Aspirin is not a god drug, no indication of abuse may be "deadly"

According to a recent analysis, if people without cardiovascular disease take a small dose of aspirin (75 ‰ - 100 ‰) every day, the risk of intracranial hemorrhage will increase significantly, especially in Asians and those with emaciationThe study was published in the journal Neurology, a sub Journal of JAMACan aspirin be used? Who is available? How to use it? < br / > the benefits of primary prevention are questioned < br / > before answering these questions, it is necessary to understand what "primary prevention" and "secondary prevention" areLiu Zhijun, chief pharmacist of the Pharmaceutical Department of Beijing Anzhen Hospital Affiliated to Capital Medical University, told Science and Technology Daily that the first level prevention is to take measures to reduce the causes or pathogenic factors before the disease occurs; the second level prevention is to take measures to slow down the development or recurrence of the disease, including early detection, early diagnosis and early treatment< br / > in addition, the balance of benefits and risks is indispensable to measure the quality of drugsBenefit refers to the efficacy of drugs, and risk refers to the adverse reactions of drugsAll drugs approved for sale have curative effects and adverse reactions"Aspirin can relieve fever, relieve pain, anti-inflammatory and antithrombotic, but it also has side effects such as bleeding, increasing gastric acid secretion and causing gastric erosion." Sun Yong'an, chief physician of Neurology Department of Peking University First Hospital, told Science and technology daily< br / > Liu said< br / > according to the new guidelines for cardiovascular disease prevention in the United States, the vast majority of people should not use aspirin for primary prevention of cardiovascular diseaseIt is only recommended that people aged 50-70 with high risk of cardiovascular disease and low risk of bleeding should use small doses< br / > in fact, we used to give advice to patients according to strict standardsAspirin was not a god drug Sun said< br / > the three major studies triggered drug disputes < br / > Liu Zhijun told reporters that the reason why aspirin was so controversial was related to the three major studies disclosed in 2018The first is the ascend study, which is carried out in the diabetic population75% of patients use statins (statins themselves directly inhibit the production of "bad cholesterol", delay the occurrence of atherosclerotic cardiovascular and cerebrovascular diseases, and "reduce" the benefits of aspirin treatment in these populations)< br / > in addition, these patients did not exclude the high-risk group of bleeding, and aspirin was given for preventionHowever, the primary prevention of aspirin still has the benefit of reducing the incidence of cardiovascular and cerebrovascular events, but at the same time increasing the risk of bleeding< br / > Liu said< br / > the second study is ARI VE, which includes people with low risk of cardiovascular and cerebrovascular events, that is, under normal circumstances, even if not prevented, the risk of cardiovascular and cerebrovascular events is very lowThe study found that these groups did not benefit significantly from aspirin prophylaxis"The biggest revelation of this study is that the high-risk population of cardiovascular and cerebrovascular diseases is suitable for primary prevention of aspirin, not all people." Liu Zhijun stressed< br / > the third study was ASPREE, which included healthy elderly people and did not consider cardiovascular and cerebrovascular risksTo this end, Liu Zhijun said bluntly: "this study is to observe the effect of aspirin application on the death, dementia or persistent physical disability of healthy elderly people, not a strictly primary prevention of cardiovascular and cerebrovascular diseases." < br / > there is no doubt about the role of secondary prevention < br / > nevertheless, there is no doubt about the significance and important role of aspirin in secondary prevention of cardiovascular and cerebrovascular diseases Liu stressed that if you want to prolong your life and improve the quality of life, lifelong prevention of aspirin is necessaryThe premise is that the patient does not have aspirin contraindications< br / > moreover, the results of randomized controlled trials based on European and American populations can not fully represent the actual situation in ChinaIn recent 30 years, the trend of population aging has intensified in ChinaThe prevention and control situation of atherosclerotic cardiovascular and cerebrovascular diseases is very severeThe prevalence rate, incidence rate and