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阿斯匹林是成本效益最高的心脏病预防药物
这项研究发现，在疗效方面，低剂量的阿斯匹林与降胆固醇药物他汀类（statin）和法国药厂赛诺菲·圣德拉堡（Sanofi-Synthelabo）（SASY）产品名为Plavix的氯吡格雷（clopidogrel）血液稀释剂效果相仿，但价钱要低得多。
英格兰伯明翰大学的马歇尔（Tom Marshall）在《英国医学杂志》（British Medical Journal）上表示：“这项分析证实，在抗高血压治疗中，他汀类和氯吡格雷比阿斯匹林的成本效益比差。”
冠状动脉心脏病每年造成全球数以百万计的人丧生。上述的药物都可以有效地预防这种疾病，但其价格却有大幅差距。
根据马歇尔的计算，有10%心脏病罹患率的人，使用五年阿斯匹林做预防的费用约为3,500英镑（5,946美元），而使用降血压药物的费用为18,300英镑，而使用氯吡格雷和辛伐他汀（simvastatin）的费用分别是60,000英镑和61,400英镑。降胆固醇药物辛伐他汀系默克（Merck）（MRK）所生产，商品名为舒降之（Zocor）。
目前未能取得各药品生产商对此项研究的评论。
BMJ 2003;327:1264 (29 November)
Coronary heart disease prevention: insights from modelling incremental cost effectiveness
Tom Marshall
Department of Public Health and Epidemiology, University of Birmingham, Birmingham B15 2TT
Correspondence to: T Marshall, c/o Partners Healthcare, 1620 Tremont Street, Boston, MA 02120, USA T.P.Marshall@bham.ac.uk
Objective To determine which treatments for preventing coronary heart disease should be offered to which patients by assessing their incremental cost effectiveness. Design Modelling study Data sources Cost estimates (for NHS) and estimates of effectiveness obtained for aspirin, antihypertensive drugs, statins and clopidogrel. Data synthesis Treatment effects were assumed to be independent, and cost per coronary event prevented was calculated for treatments individually and in combination across patients at a range of coronary risks. Results The most cost effective preventive treatments are aspirin, initial antihypertensive treatment (bendrofluazide and atenolol), and intensive antihypertensive treatment (bendrofluazide, atenolol and enalapril), whereas simvastatin and clopidogrel are the least cost effective (cost per coronary event prevented in a patient at 10% coronary risk over five years is ￡3500 for aspirin, ￡12 500 for initial antihypertensives, ￡18 300 for intensive antihypertensives, ￡60 000 for clopidogrel, and ￡61 400 for simvastatin). Aspirin in a patient at 5% five year coronary risk costs less than a fifth as much per event prevented (￡7900) as simvastatin in a patient at 30% five year risk (￡40 800). Discussion A cost effective prevention strategy would offer aspirin and initial antihypertensive treatment to all patients at greater than 7.5% five year coronary risk before offering statins or clopidogrel to patients at greater than 15% five year coronary risk. Incremental cost effectiveness analysis of treatments produces robust, practical cost effectiveness rankings that can be used to inform treatment guidelines.
screen.width-333)this.width=screen.width-333" width=440 height=307 title="Click to view full 100255mart.f1 (440 X 307)" border=0 align=absmiddle> 同时，又有研究表明切勿突然停用阿司匹林
法国新近公布的一项研究显示，突然停止服用阿司匹林可能导致心脏病发作。经调查因冠状动脉病症住院的1236名患者，发现有51人在停用阿司匹林后不到一周的时间内，出现了心脏病发作或不稳定的心绞痛等严重情况。而停用之前没有出现过类似症状。
阿司匹林在体内会分解产生水杨酸，与血小板中的环氧化酶结合，抑制血小板的聚集功能，起到抗血栓的作用。由于血小板在血循环中的生存期约为7天，故口服一次阿司匹林，其抗血小板作用的时间可持续5—7天。一旦突然停药，体内水杨酸的浓度降低，不能抑制血小板的聚集，抗凝血作用减弱，反而容易引起血栓形成，可能对心脏病患者造成危险。（医药养生保健报） [标签:content1][标签:content2]
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作者:admin@医学,生命科学 2011-07-05 05:52
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