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AHA 2021:长期、低剂量阿司匹林不影响2型糖尿病患者的痴呆风险

2021-11-17 Shirley MedSci原创

2021年11月15日在2021年美国心脏协会科学会议上发表的最新研究,每天服用低剂量阿司匹林长达7年并不影响2型糖尿病成人患者痴呆或智力衰退的风险。

2021年11月13日AHA大会于线上举行,是全球首屈一指的交流血管科学领域最新科学进展,研究和循证临床实践的一大盛会。根据11月15日,在2021年美国心脏协会科学会议上发表的最新研究,每天服用低剂量阿司匹林长达7年并不影响2型糖尿病成人患者痴呆或智力衰退的风险。

•经过7年的随访,平均每天服用低剂量阿司匹林不会影响成人2型糖尿病患者患痴呆症的风险。

•阿司匹林疗法对患痴呆症风险既无益处亦无危害。

•患痴呆症会使心脏病或卒中风险至少增加两倍。

根据美国心脏病学会/美国心脏协会2019年一级预防建议,无已知心血管疾病的成年人只有在心血管疾病风险最高且出血风险极低的情况下才应服用阿司匹林预防心脏病发作和卒中

美国预防服务工作组的最新指南草案也表示:不应每日服用低剂量阿司匹林用于无心血管疾病的成人预防的心血管疾病。但是,既往诊断为心血管疾病或既往发生心脏事件(如心脏病发作或卒中)的成年人,应遵医嘱继续每天服用小剂量阿司匹林。

研究内容

研究人员旨在评估入组ASCEND(糖尿病心血管事件研究)的受试者服用低剂量阿司匹林对痴呆和认知障碍风险的影响。ASCEND试验纳入超过15000名在英国生活的2型糖尿病成人患者,他们没有卒中、心脏病发作或其他循环问题的病史,并且在研究开始时没有痴呆。一半的受试者每天服用单一的100 mg阿司匹林,一半接受相应的安慰剂。这项研究对受试者进行了近九年的随访,包括平均约七年的治疗和约两年的额外随访。

在随访结束时,通过几种方法确定是否存在痴呆:认知功能测试(通过电话访谈进行认知状态和语言流畅性或健康心理测试);住院数据或死亡记录中列出的诊断;以及电子健康记录中列出的其他认知障碍指标。研究人员还关注了严重疾病、心脏病发作、卒中或严重内出血的发生。

研究人员发现,1146名受试者出现了“广义痴呆”,即痴呆、认知障碍、谵妄或意识混乱;他们服用了痴呆药物,或被转诊到记忆诊所或老年精神科。

“结果显示,每天服用低剂量阿司匹林对痴呆风险没有明显影响,风险降低的比例为9%,无显著性。然而,这9%获益的不确定性范围从痴呆风险降低19%到增加2%不等。这是令人欣慰的,对于全球数百万定期服用阿司匹林以预防心脏病发作和卒中风险的人来说,几乎不会增加痴呆的风险。Armitage说:“结果显示,每日服用低剂量阿司匹林对痴呆风险可能有一定益处,但是,我们需要对更多发生痴呆的患者进行研究。”

然而,研究人员确实发现,严重的血管事件如心脏病发作或大出血事件入卒中与痴呆相关,在研究期间, 990名受试者在一次严重血管事件中存活,496名受试者在一次大出血中幸存。

  • 与未发生重大血管事件的受试者相比,发生重大血管事件的受试者在研究期间发生痴呆、记忆丧失、意识模糊或智力下降的可能性几乎高出2.5倍。
  • 大出血者出现痴呆、记忆丧失、意识模糊或智力下降的可能性是未出血者的两倍。

该研究的一个局限性是可能没有足够的痴呆病例来明确评估每日低剂量阿司匹林对患痴呆风险的影响。“更多痴呆病例的大规模研究可能有助于发现所有益处或危害。我们计划继续对受试者进行几年随访,以观察是否会出现更多的痴呆病例,”Armitage说。

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    2021-11-19 zhaohui6731
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    2021-11-17 neuro.Dr

    老年性痴呆,未来还是希望借助神经电生理吧,也许更为有效!

    0

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