代謝症候群中血脂異常的治療

970 707

ၡāāࢋ

( )

2001 III statin

ᙯᔣෟĈ΃ᔁা࣏ཏ ( Metabolic Syndrome ) ҕ਌ள૱ ( Dyslipidemia )

၁ᙋᗁጯ ( Evidence-based medicine )

݈֏

΃ᔁা࣏ཏ ( metabolic syndrome ) ߏ͕ҕგ ПᐍЯ̄۞ඕЪΐ˯۲ࡡĄд࿅ΝĂ΃ᔁা࣏ཏ

˫Ⴭ਍फ৵޻ԩা࣏ཏ ( insulin resistance syn- drome )ăাې X ( syndrome X ) ٕ΃ᔁள૱া࣏ཏ ( dysmetabolic syndrome )

Ą 2001 ѐ઼࡚ᓙ׽ዔି

ֈࢍထ ( National Cholesterol Education Program, N- CEP ) јˠڼᒚ޽͔ ( Adult Treatment Panel, ATP ) III ޽΍Б࡚ 20-70 ໐۞ˠ˾̚ࡗѣ 24% ࠎ΃ᔁّ

া࣏ཏ

( ॲፂҖ߆ੰ኎Ϡཌ઼ϔઉ૵Ԋ۞შ৭ྤ

फ़ ព ϯ Ĉ д ᄂ ៉ ͧ த Ă շ ّ 1 6 . 9 % Ă ̃ ّ

13.8% Ăᐌѐ᛬۞ᆧΐ҃ᆧΐ )Ą NCEP ATP III ၆

΃ᔁّা࣏ཏטؠ˘इ෧ᕝᇾ໤Ă׎ؠཌྷࠎ˭Е

̣ีᅮѣˬี ( ӣ ) ͽ˯Ĉ 1.ཕಛ۲ࡡ ( abdomi- nal obesity )Ăշّཕಛ෹࿅ 102 cm Ẵّཕಛ෹

࿅ 88 cm Ą 2.ˬᅕϟڵ⟯( triglyceride ) ፧ޘŸ 150 m g / d l Ą 3.੼૜ޘ਌కϨᓙ׽ዔ ( high-density lipoprotein cholesterol, HDL-C ) ፧ޘĂշّŴ 40 m g / d l ẴّŴ 5 0 m g / d l Ą 4 . ҕᑅŸ 1 3 0 / 8 5 mmHg Ą 5.۩ཛҕᎤ፧ޘŸ 110 mg/dl ( Β߁ᎤԌ ঽĂ 2004 ѐ࣒ࢎ ATP III

̏Լࠎ 100 mg/dl )Ą҃

ֲ߷ᄃለ઼࡚छ၆ཕಛ۲ࡡؠཌྷரѣ̙ТĈдᄂ

៉Ăշّࢋ෹࿅ 90 ̶̳Ẵّࢋ෹࿅ 80 ̶̳Ą

΃ᔁা࣏ཏߏ൴णјௐ˟ݭᎤԌঽ̈́જਔඓېർ

ّ̼͕᝙ҕგ়ঽ۞ПᐍЯ̄

ĄܕѐֽϤٺϠ

߿ͪ໤೩چ̈́฼ࢴҘ̼Ă۲ࡡˠ˾ͧத͟ৈᆧ ΐĂтңд͟૱۞෧၅̚൴னѩᙷঽˠĂซ҃Ա

΍͕ҕგ়ঽ۞ሕдПᐍ҃ѝഇڼᒚĂ྿ז࿰֨

ᗁጯ۞ϫ۞Ăߏ˘࣎ࢦࢋኝᗟĄ҃΃ᔁّা࣏ཏ

۞΃ᔁّયᗟĂֶ໰ؠཌྷ׎̚ҕ਌ள૱ ( dyslipi- demia ) ಶΒӣ˟ีĄ఺ቔ͛ౢ૟੫၆΃ᔁা࣏ཏ ҕ਌ள૱۞ڼᒚֽፋநϫ݈၁ᙋᗁጯ۞ᙋፂĄ

΃ᔁা࣏ཏؠཌྷ

ੵ˞ NCEP ATP III ؠཌྷγĂд 2005 ѐѣ઼ᅫ ᎤԌঽᓑ༖ ( IDF ) ઼઼࡚̈́छ͕۱̈́ҕ୵ࡁտ̚

͕/઼࡚͕᝙ጯົ ( NHLBI/AHA ) ۞ؠཌྷ ( ܑ˘ )

Ą IDF ඾ࢦдཕಛ۲ࡡ҃ NHLBI/AHA ԯ۩ཛҕᎤ

፧ޘᇾ໤ࢫҲҌ 100 mg/dl Ąᔵ൒΃ᔁা࣏ཏ఺

࣎Щෟ̪ѣۋᛉ

Ăҭߏд͕ҕგПᐍЯ̄۞ෞ

ҤĂ̪׍ѣࢦࢋгҜĄ

΃ᔁা࣏ཏᄃ਌ኳ΃ᔁள૱

΃ᔁা࣏ཏ౵ࢦࢋ۞јЯĈ۲ࡡĂҭ΃ᔁা

࣏ཏ̙˘ؠߏវࢦ࿅ࢦĂ͹ࢋߏវ਌۹̙ϒ૱Ҝ ཉ۞ુ᎕

Ă͍׎дཛొĄཕಛ۲ࡡᄃ਍फ৵޻

ԩ ( insulin resistance ) ѣޝ̂࠹ᙯّĄ˘ਠֽ

ᄲĂ਌ኳள૱ࢋͧཬ෈Ꭴ࡝צ̙։ ( glucose in- tolerance ) ѝ΍ன

Ą΃ᔁা࣏ཏ׎਌ኳள૱፟ᖼ

т˭

Ĉཛొ۲ࡡଈ۰۞਌۹௟ࡪЯࠎ਍फ৵

޻ԩົᛖ΍ഫᗓ۞਌۹ᅕ ( free fatty acid )Ă҃఺

ֱഫᗓ਌۹ᅕซˢք᝙Ăԛјˬᅕϟڵ⟯ĂЯѩ ᆧΐໂҲ૜ޘ਌కϨ ( very low-density lipopro- tein,VLDL)۞யϠĄ׎ಱӣˬᅕϟڵ⟯۞ໂҲ૜

ޘ਌కϨĂົ౅࿅ᓙ׽ዔ⟯ᖼೱకϨ ( cholesteryl ester transfer Protein, CETP ) ̈́਌కϨ਌ྋ ( lipoprotein lipase ) ٕք਌ྋ ( hepatic lipase)Ă ӛќҲ૜ޘ਌కϨᓙ׽ዔ ( low-density lipoprotein cholesterol, LDL-C ) ۞ᓙ׽ዔ⟯ ( cholesteryl ester )

҃૟ˬᅕϟڵ⟯็ਖ਼ගҲ૜ޘ਌కϨᓙ׽ዔĂֹ

଀Ҳ૜ޘ਌కϨ௕̄ᒺ̈ͷ૜ޘត۞Հࠎღ૜Ą

̈҃ቜ૜۞Ҳ૜ޘ਌కϨᓙ׽ዔटٽజউ̼Ă҃

జӌጥ௟ࡪӌጥĂԛјڽڰ௟ࡪ ( foam cell )Ăౄ

јඓېજਔർ̼۞ԛјĂ˵ົ၆ҕგ̰ϩ௟ࡪ׍

ѣّ߲Ăᆧΐ cytokines ۞ૄЯܑனĂౄјҕგ

൴ۆĄ߇ѣֱ͛ᚥՀԯ΃ᔁা࣏ཏᇃھؠཌྷࠎ൴ ۆ݈/ҕংԛј݈۞ېၗ ( proinflammatory/pro- thrombotic status )

ĄΩ˘͞ࢬĂ΃ᔁা࣏ཏଈ۰ វ̰۞੼૜ޘ਌కϨᓙ׽ዔ፧ޘள૱Ă׎ࣧЯ̙

ځĂΞਕ۞፟ᖼࠎ۲ࡡౄјഫᗓ਌۹ᅕ׶ಱӣϟ ڵˬ⟯۞਌కϨ ( triglyceride-rich lipoprotein )ᆧ ΐĂֹᓙ׽ዔ⟯ᖼೱకϨ̈́ք਌ྋ ߿ّᆧΐĂ

ౄј੼૜ޘ਌కϨᓙ׽ዔдᓙ׽ዔ⟯ᖼೱకϨү ϡ˭ᒔ଀ˬᅕϟڵ⟯̈́ຫεᓙ׽ዔ⟯Ă൒ޢдք

਌ྋ үϡ˭εΝˬᅕϟڵ⟯̈́ L i p i d - f r e e apoA-1 ( Ϥඪ᝙ଵੵ )ĂТॡ˵ົЯ੼૜ޘ਌క Ϩᓙ׽ዔ۞΃ᔁதᆧ੼Ă҃ౄј੼૜ޘᓙ׽ዔณ

ܑ˘Ĉ΃ᔁা࣏ཏ۞෧ᕝᇾ໤⁷

NHLBI/AHA criteria (2005) IDF Criteria (2005)

ͽ˭ˬี(ӣ)ͽ˯௑Ъ ௐ˘ีΐ˯ͽ˭Ї˟ี(ӣ)ͽ˯௑Ъ

1.ཛొ۲ࡡ(central obesity) 1.ཛొ۲ࡡ

2.ཕಛ(waist circumference) 2.ཕಛ(ֲ߷)

