糖尿病患者的抗栓治疗ppt课件.pptVIP

既往中国指南并没有单独的抗血小板章节，2008中国指南首次将抗血小板治疗单独列为一个章节，进一步强调抗血小板治疗的重要性。其一级预防推荐和美国ADA2007年指南类似。 2007年一项长达24年（截至到2004年）的随访研究－护士健康研究中期报告发布，79439例30－55岁美国注册健康女护士，问卷调查，随访24年结果年显示阿司匹林长期使用，可是全因死亡风险降低25％，心血管死亡、冠心病死亡和卒中死亡风险降低38％，显示长期应用阿司匹林，持续获益. 该试验目前仍在继续，最长的随访时间已经达到31年。 Background: The influence of long-term use of aspirin on total mortality in women remains uncertain.Methods: We conducted a prospective, nested, casecontrol study of 79 439 women enrolled in the Nurses’ Health Study who had no history of cardiovascular disease or cancer. Women provided data on medication use biennially since 1980. We assessed relative risk (RR) of death according to aspirin use before diagnosis of incident cardiovascular disease or cancer and during the corresponding period for each control subject. Results: During 24 years, we documented 9477 deaths from all causes. In women who reported current aspirin use, the multivariate RR of death from all causes was 0.75(95% confidence interval, 0.71-0.81) compared with women who never used aspirin regularly. The risk reduction was more apparent for death from cardiovascular disease (RR, 0.62; 95% confidence interval, 0.55-0.71) than for death from cancer (RR, 0.88; 95% confidence interval0.81-0.96). Use of aspirin for 1 to 5 years was associated with significant reductions in cardiovascular mortality (RR, 0.75; 95% confidence interval, 0.61-0.92). In contrast, a significant reduction in risk of cancer deaths was not observed until after 10 years of aspirin use (Plinear trend=.005). The benefit associated with aspirin was confined to low and moderate doses and was significantly greater in older participants (Pinteraction.001) and those with more cardiac risk factors (Pinteraction=.02). Conclusions: In women, low to moderate doses of aspirin are associated with significantly lower risk of allcause mortality, particularly in older women and those with cardiac risk factors. A significant benefit is evident within 5 years for cardiovascular disease, whereas a mod