COPD/哮喘患者ASCVD二级预防的阿司匹林剂量策略：ADAPTABLE研究解读
2026/01/28
背景：现行指南推荐使用阿司匹林（每日75-100 mg）用于动脉粥样硬化性心血管疾病（ASCVD）的二级预防。然而，对于既往已确诊ASCVD且合并慢性阻塞性肺疾病（COPD）或哮喘（二者均为ASCVD的独立危险因素）的患者，更高剂量的阿司匹林是否带来额外获益，目前尚不明确。
方法：作者基于ADAPTABLE研究数据，比较了合并与不合并COPD/哮喘的患者在两种阿司匹林剂量下的疗效与安全性。ADAPTABLE是一项开放标签、实效性随机对照临床试验，将ASCVD患者随机分配至阿司匹林81或325 mg组。本研究对该试验数据进行二次分析，旨在评估在阿司匹林325 mg 与81 mg两种策略下，既往有无COPD或哮喘病史的人群在临床疗效与安全性方面的差异，并探究COPD/哮喘病史是否对阿司匹林剂量与临床结局之间的关联产生效应修饰作用。
研究结果：在14,662名受试者中，2,778名有COPD或哮喘病史，11,884名无此病史。在调整后的主要复合性终点方面，未观察到阿司匹林剂量与COPD/哮喘病史之间存在显著相互作用（标准化风险比[aHR]，1.15 [95% CI，0.92-1.43]; P值=0.349）。然而，与阿司匹林325 mg治疗的患者相比，有COPD/哮喘病史的个体在接受81 mg治疗时，卒中风险显著更高（aHR，2.41 [95% CI，1.27-4.57]）。
结论：在同时患有ASCVD与COPD/哮喘的患者中，除卒中风险外，不同阿司匹林剂量在ASCVD相关结局方面未见显著差异。针对该人群的卒中预防策略，仍需进一步研究加以明确。
关键词：阿司匹林；哮喘；动脉粥样硬化性心血管疾病；慢性阻塞性肺疾病；二级预防。
Background: Guidelines recommend aspirin (75–100 mg daily) for the secondary prevention of atherosclerotic cardiovascular disease (ASCVD). However, it is unknown if people with a history of ASCVD and chronic obstructive pulmonary disease (COPD) or asthma, which are independent risk factors for ASCVD, would benefit from higher dose aspirin.
Methods: We evaluated the effectiveness and safety of 2 aspirin doses among individuals with and without COPD/asthma in the ADAPTABLE (Aspirin Dosing: A Patient-Centric Trial Assessing Benefits and Long-Term Effectiveness) trial. The ADAPTABLE study was an open-label, randomized clinical trial that assigned people with ASCVD to aspirin 81 or 325 mg. We performed a secondary analysis of data from the ADAPTABLE study to investigate the difference in clinical effectiveness and safety among people with and without COPD or asthma randomized to aspirin 325 versus 81 mg. We assessed if history of COPD/asthma modified the association between aspirin dose and outcomes.
Results: Among the 14662 participants, 2778 had a history of COPD or asthma and 11884 had no history of COPD or asthma. We observed no significant interaction between aspirin dose and history of COPD/asthma in our adjusted primary composite outcome (adjusted hazard ratio [aHR], 1.15 [95% CI, 0.92–1.43]; P value=0.349). We observed individuals with a history of COPD/asthma treated with aspirin 81 mg had a significantly higher risk of stroke (aHR, 2.41 [95% CI, 1.27–4.57]) compared with a treatment strategy of aspirin 325 mg.
Conclusions: Among people with ASCVD and COPD/asthma, there were no significant differences in ASCVD outcomes based on aspirin dosing except stroke. Further evaluation of stroke prevention in this population is warranted.
