血管新生変換酵素阻害剤と大動脈破裂:集団ベースの症例対照研究
Daniel G Hackam1, Deva Thiruchelvam, Donald A Redelmeier
1Clinical Epidemiology and Health Care Research Program, Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. daniel.hackam@ices.on.ca
Lancet (London, England)
|August 22, 2006
まとめ
アンジオテンシン変換酵素 (ACE) 阻害剤は,65歳以上の患者において,腹動脈動脈瘤の破裂のリスクを大幅に軽減します. この保護効果は,他の一般的な血圧薬では見られなかった.
科学分野:
- 心血管医学 心血管医学
- 薬理学 薬理学とは
- エピデミオロジー エピデミオロジー
背景:
- 動物の研究は,アニオテンシン変換酵素 (ACE) 阻害剤が,大動脈動脈瘤の膨張と破裂を防ぐことができることを示しています.
- ACE阻害剤とヒト患者における腹動脈動脈瘤 (AAA) 破裂との関連性を確認するために,臨床的証拠が必要である.
研究 の 目的:
- 腹部大動脈動脈瘤と診断された患者のACE阻害剤の使用と破裂のリスクとの関連を調べる.
主な方法:
- カナダのオンタリオ州で,リンクされた行政データベースを使用して,人口ベースのケース・コントロール研究が行われました.
- この研究では,1992年から2002年の間に破裂または無傷な腹動脈動脈瘤の診断で入院した65歳以上の患者15,326人が対象となった.
主要な成果:
- 入院前にACE阻害剤を使用した患者は,破裂性動脈瘤 (OR 0.82) を呈する確率が著しく低いことを示しました.
- この保護的関連性は,さまざまな人口統計的要因,併発症,および医療利用率を調整した後も一貫したままでした.
- ベータブロッカー,カルシウムチャネルブロッカー,利尿剤を含む他の抗高血圧薬のクラスでは,同様の保護的関連は観察されなかった.
結論:
- ACE阻害剤は,腹動脈動脈瘤の破裂のリスクの低下と関連しています.
- 他の抗高血圧剤とは異なり,ACE阻害剤はAAA破裂における潜在的な保護的役割を果たしています.
- AAA破裂の予防のためのACE阻害剤を調査するランダム化比較試験は正当化されています.
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