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∆∂ÀÃ√™ 9 ñ MAƒ∆π√™ 2006
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KÏÈÓÈΤ˜ MÂϤÙ˜
EӉȷʤÚÔÓ ¶ÂÚÈÛÙ·ÙÈÎfi £Âڷ›· - º¿Ú̷η
¶ÚÔÙÂÈÓfiÌÂÓË µÈ‚ÏÈÔÁÚ·Ê›·
™YNTAKTIKH E¶ITPO¶H ¢È¢ı˘ÓÙ‹˜ ™‡ÓÙ·Í˘ XÂÈÌÒÓ·˜ HÏ›·˜ K·Ú‰ÈÔÏfiÁÔ˜ YÔÙ¤Ú·Ú¯Ô˜ Â.·.
M¤ÏË Õı˘ÚÔ˜ B·Û›ÏÂÈÔ˜ AÓ·ÏËÚˆÙ‹˜ ¢È¢ı˘ÓÙ‹˜ E™Y K·Ú‰ÈÔÏÔÁÈÎfi TÌ‹Ì· B’ ¶ÚÔ·È‰Â˘ÙÈ΋˜ KÏÈÓÈ΋˜ A¶£ IÔÎÚ¿ÙÂÈÔ NÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔӛ΢ °·ÓˆÙ¿Î˘ EÌÌ·ÓÔ˘‹Ï E›ÎÔ˘ÚÔ˜ K·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜ I·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ HÚ·ÎÏ›Ԣ ¶ÂÚÈÊÂÚÂÈ·Îfi ¶·ÓÂÈÛÙËÌÈ·Îfi NÔÛÔÎÔÌÂ›Ô HÚ·ÎÏ›Ԣ KÚ‹Ù˘
¶APA°ONTE™ KIN¢YNOY - ∂¶π¢∏ªπ√§√°π∞ ∂ȉËÌÈÔÏÔÁ›· ÙÔ˘ ªÂÙ·‚ÔÏÈÎÔ‡ ™˘Ó‰ÚfiÌÔ˘
2
∫. ∆˙ÈfiÌ·ÏÔ˜, ∞. ∫·Î·Ê‹Î·, ª. ™›ÏÂÏË, π. ¢Ô˘ÏÔ˘Ì¿Î·˜, °. ™Ê‹Î·˜, ∞. ¶ÈÚ·ÛÔÔ‡ÏÔ˘, ª. ºÏˆÚÂÓÙ›Ó, ∞. ™Î·¤Ú‰·˜, ∞. ∫·Ú·ÁÈ¿ÓÓ˘, µ. Õı˘ÚÔ˜
¶ÚfiÛÊ·Ù˜ ∞Ó·ÛÎÔ‹ÛÂȘ Î·È ÕÚıÚ· ∂ΉfiÙË ÁÈ· ÙÔ ªÂÙ·‚ÔÏÈÎfi ™‡Ó‰ÚÔÌÔ
4
πˆ¿ÓÓ˘ ∞. °Ô˘‰¤‚ÂÓÔ˜
¢È·ÁÓˆÛÙÈ΋ ¶ÚÔÛ¤ÁÁÈÛË ÙÔ˘ ∞ÛıÂÓ‹ Ì ∞ÓıÂÎÙÈ΋ À¤ÚÙ·ÛË
5
°ÂÒÚÁÈÔ˜ ™Ê‹Î·˜, ¡È΋ٷ˜ ∫·Îη‚¿˜, πˆ¿ÓÓ˘ ∆ÛfiÚÏ·Ï˘, ∞ÛÙ¤ÚÈÔ˜ ∫·Ú·ÁÈ¿ÓÓ˘
÷ÌËÏfi B¿ÚÔ˜ °¤ÓÓËÛ˘ ¶ÚԂϤÂÈ ªÂÙ·‚ÔÏÈÎfi ™‡Ó‰ÚÔÌÔ Û N·ÚÔ‡˜ EÓ‹ÏÈΘ: ªÂϤÙË ARYA (Atherosclerosis Risk in Young Adults)
8
Ramadhani MK, Grobbee DE, Bots ML, Cabezas MC, Vos LE, Oren A, Uiterwaal CSPM Atherosclerosis 2006;184:21-27
¶A£OºY™IO§O°IA √ ƒfiÏÔ˜ Ù˘ °ÎÚÂÏ›Ó˘ ÛÙÔ ªÂÙ·‚ÔÏÈÛÌfi Î·È ÙËÓ ¶·¯˘Û·ÚΛ·
9
µ·Ï·ÓÙ‹Ó ¢ÈÛÏÈ¿Ó, ∞ÛÙ¤ÚÈÔ˜ ∫·Ú·ÁÈ¿ÓÓ˘
™Ù¿‰È· Î·È ¶·Ú¿ÁÔÓÙ˜ Ô˘ ∂˘ÓÔÔ‡Ó ÙÔ ™¯ËÌ·ÙÈÛÌfi Ù˘ ∞ıËڈ̷ÙÈ΋˜ ¶Ï¿Î·˜
13
°ÂÓÔ‚¤Ê· ∫ÔÏÔ‚Ô‡, µ·ÛÈÏÈ΋ °È·ÓÓ·ÎÔÔ‡ÏÔ˘ EÏÈÛ¿Ê Mˆ˘Û‹˜ K·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜ I·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ Iˆ·ÓÓ›ÓˆÓ ¶ÂÚÈÊÂÚÂÈ·Îfi ¶·ÓÂÈÛÙËÌÈ·Îfi NÔÛÔÎÔÌÂ›Ô Iˆ·ÓÓ›ÓˆÓ
K§INIKE™ ME§ETE™ ™˘Ó‰˘·Ṳ̂ÓË AÓÙÈÌÂÙÒÈÛË Y¤ÚÙ·Û˘ Î·È ¢˘ÛÏÈȉ·ÈÌ›·˜: ∂˘Ú‹Ì·Ù· Ù˘ ªÂϤÙ˘ ASCOT
15
BjØrn DahlØf, Peter S Sever, Neil R Poulter, et al, for the ASCOT Investigators. Lancet. 2005;366:907-13 ∂È̤ÏÂÈ·: ∫. ∆˙ÈfiÌ·ÏÔ˜, ∞. ∫·Î·Ê‹Î·, ª. ™›ÏÂÏË, π. ¢Ô˘ÏÔ˘Ì¿Î·˜, °. ™Ê‹Î·˜, ∞. ¶ÈÚ·ÛÔÔ‡ÏÔ˘, ª. ºÏˆÚÂÓÙ›Ó, ∞. ™Î·¤Ú‰·˜, ∞. ∫·ÚÁÈ¿ÓÓ˘, µ. Õı˘ÚÔ˜
KÔÏÔ‚Ô‡ °ÂÓÔ‚¤Ê· K·Ú‰ÈÔÏfiÁÔ˜ YԉȢı‡ÓÙÚÈ· A’ K·Ú‰ÈÔÏÔÁÈ΋˜ KÏÈÓÈ΋˜ Î·È Y‡ı˘ÓÔ˜ §Èȉ·ÈÌÈÎÔ‡
∂¡¢π∞º∂ƒ√¡ ¶∂ƒπ™∆∞∆π∫√ ∞ÛıÂÓ‹˜ Ì X·ÌËÏ‹ HDL-XÔÏËÛÙÂÚfiÏË
18
ÃÂÈÌÒÓ·˜ £Âfi‰ˆÚÔ˜, ∫ÔÏÔ‚Ô‡ °ÂÓÔ‚¤Ê·
I·ÙÚ›Ԣ øÓ·Û›Ԣ K·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈÎÔ‡ K¤ÓÙÚÔ˘ MÈÏÈ·ÓÔ‡ EϤÓË K·Ú‰ÈÔÏfiÁÔ˜ EÈÌÂÏËÙ‹˜ A’ Ù˘ K·Ú‰ÈÔÏÔÁÈ΋˜ KÏÈÓÈ΋˜ Î·È Y‡ı˘ÓÔ˜ §Èȉ·ÈÌÈÎÔ‡ I·ÙÚ›Ԣ T˙·Ó›Ԣ NÔÛÔÎÔÌ›Ԣ ¶ÂÈÚ·ÈÒ˜
∞ÛıÂÓ‹˜ ÌÂ Ã˘ÏÔÌÈÎÚÔÓ·ÈÌ›·
20
∂ÈÚ‹ÓË °·˙‹, ∂˘¿ÁÁÂÏÔ˜ §˘ÌÂÚfiÔ˘ÏÔ˜, ªˆ˘Û‹˜ ∂ÏÈÛ¿Ê
£EPA¶EIA — ºAPMAKA £ÚÔÌ‚ÔÂÓ›· Û ∞ÛıÂÓ›˜ Ô˘ ¶·›ÚÓÔ˘Ó ∏·Ú›ÓË (HIT)
23
¢È¿ÎÔ˘ ª·Ú›·, ªˆ˘Û‹˜ ∂ÏÈÛ¿Ê
∂ÈıÂÙÈ΋ ∞ÓÙÈÌÂÙÒÈÛË Ù˘ ÷ÌËÏ‹˜ HDL - ¯ÔÏËÛÙÂÚfiÏ˘ ™˘ÌÂÚ¿ÛÌ·Ù· ¶ÚÔÁÂÓ¤ÛÙÂÚˆÓ ªÂÏ¤ÙˆÓ – H ªÂϤÙË ARBITER
26
¡›ÎÔ˜ ¢È·ÎÔ˘Ì¿ÎÔ˜ ¶›ÙÛ·‚Ô˜ XÚ‹ÛÙÔ˜ AÓ·ÏËÚˆÙ‹˜ K·ıËÁËÙ‹˜ K·Ú‰ÈÔÏÔÁ›·˜, I·ÙÚÈ΋˜ ™¯ÔÏ‹˜
¶Ú¤ÂÈ Ó· ™˘Ó¯›˙ÂÙ·È Ë ÃÔÚ‹ÁËÛË ∞ÛÈÚ›Ó˘ Û ∞ÛıÂÓ›˜ Ô˘ ¶·›ÚÓÔ˘Ó ∫Ô˘Ì·ÚÈÓÈο ∞ÓÙÈËÎÙÈο;
30
¢È¿ÎÔ˘ ª·Ú›·, ªˆ˘Û‹˜ ∂ÏÈÛ¿Ê
¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ IÔÎÚ¿ÙÂÈÔ NÔÛÔÎÔÌÂ›Ô AıËÓÒÓ
¶POTEINOMENH BIB§IO°PAºIA
32
ATHIROSKLIROSI 9b 23-02-06 10:17 ™ÂÏ›‰·1
· Ôʈӛ·, Ù Ì Ô È Â ¯ Ú ¿ ΛӉ˘ÓÔ ÌÔ˘ ‰ÂÓ ˘ fi fi Ú Î ‰ · Ó È ˘  ™ Á Á ‡ Ô ÙÔ Î·Ú‰È· ªÂÙ·‚ÔÏÈÎ · › Ù ˘ Û Ô È Ù ∞˘Ùfi ÚÔÔ fi . È I Ì Í B Û · È L Ú Â H Ô Ì N / ˘Ó HA ÙË °È· ÙÔÓ ÚÔ‚Ï¤Ô Î·È ÙˆÓ A ˘ I Ô I I ›‰È· ÌÂϤ P ˜ ∏ T ˆ A Ì . fi Ë P Î E › · C Ó È N Ô Ú ˘ ·Ï ÎÚÈÙ‹ ÏËı˘ÛÌfi. ÛÙË £ÂÛÛ È ·˘Ù¿ ÙÔ · Ó Ó › fi ˆ Â Î Ó È È fi Ó Ù Ì Ë Ë fi Ï ÛÙ ∂Ï È· Ê·›ÓÂÙ·È Ï‹ÓˆÓ ÂÈ ÏÔ˜ ÛÙÔÓ Ï ¿ ∂ Á Â Ë Ì Ù ÈÓ‰‡ÓÔ˘ Á ¤ È Î Ï · Â Ó › ˜ Ì Â · Ù fi ™ Ó ª Ô · ˘ ¿Á ¤Î˘„ ÈÛË ÙÔ˘ ËÙÔ˜ ·Ú Ï·ÛÌfi˜ ÙÔ Á Ù Ô Á Ú ¤ È ¿ Û Í Â Ô Â Ó Ú Ô · È È ‹ ¤‰ÂÈÍ fiÙ ËÛ˘ ›ӷ È·ÁÓˆÛÙÈÎ Ó ‰ Ó ¤ ∏ Á . ÛÙÔÚÈÎÔ‡, ˜ È ‹ Ô ˆ Ú Ë ˙ ¿ „ ‚ ‹ Ô Ï Î fi È Ï Ï ‹ ÂÓ‹ ˘ ∆Ô ¯·ÌË ÚÔÛÂÎÙÈÎ ÌÔ ÛÙËÓ › Ô Â Ú Ù È ¿ÛÂˆÓ Ô ‰ Ù · Ó Â ‡ Í ™ ·  fi Ë Ó Î Û È Ò · Ï Î Ù È· ¤Ú ÌÂÙ·‚Ô ÂÚÁ·ÛÙËÚ ›ÓË Â›Ó·È ÂÎÙÈ΋ ˘ Ï Ó ı Â Ó Ò Ú Î · Î È Á Û Â · Ì ∏ ‚ ˜. ·ÛıÂÓÔ‡˜ ‰ÈÂÓ¤ÚÁÂÈ· ÈÙÈÔÏÔÁ›· · È · ˜ ‹˜ Î·È Ë Î Ë Ê Ù Ô Ë Ë Ú Û Û Ù · ˆ Ù Ó ˜ ¤ Í Ë Á  „ ¿ ‰È ÏË Ê˘ÛÈ΋ Ù˘ ÚfiÛ ÙË ÛˆÛÙ‹ Û Ë Û Ó ıÂڷ¢ÙÈ È ‡ Ì Ô ˜ ı  Á ‡ ¤ Ë Ú Ó ‰ Ô Â Ë Û Ù ˜ Û È ˆ Â È Û˘Ó‹ı ڈ̷ÙÈÓ· Ô‰ËÁ‹Û ÂÌϤÎÂÙ· Ë ı ˜ ˘ · ˆ Ô Ó ˜ ¤ Ë Ì Ù Ë Ô Ó ¯ · ‰Â ‰È Ì›· ÔÚÌfi Ô˘ Ù˘ ÂÓ ·È Ù· ÛÙ¿ Ï Î fi Ú ‡ Ô ˘ ÈÛË ·ÛıÂ Ì Ô Ò Û Ù Ù È Â Ù Ë Ì · È Û Ì Ù Ó Ë Ó · ¯ · Î Û Ë ‰È·Ï‡ ˜ ASCOT, ˯·ÓÈÛÌfi˜ ÛÈÚ›Ó˘ Ë Ì · Ù ¤ √ Ë Ï Û . Â Ë ˜ Ì Á ˘ ‹ ˜ Ô ÔÚ ÙË Î¤˜ ÌÂıfi‰ ·È Ë Û˘Á¯ ÂϤÛÌ·Ù· Î Ù Ô , ˜ ÛÎÔ‹ÛÂË · · Ï Ó fi · · Ú Ù Â , Ô Ù ˜ Ó Û Â · Ë Ì Î Ï ¯Ô Λ ο ΋˜ Ï¿ ‰· HDLÓ ÙÔ ·ÓÙÈ ‡ › Ô Ï Â Â ÂÚÈÛÙ·ÙÈ Ù ¿ Ô Ï ¿ Ë Î È · Ì Ù · Î ¯ Ó · ‰ Â Ò È Î ÓÒÓ Ì ·ÓÙÈËÎÙÈ ÓÙ· Î·È ‰ Ô Ó Ú Ò ¤ Î Ê È · Ó È È ‰ Ú Ó · Ô Â Î·È ÎÔ˘Ì ˙ÔÓÙ·È ‰‡ ¿ È Û ˘ Ô Ú · ÃÂÈÌÒÓ·˜ ˜ ˜ · › Ô Ï Ï H ¤ ∆ Ó . ˆ ›  ˆÓ ˜ ÈÎÒÓ È·ÙÚ Á Ô Ï Ô ˜ ™‡ÓÙ·ÍË È ‰ È È ¢È¢ı˘ÓÙ‹ ÙˆÓ Ï
Ù·ÍË T˘ ™‡Ó
˜
ATHIROSKLIROSI 9b 23-02-06 10:17 ™ÂÏ›‰·2
·ıËÚÔÛÎÏ‹ÚˆÛË MAƒ∆π√™
2006
∂ȉËÌÈÔÏÔÁ›· ÙÔ˘ ªÂÙ·‚ÔÏÈÎÔ‡ ™˘Ó‰ÚfiÌÔ˘ ∫. ∆˙ÈfiÌ·ÏÔ˜, ∞. ∫·Î·Ê‹Î·, ª. ™›ÏÂÏË, π. ¢Ô˘ÏÔ˘Ì¿Î·˜, °. ™Ê‹Î·˜, ∞. ¶ÈÚ·ÛÔÔ‡ÏÔ˘, ª. ºÏˆÚÂÓÙ›Ó, ∞. ™Î·¤Ú‰·˜, ∞. ∫·Ú·ÁÈ¿ÓÓ˘, µ. Õı˘ÚÔ˜ ªÔÓ¿‰Â˜ ∞ıËÚÔÛÎÏ‹ÚˆÛ˘ Î·È ªÂÙ·‚ÔÏÈÎÔ‡ ™˘Ó‰ÚfiÌÔ˘, µ’ ¶ÚÔ. ¶·ıÔÏÔÁÈ΋ ∞¶£, πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌ›Ô, £ÂÛÛ·ÏÔÓ›ÎË
∆Ô ªÂÙ·‚ÔÏÈÎfi ™‡Ó‰ÚÔÌÔ (ª™) ıˆÚÂ›Ù·È ÛËÌ·ÓÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ Î·Ú‰È·ÁÁÂȷ΋ ÓfiÛÔ (∫∞¡). ŸÌˆ˜ ‰ÂÓ ˘¿Ú¯ÂÈ ÔÌÔʈӛ· fiÛÔÓ ·ÊÔÚ¿ ÙÔÓ ÔÚÈÛÌfi Î·È Ù· ‰È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ·. ŒÙÛÈ ·˘Ù‹Ó ÙËÓ ÂÚ›Ô‰Ô ˘¿Ú¯Ô˘Ó ‰È¿ÊÔÚÔÈ ÔÚÈÛÌÔ› Ô˘ ¤¯Ô˘Ó ‰Ôı› ·fi ÙÔ˘˜ ÎÔÚ˘Ê·›Ô˘˜ ÔÚÁ·ÓÈÛÌÔ‡˜ (¶›Ó·Î˜ 1-4). √ ÂÈÔÏ·ÛÌfi˜ Î·È Ë Û˘Û¯¤ÙÈÛË ÙÔ˘ ª™ Ì ÙÔÓ Î›Ó‰˘ÓÔ ÁÈ· ∫∞¡ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔÓ ÔÚÈÛÌfi Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙÔ˘.
¶›Ó·Î·˜ 2: √ÚÈÛÌfi˜ ª™ NCEP (2001) ¶·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘
∂›Â‰Ô ª™ = 3-5 ·fi ÙÔ˘˜ ·Ú·Î¿Ùˆ
∫ÔÈÏȷ΋ ·¯˘Û·ÚΛ· (¶ÂÚ›ÌÂÙÚÔ˜ ̤Û˘) ÕÓ‰Ú˜ °˘Ó·›Î˜
>102 cm (>40 in) >88 cm (>35 in)
∆ÚÈÁÏ˘ÎÂÚ›‰È·
≥150 mg/dl
HDL-à ÕÓ‰Ú˜ °˘Ó·›Î˜
<40 mg/dl <50 mg/dl
∞ÚÙËÚȷ΋ ›ÂÛË
≥130/≥85 mm Hg
°Ï˘Îfi˙Ë ÓËÛÙ›·˜
≥110 mg/dl
¶›Ó·Î·˜ 1: √ÚÈÛÌfi˜ ª™ WHO (1999) ¶›Ó·Î·˜ 3: √ÚÈÛÌfi˜ ª™ IDF (2005) ñ ∞ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË (‰È·‚‹Ù˘ Ù‡Ô˘ 2, ‰È·Ù·Ú·¯‹ ·ÓÔ¯‹˜ ÁÏ˘Îfi˙˘ ÓËÛÙ›·˜, ·ıÔÏÔÁÈ΋ η̇ÏË ÁÏ˘Îfi˙˘) ñ ™˘Ó 2 ·fi Ù· ·Ú·Î¿Ùˆ: ❍ ∞ÚÙËÚȷ΋ ›ÂÛË (≥140/90 ‹ ·ÓÙÈ˘ÂÚÙ·ÛÈ΋ ·ÁˆÁ‹) ❍ ∆ÚÈÁÏ˘ÎÂÚ›‰È· ≥150 mg/dl ❍ HDL-à <35 mg/dl (ÕÓ‰Ú˜); <40 mg/dl (°˘Ó·›Î˜) ❍ ¢ª™ >30 ηÈ/‹ ¶ª/¶° >0,9 (ÕÓ‰Ú˜), >0,85 (°˘Ó·›Î˜) ❍ ªÈÎÚÔÏÂ˘ÎˆÌ·ÙÈÓÔ˘Ú›· (§>20 Ìg/min ‹ §/∫Ú >30 Ìg/g
¶·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘
∂›Â‰Ô
∫ÔÈÏȷ΋ ·¯˘Û·ÚΛ· (¶ÂÚ›ÌÂÙÚÔ˜ ̤Û˘) ¶ÚÔ··ÈÙÔ‡ÌÂÓÔ ÕÓ‰Ú˜ >94 cm °˘Ó·›Î˜ >80 cm ™˘Ó 2-4 ·fi ÙÔ˘˜ ·Ú·Î¿Ùˆ ∆ÚÈÁÏ˘ÎÂÚ›‰È·
≥150 mg/dl
HDL-à ÕÓ‰Ú˜ °˘Ó·›Î˜
<40 mg/dl <50 mg/dl
∞ÚÙËÚȷ΋ ›ÂÛË
≥130/≥85 mm Hg
°Ï˘Îfi˙Ë ÓËÛÙ›·˜
≥100 mg/dl
¢ª™= ‰Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜, ¶ª = ÂÚ›ÌÂÙÚÔ˜ ̤Û˘, ¶°= ÂÚ›ÌÂÙÚÔ˜ ÁÔÊÒÓ, §= χΈ̷, ∫Ú= ÎÚ·ÙÈÓ›ÓË.
¶›Ó·Î·˜ 4: √ÚÈÛÌfi˜ ª™ AHA/NHLBI (2005) √ ÔÚÈÛÌfi˜ ÙÔ˘ WHO ‰ÂÓ ÂÊ·ÚÌfiÛÙËΠ¢ڤˆ˜ ÛÙË ÎÏÈÓÈ΋ Ú¿ÍË ÁÈ·Ù› ··ÈÙ› ÂÚÁ·ÛÙËÚȷΤ˜ ÂÍÂÙ¿ÛÂȘ Ô˘ ‰ÂÓ Â›Ó·È Â‡ÎÔÏÔ Ó· Á›ÓÔ˘Ó (.¯. ̤ÙÚËÛË ÈÓÛÔ˘Ï›Ó˘ ÔÚÔ‡ ‹ hyperinsulinemic euglycemic clamp). °È· Ó· ÂÚ¢ӋÛÔ˘Ì ÙËÓ Â›ÙˆÛË ÙÔ˘ ª™ ÛÙÔÓ ∂ÏÏËÓÈÎfi ÏËı˘ÛÌfi Î·È Ó· ˘ÔÏÔÁ›ÛÔ˘Ì ÙÔÓ Û˘ÓÔ‰fi ΛӉ˘ÓÔ ÁÈ· ∫∞¡ ·Ó¿ÏÔÁ· Ì ÙÔÓ Î¿ı ÔÚÈÛÌfi ‰ÈÂÓÂÚ-
2
¶·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘
∂›Â‰Ô ª™ = 3-5 ·fi ÙÔ˘˜ ·Ú·Î¿Ùˆ
∫ÔÈÏȷ΋ ·¯˘Û·ÚΛ· (¶ÂÚ›ÌÂÙÚÔ˜ ̤Û˘) ÕÓ‰Ú˜ °˘Ó·›Î˜
>102 cm (>40 in) >88 cm (>35 in)
∆ÚÈÁÏ˘ÎÂÚ›‰È·
≥150 mg/dl
HDL-à ÕÓ‰Ú˜ °˘Ó·›Î˜
<40 mg/dl <50 mg/dl
∞ÚÙËÚȷ΋ ›ÂÛË
≥130/≥85 mm Hg
°Ï˘Îfi˙Ë ÓËÛÙ›·˜
≥100 mg/dl
ATHIROSKLIROSI 9b 23-02-06 10:17 ™ÂÏ›‰·3
¶∞ƒ∞°√¡∆∂™ ∫π¡¢À¡√À – E¶π¢∏ªπ√§√°π∞ Á‹Û·Ì ̛· ·Ó¿Ï˘ÛË - ÙÔÌ‹ ÂÓfi˜ ·ÓÙÈÚÔÛˆÂ˘ÙÈÎÔ‡ ‰Â›ÁÌ·ÙÔ˜ ÂÏÏ‹ÓˆÓ ÂÓËÏ›ÎˆÓ (n = 9,669). ÃÚËÛÈÌÔÔÈ‹Û·Ì ÙÔ˘˜ ÔÚÈÛÌÔ‡˜ Ù˘ ∂ıÓÈ΋˜ ÙˆÓ ∏¶∞ ∂ÈÙÚÔ‹˜ ÁÈ· ÙËÓ À„ËÏ‹ ÃÔÏËÛÙÂÚfiÏË (NCEP - ATP III), Ù˘ ¢ÈÂıÓÔ‡˜ √ÌÔÛÔÓ‰›·˜ ¢È·‚‹ÙË (IDF) Î·È Ù˘ ∞ÌÂÚÈηÓÈ΋˜ ŒÓˆÛ˘ ∫·Ú‰ÈÔÏfiÁˆÓ/∂ıÓÈÎÔ‡ πÓÛÙÈÙÔ‡ÙÔ˘ ÁÈ· ∫·Ú‰È¿, ¶Ó‡ÌÔÓ· Î·È ∞›Ì· (AHA/NHLBI) (¶›Ó·Î˜ 2-4). Ÿˆ˜ Ê·›ÓÂÙ·È ÛÙËÓ ∂ÈÎfiÓ· 1 Ô ÂÈÔÏ·ÛÌfi˜ ÙÔ˘ ª™ Ì ÙÔ˘˜ ÔÚÈÛÌÔ‡˜ NCEP Î·È AHA/NHLBI ÛÙÔ Û‡ÓÔÏÔ ÙÔ˘ ÏËı˘ÛÌÔ‡ ‹Ù·Ó 24,5% Î·È 26% ·ÓÙ›ÛÙÔȯ· (p= NS). ™‡Ìʈӷ fï˜ Ì ÙÔÓ ÔÚÈ-
ÛÌfi IDF Ô ÂÈÔÏ·ÛÌfi˜ ÙÔ˘ ª™ ‹Ù·Ó 44% (˘„ËÏfiÙÂÚÔ˜ ηٿ 77%. p<0,0001 vs NCEP Î·È AHA/NHLBI). ™ÙËÓ ËÏÈÎȷ΋ ÔÌ¿‰· 50-60 ÂÙÒÓ ‹Ù·Ó 56% Î·È Û ·˘Ù¤˜ ¿Óˆ ÙˆÓ 60 ÂÙÒÓ ÏËÛ›·˙ ÙÔ 70%, Ú¿ÁÌ· Ô˘ ÙÂÏÈο ··ÍÈÒÓÂÈ ÙËÓ ¤ÓÓÔÈ· ÙÔ˘ ª™. ∏ ¯Ú‹ÛË ÙÔ˘ fiÚÔ˘ ª™ ¤¯ÂÈ ·Í›· fiÙ·Ó Û˘Û¯ÂÙ›˙ÂÙ·È Ì ·˘ÍË̤ÓÔ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ. Ÿˆ˜ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 5, Ë ‰ÈÔÚıˆÌ¤ÓË ˆ˜ ÚÔ˜ ÙËÓ ËÏÈΛ· ›وÛË Ù˘ ∫∞¡ ‹Ù·Ó: 11,4% ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi, 23,3% ÛÙÔ NCEP (+) ª™, 22,6% ÛÙÔ AHA/NHLBI(+) ª™ Î·È 18,3% ÛÙÔ IDF(+) ª™ [p<0,001 ÁÈ· ÙË Û‡-
∂ÈÎfiÓ· 1: √ ÂÈÔÏ·ÛÌfi˜ ÙÔ˘ ª™ ÛÙËÓ ∂ÏÏ¿‰· ÛÙÔ Û‡ÓÔÏÔ ÙÔ˘ ÂÓ‹ÏÈη ÏËı˘ÛÌÔ‡ Î·È Û 6 ËÏÈÎȷΤ˜ ÔÌ¿‰Â˜ Û‡Ìʈӷ Ì ÙÔ˘˜ 3 ÔÚÈÛÌÔ‡˜ ÙÔ˘ ª™ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËηÓ.
ÁÎÚÈÛË ÌÂٷ͇ ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘ÛÌÔ‡ Î·È fiÏˆÓ ÙˆÓ ÔÌ¿‰ˆÓ M™ Î·È p<0,0001 ÁÈ· ÙË Û‡ÁÎÚÈÛË ÌÂٷ͇ IDF(+) ª™ Î·È NCEP(+) ª™ ‹ AHA/NHLBI(+) ª™]. ∂ÓÙÔ‡ÙÔȘ, Ë Â›ÙˆÛË Ù˘ ∫∞¡ ‹Ù·Ó ÌfiÓÔ 11,2% ÛÙ· ¿ÙÔÌ· Ô˘ ‰ÂÓ Â›¯·Ó NCEP ‹ AHA/NHLBI ª™ ·ÏÏ¿ ›¯·Ó ª™ Û‡Ìʈӷ Ì ÙÔÓ ÔÚÈÛÌfi IDF. ™Ù· 1.626 ·˘Ù¿ ¿ÙÔÌ· (ÙÂÏÂ˘Ù·›· ÛÙ‹ÏË ¶›Ó·Î· 5) Ë Â›ÙˆÛË Ù˘ ∫∞¡ ‰ÂÓ ‹Ù·Ó ‰È·ÊÔÚÂÙÈ΋ ·fi ·˘Ù‹ ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘ÛÌÔ‡. ∂Ô̤ӈ˜ Ê¿ÓËΠfiÙÈ Ë Â›ÙˆÛË Ù˘ ∫∞¡ ‹Ù·Ó ·˘ÍË̤ÓË Û ¿ÙÔÌ· Ì ª™ ·ÓÂÍ¿ÚÙËÙ· ·fi ÙÔÓ ÔÚÈÛÌfi Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ. ∞˘Ù‹ Ë ·˘ÍË̤ÓË Â›ÙˆÛË ‹Ù·Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚË fiÙ·Ó ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÔÈ ÔÚÈÛÌÔ› NCEP Î·È AHA/NHLBI ¤Ó·ÓÙÈ ÙÔ˘ ÔÚÈÛÌÔ‡ IDF. √ ÔÚÈÛÌfi˜ IDF Â›Ó·È Â˘Ú‡ÙÂÚÔ˜ Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ Û¯Â‰fiÓ fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ª™ Û‡Ìʈӷ Ì ÙÔ˘˜ ÔÚÈÛÌÔ‡˜ NCEP Î·È AHA/NHLBI. ∞fi ÙÔ˘˜ ÙÂÏÂ˘Ù·›Ô˘˜ ‰È·ÌÔÚÊÒÓÂÙ·È ·ÔÎÏÂÈÛÙÈο Ô Î›Ó‰˘ÓÔ˜ ÁÈ· ∫∞¡ ÛÙËÓ Â˘Ú‡ÙÂÚË ÔÌ¿‰· Ô˘ ¤¯ÂÈ ª™ Û‡Ìʈӷ Ì ÙÔÓ IDF. ∂Ô̤ӈ˜ Ô ÔÚÈÛÌfi˜ IDF ı· ‹Ù·Ó ¯Ú‹ÛÈÌÔ˜ Ó· ÚÔÛ‰ÈÔÚ›ÛÂÈ ÙÔ «ÚÔÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ» ÁÈ· ÙÔ ÔÔ›Ô Ú¤ÂÈ Ó· ÂÊ·ÚÌfi˙ÔÓÙ·È ˘ÁÈÂÈÓԉȷÈÙËÙÈο ̤ÙÚ· ÚÈÓ ÂÍÂÏȯı› Û ª™ Û‡Ìʈӷ Ì ÙÔ˘˜ ÔÚÈÛÌÔ‡˜ NCEP ‹ AHA/NHLBI, ÙÔ ÔÔ›Ô fiÓÙˆ˜ Û˘Ó‰¤ÂÙ·È Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ∫∞¡.
¶›Ó·Î·˜ 5: ∂›ÙˆÛË ∫∞¡ ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi Î·È Û ¿ÙÔÌ· Ì ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ, Û‡Ìʈӷ Ì ÙÔ˘˜ 3 ÔÚÈÛÌÔ‡˜ ÙÔ˘ ª™ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËηÓ. °ÂÓÈÎfi˜ ¶ÏËı˘ÛÌfi˜ n=9,669
NCEP ª™ n=2,369
AHA/NHLBI ª™ n=2,543
IDF ª™ n=4,169
NCEP ª™ (-) AHA/NHLBI ª™ (-) IDF ª™ (+) n=1,626
™ÙÂÊ·ÓÈ·›· ÓfiÛÔ˜
7,5 (725)
19,1* (452)
18,4* (467)
13,9*§ (582)
7,1§ (115)
∞ÁÁÂÈ·Îfi ÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔ
3,3 (319)
7,1* (168)
6,9* (175)
5,5*§ (229)
3,2§ (52)
¶ÂÚÈÊÂÚÈ΋ ·ÚÙËÚÈÔ¿ıÂÈ·
1,8 (174)
4,5* (107)
4,4* (112)
3,4*§ (141)
1,8§ (29)
∫∞¡ (‰ÈÔÚıˆÌ¤ÓË ÁÈ· ÙËÓ ·ÏÏËÏÔÂÈÎ¿Ï˘„Ë ÙˆÓ Û˘ÛÙ·ÙÈÎÒÓ Ù˘)
11,4 (1.102)
23,3* (552)
22,6* (574)
18,3*§ (763)
11,2§ (182)
¶ÔÛÔÛÙfi ·ÛıÂÓÒÓ (·fiÏ˘ÙÔ˜ ·ÚÈıÌfi˜ Û ·Ú¤ÓıÂÛË). M™ = ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ, NCEP = National Cholesterol Education Program, IDF = International Diabetes Federation, AHA = American Heart Association, NHLBI = National Heart Lung and Blood Institute, ∫∞¡ = ηډȷÁÁÂȷ΋ ÓfiÛÔ˜. * = p<0,05 vs ÁÂÓÈÎÔ‡ ÏËı˘ÛÌÔ‡, § = p<0,05 vs NCEP Î·È AHA/NHLBI M™.
3
ATHIROSKLIROSI 9b 23-02-06 10:17 ™ÂÏ›‰·4
·ıËÚÔÛÎÏ‹ÚˆÛË MAƒ∆π√™
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ATHIROSKLIROSI 9b 23-02-06 10:17 ™ÂÏ›‰·5
∫§π¡π∫∂™ ª∂§∂∆∂™
¢È·ÁÓˆÛÙÈ΋ ¶ÚÔÛ¤ÁÁÈÛË ÙÔ˘ ∞ÛıÂÓ‹ Ì ∞ÓıÂÎÙÈ΋ À¤ÚÙ·ÛË °ÂÒÚÁÈÔ˜ ™Ê‹Î·˜, ∂ȉÈ΢fiÌÂÓÔ˜ ¶·ıÔÏÔÁ›·˜ ¡È΋ٷ˜ ∫·Îη‚¿˜, ∂ȉÈ΢fiÌÂÓÔ˜ ∫·Ú‰ÈÔÏÔÁ›·˜ πˆ¿ÓÓ˘ ∆ÛfiÚÏ·Ï˘, ∂ȉÈ΢fiÌÂÓÔ˜ ¶·ıÔÏÔÁ›·˜ ∞ÛÙ¤ÚÈÔ˜ ∫·Ú·ÁÈ¿ÓÓ˘, ∞Ó·ÏËÚˆÙ‹˜ ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜ ∞¶£, µ’ ¶ÚÔ·È‰Â˘ÙÈ΋ ¶·ıÔÏÔÁÈ΋ ∫ÏÈÓÈ΋, πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌ›Ô, £ÂÛÛ·ÏÔÓ›ÎË
˜ ·ÓıÂÎÙÈ΋ ˘¤ÚÙ·ÛË ÔÚ›˙ÂÙ·È Ë Â›ÌÔÓË ·Ú·ÌÔÓ‹ Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ Û ›‰· ˘„ËÏfiÙÂÚ· ·fi 140/90 mmHg ·Ú¿ ÙË ÛˆÛÙ‹ ¯Ú‹ÛË Û˘Ó‰˘·ÛÌÔ‡ ÙÚÈÒÓ ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ Ê·ÚÌ¿ÎˆÓ Û ϋÚÂȘ ‰fiÛÂȘ, ·fi Ù· ÔÔ›· ÙÔ ¤Ó· Â›Ó·È ÔˆÛ‰‹ÔÙ ‰ÈÔ˘ÚËÙÈÎfi. ∏ Û˘¯ÓfiÙËÙ· Ù˘ ·ÓıÂÎÙÈ΋˜ ˘¤ÚÙ·Û˘ ÛÙÔ ÁÂÓÈÎfi ˘ÂÚÙ·ÛÈÎfi ÏËı˘ÛÌfi Â›Ó·È ÂÚ›Ô˘ 5%. ŸÌˆ˜, Û ÂȉÈο ΤÓÙÚ·, fiˆ˜ Û ÓÂÊÚÔÏÔÁÈΤ˜ ÎÏÈÓÈΤ˜, Ë Û˘¯ÓfiÙËÙ· ÌÔÚ› Ó· Êı¿ÛÂÈ ‹ Î·È Ó· ˘Âڂ› ÙÔ 50%, ÔÛÔÛÙfi Ô˘ ÂÍ·ÚÙ¿Ù·È Î˘Ú›ˆ˜ ·fi ÙÔ ·›ÙÈÔ Î·È ÙÔ ‚·ıÌfi ¤ÎÙˆÛ˘ Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜. ∞ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ Ú·ÁÌ·ÙÈ΋ Û˘¯ÓfiÙËÙ·, Ë ·ÓıÂÎÙÈ΋ ˘¤ÚÙ·ÛË ÌÔÚ› Ó· ¤¯ÂÈ ÛÔ‚·Ú¤˜ Û˘Ó¤ÂȘ, ‰ÈfiÙÈ Ô ·ÛıÂÓ‹˜ ·Ú·Ì¤ÓÂÈ ÂÎÙÂıÂÈ̤ÓÔ˜ Û ˘„ËÏ¿ ›‰· ·ÚÙËÚȷ΋˜ ›ÂÛ˘. ∏ ·ÓıÂÎÙÈ΋ ˘¤ÚÙ·ÛË Û˘Óԉ‡ÂÙ·È Û˘Ó‹ıˆ˜ ·fi ÂÎÙÂٷ̤ÓË ‚Ï¿‚Ë ÙˆÓ ÔÚÁ¿ÓˆÓ-ÛÙfi¯ˆÓ, fiˆ˜ ¿¯˘ÓÛË ÙÔ˘ ·ÚÙËÚÈ·ÎÔ‡ ÙÔȯÒÌ·ÙÔ˜, ˘ÂÚÙÚÔÊ›· Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ Î·È ÓÂÊÚÔÛÎÏ‹Ú˘ÓÛË. ∫¿ı ̛· ·fi ·˘Ù¤˜, Ì ÙË ÛÂÈÚ¿ Ù˘, ÌÔÚ› Ó· ÂÏ·ÙÙÒÓÂÈ ÙËÓ ·ÓÙ·fiÎÚÈÛË Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ÛÙËÓ ·ÓÙÈ˘ÂÚÙ·ÛÈ΋ ·ÁˆÁ‹, .¯. Ë ÚÔԉ¢ÙÈο ÂÍÂÏÈÛÛfiÌÂÓË ÓÂÊÚÈ΋ ‚Ï¿‚Ë ÌÔÚ› Ó· ˘ÚÔ‰ÔÙ› ÙÔ Ê·‡ÏÔ Î‡ÎÏÔ ˘¤ÚÙ·ÛË-ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ·-Âȉ›ӈÛË ˘¤ÚÙ·Û˘-Âȉ›ӈÛË ÓÂÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜. ∆· ·ÚÈ· ·›ÙÈ· Ù˘ ·ÓıÂÎÙÈ΋˜ ˘¤ÚÙ·Û˘ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1. ∏ „¢‰Ô·ÓÙ›ÛÙ·ÛË, ÙÔ ÚÒÙÔ ·›ÙÈÔ Ô˘ ·Ó·Ê¤ÚÂÙ·È, ‰ÂÓ ·ÔÙÂÏ› ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· ·›ÙÈÔ ·ÏËıÔ‡˜ ·ÓÙ›ÛÙ·Û˘ ÛÙËÓ ·ÁˆÁ‹, ·ÏÏ¿ Ì¿ÏÏÔÓ ¤Ó· Û˘¯Ófi Ê·ÈÓfiÌÂÓÔ, ·Ó‡ÚÂÛ˘ ·˘ÍËÌ¤ÓˆÓ ·ÚÙËÚÈ·ÎÒÓ È¤ÛÂˆÓ ÛÙÔ È·-
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¶›Ó·Î·˜ 1. ∞›ÙÈ· ·ÓıÂÎÙÈ΋˜ ˘¤ÚÙ·Û˘ 1. 梉ԷÓÙ›ÛÙ·ÛË 2. ªË Û˘ÌÌfiÚʈÛË ÛÙË ıÂڷ›· 3. ∞›ÙÈ· Û¯ÂÙÈ˙fiÌÂÓ· Ì ÙË Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ 4. ™˘ÓÔ‰¤˜ ηٷÛÙ¿ÛÂȘ 5. ¢Â˘ÙÂÚÔ·ı‹ ·›ÙÈ· ·ÚÙËÚȷ΋˜ ›ÂÛ˘ 6. ∞‡ÍËÛË ÂÓ‰·ÁÁÂÈ·ÎÔ‡ fiÁÎÔ˘
ÙÚÂ›Ô Î·È Ê˘ÛÈÔÏÔÁÈÎÒÓ ·ÚÙËÚÈ·ÎÒÓ È¤ÛÂˆÓ ÂÎÙfi˜ È·ÙÚ›Ԣ, ‡ÚËÌ· Ô˘ ÌÔÚ› Ó· ‰È·ÁÓˆÛı› Ì ÙËÓ 24ˆÚË Î·Ù·ÁÚ·Ê‹ Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘. √È ·ÛıÂÓ›˜ ·˘ÙÔ› ‰ÂÓ ÂÌÊ·Ó›˙Ô˘Ó ÙÔ Ê·ÈÓfiÌÂÓÔ Ù˘ «˘¤ÚÙ·Û˘ Ù˘ Ï¢΋˜ ÌÏÔ‡˙·˜», ·ÏÏ¿ Ì¿ÏÏÔÓ Ì›· «ÂÈ‚¿Ú˘ÓÛË Ù˘ ˘¤ÚÙ·Û˘ ÛÙË ı¤· Ù˘ Ï¢΋˜ ÌÏÔ‡˙·˜». ∏ ·ÓÙ›‰Ú·ÛË ·˘Ù‹, Ô˘ ÌÔÚ› Ó· ·Ú·ÙËÚËı› Û ÔÛÔÛÙfi ¤ˆ˜ Î·È 80% ÙˆÓ ·ÛıÂÓÒÓ fiÙ·Ó Ë ›ÂÛ‹ ÙÔ˘˜ ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ÛÙÔ È·ÙÚ›Ô, ÚÔηÏ› ¿ÓÔ‰Ô Ù˘ ηϿ Ú˘ıÌÈṲ̂Ó˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘, ¿Óˆ ·fi 140/90 mmHg. ª›· ÌÈÎÚ‹ ÌÂϤÙË ·Ú·Ù‹ÚËÛ˘ 86 ·ÛıÂÓÒÓ Ô˘ ÂÌÊ¿ÓÈ˙·Ó „¢‰Ô·ÓÙ›ÛÙ·ÛË ¤‰ÂÈÍ fiÙÈ, ÌÂÙ¿ ·fi 6-7 ¤ÙË, ·˘ÙÔ› Ô˘ Ì 24ˆÚË Î·Ù·ÁÚ·Ê‹ ›¯·Ó ·ÚÙËÚȷ΋ ›ÂÛË <130/80 mmHg ‰ÂÓ ·ÚÔ˘Û›·˙·Ó ÂÚÈÛÛfiÙÂÚ· ηډȷÁÁÂȷο Û˘Ì‚¿Ì·Ù· ·’ fi,ÙÈ ı· ·Ó·ÌÂÓfiÙ·Ó Û ÓÔÚÌÔÙ·ÛÈο ¿ÙÔÌ· 1. øÛÙfiÛÔ, ÙÔ ı¤Ì· ·Ú·Ì¤ÓÂÈ ·ÌÊÈÏÂÁfiÌÂÓÔ, ‰ÈfiÙÈ Î·È Ë ˘¤ÚÙ·ÛË Ù˘ Ï¢΋˜ ÌÏÔ‡˙·˜ ÌÔÚ› Ó· Â›Ó·È Î·ÏÔ‹ı˘ ÁÈ· ·ÚÎÂÙ¿ ¯ÚfiÓÈ· Î·È ÌÂÙ¿ Ó· ÂÌÊ·Ó›ÛÂÈ ÂÈÏÔΤ˜ ·fi Ù· fiÚÁ·Ó·-ÛÙfi¯Ô˜. ∂Ô̤ӈ˜, ı· Ú¤ÂÈ Ó· ÂÓı·ÚÚ‡ÓÂÙ·È Ë Ì¤ÙÚËÛË Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ÛÙÔ Û›ÙÈ Ì ÛÎÔfi
Ó· ·ÔʇÁÂÙ·È ÙfiÛÔ Ë ˘ÔıÂڷ›· fiÛÔ Î·È Ë ˘ÂÚıÂڷ›· ÙˆÓ ·ÛıÂÓÒÓ. ŒÓ· ‰Â‡ÙÂÚÔ ·›ÙÈÔ ·ÓıÂÎÙÈ΋˜ ˘¤ÚÙ·Û˘ Â›Ó·È Ë ¤ÏÏÂÈ„Ë Û˘ÌÌfiÚʈÛ˘ ÙˆÓ ·ÛıÂÓÒÓ ÛÙË ıÂڷ›·. ™Â ÔÛÔÛÙfi Ô˘ ÍÂÂÚÓ¿ÂÈ ÙÔ 50%, ·ÛıÂÓ›˜ Ô˘ ÍÂÎÈÓÔ‡Ó ·ÓÙÈ˘ÂÚÙ·ÛÈ΋ ·ÁˆÁ‹ ‰ÂÓ ÙËÓ Ï·Ì‚¿ÓÔ˘Ó ÌÂÙ¿ ·fi 12 Ì‹Ó˜ 2. ∏ η΋ Û˘ÌÌfiÚʈÛË ÌÔÚ› Ó· ·Ô‰Ôı› Û ¤ÏÏÂÈ„Ë Â·ÚÎÔ‡˜ ÂÓË̤ڈÛ˘ ÙÔ˘ ·ÛıÂÓ‹ ·fi ÙÔÓ È·ÙÚfi, ÛÙ· ·Ó·Ú΋ Î·È ÔÏϤ˜ ÊÔÚ¤˜ ÔχÏÔη ıÂڷ¢ÙÈο Û¯‹Ì·Ù·, ÛÙȘ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ÙˆÓ Ê·Ú̿ΈÓ, ÛÙÔ ÎfiÛÙÔ˜ ·ÏÏ¿ Î·È ÛÙË Û˘Ó‡·ÚÍË ¿ÏÏˆÓ ÓÔÛËÌ¿ÙˆÓ, fiˆ˜ ‰È·Ù·Ú·¯¤˜ Ù˘ ÌÓ‹Ì˘. Ÿˆ˜ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 2, Ù· Û˘ÓÙ·ÁÔÁÚ·ÊÔ‡ÌÂÓ· Ê¿Ú̷η ÌÔÚ› Ó· ÌËÓ Â›Ó·È Â·Ú΋ ÁÈ· ÔÏÏÔ‡˜ ÏfiÁÔ˘˜. √ ÈÔ Û˘Ó‹ı˘ Â›Ó·È ÔÈ ·ÏÏËÏÂȉڿÛÂȘ ÙˆÓ Ê·Ú̿ΈÓ, ÌÂ Û˘¯ÓfiÙÂÚË ÙËÓ ÂÏ¿ÙÙˆÛË Ù˘ ‰Ú·ÛÙÈÎfiÙËÙ·˜ ÙˆÓ ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ Ê·ÚÌ¿ÎˆÓ fiÏˆÓ ÙˆÓ ÔÌ¿‰ˆÓ, ÂÎÙfi˜ ›Ûˆ˜ ·fi ÙÔ˘˜ ·ÓÙ·ÁˆÓÈÛÙ¤˜ ·Û‚ÂÛÙ›Ô˘, ·fi Ù· ÌË ÛÙÂÚÔÂȉ‹ ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë Ê¿Ú̷η (ª™∞º),
¶›Ó·Î·˜ 2. ∞›ÙÈ· Û¯ÂÙÈ˙fiÌÂÓ· Ì ÙË Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ 1. ∞ÏÏËÏÂȉڿÛÂȘ Ê·ÚÌ¿ÎˆÓ 2. ¶Ôχ ¯·ÌËϤ˜ ‰fiÛÂȘ 3. ∞ηٿÏÏËÏÔÈ Û˘Ó‰˘·ÛÌÔ› 4. ∆·¯Â›· ·ÂÓÂÚÁÔÔ›ËÛË Ù˘ ‰Ú¿Û˘ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ (.¯. ˘‰Ú·Ï·˙›ÓË) 5. ∂ÎÛÂÛËÌ·Ṳ̂ÓË ÂÏ¿ÙÙˆÛË ÙÔ˘ ÂÓ‰·ÁÁÂÈ·ÎÔ‡ fiÁÎÔ˘ 6. ÀÔηÏÈ·ÈÌ›· 7. º·ÈÓfiÌÂÓÔ ·fiÛ˘ÚÛ˘ ÌÂÙ¿ ·fi ·fiÙÔÌË ‰È·ÎÔ‹ Ù˘ ÎÏÔÓȉ›Ó˘
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ATHIROSKLIROSI 9b 23-02-06 10:17 ™ÂÏ›‰·6
·ıËÚÔÛÎÏ‹ÚˆÛË MAƒ∆π√™
2006
Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Ù˘ ·ÛÈÚ›Ó˘ (¶›Ó·Î·˜ 3). ∏ ‰˘ÛÌÂÓ‹˜ ·˘Ù‹ ›‰Ú·ÛË ·Ô‰›‰ÂÙ·È Î˘Ú›ˆ˜ ÛÙËÓ Î·Ù·ÎÚ¿ÙËÛË ˘ÁÚÒÓ ÏfiÁˆ ·Ó·ÛÙÔÏ‹˜ ÙˆÓ ·ÁÁÂÈԉȷÛÙ·ÏÙÈÎÒÓ Î·È Ó·ÙÚÈÔ˘ÚËÙÈÎÒÓ ÚÔÛÙ·ÁÏ·Ó‰ÈÓÒÓ. ™Â ·ÛıÂÓ›˜ Ô˘ ¯ÚÂÈ¿˙ÔÓÙ·È ª™∞º, ··ÈÙÔ‡ÓÙ·È ÌÂÁ·Ï‡ÙÂÚ˜ ‰fiÛÂȘ Î·È ÔÏϤ˜ ÊÔÚ¤˜ Û˘Ó‰˘·ÛÌÔ› ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ Ê·Ú̿ΈÓ.
