Ацетилсалициловая кислота и первичная профилактика: новые возможности


П.С. Лагута

Институт клинической кардиологии им. А.Л. Мясникова, Российский кардиологический научно-производственный комплекс Минздрава РФ, Москва
Активация тромбоцитов и последующее тромбообразование играют ключевую роль в развитии и прогрессировании атеросклероза и его осложнений. Ацетилсалициловая кислота (АСК), чья клиническая эффективность и безопасность подтверждены многочисленными контролируемыми исследованиями и мета-анализами, и на сегодняшний день продолжает рассматриваться в качестве стандарта антитромботической терапии. Вместе с тем, несмотря на широкий и многолетний опыт использования АСК, сохраняются некоторые спорные вопросы относительно ее применения. Эффективность АСК при назначении больным высокого риска с целью снижения частоты инфаркта миокарда, инсульта и сосудистой смерти не вызывает сомнений. В то же время целесообразность ее использования у пациентов низкого/среднего риска для первичной профилактики сердечно-сосудистых событий не столь очевидна и требует тщательной оценки предполагаемой пользы и возможного риска от проведения подобной терапии.

Литература


1. Heron M. Deaths: leading causes for 2011. Natl. Vital. Stat. Rep. 2015;64:1–96.

2. Thom T., Haase N., Rosamond W., et al. American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics – 2006 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2006;113:85–151.

3. Nowak J., Murray J.J., Oates J., Fitzgerald G. Biochemical evidence of a chronic abnormality in platelet and vascular function in healthy individuals who smoke cigarettes. Circulation. 1987;76:6–14.

4. Davi G., Catalano I., Averna M., Notarbartolo A., Strano A., Ciabattoni G., Patrono C. Thromboxane biosynthesis and platelet function in type-2 diabetes mellitus. N. Engl. J. Med. 1990;322:1769–74.

5. Davi G., Averna M., Catalano I., Barbagallo C., Ganci A., Notarbartolo A., Ciabattoni G., Patrono C. Increased thromboxane biosynthesis in type 2a hypercholesterolemia. Circulation. 1992;85:1792–98.

6. McConnel H. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. Br. Med. J. 2002;324:71–86.

7. Antithrombotic Trialists (ATT) Collaboration, Baigent C., Blackwell L., Collins R., Emberson J., Godwin J., Peto R., Buring J., Hennekens C., Kearney P., Meade T., Patrono C., Roncaglioni M.C., Zanchetti A. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet. 2009;373:1849–60.

8. Final report on the aspirin component of the ongoing Physicians’ Health Study. Steering Commitee of the Physicians’ Health Study Research Group. N. Engl. J. Med. 1989;321:129–35.

9. Peto R., Gray R., Collins R., Wheatley K., Hennekens C., Jamrozik K., Warlow C., Hafner B., hompson E., Norton S., et al. Randomized trial of prophylactic daily aspirin in British male doctors. Br. Med. J. 1988;296:313–16.

10. Thrombosis prevention trial: randomised trial of low-intensity oral anticoagulation with warfarin and low-dose aspirin in the primary prevention of ischaemic heart disease in men at increased risk. The Medical Research Council’s General Practice Research Framework. Lancet. 1998; 351:233–41.

11. Hansson L., Zanchetti A., Carruthers S.G., Dahlöf B., Elmfeldt D., Julius S., Ménard J., Rahn K.H., Wedel H., Westerling S. Effects of intensive blood-pressure lowering and low dose aspirin in patients with hypertension: principal results of Hypertension Optimal Treatment (HOT) randomized trial. Lancet. 1988;351:1766–62.

12. Collaborative Group of the Primary Prevention Project. Low-dose aspirin and vitamin E in people at cardiovascular risk: a randomised trial in general practice. Lancet. 2001;357:89–95.

13. Ridker P., Cook N., Min Lee L., Gordon D., Gaziano J., Manson J., Hennekens C., Buring J. A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women. N. Engl. J. Med. 2005;352(13):1293– 304.

14. Bartolucci A.A., Tendera M., Howard G. Metaanalysis of multiple primary prevention trials of cardiovascular events using aspirin. Am. J. Cardiol 2011;107:1796–801.

