研究の背景：SGLT2阻害薬はアジア人には向かない？ 2015年のEMPA-REG OUTCOME試験（N Engl J Med 2015；373：2117-2128）の報告は、米食品医薬品局（FDA）をして、SGLT2阻害薬エンパグリフロジンに心血管疾患を有する糖尿病患者の心血管死予防の適応を追加せしめるほどのインパクトがあった（関連記事）。そして、2016年には腎症の発症・進展予防効果も示され（N Engl J Med 2016；375：323-334）、そのあまりに際立った臓器保護効果の機序をめぐって、さまざまな議論が展開されているところである（関連記事）。 その一方で、当初、SGLT2阻害薬は肥満の若年者に、別な表現をすればアジア人よりも欧米人でよい適応があると見られがちであった。それ故に、SGLT2阻害薬のわが国での広がりは、極めて緩徐であったことは多くの先生が記憶されているであろう。 このたび、EMPA-REG OUTCOME試験の全7,020例の21.6%を占めるアジア人1,517例を対象にしたサブ解析の結果が、日本循環器病学会の機関誌Circ Jに報告された（2017；81：227-234）。川崎医科大学の加来浩平氏が筆頭著者である。理論通りにはならないからこそ臨床研究は面白く、また、臨床研究の予想外の結果から新たな理論が見えてくることの典型例としてご紹介したい。 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