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∆ƒπª∏¡π∞π√ ¶∂ƒπ√¢π∫√ §π¶π¢πø¡

∆∂ÀÃ√™ 21 ñ ª∞ƒ∆IO™ 2009

2 8 14 17 26 32

¶·ıÔÊ˘ÛÈÔÏÔÁ›·

∂ȉËÌÈÔÏÔÁ›· - ¶·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ∫ÏÈÓÈ΋ ¶Ú¿ÍË

£ÂÚ·›· - º¿Ú̷η

ÀÁÈÂÈÓԉȷÈÙËÙÈ΋ ∞ÁˆÁ‹

¶ÚÔÙÂÈÓfiÌÂÓË µÈ‚ÏÈÔÁÚ·Ê›·


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IA

À‡ı˘ÓÔ˜ ™‡ÓÙ·Í˘ HÏ›·˜ XÂÈÌÒÓ·˜ K·Ú‰ÈÔÏfiÁÔ˜ YÔÙ¤Ú·Ú¯Ô˜ Â.·.

¶∞£√ºÀ™π√§√°π∞ √È Àԉԯ›˜ ∆‡Ô˘ Toll (Toll-like receptors) Î·È Ô ƒfiÏÔ˜ ÙÔ˘˜ ÛÙËÓ ∞ıËÚÔÛÎÏ‹ÚˆÛË ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ Ã. ∆¤ÏÏ˘, ∞ϤͷӉÚÔ˜ ¢. ∆ÛÂϤ˘ ∂ÚÁ·ÛÙ‹ÚÈÔ µÈÔ¯ËÌ›·˜, ∆Ì‹Ì· ÃËÌ›·˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ,

∂¶π¢∏ªπ√§√°π∞ - ¶∞ƒ∞°√¡∆∂™ ∫π¡¢À¡√À

¢ÈÔÈÎËÙÈÎfi ™˘Ì‚Ô‡ÏÈÔ ∂ÏÏËÓÈ΋˜ ∂Ù·ÈÚ›·˜ ∞ıËÚÔÛÎÏ‹ÚˆÛ˘ ªˆ˘Û‹˜ ∂ÏÈÛ¿Ê ¶Úfi‰ÚÔ˜ µ·Û›Ï˘ Õı˘ÚÔ˜ ∞ÓÙÈÚfi‰ÚÔ˜ HÏ›·˜ XÂÈÌÒÓ·˜ °ÂÓÈÎfi˜ °Ú·ÌÌ·Ù¤·˜ ¢ËÌÔÛı¤Ó˘ ¶·Ó·ÁȈٿÎÔ˜ ∂ȉÈÎfi˜ °Ú·ÌÌ·Ù¤·˜ ∂ϤÓË ªÈÏÈ·ÓÔ‡ ∆·Ì›·˜ ª·ÓÒÏ˘ °·ÓˆÙ¿Î˘ ª¤ÏÔ˜ ∞ÛÙ¤ÚÈÔ˜ ∫·Ú·ÁÈ¿ÓÓ˘ ª¤ÏÔ˜ °ÂÓÔ‚¤Ê· KÔÏÔ‚Ô‡ ª¤ÏÔ˜ µ·Û›Ï˘ ¡ÈÎÔÏ¿Ô˘ ª¤ÏÔ˜

∞ϤͷӉÚÔ˜ ∆ÛÂϤ˘ ª¤ÏÔ˜

8

∞ÓÙÈÏ‹„ÂȘ ÙÔ˘ ¶ÏËı˘ÛÌÔ‡ ÁÈ· ÙÔ ƒfiÏÔ Ù˘ ¢È·ÙÚÔÊ‹˜ ÛÙËÓ ∫·Ú‰È·ÁÁÂȷ΋ ¡fiÛÔ ¶ÈÏÔÙÈο ™ÙÔȯ›· ·fi ÙËÓ ¶·ÓÂÏÏ·‰È΋ ŒÚ¢ӷ Ù˘ √Ì¿‰·˜ ∂ÚÁ·Û›·˜ ∂ȉËÌÈÔÏÔÁ›·˜ & ¶ÚfiÏ˄˘ Ù˘ ∞ıËÚÔÛÎÏ‹ÚˆÛ˘ Ù˘ ∂ÏÏËÓÈ΋˜ ∂Ù·ÈÚ›·˜ ∞ıËÚÔÛÎÏ‹ÚˆÛ˘ ∞Ì·Ï›· °ÈˆÙÔÔ‡ÏÔ˘, ∂ο‚Ë °ÂˆÚÁÔ˘ÛÔÔ‡ÏÔ˘, ¢È·ÈÙÔÏfiÁÔÈ ¢È·ÙÚÔÊÔÏfiÁÔÈ ∆Ì‹Ì·ÙÔ˜ ∂ÈÛÙ‹Ì˘ ¢È·ÈÙÔÏÔÁ›·˜ - ¢È·ÙÚÔÊ‹˜, ÷ÚÔÎÔ›Ԣ ¶·ÓÂÈÛÙËÌ›Ô˘

∞ı·Ó¿ÛÈÔ˜ ¶··ı·Ó·Û›Ô˘, π·ÙÚfi˜ - ∫·Ú‰ÈÔÏfiÁÔ˜, π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ ∂˘¿ÁÁÂÏÔ˜ ¶ÔÏ˘¯ÚÔÓfiÔ˘ÏÔ˜, ∂ÈÎ. ∫·ıËÁËÙ‹˜ ∆Ì‹Ì·ÙÔ˜ ∂ÈÛÙ‹Ì˘ ¢È·ÈÙÔÏÔÁ›·˜ ¢È·ÙÚÔÊ‹˜ ÷ÚÔÎÔ›Ԣ ¶·ÓÂÈÛÙËÌ›Ô˘

¢ËÌÔÛı¤Ó˘ ¶·Ó·ÁȈٿÎÔ˜, ∞Ó·Ï. ∫·ıËÁËÙ‹˜ ∆Ì‹Ì·ÙÔ˜ ∂ÈÛÙ‹Ì˘ ¢È·ÈÙÔÏÔÁ›·˜ ¢È·ÙÚÔÊ‹˜ ÷ÚÔÎÔ›Ԣ ¶·ÓÂÈÛÙËÌ›Ô˘

πˆ¿ÓÓ˘ °Ô˘‰¤‚ÂÓÔ˜, ∫·ıËÁËÙ‹˜, π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ

∫§π¡π∫∏ ¶ƒ∞•∏

14

™Ê¿ÏÌ·Ù· Î·È ¶·Ú·Ï›„ÂȘ ÛÙË ¢È¿ÁÓˆÛË Ù˘ ¢˘ÛÏÈȉ·ÈÌ›·˜ ªÈ¯¿Ï˘ ∫ˆÛÙ·¿ÓÔ˜, π·ÙÚfi˜, ∂ÈÛÙËÌÔÓÈÎfi˜ ™˘ÓÂÚÁ¿Ù˘ Ù˘ µ' ¶·ıÔÏÔÁÈ΋˜ ∫ÏÈÓÈ΋˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ πˆ·ÓÓ›ÓˆÓ ªˆ˘Û‹˜ ∂ÏÈÛ¿Ê, ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ

£∂ƒ∞¶∂π∞ - º∞ƒª∞∫∞

17

ÀÔÏÈȉ·ÈÌÈΤ˜ Î·È ¶ÏÂÈÔÙÚÔÈΤ˜ ¢Ú¿ÛÂȘ ÙˆÓ ™Ù·ÙÈÓÒÓ ÛÙ· ∞ÁÁÂȷο ∂ÁÎÂÊ·ÏÈο ∂ÂÈÛfi‰È· £Âfi‰ˆÚÔ˜ ∏. ÃÂÈÌÒÓ·˜, ∂ȉÈ΢fiÌÂÓÔ˜ ¶·ıÔÏÔÁ›·˜, °¡ ÕÚÁÔ˘˜.

∫·Ú‰È·Î‹ ∞ÓÂ¿ÚÎÂÈ· ÁÈ· ÙÔÓ ªË ∫·Ú‰ÈÔÏfiÁÔ ÃÚ‹ÛÙÔ˜ ¶›ÙÛ·‚Ô˜ ª¤ÏÔ˜

2

22

¶··ı·Ó·Û›Ô˘ ∞ı·Ó¿ÛÈÔ˜, ∫·Ú‰ÈÔÏfiÁÔ˜-EÓÙ·ÙÈÎÔÏfiÁÔ˜ °È¿ÓÓ˘ °Ô˘‰¤‚ÂÓÔ˜ ∫·ıËÁËÙ‹˜ K·Ú‰ÈÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ

À°π∂π¡√¢π∞π∆∏∆π∏ ∞°ø°∏

26

ÕÛÎËÛË Î·È ∫·Ú‰È¿ ÃÚÈÛÙ›Ó· ÃÚ˘ÛÔ¯fiÔ˘, ÃÚ‹ÛÙÔ˜ ¶›ÙÛ·‚Ô˜, ÃÚÈÛÙfi‰Ô˘ÏÔ˜ ™ÙÂÊ·Ó¿‰Ë˜ ∞’ ¶·ÓÂÈÛÙËÌȷ΋˜ ∫·Ú‰ÈÔÏÔÁÈ΋˜ ∫ÏÈÓÈ΋˜, π°¡∞

¶POTEINOMENH BIB§IO°PAºIA

32


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IATPOI KA§§ITEXNE™

IATPOI KA§§ITEXNE™

IATPOI KA§§ITEXNE™

∆›ÙÏÔ˜ ʈÙÔÁÚ·Ê›·˜: ª¿Ó· ∆Ú·‚ËÁ̤ÓË ÛÙË µÔ˘‰·¤ÛÙË Ì ÙÔ Î·Ù·Ó˘ÎÙÈÎfi Ê˘ÛÈÎfi ʈ˜ Ô˘ ÂÈÙÚ¤ÂÈ Ë ÂÎÎÏËÛ›· ÙÔ˘ ∞Á›Ô˘ ™ÙÂÊ¿ÓÔ˘ Ó· ÊÙ¿ÛÂÈ ˆ˜ ÙËÓ ·ÈÒÓÈ· ª¿Ó·.

°∂øƒ°π√™ ∞¡¢ƒπ∫√¶√À§√™ √ °ÂÒÚÁÈÔ˜ ∞Ó‰ÚÈÎfiÔ˘ÏÔ˜ Â›Ó·È ∫·Ú‰ÈÔÏfiÁÔ˜. ∞ÔÊÔ›ÙËÛ ·fi ÙËÓ π·ÙÚÈ΋ Û¯ÔÏ‹ ∞ıËÓÒÓ ÙÔ 1990, Â›Ó·È °Ú·ÌÌ·Ù¤·˜ Ù˘ ∂ÏÏËÓÈ΋˜ ∂Ù·ÈÚ›·˜ ∫·Ú‰È·ÁÁÂȷ΋˜ ŒÚ¢ӷ˜ ÎÈ ÂÚÁ¿˙ÂÙ·È ˆ˜ ∞Ó·ÏËÚˆÙ‹˜ ¢È¢ı˘ÓÙ‹˜ ÛÙËÓ Î·Ú‰ÈÔÏÔÁÈ΋ ÎÏÈÓÈ΋ ÙÔ˘ °¡ «∂ÚÚ›ÎÔ˜ ¡Ù˘Ó¿Ó». ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÛÔ˘‰ÒÓ ÙÔ˘ ·Û¯ÔÏ‹ıËÎÂ Û˘ÛÙËÌ·ÙÈο Ì ÙË ÊˆÙÔÁÚ·Ê›· Î·È È‰È·›ÙÂÚ· Ì ٷ Ó˘¯ÙÂÚÈÓ¿ ÙÔ›· Î·È ÙȘ Ï‹„ÂȘ ÛÂ Û˘Óı‹Î˜ ¯·ÌËÏÔ‡ ʈÙÈÛÌÔ‡. £ÂˆÚ› fiÙÈ Ë ÂÓ·ÏÏ·Á‹ ÙˆÓ ÛÎÈÒÓ Û ÔÈΛϘ Û˘Óı‹Î˜ ʈÙÈÛÌÔ‡ ÌÔÚ› Ó· ÚÔÛ‰ÒÛÂÈ ÙËÓ ÚÔÛˆÈ΋ ·ÊËÁËÌ·ÙÈ΋ Ì·ÙÈ¿ ÙÔ˘ ʈÙÔÁÚ¿ÊÔ˘ ÛÙË ÊˆÙÔÁÚ·ÊÈ΋ ·ÚÔ˘Û›·ÛË ÙÔ˘ ı¤Ì·ÙÔ˜, ·ÔÁÂÈÒÓÔÓÙ¿˜ ÙÔ ·fi ÙË ÛÙ›ڷ ·ÂÈÎfiÓÈÛË Ù˘ Ú·ÁÌ·ÙÈÎfiÙËÙ·˜. ∞ÓÙ›ıÂÙ·, Ë Ù¯ÓÈ΋ ·ÚÙÈfiÙËÙ· Î·È Ë Ù‹ÚËÛË ÙˆÓ «‚·ÛÈÎÒÓ Î·ÓfiÓˆÓ» Û˘¯Ó¿ ·Ó··Ú¿ÁÂÈ ÙËÓ Ù¤ÏÂÈ· ÌÔÓÔÙÔÓ›· Ô˘ Û˘ÓÂÈÎÔ˘ÚÔ‡ÌÂÓË ·fi ÙËÓ Ù¯ÓÔÏÔÁÈ΋ ÚfiÔ‰Ô ÙˆÓ ÓÂÒÙÂÚˆÓ „ËÊÈ·ÎÒÓ DSL Ù›ÓÂÈ Ó· ‰ËÌÈÔ˘ÚÁ‹ÛÂÈ ÌÈ· ÁÂÓÈ¿ ʈÙÔÁÚ¿ÊˆÓ Ì ·ÊfiÚËÙ· ÔÌÔÈfiÌÔÚÊË ·Ú·ÁˆÁ‹. ∏ ʈÙÔÁÚ·Ê›· ·˘Ù‹ ÂÏ‹ÊıË Û ¤Ó· Tango show ÛÙÔ Buenos Aires. ªÔÏÔÓfiÙÈ ¯ÚËÛÈÌÔÔÈ‹ıËΠ¤Ó·˜ «ÛÎÔÙÂÈÓfi˜» Ê·Îfi˜ Ì f=3.5 Î·È ·Ú¿ ÙËÓ ·ÈÛıËÙ‹ ·Ô˘Û›· ÙÚ›Ô‰Ô˘ ÚԤ΢„ ¤Ó· ÂӉȷʤÚÔÓ ÊˆÙÔÁÚ·ÊÈÎfi ·ÔÙ¤ÏÂÛÌ·, Ô˘ ÚÔηÏ› ÙÔ ‚ϤÌÌ· ·Ú¿ ÙËÓ ÂÓÔ¯ÏËÙÈ΋ ·Û·ÊÔÔ›ËÛË ÙˆÓ ÂÚÈÁÚ·ÌÌ¿ÙˆÓ. ∏ ÁˆÓ›· Ï‹„ˆ˜ Î·È ÔÈ «ÛÎÏËÚ¤˜» Û˘Óı‹Î˜ ʈÙÈÛÌÔ‡ ·Ó·‰ÂÈÎÓ‡Ô˘Ó ÙÔ ¿ıÔ˜ ÙˆÓ ¯ÔÚ¢ÙÒÓ Î·È ‰È·ÛÒ˙Ô˘Ó ÌÈ· Ù¯ÓÈο ̤ÙÚÈ· ʈÙÔÁÚ·Ê›·.


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™ÂÏ›‰·1

, e Receptors ik L ll o (T ll ˘ ‡Ô˘ To ˘ÛÙ‹Ì·ÙÔ˜ Ù ˆÛ˘. ∏ Ï‹Ú Û Ú Ï‹ ‡ Î Ô Û ÈÎ Ô Ù Ú Ë ÈË ı Ô ·  ÂÈ· Ù˘ ˆÓ ÙÔ˘ ·ÓÔÛÔ ÛÙËÓ ·ıÔÁ¤Ó Ë ÂÍÂȉÈÎÂ˘Ì¤Ó ˘Í ÏÔ Ù fi  Ú √È ˘ԉԯ›˜ Ó¿ fi · ÈÎ Ó Ë ÓÙ Ù · ÙËÓ Ëı‹ÛÂÈ Û Ì·Ù›˙Ô˘Ó ÛËÌ ÌÔÚ› Ó· ‚Ô fiÏË„Ë ‹ Î·È Ú ˘˜  Ô TLRs) ‰È·‰Ú· Ó Ù Ë ˜ Ù ›· Á È· Á ÏÔ ‚¿ÛÂˆÓ ÁÈ΋ ˜ ·ıÔÊ˘ÛÈÔ ËÙÈÎÒÓ ·ÚÂÌ ∏ ÂȉËÌÈÔÏÔ ÈÙ È· ˘. ‰ ηٷÓfiËÛË ÙË Ô Û È · Ófi Î ˜ Ó ‹ fi È·ÁÁÂÈ·Î ÚÔÛÂÁÁ›Ûˆ ÚˆÛ˘ Ì ÛÎÔ ·È Ù˘ ηډ Î Ï‹ Î ˜ Û ıÂÚ·¢ÙÈÎÒÓ Ë Ô Û Ú Ë ˆ ı Ú ∞ Ï‹ Î ›· ˆ˜ ΋ ∂Ù·ÈÚ Ù˘ ·ıËÚÔÛ ÙË ‰È·ÙÚÔÊ‹ 007 Ë ∂ÏÏËÓÈ È· 2 Á Ô ·ÓÙÈÌÂÙÒÈÛË ‡ Ù Ô Ì fi  ˘Û · ı › ÏË ¤¯ÂÈ ËÓÈÎÔ‡  Ú·ÁÌ·ÙÔÔÈ ÂÚˆÙËı¤ÓÙˆÓ ‹„ÂȘ ÙÔ˘ ∂ÏÏ Ó ÈÏ ˆ ¤Ú¢ӷ Ô˘  Ù ÓÙ · ˜ È Ô · Î ¤Ú Ì ˜ ÂÁ¿ÏÔ ÙˆÓ ÙȘ ÁÓÒÛÂÈ ¤‰ÂÈÍ fiÙÈ Ì ÙËÓ ÚfiÏË„Ë ˘, ÓÔ È· Ó· ·ÔÙÈÌ‹ÛÂÈ ‡ Á ‰ ÈÓ Â› Î ˘ı ‡ Ô ÏÔ Ó· ·ÎÔ ÛÙÈ΋ ·Ú‰È·ÁÁÂÈ·Î ˜ Ô˘ Ú¤ÂÈ Ë ÛÙË ‰È·ÁÓˆ ‹ ı Ê ·Ú¿ÁÔÓÙ· Î Ô Ï¿ Ú Ù ¿ È· ÂÙ ‰ Î Ú ˜ · Ë Ù¿›ÓÔÓÙ·È ÙÔ Â›‰Ô˜ Ù ÓÈ΋ Ú¿ÍË Á È ‰›ÓÔÓÙ·È Û˘Û · ÏÈ Î Î ¿ÁÓÔÈ· ÁÈ· È Ó · Ë Ù ÓÙ ™ Ô Ê Ó. ¿ ˆ Ú Ù· ÂÚÈÁ ¿ÚÌ·ÒÓ ÓÔÛËÌ¿Ù ¿ Ù· ÛÊ¿ÏÌ· Ù›Ó˜ Â›Ó·È Ê · ˘Ù ٠ηډȷÁÁÂÈ·Î ∞ Û È Ó. √ ÈÒ . ÈÌ · ›· ÏÈȉ·ÈÌ , ÙfiÛÔ ˆÓ ‰˘ÛÏÈȉ ıÂÓÒÓ Ì ‰˘Û ‡ÓÔ˘ ÁÈ· ∞∂∂ Û ‰ · ÚÔÛ¤ÁÁÈÛË Ù ÈÓ Ó Î ˆ Ù ˘ Ô Ë Ù ÈÛ Ë Ú Û ·ÏÏ¿ Ó ÂÏ¿ÙÙˆ ˆÛÙ‹ ‰È·¯Â› ‹ ÈηÓfiÙËÙ· ËÙ¿ ÙÔ˘˜ ÛÙË Ù ÈÎ fi ÛÂȘ ÁÈ· ÙË Û ÈÌ ÈÌ · Û È‰ Ë  Ú ¯ ÏÈ Ô Ë Ù ˘ „Ë. ∏ ·Ûı·ԉ›ÍÂÈ ÂÛÌ·. ¶ÔÏÏÔ› ÂÚÔÁÂÓ‹ ÚfiÏË Ù ¤Ï η Ô˘ ¤¯Ô˘Ó Ù Â˘ Ô ‰  · Ë Ù fi Û ÈÎ È · ·ÎfiÌË Ô Â˘ÂÚÁÂÙ ÂÓ‹ fiÛÔ Î ÎÏÈÓÈΤ˜ Î·È ˘Ì‚¿ÏÏÔ˘Ó ÛÙ Û ÛÙËÓ ÚˆÙÔÁ ¤˜ Ó ˆ ÈÎ Ù Á ˜ ÏÔ ÂÈ Û ÈÔ ‰ ¿ ÛÂ Î·Ú ÏÈÓÈÎÔ‡ ÚÔÈΤ˜ ‰Ú ÓÔÛËχÔÓÙ·È ÓfiËÛË ÙÔ˘ Î · Î·È ÔÈ ÏÂÈÔÙ ÂÓ Ù ‰ · Î · ∏ ÂÈ Î . Ú ˘˜ ¿ ÙËÌ·‰ÈÔÏfiÁÔ È·Î‹ ·ÓÂ ·È ·fi Î·Ú ÈÛË ÙÔ˘. ∏ Û˘Û Ó›˜ Ì ηډ  ÓÙ ‡ Ò Ô ÂÙ ˘ı ÈÌ ÏÔ ÓÙ Ô · Î · ‰ÂÓ ·Ú  Ì›ˆÛÙËÓ Î·Ï‹ ÔÓÙ· ÁÈ·ÙÚfi ˘ÓÔ, Ô‰ËÁ› Û ÂÚÈÛÛfiÙÂÚÔÈ  ‰ ¿ ›Ó Î ÂÚ ı fi Î Ó · Ô Ù ÂÈ Á ‰È¿ÚηډȷÁ ‚ÔËı‹ÛÂÈ Â‚‰ÔÌ·‰È·›ˆ˜ Ì ‰Â‰Ô̤ÓÔ Û˘Ó‰ÚfiÌÔ˘ ı· · ¤˜ Ì Ú Ô Ô Ù Ê ¿ 5 Â Û Â È Ì · ·ÎfiÌ· Î ÕÛÎËÛË 4 ıÓËÙfiÙËÙ·˜. ÙÈ΋ ¿ÛÎËÛË ˜ ‹ Î · ÂÈ Á Á È· fiÙËÙ·˜. Ù˘ ηډ ˆÛË Ù˘ ıÓËÙ ÛË Î·Ù¿ 50% › Ì Â Ì È · ÂÙ ÒÓ Û¯ÂÙ›˙ ÎÂÈ·˜ 30 ÏÂÙ

˘ T˘ ™‡ÓÙ·Í

·˜ ∏Ï›·˜ ÃÂÈÌÒÓ ÓÙ·Í˘ Y‡ı˘ÓÔ˜ ™‡

EΉ›‰ÂÙ·È Ì ÙËÓ Â˘ÁÂÓÈ΋ ¯ÔÚËÁ›· Ù˘ 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›·.

π∞∆ƒπ∫∂™ ∂∫¢√™∂π™


ATHIROSK 21-

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ª ∞ ƒ ∆ π √ ™

™ÂÏ›‰·2

2 0 0 9

√È Àԉԯ›˜ ∆‡Ô˘ Toll (Toll-like receptors) Î·È Ô ƒfiÏÔ˜ ÙÔ˘˜ ÛÙËÓ ∞ıËÚÔÛÎÏ‹ÚˆÛË ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ Ã. ∆¤ÏÏ˘, ∞ϤͷӉÚÔ˜ ¢. ∆ÛÂϤ˘ ∂ÚÁ·ÛÙ‹ÚÈÔ µÈÔ¯ËÌ›·˜, ∆Ì‹Ì· ÃËÌ›·˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ,

∂ÈÛ·ÁˆÁ‹ ∏ ·ıËÚÔÛÎÏ‹ÚˆÛË Â›Ó·È ¯ÚfiÓÈ· ÊÏÂÁÌÔÓ҉˘ ÓfiÛÔ˜ ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ ÙˆÓ ·ÚÙËÚÈÒÓ. ¶ÔÏϤ˜ ÌÂϤÙ˜ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ˘¿Ú¯ÂÈ ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ‰È·ÌÂÛÔÏ·‚ËÙÒÓ Ù˘ ÊÏÂÁÌÔÓ‹˜ fiˆ˜ Ë C-·ÓÙȉÚÒÛ· ÚˆÙ½ÓË (CRP), Ë ÈÓÙÂÚÏ¢ΛÓË-6 (IL-6), Ù· ‰È·Ï˘Ù¿ ÌfiÚÈ· ÚÔÛÎfiÏÏËÛ˘ (ICAM-1, VCAM-1), Ô ·Ú¿ÁÔÓÙ·˜ Ó¤ÎÚˆÛ˘ fiÁÎˆÓ (TNF-a), Ë E-ÛÂÏÂÎÙ›ÓË, ÎÏ, Î·È ÙÔ˘ ·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ·ıËÚÔÛÎÏ‹ÚˆÛË Î·È Î·Ú‰È·ÁÁÂȷ΋ ÓfiÛÔ. ∆Ô Ï‹Ú˜ Ê¿ÛÌ· fï˜ ÙˆÓ ÊÏÂÁÌÔÓˆ‰ÒÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ÂÌϤÎÔÓÙ·È ÛÙ· ‰È¿ÊÔÚ· ÛÙ¿‰È· ·Ó¿Ù˘Í˘ Ù˘ ·ıËڈ̷ÙÈ΋˜ Ͽη˜ ‚Ú›ÛÎÂÙ·È ·ÎfiÌ· ˘fi ‰ÈÂÚ‡ÓËÛË. ¶ÚÔ˜ ÙËÓ Î·Ù‡ı˘ÓÛË ·˘Ù‹, ¤Ó· Ó¤Ô ÂÚ¢ÓËÙÈÎfi ‰›Ô ·ÓÔ›¯ıËΠÚfiÛÊ·Ù·, Ì ÙËÓ ·Ó·Î¿Ï˘„Ë fiÙÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ·Ó¿Ù˘ÍË Ù˘ ·ıËÚÔÛÎÏ‹ÚˆÛ˘ ‰È·‰Ú·Ì·Ù›˙Ô˘Ó ÔÈ ˘ԉԯ›˜ ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Ù‡Ô˘ Toll (Toll-Like Receptors, TLRs). √È ˘ԉԯ›˜ TLRs ¤ÁÈÓ·Ó ·Ú¯Èο ÁÓˆÛÙÔ› ˆ˜ ÔÈ “·ÈÛıËÙ‹Ú˜” ÙÔ˘ ¤ÌÊ˘ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÁÈ· ÙËÓ ·Ó·ÁÓÒÚÈÛË ·ıÔÁfiÓˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ, Ô‰ËÁÒÓÙ·˜ ÛÙË Û˘Ó¤¯ÂÈ· ÛÙËÓ ·ÓÔÛÔÏÔÁÈ΋ ·¿ÓÙËÛË ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ ηٿ ÙˆÓ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ. √È ∆LRs ÂÌÊ·Ó›˙ÔÓÙ·È Û ‰È¿ÊÔÚ· ·ÙÙ·Ú· fiˆ˜ ÂÈıËÏȷο ·ÙÙ·Ú·, ¡∫ ·ÙÙ·Ú·, ‰ÂÓ‰ÚÈÙÈο ·ÙÙ·Ú·, Ú˘ıÌÈÛÙÈο ∆ ÏÂÌÊÔ·ÙÙ·Ú·, ÌÔÓÔ·ÙÙ·Ú·, Ì·ÎÚÔÊ¿Á·, Ô˘‰ÂÙÂÚfiÊÈÏ·, ‚·ÛÂfiÊÈÏ·, ÂÓ‰ÔıËÏȷο ·ÙÙ·Ú·, ÎÏ [ 1]. ∏ ÔÓÔÌ·Û›· ÙˆÓ TLRs ÙˆÓ ıËÏ·ÛÙÈÎÒÓ ÚÔ¤Ú¯ÂÙ·È ·fi ÙËÓ ÚˆÙ½ÓË Toll Ù˘ Drosophila, Ì ÙËÓ ÔÔ›· ÂÌÊ·Ó›˙Ô˘Ó ÛËÌ·ÓÙÈΤ˜ ‰ÔÌÈΤ˜ ÔÌÔÈfiÙËÙ˜ [2]. ¢ÂηÙÚ›˜ ˘ԉԯ›˜ TLR ΢ÙÙ¿ÚˆÓ ıËÏ·ÛÙÈÎÒÓ ¤¯Ô˘Ó Ù·˘ÙÔÔÈËı› ̤¯ÚÈ Û‹ÌÂÚ·, ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ ÔÈ 11 ÂÎÊÚ¿˙ÔÓÙ·È Û ·ÓıÚÒÈÓ· ·ÙÙ·Ú· [3]. √È ∆LR -1, -2, -4, -5 Î·È -6 ÂÓÙÔ›˙ÔÓÙ·È

2

ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÂÓÒ ÔÈ -3, -7, -8 Î·È -9 Â›Ó·È ÂÓ‰Ô΢ÙÙ¿ÚÈÔÈ (™¯‹Ì·1).

¢ÔÌÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ TLRs √È TLRs Â›Ó·È ‰È·ÌÂÌ‚Ú·ÓÈΤ˜ ÁÏ˘ÎÔÚˆÙ½Ó˜ ÔÈ Ôԛ˜ ·Ó‹ÎÔ˘Ó ÛÙËÓ ˘ÂÚÔÈÎÔÁ¤ÓÂÈ· ÙˆÓ ˘Ô‰Ô¯¤ˆÓ Ù˘ ÈÓÙÂÚÏ¢ΛÓ˘-1 (IL-1Rs), ηıÒ˜ ÙÔ Î˘ÙÙ·ÚÔÏ·ÛÌ·ÙÈÎfi ÙÌ‹Ì· ÙˆÓ TLRs ¤¯ÂÈ ÙËÓ ›‰È· ÔÌÔÏÔÁ›· Ì ·˘Ù‹ ÙˆÓ IL-1Rs Î·È ÔÓÔÌ¿˙ÂÙ·È ∆Ôll/πÓÙÂÚÏ¢ΛÓË-1 (∆πR). ∆Ô Î˘ÙÙ·ÚÔÏ·ÛÌ·ÙÈÎfi ÙÌ‹Ì· TIR ·ÔÙÂÏÂ›Ù·È ·fi ÙÚÂȘ ÂÚÈÔ¯¤˜ (boxes,) ÔÈ Ôԛ˜ ·›˙Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙË ÌÂÙ¿‰ÔÛË ÙÔ˘ ÂÓ‰Ô΢ÙÙ¿ÚÈÔ˘ Û‹Ì·ÙÔ˜. ∆Ô ÂÍˆÎ˘ÙÙ¿ÚÈÔ ÙÌ‹Ì· ÙˆÓ TLRs ‰È·Ê¤ÚÂÈ ÛËÌ·ÓÙÈο ·fi ·˘Ùfi ÙˆÓ IL1Rs ηıÒ˜ Ë ·ÌÈÓÔÍÈ΋ ·ÏÏËÏÔ˘¯›· ÙÔ˘˜ ·ÔÙÂÏÂ›Ù·È ·fi ¤Ó· Â·Ó·Ï·Ì‚·ÓfiÌÂÓÔ ÌÔÙ›‚Ô ÏÔ‡ÛÈÔ Û Ï¢ΛÓË (Leucine-Rich

Repeat, LRR) [4]. ∞Ó·Ï˘ÙÈÎfiÙÂÚ·, ÙÔ ÌÔÙ›‚Ô LRR ÂÚȤ¯ÂÈ 24 - 29 ·ÌÈÓÔͤ· Ù˘ ÌÔÚÊ‹˜ XLXXLXLXX (L = Ï¢ΛÓË Î·È Ã = ·ÌÈÓÔ͇) ÙÔ ÔÔ›Ô ·Ó¿ÏÔÁ· Ì ÙÔÓ TLR ˘Ô‰Ô¯¤· Â·Ó·Ï·Ì‚¿ÓÂÙ·È 19 - 25 ÊÔÚ¤˜. ŒÙÛÈ ÏÔÈfiÓ, οı TLRs ·Ó¿ÏÔÁ· Ì ÙÔ Â·Ó·Ï·Ì‚·ÓfiÌÂÓÔ ÌÔÙ›‚Ô Ô˘ ÂÚȤ¯ÂÈ, ÂÍÂȉÈ·ÂÙ·È ÛÙËÓ ·Ó·ÁÓÒÚÈÛË ÂȉÈÎÒÓ ÌÔÚ›ˆÓ (ÚÔÛ‰ÂÌ¿ÙˆÓ). ∆· ÚÔÛ‰¤Ì·Ù· ·˘Ù¿ ÔÓÔÌ¿˙ÔÓÙ·È ÌÔÚȷο ÚfiÙ˘· ÙˆÓ ·ıÔÁfiÓˆÓ (Pathogen-Associated Molecular Patterns (PAMPs) [5], [6], [7]. √È TLRs ¤¯Ô˘Ó ÔÌ·‰ÔÔÈËı› Û‡Ìʈӷ Ì ÙÔ Â›‰Ô˜ ÙˆÓ ÚÔÛ‰ÂÌ¿ÙˆÓ Ô˘ ·˘ÙÔ› ·Ó·ÁÓˆÚ›˙Ô˘Ó. √ TLR-2, ·Ó·ÁÓˆÚ›˙ÂÈ ÏÈÔÂÙ›‰È· ÙÔ˘ ΢ÙÙ·ÚÈÎÔ‡ ÙÔȯÒÌ·ÙÔ˜ ÙˆÓ Gram (+) Î·È Gram (-) ‚·ÎÙËÚ›ˆÓ, Ì˘ÎÔ‚·ÎÙ‹ÚÈ·, ̇ÎËÙ˜, ·Ú¿ÛÈÙ· Î·È ÈÔ‡˜. √ TLR-4 ·Ó·ÁÓˆÚ›˙ÂÈ ÂȉÈο Û˘ÛÙ·ÙÈο ÙˆÓ Gram (-) ‚·ÎÙËÚ›ˆÓ (ÏÈÔÔÏ˘Û·Î¯·Ú›Ù˘ LPS). √È TLR -3, -7, -8

™¯‹Ì· 1. O ΢ÙÙ·ÚÈÎfi˜ ÂÓÙÔÈÛÌfi˜ ÙˆÓ TLRs, Ù· ÚÔÛ‰¤Ì·Ù¿ ÙÔ˘˜ ηıÒ˜ Î·È Ô Û¯ËÌ·ÙÈÛÌfi˜ ÚÔÊÏÂÁÌÔÓˆ‰ÒÓ ·Ú·ÁfiÓÙˆÓ ‰È·Ì¤ÛÔ˘ Ù˘ ÂÓ‰Ô΢ÙÙ¿ÚÈ·˜ ÌÂÙ·ÁˆÁ‹˜ Û‹Ì·ÙÔ˜ ηٿ ÙË ‰È¤ÁÂÚÛË ÙˆÓ TLRs (Abbas A.K., et al. Cellular and Molecular Immunology, 6th Edition).


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™ÂÏ›‰·3

¶∞£√ºÀ™π√§√°π∞ Î·È -9, fiˆ˜ ·Ó·Ê¤Ú·Ì ÂÓÙÔ›˙ÔÓÙ·È ÂÓ‰Ô΢ÙÙ¿ÚÈ· Î·È ·Ó·ÁÓˆÚ›˙Ô˘Ó ÈÈο Î·È ‚·ÎÙËÚȷο ÓÔ˘ÎÏÂ˚ÓÈο Ôͤ·. ∆Ô ‰›ÎψÓÔ dsRNA ·Ó·ÁÓˆÚ›˙ÂÙ·È ·fi ÙÔÓ TLR-3 ÂÓÒ Ô ∆LR-9 ·Ó·ÁÓˆÚ›˙ÂÈ ‚·ÎÙËÚÈ·Îfi DNA (CpG DNA). ∆¤ÏÔ˜, ÔÈ ∆LR-5 Î·È TLR-11 ·Ó·ÁÓˆÚ›˙Ô˘Ó ÚˆÙ½Ó˜ ·ıÔÁfiÓˆÓ [4] (™¯‹Ì· 1).

ªÂÙ·ÁˆÁ‹ Û‹Ì·ÙÔ˜ ‰È·Ì¤ÛÔ˘ ÙˆÓ TLRs ¢‡Ô Â›Ó·È ÔÈ Î‡ÚȘ ÔÚ›˜ ÌÂÙ¿‰ÔÛ˘ Û‹Ì·ÙÔ˜ ‰È·Ì¤ÛÔ˘ ÙˆÓ TLRs. ∏ ÌÈ· ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ÚˆÙ½ÓË 88 ÙˆÓ ‰È·ÊÔÚÔÔÈËÌ¤ÓˆÓ Ì˘ÂÏÈÎÒÓ Î˘ÙÙ¿ÚˆÓ (MyD88), ÂÓÒ Ë ¿ÏÏË ÔÚ›· Â›Ó·È ·ÓÂÍ¿ÚÙËÙË Ù˘ MyD88. ∏ ‰È¤ÁÂÚÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ ‰È·Ì¤ÛÔ˘ Ù˘ MyD88 ÂÍ·ÚÙÒÌÂÓ˘ ÔÚ›·˜, Ô‰ËÁ› ÛÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘ ·Ú¿ÁÔÓÙ· NF-΂, Ë ÔÔ›· ηٷϋÁÂÈ ÛÙË ÁÔÓȉȷ΋ ¤ÎÊÚ·ÛË Î·È ·Ú·ÁˆÁ‹ ÙˆÓ ÚÔÊÏÂÁÌÔÓˆ‰ÒÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ fiˆ˜ TNF-·, IL-1, IL-6 Î·È Ù˘ ¯ËÌÂÈÔΛÓ˘ IL-8 [8]. ∏ ·ÓˆÙ¤Úˆ ÔÚ›· ÂÓÂÚÁÔÔ›ËÛ˘ ·ÊÔÚ¿ fiÏÔ˘˜ ÙÔ˘˜ TLRs ÂÎÙfi˜ ·fi ÙÔÓ TLR-3. ∏ ·ÓÂÍ¿ÚÙËÙË ·fi ÙËÓ MyD88 ÔÚ›· ÌÂÙ¿‰ÔÛ˘ Û‹Ì·ÙÔ˜ ÂÓÂÚÁÔÔÈ› ÙÔ Ú˘ıÌÈÛÙÈÎfi ·Ú¿ÁÔÓÙ· ÙˆÓ ÈÓÙÂÚÊÂÚÔÓÒÓ (IFN-regulatory factor, IRF3), Ô‰ËÁÒÓÙ·˜ ÛÙËÓ ¤ÎÊÚ·ÛË ÙˆÓ ÁÔÓȉ›ˆÓ ÙˆÓ ÈÓÙÂÚÊÂÚÔÓÒÓ (IFN) [4]. (™¯‹Ì· 2) [4].

ŒÎÊÚ·ÛË ÙˆÓ TLRs ÛÙËÓ ·ıËڈ̷ÙÈ΋ Ͽη √È ˘ԉԯ›˜ TLR Ô˘ ÂÎÊÚ¿˙ÔÓÙ·È ÛÙËÓ ·ıËڈ̷ÙÈ΋ Ͽη Â›Ó·È ÔÈ TLR-1, -2, -4, -5 Î·È -6. √È ˘ԉԯ›˜ ·˘ÙÔ› Â›Ó·È ˘ÂÚÂÎÊÚ·Ṳ̂ÓÔÈ ÛÙÔ ·ıËڈ̷ÙÈÎfi ÛÂ

™¯‹Ì· 2. ∏ ÂÓ‰Ô΢ÙÙ¿ÚÈ· ÌÂÙ·ÁˆÁ‹ Û‹Ì·ÙÔ˜ ηٿ ÙË ‰È¤ÁÂÚÛË ÙˆÓ TLRs (Akira S, et al. Immunology, 4: 499-511, 2004).

Û¯¤ÛË Ì ÙÔ ˘ÁȤ˜ ·ÚÙËÚÈ·Îfi ÙÔ›¯ˆÌ· Î·È Ì¿ÏÈÛÙ· Ë ˘ÂÚ¤ÎÊÚ·ÛË ·˘Ù‹ Û˘Óԉ‡ÂÙ·È ·fi ·˘ÍË̤ÓË ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ÚˆÙÂ˚ÓÒÓ Ô˘ Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ ÂÓ‰Ô΢ÙÙ¿ÚÈ· ÛËÌ·ÙÔ‰fiÙËÛË Î·È ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ ‰È·Ì¤ÛÔ˘ ÙˆÓ TLRs, fiˆ˜ Â›Ó·È Ô NF-΂ [9],[10],[11]. ∏ ˘ÂÚ¤ÎÊÚ·ÛË ÙˆÓ TLRs ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ·ıËڈ̷ÙÈ΋˜ Ͽη˜, ÂÓÙÔ›˙ÂÙ·È Î˘Ú›ˆ˜ ÛÙ· ÂÓ‰ÔıËÏȷο ·ÙÙ·Ú· Î·È ÛÙ· Ì·ÎÚÔÊ¿Á·. ™Â ÂÚÈÔ¯¤˜ ÌÂȈ̤Ó˘ ÚÔ‹˜ ·›Ì·ÙÔ˜, fiÔ˘ ˘¿Ú¯ÂÈ

ÚԉȿıÂÛË ÁÈ· ·Ó¿Ù˘ÍË ·ıËڈ̷ÙÈ΋˜ Ͽη˜, Ë ÂÓ‰ÔıËÏȷ΋ ¤ÎÊÚ·ÛË ÙÔ˘ TLR-2 Â›Ó·È È‰È·›ÙÂÚ· ·˘ÍË̤ÓË, Ô˘ ‰Â›¯ÓÂÈ fiÙÈ Ù· ·ÙÙ·Ú· ·˘Ù¿ Â›Ó·È Â˘·›ÛıËÙ· ÛÙËÓ Â›‰Ú·ÛË ÙˆÓ ÌÔÚÈ·ÎÒÓ ÚÔÙ‡ˆÓ ÙˆÓ ·ıÔÁfiÓˆÓ ‚·ÎÙËÚ›ˆÓ (PAMPs). ∞˘ÍË̤ÓË ¤ÎÊÚ·ÛË ÙÔ˘ TLR-4 ÛÙ· ÌÔÓÔ·ÙÙ·Ú· ÙÔ˘ ·›Ì·ÙÔ˜ ¤¯ÂÈ Â›Û˘ ·Ó·ÊÂÚı› Û ·ÛıÂÓ›˜ Ì ÛÙ·ıÂÚ‹ ÛÙËı¿Á¯Ë ‹ Ô͇ ÛÙÂÊ·ÓÈ·›Ô Û‡Ó‰ÚÔÌÔ [12].

¶›Ó·Î·˜ 1. ƒfiÏÔ˜ ÙˆÓ ÌÔÚÈ·ÎÒÓ ÚÔÙ‡ˆÓ ÙˆÓ ·ıÔÁfiÓˆÓ (PAMPs) Î·È ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ ˘Ô‰Ô¯¤ˆÓ TLRs ÛÙËÓ ·ıËÚÔÁ¤ÓÂÛË PAMPs

ÀÔ‰Ô¯¤·˜

ƒfiÏÔ˜ ÛÙËÓ ·ıËÚÔÁ¤ÓÂÛË

¢È/ÙÚÈ-·Î˘ÏÔÏÈÔÂÙ›‰ÈÔ

TLR-2/1/6

¶ÚÔ¿ÁÂÈ ÙÔ Û¯ËÌ·ÙÈÛÌfi ·ÊÚˆ‰ÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ÂÓÂÚÁÔÔÈ› Ù· ÌÔÓÔ·ÙÙ·Ú· Î·È Ù· ÂÓ‰ÔıËÏȷο ·ÙÙ·Ú· (Cao et al. 2007, Dunzendorfer et al. 2004)

dsRNA

TLR-3

¶ÚÔ¿ÁÂÈ ÙÔ Û¯ËÌ·ÙÈÛÌfi ·ÊÚˆ‰ÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ÂÓÂÚÁÔÔÈ› Ù· ÌÔÓÔ·ÙÙ·Ú· Î·È ÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙˆÓ Ï›ˆÓ Ì˘ÈÎÒÓ Î˘ÙÙ¿ÚˆÓ. (Castrillo et al. 2003, Takeda and Akira 2004)

LPS

TLR-4

¶ÚÔ¿ÁÂÈ ÙÔ Û¯ËÌ·ÙÈÛÌfi ·ÊÚˆ‰ÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ÂÓÂÚÁÔÔÈ› Ù· ÌÔÓÔ·ÙÙ·Ú· Î·È Ù· ÂÓ‰ÔıËÏȷο ·ÙÙ·Ú· (Castrillo et al. 2003, Rice et al. 2003, Juvonen et al 1997)

ºÏ·ÁÂÏ›ÓË

TLR-5

∂ÓÂÚÁÔÔÈ› Ù· ÌÔÓÔ·ÙÙ·Ú· Î·È Ù· ÂÓ‰ÔıËÏȷο ·ÙÙ·Ú· (Takeda and Akira 2004)

πÈÎfi ssRNA

TLR-7/8

∂ÓÂÚÁÔÔÈ› Ù· ÌÔÓÔ·ÙÙ·Ú· Î·È Ù· ÂÓ‰ÔıËÏȷο ·ÙÙ·Ú· (Takeda and Akira 2004)

CpG DNA

TLR-9

BÚ›ÛÎÂÙ·È ÛÙÔ ·ÓıÚÒÈÓÔ ·ı‹ÚˆÌ· (Ott et al. 2006)

¶ÂÙȉÔÁÏ˘Î¿Ó˜

TLR-1/2

¶ÚÔ¿ÁÔ˘Ó ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ÌÔÓÔ΢ÙÙ¿ÚˆÓ, ‚Ú›ÛÎÔÓÙ·È ÛÙÔ ·ÓıÚÒÈÓÔ ·ı‹ÚˆÌ· Î·È Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ʷÈÓfiÙ˘Ô ·ÛÙ·ıÔ‡˜ Ͽη˜ Laman et al. 2002

3


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ª ∞ ƒ ∆ π √ ™

™ÂÏ›‰·4

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ªÂϤÙ˜ Û ‰È·ÁÔÓȉȷο ÂÈÚ·Ì·Ùfi˙ˆ· ªÂϤÙ˜ Û ‰È¿ÊÔÚ· ÌÔÓ٤Ϸ ‰È·ÁÔÓȉȷÎÒÓ ÔÓÙÈÎÒÓ ¤‰ÂÈÍ·Ó fiÙÈ Ë ÂÍ·ÚÙÒÌÂÓË ·fi ÙËÓ MyD88 ÔÚ›· ÂÓÂÚÁÔÔ›ËÛ˘ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ‰È·Ì¤ÛÔ˘ ÙˆÓ TLRs, ‰È·‰Ú·Ì·Ù›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ·Ó¿Ù˘ÍË Ù˘ ·ıËÚÔÛÎÏ‹ÚˆÛ˘. ŒÙÛÈ, Û apoE Î·È MyD88 ‰ÈÏ¿ ∫/√ ÔÓÙ›ÎÈ·, ·Ú·ÙËÚ‹ıËΠ̛ˆÛË Ù˘ ·ıËڈ̷ÙÈ΋˜ ‚Ï¿‚˘ ηٿ 60% [13], Ì›ˆÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Ì·ÎÚÔÊ¿ÁˆÓ Ù˘ Ͽη˜ Î·È ¯·ÌËÏ¿ Â›‰· MCP-1 ÛÙËÓ Î˘ÎÏÔÊÔÚ›· ÙÔ˘ ·›Ì·ÙÔ˜. ∂›Û˘, ¿ÏÏË ÌÂϤÙË ¤‰ÂÈÍ fiÙÈ Û TLR-4 ∫/√ ηıÒ˜ Î·È Û TLR-2 ∫/√ ÔÓÙ›ÎÈ· Ô‰‹ÁËÛ Û Ì›ˆÛË Ù˘ ·ıËڈ̿وÛ˘ Ù˘ ·ÔÚÙ‹˜ ηٿ ÂÚ›Ô˘ 30% ‹ 60% ·ÓÙ›ÛÙÔȯ· [14]. ∞ÓÙ›ıÂÙ·, ÛÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘, ·Ú·ÙËÚ‹ıËΠfiÙÈ Ë Â·Ó·Ï·Ì‚·ÓfiÌÂÓË ¯ÔÚ‹ÁËÛË LPS (ÚfiÛ‰ÂÌ· ÙÔ˘ TLR-4) Î·È Pam3CSK4 (ÚfiÛ‰ÂÌ· ÙÔ˘ TLR-2) ·ÓÙ›ÛÙÔȯ· ›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂÈÙ¿¯˘ÓÛË Ù˘ ·Ó¿Ù˘Í˘ Ù˘ ·ıËڈ̷ÙÈ΋˜ Ͽη˜. ∂ÈϤÔÓ, Ù· TLR-4 ∫/√ ÔÓÙ›ÎÈ· ÂÌÊ¿ÓÈÛ·Ó ÏÈÁfiÙÂÚÔ ÏÈÒ‰Ë ÈÛÙfi Î·È ÈÔ ÈÛ¯˘Úfi ÛÎÂÏÂÙfi Û ۯ¤ÛË Ì ٷ ·ÁÚ›Ô˘ Ù‡Ô˘ ÔÓÙ›ÎÈ· [15]. ∂›Û˘ ¤¯ÂÈ ‰Âȯı› fiÙÈ Ù· TLR-2 Î·È LDL-R ‰ÈÏ¿ ∫/√ ÔÓÙ›ÎÈ·, ·Ó¤Ù˘Í·Ó ÌÈÎÚfiÙÂÚË ‚Ï¿‚Ë ·fi fi,ÙÈ Ù· Ê˘ÛÈÔÏÔÁÈο ÔÓÙ›ÎÈ·. ∂ÈϤÔÓ, Ë ˘ÂÚÏÈȉ·ÈÌ›· ÂÓÂÚÁÔÔÈ› ÙËÓ MyD88 ÔÚ›·, ÂÓÒ Ë ·Ô˘Û›· Ù˘ MyD88 ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙË Ì›ˆÛË Ù˘

ÚÔÛÎfiÏÏËÛ˘ ÙˆÓ Ï¢ÎÔ΢ÙÙ¿ÚˆÓ ÛÙÔ ÂÓ‰Ôı‹ÏÈÔ Ô˘ ÚÔηÏ› Ë ÔÍÂȉˆÌ¤ÓË LDL. ∞fi Ù· ·Ú·¿Óˆ ·ÔÙÂϤÛÌ·Ù· Ê·›ÓÂÙ·È fiÙÈ Ë ÂÍ·ÚÙÒÌÂÓË ·fi MyD88 ÔÚ›· ΢ÙÙ·ÚÈ΋˜ ÂÓÂÚÁÔÔ›ËÛ˘ ‰È·Ì¤ÛÔ˘ ÙˆÓ TLRs ‰È·‰Ú·Ì·Ù›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË. ™˘ÓÂÒ˜, ÔÈ ˘ԉԯ›˜ ÙÔ˘ ¤ÌÊ˘ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ TLR-2 Î·È TLR-4, ηıÒ˜ Î·È Ë ÂÍ·ÚÙÒÌÂÓË ·fi ÙËÓ MyD88 ÔÚ›· ÂÓÂÚÁÔÔ›ËÛ˘ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ‰È·‰Ú·Ì·Ù›˙Ô˘Ó ÛËÌ·ÓÙÈÎfi ·ıËÚÔÁfiÓÔ ÚfiÏÔ, ÚÔ¿ÁÔÓÙ·˜ ÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË [16].

