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Title Transcription
トウニョウビョウ カンジャ ニ スタチン ハ キンキ キンキュウ テイゲン
Title Alternative (English)
Statins are Contraindicant to Diabetics - Urgent Proposal
Author
Okuyama, Harumi
Hamazaki, Tomohito
Ogushi, Yoichi
Hama, Rokuro
Uchino, Hajime
Watanabe, Hiroyuki
Hashimoto, Michio
Description
医療現場では多くの場合、糖尿病者により厳しいコレステロールの管理を求め(リスクのない人は LDL-C 値として 160mg/dL 未満、糖尿病者は 120mg/dL 未満)、多くの場合、スタチン(コレステロール低下剤)の使用を必須なものとしている。しかし糖尿病者に対してもスタチンには心疾患予防効果は認められず、スタチン類はむしろ糖尿病を新規発症させることが確かと
なった。またその生化学的基盤も明らかにされてきた。すなわち糖尿病者にスタチンは禁忌であり、医師の合理的な判断による特別なケースを除き、その使用を制限するよう提言する。
Description Alternative
Statins have been recognized clinically to raise blood glucose and glycated protein (HbA1c) levels enhancing the development of insulin resistance. However, most clinicians appear to adopt the interpretation that the benefit (prevention of CHD) outweighs the risk (new-onset of diabetes mellitus). Consistently, "Japan Atherosclerosis Society Guidelines for the Prevention of Atherosclerotic Cardiovascular Diseases 2012" recommends diabetics to maintain LDL-C levels below 120 mg/dL; 40 mg/dL lower than the value for those without risky complications. This recommendation necessitates many diabetics to use statins. However, we pointed out that statins exhibited no significant benefit for the prevention of CHD in the trials performed by scientists independent of industries after 2004, when a new regulation on clinical trials took effect in EU (Cholesterol Guidelines for Longevity, 2010). Here, we reviewed clinical evidence that statins could induce diabetes mellitus, and biochemical evidence that statins are toxic to mitochondria; they suppress electron transport and ATP generation through decreased prenyl-intermediate levels. They also inhibit seleno-protein synthesis and dolichol-mediated glycation of insulin receptor leading to insulin resistance and cardiac failure, similarly to the case of Se-deficiency. These mechanisms of statin actions are consistent with clinically observed decreases in blood ketone body, mitochondrial dysfunctions and enhanced glucose intolerance. Based on these lines of evidence, we urgently propose that statins are contraindicant to diabetics and their prescription should be restricted to special cases* for which medical doctors rationally decide to be necessary.
Subject
スタチン
禁忌
糖尿病
プレニル中間体
インスリン受容体
Journal Title
Journal of Lipid Nutrition
Volume
22
Issue
2
Start Page
173
End Page
186
ISSN
1343-4594
ISSN(Online)
1883-2237
Published Date
2013
DOI
Publisher
日本脂質栄養学会
Publisher Transcription
ニホン シシツ エイヨウ ガッカイ
NII Type
Journal Article
Format
PDF
Text Version
出版社版
Gyoseki ID
e21606
OAI-PMH Set
Faculty of Medicine