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Anders sah es bei jenen 17.000 Patienten aus,
die in der Vergangenheit bereits einen Schlaganfall
oder einen Herzinfarkt erlitten hatten. Diese
Patienten hatten an an 6 Studien teilgenommen.
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THE LANCET: Press Release
ASPIRIN IN PRIMARY PREVENTION: REDUCES HEART ATTACKS, BUT INCREASES BLEEDS—SO NET VALUE UNCERTAIN
Use of aspirin by people with no history of relevant disease (primary prevention) reduces non-fatal heart attacks by around a fifth—but it also increases the risk of internal bleeding by around a third. Thus its long-term use in this population is of uncertain net benefit since these benefits and risks could cancel each other out. For secondary prevention (among those who already have occlusive vascular disease), aspirin’s benefits generally outweigh its small risks. The findings are discussed in an Article published in this week’s edition of The Lancet.
In this UK Medical Research Council
funded study, Professor Colin Baigent, Clinical
Trial Service Unit and Epidemiological Studies Unit
(CTSU), University of Oxford, UK, and colleagues
did an individual patient meta-analysis of
serious vascular events (heart attack, stroke, or
vascular death) and major bleeds in
six primary prevention trials, involving
95,000 people at low-average risk, and
16 secondary prevention trials, involving
17,000 people at high risk.
The studies compared long-term aspirin use with
control.
The researchers found that in the
primary prevention trials, aspirin
reduced the already small risk of serious vascular
events (stroke, heart attack, vascular death) by
12%, mainly due to the reduction in non-fatal heart
attack mentioned above. There was no significant
difference in stroke or in vascular mortality, but
the small risk of internal bleeds increased by around
a third in those given aspirin.
In the secondary prevention studies, where people
had already had a stroke or heart attack and were
at substantial risk of recurrence, aspirin reduced
the risk of serious vascular events by about
a fifth, and this benefit clearly outweighed
any small extra risk of bleeding. In both sets
of trials, the proportional reductions in vascular
events were similar for men and women.
The authors conclude: “The currently available trial results…do not seem to justify general guidelines advocating the routine use of aspirin in all healthy individuals above a moderate level of risk for coronary heart disease.”
Professor Baigent adds*: “Drug safety really matters when making recommendations for tens of millions of healthy people. We don’t have good evidence that, for healthy people, the benefits of long-term aspirin exceed the risks by an appropriate margin. If effectiveness is uncertain, then cost-effectiveness calculations are irrelevant.”
In an accompanying Comment, Professor Ale Algra and Dr Jacoba P Greving, University Medical Centre Utrecht, Utrecht, Netherlands, use a cost-effectiveness model to create a table** showing which populations might or might not benefit from aspirin in primary prevention — which shows that, in most cases, it is not justified. They conclude: “Patients might not wish to be medicalised —such considerations are important in the decision to take aspirin or not. Whether statins should be preferred above aspirin is a different and difficult question that needs careful consideration too. Apart from drug treatment, one must not forget the importance of lifestyle changes, such as cessation of smoking, healthy diet, and regular exercise.”
For Professor Colin Baigent, please contact UK Medical Research Council Press Office T) press.office (at)headoffice.mrc.ac.uk
Professor Ale Algra, University Medical Centre Utrecht, Utrecht, Netherlands T) a.algra (at) umcutrecht.nl
For full Article and Comment, see: http://press.thelancet.com/aspirin.pdf
Note to editors: *Quote direct from Professor Baigent and cannot be found in text of the Article
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 ÄRZTE
FÜR TIERE e. V. verfolgt zwei grundsätzliche Ziele:
den politischen Tierschutz und die Förderung tiergestützter Therapieformen. mehr |
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