շّŵ 102 ̶̳ շّŵ 90 ̶̳

ّ̃ŵ 88 ̶̳ ّ̃ŵ 80 ̶̳

3.ҕᑅ Ÿ 130/85 mmHg ٕ ڇᘽ 3.ҕᑅ Ÿ 130/85 mmHg ٕ ڇᘽ 4.ˬᅕϟڵ⟯Ÿ 150 mg/dl ٕ ڇᘽ 4.ˬᅕϟڵ⟯Ÿ 150 mg/dl ٕ ڇᘽ

5.੼૜ޘᓙ׽ዔ 5.੼૜ޘᓙ׽ዔ

շّŴ 40 mg/dl ٕ ڇᘽ շّŴ 40 mg/dl ٕ ڇᘽ

ّ̃Ŵ 50 mg/dl ٕ ڇᘽ ّ̃Ŵ 50 mg/dl ٕ ڇᘽ

6.ฺ݈ҕᎤŸ 100 mg/dl ٕ ڇᘽ 6.ฺ݈ҕᎤŸ 100 mg/dl

˭ࢫͷ௕̄˵ົᒺ̈

ĂࢫҲ୻ੵវ̰ᓙ׽ዔ۞

ਕ˧Ą

਌ኳ΃ᔁள૱ᄃ൴ۆ۞ᙯܼ

΃ᔁা࣏ཏଈ۰វ̰ົѣ൴ۆଐԛĂ׎͹ࢋ

۞፟ᖼт˭

Ĉ˘ăଈ۰វ̰۞ഫᗓ਌۹ᅕົ

ᆧΐĂ҃ഫᗓ਌۹ᅕົౄјউ̼ᑅ˧ ( oxidative stress ) ă൴ۆ̈́ࢫҲҕგͅᑕ( vascular reactivity )Ą

˟ă਌۹௡ᖐົᛖ΍൴ۆ௟ࡪ፬৵ ( inflammato- ry cytokines)т TNF-ɗĂ IL-6 ົᄵ൴ք᝙யϠ C- reactive protein ( CRP ) ̈́ fibrinogen Ąˬă਌቙৵ ( adiponectin ) ົࢫҲĄ҃਌቙৵ѣΐૻ၆਍फ৵

۞ୂຏّăҕᎤ࡝צޘăԩ൴ۆ̈́ԩજਔർ̼ү ϡĄԩ൴ۆүϡߏЯιΞԺט TNF-ɗ̈́ nuclear factor-ɠ B pathways Ąѣ͛ᚥ޽΍ࡶវ̰਌቙৵

̈ٺ 4 ɢ g / d l Ăົᆧΐ˟ࢺ݄ېજਔঽ۞൴Ϡ தĂ҃ഴᅅវࢦ݋ົᆧΐ਌቙৵

Ąαă PAI-1 ( plasminogen Activator Inhibitor-1 ) ᆧΐĂౄјҕ გ൴ۆĄ̣ăউ̼۞Ҳ૜ޘ਌కϨᓙ׽ዔົו፬

̰ϩ௟ࡪ̶ک MCP-1 ( macrophage chemoattract protein-1 )Ăΐిಏ८஧ซˢҕგ̰ϩ˭ԛјλ ጥ௟ࡪćλጥ௟ࡪົӌጥউ̼۞Ҳ૜ޘ਌కϨԛ јڽڰ௟ࡪޢĂᛖ΍ϠܜЯ̄ ( growth factors )Ă

ܳซҕგ̰π໣҉௟ࡪᆧϠĂౄјજਔർ̼ሶ۞

ԛјćΩ˘͞ࢬڽڰ௟ࡪົᛖ΍ૄኳకϨᅔ৵ ( metalloproteinases ) ౄјҕგ̰ቯૄኳ̶ྋĂֹ

જਔർ̼ሶត۞̙ᘦؠĂౄјજਔർ̼ሶटٽ৔

ෘĂٽѣҕং۞ԛј

Ą

਌ኳ΃ᔁள૱ᄃ੼ҕᑅ۞ᙯܼ

ଈ۰វ̰۞ഫᗓ਌۹ᅕົᆧΐĂ҃ഫᗓ਌۹ ᅕߏ˘჌ҕგќᒺ৵Ą਌ኳள૱Β߁Ҳ۞੼૜ޘ ᓙ׽ዔă੼ˬᅕϟڵ਌ҕা ( h y p e r t r i g l y c - eridemia ) ̈́̈ღቜݭҲ૜ޘ਌కϨᓙ׽ዔ(small dense LDL-C )ĂົԺט̰ϩֶᏥّҕგᗫђ ( en- dothelium dependent vasodilation ) ̈́ᆧΐҕგ̰ቯ ݓޘĂౄј੼ҕᑅ

Ą

΃ᔁা࣏ཏă਌ኳ΃ᔁள૱ᄃ͕ҕ გ়ঽᙯܼ۞ᙋፂ

ॲፂ Lancet2004 ѐ͛ᚥ INTERHEART ᙋ၁΃

ᔁা࣏ཏ۞ЧีЯ̄ᄃ͕҉ୟ๫ѣቢّ࠹ᙯ

Ą ѩγĂд 2006 ѐ˘࣎͛ᚥ൴ܑ੠ᖸّࡁտଣ੅

΃ ᔁ া ࣏ ཏ ᄃ ͕ ҕ გ ় ঽ ߏ ӎ ࠹ ᙯ Ă ү ۰ Ϥ MEDLINE search ( 1966-April 2005 ) ઇޢన̶ژ ڱ ( meta- analysis ) ଀ז˭ЕඕኢĈ΃ᔁা࣏ཏߏ

࿰ീ͕ҕგ়ঽă͕ҕგѪ˸̈́ٙѣࣧЯጱ࡭۞

Ѫ˸۞ࢦࢋПᐍЯ̄Ă࠹၆Пᐍ ( Relative risk )

ّ̃ͧշّ੼

ĄՀѣࡁտ̶ژ޽΍΃ᔁা࣏ཏ ߏдշّŵ 45 ໐ẵّŵ 55 ໐ព඾͕ҕგ়ঽ

۞ПᐍЯ̄

Ą݈ࢬ೩ז΃ᔁা࣏ཏଈ۰ົѣ൴ ۆଐԛĂវ̰ CRP ົ˯چĂ҃ CRP ̏ᙋ၁ߏ͕

ҕგְІ۞࿰ീЯ̄

Ąд̏གྷѣᎤԌঽă͕

ҕგ়ঽٕ੼͕ҕგ়ঽࢲᐍ۞ଈ۰ĂࢫҲҲ૜

ޘ਌కϨᓙ׽ዔቁ၁ѣр఍Ą Statin ᘽۏΞͽԺ ט̰Ϡّᓙ׽ዔ۞ЪјĂ҃ࢫҲ݄͕ঽ۞൴ϠĂ ߇ NCEP ATP III ԯ statin ᘽۏ༊ઇڼᒚ˯়ࢗঽ

۞ࢵᏴĄ΃ᔁা࣏ཏ̈́ᎤԌঽଈ۰׎਌ኳள૱Ӯ ͽ੼ˬᅕϟڵ਌ҕা׶Ҳ۞੼૜ޘ਌కϨᓙ׽ዔ ࠎ͹Ąᔵ൒఺ᙷଈ۰វ̰Ҳ૜ޘ਌కϨ፧ޘ఼૱

ࠎϒ૱ٕൾ຋ᆧΐĂҭ̈҃ቜ૜۞Ҳ૜ޘ਌కϨ

̈́ྶវకϨ B ( apolipoprotein B )

ߏᆧΐ۞Ăڼ ᒚ˯̪ࢋͽ statin ᘽۏࠎᐹАĂҭߏ̙ΞᏕ֏Ă ಶზତצ Statin ᘽۏڼᒚ۞ᎤԌঽঽˠ̪ͧܧᎤ Ԍঽঽˠ۞͕ҕგְІ੼

Ăܑϯ఺ᙷঽˠд

྿זநຐҲ૜ޘ਌కϨᓙ׽ዔ፧ޘޢ̪׍ѣണዶ

۞͕ҕგ়ঽࢲᐍĄ߇Ξଯീ΃ᔁা࣏ཏଈ۰۞

਌ኳள૱׍ѣ͕ҕგ়ঽࢲᐍĂͽ˭ߏ఺ᙷ਌ኳ ள૱ᄃ͕ҕგ়ঽ۞ᙯܼд၁ᙋᗁጯ˯۞ᙋፂĈ

˘ă੼ˬᅕϟڵ਌ҕাĈд˘ֱࡁտពϯĂ

੼ˬᅕϟڵ਌ᄃѝ൴ّ݄͕ঽѣᙯ

Ąд˘ቔ

͛ᚥ޽΍дΝੵ׎ι਌ኳள૱۞̒ᕘĂˬᅕϟڵ

਌Տ˯چ 89 mg/dl ົᆧΐշ݄͕̃ঽ۞፟த̶Ҿ ࠎ 14% ׶ 37%

Ą Jeppensen ඈࡁտ̙ኢ੼૜ޘ ᓙ׽ዔ፧ޘࠎңĂ੼ˬᅕϟڵ਌ҕাᄃ৿ҕّ͕

᝙ঽ ( ischemic heart disease ) ѣᙯ

Ą 2007 ѐ Circulation ˘ቔ͛ᚥ޽΍ˬᅕϟڵ਌ᄃ݄͕ঽߏ

̚ޘ࠹ᙯ ( ࡁտ୉ཏ̚ˬᅕϟڵ਌፧ޘ̶Ҷ݈ˬ

̶̝˘ᄃޢˬ̶̝˘۞࠹၆Пᐍّࠎ 1.7 )

