動脈硬化性疾患予防ガイドライン（２００７）に対する主論点と私見
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概要
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1. In the Guideline (2007), diagnostic criteria were proposed in terms of LDL-C instead of total cholesterol (TC). In the Joint Panel Discussion, it was criticized that no available data in Japan support the criteria proposed. Moreover, LDL-C was revealed to be a predictor of longevity in the Koriyama-Isehara Study.<BR>2. The Guideline described that high-LDL-C is a risk factor for CHD even in aged populations, citing several references. However, the cited references do not present LDL-C but TC, and that the association of TC with CHD mortality is weak and not conclusive. An example was reproduced here that a significantly negative association of TC with CHD changed to positive after adjustments for several confounding factors. Thus, the evidence presented so far does not justify hypocholesterolemic medications but it tells us that such medications are inappropriate for aged populations. <BR>3. Those with inborn genetic factors such as familial hypercholesterolemia (FH) and an apo E genotype are different from hypercholesterolemic non-FH subjects in that the supply of LDL-carried lipids to peripheral tissues is restricted from young ages in the former but is fulfilled in the latter. The delegates from the Japan Atherosclerosis Society appeared not to accept this interpretation. <BR> As a chairperson, I emphasize that the ω6⁄ω3 balance of dietary and tissue lipids rather than plasma cholesterol is a critical factor for atherosclerotic diseases, and that dietary recommendations in the Guideline (2007) need to be revised.
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