1. 'i (;cy)t: B*'j:" ID\*:'j:v\OOM.tLt.*]t$UJ.t (.) ijo.'j: **" *}!,0)!f.M96J!t!f.MtEi.1389tL""(v\to LiJL".1bno*UJE ijwo t".wt.-?fbti.o)?blj*toijli:v\

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

*tf{p~_l)

'\

IJ,,**tf~2)

ij~$Ji=t~JtlMJ!~~T-7«- Afff~~~OSSRS)~')V-7'3) l)*m*~~~g~·£ff~~*~ 2)~fN*~~~g~()1f ~m(;t~ 3)B*H~$g=ttbh~

1);=259-1143

1$*JII~f~~JJj{mr*,~143

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 those

who are in a lower LDL-C level

Yoichi Ogushil), Syoutai Kobayashi

2_),

Japanese Standard Stroke Registry Study Group

3)

1)

Department of Medical Informatics of Tokai University School of Medicine

2)

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.

1.

'i

(;cY)t:

B*~'j:" ID\*~:'j:~v\~OO~~M.tLt~.*~~]t$UJ.t (.~~) iJ~~~o .~~'j:

**"

*}!,0)!f.M96J!t!f.MtEi.~1389t

L

""(v\t~o LiJ~L" .~~~1~bno*UJE£

~iJ~~~W~~o

t"

~.Wt~~.-?fB~ti~~.O)?BlJ*t~~oijli~~:~v\""('j:~£?

<

O)ra'"

~:J VATO--)v(TCH)O)*UJE£~t

L""( B

*fhIDRiI1t~~iJ~JE«)t~220mg/dl

iJ~1~bn""( ~ t~(l)o .~~O)~~ ~-r~.O)~ti~b" ~0)1B~@;to t~~tEi.O)

M.

t

~n""( ~ t~o LiJ~

L"

~*~0)~~tEi.rmMi£~'j:LDL-C~190mg/dl~~ ~

(2)" TCH--c"j:270 - 280

mg/dl':f§~Too :JvATo--)v1~rtEi.0)13B9'j:JL,1J1j1I

~0)7~jj~~oiJ~" B*A~0)96~$'j:~*~:fX~""(*937t0)1--c'~oo ~t~"

JL,1J1jlI

~reLO)*990%iJ~60=t~l:0)~tMl~~96~

L""(.B

~(3)" ~0)1:F1-t'j:J:P1:F~:fX~-c::r

V

ATO--)viJ~u

L0

r~~

L""(v\oo

~O)J:

1

~

B

*~:.BV\""(" ~*J: ~ ~j«)""(Mt

Lv\£

~iJ~~'~~O)--c'~~ ~ iJ~? ~O)~rJl',:~;to ~

t

~

<"

20071:F':TCH'j:~~jW

L-C"

LDL-C"

J=P

it!

Ht1JJ1i"

HDL-C~:

J:

0

I

Ht1.~1it~J iJ~1!~ ~nt~(4)o ~ ~

--c'O)LDL-C

0)£~'j:140 mg/dl~~~" ~*tO)£~0))f!v\iJ~J!':l~aAt~0t~o ~*£~':J: 0% 0.0 30% 5.0 25% 4.0 20%

mt-

3.0 ...

-u

~ ~

mt-

15% ~

-u

-i! ~ 2.0 10% 1.0 _5%

(a) JaIb_~J!JEc (b)

t(tJEc

(gJ1 8*I1JJJl~~:t.f{

1'·71

/,:.stt

Qii::JV.A

-rCJ-)lIt*6MJE'L$

-22-J.Lipid Nutr. Vol. 18, No.1 (2009)

Q

~~$,j:40=t~J:.(/)A3%~~

Q

1J{"

B

*'JJIDR~!1t~~(/)£~ ~

,j:33%

tIl

ffl~:

7j:

Qo

8

*fJJIDRi!1t~~(/)2007iF7i'1

1"71

/~.*)]~::I VATO-}v(1).iX:1J{~~ ~tL

'"(

V'Q

(~la)

0

~O)~O)fi.'j:TCH1:"

*l.,j:TCH1J{160-179

mg/dlffO)ret:$~l.O

t

Lt~f~M~t:$1:~fJJJDRm}llret:$1J{~~tLlJ"3~" TCHO)l:~~:1$v'ret:$1JU:

