著作: [東 博之]/動脈硬化と高脂血症/[四国医学雑誌]
(英) Atherosclerosis and hyperlipidemia
(日) It is well known that four major risk factors for atherosclerosis include diabetes mellitus,hypertension, hyperlipidemia and smoking. Among these risk factors, management ofhyperlipidemia, especially hyper-LDL cholesterolemia, has become to be strictly achieved by theappearance of statins. Many randomized control trials using statins have been performed, andthe effectiveness in reduction of cardiovascular events is clearly established. Under thesecircumstances, we planed and performed the Shikoku Hyperlipidemia Study(SHS)to revealhow do we treat and what degree do we strictly manage patients with hyperlipidemia.Evidence obtained by The SHS study were 1)unmeasurement rates of serum cholesterollevels in categories B and C were 28.1% and 18.2%, respectively, 2)among patients incategories B and C who need to be treated by drugs, only 35.5% and 35.9% of patients incategories B and C were treated, respectively, 3)drugs medicated in such patients weremostly statins and a single kind of statin was administered, and 4)rate of successfullytreated patients in category B was 40∼50% and that in category C was 20∼30%. Whenthis analysis, which was performed based upon guideline published in 1997, was re-analyzedby new guideline published in 2002, rates of successfully treated patients in categories A, B1,B2, B3, B4, and C were 91.7%, 66.1%, 77.6%, 42.9%, 60.7%, and 32.6%, respectively.Pleiotropic effects of statins have been postulated, however, a couple of issues are stillelusive ; that is, 1)can statins suppress the progression of atherosclerosis by the mechanismother than cholesterol lowering in humans? and 2)should statins be administered to patientsfor secondary and primary preventions against cardiovascular events to anticipate pleiotropiceffects of statins?. Evidence obtained so far suggest that statins exert its pleiotropic effectsvia 1)enhancement of NO production by phosphorylation of eNOS, Akt and PI 3 kinase, 2)inhibition of Ras activation by reduction of farnesyl-pyrophosphate, and 3)inhibition of Rhofamily activation by reduction of geranylgeranyl-pyrophosphate, and that Heart ProtectionStudy and ASCOT-LLA study revealed that additive benefits can be elicited whenhyperlipidemic patients bearing many risk factors including diabetes mellitus were treatedwith statins.In conclusion, we need to treat patients with hyperlipidemia in consideration of thequality and quantity of risk factors for cardiovascular diseases.
|年月日||必須||2004年 8月 25日|