5．大血管障害
糖尿病患者には初期から動脈硬化疾患（糖尿病大血管障害）が多発する．糖尿病患者において，大血管障害を予防するためには，血糖のみならず血清脂質，血圧，生活習慣など多くの因子に対する総合的管理が必要である．糖尿病患者に対する血圧や血清脂質の治療管理目標値は一般より厳しく設定されているが，目標値に達しない患者は多い．一方，大血管障害の頻度やリスクファクターには人種差がみられるが，日本人の大規模前向きデータは十分でなく，今後さらに蓄積する必要がある．...
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| Published in | 日本内科学会雑誌 Vol. 98; no. 4; pp. 794 - 801 |
|---|---|
| Main Authors | , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本内科学会
2009
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0021-5384 1883-2083 |
| DOI | 10.2169/naika.98.794 |
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| Abstract | 糖尿病患者には初期から動脈硬化疾患（糖尿病大血管障害）が多発する．糖尿病患者において，大血管障害を予防するためには，血糖のみならず血清脂質，血圧，生活習慣など多くの因子に対する総合的管理が必要である．糖尿病患者に対する血圧や血清脂質の治療管理目標値は一般より厳しく設定されているが，目標値に達しない患者は多い．一方，大血管障害の頻度やリスクファクターには人種差がみられるが，日本人の大規模前向きデータは十分でなく，今後さらに蓄積する必要がある． |
|---|---|
| AbstractList | 糖尿病患者には初期から動脈硬化疾患（糖尿病大血管障害）が多発する．糖尿病患者において，大血管障害を予防するためには，血糖のみならず血清脂質，血圧，生活習慣など多くの因子に対する総合的管理が必要である．糖尿病患者に対する血圧や血清脂質の治療管理目標値は一般より厳しく設定されているが，目標値に達しない患者は多い．一方，大血管障害の頻度やリスクファクターには人種差がみられるが，日本人の大規模前向きデータは十分でなく，今後さらに蓄積する必要がある． |
| Author | 曽根, 博仁 山田, 信博 |
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| Copyright | 2009 一般社団法人 日本内科学会 |
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| References | 7) Kubo M, et al: Trends in the incidence, mortality, and survival rate of cardiovascular disease in a Japanese community: the Hisayama study. Stroke 34: 2349-2354, 2003. 8) UK Prospective Diabetes Study (UKPDS) Group: Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 352: 837-853, 1998. 39) Sone H, et al: The new worldwide definition of metabolic syndrome is not a better diagnostic predictor of cardiovascular disease in Japanese diabetic patients than the existing definitions: additional analysis from the Japan Diabetes Complications Study. Diabetes Care 29: 145-147, 2006. 26) Shepherd J, et al: Effect of lowering LDL cholesterol substantially below currently recommended levels in patients with coronary heart disease and diabetes: the Treating to New Targets (TNT) study. Diabetes Care 29: 1220-1226, 2006. 16) Yan AT, et al: Contemporary management of dyslipidemia in high-risk patients: targets still not met. Am J Med 119: 676-683, 2006. 30) Whelton PK, et al: Clinical outcomes in antihypertensive treatment of type 2 diabetes, impaired fasting glucose concentration, and normoglycemia: Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Arch Intern Med 165: 1401-1409, 2005. 41) Cull CA, et al: Impact of the metabolic syndrome on macrovascular and microvascular outcomes in type 2 diabetes mellitus: United Kingdom Prospective Diabetes Study 78. Circulation 116: 2119-2126, 2007. 34) Trichopoulou A, et al: Diet and physical activity in relation to overall mortality amongst adult diabetics in a general population cohort. J Intern Med 259: 583-591, 2006. 31) Hansson L, et al: Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet 351: 1755-1762, 1998. 18) Sone H, et al: Outcome of one-year of specialist care of patients with type 2 diabetes: a multi-center prospective survey (JDDM 2). Intern Med 45: 589-597, 2006. 20) Hanefeld M, et al: Acarbose reduces the risk for myocardial infarction in type 2 diabetic patients: meta-analysis of seven long-term studies. Eur Heart J 25: 10-16, 2004. 2) Hashimoto K, et al: Glucose intolerance is common in Japanese patients with acute coronary syndrome who were not previously diagnosed with diabetes. Diabetes Care 28: 1182-1186, 2005. 14) Davis TM, et al: Relationship between ethnicity and glycemic control, lipid profiles, and blood pressure during the first 9 years of type 2 diabetes: U.K. Prospective Diabetes Study (UKPDS 55). Diabetes Care 24: 1167-1174, 2001. 5) 佐々木陽, 他: 2型糖尿病患者における虚血性心疾患および脳血管疾患の死亡率とその危険因子. 糖尿病 43: 1057-1063, 2000. 32) Ogawa H, et al: Japanese Primary Prevention of Atherosclerosis With Aspirin for Diabetes (JPAD) Trial Investigators. Low-dose aspirin for primary prevention of atherosclerotic events in patients with type 2 diabetes: a randomized controlled trial. JAMA 300: 2134-2141, 2008. 