Ą˘

ਠˬᅕϟڵ਌дΝੵ੼૜ޘᓙ׽ዔ۞ᇆᜩౄј͕

ҕგ়ঽࢲᐍ̪๻ᓠऴ

Ă߇ѣˠ೩΍Ϗ༰ࢴ

۞ˬᅕϟڵ਌፧ޘ ( nonfasting triglyceride ) ̖ߏ

ᄃ͕ҕგְІѣૻধ࠹ᙯĄд Physician's Health Study ޽΍ฺޢ੼۞ˬᅕϟڵ਌፧ޘ ( postprandi- al hypertriglyceridemia ) ົᆧΐ͕҉ୟ๫൴Ϡத

Ą 2007 ѐ JAMA ѣ˟ቔᙯٺ੼ˬᅕϟڵ਌ҕা۞

ኢ͛ୃࢗт˭Ĉ

Bansal ඈˠ੠ᖸّࡁտ ( prospective study )Ă

ଂ 1992 ז 1995 ѐВќะ 26509 Ҝઉ૵઼ّ࡚̃

( 20118 Ҝ༰ࢴĂ 6391 ҜϏ༰ࢴ )Ă੠ᖸ 11.4 ѐֽ

៍၅͕ҕგְІ(Β߁͕҉ୟ๫ă̚ࢲăତצ݄

ېજਔГ఼ఙ ( coronary revascularization ) ͕̈́Я

ّѪ˸ ) ۞൴ϠĄ൴னϏ༰ࢴ۞੼ˬᅕϟڵ਌፧

ޘົᆧΐ͕ҕგְІĂ͍׎ฺޢ 2 ז 4 ̈ॡ۞ˬ ᅕϟڵ਌፧ޘ౵ࠎ࠹ᙯĂҭߏฺޢ 2 ̈ॡ̰۞ᇴ ࣃ݋൑࿰ീᆊࣃ

Ą

Nordestgaard ඈˠ͵΃੠ᖸّࡁտĂВ 7587 Ҝّ̃Ă 6394 ҜշّϤ 1976 ѐ੠ᖸז 2004 ѐֽ

៍၅͕ҕგְІ ( ͕҉ୟ๫ă৿ҕّ͕᝙ঽăѪ

˸ )Ą൴னϏ༰ࢴ۞੼ˬᅕϟڵ਌፧ޘдѐ᛬ٕ

׎ιЯ৵ᒣϒޢĂ̙ኢշ̃Ăᄃ͕ҕგְІѣ࠹

ᙯ ( p Ŵ 0.001 )

Ą

઱˯ࢗ˟ቔࡁտࢨט ( limitations of both studies ) ߏঽˠפᇹϏᐌ፟Ă٩פϏ༰ࢴ۞੼ˬ ᅕϟڵ਌፧ޘϏᇾ໤̼̈́͵΃ࡁտ۞ࢨטĄдϫ

݈ᓜԖ˯٩פϏ༰ࢴ۞੼ˬᅕϟڵ਌፧ޘ̪̙జ ޙᛉ

Ăҭߏ೩ֻԧࣇ˘࣎ޥ҂͞ШĄ

˟ă੼૜ޘ਌కϨᓙ׽ዔ˭ࢫĈ Framingham Heart Study, PROCAM study, Helsinki Heart study and the MRFIT study Ӯᙋ၁੼૜ޘ਌కϨᓙ׽ዔᄃ݄

͕ঽѣᙯ

Ąѣˠԯ˯ࢗࡁտტЪ̶ژ଀זඕ ኢĈ੼૜ޘ਌కϨᓙ׽ዔՏ˯چ 1 mg/dl ົഴ݄͌

͕ঽ۞፟தࠎ 2-5%

ĄΩγજۏ၁រ̚ᐖਔڦड

੼૜ޘ਌కϨᓙ׽ዔдᓙ׽ዔᔼࢴ۞׉̄׍ѣ࿰

֨જਔඓᇹർ̼үϡ

Ă҃ԩજਔඓᇹർ̼۞፟

טΒӣԺטҲ૜ޘ਌కϨᓙ׽ዔ۞উ̼ăԺט௡

ᖐЯ̄ ( tissue factor )ăԺט̰ϩ௟ࡪᕆా̶̄

( endothelium adhesion molecule )ăו፬̰ϩ௟ࡪய Ϡ NO ̈́ૻ̼ᓙ׽ዔϤ௟ࡪ۞ொੵ

Ą౵ܕ NEJM

۞ኢ͛೩זϡ Statin ᘽۏڼᒚ۞ঽˠ ( Β߁Ҳ૜ޘ

਌కϨᓙ׽ዔజଠטזŴ 70 mg/dl )ĂҲ۞੼૜ޘ

਌కϨᓙ׽ዔߏ࿰ീ͹ࢋ͕ҕგְІ۞Я̄

Ą ˬăˬᅕϟڵ਌ᄃ੼૜ޘ਌కϨᓙ׽ዔͧࣃ

( triglyceride/HDL-C ) ߏ͕ҕგ়ঽࢲᐍ۞࿰ീ

Я̄Ăͧࣃ෸੼෸ѣࢲᐍ

Ą

αăᓁᓙ׽ዔᄃ੼૜ޘ਌కϨᓙ׽ዔͧࣃ ( total cholesterol/HDL-C )Ĉֶፂ઼࡚ Framingham Study Ăᓁᓙ׽ዔᄃ੼૜ޘ਌కϨᓙ׽ዔͧࣃࡶ

̈ٺ 5 Ă݄͕ঽ۞൴Ϡ፟தҲٺ 7% Ă 5-7 ۞፟

தߏ 12% Ă෹࿅ 7 ۞፟தߏ 20% Ąд˘ቔࡁտ

੠ᖸّќะ 2439 Ҝշّ׶ 2812 Ҝّ̃׎ 20 ѐ൴ Ϡ݄͕ঽ۞፟தĂ଀ז˭ЕඕኢĈдշّĂᓁᓙ

׽ዔᄃ੼૜ޘ਌కϨᓙ׽ዔͧࣃͧಏ˘ᓁᓙ׽ዔ

፧ޘ၆݄͕ঽѣ࿰ീᆊࣃćдّ̃Ă˟۰Ӯ၆݄

͕ঽѣඈТ࿰ീᆊࣃ

Ąдΐो̂໤݋ĂᎤԌ ঽă͕ҕგ়ঽٕ੼͕ҕგ়ঽࢲᐍ۞ଈ۰౵р ჯ޺ͧࣃ̈ٺ 4

Ą

̣ăྶវకϨ ( apolipoprotein )ĈྶវకϨ B

ീณΞડ̶छ୉ّ஄Ъݭ੼਌ҕা ( familial com- bined hyperlipidemia ) ̈́छ୉ّ੼ˬᅕϟڵ⟯ҕ

া ( familial hypertriglyceridemia )Ăͷѣֱ͛ᚥ޽

΍ιд࿰ീ͕ҕგ়ঽࢲᐍͧܧ੼૜ޘᓙ׽ዔ р

ĄҭᓜԖ˯̙ޙᛉ૱ఢീณĂЯࠎྶវకϨ B/A-I ͧࣃд࿰ീ͕ҕგ়ঽࢲᐍᄃᓁᓙ׽ዔᄃ

੼૜ޘᓙ׽ዔͧࣃ՟ѣमள

Ą

̱ă Global risk score ĈፋЪ˘ֱ໤݋̚ΞԼ ච͕ҕგ়ঽࢲᐍ۞Я̄Ă Goal Ŵ 4.0 Ŷ Total cholesterol/HDL-C Ů ( HbA1c -7.0 ) Ů ( systolic blood pressure -130/10 mm Hg ) Ů number of cigarette packs/day Ă׎̚˵Βӣᓁᓙ׽ዔᄃ੼૜

ޘ਌కϨᓙ׽ዔ۞ࢍზ

Ą

΃ᔁা࣏ཏҕ਌ள૱۞ڼᒚ

΃ᔁা࣏ཏдؠཌྷ˯ѣ̣࣎ีϫĂੵ˞˘ਠ ڼᒚγĂ˵ࢋ၆ጾѣ۞ีϫΐͽڼᒚĂͽ྿ז࿰

֨ௐ˟ݭᎤԌঽ͕̈́᝙ҕგ়ঽ۞൴ϠĄ҃ٙᏜ

˘ਠڼᒚಶߏϠ߿ݭၗ۞Լត ( t h e r a p e u t i c lifestyle changes ) Β߁ഴᅅវࢦă฼ࢴଠט׶ఢ

݋ྻજ

Ą Яࠎॲፂ Finnish Diabetes Prevention study ̈́ Diabetes Prevention Program ޽΍Ă΃ᔁ

ّা࣏ཏ۞ଈ۰྿זഴᅅ 7% វࢦ֭ͷ੨Ъఢޠ

ّྻજĂ෹࿅ 3 ѐ൴னΞࢫҲྍ୉ཏ൴णࠎௐ˟

ݭᎤԌঽࡗ 58% ۞൴Ϡத

Ą

˘ăϠ߿ݭၗ۞ԼតĈፂࡁտͧᘽۏ ( met-

formin ) Հਕ࿰֨ᎤԌঽ۞யϠ

ĄᖣϤԼត฼

ࢴ௫ၚ̈́ఢޠྻજֽഴᅅវࢦĂΞࢫҲˬᅕϟڵ

਌ 22% Ăᆧΐ੼૜ޘ਌కϨ 9% ̈́ࢫҲ̈҃ቜ૜

۞Ҳ૜ޘ਌కϨ 4 0 %

Ąॲፂ઼࡚ྻજᗁጯົ

( American College of Sports Medicine ) ઼࡚͕̈́᝙

ጯົ۞ޙᛉ֗វ߿જณᑕ྿זՏฉ̣͇Տ͇ਕଂ

ְҌ͌ 30 ̶ᛗ̚ඈૻޘ ( moderate-intensity ) ۞ѣ উّ֗វ߿જ ( aerobic physical activity ) тĈ˘ਠ ՎҖćٕՏฉˬ͇Տ͇Ҍ͌ 2 0 ̶ᛗ۞෱˧ّྻ

