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Editors rank cardiovascular disease (CVD) as the leading cause of death in the world. Among the CVD prevention medications, aspirin is one of the commonly used drugs, but from a global perspective, the current status of aspirin application is unsatisfactory, with a low application rate and Higher misuse rates.

Regulate the use of aspirin

Editors rank cardiovascular disease (CVD) as the leading cause of death in the world. Among the CVD prevention medications, aspirin is one of the commonly used drugs, but from a global perspective, the current status of aspirin application is unsatisfactory, with a low application rate and Higher misuse rates.

Chinese name

Regulate the use of aspirin

Review

Zhu Junren

Translate

" Regulating the Use of Aspirin"

THE PRINCIPLE OF ASPIRIN USE

Questions and answers on clinical application of acetylsalicylic acid in anti-platelet aggregation

First edition in 2005

2005 First Edition

Price USD 5.5 / HKD 45

Recently, Professor Hennkens, a well-known international cardiovascular expert, visited China and exchanged views with domestic doctors on this issue. Professor Hennekens has a good reputation in the field of epidemiology and preventive medicine, and is the lead of many large-scale aspirin primary and secondary prevention research. He pointed out that aspirin is a drug with high benefit-risk ratio and cost-effectiveness ratio, which is very suitable for China, a country where cardiovascular disease is increasing year by year. Physicians should standardize and rationally use aspirin to make it more widely available to the people. In the end, Professor Hennekens ended his wonderful speech with the finishing touch of a sentence that is familiar to the Chinese people-"Serving the People". Professor Zhu Junren made a report entitled Comprehensive Understanding of ESC Antiplatelet Drugs at the meeting. The meeting was co-chaired by professors Wu Zhaosu and Liu Lisheng, and summarized by Professor Liu Lisheng.

Make aspirin serve the public more widely

Charles H Hennekens, University of Miami, Florida

Professor Hennekens is an internationally renowned expert in cardiovascular, epidemiological and preventive medicine. He has published a number of articles on cardiovascular protection, such as aspirin, statins, ACEI and blockers. His citation rate is ranked globally seventh.

Professor Hennekens is a pioneer in aspirin research. In a number of large-scale aspirin primary and secondary prevention studies (such as ATT, ISIS, PHS, and Women's Health Studies), Professor Henkenens has assumed the role of sponsor and principal investigator. These studies have established the role of aspirin in cardiovascular prevention.

Good medicine to prevent cardiovascular disease

Aspirin is almost the oldest medicine in the world. In recent decades, with the emergence of a large amount of evidence for CVD prevention, aspirin has become more and more important in cardiovascular prevention and treatment. Whether it is acute treatment, secondary prevention or primary prevention, aspirin plays a role that cannot be ignored.

Affirmative treatment effect in the acute phase

Studies have shown that the use of aspirin within 24 hours of acute myocardial infarction (MI) can reduce the mortality rate of patients by 23% after 35 days. The continued use of aspirin in the future will further expand its benefits. A number of guidelines recommend that aspirin should be given immediately and for long-term use in all patients with acute MI and stroke.

Significant secondary prevention effect

A large meta-analysis ATT study showed that aspirin reduced the incidence of severe vascular events by 25% in patients with previous occlusive vascular events. While aspirin has achieved such great benefits, it only slightly increases the absolute risk of hemorrhagic stroke (0.3 ), even if the upper limit of the 95% confidence interval is less than 1 . As a result, high-risk patients benefit from aspirin prevention far outweighing the possible minor risks.

Primary prevention assessment risk

Individuals who benefit from primary prevention will be several times more likely than secondary prevention. There is an old saying in China that "the disease is not diseased by the medical practitioner, the disease is diseased by the traditional Chinese medicine practitioner, and the disease is already diseased by the lower physician". Therefore, the prevention and treatment of diseases in healthy people cannot be ignored.

There are currently 5 published aspirin primary prevention studies, 4 of which clearly support the beneficial role of aspirin in primary prevention. A meta-analysis of these five studies showed that aspirin significantly reduced the risk of first-time non-fatal MI by 32% and reduced important vascular events by 15%.

However, taking aspirin can also cause some adverse reactions, so the absolute benefit and absolute risk of the patient should be weighed. Existing guidelines vary on the 10-year risk index for aspirin primary prevention of first cardiovascular events, but in fact, the value is not absolute, and patients with absolute benefits exceeding absolute risk should take aspirin.

Regulated use is a guarantee for patient benefit

Low aspirin application rate and high misuse rate

Although aspirin plays a pivotal role in the prevention and treatment of cardiovascular disease, unfortunately, the application of aspirin is far from universal. A recent national survey of aspirin use in the United States shows that in secondary prevention, only 50% of patients take aspirin, and more unfortunately, in these 50% of patients, 21% of patients have misused aspirin (10% of NSAIDS, 11% take paracetamol).

Aspirin should be used properly

Incorrect application of aspirin is one of the important reasons why aspirin is not standardized. A meta-analysis showed that taking aspirin over 75 mg / d for a long time can significantly reduce the incidence of cardiovascular events, but the efficacy is uncertain at doses below 75 mg / d. Since it takes 2 days for 75 mg / d aspirin to reach the maximum inhibition rate of thromboxane B2, a first dose of 162 to 325 mg of aspirin is needed in the acute phase of CVD.

Based on the above data, the American College of Cardiology recommends the optimal dose of aspirin for CVD prevention: primary prevention or secondary prevention is 75-325 mg / d; acute phase CVD treatment is 162.5-325 mg.

Aspirin should be used more widely

Whether in developed or developing countries, the wider use of aspirin will avoid more early deaths in secondary prevention, acute ischemic stroke, and acute myocardial infarction, and will prevent more first-time deaths in primary prevention. Myocardial infarction.

For China, the most populous country in the world, the incidence of occlusive vascular events is also increasing year by year. According to statistics, about 5 million people die of coronary heart disease (CHD) each year in China, but only 15% of patients with CHD receive aspirin. If aspirin is used in 100% of patients with CHD, nearly one million deaths will be avoided each year. This program is both effective and cheap. Not only is the cost of aspirin treatment low, but it can also greatly reduce the costs of hospitalization and long-term disability.

In order to reduce the mortality and disability of CVD, people are working on the development of newer and more perfect drugs or treatments. However, it should not be forgotten that the wider and more appropriate use of aspirin can now reduce the mortality and disability of cardiovascular and cerebrovascular diseases in China. Clinicians should standardize the use of aspirin based on evidence-based medical evidence so that aspirin can truly serve the people.