weight.  Keeping your body mass index between 20 and 25 is hard in our society, but so valuable for your overall health.
• Quit smoking.
• Eat a heart-healthy, portion-controlled diet.
• Exercise several times a week.

If you have high blood pressure, diabetes or high cholesterol, work with your doctor to bring your blood pressure, blood sugar and cholesterol as close to the normal range as you safely can. Take your medicines daily as prescribed.

If you want to know more about your own heart disease risk, one way to look at it is using this risk calculator.  Many other calculators can be found as well.

Remember, this study was for people who have not had a heart attack or stroke. If you have a history of heart disease already, then the benefits and risks of aspirin are quite different.

 

What Can I Expect Looking to the Future?

I think this study beautifully highlights the role of personalized medicine. Doctors need to think with patients about their risk of heart disease and stroke and make medical decisions based on the person sitting in front of us. Fortunately, three studies are in the works to help us make better sense of the risks and benefits of aspirin in many different settings.  Stay tuned!

所有跟帖： 

• 以上研究的病人从未有过心肌梗塞或中风，如果有过，阿司匹林的作用可能不一样，要照医嘱。。。 -志在千里- ♀ (550 bytes) () 02/08/2015 postreply 11:26:02

• 谢谢转载这篇文章。。。俺还是吃丹参吧。。。 -御用文人- ♀ (0 bytes) () 02/08/2015 postreply 11:33:07

• 谢谢！ -志在千里- ♀ (0 bytes) () 02/08/2015 postreply 21:58:35