{"id":21595,"date":"2023-02-07T20:48:37","date_gmt":"2023-02-07T11:48:37","guid":{"rendered":"https:\/\/promea2014.com\/blog\/?p=21595"},"modified":"2023-02-07T20:48:37","modified_gmt":"2023-02-07T11:48:37","slug":"ldl%e3%82%b3%e3%83%ac%e3%82%b9%e3%83%86%e3%83%ad%e3%83%bc%e3%83%ab%e3%81%af%e4%bd%8e%e3%81%84%e3%81%bb%e3%81%a9%e8%89%af%e3%81%84%ef%bc%9f","status":"publish","type":"post","link":"https:\/\/promea2014.com\/blog\/?p=21595","title":{"rendered":"LDL\u30b3\u30ec\u30b9\u30c6\u30ed\u30fc\u30eb\u306f\u4f4e\u3044\u307b\u3069\u826f\u3044\uff1f"},"content":{"rendered":"

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PCSK9\u963b\u5bb3\u5264\u3068\u3044\u3046\u3082\u306e\u304c\u3042\u308a\u307e\u3059\u3002\u3053\u308c\u306f\u5f37\u529b\u306bLDL\u30b3\u30ec\u30b9\u30c6\u30ed\u30fc\u30eb\u3092\u4f4e\u4e0b\u3055\u305b\u307e\u3059\u3002\u305d\u306e\u6709\u52b9\u6027\u3092\u793a\u3057\u305fFOURIER\u8a66\u9a13\u304c\u3042\u3063\u3066\u3001\u4e0b\u306e\u56f3\u306e\u3088\u3046\u306b\u3053\u3053\u307e\u3067LDL\u30b3\u30ec\u30b9\u30c6\u30ed\u30fc\u30eb\u304c\u4e0b\u304c\u308a\u307e\u3057\u305f\u3002\uff08\u56f3\u306f\u3053\u3053<\/a>\u53c2\u7167\uff09<\/p>\n

\"\"<\/a><\/p>\n

\u30a2\u30c6\u30ed\u30fc\u30e0\u6027\u52d5\u8108\u786c\u5316\u6027\u5fc3\u8840\u7ba1\u75be\u60a3\u3067LDL\u30b3\u30ec\u30b9\u30c6\u30ed\u30fc\u30eb\u5024\u304c70 mg\/dl \u4ee5\u4e0a\u306e\u30b9\u30bf\u30c1\u30f3\u7642\u6cd5\u3092\u53d7\u3051\u3066\u3044\u308b27,564 \u4eba\u306e\u60a3\u8005\u3092\u5bfe\u8c61\u3068\u3057\u3066\u3044\u307e\u3059\u3002\u4e0a\u306e\u56f3\u306e\u3088\u3046\u306b\u3001PCSK9\u963b\u5bb3\u5264\u3067\u3042\u308b\u30a8\u30dc\u30ed\u30af\u30de\u30d6\u306fLDL\u30b3\u30ec\u30b9\u30c6\u30ed\u30fc\u30eb\u3092 59% \uff08\u30d9\u30fc\u30b9\u30e9\u30a4\u30f3\u306e\u4e2d\u592e\u5024 92 mg\/dL\u304b\u308930 mg\/dL\uff09\u6e1b\u5c11\u3055\u305b\u305f\u306e\u306b\u5bfe\u3057\u3001\u30d7\u30e9\u30bb\u30dc\u7fa4\u3067\u306f LDL\u30b3\u30ec\u30b9\u30c6\u30ed\u30fc\u30eb\u306f\u5909\u5316\u3057\u307e\u305b\u3093\u3067\u3057\u305f\u3002\u305d\u306e\u7d50\u679c\u306f\u6b21\u306e\u3088\u3046\u3067\u3059\u3002\u4e3b\u8981\u6709\u52b9\u6027\u30a8\u30f3\u30c9\u30dd\u30a4\u30f3\u30c8\u306f\u3001\u5fc3\u8840\u7ba1\u6b7b\u3001\u5fc3\u7b4b\u6897\u585e\u3001\u8133\u5352\u4e2d\u3001\u4e0d\u5b89\u5b9a\u72ed\u5fc3\u75c7\u306b\u3088\u308b\u5165\u9662\u3001\u307e\u305f\u306f\u51a0\u52d5\u8108\u8840\u884c\u518d\u5efa\u8853\u306e\u8907\u5408\u3057\u305f\u3082\u306e\u3067\u3057\u305f\u3002\u91cd\u8981\u306a\u526f\u6b21\u6709\u52b9\u6027\u30a8\u30f3\u30c9\u30dd\u30a4\u30f3\u30c8\u306f\u3001\u5fc3\u8840\u7ba1\u6b7b\u3001\u5fc3\u7b4b\u6897\u585e\u3001\u307e\u305f\u306f\u8133\u5352\u4e2d\u306e\u8907\u5408\u3067\u3057\u305f\u3002\u8ffd\u8de1\u671f\u9593\u306e\u4e2d\u592e\u5024\u306f2.2\u5e74\u3067\u3057\u305f\u3002\uff08\u672c\u5f53\u306f4.7\u5e74\u3060\u3063\u305f\u306e\u306b\u6709\u52b9\u6027\u304c\u660e\u3089\u304b\u3068\u3044\u3046\u3053\u3068\u3067\u65e9\u304f\u7d42\u4e86\u3057\u307e\u3057\u305f\u3002\uff09<\/p>\n

