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¡›ÎÔ˜ ¢È·ÎÔ˘Ì¿ÎÔ˜

K·Ú‰ÈÔÏfiÁÔ˜ YÔÙ¤Ú·Ú¯Ô˜ Â.·.

¶A£OºY™IO§O°IA M¤ÏË Õı˘ÚÔ˜ B·Û›ÏÂÈÔ˜ AÓ·ÏËÚˆÙ‹˜ ¢È¢ı˘ÓÙ‹˜ E™Y K·Ú‰ÈÔÏÔÁÈÎfi TÌ‹Ì·

÷ÌËÏ¿ Â›‰· ∏DL ÓËÛÙ›·˜ Î·È ÌÂÙ·ÁÂ˘Ì·ÙÈ΋ ÏÈ·ÈÌ›·

5

Kolovou GD, Anagnostopoulou KK, Pilatis N, Kafaltis N, Sorodila K, Psarros E, Cokkinos DV. Lipids Health Dis. 2004;23:18 ∂È̤ÏÂÈ·: ∞ϤͷӉÚÔ˜ ¶·ÓÙÂÏ¿Î˘, ∞ÓÙÒÓ˘ ¶·˘Ï›‰Ë˜

B’ ¶ÚÔ·È‰Â˘ÙÈ΋˜ KÏÈÓÈ΋˜ A¶£ IÔÎÚ¿ÙÂÈÔ NÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔӛ΢ °·ÓˆÙ¿Î˘ EÌÌ·ÓÔ˘‹Ï E›ÎÔ˘ÚÔ˜ K·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜ I·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ HÚ·ÎÏ›Ԣ

K§INIKE™ ME§ETE™ PROVE IT: E›‰· C-·ÓÙȉÚÒÛ·˜ ÚˆÙ½Ó˘ Î·È ÎÏÈÓÈ΋ ¤Î‚·ÛË ÌÂÙ¿ ıÂÚ·›· Ì ÛÙ·Ù›Ó˜

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Ridker PM, Cannon CP, Morrow D, et al; for the Pravastatin or Atorvastatin Evaluation and Infection Therapy–Thrombolysis in Myocardial Infarction 22 (PROVE IT–TIMI 22) Investigators. N Engl J Med 2005;352:20-8 ∂È̤ÏÂÈ·: µ·Û›ÏÂÈÔ˜ Õı˘ÚÔ˜

¶ÂÚÈÊÂÚÂÈ·Îfi ¶·ÓÂÈÛÙËÌÈ·Îfi NÔÛÔÎÔÌÂ›Ô HÚ·ÎÏ›Ԣ KÚ‹Ù˘

£EPA¶EIA — ºAPMAKA EÏÈÛ¿Ê Mˆ˘Û‹˜ K·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜ I·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ Iˆ·ÓÓ›ÓˆÓ ¶ÂÚÈÊÂÚÂÈ·Îfi ¶·ÓÂÈÛÙËÌÈ·Îfi NÔÛÔÎÔÌÂ›Ô Iˆ·ÓÓ›ÓˆÓ KÔÏÔ‚Ô‡ °ÂÓÔ‚¤Ê· K·Ú‰ÈÔÏfiÁÔ˜ YԉȢı‡ÓÙÚÈ· A’ K·Ú‰ÈÔÏÔÁÈ΋˜

ÃÔÚ‹ÁËÛË ÛÙ·Ù›Ó˘ ÚÈÓ ÙË ‰ÈÂÓ¤ÚÁÂÈ· ·ÁÁÂÈÔÏ·ÛÙÈ΋˜: Â›‰Ú·ÛË ÛÙËÓ ÂÚÈÂÂÌ‚·ÙÈ΋ ÂÌÊ¿ÓÈÛË ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ôηډ›Ô˘

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Briguori C, Colombo A, Airoldi F, Violante A, Facaccio A, Balestrieri P, Elia PP, Golia B, Lepore S, Rivezzo G, Scarpato P, Libera M, Bonizzoni E, Ricciardelli B Eur Heart J 2004;25:1822-28 ∂È̤ÏÂÈ·: ∏Ï›·˜ ÃÂÈÌÒÓ·˜

∏ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ˘¤ÚÙ·Û˘ ÌÂÙ¿ ·fi ¤Ó· ÈÛ¯·ÈÌÈÎfi ·ÁÁÂÈ·Îfi ÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔ

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ªÈ¯¿Ï˘ ∫·ÏÔÁ‹ÚÔ˘, ªˆ˘Û‹˜ ∂ÏÈÛ¿Ê

∏ ·ÓÙ·fiÎÚÈÛË Ù˘ HDL ÛÙËÓ ˘ÔÏÈȉ·ÈÌÈ΋ ıÂÚ·›·

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°ÂÓÔ‚¤Ê· ¢. KÔÏÔ‚Ô‡, K·ÙÂÚ›Ó· K. AÓ·ÁÓˆÛÙÔÔ‡ÏÔ˘, AϤͷӉÚÔ˜ E. ¶·ÓÙÂÏ¿Î˘

KÏÈÓÈ΋˜ Î·È ˘‡ı˘ÓÔ˜ §Èȉ·ÈÌÈÎÔ‡ I·ÙÚ›Ԣ øÓ·Û›Ԣ K·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈÎÔ‡ K¤ÓÙÚÔ˘

E›‰Ú·ÛË Ù˘ ıÂÚ·›·˜ Ì ÛÙ·Ù›Ó˜ ÛÙËÓ ÔÌÔÈÔÛÙ·Û›· ÙÔ˘ Ô˘ÚÈÎÔ‡ ÔͤԘ Û ·ÛıÂÓ›˜ Ì ÚˆÙÔ·ı‹ ˘ÂÚÏÈȉ·ÈÌ›·

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Milionis H, Kakafika A, Tsouli S, Athyros V, Seferiadis K, Elisaf M. Am Heart J 2004; 148: 635-640

MÈÏÈ·ÓÔ‡ EϤÓË K·Ú‰ÈÔÏfiÁÔ˜ EÈÌÂÏËÙ‹˜ A’ Ù˘ K·Ú‰ÈÔÏÔÁÈ΋˜ KÏÈÓÈ΋˜ Î·È ˘‡ı˘ÓÔ˜ §Èȉ·ÈÌÈÎÔ‡ I·ÙÚ›Ԣ T˙·Ó›Ԣ NÔÛÔÎÔÌ›Ԣ ¶ÂÈÚ·ÈÒ˜ ¶›ÙÛ·‚Ô˜ XÚ‹ÛÙÔ˜ AÓ·ÏËÚˆÙ‹˜ K·ıËÁËÙ‹˜

™Y°XPONE™ O¢H°IE™ ™‡Á¯ÚÔÓ˜ ˘ÁÈÂÈÔÓԉȷÈÙËÙÈΤ˜ Ô‰ËÁ›Â˜ ÁÈ· ÙËÓ ÚfiÏË„Ë Ù˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘

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HÏ›·˜ XÂÈÌÒÓ·˜

AÓ·ÛÎfiËÛË ÙˆÓ O‰ËÁÈÒÓ ÁÈ· ÙË ¢Â˘ÙÂÚÔÁÂÓ‹ ¶ÚfiÏË„Ë Ù˘ K·Ú‰È·ÁÁÂȷ΋˜ NfiÛÔ˘

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M. KˆÛÙ·¿ÓÔ˜, M. EÏÈÛ¿Ê

K·Ú‰ÈÔÏÔÁ›·˜, I·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ IÔÎÚ¿ÙÂÈÔ NÔÛÔÎÔÌÂ›Ô AıËÓÒÓ

¶POTEINOMENH BIB§IO°PAºIA

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ÚˆÛË Â›‹ Ï Î Û Ô Ú Ë ı ›Ë˜ ÛÙËÓ · Ù ˜ Ô Ï fi fiÙÈ Ë ·ÓÙ Ú fi Ô Ù Û È ˆ · Ó Î Á È ›· ÓÔ ÙÔ˘ Ô˘˜. ∂›Ó· ÛÏÈȉ·ÈÌ fi ¯ ˘ Ì ‡ ‰ Â È Ù ‹ ¯ Î fi ˜ È Ô Ù ‹ Ù Ë ¯ Ó · ∏ ‰È·‚ ÙÔ˘ ·Úfi ÙË ‰È·Ù·Ú · Û Ì ¤ ›  ı ÂÛÌ· ÙËÓ Á Ï Ô Ë ¤ Ù ‰ Ù Ò Ô Ô Ú  Ë  · Ó › Â Ô Ï Ì ˘ , Ó·È Ù ¤˜ ÛÙËÓ ÈÓÛÔ Ó ÏÈȉ›ˆÓ Ó ˆ Ò Ù Ù È Û ‰È·Ù·Ú·¯ È · Î ˜ Ó ¤ ˆ ¿ Î Ù Ï È Ï Ù Ë · · Û Ì ˜ · ˘ ˙Ë ÛÙ √È ÌÂÙ·Á ˘ı› ¤Ó· Ù˘ ÁÏ˘Îfi . Ô Ó ‡ Ï Ò Ô Ô È Ì Î Ú Û ∞ Ë È Ù Ï . Ú Ó Ô ˆ Ó · ÌÂÙ·‚ ¤ÓˆÓ ¿ÚıÚ ‹ÚˆÛË Ùˆ Ì Ï Ô Î  Û Â Ô ˜ ÚfiÁÓˆÚ Ë Ô Ë Ù ‡ ı ‰ Ë · Û Ó Ë ˆ ˆ › Ì Ù È Ù · ÂÏ ÚÒ Ë˜ ·È ÙÔ ı¤Ì ‰Â˜ ÁÈ· ‚ › Ó ›  Â Ï Â Ó Ë˜ ÛÙ·Ù›Ó ˆ ¿ Û › Ó Ë ‰ Ó Á È Â ‹  Á È Ú Ï Ô Ô › ¯ Ó Ô Ùˆ ÍË Ô ‹˜ ÌÂÈÒ‹: Ë ¤Ó·Ú ÚıÚÔ, ÙÔ Î Î È ¿ È Ù Ù Ó Û Û Ô · · Ú Ï Ï ¤   Ê Ô Ô È ÂÈ ÂӉȷ ÌÂÙ¿ ·ÁÁ ÚÁÂÈ· ·ÁÁ ¤ Ó Ó Ò Â Ó È ˘Ôηډ›Ô˘  ‰ Ì ı Û Ë ˘ · Ù Ô Ó Ù Ó È ˆ Ú ˜ Ù  Ô Ù ˜ Û˘ ÂÌÊÚ¿ÁÌ· Ó ˘ÔÂȘ Ë̤ÚÂ Ë Ú Ù Q Ù Û Ó n ˜ Ô o Ë Ù Ï n Û fi È ˜ Ú Ë Ù ÙÔ˘Ï¿¯ · ÂÌÊ¿ÓÈÛ DL-¯ÔÏËÛ Ù H Ë Ù ˜ fi Ë ·ÛÎfiËÛË Ó Ù Ó · · Ë ı È Û ˜ È  ‹ Ú Ú Î Ó Â Ë fi Ì Ù  · ÙÔ ÓÂÈ fi ÛË. ∏ ·ÓÙ · Î·È ÏÂ · Û ‚ ˘ Ì Ô ¤ ÂÁÎÂÊ·ÏÈÎ Ú  ¤ Â Ê fi Ó Î · È È Ë Ì ‰ Ù È Ó ·  ¿ ¯ Ù ÈÛ È· η ÌÂÙ¿ ÙÔ ˆÁ‹ Î·È Ì È·Ú·Á‰ Á ˜ · Ë · Û Ú ‹ · ı Î Ù È Ú Ú Ì ¿ È ¤ Ô ˘ ÏÈȉ· ‹ ÚıÚˆÓ. ¢‡ ¿ ÒÈÛË Ù˘ Ù Ó Â ˆ Ì Ï È΋ ·ÁˆÁ È Ï Ù Ù ¿ Ó Ë Ù · È Ô Ó · Ó È Â Ë ‰ Ì Ù › Ô Â ÈÎ ÂÈÓ ÁÈ· ÂÏÔ‡Ó ·ÓÙ ËÌ¿ÙˆÓ. · ÙËÓ ˘ÁÈ Ù È Û Ô Á Ô  Ó ˜ · Â Ó › Ô Ò Á È Ë Î ‰ ‰ · ÂÂÈÛfi ·Ú‰È·ÁÁÂÈ Á¯ÚÔÓ˜ Ô Î ‡ Û Ó ˆ ˜ PROVE IT È Ù Ù ˜ Ë Ë È Ù „ · ¤ Ë Ù Ï Ï Ó Â fi Ô Ì Ú ‡  ˜ Ì·Ù ¿ ‹Ì·Ù· ÙË Ú ˘ÙÂÚÔÁÂÓ‹ ˘   ‰ · ΂·ÛË ÌÂÙ Ó Ù ¤ Ë Ó Ù ‹ Ô Î Ú · È ¤ È Ó Ê È Á Ï · È È Î Ó Î· ÂÓ‰ · Ù˘ ÛÙË › È¿˙ÔÓÙ·È Û Û ˘ · Ô Ì Ë Ú Û ·  Ë Ù ∆¤ÏÔ˜ ˜ ˜ CRP Î·È Ë Ù · ‰ ˜ ÃÂÈÌÒÓ·  ·  › › Ï  H  · Ù ÁÈ· ˘ ˜  ÛÙ·Ù›Ó ‹˜ ™‡ÓÙ·Í Ì Ù Ó ˘ · › ı  ˘  Â È · ¢ Ú ıÂ

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A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·2

·ıËÚÔÛÎÏ‹ÚˆÛË MAPTIO™ 2005

¢È·‚ËÙÈ΋ ‰˘ÛÏÈȉ·ÈÌ›· Î·È ·ıËÚÔÛÎÏ‹ÚˆÛË ¡›ÎÔ˜ ¢È·ÎÔ˘Ì¿ÎÔ˜, ∫·Ú‰ÈÔÏfiÁÔ˜. ¢È·ÁÓˆÛÙÈÎfi ∫·Ú‰ÈÔÏÔÁÈÎfi ∫¤ÓÙÚÔ ¶ÂÈÚ·È¿, ™˘ÓÂÚÁ¿Ù˘ ¡ÔÛÔÎÔÌ›Ԣ Metropolitan

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∏ ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË Û˘Ó‰¤ÂÙ·È Ì ̛· ÏÂÈ¿‰· ‰È·Ù·Ú·¯ÒÓ, Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ˘¤ÚÙ·ÛË, ÙËÓ ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›·, ÙËÓ ÂÈÎÚ¿ÙËÛË ÌÈÎÚÒÓ ˘ÎÓÒÓ ÛˆÌ·Ùȉ›ˆÓ Ù˘ ÏÈÔÚˆÙ½Ó˘ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ (LDL), Ù· ¯·ÌËÏ¿ Â›‰· HDL-¯ÔÏËÛÙÂÚfiÏ˘ (HDL-C), ηıÒ˜ Î·È ÙËÓ ˘ÂÚËÎÙÈÎfiÙËÙ·. ∏ ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË Â›Ó·È, ‚¤‚·È·, ¤Ó·˜ ·ÚÈÔ˜ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ‰È·‚‹ÙË. ∏ ·¯˘Û·ÚΛ· ‰È·‰Ú·Ì·Ù›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ, ÙfiÛÔ ‰ÈfiÙÈ ÂÈÙ›ÓÂÈ ÙËÓ ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË, fiÛÔ Î·È ‰ÈfiÙÈ ·ÔÙÂÏ› ·ÓÂÍ¿ÚÙËÙÔ ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÁÈ· ·ıËÚÔÛÎÏ‹ÚˆÛË. ŒÙÛÈ, ÔÈ ·ÛıÂÓ›˜ Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË, ¤¯Ô˘Ó ÔÏÏÔ‡˜ ÏfiÁÔ˘˜ Ó· ‰È·ÙÚ¤¯Ô˘Ó Ôχ ˘„ËÏfi ΛӉ˘ÓÔ ÁÈ· ·ıËÚÔÛÎÏËÚˆÙÈ΋ ηډȷÁÁÂȷ΋ ÓfiÛÔ (∞£™∫∞¡). ∞fi Ù· ‰Â‰Ô̤ӷ ÙÔ˘ ÈÛÙÔÚÈÎÔ‡, Ù˘ ÎÏÈÓÈ΋˜ ÂͤٷÛ˘ Î·È ÙÔ˘ ÂÚÁ·ÛÙËÚÈ·ÎÔ‡ ÂϤÁ¯Ô˘, Ù· ÛÙÔȯ›· ÁÈ· ÙËÓ ·Ó·ÁÓÒÚÈÛË ÙˆÓ ˘ÂÚÈÓÛÔ˘ÏÈÓ·ÈÌÈÎÒÓ ·ÛıÂÓÒÓ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙË ÎÔÈÏȷ΋ ·¯˘Û·ÚΛ· Î·È ÙË ·ÚÔ˘Û›· ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›·˜ Ì ¯·ÌËÏ‹ HDL-C. ªÂÚÈΤ˜ ÊÔÚ¤˜ ÌÔÚ› Ó· ·ÓȯÓ¢ı› ‰˘Û·ÓÂÍ›· ÛÙË ÁÏ˘Îfi˙Ë ÓËÛÙ›·˜ (ÙÈ̤˜ ÌÂٷ͇ 110-126 mg/dL), ÂÓÒ Ù· ¿ÏÏ· ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·ÙfiÌˆÓ Ì ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙËÓ ˘¤ÚÙ·ÛË Î·È ÙËÓ ‹‰Ë ÂÁηÙÂÛÙË̤ÓË ∞£™∫∞¡. √ÚÈṲ̂Ó˜ ÂıÓÔÏÔÁÈΤ˜ ÔÌ¿‰Â˜ (ÁËÁÂÓ›˜ ∞ÌÂÚÈηÓÔ›, ¿ÙÔÌ· ÚÔÂÚ¯fiÌÂÓ· ·fi ÙË ¡ÔÙÈ·Ó·ÙÔÏÈ΋ ∞Û›·) 2

·ÚÔ˘ÛÈ¿˙Ô˘Ó ˘„ËÏ‹ ÁÂÓÂÙÈ΋ ÚԉȿıÂÛË ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ·ÓÙ›ÛÙ·Û˘ ÛÙËÓ ÈÓÛÔ˘Ï›ÓË. ∏ ‰˘ÛÏÈȉ·ÈÌ›· ÙÔ˘ ™˘Ó‰ÚfiÌÔ˘ ∞ÓÙ›ÛÙ·Û˘ ÛÙËÓ πÓÛÔ˘Ï›ÓË ÂÚÈÏ·Ì‚¿ÓÂÈ ·˘ÍË̤ӷ Â›‰· ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ (TG), ÌÂȈ̤ÓË HDL-C Î·È ÌÂȈ̤ӷ Â›‰· ·ÔÚˆÙ½Ó˘ ∞-π (Apo A-I), ·ÚÔ˘Û›· ·˘ÍË̤Ó˘ LDL-C (fi¯È ··Ú·›ÙËÙ·) Î·È ·˘ÍË̤ÓË ·Ó·ÏÔÁ›· ÌÈÎÚÒÓ, ˘ÎÓÒÓ, Ùˆ¯ÒÓ Û ¯ÔÏËÛÙÂÚfiÏË ÛˆÌ·Ùȉ›ˆÓ LDL, ·˘ÍË̤ӷ Â›‰· VLDL– ¯ÔÏËÛÙÂÚfiÏ˘ (VLDL-C) Î·È ·ÔÚˆÙ½Ó˘ µ (Apo-B). ™Â Ì›· ·Ó¿Ï˘ÛË Ù˘ Framingham Heart Study, Ô˘ Û˘Ó¤ÎÚÈÓ ٷ ÏÈȉÈο Â›‰· ·Ó‰ÚÒÓ Î·È Á˘Ó·ÈÎÒÓ, Ì ‹ ¯ˆÚ›˜ ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ 2 (™¢ 2), Ì ٷ ·ÓÙ›ÛÙÔȯ· ̤۷ Â›‰· ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ ÏËı˘ÛÌÔ‡ ÙˆÓ ∏¶∞, ‰È·ÈÛÙÒıËΠfiÙÈ ÁÈ· ÙËÓ ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË (TC) Î·È ÙËÓ LDL-C ‰ÂÓ ˘‹Ú¯·Ó ‰È·ÊÔÚ¤˜ ÌÂٷ͇ Ê˘ÛÈÔÏÔÁÈÎÒÓ Î·È ‰È·‚ËÙÈÎÒÓ ·Ó‰ÚÒÓ Î·È Á˘Ó·ÈÎÒÓ, ·ÏÏ¿ ÔÈ ‰È·‚ËÙÈÎÔ› ·ÛıÂÓ›˜ (¿Ó‰Ú˜ Î·È Á˘Ó·›Î˜) ·ÚÔ˘Û›·˙·Ó 2Ï¿ÛÈ· ۯ‰fiÓ Â›ÙˆÛË ¯·ÌËÏ‹˜ HDL-C Î·È ˘„ËÏÒÓ TG, Û ۯ¤ÛË Ì ÙÔ˘˜ ÌË ‰È·‚ËÙÈÎÔ‡˜ ÔÌÔÏfiÁÔ˘˜ ÙÔ˘˜1. ¶·ÚfiÌÔÈ· Ì ÂΛӷ Ù˘ Framingham Heart Study, ‹Ù·Ó Î·È Ù· ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ÏÈȉÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ ÙˆÓ ·ÛıÂÓÒÓ Ì ™¢ 2, Û ̛· ·Ó¿Ï˘ÛË Ù˘ United Kingdom Prospective Diabetes Study (UKPDS), Ì ÌfiÓË ÙË ‰È·ÊÔÚ¿ Ù˘ ‹È·˜, ·ÏÏ¿ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋˜, ·‡ÍËÛ˘ Ù˘ LDL-C ÛÙȘ ‰È·‚ËÙÈΤ˜, ¤Ó·ÓÙÈ ÙˆÓ ÌË ‰È·‚ËÙÈÎÒÓ Á˘Ó·ÈÎÒÓ2.

§Èȉ·ÈÌÈΤ˜ ¢È·Ù·Ú·¯¤˜ – ¶·ıÔÊ˘ÛÈoÏÔÁ›·

∏ ÈÓÛÔ˘Ï›ÓË Ê˘ÛÈÔÏÔÁÈο ηٷÛÙ¤ÏÏÂÈ ÙË ‰Ú¿ÛË Ù˘ ÔÚÌÔÓÔ¢·›ÛıËÙ˘ ÏÈ¿Û˘, ‰ËÏ·‰‹ ÙÔ˘ ÂÓ˙‡ÌÔ˘ Ô˘ ‰È·Û¿ Ù· TG ÙÔ˘ ÏÈÒ‰Ô˘˜ ÈÛÙÔ‡ Î·È ·ÂÏ¢ıÂÚÒÓÂÈ ÏÈ·Ú¿ Ôͤ· ÁÈ· ÙȘ ÌÂÙ·‚ÔÏÈΤ˜ Î·È ÂÓÂÚÁÂȷΤ˜ ·Ó¿ÁΘ ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡. ∏ ·Ó·ÛÙÔÏ‹ ‹ Ì›ˆÛË Ù˘ ‰Ú¿Û˘ Ù˘ ÈÓÛÔ˘Ï›Ó˘, Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÙÔ ™‡Ó‰ÚÔÌÔ ∞ÓÙ›ÛÙ·Û˘ ÛÙËÓ πÓÛÔ˘Ï›ÓË, ÂÈÙÚ¤ÂÈ ÛÙÔ ¤Ó˙˘ÌÔ ·˘Ùfi Ó· οÓÂÈ ÌÂÁ·Ï‡ÙÂÚË ‰È¿Û·ÛË ÙˆÓ ÂÓ·ÔıËÎÂ˘Ì¤ÓˆÓ ÛÙ· ÏÈÔ·ÙÙ·Ú· TG. ∏ ·˘ÍË̤ÓË ‰È¿Û·ÛË ÙˆÓ TG ·ÎÔÏÔ˘ıÂ›Ù·È ·fi ·˘ÍË̤ÓË ·fi‰ÔÛË ÂχıÂÚˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ (FFA) ÛÙË Î˘ÎÏÔÊÔÚ›·. ¶ÚfiÎÂÈÙ·È ÁÈ· Ì›· Û˘ÓËıÈṲ̂ÓË ‰È·Ù·Ú·¯‹, Ô˘ ·Ú·ÙËÚÂ›Ù·È ÙfiÛÔ Û ·¯‡Û·Úη, fiÛÔ Î·È Û ÏÂÙfiۈ̷ ¿ÙÔÌ· Ì ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË, fiˆ˜ Î·È Û ·ÛıÂÓ›˜ Ì ™¢ 2. ∆· ·˘ÍË̤ӷ ÛÙÔ Ï¿ÛÌ· FFA ÚÔÛÏ·Ì‚¿ÓÔÓÙ·È Ì ÂÓÙÔÓfiÙÂÚÔ Ú˘ıÌfi ·fi ÙÔ ‹·Ú. ™Â ηٿÛÙ·ÛË ÓËÛÙ›·˜ Î·È Â› ·ÚÔ˘Û›·˜ Â·ÚÎÒÓ ·ÔıÂÌ¿ÙˆÓ ÁÏ˘ÎÔÁfiÓÔ˘, ηٿÛÙ·ÛË Ô˘ ·ÓÙÈÚÔÛˆ‡ÂÈ ÙË Û˘¯ÓfiÙÂÚË ÂÈÎfiÓ· Û ‰È·‚ËÙÈÎÔ‡˜ Ì ÏÔÁÈο ÂÏÂÁ¯fiÌÂÓÔ ‰È·‚‹ÙË Î·È Û ÌË ‰È·‚ËÙÈÎÔ‡˜ Ì ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË, ÙÔ ‹·Ú ¯ÚËÛÈÌÔÔÈ› Ù· ÚÔÛÏ·Ì‚·ÓfiÌÂÓ· ÏÈ·Ú¿ Ôͤ· ÁÈ· ÙË Û‡ÓıÂÛË TG. H ·ÚÔ˘Û›· ·˘ÍËÌ¤ÓˆÓ TG ‰ÈÂÁ›ÚÂÈ ÙËÓ ¤ÎÎÚÈÛË Apo B Î·È VLDL, ÌÂ Û˘Ó¤ÂÈ· ÙÔÓ ·˘ÍË̤ÓÔ ·ÚÈıÌfi ۈ̷Ùȉ›ˆÓ VLDL Î·È ÙËÓ ·‡ÍËÛË ÙÔ˘ ÂÈ¤‰Ô˘ ÙˆÓ TG ÛÙÔ Ï¿ÛÌ·. ™Â ·ÚÔ˘Û›· ·˘ÍË̤ӈÓ


A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·3

¶∞ƒ∞°√¡∆∂™ ∫π¡¢À¡√À ÂÈ¤‰ˆÓ VLDL ÛÙÔ Ï¿ÛÌ· Î·È Ê˘ÛÈÔÏÔÁÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ÚˆÙ½Ó˘ ÌÂÙ·ÊÔÚ¿˜ ÙˆÓ ÂÛÙ¤ÚˆÓ ¯ÔÏËÛÙÂÚfiÏ˘ (CETP), Á›ÓÂÙ·È ·ÓÙ·ÏÏ·Á‹ ÂÓfi˜ ÌÔÚ›Ô˘ ÂÛÙ¤Ú· ¯ÔÏËÛÙÂÚfiÏ˘, ÚÔÂÚ¯fiÌÂÓÔ˘ ·fi ÙËÓ HDL, ¤Ó·ÓÙÈ ÂÓfi˜ ÌÔÚ›Ô˘ TG, ÚÔÂÚ¯fiÌÂÓÔ˘ ·fi ÙË VLDL. ∏ ·ÓÙ·ÏÏ·Á‹ ·˘Ù‹ ¤¯ÂÈ ‰‡Ô Û˘Ó¤ÂȘ: ÚÒÙÔÓ ÙË ‰ËÌÈÔ˘ÚÁ›· ÂÓfi˜ ÏÔ‡ÛÈÔ˘ Û ¯ÔÏËÛÙÂÚfiÏË ˘ÔÏÂÈÌÌ·ÙÈÎÔ‡ ۈ̷Ùȉ›Ô˘ VLDL, Ô˘ Â›Ó·È ·ıËÚÔÁfiÓÔ Î·È ‰Â‡ÙÂÚÔÓ ÙË ‰ËÌÈÔ˘ÚÁ›· ÂÓfi˜ Ùˆ¯Ô‡ Û ÂÛÙ¤Ú˜ ¯ÔÏËÛÙÂÚfiÏ˘, ·ÏÏ¿ ÏÔ‡ÛÈÔ˘ Û TG ۈ̷Ùȉ›Ô˘ HDL. ∆Ô ÙÂÏÂ˘Ù·›Ô ·˘Ùfi ۈ̷ٛ‰ÈÔ HDL ˘Ê›ÛÙ·Ù·È ÂÚ·ÈÙ¤Úˆ ÙÚÔÔÔ›ËÛË, Ô˘ Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÈ ÙË ÏÈÔÏ˘ÙÈ΋ Â›‰Ú·ÛË Ù˘ Ë·ÙÈ΋˜ ÏÈ¿Û˘, ‰È·‰Èηۛ· Ô˘ Ô‰ËÁ› ÛÙËÓ ·fiÛ·ÛË ·fi ·˘Ùfi Ù˘ ‰ÔÌÈο ÛËÌ·ÓÙÈ΋˜ Apo A-I. ∏ ÂχıÂÚË ÛÙÔ Ï¿ÛÌ· Apo A-I ·Ô‚¿ÏÏÂÙ·È Ù·¯‡ÙÂÚ·, ·ÚÈ· ·fi ÙÔ ÓÂÊÚfi, Û ۯ¤ÛË Ì ÙË Û˘Ó‰Â‰Â̤ÓË ÛÙÔ ÛˆÌ·Ù›‰ÈÔ Ù˘ HDL. ∞ÔÙ¤ÏÂÛÌ· Â›Ó·È Ë Ì›ˆÛË Ù˘ ÔÛfiÙËÙ·˜ Ù˘ Apo A-I ÛÙË Î˘ÎÏÔÊÔÚ›· Î·È ¿Ú· Î·È ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÛˆÌ·Ùȉ›ˆÓ HDL. ™Â ·ÚÔ˘Û›· Ê˘ÛÈÔÏÔÁÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ CETP ÙÔ˘ Ï¿ÛÌ·ÙÔ˜, Ù· ·˘ÍË̤ӷ Â›‰· ÙˆÓ TG ÙˆÓ VLDL ·ÓÙ·ÏÏ¿ÛÛÔÓÙ·È Ì ÂÛÙ¤Ú˜ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ·fi ÙȘ LDL. ∆· ÚÔ·ÙÔÓÙ· ÏÔ‡ÛÈ· Û TG ۈ̷ٛ‰È· LDL ˘Ê›ÛÙ·ÓÙ·È ÙË ÏÈÔÏ˘ÙÈ΋ ‰Ú¿ÛË Ù˘ Ë·ÙÈ΋˜ ‹ Î·È Ù˘ ÏÈÔÚˆÙ½ÓÈ΋˜ ÏÈ¿Û˘, ÌÂ Û˘Ó¤ÂÈ· ÙË ‰ËÌÈÔ˘ÚÁ›· ÌÈÎÚÒÓ, ˘ÎÓÒÓ Î·È Ùˆ¯ÒÓ Û ¯ÔÏËÛÙÂÚfiÏË ÛˆÌ·Ùȉ›ˆÓ LDL. ∂ÈÙÒÛÂȘ

™ÙÔȯ›· ·fi ÌÂϤÙ˜ in vitro Î·È in vivo ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ ÔÈ ÌÈÎÚ¤˜, ˘ÎÓ¤˜ LDL Â›Ó·È È‰È·›ÙÂÚ· ·ıËÚÔÁfiÓ˜. ™Â ÌÂϤÙ˜ in vitro, ‰È·ÈÛÙÒıËΠfiÙÈ ÔÈ ÌÈÎÚ¤˜, ˘ÎÓ¤˜ LDL Â›Ó·È ÂÚÈÛ-

ÛfiÙÂÚÔ Â˘·ı›˜ Û ÔÍÂȉˆÙÈ΋ ÙÚÔÔÔ›ËÛË, Î·È ÂÂȉ‹ Â›Ó·È ÌÈÎÚfiÙÂÚ˜ Û ̤ÁÂıÔ˜, Ê·›ÓÂÙ·È fiÙÈ ÂÈÛ‰‡Ô˘Ó ¢ÎÔÏfiÙÂÚ· ÛÙËÓ ˘ÂÓ‰ÔıËÏȷ΋ ÛÙÈ‚¿‰· ÙÔ˘ ·ÚÙËÚÈ·ÎÔ‡ ÙÔȯÒÌ·ÙÔ˜. ∆Ô ÌfiÚÈÔ Ù˘ Apo B ÙˆÓ ÌÈÎÚÒÓ, ˘ÎÓÒÓ LDL ˘Ê›ÛÙ·Ù·È ÙÚÔÔÔ›ËÛË Ô˘ Ô‰ËÁ› Û Ì›ˆÛË Ù˘ Û˘ÁÁ¤ÓÂÈ¿ Ù˘ ÚÔ˜ ÙÔÓ ˘Ô‰Ô¯¤· Ù˘ LDL, ÂÈÙÚ¤ÔÓÙ·˜ ¤ÙÛÈ ÙË ÌÂÁ·Ï‡ÙÂÚË, ¯ÚÔÓÈο, ·Ú·ÌÔÓ‹ ÙÔ˘˜ ÛÙË Î˘ÎÏÔÊÔÚ›· Î·È ÛÙÔ ·ÁÁÂÈ·Îfi ÙÔ›¯ˆÌ·. ™Â ÌÂϤÙ˜ ÏËı˘ÛÌÒÓ Î·È Û ÌÈÎÚ¤˜ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜, Ë ·ÚÔ˘Û›· ÌÈÎÚÒÓ, ˘ÎÓÒÓ LDL Û˘Ó‰¤ıËΠ̠ÙÔ Û‡Ó‰ÚÔÌÔ ·ÓÙ›ÛÙ·Û˘ ÛÙËÓ ÈÓÛÔ˘Ï›ÓË, fiˆ˜ Â›Û˘ Î·È Ì ÙËÓ ·ÚÔ˘Û›· ˘„ËÏÔ‡ ÂÈ¤‰Ô˘ TG Î·È ¯·ÌËÏ‹˜ HDL-C3. ∞Ó·ÊÔÚÈο Ì ÙË Û¯¤ÛË ˘ÂÚÈÓÛÔ˘ÏÈÓ·ÈÌ›·˜ Î·È ¯·ÌËÏ‹˜ HDL-C, Ì›· ÌÂϤÙË ·fi ÙÔ ¶·ÓÂÈÛÙ‹ÌÈÔ Stanford4 ¤‰ÂÈÍ fiÙÈ ÙfiÛÔ ÛÙÔ˘˜ ·¯‡Û·ÚÎÔ˘˜, fiÛÔ Î·È ÛÙÔ˘˜ ÏÂÙfiÛˆÌÔ˘˜ ·ÛıÂÓ›˜, ÂΛÓÔÈ Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ˘ÂÚÈÓÛÔ˘ÏÈÓ·ÈÌ›· ¤¯Ô˘Ó ¯·ÌËÏfiÙÂÚ· Â›‰· HDL-C, Û ۯ¤ÛË Ì ٷ ¿ÙÔÌ· Ì ÈÓÛÔ˘Ï›ÓË Î¿Ùˆ Ù˘ ̤Û˘ ÙÈÌ‹˜. ™¯ÂÙÈο Ì ÙÔ Â›Ì·¯Ô ˙‹ÙËÌ· Ù˘ Û˘Û¯¤ÙÈÛ˘ ÌÂٷ͇ TG Î·È ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ (™¡), Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ ˘¿Ú¯Ô˘Ó ·ÚÎÂÙÔ› ÏfiÁÔÈ, ÁÈ· ÙÔ˘˜ ÔÔ›Ô˘˜ ı· Ú¤ÂÈ Ó· ıˆÚÂ›Ù·È fiÙÈ Ë ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›· ·ÔÙÂÏ›, ÙÔ˘Ï¿¯ÈÛÙÔÓ, ¤Ó· ‰Â›ÎÙË ·˘ÍË̤Ó˘ ·ıËÚÔÁfiÓÔ˘ Èı·ÓfiÙËÙ·˜. ¶ÚÒÙ· ·fi fiÏ·, Ë ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›· Û˘Ó‰¤ÂÙ·È Ì ·˘ÍË̤ӷ Â›‰· ÙˆÓ ·ıËÚÔÁfiÓˆÓ ˘ÔÏÂÈÌÌ¿ÙˆÓ ÙˆÓ ¯˘ÏÔÌÈÎÚÒÓ Î·È ÙˆÓ VLDL, Î·È Ô‰ËÁ›, fiˆ˜ ÚԷӷʤÚıËÎÂ, ÛÙË ·Ú·ÁˆÁ‹ ÌÈÎÚÒÓ, ˘ÎÓÒÓ LDL Î·È ·ÔÙÂÏ› ÙË ‚¿ÛË ÁÈ· Ù· ¯·ÌËÏ¿ Â›‰· HDL. ∏ ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›· Û˘Ó‰¤ÂÙ·È Â›Û˘ Ì ·˘ÍË̤ÓË ËÎÙÈÎfiÙËÙ· Î·È ÌÂȈ̤ÓË ÈÓˆ‰fiÏ˘ÛË, fiˆ˜ Û˘ÌÂÚ·›ÓÂÙ·È ·fi Ù· ·˘ÍË̤-