mortality rate of cardiovascular diseases are still increasingThis brings heavy burden to society, economy and health careAccording to China cardiovascular report 2016, there are about 290 million cardiovascular patients in China, including 270 million hypertension, 11 million myocardial infarction and 15 million stroke< br / > according to the results of the evaluation of the medical results of coronary heart disease and clinical transformation research in China, among the 1.7 million adults aged 35-75 in 31 provinces of China, the high-risk population of atherosclerotic cardio cerebrovascular disease accounts for 9.5%, but the primary prevention rate of aspirin and statins is only 2.4% and 0.6%, far lower than that of the high-risk population in the United States in the same period< br / > At present, a box of original aspirin enteric coated tablets (30 tablets) costs 15.4 yuan, can be taken for 30 days, with an average of 5 cents per day If used in the right high-risk population, it can significantly reduce the incidence of ischemic cardio cerebrovascular disease " Liu said < br / > to use, we need to strictly grasp the indications < br / > so which people are the right people for primary prevention of aspirin? < br / > Therefore, we should strictly grasp the indications and not use them at will " Liu Zhijun said < br / > according to sun Yongan, age, race, male, diabetes, smoking and hypertension are all related to the occurrence of ischaemic cardiovascular and cerebrovascular disease, and these factors are recognized as risk factors of cardiovascular and cerebrovascular events That is to say, under the same hemorrhagic risk, the greater the risk of cardiovascular and cerebrovascular events, the greater the benefit of aspirin treatment, and the greater the risk of bleeding "Primary prevention with aspirin is meaningful when the benefits of preventing cardiovascular and cerebrovascular events significantly outweigh the risk of bleeding." Sun Yongan stressed < br / > therefore, when aspirin is used for primary prevention of atherosclerotic cardiovascular disease, it is necessary to weigh the benefits (reducing major cardiovascular events) and risks (increasing bleeding, gastrointestinal discomfort, etc.) < br / > if the primary prevention of aspirin is needed, it is still necessary to go to a large regular hospital for professional doctor evaluation "Based on evidence-based medical evidence and clinical experience, doctors will give advice on whether to use, dosage, precautions, etc There are established standards to determine whether aspirin can be used, but more attention should be paid to the individualization of patients There is no answer that is black or white " Sun said < br / > "it is important to remember that self medication is not optional, as there have been several studies that suggest that aspirin abuse for primary prevention increases the risk of bleeding." Liu Zhijun reminded < br / > related links < br / > who can use aspirin for primary prevention < br / > there are two points to be grasped in primary prevention of aspirin: one is the high-risk group of ischemic cardio cerebrovascular disease; the other is the low-risk group of bleeding According to China's guidelines for cardiovascular disease prevention (2017) and clinical application of aspirin in atherosclerotic cardiovascular disease: consensus of Chinese experts (2019 update) (to be published): people aged 70 years or over or under 50 years, people with high bleeding risk, and patients with assessed bleeding risk greater than thrombus risk should not be given aspirin level 1 pre-treatment Prevention < br / > the following high-risk groups of atherosclerotic cardiovascular disease may consider taking low-dose aspirin for primary prevention, provided that the benefit bleeding risk ratio of patients is evaluated first, and preventive drugs are taken with the consent of patients If the patient is positive for Helicobacter pylori, it is recommended to eradicate before prevention < br / > ① 50-69 year old adults with expected ASCVD risk ≥ 10% in 10 years; < br / > ② hypertensive patients, 50-69 years old, blood pressure under control, with at least 2 other major risk factors *; < br / > ③ diabetic patients, 50-69 years old, with at least 2 other major risk factors *; < br / > ④ adults 50-69 years old who do not meet the above conditions, with at least 2 major risk factors *, And the coronary artery calcification score ≥ 100 or non obstructive coronary artery stenosis < 50% < br / > * the main risk factors include: hypertension, diabetes, dyslipidemia, smoking, family history of early cardiovascular and cerebrovascular diseases (male < 55 years old, female < 65 years old), obesity