37) Gaede P, et al: Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med 348: 383-393, 2003. 11) Selvin E, et al: Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus. Ann Intern Med 141: 421-431, 2004. 38) Gaede P, et al: Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med 358: 580-591, 2008. 12) Nathan DM, et al: Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med 353: 2643-2653, 2005. 1) Booth GL, et al: Relation between age and cardiovascular disease in men and women with diabetes compared with non-diabetic people: a population-based retrospective cohort study. Lancet 368: 29-36, 2006. 10) Selvin E, et al: Glycemic control and coronary heart disease risk in persons with and without diabetes: the atherosclerosis risk in communities study. Arch Intern Med 165: 1910-1916, 2005. 19) Tominaga M, et al: Impaired glucose tolerance is a risk factor for cardiovascular disease, but not impaired fasting glucose. The Funagata Diabetes Study. Diabetes Care 22: 920-924, 1999. 9) Khaw KT, et al: Association of hemoglobin A1c with cardiovascular disease and mortality in adults: the European prospective investigation into cancer in Norfolk. Ann Intern Med 141: 413-420, 2004. 6) Sone H, et al: Effects of lifestyle modifications on patients with type 2 diabetes: the Japan Diabetes Complications Study (JDCS) study design, baseline analysis and three year-interim report. Horm Metab Res 34: 509-515, 2002. 21) Asia Pacific Cohort Studies Collaboration: Cholesterol, diabetes and major cardiovascular diseases in the Asia-Pacific region. Diabetologia 50: 2289-2297, 2007. 15) Saydah SH, et al: Poor control of risk factors for vascular disease among adults with previously diagnosed diabetes. JAMA 291: 335-342, 2004. 4) Fox CS, et al: Increasing cardiovascular disease burden due to diabetes mellitus: the Framingham Heart Study. Circulation 115: 1544-1550, 2007. 36) Sone H, et al: Alcohol use and diabetes mellitus. Ann Intern Med 141: 408-409, 2004. 35) Howard AA, et al: Effect of alcohol consumption on diabetes mellitus: a systematic review. Ann Intern Med 140: 211-219, 2004. 22) Sone H, et al: Is the diagnosis of metabolic syndrome useful for predicting cardiovascular disease in asian diabetic patients? Analysis from the Japan Diabetes Complications Study. Diabetes Care 28: 1463-1471, 2005. 28) Chan WB, et al: Triglyceride predicts cardiovascular mortality and its relationship with glycaemia and obesity in Chinese type 2 diabetic patients. Diabetes Metab Res Rev 21: 183-188, 2005. 13) Holman RR, et al: Long-term follow-up after tight control of blood pressure in type 2 diabetes. N Engl J Med 359: 1565-1576, 2008. 23) Cholesterol Treatment Trialists' (CTT) Collaborators: Efficacy of cholesterol-lowering therapy in 18686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet 371: 117-125, 2008. 24) Colhoun HM, et al: Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial. Lancet 364: 685-696, 2004. 3) Vijan S, Hayward RA: Treatment of hypertension in type 2 diabetes mellitus: blood pressure goals, choice of agents, and setting priorities in diabetes care. Ann Intern Med 138: 593-602, 2003. 17) Kobayashi M, et al: The status of diabetes control and antidiabetic drug therapy in Japan-a cross-sectional survey of 17,000 patients with diabetes mellitus (JDDM 1). Diabetes Res Clin Pract 73: 198-204, 2006. 25) Sever PS, et al: Reduction in cardiovascular events with atorvastatin in 2,532 patients with type 2 diabetes: Anglo-Scandinavian Cardiac Outcomes Trial-lipid-lowering arm (ASCOT-LLA). Diabetes Care 28: 1151-1157, 2005. 27) Keech A, et al: Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. Lancet 366: 1849-1861, 2005. 40) Sone H, et al: Waist circumference as a cardiovascular and metabolic risk in Japanese patients with type 2 diabetes. obesity (in press). 29) Turnbull F, et al: Effects of different blood pressure-lowering regimens on major cardiovascular events in individuals with and without diabetes mellitus: results of prospectively designed overviews of randomized trials. Arch Intern Med 165: 1410-1419, 2005. 33) Soinio M, et al: Dietary fat predicts coronary heart disease events in subjects with type 2 diabetes. Diabetes Care 26: 619-624, 2003. |
