2020 / IAS IAS IAS 1
/ NCEP III ATPIII,NCEP 2001 2
3 NCEP ATPIII - Meta,, N-9 N-6
N-3 N-9 N-9 N-9 N-3 / BMI kg/m 2 BMI BMI kg/m 2 BMI kg/m 2 18.5 18.5 18.5-24.9 18.5-22.9 25-29.9 23-24.9 30 30-34.9 35.0-39.9 40 25 25-29.9 30 / 4
102cm 40in 90cm 85cm 88cm 35in 80cm 90cm 5
1/3 6 LDL LDL LDL LDL HDL LDL LDL 6
LDL LDL HDL HDL HDL HDL HDL-C HDL HDL HDL HDL HDL HDL HDL HDL HDL LDL HDL-C HDL-C HDL-C 126mg/dl 7.0mmol/l 1 2 1 2 7
ATP CHD CVD CHD 1 CHD 2 2 ATP CVD CVD CVD CHD CVD CVD 1 2 CVD CHD 8
LDL-C 2-12 (a) PROCAM 10-15 9
LDL HDL (a) B C AI Meta LDL HDL (a) (a) LDL Lp(a) LDL Lp(a) B(apoB) LDL TGRLP apob LDL-C apob HDL-C TC HDL-C LDL HDL-C ATPIII HDL-C LDL-C CIII (apociii) HDL-C AI(apo AI) 10
-1(PAI-1) D- PAI-1 D- V (tpa) vw V Leiden C III PAI-1 Antithrombotic Trialists Collaboration 287 135000 77000 Meta 1/4 1/3 1/4 1/6 C- (hs-crp) -6 1(sICAM-1) E- P- hs-crp hs-crp 11
12 hs-crp HMG-CoA (statin) PPAR PPAR TZDS /, 110-125mg/dl 2 / ( ) 2 PROCAM MONICA ARIC /
TC HDL-C TC/HDL-C TC/HDL-C TC/HDL-C 5 TC/HDL-C TC HDL-C X ATPIII - - LDL - HDL ATP ATPIII * 150mg/dl 1.69mmol/l HDL-C - <40mg/dl 1.0mmol/l - <50mg/dl 1.3mmol/l - 130mmHg 13
85mmHg 110mg/dl 6.0mol/l * 102cm 40in 90cm 85cm 88cm 35in 80cm 90cm WHO ATPIII ATP CVD 2 20 2 10 40 ATPIII CHD 14
CHD CHD CHD 20% CHD CHD ABI<0.9 TIAs 50 10 20 CHD 10 20 a. b Framingham PROCAM 15
ATPIII CHD 10 1 2 CHD 1997 CHD CHD 30 CHD, HDL C ATP CHD PROCAM Westphalia PROCAM 3 5389 35 65 10 325 PROCAM LDL C HDL C CHD PROCAM CHD (http://www.chd-taskforce. com) PROCAM PROCAM CHD CVD 16
2 2 ATP CHD 10 20 ATP CHD CHD CVD PROCAM CHD 10 20 CVD CHD PROCAM CHD CHD 2 CHD CHD CVD CHD CHD CHD CHD CHD 10 20 10 20 CHD CVD CVD 17
ATP CHD ATPIII IAS ATPIII CHD 20 /10, 10 20 /10 LDL C 130mg/dl( 2.6mmol/l) CHD 10 10 QALY 50 000 OALY 50 000 600 10 10 20 LDL C 130mg/dl 18
ATP CHD CHD 10 10 LDL C LDL C 160mg/dl 2 CHD CHD ATP CVD CHD PROCAM CVD 10 19
CVD CHD 1 CVD CVD 10 LDL C 190mg/dl 4.9mmol/l 1 30kg m 2 IAS CHO 10 20% 20
LDL- ATP NCEP 2001 7% 200mg/ LDL-C ATP / 2g/ 10g/ LDL 21
5 400-1000mg N-3 1% -- N-3 1g/ 20-30g 10-20g 100mmol 2.4 6 1-2 30-45 90mmol / / 10% 10% 10% 500-1000kcal 22
/ 3 30 5 45 / 30 3-4 U.S. Surgeon General's 23
a / b c a SR b c d e a b / / 130/85mmHg 24