15. Raju N., Sobieraj-Teague M., Hirsh J., O’Donnell M., Eikelboom J. Effect of aspirin on mortality in the primary prevention of cardiovascular disease. Am. J. Med 2011;124:621–29.

16. Berger J.S., Lala A., Krantz M.J., Baker G.S., Hiatt W.R. Aspirin for the prevention of cardiovascular events in patients without clinical cardiovascular disease: a metaanalysis of randomized trials. Am. Heart J. 2011;162:115– 24.

17. Seshasai S.R., Wijesuriya S., Sivakumaran R., Nethercott S., Erqou S., Sattar N., Ray K.K. Effect of aspirin on vascular and nonvascular outcomes: meta-analysis of randomized controlled trials. Arch. Intern. Med. 2012;172:209–16.

18. Ogawa H., Nakayama M., Morimoto T., Uemura S., Kanauchi M., Doi N., Jinnouchi H., Sugiyama S., Saito Y.; Japanese Primary Prevention of Atherosclerosis with Aspirin for Diabetes (JPAD) Trial Investigators. Low-dose aspirin for primary prevention of atherosclerotic events in patients with type 2 diabetes: a randomized controlled trial. JAMA. 2008;300(18):2134–41.

19. Belch J., MacCuish A., Campbell I., et al. The prevention of progression of arterial disease and diabetes (POPADAD) trial: factorial randomized placebo controlled trial of aspirin and antioxidants in patients with diabetes and asymptomatic peripheral arterial disease. Br. Med. J. 2008;337:a1840.

20. Fowkes F.G., Price J.F., Stewart M.C., Butcher I., Leng G.C., Pell A.C., Sandercock P.A., Fox K.A., Lowe G.D., Murray G.D. Aspirin for Asymptomatic Atherosclerosis Trialists. Aspirin for prevention of cardiovascular events in a general population screened for a low ankle brachial index: a randomized controlled trial. JAMA. 2010;303(9):841–48.

21. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. Eur. Heart J. 2012;33:1635–701.

22. Vandvik O. Lincoff A.M., Gore J.M., Gutterman D.D., Sonnenberg F.A., Alonso-Coello P., Akl E.A., Lansberg M.G., Guyatt G.H., Spencer F.A. Primary and secondary prevention of cardiovascular disease. Antithrombotic therapy and prevention of thrombosis, 9th ACCP Evidence – based Clinical Practice Guidelines. Chest. 2012;141(2):637–68.

23. Centers for Disease Control and Prevention. National Diabetes Fact Sheet: General Information and National Estimates on Diabetes in the United States, 2007, Atlanta, US Department of Health and Human Services, Centers for Disease Control and Prevention. 2008.

24. Pignone M., Alberts MJ., Colwell J.A. Aspirin for Primary Prevention of Cardiovascular Events in people with diabetes. Circulation. 2010;121:2694–701.

25. Aspirin effects on mortality and morbidity in patients with diabetes mellitus. Early treatment diabetic retinopathy study report 14. ETDRS Investigators. JAMA. 1992;268:1292–300.

26. De Berardis G., Sacco M., Strippoli G.F., Pellegrini F., Graziano G., Tognoni G., Nicolucci A. Aspirin for primary prevention of cardiovascular events in people with diabetes: metaanalysis of randomised controlled trials. BMJ. 2009;339:b4531.

27. Zhang C., Sun A., Zhang P., Wu C., Zhang S., Fu M., Wang K., Zou Y., Ge J. Aspirin for primary prevention of cardiovascular events in patients with diabetes: a meta-analysis. Diabetes Res. Clin. Pract. 2010;87:211–18.

28. Calvin A.D., Aggarwal N.R., Murad M.H., et al. Aspirin for the primary prevention of cardiovascular events: a systematic review and metaanalysis comparing patients with and without diabetes. Diabetes Care. 2009;32:2300–306.

29. American Diabetes Association. Standarts of Medical Care in Diabetes – 2016. Diabetes Care. 2016;39(Suppl. 1):56–7.

30. Criqui M.H., Langer R.D., Frontek A., Feigelson H.S., Klauber M.R., McCann T.J., Browner D. Mortality over a period of 10 years in patients with peripheral arterial disease. N. Engl. J. Med. 1992;326:381–86.

