J. Lipid Nutr. Vol.18, No.1 (2009)

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TEL: 0463-93-1121 ext.2140~ Fax: 0463-96-4301~

E-mail: youichi@keyaki.cc.u-tokai.ac.jp

4=-- ry - 1" : LDL-C~ g=tltlij~1JJj~ HDL-C" ~t.7i'1 1"71 /'"~L$

Japanese who are in a higher LDL-C level will live longer than thosewho are in a lower LDL-C level

Yoichi Ogushil), Syoutai Kobayashi2),

Japanese Standard Stroke Registry Study Group3)

1) Department of Medical Informatics of Tokai University School of Medicine2) Shimane University Hospital, 3) Japanese Stroke Association

1)143 Shimokasuya, Isehara, Kanagawa, 259-1143, Japan

Summary

The targets of lipid lowering therapy in Japan are severer than those in western

countries. Two hundred twenty mg/dl for total cholesterol (TCH), 140mg/dl for LDL-C,

150 mg/dl for triglyceride (TG) are used for the target values. In western countries, those

values are 270 mg/dl, 190 mg/dl and 1,000 mg/dl respectively for low risk persons. But, a

morbidity rate of coronary heart disease in Japan is a third in western countries. Strange

to say, the number of women who accepts the therapy is twice of that of men in Japan. We

have verified the targets used in Japan by some kinds of studies. We established clinical

reference intervals of TCH, LDL-C, TG and HDL-C from the results of health checkup of

about 700,000 persons by the method comparable to NCCLS in USA. We performed cohort

studies and found cutoff points where mortalities increased significantly. These results

are equal to the targets used in western countries. People diagnosed as hyperlipidemia by

Japanese standard have less morbidity of strokes. If they develop strokes, their clinical

indexes are better than persons in normal lipid level. In conclusion, the guideline for

hyperlipidemia in Japan should be revised according to Japanese evidences soon.

Keywords: LDL-C, triglyceride, HDL-C, clinical guideline, mortality

-21-

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-22-

J. Lipid Nutr. Vol.18, No.1 (2009)

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J. Lipid Nutr. Vol. 18, No.1 (2009)

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-27-

脂質栄養学 第18巻,第1号(2009)

3.まとめ

1.日本人でも女性にはコレステロール低下治療は不要である｡

2.男性でも1次予防としては､LDL-Cが190mg/dl未満でのコレステロール低下治療

は不要である｡

*2次予防については日本人のデータが存在しない｡

3.糖尿病患者についても､上と同じである｡

*禁煙と血糖値コントロールに集中すべきである｡

4.LDLCが悪玉､HDLCが善玉とは言えない｡

5.欧米の中性脂肪の治療ガイドラインは日本人にも適切と思われる｡

参考文献

1. 日本動脈硬化学会.高脂血症治療ガイドライン､日本動脈硬化学会､2004

2.GrundySM,CleemanJI,MerzCNand6others:Implicationsofrecentclinical

trialsforthenationalcholesteroleducationprogramadulttreatmentpanelIII

guidelines,Circulation,110,22㌢239,2004.

3.厚生労働省大臣官房統計情報部.平成18年度人口動態統計 厚生統計協会､

2008

4. 日本動脈硬化学会.動脈硬化性疾患予防ガイドライン2007年版､日本動脈硬化学

会､2007

5. OkayamaT,TanakaH,MiyamatsuN,and6others:Therelationship

betweenserumtotalcholesterolandall-causeorcause-speci丘cmortalityina

17.3-yearstudyofaJapanesecohort.Atherosclerosis,190,216-223,2007.

6.大櫛陽一､柴田健雄､小川哲平ほか:年齢別基準値の意義と地域および年次比較｡

総合健診､31(1)､95-105､2004.

7. KannoT,TauchiK.OgushiY,and5others:Estimationofreferenceintervals

fortheShizuokaprefectureofJapanandcomparisonwiththoseobtained

from othertwolarge-scalestudiesofreferencepopulationinJapan.Health

EvalProm,33(4),465-469,2006.

8. 大櫛陽一 :コレステロールと中性脂肪で､薬は飲むな｡詳伝社新書､2008.

9.BrunzellJD:Hypertriglyceridemia.NEnglJMed.357(10),1009-1017,2007.

10.KassirerJP:Whyshouldweswallow whatthesestudiessay?,The

WashingtonPost,August12004.

ll.大櫛陽一 :血中脂質の男女差 ･年齢差とその考察(4)一糖尿病ではコレステロールを

どこまで下げる必要があるか-､性差と医療､3(2)､223-230､2006.

-32-