公衆衛生80巻3号

2016年03月発行

特集 心疾患最前線

日本人の虚血性心疾患の危険因子と発症予防

著者： 今野弘規¹ 磯博康¹

所属機関： ¹大阪大学大学院医学系研究科社会医学講座公衆衛生学

ページ範囲：P.172 - P.178

　日本人は，欧米人と比較して脳卒中の発症・死亡は多いが，心筋梗塞などの虚血性心疾患は少ないという特徴がある．病理学的には，日本人の動脈硬化は，冠動脈など太い動脈に起こる粥状硬化よりも，高血圧による穿通枝動脈など細い動脈に起こる細動脈硬化が多い¹⁾．さらに，同じ心筋梗塞でも，日本の都市部では心筋層は塊状壊死型で冠動脈は脂質に富むプラークを伴うタイプが多く，農村部では心筋層は散在壊死型で冠動脈の起始部から末梢部にかけて石灰化を伴うタイプが多い²⁾．われわれが長年継続している地域疫学研究(CIRCS)(※)の結果によると，心筋梗塞発症率は，都市近郊の中年男性で増加傾向にある一方，農村部ではその傾向は認められていない³⁾(※以下，本稿中に出てくる略語の一覧を表1にまとめる)．
　日本人の虚血性心疾患の発症率について，CIRCSを例にすると，1975〜1987年をベースラインにした秋田・大阪・茨城・高知の4地域における40〜69歳住民を2003年まで追跡したコホート研究⁴⁾において，虚血性心疾患の年間千人当たり発症率は男性1.5人，女性0.5人程度で，致死的虚血性心疾患(発症後28日以内の死亡)は，全発症者の4人に1人程度であった．したがって，コホート研究で十分な検出力を得るためには，相当の追跡年数あるいは対象者数が必要とされることから，近年は従来の単独のコホート研究(久山町研究，CIRCS，吹田研究など)のみならず，10万人規模の共同研究(JACC，JPHC，茨城健康研究など)や既存のコホート研究のメタアナリシスや統合研究(JALS-ECC，EPOCH-JAPANなど)も行われるようになり，それらの成果が海外の学術雑誌に相次いで報告されるようになった．本稿では，そうした最近の国内のコホート研究の知見を中心に，日本人の虚血性心疾患の危険因子について概説する．

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