¶›Ó·Î·˜ 3. ∞ÏÏËÏÂȉڿÛÂȘ Ê·ÚÌ¿ÎˆÓ 1. ªË ÛÙÂÚÔÂȉ‹ ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë Ê¿Ú̷η 2. ™˘Ì·ıËÙÈÎÔÌÈÌËÙÈο-ÚÈÓÈο ·ÔÛ˘ÌÊÔÚËÙÈο, ηٷÛÙ·ÏÙÈο Ù˘ fiÚÂ͢, ÎÔη˝ÓË, ηʽÓË 3. ∞ÓÙÈÛ˘ÏÏËÙÈο ·fi ÙÔ ÛÙfiÌ· 4. ∞Ï·ÙÔ- Î·È ÁÏ˘ÎÔÎÔÚÙÈÎÔÂȉ‹ 5. °Ï˘Î‡ÚÈ˙· (Ì·ÛÒÌÂÓÔ˜ ηÓfi˜) 6. ∫˘ÎÏÔÛÔÚ›ÓË 7. ∂Ú˘ıÚÔÔÈËÙ›ÓË 8. ÃÔÏÂÛÙ˘Ú·Ì›ÓË 9. ∞ÓÙÈηٷıÏÈÙÈο (·Ó·ÛÙÔÏ›˜ Ù˘ ÌÔÓÔ·ÌÈÓÔÔÍÂȉ¿Û˘, ÙÚÈ΢ÎÏÈο)
™ÙÔÓ ¶›Ó·Î· 4 Ê·›ÓÔÓÙ·È Î·Ù·ÛÙ¿ÛÂȘ Ô˘ ÂÓ‰¤¯ÂÙ·È Ó· ‰˘Û¯ÂÚ·›ÓÔ˘Ó ÙË Ú‡ıÌÈÛË Ù˘ ·ÚÙËÚȷ΋˜ ˘¤ÚÙ·Û˘. ∆Ô Î¿ÓÈÛÌ· ·˘Í¿ÓÂÈ Ôͤˆ˜ ÙËÓ ·ÚÙËÚȷ΋ ›ÂÛË, ‰Ú¿ÛË Ô˘ Â›Ó·È ·ÚÔ‰È΋ Î·È ÂÍ·Ê·Ó›˙ÂÙ·È Û 30 min, Û˘Ó‰¤ÂÙ·È ‰Â Ì ·‡ÍËÛË ÙˆÓ ÂȤ‰ˆÓ Ù˘ ÂÓ‰ÔıËÏ›Ó˘, Ì ÂÏ¿ÙÙˆÛË Ù˘ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜ ÙÔ˘ ÂÓ‰ÔıËÏ›Ô˘ Î·È Ì ·‡ÍËÛË Ù˘ ·ÓÙ›ÛÙ·Û˘ ÛÙËÓ ÈÓÛÔ˘Ï›ÓË. ∏ ›‰Ú·ÛË ÙÔ˘ ηӛÛÌ·ÙÔ˜ ÌÔ-
¶›Ó·Î·˜ 4. ™˘ÓÔ‰¤˜ ηٷÛÙ¿ÛÂȘ 1. ∫¿ÓÈÛÌ· 2. ¶·¯˘Û·ÚΛ· 3. ÕÓÔÈ· ‡ÓÔ˘ 4. ∞ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË/˘ÂÚÈÓÛÔ˘ÏÈÓ·ÈÌ›· 5. §‹„Ë ·Èı·ÓfiÏ˘ (¿Óˆ ·fi 3 ÔÙ¿ ËÌÂÚËÛ›ˆ˜) 6. ÀÂÚ·ÂÚÈÛÌfi˜ ÚÔηÏÔ‡ÌÂÓÔ˜ ·fi ÎÚ›ÛË ¿Á¯Ô˘˜ ‹ ÎÚ›ÛÂȘ ·ÓÈÎÔ‡ 7. ÃÚfiÓÈÔ˜ fiÓÔ˜ 8. ŒÓÙÔÓË ·ÁÁÂÈÔÛ‡Û·ÛË (·ÚÙËÚ›Ùȉ· Raynaud)
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Ú› Ó· ‰È·Ê‡ÁÂÈ fiÙ·Ó Ï·Ì‚¿ÓÂÙ·È Ë ·ÚÙËÚȷ΋ ›ÂÛË Û ȷÙÚ›Ô, fiÔ˘ ÙÔ Î¿ÓÈÛÌ· ··ÁÔÚ‡ÂÙ·È. ∏ ·¯˘Û·ÚΛ· ·ÔÙÂÏ› ÙË Ó¤· Ì¿ÛÙÈÁ· ÛÙȘ ·Ó·Ù˘Á̤Ó˜ ¯ÒÚ˜, Ì ·ÚÈÔ ÂÎÚfiÛˆÔ ÙȘ ∏ӈ̤Ó˜ ¶ÔÏÈÙ›˜, fiÔ˘ ÙÔ 67% ÙÔ˘ ÂÓ‹ÏÈη ÏËı˘ÛÌÔ‡ ¤¯ÂÈ ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜ ≥25. ∆Ô ÂÚÈÙÙfi ‚¿ÚÔ˜ ÔÊ›ÏÂÙ·È Î˘Ú›ˆ˜ ÛÙËÓ ÂÓ·fiıÂÛË ÎÔÈÏÈ·ÎÔ‡ ‹ ÛÏ·¯ÓÈÎÔ‡ Ï›Ô˘˜ Î·È Û¯ÂÙ›˙ÂÙ·È ÙfiÛÔ Ì ˘¤ÚÙ·ÛË fiÛÔ Î·È Ì ÂËÚ·Ṳ̂ÓË ·ÓÔ¯‹ ÁÏ˘Îfi˙˘ Î·È ‰˘ÛÏÈȉ·ÈÌ›·, ηٷÛÙ¿ÛÂȘ Ô˘ ·ÔÙÂÏÔ‡Ó Ù· ‰˘ÓËÙÈο ı·Ó·ÙËÊfiÚ· Û˘ÛÙ·ÙÈο ÙÔ˘ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘. ∏ ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË Î·È Ë ¿ÓÔÈ· ‡ÓÔ˘, Ô˘ Û˘ÓÔ‰Â‡Ô˘Ó Û˘¯Ó¿ ÙËÓ ·¯˘Û·ÚΛ·, ÌÔÚ› Ó· ÂȉÂÈÓÒÛÔ˘Ó ÛËÌ·ÓÙÈο ÙÔ ‚·ıÌfi Ù˘ ˘¤ÚÙ·Û˘. ªÂÙ¿ ·fi ¯Ú‹ÛË ·ÏÎÔfiÏ ÚÔηÏÂ›Ù·È ·ÁÁÂÈԉȷÛÙÔÏ‹ Î·È ÂÏ¿ÙÙˆÛË Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘. ∏ ̤ÙÚÈ· ¯Ú‹ÛË ÂÏ·ÙÙÒÓÂÈ ÙË Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ Ù˘ ˘¤ÚÙ·Û˘ Î·È Ù˘ ıÓËÛÈÌfiÙËÙ·˜ ·fi ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ Î·È ÂÁÎÂÊ·ÏÈο ÂÂÈÛfi‰È·. ŸÌˆ˜, Ë ¯ÚfiÓÈ· ¯Ú‹ÛË ·˘Í¿ÓÂÈ ÙËÓ ·ÚÙËÚȷ΋ ›ÂÛË Î·È Ë ˘ÂÚ‚ÔÏÈ΋ ¯Ú‹ÛË ·ÏÎÔfiÏ ıˆÚÂ›Ù·È ˘Â‡ı˘ÓË ÁÈ· ÙËÓ ·ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË Û ÔÛÔÛÙfi 10% ÙˆÓ ·ÛıÂÓÒÓ. ∏ ·ÚÙËÚȷ΋ ›ÂÛË, fiˆ˜ Î·È Ë Î·Ú‰È·Î‹ Û˘¯ÓfiÙËÙ·, ·˘Í¿ÓÔ˘Ó Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ stress, Ù· ‰Â ›‰· ·‡ÍËÛ˘ ÂÍ·ÚÙÒÓÙ·È ·fi Ù· ›‰· ÂÎΛÓËÛ˘. ∂Ô̤ӈ˜, ÔÈ ˘ÂÚÙ·ÛÈÎÔ› ·ÛıÂÓ›˜ ÌÔÚ› Ó· ÂÌÊ·Ó›ÛÔ˘Ó ·ÚÎÂÙ¿ ˘„ËÏ¿ ›‰· ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ηٿ ÙË ‰È¿ÚÎÂÈ· ÔͤԘ stress. ∂›Û˘, ÙÔ ¯ÚfiÓÈÔ stress Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ·ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË Î·È ı· Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ›˙ÂÙ·È Ì ÙË Û˘Ì‚Ô˘Ï‹ ÂȉÈÎÒÓ È·ÙÚÒÓ. √ ‰˘ÛÌÂÓ‹˜ ÚfiÏÔ˜ ÙˆÓ ·Ú·¿Óˆ ηٷÛÙ¿ÛÂˆÓ ÛÙË Ú‡ıÌÈÛË Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ÌÔÚ› Ó· ÂÚÈÔÚÈÛÙ› ÌÂÙ¿ ·fi ηٿÏÏËϘ ÙÚÔÔÔÈ‹ÛÂȘ ÙÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜ (¶›Ó·Î·˜ 5). ª›· ·fi ÙȘ Û˘¯ÓfiÙÂÚ˜ ·Èٛ˜ ·ÓıÂÎÙÈ΋˜ ˘¤ÚÙ·Û˘ Â›Ó·È Ë ·‡ÍËÛË ÙÔ˘ ÂÓ‰·ÁÁÂÈ·ÎÔ‡ fiÁÎÔ˘ ˘ÁÚÒÓ, Ë ÔÔ›· ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È ÛÂ Û˘Ó‰˘·ÛÌfi ‰È·ÊfiÚˆÓ ·Ú·ÁfiÓÙˆÓ. ™ÙÔ ¢˘ÙÈÎfi ÎfiÛÌÔ, ÔÏÏÔ› ¿ÓıÚˆÔÈ Î·Ù·Ó·ÏÒÓÔ˘Ó ÌÂÁ¿Ï˜ ÔÛfiÙËÙ˜ ¯Ïˆ-
¶›Ó·Î·˜ 5. ∞ÏÏ·Á¤˜ ÙÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ·ÚÙËÚȷ΋˜ ˘¤ÚÙ·Û˘ 1. ∂Ï¿ÙÙˆÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜ 2. ¢È·ÎÔ‹ ηӛÛÌ·ÙÔ˜ 3. ¶ÂÚÈÔÚÈÛÌfi˜ Ù˘ ¯Ú‹Û˘ ηʤ Î·È ·ÏÎÔfiÏ 4. ¶ÂÚÈÔÚÈÛÌfi˜ Ù˘ ÚfiÛÏ˄˘ Ó·ÙÚ›Ô˘ 5. ∂·Ú΋˜ ÚfiÛÏË„Ë Î·Ï›Ô˘ Î·È ·Û‚ÂÛÙ›Ô˘ 6. ™ˆÌ·ÙÈ΋ ¿ÛÎËÛË 7. ∂Ï¿ÙÙˆÛË ÙÔ˘ stress 8. ¢›·ÈÙ· DASH
ÚÈÔ‡¯Ô˘ Ó·ÙÚ›Ô˘. ∂›Û˘, ·ÚÎÂÙÔ› ˘ÂÚÙ·ÛÈÎÔ› ·ÛıÂÓ›˜ ¤¯Ô˘Ó οÔÈÔ ‚·ıÌfi ÓÂÊÚÈ΋˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜, Ô˘ ÔÊ›ÏÂÙ·È Û ÓÂÊÚÔÛÎÏ‹Ú˘ÓÛË ‹ Û ¿ÏÏË ·ÚÂÁ¯˘Ì·ÙÈ΋ ÓÂÊÚÈ΋ ÓfiÛÔ, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ¤¯Ô˘Ó ÂÏ·Ùو̤ÓË ÈηÓfiÙËÙ· ÁÈ· ·Ô‚ÔÏ‹ Ó·ÙÚ›Ô˘. ∞ÎfiÌË, Û ÔÏÏÔ‡˜ ·ÛıÂÓ›˜, Ë ÂÏ¿ÙÙˆÛË Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ Ì ÔÔÈÔ‰‹ÔÙ ·ÓÙÈ˘ÂÚÙ·ÛÈÎfi Ê¿ÚÌ·ÎÔ, ÂÎÙfi˜ ·fi ‰ÈÔ˘ÚËÙÈο, Ô‰ËÁ› Û ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ÚÂÓ›Ó˘-·ÁÁÂÈÔÙ·Û›Ó˘-·Ï‰ÔÛÙÂÚfiÓ˘ Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ Î·Ù·ÎÚ¿ÙËÛË Ó·ÙÚ›Ô˘ Î·È ‡‰·ÙÔ˜. ™Â ·˘Ù¤˜ ÙȘ ÂÚÈÙÒÛÂȘ Â›Ó·È ÂȂ‚ÏË̤ÓË Ë ¯ÔÚ‹ÁËÛË ÂÓfi˜ ‰ÈÔ˘ÚËÙÈÎÔ‡. ŸÌˆ˜, ÔÏϤ˜ ÊÔÚ¤˜ ÁÈ· Ó· ÂÈÙ¢¯ı› Ë ÂÈı˘ÌËÙ‹ Ó·ÙÚÈÔ‡ÚËÛË ÂÈϤÁÂÙ·È ¤Ó· ‰ÈÔ˘ÚËÙÈÎfi Ù˘ ·Á·Ï˘ ÙÔ˘ Henle, fiˆ˜ Ë ÊÔ˘ÚÔÛÂÌ›‰Ë. ŸÙ·Ó ¯ÔÚËÁÂ›Ù·È Ì›· ÊÔÚ¿ ÙËÓ Ë̤ڷ, Ë ‰È¿ÚÎÂÈ· ‰Ú¿Û˘ Ù˘ ÊÔ˘ÚÔÛÂÌ›‰Ë˜ Â›Ó·È ÌfiÓÔ 3-6 ÒÚ˜, Ì ·ÔÙ¤ÏÂÛÌ· Ô ·ÛıÂÓ‹˜ Ó· ̤ÓÂÈ ·ÚÔÛٿ٢ÙÔ˜ ·fi ÙËÓ Î·Ù·ÎÚ¿ÙËÛË Ó·ÙÚ›Ô˘ fiÏË ÙËÓ ˘fiÏÔÈË Ë̤ڷ. ∂Ô̤ӈ˜, fiÙ·Ó ÎÚ›ÓÂÙ·È ÛÎfiÈÌË Ë ¯ÔÚ‹ÁËÛË ÂÓfi˜ ‰ÈÔ˘ÚËÙÈÎÔ‡ Ì›· ÊÔÚ¿ ÙËÓ Ë̤ڷ, Û ·ÛıÂÓ›˜ ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· ı· Ú¤ÂÈ Ó· ÂÈϤÁÂÙ·È Ì›· ıÂÈ·˙›‰Ë, fiˆ˜ Ë ˘‰ÚԯψÚÔıÂÈ·˙›‰Ë. ∏ ÊÔ˘ÚÔÛÂÌ›‰Ë ı· Ú¤ÂÈ Ó· ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÌfiÓÔ Û ·ÛıÂÓ›˜ Ì ¤ÎÙˆÛË Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ (GFR <60 ml/min) Î·È Û ‰‡Ô ‹ ÙÚÂȘ ‰fiÛÂȘ ËÌÂÚËÛ›ˆ˜. ∆· ·ÚÈ· ·›ÙÈ· Ù˘ ‰Â˘ÙÂÚÔ·ıÔ‡˜ ˘¤ÚÙ·Û˘ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 6. ∆Ô Û˘¯ÓfiÙÂÚÔ
ATHIROSKLIROSI 9b 23-02-06 10:17 ™ÂÏ›‰·7
¶∞ƒ∞°√¡∆∂™ ∫π¡¢À¡√À – E¶π¢∏ªπ√§√°π∞ ·fi ·˘Ù¿ Â›Ó·È Ë ¯ÚfiÓÈ· ·ÚÂÁ¯˘Ì·ÙÈ΋ ÓfiÛÔ˜ ÙˆÓ ÓÂÊÚÒÓ. ∏ ‰È¿ÁÓˆÛ‹ Ù˘ ‰ÂÓ ı· Ú¤ÂÈ Ó· ‚·Û›˙ÂÙ·È ÛÙËÓ ·‡ÍËÛË ÙˆÓ ÂȤ‰ˆÓ Ù˘ ÎÚ·ÙÈÓ›Ó˘ ÔÚÔ‡, Ë ÔÔ›· ·Ú·ÙËÚÂ›Ù·È Û ϛÁÔ˘˜ ÌfiÓÔ ˘ÂÚÙ·ÛÈÎÔ‡˜ ·ÛıÂÓ›˜. ∏ ·Ó›¯Ó¢ÛË Ù˘ ÚÒÈÌ˘ ¤ÎÙˆÛ˘ Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È Ì ‚¿ÛË ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘ Ú˘ıÌÔ‡ ÛÂÈÚ·Ì·ÙÈ΋˜ ‰È‹ıËÛ˘, Ô˘ ˘ÔÏÔÁ›˙ÂÙ·È Â‡ÎÔÏ· fiÙ·Ó Â›Ó·È ÁÓˆÛÙ¿ Ô ‰Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ ÙÔ˘ ·ÛıÂÓ‹, Ë ËÏÈΛ·, ÙÔ Ê‡ÏÔ Î·È Ë ÎÚ·ÙÈÓ›ÓË ÔÚÔ‡ 3. ∂›Û˘, Û fiÏÔ˘˜ ÙÔ˘˜ ˘ÂÚÙ·ÛÈÎÔ‡˜ ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÔÛÔÙÈÎfi˜ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙÔ˘ Ï¢ÎÒÌ·ÙÔ˜ Ô‡ÚˆÓ 24ˆÚÔ˘, ·ÊÔ‡ Ë ÌÈÎÚÔÏÂ˘ÎˆÌ·ÙÈÓÔ˘Ú›· ·ÊÂÓfi˜ ÌÂÓ Â›Ó·È Û˘¯ÓfiÙÂÚË ·’ fi,ÙÈ ÈÛÙ¢fiÙ·Ó, ·ÊÂÙ¤ÚÔ˘ ‰Â ·ÔÙÂÏ› ÛËÌ·ÓÙÈÎfi ÚÔÁÓˆÛÙÈÎfi ‰Â›ÎÙË ÂͤÏÈ͢ ÚÔ˜ ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ· ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ Î·È Î·Ú‰È·ÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ 4.
¶›Ó·Î·˜ 6. ∫‡ÚÈ· ·›ÙÈ· ‰Â˘ÙÂÚÔ·ıÔ‡˜ ˘¤ÚÙ·Û˘ 1. ¡ÂÊÚÈ΋ ·ÚÂÁ¯˘Ì·ÙÈ΋ ÓfiÛÔ˜ 2. ¡ÂÊÚ·ÁÁÂȷ΋ ˘¤ÚÙ·ÛË 3. ¶ÚˆÙÔ·ı‹˜ ·Ï‰ÔÛÙÂÚÔÓÈÛÌfi˜ 4. º·ÈÔ¯ÚˆÌÔ·و̷
∏ ‰È¿ÁÓˆÛË Ù˘ ÓÂÊÚ·ÁÁÂȷ΋˜ ˘¤ÚÙ·Û˘ ÌÔÚ› Ó· Â›Ó·È ‰‡ÛÎÔÏË, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ‰ÂÓ ˘¿Ú¯Ô˘Ó ·ıÔÁÓˆÌÔÓÈο ÎÏÈÓÈο ÛËÌ›·. ∆Ô Ê‡ÛËÌ· ÛÙÔ ÂÈÁ¿ÛÙÚÈÔ ˘¿Ú¯ÂÈ ÛÙÔ 46% ÙˆÓ ·ÛıÂÓÒÓ Ì ÓÂÊÚ·ÁÁÂȷ΋ ˘¤ÚÙ·ÛË, ·ÏÏ¿ Î·È ÛÙÔ 9% ÙˆÓ ·ÛıÂÓÒÓ Ì ȉÈÔ·ı‹ ˘¤ÚÙ·ÛË. ŸÙ·Ó Ô ‚·ıÌfi˜ ˘fiÓÔÈ·˜ Â›Ó·È ÌÂÁ¿ÏÔ˜, Ë Î·Ï‡ÙÂÚË ·Ú·ÎÏÈÓÈ΋ ̤ıÔ‰Ô˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ ÏÂÈ-
ÙÔ˘ÚÁÈ΋˜ ÛÙ¤ÓˆÛ˘ Ù˘ ÓÂÊÚÈ΋˜ ·ÚÙËÚ›·˜ Â›Ó·È ÙÔ Ú·‰ÈÂÓÂÚÁfi ÓÂÊÚfiÁÚ·ÌÌ· ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË Î·ÙÔÚ›Ï˘. ∏ Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· Î·È Ë spiral ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÌÔÚ› Ó· ·Ó·‰Â›ÍÔ˘Ó ÛÙ¤ÓˆÛË, ‰ÂÓ Â›Ó·È fï˜ Û ı¤ÛË Ó· ·Ô‰Â›ÍÔ˘Ó ·Ó Â›Ó·È ÏÂÈÙÔ˘ÚÁÈ΋. ŸÙ·Ó ÙÔ ·›ÙÈÔ Â›Ó·È Ë ÈÓÔÌ˘ˆÌ·Ù҉˘ ‰˘ÛÏ·Û›·, Ë ·ÁÁÂÈÔÏ·ÛÙÈ΋ Ì ‹ ¯ˆÚ›˜ ÙÔÔı¤ÙËÛË stent ÌÔÚ› Ó· ÚÔÛʤÚÂÈ Ï‹ÚË ›·ÛË ‹ ¢¯ÂÚ¤ÛÙÂÚË Ú‡ıÌÈÛË Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘. ™Â ÂÚÈÙÒÛÂȘ ·ıËڈ̷ÙÒ‰Ô˘˜ ÓfiÛÔ˘, Ë ‰È¿ÁÓˆÛË Á›ÓÂÙ·È Û˘Ó‹ıˆ˜ ·ÚÎÂÙ¿ ·ÚÁ¿, Ì ·ÔÙ¤ÏÂÛÌ· Ë ·ÔηٿÛÙ·ÛË Ù˘ ·ÈÌ¿ÙˆÛ˘ ÙÔ˘ ›Û¯·ÈÌÔ˘ ÓÂÊÚÔ‡ Ó· ÌËÓ ¤¯ÂÈ Ù· ·Ó·ÌÂÓfiÌÂÓ· ıÂڷ¢ÙÈο ·ÔÙÂϤÛÌ·Ù·, ‰ÈfiÙÈ Û˘Ó˘¿Ú¯ÂÈ ÚÔÛ‚ÔÏ‹ ÙˆÓ ÌÈÎÚÒÓ ·ÚÙËÚÈÒÓ ÙÔ˘ ÓÂÊÚÔ‡ 5. £· Ú¤ÂÈ Ó· ηٷ‚¿ÏÏÂÙ·È È‰È·›ÙÂÚË ÚÔÛ¿ıÂÈ· ÁÈ· ηϋ Ú‡ıÌÈÛË Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘, Ë ÔÔ›· ÛÂ Û˘Ó‰˘·ÛÌfi Î·È Ì ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Û˘Ó˘·Ú¯fiÓÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ı· Ô‰ËÁ‹ÛÂÈ ÛÙËÓ ÚÔÛÙ·Û›· Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ·ÛıÂÓ‹. ∏ ·Ú¯È΋ ‰È¿ÁÓˆÛË ÙÔ˘ ÚˆÙÔ·ıÔ‡˜ ·Ï‰ÔÛÙÂÚÔÓÈÛÌÔ‡ ÛÙËÚ›˙ÂÙ·È Û˘Ó‹ıˆ˜ ÛÙË Û˘Ó‡·ÚÍË ˘ÔηÏÈ·ÈÌ›·˜ Î·È ·˘ÍË̤Ó˘ ·¤ÎÎÚÈÛ˘ Î·Ï›Ô˘ ÛÙ· Ô‡Ú· 24ÒÚÔ˘ 6. øÛÙfiÛÔ, ÂÂȉ‹ ˘ÔηÏÈ·ÈÌ›· ÂÌÊ·Ó›˙ÂÈ ÌfiÓÔ ÙÔ 50% ÂÚ›Ô˘ ÙˆÓ ·ÛıÂÓÒÓ, ηχÙÂÚÔ˜ ‰Â›ÎÙ˘ ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ Â›Ó·È Ë ‡·ÚÍË ÏfiÁÔ˘ ·Ï‰ÔÛÙÂÚfiÓ˘ Ï¿ÛÌ·ÙÔ˜/‰Ú·ÛÙÈÎfiÙËÙ· ÚÂÓ›Ó˘ Ï¿ÛÌ·ÙÔ˜ ÌÂÁ·Ï‡ÙÂÚÔ˘ ·fi 20. ∏ ÂÓÙfiÈÛË ÙÔ˘ ·‰ÂÓÒÌ·ÙÔ˜ ‹ Ù˘ ·ÌÊÔÙÂÚfiÏ¢Ú˘ ˘ÂÚÏ·Û›·˜ ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ Á›ÓÂÙ·È Ì ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÈÓÂÊÚȉ›ˆÓ. ∏ ıÂڷ›· Û˘Ó›ÛÙ·Ù·È ÛÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË ÙÔ˘ ·‰ÂÓÒÌ·ÙÔ˜, ÂÓÒ Û ÂÚÈÙÒÛÂȘ ·ÌÊÔÙÂÚfiÏ¢-
Ú˘ ˘ÂÚÏ·Û›·˜ ¯ÔÚËÁÂ›Ù·È ¤Ó·˜ ·ÓÙ·ÁˆÓÈÛÙ‹˜ ÙˆÓ ˘Ô‰Ô¯¤ˆÓ Ù˘ ·Ï‰ÔÛÙÂÚfiÓ˘, Ë ÛÂÈÚÔÓÔÏ·ÎÙfiÓË. ∆ÂÏÂ˘Ù·›·, ÙÔ ı¤Ì· Ù˘ ¯ÂÈÚÔ˘ÚÁÈ΋˜ ÂÍ·›ÚÂÛ˘ ÙÔ˘ ÂÈÓÂÊÚȉÈÎÔ‡ ·‰ÂÓÒÌ·ÙÔ˜ ¤¯ÂÈ ÙÂı› ˘fi ·ÌÊÈÛ‚‹ÙËÛË, ‰ÈfiÙÈ Û ÔÚÈṲ̂ÓÔ˘˜ ·ÛıÂÓ›˜ ·Ú·ÙËÚ‹ıËΠÌÂÙ¿ ·fi Ï›Á· ¯ÚfiÓÈ· Ë ·Ó¿Ù˘ÍË ˘ÂÚÏ·Û›·˜ ÛÙÔ ÂÓ·ÔÌÂ›Ó·Ó ÂÈÓÂÊÚ›‰ÈÔ Î·È Ë Â·ÓÂÌÊ¿ÓÈÛË ÙÔ˘ ·Ï‰ÔÛÙÂÚÔÓÈÛÌÔ‡. ∂Ô̤ӈ˜, ÔÚÈṲ̂ÓÔÈ Û˘ÓÈÛÙÔ‡Ó Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ڈÙÔ·ı‹ ·Ï‰ÔÛÙÂÚÔÓÈÛÌfi ÙË ¯ÚfiÓÈ· ¯ÔÚ‹ÁËÛË ÛÂÈÚÔÓÔÏ·ÎÙfiÓ˘. ∆Ô Ê·ÈÔ¯ÚˆÌÔ·و̷ ·ÔÙÂÏ› ÙË Û·ÓÈfiÙÂÚË ÌÔÚÊ‹ ‰Â˘ÙÂÚÔ·ıÔ‡˜ ˘¤ÚÙ·Û˘. ŸÙ·Ó ÙÂı› Ë ˘fiÓÔÈ· Ù˘ ÓfiÛÔ˘ ·fi ÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ·, Á›ÓÂÙ·È ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ Î·Ù¯ÔÏ·ÌÈÓÒÓ ‹ ÙˆÓ ÌÂÙ·‚ÔÏÈÙÒÓ ÙÔ˘˜ Û ԇڷ 24ÒÚÔ˘ ‹ ÙˆÓ Î·Ù¯ÔÏ·ÌÈÓÒÓ ÛÙÔ Ï¿ÛÌ·. ∏ ÂÓÙfiÈÛË ÙÔ˘ fiÁÎÔ˘ Á›ÓÂÙ·È Ì ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÈÓÂÊÚȉ›ˆÓ. ∆· Â͈ÂÈÓÂÊÚȉÈο Ê·ÈÔ¯ÚˆÌÔ΢ÙÒÌ·Ù·, Ô˘ ηÏÔ‡ÓÙ·È ·Ú·Á·ÁÁÏÈÒÌ·Ù·, ÂÓÙÔ›˙ÔÓÙ·È Ì ÙÔ ÛÈÓıËÚÔÁÚ¿ÊËÌ· Ì 131I-ÌÂÙ·-Ȉ‰Ô‚ÂÓ˙˘ÏÁÔ˘·Óȉ›ÓË (131I-MIBG). ∏ ıÂڷ¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Â›Ó·È ¿ÓÙ· ¯ÂÈÚÔ˘ÚÁÈ΋, ‰Â‰Ô̤ÓÔ˘ Ì¿ÏÈÛÙ· fiÙÈ Û ÔÛÔÛÙfi 10% ÔÈ fiÁÎÔÈ ·˘ÙÔ› Â›Ó·È Î·ÎÔ‹ıÂȘ. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ·ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË ÌÔÚ› Ó· Â›Ó·È Ê·ÈÓÔÌÂÓÈο ·ÓıÂÎÙÈ΋. ∏ ÚÔÛÂÎÙÈ΋ Ï‹„Ë ÙÔ˘ ÈÛÙÔÚÈÎÔ‡ ÙÔ˘ ·ÛıÂÓ‹, Ë Ê˘ÛÈ΋ ÂͤٷÛË (Ô˘ ı· Ú¤ÂÈ Ó· Û˘Óԉ‡ÂÙ·È Î·È ·fi ÔÏϷϤ˜ ÌÂÙÚ‹ÛÂȘ Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ÛÙÔ Û›ÙÈ) Î·È Ë ‰ÈÂÓ¤ÚÁÂÈ· ‚·ÛÈÎÒÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ Ô‰ËÁÔ‡Ó Û˘Ó‹ıˆ˜ ÛÙË ÛˆÛÙ‹ ‰È¿ÁÓˆÛË Î·È ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ıÂڷ›·.
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ATHIROSKLIROSI 9b 23-02-06 10:17 ™ÂÏ›‰·8
·ıËÚÔÛÎÏ‹ÚˆÛË MAƒ∆π√™
2006
÷ÌËÏfi B¿ÚÔ˜ °¤ÓÓËÛ˘ ¶ÚԂϤÂÈ ªÂÙ·‚ÔÏÈÎfi ™‡Ó‰ÚÔÌÔ Û N·ÚÔ‡˜ EÓ‹ÏÈΘ: ªÂϤÙË ARYA (Atherosclerosis Risk in Young Adults) Ramadhani MK, Grobbee DE, Bots ML, Cabezas MC, Vos LE, Oren A, Uiterwaal CSPM
Atherosclerosis 2006;184:21-27 Ô ¯·ÌËÏfi ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ ηٿ ÙË Á¤ÓÓËÛË ıˆÚÂ›Ù·È ·Ú¿ÁˆÓ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛ˘ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ ÛÙËÓ ÂÓ‹ÏÈÎÔ ˙ˆ‹. ∞ÚÎÂÙ¤˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ÂÚÈÔÚÈÛÌfi˜ ÛÙËÓ ÂÓ‰ÔÌ‹ÙÚÈÔ ·Ó¿Ù˘ÍË Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÂÌÊ¿ÓÈÛË ·ÚÙËÚȷ΋˜ ˘¤ÚÙ·Û˘, ۷ί·ÚÒ‰Ô˘˜ ‰È·‚‹ÙË Î·È ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘, ÚÔ·ÓÙfi˜ Û ·˘ÙÔ‡˜ Ô˘ Êı¿ÓÔ˘Ó Û ‚¿ÚÔ˜ ÙÔ˘˜ Û˘ÓÔÌËÏ›ÎÔ˘˜ ÙˆÓ ÛÙËÓ ÚÒÙË ·È‰È΋ ËÏÈΛ· ∏ ÌÂϤÙË ARYA ‰ÈÂÚ‡ÓËÛ ÙË Û¯¤ÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙÔ˘ ÓÂÔÁÓÔ‡ ηٿ ÙË ÛÙÈÁÌ‹ Ù˘ Á¤ÓÓËÛ˘ Ì ÙÔ ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ÙÔ ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ Â›Ó·È ÛÔ‚·Úfi˜ ·Ú¿ÁˆÓ ÎÈÓ‰‡ÓÔ˘ Ù˘ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘. 4.207 ¿ÙÔÌ· Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÛÙËÓ √˘ÙÚ¤¯ÙË Ù˘ √ÏÏ·Ó‰›·˜ ÌÂٷ͇ 1970 Î·È 1973 Î·È ·Ú·ÎÔÏÔ˘ıÔ‡Û·Ó ÙËÓ ‰Â˘ÙÂÚÔ‚¿ıÌÈ· Âη›‰Â˘ÛË ÛÙËÓ fiÏË ·˘Ù‹ ›¯·Ó Ï‹ÚÂȘ È·ÙÚÈÎÔ‡˜ ʷΤÏÔ˘˜ Ì ٷ ·ÓıÚˆÔÌÂÙÚÈο ¯·Ú·ÎÙËÚÈÛÙÈο ηٿ ÙË Á¤ÓÓËÛË. ∞Ó·˙ËÙ‹ıËÎ·Ó ÁÈ· ÂͤٷÛË Î·È ·ÓÙ·ÔÎÚ›ıËÎ·Ó Ù· 820. ∆ÂÏÈο ÂÚÈÏ‹ÊıËÎ·Ó ÛÙË ÌÂϤÙË 749 ¿ÙÔÌ·, ËÏÈΛ·˜ 26-31 ÂÙÒÓ. ∏ ‰È¿ÁÓˆÛË ÙÔ˘ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ ¤ÁÈÓ Ì ٷ ÎÚÈÙ‹ÚÈ· ∞∆ƒ πππ (ÂÚ›ÌÂÙÚÔ˜ ̤Û˘ >102 ÂÎ. ÛÙÔ˘˜ ¿Ó‰Ú˜ ‹ >88 ÂÎ. ÛÙȘ Á˘Ó·›Î˜, ÙÚÈÁÏ˘ÎÂÚ›‰È· ≥150 mg%, HDL-¯ÔÏËÛÙ < 40 mg% ÛÙÔ˘˜ ¿Ó‰Ú˜ ‹ <50 mg% ÛÙȘ Á˘Ó·›Î˜, ∞¶ ≥130/85 mmHg Î·È Û¿Î¯·ÚÔ ·›Ì·ÙÔ˜ ≥110 mg%) ¢È·ÈÛÙÒıËΠfiÙÈ Ù· ¿ÙÔÌ· Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ÛÙ· ‰‡Ô ηÙÒÙÂÚ· ÙÚÈÙËÌfiÚÈ· (1.250-3.209
∆
8
Î·È 3.210-3.649 ÁÚ·ÌÌ¿ÚÈ·) ›¯·Ó ÌÂÁ·Ï‡ÙÂÚË Èı·ÓfiÙËÙ· Ó· ¿Û¯Ô˘Ó ·fi ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ, Û˘ÁÎÚÈÙÈο Ì ٷ ¿ÙÔÌ· Ô˘ ‚Ú›ÛÎÔÓÙ·Ó ÛÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÙÚÈÙËÌfiÚÈÔ (3.650-5.500 ÁÚ·ÌÌ¿ÚÈ·): ÏfiÁÔ˜ Èı·ÓÔÙ‹ÙˆÓ 1,8 (CI 1,0-3,5) Î·È 1,4 (CI 0,7-2,7) ·ÓÙ›ÛÙÔȯ·, ·ÊÔ‡ ÂÏ‹ÊıË ˘fi„Ë Î·È ¤ÁÈÓ ‰ÈfiÚıˆÛË ˆ˜ ÚÔ˜ ÙÔ Ê‡ÏÔ, ÙÔÓ ÙÚ¤¯ÔÓÙ· ¢Â›ÎÙË ª¿˙·˜ ™ÒÌ·ÙÔ˜ Î·È ÙÔ Â›Â‰Ô Âη›‰Â˘Û˘. ∆Ô ‚¿ÚÔ˜ ηٿ ÙË Á¤ÓÓËÛË Û¯ÂÙÈ˙fiÙ·Ó ·ÚÓËÙÈο, ÛÂ
ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈÎfi ›‰Ô, Ì ÙË Û˘ÛÙÔÏÈ΋ ·ÚÙËÚȷ΋ ›ÂÛË Î·È Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È· ÙÔ˘ ÔÚÔ‡. ∂›Û˘ ›¯Â ·ÚÓËÙÈ΋ Û˘Û¯¤ÙÈÛË, ÛÂ Â›Â‰Ô fï˜ ÌË ÛËÌ·ÓÙÈÎfi ÛÙ·ÙÈÛÙÈο, Ì ÙË ‰È·ÛÙÔÏÈ΋ ·ÚÙËÚȷ΋ ›ÂÛË, ÙÔ Û¿Î¯·ÚÔ ·›Ì·ÙÔ˜, ÙËÓ ÔÏÈ΋ Î·È ÙËÓ LDL-¯ÔÏËÛÙÂÚfiÏË, Î·È ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË, ›Û˘ ÌË ÛËÌ·ÓÙÈ΋ ÛÙ·ÙÈÛÙÈο, Ì ÙËÓ HDL-¯ÔÏËÛÙÂÚfiÏË Î·È ÙËÓ ÂÚ›ÌÂÙÚÔ Ì¤Û˘. ∆Ô Ì‹ÎÔ˜ ÛÒÌ·ÙÔ˜ ηٿ ÙË Á¤ÓÓËÛË Î·È Ô ‰Â›ÎÙ˘ ponderal (‚¿ÚÔ˜ Á¤ÓÓËÛ˘ Û ÁÚ·ÌÌ¿-
ÚÈ· ÚÔ˜ ÙÔ Ì‹ÎÔ˜ Û ÂηÙÔÛÙ¿ ˘„ˆÌ¤ÓÔ ÛÙÔÓ Î‡‚Ô) ‰ÂÓ Â›¯·Ó Û˘Û¯¤ÙÈÛË Ì ÙÔ ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ ‹ ÙȘ ÏÈȉ·ÈÌÈΤ˜ ·Ú·Ì¤ÙÚÔ˘˜. √ Ì˯·ÓÈÛÌfi˜ Ì ÙÔÓ ÔÔ›Ô Û˘Ó‰¤ÂÙ·È ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ Ì ÙÔ ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ Èı·ÓÒ˜ ¤ÁÎÂÈÙ·È ÛÙËÓ ·Ó¿ÚÎÂÈ· Ù˘ ÂÓ‰ÔÌ‹ÙÚÈ·˜ ·Ó¿Ù˘Í˘ ÏfiÁˆ η΋˜ ıÚ¤„˘ Ù˘ ÌËÙ¤Ú·˜, ¤ÎıÂÛ˘ Û ÛÙÚ¤˜, ·ÓˆÌ·Ï›·˜ Ù˘ ÌËÙÚÔÏ·ÎÔ‡ÓÙÈ·˜ ΢ÎÏÔÊÔÚ›·˜ ‹ Û ·Ú¿ÁÔÓÙ˜ Ô˘ ‰ÚÔ˘Ó ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË. ∆Ô ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ÂËÚ¿˙ÂÈ ÙÔÓ ÙÚfiÔ ‰È·ÙÚÔÊ‹˜ ÙÔ˘ ÓÂÔÁÓÔ‡. ŸÛÔ ÌÈÎÚfiÙÂÚÔ ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ÙfiÛÔ ÌÈÎÚfiÙÂÚË Ë Èı·ÓfiÙËÙ· Ó· ıËÏ¿ÛÂÈ ÙÔ ÓÂÔÁÓfi Î·È ÔÈ ·ÏÏ·Á¤˜ ÛÙÔ ‰È·ÈÙËÙÈÎfi ϛԘ Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙÔ Í¤ÓÔ Á¿Ï· ÛÙËÓ Â˘·›ÛıËÙË ÓÂÔÁÓÈ΋ ËÏÈΛ· ÂӉ¯Ô̤ӈ˜ ÚÔηÏÔ‡Ó ÚÔÛ·ÚÌÔÁ¤˜ ÛÙÔÓ ÌÂÙ·‚ÔÏÈÛÌfi, ÛÙÔÓ ÔÚÌÔÓÈÎfi ¿ÍÔÓ· Î·È ÛÙË ‰ÔÌ‹ ÙˆÓ ÔÚÁ¿ÓˆÓ, Ì ·fiÙÔÎÔ ÙËÓ ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›· ÛÙËÓ ÂÓ‹ÏÈÎÔ ˙ˆ‹. ¶Èı·ÓÒ˜ Î·È ÔÈ ‰‡Ô Ì˯·ÓÈÛÌÔ›, ÂÓ‰ÔÌ‹ÙÚÈÔÈ Î·È ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË Û˘ÓÂÚÁ¿˙ÔÓÙ·È ·fi ÎÔÈÓÔ‡ ÛÙËÓ ÂΉ‹ÏˆÛË Ù˘ ‰È·Ù·Ú·¯‹˜ ∆Ô Û˘Ì¤Ú·ÛÌ· Ô˘ ÚÔ·ÙÂÈ ·fi ÙË ÌÂϤÙË ·˘Ù‹ Â›Ó·È fiÙÈ Ë ÚfiÏË„Ë ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ Ú¤ÂÈ Ó· ·Ú¯›˙ÂÈ ·fi ÙËÓ ÂÚ›Ô‰Ô Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ Ì ηϋ ‰È·ÙÚÔÊ‹ Ù˘ ÂÁ·Ԣ, „˘¯È΋ ËÚÂÌ›· (·ÔÊ˘Á‹ ÛÙÚ˜) Î·È ÂÍ·ÛÊ¿ÏÈÛË ıËÏ·ÛÌÔ‡ ÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹Ó˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË. ∂È̤ÏÂÈ·: ∏Ï›·˜ ÃÂÈÌÒÓ·˜
ATHIROSKLIROSI 9b 23-02-06 10:17 ™ÂÏ›‰·9
¶∞£√ºÀ™π√§√°π∞
√ ƒfiÏÔ˜ Ù˘ °ÎÚÂÏ›Ó˘ ÛÙÔ ªÂÙ·‚ÔÏÈÛÌfi Î·È ÙËÓ ¶·¯˘Û·ÚΛ· µ·Ï·ÓÙ‹Ó ¢ÈÛÏÈ¿Ó, π·ÙÚfi˜, ªÂÙ·Ù˘¯È·Î‹ ºÔÈÙ‹ÙÚÈ· π·ÙÚÈ΋˜ ∞¶£ ∞ÛÙ¤ÚÈÔ˜ ∫·Ú·ÁÈ¿ÓÓ˘, ∞Ó·ÏËÚˆÙ‹˜ ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜ ∞¶£, µ’ ¶ÚÔ·È‰Â˘ÙÈ΋ ¶·ıÔÏÔÁÈ΋ ∫ÏÈÓÈ΋, πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌ›Ô, £ÂÛÛ·ÏÔÓ›ÎË
ÁÎÚÂÏ›ÓË Â›Ó·È ¤Ó· ÂÙ›‰ÈÔ Ô˘ ·ÔÌÔÓÒıËΠÙÔ 1999 ·fi ÙÔ ÛÙfiÌ·¯Ô ÔÓÙÈÎÔ‡1. ∆Ô 1981, ›¯·Ó ·Ó·Î·Ï˘Êı› Û˘ÓıÂÙÈο ÂÙ›‰È· Ô˘ ‰ÈÂÁ›ÚÔ˘Ó ÙËÓ ·ÂÏ¢ı¤ÚˆÛË Ù˘ ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ (Growth Hormone Secretagogues, GHS), ÂÓÒ ÙÔ 1996 ·Ó·ÁÓˆÚ›ÛÙËÎÂ Î·È Ô ˘Ô‰Ô¯¤·˜ ÙÔ˘˜, (Growth Hormone Secretagogues-Receptor, GHS-R). ™ÙËÓ ÈÓ‰È΋ ÁÏÒÛÛ· ÁÎÚÂÏ›ÓË ÛËÌ·›ÓÂÈ ·‡ÍËÛË, ·Ú·ÁˆÁ‹, ·Ó¿Ù˘ÍË. ∏ ÁÎÚÂÏ›ÓË ·ÔÙÂÏ› ÙÔ Ê˘ÛÈÎfi Û˘Ó‰ÂÙÈÎfi ÎÚ›ÎÔ ÌÂٷ͇ ÙˆÓ GHS Î·È ÙÔ˘ ˘Ô‰Ô¯¤· ÙÔ˘˜ Î·È ÚÔ¿ÁÂÈ ÙËÓ ¤ÎÎÚÈÛË Ù˘ ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ (growth hormone, GH).