\"\"<\/a><\/p>\n

\u30b9\u30bf\u30c1\u30f3\u306bPCSK9\u963b\u5bb3\u5264\u3067\u3042\u308b\u30a8\u30dc\u30ed\u30af\u30de\u30d6\u3092\u8ffd\u52a0\u3059\u308b\u3068\u3001\u4e3b\u8981\u8907\u5408\u30a8\u30f3\u30c9\u30dd\u30a4\u30f3\u30c8\u306e\u767a\u751f\u7387\u304c15\uff05\u4f4e\u4e0b\u3057\u307e\u3057\u305f \uff089.8%\u5bfe11.3%\uff09\u3002\u6b7b\u4ea1\u7387\u3068\u5fc3\u8840\u7ba1\u6b7b\u306f\u3001\u30a8\u30dc\u30ed\u30af\u30de\u30d6\u7fa4\u3067\u6570\u5024\u7684\u306b\u5897\u52a0\u3057\u307e\u3057\u305f.\u307b\u3068\u3093\u3069\u306e\u5fc3\u8840\u7ba1\u6b7b (n=372\/491; 75.8%) \u306f\u3001\u901a\u5e38\u3001\u5fc3\u8840\u7ba1\u6b7b\u306e\u4e2d\u3067\u512a\u52e2\u306a\u5fc3\u7b4b\u6897\u585e\u307e\u305f\u306f\u3046\u3063\u8840\u6027\u5fc3\u4e0d\u5168\u3068\u3057\u3066\u3067\u306f\u306a\u304f\u3001\u300c\u305d\u306e\u4ed6\u306e\u5fc3\u8840\u7ba1\u6b7b\u300d\u3068\u3057\u3066\u5206\u985e\u3055\u308c\u307e\u3057\u305f.<\/p>\n

\u88fd\u9020\u696d\u8005\u306b\u3088\u3063\u3066\u4f5c\u6210\u3055\u308c\u3001\u533b\u85ac\u54c1\u8a55\u4fa1\u306e\u627f\u8a8d\u306e\u305f\u3081\u306b\u63d0\u51fa\u3055\u308c\u308b\u6587\u66f8\u3067\u3042\u308b\u81e8\u5e8a\u7814\u7a76\u5831\u544a\u66f8 \uff08CSR\uff09\u306f\u3001\u4e0a\u306e\u8ad6\u6587\u3067\u516c\u958b\u3055\u308c\u305f\u3082\u306e\u3088\u308a\u3082\u8c4a\u5bcc\u3067\u8a73\u7d30\u306a\u8a3c\u62e0\u3092\u63d0\u4f9b\u3057\u307e\u3059\u3002\u305d\u308c\u3092\u8abf\u3079\u308b\u3068\u3053\u306e\u8ad6\u6587\u304c\u9055\u3063\u305f\u3082\u306e\u306b\u898b\u3048\u3066\u304d\u307e\u3057\u305f\u3002<\/p>\n

