高脂血症の薬物療法

―三段階的適用決定法, 薬物選択法の試論―

抄録

A three step regimen is proposed for treatment of hyperlipidemias. This is based on classifications of hyperlipidemias by degree of severity and antihyperlipidemic drugs according to their efficacy. Hyperlipidemias categorized as normal are TC<220mg/dl and/or TG<150mg/dl, 1st degree (mild) disorder 220≤TC<260mg/dl and/or 150≤TG<300mg/dl, 2nd degree (moderate) 260≤TC<300mg/dl and/or 300≤TG<750mg/dl, and 3 degree (severe): 300mg/dl≤TC and/or 750mg/dl≤TG. Antihyperlipidemic drugs are grouped as: a) lowering TC by 5% (γ-oryzanol, soysterol and melinamide) or TG by 15% (dextran sulfate, nicotinic acid derivatives and pantethine), b) reducing TC by 8% (nicotinic acid derivatives, clofibrate derivatives and pantethine) or TG 30% (clofibrate derivatives), and c) decreasing TC by 15% (probucol, cholestyramine), or TG by 50% (so far none).
Indication for drug treatment is determined when a patient has 1st degree hyperlipisemia (s) with two or more risk factors (Indication I), or when the patient has 2nd degree hyperlipidemia (s) with one more risk factor (Ind. II), or when he or she has 3rd degree hyperlipidemia (s) (Ind. III). Selection criteria for the drug is primarily one drug from group a) for the indication (I), one from group b) for the indication (II), and one from group c) for the indication (III). If the first choice drug is not satisfactory, the second choice is another drug from the same group, or a combination of two drugs from the same group. If the second choice does not work, the third choice may be one from the group of drugs of higher efficacy, or a combination with a drug of higher class. The strategy of treatment is to lower the grade of disorders step by step, with the final aim levels of 190mg/dl for TC, 130mg/dl for TG, and 50mg/dl for HDL-cholesterol.