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∆∂ÀÃ√™ 6 ñ π√À¡π√™ 2005

¶·Ú¿ÁÔÓÙ˜ ∫ÈÓ‰‡ÓÔ˘

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¶·ıÔÊ˘ÛÈÔÏÔÁ›·

KÏÈÓÈΤ˜ MÂϤÙ˜

£ÂÚ·›· - º¿Ú̷η ™‡Á¯ÚÔÓ˜ √‰ËÁ›Â˜

¶ÚÔÙÂÈÓfiÌÂÓË µÈ‚ÏÈÔÁÚ·Ê›·


™YNTAKTIKH E¶ITPO¶H ¢È¢ı˘ÓÙ‹˜ ™‡ÓÙ·Í˘ XÂÈÌÒÓ·˜ HÏ›·˜ K·Ú‰ÈÔÏfiÁÔ˜ YÔÙ¤Ú·Ú¯Ô˜ Â.·.

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¶APA°ONTE™ KIN¢YNOY ∆Ô ¢˘ÛÏÈȉ·ÈÌÈÎfi ¶ÚÔÊ›Ï ÙˆÓ ∞ÛıÂÓÒÓ Ì ¡ÂÊÚÈ΋ ∞ÓÂ¿ÚÎÂÈ· ∆ÂÏÈÎÔ‡ ™Ù·‰›Ô˘ Î·È Ë ∂›‰Ú·ÛË ÙˆÓ £ÂÚ·ÂÈÒÓ ÀÔηٿÛÙ·Û˘

2

πˆ¿ÓÓ˘ ¶··‰¿Î˘, µ·Û›ÏÂÈÔ˜ ¡ÈÎÔÏ¿Ô˘, ™ÔÊ›· ¢ÂÚÌÈÙ˙¿ÎË, Egidio Lusvarghi

ªÂÙ·‚ÔÏÈÎfi ™‡Ó‰ÚÔÌÔ: µ·‰›˙Ô˘Ì ÚÔ˜ ∞ÏÏ·Á‹ ÙˆÓ ¢È·ÁÓˆÛÙÈÎÒÓ ∫ÚÈÙËÚ›ˆÓ; ∏Ï›·˜ ÃÂÈÌÒÓ·˜, ∫·Ú‰ÈÔÏfiÁÔ˜

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Õı˘ÚÔ˜ B·Û›ÏÂÈÔ˜ AÓ·ÏËÚˆÙ‹˜ ¢È¢ı˘ÓÙ‹˜ E™Y K·Ú‰ÈÔÏÔÁÈÎfi TÌ‹Ì· 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 ¶ÂÚÈÊÂÚÂÈ·Îfi ¶·ÓÂÈÛÙËÌÈ·Îfi

¶A£OºY™IO§O°IA °ÂÓÂÙÈ΋ ¢È¿ÁÓˆÛË Û ŒÏÏËÓ˜ Î·È °ÂÚÌ·ÓÔ‡˜ ∞ÛıÂÓ›˜ Ì √ÈÎÔÁÂÓ‹ ÀÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·

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Dedoussis GV, Genschel J, Bochow B, Pitsavos C, Skoumas J, Prassa M, Lkhagvasuren S, Toutouzas P, Vogt A, Kassner U, Thomas HP, Schmidt H Hum Mutat. 2004 Mar;23(3):285-6

∏ ∂›‰Ú·ÛË Ù˘ ªÂÙ·ÁÂ˘Ì·ÙÈ΋˜ ÀÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›·˜ Î·È ÀÂÚÁÏ˘Î·ÈÌ›·˜ ÛÙ· ∫˘ÎÏÔÊÔÚÔ‡ÓÙ· ªfiÚÈ· ¶ÚÔÛÎfiÏÏËÛ˘ Î·È ÙÔ √ÍÂȉˆÙÈÎfi ™ÙÚ˜ Î·È Ô ƒfiÏÔ˜ Ù˘ £ÂÚ·›·˜ Ì ™ÈÌ‚·ÛÙ·Ù›ÓË

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Ceriello A, Quagliaro L, Piconi L, Assaloni R, Da Ros R, Maier A, Esposito K, Giugliano D Diabetes 2004;53:701-710

NÔÛÔÎÔÌÂ›Ô HÚ·ÎÏ›Ԣ KÚ‹Ù˘ 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˜

K§INIKE™ ME§ETE™ Treating to New Targets Study (TNT): ∂ÈıÂÙÈ΋ ÀÔÏÈȉ·ÈÌÈ΋ ∞ÁˆÁ‹ Ì ∞ÙÔÚ‚·ÛÙ·Ù›ÓË Û ∞ÛıÂÓ›˜ Ì ™Ù·ıÂÚ‹ ™ÙÂÊ·ÓÈ·›· ¡fiÛÔ

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LaRosa JC, Grundy SM, Waters DD, Shear C, Barter P, Fruchart J-C, Gotto AM, Greten H, Kastelein JJP, Shepherd J, Wenger NK, for the Treating to New Targets (TNT) Investigators N Engl J Med 2005(8 April);352

Anglo-Scandinavian Cardiac Outcomes Trial: Blood Pressure-Lowering Arm (ASCOT-BPLA)

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Dr. Peter S.

YԉȢı‡ÓÙÚÈ· A’ K·Ú‰ÈÔÏÔÁÈ΋˜ KÏÈÓÈ΋˜ Î·È Y‡ı˘ÓÔ˜ §Èȉ·ÈÌÈÎÔ‡ I·ÙÚ›Ԣ øÓ·Û›Ԣ K·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈÎÔ‡ K¤ÓÙÚÔ˘ MÈÏÈ·ÓÔ‡ EϤÓË K·Ú‰ÈÔÏfiÁÔ˜ EÈÌÂÏËÙ‹˜ A’ Ù˘ K·Ú‰ÈÔÏÔÁÈ΋˜

£EPA¶EIA — ºAPMAKA ™Ù·Ù›Ó˜ Î·È √ÛÙÂÔÔÚˆÙÈο ∫·Ù¿ÁÌ·Ù·

10

∂ÈÚ‹ÓË °·˙‹, ªˆ˘Û‹˜ ∂ÏÈÛ¿Ê

∏ ÃÚ‹ÛË ÙˆÓ ∞Ó·ÛÙÔϤˆÓ Ù˘ HMG-CoA ∞Ó·ÁˆÁ¿Û˘ ÛÙ· √ͤ· ™ÙÂÊ·ÓÈ·›· ™‡Ó‰ÚÔÌ· – ªË¯·ÓÈÛÌÔ› ¢Ú¿Û˘ Î·È ¡ÂÒÙÂÚ· ¢Â‰Ô̤ӷ

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µ·Û›ÏÂÈÔ˜ ™·Ô˘ÁÎfi˜, ªˆ˘Û‹˜ ∂ÏÈÛ¿Ê

KÏÈÓÈ΋˜ Î·È Y‡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™ ™˘ÛÙ¿ÛÂȘ Ù˘ ∂˘Úˆ·˚΋˜ ∂Ù·ÈÚ›·˜ À¤ÚÙ·Û˘ ÁÈ· ÙË ™˘Ì‚·ÙÈ΋ ª¤ÙÚËÛË Î·È ÙËÓ ∂ÈÎÔÛÈÙÂÙÚ¿ˆÚË ∫·Ù·ÁÚ·Ê‹ Ù˘ ∞ÚÙËÚȷ΋˜ ¶›ÂÛ˘, ηıÒ˜ Î·È ÁÈ· ÙË ª¤ÙÚËÛË Ù˘ ∞ÚÙËÚȷ΋˜ ¶›ÂÛ˘ ÛÙÔ ™›ÙÈ

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ªÈ¯¿Ï˘ ∫·ÏÔÁ‹ÚÔ˘, µ. ∆ÛÈÌȯfi‰ËÌÔ˜, ªˆ˘Û‹˜ ∂ÏÈÛ¿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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Ó Ó ÏÔ‡ÛȈ ˆ Ù fi Ì Û È Ï LÓÔ Î·Ù·‚Ô ¤ Ì ˆ È Â Ì ˆÓ Ù˘ HD ‰ › ¤   Ï È ·  Î Â Ô Ó Ú  Ì›ˆÛË Ùˆ È·Ù·Ú·Â¿ÚÎÂÈ· È ‰ Ó · · ˜ Î È ‹ Ù Ó Î È Ò fi Ú Ó Ì ˚ Ê ·ı Ù ∏ ÓÂ È Û ¤Ó· ‚ · ÏÈÔÚˆ Â È Ó ‰ › Ò È Ú ˘ ÚÔÙÂ›Â Ù Ô Ï Î Ì Â ˘ fi ‚ Ï Ú Á È Ë ‰ Ú Û Ó Ù ˘ Ú Û · Û ‹ ·‚ÔÏÈÎÔ‡ ∏ ·ÈÌÔοı Ù .  ˜ Ì Ë Ï ˘ ·ÁÂ˘Ì·ÙÈÎ fi Ù Ô Â Ù Ú Â Ì Ù · È Û ∏ Ú Ë ‹ Ï . Ù Ô Ô ¯ ÚÈ ˘ÛÙËÚfiÙÂÚ ÓˆÛÙÈο Î · ÌfiÚÈ· · Ù Á · È È Ô ‰ · Ù Î · › ∆ ˜   ¯¤˜. ÙÈÎfi ÛÙÚ ÔÈËıÔ‡Ó ˆ  ‰ Ô È  Â Ô Í ÂÏ¿ÙÙˆÛË Ú Ô Ù Ë Ô Ô Ù · Ó Û È fi Â Ó È Ó · · Í¿ ÓÂÙ Â ÛÙÂÊ·ÓÈ·› ‰·ÈÌ›· ·˘ ‹ È Ú Ú Â Â Ù›˙ÂÙ·È Ì ı Î Â ˘ · ¯ Ï Ù Û Á Û È Ú Â L Ù Ì d Ú / ˜  g › ˘ ˘˜ ™Â ·ÛıÂÓÂ ÙˆÓ 80 m . · ˜ Ú Ë Â Û Ì ÂΛÓÔ Ù Ë fi Ï Ë Ï Ï Û Ë fi È Ì Î Ú · Û Î ¯ Ô Á Ú ‡ à  Û LÌ¿ÙˆÓ Û ˘„ ·fi Ó Ù˘ LD · Î ‚ ¤ ˆ Ì ‰ Ô ˘ ¤ Ú Û   È Ó  fi Â Ò Ù Î ÙˆÓ mg/dL. ∞˘ ډȷÁÁÂÈ· · 0 Î 0 1 Ó ÙË ASCOT ˆ ¤ Ó Ù Ï ˆ Â Ù Ë Ì Û · ∏ ˆ Ú Ù Â . Ù ) Ù dy Ïfi ÂÏ¿ ‰· ¯·ÌË gets Stu  r › a  T ÚÙËÚȷ΋˜  · Ó w ˘ e ˜ Ô N Ë ¯ Ù ¤ o t ˘ · › Ô  Ë ıÂÚ· (Treating ÁÂȷο Á È ∆ · Ù ¡ È fi ∆ ‰ Ú Ë Â · Ù Í Î ¤ È Ï Â ‰ Ù· ÙË Ì ÛΤÏÔ˜) ¤ ÈÛÛfiÙÂÚÔ Ú fi  Π È ÛÙÂÔoÛ Ô Â · Û Ù · ˆ Ú Ù Ù Â Ù Ó  ˘ ˘ ¿ È Ï Ô Ù Â Ó (·Ó ˜ Ù›Ó˜ ÌÂÈÒ ÌÏÔ‰È›ÓË · · Ù Â Û Ì Ú·ÛË ÂÓfi È Ê √ ˜ Î Ë . ¤ Û Ë · Ï Ó Ù Ë fi Ú Ï Ù ¤ Ô Ó ˘ ÛË ÂËÚ¿˙ÂÈ fi ÙËÓ ·Ù ˘  Ô ·  ÊÔÚÔÔ›Ë · fi Ù · Ì È · ‰ Û Ì È Ó ¿ Ë ‚ · Ù Ì ¯ ˘ È Ë Û Ì Ó Ԣ Â˘Ô‰Ò ÙÂÊ·ÓÈÁÌ·Ù· Ì  Û ¿ Ù , · 2 · ¤ Î Í ƒ Ô ª ¿ · Î µ ÛÙ ˜ ÚˆÙÈ Ó ÂÓˆÚ›˜ ÁÔÓÙ·, ÙË Ò ¿ Ó Â›‰· È Ú Ù · ¿ ·  Î Ù È Û ‡ ¯ Ô Ú Ë Î · Û È Ù Ë Ë Á · Ù Ú‹ ·˘Í ˚ÙËÙ· ·fi ÙÒÓ. ∏ ¯Ô Ú Û ¿ · Í Ï Â ‚ ˜ ∂˘Úˆ· Ó Ô Ë ·  ٠٠, ˜ Û ˜ È Ô ‹ Â Ï Û Ó Â ¿ ˆ Ê Ù ÛÙ Â›Ó·È Âˆ Û˘ Â›Î·È ÔÈ Û˘  · › ˜ Ì ¶ Ò Ô ı ˜ Ú · ‹ ‰ Î Ó Î ‡ · , È Ù¿ ·›· Û Ù˘ ∞ÚÙËÚ ÚfiÏ˘. ∞˘ Ë Â Û Ù Ë Û Ú Ë Ù Ï ¤ Ô Ì ¯ Ë . Ù˘ LDLÛ˘ ÁÈ· Ù · Ù Ú ¤  ˜ Ù‡¯Ô˘˜ À Ô Ù ˜ Ó · fi › Ú Â · Ú È  ˘ ÂÈÌÒÓ·˜ Ô Ã Ù ˜ · · › ٠΋˜ ∂Ù· Ï · H Ì ¤ ı ¿ ·fi Ù· Î È Ú Â ™‡ÓÙ·Í˘ Ì È ˜ ‹ · Ó Ù Ó ˘ ı ˘ ¢ÈÂ

Ù·ÍË Ó ‡ ™ ˜ Ë T


·ıËÚÔÛÎÏ‹ÚˆÛË π√À¡IO™ 2005

TÔ ¢˘ÛÏÈȉ·ÈÌÈÎfi ¶ÚÔÊ›Ï ÙˆÓ AÛıÂÓÒÓ Ì NÂÊÚÈ΋ AÓÂ¿ÚÎÂÈ· TÂÏÈÎÔ‡ ™Ù·‰›Ô˘ Î·È Ë E›‰Ú·ÛË ÙˆÓ £ÂÚ·ÂÈÒÓ YÔηٿÛÙ·Û˘ ¶··‰¿Î˘ πˆ¿ÓÓ˘: ∂ȉÈ΢fiÌÂÓÔ˜ K·Ú‰ÈÔÏfiÁÔ˜ ∞` ∫·Ú‰ÈÔÏÔÁÈ΋˜ KÏÈÓÈ΋˜ ¡.∂.∂.™, Ù. EÈÛÙËÌÔÓÈÎfi˜ ™˘ÓÂÚÁ¿Ù˘ ¶·ÓÂÈÛÙËÌȷ΋˜ ¡ÂÊÚÔÏÔÁÈ΋˜ ∫ÏÈÓÈ΋˜ ªfiÓÙÂÓ·, πÙ·Ï›·. ¡ÈÎÔÏ¿Ô˘ µ·Û›ÏÂÈÔ˜: ∞Ó·ÏËÚˆÙ‹˜ ¢È¢ı˘ÓÙ‹˜ –À‡ı˘ÓÔ˜ §Èȉ·ÈÌÈÎÔ‡ π·ÙÚ›Ԣ ∞` ∫·Ú‰ÈÔÏÔÁÈ΋˜ ∫ÏÈÓÈ΋˜ ¡.∂.∂.™ ¢ÂÚÌÈÙ˙¿ÎË ™ÔÊ›·: ∂ȉÈ΋ ¶·ıÔÏfiÁÔ˜. Lusvarghi Egidio: Ù. ¢È¢ı˘ÓÙ‹˜ ¶·ÓÂÈÛÙËÌȷ΋˜ ¡ÂÊÚÔÏÔÁÈ΋˜ ∫ÏÈÓÈ΋˜ ª.∆.¡ ªfiÓÙÂÓ·, πÙ·Ï›·

∂ÈÛ·ÁˆÁ‹: √È ·ÛıÂÓ›˜ Ì ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ ¤¯Ô˘Ó Ôχ ÌÂÁ¿ÏÔ Î›Ó‰˘ÓÔ ÁÈ· ηډȷÁÁÂÈ·Îfi ۇ̂·Ì·. ÀÔÏÔÁ›˙ÂÙ·È fiÙÈ ÛÙȘ ∏¶∞, Ë ıÓËÛÈÌfiÙËÙ· ηډÈÔÁÂÓÔ‡˜ ·ÈÙÈÔÏÔÁ›·˜ Û ԢڷÈÌÈÎÔ‡˜ ·ÛıÂÓ›˜ οو ÙˆÓ 45 ÂÙÒÓ Â›Ó·È 100 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚË ·’ fiÙÈ ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi1. H ‰˘ÛÏÈȉ·ÈÌ›· ÙˆÓ Ô˘Ú·ÈÌÈÎÒÓ ·ÛıÂÓÒÓ ·ÔÙÂÏ› ¤Ó·Ó ·fi ÙÔ˘˜ ΢ÚÈfiÙÂÚÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ·Ó¿Ù˘ÍË Î·Ú‰È·ÁÁÂȷ΋˜ ÓfiÛÔ˘ Î·È ÚÒÈÌ˘ ·ıËڈ̿وÛ˘2. ™ÎÔfi˜: √ ÛÎÔfi˜ Ù˘ ÌÂϤÙ˘ ·˘Ù‹˜ ‹Ù·Ó Ë ÂÎÙ›ÌËÛË ÙˆÓ Î˘ÚÈfiÙÂÚˆÓ ÏÈȉ·ÈÌÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ (ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË, LDL¯ÔÏËÛÙÂÚfiÏË, HDL-¯ÔÏËÛÙÂÚfiÏË Î·È ÙÚÈÁÏ˘ÎÂÚ›‰È·) Û ÓÂÊÚÔ·ı›˜ ˘fi ·ÈÌÔοı·ÚÛË (HD), ˘fi ÂÚÈÙÔÓ·˚΋ οı·ÚÛË (PD) ηıÒ˜ Î·È Û ÌÂÙ·ÌÔÛ¯Â˘Ì¤ÓÔ˘˜ ·ÛıÂÓ›˜ (TS), ÒÛÙ ӷ ηٷ‰Âȯı› Ë Â›‰Ú·ÛË ÙˆÓ ıÂÚ·ÂÈÒÓ ˘ÔηٿÛÙ·Û˘ ÛÙÔ ÏÈȉ·ÈÌÈÎfi ÚÔÊ›Ï ÙˆÓ ÓÂÊÚÔ·ıÒÓ.

ÀÏÈÎfi-ª¤ıÔ‰Ô˜: ªÂÏÂÙ‹Û·Ì 44 ·ÛıÂÓ›˜ Ì ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘, ÂÎ ÙˆÓ ÔÔ›ˆÓ 16 ˘Ô‚¿ÏÏÔÓÙ·Ó Û ·ÈÌÔοı·ÚÛË ‰È¿ÚÎÂÈ·˜ 4 ˆÚÒÓ, 3 ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰·,16 ˘Ô‚¿ÏÏÔÓÙ·Ó Û ÂÚÈÙÔÓ·˚΋ οı·ÚÛË Î·È 12 ›¯·Ó ‰Â¯ı› ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡ 43±26 Ì‹Ó˜ ÚÈÓ ÙË ÌÂϤÙË. ™ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·Ó Û ·ÈÌÔοı·ÚÛË ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó Û˘ÓıÂÙÈΤ˜ ÌÂÌ‚Ú¿Ó˜ low-flex, Ë ÚÔ‹ ÙÔ˘ ·›Ì·ÙÔ˜ ‹Ù·Ó 300-500 ml/min Î·È Ô Ú˘ıÌfi˜ ‰È‡ÏÈÛ˘ ‹Ù·Ó 7-17 ml/min. √È ·ÛıÂÓ›˜ Û ÂÚÈÙÔÓ·˚΋ οı·ÚÛË ¯ÚËÛÈÌÔÔÈÔ‡Û·Ó 4-5 ·ÛÎÔ‡˜ ÂÚÈÙÔÓ·˚ÎÔ‡ ˘ÁÚÔ‡ ÙˆÓ ‰‡Ô Ï›ÙÚˆÓ Ë Î·ıÂÌ›·, ηıËÌÂÚÈÓ¿. ∏ ̤ÛË ‰È¿ÚÎÂÈ· Ù˘ ·Ú·ÎÔÏÔ‡ıËÛ˘ ‹Ù·Ó 18,4±11 Ì‹Ó˜ Î·È Î·Ó›˜ ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ ‰ÂÓ Â›¯Â ·ÚÔ˘ÛÈ¿ÛÂÈ Î¿ÔÈÔ ÂÂÈÛfi‰ÈÔ ÂÚÈÙÔÓ›Ùȉ·˜ ÙÔ˘˜ ÙÂÏÂ˘Ù·›Ô˘˜ 6 Ì‹Ó˜. ∏ ÔÌ¿‰· ÂϤÁ¯Ô˘ ·ÔÙÂÏ›ÙÔ ·fi 16 ¿ÙÔÌ· ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›·. ∞fi ÙË ÌÂϤÙË ÂÍ·ÈÚ¤ıËÎ·Ó ·ÛıÂÓ›˜ ¿Û¯ÔÓÙ˜ ·fi ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË, ¯ÚfiÓȘ

250 200 CHOL

150

TRIG 100

HDL LDL

50 0 CG

HDG

PDG

TSG

∂ÈÎfiÓ· 1: °Ú·ÊÈ΋ ·ÂÈÎfiÓÈÛË ÙÈÌÒÓ ÏÈȉ·ÈÌÈÎÔ‡ ÚÔÊ›Ï ÓÂÊÚÔ·ıÒÓ Û ·ÈÌÔοı·ÚÛË (HDG), Û ÂÚÈÙÔÓ·˚΋ οı·ÚÛË (PDG) Î·È ÌÂÙ·ÌÔÛ¯Â˘Ì¤ÓˆÓ (TSG). CG: √Ì¿‰· ÂϤÁ¯Ô˘.

2

ÓfiÛÔ˘˜ ÙÔ˘ ‹·ÙÔ˜, ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘ Î·È ·fi ÓÂÔÏ¿ÛÌ·Ù·. √È Î˘ÚÈfiÙÂÚ˜ ·ÓıÚˆÔÌÂÙÚÈΤ˜ Î·È ·ÈÌ·ÙÔÏÔÁÈΤ˜ ·Ú¿ÌÂÙÚÔÈ ÙˆÓ ·ÙfiÌˆÓ Ù˘ ÌÂϤÙ˘ ·Ó·ÁÚ¿ÊÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1. ∆· ‰Â›ÁÌ·Ù· ·›Ì·ÙÔ˜ ÂÏ‹ÊıËÛ·Ó ÚˆÈÓ‹ ÒÚ·, Ì ÙÔ˘˜ ·ÛıÂÓ›˜ ÓËÛÙÈÎÔ‡˜, Î·È ÛÙÔ˘˜ ˘fi ·ÈÌÔοı·ÚÛË ·Ì¤Ûˆ˜ ÚÈÓ ÙËÓ ¤Ó·ÚÍË Ù˘ Û˘Ó‰ڛ·˜.

∞ÔÙÂϤÛÌ·Ù·: ∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2 Î·È ·ÂÈÎÔÓ›˙ÔÓÙ·È ÁÚ·ÊÈο ÛÙËÓ ∂ÈÎfiÓ· 1. √È ·ÛıÂÓ›˜ ˘fi ·ÈÌÔοı·ÚÛË ·ÚÔ˘Û›·˙·Ó ̤ÛË ÙÈÌ‹ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ 178±34 mg/dl, ÂÓÒ ÂΛÓÔÈ ˘fi ÂÚÈÙÔÓ·˚΋ οı·ÚÛË 237±51 mg/dl, ‰È·ÊÔÚ¿ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ (p< 0,05). ∏ ‰È·ÊÔÚ¿ Ù˘ ÙÈÌ‹˜ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ ÙˆÓ ·ÛıÂÓÒÓ Û ÂÚÈÙÔÓ·˚΋ οı·ÚÛË ‹Ù·Ó Â›Û˘ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ÙfiÛÔ Ì ·˘Ù‹ ÙˆÓ ÌÂÙ·ÌÔÛ¯Â˘Ì¤ÓˆÓ ·ÛıÂÓÒÓ (209±33 mg/dl), fiÛÔ Î·È Ì ·˘Ù‹ Ù˘ ÔÌ¿‰·˜ ÂϤÁ¯Ô˘ (194±22 mg/dl) (p< 0,05). ∏ ̤ÛË ÙÈÌ‹ ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ÛÙÔ˘˜ ˘fi ·ÈÌÔοı·ÚÛË ‹Ù·Ó 201±98 mg/dl, ÛÙÔ˘˜ ·ÛıÂÓ›˜ ˘fi ÂÚÈÙÔÓ·˚΋ οı·ÚÛË 224±96 mg/dl Î·È ÛÙÔ˘˜ ÌÂÙ·ÌÔÛ¯Â˘ı¤ÓÙ˜ 149±75 mg/dl (p= NS). √È ÙÈ̤˜ Ù˘ HDL-¯ÔÏËÛÙÂÚfiÏ˘ ‹Ù·Ó ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚ˜ ÛÙÔ˘˜ ˘fi ·ÈÌÔοı·ÚÛË ·ÛıÂÓ›˜ (31,7± 7.3 mg/dl) Î·È ÛÙÔ˘˜ ·ÛıÂÓ›˜ ˘fi ÂÚÈÙÔÓ·˚΋ οı·ÚÛË (36,5±9,6 mg/dl) (p< 0,05) Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ (50,2±15,3 mg/dl), ÂÓÒ ÔÈ ÌÂÙ·ÌÔÛ¯Â˘ı¤ÓÙ˜ ›¯·Ó ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË ÙÈÌ‹ (53,2±14,2 mg/dl) (p<0,05) ¤Ó·ÓÙÈ ÙˆÓ ÔÌ¿‰ˆÓ ·ÈÌÔοı·ÚÛ˘ Î·È ÂÚÈÙÔÓ·˚΋˜ οı·ÚÛ˘. H ̤ÛË ÙÈÌ‹ Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ ÛÙÔ˘˜ ˘fi


¶∞ƒ∞°√¡∆∂™ ∫π¡¢À¡√À

∞ÚÈıÌfi˜ ·ÛıÂÓÒÓ ∏ÏÈΛ· ∞ÈÌÔÛÊ·ÈÚ›ÓË g/dl EÚ˘ıÚ¿ ·ÈÌÔÛÊ·›ÚÈ· 106/mm3 §Â˘ÎˆÌ·Ù›ÓË g/dl

CG 16 57,9±14,4 14,9±1,1 5,27±0,5

HDG 16 61,5±12,2 9,3±1,2 2,9±0,3

PDG 16 60±17,1 10,1±1,1 3,2±0,5

TSG 12 47,6±7,4 13,7±2,2 5,13±0,8

4,21±0,39

3,9±0,2

3,7±0,5

3,9±0,41

¶›Ó·Î·˜ 1: ∞ÓıÚˆÔÌÂÙÚÈΤ˜ Î·È ‚ÈÔ¯ËÌÈΤ˜ ·Ú¿ÌÂÙÚÔÈ ÙˆÓ ·ÛıÂÓÒÓ. CG: √Ì¿‰· ÂϤÁ¯Ô˘. HDG: ∞ÈÌÔοı·ÚÛË. PDG: ¶ÂÚÈÙÔÓ·˚΋ οı·ÚÛË. TSG: ªÂÙ·ÌÔÛ¯Â˘ı¤ÓÙ˜.

√§.Ã√§∏™∆∂ƒ√§∏ (mg/dl) ∆ƒπ°§À∫∂ƒπ¢π∞ (mg/dl) HDL (mg/dl) LDL (mg/dl)

CG

HDG

PDG

TSG

194±22

178±34

237±51·‚‰

209±33‚

168±80

201±98

224±96

149±75

50,2±15,3 31,7±7,3· 36,5±9,6· 53,2±14,2‚Á 110,2±9,3 106,3±6,9 155,7±22·‚‰ 126±3,8‚

¶›Ó·Î·˜ 2: ∆È̤˜ ÏÈȉ·ÈÌÈÎÔ‡ ��ÔÊ›Ï ÓÂÊÚÔ·ıÒÓ Û ·ÈÌÔοı·ÚÛË (HDG), Û ÂÚÈÙÔÓ·˚΋ οı·ÚÛË (PDG) Î·È Û ÌÂÙ·ÌÔÛ¯Â˘Ì¤ÓÔ˘˜ (TSG). CG: √Ì¿‰· ÂϤÁ¯Ô˘. ·: ™Ù·ÙÈÛÙÈ΋ ÛËÌ·ÓÙÈÎfiÙËÙ· ¤Ó·ÓÙÈ ÔÌ¿‰·˜ ÂϤÁ¯Ô˘. ‚: ™Ù·ÙÈÛÙÈ΋ ÛËÌ·ÓÙÈÎfiÙËÙ· ¤Ó·ÓÙÈ ·ÈÌÔοı·ÚÛ˘. Á: ™Ù·ÙÈÛÙÈ΋ ÛËÌ·ÓÙÈÎfiÙËÙ· ¤Ó·ÓÙÈ ÂÚÈÙÔÓ·˚΋˜ οı·ÚÛ˘ ‰: ™Ù·ÙÈÛÙÈ΋ ÛËÌ·ÓÙÈÎfiÙËÙ· ¤Ó·ÓÙÈ ÌÂÙ·ÌfiÛ¯Â˘Û˘.

·ÈÌÔοı·ÚÛË ·ÛıÂÓ›˜ ‹Ù·Ó 106,3±6,9 mg/dl ÂÓÒ ·˘Ù‹ ÛÙÔ˘˜ ·ÛıÂÓ›˜ ˘fi ÂÚÈÙÔÓ·˚΋ οı·ÚÛË 155,7±22 mg/dl, ‰È·ÊÔÚ¿ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋. ™Ù·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈ΋ ‹Ù·Ó Ë ‰È·ÊÔÚ¿ Î·È ¤Ó·ÓÙÈ ÙˆÓ ÌÂÙ·ÌÔÛ¯Â˘ı¤ÓÙˆÓ (126±3,8 mg/dl) (p< 0,05).