H Û˘Ì‚ÔÏ‹ ÙˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ ÛÙËÓ ·Ó¿Ù˘ÍË Ù˘ ·ıËڈ̷ÙÈ΋˜ Ͽη˜ ∏ ȉ¤· fiÙÈ ÔÈ ÌÔÏ˘ÛÌ·ÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ Û˘ÓÂÈÛʤÚÔ˘Ó ÛËÌ·ÓÙÈο ÛÙȘ ηډÈÔ·ÁÁÂȷΤ˜ ·ı‹ÛÂȘ ÂÏ‹ÊıË ÛÔ‚·Ú¿ ˘fi„Ë ÌÂÙ¿ ÙÔ 1988 fiÙ·Ó ÔÈ Saikku et al. [17] ·ÚÔ˘Û›·Û·Ó ‰Â‰Ô̤ӷ Ô˘ Û˘Ó‰¤Ô˘Ó ÙË ÌfiÏ˘ÓÛË ·fi ÙÔ Clamydia pneumoniae, Û 70 ¿Ó‰Ú˜ ·ÛıÂÓ›˜, Ì ¤ÌÊÚ·ÁÌ· Ì˘Ôηډ›Ô˘ Î·È ¯ÚfiÓÈ· ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ. ∏ ÌÂϤÙË ·˘Ù‹ ÂȂ‚·ÈÒıËÎÂ Î·È Ì ÂfiÌÂÓ˜ ÂÚÁ·Û›Â˜ [18]. πÛÙÔÏÔÁÈΤ˜ Î·È ÌÔÚȷΤ˜ ÌÂϤÙ˜ ÂȂ‚·›ˆÛ·Ó fiÙÈ ÙÔ Clamydia pneumoniae, Û˘ÓÂÈÛʤÚÂÈ ÛËÌ·ÓÙÈο ÛÙËÓ ·Ó¿Ù˘ÍË Ù˘ ·ıËڈ̷ÙÈ΋˜ Ͽη˜, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ËÏÈΛ·. ™‹ÌÂÚ·, ¤Ó·˜ ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ·fi ÌÔÏ˘ÛÌ·ÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ¤¯ÂÈ

Û˘Û¯ÂÙÈÛÙ› Ì ÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË fiˆ˜ ÙÔ ÂÏÈÎÔ‚·ÎÙËÚ›‰ÈÔ ÙÔ˘ ˘ÏˆÚÔ‡, Ô Î˘ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi˜ (CMV), Ô Èfi˜ Ù˘ ÏÔÈÌÒ‰Ô˘˜ ÌÔÓÔ˘Ú‹ÓˆÛ˘ Epstein Barr Virus (EBV), Ô Èfi˜ Ù˘ ·ÓıÚÒÈÓ˘ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜ (HIV), Ô Èfi˜ ÙÔ˘ ¤ÚËÙ· 1 (HSV1) Î·È 2, (HSV2), ÔÈ ÈÔ› Ù˘ Ë·Ù›Ùȉ·˜ B, Î·È C, ÎÏ.

∏ Â›‰Ú·ÛË ÙˆÓ Â͈ÁÂÓÒÓ ÚÔÛ‰ÂÌ¿ÙˆÓ ÙˆÓ TLRs ÛÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË ∏ ¿Ô„Ë fiÙÈ Ë ÌfiÏ˘ÓÛË ÚÔ¿ÁÂÈ ÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË ¤¯ÂÈ ˘ÔÛÙËÚȯı› ·fi ÌÂÁ¿Ï˜ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ [19]. ∏ ·Ó›¯Ó¢ÛË ‚·ÎÙËÚ›ˆÓ Û ·ıËڈ̷ÙÈΤ˜ ϿΘ, Ô‰‹ÁËÛ·Ó ÛÙËÓ ˘fiıÂÛË fiÙÈ Ë ‚·ÎÙËÚȷ΋ ÌfiÏ˘ÓÛË Ô˘ ÚÔ¤Ú¯ÂÙ·È ·fi ‚·ÎÙËÚȷΤ˜ ·ÔÈ˘ Ô˘ ·Ó·Ù‡ÛÛÔÓÙ·È ÛÙÔ ·ÚÙËÚÈ·Îfi ÙÔ›¯ˆÌ·, ÚÔ¿ÁÔ˘Ó ÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË [20]. ¶·ÚfiÏ· ·˘Ù¿, ÌÂϤÙ˜ ÛÙȘ Ôԛ˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ·ÓÙÈ‚ÈÔÙÈο ‰ÂÓ Â›¯·Ó ıÂÙÈο ·ÔÙÂϤÛÌ·Ù· ˆ˜ ÚÔ˜ ÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË. ™˘ÓÂÒ˜ Ë ˘fiıÂÛË ÁÈ· ÙÔ ÚfiÏÔ ÙˆÓ ‚·ÎÙËÚ›ˆÓ ÛÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË ÂÛÙÈ¿ÛÙËΠÛÙË ‰È·ÌÂÛÔÏ¿‚ËÛË ÙˆÓ PAMPs Î·È fi¯È ÛÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ ÛÙËÓ ·ıËڈ̷ÙÈ΋ Ͽη. ™‡Ìʈӷ Ì ÙËÓ ˘fiıÂÛË ·˘Ù‹, Ù· PAMPs, ·Ú¿ ÙËÓ Î·Ù·ÛÙÚÔÊ‹ ÙˆÓ ‚·ÎÙËÚ›ˆÓ ·fi Ù· ·ÓÙÈ‚ÈÔÙÈο, ÌÔÚÔ‡Ó Ó· ·ÂÏ¢ıÂÚˆıÔ‡Ó ·fi ¿ÏÏÔ˘˜ ·ÓıÂÎÙÈÎÔ‡˜, ‚ÈÒÛÈ-

™¯‹Ì· 4. √ ÚfiÏÔ˜ ÙˆÓ PAMPs ÛÙËÓ ·ıËÚÔÁ¤ÓÂÛË (Erridge C. Trends Cardiovasc Med, 18:52-56, 2008)

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ATHIROSK 21-

05-03-09

12:25

™ÂÏ›‰·5

¶∞£√ºÀ™π√§√°π∞ ÌÔ˘˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜. ™‡Ìʈӷ Ì ÙȘ ̤¯ÚÈ Û‹ÌÂÚ· ÌÂϤÙ˜, Ù· PAMPs ÚÔ¿ÁÔ˘Ó ÙËÓ ·ıËÚÔÁ¤ÓÂÛË Ì ÙÚ›˜ ‰È·ÊÔÚÂÙÈÎÔ‡˜ ÙÚfiÔ˘˜: 1. ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ÌÔÓÔ΢ÙÙ¿ÚˆÓ Î·È ÙËÓ ¤ÎÎÚÈÛË ÙˆÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛ˘ VLA-4, LFA-1, Mac-1, uPAR. 2. ∆ËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ÙËÓ ¤ÎÊÚ·ÛË ÙˆÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛ˘ E-ÛÂÏÂÎÙ›ÓË, ICAM-1, VCAM-1, MCP-1, ηıÒ˜ Î·È Ù˘ ¯ËÌÂÈÔΛÓ˘ IL-8, [21]. 3. ∆ËÓ ·Ó·ÛÙÔÏ‹ ÙÔ˘ Ì˯·ÓÈÛÌÔ‡ ÂÎÚÔ‹˜ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ·fi Ù· Ì·ÎÚÔÊ¿Á· ‰È·Ì¤ÛÔ˘ ÙÔ˘ ÂȉÈÎÔ‡ ÌÂÙ·ÊÔÚ¤· ABCA-1 (ATP binding cassette transporter A1) Î·È ÙÔ˘ ˘Ô‰Ô¯¤· ÂÎηı·ÚÈÛÙ‹ SR-B1(scavenger receptor B1), Ì ·ÔÙ¤ÏÂÛÌ· ÙÔ Û¯ËÌ·ÙÈÛÌfi ·ÊÚˆ‰ÒÓ Î˘ÙÙ¿ÚˆÓ (™¯‹Ì· 4).

¶·Ú¿ÁÔÓÙ˜ Ô˘ ·˘Í¿ÓÔ˘Ó Ù· PAMPs ÛÙÔ ·›Ì· √È ·ÚÙËڛ˜ ÌÔÚÔ‡Ó Ó· ÂÎÙÂıÔ‡Ó Û PAMPs Ì ‰È¿ÊÔÚÔ˘˜ ÙÚfiÔ˘˜. PAMPs fiˆ˜ Ë ÚˆÙ½ÓË Û‡Ó‰ÂÛ˘ ÙÔ˘ ÏÈÔÔÏ˘Û·Î¯·Ú›ÙË (LBP), Ô LPS, Ë Flagellin, ·ÂÏ¢ıÂÚÒÓÔÓÙ·È ·fi Ù· Á·ÛÙÚÂÓÙÂÚÈο ‚·ÎÙ‹ÚÈ·, Ù· ÔÔ›· ˘¿Ú¯Ô˘Ó ÛÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi ۈϋӷ Û ÌÂÁ¿ÏË ‰È·ıÂÛÈÌfiÙËÙ·. ªÈÎÚfi ÔÛÔÛÙfi ·fi ·˘Ù¿, ÌÔÚ› Ó· ÌÂÙ·ÊÂÚı› ÛÙÔ Î˘ÎÏÔÊÔÚÈÎfi ·ÎfiÌË Î·È Û ۯÂÙÈο Ê˘ÛÈÔÏÔÁÈΤ˜ Û˘Óı‹Î˜. ªÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ¤ÛÙˆ Î·È ÌÈÎÚ‹ ·‡ÍËÛË Ù˘ ÂÓ‰ÔÙÔ͛Ӣ ÛÙÔ Î˘ÎÏÔÊÔÚÈÎfi, ÌÔÚ› Ó· ÙÚÈÏ·ÛÈ¿ÛÂÈ ÙËÓ ·‡ÍËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ηڈÙȉÈ΋ ·ıËÚÔÛÎÏ‹ÚˆÛË. ¢È·ÙÚÔÊÈÎÔ› ·Ú¿ÁÔÓÙ˜ ηıÒ˜ Î·È Ô ÙÚfiÔ˜ ˙ˆ‹˜ Ê·›ÓÂÙ·È Ó· ÂËÚ¿˙Ô˘Ó ÙËÓ ¤ÎıÂÛË ÙˆÓ ·ÚÙËÚÈÒÓ Û PAMPs. √ ηÓfi˜ ÙˆÓ ÙÛÈÁ¿ÚˆÓ ÂÚȤ¯ÂÈ ÌÂÁ¿Ï˜ ÔÛfiÙËÙ˜ ÂÓ‰ÔÙÔ͛Ӣ Î·È ¤¯ÂÈ ‰Âȯı› fiÙÈ Ë ÂÓ‰ÔÙÔÍ›ÓË ÛÙÔ Î˘ÎÏÔÊÔÚÈÎfi ÙˆÓ Î·ÓÈÛÙÒÓ Â›Ó·È ˘„ËÏfiÙÂÚË ·fi fiÙÈ ÛÙÔ˘˜ ÌË Î·ÓÈÛÙ¤˜. √È ‰È·ÈÙËÙÈΤ˜ Û˘Ó‹ıÂȘ Ê·›ÓÂÙ·È Ó· ÌÂÙ·‚¿ÏÔ˘Ó ÛËÌ·ÓÙÈο ÙË Û˘ÁΤÓÙÚˆÛË Ù˘ ÂÓ‰ÔÙÔ͛Ӣ ÛÙÔ ·›Ì·. §È·Ú¿ Á‡̷ٷ ·˘Í¿ÓÔ˘Ó ÙËÓ ÂÓ‰ÔÙÔÍ›ÓË ÛÙÔ Ï¿ÛÌ· ÔÓÙÈÎÒÓ ÂÓÒ ·ÓÙ›ıÂÙ·, Û TLR-4 ∫/√ ÔÓÙ›ÎÈ·, ·Ú·ÙËÚÂ›Ù·È ÛËÌ·ÓÙÈ΋ Ì›ˆÛË Ù˘ ÊÏÂÁÌÔÓ‹˜ ÛÙÔ ·ÚÙËÚÈ·Îfi ÙÔ›¯ˆÌ· Ô˘ ÚÔηÏÂ›Ù·È ·fi ÏÈ·Ú‹ ‰›·ÈÙ· ÏÔ‡ÛÈ· Û ÏÈ·Ú¿ (™¯‹Ì· 5). ∏ ·¯˘Û·ÚΛ· Û˘Ó‰¤ÂÙ·È Ì ·˘ÍË̤ÓË

™¯‹Ì· 5. ¶·Ú¿ÁÔÓÙ˜ Ô˘ ÂËÚ¿˙Ô˘Ó ÙËÓ Û˘ÁΤÓÙÚˆÛË Ù˘ ÂÓ‰ÔÙÔ͛Ӣ ÛÙÔ ·›Ì·.

ÂÓ‰ÔÙÔÍÈÓ·ÈÌ›·. ∏ ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË Û˘Óԉ‡ÂÙ·È ·fi ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙÔ˘ LPS ÛÙÔ ·›Ì·, Ô Ì˯·ÓÈÛÌfi˜ fï˜ ‚Ú›ÛÎÂÙ·È ·ÎfiÌ· ˘fi ‰ÈÂÚ‡ÓËÛË. ¶·Ú¿ÏÏËÏ·, ÔÈ ·ÛıÂÓ›˜ Ì ‰È·‚‹ÙË Ù‡Ô˘ ππ ¤¯Ô˘Ó ·˘ÍË̤ӷ ηٿ 75% Â›‰· ÂÓ‰ÔÙÔ͛Ӣ Û ۯ¤ÛË Ì ÙÔ˘˜ ˘ÁÈ›˜. ∆¤ÏÔ˜, Ë ·˘ÍË̤ÓË Û˘ÁΤÓÙÚˆÛË LDL ÛÙÔ Ï¿ÛÌ· ·˘Í¿ÓÂÈ ÙËÓ Î˘ÙÙ·ÚÈ΋ ¢·ÈÛıËÛ›· ÛÙÔ LPS ÂÓÒ ·ÓÙ›ıÂÙ· Ë HDL Â›Ó·È ¤Ó·˜ ·ÔÙÂÏÂÛÌ·ÙÈÎfi˜ ÂÎηı·ÚÈÛÙ‹˜ Ù˘ ÂÓ‰ÔÙÔ͛Ӣ [13].

∏ Â›‰Ú·ÛË ÙˆÓ ÂÓ‰ÔÁÂÓÒÓ ÚÔÛ‰ÂÌ¿ÙˆÓ ÙˆÓ TLRs ÛÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË ¢È¿ÊÔÚ· ÂÓ‰ÔÁÂÓ‹ ÚÔÛ‰¤Ì·Ù· ÙˆÓ TLRs Ô˘ ÚÔ¿ÁÔ˘Ó ÙË ÊÏÂÁÌÔÓ‹ ¤¯Ô˘Ó ÚÔÙ·ı› ˆ˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ÚÔ¿ÁÔ˘Ó ÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË ‰È·Ì¤ÛÔ˘ ÙˆÓ TLRs. ™Â ·˘Ù¿ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÔÈ ÚˆÙ½Ó˜ ıÂÚÌÈÎÔ‡ shock (∏eat Shock Proteins (HSPs), Ë ÔÍÂȉˆÌ¤ÓË ÌÔÚÊ‹ Ù˘ LDL, Ù· ÔÍÂȉˆÌ¤Ó· ʈÛÊÔÏÈ›‰È·, ÙÔ ÈÓˆ‰ÔÁfiÓÔ, ÙÔ ÂÈϤÔÓ ÙÌ‹Ì· ∞ Ù˘ ÊÈ‚ÚÔÓÂÎÙ›Ó˘ (EDFA) Î·È ÙÔ ‰È·Ï˘Ùfi ˘·ÏÔ˘ÚÔÓÈÎfi [22] [23]. √ Û·Ê‹˜ ηıÔÚÈÛÌfi˜ ÙˆÓ ÂÓ‰ÔÁÂÓÒÓ ÚÔÛ‰ÂÌ¿ÙˆÓ Â›Ó·È ‰‡ÛÎÔÏÔ˜, ÂÍ·ÈÙ›·˜ ÙˆÓ Û˘Ó¯ÒÓ ÌÔχÓÛÂˆÓ ·fi ·ıÔÁfiÓÔ˘˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ Î·È Ù˘ ÈÛ¯˘Ú‹˜ ‰È¤ÁÂÚÛ˘ Ô˘ ÚÔηÏÔ‡Ó Ù· ÚÔÛ‰¤Ì·Ù¿ ÙÔ˘˜. √È

HSPs Â›Ó·È ÌÈ· ÔÌ¿‰· ÚˆÙÂ˚ÓÒÓ Ô˘ ÂÎÊÚ¿˙ÂÙ·È ·fi ÔÏÏ¿ ·ÙÙ·Ú·, ΢ڛˆ˜ ÛÂ Û˘Óı‹Î˜ stress (ÌÂÙ·‚ÔÏÈÎfi, ÂÚÈ‚·ÏÏÔÓÙÈÎfi), Ì ÛÎÔfi ÙËÓ ÚÔÛÙ·Û›· ÙˆÓ Î˘ÙÙ¿ÚˆÓ Î·È ÙËÓ ·ÔÙÚÔ‹ Ù˘ ΢ÙÙ·ÚÈ΋˜ ‚Ï¿‚˘ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂԇψÛ˘ ÙÔ˘ ÙÚ·‡Ì·ÙÔ˜. √È HSPs ÂÎÊÚ¿˙ÔÓÙ·È ÛÙËÓ ·ıËڈ̷ÙÈ΋ Ͽη Î·È ›Ûˆ˜ Û˘ÓÂÈÛʤÚÔ˘Ó ÛÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË Ì ‰È¿ÊÔÚÔ˘˜ Ì˯·ÓÈÛÌÔ‡˜. ªÂٷ͇ ·˘ÙÒÓ ¤¯ÂÈ ÚÔÙ·ı› fiÙÈ Ô Û˘Ó‰˘·ÛÌfi˜ ·ÓıÚÒÈÓˆÓ HSPs Ì HSPs ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ ÂÓÂÚÁÔÔÈ› ÙÔ ·ÁÁÂÈ·Îfi ÂÓ‰Ôı‹ÏÈÔ, Ù· Ì·ÎÚÔÊ¿Á· Î·È Ù· Ï›· Ì˘˚ο ·ÙÙ·Ú· ‰È·Ì¤ÛÔ˘ ÙˆÓ TLR-2 Î·È TLR-4 Î·È Ù˘ MyD88-ÂÍ·ÚÙÒÌÂÓ˘ ÛËÌ·ÙÔ‰ÔÙÈ΋˜ ÔÚ›·˜. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ë ÔÍÂȉˆÌ¤ÓË LDL ‰È·‰Ú·Ì·Ù›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË ·ÛÎÒÓÙ·˜ ÔÈΛϘ ‰Ú¿ÛÂȘ Û ‰È¿ÊÔÚ· ·ÙÙ·Ú· ÙÔ˘ ·ÚÙËÚÈ·ÎÔ‡ ÙÔȯÒÌ·ÙÔ˜. ¶ÂÈÚ·Ì·ÙÈο ‰Â‰Ô̤ӷ ¤‰ÂÈÍ·Ó fiÙÈ Ë ÂÏ¿¯ÈÛÙ· ÔÍÂȉˆÙÈο ÙÚÔÔÔÈË̤ÓË LDL (mmLDL) ÂÓÂÚÁÔÔÈ›: 1. ΢ÙÙ·ÚÔÛÎÂÏÂÙÈΤ˜ ·ÏÏ·Á¤˜ ÛÙ· Ì·ÎÚÔÊ¿Á· ̤ۈ Ù˘ CD14/TLR4/MyD88 ÔÚ›·˜, 2. ÙËÓ ÚÔÛÎfiÏÏËÛË ÙˆÓ Ï¢ÎÔÎÎ˘Ù¿ÚˆÓ ÛÙÔ ÂÓ‰Ôı‹ÏÈÔ Ì¤Ûˆ Ù˘ ÂÍ·ÚÙÒÌÂÓ˘ TLR4 /MyD88 ÔÚ›·˜ Î·È 3. ‰ÈÂÁ›ÚÂÈ ÙËÓ ¤ÎÎÚÈÛË Î˘ÙÙ·ÚÔÎÈÓÒÓ ·fi Ù· Ì·ÎÚÔÊ¿Á· ‰È·Ì¤ÛÔ˘ ÙfiÛÔ Ù˘ ÂÍ·ÚÙÒÌÂÓ˘ fiÛÔ Î·È Ù˘ ·ÓÂÍ¿ÚÙËÙ˘ TLR4/ MyD88 ÔÚ›·˜. ¶·ÚfiÏ· ·˘Ù¿ Ô

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™¯‹Ì· 6. ¶ÔÚ›˜ ÌÂÙ¿‰ÔÛ˘ Û‹Ì·ÙÔ˜ ÙˆÓ TLRs Ô˘ Ï·Ì‚¿ÓÔ˘Ó ¯ÒÚ· ηٿ ÙËÓ ·Ó¿Ù˘ÍË Ù˘ ·ıËÚÔÛÎÏ‹ÚˆÛ˘. √È TLR 2 Î·È 4 ηıÒ˜ Î·È Ë MyD88 ÂÍ·ÚÙÒÌÂÓË ÔÚ›·, Ê·›ÓÂÙ·È Ó· Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ ÂͤÏÈÍË Ù˘ ·ıËÚÔÛÎÏ‹ÚˆÛ˘ Ì ‰È¤ÁÂÚÛË ·fi ÂÓ‰ÔÁÂÓ‹ Î·È Â͈ÁÂÓ‹ ÚÔÛ‰¤Ì·Ù· (Bjorkbacka H. Curr Opin Lipidol, 17:527533, 2006).

·ÎÚÈ‚‹˜ Ì˯·ÓÈÛÌfi˜ ‰Ú¿Û˘ Ù˘ mmLDL ‰È·Ì¤ÛÔ˘ ÙˆÓ TLRs ‰ÂÓ Â›Ó·È ·ÎfiÌ· Ï‹Úˆ˜ ‰È¢ÎÚÈÓÈṲ̂ÓÔ˜ [24], [25], [26]. ∏ TLR ÔÚ›· Ê·›ÓÂÙ·È Ó· Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË Î·È Ì ¿ÏÏÔ ÙÚfiÔ ¤Ú· ·fi ÙË ÊÏÂÁÌÔÓ‹ Î·È ÙËÓ ·ÓÔÛÔÏÔÁÈ΋ ·¿ÓÙËÛË. √È ˘ԉԯ›˜ X ÙÔ˘ ‹·ÙÔ˜ (LXRs) Â›Ó·È ÌÂÙ·ÁÚ·ÊÈÎÔ› Ú˘ıÌÈÛÙ¤˜ Ù˘ Ì›ˆÛ˘ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ·fi Ù· ·ÊÚÒ‰Ë Î‡ÙÙ·Ú·. ∂ÓÂÚÁÔÔÈÔ‡Ó ÙËÓ ·ÓÙ›ÛÙÚÔÊË ÌÂÙ·ÊÔÚ¿ ¯ÔÏËÛÙÂÚfiÏ˘ Ô˘ ‰È·ÌÂÛÔÏ·‚Â›Ù·È ·fi ÌÂÙ·ÊÔÚ›˜ fiˆ˜ Ô ABCA-1. ™˘ÓıÂÙÈο ÚÔÛ‰¤Ì·Ù· Ô˘ ÂÓÂÚÁÔÔÈÔ‡Ó ÙÔ˘˜ LXRs ÌÂÈÒÓÔ˘Ó ÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË, ÂÓÒ Ë ·Ô˘Û›· ¤ÎÊÚ·Û˘ ÙˆÓ LXRs ÛÙ· Ì·ÎÚÔÊ¿Á· ÙËÓ ÂÈÙ·¯‡ÓÔ˘Ó. µ·ÎÙËÚȷ΋ ‹ ÈÈ΋ ÂÓÂÚÁÔÔ›ËÛË Ù˘ IRF3 ÔÚ›·˜ ÙˆÓ TLR-3 Î·È TLR-4 Ê·›ÓÂÙ·È Ó· ·Ó·ÛÙ¤ÏÏÂÈ ÙË ÌÂÙ·ÁÚ·ÊÈ΋ ÂÓÂÚÁfiÙËÙ· ÙÔ˘ LXRs Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ÛÙ· ·ÊÚÒ‰Ë Î‡ÙÙ·Ú· Â¿ÁÔÓÙ·˜ ¤ÙÛÈ ÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË (™¯‹Ì· 6) [27].

¶ÔÏ˘ÌÔÚÊÈÛÌÔ› ÙˆÓ ∆LRs Î·È Ë Û¯¤ÛË ÙÔ˘˜ Ì ÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË ¢È¿ÊÔÚÔÈ ÔÏ˘ÌÔÚÊÈÛÌÔ› ÙˆÓ ÁÔÓȉ›ˆÓ ÙˆÓ TLRs ¤¯Ô˘Ó ÌÂÏÂÙËı› Û ۯ¤ÛË Ì ÙËÓ ·ıËÚÔÛÎÏ‹Úˆ-

6

ÛË. ªÂٷ͇ ·˘ÙÒÓ ‰‡Ô ÔÏ˘ÌÔÚÊÈÛÌÔ› Ê·›ÓÂÙ·È Ó· ÂËÚ¿˙Ô˘Ó ÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË Î·È ÙËÓ Î·Ú‰È·ÁÁÂȷ΋ ÓfiÛÔ. √ ÔÏ˘ÌÔÚÊÈÛÌfi˜ Asp299Gly ÙÔ˘ TLR-4 ¤¯ÂÈ ÂÎÙÂÓÒ˜ ÌÂÏÂÙËı› Î·È Û‡Ìʈӷ Ì ٷ ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ÌÂÏÂÙÒÓ ·˘ÙÒÓ Û˘Óԉ‡ÂÙ·È ·fi ÌÂȈ̤ÓË ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘ Ì˯·ÓÈÛÌÔ‡ ÌÂÙ¿‰ÔÛ˘ Û‹Ì·ÙÔ˜ ‰È·Ì¤ÛÔ˘ ÙÔ˘ TLR-4 ÁÈ· ÙËÓ ·Ú·ÁˆÁ‹ ΢ÙÙ·ÚÔÎÈÓÒÓ [28]. ™Â ÎÏÈÓÈÎfi Â›‰Ô, Ô ÔÏ˘ÌÔÚÊÈÛÌfi˜ ·˘Ùfi˜ Û˘Óԉ‡ÂÙ·È ·fi ÌÂȈ̤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ·ıËÚÔÛÎÏ‹ÚˆÛË Î·È ÁÈ· Ô͇ ÛÙÂÊ·ÓÈ·›Ô Û‡Ó‰ÚÔÌÔ [28]. ŒÓ·˜ ¿ÏÏÔ˜ ÔÏ˘ÌÔÚÊÈÛÌfi˜ Ô˘ ¤¯ÂÈ Èı·ÓÒ˜ ÛËÌ·Û›· ÁÈ· ÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË Î·È ÙËÓ Î·Ú‰È·ÁÁÂȷ΋ ÓfiÛÔ Â›Ó·È Ô ÔÏ˘ÌÔÚÊÈÛÌfi˜ Arg 753Gln ÙÔ˘ ˘Ô‰Ô¯¤· TLR-2 Ô ÔÔ›Ô˜ Ê·›ÓÂÙ·È Ó· Â›Ó·È ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ·ıËڈ̿وÛË Î·È ÛÙ¤ÓˆÛË ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÚÙËÚÈÒÓ [29].

º·ÚÌ·ÎÔÏÔÁÈΤ˜ Î·È ‰È·ÈÙËÙÈΤ˜ ·ÚÂÌ‚¿ÛÂȘ ∏ ÁÓÒÛË ÙˆÓ Ì˯·ÓÈÛÌÒÓ ‰È·Ì¤ÛÔ˘ ÙˆÓ ÔÔ›ˆÓ Ù· PAMPs ‰ÈÂÁ›ÚÔ˘Ó ÙËÓ ·Ó¿Ù˘ÍË Ù˘ ·ıËڈ̷ÙÈ΋˜ Ͽη˜, ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ ÛÙËÓ ·Ó¿Ù˘ÍË ÂÍÂȉÈÎÂ˘Ì¤ÓˆÓ ·ÓÙ·ÁˆÓÈÛÙÒÓ ÙˆÓ TLRs ‹ ·Ó·ÛÙÔϤˆÓ Ù˘ ÛËÌ·ÙÔ‰ÔÙÈ΋˜ ÔÚ›·˜ ‰È·Ì¤ÛÔ˘ Ù˘ ÔÔ›·˜ ·˘-

ÙÔ› ÂÓÂÚÁÔÔÈÔ‡Ó Ù· ·ÙÙ·Ú·. ªÈ· Ù¤ÙÔÈ· ÚÔÛ¤ÁÁÈÛË ı· ÌÔÚÔ‡Û ӷ Ô‰ËÁ‹ÛÂÈ Û Ôχ ηϿ ıÂÚ·¢ÙÈο ·ÔÙÂϤÛÌ·Ù· ·ÊÔ‡ Ù· ·ÓÙÈ‚ÈÔÙÈο ¤¯Ô˘Ó ·Ô‰Âȯı› ·Ó·ÔÙÂÏÂÛÌ·ÙÈο, ÂÓÒ Ë Ì·ÎÚÔ¯ÚfiÓÈ· ¯ÔÚ‹ÁËÛË ÙˆÓ ˘·Ú¯fiÓÙˆÓ ·ÓÙÈÊÏÂÁÌÔÓˆ‰ÒÓ Ê·ÚÌ¿ÎˆÓ ÌÔÚ› Ó· ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·Ó·ÛÙÔÏ‹ ÂȉÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Ì Èı·Ófi ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·ÓÔÛÔηٷÛÙÔÏ‹. ∞fi Ù· ˘¿Ú¯ÔÓÙ· Ê¿Ú̷η, ÛËÌ·ÓÙÈ΋ ·Ó·ÛÙ·ÏÙÈ΋ ‰Ú¿ÛË ˆ˜ ÚÔ˜ ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ·ÚÙËÚÈ·ÎÔ‡ ÙÔȯÒÌ·ÙÔ˜ ‰È·Ì¤ÛÔ˘ ÙˆÓ TLRs Ê·›ÓÂÙ·È Ó· ¤¯Ô˘Ó ÔÈ ÛÙ·Ù›Ó˜ fiˆ˜ Ë ·ÙÔÚ‚·ÛÙ·Ù›ÓË Î·È Ë ÏÔ‚ÔÛÙ·Ù›ÓË, ÔÈ Ôԛ˜ Û ÂÈÚ·Ì·ÙÈΤ˜ ÌÂϤÙ˜ ·Ó¤ÛÙÂÈÏ·Ó ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ·ÚÙËÚÈ·ÎÔ‡ ÙÔȯÒÌ·ÙÔ˜ ·fi ÙÔÓ LPS ̤ۈ ÂÓfi˜ Ì˯·ÓÈÛÌÔ‡ ·ÓÂÍ¿ÚÙËÙÔ˘ ·fi ÙË Ì›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ ÛÙÔ Ï¿ÛÌ·. ∂›Û˘, ÔÈ ıÈ·˙ÔÏȉÈÓ‰ÈfiÓ˜ Ô˘ ¯ÔÚËÁÔ‡ÓÙ·È Û ·ÛıÂÓ›˜ Ì ‰È·‚‹ÙË Ù‡Ô˘ ππ ÌÂÈÒÓÔ˘Ó Ù· Â›‰· ÙÔ˘ LPS Û ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Î·È Â›Û˘ ·Ó·ÛÙ¤ÏÏÔ˘Ó ÙËÓ ÔÚ›· ÛËÌ·ÙÔ‰fiÙËÛ˘ ‰È·Ì¤ÛÔ˘ ÙˆÓ TLRs. ¶¤Ú· fï˜ ·fi Ê·ÚÌ·ÎÔÏÔÁÈΤ˜ ·ÚÂÌ‚¿ÛÂȘ ˘¿Ú¯ÂÈ Î·È Ë ‰È·ÙÚÔÊÈ΋ ÚÔÛ¤ÁÁÈÛË ˆ˜ ÚÔ˜ ÙË Ì›ˆÛË Ù˘ ÊÏÂÁÌÔÓ‹˜ Ô˘ ÚÔηÏÂ›Ù·È ·fi Ù· PAMPs. ¢›·ÈÙ˜ ÏÔ‡ÛȘ Û ˆ-3 ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ· (PUFAs) ¤‰ÂÈÍ·Ó fiÙÈ ÌÂÈÒÓÔ˘Ó ÙËÓ Â˘·ÈÛıËÛ›· ÙˆÓ ÌÔÓÔ΢ÙÙ¿ÚˆÓ ÛÙÔ LPS Û ÌÂϤÙ˜ Ì ·ÓıÚÒÔ˘˜ ηıÒ˜ Î·È fiÙÈ ÙÔ ÂÈÎÔÛ·ÂÓÙ·ÂÓÔ˚Îfi Ô͇ (EPA) Î·È ÙÔ ÂÈÎÔÛȉ˘ÔÂÍ·ÓÔ˚Îfi Ô͇ (DHA) Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈÎÔ› ·Ó·ÛÙÔÏ›˜ Ù˘ ÔÚ›·˜ ÙˆÓ TLR invitro. ∆Ô ÂÏ·ÈfiÏ·‰Ô Î·È Ë ÚÂÛ‚ÂÚ·ÙÚfiÏË Â›Û˘ ·Ó·ÛÙ¤ÏÏÔ˘Ó ÙËÓ Î˘ÙÙ·ÚÈ΋ ÛËÌ·ÙÔ‰fiÙËÛË ‰È·Ì¤ÛÔ˘ ÙÔ˘ LPS in vitro. ∂›Û˘ ‰È·ÙÚÔÊÈΤ˜ ÚÔÛÂÁÁ›ÛÂȘ Ô˘ ÌÂÈÒÓÔ˘Ó ÙËÓ ÂÓ‰ÔÙÔÍ·ÈÌ›· ̤ۈ Ù˘ Ú‡ıÌÈÛ˘ Ù˘ ÌÈÎÚԂȷ΋˜ ¯ÏˆÚ›‰·˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘ ‰ÂÓ Ú¤ÂÈ Ó· ·ÔÎÏ›ÔÓÙ·È. ∆· ÚԂȈÙÈο, ˙ˆÓÙ·Ó‹ ÌÈÎÚԂȷ΋ ÙÚÔÊ‹ Ô˘ ‚ÂÏÙÈÒÓÂÈ ÙË ÌÈÎÚԂȷ΋ ÈÛÔÚÚÔ›· ÛÙÔ ¤ÓÙÂÚÔ, ÌÂÈÒÓÔ˘Ó ÙËÓ ÂÓ‰ÔÙÔÍ›ÓË ÛÙÔ ¤ÓÙÂÚÔ ‚ÂÏÙÈÒÓÔÓÙ·˜ ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘. °È· ·Ú¿‰ÂÈÁÌ· Ô Ï·ÎÙÔ‚¿ÎÈÏÔ˜ ¤‰ÂÈÍ fiÙÈ ÌÂÈÒÓÂÈ ÛËÌ·ÓÙÈο ÙËÓ ÂÓ‰ÔÙÔÍ·ÈÌ›· Û ‰ÈÂÁÂṲ́ÓÔ Ì ·ÏÎÔfiÏË ¤ÓÙÂÚÔ ÔÓÙÈÎÔ‡. ∆· ÚÔ˚fiÓÙ· ˙‡ÌˆÛ˘


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¶∞£√ºÀ™π√§√°π∞ ·fi ÚԂȈÙÈο ›‰Ë ¤‰ÂÈÍ·Ó fiÙÈ ‚ÂÏÙÈÒÓÔ˘Ó ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÂÓÙ¤ÚÔ˘ ÂÓÒ Ë ÔÛfiÙËÙ· Ù˘ ÂÓ‰ÔÙÔ͛Ӣ ÌÂÈÒÓÂÙ·È ÛËÌ·ÓÙÈο. √È Ï·ÎÙÔ‚¿ÎÈÏÔÈ ·fi ÚԂȈÙÈο ‹ Ú‚ȈÙÈο Û˘ÌÏËÚÒÌ·Ù· ‰È·ÙÚÔÊ‹˜ Ê·›ÓÂÙ·È Â›Û˘ fiÙÈ ÌÂÈÒÓÔ˘Ó ÙËÓ ÂÓ‰ÔÙÔÍ·ÈÌ›· ÛÙÔÓ ¿ÓıÚˆÔ.

™˘ÌÂÚ·ÛÌ·ÙÈο, ÔÈ TLRs ‰È·‰Ú·Ì·Ù›˙Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË ÂÓÂÚÁÔÔÈÒÓÙ·˜ ÔχÏÔÎÔ˘˜ ÛËÌ·ÙÔ‰ÔÙÈÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜ Û ·ÙÙ·Ú· ÙÔ˘ ·ÚÙËÚÈ·ÎÔ‡ ÙÔȯÒÌ·ÙÔ˜. ∏ ÂÚ·ÈÙ¤Úˆ ηٷÓfiËÛË ÙˆÓ Ì˯·ÓÈÛÌÒÓ ·˘ÙÒÓ Î·ıÒ˜ Î·È Ë ‰È·Ï‡ηÓÛË ÙˆÓ Û˘ÓıËÎÒÓ Ô˘ ÂË-

Ú¿˙Ô˘Ó Ù· Â›‰· ÙˆÓ PAMPs ÛÙÔ Ï¿ÛÌ· ÌÔÚ› Ó· Ô‰ËÁ‹ÛÔ˘Ó ÛÙËÓ ·Ó¿Ù˘ÍË ÂÍÂȉÈÎÂ˘Ì¤ÓˆÓ ıÂÚ·¢ÙÈÎÒÓ ÚÔÛÂÁÁ›ÛÂˆÓ Î·ıÒ˜ Î·È ‰È·ÈÙËÙÈÎÒÓ ·ÚÂÌ‚¿ÛÂˆÓ ÁÈ· ÙËÓ ÚfiÏË„Ë ‹ Î·È ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ·ıËÚÔÛÎÏ‹ÚˆÛ˘ Î·È Ù˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘.

13. Michelson K.S., Wong M.H., Shah P.K., Zhang W., Yano J., Doherty T.M., et al. (2004) Lack of Toll-like receptor 4 or myeloid differentiation factor 88 reduces atherosclerosis and alters plaque phenotype in mice deficient in apolipoprotein E. Proc Natl Acad Sci USA 101:10679-10684.

21. Erridge C. (2008) The Roles of Pathogen- Associated Molecular Patterns in Atherosclerosis. Trends Cardiovasc Med 18:52-56.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Hopkins PA, Sriskandan S. (2005) Mammalian Toll-like receptors: to immunity and beyong. Clin. Exp. Immunol. 140:395-407. 2. Medzhitov R, Preston-Hurlburt P, Janeway CA Jr. (1997) A human homologue of the Drosophila Toll protein signals activation of adaptive immunity. Nature 388(6640):394-7. 3. Takeda K, Kaisho T, Akira S. (2003) Toll-like receptors. Annu. Rev. Immunol. 21:335-76. 4. Akira S and Takeda K, (2004) Toll-like receptors signaling. Immunology 4: 499-511. 5. Akira S, Takeda K, Kaiso T (2001). Toll-like receptors; critical proteins linking innate and acquired immunity. Nat. Immunol. 2:675-80. 6. Frantz S, Bauersachs J, Kelly RA. (2005) Innate immunity and the heart. Curr Pharm Des. 11:1279-1290. 7. Akira S et al. (2006) Pathogen recognition and innate immunity. Cell 124: 783-801. 8. Wang C, Deng L, Hong M, Akkaraju GR, Inoue J, Chen ZJ (2001). TAK1 is a ubiquitin-dependent kinase of MKK and IKK. Nature 412:346-51. 9. Edfeldt K., Swedenborg J., Hansson G. K. and Yan Z.-qun (2002) Expression of Toll Like Receptors in Human Atherosclerotic Lesions A Possible Pathway for Plaque Activation Circulation 105:1158-1161 10. Ishikawa Y., Satoh M., Itoh T., Minami Y., Takahashi Y., Akamura M. (2008) Local expression of Toll-like receptor 4 at the site of ruptured plaques in patients with acute myocardial infarction Clinical Science 115:133-140 11. Frantz S., Ertl G. and Bauersachs J. (2007) Mechanisms of Disease: Tolllike receptors in cardiovascular disease Nat Clin Pract Cardiovasc Med. 4: 444-454 12. Methe H, Kim JO, Kofler S, Weis M, Nabauer M, Koglin J. (2005) Expansion of circulating Toll-like receptor 4-positive monocytes in patients with acute coronary syndrome. Circulation. 111(20):265461.

14. Liu X., Ukai T, Yumoto H., Davey M., Goswami S.,. Gibson III F., Genco C. (2008) Toll-like receptor 2 plays a critical role in the progression of atherosclerosis that is independent of dietary lipids. Atherosclerosis 196(1): 146-154. 15. Johnson G.B., Riggs B.L., Platt J.L.. (2004) A genetic basis for the Adonis phenotype of low adiposity and strong bones. FASEB J 18:1282-1284. 16. Schoneveld A.H., Hoefer I., Sluijter J.P.G., Lamanc J.D., de Kleijn D.P.V, Pasterkamp G. (2008) Atherosclerotic lesion development and Toll like receptor 2 and 4 responsiveness. Atherosclerosis 197: 95-104. 17. Saikku, P., Leinonen M., Mattila K., Ekman M.R., Nieminen M.S., Makela P.H., Huttunene J. K., and Valtonen V. (1988) Serological evidence of an association of a novel Chlamydia, TWAR, with chronic heart disease and acute myocardial infarction. Lancet 2:983. 18. Lepper P M., Schumann C., Triantafilou K., Rasche F. M., Schuster T., Frank H., Schneider E. M, Triantafilou M., M. von Eynatten (2007) Association of LipopolysaccharideBinding Protein and Coronary Artery Disease in Men. J Am Coll Cardiol. 50(1) 25-31 19. Kiechl, S., Egger G., Mayr M., Wiedermann C.J., Bonora E., Oberhollenzer F., Muggeo M., Xu Q., Wick G., Poewe W., and Willeir J. (2001) Cronic infections and the risk of carotid atherosclerosis: prospective results from a large population study. Circulation 103:1064. 20. Lynn L. Stoll, Gerene M. Denning, Neal L. Weintraub. (2004) Potential Role of Endotoxin as a Proinflammatory Mediator of Atherosclerosis Arterioscler. Thromb. Vasc. Biol. 24: 2227-2236.

22. Rick de Graaf, Kloppenburg G, Kitslaar P J.H.M.,. Bruggeman C A., Stassen F. (2006) Human heat shock protein 60 stimulates vascular smooth muscle cell proliferation through Toll-like receptors 2 and 4. Microbes and Infection 8(7): 18591865. 23. Okamura Y, Watari M, Jerud ES, Young DW, Ishizaka ST, Rose J, Chow JC, Strauss JF 3rd. (2001) The extra domain A of fibronectin activates Toll-like receptor 4. J Biol Chem. 276(13):10229-33. 24. Binder, C.J.S. Horkko, A. Dewan, M.K. Chang, E.P.Kieu C.S. Goodyear, P.X. Shaw,W. Palinski, JL. Witztum and G J Silverman (2003). Pneumococcal vaccination decreases atherosclerosis lesion formation: molecular mimicry between Streptococcus pneumoniae and oxidized LDL. Nat. Med. 9:736 25. Yeh M., Leitinger N. and R. de Martin et al., (2001) Increased transcription of IL-8 in endothelial cells is differentially regulated by TNF-a and oxidised phospholipids. Arterioscler Thromb Vasc Biol 21:1585-1591 26. Erridge C, Webb D J., Spickett C M. (2007) Toll-like receptor 4 signalling is neither sufficient nor required for oxidised phospholipid mediated induction of interleukin-8 expression Atherosclerosis 193(1): 77-85. 27. Bjorkbacka H. (2006) Multiple roles of Toll-like receptor signaling in atherosclerosis Curr Opin Lipidol 17:527-533 28. Kiechl S, Lorenz E, Reindl M, Wiedermann CJ, Oberhollenzer F, Bonora E, Willeit J, Schwartz DA. (2002) Toll-like receptor-4 polymorphisms and atherosclerosis N Engel J Med 347(3):185-192 29. Hamann L, Gomma A, Schröder NW, Stamme C, Glaeser C, Schulz S, Gross M, Anker SD, Fox K, Schumann RR (2005) A frequent toll-like receptor (TLR)-2 polymorphism is a risk factor for coronary restenosis J Mol Med. 83(6):478-85

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ATHIROSK 21-

05-03-09

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∞ÓÙÈÏ‹„ÂȘ ÙÔ˘ ¶ÏËı˘ÛÌÔ‡ ÁÈ· ÙÔ ƒfiÏÔ Ù˘ ¢È·ÙÚÔÊ‹˜ ÛÙËÓ ∫·Ú‰È·ÁÁÂȷ΋ ¡fiÛÔ. ¶ÈÏÔÙÈο ™ÙÔȯ›· ·fi ÙËÓ ¶·ÓÂÏÏ·‰È΋ ŒÚ¢ӷ Ù˘ √Ì¿‰·˜ ∂ÚÁ·Û›·˜ ∂ȉËÌÈÔÏÔÁ›·˜ & ¶ÚfiÏ˄˘ Ù˘ ∞ıËÚÔÛÎÏ‹ÚˆÛ˘ Ù˘ ∂ÏÏËÓÈ΋˜ ∂Ù·ÈÚ›·˜ ∞ıËÚÔÛÎÏ‹ÚˆÛ˘ ∞Ì·Ï›· °ÈˆÙÔÔ‡ÏÔ˘, ∂ο‚Ë °ÂˆÚÁÔ˘ÛÔÔ‡ÏÔ˘, ¢È·ÈÙÔÏfiÁÔÈ - ¢È·ÙÚÔÊÔÏfiÁÔÈ ∆Ì‹Ì·ÙÔ˜ ∂ÈÛÙ‹Ì˘ ¢È·ÈÙÔÏÔÁ›·˜-¢È·ÙÚÔÊ‹˜, ÷ÚÔÎÔ›Ԣ ¶·ÓÂÈÛÙËÌ›Ô˘

∞ı·Ó¿ÛÈÔ˜ ¶··ı·Ó·Û›Ô˘, π·ÙÚfi˜ - ∫·Ú‰ÈÔÏfiÁÔ˜, π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ ∂˘¿ÁÁÂÏÔ˜ ¶ÔÏ˘¯ÚÔÓfiÔ˘ÏÔ˜, ∂ÈÎ. ∫·ıËÁËÙ‹˜ ∆Ì‹Ì·ÙÔ˜ ∂ÈÛÙ‹Ì˘ ¢È·ÈÙÔÏÔÁ›·˜ ¢È·ÙÚÔÊ‹˜ ÷ÚÔÎÔ›Ԣ ¶·ÓÂÈÛÙËÌ›Ô˘

¢ËÌÔÛı¤Ó˘ ¶·Ó·ÁȈٿÎÔ˜, ∞Ó·Ï. ∫·ıËÁËÙ‹˜ ∆Ì‹Ì·ÙÔ˜ ∂ÈÛÙ‹Ì˘ ¢È·ÈÙÔÏÔÁ›·˜ ¢È·ÙÚÔÊ‹˜ ÷ÚÔÎÔ›Ԣ ¶·ÓÂÈÛÙËÌ›Ô˘

πˆ¿ÓÓ˘ °Ô˘‰¤‚ÂÓÔ˜, ∫·ıËÁËÙ‹˜, π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ ∂ÈÛ·ÁˆÁ‹ ∆· ηډȷÁÁÂȷο ÓÔÛ‹Ì·Ù· ·ÔÙÂÏÔ‡Ó ÙËÓ ÚÒÙË ·ÈÙ›· ı·Ó¿ÙÔ˘ fiÛÔÓ ·ÊÔÚ¿ ÙȘ ÌË ÌÂÙ·‰ÔÙÈΤ˜ ·Ûı¤ÓÂȘ, ηıÒ˜ ·ÔÙÂÏÔ‡Ó ÙÔ 30% fiÏˆÓ ÙˆÓ ı·Ó¿ÙˆÓ ·ÁÎÔÛÌ›ˆ˜ [1,2]. ™‡Ìʈӷ Ì ÙËÓ ∂ıÓÈ΋ ™Ù·ÙÈÛÙÈ΋ ÀËÚÂÛ›· Ù˘ ∂ÏÏ¿‰Ô˜ (∂™À∂) ÂÚ›Ô˘ 51600 ı¿Ó·ÙÔÈ (ÂÚ›Ô˘ 49%) Û ۇÓÔÏÔ 105529 ı·Ó¿ÙˆÓ, ÙÔ 2003 ÔÊ›ÏÔÓÙ·Ó Û ηډȷÁÁÂȷΤ˜ ·ı‹ÛÂȘ [3], ÂÓÒ Û‡Ìʈӷ Ì ÛÙÔȯ›· ÙÔ˘ ¶·ÁÎfiÛÌÈÔ˘ √ÚÁ·ÓÈÛÌÔ‡ ÀÁ›·˜, ÁÈ· ÙÔ ¤ÙÔ˜ 2002 ÔÈ Î·Ú‰È·ÁÁÂȷΤ˜ ·ı‹ÛÂȘ ‹Ù·Ó ÔÈ ÚÒÙ˜ ·Èٛ˜ ı·Ó¿ÙÔ˘ ÛÙËÓ ∂ÏÏ¿‰· Ì ÙÔ 35% ÙˆÓ ı·Ó¿ÙˆÓ Ó· ·Ô‰›‰ÔÓÙ·È Û ·˘Ù¤˜ [4, 5]. √È ¿Ó‰Ú˜ ÂÌÊ·Ó›˙Ô˘Ó ÌÂÁ·Ï‡ÙÂÚË ıÓËÛÈÌfiÙËÙ· ·fi ÙȘ Á˘Ó·›Î˜ Î·È ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ¯ÒÚ˜ Ù˘ ∂˘ÚÒ˘. ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ∂ÏÏ¿‰·, Ô Ú˘ıÌfi˜ ı·Ó¿ÙˆÓ ·Ú·Ì¤ÓÂÈ Û¯ÂÙÈο ÛÙ·ıÂÚfi˜ ·fi ÙÔ 1999 ̤¯ÚÈ ÙÔ 2005, ·ÓÙ›ıÂÙ· Ì ÙÔ Û‡ÓÔÏÔ ÙˆÓ ∂˘Úˆ·˚ÎÒÓ ¯ˆÚÒÓ fiÔ˘ Ô Ú˘ıÌfi˜ Ê·›ÓÂÙ·È Ó· ÌÂÈÒÓÂÙ·È [6]. ¶¿Óˆ ·fi 300 ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛÙ› Ì ٷ ηډȷÁÁÂȷο ÓÔÛ‹Ì·Ù·. ∫¿ÔÈÔÈ ·fi ÙÔ˘˜ ÛËÌ·ÓÙÈÎfiÙÂÚÔ˘˜ ·Ú¿ÁÔÓÙ˜, fiˆ˜ Ë ËÏÈΛ·, Â›Ó·È ÌË ÙÚÔÔÔÈ‹ÛÈÌÔÈ ÂÓÒ Î¿ÔÈÔÈ ¿ÏÏÔÈ Â›Ó·È ÙÚÔÔÔÈ‹ÛÈÌÔÈ Î·È ÌÔÚÔ‡Ó Ó· ÚÔÏËÊıÔ‡Ó ‹ Ó· ·ÓÙÈÌÂÙˆÈÛÙÔ‡Ó Ì ÛÎÔfi ÙË Ì›ˆÛË ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘. ∞fi ÙÔ Û‡ÓÔÏÔ ·˘ÙÒÓ ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÔÈ ÎÏ·ÛÛÈÎÔ› ·Ú¿ÁÔÓÙ˜, fiˆ˜ οÓÈÛÌ·, ˘ÂÚÏÈȉ·ÈÌ›·, ˘¤ÚÙ·ÛË Î·È Û·Î-

8

¯·Ú҉˘ ‰È·‚‹Ù˘ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙË Î·ıÈÛÙÈ΋ ˙ˆ‹ Î·È ÙËÓ ·Óı˘ÁÈÂÈÓ‹ ‰È·ÙÚÔÊ‹, ÈÛÙ‡ÂÙ·È fiÙÈ ÌÔÚÔ‡Ó Ó· ÂÍËÁ‹ÛÔ˘Ó Ì¤¯ÚÈ Î·È ÙÔ 75% ÙˆÓ ÂÂÈÛÔ‰›ˆÓ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ ÛÙ· ¿ÙÔÌ· ÂÓfi˜ ÏËı˘ÛÌÔ‡ [7-9]. ∞Ó·ÊÔÚÈο Ì ÙË ‰È·ÙÚÔÊ‹, ·ÔÙÂÏ› ȉȷ›ÙÂÚ· ÛËÌ·ÓÙÈÎfi ·Ú¿ÁÔÓÙ· ÛÙËÓ Â›ÙˆÛË ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ. ª¿ÏÈÛÙ·, ÔÏÏÔ› ·fi ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· Ù· ηډȷÁÁÂȷο ÓÔÛ‹Ì·Ù· ¤¯ÂÈ Ê·Ó› fiÙÈ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ‰È·ÙÚÔÊ‹ [9]. º·›ÓÂÙ·È, ÏÔÈfiÓ fiÙÈ Ë Â›‰Ú·Û‹ Ù˘ ‰È·ÙÚÔÊ‹˜ ÛÙËÓ Î·Ú‰È·ÁÁÂȷ΋ ÓfiÛÔ Â›Ó·È Ì¤Ûˆ Ù˘ ÙÚÔÔÔ›ËÛ˘ Ô˘ ÚÔηÏ› ÛÙȘ ÙÈ̤˜ ÙˆÓ ÏÈȉ›ˆÓ ÙÔ˘ ÔÚÔ‡, Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ Î·È Ù˘ ·¯˘Û·ÚΛ·˜ [10]. °È· ÂÚÈÛÛfiÙÂÚÔ ·fi 40 ¯ÚfiÓÈ·, ‰È¿ÊÔÚ˜ ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜, Î·È ÎÏÈÓÈΤ˜ ‰ÔÎÈ̤˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ÏËıÒÚ· ‰È·ÙÚÔÊÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÂËÚ¿˙Ô˘Ó Ù· ÏÈ›‰È· ÙÔ˘ ÔÚÔ‡, ÙËÓ ·ıËÚÔÁ¤ÓÂÛË Î·È ÙËÓ Î·Ú‰È·ÁÁÂȷ΋ ÓÔÛËÚfiÙËÙ·. √È Î˘ÚÈfiÙÂÚÔÈ ‰È·ÙÚÔÊÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ô˘ ÌÔÚÔ‡Ó Ó· ·˘Í‹ÛÔ˘Ó ÙÔ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ Â›Ó·È Ù· ÎÔÚÂṲ̂ӷ ÏÈ·Ú¿ Ôͤ·, Ù· trans-ÌÔÓÔ·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ·, Ë ‰È·ÈÙËÙÈ΋ ¯ÔÏËÛÙÂÚfiÏË, Ë ˘„ËÏ‹ ÚfiÛÏË„Ë ˘‰·Ù·ÓıÚ¿ÎˆÓ ¯·ÌËÏÒÓ ÛÂ Ê˘ÙÈΤ˜ ›Ó˜, Ë ˘„ËÏ‹ ÚfiÛÏË„Ë Ó·ÙÚ›Ô˘ Î·È Ë ˘ÂÚ‚ÔÏÈ΋ ηٷӿψÛË ·ÏÎÔfiÏ [1113]. ¶·ÚfiÏ· ·˘Ù¿, ÙËÓ ›‰È· ÛÙÈÁÌ‹ Ô˘ Ë ÂÈÛÙËÌÔÓÈ΋ ¤Ú¢ӷ Î·È ÔÈ ÁÓÒÛÂȘ ÁÈ· ÙË Û¯¤ÛË ‰È·ÙÚÔÊ‹˜ Ì ÙËÓ ˘Á›· ‰È¢ڇÓÔÓÙ·È ‰È·ÚÎÒ˜, Ô ÁÂÓÈÎfi˜ ÏËı˘ÛÌfi˜ ÂÌÊ·-

Ó›˙ÂÙ·È fiÏÔ Î·È ÈÔ ·ÓÂÓË̤ڈÙÔ˜ Û ı¤Ì·Ù· ‰È·ÙÚÔÊ‹˜. ª¿ÏÈÛÙ·, ·Ó Î·È Ë ·Óı˘ÁÈÂÈÓ‹ ‰È·ÙÚÔÊ‹ ¤¯ÂÈ ·Ó·‰Âȯı› ˆ˜ Ì›˙ˆÓ ·Ú¿ÁˆÓ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘, Ë ÛÙ¿ÛË Î·È ÔÈ ·ÓÙÈÏ‹„ÂȘ ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘ÛÌÔ‡ ·¤Ó·ÓÙÈ Û ·˘Ù‹ ÙËÓ ıÂÒÚËÛË ‰ÂÓ ¤¯ÂÈ ‰ÈÂÚ¢ÓËı›, ȉȷ›ÙÂÚ· ÛÙËÓ ∂ÏÏ¿‰·. °È· ÙÔ ÏfiÁÔ ·˘Ùfi Ë ∂ÏÏËÓÈ΋ ∂Ù·ÈÚ›· ∞ıËÚÔÛÎÏ‹ÚˆÛ˘ Ú·ÁÌ·ÙÔÔÈ› ·fi ÙÔ 2007 ÌÈ·, ÌÂÁ¿Ï˘ Îϛ̷η˜, ÂȉËÌÈÔÏÔÁÈ΋ ¤Ú¢ӷ Ì ÛÙfi¯Ô ÙËÓ Î·Ù·ÁÚ·Ê‹ ·ÓÙÈÏ‹„ÂˆÓ Û¯ÂÙÈ˙fiÌÂÓˆÓ Ì ÙÔ˘˜ ÎÏ·ÛÛÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘, ηıÒ˜ Î·È Ì ÙÔÓ Û‡Á¯ÚÔÓÔ ÙÚfiÔ ˙ˆ‹˜ Î·È ÙË ‰È·ÙÚÔÊ‹ ÂȉÈÎfiÙÂÚ·. ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜ Â›Ó·È Ë ·ÔÙ›ÌËÛË ÙˆÓ ÁÓÒÛÂˆÓ Î·È ÙˆÓ ·ÓÙÈÏ‹„ÂˆÓ ÙˆÓ ·ÙfiÌˆÓ ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘ÛÌÔ‡ Û ۯ¤ÛË Ì ÙË ‰È·ÙÚÔÊ‹ ˆ˜ ·Ú¿ÁÔÓÙ· ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘.