~T

Q

t

~n

'"(v 'Qo

L1J~

L"

~(/)~O)~~~'j:*1f~tA9~!l~1J{J!ij~c ~tL

'"( v'7j:",o

JG(/)~ia)((5)~

J!Q

t"

~Ji5:~1J{~

Q(/) ,j:TCH1J{260

mg/dl~J:.(/)#f(/)~ ~~

":)

t:..

o

L

1J~

b"

JG(/)A~'j:9,216A

1:"

~1Et:~tt'j:l,841A" ~'JJJDRml!1Et:~~'j:-t-O)

1*)(1)

128A"

TCH1J{260mg/dl~l:(/)~fJJJDRmli!',~t:~~'j:12A 1:~

":)

t~o ~ tL'j:~1*(1)

O.l%~:~t~Qo JGO)~ia)(1J~~~ret:~:0v'l(ll]f*0)~~:TQ t~lbt7d:Qo ~(1)~1J~

~" ~fJJIDRm}~,ret:~~ L5Iv't~

r

~0)1&J O))Jj{l!I~:

J:

Qret:$1:'j:"

TCH(1)1~~:

1bJP

~-rt1t;r--J-Et

7d:0'"("'Qo

0~ ~" ~TCH1J{l)

A

7l!1-=ft

7j:Q (/)'j:" TCHiJ{260

mg/dl~J:.O)~~~~" b-r1J~O.l%(/)A(/)~t

"'-?

~

t

~:7j:Qo ~(/)~)((/)M~~~'j:

~nj€~t!~DljJfDjiE(FH)1J{I*1J~tL

'"("

'7j:"

'0 0.1%

t",

-? (/)

'j:" FH(/)$

t

L

-C~D ~tL-C"'~

O.2%(/)~7t" 0~ ~FHO)JJ~t!(/)$

t

-itTQo

FH(/)JJ~t!(1)~1:~TCH1J{l)

A

7

t

7j:

Q

~

t

~~L

lV'Q

1iJn~~t!1J{~Qo

~IID" B*AO)T-~~:£w:1~" 8*fJJIDRi!1t~~0)rHli.~~liEJ £~~:0v''"( ~~iELt~o

2.

ttilO>~._, nj~, '~!I

2-1.a.lllllfJ\; O>ttil

8

*~~f@~~~~ ~:PJf~

T Q

~00451iti!~(/)7073A(/)f@~~~fi*1J~~" 1Yi**~~7t lf1:t~~t ~tL'"(v'Q*ooNCCLS(/)~J-Ei!~:~~

L'"(" 20 -

79=tO)A~:0v''"(''

JJ

9:}j1j ·

5=t~0)£~$BIm~*cVJt~(6)0 JJ~t!0)£~$BIm~~2a, 9:~t!~~2b~:~To

fl

$dJ'j:iFfif11:"

*l.'j:LDL-C(/)1H~~Qo

4

*O)*,~,j:--j:J:.tr1J{£~.ffi (iE~~)

(/)95%~~u~Im~"'b~QlE~~Im~~t)" r=p9c(/)2*(1).'j:£~.m(1)t=P9c50%

~~u~Im~~*~ ~

ptL

'"(v'Q~itiB~tI2)(~l3t~~Im~:ffi~T~0

JJ9:t

b1JDfifj~: 1$v'l:~

Ll"

£~$BIml:~l{IR'j:r=p~iFJJt!1:'j:180

mg/dl"

9:~t!-c"j:190 mg/dl~~

~" I3t~$BIml:~l1IR'j:JJ~t!150

mg/dl"

9:~t!160 mg/dl1:~~o ~tL~(/)1IR'j:"

*00

NCEP ATP III(J)1tt

1)

A

7

~~:MT~ ~~iamrm~£~j3

J:

(J~iI5B~tlci~

I3

t~

t

J:

<

-itT~o

8

*~~f@~~~~~(/)JJ9:}J1j

· 5

=t~'t £~~Im'j:" -t-(/)f~(1)ijJWiJ~(1)157JA--c' (/)7tlJf~*

t

T~l(/)~itJlI3

--c't1t;r--it L

-C"

't:..(7)0

",-rtLb

.ltJfB9M1f~,j:~ ~

1J{"

:r-

~~1J{*~

<"

~~(/)liJf1f~5*rdj~

J:

<

--itL

lV'~(/)~, f~,Jt~t!'j:~"'t~

200 180 160 140 ~ 'bo 120 E 100 80 60 40

I

l l l l l l l l l l l l

0 & n 0 & n 0 & n 0 & n 0 & n 0 & n

NNMM~~&n&nCOCO""'''''' 4. 200 180 160 140 ~ 'bo 120 E 100 80 60 40 '1llll~l~

¥

¥...,~...,~ ~ ~~~~~~ro~~A"~A",,j 4M -+-Llllfl -ll-I§I • •IIIL -6-1§I • •III1' ---1'Plfl (a) ~11 (b)

it11

~2 LDL-CO)~jr:jIJ •

5?"c:'·taiJiBll

2-2.f~~::J*-

i'iJfJtfJ'&O)tlii

~3'j:~*

JII

~fft~)Jj{m~19951f~1J~ ~20051f~"£ ~JJJIi9,949A

(SfteJ1fiif164.9

:t), 3(JIi16,172A (SfteJ1ffit161.8:t)

~it!~L

l,

LDL-Cv~}vt)Jj{~}JIj~L$'d:-WIJ

~t~~*~~Q(8)0 SfteJit!~Mra"j:8.11f~~Qo ~(J)fIi.'j:

7

~~(J)LDL-Cv~}v ~,

• •

'j:~)Jj{~}JJj~L:$(J)irat~~QoJJJtl~~t~0lv\Q(J),j:100mg/dl*iOO~

Q)1Ec$Q)l:Jf-t

~f*t

L

'"(Q)tir~~~ 1IirttJ~~~0 f~LDL-C~Q)1EL$J:Jf-Q)}Jj{~

~j:~JIi~~~t~JPk~~~~',~~oo

159

mg/dl"£~tir~t~~,

160

mg/dlJ;AL~Y

LL~To~t, A~t

L

l~j:Y7d:

<, 100

mg/dl*iPij~:fX~o t~O)L~$'j:fl1J~~~

00 QJ£0l,

JJJIi~'j:100

-160

mg/dl1Jt.~1it!~~00 3(JIi~'j:, JJJIi~:~~o

t

T~l(J)LDL-Cv~}V~~L$1Jt1ttv\~t,

120

mg/dl*iOO~'j:~L$~tYLL~L

l

v\Qo

:'(J))Jj{~'j:~IYk~~~li!',~~Qo 3(Jtl~'j:i\1jLDL-Cv~}v~(J)reL$(J).-t~'j:

h.t:>n7d:v\O)~, LDL-C~r~1'0£<~JIi~±~< ~v\o

Vt0l'

3(JIi~~±120 mg/dl~

-24-J.Lipid Nutr. Vol.1S, No.1 (2009)

L

iJ{Ji

~

fIll --c'

~

Q

0 3500 3000

*'

-79 80- 100- 120- 140- 160- 180-LDL-Cv~}~ (a) ~~ 3500 3000 2500

*'

--< ~ 2000 o r-~ iJ ~ 1500 :!: Jtt 1000 500 o -79 80- 100- 120- 140- 160- 180-LDL-Cv~}~ (b) 3t~

F(/)itIl

IIII~~ • ftii9ltn.~m [Jitt!flilift~m [JJlltn11,(,\~m 1Ipq!l!ift~ 1I~11ii~~

r&J

3 LDL-C

v

~JII

t

JEC2¥

*OO--c"j:JL~JUjlJ!~T~jj~:MT~~~m~mJMi71

/;6{190

mg/dl~ ~itrfi~tl(J)2t

~l3t~1Ill;6{160 mg/dl--c'~~(NCEP

ATP

111)0

0~ ~160 mg/dl~~;6{J1i~c"'~ ~

c--c'"

~(J)~t-ftT~o t~y';6{" B*(J)~~~1@~t--c"j:120 mg/dlJ,~L~

r'f*1@m

2JJ"

140

mg/dl~L'j:

r

~~ifJJ~J

t L

-Cv'Qo

140

mg/dl~L--c"j:~~~,~--c'"

120

mg/dl*~~ §mLt~m~iJ{qTbnQ

t

v'~ ~

t

--c'~Qo

a::r

VATO--)viJ~C?LDL::r

v

ATO--)v~:~b0t~~

t

--c'"