Ó· Â›‰· ÙÔ˘ PAI-I Î·È ÙÔ˘ ·Ú¿ÁÔÓÙ· VII, Î·È ·fi ÙËÓ ÂÓÂÚÁÔÔ›ËÛË Ù˘ ÚÔıÚÔÌ‚›Ó˘ Û ıÚÔÌ‚›ÓË. ŒÓ· ı¤Ì·, Ô˘ ‰ÂÓ ¤¯ÂÈ Û˘˙ËÙËı› ·ÚÎÂÙ¿ Â›Ó·È ÔÈ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ TG ÛÙÔ ÏËı˘ÛÌfi Ì ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË, Î·È ÔÈ Ôԛ˜ ÂÌÊ·Ó›˙ÔÓÙ·È fi¯È ÌfiÓÔ fiÙ·Ó ÔÈ ·ÛıÂÓ›˜ Â›Ó·È Û ηٿÛÙ·ÛË ÓËÛÙ›·˜, ·ÏÏ¿ Î·È ÌÂÙ¿ ·fi ¤Ó· ÏÈ·Úfi Á‡̷. Œ¯ÂÈ ·Ô‰Âȯı› fiÙÈ Ë ÌÂÙ·ÁÂ˘Ì·ÙÈ΋ ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›· ·ÔÙÂÏ› ‰Â›ÎÙË ·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ ™¡. ™Â Ì›· ·ÚÎÂÙ¿ ·ÏÈ¿ ÌÂϤÙË, ÔÈ Patsch et al.5, Û‡ÁÎÚÈÓ·Ó ·ÛıÂÓ›˜ Ì ·ÁÁÂÈÔÁÚ·ÊÈο ‚‚·ÈˆÌ¤ÓË ™¡, Ì ÂΛÓÔ˘˜ ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ ÛÙÂÊ·ÓÈÔÁÚ·Ê›·, Î·È ‰È·›ÛÙˆÛ·Ó fiÙÈ ÔÈ ÛÙÂÊ·ÓÈ·›ÔÈ ·ÛıÂÓ›˜ ·ÚÔ˘Û›·˙·Ó ˘„ËÏfiÙÂÚË ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›· ÌÂÙ¿ ·fi ¤Ó· ÏÈ·Úfi Á‡̷, ÂÓÒ Û ¿ÏÏË ÌÂϤÙË ‰È·ÈÛÙÒıËΠfiÙÈ Ë ‰È·Ù·Ú·¯‹ Ù˘ ÌÂÙ·ÁÂ˘Ì·ÙÈ΋˜ ÏÈ·ÈÌ›·˜ ·ÔÙÂÏ› ¤Ó· ·ÓÂÍ¿ÚÙËÙÔ ·Ú¿ÁÔÓÙ· Úfi‚Ï„˘ Ù˘ ·ÚÔ˘Û›·˜ ∞£™∫∞¡, ·ÓÂÍ¿ÚÙËÙÔ ·ÎfiÌË Î·È ·fi ÙÔ Â›Â‰Ô TG ÓËÛÙ›·˜. √ ۷ί·Ú҉˘ ‰È·‚‹Ù˘ Û˘Ó‰˘¿˙ÂÙ·È, Â›Û˘, Ì ˘ÂÚËÎÙÈÎfiÙËÙ· Î·È ÚԉȿıÂÛË ÁÈ· ıÚÔÌ‚ÔÂÌ‚ÔÏÈο Ê·ÈÓfiÌÂÓ·. ∆· ‰È·‚ËÙÈο ¿ÙÔÌ· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·˘ÍË̤ӷ Â›‰· ÈÓˆ‰ÔÁfiÓÔ˘ Î·È PAI-I Ï¿ÛÌ·ÙÔ˜, Î·È ·˘ÍË̤ÓË Ù¿ÛË Û˘ÛÛÒÚ¢Û˘ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ6. ∏ ÚԉȿıÂÛË ÁÈ· ıÚfiÌ‚ˆÛË ÔÊ›ÏÂÙ·È ÛÙËÓ ·˘ÍË̤ÓË Û˘ÛÛˆÚ¢ÙÈÎfiÙËÙ· ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ, ÙȘ ·˘ÍË̤Ó˜ Û˘ÁÎÂÓÙÚÒÛÂȘ ÚÔËÎÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, fiˆ˜ Î·È ÛÙË ÌÂȈ̤ÓË Û˘ÁΤÓÙÚˆÛË Î·È ‰Ú·ÛÙËÚÈfiÙËÙ· ÙˆÓ ·ÓÙÈıÚÔÌ‚ˆÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, ÂÓÒ ÔÈ ·Ú¿ÁÔÓÙ˜ Ô˘ Úԉȷı¤ÙÔ˘Ó ÛÙËÓ ÂÍ·Ûı¤ÓËÛË Ù˘ Ê˘ÛÈÔÏÔÁÈ΋˜ ÈÓˆ‰fiÏ˘Û˘ Â›Ó·È Ë ÌÂȈ̤ÓË ‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘ t-PA, Ù· ·˘ÍË̤ӷ Â›‰· ÙÔ˘ ƒ∞π-π Î·È Ë ·˘ÍË̤ÓË Û˘ÁΤÓÙÚˆÛË Ù˘ ·2 ·ÓÙÈÏ·ÛÌ›Ó˘7. 3


A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·4

·ıËÚÔÛÎÏ‹ÚˆÛË MAPTIO™ 2005

∏ ‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘ ƒ∞π-π Â›Ó·È ·˘ÍË̤ÓË ÛÙÔ Ï¿ÛÌ· ÙˆÓ ·ÛıÂÓÒÓ Ì ™¢ 2, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙÔ ÛˆÌ·ÙÈÎfi ÙÔ˘˜ ‚¿ÚÔ˜ (·¯‡Û·ÚÎÔÈ ‹ ÏÂÙfiÛˆÌÔÈ), ·ÏÏ¿ Ù· ·¯‡Û·Úη ¿ÙÔÌ·, Ì ‹ ¯ˆÚ›˜ ‰È·‚‹ÙË, ·ÚÔ˘ÛÈ¿˙Ô˘Ó ˘„ËÏfiÙÂÚ· Â›‰· ƒ∞π-π, Û ۯ¤ÛË Ì ٷ ¿ÙÔÌ· ηÓÔÓÈÎÔ‡ ‚¿ÚÔ˘˜. ∆· Â›‰· ÙÔ˘ ƒ∞π-π ·˘Í¿ÓÔÓÙ·È ÙfiÛÔ Û ˘ÂÚÈÓÛÔ˘ÏÈÓ·ÈÌ›·, fiÛÔ Î·È Û ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›·8. ∞ÎfiÌË Î·È ÛÂ Ê˘ÛÈÔÏÔÁÈο ¿ÙÔÌ·, Ë ÂÈÚ·Ì·ÙÈ΋ ÚfiÎÏËÛË ˘ÂÚÈÓÛÔ˘ÏÈÓ·ÈÌ›·˜ Î·È ˘ÂÚÁÏ˘Î·ÈÌ›·˜ (Ì ÙË ¯ÔÚ‹ÁËÛË ÁÏ˘Îfi˙˘ Î·È intralipid), Ì·˙› Ì ·˘ÍË̤ӷ Â›‰· ÂχıÂÚˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ, Ô‰‹ÁËÛ Û ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙÔ˘ ƒ∞π-π ÛÙÔ Ï¿ÛÌ·, ÁÈ· ·ÚÎÂÙ¤˜ ÒÚ˜ 9. ∞ÓÙÈÌÂÙÒÈÛË Ù˘ ¢È·‚ËÙÈ΋˜ ¢˘ÛÏÈȉ·ÈÌ›·˜

√È ÚÔÙÂÚ·ÈfiÙËÙ˜ ·ÓÙÈÌÂÙÒÈÛ˘ ÙˆÓ ‰È·Ù·Ú·¯ÒÓ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ ÏÈȉ›ˆÓ ÛÙÔ˘˜ ‰È·‚ËÙÈÎÔ‡˜ ·ÛıÂÓ›˜

¤¯Ô˘Ó ÙÂı› ·fi ÙËÓ ∞ÌÂÚÈηÓÈ΋ ¢È·‚ËÙÔÏÔÁÈ΋ ∂Ù·ÈÚ›· (ADA)10. ∂ÙÛÈ, Ë Ì›ˆÛË Ù˘ LDL-C ·ÔÙÂÏ› ÙË ÚÒÙË ÚÔÙÂÚ·ÈfiÙËÙ·, Ì ‚¿ÛË ÙȘ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜, Ô˘ ¤‰ÂÈÍ·Ó ÛËÌ·ÓÙÈΤ˜ ÌÂÈÒÛÂȘ Ù˘ ÓÔÛËÚfiÙËÙ·˜ Î·È Ù˘ ıÓËÙfiÙËÙ·˜ ÛÙȘ ˘Ô-ÔÌ¿‰Â˜ ÙˆÓ ‰È·‚ËÙÈÎÒÓ ·ÛıÂÓÒÓ. ∏ ·‡ÍËÛË Ù˘ HDL-C ·ÔÙÂÏ› ÙË ‰Â‡ÙÂÚË ÚÔÙÂÚ·ÈfiÙËÙ·, Ô˘ ·ÎÔÏÔ˘ıÂ›Ù·È ·fi ÙË ÚÔÛ¿ıÂÈ· Ì›ˆÛ˘ ÙˆÓ TG. √È ÛÙ·Ù›Ó˜, Ô˘ ·ÔÙÂÏÔ‡Ó ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÚÒÙ˘ ÂÈÏÔÁ‹˜, Â›Ó·È Ôχ ·ÔÙÂÏÂÛÌ·ÙÈΤ˜ ÁÈ· ÙË Ì›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ LDL-C ÛÙÔ˘˜ ‰È·‚ËÙÈÎÔ‡˜ ·ÛıÂÓ›˜ Î·È ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÔÈΛϘ ·ÏÏ¿ Û˘¯Ó¿ ÛËÌ·ÓÙÈΤ˜ ÂȉڿÛÂȘ ÛÙ· TG. ∏ Ì›ˆÛË ÙˆÓ TG ÂÍ·ÚÙ¿Ù·È ·fi ÙË ÈÛ¯‡ Ù˘ ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓ˘ ÛÙ·Ù›Ó˘ Î·È Â›Ó·È ‰ÔÛÔÂÍ·ÚÙÒÌÂÓË. ∏ ‰˘Ó·ÙfiÙËÙ· ·‡ÍËÛ˘ ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ HDL-C Â›Ó·È Ì¤ÙÚÈ·, ·Ó Î·È ÂӉ¯fiÌÂÓ· ÛËÌ·ÓÙÈ΋. √È ÊÈÌÚ¿Ù˜ Â›Ó·È Ôχ ·ÔÙÂÏÂÛÌ·ÙÈΤ˜ ÁÈ· ÙËÓ ·‡ÍËÛË Ù˘ HDL-C Î·È ÙË Ì›ˆÛË

ÙˆÓ TG, ·ÏÏ¿ ÌÈÎÚ‹ ÌfiÓÔ Â›‰Ú·ÛË ·ÛÎÔ‡Ó ÛÙ· Â›‰· Ù˘ LDL-C, ÙËÓ ÔÔ›· ÂÓ‰¤¯ÂÙ·È Î·È Ó· ·˘Í‹ÛÔ˘Ó Û ·ÛıÂÓ›˜ Ì ÛÔ‚·Ú‹ ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›· . √È ÚËÙ›Ó˜ ‰¤ÛÌ¢Û˘ ÙˆÓ ¯ÔÏÈÎÒÓ ·Ï¿ÙˆÓ ÂÈÙ˘Á¯¿ÓÔ˘Ó ÂÈÚfiÛıÂÙË Ì›ˆÛË Ù˘ LDLC, fiÙ·Ó ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÛÙ·Ù›Ó˜, ·ÏÏ¿ Ë ¯ÚËÛÈÌÔÔ›ËÛ‹ ÙÔ˘˜ ÂÚÈÔÚ›˙ÂÙ·È ·fi ÙȘ Á·ÛÙÚÂÓÙÂÚÈΤ˜ ÙÔ˘˜ ·ÚÂÓ¤ÚÁÂȘ. ™Ù· Ê¿Ú̷η Ô˘ ÌÂÈÒÓÔ˘Ó ÙËÓ ·ÔÚÚfiÊËÛË Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ·fi ÙÔ ÏÂÙfi ¤ÓÙÂÚÔ Ú¤ÂÈ Ó· ·Ó·ÊÂÚı› Î·È Ô ÚÒÙÔ˜, ÚÔ˜ ÙÔ ·ÚfiÓ, ÂÎÚfiÛˆfi ÙÔ˘˜, Ë Â˙ÂÙÈÌ›ÌË. ∏ ÓÈ·Û›ÓË Â›Ó·È Ô ÂÚÈÛÛfiÙÂÚÔ ·ÔÙÂÏÂÛÌ·ÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÁÈ· ÙËÓ ·‡ÍËÛË Ù˘ HDL-C, ÂÓÒ ÚÔηÏ›, Â›Û˘, ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÙˆÓ TG, Î·È Ì¤ÙÚÈ· Ì›ˆÛË Ù˘ LDL-C, ·ÏÏ¿ Ë ¯ÚËÛÈÌÔÔ›ËÛ‹ Ù˘ Â›Ó·È ÚÔ‚ÏËÌ·ÙÈ΋ ÛÙÔ˘˜ ‰È·‚ËÙÈÎÔ‡˜ ·ÛıÂÓ›˜, ‰ÈfiÙÈ Ê·›ÓÂÙ·È fiÙÈ ·˘Í¿ÓÂÈ ÙËÓ ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË.

5.

8.

µÈ‚ÏÈÔÁÚ·Ê›· 1.

2.

3. 4.

4

Garg A, Grundy SM. Manegement of dyslipidemia in NIDDM. Diabetes Care 1990 ; 13: 153- 169. UK Prospective Diabetes Study Group. U. K Prospective Diabetes Study 27 : plasma lipids and lipoproteins at diagnosis of NIDDM by age and sex. Diabetes Care 1997 ; 20: 1683-1687. Austin MA, Edwards KL. Curr Opin Lipidol 1996 ; 7: 167-171 Reaven GM, Insulin resistance and its consequences : non-insulin dependent diabetes mellitus and coronary heart disease. In LeRoith D, Taylor SI, Olefsky JM, eds. Diabetes Mellitus : a Fundamental and Clinical Text. Philadelphia : Lippincot-Raven, 1996 : 509-519.

6.

7.

Patsch JR, Miesenbock G, Hopferwieser T, Muhiberger V, Knapp E, Dunn JK, Gotto AM Jr, Patsch W. Relation of triglyceride metabolism and coronary artery disease : studies in the postprandial state. Atheroscler Thromb 1992 ; 12: 1336-1345. Thompson SG, Kienast J, Pyke SD, Haverkate F, van de Loo JC, for the European Concerted Action on Thrombosis and Diasabilities Angina Pectoris Study Group. Hemostatic factors and the risk of myocardial infarction or sudden death in patients with angina pectoris. N Engl J Med 1995 ; 332: 635-641. Sobel BE. Potentiation of vasculopathy by insulin : implications from an NHLBI clinical alert. Circulation 1996 ; 93 : 16131615.

McGill JB, Schneider DJ, Arfken CL, Lucore CL, Sobel BE. Factors responsible for impaired fibrinolysis in obese subjects and NIDDM patients. Diabetes 1994 ; 43: 104-109. 9. Calles-Escandon J, Mirza SA, Sobel BE, Schneider DJ. Induction of hyperinsulinemia combined with hyperglycemia and hypertriglyceridemia increases plasminogen activator inhibitor 1 in blood in normal human subjects. Diabetes 1998 ; 47: 290-293. 10. American Diabetes Association. Management of dyslipidemia in adults with diabetes. Diabetes Care 2000; 23 (suppl 1) : S57-S60.


A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·5

¶A£OºY™IO§O°IA

÷ÌËÏ¿ Â›‰· HDL ÓËÛÙ›·˜ Î·È ÌÂÙ·ÁÂ˘Ì·ÙÈ΋ ÏÈ·ÈÌ›· Kolovou GD, Anagnostopoulou KK, Pilatis N, Kafaltis N, Sorodila ∫, Psarros E, Cokkinos DV. Lipids Health Dis. 2004;23:18

∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ù· ¯·ÌËÏ¿ Â›‰· Ù˘ HDL ¯ÔÏËÛÙÂÚfiÏ˘ ηıÒ˜ Î·È Ë ‰È·Ù·Ú·Á̤ÓË ÌÂÙ·ÁÂ˘Ì·ÙÈ΋ ÏÈ·ÈÌ›· Û¯ÂÙ›˙ÔÓÙ·È Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ‰ÈÂÚ¢ӋıËÎÂ Ë ÌÂÙ·ÁÂ˘Ì·ÙÈ΋ ·¿ÓÙËÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ (∆°§) Û ۯ¤ÛË Ì ٷ Â›‰· Ù˘ HDL. ¶ÂÚÈÂÏ‹ÊıËÛ·Ó 52 ŒÏÏËÓ˜ ¿ÓÙÚ˜ ÔÈ ÔÔ›ÔÈ ¯ˆÚ›ÛÙËÎ·Ó Û ‰‡Ô ÔÌ¿‰Â˜: ÙËÓ ÔÌ¿‰· Ì ¯·ÌËÏ‹ HDL (<40 mg/dl) Î·È ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘. ∆· Â›‰· ∆°§ ÓËÛÙ›·˜ ‹Ù·Ó ˘„ËÏfiÙÂÚ· ÛÙËÓ ÔÌ¿‰· Ì ¯·ÌËÏ‹ HDL Û˘-

ÁÎÚÈÙÈο Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ (p = 0,002). H ÔÌ¿‰· Ì ¯·ÌËÏ‹ HDL ÂÌÊ¿ÓÈÛ ˘„ËÏfiÙÂÚ· Â›‰· ∆°§ ÛÙȘ 4, 6 Î·È 8 ÒÚ˜ Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ (p = 0,006, p = 0,002 Î·È p < 0,001 ·ÓÙ›ÛÙÔȯ·). øÛÙfiÛÔ, ÌÂÙ¿ ÙËÓ ÂÍÔÌÔ›ˆÛË ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ˆ˜ ÚÔ˜ Ù· Â›‰· ∆°§ ÓËÛÙ›·˜, Ë ÔÌ¿‰· Ì ¯·ÌËÏ‹ HDL ·ÚÔ˘Û›·Û ˘„ËÏfiÙÂÚ· Â›‰· ∆°§ ÌfiÓÔ ÛÙȘ 8 ÒÚ˜ ÌÂÙ¿ ·fi ÙË Ï‹„Ë ÙÔ˘ ÏÈ·ÚÔ‡ Á‡̷ÙÔ˜ (p = 0,0017) [∂ÈÎfiÓ· 1]. ∏ ·Ó¿Ï˘ÛË ROC ¤‰ÂÈÍ fiÙÈ Â›‰· ∆°§ ÓËÛÙ›·˜ ≥ 121 mg/dl ÚԂϤ-

Ô˘Ó Ì ¢·ÈÛıËÛ›· 100% Î·È ÂȉÈÎfiÙËÙ· 81% Ì›· ·ıÔÏÔÁÈ΋ ÌÂÙ·ÁÂ˘Ì·ÙÈ΋ ·¿ÓÙËÛË (auc = 0,962, p < 0,001). ™˘ÌÂÚ·›ÓÂÙ·È fiÙÈ Ë Î·ı˘ÛÙÂÚË̤ÓË ÌÂÙ·ÁÂ˘Ì·ÙÈ΋ οı·ÚÛË ÙˆÓ ∆°§ Ô‰ËÁ› Û ¯·ÌËÏ¿ Â›‰· HDL ·ÎfiÌ· Î·È Û ·ÛıÂÓ›˜ Ì ¯·ÌËÏ¿ Â›‰· ∆°§ ÓËÛÙ›·˜. ∂›‰· ∆°§ ÓËÛÙ›·˜ > 121 mg/dl Úԉȷı¤ÙÔ˘Ó Û ·ıÔÏÔÁÈ΋ ·¿ÓÙËÛË ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË ÏÈ·ÚÔ‡ Á‡̷ÙÔ˜. ∂È̤ÏÂÈ·: ∞ϤͷӉÚÔ˜ ¶·ÓÙÂÏ¿Î˘, ∞ÓÙÒÓ˘ ¶·˘Ï›‰Ë˜

350 300 250 TÚÈÁÏ˘ÎÂÚ›‰È· (mg/dl)

200 150 100 50

8 6 4 0

XÚfiÓÔ˜ (ÒÚ˜)

Controls

Low HDL-N

Low HDL-A

Matched controls

Matched Low HDL

Low HDL

0

Groups

∂ÈÎfiÓ· 1: ªÂÙ·‚ÔÏ‹ ÙˆÓ ÂÈ¤‰ˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ÛÂ Û˘Ó¿ÚÙËÛË Ì ÙÔÓ ¯ÚfiÓÔ (AUC) Û fiϘ ÙȘ ÔÌ¿‰Â˜. √È ˘„ËÏfiÙÂÚ˜ ÙÈ̤˜ AUC ‚Ú¤ıËÎ·Ó ÛÙȘ ÔÌ¿‰Â˜ low HDL Î·È low HDL-A Ô˘ ›¯·Ó ¯·ÌËÏ¿ Â›‰· HDL Î·È Ù· ˘„ËÏfiÙÂÚ· Â›‰· ∆°§ ÓËÛÙ›·˜ Û ۯ¤ÛË Ì ÙȘ ¿ÏϘ ÔÌ¿‰Â˜. √È ¯·ÌËÏfiÙÂÚ˜ ÙÈ̤˜ AUC ‚Ú¤ıËÎ·Ó ÛÙȘ ÔÌ¿‰Â˜ matched-low HDL, matchedcontrols, low HDL-N Î·È ÛÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘. ∞˘Ù¤˜ ›¯·Ó ¯·ÌËÏfiÙÂÚ· Â›‰· ∆°§ ÓËÛÙ›·˜ ·ÏÏ¿ Î·È ÔÈΛϷ Â›‰· HDL [·fi 30(9) ̤¯ÚÈ 55(20) mg/dl]. TG-AUC: triglyceride-area under the curve, Low HDL-A: ÔÌ¿‰· Ì ¯·ÌËÏ‹ HDL Î·È ·ıÔÏÔÁÈÎfi Á‡̷, Low HDL-N: ÔÌ¿‰· Ì ¯·ÌËÏ‹ HDL Î·È Ê˘ÛÈÔÏÔÁÈÎfi Á‡̷, Controls: ÔÌ¿‰· ÂϤÁ¯Ô˘, Matched-Low HDL: ÂÍÔÌÔȈ̤ÓË ÔÌ¿‰· Ì ¯·ÌËÏ‹ HDL, Matched Controls: ÂÍÔÌÔȈ̤ÓË ÔÌ¿‰· ÂϤÁ¯Ô˘.

5


A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·6

·ıËÚÔÛÎÏ‹ÚˆÛË

∫§π¡π∫∂™ ª∂§∂∆∂™

MAPTIO™ 2005

PROVE IT: ∂›‰· C-·ÓÙȉÚÒÛ·˜ ÚˆÙ½Ó˘ Î·È ÎÏÈÓÈ΋ ¤Î‚·ÛË ÌÂÙ¿ ıÂÚ·›· Ì ÛÙ·Ù›Ó˜ Ridker PM, Cannon CP, Morrow D, et al; for the Pravastatin or Atorvastatin Evaluation and Infection Therapy–Thrombolysis in Myocardial Infarction 22 (PROVE IT–TIMI 22) Investigators. N Engl J Med 2005;352:20-8

√È ÛÙ·Ù›Ó˜ ÂÏ·ÙÙÒÓÔ˘Ó ÙËÓ LDL-Ã Î·È ÙËÓ (˘„ËÏ‹˜ ¢·ÈÛıËÛ›·˜) C-·ÓÙȉÚÒÛ· ÚˆÙ½ÓË (hsCRP), ÙÔ Î·Ù¿ fiÛÔ fï˜ Ô Û˘Ó‰˘·ÛÌfi˜ ·˘ÙÒÓ ÙˆÓ ‰Ú¿ÛÂˆÓ ÙÔ˘˜ ÂËÚ¿˙ÂÈ ÙË ÎÏÈÓÈ΋ ¤Î‚·ÛË ÙˆÓ ·ÛıÂÓÒÓ ‰ÂÓ Â›Ó·È ÁÓˆÛÙfi. ∂ÎÙÈÌ‹ıËÎÂ Ë Û˘Û¯¤ÙÈÛË Ù˘ ÂÏ¿ÙÙˆÛ˘ Ù˘ LDL-Ã Î·È Ù˘ CRP Ô˘ ÂÂÙ‡¯ıËÛ·Ó ÌÂÙ¿ ıÂÚ·›· Ì 80 mg ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ ‹ 40 mg Ú·‚·ÛÙ·Ù›Ó˘ Î·È Ë Â›‰Ú·Û˘ Ù˘ Û˘Û¯¤ÙÈÛ˘ ·˘Ù‹˜ ÛÙËÓ ÂÌÊ¿ÓÈÛË Ó¤Ô˘ ÂÌÊÚ¿ÁÌ·ÙÔ˜ Ì˘Ôηډ›Ô˘ ‹ ηډȷÁÁÂÈ·ÎÔ‡ ı·Ó¿ÙÔ˘ Û 3.745 ·ÛıÂÓ›˜ Ì Ôͤ· ÛÙÂÊ·-

∂ÈÎfiÓ· 1

M¤ÛË ÙÈÌ‹ CRP mg/1

100

P=0,60 10 ¶Ú·‚·ÛÙ·Ù›ÓË (n=1873) P<0,001

1

P<0,001

AÙÔÚ‚·ÛÙ·Ù›ÓË (n=1873) ∆˘¯·ÈÔÔ›ËÛË

30 Ë̤Ú˜

4 Ì‹Ó˜

AıÚÔÈÛÙÈ΋ Û˘¯ÓfiÙËÙ· ˘ÔÙÚÔ‹˜ ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ôηډ›Ô˘ ‹ ı·Ó¿ÙÔ˘ ÛÙÂÊ·ÓÈ·›·˜ ·ÈÙÈÔÏÔÁ›·˜

∂ÈÎfiÓ· 2 0,10

LDL-X <70 mg/dl CRP <1 mg/L ›¯·Ó 58% ÏÈÁfiÙÂÚ· Û˘Ì‚¿Ì·Ù· ·fi ·˘ÙÔ‡˜ Ô˘ ›¯·Ó LDL-X ≥70 mg/dl Î·È CRP ≥ 1 mg/L, 39% ÏÈÁfiÙÂÚ· Û˘Ì‚¿Ì·Ù· ·fi Ù· ¿ÙÔÌ· Ì <70 mg/dl Î·È CRP ≥1 mg/L Î·È 17% ÏÈÁfiÙÂÚ· Û˘Ì‚¿Ì·Ù· ·fi Ù· ¿ÙÔÌ· Ì ≥70 mg/dl Î·È CRP <1 mg/L. √È ·ÛıÂÓ›˜ Ì ÙȘ ÌÈÎÚfiÙÂÚ˜ ÙÈ̤˜ CRP ›¯·Ó ÙË Î·Ï‡ÙÂÚË ÚfiÁÓˆÛË ·fi fiÏÔ˘˜, ·ÓÂÍ¿ÚÙËÙ· Ì ٷ Â›‰· LDL-X. ∞˘Ùfi ‚¿˙ÂÈ ÙËÓ ¤Ó‰ÂÈÍË fiÙÈ Ë CRP Ú¤ÂÈ Ó· ·ÔÙÂÏ› ÛÙfi¯Ô Ù˘ ˘ÔÏÈȉ·ÈÌÈ΋˜ Ê·Ú̷΢ÙÈ΋˜ ·ÁˆÁ‹˜, ÙÔ˘Ï¿¯ÈÛÙÔÓ Û ·ÛıÂÓ›˜ Ì Ôͤ· ÛÙÂÊ·ÓÈ·›· Û˘Ì‚¿Ì·Ù·. ™˘ÌÂÚ¿ÛÌ·Ù·: ∏ ÂÈıÂÙÈ΋ ˘ÔÏÈȉ·ÈÌÈ΋ Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ Ì ÛÙ·Ù›Ó˜ ÁÈ· ÙËÓ Â›Ù¢ÍË ÂÏ¿ÙÙˆÛ˘ ÙfiÛÔ Ù˘ LDL-à ·ÏÏ¿ Î·È Ù˘ CRP ÂÏ·ÙÙÒÓÂÈ ÛËÌ·ÓÙÈο ÙÔÓ Î›Ó‰˘ÓÔ ÁÈ· ηډȷÁÁÂȷο Û˘Ì‚¿Ì·Ù· Û ·ÛıÂÓ›˜ ÌÂÙ¿ ·fi Ôͤ· ÛÙÂÊ·ÓÈ·›· Û‡Ó‰ÚÔÌ·. ∏ ÂÈÏÔÁ‹ ˘ÔÏÈȉ·ÈÌÈ΋˜ Ê·Ú̷΢ÙÈ΋˜ ·ÁˆÁ‹˜ Ô˘ ÂÏ·ÙÙÒÓÂÈ ÙË ÊÏÂÁÌÔÓ‹ (CRP) ÌÔÚ› Ó· ‚ÂÏÙÈÒÛÂÈ ÂÚ·ÈÙ¤Úˆ ÙËÓ ÎÏÈÓÈ΋ ¤Î‚·ÛË ÙˆÓ ·ÛıÂÓÒÓ ·˘ÙÒÓ. ∂È̤ÏÂÈ·: µ·Û›ÏÂÈÔ˜ Õı˘ÚÔ˜

≥ 70 mg/dl, CRP ≥ 2 mg/liter

0,08

LDL-¯ÔÏËÛÙÂÚfiÏË < 70 mg/dl, CRP ≥ 2 mg/liter

¶›Ó·Î·˜ 1

0,06

LDL-¯ÔÏËÛÙÂÚfiÏË ≥ 70 mg/dl, CRP < 2 mg/liter

∂›Â‰Ô LDL

LDL-¯ÔÏËÛÙÂÚfiÏË < 70 mg/dl, CRP < 2 mg/liter

0,04

∂›Â‰Ô CRP

™˘¯ÓfiÙËÙ· Û˘Ì‚·Ì¿ÙˆÓ/ 100 ·ÓıÚˆÔÂÙ‹

LDL ≥70 mg/dl, CRP ≥1 mg/liter

4.5

LDL <70 mg/dl, CRP ≥1 m g/liter

3.1

LDL ≥70 mg/dl

CRP <1 mg/liter

2.3

LDL <70 mg/dl, CRP <1 mg/liter

1.9

0,02

0,00 0,0

0,5

1,0

1,5

2,0

¶·Ú·ÎÔÏÔ‡ıËÛË (¤ÙË)

6

ÓÈ·›· Û‡Ó‰ÚÔÌ· ÛÙ· Ï·›ÛÈ· Ù˘ ÌÂϤÙ˘ PROVE IT. ∞ÔÙÂϤÛÌ·Ù·: ™ÙËÓ EÈÎfiÓ· 1 Ê·›ÓÔÓÙ·È Ù· Â›‰· Ù˘ CRP ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ıÂÚ·›·˜ Ì ·ÙÔÚ‚·ÛÙ·Ù›ÓË ‹ Ú·‚·ÛÙ·Ù›ÓË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂϤÙ˘ (2 ¯ÚfiÓÈ·). ™ÙËÓ EÈÎfiÓ· 2 Ê·›ÓÂÙ·È Ë ·ıÚÔÈÛÙÈ΋ Û˘¯ÓfiÙËÙ· Û˘Ì‚·Ì¿ÙˆÓ Û ·ÛıÂÓ›˜ Ì ‰È¿ÊÔÚÔ˘˜ Û˘Ó‰˘·ÛÌÔ‡˜ ÂÈ¤‰ˆÓ LDL-X Î·È CRP. ∆· ¿ÙÔÌ· Ì LDL-X <70 mg/dl Î·È CRP <2 mg/L ›¯·Ó 50% ÏÈÁfiÙÂÚ· Û˘Ì‚¿Ì·Ù· ·fi ·˘ÙÔ‡˜ Ô˘ ›¯·Ó LDL-X ≥70 mg/dl Î·È CRP ≥2 mg/L Î·È 32% ÏÈÁfiÙÂÚ· Û˘Ì‚¿Ì·Ù· ·fi Ù· ¿ÙÔÌ· Ì ̛· ·fi ÙȘ ‰‡Ô ÙÈ̤˜ ˘„ËÏ‹ Î·È ÙËÓ ¿ÏÏË ¯·ÌËÏ‹. ™ÙÔÓ ¶›Ó·Î· 1 Ê·›ÓÂÙ·È Ë Û˘¯ÓfiÙËÙ· Û˘Ì‚·Ì¿ÙˆÓ/100 ·ÓıÚˆÔÂÙ‹ Û ‰È¿ÊÔP<0,001 ÚÔ˘˜ Û˘Ó‰˘·ÛÌÔ‡˜ Â›¤‰ˆÓ LDL-X Î·È ∆¤ÏÔ˜ ÌÂϤÙ˘ CRP (Â‰Ò ¯ÚËÛÈÌÔÔÈ‹ıËΠˆ˜ fiÚÈÔ Ë ÙÈÌ‹ 1 mg/L - post hoc ·Ó¿Ï˘ÛË). ∆· ¿ÙÔÌ· Ì LDL-¯ÔÏËÛÙÂÚfiÏË

2,5


A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·7

£∂ƒ∞¶∂π∞ – º∞ƒª∞∫∞

ÃÔÚ‹ÁËÛË ÛÙ·Ù›Ó˘ ÚÈÓ ÙË ‰ÈÂÓ¤ÚÁÂÈ· ·ÁÁÂÈÔÏ·ÛÙÈ΋˜: Â›‰Ú·ÛË ÛÙËÓ ÂÚÈÂÂÌ‚·ÙÈ΋ ÂÌÊ¿ÓÈÛË ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ôηډ›Ô˘ Briguori C, Colombo A, Airoldi F, Violante A, Facaccio A, Balestrieri P, Elia PP, Golia B, Lepore S, Rivezzo G, Scarpato P, Libera M, Bonizzoni E, Ricciardelli B Eur Heart J 2004;25:1822-28

Œ¯ÂÈ ·Ú·ÙËÚËı› fiÙÈ ÌÂÙ¿ ·fi Ì›· ÂÈÙ˘¯Ë̤ÓË Î·Ù¿ Ù· ¿ÏÏ· ·ÁÁÂÈÔÏ·ÛÙÈ΋ ÂÌÊ·Ó›˙ÂÙ·È ·‡ÍËÛË ÙˆÓ Ì˘ÔηډȷÎÒÓ ÂÓ˙‡ÌˆÓ (CK-MB Î·È Î·Ú‰È·ÎÒÓ ÙÚÔÔÓÈÓÒÓ) ÛÂ Û˘¯ÓfiÙËÙ· 5 – 30%. ∏ ·‡ÍËÛË ·˘Ù‹ ˘Ô‰ËÏÒÓÂÈ Ó¤ÎÚˆÛË Ì˘ÔηډȷÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È fiˆ˜ ¤¯ÂÈ ·Ô‰Âȯı› ·fi ÌÂϤÙ˜ ¤¯ÂÈ ÎÏÈÓÈ΋ ÛËÌ·Û›·. ™‡Ìʈӷ Ì ٷ Ó¤· ‰È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· ÔÈ Î·Ù·ÛÙ¿ÛÂȘ ·˘Ù¤˜ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ˆ˜ ÂÌÊÚ¿ÁÌ·Ù· ÙÔ˘ Ì˘Ôηډ›Ô˘ (non-Q). ∞ÛıÂÓ›˜ Ì ·‡ÍËÛË Ù˘ CK-MB > 5 ÊÔÚ¤˜ ¿Óˆ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ (∞Ùº√) ÂÌÊ·Ó›˙Ô˘Ó ˘„ËÏfiÙÂÚË ·ÒÙÂÚË ıÓËÛÈÌfiÙËÙ· Î·È ‰˘ÛÌÂÓ¤ÛÙÂÚË Î·Ì‡ÏË ÂÈ‚›ˆÛ˘ ¯ˆÚ›˜ Û˘Ì‚¿Ì·Ù·. Œ¯ÂÈ ÂȯÂÈÚËı› Ë ÂÊ·ÚÌÔÁ‹ ‰È·ÊfiÚˆÓ ÛÙÚ·ÙËÁÈÎÒÓ ÁÈ· ÙËÓ ÚfiÏË„Ë Ù˘ ÂÈÏÔ΋˜ ·˘Ù‹˜. √È ÛÙ·Ù›Ó˜, Û‡Ìʈӷ Ì ÔÚÈṲ̂Ó˜ ÎÏÈÓÈΤ˜ Î·È ÂÈÚ·Ì·ÙÈΤ˜ ÌÂϤÙ˜, ¤¯Ô˘Ó, ¤Ú·Ó Ù˘ ˘ÔÏÈȉ·ÈÌÈ΋˜ Î·È ·ÓÙÈıÚÔÌ‚ˆÙÈ΋ ‰Ú¿ÛË (ÏÂÈÔÙÚÔÈ΋ ‰Ú¿ÛË ÙˆÓ ÛÙ·ÙÈÓÒÓ). ª›· ÌÂϤÙË ·Ú·Ù‹ÚËÛ˘ Ô˘ ‰ËÌÔÛȇıËΠÙÔ 2002 ‰È·›ÛÙˆÛ fiÙÈ Ë

¯ÔÚ‹ÁËÛË ÛÙ·Ù›Ó˘ ÚÈÓ ÙËÓ ÙÔÔı¤ÙËÛË stent Û¯ÂÙ›˙ÂÙ·È Ì ÌÈÎÚfiÙÂÚÔ Î›Ó‰˘ÓÔ ·‡ÍËÛ˘ Ù˘ CK-MB ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË. °È· ‰ÈÂÚ‡ÓËÛË Ù˘ Èı·ÓfiÙËÙ·˜ ÚfiÏ˄˘ ÙÔ˘ ÂÚÈÂÂÌ‚·ÙÈÎÔ‡ non-Q ÂÌÊÚ¿ÁÌ·ÙÔ˜, ¤ÁÈÓ ̛· Ù˘¯·ÈÔÔÈË̤ÓË ÚÔÔÙÈ΋ ÌÂϤÙË Û 451 ·ÛıÂÓ›˜ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û ÂÈÏÂÎÙÈ΋ ÙÔÔı¤ÙËÛË stent Û Ӥ˜ ‚Ï¿‚˜ ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ Î·È ‰ÂÓ ÂÏ¿Ì‚·Ó·Ó ̤¯ÚÈ ÙfiÙ ÛÙ·Ù›ÓË. ŸÛÔÈ Ù˘¯·ÈÔÔÈ‹ıËÎ·Ó Ó· ¿ÚÔ˘Ó ÛÙ·Ù›ÓË ¿Ú¯ÈÛ·Ó ÙËÓ ·ÁˆÁ‹ Ì ·˘Ù‹Ó ≥ 3 Ë̤Ú˜ ÚÈÓ ÙËÓ Â¤Ì‚·ÛË. √ Ù‡Ô˜ Î·È Ë ‰fiÛË Ù˘ ÛÙ·Ù›Ó˘ ·Ê¤ıËΠÛÙËÓ ÂÈÏÔÁ‹ ÙÔ˘ ıÂÚ¿ÔÓÙÔ˜ È·ÙÚÔ‡. ŸÏÔÈ ¤Ï·‚·Ó ·ÛÈÚ›ÓË Î·È ÙÈÎÏÔȉ›ÓË ‹ ÎÏÔȉÔÁÚ¤ÏË. ªÂÙ¿ ÙËÓ Â¤Ì‚·ÛË ¯ÔÚËÁ‹ıËΠÛÙ·Ù›ÓË Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜. ∏ ̤ÛË ÙÈÌ‹ Ù˘ ̤ÁÈÛÙ˘ ·‡ÍËÛ˘ Ù˘ CK-MB ÌÂÙ¿ ÙËÓ ·ÁÁÂÈÔÏ·ÛÙÈ΋ ‹Ù·Ó 1,70 ng/ml ÛÙËÓ ÔÌ¿‰· Ù˘ ÛÙ·Ù›Ó˘ Î·È 2,20 ng/ml ÛÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ (ƒ=0,015). ∏ ̤ÛË ÙÈÌ‹ Ù˘ ηډȷ΋˜ ÙÚÔÔÓ›Ó˘ π (cTnI) ‹Ù·Ó

0,13 ng/ml ÛÙËÓ ÔÌ¿‰· Ù˘ ÛÙ·Ù›Ó˘ Î·È 0,21 ng/ml ÛÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ (ƒ=0,033). ∏ Â›ÙˆÛË ÌÂÁ¿ÏÔ˘ non-Q ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ôηډ›Ô˘ (C∫-MB > 5 ÊÔÚ¤˜ ∞Ùº√) ‹Ù·Ó 8% ÛÙËÓ ÔÌ¿‰· Ù˘ ÛÙ·Ù›Ó˘ Î·È 15,6% ÛÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ (ƒ=0,012). ∏ ·‡ÍËÛË Ù˘ cTnI > 5 ÊÔÚ¤˜ ∞Ùº√ ‹Ù·Ó 23,5% ÛÙËÓ ÔÌ¿‰· Ù˘ ÛÙ·Ù›Ó˘ Î·È 32% ÛÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ (ƒ=0,043) (∂ÈÎfiÓ· 1). ªÂ ÙËÓ ÏÔÁÈÛÙÈ΋ ·Ó¿Ï˘ÛË Û˘Û¯¤ÙÈÛ˘ ‚Ú¤ıËΠfiÙÈ Ë ·‡ÍËÛË Ù˘ CK-MB >5 ÊÔÚ¤˜ ∞Ùº√ Û¯ÂÙ›˙ÂÙ·È ÛËÌ·ÓÙÈο Ì ÙȘ ·ÁÁÂÈÔÁÚ·ÊÈΤ˜ ÂÈÏÔΤ˜ Ù˘ Â¤Ì‚·Û˘ (OR = 9,36 ƒ<0,001), Ì ÙËÓ ÚÔıÂÚ·›· Ì ÛÙ·Ù›ÓË (OR = 0,33 ƒ= 0,023) Î·È Ì ÙËÓ ËÏÈΛ· > 65 ÂÙÒÓ (OR = 2,58 ƒ= 0,031). ™˘ÌÂÚ·›ÓÂÙ·È fiÙÈ Ë ¤Ó·ÚÍË ¯ÔÚ‹ÁËÛ˘ ÛÙ·Ù›Ó˘ ÚÈÓ ÙËÓ Â¤Ì‚·ÛË (ÙÔ˘Ï¿¯ÈÛÙÔÓ 3 Ë̤Ú˜ ÂÓˆÚ›ÙÂÚ·) ÌÂÈÒÓÂÈ ÙËÓ Â›ÙˆÛË non-Q ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ôηډ›Ô˘ ÌÂÙ¿ ÙËÓ ·ÁÁÂÈÔÏ·ÛÙÈ΋. ∂È̤ÏÂÈ·: ∏Ï›·˜ ÃÂÈÌÒÓ·˜ p = 0,043

18 16 14 12 10 8 6 4 2 0

35

15,6 ∞‡ÍËÛË cTnI>5¯∞ÙºÔ (% ÙˆÓ ÂÚÈÙÒÛˆÓ)

∞‡ÍËÛË CK-MB>5x∞Ùº√ (% ÙˆÓ ÂÚÈÙÒÛˆÓ)

p = 0,012

8,0

√Ì¿‰Â˜ ÛÙ·Ù›Ó˘

√Ì¿‰Â˜ ÂϤÁ¯Ô˘

32

30 25

23,5

20 15 10 5 0

√Ì¿‰Â˜ ÛÙ·Ù›Ó˘

√Ì¿‰Â˜ ÂϤÁ¯Ô˘

∂ÈÎfiÓ˜: ·) ∂›ÙˆÛË Ù˘ ·‡ÍËÛ˘ Ù˘ CK-MB>5 ÊÔÚ¤˜ ¿Óˆ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ (∞Ùº√) ÛÙȘ ÔÌ¿‰Â˜ ÛÙ·Ù›Ó˘ Î·È ÂϤÁ¯Ô˘. ‚) ∂›ÙˆÛË Ù˘ ·‡ÍËÛ˘ Ù˘ cTnI > 5x∞Ùº√.