\"\"<\/a><\/p>\n

\u307e\u305a\u306f\u4e0a\u306e\u8ad6\u6587\u306e\u5fc3\u81d3\u8840\u7ba1\u6b7b\uff08Cardiovascular deaths\uff09\u3068\u7dcf\u6b7b\u4ea1\uff08Death from any cause\uff09\u306b\u95a2\u3057\u3066\u30a8\u30dc\u30ed\u30af\u30de\u30d6\u7fa4\u306e\u65b9\u304c\u30d7\u30e9\u30bb\u30dc\u3088\u308a\u6570\u5024\u7684\u306b\u306f\u591a\u304f\u306a\u3063\u3066\u3044\u307e\u3057\u305f\u3002<\/p>\n

CSR\u306e\u8aac\u660e\u3067\u306f\u3001\u3059\u3079\u3066\u306e\u6b7b\u4ea1\u8005\u306f\u3001\u300c\u5fc3\u8840\u7ba1\u7cfb\u300d\u3001\u300c\u975e\u5fc3\u8840\u7ba1\u7cfb\u300d\u3001\u307e\u305f\u306f\u300c\u672a\u78ba\u5b9a\u300d\u306e3\u3064\u306e\u30ab\u30c6\u30b4\u30ea\u306e\u3044\u305a\u308c\u304b\u306b\u5272\u308a\u5f53\u3066\u3089\u308c\u307e\u3057\u305f\u3002\u3053\u306e\u5206\u985e\u3092\u300c\u6b7b\u4ea1\u5206\u985e\u300d\u3068\u3057\u307e\u3059\u3002870\u4eba\u306e\u6b7b\u4ea1\u8005\u306e\u3046\u3061226\u4eba (26.0%) \u306b\u3064\u3044\u3066\u3001\u300c\u6b7b\u4ea1\u5206\u985e\u300d\u3068\u300cFOURIER\u8a66\u9a13\u306e\u6b7b\u56e0\u300d\u3067\u306f\u77db\u76fe\u3057\u3066\u3044\u307e\u3057\u305f\u3002\u305f\u3068\u3048\u3070\u3001\u300c\u6b7b\u4ea1\u5206\u985e\u300d\u3067\u300c\u5fc3\u8840\u7ba1\u7cfb\u300d\u306b\u5206\u985e\u3055\u308c\u305f24\u4eba\u306e\u6b7b\u4ea1\u306e\u3046\u3061\u3001\u300cFOURIER\u8a66\u9a13\u306e\u6b7b\u56e0\u300d\u306f12\u4eba\u304c\u300c\u975e\u5fc3\u8840\u7ba1\u7cfb\u300d\u300112 \u4eba\u304c\u300c\u672a\u78ba\u5b9a\u300d\u3067\u3057\u305f\u3002\u300c\u975e\u5fc3\u8840\u7ba1\u6027\u300d\u306b\u5206\u985e\u3055\u308c\u305f66\u4eba\u306e\u6b7b\u4ea1\u306e\u3046\u3061\u3001\u300cFOURIER\u8a66\u9a13\u306e\u6b7b\u56e0\u300d\u306f56\u4eba\u304c\u300c\u5fc3\u8840\u7ba1\u6027\u300d\u300110\u4eba\u304c\u300c\u672a\u78ba\u5b9a\u300d\u3067\u3057\u305f\u3002\u300c\u672a\u78ba\u5b9a\u300d\u306b\u5206\u985e\u3055\u308c\u305f136\u4eba\u306e\u6b7b\u4ea1\u306e\u3046\u3061\u3001\u300cFOURIER\u8a66\u9a13\u306e\u6b7b\u56e0\u300d\u306f101\u4eba\u304c\u300c\u5fc3\u8840\u7ba1\u7cfb\u300d\u300135\u4eba\u304c\u300c\u975e\u5fc3\u8840\u7ba1\u7cfb\u300d\u3067\u3057\u305f\u3002\u3082\u3046\u7121\u8336\u82e6\u8336\u3067\u3059\u306d\u3002\u7dcf\u6b7b\u4ea1\u8005\u306e870\u4eba\u4e2d360\u4eba\uff0841.4%\uff09\u304c\u9055\u3046\u306e\u3067\u3059\u304b\u3089\u3002<\/p>\n

