{"id":2627,"date":"2024-04-23T10:01:23","date_gmt":"2024-04-23T01:01:23","guid":{"rendered":"https:\/\/www.hcfm.jp\/journal\/?p=2627"},"modified":"2024-04-23T10:01:23","modified_gmt":"2024-04-23T01:01:23","slug":"%e9%a7%86%e5%87%ba%e7%8e%87%e3%81%ae%e4%bd%8e%e4%b8%8b%e3%82%92%e4%bc%b4%e3%81%86%e5%bf%83%e4%b8%8d%e5%85%a8%e3%81%ae%e8%96%ac%e7%89%a9%e6%b2%bb%e7%99%82%e3%81%ae%e7%b3%bb%e7%b5%b1%e7%9a%84%e3%83%ac","status":"publish","type":"post","link":"https:\/\/www.hcfm.jp\/journal\/?p=2627","title":{"rendered":"\u99c6\u51fa\u7387\u306e\u4f4e\u4e0b\u3092\u4f34\u3046\u5fc3\u4e0d\u5168\u306e\u85ac\u7269\u6cbb\u7642\u306e\u7cfb\u7d71\u7684\u30ec\u30d3\u30e5\u30fc\u3068\u30cd\u30c3\u30c8\u30ef\u30fc\u30af\u30e1\u30bf\u30a2\u30ca\u30ea\u30b7\u30b9"},"content":{"rendered":"

\u2015\u6587\u732e\u540d\u2015
\nTromp J, Ouwerkerk W, van Veldhuisen DJ, Hillege HL, Richards AM, van der Meer P, Anand IS, Lam CSP, Voors AA. A Systematic Review and Network Meta-Analysis of Pharmacological Treatment of Heart Failure With Reduced Ejection Fraction. JACC Heart Fail. 2022 Feb;10(2):73-84<\/p>\n

