脂質異常症 治療の目標値は？ - hospi.sakura.ne.jp

1 Clinical question 2014 12 29 JHOSPITALIST NETWORK 59 ACE & BP 110/60mmHg TC 240 mg/dL LDL-C 158 mg/dL HDL-C 51 mg/dL TG 155 mg/dL BUN 15mg/dL Cre HbA1c(NGSP) Clinical Question 2013 NCEP ATP-III 2013 ACC/AHA 2013 Blood Cholesterol Guidelines 2012 NCEP; National Cholesterol Education Program ATP-III; Adult Treatment Panel-III ATP-III Adult Treatment Panel-III NCEP 2001 3 2004 CHD CHD Framingham risk score 10 CHD (Circulation 2002;106:3143-421.)

2 CHD Coronary Heart Disease ATP-III LDL-C CHD CHD equivalent CHD equivalent Peripheral Arterial Diseases; PAD TIA Framingham score 20 45 55 CHD 55 65 HDL-C<40mg/dL 140/90 Framingham score 10% 2 LDL-C 130 Risk 70 CHD or CHD equivalent(*1) 100 100 100 (*2) 2 130 130 Framingham score FS 10-20% 130 FS 10% 160 0-1 160 160 190 ATP-III LDL-C ACC/AHA 2013 Blood Cholesterol Guidelines 2013 11 Circulation JACC NIH ATP-III ATP-IV ATP-III 4 Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults (Stone NJ, Robinson J, Lichtenstein AH, et al.)

3 J Am Coll Cardiol. 2014 Jul 1;63(25):2889-934) ATP-III 4 Statin-Benefit Group Statin ASCVD(Atherosclerotic Cardiovascular Disease CHD PAD ) LDL-C 190mg/dL 40-75 40-75 LDL-C 70-189mg/dL ASCVD LDL-C Non-HDL-C RCT ASCVD Global Risk Assessment (David C. Goff, Jr, et al. J Am Coll Cardiol. 2014 Jul 1;63(25):2935-59) ASCVD ASCVD Heart Healthy lifestyle habits 40-75 4-6 ASCVD 10 clinical ASCVD/DM LDL-C 70-189 mg/dL Clinical ASCVD 21 LDL-C 190mg/dL 75 High-Intensity Statin Moderate-Intensity 75 or High-Intensity Statin Moderate-Intensity Statin High-Intensity Statin Moderate-Intensity Yes Yes Yes Yes No No ACC/AHA 2013 Stone NJ, Robinson J, Lichtenstein AH, et al.

4 J Am Coll Cardiol 2014. DM 1 /2 40-75 10-y ASCVD 40-75 Moderate-Intensity Statin 10-y ASCVD High-Intensity Statin 10-y ASCVD Risk Moderate - High-Intensity Statin Yes Yes Yes No ACC/AHA 2013 Stone NJ, Robinson J, Lichtenstein AH, et al. J Am Coll Cardiol 2014. 10 year ASCVD Moderate High-intensity statin therapy LDL-C High-Intensity Moderate-Intensity ASCVD 75 LDL-C 190mg/dL 40-75 DM 10-y ASCVD risk ASCVD 76 40-75 DM 10-y ASCVD risk < 10-y ASCVD risk 2013 ACC/AHA guideline Stone NJ, Robinson J, Lichtenstein AH, et al. J Am Coll Cardiol 2014. ACC/AHA 2013 Intensity High-Intensity Moderate-Intensity Low-Intensity 50% LDL-C 30% 50% LDL-C 30% LDL-C (40)-80mg 20 (40)mg 10(20)mg (5)10mg 20-40mg 40(80)

5 Mg 40mg XL80mg 40mg bid 2-4mg 10mg 10-20mg 20mg 20-40mg 1mg RCT FDA RCT UpToDate -55% 20mg -50% 10mg 40mg -45% 5mg 20mg -40% 10mg -35% 5mg 20mg -30% 10mg 40mg -20% 10mg 10mg -10% 5mg Robert S Rosenson. Statins: Actions, side effects, and administration. Comparison of the efficacy of statin drugs. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. (Accessed on December 23, 2014.)

6 Liao JK. Am J Cardiol. 2007;99(3):410. ACC/AHA 2013 ACC/AHA 2013 LDL-C LDL-C (ACC/AHA ) 2012 II LDL-C <140 (CKD) (PAD) III HDL-C<40mg/dL 1 III 2012 . , 2012 mg/dL LDL-C HDL-C TG non HDL-C I <160 40 <150 <190 II <140 <170 III <120 <150 <100 <130 LDL-C ATP-III 130 mg/dL ACC/AHA 2013 Moderate-High Intensity Statin 2012 140 mg/dL ACC/AHA 2013 500mg/dL trigger (N Engl J Med 2007.)

7 357:1009-1017) CKD / 50 eGFR<60mL/min (KDIGO Clinical Practice Guideline for Lipid Management in Chronic Kidney 2013) Take Home Message LDL-C LDL-C