B

*--c'q)£~q)~1it~iJ{J!~:JY=jfJt~:tj:0t~0

~L$(J)LJtTQJlEB~~DQt~9)~:" ~LJjj{~q)rp--c'LDL-Ct(J)OO1*iJ{i~v' r~~tl

$Jf~~

+

,*g&~*J

t

I

JRJfiJ.~tlJL~*J~'

+

1tB~~~*J~'

+

8~JfiJ.1f*J~,J 0)~L:~':1±

EI

Lt~o

lWtf'j:IC

L

-C~~f~r':fMJ1*T~~}~,--c'" ~~tf'j:JL~1fD.1f*--c'~~o ~tl--c'13

1L0(J);6{100

mg/dl*~--c'(J) 1~~tl$Jf~~+ ~g&~*~}it\,J

':J:

~~t:$(J)LJt--c'~

Qo LDL-CiJ{P7d:T

~~ ~

t

*HJ~IJl(J)~nX:iJ{~-t7t--c'~

-1

)vA~*HJm(J)~A ~ ~jjfMJ--c' ~

~:J:o~LiJ{!~X.obO)t~~,bttoo ~t~~ ~lt1:~'j:LDL-CiJ{180

mg/dl'd:mX.ot*

OOA

~m~~tt

lV'O J:

1~: liL~1fD.1f*J ~1ifl,~0)~t:$'j:!~x.oo

*

000)

J:

1~: 11~

~T o1fiJ.1f(J)~~J

iJ{2VJ

o~lt!--c"j:~LDL-CiJ{iL~~nlI~O) 1)A

7

~:7d:oiJ{~

B*A--c'

'j:A~iJ{:Jl7d:

<

~ ret:$l:=1}(1)~l}b*~

<

'j:~v'o ~3c

t

b

~

fttLDL-C--c'b

liL~1fiJ.1f

*J

~1~1,~(J)ret:$iJ{l:=1}T

00

~ tL'j:~ fttLDL-C~:

J:

~ 1fiJ.1f~iJ{~ij

<7d:o

t~&')

