1. Journal Club 埼玉医科大学 総合医療センター 内分泌・糖尿病内科 Department of Endocrinology and Diabetes, Saitama Medical Center, Saitama Medical University 松田 昌文 Matsuda, Masafumi 2012 年 7 月 12 日 8:30-8:55 ８階 医局 Lagiou P, Sandin S, Lof M, Trichopoulos D, Adami HO, Weiderpass E. Low carbohydrate-high protein diet and incidence of cardiovascular diseases in Swedish women: prospective cohort study. BMJ. 2012 Jun 26;344:e4026. doi: 10.1136/bmj.e4026. Shinozaki T, Matsuyama Y, Iimuro S, Umegaki H, Sakurai T, Araki A, Ohashi Y, Ito H; Japanese Elderly Diabetes Intervention Trial Research Group. Effective prevention of cardiovascular disease and diabetes-related events with atorvastatin in Japanese elderly patients with type 2 diabetes mellitus: adjusting for treatment changes using a marginal structural proportional hazards model and a rank- preserving structural failure time model. Geriatr Gerontol Int. 2012 Apr;12 Suppl 1:88-102. doi: 10.1111/j.1447-0594.2011.00816.x.

2. http://lsm.diabetes-smc.jp/

3. ①日程： 11 月 21 日か 11 月 28 日（水曜日） ②時間： 19 ： 00 ～ ③講演： 埼玉医科大学総合医療センター内分泌・糖尿病内科 松田昌文教授 『カボーカウントの基礎』 徳島大学糖尿病臨床・研究開発センター 黒田暁生先生『カボーカウントの実際』 秋の講演会

5. Objective To study the long term consequences of low carbohydrate diets, generally characterised by concomitant increases in protein intake, on cardiovascular health.

6. Design Prospective cohort study. Setting Uppsala, Sweden. Participants From a random population sample, 43 396 Swedish women, aged 30-49 years at baseline, completed an extensive dietary questionnaire and were followed-up for an average of 15.7 years. Main outcome measures Association of incident cardiovascular diseases (ascertained by linkage with nationwide registries), overall and by diagnostic category, with decreasing carbohydrate intake (in tenths), increasing protein intake (in tenths), and an additive combination of these variables (low carbohydrate-high protein score, from 2 to 20), adjusted for intake of energy, intake of saturated and unsaturated fat, and several non- dietary variables.

13. Results A one tenth decrease in carbohydrate intake or increase in protein intake or a 2 unit increase in the low carbohydrate-high protein score were all statistically significantly associated with increasing incidence of cardiovascular disease overall (n=1270)—incidence rate ratio estimates 1.04 (95% confidence interval 1.00 to 1.08), 1.04 (1.02 to 1.06), and 1.05 (1.02 to 1.08). No heterogeneity existed in the association of any of these scores with the five studied cardiovascular outcomes: ischaemic heart disease (n=703), ischaemic stroke (n=294), haemorrhagic stroke (n=70), subarachnoid haemorrhage (n=121), and peripheral arterial disease (n=82).

14. Conclusions Low carbohydrate-high protein diets, used on a regular basis and without consideration of the nature of carbohydrates or the source of proteins, are associated with increased risk of cardiovascular disease.

15. Message スウェーデンで 30-49 歳の女性 4 万 3396 人を対 象に、低炭水化物 - 高たんぱく質食と心血管疾患 の関連を前向きコホート研究で検証。平均 15.7 年の追跡調査で、たんぱく質摂取量の 10 分の 1 の 増加、炭水化物摂取量の 10 分の 1 の減少、または 低炭水化物 - 高たんぱく質スコアの 2 単位増加が 心血管疾患の増加と統計学的有意に関連した

17. 目的 高齢糖尿病患者における血糖、脂質、血圧の多因子介入の細小血管症、大血管合併症、 死亡、および機能的予後（身体機能、認知機能、心理機能）に対する効果を検討する https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&recptno=R000001068&type=summary&language=J 強化治療群：血圧 130/85mmHg 未満、総コレステロール：冠動脈疾患がある場合 180mg/dl 以下、冠動脈疾患がない場合 200mg/dl 以下、トリグリセリド 150mg/dl 以 下、 HDL コレステロール 40mg/dl 以上、 BMI25 未満 通常治療群：主治医が妥当と考える治療 ： FPG 200mg/dl 以下または HbA1c 9.0% 未満

19. 第 54 回日本老年医学会学術集会会長大庭建三 会期： 2012 年 6 月 28 日（木）， 29 日（金）， 30 日（土） 会場：東京国際フォーラム（東京都千代田区丸の内） 学会テーマ：超高齢社会における老年医学

20. Geriatr Gerontol Int 2012; 12 (Suppl. 1): 88–102.

21. Aim: To assess the preventive effect of atorvastatin on cardiovascular disease and on diabetes-related events in elderly type 2 diabetic patients enrolled in the Japanese Elderly Diabetes Intervention Trial (J-EDIT).

22. Methods: Data were obtained from 1173 patients aged 65–84 years who were enrolled in the J- EDIT. Patients were followed prospectively for 6 years to determine the effects of atorvastatin on serum cholesterol levels, and cardiovascular and diabetes-related events. Because the study protocol allowed atorvastatin to be prescribed according to the clinical needs of each patient, we regarded the J-EDIT data as if they came from a cohort study. We adjusted for clinical characteristics during the study as time- dependent confounders using two methods, inverse-probability-of-treatment (IPT) weighting and g-estimation method.

29. Results: The total follow-up period was 5310.8 person-years (5.7 years of median follow up), during which 202 patients received atorvastatin treatment. Atorvastatin was associated with moderate reductions in cholesterol levels: 24.2 mg/dL for total cholesterol, 22.9 mg/dL for low-density lipoprotein (LDL) cholesterol and 24.3 mg/dL for non-highdensity lipoprotein cholesterol at the first post-treatment year. As a result, the proportion of patients who achieved targeted levels of LDL cholesterol clearly increased after atorvastatin treatment. Eight patients in 476.6 person-years among atorvastatin-treated and 113 untreated patients in 4721.4 person-years had cardiovascular events (the composite endpoint of fatal/non-fatal myocardial infarction, angina pectoris, coronary intervention, and fatal/non-fatal cerebrovascular disease); hazard ratio (HR) = 0.48, 95% confidence interval (CI) = 0.19–1.16, P = 0.10, and HR = 0.32, 95% CI = 0.05–1.87, P = 0.21 from IPT weighting and g-estimation method, respectively. Furthermore, seven in 475.0 person-years among atorvastatin- treated and 149 untreated patients in 4682.4 person-years had diabetes-related events (the composite end-point of sudden death, renal failure death, death as a result of hyperglycemia or hypoglycemia, diabetic gangrene and congestive heart failure in addition to cardiovascular event); HR = 0.30, 95% CI = 0.12– 0.77, P = 0.01, and HR = 0.40, 95% CI = 0.09–0.89, P = 0.03 from IPT weighting and g-estimation method, respectively. When cardiovascular events were further differentiated into coronary vascular and cerebrovascular events, atorvastatin especially decreased the cerebrovascular risk.

30. Conclusion: The use of atorvastatin to lower cholesterol levels in elderly Japanese patients with type 2 diabetes mellitus appears to reduce the risk of cardiovascular and diabetes-related events.

31. Geriatr Gerontol Int 2012; 12 (Suppl. 1): 141–144

32. Message J-EDIT 研究で、脂質と血圧管理は有用だが、血 糖管理はやはり低血糖が起きないようにすること が重要であった。