7


A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·8

·ıËÚÔÛÎÏ‹ÚˆÛË MAPTIO™ 2005

∏ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ˘¤ÚÙ·Û˘ ÌÂÙ¿ ·fi ¤Ó· ÈÛ¯·ÈÌÈÎfi ·ÁÁÂÈ·Îfi ÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔ ªÈ¯¿Ï˘ ∫·ÏÔÁ‹ÚÔ˘, ∂ÈÛÙËÌÔÓÈÎfi˜ ™˘ÓÂÚÁ¿Ù˘ π·ÙÚ›Ԣ §Èȉ›ˆÓ ªˆ˘Û‹˜ ∂ÏÈÛ¿Ê, ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜

∏ ˘¤ÚÙ·ÛË ·ÔÙÂÏ› ¤Ó· ȉȷ›ÙÂÚ· ÛËÌ·ÓÙÈÎfi ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ÈÛ¯·ÈÌÈ΋˜ ÓfiÛÔ˘ ÙˆÓ ·ÁÁ›ˆÓ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘. ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi ¤¯ÂÈ ÈÛÙÔÔÈËı› ·fi ÔÏϤ˜ ÂȉËÌÈÔÏÔÁÈΤ˜ Î·È ÎÏÈÓÈΤ˜ ÌÂϤÙ˜, ÔÈ Ôԛ˜ ¤‰ÂÈÍ·Ó fiÙÈ fiϘ ÔÈ ÌÔÚʤ˜ Ù˘ ˘¤ÚÙ·Û˘ (Ë ÌÂÌÔӈ̤ÓË Û˘ÛÙÔÏÈ΋, Ë ‰È·ÛÙÔÏÈ΋, ηıÒ˜ Î·È Ë ·‡ÍËÛË ÙfiÛÔ Ù˘ Û˘ÛÙÔÏÈ΋˜ fiÛÔ Î·È Ù˘ ‰È·ÛÙÔÏÈ΋˜ ·ÚÙËÚȷ΋˜ ›ÂÛ˘) Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ·‡ÍËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛ˘ ÈÛ¯·ÈÌÈÎÒÓ ·ÁÁÂÈ·ÎÒÓ ÂÁÎÂÊ·ÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ (∞∂∂) [1] . ª¿ÏÈÛÙ· ÔÈ ·Ó·ÌÊÈÛ‚‹ÙËÙ˜ ÂӉ›ÍÂȘ Ô˘ ÚԷӷʤÚıËÎ·Ó ÈÛ¯‡Ô˘Ó ÙfiÛÔ ÁÈ· ÙËÓ ÚˆÙÔÁÂÓ‹ fiÛÔ Î·È ÁÈ· ÙË ‰Â˘ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë Ù˘ ÈÛ¯·ÈÌÈ΋˜ ÓfiÛÔ˘ ÙˆÓ ·ÁÁ›ˆÓ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ [2,3]. ∫·Ù¿ Û˘Ó¤ÂÈ·, Û ¤Ó· ˘ÂÚÙ·ÛÈÎfi ·ÛıÂÓ‹ Ô˘ ‰ÂÓ Ï·Ì‚¿ÓÂÈ ·ÓÙÈ˘ÂÚÙ·ÛÈ΋ ıÂÚ·›· Î·È Ô ÔÔ›Ô˜ ¤¯ÂÈ ˘ÔÛÙ› ¤Ó· ÈÛ¯·ÈÌÈÎfi ∞∂∂ Ú¤ÂÈ Ó· ¯ÔÚËÁËı› Ë Î·Ù¿ÏÏËÏË ·ÓÙÈ˘ÂÚÙ·ÛÈ΋ ·ÁˆÁ‹, ¤ÙÛÈ ÒÛÙ ӷ ·ÔÊ¢¯ı› Ë ÂÌÊ¿ÓÈÛË ÂÓfi˜ Ó¤Ô˘ ∞∂∂. øÛÙfiÛÔ, ·˘Ù‹ Ë Ê·ÈÓÔÌÂÓÈο ·Ï‹ ‰È·›ÛÙˆÛË ÂÁ›ÚÂÈ ÔÚÈṲ̂ӷ Ú·ÎÙÈο ÂÚˆÙ‹Ì·Ù· ÛÙÔÓ ÎÏÈÓÈÎfi ÁÈ·ÙÚfi: ¶fiÙ ÌÔÚ› Ó· ÍÂÎÈÓ‹ÛÂÈ Ì ·ÛÊ¿ÏÂÈ· Ë ·ÓÙÈ˘ÂÚÙ·ÛÈ΋ ·ÁˆÁ‹ Û ¤Ó· ·ÛıÂÓ‹ Ô˘ ¤¯ÂÈ ˘ÔÛÙ› ¤Ó· ÈÛ¯·ÈÌÈÎfi ∞∂∂; ¶ÔÈÔ˜ Â›Ó·È Ô ÛÙfi¯Ô˜ Ù˘ ∞¶ Û ·˘ÙfiÓ ÙÔÓ ·ÛıÂÓ‹; À¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ fiÙÈ Î¿ÔÈ· ηÙËÁÔÚ›· ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ˘ÂÚ¤¯ÂÈ fiÛÔÓ ·ÊÔÚ¿ ÙË ‰Â˘ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë ÙˆÓ ÈÛ¯·ÈÌÈÎÒÓ ∞∂∂; ∏ Ì›ˆÛË Ù˘ ∞¶ Û ¤Ó· ËÏÈÎȈ̤ÓÔ ·ÛıÂÓ‹ ÌÂÙ¿ ·fi ¤Ó· Ô͇ ÈÛ¯·ÈÌÈÎfi ∞∂∂ Â›Ó·È Ì›· ·ÛÊ·Ï‹˜ ÛÙÚ·ÙËÁÈ΋ ‹ ÂÓ‰¤¯ÂÙ·È Ó· Ô‰ËÁ‹ÛÂÈ Û ¤Ó· Ó¤Ô ∞∂∂; ∂¿Ó ¤Ó·˜ ·ÛıÂÓ‹˜ ¿Û¯ÂÈ ·fi ¿ÓÔÈ·, ÙfiÙ Û ÔÈ· Â›‰· Ú¤ÂÈ Ó· Î˘Ì·›ÓÂÙ·È Ë ·ÚÙËÚȷ΋ ÙÔ˘ ›ÂÛË;

8

¶fiÙÂ Â›Ó·È ·ÛÊ·Ï‹˜ Ë ¤Ó·ÚÍË Ù˘ ·ÓÙÈ˘ÂÚÙ·ÛÈ΋˜ ·ÁˆÁ‹˜ Û ¤Ó· ·ÛıÂÓ‹ Ô˘ ¤¯ÂÈ ˘ÔÛÙ› ¤Ó· Ô͇ ÈÛ¯·ÈÌÈÎfi ∞∂∂; ¢ÂÓ ˘¿Ú¯Ô˘Ó Û·Ê‹ ‰Â‰Ô̤ӷ ·fi ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ fiÛÔÓ ·ÊÔÚ¿ ÙÔ ¯ÚfiÓÔ ¤Ó·Ú͢ Ù˘ ·ÓÙÈ˘ÂÚÙ·ÛÈ΋˜ ·ÁˆÁ‹˜ ÌÂÙ¿ ·fi ¤Ó· ∞∂∂. Œ¯ÂÈ ‰È·Ù˘ˆı› Ë ¿Ô„Ë fiÙÈ Ë ·ÓÙÈ˘ÂÚÙ·ÛÈ΋ ·ÁˆÁ‹ Ú¤ÂÈ Ó· ÍÂÎÈÓ¿ 7 Ë̤Ú˜ (›Ûˆ˜ Î·È ÓˆÚ›ÙÂÚ·) ¤ˆ˜ Î·È 30 Ë̤Ú˜ ÌÂÙ¿ ÙÔ Û‡Ì‚·Ì· [1,4]. ¶Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ fiÛÔ ÓˆÚ›ÙÂÚ· ÌÂÙ¿ ÙÔ Û‡Ì‚·Ì· ¯ÔÚËÁÂ›Ù·È Ë ·ÁˆÁ‹ ÙfiÛÔ Î·Ï‡ÙÂÚË ·Ó·Ì¤ÓÂÙ·È Ó· Â›Ó·È Î·È Ë Û˘ÌÌfiÚʈÛË ÙÔ˘ ·ÛıÂÓ‹. ¶ÔÈÔ˜ Â›Ó·È Ô ÛÙfi¯Ô˜ Ù˘ ∞¶ Î·È ÔÈfi Â›Ó·È ÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ̤۷ ÛÙÔ ÔÔ›Ô Ú¤ÂÈ Ó· ÂÈÙ¢¯ı›; ªÂÁ¿Ï˜ ÂȉËÌÈÔÏÔÁÈΤ˜ Î·È Ù˘¯·ÈÔÔÈË̤Ó˜ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó: ·) fiÙÈ Ô Î›Ó‰˘ÓÔ˜ ÂÌÊ¿ÓÈÛ˘ ÂÓfi˜ ∞∂∂ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ٷ Â›‰· Ù˘ ∞¶ Î·È ‚) fiÙÈ ‰ÂÓ ˘¿Ú¯ÂÈ Î¿ÔÈ· ÙÈÌ‹ Ù˘ ∞¶ ¿Óˆ ·fi ÙËÓ ÔÔ›· Ó· ·˘Í¿ÓÂÙ·È ·fiÙÔÌ· Ô Î›Ó‰˘ÓÔ˜ ÂÌÊ¿ÓÈÛ˘ Ù˘ ÈÛ¯·ÈÌÈ΋˜ ÓfiÛÔ˘ ÙˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ ·ÁÁ›ˆÓ. ™ÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÙˆÓ ·ÙfiÌˆÓ Ô˘ ÂÌÊ·Ó›˙ÂÈ ¤Ó· ∞∂∂ ¤¯ÂÈ ˘¤ÚÙ·ÛË ÛÙ·‰›Ô˘ π ‹ ·Ï¿ «˘„ËÏ‹ Ê˘ÛÈÔÏÔÁÈ΋» ∞¶ (Û‡Ìʈӷ Ì ÙËÓ Î·Ù¿Ù·ÍË Ù˘ JNC VI). ™Â Ì›· ÚfiÛÊ·ÙË ‰ËÌÔÛ›Â˘ÛË ÔÈ Lewington Î·È Û˘ÓÂÚÁ¿Ù˜ ¤‰ÂÈÍ·Ó fiÙÈ Ë ıÓËÙfiÙËÙ· ·fi ∞∂∂ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ٷ Â›‰· Ù˘ ∞¶ Î·È fiÙÈ ·˘Ù‹ Ë Û˘Û¯¤ÙÈÛË ÍÂÎÈÓ¿ ·fi Ôχ ¯·ÌËϤ˜ ÙÈ̤˜ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ (Ù· 115/75 mmHg ‹Ù·Ó Ë ¯·ÌËÏfiÙÂÚË ÙÈÌ‹ Ô˘ Û˘ÌÂÚÈÏ‹ÊıËΠÛÙË ÌÂϤÙË). ™˘ÁÎÂÎÚÈ̤ӷ, ÁÈ· οı ·‡ÍËÛË Ù˘ ™∞¶ ηٿ 20 mmHg ‹ Î·È Ù˘ ¢∞¶ ηٿ 10 mmHg, ·Ú¯‹˜ ÁÂÓÔ̤Ó˘ ·fi Ù· 115/75 mmHg,

‰ÈÏ·ÛÈ¿˙ÂÙ·È Ë ıÓËÙfiÙËÙ· ·fi ∞∂∂ [5]. ∂ÎÙfi˜ ·fi ÙË ÌÂϤÙË PROGRESS (Perindopril Protection Against Recurrent Stroke Study) ̤¯ÚÈ Û‹ÌÂÚ· ‰ÂÓ ¤¯Ô˘Ó ‰ÈÂÍ·¯ı› ÌÂÁ¿Ï˜ Ù˘¯·ÈÔÔÈË̤Ó˜ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ ÔÈ Ôԛ˜ Ó· ÛÙÔ¯Â‡Ô˘Ó ÛÙËÓ ÚfiÏË„Ë Ù˘ ˘ÔÙÚÔ‹˜ ÙˆÓ ÈÛ¯·ÈÌÈÎÒÓ ∞∂∂. ™ÙË ÌÂϤÙË PROGRESS Û˘ÌÌÂÙ›¯·Ó 6.105 ¿ÙÔÌ· Ô˘ ›¯·Ó ˘ÔÛÙ› ¤Ó· ÈÛ¯·ÈÌÈÎfi ∞∂∂ ‹ ¤Ó· ·ÚÔ‰ÈÎfi ÈÛ¯·ÈÌÈÎfi ∞∂∂. ∏ Û˘ÁÎÂÎÚÈ̤ÓË ÌÂϤÙË ¤‰ÂÈÍ fiÙÈ Ë ÂÈıÂÙÈ΋ Ì›ˆÛË Ù˘ ∞¶, Ë ÔÔ›· ÛÙËÓ ÚÔÎÂÈ̤ÓË ÂÚ›ÙˆÛË ÂÈÙ‡¯ıËΠ̠ÙË Û˘Á¯ÔÚ‹ÁËÛË ÂÓfi˜ ·Ó·ÛÙÔϤ· ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘ (ÂÚÈÓÙÔÚ›ÏË) Î·È ÂÓfi˜ ıÂÈ·˙ȉÈÎÔ‡ ‰ÈÔ˘ÚËÙÈÎÔ‡ (ÈÓ‰··Ì›‰Ë), Ô‰ËÁ› Û ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÙˆÓ ı·Ó·ÙËÊfiÚˆÓ Î·È ÌË ı·Ó·ÙËÊfiÚˆÓ ∞∂∂ ηıÒ˜ Î·È ÙˆÓ ÌË ı·Ó·ÙËÊfiÚˆÓ ÂÌÊÚ·ÁÌ¿ÙˆÓ ÙÔ˘ Ì˘Ôηډ›Ô˘. ª¿ÏÈÛÙ·, Ù· ıÂÙÈο ·ÔÙÂϤÛÌ·Ù· ·ÊÔÚÔ‡Û·Ó ÙfiÛÔ ÙÔ˘˜ ˘ÂÚÙ·ÛÈÎÔ‡˜ ·ÛıÂÓ›˜ fiÛÔ Î·È Ù· ÓÔÚÌÔÙ·ÛÈο ¿ÙÔÌ· [6]. ∏ ÌÂϤÙË HOPE (Heart Outcome Prevention Study) ۯ‰ȿÛıËΠÁÈ· Ó· ÂÎÙÈÌ‹ÛÂÈ ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙÔ˘ ·Ó·ÛÙÔϤ· ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘ (Ú·ÌÈÚ›ÏË) Û ·ÛıÂÓ›˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË Î·Ú‰È·ÁÁÂȷ΋˜ ÓfiÛÔ˘. ™ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ¤·ÈÚÓ·Ó Ú·ÌÈÚ›ÏË Ë ∞¶ ÌÂÈÒıËΠηٿ ÂÚ›Ô˘ 3/2 mmHg Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ¤·ÈÚÓ·Ó ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ. ∞˘Ù‹ Ë Ì›ˆÛË Û˘Û¯ÂÙ›ÛıËΠ̠ÛËÌ·ÓÙÈ΋ Ì›ˆÛË Ù˘ Â›ÙˆÛ˘ ÔÏÏÒÓ Î·Ù·ÏËÎÙÈÎÒÓ ÛËÌ›ˆÓ, Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ Î·È ÙˆÓ ÈÛ¯·ÈÌÈÎÒÓ ∞∂∂. ª¿ÏÈÛÙ· ·˘Ù¿ Ù· ıÂÙÈο ·ÔÙÂϤÛÌ·Ù· ·ÊÔÚÔ‡Û·Ó ÙfiÛÔ ÙÔ˘˜ ˘ÂÚÙ·ÛÈÎÔ‡˜ ·ÛıÂÓ›˜ fiÛÔ Ù· ÓÔÚÌÔÙ·ÛÈο ¿ÙÔÌ·. ∂ÈÚfiÛıÂÙ·, ÛÙËÓ ˘Ô-ÔÌ¿‰· ÙˆÓ ·ÛıÂ-


A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·9

£∂ƒ∞¶∂π∞ – º∞ƒª∞∫∞ ÓÒÓ Ô˘ ÂÌÊ¿ÓÈÛ·Ó ÛÙÔ ·ÚÂÏıfiÓ ÈÛ¯·ÈÌÈ΋ ÓfiÛÔ ÙˆÓ ·ÁÁ›ˆÓ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ (∞∂∂ ‹ ·ÚÔ‰ÈÎfi ∞∂∂) Î·È ÔÈ ÔÔ›ÔÈ ¤Ï·‚·Ó Ú·ÌÈÚ›ÏË ·Ú·ÙËÚ‹ıËΠ̛· Ù¿ÛË Ì›ˆÛ˘ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ Â·ÓÂÌÊ¿ÓÈÛ˘ ∞∂∂, Ë ÔÔ›· fï˜ ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ [7]. ¢ÂÓ ˘¿Ú¯Ô˘Ó ·ÚÎÂÙ¿ ‰Â‰Ô̤ӷ ·fi ÌÂÁ¿Ï˜ Ù˘¯·ÈÔÔÈË̤Ó˜ ÌÂϤÙ˜ Ù· ÔÔ›· Ó· ÛÙÔȯÂÈÔıÂÙÔ‡Ó ÙË ¯Ú‹ÛË ÂÓfi˜ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ÔÚ›Ô˘-ÛÙfi¯Ô˘ Ù˘ ∞¶, fiÛÔÓ ·ÊÔÚ¿ ÙË ‰Â˘ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë ÙˆÓ ∞∂∂. ø˜ ÂÎ ÙÔ‡ÙÔ˘, ÌÈ· ÏÔÁÈ΋ ÂÓ·ÏÏ·ÎÙÈ΋ χÛË Â›Ó·È Ë ÙÔÔı¤ÙËÛË ÙˆÓ ÛÙfi¯ˆÓ Ù˘ ∞¶ Ô˘ ÚÔÙ›ÓÔÓÙ·È ·fi ÙËÓ 7Ë ·Ó·ÊÔÚ¿ Ù˘ JNC. ™‡Ìʈӷ Ì ·˘Ù¤˜ ÙȘ Ô‰ËÁ›Â˜, Û ¤Ó· ·ÛıÂÓ‹ Ô˘ ¤¯ÂÈ ‹‰Ë ˘ÔÛÙ› ¤Ó· ÈÛ¯·ÈÌÈÎfi ∞∂∂ Ô ÛÙfi¯Ô˜ Ù˘ ·ÓÙÈ˘ÂÚÙ·ÛÈ΋˜ ·ÁˆÁ‹˜ Â›Ó·È Ë Ì›ˆÛË Ù˘ ∞¶ οو ·fi 140/90 mmHg, ÂÓÒ Â¿Ó Û˘Ó˘¿Ú¯ÂÈ ‰È·‚‹Ù˘ Ù‡Ô˘ ππ ‹ Î·È ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ÓfiÛÔ˜ ÙfiÙÂ Ô ÛÙfi¯Ô˜ Ù˘ ·ÁˆÁ‹˜ Ú¤ÂÈ Ó· Â›Ó·È Ë Ì›ˆÛË Ù˘ ∞¶ <130/80 mmHg [8]. ¢ÂÓ Â›Ó·È ÁÓˆÛÙfi Â¿Ó Ë ÂÚ·ÈÙ¤Úˆ Ì›ˆÛË Ù˘ ∞¶ Â›Ó·È ·ÛÊ·Ï‹˜ Î·È ·ÔÙÂÏÂÛÌ·ÙÈ΋. ∏ ÌÂϤÙË HOT (Hypertensive Optimal Treatment), Ô˘ ۯ‰ȿÛıËΠÁÈ· ·˘Ùfi ÙÔ ÛÎÔfi, ¤‰ÂÈÍ fiÙÈ Ë Ì›ˆÛË Ù˘ ∞¶ Û Â›‰· 140/85 mmHg Û˘Û¯ÂÙ›ÛıËΠ̛̠ˆÛË ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ, ÂÓÒ Ë ÂÚ·ÈÙ¤Úˆ Ì›ˆÛË Ù˘ ∞¶ Û Â›‰· 120/70 mmHg ÚfiÛıÂÛ ÌÈÎÚfi ÌfiÓÔ fiÊÂÏÔ˜ [9]. ŸÛÔÓ ·ÊÔÚ¿ ÙÔ ˙‹ÙËÌ· ÙÔ˘ ¯ÚÔÓÈÎÔ‡ ‰È·ÛÙ‹Ì·ÙÔ˜ ̤۷ ÛÙÔ ÔÔ›Ô Ú¤ÂÈ Ó· ÂÈÙ¢¯ı› Ô ÛÙfi¯Ô˜ Ù˘ ∞¶, ‰ÂÓ ˘¿Ú¯Ô˘Ó ‰Â‰Ô̤ӷ ·fi ÎÏÈÓÈΤ˜ ÌÂϤÙ˜. ∂Ô̤ӈ˜ Î·È ÁÈ· ·˘Ùfi ÙÔ ı¤Ì· Û˘ÓÈÛÙ¿Ù·È Ë ˘ÈÔı¤ÙËÛË ÙˆÓ Î·Ù¢ı˘ÓÙ‹ÚÈˆÓ Ô‰ËÁÈÒÓ Ù˘ 7˘ ·Ó·ÊÔÚ¿˜ Ù˘ JNC. ™‡Ìʈӷ Ì ·˘Ù¤˜ ÙȘ Ô‰ËÁ›Â˜, Û ˘ÂÚÙ·ÛÈÎÔ‡˜ ·ÛıÂÓ›˜ Ô˘ ‰ÂÓ ¤¯Ô˘Ó ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Ë Â›Ù¢ÍË ÙÔ˘ ÛÙfi¯Ô˘ Ù˘ ·ÁˆÁ‹˜ Ú¤ÂÈ Ó· Á›ÓÂÙ·È Û 3 ¤ˆ˜ 6 Ì‹Ó˜ Î·È ÛÙË Û˘Ó¤¯ÂÈ· ÔÈ ·ÛıÂÓ›˜ Ú¤ÂÈ Ó· ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È Î¿ı 3 ¤ˆ˜ 6 Ì‹Ó˜. √È ·ÛıÂÓ›˜ Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ˘¤ÚÙ·ÛË ÛÙ·‰›Ô˘ ππ ‹ ÂΛÓÔÈ Ô˘ ¤¯Ô˘Ó Î·È ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ¯ÚÂÈ¿˙ÔÓÙ·È Ù·ÎÙÈÎfiÙÂÚË ·Ú·ÎÔÏÔ‡ıËÛË.

À¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ fiÙÈ Î¿ÔÈ· ηÙËÁÔÚ›· ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ˘ÂÚ¤¯ÂÈ fiÛÔÓ ·ÊÔÚ¿ ÙË ‰Â˘ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë ÙˆÓ ÈÛ¯·ÈÌÈÎÒÓ ∞∂∂; ∆· ‰Â‰Ô̤ӷ Ô˘ ˘¿Ú¯Ô˘Ó ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ‰Â›¯ÓÔ˘Ó fiÙÈ fiϘ ÔÈ Î·ÙËÁÔڛ˜ ÙˆÓ ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ Ê·ÚÌ¿ÎˆÓ (.¯. Ù· ‰ÈÔ˘ÚËÙÈο, ÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜, ÔÈ ·Ó·ÛÙÔÏ›˜ ÙÔ˘ ª∂∞ Î.Ï) ÌÂÈÒÓÔ˘Ó ÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ Ù˘ ÈÛ¯·ÈÌÈ΋˜ ÓfiÛÔ˘ ÙˆÓ ·ÁÁ›ˆÓ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ [10]. Œ¯ÂÈ ‰È·Ù˘ˆı› Ë ¿Ô„Ë fiÙÈ ÔÈ ·ÔÎÏÂÈÛÙ¤˜ ÙˆÓ ‰È·‡ÏˆÓ ÙÔ˘ ·Û‚ÂÛÙ›Ô˘ ÂӉ¯fiÌÂÓ· ·Ú¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚË ÚÔÛÙ·Û›· fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ÚˆÙÔÁÂÓ‹ ÚfiÏË„Ë ÙˆÓ ÈÛ¯·ÈÌÈÎÒÓ ∞∂∂. ∏ ÌÂϤÙË CAPPP ¤‰ÂÈÍ fiÙÈ Ù· ı·Ó·ÙËÊfiÚ· Î·È ÌË ı·Ó·ÙËÊfiÚ· ∞∂∂ ‹Ù·Ó ÈÔ Û˘¯Ó¿ ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË Ù˘ ηÙÔÙÚ›Ï˘ Û ۇÁÎÚÈÛË Ì ÙË ¯ÔÚ‹ÁËÛË ÂÓfi˜ ‰ÈÔ˘ÚËÙÈÎÔ‡ ‹ ÂÓfi˜ ‚-·ÔÎÏÂÈÛÙ‹ [11] . øÛÙfiÛÔ ·˘Ù¿ Ù· ·ÔÙÂϤÛÌ·Ù· ÌÔÚ› Ó· ÔÊ›ÏÔÓÙ·È ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÛÙËÓ ÔÌ¿‰· Ù˘ ηÙÔÙÚ›Ï˘ Ë Ì¤ÛË ∞¶ ÚÈÓ ÙËÓ ¤Ó·ÚÍË Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·ÁˆÁ‹˜ ‹Ù·Ó ˘„ËÏfiÙÂÚË Û ۇÁÎÚÈÛË Ì ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÙˆÓ ¿ÏÏˆÓ ‰‡Ô ÔÌ¿‰ˆÓ [2]. √È Chapman Î·È Neal [2] ‰È·Ù‡ˆÛ·Ó ÙËÓ ¿Ô„Ë fiÙÈ fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ÚˆÙÔÁÂÓ‹ ÚfiÏË„Ë ÙˆÓ ÈÛ¯·ÈÌÈÎÒÓ ∞∂∂ Ë ÂÈÏÔÁ‹ ÙÔ˘ ·ÓÙÈ˘ÂÚÙ·ÛÈÎÔ‡ ·Ú¿ÁÔÓÙ· ‰ÂÓ ‰È·‰Ú·Ì·Ù›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ. ∞ÓÙ›ıÂÙ·, Ê·›ÓÂÙ·È fiÙÈ ¤¯ÂÈ ÌÂÁ·Ï‡ÙÂÚË ÛËÌ·Û›· Ë ·ÔÙÂÏÂÛÌ·ÙÈ΋ Ì›ˆÛË Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘. ªÂϤÙ˜ Ô˘ ‰ËÌÔÛȇıËÎ·Ó ÚfiÛÊ·Ù· ¤‰ÂÈÍ·Ó fiÙÈ ÔÈ ·Ó·ÛÙÔÏ›˜ ÙÔ˘ ª∂∞ Î·È ÔÈ ·ÔÎÏÂÈÛÙ¤˜ ÙˆÓ ˘Ô‰Ô¯¤ˆÓ Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘ ˘ÂÚ¤¯Ô˘Ó Û ۇÁÎÚÈÛË Ì ÙȘ ¿ÏϘ ÔÌ¿‰Â˜ ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ Ê·ÚÌ¿ÎˆÓ fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ÚfiÏË„Ë Ù˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘. ∏ ·Ú·Ù‹ÚËÛË ·˘Ù‹ Ô‰‹ÁËÛ ÛÙËÓ ˘fiıÂÛË fiÙÈ ›Ûˆ˜ ·˘ÙÔ› ÔÈ ·Ú¿ÁÔÓÙ˜ ‰È·ı¤ÙÔ˘Ó Î¿ÔȘ ¢ÂÚÁÂÙÈΤ˜ ȉÈfiÙËÙ˜ Ô˘ Â›Ó·È ·ÓÂÍ¿ÚÙËÙ˜ Ù˘ ·ÓÙÈ˘ÂÚÙ·ÛÈ΋˜ ÙÔ˘˜ ‰Ú¿Û˘ Î·È ÔÈ Ôԛ˜ ‰È·‰Ú·Ì·Ù›˙Ô˘Ó Ôχ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ÚfiÏË„Ë Ù˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘ [12-14]. øÛÙfiÛÔ ÌÈ· Ù¤ÙÔÈ· ˘fiıÂÛË ‰ÂÓ ÌÔÚ› Ó· ÛÙÔȯÂÈÔıÂÙËı› Ì ‚‚·ÈfiÙËÙ· ·fi Ù· ̤¯ÚÈ Û‹ÌÂÚ· ‰Â‰Ô̤ӷ. ÕÏψÛÙÂ, Ì›· ÚfiÛÊ·ÙË ÌÂÙ··Ó¿Ï˘ÛË ¤‰ÂÈÍ fiÙÈ fiϘ ÔÈ Î·ÙË-

ÁÔڛ˜ ÙˆÓ ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ÌÂÈÒÓÔ˘Ó ÛËÌ·ÓÙÈο ÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ÙˆÓ ÈÛ¯·ÈÌÈÎÒÓ ∞∂∂, ηıÒ˜ Î·È ÙˆÓ ¿ÏÏˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ [15]. ∫·Ù¿ Û˘Ó¤ÂÈ·, Ë ÂÈıÂÙÈ΋ Ì›ˆÛË Ù˘ ∞¶ ·Ú·Ì¤ÓÂÈ Ô ·ÎÚÔÁˆÓÈ·›Ô˜ Ï›ıÔ˜ ÁÈ· ÙË ‰Â˘ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë ÙˆÓ ÈÛ¯·ÈÌÈÎÒÓ ∞∂∂. ∏ Ì›ˆÛË Ù˘ ∞¶ Û ¤Ó· ËÏÈÎȈ̤ÓÔ ·ÛıÂÓ‹ ÌÂÙ¿ ·fi ¤Ó· Ô͇ ÈÛ¯·ÈÌÈÎfi ∞∂∂ Â›Ó·È Ì›· ·ÛÊ·Ï‹˜ ÛÙÚ·ÙËÁÈ΋ ‹ ÂÓ‰¤¯ÂÙ·È Ó· Ô‰ËÁ‹ÛÂÈ ÛÂ Ó¤Ô ∞∂∂; √ÚÈṲ̂ÓÔÈ ÁÈ·ÙÚÔ› ¤¯Ô˘Ó ÂÎÊÚ¿ÛÂÈ ÙÔ Êfi‚Ô fiÙÈ Ë Ì›ˆÛË Ù˘ ∞¶ Û ¤Ó· ËÏÈÎȈ̤ÓÔ ·ÛıÂÓ‹ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ÂÁÎÂÊ·ÏÈ΋ ÈÛ¯·ÈÌ›· Î·È ∞∂∂, ȉȷ›ÙÂÚ· Â¿Ó Û˘Ó˘¿Ú¯ÂÈ ÂÛÙȷ΋ ‹ ÔÏ˘ÂÛÙȷ΋ ÓfiÛÔ˜ ÙˆÓ ·ÁÁ›ˆÓ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘. ™Â ·ÓÙ›ıÂÛË Ì ·˘Ù¤˜ ÙȘ ‰˘ÛÌÂÓ›˜ ÚԂϤ„ÂȘ, ÙÚÂȘ ÌÂÁ¿Ï˜ ÌÂϤÙ˜ (Ë SHEP, Ë Syst Eur Î·È Ë STOP [16-18]) ¤‰ÂÈÍ·Ó fiÙÈ Ë Ì›ˆÛË Ù˘ ∞¶ Ô‰ËÁ› Û Ì›ˆÛË ÙˆÓ ÈÛ¯·ÈÌÈÎÒÓ ∞∂∂ Û ËÏÈÎȈ̤ӷ ¿ÙÔÌ·. øÛÙfiÛÔ, ‰ÂÓ Ú¤ÂÈ Ó· ‰È·Ê‡ÁÂÈ Ù˘ ÚÔÛÔ¯‹˜ Ì·˜ fiÙÈ Û ·˘Ù‹ ÙËÓ Â˘·›ÛıËÙË ÔÌ¿‰· ·ÛıÂÓÒÓ Ë ÙÈÙÏÔÔ›ËÛË Ù˘ ‰fiÛ˘ ÙˆÓ Ê·ÚÌ¿ÎˆÓ Ú¤ÂÈ Ó· Á›ÓÂÙ·È Ì ÌÂÁ¿ÏË ÚÔÛÔ¯‹. ∂›Û˘, Û˘¯Ó¿ ÔÈ ËÏÈÎȈ̤ÓÔÈ ·ÛıÂÓ›˜ ÂÌÊ·Ó›˙Ô˘Ó ·ÓÂ¿ÚÎÂÈ· ÙÔ˘ ·˘ÙfiÓÔÌÔ˘ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, Ì›· ηٿÛÙ·ÛË Ô˘ Ô‰ËÁ› Û ÌÂÁ¿Ï˜ ÌÂÙ·‚ÔϤ˜ Ù˘ ∞¶ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ 24ÒÚÔ˘. ∏ 24ˆÚË Î·Ù·ÁÚ·Ê‹ Ù˘ ∞¶ ÌÔÚ› Ó· ·Ó·‰Â›ÍÂÈ ·˘Ù‹ ÙË ‰È·Ù·Ú·¯‹ Î·È Ó· Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ Î·Ï‡ÙÂÚË ·ÓÙÈÌÂÙÒÈÛË Ù˘ ˘¤ÚÙ·Û˘ ÛÙÔ˘˜ ËÏÈÎȈ̤ÓÔ˘˜ ·ÛıÂÓ›˜. ∂¿Ó ¤Ó·˜ ·ÛıÂÓ‹˜ ¿Û¯ÂÈ ·fi ¿ÓÔÈ·, ÙfiÙ Û ÔÈ¿ Â›‰· Ú¤ÂÈ Ó· Î˘Ì·›ÓÂÙ·È Ë ·ÚÙËÚȷ΋ ÙÔ˘ ›ÂÛË; ∞ÚÎÂÙ¤˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ Ë Ì›ˆÛË Ù˘ ∞¶ Û˘Û¯ÂÙ›˙ÂÙ·È Ì Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛ˘ Ù˘ ¿ÓÔÈ·˜. ∏ ÌÂϤÙË Syst Eur ¤‰ÂÈÍ fiÙÈ Ë Ì·ÎÚÔ¯ÚfiÓÈ· ¯ÔÚ‹ÁËÛË ÂÓfi˜ Ì·ÎÚ¿˜ ‰Ú¿Û˘ ·ÔÎÏÂÈÛÙ‹ ÙˆÓ ‰È·‡ÏˆÓ ·Û‚ÂÛÙ›Ô˘ ›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙË Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛ˘ Ù˘ ¿ÓÔÈ·˜ ηٿ 55% [19]. ª¿ÏÈÛÙ· ÙÔ ıÂÙÈÎfi ·ÔÙ¤ÏÂÛÌ· ·ÊÔÚÔ‡Û ÙfiÛÔ ÙË ÓfiÛÔ ÙÔ˘ Alzheimer fiÛÔ

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A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·10

·ıËÚÔÛÎÏ‹ÚˆÛË MAPTIO™ 2005

Î·È ÙËÓ ¿ÓÔÈ· ·ÁÁÂȷ΋˜ ·ÈÙÈÔÏÔÁ›·˜. ™Â ÂÚ›ÙˆÛË Ô˘ ÚÔ¸¿Ú¯ÂÈ ¿ÓÔÈ· Ë ¯ÔÚ‹ÁËÛË ·ÓÙÈ˘ÂÚÙ·ÛÈ΋˜ ·ÁˆÁ‹˜ ‰ÂÓ Ê·›ÓÂÙ·È Ó· Û˘Û¯ÂÙ›˙ÂÙ·È Ì ‚ÂÏÙ›ˆÛË Ù˘ ÁÓˆÛȷ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ·ÛıÂÓ‹. ª›· ÌÂϤÙË ·Ú·Ù‹ÚËÛ˘ Û ·ÛıÂÓ›˜ Ì ÔÏÏ·Ï¿ ÂÁÎÂÊ·ÏÈο ¤ÌÊÚ·ÎÙ· (Ì ‹ ¯ˆÚ›˜ ÙË Û˘Ó‡·ÚÍË ¿ÓÔÈ·˜) ¤‰ÂÈÍ fiÙÈ Ë ‰È·Ù‹ÚËÛË ·˘ÍËÌ¤ÓˆÓ ÂÈ¤‰ˆÓ Ù˘ ™∞¶ ÂÌfi‰ÈÛ ÙËÓ ÂÚ·ÈÙ¤Úˆ Âȉ›ӈÛË Ù˘ ÁÓˆÛȷ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Û fiÛÔ˘˜ ÂÌÊ¿ÓÈ˙·Ó ¿ÓÔÈ· [20] . ª›· ¿ÏÏË ÌÂϤÙË Û ·ÛıÂÓ›˜ Ì ¿ÓÔÈ· ·ÁÁÂȷ΋˜ ·ÈÙÈÔÏÔÁ›·˜ ¤‰ÂÈÍ fiÙÈ Ù· ·˘ÍË̤ӷ Â›‰· Ù˘ ™∞¶ (·fi 135 ¤ˆ˜ 150 mmHg) Û˘Û¯ÂÙ›ÛıËÎ·Ó Ì ‚ÂÏÙ›ˆÛË Ù˘ ÁÓˆÛȷ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜, ÂÓÒ Ë Ì›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ™∞¶ Û˘Û¯ÂÙ›ÛıËΠ̠Âȉ›ӈÛË Ù˘ ÁÓˆÛȷ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ [21] .