| References_xml | – reference: 29) Turnbull F, et al: Effects of different blood pressure-lowering regimens on major cardiovascular events in individuals with and without diabetes mellitus: results of prospectively designed overviews of randomized trials. Arch Intern Med 165: 1410-1419, 2005. – reference: 35) Howard AA, et al: Effect of alcohol consumption on diabetes mellitus: a systematic review. Ann Intern Med 140: 211-219, 2004. – reference: 1) Booth GL, et al: Relation between age and cardiovascular disease in men and women with diabetes compared with non-diabetic people: a population-based retrospective cohort study. Lancet 368: 29-36, 2006. – reference: 16) Yan AT, et al: Contemporary management of dyslipidemia in high-risk patients: targets still not met. Am J Med 119: 676-683, 2006. – reference: 20) Hanefeld M, et al: Acarbose reduces the risk for myocardial infarction in type 2 diabetic patients: meta-analysis of seven long-term studies. Eur Heart J 25: 10-16, 2004. – reference: 18) Sone H, et al: Outcome of one-year of specialist care of patients with type 2 diabetes: a multi-center prospective survey (JDDM 2). Intern Med 45: 589-597, 2006. – reference: 33) Soinio M, et al: Dietary fat predicts coronary heart disease events in subjects with type 2 diabetes. Diabetes Care 26: 619-624, 2003. – reference: 24) Colhoun HM, et al: Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial. Lancet 364: 685-696, 2004. – reference: 6) Sone H, et al: Effects of lifestyle modifications on patients with type 2 diabetes: the Japan Diabetes Complications Study (JDCS) study design, baseline analysis and three year-interim report. Horm Metab Res 34: 509-515, 2002. – reference: 39) Sone H, et al: The new worldwide definition of metabolic syndrome is not a better diagnostic predictor of cardiovascular disease in Japanese diabetic patients than the existing definitions: additional analysis from the Japan Diabetes Complications Study. Diabetes Care 29: 145-147, 2006. – reference: 12) Nathan DM, et al: Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med 353: 2643-2653, 2005. – reference: 4) Fox CS, et al: Increasing cardiovascular disease burden due to diabetes mellitus: the Framingham Heart Study. Circulation 115: 1544-1550, 2007. – reference: 11) Selvin E, et al: Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus. Ann Intern Med 141: 421-431, 2004. – reference: 17) Kobayashi M, et al: The status of diabetes control and antidiabetic drug therapy in Japan-a cross-sectional survey of 17,000 patients with diabetes mellitus (JDDM 1). Diabetes Res Clin Pract 73: 198-204, 2006. – reference: 26) Shepherd J, et al: Effect of lowering LDL cholesterol substantially below currently recommended levels in patients with coronary heart disease and diabetes: the Treating to New Targets (TNT) study. Diabetes Care 29: 1220-1226, 2006. – reference: 31) Hansson L, et al: Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet 351: 1755-1762, 1998. – reference: 36) Sone H, et al: Alcohol use and diabetes mellitus. Ann Intern Med 141: 408-409, 2004. – reference: 37) Gaede P, et al: Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med 348: 383-393, 2003. – reference: 41) Cull CA, et al: Impact of the metabolic syndrome on macrovascular and microvascular outcomes in type 2 diabetes mellitus: United Kingdom Prospective Diabetes Study 78. Circulation 116: 2119-2126, 2007. – reference: 21) Asia Pacific Cohort Studies Collaboration: Cholesterol, diabetes and major cardiovascular diseases in the Asia-Pacific region. Diabetologia 50: 2289-2297, 2007. – reference: 22) Sone H, et al: Is the diagnosis of metabolic syndrome useful for predicting cardiovascular disease in asian diabetic patients? Analysis from the Japan Diabetes Complications Study. Diabetes Care 28: 1463-1471, 2005. – reference: 5) 佐々木陽, 他: 2型糖尿病患者における虚血性心疾患および脳血管疾患の死亡率とその危険因子. 