مقاله ای که در زیر به شما ارائه می شود با هدف تعیین آستانه های ریسک قلبی عروقی و کرونری که آسپیرین در آن به عنوان عامل پیشگیری اصلی بیماری کرونرری قلبی ایمن محسوب میشود، انجام شده است. این تحقیق از یک فراتحلیل در مورد آزمون های کنترل شده تصادفی آسپیرین برای پیشگیری اولیه برگرفته شده است. برای سفارش ترجمه مقاله به شکل فوری یا عادی می توانید از لینک دوستان ما در بخش پیوندها استفاده کنید و با ذکر بازدید کننده وبلاگ ما بودن از تخفیف مناسب برخوردار شوید.
OBJECTIVE To determine the cardiovascular and coronary risk thresholds at which aspirin for primary prevention of coronary heart disease is safe and worthwhile.
DESIGN Meta-analysis of four randomised controlled trials of aspirin for primary prevention. The benefit and harm from aspirin treatment were examined to determine: (1) the cardiovascular and coronary risk threshold at which benefit in prevention of myocardial infarction exceeds harm from significant bleeding; and (2) the absolute benefit expressed as number needed to treat (NNT) for aspirin net of cerebral haemorrhage and other bleeding complications at different levels of coronary risk.
MAIN OUTCOME MEASURES Benefit from aspirin, expressed as reduction in cardiovascular events, myocardial infarctions, strokes, and total mortality; harm caused by aspirin in relation to significant bleeds and major haemorrhages.
RESULTS Aspirin for primary prevention significantly reduced all cardiovascular events by 15% (95% confidence interval (CI) 6% to 22%) and myocardial infarctions by 30% (95% CI 21% to 38%), and non-significantly reduced all deaths by 6% (95% CI −4% to 15%). Aspirin non-significantly increased strokes by 6% (95% CI −24% to 9%) and significantly increased bleeding complications by 69% (95% CI 38% to 107%). The risk of major bleeding balanced the reduction in cardiovascular events when cardiovascular event risk was 0.22%/year. The upper 95% CI for this estimate suggests that harm from aspirin is unlikely to outweigh benefit provided the cardiovascular event risk is 0.8%/year, equivalent to a coronary risk of 0.6%/year. At coronary event risk 1.5%/year, the five year NNT was 44 to prevent a myocardial infarction, and 77 to prevent a myocardial infarction net of any important bleeding complication. At coronary event risk 1%/year the NNT was 67 to prevent a myocardial infarction, and 182 to prevent a myocardial infarction net of important bleeding.
CONCLUSIONS Aspirin treatment for primary prevention is safe and worthwhile at coronary event risk ⩾ 1.5%/year; safe but of limited value at coronary risk 1%/year; and unsafe at coronary event risk 0.5%/year. Advice on aspirin for primary prevention requires formal accurate estimation of absolute coronary event risk.
پزشکی جامع هدفی است که پزشکان زیادی در سراسر دنیا ان را دنبال می کنند در این پست مقدمه کتابی که از مقالات اجلاس سال 2009 در مورد این موضوع برگزار شده است را به شما علاقمندان به مباحث علم پزشکی عرضه می کنیم باشد که مورد توجه شما دوستان قرار بگیرد.و شاهد رشد روز افزون استفاده از پزشکی جامع در ایران عزیزمان باشیم
Health is a personal matter, as is the way each of us chooses to inte-
grate concerns about health into our lives. Like a Rorschach blot, the no-
tion of integrative medicine, or integrative health, means different things
to different people. As an approach to enhancing health, integrative
health seeks to combine the best scientific and evidence-based ap-
proaches to care with a focus on the full range of needs of the individual.
Integrative medicine seeks to enable everyone to maintain their health
insofar as possible, and to be empowered in partnering with health care
providers when illness occurs. With this approach, patients can be more
effective stewards of their own health and wellness.
This publication, Integrative Medicine and the Health of the Public:
A Summary of the 2009 Summit, provides an account of the discussion
and presentations of the two-and-a-half day summit in Washington, DC,
held February 25–27, 2009. While this summary captures the discussion,
it cannot adequately convey the energy and enthusiasm of the partici-
pants who filled the auditorium throughout the event. The Institute of
Medicine (IOM) was honored to host such a large and diverse group to
discuss such a timely topic, especially at such a critical time in American
health care policy making.
Under the direction of Ralph Snyderman, the summit planning com-
mittee assembled an outstanding group of speakers and discussants who
provided valuable insights on the potential and limitations of integrative
health care, models that might be most conducive to its delivery, the mul-
tiple dimensions of scientific endeavor that intersect as its support base,
and possible economic implications and incentives. Participants had an
exceptional opportunity to examine the role and value of integrative
medicine in meeting health needs and overcoming fragmentation in the
health care delivery system.
The summit discussions were fruitful and collaborative, and I believe
that every participant came away from the meeting having learned some-
thing each did not know before. It is my hope that this publication will
advance thoughtful consideration of integrative medicine and extend the
enthusiasm that was ignited at the summit.
I would like to thank the Bravewell Collaborative for their spirit of
partnership and support of this activity, Ralph Snyderman for his leader-
ship and guidance, the planning committee for their commitment and
wisdom, and the IOM staff for their hard work and dedication.