ªÂıÔ‰ÔÏÔÁ›· ¢Â›ÁÌ· Ù˘ ¤Ú¢ӷ˜ ∫·Ù¿ Ù· ¤ÙË 2007 Î·È 2008, Û˘ÏϤ¯ıËΠÏËÚÔÊÔÚ›· ·fi ¤Ó· Ù˘¯·›· ÂÈÏÂÁ̤ÓÔ ‰Â›ÁÌ· 3218 ÂÓ‹ÏÈÎˆÓ ·ÙfiÌˆÓ ·fi ‰È¿ÊÔÚ˜ fiÏÂȘ Ù˘ ∂ÏÏ¿‰·˜. ∞fi ÙÔ Û‡ÓÔÏÔ ·˘ÙÒÓ ÙˆÓ ·ÙfiÌˆÓ ÙÔ 44,4% (Ó=1428) Â›Ó·È ¿Ó‰Ú˜ ̤Û˘ ËÏÈΛ·˜ 40±16 ÂÙÒÓ Î·È ÙÔ 55,6% (Ó=1790) Â›Ó·È Á˘Ó·›Î˜ ̤Û˘ ËÏÈΛ·˜ 38±15 ÂÙÒÓ. ™˘ÁÎÂÎÚÈ̤ӷ, Ë ·ÚÔ‡Û· ‰ÂÈÁÌ·ÙÔÏË„›· ¤ÁÈÓ ÛÙÔ˘˜ ÓÔÌÔ‡˜: ∞ÙÙÈ΋˜, πˆ·ÓÓ›ÓˆÓ, ÕÚÙ·˜, ∏Ï›·˜, §·ÎˆÓ›·˜, ∞Ú牛·˜, ∞¯·˝·˜, §¿ÚÈÛ·˜, ƒfi‰Ô˘ Î·È Ã›Ô˘. ∆Ô ÙÂÏÈÎfi ‰Â›ÁÌ· Ù˘


ATHIROSK 21-

05-03-09

12:25

™ÂÏ›‰·9

∂¶π¢∏ªπ√§√°π∞ - ¶∞ƒ∞°√¡∆∂™ ∫π¡¢À¡√À ¤Ú¢ӷ˜ ı· ÂÚÈÏ·Ì‚¿ÓÂÈ 5000 ¿ÙÔÌ· ·fi fiÏË ÙË ¯ÒÚ·. ∂ÓÒ, ÙÔ ·ÚfiÓ ‰Â›ÁÌ· ¯ÚËÛÈ̇ÂÈ ÁÈ· ÙËÓ ÈÏÔÙÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ ÛÙÔȯÂÈÒÓ Ù˘ ¤Ú¢ӷ˜. ∏ ¤Ú¢ӷ ‰ÈÂÍ¿ÁÂÙ·È ˘fi ÙËÓ ·ÈÁ›‰· Ù˘ ∂ÏÏËÓÈ΋˜ ∂Ù·ÈÚ›·˜ ∞ıËÚÔÛÎÏ‹ÚˆÛ˘ Î·È Î·Ù¿ ÙË ‰ÂÈÁÌ·ÙÔÏË„›· ÙËÚ‹ıËÎ·Ó ÔÈ ·Ú¯¤˜ µÈÔËıÈ΋˜ Î·È ¢ÂÔÓÙÔÏÔÁ›·˜ ÙÔ˘ ¶·ÁÎfiÛÌÈÔ˘ √ÚÁ·ÓÈÛÌÔ‡ ÀÁ›·˜ (∂ÏÛ›ÓÎÈ 1989). ªÂÙÚ‹ÛÈÌ· ¯·Ú·ÎÙËÚÈÛÙÈο ¶ÂÚÈÁÚ·Ê‹ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ °È· ÙÔ˘˜ ÛÎÔÔ‡˜ Ù˘ ÌÂϤÙ˘ ¯ÚËÛÈÌÔÔÈ‹ıËΠ¤Ó· ÂȉÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÙÔ ÔÔ›Ô ÂÚÈÂÏ¿Ì‚·Ó 10 ÂÚˆÙ‹ÛÂȘ ÁÈ· ÙËÓ ·ÍÈÔÏfiÁËÛË ÙˆÓ ·ÓÙÈÏ‹„ÂˆÓ ÁÈ· ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ‰È·ÙÚÔÊ‹, ÙÔ È·ÙÚÈÎfi ÈÛÙÔÚÈÎfi, ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈο Î·È ¿ÏÏ· ·ÙÔÌÈο ÛÙÔȯ›·. ¶ÈÔ ·Ó·Ï˘ÙÈο: ∫ÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈο Î·È ¿ÏÏ· ·ÙÔÌÈο ÛÙÔȯ›· ŸÛÔÓ ·ÊÔÚ¿ Ù· ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈο Î·È Ù· ˘fiÏÔÈ· ·ÙÔÌÈο ÛÙÔȯ›·, Ì ‰‹ÏˆÛË ÙˆÓ ÂÚˆÙËı¤ÓÙˆÓ Î·Ù·ÁÚ¿ÊËÎÂ Ë ËÏÈΛ·, ÙÔ Ê‡ÏÔ, ηıÒ˜ Î·È ÙÔ ‚¿ÚÔ˜ ÙÔ˘˜ Î·È ÙÔ ‡„Ô˜ ÙÔ˘˜ Î·È Î·ÙfiÈÓ ˘ÔÏÔÁ›ÛÙËÎÂ Ô ¢ª™ (kg/m2). ∂›Û˘, Û˘ÏϤ¯ıËÎ·Ó ÏËÚÔÊÔڛ˜ ÁÈ· ÙËÓ ÔÈÎÔÁÂÓÂȷ΋ ηٿÛÙ·ÛË (¿Á·ÌÔ˜, ¤ÁÁ·ÌÔ˜, ‰È·˙¢Á̤ÓÔ˜, ¯‹ÚÔ˜), ÁÈ· ÙÔ Â¿ÁÁÂÏÌ· Ô˘ οÓÔ˘Ó (‰ËÌfiÛÈÔ˜ ˘¿ÏÏËÏÔ˜, ȉȈÙÈÎfi˜ ˘¿ÏÏËÏÔ˜, ÂχıÂÚÔ˜ Â·ÁÁÂÏÌ·Ù›·˜, ËÌÈ··Û¯ÔÏÔ‡ÌÂÓÔ˜, ¿ÓÂÚÁÔ˜/ Ë) Î·È ÁÈ· ÙÔ ÂÙ‹ÛÈÔ ·ÙÔÌÈÎfi ÂÈÛfi‰ËÌ· (<10.000 ∂, 10.001-20.000∂, 20.001-40.000∂, >40000∂). ∆Ô ÌÔÚʈÙÈÎfi Â›Â‰Ô ÙˆÓ ÂÚˆÙËı¤ÓÙˆÓ ÌÂÙÚ‹ıËΠ̠ٷ Û˘ÓÔÏÈο ¤ÙË ÛÔ˘‰ÒÓ. ∞ÎfiÌ·, ηٷÁÚ¿ÊËΠÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi Î·È ·ÙÔÌÈÎfi È·ÙÚÈÎfi ÈÛÙÔÚÈÎfi Û‡Ìʈӷ Ì ÙȘ ‰ËÏÒÛÂȘ ÙˆÓ ÂÚˆÙËı¤ÓÙˆÓ. ∞˘Ùfi ÂÚÈÏ¿Ì‚·Ó ÙËÓ ‡·ÚÍË ‹ fi¯È ‰È·ÁÓˆṲ̂Ó˘ ˘¤ÚÙ·Û˘, ۷ί·ÚÒ‰Ô˘˜ ‰È·‚‹ÙË, ‰˘ÛÏÈȉ·ÈÌ›·˜, ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ ‹ ¿ÏÏ˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘. ∏ ‡·ÚÍË ‹ fi¯È ·¯˘Û·ÚΛ·˜ ηıÔÚ›ÛÙËΠ̤ۈ ÙÔ˘ ¢ª™ (>29,9 kg/m2), Û‡Ìʈӷ Ì ٷ ÎÚÈÙ‹ÚÈ· ÙÔ˘ ¶·ÁÎfiÛÌÈÔ˘ √ÚÁ·ÓÈÛÌÔ‡ ÀÁ›·˜ (WHO, 1997). ∆¤ÏÔ˜, ˆ˜ ηÓÈÛÙ¤˜ ÔÚ›ÛÙËÎ·Ó ·˘ÙÔ› Ô˘ οÓÈ˙·Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ 1 ÙÛÈÁ¿ÚÔ/ Ë̤ڷ ‹ fiÛÔÈ ¤¯Ô˘Ó ‰È·Îfi„ÂÈ ÙÔ Î¿ÓÈÛÌ· ÏÈÁfiÙÂÚÔ ·fi ¤Ó· ¤ÙÔ˜ ÙË ÛÙÈÁÌ‹ Ù˘ Û˘ÌÏ‹-

ÚˆÛ˘ ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘. √È ÚÒËÓ Î·ÓÈÛÙ¤˜ ‹Ù·Ó ¿ÙÔÌ· Ô˘ ›¯·Ó ÛÙ·Ì·Ù‹ÛÂÈ ÙÔ Î¿ÓÈÛÌ· ÁÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 1 ¯ÚfiÓÔ, ÂÓÒ ÔÈ ÌË Î·ÓÈÛÙ¤˜ ‹Ù·Ó ·˘ÙÔ› Ô˘ ‰ÂÓ Â›¯·Ó ηÓ›ÛÂÈ ÔÙ¤. ∑ËÙ‹ıËÎ·Ó ÂÈÚfiÛıÂÙ˜ ÏËÚÔÊÔڛ˜ Û¯ÂÙÈο Ì ÙÔÓ ·ÚÈıÌfi ÙÛÈÁ¿ÚˆÓ ·Ó¿ Ë̤ڷ Î·È ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÂÙÒÓ Ô˘ ηÓ›˙Ô˘Ó ‹ ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÂÙÒÓ Ô˘ ‰È¤ÎÔ„·Ó ÙÔ Î¿ÓÈÛÌ· ÁÈ· ÂÚÈÛÛfiÙÂÚÔ ·fi ¤Ó· ¯ÚfiÓÔ. ∞ÓÙÈÏ‹„ÂȘ ÁÈ· ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ‰È·ÙÚÔÊ‹ √È ·ÓÙÈÏ‹„ÂȘ ÙˆÓ ·ÙfiÌˆÓ ÁÈ· ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ‰È·ÙÚÔÊ‹ ·ÍÈÔÏÔÁ‹ıËÎ·Ó Ì ‚¿ÛË 10 ÂȉÈΤ˜ ÂÚˆÙ‹ÛÂȘ. ¶ÈÔ ·Ó·Ï˘ÙÈο: Ë ÚÒÙË ÂÚÒÙËÛË ·ÊÔÚÔ‡Û ÙËÓ ·Óı˘ÁÈÂÈÓ‹ ‰È·ÙÚÔÊ‹ Î·È Î·Ù¿ fiÛÔ ÔÈ «Î·Î¤˜» ‰È·ÙÚÔÊÈΤ˜ Û˘Ó‹ıÂȘ ÌÔÚÔ‡Ó Ó· ıˆÚËıÔ‡Ó ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ηډȷÁÁÂȷΤ˜ ·ı‹ÛÂȘ. √È Èı·Ó¤˜ ··ÓÙ‹ÛÂȘ ‹Ù·Ó: fi¯È ηıfiÏÔ˘, Ó·È ·ÏÏ¿ ¤¯ÂÈ ˘ÂÚÂÎÙÈÌËı› ·fi ÙÔ˘˜ ‰È·ÈÙÔÏfiÁÔ˘˜, Ó·È ·ÏÏ¿ ‰ÂÓ Â›Ì·È Û›ÁÔ˘ÚÔ˜/Ë, Ó·È ·Ó·ÌÊÈÛ‚‹ÙËÙ·. ∏ ‰Â‡ÙÂÚË ÂÚÒÙËÛË ·ÊÔÚÔ‡Û ÙÔ ÂÏ·ÈfiÏ·‰Ô Î·È Î·Ù¿ fiÛÔ ·˘Ùfi ÌÔÚ› Ó· ÌÂÈÒÛÂÈ ÙÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ. √ Ù‡Ô˜ Ù˘ ·¿ÓÙËÛ˘ ‹Ù·Ó ÌÈ· Îϛ̷η ·fi 1 (ηıfiÏÔ˘) ¤ˆ˜ 4 (ÌÔÚ›). ∏ ÙÚ›ÙË ÂÚÒÙËÛË ·ÊÔÚÔ‡Û ٷ ÊÚÔ‡Ù· Î·È Ù· Ï·¯·ÓÈο Î·È Î·Ù¿ fiÛÔ ·˘Ù¿ ÌÔÚÔ‡Ó Ó· ÌÂÈÒÛÔ˘Ó ÙÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ. √ Ù‡Ô˜ Ù˘ ·¿ÓÙËÛ˘ ‹Ù·Ó fiÌÔÈÔ˜ Ì ·˘ÙfiÓ Ù˘ ÚÔËÁÔ‡ÌÂÓ˘ ÂÚÒÙËÛ˘. ∏ ٤ٷÚÙË ÂÚÒÙËÛË ·ÊÔÚÔ‡Û ٷ Û˘ÌÏËÚÒÌ·Ù· ‰È·ÙÚÔÊ‹˜ Î·È Î·Ù¿ fiÛÔ ·˘Ù¿ ÌÔÚÔ‡Ó Ó· ÌÂÈÒÛÔ˘Ó ÙÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ. √ Ù‡Ô˜ Ù˘ ·¿ÓÙËÛ˘ ‹Ù·Ó fiÌÔÈÔ˜ Ì ·˘ÙfiÓ Ù˘ ÚÔËÁÔ‡ÌÂÓ˘ ÂÚÒÙËÛ˘. ∏ ¤ÌÙË ÂÚÒÙËÛË ·ÊÔÚÔ‡Û ÙȘ ÁÓÒÛÂȘ ÁÈ· ÙË Û¯¤ÛË Ù˘ ‰È·ÙÚÔÊ‹˜ Ì ÙËÓ ˘Á›·. √ Ù‡Ô˜ Ù˘ ·¿ÓÙËÛ˘ ‹Ù·Ó ÌÈ· Îϛ̷η ·fi ÙÔ 1 (ηıfiÏÔ˘) ¤ˆ˜ 4 (·ÚÎÂÙ¿). ∏ ¤ÎÙË ÂÚÒÙËÛË ·ÍÈÔÏÔÁÔ‡Û ÔÈÔ ÚfiÙ˘Ô ‰È·ÙÚÔÊ‹˜ ÂÊ·ÚÌfi˙Ô˘Ó ÛÙÔ ÓÔÈÎÔ΢ÚÈfi ÙÔ˘˜ ÔÈ ÂÚˆÙËı¤ÓÙ˜. √È Èı·Ó¤˜ ··ÓÙ‹ÛÂȘ ‹Ù·Ó ÌÂÈÎÙ‹, ÌÂÛÔÁÂȷ΋ ÎÔ˘˙›Ó·, ‰˘ÙÈÎÔ‡ Ù‡Ô˘ (·˘ÍË̤ÓÔ ÎÚ¤·˜), ¿ÏÏË. ∏ ¤‚‰ÔÌË ÂÚÒÙËÛË ·Ó·ÊÂÚfiÙ·Ó ÛÙȘ ‰È¿ÊÔÚ˜ Ì·ÚÁ·Ú›Ó˜ ÌÂ Ê˘ÙÈΤ˜ ÛÙÂÚfiϘ Î·È Î·Ù¿ fiÛÔ ›ÛÙ¢·Ó fiÙÈ ÌÔÚÔ‡Ó Ó· ÌÂÈÒÛÔ˘Ó Ù· ÏÈ›‰È· Î·È ÙÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ. √ Ù‡Ô˜ Ù˘ ·¿ÓÙËÛ˘ ‹Ù·Ó

ÌÈ· Îϛ̷η ·fi ÙÔ 1 (ηıfiÏÔ˘) ¤ˆ˜ 4 (·ÚÎÂÙ¿). ∏ fiÁ‰ÔË ÂÚÒÙËÛË ·ÊÔÚÔ‡Û ÙÔ ÛËÌ·ÓÙÈÎfiÙÂÚÔ Û˘ÛÙ·ÙÈÎfi ÌÈ·˜ ˘ÁÈÂÈÓ‹˜ ‰È·ÙÚÔÊ‹˜ Ì Èı·Ó¤˜ ··ÓÙ‹ÛÂȘ: Ù· ÌÔÓÔ·ÎfiÚÂÛÙ· ÏÈ·Ú¿, ÙȘ Ê˘ÙÈΤ˜ ›Ó˜, ÙȘ ·ÓÙÈÔÍÂȉˆÙÈΤ˜ Ô˘Û›Â˜, Ù· ÌÈÎÚ¿ Î·È Û˘¯Ó¿ Á‡̷ٷ Î·È ÙËÓ ÔÈÎÈÏ›· ÙÚÔÊÒÓ. ∏ ¤Ó·ÙË ÂÚÒÙËÛË ·ÊÔÚÔ‡Û ÙËÓ ·ÁÔÚ¿ ÙÚÔÊ›ÌˆÓ Î·È ÙÔ Ì¤ÚÔ˜ ÙÔ ÔÔ›Ô ıˆÚÂ›Ù·È ÙÔ ·ÛʷϤÛÙÂÚÔ ÁÈ· ÙËÓ ·ÁÔÚ¿ ÙÔ˘˜. √È Èı·Ó¤˜ ··ÓÙ‹ÛÂȘ ‹Ù·Ó Ù· ÛÔ‡ÂÚ Ì¿ÚÎÂÙ, Ë Ï·˚΋, Ù· ÌÈÎÚ¿ ÂÌÔÚÈο Ù˘ ÁÂÈÙÔÓÈ¿˜ Î·È Ë ‰È΋ ÙÔ˘˜ ‹ ÊÈÏÈ΋ ·Ú·ÁˆÁ‹. ∏ ‰¤Î·ÙË Î·È ÙÂÏÂ˘Ù·›· ÂÚÒÙËÛË ·ÊÔÚÔ‡Û ÔÈÔÓ ıˆÚÔ‡Ó ÔÈ ÂÚˆÙÒÌÂÓÔÈ ÙÔÓ ÛËÌ·ÓÙÈÎfiÙÂÚÔ ‰È·ÙÚÔÊÈÎfi ΛӉ˘ÓÔ fiÛÔÓ ·ÊÔÚ¿ Ù· ηډȷÁÁÂȷο ÓÔÛ‹Ì·Ù·. √È Èı·Ó¤˜ ··ÓÙ‹ÛÂȘ ‹Ù·Ó: ·Ï¿ÙÈ, ˙¿¯·ÚË, ÎÔÚÂṲ̂ӷ Ï›Ë, ¿Ì˘ÏÔ, ·ÏÎÔfiÏ. ™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË √È Û˘Ó¯›˜ ÌÂÙ·‚ÏËÙ¤˜ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ˆ˜ ̤ÛÔ˜ fiÚÔ˜ ± ÌÈ· Ù˘È΋ ·fiÎÏÈÛË, ÂÓÒ ÔÈ Î·ÙËÁÔÚÈΤ˜ ÌÂÙ·‚ÏËÙ¤˜ ˆ˜ Û¯ÂÙÈΤ˜ Û˘¯ÓfiÙËÙ˜. ∆Ô Â›Â‰Ô Ù˘ ÛÙ·ÙÈÛÙÈ΋˜ ÛËÌ·ÓÙÈÎfiÙËÙ·˜ ÔÚ›ÛÙËΠÛÙÔ 5%. °È· ÙËÓ Î·Ï‡ÙÂÚË ·ÚÔ˘Û›·ÛË ÙˆÓ ÂÚÈÁÚ·ÊÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙˆÓ ·ÙfiÌˆÓ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ Ù· ·ÔÙÂϤÛÌ·Ù· ‰È·¯ˆÚ›ÛÙËÎ·Ó ÁÈ· ÙÔ˘˜ ¿Ó‰Ú˜ Î·È ÙȘ Á˘Ó·›Î˜. °È· ÙȘ Û˘Û¯ÂÙ›ÛÂȘ ÙÔ˘ ʇÏÔ˘ Î·È ÙˆÓ ÔÛÔÙÈÎÒÓ ÌÂÙ·‚ÏËÙÒÓ (ËÏÈΛ·, ‚¿ÚÔ˜, ‡„Ô˜, ¢ª™) ¯ÚËÛÈÌÔÔÈ‹Û·Ì ÙÔ Student's t-test, ÂÓÒ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ Û¯¤Û˘ ÙÔ˘ ʇÏÔ˘ Î·È ÙˆÓ ÔÈÔÙÈÎÒÓ ÌÂÙ·‚ÏËÙÒÓ (ÔÈÎÔÁÂÓÂȷ΋ ηٿÛÙ·ÛË, ÌÔÚʈÙÈÎfi Â›‰Ô, ÂÙ‹ÛÈÔ ·ÙÔÌÈÎfi ÂÈÛfi‰ËÌ·, ȉÈfiÎÙËÙË Î·ÙÔÈΛ·, Â¿ÁÁÂÏÌ·) ¯ÚËÛÈÌÔÔÈ‹ıËΠÙÔ ¯2-ÎÚÈÙ‹ÚÈÔ. ∆Ô ÛÙ·ÙÈÛÙÈÎfi ÚfiÁÚ·ÌÌ· SPSS (¤Î‰ÔÛË 13.0) ¯ÚËÛÈÌÔÔÈ‹ıËΠÁÈ· fiÏÔ˘˜ ÙÔ˘˜ ˘ÔÏÔÁÈÛÌÔ‡˜.

∞ÔÙÂϤÛÌ·Ù· √ ¶›Ó·Î·˜ 1 ÂÚÈÁÚ¿ÊÂÈ Ù· ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·ÙfiÌˆÓ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜. ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÔÈÎÔÁÂÓÂȷ΋ ηٿÛÙ·ÛË ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜, Ù· ÔÛÔÛÙ¿ ÌÂٷ͇ ·ÓÙÚÒÓ Î·È Á˘Ó·ÈÎÒÓ ‰ÂÓ ‰È·Ê¤ÚÔ˘Ó Ôχ Ì ÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜ Ó· ‰ËÏÒÓÔ˘Ó ¿Á·ÌÔÈ ‹ ¤ÁÁ·ÌÔÈ. ∞Ó·ÊÔÚÈο Ì ÙÔ ÌÔÚʈÙÈÎfi Â›Â‰Ô ÔÈ ¿Ó‰Ú˜ Ê·›ÓÂÙ·È Ó· ˘ÂÚ¤¯Ô˘Ó ÂÏ·ÊÚ¿ ¤Ó·ÓÙÈ ÙˆÓ Á˘Ó·ÈÎÒÓ. ∂›-

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¶›Ó·Î·˜ 1. ∫ÔÈÓˆÓÈÎfi-‰ËÌÔÁÚ·ÊÈο ÛÙÔȯ›· ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜.

¡ ∏ÏÈΛ· (¤ÙË) ŒÙË ÛÔ˘‰ÒÓ √ÈÎÔÁÂÓÂȷ΋ ηٿÛÙ·ÛË, % ÕÁ·ÌÔÈ ŒÁÁ·ÌÔÈ ¢È·˙¢Á̤ÓÔÈ Ã‹ÚÔÈ ∂Ù‹ÛÈÔ ÂÈÛfi‰ËÌ·, % <10000 10001-20000 20001-40000 >40000 ∂·ÁÁÂÏÌ·ÙÈ΋ ηٿÛÙ·ÛË % ¢ËÌfiÛÈÔ˜ ˘¿ÏÏËÏÔ˜ π‰ÈˆÙÈÎfi˜ ˘¿ÏÏËÏÔ˜ ∂χıÂÚÔ˜ Â·ÁÁÂÏÌ·Ù›·˜ ∏ÌÈ··Û¯fiÏËÛË ÕÓÂÚÁÔ˜ Û˘, fiÛÔÓ ·ÊÔÚ¿ ÛÙÔ ÂÙ‹ÛÈÔ ·ÙÔÌÈÎfi ÂÈÛfi‰ËÌ·, ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÙˆÓ Á˘Ó·ÈÎÒÓ Â›Ó·È ¯·ÌËÏfiÌÈÛı˜ Û ۯ¤ÛË Ì ÙÔ˘˜ ¿Ó‰Ú˜, ÂÓÒ ÌÂÁ·Ï‡ÙÂÚÔ Â›Ó·È ÙÔ ÔÛÔÛÙfi ÙˆÓ Á˘Ó·ÈÎÒÓ Ô˘ Â›Ó·È ¿ÓÂÚÁ˜ Û ۯ¤ÛË Ì ÙÔ˘˜ ¿Ó‰Ú˜. ™ÙÔÓ ¶›Ó·Î· 2 Ê·›ÓÂÙ·È Ô ÂÈÔÏ·ÛÌfi˜ ÙˆÓ Î˘ÚÈfiÙÂÚˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ· Ù· ηډȷÁÁÂȷο ÓÔÛ‹Ì·Ù·, ·ÏÏ¿ Î·È ÁÂÓÈÎfiÙÂÚ· ÛÙÔȯ›· ÁÈ· ÙÔ È·ÙÚÈÎfi ÈÛÙÔÚÈÎfi ÙˆÓ Û˘ÌÌÂÙ¯fiÓÙˆÓ. Ÿˆ˜ Ê·›ÓÂÙ·È, ÔÈ ¿Ó‰Ú˜ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ηÓ›˙Ô˘Ó ÂÚÈÛÛfiÙÂÚÔ ·fi ÙȘ Á˘Ó·›Î˜ Î·È ÂÌÊ·Ó›˙Ô˘Ó ·¯˘Û·ÚΛ· Û ÌÂÁ·Ï‡ÙÂÚÔ

ÕÓ‰Ú˜

°˘Ó·›Î˜

1428 40±16 13,43±4

1790 38±16 13,32±3,8

42,6% 51,5% 4,7% 1,2%

44,2% 45,9% 4,9% 5,0%

27,7% 38,9% 25,8% 7,7%

46,6% 37,9% 12,9% 2,6%

28,3% 29,7% 24,4% 4,7% 12,9%

22,6% 30,4% 13,0% 9,6% 24,5%

P

<0,001 <0,001 <0,001

<0,001

<0,001

ÔÛÔÛÙfi ·fi ·˘Ù¤˜. ∂›Û˘, ‰ËÏÒÓÔ˘Ó fiÙÈ ¤¯Ô˘Ó ‰È·ÁÓˆṲ̂ÓË ·ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË Î·È ‰˘ÛÏÈȉ·ÈÌ›· Û ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi Û ۯ¤ÛË Ì ÙȘ Á˘Ó·›Î˜. ™ÙÔÓ ¶›Ó·Î· 3 Ê·›ÓÔÓÙ·È ÔÈ ·ÓÙÈÏ‹„ÂȘ Î·È ÔÈ ÛÙ¿ÛÂȘ ÙˆÓ ·ÙfiÌˆÓ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ·Ó·ÊÔÚÈο Ì ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ‰È·ÙÚÔÊ‹. ∞Ú¯Èο, ÙÔ 72,6% ÙˆÓ ·Ó‰ÚÒÓ Î·È ÙÔ 80,5% ÙˆÓ Á˘Ó·ÈÎÒÓ Â›Ó·È ·fiÏ˘Ù· Û›ÁÔ˘ÚÔÈ fiÙÈ Ë ·Óı˘ÁÈÂÈÓ‹ ‰È·ÙÚÔÊ‹ Â›Ó·È ·Ú¿ÁÔÓÙ·˜ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘. ∂›Û˘, Î·È Ù· ‰‡Ô ʇϷ Û˘ÌʈÓÔ‡Ó fiÙÈ ÙfiÛÔ ÙÔ ÂÏ·ÈfiÏ·‰Ô (83,9% ÔÈ ¿Ó‰Ú˜,

¶›Ó·Î·˜ 2. ∫ÏÈÓÈο Î·È ·ÓıÚˆÔÌÂÙÚÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜.

ÕÓ‰Ú˜ ¡ ∫¿ÓÈÛÌ· ÙÒÚ·, % ∆ÛÈÁ¿Ú· / Ë̤ڷ ∞ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË, %

P

1428

1790

43,2%

37,0%

<0,001

13,7±14,7

8,9±11,4

<0,001

19,3%

12,3%

<0,001

™·Î¯·Ú҉˘ ‰È·‚‹Ù˘, %

5,1%

5,3%

0,742

¢˘ÛÏÈȉ·ÈÌ›·, %

12,5%

9,3%

0,003

26,4±3,97

23,95±4,36

<0,001

¶·¯˘Û·ÚΛ·, %

16,2%

10,7%

<0,001

πÛÙÔÚÈÎfi ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘, %

4,1%

1,7%

<0,001

¢Â›ÎÙ˘ ª¿˙·˜ ™ÒÌ·ÙÔ˜ (kg/m2)

10

°˘Ó·›Î˜

ÕÏÏË Î·Ú‰È·ÁÁÂȷ΋ ÓfiÛÔ˜, %

4,4%

4,5%

0,946

√ÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘, %

31,2%

37,5%

<0,001

86,9% ÔÈ Á˘Ó·›Î˜) fiÛÔ Î·È Ù· ÊÚÔ‡Ù· Î·È Ù· Ï·¯·ÓÈο (92,4% ÔÈ ¿Ó‰Ú˜, 94,1% ÔÈ Á˘Ó·›Î˜) ÌÔÚÔ‡Ó Ó· ÌÂÈÒÛÔ˘Ó ÙÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ. ŸÌˆ˜, ÛÙËÓ ÂÚ›ÙˆÛË ÙˆÓ Û˘ÌÏËÚˆÌ¿ÙˆÓ ‰È·ÙÚÔÊ‹˜ (.¯. ‚Èٷ̛Ә), ¤Ó· ÌÂÁ¿ÏÔ ÔÛÔÛÙfi Î·È ÙˆÓ ‰‡Ô Ê‡ÏˆÓ (36,2% ÔÈ ¿Ó‰Ú˜ Î·È 37,1% ÔÈ Á˘Ó·›Î˜) ıˆÚ› Ï·Óı·Ṳ̂ӷ fiÙÈ ·˘Ù¿ ÌÔÚÔ‡Ó Ó· ÌÂÈÒÛÔ˘Ó ÙÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ. ™ËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ‰‡Ô Ê‡ÏˆÓ Ê·›ÓÂÙ·È Ó· ˘¿Ú¯ÂÈ ÛÙËÓ ÂÚÒÙËÛË Ô˘ ·ÊÔÚ¿ ÙȘ ÁÓÒÛÂȘ Ô˘ Ù· ¿ÙÔÌ· ıˆÚÔ‡Ó fiÙÈ ¤¯Ô˘Ó fiÛÔÓ ·ÊÔÚ¿ ÙË Û¯¤ÛË ‰È·ÙÚÔÊ‹˜ Î·È ˘Á›·˜, Ì ÙȘ Á˘Ó·›Î˜ Ó· ˘ÂÚÙÂÚÔ‡Ó Û ۯ¤ÛË Ì ÙÔ˘˜ ¿Ó‰Ú˜ (81,8% ÔÈ Á˘Ó·›Î˜, 69% ÔÈ ¿Ó‰Ú˜). ∂›Û˘, ÔÈ Á˘Ó·›Î˜ ·ÎÔÏÔ˘ıÔ‡Ó Û ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÙÔ ÌÂÛÔÁÂÈ·Îfi ÚfiÙ˘Ô ‰È·ÙÚÔÊ‹˜ (52%) Û ۯ¤ÛË Ì ÙÔ˘˜ ¿Ó‰Ú˜ (39,8%). ∆Ô 55,1% ÙˆÓ ·Ó‰ÚÒÓ Î·È ÙÔ 51% ÙˆÓ Á˘Ó·ÈÎÒÓ ıˆÚÔ‡Ó fiÙÈ ÔÈ ‰È¿ÊÔÚ˜ Ì·ÚÁ·Ú›Ó˜ ÌÂ Ê˘ÙÈΤ˜ ÛÙÂÚfiϘ ‰ÂÓ ÌÔÚÔ‡Ó Ó· ÌÂÈÒÛÔ˘Ó Ù· ÏÈ›‰È· Î·È ÙÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ. ∞ÎfiÌ·, ·Ó ıˆڋÛÔ˘Ì ٷ ÌÔÓÔ·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ·, ÙȘ Ê˘ÙÈΤ˜ ›Ó˜ Î·È ÙȘ ·ÓÙÈÔÍÂȉˆÙÈΤ˜ Ô˘Û›Â˜ ˆ˜ Ù· ÛËÌ·ÓÙÈÎfiÙÂÚ· Û˘ÛÙ·ÙÈο ÌÈ·˜ ˘ÁÈÂÈÓ‹˜ ‰È·ÙÚÔÊ‹˜, ÙÔ 73% ÙˆÓ ·Ó‰ÚÒÓ Î·È ÙÔ 75,1% ÙˆÓ Á˘Ó·ÈÎÒÓ Ê·›ÓÂÙ·È Ó· ··ÓÙ¿ Ï·Óı·Ṳ̂ӷ ÛÙËÓ Û˘ÁÎÂÎÚÈ̤ÓË ÂÚÒÙËÛË. ª¿ÏÈÛÙ·, Ù· ÔÛÔÛÙ¿ ·˘Ù¿ ÙˆÓ ·Ó‰ÚÒÓ Î·È ÙˆÓ Á˘Ó·ÈÎÒÓ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ·ÓÙ›ÛÙÔȯ· ıˆÚÔ‡Ó ÛËÌ·ÓÙÈÎfiÙÂÚ· Ù· ÌÈÎÚ¿ Î·È Û˘¯Ó¿ Á‡̷ٷ Î·È ÙËÓ ÔÈÎÈÏ›· ÙÚÔʛ̈Ó. ŒÓ· ¿ÏÏÔ ÛËÌ·ÓÙÈÎfi ‡ÚËÌ· Â›Ó·È fiÙÈ ÙÔ 68,9% ÙˆÓ ·Ó‰ÚÒÓ Î·È ÙÔ 70% ÙˆÓ Á˘Ó·ÈÎÒÓ ıˆÚÔ‡Ó fiÙÈ Ë ÚÔÛˆÈ΋ ‹ Ë ÊÈÏÈ΋ ·Ú·ÁˆÁ‹ ·ÔÙÂÏ› ÙËÓ ·ÛʷϤÛÙÂÚË ·ÁÔÚ¿ ÙÚÔÊ›ÌˆÓ ∆¤ÏÔ˜, ÙÔ 69,3% ÙˆÓ ·Ó‰ÚÒÓ Î·È ÙÔ 71,6% ÙˆÓ Á˘Ó·ÈÎÒÓ ıˆÚÔ‡Ó ÙÔ ·Ï¿ÙÈ Î·È Ù· ÎÔÚÂṲ̂ӷ Ï›Ë ˆ˜ ÙÔ ÛËÌ·ÓÙÈÎfiÙÂÚÔ ‰È·ÙÚÔÊÈÎfi ΛӉ˘ÓÔ ÁÈ· Ù· ηډȷÁÁÂȷο ÓÔÛ‹Ì·Ù·.

™˘˙‹ÙËÛË ∏ ·ÚÔ‡Û· ‰ÂÈÁÌ·ÙÔÏËÙÈ΋ ¤Ú¢ӷ, ÁÈ· ÚÒÙË ÊÔÚ¿ ÛÙËÓ ∂ÏÏ¿‰·, ÂȯÂÈÚ› ÙËÓ ·ÔÙ‡ˆÛË Ù¿ÛÂˆÓ Î·È ·ÓÙÈÏ‹„ÂˆÓ ·¤Ó·ÓÙÈ ÛÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘. ™ÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ¿ÚıÚÔ ÙÔ ÂӉȷʤÚÔÓ ÂÛÙÈ¿ÛÙËΠÛÙË


ATHIROSK 21-

05-03-09

12:25

™ÂÏ›‰·11

∂¶π¢∏ªπ√§√°π∞ - ¶∞ƒ∞°√¡∆∂™ ∫π¡¢À¡√À

¶›Ó·Î·˜ 3. ∞ÓÙÈÏ‹„ÂȘ ÁÈ· ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ‰È·ÙÚÔÊ‹

ÕÓ‰Ú˜ ¶ÈÛÙ‡ÂÙ fiÙÈ ÔÈ «Î·Î¤˜» ‰È·ÙÚÔÊÈΤ˜ Û˘Ó‹ıÂȘ Â›Ó·È ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ηډȷÁÁÂȷΤ˜ ·ı‹ÛÂȘ; % ∫·ıfiÏÔ˘ ¡·È, ·ÏÏ¿ ¤¯ÂÈ ˘ÂÚÂÎÙÈÌËı› ·fi ‰È·ÈÙÔÏfiÁÔ˘˜ ¡·È, ·ÏÏ¿ ‰ÂÓ Â›Ì·È Ôχ Û›ÁÔ˘ÚÔ˜ ¡·È, ·Ó·ÌÊÈÛ‚‹ÙËÙ· ¶ÈÛÙ‡ÂÙ fiÙÈ Ë Î·Ù·Ó¿ÏˆÛË ÂÏ·ÈÔÏ¿‰Ô˘ ÌÔÚ› Ó· ÌÂÈÒÛÂÈ ÙÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi Û·˜ ΛӉ˘ÓÔ; ∫·ıfiÏÔ˘ §›ÁÔ ∞ÚÎÂÙ¿ ¶Ôχ ¶ÈÛÙ‡ÂÙ fiÙÈ Ë Î·Ù·Ó¿ÏˆÛË ÊÚÔ‡ÙˆÓ & Ï·¯·ÓÈÎÒÓ ÌÔÚ› Ó· ÌÂÈÒÛÂÈ ÙÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi Û·˜ ΛӉ˘ÓÔ; ∫·ıfiÏÔ˘ §›ÁÔ ∞ÚÎÂÙ¿ ¶Ôχ ¶ÈÛÙ‡ÂÙ ·Ó Ù· Û˘ÌÏËÚÒÌ·Ù· ‰È·ÙÚÔÊ‹˜ (.¯. ‚Èٷ̛Ә) ÌÔÚÔ‡Ó Ó· ÌÂÈÒÛÔ˘Ó ÙÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi Û·˜ ΛӉ˘ÓÔ; ∫·ıfiÏÔ˘ §›ÁÔ ∞ÚÎÂÙ¿ ¶Ôχ ¶fiÛÔ ÈÛÙ‡ÂÙ fiÙÈ ÁÓˆÚ›˙ÂÙ ÁÈ· ÙËÓ ‰È·ÙÚÔÊ‹; ∫·ıfiÏÔ˘ §›ÁÔ ∞ÚÎÂÙ¿ ¶Ôχ ∂Ê·ÚÌfi˙ÂÙ οÔÈÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ÚfiÙ˘Ô ‰È·ÙÚÔÊ‹˜ ÛÙÔ ÓÔÈÎÔ΢ÚÈfi Û·˜.% Ÿ¯È, ·ÎÔÏÔ˘ıÒ ÌÈÎÙ‹ ªÂÛÔÁÂȷ΋ ÎÔ˘˙›Ó· ¢˘ÙÈÎÔ‡ Ù‡Ô˘ (·˘ÍË̤ÓÔ ÎÚ¤·˜) ÕÏÏË ¶ÈÛÙ‡ÂÙ fiÙÈ ÔÈ ‰È¿ÊÔÚ˜ Ì·ÚÁ·Ú›Ó˜ ÌÂ Ê˘ÙÈΤ˜ ÛÙÂÚfiϘ ÌÔÚÔ‡Ó Ó· ÌÂÈÒÛÔ˘Ó Ù· ÏÈ›‰È· Î·È ÙÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi Û·˜ ΛӉ˘ÓÔ; ∫·ıfiÏÔ˘ §›ÁÔ ∞ÚÎÂÙ¿ ¶Ôχ ¶ÔÈÔ ÙÔ ÛËÌ·ÓÙÈÎfiÙÂÚÔ Û˘ÛÙ·ÙÈÎfi ÌÈ·˜ ˘ÁÈÂÈÓ‹˜ ‰È·ÙÚÔÊ‹˜;% ªfiÓÔ-·ÎfiÚÂÛÙ· ÏÈ·Ú¿ º˘ÙÈΤ˜ ›Ó˜ ∞ÓÙÈÔÍÂȉˆÙÈΤ˜ Ô˘Û›Â˜ ªÈÎÚ¿ Î·È Û˘¯Ó¿ Á‡̷ٷ ¶ÔÈÎÈÏ›· ÙÚÔÊÒÓ ¶ÈÛÙ‡ÂÙ fiÙÈ Â›Ó·È ÈÔ ·ÛÊ·Ï‹˜ Ë ·ÁÔÚ¿ ÙÚÔʛ̈Ó% ·fi Ù· ™Ô‡ÂÚ Ì¿ÚÎÂÙ ·fi ÙËÓ Ï·˚΋ ·fi Ù· ÌÈÎÚ¿ ÂÌÔÚÈο Ù˘ ÁÂÈÙÔÓÈ¿˜ ·fi ‰È΋ Û·˜ ‹ ÊÈÏÈ΋ ·Ú·ÁˆÁ‹ ¶ÔÈÔ˜ Â›Ó·È Î·Ù¿ ÙËÓ ÁÓÒÌË Û·˜ Ô ÛËÌ·ÓÙÈÎfiÙÂÚÔ˜ ‰È·ÙÚÔÊÈÎfi˜ ΛӉ˘ÓÔ˜;% ∞Ï¿ÙÈ ∑¿¯·ÚË ∫ÔÚÂṲ̂ӷ Ï›Ë ÕÌ˘ÏÔ ∞ÏÎÔfiÏ

°˘Ó·›Î˜

P <0,001

1,2% 9,8% 16,5% 72,6%

0,2% 8,3% 11,0% 80,5%

3,1% 13% 58% 25,9%

1,9 11,1% 62% 24,9%

1,3% 6,3% 53,4% 39%

0,6% 5,3% 53,2% 40,9%

22,2% 41,3% 30,3% 6,2%

22,9% 40% 32,1% 5%

6,4% 24,6% 55,4% 13,6%

2,2% 16% 61,4% 20,4%

38,8% 39,8% 15,2% 6,2%

34,6% 52,0% 9,1% 4,4%

13,9% 41,2% 40,5% 5%

12,6% 38,4% 42,5% 6,5%

4,0% 13,3% 9,7% 27,6% 45,4%

3,1% 13,8% 8,0% 34,8% 40,3%

14,1% 10,7% 6,3% 68,9%

13,1% 12,8% 4,2% 70,0%

17,7% 8,6% 51,6% 0,8% 21,4%

16,5% 7,6% 55,1% 0,8% 19,9%

0,024

0,113

0,358

<0,001

<0,001

0,081

<0,001

0,015

0,380

11


ATHIROSK 21-

05-03-09

12:25

ª ∞ ƒ ∆ π √ ™

™ÂÏ›‰·12

2 0 0 9

‰È·ÙÚÔÊ‹. Ÿˆ˜ Ê¿ÓËΠ·fi ÙËÓ ·Ó¿Ï˘ÛË ÙˆÓ ÛÙÔȯ›ˆÓ, ÌÂÁ¿ÏÔ Ì¤ÚÔ˜ ÙˆÓ ÂÚˆÙËı¤ÓÙˆÓ Â›¯Â ¿ÁÓÔÈ· ÁÈ· ÙȘ ‚·ÛÈΤ˜ ‰È·ÙÚÔÊÈΤ˜ Û˘ÛÙ¿ÛÂȘ, ·Ó·‰ÂÈÎÓ‡ÔÓÙ·˜ ÙÔ ¯·ÌËÏfi Â›Â‰Ô ÁÓÒÛ˘ ÙˆÓ ·ÙfiÌˆÓ fiÛÔÓ ·ÊÔÚ¿ ÙË ÛˆÛÙ‹ ‰È·ÙÚÔÊ‹ Ô˘ Ú¤ÂÈ Ó· ·ÎÔÏÔ˘ı‹ÛÔ˘Ó ÁÈ· ÙËÓ ÚfiÏË„Ë ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ. Ÿˆ˜ Ê·›ÓÂÙ·È ·fi ÙËÓ ·Ó¿Ï˘ÛË ÙˆÓ ÛÙÔȯ›ˆÓ, ÔÈ Á˘Ó·›Î˜ Ù›ÓÔ˘Ó Ó· Â›Ó·È ÈÔ Â˘·ÈÛıËÙÔÔÈË̤Ó˜ ·fi ÙÔ˘˜ ¿Ó‰Ú˜, ηıÒ˜ ‰ËÏÒÓÔ˘Ó Û ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi fiÙÈ ÁÓˆÚ›˙Ô˘Ó ·ÚÎÂÙ¿ ÁÈ· ÙË Û¯¤ÛË ‰È·ÙÚÔÊ‹˜ Î·È ˘Á›·˜. ª¿ÏÈÛÙ·, ÔÈ Á˘Ó·›Î˜ Ê·›ÓÂÙ·È Ó· ˘ÈÔıÂÙÔ‡Ó Û ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÙÔ «ÌÂÛÔÁÂÈ·Îfi ÚfiÙ˘Ô» ‰È·ÙÚÔÊ‹˜ ÛÙÔ ÓÔÈÎÔ΢ÚÈfi ÙÔ˘˜, ¤Ó· ÚfiÙ˘Ô ‰È·ÙÚÔÊ‹˜ Ô˘ fiˆ˜ ¤¯ÂÈ Ê·Ó› ·fi ÏËıÒÚ· ÌÂÏÂÙÒÓ, ¤¯ÂÈ Î·Ú‰ÈÔÚÔÛٷ٢ÙÈ΋ ‰Ú¿ÛË. ™ËÌ·ÓÙÈÎfi Â›Ó·È Î·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Û ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ÙfiÛÔ ÔÈ ¿Ó‰Ú˜ fiÛÔ Î·È ÔÈ Á˘Ó·›Î˜ ‰ÂÓ ÁÓˆÚ›˙Ô˘Ó fiÙÈ ÔÈ Ì·ÚÁ·Ú›Ó˜ ÌÂ Ê˘ÙÈΤ˜ ÛÙÂÚfiϘ ÌÔÚÔ‡Ó Ó· ÌÂÈÒÛÔ˘Ó Ù· ÏÈ›‰È· Î·È ÙÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ. £¤ÏÔÓÙ·˜ Ó· ÂÚÌËÓ‡ÛÔ˘Ì ·˘Ù¿ Ù· ·ÔÙÂϤÛÌ·Ù· ı· ÌÔÚÔ‡Û·Ì ӷ ԇ̠fiÙÈ ·˘Ù¿ Ù· ÚÔ˚fiÓÙ· Â›Ó·È Û¯ÂÙÈο ηÈÓÔ‡ÚÈ· Î·È ÔÈ Ôϛ٘ ›Ù ‰ÂÓ ¤¯Ô˘Ó ÂÓËÌÂÚˆı› ·ÎfiÌ· ÁÈ· ÙË ¯Ú‹ÛË ·˘ÙÒÓ Â›Ù ‰ÂÓ ¤¯Ô˘Ó ÂÓËÌÂÚˆı› ÛˆÛÙ¿ ÁÈ' ·˘Ù¿. ŸÛÔÓ ·ÊÔÚ¿ fï˜ Ù· ÎÔÚÂṲ̂ӷ Ï›Ë Î·È ÙÔ ·Ï¿ÙÈ ÙÔ Û‡ÓÔÏÔ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ Ê·›ÓÂÙ·È Ó· Â›Ó·È ÈÔ ÂÍÔÈÎÂȈ̤ÓÔ Ì ·˘ÙÔ‡˜ ÙÔ˘˜ fiÚÔ˘˜ ˆ˜ ‰È·ÙÚÔÊÈÎÔ‡˜ ÎÈÓ‰‡ÓÔ˘˜, ηıÒ˜ Â‰Ò Î·È ÔÏÏ¿ ¯ÚfiÓÈ· ¤¯ÂÈ ‰ÂȯÙ› Ë Â›‰Ú·Û‹ ÙÔ˘˜ ÛÙ· ηډȷÁÁÂȷο ÓÔÛ‹Ì·Ù·. ∞˘Ùfi ı· ÌÔÚÔ‡Û ӷ ÂÍËÁ› Î·È ÙËÓ ÔÚı‹ ÁÓÒÛË Ô˘ Ê·›ÓÂÙ·È Ó· ¤¯Ô˘Ó ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ÙfiÛÔ ÙˆÓ ·ÓÙÚÒÓ fiÛÔ Î·È ÙˆÓ Á˘Ó·ÈÎÒÓ ÁÈ· ÙËÓ Î·Ú‰ÈÔÚÔÛٷ٢ÙÈ΋ ‰Ú¿ÛË ÙÔ˘ ÂÏ·ÈÔÏ¿‰Ô˘ (ÏÔ‡ÛÈÔ Û ÌÔÓÔ·ÎfiÚÂÛÙ· ÏÈ·Ú¿), ηıÒ˜ Î·È ÙˆÓ ÊÚÔ‡ÙˆÓ Î·È ÙˆÓ Ï·¯·ÓÈÎÒÓ (ÏÔ‡ÛÈ· Û ·ÓÙÈÔÍÂȉˆÙÈο). ∆¤ÏÔ˜, ·Ó·ÊÔÚÈο Ì ÙËÓ ·ÛʷϤÛÙÂÚË ·ÁÔÚ¿ ÙÚÔʛ̈Ó, Â›Ó·È ÂÌÊ·Ó¤˜ fiÙÈ ˘¿Ú¯ÂÈ ÌÈ· Û‡Á¯˘ÛË ÛÙȘ ·fi„ÂȘ ÙÔ˘ Û‡Á¯ÚÔÓÔ˘ ŒÏÏËÓ· ηıÒ˜ ÙÔ 69% ÙˆÓ ·Ó‰ÚÒÓ Î·È ÙÔ 70% ÙˆÓ Á˘Ó·ÈÎÒÓ ‰ËÏÒÓÔ˘Ó ÙËÓ ‰È΋ ÙÔ˘˜ ‹ ÙË ÊÈÏÈ΋ ·Ú·ÁˆÁ‹ ˆ˜ ÙËÓ ÈÔ ·ÛÊ·-