∏
¢ÔÌ‹ Î·È ·Ú·ÁˆÁ‹ Ù˘ ÁÎÚÂÏ›Ó˘ ∏ ÁÎÚÂÏ›ÓË Â›Ó·È ¤Ó· ·ÎÂÙ˘ÏȈ̤ÓÔ ÂÙ›‰ÈÔ Ô˘ ·ÔÙÂÏÂ›Ù·È ·fi 28 ·ÌÈÓÔͤ· Î·È ÂÌÊ·Ó›˙ÂÈ ‰ÔÌÈ΋ ÔÌÔÈfiÙËÙ· Ì ÙË ÌÔÙÈÏ›ÓË Î·Ù¿ 36%2. ∏ ·ÓıÚÒÈÓË ÁÎÚÂÏ›ÓË Â›Ó·È ÔÌfiÏÔÁË Ì ·˘Ù‹ ÙÔ˘ ÔÓÙÈÎÔ‡, ‰È·Ê¤ÚÔÓÙ·˜ ÌfiÓÔ Î·Ù¿ ‰‡Ô ·ÌÈÓÔͤ·. ∏ ÁÎÚÂÏ›ÓË ·Ú¿ÁÂÙ·È Î˘Ú›ˆ˜ ÛÙÔ ÛÙfiÌ·¯Ô, ·fi Ó¢ÚÔÂÓ‰ÔÎÚÈÓÈο ·ÙÙ·Ú· ÙÔ˘ ıfiÏÔ˘ ÙÔ˘ ÛÙÔÌ¿¯Ô˘ Î·È ·fi ÂΛ ÂÎÎÚ›ÓÂÙ·È ÛÙËÓ Î˘ÎÏÔÊÔÚ›·. ∫‡ÙÙ·Ú· Ô˘ ·Ú¿ÁÔ˘Ó ÙËÓ ÔÚÌfiÓË ·˘Ù‹ ·Ó¢ڛÛÎÔÓÙ·È Î·È Î·Ù¿ Ì‹ÎÔ˜ ÔÏfiÎÏËÚÔ˘ ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ ۈϋӷ, ·fi ÙÔ ÛÙfiÌ·¯Ô ˆ˜ ÙÔ ·¯‡ ¤ÓÙÂÚÔ, Ì ÙËÓ ˘ÎÓfiÙËÙ¿ ÙÔ˘˜ Ó· ÌÂÈÒÓÂÙ·È ÚÔԉ¢ÙÈο ÛÙ· ηوÊÂÚ¤ÛÙÂÚ· ÙÌ‹Ì·Ù·. ¶Èı·ÓÔÏÔÁÂ›Ù·È Ë ‡·ÚÍË ‰‡Ô Ù‡ˆÓ Ù¤ÙÔÈˆÓ Î˘ÙÙ¿ÚˆÓ, ÂӉ¯Ô̤ӈ˜ Ì ‰È·ÊÔÚÂÙÈΤ˜ ȉÈfiÙËÙ˜3. ¶·Ú·ÁˆÁ‹ ÁÎÚÂÏ›Ó˘ ¤¯ÂÈ ‰È·ÈÛÙˆı› Û ÌÈÎÚfiÙÂÚÔ ‚·ıÌfi Î·È ·ÏÏÔ‡, fiˆ˜ ÛÙÔÓ ÙÔÍÔÂȉ‹ ˘Ú‹Ó· ÙÔ˘ ˘Ôı·Ï¿ÌÔ˘ Î·È ÛÙËÓ ˘fiÊ˘ÛË. Œ¯ÂÈ ‚ÚÂı› fiÙÈ ÙfiÛÔ Ù· · fiÛÔ Î·È Ù· ‚ ·ÙÙ·Ú·
ÙˆÓ ÓËÛȉ›ˆÓ ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜ ·Ú¿ÁÔ˘Ó ÁÎÚÂÏ›ÓË, Û˘Ì‚¿ÏÏÔÓÙ·˜ ÛÙË Ú‡ıÌÈÛË Ù˘ ¤ÎÎÚÈÛ˘ ÈÓÛÔ˘Ï›Ó˘. ¶ÚfiÛÊ·Ù· ‰È·ÈÛÙÒıËΠ¤ÎÊÚ·ÛË Ù˘ ÁÎÚÂÏ›Ó˘ Û ¤Ó· ‰È·ÊÔÚÂÙÈÎfi ÏËı˘ÛÌfi ÓËÛȉȷÎÒÓ Î˘ÙÙ¿ÚˆÓ ÛÙÔ ¿ÁÎÚ·˜ ÂÌ‚Ú‡ˆÓ ÓÂÔÁÓÒÓ Î·È ÂÓËϛΈÓ, ÂÓÒ Î·È ·ÁÎÚ·ÙÈÎÔ› ÂÓ‰ÔÎÚÈÓÈÎÔ› fiÁÎÔÈ ·Ú¿ÁÔ˘Ó ÙËÓ ÔÚÌfiÓË Î·È Ê¤ÚÔ˘Ó ˘Ô‰Ô¯Â›˜ ÁÈ’ ·˘Ù‹Ó, ÁÂÁÔÓfi˜ Ô˘ ˘ÔÓÔ› οÔÈ· ·Ú·ÎÚÈÓÈ΋ ‰Ú¿ÛË4. ∆Ô ›‰ÈÔ ÈÛ¯‡ÂÈ Î·È ÁÈ· ηÚÎÈÓÔÂȉ‹ ÙÔ˘ ÛÙÔÌ¿¯Ô˘ Î·È ÙÔ˘ ÂÓÙ¤ÚÔ˘, ‰È·ÊfiÚÔ˘˜ Ù‡Ô˘˜ ·‰ÂÓˆÌ¿ÙˆÓ Ù˘ ˘fiÊ˘Û˘ Î·È ÁÈ· ·ÙÙ·Ú· Ì˘ÂÏÔÂȉԇ˜ ηÚΛÓÔ˘ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜. ∂›Û˘, Ë ÔÚÌfiÓË Î·ıÒ˜ Î·È Ô ˘Ô‰Ô¯¤·˜ Ù˘ ÂÎÊÚ¿˙ÔÓÙ·È Û fiÏ· Ù· ·ÙÙ·Ú· ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ÛÙ· ·ÙÙ·Ú· ÙÔ˘ ·ÓıÚÒÈÓÔ˘ Ï·ÎÔ‡ÓÙ·, ÛÙÔ˘˜ fiÚ¯ÂȘ Î·È ÛÙȘ ˆÔı‹Î˜, ÛÙȘ ÎÔÈϛ˜ Î·È ÛÙ· ·ÈÌÔÊfiÚ· ·ÁÁ›· Ù˘ ηډȿ˜, ηıÒ˜ ›Û˘ Î·È Û ‰È¿ÊÔÚÔ˘˜ ÓÂÔÏ·ÛÌ·ÙÈÎÔ‡˜ ÈÛÙÔ‡˜ (ηÚÎÈÓÒÌ·Ù· Ì·ÛÙÔ‡, ‹·ÙÔ˜, Ó¢ÌfiÓˆÓ Î·È ÚÔÛÙ¿ÙË)5. ∏ ·Ó‡ÚÂÛË Ù˘ ÁÎÚÂÏ›Ó˘ Û ‰È¿ÊÔÚ· Û˘ÛÙ‹Ì·Ù· ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ Û˘ÓËÁÔÚ› ˘¤Ú ÌÈ·˜ ÔχÏÔ΢ Î·È ÔÈΛÏ˘ ‰Ú¿Û˘.
ƒ‡ıÌÈÛË ¤ÎÎÚÈÛ˘ Ù˘ ÁÎÚÂÏ›Ó˘ ∏ ¤ÎÎÚÈÛË Ù˘ ÁÎÚÂÏ›Ó˘, fiˆ˜ Î·È Ù˘ ÏÂÙ›Ó˘, Á›ÓÂÙ·È Î·Ù¿ ÒÛÂȘ Î·È Ù· ›‰¿ Ù˘ ˘Ê›ÛÙ·Ù·È ‰È·Î˘Ì¿ÓÛÂȘ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ë̤ڷ˜. ¶·Ú·ÙËÚÂ›Ù·È Ì›· ¤ÓÙÔÓË ·‡ÍËÛË Ï›ÁÔ ÚÈÓ ·fi ÙËÓ ÚfiÛÏË„Ë ÙÚÔÊ‹˜ Î·È Ì›ˆÛË Ì›· ÒÚ· ÂÚ›Ô˘ ÌÂÙ¿, Ì ÙËÓ Â¤Ï¢ÛË ÙÔ˘ ÎÔÚÂÛÌÔ‡6. ∆· ›‰· Ù˘ ΢ÎÏÔÊÔÚÔ‡Û·˜ ÁÎÚÂÏ›Ó˘ Û˘Û¯ÂÙ›˙ÔÓÙ·È ·ÚÓËÙÈο ÌÂ
ÙÔ ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜. ∞˘ÍË̤ÓË ¤ÎÎÚÈÛË ·Ú·ÙËÚÂ›Ù·È ÛÙËÓ ·ÓÔÚÂÍ›· Î·È ÙËÓ Î·¯ÂÍ›· Î·È ÌÂȈ̤ÓË ÛÙËÓ ·¯˘Û·ÚΛ·, fiÔ˘ ÙÔ ÂÓÂÚÁÂÈ·Îfi ÈÛÔ˙‡ÁÈÔ Â›Ó·È ıÂÙÈÎfi. ∏ ÌfiÓË ÂÍ·›ÚÂÛË Ù˘ ·ÚÓËÙÈ΋˜ Û˘Û¯¤ÙÈÛ˘ ÙÔ˘ ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜ Î·È Ù˘ ¤ÎÎÚÈÛ˘ ÁÎÚÂÏ›Ó˘ Â›Ó·È ÙÔ Û‡Ó‰ÚÔÌÔ PraderWilli, ÛÙÔ ÔÔ›Ô Ë ·¯˘Û·ÚΛ· Û˘Û¯ÂÙ›˙ÂÙ·È Ì ˘ÂÚ¤ÎÎÚÈÛË Ù˘ ÔÚÌfiÓ˘7. ∏ ·¯˘Û·ÚΛ· Û˘Ó‰¤ÂÙ·È Ì ̛· ·Ó·ÛÙÚ¤„ÈÌË ÂÏ¿ÙÙˆÛË ·Ú·ÁˆÁ‹˜ Ù˘ ÔÚÌfiÓ˘. ¶·Ú·ÏÏËÏÈÛÌfi˜ ÙˆÓ ËÌÂÚ‹ÛÈˆÓ ‰È·Î˘Ì¿ÓÛÂˆÓ Ù˘ ÁÎÚÂÏ›Ó˘ ÛÙÔ Ï¿ÛÌ·, Û ·¯‡Û·Úη Î·È ÏÂÙfiۈ̷ ¿ÙÔÌ·, ¤‰ÂÈÍ fiÙÈ Ë ÚÔÁÂ˘Ì·ÙÈ΋ ·‡ÍËÛË Â›Ó·È ÌÈÎÚfiÙÂÚË ÛÙ· ·¯‡Û·Úη ·’ fi,ÙÈ ÛÙ· ÏÂÙfiۈ̷ ¿ÙÔÌ·, ηıÒ˜ ›Û˘ Ë ÌÂÙ·ÁÂ˘Ì·ÙÈ΋ Ì›ˆÛË Â›Ó·È Û¯Â‰fiÓ ·ÌÂÏËÙ¤· ÛÙ· ·¯‡Û·Úη ¿ÙÔÌ·, ÁÂÁÔÓfi˜ Ô˘ ÂӉ¯Ô̤ӈ˜ Ô‰ËÁ› ÛÙËÓ ·˘ÍË̤ÓË ÚfiÛÏË„Ë ÙÚÔÊ‹˜ Î·È ÙË ‰È·Ù‹ÚËÛË Ù˘ ·¯˘Û·ÚΛ·˜8. ªÂÙ¿ ·fi ¤̂·ÛË Á·ÛÙÚÈ΋˜ ·Ú¿Î·Ì„˘, Ù· ›‰· ÁÎÚÂÏ›Ó˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙ·ıÂÚ¿ ÌÂȈ̤ӷ, ·Ú¿ ÙËÓ Â·ÎfiÏÔ˘ıË ·ÒÏÂÈ· ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜, Ì ۇÁ¯ÚÔÓË ‰È·Ù‹ÚËÛË ÙÔ˘ ËÌÂÚ‹ÛÈÔ˘ Ú˘ıÌÔ‡ ¤ÎÎÚÈÛ‹˜ Ù˘, Û ·ÓÙ›ıÂÛË Ì ÙËÓ ·ÒÏÂÈ· ‚¿ÚÔ˘˜ Ô˘ ·ÎÔÏÔ˘ı› ‰›·ÈÙ·, οÙÈ Ô˘ ÂӉ¯Ô̤ӈ˜ ÂÍËÁ› ÙË ÌÂÁ·Ï‡ÙÂÚË ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ¯ÂÈÚÔ˘ÚÁÈ΋˜ ÌÂıfi‰Ô˘ ÛÙË ÌË Â·Ó¿ÎÙËÛË ÙÔ˘ ·ˆÏÂÛı¤ÓÙÔ˜ ‚¿ÚÔ˘˜. ¶Èı·Ófi ·›ÙÈÔ ÙˆÓ ÌÂÈˆÌ¤ÓˆÓ ÂȤ‰ˆÓ ÁÎÚÂÏ›Ó˘, ÌÂÙ¿ ·fi ¤̂·ÛË Á·ÛÙÚÈ΋˜ ·Ú¿Î·Ì„˘, Â›Ó·È Ë ·ÒÏÂÈ· ÛËÌ·ÓÙÈÎÔ‡ ·ÚÈıÌÔ‡ Á·ÛÙÚÈÎÒÓ Î˘ÙÙ¿ÚˆÓ, Ô˘ ·Ú¿ÁÔ˘Ó ÙËÓ ÔÚÌfiÓË ·˘Ù‹9. ∏ ÂÓ‰ÔÊϤ‚È· ‹ Î·È ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ¯ÔÚ‹ÁËÛË ÁÏ˘Îfi˙˘ ÚÔηÏ› Ì›ˆÛË ÙˆÓ ÂȤ‰ˆÓ ÁÎÚÂÏ›Ó˘. ¶·ÚfiÌÔÈ· ›‰Ú·ÛË ·ÛΛ Î·È Ë ÈÓÛÔ˘Ï›ÓË. ∂Ô̤ӈ˜ ˘¿Ú¯ÂÈ Ì›· ÈÛ¯˘Ú‹ ·ÚÓËÙÈ΋ Û˘-
9
ATHIROSKLIROSI 9b 23-02-06 10:17 ™ÂÏ›‰·10
·ıËÚÔÛÎÏ‹ÚˆÛË MAƒ∆π√™
2006
Û¯¤ÙÈÛË ÌÂٷ͇ ÂȤ‰ˆÓ ÈÓÛÔ˘Ï›Ó˘ Î·È ¤ÎÎÚÈÛ˘ ÁÎÚÂÏ›Ó˘. ¢È·ÈÛÙÒıËΠ̛ˆÛË Ù˘ ÁÎÚÂÏ›Ó˘ ÌÂÙ¿ ·fi ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË ÈÓÛÔ˘Ï›Ó˘, ηٿ ÙÚfiÔ Èı·ÓÒ˜ ·ÓÂÍ¿ÚÙËÙÔ ·fi ÙË Ì›ˆÛË Ô˘ ÚÔηÏÂ›Ù·È ·fi ÙË ÁÏ˘Îfi˙Ë10. ∏ Ú‡ıÌÈÛË ¤ÎÎÚÈÛ˘ Ù˘ ÁÎÚÂÏ›Ó˘ ÂϤÁ¯ÂÙ·È Î·È ·fi ÔÚÌÔÓÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜. ∏ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ˘Ô‰Ô¯¤ˆÓ Ù˘ ۈ̷ÙÔÛÙ·Ù›Ó˘ ·Ó·ÛÙ¤ÏÏÂÈ ÙËÓ ·Ú·ÁˆÁ‹ Ù˘. ∏ ¯ÔÚ‹ÁËÛË ıÂڷ¢ÙÈ΋˜ ‰fiÛ˘ Ê˘ÛÈ΋˜ ۈ̷ÙÔÛÙ·Ù›Ó˘, ηıÒ˜ Î·È ÙÔ˘ Û˘ÓıÂÙÈÎÔ‡ Ù˘ ·Ó·ÏfiÁÔ˘, Ù˘ ÔÎÙÚÂÔÙ›‰Ë˜, ÚÔηÏ› ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÙˆÓ ÂȤ‰ˆÓ Ù˘ ÁÎÚÂÏ›Ó˘ ÛÙÔÓ ¿ÓıÚˆÔ Î·È Ì¿ÏÈÛÙ· ÌÂÁ·Ï‡ÙÂÚË ·fi ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË ÁÏ˘Îfi˙˘ ‹ ÈÓÛÔ˘Ï›Ó˘11. ∏ ÁÎÚÂÏ›ÓË, Ì ÙË ÛÂÈÚ¿ Ù˘, ·˘Í¿ÓÂÈ Ù· ΢ÎÏÔÊÔÚÔ‡ÓÙ· ›‰· Ù˘ ۈ̷ÙÔÛÙ·Ù›Ó˘. ÕÏϘ ÔÚÌfiÓ˜ Ô˘ ÂÌϤÎÔÓÙ·È ÛÙË Ú‡ıÌÈÛË ·Ú·ÁˆÁ‹˜ ÁÎÚÂÏ›Ó˘ Â›Ó·È ÙÔ Ó¢ÚÔÂÙ›‰ÈÔ PYY336, Ë Ô͢ÓÙÔÌÔÓÙÔ˘Ï›ÓË, Ë Ô˘ÚÔÎÔÚÙ›ÓË, ÔÈ ı˘ÚÂÔÂȉÈΤ˜ ÔÚÌfiÓ˜, ÔÈ ÁÔÓ·‰ÔÙÚÔ›Ó˜, Ë ÙÂÛÙÔÛÙÂÚfiÓË Î·È Ë ·˘ÍËÙÈ΋ ÔÚÌfiÓË12.
µÈÔÏÔÁÈΤ˜ ‰Ú¿ÛÂȘ Ù˘ ÁÎÚÂÏ›Ó˘ ∞˘ÍËÙÈ΋ ÔÚÌfiÓË ∏ ·˘ÍËÙÈ΋ ÔÚÌfiÓË (GH) Â›Ó·È Ì›· ·Ó·‚ÔÏÈ΋ ÔÚÌfiÓË, ··Ú·›ÙËÙË ÁÈ· ÙË Ê˘ÛÈÔÏÔÁÈ΋ ·Ó¿Ù˘ÍË ÙÔ˘ ·ÓıÚÒÈÓÔ˘ ÔÚÁ·ÓÈÛÌÔ‡, ÂÓÒ ¤¯ÂÈ Î·È ÛËÌ·ÓÙÈΤ˜ ÌÂÙ·‚ÔÏÈΤ˜ ÂȉڿÛÂȘ ηı’ fiÏË ÙË ‰È¿ÚÎÂÈ· Ù˘ ˙ˆ‹˜. ∏ ¤ÎÎÚÈÛ‹ Ù˘ ‚Ú›ÛÎÂÙ·È Î¿Ùˆ ·fi ÙÔ Ú˘ıÌÈÛÙÈÎfi ¤ÏÂÁ¯Ô ‰‡Ô ˘Ôı·Ï·ÌÈÎÒÓ ÔÚÌÔÓÒÓ, Ù˘ ۈ̷ÙÔÛÙ·Ù›Ó˘ Î·È Ù˘ ÂÎÏ˘ÙÈ΋˜ ÔÚÌfiÓ˘ Ù˘ GH (Growth Hormone Releasing Hormone-GHRH). ªÂ ÙËÓ ·Ó·Î¿Ï˘„Ë Ù˘ ÁÎÚÂÏ›Ó˘ ÚÔÙ›ÓÂÙ·È Ë ‡·ÚÍË ÂÓfi˜ ÚfiÛıÂÙÔ˘ Ó¢ÚÔÂÓ‰ÔÎÚÈÓÈÎÔ‡ ¿ÍÔÓ·, Ô˘ ˘ÂÈÛ¤Ú¯ÂÙ·È ÛÙË Ú‡ıÌÈÛË Ù˘ GH. ∏ ÁÎÚÂÏ›ÓË, fiˆ˜ Î·È ÔÈ GHS, ÚÔηÏÔ‡Ó Ì›· ÈÛ¯˘Ú‹ Î·È ‰ÔÛÔÂÍ·ÚÙÒÌÂÓË ·ÂÏ¢ı¤ÚˆÛË Ù˘ GH. ∏ ÁÎÚÂÏ›ÓË ÂÌÊ·Ó›˙ÂÈ Û˘ÓÂÚÁÈ΋ ‰Ú¿ÛË Ì ÙËÓ GHRH, Èı·Ófiٷٷ ̤ۈ ‰È·ÊÔÚÂÙÈÎÒÓ Ì˯·ÓÈÛÌÒÓ. ∆Ô Î‡Îψ̷ ·Ó·ÙÚÔÊÔ‰fiÙË-
10
Û˘ ÌÂٷ͇ ÁÎÚÂÏ›Ó˘ Î·È GH ‰ÂÓ ¤¯ÂÈ ·ÎfiÌË ‰È¢ÎÚÈÓÈÛÙ› Ï‹Úˆ˜. ∏ ˘ÂÚ- Î·È ˘Ô¤ÎÎÚÈÛË Ù˘ GH, ÛÙËÓ ·ÓÔÚÂÍ›· Î·È ÙËÓ ·¯˘Û·ÚΛ·, ·ÓÙ›ÛÙÔȯ·, Û˘Ó˘¿Ú¯Ô˘Ó Ì ˘„ËÏ¿ Î·È ¯·ÌËÏ¿ ›‰· ÁÎÚÂÏ›Ó˘, Ô˘ ˆ˜ ÁÓˆÛÙfi ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙȘ ηٷÛÙ¿ÛÂȘ ·˘Ù¤˜, ·ÓÙ›ÛÙÔȯ·. ∂Ô̤ӈ˜, Ê·›ÓÂÙ·È Ë ÔÚÌfiÓË ·˘Ù‹ ‰È·‰Ú·Ì·Ù›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ·¿ÓÙËÛË Ù˘ GH Û ηٷÛÙ¿ÛÂȘ ÓËÛÙ›·˜ Î·È ÂÓÂÚÁÂÈ·ÎÔ‡ ÂÚÈÔÚÈÛÌÔ‡13. °ÔÓ·‰ÔÙÚÔ›Ó˜ ∏ ÏÂÙ›ÓË, Ì›· ÔÚÌfiÓË Ô˘ ·Ó·Î·Ï‡ÊıËΠÙÔ 1994 Î·È ·Ú¿ÁÂÙ·È ·fi Ù· ·ÙÙ·Ú· ÙÔ˘ Ï¢ÎÔ‡ ÏÈÒ‰Ô˘˜ ÈÛÙÔ‡, Û˘ÌÌÂÙ¤¯ÂÈ ÛÙË Ú‡ıÌÈÛË Ù˘ ÚfiÛÏ˄˘ ÙÚÔÊ‹˜ ηıÒ˜ Î·È ÛÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ·Ó··Ú·ÁˆÁÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜. ∏ ÁÎÚÂÏ›ÓË ¤¯ÂÈ ·ÓÙ›ıÂÙÔ ÚfiÏÔ ·fi ÙË ÏÂÙ›ÓË ÛÙËÓ ÔÌÔÈfiÛÙ·ÛË ÙÔ˘ ‚¿ÚÔ˘˜ ÙÔ˘ ÛÒÌ·ÙÔ˜, Î·È Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ‰ÈÂÚÂ˘Ó¿Ù·È Ë ‰Ú¿ÛË Ù˘ ÛÙÔ ·Ó··Ú·ÁˆÁÈÎfi Û‡ÛÙËÌ·, ¯ˆÚ›˜ ˆÛÙfiÛÔ Ó· ¤¯ÂÈ ‰È¢ÎÚÈÓÈÛÙ› Ï‹Úˆ˜. À¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ ÁÈ· ‰ÈÏ‹ ‰Ú¿ÛË Ù˘ ÁÎÚÂÏ›Ó˘ ÛÙÔÓ ·Ó··Ú·ÁˆÁÈÎfi ¿ÍÔÓ·. ∂ÌÊ·Ó›˙ÂÈ Û˘ÛÙËÌ·ÙÈ΋ ‰Ú¿ÛË, Ô˘ ·ÛÎÂ›Ù·È ÛÙÔ Â›Â‰Ô ÙÔ˘ ˘Ôı·Ï·ÌÔ-˘ÔÊ˘ÛÈ·ÎÔ‡ÁÔÓ·‰ÈÎÔ‡ ¿ÍÔÓ·, ηıÒ˜ Î·È ÙÔÈ΋ ‰Ú¿ÛË ÙfiÛÔ ÛÙÔ˘˜ fiÚ¯ÂȘ fiÛÔ Î·È ÛÙȘ ˆÔı‹Î˜. ¶ÚfiÛÊ·Ù· ‰È·ÈÛÙÒıËΠfiÙÈ Ë ÁÎÚÂÏ›ÓË ·Ó·ÛÙ¤ÏÏÂÈ ÙËÓ ¤ÎÎÚÈÛË Ù˘ ˆ¯ÚÈÓÔÙÚfiÔ˘ ÔÚÌfiÓ˘ (Luteinizing Hormone-LH) in vivo Û ÂÈÚ·Ì·Ùfi˙ˆ·. ∏ ÁÎÚÂÏ›ÓË Âȉڿ ÛÙËÓ ¤ÎÎÚÈÛË Î·È ÙˆÓ ‰‡Ô ÁÔÓ·‰ÔÙÚÔÈÓÒÓ ÛÙËÓ ˘fiÊ˘ÛË, fï˜ Ë ·¿ÓÙËÛË ‰È·Ê¤ÚÂÈ, ‰ËÏ·‰‹ Ù˘ LH ·Ó·ÛÙ¤ÏÏÂÙ·È, ÂÓÒ Ù˘ ˆÔıËÏ·ÎÈÔÙÚfiÔ˘ ÔÚÌfiÓ˘ (Follicle Stimulating Hormone-FSH) ·˘Í¿ÓÂÙ·È14.
∫ÂÓÙÚÈΤ˜ ‰Ú¿ÛÂȘ Ù˘ ÁÎÚÂÏ›Ó˘ ƒ‡ıÌÈÛË ÚfiÛÏ˄˘ ÙÚÔÊ‹˜ ∏ ÁÎÚÂÏ›ÓË Â›Ó·È Ì›· Á·ÛÙÚÂÓÙÂÚÈ΋˜ ΢ڛˆ˜ ÚÔ¤Ï¢Û˘ ÔÚÌfiÓË, Ô˘ ‰È·‰Ú·Ì·Ù›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙÔ Â›Â‰Ô ÙÔ˘ ÂÁÎÂÊ·ÏÔÂÓÙÂÚÈÎÔ‡ ¿ÍÔÓ· (brain-gut axis). Œ¯ÂÈ ¯·Ú·ÎÙËÚÈÛı› ˆ˜ Ë "ÔÚÌfi-
ÓË Ù˘ fiÚÂ͢". ∏ ÔÚÂÍÈÔÁfiÓÔ˜ ‰Ú¿ÛË Ù˘ ÁÎÚÂÏ›Ó˘ Â›Ó·È ·ÓÂÍ¿ÚÙËÙË ·fi ÙËÓ ·ÂÏ¢ı¤ÚˆÛË Ù˘ GH, Î·È Ú·ÁÌ·ÙÔÔÈÂ›Ù·È Ì¤Ûˆ ÂȉÈÎÒÓ ÎÂÓÙÚÈÎÒÓ Ó¢ÚÒÓˆÓ, ÔÈ ÔÔ›ÔÈ Â›Û˘ ÂËÚ¿˙ÔÓÙ·È Î·È ·fi ÙË ÏÂÙ›ÓË. √È ‰‡Ô ·˘Ù¤˜ ÔÚÌfiÓ˜ Â›Ó·È Î˘Ú›ˆ˜ ˘Â‡ı˘Ó˜ ÁÈ· ÙË Ú‡ıÌÈÛË Ù˘ ÚfiÛÏ˄˘ ÙÚÔÊ‹˜ Î·È ÙË ‰È·Ù‹ÚËÛË ÙÔ˘ ÂÓÂÚÁÂÈ·ÎÔ‡ ÈÛÔ˙˘Á›Ô˘, ¤¯ÔÓÙ·˜ ·ÓÙ›ıÂÙË ‰Ú¿ÛË15. ∏ ÁÎÚÂÏ›ÓË ÂÎÎÚ›ÓÂÙ·È ·fi Ù· X/A like ·ÙÙ·Ú· ÙÔ˘ Ô͢ÓÙÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘ ÙÔ˘ ÛÙÔÌ¿¯Ô˘ Î·È ·fi ÂΛ ÂÚÓ¿ÂÈ ÛÙË Û˘ÛÙËÌ·ÙÈ΋ ΢ÎÏÔÊÔÚ›· Î·È Î·Ù¢ı‡ÓÂÙ·È ÚÔ˜ ÙÔÓ ˘Ôı¿Ï·ÌÔ. ™ÙÔÓ ˘Ôı¿Ï·ÌÔ, Î·È Û˘ÁÎÂÎÚÈ̤ӷ ÛÙÔÓ ÙÔÍÔÂȉ‹ ˘Ú‹Ó·, ˘¿Ú¯Ô˘Ó ÂȉÈÎÔ› Ó¢ÚÒÓ˜ Ô˘ ·Ú¿ÁÔ˘Ó ÙÔ Ó¢ÚÔÂÙ›‰ÈÔ Y (Neuropeptide Y-NPY) Î·È ÙËÓ ÚˆÙ½ÓË Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ÙÔ agouti (Agouti Related Protein-AgRP), ÙÔ˘˜ ÔÔ›Ô˘˜ Î·È ‰ÈÂÁ›ÚÂÈ Ë ÁÎÚÂÏ›ÓË. √È Ó¢ÚÒÓ˜ ·˘ÙÔ› ·ÔÙÂÏÔ‡Ó ÙÔ˘˜ ·ÚÈÔ˘˜ ˘Ôı·Ï·ÌÈÎÔ‡˜ ÛÙfi¯Ô˘˜ Ù˘ ÁÎÚÂÏ›Ó˘ Î·È Ë ‰È¤ÁÂÚÛ‹ ÙÔ˘˜ Ô‰ËÁ› Û ·˘ÍË̤ÓË ÚfiÛÏË„Ë ÙÚÔÊ‹˜. ∏ ¤ÎÎÚÈÛË Ù˘ ÁÎÚÂÏ›Ó˘ Á›ÓÂÙ·È Î·Ù¿ ÒÛÂȘ, fiˆ˜ ¿ÏψÛÙÂ Î·È Ù˘ ÏÂÙ›Ó˘. ∏ ÁÎÚÂÏ›ÓË ·ÓÙ·ÁˆÓ›˙ÂÙ·È ÙËÓ Î·Ù·ÛÙ·ÏÙÈ΋ ‰Ú¿ÛË Ù˘ ÏÂÙ›Ó˘ ÛÙÔ˘˜ NPY Î·È AgRP Ó¢ÚÒÓ˜ ÙÔ˘ ˘Ôı·Ï¿ÌÔ˘16. ∂ÎÙfi˜ ·fi ÙË ÁÎÚÂÏ›ÓË Î·È ÙËÓ ÏÂÙ›ÓË, ˘¿Ú¯Ô˘Ó ·ÚÎÂÙ¤˜ ·ÎfiÌË Á·ÛÙÚÂÓÙÂÚÈΤ˜ ÔÚÌfiÓ˜ Ô˘ ÂËÚ¿˙Ô˘Ó ÙËÓ ÚfiÛÏË„Ë ÙÚÔÊ‹˜, fiˆ˜ Ë ¯ÔÏÔ΢ÛÙÔÎÈÓ›ÓË (Cholecystokinin-CCK), Ë Ô͢ÓÙÔÌÔÓÙÔ˘Ï›ÓË, ÙÔ ÂÙ›‰ÈÔ YY3-36, Ë ·Ì˘Ï›ÓË, ÙÔ ÂÙ›‰ÈÔ Ô˘ ÌÔÈ¿˙ÂÈ Ì ÙÔ ÁÏԢηÁfiÓÔ (Glucagonlike Peptide, GLP-1), Ë ·ÔÏÈÔÚˆÙ½ÓË ∞-πV, Ë ÂÓÙÂÚÔÛÙ·Ù›ÓË Î·È Ë ÌÔÌÂÛ›ÓË. ∞ÍÈÔÛËÌ›ˆÙÔ Â›Ó·È fiÙÈ fiϘ ÔÈ ·Ú·¿Óˆ ÔÚÌfiÓ˜ ÂÏ·ÙÙÒÓÔ˘Ó ÙËÓ ÚfiÛÏË„Ë ÙÚÔÊ‹˜, ÂÎÙfi˜ ·fi ÙË ÁÎÚÂÏ›ÓË17.
¶ÂÚÈÊÂÚÈΤ˜ ÂÓ‰ÔÎÚÈÓÈΤ˜ Î·È ÌÂÙ·‚ÔÏÈΤ˜ ‰Ú¿ÛÂȘ Ù˘ ÁÎÚÂÏ›Ó˘ °ÎÚÂÏ›ÓË – ¿ÁÎÚ·˜ - ÏÈ҉˘ ÈÛÙfi˜ Î·È ‹·Ú ∏ ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ÁÎÚÂÏ›Ó˘ ‰ÂÓ ÂÚÈÔÚ›˙ÂÙ·È ÌfiÓÔ Û ÎÂÓÙÚÈÎfi ›‰Ô. ∏ ·Ó›¯Ó¢ÛË Ù˘ ÔÚÌfiÓ˘ Î·È ÙˆÓ ˘Ô‰Ô¯¤ˆÓ ÙˆÓ
ATHIROSKLIROSI 9b 23-02-06 10:17 ™ÂÏ›‰·11
¶∞£√ºÀ™π√§√°π∞ GHS (GHSR) Û ‰È¿ÊÔÚÔ˘˜ ÈÛÙÔ‡˜ Î·È fiÚÁ·Ó· ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡, ˘Ô‰ËÏÒÓÂÈ ÙËÓ ·Ú¿ÏÏËÏË ‰Ú¿ÛË Ù˘ ÛÙËÓ ÂÚÈʤÚÂÈ·, ̤ۈ ÂÓ‰ÔÎÚÈÓÈÎÒÓ Î·È ÌË Ì˯·ÓÈÛÌÒÓ. °ÎÚÂÏ›ÓË Î·È ˘Ô‰Ô¯Â›˜ ÙˆÓ GHS ˘¿Ú¯Ô˘Ó ÛÙÔ ¿ÁÎÚ·˜ ·ÓıÚÒˆÓ Î·È ˙ÒˆÓ. ™˘ÁÎÂÎÚÈ̤ӷ Ë ÔÚÌfiÓË ÂÎÊÚ¿˙ÂÙ·È ·fi ‰È¿ÊÔÚ· ·ÙÙ·Ú· Ù˘ ÂÓ‰ÔÎÚÈÓÔ‡˜ ÌÔ›Ú·˜ ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜, fiˆ˜ Ù· ·, Ù· ‚ Î·È Ù· ÌË-· ÌË-‚ ·ÙÙ·Ú·4. ªÂϤÙ˜ Ô˘ ¤ÁÈÓ·Ó Û ÂÈÚ·Ì·Ùfi˙ˆ· in vivo ¤‰ÂÈÍ·Ó ÙËÓ ÈηÓfiÙËÙ· Ù˘ ÁÎÚÂÏ›Ó˘ Ó· ·Ó·ÛÙ¤ÏÏÂÈ ÙËÓ ¤ÎÎÚÈÛË ÈÓÛÔ˘Ï›Ó˘ Ô˘ ÚÔηÏÂ›Ù·È ·fi ÙË ÁÏ˘Îfi˙Ë. ∞ÓÙ›ÛÙÔȯ˜ ÌÂϤÙ˜ ÛÙÔÓ ¿ÓıÚˆÔ ¤‰ÂÈÍ·Ó fiÙÈ Ë ¯ÔÚ‹ÁËÛË ÁÎÚÂÏ›Ó˘ ·Ó·ÛÙ¤ÏÏÂÈ ÙËÓ ¤ÎÎÚÈÛË ÈÓÛÔ˘Ï›Ó˘, ÚÔηÏÔ‡ÌÂÓË ·fi ÙËÓ ·ÚÁÈÓ›ÓË, ÂÓÒ ‰Â Ê¿ÓËΠӷ Âȉڿ ÛÙËÓ ·¿ÓÙËÛË Ù˘ ÈÓÛÔ˘Ï›Ó˘ ÛÙËÓ ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ¯ÔÚ‹ÁËÛË ÁÏ˘Îfi˙˘, ÛÙ· Ï·›ÛÈ· Ù˘ ‰ÔÎÈÌ·Û›·˜ ·ÓÔ¯‹˜ ÁÏ˘Îfi˙˘ (Oral Glucose Tolerance TestOGTT)18. ∂›Û˘, Ë ÁÎÚÂÏ›ÓË ÚÔηÏ› ·‡ÍËÛË Ù˘ ÁÏ˘Îfi˙˘ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜, Ô˘ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÔÊ›ÏÂÙ·È Û ‰È¤ÁÂÚÛË ÙÔ˘ ÁÏԢηÁfiÓÔ˘. ∏ ÁÏ˘Î·ÈÌÈ΋ ›‰Ú·ÛË Ù˘ ÁÎÚÂÏ›Ó˘ ÚÔηÏÂ›Ù·È Ì ‰‡Ô Ì˯·ÓÈÛÌÔ‡˜, ›Ù ¤ÌÌÂÛ·, ̤ۈ ÁÏ˘ÎÔÁÔÓfiÏ˘Û˘ ·fi ÙËÓ ·ÂÏ¢ı¤ÚˆÛË Î·Ù¯ÔÏ·ÌÈÓÒÓ, ›Ù ¿ÌÂÛ·, ÚÔ¿ÁÔÓÙ·˜ ÙËÓ ÁÏ˘ÎÔÓÂÔÁ¤ÓÂÛË ·fi Ù· Ë·ÙÔ·ÙÙ·Ú·. ∏ Ì›ˆÛË Ù˘ ÈÓÛÔ˘Ï›Ó˘ ı· ÌÔÚÔ‡Û ӷ ÂÍËÁËı› ·fi ÙËÓ ·‡ÍËÛË Ù˘ ΢ÎÏÔÊÔÚÔ‡Û·˜ ۈ̷ÙÔÛÙ·Ù›Ó˘, ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË ÁÎÚÂÏ›Ó˘. ∫·ıÒ˜ Ë ÈÓÛÔ˘Ï›ÓË Î·È Ë ÁÏ˘Îfi˙Ë ÂËÚ¿˙Ô˘Ó ·ÚÓËÙÈο ÙËÓ ¤ÎÎÚÈÛË ÁÎÚÂÏ›Ó˘, ˘ÔÛÙËÚ›˙ÂÙ·È Ë ‡·ÚÍË ÏÂÈÙÔ˘ÚÁÈ΋˜ Û‡Ó‰ÂÛ˘ ÙˆÓ ÌÔÚ›ˆÓ ·˘ÙÒÓ. ∂ÎÙfi˜ ·fi ÙÔ ÌÂÙ·‚ÔÏÈÛÌfi Ù˘ ÁÏ˘Îfi˙˘, Ë ÁÎÚÂÏ›ÓË Ê·›ÓÂÙ·È Ó· ˘ÂÈÛ¤Ú¯ÂÙ·È Û ÌÂÙ·‚ÔÏÈΤ˜ ‰ÈÂÚÁ·Û›Â˜ ÙÔ˘ ÏÈÒ‰Ô˘˜ ÈÛÙÔ‡. ¢ÈÂÁ›ÚÂÈ ÙË ÏÈÔÁ¤ÓÂÛË Û ‰È·ÊÔÚÔÔÈË̤ӷ ÏÈÔ·ÙÙ·Ú· in vitro, Î·È ·Ó·ÛÙ¤ÏÏÂÈ ÙË ÏÈÔÏ˘ÙÈ΋ ‰Ú¿ÛË ÙˆÓ ‚-·‰ÚÂÓÂÚÁÈÎÒÓ ·ÁˆÓÈÛÙÒÓ Û ÌË ‰È·ÊÔÚÔÔÈË̤ӷ ÏÈÔ·ÙÙ·Ú· ÂÈÚ·Ì·ÙÔ˙ÒˆÓ19. ™‡Ìʈӷ Ì ÙËÓ ˘¿Ú¯Ô˘Û· ‚È‚ÏÈÔÁÚ·Ê›·, ηٷ‰ÂÈÎÓ‡ÂÙ·È Ô ÛËÌ·ÓÙÈÎfi˜ ÚfiÏÔ˜ Ù˘ ÔÚÌfiÓ˘ ·˘Ù‹˜ ÛÙËÓ ÂÓ‰ÔÎÚÈÓÈ΋ Î·È ÌÂÙ·-
‚ÔÏÈ΋ Ú‡ıÌÈÛË Û ÂÚÈÊÂÚÈÎfi ϤÔÓ Â›Â‰Ô. øÛÙfiÛÔ, ˘¿Ú¯Ô˘Ó ·ÎfiÌË ÔÏÏ¿ ·Ó·¿ÓÙËÙ· ÂÚˆÙ‹Ì·Ù·. °ÎÚÂÏ›ÓË Î·È ÁÔÓ¿‰Â˜ ∞ӷʤÚıËΠ·Ú·¿Óˆ Ë Û˘ÛÙËÌ·ÙÈ΋ ‰Ú¿ÛË Ù˘ ÁÎÚÂÏ›Ó˘ ÛÙÔ Â›Â‰Ô ÙÔ˘ ˘Ôı·Ï·ÌÔ-˘ÔÊ˘ÛÈ·ÎÔ‡-ÁÔÓ·‰ÈÎÔ‡ ¿ÍÔÓ·. ªÂ ·ÓÔÛÔ˚ÛÙÔ¯ËÌÈΤ˜ ÌÂıfi‰Ô˘˜ ‰È·ÈÛÙÒıËÎÂ Ë ¤ÎÊÚ·ÛË Ù˘ ÁÎÚÂÏ›Ó˘ ÛÙ· ·ÙÙ·Ú· ÙÔ˘ Leydig ÛÙÔ˘˜ fiÚ¯ÂȘ, ÂÓÒ ˘Ô‰Ô¯Â›˜ ÙˆÓ GHS ‚Ú¤ıËÎ·Ó Î·È ÛÙ· ·ÙÙ·Ú· ÙÔ˘ Sertoli. ∏ ‰Ú¿ÛË Ù‹˜ ÙÔÈο ·Ú·ÁfiÌÂÓ˘ ÁÎÚÂÏ›Ó˘ ÂÚÈÏ·Ì-
‚¿ÓÂÈ ÙËÓ ·Ó·ÛÙÔÏ‹ ¤ÎÎÚÈÛ˘ ÙÂÛÙÔÛÙÂÚfiÓ˘ Î·È Ú‡ıÌÈÛË ¤ÎÊÚ·Û˘ ÙÔ˘ ÁÔÓȉ›Ô˘ ÙÔ˘ Stem cell factor (SCF). ∏ ÁÎÚÂÏ›ÓË Û˘ÁÎÂÎÚÈ̤ӷ ·Ó·ÛÙ¤ÏÏÂÈ ÙËÓ ¤ÎÊÚ·ÛË ÙÔ˘ SCF ·fi Ù· ·ÙÙ·Ú· ÙÔ˘ Sertoli. √ SCF ·ÛΛ ·Ú·ÎÚÈÓÈ΋ ‰Ú¿ÛË ÛÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ÛÂÚÌ·ÙÔ΢ÙÙ¿ÚˆÓ. ∂Ô̤ӈ˜, Ë ‰Ú¿ÛË Ù˘ ÁÎÚÂÏ›Ó˘ ÛÙÔÓ SCF ÂÓ¤¯ÂÙ·È ÛÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ Leydig Î·È ÛÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ÛÂÚÌ·ÙÔÁ¤ÓÂÛ˘. ¶·ÚfiÌÔÈ· ·Ú·ÎÚÈÓÈ΋ Ú‡ıÌÈÛË ·Ú·ÙËÚ‹ıËÎÂ Î·È ÛÙȘ ˆÔı‹Î˜14.
