medicina61巻8号

2024年07月発行

特集 “とりあえずスタチン”から脱却！—動脈硬化性疾患一次予防・最新の考え方 診断

動脈硬化性疾患における画像診断の進歩②—頸動脈超音波検査/冠動脈CT検査

著者： 岩谷俊之¹ 南尚賢¹ 阿古潤哉¹

所属機関： ¹北里大学医学部循環器内科学

ページ範囲：P.1224 - P.1228

Point
◎頸動脈内膜中膜複合体厚（IMT）の肥厚は動脈硬化危険因子と関連し，脳・心血管イベントの予測因子である．
◎冠動脈石灰化は粥状硬化総量と相関があり，石灰化スコアは心血管イベントとの相関が報告されている．
◎頸動脈IMT，石灰化スコアともに，一次予防におけるリスク層別化の一環として評価することに対するエビデンスは十分ではない．

参考文献

1）日本超音波医学会用語・診断基準委員会，頸動脈超音波診断ガイドライン小委員会：超音波による頸動脈病変の標準的評価法2017, 2017　https://www.jsum.or.jp/committee/diagnostic/pdf/jsum0515_guideline.pdf（2024年5月閲覧）

2）Lorenz MW, et al：Prediction of clinical cardiovascular events with carotid intima-media thickness；A systematic review and meta-analysis. Circulation 115：459-467, 2007 PMID 17242284

3）Kokubo Y, et al：Impact of intima-media thickness progression in the common carotid arteries on the risk of incident cardiovascular disease in the Suita Study. J Am Heart Assoc 7：e007720, 2018 PMID 29858361

4）Katakami N, et al：Clinical utility of carotid ultrasonography in the prediction of cardiovascular events in patients with diabetes；A combined analysis of data obtained in five longitudinal studies. J Atheroscler Thromb 25：1053-1066, 2018 PMID 29445076

5）Kadota A, et al；SESSA Research Group；NIPPON DATA80/90 Research Group：Carotid intima-media thickness and plaque in apparently healthy Japanese individuals with an estimated 10-year absolute risk of CAD death according to the Japan Atherosclerosis Society（JAS）guidelines 2012；The Shiga Epidemiological Study of Subclinical Atherosclerosis（SESSA）. J Atheroscler Thromb 20：755-766, 2013 PMID 23831585

6）Mannami T, et al：Strong and significant relationships between aggregation of major coronary risk factors and the acceleration of carotid atherosclerosis in the general population of a Japanese city；The Suita Study. Arch Intern Med 160：2297-2303, 2000 PMID 10927726

7）Hosomi N, et al：Angiotensin-converting enzyme inhibition with enalapril slows progressive intima-media thickening of the common carotid artery in patients with non-insulin-dependent diabetes mellitus. Stroke 32：1539-1545, 2001 PMID 11441198

8）Nohara R, et al；Justification for Atherosclerosis Regression Treatment（JART）Investigators：Effect of intensive lipid-lowering therapy with rosuvastatin on progression of carotid intima-media thickness in Japanese patients；Justification for Atherosclerosis Regression Treatment（JART）study. Circ J 76：221-229, 2012 PMID 22094911

9）Koyasu M, et al：Impact of acarbose on carotid intima-media thickness in patients with newly diagnosed impaired glucose tolerance or mild type 2 diabetes mellitus；A one-year, prospective, randomized, open-label, parallel-group study in Japanese adults with established coronary artery disease. Clin Ther 32：1610-1617, 2010 PMID 20974318

10）Okada K, et al：The influence of lifestyle modification on carotid artery intima-media thickness in a suburban Japanese population. Atherosclerosis 173：329-337, 2004 PMID 15064110

11）Goldberger ZD, et al：Are changes in carotid intima-media thickness related to risk of nonfatal myocardial infarction? A critical review and meta-regression analysis. Am Heart J 160：701-714, 2010 PMID 20934565

12）Lorenz MW, et al；PROG-IMT Study Group：Carotid intima-media thickness progression to predict cardiovascular events in the general population（the PROG-IMT collaborative project）；A meta-analysis of individual participant data. Lancet 379：2053-2062, 2012 PMID 22541275

13）Arnett DK, et al：2019 ACC/AHA guideline on the primary prevention of cardiovascular disease；A report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Circulation 140：e596-e646, 2019 PMID 30879355

14）日本循環器学会，日本糖尿病学会（監）：糖代謝異常者における循環器病の診断・予防・治療に関するコンセンサスステートメント，南江堂，2020

15）日本動脈硬化学会（編）：動脈硬化性疾患予防ガイドライン2022年版，日本動脈硬化学会，2022

16）日本循環器学会，他：2022年JCSガイドライン フォーカスアップデート版 安定冠動脈疾患の診断と治療，2022　https://www.j-circ.or.jp/cms/wp-content/uploads/2022/03/JCS2022_Nakano.pdf（2024年5月閲覧）

17）Wexler L, et al：Coronary artery calcification；Pathophysiology, epidemiology, imaging methods, and clinical implications. A statement for health professionals from the American Heart Association. Writing Group. Circulation 94：1175-1192, 1996 PMID 8790070

18）Budoff MJ, et al：Ten-year association of coronary artery calcium with atherosclerotic cardiovascular disease（ASCVD）events；The multi-ethnic study of atherosclerosis（MESA）. Eur Heart J 39：2401-2408, 2018 PMID 29688297

19）Zeitouni M, et al：2019 ESC/EAS Guidelines for management of dyslipidaemia；Strengths and limitations. Eur Heart J Cardiovasc Pharmacother 7：324-333, 2021 PMID 32652000

20）Motoyama S, et al：Computed tomographic angiography characteristics of atherosclerotic plaques subsequently resulting in acute coronary syndrome. J Am Coll Cardiol 54：49-57, 2009 PMID 19555840

21）Ferencik M, et al：Use of high-risk coronary atherosclerotic plaque detection for risk stratification of patients with stable chest pain；A secondary analysis of the PROMISE randomized clinical trial. JAMA Cardiol 3：144-152, 2018 PMID 29322167