12

Ï‹ ËÁ‹ ·ÁÔÚ¿˜ ÙÚÔʛ̈Ó. ™ÙËÓ Û‡Á¯˘ÛË ·˘Ù‹ Ê·›ÓÂÙ·È Ó· Û˘Ì‚¿ÏÏÔ˘Ó Ù· ̤۷ Ì·˙È΋˜ ÂÓË̤ڈÛ˘ Ô˘ Ê·ÓÂÚÒÓÔ˘Ó Û˘Ó¯Ҙ ηÈÓÔ‡ÚȘ ·Ú·Ù˘›Â˜ ÙˆÓ ‚ÈÔÌ˯·ÓÈÒÓ ÙÚÔÊ›ÌˆÓ Î·ıÒ˜ Î·È ÂÈÌÔχÓÛÂȘ ÙÚÔÊ›ÌˆÓ Â˘Ú›·˜ ηٷӿψÛ˘. ™Ù· ·Ú·¿Óˆ Û˘ÓËÁÔÚ› Î·È ÌÈ· ¿ÏÏË ¤Ú¢ӷ ÙˆÓ ÌÂÏÒÓ Ù˘ BEUC, Ô˘ ‰Â›¯ÓÂÈ fiÙÈ ÔÈ Î·Ù·Ó·ÏˆÙ¤˜ ‰ÂÓ ÁÓˆÚ›˙Ô˘Ó ÔÈÔ Â›‰Ô˜ ‰È·ÙÚÔÊ‹˜ ÌÔÚ› Ó· Â›Ó·È ˘ÁÈÂÈÓfi. ™˘ÁÎÂÎÚÈ̤ӷ, ÔÈ 9 ÛÙÔ˘˜ 10 ıˆÚÔ‡Ó fiÙÈ Í¤ÚÔ˘Ó ÔÈ· Â›Ó·È ˘ÁÈÂÈÓ¿ ÙÚfiÊÈÌ·, ÂÓÒ ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· ÂÏ¿¯ÈÛÙÔÈ ÁÓˆÚ›˙Ô˘Ó ÔȘ ÔÛfiÙËÙ˜ ÏÈ·ÚÒÓ, ۷ί¿ÚˆÓ Î·È ¿Ï·ÙÔ˜ Ú¤ÂÈ Ó· ηٷӷÏÒÓÔ˘Ó Û ηıËÌÂÚÈÓ‹ ‚¿ÛË ÒÛÙ ӷ ÚÔÊ˘Ï¿ÛÛÔ˘Ó ÙËÓ ˘Á›· ÙÔ˘˜. øÛÙfiÛÔ ÙÔ Î˘ÚÈfiÙÂÚÔ Úfi‚ÏËÌ· Ô˘ ‰È·Ê·›ÓÂÙ·È, Â›Ó·È fiÙÈ ÂÓÒ Ô ÎfiÛÌÔ˜ ÁÓˆÚ›˙ÂÈ ÌÂÚÈΤ˜ ‚·ÛÈΤ˜ ‰È·ÙÚÔÊÈΤ˜ ·Ú¯¤˜ ·˘Ù¤˜ Â›Ó·È ÔÏϤ˜ ÊÔÚ¤˜ Û˘Áί˘Ì¤Ó˜. ™ËÌ·ÓÙÈÎfi ·›ÙÈÔ ·˘Ù‹ Ù˘ ηٿÛÙ·Û˘ ı· ϤÁ·Ì fiÙÈ Â›Ó·È ÔÈ ÔÏÏ·Ϥ˜ ËÁ¤˜ ÂÓË̤ڈÛ˘, ΢ڛˆ˜ ̤ۈ ÙˆÓ ªª∂, Ô˘ Û˘¯Ó¿ ‰ÂÓ Â›Ó·È ¤Á΢Ú˜. ∂›Û˘, ¤Ó· ‰Â˘ÙÂÚ‡ÔÓ Â‡ÚËÌ· Â›Ó·È fiÙÈ Ô ÂÈÔÏ·ÛÌfi˜ ÙˆÓ ·Ú·ÁfiÓÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘, fiˆ˜ ˘ÔÏÔÁ›ÛıËΠ·fi ÙȘ ‰ËÏÒÛÂȘ ÙˆÓ Û˘ÌÌÂÙ¯fiÓÙˆÓ, Â›Ó·È Û·ÊÒ˜ ÌÈÎÚfiÙÂÚÔ˜ ·fi ¿ÏϘ Û‡Á¯ÚÔÓ˜ ÂȉËÌÈÔÏÔÁÈΤ˜ ¤Ú¢Ó˜ Ô˘ ¯ÚËÛÈÌÔÔ›ËÛ·Ó ÂÁ΢ÚfiÙÂÚ˜ ÌÂıfi‰Ô˘˜ ÁÈ· ÙËÓ ·ÔÙ›ÌËÛË ÙˆÓ ÎÏÈÓÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ. ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi Ô‰ËÁ› ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘ÛÌÔ‡ ¤¯ÂÈ ¿ÁÓÔÈ· Ù˘ Ú·ÁÌ·ÙÈ΋˜ ηٿÛÙ·Û˘ Ù˘ ˘Á›·˜ ÙÔ˘. ∂ȉÈÎfiÙÂÚ·, Û˘ÁÎÚ›ÓÔÓÙ·˜ Ù· ÛÙÔȯ›· ·fi ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË Ì ·˘Ù¿ ·fi ÙËÓ ÂȉËÌÈÔÏÔÁÈ΋ ÌÂϤÙË ATTICA ·Ú·ÙËÚ‹Û·Ì ÛËÌ·ÓÙÈΤ˜ ·ÔÎÏ›ÛÂȘ fiÛÔÓ ·ÊÔÚ¿ ÛÙÔ˘˜ ΢ÚÈfiÙÂÚÔ˘˜ ·Ú¿ÁÔÓÙ˜ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ fiˆ˜ Â›Ó·È Ë ·¯˘Û·ÚΛ·, Ë ·ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË Î·È Ë ‰˘ÛÏÈȉ·ÈÌ›·, Ì ÂÍ·›ÚÂÛË ÙÔ ‰È·‚‹ÙË [14-16]. ∆· ·ÔÙÂϤÛÌ·Ù· ÚÔηÏÔ‡Ó ÙÔ ÂÚÒÙËÌ· ÔÈÔÈ ÌÔÚ› Ó· Â›Ó·È ÔÈ ÏfiÁÔÈ ¿ÁÓÔÈ·˜ Ù˘ ηٿÛÙ·Û˘ ˘Á›·˜ ÙˆÓ Û˘ÌÌÂÙ¯fiÓÙˆÓ. ŒÙÛÈ, ÌÔÚԇ̠ӷ ıˆڋÛÔ˘Ì fiÙÈ ·˘Ùfi Èı·ÓfiÓ Ó· ÔÊ›ÏÂÙ·È ÛÙÔ

ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ÂÈÙÒÛÂȘ ·˘ÙÒÓ ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ‰ÂÓ Â›Ó·È Û˘¯Ó¿ ¿ÌÂÛ· ÔÚ·Ù¤˜, Û ·ÓÙ›ıÂÛË Ì ÙÔ ‰È·‚‹ÙË Ô˘ ¤¯ÂÈ ÈÔ ¿ÌÂÛ· ·ÔÙÂϤÛÌ·Ù· Î·È ÔÈ Ôϛ٘ ›Ûˆ˜ Â›Ó·È ÈÔ ÂÓËÌÂڈ̤ÓÔÈ. ŸÛÔÓ ·ÊÔÚ¿ ÛÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÂÓÈÎfiÙÂÚ·, ÔÏϤ˜ Â›Ó·È ÔÈ ¤Ú¢Ó˜ Ô˘ ·Ô‰ÂÈÎÓ‡Ô˘Ó ÙË ¯·ÌËÏ‹ ÁÓÒÛË ·˘ÙÒÓ ·fi ÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi [17]. ªÈ· Û¯ÂÙÈο ÚfiÛÊ·ÙË ÌÂϤÙË ‰ÈÂÚ‡ÓËÛ ÙËÓ Èı·ÓfiÙËÙ· ‰È·ÊÔÚÔÔ›ËÛ˘ ÙˆÓ ÁÓÒÛÂˆÓ ÁÈ· ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ÌÂٷ͇ ÙˆÓ ·¯‡Û·ÚÎˆÓ ·ÙfiÌˆÓ Î·È ·˘ÙÒÓ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ‚¿ÚÔ˜, ¯ˆÚ›˜ Ó· ‚ÚÂı› ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙÔ˘˜ [18]. ∞ÎfiÌ·, Û ÌÈ· ¿ÏÏË ÌÂϤÙË Ô˘ ¤ÁÈÓ Û ÊÔÈÙËÙ¤˜, ¤‰ÂÈÍ fiÙÈ Ë ÁÓÒÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ‚Ú¤ıËΠӷ Â›Ó·È ¯·ÌËÏ‹. ¶·Ú' fiÏ· ·˘Ù¿, ÛÙËÓ ÂÚ›ÙˆÛË Ô˘ ÔÈ ÂÍÂÙ·˙fiÌÂÓÔÈ ·ÚÔ˘Û›·˙·Ó οÔÈÔ ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ Ë ÁÓÒÛË ÙÔ˘˜ Ê¿ÓËΠӷ ·˘Í¿ÓÂÈ [19]. ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Ë Úfi‚ÏÂ„Ë ÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ̤ۈ Ì·ıËÌ·ÙÈÎÒÓ ÌÔÓÙ¤ÏˆÓ Ô˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÛÙÔȯ›· ÁÈ· ÙÔ˘˜ ΢ÚÈfiÙÂÚÔ˘˜ ·Ú¿ÁÔÓÙ˜ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ (.¯. SCORE project) ·ÔÙÂÏ› ·ÓÙÈΛÌÂÓÔ ·˘ÍË̤Ó˘ ÚÔÛÔ¯‹˜ Î·È ÂÊ·ÚÌfi˙ÂÙ·È ·fi ·ÚÎÂÙÔ‡˜ ÎÏÈÓÈÎÔ‡˜ ÛÙËÓ ÚˆÙÔ‚¿ıÌÈ· ÚfiÏË„Ë. ª¤Ûˆ ·˘ÙÒÓ ÙˆÓ ÌÔÓÙ¤ÏˆÓ Ù· ¿ÙÔÌ· ı· ÌÔÚÔ‡Û·Ó Ó· ÌÂÙÚ‹ÛÔ˘Ó ÙÔÓ ·ÙÔÌÈÎfi ÙÔ˘˜ ΛӉ˘ÓÔ ÁÈ· ÂÌÊ¿ÓÈÛË Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ, ÒÛÙ ӷ ÌÔÚÔ‡Ó Ì ÙË ‚Ô‹ıÂÈ· ÙˆÓ ÂÈÛÙËÌfiÓˆÓ ˘Á›·˜ Ó· ÂÊ·ÚÌfiÛÔ˘Ó ¿ÌÂÛ· ÙÔ ·ÙÔÌÈÎfi ÙÔ˘˜ ÚfiÁÚ·ÌÌ· ÚfiÏ˄˘ Ù˘ ÓfiÛÔ˘. ∏ ÂÊ·ÚÌÔÁ‹ ÙˆÓ ÌÔÓÙ¤ÏˆÓ ·˘ÙÒÓ Û ¢Ú›· Îϛ̷η ı· ÌÔÚÔ‡Û ӷ ¢·ÈÛıËÙÔÔÈ‹ÛÂÈ ÂÚÈÛÛfiÙÂÚÔ ÙÔ˘˜ Ôϛ٘ ·¤Ó·ÓÙÈ ÛÙËÓ Ú·ÁÌ·ÙÈ΋ ηٿÛÙ·ÛË Ù˘ ˘Á›·˜ ÙÔ˘˜.

¶ÂÚÈÔÚÈÛÌÔ› Ù˘ ¤Ú¢ӷ˜ ø˜ ÂÚÈÔÚÈÛÌfi Ù˘ ·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜ ı· ÌÔÚÔ‡Û·Ì ӷ ·Ó·Ê¤ÚÔ˘Ì fiÙÈ Ù· ·ÔÙÂϤÛÌ·Ù· ‚·Û›˙ÔÓÙ·È ÛÙËÓ ÈÏÔÙÈ΋ ·Ó¿Ï˘ÛË, ÂÓÒ Ë ¤Ú¢ӷ Û˘Ó¯›˙ÂÈ Ó· ‰ÈÂÍ¿ÁÂÙ·È Î·È ˆ˜ ·ÒÙÂÚÔ˜ ÛÙfi¯Ô˜ Â›Ó·È Ë Û˘ÏÏÔÁ‹ ‰Â‰ÔÌ¤ÓˆÓ ·fi 10000 ¿ÙÔÌ·, ·fi ÔÏfiÎÏËÚË ÙË ¯ÒÚ·.


ATHIROSK 21-

05-03-09

12:25

™ÂÏ›‰·13

∂¶π¢∏ªπ√§√°π∞ - ¶∞ƒ∞°√¡∆∂™ ∫π¡¢À¡√À ™˘ÌÂÚ¿ÛÌ·Ù· ∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÈÏÔÙÈ΋˜ ·Ó¿Ï˘Û˘ Ù˘ ¤Ú¢ӷ˜ ÁÈ· ÙËÓ Î·Ù·ÁÚ·Ê‹ ÙˆÓ Ù¿ÛÂˆÓ Î·È ÙˆÓ ·ÓÙÈÏ‹„ÂˆÓ ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘ÛÌÔ‡, ·Ó·‰ÂÈÎÓ‡Ô˘Ó ÙËÓ ·Ó·ÁηÈfiÙËÙ· ·‡ÍËÛ˘ ÙˆÓ ÁÓÒÛÂˆÓ ÙÔ˘ ÏËı˘ÛÌÔ‡ ·Ó·ÊÔÚÈο Ì ÙË ˘ÁÈ-

ÂÈÓ‹ ‰È·ÙÚÔÊ‹ Î·È ÙȘ ηډȷÁÁÂȷΤ˜ ·ı‹ÛÂȘ. ∂›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·fi ÔÙ¤ ·Ó·Áη›· Ë ‰È·ÌfiÚʈÛË ÌÈ·˜ ∂ıÓÈ΋˜ ¢È·ÙÚÔÊÈ΋˜ ¶ÔÏÈÙÈ΋˜ Î·È Ë ‰ËÌÈÔ˘ÚÁ›· ÌÈ·˜ ÂÓËÌÂÚˆÙÈ΋˜ ηÌ¿ÓÈ·˜ ÁÈ· ı¤Ì·Ù· ‰È·ÙÚÔÊ‹˜-˘Á›·˜. ∏ ÔÏÈÙ›·, ·ÏÏ¿ Î·È ÔÈ ‰È¿ÊÔÚÔÈ ÂÈÛÙË-

ÌÔÓÈÎÔ› ÊÔÚ›˜ ÔÊ›ÏÔ˘Ó Ó· ·Ó·‰Â›ÍÔ˘Ó ÙÔ Úfi‚ÏËÌ· ÙÔ˘ ¯·ÌËÏÔ‡ ÂÈ¤‰Ô˘ ÁÓÒÛÂˆÓ ÙÔ˘ ÏËı˘ÛÌÔ‡ ·Ó·ÊÔÚÈο Ì ÙË ‰È·ÙÚÔÊ‹ Î·È ÙÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ, Î·È Ó· ‰Ú¿ÛÔ˘Ó ¿ÌÂÛ·, Ì ÛÙfi¯Ô ÙËÓ Ì›ˆÛË Ù˘ ηډȷÁÁÂȷ΋˜ ÓÔÛËÚfiÙËÙ·˜ ÛÙËÓ ¯ÒÚ·.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Mackay J, Measay G. The atlas of heart disease and stroke. World Heart Organisation 2005. 2. ∂˘Úˆ·˚Îfi˜ ¯¿ÚÙ˘ ÁÈ· ÙËÓ ˘Á›· Ù˘ ηډȿ˜. European society of cardiology, European Cardiovascular Disease Statistics - British Heart Foundation and European Heart Network - 2005. 3. ¶·Ó·ÁȈٿÎÔ˜ ¢, ∫Ô˘ÚÏ·Ì¿ °. ∂ȉËÌÈÔÏÔÁ›· ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÛÙËÓ ∂ÏÏ¿‰·, ∫·Ú‰È·ÁÁÂȷ΋ ∂ȉËÌÈÔÏÔÁ›· 2005, ∂™À∂ http://www.statistics.gr/anaz.asp 4. World Heart Organisation 2005, world health statistics 2006 (www.who.int). 5. World Heart Organisation 2005, world health statistics 2007 (www.who.int). 6. Allender S, Scarborough P, Peto V, Rayner M, Leal J, Luengo-Fernandez R, Gray A. European cardiovascular disease statistics, 2nd edition 2008, 11-36. 7. Beaglehole R. Global cardiovascular disease prevention: time to get serious. Lancet 2001; 358:661-663. 8. ¶›ÙÛ·‚Ô˜ Ã, ¶·Ó·ÁȈٿÎÔ˜ ¢, ™ÙÂÊ·Ó¿‰Ë˜ Ã. ∏ ÂȉËÌÈÔÏÔÁ›· Ù˘ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ ÛÙËÓ ∂ÏÏ¿‰·. √ͤ· ÛÙÂÊ·ÓÈ·›· Û‡Ó‰ÚÔÌ·. ∂ΉfiÛÂȘ ∫ˆÛÙ¿ÎË, ∞ı‹Ó· 2004. 9. De Caterina R, Zampolli A, Del Turco S, Madonna R, Massaro M. Nutritional mechanisms that influence cardiovascular disease. Am J Clin Nutr 2006;83:421S-426S.

10. Elisaf M. The treatment of coronary heart disease: an update. Part 1: An overview of the risk factors for cardiovascular disease. Curr Med Res Opin 20014;17:18-26. 11. ∑·Ì¤Ï·˜ ∞. ∫ÏÈÓÈ΋ ¢È·ÈÙÔÏÔÁ›· & ¢È·ÙÚÔÊ‹ Ì ÛÙÔȯ›· ·ıÔÏÔÁ›·˜. π·ÙÚÈΤ˜ ∂ΉfiÛÂȘ ¶.à ¶·Û¯·Ï›‰Ë˜ 2005 12. Groff JL, Gropper SS. ¢È·ÙÚÔÊ‹ Î·È ªÂÙ·‚ÔÏÈÛÌfi˜. π·ÙÚÈΤ˜ ÂΉfiÛÂȘ ¶.Ã. ¶·Û¯·Ï›‰Ë 2004. 13. American Heart Association. Risk Factors and Coronary Heart Disease and Stroke (http://www.americanheart.org/ presenter.jhtml?indetifier=539). 14. Panagiotakos DB, Chrysohoou C, Pitsavos C, Stefanadis C. Association between the prevalence of obesity and adherence to the Mediterranean diet: the ATTICA study. Nutrition. 2006;22:449-56. 15. Panagiotakos DB, Pitsavos CH, Chrysohoou C, Skoumas J, Papadimitriou L, Stefanadis C, Toutouzas PK. Status and management of hypertension in Greece: role of the adoption of a Mediterranean diet: the Attica study. J Hypertens. 2003;21:1483-9.

of glucose homoeostasis: the ATTICA study. J Am Coll Nutr. 2007;26:32-8 17. Kirkland SA, MacLean DR, Langille DB, Joffres MR, MacPherson KM, Andreou P. Knowledge and awareness of risk factors for cardiovascular disease among Canadians 55 to 74 years of age: results from the Canadian Heart Health Surveys, 1986-1992. 18. Andersson P, Sjöberg RL, Ohrvik J, Leppert J. Knowledge about cardiovascular risk factors among obese individuals. Eur J Cardiovasc Nurs. 2006;5:275-9. 19. Danielsson B, Aberg H. The public view on cardiovascular risk factors and changes in lifestyle. Scand J Prim Health Care. 1995;13:74-80. 20. Plous S, Chense R, McDowell A. Nutrition Knowledge and Attitudes of Cardiac Patients. J Am Diet Assoc. 1995;95:442-6. 21. Lynch EB, Liu K, Kiefe CI, Greenland. Cardiovascular disease risk factor knowledge in young adults and 10year change in risk factors: the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am J Epidemiol. 2006;164:1171-9.

16. Panagiotakos DB, Tzima N, Pitsavos C, Chrysohoou C, Zampelas A, Toussoulis D, Stefanadis C. The association between adherence to the Mediterranean diet and fasting indices

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ªˆ˘Û‹˜ ∂ÏÈÛ¿Ê, ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ ∏ ‰˘ÛÏÈȉ·ÈÌ›· Â›Ó·È ¤Ó·˜ ·fi ÙÔ˘˜ ÎÏ·ÛÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘. °È· ·˘Ùfi ÙÔ ÏfiÁÔ, Ë ÛˆÛÙ‹ ‰È¿ÁÓˆÛË Ù˘ ‰˘ÛÏÈȉ·ÈÌ›·˜ ¤¯ÂÈ È‰È·›ÙÂÚË ÛËÌ·Û›· ÁÈ· ÙËÓ ÚfiÏË„Ë Ù˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘. ™ÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË Á›ÓÔÓÙ·È ·ÚÎÂÙ¿ Ï¿ıË ÛÙË ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË ÙˆÓ ‰˘ÛÏÈȉ·ÈÌÈÒÓ. ™ÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ¿ÚıÚÔ ÂÚÈÁÚ¿ÊÔÓÙ·È ·˘Ù¿ Ù· ÛÊ¿ÏÌ·Ù· Î·È ‰›ÓÔÓÙ·È Û˘ÛÙ¿ÛÂȘ ÁÈ· ÙË ÛˆÛÙ‹ ‰È·¯Â›ÚÈÛË ÙˆÓ ·ÛıÂÓÒÓ Ì ‰˘ÛÏÈȉ·ÈÌ›·. ∞’ ™ˆÛÙfi Î·È Ï¿ıÔ˜ ÛÙË ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË ÙˆÓ ˘ÂÚÏÈȉ·ÈÌÈÒÓ 1. ∂›Ó·È Ï¿ıÔ˜ Ó· Á›ÓÂÙ·È Ë ‰È¿ÁÓˆÛË Ù˘ ‰˘ÛÏÈȉ·ÈÌ›·˜ ·fi Ì›· ÌfiÓÔ ÂÚÁ·ÛÙËÚȷ΋ ÂÎÙ›ÌËÛË, ‰ÈfiÙÈ ˘¿Ú¯ÂÈ Ë Èı·ÓfiÙËÙ· ÂÚÁ·ÛÙËÚÈ·ÎÔ‡ ÛÊ¿ÏÌ·ÙÔ˜. ∞·ÈÙÔ‡ÓÙ·È ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰‡Ô ÂÍÂÙ¿ÛÂȘ, Ì ·fiÛÙ·ÛË ‰‡Ô ‚‰ÔÌ¿‰ˆÓ ÌÂٷ͇ ÙÔ˘˜, ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ ‰˘ÛÏÈȉ·ÈÌ›·˜. 2. ∂›Ó·È ··Ú·›ÙËÙÔ Ó· Ï·Ì‚¿ÓÔÓÙ·È ˘fi„Ë ÔÈ Û˘Óı‹Î˜ ÚÔÛ‰ÈÔÚÈÛÌÔ‡ ÙˆÓ ÙÈÌÒÓ ÙˆÓ ÏÈȉ·ÈÌÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ. √ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ÏÈȉ·ÈÌÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÌÂÙ¿ ÓËÛÙ›· ÙÔ˘Ï¿¯ÈÛÙÔÓ 12 ˆÚÒÓ. ∂ÈÚfiÛıÂÙ·, Â›Ó·È ÛËÌ·ÓÙÈÎfi Ó· Ï·Ì‚¿ÓÔÓÙ·È ˘fi„Ë Î·È ¿ÏÏÔÈ ·Ú¿ÁÔÓÙ˜, fiˆ˜ Â›Ó·È Ë ·ÈÌÔÛ˘Ì‡ÎÓˆÛË ÙÔ˘ ·ÛıÂÓ‹, ÁÈ· ·Ú¿‰ÂÈÁÌ· Û ¿ÙÔÌ· Ô˘ ‚Ú›ÛÎÔÓÙ·È Û fiÚıÈ· ı¤ÛË, ηıÒ˜ Î·È Ë ÌÂÙ·‚ÏËÙfiÙËÙ· ÙˆÓ ÙÈÌÒÓ ÙˆÓ ÏÈȉ·ÈÌÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ, ÂÓÒ Â›Ó·È ··Ú·›ÙËÙÔ˜ Î·È Ô ÔÈÔÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ ÂÚÁ·ÛÙËÚ›Ô˘ ÛÙÔ ÔÔ›Ô Á›ÓÔÓÙ·È ÔÈ ÂÚÁ·ÛÙËÚȷΤ˜ ·Ó·Ï‡ÛÂȘ. √È Û˘Óı‹Î˜ Ù˘ ·ÈÌÔÏË„›·˜ Î·È Ô ¯ÂÈÚÈÛÌfi˜ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ¤¯Ô˘Ó ÌÂÁ¿ÏË ÛËÌ·Û›· ÁÈ· ÙËÓ ·ÍÈÔÈÛÙ›· ÙÔ˘ ÂÚÁ·ÛÙËÚÈ·ÎÔ‡ ÚÔÛ‰ÈÔÚÈÛÌÔ‡ ÙÔ˘ ÏÈȉ·ÈÌÈÎÔ‡ ÚÔÊ›Ï. °È· ·Ú¿‰ÂÈÁÌ·, Ë ÔÚıÔÛÙ·Û›· ÁÈ· 5 Î·È 15 ÏÂÙ¿ ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ·ÈÌÔÛ˘Ì‡ÎÓˆÛË Î·È ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ηٿ 9% Î·È 16% ·ÓÙ›ÛÙÔȯ·. ¶ÚÈÓ ÙËÓ ·ÈÌÔÏË„›·, Ô ·ÛıÂÓ‹˜ Ú¤ÂÈ Ó· Â›Ó·È Î·ıÈÛÙfi˜ ÁÈ· 5 ÏÂ-

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Ù¿ ÂÚ›Ô˘, ÂÓÒ Ë ÂÚȯÂÈÚ›‰· ‰ÂÓ Ú¤ÂÈ Ó· ·Ú·Ì¤ÓÂÈ ÁÈ· ÂÚÈÛÛfiÙÂÚÔ ·fi 1 ÏÂÙfi, ·ÊÔ‡ ÌÔÚ› Ó· ÚÔηϤÛÂÈ ÙÔÈ΋ ·ÈÌÔÛ˘Ì‡ÎÓˆÛË Î·È ·‡ÍËÛË Ù˘ ÙÈÌ‹˜ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘. 3. √ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ÏÈȉ›ˆÓ Ú¤ÂÈ Ó· ·Ó·‚¿ÏÏÂÙ·È Û ÂÚÈÙÒÛÂȘ stress, fiˆ˜ Û ·ÛıÂÓ›˜ Ì Ôͤ· ÓÔÛ‹Ì·Ù· (ÙÚ·‡Ì·Ù·, ¯ÂÈÚÔ˘ÚÁÈΤ˜ ÂÂÌ‚¿ÛÂȘ, ÏÔÈÌÒÍÂȘ, ÂÌÊÚ¿ÁÌ·Ù·, ·ÁÁÂȷο ÂÁÎÂÊ·ÏÈο ÂÂÈÛfi‰È·). ∞˘Ù¤˜ ÔÈ Î·Ù·ÛÙ¿ÛÂȘ Û˘Óԉ‡ÔÓÙ·È ·fi ·ÏÏ·Á¤˜ ÛÙË Û‡ÛÙ·ÛË ‹ ÛÙË Û˘ÁΤÓÙÚˆÛË ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ. ∆¤ÙÔȘ ·ÏÏ·Á¤˜ Â›Ó·È Ë Ì›ˆÛË Ù˘ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘, Ë Ì›ˆÛË Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ÙˆÓ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ (LDL-¯ÔÏËÛÙÂÚfiÏ˘) Î·È Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ÙˆÓ ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ (HDL-¯ÔÏËÛÙÂÚfiÏ˘), ηıÒ˜ Î·È Ë ·‡ÍËÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ. 4. ∂›Ó·È Ï¿ıÔ˜ Ó· Ù›ıÂÙ·È Ë ‰È¿ÁÓˆÛË Ù˘ ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›·˜ ÂÍ·ÈÙ›·˜ ·ÓÂ·ÚÎÔ‡˜ ÓËÛÙ›·˜ (<12 ÒÚ˜) ÙÔ˘ ·ÛıÂÓ‹. √ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÌÂÙ¿ 12ˆÚË ÓËÛÙ›·. ™Â ·ÓÙ›ıÂÛË Ì ٷ ÙÚÈÁÏ˘ÎÂÚ›‰È·, ÔÈ ÙÈ̤˜ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ‰ÂÓ ÂËÚ¿˙ÔÓÙ·È ·fi ÙËÓ ÚfiÛÏË„Ë ÙÚÔÊ‹˜. 5. ∂›Ó·È Ï¿ıÔ˜ Ó· ˘ÔÏÔÁ›˙ÂÙ·È Ë LDL-¯ÔÏËÛÙÂÚfiÏË ·fi ÙËÓ Â͛ۈÛË ÙÔ˘ Friedewald (LDL¯ÔÏËÛÙÂÚfiÏË = ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË - [HDL-¯ÔÏËÛÙÂÚfiÏË+ÙÚÈÁÏ˘ÎÂÚ›‰È·/5]) Û ·ÛıÂÓ›˜ Ì Â›‰· ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ >400 mg/dL. ™Â ·˘Ù¿ Ù· ¿ÙÔÌ·, Ô ˘ÔÏÔÁÈÛÌfi˜ ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ Ú¤ÂÈ Ó· Á›ÓÂÙ·È Â›Ù ÌÂÙ¿ ·fi Ì›ˆÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ, ›Ù Ì ¿ÌÂÛË Ì¤ÙÚËÛË Ù˘ LDL¯ÔÏËÛÙÂÚfiÏ˘ ÛÙÔÓ ÔÚfi. 6. ¢ÂÓ Ú¤ÂÈ Ó· Á›ÓÂÙ·È Î·Ù¿¯ÚËÛË ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙˆÓ ‰˘ÛÏÈȉ·ÈÌÈÒÓ. °È· ÙË ‰È¿ÁÓˆÛË Ù˘ ‰˘ÛÏÈȉ·ÈÌ›·˜, ··ÈÙÂ›Ù·È Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ÎÏ·ÛÈÎÒÓ ÏÈȉ·ÈÌÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ, fiˆ˜

Â›Ó·È Ë ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË, Ë LDL-¯ÔÏËÛÙÂÚfiÏË, Ë HDL-¯ÔÏËÛÙÂÚfiÏË Î·È Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È·. √ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ·ÔÏÈÔÚˆÙÂ˚ÓÒÓ (apo) ‰ÂÓ ‰›ÓÂÈ ÂÚÈÛÛfiÙÂÚ˜ ÏËÚÔÊÔڛ˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË Î·È ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ‰˘ÛÏÈȉ·ÈÌÈÒÓ. ∂Í·›ÚÂÛË ·ÔÙÂÏ› Ë apoB, Ù˘ ÔÔ›·˜ Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÂÓ‰¤¯ÂÙ·È Ó· ¤¯ÂÈ Î¿ÔÈ· ‰È·ÁÓˆÛÙÈ΋ Î·È ÚÔÁÓˆÛÙÈ΋ ·Í›·. √ ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ ÏÈÔÚˆÙ½Ó˘ · [Lp(a)] Ú¤ÂÈ Ó· Á›ÓÂÙ·È Û ÂÍ·ÈÚÂÙÈΤ˜ ÂÚÈÙÒÛÂȘ, fiˆ˜ ÁÈ· ·Ú¿‰ÂÈÁÌ· Û ·ÛıÂÓ›˜ Ì ·ÁÁÂȷ΋ ÓfiÛÔ Ô˘ ‰ÂÓ ¤¯Ô˘Ó ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙ˜ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘, ηıÒ˜ Î·È Û ¿ÙÔÌ· Ì ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· ‹ ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ. 7. ∂›Ó·È Ï¿ıÔ˜ Ó· Ù›ıÂÙ·È Ë ‰È¿ÁÓˆÛË Ù˘ ‰˘ÛÏÈȉ·ÈÌ›·˜ Î·È Ó· ÍÂÎÈÓ¿ Ë ıÂÚ·›· Ù˘ ÚÈÓ ÙÔÓ ·ÔÎÏÂÈÛÌfi ÙˆÓ ·ÈÙ›ˆÓ Ù˘ ‰Â˘ÙÂÚÔ·ıÔ‡˜ ‰˘ÛÏÈȉ·ÈÌ›·˜. √ ۷ί·Ú҉˘ ‰È·‚‹Ù˘ Û˘Óԉ‡ÂÙ·È Û˘¯Ó¿ ·fi ‰Â˘ÙÂÚÔ·ı‹ ‰˘ÛÏÈȉ·ÈÌ›·, Ë ÔÔ›· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·˘ÍË̤ӷ ÙÚÈÁÏ˘ÎÂÚ›‰È· Î·È ¯·ÌËÏ‹ HDL-¯ÔÏËÛÙÂÚfiÏË. °È· ·˘Ùfi ÙÔ ÏfiÁÔ, Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ÁÏ˘Îfi˙˘ ÓËÛÙ›·˜. ∏ ·¯˘Û·ÚΛ· Â›Û˘ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ·˘ÍË̤ӷ ÙÚÈÁÏ˘ÎÂÚ›‰È· Î·È ¯·ÌËÏ‹ HDL-¯ÔÏËÛÙÂÚfiÏË. ¶·Ú¿ÏÏËÏ·, Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ı˘ÚÂÔÂȉÔÙÚfiÔ˘ ÔÚÌfiÓ˘ (TSH), ·ÊÔ‡ Ô ˘Ôı˘ÚÂÔÂȉÈÛÌfi˜ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ˘„ËÏ¿ Â›‰· ÔÏÈ΋˜ Î·È LDL-¯ÔÏËÛÙÂÚfiÏ˘. ∂ÈÚfiÛıÂÙ·, Ë ÁÂÓÈ΋ ÂͤٷÛË ÙˆÓ Ô‡ÚˆÓ Â›Ó·È ··Ú·›ÙËÙË ÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÌfi ÙÔ˘ ÓÂÊÚˆÛÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘, ÙÔ ÔÔ›Ô Û˘Óԉ‡ÂÙ·È ·fi ·˘ÍË̤ӷ Â›‰· ÔÏÈ΋˜ Î·È LDL-¯ÔÏËÛÙÂÚfiÏ˘, ηıÒ˜ Î·È ·fi ·˘ÍË̤ӷ ÙÚÈÁÏ˘ÎÂÚ›‰È·. √ ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ ÎÚ·ÙÈÓ›Ó˘ ÙÔ˘ ÔÚÔ‡ ÌÔÚ› Ó· ·Ôηχ„ÂÈ ÙËÓ ·ÚÔ˘Û›· ¯ÚfiÓÈ·˜ ÓÂÊÚÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜, Ë ÔÔ›· Û˘Û¯ÂÙ›˙ÂÙ·È Ì ·˘ÍË̤ӷ ÙÚÈÁÏ˘ÎÂÚ›‰È· Î·È ¯·ÌËÏ‹ HDL-¯ÔÏËÛÙÂÚfiÏË. ∏


ATHIROSK 21-

05-03-09

12:25

™ÂÏ›‰·15

∫§π¡π∫∏ ¶ƒ∞•∏ ÚˆÙÔ·ı‹˜ ¯ÔÏÈ΋ ΛÚÚˆÛË ÌÔÚ› Ó· Û˘Óԉ‡ÂÙ·È ·fi ·˘ÍË̤ӷ Â›‰· ¯ÔÏËÛÙÂÚfiÏ˘. °È· ·˘Ùfi ÙÔ ÏfiÁÔ, Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Ú¤ÂÈ Ó· ÚÔÛ‰ÈÔÚ›˙ÔÓÙ·È Ù· Â›‰· Ù˘ ·ÏηÏÈ΋˜ ʈÛÊ·Ù¿Û˘ (ALP). ∆¤ÏÔ˜, ÔÚÈṲ̂ӷ Ê¿Ú̷η ÚÔηÏÔ‡Ó ‰È·Ù·Ú·¯¤˜ ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ ÙÔ˘ ÔÚÔ‡. º¿Ú̷η Ô˘ ·˘Í¿ÓÔ˘Ó Ù· Â›‰· Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ Â›Ó·È Ù· ‰ÈÔ˘ÚËÙÈο, Ë Î˘ÎÏÔÛÔÚ›ÓË, Ë ·ÌÈÔ‰·ÚfiÓË, Ù· ·ÓÙÈÚÂÙÚÔ˚ο Ê¿Ú̷η, ηıÒ˜ Î·È ÔÈ ÁÏÈÙ·˙fiÓ˜. ∆· Â›‰· ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ·˘Í¿ÓÔÓÙ·È ·fi ÙË ¯ÔÚ‹ÁËÛË Ê·Ú̿ΈÓ, fiˆ˜ Â›Ó·È ÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜, Ù· ‰ÈÔ˘ÚËÙÈο, Ë ÈÓÙÂÚÊÂÚfiÓË, Ù· ÚÂÙÈÓÔÂȉ‹, Ù· ¿Ù˘· ·ÓÙÈ„˘¯ˆÛÈο Ê¿Ú̷η, Ù· ÔÈÛÙÚÔÁfiÓ· Î·È Ë Ù·ÌÔÍÈÊ·›ÓË. 8. ™ÙË ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË ÙˆÓ ·ÛıÂÓÒÓ Ì ‰˘ÛÏÈȉ·ÈÌ›· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÛˆÛÙ‹ ·ÍÈÔÏfiÁËÛË fiÏˆÓ ÙˆÓ Â˘ÚËÌ¿ÙˆÓ Ô˘ ÚÔ·ÙÔ˘Ó ·fi ÙÔ ÈÛÙÔÚÈÎfi Î·È ÙË Ê˘ÛÈ΋ ÂͤٷÛË, Ì ÛÙfi¯Ô ÙË ‰È¿ÁÓˆÛË Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÓÔÛÔÏÔÁÈÎÒÓ ÔÓÙÔًوÓ. µ’ ¶ÚˆÙÔ·ı›˜ Î·È ‰Â˘ÙÂÚÔ·ı›˜ ‰˘ÛÏÈȉ·È̛˜ Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË. ŒÓ·˜ ·ÛıÂÓ‹˜ Ì ˘„ËÏ¿ Â›‰· ÔÏÈ΋˜ Î·È LDL-¯ÔÏËÛÙÂÚfiÏ˘ ÌÔÚ› Ó· ÂÌÊ·Ó›˙ÂÈ Â›Ù ÚˆÙÔ·ı›˜ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ ÏÈȉ›ˆÓ, fiˆ˜ Â›Ó·È Ë ÔÈÎÔÁÂÓ‹˜ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·, Ë ÔÏ˘ÁÔÓÈ΋ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· Î·È Ë ÚˆÙÔ·ı‹˜ ÌÈÎÙ‹ ‰˘ÛÏÈȉ·ÈÌ›· ›Ù ‰Â˘ÙÂÚÔ·ı‹ ‰˘ÛÏÈȉ·ÈÌ›·, Ô˘ ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È Û ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ, ˘Ôı˘ÚÂÔÂȉÈÛÌfi ‹ ÚˆÙÔ·ı‹ ¯ÔÏÈ΋ ΛÚÚˆÛË. ∏ ·ÚÔ˘Û›· ıÂÙÈÎÔ‡ ÎÏËÚÔÓÔÌÈÎÔ‡ ÈÛÙÔÚÈÎÔ‡ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜ Î·È Î·Ú‰È·ÁÁÂȷ΋˜ ÓfiÛÔ˘ ‚ÔËı¿ ÛÙË ‰È¿ÁÓˆÛË ÙˆÓ ÚˆÙÔ·ıÒÓ ‰È·Ù·Ú·¯ÒÓ Ô˘ Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·. ∞ÓÙ›ıÂÙ·, ÔÚÈṲ̂ӷ ÛÙÔȯ›· ·fi ÙÔ ÈÛÙÔÚÈÎfi ÛÂ Û˘Ó‰˘·ÛÌfi Ì ٷ Â˘Ú‹Ì·Ù· ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ ÌÔÚÔ‡Ó Ó· ‚ÔËı‹ÛÔ˘Ó ÛÙËÓ ‰È¿ÁÓˆÛË ÙˆÓ ·ÈÙ›ˆÓ Ù˘ ‰Â˘ÙÂÚÔ·ıÔ‡˜ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜. ∏ ÔÈÎÔÁÂÓ‹˜ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· Â›Ó·È Ë ÈÔ Û˘¯Ó‹ ÁÂÓÂÙÈ΋ ‰˘ÛÏÈȉ·ÈÌ›· (ÂÙÂÚÔ˙˘ÁÒÙ˜ 1/500 ¿ÙÔÌ·) Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÌÂȈ̤ÓË ‰Ú·ÛÙËÚÈfiÙËÙ· ÙˆÓ LDL-˘Ô‰Ô¯¤ˆÓ, ·fi ÌÂÁ¿ÏË ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘, ηıÒ˜ Î·È ·fi ÚÒÈÌË ·ıËڈ̿وÛË. ∆Ô ıÂÙÈÎfi ÔÈÎÔÁÂ-

ÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜ Î·È ÚÒÈÌ˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘ ‚ÔËıÔ‡Ó ÛÙË ‰È¿ÁÓˆÛË Ù˘ ÔÈÎÔÁÂÓÔ‡˜ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜. ∂˘Ú‹Ì·Ù· ·fi ÙË Ê˘ÛÈ΋ ÂͤٷÛË Ô˘ Û˘¯Ó¿ ·Ú·ÙËÚÔ‡ÓÙ·È Û ¿ÙÔÌ· Ì ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· Â›Ó·È Ù· ÙÂÓfiÓÙÈ· Í·ÓıÒÌ·Ù·, Ù· Í·ÓıÂÏ¿ÛÌ·Ù·, ÙÔ ÁÂÚÔÓÙfiÙÔÍÔ, ηıÒ˜ Î·È ¤Ó· Û˘ÛÙÔÏÈÎfi ʇÛËÌ· Ô˘ Â›Ó·È ÂÓ‰ÂÈÎÙÈÎfi ·ÔÚÙÈ΋˜ ÛÙ¤ÓˆÛ˘. ∏ ·ÚÔ˘Û›· ÙˆÓ ÙÂÓfiÓÙÈˆÓ Í·ÓıˆÌ¿ÙˆÓ ·ÔÙÂÏ› Î·È ÙÔ ·ıÔÁÓˆÌÔÓÈÎfi ÁÓÒÚÈÛÌ· Ù˘ ÓfiÛÔ˘. ∆· ÙÂÓfiÓÙÈ· Í·ÓıÒÌ·Ù· Â›Ó·È ÏÂ˘Îˆ¤˜ Ô˙Ò‰ÂȘ ‰ÈÔÁÎÒÛÂȘ, Ô˘ Ù˘Èο ·ÊÔÚÔ‡Ó ÙÔÓ ∞¯›ÏÏÂÈÔ Ù¤ÓÔÓÙ·, ηıÒ˜ Î·È ÛÙÔ˘˜ Ù¤ÓÔÓÙ˜ Ù˘ ÎÓ‹Ì˘, ÙÔ˘ ·ÁÎÒÓ· Î·È Ù˘ Ú·¯È·›·˜ ÂÈÊ¿ÓÂÈ·˜ ÙˆÓ ¿ÎÚˆÓ ¯ÂÈÚÒÓ. ∆· Í·ÓıÂÏ¿ÛÌ·Ù· Î·È ÙÔ ÁÂÚÔÓÙfiÙÔÍÔ ·ÔÙÂÏÔ‡Ó ÂÓ·Ôı¤ÛÂȘ ¯ÔÏËÛÙÂÚfiÏ˘ ÛÙ· ‚Ϥʷڷ Î·È ÛÙÔÓ ÎÂÚ·ÙÔÂȉ‹ ·ÓÙ›ÛÙÔȯ·. ∏ ÔÏ˘ÁÔÓÈ΋ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· ·ÔÙÂÏ› ÙËÓ ÈÔ Û˘¯Ó‹ ·ÈÙ›· ·‡ÍËÛ˘ Ù˘ ÔÏÈ΋˜ Î·È LDL-¯ÔÏËÛÙÂÚfiÏ˘ ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi, Ë ÔÔ›· ‰ÂÓ ÔÊ›ÏÂÙ·È Û ÌÂÙ·ÏÏ¿ÍÂȘ Û ¤Ó· Û˘ÁÎÂÎÚÈ̤ÓÔ ÁÔÓ›‰ÈÔ, ·ÏÏ¿ Û ̛· ÔχÏÔÎË ·ÏÏËÏÂ›‰Ú·ÛË ÔÏÏ·ÏÒÓ ÁÂÓÂÙÈÎÒÓ Î·È ÂÚÈ‚·ÏÏÔÓÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ (.¯. ‰›·ÈÙ·, ·‡ÍËÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜). ∏ ÚˆÙÔ·ı‹˜ ÌÈÎÙ‹ ˘ÂÚÏÈȉ·ÈÌ›· ·ÔÙÂÏ› Ì›· ÁÂÓÂÙÈ΋ ‰È·Ù·Ú·¯‹, Ë ÔÔ›· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÙËÓ ÂÌÊ¿ÓÈÛË ÚÒÈÌ˘ ·ıËڈ̿وÛ˘, ηıÒ˜ Î·È ·fi ·˘ÍË̤ÓË Ë·ÙÈ΋ ·Ú·ÁˆÁ‹ apoB. ∆Ô 1/3 ÙˆÓ ·ÙfiÌˆÓ ÌÈ·˜ ÔÈÎÔÁ¤ÓÂÈ·˜ Ô˘ ÂÌÊ·Ó›˙ÂÈ ·˘Ù‹ ÙË ‰È·Ù·Ú·¯‹ ÂÌÊ·Ó›˙ÂÈ ·˘ÍË̤ӷ Â›‰· LDL-¯ÔÏËÛÙÂÚfiÏ˘, ÙÔ 1/3 ˘„ËÏ¿ ÙÚÈÁÏ˘ÎÂÚ›‰È·, ÂÓÒ ÙÔ ˘fiÏÔÈÔ 1/3 Û˘Ó‰˘·ÛÌfi ·˘ÍËÌ¤ÓˆÓ ÂÈ¤‰ˆÓ LDL-¯ÔÏËÛÙÂÚfiÏ˘ Î·È ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ. ™Â ·ÛıÂÓ›˜ Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ·˘Ùfi ÙÔÓ Ù‡Ô Ù˘ ‰˘ÛÏÈȉ·ÈÌ›·˜, Ô Ê·ÈÓfiÙ˘Ô˜ ÌÔÚ› Ó· ÌÂÙ·‚¿ÏÏÂÙ·È Ì ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘ ‹ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ‰È·ÈÙËÙÈ΋˜ ‹ Ù˘ Ê·Ú̷΢ÙÈ΋˜ ıÂÚ·›·˜. √È ·ÛıÂÓ›˜ Ì ·˘ÍË̤ӷ ÙÚÈÁÏ˘ÎÂÚ›‰È· ÓËÛÙ›·˜ ‰È·ÎÚ›ÓÔÓÙ·È Û ‰‡Ô ηÙËÁÔڛ˜ ·Ó¿ÏÔÁ· Ì ٷ Â›‰· ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ (>1000 mg/dL ‹ 200-1000 mg/dL). √È ·ÛıÂÓ›˜ Ì ÙÚÈÁÏ˘ÎÂÚ›‰È· ÓËÛÙ›·˜ > 1000 mg/dL ÌÔÚ› Ó· ¿Û¯Ô˘Ó ·fi ÔÈÎÔÁÂÓ‹ ‹ Â›ÎÙËÙË ¯˘ÏÔÌÈÎÚÔÓ·ÈÌ›·. ∞˘Ù¤˜ ÔÈ ‰‡Ô ÓÔÛÔÏÔÁÈΤ˜ ÔÓÙfiÙËÙ˜ ·˘-

Í¿ÓÔ˘Ó ÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ·ÁÎÚ·ٛÙȉ·˜, ÂÓÒ ÂӉ¯fiÌÂÓ· ·˘Í¿ÓÂÙ·È Î·È Ô Î›Ó‰˘ÓÔ˜ ÂÌÊ¿ÓÈÛ˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘. ∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ù˘ ÚˆÙÔ·ıÔ‡˜ ¯˘ÏÔÌÈÎÚÔÓ·ÈÌ›·˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ˘ÔÙÚÔÈ¿˙ÔÓÙ· ÎÔÈÏȷο ¿ÏÁË Î·È ÂÂÈÛfi‰È· ÔÍ›·˜ ·ÁÎÚ·ٛÙȉ·˜, ηıÒ˜ Î·È ·fi ÙËÓ ·ÚÔ˘Û›· ÏÈ·ÈÌ›·˜ ÛÙÔ ‚˘ıfi ÙÔ˘ ÔÊı·ÏÌÔ‡ (lipemia retinalis), ÂÍ·ÓıËÌ·ÙÈÎÒÓ Í·ÓıˆÌ¿ÙˆÓ Î·È ÏÈ·ÈÌÈÎÔ‡ ÔÚÔ‡. ∆· ÂÍ·ÓıËÌ·ÙÈο Í·ÓıÒÌ·Ù· Â›Ó·È ÌÈÎÚ¤˜ ÎÈÙÚÈÓˆ¤˜ ÎËÏ›‰Â˜ Ô˘ ÂÚÈ‚¿ÏÏÏÔÓÙ·È ·fi ÂÚ˘ıËÌ·ÙÒ‰Ë ¿Ïˆ Î·È ·Ó¢ڛÛÎÔÓÙ·È ÛÙÔ˘˜ ÁÏÔ˘ÙÔ‡˜, ÛÙË Ú¿¯Ë Î·È ÛÙȘ ÂÎÙ·ÙÈΤ˜ ÂÈÊ¿ÓÂȘ ÙˆÓ ¿ÎÚˆÓ. ∏ ‰È¿ÁÓˆÛË Ù˘ ¯˘ÏÔÌÈÎÚÔÓ·ÈÌ›·˜ Ù›ıÂÙ·È ·fi ÙËÓ ·ÚÔ˘Û›· ÏÈ·ÈÌÈÎÔ‡ ÔÚÔ‡ ‹ Ï¿ÛÌ·ÙÔ˜ Û ·ÈÌÔÏË„›·, ÌÂÙ¿ ÓËÛÙ›· ÙÔ˘Ï¿¯ÈÛÙÔÓ 12 ˆÚÒÓ. ∂›Ó·È Ï¿ıÔ˜ Ó· ÌËÓ ·Ó·ÁÓˆÚ›˙ÔÓÙ·È Ù· ·›ÙÈ· Ù˘ Â›ÎÙËÙ˘ ¯˘ÏÔÌÈÎÚÔÓ·ÈÌ›·˜. ∆¤ÙÔÈ· ·›ÙÈ· ›ӷÈ: Ô Û·Î¯·Ú҉˘ ‰È·‚‹Ù˘, Ë ·¯˘Û·ÚΛ·, Ë ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ·, Ë Î·Ù¿¯ÚËÛË ÔÈÓÔÓ‡̷ÙÔ˜, ηıÒ˜ Î·È Ë ¯ÔÚ‹ÁËÛË ÔÚÈÛÌ¤ÓˆÓ Ê·Ú̿ΈÓ. ∆· ¿ÙÔÌ· Ô˘ οÓÔ˘Ó Î·Ù¿¯ÚËÛË ÔÈÓÔÓ‡̷ÙÔ˜ ·Ó·ÁÓˆÚ›˙ÔÓÙ·È ·fi ÙËÓ ·ÚÔ˘Û›· ÔÚÈÛÌ¤ÓˆÓ ÎÏÈÓÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ, fiˆ˜ Â›Ó·È Ë ÂÚ˘ıÚfiÙËÙ· ÙÔ˘ ı¤Ó·ÚÔ˜ Î·È ÙÔ˘ ˘Ôı¤Ó·ÚÔ˜, ÔÈ ÙÂÏ·ÁÁÂÈÂÎٷۛ˜, ÔÈ ·Ï¿Ì˜ Dupuytren, ÙÔ ÂÚ‡ıËÌ· ÙÔ˘ ÚÔÛÒÔ˘, Ë Á˘Ó·ÈÎÔÌ·ÛÙ›·, ηıÒ˜ Î·È Ë ‰ÈfiÁΈÛË ÙˆÓ ·ÚˆÙ›‰ˆÓ. ∂ÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· Ô˘ ˘ÔÛËÌ·›ÓÔ˘Ó ÙËÓ Î·Ù¿¯ÚËÛË ÔÈÓÔÓ‡̷ÙÔ˜ Â›Ó·È Ë ·‡ÍËÛË ÙÔ˘ ̤ÛÔ˘ fiÁÎÔ˘ ÙˆÓ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ (MCV), ηıÒ˜ Î·È Ù· ·˘ÍË̤ӷ Â›‰· ÙÔ˘ Ô˘ÚÈÎÔ‡ ÔͤԘ, Ù˘ ÁGT Î·È Ù˘ ·Û·ÚÙÈ΋˜ ·ÌÈÓÔÙÚ·ÓÛÊÂÚ¿Û˘ (AST). ∏ ‰ÈÏ¿ÛÈ· ·‡ÍËÛË Ù˘ AST Û ۇÁÎÚÈÛË Ì ÙËÓ ·ÌÈÓÔÙÚ·ÓÛÊÂÚ¿ÛË Ù˘ ·Ï·Ó›Ó˘ (ALT) ·ÔÙÂÏ› ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÂÚÁ·ÛÙËÚÈ·Îfi ‡ÚËÌ· Û ¿ÙÔÌ· Ô˘ οÓÔ˘Ó Î·Ù¿¯ÚËÛË ÔÈÓÔÓ‡̷ÙÔ˜. ¶Ú¤ÂÈ ¿ÓÙÔÙ ӷ ·Ó·˙ËÙÂ›Ù·È Ë ¯ÔÚ‹ÁËÛË Ê·ÚÌ¿ÎˆÓ Ô˘ ÂËÚ¿˙Ô˘Ó ‰˘ÛÌÂÓÒ˜ ÙÔ ÌÂÙ·‚ÔÏÈÛÌfi ÙˆÓ ÏÔ‡ÛÈˆÓ Û ÙÚÈÁÏ˘ÎÂÚ›‰È· ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È ÚÔηÏÔ‡Ó ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ. ∆¤ÙÔÈ· Ê¿Ú̷η Â›Ó·È ÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜, Ë ÈÓÙÂÚÊÂÚfiÓË, Ù· ÚÂÙÈÓÔÂȉ‹, Ù· ¿Ù˘· ·ÓÙÈ„˘¯ˆÛÈο Ê¿Ú̷η, Ù· ÔÈÛÙÚÔÁfiÓ·, ηıÒ˜ Î·È Ë Ù·ÌÔÍÈÊ·›ÓË.