CSR\u306f\u3088\u308a\u8a73\u7d30\u306a\u6b7b\u56e0\u304c\u5831\u544a\u3055\u308c\u3066\u3044\u307e\u3057\u305f\u3002\uff08\u8868\u306f\u539f\u6587\u3088\u308a\uff09<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
<\/td>\nEVO
\n(RA)<\/td>\n		EVO (NEJM<\/em>)<\/td>\nPLA
\n(RA)<\/td>\n		PLA (NEJM<\/em>)<\/td>\n<\/tr>\n<\/thead>\n
Cardiac death<\/strong><\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
\u2003Sudden cardiac<\/td>\n43<\/td>\nn.r.<\/td>\n43<\/td>\nn.r.<\/td>\n<\/tr>\n
\u2003Acute myocardial infarction<\/td>\n36<\/td>\n25<\/td>\n27<\/td>\n30<\/td>\n<\/tr>\n
\u2003Heart failure<\/span><\/td>\n31<\/span><\/td>\nn.r.<\/span><\/td>\n16<\/span><\/td>\nn.r.<\/span><\/td>\n<\/tr>\n
\u2003Acute coronary syndrome<\/td>\n1<\/td>\nn.r.<\/td>\n0<\/td>\nn.r.<\/td>\n<\/tr>\n
\u2003Ischaemic heart disease<\/td>\n1<\/td>\nn.r.<\/td>\n0<\/td>\nn.r.<\/td>\n<\/tr>\n
\u2003Postinfarction cardiosclerosis<\/td>\n1<\/td>\nn.r.<\/td>\n0<\/td>\nn.r.<\/td>\n<\/tr>\n
\u2003Ventricular tachycardia<\/td>\n0<\/td>\nn.r.<\/td>\n1<\/td>\nn.r.<\/td>\n<\/tr>\n
\u2003Other causes<\/td>\n0<\/td>\nn.r.<\/td>\n1<\/td>\nn.r.<\/td>\n<\/tr>\n
\u2003Subtotal<\/td>\n113<\/td>\nn.r.<\/td>\n88<\/td>\nn.r.<\/td>\n<\/tr>\n
Non-cardiac vascular death<\/strong><\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
\u2003Stroke<\/td>\n23<\/td>\n31<\/td>\n25<\/td>\n33<\/td>\n<\/tr>\n
\u2003Pulmonary embolism<\/td>\n7<\/td>\nn.r.<\/td>\n7<\/td>\nn.r.<\/td>\n<\/tr>\n
\u2003Cardiovascular haemorrhage<\/td>\n5<\/td>\nn.r.<\/td>\n3<\/td>\nn.r.<\/td>\n<\/tr>\n
\u2003Cardiovascular procedures<\/td>\n1<\/td>\nn.r.<\/td>\n1<\/td>\nn.r.<\/td>\n<\/tr>\n
