Lipid Management in a Japanese Community: Attainment Rate of Target Set by the Japan Atherosclerosis Society Guidelines for the Prevention of Atherosclerotic Cardiovascular Diseases 2012
Tada H, Kawashiri MA, Nohara A, Inazu A, Kobayashi J, Yasuda K, Mabuchi H, Yamagishi M, Hayashi K.
J Atheroscler Thromb. 2017 Mar 1;24(3):338-345. 
Impact Factor (2016): 2.442
先の第81回日本循環器学会学術集会（2017年3月金沢）で採択された「金沢宣言：ストップCVD（心臓血管病）」が示す通り、本邦における心血管病の予防はますます重要となっています。私たち臨床家は日本動脈硬化学会が示す動脈硬化性疾患予防ガイドラインなどに従って疾病予防に取り組んでいますが、一般人口レベルで適切な指標コントロールが行われているかはデータが不足しています。
本研究では金沢市の8万人を超す健診データを用いた解析により、CVD予防のエビデンスが確立しているLDLコレステロールの管理状況について決して十分ではない現状を明らかにしました。特に慢性腎臓病を合併している方や、既にCVDを発症され二次予防を目的として管理されている方では目標に到達していないことが浮き彫りとなり、疾病予防を担う実地臨床家への警鐘を鳴らしています。
Abstract
AIM:
The Japan Atherosclerosis Society (JAS) guidelines for the prevention of atherosclerotic diseases 2012 (JAS2012) proposed lipid management targets; however, less data is available regarding the attainment rates of each target in community-based settings. Therefore, we assessed the attainment rates of lipid management targets among subjects who underwent Japanese specific health checkups.
METHODS:
A total of 85,716 subjects (male=29,282, 34.2%) aged 40-74 years who underwent specific health checkups from 2012 to 2014 in Kanazawa city, Japan, were included in this study. We evaluated the attainment rates of the lipid management targets according to the JAS2012 guideline and investigated the clinical characteristics of the subjects without achieving the targets.
RESULTS:
The target for LDL cholesterol (LDL-C) was the least attained in all risk categories, 89, 72, 50, and 34% for category I, II, III, and secondary prevention, respectively, in 2014. In addition, these rates inversely correlated with the grade of risk categories (p-value for trends ＜0.001). Attainment rate of the LDL-C target in the suspected chronic kidney disease (CKD) group was significantly lower than in the groups with diabetes, stroke, or absolute risk in category III (49.2, 60.3, 63.5, 54.4%, respectively, p-value ＜0.001 for each). Moreover, the attainment rate of the LDL-C target was significantly lower in subjects that did not receive lipid-lowering therapy than in those who received it in the secondary prevention (27.7 and 40.6%, respectively, p-value ＜0.001).
CONCLUSIONS:
Lipid management is inadequate in community-based settings, particularly, in subjects with CKD and secondary prevention.