/ 130-139/85-89mmHg 1999 4 - LDL-C LDL HMG A LDL-C 30% 1/3 LDL-C NCEP LDL-C 100mg/dL 2.6mmol/L LDL-C 3.0mmol/L 115mg/dL LDL-C LDL-C LDL LDL-C 100mg/dL 2.6mmol/L 100mg/dL LDL-C ATP LDL LDL-C LDL LDL-C 30% LDL-C 100 mg/dl ( 2.6 mmol/l) LDL-C< 100 mg/dl(< 2.6 mmol/l) LDL 25
LDL-C LDL LDL-C HDL-C HDL LDL LDL-C HDL HDL HDL HDL ATP HDL-C HDL 75-325mg 75mg/ 2.0-3.0 7% LDL JNC <130/85mmHg <130/80mmHg ATP LDL-C<100mg/dl(< 2.6mmol/L) CHD10 >20% PROCAM <20% ATP 26
CHD ATP 10 10-20% 10 10-20% 10 >20% PROCAM ATP CHD CHD (10 10-20%) (Killip II ) - - CHD10 <20% CHD10 <20% 27
IAS CHD10 <20% CHD10 5-20% / / 10% / 28
/ 30 30-60 3-6 60-75% 5-10 30 8-10 10-15 10-15 40%-50% 29
JNC CHD10 20% 130-139/85-89mmHg 1 140-159/90-99mmHg 2/3 160/ 100mmHg JNC JNC <140/90mmHg 100mmol 1 2 30-45 90mmol JNC - - - JNC LDL-C LDL 10 <20% LDL-C 30
10 <20% LDL 5 ATP 10 <20% LDL 2 0-1 ATP 2 10 >20% 10 LDL-C 2 10 10 20 LDL-C <130mg/dl <3.4mmol/l LDL-C 130mg/dl 3 3 LDL-C 130mg/dl LDL LDL-C<130 mg/dl LDL LDL 130mg/dl 65 2 10 10 LDL-C <130mg/dl LDL-C 130mg/dl LDL-C LDL-C<160mg/dl <4.1mmol/l LDL LDL-C l60mg/dl LDL-C<130mg/dl 0-1 LDL-C <160mg/dl 3 LDL-C<160mg/dl LDL-C 160-189mg/dl 4.1-4.9mmol/l CHD 31
HDL-C 10 10% LDL-C 190mg/dl 4.9mmol/l LDL-C<160mg/dl 0-1 LDL-C 160mg/dl LDL LDL-C 190mg/dl 4.9mmol/l LDL-C LDL-C 10 20% CHD HDL-C HDL IAS ATP HDL-C HDL-C LDL-C LDL HDL-C 200-499mg/dl 2.24-5.63mmol/l HDL-C 200mg/dl 2.24mmol/l HDL-C HDL CHD CHD 32
Lp(a) 33
LDL-C 190mg/dl 4.9mmol/l LDL-C B CHD + LDL Meta CHD 60% 2 A ATP < 150 mg/dl (< 1.69 mmol/l) 150-199 mg/dl (1.69-2.24 mmol/l) 200-499 mg/dl (2.24-5.63 mmol/l) 500 mg/dl ( 5.63 mmol/l) CHD VLDL VLDL-C VLDL-C ATP LDL-C VLDL-C HDL-C TC HDL-C 200mg/dl 2.24mmol/l HDL-C 30mg/dl 0.8mmol/l LDL-C VLDL-C 30mg/dl 0.8mmol/l LDL-C 100mg/dl(< 2.6 mmol/l) HDL-C 130mg/dl(< 3.4 mmol/l) 34
LDL-C 150-199mg/dl 1.69-2.24mmol/l ATP 200-499mg/dl 2.24-5.63mmol/l HDL-C LDL-C HDL-C VLDL-C HDL-C HDL-C 500mg/dl 5.63mmol/l 15% 500mg/dl (< 5.63 mmol/l) LDL CHD 2 LDL HDL-C / HDL-C LDL-C ATP CHD LDL-C 100mg/dl(< 2.6 mol.l) ATP LDL-C 130mg/dl 3.4mmol/l LDL-C LDL-C 100-129mg/dl 2.6-3.4mmol/l LDL LDL-C 100-129mg/dl LDL CHD 65 35
35-65 CHD CHD CHD LDL 45-75 CHD 10-15 CHD 65 CHD 65 CHD CHD CHD 10 LDL-C CHD LDL-C 65 75 CHD 65 LDL-C HDL-C CHD 65 CHD LDL LDL LDL 36