¶ÂÚÈÊÂÚÈΤ˜ ÌË ÂÓ‰ÔÎÚÈÓÈΤ˜ ‰Ú¿ÛÂȘ Ù˘ ÁÎÚÂÏ›Ó˘ ∫·Ú‰È·ÁÁÂȷΤ˜ Î·È ·ÈÌÔ‰˘Ó·ÌÈΤ˜ ‰Ú¿ÛÂȘ ¶ÚfiÛÊ·Ù˜ ¤Ú¢Ó˜ ÛÙÔÓ ÙÔ̤· Ù˘ Ó¢ÚÔÂÓ‰ÔÎÚÈÓÔÏÔÁ›·˜ ·ÔÎ¿Ï˘„·Ó ÙȘ ¢ÂÚÁÂÙÈΤ˜ ‰Ú¿ÛÂȘ Ù˘ ÁÎÚÂÏ›Ó˘ Î·È ÙˆÓ GHS ÛÙÔ Î·Ú‰È·ÁÁÂÈ·Îfi Û‡ÛÙËÌ·20. ªÂϤÙ˜ Û ÂÈÚ·Ì·Ùfi˙ˆ· ·¤‰ÂÈÍ·Ó ÙËÓ ·ÁÁÂÈԉȷÛÙ·ÏÙÈ΋ ‰Ú¿ÛË Ù˘ ÔÚÌfiÓ˘. ™ÙÔÓ ¿ÓıÚˆÔ, Ë ‰Ú¿ÛË ·˘Ù‹ ÌÂÏÂÙ‹ıËΠ̠ÙË Ì¤ıÔ‰Ô Ù˘ ÏËı˘ÛÌÔÁÚ·Ê›·˜ Û ˘ÁÈ›˜ ÂıÂÏÔÓÙ¤˜. ™˘ÁÎÂÎÚÈ̤ӷ ÌÂÏÂÙ‹ıËÎÂ Ë ÚÔ‹ ·›Ì·ÙÔ˜ ÛÙÔ ‚Ú·¯›ÔÓ· ÌÂÙ¿ ·fi ÂÓ‰·ÚÙËÚȷ΋ ¤Á¯˘ÛË ÁÎÚÂÏ›Ó˘. ¢È·ÈÛÙÒıËΠ·‡ÍËÛË Ù˘ ÚÔ‹˜ ·›Ì·ÙÔ˜, ηıÒ˜ ›Û˘ Î·È Ì›ˆÛË Ù˘ ̤Û˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘. √È ÂÚ¢ÓËÙ¤˜ η٤ÏËÍ·Ó fiÙÈ Ë ÁÎÚÂÏ›ÓË Â›Ó·È ¤Ó·˜ ·ÓÂÍ¿ÚÙËÙÔ˜ ·fi ÙÔ ÂÓ‰Ôı‹ÏÈÔ ·ÁÁÂÈԉȷÛÙ·ÏÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜, Î·È fiÙÈ Ë ‰Ú¿ÛË Ù˘ ·ÓÙ·ÁˆÓ›˙ÂÙ·È ·˘Ù‹Ó Ù˘ ÂÓ‰ÔıËÏ›Ó˘1. ™Â ·ÛıÂÓ›˜ ÌÂ Û˘ÌÊÔÚËÙÈ΋ ηډȷ΋ ·Ó¿ÚÎÂÈ·, Ë ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË ÁÎÚÂÏ›Ó˘ Ì›ˆÛ ÙË Ì¤ÛË ·ÚÙËÚȷ΋ ›ÂÛË Î·È ·‡ÍËÛ ÙÔÓ Î·Ú‰È·Îfi ‰Â›ÎÙË, ÂÓÒ Ë ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· ‰ÂÓ ÂËÚ¿ÛÙËÎÂ. ∏ ·‡ÍËÛË Ù˘ ηډȷ΋˜ ·ÚÔ¯‹˜ ›Ûˆ˜ Ó· ÔÊ›ÏÂÙ·È ÛÙËÓ ÂÏ¿ÙÙˆÛË ÙÔ˘ ÌÂÙ·ÊÔÚÙ›Ô˘ Î·È ÛÙËÓ ÈÓfiÙÚÔË ‰Ú¿ÛË Ù˘ ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘21. ∂ÎÙfi˜ ·fi ÙËÓ ¿ÌÂÛË ·ÁÁÂÈԉȷÛÙ·ÏÙÈ΋ ‰Ú¿ÛË Ù˘ ÁÎÚÂÏ›Ó˘, ‰È·ÈÛÙÒıËÎÂ Î·È Ì›· ¤ÌÌÂÛË Â˘ÓÔ˚΋ ‰Ú¿ÛË Ù˘ ÛÙËÓ Î·Ú‰È·Î‹ ÏÂÈÙÔ˘ÚÁ›·, ÂÍ·ÚÙÒÌÂÓË ·fi ÙËÓ GH Î·È ÙÔÓ IGF-1. √ ÈÓÛÔ˘ÏÈÓfiÌÔÚÊÔ˜ ·˘ÍËÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜(Insulin-like Growth Factor, IGF-1) ÚÔηÏ› ·ÁÁÂÈԉȷÛÙÔÏ‹ ̤ۈ ÂÓÂÚÁÔÔ›ËÛ˘ Ù˘ Û‡ÓıÂÛ˘ ÙÔ˘ ÌÔÓÔÍÂȉ›Ô˘ ÙÔ˘ ·˙ÒÙÔ˘ (NO). ∆· ›‰· Ù˘ ÁÎÚÂÏ›Ó˘ ‚Ú¤ıËÎ·Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚ· Û ·ÛıÂÓ›˜ ÌÂ Û˘ÌÊÔÚËÙÈ΋ ηډȷ΋ ·Ó¿ÚÎÂÈ· Î·È Û˘ÓÔ‰fi η¯ÂÍ›·, Û˘ÁÎÚÈÓfiÌÂÓ· Ì ·˘Ù¿ ÙˆÓ ·ÛıÂÓÒÓ ¯ˆÚ›˜ η¯ÂÍ›·. ø˜ ÁÓˆÛÙfi, Ë ÁÎÚÂÏ›ÓË Û˘Û¯ÂÙ›˙ÂÙ·È ·ÚÓËÙÈο Ì ÙÔ ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜. ∂Ô̤ӈ˜, Û ηٷÛÙ¿ÛÂȘ η¯ÂÍ›·˜, ηډȷ΋˜ ‹ ÌË ·ÈÙÈÔÏÔÁ›·˜, ·Ú·ÙËÚÂ›Ù·È ·˘ÍË̤ÓË ¤ÎÎÚÈÛË ÁÎÚÂÏ›Ó˘, Ë ÔÔ›· ÌÂ
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ATHIROSKLIROSI 9b 23-02-06 10:17 ™ÂÏ›‰·12
·ıËÚÔÛÎÏ‹ÚˆÛË MAƒ∆π√™
2006
ÙË ÛÂÈÚ¿ Ù˘ ‰ÈÂÁ›ÚÂÈ ÙËÓ ·ÂÏ¢ı¤ÚˆÛË Ù˘ GH, Ô˘ ˆ˜ ÁÓˆÛÙfi ¤¯ÂÈ ·Ó·‚ÔÏÈ΋ ‰Ú¿ÛË22.
™˘ÌÂÚ¿ÛÌ·Ù· Î·È Èı·Ó¤˜ ÎÏÈÓÈΤ˜ ÂÊ·ÚÌÔÁ¤˜ ∏ ÚfiÛÊ·ÙË ·Ó·Î¿Ï˘„Ë Ù˘ ÁÎÚÂÏ›Ó˘ Ô‰‹ÁËÛ Û ÂӉȷʤÚÔÓÙ· ÛÙÔȯ›· ·Ó·ÊÔÚÈο Ì ÙÔ˘˜ Ì˯·ÓÈÛÌÔ‡˜ ÚfiÛÏ˄˘ Ù˘ ÙÚÔÊ‹˜. ∏ ÁÎÚÂÏ›ÓË ¤¯ÂÈ ÔÓÔÌ·Ûı› ·fi ÔÏÏÔ‡˜ ˆ˜ "Ë ÔÚÌfi-
ÓË Ù˘ fiÚÂ͢". ∏ ÔÚÂÍÈÔÁfiÓÔ˜ ‰Ú¿ÛË Ù˘ ηıÈÛÙ¿ Èı·Ó‹ ÙË ¯ÔÚ‹ÁËÛË ·ÓÙ·ÁˆÓÈÛÙÒÓ Ù˘ ˆ˜ Ê·ÚÌ¿ÎˆÓ Î·Ù¿ Ù˘ ·¯˘Û·ÚΛ·˜. ∆Ô ı¤Ì· ‚¤‚·È· ‰ÂÓ Â›Ó·È ÙfiÛÔ ·Ïfi, ·Ó ÏËÊı› ˘fi„Ë Ë ÔÈΛÏË ‰Ú¿ÛË Ù˘. ∂›Ó·È ÈÛ¯˘Úfi˜ ‰ÈÂÁ¤ÚÙ˘ ¤ÎÎÚÈÛ˘ Ù˘ ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ Î·È ¤¯ÂÈ Â˘ÓÔ˚΋ ›‰Ú·ÛË ÛÙÔ Î·Ú‰È·ÁÁÂÈ·Îfi Û‡ÛÙËÌ·. ∂Ô̤ӈ˜, Ë ¯ÔÚ‹ÁËÛË ·ÓÙ·ÁˆÓÈÛÙÒÓ Ù˘ ı· ¤¯ÂÈ ÛËÌ·ÓÙÈΤ˜ ·ÚÓËÙÈΤ˜ ÂÈÙÒÛÂȘ ÛÙÔÓ ÔÚÁ·ÓÈÛÌfi. £· ÌÔÚÔ‡Û ˆÛÙfiÛÔ Ó· ¯ÔÚËÁËı› ÁÈ· ÙË ıÂڷ›· Ù˘
Û˘ÌÊÔÚËÙÈ΋˜ ηډȷ΋˜ ·Ó¿ÚÎÂÈ·˜, Ù˘ ‰È·Ù·ÙÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜ ηıÒ˜ Î·È Û ÂÚÈÙÒÛÂȘ ¤ÏÏÂȄ˘ ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘. À¿Ú¯Ô˘Ó ˆÛÙfiÛÔ ·ÚÎÂÙ¿ ÛËÌ›· ÛÙÔ˘˜ Ì˯·ÓÈÛÌÔ‡˜ ‰Ú¿Û˘ Ù˘ ÔÚÌfiÓ˘ ·˘Ù‹˜, Ô˘ ‰ÂÓ ¤¯Ô˘Ó ‰È¢ÎÚÈÓÈÛÙ› Ï‹Úˆ˜. ∏ ‰ÈÂÚ‡ÓËÛË ÙˆÓ Û‡ÓıÂÙˆÓ ·ıÔÊ˘ÛÈÔÏÔÁÈÎÒÓ ‰ÈÂÚÁ·ÛÈÒÓ, ÛÙȘ Ôԛ˜ ˘ÂÈÛ¤Ú¯ÂÙ·È Ë ÁÎÚÂÏ›ÓË, Èı·Ófi Ó· Ô‰ËÁ‹ÛÂÈ Û ÛËÌ·ÓÙÈΤ˜ ‰È·ÁÓˆÛÙÈΤ˜ Î·È ıÂڷ¢ÙÈΤ˜ ÌÂıfi‰Ô˘˜.
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10. Flanagan D, Evans MI, Monsod TP, Rife F, Heptulla Ra, Tamborlane WV. The influence of insulin on circulating ghrelin. Am J Physiol 2003; 284: E313-E316. 11. Broglio F, Koetsvelt PP, Benso A et al. Ghrelin secretion is inhibited by either somatostatin or cortistatin in humans. J Clin Endocrinol Metab 2002c; 87: 48294832. 12. Batterham RL, Cohen MA, Ellis SM et al. Inhibition of food intake in obese subjects by peptide YY3-36. N Engl J Med 2003; 349: 941-948. 13. Ghigo E, Broglio F, Arvat M, Maccario M, Papotti M, Muccioli G. Ghrelin more than a natural GH secretagogue and/or an orexigenic factor. Clin Endocrinol 2005; 62: 1-17. 14. Barreiro ML, Tena-Sempere M. Ghrelin and reproduction: a novel signal linking energy status and fertility. Mol Cell Endocrinol 2004; 226: 1-9. 15. Williams J, Mobarhan S. A critical interaction: leptin and ghrelin. Nutr Rev 2003; 61: 391-393.
17. Strader AD, Woods SC Gastrointestinal hormones and food intake. Gastroenterology 2005; 128: 175-191. 18. Broglio F, Gottero C, Benso A et al. Effects of ghrelin on the insulin and glycemic responses to glucose, arginine or fatty acids load in humans. J Clin Endocrinol Metab 2003b; 88: 4268-4272. 19. Choi K, Roh SG, Hong YH. et al. The role of ghrelin and growth hormone secretagogues receptor on rat adipogenesis. Endocrinology 2003; 144: 754759. 20. Nagaya N, Kangawa K. Ghrelin improves left ventricular dysfunction and cardiac cachexia in heart failure. Curr Opin Pharmacol 2003; 3: 146-151. 21. Nagaya N, Miyatake K, Uematsu M et al. Hemodynamic, renal and hormonal effects of ghrelin infusion in patients with chronic heart failure. J Clin Endocrinol Metab 2001; 86: 5854-5859. 22. Boger RH, Skamira C, Bode-Boger SM, Brabant G, von zur Muhlen A, Frolich JC. Nitric oxide may mediate the hemodynamic effects of recombinant growth hormone in patients with acquired growth hormone deficiency: a doubleblind, placebo controlled study. J Clin Invest 1996; 98: 2706-2713.
ATHIROSKLIROSI 9b 23-02-06 10:17 ™ÂÏ›‰·13
¶∞£√ºÀ™π√§√°π∞
™Ù¿‰È· Î·È ¶·Ú¿ÁÔÓÙ˜ Ô˘ ∂˘ÓÔÔ‡Ó ÙÔ ™¯ËÌ·ÙÈÛÌfi Ù˘ ∞ıËڈ̷ÙÈ΋˜ ¶Ï¿Î·˜ °ÂÓÔ‚¤Ê· ∫ÔÏÔ‚Ô‡, ÀԉȢı‡ÓÙÚÈ· ∞’ ∫·Ú‰ÈÔÏÔÁÈ΋˜ ∫ÏÈÓÈ΋˜, À‡ı˘ÓË §ÈȉȷÈÌÈÎÔ‡ π·ÙÚ›Ԣ, øÓ¿ÛÂÈÔ ∫·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈÎfi ∫¤ÓÙÚÔ µ·ÛÈÏÈ΋ °È·ÓÓ·ÎÔÔ‡ÏÔ˘, ∂ÈÌÂÏ‹ÙÚÈ· µ’ ∫·Ú‰ÈÔÏÔÁÈ΋˜, ∫ÏÈÓÈ΋˜ £ÚÈ¿ÛÈÔ ¡ÔÛÔÎÔÌÂ›Ô ™˘ÓÂÚÁ¿Ù˘ §ÈȉȷÈÌÈÎÔ‡ π·ÙÚ›Ԣ, øÓ¿ÛÂÈÔ ∫·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈÎfi ∫¤ÓÙÚÔ
∂ÈÛ·ÁˆÁ‹ ∏ ·ıËڈ̿وÛË ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÁÁ›ˆÓ Â›Ó·È Ë Û˘¯ÓfiÙÂÚË ·ÈÙ›· Ù˘ ÈÛ¯·ÈÌÈ΋˜ ηډÈÔ¿ıÂÈ·˜. √È ÛËÌÂÚÈÓ¤˜ ÌÂϤÙ˜ ÂÈÎÂÓÙÚÒÓÔÓÙ·È ÛÙËÓ ·ıËڈ̷ÙÈ΋ Ͽη Î·È ÙËÓ Î·Ù·ÔϤÌËÛ‹ Ù˘. Œ¯Ô˘Ó ÂÚÈÁÚ·Ê› ¿Óˆ ·fi 200 ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Ô˘ Ô‰ËÁÔ‡Ó ÛÙÔÓ ÚfiˆÚÔ Û¯ËÌ·ÙÈÛÌfi Ù˘ ·ıËڈ̷ÙÈ΋˜ Ͽη˜. √È ÈÔ Î·Ï¿ ÌÂÏÂÙË̤ÓÔÈ ·Ú¿ÁÔÓÙ˜ ›ӷÈ: Ë ·˘ÍË̤ÓË Û˘ÁΤÓÙÚˆÛË ÛÙÔ Ï¿ÛÌ· Ù˘ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ Ô˘ ÂÚȤ¯ÂÙ·È ÛÙË ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙ½ÓË (LDL-C; low density lipoproteincholesterol), ÙÔ Î¿ÓÈÛÌ·, Ô Û·Î¯·Ú҉˘ ‰È·‚‹Ù˘, Ë ·ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË, Ë ˘ÂÚÔÌÔ΢ÛÙÂ˚Ó·ÈÌ›· 1-3. ∞fi Ù· ÈÔ ÛËÌ·ÓÙÈο Â˘Ú‹Ì·Ù· ‹Ù·Ó Ë ·Ó·Î¿Ï˘„Ë Ù˘ ›‰Ú·Û˘ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ Û ‰È¿ÊÔÚ· ̤ÚË ÙÔ˘ ·ÁÁÂÈ·ÎÔ‡ ÙÔȯÒÌ·ÙÔ˜, Ë ÔÔ›· ¤¯ÂÈ ·ÏÏ¿ÍÂÈ ÙȘ ·fi„ÂȘ Ì·˜ ÁÈ· ÙÔ ÚfiÏÔ Ù˘ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜ ÛÙËÓ ·ıÔÁ¤ÓÂÛË Ù˘ ·ıËÚÔÛÎÏ‹ÚˆÛ˘ 4-10. ª¤¯ÚÈ ÚfiÛÊ·Ù· ‚Ϥ·Ì ÙÔ Ê·ÈÓfiÌÂÓÔ Ù˘ ·ıËÚÔÛÎÏ‹ÚˆÛ˘ ΢ڛˆ˜ ·fi ÙËÓ ÏÂ˘Ú¿ Ù˘ Ì˯·ÓÈ΋˜ ‰È·Ù·Ú·¯‹˜ Ô˘ ÚÔηÏÔ‡Ó ÔÈ ·ıËڈ̷ÙÈΤ˜ ϿΘ. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ 70, ÔÈ Ross Î·È Glomset 11 ˘ÔÛÙ‹ÚÈÍ·Ó ÁÈ· ÚÒÙË ÊÔÚ¿ ÙËÓ ˘fiıÂÛË «·¿ÓÙËÛË Û ÙÚ·‡Ì·». ™‡Ìʈӷ Ì ÙËÓ ˘fiıÂÛË ·˘Ù‹, ÔÈ ·ıËڈ̷ÙÈΤ˜ ·ÏÏÔÈÒÛÂȘ ·ÓÙÈηÙÔÙÚ›˙Ô˘Ó Ì›· ¯ÚfiÓÈ· ÌÔÚÊ‹ ÊÏÂÁÌÔÓÒ‰Ô˘˜-ÈÓˆ‰Ô·Ú·ÁˆÁÈ΋˜ ·¿ÓÙËÛ˘ ÙÔ˘ ·ÚÙËÚÈ·ÎÔ‡ ÙÔȯÒÌ·ÙÔ˜ ÛÙ· ‰È¿ÊÔÚ· ÙÚ·‡Ì·Ù·. ¶ÚfiÎÂÈÙ·È ÁÈ· ·ÓÙÈÚÚÔÈÛÙÈÎfi Ì˯·ÓÈÛÌfi ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡, Ô ÔÔ›Ô˜ Û ˘ÂÚ‚ÔÏ‹ Ô‰ËÁ› ÛÙËÓ ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘ 12. ∏ ¯ÔÏËÛÙÂÚfiÏË
·ÔÙÂÏ› ÙÔ ÚˆÙ·Ú¯ÈÎfi ‰ÔÌÈÎfi Û˘ÛÙ·ÙÈÎfi ÙˆÓ Ï·ÎÒÓ. ∆˘¯fiÓ ÙÚ·˘Ì·ÙÈÛÌfi˜ ÙˆÓ ·ÁÁ›ˆÓ, ÂÈÛ‡‰ÂÈ ÙË ‰È›ۉ˘ÛË ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ, Ì ·ÔÙ¤ÏÂÛÌ· ÙË Û˘ÛÛÒÚ¢ÛË Î·È ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ ÛÙËÓ ÂÎÙÂıÂÈ̤ÓË ·fi ÙÔÓ ÙÚ·˘Ì·ÙÈÛÌfi ÂÚÈÔ¯‹ 11.
∏ ›‰Ú·ÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÛÙËÓ ·ıËÚÔÁ¤ÓÂÛË ∏ ·Ó¿Ù˘ÍË Ù˘ ·ıËڈ̿وÛ˘ Ê·›ÓÂÙ·È Ó· ÚÔ¿ÁÂÙ·È ·fi ·Ú¿ÁÔÓÙ˜ fiˆ˜: ˘„ËÏ¿ ›‰· ÙˆÓ LDL, IDL Î·È VLDL, ¯·ÌËÏ¿ ›‰· ∏DL, ·ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË, ۷ί·Ú҉˘ ‰È·‚‹Ù˘, οÓÈÛÌ·, ·¯˘Û·ÚΛ·, „˘¯ÔÎÔÈÓˆÓÈÎÔ› ·Ú¿ÁÔÓÙ˜, ÏÔÈÌÒÍÂȘ ÎÏ. √ ·ÎÚÈ‚‹˜ Ì˯·ÓÈÛÌfi˜ Ô˘ ÂÈÙ·¯‡ÓÂÈ ÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË ‰ÂÓ Â›Ó·È ÁÓˆÛÙfi˜, ·Ó Î·È ÔÏϤ˜ ˘Ôı¤ÛÂȘ ¤¯Ô˘Ó Á›ÓÂÈ. À„ËÏ¿ ›‰· .¯. ÙˆÓ LDL, IDL Î·È VLDL ÛÙËÓ Î˘ÎÏÔÊÔÚ›·, ¤¯ÂÈ ˘ÔÛÙËÚȯı› fiÙÈ Ô‰ËÁÔ‡Ó Û ‰È›ۉ˘Û‹ ÙÔ˘˜ Û ˘„ËÏfi ÔÛÔÛÙfi ÛÙ· ·ÚÙËÚȷο ÙÔȯÒÌ·Ù· Ì ·ÔÙ¤ÏÂÛÌ· ÙÔ Û¯ËÌ·ÙÈÛÌfi ·ÊÚˆ‰ÒÓ Î˘ÙÙ¿ÚˆÓ. ÷ÌËÏ¿ ›‰· Ù˘ HDL ÛÙËÓ Î˘ÎÏÔÊÔÚ›· ‰ÂÓ ÂÈÙÚ¤Ô˘Ó ÙË ÌÂÙ·ÊÔÚ¿ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ·fi Ù· ·ÙÙ·Ú· ÛÙÔ ‹·Ú. ∏ ˘¤ÚÙ·ÛË Èı·ÓfiÓ ·˘Í¿ÓÂÈ ÙË ‰È›ۉ˘ÛË ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ ÛÙ· ·ÚÙËÚȷο ÙÔȯÒÌ·Ù·, ÏfiÁˆ ·˘ÍË̤Ó˘ Ù·¯‡ÙËÙ·˜ ÚÔ‹˜ ÙÔ˘ ·›Ì·ÙÔ˜, ÚÔηÏÒÓÙ·˜ ÙÚ·˘Ì·ÙÈÛÌfi ÙÔ˘ ÂÓ‰ÔıËÏ›Ô˘ 17. µÏ¿‚˜ ÙÔ˘ ÂÓ‰ÔıËÏ›Ô˘ ÌÔÚÔ‡Ó Ó· ÚÔÎÏËıÔ‡Ó Î·È ·fi ÙÔÍÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ fiˆ˜ Ë ÓÈÎÔÙ›ÓË 14. ¶ÚfiÛÊ·Ù˜ ¤Ú¢Ó˜ ÚÔÛ·Ó·ÙÔÏ›˙ÔÓÙ·È ÛÙË ‰ÈÂÚ‡ÓËÛË ÙÔ˘ ÚfiÏÔ˘ ‰È·ÊfiÚˆÓ ÏÔÈÌÒÍÂˆÓ ÛÙËÓ ·ıÔÁ¤ÓÂÛË Ù˘ ·ıËÚÔÛÎÏ‹ÚˆÛ˘ 15-21. ∞ÍÈÔÛËÌ›ˆÙË Â›Ó·È Î·È Ë
›‰Ú·ÛË ÙˆÓ „˘¯ÔÎÔÈÓˆÓÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÛÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ·ıËÚÔÛÎÏ‹ÚˆÛ˘ 22. √ ۷ί·Ú҉˘ ‰È·‚‹Ù˘ Ù¤ÏÔ˜ Ê·›ÓÂÙ·È Ó· Ô‰ËÁ› ÛÙËÓ ·Ó¿Ù˘ÍË Ù˘ ·ıËÚÔÛÎÏ‹ÚˆÛ˘ ̤ۈ ‰˘ÛÏÈȉ·ÈÌ›·˜, ‰ËÏ·‰‹ ·‡ÍËÛ˘ ÙˆÓ VLDL Î·È Ì›ˆÛ˘ ÙˆÓ HDL 23. ∏ ·ıÔÏÔÁÈ΋ ηٿÛÙ·ÛË Ô˘ Ô‰ËÁ› ÛÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË Â›Ó·È Î·Ù¿ ‚¿ÛË Ë ‰È›ۉ˘ÛË ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ ÛÙ· ÙÔȯÒÌ·Ù· ÙˆÓ ·ÁÁ›ˆÓ Î·È Ô Û¯ËÌ·ÙÈÛÌfi˜ ÙˆÓ ·ÊÚˆ‰ÒÓ Î˘ÙÙ¿ÚˆÓ 25 Ù· ÔÔ›· Ì·˙› Ì ٷ ·ÈÌÔÂÙ¿ÏÈ· ÂÎÎÚ›ÓÔ˘Ó ·˘ÍËÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ (growth factors) Ô˘ ·˘Í¿ÓÔ˘Ó ÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙˆÓ Ï›ˆÓ Ì˘˚ÎÒÓ Î˘ÙÙ¿ÚˆÓ. ∏ ˘ÂÚÛ˘ÁΤÓÙÚˆÛË ÏÈÒÓ Ì¤Û· ÛÙ· ·ÊÚÒ‰Ë Î‡ÙÙ·Ú· Ô‰ËÁ› Û ӤÎÚˆÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ ·˘ÙÒÓ Î·È ·ÂÏ¢ı¤ÚˆÛË Ù˘ ÂÛÙÂÚÔÔÈË̤Ó˘ ¯ÔÏËÛÙÂÚfiÏ˘ Ë ÔÔ›· Û¯ËÌ·Ù›˙ÂÈ, Ì·˙› Ì Ï›· Ì˘˚ο ·ÙÙ·Ú· Î·È ÈÓÒ‰Ë ÈÛÙfi, ¤Ó· ÏÈÒ‰Ë ˘Ú‹Ó·. ªÂ ‚¿ÛË ·˘ÙfiÓ ÙÔÓ ˘Ú‹Ó· Û¯ËÌ·Ù›˙ÔÓÙ·È Ï¿Î˜ Ô˘ ÌÔÚÔ‡Ó Ó· ÂÈÏ·ÎÔ‡Ó Ì ·ÈÌÔÚÚ·Á›·, ıÚfiÌ‚ˆÛË Î·È Ó· ÚÔηϤÛÔ˘Ó ·fiÊÚ·ÍË ÙˆÓ ·ÁÁ›ˆÓ. ∆· ÌfiÚÈ· ÙˆÓ LDL Ô˘ ΢ÎÏÔÊÔÚÔ‡Ó ÛÙÔ Ï¿ÛÌ· ‰ÈÂÈÛ‰‡Ô˘Ó ÛÙÔ ÂÓ‰Ôı‹ÏÈÔ ÙÔ˘ ·ÚÙËÚÈ·ÎÔ‡ ÙÔȯÒÌ·ÙÔ˜ Î·È ÂÈÛ¤Ú¯ÔÓÙ·È ÛÙÔÓ ¤Ûˆ ¯ÈÙÒÓ· Ù˘ ·ÚÙËÚ›·˜.. ª¤Ûˆ ÙˆÓ ÙÚȯÔÂȉÒÓ ·ÔÌ·ÎÚ‡ÓÔÓÙ·È Î·È ‰ÈÔ¯ÂÙ‡ÔÓÙ·È ÛÙÔ˘˜ ÈÛÙÔ‡˜. ŸÙ·Ó ˘¿Ú¯Ô˘Ó ÔÏϤ˜ LDL ÌÂÚÈΤ˜ ·Áȉ‡ÔÓÙ·È ÛÙÔÓ ¤Ûˆ ¯ÈÙÒÓ·, ·ÏÏËÏÂȉÚÔ‡Ó ÌÂ Û˘ÛÙ·ÙÈο ÙÔ˘ Î·È ˘Ê›ÛÙ·ÓÙ·È ‰‡Ô ÌÂÙ·ÙÚÔ¤˜: 1. √Í›‰ˆÛË Ù˘ ·ÔÏÈÔÚˆÙ½Ó˘ µ-100. 2. ¶ÚÔÛÎfiÏÏËÛË ÛÙËÓ ·ÔÏÈÔÚˆÙ½ÓË µ-π00 Ù˘ Ì·ÏÔÓ·Ï‰Â˛‰Ë˜ Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÙÚÔÔÔ›ËÛË Ù˘ ·ÔÏÈÔ-
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ATHIROSKLIROSI 9b 23-02-06 10:17 ™ÂÏ›‰·14
·ıËÚÔÛÎÏ‹ÚˆÛË MAƒ∆π√™
2006
ÚˆÙ½Ó˘ µ-π00. √È LDL Â›Ó·È Ï¤ÔÓ ¤ÙÔÈ̘ ÁÈ· Ó· Ê·ÁÔ΢ÙÙˆıÔ‡Ó ·fi Ù· Ì·ÎÚÔÊ¿Á·. ∆· Ì·ÎÚÔÊ¿Á· ‰È·ı¤ÙÔ˘Ó ˘Ô‰Ô¯Â›˜ ÁÈ· ÙË ÌÂÙ·ÏÏ·Á̤ÓË LDL Ë ÔÔ›· ÂÈÛ¤Ú¯ÂÙ·È ÛÙÔ Î‡ÙÙ·ÚÔ ·ÓÂͤÏÂÁÎÙ·, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ˘ÂÚ‚ÔÏÈ΋ ·‡ÍËÛË Ù˘ Û˘ÁΤÓÙÚˆÛ˘ Ù˘ ÂÛÙÂÚÔÔÈË̤Ó˘ ¯ÔÏËÛÙÂÚfiÏ˘. ∆· ·ÙÙ·Ú· ·ÔÎÙÔ‡Ó Ï¤ÔÓ ·ÊÚÒ‰Ë ÂÌÊ¿ÓÈÛË ÛÙËÓ ÔÔ›· ÔÊ›ÏÔ˘Ó ÙËÓ ÔÓÔÌ·Û›· ÙÔ˘˜, ·ÊÚÒ‰Ë Î‡ÙÙ·Ú· (foam cells)
™Ù¿‰È· Ù˘ ·ıËÚÔÛÎÏ‹ÚˆÛ˘ ∏ ·ıËÚÔÛÎÏ‹ÚˆÛË ÂÚÈÏ·Ì‚¿ÓÂÈ 3 ÛÙ¿‰È·: 1. ∆Ô ÛÙ¿‰ÈÔ Û¯ËÌ·ÙÈÛÌÔ‡ ÏȈ‰ÒÓ ÁÚ·ÌÌÒÛÂˆÓ (fatty streaks) 24. 2. ∆Ô ÛÙ¿‰ÈÔ Û¯ËÌ·ÙÈÛÌÔ‡ ·ıËڈ̷ÙÈ΋˜ Ͽη˜, Î·È 3. ∆Ô ÛÙ¿‰ÈÔ Ù˘ ÂÈÏÂÁ̤Ó˘ ‚Ï¿‚˘ 25-26. ∆·ÍÈÓfiÌËÛË Ï·ÎÒÓ
ÙˆÓ ·ıËڈ̷ÙÈÎÒÓ
∞. ∞ÛÙ·ı‹˜ µ. ∂ÏÎ҉˘ °. ™Ù·ıÂÚ‹ °È· ÙËÓ ÚfiÎÏËÛË ÙˆÓ ÔͤˆÓ ηډȷÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ ˘Â‡ı˘ÓË Â›Ó·È Ë ·ÛÙ·ı‹˜ Ͽη.
ŒÙÛÈ, ÎÏÈÓÈ΋ ÛËÌ·Û›· ¤¯ÂÈ Ô ÂÓÙÔÈÛÌfi˜ Î·È Ë ıÂڷ›· ·˘ÙÔ‡ ÙÔ˘ ›‰Ô˘˜ Ù˘ ‚Ï¿‚˘ 27-28. ∆· ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ·ÛÙ·ıÔ‡˜ Ͽη˜ ·) ªÂÁ¿ÏÔ˜ ÏÈ҉˘ ˘Ú‹Ó·˜ ‚) §ÂÙfi ÈÓ҉˜ ÂÚ›‚ÏËÌ· Á) ºÏÂÁÌÔÓ‹
ÀÔÛÙÚÔÊ‹ Ù˘ ·ıËڈ̷ÙÈ΋˜ Ͽη˜ ∆· ÓÂfiÙÂÚ· Ê¿Ú̷η fiˆ˜ ÔÈ ÛÙ·Ù›Ó˜ Ê·›ÓÂÙ·È Ó· ¤¯Ô˘Ó ÔÏϷϤ˜ ‰Ú¿ÛÂȘ ÛÙËÓ ·ıËڈ̷ÙÈ΋ Ͽη. √È ‰Ú¿ÛÂȘ ·˘Ù¤˜ ÔÓÔÌ¿˙ÔÓÙ·È ÏÂÈÔÙÚÔÈΤ˜. ¶ÂÈÚ·Ì·ÙÈΤ˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ·Ô‰Â›ÍÂÈ fiÙÈ ÔÈ ÛÙ·Ù›Ó˜ ÛÙ·ıÂÚÔÔÈÔ‡Ó ÙËÓ ·ıËڈ̷ÙÈ΋ Ͽη. ∏ ÛÙ·ıÂÚÔÔ›ËÛË ·˘Ù‹ ÚÔ¤Ú¯ÂÙ·È ·fi: ÙË Ì›ˆÛË ÙÔ˘ ÏÈÒ‰Ô˘˜ ˘Ú‹Ó·, ÙË Ì›ˆÛË Ù˘ ÊÏÂÁÌÔÓ‹˜ (Ì·ÎÚÔÊ¿Á·), ÙËÓ ·‡ÍËÛË ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘, ÙËÓ ·‡ÍËÛË ÙˆÓ Ï›ˆÓ Ì˘˚ÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ÙË Ì›ˆÛË ÙˆÓ ÓÂÔÛ‡ÛÙ·ÙˆÓ ·ÁÁ›ˆÓ. ∆ÂÏÂ˘Ù·›· Û˘˙ËÙÔ‡ÓÙ·È Î·È ÔÈ ·ÓÙÈÔÍÂȉˆÙÈΤ˜ ȉÈfiÙËÙ˜ ÙˆÓ ÛÙ·ÙÈÓÒÓ 29-34. ∏ ÛÈÌ‚·ÛÙ·Ù›ÓË Î·È Ë ÊÏÔ˘‚·ÛÙ·Ù›ÓË ÌÔÚÔ‡Ó Ó· ·Ó·ÛÙ›ÏÔ˘Ó ÙȘ ÔÍÂȉˆÙÈΤ˜ ÈηÓfiÙËÙ˜ ÙˆÓ Ì·ÎÚÔÊ¿ÁˆÓ. √È LDL ·fi ·ÛıÂÓ›˜ Ô˘ ‚Ú›ÛÎÔÓÙ·È Û ıÂڷ›· Ì ÏÔ‚·ÛÙ·Ù›ÓË, ÛÈÌ‚·ÛÙ·Ù›ÓË Ú·‚·ÛÙ·Ù›ÓË ‹ ÊÏÔ˘‚·ÛÙ·Ù›ÓË ¤¯Ô˘Ó ÌÂȈ̤Ó˜ ÈηÓfiÙËÙ˜ ÁÈ· ÔÍ›‰ˆÛË in vivo. Œ¯ÂÈ Â›Û˘
‚ÚÂı› fiÙÈ ÔÈ ÌÂÙ·‚Ôϛ٘ Ù˘ ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ ÚÔÛÙ·ÙÂ‡Ô˘Ó ÙËÓ LDL ·fi ÙËÓ ÔÍ›‰ˆÛË. ¶·Ú¿ ÙË Ú‡ıÌÈÛË fiÏˆÓ ÙˆÓ ÎÏ·ÛÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ‰ÂÓ ¤¯ÂÈ ÂÈÙ¢¯ı› ¿Óˆ ·fi 35% Ì›ˆÛË Ù˘ ıÓËÛÈÌfiÙËÙÔ˜ ·fi ηډȷÁÁÂȷο ÓÔÛ‹Ì·Ù·. ŒÙÛÈ Ë ·Ó‡ÚÂÛË ¿ÏÏˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ Î·È Ë ÂÓÙÔÓfiÙÂÚË Ú‡ıÌÈÛË ÙˆÓ ÎÏ·ÛÈÎÒÓ ¤ÁÈÓ ÂÈÙ·ÎÙÈ΋. ∏ ÂÎÙÂٷ̤ÓË ¯Ú‹ÛË ÙˆÓ Ù¯ÓÈÎÒÓ Â·Ó·ÈÌ¿ÙˆÛ˘ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ‰ÂÓ Ô‰‹ÁËÛ ÛÙËÓ ·Ó·ÌÂÓfiÌÂÓË Ì›ˆÛË Ù˘ ηډȷÁÁÂȷ΋˜ ıÓËÙfiÙËÙ·˜. ªÂϤÙ˜ Ì ˘ÔÏÈȉ·ÈÌÈο Ê¿Ú̷η ¤‰ÂÈÍ·Ó Â˘ÂÚÁÂÙÈο ÎÏÈÓÈο ·ÔÙÂϤÛÌ·Ù·, ÚÔÙÔ‡ ÈÛÙÔÔÈËı› Ì ÙËÓ ·ÁÁÂÈÔÁÚ·Ê›· Ë ˘ÔÛÙÚÔÊ‹ ÙˆÓ ·ıËڈ̷ÙÈÎÒÓ Ï·ÎÒÓ. ∂·Ó¿ÛÙ·ÛË ÛÙÔÓ ÙÚfiÔ Ô˘ ÛÎÂÊÙfiÌ·ÛÙ ¤ÊÂÚÂ Ë ·Ú·Ù‹ÚËÛË fiÙÈ ÔÈ ·ıËڈ̷ÙÈΤ˜ ϿΘ Ô˘ Â›Ó·È ÈÔ Â˘¿ÏˆÙ˜ ÛÙËÓ Ú‹ÍË, Â›Ó·È Û˘¯Ó¿ ÌÈÎÚfiÙÂÚ˘ ·ÈÌÔ‰˘Ó·ÌÈ΋˜ ÛËÌ·Û›·˜ (< 50%) ŒÙÛÈ, Ô Î›Ó‰˘ÓÔ˜ Ù˘ ÔÍ›·˜ ·fiÊڷ͢ Ù˘ ·ÚÙËÚ›·˜ ‰ÂÓ ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ·ÈÌÔ‰˘Ó·ÌÈ΋ ÛÔ‚·ÚfiÙËÙ· Ù˘ ÛÙ¤ÓˆÛ˘ Ô˘ ÚÔηÏ› Ë Ï¿Î·, ·ÏÏ¿ ·fi ÙË Ì˯·ÓÈ΋ Ù˘ ÛÙ·ıÂÚfiÙËÙ· Ô˘ ÙËÓ Î¿ÓÂÈ Â˘¿ÏˆÙË Û ڋÍË (∞ÛÙ·ı‹˜ Ͽη). ∏ ÛÙ·ıÂÚÔÔ›ËÛË ÙˆÓ Ï·ÎÒÓ Ô˘ ·ÎÔÏÔ‡ıËÛ ÙËÓ Ì›ˆÛË ÙˆÓ ÂȤ‰ˆÓ Ù˘ ¯ÔÏËÛÙÂÚ›Ó˘, Ô‰‹ÁËÛÂ Î·È ÛÙË Ì›ˆÛË ÙˆÓ ÔͤˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ÂÂÈÛÔ‰›ˆÓ.
µÈ‚ÏÈÔÁÚ·Ê›· 1.
Bhatia V.et al. J Postgrad Med 49: 361368 2. Falk E. et al. Circulation 92:657-671 3. Ambrose JA. Et al. J Am Coll Cardiol 12: 56-62 4. Richarson PD. et al. Lancet 2:941-944 5. Buja LM.et al. Circulation 89:503-505 6. Fuster V.et al. Lancet 353 S 115-119 7. Zaman AG. Et al. Atherosclerosis 149: 251-266 8. van der Wall AC. Et al. Circulation 89:3644 9. Goldstein JA. Et al. N Engl J Med 343: 915-922 10. Ross R. et al. Science 180:1332-1339
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11. Gravanis AI. Et al. Microsurgery 23:402409 12. Wilson PW. Et al. Am J Hypetens 7:7S12S 13. U.S. Department of Health and Human Services. The Health Consequences of Smoking. 3:371-383 14. Morrow DA. et al. Med Clin North Am 84:149-161 15. Libby P. et al. Circulation 91:2844 16. Zhu J. et al. Am J Cardiol 85:140-146 17. Kolovou G. et al. Book 429-436 18. Navad M. et al. Atheroscler Thromb Vasc Biol 16:831-842 19. Moreno PR.et al. Circulation 105:923927
20. Hatsukami TS. Et al. Circulation 102: 959-964 21. Kullo IJ.et al. Ann Intern Med 129:10501060 22. Ambrose JA. Et al. Circulation 105:20002004 23. Nissen SE.et al. Am J Cardiol. 5;96(5A): 61F-68F 24. Liao JK. et al. Annu Rev Pharmacol Toxicol.; 45:89-118 25. alam AM. et al. Cardiovasc Drugs; 18(5): 387-9 Review 26. Ganda OP. et al. Cardiol Clin. 23(2):15364
ATHIROSKLIROSI 9b 23-02-06 10:17 ™ÂÏ›‰·15
∫§π¡π∫∂™ ª∂§∂∆∂™
™˘Ó‰˘·Ṳ̂ÓË AÓÙÈÌÂÙÒÈÛË Y¤ÚÙ·Û˘ Î·È ¢˘ÛÏÈȉ·ÈÌ›·˜: ∂˘Ú‹Ì·Ù· Ù˘ ªÂϤÙ˘ ASCOT BjØrn DahlØf, Peter S Sever, Neil R Poulter, et al, for the ASCOT Investigators. Lancet. 2005;366:907-13 ∂È̤ÏÂÈ·: ∫. ∆˙ÈfiÌ·ÏÔ˜, ∞. ∫·Î·Ê‹Î·, ª. ™›ÏÂÏË, π. ¢Ô˘ÏÔ˘Ì¿Î·˜, °. ™Ê‹Î·˜, ∞. ¶ÈÚ·ÛÔÔ‡ÏÔ˘, ª. ºÏˆÚÂÓÙ›Ó, ∞. ™Î·¤Ú‰·˜, ∞. ∫·Ú·ÁÈ¿ÓÓ˘, µ. Õı˘ÚÔ˜ B’ ¶ÚÔ·È‰Â˘ÙÈ΋ ¶·ıÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ∞ÚÈÛÙÔÙ¤ÏÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ £ÂÛÛ·ÏÔӛ΢ °¶¡ «π¶¶√∫ƒ∞∆∂π√»
·ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË Î·È Ë ‰˘ÛÏÈȉ·ÈÌ›· ·ÔÙÂÏÔ‡Ó ‰‡Ô ·fi ÙÔ˘˜ ÛËÌ·ÓÙÈÎfiÙÂÚÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Ù˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘ (∫∞¡). ∞fi ÙË ÌÂϤÙË MRFIT, Ë ÔÔ›· ‰ËÌÔÛȇıËΠÙÔ 1992 Î·È ÂÚȤϷ‚ 316.000 ¿ÙÔÌ· Ô˘ ·Ú·ÎÔÏÔ˘ı‹ıËÎ·Ó ÁÈ· 12 ¯ÚfiÓÈ·, ‰È·ÈÛÙÒıËΠfiÙÈ Ë Û˘Ó‡·ÚÍË Ù˘ ·ÚÙËÚȷ΋˜ ˘¤ÚÙ·Û˘ Î·È Ù˘ ‰˘ÛÏÈȉ·ÈÌ›·˜ ·˘Í¿ÓÂÈ ÙÔ Î›Ó‰˘ÓÔ ∫∞¡ ÔÏÏ·Ï·ÛÈ·ÛÙÈο Î·È fi¯È ·ıÚÔÈÛÙÈο (∂ÈÎfiÓ· 1). ª¤¯ÚÈ Û‹ÌÂÚ· Ë ÚÔÛ¿ıÂÈ· ÂÏ¿ÙÙˆÛ˘ Ù˘ ÔÏÈ΋˜ Î·È Î·Ú‰È·ÁÁÂȷ΋˜ ıÓËÙfiÙËÙ·˜ Î·È ÓÔÛËÚfiÙËÙ·˜ Û ˘ÂÚÙ·ÛÈÎÔ‡˜ ·ÛıÂÓ›˜ Ì ÂÏ¿ÙÙˆÛË ÌfiÓÔ Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ‰ÂÓ ‹Ù·Ó ȉȷ›ÙÂÚ· ÂÈÙ˘¯‹˜. ∆Ô 2002, 10 ¯ÚfiÓÈ· ÌÂÙ¿ Ù· Â˘Ú‹Ì·Ù· Ù˘ MRFIT ¤ÁÈÓÂ Ë ÚÒÙË ÚÔÛ¿ıÂÈ· ˘ÔÏÔÁÈÛÌÔ‡ ÙÔ˘ ÔʤÏÔ˘˜ ·fi ÙË Ù·˘Ùfi¯ÚÔÓË ·ÔÙÂÏÂÛÌ·-
∏
EIKONA 1
ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ·ÚÙËÚȷ΋˜ ˘¤ÚÙ·Û˘ Î·È Ù˘ ‰˘ÛÏÈȉ·ÈÌ›·˜. ¢È·ÈÛÙÒıËΠfiÙÈ Ë ·ÓÙÈÌÂÙÒÈÛË Ù˘ ·ÚÙËÚȷ΋˜ ˘¤ÚÙ·Û˘ ÂÏ¿ÙÙˆÛ ÙÔ Î›Ó‰˘ÓÔ ÁÈ· ∫∞¡ ηٿ 25%, Ë ·ÓÙÈÌÂÙÒÈÛË Ù˘ ‰˘ÛÏÈȉ·ÈÌ›·˜ ηٿ 30% Î·È Ë ·ÓÙÈÌÂÙÒÈÛË Î·È ÙˆÓ ‰‡Ô Ù·˘Ùfi¯ÚÔÓ· ηٿ 50% (∂ÈÎfiÓ· 2). °È· Ó· ‰È¢ÎÚÈÓÈÛÙ› ÙÔ ı¤Ì· ·˘Ùfi ۯ‰ȿÛÙËΠASCOT Ë ÔÔ›· ›¯Â ‰‡Ô ÛΤÏË: ∆Ô ·ÓÙÈ˘ÂÚÙ·ÛÈÎfi ÛΤÏÔ˜ (ASCOT-BPLA), ÙÔ ÔÔ›Ô ÂÚȤϷ‚ 19.257 ˘ÂÚÙ·ÛÈÎÔ‡˜ ·ÛıÂÓ›˜ Ì ¿ÏÏÔ˘˜ ÙÚÂȘ ÙÔ˘Ï¿¯ÈÛÙÔÓ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ∫∞¡ Î·È ÙÔ ˘ÔÏÈȉ·ÈÌÈÎfi (ASCOT-LLA) Ô˘ ÂÚȤϷ‚ ÂÚ›Ô˘ ÙÔ˘˜ ÌÈÛÔ‡˜ ·fi ·˘ÙÔ‡˜ (10.303) Ô˘ ›¯·Ó ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË <250 mg/dl. ∆Ô ·ÓÙÈ˘ÂÚÙ·ÛÈÎfi ÛΤÏÔ˜ ›¯Â ÛÎÔfi Ó· Û˘ÁÎÚ›ÓÂÈ ÙË ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙˆÓ "ÓÂfiÙÂÚˆÓ" ·ÓÙÈ˘ÂÚÙ·ÛÈ-
ÎÒÓ, Ì ÂÎÚfiÛˆÔ ÙÔÓ ·ÔÎÏÂÈÛÙ‹ ÙˆÓ Î·Ó·ÏÈÒÓ ·Û‚ÂÛÙ›Ô˘ (CCB) ·ÌÏԉțÓË Û ‰fiÛË 5-10 mg Î·È Â¿Ó ‹Ù·Ó ··Ú·›ÙËÙÔ Ì ÙË ÚÔÛı‹ÎË ÙÔ˘ ·Ó·ÛÙÔϤ· ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ Ù˘ ·ÁÁÂÈÔÙ·Û›Ó˘ (ACE-I) ÂÚÈÓ‰ÔÚ›ÏË, ÁÈ· Ó· ÂÈÙ‡¯ÂÈ ÙÔ˘˜ ÛÙfi¯Ô˘˜ Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ (∂ÈÎfiÓ· 3), ¤Ó·ÓÙÈ ÌÈ·˜ ıÂڷ¢ÙÈ΋˜ ·ÁˆÁ‹˜ Ì "·Ï·ÈfiÙÂÚ·" ·ÓÙÈ˘ÂÚÙ·ÛÈο: ÂÓfi˜ ‚‹Ù· ·ÔÎÏÂÈÛÙ‹ (‚-blocker), Ù˘ ·ÙÂÓÔÏfiÏ˘ Î·È Â¿Ó ‹Ù·Ó ··Ú·›ÙËÙÔ, Ì ÙË ÚÔÛı‹ÎË ÂÓfi˜ ‰ÈÔ˘ÚËÙÈÎÔ‡, bendroflumethiazide (ıÂÈ·˙ȉÈÎfi ‰ÈÔ˘ÚËÙÈÎfi Ô˘ ‰ÂÓ Î˘ÎÏÔÊÔÚ› ÛÙËÓ ∂ÏÏ¿‰·), ÁÈ· Ó· ÂÈÙ‡¯ÂÈ ÙÔ˘˜ ÛÙfi¯Ô˘˜ Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ (∂ÈÎfiÓ· 3). ∏ ‰ÔÍ·˙ÔÛ›ÓË (·-blocker) ÌÔÚÔ‡Û ӷ ÚÔÛÙÂı› Û ηıÂÌ›· ·fi ÙȘ ıÂڷ¢ÙÈΤ˜ ·ÁˆÁ¤˜ Â¿Ó ··ÈÙ›ÙÔ ÚfiÛıÂÙÔ˜ ¤ÏÂÁ¯Ô˜ Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ (∂ÈÎfiÓ· 3).
