Neurological Surgery 脳神経外科42巻8号

2014年08月発行

連載 脳卒中専門医に必要な基本的知識

（1）脳卒中リスクファクター管理

著者： 芝﨑謙作¹

所属機関： ¹川崎医科大学脳卒中医学教室

ページ範囲：P.769 - P.776

Ⅰ．はじめに

　脳卒中は，本邦における死因の第4位であり，寝たきりになる原因疾患の第1位である．近年，遺伝子組み換え組織プラスミノーゲンアクチベータ（recombinant tissue plasminogen activator：rt-PA）療法やMerci^®リトリーバーやPenumbraシステム^®を用いた機械的再開通療法など，脳梗塞に対する超急性期治療は大きく変貌を遂げた．しかしながら，脳卒中リスクファクターの管理を行い，脳卒中の発症を予防することが最も重要である．本稿では，主な脳卒中のリスクファクター（危険因子）とその管理について概説する．

参考文献

1) Amarenco P, Labreuche J：Lipid management in the prevention of stroke：review and updated meta-analysis of statins for stroke prevention. Lancet Neurol 8：453-463, 2009

2) Arima H, Tanizaki Y, Kiyohara Y, Tsuchihashi T, Kato I, Kubo M, Tanaka K, Ohkubo K, Nakamura H, Abe I, Fujishima M, Iida M：Validity of the JNC VI recommendations for the management of hypertension in a general population of Japanese elderly：the Hisayama study. Arch Intern Med 163：361-366, 2003

3) Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, Pogue J, Reilly PA, Themeles E, Varrone J, Wang S, Alings M, Xavier D, Zhu J, Diaz R, Lewis BS, Darius H, Diener HC, Joyner CD, Wallentin L；RE-LY Steering Committee and Investigators：Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 361：1139-1151, 2009

4) Cui R, Iso H, Yamagishi K, Saito I, Kokubo Y, Inoue M, Tsugane S：Diabetes mellitus and risk of stroke and its subtypes among Japanese：the Japan public health center study. Stroke 42：2611-2614, 2011

5) Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ：Validation of clinical classification schemes for predicting stroke：results from the National Registry of Atrial Fibrillation. JAMA 285：2864-2870, 2001

6) Granger CB, Alexander JH, McMurray JJ, Lopes RD, Hylek EM, Hanna M, Al-Khalidi HR, Ansell J, Atar D, Avezum A, Bahit MC, Diaz R, Easton JD, Ezekowitz JA, Flaker G, Garcia D, Geraldes M, Gersh BJ, Golitsyn S, Goto S, Hermosillo AG, Hohnloser SH, Horowitz J, Mohan P, Jansky P, Lewis BS, Lopez-Sendon JL, Pais P, Parkhomenko A, Verheugt FW, Zhu J, Wallentin L；ARISTOTLE Committees and Investigators：Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 365：981-992, 2011

7) Hata J, Doi Y, Ninomiya T, Fukuhara M, Ikeda F, Mukai N, Hirakawa Y, Kitazono T, Kiyohara Y：Combined effects of smoking and hypercholesterolemia on the risk of stroke and coronary heart disease in Japanese：the Hisayama study. Cerebrovasc Dis 31：477-484, 2011

8) Imamura T, Doi Y, Arima H, Yonemoto K, Hata J, Kubo M, Tanizaki Y, Ibayashi S, Iida M, Kiyohara Y：LDL cholesterol and the development of stroke subtypes and coronary heart disease in a general Japanese population：the Hisayama study. Stroke 40：382-388, 2009

9) Iso H, Baba S, Mannami T, Sasaki S, Okada K, Konishi M, Tsugane S；JPHC Study Group：Alcohol consumption and risk of stroke among middle-aged men：the JPHC Study Cohort I. Stroke 35：1124-1129, 2004

10) Kimura K, Minematsu K, Kazui S, Yamaguchi T；Japan Multicenter Stroke Investigators' Collaboration（J-MUSIC）：Mortality and cause of death after hospital discharge in 10,981 patients with ischemic stroke and transient ischemic attack. Cerebrovasc Dis 19：171-178, 2005

11) Lip GY, Frison L, Halperin JL, Lane DA：Comparative validation of a novel risk score for predicting bleeding risk in anticoagulated patients with atrial fibrillation：the HAS-BLED（Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly）score. J Am Coll Cardiol 57：173-180, 2011

12) メタボリックシンドローム診断基準検討委員会：メタボリックシンドロームの定義と診断基準．日内会誌94：794-809, 2005

13) 日本高血圧学会高血圧治療ガイドライン作成委員会：高血圧治療ガイドライン2014．日本高血圧学会，東京，2014

14) Ninomiya T, Kubo M, Doi Y, Yonemoto K, Tanizaki Y, Rahman M, Arima H, Tsuryuya K, Iida M, Kiyohara Y：Impact of metabolic syndrome on the development of cardiovascular disease in a general Japanese population：the Hisayama study. Stroke 38：2063-2069, 2007

15) Ninomiya T, Kiyohara Y, Tokuda Y, Doi Y, Arima H, Harada A, Ohashi Y, Ueshima H；Japan Arteriosclerosis Longitudinal Study Group：Impact of kidney disease and blood pressure on the development of cardiovascular disease：an overview from the Japan Arteriosclerosis Longitudinal Study. Circulation 118：2694-2701, 2008

16) Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, Hacke W, Breithardt G, Halperin JL, Hankey GJ, Piccini JP, Becker RC, Nessel CC, Paolini JF, Berkowitz SD, Fox KA, Califf RM；ROCKET AF Investigators：Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 365：883-891, 2011

17) Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip GY：A novel user-friendly score（HAS-BLED）to assess 1-year risk of major bleeding in patients with atrial fibrillation：the Euro Heart Survey. Chest 138：1093-1100, 2010

18) 芝崎謙作，木村和美，植村順一，坂井健一郎，坂本悠記，藤井修一：脳血管障害患者における睡眠呼吸障害に関する検討．脳卒中33：488-494, 2011

19) Shinton R, Beevers G：Meta-analysis of relation between cigarette smoking and stroke. BMJ 298：789-794, 1989

20) Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V：Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med 353：2034-2041, 2005

21) Yasaka M, Minematsu K, Yamaguchi T：Optimal intensity of international normalized ratio in warfarin therapy for secondary prevention of stroke in patients with non-valvular atrial fibrillation. Intern Med 40：1183-1188, 2001