血清コレステロール値に上限を設けることはほとんど無意味

抄録

In 2007, Japan Atherosclerosis Society published Guidelines for prevention of atherosclerotic cardiovascular diseases. However, the Guidelines had serious flaws with regard to serum cholesterol levels. The followings are the list of those flaws: #1. They started to use LDL-cholesterol (LDL-C) levels instead of serum total cholesterol (TC) levels. In this case they must show at least some basic data on the relationship between LDL-C and mortality or morbidity from coronary heart disease (CHD). In the Guidelines there were no such data at all! #2. They recommended LDL-C be below 140 mg⁄dL or 3.6 mmol⁄L (corresponding to TC of 220 mg⁄dL or 5.7 mmol⁄L). These levels were unreasonable considering that TC levels of 240-260 are the best in terms of all-cause mortality in Japan. They did not show any data on all-cause mortality in the Guidelines. #3. There are big differences in mortality and morbidity from CHD between sexes. However, they discussed the matter without differentiating sexes, just counting being male as one risk factor. #4. Conflict of interest of editors of the Guidelines has never been disclosed as of the end of year 2008. #4. Diets for preventing CHD have never succeeded in Japan yet. #5. The only large-scaled study with a statin in Japan (MEGA Study) had incredible defects; the cholesterol-lowering strategy depended on that extremely unreliable study. #6. The astonishing results of 4S (Simvastatin Scandinavian Survival Study) has hardly been reproduced by any other trials. There are serious doubts about the data from pharmaceutical company-supported trials. In conclusion, familial hypercholesterolemia is probably the only target of statins.