™˘˙‹ÙËÛË: √È Î·Ú‰È·ÁÁÂȷΤ˜ ÂÈÏÔΤ˜ ·ÔÙÂÏÔ‡Ó ÙÔ ÈÔ ÛËÌ·ÓÙÈÎfi ·›ÙÈÔ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÙfiÙËÙ·˜ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ·, ÏfiÁˆ Ù˘ ÌÂÁ·Ï‡ÙÂÚ˘ Â›ÙˆÛ˘ ÛÙÔ˘˜ ÓÂÊÚÔ·ı›˜ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ fiˆ˜ Ë ·ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË, Ô Û·Î¯·Ú҉˘ ‰È·‚‹Ù˘ Î·È Ë ‰˘ÛÏÈȉ·ÈÌ›·3. √È Ù¯ÓÈΤ˜ οı·ÚÛ˘ fiˆ˜ Î·È Ë ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡ ·˘Í¿ÓÔ˘Ó Ù· Â›‰· ηډȷÁÁÂȷ΋˜ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÙfiÙËÙ·˜ Û ۇÁÎÚÈÛË Ì ÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi ηٿ 40% Î·È 34% ·ÓÙ›ÛÙÔȯ·4,5. ∏ ‰˘ÛÏÈȉ·ÈÌ›· Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÙËÓ ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ Ê·›ÓÂÙ·È Ó· ÔÊ›ÏÂÙ·È Û ÌÂÙ·‚ÔϤ˜ ÛÙÔ ÌÂÙ·‚ÔÏÈÛÌfi Î·È ÙËÓ Û‡ÓıÂÛË ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ. ∏ ÈÔ ÛËÌ·ÓÙÈ΋ ‰È·Ù·Ú·¯‹ Û˘Ó›ÛÙ·Ù·È ÛÙÔ ÌÂȈ̤ÓÔ Î·Ù·‚ÔÏÈÛÌfi ÙˆÓ ÏÔ‡ÛÈˆÓ Û ÙÚÈÁÏ˘ÎÂÚ›‰È· ÏÈÔÚˆÙÂ˚ÓÒÓ Ì ·ÔÏÈÔÚˆÙ½ÓË µ (apo µ), (VLDL, IDL Î·È LDL), ÂÍ·ÈÙ›·˜ ÌÂȈ̤Ó˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÙˆÓ ÏÈÔÏ˘ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ, ·ÓˆÌ·ÏÈÒÓ ÛÙË Û‡ÓıÂÛË ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ ‹ ÌÂȈ̤Ó˘ ÚfiÛÏË„‹˜ ÙÔ˘˜ ·fi ÙÔ˘˜ ÏÈÔ-

ÚˆÙÂ˚ÓÈÎÔ‡˜ ˘ԉԯ›˜6. ¶·Ú¿ÏÏËÏ·, ÔÈ Û˘ÁÎÂÓÙÚÒÛÂȘ ÙˆÓ ·ÔÏÈÔÚˆÙÂ˚ÓÒÓ ∞, (·ÚȘ ·ÔÏÈÔÚˆÙ½Ó˜ Ù˘ HDL), ÌÂÈÒÓÔÓÙ·È Î·ıÒ˜ Î·È Ô ÏfiÁÔ˜ apoA-I /apoCIII7. ∆Ô ÙÂÏÈÎfi ·ÔÙ¤ÏÂÛÌ· Â›Ó·È Ë ·‡ÍËÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ Î·È Ù˘ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ Û fiϘ ۯ‰fiÓ ÙȘ ÏÈÔÚˆÙ›Ó˜ Î·È Ë Ì›ˆÛË Ù˘ HDL-C, Ú¿ÁÌ· Ô˘ ·Ú·ÙËÚÂ›Ù·È Î·È ÛÙË ‰È΋ Ì·˜ ÌÂϤÙË Î·È Ì¿ÏÈÛÙ· fiÛÔ ·ÊÔÚ¿ ÙËÓ HDL-C Û ‚·ıÌfi ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈÎfi. (p< 0,05) ∏ ·ÈÌÔοı·ÚÛË Î·È Ë ÂÚÈÙÔÓ·˚΋ οı·ÚÛË Â›Ó·È Û ı¤ÛË Ó· ‚ÂÏÙÈÒÛÔ˘Ó Ù· Û˘ÌÙÒÌ·Ù· Ù˘ Ô˘Ú·ÈÌ›·˜, ˆÛÙfiÛÔ Ë Â›‰Ú·ÛË ÙˆÓ ‰È·ÊfiÚˆÓ Ù¯ÓÈÎÒÓ Î¿ı·ÚÛ˘ ÛÙÔ ‰˘ÛÏÈȉ·ÈÌÈÎfi ÚÔÊ›Ï ÙˆÓ ·ÛıÂÓÒÓ Â›Ó·È ‰È·ÊÔÚÂÙÈ΋8. √È ÌÂÙ·‚ÔϤ˜ Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙË ¯ÚfiÓÈ· ·ÈÌÔοı·ÚÛË ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙËÓ ·‡ÍËÛË ÙˆÓ ·ÔÏÈÔÚˆÙÂ˚ÓÒÓ µ, ∂ Î·È C-III ηıÒ˜ Î·È ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ Ôχ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ (VLDL) Î·È ÙËÓ ÂÏ¿ÙÙˆÛË ÙˆÓ ·ÔÏÈÚˆÙÂ˚ÓÒÓ A-I, A-II Î·È ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ (HDL)8,9. ∏ ¯ÚËÛÈÌÔÔ›ËÛË ¯·ÌËÏÔ‡ ÌÔÚÈ·ÎÔ‡ ‚¿ÚÔ˘˜ Ë·Ú›Ó˘ ˆ˜ ·ÓÙÈËÎÙÈÎfi, Ê·›ÓÂÙ·È Ó· Âȉڿ ÛÙÔ ÌÂÙ·‚ÔÏÈÛÌfi Ù˘ ÏÈÔÚˆÙÂ˚ÓÈ΋˜ ÏÈ¿Û˘ ÚÔηÏÒÓÙ·˜ Ì›· ÂÏ·ÊÚ¿ ˘Ô¯ÒÚËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ Û ۇÁÎÚÈÛË Ì ÙȘ ÌË ÎÏ·ÛÌ·ÙÈΤ˜ Ë·Ú›Ó˜9. ∏ ÂÚÈÙÔÓ·˚΋ οı·ÚÛË ·fi ÙËÓ ¿ÏÏË ÏÂ˘Ú¿, ·ÚfiÏÔ Ô˘ ·-

ÚÔ˘ÛÈ¿˙ÂÈ, Û‡Ìʈӷ Ì ÚfiÛÊ·Ù· ‰ËÌÔÛÈÂ˘Ì¤ÓË ÌÂϤÙË Ì·˜, ηχÙÂÚ· ·ÔÙÂϤÛÌ·Ù· ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ fiˆ˜ ÙÔ ÔÍÂȉˆÙÈÎfi ÛÙÚ˜ Û ۇÁÎÚÈÛË Ì ÙËÓ ·ÈÌÔοı·ÚÛË, Ê·›ÓÂÙ·È Ó· ÂȉÂÈÓÒÓÂÈ ÛËÌ·ÓÙÈο ÙË ‰˘ÛÏÈȉ·ÈÌ›· ÙˆÓ Ô˘Ú·ÈÌÈÎÒÓ ·ÛıÂÓÒÓ ·˘Í¿ÓÔÓÙ·˜ ÙȘ ·ıËÚÔÁfiÓ˜ ÏÈÔÚˆÙ›Ó˜10. ¶ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ, Ù· Â›‰· LDL-C Î·È ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ Ï¿ÛÌ·ÙÔ˜ Â›Ó·È ˘„ËÏfiÙÂÚ· Û ۇÁÎÚÈÛË Ì ÙËÓ ·ÈÌÔ‰È‡Ï˘ÛË, ÂÓÒ Ôχ „ËϤ˜ ÙÈ̤˜ ·ÚÔ˘ÛÈ¿˙ÂÈ Î·È Ë Lp(·)11. ¶·Ú¿ÏÏËÏ·, ÔÈ ÙÈ̤˜ apoB 100 ÛÙÔ Ï¿ÛÌ· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ·˘ÍË̤Ó˜, ȉȷ›ÙÂÚ· ÛÙȘ ÏÈÔÚˆÙ½Ó˜ VLDL Î·È IDL12. ¢È¿ÊÔÚÔÈ Ì˯·ÓÈÛÌÔ› ¤¯Ô˘Ó ÚÔÙ·ı› ÁÈ· ÙËÓ ·‡ÍËÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ÛÙËÓ ÂÚÈÙÔÓ·˚΋ οı·ÚÛË fiˆ˜ Ô ÌÂȈ̤ÓÔ˜ ηٷ‚ÔÏÈÛÌfi˜ ÙˆÓ VLDL ·fi ÙËÓ ÏÈÔÚˆÙÂ˚ÓÈ΋ Î·È ·fi ÙËÓ Ë·ÙÈ΋ ÏÈ¿ÛË Î·È Ë ·˘ÍË̤ÓË ÏÈÔÚˆÙÂ˚ÓÈ΋ Û‡ÓıÂÛË ÏfiÁˆ Ù˘ ·ÒÏÂÈ·˜ ÌÂÁ¿ÏˆÓ ÔÛÔÙ‹ÙˆÓ ÚˆÙÂ˚ÓÒÓ ÛÙÔ ÂÚÈÙÔÓ·˚Îfi ˘ÁÚfi13. ÀÂÚÏÈȉ·ÈÌ›· ·Ú·ÙËÚÂ›Ù·È ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ÌÂÙ·ÌÔÛ¯Â˘ı¤ÓÙˆÓ ÓÂÊÚÔ·ıÒÓ Î·È ÌÔÚ› Ó· ·›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÙfiÛÔ ÛÙËÓ ·Ô‰Ô¯‹ ÙÔ˘ ÌÔۯ‡̷ÙÔ˜ fiÛÔ Î·È ÛÙËÓ ÂͤÏÈÍË Ù˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘14. ∏ Â›‰Ú·ÛË ÙˆÓ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ Î·È Ù˘ ΢ÎÏÔÛÔÚ›Ó˘ ÛÙÔ ÏÈȉ·ÈÌÈÎfi ÚÔÊ›Ï ÙˆÓ ·ÛıÂÓÒÓ ·˘ÙÒÓ ·Ú·Ì¤ÓÂÈ ˘fi ‰ÈÂÚ‡ÓËÛË Î·ıÒ˜ ·ÓÙÈÎÚÔ˘fiÌÂÓ˜ ·fi„ÂȘ ¤¯Ô˘Ó ‰È·Ù˘ˆı› 14,15. ÀÔÛÙËÚ›˙ÂÙ·È fiÙÈ ÌÂÁ¿ÏË ÛËÌ·Û›· ÛÙËÓ ÂͤÏÈÍË Ù˘ ÌÂÙ·ÌfiÛ¯Â˘Û˘, ÙÔ˘Ï¿¯ÈÛÙÔÓ Î·Ù¿ ÙÔ ÚÒÙÔ ¤ÙÔ˜ ¤¯Ô˘Ó ÔÈ ‰È·Ù·Ú·¯¤˜ ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ ÚÈÓ ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË16. ™ÙË ÌÂϤÙË Ì·˜, Ï·Ì‚¿ÓÔÓÙ·˜ ˘fi„Ë fiÙÈ ¤¯Ô˘Ó ÂÚ¿ÛÂÈ Î·Ù¿ ̤ÛÔ fiÚÔ 4 ¤ÙË ·fi ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË, ÔÈ ·ÛıÂÓ›˜ ·ÚÔ˘Û›·Û·Ó ¤Ó· Ôχ ÈηÓÔÔÈËÙÈÎfi ÏÈȉ·ÈÌÈÎfi ÚÔÊ›Ï.

™˘ÌÂÚ¿ÛÌ·Ù·: ∂›Ó·È ¤Ú· ·fi οı ·ÌÊÈ‚ÔÏ›· ˆ˜ Ë ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ Û˘Óԉ‡ÂÙ·È ·fi ÌÂÙ·‚ÔϤ˜ ÛÙÔ ÏÈȉ·ÈÌÈÎfi ÚÔÊ›Ï ÙˆÓ ·ÛıÂÓÒÓ, Ô˘ ÂÈÙ›ÓÔ˘Ó ÙÔÓ Î›Ó‰˘ÓÔ ·Ó¿Ù˘Í˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘. ∏ ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡ Ê·›ÓÂÙ·È Ó· ˘ÂÚÙÂÚ› ÛËÌ·ÓÙÈο ÛÙËÓ ÔÌ·ÏÔÔ›ËÛË ÙˆÓ ÏÈȉ·ÈÌÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ Û ۇÁÎÚÈÛË Ì ÙËÓ ·ÈÌÔοı·ÚÛË Î·È ÙËÓ ÂÚÈÙÔÓ·˚΋ οı·ÚÛË.

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Foley RN, Parfrey PS,Sarnak MJ: Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis (1998) 21 (Suppl 3):S112-19. Vera Krane, Christoph Wanner: The metabolic burden of diabetes and dyslipidaemia in chronic kidney disease. Nephrol Dial Trasplant (2002) 17 (Suppl 11):23-27. Sarnak MJ, Levey AS. Cardiovascular disease and chronic renal disease: a new paradigm. Am J Kidney Dis 2000; 35(Suppl 1):S117-S131. Goldsmith DJ, Covic A. Coronary artery disease in uremia: etiology, diagnosis, and therapy. Kidney Int 2001;60:205978. Kasiske BL, Guijarro C, Massy ZA, Wiederkehr MR, Ma JZ. Cardiovascular disease after renal transplantation. J Am Soc Nephrol 1996;7:158-65. Attman P.O, Samuelson O, Alaupovic P: Lipoprotein metabolism and renal failure. Am J Kidney Dis 21:573-591,1993. Moberly JB, Attman P.O, Samuelson O, et al:Apolipoprotein C-III, hypertriglyceri-

demia and triglyceride-rich lipoproteins in uremia. Miner Electrolyte Metab 25: 258-262,1999. 8) Takashi Sakurai, Hiroyuki Akiyama, Toru Oka, Kenn-ichi Sekita, Koichi Yokono, Takeo Goto. Serum lipids status in patients with diabetic uremia on 10 years of maintenance hemodialysis. Kidney International (1999) 56 (Supp 71):S216-18. 9) Per-Ola Attman, Ola Samuelsson, AnnCathrine Johansson, James B. Moberly, Petar Alaupovic. Dialysis modalities and dyslipidemia. Kidney International (2003) 63 (Supp 84):S110-12. 10) Lucchi L, Bergamini S, Iannone A,et al: Erythrocyte susceptibility to oxidative stress in chronic renal failure patients under different substitutive treatments. Artif Organs. (2005) 29 (1):67-72. 11) Florian Kronemberg, Arno Lingenheil, Ulrich Never, Karl Lhotta, Paul Konig, Martin Auinger, Martin Wiesholzer, Helene Andersson, and Hans Dieplinger. Prevalence of dyslipidemic risk factors in hemodialysis and CAPD patients. Kidney International (2003) 63 (Supp 84):S11316.

12) Attman PO, Samuelsson OG, Moberly J,et al: Apolipoprotein B-containing lipoproteins in renal failure:the relation to mode of dialysis. Kidney Int (1999) 55:1536-42. 13) Berthil H.C.M.T. Prinsen, Monique G.M.de Sain-Van der Velden, Eelco J.P. de Koning, Hein A. Koomans, Ruud Berger, Ton J.Rabelink. Hypertriglyceridemia in patients with chronic renal failure: Possible mechanisms. Kidney International (2003) 63, (Supp 84): S121-24. 14) Hricik DE. Posttransplant hyperlipidemia: the treatment dilemma. Am J Kidney Dis. 1994 May;23(5):766-71 15) Zdrojewski Z, Kisielnicka E, Kortas B, Spineter-Sokolowska EA, Badzio T, Rutkowski B. Dynamics of changes in lipid metabolism during the first year after kidney transplantation. Pol Arch Med Wewn. 1994 Sep;92(3): 229-36. 16) Dimeny E, Tufveson G, Lithell H, Larsson E, Siegbahn A, Fellstrom B. The influence of pretransplant lipoprotein abnormalities on the early results of renal transplantation. Eur J Clin Invest. 1993 Sep;23(9):572-9.

ªÂÙ·‚ÔÏÈÎfi ™‡Ó‰ÚÔÌÔ: µ·‰›˙Ô˘Ì ÚÔ˜ ∞ÏÏ·Á‹ ÙˆÓ ¢È·ÁÓˆÛÙÈÎÒÓ ∫ÚÈÙËÚ›ˆÓ; ∏Ï›·˜ ÃÂÈÌÒÓ·˜, ∫·Ú‰ÈÔÏfiÁÔ˜ ˆ˜ Â›Ó·È ÁÓˆÛÙfi ªÂÙ·‚ÔÏÈÎfi ™‡Ó‰ÚÔÌÔ (ª™) Â›Ó·È Ì›· ÔÌ¿‰· ÌÂÙ·‚ÔÏÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ÌÂٷ͇ ÙÔ˘˜ ·ıÔÁÂÓÂÙÈο Î·È Û˘ÓÂ¿ÁÔÓÙ·È ·˘ÍË̤ÓÔ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ. √È ÚÒÙ˜ ·Ó·ÊÔÚ¤˜ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ÁÈ· ÙË Û¯¤ÛË Ù˘ ۈ̷ÙÈ΋˜ ηٷÓÔÌ‹˜ ÙÔ˘ Ï›Ô˘˜ Ì ÙÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ ¤ÁÈÓ·Ó ÚÈÓ 60 ¯ÚfiÓÈ· ∆Ô 1988 Ô Reaven Û˘Ó¤‰ÂÛ ÙËÓ ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË Ì ÙËÓ ÂÌÊ¿ÓÈÛË ‰È·Ù·Ú·¯ÒÓ ÛÙÔ ÌÂÙ·‚ÔÏÈÛÌfi ÙˆÓ ˘‰·Ù·ÓıÚ¿ÎˆÓ Î·È ÙˆÓ ÏÈȉ›ˆÓ Î·È Ì ·˘ÍË̤ÓË ·ÚÙËÚȷ΋ ›ÂÛË Î·È ¯ÚËÛÈÌÔÔ›ËÛ ÙÔ fiÚÔ «™‡Ó‰ÚÔÌÔ Ã» ÁÈ· Ó· ÂÚÈÁÚ¿„ÂÈ ÙËÓ ÎÏÈÓÈ΋ Û˘Ó‰ÚÔÌ‹ ÛÙËÓ ÔÔ›· Û˘Ó˘¿Ú¯Ô˘Ó ·˘ÍË̤ӷ ÙÚÈÁÏ˘ÎÂÚ›‰È·, ÌÂȈ̤ÓË HDL- ¯ÔÏËÛÙÂÚfiÏË, ˘ÂÚÈÓÛÔ˘ÏÈÓ·ÈÌ›· Î·È ·˘ÍË̤ÓË ∞¶. ¢ÂÓ ıˆÚÔ‡Û ··Ú·›ÙËÙË ÙËÓ ‡·ÚÍË ·¯˘Û·ÚΛ·˜, ÁÈ·Ù› ·Ú·Ù‹ÚËÛ fiÙÈ ˘¿Ú¯ÂÈ ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË ·ÎfiÌË Î·È Û ÌË ·¯‡Û·Úη ¿ÙÔÌ·. ∞ÚÁfiÙÂÚ· ‰È·ÈÛÙÒıËΠfiÙÈ ·¯˘Û·ÚΛ· fiÓÙˆ˜ Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË Î·È fiÙÈ Èı·Ófiٷٷ ·ÔÙÂÏ› ÙËÓ Î˘ÚÈfiÙÂÚË ·ÈÙ›· Ù˘ ·ÏÏ¿ fiÙÈ ÛËÌ·Û›· ‰ÂÓ ¤¯ÂÈ ÙÔ ·˘ÍË̤ÓÔ ÛˆÌ·ÙÈÎfi ‚¿ÚÔ˜ ηı ·˘Ùfi ·ÏÏ¿ Ë Î·Ù·ÓÔÌ‹ ÙÔ˘ Ï›Ô˘˜, Î·È Û˘ÁÎÂÎÚÈ̤ӷ Ë ÎÔÈÏȷ΋ ·¯˘Û·ÚΛ·, ‹

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·¯˘Û·ÚΛ· ÎÂÓÙÚÈÎÔ‡ Ù‡Ô˘ ‹ ·Ó‰ÚÔÂȉ‹˜ ·¯˘Û·ÚΛ·. ¶·Ú¿ ÙÔÓ fiÁÎÔ ÙˆÓ ‰ËÌÔÛȇÛÂˆÓ Ô˘ Á›ÓÔÓÙ·È Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ‰È¯ÔÁӈ̛· Î·È Û‡Á¯˘ÛË ÂÍ·ÎÔÏÔ˘ı› Ó· ˘¿Ú¯ÂÈ fiÛÔÓ ·ÊÔÚ¿ ÙÔÓ ÔÚÈÛÌfi Î·È Ù· ‰È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· ÙÔ˘ ª™. ∏ ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË, ÔÈ ‰È·Ù·Ú·¯¤˜ Ù˘ ÈÛÔÚÚÔ›·˜ ÌÂٷ͇ ‹Í˘ Î·È ÈÓˆ‰fiÏ˘Û˘ ÙÔ˘ ·›Ì·ÙÔ˜ Î·È ‰È·Ù·Ú·¯¤˜ ÛÙÔ˘˜ ‰Â›ÎÙ˜ ÊÏÂÁÌÔÓ‹˜ Û˘Ó˘¿Ú¯Ô˘Ó ÛÙÔ ª™ ·ÏÏ¿ ‰ÂÓ Â›Ó·È Â‡ÎÔÏÔ Ó· ÌÂÙÚËıÔ‡Ó ÛÙËÓ Î·ı Ë̤ڷ ÎÏÈÓÈ΋ Ú¿ÍË. °È ·˘Ùfi ÙÔ NCEP ATP III ηıȤڈÛË ÌÂÚÈο ·Ï¿ ‰È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙÔ˘ ª™, Ù· ÔÔ›· ‚Ô‹ıËÛ·Ó ÛËÌ·ÓÙÈο ÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË ·ÏÏ¿ Î·È ÙËÓ ÂȉËÌÈÔÏÔÁÈ΋ ¤Ú¢ӷ. ∞˘Ù¿ ›ӷÈ: ÂÚ›ÌÂÙÚÔ˜ ̤Û˘ >102 cm ÛÙÔ˘˜ ¿Ó‰Ú˜ ‹ >88 cm ÛÙȘ Á˘Ó·›Î˜, HDL-¯ÔÏËÛÙÂÚfiÏË <40 mg/dl ÛÙÔ˘˜ ¿Ó‰Ú˜ ‹ <50 mg/dl ÛÙȘ Á˘Ó·›Î˜, ÙÚÈÁÏ˘ÎÂÚ›‰È· ≥150 mg/dl, ∞¶ ≥ 130/85 mmHg Î·È Û¿Î¯·ÚÔ ·›Ì·ÙÔ˜ ÓËÛÙ›·˜ ≥110 mg/dl. ⁄·ÚÍË ÔÔȈӉ‹ÔÙ ÙÚÈÒÓ ·fi Ù· ÎÚÈÙ‹ÚÈ· ·˘Ù¿ Â›Ó·È ·ÚÎÂÙ¿ ÁÈ· Ó· ÙÂı› ‰È¿ÁÓˆÛË ª™. ™ÙÔ 75Ô ™˘Ó¤‰ÚÈÔ Ù˘ ∂˘Úˆ·˚΋˜ ∂Ù·ÈÚ›·˜ ∞ıËÚÔÛÎÏ‹ÚˆÛ˘ (EAS) Ô˘ ¤ÁÈÓ ÛÙËÓ ¶Ú¿Á·

·fi 24 ¤ˆ˜ 26 ∞ÚÈÏ›Ô˘ 2005 Ú·ÁÌ·ÙÔÔÈ‹ıËΠ̛· ÎÔÈÓ‹ Û˘Ó‰ڛ·ÛË Ù˘ EAS Ì ÙËÓ ∂˘Úˆ·˚΋ ¢È·‚ËÙÔÏÔÁÈ΋ ∂Ù·ÈÚ›· (EDS) ÛÙËÓ ÔÔ›· ÚÔÙ¿ıËÎ·Ó Ó¤Â˜ ÙÈ̤˜ ÁÈ· Ù· ‰È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ·, ÂÚÈÛÛfiÙÂÚÔ ·˘ÛÙËÚ¿. ∆· fiÚÈ· Ù˘ ÂÚÈ̤ÙÚÔ˘ ̤Û˘ ÂÚÈÔÚ›˙ÂÙ·È ÛÙ· 94 cm ÁÈ· ÙÔ˘˜ ¿Ó‰Ú˜ Î·È ÛÙ· 80 cm ÛÙȘ Á˘Ó·›Î˜ (ÁÈ· ÙÔ Ï¢Îfi ÏËı˘ÛÌfi) Î·È ÙÔ fiÚÈÔ Ù˘ ÁÏ˘Îfi˙˘ ÓËÛÙ›·˜ <100 mg/dl. √È ˘fiÏÔÈ˜ ÙÈ̤˜ fiÚÈ· ·Ú·Ì¤ÓÔ˘Ó ÛÙ· ÚÔËÁÔ‡ÌÂÓ· Â›‰·. ∏ ÂÚ›ÌÂÙÚÔ˜ ̤Û˘ ·ÔÙÂÏ› ··Ú·›ÙËÙÔ ‰È·ÁÓˆÛÙÈÎfi ÎÚÈÙ‹ÚÈÔ Î·È ·‡ÍËÛË Ù˘ ¿Óˆ ·fi Ù· ·Ú·¿Óˆ fiÚÈ· Î·È ‡·ÚÍË ‰‡Ô ÔÔȈӉ‹ÔÙ ·fi Ù· ¿ÏÏ· 4 ÎÚÈÙ‹ÚÈ· (∞¶≥ 130/85, HDL-¯ÔÏËÛÙÂÚfiÏË < 40 mg/dl ÛÙÔ˘˜ ¿Ó‰Ú˜ ‹ < 50 mg/dl ÛÙȘ Á˘Ó·›Î˜, ÙÚÈÁÏ˘ÎÂÚ›‰È· ≥150 mg/dl Î·È Û¿Î¯·ÚÔ ·›Ì·ÙÔ˜ ÓËÛÙ›·˜ ≥ 100 mg/dl) Â›Ó·È ·ÚÎÂÙ¿ ÁÈ· ÙË ‰È¿ÁÓˆÛË ª™. ∏ ·Ô‰Ô¯‹ ÙˆÓ ·ÓˆÙ¤Úˆ ÎÚÈÙËÚ›ˆÓ Î·È ·fi Ù· ¿ÏÏ· ÂÈÛÙËÌÔÓÈο ÛÒÌ·Ù· (¶√À, NCEP, ∂SC) ı· ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· Ó· ÂÓÙ·¯ıÔ‡Ó ÛÙÔ ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ Î·È Û˘ÓÂÒ˜ Ó· ¤¯Ô˘Ó ·Ó¿ÁÎË ıÂÚ·›·˜ ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ·ÙfiÌˆÓ Ì ÛËÌ·ÓÙÈΤ˜ Û˘Ó¤ÂȘ ÁÈ· ÙË ‰ËÌfiÛÈ· ˘Á›·.


¶A£OºY™IO§O°IA

°ÂÓÂÙÈ΋ ¢È¿ÁÓˆÛË Û ŒÏÏËÓ˜ Î·È °ÂÚÌ·ÓÔ‡˜ ∞ÛıÂÓ›˜ Ì √ÈÎÔÁÂÓ‹ ÀÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· Dedoussis GV, Genschel J, Bochow B, Pitsavos C, Skoumas J, Prassa M, Lkhagvasuren S, Toutouzas P, Vogt A, Kassner U, Thomas HP, Schmidt H. Molecular Characterization of Familial Hypercholesterolemia in German and Greek Patients Hum Mutat. 2004 Mar;23(3):285-6

ÔÈÎÔÁÂÓ‹˜ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· Â›Ó·È Ì›· ·˘ÙÔÛˆÌÈ΋ ÂÈÎÚ·ÙÔ‡Û· ·Ûı¤ÓÂÈ· ÌÂ Û˘¯ÓfiÙËÙ· 1:500 ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi. ™Â ·˘Ù‹Ó ·Ô‰›‰ÂÙ·È ÙÔ 15% ÙˆÓ Î·Ú‰È·ÎÒÓ ÚÔÛ‚ÔÏÒÓ Î·È ÔÊ›ÏÂÙ·È Û ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙ· ÁÔÓ›‰È· ÙÔ˘ ˘Ô‰Ô¯¤· Ù˘ ÏÈÔÚˆÙ½Ó˘ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ (Low Density Lipoprotein Receptor: LDLR), Ù˘ ·ÔÏÈÔÚˆÙ½Ó˘ µ-100 (ApoB) Î·È Ù˘ ÚˆÙÂ˚Ó¿Û˘ PCSK9. √È ÂÚÈÛÛfiÙÂÚÔÈ ·ÛıÂÓ›˜ Ì FH Â›Ó·È ·‰È¿ÁÓˆÛÙÔÈ. ¶ÔÏϤ˜ ÊÔÚ¤˜ Ë ‰È¿ÁÓˆÛË Á›ÓÂÙ·È ÌÂÙ¿ ·fi οÔÈÔ ÂÂÈÛfi‰ÈÔ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘. ∂ÈϤÔÓ Û 5-10% ÙˆÓ ·È‰ÈÒÓ Î·È Û 15-20% ÙˆÓ Û˘ÁÁÂÓÒÓ Ì ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· Á›ÓÂÙ·È Ï¿ıÔ˜ ‰È¿ÁÓˆÛË. ∫·Ù’ Â¤ÎÙ·ÛË ·Ú¿ ÙÔ ÁÂÁÔÓfi˜, fiÙÈ ·ÁÎÔÛÌ›ˆ˜ ˘ÔÏÔÁ›˙ÂÙ·È Ó· ˘¿Ú¯Ô˘Ó 10.000.000 ·ÛıÂÓ›˜, ¤¯Ô˘Ó ‰È·ÁÓˆÛÙ› ÏÈÁfiÙÂÚÔÈ ·fi 10% Î·È ÏÈÁfiÙÂÚÔÈ ·fi 25% ·ÎÔÏÔ˘ıÔ‡Ó ıÂÚ·›·. ∏ ÁÂÓÂÙÈ΋ ·Ó¿Ï˘ÛË ‰›ÓÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· ÁÈ· ‚¤‚·ÈË ‰È¿ÁÓˆÛË, ÔfiÙ Ì ÙËÓ ¤ÁηÈÚË Ê·Ú̷΢ÙÈ΋ ıÂÚ·›· Î·È ÙË ÂÊ·ÚÌÔÁ‹ Ù˘ ηٿÏÏËÏ˘ ‰›·ÈÙ·˜ ÌÂÈÒÓÂÙ·È Ô Î›Ó‰˘ÓÔ˜ Âȉ›ӈÛ˘ Ù˘ ÓfiÛÔ˘. ™ÙÔ ÂÚÁ·ÛÙ‹ÚÈÔ ªÔÚȷ΋˜ µÈÔÏÔÁ›·˜ ÙÔ˘ ÷ÚÔÎfiÂÈÔ˘

¶·Ó/Ì›Ô˘ ÂÊ·ÚÌfiÛ·Ì ÙË Ì¤ıÔ‰Ô Ù˘ οıÂÙ˘ ËÏÂÎÙÚÔÊfiÚËÛ˘ Û ÎÏ›ÛË ·ԉȷٷÎÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, ÁÈ· Ó· ηıÔÚ›ÛÔ˘Ì ÙȘ ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ˘ÔÎÈÓËÙ‹ ÛÙ· 18 ÂÍÒÓÈ· Î·È ÛÙȘ ·ÚÂÌ‚·ÏÏfiÌÂÓ˜ ·ÏÏËÏÔ˘¯›Â˜ ÙÔ˘ ÁÔÓȉ›Ô˘ ÙÔ˘ ˘Ô‰Ô¯¤· Ù˘ LDL (LDLR) Û 100 ŒÏÏËÓ˜ Î·È 100 °ÂÚÌ·ÓÔ‡˜ Ì ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·. ∂ÈϤÔÓ, ÂϤÁÍ·Ì Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ ÙËÓ ‡·ÚÍË ÌÂÙ·ÏÏ¿ÍÂˆÓ ÛÙ· Έ‰Èο 3456-3553 ÙÔ˘ ÁÔÓȉ›Ô˘ Ù˘ ApoB-100. ∆·˘ÙÔÔÈ‹Û·Ì 26 ‰È·ÊÔÚÂÙÈο ËÏÂÎÙÚÔ-

ÊÔÚËÙÈο ÚfiÙ˘· Ì ÙË Ì¤ıÔ‰Ô Ù˘ ·ÏÏËÏÔ‡¯ÈÛ˘ ÙÔ˘ DNA. ™ÙÔ˘˜ °ÂÚÌ·ÓÔ‡˜ ·ÛıÂÓ›˜ ‚ڋηÌ 2 Ӥ˜ ·ÚÂÚÌËÓ‡ÛÈ̘ ÌÂÙ·ÏÏ¿ÍÂȘ (c. 1957G>T/p. V653F, c.647 G> A/p.C216Y) Î·È Ì›· Ó¤· ÔÌfi˙˘ÁË ÓÔ˘ÎÏÂÔÙȉÈ΋ ·ÓÙÈηٿÛÙ·ÛË (c.1-156 C>T) ÛÙËÓ ·ÏÏËÏÔ˘¯›· 2 ÙÔ˘ ˘ÔÎÈÓËÙ‹ ÙÔ˘ ÁÔÓȉ›Ô˘ ÙÔ˘ LDLR. ™ÙÔ˘˜ ŒÏÏËÓ˜ ·ÛıÂÓ›˜ ‚ڋηÌ 1 Ó¤· ÓÔ˘ÎÏÂÔÙȉÈ΋ ·ÓÙÈηٿÛÙ·ÛË Ì·Ù›ÛÌ·ÙÔ˜ (c. 1060+10C>G). ™Â ¤Ó· ·fi ÙÔ˘˜ °ÂÚÌ·ÓÔ‡˜ ·ÛıÂÓ›˜ ‚Ú¤ıËΠ‰ÈÏ‹ ÌÂÙ¿ÏÏ·ÍË (c. 1171G>A/p.A391T; p.V653F), fiˆ˜ Â›Û˘ Î·È Û ‰‡Ô ŒÏÏËÓ˜ ·ÛıÂÓ›˜ (c.1150C> T/p. Q384X; c.1158C>G/p. D386E). ™Â ‰‡Ô °ÂÚÌ·ÓÔ‡˜ ·ÛıÂÓ›˜ ‚ڋηÌ ÙË ÌÂÙ¿ÏÏ·ÍË p.R3500Q ÛÙÔ ÁÔÓ›‰ÈÔ Ù˘ ApoB. ™˘ÁÎÚ›ÓÔÓÙ·˜ ÙȘ ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ˘˜ ‰‡Ô ÏËı˘ÛÌÔ‡˜, ‰È·ÈÛÙÒÛ·Ì fiÙÈ Ô °ÂÚÌ·ÓÈÎfi˜ ÏËı˘ÛÌfi˜ ‹Ù·Ó ÈÔ ÂÙÂÚÔÁÂÓ‹˜ ·fi ÙÔÓ ∂ÏÏËÓÈÎfi. ™Â ÂfiÌÂÓ˜ ÌÂϤÙ˜ Ô˘ Â›Ó·È Û ÂͤÏÈÍË ÚÔÛ·ıԇ̠ӷ ‰È·Û·ÊËÓ›ÛÔ˘Ì ÙËÓ ·ÓÙ·fiÎÚÈÛË ÛÙË Ê·ÚÌ·ÎÔıÂÚ·›· Û ۯ¤ÛË Ì ÙËÓ ÌÂÙ¿ÏÏ·ÍË ÙÔ˘ LDLR Î·È ÙȘ ‰È·ÙÚÔÊÈΤ˜ Û˘Ó‹ıÂȘ ÙˆÓ ‰‡Ô ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌÈÎÒÓ ÏËı˘ÛÌÒÓ. ∂È̤ÏÂÈ·: °ÈÒÚÁÔ˜ ¢Â‰Ô‡Û˘

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·ıËÚÔÛÎÏ‹ÚˆÛË π√À¡IO™ 2005

∏ ∂›‰Ú·ÛË Ù˘ ªÂÙ·ÁÂ˘Ì·ÙÈ΋˜ ÀÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›·˜ Î·È ÀÂÚÁÏ˘Î·ÈÌ›·˜ ÛÙ· ∫˘ÎÏÔÊÔÚÔ‡ÓÙ· ªfiÚÈ· ¶ÚÔÛÎfiÏÏËÛ˘ Î·È ÙÔ √ÍÂȉˆÙÈÎfi ™ÙÚ˜ Î·È Ô ƒfiÏÔ˜ Ù˘ £ÂÚ·›·˜ Ì ™ÈÌ‚·ÛÙ·Ù›ÓË Ceriello A, Quagliaro L, Piconi L, Assaloni R, Da Ros R, Maier A, Esposito K, Giugliano D Diabetes 2004;53:701-710

∆· ΢ÙÙ·ÚÈο ÌfiÚÈ· ÚÔÛÎfiÏÏËÛ˘ Î·È È‰È·›ÙÂÚ· Ù· ICAM1, VCAM-1 Î·È Ë ∂-ÛÂÏÂÎÙ›ÓË ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛÙ› Ì ÙËÓ ÂÌÊ¿ÓÈÛË Î·Ú‰È·ÁÁÂȷ΋˜ ÓfiÛÔ˘. ¶·Ú¿ÏÏËÏ·, ·˘ÍË̤ӷ Â›‰· ÙˆÓ ÌÔÚ›ˆÓ ·˘ÙÒÓ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› Î·È Û ·ÛıÂÓ›˜ Ì ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË. ∏ ÌÂÙ·ÁÂ˘Ì·ÙÈ΋ ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›· Î·È ˘ÂÚÁÏ˘Î·ÈÌ›· ıˆÚÔ‡ÓÙ·È ˆ˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ·ıËÚÔÛÎÏ‹ÚˆÛ˘, ÂÓÒ ÌÔÚ› Ó· Û˘Óԉ‡ÔÓÙ·È Î·È ·fi ·˘ÍË̤ӷ Â›‰· ÙˆÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛ˘. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ÂÚÈÂÏ‹ÊıËÛ·Ó 30 ·ÛıÂÓ›˜ Ì ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ 2 Î·È 20 Ê˘ÛÈÔÏÔÁÈÎÔ› ·ÛıÂÓ›˜ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ¤ÁÈÓ ÊfiÚÙÈÛË Ì ÙÚ›· ‰È·ÊÔÚÂÙÈο Á‡̷ٷ: ¤Ó· Á‡̷ ÏÔ‡ÛÈÔ Û ϛÔ˜, ¤Ó· Ì 75 gr ÁÏ˘Îfi˙˘ Î·È ¤Ó· Ô˘ ÂÚÈ›¯Â ÙfiÛÔ ÁÏ˘Îfi˙Ë fiÛÔ Î·È ˘„ËÏ‹ ÂÚÈÂÎÙÈÎfiÙËÙ· Û ϛÔ˜. ∞ÎÔÏÔ‡ıˆ˜, ÔÈ ‰È·‚ËÙÈÎÔ› ·ÛıÂÓ›˜ ¤Ï·‚·Ó ıÂÚ·›· Ì ÛÈÌ‚·ÛÙ·Ù›ÓË 40 mg/dl ‹ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ ÁÈ· 12 ‚‰ÔÌ¿‰Â˜. ™ÙÔ˘˜ ·ÛıÂÓ›˜ ¤ÁÈÓÂ Î·È ¿ÏÈ ÊfiÚÙÈÛË Ì ٷ ·Ú·¿Óˆ Á‡̷ٷ ÌÂٷ͇ 3˘ Î·È 6˘ Ë̤ڷ˜ Ù˘ ıÂÚ·›·˜ Î·È ÛÙÔ Ù¤ÏÔ˜ Ù˘ ÌÂϤÙ˘. ∏ ÊfiÚÙÈÛË Ô‰‹ÁËÛ Û ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ÓÈÙÚÔÙ˘ÚÔÛ›Ó˘, ÙÔ˘ ICAM-1, ÙÔ˘ VCAM-1 Î·È Ù˘ ∂-ÛÂÏÂÎÙ›Ó˘ 6

ÙÔ˘ Ï¿ÛÌ·ÙÔ˜, Ë ÔÔ›· ‹Ù·Ó ÈÔ ÂÎÛÂÛËÌ·Ṳ̂ÓË ÛÙËÓ ÂÚ›ÙˆÛË ÙÔ˘ Á‡̷ÙÔ˜ Ô˘ ÂÚÈ›¯Â ÙfiÛÔ ÁÏ˘Îfi˙Ë fiÛÔ Î·È ˘„ËÏ‹ ÂÚÈÂÎÙÈÎfiÙËÙ· Û ϛÔ˜. ∏ ‚Ú·¯˘¯ÚfiÓÈ· ıÂÚ·›· Ì ÛÈÌ‚·ÛÙ·Ù›ÓË (3-6 Ë̤Ú˜) ‰ÂÓ Â›¯Â η̛· Â›‰Ú·ÛË ÛÙȘ ·Ú·Ì¤ÙÚÔ˘˜ ÙˆÓ ÏÈȉ›ˆÓ, ÂÏ¿ÙÙˆÛ fï˜ ÙËÓ Â›‰Ú·ÛË ÛÙ· ÌfiÚÈ· ÚÔÛÎfiÏÏËÛ˘ Î·È ÙË ÓÈÙÚÔÙ˘ÚÔÛ›ÓË. ∏ Ì·ÎÚÔ¯ÚfiÓÈ· ıÂÚ·›· Ì ÛÈÌ‚·ÛÙ·Ù›ÓË (12 ‚‰ÔÌ¿‰Â˜) Ô‰‹ÁËÛ Û ÂÚÈÔÚÈÛÌfi Ù˘ ·‡ÍËÛ˘ ÙˆÓ ÌÂÙ·ÁÂ˘Ì·ÙÈÎÒÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ Î·È ÌÈÎÚfiÙÂÚ˜ ‰È·Î˘Ì¿ÓÛÂȘ ÙˆÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛ˘ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÁÂ˘Ì¿ÙˆÓ.