™˘Ì¤Ú·ÛÌ· À¿Ú¯Ô˘Ó Û‹ÌÂÚ· ·Ó·ÌÊÈÛ‚‹ÙËÙ˜ ÂӉ›ÍÂȘ fiÙÈ Ë Ì›ˆÛË Ù˘ ∞¶ ‰È·‰Ú·Ì·Ù›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ÚˆÙÔÁÂÓ‹ Î·È ÙË ‰Â˘ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë ÙˆÓ ÈÛ¯·ÈÌÈÎÒÓ ∞∂∂, ηıÒ˜ Î·È ¿ÏÏˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ. ∂ÈÚfiÛıÂÙ· Ë Ì›ˆÛË Ù˘ ∞¶ Ê·›ÓÂÙ·È fiÙÈ Û˘Û¯ÂÙ›˙ÂÙ·È Î·È Ì Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛ˘ ¿ÓÔÈ·˜ (ÙfiÛÔ ·ÁÁÂȷ΋˜ fiÛÔ Î·È ÌË ·ÁÁÂȷ΋˜ ·ÈÙÈÔÏÔÁ›·˜). Œ¯ÂÈ ‰È·Ù˘ˆı› Ë ¿Ô„Ë fiÙÈ ÔÈ ÏÂÈÔÙÚÔÈΤ˜ ‰Ú¿ÛÂȘ ÔÚÈÛÌ¤ÓˆÓ ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ Ê·ÚÌ¿ÎˆÓ (·Ó·ÛÙÔÏ›˜ ÙÔ˘ ª∂∞ Î·È ·ÔÎÏÂÈÛÙ¤˜ ÙˆÓ ˘Ô‰Ô¯¤ˆÓ Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘) ‰È·‰Ú·Ì·Ù›˙Ô˘Ó ¤Ó·Ó ÂÈÚfiÛıÂÙÔ ÚfiÏÔ (·ÓÂÍ¿ÚÙËÙÔ Ù˘ ·ÓÙÈ˘ÂÚÙ·ÛÈ΋˜ ÙÔ˘˜ ‰Ú¿Û˘) ÛÙËÓ ÂÌÊ¿ÓÈÛË ÙˆÓ ıÂÙÈÎÒÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Ô˘ ‹‰Ë ÂÚÈÁÚ¿ÊË-

ηÓ. øÛÙfiÛÔ, ·˘Ù‹ Ë ·Ú·Ù‹ÚËÛË ‰ÂÓ ¤¯ÂÈ ·ÎfiÌË ÂȂ‚·Èˆı› Î·È ÂÔ̤ӈ˜ fiϘ ÔÈ ÔÌ¿‰Â˜ ÙˆÓ ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ Ê·ÚÌ¿ÎˆÓ Â›Ó·È Ê¿Ú̷η ÚÒÙ˘ ÂÈÏÔÁ‹˜ ÁÈ· ÙËÓ ÚfiÏË„Ë Ù˘ ÈÛ¯·ÈÌÈ΋˜ ÓfiÛÔ˘ ÙˆÓ ·ÁÁ›ˆÓ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘. ∂Í·ÈÙ›·˜ Ù˘ ·Ô˘Û›·˜ ‰Â‰ÔÌ¤ÓˆÓ ·fi Ù˘¯·ÈÔÔÈË̤Ó˜ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ ‰ÂÓ ¤¯ÂÈ Î·ıÔÚÈÛı› Û˘ÁÎÂÎÚÈ̤ÓÔ˜ ÛÙfi¯Ô˜ Ù˘ ∞¶ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ¤¯Ô˘Ó ˘ÔÛÙ› ¤Ó· ÈÛ¯·ÈÌÈÎfi ∞∂∂. ∫·Ù¿ Û˘Ó¤ÂÈ· Ë ·ÓÙÈÌÂÙÒÈÛË Ù˘ ˘¤ÚÙ·Û˘ Û ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Ú¤ÂÈ Ó· Á›ÓÂÙ·È Û‡Ìʈӷ Ì ÙȘ ηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ Ù˘ 7˘ ·Ó·ÊÔÚ¿˜ Ù˘ JNC. øÛÙfiÛÔ ·fi Ù· ÂÚÈÔÚÈṲ̂ӷ ‰Â‰Ô̤ӷ Ô˘ ¤¯Ô˘Ó ‰ËÌÔÛÈ¢ı› Ê·›ÓÂÙ·È fiÙÈ ¯·ÌËÏfiÙÂÚ· Â›‰· Ù˘ ∞¶ Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ·ÎfiÌË ÌÂÁ·Ï‡ÙÂÚÔ fiÊÂÏÔ˜ Î·È ÌÈÎÚfi ÌfiÓÔ ÂÈÚfiÛıÂÙÔ Î›Ó‰˘ÓÔ.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Gorelick PB. New horizons for stroke prevention: PROGRESS and HOPE. Lancet Neurology. 2002;1:149-156. 2. Chapman N, Neal B. Blood pressure lowering for the prevention of first stroke. In: Chalmers J, ed.:Clinician's Manual on Blood Pressure and Stroke Prevention. 3rd ed. London, UK: Science Press; 2002:2131. 3. Chalmers J. Progress with blood pressure lowering in the secondary prevention of stroke. In: Chalmers J, ed. Clinician's Manual on Blood Pressure and Stroke Prevention. 3rd ed. London, UK: Science Press; 2002:33-53. 4. Goldstein, LB. Blood pressure management in patients with acute ischemic stroke. Hypertension 2004;43:137-141. 5. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R; Prospective Studies Collaboration. Age-specific relevance or usual blood pressure to vascular mortality: a metaanalysis of individual data for one million adults in 61 prospective studies. Lancet 2002;360:1903-1913. 6. PROGRESS Collaborative Study Group. Randomized trial of a perindopril-based blood-pressure-lowering regimen among 6105 individuals with previous stroke or transient ischemic attack. Lancet 2001; 358:1033-1041. 7. Bosch J. Yusuf S. Pogue J. Sleight P. Lonn E. Rangoonwala B. Davies R. Ostergren J. Probstfield J. HOPE Investigators. Heart outcomes prevention evaluation. Use of ramipril in preventing stroke: double blind randomized trial. BMJ 2002;324:1-5. 8. Chobanian AV, Bakris GL, Black HR, Cushman W, Lee A, Izzo JL, Jones DW, Materson BJ, Oparil S, Wright JT, Roccella EJ. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The JNC 7 Report. JAMA 2003;289: 2560-2572. 9. Hansson L, Zanchetti A, Carruthers SG,

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£∂ƒ∞¶∂π∞ – º∞ƒª∞∫∞

∏ ·ÓÙ·fiÎÚÈÛË Ù˘ HDL ÛÙËÓ ˘ÔÏÈȉ·ÈÌÈ΋ ıÂÚ·›· °ÂÓÔ‚¤Ê· ¢. ∫ÔÏÔ‚Ô‡, ∫·ÙÂÚ›Ó· ∫. ∞Ó·ÁÓˆÛÙÔÔ‡ÏÔ˘, ∞ϤͷӉÚÔ˜ ∂. ¶·ÓÙÂÏ¿Î˘ ∞’ ∫·Ú‰ÈÔÏÔÁÈ΋ ∫ÏÈÓÈ΋, øÓ¿ÛÂÈÔ ∫·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈÎfi ∫¤ÓÙÚÔ ∞) ¢›·ÈÙ· Œ¯ÂÈ ‹‰Ë ·Ó·ÊÂÚı› ·fi ÙËÓ NCEP ATP III fiÙÈ Ë ÚÔÙÂÈÓfiÌÂÓË ‰›·ÈÙ· Ô˘ ·ÔÛÎÔ› Û Ì›ˆÛË ÙˆÓ ÏÈȉ›ˆÓ1-2 fi¯È ÌfiÓÔ ÌÂÈÒÓÂÈ ÙËÓ ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË ·ÏÏ¿ Î·È Ù· Â›‰· Ù˘ HDL ¯ÔÏËÛÙÂÚfiÏ˘ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜3-5. Œ¯Ô˘Ì ‰Â›ÍÂÈ fiÙÈ Ë ·ÓÙ·fiÎÚÈÛË Ù˘ HDL ÛÙË ˘ÔÏÈȉ·ÈÌÈ΋ ‰›·ÈÙ· ÂÍ·ÚÙ¿Ù·È ·fi Ù· ·Ú¯Èο Ù˘ Â›‰·6. ™Â ·ÛıÂÓ›˜ Ì ·Ú¯È΋ ÙÈÌ‹ ∏DL < 39 mg/dl, Ë ˘ÔÏÈȉ·ÈÌÈ΋ ‰›·ÈÙ· ÌÂÈÒÓÂÈ ÙËÓ ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË Î·È Ù· Â›‰· ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ, ·˘Í¿ÓÔÓÙ·˜ ÙËÓ HDL ¯ÔÏËÛÙÂÚfiÏË, ÂÓÒ Û ·ÛıÂÓ›˜ Ì HDL ≥ 39 mg/dl Ë Ì›ˆÛË Ù˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ‰ÂÓ Û˘Óԉ‡ÂÙ·È ·fi ·‡ÍËÛË Ù˘ HDL6. ¶·ÚfiÌÔÈÔ ·ÔÙ¤ÏÂÛÌ· ›¯Â Î·È Ì›· ¿ÏÏË ÌÂϤÙË Ì ‰ÈÏ¿ÛÈ· Û˘ÌÌÂÙÔ¯‹ ·ÛıÂÓÒÓ fiÔ˘ ‰È·ÈÛÙÒıËΠ̛ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ HDL ÌÂÙ¿ ·fi ˘ÔÏÈȉ·ÈÌÈ΋ ‰›·ÈÙ· fiÙ·Ó Ù· ·Ú¯Èο Ù˘ Â›‰· ‹Ù·Ó ≥ 39 mg/dl7 (¶›Ó·Î·˜ 1). ∞Ó¿ÏÔÁË Ì›ˆÛË Ù˘ HDL ÌÂÙ¿ ·fi ˘ÔÏÈȉ·ÈÌÈ΋ ‰›·ÈÙ· ¤¯ÂÈ ·Ó·ÊÂÚı› ·fi ÙÔ˘˜ Maki et al8, ·fi ÙȘ ÌÂϤÙ˜ beFIT Î·È DAS9 ηıÒ˜ Î·È ·fi ¿ÏÏÔ˘˜10-12 (¶›Ó·Î·˜ 2).

ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ‰˘ÛÏÈȉ·ÈÌÈÒÓ 13 Â‰Ò Î·È ÔÏϤ˜ ‰ÂηÂٛ˜ (¶›Ó·Î·˜ 2). ¶ÂÚÈÛÛfiÙÂÚÔ ¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈËı› ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›·˜14. √È ÌÂÁ¿Ï˜ ÌÂϤÙ˜ Ì ÊÈ‚Ú¿Ù˜ ¤‰ÂÈÍ·Ó Ì›· ·‡ÍËÛË Ù˘ ∏DL ·fi 6% 15 ¤ˆ˜ 10%16 Î·È 18%17 Ì ·Ú¿ÏÏËÏË Ì›ˆÛË Ù˘ LDL Ù˘ ٿ͈˜ ÙÔ˘ 10%16, ‹ η̛· ÌÂÙ·‚ÔÏ‹15, ηıÒ˜ Î·È Ì›ˆÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ (∆°§) Ù˘ ٿ͈˜ ÙÔ˘ 21%17, 31% 15 ‹ 43%16. ∏ Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial Î·È ÔÈ ÌÂϤÙ˜ Bezafibrate Infraction Prevention ‰Â›¯ÓÔ˘Ó fiÙÈ Ë ıÂÚ·›· Ì ÊÈ‚Ú¿Ù˜ Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ¯·ÌËÏ¿ Â›‰· HDL Î·È ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›·15,17. ªÂϤÙ˜ Ì·˜ ¤‰ÂÈÍ·Ó fiÙÈ ÔÈ ÊÈ‚Ú¿Ù˜ ‰ÂÓ ¤¯Ô˘Ó η̛· ·ÚÓËÙÈ΋ Â›‰Ú·ÛË ÛÙ· Â›‰· Ù˘ HDL, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ·Ú¯È΋ Ù˘ Û˘ÁΤÓÙÚˆÛË7 (¶›Ó·Î·˜ 1). ¶·Ú¿ÏÏËÏ·, ·Ú·ÙËÚÂ›Ù·È ·‡ÍËÛË Ù˘ HDL (+18%) fiÙ·Ó Ë ·Ú¯È΋ Ù˘ ÙÈÌ‹ Â›Ó·È ¯·ÌËÏ‹ Î·È ·ÚÂÌÊÂÚ‹˜ Ì ·˘Ù‹ Ô˘ ·Ó·Ê¤ÚÂÙ·È ÛÙË ÌÂϤÙË BIP (+18%) 15.

°) ¡ÈÎÔÙÈÓÈÎfi Ô͇ Î·È ·Ú¿ÁˆÁ· ∆Ô ÓÈÎÔÙÈÓÈÎfi Ô͇ ¤¯ÂÈ Â›Ó·È µ) ºÈ‚Ú¿Ù˜ ÁÓˆÛÙfi fiÙÈ ÌÂÈÒÓÂÈ ÙË ¯ÔÏËÛÙÂÚfi√È ÊÈ‚Ú¿Ù˜ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÏË Î·È Ù· Â›‰· ÙˆÓ ∆°§, ÂÏ·ÙÙÒÓÔÓÙ·˜ ÙȘ VLDL ηıÒ˜ Î·È Ù· Â›‰· ¶›Ó·Î·˜ 1: ∏ Â›‰Ú·ÛË Ù˘ ‰›·ÈÙ·˜, ÙˆÓ ÛÙ·ÙÈÓÒÓ, Ù˘ LDL, ÂÓÒ Â›Û˘ ÙˆÓ ÊÈ‚Ú·ÙÒÓ Î·È ÙÔ˘ ÓÈÎÔÙÈÓÈÎÔ‡ Ôͤˆ˜ ‹ ÙÔ˘ ¤¯ÂÈ ÙËÓ ÈηÓfiÙËÙ· Ó· ·Ó·ÏfiÁÔ˘ ÙÔ˘ (Acipimox) ÛÙ· Â›‰· Ù˘ HDL ·˘Í¿ÓÂÈ Ù· Â›‰· Ù˘ HDL17-19 (¶›Ó·Î·˜ ≥39 mg/dl <39 mg/dl 2). ∂ÈÚfiÛıÂÙ·, Ë n=149 n=92 ¢›·ÈÙ· ıÂÚ·›· Ì ÓÈÎÔÙÈÓÈHDL (·Ú¯Èο Â›‰·) 52 32 Îfi Ô͇ ÌÂÈÒÓÂÈ ÙÔÓ ªÂÙ·‚ÔÏ‹ (%) -12* +19* ΛӉ˘ÓÔ ÁÈ· ÛÙÂÊ·ÓșٷٛÓ˜ n=206 n=106 ·›· ÓfiÛÔ Î·È ÙËÓ ÈHDL (·Ú¯Èο Â›‰·) 54 32 ı·ÓfiÙËÙ· Â·ÓÂÌÊ¿ªÂÙ·‚ÔÏ‹ (%) -7* +22* ÓÈÛ˘ ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ôηډ›Ô˘ 20,21. ºÈ‚Ú¿Ù˜ n=86 n=79 √ Ì˯·ÓÈÛÌfi˜ ‰Ú¿HDL (·Ú¯Èο Â›‰·) 51 31 Û˘ ÙÔ˘ ÓÈÎÔÙÈÓÈÎÔ‡ ªÂÙ·‚ÔÏ‹ (%) +2 +19* ÔͤԘ ‰ÂÓ ¤¯ÂÈ Ï‹¡ÈÎÔÙÈÓÈÎfi √͇/Acipimox n=50 n=33 Úˆ˜ ·ÔÛ·ÊËÓÈÛı›. HDL (·Ú¯Èο Â›‰·) 48 30 º·›ÓÂÙ·È fï˜ Ó· ÌÂȪÂÙ·‚ÔÏ‹ (%) +6 +27* ÒÓÂÈ ÙËÓ ·Ú·ÁˆÁ‹ ÙˆÓ ÂχıÂÚˆÓ ÏÈ·*p<0.001 Û‡ÁÎÚÈÛË ÚÈÓ Î·È ÌÂÙ¿ ÙË ıÂÚ·›·.

ÚÒÓ ÔͤˆÓ ·Ó·ÛÙ¤ÏÏÔÓÙ·˜ ÙËÓ ÏÈfiÏ˘ÛË ÛÙÔ ÏÈÒ‰Ë ÈÛÙfi Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÌÂȈ̤ÓË ‰È·ıÂÛÈÌfiÙËÙ· ÙˆÓ ˘ÔÛÙÚˆÌ¿ÙˆÓ Ù˘ VLDL Ô˘ Û˘ÓÙ›ıÂÓÙ·È ÛÙÔ ‹·Ú. Œ¯ÂÈ Â›Û˘ ·Ó·ÊÂÚı› fiÙÈ ÙÔ ÓÈÎÔÙÈÓÈÎfi Ô͇ ·Ó·ÛÙ¤ÏÏÂÈ ·¢ı›·˜ ÙËÓ Ë·ÙÈ΋ Û‡ÓıÂÛË ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ Ô˘ ÂÚȤ¯Ô˘Ó ·ÔÏÈÔÚˆÙ½ÓË ‚.17,18,22 ∆Ô ÓÈÎÔÙÈÓÈÎfi Ô͇ ¤¯ÂÈ ‚ÚÂı› Ó· ÚÔηÏ› ÙËÓ ÌÂÁ·Ï‡ÙÂÚË ·‡ÍËÛË (17-31%) Ù˘ HDL Ì ·Ú¿ÏÏËÏ· ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÙfiÛÔ Ù˘ LDL (12-20%), fiÛÔ Î·È ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ∆°§23. ∆· Â˘Ú‹Ì·Ù· Ì·˜ fiÛÔÓ ·ÊÔÚ¿ ÙÔ ÓÈÎÔÙÈÓÈÎfi Ô͇ Î·È Ù· ·Ó¿ÏÔÁ· ÙÔ˘ (acipimox) Â›Ó·È ·ÚÂÌÊÂÚ‹. øÛÙfiÛÔ, ·ÛıÂÓ›˜ Ì ·Ú¯È΋ HDL ≥ 39 mg/dl ·ÚÔ˘Û›·Û·Ó ÌÂÁ·Ï‡ÙÂÚË Ì›ˆÛË Ù˘ LDL Î·È ÙˆÓ ∆°§7. √È ·ÛıÂÓ›˜ Ì ·Ú¯È΋ ∏DL < 39 mg/dl ÂÌÊ¿ÓÈÛ·Ó ÌÂÁ·Ï‡ÙÂÚË ·‡ÍËÛË Ù˘ HDL Û ۇÁÎÚÈÛË Ì ·ÛıÂÓ›˜ Ô˘ ›¯·Ó ·Ú¯È΋ HDL ≥ 39 mg/dl ηıÒ˜ Î·È Û ۇÁÎÚÈÛË Ì fiϘ ÙȘ ¿ÏϘ ÔÌ¿‰Â˜7 (¶›Ó·Î·˜ 1). ¢. ™Ù·Ù›Ó˜ ∏ ÂÈÛ·ÁˆÁ‹ ÙˆÓ ·Ó·ÛÙÔϤˆÓ ÙÔ˘ 3-‡‰ÚÔ͢-3-ÌÂı˘ÏÔÁÏÔ˘Ù¿Ú˘ÏÔ Û˘Ó¤Ó˙˘ÌÔ ∞ (HMG-CoA) (ÛÙ·Ù›Ó˜) ¤ÊÂÚ Â·Ó¿ÛÙ·ÛË ÛÙËÓ ıÂÚ·›· ÙˆÓ ‰˘ÛÏÈȉ·ÈÌÈÒÓ24,2,25,26. ∏ ¯ÔÚ‹ÁËÛË ÙˆÓ ÛÙ·ÙÈÓÒÓ ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·Ó·‚¿ıÌÈÛË ÙˆÓ Ë·ÙÈÎÒÓ LDL ˘Ô‰Ô¯¤ˆÓ, ‰È·ÙËÚÒÓÙ·˜ Ù· ÂÓ‰Ô΢ÙÙ·ÚÈο Â›‰· Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘. ∞ÔÙÂÏÔ‡Ó Ù· Û˘¯ÓfiÙÂÚ· Û˘ÓÙ·ÁÔÁÚ·ÊÔ‡ÌÂÓ· ˘ÔÏÈȉ·ÈÌÈο Ê¿Ú̷η ÂÍ·ÈÙ›·˜ Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ÙÔ˘˜ ÛÙË Ì›ˆÛË Ù˘ LDL, ηıÒ˜ Î·È ÙÔ˘ ÁÂÁÔÓfiÙÔ˜ fiÙÈ ÚfiÎÂÈÙ·È ÁÈ· Ê¿Ú̷η ηϿ ·ÓÂÎÙ¿ Î·È ·ÛÊ·Ï‹27. √È ÛÙ·Ù›Ó˜ ¤¯Ô˘Ó ·ԉ‰ÂÈÁ̤ӷ ÙËÓ ÈηÓfiÙËÙ· Ó· ÌÂÈÒÓÔ˘Ó ÙËÓ ÔÏÈ΋ ıÓËÙfiÙËÙ·, ÙÔ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ôηډ›Ô˘ Î·È ·ÁÁÂÈ·ÎÔ‡ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘, ηıÒ˜ Î·È ÙËÓ ·Ó¿ÁÎË ÁÈ· Â·Ó·ÁÁ›ˆÛË28-34. ∏ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ LDL Î·È ÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ÚÈÓ Î·È ÌÂÙ¿ ÙËÓ ıÂÚ·›· Ì ÛÙ·Ù›Ó˜ ¤¯Ô˘Ó ÂÎÙÈÌËı› Û ÔÏϤ˜ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜28,30,33,35. ™ÙȘ ÌÂ-

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A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·12

·ıËÚÔÛÎÏ‹ÚˆÛË MAPTIO™ 2005

·ÛıÂÓ›˜ Ì ˘„ËϤ˜ ‹ ̤ÙÚȘ ÙÈ̤˜ LDL ¯ÔÏËÛÙÂÚfiÏ˘41. ∏ ‰Ú¿ÛË ÙˆÓ ÛÙ·ÙÈÓÒÓ ÛÙË Û˘ÁΤÓÙÚˆÛË Ù˘ ∞Ú¯Èο ∂›‰Ô˜ HDL ¯ÔÏËÛÙÂÚfiÏ˘ ‰ÂÓ Â›ªÂϤÙ˜ (¤ÙÔ˜) ∞ÚÈıÌfi˜ Â›‰· ˘ÔÏÈȉ·ÈÌÈ΋˜ ªÂÙ·‚ÔÏ‹ [‚È‚ÏÈÔÁÚ·Ê›·] ·ÛıÂÓÒÓ HDL (mg/dl) ıÂÚ·›·˜ (%) Ó·È ·fiÏ˘Ù· Û·Ê‹˜. ∂›Ó·È Èı·Ófi fiÙÈ ÚÔηÏÔ‡Ó ÂÈ¢›·ÈÙ· ÏÂÎÙÈ΋ ·‡ÍËÛË ÙˆÓ ˘Ô‰ÔKolovou et al (1994) [6] 129 44 Step I -2 ¯¤ˆÓ (Scavenger Azen et al (1996) [12] 162 42 Step I +2 De Lorgeril et al (1999) [43] 219 45 mediterranean +10 Receptors) Ù‡Ô˘ B1, ¤¯ÔKnopp et al (2000) [9] 792 41 Step II -2.5 ÓÙ·˜ Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙËÓ Knopp et al (2000) [9] 792 58 Step II -8 ·˘ÍË̤ÓË ·ÔÌ¿ÎÚ˘ÓÛË Obarzanek et al (2001) [11] 436 49 DASH diet -3 ÙˆÓ HDL2 ·fi ÙÔ ‹·Ú Î·È Maki et al (2001) [8] 75 52 Step I + low sterols -4 ÙË Ì›ˆÛË Ù˘ HDL ¯ÔÏËMaki et al (2001) [8] 35 52 Step I + high sterols -7 ÛÙÂÚfiÏ˘41. ∞fi ÙËÓ ¿ÏÏË Kolovou et al (2003) [7] 241 45 Step I -4 ÌÂÚÈ¿ ÔÈ ÛÙ·Ù›Ó˜ Â›Ó·È ÈηӤ˜ Ó· ·˘Í‹ÛÔ˘Ó ÙËÓ HDL ºÈ‚Ú¿Ù˜ Manttari et al (1987) [44] 4081 50 Gemfibrozil +10 ̤ۈ ·˘ÍË̤Ó˘ Û‡ÓıÂÛ˘ Steiner (1996) [45] 418 39 Fenofibrate +7.5 ÙˆÓ ·ÔÏÈÔÚˆÙÂ˚ÓÒÓ AFrick et al (1997) [16] 372 32 Gemfibrozil +15 I41. ∂›Ó·È Â›Û˘ Èı·Ófi ‰È·Rubins et al (1999) [46] 2531 32 Gemfibrozil +6 ÊÔÚÂÙÈΤ˜ ÛÙ·Ù›Ó˜ Ó· BIP Study Group (2000) [15] 2825 35 Bezafibrate +18 ¤¯Ô˘Ó ‰È·ÊÔÚÂÙÈ΋ Â›‰Ú·Sakai et al (2001) [47] 65 31 Gemfibrozil +13 ÛË ÛÙ· Â›‰· Ù˘ HDL41 +10 Kolovou et al (2003) [7] 165 41 Fibratesa (¶›Ó·Î·˜ 2). ∏ ÚÔËÁԇ̡ÈÎÔÙÈÓÈÎfi √͇ ÓË ÌÂϤÙË6 ·Ó·Ê¤ÚÂÈ fiÙÈ ÔÈ Sakai et al (2001) [47] 69 31 N-SL +22 ÛÙ·Ù›Ó˜ ‰ÂÓ ¤¯Ô˘Ó η̛· Cheung et al (2001) [48] 146 31 N+Simvastatin +26 Â›‰Ú·ÛË ÛÙËÓ HDL fiÙ·Ó Ù· Kolovou et al (2003) [7] 83 41 N or Acipimox +10 Â›‰· Ù˘ Â›Ó·È ≥ 39 mg/dl. ™ÙËÓ ›‰È· ÌÂϤÙË ÛÙÔ ™Ù·Ù›Ó˜ 11% ÙˆÓ ·ÛıÂÓÒÓ ·fi ÙËÓ Sacks et al (1991) [49] 4159 38 Pravastatin +4 ÔÌ¿‰· ÙˆÓ ÛÙ·ÙÈÓÒÓ ¯ÔÚËShepherd et al (1995) [50] 6595 43 Pravastatin +5 4S Study Group (1995) [51] 4444 46 Simvastatin +8 Á‹ıËΠÛÈÌ‚·ÛÙ·Ù›ÓË Î·È Û Bruschke et al (1995) [52] 450 36 Pravastatin +9 Î·Ó¤Ó·Ó ·ÛıÂÓ‹ ‰Â ¯ÔÚËÁ‹Herd et al (1994) [53] 339 34 Fluvastatin +9 ıËΠ·ÙÔÚ‚·ÛÙ·Ù›ÓË, ÂÓÒ Herd et al (1994 [53] 339 48 Fluvastatin +4 ÛÙË ‰ÈÎÈ¿ Ì·˜ ÌÂϤÙË ÛÙÔ Downs et al (1997) [38] 5742 38 Lovastatin +6 21% ÙˆÓ ·ÛıÂÓÒÓ ¯ÔÚËÁ‹LIPID Study Group (1998) [54] 7684 36 Pravastatin +5 ıËΠÛÈÌ‚·ÛÙ·Ù›ÓË Î·È ÛÙÔ Schwartz et al (2001) [55] 3086 46 Atorvastatin NC 18% ·ÙÔÚ‚·ÛÙ·Ù›ÓË. Shepherd et al (2002) [56] 5804 50 Pravastatin +5 Œ¯ÂÈ ·Ó·ÊÂÚı› fiÙÈ Ë Colhoun et al (2002) [57] 1421 52 Atorvastatin +1 ÛÈÌ‚·ÛÙ·Ù›ÓË ÌÔÚ› ‰ÔÛÔSever et al (2003) [58] 19342 51 Pravastatin NC ÂÍ·ÚÙÒÌÂÓ· Ó· ·˘Í‹ÛÂÈ ÙËÓ -2 Kolovou et al (2003) [7] 312 47 Statinsb HDL ÂÓÒ Ì ÙËÓ ·ÙÔÚ‚·McKenney et al (2003) [59] 313 51 Rosuvastatin +10 ÛÙ·Ù›ÓË fiÛÔ Ë ‰fiÛË ·˘Í¿McKenney et al (2003) [59] 323 50 Atorvastatin +2 McKenney et al (2003) [59] 328 51 Simvastatin +7 ÓÂÙ·È ÙfiÛÔ ÂÚÈÔÚ›˙ÂÙ·È Ë McKenney et al (2003) [59] 321 50 Pravastatin +6 ıÂÙÈ΋ Ù˘ Â›‰Ú·ÛË ÛÙ· Prove-it (2004) [34] 2099 39 Atorvastatin +6.5 Â›‰· Ù˘ HDL (·ÚÓËÙÈ΋ Prove-it (2004) [34] 2063 39 Pravastatin +8 ‰ÔÛÔÂÍ¿ÚÙËÛË)42. ¢ÂÓ ÂÎÙÈÌ‹Û·Ì ÙËÓ Â›‰Ú·ÛË Ù˘ √È ÊÈ‚Ú¿Ù˜ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÂÚÈÏ·Ì‚¿ÓÔ˘Ó: Gemfibrozil, Bezafibrate Î·È Fenofibrate οı ÛÙ·Ù›Ó˘ ͯˆÚÈÛÙ¿ √È ÛÙ·Ù›Ó˜ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÂÚÈÏ·Ì‚¿ÓÔ˘Ó: Lovastatin, Simvastatin, Pravastatin Î·È Atorvastatin HDL: high density lipoprotein cholesterol, N-SL: slow release, N: nicotinic acid, NC: no change Step I & II diets ÛÙ· Â›‰· Ù˘ HDL ÂÍ’ ·Èaccording to NCEP ATP II guidelines (1) Ù›·˜ ÙÔ˘ ÌÈÎÚÔ‡ ·ÚÈıÌÔ‡ ÙÔÓ ·ÛıÂÓÒÓ ·Ó¿ Ê¿ÚÌ·ÎÔ. ∂ÈϤÔÓ Ë ÌÂϤÙË ‰ÂÓ Û¯ÂϤÙ˜ Ì·˜, ÔÈ ÛÙ·Ù›Ó˜ Ì›ˆÛ·Ó ÙËÓ Â›‰· HDL ÛÙ· ¯·ÌËÏfiÙÂÚ· 2/3 ‰È¿ÛÙËΠÁÈ· Ó· ‰ÈÂÚ¢ӋÛÂÈ ‰È·ÔÏÈ΋ Î·È ÙËÓ LDL ¯ÔÏËÛÙÂÚfiÏË Î·ÙÔÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÙÈÌÒÓ Î·È ÔÚȷο ÊÔÚ¤˜ ÌÂٷ͇ ÛÙ·ÙÈÓÒÓ Ô˘ ·ÊÔıÒ˜ Î·È Ù· Â›‰· ÙˆÓ ∆°§, ÌÂÈÒÂ›‰· LDL Î·È ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÚÔ‡Ó Ù· Â›‰· Ù˘ HDL ¯ÔÏËÛÙÂÓÔÓÙ·˜ fï˜ ÛËÌ·ÓÙÈο Ù· Â›‰· Ï˘ ÂÌÊ·Ó›˙Ô˘Ó ÌÂÁ·Ï‡ÙÂÚË Ì›ˆÚfiÏ˘. Ù˘ HDL (¶›Ó·Î·˜ 1). ÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÌÂÙ¿ ·fi ÙË ¯ÔÚ‹¶·ÚÔÏ’·˘Ù¿, Ë ÌÂϤÙË ·˘Ù‹ ∂›Ó·È ‰‡ÛÎÔÏÔ Ó· ÚÔ‚ÏÂÊı› ÁËÛË ÛÙ·ÙÈÓÒÓ (45% Î·È 44%) 36-38. ˘Ô‰ÂÈÎÓ‡ÂÈ fiÙÈ Ë ¯ÔÚ‹ÁËÛË ÛÙ·ÙÈ∂›Û˘, Ë ÌÂÁ·Ï‡ÙÂÚË ·ÁÁÂÈÔÁÚ··Ó Ì›· Ù¤ÙÔÈ· Ì›ˆÛË Ù˘ HDL ı· ÓÒÓ Û ·ÛıÂÓ›˜ Ì ·Ú¯Èο Â›‰· ÊÈ΋ ‚ÂÏÙ›ˆÛË ÌÂÙ¿ ·fi ıÂÚ·›· ›¯Â οÔÈ· ·ÚÓËÙÈ΋ Â›‰Ú·ÛË HDL ¯ÔÏËÛÙÂÚfiÏ˘ ≥ 39 mg/dl, Ì ÛÙ·Ù›Ó˜ ¤¯ÂÈ ·Ó·ÊÂÚı› ·fi ÛÙÔÓ Î·Ú‰ÈÔ·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ ÙÔ˘ ÂÎÙfi˜ ·fi ÙËÓ ÚÔÛ‰ÔÎÔ‡ÌÂÓË Ì›ÙÔ˘˜ Ballantne et al, Û ·ÛıÂÓ›˜ Ì ·ÛıÂÓÔ‡˜ ‰Â‰Ô̤ÓÔ˘ fi,ÙÈ Ù¤ÙÔÈÔ˘ ˆÛË Ù˘ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘, Ù˘ ·Ú¯È΋ ÙÈÌ‹ HDL < 35 mg/dl39. ›‰Ô˘˜ ‰Â‰Ô̤ӷ ·Ô˘ÛÈ¿˙Ô˘Ó. LDL Î·È ÙˆÓ ∆°§, Û˘Óԉ‡ÂÙ·È Î·È √È ÛÙ·Ù›Ó˜ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡øÛÙfiÛÔ, ÛÙË ÌÂϤÙË Air Force / Te·fi Ì›· ·ÓÂÈı‡ÌËÙË ÂÏ¿ÙÙˆÛË Ù˘ ÓÙ·È Ì¤¯ÚÈ Û‹ÌÂÚ· ¤¯Ô˘Ó ‰Â›ÍÂÈ Â˘xas Coronary Atherosclerosis PreHDL ¯ÔÏËÛÙÂÚfiÏ˘7. ÂÚÁÂÙÈο ·ÔÙÂϤÛÌ·Ù· ΢ڛˆ˜ Û vention Study ·ÛıÂÓ›˜ Ì ·Ú¯Èο

¶›Ó·Î·˜ 2. ªÂÙ·‚ÔϤ˜ ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ HDL Û ‰È¿ÊÔÚ˜ ÌÂϤÙ˜ ˘ÔÏÈȉ·ÈÌÈ΋˜ ıÂÚ·›·˜.

a

b

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£EPA¶EIA – ºAPMAKA µÈ‚ÏÈÔÁÚ·Ê›· 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17.

18. 19. 20. 21. 22.

JAMA 1993 269, 3015-3023. JAMA 2001 285, 2486-2497. Ehnholm C, et al. N Engl J Med 1982 307, 850-855. Arntzenius AC, et al. N Engl J Med 1985 312, 805-811. Ornish D, et al. Lance, 1990 336, 129-133. Kolovou G, et al. Coronary Arter Dis 1994 5, 359-364. Kolovou G, et al. Am J Cardio 2003 92, 1339-1342. Maki KC, et al. Am J Clin Nut 2001 74, 33-43. Knopp, et al. Proc Soc Exp Biol Me 2000 225, 191-199. Watts GF, et al. Lancet 1992 339, 563569. Obarzanek E, et al. Am J Clin Nutr 2001 74, 80-89. Azen SP, et al. Circulation 1996 93, 34-41. Lancet 2001 357, 905-910. Todd PA, et al. Drugs 1988 36, 314-39. Circulation 2000 102, 21-27. Frick MH, et al. N Engl J Med, 1987 317, 1237-1245. Walldius G et al. Affecting Lipid Metabolism VIII Drugs. New York: Plenum Publishing Corporation; 1985; 281-293. Carlson LA. Treatment of Hyperlipoproteinemia. Raven Press; 1984; 115. Blum CB, et al. JAMA 1989 261, 35823587. Canner PL, et al. J Am Coll Cardiol 1986 8, 1245-1255. J Am Med Assoc 1975 231, 360-381. Tat_ F, et al. Am J Cardiol 1998 81, 805808.

23. Superko HR, et al. Atherosclerosis 1992 95, 69-76. 24. Kolovou G, Am J Cardiol 1995 75, 293295. 25. Smith SC. Am J Cardiol 2000 85(12A), 1E-2E. 26. Kolovou G. Curr Med Res Opin 2001 17, 34-37. 27. Maron DJ, et al. Circulation 2000 101, 207-213. 28. The Scandinavian Simvastatin Survival Study Group. Lancet 1994 344, 13831389. 29. Waters D, et al. Circulation 1994 89, 959968. 30. Sacks FM, et al. N Engl J Med 1996 335, 1001-1009. 31. de Groot E, et al. J Am Coll Cardiol 1998 31, 1561-1567. 32. West of Scotland Coronary Prevention Study Group. Circulation 1998 97, 14401445. 33. Heart Protection Study Collaborative Group. Lancet 2002 360, 7-22. 34. Harrington RA. Curr Cardiol Rep 2004 6, 272. 35. Am J Cardiol 1995 76, 474-479. 36. Boden WE, Am J Cardiol 2000 85, 645650. 37. GottoAM Jr, et al. Circulation 2000 101, 477-484. 38. Downs JR, et al. Am J Cardio 1997 80, 287-293. 39. Ballantyne CM, et al. Circulation 1999 99, 736-743. 40. Gotto A Circulation 2001 103, 2213-2218. 41. Assmann G. Am J Cardiol 2001 87, 2B-

7B. 42. Mikhailidis DP, et al. Curr Med Res Opin 2000 16, 139-146. 43. de Lorgeril M, et al. Circulation 1999 99, 779-785. 44. Manttari M, et al. Eur Heart J 1987 8, I1I29. 45. Steiner G. et al. Diabetologia 1996 39, 1655-1661. 46. Rubins HB, et al. N Engl J Med 1999 341, 410-418. 47. Sakai T, et al. Arteriosclerosis, Thrombosis, and Vascular Biology 2001 21, 17831789. 48. Cheung M, et al. Arteriosclerosis, Thrombosis, and Vascular Biology 2001 21, 1320-1326. 49. Sacks FM, et al. Am J Cardiol 1991 68, 1436-1446. 50. Shepherd J, et al. N Engl J Med 1995 333, 1301-1307. 51. Lancet, 1995 345, 1274-1275. 52. Bruschke J, et al. Circulation 1995 91, 2528-2540. 53. Herd JA, et al. Am J Cardiol 1994 73, 42D-49D. 54. N Engl J Med 1998 339, 1349-1357. 55. Schwartz GG, et al. JAMA 2001 285, 1711-1718. 56. Shepherd J, et al. Lancet 2002 360, 1623-1630. 57. Colhoun HM, et al. Diabet Med 2002 19, 201-211. 58. Sever PS, et al. Lancet 2003 61, 11491158. 59. McKenney JM, et al. Curr Med Res Opin 2003 19, 689-698.

