russjcardiolРоссийский кардиологический журналRussian Journal of Cardiology1560-40712618-7620«SILICEA-POLIGRAF» LLCrussjcardiol-1476Research ArticleОБЗОРЫ ЛИТЕРАТУРЫREVIEWАСПИРИН В ПРОФИЛАКТИКЕ АТЕРОТРОМБОЗА И КОРОНАРНОЙ БОЛЕЗНИ СЕРДЦАASPIRIN IN THE PREVENTION OF ATHEROTHROMBOSIS AND CORONARY HEART DISEASEБубноваМ. Г.BubnovaM. G.

д.м.н, профессор кафедры доказательной медицины

mbubnova@gnicpm.ruФГУ Государственный научно-исследовательский Центр профилактической медицины Росмедтехнологии, МоскваRussian Federation20102808201004115121Copyright © Бубнова М.Г., 20102010Бубнова М.Г.Bubnova M.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://russjcardiol.elpub.ru/jour/article/view/1476

В представленном обзоре освещены основные вопросы, касающиеся применения аспирина в профилактике различных проявлений атеротромбоза и коронарной болезни сердца (КБС). Представлены данные, раскрывающие основной механизм действия аспирина, а также описаны другие положительные его эффекты, не связанные с антиагрегационной активностью препарата. Обозначены группы пациентов в первичной и вторичной профилактике, которым следует назначать аспирин в виде его доказанных в крупных исследования профилактических эффектах. В статье рассматриваются вопросы баланса клинической пользы аспирина к риску его приема.

 

 

 

 

This review is focused on the main aspects of aspirin therapy in the prevention of various atherothrombosis manifestations and coronary heart disease (CVD). The major mechanism of aspirin action is explained, and additional aspirin benefits, unrelated to its anti-aggregant activity, are described. Clinical groups in need for aspirin therapy, as a part of primary or secondary prevention, are specified, based on the evidence from large clinical trials. The benefits and risks of aspirin therapy are discussed.