\u2015\u8981\u7d04\u2015
\nIntroduction\uff1a \u30a2\u30f3\u30b8\u30aa\u30c6\u30f3\u30b7\u30f3\u5909\u63db\u9175\u7d20\u963b\u5bb3\u85ac\uff08ACEi\uff09\u3001\u30a2\u30f3\u30b8\u30aa\u30c6\u30f3\u30b7\u30f3\u53d7\u5bb9\u4f53\u62ee\u6297\u85ac\uff08ARB\uff09\u3001\u03b2\u906e\u65ad\u85ac\uff08BB\uff09\u3001\u30df\u30cd\u30e9\u30eb\u30b3\u30eb\u30c1\u30b3\u30a4\u30c9\u53d7\u5bb9\u4f53\u62ee\u6297\u85ac\uff08MRA\u30b9\u30d4\u30ed\u30ce\u30e9\u30af\u30c8\u30f3,\u30bb\u30e9\u30e9,\u30df\u30cd\u30d6\u30ed\uff09\u304c\u99c6\u51fa\u7387\u4f4e\u4e0b\u578b\u5fc3\u4e0d\u5168\uff08HFrEF\uff09\u306e\u85ac\u7406\u5b66\u7684\u6cbb\u7642\u306e\u57fa\u790e\u3068\u3057\u3066\u78ba\u7acb\u3055\u308c\u305f\u3002\u3053\u306e10\u5e74\u9593\u3067\u3001\u30b5\u30af\u30d3\u30c8\u30ea\u30eb\uff0f\u30d0\u30eb\u30b5\u30eb\u30bf\u30f3\uff08ARNi \u30a2\u30fc\u30cb\u30fc\u00ae\ufe0f\u30a8\u30f3\u30ec\u30b9\u30c8\uff09\u3068\u30a4\u30d0\u30d6\u30e9\u30b8\u30f3(\u00ae\ufe0f\u30b3\u30e9\u30e9\u30f3)\u304c\u8ffd\u52a0\u3055\u308c\u3001HFrEF\u306b\u5bfe\u3059\u308b\u6cbb\u7642\u306e\u9078\u629e\u80a2\u304c\u5897\u3048\u305f\u3002\u904e\u53bb1\u5e74\u9593\u306b\u767a\u8868\u3055\u308c\u305f\u8a66\u9a13\u306e\u7d50\u679c\u3067\u306f\u3001\u30ca\u30c8\u30ea\u30a6\u30e0-\u30b0\u30eb\u30b3\u30fc\u30b9\u5171\u8f38\u9001\u4f532\u963b\u5bb3\u85ac\uff08SGLT2i\uff09\u3067\u3042\u308b\u30a8\u30f3\u30d1\u30b0\u30ea\u30d5\u30ed\u30b8\u30f3\uff08\u00ae\ufe0f\u30b8\u30e3\u30c7\u30a3\u30a2\u30f3\u30b9\uff09\u304a\u3088\u3073\u30c0\u30d1\u30b0\u30ea\u30d5\u30ed\u30b8\u30f3\uff08\u00ae\ufe0f\u30d5\u30a9\u30b7\u30fc\u30ac\uff09\u3001\u53ef\u6eb6\u6027\u30b0\u30a2\u30cb\u30e9\u30fc\u30bc\u30b7\u30af\u30e9\u30fc\u30bc\u523a\u6fc0\u85ac\u3067\u3042\u308b\u30d9\u30ea\u30b7\u30b0\u30a2\u30c8\uff08\u00ae\ufe0f\u30d9\u30ea\u30ad\u30e5\u30fc\u30dc\uff09\u3001\u5fc3\u7b4b\u7279\u7570\u7684\u30df\u30aa\u30b7\u30f3\u6d3b\u6027\u5316\u85ac\u3067\u3042\u308b\u30aa\u30e1\u30ab\u30e0\u30c1\u30d6\u30e1\u30ab\u30eb\u30d3\u30eb\u306b\u3088\u308b\u6cbb\u7642\u304cHFrEF\u306e\u4e88\u5f8c\u3092\u3055\u3089\u306b\u6539\u5584\u3067\u304d\u308b\u3053\u3068\u304c\u793a\u3055\u308c\u305f\u3002
\n\u6700\u8fd1\u306e\u81e8\u5e8a\u8a66\u9a13\u306e\u7d50\u679c\u306f\u3001\u6cbb\u7642\u306e\u9806\u5e8f\u3092\u6c7a\u3081\u305f\u308a\u3001\u6700\u3082\u6709\u76ca\u306a\u85ac\u7269\u7642\u6cd5\u306e\u7d44\u307f\u5408\u308f\u305b\u3092\u6c7a\u5b9a\u3057\u305f\u308a\u3059\u308b\u3053\u3068\u306f\u3067\u304d\u306a\u3044\u3002\u30cd\u30c3\u30c8\u30ef\u30fc\u30af\u30fb\u30e1\u30bf\u30a2\u30ca\u30ea\u30b7\u30b9\u3067\u306f\u3001\u6cbb\u7642\u52b9\u679c\u306e\u7dcf\u548c\u306e\u5dee\u3092\u6bd4\u8f03\u3059\u308b\u305f\u3081\u306b\u3001\u7570\u306a\u308b\u6cbb\u7642\u6cd5\u306e\u7d44\u307f\u5408\u308f\u305b\u9593\u306e\u6bd4\u8f03\u304c\u53ef\u80fd\u3067\u3042\u308b\u3002\u6cbb\u7642\u306e\u6700\u9069\u306a\u7d2f\u7a4d\u52b9\u679c\u306b\u95a2\u3059\u308b\u60c5\u5831\u306f\u3001\u533b\u5e2b\u3068\u60a3\u8005\u304c\u5171\u6709\u3059\u308b\u6cbb\u7642\u65b9\u91dd\u306e\u6c7a\u5b9a\u306b\u5f79\u7acb\u3064\u3002\u57fa\u790e\u3068\u306a\u308b\u4eee\u5b9a\u306f\u3001\u6cbb\u7642\u306b\u306f\u76f8\u52a0\u52b9\u679c\u304c\u3042\u308b\u3068\u3044\u3046\u3053\u3068\u3067\u3042\u308b\u3002ARNi\u3001SGLT2i\u3001\u30d9\u30ea\u30b7\u30b0\u30a2\u30c8\u3001\u30aa\u30e1\u30ab\u30e0\u30c1\u30d6\u30e1\u30ab\u30eb\u30d3\u30eb\u306b\u3064\u3044\u3066\u306f\u3001\u6f5c\u5728\u7684\u306b\u7570\u306a\u308b\u75be\u60a3\u7d4c\u8def\u3092\u6a19\u7684\u3068\u3057\u3066\u3044\u308b\u305f\u3081\u3001\u3053\u308c\u306f\u3082\u3063\u3068\u3082\u3089\u3057\u3044\u3002\u305d\u3053\u3067\u308f\u308c\u308f\u308c\u306f\u3001HFrEF\u306b\u5bfe\u3059\u308b\u85ac\u7269\u7642\u6cd5\u306e\u6cbb\u7642\u52b9\u679c\u3092\u63a8\u5b9a\u3057\u6bd4\u8f03\u3059\u308b\u305f\u3081\u306b\u3001\u7cfb\u7d71\u7684\u30ec\u30d3\u30e5\u30fc\u3068\u30cd\u30c3\u30c8\u30ef\u30fc\u30af\u30e1\u30bf\u89e3\u6790\u3092\u884c\u3063\u305f\u3002<\/p>\n