∂›‰Ú·ÛË Ù˘ ıÂÚ·›·˜ Ì ÛÙ·Ù›Ó˜ ÛÙËÓ ÔÌÔÈÔÛÙ·Û›· ÙÔ˘ Ô˘ÚÈÎÔ‡ ÔͤԘ Û ·ÛıÂÓ›˜ Ì ÚˆÙÔ·ı‹ ˘ÂÚÏÈȉ·ÈÌ›· Milionis H, Kakafika A, Tsouli S, Athyros V, Seferiadis K, Elisaf M. Am Heart J 2004; 148: 635-640 ªÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ Ù· ·˘ÍË̤ӷ Â›‰· Ù˘ Ô˘ÚÈÎÔ‡ ÔͤԘ ·ÔÙÂÏÔ‡Ó ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË Î·Ú‰È·ÁÁÂȷ΋˜ ÓfiÛÔ˘. øÛÙfiÛÔ, ÔÈ ·ıÔÊ˘ÛÈÔÏÔÁÈÎÔ› Ì˯·ÓÈÛÌÔ› Ô˘ ‰È¤Ô˘Ó ÙË Û˘Û¯¤ÙÈÛË ÙÔ˘ Ô˘ÚÈÎÔ‡ ÔͤԘ Ì ÙË ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ ‰ÂÓ ¤¯Ô˘Ó Ï‹Úˆ˜ ‰È¢ÎÚÈÓÈÛı›. À¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ fiÙÈ Ë ¯ÔÚ‹ÁËÛË ˘ÔÏÈȉ·ÈÌÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, Î·È È‰È·›ÙÂÚ· Ù˘ Ê·ÈÓÔÊÈÌÚ¿Ù˘, ÌÂÈÒÓÂÈ Ù· Â›‰· Ô˘ÚÈÎÔ‡ ÔͤԘ. ∞ÓÙ›ıÂÙ·, Ô ·ÚÈıÌfi˜ ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ Û¯ÂÙÈο Ì ÙËÓ Â›‰Ú·ÛË ÙˆÓ ÛÙ·ÙÈÓÒÓ ÛÙ· Â›‰· ÙÔ˘ Ô˘ÚÈÎÔ‡ ÔͤԘ Â›Ó·È ÂÚÈÔÚÈṲ̂ÓÔ˜.

™ÎÔfi˜ Ù˘ ÌÂϤÙ˘: ∏ ÂÎÙ›ÌËÛË Ù˘ Â›‰Ú·Û˘ ÌÈ·˜ Ê˘ÛÈ΋˜ ÛÙ·Ù›Ó˘ (ÛÈÌ‚·ÛÙ·Ù›Ó˘) Î·È ÌÈ·˜ Û˘ÓıÂÙÈ΋˜ ÛÙ·Ù›Ó˘ (·ÙÔÚ‚·ÛÙ·Ù›Ó˘) ÛÙ· Â›‰· Ô˘ÚÈÎÔ‡ ÔͤԘ ÙÔ˘ ÔÚÔ‡ Û ·ÛıÂÓ›˜ Ì ÚˆÙÔ·ı‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·. ™¯Â‰È·ÛÌfi˜ Ù˘ ÌÂϤÙ˘: ªÂÏÂÙ‹ıËÎ·Ó 180 ·ÛıÂÓ›˜ Ì ÚˆÙÔ·ı‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·, ÔÈ ÔÔ›ÔÈ Ù˘¯·ÈÔÔÈ‹ıËÎ·Ó Ó· ¿ÚÔ˘Ó ·ÁˆÁ‹ ›Ù Ì ·ÙÔÚ‚·ÛÙ·Ù›ÓË 40 mg ËÌÂÚËÛ›ˆ˜ (52 ¿Ó‰Ú˜ Î·È 38 Á˘Ó·›Î˜, ËÏÈΛ·˜ 58,0±8,7 ÂÙÒÓ, BMI 27,7±4,0 kg/m2) ›Ù Ì ÛÈÌ‚·ÛÙ·Ù›ÓË 40 mg ËÌÂÚË-

Û›ˆ˜ (54 ¿Ó‰Ú˜ Î·È 36 Á˘Ó·›Î˜, ËÏÈΛ·˜ 58,6±9. ÂÙÒÓ, BMI 27,3± 4,4 kg/m2). ™Â fiÏ· Ù· ¿ÙÔÌ· Ù˘ ÌÂϤÙ˘ ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó ÔÈ ÏÈȉ·ÈÌÈΤ˜ Î·È ÔÈ ÌÂÙ·‚ÔÏÈΤ˜ ·Ú¿ÌÂÙÚÔÈ ÙÔ˘ ÔÚÔ‡ ÚÈÓ, 6 Î·È 12 ‚‰ÔÌ¿‰Â˜ ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ıÂÚ·›·˜ Ì ÛÙ·Ù›ÓË. ∂ÈÚfiÛıÂÙ·, Û ‰Â›ÁÌ· Ô‡ÚˆÓ ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó ÔÈ ÎÏ·ÛÌ·ÙÈΤ˜ ·ÂÎÎÚ›ÛÂȘ ÙÔ˘ Ó·ÙÚ›Ô˘ Î·È ÙÔ˘ Ô˘ÚÈÎÔ‡ ÔͤԘ. ∞ÔÙÂϤÛÌ·Ù·: ∆· Â›‰· ÙÔ˘ Ô˘ÚÈÎÔ‡ ÔͤԘ Û˘Û¯ÂÙ›˙ÔÓÙ·Ó ıÂÙÈο Ì ÙÔ ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜, Ì ٷ Â›Â-

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A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·14

·ıËÚÔÛÎÏ‹ÚˆÛË MAPTIO™ 2005

‰· Ù˘ ÈÓÛÔ˘Ï›Ó˘, Ù˘ ÎÚ·ÙÈÓ›Ó˘ Î·È ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ, Î·È ·ÚÓËÙÈο Ì ÙȘ Û˘ÁÎÂÓÙÚÒÛÂȘ Ù˘ HDL ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ÙȘ ÙÈ̤˜ Ù˘ ÎÏ·ÛÌ·ÙÈ΋˜ ·¤ÎÎÚÈÛ˘ ÙÔ˘ Ô˘ÚÈÎÔ‡ ÔͤԘ (FEUA). ∏ ¯ÔÚ‹ÁËÛË Â›Ù ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ ›Ù ÛÈÌ‚·ÛÙ·Ù›Ó˘ ‚ÂÏÙ›ˆÛ ÛËÌ·ÓÙÈο ÙȘ ÙÈ̤˜ ÙˆÓ ÏÈȉ›ˆÓ ÙÔ˘ ÔÚÔ‡ (™¯‹Ì· 1) Î·È ÚÔοÏÂÛ ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÙˆÓ ÙÈÌÒÓ ÙÔ˘ ÈÓˆ‰ÔÁfiÓÔ˘ Î·È Ù˘ C-·ÓÙȉÚÒÛ·˜ ÚˆÙ½Ó˘ (™¯‹Ì· 2). ∂›Ó·È ȉȷ›ÙÂÚ· ÂӉȷʤÚÔÓ ÙÔ Â‡ÚËÌ· fiÙÈ ÌfiÓÔ Ë ·ÙÔÚ‚·ÛÙ·Ù›ÓË Ì›ˆÛ ÛËÌ·ÓÙÈο Ù· Â›‰· ÙÔ˘ Ô˘ÚÈÎÔ‡ ÔͤԘ ÙÔ˘ (·fi 5,6±1,7 Û 4,9±1,5 mg/dl, p<0,0001) Î·È ·‡ÍËÛ ÛËÌ·ÓÙÈο ÙȘ ÎÏ·ÛÌ·ÙÈΤ˜ ·ÂÎÎÚ›ÛÂȘ ÙÔ˘ Ó·ÙÚ›Ô˘ (·fi 1,0±0,6 Û 1.4±0,7, p<0,01) Î·È ÙÔ˘ Ô˘ÚÈÎÔ‡ (·fi 10,4±7,9 Û 12,0±7,4, p<0,01) (™¯‹Ì· 3). ™Â ÔÏ˘·Ú·ÁÔÓÙÈ΋ ·Ó¿Ï˘ÛË ÏÔÁÈÛÙÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘ (multivariate logistic regression analysis), ÂÍÂÙ¿ÛıËÎ·Ó ÔÈ ÌÂÙ·‚ÏËÙ¤˜ Ô˘ ‰˘ÓËÙÈο ÌÔÚÔ‡Ó Ó· ÚÔηϤÛÔ˘Ó Ì›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙÔ˘ Ô˘ÚÈÎÔ‡ ÔͤԘ Ù˘ ٿ͈˜ ÙˆÓ 0,2 mg/dl ‹ ÂÚÈÛÛfiÙÂÚÔ. √È ÌÂÙ·‚ÏËÙ¤˜ Ô˘ Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó ÛÙÔ ÛÙ·ÙÈÛÙÈÎfi ÌÔÓÙ¤ÏÔ ‹Ù·Ó Ë ËÏÈΛ·, ÙÔ Ê‡ÏÔ, Ô ‰Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜, Ë ·ÚÔ˘Û›· ˘¤ÚÙ·Û˘, Ù· ·Ú¯Èο Â›‰· ÙÔ˘ Ô˘ÚÈÎÔ‡ ÔͤԘ, ηıÒ˜ Î·È ÔÈ ÌÂÙ·‚ÔϤ˜ Ù˘ ÎÚ·ÙÈÓ›Ó˘ Ù˘ ÁÏ˘Îfi˙˘, Ù˘ ÈÓÛÔ˘Ï›Ó˘ Î·È ÙˆÓ ÏÈȉ·ÈÌÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ ÌÂÙ¿ ÙË ıÂÚ·›· Ì ·ÙÔÚ‚·ÛÙ·Ù›ÓË. ∆· ·Ú¯Èο Â›‰· ÙÔ˘ Ô˘ÚÈÎÔ‡ ÔͤԘ ÙÔ˘ ÔÚÔ‡ ‹Ù·Ó Ë ÌÔÓ·‰È΋ ·ÓÂÍ¿ÚÙËÙË ·Ú¿ÌÂÙÚÔ˜ Ô˘ Û˘Û¯ÂÙ›˙ÔÓÙ·Ó Ì ÙËÓ ˘ÔÔ˘Úȯ·ÈÌÈ΋ ‰Ú¿ÛË Ù˘ ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ (odds ratio, OR = 1,65, 95% CI = 1,142,40, p=0,008). ™˘Ì¤Ú·ÛÌ·: ∏ ¯ÔÚ‹ÁËÛË ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ (Î·È fi¯È ÛÈÌ‚·ÛÙ·Ù›Ó˘) Û ˘„ËÏ‹ ‰fiÛË ÚÔηÏ› ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙÔ˘ Ô˘ÚÈÎÔ‡ ÔͤԘ ÙÔ˘ ÔÚÔ‡ ·˘Í¿ÓÔÓÙ·˜ ÙËÓ ·¤ÎÎÚÈÛ‹ ÙÔ˘. ∞˘Ù‹ Ë È‰ÈfiÙËÙ· Ù˘ ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ Â›Ó·È È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈ΋ ÛÙËÓ ÂÈÏÔÁ‹ Ù˘ ˘ÔÏÈȉ·ÈÌÈ΋˜ ·ÁˆÁ‹˜ ÁÈ· ÙË ıÂÚ·›· ˘ÂÚÏÈȉ·ÈÌÈÎÒÓ ·ÛıÂÓÒÓ Ì ·˘ÍË̤ӷ Â›‰· Ô˘ÚÈÎÔ‡ ÔͤԘ.

14

∞ÔÙÂϤÛÌ·Ù· Ù˘ ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ Î·È Ù˘ ÛÈÌ‚·ÛÙ·Ù›Ó˘ ÛÙȘ ÏÈȉ·ÈÌÈΤ˜ ·Ú·Ì¤ÙÚÔ˘˜ ·ÛıÂÓÒÓ Ì ÚˆÙÔ·ı‹ ˘ÂÚÏÈȉ·ÈÌ›·

∞ÙÔÚ‚·ÛÙ·Ù›ÓË 40 mg/ËÌÂÚ.

™ÈÌ‚·ÛÙ·Ù›ÓË 40 mg/ËÌÂÚ.

¶ÚÈÓ ÙËÓ ·ÁˆÁ‹ 6 ‚‰ÔÌ¿‰Â˜ 12 ‚‰ÔÌ¿‰Â˜

∞ÔÙÂϤÛÌ·Ù· Ù˘ ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ Î·È Ù˘ ÛÈÌ‚·ÛÙ·Ù›Ó˘ ÛÙ· Â›‰· ÙÔ˘ ÈÓˆ‰ÔÁfiÓÔ˘ Î·È Ù˘ C-·ÓÙȉÚÒÛ·˜ ÚˆÙÂ˚Ó˘ ·ÛıÂÓÒÓ Ì ÚˆÙÔ·ı‹ ˘ÂÚÏÈȉ·ÈÌ›· ∞ÙÔÚ‚·ÛÙ·Ù›ÓË 40 mg/ËÌÂÚ.

™ÈÌ‚·ÛÙ·Ù›ÓË 40 mg/ËÌÂÚ.

¶ÚÈÓ ÙËÓ ·ÁˆÁ‹ 6 ‚‰ÔÌ¿‰Â˜ 12 ‚‰ÔÌ¿‰Â˜

∞ÔÙÂϤÛÌ·Ù· Ù˘ ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ Î·È Ù˘ ÛÈÌ‚·ÛÙ·Ù›Ó˘ ÛÙ· Â›‰· ÙÔ˘ Ô˘ÚÈÎÔ‡ ÔͤԘ ÛÙÔÓ ÔÚfi (SUA) Î·È ÛÙËÓ ·¤ÎÎÚÈÛ‹ ÙÔ˘ ÛÙ· Ô‡Ú· (FEUA)

∞ÙÔÚ‚·ÛÙ·Ù›ÓË 40 mg/ËÌÂÚ.

™ÈÌ‚·ÛÙ·Ù›ÓË 40 mg/ËÌÂÚ.

¶ÚÈÓ ÙËÓ ·ÁˆÁ‹ 6 ‚‰ÔÌ¿‰Â˜ 12 ‚‰ÔÌ¿‰Â˜


A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·15

™Y°XPONE™ O¢H°IE™

™‡Á¯ÚÔÓ˜ ˘ÁÈÂÈÔÓԉȷÈÙËÙÈΤ˜ Ô‰ËÁ›Â˜ ÁÈ· ÙËÓ ÚfiÏË„Ë Ù˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘ ∏Ï›·˜ ÃÂÈÌÒÓ·˜, ∫·Ú‰ÈÔÏfiÁÔ˜ , ÀÔÙ¤Ú·Ú¯Ô˜ Â.·.

Âٷ͇ ÙˆÓ Ì¤ÙÚˆÓ Ô˘ Û˘ÓÈÛÙÔ‡Ó ÔÈ Û‡Á¯ÚÔÓ˜ Ô‰ËÁ›Â˜ ÁÈ· ÙËÓ ÚfiÏË„Ë ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ 1,2 Ë ˘ÁÈÂÈÓԉȷÈÙËÙÈ΋ ·ÁˆÁ‹ ·ÔÙÂÏ› ÙÔ ıÂ̤ÏÈÔ Ï›ıÔ. ∏ ·ÁˆÁ‹ ·˘Ù‹ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ Î·Ù¿ÏÏËÏË ‰›·ÈÙ·, ÙË ÛˆÌ·ÙÈ΋ ¿ÛÎËÛË, ÙËÓ ·ÒÏÂÈ· ‚¿ÚÔ˘˜ ·fi Ù· ˘¤Ú‚·Ú· ¿ÙÔÌ· Î·È ÙË ‰È·ÎÔ‹ ÙÔ˘ ηÓ›ÛÌ·ÙÔ˜. ∏ ÛËÌ·Û›· Ù˘ ‰›·ÈÙ·˜ ÁÈ· ÙËÓ ˘Á›· ÙÔ˘ ·ÓıÚÒÔ˘ ÁÂÓÈο ‹Ù·Ó ÁÓˆÛÙ‹ ·fi ÙËÓ ·Ú¯·ÈfiÙËÙ·, Ë Û¯¤ÛË fï˜ Ù˘ ‰È·ÙÚÔÊ‹˜ Ì ٷ Â›‰· ÙˆÓ ÏÈȉ›ˆÓ ÙÔ˘ ·›Ì·ÙÔ˜, ÙËÓ ·ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË Î·È Ù· ηډȷÁÁÂȷο ÓÔÛ‹Ì·Ù· ¤ÁÈÓ ηٷÓÔËÙ‹ ÙȘ ÙÂÏÂ˘Ù·›Â˜ ‰ÂηÂٛ˜, ÌÂÙ¿ ·fi ÔÏϤ˜ ÂȉËÌÈÔÏÔÁÈΤ˜, ÂÈÚ·Ì·ÙÈΤ˜ Î·È ÎÏÈÓÈΤ˜ ÌÂϤÙ˜. ∏ ÌÂϤÙË ÙˆÓ 7 ¯ˆÚÒÓ ¤‰ÂÈÍ fiÙÈ Ô ÂÈÔÏ·ÛÌfi˜ Î·È Ë ıÓËÛÈÌfiÙËÙ· ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ Û οı ÏËı˘ÛÌfi Â›Ó·È ·Ó¿ÏÔÁ· ÙÔ˘ ‡„Ô˘˜ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ÛÙÔ ·›Ì· Î·È fiÙÈ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔ ÔÛÔÛÙfi ÙˆÓ ÎÔÚÂÛÌ¤ÓˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ Ù˘ ÙÚÔÊ‹˜3. ∞ÚÎÂÙ¤˜ ÌÂÙ·-·Ó·Ï‡ÛÂȘ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ÁÈ· οı 1% ·‡ÍËÛË ÙÔ˘ ÔÛÔÛÙÔ‡ ÙˆÓ ıÂÚÌ›‰ˆÓ Û ÎÔÚÂṲ̂ÓÔ Ï›Ô˜ Ô‰ËÁ› Û ·‡ÍËÛË Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ ηٿ 2%4. ÕÏϘ ÌÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ë Ì›ˆÛË Ù˘ ηٷӿψÛ˘ ÎÔÚÂÛÌ¤ÓˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ ηٿ 1% ÚÔηÏ› Ì›ˆÛË Ù˘ LDL ηٿ 2%. ∞ÎfiÌË Î·È ÛÙ· ·È‰È¿ Ë Ì›ˆÛË ÙˆÓ ÎÔÚÂÛÌ¤ÓˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ ‰ÂÓ ¤¯ÂÈ ‰˘ÛÌÂÓ‹ Â›‰Ú·ÛË ÛÙËÓ ·Ó¿Ù˘ÍË. √È Û˘ÛÙ¿ÛÂȘ ÙˆÓ ∂˘Úˆ·˚ÎÒÓ Ô‰ËÁÈÒÓ ÁÈ· ÙË ‰›·ÈÙ· ÂÚÈÏËÙÈο Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1. √È Û˘ÛÙ¿ÛÂȘ ÙˆÓ ∞ÌÂÚÈοÓÈÎˆÓ Ô‰ËÁÈÒÓ (NCEP - ATP III) ÁÈ· ÙË ‰›·ÈÙ· ÂÚÈÏËÙÈο Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2. ∏ ÛÔ˘‰·ÈfiÙÂÚË ËÁ‹ ÎÔÚÂÛÌ¤ÓˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ Â›Ó·È Ù· Á·Ï·ÎÙÔÎÔÌÈο ÚÔ˚fiÓÙ· (Ï‹Ú˜ Á¿Ï·, Ù˘Ú› ‚Ô‡Ù˘ÚÔ, Îڤ̷ Á¿Ï·ÎÙÔ˜ Î·È ·Ú·Û΢¿ÛÌ·Ù· Îڤ̷˜ Á¿Ï·ÎÙÔ˜ fiˆ˜ ·ÁˆÙ¿, ÁÏ˘-

ª

¶›Ó·Î·˜ 1. ™‡ÛÙ·ÛË Ù˘ ‰›·ÈÙ·˜ Û ÏËı˘ÛÌÈ·Îfi Â›‰Ô. ·. πÛ¯˘Ú¤˜ ÂӉ›ÍÂȘ Î·È ÌÂÁ¿ÏÔ fiÊÂÏÔ˜ ÁÈ· ÙËÓ ‰ËÌfiÛÈ· ˘Á›·. 1. ∫ÔÚÂṲ̂ӷ Î·È trans ÏÈ·Ú¿ Ôͤ· ñ ∫¿Ùˆ ÙˆÓ 10% ÙˆÓ ıÂÚÌ›‰ˆÓ Û ÎÔÚÂṲ̂ÓÔ Ï›Ô˜ ñ ∫¿Ùˆ ÙÔ˘ 2% ÙˆÓ ıÂÚÌ›‰ˆÓ Û trans ÏÈ·Ú¿ Ôͤ· 2. ºÚÔ‡Ù· Î·È Ï·¯·ÓÈο ñ ¶¿Óˆ ·fi 400 gr/ËÌÂÚËÛ›ˆ˜ 3. ∞Ï¿ÙÈ ñ §ÈÁfiÙÂÚÔ ·fi 6 gr/ËÌÂÚËÛ›ˆ˜ 4. ¶·¯˘Û·ÚΛ· Î·È ˘ÂÚ‚¿ÏÏÔÓ ÛˆÌ·ÙÈÎfi ‚¿ÚÔ˜ ñ ¢ª™ < 25 kg/m2 ñ ∂º¢ ¿Óˆ ·fi 1,75* ‚. ∂Ӊ›ÍÂȘ ̤ÙÚȘ Î·È Ì¤ÙÚÈÔ fiÊÂÏÔ˜ ÁÈ· ÙË ‰ËÌfiÛÈ· ˘Á›· 5. √ÏÈÎfi Ï›Ô˜ ñ ∫¿Ùˆ ÙˆÓ 30% ÙˆÓ ÚÔÛÏ·Ì‚·ÓÔÌ¤ÓˆÓ ıÂÚÌ›‰ˆÓ 6. ¶ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ· ñ ˆ-6 ÔÏ˘·ÎfiÚÂÛÙ·: 4-8% ÙˆÓ ıÂÚÌ›‰ˆÓ ñ ˆ-3 ÔÏ˘·ÎfiÚÂÛÙ·: 2 gr/ËÌÂÚ. ÏÈÓÔÏÂÓÈÎfi Î·È 200 mg/ËÌÂÚ. ˆ-3 ÏÈ·ÚÒÓ ÔͤˆÓ Ôχ Ì·ÎÚ¿˜ ·Ï‡ÛÔ˘. Á. ∞ÛıÂÓ›˜ ÂӉ›ÍÂȘ Î·È ÌÈÎÚfi fiÊÂÏÔ˜ ÁÈ· ÙËÓ ‰ËÌfiÛÈ· ˘Á›· 7. º˘ÙÈΤ˜ ›Ó˜ ¿Óˆ ·fi 25 gr/ËÌÂÚ Î·È ¿Óˆ ·fi 55% ÙˆÓ ıÂÚÌ›‰ˆÓ Û‡ÌÏÔÎÔÈ ˘‰·Ù¿ÓıڷΘ 8. º˘ÏÏÈÎfi Ô͇ Ì ÙȘ ÙÚÔʤ˜ ¿Óˆ ·fi 400 Ìg/ËÌÂÚ. 9. ™·Î¯·ÚÒ‰ÂȘ ÙÚÔʤ˜ Ù¤ÛÛÂÚȘ ‹ ÏÈÁfiÙÂÚ˜ 2 ÊÔÚ¤˜ ÙËÓ Ë̤ڷ * ∂º¢ §fiÁÔ˜ ÙÔ˘ ÔÛÔ‡ ÙˆÓ ÚÔÛÏ·Ì‚·ÓÔÌ¤ÓˆÓ ıÂÚÌ›‰ˆÓ ÚÔ˜ ÙÔ ‚·ÛÈÎfi ÌÂÙ·‚ÔÏÈÛÌfi ÙÔ˘ ·ÙfiÌÔ˘. 1,75 ∂º¢ Â›Ó·È ÈÛÔ‰‡Ó·ÌÔ Ì 60 ÏÂÙ¿ ÙËÓ Ë̤ڷ ̤ÙÚÈ·˜ ¿ÛÎËÛ˘ ‹ 30 ÏÂÙ¿ ¤ÓÙÔÓ˘ ¿ÛÎËÛ˘.

ο Î.Ï), ÙÔ ÎÚ¤·˜ Î·È ·Ú¿ÁˆÁ· ÙÔ˘ (ÏÔ˘Î¿ÓÈη, ÎÈÌ¿˜ Î.Ï) Î·È ÔÚÈṲ̂ӷ ÙÚÔÈο ¤Ï·È·, fiˆ˜ ÙÔ ÊÔÈÓÈΤϷÈÔ. ∆Ô Â˘ÓÔ˚Îfi ·ÔÙ¤ÏÂÛÌ· Ù˘ ÌÂȈ̤Ó˘ ÚfiÛÏ˄˘ ÎÔÚÂÛÌ¤ÓˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ ÌÔÚ› Ó· ÂÓÈÛ¯˘ı› fiÙ·Ó Û˘Óԉ‡ÂÙ·È ·fi Ì›ˆÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜ ÛÙ· ˘¤Ú‚·Ú· ¿ÙÔÌ·. ¶Ú¿ÁÌ·ÙÈ Ì›ˆÛË ÙÔ˘ ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜, ·ÎfiÌË Î·È Ï›Á· ÎÈÏ¿, ÚÔηÏ› Ì›ˆÛË Ù˘ LDL ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ Û‡ÛÙ·ÛË Ù˘ ÙÚÔÊ‹˜. ∞Ó fï˜ Ë ÙÚÔÊ‹ Â›Ó·È ¯·ÌËÏ‹ Û ÏÈ·Ú¿ Ôͤ· Ë Ì›ˆÛË Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË Î·È ‰È·ÚΤÛÙÂÚË. ∆· trans-ÏÈ·Ú¿ Ôͤ· Â›Ó·È ·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ· Ì ‰ÈÏÔ‡˜ ‰ÂÛÌÔ‡˜ transÌÔÚÊ‹˜. µÚ›ÛÎÔÓÙ·È ÛÙȘ Ê˘ÛÈΤ˜ ÙÚÔʤ˜ (ÎÚ¤·˜, Á·Ï·ÎÙÔÎÔÌÈο), ΢ڛˆ˜ fï˜ ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È Î·Ù¿ ÙË ‚ÈÔÌ˯·ÓÈ΋ ÂÂÍÂÚÁ·Û›·

ÙˆÓ ÙÚÔʛ̈Ó, fiˆ˜ Ë ˘‰ÚÔÁfiÓˆÛË ÔÏ˘·ÎfiÚÂÛÙˆÓ Ê˘ÙÈÎÒÓ ÂÏ·›ˆÓ Ì ÛÎÔfi Ó· ÌÂÙ·‚ÏËıÔ‡Ó Û ÛÙÂÚ¿ Î·È Ó· ˘ÔηٷÛÙ‹ÛÔ˘Ó ÙÔ ‚Ô‡Ù˘ÚÔ. ÃÚËÛÈÌÔÔÈÔ‡ÓÙ·È Û ۿÏÙÛ˜, ÌÈÛÎfiÙ· Î·È Û ÙËÁ·ÓÈṲ̂Ó˜ ÙÚÔʤ˜. Œ¯ÂÈ ‰È·ÈÛÙˆı› fiÙÈ ·˘Ù¿ Ù· ÏÈ·Ú¿ Ôͤ· ·˘Í¿ÓÔ˘Ó ÙËÓ LDL-¯ÔÏËÛÙÂÚfiÏË fiÛÔ Î·È Ù· ÎÔÚÂṲ̂ӷ Î·È ÌÂÈÒÓÔ˘Ó ÙËÓ HDL¯ÔÏËÛÙÂÚfiÏË. √È ÛÎÏËÚ¤˜ Ì·ÚÁ·Ú›Ó˜ Î·È ÙÚÔʤ˜ ·Ú·Û΢·Ṳ̂Ó˜ (ÙËÁ·ÓÈṲ̂Ó˜ ‹ „Ë̤Ó˜) Ì trans-ÏÈ·Ú¿ Ôͤ· Ú¤ÂÈ Ó· ·ÔʇÁÔÓÙ·È, ÂÎÙfi˜ Â¿Ó ÛÙË Û˘Û΢·Û›· ÙÔ˘˜ ·Ó·Ê¤ÚÔ˘Ó fiÙÈ Â›Ó·È ÂχıÂÚ˜ ·fi Ù¤ÙÔÈ· ÏÈ·Ú¿ Ôͤ·. ∏ ¯ÔÏËÛÙÂÚfiÏË Ù˘ ÙÚÔÊ‹˜ ÚÔηÏ› ÛËÌ·ÓÙÈ΋ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· Û ÂÈÚ·Ì·Ùfi˙ˆ·. ™ÙÔÓ ¿ÓıÚˆÔ Â›Û˘ ·˘Í¿ÓÂÈ ÙË

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A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·16

·ıËÚÔÛÎÏ‹ÚˆÛË MAPTIO™ 2005

¶›Ó·Î·˜ 2. ∫‡ÚÈ· Û˘ÛÙ·ÙÈο Ù˘ ‰È·ÙÚÔÊ‹˜ ÛÙËÓ ˘ÁÈÂÈÓԉȷÙËÙÈ΋ ·ÁˆÁ‹. ñ ñ ñ ñ ñ ñ ñ ñ ñ

∫ÔÚÂṲ̂ӷ Ï›Ë < 7% ÙˆÓ Û˘ÓÔÏÈÎÒÓ ıÂÚÌ›‰ˆÓ* ¶ÔÏ˘·ÎfiÚÂÛÙ· Ï›Ë Ì¤¯ÚÈ ÙÔ 10% ÙˆÓ Û˘ÓÔÏÈÎÒÓ ıÂÚÌ›‰ˆÓ ªÔÓÔ·ÎfiÚÂÛÙ· Ï›Ë Ì¤¯ÚÈ ÙÔ 20% ÙˆÓ Û˘ÓÔÏÈÎÒÓ ıÂÚÌ›‰ˆÓ ™˘ÓÔÏÈÎfi Ï›Ô˜ 25% - 35% ÙˆÓ Û˘ÓÔÏÈÎÒÓ ıÂÚÌ›‰ˆÓ À‰·Ù¿ÓıڷΘ 50% - 60% ÙˆÓ Û˘ÓÔÏÈÎÒÓ ıÂÚÌ›‰ˆÓ# º˘ÙÈΤ˜ ›Ó˜ 20 – 30 gr/ËÌÂÚ. §Â˘ÎÒÌ·Ù· ÂÚ›Ô˘ 15% ÙˆÓ Û˘ÓÔÏÈÎÒÓ ıÂÚÌ›‰ˆÓ ÃÔÏËÛÙÂÚfiÏË < 200 gr/ËÌÂÚ. ™˘ÓÔÏÈΤ˜ ıÂÚÌ›‰Â˜+ πÛÔÚÚÔ›· ÌÂٷ͇ ÚÔÛÏ·Ì‚·ÓÔÌ¤ÓˆÓ Î·È Î·Ù·Ó·ÏÈÛÎÔÌ¤ÓˆÓ ıÂÚÌ›‰ˆÓ ÁÈ· ·fiÎÙËÛË Î·È ‰È·Ù‹ÚËÚÛË ÂÈı˘ÌËÙÔ‡ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜/·ÔÊ˘Á‹ ˘ÂÚ‚¿ÏÏÔÓÙÔ˜ ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜

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∆· trans-ÏÈ·Ú¿ Ôͤ· ·˘Í¿ÓÔ˘Ó ÙËÓ LDL Î·È Ú¤ÂÈ Ó· ηٷӷÏÒÓÔÓÙ·È fiÛÔ ÙÔ ‰˘Ó·Ùfi ÏÈÁfiÙÂÚÔ # √È ˘‰·Ù¿ÓıڷΘ Ú¤ÂÈ Ó· ÚÔ¤Ú¯ÔÓÙ·È Î·Ù¿ ·ÚÈÔ ÏfiÁÔ ·fi ÙÚÔʤ˜ ÏÔ‡ÛȘ Û ۇÌÏÔÎÔ˘˜ ˘‰·Ù¿ÓıڷΘ, fiˆ˜ ‰ËÌËÙÚȷο, ÊÚÔ‡Ù· Î·È Ï·¯·ÓÈο + ™ÙȘ ËÌÂÚ‹ÛȘ η‡ÛÂȘ ıÂÚÌ›‰ˆÓ Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÙ·È ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì¤ÙÚÈ· ۈ̷ÙÈ΋ ¿ÛÎËÛË (200 kcal/ËÌÂÚ)

¯ÔÏËÛÙÂÚfiÏË ÙÔ˘ ·›Ì·ÙÔ˜, fi¯È fï˜ Û ÌÂÁ¿ÏÔ ‚·ıÌfi. √ ‚·ıÌfi˜ Ù˘ ·‡ÍËÛ˘ ÔÈΛÏÂÈ ·fi ¿ÙÔÌÔ Û ¿ÙÔÌÔ, ηٿ ̤ÛÔ fiÚÔ fï˜ ·Ó¤Ú¯ÂÙ·È Û 10 mg % ·Ó¿ 100 mg ‰È·ÈÙËÙÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ ·Ó¿ 1000 ıÂÚÌ›‰Â˜ ÙÚÔÊ‹˜. ÃÔÏËÛÙÂÚfiÏË ÂÚȤ¯ÂÈ Ô ÎÚfiÎÔ˜ ÙÔ˘ ·˘ÁÔ‡, Ù· ÏÈ·Ú¿ ÎÚ¤·Ù·, Ù· ÌË ·Ô‚Ô˘Ù˘ÚˆÌ¤Ó· Á·Ï·ÎÙÔÎÔÌÈο, Ù· Ô˘ÏÂÚÈο Î·È Ù· ÔÛÙÚ·ÎÔÂȉ‹ ı·Ï·ÛÛÈÓ¿. ∏ ËÌÂÚ‹ÛÈ· ÚfiÛÏË„Ë ¯ÔÏËÛÙÂÚfiÏ˘ Ú¤ÂÈ Ó· Â›Ó·È Î¿Ùˆ ·fi Ù· 200-300 mg, Ú¿ÁÌ· Ô˘ ÛËÌ·›ÓÂÈ fiÙÈ ‰ÂÓ Ú¤ÂÈ Ó· ηٷӷÏÒÓÔÓÙ·È ¿Óˆ ·fi ‰‡Ô ÎÚfiÎÔÈ ·˘ÁÔ‡ ÙËÓ Â‚‰ÔÌ¿‰·. ∆· ÌÔÓÔ·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ·, ΢ÚÈfiÙÂÚÔ˜ ÂÎÚfiÛˆÔ˜ ÙˆÓ ÔÔ›ˆÓ Â›Ó·È ÙÔ ÔÏÂ˚Îfi Ô͇ Ô˘ ··ÓÙ¿Ù·È ÛÙË cis ÌÔÚÊ‹, ÌÂÈÒÓÔ˘Ó ÙËÓ LDL-¯ÔÏËÛÙÂÚfiÏË ¯ˆÚ›˜ Ó· ÌÂÈÒÓÔ˘Ó ÙËÓ HDL-¯ÔÏËÛÙÂÚfiÏË Î·È ¯ˆÚ›˜ Ó· ·˘Í¿ÓÔ˘Ó Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È·. ™˘ÓÈÛÙ¿Ù·È Ó· ηٷӷÏÒÓÔÓÙ·È Ì¤¯ÚÈ ÙÔ 20% ÙˆÓ Û˘ÓÔÏÈÎÒÓ ıÂÚÌ›‰ˆÓ. ∫‡ÚÈ· ËÁ‹ ÙÔ˘ ÔÏÂ˚ÎÔ‡ ÔͤԘ Â›Ó·È ÙÔ ÂÏ·ÈfiÏ·‰Ô, ÙÔ ÔÔ›Ô ÂÚȤ¯ÂÈ Â›Û˘ ·ÓÙÈÔÍÂȉˆÙÈΤ˜ Ô˘Û›Â˜ Î·È ‚Èٷ̛Ә Î·È ¤ÙÛÈ ¤¯ÂÈ ÌÂÁ·Ï‡ÙÂÚË Â˘ÂÚÁÂÙÈ΋ ‰Ú¿ÛË. ÕÏϘ ËÁ¤˜ ÌÔÓÔ·ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ Â›Ó·È ÔÈ ÍËÚÔ› ηÚÔ› Î·È Ê˘ÙÈο ¤Ï·È·. ∆· ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ·, ΢ÚÈfiÙÂÚÔ˜ ÂÎÚfiÛˆÔ˜ ÙˆÓ ÔÔ›ˆÓ Â›Ó·È ÙÔ ˆ-6 ÏÈÓÔÏÂ˚Îfi Ô͇, ÌÂÈÒÓÔ˘Ó ÙËÓ LDL-¯ÔÏËÛÙÂÚfiÏË ·ÏÏ¿ ÌÔÚÔ‡Ó Ó· ÚÔηϤÛÔ˘Ó Î·È ÌÈÎÚ‹ Ì›ˆÛË Ù˘ HDL-

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¯ÔÏËÛÙÂÚfiÏ˘ Î·È ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ. º·›ÓÂÙ·È fiÙÈ Ù· ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ· Â›Ó·È Â˘·›ÛıËÙ· ÛÙËÓ ÔÍ›‰ˆÛË. ¶·ÚfiÏ· ·˘Ù¿ ¤¯Ô˘Ó ¢ڤˆ˜ ÌÂÏÂÙËı› Î·È ¤¯ÂÈ ‰È·ÈÛÙˆı› fiÙÈ ÚÔηÏÔ‡Ó Ì›ˆÛË ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ. ™˘ÓÈÛÙ¿Ù·È Ó· ηٷӷÏÒÓÔÓÙ·È Ì¤¯ÚÈ ÙÔ 10% ÙˆÓ Û˘ÓÔÏÈÎÒÓ ËÌÂÚ‹ÛÈˆÓ ıÂÚÌ›‰ˆÓ. ∆· ˆ-3 ÏÈ·Ú¿ Ôͤ· Â›Ó·È ÔÏ˘·ÎfiÚÂÛÙ· Î·È ÂÚȤ¯ÔÓÙ·È Û ÔÚÈṲ̂ӷ Ê˘ÙÈο ¤Ï·È·, fiˆ˜ ÙÔ ÛÔÁ¤Ï·ÈÔ Î·È ÙÔ ÊÔ˘ÓÙÔ˘Î¤Ï·ÈÔ, ÛÙ· ÔÔ›· ·ÚÈÔ Û˘ÛÙ·ÙÈÎfi Â›Ó·È ÙÔ ·-ÏÈÓÔÏÂ˚Îfi Ô͇ Î·È ÛÙ· „¿ÚÈ·, ÛÙ· ÔÔ›· ΢ÚÈ·Ú¯Ô‡Ó ÙÔ ÂÈÎÔÛÈÂÓÙ·ÓÔ˚Îfi Î·È ÙÔ ‰ÔÎÔÛÔÂÍ·ÓÔ˚Îfi Ô͇. ∏ ̤ÙÚÈ· ηٷӿψÛË ˆ-3 ÏÈ·ÚÒÓ ÔͤˆÓ ÌÂÈÒÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ Ì¤Ûˆ ¢ÓÔ˚΋˜ ÙÚÔÔÔ›ËÛ˘ Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ Î·È Ù˘ ÊÏÂÁÌÔÓÒ‰Ô˘˜ ·fiÎÚÈÛ˘5. ªÂÁ·Ï‡ÙÂÚË Î·Ù·Ó¿ÏˆÛË ÚÔηÏ› Ì›ˆÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ‰Â˘ÙÂÚÔÁÂÓÒ˜ ÏfiÁˆ Ì›ˆÛ˘ Ù˘ ·Ú·ÁˆÁ‹˜ VLDL. ™ÙËÓ LDL ÁÂÓÈο ‰ÂÓ ÂÈʤÚÔ˘Ó ÌÂÙ·‚ÔÏ‹ ·ÏÏ¿ Û ÌÂÁ¿Ï˜ ‰fiÛÂȘ ÌÔÚ› Ó· ÙËÓ ·˘Í‹ÛÔ˘Ó ÛÙ· ¿ÙÔÌ· Ì ˘„ËÏ¿ ÙÚÈÁÏ˘ÎÂÚ›‰È·. ∆Ô Û˘ÓÔÏÈÎfi Ï›Ô˜ ÙˆÓ ıÂÚÌ›‰ˆÓ Ú¤ÂÈ Ó· ·ÔÙÂÏ› ÙÔ 25%35% ÙˆÓ Û˘ÓÔÏÈÎÒÓ ËÌÂÚ‹ÛÈˆÓ ıÂÚÌ›‰ˆÓ. √È ·Ï·ÈfiÙÂÚ˜ Ô‰ËÁ›Â˜ ÙÔ˘ ¡C∂ƒ (∞∆ƒ π Î·È ∞∆ƒ II) Û˘ÓÈÛÙÔ‡Û·Ó ÂÚÈÔÚÈÛÌfi ÙÔ˘ ÔÏÈÎÔ‡ Ï›Ô˘˜ Û ÏÈÁfiÙÂÚÔ ·fi ÙÔ 30% ÙˆÓ ËÌÂÚËÛ›ˆÓ ıÂÚÌ›‰ˆÓ,

