medicina48巻5号

2011年05月発行

今月の主題 脂質異常症―動脈硬化症を予防するためのStrategy 動脈硬化症と脂質異常症の理解のために 【動脈硬化症発症に及ぼす各危険因子の影響】

糖尿病が果たす役割

著者： 藤原和哉¹ 曽根博仁¹

所属機関： ¹筑波大学大学院疾患制御医学専攻水戸地域医療教育センター内分泌代謝・糖尿病内科

ページ範囲：P.734 - P.738

ポイント

★糖尿病患者では初期から大血管症が認められ，非糖尿病患者と比較して心血管疾患発症が2～4倍高く，重症度も高い．

★糖尿病患者では，高TG血症，低HDL血症といった動脈硬化を促進する危険因子が重複しやすい．

★糖尿病患者では，small dense LDL，酸化LDL，糖化LDLなど動脈硬化を惹起する物質の増加を含む脂質代謝の質的異常を有する．

★食後高血糖，負荷後高血糖は冠動脈疾患の危険因子であり，耐糖能障害の段階から心血管疾患の危険因子となる．

参考文献

1）Turner RC, et al：Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus：United Kingdom Prospective Diabetes Study（UKPDS：23）. BMJ 316：823-828, 1998

2）Sone H, Yamada N：Japan Diabetes Complications Study（JDCS）. Nippon Rinsho 68：865-871, 2010

3）Haffner SM, et al：Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 339：229-234, 1998

4）Krolewski AS, et al：Magnitude and determinants of coronary artery disease in juvenile-onset, insulin-dependent diabetes mellitus. Am J Cardiol 59：750-755, 1987

5）Sarwar N, et al：Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease；A collaborative meta-analysis of 102 prospective studies. Lancet 375：2215-2222, 2010

6）Fox CS, et al：Trends in cardiovascular complications of diabetes. JAMA 292：2495-2499, 2004

7）Doi Y, et al：Impact of glucose tolerance status on development of ischemic stroke and coronary heart disease in a general Japanese population；the Hisayama study. Stroke 41：203-209, 2010

8）Hashimoto K, et al：Glucose intolerance is common in Japanese patients with acute coronary syndrome who were not previously diagnosed with diabetes. Diabetes Care 28：1182-1186, 2005

9）Urabe T, et al：Prevalence of abnormal glucose metabolism and insulin resistance among subtypes of ischemic stroke in Japanese patients. Stroke 40：1289-1295, 2009

10）Sone H, et al：The new worldwide definition of metabolic syndrome is not a better diagnostic predictor of cardiovascular disease in Japanese diabetic patients than the existing definitions：additional analysis from the Japan Diabetes Complications Study. Diabetes Care 29：145-147, 2006

11）Hanefeld M, et al：Risk factors for myocardial infarction and death in newly detected NIDDM；The Diabetes Intervention Study, 11-year follow-up. Diabetologia 39：1577-1583, 1996

12）Tominaga M, et al：Impaired glucose tolerance is a risk factor for cardiovascular disease, but not impaired fasting glucose；The Funagata Diabetes Study. Diabetes Care 22：920-924, 1999