循環器系医学雑誌では世界最高峰と言われる欧州心臓病学会誌に、循環器グループの多田隼人助教の原著論文が3年連続で採択されました！

原著論文

多田隼人　助教（循環器グループ）

Serum Triglycerides Predict First Cardiovascular Events in Diabetic Patients with Hypercholesterolemia and Retinopathy

Hayato Tada, MD, Masa-aki Kawashiri, MD, Akihiro Nomura, MD, Kenichi Yoshimura, PhD, Hiroshi Itoh, MD, Issei Komuro, MD, Masakazu Yamagishi, MD.

Eur J Prev Cardiol. 2018;30:2047487318796989. doi: 10.1177/2047487318796989.

Abstract
Aims: LDL cholesterol predicts cardiovascular events in patients with diabetes. However, it is uncertain whether serum triglycerides level is also associated with an occurrence of future cardiovascular events in diabetic patients. We aimed to test whether serum triglycerides is associated with first cardiovascular events in diabetic patients.
Methods and Results: We recruited 5,042 participants with diabetes mellitus from the standard versus intEnsive statin therapy for hypercholesteroleMic Patients with diAbetic retinopaTHY (EMPATHY), multicenter, prospective, randomized, open-label, blinded-endpoint study. Median follow-up was 3 years. We evaluated an association of serum triglycerides with first cardiovascular events in cox-regression hazard models adjusted by age, sex, hypertension, current smoking, LDL cholesterol, and body mass index. Cardiovascular events were defined as 1) major adverse cardiac events (MACE) including myocardial infarction, stroke, or cardiac death; and 2) cardiovascular diseases (CVD) including myocardial infarction, unstable angina, ischemic stroke, or large artery disease or peripheral arterial disease. Serum triglycerides were associated with MACE (adjusted hazard ratio [HR]: 1.021 per 10 mg/dL; 95% confidence interval [CI]: 1.007―1.035; p=2.5×10-3) and CVD (adjusted HR: 1.023 per 10 mg/dL; 95% CI: 1.013―1.034; p=7.7×10-6). Compared top quintile (>185 mg/dL) with bottom quintile (<79 mg/dL), adjusted HR increased 1.89 (95% CI: 1.03―2.80, p=0.04) for MACE, and 1.90 (95% CI: 1.18―3.07, p=7.0×10-3) for CVD. There were no overall interactions of triglycerides and treatment assignment (standard/intensive statins) on both outcomes (p-trend = 0.33 for MACE, p-trend = 0.62 for CVD).
Conclusions: Serum triglycerides were associated with first cardiovascular events among high-risk diabetes patients with hypercholesterolemia and retinopathy.

本論文では、本邦における糖尿病性網膜症及び高LDLコレステロール血症を有する高リスク1次予防例に対して全例にスタチンを投与し治療下でのトリグリセライド値が、日本人においてもいわゆる残余リスクかどうかを検討した研究です。外来でよく遭遇するスタチン投与下でのトリグリセライド186mg/dlを超える上述症例は89％のリスク増加を伴うことが示されました。本内容は、2018年3月に大阪で開催された第82回日本循環器学会会術集会Late Breaking Clinical Trialにおいてまず発表され、大きな反響を呼びました。
なお、2017年にはTada H, et al. Eur Heart J. 2017 May 21;38(20):1573-1579、2016年にはTada H, et al. Eur Heart J. 2016 Feb 7;37(6):561-7ということで、希少遺伝子変異、高頻度遺伝子多型と心臓病に関する原著論文が掲載されていますが、今回は臨床データによる原著論文掲載となりました。