‰È·ÈÛÙÒıËΠfï˜ fiÙÈ ·˘Ùfi ÌÔÚÔ‡Û ӷ ›¯Â ‰˘ÛÌÂÓ›˜ ÂȉڿÛÂȘ Û ÂÚÈÙÒÛÂȘ ÔÏ˘ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘, fiÔ˘ ¯ÔÚ‹ÁËÛË ˘‰·Ù·ÓıÚ¿ÎˆÓ Û ÔÛÔÛÙfi >60% ÚÔηÏ› ·‡ÍËÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ, ÌÂÙ·ÙÚÔ‹ ÙˆÓ LDL Û ÌÈÎÚ¿ Î·È ˘ÎÓ¿ ÌfiÚÈ·, Ì›ˆÛË Ù˘ ∏DL Î·È ·‡ÍËÛË Ù˘ ·ÓÙÔ¯‹˜ ÛÙËÓ ÈÓÛÔ˘Ï›ÓË. ¶·Ï·ÈfiÙÂÚ˜ ·fi„ÂȘ fiÙÈ ·‡ÍËÛË ÙÔ˘ ÔÛÔÛÙÔ‡ ÙÔ˘ Ï›Ô˘˜ Ù˘ ÙÚÔÊ‹˜ ÚÔηÏ› ·¯˘Û·ÚΛ· ‰ÂÓ ÂȂ‚·ÈÒıËηÓ. ∞ÓÙ›ıÂÙ· ηٷӿψÛË ˘‰·Ù·ÓıÚ¿ÎˆÓ Û ÔÛÔÛÙfi >60% Ô‰ËÁ› Û ·¯˘Û·ÚΛ·. √È ˘‰·Ù¿ÓıڷΘ, fiÙ·Ó ·ÓÙÈηıÈÛÙÔ‡Ó Ù· ÎÔÚÂṲ̂ӷ ÏÈ·Ú¿ Ôͤ· Ù˘ ÙÚÔÊ‹˜ ÚÔηÏÔ‡Ó ÙÒÛË Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ fiÛË ÚÔηÏÔ‡Ó Î·È Ù· ÌÔÓÔ·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ·. ŸÌˆ˜ ÚÔηÏÔ‡Ó Î·È ÙÒÛË Ù˘ ∏DL-¯ÔÏËÛÙÂÚfiÏ˘ Î·È ¿ÓÔ‰Ô ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ. ŸÙ·Ó ‚¤‚·È· ηٷӷÏÒÓÔÓÙ·È Ì·˙› ÌÂ Ê˘ÙÈΤ˜ ›Ó˜ Ë ÙÒÛË Ù˘ ∏DL Î·È Ë ·‡ÍËÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ÌÂÙÚÈ¿˙ÔÓÙ·È. À‰·Ù¿ÓıڷΘ Â›Ó·È Ù· ¿Ì˘Ï· Î·È Ù· ۿί·Ú· Î·È ˘¿Ú¯Ô˘Ó Û ÔÏϤ˜ ÙÚÔʤ˜, ΢ڛˆ˜ Ê˘ÙÈΤ˜ fiˆ˜ Ù· ‰ËÌËÙÚȷο, Ù· fiÛÚÈ·, Ù· Ï·¯·ÓÈο, Ù· ÁÂÒÌËÏ· Î.Ï. ∂ӉȷʤÚÔÓ ¤¯ÂÈ Ô ÁÏ˘Î·ÈÌÈÎfi˜ ‰Â›ÎÙ˘ οı ÙÚÔÊ‹˜, ÂÂȉ‹ ÚÔÛ‰ÈÔÚ›˙ÂÈ ÙËÓ ·‡ÍËÛË ÙÔ˘ ۷ί¿ÚÔ˘ ·›Ì·ÙÔ˜ Ô˘ Ë ÙÚÔÊ‹ ÚÔηÏ›, fï˜ Ô ˘ÔÏÔÁÈÛÌfi˜ ÙÔ˘ Â›Ó·È ÔχÏÔÎÔ˜ Î·È ‰‡ÛÎÔÏ· ˘ÔÏÔÁ›˙ÂÙ·È ÛÙËÓ Î·ıËÌÂÚÈÓ‹ Ú¿ÍË. √È Û‡ÌÏÔÎÔÈ ˘‰·Ù¿ÓıڷΘ ÌÂÁ¿Ï˘ ·Ï‡ÛÔ˘ Ô˘ ÂÚȤ¯ÔÓÙ·È ÛÙ· ‰ËÌËÙÚȷο ¤¯Ô˘Ó ÌÈÎÚfi ÁÏ˘Î·ÈÌÈÎfi ‰Â›ÎÙË ÂÓÒ Ù· ۿί·Ú· Î·È ÔÈ ·Ù¿Ù˜ ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÔ. ∆Ô „ˆÌ›, ÏfiÁˆ Ù˘ ˙‡ÌˆÛ˘ Î·È Ù˘ „‹Û˘, ·ÔÎÙ¿ ¯·ÌËÏfi ÁÏ˘Î·ÈÌÈÎfi ‰Â›ÎÙË6. ∏ ËÌÂÚ‹ÛÈ· ÚfiÛÏË„Ë ˘‰·Ù·ÓıÚ¿ÎˆÓ Ú¤ÂÈ Ó· ÂÚÈÔÚ›˙ÂÙ·È Û ÔÛÔÛÙfi οو ÙˆÓ 60% ÙˆÓ ıÂÚÌ›‰ˆÓ Î·È Û ¿ÙÔÌ· Ì ˘„ËÏ¿ ÙÚÈÁÏ˘ÎÂÚ›‰È· οو ÙˆÓ 50%. ∆· Ï¢ÎÒÌ·Ù· ‰ÂÓ ¤¯Ô˘Ó Â›‰Ú·ÛË ÛÙ· ÏÈ›‰È·. ∆· ˙ˆÈ΋˜ ÚÔ¤Ï¢Û˘ Ï¢ÎÒÌ·Ù· Â›Ó·È ˘„ËÏfiÙÂÚË ıÂÚÌȉÈ΋ ·Í›· ÁÈ·Ù› ÂÚȤ¯Ô˘Ó ·Ó·ÓÙÈηٿÛٷٷ ·ÌÈÓÔͤ·, ÂÚȤ¯ÔÓÙ·È fï˜ Û ÙÚfiÊÈÌ· Ô˘ ÂÚȤ¯Ô˘Ó Â›Û˘ ÎÔÚÂṲ̂ӷ Ï›Ë (ÎÚ¤·˜, Á·Ï·ÎÙÔÎÔÌÈο, ·˘Á¿) Î·È ·˘Ù¿ Ù· ÙÚfiÊÈÌ· ¯ÚÂÈ¿˙ÔÓÙ·È ÚÔÛÔ¯‹. ÷ÌËÏfiÙÂÚ˘ ÔÈfiÙËÙ·˜ Ï¢ÎÒÌ·Ù· ÂÚȤ¯ÔÓÙ·È ÛÂ Ê˘ÙÈΤ˜ ÙÚÔʤ˜ (fiÛÚÈ·, ‰ËÌËÙÚȷο). ∏ Û˘ÓÔÏÈ΋ ÔÛfiÙËÙ· ÏÂ˘ÎˆÌ¿-


A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·17

™Y°XPONE™ O¢H°IE™ ÙˆÓ Û˘ÓÈÛÙ¿Ù·È Ó· ·ÔÙÂÏ› ÙÔ 15% ÙˆÓ ËÌÂÚ‹ÛÈˆÓ ıÂÚÌ›‰ˆÓ. √È Ê˘ÙÈΤ˜ ›Ó˜ Â›Ó·È ÔÏ˘Û·Î¯·ÚÈÙȉÈΤ˜ ¿Ï˘ÛÛÔÈ (˘‰·Ù¿ÓıڷΘ) ÌË ·ÔÚÚÔÊ‹ÛÈ̘ fï˜. ¶ÂÚȤ¯ÔÓÙ·È Û ÔÏÏ¿ ÙÚfiÊÈÌ· Ê˘ÙÈ΋˜ ÚÔ¤Ï¢Û˘ (‚ÚÒÌË, Ê·ÛfiÏÈ·, ÊÚÔ‡Ù·). ∂›Ó·È ¯Ú‹ÛÈÌ· Û˘ÛÙ·ÙÈο Ù˘ ÙÚÔÊ‹˜, ΢ڛˆ˜ ÔÈ ‰È·Ï˘Ù¤˜ ·fi ·˘Ù¤˜ ÁÈ·Ù› ÂÌÔ‰›˙Ô˘Ó ÙËÓ ·ÔÚÚfiÊËÛË ÙˆÓ ÏÈÒÓ Î·È ÚÔηÏÔ‡Ó Ì›ˆÛË Ù˘ LDL. ∂›Û˘ ‰È¢ÎÔχÓÔ˘Ó ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÂÓÙ¤ÚÔ˘. ¶Ú¤ÂÈ Ó· ÚÔÛÏ·Ì‚¿ÓÔÓÙ·È Û ÔÛfiÙËÙ· ¿Óˆ ·fi 25 gr ÙËÓ Ë̤ڷ, ÂÎ ÙˆÓ ÔÔ›ˆÓ Ù· 510 gr Ú¤ÂÈ Ó· Â›Ó·È ‰È·Ï˘Ù¤˜. √È ‚Èٷ̛Ә Î·È Ù· ·ÓÙÈÔÍÂȉˆÙÈο ÙˆÓ ÙÚÔÊÒÓ Ê·›ÓÂÙ·È fiÙÈ ˆÊÂÏÔ‡Ó. ∆Ô Ê˘ÏÏÈÎfi Ô͇, Ë µ6 Î·È Ë µ12 ‰È·‰Ú·Ì·Ù›˙Ô˘Ó ÚfiÏÔ ÛÙÔ ÌÂÙ·‚ÔÏÈÛÌfi Ù˘ ÔÌÔ΢ÛÙ½Ó˘. ∆Ô Ê˘ÏÏÈÎfi Ô͇ Ú¤ÂÈ Ó· ÚÔÛÏ·Ì‚¿ÓÂÙ·È Î·ıËÌÂÚÈÓ¿ Û ÔÛfiÙËÙ˜ ·fi 400 ¤ˆ˜ 1000 ÌÈÎÚÔÁÚ·ÌÌ¿ÚÈ· Ì ÙËÓ ÙÚÔÊ‹, ‰ÂÓ ˘¿Ú¯Ô˘Ó fï˜ ÂӉ›ÍÂȘ Ô˘ Ó· ˘ÔÛÙËÚ›˙Ô˘Ó ÙËÓ Û˘ÌÏËڈ̷ÙÈ΋ ¯ÔÚ‹ÁËÛË. ∆Ô ›‰ÈÔ ÈÛ¯‡ÂÈ Î·È ÁÈ· ÙËÓ ‚ÈÙ·Ì›ÓË ∂, ÙÔ ·ÛÎÔÚ‚ÈÎfi Ô͇, ÙËÓ ‚-ηÚÔÙ¤ÓË Î·È ¿ÏÏ· ÔÍÂȉˆÙÈο fiˆ˜ Ù· ‚ÈÔÊÏ·‚ÈÓÔÂȉ‹, ÙÔ ÛÂÏ‹ÓÈÔ Î·È Ë Ô˘ÌÈÎÈÓfiÓË (Û˘Ó¤Ó˙˘ÌÔ Q10). ∂ȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ Û ÏËı˘ÛÌÔ‡˜ Î·È ÂÈÚ·Ì·ÙÈΤ˜ Û ˙Ò· ¤‰ÂÈÍ·Ó fiÙÈ Ë ÚfiÛÏË„Ë ÙˆÓ Ô˘ÛÈÒÓ ·˘ÙÒÓ ÚÔÛٷهÂÈ ·fi ÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË, ÔÈ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ fï˜ ÛÙÔ˘˜ ·ÓıÚÒÔ˘˜ ‰ÂÓ ¤‰ÂÈÍ·Ó ˆÊ¤ÏÂÈ· ·fi ÙË Û˘ÌÏËڈ̷ÙÈ΋ ¯ÔÚ‹ÁËÛË ÙÔ˘˜. ¢ÂÓ ÂËÚ¿˙Ô˘Ó ÙȘ ÙÈ̤˜ ÙˆÓ ÏÈȉ›ˆÓ, ÚÔÛÙ·ÙÂ‡Ô˘Ó fï˜ ÙËÓ LDL ·fi ÔÍ›‰ˆÛË. ∏ ̤ÙÚÈ· ÚfiÛÏË„Ë ÔÈÓÔÓ‡̷ÙÔ˜ (̤¯ÚÈ ÙÚ›· ÔÙ¿ ÙËÓ Ë̤ڷ ·fi ÙÔ˘˜ ¿Ó‰Ú˜ Î·È ¤Ó· Ì ÂÓ¿ÌÈÛ˘ ·fi ÙȘ Á˘Ó·›Î˜) Â›Ó·È Â˘ÂÚÁÂÙÈ΋ ÁÈ· ÙËÓ ÚfiÏË„Ë ı·Ó¿ÙˆÓ ηÈ

·ıËÚÔÛÎÏ‹ÚˆÛ˘. ªÂٷ͇ ÙˆÓ Ì˯·ÓÈÛÌÒÓ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ·Ô‰›‰ÂÙ·È Ë ˆÊ¤ÏÂÈ· Â›Ó·È Î·È Ë ·‡ÍËÛË Ù˘ HDL ÙËÓ ÔÔ›· ÙÔ ÔÈÓfiÓÂ˘Ì· ÂÈÙ˘Á¯¿ÓÂÈ. ¶ÚÔÛÔ¯‹ ¯ÚÂÈ¿˙ÂÙ·È fï˜ ÁÈ·Ù› ÌÂÁ·Ï‡ÙÂÚË Î·Ù·Ó¿ÏˆÛË ÔÈÓÔÓ‡̷ÙÔ˜ ÚÔηÏ› ·‡ÍËÛË Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘, ÙˆÓ ·ÁÁÂÈ·ÎÒÓ ÂÁÎÂÊ·ÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ Î·È ÙˆÓ ı·Ó¿ÙˆÓ. ™Â ¿ÙÔÌ· Ì ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉËÌ›· ÌÔÚ› ÙÔ ÔÈÓfiÓÂ˘Ì· Ó· ·˘Í‹ÛÂÈ Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È· ÂÚÈÛÛfiÙÂÚÔ Î·È Ó· ÚÔηϤÛÂÈ ·ÁÎÚ·ٛÙȉ·. ŸÏ˜ ÙȘ ··ÈÙ‹ÛÂȘ Ù˘ ·ÓˆÙ¤Úˆ ‰È·ÙÚÔÊ‹˜ ÌÔÚ› Ó· ÙȘ ÈηÓÔÔÈ‹ÛÂÈ Ë ªÂÛÔÁÂȷ΋ ‰›·ÈÙ·, fiˆ˜ ¤¯ÂÈ ÔÓÔÌ·Ûı› Ë ·Ú·‰ÔÛȷ΋ ‰›·ÈÙ· ÙˆÓ ªÂÛÔÁÂÈ·ÎÒÓ Ï·ÒÓ Î·È È‰›ˆ˜ ÙˆÓ ∂ÏÏ‹ÓˆÓ. √È ÔÛfiÙËÙ˜ Î·È Ë Û˘¯ÓfiÙËÙ· Ô˘ Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È Î¿ı ÙÚfiÊÈÌÔ Ê·›ÓÂÙ·È ÛÙËÓ ˘Ú·Ì›‰· Ù˘ ªÂÛÔÁÂȷ΋˜ ‰È·ÙÚÔÊ‹˜ Ô˘ ‰È·ÌÔÚÊÒıËΠ·fi Ì›· ÂÚ¢ÓËÙÈ΋ ÔÌ¿‰· ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ÙÔ˘ Harvard Ì ÛËÌ·ÓÙÈ΋ Û˘Ì‚ÔÏ‹ ·fi ŒÏÏËÓ˜ ÂÈÛÙ‹ÌÔÓ˜. ∏ ˘Ú·Ì›‰· ·˘Ù‹ ÚÔÛ·ÚÌfiÛıËΠÛÙ· ∂ÏÏËÓÈο ‰Â‰Ô̤ӷ ·fi ÙÔ ∞ÓÒÙ·ÙÔ ∂ȉÈÎfi ∂ÈÛÙËÌÔÓÈÎfi ™˘Ì‚Ô‡ÏÈÔ ÀÁ›·˜ ÙÔ˘ ÀÀ¶6. ∏ Ê˘ÛÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· Ú¤ÂÈ Ó· ÚÔ¿ÁÂÙ·È Û fiϘ ÙȘ ËÏÈÎȷΤ˜ ÔÌ¿‰Â˜. ™˘ÓÈÛÙ¿Ù·È ÙÔ˘Ï¿¯ÈÛÙÔÓ ÌÈÛ‹ ÒÚ· ¿ÛÎËÛ˘ ÙËÓ Ë̤ڷ, ÙȘ ÂÚÈÛÛfiÙÂÚ˜ Ë̤Ú˜ Ù˘ ‚‰ÔÌ¿‰·˜, ·ÏÏ¿ Î·È ÏÈÁfiÙÂÚË ¿ÛÎËÛË Â›Ó·È ÂˆÊÂÏ‹˜. √È ¿Û¯ÔÓÙ˜ Ó· ·ÛÎÔ‡ÓÙ·È Ì¤¯ÚÈ ÙÔ ÛËÌÂ›Ô Ô˘ ¤¯Ô˘Ó ÙÔÓ ÌÈÎÚfiÙÂÚÔ Î›Ó‰˘ÓÔ. ¶ÚÔ˜ ÙÔ‡ÙÔ ¯ÚÂÈ¿˙ÂÙ·È Î·Ï‹ ÎÏÈÓÈ΋ ÂÎÙ›ÌËÛË, ÛÙËÓ ÔÔ›· ÂÚÈÏ·Ì‚¿ÓÂÙ·È Ë ‰ÔÎÈÌ·Û›· ÎÔÒÛˆ˜. √È ˘ÁÈ›˜ ÌÔÚÔ‡Ó Ó· ÂÈϤÁÔ˘Ó ÙȘ ‰Ú·ÛÙËÚÈfiÙËÙ˜ Ô˘ ÙÔ˘˜ ¢¯·ÚÈÛÙÔ‡Ó Î·È ÙÔ˘˜ Ù·ÈÚÈ¿˙Ô˘Ó ÛÙȘ ηıËÌÂÚÈÓ¤˜ ·Û¯Ôϛ˜ ÙÔ˘˜, ·ÚΛ Ó· ·ÛÎÔ‡ÓÙ·È 30-45 ÏÂÙ¿, 4

Ì 5 ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰·, ÛÙÔ 6070% Ù˘ ÌÂÁ›ÛÙ˘ ÙÔ˘˜ ηډȷ΋˜ Û˘¯ÓfiÙËÙ·˜. ∏ ·¯˘Û·ÚΛ· (¢ª™ > 30 km/m2) Î·È ÙÔ ˘ÂÚ‚¿ÏÏÔÓ ÛˆÌ·ÙÈÎfi ‚¿ÚÔ˜ (¢ª™ > 25 Î·È < 30 km/m2) Ú¤ÂÈ Ó· ·ÔʇÁÔÓÙ·È Î·È Ó· ‰ÈÔÚıÒÓÔÓÙ·È fiÔ˘ ˘¿Ú¯Ô˘Ó. ÕÓ‰Ú˜ Ì ÂÚ›ÌÂÙÚÔ Ì¤Û˘ > 102 cm Î·È Á˘Ó·›Î˜ Ì ̤ÛË > 88 cm ¤¯Ô˘Ó ·˘ÍË̤ÓÔ ÛÏ·¯ÓÈÎfi Ï›Ô˜ Î·È Ú¤ÂÈ Ó· ¯¿ÓÔ˘Ó ‚¿ÚÔ˜. ∏ ÂÈÙ˘¯›· Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ Èı·Ó‹ fiÙ·Ó Ë ÚÔÛ¿ıÂÈ· ˘ÔÛÙËÚ›˙ÂÙ·È Â·ÁÁÂÏÌ·ÙÈο ·ÏÏ¿ ¯ÚÂÈ¿˙ÂÙ·È Î·È ÙÔ ¿ÙÔÌÔ Ó· ¤¯ÂÈ ÈÛ¯˘Úfi ΛÓËÙÚÔ. ∆¤ÏÔ˜ Ë ÌfiÓÈÌË ‰È·ÎÔ‹ Ù˘ ¯Ú‹Û˘ fiÏˆÓ ÙˆÓ ÌÔÚÊÒÓ Î·ÓÔ‡ Ú¤ÂÈ Ó· ·ÔÙÂÏ› ÛÙ·ıÂÚ‹ Âȉ›ˆÍË Û fiÏÔ˘˜ ÙÔ˘˜ ηÓÈÛÙ¤˜, ÁÈ· ·ÔÊ˘Á‹ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ Ô˘ ‰È·ÙÚ¤¯Ô˘Ó ÔÈ ›‰ÈÔÈ ·ÏÏ¿ Î·È Ù· ¿ÙÔÌ· ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÙÔ˘˜ ˆ˜ ·ıËÙÈÎÔ› ηÓÈÛÙ¤˜. ∆· ̤ÙÚ· Ô˘ ÌÔÚ› Ó· ‚ÔËı‹ÛÔ˘Ó Â›Ó·È ÂÚÈÏËÙÈο Ù· ηو٤ڈ (ÌÓËÌÔÙ¯ÓÈο 5 ∞’s ÛÙ· ∞ÁÁÏÈο) ñ ∂ÚÒÙËÛË (ask): Ó· ÂÓÙÔ›˙ÔÓÙ·È ÔÈ Î·ÓÈÛÙ¤˜ Û˘ÛÙËÌ·ÙÈο Û οı ¢ηÈÚ›· ñ ∂ÎÙ›ÌËÛË (asses): Ó· ÂÎÙÈÌ¿Ù·È Û ÙÈ ‚·ıÌfi Â›Ó·È Ô ·ÛıÂÓ‹˜ ÂıÈṲ̂ÓÔ˜ Î·È fiÛÔ ¤ÙÔÈÌÔ˜ Â›Ó·È Ó· ‰È·Îfi„ÂÈ ÙÔ Î¿ÓÈÛÌ· ñ ™˘Ì‚Ô˘Ï‹ (advise): Ó· Û˘ÓÈÛÙ¿Ù·È Ì οı ÂÈÛÙÈÎfiÙËÙ· Ë ‰È·ÎÔ‹ ÙÔ˘ ηÓ›ÛÌ·ÙÔ˜ ñ µÔ‹ıÂÈ· (assist): Ó· ·Ú¤¯ÂÙ·È ‚Ô‹ıÂÈ· ›Ù Ì ÙË ÌÔÚÊ‹ „˘¯ÔÏÔÁÈ΋˜ ˘ÔÛÙ‹ÚÈ͢ ‹ Î·È Ê·Ú̷΢ÙÈο Ì ˘ÔηٿÛٷٷ ÓÈÎÔÙ›Ó˘ ‹ ¿ÏÏ· Ê¿Ú̷η ñ ¶ÚÔÁÚ·ÌÌ·ÙÈÛÌfi˜ (arrange): Ó· ÚÔÁÚ·ÌÌ·Ù›˙ÔÓÙ·È ÔÈ ÂÈÛΤ„ÂȘ ÁÈ· ·Ú·ÎÔÏÔ‡ıËÛË.

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5.

6.

Nutr 1997, 65 (suppl 5): 1628S-44S. Stamler J, Briefel RR, Milas C, Grandits GA, Caggiula AW. Relation of changes in dietary lipids and weight, trial years 1-6, to change in blood lipids in the special intervention and usual care groups in the Multiple Risk Factor Intervention Trial. Am J Clin Nutr 1997;65:272S-88S. ÀÔ˘ÚÁÂ›Ô ÀÁ›·˜ Î·È ¶ÚfiÓÔÈ·˜. ∞ÓÒÙ·ÙÔ ∂ȉÈÎfi ∂ÈÛÙËÌÔÓÈÎfi ™˘Ì‚Ô‡ÏÈÔ ÀÁ›·˜. ¢È·ÙÚÔÊÈΤ˜ Ô‰ËÁ›Â˜ ÁÈ· ÂÓ‹ÏÈΘ ÛÙËÓ ∂ÏÏ¿‰·. 1999.

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A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·18

·ıËÚÔÛÎÏ‹ÚˆÛË MAPTIO™ 2005

∞Ó·ÛÎfiËÛË ÙˆÓ √‰ËÁÈÒÓ ÁÈ· ÙË ¢Â˘ÙÂÚÔÁÂÓ‹ ¶ÚfiÏË„Ë Ù˘ ∫·Ú‰È·ÁÁÂȷ΋˜ ¡fiÛÔ˘ ª. ∫ˆÛÙ·¿ÓÔ˜, ∂ÈÛÙËÌÔÓÈÎfi˜ ™˘ÓÂÚÁ¿Ù˘ ÙÔ˘ π·ÙÚ›Ԣ §Èȉ›ˆÓ ª. ∂ÏÈÛ¿Ê, ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ ∆Ô̤·˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ

∏ ÛˆÛÙ‹ ÂÊ·ÚÌÔÁ‹ ÙˆÓ ÔÏ˘¿ÚÈıÌˆÓ Ê·Ú̷΢ÙÈÎÒÓ Î·È ˘ÁÈÂÈÓԉȷÈÙËÙÈÎÒÓ ‰˘Ó·ÙÔÙ‹ÙˆÓ ÁÈ· ÙË ‰Â˘ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ ·ÔÙÂÏ› ÚˆÙ·Ú¯ÈÎfi ÛÙfi¯Ô ÙfiÛÔ Ù˘ ÚˆÙÔ‚¿ıÌÈ·˜ ÊÚÔÓÙ›‰·˜ ˘Á›·˜ fiÛÔ Î·È ÙˆÓ ÂȉÈÎÒÓ È·ÙÚÒÓ. ¶·Ú¿ ÙËÓ ‡·ÚÍË Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ Î·Ù¢ı˘ÓÙ‹ÚÈˆÓ Ô‰ËÁÈÒÓ ÁÈ· ÙËÓ ÚfiÏË„Ë Ù˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘, Ù· Ê¿Ú̷η Ô˘ Â›Ó·È ÁÓˆÛÙfi fiÙÈ ÂÏ·ÙÙÒÓÔ˘Ó ÙËÓ ıÓËÛÈÌfiÙËÙ· Î·È ÓÔÛËÚfiÙËÙ· ‰ÂÓ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ·fi ÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜ ·ÛıÂÓ›˜. ™Ùfi¯Ô˜ Ù˘ ·ÚÔ‡Û·˜ ·Ó·ÛÎfiËÛ˘ Â›Ó·È Ë Û‡ÓÔ„Ë ÙˆÓ Ô‰ËÁÈÒÓ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ·ÛıÂÓÒÓ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘.

∞¡∆π∞πª√¶∂∆∞§π∞∫√π ¶∞ƒ∞°√¡∆∂™ ∞™¶πƒπ¡∏ ∏ ·ÛÈÚ›ÓË ·Ó·ÛÙ¤ÏÏÂÈ ÌË ·Ó·ÛÙÚ¤„ÈÌ· ÙÔ ¤Ó˙˘ÌÔ Î˘ÎÏÔÔ͢ÁÂÓ¿ÛË, ÙÔ ÔÔ›Ô ÂÌϤÎÂÙ·È ÛÙËÓ ·Ú·ÁˆÁ‹ Ù˘ ıÚÔÌ‚ÔÍ¿Ó˘, Ë ÔÔ›· Â¿ÁÂÈ ÙË Û˘ÛÛÒÚ¢ÛË ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ. ∫¿ı ·ÛıÂÓ‹˜ Ì ÈÛÙÔÚÈÎfi ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘ ηÈ/‹ ™¢ Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÈ 75 ¤ˆ˜ 325 mg ·ÛÈÚ›Ó˘ ËÌÂÚËÛ›ˆ˜. √È Î‡ÚȘ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ Ù˘ ·ÛÈÚ›Ó˘ Â›Ó·È ÔÈ ‰ÔÛÔ-ÂÍ·ÚÙÒÌÂÓ˜ ·ÈÌÔÚÚ·ÁÈΤ˜ ÂÈÏÔΤ˜, ÔÈ Á·ÛÙÚÂÓÙÂÚÈΤ˜ ‰È·Ù·Ú·¯¤˜ (ÛÙÔ 2-10% ÙˆÓ ·ÛıÂÓÒÓ), ÔÈ ÂÌ‚Ô¤˜ Î·È Ë ·ÒÏÂÈ· Ù˘ ·ÎÔ‹˜ (ÛÙÔ 0,3% ÙˆÓ ·ÛıÂÓÒÓ Û ˘„ËÏfiÙÂÚ˜ ‰fiÛÂȘ), ηıÒ˜ Î·È ÔÈ ·ÓÙȉڿÛÂȘ ˘ÂÚ¢·ÈÛıËÛ›·˜, fiˆ˜ Ô ‚ÚÔÁ¯fiÛ·ÛÌÔ˜, Ë ÎÓ›‰ˆÛË Î·È ÙÔ 18

·ÁÁÂÈÔÔ›‰ËÌ· (ÛÙÔ 0,3% ÙˆÓ ·ÛıÂÓÒÓ). ªÂÁ¿Ï˘ Îϛ̷η˜ ÌÂÙ··Ó·Ï‡ÛÂȘ ¤‰ÂÈÍ·Ó ÙÔ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ Ù˘ ·ÛÈÚ›Ó˘ ÛÙË ‰Â˘ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ, ηıÒ˜ ·ԉ›¯ıËΠfiÙÈ Ë ¯ÔÚ‹ÁËÛ‹ Ù˘ Ì›ˆÛ ÛËÌ·ÓÙÈο ÙfiÛÔ ÙËÓ Î·Ú‰È·ÁÁÂȷ΋ ıÓËÛÈÌfiÙËÙ·, fiÛÔ Î·È Ù· ηډȷÁÁÂȷο Û˘Ì‚¿Ì·Ù·1.

∫§√¶π¢√°ƒ∂§∏ ∏ ÎÏÔȉÔÁÚ¤ÏË ·Ó·ÛÙ¤ÏÏÂÈ ÙË Û‡Ó‰ÂÛË Ù˘ ‰ÈʈÛÊÔÚÈ΋˜ ·‰ÂÓÔÛ›Ó˘ ÛÙÔÓ ˘Ô‰Ô¯¤· Ù˘ ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ Î·È ¤ÙÛÈ ÂÌÔ‰›˙ÂÈ ÙËÓ ÂÓÂÚÁÔÔ›ËÛ‹ ÙÔ˘˜. ∆Ô Ê¿ÚÌ·ÎÔ ·˘Ùfi Ú¤ÂÈ Ó· ¯ÔÚËÁÂ›Ù·È ·ÓÙ› Ù˘ ·ÛÈÚ›Ó˘ Û ·ÛıÂÓ›˜ Ô˘ ‰ÂÓ ·Ó¤¯ÔÓÙ·È ‹ Â›Ó·È ·ÓıÂÎÙÈÎÔ› ÛÙË ‰Ú¿ÛË Ù˘ ·ÛÈÚ›Ó˘. ∂›Û˘, Ú¤ÂÈ Ó· ¯ÔÚËÁÂ›Ù·È Û ‰fiÛË 75 mg ËÌÂÚËÛ›ˆ˜ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ·ÛÈÚ›ÓË (75-325 mg ËÌÂÚËÛ›ˆ˜) ÁÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 8-12 Ì‹Ó˜ Û ·ÛıÂÓ›˜ Ì Ôͤ· ÛÙÂÊ·ÓÈ·›· Û‡Ó‰ÚÔÌ· Î·È È‰È·›ÙÂÚ· Û ¿ÙÔÌ· Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û ·ÁÁÂÈÔÏ·ÛÙÈ΋ ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÁÁ›ˆÓ. √È Î‡ÚȘ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ Ù˘ ÎÏÔȉÔÁÚ¤Ï˘ Â›Ó·È ÙÔ ÂÍ¿ÓıËÌ· (ÛÙÔ 4,2% ÙˆÓ ·ÛıÂÓÒÓ) Î·È Ë ·ÈÌÔÚÚ·Á›· ·fi ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi (ÛÙÔ 2% ÙˆÓ ·ÛıÂÓÒÓ). ªÂϤÙ˜ Ô˘ Û˘Ó¤ÎÚÈÓ·Ó ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ÎÏÔȉÔÁÚ¤Ï˘ Ì ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë Ù˘ ·ÛÈÚ›Ó˘2 ÛÙË ‰Â˘ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ ¤‰ÂÈÍ·Ó ¤Ó· ÌÈÎÚfi, ·ÏÏ¿ ÛÙ·ÙÈÛÙÈ-

ο ÛËÌ·ÓÙÈÎfi ÏÂÔÓ¤ÎÙËÌ· Ù˘ ÎÏÔȉÔÁÚ¤Ï˘ fiÛÔÓ ·ÊÔÚ¿ ÙÔ Î‡ÚÈÔ Î·Ù·ÏËÎÙÈÎfi ÛËÌÂ›Ô ·˘ÙÒÓ ÙˆÓ ÌÂÏÂÙÒÓ, ÂÓÒ ‰ÂÓ ·Ó¤‰ÂÈÍ·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ fiÛÔÓ ·ÊÔÚ¿ ÙȘ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ÙˆÓ ‰‡Ô Ê·Ú̿ΈÓ3.

∞¡∆π¶∏∫∆π∫∏ ∞°ø°∏ µ∞ƒº∞ƒπ¡∏ ∏ ‚·ÚÊ·Ú›ÓË ÔÊ›ÏÂÈ ÙËÓ ·ÓÙÈËÎÙÈ΋ Ù˘ ‰Ú¿ÛË Î˘Ú›ˆ˜ ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ ·ÓÙ·ÁˆÓ›˙ÂÙ·È ÙËÓ ÂÍ·ÚÙÒÌÂÓË ·fi ÙË ‚ÈÙ·Ì›ÓË ∫ ηڂÔÍ˘Ï›ˆÛË ÔÚÈÛÌ¤ÓˆÓ ·Ú·ÁfiÓÙˆÓ ‹Í˘ (II, VII, IX, X). ∏ ·ÓÙÈËÎÙÈ΋ ıÂÚ·›· Ì ‚·ÚÊ·Ú›ÓË ÂӉ›ÎÓ˘Ù·È Û ·ÛıÂÓ›˜ Ì ÎÔÏÈ΋ Ì·ÚÌ·Ú˘Á‹ ηÈ/‹ ıÚfiÌ‚Ô˘˜ ÛÙËÓ ·ÚÈÛÙÂÚ¿ ÎÔÈÏ›·, fiˆ˜ Â›Û˘ Î·È Û ¿ÙÔÌ· ÛÙ· ÔÔ›· ·ÓÙÂӉ›ÎÓ˘Ù·È Ë ¯ÔÚ‹ÁËÛË ·ÛÈÚ›Ó˘ ÌÂÙ¿ ·fi ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘. √È Î‡ÚȘ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ÙˆÓ ÎÔ˘Ì·ÚÈÓÈÎÒÓ ·ÓÙÈËÎÙÈÎÒÓ Â›Ó·È ÔÈ ‰ÔÛÔ-ÂÍ·ÚÙÒÌÂÓ˜ ·ÈÌÔÚÚ·ÁÈΤ˜ ÂÈÏÔΤ˜ Î·È Ë ·ÏÏËÏÂ›‰Ú·ÛË ÙÔ˘˜ Ì ʿÚ̷η, ÂȉÈο Ì ÂΛӷ Ô˘ ÌÂÙ·‚ÔÏ›˙ÔÓÙ·È ·fi Ù· Ë·ÙÈο ÈÛÔ¤Ó˙˘Ì· CYP2C9 Î·È CYP3A4. ∞ÚÎÂÙ¤˜ ‰È·ÊˆÓ›Â˜ ˘¿Ú¯Ô˘Ó Û¯ÂÙÈο Ì ÙÔ ·Ó ¯·ÌËϤ˜ ‰fiÛÂȘ ·ÛÈÚ›Ó˘ Ú¤ÂÈ Ó· Û˘Á¯ÔÚËÁÔ‡ÓÙ·È Ì ‚·ÚÊ·Ú›ÓË. ¶ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó Î·Ï‡ÙÂÚË ÚfiÁÓˆÛË Û ·ÛıÂÓ›˜ Ì ÁÓˆÛÙ‹ ηډȷÁÁÂȷ΋ ÓfiÛÔ Ô˘ ¤·ÈÚÓ·Ó Û˘Ó‰˘·Ṳ̂ÓË ·ÁˆÁ‹4. ª›· ÌÂÙ·-·Ó¿Ï˘ÛË 31 ÌÂÏÂÙÒÓ5 Ô˘ Û˘Ó¤ÎÚÈÓ·Ó ÙË ¯ÔÚ‹ÁËÛË ‚·ÚÊ·Ú›Ó˘, ÌfiÓ˘ ‹ ÛÂ


A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·19

™Y°XPONE™ O¢H°IE™ Û˘Ó‰˘·ÛÌfi Ì ·ÛÈÚ›ÓË, Ì ÙË ¯ÔÚ‹ÁËÛË ·ÛÈÚ›Ó˘ ‹ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘, ¤‰ÂÈÍ fiÙÈ Ì¤ÙÚȘ ‹ ˘„ËϤ˜ ‰fiÛÂȘ ‚·ÚÊ·Ú›Ó˘ ÏÂÔÓÂÎÙÔ‡Û·Ó ¤Ó·ÓÙÈ ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ fiÛÔÓ ·ÊÔÚ¿ ÙË Ì›ˆÛË ÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘, ÂÓÒ ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ Û ۇÁÎÚÈÛË Ì ÙËÓ ·ÛÈÚ›ÓË. ∂›Û˘, ÛËÌÂÈÒıËΠ̛· ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÛËÌ·ÓÙÈ΋˜ ·ÈÌÔÚÚ·Á›·˜ Û ·ÛıÂÓ›˜ Ô˘ ¤·ÈÚÓ·Ó Ì¤ÙÚȘ ‹ ˘„ËϤ˜ ‰fiÛÂȘ ‚·ÚÊ·Ú›Ó˘, Û ۇÁÎÚÈÛË Ì ·ÛıÂÓ›˜ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ¯ÔÚËÁ‹ıËΠ·ÛÈÚ›ÓË ‹ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ.

