循環器ジャーナル67巻4号

2019年10月発行

特集 冠動脈疾患のリスク管理のフロントライン Ⅱ．冠動脈疾患リスクファクターをどう管理する？

コレステロールはどこまで下げる？

著者： 西尾亮太¹ 和田英樹¹ 宮内克己²

所属機関： ¹順天堂大学医学部附属静岡病院循環器内科 ²順天堂大学大学院医学研究科循環器内科学講座

ページ範囲：P.594 - P.599

Point
・スタチンは高LDL-C血症に対する薬物治療の中心であり，一次予防，二次予防に関して豊富なエビデンスが蓄積されている．
・スタチンに加えてエゼチミブやPCSK9阻害薬といった新たな脂質低下薬を用いた大規模臨床試験が発表されており，LDL-C値がスタチンのみでは管理目標値に到達しないような高リスクの患者群においては併用を検討する必要がある．
・心血管イベント発症率が欧米と比較し少ない日本人においても，REAL-CAD試験にて高用量のストロングスタチンの使用が，通常量と比較し心血管イベントを抑制することが示された．

参考文献

1) Shepherd J, Cobbe SM, Ford I, et al:Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of Scotland Coronary Prevention Study Group. N Engl J Med 333:1301-1307, 1995

2) Nakamura H, Arakawa K, Itakura H, et al:Primary prevention of cardiovascular disease with pravastatin in Japan（MEGA Study）:a prospective randomised controlled trial. Lancet 368:1155-1163, 2006

3) Baigent C, Keech A, Kearney PM, et al:Efficacy and safety of cholesterol-lowering treatment:prospective meta-analysis of data from 90, 056 participants in 14 randomised trials of statins. Lancet 366:1267-1278, 2005

4) Cholesterol Treatment Trialists'（CTT）Collaborators, Mihaylova B, Emberson J, et al:The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease:meta-analysis of individual data from 27 randomised trials. Lancet 380:581-590, 2012

5) Scandinavian Simvastatin Survival Study Group:Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease:the Scandinavian Simvastatin Survival Study（4S）Lancet 344:1383-1389, 1994

6) Cholesterol Treatment Trialists'（CTT）Collaboration, Baigent C, Blackwell L, et al:Efficacy and safety of more intensive lowering of LDL cholesterol:a meta-analysis of data from 170, 000 participants in 26 randomised trials. Lancet 376:1670-1681, 2010

7) Schwartz GG, Olsson AG, Ezekowitz MD, et al:Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes:the MIRACL study:a randomized controlled trial. JAMA 285:1711-1718, 2001

8) Cannon CP, Braunwald E, McCabe CH, et al:Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med 350:1495-1504, 2004

9) Hulten E, Jackson JL, Douglas K, et al:The effect of early, intensive statin therapy on acute coronary syndrome:a meta-analysis of randomized controlled trials. Arch Intern Med 166:1814-1821, 2006

10) Sakamoto T, Kojima S, Ogawa H, et al:Effects of early statin treatment on symptomatic heart failure and ischemic events after acute myocardial infarction in Japanese. Am J Cardiol 97:1165-1171, 2006

11) Okazaki S, Yokoyama T, Miyauchi K, et al:Early statin treatment in patients with acute coronary syndrome:demonstration of the beneficial effect on atherosclerotic lesions by serial volumetric intravascular ultrasound analysis during half a year after coronary event:the ESTABLISH Study. Circulation 110:1061-1068, 2004

12) Hiro T, Kimura T, Morimoto T, et al:Effect of intensive statin therapy on regression of coronary atherosclerosis in patients with acute coronary syndrome:a multicenter randomized trial evaluated by volumetric intravascular ultrasound using pitavastatin versus atorvastatin（JAPAN-ACS［Japan assessment of pitavastatin and atorvastatin in acute coronary syndrome］study）. J Am Coll Cardiol 54:293-302, 2009

13) Cannon CP, Blazing MA, Giugliano RP, et al:Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes. N Engl J Med 372:2387-2397, 2015

14) Sabatine MS, Giugliano RP, Keech AC, et al:Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease. N Engl J Med 376:1713-1722, 2017

15) Bonaca MP, Nault P, Giugliano RP, et al:Low-Density Lipoprotein Cholesterol Lowering With Evolocumab and Outcomes in Patients With Peripheral Artery Disease:Insights From the FOURIER Trial（Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk）. Circulation 137:338-350, 2018

16) Sabatine MS, Giugliano RP, Keech AC, et al:Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease. Circulation 376:1713-1722, 2017

17) Schwartz GG, Steg PG, Szarek M, et al:Alirocumab and Cardiovascular Outcomes after Acute Coronary Syndrome. N Engl J Med 379:2097-2107, 2018

18) Taguchi I, Iimuro S, Iwata H, et al:High-Dose Versus Low-Dose Pitavastatin in Japanese Patients With Stable Coronary Artery Disease（REAL-CAD）:A Randomized Superiority Trial. Circulation 137:1997-2009, 2018

19) 日本動脈硬化学会(編)：動脈硬化性疾患予防ガイドライン2017年版．日本動脈硬化学会，2017

20) 日本循環器学会(編)：急性冠症候群ガイドライン（2018年改訂版）．日本循環器学会，2019