∏ ÌÂϤÙË ·˘Ù‹ ‰Â›¯ÓÂÈ Ì›· ·ıÚÔÈÛÙÈ΋ Î·È ·ÓÂÍ¿ÚÙËÙË Â›‰Ú·ÛË Ù˘ ÌÂÙ·ÁÂ˘Ì·ÙÈ΋˜ ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›·˜ Î·È Ù˘ ˘ÂÚÁÏ˘Î·ÈÌ›·˜ ÛÙ· ΢ÎÏÔÊÔÚÔ‡ÓÙ· ÌfiÚÈ· ÚÔÛÎfiÏÏËÛ˘ Ì ÎÔÈÓfi ·ÚÔÓÔÌ·ÛÙ‹ ÙÔ Ì˯·ÓÈÛÌfi ÙÔ˘ ÔÍÂȉˆÙÈÎÔ‡ ÛÙÚ˜. ∏ ÛÈÌ‚·ÛÙ·Ù›ÓË Ê·›ÓÂÙ·È, Ù·˘Ùfi¯ÚÔÓ· Ì ÙËÓ ˘ÔÏÈȉ·ÈÌÈ΋ Ù˘ ‰Ú¿ÛË, Ó· ¤¯ÂÈ Ì›· ¿ÌÂÛË Â˘ÓÔ˚΋ Â›‰Ú·ÛË ÛÙÔ ÔÍÂȉˆÙÈÎfi ÛÙÚ˜ ·ÏÏ¿ Î·È ÛÙ· Â›‰· ÙˆÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛ˘. ∂È̤ÏÂÈ·: ∞ϤͷӉÚÔ˜ ¶·ÓÙÂÏ¿Î˘, ∞ÓÙÒÓ˘ ¶·˘Ï›‰Ë˜


∫§π¡π∫∂™ ª∂§∂∆∂™

Treating to New Targets Study (TNT): ∂ÈıÂÙÈ΋ ÀÔÏÈȉ·ÈÌÈ΋ ∞ÁˆÁ‹ Ì ∞ÙÔÚ‚·ÛÙ·Ù›ÓË Û ∞ÛıÂÓ›˜ Ì ™Ù·ıÂÚ‹ ™ÙÂÊ·ÓÈ·›· ¡fiÛÔ LaRosa JC, Grundy SM, Waters DD, Shear C, Barter P, Fruchart J-C, Gotto AM, Greten H, Kastelein JJP, Shepherd J, Wenger NK, for the Treating to New Targets (TNT) Investigators N Engl J Med 2005 (8 April) ; 352 ¶·ÚÔ˘ÛÈ¿ÛÙËΠ·fi ÙÔÓ Dr. John C. LaRosa ÛÙÔ 2005 (8 ª·ÚÙ›Ô˘) American College of Cardiology Scientific Sessions, Orlando, FL

¶ÂÚÈÁÚ·Ê‹

¶ÚˆÙÔÁÂÓ¤˜ ÙÂÏÈÎfi ÛËÌ›Ô

√ ÛÙfi¯Ô˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ó· ÂÎÙÈÌ‹ÛÂÈ ÙË ¯ÚËÛÈÌfiÙËÙ· Ù˘ ıÂÚ·›·˜ Ì ·ÙÔÚ‚·ÛÙ·Ù›ÓË Ô˘ ÛÙfi¯Â˘Â Û Â›‰· LDLà ¯·ÌËÏfiÙÂÚ· ·fi Ù· Û˘ÓÈÛÙÒÌÂÓ· (·fi ÙȘ Ô‰ËÁ›Â˜ NCEP) ÙˆÓ 100 mg/dL Û ·ÛıÂÓ›˜ Ì ÛÙ·ıÂÚ‹ ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ.

ªÂ›˙ˆÓ ηډȷÁÁÂÈ·Îfi ÂÂÈÛfi‰ÈÔ: ∫·Ú‰È·Îfi˜ ı¿Ó·ÙÔ˜, ÌË ı·Ó·ÙËÊfiÚÔ ¤ÌÊÚ·ÁÌ· Ì˘Ôηډ›Ô˘ ·Ó¿Î·Ì„Ë ·fi ηډȷ΋ ·Ó·ÎÔ‹ Î·È ·ÁÁÂÈ·Îfi ÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔ (ı·Ó·ÙËÊfiÚÔ ‹ ÌË).

ÀfiıÂÛË

ªÂ›˙ˆÓ ηډȷÁÁÂÈ·Îfi ÂÂÈÛfi‰ÈÔ, ·ÁÁÂÈ·Îfi ÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔ, ÓÔÛËÏ›· ÁÈ· ηډȷ΋ ·ÓÂ¿ÚÎÂÈ·, ÔÏÈ΋ ıÓËÙfiÙËÙ·, ÂÚÈÊÂÚÈ΋ ·ÁÁÂÈÔ¿ıÂÈ·.

∏ ıÂÚ·›· ·ÛıÂÓÒÓ Ì ÛÙ·ıÂÚ‹ ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ Ì ˘„ËÏ‹ ‰fiÛË ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ (80 mg/ ËÌ.) ÁÈ· Â›Ù¢ÍË ÂÈ¤‰ˆÓ LDL-à < 100 mg/dL ı· Û¯ÂÙ›˙ÂÙ·È Ì ÂÏ¿ÙÙˆÛË ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ Û ۇÁÎÚÈÛË Ì ÙËÓ ¯·ÌËÏ‹ ‰fiÛË ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ (10 mg/ ËÌ.) ªÂ ·˘Ù‹ ÙËÓ ¤ÓÓÔÈ· ·ÔÙÂÏ› ÌÂϤÙË ÛÙ·ıÌfi ÁÈ·Ù› οÓÂÈ Û‡ÁÎÚÈÛË Ì ÂÓÂÚÁfi ıÂÚ·›·, ÂÓÒ fiϘ ÔÈ ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜ ‰Â˘ÙÂÚÔÁÂÓÔ‡˜ ÚfiÏ˄˘ (4S, CARE, LIPID) Û˘Ó¤ÎÚÈÓ·Ó Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ıÂÚ·›·˜ Ì ÛÙ·Ù›ÓË ¤Ó·ÓÙÈ ·˘ÙÒÓ Ì ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ (placebo).

™¯Â‰È·ÛÌfi˜ Ù˘ ÌÂϤÙ˘ ¶·ÁÎfiÛÌÈ·, ‰ÈÏ‹-Ù˘ÊÏ‹, Ù˘¯·ÈÔÔÈË̤ÓË Î·È ·Ú¿ÏÏËÏË. ¶ÂÚȤϷ‚ 10.003 ·ÛıÂÓ›˜ (19% Á˘Ó·›Î˜), ̤Û˘ ËÏÈΛ·˜ 60,3 ÂÙÒÓ. ª¤ÛË ·Ú·ÎÔÏÔ‡ıËÛË 4,9 ¯ÚfiÓÈ·.

¢Â˘ÙÂÚÔÁÂÓ‹ ÙÂÏÈο ÛËÌ›·

º¿Ú̷η / ¢È·‰Èηۛ˜ ŸÏÔÈ ÔÈ ·ÛıÂÓ›˜ ‹Ú·Ó ıÂÚ·›· Ì 10 mg/ ËÌ. ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ ÁÈ· 8 ‚‰ÔÌ¿‰Â˜. ∂¿Ó ÔÈ ·ÛıÂÓ›˜ ›¯·Ó Â›‰· LDL-à < 130 mg/dL ÛÙÔ Ù¤ÏÔ˜ ·˘Ù‹˜ Ù˘ ÂÚÈfi‰Ô˘ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·Ó ÛÙË ÌÂϤÙË. ªÂÙ¿, ÔÈ ·ÛıÂÓ›˜ Ù˘¯·ÈÔÔÈ‹ıËÎ·Ó Û ‰‡Ô ÔÌ¿‰Â˜ ıÂÚ·›·˜ Ì›· Ô˘ ‹Ú 80 mg/ËÌ. ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ (n=4,995) Î·È Ë ¿ÏÏË Ô˘ Û˘Ó¤¯ÈÛ Ì 10 mg/ËÌ. ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ (n=5,006). ∆· ‰ÔÛÔÏÔÁÈο Û¯‹Ì·Ù· ÂÈϤ¯ıËÎ·Ó ÒÛÙ ӷ ÂÙ‡¯Ô˘Ó ̤۷ Â›‰· LDL-¯ÔÏËÛÙÂÚfiÏ˘ 75 mg/dL Î·È 100 mg/dL ·ÓÙ›ÛÙÔȯ·.

∞ÔÙ¤ÏÂÛÌ· Ù˘ ˘ÔÏÈȉ·ÈÌÈ΋˜ ·ÁˆÁ‹˜ ∆· ‰ËÌÔÁÚ·ÊÈο Î·È ¿ÏÏ· ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ıÂÚ·›·˜ ‹Ù·Ó ·ÚfiÌÔÈ· ηٿ ÙËÓ ¤Ó·ÚÍË Ù˘ ÌÂϤÙ˘. ∆· ̤۷ Â›‰· LDL-à ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂϤÙ˘ ‹Ù·Ó ÁÈ· ÙËÓ ÔÌ¿‰· Ô˘ ¤·ÈÚÓ ٷ 10 mg/ËÌ. ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ 101 mg/dL Î·È ÁÈ· ·˘Ù‹ Ô˘ ¤·ÈÚÓ 80 mg/ËÌ. ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ 77 mg/dL. √È ÂÏ·ÙÙÒÛÂȘ Ù˘ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚ˜ ÛÙËÓ ÔÌ¿‰· Ù˘ ˘„ËÏ‹˜ ‰fiÛ˘ (p<0,001), ÂÓÒ ‰ÂÓ ˘‹Ú¯Â ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙË HDL-Ã.

∞ÔÙÂϤÛÌ·Ù· ∏ ÂÏ¿ÙÙˆÛË ÙÔ˘ ÚˆÙÔÁÂÓÔ‡˜ ÙÂÏÈÎÔ‡ ÛËÌ›Ԣ ÛÙËÓ ÔÌ¿‰· ÙˆÓ 80 mg/ËÌ. ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ ‹Ù·Ó 22% (p<0,001) Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· 10 mg/ËÌ. ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ (∂ÈÎfiÓ· 1). √È ÂÏ·ÙÙÒÛÂȘ ‰Â˘ÙÂÚÔÁÂÓÒÓ ÙÂÏÈÎÒÓ ÛËÌ›ˆÓ ‹Ù·Ó ·ÚfiÌÔȘ Ì ÎÔÚ˘Ê·›· ·˘Ù‹ ÙˆÓ ·ÁÁÂÈ·ÎÒÓ ÂÁÎÂÊ·ÏÈÎÒÓ (25%, p<0,02)

™˘ÌÂÚ¿ÛÌ·Ù· ™Â ·ÛıÂÓ›˜ Ì ÛÙ·ıÂÚ‹ ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ Ë ÂÏ¿ÙÙˆÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ LDL-à ¯·ÌËÏfiÙÂÚ· ÙˆÓ 80 mg/dL Û¯ÂÙ›˙ÂÙ·È Ì ÂÏ¿ÙÙˆÛË ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ Û ۇÁÎÚÈÛË

7


·ıËÚÔÛÎÏ‹ÚˆÛË π√À¡IO™ 2005

∂ÈÎfiÓ· 2

∂ÈÎfiÓ· 1

Ì ÂΛÓÔ˘˜ Ô˘ ¤¯Ô˘Ó Â›‰· ¯·ÌËÏfiÙÂÚ· ÙˆÓ 100 mg/dL. ∆· Â˘Ú‹Ì·Ù· ·˘Ù¿ Û˘ÓËÁÔÚÔ‡Ó ˘¤Ú Ù˘ ¿Ԅ˘ fiÙÈ ˘¿Ú¯ÂÈ ÁÚ·ÌÌÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ ÂÏ¿ÙÙˆÛ˘ ÙˆÓ ÂÈ¤‰ˆÓ LDL-Ã Î·È Ù˘ ÂÏ¿ÙÙˆÛ˘ ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ

Û˘Ì‚·Ì¿ÙˆÓ Î·È fiÙÈ Ë Û˘Û¯¤ÙÈÛË ·˘Ù‹ ÂÂÎÙ›ÓÂÙ·È Î·È Û ¯·ÌËÏfiÙÂÚ· Â›‰· ·fi ·˘Ù¿ Ô˘ ¤‰ÂÈÍ·Ó ÔÈ ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜ ‰Â˘ÙÂÚÔÁÂÓÔ‡˜ ÚfiÏ˄˘ Ù˘ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ (∂ÈÎfiÓ· 2). ∆· Â˘Ú‹Ì·Ù· ·˘Ù¿ ·Ó·Ì¤ÓÂÙ·È Ó· ÂËÚ¿ÛÔ˘Ó ÙȘ Âfi-

ÌÂÓ˜ ηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ ÁÈ· ÙÔ˘˜ ÛÙfi¯Ô˘˜ Ù˘ ˘ÔÏÈȉ·ÈÌÈ΋˜ ·ÁˆÁ‹˜ ÛÙË ‰Â˘ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë Ù˘ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ Î·È ÂȉÈο Ù˘ ÛÙ·ıÂÚ‹˜ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘. ∂È̤ÏÂÈ·: µ·Û›ÏÂÈÔ˜ Õı˘ÚÔ˜

Anglo-Scandinavian Cardiac Outcomes Trial: Blood Pressure-Lowering Arm (ASCOT-BPLA) Presented by Dr. Peter S. Sever at the 2005 ACC Scientific Sessions, Orlando, FL.

ÀÂÓı˘Ì›˙ÂÙ·È fiÙÈ ÙÔ ˘ÔÏÈȉ·ÈÌÈÎfi ÛΤÏÔ˜ Ù˘ ÌÂϤÙ˘ Ì 10.000 ·ÛıÂÓ›˜ ·Ó·ÎÔÈÓÒıËΠÚÈÓ ‰‡Ô ¯ÚfiÓÈ·. ∆Ô ÛΤÏÔ˜ ·˘Ùfi ›¯Â ‰È·ÎÔ› ÚfiˆÚ· (3.3 ·ÓÙ› ÙˆÓ ÚÔÁÚ·ÌÌ·ÙÈÛÌ¤ÓˆÓ 5 ÂÙÒÓ) ÁÈ· ËıÈÎÔ‡˜ ÏfiÁÔ˘˜: Ë ıÂÚ·›· Ì 10 mg/ ËÌ. ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ Û ˘ÂÚÙ·ÛÈÎÔ‡˜ ·ÛıÂÓ›˜ Ì 3 ÙÔ˘Ï¿¯ÈÛÙÔÓ ÂÈϤÔÓ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Î·È ·Ú¯Èο Ê˘ÛÈÔÏÔÁÈ΋ LDL-X (130 mg/dL) ÚÔοÏÂÛ ÂÏ¿ÙÙˆÛË Ù˘ LDLX <100 mg/dL. ∞˘Ùfi Û¯ÂÙ›ÛÙËΠ̠ÂÏ¿ÙÙˆÛË ÙÔ˘ ÚˆÙÔÁÂÓÔ‡˜ ÙÂÏÈÎÔ‡ ÛËÌ›Ԣ (ÌË ı·Ó·ÙËÊfiÚÔ ¤ÌÊÚ·ÁÌ· Ì˘Ôηډ›Ô˘ Î·È Î·Ú‰È·ÁÁÂÈ·Îfi˜ ı¿Ó·ÙÔ˜) ηٿ 36% Û ۇÁÎÚÈÛË Ì ÙÔ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·8

ÎÔ. ∆· ·ÔÙÂϤÛÌ·Ù· ·˘Ù¿ ÂËÚ¤·Û·Ó ÙȘ Ô‰ËÁ›Â˜ ÁÈ· ÙËÓ ÂÏ¿ÙÙˆÛË Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ÛÙËÓ ÚˆÙÔÁÂÓ‹ ÚfiÏË„Ë Î·Ù¿ ÙËÓ ·Ó·ıÂÒÚËÛË ÙˆÓ Ô‰ËÁÈÒÓ ÙÔ˘ NCEP ÙÔ 2004.

¶ÂÚÈÁÚ·Ê‹ √ ÛÙfi¯Ô˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ó· ÂÎÙÈÌ‹ÛÂÈ ÙÔ Î·Ù¿ fiÛÔ Ì›· ·ÓÙÈ˘ÂÚÙ·ÛÈ΋ ·ÁˆÁ‹ ‚·ÛÈṲ̂ÓË Û ·ÓÙ·ÁˆÓÈÛÙ‹ ·Û‚ÂÛÙ›Ô˘ Ì ‹ ¯ˆÚ›˜ ÙË ÚÔÛı‹ÎË ∞ª∂∞ Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·fi ÙË ÎÏ·ÛÈ΋ ·ÓÙÈ˘ÂÚÙ·ÛÈ΋ ·ÁˆÁ‹ Ì ‚‹Ù· ·ÔÎÏÂÈÛÙ‹ Ì ‹ ¯ˆÚ›˜ ÙË ÚÔÛı‹ÎË ‰ÈÔ˘ÚËÙÈÎÔ‡ ÛÙËÓ ÂÏ¿ÙÙˆÛË ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ.

ÀfiıÂÛË ∏ ASCOT ۯ‰ȿÛÙËΠӷ ·ԉ›ÍÂÈ fiÙÈ Ë ¯Ú‹ÛË ·ÌÏÔ‰È›Ó˘ Ì ‹ ¯ˆÚ›˜ ÂÚȉÔÚ›ÏË Â›Ó·È ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·fi ÙË ¯Ú‹ÛË ·ÙÂÓÔÏfiÏ˘ Ì ‹ ¯ˆÚ›˜ ıÂÈ·˙ȉÈÎfi ‰ÈÔ˘ÚËÙÈÎfi ÛÙËÓ ÂÏ¿ÙÙˆÛË ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ Û ˘ÂÚÙ·ÛÈÎÔ‡˜ ·ÛıÂÓ›˜ Ì ۯÂÙÈο ¯·ÌËÏ¿ Â›‰· LDL-X.

™¯Â‰È·ÛÌfi˜ Ù˘ ÌÂϤÙ˘ ¶·ÁÎfiÛÌÈ·, ‰ÈÏ‹-Ù˘ÊÏ‹, Ù˘¯·ÈÔÔÈË̤ÓË Î·È ·Ú¿ÏÏËÏË. ¶ÂÚȤϷ‚ 19.257 ·ÛıÂÓ›˜ (23% Á˘Ó·›Î˜), ̤Û˘ ËÏÈΛ·˜ 63 ÂÙÒÓ. ª¤ÛË ·Ú·ÎÔÏÔ‡ıËÛË 5,4 ¯ÚfiÓÈ·.


∫§π¡π∫∂™ ª∂§∂∆∂™ ¶ÚˆÙÔÁÂÓ¤˜ ÙÂÏÈÎfi ÛËÌÂ›Ô ªË ı·Ó·ÙËÊfiÚÔ ¤ÌÊÚ·ÁÌ· Ì˘Ôηډ›Ô˘ Î·È Î·Ú‰È·ÁÁÂÈ·Îfi˜ ı¿Ó·ÙÔ˜.

¢Â˘ÙÂÚÔÁÂÓ‹ ÙÂÏÈο ÛËÌ›· √ÏÈ΋ ıÓËÙfiÙËÙ·, ηډȷÁÁÂȷ΋ ıÓËÙfiÙËÙ·, fiÏ· Ù· Ì›˙ÔÓ· ηډȷÁÁÂȷο ÂÂÈÛfi‰È·, fiÏ· Ù· Ì›˙ÔÓ· ηډȷÁÁÂȷο ÂÂÈÛfi‰È· + ÂÂÌ‚·ÙÈ΋ Â·Ó·ÈÌ¿ÙˆÛË, ·ÁÁÂÈ·Îfi ÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔ (ı·Ó·ÙËÊfiÚÔ ‹ ÌË), Ó¤· ÂÌÊ¿ÓÈÛË Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË.

∞ÔÙÂϤÛÌ·Ù· ∆Ô ·ÓÙÈ˘ÂÚÙ·ÛÈÎfi ÛΤÏÔ˜ Ù˘ ASCOT ‰ÈÂÎfiË ÚÔÒÚˆ˜ Ïfi-

Áˆ ÙÔ˘ fiÙÈ ˘‹Ú¯Â ÛËÌ·ÓÙÈ΋ ÂÏ¿ÙÙˆÛË Ù˘ ÔÏÈ΋˜ Î·È Î·Ú‰È·ÁÁÂȷ΋˜ ıÓËÙfiÙËÙ·˜ ÛÙËÓ

ÔÌ¿‰· Ù˘ ·ÌÏÔ‰È›Ó˘, Û ۇÁÎÚÈÛË Ì ·˘Ù‹ Ù˘ ·ÙÂÓÔÏfiÏ˘.

¶›Ó·Î·˜ 1

∆ÂÏÈÎfi ™ËÌÂ›Ô √ÏÈ΋ ıÓËÙfiÙËÙ· ¶ÚˆÙÔÁÂÓ¤˜ ÙÂÏÈÎfi ÛËÌÂ›Ô ™‡ÓÔÏÔ ∫/∞ Û˘Ì‚·Ì¿ÙˆÓ ∞ÁÁÂÈ·Îfi ÂÁÎÂÊ·ÏÈÎfi (ı·Ó·ÙËÊfiÚÔ ‹ ÌË) ™‡ÓÔÏÔ ∫/∞ + ∂·Ó·ÈÌ¿ÙˆÛË ∫·Ú‰È·ÁÁÂȷ΋ ıÓËÙfiÙËÙ· ¡¤· ÂÌÊ¿ÓÈÛË ‰È·‚‹ÙË

% ÂÏ¿ÙÙˆÛË ∞ÌÏÔ‰È›ÓË vs AÙÂÓÔÏfiÏË

p

14 10 14

0,005 0,12 0,0048

23

0,0007

14 24 32

<0,0001 0,0017 <0,0001

¶ËÁ‹: The Heart Org

™˘ÌÂÚ¿ÛÌ·Ù· ™Â ˘ÂÚÙ·ÛÈÎÔ‡˜ ·ÛıÂÓ›˜, Ì ۯÂÙÈο ¯·ÌËÏ‹ LDL-Ã, Ë ıÂÚ·›· Ì ·ÌÏÔ‰È›ÓË Î·È ÂÚȉÔÚ›ÏË (ÌfiÓÔ ÂÊfiÛÔÓ ¯ÚÂÈ¿˙ÂÙ·È) ÂÏ·ÙÙÒÓÂÈ ÛËÌ·ÓÙÈο Ù· ηډȷÁÁÂȷο Û˘Ì‚¿Ì·Ù· Î·È Î˘Ú›ˆ˜ ÙË ıÓËÙfiÙËÙ· Û ۇÁÎÚÈÛË Ì ÙËÓ ·ÙÂÓÔÏfiÏË Î·È ıÂÈ·˙ÈÎfi ‰ÈÔ˘ÚËÙÈÎfi (ÌfiÓÔ ÂÊfiÛÔÓ ¯ÚÂÈ¿˙ÂÙ·È). ™ËÌ·ÓÙÈ΋ ‹Ù·Ó Â›Û˘ Ë ·ÔÙÚÔ‹ ÂÌÊ¿ÓÈÛ˘ Ó¤ˆÓ ÂÚÈÙÒÛÂˆÓ ‰È·‚‹ÙË. ∆· Â˘Ú‹Ì·Ù· ·˘Ù¿ ·Ó·Ì¤ÓÂÙ·È Ó· ÂËÚ¿ÛÔ˘Ó ÙȘ ÂfiÌÂÓ˜ ηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ·ÚÙËÚȷ΋˜ ˘¤ÚÙ·Û˘. ∂›Ó·È Èı·Ófi Ó· Û˘Ì‚¿ÏÔ˘Ó ÛÙËÓ ·Ó·ÙÚÔ‹ ÙÔ˘ ‰fiÁÌ·ÙÔ˜ fiÙÈ ‰ÂÓ ¤¯ÂÈ ÛËÌ·Û›· Ì ÙÈ Î·Ù‚¿˙ÂȘ ÙËÓ ·ÚÙËÚȷ΋ ›ÂÛË ·ÚΛ Ó· ÙËÓ Î·Ù‚¿ÛÂȘ ·ÔÙÂÏÂÛÌ·ÙÈο. º·›ÓÂÙ·È fiÙÈ ÌÂÚÈο ·ÓÙÈ˘ÂÚÙ·ÛÈο Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ˆÊ¤ÏÈÌ· ·fi ¿ÏÏ· ÁÈ· ÙÔÓ ›‰ÈÔ ‚·ıÌfi ÂÏ¿ÙÙˆÛ˘ Ù˘ Û˘ÛÙÔÏÈ΋˜ Î·È ‰È·ÛÙÔÏÈ΋˜ ·ÚÙËÚȷ΋˜ ›ÂÛ˘. ∂È̤ÏÂÈ·: µ·Û›ÏÂÈÔ˜ Õı˘ÚÔ˜

¶·Ú·Û΢‹ Ê·ÚÌ¿ÎÔ˘. ÃÂÈÚfiÁÚ·ÊÔ˜ ÎÒ‰ÈÍ 10Ô˘ ·È. ÙÔ˘ ‚È‚Ï›Ô˘ ÙÔ˘ ¡ÈοӉÚÔ˘ «£ËÚȷο Î·È ·ÏÂÍÈÊ¿Ú̷η». ∂ıÓÈ΋ ¶ÈÓ·ÎÔı‹ÎË, ¶·Ú›ÛÈ.

9


·ıËÚÔÛÎÏ‹ÚˆÛË π√À¡IO™ 2005

™Ù·Ù›Ó˜ Î·È √ÛÙÂÔÔÚˆÙÈο ∫·Ù¿ÁÌ·Ù· °·˙‹ ∂ÈÚ‹ÓË, ∂ÈÛÙËÌÔÓÈÎfi˜ ™˘ÓÂÚÁ¿Ù˘ π·ÙÚ›Ԣ §Èȉ›ˆÓ ∂ÏÈÛ¿Ê ªˆ˘Û‹˜, ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜

ÔÛÙÂÔfiÚˆÛË Â›Ó·È Û˘¯Ó‹ ÓfiÛÔ˜ ÙÔ˘ ÛÎÂÏÂÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÌÂȈ̤ÓË ÔÛÙÈ΋ Ì¿˙· Î·È ‰È·Ù·Ú·¯‹ Ù˘ ÌÈÎÚÔ·Ú¯ÈÙÂÎÙÔÓÈ΋˜ ÙˆÓ ÔÛÙÒÓ, Ë ÔÔ›· ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·‡ÍËÛË Ù˘ Â›ÙˆÛ˘ ÙˆÓ Î·Ù·ÁÌ¿ÙˆÓ [1]. ∏ ·ÚÈ· ‰Ú¿ÛË ÙˆÓ Ê·ÚÌ¿ÎˆÓ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Û‹ÌÂÚ· ÁÈ· ÙËÓ ÚfiÏË„Ë Î·È ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÔÛÙÂÔfiÚˆÛ˘ ÂÓÙÔ›˙ÂÙ·È ÛÙËÓ ·Ó·ÛÙÔÏ‹ Ù˘ ·ÔÚÚfiÊËÛ˘ ÙˆÓ ÔÛÙÒÓ (·Ó·ÛÙÔÏ‹ Ù˘ ‰Ú¿Û˘ ÙˆÓ ÔÛÙÂÔÎÏ·ÛÙÒÓ) Ì ·ÔÙ¤ÏÂÛÌ· ÙË ÌÂȈ̤ÓË ·ÒÏÂÈ· ÔÛÙÈ΋˜ Ì¿˙·˜ Î·È ÙÔ ÌÂȈ̤ÓÔ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ÔÛÙÂÔÔÚˆÙÈÎÒÓ Î·Ù·ÁÌ¿ÙˆÓ [2,3]. ∏ ÈηÓfiÙËÙ· ·˘ÙÒÓ ÙˆÓ Ê·ÚÌ¿ÎˆÓ Ó· ·˘Í¿ÓÔ˘Ó ÙËÓ ÔÛÙÈ΋ Ì¿˙· Â›Ó·È Û¯ÂÙÈο ÌÈÎÚ‹, ÂÚ›Ô˘ 2% ÙÔ ¯ÚfiÓÔ [2]. ŒÙÛÈ, Ê¿Ú̷η Èηӿ Ó· ÚÔ¿ÁÔ˘Ó ÙËÓ ·Ú·ÁˆÁ‹ Ó¤Ô˘ ÔÛÙ›ÙË ÈÛÙÔ‡ ı· ‹Ù·Ó ȉȷ›ÙÂÚ· ¯Ú‹ÛÈÌ· Û ÂÚÈÙÒÛÂȘ ÛÔ‚·Ú‹˜ ÔÛÙÂÔfiÚˆÛ˘ [4]. √È ÛÙ·Ù›Ó˜ (·Ó·ÛÙÔÏ›˜ Ù˘ ·Ó·ÁˆÁ¿Û˘ ÙÔ˘ 3-˘‰ÚÔ͢-3-ÌÂı˘Ï-ÁÏÔ˘Ù·Ú˘Ï Û˘ÓÂÓ˙‡ÌÔ˘ ∞, HMG CoA) ·ÔÙÂÏÔ‡Ó Ù· ÈÔ ÛËÌ·ÓÙÈο Ê¿Ú̷η ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ‰˘ÛÏÈȉ·ÈÌÈÒÓ. ªÂÁ¿Ï˜ ÚÔÔÙÈΤ˜ Ù˘¯·ÈÔÔÈË̤Ó˜ ÌÂϤÙ˜ ÂȂ‚·›ˆÛ·Ó ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿ ÙÔ˘˜ fiÛÔÓ