EIKONA 2
15
ATHIROSKLIROSI 9b 23-02-06 10:17 ™ÂÏ›‰·16
·ıËÚÔÛÎÏ‹ÚˆÛË MAƒ∆π√™
2006
EIKONA 3
∆Ô ˘ÔÏÈȉ·ÈÌÈÎfi ÛΤÏÔ˜ (ASCOT-LLA) ÂÚȤϷ‚ 10.305 ·fi ÙÔ˘˜ 19.257 ·ÛıÂÓ›˜, fiÛÔ˘˜ ›¯·Ó ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË <250 mg/dl (∂ÈÎfiÓ· 3). ∞˘Ùfi ¤ÁÈÓ ÁÈ· ËıÈÎÔ‡˜ ÏfiÁÔ˘˜ ÂÂȉ‹ Ë ÌÂϤÙË ÚÔ¤‚Ï ۇÁÎÚÈÛË ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ 10 mg ¤Ó·ÓÙÈ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ (‰ÈÏ¿ Ù˘ÊÏ‹ ÌÂϤÙË) (∂ÈÎfiÓ· 3). ∂Âȉ‹ ˘‹Ú¯Â Ë Èı·ÓfiÙËÙ· οÔÈÔ˜ ˘ÂÚÙ·ÛÈÎfi˜ Ì Ôχ ˘„ËÏ‹ ¯ÔÏËÛÙÂÚfiÏË Ó· Ù˘¯·ÈÔÔÈÔ‡ÓÙ·Ó ÛÙÔ ÛΤÏÔ˜ ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ (Ú¿ÁÌ· Ô˘ ‰ÂÓ ıˆÚÂ›Ù·È ÂÈÙÚÂÙfi) ·˘ÙÔ› ÂÍ·ÈÚ¤ıËηÓ. ™ÎÔfi˜ ÙÔ˘ ˘ÔÏÈȉ·ÈÌÈÎÔ‡ ÛΤÏÔ˘˜ ‹Ù·Ó Ó· ‰È·ÈÛÙÒÛÂÈ Ù· ÔʤÏË ·fi ÙË Ù·˘Ùfi¯ÚÔÓË ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ·ÚÙËÚȷ΋˜ ˘¤ÚÙ·Û˘ Î·È ‰˘ÛÏÈȉ·ÈÌ›·˜ Î·È Â›Û˘ ÙÔ Î·Ù¿ fiÛÔ Ù· ÔʤÏË ·˘Ù¿ ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚ· Ì ٷ "ÓÂfiÙÂÚ·" ‹ Ù· "·Ï·ÈfiÙÂÚ·" ·ÓÙÈ˘ÂÚÙ·ÛÈο Ê¿Ú̷η. ∆Ô ÚˆÙÔÁÂÓ¤˜ ÙÂÏÈÎfi ÛËÌÂ›Ô Ù˘ ÌÂϤÙ˘ ‹Ù·Ó ÙÔ ÌË ı·Ó·ÙËÊfiÚÔ ¤ÌÊÚ·ÁÌ· Ì˘Ôηډ›Ô˘ (∂ª) ηÈ
EIKONA 5
16
EIKONA 4
Ù· ı·Ó·ÙËÊfiÚ· ÛÙÂÊ·ÓÈ·›· Û˘Ì‚¿Ì·Ù·. À‹ÚÍ ¤Ó·˜ ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ÚfiÛıÂÙˆÓ (‰Â˘ÙÂÚÔÁÂÓÒÓ Î·È ÙÚÈÙÔÁÂÓÒÓ) ÙÂÏÈÎÒÓ ÛËÌ›ˆÓ: Ù· ηډȷÁÁÂȷο Û˘Ì‚¿Ì·Ù·, Ù· Û˘ÓÔÏÈο ÛÙÂÊ·ÓÈ·›· Û˘Ì‚¿Ì·Ù·, ÙÔ ı·Ó·ÙËÊfiÚÔ ‹ ÌË ·ÁÁÂÈ·Îfi ÂÁÎÂÊ·ÏÈÎfi (∞∂∂) ÂÂÈÛfi‰ÈÔ, Ë ÔÏÈ΋ ıÓËÙfiÙËÙ·, Ë Î·Ú‰È·Î‹ ·Ó¿ÚÎÂÈ·, Ë Û˘ÓÔÏÈ΋ ηډȷÁÁÂȷ΋ ıÓËÙfiÙËÙ·, Ù· Û˘ÓÔÏÈο Û˘Ì‚¿Ì·Ù·, ÔÈ ‰È·‰Èηۛ˜ ·ӷÈÌ¿ÙˆÛ˘, ÙÔ ÌË ı·Ó·ÙËÊfiÚÔ ∂ª (¯ˆÚ›˜ ÙÔ ÛȈËÏfi) Î·È Ë ·Ó¿Ù˘ÍË Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË ‹ ÓÂÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜. ∆Ô ˘ÔÏÈȉ·ÈÌÈÎfi ÛΤÏÔ˜ (ASCOT-LLA) ‰ÈÂÎfiË ÚfiˆÚ· ÙÔ 2002 ÛÙ· 3,3 ¯ÚfiÓÈ· (·ÓÙ› ÁÈ· 5 ¯ÚfiÓÈ· Ô˘ ÚÔ¤‚ÏÂÂ Ô ·Ú¯ÈÎfi˜ ۯ‰ȷÛÌfi˜) ÁÈ·Ù› ÂÂÙ‡¯ıË Ë ÛÙfi¯Ô˜ (ÂÏ¿ÙÙˆÛË ÙÔ˘ ÚˆÙÔÁÂÓÔ‡˜ ÙÂÏÈÎÔ‡ ÛËÌ›Ԣ > 30% ÛÙËÓ ÔÌ¿‰· Ù˘ ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ ¤Ó·ÓÙÈ ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘). ∏ ÂÏ¿ÙÙˆÛË ·˘Ù‹ ‹Ù·Ó 36% (∂ÈÎfiÓ· 4). √È ·ÛıÂÓ›˜ ÛÙËÓ ·Ú¯‹ Ù˘ ÌÂϤÙ˘ ›¯·Ó LDL-X 130
EIKONA 6
mg/dl Î·È Û‡Ìʈӷ Ì ÙȘ ÙÚ¤¯Ô˘Û˜ Ô‰ËÁ›Â˜ (NCEP-ATP III, 2001) ‰ÂÓ ¤Ú ӷ ¿ÚÔ˘Ó ˘ÔÏÈȉ·ÈÌÈ΋ ·ÁˆÁ‹. ™ÙË ÌÂϤÙË ASCOT ‹Ú·Ó 10 mg ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ Î·È Ë LDL-X ÂÏ·ÙÙÒıËΠÛÙ· 90 mg/dl. ∞˘Ùfi ÚÔοÏÂÛ ÂÏ¿ÙÙˆÛË ÙÔ˘ ÚˆÙÔÁÂÓÔ‡˜ ÙÂÏÈÎÔ‡ ÛËÌ›Ԣ ηٿ 36%, ¤Ú· ·fi ÙÔ fiÊÂÏÔ˜ ·fi ÙËÓ ÂÏ¿ÙÙˆÛË Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ Ô˘ ‹Ù·Ó ÂÓÙ˘ˆÛȷ΋ (-25 mmHg Ë Û˘ÛÙÔÏÈ΋ Î·È -15 mmHg Ë ‰È·ÛÙÔÏÈ΋ Î·È ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜: ·ÙÔÚ‚·ÛÙ·Ù›ÓË Î·È ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ). ∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ ASCOT-LLA Ô‰‹ÁËÛ·Ó ÛÙËÓ ·ÏÏ·Á‹ ÙˆÓ Î·Ù¢ı˘ÓÙ‹ÚÈˆÓ Ô‰ËÁÈÒÓ ÁÈ· ˘ÂÚÙ·ÛÈÎÔ‡˜ Ì ¿ÏÏÔ˘˜ ÙÚÂȘ ÙÔ˘Ï¿¯ÈÛÙÔÓ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ (NCEP 2004 Update). √ ÛÙfi¯Ô˜ ÁÈ· ÙËÓ LDL-X ÛÙÔ˘˜ ·ÛıÂÓ›˜ ·˘ÙÔ‡˜ ·ӷÚÔÛ‰ÈÔÚ›ÛÙËΠ·fi < 130 mg/dl Û < 100 mg/dl. ∆Ô ·ÓÙÈ˘ÂÚÙ·ÛÈÎfi ÛΤÏÔ˜ (ASCOT-BPLA) ‰ÈÂÎfiË Î·È ·˘Ùfi ÚfiˆÚ· (4.9 ¯ÚfiÓÈ·) Î·È ¤‰ÂÈÍÂ
ATHIROSKLIROSI 9b 23-02-06 10:17 ™ÂÏ›‰·17
∫§π¡π∫∂™ ª∂§∂∆∂™ ˘ÂÚÔ¯‹ Ù˘ ıÂڷ›·˜ Ô˘ ‚·Û›˙ÔÓÙ·Ó ÛÙË ·ÌÏԉțÓË (82,5% ÙˆÓ ·ÛıÂÓÒÓ-∂ÈÎfiÓ· 5) Û ۇÁÎÚÈÛË Ì ·˘Ù‹ Ô˘ ‚·Û›˙ÔÓÙ·Ó ÛÙËÓ ·ÙÂÓÔÏfiÏË (79,4% ÙˆÓ ·ÛıÂÓÒÓ-∂ÈÎfiÓ· 5). ∆Ô ›‰ÈÔ ÙÂÏÈÎfi ÛËÌÂ›Ô Ì ÙËÓ ASCOT-LLA (ÌË ı·Ó·ÙËÊfiÚÔ ∂ª Î·È Ù· ı·Ó·ÙËÊfiÚ· ÛÙÂÊ·ÓÈ·›· Û˘Ì‚¿Ì·Ù·) ›¯Â ÂÏ¿ÙÙˆÛË Î·Ù¿ 23% ÛÙËÓ ÔÌ¿‰· Ù˘ ·ÌÏԉțÓ˘ ¤Ó·ÓÙÈ ·˘Ù‹˜ Ù˘ ·ÙÂÓÔÏfiÏ˘ (∂ÈÎfiÓ· 6). ∞˘Ùfi Ô˘ ›¯Â ÌÂÁ¿ÏÔ ÂӉȷʤÚÔÓ ‹Ù·Ó ÙÔ fiÊÂÏfi˜ ·fi ÙË ¯ÔÚ‹ÁËÛË ·ÌÏԉțÓ˘ ± ÂÚÈÓ‰ÔÚ›ÏË Ì ·ÙÔÚ‚·ÛÙ·Ù›ÓË Û ۇÁÎÚÈÛË Ì ·˘Ù‹ Ù˘ ·ÙÂÓÔÏfiÏ˘ ± ıÂÈ·˙ȉÈÎfi ‰ÈÔ˘ÚËÙÈÎfi ¯ˆ-
Ú›˜ ·ÙÔÚ‚·ÛÙ·Ù›ÓË (∂ÈÎfiÓ· 7). ∆Ô ÌË ı·Ó·ÙËÊfiÚÔ ∂ª Î·È Ù· ı·Ó·ÙËÊfiÚ· ÛÙÂÊ·ÓÈ·›· Û˘Ì‚¿Ì·Ù· ‹ Ù· ∞∂∂ ‹Ù·Ó ۯ‰fiÓ Ù· ÌÈÛ¿ ÛÙËÓ ÔÌ¿‰· Ù˘ ·ÌÏԉțÓ˘ Û ۇÁÎÚÈÛË Ì ·˘Ù¿ Ù˘ ÔÌ¿‰·˜ Ù˘ ·ÙÂÓÔÏfiÏ˘. ¶ÚfiÛÊ·Ù· ·Ó·ÎÔÈÓÒıËÎÂ Ô Û˘Ó‰˘·ÛÌfi˜ ·ÌÏԉțÓË + ·ÙÔÚ‚·ÛÙ·Ù›ÓË Û ۇÁÎÚÈÛË Ì ·˘ÙfiÓ ·ÙÂÓÔÏfiÏË + ·ÙÔÚ‚·ÛÙ·Ù›ÓË (·Ó¿Ï˘ÛË 2 à 2, ∂ÈÎfiÓ· 8). º¿ÓËΠfiÙÈ ÙÔ fiÊÂÏfi˜ ÛÙÔ ÚˆÙÔÁÂÓ¤˜ ÙÂÏÈÎfi ÛËÌÂ›Ô Ù˘ ASCOTLLA (-36%) ÔÊ›ÏÔÓÙ·Ó Î˘Ú›ˆ˜ ÛÙËÓ ÂÏ¿ÙÙˆÛ‹ ÙÔ˘ ÛÙËÓ ÔÌ¿‰· Ù˘ ·ÌÏԉțÓ˘ (-53%) Î·È Ôχ ÏÈÁfiÙÂÚÔ ÛÙËÓ ÔÌ¿‰· Ù˘
EIKONA 7
·ÙÂÓÔÏfiÏ˘ (-16%, p<0,0001) (∂ÈÎfiÓ· 8). ™˘ÌÂÚ·ÛÌ·ÙÈο ÌÔÚԇ̠ӷ ԇ̠fiÙÈ Ë Ù·˘Ùfi¯ÚÔÓË ·ÓÙÈÌÂÙÒÈÛË Ù˘ ·ÚÙËÚȷ΋˜ ˘¤ÚÙ·Û˘ Î·È Ù˘ (‹È·˜ ¤ÛÙˆ) ‰˘ÛÏÈȉ·ÈÌ›·˜ ÚÔÛʤÚÂÈ ÂÍ·ÈÚÂÙÈο ¢ÓÔ˚ο ·ÔÙÂϤÛÌ·Ù·. √ Û˘Ó‰˘·ÛÌfi˜ ÌÈÎÚ‹˜ ‰fiÛ˘ ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ (10 mg) Ì ·ÌÏԉțÓË Î·È Â¿Ó ¯ÚÂÈ·ÛÙ› ÂÚÈÓ‰ÔÚ›ÏË ÂÏ·ÙÙÒÓÂÈ ÛÙÔ ÌÈÛfi Ù· ∫/∞ Û˘Ì‚¿Ì·Ù· Û ۯ¤ÛË Ì ÙÔ Û˘Ó‰˘·ÛÌfi ·ÙÔÚ‚·ÛÙ·Ù›ÓË Ì ·ÙÂÓÔÏfiÏË Î·È Â¿Ó ¯ÚÂÈ·ÛÙ› ıÂÈ·˙ȉÈÎfi ‰ÈÔ˘ÚËÙÈÎfi.
EIKONA 8
µÈ‚ÏÈÔÁÚ·Ê›· 1.
2.
3.
Dahlöf B, Sever PS, Poulter NR, et al for the ASCOT investigators. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol as required, in the Anglo-Scandinavian Cardiac Outcomes Trial–Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet 2005;366:895-906. Sever PS, Dahlöf B, Poulter NR, et al for the ASCOT investigators. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the AngloScandinavian Cardiac Outcomes TrialLipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial. Lancet 2003;361:1149-1158. Sever PS, Dahlöf B, Poulter NR, et al. The Anglo-Scandinavian Cardiac Outcomes Trial: morbidity-mortality outcomes in the blood pressure-lowering arm of the trial. Presented at: American College of Cardiology Scientific Sessions 2005; March 8, 2005; Orlando, FL.
4.
5.
6.
7.
ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin converting enzyme inhibitor or calcium channel blocker vs diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002;288:2981-2997. Julius S, Kjeldsen SE, Weber M, et al for the VALUE trial group. Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomised trial. Lancet 2004;363: 2022-2031. Nissen SE, Tuzcu ME, Libby, P et al. Effect of antihypertensive agents on cardiovascular events in patients with coronary Disease and normal blood pressure. The CAMELOT study: A randomized controlled trial. JAMA 2004; 292:2217-2226. Poulter NR, Wedel H, Dahlöf B, et al, for the ASCOT Investigators. Role of blood pressure and other variables in the differential cardiovascular event rates no-
ted in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA). Lancet 2005; DOI: 10.1016/50140-6736(05)67186-3. Available at: http://www.lancet.com. 8.
Staessen JA, Birkenhäger WH. Evidence that new antihypertensives are superior to older drugs. Lancet 2005: DOI: 10.1016/50140-6736(05)67147-4. Available at: http://www.lancet.com.
9.
Expert Panel on Detection Evaluation, and Treatment of High Blood Cholesterol in Adults, Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285:2486-97.
10. Grundy SM et al. Expert Panel on Detection Evaluation, and Treatment of High Blood Cholesterol in Adults, Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP). Update 2004. Circulation 2004;110:227-239.
17
ATHIROSKLIROSI 9b 23-02-06 10:17 ™ÂÏ›‰·18
·ıËÚÔÛÎÏ‹ÚˆÛË MAƒ∆π√™
2006
∞ÛıÂÓ‹˜ Ì X·ÌËÏ‹ HDL-XÔÏËÛÙÂÚfiÏË £Âfi‰ˆÚÔ˜ ÃÂÈÌÒÓ·˜, ∂ÈÛÙËÌÔÓÈÎfi˜ ™˘ÓÂÚÁ¿Ù˘ øÓ¿ÛÂÈÔ˘ ∫·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈÎÔ‡ ∫¤ÓÙÚÔ˘ °ÂÓÔ‚¤Ê· ∫ÔÏÔ‚Ô‡, ÀԉȢı‡ÓÙÚÈ· ∞’ ∫·Ú‰ÈÔÏÔÁÈ΋˜ ∫ÏÈÓÈ΋˜, À‡ı˘ÓË §ÈȉÈÔÏÔÁÈÎÔ‡ π·ÙÚ›Ԣ øÓ¿ÛÂÈÔ˘ ∫·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈÎÔ‡ ∫¤ÓÙÚÔ˘
∂ÈÛ·ÁˆÁ‹ ∏ ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ˜ ·ÔÙÂÏ› Û‹ÌÂÚ· ¤Ó· ·fi Ù· ·ÚÈ· ·›ÙÈ· ı·Ó¿ÙÔ˘ ÛÙÔ ‰˘ÙÈÎfi ÎfiÛÌÔ. ∏ ÚˆÙÔÁÂÓ‹˜ Î·È ‰Â˘ÙÂÚÔÁÂÓ‹˜ ÚfiÏË„‹ Ù˘ ÂÛÙÈ¿˙ÂÙ·È Â› ÙÔ˘ ·ÚfiÓÙÔ˜ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÚˆÙ·Ú¯Èο Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘. ∂˘Ú‹Ì·Ù· fï˜ ·fi ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ‰Â›¯ÓÔ˘Ó fiÙÈ Î·È Ë HDL-¯ÔÏËÛÙÂÚfiÏË ·ÔÙÂÏ› ·ÓÂÍ¿ÚÙËÙÔ ÚÔÁÓˆÛÙÈÎfi ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÁÈ· ηډȷÁÁÂȷ΋ ÓfiÛÔ, ÂÓÒ ·fi ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ Ê·›ÓÂÙ·È fiÙÈ Ë ‰ÈfiÚıˆÛË Ù˘¯fiÓ ¯·ÌËÏ‹˜ HDL-¯ÔÏËÛÙÂÚfiÏ˘ Û ·ÛıÂÓ›˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ‹ Ì ÂÁηÙÂÛÙË̤ÓË ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ ‚ÂÏÙÈÒÓÂÈ ÙË Î·Ú‰È·ÁÁÂȷ΋ ÓÔÛËÚfiÙËÙ· Î·È ıÓËÙfiÙËÙ·. ∆Ô ·ÚfiÓ ¿ÚıÚÔ ·ÚÔ˘ÛÈ¿˙ÂÈ ÙÔÓ ÙÚfiÔ ÚÔÛ¤ÁÁÈÛ˘ Î·È ·ÓÙÈÌÂÙÒÈÛ˘ ÂÓfi˜ ·ÛıÂÓ‹ Ì ÚÒÈÌË ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ Î·È ¯·ÌËÏ‹ HDL-¯ÔÏËÛÙÂÚfiÏË Û¿ÓÈ·˜, ÎÏËÚÔÓÔÌÈ΋˜ ·ÈÙÈÔÏÔÁ›·˜.
¶·ÚÔ˘Û›·ÛË √ ·ÛıÂÓ‹˜, ¿Ó‰Ú·˜ ËÏÈΛ·˜ 27 ÂÙÒÓ, Ì ÈÛÙÔÚÈÎfi ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ ·fi 3ÂÙ›·˜, Ô͇ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘ Î·È Â¤Ì‚·ÛË ·ÔÚÙÔÛÙÂÊ·ÓÈ·›·˜ ·Ú¿Î·Ì„˘ ÚÔ ¤ÙÔ˘˜ ÚÔÛ‹Ïı ÛÙÔ ÏÈȉÈÔÏÔÁÈÎfi È·ÙÚÂ›Ô ÚÔ˜ ‰ÈÂÚ‡ÓËÛË Î·È ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘. ∂›¯Â µªπ 25 kg/m2, ·ÚÙËÚȷ΋ ›ÂÛË 120/80 mmHg Î·È ‹Ù·Ó ÚÒËÓ Î·ÓÈÛÙ‹˜. ¢ÂÓ ·Ó¤ÊÂÚ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘. ∞fi ÙË Ê˘ÛÈ΋ ÂͤٷÛË ‰ÂÓ ·Ó¢ڤıË Ù›ÔÙ ÙÔ ·ÍÈfiÏÔÁÔ. ∏ Ê·Ú̷΢ÙÈ΋ ÙÔ˘ ·ÁˆÁ‹ ÂÚÈÔÚÈ˙fiÙ·Ó Û 1 ‰ÈÛÎ›Ô ·ÛÈÚ›Ó˘ 100 mg ÙËÓ Ë̤ڷ. √È ÙÈ̤˜ ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ Ô˘ ›¯Â ÛÙÔ ·ÚÂÏıfiÓ Î˘Ì·›ÓÔÓÙ·Ó ˆ˜ ÂÍ‹˜: ۿί·ÚÔ 90-105 mg/dl, ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË 230-250 mg/dl, ÙÚÈ-
18
ÁÏ˘ÎÂÚ›‰È· 250-300 mg/dl, HDL¯ÔÏËÛÙÂÚfiÏË 16-30 mg/dl Î·È LDL-¯ÔÏËÛÙÂÚfiÏË 140-160 mg/dl. ¶ÈÔ ÂÍÂȉÈÎÂ˘Ì¤ÓÔ˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍ ٷ ·Ú·Î¿Ùˆ: apo-B 116 mg/dl, apoA-I 69 mg/dl Î·È Lp(a) 9 mg/dl.
∞›ÙÈ· ¯·ÌËÏ‹˜ HDL-C ∏ ¯·ÌËÏ‹ HDL-¯ÔÏËÛÙÂÚfiÏË, ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È Û ÂÚÈ‚·ÏÏÔÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, fiˆ˜ ÙÔ Î¿ÓÈÛÌ·, Ë ·¯˘Û·ÚΛ· Î·È Ë ¤ÏÏÂÈ„Ë ¿ÛÎËÛ˘, Ó· ÂÌÊ·Ó›˙ÂÙ·È ÛÙ· Ï·›ÛÈ· ¿ÏÏˆÓ ‰˘ÛÏÈȉ·ÈÌÈÒÓ fiˆ˜ Ë ÔÈÎÔÁÂÓ‹˜ Û˘Ó‰˘·Ṳ̂ÓË ˘ÂÚÏÈȉ·ÈÌ›· (FCH), Ë ‰˘ÛÏÈȉ·ÈÌ›· Ù‡Ô˘ πππ Î·È Ë ÔÈÎÔÁÂÓ‹˜ ˘ÂÚÙÚÁÏ˘ÎÂÚȉ·ÈÌ›·, Ó· Û¯ÂÙ›˙ÂÙ·È Ì ÙÔ ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ ‹ Ó· ˘Ô‰ËÏÒÓÂÈ ¤Ó· ·fi Ù· Û¿ÓÈ· ÎÏËÚÔÓÔÌÈο ÓÔÛ‹Ì·Ù· ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ Ù˘ HDL, fiˆ˜ Ë ÓfiÛÔ˜ Tangier (·Ó¿ÚÎÂÈ· ÙÔ˘ ATPbinding cassette transporter A1 [ABCA1]), Ë ÔÈÎÔÁÂÓ‹˜ ˘Ô·ÏÊ·ÏÈÔÚˆÙÂ˚Ó·ÈÌ›·, Ë ÎÏ·ÛÈ΋ ¤ÏÏÂÈ„Ë ÙÔ˘ ÂÓ˙‡ÌÔ˘ ÏÂÎÈıÈÓÔ-·Î˘ÏÔÙÚ·ÓÛÊÂÚ¿ÛË Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ (LCAT) Î·È Ë ÓfiÛÔ˜ Fish Eye.
¢È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ∏ Û˘Ì‚ÔÏ‹ ÙÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜ Ê˘ÛÈο ‰ÂÓ ÌÔÚ› Ó· ·ÔÎÏÂÈÛÙ›, ‰ÂÓ Â·ÚΛ fï˜ ÁÈ· Ó· ‰ÈηÈÔÏÔÁ‹ÛÂÈ ÙfiÛÔ ÚÒÈÌË ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ. ∂Ó·ÓÙ›ÔÓ Ù˘ ‰È¿ÁÓˆÛ˘ Ù˘ FCH ÛÙÔÓ ÂÓ ÏfiÁˆ ·ÛıÂÓ‹ Â›Ó·È ÔÈ ¯·ÌËϤ˜ ÙÈ̤˜ apoB. √È ÙÈ̤˜ ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ Â›Ó·È Ôχ ÌÈÎÚ¤˜ ÁÈ· ÔÈÎÔÁÂÓ‹ ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›·, Ë ÔÔ›· ¿ÏψÛÙ ‰ÂÓ ÚÔηÏ› ÚÒÈÌË ·ıËÚÔÛÎÏ‹ÚˆÛË. ™ÙË ‰˘ÛÏÈȉ·ÈÌ›· Ù‡Ô˘ πππ ı· ·Ó·Ì¤Ó·Ì ·Ó‡ÚÂÛË ·Ï·ÌÈ·›ˆÓ ‹ Ô˙Ò‰ˆÓ Í·ÓıˆÌ¿ÙˆÓ Î·È ÙÈ̤˜ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ÂÚ›Ô˘ ‰ÈÏ¿ÛȘ (Û mg/dl) ·fi ÙËÓ ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË. ∂›Û˘, ÁÈ· ÙËÓ ÂÎ-
‰‹ÏˆÛË Ù˘ ÓfiÛÔ˘ ··ÈÙÔ‡ÓÙ·È Û˘Ó‹ıˆ˜ Î·È ¿ÏÏÔÈ ÂÈ‚·Ú˘ÓÙÈÎÔ› ·Ú¿ÁÔÓÙ˜. ∏ ÓfiÛÔ˜ Tangier ¯·Ú·ÎÙËÚ›˙ÂÙ·È Û˘¯Ó¿ ·fi ÎÈÙÚÈÓÔÔÚÙÔηÏfi¯ÚÔ˜ ·Ì˘Á‰·Ï¤˜ (Û˘ÛÛÒÚ¢ÛË ¯ÔÏËÛÙÂÚfiÏ˘ ÛÙ· Ì·ÎÚÔÊ¿Á·), ÔÈ Ôԛ˜ Â‰Ò ·Ô˘ÛÈ¿˙Ô˘Ó. ™ÙËÓ ÎÏ·ÛÈ΋ ¤ÏÏÂÈ„Ë Ù˘ LCAT Î·È ÙË ÓfiÛÔ Fish Eye ˘¿Ú¯ÂÈ Û˘Ó‹ıˆ˜ ¯·Ú·ÎÙËÚÈÛÙÈ΋ ÎÏÈÓÈ΋ ÂÈÎfiÓ·, Ì ıÔÏÂÚfiÙËÙ· ÎÂÚ·ÙÔÂȉԇ˜ Î.·. ¶Èı·Ó‹ ‰È¿ÁÓˆÛË Â›Ó·È Û˘ÓÂÒ˜ Ë ÔÈÎÔÁÂÓ‹˜ ˘Ô·ÏÊ·ÏÈÔÚˆÙÂ˚Ó·ÈÌ›·.
¢È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· Ù˘ ÔÈÎÔÁÂÓÔ‡˜ ˘Ô·ÏÊ·ÏÈÔÚˆÙÂ˚Ó·ÈÌ›·˜ 1. ÷ÌËÏ¿ ›‰· HDL-¯ÔÏËÛÙÂÚfiÏ˘ ÛÙÔ Ï¿ÛÌ·. 2. ∞ÔÏÈÔÚˆÙ½ÓË ∞-π < 70 mg/dl. 3. ¶·ÚfiÌÔÈÔ˜ Ê·ÈÓfiÙ˘Ô˜ Û ‰‡Ô ÙÔ˘Ï¿¯ÈÛÙÔÓ ·ÎfiÌ· ̤ÏË Ù˘ ›‰È·˜ ÔÈÎÔÁ¤ÓÂÈ·˜. ¶Ú¿ÁÌ·ÙÈ, Ô ÂÓ ÏfiÁˆ ·ÛıÂÓ‹˜ ÏËÚÔ‡Û ۷ÊÒ˜ Ù· ‰‡Ô ÚÒÙ· ÎÚÈÙ‹ÚÈ·. ªÂÙ¿ ·fi ÂͤٷÛË ÙˆÓ ¿ÏÏˆÓ ÌÂÏÒÓ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ‚Ú¤ıËΠfiÙÈ Î·È ¿ÏÏ· 5 ̤ÏË (Ô ·Ù¤Ú·˜ ÙÔ˘, ‰‡Ô ·‰¤ÏÊÈ· Î·È ‰‡Ô ·Ó‹„È·) ÂÌÊ¿ÓÈ˙·Ó ÙÈ̤˜ apo A-π < 70 mg/dl (‚Ï. ™¯‹Ì· 1).
¶·ıÔÁÂÓÂÙÈ΋ ‚¿ÛË Î·È ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ Ù˘ ÔÈÎÔÁÂÓÔ‡˜ ˘Ô·ÏÊ·ÏÈÔÚˆÙÂ˚Ó·ÈÌ›·˜ ∏ ÓfiÛÔ˜ ÔÊ›ÏÂÙ·È Û ÌÂÙ¿ÏÏ·ÍË ÙÔ˘ ÁÔÓȉ›Ô˘ Ù˘ apo ∞-π, fiˆ˜ ·ÏÏ·Á‹ ÂÓfi˜ ·ÌÈÓÔͤԘ, nonsense ÌÂÙ·ÏÏ¿ÍÂȘ ‹ ‰ËÌÈÔ˘ÚÁ›· ÂÓfi˜ Έ‰ÈÎÔÓ›Ô˘ ÙÂÚÌ·ÙÈÛÌÔ‡. ∂Ó‰¤¯ÂÙ·È Ó· Ô‰ËÁ› Û ÂÏ¿ÙÙˆÛË Ù˘ ·Ú·ÁˆÁ‹˜ Ù˘ apo A-I ‹ Û ·˘ÍË̤ÓÔ Î·Ù·‚ÔÏÈÛÌfi Ù˘. ∏ ÁÂÓÂÙÈ΋ ·˘Ù‹ ÂÙÂÚÔÁ¤ÓÂÈ· ·ÓÙ·Ó·-
ATHIROSKLIROSI 9b 23-02-06 10:17 ™ÂÏ›‰·19
∂¡¢π∞º∂ƒ√¡ ¶∂ƒπ™∆∞∆π∫√ ™¯‹Ì· 1 °ÂÓ·ÏÔÁÈÎfi ‰¤Ó‰ÚÔ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ÙÔ˘ ·ÛıÂÓÔ‡˜. ªÂ ‚¤ÏÔ˜ ÛËÌÂÈÒÓÂÙ·È Ô ›‰ÈÔ˜. ∏ ÛΛ·ÛË ÙÔ˘ ¿Óˆ ̤ÚÔ˘˜ ˘Ô‰ËÏÒÓÂÈ ·ıÔÏÔÁÈο ¯·ÌËÏ‹ HDL ¯ÔÏËÛÙÂÚfiÏË.
68 AEE
ÎÏ¿Ù·È Î·È ÛÙÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ: ¿ÏϘ ÌÂÙ·ÏÏ¿ÍÂȘ Â›Ó·È ˘Â‡ı˘Ó˜ ÁÈ· ÚÒÈÌË Î·Ú‰È·ÁÁÂȷ΋ ÓfiÛÔ, ¿ÏϘ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÂËÚ¿˙Ô˘Ó ÙÔÓ Î·Ú‰È·Îfi ΛӉ˘ÓÔ, ÂÓÒ ˘¿Ú¯ÂÈ Î·È Ì›· (Ë apoAMilano) Ë ÔÔ›· ‰Ú· ÚÔÛٷ٢ÙÈο. ™ÙÔÓ ¶›Ó·Î· 1 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÌÂÚÈΤ˜ ÂÓ‰ÂÈÎÙÈΤ˜ ÌÂ-
Ù·ÏÏ¿ÍÂȘ Î·È Ë Â›‰Ú·Û‹ ÙÔ˘˜ ÛÙÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ.
£Âڷ›· Ù˘ ÔÈÎÔÁÂÓÔ‡˜ ˘Ô·ÏÊ·ÏÈÔÚˆÙÂ˚Ó·ÈÌ›·˜ ∆· ˘ÁÈÂÈÓԉȷÈÙËÙÈο ̤ÙÚ· (ۈ̷ÙÈ΋ ¿ÛÎËÛË, ‰È·ÎÔ‹ ηӛ-
ÛÌ·ÙÔ˜ fiÔ˘ ˘¿Ú¯ÂÈ, ·ÒÏÂÈ· ‚¿ÚÔ˘˜ Â¿Ó ÎÚÈı› ·Ó·Áη›·) Â›Ó·È ··Ú·›ÙËÙ· Û fiϘ ÙȘ ÂÚÈÙÒÛÂȘ. ŸÙ·Ó ·˘Ù¿ ‰ÂÓ Â·ÚÎÔ‡Ó ¯ÔÚËÁÔ‡ÓÙ·È Ê¿Ú̷η Ô˘ ·˘Í¿ÓÔ˘Ó Ù· ›‰· Ù˘ HDL-¯ÔÏËÛÙÂÚfiÏ˘. ∆¤ÙÔÈ· Ê¿Ú̷η Â›Ó·È ÔÈ ÊÈ‚Ú¿Ù˜, ÙÔ ÓÈÎÔÙÈÓÈÎfi Ô͇ Î·È ÔÚÈṲ̂Ó˜ ÛÙ·Ù›Ó˜. ™Â ÔÚÈṲ̂Ó˜ ÂÚÈÙÒÛÂȘ ÌÔÚ› Ó· ¯ÚÂÈ·ÛÙ› Û˘Ó‰˘·ÛÌfi˜ Ê·Ú̿ΈÓ. √ Û˘ÁÎÂÎÚÈ̤ÓÔ˜ ·ÛıÂÓ‹˜ ¤Ï·‚Â Û˘Ó‰˘·ÛÌfi ÛÙ·Ù›Ó˘ Î·È ÊÈ‚Ú¿Ù˘. ™Â Ó¤Ô ¤ÏÂÁ¯Ô ÔÈ ÙÈ̤˜ ÙˆÓ ÏÈȉ·ÈÌÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ ÙÔ˘ ›¯·Ó ‰È·ÌÔÚʈı› ˆ˜ ÂÍ‹˜: ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË 152 mg/dl, ÙÚÈÁÏ˘ÎÂÚ›‰È· 160 mg/dl, HDL-C 38 mg/dl, LDL-C 82 mg/dl, apo A-I 119 mg/dl, apo B 81 mg/dl Î·È Lp (a) 9 mg/dl, ¤¯ÂÈ ÂÙ‡¯ÂÈ ‰ËÏ·‰‹ ۯ‰fiÓ ÙȘ ÙÈ̤˜ ÛÙfi¯Ô˘˜. ∏ ÎÏÈÓÈ΋ ÙÔ˘ ηٿÛÙ·ÛË ¤ÎÙÔÙ ·Ú·Ì¤ÓÂÈ ÛÙ·ıÂÚ‹ Î·È Û ÛÙÂÊ·ÓÈÔÁÚ·ÊÈÎfi ·ӤÏÂÁ¯Ô 9 ¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ·ÁˆÁ‹˜ Ë ÂÈÎfiÓ· ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÁÁ›ˆÓ ÙÔ˘ ‰ÂÓ Â›¯Â ·ÚÔ˘ÛÈ¿ÛÂÈ ÌÂÙ·‚ÔϤ˜.
¶›Ó·Î·˜ 1 ªÂÚÈΤ˜ ÂÓ‰ÂÈÎÙÈΤ˜ ÌÂÙ·ÏÏ¿ÍÂȘ Ù˘ apoA ÛÙËÓ ÔÈÎÔÁÂÓ‹ ˘Ô·ÏÊ·ÏÈÔÚˆÙÂ˚Ó·ÈÌ›· 184delC
Stop codon at 200
ÕÁÓˆÛÙË Â›‰Ú·ÛË ÛÙË ™¡
Yokota et al, 2002
Fin
Arg159_ Leu
∫·Ì›· ›‰Ú·ÛË ÛÙË ™¡
Miettinen et al, 1997
Iowa
Gly26_ Arg
ÕÁÓˆÛÙË Â›‰Ú·ÛË ÛÙË ™¡ (∞Ì˘ÏÔ›‰ˆÛË)
Rader et al, 1992
L178P
Leu178_ Pro
¶ÚfiˆÚË ™¡
Hovingh et al, 2004
Milano
Arg173_ Cys
¶ÚÔÛÙ·Û›· ·fi ™¡
Roma et al, 1993
Nichinan
Glu235_ 0
ÕÁÓˆÛÙË Â›‰Ú·ÛË ÛÙË ™¡
Han et al, 1999
Oita
Val156_ Glu
ÕÁÓˆÛÙË Â›‰Ú·ÛË ÛÙË ™¡
Huang et al, 1998
Oslo
Arg160_ Leu
ÕÁÓˆÛÙË Â›‰Ú·ÛË ÛÙË ™¡
Leren et al, 1997
Paris
Arg151_ Cys
∫·Ì›· ›‰Ú·ÛË ÛÙË ™¡
Bruckert et al, 1997
Pisa
Leu141_ Arg
¶ÚfiˆÚË ™¡
Miccoli et al, 1996
Q[-2]X
Nonsense codon at [-2]
¶ÚfiˆÚË ™¡
Ng et al, 1994
Q32X
Nonsense codon at 32
∫·Ì›· ›‰Ú·ÛË ÛÙË ™¡
Romling et al, 1994
Q5FsX11
Stop codon at 85
ÕÁÓˆÛÙË Â›‰Ú·ÛË ÛÙË ™¡
Pisciotta et al, 2003
Shinbashi
Stop codon at 178
¶ÚfiˆÚË ™¡
Ikewaki et al, 2004
Zavalla
Leu159_ Pro
ÕÁÓˆÛÙË Â›‰Ú·ÛË ÛÙË ™¡
Miller et al, 1998
µÈ‚ÏÈÔÁÚ·Ê›· 1.
Braunwald E, Zippes D, Libby P. Heart Disease. Textbook of Cardiovascular Medicine. 6th Ed. 2001, Saunders
2.
∫ÔÏÔ‚Ô‡ °, ∫fiÎÎÈÓÔ˜ ¢, ∆· ÏÈ›‰È· ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË. 2005, ∂Ή. ¶·ÚÈÛÈ¿ÓÔ˘.
3.
Batal R, Tremblay M, Krimbou L, Mamer O, Davignon J, Genest J Jr, Cohn JS. HDL deficiency characterized by hypercatabolism of mature apoA-I but not
risk: the role of nicotinic acid – a position paper. Current Medical Research And Opinion 2004;20, (8): 1253–1268
proapoA-I. Arterioscler Thromb Vasc Biol. 1998 Apr;18(4):655-64. 4.
5.
Kolovou GD, Cokkinos DV. Low serum levels of high-density lipoprotein cholesterol and hypolipidaemic treatment. Curr Med Res Opin. 2002;18(5):265-8. European Consensus Panel on HDL-C. Raising high-density lipoprotein cholesterol with reduction of cardiovascular
6.
von Eckardstein A. Differential diagnosis of familial high density lipoprotein deficiency syndromes. Atherosclerosis. 2005 Dec 9; [Epub ahead of print]
19
ATHIROSKLIROSI 9b 23-02-06 10:18 ™ÂÏ›‰·20
·ıËÚÔÛÎÏ‹ÚˆÛË MAƒ∆π√™
2006
∞ÛıÂÓ‹˜ ÌÂ Ã˘ÏÔÌÈÎÚÔÓ·ÈÌ›· ∂ÈÚ‹ÓË °·˙‹, ∂ÈÛÙËÌoÓÈÎfi˜ ™˘ÓÂÚÁ¿Ù˘ π·ÙÚ›Ԣ §Èȉ›ˆÓ ∂˘¿ÁÁÂÏÔ˜ §˘ÌÂÚfiÔ˘ÏÔ˜, ¶·ıÔÏfiÁÔ˜, ¢È‰¿ÎÙˆÚ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ªˆ˘Û‹˜ ∂ÏÈÛ¿Ê, ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜
¶·ÚÔ˘Û›·ÛË ÂÚÈÛÙ·ÙÈÎÔ‡ ÕÓ‰Ú·˜ ËÏÈΛ·˜ 32 ÂÙÒÓ ÚÔÛ¤Ú¯ÂÙ·È ÛÙÔ È·ÙÚÂ›Ô Ì ÈÛÙÔÚÈÎfi ˘ÔÙÚÔÈ·˙fiÓÙˆÓ ÎÔÈÏÈ·ÎÒÓ ·ÏÁÒÓ ·fi ÙËÓ ·È‰È΋ ËÏÈΛ· Î·È Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË ÚfiÛÊ·Ù˘ ¤Ó·Ú͢. √ ·ÛıÂÓ‹˜ ¤·ÈÚÓ ÌÂÙÊÔÚÌ›ÓË 850 mg b.i.d Î·È ÁÂÌÊÈ‚ÚÔ˙›ÏË 900 mg/Ë̤ڷ. ™ÙË Ê˘ÛÈ΋ ÂͤٷÛË ‰È·ÈÛÙÒıËÎ·Ó ÂÍ·ÓıËÌ·ÙÈο (eruptive) Í·ÓıÒÌ·Ù· (∂ÈÎfiÓ· 1), ÂÓÒ ÛÙËÓ ÔÊı·ÏÌÔÛÎfiËÛË ‰È·ÈÛÙÒıËΠˆ¯ÚfiÙËÙ· ÙÔ˘ ‚˘ıÔ‡ Î·È ÏÂ˘Îˆ‹ ·fi¯ÚˆÛË ÙˆÓ ·ÁÁ›ˆÓ ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂȉԇ˜ (lipaemia retinalis) (∂ÈÎfiÓ· 2). ∆Ô ÛˆÌ·ÙÈÎfi ‚¿ÚÔ˜ ÙÔ˘ ‹Ù·Ó 99 kg. √ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍ ÁÏ˘Îfi˙Ë 310 mg/dl, TC 820 mg/dl, TRG 7000 mg/dl Î·È HDLC 24 mg/dl (ÏÈ·ÈÌÈÎfi˜ ÔÚfi˜, ∂ÈÎfiÓ· 3).