Method\uff1aEDLINE\/EMBASE\u3068Cochrane Central Register of Controlled Trials\u3092\u7528\u3044\u3066\u30011987\u5e741\u6708\uff5e2020\u5e741\u6708\u306b\u767a\u8868\u3055\u308c\u305f\u30e9\u30f3\u30c0\u30e0\u5316\u6bd4\u8f03\u8a66\u9a13\u3092\u5bfe\u8c61\u306b\u7cfb\u7d71\u7684\u30cd\u30c3\u30c8\u30ef\u30fc\u30af\u30e1\u30bf\u89e3\u6790\u3092\u884c\u3063\u305f\u3002\u30a2\u30f3\u30b8\u30aa\u30c6\u30f3\u30b7\u30f3\u5909\u63db\u9175\u7d20\u963b\u5bb3\u85ac\u3001\u30a2\u30f3\u30b8\u30aa\u30c6\u30f3\u30b7\u30f3\u53d7\u5bb9\u4f53\u62ee\u6297\u85ac\u3001\u03b2\u906e\u65ad\u85ac\uff08BB\uff09\u3001\u30df\u30cd\u30e9\u30eb\u30b3\u30eb\u30c1\u30b3\u30a4\u30c9\u53d7\u5bb9\u4f53\u62ee\u6297\u85ac\uff08MRA\uff09\u3001\u30b8\u30b4\u30ad\u30b7\u30f3\u3001\u30d2\u30c9\u30e9\u30b8\u30f3-\u785d\u9178\u30a4\u30bd\u30bd\u30eb\u30d3\u30c9\u3001\u30a4\u30d0\u30d6\u30e9\u30b8\u30f3\u3001\u30a2\u30f3\u30b8\u30aa\u30c6\u30f3\u30b7\u30f3\u53d7\u5bb9\u4f53-\u30cd\u30d7\u30ea\u30e9\u30a4\u30b7\u30f3\u963b\u5bb3\u85ac\uff08ARNi\uff09\u3001\u30ca\u30c8\u30ea\u30a6\u30e0\u30b0\u30eb\u30b3\u30fc\u30b9\u5171\u8f38\u9001\u4f53-2\u963b\u5bb3\u85ac\uff08SGLT2i\uff09\u3001\u30d9\u30ea\u30b7\u30b0\u30a2\u30c8\u3001\u30aa\u30e1\u30ab\u30e0\u30c1\u30d6\u30e1\u30ab\u30eb\u30d3\u30eb\u3092\u5bfe\u8c61\u3068\u3057\u305f\u3002
\n\u5fc3\u4e0d\u5168\u3092\u6709\u3059\u308b\u6210\u4eba\u96c6\u56e3\uff0818\u6b73\u4ee5\u4e0a\uff09\u306b\u9650\u5b9a\u3055\u308c\u305f\u3002\u8ee2\u5e30\u306b\u5927\u304d\u306a\u5f71\u97ff\u3092\u4e0e\u3048\u308b\u53ef\u80fd\u6027\u304c\u9ad8\u3044\u8a3a\u65ad\u3092\u4f75\u767a\u3057\u3066\u3044\u308b\u60a3\u8005\u304c\u96c6\u56e3\u5168\u4f53\u306b\u542b\u307e\u308c\u3066\u3044\u308b\u5834\u5408\uff08\u4f8b\u3001\u5fc3\u7b4b\u6897\u585e\u5f8c\u306e\u5de6\u5fc3\u5ba4\u6a5f\u80fd\u969c\u5bb3\u306e\u3042\u308b\u60a3\u8005\u3001\u307e\u305f\u306f\u7cd6\u5c3f\u75c5\u60a3\u8005\u306e\u307f\u3092\u542b\u3080\u8a66\u9a13\uff09\u3001\u7814\u7a76\u306f\u9664\u5916\u3055\u308c\u305f\u3002\u5fc3\u4e0d\u5168\u306e\u6025\u6027\u671f\u306e\u60a3\u8005\u3092\u6cbb\u7642\u3059\u308b\u7814\u7a76\u3084\u3001\u540c\u3058\u85ac\u5264\u30b0\u30eb\u30fc\u30d7\u5185\u306e\u85ac\u5264\u3092\u6bd4\u8f03\u3059\u308b\u7814\u7a76\u306f\u9664\u5916\u3055\u308c\u305f\u3002\uff08Figure 1\uff09
\n\u4e3b\u8981\u30a2\u30a6\u30c8\u30ab\u30e0\u306f\u5168\u6b7b\u4ea1\u3067\u3042\u3063\u305f\u3002\u3055\u3089\u306b\u3001\u5fc3\u8840\u7ba1\uff08CV\uff09\u6b7b\u4ea1\u3068\u5fc3\u4e0d\u5168\uff08HHF\uff09\u306b\u3088\u308b\u5165\u9662\u3001CV\u6b7b\u4ea1\u306e\u307f\u3001\u304a\u3088\u3073\u4f55\u3089\u304b\u306e\u7406\u7531\u306b\u3088\u308b\u85ac\u7269\u4e2d\u6b62\u306e\u53ef\u80fd\u6027\u306e\u8907\u5408\u8ee2\u5e30\u3092\u5206\u6790\u3057\u305f\u3002\u4e8c\u6b21\u89e3\u6790\u3067\u306f\u30012\u3064\u306e\u5fc3\u4e0d\u5168\u96c6\u56e3\uff08BIOSTAT-CHF [BIOlogy Study to TAilored Treatment in Chronic Heart Failure]\u304a\u3088\u3073ASIAN-HF [Asian Sudden Cardiac Death in Heart Failure Registry]\uff09\u3067\u5f97\u3089\u308c\u305f\u751f\u547d\u5e74\u3092\u63a8\u5b9a\u3057\u305f\u3002<\/p>\n