જ ( vigorous activity ) тĈഫڧă޺ᜈّ۞஧ᙷྻ

જăЗ௺ٕၙ෿ඈĄ޺ᜈྻજΞԼච΃ᔁّা࣏

ཏଈ۰۞਌ኳள૱

̈́ഴ͌ 30% யϠ݄͕ঽ۞ࢲ ᐍ

Ą฼ࢴ௫ၚ۞ԼតĂࡁտ൴னᛷפг̚ঔ฼

ࢴ ( mediterranean diet Ĉтቸ෉ăͪڍă቉ᙷă֑

ᙷă౦ă͌ࡓ҇ )ĂΞഴ͌ 20% யϠ΃ᔁّা࣏

ཏ۞ࢲᐍĂҭߏ৿ᕇߏ൑ڱഴᅅវࢦĂ߇ᑕ੨Ъ

ྻ જ ̈́ ഴ ͌ ሤ ณ ᛷ פ

Ą ѩ γ Ă д L y o n

diet heart study ൴னĂѣ࿅͕҉ୟ๫۞ঽˠЫг̚

ঔ฼ࢴࡗˬѐĂΞഴ͌ 50-70% ГѨ͕҉ୟ๫፟

த

Ą࿸׶਌۹ᅕߏౄјҕ̚Ҳ૜ޘ਌కϨ̿

੼۞͹ࢋЯ৵Ă NCEP ATPIII ޙᛉ૟࿸׶਌۹ᛷ פณଠטдՏ͟ሤณ۞ 7% ͽ˭Ą͌Ыӣ̂ณ࿸

׶਌۹ᅕ۞ࢴۏĂт҇ᙷăηڵăٕБ਌֯ᙷ ඈĂᑕкᛷפк̮̙࿸׶਌۹ᅕĂт८ڍăเ֑

ڵăϜѼڵć̈́ಏ̮̙࿸׶਌۹ᅕĂтፙៈڵă

િڍඈĄᑕᔖҺಏᎤ͍׎ߏ֯ᎤĂ׎૱୹ΐٺڍ ϗͱηٕ჆ᅕ฼फ़Ăົౄјฺޢ੼ˬᅕϟڵ਌፧

ޘᆧΐĄԦඵΞᆧΐ੼૜ޘ਌కϨ̈́၆਍फ৵۞

ୂຏޘ ( insulin sensitivity )ĂҭߏࢋڦຍԦඵΞਕ

ົᆧΐវࢦĄ͌ณ฼੧ ( շّՏ͇̙෹࿅ 2 ړĂ

ّ̃Տ͇̙෹࿅ 1 ړ ) Ξᆧΐ੼૜ޘ਌కϨĂ҃

ЫՃ̥ΞࢫҲҲ૜ޘ਌కϨᄃ੼૜ޘᓙ׽ዔͧ

ࣃ

Ąᔡ ( magnesium ) ӣณᖳಱ۞ࢴۏт቉ۏă

֑̄ăિڍăქҒቸ෉Ξͽ࿰֨੼ҕᑅăᎤԌ ঽăࢫҲˬᅕϟڵ਌̈́ᆧΐ੼૜ޘ਌కϨ

Ąѩ γĂѣᎤԌঽ۞ঽˠĂଠטҕᎤΞԼච੼ˬᅕϟ ڵ਌ҕাĄ༊ଈ۰ତצ 12 ฉ۞Ϡ߿ݭၗԼតĂ̪

൑ڱ྿זநຐ۞ҕ਌ࣃĂ݋҂ᇋֹϡᘽۏڼᒚĄ

˟ăѨ൴ّҕ਌ள૱Ĉ̙༊฼ࢴ ( Β߁̂ณ ಅ੧ )ăϥېཛྷăք᝙ٕඪ᝙۞়ঽĂᘽۏֹϡ тᙷ׽ዔăҺࠪԺט጗ăຑൄঽᘽۏăӀԌ጗ă ɘ-Ϲຏৠགྷܡᕝ጗ẵّෲႬᄋඈĂυืڦຍ

҃ፂͽߤᙋڼᒚ

Ą

ܑ˟Ĉ જਔඓᇹർّ̼͕ҕგ়ঽ۞ࢲᐍෞҤ⁷

ࢲᐍෞҤ ࢲᐍЯ̄

Very high risk ౵ܕѣ͕҉ୟ๫ă݄͕াΐ˯˭ЕЇ˘ีĈкࢦПᐍЯ̄ ( ͍׎ߏᎤԌঽ )Ăᚑࢦͷᙱͽ ଠט۞ПᐍЯ̄ ( т޺ᜈ٩໬ )Ă΃ᔁّা࣏ཏ

High risk 10 ѐ݄͕াࢲᐍ̂ٺ 20 % ăજਔඓᇹർّ̼͕ҕგ়ঽ ( atherosclerotic cardiovascular dis- ease )ăᎤԌঽăൺᇶّཝ৿ҕ൴ү ( transient ischemic attack )ăᐚજਔܡ๫ౄј۞̚ࢲăᐚ જਔব৫ŵ 50%

Moderately high-risk 10 ѐ݄͕াࢲᐍ 10-20 %

(Higher-risk in this category) ( ˯ࢗࢲᐍΐ˯кࢦПᐍЯ̄ăᚑࢦͷᙱͽଠט۞ПᐍЯ̄ ( т޺ᜈ٩໬ )ă΃ᔁّা࣏

ཏă൑াې۞જਔඓᇹർ̼Ăт݄ېજਔถ̼ٕᐚજਔ̰ቯᆧݓ෹࿅Тѐ᛬ăّҾ 75 ࣎ Ѻ̶ͧͽ˯ )

Moderate-risk 10 ѐ݄͕াࢲᐍŴ 10% ΐ 2 ࣎ͽ˯ПᐍЯ̄

Low-risk 10 ѐ݄͕াࢲᐍŴ 10 % ΐ 0 ٕ 1 ࣎ПᐍЯ̄

ොĈПᐍЯ̄Β߁٩ඵĂҕ̚੼૜ޘᓙ׽ዔ࿅ҲĞŴ 40 mg/dlğĂछ୉᏷็ΫĞշّŴ 55 ໐ẴّŴ 65 ໐݈൴Ϡ

݄͕াğĂѐ᛬Ğշّŵ 45 ໐Ẵّŵ 55 ໐ğĂ੼ҕᑅĞҕᑅŵ 140/90 mmHg ٕϒдڇϡࢫҕᑅᘽۏğĄ

ܑˬĈҕ਌۹ޙᛉڼᒚϫᇾ⁷

LDL-C Goal Non-HDL-C Goal

ࢲᐍෞҤ (mg/dl) (mg/dl)

(When TG ŵ 200 mg/dl) Very high risk Ŵ 70 Ŵ 100 High risk Ŵ 100 Ŵ 130 Moderately high-risk Ŵ 130 Ŵ 160 (Higher-risk in this category) (Ŵ 100 ) (Ŵ 100 ) Moderate-risk Ŵ 130 Ŵ 160

Low-risk Ŵ 160 Ŵ 190

ˬăҕ਌ள૱۞ᘽۏڼᒚĈͽϫ݈ N C E P ATPIII/AHA/NHLBI ۞໤݋̪ߏͽҲ૜ޘ਌కϨ ᓙ ׽ ዔ ࠎ ͹ ࢋ ϫ ᇾ Ă ܧ ੼ ૜ ޘ ਌ క Ϩ ᓙ ׽ ዔ ( non-HDL-C=total cholesterol - HDL-C ) ࠎѨࢋϫ ᇾ̈́੼૜ޘ਌కϨᓙ׽ዔࠎˬ৺ϫᇾ

Ąܧ੼૜

ޘ਌కϨΒ߁ໂҲ૜ޘ਌కϨăҲ૜ޘ਌కϨă

̚૜ޘ਌కϨ ( intermediate-density lipoprotein)̈́

਌కϨ ( a ) ( lipoprotein ( a ) )Ąѣ͛ᚥ೩΍ܧ੼

૜ޘ਌కϨᓙ׽ዔΞ፾ϲ࿰ീ͕ҕგְІ

̈́ᄃк ୧݄ېજਔঽଈ۰۞͕ඔ൭׶͕҉ୟ๫ѣᙯ

Ą NCEP ATPIII ࢎ΍ι۞ᇾ໤ߏҲ૜ޘ਌కϨᓙ׽

ዔΐ 30 mg/dl Ąధк྿זҲ૜ޘ਌కϨᓙ׽ዔᇾ

໤۞ଈ۰׎ܧ੼૜ޘ਌కϨᓙ׽ዔ̪੼Ąҋଂ

2001 ѐ NCEP ATPIII ೩΍ιࠎѨࢋϫᇾĂ̏ѣధ к૞छڦຍĄࢦࢋ۞ߏĂдฟؕෞҤڼᒚঽˠ۞

ҕ਌ள૱υืАଵੵѨ൴ّࣧЯĂтᘽۏă̙༊

฼ࢴ়ٕঽٙౄј۞ҕ਌ள૱ඈĄҌٺՏ჌ҕ਌

۹۞ϫᇾࠎңĂ݋ᑕАᑒঽˠઇࢲᐍෞҤ ( ͽ Framingham risk scoring ( FRS ) ֽ௚ࢍঽˠ͕᝙ҕ გ 1 0 ѐ۞൴ϠПᐍத ) ĂГనؠঽଈ۞ϫᇾࣃ ( ֍ܑ˟ܑ̈́ˬ )

