Ioannis Bellos, Smaragdi Marinaki, Pagona Lagiou, Vassiliki Benetou
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The meta-analysis of RCTs indicated that aspirin was associated with lower risk of major adverse cardiovascular events [hazard ratio (HR): 0.79; 95% confidence intervals (CI): 0.64–0.97] and higher risk of major bleeding [risk ratio (RR): 1.35; 95% CI 1.15–1.58]. Incorporating observational evidence led to statistically non-significant findings in terms of risk of both cardiovascular events (pooled HR: 0.97; 95% CI 0.75–1.25; low certainty) and major bleeding (pooled RR: 1.21; 95% CI 0.99–1.48; moderate certainty). No statistically significant differences between aspirin and placebo were observed in the outcomes of mortality, coronary heart disease, stroke and renal events.</p><h3>Conclusions</h3><p>RCT evidence points to a possible benefit in cardiovascular event reduction from aspirin administration, at the cost of increased major bleeding risk. This finding was not confirmed when the existing observational evidence was incorporated. 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引用次数: 0
摘要
目的：慢性肾脏病与心血管疾病（CVD）风险增加有关。这项荟萃分析旨在评估慢性肾脏病患者服用阿司匹林进行心血管疾病一级预防的有效性和安全性：方法：系统检索了 PubMed、Scopus、Web of Science、CENTRAL 和 Clinicaltrials.gov，检索时间从开始至 2023 年 6 月 22 日。纳入了评估阿司匹林作为慢性肾病心血管疾病一级预防药物的随机对照试验（RCT）和队列研究。采用随机效应模型进行了 Meta 分析：总共纳入了 11 项研究（6 项研究性临床试验和 5 项队列研究），共 24,352 名患者。对研究性试验的荟萃分析表明，阿司匹林与较低的主要不良心血管事件风险[危险比（HR）：0.79；95% 置信区间（CI）：0.64-0.97]和较高的主要出血风险[危险比（RR）：1.35；95% CI 1.15-1.58]相关。纳入观察性证据后，在心血管事件风险（汇总 HR：0.97；95% CI 0.75-1.25；低确定性）和大出血风险（汇总 RR：1.21；95% CI 0.99-1.48；中度确定性）方面均得出了无统计学意义的结果。阿司匹林和安慰剂在死亡率、冠心病、中风和肾脏事件等结果上没有统计学意义上的差异：研究证据表明，服用阿司匹林可能有利于减少心血管事件，但代价是增加大出血风险。结合现有的观察证据，这一结论并未得到证实。进一步的研究应确定慢性肾病患者中最适合接受预防性阿司匹林治疗的亚群： 研究方案已进行了前瞻性注册，可从以下网址公开获取：https://doi.org/10.17504/protocols.io.261ged63jv47/v1 。
Aspirin for the Primary Prevention of Cardiovascular Diseases in Patients with Chronic Kidney Disease: An Updated Meta-analysis
Aim
Chronic kidney disease is associated with increased risk of cardiovascular diseases (CVD). This meta-analysis aims to evaluate the efficacy and safety of aspirin administered for primary prevention of CVD in patients with chronic kidney disease.
Methods
PubMed, Scopus, Web of Science, CENTRAL and Clinicaltrials.gov were systematically searched from inception to 22 June 2023. Randomized controlled trials (RCTs) and cohort studies evaluating aspirin as primary prevention of CVD in chronic kidney disease were included. Meta-analysis was conducted using random-effects models.
Results
Overall, 11 studies (6 RCTs and 5 cohort studies) with 24,352 patients were included. The meta-analysis of RCTs indicated that aspirin was associated with lower risk of major adverse cardiovascular events [hazard ratio (HR): 0.79; 95% confidence intervals (CI): 0.64–0.97] and higher risk of major bleeding [risk ratio (RR): 1.35; 95% CI 1.15–1.58]. Incorporating observational evidence led to statistically non-significant findings in terms of risk of both cardiovascular events (pooled HR: 0.97; 95% CI 0.75–1.25; low certainty) and major bleeding (pooled RR: 1.21; 95% CI 0.99–1.48; moderate certainty). No statistically significant differences between aspirin and placebo were observed in the outcomes of mortality, coronary heart disease, stroke and renal events.
Conclusions
RCT evidence points to a possible benefit in cardiovascular event reduction from aspirin administration, at the cost of increased major bleeding risk. This finding was not confirmed when the existing observational evidence was incorporated. Further research should determine the most appropriate subpopulation of chronic kidney disease patients that would benefit the most from prophylactic aspirin therapy.
Registration
The study protocol has been prospectively registered and is publicly available from:
期刊介绍：
Promoting rational therapy within the discipline of cardiology, the American Journal of Cardiovascular Drugs covers all aspects of the treatment of cardiovascular disorders, particularly the place in therapy of newer and established agents.
Via a program of reviews and original clinical research articles, the journal addresses major issues relating to treatment of these disorders, including the pharmacology, efficacy and adverse effects of the major classes of drugs; information on newly developed drugs and drug classes; the therapeutic implications of latest research into the aetiology of cardiovascular disorders; and the practical management of specific clinical situations.
The American Journal of Cardiovascular Drugs offers a range of additional enhanced features designed to increase the visibility, readership and educational value of the journal’s content. Each article is accompanied by a Key Points summary, giving a time-efficient overview of the content to a wide readership. Articles may be accompanied by plain language summaries to assist patients, caregivers and others in understanding important medical advances. The journal also provides the option to include various other types of enhanced features including slide sets, videos and animations. All enhanced features are peer reviewed to the same high standard as the article itself. Peer review is conducted using Editorial Manager®, supported by a database of international experts. This database is shared with other Adis journals.
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