Results\uff1a95,444\u4eba\u306e\u53c2\u52a0\u8005\u3092\u5bfe\u8c61\u3068\u3057\u305f75\u306e\u95a2\u9023\u8a66\u9a13\u3092\u540c\u5b9a\u3057\u305f\u3002ARNi\u3001BB\u3001MRA\u3001SGLT2i\u306e\u4f75\u7528\u304c\u5168\u6b7b\u4ea1\u306e\u6e1b\u5c11\u306b\u6700\u3082\u6709\u52b9\u3067\u3042\u308a\uff08HR\uff1a0.39\u300195\uff05CI\uff1a0.31-0.49\uff09\u3001\u6b21\u3044\u3067ARNi\u3001BB\u3001MRA\u3001\u30d9\u30ea\u30b7\u30b0\u30a2\u30c8\uff08HR\uff1a0.41\u300195\uff05CI\uff1a0.32-0.53\uff09\u3001ARNi\u3001BB\u3001MRA\uff08HR\uff1a0.44\u300195\uff05CI\uff1a0.36-0.54\uff09\u3067\u3042\u3063\u305f(Central Illustration A)\u3002\u5fc3\u8840\u7ba1\u6b7b\u307e\u305f\u306fHF\u306b\u3088\u308b\u521d\u56de\u5165\u9662\u306e\u8907\u5408\u30a2\u30a6\u30c8\u30ab\u30e0\u306b\u3064\u3044\u3066\u3082\u7d50\u679c\u306f\u540c\u69d8\u3067\u3042\u3063\u305f\uff08ARNi\u3001BB\u3001MRA\u3001SGLT2i\u306eHR\uff1a0.36\u300195\uff05CI\uff1a0.29-0.46\u3001ARNi\u3001BB\u3001MRA\u3001\u30aa\u30e1\u30ab\u30e0\u30c1\u30d6\u30e1\u30ab\u30eb\u30d3\u30eb\u306eHR\uff1a0.44\u300195\uff05CI\uff1a0.35-0.56\u3001ARNi\u3001BB\u3001MRA\u3001\u30d9\u30ea\u30b7\u30b0\u30a2\u30c8\u306eHR\uff1a0.43\u300195\uff05CI\uff1a0.34-0.55\uff09\uff08Central Illustration B\uff09\u3002
\nARNi\u3001BB\u3001MRA\u3001SGLT2i\u3092\u6295\u4e0e\u3055\u308c\u305f70\u6b73\u306e\u60a3\u8005\u306b\u304a\u3044\u3066\u3001\u4e8c\u6b21\u89e3\u6790\u3067\u7121\u6cbb\u7642\u3068\u6bd4\u8f03\u3057\u3066\u8ffd\u52a0\u7684\u306b\u5f97\u3089\u308c\u308b\u3068\u63a8\u5b9a\u3055\u308c\u305f\u751f\u547d\u5e74\u6570\u306f5.0\u5e74\uff082.5\uff5e7.5\u5e74\uff09\u3067\u3042\u3063\u305f\uff08Figure 3\uff09\u3002<\/p>\n