10

·ÊÔÚ¿ ÙË Ì›ˆÛË Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ÙËÓ ÚfiÏË„Ë ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ [5-8]. T· ÙÂÏÂ˘Ù·›· ¤ÙË ˘¿Ú¯ÂÈ È‰È·›ÙÂÚÔ ÂӉȷʤÚÔÓ ÁÈ· ÙȘ ÏÂÁfiÌÂÓ˜ «ÏÂÈÔÙÚÔÈΤ˜» ‰Ú¿ÛÂȘ ÙˆÓ ÛÙ·ÙÈÓÒÓ. ™Â ·˘Ù¤˜ Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÙ·È Î·È Ë Â›‰Ú·ÛË ÙˆÓ ÛÙ·ÙÈÓÒÓ ÛÙÔ ÌÂÙ·‚ÔÏÈÛÌfi ÙˆÓ ÔÛÙÒÓ. ™˘ÁÎÂÎÚÈ̤ӷ, ÔÈ ÛÙ·Ù›Ó˜, ·Ú¿ÏÏËÏ· Ì ÙË Ì›ˆÛË Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘, ÌÂÈÒÓÔ˘Ó ÙËÓ ·Ú·ÁˆÁ‹ ÔÏÏÒÓ ÂӉȿÌÂÛˆÓ ÚÔ˚fiÓÙˆÓ Ù˘ ‚ÈÔÛ‡ÓıÂÛ˘ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ [9, 10]. T· ÂӉȿÌÂÛ· ·˘Ù¿ ÚÔ˚fiÓÙ· ÂÓÂÚÁÔÔÈÔ‡Ó ÙË ‰Ú¿ÛË ÙˆÓ ÔÛÙÂÔÎÏ·ÛÙÒÓ Î·È Ì ·˘Ùfi ÙÔÓ ÙÚfiÔ ÔÈ ÛÙ·Ù›Ó˜ Èı·Ó¿ ÚÔ¿ÁÔ˘Ó ÙËÓ ·fiÙˆÛË ·˘ÙÒÓ ÙˆÓ Î˘ÙÙ¿ÚˆÓ [9,10]. ∂ÈÚfiÛıÂÙ·, ÔÈ ÛÙ·Ù›Ó˜ ÚÔ¿ÁÔ˘Ó ÙËÓ ¤ÎÊÚ·ÛË Ù˘ BMP-2 (Bone Morphogenetic Protein-2), ÂÓfi˜ ·˘ÍËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· Ô˘ ¢ԉÒÓÂÈ ÙË ‰È·ÊÔÚÔÔ›ËÛË ÙˆÓ ÔÛÙÂÔ‚Ï·ÛÙÒÓ Î·È ÙÔ Û¯ËÌ·ÙÈÛÌfi Ó¤Ô˘ ÔÛÙ›ÙË ÈÛÙÔ‡ [10, 11]. ∆· ‰Â‰Ô̤ӷ fiÛÔÓ ·ÊÔÚ¿ ÙËÓ Â›‰Ú·ÛË ÙˆÓ ÛÙ·ÙÈÓÒÓ ÛÙËÓ Â›ÙˆÛË ÙˆÓ ÔÛÙÂÔÔÚˆÙÈÎÒÓ Î·Ù·ÁÌ¿ÙˆÓ Â›Ó·È ·ÓÙÈÎÚÔ˘fiÌÂÓ·. ™˘ÁÎÂÎÚÈ̤ӷ, 4 ÚÔÔÙÈΤ˜ ÌÂϤÙ˜ (Study of Osteoporotic Fractures-SOF, Fracture Intervention Trial-FIT, Heart and Estrogen/ Progestin Replacement Study- HERS Î·È Rotterdam Study) ¤‰ÂÈÍ·Ó ÌÂȈ̤ÓË Â›ÙˆÛË Î·Ù·ÁÌ¿ÙˆÓ ÙÔ˘ ÈÛ¯›Ô˘ Û ÌÂÙÂÌÌËÓÔ·˘ÛȷΤ˜ Á˘Ó·›Î˜ Ô˘ ¤·ÈÚÓ·Ó ÛÙ·Ù›Ó˜ (Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ 0,19 - 0,62) Û ۇÁÎÚÈÛË Ì Á˘Ó·›Î˜ Ô˘ ‰ÂÓ ¤·ÈÚÓ·Ó ÛÙ·Ù›Ó˜ [12-16]. ∂ÈÚfiÛıÂÙ·, ÛÙË ÌÂϤÙË FIT ‹Ù·Ó ÌÂȈ̤ÓË Î·È Ë

Â›ÙˆÛË ÙˆÓ Î·Ù·ÁÌ¿ÙˆÓ Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘ – ·Ó Î·È Û ÌÈÎÚfiÙÂÚÔ ‚·ıÌfi [14]. ¶Ú¤ÂÈ Ó· ÂÈÛËÌ·Óı› fiÙÈ Ô ÌÂȈ̤ÓÔ˜ ΛӉ˘ÓÔ˜ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ÔÛÙÂÔÔÚˆÙÈÎÒÓ Î·Ù·ÁÌ¿ÙˆÓ ‰ÂÓ ·ÊÔÚÔ‡Û ÙË ¯ÔÚ‹ÁËÛË ¿ÏÏˆÓ ˘ÔÏÈȉ·ÈÌÈÎÒÓ ·Ú·ÁfiÓÙˆÓ [12]. ∆· ·Ú·¿Óˆ ‰Â‰Ô̤ӷ ÂȂ‚·ÈÒÓÔÓÙ·È Î·È ·fi Ù· ·ÔÙÂϤÛÌ·Ù· ÌÈ·˜ ÌÂÙ·-·Ó¿Ï˘Û˘ ÙÂÛÛ¿ÚˆÓ ÌÂÏÂÙÒÓ ·Ú·Ù‹ÚËÛ˘, Ë ÔÔ›· ¤‰ÂÈÍ Ì›ˆÛË ÙÔ˘ Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛ˘ ηٷÁÌ¿ÙˆÓ ÙÔ˘ ÈÛ¯›Ô˘ ηٿ 57% Û ¿ÙÔÌ· Ô˘ ¤·ÈÚÓ·Ó ÛÙ·Ù›ÓË Û ۇÁÎÚÈÛË Ì ¿ÙÔÌ· Ô˘ ‰ÂÓ ¤·ÈÚÓ·Ó ÛÙ·Ù›ÓË [12]. ∂ÈϤÔÓ, Ë ›‰È· ÌÂÙ·-·Ó¿Ï˘ÛË ¤‰ÂÈÍ Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛ˘ ηٷÁÌ¿ÙˆÓ Ô˘ ‰ÂÓ ÂÓÙÔ›˙ÔÓÙ·È ÛÙÔÓ ·ÍÔÓÈÎfi ÛÎÂÏÂÙfi ηٿ 31% Û ¿ÙÔÌ· Ô˘ ¤·ÈÚÓ·Ó ÛÙ·Ù›ÓË Û ۇÁÎÚÈÛË Ì ¿ÙÔÌ· Ô˘ ‰ÂÓ ¤·ÈÚÓ·Ó ÛÙ·Ù›ÓË [12]. ¶·ÚfiÌÔÈ· ‹Ù·Ó Î·È Ù· ·ÔÙÂϤÛÌ·Ù· ¿ÏÏˆÓ ÌÂÏÂÙÒÓ ·Ú·Ù‹ÚËÛ˘, Û‡Ìʈӷ Ì ٷ ÔÔ›· Ô Î›Ó‰˘ÓÔ˜ ÂÌÊ¿ÓÈÛ˘ ÔÛÙÂÔÔÚˆÙÈÎÒÓ Î·Ù·ÁÌ¿ÙˆÓ Â›Ó·È ÛËÌ·ÓÙÈο ÌÂȈ̤ÓÔ˜ Û ·ÛıÂÓ›˜ Ô˘ ·›ÚÓÔ˘Ó ÛÙ·Ù›Ó˜ [17-19]. ∏ ¢ÓÔ˚΋ Â›‰Ú·ÛË ÙˆÓ ÛÙ·ÙÈÓÒÓ ÛÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ÔÛÙÂÔÔÚˆÙÈÎÒÓ Î·Ù·ÁÌ¿ÙˆÓ ÌÔÚ› Ó· ÂÍËÁËı› –ÙÔ˘Ï¿¯ÈÛÙÔÓ ÂÓ Ì¤ÚÂÈ– ·fi ÙËÓ ÈηÓfiÙËÙ· ·˘ÙÒÓ ÙˆÓ Ê·ÚÌ¿ÎˆÓ Ó· ·˘Í¿ÓÔ˘Ó ÙËÓ ÔÛÙÈ΋ ˘ÎÓfiÙËÙ· Î·È Ó· ‚ÂÏÙÈÒÓÔ˘Ó ÙÔÓ ÔÛÙÈÎfi ÌÂÙ·‚ÔÏÈÛÌfi [10, 19-22]. ¶Ú¤ÂÈ Ó· ÂÈÛËÌ·Óı› fiÙÈ ˘¿Ú¯Ô˘Ó ÌÂϤÙ˜ Ù· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ÔÔ›ˆÓ ‰ÂÓ ÙÂÎÌËÚÈÒÓÔ˘Ó ÙË Ì›ˆÛË ÙÔ˘ ÎÈÓ-


£∂ƒ∞¶∂π∞ – º∞ƒª∞∫∞ ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛ˘ ÔÛÙÂÔÔÚˆÙÈÎÒÓ Î·Ù·ÁÌ¿ÙˆÓ Û ·ÛıÂÓ›˜ Ô˘ ·›ÚÓÔ˘Ó ÛÙ·Ù›Ó˜. ™˘ÁÎÂÎÚÈ̤ӷ, Ì›· ·Ó·‰ÚÔÌÈ΋ ÌÂϤÙË, ÛÙËÓ ÔÔ›· Û˘ÌÌÂÙ›¯·Ó ÂÚ›Ô˘ 12.500 ·ÛıÂÓ›˜ Ô˘ ¤·ÈÚÓ·Ó ÛÙ·Ù›ÓË, 5.000 ·ÛıÂÓ›˜ Ô˘ ¤·ÈÚÓ·Ó ¿ÏÏÔ ˘ÔÏÈȉ·ÈÌÈÎfi ·Ú¿ÁÔÓÙ· Î·È 17.000 ˘ÁÈ›˜ Ì¿ÚÙ˘Ú˜ ¤‰ÂÈÍ fiÙÈ Ë Èı·Ó‹ ¢ÓÔ˚΋ Â›‰Ú·ÛË Ù˘ ¯ÔÚ‹ÁËÛ˘ ÛÙ·ÙÈÓÒÓ ÛÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ÔÛÙÂÔÔÚˆÙÈÎÒÓ Î·Ù·ÁÌ¿ÙˆÓ ÌÔÚ› Ó· ·Ô‰Ôı› Û ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙ˜ Î·È fi¯È ÛÙËÓ ›‰È· ÙË ÛÙ·Ù›ÓË [23]. ∂ÈÚfiÛıÂÙ·, ÛÙË ÌÂϤÙË Women’s Health Initiative Observational Study Ë ¯ÔÚ‹ÁËÛË ÛÙ·ÙÈÓÒÓ Û ÌÂÙÂÌÌËÓÔ·˘ÛȷΤ˜ Á˘Ó·›Î˜ ‰ÂÓ ÂË-

Ú¤·Û ÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ηٷÁÌ¿ÙˆÓ ‹ ÙËÓ ÔÛÙÈ΋ ˘ÎÓfiÙËÙ· (Bone Mineral Density, BMD) [24]. ∞ÎfiÌË, �� ·Ó¿Ï˘ÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ‰‡Ô ÌÂÁ¿ÏˆÓ Ù˘¯·ÈÔÔÈËÌ¤ÓˆÓ ÎÏÈÓÈÎÒÓ ÌÂÏÂÙÒÓ Ì ηډȷÁÁÂȷο ÙÂÏÈο ÛËÌ›· (Î·È Û˘ÁÎÂÎÚÈ̤ӷ ÙˆÓ ÌÂÏÂÙÒÓ LIPID Î·È 4S) ‰ÂÓ ÂȂ‚·›ˆÛ ÙËÓ ÚÔÛٷ٢ÙÈ΋ Â›‰Ú·ÛË ÙˆÓ ÛÙ·ÙÈÓÒÓ ÛÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ÔÛÙÂÔÔÚˆÙÈÎÒÓ Î·Ù·ÁÌ¿ÙˆÓ [25,26]. øÛÙfiÛÔ Ú¤ÂÈ Ó· ÙÔÓÈÛı› ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÛÙË ÌÂϤÙË LIPID ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë Ú·‚·ÛÙ·Ù›ÓË, Ì›· ÛÙ·Ù›ÓË Ô˘ Â›Ó·È ˘‰·ÙÔ‰È·Ï˘Ù‹ Î·È ¤¯ÂÈ ˆ˜ ÂÎ ÙÔ‡ÙÔ˘ ÂÏ¿¯ÈÛÙË Â›‰Ú·ÛË ÛÙËÓ BMP-2 [22]. ™˘ÌÂÚ·ÛÌ·ÙÈο, ·ÚÎÂÙ¿

ÂÈÚ·Ì·ÙÈο ‰Â‰Ô̤ӷ ηıÒ˜ Î·È in vitro ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ Ë ¯ÔÚ‹ÁËÛË ÛÙ·ÙÈÓÒÓ, ·ÛΛ ¢ÓÔ˚΋ Â›‰Ú·ÛË ÛÙÔ ÌÂÙ·‚ÔÏÈÛÌfi ÙˆÓ ÔÛÙÒÓ, ›Ù ‰È·Ì¤ÛÔ˘ ·Ó·ÛÙÔÏ‹˜ Ù˘ ‰Ú¿Û˘ ÙˆÓ ÔÛÙÂÔÎÏ·ÛÙÒÓ Â›Ù ‰È·Ì¤ÛÔ˘ Â·ÁˆÁ‹˜ Ù˘ ‰Ú¿Û˘ ÙˆÓ ÔÛÙÂÔ‚Ï·ÛÙÒÓ. øÛÙfiÛÔ, Ù· ‰Â‰Ô̤ӷ Ô˘ ·ÊÔÚÔ‡Ó ÙË Û˘Û¯¤ÙÈÛË Ù˘ in vivo ¯oÚ‹ÁËÛ˘ ÛÙ·ÙÈÓÒÓ Ì ÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ÔÛÙÂÔÔÚˆÙÈÎÒÓ Î·Ù·ÁÌ¿ÙˆÓ Â›Ó·È ·ÓÙÈÎÚÔ˘fiÌÂÓ·. ø˜ ÂÎ ÙÔ‡ÙÔ˘, Â›Ó·È ··Ú·›ÙËÙ˜ ÌÂÁ¿Ï˜ Ù˘¯·ÈÔÔÈË̤Ó˜ ÌÂϤÙ˜ ÁÈ· Ó· ‰ÈÂÚ¢ÓËı› Ô ·ÎÚÈ‚‹˜ ÚfiÏÔ˜ ÙˆÓ ÛÙ·ÙÈÓÒÓ ÛÙÔ ÌÂÙ·‚ÔÏÈÛÌfi ÙˆÓ ÔÛÙÒÓ.

18. Schoofs MW, Sturkenboom Der Klift M et al. HMG-CoA inhibitors and the risk of fracture. J Bone Miner Res 1525-1530

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Schlienger RG, Meier CR. HMG-CoA reductase inhibitors in osteoporosis: do they reduce the risk of fracture? Drugs Aging 2003; 20: 321-336 Neer RM, Arnaud CD, Zanchetta JR, Prince R, Gaich GA, Reginster JY et al. Effect of parathyroid hormone on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 2001; 344: 1434-1341 Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 1994; 344: 1383-1389 Downs JR, Clearfield M, Weis S, Whitney E, Shapiro DR, Beere PA et al. Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/ TexCAPS. Air Force? Texas Coronary Atherosclerosis Prevention Study. JAMA 1998; 279: 16151622 Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. The Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group. N Engl J Med 1998; 339: 13491357 LaRosa JC, He J, Vupputuri S. Effects of statins on risk of coronary disease: a meta-analysis of randomized controlled trials. JAMA 1999; 282: 2340-2346

Zhang FL, Casey PJ. Protein prenylation: Molecular mechanisms and functional consequences. Ann Rev Biochem 1996; 65: 241-269

11. Baghdasarian SB, JneidH, Hoogwerf BJ. Association of dyslipidemia and effects of statins on nonmacrovascular diseases. Clin Ther 2004; 26: 337-351 12. Bauer DC, Mundy GR, Jamal SA, Black DM et al. Results of 4 prospective studies and cumulative meta-analysis of observational studies and controlled trials. Arch Intern Med 2004; 164: 146152 13. Cummings SR, Nevitt MC, Browner WS et al. Risk factors for hip fracture in white women. N Engl J Med 1995; 332: 767-773 14. Black DM, Cummings SR, Karpf D, FITR Group. Randomized trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Lancet 1996; 348: 1535-1541 15. Hulley S, Grady D, Bush T et al, Heart and Estrogen/Progestin Replacement Study Group. Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. JAMA 1998; 280: 605-613 16. Burger H, de Laet C, van Daele P et al. Risk factors for increased bone loss in an elderly population: the Rotterdam Study. Am J Epidemiol 1998; 147: 871879 17. Rejnmark L. Olsen ML, Johnsen SR et al. Hip fracture risk in statin users- a population-based Danish case-control study. Osteoporos Int 2004; 15: 452-458

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19. Pasco JA, Kotowicz MA, Henry MJ et al. Statin use, bone mineral density and fracture risk- Geelong Osteoporosis Study. Arch Intern Med 2002; 162: 537540 20. Montagnani A, Gonnelli S, Cepollaro C et al. Effect of simvastatin treatment on bone mineral density and bone turnover in hypercholesterolemic postmenopausal women: a 1-year longitudinal study. Bone 2003; 32: 427-433 21. Garrett IR, Esparza J, Chen D et al. Statins mediate their effects on osteoblasts by inhibition of HMG-CoA reductase and ultimately BMP-2. J Bone Miner Res 2000; 15(suppl); S225 22. Sugiyama M, Kodama K, Konishi K et al. Compactin and simvastatin, but not pravastatin, induce bone morphogenetic protein 2 in human osteosarcoma cells. Biochem Biophys Res Commun 2000; 271: 688-692 23. Ray WA, Daugherty JR, Griffin MR. Lipid-lowering agents and the risk of hip fracture in a Medicaid population. Inj Prev 2002; 8: 276-279 24. La Croix AZ, Cauley JA, Pettinger M et al. Statin use, clinical fracture and bone density in postmenopausal women: Results from the Women’s Health Initiative Observational Study. Ann Intern Med 2003; 139: 97-104 25. Reid IR, Hague W, Emberson J et al. Effect of pravastatin on frequency of fracture in the LIPID study: secondary analysis of a randomized controlled trial. Lancet 2001; 357: 509-512 26. Pedersen TR, Kjekshus J, 4S Study Group. Statin drugs and the risk of fracture. JAMA 2000; 284: 1921-1922

11


·ıËÚÔÛÎÏ‹ÚˆÛË π√À¡IO™ 2005

∏ ÃÚ‹ÛË ÙˆÓ ∞Ó·ÛÙÔϤˆÓ Ù˘ HMG-CoA ∞Ó·ÁˆÁ¿Û˘ ÛÙ· √ͤ· ™ÙÂÊ·ÓÈ·›· ™‡Ó‰ÚÔÌ· – ªË¯·ÓÈÛÌÔ› ¢Ú¿Û˘ Î·È ¡ÂÒÙÂÚ· ¢Â‰Ô̤ӷ ™∞√À°∫√™ µ∞™π§∂π√™, ∂ÈÛÙËÌÔÓÈÎfi˜ ™˘ÓÂÚÁ¿Ù˘ µ’ ¶·ıÔÏÔÁÈ΋˜ ∫ÏÈÓÈ΋˜ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ πˆ·ÓÓ›ÓˆÓ ∂§π™∞º ªøÀ™∏™, ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜, ¢È¢ı˘ÓÙ‹˜ µ’ ¶·ıÔÏÔÁÈ΋˜ ∫ÏÈÓÈ΋˜ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ πˆ·ÓÓ›ÓˆÓ

¶∂ƒπ§∏æ∏ ∞Ó Î·È Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙˆÓ ·Ó·ÛÙÔϤˆÓ Ù˘ HMGCoA ·Ó·ÁˆÁ¿Û˘ (ÛÙ·ÙÈÓÒÓ) ÛÙË ‰Â˘ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ ¤¯ÂÈ ‰È·ÈÛÙˆı› ·fi Ù· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ÌÂÁ¿ÏˆÓ ÚÔÔÙÈÎÒÓ ÌÂÏÂÙÒÓ (4S, CARE, LIPID, LIPS, HPS Î·È GREACE), ‰ÂÓ ¤¯ÂÈ ·ÔÛ·ÊËÓÈÛı› Ô ÚfiÏÔ˜ ÙˆÓ ÛÙ·ÙÈÓÒÓ Û ·ÛıÂÓ›˜ Ì Ôͤ· ÛÙÂÊ·ÓÈ·›· Û‡Ó‰ÚÔÌ·. ¡ÂÒÙÂÚ˜ ÌÂϤÙ˜, fiˆ˜ Ë MIRACL Î·È Î˘Ú›ˆ˜ Ë PROVE-IT, ¤‰ÂÈÍ·Ó ÙË ÛËÌ·Û›· Ù˘ ¯ÔÚ‹ÁËÛ˘ ÛÙ·ÙÈÓÒÓ ÛÙËÓ ÔÍ›· Ê¿ÛË ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ Û˘Ì‚·Ì¿ÙˆÓ Î·È ¤¯Ô˘Ó ·Ó·‰Â›ÍÂÈ Ù·˘Ùfi¯ÚÔÓ· ¤Ó· ¢ڇÙÂÚÔ ‰›Ô Ù˘ ‰Ú¿Û˘ ·˘ÙÒÓ ÙˆÓ Ê·Ú̿ΈÓ, ÙȘ ÏÂÈÔÙÚÔÈΤ˜ ÙÔ˘˜ ‰Ú¿ÛÂȘ.

¢∂À∆∂ƒ√°∂¡∏™ ¶ƒ√§∏æ∏ ∆∏™ ∫∞ƒ¢π∞°°∂π∞∫∏™ ¡√™√À ªÂϤÙ˜ ‰Â˘ÙÂÚÔÁÂÓÔ‡˜ ÚfiÏ˄˘, fiˆ˜ Ë 4S3 (Scandinavian Simvastatin Survival Study), Ë CARE4 (Cholesterol And Recurrent Events) Î·È Ë LIPID5 (Long-term Intervention with Pravastatin in Ischemic Disease) ¤‰ÂÈÍ·Ó Ù· ÔʤÏË ·fi ÙË Ì›ˆÛË Ù˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘ Û ÛÙÂÊ·ÓÈ·›Ô˘˜ ·ÛıÂ12

Ó›˜. ¶·ÚfiÏ· fï˜ ·˘Ù¿ Ù· ·ÍÈÔÛËÌ›ˆÙ· ·ÔÙÂϤÛÌ·Ù·, fiϘ ÔÈ ÌÂϤÙ˜ ‰Â˘ÙÂÚÔÁÂÓÔ‡˜ ÚfiÏ˄˘ ›¯·Ó ¤Ó· ÛËÌ·ÓÙÈÎfi ÌÂÈÔÓ¤ÎÙËÌ·, ÙËÓ ·Ô˘Û›· ·ÛıÂÓÒÓ Ì Ôͤ· ÛÙÂÊ·ÓÈ·›· Û˘Ì‚¿Ì·Ù·. ∆Ô ÎÂÓfi ·˘Ùfi ‹Úı ӷ ηχ„ÂÈ Ë ÌÂϤÙË MIRACL6 (Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering). ◊Ù·Ó Ì›· ÚÔÔÙÈ΋ ‰ÈÏ‹ Ù˘ÊÏ‹ Ù˘¯·ÈÔÔÈË̤ÓË ÌÂϤÙË, ÛÙËÓ ÔÔ›· ‰ÈÂÚ¢ӋıËÎÂ Ë Â›‰Ú·ÛË Ù˘ ¯ÔÚ‹ÁËÛ˘ Ù˘ ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ 80 mg/Ë̤ڷ ‹ placebo Û 3.086 ·ÛıÂÓ›˜ Ì ·ÛÙ·ı‹ ÛÙËı¿Á¯Ë ‹ non-Q ¤ÌÊÚ·ÁÌ·, 24 ¤ˆ˜ 96 ÒÚ˜ ÌÂÙ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘˜ ÛÙo ÓÔÛÔÎÔÌ›Ô. ∏ ‰È¿ÚÎÂÈ· ·Ú·ÎÔÏÔ‡ıËÛ˘ ‹Ù·Ó 16 ‚‰ÔÌ¿‰Â˜. ŒÓ· ¿ÏÏÔ ·ÍÈÔÛËÌ›ˆÙÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi ·˘Ù‹˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó fiÙÈ ‰ÂÓ ÂÏ‹ÊıËÛ·Ó ˘fi„Ë Ù· Â›‰· Ù˘ ÔÏÈ΋˜ Î·È LDL ¯ÔÏËÛÙÂÚfiÏ˘ ÙˆÓ ·ÛıÂÓÒÓ. ø˜ ·ÚÈÔÈ Î·Ù·ÏËÎÙÈÎÔ› ÛÙfi¯ÔÈ ÔÚ›ÛıËÎ·Ó Ô ı¿Ó·ÙÔ˜, ÙÔ ÌË ı·Ó·ÙËÊfiÚÔ ¤ÌÊÚ·ÁÌ·, Ë Î·Ú‰È·Î‹ ·Ó·ÎÔ‹ Î·È Ë Âȉ›ӈÛË Ù˘ ÛÙËı¿Á¯Ë˜ Ì Â›ÁÔ˘Û· Â·ÓÂÈÛ·ÁˆÁ‹ ÛÙÔ ÓÔÛÔÎÔÌ›Ô. ∏ ·Ó¿Ï˘ÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ¤‰ÂÈÍ fiÙÈ Ë ¯ÔÚ‹ÁËÛË Ù˘ ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ ÁÈ· 16 ‚‰ÔÌ¿‰Â˜ ›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÙˆÓ Î‡ÚÈˆÓ Î·Ù·ÏËÎÙÈÎÒÓ ÛÙfi¯ˆÓ Û ۇÁÎÚÈÛË Ì ÙÔ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ (14,8% ¤Ó·ÓÙÈ 17,2%), ÂÓÒ ·Ú·ÙËÚ‹ıËÎÂ Î·È Ì›ˆÛË Ù˘ Â›ÙˆÛ˘ ÙˆÓ ·ÁÁÂÈ·ÎÒÓ

ÂÁÎÂÊ·ÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ (0,8% ÛÙËÓ ÔÌ¿‰· Ù˘ ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ Î·È 1,6% ÛÙËÓ ÔÌ¿‰· ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘). ŒÓ· ¿ÏÏÔ ÂӉȷʤÚÔÓ Â‡ÚËÌ· Ù˘ ÌÂϤÙ˘ MIRACL ‹Ù·Ó fiÙÈ Ù· ·Ú·¿Óˆ ·ÔÙÂϤÛÌ·Ù· ‰ÂÓ Û˘Û¯ÂÙ›˙ÔÓÙ·Ó Ì ٷ Â›‰· Ù˘ ÔÏÈ΋˜ ‹ LDL ¯ÔÏËÛÙÂÚfiÏ˘ ηٿ ÙËÓ ¤Ó·ÚÍË Ù˘ ·ÁˆÁ‹˜. ∂ÈϤÔÓ, ‰ÂÓ ˘‹Ú¯Â Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ ÌÂÙ·‚ÔÏ‹˜ Ù˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ 16 ‚‰ÔÌ¿‰ˆÓ ·Ú·ÎÔÏÔ‡ıËÛ˘ Î·È Ù˘ ÂÌÊ¿ÓÈÛ˘ οÔÈÔ˘ ·fi ÙÔ˘˜ ηٷÏËÎÙÈÎÔ‡˜ ÛÙfi¯Ô˘˜. ∆·˘Ùfi¯ÚÔÓ·, ÙfiÛÔ Ë ÌÂϤÙË MIRACL fiÛÔ Î·È ¿ÏϘ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó ÙË ÛËÌ·Û›· Ù˘ ¯ÔÚ‹ÁËÛ˘ ˘ÔÏÈȉ·ÈÌÈ΋˜ ·ÁˆÁ‹˜ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Û ·ÛıÂÓ›˜ Ì Ôͤ· ÛÙÂÊ·ÓÈ·›· Û‡Ó‰ÚÔÌ·, fiÛÔÓ ·ÊÔÚ¿ ÙË Û˘ÌÌfiÚʈÛË ÙˆÓ ·ÛıÂÓÒÓ ÛÙËÓ ÈÛÙ‹ Î·È Û¯ÔÏ·ÛÙÈ΋ Ù‹ÚËÛË ÙˆÓ Ô‰ËÁÈÒÓ. µÚ¤ıËΠ‰ËÏ·‰‹ fiÙÈ ÔÈ ·ÛıÂÓ›˜ ÛÙÔ˘˜ ÔÔ›Ô˘˜ Ë ¤Ó·ÚÍË Ù˘ ·ÁˆÁ‹˜ Ì ÛÙ·Ù›ÓË ¤ÁÈÓ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÓ‰ÔÓÔÛÔÎÔÌÂȷ΋˜ ÓÔÛËÏ›·˜ ÙÔ˘˜ ›¯·Ó ηχÙÂÚ· ÔÛÔÛÙ¿ Ì·ÎÚÔ¯ÚfiÓÈ·˜ Û˘ÌÌfiÚʈÛ˘ Î·È Î·Ù¿ Û˘Ó¤ÂÈ· ÌÈÎÚfiÙÂÚ· ÔÛÔÛÙ¿ ıÓËÛÈÌfiÙËÙ·˜7. ∆· Û˘ÌÂÚ¿ÛÌ·Ù· Ô˘ ÚԤ΢„·Ó ·fi ÙË ÌÂϤÙË MIRACL ÂȂ‚·ÈÒıËÎ·Ó ·fi Ì›· ¿ÏÏË ÌÂϤÙË Ô˘ ‰ËÌÔÛȇıËΠÚfiÛÊ·Ù·, ÙËÓ Pravastatin to Atorvastatin Evaluation and Infection Therapy (PROVE-IT)8. ¶ÚfiÎÂÈÙ·È ÁÈ· Ì›· ÚÔÔÙÈ΋


£EPA¶EIA – ºAPMAKA ÌÂϤÙË 4.162 ·ÛıÂÓÒÓ Ô˘ ›¯·Ó ÓÔÛËÏ¢ı› ÁÈ· Ô͇ ÛÙÂÊ·ÓÈ·›Ô ÂÂÈÛfi‰ÈÔ Î·È ÛÙÔ˘˜ ÔÔ›Ô˘˜ Û˘ÁÎÚ›ıËÎÂ Ë ¯ÔÚ‹ÁËÛË ÂÈıÂÙÈ΋˜ ˘ÔÏÈȉ·ÈÌÈ΋˜ ·ÁˆÁ‹˜ (80 mg/Ë̤ڷ ·ÙÔÚ‚·ÛÙ·Ù›Ó˘) Ì ÙË Û˘Ì‚·ÙÈ΋ ˘ÔÏÈȉ·ÈÌÈ΋ ·ÁˆÁ‹ (40 mg/Ë̤ڷ Ú·‚·ÛÙ·Ù›Ó˘). ø˜ ·ÚÈÔÈ Î·Ù·ÏËÎÙÈÎÔ› ÛÙfi¯ÔÈ ÔÚ›ÛıËÎ·Ó ÙÔ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘, Ë ·ÛÙ·ı‹˜ ÛÙËı¿Á¯Ë fiÙ·Ó ·˘Ù‹ ··ÈÙÔ‡Û Â·ÓÂÈÛ·ÁˆÁ‹ ÛÙÔ ÓÔÛÔÎÔÌ›Ô, ÙÔ ·ÁÁÂÈ·Îfi ÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔ Î·È Ô ı¿Ó·ÙÔ˜, ÂÓÒ Ë ‰È¿ÚÎÂÈ· Ù˘ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÙˆÓ ·ÛıÂÓÒÓ ‹Ù·Ó 24 Ì‹Ó˜. ∏ ÌÂϤÙË ·˘Ù‹ ¤‰ÂÈÍ fiÙÈ Ë ¯ÔÚ‹ÁËÛË ÂÈıÂÙÈ΋˜ ˘ÔÏÈȉ·ÈÌÈ΋˜ ·ÁˆÁ‹˜ ›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· ηٿ 16% ÏÈÁfiÙÂÚ· Û˘Ì‚¿Ì·Ù· Û ۇÁÎÚÈÛË Ì ÙË Û˘Ì‚·ÙÈ΋ ˘ÔÏÈȉ·ÈÌÈ΋ ·ÁˆÁ‹. ∞ÍÈÔÛËÌ›ˆÙÔ Ì¿ÏÈÛÙ· Â›Ó·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ·˘Ù‹ Ë ÂÏ¿ÙÙˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛ˘ ÛÙÂÊ·ÓÈ·›ˆÓ Û˘Ì‚·Ì¿ÙˆÓ ¿Ú¯ÈÛ ӷ Á›ÓÂÙ·È ÂÌÊ·Ó‹˜ ‹‰Ë ·fi ÙȘ ÚÒÙ˜ 30 Ë̤Ú˜ Ù˘ ·ÁˆÁ‹˜. ∏ ϤÔÓ ÚfiÛÊ·Ù· ‰ËÌÔÛÈÂ˘Ì¤ÓË ÌÂϤÙË Ô˘ Âȯ›ÚËÛ ӷ ‰È¢ÎÚÈÓ›ÛÂÈ ÙÔ Î·Ù¿ fiÛÔ Â›Ó·È ‰fiÎÈÌË Ë ¯ÔÚ‹ÁËÛË ÂÈıÂÙÈ΋˜ ˘ÔÏÈȉ·ÈÌÈ΋˜ ·ÁˆÁ‹˜ Û ·ÛıÂÓ›˜ Ì Ôͤ· ÛÙÂÊ·ÓÈ·›· Û‡Ó‰ÚÔÌ· Â›Ó·È Ë ∞ to Z9. ¶ÚfiÎÂÈÙ·È ÁÈ· Ì›· ‰ÈÏ‹ Ù˘ÊÏ‹ Ù˘¯·ÈÔÔÈË̤ÓË ÚÔÔÙÈ΋ ÌÂϤÙË 4.497 ·ÛıÂÓÒÓ Ì Ô͇ ÛÙÂÊ·ÓÈ·›Ô ÂÂÈÛfi‰ÈÔ, ÛÙÔ˘˜ ÔÔ›Ô˘˜ ¯ÔÚËÁ‹ıËΠÛÈÌ‚·ÛÙ·Ù›ÓË (40 mg/Ë̤ڷ) ÁÈ· 1 Ì‹Ó· Î·È ÛÙË Û˘Ó¤¯ÂÈ· 80 mg/Ë̤ڷ ̤¯ÚÈ ÙÔ Ù¤ÏÔ˜ Ù˘ ÌÂϤÙ˘ ‹ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ ÁÈ· 4 Ì‹Ó˜ Î·È ÛÙË Û˘Ó¤¯ÂÈ·

