Aspirin在糖尿病對於心臟血管疾病初級預防的新進展

New Development of Aspirin for the Primary Prevention of Cardiovascular Events in People with Diabetes

溫旻杰(Min-Jie Wen) ； 蘇聖強(Sheng-Chiang Su) ； 何志聰(Chih-Tsueng He)

《內科學誌》 21卷4期 (2010/08) Pp. 235-242

https://doi.org/10.6314/JIMT.2010.21(4).01

摘要

在心臟血管疾病中，糖尿病是大家所熟知的主要危險因子，雖然Aspirin已經是臨床使用上相當普遍的藥物，在糖尿病對於冠心病的次級預防已經有很強的證據來加以佐證，但是直接針對糖尿病病患的初級預防方面直到最近兩年才有The Prevention of Progression of Arterial Disease and Diabetes (POPADAD) Trial、Japanese Primary Prevention of Atherosclerosis with Aspirin for Diabetes (JPAD) Trial、The Fremantle Diabetes Study、以及香港Leung等人多個的大型臨床試驗被發表出來。雖然POPADAD及JPAD研究中並沒有發現aspirin在降低心臟血管疾病風險具有統計學意義，但是在The Fremantle Diabetes Study中便可以發現，aspirin在降低所有原因死亡及心臟血管疾病死亡為獨立的相關因子，且在子群分析中可以發現在大於65歲的病人以及男性，aspirin亦可以是降低所有原因死亡的獨立預測因子，在香港Leung等人的研究中卻發現aspirin不但沒有減少血管事件發生反而增加其傷害比率。在關於aspirin所產生的出血併發症方面，雖然發現aspirin可以增加出血的機率，但其所佔的比率並不算高，在所有原因死亡上亦沒有達到統計學上的意義，而香港Leung等人研究中卻發現aspirin可以增加腸胃道出血的機率，並達到統計學意義。因此，低劑量的aspirin對於糖尿病之心臟血管疾病的初級預防，雖然在某部分有正面的幫助，但考慮其仍然有出血的風險，所以建議依病患有無腸胃道出血病史及所含心血管疾病風險因子多寡分別考量使用，使病人獲得最大的益處。

關鍵字

Aspirin ； 糖尿病 ； 心臟血管事件 ； 死亡率

並列摘要

Diabetes is well known to be the major risk factor of cardiovascular disease (CVD). The clinical use of aspirin is already quite common in diabetes for secondary prevention of coronary heart disease under much strong evidence being corroborated. In recent two years, there were several large-scale clinical trials published for the clinical use of aspirin directly to diabetic patients in primary prevention. Although there was no statistically significant data of aspirin in reducing the risk of CVD, aspirin was an independent associated factor in reducing all-cause mortality and CVD mortality reported in the Fremantle Diabetes Study (FDS). Aspirin was also an independent associated factor in reducing all-cause mortality in the subgroup analysis of more than 65-year-old patient, as well as men in the FDS. But in the study of Leung et al. in Hong Kong, aspirin had not only failed to reduce vascular events but also increased their hazard ratio. Although aspirin could increase the chance of bleeding, the risk was not high, and the all-cause mortality didn't reach the statistical significance, neither. Otherwise, in the study of Leung et al., aspirin could increase the chance of gastrointestinal bleeding, and reached statistical significance. Therefore, the low-dose aspirin for primary prevention of CVD in diabetic patients has a certain part of the positive help, but there is still the risk of bleeding. It is proposed to do in accordance with the use of patients with the number of risk factor of CVD and previous history of gastrointestinal bleeding, in which patients receive the maximum benefits.

並列關鍵字

Aspirin ； Diabetes ； Cardiovascular events ； Mortality