{"title":"阿司匹林在初级心血管预防中的作用:硬币的两面和治疗所需数量的重要性:一项系统回顾和荟萃分析。","authors":"Gilberto Vizcaino, Jesús Weir Medina","doi":"10.54817/ic.v64n3a011","DOIUrl":null,"url":null,"abstract":"Aspirin has been an essential treatment for the primary preven-tion of cardiovascular diseases (CVD). Several randomized controlled studies do not support the routine use of aspirin, mainly due to its association with bleed-ing risk. This systematic review aims to advocate aspirin prescription based on the Number Needed to Treat (NNT) and the Number Needed to Harm (NNH). This combination provides a good measure of the effort to avoid an unfavor-able outcome, weighed against possible associated risks. A search of random-ized studies on aspirin treatment was conducted in two separate periods. Four studies from 1988-1998 and six from 2001-2018 were included in the analysis (157,060 participants). The primary endpoint was a composite outcome of Non-fatal Myocardial Infarction (NFMI), Non-fatal Ischemic Stroke (NFIS), and CV mortality. Major bleeding was a safety endpoint. We calculated the Absolute Risk Reduction (ARR%), NNT, and NNH, alongside the Relative Risk (RR) and 95% CI of each primary endpoint. The results of all included studies (10) showed a net benefit with aspirin treatment for NFMI (NNT= 259) and the composite outcome (NNT=292) with a significant relative risk reduction of 20% (p=0.003; I2= 0%) and 10% (p<0.001; I2= 0%), respectively. There was a relevant 60% in-crease in the bleeding risk (p<0.0001, NNH=208; I2= 3%). The NNT and NNH may constitute measures of efficacy and risk in clinical shared decision-making. However, it is essential to consistently establish that patients’ benefit-risk should be individualized and not represent a clinical guide for everyone.","PeriodicalId":14514,"journal":{"name":"Investigacion clinica","volume":" ","pages":""},"PeriodicalIF":0.1000,"publicationDate":"2023-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Aspirin in primary cardiovascular prevention: the two faces of the coin and the importance of the Number Needed to Treat: a systematic review and meta-analysis.\",\"authors\":\"Gilberto Vizcaino, Jesús Weir Medina\",\"doi\":\"10.54817/ic.v64n3a011\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Aspirin has been an essential treatment for the primary preven-tion of cardiovascular diseases (CVD). Several randomized controlled studies do not support the routine use of aspirin, mainly due to its association with bleed-ing risk. This systematic review aims to advocate aspirin prescription based on the Number Needed to Treat (NNT) and the Number Needed to Harm (NNH). This combination provides a good measure of the effort to avoid an unfavor-able outcome, weighed against possible associated risks. A search of random-ized studies on aspirin treatment was conducted in two separate periods. Four studies from 1988-1998 and six from 2001-2018 were included in the analysis (157,060 participants). The primary endpoint was a composite outcome of Non-fatal Myocardial Infarction (NFMI), Non-fatal Ischemic Stroke (NFIS), and CV mortality. Major bleeding was a safety endpoint. We calculated the Absolute Risk Reduction (ARR%), NNT, and NNH, alongside the Relative Risk (RR) and 95% CI of each primary endpoint. The results of all included studies (10) showed a net benefit with aspirin treatment for NFMI (NNT= 259) and the composite outcome (NNT=292) with a significant relative risk reduction of 20% (p=0.003; I2= 0%) and 10% (p<0.001; I2= 0%), respectively. There was a relevant 60% in-crease in the bleeding risk (p<0.0001, NNH=208; I2= 3%). The NNT and NNH may constitute measures of efficacy and risk in clinical shared decision-making. However, it is essential to consistently establish that patients’ benefit-risk should be individualized and not represent a clinical guide for everyone.\",\"PeriodicalId\":14514,\"journal\":{\"name\":\"Investigacion clinica\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":0.1000,\"publicationDate\":\"2023-08-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Investigacion clinica\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.54817/ic.v64n3a011\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"MEDICINE, RESEARCH & EXPERIMENTAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Investigacion clinica","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.54817/ic.v64n3a011","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"MEDICINE, RESEARCH & EXPERIMENTAL","Score":null,"Total":0}
Aspirin in primary cardiovascular prevention: the two faces of the coin and the importance of the Number Needed to Treat: a systematic review and meta-analysis.
Aspirin has been an essential treatment for the primary preven-tion of cardiovascular diseases (CVD). Several randomized controlled studies do not support the routine use of aspirin, mainly due to its association with bleed-ing risk. This systematic review aims to advocate aspirin prescription based on the Number Needed to Treat (NNT) and the Number Needed to Harm (NNH). This combination provides a good measure of the effort to avoid an unfavor-able outcome, weighed against possible associated risks. A search of random-ized studies on aspirin treatment was conducted in two separate periods. Four studies from 1988-1998 and six from 2001-2018 were included in the analysis (157,060 participants). The primary endpoint was a composite outcome of Non-fatal Myocardial Infarction (NFMI), Non-fatal Ischemic Stroke (NFIS), and CV mortality. Major bleeding was a safety endpoint. We calculated the Absolute Risk Reduction (ARR%), NNT, and NNH, alongside the Relative Risk (RR) and 95% CI of each primary endpoint. The results of all included studies (10) showed a net benefit with aspirin treatment for NFMI (NNT= 259) and the composite outcome (NNT=292) with a significant relative risk reduction of 20% (p=0.003; I2= 0%) and 10% (p<0.001; I2= 0%), respectively. There was a relevant 60% in-crease in the bleeding risk (p<0.0001, NNH=208; I2= 3%). The NNT and NNH may constitute measures of efficacy and risk in clinical shared decision-making. However, it is essential to consistently establish that patients’ benefit-risk should be individualized and not represent a clinical guide for everyone.