卒中予防のためのスタチン:失望と希望
Pierre Amarenco1, Andrew M Tonkin
1Department of Neurology and Stroke Center, Bichat University Hospital and Medical School, Denis Diderot University-Paris VII, 46 rue Henri Huchard, 75018 Paris, France. amarenco@ccr.jussieu.fr
Circulation
|June 17, 2004
まとめ
スタチンは,冠動脈性心疾患 (CHD) の患者の脳卒中リスクを低減し,5年間で1000人当たり9人の脳卒中を予防します. しかし,その利点は,一般の人々にとって,あるいは再発性脳卒中を予防するために,まだ証明されていません.
科学分野:
- 心血管医学 心血管医学
- 神経学 神経学とは
- 薬理学 薬理学とは
背景:
- 脳卒中の発生率は年齢とともに増加し,冠動脈疾患 (CHD) のリスクも高い高齢者に不均衡に影響を及ぼします.
- コレステロールレベルは,流行病学的な研究で,すべての脳卒中の原因と明確な関連性が欠けている.
- 長期スタチンの試験は,既定または高リスクのCHDを有する患者の脳卒中発生率の減少を示しています.
研究 の 目的:
- ストロックの発生率を減らすためにスタチンの有効性を評価する.
- スタチンの脳卒中に対する非コレステロール低下作用の潜在的メカニズムを探求する.
- 治療戦略における世界的な心血管リスクの役割を評価する.
主な方法:
- 7万7070人の患者が参加した9つの大規模な長期スタチン試験のメタ分析.
- スタチンによる脳卒中リスク低下の比較と抗血小板剤の比較.
- 既存の疫学および観察データのレビュー.
主要な成果:
- スタチンは,CHD集団における脳卒中の相対リスクの21%と絶対リスクの0.9%の減少を示した.
- スタチンを5年間服用した1000人当たり9人の脳卒中が,心臓病患者で予防された.
- スタチンは,一般人群における脳卒中リスクの減少や,再発性脳卒中を予防する効果を示さなかった.
結論:
- スタチンは,既定または高リスクのCHDを有する患者の脳卒中の発生率を低減するのに有効です.
- コレステロールを下げない効果は,スタチンの脳保護効果に寄与する可能性があります.
- グローバルな心血管リスクに焦点を当てた治療戦略を推奨し,典型的な脳卒中集団におけるさらなる研究が必要である.
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