所属 医学部 医学科（東京女子医科大学病院） 職種 特任教授
|発表タイトル||Impact of Type 2 Diabetes on Optimal Target LDL-C Level for Secondary Prevention of Cardiovascular Disease in Patients With Acute Coronary Syndrome: A Subanalysis of HIJ-PROPER|
|会議名||American Heart Association (AHA) Scientific Sessions 2017|
|主催者||American Heart Association|
|発表者・共同発表者||◎SEKIGUCHI Haruki, WATANABE Erisa, ARASHI Hiroyuki, YAMAGUCHI Junichi, OGAWA Hiroshi, HAGIWARA Nobuhisa|
|学会抄録||Circulation 136(Suppl 1),A18891 2017|
|概要||Introduction: Lipid-lowering therapy is essential for the secondary prevention of cardiovascular disease (CVD), especially in the setting of acute coronary syndrome (ACS). However, the impact of diabetes mellitus (DM) on optimal target LDL-C level for secondary prevention of CVD in ACS patients remains to be determined.
Methods: In the HIJ-PROPER study, we enrolled 1,734 ACS patients with dyslipidemia prospectively. Participants were randomly assigned to receive pitavastatin only or pitavastatin + ezetimibe and followed-up for an average of 3.86 years. The present study investigated the optimal LDL-C cut-off for secondary cardiac event prevention. We excluded patients who had a cardiac event 3 to 6 months before the first visit. Then, we performed multivariate Cox regression analysis of secondary cardiac events by using the average LDL-C over 36 months. In terms of the average LDL-C during follow-up period, cut-off values of LDL-C were divided three groups; high LDL-C (≥100 mg/dl), intermediate (70≤ <100 mg/dl), low (<70 mg/dl) according to contemporary treatment guidelines. We also analyzed patients with and without type2 DM (T2DM). The definition of primary endpoint was shown below.
Results: During the observation period, primary endpoints were documented in 450 patients. The high group had a significantly higher event rate than the other groups (P=0.043). In patients without T2DM (N=1044), the incidence of primary endpoint was significantly higher in high LDL-C than middle and low LDL-C patients (Figure A). However, in T2DM patients (N=445), there were no significant differences among three groups (Figure B).
Conclusions: Our results suggest that in ACS patients with dyslipidemia, T2DM has a great impact on optimal target LDL-C level in ACS patients. Subsequently, optimal target of LDL-C control level might be far lower than those of contemporary guidelines in such population.