糖尿病 43: 1057-1063, 2000. – reference: 23) Cholesterol Treatment Trialists' (CTT) Collaborators: Efficacy of cholesterol-lowering therapy in 18686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet 371: 117-125, 2008. – reference: 7) Kubo M, et al: Trends in the incidence, mortality, and survival rate of cardiovascular disease in a Japanese community: the Hisayama study. Stroke 34: 2349-2354, 2003. – reference: 10) Selvin E, et al: Glycemic control and coronary heart disease risk in persons with and without diabetes: the atherosclerosis risk in communities study. Arch Intern Med 165: 1910-1916, 2005. – reference: 32) Ogawa H, et al: Japanese Primary Prevention of Atherosclerosis With Aspirin for Diabetes (JPAD) Trial Investigators. Low-dose aspirin for primary prevention of atherosclerotic events in patients with type 2 diabetes: a randomized controlled trial. JAMA 300: 2134-2141, 2008. – reference: 28) Chan WB, et al: Triglyceride predicts cardiovascular mortality and its relationship with glycaemia and obesity in Chinese type 2 diabetic patients. Diabetes Metab Res Rev 21: 183-188, 2005. – reference: 15) Saydah SH, et al: Poor control of risk factors for vascular disease among adults with previously diagnosed diabetes. JAMA 291: 335-342, 2004. – reference: 2) Hashimoto K, et al: Glucose intolerance is common in Japanese patients with acute coronary syndrome who were not previously diagnosed with diabetes. Diabetes Care 28: 1182-1186, 2005. – reference: 8) UK Prospective Diabetes Study (UKPDS) Group: Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 352: 837-853, 1998. – reference: 38) Gaede P, et al: Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med 358: 580-591, 2008. – reference: 30) Whelton PK, et al: Clinical outcomes in antihypertensive treatment of type 2 diabetes, impaired fasting glucose concentration, and normoglycemia: Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Arch Intern Med 165: 1401-1409, 2005. – reference: 9) Khaw KT, et al: Association of hemoglobin A1c with cardiovascular disease and mortality in adults: the European prospective investigation into cancer in Norfolk. Ann Intern Med 141: 413-420, 2004. – reference: 40) Sone H, et al: Waist circumference as a cardiovascular and metabolic risk in Japanese patients with type 2 diabetes. obesity (in press). – reference: 13) Holman RR, et al: Long-term follow-up after tight control of blood pressure in type 2 diabetes. N Engl J Med 359: 1565-1576, 2008. – reference: 25) Sever PS, et al: Reduction in cardiovascular events with atorvastatin in 2,532 patients with type 2 diabetes: Anglo-Scandinavian Cardiac Outcomes Trial-lipid-lowering arm (ASCOT-LLA). Diabetes Care 28: 1151-1157, 2005. – reference: 19) Tominaga M, et al: Impaired glucose tolerance is a risk factor for cardiovascular disease, but not impaired fasting glucose. The Funagata Diabetes Study. Diabetes Care 22: 920-924, 1999. – reference: 3) Vijan S, Hayward RA: Treatment of hypertension in type 2 diabetes mellitus: blood pressure goals, choice of agents, and setting priorities in diabetes care. Ann Intern Med 138: 593-602, 2003. – reference: 14) Davis TM, et al: Relationship between ethnicity and glycemic control, lipid profiles, and blood pressure during the first 9 years of type 2 diabetes: U.K. Prospective Diabetes Study (UKPDS 55). Diabetes Care 24: 1167-1174, 2001. – reference: 34) Trichopoulou A, et al: Diet and physical activity in relation to overall mortality amongst adult diabetics in a general population cohort. J Intern Med 259: 583-591, 2006. – reference: 27) Keech A, et al: Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. Lancet 366: 1849-1861, 2005. |
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| Title | 5．大血管障害 |
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