JAMA 子刊:老年人可能会过度使用阿司匹林,尤其是糖尿病患者

2021-06-27 MedSci原创 MedSci原创

阿司匹林,作为医药史上三大经典药物之一,自临床应用开始已有上百年的历史,至今依旧是解热、镇痛和抗炎药的良药。

阿司匹林,作为医药史上三大经典药物之一,自临床应用开始已有上百年的历史,至今依旧是解热、镇痛和抗炎药的良药。随着医学发展,诸多研究发现,阿司匹林可降低血管事件的发生,对于年龄在50 - 59岁心血管疾病高危群,指南已将其作为心血管疾病的一级预防

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有研究显示,糖尿病患者患 CVD 的风险是非糖尿病患者的 2 4 倍,但阿司匹林在糖尿病患者人群的一级预防中的作用尚不清楚。近日,发表在JAMA Netw Open杂志的一项研究探索了在美国患有和未患有糖尿病的老年人中阿司匹林的使用率。

该研究使用了 2011 年至 2018 年全国健康和营养检查调查的全国代表性数据。共有 7103 60 岁或以上的糖尿病患者和非糖尿病患者完成了一份关于预防性阿司匹林使用的问卷。预防性阿司匹林的使用被定义为参与者根据医生的建议或自我决定使用低剂量阿司匹林。统计分析时间为201971日至202141日。

研究结果显示,共纳入710360 岁或以上的参与者,其中45.2%为男性,75.8%为白人。总体而言,阿司匹林使用率总体为 46.7%61.7%的糖尿病患者和42.2%的非糖尿病患者在使用阿司匹林。在美国估计有 990 70 岁或以上患有或不患有糖尿病的美国人群在使用阿司匹林治疗进行一级预防。

在没有心血管疾病但患有糖尿病的人群中,服用阿司匹林的人也更有可能是男性,而且平均腰围(平均[SD]110.2[0.8]cm)更高。在平均年龄、BMI、种族/民族或血红蛋白A1c方面没有显著差异。

患有与未患有糖尿病的老年人中不同年龄组和心血管疾病 (CVD) 状态的阿司匹林使用情况

在没有心血管疾病和糖尿病的人群中,阿司匹林使用者的平均年龄更高(使用阿司匹林,70.2[0.3]vs不使用阿司匹林,68.4[0.2]岁),更可能是白人(使用阿司匹林,82.7%[SE1.5%] vs不使用阿司匹林,76.4%[SE1.6%] ),而且平均腰围102.1 [0.6] cm vs 99.8 [0.5] cm)、BMI28.9 [0.3] kg/m2 vs 28.2 [0.2] kg/m2以及血红蛋白A1c5.67% [0.01%] vs 5. 62% [0.01%]水平更高更有可能患有高血压61.4% [SE, 2.1%] vs 42.9% [SE, 1.6%]或高胆固醇血症68.8% [SE, 1.6%] vs 53.4% [SE, 1.2%])。

年龄、性别和心血管疾与阿司匹林用于一级或二级预防的关联

在逻辑回归模型中,对年龄、种族/民族、性别、教育、CVD风险和BMI调整后,糖尿病与使用阿司匹林的几率明显升高有关。在患有糖尿病人群中,高危与低危人群使用阿司匹林进行一级或二级预防的可能性并无差异。在患有糖尿病的老年人中,有CVD病史与使用阿司匹林的几率明显较高。在调整协变量后,女性与使用阿司匹林的几率明显较低相关。

综上,在美国,糖尿病患者使用阿司匹林进行初级预防的可能性比非糖尿病患者高1倍。女性使用阿司匹林的可能性明显低于男性,特别是在糖尿病患者中。在没有糖尿病人群中,年龄越大与使用阿司匹林的可能性越大。医疗服务提供者更有必要向他们的老年患者询问阿司匹林的使用情况,并且鉴于最近指南的变化,讨论继续阿司匹林治疗预防心血管疾病的风险和益处。

原始出处

Elizabeth Y. Liu, BA1; Mohammed E. Al-Sofiani, MBBS, MSc1,2Hsin-Chieh Yeh, PhD3,4,5; et al.Use of Preventive Aspirin Among Older US Adults With and Without Diabetes.JAMA Netw Open. 2021;4(6):e2112210. doi:10.1001/jamanetworkopen.2021.12210

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    2021-06-27 小可爱萌萌

    写的值得思考

    0

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    2021-06-27 weigq

    利弊较难平衡。

    0

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    2021-06-27 小小医者

    #阿司匹林#,尤其是#糖尿病#人群,凡事物及必反。阿司匹林作为神药后,中老年人几乎是必备,虽然有一定的出血风险,但是相对较低。但是过度使用,也可能对消化道造成不利的风险。

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=977281, encodeId=58a39e7281da, content=写的值得思考, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32515535103, createdName=小可爱萌萌, createdTime=Sun Jun 27 13:07:55 CST 2021, time=2021-06-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1475092, encodeId=db6514e50928d, content=<a href='/topic/show?id=935fe6718e3' target=_blank style='color:#2F92EE;'>#糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76718, encryptionId=935fe6718e3, topicName=糖尿病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a38f7243741, createdName=xue8604, createdTime=Tue Jun 29 01:42:05 CST 2021, time=2021-06-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=977341, encodeId=4efa9e734136, content=利弊较难平衡。, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210703/9c448fe1b3b54fd7bc9477662f4861bb/4bdadad22bfd46f2921aabb4c40265d3.jpg, createdBy=a8d81938466, createdName=weigq, createdTime=Sun Jun 27 15:46:26 CST 2021, time=2021-06-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=977320, encodeId=811d9e732029, content=<a href='/topic/show?id=51639e734cb' target=_blank style='color:#2F92EE;'>#阿司匹林#</a>,尤其是<a href='/topic/show?id=4f77e665253' target=_blank style='color:#2F92EE;'>#糖尿病#</a>人群,凡事物及必反。阿司匹林作为神药后,中老年人几乎是必备,虽然有一定的出血风险,但是相对较低。但是过度使用,也可能对消化道造成不利的风险。, beContent=null, objectType=article, channel=null, level=null, likeNumber=203, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97734, encryptionId=51639e734cb, topicName=阿司匹林), TopicDto(id=76652, encryptionId=4f77e665253, topicName=糖尿病)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=小小医者, createdTime=Sun Jun 27 14:43:07 CST 2021, time=2021-06-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036704, encodeId=28c91036e04fd, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Sun Jun 27 13:42:05 CST 2021, time=2021-06-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1043669, encodeId=78e1104366913, content=谢谢MedSci提供最新的资讯, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Sun Jun 27 13:42:05 CST 2021, time=2021-06-27, status=1, ipAttribution=)]
    2021-06-27 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

    0

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    2021-06-27 misszhang

    谢谢MedSci提供最新的资讯

    0

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