атеротромбозкоронарная болезнь сердцааспиринпрофилактикаAtherothrombosiscoronary heart diseaseaspirinpreventionReferencesПанченко Е.П. Атеротромбоз: механизмы развития и реально проводимая терапия. Атеротромбоз 2008; 1: 22-26.Панченко Е.П. Атеротромбоз: механизмы развития и реально проводимая терапия. Атеротромбоз 2008; 1: 22-26.Weiss HJ, Aledort LM Impaired platelet/connective-tissue reaction in man after aspirin ingestion. Lancet 1967; II: 495-497.Weiss HJ, Aledort LM Impaired platelet/connective-tissue reaction in man after aspirin ingestion. Lancet 1967; II: 495-497.Vane JR Inhibition of prostaglandin synthesis as a mechanism of action of aspirin-like drug. Nature (New Biol) 1971; 231: 232-235.Vane JR Inhibition of prostaglandin synthesis as a mechanism of action of aspirin-like drug. Nature (New Biol) 1971; 231: 232-235.Smith JH, Willis AL. Aspirin selectively inhibits prostaglandin production in human platelets. Nature (New Biol) 1971; 231: 235-237.Smith JH, Willis AL. Aspirin selectively inhibits prostaglandin production in human platelets. Nature (New Biol) 1971; 231: 235-237.Cleland JGF. Fspirin, In D.L.Mann. Heart Failure 2004, Elsevier Inc.; 660-669.Cleland JGF. Fspirin, In D.L.Mann. Heart Failure 2004, Elsevier Inc.; 660-669.Grosser N, Schr der H. Aspirin Protects Endothelial Cells From Oxidant Damage Via the Nitric Oxide-cGMP Pathway. Arterios Thromb Vasc Biol 2003; 23: 1345-1348.Grosser N, Schr der H. Aspirin Protects Endothelial Cells From Oxidant Damage Via the Nitric Oxide-cGMP Pathway. Arterios Thromb Vasc Biol 2003; 23: 1345-1348.Jimenez AH et al Rapidity and duration of platelet suppression by enteric-coated aspirin in healthy young man. Am J Cardiol 1992; 69: 258-262.Jimenez AH et al Rapidity and duration of platelet suppression by enteric-coated aspirin in healthy young man. Am J Cardiol 1992; 69: 258-262.Antiplatelet Trialists`Collaboration. Collaborative overview of ran-domized of antiplatelet therapy: I Prevention of death, myocardial infarction, and stroke by prolonged anti-platelet in various categories of patients. BMJ 1994; 308: 81-106.Antiplatelet Trialists`Collaboration. Collaborative overview of ran-domized of antiplatelet therapy: I Prevention of death, myocardial infarction, and stroke by prolonged anti-platelet in various categories of patients. BMJ 1994; 308: 81-106.Juul-Moller S, Edvardsson N, Jahnmatz B. et al. Double-blind trial of aspirin in primary prevention of myocardial infarction in patients with chronic angina pectoris. Lancet 1992; 340: 1412-1425.Juul-Moller S, Edvardsson N, Jahnmatz B. et al. Double-blind trial of aspirin in primary prevention of myocardial infarction in patients with chronic angina pectoris. Lancet 1992; 340: 1412-1425.Collaborative meta-analysis of randomized of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002; 342: 71-86.Collaborative meta-analysis of randomized of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002; 342: 71-86.ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Randomized trail of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2, Lancet 1988; 2i: 349-360.ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Randomized trail of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2, Lancet 1988; 2i: 349-360.ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Short- and long-term risk reduction in vascular events with aspirin. Expert Rev Cardiovasc Ther 2008; 6(1): 95-107.ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Short- and long-term risk reduction in vascular events with aspirin. Expert Rev Cardiovasc Ther 2008; 6(1): 95-107.Панченко Е.П., Кропачева Е.С. Рекомендации по антитромботической терапии у больных со стабильными проявлениями атеротромбоза. Атеротромбоз 2009; 1 (2): 38-54.Панченко Е.П., Кропачева Е.С. Рекомендации по антитромботической терапии у больных со стабильными проявлениями атеротромбоза. Атеротромбоз 2009; 1 (2): 38-54.Sanmuganathan PS, Gharamani P, Jackson PR, et al. Aspirin for primary prevention of coronary heart disease: safety and absolute benefit related to coronary risk derived from meta-analysis of ran-domized trials. Heart 2001; 85: 265-271.Sanmuganathan PS, Gharamani P, Jackson PR, et al. Aspirin for primary prevention of coronary heart disease: safety and absolute benefit related to coronary risk derived from meta-analysis of ran-domized trials. Heart 2001; 85: 265-271.Hansson L, Zanchetti A, Carruthers S. et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomized