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To maximise the excess of benefit over hazard in primary prevention, most current guidelines3–5 recom- mend that aspirin be given to those with risk of coronary heart disease exceeding a particular threshold. These guidelines implicitly assume, however, either that the absolute risk of bleeding remains approximately constant irrespective of risk of coronary heart disease,4,5 or that it depends solely on age,3 whereas the present analyses showed that other risk factors for this disease are also risk factors for bleeding (table 3). As a result, even for people at moderately increased risk of coronary heart disease, the major absolute benefits and hazards of adding aspirin to a statin-based primary prevention regimen could still be approximately evenly balanced, as is suggested by the calculations in figure 7. A non-fatal stroke or heart attack is more likely to result in long-term disability than is a non-fatal gastrointestinal (or other extracranial) bleed, but in primary prevention the net absolute reduction in disabling or fatal occlusive events is likely to be small, and at least partially offset by a small increase in serious intracranial and extracranial bleeds. Thus, although it might cost little to add aspirin to any other drugs that are being used for the primary prevention of vascular disease, the additional effectiveness against fatal or disabling outcomes has not been reliably demonstrated for men or women of any age who do not yet have any relevant disease (and, if effectiveness is uncertain then detailed estimates of cost-effectiveness29 are of limited relevance). Moreover, drug safety (like vaccine safety) is of particular importance in public health recommendations for large, apparently disease-free populations; there should be good evidence that benefits exceed risks by an appropriate margin. Hence, although the currently available trial results could well help inform personally appropriate judgments by individuals about their own use of long-term aspirin, they do not seem to justify general guidelines advocating the routine use of aspirin in all apparently healthy individuals above a moderate level of risk of coronary heart disease.3–8 Contributors All members of the writing committee contributed to the collection or analysis of the data, or both, to the interpretation of the results, and to the preparation of the report. |
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zap65535(金币+0,VIP+0):质量不达标 12-23 22:51
zap65535(金币+1,VIP+0):抱歉，失误。很好的翻译。 12-23 22:53
zap65535(金币+0,VIP+0):已经做了说明，翻译得没问题，原文比较难理解。抱歉。 12-24 16:54
sunnymin(金币+15,VIP+0):10 12-24 19:31
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zap65535(金币+0,VIP+0):质量不达标 12-23 22:51
zap65535(金币+1,VIP+0):抱歉，失误。很好的翻译。 12-23 22:53
zap65535(金币+0,VIP+0):已经做了说明，翻译得没问题，原文比较难理解。抱歉。 12-24 16:54
sunnymin(金币+15,VIP+0):10 12-24 19:31
sunnymin(金币+3,VIP+0): 12-24 19:32
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为了在初期防护工作中使超越危险的益处最大化，当前大部分指导方针建议对有冠心病风险的病人给予阿司匹林来度过特殊的开始阶段。然而，这些指导方针也含蓄认为，出血的绝对风险与冠心病风险无关而保持一个近似的常数，要么出血的风险仅取决于年龄因素。然而目前的分析表明，这种疾病的其他风险性因素也会导致出血的发生（表3）因此，即使对于一个有患有适度增加冠心病风险的病人来说，向以抑制素为基础的主要预防体系中加入阿司匹林，它的绝对利处和存在的风险大约是持平的。这点可以从图7中计算得出。 非致命的打击或者心脏病发作相对于肠胃（或其他颅外）的出血更可能导致长期残疾。但是在初期预防中，残疾的净绝对减少值以及致命性闭塞的事件可能会减少，至少...... 写作委员会的所有成员对于数据的收集及分析都作出了贡献，或者说他们在结果的解释及报告准备方面给予了帮助。 |
2楼2009-12-19 16:42:30
tianyu4683
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3楼2009-12-19 21:46:18