\u2003Intestinal ischaemia<\/td>\n1<\/td>\nn.r.<\/td>\n0<\/td>\nn.r.<\/td>\n<\/tr>\n
\u2003Mesenteric ischaemia<\/td>\n0<\/td>\nn.r.<\/td>\n1<\/td>\nn.r.<\/td>\n<\/tr>\n
\u2003Subtotal<\/td>\n37<\/td>\nn.r.<\/td>\n37<\/td>\nn.r.<\/td>\n<\/tr>\n
Non-cardiovascular death<\/strong><\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
\u2003Malignancy<\/td>\n80<\/td>\nn.r.<\/td>\n72<\/td>\nn.r.<\/td>\n<\/tr>\n
\u2003Infection; includes sepsis<\/td>\n34<\/td>\nn.r.<\/td>\n32<\/td>\nn.r.<\/td>\n<\/tr>\n
\u2003Pulmonary<\/td>\n7<\/td>\nn.r.<\/td>\n12<\/td>\nn.r.<\/td>\n<\/tr>\n
\u2003Hepatobiliary<\/td>\n3<\/td>\nn.r.<\/td>\n2<\/td>\nn.r.<\/td>\n<\/tr>\n
\u2003Non-cardiovascular haemorrhage<\/td>\n3<\/td>\nn.r.<\/td>\n2<\/td>\nn.r.<\/td>\n<\/tr>\n
\u2003Non-cardiovascular procedure or surgery<\/td>\n3<\/td>\nn.r.<\/td>\n0<\/td>\nn.r.<\/td>\n<\/tr>\n
\u2003Pancreatic<\/td>\n3<\/td>\nn.r.<\/td>\n1<\/td>\nn.r.<\/td>\n<\/tr>\n
\u2003Suicide<\/td>\n3<\/td>\nn.r.<\/td>\n3<\/td>\nn.r.<\/td>\n<\/tr>\n
\u2003Trauma<\/td>\n3<\/td>\nn.r.<\/td>\n6<\/td>\nn.r.<\/td>\n<\/tr>\n
\u2003Renal<\/td>\n2<\/td>\nn.r.<\/td>\n2<\/td>\nn.r.<\/td>\n<\/tr>\n
\u2003Other causes<\/td>\n9<\/td>\nn.r.<\/td>\n5<\/td>\nn.r.<\/td>\n<\/tr>\n
Cause of death after readjudication<\/strong><\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
\u2003Death\u2014cardiovascular<\/td>\n150<\/td>\n251<\/td>\n125<\/td>\n240<\/td>\n<\/tr>\n
\u2003Death\u2014non-cardiovascular<\/td>\n150<\/td>\nn.r.<\/td>\n137<\/td>\nn.r.<\/td>\n<\/tr>\n
\u2003Death\u2014undetermined<\/td>\n144<\/td>\nn.r.<\/td>\n164<\/td>\nn.r.<\/td>\n<\/tr>\n
\u2003Total<\/td>\n444<\/td>\n444<\/td>\n426<\/td>\n426<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
\n

