Primäre Prävention kardiovaskulärer Erkrankungen mit Acetylsalicylsäure

Zusammenfassung

Hintergrund und Fragestellung: Der Nutzen einer Therapie mit Acetylsalicylsäure in der Sekundärprävention kardiovaskulärer Erkrankungen gilt als gesichert, ein protektiver Effekt einer Primärprävention wird kontrovers diskutiert. Es stellt sich daher die Frage, ob eine medikamentöse Therapie mit Acetylsalicylsäure bei Patienten ohne bekannte kardiovaskuläre Vorerkrankung zu einer Reduktion der Gesamtsterblichkeit und/oder der kardiovaskulären Ereignisse führt.

Methode: Unter dieser Fragestellung führten wir eine systematische Literaturrecherche nach randomisierten kontrollierten Studien und Metaanalysen durch.

Ergebnis: Wir fanden sechs relevante Einzelstudien und drei Metaanalysen. Die Validität dreier Einzelarbeiten und damit auch der Metaanalysen war durch Einschluss von Patienten mit bekannten kardiovaskulären Vorerkrankungen eingeschränkt.

Die Gabe von Acetylsalicylsäure führte weder zu einer statistisch signifikanten Reduktion der Gesamtmortalität, noch der kardiovaskulären Mortalität.

Bei Männern scheint das Risiko eines nicht tödlichen Myokardinfarktes gesenkt zu werden (jährliche NNT ca. 670), ein entsprechender protektiver Effekt konnte für Frauen nicht nachgewiesen werden (mit Ausnahme von Frauen ³ 65 Jahre).

Eine signifikante Senkung des Schlaganfallrisikos wurde lediglich in der mit ausschließlich weiblichen Probanden durchgeführten WomenŽs Health Study gezeigt, der Effekt ist sehr gering (jährliche NNT ca. 3890). Ein entsprechender Nutzen für Männer scheint nicht zu bestehen.

Summary

Background and objective: Although the benefit of aspirin for patients with known cardiovascular disease is well established, the protective effect in primary prevention remains the subject of a controversial discussion. This meta-analsysis was undertaken to ascertain wheter a risk reduction regarding mortalitiy and/or cardiovascular events can be achievment with aspirin in persons without known cardiovascular disease?

Methods: A systematic literature search for randomized controlled trials and meta-analyses was done.

Results: Six relevant primary trials and three meta-analyses were found. The validity of three of the trials and thus also the meta-analyses was limited by inclusion of patients with known cardiovascular disease.

Therapy with aspirin showed no reduction in terms of overall mortality rate or rate of cardiovascular death.

In men the primary prevention with aspirin reduced the risk of a non-fatal myocardial infarction with an annual numbers needed to treat of about 670. There was no equivalent effect in women (except for women ³ 65 years).

A reduction of stroke events was only seen in the Women’s Health Study, which included only female participants. The effect was quite small, the annual numbers needed to treat were about 3890. An equivalent benefit for men was not proven in any of the other trials.

Conclusion: In view of the absence of life prolonging effect and no possibility of determining a definite risk group, that would have a special or accessory effect from a primary prevention with aspirin, there is no indication for such a scheme.

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