‰) ÔÈÎÔÁÂÓ‹˜ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· Ã˘ÏÔÌÈÎÚÔÓ·ÈÌ›· ‰ËÌÈÔ˘ÚÁÂ›Ù·È fiÙ·Ó: ·) Ë Û˘ÁΤÓÙÚˆÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ÓËÛÙ›·˜ Â›Ó·È >5.000 mg/dl ‚) Ë Û˘ÁΤÓÙÚˆÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ÓËÛÙ›·˜ Â›Ó·È >1.000 mg/dl Á) Ë Û˘ÁΤÓÙÚˆÛË Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ÓËÛÙ›·˜ Â›Ó·È >300 mg/dl ‰) Ë Û˘ÁΤÓÙÚˆÛË Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ÓËÛÙ›·˜ Â›Ó·È >600 mg/dl
‚) ›ÎÙËÙË ¯˘ÏÔÌÈÎÚÔÓ·ÈÌ›· (˘ÂÚÏÈȉ·ÈÌ›· Ù‡Ô˘ V) Á) ‰˘Û‚ËÙ·ÏÈÔÚˆÙÂïÓ·ÈÌ›·
·) Ë Î·Ù·Ó¿ÏˆÛË ÔÈÓÔÓ‡̷ÙÔ˜ ‚) Ë ¯ÔÚ‹ÁËÛË ‚-·ÔÎÏÂÈÛÙÒÓ Á) Ë ¯ÔÚ‹ÁËÛË ÔÈÛÙÚÔÁfiÓˆÓ ‰) Ô Û·Î¯·Ú҉˘ ‰È·‚‹Ù˘ Â) Ë ÚˆÙÔ·ı‹˜ ¯ÔÏÈ΋ ΛÚÚˆÛË ˙) Ë ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ·
‚) Û˘ÛÛÒÚ¢ÛË ¯˘ÏÔÌÈÎÚÒÓ Î·È VLDL
∏ ÔÈÎÔÁÂÓ‹˜ ¯˘ÏÔÌÈÎÚÔÓ·ÈÌ›· ÔÊ›ÏÂÙ·È ÛÂ:
Á) Û˘ÛÛÒÚ¢ÛË VLDL
·) ¤ÏÏÂÈ„Ë Ù˘ Ë·ÙÈ΋˜ ÏÈ¿Û˘
÷ڷÎÙËÚÈÛÙÈÎfi ÎÏÈÓÈÎfi ÁÓÒÚÈÛÌ· Ù˘ ÓfiÛÔ˘ ›ӷÈ: ·) Ë ‡·ÚÍË ·Ï·ÌÈ·›ˆÓ Í·ÓıˆÌ¿ÙˆÓ
‚) ¤ÏÏÂÈ„Ë Ù˘ ÏÈÔÚˆÙÂïÓÈ΋˜ ÏÈ¿Û˘ Á) ¤ÏÏÂÈ„Ë Ù˘ LCAT ‰) ÌÂȈ̤ÓË ‰Ú·ÛÙËÚÈfiÙËÙ· ÙˆÓ LDL ˘Ô‰Ô¯¤ˆÓ
‚) Ë ‡·ÚÍË ÙÂÓfiÓÙÈˆÓ Í·ÓıˆÌ¿ÙˆÓ ÛÙÔ˘˜ ·¯›ÏÏÂÈÔ˘˜ Ù¤ÓÔÓÙ˜
∂ÈÎfiÓ· 1. ∂Í·ÓıËÌ·ÙÈο (eruptive) Í·ÓıÒÌ·Ù· Û ·ÛıÂÓ‹ Ì ¯˘ÏÔÌÈÎÚÔÓ·ÈÌ›·.
20
ŸÏÔÈ ÔÈ ·Ú·Î¿Ùˆ ·Ú¿ÁÔÓÙ˜ ÌÔÚ› Ó· ÚÔηϤÛÔ˘Ó ÙË Ê·ÈÓÔÙ˘È΋ ¤ÎÊÚ·ÛË Ù˘ ÓfiÛÔ˘, ÂÎÙfi˜ ·fi:
·) Û˘ÛÛÒÚ¢ÛË ¯˘ÏÔÌÈÎÚÒÓ
∂ÚˆÙ‹ÛÂȘ
·) ÔÈÎÔÁÂÓ‹˜ ¯˘ÏÔÌÈÎÚÔÓ·ÈÌ›·
‰) Ë ‡·ÚÍË ˘Ô‰ÂÚÌ·ÙÈÎÒÓ Í·ÓıˆÌ¿ÙˆÓ
ÛÙ) Ë ·¯˘Û·ÚΛ· H ÓfiÛÔ˜ Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂ:
‰) Û˘ÛÛÒÚ¢ÛË LDL
∏ ÈÔ Èı·Ó‹ ‰È¿ÁÓˆÛË Â›Ó·È:
Á) Ë ‡·ÚÍË ÂÍ·ÓıËÌ·ÙÈÎÒÓ Í·ÓıˆÌ¿ÙˆÓ
∂ÈÎfiÓ· 2. Lipaemia retinalis Û ·ÛıÂÓ‹ Ì ¯˘ÏÔÌÈÎÚÔÓ·ÈÌ›·.
ATHIROSKLIROSI 9b 23-02-06 10:18 ™ÂÏ›‰·21
∂¡¢π∞º∂ƒ√¡ ¶∂ƒπ™∆∞∆π∫√ ™ÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ·ÛıÂÓ‹ ÙÔ ˘ÔÏÈȉ·ÈÌÈÎfi Ê¿ÚÌ·ÎÔ ÚÒÙ˘ ÂÎÏÔÁ‹˜ ›ӷÈ: ·) Ë ¯ÔÏÂÛÙ˘Ú·Ì›ÓË ‚) ÙÔ ÓÈÎÔÙÈÓÈÎfi Ô͇ Á) ÔÈ ÊÈÌÚ¿Ù˜ ‰) ÔÈ ÛÙ·Ù›Ó˜
™¯fiÏÈ·
Û˘ Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·ÂÏ¢ı¤ÚˆÛË ÙÔÈο ÂχıÂÚˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ Î·È Ï˘ÛÔÏÂÎÈı›Ó˘. ∞˘Ù¿ Ù· ÏÈ·Ú¿ Ôͤ· ‰ÚÔ˘Ó ÙÔÍÈο ÛÙȘ ΢ÙÙ·ÚÈΤ˜ ÌÂÌ‚Ú¿Ó˜ Î·È ·˘Í¿ÓÔ˘Ó ÙËÓ ÙÔÈ΋ ·ÂÏ¢ı¤ÚˆÛË ÏÈ¿Û˘ Ì ·ÔÙ¤ÏÂÛÌ· ÙË ‰ËÌÈÔ˘ÚÁ›· ÂÓfi˜ Ê·‡ÏÔ˘ ·ÎÏÔ˘ Ô˘ Ô‰ËÁ› Û ÊÏÂÁÌÔÓ‹ ÙÔ˘ ·ÁÎÚ·ÙÈÎÔ‡ ÈÛÙÔ‡. ∆Ë ÛÙÈÁÌ‹ Ù˘ ‰È¿ÁÓˆÛ˘ Ô ÔÚfi˜ ÙÔ˘ ·ÛıÂÓ‹ Â›Ó·È ÏÈ·ÈÌÈÎfi˜ Î·È Ë Û˘ÁΤÓÙÚˆÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ Û˘Ó‹ıˆ˜ ÍÂÂÚÓ¿ÂÈ Ù· 1.000 ‹ 2.000 mg/dl (∂ÈÎfiÓ· 3). To ¿ÏÏÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÎÏÈÓÈÎfi ÁÓÒÚÈÛÌ· Ù˘ ÓfiÛÔ˘ Â›Ó·È Ë ÂÌÊ¿ÓÈÛË ÙˆÓ ÂÍ·ÓıËÌ·ÙÈÎÒÓ (eruptive) Í·ÓıˆÌ¿ÙˆÓ (∂ÈÎfiÓ· 1). ¶ÚfiÎÂÈÙ·È ÁÈ· ÌÈÎÚ¤˜ ÎÈÙÚÈÓˆ-
∏ ÔÈÎÔÁÂÓ‹˜ ¯˘ÏÔÌÈÎÚÔÓ·ÈÌ›· ·ÊÔÚ¿ Ì›· Û¿ÓÈ· ÁÂÓÂÙÈ΋ ‰È·Ù·Ú·¯‹, Ë ÔÔ›· ÎÏËÚÔÓÔÌÂ›Ù·È Ì ·˘ÙÔÛˆÌÈÎfi ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú·. ÷ڷÎÙËÚ›˙ÂÙ·È ·fi ÙËÓ ·ÚÔ˘Û›· Ôχ ˘„ËÏÒÓ Û˘ÁÎÂÓÙÚÒÛÂˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ Ï¿ÛÌ·ÙÔ˜ ÓËÛÙ›·˜ (¿Óˆ ÙˆÓ 1.000 mg/dl). H ·‡ÍËÛË ·˘Ù‹ ÔÊ›ÏÂÙ·È ÛÙË Û˘ÛÛÒÚ¢ÛË ¯˘∂ÈÎfiÓ· 3. §È·ÈÌÈÎfi˜ ÔÚfi˜ Û ·ÛıÂÓ‹ Ì ÏÔÌÈÎÚÒÓ. ∏ ·ÚÈ· ¯˘ÏÔÌÈÎÚÔÓ·ÈÌ›·. ˘ÔΛÌÂÓË ÁÂÓÂÙÈ΋ ‰È·Ù·Ú·¯‹ ·ÊÔÚ¿ ÙËÓ ·Ó¿ÚÎÂÈ· ‹ ÙËÓ Ï‹ÚË ·Ô˘Û›· Ù˘ ÏÈÔÚˆÙÂïÓÈ΋˜ ÏÈ¿Û˘, Ë ÔÔ›· Â›Ó·È ··Ú·›ÙËÙË ÁÈ· ÙÔÓ Î·Ù·‚ÔÏÈÛÌfi ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ÙˆÓ ¯˘ÏÔÌÈÎÚÒÓ Î·È ÙˆÓ VLDL (∂ÈÎfiÓ· 4). ™·ÓÈfiÙÂÚ· Ë ÓfiÛÔ˜ ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È Û ·Ó¿ÚÎÂÈ· ‹ Ï‹ÚË ·Ô˘Û›· Ù˘ ·ÔÏÈÔÚˆÙ½Ó˘ C-II, Ë ÔÔ›· Â›Ó·È ¤˜ ÎËÏ›‰Â˜ Ô˘ ÂÚÈ‚¿ÏÏÔÓÙ·È ··Ú·›ÙËÙÔ Û˘Ó¤Ó˙˘ÌÔ ÁÈ· ÙËÓ ·fi ÂÚ˘ıËÌ·ÙÒ‰Ë ¿Ïˆ Î·È ·Ó¢ÂÓÂÚÁÔÔ›ËÛË Ù˘ ÏÈÔÚˆÙÂïÓÈÚ›ÛÎÔÓÙ·È ÛÙÔ˘˜ ÁÏÔ˘ÙÔ‡˜, ÛÙË Î‹˜ ÏÈ¿Û˘. ™Ù· Ê˘ÛÈÔÏÔÁÈο Ú¿¯Ë Î·È ÛÙȘ ÂÎÙ·ÙÈΤ˜ ÂÈÊ¿¿ÙÔÌ·, Ù· ¯˘ÏÔÌÈÎÚ¿ ηٷ‚ÔÏ›ÓÂȘ ÙˆÓ ¿ÎÚˆÓ (ÛËÌ›· ›Â˙ÔÓÙ·È ÁÚ‹ÁÔÚ· ·fi ÙË ÏÈÔÚˆÛ˘). ∆· Í·ÓıÒÌ·Ù· ·˘Ù¿ ÔÊ›ÙÂïÓÈ΋ ÏÈ¿ÛË Î·È ¤ÙÛÈ ‰ÂÓ ˘¿ÚÏÔÓÙ·È ÛÙËÓ ÂÓ·fiıÂÛË ÌÂÁ¿ÏˆÓ ¯Ô˘Ó ÛÙÔ Ï¿ÛÌ· ÌÂÙ¿ ·fi 12 ÔÛÔÙ‹ÙˆÓ ÏÈȉ›ˆÓ ÛÙ· ÈÛÙÈο ÒÚ˜ ÓËÛÙ›·˜. ∞ÓÙ›ıÂÙ· Û ̷ÎÚoÊ¿Á· ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ Î·È ·ÛıÂÓ›˜ Ô˘ Â›Ó·È ÔÌÔ˙˘ÁÒÙ˜ Û˘Ó‹ıˆ˜ Û˘Ó‰˘¿˙ÔÓÙ·È Ì ÙÈ̤˜ fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ·Ó¿ÚÎÂÈ· ·˘ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ÔÚÔ‡ ÌÂÁ·Ï‡ÙÂÙÔ‡ ÙÔ˘ ÂÓ˙‡ÌÔ˘, Ù· ¯˘ÏÔÌÈÎÚ¿ Ú˜ ·fi 2.000 mg/dl. ·Ó¢ڛÛÎÔÓÙ·È ÛÙÔ Ï¿ÛÌ· ·Ú∏ ÂÓ·fiıÂÛË ¯˘ÏÔÌÈÎÚÒÓ ÎÂÙ¤˜ Ë̤Ú˜ ÌÂÙ¿ ÙËÓ Î·Ù·Ó¿ÛÙ· Ì·ÎÚÔÊ¿Á· Ùo˘ ‰ÈÎÙ˘ÔÂÓψÛË ÂÓfi˜ ÏÈ·ÚÔ‡ Á‡̷ÙÔ˜. ‰ÔıËÏÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÌÔÚ› ∏ ÓfiÛÔ˜ ÂΉËÏÒÓÂÙ·È Û˘Ó‹Ó· ÚÔηϤÛÂÈ Ë·ÙÔÌÂÁ·Ï›·, ıˆ˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ· Ì ˘ÔÛÏËÓÔÌÂÁ·Ï›· Î·È ‰È‹ıËÛË ÙÔ˘ ÙÚÔÈ¿˙ÔÓÙ· ÎÔÈÏȷο ¿ÏÁË, Ù· Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ·fi ÏÈÒ‰Ë ÔÔ›· ÔÊ›ÏÔÓÙ·È Û ÂÂÈÛfi‰È· ·ÙÙ·Ú·. ™ÙËÓ ÔÊı·ÏÌÔÛÎfiËÛË ÔÍ›·˜ ·ÁÎÚ·ٛÙȉ·˜. ∫·Ù¿ ÙË Ô ‚˘ıfi˜ ·ÚÔ˘ÛÈ¿˙ÂÙ·È ˆ¯Úfi˜, ‰È¤Ï¢ÛË ÙˆÓ ¯˘ÏÔÌÈÎÚÒÓ ·fi ÙË ÂÓÒ Ù· ·ÁÁ›· ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÌÈÎÚÔ΢ÎÏÔÊÔÚ›· ÙÔ˘ ·ÁÎÚ¤·Âȉԇ˜ ÏÂ˘Î¿ (lipaemia retinalis). ÙÔ˜, ·˘Ù¿ ÂÎÙ›ıÂÓÙ·È Û ÌÈÎÚ¤˜ (∂ÈÎfiÓ· 2). ÔÛfiÙËÙ˜ ·ÁÎÚ·ÙÈ΋˜ ÏÈ¿-
∆¤ÏÔ˜ Ú¤ÂÈ Ó· ÂÈÛËÌ·Óı› fiÙÈ Ë ‰˘ÛÏÈȉ·ÈÌ›· Ù‡Ô˘ π ‰ÂÓ Û˘Ó‰˘¿˙ÂÙ·È Ì ·˘ÍË̤ÓË Â›ÙˆÛË ÚÒÈÌ˘ ·ıËڈ̷ÙÈ΋˜ ÓfiÛÔ˘. ∏ ‰È¿ÁÓˆÛË Ù˘ ¯˘ÏÔÌÈÎÚÔÓ·ÈÌ›·˜ Ù›ıÂÙ·È ·fi ÙËÓ ·ÚÔ˘Û›· ÏÈ·ÈÌÈÎÔ‡ ÔÚÔ‡ ‹ Ï¿ÛÌ·ÙÔ˜ Û ·ÈÌÔÏË„›· ÌÂÙ¿ ·fi ÓËÛÙ›· ÙÔ˘Ï¿¯ÈÛÙÔÓ 12 ˆÚÒÓ. ∞Ó Ì¿ÏÈÛÙ· Ë Û˘ÏÏÔÁ‹ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ Á›ÓÂÈ ·ÚÔ˘Û›· EDTA ˆ˜ ·ÓÙÈËÎÙÈÎÔ‡ Î·È ÙÔ ‰Â›ÁÌ· ‰È·ÙËÚËı› ÛÙÔ˘˜ 4ÆC fiÏË ÙË Ó‡¯Ù·, Ì›· ÏÂ˘Îˆ‹ ÎÚÂÌ҉˘ ÛÙÈ‚¿‰· ÂÌÊ·Ó›˙ÂÙ·È ÛÙÔ ¿Óˆ ̤ÚÔ˜, ÂÓÒ ÙÔ ˘ÔΛÌÂÓÔ Ï¿ÛÌ· Â›Ó·È ‰È·˘Á¤˜. ∫·Ù¿ ÙËÓ ËÏÂÎÙÚÔÊfiÚËÛË ÙˆÓ ÏÈÔÚˆÙÂïÓÒÓ Û Á¤ÏË ·Á·Úfi˙˘ ·Ú·ÙËÚÂ›Ù·È Ë ¯·Ú·ÎÙËÚÈÛÙÈ΋ Ì¿ÓÙ· ÙˆÓ ¯˘ÏÔÌÈÎÚÒÓ (Ê·ÈÓfiÙ˘Ô˜ Ù‡Ô˘ π). ∏ ‰È¿ÁÓˆÛË ÂȂ‚·ÈÒÓÂÙ·È Ì ÙËÓ ·‰˘Ó·Ì›· ·‡ÍËÛ˘ Ù˘ ÏÈÔÚˆÙÂïÓÈ΋˜ ÏÈ¿Û˘ ÌÂÙ¿ ·fi ÂÓ‰ÔÊϤ‚È· ¤Á¯˘ÛË Ë·Ú›Ó˘. ™Â Ê˘ÛÈÔÏÔÁÈο ¿ÙÔÌ· Ë Ë·Ú›ÓË ·ÂÏ¢ıÂÚÒÓÂÈ ÙË ÏÈÔÚˆÙÂïÓÈ΋ ÏÈ¿ÛË ·fi ÙȘ ı¤ÛÂȘ ‰¤ÛÌÂ˘Û‹˜ Ù˘ ÛÙ· ÙÚȯÔÂȉ‹, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·‡ÍËÛË Ù˘ Û˘ÁΤÓÙÚˆÛ˘ Î·È Ù˘ ÂÓÂÚÁfiÙËÙ¿˜ Ù˘ ÛÙÔ Ï¿ÛÌ·. ∏ ËÏÂÎÙÚÔÊfiÚËÛË ÙˆÓ ·ÔÏÈÔÚˆÙÂïÓÒÓ Ù˘ VLDL Ì ÙËÓ ÔÔ›· ·ÓȯÓ‡ÂÙ·È Ë Ê˘ÛÈÔÏÔÁÈ΋ Ì¿ÓÙ· Ù˘ ApoC-II ÌÔÚ› Ó· ·ÔÎÏ›ÛÂÈ ‹ Ó· ÂȂ‚·ÈÒÛÂÈ ÙËÓ ·Ó¿ÚÎÂÈ· ·˘Ù‹˜ Ù˘ ·ÔÏÈÔÚˆÙ½Ó˘. ™ÙËÓ ÙÂÏÂ˘Ù·›· ÂÚ›ÙˆÛË Ë ÌÂÙ¿ÁÁÈÛË Ê˘ÛÈÔÏÔÁÈÎÔ‡ Ï¿ÛÌ·ÙÔ˜ ÛÙÔÓ ·ÛıÂÓ‹ Ô‰ËÁ› Û ‰Ú·Ì·ÙÈ΋ Ì›ˆÛË ÙˆÓ ÂȤ‰ˆÓ ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ÙÔ˘ ÔÚÔ‡. ∆¤ÏÔ˜ Ú¤ÂÈ Ó· ÂÈÛËÌ·Óı› Ë ·ÚÂÌ‚ÔÏ‹ Ù˘ ÛÔ‚·Ú‹˜ ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›·˜ ÛÙȘ ‚ÈÔ¯ËÌÈΤ˜ ÌÂÙÚ‹ÛÂȘ ÛÙÔÓ ÔÚfi. ∆˘ÈÎfi ·Ú¿‰ÂÈÁÌ· Â›Ó·È Ë „¢‰Ô¸ÔÓ·ÙÚÈ·ÈÌ›· ·˘ÙÒÓ ÙˆÓ ·ÛıÂÓÒÓ, Ô˘ ·Ú·ÙËÚÂ›Ù·È Û˘¯ÓfiÙÂÚ· fiÙ·Ó Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙÔ˘ Ó·ÙÚ›Ô˘ Á›ÓÂÙ·È Ì ʷÛÌ·ÙÔʈÙÔÌÂÙÚ›·. ¶·ÚfiÌÔÈ· ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÂÌÊ·Ó›˙Ô˘Ó Î·È ÔÈ ·ÛıÂÓ›˜ Ì ˘ÂÚÏÈȉ·ÈÌ›· Ù‡Ô˘ V (›ÎÙË-
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ATHIROSKLIROSI 9b 23-02-06 10:18 ™ÂÏ›‰·22
·ıËÚÔÛÎÏ‹ÚˆÛË MAƒ∆π√™
2006
∂ÈÎfiÓ· 4. ™¯ËÌ·ÙÈ΋ ·ÂÈÎfiÓÈÛË Ù˘ ‰È·Ù·Ú·¯‹˜ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ Û ÔÈÎÔÁÂÓ‹ ¯˘ÏÔÌÈÎÚÔÓ·ÈÌ›· (˘ÂÚÏÈÔÚˆÙÂïÓ·ÈÌ›· Ù‡Ô˘ π).
∂ÈÎfiÓ· 5. ™¯ËÌ·ÙÈ΋ ·ÂÈÎfiÓÈÛË Ù˘ ‰È·Ù·Ú·¯‹˜ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ Û ›ÎÙËÙË ¯˘ÏÔÌÈÎÚÔÓ·ÈÌ›· (˘ÂÚÏÈÔÚˆÙÂïÓ·ÈÌ›· Ù‡Ô˘ V)
ÙË ¯˘ÏÔÌÈÎÚÔÓ·ÈÌ›·). A˘ÙÔ› ÔÈ ·ÛıÂÓ›˜ ÂÌÊ·Ó›˙Ô˘Ó Ì›· ÂÓ‰ÔÁÂÓ‹ ‰È·Ù·Ú·¯‹ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ ÏÔ‡ÛÈˆÓ ÛÙ· ÙÚÈÁÏ˘ÎÂÚ›‰È· ÏÈÔÚˆÙÂïÓÒÓ Î·È ·˘ÍË̤ӷ ›‰· ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ÓËÛÙ›·˜ (∂ÈÎfiÓ· 5). ¢È¿ÊÔÚÔÈ ÂÚÈ‚·ÏÏÔÓÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ (·¯˘Û·ÚΛ·, ‰È·ÈÙËÙÈΤ˜ ·ÚÂÎÙÚÔ¤˜, Ê¿Ú̷η fiˆ˜ Ù· ÚÂÙÈÓÔÂÈ-
22
‰‹, ÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜, Ù· ÔÈÛÙÚÔÁfiÓ·, Ë Ù·ÌÔÍÈÊ·›ÓË Î·È Ë ÈÓÙÂÚÊÂÚfiÓË, ۷ί·Ú҉˘ ‰È·‚‹Ù˘, ηıÒ˜ Î·È Î·Ù·Ó¿ÏˆÛË ÔÈÓÔÓ‡̷ÙÔ˜) Ô‰ËÁÔ‡Ó Û ÂÚ·ÈÙ¤Úˆ Âȉ›ӈÛË ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ ÏÔ‡ÛÈˆÓ Û ÙÚÈÁÏ˘ÎÂÚ›‰È· ÏÈÔÚˆÙÂïÓÒÓ Ì ·ÔÙ¤ÏÂÛÌ· ÙË Ê·ÈÓÔÙ˘È΋ ¤ÎÊÚ·ÛË Ù˘ ÓfiÛÔ˘ Î·È ÙȘ ÂÈÏÔΤ˜ Ù˘.
∏ ‰È¿ÁÓˆÛË Ù˘ ›ÎÙËÙ˘ ¯˘ÏÔÌÈÎÚÔÓ·ÈÌ›·˜ Ù›ıÂÙ·È ·fi ÙËÓ ·ÚÔ˘Û›· ıÔÏÂÚÔ‡ ‹ Î·È ÏÈ·ÈÌÈÎÔ‡ ÔÚÔ‡ ÌÂÙ¿ ·fi 12 ÒÚ˜ ÓËÛÙ›·˜ Û ·ÛıÂÓ‹ Ì ·ÚÓËÙÈÎfi ·ÙÔÌÈÎfi Î·È ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ¯˘ÏÔÌÈÎÚÔÓ·ÈÌ›·˜. ∂›Û˘ Ë ÂÓÂÚÁfiÙËÙ· Ù˘ ÏÈÔÚˆÙÂïÓÈ΋˜ ÏÈ¿Û˘ Â›Ó·È Û˘Ó‹ıˆ˜ Ê˘ÛÈÔÏÔÁÈ΋, Û ·ÓÙ›ıÂÛË Ì ÙËÓ ˘ÂÚÏÈȉ·ÈÌ›· Ù‡Ô˘ π. ™Â ·ÛıÂÓ›˜ Ì ÔÈÎÔÁÂÓ‹ ¯˘ÏÔÌÈÎÚÔÓ·ÈÌ›· Ú¤ÂÈ Ó· ηٷ‚¿ÏÏÂÙ·È Î¿ı ‰˘Ó·Ù‹ ÚÔÛ¿ıÂÈ· ÁÈ· Ó· ‰È·ÙËÚËıÔ‡Ó Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È· ÓËÛÙ›·˜ οو ·fi 1000 mg/dl, ÒÛÙ ӷ ÌÂȈı› Ô Î›Ó‰˘ÓÔ˜ ÂÌÊ¿ÓÈÛ˘ ÔÍ›·˜ ·ÁÎÚ·ٛÙȉ·˜. ŒÙÛÈ, Û˘ÓÈÛÙ¿Ù·È Ô ÛËÌ·ÓÙÈÎfi˜ ÂÚÈÔÚÈÛÌfi˜ Ù˘ ηٷӿψÛ˘ Ï›Ô˘˜ (<20 g ËÌÂÚËÛ›ˆ˜), Ô˘ Ú·ÎÙÈο ÛËÌ·›ÓÂÈ Ì›· ÂχıÂÚË Ï›Ô˘˜ ‰›·ÈÙ·, ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÔÊ¢¯ı› Ë ‰ËÌÈÔ˘ÚÁ›· ¯˘ÏÔÌÈÎÚÒÓ. √È ˘‰·Ù¿ÓıڷΘ Î·È ÔÈ ÚˆÙ½Ó˜ Ú¤ÂÈ Ó· ˘ÔηٷÛÙ‹ÛÔ˘Ó Ù· Ï›Ë ˆ˜ ËÁ‹ ÂÓ¤ÚÁÂÈ·˜ Û ÌË ·¯‡Û·ÚÎÔ˘˜ ·ÛıÂÓ›˜. ∂›Û˘, Ë ‰›·ÈÙ· Ú¤ÂÈ Ó· Û˘ÌÏËÚÒÓÂÙ·È Ì ÏÈÔ‰È·Ï˘Ù¤˜ ‚Èٷ̛Ә. ™Â ÂÚ›ÙˆÛË Ï‹ÚÔ˘˜ ¤ÏÏÂȄ˘ Ù˘ ÏÈÔÚˆÙÂ˚ÓÈ΋˜ ÏÈ¿Û˘, Ë Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ ‰ÂÓ ¤¯ÂÈ Î·Ó¤Ó· ÚfiÏÔ. ™Â ·ÛıÂÓ›˜ Ì ›ÎÙËÙË ¯˘ÏÔÌÈÎÚÔÓ·ÈÌ›· ÚˆÙ‡ÔÓÙ· ÚfiÏÔ ÛÙË ıÂڷ›· ¤¯ÂÈ, ÂÎÙfi˜ ·fi ÙȘ ‰È·ÈÙËÙÈΤ˜ Ô‰ËÁ›Â˜, Ë ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÚԉȷıÂÛÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Ô˘ Û˘Ì‚¿ÏÏÔ˘Ó ÛÙË Ê·ÈÓÔÙ˘È΋ ¤ÎÊÚ·ÛË Ù˘ ÓfiÛÔ˘. ŒÙÛÈ, Ë ·ÒÏÂÈ· ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜ Û ·¯‡Û·ÚÎÔ˘˜ ·ÛıÂÓ›˜, Ë Ú‡ıÌÈÛË ÙÔ˘ ۷ί¿ÚÔ˘ Û ‰È·‚ËÙÈÎÔ‡˜ ·ÛıÂÓ›˜, Ë ‰È·ÎÔ‹ ÙÔ˘ ÔÈÓÔÓ‡̷ÙÔ˜, ηıÒ˜ Î·È Ë ‰È·ÎÔ‹-·Ó Â›Ó·È ‰˘Ó·Ùfi- ÙˆÓ Ê·ÚÌ¿ÎˆÓ ÂÎÂ›ÓˆÓ Ô˘ ÂËÚ¿˙Ô˘Ó ÙÔ ÌÂÙ·‚ÔÏÈÛÌfi ÙˆÓ ÏÔ‡ÛÈˆÓ Û ÙÚÈÁÏ˘ÎÂÚ›‰È· ÏÈÔÚˆÙÂ˚ÓÒÓ ‚ÔËıÔ‡Ó ÛËÌ·ÓÙÈο ÛÙË Ì›ˆÛË ÙˆÓ ÂȤ‰ˆÓ ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ÙÔ˘ ÔÚÔ‡. ∆¤ÏÔ˜, Û ·ÛıÂÓ›˜ Ì ›ÎÙËÙË ¯˘ÏÔÌÈÎÚÔÓ·ÈÌ›· ÔÈ ÊÈÌÚ¿Ù˜ ·ÔÙÂÏÔ‡Ó Ù· Ê¿Ú̷η ÚÒÙ˘ ÂÈÏÔÁ‹˜.
ATHIROSKLIROSI 9b 23-02-06 10:18 ™ÂÏ›‰·23
∂¡¢π∞º∂ƒ√¡ ¶∂ƒπ™∆∞∆π∫√
£ÚÔÌ‚ÔÂÓ›· Û ∞ÛıÂÓ›˜ Ô˘ ¶·›ÚÓÔ˘Ó ∏·Ú›ÓË (HIT) ª·Ú›· ¢È¿ÎÔ˘, ∂ÈÛÙËÌÔÓÈÎfi˜ ™˘ÓÂÚÁ¿Ù˘ µ' ¶·ıÔÏÔÁÈ΋˜ ∫ÏÈÓÈ΋˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ °ÂÓÈÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ πˆ·ÓÓ›ÓˆÓ
ªˆ˘Û‹˜ ∂ÏÈÛ¿Ê, ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜, ¢È¢ı˘ÓÙ‹˜ µ' ¶·ıÔÏÔÁÈ΋˜ ∫ÏÈÓÈ΋˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ °ÂÓÈÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ πˆ·ÓÓ›ÓˆÓ ∆Ô̤·˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ
ıÚÔÌ‚ÔÂÓ›· ÌÂÙ¿ ·fi Ë·ÚÈÓÔıÂڷ›· Â›Ó·È Ì›· ·ÓÔÛÔÏÔÁÈ΋ ·ÓÙ›‰Ú·ÛË Ô˘ ·Ú·ÙËÚÂ›Ù·È Û ·ÛıÂÓ›˜ Ô˘ ·›ÚÓÔ˘Ó Ë·Ú›ÓË (ÎÏ·ÛÈ΋ ‹ ¯·ÌËÏÔ‡ ÌÔÚÈ·ÎÔ‡ ‚¿ÚÔ˘˜) Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ıÚÔÌ‚ÔÂÓ›· Î·È ·ÚÙËÚȷΤ˜ Î·È Î˘Ú›ˆ˜ ÊÏ‚ÈΤ˜ ıÚÔÌ‚ÒÛÂȘ 1. °È· ·˘Ùfi ÙÔ ÏfiÁÔ ÔÓÔÌ¿˙ÂÙ·È Î·È Û‡Ó‰ÚÔÌÔ ÙÔ˘ ‘’Ï¢ÎÔ‡ ıÚfiÌ‚Ô˘’’ 2. ∆Ô Û‡Ó‰ÚÔÌÔ ·˘Ùfi ˘Ô‰È·ÁÈÁÓÒÛÎÂÙ·È ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË, ÂÓÒ ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· ·Ú·ÙËÚÂ›Ù·È Û¯ÂÙÈο Û˘¯Ó¿ Ì ̛· ›وÛË 1-5% Û ·ÛıÂÓ›˜ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ÎÏ·ÛÈ΋ Ë·Ú›ÓË 3,4,5 Î·È 0,5% Û ·ÛıÂÓ›˜ Ô˘ Ï·Ì‚¿ÓÔ˘Ó Ë·Ú›ÓË ¯·ÌËÏÔ‡ ÌÔÚÈ·ÎÔ‡ ‚¿ÚÔ˘˜ 4.
∏
¶·ıÔÁ¤ÓÂÈ· ∆Ô Û‡Ó‰ÚÔÌÔ ÚÔηÏÂ›Ù·È ·fi Ì›· ·ÓÔÛÔÏÔÁÈ΋ ·ÓÙ›‰Ú·ÛË Ô˘ ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂÎÙÂٷ̤ÓË ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ Î·È ÙˆÓ ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ÙË Ì·˙È΋ ·ÂÏ¢ı¤ÚˆÛË ıÚÔÌ‚›Ó˘ ÛÙËÓ Î˘ÎÏÔÊÔÚ›· 6. ŸÙ·Ó Ë Ë·Ú›ÓË ÂÈÛ¤Ú¯ÂÙ·È ÛÙËÓ Î˘ÎÏÔÊÔÚ›·, Ù· ·ÈÌÔÂÙ¿ÏÈ· ·ÂÏ¢ıÂÚÒÓÔ˘Ó ¤Ó· ÚˆÙÂ˚ÓÈÎfi ÌfiÚÈÔ, ÙÔÓ ·Ú¿ÁÔÓÙ· PF4 (Platelet factor 4). √ ·Ú¿ÁÔÓÙ·˜ ·˘Ùfi˜ ÛÂ Ê˘ÛÈÔÏÔÁÈο ¿ÙÔÌ· Ô˘ ‰ÂÓ ¤¯Ô˘Ó ÂÎÙÂı› Û ˷ڛÓË ‚Ú›ÛÎÂÙ·È ÛÙÔ Ï¿ÛÌ· Û Ôχ ÌÈÎÚ¤˜ ÔÛfiÙËÙ˜, ÂÓÒ ÌÂÙ¿ ÙËÓ ¤ÎıÂÛË Û ˷ڛÓË ·˘Í¿ÓÂÙ·È Î·Ù¿ 15-30 ÊÔÚ¤˜7. √ ·Ú¿ÁÔÓÙ·˜ PF4 ‰ËÌÈ-
Ô˘ÚÁ› Û‡ÌÏÂÁÌ· Ì ÙËÓ Ë·Ú›ÓË (PF4/Ë·Ú›ÓË).∆Ô Û‡ÌÏÂÁÌ· ·˘Ùfi ‚Ú›ÛÎÂÙ·È Â›Ù ÛÙÔ Ï¿ÛÌ· ›Ù ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ 1,3. ™Â ÔÚÈṲ̂ӷ ¿ÙÔÌ· fiÙ·Ó Ô ·Ú¿ÁÔÓÙ·˜ PF4 ·˘ÍËı› ÛÙÔ Ï¿ÛÌ· ·Ó·ÁÓˆÚ›˙ÂÙ·È ·fi ÙÔ ·ÓÔÛÔÏÔÁÈÎfi Û‡ÛÙËÌ· Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·Ú·ÁˆÁ‹ ·ÓÙÈÛˆÌ¿ÙˆÓ IgG 1,8. ∆· ·ÓÙÈÛÒÌ·Ù· ·˘Ù¿ Û˘Ó‰¤ÔÓÙ·È Ì ٷ Û˘ÌϤÁÌ·Ù· PF4/ Ë·Ú›Ó˘ Ô˘ ‚Ú›ÛÎÔÓÙ·È ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ Î·È ÙË Ì·˙È΋ ·Ú·ÁˆÁ‹ ıÚÔÌ‚›Ó˘ ·ÏÏ¿ Î·È ÙÔ˘ ·Ú¿ÁÔÓÙ· PF4. ∏ ·Ú·ÁˆÁ‹ ÙÔ˘ ·Ú¿ÁÔÓÙ· PF4 Ô‰ËÁ› Û ·Ó·ÙÚÔÊÔ‰fiÙËÛË ÙÔ˘ ηٷÚÚ¿ÎÙË (ıÂÙÈÎfi feedback) 1. √ Ì˯·ÓÈÛÌfi˜ ÂÓÂÚÁÔÔ›ËÛ˘ ÙˆÓ ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ Â›Ó·È ÏÈÁfiÙÂÚÔ ÁÓˆÛÙfi˜. ¶Èı·Ó¿ ÔÊ›ÏÂÙ·È Û ڈÙÂ˚ÓÈο ÌfiÚÈ· (Ë·Ú¿Ó˜) Ô˘ ‚Ú›ÛÎÔÓÙ·È ÛÙËÓ ÂÈÊ¿ÓÂÈ· ·˘ÙÒÓ ÙˆÓ Î˘ÙÙ¿ÚˆÓ Î·È ÌÔÈ¿˙Ô˘Ó Û ÌÔÚÈ·Îfi Â›Â‰Ô Ì ÙËÓ Ë·Ú›ÓË Ì ·ÔÙ¤ÏÂÛÌ· Ó· ·Ó·ÁÓˆÚ›˙ÔÓÙ·È ·fi ÙÔÓ ·Ú¿ÁÔÓÙ· PF4 Î·È Ó· ‰ËÌÈÔ˘ÚÁÔ‡Ó Û˘ÌϤÁÌ·Ù· ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙˆÓ ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ 1.
∫ÏÈÓÈ΋ ÂÈÎfiÓ· Î·È ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· À¿Ú¯Ô˘Ó ‰‡Ô Ù‡ÔÈ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. √ Ù‡Ô˜ π Â›Ó·È Û˘¯ÓfiÙÂÚÔ˜ (·Ú·ÙËÚÂ›Ù·È ÛÙÔ 5-30% ÙˆÓ ·ÙfiÌˆÓ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ıÂڷ›· Ì ˷ڛÓË) Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ‹È· ıÚÔÌ‚ÔÂÓ›· ¯ˆÚ›˜ ȉȷ›ÙÂÚË ÎÏÈÓÈ΋ ÛËÌ·Û›· Î·È Ô Ù‡Ô˜ ππ Ô˘ Â›Ó·È ÏÈÁfiÙÂÚÔ Û˘¯Ófi˜ (·Ú·ÙËÚ›ٷÈ
ÛÙÔ 1-5% ÙˆÓ ·ÙfiÌˆÓ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ıÂڷ›· Ì ˷ڛÓË) Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ Î·È ıÚÔÌ‚ÒÛÂȘ Û ÔÛÔÛÙfi 2050% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ì¤Û· Û ̛· ÂÚ›Ô‰Ô 30 ËÌÂÚÒÓ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜1,9. ™ÙËÓ Ù˘È΋ ÙÔ˘ ÌÔÚÊ‹ ÙÔ Û‡Ó‰ÚÔÌÔ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ıÚÔÌ‚ÔÂÓ›· (ÙÒÛË ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ >50% Ù˘ ·Ú¯È΋˜ ÙÈÌ‹˜10), Ë ÔÔ›· ÂÌÊ·Ó›˙ÂÙ·È Ì¤Û· Û ‰È¿ÛÙËÌ· 5-12 ËÌÂÚÒÓ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜ Ì ˷ڛÓË 3,4,11. ¶Ú¤ÂÈ Ó· ·Ó·ÊÂÚı› fiÙÈ Û ¤Ó· ÌÈÎÚfi ÔÛÔÛÙfi ·ÛıÂÓÒÓ Ë ıÚÔÌ‚ÔÂÓ›· ÂÌÊ·Ó›˙ÂÙ·È ÓˆÚ›ÙÂÚ· ·fi ÙËÓ ¤ÌÙË Ë̤ڷ ıÂڷ›·˜ Î·È Û˘Ó‹ıˆ˜ ÔÊ›ÏÂÙ·È Â›Ù Û ÚÔËÁÔ‡ÌÂÓË ıÂڷ›· Ì ˷ڛÓË Â›Ù ÛÙËÓ ¤ÎÏ˘ÛË ÙˆÓ ÊÏ‚ÈÎÒÓ Î·ıÂÙ‹ÚˆÓ Ì ˷ڛÓË, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ˘¿Ú¯Ô˘Ó ·ÓÙÈÛÒÌ·Ù· ηٿ ÙÔ˘ ·Ú¿ÁÔÓÙ· PF4. ∂›Û˘ ¤Ó· ÌÈÎÚfi ÔÛÔÛÙfi ·ÛıÂÓÒÓ Ô˘ ·˘Í¿ÓÂÙ·È Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÂÍ·ÈÙ›·˜ Ù˘ ¢·ÈÛıËÙÔÔ›ËÛ˘ ÙˆÓ È·ÙÚÒÓ ÂÌÊ·Ó›˙ÂÙ·È ÌÂÙ¿ ÙË ‰È·ÎÔ‹ Ù˘ ıÂڷ›·˜ Ì ˷ڛÓË 11 Î·È ÔÊ›ÏÂÙ·È Û ·ÓÙÈÛÒÌ·Ù· ηٿ ÙÔ˘ ·Ú¿ÁÔÓÙ· PF4 Ô˘ ‰ËÌÈÔ˘ÚÁ‹ıËÎ·Ó ·fi ÚÔËÁÔ‡ÌÂÓË ıÂڷ›· Ì ˷ڛÓË 4. Ÿˆ˜ ·Ó·Ê¤ÚıËÎÂ, ÙÔ Î‡ÚÈÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Â›Ó·È Ë ıÚÔÌ‚ÔÂÓ›· (Û ÔÛÔÛÙfi 90%). ∏ ÈÔ ÛÔ‚·Ú‹ ÂÈÏÔ΋ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Â›Ó·È ÔÈ ıÚÔÌ‚ÒÛÂȘ ÙˆÓ ·ÚÙËÚÈÒÓ Î·È ÙˆÓ ÊÏ‚ÒÓ Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È Û ÔÛÔÛÙfi 2050% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Ù‡Ô˘ ππ. √È ıÚÔÌ‚ÒÛÂȘ Û˘Ó‹ıˆ˜ ÂÌÊ·Ó›˙ÔÓÙ·È ÎÏÈÓÈο ˆ˜ Ó¢ÌÔÓÈΤ˜ ÂÌ‚Ô-
23
ATHIROSKLIROSI 9b 23-02-06 10:18 ™ÂÏ›‰·24
·ıËÚÔÛÎÏ‹ÚˆÛË MAƒ∆π√™
2006
Ϥ˜, ÈÛ¯·ÈÌ›· Î·È Á¿ÁÁÚ·ÈÓ· ÙˆÓ ¿ÎÚˆÓ Î·È ÔÊ›ÏÔÓÙ·È Û ·fiÊÚ·ÍË ÙˆÓ ÌÂÁ¿ÏˆÓ ·ÚÙËÚÈÒÓ Î·È ÈÔ Û¿ÓÈ· ˆ˜ ıÚÔÌ‚ˆÙÈο ÂÁÎÂÊ·ÏÈο ÂÂÈÛfi‰È· ‹ ÂÌÊÚ¿ÁÌ·Ù· ÙÔ˘ Ì˘Ôηډ›Ô˘1,3. ∞ÎfiÌ· ÈÔ Û¿ÓÈ· Â›Ó·È ‰˘Ó·Ùfi Ó· ·Ú·ÙËÚËı› ıÚfiÌ‚ˆÛË ÙˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ ÊÏ‚ÒÓ Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÛÔ‚·Úfi ÔÓÔΤʷÏÔ Î·È Ó¢ÚÔÏÔÁÈ΋ ÛËÌÂÈÔÏÔÁ›· Ô˘ ÂȉÂÈÓÒÓÂÙ·È ÚÔԉ¢ÙÈο ‹ ·ÎfiÌ· Î·È ÂÙÂÚfiÏ¢ÚË ‹ ·ÌÊÔÙÂÚfiÏ¢ÚË ıÚfiÌ‚ˆÛË ÙˆÓ ÊÏ‚ÒÓ ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ Ì ·ÔÙ¤ÏÂÛÌ· ÔÍ›· ÂÈÓÂÊÚȉȷ΋ ·Ó¿ÚÎÂÈ·1. Œ¯Ô˘Ó ›Û˘ ·Ó·ÊÂÚı› ÂÚÈÙÒÛÂȘ ÛÙȘ Ôԛ˜ ·Ú·ÙËÚÔ‡ÓÙ·È ‚Ï¿‚˜ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ ÛÙȘ ÂÚÈÔ¯¤˜ ÛÙȘ Ôԛ˜ Á›ÓÔÓÙ·È ÔÈ ÂÁ¯‡ÛÂȘ Ë·Ú›Ó˘, ÔÈ Ôԛ˜ ÌÔÚ› Ó· ÂÌÊ·Ó›˙ÔÓÙ·È ˆ˜ ·Ïfi ÂÚ‡ıËÌ· ‹ Î·È ‰ÂÚÌ·ÙÈΤ˜ ÓÂÎÚÒÛÂȘ. ¶ÂÚ›Ô˘ ÙÔ 1/4 ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ¤¯Ô˘Ó ·ÓÙÈÛÒÌ·Ù· HIT (·ÓÙÈÛÒÌ·Ù· ηٿ ÙÔ˘ ·Ú¿ÁÔÓÙ· PF4) Î·È ·›ÚÓÔ˘Ó ÂÓ‰ÔÊϤ‚È· bolus Ë·Ú›ÓË Û ‰È¿ÛÙËÌ· 5-30 ÏÂÙÒÓ ·fi ÙËÓ ¤Á¯˘ÛË ÂÌÊ·Ó›˙Ô˘Ó ÔÍ›· Û˘ÛÙËÌ·ÙÈ΋ ·ÓÙ›‰Ú·ÛË Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ˘ÚÂÙfi, Ú›ÁÔ˜, ·Ó·Ó¢ÛÙÈΤ˜ ‰È·Ù·Ú·¯¤˜, ˘¤ÚÙ·ÛË, ·ÌÓËÛ›· Î·È Û¿ÓÈ· ·Ó·Ó¢ÛÙÈ΋ ‹ ηډȷ΋ ·Ó¿ÚÎÂÈ·. ∏ ÔÍ›· Û˘ÛÙËÌ·ÙÈ΋ ·ÓÙ›‰Ú·ÛË ÔÊ›ÏÂÙ·È ÛÙ· ‹‰Ë ΢ÎÏÔÊÔÚÔ‡ÓÙ· ·ÓÙÈÛÒÌ·Ù· ηٿ ÙÔ˘ ·Ú¿ÁÔÓÙ· PF4. ª›· Ôχ Û¿ÓÈ· ·ÏÏ¿ ÛÔ‚·Ú‹ ÂÈÏÔ΋ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Â›Ó·È Ë ‰È¿¯˘ÙË ÂÓ‰·ÁÁÂȷ΋ ‹ÍË 1.
¢È¿ÁÓˆÛË ∏ ‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ‚·Û›˙ÂÙ·È ÙfiÛÔ ÛÙ· ÎÏÈÓÈο ÛËÌ›· Ù˘ ÓfiÛÔ˘ fiÛÔ Î·È ÛÙ· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù·. °È· Ó· ‰È·ÁÓˆÛı› ÙÔ Û‡Ó‰ÚÔÌÔ Ú¤ÂÈ Ó· ˘¿Ú¯ÂÈ: ·) ıÚÔÌ‚ÔÂÓ›· (Ú¤ÂÈ Ó· ·Ó·ÊÂÚı› fiÙÈ ÙÔ Û‡Ó‰ÚÔÌÔ Û ÌÈÎÚfi ÔÛÔÛÙfi ·Ú·ÙËÚÂ›Ù·È Î·È Û ¿ÙÔÌ· ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ·ÚÈıÌfi ·ÈÌÔÂÙ·Ï›ˆÓ 9), ‚) ÎÏÈÓÈο ÛËÌ›· ıÚfiÌ‚ˆÛ˘ Î·È Á) ·ÔÌfiÓˆÛË ·ÓÙÈÛˆÌ¿ÙˆÓ Î·Ù¿ ÙÔ˘ ·Ú¿ÁÔÓÙ· PF4 ÛÙÔ Ï¿ÛÌ· ÙÔ˘ ·ÛıÂÓÔ‡˜. √È È·ÙÚÔ› Ú¤ÂÈ Ó· ˘Ô„È¿˙ÔÓÙ·È ÙÔ Û‡Ó‰ÚÔÌÔ fiÙ·Ó ˘¿Ú¯ÂÈ ıÚÔÌ‚ÔÂÓ›· Ô˘ Û˘Ì›ÙÂÈ
24
¯ÚÔÓÈο Ì ÙË ¯ÔÚ‹ÁËÛË Ù˘ Ë·Ú›Ó˘ Î·È ‰ÂÓ ˘¿Ú¯ÂÈ ¿ÏÏÔ˜ ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ Ô˘ Ó· ÂÍËÁ› ÙË Ì›ˆÛË ÙÔÓ ·ÈÌÔÂÙ·Ï›ˆÓ. ∂›Û˘ Ú¤ÂÈ Ó· ·Ó·ÊÂÚı› fiÙÈ ÛÔ‚·Ú‹ ıÚÔÌ‚ÔÂÓ›· ÌÂ Û˘ÓÔ‰fi ·ÈÌÔÚÚ·Á›· ·ÔÌ·ÎÚ‡ÓÂÈ ·fi ÙË ‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘.