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∂›Ó·È Ï¿ıÔ˜ Ó· ÌËÓ Á›ÓÂÙ·È ·ÎÚÈ‚‹˜ ‰È¿ÁÓˆÛË Ù˘ ˘ÔΛÌÂÓ˘ ‰È·Ù·Ú·¯‹˜ Ô˘ Ô‰ËÁ› Û ̤ÙÚÈ· ·‡ÍËÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ (200-1000 mg/dL). ∞˘Ù¤˜ ÔÈ ‰È·Ù·Ú·¯¤˜ ‰È·ÎÚ›ÓÔÓÙ·È Û ÚˆÙÔ·ı›˜ Î·È ‰Â˘ÙÂÚÔ·ı›˜. √È ÈÔ Û˘Ó‹ıÂȘ ÚˆÙÔ·ı›˜ ‰È·Ù·Ú·¯¤˜ Â›Ó·È Ë ÔÈÎÔÁÂÓ‹˜ ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›·, Ë ÔÔ›· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÌÂÌÔӈ̤ÓË ·‡ÍËÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ Î·È ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›·˜, ηıÒ˜ Î·È Ë ÚˆÙÔ·ı‹˜ ÌÈÎÙ‹ ˘ÂÚÏÈȉ·ÈÌ›·, Ë ÔÔ›· ¯·Ú·ÎÙËÚ›˙ÂÙ·È, fiˆ˜ ·Ó·Ê¤ÚıËÎÂ, ·fi ÔÏÏ·ÏÔ‡˜ ÏÈȉ·ÈÌÈÎÔ‡˜ Ê·ÈÓfiÙ˘Ô˘˜. ∏ ÚˆÙÔ·ı‹˜ ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›· ‰ÂÓ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ·‡ÍËÛË ÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘, Û ·ÓÙ›ıÂÛË Ì ÙËÓ ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›· Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÙ· Ï·›ÛÈ· Ù˘ ÚˆÙÔ·ıÔ‡˜ ÌÈÎÙ‹˜ ˘ÂÚÏÈȉ·ÈÌ›·˜ ‹ ÙÔ˘ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘, Ë ÔÔ›· ·˘Í¿ÓÂÈ ÙÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ. °È· ·˘Ùfi ÙÔ ÏfiÁÔ, Ú¤ÂÈ Û οı ÂÚ›ÙˆÛË Ó· ·ÍÈÔÏÔÁÂ›Ù·È Ë ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›· ˆ˜ ‰˘ÓËÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË Î·Ú‰È·ÁÁÂȷ΋˜ ÓfiÛÔ˘. °È· ÙË ÛˆÛÙ‹ ·ÍÈÔÏfiÁËÛË Ù˘ ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›·˜ ¤¯ÂÈ È‰È·›ÙÂÚË ÛËÌ·Û›· ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi. ∂ÈÚfiÛıÂÙ·, Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ apoB ÌÔÚ› Ó· Â›Ó·È ·ÚÎÂÙ¿ ¯Ú‹ÛÈÌÔ˜, ·ÊÔ‡ Ù· Â›‰· Ù˘ apoB ·ÔÙÂÏÔ‡Ó ¤Ó· Ôχ ηÏfi ‰Â›ÎÙË Ù˘ ·ÚÔ˘Û›·˜ ÙˆÓ ·ıËÚÔÁfiÓˆÓ ÌÈÎÚÒÓ-˘ÎÓÒÓ LDL ۈ̷Ùȉ›ˆÓ. ªÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ Ô Î·Ú‰È·ÁÁÂÈ·Îfi˜ ΛӉ˘ÓÔ˜ Â›Ó·È È‰È·›ÙÂÚ· ·˘ÍË̤ÓÔ˜ fiÙ·Ó Ù· Â›‰· Ù˘ apoB Â›Ó·È >120 mg/dL. ¶Ú¿ÁÌ·ÙÈ, Û ·ÛıÂÓ›˜ Ì ÔÈÎÔÁÂÓ‹ ÌÈÎÙ‹ ˘ÂÚÏÈȉ·ÈÌ›· Ù· Â›‰· Ù˘ apoB Â›Ó·È ·˘ÍË̤ӷ. ∂›Ó·È Ï¿ıÔ˜ Ë ÌË ÛˆÛÙ‹ ·ÍÈÔÏfiÁËÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ HDL¯ÔÏËÛÙÂÚfiÏ˘. ∆· ·˘ÍË̤ӷ Â›‰· ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ¯·ÌËÏ¿ Â›‰· HDL-

¯ÔÏËÛÙÂÚfiÏ˘. ∂ÈÚfiÛıÂÙ·, ¯·ÌËÏ¿ Â›‰· HDL-¯ÔÏËÛÙÂÚfiÏ˘ Û˘¯Ó¿ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙ· Ï·›ÛÈ· Ì›·˜ ÁÂÓÂÙÈ΋˜ ‰È·Ù·Ú·¯‹˜, Ù˘ ˘Ô·ÏÊ·ÏÈÔÚˆÙÂ˚Ó·ÈÌ›·˜, Ë ÔÔ›· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·˘ÍË̤ÓÔ Î·Ù·‚ÔÏÈÛÌfi ÙˆÓ HDL Î·È Û˘Û¯ÂÙ›˙ÂÙ·È Ì ·˘ÍË̤ÓÔ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ. ™Â ·ÓÙ›ıÂÛË Ì ÙËÓ ˘Ô·ÏÊ·ÏÈÔÚˆÙÂ˚Ó·ÈÌ›·, Ë ˘ÂÚ·ÏÊ·ÏÈÔÚˆÙÂ˚Ó·ÈÌ›· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÌÂÌÔӈ̤ÓË ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ HDL-¯ÔÏËÛÙÂÚfiÏ˘, ¯ˆÚ›˜ Ó· ÂËÚ¿˙ÔÓÙ·È Ù· Â›‰· ÙˆÓ ¿ÏÏˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ. ∆· ¿ÙÔÌ· Ì ˘ÂÚ·ÏÊ·ÏÈÔÚˆÙÂ˚Ó·ÈÌ›· ÂÌÊ·Ó›˙Ô˘Ó ¯·ÌËÏfi ηډȷÁÁÂÈ·Îfi ΛӉ˘ÓÔ. øÛÙfiÛÔ, ÔÚÈṲ̂ӷ ¿ÙÔÌ· Ì ˘„ËÏ¿ Â›‰· HDL-¯ÔÏËÛÙÂÚfiÏ˘ ¤¯Ô˘Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘. ™˘ÌÂÚ·ÛÌ·ÙÈο, Û ¿ÙÔÌ· ÙfiÛÔ Ì ÌÂȈ̤ӷ fiÛÔ Î·È Ì ·˘ÍË̤ӷ Â›‰· HDL-¯ÔÏËÛÙÂÚfiÏ˘, ¤¯ÂÈ È‰È·›ÙÂÚË ÛËÌ·Û›· ÙÔ ÎÏËÚÔÓÔÌÈÎfi ÈÛÙÔÚÈÎfi ÚÒÈÌ˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘. ∂Í·ÎÔÏÔ˘ıÔ‡Ó Ó· ˘¿Ú¯Ô˘Ó ·ÚÎÂÙ¿ ·Ó·¿ÓÙËÙ· ÂÚˆÙ‹Ì·Ù· fiÛÔÓ ·ÊÔÚ¿ ÙË ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË ÙˆÓ ·ÛıÂÓÒÓ Ì ‰˘ÛÏÈȉ·ÈÌ›·. ŒÓ· ·fi ·˘Ù¿ Ù· ÂÚˆÙ‹Ì·Ù· Â›Ó·È Ë ·ÎÚÈ‚‹˜ ÛËÌ·Û›· ÙÔ˘ ÚÔÛ‰ÈÔÚÈÛÌÔ‡ ÙˆÓ ·ÔÏÈÔÚˆÙÂ˚ÓÒÓ ÙÔ˘ ÔÚÔ‡ (apoB/apoA1). ∏ ÌÂϤÙË INTERHEART ¤‰ÂÈÍ fiÙÈ Ô ·ıËڈ̷ÙÈÎfi˜ ‰Â›ÎÙ˘ apoB/apoA1 ·ÔÙÂÏ› ÙÔÓ Î·Ï‡ÙÂÚÔ ÚÔÁÓˆÛÙÈÎfi ‰Â›ÎÙË ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ôηډ›Ô˘ Û ۇÁÎÚÈÛË Ì ÔÚÈṲ̂ÓÔ˘˜ ÎÏ·ÛÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘, fiˆ˜ Â›Ó·È ÙÔ Î¿ÓÈÛÌ·, Ô Û·Î¯·Ú҉˘ ‰È·‚‹Ù˘, Ë ·ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË Î·È Ë ÎÔÈÏȷ΋ ·¯˘Û·ÚΛ·. ŒÓ· ¿ÏÏÔ ÂÚÒÙËÌ· Â›Ó·È Â¿Ó ··ÈÙÂ›Ù·È Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ Lp(a). ∏ ̤ÙÚËÛË Ù˘ Lp(a), Ì ELISA ‹ ÓÂÊÂÏÔÌÂÙÚ›·, Ú¤ÂÈ Ó· Á›ÓÂÙ·È Û ¿ÙÔÌ· Ì ÁÓˆÛÙ‹ ·ÁÁÂȷ΋ ÓfiÛÔ Ô˘ ‰ÂÓ ¤¯Ô˘Ó ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙ˜ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘. √ ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ Lp(a) ÌÔ-

Ú› Ó· Á›ÓÂÙ·È ÚÔ·ÈÚÂÙÈο Î·È Û ¿ÙÔÌ· Ì ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· ‹ ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ, ηıÒ˜ Î·È Û ¿ÏÏ· ¿ÙÔÌ· ˘„ËÏÔ‡ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘. ™Â ¿ÙÔÌ· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Ì Â›‰· Lp(a) >30 mg/dL ··ÈÙÂ›Ù·È Ì›· ÈÔ ÂÈıÂÙÈ΋ Ì›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘. ™˘¯Ó¿ ÛÙË ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË ÙˆÓ ˘ÂÚÏÈȉ·ÈÌÈÒÓ Á›ÓÂÙ·È Î·È Ô ˘ÔÏÔÁÈÛÌfi˜ ÙˆÓ ·ıËڈ̷ÙÈÎÒÓ ‰ÂÈÎÙÒÓ: ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË/HDL-¯ÔÏËÛÙÂÚfiÏË, LDL-¯ÔÏËÛÙÂÚfiÏË/HDL-¯ÔÏËÛÙÂÚfiÏË Î·È apoB/apoA1. ™‡Ìʈӷ Ì ÙË ÌÂϤÙË Framingham, Ë ÚÔÁÓˆÛÙÈ΋ ·Í›·, fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ÂÌÊ¿ÓÈÛË Î·Ú‰È·ÁÁÂȷ΋˜ ÓfiÛÔ˘ ÛÙÔ˘˜ ¿Ó‰Ú˜, ÙÔ˘ ÏfiÁÔ˘ ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË/HDL-¯ÔÏËÛÙÂÚfiÏË Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË Û ۇÁÎÚÈÛË Ì ÙÔÓ Î¿ı ·Ú¿ÁÔÓÙ· ͯˆÚÈÛÙ¿. ∂ÈÚfiÛıÂÙ·, Ô ÏfiÁÔ˜ apoB/ apoA1 ıˆÚÂ›Ù·È Ô Î·Ï‡ÙÂÚÔ˜ ·ıËڈ̷ÙÈÎfi˜ ‰Â›ÎÙ˘, ·ÊÔ‡ Ù· Â›‰· Ù˘ apoB Î·È Ù˘ apoA1 Â›Ó·È Ôχ ηÏÔ› ‰Â›ÎÙ˜ ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·ıËÚÔÁfiÓˆÓ Î·È ÙˆÓ ·ÓÙÈ·ıËÚÔÁfiÓˆÓ ÛˆÌ·Ùȉ›ˆÓ ·ÓÙ›ÛÙÔȯ·. øÛÙfiÛÔ, Ú¤ÂÈ Ó· ÙÔÓÈÛı› fiÙÈ ·Ú¿ ÙË ÌÂÁ¿ÏË ÚÔÁÓˆÛÙÈ΋ ·Í›· ÙˆÓ ·Ú·¿Óˆ ·ıËڈ̷ÙÈÎÒÓ ‰ÂÈÎÙÒÓ, ÔÈ ÙÂÏÂ˘Ù·›ÔÈ ‰ÂÓ ·ÔÙÂÏÔ‡Ó ÙÔ˘˜ ÛÙfi¯Ô˘˜ Ù˘ ıÂÚ·¢ÙÈ΋˜ ·Ú¤Ì‚·Û˘ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ‰˘ÛÏÈȉ·ÈÌ›·˜. ™˘ÌÂÚ·ÛÌ·ÙÈο, ÁÈ· ÙË ÛˆÛÙ‹ ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË ÙˆÓ ˘ÂÚÏÈȉ·ÈÌÈÒÓ Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ÎÏ·ÛÈÎÒÓ ÏÈȉ·ÈÌÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ, Ó· ·ÔÎÏ›ÔÓÙ·È Ù· ·›ÙÈ· Ù˘ ‰Â˘ÙÂÚÔ·ıÔ‡˜ ‰˘ÛÏÈȉ·ÈÌ›·˜, Ó· ·ÍÈÔÏÔÁÔ‡ÓÙ·È ÚÔÛÂÎÙÈο Ù· Â˘Ú‹Ì·Ù· ·fi ÙÔ ÈÛÙÔÚÈÎfi Î·È ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË ÙÔ˘ ·ÛıÂÓ‹ Î·È Ù¤ÏÔ˜ Ó· ÂÎÙÈÌ¿Ù·È Ô Û˘ÓÔÏÈÎfi˜ ηډȷÁÁÂÈ·Îfi˜ ΛӉ˘ÓÔ˜ ÙÔ˘ οı ·ÛıÂÓ‹, Ì ‚¿ÛË ÙÔÓ ÔÔ›Ô Á›ÓÂÙ·È Î·È Ô Î·ıÔÚÈÛÌfi˜ ÙˆÓ ÛÙfi¯ˆÓ Ù˘ ˘ÔÏÈȉ·ÈÌÈ΋˜ ·ÁˆÁ‹˜.

µÈ‚ÏÈÔÁÚ·Ê›· 1. ∂ÏÈÛ¿Ê ª. ¢˘ÛÏÈȉ·ÈÌ›·, ‰È¿ÁÓˆÛË Î·È ·ÓÙÈÌÂÙÒÈÛË. ∂ΉfiÛÂȘ µ·ÁÈÔÓ¿Î˘, 2003. 2. Durrington PN, Sniderman A. Hyperlipidaemia. Oxford: Health Press, 2000. 3. Hobbs H, White AL. Lipoprotein (a): intrigues and insights. Curr Opin Lipidol 1999;4:107-113. 4. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The

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National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001;285:2486-2497. 5. Grundy SM, Cleeman JI, Merz CN, Brewer HB Jr, Clark LT, Hunninghake DB, Pasternak RC, Smith SC Jr, Stone NJ; National Heart, Lung, and Blood Institute; American College of Cardiology Foundation; American Heart Association. Implications of

recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation. 2004;110:227-239. 6. Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, McQueen M, Budaj A, Pais P, Varigos J, Lisheng L; INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364:937-952.


ATHIROSK 21-

05-03-09

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™ÂÏ›‰·17

£∂ƒ∞¶∂π∞ - º∞ƒª∞∫∞

ÀÔÏÈȉ·ÈÌÈΤ˜ Î·È ¶ÏÂÈÔÙÚÔÈΤ˜ ¢Ú¿ÛÂȘ ÙˆÓ ™Ù·ÙÈÓÒÓ ÛÙ· ∞ÁÁÂȷο ∂ÁÎÂÊ·ÏÈο ∂ÂÈÛfi‰È· £Âfi‰ˆÚÔ˜ ∏. ÃÂÈÌÒÓ·˜, ∂ȉÈ΢fiÌÂÓÔ˜ ¶·ıÔÏÔÁ›·˜, °¡ ÕÚÁÔ˘˜.

∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ÔÈ ÛÙ·Ù›Ó˜ ·ÔÎÙÔ‡Ó ÔÏÔ¤Ó· Î·È ÌÂÁ·Ï‡ÙÂÚË ÛËÌ·Û›· ÛÙËÓ ÚfiÏË„Ë Î·È ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·ÁÁÂÈ·ÎÒÓ ÂÁÎÂÊ·ÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ (∞∂∂). ¢ÚÔ˘Ó ÚˆÙ·Ú¯Èο ÛÙÔ ÌÂÙ·‚ÔÏÈÛÌfi ÙˆÓ ÏÈȉ›ˆÓ Î·È ÂÏ·ÙÙÒÓÔ˘Ó Ù· Â›‰· Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘, Ë ÔÔ›· ÂÓÔ¯ÔÔÈÂ›Ù·È ÁÈ· ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÂÂÈÛÔ‰›ˆÓ. ¶¤Ú·Ó ÙÔ˘ ‚·ÛÈÎÔ‡ ·˘ÙÔ‡ Ì˯·ÓÈÛÌÔ‡, Ë ¤Ú¢ӷ ¤¯ÂÈ ·Ôηχ„ÂÈ Î·È ÌÈ· ÛÂÈÚ¿ ·fi ‰Â˘ÙÂÚ‡ԢÛ˜ ¢ÂÚÁÂÙÈΤ˜ ȉÈfiÙËÙ˜, ÔÈ Ôԛ˜ Â›Ó·È ÁÓˆÛÙ¤˜ ˆ˜ «ÏÂÈÔÙÚÔÈΤ˜». ∞˘Ù¤˜ ÔÈ ÏÂÈÔÙÚÔÈΤ˜ ‰Ú¿ÛÂȘ ·ÊÂÓfi˜ ‚ÔËıÔ‡Ó ÛÙËÓ ÚfiÏË„Ë ÙˆÓ ∞∂∂, ·ÊÂÙ¤ÚÔ˘ ·ÛÎÔ‡Ó Ó¢ÚÔÚÔÛٷ٢ÙÈ΋ ‰Ú¿ÛË ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ÔÍ›·˜ Ê¿Û˘ Ù˘ ÂÁÎÂÊ·ÏÈ΋˜ ÈÛ¯·ÈÌ›·˜.

ªË¯·ÓÈÛÌÔ› ‰Ú¿Û˘ ÙˆÓ ÛÙ·ÙÈÓÒÓ ∂›‰Ú·ÛË ÛÙÔ ÌÂÙ·‚ÔÏÈÛÌfi Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ∏ ¯ÔÏËÛÙÂÚfiÏË ·Ó‹ÎÂÈ ·fi ¯ËÌÈ΋˜ ·fi„ˆ˜ ÛÙ· ÛÙÂÚÔÂȉ‹ Î·È ·ÔÙÂÏ› ‚·ÛÈÎfi ÌfiÚÈÔ ÁÈ· ÙË ‰ÔÌ‹ Î·È ÌÂÙ·‚ÔÏÈÛÌfi ÙˆÓ Â˘Î·Ú˘ˆÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ. ∂›Ó·È ··Ú·›ÙËÙÔ Û˘ÛÙ·ÙÈÎfi ÙˆÓ Î˘ÙÙ·ÚÈÎÒÓ ÌÂÌ‚Ú·ÓÒÓ, ÙˆÓ ÔÔ›ˆÓ Ú˘ıÌ›˙ÂÈ ÙË Ú¢ÛÙfiÙËÙ·, ÂÓÒ ·ÔÙÂÏ› Î·È Úfi‰ÚÔÌË Ô˘Û›· ÙˆÓ ÛÙÂÚÔÂȉÈÎÒÓ ÔÚÌÔÓÒÓ, fiˆ˜ Ë ÎÔÚÙÈ˙fiÏË, Ë ÚÔÁÂÛÙÂÚfiÓË, Ë ÙÂÛÙÔÛÙÂÚfiÓË, Ù· ÔÈÛÙÚÔÁfiÓ· Î·È Ë ·Ï‰ÔÛÙÂÚfiÓË, ηıÒ˜ Î·È ÙˆÓ ¯ÔÏÈÎÒÓ ·Ï¿ÙˆÓ. ™˘ÌÌÂÙ¤¯ÂÈ Â›Û˘ Î·È Û ÂÓ‰Ô΢ÙÙ¿ÚȘ Ô‰Ô‡˜ ÌÂÙ·ÁˆÁ‹˜ ÌËÓ˘Ì¿ÙˆÓ, ˆ˜ Û˘ÛÙ·ÙÈÎfi ÌÂÌ‚Ú·ÓÈÎÒÓ ÌÈÎÚÔÂÚÈÔ¯ÒÓ, ÁÓˆÛÙÒÓ ˆ˜ ÏÈȉȷΤ˜ ۯ‰›Â˜ (lipid rafts) [1]. ∏ ¯ÔÏËÛÙÂÚfiÏË ÛÙÔÓ ·ÓıÚÒÈÓÔ ÔÚÁ·ÓÈÛÌfi ÚÔ¤Ú¯ÂÙ·È ·fi ‰‡Ô ËÁ¤˜: ¤Ó· ̤ÚÔ˜ Û˘ÓÙ›ıÂÙ·È ÂÓ‰ÔÁÂÓÒ˜ ÛÙÔ ‹·Ú ·fi ·Î¤Ù˘ÏÔ-CoA, ÂÓÒ ¤Ó· ¿ÏÏÔ Ì¤ÚÔ˜ ÚÔÛÏ·Ì‚¿ÓÂÙ·È Â͈ÁÂÓÒ˜, Ì ÙȘ ÙÚÔʤ˜. ∏ ÂÓ‰ÔÁÂÓ‹˜ ·Ú·ÁˆÁ‹ ηχÙÂÈ ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ

̤ÚÔ˜ ÙˆÓ ·Ó·ÁÎÒÓ Û ¯ÔÏËÛÙÂÚfiÏË, ÂÚ›Ô˘ 900 mg/Ë̤ڷ, ÂÓÒ Ë ‰È·ÈÙËÙÈ΋ ÚfiÛÏË„Ë ·Ú¤¯ÂÈ, ·Ó¿ÏÔÁ· ‚¤‚·È· Ì ÙÔ ‰È·ÈÙÔÏfiÁÈÔ, ÂÚ›Ô˘ 300 mg/Ë̤ڷ [2]. ∏ ¯ÔÏËÛÙÂÚfiÏË ÌÂٷʤÚÂÙ·È ·fi ÙÔ ‹·Ú ÚÔ˜ ÙÔ˘˜ ÈÛÙÔ‡˜ ΢ڛˆ˜ ̤ۈ Ù˘ ÏÈÔÚˆÙ½Ó˘ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ (LDL), ÂÓÒ ÂÈÛÙÚ¤ÊÂÈ ÛÙÔ ‹·Ú ̤ۈ Ù˘ ÏÈÔÚˆÙ½Ó˘ ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ (HDL). ∆Ô Î·ıÔÚÈÛÙÈÎfi ‚‹Ì· ÛÙË ‚ÈÔÛ‡ÓıÂÛË Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ Â›Ó·È Ë ÌÂÙ·ÙÚÔ‹ ÙÔ˘ HMG-CoA Û Ì‚·ÏÔÓÈÎfi Ô͇, ·ÓÙ›‰Ú·ÛË Ë ÔÔ›· ηٷχÂÙ·È ·fi ÙËÓ ·Ó·ÁˆÁ¿ÛË ÙÔ˘ HMG-CoA. √È ÛÙ·Ù›Ó˜ ·Ó·ÛÙ¤ÏÏÔ˘Ó ÙÔ ¤Ó˙˘ÌÔ ·˘Ùfi ÌÂ Û˘Ó·ÁˆÓÈÛÙÈÎfi ÙÚfiÔ, ηٷϷ̂¿ÓÔÓÙ·˜ ÙË ı¤ÛË ‰¤ÛÌ¢Û˘ ÙÔ˘ ˘ÔÛÙÚÒÌ·ÙÔ˜ ÛÙÔ ÂÓÂÚÁfi ΤÓÙÚÔ ÙÔ˘ ÂÓ˙‡ÌÔ˘ [3]. ªÂ ÙÔÓ ÙÚfiÔ ·˘Ùfi, ÂÏ·ÙÙÒÓÂÙ·È Ë Û˘ÁΤÓÙÚˆÛË ¯ÔÏËÛÙÂÚfiÏ˘ ÂÓÙfi˜ ÙˆÓ Ë·ÙÔ΢ÙÙ¿ÚˆÓ. ∆· ·ÙÙ·Ú· ·ÓÙȉÚÔ‡Ó Û ·˘Ù‹Ó ÙËÓ ·Ó·ÛÙÔÏ‹ Ù˘ ·Ú·ÁˆÁ‹˜ ¯ÔÏËÛÙÂÚfiÏ˘ ·˘Í¿ÓÔÓÙ·˜ ÙË Û‡ÓıÂÛË HMG-CoA Î·È ÙÔÓ ·ÚÈıÌfi ÙˆÓ LDL ˘Ô‰Ô¯¤ˆÓ ÛÙËÓ ÂÈÊ¿ÓÂÈ¿ ÙÔ˘˜. ∆ÂÏÈÎfi ·ÔÙ¤ÏÂÛÌ· Â›Ó·È Ó· ‰È¢ÎÔχÓÂÙ·È Ë ÚfiÛÏË„Ë ÌÔÚ›ˆÓ LDL ·fi ÙÔ ·›Ì· Î·È Ó· ÂÏ·ÙÙÒÓÔÓÙ·È Ù· Â›‰· LDL¯ÔÏËÛÙÂÚfiÏ˘ ÛÙÔÓ ÔÚfi ηٿ 20-55% [4]. ¶ÏÂÈÔÙÚÔÈΤ˜ ‰Ú¿ÛÂȘ ÙˆÓ ÛÙ·ÙÈÓÒÓ ¶¤Ú·Ó Ù˘ ÂÏ¿ÙÙˆÛ˘ ÙˆÓ ÂÈ¤‰ˆÓ LDL-¯ÔÏËÛÙÂÚfiÏ˘, ‰Ú¿ÛË ÁÈ· ÙËÓ ÔÔ›· Î·È Û¯Â‰È¿ÛÙËηÓ, ÔÈ ÛÙ·Ù›Ó˜ ·ÛÎÔ‡Ó, fiˆ˜ ÚԷӷʤÚıËÎÂ, Î·È ÌÈ· ÛÂÈÚ¿ ¿ÏÏˆÓ ÂȉڿÛˆÓ, ÙȘ ÏÂÁfiÌÂÓ˜ ÏÂÈÔÙÚÔÈΤ˜. ¶·ÚfiÙÈ ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ·fi ·˘Ù¤˜ ÙȘ ‰Ú¿ÛÂȘ ÔÊ›ÏÔÓÙ·È ÛÙËÓ ·Ó·ÛÙÔÏ‹ Ù˘ HMGCoA ·Ó·ÁˆÁ¿Û˘, Ë ¯ÔÚ‹ÁËÛË ÛÙ·ÙÈÓÒÓ Ê·›ÓÂÙ·È Ó· ÂËÚ¿˙ÂÈ Î·È ¿ÏÏÔ˘˜ Ì˯·ÓÈÛÌÔ‡˜, fiˆ˜ ÙÔ ÌÂÙ·‚ÔÏÈÛÌfi ÙÔ˘ ÌÔÓÔÍÂȉ›Ô˘ ÙÔ˘ ·˙ÒÙÔ˘ (¡√) Î·È ÙÔ˘ ÁÏÔ˘Ù·-

ÌÈÓÈÎÔ‡, ÙË ÊÏÂÁÌÔÓ‹, ÙËÓ ·ÁÁÂÈÔÁ¤ÓÂÛË, ÙË Û˘ÛÛÒÚ¢ÛË ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ, ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È ÙËÓ ·fiÙˆÛË. ∏ ·Ó·ÛÙÔÏ‹ Ù˘ HMG-CoA ·Ó·ÁˆÁ¿Û˘ ÂÌÔ‰›˙ÂÈ ÙË Û‡ÓıÂÛË fi¯È ÌfiÓÔ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘, ·ÏÏ¿ Î·È ·ÚÎÂÙÒÓ ÈÛÔÚÂÓÔÂȉÒÓ ÂӉȿÌÂÛˆÓ ÂÓÒÛˆÓ, fiˆ˜ ÙÔ ÊˆÛÊÔÚÈÎfi Ê·ÚÓÂÛ‡ÏÈÔ Î·È ÙÔ ÊˆÛÊÔÚÈÎfi ÁÂÚ·Ó‡Ï-ÁÂÚ·Ó‡ÏÈÔ. √È Ô˘Û›Â˜ ·˘Ù¤˜ Û˘ÌÌÂÙ¤¯Ô˘Ó Û ÌÂÙ·‚ÔÏÈΤ˜ Ô‰Ô‡˜, Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ·˘ÙÒÓ ÙˆÓ GTP-‰ÂÛÌ¢ÙÈÎÒÓ ÚˆÙÂ˚ÓÒÓ Rho Î·È Rac, ÔÈ Ôԛ˜ ηٷÛÙ¤ÏÏÔ˘Ó ÙËÓ ·Ú·ÁˆÁ‹ ¡√ Î·È ÂÓÂÚÁÔÔÈÔ‡Ó ÙËÓ NAD(P)H ÔÍÂȉ¿ÛË, ·ÓÙ›ÛÙÔȯ· [5]. ∆Ô NO Û˘ÓÙ›ıÂÙ·È ÛÙ· ÂÓ‰ÔıËÏȷο ·ÙÙ·Ú· ·fi ÙËÓ ÂÓ‰ÔıËÏȷ΋ Û˘ÓıÂÙ¿ÛË ÙÔ˘ ÌÔÓÔÍÂȉ›Ô˘ ÙÔ˘ ·˙ÒÙÔ˘ (eNOS). Œ¯ÂÈ ÈÛ¯˘Ú‹ ·ÁÁÂÈԉȷÛÙ·ÏÙÈ΋ ‰Ú¿ÛË Î·È ÂÌϤÎÂÙ·È ÛÙË Û˘ÛÛÒÚ¢ÛË ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ, ÛÙË ıÚÔÌ‚ÔÁ¤ÓÂÛË, ÛÙË ÌÂÙ·Ó¿ÛÙ¢ÛË Î·È ÚÔÛÎfiÏÏËÛË ÙˆÓ Ï¢ÎÔ΢ÙÙ¿ÚˆÓ, ηıÒ˜ Î·È ÛÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙˆÓ Ï›ˆÓ Ì˘˚ÎÒÓ Î˘ÙÙ¿ÚˆÓ. √È ÛÙ·Ù›Ó˜ ·˘Í¿ÓÔ˘Ó Ù· Â›‰· ¡√ ̤ۈ Ì˯·ÓÈÛÌÒÓ ·ÓÂÍ¿ÚÙËÙˆÓ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ [6, 7]. ™ÙË ‰È¿ÚÎÂÈ· ÂÁÎÂÊ·ÏÈ΋˜ ÈÛ¯·ÈÌ›·˜, ÙÔ ¡√ Ô˘ ·Ú¿ÁÂÙ·È ·fi ÙËÓ ÂÓ‰ÔıËÏȷ΋ ÈÛÔÌÔÚÊ‹ Ù˘ Û˘ÓıÂÙ¿Û˘ ÙÔ˘ ¡√ (eNOS) ¤¯ÂÈ ·ÓÙÈıÚÔÌ‚ˆÙÈ΋, ·ÁÁÂÈԉȷÛÙ·ÏÙÈ΋ Î·È ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë ‰Ú¿ÛË, Û ·ÓÙ›ıÂÛË Ì ÙÔ ¡√ Ô˘ ·Ú¿ÁÂÙ·È ·fi ÙȘ ÓÂ˘ÚˆÓÈΤ˜ (nNOS) Î·È Â·ÁÒÁÈ̘ (iNOS) ÈÛÔÌÔÚʤ˜ ÙÔ˘ ÂÓ˙‡ÌÔ˘, ÔÈ Ôԛ˜ ÚÔηÏÔ‡Ó Î·Ù·ÛÙÚÔÊ‹ ÙˆÓ Ó¢ÚÒÓˆÓ Ì¤Ûˆ ·Ú·ÁˆÁ‹˜ ÂÏ¢ı¤ÚˆÓ ÚÈ˙ÒÓ Î·È ÚÔÊÏÂÁÌÔÓˆ‰ÒÓ Î˘ÙÔÎÈÓÒÓ. ∏ ¯ÔÚ‹ÁËÛË ÛÙ·ÙÈÓÒÓ Û ÂÈÚ·Ì·Ùfi˙ˆ· ¤¯ÂÈ ‚ÚÂı› fiÙÈ ·˘Í¿ÓÂÈ ÙËÓ ¤ÎÊÚ·ÛË Ù˘ eNOS, Èı·Ófiٷٷ ̤ۈ Ù˘ ÚÔ·Ó·ÊÂÚı›۷˜ ÂÏ¿ÙÙˆÛ˘ ÛÙ· Â›‰· ÈÛÔÚÂÓÔÂȉÒÓ, Ë ÔÔ›· Û˘ÓÔ-

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‰Â‡ÂÙ·È ·fi ·‡ÍËÛË Ù˘ ÂÁÎÂÊ·ÏÈ΋˜ ·ÈÌ·ÙÈ΋˜ ÚÔ‹˜ Î·È ÂÏ¿ÙÙˆÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙÔ˘ ÂÌÊÚ¿ÎÙÔ˘ [8]. √È ÛÙ·Ù›Ó˜ ‚ÂÏÙÈÒÓÔ˘Ó ÙËÓ ÂÓ‰ÔıËÏȷ΋ ÏÂÈÙÔ˘ÚÁ›· ̤ۈ Î·È Ù˘ ·ÓÙÈÔÍÂȉˆÙÈ΋˜ ÙÔ˘˜ ‰Ú¿Û˘. ∂Ï·ÙÙÒÓÔ˘Ó ÙËÓ Â·ÁfiÌÂÓË ·fi ÙËÓ ·ÁÁÂÈÔÙÂÓÛ›ÓË ππ ·Ú·ÁˆÁ‹ ‚Ï·‚ÂÚÒÓ ÂχıÂÚˆÓ ÚÈ˙ÒÓ, ηٷÛÙ¤ÏÏÔÓÙ·˜ ÙËÓ ÂÓÂÚÁfiÙËÙ· Ù˘ NAD(P)H-ÔÍÂȉ¿Û˘ Î·È ÙËÓ ¤ÎÊÚ·ÛË ÙˆÓ ˘Ô‰Ô¯¤ˆÓ AT1 [5]. ª›· ·ÎfiÌË Â˘ÂÚÁÂÙÈ΋ ‰Ú¿ÛË ÙˆÓ ÛÙ·ÙÈÓÒÓ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ÔÍ›·˜ Ê¿Û˘ ÙÔ˘ ∞∂∂ Â›Ó·È Ë ÂÏ¿ÙÙˆÛË Ù˘ Ó¢ÚÔÙÔÍÈ΋˜ ‰ÈÂÁÂÚÙÈ΋˜ ‰Ú¿Û˘ (excitotoxicity) ÙÔ˘ ÁÏÔ˘Ù·ÌÈÓÈÎÔ‡ ÔͤԘ. ªÂϤÙ˜ Û ·ÙÙ·Ú· ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ë ¯ÔÚ‹ÁËÛË ÛÙ·ÙÈÓÒÓ ÂÏ·ÙÙÒÓÂÈ ÙÔ ÓÂ˘ÚˆÓÈÎfi ı¿Ó·ÙÔ Ô˘ ÚÔηÏÔ‡Ó ÔÈ ·ÁˆÓÈÛÙ¤˜ ÙˆÓ N-methylD-aspartate (NMDA) ˘Ô‰Ô¯¤ˆÓ [9]. ŒÓ·˜ Èı·Ófi˜ Ì˯·ÓÈÛÌfi˜ ·˘Ù‹˜ Ù˘ Ó¢ÚÔÚÔÛٷ٢ÙÈ΋˜ ‰Ú¿Û˘ ÙˆÓ ÛÙ·ÙÈÓÒÓ Â›Ó·È Ë ÂÍ·Ûı¤ÓËÛË Ù˘ Û‡Ó‰ÂÛ˘ ÌÂٷ͇ ÙˆÓ NMDA ˘Ô‰Ô¯¤ˆÓ Î·È ÙÔ˘ ÁÏÔ˘Ù·ÌÈÓÈÎÔ‡, Èı·Ófiٷٷ ÏfiÁˆ ÂÏ¿ÙÙˆÛ˘ Ù˘ ‰¤ÛÌ¢Û˘ ÙˆÓ NMDA ˘Ô‰Ô¯¤ˆÓ ÛÙȘ ÏÈȉȷΤ˜ ۯ‰›Â˜ [10]. ªÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ÔÈ ÛÙ·Ù›Ó˜ ÂÏ·ÙÙÒÓÔ˘Ó ÙËÓ ¤ÎÊÚ·ÛË ÊÏÂÁÌÔÓˆ‰ÒÓ ÌÂÛÔÏ·‚ËÙÒÓ fiˆ˜ C-·ÓÙȉÚÒÛ· ÚˆÙ½ÓË, CD40, IL-1, IL-6, TNF-a [11, 12] Î·È ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛ˘ fiˆ˜ ICAM1, VCAM1, E-ÛÂÏÂÎÙ›ÓË Î·È LFA-1 [13-15]. ™ÙËÓ ÚfiÛÊ·ÙË ÌÂϤÙË JUPITER, Ë ¯ÔÚ‹ÁËÛË ÛÙ·Ù›Ó˘ Û ¿ÙÔÌ· Ì ÂχıÂÚÔ Î·Ú‰ÈÔÏÔÁÈÎfi ÈÛÙÔÚÈÎfi, ¯ˆÚ›˜ ‰˘ÛÏÈȉ·ÈÌ›·, ·ÏÏ¿ Ì ·˘ÍË̤ӷ Â›‰· CRP, ¤Ù˘¯Â ÂÏ¿ÙÙˆÛË ÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘, Ì ٷ ∞∂∂ Ó· ÌÂÈÒÓÔÓÙ·È Î·Ù¿ 48% [16]. Œ¯ÂÈ ·Ó·ÊÂÚı› Â›Û˘ ·ÓÙÈÊÏÂÁÌÔÓ҉˘ ‰Ú¿ÛË ÙˆÓ ÛÙ·ÙÈÓÒÓ Ì¤Ûˆ ÂÏ¿ÙÙˆÛ˘ Ù˘ ÂÓÂÚÁÔÔ›ËÛ˘ ÙÔ˘ ·Ú¿ÁÔÓÙ· NF-kappa-B [17], ÙÚÔÔÔ›ËÛ˘ Ù˘ ·Ú·ÁˆÁ‹˜ ΢ÙÔÎÈÓÒÓ, ηıÒ˜ Î·È ÂÚÈÔÚÈÛÌÔ‡ Ù˘ ÔÍ›‰ˆÛ˘ ÙˆÓ ÏÈȉ›ˆÓ Î·È Ù˘ ‚Ï·‚ÂÚ‹˜ Â›‰Ú·Û˘ ÙˆÓ ÂχıÂÚˆÓ ÚÈ˙ÒÓ, ̤ۈ ‰È·Ù‹ÚËÛ˘ Ù˘ ‰ÈÛÌÔ˘Ù¿Û˘ ÙÔ˘ ˘ÂÚÔÍÂȉ›Ô˘ [18]. √È ÛÙ·Ù›Ó˜ ÂÏ·ÙÙÒÓÔ˘Ó Â›Û˘ ÙË ‰Ú·ÛÙÈÎfiÙËÙ· ÙˆÓ ÌÂÙ·ÏÏÔÚˆÙÂ˚Ó·ÛÒÓ (MMPs), ÌÔÚ›ˆÓ Ô˘ ÂÎÎÚ›ÓÔÓÙ·È ·fi Ù· Ì·ÎÚÔÊ¿Á· Î·È ·‰˘Ó·Ù›˙Ô˘Ó ÙËÓ ÈÓÒ‰Ë

18

ο„· ÙˆÓ ·ıËÚÔÛÎÏËÚˆÙÈÎÒÓ Ï·ÎÒÓ. ∏ Â·ÎfiÏÔ˘ıË ÛÙ·ıÂÚÔÔ›ËÛË ÙˆÓ Â˘¿ÏˆÙˆÓ Ï·ÎÒÓ ÂÚÈÔÚ›˙ÂÈ ÙÔÓ Î›Ó‰˘ÓÔ Ú‹Í˘ ÙÔ˘˜ [19]. √È ÛÙ·Ù›Ó˜ Ê·›ÓÂÙ·È Ó· ÚÔ¿ÁÔ˘Ó ÙËÓ ·ÁÁÂÈÔÁ¤ÓÂÛË, Ó¢ÚÔÁ¤ÓÂÛË Î·È Û˘Ó·ÙÔÁ¤ÓÂÛË ÌÂÙ¿ ·fi ∞∂∂ Û ÂÈÚ·Ì·Ùfi˙ˆ· [20]. ¢ÚÔ˘Ó ·ÊÂÓfi˜ ÂÓÂÚÁÔÔÈÒÓÙ·˜ ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Akt Î·È KLF2 Î·È ·˘Í¿ÓÔÓÙ·˜ ÙÔ ¡√ [21, 22] Î·È ·ÊÂÙ¤ÚÔ˘ ·˘Í¿ÓÔÓÙ·˜ ÙËÓ ÎÈÓËÙÔÔ›ËÛË Î·È ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· ÙˆÓ ÚÔÁÔÓÈÎÒÓ ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ (endothelial progenitor cells - EPCs) [23, 24]. ∏ ·ÓÙÈıÚÔÌ‚ˆÙÈ΋ ‰Ú¿ÛË ÙˆÓ ÛÙ·ÙÈÓÒÓ ¤¯ÂÈ ‰ÈÂÚ¢ÓËı› ·fi ·ÚÎÂÙ¤˜ ÌÂϤÙ˜. √È ÛÙ·Ù›Ó˜ ηٷÛÙ¤ÏÏÔ˘Ó ÙË ÌÂÙ·ÙÚÔ‹ Ù˘ ÚÔıÚÔÌ‚›Ó˘ Û ıÚÔÌ‚›ÓË ÂÏ·ÙÙÒÓÔÓÙ·˜ ÙË ‰Ú·ÛÙÈÎfiÙËÙ· ÙˆÓ ·Ú·ÁfiÓÙˆÓ V Î·È VIIa [25, 26], ÂÓÒ ·Ó·ÛÙ¤ÏÏÔ˘Ó Â›Û˘ ÙËÓ ¤ÎÊÚ·ÛË ÙÔ˘ ÈÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· (tissue factor - TF) [27], ÙËÓ ÂÍ·ÚÙÒÌÂÓË ·fi ÙÔÓ TF ÂÓÂÚÁÔÔ›ËÛË Ù˘ ÚÔıÚÔÌ‚›Ó˘ [28] Î·È ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ [29]. √È ÛÙ·Ù›Ó˜ ÂȉÚÔ‡Ó ÛÙÔ ·ÓÔÛÔÔÈËÙÈÎfi Û‡ÛÙËÌ· ÂÏ·ÙÙÒÓÔÓÙ·˜ ÙËÓ Â·ÁfiÌÂÓË ·fi ÙȘ ÈÓÙÂÚÊÂÚfiÓ˜ ¤ÎÊÚ·ÛË ÙÔ˘ Ì›˙ÔÓÔ˜ Û˘ÛÙ‹Ì·ÙÔ˜ ÈÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜ ππ (MHC-II) Û ·ÙÙ·Ú· fiˆ˜ Ù· Ì·ÎÚÔÊ¿Á· Î·È ÙÔ ÂÓ‰Ôı‹ÏÈÔ [30]. ∂›Û˘ ÂÏ·ÙÙÒÓÔ˘Ó ÙËÓ ·fiÙˆÛË, ·ÊÂÓfi˜ ηٷÛÙ¤ÏÏÔÓÙ·˜ ÙË ÊÏÂÁÌÔÓ‹, ·ÊÂÙ¤ÚÔ˘ ÂȉÚÒÓÙ·˜ ·¢ı›·˜ ÛÙÔ˘˜ ·ÔÙˆÙÈÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜. Œ¯ÂÈ ‚ÚÂı› fiÙÈ Ë Ï‹„Ë ·ÙÔÚ‚·ÛÙ·Ù›Ó˘, ÏÔ‚·ÛÙ·Ù›Ó˘ Î·È ÛÈÌ‚·ÛÙ·Ù›Ó˘ Û¯ÂÙ›˙ÂÙ·È Ì ÂÏ¿ÙÙˆÛË Ù˘ ÚÂÓ˘Ï›ˆÛ˘ Ù˘ p21-Rho B, ÌÈ·˜ ÚˆÙ½Ó˘ Ô˘ Û˘ÌÌÂÙ¤¯ÂÈ ÛÙË Ú‡ıÌÈÛË Ù˘ ·fiÙˆÛ˘ [31]. ™Â ÌÈ· ¿ÏÏË ÌÂϤÙË, Ë ¯ÔÚ‹ÁËÛË Ú·‚·ÛÙ·Ù›Ó˘ ÂÏ¿ÙÙˆÛ ÙËÓ ·fiÙˆÛË ÙˆÓ Ï›ˆÓ Ì˘˚ÎÒÓ Î˘ÙÙ¿ÚˆÓ ÛÙȘ ·ıËڈ̷ÙÈΤ˜ ϿΘ ÙˆÓ Î·ÚˆÙ›‰ˆÓ [32].