trial. Lancet, 1998; 351: 1755-1762.Hansson L, Zanchetti A, Carruthers S. et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomized trial. Lancet, 1998; 351: 1755-1762.Ridker PM, Cook NR, Lee I-M., et al. A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women N Engl J Med 2005; 352: 1293-12304.Ridker PM, Cook NR, Lee I-M., et al. A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women N Engl J Med 2005; 352: 1293-12304.Calonge N, Petitti DB, DeWitt TG, et al. Aspirin for the Prevention of Cardiovascular Disease: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med 2009; 150: 396-404.Calonge N, Petitti DB, DeWitt TG, et al. Aspirin for the Prevention of Cardiovascular Disease: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med 2009; 150: 396-404.Lanas A. Cyclo-oxygenase-1/cyclo-oxygenase-2 non selective non-steroidal anti-inflammatory drugs: epidemiology of gastrointerstinal events. Dig Liver Dis 2002; 33 (Suppl.2): S29-S34.Lanas A. Cyclo-oxygenase-1/cyclo-oxygenase-2 non selective non-steroidal anti-inflammatory drugs: epidemiology of gastrointerstinal events. Dig Liver Dis 2002; 33 (Suppl.2): S29-S34.Raderick PJ, Wilkes HC, Meade TW. The gastrointestinal toxicity of aspirin: an overview of randomized controlled trials. Br J Clin Pharmacol 1993; 35: 219-226.Raderick PJ, Wilkes HC, Meade TW. The gastrointestinal toxicity of aspirin: an overview of randomized controlled trials. Br J Clin Pharmacol 1993; 35: 219-226.Patrono C., Coller B, Dalen J et al. Platelet-active drugs: the relationships among dose, effectiveness, and side effects. Sixth ACCP Consensus Conference on Antithrombotic Therapy. Chest, 2001; 119: 39S-63S.Patrono C., Coller B, Dalen J et al. Platelet-active drugs: the relationships among dose, effectiveness, and side effects. Sixth ACCP Consensus Conference on Antithrombotic Therapy. Chest, 2001; 119: 39S-63S.Рафальский В.В., Крикова А.В., Багликов А.Н. Особенности клинической фармакологии ацетилсалициловой кислоты как антитромботического препарата. Кардиоваскулярная терапия и профилактика, 2009; 8(7): 102-107.Рафальский В.В., Крикова А.В., Багликов А.Н. Особенности клинической фармакологии ацетилсалициловой кислоты как антитромботического препарата. Кардиоваскулярная терапия и профилактика, 2009; 8(7): 102-107.Yeomans N, Lanas A, Labenz J et al Efficacy of esomeprazole (20 mg once daily) for reducing the risk of gastroduodenal ulcers associated with continuous use of low-dose aspirin. Am J Gastroenterol 2008; 103: 2465-2473.Yeomans N, Lanas A, Labenz J et al Efficacy of esomeprazole (20 mg once daily) for reducing the risk of gastroduodenal ulcers associated with continuous use of low-dose aspirin. Am J Gastroenterol 2008; 103: 2465-2473.Kelly JP, Kaufman DW, Jurgelon JM et al. Risk of aspirin-associated major upper-gastrointestinal bleeding with enteric-coated or buffered product. Lancet 1996; 348: 1413-1416.Kelly JP, Kaufman DW, Jurgelon JM et al. Risk of aspirin-associated major upper-gastrointestinal bleeding with enteric-coated or buffered product. Lancet 1996; 348: 1413-1416.Garcia Rodriguez LA, Hernandez-Diaz S, de Abajo FJ. Association between aspirin and upper gastrointestinal complications: systematic review of epidemiologic studies. Br J Clin Pharmacol 2001; 52: 563-571.Garcia Rodriguez LA, Hernandez-Diaz S, de Abajo FJ. Association between aspirin and upper gastrointestinal complications: systematic review of epidemiologic studies. Br J Clin Pharmacol 2001; 52: 563-571.Dietz R, Rauch B, Leitlinie zur Diagnose und Behandlung der chronischen koronaren Herzerkrankung der Deutschen Gesellschaft Kardiologie – Herz- und Kreislaufforschung (DGK) Z Kardiol 2003; 92: 501-521.Dietz R, Rauch B, Leitlinie zur Diagnose und Behandlung der chronischen koronaren Herzerkrankung der Deutschen Gesellschaft Kardiologie – Herz- und Kreislaufforschung (DGK) Z Kardiol 2003; 92: 501-521.Kubler W, Darius H, Primγre Prγvention der koronaren Herzkrankheit mit Aspirin Z Kardiol 2005; 93: 66-73.Kubler W, Darius H, Primγre Prγvention der koronaren Herzkrankheit mit Aspirin Z Kardiol 2005; 93: 66-73.Cole FT, Hundson N, Liew LC et al Protection of Human gastric mucosa against aspirin-enteric coating or dose reduction? Aliment Pharmacol Ther 1999; 13 (2): 187-193.Cole FT, Hundson N, Liew LC et al Protection of Human gastric mucosa against aspirin-enteric coating or dose reduction? Aliment Pharmacol Ther 1999; 13 (2): 187-193.

The authors declare that there are no conflicts of interest present.