¹Ì±¹½ÉÀåÇÐȸ(ACC)¿Í ½ÉÀåÇùȸ(AHA)´Â ÃÖ±Ù ‘½ÉÇ÷°üÁúȯ 1Â÷¿¹¹æ °¡À̵å¶óÀÎ’À» ¹ßÇ¥, ¾Æ½ºÇǸ° °æ±¸Åõ¿©¿Í °ü·ÃÇØ ºÎÁ¤ÀûÀÎ ÀÔÀå¿¡ ´õ ¹«°Ô¸¦ ½Ç¾ú´Ù. ½ÉÇ÷°üÁúȯ 1Â÷¿¹¹æ ¸ñÀûÀÇ ¾Æ½ºÇǸ° Åõ¿©¸¦ ¸Å¿ì Á¦ÇÑÀûÀ¸·Î ±Ç°íÇÏ°í Àִµ¥, »ý¾Ö ù ½ÉÇ÷°üÁúȯ ¹ß»ýÀ» ¸·´Âµ¥ ¾Æ½ºÇǸ° Åõ¿©ÀÇ À§Çè ´ëºñ ÇýÅÃÀÌ ¸íÈ®ÇÏÁö ¾Ê´Ù´Â °ÍÀÌ ÀÌÀ¯´Ù. ¾ç ÇÐȸÀÇ ¾Æ½ºÇǸ° ±Ç°í¾ÈÀº ½ÉÇ÷°üÁúȯ 1Â÷¿¹¹æ¿¡ ÀÖ¾î Ç×Ç÷¼ÒÆÇ¿ä¹ý ÀÓ»óÀû¿ëÀÇ ÇöÁÖ¼Ò¸¦ ¿©½ÇÈ÷ º¸¿©ÁÖ°í ÀÖ´Ù. |
ACC·AHA ½ÉÇ÷°üÁúȯ 1Â÷¿¹¹æ °¡À̵å¶óÀο¡¼ ¾Æ½ºÇǸ° ±Ç°í¾È
– Á׻󵿸ưæȼº ½ÉÇ÷°üÁúȯ(ASCVD) À§ÇèÀÌ ³ôÀ¸³ª ÃâÇ÷À§Çè Áõ°¡´Â ¾ø´Â 40~70¼¼ ¿¬·É´ëÀÇ ¼±º°µÈ ¼ºÀο¡°Ô ASCVD 1Â÷¿¹¹æ ¸ñÀûÀ¸·Î Àú¿ë·® ¾Æ½ºÇǸ°(1ÀÏ 75~100mg °æ±¸¿ë·®) Ä¡·á¸¦ °í·ÁÇÒ ¼öµµ ÀÖ´Ù(±Ç°íµî±Þ IIb, ±Ù°Å¼öÁØ A). Low-dose aspirin(75-100 mg orally daily) might be considered for the primary prevention of ASCVD among select adults 40 to 70 years of age who are at higher ASCVD risk but not at increased bleeding risk. (Class of Recommendation IIb, Level of Evidence A)
– 70¼¼ ÃÊ°úÀÇ °í¿¬·É´ë¿¡°Ô´Â ASCVD 1Â÷¿¹¹æ ¸ñÀûÀ¸·Î Àú¿ë·® ¾Æ½ºÇǸ°(1ÀÏ 75~100mg °æ±¸¿ë·®)À» ÀÏ»óÀûÀ¸·Î(Á¤±âÀûÀ¸·Î) Åõ¿©Çؼ´Â ¾ÈµÈ´Ù(±Ç°íµî±Þ III: À§ÇØ, ±Ù°Å¼öÁØ B-R). Low-dose aspirin(75-100 mg orally daily) should not be administered on aroutine basis for the primary prevention of ASCVD among adults £¾70 years of age(Class of Recommendation III: Harm, Level of Evidence B-R).
– ÃâÇ÷À§ÇèÀÌ ³ôÀº ¸ðµç ¿¬·É´ëÀÇ ¼ºÀο¡°Ô ASCVD 1Â÷¿¹¹æÀ» ¸ñÀûÀ¸·Î Àú¿ë·® ¾Æ½ºÇǸ°(1ÀÏ 75~100mg °æ±¸¿ë·®)À» Åõ¿©Çؼ´Â ¾ÈµÈ´Ù(±Ç°íµî±Þ III: À§ÇØ, ±Ù°Å¼öÁØ C-LD). Low-dose aspirin(75-100 mg orally daily) should not be administered for the primary prevention of ASCVD among adults of any age who are at increased risk of bleeding(Class of Recommendation III: Harm, Level of Evidence C-LD).
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¸ÕÀú ÃâÇ÷À§ÇèÀÌ ³·°í Á׻󵿸ưæȼº ½ÉÇ÷°üÁúȯ(ASCVD) À§ÇèÀº ³ôÀº ¼±º°Àû ȯÀÚ±×·ì¿¡°Ô Àú¿ë·® ¾Æ½ºÇǸ° Åõ¿©¸¦ °í·ÁÇϵµ·Ï ±Ç°íÇß´Ù. ¿ø¹®À» ÀÚ¼¼È÷ »ìÆ캸¸é, Åõ¿©´ë»ó¿¡ Á¦ÇÑÀ» µÐ »óÅ¿¡¼ “might be considered”¶ó´Â ¿ë¾î¸¦ ¼±ÅÃÇØ ±Ç°íÀÇ °µµ¸¦ ³·Ãè´Ù. ±Ç°íµî±Þ ¿ª½Ã Class IIb(WEAK, Benefit ≥ Risk)¸¦ ºÎ¿©Çߴµ¥, ¾àÁ¦ÀÇ È¿°ú¿Í À¯¿ë¼ºÀÌ ¸íÈ®ÇÏÁö ¾Ê´Ù´Â Àǹ̴Ù.