∞ÚÈıÌfi˜ ·ÛıÂÓÒÓ

ÛÈÌ‚·ÛÙ·Ù›ÓË (20 mg/ Ë̤ڷ). ∏ ‰È¿ÚÎÂÈ· Ù˘ ÌÂϤÙ˘ ‹Ù·Ó 24 Ì‹Ó˜, ÂÓÒ ˆ˜ ·ÚÈÔÈ Î·Ù·ÏËÎÙÈÎÔ› ÛÙfi¯ÔÈ ÔÚ›ÛıËÎ·Ó Ô ı¿Ó·ÙÔ˜, ÙÔ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘, Ë Â·ÓÂÈÛ·ÁˆÁ‹ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Î·È ÙÔ ·ÁÁÂÈ·Îfi ÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔ. ∏ ÌÂϤÙË ·˘Ù‹, fï˜, ‰ÂÓ ÂȂ‚·›ˆÛ ٷ ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ÚÔËÁÔ‡ÌÂÓˆÓ ÌÂÏÂÙÒÓ. ™˘ÁÎÂÎÚÈ̤ӷ, ·Ú·ÙËÚ‹ıËΠ̛· Ì›ˆÛË ÙÔ˘ ÔÛÔÛÙÔ‡ ÂÌÊ¿ÓÈÛ˘ ÔÔÈÔ˘‰‹ÔÙ ·fi ÙÔ˘˜ ·ÚÈÔ˘˜ ηٷÏËÎÙÈÎÔ‡˜ ÛÙfi¯Ô˘˜ ÛÙËÓ ÔÌ¿‰· ÛÙËÓ ÔÔ›· ¯ÔÚËÁ‹ıËΠÂÈıÂÙÈ΋ ˘ÔÏÈȉ·ÈÌÈ΋ ·ÁˆÁ‹ ηٿ 11%, Ë ÔÔ›·, ˆÛÙfiÛÔ, ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋. ™ÙÔÓ ¶›Ó·Î· 1 Ô˘ ·ÎÔÏÔ˘ı› ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Û˘ÓÔÙÈο Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ¯ÔÚ‹ÁËÛ˘ ÂÈıÂÙÈ΋˜ ˘ÔÏÈȉ·ÈÌÈ΋˜ ·ÁˆÁ‹˜ Û ·ÛıÂÓ›˜ Ì Ôͤ· ÛÙÂÊ·ÓÈ·›· Û‡Ó‰ÚÔÌ·, fiˆ˜ ·˘Ù¿ ÚԤ΢„·Ó ·fi ÙȘ ÚÔ·Ó·ÊÂÚı›Û˜ ÌÂϤÙ˜. ∞fi ÙÔÓ ·Ú·¿Óˆ ›Ó·Î· ÚÔ·ÙÂÈ fiÙÈ ÛÙË ÌÂϤÙË A to Z ·Ú·ÙËÚ‹ıËΠÌÂÁ·Ï‡ÙÂÚË Ì›ˆÛË Ù˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘ Û ۇÁÎÚÈÛË Ì ÙË ÌÂϤÙË PROVE IT. ¶·ÚfiÏ· ·˘Ù¿, ÛÙË ÌÂϤÙË PROVE IT, ‹‰Ë ·fi ÙȘ ÚÒÙ˜ 30 Ë̤Ú˜, ¿Ú¯ÈÛ ӷ ·Ú·ÙËÚÂ›Ù·È Ì›ˆÛË Î·Ù¿ 16% ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ, Ë ÔÔ›· Î·È ·Ú¤ÌÂÈÓ ÛÙ·ıÂÚ‹ ˆ˜ ÙÔ Ù¤ÏÔ˜ Ù˘ ¤Ú¢ӷ˜, ÂÓÒ ÛÙË ÌÂϤÙË A to Z ‰ÂÓ ·Ú·ÙËÚ‹ıËΠÛËÌ·ÓÙÈ΋ ÌÂÙ·‚ÔÏ‹ ÛÙËÓ Â›ÙˆÛË ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ Û˘Ì‚·Ì¿ÙˆÓ. ∞˘Ùfi ÙÔ Ê·ÈÓÔÌÂÓÈο ·Ú¿‰ÔÍÔ ·ÔÙ¤ÏÂÛÌ· ÌÔÚ› Ó· ÂÚÌËÓ¢ı› ÌfiÓÔ Ì ÙËÓ ·Ú·A to Z

MIRACL

PROVE IT

4497

3086

4162

ªÂ›ˆÛË LDL ¯ÔÏËÛÙÂÚfiÏ˘(mg/dl)

62

63

33

ªÂ›ˆÛË CRP(%)

17

34

38

ªÂ›ˆÛË Ù˘ Â›ÙˆÛ˘ ÙˆÓ Î‡ÚÈˆÓ Î·Ù·ÏËÎÙÈÎÒÓ ÛÙfi¯ˆÓ(%)

11

16

18

¶›Ó·Î·˜ 1

‰Ô¯‹ fiÙÈ ÔÈ Â˘ÂÚÁÂÙÈΤ˜ ‰Ú¿ÛÂȘ ÙˆÓ ÛÙ·ÙÈÓÒÓ ‰ÂÓ ÂÚÈÔÚ›˙ÔÓÙ·È ·ÔÎÏÂÈÛÙÈο ÛÙȘ ˘ÔÏÈȉ·ÈÌÈΤ˜ ÙÔ˘˜ ‰˘Ó·ÙfiÙËÙ˜, ·ÏÏ¿ ÂÂÎÙ›ÓÔÓÙ·È Î·È Û ÂÈÚfiÛıÂÙ˜ ‰Ú¿ÛÂȘ, ÙȘ ÏÂÈÔÙÚÔÈΤ˜ ‰Ú¿ÛÂȘ ÙÔ˘˜. ¶Ú¿ÁÌ·ÙÈ, ÌÂÏÂÙÒÓÙ·˜ ÙÔÓ ·Ú·¿Óˆ ›Ó·Î· οو ·fi ·˘Ùfi ÙÔ Ú›ÛÌ· Á›ÓÂÙ·È ·ÓÙÈÏËÙfi fiÙÈ ÛÙȘ ÌÂϤÙ˜ PROVE IT Î·È MIRACL ·Ú·ÙËÚ‹ıËΠ̛· ÛËÌ·ÓÙÈ΋ Ì›ˆÛË Ù˘ CRP, οÙÈ Ô˘ ·¤Ù˘¯Â Ó· οÓÂÈ Ë ÂÈıÂÙÈ΋ ¯ÔÚ‹ÁËÛË ÛÈÌ‚·ÛÙ·Ù›Ó˘ ÛÙË ÌÂϤÙË A to Z.

¶§∂π√∆ƒ√¶π∫∂™ ¢ƒ∞™∂π™ ™∆∞∆π¡ø¡ √È Î˘ÚÈfiÙÂÚ˜ ÏÂÈÔÙÚÔÈΤ˜ ‰Ú¿ÛÂȘ ÙˆÓ ÛÙ·ÙÈÓÒÓ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 210. ∞ÓÙÈÊÏÂÁÌÔÓÒ‰ÂȘ ‰Ú¿ÛÂȘ ∞ÓÙÈÔÍÂȉˆÙÈΤ˜ ‰Ú¿ÛÂȘ ∞ÓÙÈıÚÔÌ‚ˆÙÈΤ˜ ‰Ú¿ÛÂȘ ∂›‰Ú·ÛË ÛÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÂÓ‰ÔıËÏ›Ô˘ ¶›Ó·Î·˜ 2

¢Ú¿ÛÂȘ ÛÙË ÊÏÂÁÌÔÓÒ‰Ë ‰ÈÂÚÁ·Û›· ™‹ÌÂÚ· Â›Ó·È Û·Ê¤˜ fiÙÈ Ë ·ıËڈ̷ÙÈ΋ ‰È·‰Èηۛ· Â›Ó·È Ì›· ηٿ ‚¿ÛË ÊÏÂÁÌÔÓ҉˘ ‰È·‰Èηۛ·11, Ë ÔÔ›· Ì¿ÏÈÛÙ· Û˘Óԉ‡ÂÙ·È ·fi ·˘ÍË̤ӷ Â›‰· ÛÙÔ ·›Ì· ÔÚÈÛÌ¤ÓˆÓ ‰ÂÈÎÙÒÓ ÊÏÂÁÌÔÓ‹˜, fiˆ˜ Ù˘ CRP, ÙÔ˘ ·Ì˘ÏÔÂȉԇ˜ ÙÔ˘ ÔÚÔ‡-∞, Ù˘ IL-6, Ù˘ ∂-ÛÂÏÂÎÙ›Ó˘, ηıÒ˜ Î·È ÙˆÓ ÚÔÛÎÔÏÏËÙÈÎÒÓ ÌÔÚ›ˆÓ ICAM-1, VCAM-1, MCP-112,13. ∏ ·Ú·ÁˆÁ‹ ·˘ÙÒÓ ÙˆÓ Ô˘ÛÈÒÓ Û˘Û¯ÂÙ›˙ÂÙ·È Î·Ù¿ ·ÚÈÔ ÏfiÁÔ Ì ÙËÓ ÔÍÂȉˆÌ¤ÓË LDL ÛÙÔ ·ÁÁÂÈ·Îfi ÙÔ›¯ˆÌ·. ªÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ ÔÚÈṲ̂Ó˜ ·fi ·˘Ù¤˜ ÙȘ Ô˘Û›Â˜, fiˆ˜ Ë high sensitive CRP, ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó Î·È ˆ˜ ÚÔÁÓˆÛÙÈÎÔ› 13


·ıËÚÔÛÎÏ‹ÚˆÛË π√À¡IO™ 2005

‰Â›ÎÙ˜ ÁÈ· ÙË ÌÂÏÏÔÓÙÈ΋ ÂÌÊ¿ÓÈÛË ÂÓfi˜ ÔͤԘ Û˘Ì‚¿Ì·ÙÔ˜14. ∫ÏÈÓÈΤ˜ Î·È ÂÈÚ·Ì·ÙÈΤ˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ ÔÈ ÛÙ·Ù›Ó˜ ¤¯Ô˘Ó ·ÓÙÈÊÏÂÁÌÔÓÒ‰ÂȘ ‰Ú¿ÛÂȘ, ·ÊÔ‡ ÌÂÈÒÓÔ˘Ó fiÏÔ˘˜ ÙÔ˘˜ ‰Â›ÎÙ˜ ÊÏÂÁÌÔÓ‹˜ Î·È Î˘Ú›ˆ˜ ÙË CRP15, Ë ÔÔ›· ÂÎÙfi˜ ·fi ÙÔ fiÙÈ ·ÔÙÂÏ› ¤Ó· Ôχ ηÏfi ‰Â›ÎÙË Ù˘ ˘ÔΛÌÂÓ˘ ÊÏÂÁÌÔÓÒ‰Ô˘˜ ‰ÈÂÚÁ·Û›·˜, Èı·Ófiٷٷ ¤¯ÂÈ Î·È ¿ÌÂÛË ‰Ú¿ÛË ÛÙË ‰È·‰Èηۛ· Ù˘ ·ıËڈ̿وÛ˘ Î·È Î·Ù¿ Û˘Ó¤ÂÈ· ÛÙË ÛÙ·ıÂÚfiÙËÙ· Ù˘ ·ıËڈ̷ÙÈ΋˜ Ͽη˜16. ¢Ú¿ÛÂȘ ÛÙÔ˘˜ Ì˯·ÓÈÛÌÔ‡˜ ıÚÔÌ‚ÔÁ¤ÓÂÛ˘ ∞Ó·fiÛ·ÛÙÔ ÚfiÏÔ ÛÙË ‰È·‰Èηۛ· ÙˆÓ ÈÛ¯·ÈÌÈÎÒÓ Î·Ú‰ÈÔ·ıÂÈÒÓ Î·È È‰›ˆ˜ ÛÙ· Ôͤ· ÛÙÂÊ·ÓÈ·›· Û˘Ì‚¿Ì·Ù· ‰È·‰Ú·Ì·Ù›˙ÂÈ Ë ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘ Ì˯·ÓÈÛÌÔ‡ ‹Í˘, Ô ÔÔ›Ô˜ ÌÂÙ¿ ÙË Ú‹ÍË Ù˘ ·ıËڈ̷ÙÈ΋˜ Ͽη˜ Ô‰ËÁ› ÛÙÔ Û¯ËÌ·ÙÈÛÌfi ıÚfiÌ‚Ô˘17. ™ÙË ‰È·‰Èηۛ· Ù˘ ‹Í˘ ηıÔÚÈÛÙÈÎfi ÚfiÏÔ ‰È·‰Ú·Ì·Ù›˙ÂÈ Ô ÈÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ (TF). √ ÈÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ Â›Ó·È Ì›· ÁÏ˘ÎÔÚˆÙ½ÓË Ô˘ ÂÎÊÚ¿˙ÂÙ·È ÛÙËÓ ·ıËڈ̷ÙÈ΋ Ͽη Î·È Ô ÔÔ›Ô˜ fiÙ·Ó ¤Ú¯ÂÙ·È Û Â·Ê‹ Ì ÙËÓ Î˘ÎÏÔÊÔÚ›· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ڋ͢ Ù˘ Ͽη˜ ÂÓÂÚÁÔÔÈ› ÙÔÓ Î·Ù·ÚÚ¿ÎÙË ÙˆÓ ·ÓÙȉڿÛÂˆÓ Ù˘ ‹Í˘ Ì ·ÔÙ¤ÏÂÛÌ· ÙÔ Û¯ËÌ·ÙÈÛÌfi ıÚfiÌ‚Ô˘18. √È ÛÙ·Ù›Ó˜ ÚÔηÏÔ‡Ó Ì›ˆÛË ÙfiÛÔ Ù˘ Û˘ÁΤÓÙÚˆÛ˘ fiÛÔ Î·È Ù˘ ÂÓÂÚÁfiÙËÙ·˜ ÙÔ˘ TF19 Î·È ÂÈϤÔÓ ‰ÚÔ˘Ó ÛÙÔÓ ÈÓˆ‰ÔÏ˘ÙÈÎfi Ì˯·ÓÈÛÌfi ‰È·Ì¤ÛÔ˘ ·‡ÍËÛ˘ Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÙÔ˘ ÂÓÂÚÁÔÔÈËÙ‹ ÙÔ˘ ÈÛÙÈÎÔ‡ Ï·ÛÌÈÓÔÁfiÓÔ˘ (tPA) Î·È Ì›ˆÛ˘ Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÙÔ˘ ·Ó·ÛÙÔϤ· ÙÔ˘ ÂÓÂÚÁÔÔÈËÙ‹ ÙÔ˘ Ï·ÛÌÈÓÔÁfiÓÔ˘-1 (PAI-1)20-23, Ì ÙÂÏÈÎfi ·ÔÙ¤ÏÂÛÌ· ÙË ÌÂÙ·‚ÔÏ‹ Ù˘ ÈÛÔÚÚÔ-

14

›·˜ ‹Í˘-ÈÓˆ‰fiÏ˘Û˘ ÛÙ· ·ÙÙ·Ú· ÙÔ˘ ·ÁÁÂÈ·ÎÔ‡ ÙÔȯÒÌ·ÙÔ˜ Î·È ÛÙ· ÌÔÓÔ·ÙÙ·Ú·/ Ì·ÎÚÔÊ¿Á· ÚÔ˜ ÙËÓ Î·Ù‡ı˘ÓÛË Ù˘ ÈÓˆ‰fiÏ˘Û˘. ŒÙÛÈ, ÔÈ ÛÙ·Ù›Ó˜ ÂËÚ¿˙Ô˘Ó ÙË ‰È·‰Èηۛ· Ù˘ ıÚfiÌ‚ˆÛ˘ Î·È Ë Â›‰Ú·ÛË ·˘Ù‹ ¤¯ÂÈ È‰È·›ÙÂÚË ÛËÌ·Û›· ÛÙËÓ ÂÚ›ÙˆÛË ÙˆÓ ÔͤˆÓ Û˘Ì‚·Ì¿ÙˆÓ. ∂›‰Ú·ÛË ÙˆÓ ÛÙ·ÙÈÓÒÓ ÛÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÂÓ‰ÔıËÏ›Ô˘ ∏ ÂÓ‰ÔıËÏȷ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ‰È·‰Ú·Ì·Ù›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ¤Ó·ÚÍË Ù˘ ·ıËÚÔÛÎÏ‹ÚˆÛ˘, ÎÂÓÙÚÈÎfi ÚfiÏÔ ÛÙËÓ ÔÔ›· ¤¯ÂÈ Ë ÔÍÂȉˆÌ¤ÓË ÌÔÚÊ‹ Ù˘ LDL24. ∏ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÂÓ‰ÔıËÏ›Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÌÂȈ̤ÓË ·Ú·ÁˆÁ‹ ‹ ÂÓÂÚÁfiÙËÙ· ÙÔ˘ ÂÓ‰ÔÁÂÓÔ‡˜ ·ÁÁÂÈԉȷÛÙ·ÏÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÙÔ˘ ÂÓ‰ÔıËÏ›Ô˘, ‰ËÏ·‰‹ ÙÔ˘ ÔÍÂȉ›Ô˘ ÙÔ˘ ·˙ÒÙÔ˘ (eNO)25. ∆Ô eNO ¤¯ÂÈ ÌÂÁ¿ÏË ÛËÌ·Û›·, ·ÊÔ‡ ÂÌÊ·Ó›˙ÂÈ ‰È¿ÊÔÚ˜ ·ÓÙÈ·ıËÚÔÁfiÓ˜ ‰Ú¿ÛÂȘ (·Ó·ÛÙÔÏ‹ Ù˘ Û˘ÁÎfiÏÏËÛ˘ ÙˆÓ ÌÔÓÔ΢ÙÙ¿ÚˆÓ ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙÔ˘ ÂÓ‰ÔıËÏ›Ô˘, ·Ó·ÛÙÔÏ‹ Ù˘ Û˘ÛÛÒÚ¢Û˘ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ Î·È Ù˘ ·ÁÁÂÈÔÛ‡Û·Û˘). ∂›Û˘, ·ÚÂÌÔ‰›˙ÂÈ ÙËÓ ÔÍ›‰ˆÛË Ù˘ LDL, Ô˘, fiˆ˜ ÚԷӷʤÚıËÎÂ, ‰È·‰Ú·Ì·Ù›˙ÂÈ Î·ıÔÚÈÛÙÈÎfi ÚfiÏÔ ÛÙË ‰È·‰Èηۛ· Ù˘ ·ıËÚÔÁ¤ÓÂÛ˘26-30. ªÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ ÔÈ ÛÙ·Ù›Ó˜ Â¿ÁÔ˘Ó ÙfiÛÔ ÙËÓ ·Ú·ÁˆÁ‹ fiÛÔ Î·È ÙËÓ ÂÓÂÚÁfiÙËÙ· ÙÔ˘ eNO, ‰È·Ì¤ÛÔ˘ Â·ÁˆÁ‹˜ ÙÔ˘ ÂÓ˙‡ÌÔ˘ Û˘ÓıÂÙ¿ÛË ÙÔ˘ eNO31, ηıÒ˜ Î·È ‰È·Ì¤ÛÔ˘ ·Ó·ÛÙÔÏ‹˜ ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ÙˆÓ ÌÈÎÚÒÓ G ÚˆÙÂ˚ÓÒÓ32-34 .

∂¶π§√°√™ ∞fi Ù· ·Ú·¿Óˆ ηı›ÛÙ·Ù·È Û·Ê¤˜ fiÙÈ Ë ¤Ó·ÚÍË ˘ÔÏÈȉ·ÈÌÈ΋˜ ·ÁˆÁ‹˜ Û ·ÛıÂÓ›˜

Ì Ôͤ· ÛÙÂÊ·ÓÈ·›· ÂÂÈÛfi‰È· ÎÚ›ÓÂÙ·È fi¯È ÌfiÓÔ ÛÎfiÈÌË ·ÏÏ¿ ıˆÚÂ›Ù·È ÂȂ‚ÏË̤ÓË, ·ÓÂÍ¿ÚÙËÙ· ·fi Ù· ·Ú¯Èο Â›‰· Ù˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘, Ù· ÔÔ›· ̤¯ÚÈ Û‹ÌÂÚ· ·ÔÙÂÏÔ‡Û·Ó Î·È ÙÔ ‚·ÛÈÎfi ÎÚÈÙ‹ÚÈÔ ÙˆÓ ‰ÈÂıÓÒÓ Î·Ù¢ı˘ÓÙ‹ÚÈˆÓ Ô‰ËÁÈÒÓ fiÛÔÓ ·ÊÔÚ¿ ÙË ¯ÔÚ‹ÁËÛË ÛÙ·ÙÈÓÒÓ35. ¡ÂÒÙÂÚ˜ ÌÂϤÙ˜ ‚Ú›ÛÎÔÓÙ·È ·˘Ù‹ ÙË ÛÙÈÁÌ‹ Û ÂͤÏÈÍË, fiˆ˜ Ë PRINCESS, Ô˘ ·Ó·Ì¤ÓÂÙ·È Ó· ·ÔÛ·ÊËÓ›ÛÔ˘Ó ÙÔ ÚfiÏÔ ÙˆÓ ÛÙ·ÙÈÓÒÓ Û ·ÛıÂÓ›˜ Ì Ôͤ· ÛÙÂÊ·ÓÈ·›· Û‡Ó‰ÚÔÌ·. ¶Ú¤ÂÈ Ó· ·Ó·ÊÂÚı› fiÙÈ ÚfiÛÊ·Ù· ¤¯Ô˘Ó ‰ËÌÔÛÈ¢Ù› ÙÚÔÔÔÈ‹ÛÂȘ ÙˆÓ Ô‰ËÁÈÒÓ ¯ÔÚ‹ÁËÛ˘ ˘ÔÏÈȉ·ÈÌÈ΋˜ ·ÁˆÁ‹˜ Ô˘ ÈÛ¯‡Ô˘Ó ¤ˆ˜ Û‹ÌÂÚ·. ™˘ÁÎÂÎÚÈ̤ӷ ÚÔÙ›ÓÂÙ·È ϤÔÓ ˆ˜ ÙÈÌ‹-ÛÙfi¯Ô˜ Ù˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘ Û ¿ÙÔÌ· Ôχ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Ù· 70 mg/dl36 ·ÓÙ› ÙˆÓ 100 mg/dl Ô˘ ›Û¯˘Â ˆ˜ ÙÒÚ·. ∂ÈÚfiÛıÂÙ·, ÚÔÙ›ÓÂÙ·È ÛÙÔ˘˜ ·ÛıÂÓ›˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Ì›· Ì›ˆÛË Ù˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘ ηٿ 30% - 40% ·ÓÂÍ¿ÚÙËÙ· ·fi Ù· ·Ú¯Èο Ù˘ Â›‰·, ηıÒ˜ ·fi ÙȘ ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ ÚÔ·ÙÂÈ fiÙÈ Ì›· Ù¤ÙÔÈ· Ì›ˆÛË Û˘Óԉ‡ÂÙ·È ·fi ·ÓÙ›ÛÙÔÈ¯Ë Ì›ˆÛË Ù˘ ηډȷÁÁÂȷ΋˜ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÙfiÙËÙ·˜. ÕÏψÛÙÂ, fiˆ˜ ¤¯ÂÈ ‰È·ÈÛÙˆı› ·fi ÚfiÛÊ·Ù· ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÌÂϤÙ˜ ÂÎÙ›ÌËÛ˘ ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙˆÓ ·ıËڈ̷ÙÈÎÒÓ ‚Ï·‚ÒÓ, Ì ÙË ¯Ú‹ÛË Û˘Û΢‹˜ ÂÓ‰ÔÛÙÂÊ·ÓÈ·›Ô˘ ˘ÂÚ‹¯Ô˘, Ë ÂÈıÂÙÈ΋ ˘ÔÏÈȉ·ÈÌÈ΋ ·ÁˆÁ‹ Û ·ÛıÂÓ›˜ Ì Ôͤ· ÛÙÂÊ·ÓÈ·›· Û˘Ì‚¿Ì·Ù· ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙË Ì›ˆÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ Ù˘ ·ıËڈ̷ÙÈ΋˜ Ͽη˜. ∂ÈϤÔÓ, Ë Ì›ˆÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙÔ˘ ·ıËÚÒÌ·ÙÔ˜ Â›Ó·È Â˘ı¤ˆ˜ ·Ó¿ÏÔÁË Ì ÙË Ì›ˆÛË Ù˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘ ·ÓÂÍ¿ÚÙËÙ· ·fi Ù· ·Ú¯Èο Â›‰· Ù˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘37.


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19. Eto M, Kozai T, Cosentino F, Joch H and Luscher TF. Statin prevents tissue factor expression in human endothelial cells; Role of Rho/Rho kinase and Akt pathways. Circulation 2002;105:17561759

31. Laufs U, La Fatat V, Plutzky J, Liao JK. Upregulation of endothelial nitric oxide synthase by HMG CoA reductase inhibitors. Circulation 1998;97:1129-1135

20. Essig M, Nguyen G, Prie D, Escoubet B, Sraer JD and Friedlander G. 3-Hydroxy-3-methylglutaryl coenzyme A reductase inhibitors increase fibrinolytic activity in rat aortic endothelial cells. Role of geranylgeranylation and Rho proteins. Circulation 1998;83:683-690 21. Bourcier T, and Libby P. HMG CoA reductase inhibitors reduce plasminogen activator inhibitor-1 expression by human vascular smooth muscle and endothelial cells. Arterioscl, Thromb and Vasc Bio 2000;20:556-562 22. Lopez S, Peiretti F, Bonardo B, JuhanVague L and Nalbone G. Effect of atorvastatin and fluvastatin on the expression of plasminogen activator inhibitor type-1 in cultured human endothelial cells. Atherosclerosis 2000;152:359366 23. Wiesbauer F, Kaun C, Zorn G, Maurer G, Huber K and Wojta J. HMG CoA reductase inhibitors affect the fibrinolytic system of human vascular cells in vitro: A comparative study using different statins. Br J Pharmacol 2002;135:284292 24. Witztum JL and Steinberg D. Role of oxidized low-density lipoprotein in atherogenesis. J Clin Invest 1991;88:17851792 25. Liao JK, Shin WS, Lee WY, Clark SL. Oxidized low-density lipoprotein decreases the expression of endothelial nitric oxide synthase. J Biol Chem 1995;270:319-324

32. Laufs U, and Liao JK. Post-transcriptional regulation of endothelial nitric oxide synthase mRNA stability by Rho GTPase. J Biol Chem 1998;273:2426624271 33. Eto M, Kozai T, Cosentino F, Joch H and Luscher TF. Statin prevents tissue factor expression in human endothelial cells; Role of Rho/Rho kinase and Akt pathways. Circulation 2002;105:17561759 34. Kureishi Y, Luo Z, et al. The HMG-CoA reductase inhibitor simvastatin activates the protein kinase Akt and promotes angiogenesis in normocholesterolemic animals. Nature Medicine 2000;7: 1004-1010 35. Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001; 285:2486-2497 36. Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Circulation 2004;110:227-239 37. Shinya Okazaki, MD; Takayuki Yokohama, MD; Katsumi Miyauchi, MD; Kazunori Shimada, MD; Takeshi Kurata, MD; Hitoshi Sato, MD; Hiroyuki Daida, MD. Demonstration of the beneficial effect on atherosclerotic lesions by serial volumetric intravascular ultrasound analysis during half a year after coronary event: The ESTABLISH Study. Circulation 2004;110: 1061-1068

15


·ıËÚÔÛÎÏ‹ÚˆÛË π√À¡IO™ 2005

™˘ÛÙ¿ÛÂȘ Ù˘ ∂˘Úˆ·˚΋˜ ∂Ù·ÈÚ›·˜ À¤ÚÙ·Û˘ ÁÈ· ÙË ™˘Ì‚·ÙÈ΋ ª¤ÙÚËÛË Î·È ÙËÓ ∂ÈÎÔÛÈÙÂÙÚ¿ˆÚË ∫·Ù·ÁÚ·Ê‹ Ù˘ ∞ÚÙËÚȷ΋˜ ¶›ÂÛ˘, ηıÒ˜ Î·È ÁÈ· ÙË ª¤ÙÚËÛË Ù˘ ∞ÚÙËÚȷ΋˜ ¶›ÂÛ˘ ÛÙÔ ™›ÙÈ ªÈ¯¿Ï˘ ∫·ÏÔÁ‹ÚÔ˘, ∂ÈÛÙËÌÔÓÈÎfi˜ ™˘ÓÂÚÁ¿Ù˘ π·ÙÚ›Ԣ §Èȉ›ˆÓ µ. ∆ÛÈÌȯfi‰ËÌÔ˜, ∂ȉÈ΢fiÌÂÓÔ˜ µ’ ¶·ıÔÏÔÁÈ΋˜ ∫ÏÈÓÈ΋˜ ∂ÏÈÛ¿Ê ªˆ˘Û‹˜, ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜

∂ÈÛ·ÁˆÁ‹ ∆ËÓ ÙÂÏÂ˘Ù·›· ÂÈÎÔÛ·ÂÙ›· Ë ·ÎÚ›‚ÂÈ· Ù˘ Û˘Ì‚·ÙÈ΋˜ ÌÂıfi‰Ô˘ ̤ÙÚËÛ˘ Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ (∞¶) Ì ÙËÓ Ù¯ÓÈ΋ ÙˆÓ Riva-Rocci / Korotkoff ¤¯ÂÈ ·ÌÊÈÛ‚ËÙËı› Î·È ¤¯Ô˘Ó Á›ÓÂÈ ÚÔÛ¿ıÂȘ ÁÈ· ÙË Ì¤ÙÚËÛË Ù˘ ∞¶ Ì ·˘ÙfiÌ·Ù˜ ËÏÂÎÙÚÔÓÈΤ˜ Û˘Û΢¤˜. ™ÙÔ ›‰ÈÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· Ë ·Ó·ÁÓÒÚÈÛË ÙÔ˘ Ê·ÈÓÔ̤ÓÔ˘ Ù˘ «˘¤ÚÙ·Û˘ Ù˘ Ï¢΋˜ ÌÏÔ‡˙·˜» ¤¯ÂÈ Ô‰ËÁ‹ÛÂÈ ÙËÓ ¤Ú¢ӷ ÛÙËÓ ·Ó‡ÚÂÛË Ó¤ˆÓ ÌÂıfi‰ˆÓ ̤ÙÚËÛ˘ Ù˘ ∞¶, ÔÈ Ôԛ˜ ·Ú¤¯Ô˘Ó Ì›· ÈÔ ÔÏÔÎÏËڈ̤ÓË ÂÈÎfiÓ· Ù˘ ∞¶ ÙÔ˘ ·ÙfiÌÔ˘. ∆¤ÙÔȘ ̤ıÔ‰ÔÈ Â›Ó·È Ë Ú·ÁÌ·ÙÔÔ›ËÛË Â·ÓÂÈÏËÌÌ¤ÓˆÓ ÌÂÙÚ‹ÛÂˆÓ Ù˘ ∞¶ ÛÙÔ È·ÙÚ›Ô, Ë Ì¤ÙÚËÛË Ù˘ ∞¶ ·fi ÙÔÓ ·ÛıÂÓ‹ ÛÙÔ Û›ÙÈ ÙÔ˘ Î·È Ë 24ˆÚË Î·Ù·ÁÚ·Ê‹ Ù˘ ∞¶. ∏ ̤ÙÚËÛË Ù˘ ∞¶ ·ÔÙÂÏ› ÙÔÓ ·ÎÚÔÁˆÓÈ·›Ô Ï›ıÔ ÁÈ· ÙË ‰È¿ÁÓˆÛË Î·È ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ˘¤ÚÙ·Û˘. ∏ ·ÎÚ›‚ÂÈ· ·˘Ù‹˜ Ù˘ ̤ÙÚËÛ˘ ¤¯ÂÈ Î·ıÔÚÈÛÙÈ΋ ÛËÌ·Û›· Î·È Û˘ÓÂÒ˜ Ú¤ÂÈ Ó· ηٷ‚¿ÏÏÂÙ·È Î¿ı ÚÔÛ¿ıÂÈ· ÒÛÙ ·˘Ù‹ Ë Ì¤ÙÚËÛË Ó· Â›Ó·È ·ÍÈfiÈÛÙË. ™ÎÔfi˜ ·˘ÙÔ‡ ÙÔ˘ ¿ÚıÚÔ˘ Â›Ó·È Ë ·Ó·ÛÎfiËÛË ÙˆÓ Î·Ù¢ı˘ÓÙ‹ÚÈˆÓ Ô‰ËÁÈÒÓ Ô˘ ÈÛ¯‡Ô˘Ó Û‹ÌÂÚ· ÁÈ· ÙË ÛˆÛÙ‹ ̤ÙÚËÛË Ù˘ ∞¶. ∆Ô ¿ÚıÚÔ ¯ˆÚ›˙ÂÙ·È Û ÙÚ›· ̤ÚË: ∆Ô 16

ÚÒÙÔ Ì¤ÚÔ˜ ·Ó·Ê¤ÚÂÙ·È Û ı¤Ì·Ù· Ô˘ ·ÊÔÚÔ‡Ó ÙË Ì¤ÙÚËÛË Ù˘ ∞¶ ÛÙÔ È·ÙÚ›Ô, ÙÔ ‰Â‡ÙÂÚÔ Ì¤ÚÔ˜ ÛÙËÓ 24ˆÚË Î·Ù·ÁÚ·Ê‹ Ù˘ ∞¶ Î·È ÙÔ ÙÚ›ÙÔ ÛÙË Ì¤ÙÚËÛË Ù˘ ∞¶ ÛÙÔ Û›ÙÈ.

ª¤ÚÔ˜ 1: ™˘ÛÙ¿ÛÂȘ ÁÈ· ÙË Ì¤ÙÚËÛË Ù˘ ∞¶ ÛÙÔ È·ÙÚÂ›Ô ∏ ÂÈÏÔÁ‹ ÌÈ·˜ Û˘Û΢‹˜ ∏ ·ÍÈÔÈÛÙ›· ÙˆÓ Û˘Û΢ÒÓ Ì¤ÙÚËÛ˘ Ù˘ ∞¶ ‰ÂÓ Ú¤ÂÈ Ó· ‚·Û›˙ÂÙ·È ÛÙȘ ‰ËÏÒÛÂȘ ÙˆÓ Î·Ù·Û΢·ÛÙÒÓ. ∞ÓÙ›ıÂÙ·, Ë ·ÍÈÔÏfiÁËÛË Ú¤ÂÈ Ó· Ú·ÁÌ·ÙÔÔÈÂ›Ù·È ·fi ·ÓÂÍ¿ÚÙËÙ˜ ·Ú¯¤˜ Î·È Ù· ·ÔÙÂϤÛÌ·Ù· Ó· ‰ËÌÔÛȇÔÓÙ·È ÛÙÔÓ ÂÚÈÔ‰ÈÎfi È·ÙÚÈÎfi Ù‡Ô. ¶ÚfiÛÊ·Ù·, Ë ESH (European Society of Hypertension) ‰ËÌÔÛ›Â˘Û ¤Ó· ·ÏÔÔÈË̤ÓÔ ÚˆÙfiÎÔÏÏÔ ÂϤÁ¯Ô˘ Ù˘ ·ÍÈÔÈÛÙ›·˜ ÙˆÓ ËÏÂÎÙÚÔÓÈÎÒÓ Î·È ÌÂÙ·ÏÏÈÎÒÓ ÈÂÛfiÌÂÙÚˆÓ, Ì ÙËÓ ÚÔÛ‰ÔΛ· fiÙÈ ÔÈ Î·Ù·Û΢·ÛÙ¤˜ ı· ˘Ô‚¿ÏÏÔ˘Ó ÁÈ· ¤ÏÂÁ¯Ô Ù· ÚÔ˚fiÓÙ· ÙÔ˘˜ [1].