31. CAPRIE Steering Committee. A randomized, blinded trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet. 1996;348:1329–39.

32. Meschia J.F., Bushnell C., Boden-Albala B., Braun L.T. Guidelines for the Primary Prevention of Stroke A Statement for Healthcare Professionals From the American Heart Association/ American Stroke Association. Stroke. 2014;45: 3754–832.

33. Jardine M.J., Ninomiya T., Perkovic V., Cass A., Turnbull F., Gallagher M.P., Zoungas S., Lambers Heerspink H.J., Chalmers J., Zanchetti A. Aspirin is beneficial in hypertensive patients with chronic kidney disease: a post-hoc subgroup analysis of a randomized controlled trial. J. Am. Coll. Cardiol. 2010;56:956–65.

34. Mancia G., Robert Fagard R., Narkiewicz K., et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur. Heart J. 2013;34:2159–219.

35. Rothwell P.M., Fowkes F.G.R., Belch J.F., Ogawa H., Warlow C.P., Meade T.W. Effect of daily aspirin on long-term risk of death due to cancer: analysis of individual patients data from randomised trials. Lancet. 2011; 377:31–41.

36. Farrel B., Godwin J., Richards S., Warlow C. The United Kingdom transient ischemic attack (UK-TIA) aspirin trial: final results. J. Neurol. Neurosurg. Phychiatry. 1991;54:1044–54.

37. Juul-Moller S., Edvardsson N., Jahnmatz B., Rosén A., Sørensen S., Omblus R. Doubleblind trial of aspirin in primary prevention of myocardial infarction in patients in patients with stable chronic angina pectoris. Lancet. 1992;340:1421–25.

38. Rothwell P.M., Price J.F., Fowkes F.G., Zanchetti A., Roncaglioni M.C., Tognoni G., Lee R., Belch J.F., Wilson M., Mehta Z., Meade T.W. Short-term effects of daily aspirin on cancer incidence, mortality, and nonvascular death: analysis of the time course of risks and benefits in 51 randomised controlled trials. Lancet. 2012;379:1602–12.

39. Cuzick J., Thorat M.A., Bosetti C., Brown P.H., Burn J., Cook N.R., Ford L.G., Jacobs E.J., Jankowski J.A., La Vecchia C., Law M., Meyskens F., Rothwell P.M., Senn H.J., Umar A. Estimates of benefits and harms of prophylactic use of aspirin in the general population. Ann. Oncol. 2015;26:47–57.

40. Bibbins-Domingo K. Aspirin use for the primary prevention of cardiovascular disease and colorectal cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann. Intern. Med. 2016;164:836–46.

41. Ikeda Y., Shimada K., Teramoto T., Uchiyama S., Yamazaki T., Oikawa S., Sugawara M., Ando K., Murata M., Yokoyama K., Ishizuka N. Low-dose aspirin for primary prevention of cardiovascular events in Japanese patients 60 years or older with atherosclerotic risk factors: a randomized clinical trial. JAMA. 2014;312:2510–20.

42. Guirguis-Blake J.M., Evans C.V., Senger C.A., O’Connor E.A., Whitlock E.P. Aspirin for the primary prevention of cardiovascular events: a systematic evidence review for the U.S. Preventive Services Task Force. Ann. Intern. Med. 2016;164:804–13.

43. Chubak J., Whitlock E.P., Williams S.B., Kamineni A., Burda B.U., Buist D.S., Anderson M.L. Aspirin for the prevention of cancer incidence and mortality: systematic evidence reviews for the U.S. Preventive Services. Ann. Intern. Med. 2016;164:814–25.


Об авторах / Для корреспонденции


Автор для связи: П.С. Лагута – к.м.н., науч. сотр. лаборатории клинических проблем атеротромбоза, Институт клинической кардиологии им. А.Л. Мясникова, Российский кардиологический научно-производственный комплекс Минздрава РФ, Москва; тел. 8 (495) 414-62-99, e-mail: pavellaguta@yandex.ru


Похожие статьи


Бионика Медиа