Discussion\uff1a\u7570\u306a\u308bHF\u8a66\u9a13\u304c\u5b9f\u65bd\u3055\u308c\u305f\u671f\u9593\u306f\u304b\u306a\u308a\u9577\u304f\u3001\u30d0\u30a4\u30a2\u30b9\u304c\u751f\u3058\u305f\u53ef\u80fd\u6027\u304c\u3042\u308b\u3002\u3057\u304b\u3057\u3001\u4e3b\u8981\u30a2\u30a6\u30c8\u30ab\u30e0\u3068\u591a\u304f\u306e\u526f\u6b21\u7684\u30a2\u30a6\u30c8\u30ab\u30e0\u306b\u304a\u3051\u308b\u7570\u8cea\u6027\u306eP\u5024\u306f\u6709\u610f\u3067\u306f\u306a\u304f\u3001\u3053\u306e\u3053\u3068\u304c\u7d50\u679c\u306b\u6709\u610f\u306a\u5f71\u97ff\u3092\u53ca\u307c\u3055\u306a\u304b\u3063\u305f\u53ef\u80fd\u6027\u3092\u793a\u5506\u3057\u3066\u3044\u308b\u3002\u4e2d\u6b62\u306b\u95a2\u3059\u308b\u7d50\u679c\u306f\u3001\u30e9\u30f3\u30c0\u30e0\u52b9\u679c\u30e2\u30c7\u30eb\u3092\u7528\u3044\u305f\u306b\u3082\u304b\u304b\u308f\u3089\u305a\u3001\u304b\u306a\u308a\u306e\u7570\u8cea\u6027\u3092\u793a\u3057\u305f\u3002\u3053\u308c\u306f\u4e2d\u6b62\u306e\u5b9a\u7fa9\u306e\u9055\u3044\u306b\u3088\u308b\u3082\u306e\u304b\u3082\u3057\u308c\u306a\u3044\u3002\u3057\u305f\u304c\u3063\u3066\u3001\u3053\u308c\u3089\u306e\u7d50\u679c\u306f\u614e\u91cd\u306b\u89e3\u91c8\u3059\u3079\u304d\u3067\u3042\u308b\u3002\u6700\u5f8c\u306b\u3001\u6cbb\u7642\u52b9\u679c\u306e\u63a8\u5b9a\u306b\u5f71\u97ff\u3092\u53ca\u307c\u3059\u53ef\u80fd\u6027\u306e\u3042\u308b\u975e\u85ac\u7406\u5b66\u7684\u88c5\u7f6e\u306e\u4f7f\u7528\u306f\u8003\u616e\u3057\u3066\u3044\u306a\u3044\u3002
\n\"\"<\/a>
\nFigure 1. Overview of Study Selection Schematic overview of study selection.<\/p>\n

