Aspirin has been shown to be effective for secondary prevention post myocardial infarction and stroke,¹ but there is uncertainty about its role in primary prevention populations, including those with cardiovascular risk factors (e.g. diabetes mellitus).² While a large number of the general population elect to take a daily aspirin for primary prevention of stroke,³ there is disagreement in current guidelines about the use of aspirin for primary prevention.⁴ The guidelines are based on interpretation of previous meta-analytic findings, which report a modest benefit for selected high risk patients, mostly related to a small absolute reduction in non-fatal myocardial infarctions in elderly patients, which is offset by an increased risk of major gastrointestinal and hemorrhagic stroke.⁵ The American Heart Association and American Stroke Association's guidelines on primary prevention of stroke give a moderate IIa recommendation for aspirin's use in primary prevention of stroke in high risk groups.⁶ A survey of U.S. adults between 45 and 75 years showed that, of the people taking aspirin, 81% were taking aspirin for primary prevention of cardiovascular disease. Two-thirds of these aspirin users reported stroke prevention as the primary indication.³

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阿司匹林用于无心血管疾病患者的中风的一级预防—荟萃分析

阿司匹林已被证明对心肌梗塞和中风后的二级预防有效，[ ^1]但其在一级预防人群中的作用尚不确定，包括那些有心血管危险因素（例如糖尿病）的人群。²虽然大量普通民众选择每天服用阿司匹林来预防中风，³但当前的指导原则中关于将阿司匹林用于主要预防方面存在分歧。⁴该指南基于对先前荟萃分析发现的解释，该发现报告了某些高危患者的适度获益，主要与老年患者非致命性心肌梗塞的绝对绝对值略有减少有关，但被重大风险的增加所抵消胃肠道出血性中风。⁵美国心脏协会和美国中风协会关于中风的一级预防的指南就高危人群中阿司匹林在一级中风的预防中给出了适度的IIa建议。⁶一项针对美国45至75岁成年人的调查显示，服用阿司匹林的人中有81％服用阿司匹林是心血管疾病的一级预防方法。这些阿司匹林使用者中有三分之二认为中风预防是主要适应症。³