√È Û˘Û΢¤˜ ̤ÙÚËÛ˘ Ù˘ ∞¶ ∆Ô ˘‰Ú·ÚÁ˘ÚÈÎfi ÈÂÛfiÌÂÙÚÔ Â›Ó·È Ì›· ·ÍÈfiÈÛÙË Û˘Û΢‹ fiÙ·Ó ÏËÚÔ‡ÓÙ·È ÔÚÈṲ̂ӷ ÎÚÈÙ‹ÚÈ·. ∆· ÛÙÔȯ›· Ô˘

Ú¤ÂÈ Ó· ÚÔÛ¤¯ÂÈ Î·Ó›˜ Û ̛· Ù¤ÙÔÈ· Û˘Û΢‹ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1 [2]. ∆· ˘‰Ú·ÚÁ˘ÚÈο ÈÂÛfiÌÂÙÚ· ÛÙ· ÓÔÛÔÎÔÌ›· ¯ÚÂÈ¿˙ÔÓÙ·È ¤ÏÂÁ¯Ô Î·È Û˘ÓÙ‹ÚËÛË Î¿ı 6 Ì‹Ó˜. ¶ÂÚ›Ô˘ ÔÈ ÌÈÛ¤˜ ˘‰Ú·ÚÁ˘ÚÈΤ˜ Û˘Û΢¤˜ ÛÙ· ÓÔÛÔÎÔÌ›· Â›Ó·È ÂÏ·Ùو̷ÙÈΤ˜. ∆Ô ÌÂÙ·ÏÏÈÎfi ÈÂÛfiÌÂÙÚÔ ‰ÂÓ Â›Ó·È ÙfiÛÔ ·ÍÈfiÈÛÙÔ fiÛÔ ÙÔ ˘‰Ú·ÚÁ˘ÚÈÎfi. ∏ ·ÍÈÔÈÛÙ›· ÙÔ˘ ÂϤÁ¯ÂÙ·È Ì ÙË Û‡ÁÎÚÈÛË ÙÔ˘ Ì ¤Ó· ˘‰Ú·ÚÁ˘ÚÈÎfi ÈÂÛfiÌÂÙÚÔ. ∏ ̤ÛË ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ‰‡Ô Û˘Û΢ÒÓ ‰ÂÓ Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÂÈ Ù· 3 mmHg. øÛÙfiÛÔ, ÙÔ 58% ÙˆÓ ÌÂÙ·ÏÏÈÎÒÓ Û˘Û΢ÒÓ ÂÌÊ·Ó›˙ÂÈ ‰È·ÊÔÚ¿ ÌÂÁ·Ï‡ÙÂÚË ·fi 4 mmHg, ÂÓÒ ÙÔ 33% ÂÌÊ·Ó›˙ÂÈ ‰È·ÊÔÚ¿ ÌÂÁ·Ï‡ÙÂÚË ·fi 7 mmHg[3]. °ÂÓÈο Ë ‚È‚ÏÈÔÁÚ·Ê›· fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ·ÍÈÔÈÛÙ›· ÙˆÓ ÌÂÙ·ÏÏÈÎÒÓ Û˘Û΢ÒÓ Â›Ó·È ÂÚÈÔÚÈṲ̂ÓË. ∆Ô «˘‚ÚȉÈÎfi» ÈÂÛfiÌÂÙÚÔ Û˘Ó‰˘¿˙ÂÈ Ù· ¯·Ú·ÎÙËÚÈÛÙÈο ÌÈ·˜ ËÏÂÎÙÚÔÓÈ΋˜ Î·È ÌÈ·˜ ˘‰Ú·ÚÁ˘ÚÈ΋˜ Û˘Û΢‹˜. ™Â ·˘Ù‹ ÙË Û˘Û΢‹ Ë ÛÙ‹ÏË ÙÔ˘ ˘‰Ú·ÚÁ‡ÚÔ˘ ·ÓÙÈηı›ÛÙ·Ù·È ·fi Ì›· ÛÙ‹ÏË Û ̛· ËÏÂÎÙÚÔÓÈ΋ ÔıfiÓË Ô˘ ·ÔÙÂÏÂ›Ù·È ·fi ˘ÁÚÔ‡˜ ÎÚ˘ÛÙ¿ÏÏÔ˘˜ (LCD) Î·È Ë Ì¤ÙÚËÛË Á›ÓÂÙ·È Ì ÙÔÓ ›‰ÈÔ ÙÚfiÔ fiˆ˜ Î·È Û ̛· ˘‰Ú·ÚÁ˘ÚÈ΋ Û˘Û΢‹ (‰ËÏ. ÊÔ‡ÛΈ̷ ÙÔ˘ ·ÂÚÔı·Ï¿ÌÔ˘, ÍÂÊÔ‡ÛΈ̷ Î·È ·ÎÚfi-


™Y°XPONE™ O¢H°IE™ ¶›Ó·Î·˜ 1: ÷ڷÎÙËÚÈÛÙÈο ÙÔ˘ ˘‰Ú·ÚÁ˘ÚÈÎÔ‡ Ì·ÓÔ̤ÙÚÔ˘ Ô˘ ηıÔÚ›˙Ô˘Ó ÙËÓ ·ÍÈÔÈÛÙ›· Ù˘ Û˘Û΢‹˜. ñ √ ÌËÓ›ÛÎÔ˜ ÙÔ˘ ˘‰Ú·ÚÁ‡ÚÔ˘ Ú¤ÂÈ Ó· ‚Ú›ÛÎÂÙ·È ÛÙÔ ÛËÌÂ›Ô 0 ñ ∏ Îϛ̷η Ú¤ÂÈ Ó· Î˘Ì·›ÓÂÙ·È ·fi Ù· 0 ¤ˆ˜ Ù· 300 mmHg Î·È Ó· ‰È·¯ˆÚ›˙ÂÙ·È Û·ÊÒ˜ Û ˘ԉȷÈÚ¤ÛÂȘ ÙˆÓ 2 mmHg ñ ∏ ‰È¿ÌÂÙÚÔ˜ Ù˘ ‰ÂÍ·ÌÂÓ‹˜ ÙÔ˘ ˘‰Ú·ÚÁ‡ÚÔ˘ Ú¤ÂÈ Ó· Â›Ó·È ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰ÂηÏ¿ÛÈ· ·fi ÙË ‰È¿ÌÂÙÚÔ Ù˘ ÛÙ‹Ï˘ ñ ∏ ÛÙ‹ÏË Ú¤ÂÈ Ó· Û˘Ì›ÙÂÈ Ì ÙËÓ Î·Ù·ÎfiÚ˘ÊË ÁÚ·ÌÌ‹. °È· ÓÔÛÔÎÔÌÂȷ΋ ¯Ú‹ÛË ÚÔÙ›ÓÂÙ·È Ë ¯Ú‹ÛË ÙÔ˘ ÛÙ·ıÂÚÔ‡ ÌÔÓÙ¤ÏÔ˘ Ô˘ ·Ó·ÚÙ¿Ù·È ÛÙÔÓ ÙÔ›¯Ô ñ ∏ Ô‹ ÁÈ· ÙË ‰È¤ÍÔ‰Ô ÙÔ˘ ·¤Ú· ÛÙËÓ ÎÔÚ˘Ê‹ Ù˘ ÛÙ‹Ï˘ ¯ÚÂÈ¿˙ÂÙ·È Û˘¯Ó¿ Û˘ÓÙ‹ÚËÛË, ‰ÈfiÙÈ fiÙ·Ó ·ÔÊÚ¿ÛÛÂÙ·È Ô ˘‰Ú¿ÚÁ˘ÚÔ˜ ÎÈÓÂ›Ù·È ÈÔ ·ÚÁ¿ Ì ÙȘ ÌÂÙ·‚ÔϤ˜ Ù˘ ›ÂÛ˘ ñ ∏ ‚·Ï‚›‰· ÂϤÁ¯Ô˘ Â›Ó·È ÙÔ ÈÔ Û˘¯Ófi ·›ÙÈÔ ÛÊ¿ÏÌ·ÙÔ˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ̤ÙÚËÛ˘ Ù˘ ∞¶. ŸÙ·Ó Â›Ó·È ÂÏ·Ùو̷ÙÈ΋ Ú¤ÂÈ Ó· ·ÓÙÈηı›ÛÙ·Ù·È ñ ∆Ô Ì‹ÎÔ˜ ÙÔ˘ ÂÏ·ÛÙÈÎÔ‡ ۈϋӷ ÌÂٷ͇ ÙÔ˘ ·ÛÎÔ‡ ÊÔ˘ÛÎÒÌ·ÙÔ˜ Î·È ÙÔ˘ ·ÂÚÔı·Ï¿ÌÔ˘ Ú¤ÂÈ Ó· Â›Ó·È ÙÔ˘Ï¿¯ÈÛÙÔÓ 30 cm, ÂÓÒ ÙÔ Ì‹ÎÔ˜ ÙÔ˘ ۈϋӷ ÌÂٷ͇ Ù˘ ÂÚȯÂÈÚ›‰·˜ Î·È ÙÔ˘ ÈÂÛfiÌÂÙÚÔ˘ Ú¤ÂÈ Ó· Â›Ó·È ÙÔ˘Ï¿¯ÈÛÙÔ 70 cm. ∆fiÛÔ ÔÈ ÂÏ·ÛÙÈÎÔ› ۈϋÓ˜ fiÛÔ Î·È ÔÈ Û˘Ó‰¤ÛÂȘ ÙÔ˘˜ Ú¤ÂÈ Ó· ÂϤÁ¯ÔÓÙ·È ÁÈ· ‰È·ÚÚÔ¤˜

·ÛË ÙˆÓ ‹¯ˆÓ Korotkoff). ∞Ó Î·È ¤¯Ô˘Ó ηٷÛ΢·ÛÙ› οÔÈ· ÌÔÓ٤Ϸ, Ë Û˘Û΢‹ ·˘Ù‹ ‰ÂÓ Â›Ó·È ‰È·ı¤ÛÈÌË ÛÙÔ ÂÌfiÚÈÔ [4]. ∆· ËÏÂÎÙÚÔÓÈο ÈÂÛfiÌÂÙÚ· Â›Ó·È Û˘Û΢¤˜ Ô˘ ÌÂÙÚÔ‡Ó ÙËÓ ∞¶ Ì ÙËÓ Ù·Ï·ÓÙˆÛÈÌÂÙÚÈ΋ Ù¯ÓÈ΋. ªÂ ÙËÓ Ù¯ÓÈ΋ ·˘Ù‹ ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ·Ú¯Èο Ë Ì¤ÛË ∞¶ Î·È ÛÙË Û˘Ó¤¯ÂÈ·, Ì ¤Ó· ÂȉÈÎfi ·ÏÁfiÚÈıÌÔ, ˘ÔÏÔÁ›˙ÔÓÙ·È Ë Û˘ÛÙÔÏÈ΋ Î·È Ë ‰È·ÛÙÔÏÈ΋ ∞¶. ∆Ô Î‡ÚÈÔ ÏÂÔÓ¤ÎÙËÌ· ·˘ÙÒÓ ÙˆÓ Û˘Û΢ÒÓ Â›Ó·È fiÙÈ ÂÎÌˉÂÓ›˙Ô˘Ó ÙËÓ Èı·ÓfiÙËÙ· ÛÊ¿ÏÌ·ÙÔ˜ ÛÙÔ ÙÂÏÈÎfi „ËÊ›Ô Î·ıÒ˜ Î·È ÛÊ¿ÏÌ·ÙÔ˜ ηٿ ÙËÓ ·ÎÚfi·ÛË. ∂›Û˘ Â›Ó·È Â‡ÎÔÏ· ÛÙË ¯Ú‹ÛË ÙÔ˘˜, ÂÓÒ ¤¯Ô˘Ó ÙË ‰˘Ó·ÙfiÙËÙ· Ó· ·ÔıËÎÂ‡Ô˘Ó ‰Â‰Ô̤ӷ ÁÈ· ÌÂÙ·ÁÂÓ¤ÛÙÂÚË ·Ó¿Ï˘ÛË. øÛÙfiÛÔ, ‰ÂÓ Â›Ó·È fiϘ ÔÈ Û˘Û΢¤˜ ·ÍÈfiÈÛÙ˜, ÂÓÒ ÙÔ ÎfiÛÙÔ˜ ÙÔ˘˜ Â›Ó·È Û¯ÂÙÈο ˘„ËÏfi. ∂›Û˘ Û ·ÛıÂÓ›˜ Ì ·ÚÚ˘ıÌ›· Ë Ù·Ï·ÓÙˆÛÈÌÂÙÚÈ΋ Ù¯ÓÈ΋ ‰ÂÓ ·Ô‰›‰ÂÈ ÛˆÛÙ¿ ÙË Û˘ÛÙÔÏÈ΋ Î·È ÙË ‰È·ÛÙÔÏÈ΋ ∞¶. ∏ BHS Î·È Ë ES∏ ·Ú¤¯Ô˘Ó ÛÙÔ ‰È·‰›ÎÙ˘Ô ·Ó·ıˆÚË̤Ó˜ Ï›ÛÙ˜ ÌÂ

·ÍÈfiÈÛÙ˜ ËÏÂÎÙÚÔÓÈΤ˜ Û˘Û΢¤˜ ̤ÙÚËÛ˘ Ù˘ ∞¶ [5,6].

∏ «˘¤ÚÙ·ÛË Ù˘ Ï¢΋˜ ÌÏÔ‡˙·˜» Î·È Ë «Â›‰Ú·ÛË Ù˘ Ï¢΋˜ ÌÏÔ‡˙·˜» ∏ «Â›‰Ú·ÛË Ù˘ Ï¢΋˜ ÌÏÔ‡˙·˜» Â›Ó·È ÂΛÓÔ ÙÔ Ê·ÈÓfiÌÂÓÔ Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·‡ÍËÛË Ù˘ ∞¶, Ë ÔÔ›· Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ Â·Ê‹ ÙÔ˘ ·ÙfiÌÔ˘ Ì ÙÔ È·ÙÚÈÎfi ÂÚÈ‚¿ÏÏÔÓ. ¶·Ú·ÙËÚÂ›Ù·È ÙfiÛÔ Û ÓÔÚÌÔÙ·ÛÈο ¿ÙÔÌ· fiÛÔ Î·È Û ˘ÂÚÙ·ÛÈÎÔ‡˜ ·ÛıÂÓ›˜ Î·È ·ÓÙÈÚÔÛˆ‡ÂÈ Ì›· Ê˘ÛÈÔÏÔÁÈ΋ «·ÓÙ›‰Ú·ÛË Û˘Ó·ÁÂÚÌÔ‡». ∏ «˘¤ÚÙ·ÛË Ù˘ Ï¢΋˜ ÌÏÔ‡˙·˜» Â›Ó·È Ì›· ηٿÛÙ·ÛË Î·Ù¿ ÙËÓ ÔÔ›· ¤Ó· ÓÔÚÌÔÙ·ÛÈÎfi ¿ÙÔÌÔ ÂÌÊ·Ó›˙ÂÙ·È Ó· ¿Û¯ÂÈ ·fi ˘¤ÚÙ·ÛË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Â·ÓÂÈÏËÌÌ¤ÓˆÓ ÌÂÙÚ‹ÛÂˆÓ Ù˘ ∞¶ Û ȷÙÚÈÎfi ÂÚÈ‚¿ÏÏÔÓ, ÂÓÒ ¤Íˆ ·fi ·˘Ùfi ÙÔ ÂÚÈ‚¿ÏÏÔÓ Ë ∞¶ ÛÙ·ıÂÚÔÔÈÂ›Ù·È ÛÂ Ê˘ÛÈÔÏÔÁÈο Â›‰· [7]. √ ‚·ıÌfi˜ ·˘Ù‹˜ Ù˘ Â›‰Ú·Û˘ ÔÈΛÏÏÂÈ ÌÂٷ͇ ÙˆÓ ·ÙfïÓ, ÂÓÒ ‰ÂÓ ÂËÚ¿-

˙ÂÙ·È ·fi ÙË ÛÙ·‰È·Î‹ ÂÍÔÈΛˆÛË Ì ÙÔ È·ÙÚÈÎfi ÂÚÈ‚¿ÏÏÔÓ. ¶·Ú·Î¿Ùˆ ı· ·Ó·ÊÂÚıÔ‡Ó ÂÚÈÛÛfiÙÂÚ· ÁÈ· ÙËÓ «˘¤ÚÙ·ÛË Ù˘ Ï¢΋˜ ÌÏÔ‡˙·˜».

∏ ‰È·‰Èηۛ· Ù˘ ̤ÙÚËÛ˘ Ù˘ ∞¶ (Û˘ÛÙ¿ÛÂȘ ÎÔÈÓ¤˜ ÁÈ· fiϘ ÙȘ Ù¯ÓÈΤ˜) ·) ¶ÚÈÓ ÙË Ì¤ÙÚËÛË ∞Ú¯Èο Ú¤ÂÈ Ó· ÂÍËÁËı› ÛÙÔÓ ·ÛıÂÓ‹ Ë ‰È·‰Èηۛ· ̤ÙÚËÛ˘ Ù˘ ∞¶, ÂÓÒ Û˘ÓÈÛÙ¿Ù·È Ô ·ÛıÂÓ‹˜ Ó· ·Ú·Ì¤ÓÂÈ ‹ÚÂÌÔ˜ ηٿ ÙË ‰È¿ÚÎÂÈ¿ Ù˘. ∫·Ù¿ Û˘Óı‹ÎË Ë Ì¤ÙÚËÛË Ù˘ ∞¶ Á›ÓÂÙ·È Û ηıÈÛÙ‹ ı¤ÛË, ·ÊÔ‡ Ô ·ÛıÂÓ‹˜ Ì›ÓÂÈ ‹ÚÂÌÔ˜ ÁÈ· 5 ÏÂÙ¿. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ̤ÙÚËÛ˘ Ë Ú¿¯Ë ÙÔ˘ ·ÛıÂÓ‹ Ú¤ÂÈ Ó· ˘ÔÛÙËÚ›˙ÂÙ·È ·fi ÙÔ Î¿ıÈÛÌ· Î·È Ù· fi‰È· ÙÔ˘ Ó· ·ÎÔ˘ÌÔ‡Ó ÛÙÔ ¤‰·ÊÔ˜ ¯ˆÚ›˜ Ó· Â›Ó·È ÛÙ·˘ÚˆÌ¤Ó·. Ÿ��·Ó Ô ‚Ú·¯›ÔÓ·˜ ÛÙÔÓ ÔÔ›Ô ÌÂÙÚ¿Ù·È Ë ∞¶ ‰ÂÓ ˘ÔÛÙËÚ›˙ÂÙ·È Ë ‰È·ÛÙÔÏÈ΋ ∞¶ (¢∞¶) ÂÓ‰¤¯ÂÙ·È Ó· ·˘ÍËı› ¤ˆ˜ 10% ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ù˘ ÈÛÔÌÂÙÚÈ΋˜ ¿ÛÎËÛ˘ (Ô˘ ÚÔ·ÙÂÈ ·fi ÙË ÌË ˘ÔÛÙ‹ÚÈÍË ÙÔ˘ ‚Ú·¯›ÔÓ·). ∞˘Ù‹ Ë Â›‰Ú·ÛË Ù˘ ÈÛÔÌÂÙÚÈ΋˜ ¿ÛÎËÛ˘ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË ÛÙÔ˘˜ ˘ÂÚÙ·ÛÈÎÔ‡˜ ·ÛıÂÓ›˜ Î·È Û ÂΛÓÔ˘˜ Ô˘ ·›ÚÓÔ˘Ó ‚ – ·ÔÎÏÂÈÛÙ¤˜ [8]. ∂Ô̤ӈ˜, Ô ‚Ú·¯›ÔÓ·˜ Ú¤ÂÈ Ó· ˘ÔÛÙËÚ›˙ÂÙ·È ·fi ÙÔÓ ÂÍÂÙ·ÛÙ‹ ÛÙÔÓ ·ÁÎÒÓ· ‹ (ηχÙÂÚ·) ·fi ¤Ó· ·ÓÂÍ¿ÚÙËÙÔ ˘ÔÛÙ‹ÚÈÁÌ· Ù˘ ηڤÎÏ·˜ [9,10]. ∂ÈÚfiÛıÂÙ·, Ô ‚Ú·¯›ÔÓ·˜ Ú¤ÂÈ Ó· ‚Ú›ÛÎÂÙ·È ÛÙÔ ‡„Ô˜ Ù˘ ηډȿ˜, ‰ÈfiÙÈ Ë ·Ó‡„ˆÛ‹ ÙÔ˘ ¿Óˆ ·fi ·˘Ùfi ÙÔ Â›Â‰Ô Ô‰ËÁ› Û ˘ÔÂÎÙ›ÌËÛË Ù˘ ∞¶, ÂÓÒ Ë Î·Ù¿Û·ÛË ÙÔ˘ οو ·fi ·˘Ùfi ÙÔ Â›Â‰Ô Ô‰ËÁ› Û ˘ÂÚÂÎÙ›ÌËÛË Ù˘ ∞¶. ∆Ô Ì¤ÁÂıÔ˜ ·˘ÙÔ‡ ÙÔ˘ ÛÊ¿ÏÌ·ÙÔ˜ ÌÔÚ› Ó· Êı¿ÛÂÈ Ù· 10 mmHg [9,10]. ™ÙËÓ ÚÒÙË Â›ÛÎÂ„Ë ÙÔ˘ ·ÛıÂÓ‹ ÛÙÔ È·ÙÚ›Ô, Ë ∞¶ Ú¤ÂÈ Ó· ÌÂÙÚ¿17


·ıËÚÔÛÎÏ‹ÚˆÛË π√À¡IO™ 2005

Ù·È Î·È ÛÙÔ˘˜ ‰‡Ô ‚Ú·¯›ÔÓ˜. ∂¿Ó ·Ú·ÙËÚËı› ÛÙ·ıÂÚ‹ ‰È·ÊÔÚ¿ ÌÂÁ·Ï‡ÙÂÚË ·fi 20 mmHg ÁÈ· ÙË ™∞¶ Î·È 10 mmHg ÁÈ· ÙË ¢∞¶ ÙfiÙ Ú¤ÂÈ Ó· ·ÔÎÏÂÈÛı› Ë ‰È¿ÁÓˆÛË Ù˘ ·ÔÊÚ·ÎÙÈ΋˜ ·ÚÙËÚȷ΋˜ ÓfiÛÔ˘. ∂¿Ó ÔÈ ‰È·ÊÔÚ¤˜ Â›Ó·È ÌÈÎÚfiÙÂÚ˜, Ë ∞¶ Ú¤ÂÈ Ó· ÌÂÙÚ¿Ù·È ÛÙÔ ‚Ú·¯›ÔÓ· ÛÙÔÓ ÔÔ›Ô ·Ú·ÙËÚ‹ıËÎ·Ó ÔÈ ˘„ËÏfiÙÂÚ˜ ÙÈ̤˜. ∆Ô ¿ÙÔÌÔ Ô˘ Ú·ÁÌ·ÙÔÔÈ› ÙË Ì¤ÙÚËÛË Ú¤ÂÈ Ó· οıÂÙ·È Û ¿ÓÂÙË ı¤ÛË, Ó· ÌË ‚È¿˙ÂÙ·È Î·Ù¿ ÙÔ ÍÂÊÔ‡ÛΈ̷ ÙÔ˘ ·ÂÚÔı·Ï¿ÌÔ˘ Î·È Ó· ηٷÁÚ¿ÊÂÈ ÙËÓ ÙÈÌ‹ Ù˘ ∞¶ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Ì¤ÙÚËÛË. ŒÓ· ı¤Ì· Ô˘ ¯Ú‹˙ÂÈ È‰È·›ÙÂÚ˘ ÚÔÛÔ¯‹˜ Â›Ó·È ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ·ÂÚÔı·Ï¿ÌÔ˘ Î·È Ù˘ ÂÚȯÂÈÚ›‰·˜ Ô˘ Ú¤ÂÈ Ó· ÂÈϤÁÔÓÙ·È ÁÈ· ÙË Ì¤ÙÚËÛË Ù˘ ∞¶. À¿Ú¯Ô˘Ó ·Ó·ÌÊÈÛ‚‹ÙËÙ˜ ÂӉ›ÍÂȘ fiÙÈ Ë ¯Ú‹ÛË ÂÓfi˜ ÌÈÎÚÔ‡ ·ÂÚÔı·Ï¿ÌÔ˘ (Û ۇÁÎÚÈÛË Ì ÙÔ ‚Ú·¯›ÔÓ· ÛÙÔÓ ÔÔ›Ô ÂÊ·ÚÌfi˙ÂÙ·È) ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ˘ÂÚÂÎÙ›ÌËÛË Ù˘ ∞¶. ∆Ô Ì¤ÁÂıÔ˜ ÙÔ˘ ÛÊ¿ÏÌ·ÙÔ˜ Î˘Ì·›ÓÂÙ·È ·fi 3,2/2,4 mmHg ¤ˆ˜ 12/8 mmHg. ∞ÓÙ›ıÂÙ·, Ë ¯Ú‹ÛË ÂÓfi˜ ÌÂÁ¿ÏÔ˘ ·ÂÚÔı·Ï¿ÌÔ˘ Ô‰ËÁ› Û ˘ÔÂÎÙ›ÌËÛË Ù˘ ∞¶ Î·È ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ÛÊ¿ÏÌ·ÙÔ˜ Î˘Ì·›ÓÂÙ·È ·fi 10 mmHg ¤ˆ˜ 30 mmHg [11]. ∏ BHS Û˘ÓÈÛÙ¿ Û‹ÌÂÚ· ÙÚ›· ÌÂÁ¤ıË ÂÚȯÂÈÚ›‰ˆÓ [9]: ñ Ì›· Û˘Ó‹ıË ÂÚȯÂÈÚ›‰· Ì ̤ÁÂıÔ˜ ·ÂÚÔı·Ï¿ÌÔ˘ 12x26 cm ÁÈ· ÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ÂÓËÏ›ÎˆÓ ·ÙfiÌˆÓ ñ Ì›· ÌÂÁ¿ÏË ÂÚȯÂÈÚ›‰· Ì ̤ÁÂıÔ˜ ·ÂÚÔı·Ï¿ÌÔ˘ 12x40 cm ÁÈ· Ù· ·¯‡Û·Úη ÂÓ‹ÏÈη ¿ÙÔÌ· ñ Ì›· ÌÈÎÚ‹ ÂÚȯÂÈÚ›‰· Ì ̤ÁÂıÔ˜ ·ÂÚÔı·Ï¿ÌÔ˘ 12x18 cm ÁÈ· Ù· ÏÂÙfiۈ̷ ÂÓ‹ÏÈη ¿ÙÔÌ· Î·È Ù· ·È‰È¿ ∏ ∞merican Heart Association ÚÔÙ›ÓÂÈ 4 ÌÂÁ¤ıË ÂÚȯÂÈÚ›‰ˆÓ [32]: 18

ñ Ì›· ÌÈÎÚ‹ ÂÚȯÂÈÚ›‰· Ì ̤ÁÂıÔ˜ ·ÂÚÔı·Ï¿ÌÔ˘ 10x24 cm ÁÈ· ‚Ú·¯›ÔÓ˜ Ì ÂÚ›ÌÂÙÚÔ 22 ¤ˆ˜ 26 cm ñ Ì›· Û˘Ó‹ıË ÂÚȯÂÈÚ›‰· Ì ̤ÁÂıÔ˜ ·ÂÚÔı·Ï¿ÌÔ˘ 13x30 cm ÁÈ· ‚Ú·¯›ÔÓ˜ Ì ÂÚ›ÌÂÙÚÔ 27 ¤ˆ˜ 34 cm ñ Ì›· ÌÂÁ¿ÏË ÂÚȯÂÈÚ›‰· Ì ̤ÁÂıÔ˜ ·ÂÚÔı·Ï¿ÌÔ˘ 16x38 cm ÁÈ· ‚Ú·¯›ÔÓ˜ Ì ÂÚ›ÌÂÙÚÔ 35 ¤ˆ˜ 44 cm ñ Ì›· ÂÚȯÂÈÚ›‰· ÁÈ· ÙÔ ÌËÚfi Ì ̤ÁÂıÔ˜ ·ÂÚÔı·Ï¿ÌÔ˘ 20x42 cm ÁÈ· ÂÚ›ÌÂÙÚÔ 45x52 cm ‚) ∏ ̤ÙÚËÛË √ ÂÍÂÙ·ÛÙ‹˜ ÙÔÔıÂÙ› ÙËÓ ÂÚȯÂÈÚ›‰· ÛÙË ÌÂÛfiÙËÙ· ÙÔ˘ ‚Ú·¯›ÔÓ·. √È ÂÏ·ÛÙÈÎÔ› ۈϋÓ˜ ÙÔÔıÂÙÔ‡ÓÙ·È Û˘Ó‹ıˆ˜ ÚÔ˜ Ù· οو, fï˜ Û‹ÌÂÚ· Û˘ÓÈÛÙ¿Ù·È Ó· ÙÔÔıÂÙÔ‡ÓÙ·È ÚÔ˜ Ù· ¿Óˆ ‹ ›Ûˆ [2,9]. ∏ ÛÙ‹ÏË ÙÔ˘ ÈÂÛfiÌÂÙÚÔ˘ Ú¤ÂÈ Ó· Â›Ó·È Î¿ıÂÙË, Ó· ‚Ú›ÛÎÂÙ·È Û ·fiÛÙ·ÛË ¤ˆ˜ 1 m ·fi ÙÔÓ ÂÍÂÙ·ÛÙ‹ Î·È ÛÙÔ ‡„Ô˜ ÙˆÓ ÔÊı·ÏÌÒÓ ÙÔ˘. √ ÂÍÂÙ·ÛÙ‹˜ „ËÏ·Ê¿ ÙË ‚Ú·¯ÈfiÓÈ· ·ÚÙËÚ›· Î·È ÊÔ˘ÛÎÒÓÂÈ ÙÔÓ ·ÂÚÔı¿Ï·ÌÔ ¤ˆ˜ 30 mmHg ¿Óˆ ·fi ÙÔ ÛËÌÂ›Ô ÛÙÔ ÔÔ›Ô ÂÍ·Ê·Ó›˙ÂÙ·È Ô ÛÊ˘ÁÌfi˜. ™ÙË Û˘Ó¤¯ÂÈ· ÍÂÊÔ˘ÛÎÒÓÂÈ Î·È Î·Ù·ÁÚ¿ÊÂÈ ÙËÓ ›ÂÛË ÛÙËÓ ÔÔ›· Â·ÓÂÌÊ·Ó›˙ÂÙ·È Ô ÛÊ˘ÁÌfi˜. ∞˘Ù‹ Ë ÙÈÌ‹ ÚÔÛÂÁÁ›˙ÂÈ ÙË ™∞¶. ∏ ÂÎÙ›ÌËÛË Ù˘ ™∞¶ Ì ÙËÓ „ËÏ¿ÊËÛË Â›Ó·È ÛËÌ·ÓÙÈ΋, ‰ÈfiÙÈ ÔÈ ‹¯ÔÈ ∫orotkoff Ù˘ ÚÒÙ˘ Ê¿Û˘ Û˘¯Ó¿ ÂÍ·Ê·Ó›˙ÔÓÙ·È Ì ÙË Ì›ˆÛË Ù˘ ›ÂÛ˘ ÛÙÔÓ ·ÂÚÔı¿Ï·ÌÔ Î·È Â·ÓÂÌÊ·Ó›˙ÔÓÙ·È Û ¯·ÌËÏfiÙÂÚË ›ÂÛË (·ÎÚÔ·ÛÙÈÎfi ¯¿ÛÌ·). À¿Ú¯ÂÈ ÏÔÈfiÓ Ô Î›Ó‰˘ÓÔ˜ Ó· ÂÎÏ¿‚ÂÈ Ô ÂÍÂÙ·ÛÙ‹˜ ÙËÓ Â·ÓÂÌÊ¿ÓÈÛË ÙˆÓ ‹¯ˆÓ ˆ˜ ÚÒÙË ÂÌÊ¿ÓÈÛË Î·È Ó· ˘ÔÂÎÙÈÌ‹ÛÂÈ ÙË ™∞¶. ∂›Û˘ Û ÌÂÚÈΤ˜ ÂÚÈÙÒÛÂȘ ÔÈ ‹¯ÔÈ ·ÎÔ‡ÁÔÓÙ·È ‰‡ÛÎÔÏ· (.¯. ·ÛıÂÓ›˜ Û ηٷÏËÍ›· Ë ¤ÁÎ˘Â˜ Á˘Ó·›Î˜). ∞ÊÔ‡

ÂÓÙÔÈÛı› Ë ‚Ú·¯ÈfiÓÈ· ·ÚÙËÚ›· Î·È ÂÎÙÈÌËı› Ë ™∞¶ Ì ÙËÓ „ËÏ¿ÊËÛË, Ô ÂÍÂÙ·ÛÙ‹˜ ÙÔÔıÂÙ› ÙÔ ‰È¿ÊÚ·ÁÌ· ÙÔ˘ ÛÙËıÔÛÎÔ›Ô˘ ¿Óˆ ·fi ÙË ‚Ú·¯ÈfiÓÈ· ·ÚÙËÚ›· ÛÙ·ıÂÚ¿ ·ÏÏ¿ ¯ˆÚ›˜ Ó· Ȥ˙ÂÈ, ‰ÈfiÙÈ Ë ˘ÂÚ‚ÔÏÈ΋ ›ÂÛË ÌÔÚ› Ó· ÚÔηϤÛÂÈ ÙËÓ ·Ú·ÁˆÁ‹ ‹¯ˆÓ οو ·fi ÙËÓ ÙÈÌ‹ Ù˘ ¢∞¶. ∏ American Heart Association ÚÔÙ›ÓÂÈ ÙË ¯Ú‹ÛË ÙÔ˘ ÎÒ‰ˆÓ·, ·ÏÏ¿ ÙÔ ‰È¿ÊÚ·ÁÌ· ηχÙÂÈ ÌÂÁ·Ï‡ÙÂÚË ÂÚÈÔ¯‹ Î·È Â›Ó·È ÈÔ Â‡ÎÔÏÔ Ó· ¯ÚËÛÈÌÔÔÈËı› ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË [2]. ™ÙË Û˘Ó¤¯ÂÈ· Ô ÂÍÂÙ·ÛÙ‹˜ ÊÔ˘ÛÎÒÓÂÈ ÙÔÓ ·ÂÚÔı¿Ï·ÌÔ Û Â›Â‰Ô ¤ˆ˜ 30 mmHg ¿Óˆ ·fi ÂΛÓÔ ÛÙÔ ÔÔ›Ô ¤¯ÂÈ ˘ÔÏÔÁÈÛÙ› Ë ™∞¶ Ì ÙËÓ „ËÏ¿ÊËÛË. ∞ÎÔÏÔ‡ıˆ˜, ÍÂÊÔ˘ÛÎÒÓÂÈ ÙËÓ ÂÚȯÂÈÚ›‰· Ì ڢıÌfi 2-3 mmHg ·Ó¿ ÎÙ‡Ô (‹ ·Ó¿ ‰Â˘ÙÂÚfiÏÂÙÔ). √ ÚÒÙÔ˜ ·fi ÙÔ˘˜ (ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰‡Ô) Ú˘ıÌÈÎÔ‡˜ ‹¯Ô˘˜ Ô˘ ·ÎÔ‡ÁÔÓÙ·È (Ê¿ÛË 1) ·ÓÙÈÛÙÔȯ› ÛÙË ™∞¶. √ ÙÂÏÂ˘Ù·›Ô˜ ‹¯Ô˜ Ô˘ ·ÎÔ‡ÁÂÙ·È (Ê¿ÛË 5) ·ÓÙÈÛÙÔȯ› ÛÙË ¢∞¶. ∞Ó ÔÈ ‹¯ÔÈ ÂÈ̤ÓÔ˘Ó Ì¤¯ÚÈ ÙÔ ÛËÌÂ›Ô 0 mmHg ÙfiÙÂ Ë ›ÂÛË ÛÙËÓ ÔÔ›· ÂÌÊ·Ó›˙ÂÙ·È Ë Ì›ˆÛË Ù˘ ¤ÓÙ·Û˘ ÙˆÓ ‹¯ˆÓ (Ê¿ÛË 4) ·ÓÙÈÛÙÔȯ› ÛÙË ¢∞¶ [74]. ŸÙ·Ó ÔÏÔÎÏËÚˆı› Ë Ì¤ÙÚËÛË Ô ÂÍÂÙ·ÛÙ‹˜ ÍÂÊÔ˘ÛÎÒÓÂÈ Î·È ·Ê·ÈÚ› ÙËÓ ÂÚȯÂÈÚ›‰·, ÒÛÙ ӷ ·ÔÊ¢¯ı› Ë ÊÏ‚È΋ Û˘ÌÊfiÚËÛË ÚÈÓ ÙËÓ ÂfiÌÂÓË Ì¤ÙÚËÛË. ™ÙË Û˘Ó¤¯ÂÈ· ηٷÁÚ¿ÊÂÈ ÙË Û˘ÛÙÔÏÈ΋ Î·È ÙË ‰È·ÛÙÔÏÈ΋ ∞¶. ∆· ÙÂÏÈο „ËÊ›· ÙˆÓ ÙÈÌÒÓ Ù˘ ™∞¶ Î·È Ù˘ ¢∞¶ Ú¤ÂÈ Ó· ÛÙÚÔÁÁ˘ÏÔÔÈÔ‡ÓÙ·È ÛÙËÓ ÏËÛȤÛÙÂÚË ˘ԉȷ›ÚÂÛË ÙÔ˘ 2 (Î·È fi¯È ÙÔ˘ 5). ∞·ÈÙÔ‡ÓÙ·È ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰‡Ô ÚÔÛÂÎÙÈΤ˜ ÌÂÙÚ‹ÛÂȘ Ù˘ ∞¶ Ì ÙË ÌÂÛÔÏ¿‚ËÛË ÂÓfi˜ ¯ÚÔÓÈÎÔ‡ ‰È·ÛÙ‹Ì·ÙÔ˜ ÂÚ›Ô˘ ÂÓfi˜ ÏÂÙÔ‡ ÌÂٷ͇ ÙÔ˘˜.