√ ÚfiÏÔ˜ ÙˆÓ ÛÙ·ÙÈÓÒÓ ÛÙËÓ ÚfiÏË„Ë ÙˆÓ ∞∂∂ ∏ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· ·ÔÙÂÏ› Ì›˙ÔÓ· ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ (™¡). √ ÚfiÏÔ˜ Ù˘ fï˜ ÛÙËÓ ÂΉ‹ÏˆÛË ÈÛ¯·ÈÌÈÎÒÓ ∞∂∂ ‰ÂÓ ¤¯ÂÈ ·ÎfiÌË ÍÂηı·ÚÈÛÙ› Ì ·ÎÚ›‚ÂÈ·. √È ÎÏ·ÛÈΤ˜ ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ›¯·Ó ۯ‰ȷÛÙ› Ì ÙË ™¡ η-

Ù¿ ÓÔ˘ ηÈ, ˆ˜ ÂÎ ÙÔ‡ÙÔ˘, Û˘ÌÂÚȤϷ‚·Ó ËÏÈÎȷΤ˜ ÔÌ¿‰Â˜ Ô˘ ÎÈÓ‰‡Ó¢·Ó ÂÚÈÛÛfiÙÂÚÔ ·fi ™¡ Î·È ÏÈÁfiÙÂÚÔ ·fi ∞∂∂. ∆· ∞∂∂ ›¯·Ó ıˆÚËı› ‰Â˘ÙÂÚÂ‡Ô˘Û· ÌÂÙ·‚ÏËÙ‹, Î·È ‰ÂÓ ‰È·¯ˆÚÈ˙fiÙ·Ó Û ÈÛ¯·ÈÌÈο Î·È ·ÈÌÔÚÚ·ÁÈο. ªÈ· ÌÂÙ·-·Ó¿Ï˘ÛË ÚÔÔÙÈÎÒÓ ÂȉËÌÈÔÏÔÁÈÎÒÓ ÌÂÏÂÙÒÓ ÌÂ Û˘ÓÔÏÈο 450.000 ¿ÙÔÌ· Â› 16 ¯ÚfiÓÈ· ·Ú·ÎÔÏÔ‡ıËÛ˘ ‰ÂÓ ·Ó¤‰ÂÈÍÂ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÂÈ¤‰ˆÓ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ÎÈÓ‰‡ÓÔ˘ ÁÈ· ∞∂∂ [33]. √È ÂÚÈÛÛfiÙÂÚ˜ fï˜ ·fi ÙȘ ÌÂϤÙ˜ Ô˘ Û˘ÌÂÚÈÏ‹ÊıËÛ·Ó Âͤٷ˙·Ó ÌfiÓÔ Ù· ı·Ó·ÙËÊfiÚ· ∞∂∂, ˆ˜ ÂÎ ÙÔ‡ÙÔ˘ Ë Û¯¤ÛË ÌÂٷ͇ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ∞∂∂ ÌÔÚ› Ó· ˘ÔÂÎÙÈÌ‹ıËÎÂ. ¶ÈÔ ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ ·Ó·‰ÂÈÎÓ‡Ô˘Ó fiÓÙˆ˜ Û¯¤ÛË ÌÂٷ͇ ˘„ËÏÒÓ ÂÈ¤‰ˆÓ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÈÛ¯·ÈÌÈο ∞∂∂ [34]. ∏ ¯ÔÚ‹ÁËÛË ÛÙ·ÙÈÓÒÓ Û ·ÛıÂÓ›˜ Ì ™¡ ÂÏ·ÙÙÒÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ∞∂∂, ˆ˜ Î·È 30% [35, 36], ÌÈ· ÂÏ¿ÙÙˆÛË Ô˘ ·ÊÔÚ¿ ¿ÙÔÌ· ÙfiÛÔ Ì ˘„ËÏ¿, fiÛÔ Î·È Ì ̤ÙÚÈ· Â›‰· ¯ÔÏËÛÙÂÚfiÏ˘. ∂›Û˘, Ë ÌÂϤÙË ASCOTT-LLA ¤‰ÂÈÍ fiÙÈ Ë ¯ÔÚ‹ÁËÛË ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ Û ˘ÂÚÙ·ÛÈÎÔ‡˜ ·ÛıÂÓ›˜ ¯ˆÚ›˜ ÈÛÙÔÚÈÎfi ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘ ÂÏ¿ÙÙˆÛ ٷ ∞∂∂ Î·È Ù· ¿ÏÏ· Ì›˙ÔÓ· ηډȷÁÁÂȷο Û˘Ì‚¿Ì·Ù· [37]. ªÈ· ÌÂÙ·-·Ó¿Ï˘ÛË ¿Óˆ ÙˆÓ 90.000 Û˘ÓÔÏÈο ·ÛıÂÓÒÓ ¤‰ÂÈÍ ÂÏ¿ÙÙˆÛË ÙÔ˘ Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ∞∂∂ ηٿ 21% (odds-ratio: 0,79; 95% CI: 0,73-0,85). ∆· ı·Ó·ÙËÊfiÚ· ∞∂∂ ÂÏ·ÙÙÒıËÎ·Ó Û ÌË ÛËÌ·ÓÙÈÎfi ‚·ıÌfi, ηٿ 9%. ∆Ô ·Ú·ÙËÚËı¤Ó fiÊÂÏÔ˜ ÌÔÚÔ‡Û ӷ ÂÍËÁËı› ηٿ 34-80% ·fi ÙËÓ ÂÈÙ¢¯ı›۷ Ì›ˆÛË Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘. ∆Ô ˘fiÏÔÈÔ fiÊÂÏÔ˜ Èı·ÓfiÓ Ó· ÔÊ›ÏÂÙ·È Û ÏÂÈÔÙÚÔÈΤ˜ ‰Ú¿ÛÂȘ ÙˆÓ ÛÙ·ÙÈÓÒÓ [38]. ªÂ Ù· ·Ú·¿Óˆ ·ÔÙÂϤÛÌ·Ù· Û˘ÌʈÓÔ‡Ó Î·È ¿ÏϘ ‰‡Ô ÚfiÛÊ·Ù˜ ÌÂÙ·-·Ó·Ï‡ÛÂȘ [39, 40]. ªÂ ‚¿ÛË ·˘Ù¿ Ù· Â˘Ú‹Ì·Ù· ¤¯Ô˘Ó ÂΉÔı› Î·È ‰ÈÂıÓ›˜ ηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ Ô˘ Û˘ÓÈÛÙÔ‡Ó ÙËÓ ÂÏ¿ÙÙˆÛË Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ Û Â›‰· οو ÙˆÓ 160 mg/dl Û ·ÛıÂÓ›˜ ¯ˆÚ›˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘, οو ÙˆÓ 130 mg/dl Û ¿ÙÔÌ· Ì ÔÏÏ·ÏÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Î·È Î¿Ùˆ ÙˆÓ 100 mg/dl Û ·ÛıÂÓ›˜ Ì ÈÛÙÔÚÈÎfi ™¢, ™¡ ‹ ÂÚÈÊÂÚÈ΋˜ ·ÚÙËÚÈÔ¿ıÂÈ·˜ [41, 42].


ATHIROSK 21-

05-03-09

12:25

™ÂÏ›‰·19

£∂ƒ∞¶∂π∞ - º∞ƒª∞∫∞ ƒfiÏÔ˜ ÙˆÓ ÛÙ·ÙÈÓÒÓ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÔÍ›·˜ Ê¿Û˘ Ù˘ ÂÁÎÂÊ·ÏÈ΋˜ ÈÛ¯·ÈÌ›·˜

™¯‹Ì· 1 ∂Ï¿ÙÙˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂΉ‹ÏˆÛ˘ ∞∂∂ ·Ó¿ÏÔÁ· Ì ÙËÓ ÂÏ¿ÙÙˆÛË Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ Û ‰È¿ÊÔÚ˜ ÌÂϤÙ˜ ¯ÔÚ‹ÁËÛ˘ ÛÙ·ÙÈÓÒÓ. ¶ÚÔÛ·ÚÌÔṲ̂ÓÔ ·fi Amarenco P. et al. Future Lipidol. 2008;3(3):319-325.

∏ ÌÂϤÙË SPARCL (Stroke Prevention by Aggressive Reduction in Cholesterol Levels) Â›Ó·È Ë ÌfiÓË Ô˘ ۯ‰ȿÛÙËΠÂȉÈο Ì ÛÙfi¯Ô Ó· ·ÍÈÔÏÔÁËı› Ë ¯Ú‹ÛË ÛÙ·ÙÈÓÒÓ ÛÙË ‰Â˘ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë ÙˆÓ ∞∂∂. ™˘ÌÂÚÈÏ‹ÊıËÛ·Ó 4731 ·ÛıÂÓ›˜ Ì ÈÛÙÔÚÈÎfi ∞∂∂ ÌË-ηډÈÔÂÌ‚ÔÏÈ΋˜ ·ÈÙÈÔÏÔÁ›·˜ ‹ ·ÚÔ‰ÈÎÔ‡ ÈÛ¯·ÈÌÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ (¶π∂), ¯ˆÚ›˜ fï˜ ™¡, ÔÈ ÔÔ›ÔÈ Ù˘¯·ÈÔÔÈ‹ıËÎ·Ó Ó· Ï¿‚Ô˘Ó 80 mg ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ ‹ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ. ªÂÙ¿ ·fi ·Ú·ÎÔÏÔ‡ıËÛË 5 ÂÙÒÓ, Ë ¯ÔÚ‹ÁËÛË ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ ‚Ú¤ıËΠӷ ÂÈÙ˘Á¯¿ÓÂÈ ÂÏ¿ÙÙˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· fiÏ· Ù· ∞∂∂ ηٿ 16%, ÁÈ· ÈÛ¯·ÈÌÈο ∞∂∂ ηٿ 23%, ÁÈ· ¶π∂ ηٿ 26%, ÁÈ· ı·Ó·ÙËÊfiÚ· ∞∂∂ ηٿ 43% Î·È ÁÈ· Ì›˙ÔÓ· ÛÙÂÊ·ÓÈ·›· Û˘Ì‚·Ì¿Ù· ηٿ 35%. £· ·Ó¤ÌÂÓ ηÓ›˜ Ë ÂÏ¿ÙÙˆÛË ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ∞∂∂ Ó· Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË, ‰Â‰Ô̤Ó˘ Ù˘ ÂÏ¿ÙÙˆÛ˘ ÙˆÓ ÂÈ¤‰ˆÓ ¯ÔÏËÛÙÂÚfiÏ˘ ηٿ 35%. ªÈ· ÂÍ‹ÁËÛË ÁÈ' ·˘Ù‹Ó ÙËÓ ·Ú·Ù‹ÚËÛË Â›Ó·È Ô ÙÚfiÔ˜ ÂÈÏÔÁ‹˜ ÙˆÓ ·ÛıÂÓÒÓ Ù˘ SPARCL. ™˘ÌÂÚÈÏ‹ÊıËΠ¤Ó·˜ ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ·ÙfiÌˆÓ Ì ÎÂÓÔÙÔÈÒ‰Ë (lacunar) ∞∂∂, ÔÈ ÔÔ›ÔÈ ˆÊÂÏ‹ıËÎ·Ó ÏÈÁfiÙÂÚÔ ·fi ·˘ÙÔ‡˜ Ì ÈÛÙÔÚÈÎfi ·ıËÚÔıÚÔÌ‚ˆÙÈÎÔ‡ ∞∂∂. ™˘ÌÌÂÙ›¯·Ó

Â›Û˘ ·ÚÎÂÙÔ› Ì ·ÈÌÔÚÚ·ÁÈÎfi ∞∂∂, fiÔ˘ Ë ˆÊ¤ÏÂÈ· ÙˆÓ ÛÙ·ÙÈÓÒÓ Â›Ó·È ·ÌÊÈÛ‚ËÙÔ‡ÌÂÓË. ªÂÙ¿ ÙËÓ SPARCL, ÔÈ Î·Ù¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ ·Ó·ıˆڋıËÎ·Ó Î·È Û˘ÓÈÛÙÔ‡Ó ϤÔÓ ¯ÔÚ‹ÁËÛË ÛÙ·ÙÈÓÒÓ Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÈÛÙÔÚÈÎfi ∞∂∂ ‹ ¶π∂ Î·È ˘„ËÏ¿ Â›‰· LDL-¯ÔÏËÛÙÂÚfiÏ˘, Ì ÛÙfi¯Ô Â›‰· <100 mg/dl (‹ <70 mg/dl ÛÙÔ˘˜ ·ÛıÂÓ›˜ ˘„ËÏfiÙÂÚÔ˘ ÎÈÓ‰‡ÓÔ˘) [43]. ™Â post-hoc ·Ó·Ï‡ÛÂȘ ˘ÔÔÌ¿‰ˆÓ Ù˘ SPARCL, ‚Ú¤ıËΠfiÙÈ ÔÈ ·ÛıÂÓ›˜ Ô˘ ¤Ù˘¯·Ó ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚË Ì›ˆÛË Ù˘ LDL¯ÔÏËÛÙÂÚfiÏ˘ (≥50%) ·ÚÔ˘Û›·Û·Ó ÂÏ¿ÙÙˆÛË ÙˆÓ ∞∂∂ ηٿ 31%, ¯ˆÚ›˜ ·‡ÍËÛË ÙˆÓ ·ÈÌÔÚÚ·ÁÈÎÒÓ ∞∂∂, ¤Ó·ÓÙÈ ÙˆÓ ·ÛıÂÓÒÓ ¯ˆÚ›˜ ÌÂÙ·‚ÔÏ‹ ‹ Î·È Ì ·‡ÍËÛË Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ [44]. ∂›Û˘, Î·È ÔÈ ·ÛıÂÓ›˜ ¿Óˆ ÙˆÓ 65 ÂÙÒÓ ˆÊÂÏ‹ıËÎ·Ó ·fi ÙË Ï‹„Ë ·ÙÔÚ‚·ÛÙ·Ù›Ó˘, Û ÌÈÎÚfiÙÂÚÔ ‚·ıÌfi fï˜ ·fi ÙÔ˘˜ ÓÂfiÙÂÚÔ˘˜. ∏ ÂÏ¿ÙÙˆÛË Ù˘ Â›ÙˆÛ˘ ı·Ó·ÙËÊfiÚˆÓ Î·È ÌË ∞∂∂ ‹Ù·Ó 10% (ÌË ÛËÌ·ÓÙÈ΋), ¤Ó·ÓÙÈ 26% ÛÙÔ˘˜ ÓÂfiÙÂÚÔ˘˜. √ ηډȷÁÁÂÈ·Îfi˜ ΛӉ˘ÓÔ˜ ÂÏ·ÙÙÒıËΠ¿ÓÙˆ˜ ÛËÌ·ÓÙÈο, Û˘ÓËÁÔÚÒÓÙ·˜ ˘¤Ú Ù˘ ¯ÔÚ‹ÁËÛ˘ ÛÙ·ÙÈÓÒÓ Î·È ÛÙÔ˘˜ ËÏÈÎȈ̤ÓÔ˘˜ [45]. ¢ÂÓ ·Ú·ÙËÚ‹ıËΠ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ Ê‡ÏˆÓ [46].

¶¤Ú·Ó Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿˜ ÙÔ˘˜ ÛÙËÓ ÚˆÙÔÁÂÓ‹ Î·È ‰Â˘ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë, ÔÈ ÛÙ·Ù›Ó˜ ‚ÔËıÔ‡Ó Î·È ÛÙËÓ ÔÍ›· Ê¿ÛË Ù˘ ÂÁÎÂÊ·ÏÈ΋˜ ÈÛ¯·ÈÌ›·˜. Ÿˆ˜ ÚԷӷʤÚıËÎÂ, Ù· Ê¿Ú̷η ·˘Ù¿ ÙÚÔÔÔÈÔ‡Ó ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÂÓ‰ÔıËÏ›Ô˘, ÛÙ·ıÂÚÔÔÈÔ‡Ó ÙËÓ ·ıËڈ̷ÙÈ΋ Ͽη Î·È Î·Ù·ÛÙ¤ÏÏÔ˘Ó ÙË ÊÏÂÁÌÔÓÒ‰Ë ·¿ÓÙËÛË [47]. ¶ÚfiÛÊ·Ù˜ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ Û˘ÓËÁÔÚÔ‡Ó ˘¤Ú Ù˘ ‡·Ú͢ Ó¢ÚÔÚÔÛٷ٢ÙÈ΋˜ ‰Ú¿Û˘ ÙˆÓ ÛÙ·ÙÈÓÒÓ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ÔÍ›·˜ Ê¿Û˘ ÙˆÓ ∞∂∂. Œ¯ÂÈ ‚ÚÂı› fiÙÈ ÔÈ ·ÛıÂÓ›˜ Ô˘ Ï¿Ì‚·Ó·Ó ‹‰Ë ·ÁˆÁ‹ ÚÔÙÔ‡ ˘ÔÛÙÔ‡Ó ∞∂∂ ›¯·Ó ηχÙÂÚË ¤Î‚·ÛË ÛÙÔ˘˜ ÙÚÂȘ Ì‹Ó˜ ·fi ·˘ÙÔ‡˜ Ô˘ ‰ÂÓ Â›¯·Ó Ï¿‚ÂÈ ÔÙ¤ ÛÙ·Ù›ÓË, ·Ú¿ ÙËÓ ·ÚfiÌÔÈ· ‚·Ú‡ÙËÙ· ÙÔ˘ ∞∂∂ ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ [48]. ∆Ô fiÊÂÏÔ˜ ·˘Ùfi ·Ú¤ÌÂÓÂ Î·È ÛÙËÓ ÂÚ›ÙˆÛË ·ÛıÂÓÒÓ Ô˘ ›¯·Ó ˘ÔÛÙ› ıÚÔÌ‚fiÏ˘ÛË Ì rtPA [49]. ªÂϤÙ˜ Û ÂÈÚ·Ì·Ùfi˙ˆ· ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ë Û˘Á¯ÔÚ‹ÁËÛË rtPA Î·È ÛÙ·ÙÈÓÒÓ ÂÏ·ÙÙÒÓÂÈ ÙËÓ ¤ÎÊÚ·ÛË ÙÔ˘ ·Ú¿ÁÔÓÙ· von Willebrand, ÙˆÓ ÌÔÚ›ˆÓ ΢ÙÙ·ÚÈ΋˜ ÚÔÛÎfiÏÏËÛ˘ Î·È ÙˆÓ ÌÂÙ·ÏÏÔÚˆÙÂ˚Ó·ÛÒÓ, ÂÚÈÔÚ›˙ÔÓÙ·˜ Ù· ıÚÔÌ‚ˆÙÈο Ê·ÈÓfiÌÂÓ· ÛÙÔ Â›Â‰Ô Ù˘ ÌÈÎÚÔ΢ÎÏÔÊÔÚ›·˜ Î·È ÂÓÈÛ¯‡ÔÓÙ·˜ ÙË ‰ÔÌÈ΋ ·ÎÂÚ·ÈfiÙËÙ· ÙˆÓ ·ÁÁ›ˆÓ [50]. ∞ÓÙ›ıÂÙ·, Ë ‰È·ÎÔ‹ ÙˆÓ ÛÙ·ÙÈÓÒÓ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ÔÍ›·˜ Ê¿Û˘ ÙÔ˘ ∞∂∂ ·˘Í¿ÓÂÈ ÙËÓ ÂÁÎÂÊ·ÏÈ΋ ‚Ï¿‚Ë. ∞˘Ùfi ÔÊ›ÏÂÙ·È ·ÊÂÓfi˜ ÛÙËÓ ·ÒÏÂÈ· Ù˘ Ó¢ÚÔÚÔÛٷ٢ÙÈ΋˜ ‰Ú¿Û˘ ÙÔ˘˜, ·ÊÂÙ¤ÚÔ˘ ÛÙËÓ Âȉ›ӈÛË Ù˘ ·ÁÁÂȷ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÂÍ·ÈÙ›·˜ ÌÈ·˜ ·fiÙÔÌ˘ ÂÏ¿ÙÙˆÛ˘ Ù˘ ÂÓ‰ÔıËÏȷ΋˜ ·Ú·ÁˆÁ‹˜ ¡√ Î·È ·‡ÍËÛ˘ ÙˆÓ ÊÏÂÁÌÔÓˆ‰ÒÓ Î·È ıÚÔÌ‚ˆÙÈÎÒÓ ‰ÈÂÚÁ·ÛÈÒÓ [51]. ªÈ· ÚfiÛÊ·ÙË ÌÂϤÙË ÂͤٷÛ ÙËÓ Â›‰Ú·ÛË Ù˘ ‰È·ÎÔ‹˜ ÙˆÓ ÛÙ·ÙÈÓÒÓ ÛÙËÓ ÔÍ›· Ê¿ÛË ÂÓfi˜ ∞∂∂. ªÂٷ͇ 89 ·ÛıÂÓÒÓ Ì ÈÛ¯·ÈÌÈÎfi ∞∂∂ Ô˘ Ï¿Ì‚·Ó·Ó ÛÙ·Ù›ÓË, ÔÈ 46 Ù˘¯·ÈÔÔÈ‹ıËÎ·Ó Ó· ‰È·Îfi„Ô˘Ó ÙËÓ ·ÁˆÁ‹ ÁÈ· ÙȘ 3 ÚÒÙ˜ Ë̤Ú˜ ÓÔÛËÏ›·˜, ÂÓÒ ÔÈ 43 Ó· Ï¿‚Ô˘Ó 20 mg/Ë̤ڷ ·ÙÔÚ‚·ÛÙ·Ù›Ó˘. ªÂÙ¿ ·fi ÙÔ ‰È¿ÛÙËÌ· ·˘Ùfi, fiÏÔÈ ¤Ï·‚·Ó

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·ÙÔÚ‚·ÛÙ·Ù›ÓË. √È ·ÛıÂÓ›˜ Ô˘ ‰È¤ÎÔ„·Ó ÙË ÛÙ·Ù›ÓË Â›¯·Ó ¯ÂÈÚfiÙÂÚË ÏÂÈÙÔ˘ÚÁÈ΋ ¤Î‚·ÛË ÛÙÔ˘˜ ÙÚÂȘ Ì‹Ó˜, ·ÚÔ˘Û›·Û·Ó Û˘¯ÓfiÙÂÚ· Ó¢ÚÔÏÔÁÈ΋ Âȉ›ӈÛË Î·È ·Ó¤Ù˘Í·Ó ÌÂÁ·Ï‡ÙÂÚÔ fiÁÎÔ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘ Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· Ô˘ Û˘Ó¤¯ÈÛ ÙËÓ ·ÁˆÁ‹ [52]. ™˘ÛÙ‹ÓÂÙ·È Û˘ÓÂÒ˜ Ó· ·ÔʇÁÂÙ·È Ë ‰È·ÎÔ‹ ÙˆÓ ÛÙ·ÙÈÓÒÓ Û ·ÛıÂÓ›˜ Ô˘ ˘Ê›ÛÙ·ÓÙ·È ÈÛ¯·ÈÌÈÎfi ∞∂∂. ªÂÚÈΤ˜ ηٷÁÚ·ÊÈΤ˜ ÌÂϤÙ˜ ·Ú·Ù‹ÚËÛ˘ ¤‰ÂÈÍ·Ó Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ¯·ÌËÏÒÓ ÂÈ¤‰ˆÓ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ˘„ËÏfiÙÂÚÔ˘ ÎÈÓ‰‡ÓÔ˘ ÌÂÙ¿ÙˆÛ˘ ÙÔ˘ ∞∂∂ Û ·ÈÌÔÚÚ·ÁÈÎfi [53]. ™Â ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ fï˜ Ô˘ Û˘ÌÂÚȤϷ‚·Ó ·ÛıÂÓ›˜ Ì LDL-¯ÔÏËÛÙÂÚfiÏË Î¿Ùˆ ÙˆÓ 70 mg/dl Î·È ¯ˆÚ›˜ ÚÔËÁÔ‡ÌÂÓÔ ÈÛÙÔÚÈÎfi ∞∂∂, ‰ÂÓ ·Ú·ÙËÚ‹ıËΠ·˘ÍË̤ÓÔ˜ ΛӉ˘ÓÔ˜ ÂÁÎÂÊ·ÏÈ΋˜ ·ÈÌÔÚÚ·Á›·˜ [54, 55]. ¶·ÚÔÌÔ›ˆ˜, ÂÓÒ Î¿ÔȘ ÚÒÈ̘ ÌÂϤÙ˜ ·Ó¤ÊÂÚ·Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÌÂÙ¿ÙˆÛ˘ ÙÔ˘ ∞∂∂ Û ·ÈÌÔÚÚ·ÁÈÎfi ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË rtPA Û ·ÛıÂÓ›˜ Ì ¯·ÌËÏ‹ ¯ÔÏËÛÙÂÚfiÏË, ÂfiÌÂÓ˜ ÌÂϤÙ˜ ‰ÂÓ ‚Ú‹Î·Ó ·ÓÂÍ¿ÚÙËÙË Û¯¤ÛË ÌÂٷ͇ Ù˘ ÚÔËÁÔ‡ÌÂÓ˘ Ï‹„˘ ÛÙ·ÙÈÓÒÓ Î·È ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ·˘ÙÔ‡ [56]. ∞ÓÙ›ıÂÙ·, ÛÙËÓ ˘·Ú·¯ÓÔÂȉ‹ ·ÈÌÔÚÚ·Á›·, ÔÈ ÛÙ·Ù›Ó˜ Ê·›ÓÂÙ·È

Ó· ‚ÔËıÔ‡Ó ÛÙËÓ ÚfiÏË„Ë Î·È ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÂÁÎÂÊ·ÏÈÎÔ‡ ·ÁÁÂÈfiÛ·ÛÌÔ˘ Ô˘ ÙËÓ ·ÎÔÏÔ˘ı›, ̤ۈ Ù˘ ‰Ú¿Û˘ ÙÔ˘˜ ÛÙËÓ eNOS Î·È ÙËÓ ·Ú·ÁˆÁ‹ ÂÏ¢ı¤ÚˆÓ ÚÈ˙ÒÓ [57, 58].

Ê·ÏÈ΋ ÈÛ¯·ÈÌ›· [59].

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√È ÏÂÈÔÙÚÔÈΤ˜ ‰Ú¿ÛÂȘ ÙˆÓ ÛÙ·ÙÈÓÒÓ ÂÓ‰¤¯ÂÙ·È Ó· ‚ÔËıÔ‡Ó ÛÙËÓ Ó¢ÚÔÏÔÁÈ΋ ÂȉÈfiÚıˆÛË ÌÂÙ¿ ·fi ¤Ó· ÈÛ¯·ÈÌÈÎfi ∞∂∂. ™Â ÂÈÚ·Ì·Ùfi˙ˆ·, Ë ¯ÔÚ‹ÁËÛË ÛÙ·ÙÈÓÒÓ Ô‰‹ÁËÛ Û ·‡ÍËÛË Ù˘ ·ÁÁÂÈÔÁ¤ÓÂÛ˘, Û ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙˆÓ ÂÓ‰ÔÁÂÓÒÓ Î˘ÙÙ¿ÚˆÓ, Ó¢ÚÔÁ¤ÓÂÛË Î·È Û¯ËÌ·ÙÈÛÌfi Ó¤ˆÓ Û˘Ó¿„ÂˆÓ [20]. ∞˘Ù‹ Ë Â·ÁfiÌÂÓË ·fi ÛÙ·Ù›Ó˜ ÓÂ˘ÚˆÓÈ΋ Ï·ÛÙÈÎfiÙËÙ· Û¯ÂÙ›˙ÂÙ·È Ì ÙË Ú‡ıÌÈÛË ·ÚÎÂÙÒÓ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, fiˆ˜ ÙÔ˘ VEGF (vascular endothelial growth factor) Î·È ÙÔ˘ BDNF (brain derived neurotrophic factor), ÔÈ ÔÔ›ÔÈ ÚÔ¿ÁÔ˘Ó ÙË ÌÂÙ·Ó¿ÛÙ¢ÛË ÙˆÓ Ó¢ÚÒÓˆÓ Î·È ÙËÓ ·Ó¿Ù˘ÍË Ó¤ˆÓ Ó¢ÚÒÓˆÓ Î·È Û˘Ó¿„ˆÓ. ™Â ÌÈ· ¿ÏÏË ÌÂϤÙË, Ë ¯ÔÚ‹ÁËÛË ÂÓ‰ÔÊϤ‚È·˜ ÚÔÛÔ˘‚·ÛÙ·Ù›Ó˘ ÂÓÙfi˜ 4 ˆÚÒÓ ·fi ÙËÓ ÚfiÎÏËÛË ∞∂∂ Û ÂÈÚ·Ì·Ùfi˙ˆ· ¤Ù˘¯Â ηχÙÂÚË ÏÂÈÙÔ˘ÚÁÈ΋ Î·È ·Ó·ÙÔÌÈ΋ ¤Î‚·ÛË, ÚÔÛٷهÔÓÙ·˜ ·fi ÙËÓ ÔÍ›· ÂÁÎÂ-

√È ÛÙ·Ù›Ó˜ Â›Ó·È Ê¿Ú̷η Ô˘ ¤¯Ô˘Ó ·ԉ›ÍÂÈ ÙË ¯ÚËÛÈÌfiÙËÙ¿ ÙÔ˘˜ ÛÙËÓ ÂÏ¿ÙÙˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ∞∂∂, ÙfiÛÔ ÛÙËÓ ÚˆÙÔÁÂÓ‹ fiÛÔ Î·È ÛÙË ‰Â˘ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë. ¶ÔÏϤ˜ ·fi ·˘Ù¤˜ ÙȘ ÂȉڿÛÂȘ ÌÔÚÔ‡Ó Ó· ÂÍËÁËıÔ‡Ó ·fi ÙËÓ ÂÏ¿ÙÙˆÛË Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ·˘Ù‹˜ ηı' ·˘Ù‹˜, ¿ÏϘ fï˜ ÔÊ›ÏÔÓÙ·È Û ·ÓÂÍ¿ÚÙËÙÔ˘˜ Ì˯·ÓÈÛÌÔ‡˜, ÙȘ ÏÂÁfiÌÂÓ˜ ÏÂÈÔÙÚÔÈΤ˜ ‰Ú¿ÛÂȘ. √È ÛÙ·Ù›Ó˜ Ê·›ÓÂÙ·È Ó· ÂÈÙ˘Á¯¿ÓÔ˘Ó ÔʤÏË ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ÔÍ›·˜ Ê¿Û˘ ÂÓfi˜ ÈÛ¯·ÈÌÈÎÔ‡ ∞∂∂, Èı·ÓÒ˜ ̤ۈ Ù˘ Ó¢ÚÔÚÔÛٷ٢ÙÈ΋˜ ÙÔ˘˜ ‰Ú¿Û˘. ¶·Ú¿ÏÏËÏ·, Ë ‰È·ÎÔ‹ ÙˆÓ ÛÙ·ÙÈÓÒÓ Û¯ÂÙ›˙ÂÙ·È Ì ‰˘ÛÌÂÓ¤ÛÙÂÚË ÏÂÈÙÔ˘ÚÁÈ΋ ¤Î‚·ÛË. °È· Ó· ÂȂ‚·ÈˆıÔ‡Ó Ù· ·Ú·¿Óˆ ı· ¯ÚÂÈ·ÛÙÔ‡Ó ‚¤‚·È· Ù˘¯·ÈÔÔÈË̤Ó˜ ÌÂϤÙ˜ Ô˘ Ó· Û˘ÁÎÚ›ÓÔ˘Ó ÙȘ ÛÙ·Ù›Ó˜ ÌÂ Û˘Ì‚·ÙÈ΋ ·ÁˆÁ‹. ∆¤ÏÔ˜, ÌÈ· ÔÏÏ¿ ˘ÔÛ¯fiÌÂÓË ‰Ú¿ÛË ÙˆÓ ÛÙ·ÙÈÓÒÓ Â›Ó·È Ë ‰È¤ÁÂÚÛË Ì˯·ÓÈÛÌÒÓ Ó¢ÚÔÂȉÈfiÚıˆÛ˘ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ¯ÚfiÓÈ·˜ Ê¿Û˘ Ù˘ ÂÁÎÂÊ·ÏÈ΋˜ ÈÛ¯·Ì›·˜, Ë ÔÔ›· ÌÔÚ› Ó· ÚÔ¿ÁÂÈ ÙË ÏÂÈÙÔ˘ÚÁÈ΋ ·ÔηٿÛÙ·ÛË ÙˆÓ ·ÛıÂÓÒÓ.

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∆Ô Ì¤ÏÏÔÓ Ù˘ ıÂÚ·›·˜ Ì ÛÙ·Ù›Ó˜ ÛÙ· ÈÛ¯·ÈÌÈο ∞∂∂

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∫·Ú‰È·Î‹ ∞ÓÂ¿ÚÎÂÈ· ÁÈ· ÙÔÓ ªË ∫·Ú‰ÈÔÏfiÁÔ ¶··ı·Ó·Û›Ô˘ ∞ı·Ó¿ÛÈÔ˜, ∫·Ú‰ÈÔÏfiÁÔ˜-∂ÓÙ·ÙÈÎÔÏfiÁÔ˜ °È¿ÓÓ˘ °Ô˘‰¤‚ÂÓÔ˜ ∫·ıËÁËÙ‹˜ ∫·Ú‰ÈÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ ¶ÔÏÏÔ› ·ÛıÂÓ›˜ Ì ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· ‰ÂÓ ÓÔÛËχÔÓÙ·È Û ηډÈÔÏÔÁÈΤ˜ ÎÏÈÓÈΤ˜ Î·È ·ÎfiÌË ÂÚÈÛÛfiÙÂÚÔÈ ‰ÂÓ ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È ·fi ηډÈÔÏfiÁÔ˘˜. ™ÙË Û‡ÓÙÔÌË ·˘Ù‹ ·Ó·ÛÎfiËÛË ·Ú·ı¤ÙÔ˘ÌÂ Û˘ÓÔÙÈο ÛÙÔȯ›· Ô˘ ı· ‚ÔËı‹ÛÔ˘Ó ÙÔÓ ÌË Î·Ú‰ÈÔÏfiÁÔ Ó· ηٷÓÔ‹ÛÂÈ ÙÔ Úfi‚ÏËÌ· Î·È Ó· ÌÔÚ› Ó· ÂÚÌËÓ‡ÂÈ ÙȘ ·Ú·ÎÏÈÓÈΤ˜ ÂÍÂÙ¿ÛÂȘ Ú¤ÂÈ Ó· Á›ÓÔÓÙ·È ÁÈ· ÙË Î·Ï‡ÙÂÚË ·ÓÙÈÌÂÙÒÈÛË Î·È ·Ú·ÎÔÏÔ‡ıËÛË ÙÔ˘ ·ÛıÂÓÔ‡˜. ¶¤Ú·Ó ·fi ÙËÓ ÏÂÈÙÔ˘ÚÁÈ΋ ηٿÛÙ·ÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ Ô˘ÛÈ·ÛÙÈ΋ Â›Ó·È Ë ÁÓÒÛË Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ Î·È Ë ÛˆÛÙ‹ ¯ÔÚ‹ÁËÛË Ù˘ Ê·Ú̷΢ÙÈ΋˜ ·ÁˆÁ‹˜. ∏ ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· (∫∞) Â›Ó·È ÙÔ ÈÔ ÛËÌ·ÓÙÈÎfi Î·È Û˘Ó¯Ҙ ÂȉÂÈÓÔ‡ÌÂÓÔ Úfi‚ÏËÌ· ‰ËÌfiÛÈ·˜ ˘Á›·˜ ÛÙȘ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜. ¶ÚfiÎÂÈÙ·È ÁÈ· Û˘¯Ó‹ ÌÈ· ÎÏÈÓÈ΋ ÔÓÙfiÙËÙ· Û˘Ó‹ıˆ˜ ÙˆÓ ËÏÈÎÈˆÌ¤ÓˆÓ (̤ÛË ËÏÈΛ· 72 ¯ÚfiÓÈ·), Ì ÊÙˆ¯‹ ÚfiÁÓˆÛË (›‰È· Ì ÔÚÈÛÌ¤ÓˆÓ ÓÂÔÏ·ÛÈÒÓ), Ì fi¯È ηϋ ÔÈfiÙËÙ· ˙ˆ‹˜ Î·È ÌÂÁ¿ÏÔ ÎfiÛÙÔ˜

∫ÏÈÓÈ΋ ÂÈÎfiÓ· ∏ ∫∞ Â›Ó·È ¤Ó· Û‡ÓıÂÙÔ ÎÏÈÓÈÎfi Û‡Ó‰ÚÔÌÔ Ô˘ ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È Û ‰ÔÌÈΤ˜ ‹ ÏÂÈÙÔ˘ÚÁÈΤ˜ ηډȷΤ˜ ‰È·Ù·Ú·¯¤˜ Ô˘ ÂÌÔ‰›˙Ô˘Ó ÙËÓ Î·Ú‰È¿ Ó· ·ÓÙÏ› ‹ Ó· Â͈ı› ·›Ì·. √È Î‡ÚȘ ÂΉËÏÒÛÂȘ Ù˘ Â›Ó·È ‰‡ÛÓÔÈ· ÛÙËÓ ÚÔÛ¿ıÂÈ· Î·È ÙËÓ ËÚÂÌ›·, ‡ÎÔÏË ÎfiˆÛË (ÌÂȈ̤ÓË ÈηÓfiÙËÙ· ÁÈ·

¿ÛÎËÛË) Î·È Î·Ù·ÎÚ¿ÙËÛË ˘ÁÚÒÓ Ô˘ Ô‰ËÁ› Û Ó¢ÌÔÓÈ΋ Û˘ÌÊfiÚËÛË Î·È ÂÚÈÊÂÚÈÎfi Ô›‰ËÌ·. ∏ ‰‡ÛÓÔÈ· Î·È Ë Â‡ÎÔÏË ÎfiˆÛË ÌÔÚ› Ó· ÂËÚ¿˙Ô˘Ó ÙËÓ ÏÂÈÙÔ˘ÚÁÈ΋ ÈηÓfiÙËÙ· Î·È ÙËÓ ÔÈfiÙËÙ· ˙ˆ‹˜ ·ÏÏ¿ ‰ÂÓ ˘¿Ú¯Ô˘Ó ¿ÓÙ· ÛÙË ÎÏÈÓÈ΋ ÂÈÎfiÓ·, ÛÙÔÓ ›‰ÈÔ ¯ÚfiÓÔ. ªÂÚÈÎÔ› ·ÛıÂÓ›˜ ¤¯Ô˘Ó ÊÙˆ¯‹ ·ÓÔ¯‹ ÛÙËÓ ¿ÛÎËÛË ·ÏÏ¿ ‰ÂÓ ¤¯Ô˘Ó ηٷÎÚ¿ÙËÛË ˘ÁÚÒÓ (Ôȉ‹Ì·Ù·, ÙÚ›˙ÔÓÙ˜ ÛÙÔ˘˜ Ó‡ÌÔÓ˜) Î·È ¿ÏÏÔÈ ·Ú·ÔÓÈÔ‡ÓÙ·È Û˘¯ÓfiÙÂÚ· ÁÈ· Ôȉ‹Ì·Ù· Î·È fi¯È ÁÈ· ‰‡ÛÓÔÈ· ‹ ‡ÎÔÏË ÎfiˆÛË. ∞ÚÎÂÙÔ› ·ÛıÂÓ›˜ ÚÈÓ ·ÚÔ˘ÛÈ·ÛıÔ‡Ó Ì Ó¢ÌÔÓÈÎfi Ô›‰ËÌ· (ÂÈÎfiÓ· 1) Ô˘ Â›Ó·È Ë ÈÔ ·ÎÚ·›· ÌÔÚÊ‹ ÂÌÊ¿ÓÈÛ˘ Ù˘ ∫∞ ÌÔÚ› Ó· ·Ú·ÔÓÔ‡ÓÙ·È ÁÈ· ·ÚÔ͢ÓÙÈ΋ Ó˘¯ÙÂÚÈÓ‹ ‰‡ÛÓÔÈ· (·Ê‡ÓÈÛË 2-3 ÒÚ˜ ÌÂÙ¿ ÙË Î·Ù¿ÎÏÈÛË Ì ‰‡ÛÓÔÈ· Î·È ·›ÛıËÌ· ÓÈÁÌÔ‡. ªfiÏȘ ÛËΈıÔ‡Ó ·fi ÙÔ ÎÚ‚¿ÙÈ Ë ‰‡ÛÓÔÈ· ‚ÂÏÙÈÒÓÂÙ·È). √ ·ÛıÂÓ‹˜ ÛÙËÓ ∂ÈÎfiÓ· 1 ·ÚÈÛÙÂÚ¿ ¤¯ÂÈ ÛËÌ›· ‰ÂÍÈ¿˜ ∫∞ (Ôȉ‹Ì·Ù·, ·˘ÍË̤Ó˜ ÛÊ·Á›Ùȉ˜, Ë·ÙÔÌÂÁ·Ï›·, ·ÛΛÙË) Ô˘ Â›Ó·È Û˘Ó¤ÂÈ· ·ÚÈÛÙÂÚ‹˜ ∫∞.

∂›ÙˆÛË, ÂÈÔÏ·ÛÌfi˜ √ ÂÈÔÏ·ÛÌfi˜ ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi Â›Ó·È 1-2% Î·È Ë Â›ÙˆÛË 5 -10/1000 ¿ÙÔÌ· ÙÔ ¯ÚfiÓÔ. ∏ ÈÔ ÛÙ·ıÂÚ‹ Î·È ÂÓÙ˘ˆÛȷ΋ ÂȉËÌÈÔÏÔÁÈ΋ ·Ú·Ù‹ÚËÛË Â›Ó·È Ë ‰Ú·Ì·ÙÈ΋ Û¯¤ÛË ÌÂٷ͇ ËÏÈΛ·˜ Î·È ÂÌÊ¿ÓÈÛ˘ ∫∞. ∞fi Ù· Ìˉ·ÌÈÓ¿ Â›‰· ÛÙËÓ ËÏÈΛ· <45

ÂÙÒÓ ·ÁÁ›˙ÂÈ ÙÔ 2%-5% ÌÂÙ¿ Ù· 70 Î·È ÏËÛÈ¿˙ÂÈ ÙÔ 10% ÌÂÙ¿ ÙËÓ ËÏÈΛ· ÙˆÓ 80 ÂÙÒÓ. √ ÂÈÔÏ·ÛÌfi˜ Ù˘ ∫∞ ÛÙËÓ ∂ÏÏ¿‰· ˘ÔÏÔÁ›˙ÂÙ·È Û 110.000 ·ÛıÂÓ›˜ Î·È Ë Â›ÙˆÛË 20.000 Ӥ˜ ÂÚÈÙÒÛÂȘ ÙÔ ¯ÚfiÓÔ. ∆¤ÏÔ˜ 4.500 ı¿Ó·ÙÔÈ ÙÔ ¯ÚfiÓÔ ÔÊ›ÏÔÓÙ·È Û ∫∞. ∞Ó¿Ï˘ÛË ÈÛÙÔÔÈËÙÈÎÒÓ ı·Ó¿ÙˆÓ ·fi ÙË ÂÚÈÔ¯‹ Ù˘ µ¢ ∂ÏÏ¿‰·˜ Ì ËÏÈÎȈ̤ÓÔ ÏËı˘ÛÌfi >75 ÂÙÒÓ ÛÙÔ7%, ¤‰ÂÈÍ fiÙÈ ÛÙÔ 22% Û·Ó ·ÈÙ›· ı·Ó¿ÙÔ˘ ‹Ù·Ó ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· Î·È Û¯Â‰fiÓ fiÏÔÈ (98%) ‹Ù·Ó ËÏÈΛ·˜ ¿Óˆ ÙˆÓ 75 ÂÙÒÓ

∞Èٛ˜: ∏ ÈÔ Û˘¯Ó‹ ·ÈÙ›· KA Â›Ó·È Ë ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ˜ (2/3 ÙˆÓ ÂÚÈÙÒÛˆÓ) Î·È È‰È·›ÙÂÚ· ÙÔ ÈÛÙÔÚÈÎfi ÔͤԘ ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ôηډ›Ô˘. ∞ÎÔÏÔ˘ı› Ë ˘¤ÚÙ·ÛË (ÈÛÙÔÚÈÎfi ÛÔ‚·Ú‹˜ ˘¤ÚÙ·Û˘ ¯ˆÚ›˜ ıÂÚ·›·), ÔÈ ‚·Ï‚ȉÔ¿ıÂȘ (ÛÙ¤ÓˆÛË ·ÔÚÙ‹˜ Û ËÏÈÎȈ̤ÓÔ˘˜, ·ÓÂ¿ÚÎÂÈ· Ì˘ÍˆÌ·ÙÒ‰Ô˘˜ ÌÈÙÚÔÂȉԇ˜ Û ÌÂÛ‹ÏÈΘ) Î·È ÔÈ Ì˘ÔηډÈÔ¿ıÂȘ. ∆ÂÏÂ˘Ù·›· ·Ó·ÁÓˆÚ›˙ÔÓÙ·È Û·Ó ·Èٛ˜ Î·È Ô ‰È·‚‹Ù˘ Ì ÙËÓ ·¯˘Û·ÚΛ·. ∏ ∂ÈÎfiÓ· 2 ‰Â›¯ÓÂÈ ˆ˜ ÔÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÚÔηÏÔ‡Ó ¤ÌÊÚ·ÁÌ· Î·È ·˘Ùfi Ì ÛÂÈÚ¿ ÙÔ˘ ∫∞ ÌÂ Û˘ÛÙÔÏÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· (ÂËÚ·Ṳ̂ÓÔ ÎÏ¿ÛÌ· ÂÍÒıËÛ˘) Î·È ı¿Ó·ÙÔ. ¶·Ú·ÙËÚԇ̠fï˜ fiÙÈ Ë ˘¤ÚÙ·ÛË ÌÔÚ› Ó· ÚÔηϤÛÂÈ ∫∞ Ì ηÏfi ÎÏ¿ÛÌ· ÂÍÒıËÛ˘ (ÁÓˆÛÙ‹ Û·Ó ‰È·ÛÙÔÏÈ΋ ∫∞ ‚Ϥ ·Ú·Î¿Ùˆ ÛÙÔ Î›ÌÂÓÔ)

∫·Ù¿Ù·ÍË:

∂ÈÎfiÓ· 1

22

∏ ∫∞ ηχÙÂÈ ¤Ó· ¢ڇ Ê¿ÛÌ· ·ÛıÂÓÒÓ Î·È ÙÔ˘˜ ¯·Ú·ÎÙËÚ›˙ÂÈ ·Ó¿ÏÔÁ· Ì ¤Ó· ·fi Ù· 4 ÛÙ¿‰È· Ô˘ ÂÌϤÎÔÓÙ·È ÛÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Ù˘ ∫∞. ∏ ∂ÈÎfiÓ· 3 ‰Â›¯ÓÂÈ ÙËÓ Û‡Á¯ÚÔÓË Î·Ù¿Ù·ÍË Ù˘ Û‡Ìʈӷ Ì ÙËÓ ACC/AHA. ª¤¯ÚÈ ÚfiÛÊ·Ù· Ë Î·Ù¿Ù·ÍË ‹Ù·Ó Û‡Ìʈӷ Ì ÙË NYHA. ∏ ∂ÈÎfiÓ· 4 ‰Â›¯ÓÂÈ ÙË Û¯¤ÛË Ù˘ ·ÏÈ¿˜ ηٿٷ͢ ηٿ NHA Ì ÙËÓ Û‡Á¯ÚÔÓË. ∆· ÚÒÙ· 2 ÛÙ¿‰È· (∞ Î·È µ) Û›ÁÔ˘Ú· ‰ÂÓ Â›Ó·È ∫∞ ·ÏÏ¿ ÌÈ· ÚÔÛ¿ıÂÈ· Ó· ‚ÔËı‹ÛÂÈ ÙÔ˘˜ ¯ÔÚËÁÔ‡˜ ˘Á›·˜ Ó· ·Ó·ÁÓˆÚ›ÛÔ˘Ó ¤ÁηÈÚ· ·ÛıÂÓ›˜ Ô˘


ATHIROSK 21-

05-03-09

12:25

™ÂÏ›‰·23

£∂ƒ∞¶∂π∞ - º∞ƒª∞∫∞ Ô˘ÚËÙÈο ‹ ÂÏÂÚÂÓfiÓË. ∏ ˘ÔÓ·ÙÚÈ·ÈÌ›· Â›Ó·È ‰Â›ÎÙ˘ ÛÔ‚·Ú‹˜ ¯ÚfiÓÈ·˜ ∫∞.

¡·ÙÚÈÔ˘ÚËÙÈο ÂÙ›‰È·:

∂ÈÎfiÓ· 2 Â›Ó·È Û ΛӉ˘ÓÔ Ó· ·Ó·Ù‡ÍÔ˘Ó ∫∞. ∆· ÛÙ¿‰È· ∞ Î·È µ ÔÚ›˙ÔÓÙ·È Î·Ï‡ÙÂÚ· Û ÂΛÓÔ˘˜ Ì ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Ô˘ Û·ÊÒ˜ Úԉȷı¤ÙÔ˘Ó ÚÔ˜ ·Ó¿Ù˘ÍË ∫∞. °È· ·Ú¿‰ÂÈÁÌ· ·ÛıÂÓ›˜ Ì ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ, ˘¤ÚÙ·ÛË ‹ ‰È·‚‹ÙË Ô˘ ‰ÂÓ ¤¯Ô˘Ó ÂËÚ·Ṳ̂ÓË ÏÂÈÙÔ˘ÚÁ›· ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ ‹ ˘ÂÚÙÚÔÊ›· ı· ıˆÚËıÔ‡Ó ÛÙ·‰›Ô˘ ∞, ÂÓÒ ·ÛıÂÓ›˜ ·Û˘Ìو̷ÙÈÎÔ› ·ÏÏ¿ Ì ˘ÂÚÙÚÔÊ›· ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ ηÈ/‹ ÂËÚ·Ṳ̂ÓË ÏÂÈÙÔ˘ÚÁ›· ı· ¯·Ú·ÎÙËÚÈÛıÔ‡Ó ÛÙ·‰›Ô˘ µ. ∆Ô ÛÙ¿‰ÈÔ ° ¯·Ú·ÎÙËÚ›˙ÂÈ ·ÛıÂÓ›˜ ÌÂ Û˘ÌÙÒÌ·Ù· (·ÚÂÏıfiÓ ‹ ·ÚfiÓ) Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ‰ÔÌÈΤ˜ ‰È·Ù·Ú·¯¤˜ (Ô Î‡ÚÈÔ˜ fiÁÎÔ˜ ·ÛıÂÓÒÓ Ì ∫∞) Î·È ÙÔ ÛÙ¿‰ÈÔ ¢ ¯·Ú·ÎÙËÚ›˙ÂÈ ·ÛıÂÓ›˜ Ì ·ÏËıÒ˜ ·ÓıÂÎÙÈ΋ ∫∞ Ô˘ ÌÔÚ› Ó· Â›Ó·È Î·Ù¿ÏÏËÏÔÈ ÁÈ· Ì˯·ÓÈ΋ ˘Ô‚Ô‹ıËÛË, Û˘Û΢¤˜ Ô˘ ·Ê·ÈÚÔ‡Ó ˘ÁÚ¿, Û˘Ó¯‹ ¤Á¯˘ÛË ÈÓÔÙÚfiˆÓ ‹ ¯ÂÈÚÔ˘ÚÁÈΤ˜ ‰ÈÔÚıÒÛÂȘ.

Ù¿ÛÙ·ÛË) ÌÔÚ› Ó· ÔÊ›ÏÔÓÙ·È Î·È Û ¿ÏϘ ηٷÛÙ¿ÛÂȘ fiˆ˜ ·fi Ê¿Ú̷η (‰È˘‰ÚÔ˘Úȉ›Ó˜, ÁÏÈÙ·˙fiÓ˜).

∞ÈÌ·ÙÔÏÔÁÈΤ˜ Î·È ‚ÈÔ¯ËÌÈΤ˜ ÂÍÂÙ¿ÛÂȘ ∞fi ÙȘ ÂÚÁ·ÛÙËÚȷΤ˜ ÂÍÂÙ¿ÛÂȘ Ú¤ÂÈ Ó· ·ÔÎÏÂÈÛı› Ë ·Ó·ÈÌ›· Ô˘ Â›Ó·È ÌÈ· ·fi ÙȘ ·Èٛ˜ ‰‡ÛÓÔÈ·˜ ·ÏÏ¿ Î·È Û˘Ó˘¿Ú¯ÂÈ Û ÌÂÁ¿ÏÔ ‚·ıÌfi. ™ÙËÓ ‹È· Î·È Ì¤ÙÚÈ· ∫∞ ÔÈ ËÏÂÎÙÚÔχÙ˜ Î·È Ë ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· Â›Ó·È Û˘Ó‹ıˆ˜ Ê˘ÛÈÔÏÔÁÈο. ¶Ú¤ÂÈ Ó· ÁÓˆÚ›˙Ô˘Ì ÙËÓ ·Ú¯È΋ ÙÈÌ‹ ÎÚ·ÙÈÓ›Ó˘ ÁÈ·Ù› ÌÔÚ› Ó· ·˘ÍËı› ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ıÂÚ·›·˜ (·˘Í¿ÓÂÈ Ì AMEA Î·È Ì ÌÂÁ¿Ï˜ ‰fiÛÂȘ ‰ÈÔ˘ÚËÙÈÎÒÓ). ∆· ‰ÈÔ˘ÚËÙÈο, ‚·ÛÈ΋ ıÂÚ·›· Ù˘ ∫∞, ÌÔÚÔ‡Ó Ó· ÚÔηϤÛÔ˘Ó ˘ÔÓ·ÙÚÈ·ÈÌ›· Î·È ˘ÔηÏÈ·ÈÌ›·. ÀÂÚηÏÈ·ÈÌ›· ÌÔÚ› Ó· ·Ú·ÙËÚËı› Û ÛÔ‚·Ú‹ ∫∞ Ì ÂËÚ·Ṳ̂ÓË ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· Î·È Î·ÏÈÔÛ˘ÓÙËÚËÙÈο ‰È-

√È Ù‡ÔÈ ÙˆÓ Ó·ÙÚÈÔ˘ÚËÙÈÎÒÓ ÂÙȉ›ˆÓ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ ∫∞ Â›Ó·È ÙÔ µ¡P Î·È ÙÔ NT-proBNP. T· Ú·ÁÌ·ÙÈο Ê˘ÛÈÔÏÔÁÈο Â›‰· ÙˆÓ ÂÙȉ›ˆÓ ‰ÂÓ Â›Ó·È ÁÓˆÛÙfi ·ÏÏ¿ ÂËÚ¿˙ÔÓÙ·È ·fi ÔÏϤ˜ ηٷÛÙ¿ÛÂȘ. ∆Ô ı‡ÏË Ê‡ÏÔ Î·È Ë ËÏÈΛ· Â›Ó·È ‰‡Ô ·fi ·˘Ù¤˜ Ô˘ ÙÔ ·˘Í¿ÓÔ˘Ó. ™·Ó ÁÂÓÈ΋ ·Ú¯‹ ηϿ Â›Ó·È Ó· ÁÓˆÚ›˙Ô˘Ì fiÙÈ ÙÔ 90% ÙˆÓ Ó¤ˆÓ ˘ÁÈÒÓ ·ÙfiÌˆÓ ¤¯ÂÈ BNP <25 pg/ml Î·È ÙÔ Pro BNP <70 pg/ml. ™Â ·ÛıÂÓ›˜ Ì ÔÍ›· ‰‡ÛÓÔÈ· Ù· ÚÔÙÂÈÓfiÌÂÓ· ηÙÒÙÂÚ· fiÚÈ· ÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÌfi ∫∞ Â›Ó·È ÁÈ· ÙÔ ÌÂÓ BNP <100 pg/ml Î·È ÁÈ· ÙÔ NT-proBNP <340 pg/ml. ∏ ÂÈÎfiÓ· 5 ‰Â›¯ÓÂÈ ·ÏÁfiÚÈıÌÔ ¯Ú‹Û˘ Ó·ÙÚÈÔ˘ÚËÙÈÎÒÓ ÂÙȉ›ˆÓ Û ·ÛıÂÓ‹ Ì ‰‡ÛÓÔÈ·.