方法：作者基于ADAPTABLE研究数据，比较了合并与不合并COPD/哮喘的患者在两种阿司匹林剂量下的疗效与安全性。ADAPTABLE是一项开放标签、实效性随机对照临床试验，将ASCVD患者随机分配至阿司匹林81或325 mg组。本研究对该试验数据进行二次分析，旨在评估在阿司匹林325 mg 与81 mg两种策略下，既往有无COPD或哮喘病史的人群在临床疗效与安全性方面的差异，并探究COPD/哮喘病史是否对阿司匹林剂量与临床结局之间的关联产生效应修饰作用。
研究结果：在14,662名受试者中，2,778名有COPD或哮喘病史，11,884名无此病史。在调整后的主要复合性终点方面，未观察到阿司匹林剂量与COPD/哮喘病史之间存在显著相互作用（标准化风险比[aHR]，1.15 [95% CI，0.92-1.43]; P值=0.349）。然而，与阿司匹林325 mg治疗的患者相比，有COPD/哮喘病史的个体在接受81 mg治疗时，卒中风险显著更高（aHR，2.41 [95% CI，1.27-4.57]）。
结论：在同时患有ASCVD与COPD/哮喘的患者中，除卒中风险外，不同阿司匹林剂量在ASCVD相关结局方面未见显著差异。针对该人群的卒中预防策略，仍需进一步研究加以明确。
关键词：阿司匹林；哮喘；动脉粥样硬化性心血管疾病；慢性阻塞性肺疾病；二级预防。
（南方医科大学南方医院 钟梓同 樊可可 赵海金）
(Mosher CL, Stebbins A, et, al. Aspirin Dosing for Secondary Prevention of Atherosclerotic Cardiovascular Disease in Chronic Obstructive Pulmonary Disease and Asthma: Insights From ADAPTABLE. J Am Heart Assoc. 2025 Dec 2;14(23):e043161. doi: 10.1161/JAHA.125.043161. Epub 2025 Nov 26. PMID: 41294093; PMCID: PMC12748523.)
Abstract(Mosher CL, Stebbins A, et, al. Aspirin Dosing for Secondary Prevention of Atherosclerotic Cardiovascular Disease in Chronic Obstructive Pulmonary Disease and Asthma: Insights From ADAPTABLE. J Am Heart Assoc. 2025 Dec 2;14(23):e043161. doi: 10.1161/JAHA.125.043161. Epub 2025 Nov 26. PMID: 41294093; PMCID: PMC12748523.)
Background: Guidelines recommend aspirin (75–100 mg daily) for the secondary prevention of atherosclerotic cardiovascular disease (ASCVD). However, it is unknown if people with a history of ASCVD and chronic obstructive pulmonary disease (COPD) or asthma, which are independent risk factors for ASCVD, would benefit from higher dose aspirin.
Methods: We evaluated the effectiveness and safety of 2 aspirin doses among individuals with and without COPD/asthma in the ADAPTABLE (Aspirin Dosing: A Patient-Centric Trial Assessing Benefits and Long-Term Effectiveness) trial. The ADAPTABLE study was an open-label, randomized clinical trial that assigned people with ASCVD to aspirin 81 or 325 mg. We performed a secondary analysis of data from the ADAPTABLE study to investigate the difference in clinical effectiveness and safety among people with and without COPD or asthma randomized to aspirin 325 versus 81 mg. We assessed if history of COPD/asthma modified the association between aspirin dose and outcomes.
Results: Among the 14662 participants, 2778 had a history of COPD or asthma and 11884 had no history of COPD or asthma. We observed no significant interaction between aspirin dose and history of COPD/asthma in our adjusted primary composite outcome (adjusted hazard ratio [aHR], 1.15 [95% CI, 0.92–1.43]; P value=0.349). We observed individuals with a history of COPD/asthma treated with aspirin 81 mg had a significantly higher risk of stroke (aHR, 2.41 [95% CI, 1.27–4.57]) compared with a treatment strategy of aspirin 325 mg.
Conclusions: Among people with ASCVD and COPD/asthma, there were no significant differences in ASCVD outcomes based on aspirin dosing except stroke. Further evaluation of stroke prevention in this population is warranted.
上一篇：
重度哮喘急性加重期间无创正压通气使用与临床结局的相关性：基于倾向评分匹配的队列研究
下一篇：
症状控制不佳的哮喘患者蛋白组学和转录组学特征：U-BIOPRED队列分析