CHD CVD CVD CVD 20-35 20-45 CHD CHD CHD LDL-C LDL-C 130mg/dl 3.4mmol/l LDL-C 160-189mg/dl 4.2-5.0mmol/m ATP LDL LDL-C 190mg/dl 5.0mmol/l CVD / 37
/ CVD / CVD HDL-C CHD IAS CVD / 38
CVD CVD CVD IAS CHD JCN IAS 6 1-6 1 10 20-34 -9 40-44 0 50-54 6 60-64 10 70-74 12 35-39 -4 45-49 3 55-59 8 65-69 11 75-79 13 20-39 40-49 50-59 60-69 70-79 <160 0 0 0 0 0 160-199 4 3 2 1 0 200-239 7 5 3 1 0 240-249 9 6 4 2 1 280+ 11 8 5 3 1 20-39 40-49 50-59 60-69 70-79 0 0 0 0 0 8 5 3 1 1 39
HDL HDL HDL HDL 60+ -1 50-59 0 40-49 1 <40 2 <120 0 0 120-129 0 1 130-139 1 2 140-159 1 2 160+ 2 3 10 10 10 <0 <1% 5 2% 11 8% 0 1% 6 2% 12 10% 1 1% 7 3% 12 12% 2 1% 8 4% 14 16% 3 1% 9 5% 15 20% 4 1% 10 6% 16 25% 17 30 40
2 10 20-34 -7 40-44 0 50-54 6 60-64 10 70-74 14 35-39 -3 45-49 3 55-59 8 65-69 12 75-79 16 20-39 40-49 50-59 60-69 70-79 <160 0 0 0 0 0 160-199 4 3 2 1 1 200-239 8 6 4 2 1 240-279 11 8 5 3 2 280+ 13 10 7 4 2 20-39 40-49 50-59 60-69 70-79 0 0 0 0 0 9 7 4 2 1 HDL HDL HDL HDL 60+ -1 50-59 0 40-49 1 <40 2 <120 0 0 120-129 1 3 130-139 2 4 140-159 3 5 160+ 4 6 10 10 10 <9 <1% 14 2% 20 11% 9 1% 15 3% 21 14% 41
10 1% 16 4% 22 17% 11 1% 17 5% 23 22% 12 1% 18 6% 24 27% 13 2% 19 8% 25 30% 42
3 10 PROCAM 35-39 0 40-44 6 45-49 11 50-54 16 55-59 21 60-65 26 LDL-C mg/dl LDL-C mmol/l 100 2.59 0 100--129 2.59---3.36 5 130--159 3.37-4.13 10 160-189 4.14-4.91 14 190 4.92 20 HDL-C TG mg/dl mmol/l mg/dl mmol/l 35 0.91 11 100 1.14 0 35-44 0.91-1.16 8 100-149 1.14-1.70 2 45-54 1.17-1.41 5 150-199 1.71-2.27 3 55 1.42 0 200 2.28 4 12 ( 60 ) 120mg/dl(6.66mmol/l) 8 6 4 0 0 0 43
120 0 120-129 2 130-139 3 140-159 5 160 8 PROCAM : 10 10 10 10 10 10 10 20 1.0 27 1.8 34 3.5 41 7.0 48 12.8 55 22.2 21 1.1 28 1.9 35 4.0 42 7.4 49 13.2 56 23.8 22 1.2 29 2.3 36 4.2 43 8.0 50 15.5 57 25.1 23 1.3 30 2.4 37 4.8 44 8.8 51 16.8 58 28.0 24 1.4 31 2.8 38 5.1 45 10.2 52 17.5 59 29.4 25 1.6 32 2.9 39 5.7 46 10.5 53 19.6 60 30.0 26 1.7 33 3.3 40 6.1 47 10.7 54 21.7 44
4 - a b c - a 2 3 b 2 3 c 45
5 CHD10 <20% LDL-C * LDL-C 2 <130mg/dL 10 (<3.4mmol/L) 20% <160mg/dL 0 1 (<4.1mmol/L) 130mg/dL ( 3.4mmol/L) 160mg/dL ( 4.1mmol/L) 10 10-20% 130mg/dL(3.4mmol/L) 10 10% 160mg/dL(4.1mmol/L) 190mg/dL(4.9mmol/L) 160-189mg/dL(4.1-4.9mmol/l): LDL * (BP 140/90mmHg ) HDL <40mg/dl <55 <65 45 55 0-1 CHD10 <10% 10 46
6 47
48