Cardiovascular Protection of Aspirin in Chronic Kidney Disease Patients: An Updated Systematic Review and Meta-Analysis.

IF 2.8 3区医学 Q2 PERIPHERAL VASCULAR DISEASE Current vascular pharmacology Pub Date : 2024-01-01 DOI:10.2174/1570161121666230530154647

Ting Chen, Yunlei Deng, Rong Gong

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Abstract

Purpose: To evaluate aspirin's cardiovascular (CV) protective effect in chronic kidney disease (CKD) patients.

Methods: We searched PubMed, Embase, Cochrane Library, and Web of Science (up to December 2022) for randomized controlled trials (RCTs) and observational studies comparing aspirin with placebo in CKD patients for the prevention of CV disease (CVD). Efficacy outcomes included CVD, heart failure, myocardial infarction, stroke, CV and all-cause mortality; safety outcomes included major bleeding, minor bleeding, and renal events.

Results: Six RCTs and 6 observational studies, including 35,640 participants, met the inclusion criteria and reported relevant CV outcomes, with a mean follow-up of 46.83 months. The pooled data showed aspirin had no significant preventive effect on CVD events (RR=1.03; 95% CI, 0.84-1.27). However, CV mortality was significantly reduced in the aspirin group (RR=0.74; 95% CI, 0.58-0.95). Furthermore, aspirin use did not increase the risk of major bleeding and renal events but significantly increased minor bleeding events (RR=2.11; 95% CI, 1.30-3.44). Renal events were significantly increased after sensitivity analysis (RR=1.10; 95% CI, 1.04-1.16).

Conclusion: Aspirin did not prevent CV events, with a significantly increased risk of minor bleeding and renal events. Besides, aspirin use had no statistically significant reduction in the risk of all-cause mortality but had a statistically significant reduction in the risk of CV mortality.

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阿司匹林对慢性肾病患者心血管的保护作用：最新系统综述和元分析。

目的：评估阿司匹林对慢性肾脏病（CKD）患者心血管（CV）的保护作用：我们检索了 PubMed、Embase、Cochrane 图书馆和 Web of Science（截至 2022 年 12 月）上的随机对照试验 (RCT) 和观察性研究，比较了阿司匹林和安慰剂对慢性肾脏病患者预防心血管疾病 (CVD) 的作用。疗效结果包括心血管疾病、心力衰竭、心肌梗死、中风、心血管疾病和全因死亡率；安全性结果包括大出血、小出血和肾脏事件：有 6 项研究性临床试验和 6 项观察性研究（包括 35,640 名参与者）符合纳入标准，并报告了相关的 CV 结果，平均随访时间为 46.83 个月。汇总数据显示，阿司匹林对心血管事件没有明显的预防作用（RR=1.03；95% CI，0.84-1.27）。不过，阿司匹林组的心血管疾病死亡率明显降低（RR=0.74；95% CI，0.58-0.95）。此外，使用阿司匹林不会增加大出血和肾脏事件的风险，但会显著增加轻微出血事件的风险（RR=2.11；95% CI，1.30-3.44）。经过敏感性分析后，肾脏事件明显增加（RR=1.10；95% CI，1.04-1.16）：结论：阿司匹林不能预防心血管事件，但会显著增加轻微出血和肾脏事件的风险。结论：阿司匹林并不能预防心血管事件的发生，反而会大大增加轻微出血和肾脏事件的风险。此外，使用阿司匹林并不能在统计学上显著降低全因死亡的风险，但在统计学上却能显著降低心血管死亡的风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current vascular pharmacology 医学-外周血管病

CiteScore

9.20

自引率

4.40%

发文量

审稿时长

6-12 weeks

期刊介绍： Current Vascular Pharmacology publishes clinical and research-based reviews/mini-reviews, original research articles, letters, debates, drug clinical trial studies and guest edited issues to update all those concerned with the treatment of vascular disease, bridging the gap between clinical practice and ongoing research. Vascular disease is the commonest cause of death in Westernized countries and its incidence is on the increase in developing countries. It follows that considerable research is directed at establishing effective treatment for acute vascular events. Long-term treatment has also received considerable attention (e.g. for symptomatic relief). Furthermore, effective prevention, whether primary or secondary, is backed by the findings of several landmark trials. Vascular disease is a complex field with primary care physicians and nurse practitioners as well as several specialties involved. The latter include cardiology, vascular and cardio thoracic surgery, general medicine, radiology, clinical pharmacology and neurology (stroke units).