Ąͽ˭ಶ΃ᔁা࣏ཏҕ਌ள૱

۞ᘽۏڼᒚ׶˘ֱϫ݈дซҖ۞ྏរઇֱୃࢗĈ 1.HMG-CoA reductase inhibitor ( Statin )Ĉ

͹ࢋࢫҲҲ૜ޘ਌కϨĂ׎үϡ፟ᖼࠎԺט ք௟ࡪ̚ HMG-CoA ᔘࣧ Ăഴ͌дք᝙๊̼

HMG-CoA តј mevalonate Ă҃ mevalonate ࠎᓙ

׽ዔЪј۞݈ᜭۏĂࢫҲք᝙ᓙ׽ዔ۞ЪјĂౄ

јք௟ࡪ΃ᐺّгᆧΐ௟ࡪܑࢬ۞Ҳ૜ޘ਌కϨ ତצጡᇴϫĂซ҃ഴ͌ҕ̚۞ᓙ׽ዔ

Ąੵ˞Ξ

྿זࢫҕ਌۞͹ࢋϫᇾγĂ˵ΞࢫҲ጖ҕّۏ ኳăࢫҲ൴ۆّۏኳăԺטҕ̈ڕ጖ะăԼච̰

ϩ௟ࡪΑਕ̙։̈́Ժטπ໣҉۞ᆧϠĂֹ҃જਔ

೹๴ᘦؠĄ఺ᙷᘽݡѣ Lovastatin ( Mevacor® )ă S i m v a s t a t i n ( Z o c o r ® ) ă P r a v a s t a t i n ( M e v a l o t i n ®) ă F l u v a s t a t i n ( L e s c o l ® ) ă Atorvastatin ( Lipitor® ) ̈́ Rosuvastatin ( Crestor® ) ඈĄѩᙷᘽݡਕࢫҲҕ̚ᓙ׽ዔ 30-40 % ĂҲ૜ޘ

਌కϨ 18-55 % Ăˬᅕϟڵ⟯ 7-30% Ăൾ຋ᆧΐ੼

૜ޘᓙ׽ዔ 5-15% Ąҕ̚քΑਕ޽ᇴΞਕᆧΐĄ ΩγĂѩᙷᘽۏ۞̙։ͅᑕѣᐝ൭ă⪰͕̈́ি

ࢽĂᚑࢦॡΞਕົౄјፖ৳҉໘ྋ̈́ඪ਽ა

Ą

2.ញჯᅕࢉϠۏ ( Fibric Acid Derivatives ) ញჯᅕࢉϠۏ͹ࢋߏࢫҲҕ̚ˬᅕϟڵ⟯۞

፧ޘĂ׎үϡ፟ᖼإϏԆБ୻຾ĂΞਕࠎញჯ ᅕࢉϠۏᄃ P PA R - ɗତצវඕЪĂ҃జඕЪ۞

P PA R - ɗົܳซ௟ࡪ८۞ᖼᐂĂயϠ˘ాҚү ϡ

Ĉ( 1 ).ᆧΐ਌కϨᙷ਌ྋ ۞̶ྋ߿ّĂܳ

ซಱӣˬᅕϟڵ⟯۞਌కϨ۞̶ྋĄ( 2 ).Ժטք

௟ࡪ̚ˬᅕϟڵ⟯۞ЪјĂഴ͌ໂҲ૜ޘ਌కϨ ᓙ׽ዔ֭ͷΞֹ̈ͷቜ૜۞Ҳ૜ޘ਌కϨᓙ׽ዔ ᖼតࠎ̶̄ྵ̂۞Ҳ૜ޘ਌కϨᓙ׽ዔĄ( 3 ).ᆧ ΐ੼૜ޘ਌కϨᓙ׽ዔĄϫ݈૱ϡ۞ញჯᅕࢉϠ ۏѣ fenofibrate ( Lipanthyl®)ă gemifibrozil ( Lopid®)

̈́ bezafibrate ( Bezalip® )ĄѩᙷᘽݡਕࢫҲҕ̚

ˬᅕϟڵ⟯፧ޘ྿40-60 %Ăᓙ׽ዔ፧ޘࡗ5-20 %Ă

֭Ξᆧΐ੼૜ޘ਌కϨᓙ׽ዔ፧ޘ 15-25% Ąѩᙷ ᘽۏ۞̙։ͅᑕΒ߁ϩቲৃăཛ൭ă⪰͕ăཛᕫă ယФ̈́ҕ̚քΑਕ޽ᇴ̿੼ĄញჯៃࢉϠۏົԼត ᓙϗјЊĂౄјᆧΐᓙඕϮ൴Ϡத۞ΞਕّĂЯѩ ଈᓙඕϮٕք၁ኳ়ঽঽˠጐณᑕᔖҺֹϡĄ఺ᙷ ᘽۏ˵ົΐૻ W a r f a r i n ۞ԩ጖ҕүϡ

Ą ԯ Gemfibrozil 1200mg/day ϡٺ̏ѣ݄͕ঽ Ъ׀Ҳ۞੼૜ޘ਌కϨᓙ׽ዔ۞ঽˠĂд T h e Veterans affairs HDL Intervention Trial ( VAHIT ) ̚

൴னĂд՟ѣព඾ࢫҲҲ૜ޘ਌కϨᓙ׽ዔ۞ଐ ڶ˭ĂΞព඾ࢫҲ͕ҕგְІ۞൴Ϡத

Ą൒҃

д FIELD ܐ৺࿰֨ࡁտ൴னĂ 9795 ࣎ௐ˟ݭᎤ Ԍঽঽˠֹϡ fenofibrate Ă੠ᖸ̣ѐޢ̙֭ਕഴ

͌࡭Ѫّ͕҉ୟ๫ٕٙѣࣧЯѪ˸த ( all-cause mortality )

Ąд˘ֱࡁտ൴னĂЪ׀ atorvastatin and fenofibrate ΞԼචҕ਌ள૱ĂࢫҲ΃ᔁّা

࣏ཏ̈́ 10 ѐ͕ҕგְІ۞൴Ϡத

Ą

ϫ ݈ ѣ ᓜ Ԗ ྏ រ ͧ ྵ ញ ჯ ᅕ ࢉ Ϡ ۏ ΐ ˯ statin ᘽۏᄃಏ˘ statin ᘽۏϡٺᎤԌঽଈ۰д ܐ৺࿰݄͕֨ঽң۰ྵр- A c t i o n t o C o n t r o l Cardiovascular Risk in Diabetes ( ACCORD ) trial Ă ඕڍົ੠ᖸז 2010 ѐ

Ą

3.ඵែᅕ ( Nicotinic Acid )

ඵែᅕಶߏჯϠ৵ B3 Ă͹ࢋᆧΐ੼૜ޘ਌

కϨᓙ׽ዔĂ׎үϡ፟ᖼࠎдք᝙ԺטໂҲ૜ޘ

਌కϨᓙ׽ዔЪј̈́ഴ͌ฉᙝഫᗓ਌۹ᅕĄඵែ

ᅕΩγѣԩউ̼̈́ԩ൴ۆүϡ

Ąϫ݈ѣܜड़ݭ

ඵែᅕ Niaspan 2g Ă׎ઘүϡྵ͌Ąѩᙷᘽݡਕ ᆧΐ੼૜ޘᓙ׽ዔ 1 5 - 3 5 % ĂࢫҲˬᅕϟڵ⟯

20-50 % ̈́Ҳ૜ޘ਌కϨ 5-25 %

Ąඵែᅕ͹ࢋઘ үϡ૱ѣࢬొ̈́֗វሗࡓன෪Ăֹϡ݈Ξڇϡ͌

ณ Aspirin ͽഴ̙͌ዋĄ׎΁ઘүϡΒ߁བࡤ̙

ዋă੼Ԍᅕă൭ࢲăքΑਕ޽ᇴᆧΐ̈́ཬ෈Ꭴ࡝

צָّ̙ඈĄѣ͛ᚥ޽΍˘Ηঽˠڇᘽ 7 ͇̰ѣ

֗វሗࡓன෪Ă҃఺჌ன෪ߏౄјҋҖઃᘽ۞͹

ࢋࣧЯ

Ą

д ARBITER-2 ࡁտ

Ăֹϡܜड़ݭ niacin 1000mg/day ϡٺ̏Ы statin ᘽۏ۞ঽˠĂΞᆧΐ

੼૜ޘ਌కϨᓙ׽ዔ 21% ( compared with baseline level )Ăؼቤᐚજਔ̰ቯඓېർ̼ ( carotid intimal atherosclerosis ) ᆧݓĄ

ϫ݈ѣ˘າᘽ laropiprant Ăࠎ݈ෘཛྷ৵ D2 ତצጡ-1 ۞޻ԩ጗ĂιਕૉࢫҲඵែᅕጱ࡭֗វ ሗࡓன෪Ą C o r d a p t i v e ® ߏ˘჌૟ඵែᅕ׶

laropiprant ඕЪд˘੓۞ᘽۏĂϫ݈̏Ш FDA ೩

΍ϦኛĄ Cordaptive® ѣ˟࣎ࡁտϒдซҖĈ 1.