™Y°XPONE™ O¢H°IE™ π‰È·ÈÙÂÚfiÙËÙ˜ Ù˘ ̤ÙÚËÛ˘ Ù˘ ∞¶ Û ÔÚÈṲ̂Ó˜ ÔÌ¿‰Â˜ ·ÛıÂÓÒÓ ™Ù· ·È‰È¿ Ë ∞¶ ÌÂÙ·‚¿ÏÏÂÙ·È ÂÚÈÛÛfiÙÂÚÔ Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ ÂÓ‹ÏÈΘ. °ÂÓÈο Û˘ÓÈÛÙ¿Ù·È Ë ·ÎÚÔ·ÛÙÈ΋ ̤ıÔ‰Ô˜ ̤ÙÚËÛ˘ Ù˘ ∞¶ ÛÙ· ·È‰È¿. ™Â ·˘Ù¤˜ ÙȘ ÂÚÈÙÒÛÂȘ Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·ÍÈfiÈÛÙË Ë Ì¤ÙÚËÛË Ù˘ ™∞¶ Û ۇÁÎÚÈÛË Ì ÙË Ì¤ÙÚËÛË Ù˘ ¢∞¶. π‰È·›ÙÂÚË ÚÔÛÔ¯‹ ¯Ú‹˙ÂÈ ÙÔ ı¤Ì· Ù˘ ÂÈÏÔÁ‹˜ Ù˘ ÂÚȯÂÈÚ›‰·˜. ¶ÚÔÙ›ÓÔÓÙ·È ÙÚ›· ÌÂÁ¤ıË ·ÂÚÔı·Ï¿Ìˆv: 4x13 cm, 8x18 cm ηÈ12x 26 cm ηٿÏÏËÏ· ÁÈ· ·È‰È¿ ËÏÈΛ·˜ 0 ¤ˆ˜ 14 ÂÙÒÓ. √È ‹¯ÔÈ Korotkoff ‰ÂÓ ·ÎÔ‡ÁÔÓÙ·È ¿ÓÙ· Ì ۷ʋÓÂÈ· Û ‚Ú¤ÊË Î·È Ó‹È· Î·È ÁÈ· ·˘Ùfi ÙÔ ÏfiÁÔ ÚÔÙ›ÓÔÓÙ·È ¿ÏϘ Ù¯ÓÈΤ˜ ̤ÙÚËÛ˘ (Doppler, ˘¤Ú˯ÔÈ ‹ Ù·Ï·ÓÙˆÛÈÌÂÙÚÈΤ˜ Ù¯ÓÈΤ˜)[12]. ∆Ô US National High Blood Pressure Education Group on Hypertension Control in Children and Adolescents ¤¯ÂÈ ‰ËÌÔÛȇÛÂÈ ›Ó·Î˜ Ì ÙȘ Ê˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜ Ù˘ ∞¶ Û ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ·Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈΛ· Î·È ÙÔ ‡„Ô˜ [13]. ™ÙÔ˘˜ ËÏÈÎȈ̤ÓÔ˘˜ ·ÛıÂÓ›˜ Ë ÈÔ Û˘ÓËıÈṲ̂ÓË ÌÔÚÊ‹ ˘¤ÚÙ·Û˘ Â›Ó·È Ë ÌÂÌÔӈ̤ÓË Û˘ÛÙÔÏÈ΋ ˘¤ÚÙ·ÛË. ª›· ÌÂϤÙË, Ë Systolic Hypertension in Europe Trial, ¤‰ÂÈÍ fiÙÈ ÔÈ ÙÈ̤˜ Ù˘ ∞¶ Ô˘ Ï·Ì‚¿ÓÔÓÙ·È Ì ̤ÙÚËÛË ÛÙÔ È·ÙÚÂ›Ô ÂÓ‰¤¯ÂÙ·È Ó· Â›Ó·È ¤ˆ˜ Î·È 20 mmHg ÌÂÁ·Ï‡ÙÂÚ˜ Û ۇÁÎÚÈÛË Ì ·˘Ù¤˜ Ô˘ Ï·Ì‚¿ÓÔÓÙ·È Ì ÙËÓ 24ˆÚË Î·Ù·ÁÚ·Ê‹ [14]. ∂ÈÚfiÛıÂÙ·, ÔÈ ËÏÈÎȈ̤ÓÔÈ ·ÛıÂÓ›˜ Ôχ Û˘¯Ó¿ ÂÌÊ·Ó›˙Ô˘Ó ·ÓÂ¿ÚÎÂÈ· ÙÔ˘ ·˘ÙfiÓÔÌÔ˘ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (∞¡™), Ì›· ηٿÛÙ·ÛË Ô˘ ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÂÎÛÂÛËÌ·Ṳ̂Ó˜ ÌÂÙ·‚ÔϤ˜ Ù˘ ∞¶ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ë̤ڷ˜ [14]. ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi ¤¯ÂÈ È‰È·›ÙÂÚË ÛËÌ·Û›·, ·ÊÔ‡ ÔÈ ËÏÈÎȈ̤ÓÔÈ Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ

¢·›ÛıËÙÔÈ ÛÙȘ ·ÚÂÓ¤ÚÁÂȘ ÙˆÓ ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ Ê·Ú̿ΈÓ. ∆· ·ÁÁ›· ¯¿ÓÔ˘Ó ÙËÓ ÂÏ·ÛÙÈÎfiÙËÙ¿ ÙÔ˘˜ Ì ÙËÓ ËÏÈΛ· Î·È ÁÈ· ·˘Ùfi ÙÔ ÏfiÁÔ ¤¯ÂÈ ˘ÔÛÙËÚȯı› fiÙÈ Ë ¤ÌÌÂÛË Ì¤ÙÚËÛË Ù˘ ∞¶ ‰ÂÓ Â›Ó·È ·ÍÈfiÈÛÙË ÛÙÔ˘˜ ËÏÈÎȈ̤ÓÔ˘˜. ∞˘Ùfi ÙÔ Ê·ÈÓfiÌÂÓÔ Ô‰‹ÁËÛ ÛÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ fiÚÔ˘ «„¢‰Ô¸¤ÚÙ·ÛË», Ô ÔÔ›Ô˜ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ· Ó· ÂÚÈÁÚ¿„ÂÈ ·ÛıÂÓ›˜ Ì ÌÂÁ¿ÏË ‰È·ÊÔÚ¿ ÌÂٷ͇ Ù˘ ¤ÌÌÂÛ˘ Î·È Ù˘ ¿ÌÂÛ˘ ̤ÙÚËÛË Ù˘ ∞¶ [15]. ∏ ÛËÌ·Û›· ·˘Ù‹˜ Ù˘ ηٿÛÙ·Û˘ ¤¯ÂÈ ·ÌÊÈÛ‚ËÙËı›, ˆÛÙfiÛÔ ÔÈ ËÏÈÎȈ̤ÓÔÈ ÛÙÔ˘˜ ÔÔ›Ô˘˜ Ù· Â›‰· Ù˘ ∞¶ (Ô˘ ÌÂÙÚÔ‡ÓÙ·È ÌÂ Û˘Ì‚·ÙÈΤ˜ Ù¯ÓÈΤ˜) ‰ÂÓ Û˘Ó¿‰Ô˘Ó Ì ٷ ÎÏÈÓÈο Â˘Ú‹Ì·Ù·, Ú¤ÂÈ Ó· ·Ú·¤ÌÔÓÙ·È Û ÂȉÈÎfi ΤÓÙÚÔ ÁÈ· ÂÚ·ÈÙ¤Úˆ ÂÎÙ›ÌËÛË. ™Â ·ÛıÂÓ›˜ Ì ·ÚÚ˘ıÌ›· (¯·Ú·ÎÙËÚÈÛÙÈÎfi ·Ú¿‰ÂÈÁÌ· Ë ÎÔÏÈ΋ Ì·ÚÌ·Ú˘Á‹) Ë ∞¶ ‰È·Ê¤ÚÂÈ ·fi ÎÙ‡Ô Û ÎÙ‡Ô, ·ÊÔ‡ Ô fiÁÎÔ˜ ·ÏÌÔ‡ ‰ÂÓ Â›Ó·È ÛÙ·ıÂÚfi˜. ¢ÂÓ ˘¿Ú¯ÂÈ ·Ô‰ÂÎÙ‹ ̤ıÔ‰Ô˜ ̤ÙÚËÛ˘ Ù˘ ∞¶ Ô‡Ù Ì ÙË Û˘Ì‚·ÙÈ΋ ·ÎÚÔ·ÛÙÈ΋ Ù¯ÓÈ΋, ·ÏÏ¿ Ô‡ÙÂ Î·È Ì ÙËÓ Ù·Ï·ÓÙˆÛÈÌÂÙÚÈ΋ Ù¯ÓÈ΋ [16]. ªÂÚÈÎÔ› ÁÈ·ÙÚÔ› ¯ÚËÛÈÌÔÔÈÔ‡Ó ÙÔÓ ÚÒÙÔ ‹¯Ô Korotkoff ˆ˜ ¤Ó‰ÂÈÍË Ù˘ ™∞¶, ÂÓÒ ¿ÏÏÔÈ ¯ÚËÛÈÌÔÔÈÔ‡Ó ÙËÓ ÂÌÊ¿ÓÈÛË ÙˆÓ Û˘Ó¯fiÌÂÓˆÓ ‹¯ˆÓ ˆ˜ ¤Ó‰ÂÈÍË Ù˘ ™∞¶. ¶·ÚfiÌÔÈÔ Úfi‚ÏËÌ· ÈÛ¯‡ÂÈ Î·È ÁÈ· ÙË ¢∞¶. °ÂÓÈο Ô Ú˘ıÌfi˜ ÍÂÊÔ˘ÛÎÒÌ·ÙÔ˜ ‰ÂÓ Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÂÈ Ù· 2 mmHg ·Ó¿ ÎÙ‡Ô, ȉȷ›ÙÂÚ· fiÙ·Ó ˘¿Ú¯ÂÈ ‚Ú·‰˘·ÚÚ˘ıÌ›·. π‰È·›ÙÂÚË ÚÔÛÔ¯‹ ··ÈÙÂ›Ù·È fiÛÔÓ ·ÊÔÚ¿ ÙË Ì¤ÙÚËÛË Ù˘ ∞¶ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ ÂÍ·ÈÙ›·˜ ÙˆÓ Èı·ÓÒÓ ÂÈÏÔÎÒÓ Ù˘ ·‡ÍËÛ˘ Ù˘ ∞¶ ÁÈ· ÙÔ ¤Ì‚Ú˘Ô Î·È ÙË ÌËÙ¤Ú·. ŒÓ· Û˘¯Ófi Úfi‚ÏËÌ· Ô˘ ·Ó·Î‡ÙÂÈ ÛÙȘ ¤ÁÎ˘Â˜ Á˘Ó·›Î˜ Â›Ó·È Ë ¤Ó‰ÂÈÍË Ù˘ ¢∞¶. ªÂÙ¿ ·fi ÂÓ‰Âϯ‹ ·Ó¿Ï˘ÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ Ë ÈÔ ·ÍÈfiÈÛÙË ¤Ó‰ÂÈÍË Ù˘ ‰È·ÛÙÔÏÈ΋˜

∞¶ Â›Ó·È Ë ÂÍ·Ê¿ÓÈÛË ÙˆÓ ‹¯ˆÓ ∫Ôrotkoff (Ê¿ÛË 5), ÂÎÙfi˜ ·Ó ÂÈ̤ÓÔ˘Ó Ì¤¯ÚÈ ÙÔ ÛËÌÂ›Ô 0 mmHg, ÔfiÙÂ Ë Ì›ˆÛË Ù˘ ¤ÓÙ·Û‹˜ ÙÔ˘˜ Ú¤ÂÈ Ó· ÂÎÏ·Ì‚¿ÓÂÙ·È ˆ˜ ¤Ó‰ÂÈÍË Ù˘ ¢∞¶ [17,18]. ∏ ™∞¶ ·˘Í¿ÓÂÈ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ¿ÛÎËÛ˘, ÂÓÒ Ë ¢∞¶ Û˘Ó‹ıˆ˜ ·Ú·Ì¤ÓÂÈ ÛÙ· ›‰È· Â›‰·. À¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ fiÙÈ Ë ˘ÂÚ‚ÔÏÈ΋ ·‡ÍËÛË Ù˘ ™∞¶ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ¿ÛÎËÛ˘ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ÂÌÊ¿ÓÈÛË ˘¤ÚÙ·Û˘ [19-21], Ì ÙË ıÓËÙfiÙËÙ· ·fi ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘ [22] Î·È Ì ÙËÓ ÂÌÊ¿ÓÈÛË ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ [23]. ∂›Û˘, ÓÔÚÌÔÙ·ÛÈÎ�� ¿ÙÔÌ· Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ÌÂÁ¿ÏË ·‡ÍËÛË Ù˘ ∞¶ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ¿ÛÎËÛ˘ ¤¯Ô˘Ó ˘„ËÏfi ΛӉ˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ˘ÂÚÙÚÔÊ›·˜ Ù˘ ·ÚÈÛÙÂÚ¿˜ ÎÔÈÏ›·˜ [24]. ∞ÓÙ›ıÂÙ·, Û ˘ÂÚÙ·ÛÈο ¿ÙÔÌ· ˘¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ fiÙÈ Ë ·‡ÍËÛË Ù˘ Ì¿˙·˜ Ù˘ ·ÚÈÛÙÂÚ¿˜ ÎÔÈÏ›·˜ Û˘Û¯ÂÙ›˙ÂÙ·È Î·Ï‡ÙÂÚ· Ì ÙËÓ ∞¶ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ¿ÛÎËÛ˘ Û ۇÁÎÚÈÛË Ì ÙËÓ ∞¶ ηٿ ÙËÓ ËÚÂÌ›·. øÛÙfiÛÔ, ÚÔ˜ ÙÔ ·ÚfiÓ, ÔÈ ÂÈÚfiÛıÂÙ˜ ÏËÚÔÊÔڛ˜ Ô˘ ÚÔÛʤÚÂÈ Ë Ì¤ÙÚËÛË Ù˘ ∞¶ ηٿ ÙËÓ ¿ÛÎËÛË ‰ÂÓ ‰ÈηÈÔÏÔÁÔ‡Ó ÙËÓ ·ÍÈÔÏfiÁËÛ‹ Ù˘ ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË.

ª¤ÚÔ˜ 2: ∏ 24ˆÚË Î·Ù·ÁÚ·Ê‹ Ù˘ ∞¶ (Ambulatory Blood Pressure Measurement, ABPM)

∏ 24ˆÚË Î·Ù·ÁÚ·Ê‹ Ù˘ ∞¶ (ABPM) ¯ÚËÛÈÌÔÔÈÂ›Ù·È fiÏÔ Î·È ÈÔ Û˘¯Ó¿ ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË Î·È ˆ˜ ÂÎ ÙÔ‡ÙÔ˘ ¤¯Ô˘Ó ‰ËÌÔÛÈ¢ı› ‰È¿ÊÔÚ˜ ηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ ÁÈ· ÙË ¯Ú‹ÛË Ù˘ Î·È ÙËÓ ÂÚÌËÓ›· ÙˆÓ Â˘ÚËÌ¿ÙˆÓ Ô˘ ÚÔ·ÙÔ˘Ó [25-27]. ∏ ∂SH ¤¯ÂÈ Î·È ·˘Ù‹ ‰ËÌÔÛȇÛÂÈ Û˘ÛÙ¿ÛÂȘ ÁÈ· ÙËÓ ABPM [28]. ∏ 24ˆÚË Î·Ù·ÁÚ·Ê‹ ˘Â19


·ıËÚÔÛÎÏ‹ÚˆÛË π√À¡IO™ 2005

Ú¤¯ÂÈ Ù˘ Û˘Ì‚·ÙÈ΋˜ ̤ÙÚËÛ˘ Ù˘ ∞¶ ÁÈ· ÔÚÈṲ̂ÓÔ˘˜ ÚÔÊ·Ó›˜ ÏfiÁÔ˘˜. ¶ÚÒÙÔÓ, ·Ú¤¯ÂÈ ÂÚÈÛÛfiÙÂÚ˜ ÌÂÙÚ‹ÛÂȘ Î·È Û˘ÓÂÒ˜ ¤Ó· ÈÔ ÔÏÔÎÏËڈ̤ÓÔ ÚÔÊ›Ï Ù˘ ∞¶ ÙÔ˘ ·ÙfiÌÔ˘. ¢Â‡ÙÂÚÔÓ, ÔÈ ÌÂÙÚ‹ÛÂȘ Á›ÓÔÓÙ·È Û ÂÚÈ‚¿ÏÏÔÓ ÂÎÙfi˜ ÙÔ˘ È·ÙÚ›Ԣ Î·È ÂÔ̤ӈ˜ ηı›ÛÙ·Ù·È ‰˘Ó·Ù‹ Ë ‰È¿ÁÓˆÛË Ù˘ «˘¤ÚÙ·Û˘ Ù˘ Ï¢΋˜ ÌÏÔ‡˙·˜», ηıÒ˜ Î·È Ë «Â›‰Ú·ÛË Ù˘ Ï¢΋˜ ÌÏÔ‡˙·˜» [29]. ∆Ú›ÙÔÓ, Ì ÙËÓ 24ˆÚË Î·Ù·ÁÚ·Ê‹ ηı›ÛÙ·Ù·È ‰˘Ó·Ù‹ Ë ·Ó·ÁÓÒÚÈÛË ÙˆÓ ·ÙfiÌˆÓ ÛÙ· ÔÔ›· Ë ∞¶ ‰ÂÓ ÌÂÈÒÓÂÙ·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘ (non-dippers), Ê·ÈÓfiÌÂÓÔ Ô˘ ¤¯ÂÈ Û˘Û¯ÂÙÈÛı› Ì ·˘ÍË̤ÓË Î·Ú‰È·ÁÁÂȷ΋ ıÓËÙfiÙËÙ· [30]. ∆¤ÏÔ˜, Ì ÙËÓ ∞µƒª ÌÔÚ› Ó· ÂÎÙÈÌËı› ηχÙÂÚ· Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ·ÓÙÈ˘ÂÚÙ·ÛÈ΋˜ ıÂÚ·›·˜. ™ÙÔ ·ÚÂÏıfiÓ ‰ÂÓ ˘‹Ú¯·Ó Â·Ú΋ ÛÙÔȯ›· Ô˘ Ó· ‰Â›¯ÓÔ˘Ó fiÙÈ Ë ∞µƒª ˘ÂÚ›¯Â Ù˘ Û˘Ì‚·ÙÈ΋˜ ̤ÙÚËÛ˘ Ù˘ ∞¶ ÛÙËÓ ÚfiÁÓˆÛË Ù˘ ηډȷÁÁÂȷ΋˜ ıÓËÙfiÙËÙ·˜. øÛÙfiÛÔ, Û‹ÌÂÚ· ˘¿Ú¯Ô˘Ó Û·Ê›˜ ÂӉ›ÍÂȘ fiÙÈ Ë ∞µƒª Â›Ó·È Î·Ï‡ÙÂÚÔ˜ ÚÔÁÓˆÛÙÈÎfi˜ ‰Â›ÎÙ˘ Ù˘ ηډȷÁÁÂȷ΋˜ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÙfiÙËÙ·˜ Û ۇÁÎÚÈÛË Ì ÙË Û˘Ì‚·ÙÈ΋ ̤ÙÚËÛË Ù˘ ∞¶ [31]. ∏ 24ˆÚË Î·Ù·ÁÚ·Ê‹ Ù˘ ∞¶ ··ÈÙ› ÙËÓ ÂÎÏ‹ÚˆÛË ÔÚÈÛÌ¤ÓˆÓ ÚÔ¸Ôı¤ÛÂˆÓ ÒÛÙ ӷ Â›Ó·È ÂÈÙ˘¯‹˜. ∆Ô ÎÏÂȉ› ÁÈ· Ì›· ÂÈÙ˘¯‹ 24ˆÚË Î·Ù·ÁÚ·Ê‹ Â›Ó·È Ó· ηٷÓÔ‹ÛÂÈ Ô ·ÛıÂÓ‹˜ ÙË ‰È·‰Èηۛ·. °È· ·˘Ùfi ÙÔ ÛÎÔfi Ú¤ÂÈ Ó· ‰›ÓÔÓÙ·È ÁÚ·Ù¤˜ Ô‰ËÁ›Â˜ ÛÙÔÓ ·ÛıÂÓ‹ Î·È Ó· ÙÔ˘ ·Ú¤¯ÂÙ·È Ì›· οÚÙ· ÛÙËÓ ÔÔ›· Ú¤ÂÈ Ó· ηٷÁÚ¿ÊÂÈ ÙËÓ

ËÌÂÚ‹ÛÈ· ‰Ú·ÛÙËÚÈfiÙËÙ· (.¯. ÒÚ˜ ÂÚÁ·Û›·˜, ‡ÓÔ˘ ÎÏ.). ¶ÚÈÓ ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ Û˘Û΢‹˜ Ú¤ÂÈ Ó· ÂÈϤÁÂÙ·È Ë Î·Ù¿ÏÏËÏË ÂÚȯÂÈÚ›‰· Î·È Ó· ÌÂÙÚ¿Ù·È Û˘Ì‚·ÙÈο Ë ∞¶ Î·È ÛÙÔ˘˜ ‰‡Ô ‚Ú·¯›ÔÓ˜. ∞Ó Ë ™∞¶ ‰È·Ê¤ÚÂÈ Î·Ù¿ ÂÚÈÛÛfiÙÂÚÔ ·fi 10 mmHg ÙfiÙÂ Ë 24ˆÚË Î·Ù·ÁÚ·Ê‹ Ú¤ÂÈ Ó· Á›ÓÂÈ ÛÙÔ ‚Ú·¯›ÔÓ· Ô˘ ÂÌÊ·Ó›˙ÂÈ ÙËÓ ˘„ËÏfiÙÂÚË ÙÈÌ‹. ∆Ô ÌÂÛԉȿÛÙËÌ· ÌÂٷ͇ ÙˆÓ ÌÂÙÚ‹ÛÂˆÓ Ú¤ÂÈ Ó· Î˘Ì·›ÓÂÙ·È ·fi 15 ¤ˆ˜ 30 ÏÂÙ¿. ∞·ÈÙÔ‡ÓÙ·È ÙÔ˘Ï¿¯ÈÛÙÔÓ 14 ÌÂÙÚ‹ÛÂȘ Ù˘ Û˘ÛÙÔÏÈ΋˜ Î·È Ù˘ ‰È·ÛÙÔÏÈ΋˜ ∞¶ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ë̤ڷ˜ Î·È ÙÔ˘Ï¿¯ÈÛÙÔÓ 7 ÌÂÙÚ‹ÛÂȘ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘ ÁÈ· Ó· ıˆÚÂ›Ù·È Ì›· 24ˆÚË Î·Ù·ÁÚ·Ê‹ Ù˘ ∞¶ ·ÍÈfiÈÛÙË. √È Ê˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜ Ù˘ ∞¶ Ì ÙË Ì¤ıÔ‰Ô Ù˘ 24ˆÚ˘ ηٷÁÚ·Ê‹˜ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2 [25]. øÛÙfiÛÔ ¤¯Ô˘Ó ÚÔÙ·ı› ¯·ÌËÏfiÙÂÚ˜ ÙÈ̤˜ ÁÈ· ÙÔ˘˜ ·ÛıÂÓ›˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, fiˆ˜ ÁÈ· ·Ú¿‰ÂÈÁÌ· ÁÈ· ÙÔ˘˜ ‰È·‚ËÙÈÎÔ‡˜ ·ÛıÂÓ›˜, ÛÙÔ˘˜ ÔÔ›Ô˘˜ ÔÈ È‰·ÓÈΤ˜ ÙÈ̤˜ Â›Ó·È ¯·ÌËÏfiÙÂÚ˜ ·fi 130/80 mmHg [27,32]. ∂ÈÚfiÛıÂÙ·, ‰Â‰Ô̤ӷ ·fi ÌÂÁ¿Ï˜ ÌÂϤÙ˜ ˘ÔÛÙËÚ›˙Ô˘Ó ÙË ı¤ÛÈÛË ¯·ÌËÏfiÙÂÚˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÙÈÌÒÓ ÁÈ· ÙËÓ 24ˆÚË Ì¤ÙÚËÛË Ù˘ ∞¶.

∫ÏÈÓÈΤ˜ ÂӉ›ÍÂȘ Ù˘ 24ˆÚ˘ ηٷÁÚ·Ê‹˜ «À¤ÚÙ·ÛË Ù˘ Ï¢΋˜ ÌÏÔ‡˙·˜» ŒÓ·˜ ÁÂÓÈÎfi˜ ÔÚÈÛÌfi˜ Ù˘ «˘¤ÚÙ·Û˘ Ù˘ Ï¢΋˜ ÌÏÔ‡˙·˜» ‰fiıËΠÚÔËÁÔ‡-

¶›Ó·Î·˜ 2. º˘ÛÈÔÏÔÁÈο Â›‰· Ù˘ 24ˆÚ˘ ηٷÁÚ·Ê‹˜ Ù˘ ∞¶ π‰·ÓÈο

20

º˘ÛÈÔÏÔÁÈο À„ËÏ¿

∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ë̤ڷ˜

<130/80

<135/85

>140/90

∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘

<115/65

<120/70

>125/65

ÌÂÓ·. ŒÓ·˜ ÂÚÈÛÛfiÙÂÚÔ ÂȉÈÎfi˜ ÔÚÈÛÌfi˜ ·˘Ù‹˜ Ù˘ ηٿÛÙ·Û˘ ÚÔ¸Ôı¤ÙÂÈ ÙË ‰È·›ÛÙˆÛË ÙÈÌÒÓ ∞¶ ÌÂÁ·Ï‡ÙÂÚˆÓ ·fi 140/90 mmHg Û ÙÔ˘Ï¿¯ÈÛÙÔÓ 3 Û˘Ì‚·ÙÈΤ˜ ÌÂÙÚ‹ÛÂȘ ÛÙÔ È·ÙÚ›Ô, ÂÓÒ Ù· Â›‰· Ù˘ ∞¶ Ì ÙËÓ 24ˆÚË Î·Ù·ÁÚ·Ê‹ Î˘Ì·›ÓÔÓÙ·È ÛÂ Ê˘ÛÈÔÏÔÁÈο Â›‰·. ∞ÚÎÂÙ¤˜ ηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ Û˘ÓÈÛÙÔ‡Ó ÙËÓ 24ˆÚË Î·Ù·ÁÚ·Ê‹ fiÙ·Ó ˘¿Ú¯ÂÈ ˘Ô„›· «˘¤ÚÙ·Û˘ Ù˘ Ï¢΋˜ ÌÏÔ‡˙·˜», ¯ˆÚ›˜ fï˜ Ó· ÂÌ‚·ı‡ÓÔ˘Ó ÛÙÔ Ò˜ ¤Ó·˜ ÁÈ·ÙÚfi˜ ı· ˘ÔÙ¢ı› ·˘Ù‹ ÙËÓ Î·Ù¿ÛÙ·ÛË. ∏ ·Ó¿Ï˘ÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ·fi ÔÚÈṲ̂Ó˜ ÌÂϤÙ˜ [33] ˘Ô‰ÂÈÎÓ‡ÂÈ fiÙÈ Ë Èı·ÓfiÙËÙ· ¤Ó· ¿ÙÔÌÔ Ó· ÂÌÊ·Ó›˙ÂÈ «˘¤ÚÙ·ÛË Ù˘ Ï¢΋˜ ÌÏÔ‡˙·˜» ·˘Í¿ÓÂÙ·È: ñ fiÙ·Ó Ë ™∞¶ Â›Ó·È ÌÂٷ͇ 140-159 mmHg ‹ fiÙ·Ó Ë ¢∞¶ Â›Ó·È ÌÂٷ͇ 90-99 mmHg ñ Û Á˘Ó·›Î˜ ñ Û ÌË Î·ÓÈÛÙ¤˜ ñ fiÙ·Ó ˘¿Ú¯ÂÈ ÂÚÈÔÚÈṲ̂ÓÔ˜ ·ÚÈıÌfi˜ ÌÂÙÚ‹ÛÂˆÓ Ù˘ ∞¶ ÛÙÔ È·ÙÚÂ›Ô ñ fiÙ·Ó Ë Ì¿˙· Ù˘ ·ÚÈÛÙÂÚ¿˜ ÎÔÈÏ›·˜ Â›Ó·È Ê˘ÛÈÔÏÔÁÈ΋

™Ù· ¿ÙÔÌ· Ô˘ ÂÌÊ·Ó›˙Ô˘Ó «˘¤ÚÙ·ÛË Ù˘ Ï¢΋˜ ÌÏÔ‡˙·˜» Ë ‰È¿ÁÓˆÛË Ú¤ÂÈ Ó· ÂȂ‚·ÈÒÓÂÙ·È Û 3 ¤ˆ˜ 6 Ì‹Ó˜ Î·È ÛÙË Û˘Ó¤¯ÂÈ· ·˘Ù¿ Ù· ¿ÙÔÌ· Ú¤ÂÈ Ó· ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È Î¿ı ¯ÚfiÓÔ Ì 24ˆÚË Î·Ù·ÁÚ·Ê‹ ÁÈ· ÙËÓ Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ÛÙ·ıÂÚ‹˜ ˘¤ÚÙ·Û˘ [27]. «∂›‰Ú·ÛË Ù˘ Ï¢΋˜ ÌÏÔ‡˙·˜» Ÿˆ˜ ¤¯ÂÈ ·Ó·ÊÂÚı› Ë «Â›‰Ú·ÛË Ù˘ Ï¢΋˜ ÌÏÔ‡˙·˜» Â›Ó·È ¤Ó· Ê·ÈÓfiÌÂÓÔ ‰È·ÊÔÚÂÙÈÎfi ·fi ÙËÓ «˘¤ÚÙ·ÛË Ù˘ Ï¢΋˜ ÌÏÔ‡˙·˜». ø˜ ÎÏÈÓÈο ÛËÌ·ÓÙÈ΋ «Â›‰Ú·ÛË Ù˘ Ï¢-


™Y°XPONE™ O¢H°IE™ ΋˜ ÌÏÔ‡˙·˜» ÔÚ›˙ÂÙ·È Ë ÂÌÊ¿ÓÈÛË ÙÈÌÒÓ ∞¶ ÛÙÔ È·ÙÚ›Ô, ÔÈ Ôԛ˜ ˘ÂÚ‚·›ÓÔ˘Ó ÙË Ì¤ÛË 24ˆÚË ∞¶ ηٿ 20 mmHg fiÛÔÓ ·ÊÔÚ¿ ÙË ™∞¶ ‹ Î·È Î·Ù¿ 10 mmHg fiÛÔÓ ·ÊÔÚ¿ ÙË ¢∞¶ [27]. ¶·ÚfiÌÔȘ ‰È·ÊÔÚ¤˜ ÂÌÊ·Ó›˙ÔÓÙ·È ÂÚ›Ô˘ ÛÙÔ 73% ÙˆÓ ˘ÂÚÙ·ÛÈÎÒÓ ·ÙfiÌˆÓ Ô˘ ·›ÚÓÔ˘Ó ·ÁˆÁ‹ Î·È ÈÔ Û˘¯Ó¿ ÛÙȘ Á˘Ó·›Î˜ Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ ¿Ó‰Ú˜. «§·Óı¿ÓÔ˘Û· ˘¤ÚÙ·ÛË» ¶ÚfiÛÊ·Ù· ¤¯ÂÈ ·Ó·ÁÓˆÚÈÛı› Ì›· ÔÌ¿‰· ·ÛıÂÓÒÓ ÛÙÔ˘˜ ÔÔ›Ô˘˜ Ë ∞¶ Î˘Ì·›ÓÂÙ·È ÛÂ Ê˘ÛÈÔÏÔÁÈο Â›‰· fiÙ·Ó ÌÂÙÚ¿Ù·È Û˘Ì‚·ÙÈο ÛÙÔ È·ÙÚ›Ô, ÂÓÒ Ë Ì¤ÛË 24ˆÚË ∞¶ (Ô˘ ÌÂÙÚ¿Ù·È Ì ÙËÓ 24ˆÚË Î·Ù·ÁÚ·Ê‹) Â›Ó·È ˘„ËÏ‹ [34]. ∞˘Ù¿ Ù· ¿ÙÔÌ· Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È ˆ˜ ˘ÂÚÙ·ÛÈο, fï˜ ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· ‰È·Ê‡ÁÔ˘Ó Ù˘ ÚÔÛÔ¯‹˜ ÙÔ˘ ÁÈ·ÙÚÔ‡. ∏ ˘Ô„›· Ù˘ «Ï·Óı¿ÓÔ˘Û·˜ ˘¤ÚÙ·Û˘» Ù›ıÂÙ·È Û ¿ÙÔÌ· Ô˘ ÛÙÔ ·ÚÂÏıfiÓ ÂÌÊ¿ÓÈÛ·Ó ·˘ÍË̤ӷ Â›‰· ∞¶, Û Ó·ڿ ¿ÙÔÌ· ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ ∞¶ ÛÙÔ È·ÙÚÂ›Ô Ô˘ ÂÌÊ·Ó›˙Ô˘Ó fï˜ ˘ÂÚÙÚÔÊ›· Ù˘ ·ÚÈÛÙÂÚ¿˜ ÎÔÈÏ›·˜, Û ¿ÙÔÌ· Ì ÎÏËÚÔÓÔÌÈÎfi ÈÛÙÔÚÈÎfi ˘¤ÚÙ·Û˘ Î·È ·fi ÙÔ˘˜ ‰‡Ô ÁÔÓ›˜, Û ¿ÙÔÌ· Ì ÔÏÏ·ÏÔ‡˜ ·Ú¿ÁÔÓÙ˜ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ Î·È ÂӉ¯Ô̤ӈ˜ Û ¿ÙÔÌ· Ì ‰È·‚‹ÙË.

