表 3.
阿司匹林用于心血管病一级预防不同策略的效果、安全性及净获益比较
Comparisons of effectiveness, safety and net benefit by different strategies with aspirin treatment for primary prevention of cardiovascular diseases
| Items | Strategy ① vs. Strategy 0 | Strategy ② vs. Strategy 0 | Strategy ③ vs. Strategy 0 | Strategy ① vs. Strategy ② | Strategy ③ vs. Strategy ① | Strategy ③ vs. Strategy ② |
| * The defined events include MI, IS, HS and GIB; Strategy 0: usual care for comparison; Strategy ①: aspirin treatment for Chinese adults aged 40-69 with a high 10-year cardiovascular risk, recommended by the 2020 Chinese Guideline on the Primary Prevention of Cardiovascular Diseases; Strategy ②: aspirin treatment for Chinese adults aged 40-59 with a high 10-year cardiovascular risk, recommended by the 2022 United States Preventive Services Task Force Recommendation Statement on Aspirin Use to Prevent Cardiovascular Disease; Strategy ③: aspirin treatment for Chinese adults aged 40-69 with a high 10-year cardiovascular risk and blood pressure well-controlled (< 150/90 mmHg), recommended by the 2019 Guideline on the Assessment and Management of Cardiovascular Risk in China. QALY, quality-adjusted life year; MI, myocardial infarction; IS, ischemic stroke; HS, hemorrhagic stroke; GIB, gastrointestinal bleeding; NNT, number needed to treat; NNH, number needed to harm. | ||||||
| Total numbers for assessment | 212 153 | 212 153 | 212 153 | |||
| Total numbers for aspirin treatment | 34 235 | 2 813 | 25 111 | |||
| Life years gained | 67 (-33, 147) | 2 (-7, 10) | 278 (191, 317) | 65 (-27, 138) | 211 (158, 236) | 276 (197, 307) |
| QALY gained | 329 (84, 509) | 12 (1, 26) | 403 (222, 511) | 317 (89, 484) | 74 (0, 140) | 391 (227, 486) |
| Ischemic events could be prevented | 368 (257, 427) | 19 (13, 22) | 260 (183, 300) | 349 (244, 405) | -108 (-127, -73) | 241 (170, 278) |
| MI events could be prevented | 27 (8, 40) | 1 (0, 2) | 19 (6, 28) | 26 (7, 38) | -8 (-13, -1) | 18 (6, 26) |
| IS events could be prevented | 341 (234, 400) | 18 (12, 21) | 241 (168, 281) | 323 (222, 380) | -100 (-119, -67) | 223 (156, 260) |
| Bleeding events would be added | 107 (52, 156) | 8 (4, 12) | 70 (32, 105) | 99 (48, 144) | -37 (-51, -20) | 62 (28, 93) |
| HS events would be added | 87 (32, 135) | 7 (3, 11) | 60 (22, 95) | 80 (30, 125) | -27 (-40, -10) | 53 (20, 84) |
| GIB events would be added | 20 (12, 29) | 1 (1, 2) | 10 (6, 14) | 19 (12, 27) | -10 (-14, -7) | 9 (5, 12) |
| Numbers of net benefit | 261 (143, 337) | 11 (4, 16) | 190 (108, 242) | 250 (139, 322) | -71 (-96, -35) | 179 (104, 226) |
| Deaths from defined events* | 6 (-8, 18) | 0 (-1, 1) | 15 (4, 23) | 6 (-7, 18) | 9 (5, 12) | 15 (6, 22) |
| All deaths could be prevented | 19 (-6, 39) | 1 (-1, 3) | 74 (52, 83) | 18 (-5, 36) | 55 (42, 61) | 73 (53, 81) |
| NNT per ischemic event | 93 (80, 133) | 148 (128, 214) | 97 (84, 137) | -55 (-80, -48) | 4 (3, 4) | -51 (-77, -45) |
| NNH per bleeding event | 320 (219, 660) | 352 (231, 716) | 359 (239, 789) | -32 (-58, -12) | 39 (19, 132) | 7 (6, 74) |
| NNT per net benefit | 131 (102, 239) | 256 (181, 737) | 132 (104, 232) | -125 (-506, -78) | 1 (-7, 3) | -124 (-514, -76) |