Treatment of HDL to Reduce the Incidence of Vascular Events ( HPS2-THRIVE ) д̏ତצࢫҲ૜

ޘ਌కϨڼᒚ۞ঽˠĂΐ˯ Cordaptive ߏӎਕഴ

͕͌᝙ঽ൴үĂ̚ࢲٕତצҕგГ఼ఙ ( revascu- larization procedure )

Ą 2. An Assessment of Coronary Health Using an Intima-Media Thickness Endpoint for Vascular Effects ( ACHIEVE )Ăдள ݭତЪ̄۞छ୉ّ੼ᓙ׽ዔҕাֹϡ Cordaptive ߏӎΞԼតᐚᓁજਔ̰ቯ̚ᆸݓޘ

Ą

ඵែᅕд΃ᔁা࣏ཏ۞ࡁտĈ Dr. Thoenes ඈˠќะ 50 ࣎ŵ 18 ໐௑Ъ΃ᔁা࣏ཏଈ۰ ( AT- PIII criteria )ĂӮ൑ڇϡ statin ᘽۏĂઇᗕ۠ྏ

រâ௡ගщᇐ጗â௡ගඵែᅕВ៍၅ 5 2 ฉ Ă ൴ ன ၁ រ ௡ ۞ Ҳ ૜ ޘ ਌ క Ϩ ᓙ ׽ ዔ ࢫ Ҳ 1 7 % Ă੼૜ޘ਌కϨᓙ׽ዔᆧΐ 24% Ăˬᅕϟ ڵ⟯ࢫҲ 23% Ă൴ۆ޽ᇴ-੼ୂຏޘ C ͅᑕకϨ ( high-sensitivity CRP ) ࢫҲĂҕგනૺΑਕᆧ ΐĂᐚᓁજਔ̰ቯ̚ᆸݓޘഴ͌ ( P Ŵ 0.001 )Ă

҃۩ཛҕᎤࣃ݋˟௡՟ѣमளĄඕኢĈඵែᅕΞ ഴҲજਔඓېർ̼ĂԼචҕგ̰ϩΑਕ҃၆΃ᔁ

া࣏ཏѣ˘ؠ۞ᑒӄ

Ą

ϫ݈ѣᓜԖྏរͧྵඵែᅕΐ statin ( Simva-

statin ) ᘽۏ׶ಏ˘੼጗ณ statin ( Simvastatin ) ᘽ ۏдҕ਌۹۞ᇆᜩ̈́ᐚજਔඓېർ̼ĄВ̶јˬ

௡ĂВ 75 ˠĈ

( 1 ) Simvastatin 20 mg daily and placebo, ( 2 ) Simvastatin 80 mg daily and placebo niacin,( 3 ) Simvastatin 20 mg daily and active niacin 2g daily.

੠ᖸ˘ѐޢĂ( 2 ) ( 3 ) ௡дࢫҲҲ૜ޘ਌కϨᓙ

׽ዔ՟ѣमளĂࡗ 25-40% Ă҃׎ιтࢫҲܧ੼

૜ޘ਌కϨᓙ׽ዔăˬᅕϟڵ⟯ăໂҲ૜ޘ਌క Ϩᓙ׽ዔ˵՟ѣमளĄ( 3 ) ௡д੼૜ޘ਌కϨᓙ

׽ዔѣᆧΐҭᄃ ( 2 ) ௡൑ព඾मளĄ൒҃Ăௐ ( 3 ) ௡дࢫҲ lipoprotein ( a ) ( 18% ) ̈́ apolipopro- tein B ᄃ ( 1 ) ( 2 ) ௡ѣព඾मளĂ֭ͷдഴ͌̈

҃ቜ૜۞Ҳ૜ޘ਌కϨᓙ׽ዔă PAI-1 ᄃᆧΐ੼

૜ޘ਌కϨᓙ׽ዔ۞௕̄̂̈Ӯͧಏ˘ϡ statin ᘽۏрĂ҃఺ֱҕ਌ள૱ᄃ΃ᔁা࣏ཏѣ࠹ᙯĄ

۩ཛҕᎤࣃˬ௡՟ѣमளĄᔵ൒ᇹώᇴྵ̈Ă͹

ࢋ۞ࡁտϫ۞ ( primary end point ) ̪ޞ̶ژඕ ڍĂҭ఺࣎ྏរ೩ֻ˞ԧࣇڼᒚણ҂

Ą

ϫ݈ѣᓜԖྏរͧྵܜड़ඵែᅕЪ׀ statin ( Simvastatin ) ᘽۏᄃಏ˘ statin ᘽۏң۰д࿰֨

݄͕ঽң۰ྵр- Atherothrombosis Intervention in M e t a b o l i c S y n d r o m e Wi t h L o w H D L / H i g h Triglycerides and Impact on Global Health Outcomes ( AIM-HIGH )Ąιߏк͕̚ăᐌ፟ᗕ۠ăπҖ၆

໰ࡁտĂВ 3300 ˠĂӮ෹࿅ 45 ໐ͷѣҕგ়ঽ

׶࡭જਔඓᇹർ̼ள૱਌ҕা ( atherogenic dys- lipidemia )Ą͹ࢋ۞ࡁտϫ۞ࠎ݄͕ঽѪ˸ăܧ

࡭Ѫّ۞͕҉ୟ๫ă৿ҕّ̚ࢲٕЯާّ݄͕া

҃ҝੰĂඕڍົ੠ᖸז 2010 ѐ

Ą 4.Omega-3 ਌۹ᅕ

Я Omega-3 ਌۹ᅕົԺטໂҲ૜ޘ਌కϨ

۞ᄦౄĂЯѩ̂጗ณֹϡĂΞͽڼᒚЯໂҲ૜ޘ

਌కϨᓙ׽ዔ፧ޘᆧΐ۞੼ˬᅕϟڵ⟯ҕাĄѩ ᘽ˵ΞͽᖣϤԼត݈Еཛྷ৵۞΃ᔁֽഴ͌ҕং۞

ПᐍĄ౦ڵ۞͹ࢋјЊΒ߁ Omega-3 ݭܜᙥк

̮̙࿸׶਌۹ᅕ EPA ̈́ DHA âਠՏֹ͇ϡ౦ ڵ 20-30 ̳ҹಶѣड़ڍĄѩᙷᘽۏ۞̙։ͅᑕѣ བࡤ̙ዋĂтཛᕫă⪰͕ăယФඈ

Ą

ፂࡁտĂ౦ڵд͕҉ୟ๫ޢ۞ঽˠѣ࿰֨↢

Ѫ۞р఍

Ą

ϫ݈ѣᓜԖྏរ Japan EPA Lipid Intervention Study ( JELIS ) Вќะ 19,466 ˠĂ 5859 Ҝշّ׶

12786 Ҝّ̃Ą׎̚ 9326 ˠՏ͇Ы੼጗ณ 1800 ୮ҹ EPA Ă҃ 9319 ˠࠎ၆໰௡Ąд఺ྏរٙѣ ˠӮѣЫҲ጗ณ statin ᘽۏͷπӮҲ૜ޘ਌కϨ ᓙ׽ዔ፧ޘࠎ 183 mg/dl Ą੠ᖸ 4.6 ѐĂЫ EPA ۞

֤˘௡ѣ 19% ࢫҲ Major coronary events Β߁͕

ЯّѪ˸ă͕҉ୟ๫ٕГତצҕგГ఼ఙĄ̶ژ

˟௡дҲ૜ޘ਌కϨࢫҲ՟ѣព඾मளĂҭˬᅕ ϟڵ⟯ѣព඾मள ( 9% vs 4%, P Ŵ 0.0001)ĄϤٺ

͟ ώ ˠ ೼ ࿆ Ы ౦ Ă ߇ ˘ ਠ ᄮ ࠎ Ը ̟ ੼ ጗ ณ Omega-3 ਌۹ᅕѣᗝγड़ڍ

Ąѣጯ۰ᄮࠎр఍

ֽҋࢫҲ͕ޠ̙ፋ፟தăԩ੼ҕᑅăԩҕংăԩ

൴ۆ̈́ࢫˬᅕϟڵ⟯үϡ

Ąᔵ൒тѩĂ̪ѣޢ న̶ژڱ۞͛ᚥᄮࠎྃ· Omega-3 ਌۹ᅕ൑ڱ ࢫҲ͕ҕგְІٕѪ˸

Ą

5.Thiazolidinedione ᙷ ( TZD )

TZD ಶߏ਍फ৵ᆧୂ጗(insulin sensitizer)Ă Яѩֹϡ఺჌ᘽۏΞԼච਍फ৵޻ԩĂΞ࿰֨΃

ᔁ ّ া ࣏ ཏ ۞ ଈ ۰ ซ Җ Ҍ ௐ ˟ ݭ Ꭴ Ԍ ঽ Ą Thiazolidinediones ᙷᘽۏ̶Ҿࠎ pioglitazone ( Actos® ) ̈́ rosiglitazone ( Avandia® )Ą

Thiazolidinediones ᙷᘽۏѣˬ჌۞үϡ፟

ᖼ

Ĉ( 1 ).TZD ߿̼ peroxisome proliferator-ac-

tivated receptor ( PPAR ) -əତצវĂΞᆧΐ਌క Ϩᙷ਌ྋ ۞̶ྋ߿ّĂࢫҲҕ̚۞ˬᅕϟڵ

⟯ă਌۹ᅕĂᆧΐ੼૜ޘ਌కϨᓙ׽ዔ֭ͷΞͽ

૟̈҃ቜ૜۞Ҳ૜ޘ਌కϨᓙ׽ዔᖼೱј̂۞̶

̄Ą( 2 ).TZD ᄃ PPAR-əତצវඕЪĂགྷϤ௟ࡪ ८۞ᖼᐂĂЪјᄃ਌ኳ΃ᔁăཬ෈Ꭴѣᙯ۞కϨ ኳĂᆧΐք᝙ă੻ᐪ҉ă਌۹௡ᖐ၆਍फ৵۞ͅ

ᑕĂ߇ΞԼච਍फ৵޻ԩଐԛĄ( 3 ).TZD ˵׍ѣ ԩ൴ۆүϡĂЯιΞഴ͌ TNF-ɗ۞யϠăഴ͌

CRP ̈́λጥ஧۞ᇴϫĄ

Thiazolidinediones ˟჌ᘽۏ̶̙੕ྸĂҭѣ ᓜԖྏរͧྵ൴னĂ Pioglitazone ׶ rosiglitazone

׌჌ᘽۏ၆ٺҕ਌۞ड़ڍ̙ТĄྏរඕڍĂ pi- oglitazone ͧ rosiglitazone ՀਕԼචҕ਌ள૱ĂΒ ߁ࢫҲˬᅕϟڵ਌ĂҲ૜ޘ਌కϨᓙ׽ዔͽ̈́̿