¢È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ∏ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Ú¤ÂÈ Ó· Á›ÓÂÙ·È ·fi ¿ÏϘ ·Èٛ˜ ıÚÔÌ‚ÔÂÓ›·˜ Î·È ıÚÔÌ‚ÒÛˆÓ, ηıÒ˜ Î·È ·fi ¿ÏϘ ÓÔÛÔÏÔÁÈΤ˜ ÔÓÙfiÙËÙ˜ Ì ·ÚfiÌÔÈ· ÎÏÈÓÈ΋ ÂÈÎfiÓ· (‰È¿¯˘ÙË ÂÓ‰·ÁÁÂȷ΋ ‹ÍË Ô˘ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ηÚΛÓÔ ‹ Ó¢ÌÔÓÈ΋ ÂÌ‚ÔÏ‹) 1. ∏ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Â›Ó·È Ôχ ÛËÌ·ÓÙÈ΋ ȉȷ›ÙÂÚ· ÛÙȘ ÂÚÈÙÒÛÂȘ Ù˘ ηı˘ÛÙÂÚË̤Ó˘ ÂÌÊ¿ÓÈÛ‹˜ ÙÔ˘ ÌÂÙ¿ ÙË ‰È·ÎÔ‹ Ù˘ Ë·Ú›Ó˘, ÛÙȘ Ôԛ˜ ·Ú·ÙËÚÔ‡ÓÙ·È ıÚÔÌ‚ÒÛÂȘ, Ô˘ ·Ó ·ÓÙÈÌÂÙˆÈÛıÔ‡Ó Ì ˷ڛÓË, ¤¯Ô˘Ó Ôχ η΋ ¤Î‚·ÛË.
£Âڷ›· ∏ ıÂڷ›· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Ú¤ÂÈ Ó· Â›Ó·È ¿ÌÂÛË Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ¿ÌÂÛË ‰È·ÎÔ‹ Ù˘ Ë·Ú›Ó˘ 1,6 Î·È ÙË ¯ÔÚ‹ÁËÛË ·Ó·ÛÙÔϤˆÓ Ù˘ ıÚÔÌ‚›Ó˘ 1,6. ¢‡Ô ÔÌ¿‰Â˜ ·ÓÙÈËÎÙÈÎÒÓ ¤¯Ô˘Ó ÌÂÏÂÙËı› ÁÈ· ÙË ıÂڷ›· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘, ÙÔ Ó·ÙÚÈÔ‡¯Ô ‰·Ó··ÚÔÂȉ¤˜ Î·È ÔÈ ¿ÌÂÛÔÈ ·Ó·ÛÙÔÏ›˜ Ù˘ ıÚÔÌ‚›Ó˘ ÏÂÈÚÔ˘‰›ÓË Î·È ·ÚηÙÚÔ¿Ó12. ∆Ô Ó·ÙÚÈÔ‡¯Ô ‰·Ó··ÚÔÂȉ¤˜ (Organan) ÌÂÙ·‚ÔÏ›˙ÂÙ·È ÛÙÔ˘˜ ÓÂÊÚÔ‡˜ Ì ·ÔÙ¤ÏÂÛÌ· Ó· ¯ÚÂÈ¿˙ÂÙ·È ·Ó·ÚÔÛ·ÚÌÔÁ‹ Ù˘ ‰fiÛ˘ Û ·ÛıÂÓ›˜ Ì ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ·. ¢›ÓÂÙ·È ˘Ô‰fiÚÈ·, ¤¯ÂÈ 100% ‚ÈԉȷıÂÛÈÌfiÙËÙ· Î·È ¤¯ÂÈ ÌÂÁ¿ÏÔ ¯ÚfiÓÔ ËÌÈ˙ˆ‹˜. ™˘ÓÈÛÙ¿Ù·È Ë ¯ÔÚ‹ÁËÛË ıÂڷ¢ÙÈ΋˜ ‰fiÛ˘ ÛÙÔ Û‡Ó‰ÚÔÌÔ Ù‡Ô˘ ππ . ∆Ô Û··ÛÌ· ·˘Ùfi ‰ÂÓ Î˘ÎÏÔÊÔÚ› ÛÙËÓ ∂ÏÏ¿‰·. ∏ ÏÂÈÚÔ˘‰›ÓË (Refludan), Â›Ó·È ¿ÌÂÛÔ˜ ·Ó·ÛÙÔϤ·˜ Ù˘
ıÚÔÌ‚›Ó˘ Î·È Â›Ó·È Ê¿ÚÌ·ÎÔ ÂÎÏÔÁ‹˜ Û ·ÛıÂÓ›˜ Ô˘ ‰ÂÓ ¤¯Ô˘Ó ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ· ÁÈ·Ù› ÌÂÙ·‚ÔÏ›˙ÂÙ·È ÛÙÔ˘˜ ÓÂÊÚÔ‡˜ 3,5. Œ¯ÂÈ ¯ÚfiÓÔ ËÌÈ˙ˆ‹˜ 80 ÏÂÙ¿ Î·È Ë ‰Ú¿ÛË ÙÔ˘ ÂϤÁ¯ÂÙ·È ‰È·Ì¤ÛÔ˘ Ù˘ ̤ÙÚËÛ˘ ÙÔ˘ aPTT, Ô ÔÔ›Ô˜ Ú¤ÂÈ Ó· Â›Ó·È 1,5-2,5 ÊÔÚ¤˜ ÙȘ ÙÈ̤˜ ÙÔ˘ Ì¿ÚÙ˘Ú· 7. ∏ Û˘Ó‹ı˘ ‰fiÛË Â›Ó·È 0,4 mg/kg ‚¿ÚÔ˘˜ ÂÓ‰ÔÊϤ‚È· Ô˘ ·ÎÔÏÔ˘ıÂ›Ù·È ·fi ÂÓ‰ÔÊϤ‚È· ¤Á¯˘ÛË 0,15 mg/kg/h 1 Û ·ÛıÂÓ›˜ Ì ۇӉÚÔÌÔ Ù‡Ô˘ ππ. ∆Ô Û··ÛÌ· ·˘Ùfi Â›Ó·È ÙÔ ÌÔÓ·‰ÈÎfi ·fi ÙÔ˘˜ ¿ÌÂÛÔ˘˜ ·Ó·ÛÙÔÏ›˜ Ù˘ ıÚÔÌ‚›Ó˘ Ô˘ ΢ÎÏÔÊÔÚÔ‡Ó ÛÙËÓ ∂ÏÏ¿‰·. ∆Ô ·ÚηÙÚÔ¿Ó (Novastan) Â›Ó·È ¿ÌÂÛÔ˜ ·Ó·ÛÙÔϤ·˜ Ù˘ ıÚÔÌ‚›Ó˘ Î·È Â›Ó·È Ê¿ÚÌ·ÎÔ ÂÎÏÔÁ‹˜ Û ·ÛıÂÓ›˜ Ì ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ· ÁÈ·Ù› ÌÂÙ·‚ÔÏ›˙ÂÙ·È ÛÙÔ ‹·Ú 3,5. Œ¯ÂÈ ¯ÚfiÓÔ ËÌÈ˙ˆ‹˜ ÌÈÎÚfiÙÂÚÔ ·fi ÙË ÏÂÈÚÔ˘‰›ÓË (40-50 vs 80 ÏÂÙ¿) Î·È Ë ‰Ú¿ÛË ÙÔ˘ ÂϤÁ¯ÂÙ·È Â›Û˘ ‰È·Ì¤ÛÔ˘ Ù˘ ̤ÙÚËÛ˘ ÙÔ˘ aPTT, Ô ÔÔ›Ô˜ Ú¤ÂÈ Ó· Â›Ó·È Î·Ù¿ 1.5-3 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔ˜ ·fi ÙȘ ·ÓÙ›ÛÙÔȯ˜ ÙÈ̤˜ ÙÔ˘ Ì¿ÚÙ˘Ú· 7. ∏ Û˘Ó‹ı˘ ‰fiÛË Â›Ó·È 2 Ìg/kg/min Î·È ‰ÂÓ ¯ÚÂÈ¿˙ÂÙ·È ·Ú¯È΋ ‰fiÛË ÂÊfi‰Ô˘ 3. ¢ÂÓ ˘¿Ú¯Ô˘Ó Ù˘¯·ÈÔÔÈË̤Ó˜ ÂÏÂÁ¯fiÌÂÓ˜ ÌÂϤÙ˜, ÔÈ Ôԛ˜ Ó· Û˘ÁÎÚ›ÓÔ˘Ó Ù· ÙÚ›· Ê¿Ú̷η. ∞fi ÔÚÈṲ̂Ó˜ ·ÓÔÈÎÙ¤˜ ÌÂϤÙ˜ Ê·›ÓÂÙ·È fiÙÈ ÔÈ ·ÛıÂÓ›˜ Ô˘ ·›ÚÓÔ˘Ó ÏÂÈÚÔ˘‰›ÓË ¤¯Ô˘Ó ÌÈÎÚfiÙÂÚÔ Î›Ó‰˘ÓÔ Ó· ·Ó·Ù‡ÍÔ˘Ó Ó¤Â˜ ıÚÔÌ‚ÒÛÂȘ, Ó· ˘ÔÛÙÔ‡Ó ·ÎÚˆÙËÚÈ·ÛÌÔ‡˜ ‹ Ó· Âı¿ÓÔ˘Ó Û ۇÁÎÚÈÛË Ì ·˘ÙÔ‡˜ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ·ÚηÙÚÔ¿Ó, ÂÓÒ ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ Ó· ÂÌÊ·Ó›ÛÔ˘Ó ·ÈÌÔÚÚ·Á›Â˜ Û ۇÁÎÚÈÛË Ì ·˘ÙÔ‡˜ Ô˘ ·›ÚÓÔ˘Ó ·ÚηÙÚÔ¿Ó 12. ∂‰Ò Ú¤ÂÈ Ó· ·Ó·ÊÂÚı› fiÙÈ ¤Ó· ÔÛÔÛÙfi 50% ÙˆÓ ·ÙfiÌˆÓ Ô˘ ·›ÚÓÔ˘Ó ÏÂÈÚÔ˘‰›ÓË ·Ó·Ù‡ÛÛÂÈ ·ÓÙÈÛÒÌ·Ù· Ù· ÔÔ›· ÌÔÚ› Ó· ·˘Í‹ÛÔ˘Ó ÙÔ ·ÓÙÈËÎÙÈÎfi ·ÔÙ¤ÏÂÛÌ· ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Î·È Ó· ÚÔηϤÛÔ˘Ó ·ÈÌÔÚÚ·Á›Â˜ 3,13. ∂›Û˘ Ê·›ÓÂÙ·È fiÙÈ ÙÔ Ó·ÙÚÈÔ‡¯Ô ‰·Ó··ÚÔÂȉ¤˜ ÂÓ¤¯ÂÈ ÌÈÎÚfiÙÂÚÔ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ·ÈÌÔÚÚ·ÁÈÒÓ. °È· ÙÔ ‰·Ó··ÚÔÂȉ¤˜ ·Ó·Ê¤ÚÂÙ·È fiÙÈ in vitro ¤¯ÂÈ ‰È·ÛÙ·˘ÚÔ‡ÌÂÓ˜ ·ÓÙȉڿÛÂȘ Ì ÙËÓ Ë·Ú›ÓË Û ÔÛÔÛÙfi 10-61%, ·ÏÏ¿ in
ATHIROSKLIROSI 9b 23-02-06 10:18 ™ÂÏ›‰·25
£∂ƒ∞¶∂π∞ – º∞ƒª∞∫∞ vivo ÙÔ ÔÛÔÛÙfi Â›Ó·È Ôχ ÌÈÎÚfiÙÂÚÔ (< 5%) 9. À¿Ú¯Ô˘Ó ÂÓ·ÏÏ·ÎÙÈΤ˜ ıÂڷ›˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘, fiˆ˜ Ë Ï·ÛÌ·Ê·›ÚÂÛË ÙȘ ÚÒÙ˜ Ù¤ÛÛÂÚȘ Ë̤Ú˜, ÔÈ ˘„ËϤ˜ ‰fiÛÂȘ Á-ÛÊ·ÈÚ›Ó˘, ÔÈ ADP ·ÓÙ·ÁˆÓÈÛÙ¤˜, Ë ·ÛÈÚ›ÓË, Ë ‰È˘Úȉ·ÌfiÏË, ÔÈ ‰ÂÍÙÚ¿Ó˜, Ù· ·Ó¿ÏÔÁ· ÚÔÛÙ·Î˘ÎÏ›Ó˘, Ë ıÚÔÌ‚ÔÏ˘ÙÈ΋ ıÂڷ›·, fiˆ˜ ›Û˘ Î·È Ë ıÚÔÌ‚ÔÂÌ‚ÔÏÂÎÙÔÌ‹ 9. ∏ ¯·ÌËÏÔ‡ ÌÔÚÈ·ÎÔ‡ ‚¿ÚÔ˘˜ Ë·Ú›ÓË ·ÓÙÂӉ›ÎÓ˘ÓÙ·È ÂÍ·ÈÙ›·˜ ÙÔ˘ ÁÂÁÔÓfiÙÔ˜ fiÙÈ ÚÔηÏ› ‰È·ÛÙ·˘ÚÔ‡ÌÂÓ˜ ·ÓÙȉڿÛÂȘ Ì ÙËÓ ÎÏ·ÛÈ΋ Ë·Ú›ÓË Û Ôχ ÌÂÁ¿ÏÔ ÔÛÔÛÙfi (80-
100%) 1,3,9. ∂›Û˘, ‰ÂÓ Û˘ÓÈÛÙÔ‡ÓÙ·È Ù· ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ·ÓÙÈËÎÙÈο, fiˆ˜ Ë ‚·ÚÊ·Ú›ÓË, ÛÙËÓ ÂÓÂÚÁfi Ê¿ÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Ù‡Ô˘ ππ, ÁÈ·Ù› ·˘Í¿ÓÂÙ·È Î·Ù¿ Ôχ Ë Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ Á¿ÁÁÚ·ÈÓ·˜ ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ
ÂÍ·ÈÙ›·˜ ÊÏ‚È΋˜ ıÚfiÌ‚ˆÛ˘. ªÔÚÔ‡Ó fï˜ Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó Û ÛÙ·ıÂÚ¤˜ ηٷÛÙ¿ÛÂȘ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Ù‡Ô˘ ππ, fiÙ·Ó ¤¯ÂÈ ·ÔηٷÛÙ·ı› Ë ·Ú·ÁˆÁ‹ Ù˘ ıÚÔÌ‚›Ó˘ 3,4,9,14.
¶ÚfiÁÓˆÛË ∆Ô Ù‡Ô˘ π Û‡Ó‰ÚÔÌÔ Â›Ó·È Î·ÏfiËı˜ Î·È ¤¯ÂÈ Ôχ ηϋ ÚfiÁÓˆÛË4. ∆Ô Û‡Ó‰ÚÔÌÔ Ù‡Ô˘ ππ ¤¯ÂÈ Ôχ η΋ ÚfiÁÓˆÛË, ·ÊÔ‡ ¤¯ÂÈ ÌÂÁ¿ÏË ıÓËÛÈÌfiÙËÙ· (30%), ÂÓÒ ¤Ó· ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ·ÛıÂÓÒÓ (20%) ı· ˘ÔÛÙ› ·ÎÚˆÙËÚÈ·ÛÌÔ‡˜ ÙˆÓ ¿ÎÚˆÓ 6. ∂‰Ò Ú¤ÂÈ Ó· ·Ó·ÊÂÚı› fiÙÈ ¿Ú· ÙËÓ ÔÔÈ·‰‹ÔÙ ıÂڷ›· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Ì ¤Ó· ·fi ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ·Ó·Ê¤ÚıËηÓ, ¤Ó· Ó¤Ô ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ·ÛıÂÓÒÓ (5-20%) ÂÌÊ·Ó›˙ÂÈ Ó¤Ô ÂÂÈÛfi‰ÈÔ ıÚfiÌ‚ˆÛ˘ 1.
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13. P. Eichler, H.J. Friesen, N. Lubenow, et al.. Antihirudin antibodies in patients with heparin-induced thrombocytopenia treated with lepirudin: incidence, effects on aPTT, and clinical relevance. Blood 2000; 96: 2373–2378 14. Srinivasan AF, Rice L, Bartholomew JR, et al. Warfarin-induced skin necrosis and venous limb gangrene in the setting of heparin-induced thrombocytopenia. Arch Intern Med 2004; 164:66–70 15. Sheth SB, DiCicco RA, Hursting MJ, et al. Interpreting the international normalized ratio (INR) in individuals receiving argatroban and warfarin. Thromb Haemost 2001; 85: 435–440. 16. Hirsh J, Heddle N, Kelton JK. Treatment of heparin-induced thrombocytopenia: a critical review. Arch Intern Med 2004: 23; 164(4): 361-9. 17. Cleveland KW. Argatroban, a new treatment option for heparin-induced thrombocytopenia. Crit Care Nurse 2003; 23(6): 61-6.
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ATHIROSKLIROSI 9b 23-02-06 10:18 ™ÂÏ›‰·26
·ıËÚÔÛÎÏ‹ÚˆÛË MAƒ∆π√™
2006
∂ÈıÂÙÈ΋ ∞ÓÙÈÌÂÙÒÈÛË Ù˘ ÷ÌËÏ‹˜ HDL - ¯ÔÏËÛÙÂÚfiÏ˘ ™˘ÌÂÚ¿ÛÌ·Ù· ¶ÚÔÁÂÓ¤ÛÙÂÚˆÓ ªÂÏ¤ÙˆÓ – H ªÂϤÙË ARBITER ¡›ÎÔ˜ ¢È·ÎÔ˘Ì¿ÎÔ˜, ∫·Ú‰ÈÔÏfiÁÔ˜ ¢È·ÁÓˆÛÙÈÎfi ∫·Ú‰ÈÔÏÔÁÈÎfi ∫¤ÓÙÚÔ ¶ÂÈÚ·È¿, ™˘ÓÂÚÁ¿Ù˘ ¡ÔÛÔÎÔÌ›Ԣ Metropolitan
ıÂڷ›· ÙˆÓ ‰˘ÛÏÈȉ·ÈÌÈÒÓ, Û‹ÌÂÚ· ηٿ ÙÔ Ï›ÛÙÔÓ Ì ÙȘ ÛÙ·Ù›Ó˜, ·ÔÙÂÏ› ¤Ó· ·fi Ù· ‚·ÛÈο ̤۷ Ì›ˆÛ˘ Ù˘ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÛÈÌfiÙËÙ·˜, ÙfiÛÔ ÛÙË ÚˆÙÔÁÂÓ‹, fiÛÔ Î·È ÙË ‰Â˘ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë Ù˘ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ (™¡). ∆· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ÎÏÈÓÈÎÒÓ ÌÂÏÂÙÒÓ, fiˆ˜ ÂΛӷ Ù˘ Scandinavian Simvastatin Survival Study (4S),1 ‰Â›¯ÓÔ˘Ó Ì›ˆÛË ÙÔ˘ Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÛÙÂÊ·ÓÈ·›· ÂÂÈÛfi‰È· ηٿ 30-35%, ¤Ó·ÓÙÈ ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘, ·ÏÏ¿ Â›Ó·È Ê·ÓÂÚfi fiÙÈ Ë ·Ú¯fiÌÂÓË ·fi ÙË ÌÔÓÔıÂڷ›· Ì ÛÙ·Ù›Ó˜ ηډȷÁÁÂȷ΋ ÚÔÛÙ·Û›·, Ì ·ÚÈÔ ·ÔÙ¤ÏÂÛÌ· ÙË Ì›ˆÛË Ù˘ LDL¯ÔÏËÛÙÂÚfiÏ˘ (LDL-C) Â›Ó·È ·Ó·Ú΋˜. º·›ÓÂÙ·È fiÙÈ ¯ÚÂÈ¿˙ÔÓÙ·È Ó¤Â˜ ÚÔÛÂÁÁ›ÛÂȘ. ª›· Ù¤ÙÔÈ· ÚÔÛ¤ÁÁÈÛË Â›Ó·È Ë ¯ÚËÛÈÌÔÔ›ËÛË ÈÛ¯˘ÚfiÙÂÚˆÓ ÛÙ·ÙÈÓÒÓ, Û ÌÂÁ·Ï‡ÙÂÚ˜ ‰fiÛÂȘ, ÁÈ· ÌÂÁ·Ï‡ÙÂÚË Ì›ˆÛË Ù˘ LDL-C. √È ÚfiÛÊ·Ù˜ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜, Û˘ÌÂÚÈÏ·Ì‚·ÓfiÌÂÓ˘ Ù˘ ROVE ITTIMI 22 2, ‰Â›¯ÓÔ˘Ó fiÙÈ ·Ó Î·È Ì›· ·ÚfiÌÔÈ· ÚÔÛ¤ÁÁÈÛË ÚÔÛʤÚÂÈ ÂÈÚfiÛıÂÙË ÚÔÛÙ·Û›·, Ù· ÛÙÂÊ·ÓÈ·›· ÂÂÈÛfi‰È· ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Ó· ÂÌÊ·Ó›˙ÔÓÙ·È Ì ˘„ËÏ‹ Û˘¯ÓfiÙËÙ· ·Ú¿ ÙËÓ ÂÈıÂÙÈ΋ Ì›ˆÛË Ù˘ LDL-C. º·›ÓÂÙ·È fiÙÈ ·˘Ùfi ÔÊ›ÏÂÙ·È, ÌÂÚÈο, ÛÙË ·ÚÔ˘Û›· Î·È ¿ÏÏˆÓ ÏÈȉ·ÈÌÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ. ∆· ¯·ÌËÏ¿ ›‰· Ù˘ HDLC Û˘Ì‚¿ÏÏÔ˘Ó, Ì ·ÓÂÍ¿ÚÙËÙÔ ÙÚfiÔ, ÛÙÔ ÛÙÂÊ·ÓÈ·›Ô ΛӉ˘ÓÔ. ™ÙÔȯ›· ·fi ÙË Framingham Heart Study (FHS) (3), fiˆ˜ Î·È ·fi ÙË ÌÂϤÙË Atherosclerosis Risk in Community (ARIC) 4 ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ, ·ÓÂÍ¿ÚÙËÙ· ·fi Ù· ›‰· Ù˘ LDL-C, Ù· ¯·ÌËÏ¿ ›‰· Ù˘ HDL-C Û¯ÂÙ›˙ÔÓÙ·È
∏
26
Ì ·˘ÍË̤ÓÔ ÛÙÂÊ·ÓÈ·›Ô ΛӉ˘ÓÔ. ŒÙÛÈ, ÔÈ ÚÔÛ¿ıÂȘ ·‡ÍËÛ˘ Ù˘ HDL-C, ÌÂ Û˘Ó‰˘·Ṳ̂ÓË ıÂڷ›·, ¤¯Ô˘Ó ÙË ‰˘Ó·ÙfiÙËÙ· Ó· ‚ÂÏÙÈÒÓÔ˘Ó ÙË ÂÚÈÔÚÈṲ̂ÓË Â›‰Ú·ÛË Ù˘ ÌÔÓÔıÂڷ›·˜ Ù˘ LDL-C. √È Û‡Á¯ÚÔÓ˜ ηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ ÁÈ· ÙËÓ HDL-C ıˆÚÔ‡Ó Û·Ó Î·ÙÒÙÂÚÔ Ê˘ÛÈÔÏÔÁÈÎfi fiÚÈÔ Ù· 40 mg/dL ÁÈ· ÙÔ˘˜ ¿Ó‰Ú˜ Î·È Ù· 50 mg/dL ÁÈ· ÙȘ Á˘Ó·›Î˜ 5, 6. ™Â Ì›· ÂÚ›Ô‰Ô ·Ú·ÎÔÏÔ‡ıËÛ˘ ÙÔ˘ ÏËı˘ÛÌÔ‡, ‰È¿ÚÎÂÈ·˜ 12 ÂÙÒÓ, ÙÔ Ì¤ÛÔ Â›Â‰Ô Ù˘ HDL-C ÌÂÈÒıËΠηٿ 3 mg/dL 7. ∞˘Ùfi Â›Ó·È Û˘Ì‚·Ùfi Ì ÙÔ ·˘Í·ÓfiÌÂÓÔ Úfi‚ÏËÌ· Ù˘ ·¯˘Û·ÚΛ·˜ Î·È Ù˘ ·ÓÙ›ÛÙ·Û˘ ÛÙËÓ ÈÓÛÔ˘Ï›ÓË, Î·È ÙËÓ ·˘Í·ÓfiÌÂÓË Â›ÙˆÛË ÙÔ˘ ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ 2. ∏ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ¯·ÌËÏ‹˜ HDL-C ÂÚÈÏ·Ì‚¿ÓÂÈ ÌË Ê·ÚÌ·ÎÔÏÔÁÈΤ˜ Î·È Ê·ÚÌ·ÎÔÏÔÁÈΤ˜ ÌÂıfi‰Ô˘˜. ∞fi Ù· ÌË Ê·ÚÌ·ÎÔÏÔÁÈο ̤۷, ÂΛÓÔ Ô˘ Û˘ÓÈÛÙ¿Ù·È Û˘¯ÓfiÙÂÚ· Â›Ó·È Ë ÛˆÌ·ÙÈ΋ ¿ÛÎËÛË, Ë ÔÔ›·, ·Ó Î·È ·ÔÙÂÏ› Ì›· Ôχ ÛËÌ·ÓÙÈ΋ ·Ú¤Ì‚·ÛË ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘, ·ÚÔ˘ÛÈ¿˙ÂÈ ÂÚÈÔÚÈṲ̂ÓË ÌfiÓÔ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÛÙËÓ ·‡ÍËÛË Ù˘ HDL-C, Ì ̤ÙÚÈ· ·ÔÙÂϤÛÌ·Ù· fiÙ·Ó ˘¿Ú¯ÂÈ Î·È ·‡ÍËÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ (TG), ÂÓÒ Ú¤ÂÈ Ó· Â›Ó·È Ù·ÎÙÈ΋ Î·È ¤ÓÙÔÓË 8, 9. ∆Ô ÔÈÓfiÓÂ˘Ì· ÚÔηÏ› ̤ÙÚÈ· ·‡ÍËÛË Ù˘ HDL-C Î·È ·˘Í¿ÓÂÈ Ù· ›‰· ÙˆÓ TG, ÂËÚ¿˙ÔÓÙ·˜ ÙË ‰Ú¿ÛË Ù˘ CETP, ÂÓÒ Ë ‰È·ÎÔ‹ ÙÔ˘ ηӛÛÌ·ÙÔ˜ Î·È Ë ·ÒÏÂÈ· ‚¿ÚÔ˘˜ ·˘Í¿ÓÔ˘Ó Â›Û˘ ÙËÓ HDL-C. ∞ÓÙ›ıÂÙ·, Ù· Ê·ÚÌ·ÎÔÏÔÁÈο ̤۷ Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·ÔÙÂÏÂÛÌ·ÙÈο ÁÈ· ÙËÓ ·‡ÍËÛË Ù˘ HDL-
C. ªÂٷ͇ ÙˆÓ ‰È·ı¤ÛÈ̈Ó, Û‹ÌÂÚ·, Ê·ÚÌ·ÎÔÏÔÁÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÁÈ· ÙËÓ ·‡ÍËÛË Ù˘ HDL-C, Ô ÂÚÈÛÛfiÙÂÚÔ ·ÔÙÂÏÂÛÌ·ÙÈÎfi˜ ıˆÚÂ›Ù·È Ë ÓÈ·Û›ÓË. ∞Ó Î·È ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ Ê·Ú̷΢ÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÙÚÔÔÔ›ËÛ˘ ÙˆÓ ÏÈȉ›ˆÓ ·˘Í¿ÓÔ˘Ó ÂÏ·ÊÚ¿ ÙËÓ HDLC, Ë ÓÈ·Û›ÓË, Û ̤ÙÚȘ ‰fiÛÂȘ (1-2 g/d) ÚÔηÏ› ·‡ÍËÛË 20%, ‹ Î·È ÂÚÈÛÛfiÙÂÚÔ, Ì ¯ÚÔÓÔ-‰ÔÛÔ-ÂÍ·ÚÙÒÌÂÓÔ ÙÚfiÔ, ÂÓÒ ·Ú¿ÏÏËÏ· ÌÂÈÒÓÂÈ ÙȘ Û˘ÁÎÂÓÙÚÒÛÂȘ Ù˘ LDL-C, ÙˆÓ TG Î·È Ù˘ Lp(a)10. √ ΛӉ˘ÓÔ˜ ÙˆÓ ·ÚÂÓÂÚÁÂÈÒÓ ·fi ÙË ¯ÔÚ‹ÁËÛË ÓÈ·Û›Ó˘ Â›Ó·È ÌÈÎÚfi˜, ·Ó Î·È ÙÔ flushing (·›ÛıËÌ· ıÂÚÌfiÙËÙ·˜ Î·È ÂÚ˘ıÚfiÙËÙ·˜, ·ÚÈ· ÛÙÔ ÚfiÛˆÔ) Â›Ó·È Ì›· Û˘¯Ó‹ ·ÚÂÓ¤ÚÁÂÈ·, Ô˘ ÌÔÚ› Ó· ÌÂÈÒÛÂÈ ÙË Û˘ÌÌfiÚʈÛË ÙˆÓ ·ÛıÂÓÒÓ. ∆Ô ÂÈÛ·ÁfiÌÂÓÔ ·fi ÙË ÓÈ·Û›ÓË flushing ÚÔηÏÂ›Ù·È ·fi ÙË ‰È¤ÁÂÚÛË Ù˘ ·Ú·ÁˆÁ‹˜ ÂÓ‰ÔıËÏÈ·ÎÒÓ ÚÔÛÙ·ÁÏ·Ó‰ÈÓÒÓ, Î·È Ë Û˘¯ÓfiÙËÙ¿ ÙÔ˘ Û¯ÂÙ›˙ÂÙ·È Ì ÙÔ ‚·ıÌfi ·ÔÚÚfiÊËÛ˘ Î·È ÙÔ ÌÂÙ·‚ÔÏÈÛÌfi ÙÔ˘ Ê·ÚÌ¿ÎÔ˘, ÂÓÒ Â›Ó·È ÁÓˆÛÙfi fiÙÈ Ë Û˘Ó¯È˙fiÌÂÓË ¯Ú‹ÛË ÓÈ·Û›Ó˘ Û˘Ó‰¤ÂÙ·È Ì ÌÈÎÚfiÙÂÚË Û˘¯ÓfiÙËÙ· flushing. H ¿ÌÂÛ˘ ·Ô‰¤ÛÌ¢Û˘ (ÎÚ˘ÛÙ·ÏÏÈ΋) ÓÈ·Û›ÓË (niacin IR-‰ÔÛÔÏÔÁÈÎfi Û¯‹Ì· 2-3 ÊÔÚ¤˜ ÙËÓ Ë̤ڷ) Ô‰ËÁ› ÛÂ Û˘¯ÓfiÙÂÚÔ Î·È ÂÓÙÔÓfiÙÂÚÔ flushing, Û ·ÓÙ›ıÂÛË Ì ÙËÓ ·Ú·ÙÂÈÓfiÌÂÓ˘ ·Ô‰¤ÛÌ¢Û˘ ÓÈ·Û›ÓË (ÓÈ·Û›ÓË ERNiaspan), Ô˘ ¯ÔÚËÁÂ›Ù·È Ì›· ÊÔÚ¿ ÙËÓ Ë̤ڷ, ηٿ ÙË Ó˘¯ÙÂÚÈÓ‹ ηٿÎÏÈÛË, Î·È Â›Ó·È Î·Ï‡ÙÂÚ· ·ÓÂÎÙ‹ Î·È ÈÛfiÙÈÌ· ·ÔÙÂÏÂÛÌ·ÙÈ΋, Ô‰ËÁÒÓÙ·˜ Û ‰ÔÛÔ-ÂÍ·ÚÙÒÌÂÓ˜ ·˘Í‹ÛÂȘ Ù˘ HDL-C. ∆Ô Úfi‚ÏËÌ· ÙÔ˘ flushing ÌÔÚ› Ó· ·ÓÙÈÌÂÙˆÈÛı› Ì ÙËÓ ÂÓË̤ڈÛË ÙˆÓ ·ÛıÂÓÒÓ, Ì ÙË Û‡Á¯ÚÔÓË
ATHIROSKLIROSI 9b 23-02-06 10:18 ™ÂÏ›‰·27
£∂ƒ∞¶∂π∞ – º∞ƒª∞∫∞ ¯ÔÚ‹ÁËÛË ·ÛÈÚ›Ó˘ (ÁÈ· ÙËÓ ·Ó·ÛÙÔÏ‹ Ù˘ ·Ú·ÁˆÁ‹˜ ÚÔÛÙ·ÁÏ·Ó‰ÈÓÒÓ), Î·È ÙË Ï‹„Ë ÂÓfi˜ ÌÈÎÚÔ‡ Á‡̷ÙÔ˜ (snack) ηٿ ÙË Î·Ù¿ÎÏÈÛË (ÁÈ· ÙËÓ ÂÈ‚Ú¿‰˘ÓÛË Ù˘ ·ÔÚÚfiÊËÛ˘ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘). ™˘ÓÈÛÙ¿Ù·È Â›Û˘ Ë ·ÔÊ˘Á‹ ÏÔ‡ÛÈˆÓ Û ÏÈ·Ú¿ Á‡̷ٷ Î·È Ë ·ÔÊ˘Á‹ ηٷӿψÛ˘ ÔÈÓÔÓÂ˘Ì·Ùˆ‰ÒÓ. ¶ÚÔÛÔ¯‹ ··ÈÙÂ›Ù·È Û ¿ÙÔÌ· Ì ÓÂÊÚÔ¿ıÂÈ· Î·È ÂÓÂÚÁfi ÂÙÈÎfi ¤ÏÎÔ˜. ŸÙ·Ó ÙÔ flushing ÂÌÊ·ÓÈÛı›, Ë ¯ÔÚ‹ÁËÛË ÌÈÎÚÒÓ ‰fiÛÂˆÓ ÌË ÛÙÂÚÔÂȉÒÓ ·ÓÙÈÊÏÂÁÌÔÓˆ‰ÒÓ ·Ú·ÁfiÓÙˆÓ, fiˆ˜ Ë ÈÌÔ˘ÚÔʤÓË (100-200 mg ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜) ÂÍ·Ê·Ó›˙ÂÈ ÁÚ‹ÁÔÚ· ÙÔ flushing. ∞Ó Î·È Ë ¯ÔÚ‹ÁËÛË ÓÈ·Û›Ó˘ ÌÔÚ› Ó· Û¯ÂÙ›˙ÂÙ·È Ì ‚Ú·¯˘¯ÚfiÓȘ ÌÂÙ·‚ÔϤ˜ ÙÔ˘ ÁÏ˘Î·ÈÌÈÎÔ‡ ÂϤÁ¯Ô˘, ÔÈ ÌÂÙ·‚ÔϤ˜ ÙˆÓ Û˘ÁÎÂÓÙÚÒÛÂˆÓ Ù˘ ÁÏ˘ÎÔ˙˘ÏȈ̤Ó˘ ·ÈÌÔÛÊ·ÈÚ›Ó˘ (HbA1c) Â›Ó·È ·Û˘Ó‹ıÈÛÙ˜, fiˆ˜ ·Ô‰Â›¯ıËΠÛÙË ÌÂϤÙË Assessment of Diabetes Control and Evaluation of the Efficacy of Niaspan (ADVENT) 11. ∏ ¯ÚËÛÈÌÔÔ›ËÛË Ù˘ ÓÈ·Û›Ó˘ Ô‰ËÁ› Û ÌÂÈÒÛÂȘ ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÂÂÈÛÔ‰›ˆÓ. ª›· ·fi ÙȘ ·Ï·ÈfiÙÂÚ˜, ÂÏÂÁ¯fiÌÂÓ˜ Ì ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ, ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ ıÂڷ›·˜ ÙˆÓ ‰˘ÛÏÈȉ·ÈÌÈÒÓ, Ë Coronary Drug Project, ÌÂϤÙËÛ ÌÂÚÈο Ê¿Ú̷η, Û˘ÌÂÚÈÏ·Ì‚·ÓfiÌÂÓ˘ Ù˘ ÓÈ·Û›Ó˘. ™ÙË ÌÂϤÙË ·˘Ù‹, Ë ÔÔ›· Â›Ó·È Ë ÌfiÓË Â·ÚÎÒ˜ ÂÓÈÛ¯˘Ì¤ÓË ÎÏÈÓÈ΋ ÌÂϤÙË Û‡ÁÎÚÈÛ˘ Ù˘ ÓÈ·Û›Ó˘ Ì ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ Û ‰Â˘ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë, Û˘ÌÂÚÈÏ‹ÊıËÎ·Ó ¿Ó‰Ú˜ Ì ÚÔËÁÔ‡ÌÂÓÔ ¤ÌÊÚ·ÁÌ· Ì˘Ôηډ›Ô˘ (∂ª) Î·È ‰È·ÈÛÙÒıËΠfiÙÈ Ë ÓÈ·Û›ÓË, Û ‰ÔÛÔÏÔÁ›· 2-3 g/d, Ô‰‹ÁËÛ Û ÛËÌ·ÓÙÈΤ˜ ÌÂÈÒÛÂȘ ÙÔ˘ ÌË ı·Ó·ÙËÊfiÚÔ˘ ∂ª Î·È ÙÔ˘ ÛÙÂÊ·ÓÈ·›Ô˘ ı·Ó¿ÙÔ˘ (-14%), ÙÔ˘ ÌË ı·Ó·ÙËÊfiÚÔ˘ ∂ª (-27%), ÙÔ˘ ·ÁÁÂÈ·ÎÔ‡ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ (∞∂∂) Î·È Ù˘ ·ÚÔ‰È΋˜ ÈÛ¯·ÈÌÈ΋˜ ÚÔÛ‚ÔÏ‹˜ (∆π∞) (-26%), fiˆ˜ Î·È ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ¯ÂÈÚÔ˘ÚÁÈÎÒÓ ·ÚÂÌ‚¿ÛÂˆÓ (-47%), ¤Ó·ÓÙÈ ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ 12, 13, 14. ∏ ÌÔÓÔıÂڷ›· Ì ÓÈ·Û›ÓË, ‹ Û˘Ó‰˘·ÛÌfi˜ Ù˘ Ì ¿ÏÏÔ˘˜ ˘ÔÏÈȉ·ÈÌÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÎÏÈÓÈο ÛÙ· Ù¤ÏË Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ 1970 Î·È ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ 1980,
·ÏÏ¿, ÛÙ· Ù¤ÏË Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ 1980, ÔÈ ıÂڷ›˜ Ì›ˆÛ˘ ÙˆÓ ÏÈȉ›ˆÓ ÛÙÚ¿ÊËÎ·Ó Û ÌÂÁ¿ÏÔ ‚·ıÌfi ÛÙȘ ÛÙ·Ù›Ó˜. ∆Ô 2002 ‰ËÌÔÛȇıËÎ·Ó Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ªÂϤÙ˘ HDL-Atherosclerosis Treatment (HATS), 15 Ô˘ ¤‰ÂÈÍ·Ó ÙÔ ÌÂÁ¿ÏÔ fiÊÂÏÔ˜ Ù˘ Û˘Ó‰˘·Ṳ̂Ó˘ ıÂڷ¢ÙÈ΋˜ ÚÔÛ¤ÁÁÈÛ˘ Ì ÛÙ·Ù›ÓË Î·È ÓÈ·Û›ÓË. ∞˘Ù‹ Ë ÂÏÂÁ¯fiÌÂÓË Ì ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ ÎÏÈÓÈ΋ ÌÂϤÙË ‰Â˘ÙÂÚÔÁÂÓÔ‡˜ ÚfiÏ˄˘ ¤‰ÂÈÍ ۷ʋ ÛÙ·ıÂÚÔÔ›ËÛË Ù˘ ·ÁÁÂÈÔÁÚ·ÊÈ΋˜ ÂÈÎfiÓ·˜ Ù˘ ™¡, Ì·˙› Ì Ì›ˆÛË ˆ˜ 90% ÙˆÓ ÎÏÈÓÈÎÒÓ Â΂¿ÛˆÓ, Ì ÙÔ Û˘Ó‰˘·ÛÌfi ÛÈÌ‚·ÛÙ·Ù›Ó˘ 10-20 mg/d Ì ÓÈ·Û›ÓË 1000 mg/bid. ∞Ó Î·È Ë ÌÂϤÙË ‹Ù·Ó ÌÈÎÚ‹, ÂÊfiÛÔÓ Ù· ·ÔÙÂϤÛÌ·Ù¿ Ù˘ ÂȂ‚·ÈˆıÔ‡Ó Ì ̛· Û˘ÁÎÚÈÙÈ΋ ÌÂϤÙË ÂϤÁ¯Ô˘ Ì ÌÔÓÔıÂڷ›· ÛÙ·Ù›Ó˘, Â›Ó·È È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈ΋ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·ÛıÂÓÒÓ Ì ÁÓˆÛÙ‹ ™¡. ∏ ‰˘Ó·ÙfiÙËÙ· ·˘ÍË̤ÓÔ˘ ÔʤÏÔ˘˜ Ù˘ Û˘Ó‰˘·Ṳ̂Ó˘ ıÂڷ›·˜ ÛÙ·Ù›Ó˘-ÓÈ·Û›Ó˘, Û ۇÁÎÚÈÛË Ì ÙË ÌÔÓÔıÂڷ›· Ì ÛÙ·Ù›ÓË, ·Ô‰Â›¯ıËΠÚfiÛÊ·Ù· ·fi ÙË ÌÂϤÙË Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol (ARBITER) 2 16. ™ÎÔfi˜ ·˘Ù‹˜ Ù˘ ÂÏÂÁ¯fiÌÂÓ˘ Ì ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ, ‰ÈÏ‹˜-Ù˘ÊÏ‹˜ ÌÂϤÙ˘ ‹Ù·Ó Ó· Û˘ÁÎÚ›ÓÂÈ ÙËÓ Â›‰Ú·ÛË Ù˘ ÌÔÓÔıÂڷ›·˜ Ì ÛÙ·Ù›ÓË, ¤Ó·ÓÙÈ Ù˘ Û˘Ó‰˘·Ṳ̂Ó˘ ıÂڷ›·˜ Ì ÛÙ·Ù›ÓË Û˘Ó ÓÈ·Û›ÓË ER, Û ‰fiÛË 1 g ηٿ ÙË Ó˘¯ÙÂÚÈÓ‹ ηٿÎÏÈÛË, ÛÙÔ ¿¯Ô˜ ÙÔ˘ ηڈÙȉÈÎÔ‡ ¤Ûˆ-̤ÛÔ˘ ¯ÈÙÒÓ· (CIMT) (·ÚÈÔ ÙÂÏÈÎfi ÛËÌ›Ô), ÌÂÙ¿ ·fi 12 Ì‹Ó˜, Û ·ÛıÂÓ›˜ Ì ÁÓˆÛÙ‹ ™¡ Î·È Û¯ÂÙÈο ηÏfi ¤ÏÂÁ¯Ô Ù˘ LDL-C, Ì ÌÔÓÔıÂڷ›· Ì ÛÙ·Ù›ÓË (LDLC<130 mg/dL). ∏ ̤ÙÚËÛË ÙÔ˘ CIMT Á›ÓÂÙ·È Û ‰È¿ÊÔÚ· ¯ÚÔÓÈο ÛËÌ›·, ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÎÙÈÌËıÔ‡Ó ÔÈ ÌÂÙ·‚ÔϤ˜ Ù˘ ·ıËÚÔÛÎÏËÚˆÙÈ΋˜ ÂÍÂÚÁ·Û›·˜, ÛÙË ‰È¿ÚÎÂÈ· Ê·ÚÌ·ÎÔÏÔÁÈ΋˜ ıÂڷ›·˜. √È ‚Ú·‰‡ÙÂÚÔÈ Ú˘ıÌÔ› ÂͤÏÈ͢ ¤¯Ô˘Ó Û˘Ó‰Âı› Ì ÌÈÎÚfiÙÂÚÔ Î›Ó‰˘ÓÔ ÛÙÂÊ·ÓÈ·›ˆÓ ÂÂÈÛÔ‰›ˆÓ ÛÙË Cholesterol Lowering Atherosclerosis Study (CLAS).17 ™ÙË ÌÂϤÙË ·˘Ù‹, ÛÙËÓ ÔÔ›· ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Û˘Ó‰˘·ÛÌfi˜ ÎÔÏÂÛÙÈfiÏ˘ -ÓÈ·Û›Ó˘, ¤Ó·ÓÙÈ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿-
ÎÔ˘, ˘‹ÚÍ ¿ÌÂÛË Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ ÂͤÏÈ͢ ÙÔ˘ CIMT Î·È ÙˆÓ ÎÏÈÓÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ. ∆ÚÈÏ¿ÛÈÔ˜ Ú˘ıÌfi˜ ÂͤÏÈ͢ ÙÔ˘ CIMT Û˘Ó‰ÂfiÙ·Ó Ì 3Ï¿ÛÈÔ Î›Ó‰˘ÓÔ ÛÙÂÊ·ÓÈ·›ˆÓ ÂÂÈÛÔ‰›ˆÓ. ∆· ÛÙÔȯ›· ·˘Ù¿ ηıÈ¤ÚˆÛ·Ó ÙÔ CIMT Û·Ó ¤Ó· ·ÍÈfiÈÛÙÔ ˘ÔηٿÛÙ·ÙÔ ÙÂÏÈÎfi ÛËÌÂ›Ô ÁÈ· Ù· ÎÏÈÓÈο ÂÂÈÛfi‰È·. ∞fi ÙÔ˘˜ 167 ·ÛıÂÓ›˜ Ù˘ ARBITER, ÔÈ 80 Ù˘¯·ÈÔÔÈ‹ıËÎ·Ó Û ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ Î·È 87 Û ÓÈ·Û›ÓË ER. ∏ ̤ÛË ËÏÈΛ· ‹Ù·Ó 68 ¯ÚfiÓÈ· Î·È ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ·ÛıÂÓ›˜ ‹Ù·Ó ¿Ó‰Ú˜. √È ÂÚÈÛÛfiÙÂÚÔÈ Â›¯·Ó ÈÛÙÔÚÈÎfi ˘¤ÚÙ·Û˘, 28% ‹Ù·Ó ‰È·‚ËÙÈÎÔ› Î·È ÔÏÏÔ› ›¯·Ó ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ (ª™), ÂÓÒ fiÏÔÈ Â›¯·Ó ÂÁηÙÂÛÙË̤ÓË ™¡. 16 ŸÏÔÈ ÔÈ ·ÛıÂÓ›˜ ıÂڷ‡ÔÓÙ·Ó Ì ÛÙ·Ù›ÓË (93% Ì ÛÈÌ‚·ÛÙ·Ù›ÓË) Û ̤ÛË ‰fiÛË 35 mg/d, ÂÓÒ Ë ıÂڷ›· ÙÔ˘˜ ÂÚÈÂÏ¿Ì‚·Ó ÙÔ˘˜ Ù˘ÈÎÔ‡˜ Ê·Ú̷΢ÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ù˘ ‰Â˘ÙÂÚÔÁÂÓÔ‡˜ ÚÔʇϷ͢, Û˘ÌÂÚÈÂÏ·Ì‚·ÓfiÌÂÓˆÓ ÙˆÓ ‚-·ÔÎÏÂÈÛÙÒÓ Î·È Ù˘ ·ÛÈÚ›Ó˘ ÛÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜. ∏ ıÂڷ›· Ì ·ÓÙÈÔÍÂȉˆÙÈΤ˜ ‚Èٷ̛Ә, fiÔ˘ ˘‹Ú¯Â, ‰È·ÎfiËÎÂ, ÒÛÙ ӷ ÌË ‰ËÌÈÔ˘ÚÁËı› Û‡Á¯˘ÛË Ì ÙȘ ÂȉڿÛÂȘ Ù˘ ÓÈ·Û›Ó˘ ÛÙËÓ ÂӉ¯fiÌÂÓË ·‡ÍËÛË Ù˘ ·ÔÏÈÔÚˆÙ½Ó˘ ∞ (apo-A). 18 ∏ ̤ÛË ‚·ÛÈ΋ ÙÈÌ‹ Ù˘ LDL-C ‹Ù·Ó ÛÙÔ ‘ÛÙfi¯Ô’ (91 mg/dL ÛÙÔ˘˜ ·ÛıÂÓ›˜ ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ Î·È 87 mg/dL ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ÓÈ·Û›Ó˘), ÂÓÒ Ë ·ÓÙ›ÛÙÔÈ¯Ë ÙÈÌ‹ Ù˘ HDL-C ‹Ù·Ó ÔÚȷο ÌfiÓÔ ¯·ÌËÏ‹ (40 mg/dL ÛÙËÓ ÔÌ¿‰· ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ Î·È 39 mg/dL ÛÙËÓ ÔÌ¿‰· Ù˘ ÓÈ·Û›Ó˘). ªÂÙ¿ ·fi 12 Ì‹Ó˜, Ë LDL-C ·Ú¤ÌÂÓ ˘fi ηÏfi ¤ÏÂÁ¯Ô, ÂÓÒ Ë HDL-C ·˘Í‹ıËΠηٿ 21% (·fi 39 Û 47 mg/dL ÛÙËÓ ÔÌ¿‰· Ù˘ ÓÈ·Û›Ó˘). ¶·Ú·ÙËÚ‹ıËΠ›Û˘ ̤ÙÚÈ· Ì›ˆÛË ÙˆÓ TG Î·È Ù˘ nonHDL-C. ∏ ˘„ËÏ‹˜ ¢·ÈÛıËÛ›·˜ C-·ÓÙȉÚÒÛ· ÚˆÙ½ÓË (hs-CRP) ‰ÂÓ ·ÚÔ˘Û›·Û ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ ıÂڷ›·˜ ‹ ÙˆÓ ‰È·ÊfiÚˆÓ ¯ÚÔÓÈÎÒÓ ÛËÌ›ˆÓ. 16 ™ËÌ·ÓÙÈ΋ ÂͤÏÈÍË ÙÔ˘ CIMT ·Ú·ÙËÚ‹ıËΠÛÙËÓ ÔÌ¿‰· ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ (0,044 mm/¤ÙÔ˜, p< 0,001), ÂÓÒ Ë ÂͤÏÈÍË ÙÔ˘ CIMT ‹Ù·Ó ηٿ 68% ÌÈÎÚfiÙÂÚË ÛÙËÓ