∏∫° ∆o HK° ‰ÂÓ ‚ÔËı¿ÂÈ Ôχ. °È· ·Ú¿‰ÂÈÁÌ· Û ÛÔ‚·Ú‹ ·ÓÂ¿ÚÎÂÈ· Ù˘ ÌÈÙÚÔÂȉԇ˜ ÌÔÚ› Ó· Â›Ó·È Î·È Ê˘ÛÈÔÏÔÁÈÎfi. ∏ ·ÚÔ˘Û›· Î˘Ì¿ÙˆÓ Q Â›Ó·È ‰ËψÙÈο ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ (·Ï·Èfi ¤ÌÊÚ·ÁÌ·) Î·È Ù· ÛËÌ›· ˘ÂÚÙÚÔÊ›·˜ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ ‰ËψÙÈο ÛÔ‚·Ú‹˜ ˘¤ÚÙ·Û˘ ‹ ÛÙ¤ÓˆÛ˘ ·ÔÚÙ‹˜. §ÈÁfiÙÂÚÔ Û˘¯Ó¿ ÙÔ ∏∫° ‰Â›¯ÓÂÈ ·ÔÎÏÂÈÛÌfi ·ÚÈÛÙÂÚÔ‡ ÛΤÏÔ˘˜ (Ì˘ÔηډÈÔ¿ıÂÈ·) ‹ /Î·È ÎÔÏÈ΋ Ì·ÚÌ·Ú˘Á‹. ™Â ·ÛıÂÓ›˜ Ì ·›ÛıËÌ· ·ÏÌÒÓ, ˙¿ÏË, ı· ¯ÚÂÈ·ÛÙ› 24ˆÚË Î·Ù·ÁÚ·Ê‹ (Holter). ∞ÚÎÂÙÔ› ·ÛıÂÓ›˜ Ì ∫∞ ¤¯Ô˘Ó ÔχÏÔΘ ÎÔÈÏȷΤ˜ ·ÚÚ˘ı̛˜ ÛÙË 24ˆÚË Î·Ù·ÁÚ·Ê‹.

¢È¿ÁÓˆÛË ¢ÂÓ ˘¿Ú¯ÂÈ ÌÔÓ·‰È΋ ‰È·ÁÓˆÛÙÈ΋ ‰ÔÎÈÌ·Û›· (¯Ú˘Ûfi standard) ‰ÈfiÙÈ Î·Ù¿ ‚¿ÛË ÚfiÎÂÈÙ·È ÁÈ· ÎÏÈÓÈ΋ ‰È¿ÁÓˆÛË Ô˘ ‚·Û›˙ÂÙ·È ÛÙÔ ÚÔÛÂÎÙÈÎfi ÈÛÙÔÚÈÎfi Î·È Ê˘ÛÈ΋ ÂͤٷÛË ˘Ô‚ÔËıÔ‡ÌÂÓ· ·fi ÂÚÁ·ÛÙËÚȷΤ˜ ÂÍÂÙ¿ÛÂȘ Î·È ÌÈ· ÔÈÎÈÏ›· ‰È·ÁÓˆÛÙÈÎÒÓ ÂÍÂÙ¿ÛˆÓ. ∆· Û˘ÌÙÒÌ·Ù· (‰‡ÛÓÔÈ· ÚÔÛ·ı›·˜ ·fi 4-6 ‚‰ÔÌ¿‰Â˜, ‡ÎÔÏË ÎfiˆÛË) Â›Ó·È Û˘¯Ó¿ ·ÏÏ¿ fi¯È ¢·›ÛıËÙ·. ∞fi ÙË º˘ÛÈ΋ ÂͤٷÛË Ù· ÛËÌ›· (ÙÚ›ÙÔ˜ ÙfiÓÔ˜, ÛÊ·Á›Ùȉ˜) ‰ÂÓ ˘¿Ú¯Ô˘Ó Î·È fiÙ·Ó ˘¿Ú¯Ô˘Ó ‰‡ÛÎÔÏ· ÂÓÙÔ›˙ÔÓÙ·È. √ȉ‹Ì·Ù· ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ ÂÎÙfi˜ ·fi ∫∞ (ÚÔ¯ˆÚË̤ÓË Î·-

∂ÈÎfiÓ· 3

23


ATHIROSK 21-

05-03-09

12:25

ª ∞ ƒ ∆ π √ ™

™ÂÏ›‰·24

2 0 0 9

∞ÓÒÙÂÚ˜ º˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜ (Û mm) ˘ÂÚ˯ÔÁÚ·Ê‹Ì·ÙÔ˜ ηډȿ˜ ∞ÔÚÙÈ΋ Ú›˙·

38

∞ÚÈÛÙÂÚfi˜ ÎfiÏÔ˜

38

¶¿¯Ô˜ ÙÔȯˆÌ¿ÙˆÓ

11

∆ÂÏԉȷÛÙÔÏÈ΋ ‰È¿ÌÂÙÚo˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜

58

¢ÂÍÈ¿˜ ÎÔÈÏ›·˜

33

∫Ï¿ÛÌ· ÂÍÒıËÛ˘ (%)

∂ÈÎfiÓ· 4

·/· ıÒڷη ∏ ·/· ıÒڷη ÌÔÚ› Ó· ‰Â›ÍÂÈ ·˘ÍË̤ÓÔ Ì¤ÁÂıÔ˜ ηډȿ˜ (ηډÈÔıˆÚ·ÎÈÎfi˜ ‰Â›ÎÙ˘ >50%) ‹ Û˘ÌÊfiÚËÛË Ó¢ÌÔÓÈÎÒÓ ÊÏ‚ÒÓ ÛÙȘ ÎÔÚ˘Ê¤˜ (Û˘Ó‹ıˆ˜ ˘Ô‰ËÏÔ‡Ó ›ÂÛË ÂÓÛÊ‹ÓˆÛ˘ ÛÙ· ÙÚȯÔÂȉ‹ >20 mmHg). AÓ Ë ›ÂÛË ÂÓÛÊ‹ÓˆÛ˘ (ÁÓˆÛÙ‹ Î·È wedge pressure) ÍÂÂÚ¿ÛÂÈ Ù· 18-25 mmHg ı· Û˘Ì‚Â› Ó¢ÌÔÓÈÎfi Ô›‰ËÌ·, ÂÍ·ÈÚÂÙÈο Â›ÁÔ˘Û· ηٿÛÙ·ÛË. ¶Ó¢ÌÔÓÈÎfi Ô›‰ËÌ· ÌÔÚ› Ó· Û˘Ì‚Â› Î·È ·fi ÌË Î·Ú‰È·Î¿ ·›ÙÈ· fiˆ˜ ‰È¿ÊÔÚ· Ê¿Ú̷η, ÛË„·ÈÌ›·. ∞ÎfiÌË Ë ·/· ıÒڷη ÌÔÚ› Ó· ‰Â›ÍÂÈ Ï¢ÚÈÙÈΤ˜ Û˘ÏÏÔÁ¤˜ ¿Ìʈ (·Ó ÌÔÓfiÏ¢ڷ, Û˘Ó‹ıˆ˜ ‰ÂÍÈ¿) ‹ ·Èٛ˜ ‰‡ÛÓÔÈ·˜ ÌË Î·Ú‰È·Î‹˜ ·ÈÙÈÔÏÔÁ›·˜. ∞Û‚ÂÛÙÒÛÂȘ ÛÙȘ ‚·Ï‚›‰Â˜ Î·È ÛÙÔ ÂÚÈοډÈÔ ‰›ÓÔ˘Ó ÔχÙÈ̘ ÏËÚÔÊÔڛ˜ ÁÈ· ‚·Ï‚ȉÔ¿ıÂȘ Î·È Ì˘ÔηډÈÔ¿ıÂȘ. ∏ ·ÚÔ˘Û›· ·Û‚ÂÛÙ›Ô˘ ÛÙË ·/· ıÒڷη ‰ÂÓ ÛËÌ·›ÓÂÈ Î·Ù' ·Ó¿ÁÎË ‚·Ï‚ȉÔ¿ıÂÈ· ‹ ÂÚÈÔÚÈÛÙÈ΋ ÂÚÈηډ›Ùȉ· ·ÏÏ¿ ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙÔ˘˜ ··ÈÙÂ›Ù·È ·Û‚¤ÛÙÈÔ ÛÙË ‚·Ï‚›‰· ‹ ÙÔ ÂÚÈοډÈÔ. º˘ÛÈÔÏÔÁÈ΋ ·/· ıÒڷη Î·È Ê˘ÛÈÔÏÔÁÈÎfi ∏∫° οÓÔ˘Ó ÙËÓ ∫∞ ·›ı·ÓË Û·Ó ·ÈÙ›· ‰‡ÛÓÔÈ·˜

∏¯ÔηډÈÔÁÚ¿ÊËÌ· ∆o ˯ÔηډÈÔÁÚ¿ÊËÌ· Â›Ó·È Ë ÈÔ ¯Ú‹ÛÈÌË ·Ó·›Ì·ÎÙË ÂͤٷÛË ÁÈ· ÂÎÙ›ÌËÛË Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜. √ ˘ÔÏÔÁÈÛÌfi˜ ÙÔ˘ ∫Ï¿ÛÌ·ÙÔ˜ ∂ÍÒıËÛ˘ Î·È ÙˆÓ ‰È·ÛÙ¿ÛÂˆÓ ÙˆÓ ÎÔÈÏÔÙ‹ÙˆÓ ·Ú¤¯Ô˘Ó ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂÈÎfiÓ· Ù˘ ηډȷ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜. ∫∂ <40 % ÙÂÏԉȷÛÙÔÏÈ΋ ‰È¿ÌÂÙÚÔ˜ >60 mm ‹ >34 mm/m2 Â›Ó·È ‰È·ÁÓˆÛÙÈο ∫∞. √È ·ı‹ÛÂȘ ÙˆÓ ‚·Ï‚›‰ˆÓ ı·

24

ÂÎÙÈÌËıÔ‡Ó ÁÈ· ÙË ÛÔ‚·ÚfiÙËÙ· ÙÔ˘˜ Ì ÙË ¯Ú‹ÛË ÙÔ˘ Doppler ∏ ÈÔ Û˘¯Ó‹ ·ÈÙ›· ‰ÂÍÈ¿˜ ηډȷ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ Ë ·ÚÈÛÙÂÚ‹ ∫∞ Î·È ÔÈ ÂΉËÏÒÛÂȘ Ù˘ Â›Ó·È Ôȉ‹Ì·Ù· Î·È ‰È·ÙÂٷ̤Ó˜ ÛÊ·Á›Ùȉ˜. ∂ÎÙfi˜ ·fi ÙÔ ÎÏ¿ÛÌ· ÂÍÒıËÛ˘ Ô ÈÔ ·ÎÚÈ‚‹˜ ‰Â›ÎÙ˘ ÂÎÙ›ÌËÛ˘ Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ Â›Ó·È Ô Î·Ú‰È·Îfi˜ ‰Â›ÎÙ˘. ∆È̤˜ <2.5l/min/M2 Â›Ó·È ‰È·ÁÓˆÛÙÈΤ˜ ∫∞.

™˘Ó˘¿Ú¯Ô˘Û˜ ·ı‹ÛÂȘ. ∆ËÓ ∫∞, Û·Ó ÓfiÛÔ ÙˆÓ ËÏÈÎȈ̤ӈÓ, ‰ÂÓ Ú¤ÂÈ Ó· ÙËÓ ‚ϤÔ˘Ì ÌÔÓÔÌÂÚÒ˜. √È ÈÔ Û˘¯Ó¤˜ Û˘Ó˘¿Ú¯Ô˘Û˜ ·ı‹ÛÂȘ Â›Ó·È Ë ÓÂÊÚÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· (̤¯ÚÈ 20%), Ë ·Ó·ÈÌ›·, Ë ·Ó·Ó¢ÛÙÈ΋ ·ÓÂ¿ÚÎÂÈ·, ÙÔ Û‡Ó‰ÚÔÌÔ ‡ÓÔ˘ ¿ÓÔÈ·˜, Ë ÌÂÏ·Á¯ÔÏ›· Î·È ÔÈ ÁÓˆÛÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ Ì fiϘ ÙȘ ÁÓˆÛÙ¤˜ Û˘Ó¤ÂȘ

¶ÚfiÁÓˆÛË, Â·Ó·ÓÔÛËÏ›˜. ∏ ÈÔ Û˘¯Ó‹ ·ÈÙ›· ÁÈ· ÓÔÛËÏ›· Â›Ó·È Ë ÌË ·ÓÙÈÚÚÔÔ‡ÌÂÓË ∫∞. OÈ

∂ÈÎfiÓ· 5

55-70

·ÚȘ ·Èٛ˜ ÁÈ· Â·Ó·ÓÔÛËÏ›· Â›Ó·È Ë ÂͤÏÈÍË (Âȉ›ӈÛË) Ù˘ ÓfiÛÔ˘, ·Î·Ù¿ÏÏËÏ· ıÂÚ·¢ÙÈο Ï¿Ó·, ÌË Û˘ÌÌfiÚʈÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ Ì ÙË ıÂÚ·›· Î·È Ë ¯Ú‹ÛË Ê·ÚÌ¿ÎˆÓ Ô˘ ÙËÓ ÂȉÂÈÓÒÓÔ˘Ó (NSAIDs, ÁÏÈÙ·˙fiÓ˜) ∏ ıÓËÙfiÙËÙ· ÛÙË ∫∞ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔÓ ˘fi ÌÂϤÙË ÏËı˘ÛÌfi. ∆o 4% Âı·›ÓÂÈ ÂÓ‰ÔÓÔÛÔÎÔÌÂȷο. ∆Ô 20% Ô˘ ‚Á·›ÓÂÈ ·fi ÙÔ ÓÔÛÔÎÔÌÂ›Ô Â·ÓÂÈÛ¿ÁÂÙ·È Û 30 Ë̤Ú˜. ŒÓ·˜ ÛËÌ·ÓÙÈÎfi ·ÏÏ¿ fi¯È ηϿ ‰È¢ÎÚÈÓÈṲ̂ÓÔ ÔÛÔÛÙfi ·ÛıÂÓÒÓ (Û ÌÂÚÈΤ˜ ÌÂϤÙ˜ ̤¯ÚÈ 50%) Âı·›ÓÂÈ ·ÈÊÓ›‰È·. ¶ÂÚÈÛÛfiÙÂÚÔÈ ·fi ¤Ó·˜ ÛÙÔ˘˜ ÙÚÂȘ ı· Âı¿ÓÔ˘Ó Ì¤Û· ÛÙÔ˘˜ 6 Ì‹Ó˜ ·fi ÙË ‰È¿ÁÓˆÛË. ™Â ·ÛıÂÓ›˜ Ì ¡YHA IV Ë ıÓËÙfiÙËÙ· ÍÂÂÚÓ¿ÂÈ ÙÔ 50% ÙÔ ÚÒÙÔ ¯ÚfiÓÔ ÌÂÙ¿ ÙË ‰È¿ÁÓˆÛË, ÍÂÂÚÓÒÓÙ·˜ ¤ÙÛÈ Î·È ÙË ıÓËÙfiÙËÙ· ÙˆÓ ÈÔ Û˘ÓËıÈÛÌ¤ÓˆÓ Î·ÎÔËıÂÈÒÓ. ∏ ıÓËÙfiÙËÙ· Û ·ÛıÂÓ›˜ Ì ¤ÌÊÚ·ÁÌ· Ì˘Ôηډ›Ô˘ Ô˘ ÂÈϤÎÂÙ·È Ì ÛÔ‚·Ú‹ ∫∞ ·Ó¤Ú¯ÂÙ·È ÛÙÔ 30% ÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ. O ΛӉ˘ÓÔ˜ Â›Ó·È È‰È·›ÙÂÚ· ˘„ËÏfi˜ ÙÔÓ ÚÒÙÔ Ì‹Ó· ÌÂÙ¿ ÙÔ ¤ÌÊÚ·ÁÌ·, ÂÏ·ÙÙÒÓÂÙ·È Ì¤Û· ÛÙÔ˘˜ ÂfiÌÂÓÔ˘˜ Ì‹Ó˜ ·ÏÏ¿ ·Ú·Ì¤ÓÂÈ ÛËÌ·ÓÙÈÎfi˜ ÁÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 15 ¯ÚfiÓÈ·. ¶·ÚÔÌÔ›ˆ˜ Ë


ATHIROSK 21-

05-03-09

12:25

™ÂÏ›‰·25

£∂ƒ∞¶∂π∞ - º∞ƒª∞∫∞

∂ÈÎfiÓ· 6 ıÓËÙfiÙËÙ· ÛÙÔ Ô͇ Ó¢ÌÔÓÈÎfi Ô›‰ËÌ· Â›Ó·È 12% ÂÓ‰ÔÓÔÛÔÎÔÌÂȷο Î·È 40% ÛÙÔ 1 ¯ÚfiÓÔ

∫·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ· Ì ‰È·ÙËÚË̤ÓÔ ÎÏ¿ÛÌ· ÂÍÒıËÛ˘ (‰È·ÛÙÔÏÈ΋ ∫∞) ™¯Â‰fiÓ ÔÈ ÌÈÛÔ› ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ∫∞ ¤¯ÂÈ ÎÏ¿ÛÌ· ÂÍÒıËÛ˘ ¿Óˆ ÙÔ˘ 50%. ∏ ÏÂÈÔ„ËÊ›· ·˘ÙÒÓ ÙˆÓ ·ÛıÂÓÒÓ Â›Ó·È ËÏÈÎȈ̤Ó˜ Á˘Ó·›Î˜, ·¯‡Û·ÚΘ, Ì ÈÛÙÔÚÈÎfi Û˘ÛÙÔÏÈ΋˜ ˘¤ÚÙ·Û˘ Î·È Ì ˘ÂÚÙÚÔÊ›· ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ ( LVH :116 gr/m2 ¿Ó‰Ú˜, 104 gr /m2 Á˘Ó·›Î˜).

£ÂÚ·›· √ ·ÎÚÔÁˆÓÈ·›Ô˜ Ï›ıÔ˜ ÛÙË ıÂÚ·›· Ù˘ ∫∞ Â›Ó·È Ù· ‰ÈÔ˘ÚËÙÈο ÙË ·Á·Ï˘ (∂ÈÎfiÓ· 7). ∏ ∂ÈÎfiÓ· 8 ·ÚÈÛÙ¿ÓÂÈ Û¯ËÌ·ÙÈο ÙÔ˘˜ ‰È¿ÊÔÚÔ˘˜ ÙÚfiÔ˘˜ ·ÓÙÈÌÂÙÒÈÛ˘ Ù˘ ∫∞. ∏ ÈÔ Û‡Á¯ÚÔÓË ıÂÚ·›· Ù˘ ∫∞ ıˆÚÂ›Ù·È Ë ¯Ú‹ÛË ‚-·ÔÎÏÂÈÛÙÒÓ (ηڂ‰ÈÏfiÏË). (µÏ Ù‡¯Ô˜ ·ıËÚÔÛÎÏ‹ÚˆÛË πÔ˘Ó›Ô˘ 2008) √È ·ª∂∞ Ú¤ÂÈ Ó· ·Ú¯›˙Ô˘Ó ÌÂ

∂ÈÎfiÓ· 7

ÌÈÎÚ¤˜ ‰fiÛÂȘ ÙÈÙÏÔÔÈÔ‡ÌÂÓ˜ ÚÔ˜ Ù· ¿Óˆ ‚·ıÌÈ·›·. ™Â ÂÚ›ÙˆÛË ‰˘Û·ÓÂÍ›·˜ ÛÙÔ˘˜ ·ª∂∞ ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ÔÈ ·ÓÙ·ÁˆÓÈÛÙ¤˜ Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘. ™Â ˘ÔÔÁηÈÌÈÎÔ‡˜ ·ÛıÂÓ›˜ (fiˆ˜ ÔÈ ˘ÂÚ‰ÈÔ˘ÚË̤ÓÔÈ) ÌÔÚ› Ó· ÚÔηϤÛÔ˘Ó ÔÚıÔÛÙ·ÙÈ΋ ˘fiÙ·ÛË. ∏ ‰·ÎÙÈÏ›Ùȉ· ÌÂÈÒÓÂÈ ÙȘ Â·Ó·ÓÔÛËÏ›˜ Î·È ¤¯ÂÈ Û›ÁÔ˘ÚË ¤Ó‰ÂÈÍË ·Ó Û˘Ó˘¿Ú¯ÂÈ ÎÔÏÈ΋ Ì·ÚÌ·Ú˘Á‹. ™ËÌ·ÓÙÈ΋ ‚Ô‹ıÂÈ· ÚÔÛʤÚÔ˘Ó Î·È Ù· ÓÈÙÚÒ‰Ë Û ÂÈÌÔÓ‹ Û˘Ìو̿وÓ. ™Â ·ÓıÂÎÙÈΤ˜ ÂÚÈÙÒÛÂȘ ∫∞ ·Ú¿ ÙËÓ Ï‹ÚË ·ÁˆÁ‹ Ì ¢ڤ· QRS (>120 msecs) fiˆ˜ Ô ·ÔÎÏÂÈÛÌfi˜ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÛΤÏÔ˘˜, ›Ûˆ˜ ¯ÚÂÈ·ÛıÔ‡Ó ÈÔ ÚÔ¯ˆÚË̤Ó˜ ÌÔÚʤ˜ ·ÓÙÈÌÂÙÒÈÛ˘ fiˆ˜ ·ÌÊÈÎÔÈÏȷ΋ ‚ËÌ·ÙÔ‰fiÙËÛË, ÂÌʇÙ¢ÛË ·˘ÙfiÌ·ÙÔ˘ ·ÈÓȉˆÙ‹ ‹ ˘Ô‚ÔËıËÙÈΤ˜ Û˘Û΢¤˜ (Û¯‹Ì· 5) Î·È Ù¤ÏÔ˜ Ë ÌÂÙ·ÌfiÛ¯Â˘ÛË. ∂ÚˆÙ‹ÛÂȘ ÁÈ· ÙË ÏÂÈÙÔ˘ÚÁÈ΋ ÈηÓfiÙËÙ· (·Ó ¢¯·ÚÈÛÙÈ¤Ù·È ÙËÓ ·Ó·ÓÔ‹, fiÛ· Ì·ÍÈÏ¿ÚÈ· ¯ÚËÛÈÌÔÔÈ› ÛÙÔ ‡ÓÔ) Î·È ·Ú·ÎÔÏÔ‡-

ıËÛË ÙÔ˘ ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜ Â›Ó·È ‚·ÛÈΤ˜ ∏ Ú·Á‰·›· ·‡ÍËÛË ÙÔ˘ ÂÈÔÏ·ÛÌÔ‡ Ù˘ ∫∞ ·ÔÙÂÏ› ÙÔ ÈÔ ÛËÌ·ÓÙÈÎfi ‰ËÌfiÛÈÔ Úfi‚ÏËÌ· ˘Á›·˜ ÛÙË Î·Ú‰È·ÁÁÂȷ΋ π·ÙÚÈ΋. √È Î‡ÚȘ ·Èٛ˜ ÁÈ· ·˘Ù‹ ÙË ¤ÎÚËÍË Â›Ó·È Ô Û˘Ó‰˘·ÛÌfi˜ ÙÔ˘ ÁËÚ·Ṳ̂ÓÔ˘ ÏËı˘ÛÌÔ‡ Î·È Ù˘ ·˘ÍË̤Ó˘ ÂÈ‚›ˆÛ˘ ÌÂÙ¿ ÙÔ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘. ∂›Ó·È Ê·ÓÂÚfi fiÙÈ Ë Ì›ˆÛË Ù˘ ÌÔÚ› Ó· ÂÈÙ¢¯ı› ÌfiÓÔ Ì ÚfiÏË„Ë Î˘Ú›ˆ˜ Ù˘ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ ‰ËÏ Ù˘ ·ıËÚÔÛÎÏ‹ÚˆÛ˘ οÙÈ ÂÍ¿ÏÏÔ˘ Ô˘ ÙÔ ·Ó¤ÊÂÚ 70 ¯ÚfiÓÈ· ÚÈÓ Ô Sir Thomas Lewis: “∆he very essence of cardiovascular practice is the early detection of heart failure”.

√Í›· ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· √Í›· ·ÔÚ‡ıÌÈÛË Ã∫∞ (70%) ÀÂÚÙ·ÛÈ΋ √∫∞ √͇ Ó¢ÌÔÓÈÎfi Ô›‰ËÌ· (√¶√) ∫·Ù·ÏËÍ›· ¢ÂÍÈ¿ ∫∞ ∂Ó‰ÔÓÔÛÔÎÔÌÂȷ΋ ıÓËÙfiÙËÙ· 47% 27% ÚÒÙÔ ¤ÙÔ˜ 24% Â·ÓÂÈÛ·ÁˆÁ¤˜ ÙÔ 1 ÙÚ›ÌËÓÔ ∏ ÔÍ›· ·ÔÚÚ‡ıÌÈÛË Ù˘ ¯ÚfiÓÈ·˜ ∫∞ ·ÔÙÂÏ› ÙË ÈÔ Û˘¯Ó‹ ÌÔÚÊ‹ Ù˘ ÔÍ›·˜ ηډȷ΋˜ ·ÓÂ¿ÚÎÂÈ·˜. √È ‚·ÛÈÎÔ› ÛÙfi¯ÔÈ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË Â›Ó·È Ë ¿ÌÂÛË ·Ó·ÎÔ‡ÊÈÛË ·fi Ù· Û˘ÌÙÒÌ·Ù·, Ë ÛÙ·ıÂÚÔÔ›ËÛË ÙˆÓ ·ÛıÂÓÒÓ Î·È Ë ¤Ó·ÚÍË ıÂÚ·›·˜ Ô˘ ‚ÂÏÙÈÒÓÂÈ ÙËÓ ÂÈ‚›ˆÛË Î·È ÙËÓ ÚfiÁÓˆÛË ÙˆÓ ·ÛıÂÓÒÓ. ∏ ÔÍ›· ∫∞ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ˘„ËÏ‹ ıÓËÙfiÙËÙ·, ÙfiÛÔ Î·Ù¿ ÙË ÓÔÛËÏ›· (3-7%) fiÛÔ Î·È ÙÔ˘˜ ÂfiÌÂÓÔ˘˜ 2-3 Ì‹Ó˜ (1016%), ηıÒ˜ Î·È ˘„ËÏ‹ Û˘¯ÓfiÙËÙ· Â·ÓÂÈÛ·ÁˆÁÒÓ Ô˘ ÊÙ¿ÓÂÈ ÙÔ 25% ηٿ ÙÔ ÚÒÙÔ ÙÚ›ÌËÓÔ

∂ÈÎfiÓ· 8

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ÕÛÎËÛË Î·È ∫·Ú‰È¿ ÃÚÈÛÙ›Ó· ÃÚ˘ÛÔ¯fiÔ˘, ÃÚ‹ÛÙÔ˜ ¶›ÙÛ·‚Ô˜, ÃÚÈÛÙfi‰Ô˘ÏÔ˜ ™ÙÂÊ·Ó¿‰Ë˜ ∞’ ¶·ÓÂÈÛÙËÌȷ΋˜ ∫·Ú‰ÈÔÏÔÁÈ΋˜ ∫ÏÈÓÈ΋˜, π°¡∞ ¶ÔÏϤ˜ ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ·Ó·‰Â›ÍÂÈ ÙÔÓ Â˘ÂÚÁÂÙÈÎfi ÚfiÏÔ Ù˘ ¿ÛÎËÛ˘ ÛÙËÓ ÚˆÙÔÁÂÓ‹ Î·È ‰Â˘ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ [1,2]. ∞Ó¿ÌÂÛ· Û ¿ÏÏÔ˘˜ ‰Â›ÎÙ˜ ¿ÛÎËÛ˘ Ë ·ÓÔ¯‹ ÛÙËÓ ¿ÛÎËÛË ¤¯ÂÈ ·Ó·ÁÓˆÚÈÛÙ› ˆ˜ Ô ÈÔ ÈÛ¯˘Úfi˜ ÚÔÁÓˆÛÙÈÎfi˜ ‰Â›ÎÙ˘ ıÓËÙfiÙËÙ·˜ ÌÂٷ͇ ¿ÏÏˆÓ Î·ıÈÂÚˆÌ¤ÓˆÓ ·Ú·ÁfiÓÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ [3]. π‰È·›ÙÂÚ·, ÈηÓfiÙËÙ· ¿ÛÎËÛ˘ ¿Óˆ ÙˆÓ 10 ª∂∆s ¯·Ú·ÎÙËÚ›˙ÂÈ Ù· ¿ÙÔÌ· Ì ηϋ ÂÈ‚›ˆÛË Û ۇÁÎÚÈÛË Ì ÌÈÎÚfiÙÂÚË ÙˆÓ 5ª∂∆s, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ˘ÔΛÌÂÓË Î·Ú‰È·ÁÁÂȷ΋ ÓfiÛÔ, ÂÓÒ ·‡ÍËÛË Î·Ù¿ 1 ª∂∆ ÛÙËÓ ÈηÓfiÙËÙ· ¿ÛÎËÛ˘ Ô‰ËÁ› Û 8-17% Ì›ˆÛË Ù˘ ıÓËÙfiÙËÙ·˜ [4]. ∏ Û˘ÛÙËÌ·ÙÈ΋ ¿ÛÎËÛË ·ÎfiÌ· Î·È Û ¿ÙÔÌ· Ì ‰Â‰Ô̤ÓÔ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ, Ô‰ËÁ› Û Ì›ˆÛË Î·Ù¿ 50% Ù˘ ηډȷÁÁÂȷ΋˜ ıÓËÙfiÙËÙ·˜, ÂÓÒ Ë ‰È¿ÚÎÂÈ· Ù˘ ¿ÛÎËÛ˘ Ô˘ Û¯ÂÙ›ÛÙËΠ̛̠ˆÛË Ù˘ ıÓËÙfiÙËÙ·˜ ‹Ù·Ó 4 Ì 5 ÊÔÚ¤˜ ‚‰ÔÌ·‰È·›ˆ˜ ‰È¿ÚÎÂÈ·˜ 30 ÏÂÙÒÓ, ‰ËÏ·‰‹ Û˘ÓÔÏÈο 130 Ì 138 ÏÂÙ¿ ¿ÛÎËÛ˘ ÙËÓ Â‚‰ÔÌ¿‰· [5]. ™ÙÔÓ ∂ÏÏËÓÈÎfi ÏËı˘ÛÌfi, Ë ÌÂϤÙË CARDIO 2000 ¤‰ÂÈÍ fiÙÈ Ë Û˘ÛÙËÌ·ÙÈ΋ ¿ÛÎËÛË ÁÈ· ÌÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ ÊÔÚ¿ ÙËÓ Â‚‰ÔÌ¿‰· Î·È ÁÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ ÌÈ· ÒÚ· Ô‰ËÁ› Û Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂΉ‹ÏˆÛ˘ ÔͤԘ ÛÙÂÊ·ÓÈ·›Ô˘ Û˘Ó‰ÚfiÌÔ˘ ηٿ 10% [6]. ∏ ÌÂϤÙË ÙˆÓ ∂Ù¿ ÈÚÒÓ ÛÙ· ·Ú¯¤˜ Ù˘ ‰ÂηÂٛ˜ ÙÔ˘ 1960 ·Ó¤‰ÂÈÍ ·Ó¿ÌÂÛ· ÛÙÔ˘˜ ÚÔÁÓˆÛÙÈÎÔ‡˜ ‰Â›ÎÙ˜ ÁÈ· ·˘ÍË̤ÓË ÔÏÈ΋ ıÓËÙfiÙËÙ· ÛÙ· 40 ¤ÙË ·Ú·ÎÔÏÔ‡ıËÛ˘ ÙÔ˘ ∂ÏÏËÓÈÎÔ‡ ˘ÔÏËı˘ÛÌÔ‡, ÙËÓ ¤ÏÏÂÈ„Ë Ê˘ÛÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ [7]. ¢˘ÛÙ˘¯Ò˜ Ù· Â›‰· ηıÈÛÙÈ΋˜ ˙ˆ‹˜ Û‹ÌÂÚ· Ê·›ÓÂÙ·È Ó· Â›Ó·È ˘„ËÏ¿ ÛÙÔÓ ∂ÏÏËÓÈÎfi ÏËı˘ÛÌfi, Ù˘ Ù¿Í˘ ÙÔ˘ 58% [8]. º˘ÛÈÔÏÔÁÈΤ˜ ÂȉڿÛÂȘ Ù˘ ¿ÛÎËÛ˘ ÛÙËÓ Î·Ú‰È¿ ∏ ¿ÛÎËÛË ·˘Í¿ÓÂÈ ÙȘ ·Ó¿ÁΘ ÙÔ˘ ÛÒÌ·ÙÔ˜ Û Ô͢ÁfiÓÔ. ∏ ÈηÓÔÔ›ËÛË ÙˆÓ ·Ó·ÁÎÒÓ ·˘ÙÒÓ ÂÈÙ˘Á¯¿ÓÂÙ·È Ì¤Ûˆ ñ ∞‡ÍËÛ˘ Ù˘ ∫·Ú‰È·Î‹˜ ¶·ÚÔ¯‹˜ (fiÁÎÔ˘ ·ÏÌÔ‡ Î·È Î·Ú‰È·Î‹˜ Û˘¯ÓfiÙËÙ·˜) ñ ∞‡ÍËÛ˘ Ù˘ ·ÚÙËÚÈÔÊÏ‚È΋˜

26

‰È·ÊÔÚ¿˜ Ô͢ÁfiÓÔ˘ Î·È ñ ∞ӷηٷÓÔÌ‹˜ Ù˘ ÚÔ‹˜ ÙÔ˘ ·›Ì·ÙÔ˜ ·fi ÏÈÁfiÙÂÚÔ ÂÓÂÚÁÔ‡˜ ÌÂÙ·‚ÔÏÈο ÈÛÙÔ‡˜ ÛÙÔ˘˜ ·ÛÎÔ‡ÌÂÓÔ˘˜ ̇˜. π‰È·›ÙÂÚ· Ë ÈÛÔÙÔÓÈ΋ ¿ÛÎËÛË ÂÈʤÚÂÈ ñ ∞‡ÍËÛË Ù˘ ηډȷ΋˜ Û˘¯ÓfiÙËÙ·˜, Ù˘ Û˘Û·ÛÙÈÎfiÙËÙ·˜ Î·È Ù˘ ηډȷ΋˜ ·ÚÔ¯‹˜. (ÏfiÁˆ ·fiÛ˘ÚÛ˘ ÙÔ˘ ·Ú·Û˘Ì·ıËÙÈÎÔ‡ Î·È ‰È¤ÁÂÚÛ˘ ÙÔ˘ Û˘Ì·ıËÙÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ·‡ÍËÛ˘ Ù˘ ÊÏ‚È΋˜ ÂÈÛÙÚÔÊ‹˜- ÂÓÂÚÁÔÔ›ËÛ˘ ÙÔ˘ ·ÓÙ·Ó·ÎÏ·ÛÙÈÎÔ‡ Bainbridge - ¯ÚËÛÈÌÔÔ›ËÛ˘ ÙÔ˘ Ì˯·ÓÈÛÌÔ‡ ÙÔ˘ Starling Î·È Bowditch staircase Ê·ÈÓÔ̤ÓÔ˘ fiÔ˘ Ë ·‡ÍËÛË Ù˘ ηډȷ΋˜ Û˘¯ÓfiÙËÙ·˜ ÂÈʤÚÂÈ ÂÚ·ÈÙ¤Úˆ ÂÈÙ¿¯˘ÓÛË ÙÔ˘ ηډȷÎÔ‡ Ú˘ıÌÔ‡) ñ ªÂ›ˆÛË ÂÚÈÊÂÚÈÎÒÓ ·ÓÙÈÛÙ¿ÛÂˆÓ ñ ∞‡ÍËÛË Ù˘ ›ÂÛ˘ ÛÊ˘ÁÌÔ‡ ñ ∞‡ÍËÛË ÛÏ·¯ÓÈ΋˜ ·ÁÁÂÈÔÛ‡Û·Û˘ ™ÙË ÛÙ·ÙÈ΋ ‹ ÈÛÔÌÂÙÚÈ΋ ¿ÛÎËÛË ·Ú·ÙËÚÂ›Ù·È ñ ∞‡ÍËÛË Û˘ÛÙÔÏÈ΋˜ Î·È ‰È·ÛÙÔÏÈ΋˜ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ñ ªÈÎÚ‹ ·‡ÍËÛË Î·Ú‰È·Î‹˜ Û˘¯ÓfiÙËÙ·˜ ñ √ fiÁÎÔ˜ ·ÏÌÔ‡ ·Ú·Ì¤ÓÂÈ ·ÌÂÙ¿‚ÏËÙÔ˜ ·ÏÏ¿ ·Ú·ÙËÚÂ›Ù·È ÌÈÎÚ‹ ·‡ÍËÛË Ù˘ ηډȷ΋˜ ·ÚÔ¯‹˜ ñ √È ÂÚÈÊÂÚÈΤ˜ ·ÓÙÈÛÙ¿ÛÂȘ ·˘Í¿ÓÔÓÙ·È ·Ó·ÏfiÁˆ˜ ¤ÚÁÔ˘ [9] ∏ Û˘ÛÙËÌ·ÙÈ΋ ¿ÛÎËÛË ‚ÂÏÙÈÒÓÂÈ ÙË Ì˘Ôηډȷ΋ ÏÂÈÙÔ˘ÚÁ›·, ·˘Í¿ÓÔÓÙ·˜ ÙË Ì¤ÁÈÛÙË Î·Ù·Ó¿ÏˆÛË Ô͢ÁfiÓÔ˘ Î·È ÙȘ ‰È·ÛÙ¿ÛÂȘ ÙˆÓ Ì˘ÔηډȷÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ‚ÂÏÙÈÒÓÔÓÙ·˜ ÙË Û˘Û·ÛÙÈÎfiÙËÙ· Î·È ÙË ‰È·¯Â›ÚÈÛË ÙÔ˘ Ì˘ÔηډȷÎÔ‡ ·Û‚ÂÛÙ›Ô˘. ™Â ÂÈÚ·Ì·ÙÈο ÌÔÓ٤Ϸ Ë ÂÈÌ‹Î˘ÓÛË ÙˆÓ Ì˘ÔηډȷÎÒÓ ÈÓÒÓ Ô˘ ·Ú·ÙËÚÂ›Ù·È Â›Ó·È Ù˘ Ù¿Í˘ ÙˆÓ 20-22%, ÂÓÒ Ë ·‡ÍËÛË ÙÔ˘ fiÁÎÔ˘ ÙÔ˘˜ Â›Ó·È Î·Ù¿ 46%. º·›ÓÂÙ·È fiÙÈ Ë ‰È·ÎÔ‹ Ù˘ ¿ÛÎËÛ˘ Ô‰ËÁ› Û ˘ÔÛÙÚÔÊ‹ ÙˆÓ ·Ú·¿Óˆ ·Ó·ÊÂÚfiÌÂÓˆÓ Î˘ÙÙ·ÚÈÎÒÓ ÂȉڿÛÂˆÓ Ì¤Û· Û ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÙÂÛÛ¿ÚˆÓ Â‚‰ÔÌ¿‰ˆÓ [10].

ÕÛÎËÛË Î·È ·ÚÙËÚȷ΋ ›ÂÛË ∏ Û˘ÛÙËÌ·ÙÈ΋ ·ÂÚfi‚ÈÔ˜ ¿ÛÎËÛË ÁÈ· 3 Ì‹Ó˜ ÌÂÈÒÓÂÈ Ù· Â›‰· ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ηٿ 8-10 mmHg ÁÈ· ÙË Û˘ÛÙÔÏÈ΋ Î·È 7-8 mmHg ÁÈ· ÙË ‰È·ÛÙÔÏÈ΋ ∞¶. ∂›Û˘ ‚ÂÏÙÈÒÓÂÈ ÙËÓ ˘¤ÚÌÂÙÚË ÈÓfiÙÚÔÔ ·¿ÓÙËÛË ÛÙËÓ ÎfiˆÛË Ì¤Ûˆ Ì›ˆÛ˘ ÙˆÓ ÂÚÈÊÂÚÈÎÒÓ ·ÓÙÈÛÙ¿ÛˆÓ, Ì›ˆÛ˘ Ù˘ Û˘Ì·ıËÙÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Î·È ÙˆÓ ÂÈ¤‰ˆÓ ÓÔÚ·‰ÚÂÓ·Ï›Ó˘ Î·È ·‡ÍËÛË Ù˘ ηډȷ΋˜ ·ÚÔ¯‹˜. ∏ ̤ÙÚÈ·˜ ¤ÓÙ·Û˘ ¿ÛÎËÛË, ‰È¿ÚÎÂÈ·˜ ÙÔ˘Ï¿¯ÈÛÙÔÓ 16 ‚‰ÔÌ¿‰ˆÓ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û Ì›ˆÛË Ù˘ ˘ÂÚÙÚÔÊ›·˜ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ [11, 12]. ∏ ÌÂϤÙË TOMHS ¤‰ÂÈÍ ‚ÂÏÙ›ˆÛË Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜ Û ˘ÂÚÙ·ÛÈο ¿ÙÔÌ· ·fi ÙËÓ ˘ÈÔı¤ÙËÛË Ê˘ÛÈ΋ ¿ÛÎËÛ˘ ·Ú¿ÏÏËÏ· Ì ÙË ¯ÔÚËÁÔ‡ÌÂÓË Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹, Ô˘ Ô‰‹ÁËÛÂ Î·È Û ηχÙÂÚË Ú‡ıÌÈÛË Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ Î·È Ì Ì›ˆÛË Ù˘ ·ÁˆÁ‹˜ [13, 14]. ∞ÎfiÌ· Î·È Ë ¿ÛÎËÛË ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ Ô‰ËÁ› Û Ì›ˆÛË Ù˘ ‰È·ÛÙÔÏÈ΋˜ ·ÚÙËÚȷ΋˜ ›ÂÛ˘, Ì›ˆÛË ÙˆÓ ÔÏÈÎÒÓ ÂÚÈÊÂÚÈÎÒÓ ·ÓÙÈÛÙ¿ÛˆÓ, ·‡ÍËÛË Ù˘ ηډȷ΋˜ ·ÚÔ¯‹˜ Î·È ÚfiÎÏËÛË ·ÁÁÂÈԉȷÛÙÔÏ‹˜ ÛÙ· ¿Óˆ ¿ÎÚ·. ∞˘Ùfi Ê·›ÓÂÙ·È fiÙÈ ˘Ô‰ËÏÒÓÂÈ ÁÂÓÈÎÂ˘Ì¤ÓË ·ÁÁÂÈԉȷÛÙ·ÏÙÈ΋ Â›‰Ú·ÛË, ΢ڛˆ˜ ÌÂÙ¿ ·fi ÂÓÙ·ÙÈ΋ ¿ÛÎËÛË. ŸÙ·Ó ·ÛÎÔ‡ÓÙ·È Ù· οو ¿ÎÚ· ÚÔηÏÂ›Ù·È ÁÚ‹ÁÔÚË Ì›ˆÛË Ù˘ Ì˘˚΋˜ ÚÔ‹˜ ÛÙÔ ·ÓÙÈ‚Ú¿¯ÈÔ, Ô˘ ·Ì¤Ûˆ˜ ÂϤÁ¯ÂÙ·È ·fi ·‡ÍËÛË ÙÔ˘ ·‰ÚÂÓÂÚÁÈÎÔ‡ ·ÁÁÂÈÔÛ˘ÛÙ·ÏÙÈÎÔ‡ ÙfiÓÔ˘. ∫·ıÒ˜ Ë ¿ÛÎËÛË Û˘Ó¯›˙ÂÙ·È ·˘Í¿ÓÂÈ Û˘Ó¯Ҙ Ë ·ÈÌ·ÙÈ΋ ÚÔ‹ ÛÙÔ ·ÓÙÈ‚Ú¿¯ÈÔ Ô˘ ·Ú·Ì¤ÓÂÈ Î·È ÌÂÙ¿ ÙË ‰È·ÎÔ‹ Ù˘ ¿ÛÎËÛ˘. √È ÌÂÙ·‚ÔϤ˜ ·˘Ù¤˜ Ê·›ÓÂÙ·È Ó· ·Ú·Ì¤ÓÔ˘Ó ÁÈ· ÌÂÙ¿ ·fi 1 ÒÚ· ·fi ÙË ‰È·ÎÔ‹ Ù˘ ¿ÛÎËÛ˘ Î·È ÂÍ·ÚÙÒÓÙ·È ·fi ÙÔ ÊÔÚÙ›Ô Ù˘ ¿ÛÎËÛ˘ ηıÒ˜ ¤¯Ô˘Ó ·Ú·ÙËÚËı› Û ˘ÂÚÙ·ÛÈο ¿ÙÔÌ· Ô˘ ·ÛÎÔ‡ÓÙ·È ÛÙÔ 70% Ù˘ ̤ÁÈÛÙ˘ ηٷӿψÛ˘ Ô͢ÁfiÓÔ˘, ·ÏÏ¿ ‰ÂÓ ¤¯Ô˘Ó ·Ú·ÙËÚËı› Û ¿ÛÎËÛË ÛÙÔ 50% Ù˘ ÌÂÁ›ÛÙ˘ ηٷӿψÛ˘ Ô͢ÁfiÓÔ˘ [15]. ∞fi ÙË ÌÂϤÙË ÛÙÔÓ ∂ÏÏËÓÈÎfi ÏËı˘ÛÌfi Ê·›ÓÂÙ·È fiÙÈ ·ÎfiÌ· ηÈ


ATHIROSK 21-

05-03-09

12:25

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À°π∂π¡√¢π∞π∆∏∆π∫∏ ∞°ø°∏ ÂÏ·ÊÚ¿ ¤ˆ˜ ̤ÙÚÈ· Ê˘ÛÈ΋ ¿ÛÎËÛË Ô‰ËÁ› Û Ì›ˆÛË Î·Ù¿ 12% ÙÔ˘ ÛÙÂÊ·ÓÈ·›Ô˘ ÎÈÓ‰‡ÓÔ˘ Û ˘ÂÚÙ·ÛÈο ¿ÙÔÌ· Ì ڢıÌÈṲ̂ӷ Â›‰· ·ÚÙËÚȷ΋˜ ›ÂÛ˘, 5% Û ÌË Î·ÏÒ˜ Ú˘ıÌÈṲ̂ÓÔ˘˜ ˘ÂÚÙ·ÛÈÎÔ‡˜ Î·È 9% Û ¿ÙÔÌ· Ô˘ ‰ÂÓ Ï·Ì‚¿ÓÔ˘Ó Î·Ì›· ·ÁˆÁ‹ ÁÈ· ÙËÓ ·ÚÙËÚȷ΋ ›ÂÛË [16]. ∂ÓÒ Ô Û˘Ó‰˘·ÛÌfi˜ ¿ÛÎËÛ˘ Î·È ÌÂÛÔÁÂÈ·ÎÔ‡ Ù‡Ô˘ ‰È·ÙÚÔÊ‹ Ô‰ËÁ› Û 25% Ì›ˆÛË ÙÔ˘ ÛÙÂÊ·ÓÈ·›Ô˘ ÎÈÓ‰‡ÓÔ˘ Û ˘ÂÚÙ·ÛÈÎÔ‡˜ Ô˘ ¤¯Ô˘Ó Ú˘ıÌ›ÛÂÈ Ù· Â›‰· ·ÚÙËÚȷ΋˜ ›ÂÛ˘, 11% Ì›ˆÛË ÙÔ˘ ÛÙÂÊ·ÓÈ·›Ô˘ ÎÈÓ‰‡ÓÔ˘ Û Ì ıÂÚ·¢fiÌÂÓÔ˘˜, Î·È 17% Ì›ˆÛË Û ÌË ÂÏÂÁ¯fiÌÂÓÔ˘˜ ˘ÂÚÙ·ÛÈÎÔ‡˜ [17]. ŸÛÔ ·ÊÔÚ¿ ÙË ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ·ÚÙËÚÈÒÓ Ë Û˘ÛÙËÌ·ÙÈ΋ ·ÂÚfi‚ÈÔ˜ ¿ÛÎËÛË ÌÔÚ› Ó· ÂÈ‚Ú·‰‡ÓÂÈ Î·È ÌÂÚÈÎÒ˜ Ó· ·ÔηٷÛÙ‹ÛÂÈ ÙË Ì›ˆÛË Ù˘ ÂÓ‰ÔÙÈÎfiÙËÙ·˜ ÙˆÓ ·ÚÙËÚÈÒÓ Ô˘ ÚÔηÏÂ›Ù·È Ì ÙË ¿ÚÔ‰Ô Ù˘ ËÏÈΛ·˜ [18]. ∂ÓÒ ·ÎfiÌ· Î·È Ë ÈÛÔÌÂÙÚÈ΋ ¿ÛÎËÛË ¤¯ÂÈ Â˘ÂÚÁÂÙÈÎfi ÚfiÏÔ ÛÙË Ú‡ıÌÈÛË Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ηıÒ˜ ‚Ú·¯Â›˜ Û˘Ó‰ڛ˜ ÈÛÔÌÂÙÚÈ΋˜ ÚÔfiÓËÛ˘ Ê·›ÓÂÙ·È Ó· ÙÚÔÔÔÈÔ‡Ó ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ·˘ÙfiÓÔÌÔ˘ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, Ô‰ËÁÒÓÙ·˜ Û Ì›ˆÛË Ù˘ ηډȷ΋˜ Û˘¯ÓfiÙËÙ·˜ ËÚÂÌ›·˜, ·‡ÍËÛË Ù˘ ÌÂÙ·‚ÏËÙfiÙËÙ·˜ Ù˘ Î·È Ì›ˆÛË Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ Û ËÏÈÎȈ̤ӷ ¿ÙÔÌ· [19]. °È ·˘ÙÔ‡˜ ÙÔ˘˜ ÏfiÁÔ˘˜ Ë ∞ÌÂÚÈηÓÈ΋ ∫·Ú‰ÈÔÏÔÁÈ΋ ∂Ù·ÈÚ›· Û˘ÓÈÛÙ¿ ÛÙȘ ÙÂÏÂ˘Ù·›Â˜ ηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ ÁÈ· ÙË Ú‡ıÌÈÛË Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ Û˘ÛÙËÌ·ÙÈ΋ ¿ÛÎËÛË 7 ÊÔÚ¤˜ ‹ ÙÔ˘Ï¿¯ÈÛÙÔÓ 150 ÏÂÙ¿ ÙËÓ Â‚‰ÔÌ¿‰· [20]. ∏ ¯Ú‹ÛË ÙˆÓ ‚-·ÔÎÏÂÈÛÙÒÓ ÂËÚ¿˙ÂÈ ÙËÓ ·ÓÔ¯‹ ÛÙËÓ ÎfiˆÛË; ∏ Â›‰Ú·ÛË Ù˘ ·ÓÙÈ-Ù·¯˘Î·Ú‰È·Î‹˜ ‰Ú¿Û˘ ÙˆÓ Ì·ÎÚ¿˜ ‰Ú¿Ûˆ˜ ‚-·ÔÎÏÂÈÛÙÒÓ Â›Ó·È ¤ÓÙÔÓË Ì›· ÒÚ· ÌÂÙ¿ ÙË Ï‹„Ë, ÂÓÒ ·Ú·Ì¤ÓÂÈ ÁÈ· ̤ÁÈÛÙÔ 2 Ì 4 ÒÚ˜ ÌÂÙ¿. ∞ÓÙ›ıÂÙ· Ë ·ÓÙÈ˘ÂÚÙ·ÛÈ΋ ‰Ú·ÛË Î·È o ‚-·ÔÎÏÂÈÛÌfi˜ ·Ú·Ì¤ÓÔ˘Ó ÁÈ· fiÏÔ ÙÔ 24ˆÚÔ [21, 22]. ŒÙÛÈ Ë ¯Ú‹ÛË ÎÏÈÓÈÎÒÓ ‰fiÛˆ˜ ÙˆÓ ‚·ÔÎÏÂÈÛÙÒÓ ‰ÂÓ ·ÔÎÏ›ÂÈ ÙË ‰Ú¿ÛË ÙÔ˘ Û˘Ì·ıËÙÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ηٿ ÙËÓ ¿ÛÎËÛË, ÏfiÁˆ Ù˘ ‡·Ú͢ ÌÈÎÚÔ‡ ÔÛÔÛÙÔ‡ · ˘Ô‰Ô¯¤ˆÓ ÛÙÔ Ì˘ÔοډÈÔ Ô˘ ÂÓÂÚÁÔÔÈÔ‡ÓÙ·È Î·È ·˘Í¿ÓÔ˘Ó ÙË Û˘Û·ÛÙÈÎfiÙËÙ· ̤ۈ ·‡ÍËÛ˘ ÂÓ‰Ô΢ÙÙ¿ÚÈÔ˘ ·Û‚ÂÛÙ›Ô˘. ∂›Û˘ Ì ÙËÓ ¿ÛÎËÛË ·˘Í¿ÓÔ˘Ó ÔÈ ÌË ·‰ÚÂÓÂÚÁÈΤ˜ ÔÚÌfiÓ˜, fiˆ˜ ÙÔ ÁÏԢηÁfiÓÔ Î·È Ë