੼੼૜ޘ਌కϨᓙ׽ዔĄѩྏរВࠎഇ 24 ฉĂ Βӣ 802 ҜТॡଈѣௐ˟ݭᎤԌঽ̈́੼ҕ਌۞ঽ

ˠĄВ̶ј׌௡â௡Տֹ͟ϡ 30 mg pioglita- zone 12 ฉĂ౺˭ 12 ฉֹϡՏ͟ 45 mg ĄΩ˘௡

݈ 12 ฉՏֹ͟ϡ 4 mg rosiglitazone Ă ౺˭ 12 ฉ Տ͇׌Ѩ 4 mg ĄྏរඕՁޢĂ HbA1c ࢫҲ࠹༊

( pioglitazone ௡ 0.7%, rosiglitazone ௡ 0.6%)Ą൒

҃Ă p i o g l i t a z o n e ࢫҲˬᅕϟڵ਌ 1 2 % Ăҭ rosiglitazone ᆧΐˬᅕϟڵ਌ 14.9% ( p Ŵ 0.001 )Ą

׌჌ᘽۏӮᆧΐ੼૜ޘ਌కϨᓙ׽ዔĂҭ piogli- tazone ͧ rosiglitazone ᆧΐՀк ( 14.9 vs. 7.8%, p Ŵ 0.001 )Ą׌჌ᘽۏӮᆧΐᓁᓙ׽ዔ̈́Ҳ૜ޘ਌

కϨᓙ׽ዔĂҭ pioglitazone ᆧΐ۞಼ޘྵ͌

Ą ϫ݈ѣ͛ᚥޙᛉѩᘽΞϡٺܧᎤԌঽҭѣ੼

͕ҕგࢲᐍ۞΃ᔁা࣏ཏଈ۰

Ą Thiazolidine- diones ۞ઘүϡѣΞਕౄј੻Զ ( ّ̃ )

ăք߲

ّĂЯѩࡶঽଈ ALT ̂ٺ 2.5 ࢺϒ૱ࣃٕ߿જّ

ք়ঽĂ݋̙ΞֹϡĄϤٺѩᘽ˵ົౄјͪཚЯ ѩ ̙ ዋ ϡ ٺ ͕ ਽ ა Ƿ ٕ Ǹ ৺ ۞ ଈ ۰ Ą ൒ ҃ Ă TZD ᘽۏ۞щБّ̪ѣۋᛉĄд 2007 ѐ JAMA

۞˘ቔ૰ёঽּ၆໰̶ژ ( nested Case-Control analysis ) а໖ّ͵΃ࡁտ޽΍

Ă̶ژ 159026 ࣎

෹࿅ 65 ໐۞ᎤԌঽଈ۰Ăͧྵֹϡ TZD ᄃιᙷ ࢫҕᎤᘽߏӎౄј͕ҕგ̙։ְІĂπӮ੠ᖸ 3.8 ѐĂ൴னֹϡ TZD ᘽۏ ( ͹ࢋߏ޽ rosiglita- zone ) ົᆧΐ͕਽აă͕҉ୟ๫̈́Ѫ˸۞፟தĄ

఺ቔࡁտ۞ࢨטдٺΞਕѣᏴᇹઐम ( Selection b i a s ) ٕ TZD ۞ڼᒚ୉ཏྵҁٕྵᚑࢦ۞ᎤԌ ঽĄԧࣇᅮࢋՀк۞ᙋፂֽᙋ၁ TZD ᄃ͕ҕგ

়ঽ۞ᙯܼĄϫֹ݈ϡѩᘽۏ݈ᑕϤᗁरෞҤ׎

ࢲᐍ ( ͍׎ѣ͕᝙়ঽ۰ ) ᄃᓜԖड़ৈયᗟĂࡶ

ᓜԖड़ৈ੼ٺࢲᐍĂΞ҂ᇋֹϡĄ 6.Rimonabant

ϫ݈ξࢬ˯ѣ˟჌ FDA ᄮΞ̝ഴ۲ᘽĂ̶

Ҿࠎ Orlistat ̈́ Sibutramine Ă݈۰ഴ͌ࢴۏ̚਌

۹۞ӛќ҃ޢ۰ࢫҲࢴᇒ̈́ᆧΐ΃ᔁதĂֹϡ 1- 2 ѐΞഴᅅវࢦ 5-10% Ą Rimonabant ߏ˘჌ྏរ

̚۞ഴ۲ᘽĂࠎᏴፄّௐ˘ݭ̂౫צវ޻ԩ጗

( type 1 cannabinoid receptor blocker ) ϡֽڼᒚк ࢦ͕ҕგ΃ᔁࢲᐍЯ̄Β߁ཛొ۲ࡡă΃ᔁা࣏

ཏ̈́ҕ਌ள૱ĄιΞᆧΐ੼૜ޘ਌కϨᓙ׽ዔ

19% ࢫҲˬᅕϟڵ਌ 16%

Ą׎үϡ፟ᖼΞਕࠎ

Ժט˭ෛ͸யϠࢴᇒăഴ̰͌Ϡّ̂౫৵ր௚࿅

ޘ߿̼̈́ܳซཛొ਌۹̶ྋĄѩγĂܐՎࡁտ˵

ΞࢫҲӛඵᇒ୕ѣᑒӄԦ໬̝үϡ

Ą

д R I O - L i p i d s ă R I O - E u r o p e ă R I O - Diabetes ăᄃ RIO-North America ௐˬഇྏរ̚Ӯ ᙋ၁၆ٺ࿅ࢦ/ ۲ࡡଈ۰Տ͇ڇϡ 5 - 2 0 ୮ҹ r i - monabant ੨ЪҲΙ฼ࢴВ˘ѐΞഴᅅវࢦăഴ

͌ཕಛăഴ͌ˬᅕϟڵ⟯ăࢫҲᎤ̼ҕҒ৵̈́ᆧ ΐ੼૜ޘ਌కϨᓙ׽ዔĂ˵ಶߏᄲ၆΃ᔁা࣏ཏ ଈ۰ѣр఍

Ąࣃ଀ڦຍ۞ߏд R I O - N o r t h America

ྏរ̚Ăௐ˘ѐڇϡ 20 ୮ҹ rimona- bant ҃ௐ˟ѐԼڇщᇐ጗ĂঽˠົೇࡡĄ

Rimonabant ͔ٙ੓۞̙։ͅᑕΒ߁⪰͕ă ཛᕫăଐჰҲརă൏ᇋ̈́ຶোĂдᚑࢦإϏଠט

۞ჟৠঽଈ̙ޙᛉֹϡĄϫ݈ᔵ̏פ଀ለ༖˯ξ ధΞĂϡٺ࿅ࡡЪ׀ѣᎤԌঽٕҕ਌ள૱дྻ

જă฼ࢴγ۞ᅃӄڼᒚĄҭ FDA إϏ८ΞĂࣧ

Яߏι۞ܜഇड़ڍࣃ଀޺ᜈෞҤ̈́щБّѣႷ ᇋ-Ξਕѣჟৠ়ঽ۞ઘүϡĂтҋ୭ăڷಉඈ

ٕৠགྷ͞ࢬ۞ઘүϡΒ߁ឩ⿔

Ą

ϫ݈ϒдซҖ۞ྏរѣ R A P S O D I

ă ARPEGGIO

ă CRESCENDO

Ą RAPSODI ߏд ۲ࡡଈ۰ѣཬ෈Ꭴ̙࡝Ăֹϡ Rimonabant ߏӎ ਕ࿰֨ᎤԌঽயϠĄ ARPEGGIO ߏдϡ਍फ৵ ڼᒚ۞ᎤԌঽଈ۰ֹϡ R i m o n a b a n t ߏӎѣᑒ ӄĄ CRESCENDO ߏෞҤ 17000 ˠдତצ 20 ୮ ҹ rimonabant ߏӎਕࢫҲࢦ͕̂ҕგְІĂ੠ᖸ ࠎഇ̣ѐĄ

7.׎ιฟ൴̚ᘽۏ

( 1 ) ᓙ׽ዔ⟯ᖼೱకϨԺט጗ ( CETP in- hibitor ) -torcetrapib

Torcetrapib ߏᓙ׽ዔ⟯ᖼೱకϨԺט጗ĂΞ

ֹវ̰੼૜ޘ਌కϨᓙ׽ዔچ੼ ( 16-91% )

׶Ҳ

૜ޘ਌కϨᓙ׽ዔࢫҲĄ Pfizer ̳Φ၆ 15,000 Щ ঽଈซҖາᘽ t or c et r api b ᓜԖྏរ- I L L U M I - NATE ( Investigation of Lipid Level Management to Understand its Impact in Atherosclerotic Events ) trial Ă֭̏൴णҌௐ 3 ล߱