t

1m

ilU~tLoo

~4~:~lt1ijli1J1j v«}v~'t (1)J!{~glj~t:$'d:~To ~3c

t

b~ ~lt1:ijli1J1jiJ{~

<l b9E

L$O)l:=1}'j:a~~tt7d:v'o ~*~(J)~lt1:ijli1J1jrE;~iJ'1

1"71

/~b~ FHO)AJ;Ljti-~

'j:l,OOO

mg/dl~~~~rE;~'j:{-rbtL lV'7d:v'(9)~

t

t-itToo

~lt1';J:150

mg/dl*

~~~ W11Yl~*~}i£l,tij~1fiJ.1f*~ll£',~:J:~~

ret:$iJ{l:=1}Too

~if1~--c"j:~

B*'JJ

JJJR~I1t~~t'j:~< ~~:150 mg/dlJ;Al:~*l1~Lt~1JiJ{~!±~

Too

II-f0)flt! II~~ -DiJtn• •m [Jflf!f11l1ft.m odtJtn~'L\.m -Pf• •~ . . .11fJr!:£~ o . -79 80- 120- 150- 200- 300-ttJ11ftilf1i 2500 3000 3500 .; ~ -c< 2000 ~ o ~ ~ . -lJ 1500 .: ..

!

~

-79 80- 120- 150- 200- 300-ttJ11ftilf1i (a) _~11 (b)

3t11

-26-J.Lipid Nutr. Vol. 18, No.1 (2009)

~5~:HDL-Cv~)v~'t(j)JJj{~~Ij~t:$~~To Y:ltl'±HDL-Cv~)v(j)l:~~:

J:

~

~t:$7J{.~i}gtPT~7J{'\ ~ltl'±U~7J-7"~~L lV\~o ~tl~:t0lHDL-C'±*~

t,±~x.tj:v\o ~ltl1:'HDL-C7J{80 mg/dlt~l:(j)#f~:0v\lLDL-C~~~~t'\

1tB(j)#f

J:

~1~<'\ rp9c1~7J{lOO mg/dl~~0t~o 0~ ~'\

LDL-C7J{lOO

mg/dl*~(j)A7J{~~ 1f:1£T~o 1t~:'\ ~lt1~LDL-C7J{lOO mg/dl*~~:7d:~tret:$7J{L~T~~t7J{flj

f!ij

L

-Cv\~o -t-0)JJj{ll~H±~lt1$Jf~~tJP]Lg&~*~}if\,~~0t~0)~'\ ~lt1~0)~HDL-C

'j:*Ji.~±j~~~ ~~P*

L

lV\~nr'~ltl7J{~P~~n~o 3500 ' . r-at oW .:

!

1500

1

o -39 40- 50- 60- 80-HDL-C 3000 2500 ~ ~ 2000 o r-at oW ~ 1500 m!. ijt-1000 o -39 40- 50- 60- 80-HDL-C II-t-O)itk III*~ .RiiliJtn.~m [JflI!fIIliU~m [J IIJtn11'i)~m .IJ!¥I!iU~ 1lI~11Ii~~ (a)

!R11

(b)

3t11

~5

HDL-C

v~)vtJEt:.

m*ffl}if:,if~'±~

Lv\::J

VATO-)v1~r §f~~{~J£ ~~1.:t:iti.~tt-Cv\~o ~tt~:

M

L

-C'±*OOI*J--c'brp,mlJ!~n

-Cv

\~(lO)o fM~~WL1rrn t1$~}II~{jt~JJj{m0)1±~~

M.t

L

-C19991F4Ji7J~~61Fra~0)*"-7°/

·

::1*-

rliJf~~1T0t~(11)o

7-1

t

L

l~

Aa*• •

t • •

~

• •

O)M~ tt&a*~~0)~Aa*M.~J:U.ti7-1~

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

1

90mg/

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､

2

004

2. Gr

undySM

,

Cl

e

e

ma

nJ

I

,

Me

r

zCNa

nd6o

t

he

r

s

:

I

mpl

i

c

a

t

i

o

nso

fr

e

c

e

ntc

l

i

ni

c

a

l

t

r

i

a

l

sf

o

rt

hena

t

i

o

na

lc

ho

l

e

s

t

e

r

o

le

duc

a

t

i

o

npr

o

gr

a

m a

dul

tt

r

e

a

t

me

n

tpane

lI

I

I

gui

de

l

i

ne

s

,

Ci

r

c

ul

a

t

i

o

n

,

1

1

0

,

2

2㌢23

9

,

2004.

3.

厚生労働省大 臣官房統 計情報部.平成

1

8

年度人 口動態統 計 厚生統 計協 会､

2

00

8

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

. Oka

yamaT

,

TanakaH

,

Mi

yama

t

s

uN

,

and6o

t

her

s:Ther

e

l

a

t

i

ons

hi

p

be

t

we

e

ns

e

r

um t

o

t

a

lc

ho

l

e

s

t

e

r

o

la

nda

l

l

-

c

a

us

eo

rc

a

us

e

-

s

pe

c

i

丘cmo

r

t

a

l

i

t

yi

na

1

7

.

3-

ye

a

rs

t

udyo

faJ

a

pa

ne

s

ec

o

ho

r

t

.

At

he

r

o

s

c

l

e

r

o

s

i

s

,

1

90

,

21

6-

2

23

,

2

007

.

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-

1

05

､

2004.

7

. Ka

nnoT

,

Ta

uc

hiK

.

Ogus

hi

Y

,

a

nd5o

t

he

r

s:Es

t

i

ma

t

i

o

no

fr

e

f

e

r

e

nc

ei

n

t

e

r

va

l

s

f

o

rt

heShi

z

uo

kapr

e

f

e

c

t

ur

eo

fJ

a

panandc

o

mpa

r

i

s

o

nwi

t

ht

ho

s

eo

bt

a

i

ne

d

f

r

o

m o

t

he

rt

wol

a

r

ge

-

s

c

a

l

es

t

udi

e

so

fr

e

f

e

r

e

nc

epo

pul

a

t

i

o

ni

nJ

a

pa

n.He

a

l

t

h

Eva

lPr

o

m

,

33(

4

)

,

465

-

469

,

2

006.

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､

2

008.

9

. Br

unz

e

l

lJ

D:

Hype

r

t

r

i

g

lyc

e

r

i

de

mi

a

.

NEng

lJMe

d

.

35

7

(

1

0)

,

1

009-

1

01

7

,

2007

.

1

0.Kas

s

i

r

erJP :Whys

houl

dwes

wal

l

o

w wha

tt

hes

es

t

udi

ess

a

y ?

,

The

Wa

s

hi

ngt

o

nPo

s

t

,

Augus

t12004.

l

l

.

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

)

､

2

23-

230

､

2006.