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ATHIROSKLIROSI 9b 23-02-06 10:18 ™ÂÏ›‰·28
·ıËÚÔÛÎÏ‹ÚˆÛË MAƒ∆π√™
2006
ÔÌ¿‰· Ù˘ ÓÈ·Û›Ó˘, Î·È Ô˘ÛÈ·ÛÙÈο ·ÌÂÙ¿‚ÏËÙË, Û ۯ¤ÛË Ì ÙË ‚·ÛÈ΋ ÙÈÌ‹ (0,014 mm/¤ÙÔ˜). ¢ÂÓ ÛËÌÂÈÒıËÎ·Ó ÛËÌ·ÓÙÈΤ˜ ·ÚÂÓ¤ÚÁÂȘ Î·È Ë Û˘ÌÌfiÚʈÛË ‹Ù·Ó >90%.16 ∂ÎÙfi˜ ·fi ÙȘ ¢ÂÚÁÂÙÈΤ˜ ÂȉڿÛÂȘ Ù˘ ÓÈ·Û›Ó˘ ·Ú·ÙÂÈÓfiÌÂÓ˘ ·Ô‰¤ÛÌ¢Û˘ ÛÙÔ CIMT, ·Ú·ÙËÚ‹ıËÎÂ Î·È Ì›· ÌË ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÙˆÓ ˘ÔÙÚÔÈ·˙fiÓÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ÂÂÈÛÔ‰›ˆÓ (Û‡ÓıÂÙÔ ÎÏÈÓÈÎfi ÙÂÏÈÎfi ÛËÌÂ›Ô - ÓÔÛËÏ›· ÁÈ· ·ÛÙ·ı‹ ÛÙËı¿Á¯Ë ‹ ∂ª, ∞∂∂, ·ÈÊÓ›‰ÈÔ˜ ηډȷÎfi˜ ı¿Ó·ÙÔ˜, PTCA, CABG, ‹ ÂÚÈÊÂÚÈ΋ ·ӷÁÁ›ˆÛË), ·ÏÏ¿ Ë ÌÂϤÙË ‰ÂÓ Â›¯Â ÙË ÛÙ·ÙÈÛÙÈ΋ ‰‡Ó·ÌË Ó· ·ÓȯÓ‡ÛÂÈ ‰È·ÊÔÚ¤˜ ÛÙ· ÎÏÈÓÈο ÂÂÈÛfi‰È·, ·Ó Î·È ÔÈ Û˘ÁÁÚ·Ê›˜ Û˘ÌÂÚ·›ÓÔ˘Ó fiÙÈ ÂÚfiÎÂÈÙÔ ÁÈ· Ì›· ·Ó·ÌÂÓfiÌÂÓË ÎÏÈÓÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙËÓ ·Ó·ÛÙÔÏ‹ Ù˘ ÂͤÏÈ͢ ÙÔ˘ CIMT.16 ∞Ó Î·È ·ÚfiÌÔÈ·, Ô˘ÛÈ·ÛÙÈο, ·ÔÙÂϤÛÌ·Ù· ·Ú·ÙËÚ‹ıËÎ·Ó Î·È ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ (™¢) 2 Î·È ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ (ª™), Ë ˘ÔÔÌ¿‰· ·˘Ù‹ ÂÚ¢ӋıËΠÏÂÙÔÌÂÚ¤ÛÙÂÚ· fiÙ·Ó ‰È·ÈÛÙÒıËΠfiÙÈ ÔÈ ÂȉڿÛÂȘ ÛÙÔ CIMT Ê·›ÓÔÓÙ·Ó Ó· ·Ì‚χÓÔÓÙ·È, ȉȷ›ÙÂÚ· ÛÙ· ¿ÙÔÌ· Ì ª™. 19 ∂›Ó·È ·ÍÈÔÛËÌ›ˆÙÔ fiÙÈ ÙÔ ª™ ›¯Â Ì›· ȉȷ›ÙÂÚ· ÛÔ‚·Ú‹ ÂÈÎfiÓ· ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘, ¯ÂÈÚfiÙÂÚË, ·fi ÔÏϤ˜ ·fi„ÂȘ, ÂΛӢ ÙˆÓ ‰È·‚ËÙÈÎÒÓ, Û˘ÌÂÚÈÏ·Ì‚·ÓfiÌÂÓ˘ Ù˘ ˘„ËÏfiÙÂÚ˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ (∞¶) Î·È Ù˘ ¯·ÌËÏfiÙÂÚ˘ HDLC. ∏ ‰È¿ÁÓˆÛË ÙÔ˘ ª™ ›¯Â Á›ÓÂÈ Ì ٷ ÎÚÈÙ‹ÚÈ· ÙÔ˘ NCEP, Î·È ÔÈ ·ÛıÂÓ›˜ ‹Ù·Ó ˘fi ıÂڷ›· Ì ÛÙ·Ù›Ó˜ Î·È ·ÓÙȸÂÚÙ·ÛÈο Ê¿Ú̷η. ™˘ÌÂÚ·›ÓÂÙ·È, ÂÔ-
̤ӈ˜, fiÙÈ ÙÔ ª™ ·ÓÙÈÚÔۈ‡ÂÈ Ì›· ÔÌ¿‰· ȉȷ›ÙÂÚ· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘. 19 ªÂÙ¿, fï˜, ·fi ÙË ÚÔÛ·ÚÌÔÁ‹ ÁÈ· Ù· ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ ª™, ‰È·ÈÛÙÒıËΠfiÙÈ ÌË ÌÂÙ·‚ÔÏ‹ Ù˘ HDL-C Û¯ÂÙÈ˙fiÙ·Ó, Ì ·ÓÂÍ¿ÚÙËÙÔ ÙÚfiÔ, Ì ÙË ÌÂÙ·‚ÔÏ‹ ÙÔ˘ CIMT. ∞˘Ù‹ Ë ÛËÌ·ÓÙÈ΋ Î·È ·ÓÂÍ¿ÚÙËÙË Û˘Û¯¤ÙÈÛË (r= - 0,16, p=0,05) Â›Ó·È ·ÚfiÌÔÈÔ˘ ÌÂÁ¤ıÔ˘˜ Ì ÂΛÓË, Ô˘ ·Ú·ÙËÚ‹ıËΠÛÙË HATS. ™ÙËÓ ARBITER 2, Ë ÂͤÏÈÍË ÙÔ˘ CIMT, Û ·ÛıÂÓ›˜ Ì ª™, Û¯ÂÙÈ˙fiÙ·Ó ¿ÌÂÛ· Ì ÙÔ Â›Â‰Ô Ù˘ ÁÏ˘Îfi˙˘ ÓËÛÙ›·˜ (FPG). 19, 20 √È ·Ú·ÙËÚ‹ÛÂȘ ÁÈ· ÙË Û˘-
Û¯¤ÙÈÛË ÌÂٷ͇ CIMT Î·È ÓÈ·Û›Ó˘ ·Ú·ÙÂÈÓfiÌÂÓ˘ ·Ô‰¤ÛÌ¢Û˘ Û˘Ó¯›ÛıËÎ·Ó ÛÙËÓ ARBITER 3, Ì›· ·ÓÔÈÎÙ‹, ‰È·ÛÙ·˘ÚÔ‡ÌÂÓË ÌÂϤÙË ÙˆÓ Û˘ÌÌÂÙ·Û¯fiÓÙˆÓ ÛÙËÓ ARBITER 2. ™ÙÔ˘˜ 24 Ì‹Ó˜, ÌÂÙ¿ ·fi ÂÈϤÔÓ 12 Ì‹Ó˜ ·ÓÔÈÎÙ‹˜ ¯ÔÚ‹ÁËÛ˘ ÓÈ·Û›Ó˘ ER, Û 104 ·ÛıÂÓ›˜, Ô˘ Û˘ÌÏ‹ÚˆÛ·Ó ÙË ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ 24 ÌËÓÒÓ, ÙÔ CIMT ÌÂÈÒıËΠÛËÌ·ÓÙÈο ηٿ 0,044 mm, ÂÓÒ Ù· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· Û˘ÌÂÚÈÂÏ¿Ì‚·Ó·Ó ·‡ÍËÛË Ù˘ HDL-C ηٿ 9,5 mg/dL, Ù· ›‰· Ù˘ LDL-C ‹Ù·Ó 81 mg/dL, ÂÓÒ ‰ÂÓ ˘‹ÚÍ·Ó ÁÏ˘Î·ÈÌÈΤ˜ ÂȉڿÛÂȘ. 21
∆· Û˘ÌÂÚ¿ÛÌ·Ù· ·fi ÙȘ ÌÂϤÙ˜ ARBITER Â›Ó·È : 1. ™Â ÌÔÓÔıÂڷ›· Ì ÛÙ·Ù›ÓË ·Ú·ÙËÚÂ›Ù·È ÛËÌ·ÓÙÈ΋ ÂͤÏÈÍË ÙÔ˘ CIMT. 2. ∏ Û˘Ó‰˘·Ṳ̂ÓË ıÂڷ›· ÛÙ·Ù›Ó˘ + ÓÈ·Û›ÓË ER 1.000 mg/d ÂÈ‚Ú·‰‡ÓÂÈ ÙËÓ ÂͤÏÈÍË ÙÔ˘ CIMT Û ¿ÙÔÌ· ·) Ì ÂÁηÙÂÛÙË̤ÓË ™¡, ‚) ηϿ ÂÏÂÁ¯fiÌÂÓË LDL-C (<100 mg/dl), Á) ̤ÙÚÈ· ¯·ÌËÏ‹ HDL-C (40 mg/dL). 3. ∂›Ó·È Ë ÚÒÙË ÎÏÈÓÈ΋ ÌÂϤÙË Ô˘ ·Ô‰ÂÈÎÓ‡ÂÈ ·) ÙËÓ ·ÓˆÙÂÚfiÙËÙ· Ù˘ Û˘Ó‰˘·Ṳ̂Ó˘ ıÂڷ›·˜, ¤Ó·ÓÙÈ Ù˘ ÌÔÓÔıÂڷ›·˜ Ì ÛÙ·Ù›ÓË, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ¤Ó· ¤Á΢ÚÔ ˘ÔηٿÛÙ·ÙÔ ÙÂÏÈÎfi ÛËÌ›Ô. 4. ∏ ÌÂÙ·‚ÔÏ‹ Ù˘ HDL-C Û¯ÂÙ›˙ÂÙ·È ·ÓÙ›ÛÙÚÔÊ· Ì ÙË ÌÂÙ·‚ÔÏ‹ ÙÔ˘ CIMT (ÔÈ ÌÂÁ·Ï‡ÙÂÚ˜ ·˘Í‹ÛÂȘ Ù˘ HDL-C Ô‰ËÁÔ‡Ó Û ˘ÔÛÙÚÔÊ‹ ÙÔ˘ CIMT. 5. ∏ ›‰Ú·ÛË ÛÙËÓ ·‡ÍËÛË Ù˘ HDL-C ÌÔÚ› Ó· ·Ì‚χÓÂÙ·È Û ηٷÛÙ¿ÛÂȘ Ì ÏËÌÌÂÏÒ˜ ıÂڷ¢fiÌÂÓÔ˘˜ ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘, ‰È·›ÛÙˆÛË Ô˘ ÂÓÈÛ¯‡ÂÈ ÙËÓ ı¤ÛË fiÙÈ Â›Ó·È ·Ó¿ÁÎË Ó· ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È ÂÈıÂÙÈο fiÏÔÈ ÔÈ ÏÈȉÈÎÔ› Î·È ÌË ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘, ·Ú¿ÏÏËÏ· Ì ÙË ÚÔÛ¿ıÂÈ· ·‡ÍËÛ˘ Ù˘ HDL-C.
µÈ‚ÏÈÔÁÚ·Ê›·
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Couillard C, Despres JP, Lamarche B, et al. Effects of endurance exercise training on plasma HDL cholesterol levels depend on levels of triglycerides: evidence from men of the Health, Risk Factors, Exercise Training and Genetics (HERITAGE) Family Study. Arterioscler Thromb Vasc Biol 2001;21:1226-1232.
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10. Capuzzi DM, Guyton JR, Morgan JM, et al. Efficacy and safety of an extendedrelease niacin (Niaspan): a long-term study. Am J Cardiol 1998;82:74U-81U. 11. Grundy SM, Vega GL, McGovern ME, et al., for the Diabetes Multicenter Research Group. Efficacy, safety, and tolerability of once-daily niacin for the treatment of dyslipidemia associated with type 2 diabetes: results of the Assessment of Diabetes Control and Evaluation of the Efficacy of Niaspan Trial. Arch Intern Med 2002;162:15681576.
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16. Taylor AJ, Sullenberger LE, Lee HJ, Lee JK, Grace KA. Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol (ARBITER) 2: a double-blind, placebo-controlled study of extended-release niacin on atherosclerosis progression in secondary prevention patients treated with statins. Circulation 2004;110:3512-3517.
18. Cheung MC, Zhao XQ, Chait A, Albers JJ, Brown BG. Antioxidant supplements block the response of HDL to simvastatin-niacin therapy in patients with coronary artery disease and low HDL. Arterioscler Thromb Vasc Biol. 2001 Aug; 21(8):1320-6. 19. Taylor AJ, Lee HY, Grace KA, Lee JK, Sullenberger LE. Relationship between diabetic status and progression of carotid atherosclerosis after the addition of extended-release niacin to statin monotherapy. J Am Coll Cardiol 2005;45:3A. Abstract. 20. Asztalos BF, Batista M, Horvath KV, Cox CE, Dallal GE, Morse JS, Brown GB, Schaefer EJ. Change in alpha1 HDL concentration predicts progression in coronary artery stenosis. Arterioscler Thromb Vasc Biol 2003;23:847852. 21. Taylor AJ, Sullenberger LE, Lee HY. ARBITER 3: Atherosclerosis regression during open-label continuation of extended-release niacin following ARBITER 2. Circulation 2005;112:II-179.
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2 0 ¶∞¡∂§§∏¡π√ ™À¡∂¢ƒπ√ ∞£∏ƒ√™∫§∏ƒø™∏™ 29 ¡ÔÂÌ‚Ú›Ô˘- 2 ¢ÂÎÂÌ‚Ú›Ô˘ •ÂÓÔ‰Ô¯Â›Ô DIVANI - CARAVEL ∞£∏¡∞ ∆ÂÏÂ˘Ù·›· ËÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜ ÂÚÁ·ÛÈÒÓ 30 πÔ˘Ó›Ô˘ 2006 ∂ÁÁڷʤ˜: °ÂÓÈ΋ Û˘ÌÌÂÙÔ¯‹: 60 ¢ÚÒ ∂ȉÈ΢fiÌÂÓÔÈ: 40 ¢ÚÒ ºÔÈÙËÙ¤˜/¡ÔÛËÏÂ˘Ù¤˜: ¢ˆÚÂ¿Ó ¶ÏËÚÔÊÔڛ˜: EVENT MAKERS, ∫ˆÓ. ¶·Ï·ÈÔÏfiÁÔ˘ 14, ∆∫ 17121 ¡ ™Ì‡ÚÓË ÙËÏ. 210 9370205-6 / 210 9311004-6 º·Í 210 9370208 e-mail: info@evenmakers.gr
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ATHIROSKLIROSI 9b 23-02-06 10:18 ™ÂÏ›‰·30
·ıËÚÔÛÎÏ‹ÚˆÛË MAƒ∆π√™
2006
¶Ú¤ÂÈ Ó· ™˘Ó¯›˙ÂÙ·È Ë ÃÔÚ‹ÁËÛË ∞ÛÈÚ›Ó˘ Û ∞ÛıÂÓ›˜ Ô˘ ¶·›ÚÓÔ˘Ó ∫Ô˘Ì·ÚÈÓÈο ∞ÓÙÈËÎÙÈο; ª·Ú›· ¢È¿ÎÔ˘, ∂ÈÛÙËÌÔÓÈÎfi˜ ™˘ÓÂÚÁ¿Ù˘ µ' ¶·ıÔÏÔÁÈ΋˜ ∫ÏÈÓÈ΋˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ °ÂÓÈÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ πˆ·ÓÓ›ÓˆÓ
ªˆ˘Û‹˜ ∂ÏÈÛ¿Ê, ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜, π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ, ¢È¢ı˘ÓÙ‹˜ µ' ¶·ıÔÏÔÁÈ΋˜ ∫ÏÈÓÈ΋˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ °ÂÓÈÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ πˆ·ÓÓ›ÓˆÓ ∆Ô̤·˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ
· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÔÈ ÎÏÈÓÈÎÔ› È·ÙÚÔ› ·ÓÙÈÌÂÙˆ›˙Ô˘Ó ¤Ó· ÌÂÁ¿ÏÔ ÂÚÒÙËÌ·: ‘¡· Û˘Ó¯›ÛÔ˘Ó ‹ fi¯È ÙËÓ ·ÛÈÚ›ÓË ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ‚·ÚÊ·Ú›Ó˘; ∞˘Ùfi ÙÔ ÂÚÒÙËÌ· Â›Ó·È ÛÔ‚·Úfi Î·È Ë ·¿ÓÙËÛË ÛÙËÚ›˙ÂÙ·È ÛÙ· ·ÔÙÂϤÛÌ·Ù· Ù˘¯·ÈÔÔÈËÌ¤ÓˆÓ ‰ÈÏÒÓ Ù˘ÊÏÒÓ ÌÂÏÂÙÒÓ Ì ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ. ™Â ·˘Ù¤˜ ÙȘ ÌÂϤÙ˜ ¤¯ÂÈ ÂÎÙÈÌËı› ÙfiÛÔ Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· fiÛÔ Î·È Ë ·ÛÊ¿ÏÂÈ· ÙÔ˘ Û˘Ó‰˘·ÛÌÔ‡ ÙˆÓ ‰‡Ô Ê·Ú̿ΈÓ.
∆
¶·ıÔÊ˘ÛÈÔÏÔÁ›· ∆fiÛÔ Ë ‚·ÚÊ·Ú›ÓË fiÛÔ Î·È Ë ·ÛÈÚ›ÓË ·ÚÂÌ‚·›ÓÔ˘Ó ÛÙÔÓ Î·Ù·ÚÚ¿ÎÙË Ù˘ ‰ËÌÈÔ˘ÚÁ›·˜ ÙÔ˘ ıÚfiÌ‚Ô˘ Û ‰È·ÊÔÚÂÙÈο ÛËÌ›·. ∏ ·ÛÈÚ›ÓË ·Ó·ÛÙ¤ÏÏÂÈ ÙË Û˘ÛÛÒÚ¢ÛË ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ, ÂÓÒ Ë ‚·ÚÊ·Ú›ÓË ·Ó·ÛÙ¤ÏÏÂÈ ÙËÓ ·Ú·ÁˆÁ‹ Ù˘ ÚÔıÚÔÌ‚›Ó˘ Î·È ÙˆÓ ¿ÏÏˆÓ ·Ú·ÁfiÓÙˆÓ ‹Í˘ ·fi ÙÔ ‹·Ú, fiÔ˘ ·ÓÙ·ÁˆÓ›˙ÂÙ·È ÙË ‰Ú¿ÛË Ù˘ ‚ÈÙ·Ì›Ó˘ ∫. £ÂˆÚËÙÈο, Ë ·Ó·ÛÙÔÏ‹ Ù˘ ‰ËÌÈÔ˘ÚÁ›·˜ ÙÔ˘ ıÚfiÌ‚Ô˘ (Ì ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Û˘Ó‰˘·ÛÌÔ‡ ÙˆÓ ‰‡Ô Ê·Ú̿ΈÓ) Û ‰‡Ô ‰È·ÊÔÚÂÙÈο ÛËÌ›· ı· ¤¯ÂÈ Î·Ï‡ÙÂÚ· ·ÔÙÂϤÛÌ·Ù· fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ÂÌÊ¿ÓÈÛË ·ıËÚÔıÚÔÌ‚ˆÙÈÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ . ™˘ÓÔÏÈο ˘¿Ú¯Ô˘Ó ÂÓÓ¤· ÌÂϤÙ˜ Ô˘ ¤¯Ô˘Ó ÂÈÎÂÓÙÚˆı› Û ·˘Ùfi ÙÔ ÛËÌÂ›Ô (¶›Ó·Î·˜ 1). √È ÌÂϤÙ˜ ·˘Ù¤˜ ‰È·¯ˆÚ›ÛıËÎ·Ó Ì ‚¿ÛË ÙË ÓfiÛÔ ·fi ÙËÓ ÔÔ›· ¤·Û¯·Ó
ÔÈ ·ÛıÂÓ›˜. ¶¤ÓÙ ÌÂϤÙ˜ ·ÊÔÚÔ‡Ó ·ÛıÂÓ›˜ Ì Ì˯·ÓÈΤ˜ ‚·Ï‚›‰Â˜ Ù˘ ηډȿ˜ 1-6, ÙÚÂȘ ÌÂϤÙ˜ ÌÂÙÂÌÊÚ·ÁÌ·ÙÈÎÔ‡˜ ·ÛıÂÓ›˜ 7-9 Î·È Ì›· ÌÂϤÙË ·ÛıÂÓ›˜ Ì ÎÔÏÈ΋ Ì·ÚÌ·Ú˘Á‹ Î·È ˘„ËÏfi ΛӉ˘ÓÔ ÁÈ· ıÚÔÌ‚ÔÂÌ‚ÔÏÈ΋ ÓfiÛÔ 10. ™Â ÔÚÈṲ̂Ó˜ ÌÂϤÙ˜ ÂÎÙÈÌ‹ıËÎÂ Ë ¯ÔÚ‹ÁËÛË ‚·ÚÊ·Ú›Ó˘ Ì ‹ ¯ˆÚ›˜ ·ÛÈÚ›ÓË (·Ï‹ ·Ú¤Ì‚·ÛË) Î·È Û ¿ÏϘ ÌÂϤÙ˜ Û˘ÁÎÚ›ıËÎÂ Ë Ì¤ÙÚÈÔ˘ ‚·ıÌÔ‡ ·ÓÙÈËÎÙÈ΋ ·ÁˆÁ‹ Ì ‚·ÚÊ·Ú›ÓË Û˘Ó ·ÛÈÚ›ÓË Û ۇÁÎÚÈÛË Ì ÙË ¯ÔÚ‹ÁËÛË ÌÔÓÔıÂڷ›·˜ Ì ˘„ËÏ‹ ‰fiÛË ‚·ÚÊ·Ú›Ó˘ (‰ÈÏ‹ ·Ú¤Ì‚·ÛË). H ÌÂϤÙ˜ ·˘Ù¤˜ ÂÚ‡ÓËÛ·Ó ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·, ÙËÓ ·ÛÊ¿ÏÂÈ· Î·È ÙË Û˘ÓÔÏÈ΋ ıÓËÙfiÙËÙ· ÙÔ˘ Û˘Ó‰˘·ÛÌÔ‡ ·ÛÈÚ›Ó˘ Ì ‚·ÚÊ·Ú›ÓË. ∏ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÔÚ›˙ÂÙ·È ˆ˜ Ë ÌÈÎÚfiÙÂÚË Â›ÙˆÛË ıÚÔÌ‚ÔÂÌ‚ÔÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ (‚·Ï‚ȉÈΤ˜ ıÚÔÌ‚ÒÛÂȘ, Û˘ÛÙËÌ·ÙÈΤ˜ ÂÌ‚ÔϤ˜, ÂÌ‚ÔÏÈο ÂÁÎÂÊ·ÏÈο ÂÂÈÛfi‰È· Î·È ÂÌÊÚ¿ÁÌ·Ù· Û ¿ÙÔÌ· ¯ˆÚ›˜ ÛËÌ·ÓÙÈ΋ ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ). ∏ ·ÛÊ¿ÏÂÈ· ÔÚ›˙ÂÙ·È ·fi ÙËÓ Â›ÙˆÛË ÌÂÁ¿ÏˆÓ ·ÈÌÔÚÚ·ÁÈÒÓ (·ÈÌÔÚÚ·Á›Â˜ ÛÙȘ Ôԛ˜ ·Ú·ÙËÚÂ›Ù·È ÙÒÛË Ù˘ ·ÈÌÔÛÊ·ÈÚ›Ó˘ >2g/dl ‹ ··ÈÙÔ‡Ó ÂÈÛ·ÁˆÁ‹ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ‹ ··ÈÙÔ‡Ó ÌÂÙ¿ÁÁÈÛË Ì ÚÔ˚fiÓÙ· ·›Ì·ÙÔ˜ ‹ fiÙ·Ó ¤¯Ô˘Ó ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙÔ ı¿Ó·ÙÔ), ÂÓÒ Ë Û˘ÓÔÏÈ΋ ıÓËÙfiÙËÙ· ÔÚ›˙ÂÙ·È ˆ˜ Ë ıÓËÙfiÙËÙ· ·fi fiϘ ÙȘ ·Èٛ˜.
ªÂϤÙ˜ Û ·ÛıÂÓ›˜ Ì Ì˯·ÓÈΤ˜ ‚·Ï‚›‰Â˜ Ù˘ ηډȿ˜ ∆· ıÚÔÌ‚ÔÂÌ‚ÔÏÈο ÂÂÈÛfi‰È· Û ·ÛıÂÓ›˜ Ì Ì˯·ÓÈΤ˜ ‚·Ï‚›‰Â˜ Ù˘ ηډȿ˜ ÌÂÈÒıËÎ·Ó Ì ÙÔ Û˘Ó‰˘·ÛÌfi ÙˆÓ Ê·ÚÌ¿ÎˆÓ ÛÙȘ Ù¤ÛÛÂÚȘ ·Ï‹˜ ·Ú¤Ì‚·Û˘ ÌÂϤÙ˜ [Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ (RR) = 0,33, 95% ‰È¿ÛÙËÌ· ÂÌÈÛÙÔÛ‡Ó˘ (CI) = 0,19-0,58, ·fiÏ˘ÙË Ì›ˆÛË ÎÈÓ‰‡ÓÔ˘ (ARR)= 7,8%, ·ÚÈıÌfi˜ ·ÙfiÌˆÓ Ô˘ Ú¤ÂÈ Ó· ¿ÚÔ˘Ó ·ÁˆÁ‹ ÁÈ· Ó· ÚÔÏËÊı› ¤Ó· ۇ̂·Ì· (NNT) = 13]. ™ÙË Ì›· ‰ÈÏ‹˜ ·Ú¤Ì‚·Û˘ ÌÂϤÙË Ù· ÂÂÈÛfi‰È· ‹Ù·Ó ÂÍ›ÛÔ˘ ÌÂȈ̤ӷ Î·È ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ ·ÛıÂÓÒÓ. √È ·ÈÌÔÚÚ·Á›Â˜ ÛÙȘ ·Ï‹˜ ·Ú¤Ì‚·Û˘ ÌÂϤÙ˜ ·˘Í‹ıËÎ·Ó (ÛÙËÓ ÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ¤·ÈÚÓ ÙÔ Û˘Ó‰˘·ÛÌfi) ‹ ‹Ù·Ó ·ÚfiÌÔȘ Î·È ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ ·ÛıÂÓÒÓ [RR = 1,58, 95% CI = 1,02-2,44, ·fiÏ˘ÙË ·‡ÍËÛË ÎÈÓ‰‡ÓÔ˘ = 5%]. ¶·Ú·‰fi͈˜ ÛÙË ‰ÈÏ‹˜ ·Ú¤Ì‚·Û˘ ÌÂϤÙË ÔÈ ·ÈÌÔÚÚ·Á›Â˜ ÌÂÈÒıËÎ·Ó Ì ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Û˘Ó‰˘·ÛÌÔ‡ ‚·ÚÊ·Ú›Ó˘ Ì ·ÛÈÚ›ÓË. ∏ ÔÏÈ΋ ıÓËÙfiÙËÙ· ÌÂÈÒıËΠηٿ 28% ÛÙȘ ·Ï‹˜ ·Ú¤Ì‚·Û˘ ÌÂϤÙ˜, ÔÛÔÛÙfi ÙÔ ÔÔ›Ô ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈÎfi [RR=0,72, 95% CI=0,29-1,83, ARR= 5,2%, NNT=40]. ™Â ‰Â‡ÙÂÚË ·Ó¿Ï˘ÛË Ô˘ ¤ÁÈÓ Ì ÙȘ ÙÚÂȘ ·fi ÙȘ Ù¤ÛÛÂÚȘ ÌÂϤÙ˜ ·Ú·ÙËÚ‹ıËΠ̛ˆÛË Î·Ù¿ 57% Ù˘ ÔÏÈ΋˜ ıÓËÙfiÙËÙ·˜, Ë
¶›Ó·Î·˜ 1. ÷ڷÎÙËÚÈÛÙÈο ÙˆÓ ÌÂÏÂÙÒÓ ™˘ÁÁڷʤ·˜
Laffort (1) Turpie (2) Dale (3,4) Altman (5) Meschengieser (6) Huynh (7) Hurlen (8) Van Es (9) Lechat (10)
30
¶·Ú¤Ì‚·ÛË ¶¿ıËÛË ∞ÚÈıÌfi˜ ª¤ÛË º‡ÏÔ ·ÙfiÌˆÓ ∏ÏÈΛ· (% ¿Ó‰Ú˜) (¤ÙË) ∞Ï‹ ∞Ï‹ ∞Ï‹ ∞Ï‹ ¢ÈÏ‹ ∞Ï‹ ¢ÈÏ‹ ¢ÈÏ‹ ∞Ï‹
ªµ∫ ªµ∫ ªµ∫ ªµ∫ ªµ∫ ª∂ ª∂ ª∂ ∫ª
229 370 148 122 503 89 2424 647 157
63 58 51 53 67 60 62 74
50 51 75 75 58 79 77 75 48
µ·ÚÊ·Ú›ÓË +·ÛÈÚ›ÓË ™Ùfi¯Ô˜ INR
¢fiÛË ·ÛÈÚ›Ó˘
2,5-3,5 200mg qd 3-4,5 100mg qd ∆∆ 10%nl 500mg bid PT 1,8-2,3 x nl 500mg qd 2,5-3,5 100mg qd 2-2,5 80mg qd 2-2,5 75mg qd 2-2,5 80mg qd 2-2,6 100mg qd
µ·ÚÊ·Ú›ÓË ™Ùfi¯Ô˜ INR
¢È¿ÚÎÂÈ· Û ¯ÚfiÓÈ·
2,5-3,5 3-4,5 TT 10%nl PT 1,8-2,3 x nl 3,5-4,5 2-2,5 2,8-4,2 3-4 2-2,6
1 2,5 2 2 2 1 4 1 0,84
ªµ∫: Ì˯·ÓÈΤ˜ ‚·Ï‚›‰Â˜ ηډȿ˜, ª∂: ÌÂÙÂÌÊÚ·ÁÌ·ÙÈο, ∫ª: ÎÔÏÈ΋ Ì·ÚÌ·Ú˘Á‹, PT: ¯ÚfiÓÔ˜ ÚÔıÚÔÌ‚›Ó˘, ∆∆: ıÚÔÌ‚ÔÙÂÛÙ
ATHIROSKLIROSI 9b 23-02-06 10:18 ™ÂÏ›‰·31
£∂ƒ∞¶∂π∞ – º∞ƒª∞∫∞ ÔÔ›· ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ [RR=0,43, 95% CI=0,23-0,81, ARR=5,2%, NNT=19]. ™ÙË ‰ÈÏ‹˜ ·Ú¤Ì‚·Û˘ ÌÂϤÙË Ë ÔÏÈ΋ ıÓËÙfiÙËÙ· ÌÂÈÒıËΠηٿ 59% Ì ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Û˘Ó‰˘·ÛÌÔ‡ ‚·ÚÊ·Ú›Ó˘ Ì ·ÛÈÚ›ÓË 11.
ªÂϤÙ˜ Û ÌÂÙÂÌÊÚ·ÁÌ·ÙÈÎÔ‡˜ ·ÛıÂÓ›˜ ∆· ÌË ı·Ó·ÙËÊfiÚ· ÂÌÊÚ¿ÁÌ·Ù· ÙÔ˘ Ì˘Ôηډ›Ô˘ ÌÂÈÒıËÎ·Ó Ì ÙÔ Û˘Ó‰˘·ÛÌfi ÙˆÓ Ê·ÚÌ¿ÎˆÓ Î·È ÛÙȘ ÙÚÂȘ ÌÂϤÙ˜, Ë Ì›ˆÛË ·˘Ù‹ ˆÛÙfiÛÔ ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ [RR=0,77, 95% CI=0,58-1,03, ARR=1,3%, NNT=77] 8,9. √È ·ÈÌÔÚÚ·Á›Â˜ ÛÙËÓ ·Ï‹˜ ·Ú¤Ì‚·Û˘ ÌÂϤÙË ‹Ù·Ó ÙÚÂȘ ÊÔÚ¤˜ ÂÚÈÛÛfiÙÂÚ˜ Ì ÙÔ Û˘Ó‰˘·ÛÌfi ÙˆÓ Ê·ÚÌ¿ÎˆÓ Û ۇÁÎÚÈÛË Ì ÙË ÌÔÓÔıÂڷ›· Ì ‚·ÚÊ·Ú›ÓË, ·ÏÏ¿ Ë ·‡ÍËÛË ·˘Ù‹ ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋. ™ÙȘ ‰ÈÏ‹˜ ·Ú¤Ì‚·Û˘ ÌÂϤÙ˜ ÛÙȘ Ôԛ˜ ÙÔ INR ‹Ù·Ó ¯·ÌËÏfiÙÂÚÔ, ÔÈ ·ÈÌÔÚÚ·Á›Â˜ ‹Ù·Ó ÏÈÁfiÙÂÚ˜ Ì ÙÔ Û˘Ó‰˘·ÛÌfi ÙˆÓ Ê·ÚÌ¿ÎˆÓ Û˘ÁÎÚÈÙÈο Ì ÙË ÌÔÓÔıÂڷ›· Ì ˘„ËϤ˜ ‰fiÛ˘ ‚·ÚÊ·Ú›Ó˘ [RR=1,14, 95% CI=0,47-2,73]. ∏ ÔÏÈ΋ ıÓËÙfiÙËÙ·, ÛÙȘ ‰‡Ô ‰ÈÏ‹˜ ·Ú¤Ì‚·Û˘ ÌÂϤÙ˜ ·˘Í‹ıËΠ̠ÙÔ Û˘Ó‰˘·ÛÌfi Û ۇÁÎÚÈÛË Ì ÙË ÌÔÓÔıÂڷ›· Ì ˘„ËϤ˜ ‰fiÛÂȘ ‚·ÚÊ·Ú›Ó˘, ¯ˆÚ›˜ fï˜ Ë ·‡ÍËÛË ·˘Ù‹ Ó· Â›Ó·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋. ™ÙËÓ ·Ï‹˜ ·Ú¤Ì‚·Û˘ ÌÂϤÙË Ë ıÓËÙfiÙËÙ· ‰ÂÓ ÌÂÙ·‚Ï‹ıËΠÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ·ÛıÂÓÒÓ [RR=
1,20, 95% CI=0,62-2,32] 11. ª›· ÙÂÏÂ˘Ù·›· ÌÂÙ·-·Ó¿Ï˘ÛË ¤ÁÈÓ ÁÈ· Ó· ÂÎÙÈÌËı› Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· (Ì›ˆÛË ÂÌÊÚ·ÁÌ¿ÙˆÓ ÙÔ˘ Ì˘Ôηډ›Ô˘ Î·È ÈÛ¯·ÈÌÈÎÒÓ ÂÁÎÂÊ·ÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ) Î·È Ë ·ÛÊ¿ÏÂÈ· (·‡ÍËÛË ·ÈÌÔÚÚ·ÁÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ) Ì ÙÔ Û˘Ó‰˘·ÛÌfi ÙˆÓ Ê·ÚÌ¿ÎˆÓ (·ÛÈÚ›Ó˘ Î·È ‚·ÚÊ·Ú›Ó˘ Ì INR>2) Û ۇÁÎÚÈÛË Ì ÙË ÌÔÓÔıÂڷ›· Ì ·ÛÈÚ›ÓË Û ÌÂÙÂÌÊÚ·ÁÌ·ÙÈÎÔ‡˜ ·ÛıÂÓ›˜. ∏ ÌÂÙ·-·Ó¿Ï˘ÛË ·˘Ù‹ ¤‰ÂÈÍ fiÙÈ Û ÌÂÙÂÌÊÚ·ÁÌ·ÙÈÎÔ‡˜ ·ÛıÂÓ›˜ Ì ÌÈÎÚfi ‹ ̤ÙÚÈÔ Î›Ó‰˘ÓÔ ÁÈ· ·ÈÌÔÚÚ·Á›Â˜ Î·È ÌÂÁ¿ÏÔ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ Ù· ÂÌÊÚ¿ÁÌ·Ù· ÙÔ˘ Ì˘Ôηډ›Ô˘ ÌÂÈÒÓÔÓÙ·È Î·Ù¿ 83 ÂÂÈÛfi‰È· ·Ó¿ 1.000 ·ÛıÂÓ›˜ ·Ó¿ ¤ÙÔ˜ (CI 0,46-0,69), Ù· ÈÛ¯·ÈÌÈο ÂÁÎÂÊ·ÏÈο ÂÂÈÛfi‰È· ÌÂÈÒÓÔÓÙ·È Î·Ù¿ 43 ÂÂÈÛfi‰È· ·Ó¿ 1.000 ·ÛıÂÓ›˜ ·Ó¿ ¤ÙÔ˜ (CI 0,27-0,77), ÂÓÒ ÔÈ ·ÈÌÔÚÚ·Á›Â˜ ·˘Í¿ÓÔÓÙ·È Î·Ù¿ 6 ÂÂÈÛfi‰È· ·Ó¿ 1000 ·ÛıÂÓ›˜ ·Ó¿ ¤ÙÔ˜ (CI 1,7-3,7). ∂ÈÚfiÛıÂÙ· Ë ÌÂÙ·-·Ó¿Ï˘ÛË ¤‰ÂÈÍ fiÙÈ ‰ÂÓ ·Ú·ÙËÚ‹ıËΠÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ fiÛÔÓ ·ÊÔÚ¿ ÙË ıÓËÙfiÙËÙ· ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ 12.
ªÂϤÙ˜ Û ·ÛıÂÓ›˜ Ì ÎÔÏÈ΋ Ì·ÚÌ·Ú˘Á‹ ∆fiÛÔ Ù· ıÚÔÌ‚ÔÂÌ‚ÔÏÈο ÂÂÈÛfi‰È· fiÛÔ Î·È ÔÈ ·ÈÌÔÚÚ·Á›Â˜ ·˘Í‹ıËÎ·Ó ÛÙËÓ ÔÌ¿‰· Ô˘ ¤·ÈÚÓ ÙÔ Û˘Ó‰˘·ÛÌfi ÙˆÓ Ê·Ú̿ΈÓ, ÂÓÒ Ë ıÓËÙfiÙËÙ· ‹Ù·Ó ·ÚfiÌÔÈ· Î·È ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ ·ÛıÂÓÒÓ 11.
™˘˙‹ÙËÛË ¶·Ú¿ ÙËÓ Â˘Ú›· ¯Ú‹ÛË Ù˘ ·ÛÈÚ›Ó˘ Î·È Ù˘ ‚·ÚÊ·Ú›Ó˘ ˘¿Ú¯Ô˘Ó ÂÏ¿¯ÈÛÙ· ‰Â‰Ô̤ӷ ÁÈ· ÙÔ Û˘Ó‰˘·ÛÌfi ÙˆÓ ‰‡Ô Ê·Ú̿ΈÓ. Ÿˆ˜ ·Ó·Ê¤ÚıËΠÂÓÓ¤· ÌÂϤÙ˜ ÂÚ‡ÓËÛ·Ó ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Î·È ÙËÓ ·ÛÊ¿ÏÂÈ· ·˘ÙÔ‡ ÙÔ˘ Û˘Ó‰˘·ÛÌÔ‡. ∞˘Ù¤˜ ÔÈ ÌÂϤÙ˜ ÂÚÈÔÚ›˙ÔÓÙ·È Û ÙÚÂȘ Û˘ÁÎÂÎÚÈ̤Ó˜ ÓÔÛÔÏÔÁÈΤ˜ ÔÓÙfiÙËÙ˜ Ô˘ ·ÔÙÂÏÔ‡Ó ÂӉ›ÍÂȘ ÁÈ· ÙË ¯ÔÚ‹ÁËÛË ÙˆÓ ‰‡Ô Ê·Ú̿ΈÓ. ∏ ¯ÔÚ‹ÁËÛË ÙÔ˘ Û˘Ó‰˘·ÛÌÔ‡ ÙˆÓ Ê·ÚÌ¿ÎˆÓ Û ·ÛıÂÓ›˜ Ì Ì˯·ÓÈΤ˜ ‚·Ï‚›‰Â˜ Ù˘ ηډȿ˜ Ê·›ÓÂÙ·È fiÙÈ ÌÂÈÒÓÂÈ ÛËÌ·ÓÙÈο Ù· ıÚÔÌ‚ÔÂÌ‚ÔÏÈο ÂÂÈÛfi‰È· Î·È ÙË Û˘ÓÔÏÈ΋ ıÓËÙfiÙËÙ·, ¯ˆÚ›˜ ˆÛÙfiÛÔ Ó· ·Ú·ÙËÚÂ›Ù·È ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙˆÓ ·ÈÌÔÚÚ·ÁÈÎÒÓ ÂÈÏÔÎÒÓ Û ۇÁÎÚÈÛË Ì ÙË ¯ÔÚ‹ÁËÛË ÌÔÓÔıÂڷ›·˜. ∞ÓÙ›ıÂÙ· Ë ¯ÔÚ‹ÁËÛË ÙÔ˘ Û˘Ó‰˘·ÛÌÔ‡ Û ÌÂÙÂÌÊÚ·ÁÌ·ÙÈÎÔ‡˜ ·ÛıÂÓ›˜ ‰ÂÓ ÌÂÈÒÓÂÈ ÙË Û˘ÓÔÏÈ΋ ıÓËÙfiÙËÙ·, ·ÚfiÏÔ Ô˘ Ê·›ÓÂÙ·È ·fi Ì›· ÙÂÏÂ˘Ù·›· ÌÂÙ·-·Ó¿Ï˘ÛË fiÙÈ ÌÂÈÒÓÂÈ Ù· ÂÌÊÚ¿ÁÌ·Ù· ÙÔ˘ Ì˘Ôηډ›Ô˘ Î·È Ù· ÈÛ¯·ÈÌÈο ÂÁÎÂÊ·ÏÈο ÂÂÈÛfi‰È·. ∆¤ÏÔ˜, Ë ÌÂϤÙË Ô˘ ¤ÁÈÓ Ì ·ÛıÂÓ›˜ Ô˘ ›¯·Ó ÎÔÏÈ΋ Ì·ÚÌ·Ú˘Á‹ ÙÂÚÌ·Ù›ÛıËΠÚfiˆÚ· Ì ·ÔÙ¤ÏÂÛÌ· Ù· ÛÙÔȯ›· Ô˘ ˘¿Ú¯Ô˘Ó Ó· ÌËÓ Ô‰ËÁÔ‡Ó Û ·ÛÊ·Ï‹ Û˘ÌÂÚ¿ÛÌ·Ù·. ¶ÔÏϤ˜ ·ÎfiÌ· ÌÂϤÙ˜ Ú¤ÂÈ Ó· Á›ÓÔ˘Ó ÁÈ· fiϘ ÙȘ ÂӉ›ÍÂȘ Ù˘ ‚·ÚÊ·Ú›Ó˘ ÁÈ· Ó· ¤¯Ô˘Ì ̛· ÍÂοı·ÚË ·¿ÓÙËÛË ÛÙÔ ÂÚÒÙËÌ· Ù˘ ¯ÔÚ‹ÁËÛ˘.
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ATHIROSKLIROSI 9b 23-02-06 10:18 ™ÂÏ›‰·32
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¶ƒ√∆∂π¡√ª∂¡∏ µπµ§π√°ƒ∞ºπ∞ 1:
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