Ą၁រ̶˟௡ͧྵ

torcetrapib ΐ˯ atorvastatin ტЪᘽᄃಏ፾ϡ ator- vastatin дҕ਌۹۞ଠטң۰ྵрĂඕڍΗᇴঽ ଈֹϡ torcetrapib ΐ˯ atorvastatin ۞֤˘௡Ăѣ 82 ЩѪ˸ćΩΗᇴ่ಏ፾ֹϡ atorvastatin ۞ঽ

ଈĂѣ 51 ЩѪ˸ĄЯࠎ࡭Ѫதྵ੼Ă఺࣎ࡁտ

̏೩݈ͤ̚Ą̶ژ൴னֹϡტЪᘽ֤௡ঽଈҕᑅ

۞ќᒺᑅĂர੼ٺಏ፾ֹϡ atorvastatin ۞ঽଈ 4 . 6 m m h g ĄҌٺ࡭Ѫதྵ੼۞ࣧЯϫ݈̪Ϗ

ۢĂΞਕҕᑅౄј۞̙։ͅᑕٕயϠ൑Αਕ۞੼

૜ޘ਌కϨᓙ׽ዔ

Ą ( 2 ) PPAR-alpha agonists

ញჯᅕࢉϠۏߏ PPAR-ɗତצវऴ۞үϡ጗

( weak agonist)âਠᄮࠎтڍѣາᘽΞͽૻड़ͷ Ᏼፄّүϡд PPAR-ɗତצវĂֽࢫҲˬᅕϟڵ

਌̈́̿੼੼૜ޘ਌కϨᓙ׽ዔĂͽ݄֨ͤېજਔ ඓᇹർ̼ᑕྍົͧញჯᅕࢉϠۏѣड़Ą Eli Lilly

̳Φࡁ൴΍ LY518674 Ăѣ˟࣎ௐ˟ഇྏរ̶Ҿ ߏ Atherogenic dyslipidemia study ( 309 ˠ ) ׶ The hypercholesterolemia study ( 304 ˠ )

ĄдᓜԖ݈

ࡁտ̚Ă LY518674 ۞ड़˧ͧ fenofibrate ੼ 10000 ࢺ Ă ҭ ߏ Ă ᓜ Ԗ ࡁ տ ֭ ՟ ѣ ព ΍ Ї ң ᐹ ๕ Ą Atherogenic dyslipidemia study ൴ன LY518674 ׶ fenofibrate ౌਕព඾۞ࢫҲˬᅕϟڵ਌Ăҭ՟ѣ

௚ࢍጯमளć fenofibrate Ξ̿੼੼૜ޘᓙ׽ዔ҃

L Y 5 1 8 6 7 4 ̿੼඀ޘ݋Я጗ณ҃ؠĂҭ˵ᄃ fenofibrate ՟ѣमளćдѩࡁտ̚Ă LY518674

ົᐌ጗ณ۞ᆧ੼҃ᆧΐҲ૜ޘ਌కϨ፧ޘĂҭ fenofibrate ݋൑ځពត̼Ąд The hypercholes- terolemia study ಏ፾ֹϡ LY518674 ົࢫҲˬᅕϟ ڵ਌ă̿੼੼૜ޘ਌కϨᓙ׽ዔ̈́ࢫҲҲ૜ޘ਌

కϨᓙ׽ዔĂҭߏ൴னᄃ Atorvastatin Ъ׀ֹϡ д ࢫ Ҳ Ҳ ૜ ޘ ਌ క Ϩ ͅ ҃ ՟ ѣ ͧ ಏ ፾ ϡ Atorvastatin рĄѩγࡁտ൴ன LY518674 Ξਕΐ ࢦඪΑਕຫचĂ఺ֱඕڍѣΞਕඕՁѩາᘽ۞׻

ྻĄ

( 3 ) ApoA-I mimetics

ApoA-I ߏវ̰ഫᗓᓙ׽ዔ۞ྶវĂߏ੼૜

ޘ਌కϨᓙ׽ዔ۞͹ࢋ௡јј̶Ąϫ݈ѣ D-4F ᘽۏߏ˘჌ 18-amino acid peptide Ăሀϼ ApoA-I ඕၹĂι̙ົజབࡤঐ̼ ̶ྋĂ߇Ξͽ˾

ڇĄдજۏ၁រᙋ၁ΞԼචඓېજਔർ̼

Ąϫ

݈ѣ˘ֱѝഇᓜԖྏរᙋ၁Ξᆧΐ੼૜ޘ਌కϨ ᓙ׽ዔԩ൴ۆΑਕ

ĄజಡӘ۞̙։ͅᑕѣᆄݟ

൴ۆ ( nasopharyngitis ) ( 11% )ăکԌ྽ຏߖ ( 8% )

ඈĄ

8.тңᏴፄᘽۏ

Ϥٺ΃ᔁা࣏ཏߏ˘Ϡ ( Life time ) ͕᝙ҕგ

়ঽ۞ࢲᐍĂ҃ FRS Ξ࿰ീ 10 ѐ͕᝙ҕგ়ঽ

۞ࢲᐍĄࣧ݋˯ĂԧࣇᑕАϡ F R S ֽΐͽҿҾ

੼ă̚ăҲࢲᐍĈ੼ࢲᐍࢋ੺˯ϡᘽĂ̚ޘࢲᐍ

҂ᇋϡᘽĂҲࢲᐍ݋Ϡ߿ݭၗ۞ԼតĄϤٺ΃ᔁ

া࣏ཏଈ۰វ̰Ҳ૜ޘ਌కϨᓙ׽ዔ፧ޘ఼૱ࠎ ϒ૱ٕൾ຋ᆧΐĂд྿זࢫҲҲ૜ޘ਌కϨᓙ׽

ዔ۞ϫᇾޢĂܧ੼૜ޘ਌కϨᓙ׽ዔಶΞਕࠎ఍

ந۞ϫᇾĄ҃ග̟ᘽۏѣ˟჌͞ёĈΐૻ statin

጗ณٕ statin ᄃ׎ιᘽۏЪ׀ڼᒚ

Ăтඵែᅕ ( Ҳ۞੼૜ޘ਌కϨᓙ׽ዔ )ă Omega-3 ਌۹ᅕ ( ѣ݄͕ঽ )ăញჯᅕࢉϠۏ ( ੼ˬᅕϟڵ⟯ҕ

াĂޙᛉ fenofibrate )Ăϫ݈Ϗѣ̂ݭྏរ̶΍

ң჌͞ёྵрĄ̙გᏴፄң჌͞ёĂ̪ࢋ૜̷੠

ᖸঽˠă៍၅ᘽۏ۞ઘүϡ̈́ߏӎ྿זࢫҕ਌ϫ ᇾĄтڍߏঽၗّ۲ࡡ ( morbid obesity; BMI Ÿ 40 ) ଈ۰Ă˵Ξ҂ᇋഴ۲͘ఙ

Ą

ඕኢ

Ϥٺ΃ᔁّা࣏ཏΞᆧΐ 2.4-3.4 ࢺ۞͕᝙

ҕგᎮঽத

ĂЯѩѝഇᎡᏴ΃ᔁّা࣏ཏĂѝ ഇ೩ֻڼᒚٕ኎ିಶΞͽѣड़۞࿰֨ௐ˟ݭᎤԌ ঽ͕̈́᝙ҕგ়ঽ۞൴ϠĄЯࠎ F R S ̙Βӣཕ ಛ۲ࡡă੼ˬᅕϟڵ⟯ٕ۩ཛҕᎤ፧ޘ࿅੼Ă߇

΃ᔁّা࣏ཏ۞ؠཌྷؼҩ˞ԧࣇ၆ٺ͕ҕგ়ঽ ࢲᐍ۞ෞҤĄ΃ᔁّা࣏ཏ۞ҕ਌ள૱˵఼૱ߏ NCEP ATP III ۞ࢫҲҕ਌ѨࢋϫᇾĄԧࣇд྿ז Ҳ૜ޘ਌కϨᓙ׽ዔ۞ڼᒚϫᇾޢĂ˵ࢋ၆Ѩࢋ

ϫᇾΐͽڼᒚĄੵ˞Ϡ߿ݭၗ۞ԼតγĂԧࣇᑕ Ա΍੼͕ҕგ়ঽࢲᐍ۞ଈ۰Ăዋॡග̟ᘽۏڼ ᒚĂͽ࿰͕֨ҕგְІ۞൴ϠĄ

ણ҂͛ᚥ

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Evidence in the Treatment of Dyslipidemia in the Metabolic Syndrome

Li-Chin Sung, and Ji-Hung Wang

The metabolic syndrome is a cluster of cardiovascular risk factors as characteristic and correlated with car- diovascular disease and the development of the diabetes mellitus. The characters of dyslipidemia are the hy- pertriglyceridemia, low high-density lipoprotein cholesterol and small dense low-density lipoprotein cholesterol.

As to the patient having a cardiovascular disease (such as coronary artery disease, stroke, or peripheral artery occlusion) or the diabetes mellitus, the 2001 National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III suggests reducing the serum low-density lipoprotein cholesterol with statin. However, there re- mains a relatively high residual risk of morbidity or mortality in patients with the metabolic syndrome or diabetes mellitus, and this is of growing importance because of the increasing prevalence of obesity and its associated co- morbidities in the world. The treatment to achieve aggressive goals is of paramount importance. This article re- views pathophysiology and emerging therapeutic strategies for the management of dyslipidemia in patients with the metabolic syndrome. ( J Intern Med Taiwan 2008; 19: 305-317 )

Division of Cardiology, Department of Internal Medicine,

Buddhist Tzuchi Medical Center, Hualien, Taiwan