\u30fbn.r., not reported; RA, data after readjudication.<\/p>\n

CSR\u3092\u5206\u6790\u3057\u305f\u518d\u5224\u5b9a\u5f8c\u3001\u300c\u672a\u78ba\u5b9a\u300d\u6b7b\u56e0\u306f308\/870 \u4eba (35.4%)\u3001\u300c\u975e\u5fc3\u8840\u7ba1\u300d\u6b7b\u306f287\/870 (33.0%)\u3001\u300c\u5fc3\u8840\u7ba1\u300d\u6b7b\u306f275\/870 (31.6%) \u3067\u3057\u305f\u3002<\/p>\n

CSR\u60c5\u5831\u3092FOURIER\u8a66\u9a13\u306e\u8ad6\u6587\u3068\u6bd4\u8f03\u3059\u308b\u3068\u3001\u30a8\u30dc\u30ed\u30af\u30de\u30d6\u7fa4\u3067\u306f\u5fc3\u7b4b\u6897\u585e\u306b\u3088\u308b\u6b7b\u4ea1\u304c11\u4eba\u591a\u304f\uff0836\u5bfe25\uff09\u3001\u30d7\u30e9\u30bb\u30dc\u7fa4\u3067\u306f3\u4eba\u5c11\u306a\u3044\uff0827\u5bfe30\uff09\u3053\u3068\u304c\u308f\u304b\u308a\u307e\u3057\u305f\u3002\u518d\u5224\u5b9a\u306b\u3088\u3063\u3066\u7279\u5b9a\u3055\u308c\u305f\u6700\u3082\u983b\u7e41\u306a\u6b7b\u56e0\u306e1\u3064\u306f\u300c\u5fc3\u4e0d\u5168\u300d\u3067\u3057\u305f\u3002\u8ad6\u6587\u3067\u306f\u3001\u3053\u306e\u7d50\u679c\u306f\u5831\u544a\u3055\u308c\u3066\u3044\u307e\u305b\u3093\u3002\u30a8\u30dc\u30ed\u30af\u30de\u30d6\u7fa4\u306e\u5fc3\u4e0d\u5168\u306b\u3088\u308b\u6b7b\u4ea1\u306f\u3001\u30d7\u30e9\u30bb\u30dc\u7fa4\u306e\u307b\u307c2\u500d\u3067\u3057\u305f (31\u5bfe16)\u3002<\/p>\n

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CSR\u3092\u8a73\u7d30\u306b\u5206\u6790\u3057\u306a\u304a\u3059\u3068\u3001\u8ad6\u6587\u3088\u308a\u3082\u5927\u5e45\u306b\u5fc3\u81d3\u8840\u7ba1\u6b7b\u306e\u6570\u304c\u5c11\u306a\u304f\u306a\u308a\u307e\u3057\u305f\u3002\u30a8\u30dc\u30ed\u30af\u30de\u30d6\u7fa4\u3067101\u4eba\u3001\u30d7\u30e9\u30bb\u30dc\u7fa4\u3067115\u4eba\u306e\u6e1b\u5c11\u3067\u3059\u3002\u610f\u56f3\u7684\u306b\u6570\u5b57\u5408\u308f\u305b\u3092\u3057\u3066\u3001\u8a66\u9a13\u306e\u4e0d\u9069\u5207\u306a\u65e9\u671f\u7d42\u4e86\u3092\u884c\u3063\u305f\u53ef\u80fd\u6027\u304c\u3042\u308a\u307e\u3059\u3002\u3057\u304b\u3057\u3001\u3053\u306e\u8ad6\u6587\u304c\u7acb\u6d3e\u306a\u30a8\u30d3\u30c7\u30f3\u30b9\u3068\u3057\u3066\u6271\u308f\u308c\u3066\u3057\u307e\u3048\u3070\u3001\u305d\u306e\u80cc\u666f\u306e\u8a73\u7d30\u306a\u751f\u30c7\u30fc\u30bf\u304c\u518d\u8a55\u4fa1\u3055\u308c\u308b\u3053\u3068\u306f\u306a\u304f\u3001\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u306b\u63b2\u8f09\u3055\u308c\u308b\u3067\u3057\u3087\u3046\u3002<\/p>\n

EBM\uff08Evidence-Based Medicine\uff09\u300c\u6839\u62e0\u306b\u57fa\u3065\u304f\u533b\u7642\u300d\u306f\u3001\u3053\u306e\u3088\u3046\u306a\u5371\u3046\u3044\u72b6\u6cc1\u3067\u533b\u7642\u306b\u6d78\u900f\u3057\u3066\u3057\u307e\u3063\u3066\u3044\u307e\u3059\u3002\u305d\u3057\u3066\u591a\u304f\u306e\u533b\u5e2b\u305f\u3061\u306f\u300c\u30a8\u30d3\u30c7\u30f3\u30b9\u300d\u3092\u53eb\u3073\u7d9a\u3051\u3066\u3044\u307e\u3059\u3002<\/p>\n

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 <\/p>\n

\u300cRestoring mortality data in the FOURIER cardiovascular outcomes trial of evolocumab in patients with cardiovascular disease: a reanalysis based on regulatory data\u300d<\/span><\/p>\n

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