∞¡∞™∆√§∂π™ ∆√À ª∂∆∞∆ƒ∂¶∆π∫√À ∂¡∑Àª√À ∆∏™ ∞°°∂π√∆∂¡™π¡∏™ (∞ª∂∞) √È ∞ª∂∞ ÂËÚ¿˙Ô˘Ó ÙË ‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘ ¿ÍÔÓ· ÚÂÓ›Ó˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘ ·ÊÔ‡ ·Ó·ÛÙ¤ÏÏÔ˘Ó ÙË ÌÂÙ·ÙÚÔ‹ Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘ I Û ·ÁÁÂÈÔÙÂÓÛ›ÓË II, ÂÓÒ ·Ú¿ÏÏËÏ· ·Ó·ÛÙ¤ÏÏÔ˘Ó ÙÔÓ Î·Ù·‚ÔÏÈÛÌfi Ù˘ ‚Ú·‰˘ÎÈÓ›Ó˘. ∆· Ê¿Ú̷η ·˘Ù¿ ÂӉ›ÎÓ˘ÓÙ·È Û ·ÛıÂÓ›˜ Ì ηډȷÁÁÂȷ΋ ÓfiÛÔ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ηډȷ΋ ·ÓÂ¿ÚÎÂÈ·, Û˘ÛÙÔÏÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ù˘ ·ÚÈÛÙÂÚ¿˜ ÎÔÈÏ›·˜ ηÈ/‹ ÚfiÛÊ·ÙÔ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘, ηıÒ˜ Â›Û˘ Î·È Û ·ÛıÂÓ›˜ Ì ηډȷÁÁÂȷ΋ ÓfiÛÔ Î·È/‹ ™¢ ·ÓÂÍ¿ÚÙËÙ· ·fi ÙË ÏÂÈÙÔ˘ÚÁ›· Ù˘ ·ÚÈÛÙÂÚ¿˜ ÎÔÈÏ›·˜, ÂÊfiÛÔÓ Ë Û˘ÛÙÔÏÈ΋ ·ÚÙËÚȷ΋ ›ÂÛË (™∞¶) ˘ÂÚ‚·›ÓÂÈ Ù· 120 mm Hg. √È Î‡ÚȘ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȤ˜ ÙÔ˘˜ Â›Ó·È Ë ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· (Û ÔÛÔÛÙfi ¤ˆ˜ Î·È 50% ÙˆÓ ·ÛıÂÓÒÓ Ì ·ÌÊÔÙÂÚfiÏ¢ÚË ÛÙ¤ÓˆÛË ÙˆÓ ÓÂÊÚÈÎÒÓ ·ÁÁ›ˆÓ), Ô ‚‹¯·˜ (ÛÙÔ 20% ÙˆÓ ·ÛıÂÓÒÓ), Ë ˘ÂÚηÏÈ·ÈÌ›· (ÛÙÔ 10%) Î·È ÙÔ ·ÁÁÂÈÔÔ›‰ËÌ·. ™‡Ìʈӷ Ì ·ÚÎÂÙ¤˜ ÌÂϤÙ˜6,7,8 (AIRE, TRACE, SAVE) Ë ¯ÔÚ‹ÁËÛË ∞ª∂∞ ÛÙË ‰Â˘ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë Ù˘ ηډȷÁ-

ÁÂȷ΋˜ ÓfiÛÔ˘ ›¯Â ¢ÂÚÁÂÙÈο ·ÔÙÂϤÛÌ·Ù· fiÛÔÓ ·ÊÔÚ¿ ÙfiÛÔ ÙÔ Î‡ÚÈÔ Î·Ù·ÏËÎÙÈÎfi ÛËÌÂ›Ô fiÛÔ Î·È ÙËÓ Î·Ú‰È·ÁÁÂȷ΋ ıÓËÛÈÌfiÙËÙ·.

∞¶√∫§∂π™∆∂™ ∆ø¡ ∞∆1 À¶√¢√Ã∂ø¡ ∆∏™ ∞°°∂π√∆∂¡™π¡∏™ ππ √È ·ÔÎÏÂÈÛÙ¤˜ ÙˆÓ ∞∆1 ˘Ô‰Ô¯¤ˆÓ Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘ ππ ·Ó·ÛÙ¤ÏÏÔ˘Ó ÙË ‰Ú¿ÛË Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘ ππ ÛÙÔ Â›Â‰Ô ÙÔ˘ ˘Ô‰Ô¯¤· Ù˘. ∆· Ê¿Ú̷η ·˘Ù¿ ÂӉ›ÎÓ˘ÓÙ·È Û ·ÛıÂÓ›˜ Ì ‰È·‚ËÙÈ΋ ÓÂÊÚÔ¿ıÂÈ·, ˘¤ÚÙ·ÛË ‹ ηډȷ΋ ·ÓÂ¿ÚÎÂÈ·. øÛÙfiÛÔ ‰ÂÓ ¤¯ÂÈ ·Ô‰Âȯı› fiÙÈ ÏÂÔÓÂÎÙÔ‡Ó ¤Ó·ÓÙÈ ÙˆÓ ∞ª∂∞ fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ÚfiÏË„Ë ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ Î·È ÁÈ· ·˘Ùfi ÙÔ ÏfiÁÔ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ˆ˜ ÚˆÙ·Ú¯È΋ ıÂÚ·›· ÌfiÓÔ Û ·ÛıÂÓ›˜ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ÔÈ ∞ª∂∞ ‰ÂÓ Â›Ó·È Î·Ï¿ ·ÓÂÎÙÔ›. √ Û˘Ó‰˘·ÛÌfi˜ ∞∆1 ·ÔÎÏÂÈÛÙÒÓ Î·È ∞ª∂∞ Ê·›ÓÂÙ·È fiÙÈ ·Ú¤¯ÂÈ Î·Ï‡ÙÂÚÔ ·ÔÎÏÂÈÛÌfi ÙÔ˘ ¿ÍÔÓ· ÚÂÓ›Ó˘-·ÁÁÂÈÔÙÂÓÛ›Ó˘. √È Î‡ÚȘ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ÙˆÓ ∞∆1 ·ÔÎÏÂÈÛÙÒÓ Â›Ó·È ·ÚfiÌÔȘ Ì ÙȘ ·ÓÙ›ÛÙÔȯ˜ ÙˆÓ ∞ª∂∞ Ì ÂÍ·›ÚÂÛË ÂΛӘ Ô˘ Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ‚Ú·‰˘ÎÈÓ›ÓË (.¯. Ô ‚‹¯·˜). ∞ÚÎÂÙ¤˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó ÙË ÓÂÊÚÔÚÔÛٷ٢ÙÈ΋ ‰Ú¿ÛË ÙˆÓ ∞∆1 ·ÔÎÏÂÈÛÙÒÓ.9 ª›· ÌÂÙ·-·Ó¿Ï˘ÛË 17 Ù˘¯·ÈÔÔÈË̤ӈÓ, ‰ÈÏÒÓ-Ù˘ÊÏÒÓ ÌÂÏÂÙÒÓ Ì ÙË ¯ÔÚ‹ÁËÛË ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ ¤‰ÂÈÍ fiÙÈ ‰ÂÓ ˘‹Ú¯Â ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Ì›ˆÛË Ù˘ ÔÏÈ΋˜ ıÓËÛÈÌfiÙËÙ·˜ Û ·ÛıÂÓ›˜ Ô˘ ¤·ÈÚÓ·Ó ∞∆1 ·ÔÎÏÂÈÛÙ¤˜, fiˆ˜ Â›Û˘ Î·È Û ·ÛıÂÓ›˜ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ¯ÔÚËÁ‹ıËÎÂ Û˘Ó‰˘·ÛÌfi˜ ∞∆1 ·ÔÎÏÂÈÛÙ‹ Î·È ∞ª∂∞. øÛÙfiÛÔ, ·ԉ›¯ıËΠfiÙÈ Ô Û˘Ó‰˘·ÛÌfi˜ ∞∆1 ·ÔÎÏÂÈÛÙÒÓ Î·È ∞ª∂∞ ÏÂÔÓÂÎÙ› ¤Ó·ÓÙÈ Ù˘ ÌÔÓÔıÂÚ·›·˜ Ì ∞ª∂∞ fiÛÔÓ ·ÊÔÚ¿ ÙȘ ÂÈÛ·ÁˆÁ¤˜ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÁÈ· ηډȷ΋ ·ÓÂ¿ÚÎÂÈ·10.

ƒÀ£ªπ™∏ ∆∏™ ∞ƒ∆∏ƒπ∞∫∏™ ¶π∂™∏™ (∞¶) ™‡Ìʈӷ Ì ÙȘ Ô‰ËÁ›Â˜ Ù˘ 7˘ ∂ıÓÈ΋˜ ∂ÈÙÚÔ‹˜ ÙˆÓ ∏¶∞ ÁÈ· ÙËÓ ÚfiÏË„Ë, ‰È¿ÁÓˆÛË Î·È ıÂÚ·›· Ù˘ ·ÚÙËÚȷ΋˜ ˘¤ÚÙ·Û˘ Ô ÛÙfi¯Ô˜ Ù˘ ∞¶ Û ·ÛıÂÓ›˜ Ì ™¢ ‹ ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ÓfiÛÔ Â›Ó·È Ë Ì›ˆÛË Ù˘ ∞¶ Û ÙÈ̤˜ ÌÈÎÚfiÙÂÚ˜ ·fi 130/80 mm Hg. √ ÛÙfi¯Ô˜ ·˘Ùfi˜ ÙÚÔÔÔÈÂ›Ù·È fiÙ·Ó Û˘Ó˘¿Ú¯ÂÈ ÛËÌ·ÓÙÈÎÔ‡ ‚·ıÌÔ‡ ÚˆÙÂ˚ÓÔ˘Ú›·, ÌÂÁ·Ï‡ÙÂÚË ·fi 1 g ·Ó¿ 24ˆÚÔ, Û ∞¶ ¯·ÌËÏfiÙÂÚË ·fi 125/75 mm Hg. øÛÙfiÛÔ ÔÈ Ô‰ËÁ›Â˜ ·˘Ù¤˜ ‰ÂÓ Û˘ÌÂÚÈÏ·Ì‚¿ÓÔ˘Ó ·ÛıÂÓ›˜ Ì ηډȷÁÁÂȷ΋ ÓfiÛÔ Î·È/‹ ηډȷ΋ ·ÓÂ¿ÚÎÂÈ·, ÁÈ· ÙÔ˘˜ ÔÔ›Ô˘˜ Û˘ÓÈÛÙ¿Ù·È Û¯ÔÏ·ÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ù˘ ∞¶ Î·È ¤Ó·ÚÍË ·ÓÙȸÂÚÙ·ÛÈ΋˜ ·ÁˆÁ‹˜ ÂÊfiÛÔÓ ÔÈ ÙÈ̤˜ Ù˘ ∞¶ ˘ÂÚ‚·›ÓÔ˘Ó Ù· 140/90 mm Hg. ªÔÏÔÓfiÙÈ ˆ˜ Ê¿Ú̷η ÚÒÙ˘ ÂÈÏÔÁ‹˜ ÁÈ· ÙË Ú‡ıÌÈÛË Ù˘ ∞¶ ıˆÚÔ‡ÓÙ·È ÔÈ ∞ª∂∞, ÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜ Î·È Ù· ıÂÈ·˙ȉÈο ‰ÈÔ˘ÚËÙÈο, ÔÈ ∞∆1 ·ÔÎÏÂÈÛÙ¤˜, ÔÈ ·ÓÙ·ÁˆÓÈÛÙ¤˜ Ù˘ ·Ï‰ÔÛÙÂÚfiÓ˘ Î·È ÔÈ Ì·ÎÚ¿˜ ‰È¿ÚÎÂÈ·˜ ‰Ú¿Û˘ ·ÓÙ·ÁˆÓÈÛÙ¤˜ ·Û‚ÂÛÙ›Ô˘ Ú¤ÂÈ Â›Û˘ Ó· Ï·Ì‚¿ÓÔÓÙ·È ÛÔ‚·Ú¿ ˘fi„Ë ÂȉÈο Û ·ÛıÂÓ›˜ Ì ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· ηÈ/‹ ÛÙ·ıÂÚ‹ ÛÙËı¿Á¯Ë. °È· ÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜ ˘ÂÚÙ·ÛÈÎÔ‡˜ ··ÈÙÔ‡ÓÙ·È ÙÔ˘Ï¿¯ÈÛÙÔÓ 2 ·ÓÙȸÂÚÙ·ÛÈο Û΢¿ÛÌ·Ù· ÁÈ· ÙËÓ Â›Ù¢ÍË ÙˆÓ ÛÙfi¯ˆÓ Ù˘ ·ÓÙȸÂÚÙ·ÛÈ΋˜ ·ÁˆÁ‹˜. ªÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ Ë ¯ÔÚ‹ÁËÛË ‚-·ÔÎÏÂÈÛÙÒÓ ‹ ‰ÈÔ˘ÚËÙÈÎÒÓ ÏÂÔÓÂÎÙÔ‡Û Ù˘ ¯ÔÚ‹ÁËÛ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ ηıÒ˜ Ì›ˆÛ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÙfiÛÔ ÙËÓ Â›ÙˆÛË ÙˆÓ ·ÁÁÂÈ·ÎÒÓ ÂÁÎÂÊ·ÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ fiÛÔ Î·È ÙˆÓ ÌÂÈ˙fiÓˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ Û˘Ì‚·Ì¿ÙˆÓ11. ∂›Û˘, Ì›· ÌÂϤÙË (Ë ALLHAT)12 ¤‰ÂÈÍ fiÙÈ ‰ÂÓ ˘‹Ú¯Â ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ıÂÈ·˙ȉÈÎÒÓ ‰ÈÔ˘ÚËÙÈÎÒÓ, ÙˆÓ ·ÓÙ·ÁˆÓÈÛÙÒÓ ·Û‚ÂÛÙ›Ô˘ Î·È ÙˆÓ ∞ª∂∞ fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ÚfiÏË„Ë ÙˆÓ Î·Ú19


A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·20

·ıËÚÔÛÎÏ‹ÚˆÛË MAPTIO™ 2005

‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ, ÁÂÁÔÓfi˜ ÙÔ ÔÔ›Ô Î·ıȤڈÛ ٷ ıÂÈ·˙ȉÈο ‰ÈÔ˘ÚËÙÈο ˆ˜ Ê¿Ú̷η ÚÒÙ˘ ÂÈÏÔÁ‹˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ·ÚÙËÚȷ΋˜ ˘¤ÚÙ·Û˘ ÂÍ·ÈÙ›·˜ ÙÔ˘ ¯·ÌËÏfiÙÂÚÔ˘ ÎfiÛÙÔ˘˜ ÙÔ˘˜. ∆¤ÏÔ˜ fiÛÔÓ ·ÊÔÚ¿ ÙÔ˘˜ ‚-·ÔÎÏÂÈÛÙ¤˜, ÙÔ˘˜ ∞∆1 ·ÔÎÏÂÈÛÙ¤˜ Î·È ÙÔ˘˜ ·ÓÙ·ÁˆÓÈÛÙ¤˜ Ù˘ ·Ï‰ÔÛÙÂÚfiÓ˘, Û˘ÓÈÛÙÒÓÙ·È ˆ˜ ·ÓÙȸÂÚÙ·ÛÈÎÔ› ·Ú¿ÁÔÓÙ˜ Û ·ÛıÂÓ›˜ Ì ηډȷÁÁÂȷ΋ ÓfiÛÔ, ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· ηÈ/‹ ™¢.

µ-∞¶√∫§∂π™∆∂™ √È ‚-·ÔÎÏÂÈÛÙ¤˜ ÂÌÔ‰›˙Ô˘Ó ·ÓÙ·ÁˆÓÈÛÙÈο ÙË ‰Ú¿ÛË ÙˆÓ Î·Ù¯ÔÏ·ÌÈÓÒÓ ÛÙÔ˘˜ ‚ ·‰ÚÂÓÂÚÁÈÎÔ‡˜ ˘ԉԯ›˜ Î·È ¤¯Ô˘Ó ·ÓÙÈ·ÚÚ˘ıÌÈ΋, ·ÓÙÈÛÙËı·Á¯È΋ Î·È ·ÚÓËÙÈ΋ ÈÓfiÙÚÔÔ, ¯ÚÔÓfiÙÚÔÔ Î·È ‰ÚÔÌfiÙÚÔÔ ‰Ú¿ÛË. ∞˘Ù¿ Ù· Ê¿Ú̷η ÂӉ›ÎÓ˘ÓÙ·È ÁÈ· ÙË ‰Â˘ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ Û ·ÛıÂÓ›˜ Ì ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘, ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· / ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ù˘ ·ÚÈÛÙÂÚ¿˜ ÎÔÈÏ›·˜ ηÈ/‹ ˘¤ÚÙ·ÛË. √È Î‡ÚȘ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȤ˜ ÙÔ˘˜ Â›Ó·È Ë Èı·Ó‹ Âȉ›ӈÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Ù˘ ηډȷ΋˜ ·ÓÂ¿ÚÎÂÈ·˜, Ë ÎfiˆÛË (1,8%) Î·È Ë ÛÂÍÔ˘·ÏÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· (0,5%). ªÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ Ë ¯ÔÚ‹ÁËÛË ‚-·ÔÎÏÂÈÛÙÒÓ Û ÌÂϤÙ˜ ‰Â˘ÙÂÚÔÁÂÓÔ‡˜ ÚfiÏ˄˘ Ì›ˆÛ ÛËÌ·ÓÙÈο ÙËÓ Î·Ú‰È·ÁÁÂȷ΋ ıÓËÛÈÌfiÙËÙ·13,14. ¢‡Ô ÌÂÁ¿Ï˜ ÌÂÙ·-·Ó·Ï‡ÛÂȘ ¤‰ÂÈÍ·Ó ÙËÓ Â˘ÂÚÁÂÙÈ΋ Â›‰Ú·ÛË ÙˆÓ ‚-·ÔÎÏÂÈÛÙÒÓ fiÛÔÓ ·ÊÔÚ¿ ÙË Ì·ÎÚÔ¯ÚfiÓÈ· ÂÈ‚›ˆÛË ·ÛıÂÓÒÓ Ì ÚÔËÁËı¤Ó ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘ Î·È ÙÔ˘˜ ηıÈ¤ÚˆÛ·Ó ˆ˜ Ê¿Ú̷η ÚÒÙ˘ ÁÚ·ÌÌ‹˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ·ÚÙËÚȷ΋˜ ˘¤ÚÙ·Û˘ Û ·ÛıÂÓ›˜ Ì ηډȷÁÁÂȷ΋ ÓfiÛÔ15. ƒÀ£ªπ™∏ ∆∏™ Ã√§∏™∆∂ƒ√§∏™ ∆√À √ƒ√À ™‡Ìʈӷ Ì ÚfiÛÊ·Ù˜ 20

Ô‰ËÁ›Â˜16, ÛÙfi¯Ô˜ Ù˘ ˘ÔÏÈȉ·ÈÌÈ΋˜ ·ÁˆÁ‹˜ Û ¿ÙÔÌ· Ì ÂÁηÙÂÛÙË̤ÓË Î·Ú‰È·ÁÁÂȷ΋ ÓfiÛÔ, ™¢ ηÈ/‹ 10ÂÙ‹ ηٿ Framingham ΛӉ˘ÓÔ ı·Ó¿ÙÔ˘ ·fi ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ ÌÂÁ·Ï‡ÙÂÚÔ ·fi 20% Â›Ó·È Ë Ì›ˆÛË Ù˘ LDL CHOL Û Â›‰· ÌÈÎÚfiÙÂÚ· ·fi 100 mg/dl. øÛÙfiÛÔ, ÚfiÛÊ·Ù˜ ÌÂϤÙ˜17 ÚÔÙ›ÓÔ˘Ó Ì›· ÂÚ·ÈÙ¤Úˆ Ì›ˆÛË ÙÔ˘ ÛÙfi¯Ô˘ Ù˘ ˘ÔÏÈȉ·ÈÌÈ΋˜ ·ÁˆÁ‹˜ Û Â›‰· ¯·ÌËÏfiÙÂÚ· ·fi 100 mg/dl, ·Ó Î·È ··ÈÙÔ‡ÓÙ·È ÂÚÈÛÛfiÙÂÚ· ‰Â‰Ô̤ӷ ÁÈ· ÙÔÓ ÙÂÏÈÎfi ηıÔÚÈÛÌfi ·˘ÙÔ‡ ÙÔ˘ ÛÙfi¯Ô˘. √È ›‰È˜ Ô‰ËÁ›Â˜ ηıÔÚ›˙Ô˘Ó Â›Û˘ ˆ˜ ÛÙfi¯Ô˘˜ Ù˘ ˘ÔÏÈȉ·ÈÌÈ΋˜ ·ÁˆÁ‹˜ ÙË Ì›ˆÛË ÙˆÓ TRG Û Â›‰· ¯·ÌËÏfiÙÂÚ· ·fi 150 mg/dl Î·È ÙËÓ ·‡ÍËÛË Ù˘ HDL CHOL Û Â›‰· ÌÂÁ·Ï‡ÙÂÚ· ·fi 40 mg/dl ÁÈ· ÙÔ˘˜ ¿Ó‰Ú˜ Î·È 50 mg/dl ÁÈ· ÙȘ Á˘Ó·›Î˜.

∞¡∞™∆√§∂π™ ∆∏™ HMG CoA ∞¡∞°ø°∞™∏™ (™∆∞∆π¡∂™) √ ÛÙ·Ù›Ó˜ ·ÔÙÂÏÔ‡Ó ÙÔÓ ÈÛ¯˘ÚfiÙÂÚÔ ·Ú¿ÁÔÓÙ· Ì›ˆÛ˘ Ù˘ LDL CHOL, ÂÓÒ ·Ú¿ÏÏËÏ· Û˘Ì‚¿ÏÏÔ˘Ó Î·È ÛÙËÓ ·‡ÍËÛË Ù˘ HDL CHOL Î·È ÙË Ì›ˆÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ. √È ÛÙ·Ù›Ó˜ Â›Ó·È ˘ÔÏÈȉ·ÈÌÈο Ê¿Ú̷η ÚÒÙ˘ ÂÈÏÔÁ‹˜ Û ·ÛıÂÓ›˜ Ì ηډȷÁÁÂȷ΋ ÓfiÛÔ Î·È/‹ ™¢. √È Î‡ÚȘ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȤ˜ ÙÔ˘˜ Â›Ó·È ÔÈ Ì˘·ÏÁ›Â˜ (1-6%), Ë ÛËÌ·ÓÙÈ΋ Î·È ‰ÔÛÔ-ÂÍ·ÚÙÒÌÂÓË ·‡ÍËÛË ÙˆÓ ÙÚ·ÓÛ·ÌÈÓ·ÛÒÓ ÙÔ˘ ÔÚÔ‡ (0,1-0,3%), Ë Ì˘Ô¿ıÂÈ· (0,7%) Î·È Ë Ú·‚‰ÔÌ˘fiÏ˘ÛË (<0,0002%). ∞ÚÎÂÙ¤˜ ÌÂÁ¿Ï˜ ÌÂϤÙ˜18,19,20,17 (4S, CARE, LIPID, HPS) ¤¯Ô˘Ó ÙÂÎÌËÚÈÒÛÂÈ ÙÔÓ È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÙˆÓ ÛÙ·ÙÈÓÒÓ ÛÙË ‰Â˘ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë Ù˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘.

ºπª¶ƒ∞∆∂™ √È ÊÈÌÚ¿Ù˜ ÂÓÂÚÁÔÔÈÔ‡Ó ÙË ÏÈÔÚˆÙÂ˚ÓÈ΋ ÏÈ¿ÛË

(LPL) Î·È ¤ÙÛÈ Û˘Ì‚¿ÏÏÔ˘Ó ÛÙË Ì›ˆÛË ÙˆÓ TRG Î·È ÙËÓ ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ HDL CHOL. ∞ÔÙÂÏÔ‡Ó Ê¿Ú̷η ÚÒÙ˘ ÂÈÏÔÁ‹˜ Û ·ÛıÂÓ›˜ Ì ÌÂÌÔӈ̤ÓË ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›·. √ Û˘Ó‰˘·ÛÌfi˜ ÙÔ˘˜ Ì ÛÙ·Ù›Ó˜ ‰ÈηÈÔÏÔÁÂ›Ù·È Û ·ÛıÂÓ›˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Ì ˘„ËÏ¿ Â›‰· LDL CHOL Î·È Â›Ù ¯·ÌËÏ¿ Â›‰· HDL CHOL, ›Ù ˘„ËÏ¿ Â›‰· TRG. ∏ ·ÚÈ· ·ÓÂÈı‡ÌËÙË ÂÓ¤ÚÁÂÈ¿ ÙÔ˘˜ Â›Ó·È Ë Ì˘Ô¿ıÂÈ· Ô˘ ·Ú·ÙËÚÂ›Ù·È Û˘¯ÓfiÙÂÚ· Û ÂÚÈÙÒÛÂȘ Û˘Á¯ÔÚ‹ÁËÛ˘ Ì ÛÙ·Ù›Ó˜. ∏ ÊÈÌÚ¿ÙË Ô˘ Ê·›ÓÂÙ·È Ó· ·ÏÏËÏÂȉڿ ÂÚÈÛÛfiÙÂÚÔ Ì ÙȘ ÛÙ·Ù›Ó˜ Â›Ó·È Ë ÁÂÌÊÈÌÚÔ˙›ÏË.21 ª›· ÌÂϤÙË22 (Ë VA-HIT) ¤‰ÂÈÍ ÙÔÓ Â˘ÂÚÁÂÙÈÎfi ÚfiÏÔ Ù˘ ÁÂÌÊÈÌÚÔ˙›Ï˘ ÛÙË ‰Â˘ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë Ù˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘.

¡π∫√∆π¡π∫√ √•À ∆Ô ÓÈÎÔÙÈÓÈÎfi Ô͇ ·˘Í¿ÓÂÈ ÙËÓ HDL CHOL, ÂÓÒ ·Ú¿ÏÏËÏ· ·Ó·ÛÙ¤ÏÏÂÈ ÙËÓ Ë·ÙÈ΋ ·Ú·ÁˆÁ‹ ÏÈÔÚˆÙÂ˚ÓÒÓ. ∆Ô Ê¿ÚÌ·ÎÔ ·˘Ùfi ÂӉ›ÎÓ˘Ù·È ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÛÙ·Ù›Ó˜ ÁÈ· ÙË ıÂÚ·›· Ù˘ ‰˘ÛÏÈȉ·ÈÌ›·˜ Û ·ÛıÂÓ›˜ ÌÂ Ê˘ÛÈÔÏÔÁÈο ‹ ¯·ÌËÏ¿ Â›‰· HDL CHOL. √È Î‡ÚȘ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȤ˜ ÙÔ˘ Â›Ó·È Ë ¤Í·„Ë (Û ¤ˆ˜ Î·È 80% ÙˆÓ ·ÛıÂÓÒÓ ÛÙËÓ ÎÚ˘ÛÙ·ÏÏÈ΋ ÌÔÚÊ‹), Ë ÔÚʇڷ, ÔÈ ·Ú·ÈÛıËۛ˜, Ë Ó·˘Ù›·, Ë Ë·ÙÔÙÔÍÈÎfiÙËÙ·, Ë ˘ÂÚÁÏ˘Î·ÈÌ›·, Ë ˘ÂÚÔ˘Úȯ·ÈÌ›·, Ë ˘fiÙ·ÛË Î·È Ë ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ÔÌÔ΢ÛÙÂ˚Ó˘ ÙÔ˘ ÔÚÔ‡. ¢π∞∫√¶∏ ∆√À ∫∞¶¡π™ª∞∆√™ ∆Ô Î¿ÓÈÛÌ· ·ÔÙÂÏ› ·ÓÂÍ¿ÚÙËÙÔ ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË Î·Ú‰È·ÁÁÂȷ΋˜ ÓfiÛÔ˘. √ Û˘Ó‰˘·ÛÌfi˜ Ù˘ Û˘Ì‚Ô˘Ï¢ÙÈ΋˜ ·Ú¤Ì‚·Û˘ Ì ʷÚÌ·ÎÔÏÔÁÈ΋ ıÂÚ·›· Ì ‚Ô˘ÚÔÚÈfiÓË Ì ‹ ¯ˆÚ›˜ ÙË ¯Ú‹ÛË ˘ÔηٿÛÙ·ÙˆÓ ÓÈÎÔÙ›Ó˘ ¤¯ÂÈ È‰È·›ÙÂ-


A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·21

™Y°XPONE™ O¢H°IE™ ÚË ÛËÌ·Û›· ÁÈ· ÙË ‰È·ÎÔ‹ ÙÔ˘ ηÓ›ÛÌ·ÙÔ˜ Û ·ÛıÂÓ›˜ Ì ÂÁηÙÂÛÙË̤ÓË Î·Ú‰È·ÁÁÂȷ΋ ÓfiÛÔ. ªÂϤÙ˜ ¤‰ÂÈÍ·Ó ÙÔ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÙfiÛÔ Ù˘ Û˘ÌÂÚÈÊÔÚÈÔÏÔÁÈ΋˜ ÙÚÔÔÔ›ËÛ˘, fiÛÔ Î·È Ù˘ Ê·Ú̷΢ÙÈ΋˜ ıÂÚ·›·˜ Ì ‚Ô˘ÚÔÚÈfiÓË23 Ì ‹ ¯ˆÚ›˜ ‰ÂÚÌ·ÙÈο ·˘ÙÔÎfiÏÏËÙ· ÓÈÎÔÙ›Ó˘ ÁÈ· ÙË ‰È·ÎÔ‹ ÙÔ˘ ηÓ›ÛÌ·ÙÔ˜.

¢π∞π∆∞ ∫∞π ƒÀ£ªπ™∏ ∆√À ™øª∞∆π∫√À µ∞ƒ√À™ √ ¢Â›ÎÙ˘ ª¿˙·˜ ™ÒÌ·ÙÔ˜ (µªπ), Ô ÔÔ›Ô˜ ÔÚ›˙ÂÙ·È ˆ˜ Ô ÏfiÁÔ˜ ÙÔ˘ ™µ (Û kg) ÚÔ˜ ÙÔ ÙÂÙÚ¿ÁˆÓÔ ÙÔ˘ ‡„Ô˘˜ (Û m), ηÙËÁÔÚÈÔÔÈ› Ù· ¿ÙÔÌ· Û ˘ÁÈ‹ (µªπ, 19-25), Û ˘¤Ú‚·Ú· (µªπ, 25-30) Î·È ·¯‡Û·Úη (µªπ >30) Î·È Û˘Û¯ÂÙ›˙ÂÙ·È ¿ÌÂÛ· Ì ÙÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ. ∂ÈϤÔÓ, ÂÚÈʤÚÂÈ· ̤Û˘ ÌÂÁ·Ï‡ÙÂÚË ÙˆÓ 102 cm ÁÈ· ÙÔ˘˜ ¿Ó‰Ú˜ ‹ 88 cm ÁÈ· ÙȘ Á˘Ó·›Î˜ ·ÔÙÂÏ› ¤Ó‰ÂÈÍË ÎÂÓÙÚÔÌÂÏÈ΋˜ ·¯˘Û·ÚΛ·˜ Ô˘ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ·˘ÍË̤ÓÔ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ. ™Â fiÏÔ˘˜ ÙÔ˘˜ ˘¤Ú‚·ÚÔ˘˜ ·ÛıÂÓ›˜ Û˘ÓÈÛÙ¿Ù·È Ì›ˆÛË ÙÔ˘ ıÂÚÌȉÈÎÔ‡ ÊÔÚÙ›Ô˘ ηٿ 500kcal/d ̤¯ÚȘ fiÙÔ˘ ·ÔÎÙ‹ÛÔ˘Ó È‰·ÓÈÎfi ™µ. ∂›Û˘, Û ·ÛıÂÓ›˜ Ì ηډȷÁÁÂȷ΋ ÓfiÛÔ Û˘ÓÈÛÙ¿Ù·È ‰›·ÈÙ· ÏÔ‡ÛÈ· Û ÚˆÙ½Ó˜, Û‡ÌÏÔÎÔ˘˜ ˘‰·Ù¿ÓıڷΘ, ˆ-3 ÏÈ·Ú¿ Ôͤ·, ÊÚÔ‡Ù·, Ï·¯·ÓÈο, ÍËÚÔ‡˜ ηÚÔ‡˜ Î·È ÛÈÙËÚ¿ ÔÏÈ΋˜ ·Ï¤Ûˆ˜ Î·È Ùˆ¯‹ Û ÎÂÎÔÚÂṲ̂ӷ Ï›Ë Î·È ¯ÔÏËÛÙÂÚfiÏË. ªÂϤÙ˜ ¤‰ÂÈÍ·Ó Ù· ÛËÌ·ÓÙÈο ÏÂÔÓÂÎÙ‹Ì·Ù· Ù˘ ªÂÛÔÁÂȷ΋˜ ‰›·ÈÙ·˜24 Î·È Ù˘ ‰›·ÈÙ·˜ Ô˘ Â›Ó·È ÏÔ‡ÛÈ· ÛÂ Ê˘ÙÈΤ˜ ›Ó˜ Î·È ÔÏ˘·ÎfiÚÂÛÙ· Ï›Ë Û ۇÁÎÚÈÛË Ì ÙË ¢˘ÙÈÎÔ‡ Ù‡Ô˘ ‰›·ÈÙ· Ô˘ Â›Ó·È ÏÔ‡ÛÈ· Û ˙ˆÈο Ï›Ë fiÛÔÓ ·ÊÔÚ¿ ÙË Ì›ˆÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜.

¶ƒ√§∏æ∏ ∫∞π £∂ƒ∞¶∂π∞ ∆√À ™∞∫Ã∞ƒø¢∏ ¢π∞µ∏∆∏ (™¢) ø˜ ™¢ ÔÚ›˙ÂÙ·È Ë ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÁÏ˘Îfi˙˘ ÓËÛÙ›·˜ ≥ 126 mg/dl ηÈ/‹ ÙÈ̤˜ ÁÏ˘Îfi˙˘ ÌÂÙ¿ ·fi ÊfiÚÙÈÛË Ì ÁÏ˘Îfi˙Ë ≥ 200 mg/dl. √ ™¢ Ù‡Ô˘ 2 ·ÔÙÂÏ› ÙÔ 90% fiÏˆÓ ÙˆÓ ÂÚÈÙÒÛÂˆÓ ™¢. ∫·Ù¿ ÙË ÌÂÙ¿‚·ÛË ·fi ÙË ÓÔÚÌÔÁÏ˘Î·ÈÌ›· ÛÙËÓ Ï‹ÚË ÂÌÊ¿ÓÈÛË ÙÔ˘ ™¢ ¤Ó·˜ ·ÛıÂÓ‹˜ ÂÓ‰¤¯ÂÙ·È Ó· ÌÂÙ·¤ÛÂÈ Î·È Û ÂӉȿÌÂÛ˜ ÌÔÚʤ˜ ·ÓÙ›ÛÙ·Û˘ ÛÙË ‰Ú¿ÛË Ù˘ ÈÓÛÔ˘Ï›Ó˘, fiˆ˜ Â›Ó·È Ë ‰È·Ù·Ú·¯‹ ·ÓÔ¯‹˜ ÁÏ˘Îfi˙˘ (IGT) Î·È Ë ‰È·Ù·Ú·¯‹ ÁÏ˘Îfi˙˘ ÓËÛÙ›·˜ (IGF). ø˜ ‰È·Ù·Ú·¯‹ ·ÓÔ¯‹˜ ÁÏ˘Îfi˙˘ ÔÚ›˙ÔÓÙ·È ÙÈ̤˜ ÁÏ˘Îfi˙˘ 140199 mg/dl ÌÂÙ¿ ·fi Ì›· ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ÊfiÚÙÈÛË Ì ÁÏ˘Îfi˙Ë Î·È ˆ˜ ‰È·Ù·Ú·¯‹ ÁÏ˘Îfi˙˘ ÓËÛÙ›·˜ ÔÚ›˙ÔÓÙ·È Â›‰· ÁÏ˘Îfi˙˘ ÓËÛÙ›·˜ 110-125 mg/dl. ŸÏÔÈ ÔÈ ·ÛıÂÓ›˜ Ì ηډȷÁÁÂȷ΋ ÓfiÛÔ ÛÙÔ˘˜ ÔÔ›Ô˘˜ Û˘Ó˘¿Ú¯Ô˘Ó ÔÈ ·Ú·¿Óˆ ‰È·Ù·Ú·¯¤˜ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÏÔÓÙ·È Û ˘ÁÈÂÈÓԉȷÈÙËÙÈ΋ ·ÁˆÁ‹ Ì ÛÙfi¯Ô ÙË Ì›ˆÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜, ÙËÓ ·‡ÍËÛË Ù˘ ۈ̷ÙÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Î·È ÙÔÓ ÂÚÈÔÚÈÛÌfi Ù˘ ‰È·ÈÙËÙÈ΋˜ ÚfiÛÏ˄˘ ÎÂÎÔÚÂṲ̂ÓÔ˘ Ï›Ô˘˜. √ ™¢ Ù‡Ô˘ 2 Â›Ó·È ¤Ó·˜ ȉȷ›ÙÂÚ· ÛËÌ·ÓÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË Î·Ú‰È·ÁÁÂȷ΋˜ ÓfiÛÔ˘ Î·È Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÂÈÙ¿¯˘ÓÛË Ù˘ ·ıËڈ̷ÙÈ΋˜ ‰È·‰Èηۛ·˜25. ∏ ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ˜ ¢ı‡ÓÂÙ·È ÁÈ· ÙÔ 65% ÙˆÓ ı·Ó¿ÙˆÓ ÙˆÓ ‰È·‚ËÙÈÎÒÓ ·ÛıÂÓÒÓ. ∞ÛıÂÓ›˜ Ì ηډȷÁÁÂȷ΋ ÓfiÛÔ Î·È ™¢ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÏÔÓÙ·È Û ۯÔÏ·ÛÙÈÎfi ÁÏ˘Î·ÈÌÈÎfi ¤ÏÂÁ¯Ô Ì ÛÙfi¯Ô ÙË Ì›ˆÛË Ù˘ ÁÏ˘ÎÔ˙˘ÏȈ̤Ó˘ ·ÈÌÔÛÊ·ÈÚ›Ó˘ (HbA1c) Û ÔÛÔÛÙfi ¯·ÌËÏfiÙÂÚÔ ÙÔ˘ 7%26. ª›· ÌÂϤÙË (Ë UKPDS) ¤‰ÂÈÍ ˆ˜ fiÛÔ Î·Ï‡ÙÂÚÔ˜ Â›Ó·È Ô

ÁÏ˘Î·ÈÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙfiÛÔ ÂÚÈÛÛfiÙÂÚÔ ÂÏ·ÙÙÒÓÂÙ·È Ô Î·Ú‰È·ÁÁÂÈ·Îfi˜ ΛӉ˘ÓÔ˜ ÙˆÓ ‰È·‚ËÙÈÎÒÓ ·ÛıÂÓÒÓ27.

∞™∫∏™∏ ∏ ·ÂÚfi‚È· Î·È ·Ó·ÂÚfi‚È· ¿ÛÎËÛË Ê·›ÓÂÙ·È fiÙÈ ÂÏ·ÙÙÒÓÔ˘Ó ÛËÌ·ÓÙÈο ÙËÓ Î·Ú‰È·ÁÁÂȷ΋ ÓÔÛËÚfiÙËÙ· Î·È ıÓËÛÈÌfiÙËÙ· Û ·ÛıÂÓ›˜ Ì ηډȷÁÁÂȷ΋ ÓfiÛÔ. ™˘ÓÈÛÙÒÓÙ·È ÙÔ˘Ï¿¯ÈÛÙÔÓ 30 ÏÂÙ¿ Á˘ÌÓ·ÛÙÈ΋˜ ËÌÂÚËÛ›ˆ˜ ÙȘ ÂÚÈÛÛfiÙÂÚ˜ Ë̤Ú˜ Ù˘ ‚‰ÔÌ¿‰·˜. ∂›Û˘, ¿ÛÎËÛË Û˘ÓÈÛÙ¿Ù·È Î·È ÛÙ· Ï·›ÛÈ· ÚÔÁÚ¿ÌÌ·ÙÔ˜ ·ÔηٿÛÙ·Û˘ ·ÛıÂÓÒÓ Ì ¯ÚfiÓÈ· ÛÙ·ıÂÚ‹ ÛÙËı¿Á¯Ë, ÚfiÛÊ·ÙÔ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘, by pass ηÈ/‹ Û˘ÛÙÔÏÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ù˘ ·ÚÈÛÙÂÚ¿˜ ÎÔÈÏ›·˜28. ∞ÚÎÂÙ¤˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó ÙÔ ÚfiÏÔ Ù˘ ¿ÛÎËÛ˘ ÛÙËÓ ÂÈ‚Ú¿‰˘ÓÛË Ù˘ ·ıËÚÔÛÎÏËÚ˘ÓÙÈ΋˜ ‰È·‰Èηۛ·˜ Î·È ÙË Ì›ˆÛË Ù˘ ηډȷÁÁÂȷ΋˜ ıÓËÛÈÌfiÙËÙ·˜ Î·È ÓÔÛËÚfiÙËÙ·˜29.