∞ÓıÂÎÙÈ΋ ˘¤ÚÙ·ÛË ø˜ ·ÓıÂÎÙÈ΋ ˘¤ÚÙ·ÛË ÔÚ›˙ÂÙ·È Ë Î·Ù¿ÛÙ·ÛË Î·Ù¿ ÙËÓ ÔÔ›· ¤Ó·˜ ˘ÂÚÙ·ÛÈÎfi˜ ·ÛıÂÓ‹˜ ÂÌÊ·Ó›˙ÂÈ ÙÈ̤˜ ∞¶ ÛÙÔ È·ÙÚÂ›Ô ¿Óˆ ·fi 140/90 mmHg ·Ú¿ ÙË ¯ÔÚ‹ÁËÛË ÙÚÈÒÓ ‰È·ÊÔÚÂÙÈÎÒÓ ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ Ê·Ú̿ΈÓ. ∏ 24ˆÚË Î·Ù·ÁÚ·Ê‹ Ù˘ ∞¶ Â›Ó·È È‰È·›ÙÂÚ· ¯Ú‹ÛÈÌË Û ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓ›˜, ·ÊÔ‡ ÌÔÚ› Ó· ·ÔÎÏ›ÛÂÈ ÙËÓ «Â›‰Ú·ÛË Ù˘ Ï¢΋˜ ÌÏÔ‡˙·˜» ‹ Ó· ÂȂ‚·ÈÒÛÂÈ

ÙȘ ÙÈ̤˜ Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙÔ È·ÙÚÂ›Ô Î·È Û˘ÓÂÒ˜ Ó· Û˘ÓÂÈÛʤÚÂÈ ÛÙËÓ ÂÚ·ÈÙ¤Úˆ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ·ÛıÂÓ‹.

∏ÏÈÎȈ̤ÓÔÈ ˘ÂÚÙ·ÛÈÎÔ› ·ÛıÂÓ›˜ ∏ ÌÂϤÙË Systolic Hypertension in Europe ¤‰ÂÈÍ fiÙÈ ÛÙÔ˘˜ ËÏÈÎȈ̤ÓÔ˘˜ ˘ÂÚÙ·ÛÈÎÔ‡˜ ·ÛıÂÓ›˜ Ù· Â›‰· Ù˘ ™∞¶ Ô˘ ÌÂÙÚÔ‡ÓÙ·È Û˘Ì‚·ÙÈο ÛÙÔ È·ÙÚÂ›Ô ÌÔÚ› Ó· Â›Ó·È Î·Ù¿ ̤ÛÔ fiÚÔ 20 mmHg ˘„ËÏfiÙÂÚ· Û ۇÁÎÚÈÛË Ì ÙË Ì¤ÛË 24ˆÚË ™∞¶ [35]. ∞˘Ùfi ÙÔ ÁÂÁÔÓfi˜ ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ˘ÂÚÂÎÙ›ÌËÛË Ù˘ Û˘ÛÙÔÏÈ΋˜ ˘¤ÚÙ·Û˘ Î·È Èı·Ó¿ ÙËÓ ˘ÂÚ‚ÔÏÈ΋ ·ÓÙÈÌÂÙÒÈÛ‹ Ù˘. ∂›Û˘, Ë ›‰È· ÌÂϤÙË ¤‰ÂÈÍ fiÙÈ Ë 24ˆÚË Î·Ù·ÁÚ·Ê‹ Ù˘ ™∞¶ Â›Ó·È Î·Ï‡ÙÂÚÔ˜ ÚÔÁÓˆÛÙÈÎfi˜ ‰Â›ÎÙ˘ ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ Û ۇÁÎÚÈÛË Ì ٷ Â›‰· Ù˘ ™∞¶ Ô˘ ÌÂÙÚÔ‡ÓÙ·È ÛÙÔ È·ÙÚÂ›Ô [35]. ∂ÈÚfiÛıÂÙ·, ÔÈ ËÏÈÎȈ̤ÓÔÈ Û˘¯Ó¿ ÂÌÊ·Ó›˙Ô˘Ó ·ÓÂ¿ÚÎÂÈ· ÙÔ˘ ·˘ÙfiÓÔÌÔ˘ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ÁÂÁÔÓfi˜ Ô˘ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ÂÓ·ÏÏ·ÛÛfiÌÂÓ˜ ÂÚÈfi‰Ô˘˜ ˘¤ÚÙ·Û˘ Î·È ˘fiÙ·Û˘ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ë̤ڷ˜. ∏ 24ˆÚË Î·Ù·ÁÚ·Ê‹ Ù˘ ∞¶ ÌÔÚ› Ó· ·Ó·‰Â›ÍÂÈ ·˘Ù‹ ÙËÓ Î·Ù¿ÛÙ·ÛË Î·È Ó· Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ Î·Ï‡ÙÂÚË ·ÓÙÈÌÂÙÒÈÛË Ù˘ ˘¤ÚÙ·Û˘, ·ÊÔ‡ ·˘ÙÔ› ÔÈ ·ÛıÂÓ›˜ Â›Ó·È È‰È·›ÙÂÚ· ¢·›ÛıËÙÔÈ ÛÙȘ ·ÚÂÓ¤ÚÁÂȘ ÙˆÓ ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ Ê·Ú̿ΈÓ.

ÀÔ„›· ·˘ÍËÌ¤ÓˆÓ ÂÈ¤‰ˆÓ ∞¶ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘ ¶ÚfiÛÊ·Ù· ‰Â‰Ô̤ӷ ¤‰ÂÈÍ·Ó fiÙÈ Ë ÌË Ê˘ÛÈÔÏÔÁÈ΋ Ì›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ∞¶ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘ (non-dipping) Â›Ó·È ¤Ó·˜ ·ÓÂÍ¿ÚÙËÙÔ˜ Î·È ÛËÌ·ÓÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ [30,36]. ∏ ˘Ô„›· ·˘Ù‹˜ Ù˘ ηٿÛÙ·-

Û˘ Ù›ıÂÙ·È Û ¿ÙÔÌ· Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ·˘ÍË̤ӷ Â›‰· ∞¶ ÙÔ ‚Ú¿‰˘ (Ù· Â›‰· Ù˘ ∞¶ ηٿ ÙËÓ ·Ê‡ÓÈÛË ‰ÂÓ Û˘Û¯ÂÙ›˙ÔÓÙ·È Î·Ï¿ Ì ÙËÓ ÂÌÊ¿ÓÈÛË Ó˘¯ÙÂÚÈÓ‹˜ ˘¤ÚÙ·Û˘) ‹ Û ¿ÙÔÌ· ÛÙ· ÔÔ›· ‰È·ÈÛÙÒÓÂÙ·È ‚Ï¿‚Ë ÔÚÁ¿ÓÔ˘-ÛÙfi¯Ô˘ Ë ÔÔ›· ‰ÂÓ ‰ÈηÈÔÏÔÁÂ›Ù·È ·fi Ù· Â›‰· Ù˘ ∞¶ Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙÔ È·ÙÚ›Ô. ∂Á΢ÌÔÛ‡ÓË ∏ ¯ÚËÛÈÌfiÙËÙ· Ù˘ 24ˆÚ˘ ηٷÁÚ·Ê‹˜ ÛÙËÓ ÂÁ΢ÌÔÛ‡ÓË ¤ÁÎÂÈÙ·È ÛÙÔÓ ·ÔÎÏÂÈÛÌfi Ù˘ «˘¤ÚÙ·Û˘ Ù˘ Ï¢΋˜ ÌÏÔ‡˙·˜» Û ̛· ¤ÁÎ˘Ô Á˘Ó·›Î· Ô˘ ÂÌÊ·Ó›˙ÂÈ ˘„ËϤ˜ ÙÈ̤˜ ∞¶ Ì ÙȘ Û˘Ì‚·ÙÈΤ˜ ÌÂıfi‰Ô˘˜. ∂ÈÚfiÛıÂÙ· ÔÈ ÙÈ̤˜ Ù˘ ∞¶ Ô˘ Ï·Ì‚¿ÓÔÓÙ·È Ì ÙËÓ 24ˆÚË Ì¤ÙÚËÛË Û˘Û¯ÂÙ›˙ÔÓÙ·È Î·Ï‡ÙÂÚ· Ì ÙËÓ ÂÌÊ¿ÓÈÛË ÚˆÙÂ˚ÓÔ˘Ú›·˜ Î·È ¿ÏÏˆÓ ˘ÂÚÙ·ÛÈÎÒÓ ÂÈÏÔÎÒÓ Û ۇÁÎÚÈÛË Ì ·˘Ù¤˜ Ô˘ Ï·Ì‚¿ÓÔÓÙ·È ÌÂ Û˘Ì‚·ÙÈΤ˜ ÌÂıfi‰Ô˘˜.

¢È·‚‹Ù˘ ™Â ·ÛıÂÓ›˜ Ì ‰È·‚‹ÙË Ù‡Ô˘ 1 Ë 24ˆÚË Î·Ù·ÁÚ·Ê‹ Â›Ó·È ¯Ú‹ÛÈÌË ‰ÈfiÙÈ ÌÔÚ› Ó· ·Ó·‰Â›ÍÂÈ ÙËÓ ·Ô˘Û›· Ù˘ Ó˘¯ÙÂÚÈÓ‹˜ Ì›ˆÛ˘ Ù˘ ∞¶, Ë ÔÔ›· Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ÂÌÊ¿ÓÈÛË ÌÈÎÚÔ·Ï‚Ô˘ÌÈÓÔ˘Ú›·˜ Î·È Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ ÛÙÔ Ì¤ÏÏÔÓ Û ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓ›˜.

ª¤ÚÔ˜ 3: ∏ ̤ÙÚËÛË Ù˘ ∞¶ ÛÙÔ Û›ÙÈ °È· ÂÚÈÛÛfiÙÂÚÔ ·fi 50 ¯ÚfiÓÈ· Â›Ó·È ÁÓˆÛÙfi fiÙÈ ÔÈ ÙÈ̤˜ Ù˘ ∞¶ ÛÙÔ Û›ÙÈ Â›Ó·È ¯·ÌËÏfiÙÂÚ˜ ·fi ÙȘ ÙÈ̤˜ Ô˘ ÌÂÙÚÔ‡ÓÙ·È ÛÙÔ È·ÙÚ›Ô. ∆Ô 1999 ÛÙȘ µÂÚ۷ϛ˜ Ú·ÁÌ·ÙÔÔÈ‹ıËΠÙÔ ÚÒÙÔ ‰ÈÂıÓ¤˜ Û˘Ó¤‰ÚÈÔ Ô˘ ·ÊÔÚÔ‡Û ÙË Ì¤ÙÚËÛË Ù˘ ∞¶ ÛÙÔ Û›ÙÈ Ì ÛÎÔfi Ó· Û˘˙ËÙËıÔ‡Ó ÔÈ ÂӉ›ÍÂȘ 21


·ıËÚÔÛÎÏ‹ÚˆÛË π√À¡IO™ 2005

˘¤Ú Î·È Î·Ù¿ ·˘Ù‹˜ Ù˘ ÌÂıfi‰Ô˘ Î·È Ó· ηıÔÚÈÛıÔ‡Ó Î·Ù¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜. √È Û˘ÛÙ¿ÛÂȘ Ô˘ ·ÎÔÏÔ˘ıÔ‡Ó ‚·Û›˙ÔÓÙ·È ÛÙȘ Û˘˙ËÙ‹ÛÂȘ Ô˘ ¤ÁÈÓ·Ó Û ·˘Ùfi ÙÔ Û˘Ó¤‰ÚÈÔ [37].

™˘Û΢¤˜ Î·È ·ÍÈÔÈÛÙ›· √È Û˘Û΢¤˜ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡Ó ÔÈ ·ÛıÂÓ›˜ Â›Ó·È ÔÈ ÌÂÙ·ÏÏÈΤ˜, ÔÈ ËÏÂÎÙÚÔÓÈΤ˜ Î·È Û¿ÓÈ· ÔÈ ˘‰Ú·ÚÁ˘ÚÈΤ˜. √ÔÈ·‰‹ÔÙÂ Û˘Û΢‹ Î·È ·Ó ¯ÚËÛÈÌÔÔÈÂ›Ù·È Ú¤ÂÈ Ó· ¤¯ÂÈ ÂÏÂÁ¯ı› Û‡Ìʈӷ Ì ٷ ÚˆÙfiÎÔÏÏ· Ô˘ ÈÛ¯‡Ô˘Ó. ŸÛÔÓ ·ÊÔÚ¿ ÙȘ ËÏÂÎÙÚÔÓÈΤ˜ Û˘Û΢¤˜ Ú¤ÂÈ Ó· ÚÔÙÈÌÒÓÙ·È ÔÈ Û˘Û΢¤˜ Ô˘ ÌÂÙÚÔ‡Ó ÙËÓ ∞¶ ÛÙÔ ‚Ú·¯›ÔÓ·, ·ÊÔ‡ ·˘Ù¤˜ ÔÈ Û˘Û΢¤˜ Ê·›ÓÂÙ·È Ó· Â›Ó·È ÔÈ ÈÔ ·ÍÈfiÈÛÙ˜. ∏ BHS Î·È Ë ∂SH ·Ú¤¯Ô˘Ó ÛÙÔ ‰È·‰›ÎÙ˘Ô Ï›ÛÙ˜ Ì ·ÚfiÌÔȘ Û˘Û΢¤˜, ÙˆÓ ÔÔ›ˆÓ Ë ·ÍÈÔÈÛÙ›· ¤¯ÂÈ ÂÏÂÁ¯ı› [5,6]. √È ËÏÂÎÙÚÔÓÈΤ˜ Û˘Û΢¤˜ Ô˘ ÌÂÙÚÔ‡Ó ÙËÓ ∞¶ ÛÙÔ ‰¿ÎÙ˘ÏÔ ‰ÂÓ Ú¤ÂÈ Ó· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È, ÂÓÒ ÂΛӘ Ô˘ ÌÂÙÚÔ‡Ó ÛÙÔÓ Î·Úfi Ú¤ÂÈ ÁÂÓÈο Ó· ·ÔʇÁÔÓÙ·È (·Ó Î·È Â›Ó·È ÈÔ ·ÎÚȂ›˜ ·fi ·˘Ù¤˜ ÙÔ˘ ‰·¯Ù‡ÏÔ˘).

™˘ÛÙ¿ÛÂȘ ÁÈ· ÙË Ì¤ÙÚËÛË Ù˘ ∞¶ ÛÙÔ Û›ÙÈ ¶ÚÈÓ ·fi οı ̤ÙÚËÛË ··ÈÙÂ›Ù·È ¤Ó· ‰È¿ÛÙËÌ· ËÚÂÌ›·˜ ‰È¿ÚÎÂÈ·˜ 5 ÏÂÙÒÓ. ¶Ú¤ÂÈ Ó· ¯ÚËÛÈÌÔÔÈÂ›Ù·È Î·Ù¿ÏÏËÏË ÂÚȯÂÈÚ›‰· Î·È Ô ‚Ú·¯›ÔÓ·˜ Ó· ‚Ú›ÛÎÂÙ·È ÛÙÔ ‡„Ô˜ Ù˘ ηډȿ˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ̤ÙÚËÛ˘. ¶ÚÔÙÈÌÒÓÙ·È ÔÈ ËÏÂÎÙÚÔÓÈΤ˜ Û˘Û΢¤˜ Ô˘ ·ÔıËÎÂ‡Ô˘Ó ÛÙË ÌÓ‹ÌË ÙÔ˘˜ ÛÙÔȯ›·, fiˆ˜ Ë ËÌÂÚÔÌËÓ›·, Ë ÒÚ· Î·È Ë ÙÈÌ‹ Ù˘ ̤ÙÚËÛ˘, ÂÓÒ Ú¤ÂÈ Ó· ·ÔʇÁÂÙ·È Ë Î·Ù·ÁÚ·Ê‹ ·˘ÙÒÓ ÙˆÓ ÛÙÔȯ›ˆÓ ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ ‰ÈfiÙÈ ‰ÂÓ ·ÓÙÈηÙÔÙÚ›˙Ô˘Ó ¿ÓÙ· ÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ·.

22

™˘¯ÓfiÙËÙ· ÙˆÓ ÌÂÙÚ‹ÛÂˆÓ ŸÛÔÓ ·ÊÔÚ¿ ÙË Û˘¯ÓfiÙËÙ· Î·È ÙË ¯ÚÔÓÈ΋ ÛÙÈÁÌ‹ ÙˆÓ ÌÂÙÚ‹ÛÂˆÓ Ù˘ ∞¶ ÛÙÔ Û›ÙÈ, Ë German Hypertension League ¤¯ÂÈ ‰ËÌÔÛȇÛÂÈ ÙȘ ·ÎfiÏÔ˘ı˜ Û˘ÛÙ¿ÛÂȘ: ñ ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ¤Ó·Ú͢ ÙˆÓ ÌÂÙÚ‹ÛÂˆÓ ÛÙÔ Û›ÙÈ, Ë ∞¶ Ú¤ÂÈ Ó· ÌÂÙÚ¿Ù·È ÁÈ· 7 Ë̤Ú˜ Ì›· ÊÔÚ¿ ÙÔ Úˆ› Î·È Ì›· ÊÔÚ¿ ÙÔ ‚Ú¿‰˘. √È ÌÂÙÚ‹ÛÂȘ Ù˘ ÚÒÙ˘ Ë̤ڷ˜ ‰ÂÓ Ú¤ÂÈ Ó· Û˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË, ·ÊÔ‡ ·ÓÙÈηÙÔÙÚ›˙Ô˘Ó Ì›· ÂÚ›Ô‰Ô ÂÍÔÈΛˆÛ˘ Ì ÙËÓ Ù¯ÓÈ΋ [38]. ñ ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ¯ÔÚ‹ÁËÛ˘ ·ÓÙÈ˘ÂÚÙ·ÛÈ΋˜ ·ÁˆÁ‹˜, Ë ∞¶ Ú¤ÂÈ Ó· ÌÂÙÚ¿Ù·È fiˆ˜ Î·È ÛÙË Ê¿ÛË ¤Ó·Ú͢. ∏ ̤ÙÚËÛË Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÚÈÓ ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘. ŸÙ·Ó ·ÏÏ¿˙ÂÈ Ë ·ÁˆÁ‹ ÙfiÙÂ Ë ∞¶ Ú¤ÂÈ Ó· ÌÂÙÚ¿Ù·È ÁÈ· 2 ‚‰ÔÌ¿‰Â˜, ÒÛÙ ӷ ÂÎÙÈÌËı› ηχÙÂÚ· Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ·ÁˆÁ‹˜ [37]. ñ ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÚÈfi‰Ô˘ ·Ú·ÎÔÏÔ‡ıËÛ˘, Ë Ì¤ÙÚËÛË Ù˘ ∞¶ Ú¤ÂÈ Ó· Á›ÓÂÙ·È Ì›· ÊÔÚ¿ ÙËÓ Â‚‰ÔÌ¿‰·, ÂÊfiÛÔÓ Ë ∞¶ ¤¯ÂÈ Ú˘ıÌÈÛı›. ∂¿Ó ˘¿Ú¯ÂÈ ˘Ô„›· ·ÚÚ‡ıÌÈÛÙ˘ ˘¤ÚÙ·Û˘ ‹ η΋˜ Û˘ÌÌfiÚʈÛ˘ ÙÔ˘ ·ÛıÂÓ‹ ÙfiÙ Ú¤ÂÈ Ó· ·˘Í¿ÓÂÙ·È Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ÌÂÙÚ‹ÛˆÓ. √ ÂÏ¿¯ÈÛÙÔ˜ ·ÚÈıÌfi˜ ÌÂÙÚ‹ÛÂˆÓ Û ÔÔÈ·‰‹ÔÙ ·fi ÙȘ Ê¿ÛÂȘ Ô˘ ÂÚÈÁÚ¿ÊËÎ·Ó Ú¤ÂÈ Ó· Â›Ó·È 12 Û 7 ÂÚÁ¿ÛÈ̘ Ë̤Ú˜ [37].

º˘ÛÈÔÏÔÁÈΤ˜ ÌÂÙÚ‹ÛÂȘ Ù˘ ÙÈÌ‹ Ù˘ ∞¶ ÛÙÔ Û›ÙÈ Ÿˆ˜ Â›Ó·È ÁÓˆÛÙfi, Ë Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙˆÓ ÙÈÌÒÓ Ù˘ ∞¶ Î·È ÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ Â›Ó·È Û˘Ó¯‹˜. ŒÙÛÈ ‰ÂÓ ˘¿Ú¯Ô˘Ó Â›‰· Ù˘ ∞¶ οو ·fi Ù· ÔÔ›· Ó· ·Ú·ÙËÚÂ›Ù·È ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘. øÛÙfiÛÔ Ù· ‰È·ÁÓˆÛÙÈο fiÚÈ· Â›Ó·È ··Ú·›ÙËÙ· ÁÈ· ÙË Ï‹„Ë ÙˆÓ ÎÏÈÓÈÎÒÓ ·ÔÊ¿ÛˆÓ. ™‡Ìʈӷ Ì ٷ ÛËÌÂÚÈÓ¿ ‰Â‰Ô̤ӷ Ë ∞¶ ÛÙÔ Û›ÙÈ ıˆÚÂ›Ù·È Ê˘ÛÈÔÏÔÁÈ΋ fiÙ·Ó Â›Ó·È Î¿Ùˆ ·fi 135/85 mmHg [39].

∂Ӊ›ÍÂȘ ÁÈ· ÙË ‰ÈÂÍ·ÁˆÁ‹ ÌÂÙÚ‹ÛÂˆÓ Ù˘ ∞¶ ÛÙÔ Û›ÙÈ ∏ ̤ÙÚËÛË Ù˘ ∞¶ ÛÙÔ Û›ÙÈ ÂӉ›ÎÓ˘Ù·È fiÙ·Ó ˘¿Ú¯ÂÈ ˘Ô„›· «˘¤ÚÙ·Û˘ ‹ Â›‰Ú·Û˘ Ù˘ Ï¢΋˜ ÌÏÔ‡˙·˜» (fiˆ˜ ·ÎÚÈ‚Ò˜ Î·È Ë 24ˆÚË Î·Ù·ÁÚ·Ê‹ Ù˘ ∞¶). ∏ ‰È·›ÛÙˆÛË ·˘ÙÒÓ ÙˆÓ Î·Ù·ÛÙ¿ÛÂˆÓ ·ÔÎÙ¿ ȉȷ›ÙÂÚË ÛËÌ·Û›· Û ÔÚÈṲ̂Ó˜ ÔÌ¿‰Â˜ ·ÛıÂÓÒÓ, fiˆ˜ ÔÈ ¤ÁÎ˘Â˜ Á˘Ó·›Î˜, ÔÈ ËÏÈÎȈ̤ÓÔÈ ·ÛıÂÓ›˜ Î·È Ù· ¿ÙÔÌ· Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ·ÓıÂÎÙÈ΋ ˘¤ÚÙ·ÛË ÛÙÔ È·ÙÚ›Ô. ∂›Û˘, ÛÙÔ˘˜ ‰È·‚ËÙÈÎÔ‡˜ ·ÛıÂÓ›˜, ÛÙÔ˘˜ ÔÔ›Ô˘˜ Ô ¤ÏÂÁ¯Ô˜ Ù˘ ∞¶ Ú¤ÂÈ Ó· Â›Ó·È ÈÔ ·˘ÛÙËÚfi˜, ÂӉ›ÎÓ˘Ù·È Ë ‰ÈÂÍ·ÁˆÁ‹ ÌÂÙÚ‹ÛÂˆÓ Ù˘ ∞¶ ÛÙÔ Û›ÙÈ.


™Y°XPONE™ O¢H°IE™ µÈ‚ÏÈÔÁÚ·Ê›· 1.

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23


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IATPOI KA§§ITEXNE™

IATPOI KA§§ITEXNE™

¢ËÌ‹ÙÚÈÔ˜ °ÂˆÚÁ›Ô˘ °È·ÓÓ¿Î˘ °ÂÓÓ‹ıËΠÛÙËÓ ∞ı‹Ó· ·fi ÁÔÓ›˜ ™ÙÂÚÂÔÂÏÏ·‰›Ù˜. ¶·Ú¿ÏÏËÏ· Ì ÙȘ ÛÔ˘‰¤˜ ÙÔ˘ ÛÙËÓ π·ÙÚÈ΋ ™¯ÔÏ‹ Ù˘ ¶ÂÚÔ‡Ù˙È· (πÙ·Ï›·), ·Ú·ÎÔÏÔ‡ıËÛ ˙ˆÁÚ·ÊÈ΋ ÛÙËÓ ∞η‰ËÌ›· ∫·ÏÒÓ ∆¯ÓÒÓ Ù˘ ›‰È·˜ fiÏ˘. √È Î·ÏÏÈÙ¯ÓÈΤ˜ ÙÔ˘ ·ÓËÛ˘¯›Â˜ ˘‹ÚÍ·Ó ÔÏϤ˜. ∞Û¯ÔÏ‹ıËΠηْ ·Ú¯‹Ó Ì ÙË µ˘˙·ÓÙÈÓ‹ ˙ˆÁÚ·ÊÈ΋ Ì ‰¿ÛηÏÔ ÙÔÓ ·Â›ÌÓËÛÙÔ ¶ÈÎÈÒÓË. ™ÙË Û˘Ó¤¯ÂÈ Â‰fiıË fiˆ˜ fiÏÔÈ ÔÈ Î·ÏÏÈÙ¤¯Ó˜ Û ‰È¿ÊÔÚ˜ ·Ó·˙ËÙ‹ÛÂȘ fiˆ˜ Ë ·ÎÔ˘·Ú¤Ï·, ÙÔ Ï¿‰È, Ë ¤Á¯ÚˆÌË ÎÂÚ·ÌÈ΋-ÁÏ˘ÙÈ΋ Î·È ¿ÏÏ· ÁÈ· Ó· ηٷϋÍÂÈ ÛÙËÓ ∫Ú˘ÛÙ·ÏÏÔ-˙ˆÁÚ·ÊÈ΋, fiˆ˜ ÙËÓ ·ÔηÏ›, ‰ËÏ·‰‹ ÎÚ‡ÛÙ·ÏÏÔ ˙ˆÁÚ·ÊÈṲ̂ÓÔ ·fi ÙËÓ Ô›ÛıÈ· ÏÂ˘Ú¿. ∂›Ó·È Ì›· ˙ˆÁÚ·ÊÈ΋ ÛÂ Ó¤Ô ÎÏ·ÛÛÈÎfi ÛÙ˘Ï Ì ‰È·Î˘Ì¿ÓÛÂȘ Î·È ¯ÚˆÌ·ÙÈΤ˜ ‰È·‚·ıÌ›ÛÂȘ Ô˘ ÔÈΛÏÔ˘Ó ÌÂٷ͇ ·ÎÔ˘·Ú¤Ï·˜ Î·È ÂÏ·ÈÔ¯ÚÒÌ·ÙÔ˜. ŸÏ˜ ·˘Ù¤˜ ÙȘ ‰È·Î˘Ì¿ÓÛÂȘ ·ÎÔÏÔ˘ıÔ‡Ó Ì›· ·ÓÙ›ÛÙÔÈ¯Ë ÔÈÎÈÏ›· Û˘Ó·ÈÛıËÌ¿ÙˆÓ Ô˘ οÓÔ˘Ó ÙÔ Â›‰Ô˜ ·˘Ùfi Ù˘ ˙ˆÁÚ·ÊÈ΋˜ Ì·˙› Ì ÙË Ï·ÌÚfiÙËÙ· ÙˆÓ ¯ÚˆÌ¿ÙˆÓ Ô˘ ‰›ÓÂÈ ÙÔ ÎÚ‡ÛÙ·ÏÏÔ, ÚÔÛÈÙfi Î·È Â˘¯¿ÚÈÛÙÔ Û ÌÂÁ¿ÏË Áο̷ ·ÓıÚÒˆÓ. ¶ÚÔ¯ˆÚ¿ÂÈ ¤ÙÛÈ ¿ÏÏÔÙ Ì ۷ʋ Û¯‹Ì·Ù· Î·È ¿ÏÏÔÙ Ì ¯ÚˆÌ·ÙÈΤ˜ ‰È·Î˘Ì¿ÓÛÂȘ Ó· ‰˘ÛÎÔχÔÓÙ·È ·˘ÙÔ› Ô˘ ·Ó¤Ï·‚·Ó ÙËÓ ÎÚÈÙÈ΋ ÙÔ˘ ¤ÚÁÔ˘ ÙÔ˘ Ó· ÙÔ ÚÔÛ‰ÈÔÚ›ÛÔ˘Ó Û·ÊÒ˜ Î·È ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ÙÔ ·Ó·Ê¤ÚÔ˘Ó Û·Ó Ó¤Ô-ÎÏ·ÛÛÈÎfi Ì ¤ÓÙÔÓ· ÛÙÔȯ›· ·Ê·›ÚÂÛ˘ Î·È ÈÌÚÂÛÈÔÓÈÛÌfi. ∂›Ó·È ‚¤‚·ÈÔ, fï˜, fiÙÈ Ë ˙ˆÁÚ·ÊÈ΋ ·˘Ù‹ Ô˘ ‰È·ÙËÚ› ÙË Ï·ÌÚfiÙËÙ· ÙˆÓ ¯ÚˆÌ¿ÙˆÓ, ·ÚfiÛ‚ÏËÙÔ ·fi ÙËÓ ·ÙÌÔÛÊ·ÈÚÈ΋ Ú‡·ÓÛË Î·È ÙÔ ¯ÚfiÓÔ ‰ËÌÈÔ˘ÚÁ› Ì ÙÔ ÚÔÛˆÈÎfi ÛÙ˘Ï ÙÔ˘ ηÏÏÈÙ¤¯ÓË ÚˆÙfiÁÓˆÚ˜ Û˘ÁÎÈÓ‹ÛÂȘ. ŒÚÁ· ÙÔ˘ ηÏÏÈÙ¤¯ÓË, Ô˘ ¤¯ÂÈ Ï¿‚ÂÈ Ì¤ÚÔ˜ Û ÔÏϤ˜ ÚÔÛˆÈΤ˜ Î·È ÔÌ·‰ÈΤ˜ ÂÎı¤ÛÂȘ, ‚Ú›ÛÎÔÓÙ·È Û ȉȈÙÈΤ˜ Û˘ÏÏÔÁ¤˜ ÛÙËÓ ∂ÏÏ¿‰· Î·È ÙÔ Â͈ÙÂÚÈÎfi ¤ˆ˜ Î·È ÛÂ Û˘ÏÏÔÁ¤˜ ÙÔ˘ ¢‹ÌÔ˘ ∞ıËÓ·›ˆÓ. ™‹ÌÂÚ· Â›Ó·È ¢È¢ı˘ÓÙ‹˜ ÙÔ˘ ∞’ ∞ÎÙÈÓÔıÂÚ·¢ÙÈÎÔ‡ ∆Ì‹Ì·ÙÔ˜ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ÕÁÈÔ˜ ™¿‚‚·˜ Î·È ÛÎÔ‡ÂÈ Ì ÙË Û˘ÓÙ·ÍÈÔ‰fiÙËÛ‹ ÙÔ˘ Ó· ·ÊÈÂÚÒÛÂÈ ÙȘ ÙÂÏÂ˘Ù·›Â˜ ÙÔ˘ ‰˘Ó¿ÌÂȘ ÛÙËÓ Ù¤¯ÓË.


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 6 ΙΟΥΝΙΟΣ 2005 - ΑΘΗΡΟΣΚΛΗΡΩΣΗ