\"\"<\/a><\/p>\n

\"\"<\/a><\/p>\n

Central Illustration. Relative Risk Reduction of Different Pharmacological Treatment Combinations for Heart Failure
\nCombination of treatment effect on all-cause mortality (A), cardiovascular (CV) death or heart failure (HF) hospitalization (B), or CV mortality (C). ACEI = angiotensin-converting enzyme inhibitor; ARB = angiotensin receptor blocker; BB = beta-blocker; Dig = digoxin; H-ISDN = hydralazine\u2013isosorbide dinitrate; HF = heart failure; IVA = ivabradine; MRA = mineralocorticoid receptor antagonist; PLBO = placebo; SGLT2 = sodium glucose cotransporter-2 inhibitors.<\/p>\n

\"\"<\/a>
\nFigure 3. Estimated Average Lifetime Graphs<\/p>\n

\u3010\u958b\u50ac\u65e5\u30112024\u5e743\u670813\u65e5\uff08\u6c34\uff09<\/p>\n","protected":false},"excerpt":{"rendered":"

\u2015\u6587\u732e\u540d\u2015 Tromp J, Ouwerkerk W, van Veldhuisen DJ, Hillege HL, Richards AM, van der Meer P, Anand IS, Lam CSP, Voo … \u7d9a\u304d\u3092\u8aad\u3080 \u99c6\u51fa\u7387\u306e\u4f4e\u4e0b\u3092\u4f34\u3046\u5fc3\u4e0d\u5168\u306e\u85ac\u7269\u6cbb\u7642\u306e\u7cfb\u7d71\u7684\u30ec\u30d3\u30e5\u30fc\u3068\u30cd\u30c3\u30c8\u30ef\u30fc\u30af\u30e1\u30bf\u30a2\u30ca\u30ea\u30b7\u30b9<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[17],"tags":[],"class_list":["post-2627","post","type-post","status-publish","format-standard","hentry","category-17"],"_links":{"self":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/2627","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=2627"}],"version-history":[{"count":1,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/2627\/revisions"}],"predecessor-version":[{"id":2632,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/2627\/revisions\/2632"}],"wp:attachment":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=2627"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=2627"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=2627"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}