¾ç ÇÐȸ´Â ¿©±â¿¡¼ ±×Ä¡Áö ¾Ê°í ¾Æ½ºÇǸ°ÀÇ ÃâÇ÷À§ÇèÀ» °Å·ÐÇÏ°í ³ª¼¹´Ù. ½ÉÇ÷°üÁúȯ 1Â÷¿¹¹æ¿¡ ¾Æ½ºÇǸ°À» ¾²±â¿¡´Â ÃâÇ÷À§ÇèÀÇ ºÎ´ãÀÌ Å©´Ù´Â °ÍÀÌ´Ù. ÇÐȸ´Â 70¼¼¸¦ ³Ñ´Â °í¿¬·É´ë¿Í ÃâÇ÷À§ÇèÀÌ ³ôÀº ȯÀÚ±×·ì¿¡°Ô´Â ½ÉÇ÷°üÁúȯ 1Â÷¿¹¹æ ¸ñÀûÀ¸·Î Àú¿ë·® ¾Æ½ºÇǸ°À» »ç¿ëÇÏÁö ¸»¶ó°í ±Ç°íÇß´Ù. ÀÌ ±Ç°í¿¡´Â ÇØ´ç ¾à¹°¿ä¹ýÀÌ À§ÇØÇÒ ¼ö ÀÖ´Ù´Â ÀǹÌÀÇ Class III µî±ÞÀ» ºÎ¿©Çß´Ù.
±× µ¿¾È Çа迡¼´Â ASCVD Áߵ·°íÀ§Ç豺¿¡¼ ¾Æ½ºÇǸ°ÀÇ ½ÉÇ÷°üÁúȯ 1Â÷¿¹¹æ ÇýÅÃÀ» ÀÔÁõÇϱâ À§ÇÑ Àӻ󿬱¸°¡ ÁøÇàµÆÁö¸¸ ÃâÇ÷ÀÌ °É¸²µ¹·Î ÀÛ¿ëÇØ ¿Ô´Ù. Áö³ÇØ ¹ßÇ¥µÈ ASCEND, ARRIVE, ASPREE ¿¬±¸¸¦ ÅëÇØ ½ÉÇ÷°üÁúȯ 1Â÷¿¹¹æ¿¡¼ ¾Æ½ºÇǸ° ‘¹«¿ë·Ð’ÀÌ Á¦±âµÇ¸é¼, ¾Æ½ºÇǸ°ÀÇ ÃâÇ÷À§ÇèÀÌ ½ÉÇ÷°üÁúȯ ¿¹¹æÈ¿°ú¸¦ »ó¼âÇÑ´Ù°í °á·Ð³»·È´Ù.
ASCEND·ARRIVE
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³í¶õÀÌ À̾îÁö´Â °¡¿îµ¥ ¿¬ÀÌ¾î º£ÀÏÀ» ¹þÀº ASPREE ¿¬±¸´Â ½ÉÇ÷°üÁúȯ 1Â÷¿¹¹æ¿¡ ÀÖ¾î ¾Æ½ºÇǸ° ¹«¿ë·Ð¿¡ ½û±â¸¦ ¹Ú¾Ò´Ù. È£ÁÖ ¸ð³»½Ã´ëÇÐ John J. McNeil ±³¼öÆÀÀº ½ÉÇ÷°üÁúȯ, Ä¡¸Å, Àå¾Ö µîÀ» µ¿¹ÝÇÏÁö ¾ÊÀº °Ç°ÇÑ °í·ÉÀÚ¸¦ ´ë»óÀ¸·Î ¾Æ½ºÇǸ°ÀÇ À¯¿ë¼ºÀ» Æò°¡ÇÑ ASPREE ¿¬±¸ ½Ã¸®Á NEJM¿¡ ¹ßÇ¥Çß´Ù.
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1Â÷Á¾·áÁ¡À¸·Î ¸ðµç ¿øÀο¡ ÀÇÇÑ »ç¸Á, Ä¡¸Å, ¿µ±¸ÀûÀÎ ½ÅüÀå¾Ö µîÀ» º¹ÇÕÀûÀ¸·Î Æò°¡Çß´Ù. 2Â÷Á¾·áÁ¡À¸·Î´Â ÁÖ¿äÃâÇ÷ ¹× ½ÉÇ÷°üÁúȯ À§ÇèÀ» ºñ±³Çß´Ù. ½ÉÇ÷°üÁúȯÀº Ä¡¸íÀû °ü»óµ¿¸Æ ½ÉÀåÁúȯ, ºñÄ¡¸íÀû ½É±Ù°æ»öÁõ, Ä¡¸íÀû ¶Ç´Â ºñÄ¡¸íÀû ³úÁ¹Áß, ½ÉºÎÀü ÀÔ¿ø µîÀ¸·Î Á¤ÀÇÇß´Ù.
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