∫§∞™ª∞ ∂•ø£∏™∏™ ∫¿ı ·ÛıÂÓ‹˜ Ì ÁÓˆÛÙ‹ ηډȷÁÁÂȷ΋ ÓfiÛÔ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÏÂÙ·È Û ÂÎÙ›ÌËÛË Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ Ù˘ ·ÚÈÛÙÂÚ¿˜ ÎÔÈÏ›·˜ Ì ÙË Ì¤ÙÚËÛË ÙÔ˘ ÎÏ¿ÛÌ·ÙÔ˜ ÂÍÒıËÛ˘. ∆Ô ÌÂȈ̤ÓÔ ÎÏ¿ÛÌ· ÂÍÒıËÛ˘ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ·ÂÈÏËÙÈÎÒÓ ÁÈ· ÙË ˙ˆ‹ ·ÚÚ˘ıÌÈÒÓ, ηډȷ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ Î·È ı·Ó¿ÙÔ˘. ∞ª∂∞: ∆Ô ¯·ÌËÏfi ÎÏ¿ÛÌ· ÂÍÒıËÛ˘, ȉȷ›ÙÂÚ· ÌÂÙ¿ ·fi ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘ ·ÔÙÂÏ› ÈÛ¯˘Ú‹ ¤Ó‰ÂÈÍË ÁÈ· ÙË ¯ÔÚ‹ÁËÛË ∞ª∂∞, ηıÒ˜ ÌÂϤÙ˜ Î·È ÌÂÙ·-·Ó·Ï‡ÛÂȘ ¤‰ÂÈÍ·Ó fiÙÈ Ë ¯ÔÚ‹ÁËÛË ∞ª∂∞ Û˘Ì‚¿ÏÏÂÈ ÛËÌ·ÓÙÈο ÛÙË Ì›ˆÛË Ù˘ ηډȷÁÁÂȷ΋˜ ıÓËÛÈÌfiÙËÙ·˜ Û ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓ›˜30. µ-·ÔÎÏÂÈÛÙ¤˜: ∆Ô ¯·ÌËÏfi ÎÏ¿ÛÌ· ÂÍÒıËÛ˘, ȉȷ›ÙÂÚ· ÌÂÙ¿ ·fi ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ô-

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A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·22

·ıËÚÔÛÎÏ‹ÚˆÛË MAPTIO™ 2005

ηډ›Ô˘, ·ÔÙÂÏ› ÈÛ¯˘Ú‹ ¤Ó‰ÂÈÍË ÁÈ· ÙË ¯ÔÚ‹ÁËÛË ‚-·ÔÎÏÂÈÛÙÒÓ, ηıÒ˜ ÔÏϤ˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ Ë ¯ÔÚ‹ÁËÛË ·˘ÙÒÓ ÙˆÓ Ê·ÚÌ¿ÎˆÓ ÌÂÈÒÓÂÈ ÛËÌ·ÓÙÈο ÙËÓ Î·Ú‰È·ÁÁÂȷ΋ ıÓËÛÈÌfiÙËÙ· 31. ∞ÓÙ·ÁˆÓÈÛÙ¤˜ Ù˘ ·Ï‰ÔÛÙÂÚfiÓ˘: ∏ ÛÂÈÚÔÓÔÏ·ÎÙfiÓË Î·È Ë ÂÏÂÚÂÓfiÓË ·ÓÙ·ÁˆÓ›˙ÔÓÙ·È ÙË ‰Ú¿ÛË Ù˘ ·Ï‰ÔÛÙÂÚfiÓ˘ ÛÙËÓ Î·Ú‰È¿, ÂÓÒ ·˘Í¿ÓÔ˘Ó ÙËÓ ·¤ÎÎÚÈÛË ÙÔ˘ Ó·ÙÚ›Ô˘ Î·È ÌÂÈÒÓÔ˘Ó ÙËÓ ·¤ÎÎÚÈÛË ÙÔ˘ Î·Ï›Ô˘. ∞ÛıÂÓ›˜ Ì 3Ô˘ ‹ 4Ô˘ ‚·ıÌÔ‡ ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· ηÈ/‹ Û˘ÛÙÔÏÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ù˘ ·ÚÈÛÙÂÚ¿˜ ÎÔÈÏ›·˜ (ÎÏ¿ÛÌ· ÂÍÒıËÛ˘ ≤ 40%) Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÔ˘Ó ÛÂÈÚÔÓÔÏ·ÎÙfiÓË (¤ˆ˜ Î·È 25 mg/d) ‹ ÂÏÂÚÂÓfiÓË (¤ˆ˜ Î·È 50 mg/d), ÂÎÙfi˜ ·Ó ˘¿Ú¯Ô˘Ó ·ÓÙÂӉ›ÍÂȘ. √È Î‡ÚȘ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȤ˜ ÙÔ˘˜ Â›Ó·È Ë Á˘Ó·ÈÎÔÌ·ÛÙ›· Î·È Ô fiÓÔ˜ ÛÙÔ ÛÙ‹ıÔ˜ (΢ڛˆ˜ Ì ÙË ÛÂÈÚÔÓÔÏ·ÎÙfiÓË) Î·È Ë ÛÔ‚·-

Ú‹ ˘ÂÚηÏÈ·ÈÌ›· Ù˘ Ù¿Í˘ ÙˆÓ 6,0 mEq/L‹ Î·È ÌÂÁ·Ï‡ÙÂÚË (΢ڛˆ˜ Ì ÂÏÂÚÂÓfiÓË). ¢·ÎÙ˘Ï›Ùȉ·: ∏ ‰·ÎÙ˘Ï›Ùȉ· Ú¤ÂÈ Ó· ¯ÔÚËÁÂ›Ù·È Û ·ÛıÂÓ›˜ Ì ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ Û˘Ìو̿وÓ. √È Î‡ÚȘ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ Ù˘ ‰·ÎÙ˘Ï›Ùȉ·˜ Â›Ó·È ÔÈ ‰ÔÛÔ-ÂÍ·ÚÙÒÌÂÓ˜ ·ÚÚ˘ı̛˜, Ô ÎÔÏÔÎÔÈÏÈ·Îfi˜ ·ÔÎÏÂÈÛÌfi˜ Ô˘ ηı›ÛÙ·Ù·È Èı·ÓfiÙÂÚÔ˜ fiÙ·Ó Û˘Ó˘¿Ú¯ÂÈ Î·È ˘ÔηÏÈ·ÈÌ›· ηÈ/‹ ˘ÔÌ·ÁÓËÛÈ·ÈÌ›·, Ô ›ÏÈÁÁÔ˜ (ÛÙÔ 5% ÙˆÓ ·ÛıÂÓÒÓ), Ë ÎÂÊ·Ï·ÏÁ›· (ÛÙÔ 3%), ÔÈ ‰È·Ù·Ú·¯¤˜ Ù˘ fiÚ·Û˘, ÔÈ Á·ÛÙÚÂÓÙÂÚÈΤ˜ ‰È·Ù·Ú·¯¤˜, ÙÔ ÂÍ¿ÓıËÌ· Î·È Ë Èı·Ó‹ ·ÏÏËÏÂ›‰Ú·ÛË Ì ¿ÏÏ· Ê¿Ú̷η. ∂ÌÊ˘Ù¢fiÌÂÓÔ˜ ·˘ÙfiÌ·ÙÔ˜ ·ÈÓȉˆÙ‹˜: ∂Âȉ‹ ÔÈ ·ÛıÂÓ›˜ Ì ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘ Î·È ÛËÌ·ÓÙÈÎÔ‡ ‚·ıÌÔ‡ Û˘ÛÙÔÏÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ù˘ ·ÚÈÛÙÂÚ¿˜ ÎÔÈÏ›·˜ ‰È·ÙÚ¤¯Ô˘Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ

·ÈÊÓȉ›Ô˘ ηډȷÎÔ‡ ı·Ó¿ÙÔ˘ Ô˘ ÔÊ›ÏÂÙ·È Û ·ÚÚ˘ı̛˜, Ë ÂÌʇÙ¢ÛË ·˘ÙfiÌ·ÙÔ˘ ·ÈÓȉˆÙ‹ ı· ÌÔÚÔ‡Û ӷ ·ÔÙÂϤÛÂÈ Ì›· ·Ô‰ÂÎÙ‹ χÛË.

™Àª¶∂ƒ∞™ª∞∆∞ ∏ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ‰Â˘ÙÂÚÔÁÂÓ‹˜ ÚfiÏË„Ë Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ Â›Ó·È ÎÂÊ·Ï·ÈÒ‰Ô˘˜ ÛËÌ·Û›·˜ ÁÈ· ÙË Ì›ˆÛË ÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘. Èڛ˜ ·ÔÙÂÏÂÛÌ·ÙÈΤ˜ ÛÙÚ·ÙËÁÈΤ˜ ÚfiÏ˄˘, Ë Î·Ú‰È·ÁÁÂȷ΋ ıÓËÛÈÌfiÙËÙ· ÌÔÚ› Ó· Êı¿ÛÂÈ ÙÔ 10% ·Ó¿ ¤ÙÔ˜. ¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ¤¯Ô˘Ó ·Ó·Ù˘¯ı› ·ÚÎÂÙ¿ ÚÔÁÚ¿ÌÌ·Ù· Ô˘ ¤¯Ô˘Ó ÛÙfi¯Ô ÙËÓ ·ÏÔ‡ÛÙ¢ÛË Ù˘ ÔÏ˘·Ú·ÁÔÓÙÈ΋˜ ÚÔÛ¤ÁÁÈÛ˘ ÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘, ¤Ó·˜ ·ÛıÂÓ‹˜ Ì ηډȷÁÁÂȷ΋ ÓfiÛÔ Ú¤ÂÈ Û‹ÌÂÚ· Ó· ¿ÚÂÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ 5 Û΢¿ÛÌ·Ù· ÁÈ· ÙËÓ fiÛÔ ÙÔ ‰˘Ó·ÙfiÓ ÌÂÁ·Ï‡ÙÂÚË Ì›ˆÛË ÙÔ˘ ηÚ-

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AÓÙÈ·ÈÌÔÂÙ·Ïȷο Ê¿Ú̷η: ñ ∞ÛÈÚ›ÓË ñ ∫ÏÔȉÔÁÚ¤ÏË

BP control (ƒ‡ıÌÈÛË ∞¶) ÌÂ: ñ ∞ª∂∞ ñ µ-·ÔÎÏÂÈÛÙ¤˜ ñ ¢ÈÔ˘ÚËÙÈο ñ ∞ÓÙ·ÁˆÓÈÛÙ¤˜ ALDO ñ ∞ÔÎÏÂÈÛÙ¤˜ ÙˆÓ ∞∆1 ˘Ô‰Ô¯¤ˆÓ ñ ∞ÓÙ·ÁˆÓÈÛÙ¤˜ ·Û‚ÂÛÙ›Ô˘

Cholesterol management (ƒ‡ıÌÈÛË ¯ÔÏËÛÙÂÚfiÏ˘) ÌÂ: ñ ™Ù·Ù›Ó˜ ñ ºÈÌÚ¿Ù˜ ñ ¡ÈÎÔÙÈÓÈÎfi Ô͇

Diet and weight management (¢›·ÈÙ· Î·È Ú‡ıÌÈÛË ™.µ.) ÌÂ: ñ ∞ÒÏÂÈ· 500 kcal/d

∂xercise (ÕÛÎËÛË) ñ ∞ÂÚfi‚È· ñ ∞Ó·ÂÚfi‚È·

Smoking Cessation (¢È·ÎÔ‹ ηÓ›ÛÌ·ÙÔ˜) ÌÂ: ñ ™˘Ì‚Ô˘Ï¢ÙÈ΋ ·Ú¤Ì‚·ÛË ñ º·Ú̷΢ÙÈ΋ ‚Ô‹ıÂÈ· (‚Ô˘ÚÔÚÈfiÓË, ‰ÂÚÌ·ÙÈο ·˘ÙÔÎfiÏÏËÙ· ÓÈÎÔÙ›Ó˘)

Diabetes mellitus ™·Î¯·Ú҉˘ ¢È·‚‹Ù˘ ¶ÚfiÏË„Ë (˘ÁÈÂÈÓԉȷÈÙËÙÈ΋ ·ÁˆÁ‹) £ÂÚ·›· (™Ùfi¯Ô˜: HbA1c <7%)

∞ª∂∞ Î·È ∞ÔÎÏÂÈÛÙ¤˜ ÙˆÓ ∞∆1 ˘Ô‰Ô¯¤ˆÓ ÛÂ: ñ ∫∞ ñ ¢˘ÛÏÂÈÙÔ˘ÚÁ›· ∞∫ ñ ¶ÚfiÛÊ·ÙÔ √∂ª ∞ÓÙÈËÎÙÈ΋ ·ÁˆÁ‹ ÛÂ: ñ ∫ÔÏÈ΋ Ì·ÚÌ·Ú˘Á‹ ñ ªÂÙ¿ ·fi √∂ª fiÙ·Ó ·ÓÙÂӉ›ÎÓ˘Ù·È Ë ·ÛÈÚ›ÓË

B-·ÔÎÏÂÈÛÙ¤˜ ÛÂ: ñ √∂ª ñ ∫∞ ñ À¤ÚÙ·ÛË

™˘ÓÙÔÌÔÁڷʛ˜: ∫∞ = ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· ∞ª∂∞ = ·Ó·ÛÙÔÏ›˜ ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘

22

∫Ï¿ÛÌ· ∂ÍÒıËÛ˘ ŸÙ·Ó Â›Ó·È ¯·ÌËÏfi: ñ ∞ª∂∞ ñ µ-·ÔÎÏÂÈÛÙ¤˜ ñ ¢·ÎÙ˘Ï›Ùȉ· ñ ∞˘ÙfiÌ·ÙÔ˜ ·ÈÓȉˆÙ‹˜ ñ ∞ÓÙ·ÁˆÓÈÛÙ¤˜ ALDO

√∂ª = Ô͇ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘ ALDO = ·Ï‰ÔÛÙÂÚfiÓË ∞∫ = ·ÚÈÛÙÂÚ¿ ÎÔÈÏ›·


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™Y°XPONE™ O¢H°IE™ ‰È·ÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘. ∆Ô ÎfiÛÙÔ˜, Ë ·ÓËÛ˘¯›· Û¯ÂÙÈο Ì ÙË Û˘Ì‚·ÙfiÙËÙ· ÙˆÓ ıÂÚ·¢ÙÈÎÒÓ Û¯ËÌ¿ÙˆÓ Î·È ÙȘ Èı·Ó¤˜ ·ÏÏËÏÂȉڿÛÂȘ ÌÂٷ͇ ÙˆÓ Ê·ÚÌ¿ÎˆÓ Î¿ÓÔ˘Ó ·ÚÎÂÙÔ‡˜ ÁÈ·ÙÚÔ‡˜ Ù˘ ÚˆÙÔ-

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ÚÔ‡Ó Ó· ÏÂÈÙÔ˘ÚÁ‹ÛÔ˘Ó ˆ˜ ¤Ó· Ï·›ÛÈÔ ¿Óˆ ÛÙÔ ÔÔ›Ô ÌÔÚ› Ó· ‚·ÛÈÛı› ¤Ó· ÂÍ·ÙÔÌÈÎÂ˘Ì¤ÓÔ Û¯¤‰ÈÔ ‰Ú¿Û˘ Ì ÛÙfi¯Ô ÙË Ì›ˆÛË Ù˘ ηډȷÁÁÂȷ΋˜ ıÓËÛÈÌfiÙËÙ·˜ Î·È ÓÔÛËÚfiÙËÙ·˜.

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·ıËÚÔÛÎÏ‹ÚˆÛË MAPTIO™ 2005

¶ƒ√∆∂π¡√ª∂¡∏ µπµ§π√°ƒ∞ºπ∞ 1: Dorval JF, Anderson T, Buithieu J, Chan S, Hutchison S, Huynh T, Jobin J, Lonn E, Poirier P, Title L, Walling A, Tran T, Boudreau G, Charbonneau F, Genest J. Reaching recommended lipid and blood pressure targets with amlodipine/atorvastatin combination in patients with coronary heart disease. Am J Cardiol. 2005 Jan 15;95(2):249-53. 2: Nissen SE, Tuzcu EM, Schoenhagen P, Crowe T, Sasiela WJ, Tsai J, Orazem J, Magorien RD, O'Shaughnessy C, Ganz P; Reversal of Atherosclerosis with Aggressive Lipid Lowering (REVERSAL) Investigators. Statin therapy, LDL cholesterol, C-reactive protein, and coronary artery disease. N Engl J Med. 2005 Jan 6;352(1):29-38. 3: Ridker PM, Cannon CP, Morrow D, Rifai N, Rose LM, McCabe CH, Pfeffer MA, Braunwald E; Pravastatin or Atorvastatin Evaluation and Infection TherapyThrombolysis in Myocardial Infarction 22 (PROVE IT-TIMI 22) Investigators. Creactive protein levels and outcomes after statin therapy. N Engl J Med. 2005 Jan 6;352(1):20-8. 4: Davidson MH. High-dose statins in acute coronary syndromes. JAMA. 2005 Jan 5;293(1):38; author reply 38-9. 5: Schachter M. Chemical, pharmacokinetic and pharmacodynamic properties of statins: an update. Fundam Clin Pharmacol. 2005 Feb;19(1):117-125. 6: Jones PH, McKenney JM, Karalis DG, Downey J. Comparison of the efficacy and safety of atorvastatin initiated at different starting doses in patients with dyslipidemia. Am Heart J. 2005 Jan; 149(1):e1. 7: Saito M, Hirata-Koizumi M, Urano T, Miyake S, Hasegawa R. A literature search on pharmacokinetic drug interactions of statins and analysis of how such interactions are reflected in package inserts in Japan. J Clin Pharm Ther. 2005 Feb;30(1):21-37. 8: Orem C, Uydu HA, Yilmaz R, Gokce M, Baykan M, Eminagaoglu S, Orem A. The effects of atorvastatin treatment on the fibrinolytic system in dyslipidemic patients. Jpn Heart J. 2004 Nov;45(6):977-87. 9: Okopien B, Huzarska M, Kulach A, Stachura-Kulach A, Madej A, Belowski D, Zielinski M, Herman ZS. Hypolipidemic Drugs Affect Monocyte IL-1beta Gene Expression and Release in Patients with IIa and IIb Dyslipidemia. J Cardiovasc Pharmacol. 2005 Feb;45(2):160-4. 10: Bennett S, Sager P, Lipka L, Melani L, Suresh R, Veltri E. Consistency in efficacy and safety of ezetimibe coadministered with statins for treatment of hypercholesterolemia in women and men. J Womens Health (Larchmt). 2004 Dec; 13(10):11017. 11: Nash MS, Johnson BM, Jacobs PL. Combined hyperlipidemia in a single subject with tetraplegia: ineffective risk reduction after atorvastatin monotherapy. J Spinal Cord Med. 2004;27(5):484-7. 12: van Wissen S, Smilde TJ, Trip MD, Stalenhoef AF, Kastelein JJ. Long-term safety and efficacy of high-dose atorvastatin treatment in patients with familial hypercholesterolemia. Am J Cardiol. 2005 Jan 15;95(2):264-6. 13: Ohkawara H, Ishibashi T, Sakamoto T, Sugimoto K, Nagata K, Yokoyama K, Sakamoto N, Kamioka M, Matsuoka I, Fukuhara S, Sugimoto N, Takuwa Y, Maruya-

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ma Y. Thrombin-induced rapid geranylgeranylation of RhoA as an essential process for RhoA activation in endothelial cells. J Biol Chem. 2005 Jan 7; [Epub ahead of print] 14: Strandberg TE, Feely J, Sigurdsson EL; DISCOVERY study group. Twelve-week, multicenter, randomized, open-label comparison of the effects of rosuvastatin 10 mg/d and atorvastatin 10 mg/d in highrisk adults: a DISCOVERY study. Clin Ther. 2004 Nov;26(11):1821-33. 15: Birnbaum Y, Ye Y, Rosanio S, Tavackoli S, Hu ZY, Schwarz ER, Uretsky BF. Prostaglandins mediate the cardioprotective effects of atorvastatin against ischemia-reperfusion injury. Cardiovasc Res. 2005 Feb 1;65(2):345-55. 16: Puccetti L, Sawamura T, Pasqui AL, Pastorelli M, Auteri A, Bruni F. Atorvastatin reduces platelet-oxidized-LDL receptor expression in hypercholesterolaemic patients. Eur J Clin Invest. 2005 Jan; 35(1):47-51. 17: Deedwania PC; Study Assessing Goals in the Elderly steering committee and investigators. Effect of aggressive versus moderate lipid-lowering therapy on myocardial ischemia: the rationale, design, and baseline characteristics of the Study Assessing Goals in the Elderly (SAGE). Am Heart J. 2004 Dec;148(6): 1053-9. 18: Lipka L, Sager P, Strony J, Yang B, Suresh R, Veltri E. Efficacy and safety of coadministration of ezetimibe and statins in elderly patients with primary hypercholesterolaemia. Drugs Aging. 2004;21(15):102532. 19: Takechi R, Hiramatsu N, Mamo JC, Pal S. Red wine polyphenolics suppress the secretion and the synthesis of Apo B48 from human intestinal CaCo-2 cells. Biofactors. 2004;22(1-4):181-3. 20: Lorkowska B, Chlopicki S. Statins as coronary vasodilators in isolated bovine coronary arteries-involvement of PGI(2) and NO. Prostaglandins Leukot Essent Fatty Acids. 2005 Feb;72(2):133-8. 21: Muck AO, Seeger H, Wallwiener D. Inhibitory effect of statins on the proliferation of human breast cancer cells. Int J Clin Pharmacol Ther. 2004 Dec;42(12): 695-700. 22: Croom KF, Plosker GL. Atorvastatin: a review of its use in the primary prevention of cardiovascular events in patients with type 2 diabetes mellitus. Drugs. 2005;65(1): 137-52. 23: Kushiya F, Wada H, Ooi K, Sakurai Y, Sakaguchi A, Noda M, Abe Y, Nakasaki T, Tsukada T, Shiku H, Nobori T. Effects of atorvastatin on serum lipids, lipoproteins, and hemostasis. Am J Hematol. 2005 Jan;78(1):1-6. 24: Pannu R, Barbosa E, Singh AK, Singh I. Attenuation of acute inflammatory response by atorvastatin after spinal cord injury in rats. J Neurosci Res. 2005 Feb 1;79(3):340-50. 25: Tousoulis D, Antoniades C, Bosinakou E, Kotsopoulou M, Tsioufis C, Tentolouris C, Trikas A, Pitsavos C, Stefanadis C. Effects of atorvastatin on reactive hyperaemia and the thrombosis-fibrinolysis system in patients with heart failure. Heart. 2005 Jan;91(1):27-31. 26: Palmer G, Chobaz V, Talabot-Ayer D, Taylor S, So A, Gabay C, Busso N. Assessment of the efficacy of different statins in murine collagen-induced arthritis. Arthritis Rheum. 2004 Dec;50(12):4051-9.

27: Soliman MF, Ibrahim MM. Antischistosomal action of atorvastatin alone and concurrently with medroxyprogesterone acetate on Schistosoma haematobium harboured in hamster: surface ultrastructure and parasitological study. Acta Trop. 2005 Jan;93(1):1-9. 28: Lawman S, Mauri C, Jury EC, Cook HT, Ehrenstein MR. Atorvastatin inhibits autoreactive B cell activation and delays lupus development in New Zealand black/white F1 mice. J Immunol. 2004 Dec 15;173(12):7641-6. 29: Castro Cabezas M, Verseyden C, Meijssen S, Jansen H, Erkelens DW. Effects of atorvastatin on the clearance of triglyceride-rich lipoproteins in familial combined hyperlipidemia. J Clin Endocrinol Metab. 2004 Dec; 89(12):5972-80. 30: Chan KY, Boucher ES, Gandhi PJ, Silva MA. HMG-CoA reductase inhibitors for lowering elevated levels of C-reactive protein. Am J Health Syst Pharm. 2004 Aug 15;61(16):1676-81. 31: Psaty BM, Furberg CD, Ray WA, Weiss NS. Potential for conflict of interest in the evaluation of suspected adverse drug reactions: use of cerivastatin and risk of rhabdomyolysis. JAMA. 2004 Dec 1;292(21):2622-31. 32: Graham DJ, Staffa JA, Shatin D, Andrade SE, Schech SD, La Grenade L, Gurwitz JH, Chan KA, Goodman MJ, Platt R. Incidence of hospitalized rhabdomyolysis in patients treated with lipid-lowering drugs. JAMA. 2004 Dec 1;292(21):258590. Epub 2004 Nov 22. 33: McGirt MJ, Woodworth GF, Lynch JR, Laskowitz DT. Synthes Award for Resident Research in Spinal Cord & Spinal Column Injury: Statins for the treatment of neurological injury: a role beyond cholesterol lowering. Clin Neurosurg. 2004;51:320-8. No abstract available. 34: Pimpinella G, Bertini Malgarini R, Martini N. Statins for patients with type 2 diabetes. Lancet. 2004 Nov 27;364(9449): 1933. 35: Wagner AM, Ordonez-Llanos J, Jorba O, Perez A. Predictors of change in low-density lipoprotein size during lipid-lowering treatment in type 2 diabetes. Metabolism. 2004 Nov;53(11):1516. 36: Kida Y. Statins and rheumatoid arthritis. Lancet. 2004 Nov 20;364(9448):1854-5. 37: Van Doornum S, McColl G, Wicks IP. Atorvastatin reduces arterial stiffness in patients with rheumatoid arthritis. Ann Rheum Dis. 2004 Dec;63(12):1571-5. 38: Silver MA, Langsjoen PH, Szabo S, Patil H, Zelinger A. Effect of atorvastatin on left ventricular diastolic function and ability of coenzyme Q10 to reverse that dysfunction. Am J Cardiol. 2004 Nov 15;94(10):1306-10. 39: Lu D, Mahmood A, Qu C, Goussev A, Lu M, Chopp M. Atorvastatin reduction of intracranial hematoma volume in rats subjected to controlled cortical impact. J Neurosurg. 2004 Nov;101(5):822-5. 40: Lu D, Mahmood A, Goussev A, Schallert T, Qu C, Zhang ZG, Li Y, Lu M, Chopp M. Atorvastatin reduction of intravascular thrombosis, increase in cerebral microvascular patency and integrity, and enhancement of spatial learning in rats subjected to traumatic brain injury. J Neurosurg. 2004 Nov;101(5):813-21. ∂È̤ÏÂÈ·: µ·Û›ÏÂÈÔ˜ Õı˘ÚÔ˜


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IATPOI KA§§ITEXNE™

IATPOI KA§§ITEXNE™

£Âfi‰ˆÚÔ˜ ¡ÙfiÏ·Ù˙·˜ √ £Âfi‰ˆÚÔ˜ ¡ÙfiÏ·Ù˙·˜ ÁÂÓÓ‹ıËΠÛÙËÓ ∞ı‹Ó· ÙÔ 1946 (24-2-1946). ∞fi ÙËÓ ·È‰È΋ ÙÔ˘ ËÏÈΛ· ·Û¯ÔÏÂ›Ù·È Ì ÙËÓ Ù¤¯ÓË. ™Â ËÏÈΛ· ‰ÂηÙÂÛÛ¿ÚˆÓ (14) ÂÙÒÓ, 1960, ˙ˆÁÚ·Ê›˙ÂÈ ÚÔÛˆÔÁڷʛ˜ Ì ÌÔχ‚È. ∆ÂÏÂÈÒÓÂÈ ÙÔ °˘ÌÓ¿ÛÈÔ ÙÔ˘ ¢‹ÌÔ˘ ∆·‡ÚÔ˘ Î·È ¤‰ˆÛ ÂÍÂÙ¿ÛÂȘ, 1964, ÛÙË ™¯ÔÏ‹ ∫·ÏÒÓ ∆¯ÓÒÓ, ÛÙËÓ π·ÙÚÈ΋, ÛÙË º·Ú̷΢ÙÈ΋ Î·È ÛÙÔ ÃËÌÈÎfi ÙÌ‹Ì·. ∂¤Ú·Û Û fiϘ ÙȘ Û¯ÔϤ˜, ÙÔÓ ·ÔÚÚfiÊËÛÂ, fï˜, Ë π·ÙÚÈ΋. ∆Ô 1970 Ù¤ÏÂȈÛ ÙËÓ π·ÙÚÈ΋ Û¯ÔÏ‹ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ Î·È ÛÙË Û˘Ó¤¯ÂÈ· ÂÍÂȉÈ·ÙËΠÛÙË ¯ÂÈÚÔ˘ÚÁÈ΋ Î·È È‰È·›ÙÂÚ· ÛÙËÓ ·È‰Ô¯ÂÈÚÔ˘ÚÁÈ΋. ŒÏ·‚ ÙÔÓ Ù›ÙÏÔ Ù˘ ÂȉÈÎfiÙËÙ·˜ ÙÔ 1980. ∆ÒÚ· ˘ËÚÂÙ› ÛÙÔ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ ∞Á›· ™ÔÊ›· (¢/ÓÙ‹˜ ∞’ ¶·È‰Ô¯ÂÈÚÔ˘ÚÁÈ΋˜ ∫ÏÈÓÈ΋˜). ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂÙÂÎ·›‰Â˘Û‹˜ ÙÔ˘ ÛÙÔ Â͈ÙÂÚÈÎfi ·Ú·ÎÔÏÔ‡ıËÛ ̷ı‹Ì·Ù· ˙ˆÁÚ·ÊÈ΋˜ Û ÂχıÂÚ· ÂÚÁ·ÛÙ‹ÚÈ· ˙ˆÁÚ·ÊÈ΋˜ (πÙ·Ï›·˜ - πÛ·Ó›·˜) ηıÒ˜ Î·È ÎÔÓÙ¿ Û ¤ÌÂÈÚÔ˘˜ ˙ˆÁÚ¿ÊÔ˘˜ ÛÙËÓ ∂ÏÏ¿‰· Î·È ÛÙÔ Â͈ÙÂÚÈÎfi. ∂› Û·Ú¿ÓÙ· (40) Û˘Ó·Ù¿ ¤ÙË ‰ÂÓ ÛÙ·Ì¿ÙËÛ ӷ ˙ˆÁÚ·Ê›˙ÂÈ. ∞ÎfiÌ· Î·È ÙȘ ‰‡ÛÎÔϘ ÒÚ˜ Ù˘ ÂÊËÌÂÚ›·˜ ÙÔ˘ ÛÙ· ‰È¿ÊÔÚ· ÓÔÛÔÎÔÌ›· ˙ˆÁÚ¿ÊÈ˙ Ì ·ÎÔ˘·Ú¤Ï˜, Ù¤ÌÂÚ˜ ‹ ‰ËÌÈÔ˘ÚÁÔ‡Û ‰È¿ÊÔÚ˜ Û˘Óı¤ÛÂȘ ‹ ÁÂÏÔÈÔÁڷʛ˜. ⁄ÛÙÂÚ· ·fi ÌÂϤÙË Î·È ·ÚÎÂÙ‹ ÂÌÂÈÚ›· ¿Óˆ ÛÙË ˙ˆÁÚ·ÊÈ΋ Û οı ˘ÏÈÎfi, ÂÌÓ‡ÛÙËÎÂ Î·È ·Ó·Î¿Ï˘„ ÙË ˙ˆÁÚ·ÊÈ΋ Ì ȷÙÚÈο - ·Ó·ÏÒÛÈÌ· ˘ÏÈο Ô˘ ÙËÓ ÔÓfiÌ·Û “medical art”. ª¤¯ÚÈ Û‹ÌÂÚ· ¤¯ÂÈ ˙ˆÁÚ·Ê›ÛÂÈ ¿Óˆ ·fi 4.000 ›Ó·Î˜ (ÂÏ·ÈÔÁڷʛ˜ - ·ÂÚÔÁڷʛ˜ - ·ÁÈÔÁڷʛ˜ - Û˘Óı¤ÛÂȘ - ·ÎÔ˘·Ú¤Ï˜ - Ù¤ÌÂÚ˜ - Û¯¤‰È· - ·ÛÙ¤Ï ·ÎÚ˘ÏÈο Î.¿.). Œ¯ÂÈ Â›Û˘ ηٷÛ΢¿ÛÂÈ ‰È¿ÊÔÚ˜ ÁÏ˘ÙÈΤ˜ Û˘Óı¤ÛÂȘ Ì ͇ÏÔ, ̤ٷÏÏÔ, Á˘„ÔÙ·Èӛ˜ Î.¿.. Œ¯ÂÈ Â›Û˘ ÂÈÎÔÓÔÁÚ·Ê‹ÛÂÈ ‰‡Ô ÌÂÁ¿Ï˜ È·ÙÚÈΤ˜ ÂÁ΢ÎÏÔ·›‰ÂȘ, Î·È ¤¯ÂÈ ‰ËÌÈÔ˘ÚÁ‹ÛÂÈ ·È‰Èο ·Ú·Ì‡ıÈ· (ΛÌÂÓÔ Î·È ÂÈÎÔÓÔÁÚ¿ÊËÛË). Œ¯ÂÈ Û˘ÓÙ¿ÍÂÈ ÙÔ Î·Ù·ÛÙ·ÙÈÎfi Ù˘ ∂ÏÏËÓÈ΋˜ ∂Ù·ÈÚ›·˜ π·ÙÚÒÓ ∫·ÏÏÈÙ¯ÓÒÓ Î·È ¤¯ÂÈ ÔÚÁ·ÓÒÛÂÈ ‰ÂηÂÓÓ¤· (19) –̤¯ÚÈ Û‹ÌÂÚ·– ·ÓÂÏÏ‹ÓȘ ÂÎı¤ÛÂȘ Ì ÙËÓ ∂.∂.π.∫.. √ £Âfi‰ˆÚÔ˜ ¡ÙfiÏ·Ù˙·˜ Â›Ó·È ·ÈÚÂÙfi˜ Úfi‰ÚÔ˜ Ù˘ ∂.∂.π.∫. ·fi ÙÔ 1990 Ô˘ ‰ËÌÈÔ˘ÚÁ‹ıËÎÂ Ë ∂.∂.π.∫.. ∂›Ó·È Â›Û˘ ÁÂÓÈÎfi˜ ÁÚ·ÌÌ·Ù¤·˜ Ù˘ UMAM (Union Artist Medecin). Œ¯ÂÈ ÁÚ¿„ÂÈ Î·È ¤¯ÂÈ ÂÈÎÔÓÔÁÚ·Ê‹ÛÂÈ ÔÏÏ¿ ‚È‚Ï›· Ù¤¯Ó˘ Î·È ÔÏÏ¿ Û¯ÂÙÈο ¿ÚıÚ· Ô˘ ¤¯Ô˘Ó ‰ËÌÔÛÈ¢ı› Û ¤Á΢ڷ ÂÚÈÔ‰Èο. Œ¯ÂÈ ¿ÚÂÈ ¤ÍÈ (6) ηÏÏÈÙ¯ÓÈο ‚Ú·‚›·. ŒÚÁ· ÙÔ˘ ˘¿Ú¯Ô˘Ó Û ÔÏϤ˜ ȉȈÙÈΤ˜ Û˘ÏÏÔÁ¤˜, ‰ËÌfiÛÈ· ÎÙ›ÚÈ·, ÈÓ·ÎÔı‹Î˜ ÛÙËÓ ∂ÏÏ¿‰· Î·È ÛÙÔ Â͈ÙÂÚÈÎfi. Œ¯ÂÈ Î¿ÓÂÈ ÂÚ›Ô˘ ÂηÙfi (100) ÂÎı¤ÛÂȘ ÛÙËÓ ∂ÏÏ¿‰· Î·È ÛÙÔ Â͈ÙÂÚÈÎfi –Û·Ú¿ÓÙ· (40) ·ÙÔÌÈΤ˜ Î·È ÂÍ‹ÓÙ· (60) ÔÌ·‰ÈΤ˜– Û ‰È¿ÊÔÚ˜ ÁηÏÂÚ›, ÍÂÓԉԯ›·, ·ÓÂÈÛÙ‹ÌÈ·, ÓÔÛÔÎÔÌ›·, ÔÏÈÙÈÛÙÈο ΤÓÙÚ·, ‰Ë̷گ›· Î.¿., ·fi ÙÔ 1984 - 2000. ªÂ ÙÔ ¤ÚÁÔ ÙÔ˘ ¤¯Ô˘Ó ·Û¯ÔÏËı› Â·ÓÂÈÏËÌ̤ӷ Ô Ù‡Ô˜ –ËÌÂÚ‹ÛÈÔ˜ Î·È Â‚‰ÔÌ·‰È·›Ô˜– Î·È Ë ÙËÏÂfiÚ·ÛË. ∆Ô fiÓÔÌ¿ ÙÔ˘ -who is who- ÂÚÈÏ·Ì‚¿ÓÂÙ·È Û ÔÏÏÔ‡˜ Â›ÛËÌÔ˘˜ ηٷÏfiÁÔ˘˜ Î·È ÂÈηÛÙÈο Ï¢ÎÒÌ·Ù·. ∫ÚÈÙÈΤ˜ Ù˘ Ù¤¯Ó˘ ÙÔ˘ ¤¯ÂÈ ·ÔÛ¿ÛÂÈ ·fi ÔÏÏÔ‡˜ ÂȉÈÎÔ‡˜ Ù¤¯Ó˘ ÛÙËÓ ∂ÏÏ¿‰· Î·È ÙÔ Â͈ÙÂÚÈÎfi. ¶ÔÏÏ¿ ¤ÚÁ· ÙÔ˘ ¤¯Ô˘Ó Á›ÓÂÈ ÂÍÒÊ˘ÏÏ·, ·Ê›Û˜, οÚÙ˜ ÙÔ˘ √∆∂ (ÙËÏÂοÚÙ˜), ÂÍÒÊ˘ÏÏ· Û CD-ROM Î·È ÔÏÏ¿ ¿ÏÏ·. ¢È¿ÊÔÚ· ¤ÚÁ· ÙÔ˘ ˘¿Ú¯Ô˘Ó Û ªÔ˘Û›·, ÈÓ·ÎÔı‹Î˜, ‰ËÌfiÛÈ· ÎÙ›ÚÈ·, ȉȈÙÈΤ˜ Û˘ÏÏÔÁ¤˜, ÛÙËÓ ∂ÏÏ¿‰· Î·È ÛÙÔ Â͈ÙÂÚÈÎfi.


EΉ›‰ÂÙ·È ·fi ÙȘ È·ÙÚÈΤ˜ ÂΉfiÛÂȘ “B·ÁÈÔÓ¿ÎË” Ì ¯ÔÚËÁ›· Ù˘ PFIZER HELLAS. OÈ ·fi„ÂȘ ÛÙÔ Î›ÌÂÓÔ ÂÎÊÚ¿˙Ô˘Ó ÌfiÓÔ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Î·È ‰ÂÓ ·ÓÙÈÚÔÛˆÂ‡Ô˘Ó ÙË ¯ÔÚËÁfi ÂÙ·ÈÚ›·.

ΤΕΥΧΟΣ 5 ΜΑΡΤΙΟΣ 2005 - ΑΘΗΡΟΣΚΛΗΡΩΣΗ  

ΤΡΙΜΗΝΙΑΙΟ ΠΕΡΙΟΔΙΚΟ ΛΙΠΙΔΙΩΝ / Υπέυθυνος Σύνταξης : Ηλίας Χειμώνας / Καρδιολόγος - Υποπτέραρχος ε.α. / Εκδίδεται από τις Ιατρικές Εκδόσεις...