·ÁÁÂÈÔÙÂÓÛ›ÓË ππ Ô˘ ÚÔ¿ÁÔ˘Ó ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘ Û˘Ì·ıËÙÈÎÔ‡ [22]. ™Â ÌÂϤÙË Ô˘ Û˘ÌÂÚȤϷ‚ 2.318 ˘ÂÚÙ·ÛÈÎÔ‡˜ ¿Ó‰Ú˜ Ë Ï‹„Ë ‚-·ÔÎÏÂÈÛÙÒÓ ¤‰ÂÈÍ ӷ ÚÔηÏ› 68% ÌÈÎÚfiÙÂÚË Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ˘ÂÚÙ·ÛÈ΋˜ ·¿ÓÙËÛ˘ ÛÙËÓ ÎfiˆÛË, ÂÓÒ Ù· Â›‰· ·ÚÙËÚȷ΋˜ ›ÂÛ˘ Î·È Î·Ú‰È·Î‹˜ Û˘¯ÓfiÙËÙ·˜ ‹Ù·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚ· Û fiÏ· Ù· ÛÙ¿‰È·. ∏ Â›‰Ú·ÛË ·˘Ù‹ ‹Ù·Ó ÛËÌ·ÓÙÈÎfiÙÂÚË ÛÙÔ˘˜ η˘Î¿ÛÈÔ˘˜ [23]. ÕÛÎËÛË Î·È ÂÓ‰ÔıËÏȷ΋ ÏÂÈÙÔ˘ÚÁ›· ∏ Û˘ÛÙËÌ·ÙÈ΋ ¿ÛÎËÛË ¤¯ÂÈ ÌÈÎÚ‹ Â›‰Ú·ÛË ÛÙËÓ ÂÓ‰ÔıËÏȷ΋ ÏÂÈÙÔ˘ÚÁ›· ÛÂ Ê˘ÛÈÔÏÔÁÈο ¿ÙÔÌ·, ·ÏÏ¿ ÚÔηÏ› ÛËÌ·ÓÙÈ΋ ‚ÂÏÙ›ˆÛË Û ·ÛıÂÓ›˜ Ì ÂËÚ·Ṳ̂ÓË ÂÓ‰ÔıËÏȷ΋ ÏÂÈÙÔ˘ÚÁ›·, fiˆ˜ ¤¯ÂÈ ‰Âȯı› Ì ÂÁ¯‡ÛÂȘ ·ÎÂÙ˘ÏÔ¯ÔÏ›Ó˘. ŒÙÛÈ Ë Û˘ÛÙËÌ·ÙÈ΋ ·ÂÚfi‚ÈÔ˜ ¿ÛÎËÛË, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙÈ̤˜ ¯ÔÏËÛÙÂÚfiÏ˘, ‰ÂÓ ‚ÂÏÙÈÒÓÂÈ ÙËÓ ÂÓ‰ÔıËÏÈÔÂÍ·ÚÙÒÌÂÓË ·ÁÁÂÈԉȷÛÙÔÏ‹ Û ӤԢ˜ ˘ÁÈ›˜ ÂÓ‹ÏÈΘ, ·ÏÏ¿ ÌÔÚ› Ó· ¤¯ÂÈ Â˘ÂÚÁÂÙÈÎfi ÚfiÏÔ Û ӤԢ˜ Ì ÂËÚ·Ṳ̂ÓË ÂÓ‰ÔıËÏȷ΋ ÏÂÈÙÔ˘ÚÁ›·, fiˆ˜ ·ÚÔ˘Û›· ·ÚÙËÚȷ΋˜ ˘¤ÚÙ·Û˘ [24, 25]. ™ÙÔ˘˜ ¿Ó‰Ú˜, Ë ÂÓ‰ÔıËÏÈÔÂÍ·ÚÙÒÌÂË ·ÁÁÂÈԉȷÛÙÔÏ‹, fiˆ˜ ¤¯ÂÈ ÌÂÏÂÙËı› ÛÙË ‚Ú·¯ÈfiÓÈÔ ·ÚÙËÚ›· Î·È ÛÙȘ ÛÙÂÊ·ÓÈ·›Â˜ ·ÚÙËڛ˜, ÌÂÈÒÓÂÙ·È ÚÔԉ¢ÙÈο Ì ÙËÓ ·‡ÍËÛË Ù˘ ËÏÈΛ·˜, ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 20 ÂÙÒÓ. H Û˘ÛÙËÌ·ÙÈ΋ ¿ÛÎËÛË Ê·›ÓÂÙ·È Ó· ‚ÂÏÙÈÒÓÂÈ ÙË ÂÓ‰ÔıËÏȷ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ù˘ Á‹Ú·ÓÛ˘ ̤ۈ ·‡ÍËÛ˘ ·Ú·ÁˆÁ‹˜ Î·È ·ÂÏ¢ı¤ÚˆÛ˘ ¡√, ·‡ÍËÛ˘ Ù˘ ¤ÎÊÚ·Û˘ ÙÔ˘ ÁÔÓȉ›Ô˘ Ù˘ ÂÓ‰ÔıËÏȷ΋˜ Û˘Óı¿Û˘ ÙÔ˘ ¡√ (eNOS), ‚ÂÏÙ›ˆÛ˘ Ù˘ ¢·ÈÛıËÛ›·˜ ÙˆÓ ÂÓ‰ÔıËÏÈ·ÎÒÓ ÌÔ˘ÛηÚÈÓÈÎÒÓ ˘Ô‰Ô¯¤ˆÓ, ·‡ÍËÛ˘ ·ÂÏ¢ı¤ÚˆÛ˘ ÚÔÛÙ·ÁÏ·Ó‰ÈÓÒÓ, Ì›ˆÛ˘ ηٷ‚ÔÏÈÛÌÔ‡ ÙÔ˘ ¡√ ·fi ÂχıÂÚ˜ Ú›˙˜ ÔÍ›‰ˆÛ˘ Î·È Ì›ˆÛ˘ ÙÔ˘ Û˘Ì·ıËÙÈÎÔ‡ ·ÁÁÂÈÔÛ˘Û·ÛÙÈÎÔ‡ ÙfiÓÔ˘ [26-30]. ÕÛÎËÛË Î·È ‰ÈÂÚÁ·Û›· ÔÍ›‰ˆÛ˘-ÊÏÂÁÌÔÓ‹˜ H ˘„ËÏ‹˜ ¤ÓÙ·Û˘ ¿ÛÎËÛË Ê·›ÓÂÙ·È Ó· ·˘Í¿ÓÂÈ ÙȘ Û˘ÁÎÂÓÙÚÒÛÂȘ Ï¿ÛÌ·ÙÔ˜ ‰ÂÈÎÙÒÓ ÙÔ˘ ÔÍÂȉˆÙÈÎÔ‡ ÛÙÚ˜ [31]. ™ÙËÓ National Health and Nutrition Examination Survey III, Û ‰Â›ÁÌ· 13748 ÂÓËÏ›ÎˆÓ Ê¿ÓËΠfiÙÈ Ô ¯ÚfiÓÔ˜ ÂÓ·Û¯fiÏËÛ˘ ÛÙË Ê˘ÛÈ΋ ¿ÛÎËÛË ‹Ù·Ó ·ÓÙ›ÛÙÚÔÊ· ·Ó¿-

ÏÔÁÔ˜ Ì ٷ Â›‰· CRP, ÈÓˆ‰ÔÁfiÓÔ˘ Î·È ÙÔÓ ·ÚÈıÌfi ÙˆÓ Ï¢ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ [32]. ™ÙË ÌÂϤÙË ∞∆∆π∫∏ Ë Ì¤ÙÚÈ· ÂÓ·Û¯fiÏËÛË Ì ¿ÛÎËÛË Ô‰‹ÁËÛ Û 33% ÌÈÎÚfiÙÂÚË Û˘ÁΤÓÙÚˆÛË hsCRP, 10% ÌÈÎÚfiÙÂÚË Û˘ÁΤÓÙÚˆÛË Ï¢ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ, 17% ÌÈÎÚfiÙÂÚË Û˘ÁΤÓÙÚˆÛË ·Ì˘ÏÔÂȉԇ˜ ∞ Î·È 3% ÌÈÎÚfiÙÂÚË Û˘ÁΤÓÙÚˆÛË ÈÓˆ‰ÔÁfiÓÔ˘ [33]. ÕÛÎËÛË Î·È ıÚÔÌ‚ÔÁ¤ÓÂÛË ∂ÓÒ Ë ‚Ú·¯Â›· ¤ÓÙÔÓË ¿ÛÎËÛË ¤¯ÂÈ ıÚÔÌ‚ÔÁfiÓ˜ ȉÈfiÙËÙ˜, ηıÒ˜ ·˘Í¿ÓÂÈ ÙÔÓ ·ÚÈıÌfi Î·È ÙË ‰Ú·ÛÙËÚÈfiÙËÙ· ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ, Ë Û˘ÛÙËÌ·ÙÈ΋ ¿ÛÎËÛË ÌÂÙÚÈ¿˙ÂÈ ÙËÓ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ Î·È ·˘Í¿ÓÂÈ ÙËÓ ·ÈÌÔÂÙ·Ïȷ΋ Û˘ÁΤÓÙÚˆÛË Û cGMP. ∏ Ê˘ÛÈ΋ ¿ÛÎËÛË Î·Ù·ÛÙ¤ÏÏÂÈ ÙËÓ ˘ÂÚËÎÙÈÎfiÙËÙ·, ÌÂÈÒÓÔÓÙ·˜ ÙÔ ÈÓˆ‰ÔÁfiÓÔ, ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ‹Í˘ VIII, von Willebrand, VII, ÙÔ Û‡ÌÏÂÁÌ· ıÚÔÌ‚›Ó˘-·ÓÙÈıÚÔÌ‚›Ó˘ πππ, ÂÓÒ ·Ú·Ù›ÓÂÈ ÙÔÓ ¯ÚfiÓÔ ÌÂÚÈ΋˜ ıÚÔÌ‚ÔÏ·ÛÙ›Ó˘. ŒÙÛÈ Ë ·Ú·ÙËÚÔ‡ÌÂÓË Ì›ˆÛË ·ÓÙÈËÎÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ fiˆ˜ ÙÔ˘ Ï·ÛÌÈÓÔÁfiÓÔ˘, ÙÔ˘ ·ÓÙÈÁfiÓÔ˘ ÙÔ˘ ÈÛÙÈÎÔ‡ ÂÓÂÚÁÔÔÈËÙ‹ ÙÔ˘ Ï·ÛÌÈÓÔÁfiÓÔ˘, ÙÔ˘ ·Ó·ÛÙÔϤ· Ù˘ Ï·ÛÌ›Ó˘ a2, ÙÔ˘ ·Ó·ÛÙÔϤ· ÙÔ˘ ÂÓÂÚÁÔÔÈËÙ‹ ÙÔ˘ Ï·ÛÌÈÓÔÁfiÓÔ˘ -1 Î·È ÙÔ˘ Û˘ÌϤÁÌ·ÙÔ˜ Ï·ÛÌ›Ó˘-a 2PI ÌÂÙ¿ Ê˘ÛÈ΋ ¿ÛÎËÛË Èı·ÓÒ˜ ÔÊ›ÏÂÙ·È ÛÙËÓ ÌÂȈ̤ÓË ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ‹Í˘/ÈÓˆ‰fiÏ˘Û˘ [34, 35]. º˘ÛÈ΋ ¿ÛÎËÛË Î·È ÏÈ›‰È· ¶·Ú fiÏÔ Ô˘ Ù· Â›‰· ÏÈȉ›ˆÓ Û¯ÂÙ›˙ÔÓÙ·È ·ÓÙ›ÛÙÚÔÊ· Ì ÙËÓ ·ÚÔ˘Û›· Ê˘ÛÈ΋˜ ¿ÛÎËÛ˘, ÌfiÓÔ Ë HDL-C Î·È Ë apolipoprotein-A1 ÂËÚ¿˙ÔÓÙ·È ÛËÌ·ÓÙÈο ·fi ÙËÓ ¿ÛÎËÛË ÛÙȘ Á˘Ó·›Î˜, ·ÏÏ¿ fi¯È ÛÙÔ˘˜ ¿Ó‰Ú˜ [36, 37]. ™Â ·ÛıÂÓ›˜ Ì ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· ·fi ÙÔ˘˜ ·ÚÈÔ˘˜ ÚÔÁÓˆÛÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ ÛÙ· 15 ÂÚ›Ô˘ ¤ÙË ·Ú·ÎÔÏÔ‡ıËÛ˘ Â›Ó·È Ë ÌÂȈ̤ÓË ·ÓÔ¯‹ ÛÙËÓ ÎfiˆÛË, Ë Î·ı˘ÛÙÂÚË̤ÓË ÙÒÛË ÙÔ˘ ηډȷÎÔ‡ Ú˘ıÌÔ‡ ηٿ ÙÔ 1Ô ÏÂÙfi Ù˘ ·ÔηٿÛÙ·Û˘ Î·È Ë ·˘ÍË̤ÓË ›ÂÛË ÛÊ˘ÁÌÔ‡ ÛÙÔ Ì¤ÁÈÛÙÔ Ù˘ ÎfiˆÛ˘. [38]. ÕÛÎËÛË Î·È Û·Î¯·Ú҉˘ ‰È·‚‹Ù˘ ∏ ̤ÙÚÈ· ¿ÛÎËÛ˘ Ù˘ Ù¿Í˘ ÙˆÓ 4-7 Kcal/ÏÂÙfi Ê·›ÓÂÙ·È Ó· ÌÂÈÒÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ Î·Ù¿ 65% ÛÙËÓ ÂÌÊ¿ÓÈÛË ÔͤԘ ÛÙÂÊ·ÓÈ·›Ô˘ ÂÂÈÛÔ‰›Ô˘ ÛÙÔ˘˜ ‰È·‚ËÙÈÎÔ‡˜ [39].

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∏ Ê˘ÛÈ΋ ¿ÛÎËÛË Ê·›ÓÂÙ·È Ó· ‰Ú· ÛÙËÓ Ì›ˆÛË Ù˘ ·ÓÙ›ÛÙ·Û˘ ÛÙËÓ ÈÓÛÔ˘Ï›ÓË Ì¤Ûˆ – Ì›ˆÛ˘ Ù˘ ÎÂÓÙÚÈ΋˜ ·¯˘Û·ÚΛ·˜ – ‚ÂÏÙ›ˆÛ˘ Ù˘ ηډÈÔ·Ó·Ó¢ÛÙÈ΋˜ ηٿÛÙ·Û˘, ·ÏÏ¿ Î·È – ÕÌÂÛ˘ ‰Ú¿Û˘ Ô˘ ÂËÚ¿˙ÂÙ·È ·fi ÙÔ ÁÔÓfiÙ˘Ô ÙÔ˘ ·ÙfiÌÔ˘ [40] ∏ Èı·ÓfiÙËÙ· ÂΉ‹ÏˆÛ˘ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ Ì ÙËÓ Î·Ù·Ó¿ÏˆÛË ˘ÁÈÂÈÓ‹˜ ‰È·ÙÚÔÊ‹˜ ÌÂÈÒÓÂÙ·È 19%, ÂÓÒ ·Ó Û˘Ó‰˘¿˙ÂÙ·È Ì ¤ÛÙˆ ‹È· Ê˘ÛÈ΋ ¿ÛÎËÛË (< 7 Kcal/min) ÌÂÈÒÓÂÙ·È Î·Ù¿ 25%. ÕÛÎËÛË Î·È ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ˜ ªÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ë ÂÊ·ÚÌÔÁ‹ Û˘ÛÙËÌ·ÙÈ΋˜ ¿ÛÎËÛ˘ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ˘ÔÛÙÚÔÊ‹ Ù˘ ÛÙÂÊ·ÓÈ·›·˜ ·ıËÚÔÛÎÏ‹ÚˆÛ˘ [41, 42]. ∏ Û˘ÛÙËÌ·ÙÈ΋ ¿ÛÎËÛË Ê·›ÓÂÙ·È Ó· ÚÔ¿ÁÂÈ ÙË ‰ËÌÈÔ˘ÚÁ›· ·Ú¿Ï¢Ú˘ ΢ÎÏÔÊÔÚ›·˜. ∏ Û˘ÛÙËÌ·ÙÈ΋ ¿ÛÎËÛË 16 ‚‰ÔÌ¿‰ˆÓ Û ÂÈÚ·Ì·Ùfi˙ˆ· ¤‰ÂÈÍ ·‡ÍËÛË Ù˘ ÙÚȯÔÂȉÈ΋˜ ˘ÎÓfiÙËÙ·˜ ηٿ 37%, ÌÂ Û˘ÓÔ‰fi Ì›ˆÛË ÙˆÓ ÂÚÈÊÂÚÈÎÒÓ ·ÓÙÈÛÙ¿ÛÂˆÓ Î·È ·‡ÍËÛË Ù˘ ÛÙÂÊ·ÓÈ·›·˜ Âʉڛ·˜. ∞Ó¿ÏÔÁË ·Ú·Ù‹ÚËÛË Û ·ÛıÂÓ›˜ ¤‰ÂÈÍ fiÙÈ Ë Û˘ÛÙËÌ·ÙÈ΋ ¿ÛÎËÛË ·˘Í¿ÓÂÈ ÙË ÛÙÂÊ·ÓÈ·›· Âʉڛ· Î·È ÙËÓ ·ÓÙ›‰Ú·ÛË ÛÙËÓ ·‰ÂÓÔÛ›ÓË [43-46]. ∏ Ê˘ÛÈ΋ ¿ÛÎËÛË Û ·ÛıÂÓ›˜ Ì ÁÓˆÛÙ‹ ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ [47-54]. ñ ∞˘Í¿ÓÂÈ ÙËÓ ·ÓÔ¯‹ ÛÙËÓ ¿ÛÎËÛË ñ ªÂÈÒÓÂÈ ÙË Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ Î·È ÙËÓ ¤ÎÙ·ÛË Ù˘ Ì˘Ôηډȷ΋˜ ÈÛ¯·ÈÌ›·˜, ñ µÂÏÙÈÒÓÂÈ ÙËÓ ÂÓ‰ÔıËÏȷ΋ ÏÂÈÙÔ˘ÚÁ›· ñ ∞fi ÚfiÛÊ·ÙË ÌÂÙ·-·Ó¿Ï˘ÛË Ê·›ÓÂÙ·È Ó· ÌÂÈÒÓÂÈ ÙËÓ Î·Ú‰È·ÁÁÂȷ΋ ıÓËÙfiÙËÙ· √È Ì˯·ÓÈÛÌÔ› Â›‰Ú·Û˘ Ù˘ ¿ÛÎËÛ˘ ÛÙË ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ Â›Ó·È: ñ µÔËı¿ ÙËÓ ÈÛ¯·ÈÌÈ΋ ÚÔÂÙÔÈÌ·Û›· ÙÔ˘ Ì˘Ôηډ›Ô˘ ÏfiÁˆ ‚Ú·¯Â›·˜ ·‰ÚÂÓÂÚÁÈ΋˜ ‰È¤ÁÂÚÛ˘ Î·È ·Ú·ÁˆÁ‹˜ COX-2 [55, 56] ñ ∞˘Í¿ÓÂÈ ÙËÓ ‰ÈÛÌÔ˘Ù¿ÛË ÙÔ˘ ˘ÂÚÔÍÂȉ›Ô˘ Ô˘ Ê·›ÓÂÙ·È Ó· Û¯ÂÙ›˙ÂÙ·È Ì ‚ÂÏÙ›ˆÛË ·ÓÔ¯‹˜ ÛÙËÓ ¿ÛÎËÛË [57]. ∏ Û˘ÛÙËÌ·ÙÈ΋ ¿ÛÎËÛË 4 ‚‰ÔÌ¿‰ˆÓ Û ·ÛıÂÓ›˜ Ì ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ ·˘Í¿ÓÂÈ ÙËÓ ¤ÎÊÚ·-

28

ÛË ÙÔ˘ eNOS Î·È ÙËÓ ·Ú·ÁˆÁ‹ ¡√ ηıÒ˜ ‚ÂÏÙÈÒÓÂÈ ÙËÓ ÂÓ‰ÔıËÏÈÔÂÍ·ÚÙÒÌÂÓË ·ÁÁÂÈԉȷÛÙÔÏ‹. ∂›Û˘ ÔÈ ÛÙÂÊ·ÓÈ·›ÔÈ ·ÛıÂÓ›˜ Â›Ó·È Û˘¯Ó¿ Û η΋ Ê˘ÛÈ΋ ηٿÛÙ·ÛË, ÔfiÙ ·Ú·ÙËÚÔ‡Ó ‚ÂÏÙ›ˆÛË ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ‰Ú·ÛÙËÚÈfiÙËÙ· ÌÂÙ¿ ·fi Û˘ÛÙËÌ·ÙÈ΋ ¿ÛÎËÛË. ∞ÎfiÌ· Î·È ·ÛıÂÓ›˜ Ì ÂËÚ·Ṳ̂ÓË ·fi‰ÔÛË Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ ·˘Í¿ÓÔ˘Ó ÙËÓ ·ÚÙËÚÈÔÊÏ‚È΋ ‰È·ÊÔÚ¿ O2 Î·È ÙËÓ ·ÓÔ¯‹ ÛÙËÓ ¿ÛÎËÛË. ∏ ·‡ÍËÛË ÙÔ˘ Ô˘‰Ô‡ ·ÂÚÈÛÌÔ‡ ·˘Í¿ÓÂÈ ÙËÓ ˘ÔÌÂÁ›ÛÙË ÈηÓfiÙËÙ· ¿ÛÎËÛ˘, ÌÂÈÒÓÔÓÙ·˜ ÙÔ ·›ÛıËÌ· ‰‡ÛÓÔÈ·˜ ÛÙËÓ ˘ÔÌÂÁ›ÛÙË ¿ÛÎËÛË, ÂÓÒ Ë Ì›ˆÛË Ù˘ ˘ÔÌÂÁ›ÛÙ˘ ηډȷ΋˜ Û˘¯ÓfiÙËÙ·˜ Î·È Û˘ÛÙÔÏÈ΋˜ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ÌÂÈÒÓÔ˘Ó ÙȘ ·Ó¿ÁΘ ÙÔ˘ Ì˘Ôηډ›Ô˘ Û Ô͢ÁfiÓÔ, ÂÈ‚Ú·‰‡ÓÔÓÙ·˜ ÙËÓ ÂÌÊ¿ÓÈÛË ÛÙËı¿Á¯Ë˜. ™Â ·ÓÙ›ıÂÛË Ì ÙËÓ ·ÂÚfi‚È· ¿ÛÎËÛË Ô˘ ·˘Í¿ÓÂÈ ÙËÓ Î˘ÎÏÔÊÔÚÈ΋ Âʉڛ·, Ë ·Ó·ÂÚfi‚ÈÔ˜ ¿ÛÎËÛË ·˘Í¿ÓÂÈ ÙËÓ Ì˘˚΋ ‰‡Ó·ÌË. ∏ ¿ÛÎËÛË ·ÓÙ›ÛÙ·Û˘ ‰ÂÓ ¤¯ÂÈ ÌÂÏÂÙËı› Â·ÚÎÒ˜ Û ÛÙÂÊ·ÓÈ·›Ô˘˜ ·ÛıÂÓ›˜, ·ÏÏ¿ ÂÓ‰˘Ó·ÌÒÓÂÈ ÙÔ Ì˘ÈÎfi Û‡ÛÙËÌ· ÛÙËÓ ÂÈÙ¤ÏÂÛË Î·ıËÌÂÚÈÓÒÓ ‰Ú·ÛÙËÚÈÔÙ‹ÙˆÓ ·‰‡Ó·ÌˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ Á˘Ó·ÈÎÒÓ [58]. ∞‡ÍËÛË ÛÙËÓ ÏÂÈÙÔ˘ÚÁÈ΋ ÈηÓfiÙËÙ· ηٿ 10-60% Î·È Ì›ˆÛË ÙˆÓ ·Ó·ÁÎÒÓ ÙÔ˘ Ì˘Ôηډ›Ô˘ ηٿ 10-25% ¤¯Ô˘Ó ·Ú·ÙËÚËı› Û ÛÙÂÊ·ÓÈ·›Ô˘˜ ·ÛıÂÓ›˜ Ô˘ ¤¯Ô˘Ó ·ÎÔÏÔ˘ı‹ÛÂÈ ÚÔÁÚ¿ÌÌ·Ù· ·ÔηٿÛÙ·Û˘. º·›ÓÂÙ·È fiÙÈ Ë ·‡ÍËÛË Ù˘ ÏÂÈÙÔ˘ÚÁÈ΋˜ ÈηÓfiÙËÙ·˜ (V√2 max) ÌÂÙ¿ 3 Ì‹Ó˜ ·fi ÙÔ Ô͇ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘, ÔÊ›ÏÂÙ·È Û ·‡ÍËÛË Ù˘ ·ÚÙËÚÈÔÊÏ‚È΋˜ ‰È·ÊÔÚ¿˜, ÂÓÒ Ë Î·Ú‰È·Î‹ ·ÚÔ¯‹ ÛÙËÓ ˘ÔÌÂÁ›ÛÙË ¿ÛÎËÛË ·˘Í¿ÓÂÈ ÌÂÙ¿ ·fi ·Ú·ÙÂٷ̤ÓË ÚÔfiÓËÛË (12 Ì‹Ó˜) [59-61]. °È ·˘Ùfi Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÛÙ·ıÂÚÔÔÈË̤ÓË ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ ÌÔÚ› Ó· Û˘ÛÙËı› ÂÓ·Û¯fiÏËÛË ÌÂ Ê˘ÛÈ΋ ¿ÛÎËÛË. ∫·Ì›· Ù˘¯·ÈÔÔÈË̤ÓË ÎÏÈÓÈ΋ ÌÂϤÙË ‰ÂÓ ¤‰ÂÈÍ ÈηӋ ÛÙ·ÙÈÛÙÈ΋ ÈÛ¯‡ ÁÈ· Ó· ·Ó·‰Â›ÍÂÈ Ì›ˆÛË ÙˆÓ ˘ÔÙÚÔÒÓ Û ηډȷο Û˘Ì‚¿Ì·Ù·, ÂÓÒ ÔÈ ÌÂٷӷχÛÂȘ ¤¯Ô˘Ó ‰Â›ÍÂÈ Ì›ˆÛË Ù˘ ıÓËÙfiÙËÙ·˜ [6264]. º˘ÛÈ΋ ·ÔηٿÛÙ·ÛË Û ÛÙÂÊ·ÓÈ·›Ô˘˜ ·ÛıÂÓ›˜ ŸÏÔÈ ÔÈ ÛÙÂÊ·ÓÈ·›ÔÈ ·ÛıÂÓ›˜ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÏÔÓÙ·È Û ‰ÔÎÈ-

Ì·Û›· ÎfiˆÛ˘ ÚÈÓ ÙËÓ ¤ÓÙ·ÍË ÙÔ˘˜ Û ÚfiÁÚ·ÌÌ· ¿ÛÎËÛ˘, ÁÈ· ηıÔÚÈÛÌfi ̤ÁÈÛÙ˘ ηډȷ΋˜ Û˘¯ÓfiÙËÙ·˜, ÂÌÊ¿ÓÈÛ˘ Û˘ÌÙˆÌ¿ÙˆÓ ‹ ·ÚÚ˘ıÌÈÒÓ, ˘fi Ï‹ÚË Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹. √È ·ÛıÂÓ›˜ Ú¤ÂÈ Ó· Ô‰ËÁÔ‡ÓÙ·È Û ÂȉÈο ÚÔÁÚ¿ÌÌ·Ù· ¿ÛÎËÛ˘, ÛÙ· ÔÔ›· Û˘Ó‹ıˆ˜ ·ÛÎÔ‡ÓÙ·È 3 ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰· ÁÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 30 ÏÂÙ¿, ÛÙ· ÔÔ›· ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È 5 ÏÂÙ¿ ÚÔı¤ÚÌ·ÓÛ˘, 5 ÏÂÙ¿ ·ÔηٿÛÙ·Û˘ Î·È 20 ÏÂÙ¿ ¿ÛÎËÛ˘ ÛÙÔ 70-85% Ù˘ ÚÔηıÔÚÈṲ̂Ó˘ ̤ÁÈÛÙ˘ ηډȷ΋˜ Û˘¯ÓfiÙËÙ·˜ ‹ ÛÙÔ 60-75% Ù˘ ̤ÁÈÛÙ˘ VO2 [65]. ¶ÚfiÛÊ·ÙË ÌÂÙ·Ó¿Ï˘ÛË Ô˘ Û˘ÌÂÚȤϷ‚ 48 ÌÂϤÙ˜ Ì 8940 ·ÛıÂÓ›˜ ¤‰ÂÈÍ fiÙÈ Ë Î·Ú‰È·Î‹ ·ÔηٿÛÙ·ÛË Ì›ˆÛ ÙËÓ ÔÏÈ΋ Î·È ÙËÓ Î·Ú‰È·Î‹ ıÓËÙfiÙËÙ· ηٿ 20 Î·È 26% ·ÓÙ›ÛÙÔȯ·, ÂÓÒ Ë Î·Ú‰È·Î‹ ÓÔÛËÚfiÙËÙ· ‰ÂÓ ÌÂÈÒıËΠÛËÌ·ÓÙÈο. ∏ Ì›ˆÛË Ù˘ ıÓËÙfiÙËÙ·˜ ÌÔÚ› Ó· ·Ô‰Ôı› Û Ì›ˆÛË Ù˘ ÂÌÊ¿ÓÈÛ˘ ÎÔÈÏȷ΋˜ Ì·ÚÌ·Ú˘Á‹˜ ÏfiÁˆ ·‡ÍËÛ˘ Ù˘ ·Ú·Û˘Ì·ıËÙÈÎÔÙÔÓ›·˜ ‹ ÏfiÁˆ ÈÛ¯·ÈÌÈ΋˜ ÚÔÂÙÔÈÌ·Û›·˜ ÙÔ˘ Ì˘Ôηډ›Ô˘ [66]. ∂›Û˘ Ë ÂÓ·Û¯fiÏËÛË Î·Ù¿ÏÏËÏ· ÂÎ·È‰Â˘Ì¤ÓÔ˘ ÚÔÛˆÈÎÔ‡ ÌÔÚ› Ó· ·Ó·ÁÓˆÚ›ÛÂÈ Î·È Ó· ·ÓÙÈÌÂÙˆ›ÛÂÈ ¿ÌÂÛ· Ù· Û˘ÌÙÒÌ·Ù· ÂÌÊ¿ÓÈÛ˘ ·ÈÊÓȉ›Ô˘ ı·Ó¿ÙÔ˘. ∞ӷʤÚÂÙ·È 1 ÂÂÈÛfi‰È· ηډȷ΋˜ ·Ó·ÎÔ‹˜ ·Ó¿ 120 000 ÒÚ˜-·ÛıÂÓÒÓ Û ηډȷ΋ ·ÔηٿÛÙ·ÛË, ·ÏÏ¿ ÌfiÓÔ 1 ı¿Ó·ÙÔ˜ ·Ó¿ 750 000 ÒÚ˜-·ÛıÂÓÒÓ [21]. ∞ÓÙÂӉ›ÍÂȘ ¿ÛÎËÛ˘ Û ÛÙÂÊ·ÓÈ·›Ô˘˜ ·ÛıÂÓ›˜ ñ ¢ÂÓ ÂÈÙÚ¤ÂÙ·È ¿ÛÎËÛË ÙËÓ ÚÒÙË Â‚‰ÔÌ¿‰· ÌÂÙ¿ ·fi Ô͇ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘, ηıÒ˜ Î·È Û fiÛÔ˘˜ ÂÌÊ·Ó›˙Ô˘Ó ÛÙ·‰È·Î¿ ÂȉÂÈÓÔ‡ÌÂÓË ·ÛÙ·ı‹ ÛÙËı¿Á¯Ë. ñ ∂›Û˘ Û ·ÛıÂÓ›˜ Ô˘ ÂÌÊ·Ó›˙Ô˘Ó Î·Ù¿ ÙËÓ ¿ÛÎËÛË ÎÔÏÈ΋ ‹ ÎÔÈÏȷ΋ ·ÚÚ˘ıÌ›·. ñ ªÂÙ¿ ·fi ·ÔÚÙÔÛÙÂÊ·ÓÈ·›· ·Ú¿Î·Ì„Ë, ¿ÛÎËÛË ÌÔÚ› Ó· Û˘ÛÙËı› ÌÂÙ¿ ÙËÓ ·Ú¤Ï¢ÛË 2 ‚‰ÔÌ¿‰ˆÓ, ÂÊ fiÛˆÓ Ô ·ÛıÂÓ‹˜ Â›Ó·È Û ·ÓÂ›ÏÂÎÙË ÔÚ›·, ÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Î·È Ù˘ ηϋ˜ Ô˘ÏÔÔ›ËÛ˘ ÙÔ˘ ÙÚ·‡Ì·ÙÔ˜. ñ ∞ÛıÂÓ›˜ Ì ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ıÚÔÌ‚ÔÊÏ‚›Ùȉ· Ú¤ÂÈ Ó· Ï¿‚Ô˘Ó Â·Ú΋ ·ÓÙÈËÎÙÈ΋ ·ÁˆÁ‹ ÁÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 2 ‚‰ÔÌ¿-


ATHIROSK 21-

05-03-09

12:25

™ÂÏ›‰·29

À°π∂π¡√¢π∞π∆∏∆π∫∏ ∞°ø°∏ ‰Â˜ ÚÈÓ ÍÂÎÈÓ‹ÛÔ˘Ó ¿ÛÎËÛË [52]. ÕÛÎËÛË ÌÂÙ¿ ‰ÈÂÓ¤ÚÁÂÈ· ·ÁÁÂÈÔÏ·ÛÙÈ΋˜ ñ ∞Ú¯ÈΤ˜ ÌÂÌÔӈ̤Ó˜ ·Ó·ÊÔÚ¤˜ Ì ÂÌÊ¿ÓÈÛË Â·Ó·ıÚfiÌ‚ˆÛ˘ ÌÂÙ¿ ·fi ·ÁÁÂÈÔÏ·ÛÙÈ΋ ¤ıÂÛ ·ÌÊÈ‚Ôϛ˜ ÁÈ· ÙËÓ ·ÛÊ¿ÏÂÈ· Ù˘ ¿ÛÎËÛ˘ [67]. ñ ∏ ÌÂϤÙË Exercise Training Intervention After Coronary Angioplasty (ETICA) [68] trial Ù˘¯·ÈÔÔ›ËÛ 130 ·ÛıÂÓ›˜ ÌÂÙ¿ ·ÁÁÂÈÔÏ·ÛÙÈ΋ Û 6ÌËÓÔ ÚfiÁÚ·ÌÌ· Û˘ÛÙËÌ·ÙÈ΋˜ ¿ÛÎËÛË ‹ fi¯È. ∏ ̤ÁÈÛÙË Î·Ù·Ó¿ÏˆÛË O2 ·˘Í‹ıËΠηٿ 26%, ÌfiÓÔ ÛÙËÓ ÔÌ¿‰· Ù˘ ·Ú¤Ì‚·Û˘ ÂÓÒ Ù· ÔÛÔÛÙ¿ Â·Ó·ÛÙ¤ÓˆÛ˘ ‹Ù·Ó 29% Î·È 32% ÛÙËÓ ÔÌ¿‰· Ù˘ ·Ú¤Ì‚·Û˘ Î·È ÙÔ˘ ÂϤÁ¯Ô˘, ·ÓÙ›ÛÙÔȯ·. ∏ ÂÓ‰Ô·˘ÏÈ΋ ÛÙ¤ÓˆÛË ÛÙÔ ÛËÌÂ›Ô Ù˘ ·ÁÁÂÈÔÏ·ÛÙÈ΋˜ ‹Ù·Ó Û˘¯ÓfiÙÂÚË ÛÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘, Ë ÔÔ›· ÂÌÊ¿ÓÈ˙Â Î·È ˘„ËÏfiÙÂÚ· ÔÛÔÛÙ¿ ηډȷÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ, Â·Ó·Ï·Ì‚·ÓfiÌÂÓˆÓ ÓÔÛËÏÂÈÒÓ Î·È ‰ÈÂÓÂÚÁÂÈÒÓ ·ÁÁÂÈÔÏ·ÛÙÈ΋˜ ‹ ·ÔÚÙÔÛÙÂÊ·ÓÈ·›·˜ ·Ú¿Î·Ì„˘. – OÈ ·ÛıÂÓ›˜ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È Û ·ÁÁÂÈÔÏ·ÛÙÈ΋ Ì ‹ ¯ˆÚ›˜ ÙÔÔı¤ÙËÛË stent ÌÔÚÔ‡Ó Ó· ˘Ô‚ÏËıÔ‡Ó ¿ÌÂÛ· Û ‰ÔÎÈÌ·Û›· ÎfiˆÛ˘ ÁÈ· ÙËÓ ¤Ó·ÚÍË Ê˘ÛÈ΋˜ ¿ÛÎËÛ˘ ‹ 7-14 Ë̤Ú˜ ÌÂÙ¿ ·fi ·ÁÁÂÈÔÏ·ÛÙÈ΋ [69]. – ªfiÓÔ ÛÙÔ 21% ÙˆÓ ·ÛıÂÓÒÓ Ì Ô͇ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘ Ô˘ ¤¯Ô˘Ó ˘Ô‚ÏËı› Û ·ÁÁÂÈÔÏ·ÛÙÈ΋ Û˘ÛÙ‹ÓÂÙ·È Î·Ú‰È·Î‹ ·ÔηٿÛÙ·ÛË. ÕÛÎËÛË Î·È Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ· ¢ÂÓ ˘¿Ú¯ÂÈ ÌÂÁ¿ÏË ÔÏ˘ÎÂÓÙÚÈ΋ ÌÂϤÙË Ô˘ Ó· ·ÍÈÔÏÔÁ› ÙËÓ Â›‰Ú·ÛË Ù˘ ¿ÛÎËÛ˘ Û ·ÛıÂÓ›˜ Ì ηډȷ΋ ·ÓÂ¿ÚÎÂÈ·, ηıÒ˜ ·Ó·Ì¤ÓÔÓÙ·È Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂÁ¿Ï˘ ÔÏ˘ÎÂÓÙÚÈ΋˜ ÌÂϤÙ˘ HF-ACTION. ∞fi ÌÂÙ·Ó¿Ï˘ÛË 81 ÌÂÏÂÙÒÓ Ô˘ Û˘ÌÂÚȤϷ‚·Ó 2387 ·ÛıÂÓ›˜ Ê·›ÓÂÙ·È fiÙÈ Ë Ì¤ÁÈÛÙË Î·Ù·Ó¿ÏˆÛË Ô͢ÁfiÓÔ˘ ·˘Í¿ÓÂÈ Ì ÙËÓ ¿ÛÎËÛË Î·Ù¿ 16%, ÂÓÒ ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ı¿Ó·ÙÔÈ ÔÊÂÈÏfiÌÂÓÔÈ ÛÙËÓ ¿ÛÎËÛË Û 60.000 ·ÓıÚˆÔÒÚ˜ ¿ÛÎËÛ˘. ∫·Ù¿ ÙË Ì¤ÛË ÚÔÔÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ 5,9 ÌËÓÒÓ, ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ‰È·ÊÔÚ¤˜ ÛÙË ÓÔÛËÚfiÙËÙ· ·ÏÏ¿ Ë ıÓËÙfiÙËÙ· ‹Ù·Ó 29% ¯·ÌËÏfiÙÂÚË ÛÙËÓ ÔÌ¿‰· Ù˘ ¿ÛÎËÛ˘ [70].

ª˘˚΋ ˘fiıÂÛË Ù˘ ηډȷ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ ∏ Ì›ˆÛË Ù˘ Û˘ÛÙÔÏÈ΋˜ ·fi‰ÔÛ˘ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ ÎÈÓËÙÔÔÈ› ηٷ‚ÔÏÈÎÔ‡˜ Î·È ÂÏ·ÙÙÒÓÂÈ ·Ó·‚ÔÏÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, Ô‰ËÁÒÓÙ·˜ Û ÛÎÂÏÂÙÈ΋ Ì˘Ô¿ıÂÈ·. ™ÙË Û˘Ó¤¯ÂÈ· ¢·ÈÛıËÙÔÔÈÔ‡ÓÙ·È ÂÚÁÔ-˘ԉԯ›˜ Ô˘ Ô‰ËÁÔ‡Ó Û ÌÂȈ̤ÓË ·ÓÔ¯‹ ÛÙËÓ ¿ÛÎËÛË Î·È Â˘·ÈÛıËÙÔÔ›ËÛË Û˘Ì·ıËÙÈÎÔ‡. √ Û˘Ó‰˘·ÛÌfi˜ ÙÔ˘ Û˘Ó¯ԇ˜ ηٷ‚ÔÏÈÛÌÔ‡ Î·È Ù˘ ÌÂȈ̤Ó˘ Ê˘ÛÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÂÈ‚·Ú‡ÓÂÈ ÂÚ·ÈÙ¤Úˆ ÙÔ˘˜ ÛÎÂÏÂÙÈÎÔ‡˜ ̇˜ Î·È Âȉڿ Î·È ÛÙË ÚfiÔ‰Ô Ù˘ ·Ó·‰È·ÌfiÚʈÛ˘ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ [71]. ∂›‰Ú·ÛË ·ÂÚfi‚È·˜ ¿ÛÎËÛ˘ ÛÙË Ì˘Ôηډȷ΋ ·fi‰ÔÛË ñ ∞ÏÏ·Á‹ ÈÛÔÌÔÚÊÒÓ ÙÚÔÔÓ›Ó˘ π ñ ∞‡ÍËÛË Ù˘ ¤ÎÊÚ·Û˘ Ù˘ ·-‚·Ú›·˜ ·Ï‡ÛÔ˘ Ì˘ÔÛ›Ó˘, Ë ÔÔ›· Ô‰ËÁ› Û ·‡ÍËÛË Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ∞∆ƒ¿Û˘ Î·È ·‡ÍËÛË Ù˘ Û˘Û·ÛÙÈÎfiÙËÙ·˜. ñ ∞‡ÍËÛË SERCA-2 Ô‰ËÁ› Û ·‡ÍËÛË Ù˘ ·ÂÏ¢ı¤ÚˆÛ˘ Ca++ ·fi ÙÔ Û·ÚÎÔÏ·ÛÌ·ÙÈÎfi ‰›ÎÙ˘Ô ñ ¶ÂÚÈÔÚÈÛÌfi˜ Ù˘ ˘ÂÚÙÚÔÊ›·˜ ñ ∞ÔηٿÛÙ·ÛË ÌÂÚÈÎÒ˜ Ù˘ Û˘Û·ÛÙÈÎfiÙËÙ·˜ ÌÂÙ¿ ·fi Ô͇ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘, ‚ÂÏÙÈÒÓÔÓÙ·˜ ÙÔ ¯ÂÈÚÈÛÌfi ÙÔ˘ ÂÓ‰Ô΢ÙÙ·ÚÈÎÔ‡ ·Û‚ÂÛÙ›Ô˘ [72]. ∏ Â›‰Ú·ÛË Ù˘ ¿ÛÎËÛ˘ ÛÙË ‚ÂÏÙ›ˆÛË Ù˘ ·Ó·‰È·ÌfiÚʈÛ˘ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ Û ·ÛıÂÓ›˜ Ì ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· ∏ Û˘ÛÙËÌ·ÙÈ΋ ̤ÙÚÈ· ¿ÛÎËÛË (60% ªVO2) Û ·ÛıÂÓ›˜ Ì ÛÙ·ıÂÚ‹ ¯ÚfiÓÈ· ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· ÚÔηÏ› ÌÈÎÚ‹ ·ÏÏ¿ ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÛÙÔ˘˜ fiÁÎÔ˘˜ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ Î·È ‚ÂÏÙÈÒÓÂÈ ÙÔ ÎÏ¿ÛÌ· ÂÍÒıËÛ˘ Ù˘. ∏ Û˘ÛÙËÌ·ÙÈ΋ ¿ÛÎËÛË ‚ÂÏÙÈÒÓÂÈ ÙËÓ ÔÍÂȉˆÙÈ΋ ÈηÓfiÙËÙ· ÙÔ˘ Ì˘ÈÎÔ‡ ΢ÎÏÔÊÔÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È ÙËÓ ÂÓ‰ÔıËÏȷ΋ ÏÂÈÙÔ˘ÚÁ›· ÙfiÛÔ ÛÙËÓ ÈÛ¯·ÈÌÈ΋ fiÛÔ Î·È ÛÙËÓ ÌË-ÈÛ¯·ÈÌÈ΋ ηډÈÔÌ˘Ô¿ıÂÈ·. ∞˘Ùfi Ô‰ËÁ› Û Ì›ˆÛË ÙˆÓ ÂÚÈÊÂÚÈÎÒÓ ·ÓÙÈÛÙ¿ÛˆÓ, ·‡ÍËÛË Ù˘ ηډȷ΋˜ ·ÚÔ¯‹˜ Î·È ‚ÂÏÙ›ˆÛË Ù˘ Ì˘Ôηډȷ΋˜ ·ÈÌ¿ÙˆÛ˘, ÚÔηÏÒÓÙ·˜ ‚ÂÏÙ›ˆÛË Ù˘ ÔÏÈ΋˜ Î·È ÙÌËÌ·ÙÈ΋˜ ·fi‰ÔÛ˘ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜. ∏ Û˘ÛÙËÌ·ÙÈ΋ ¿ÛÎËÛË ÌÂÈÒÓÂÈ Ù· ΢ÎÏÔÊÔÚÔ‡ÓÙ· Â›‰· ÊÏÂÁÌÔÓˆ‰ÒÓ Î˘ÙÔÎÈÓÒÓ Î·È ÙˆÓ ‰È·Ï˘ÙÒÓ ˘Ô‰Ô¯¤ˆÓ ÙÔ˘˜, Ù·

ÔÔ›· Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ÂͤÏÈÍË Ù˘ ·Ó·‰È·ÌfiÚʈÛ˘ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ [73, 74]. ∂›Û˘ ‚ÂÏÙÈÒÓÂÈ ÙËÓ ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ·˘ÙfiÓÔÌÔ˘ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È ÌÂÈÒÓÂÈ ÛËÌ·ÓÙÈο Ù· Â›‰· ÊÏÂÁÌÔÓˆ‰ÒÓ Î˘ÙÔÎÈÓÒÓ Ô˘ ÂÎÚÔÛˆÔ‡Ó ÙËÓ ·ÏÏËÏÂ›‰Ú·ÛË ÌÔÓÔ΢ÙÙ¿ÚˆÓ/ÂÓ‰ÔıËÏ›Ô˘, ·˘Í¿ÓÔÓÙ·˜ ·Ú¿ÏÏËÏ· ÙËÓ ·ÓÔ¯‹ ÛÙËÓ ÎfiˆÛË. º·›ÓÂÙ·È fiÙÈ Ë ·ÚÔ˘Û›· ˘ÔÎÏÈÓÈ΋˜ ÊÏÂÁÌÔÓ‹˜ ¤¯ÂÈ ·ıÔÁÂÓÂÙÈÎfi ÚfiÏÔ ÛÙË ÌÂȈ̤ÓË ·ÓÔ¯‹ ÛÙËÓ ¿ÛÎËÛË [75, 76]. ∏ ÚÔfiÓËÛË ÌÂ Û˘Ó‰ڛ˜ ¯ÂÈÚfiÛÊÈ͢ ÌÂÈÒÓÂÈ ÙÔ ·ÓÙ·Ó·ÎÏ·ÛÙÈÎfi ÙˆÓ ÂÚÁÔ-˘Ô‰Ô¯¤ˆÓ ÌÂÈÒÓÔÓÙ·˜ ÙËÓ ·¿ÓÙËÛË Ù˘ Û˘ÛÙÔÏÈ΋˜ Î·È ‰È·ÛÙÔÏÈ΋˜ ·ÚÙËÚȷ΋˜ ›ÂÛ˘, ÙËÓ Î·Ù·Ó¿ÏˆÛË Ô͢ÁfiÓÔ˘ Î·È ÙȘ ÂÚÈÊÂÚÂȷΤ˜ ·ÓÙÈÛÙ¿ÛÂȘ, ·˘Í¿ÓÔÓÙ·˜ ÙËÓ ·ÈÌ·ÙÈ΋ ÚÔ‹ ÛÙ· οو ¿ÎÚ·, ÂÓÒ ÌÂÈÒÓÂÙ·È Ë ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘ Û˘Ì·ıËÙÈÎÔ‡ [77]. µ·ÛÈÎÔ› ÛÙfi¯ÔÈ Î·Ú‰È·Î‹˜ ·ÔηٿÛÙ·Û˘ ÛÙËÓ Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ· [78]. ñ ∫·ıÔÚÈÛÌfi˜ ÎÏÈÓÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ Î·È Î·ÙËÁÔÚ›·˜ ÎÈÓ‰‡ÓÔ˘ ñ £ÂÚ·›· Ù˘ ˘ÔΛÌÂÓ˘ ÓfiÛÔ˘ Ù˘ ηډȷ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ (˘¤ÚÙ·ÛË, ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ˜, ÎÔÏÈ΋ Ì·ÚÌ·Ú˘Á‹, ‚·Ï‚ȉÈ΋ ÓfiÛÔ˜) Î·È ‰ÈfiÚıˆÛË Û˘Ó·ÊÒÓ ÂÈ‚·Ú˘ÓÙÈÎÒÓ Î·Ù·ÛÙ¿ÛÂˆÓ (¤ÏÏÂÈ„Ë Û˘ÌÌfiÚʈÛ˘ ÛÙË Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹, ¯Ú‹ÛË ÌË ÛÙÂÚÔÂȉÒÓ ·ÓÙÈÊÏÂÁÌÔÓˆ‰ÒÓ Ê·ÚÌ¿ÎˆÓ Î·È COX-2 ·Ó·ÛÙÔϤˆÓ, ÏÔÈÌÒ͈Ó, Ó¢ÌÔÓÈ΋˜ ÂÌ‚ÔÏ‹˜, ‰È·ÈÙÔÏÔÁÈÎÒÓ Û˘ÓËıÂÈÒÓ, ¤ÏÏÂÈ„Ë Ê˘ÛÈ΋˜ ¿ÛÎËÛ˘, ˘ÂÚı˘ÚÂÔÂȉÈÛÌÔ‡) ñ ∫·Ù¿ÏÏËÏË Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ Û‡Ìʈӷ Ì ÙȘ ηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ ñ ∞ÓÙÈÌÂÙÒÈÛË ÙˆÓ Û¯ÂÙÈ˙fiÌÂÓˆÓ Ì ÙËÓ Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ· ÓfiÛˆÓ ñ ŒÓÙ·ÍË Û˘Ó¯ԇ˜ ÚÔÁÚ¿ÌÌ·ÙÔ˜ Ê˘ÛÈ΋˜ ¿ÛÎËÛ˘ Î·È ·ÔηٿÛÙ·Û˘. ñ ŒÓÙ·ÍË ÛÂ Û˘Ó¯¤˜ ÚfiÁÚ·ÌÌ· ÂÈÌfiÚʈÛ˘ Î·È Û˘Ì‚Ô˘Ï¢ÙÈ΋˜ ÓÔÛËÏ¢ÙÈ΋˜ ñ æ˘¯ÔÏÔÁÈ΋ ˘ÔÛÙ‹ÚÈÍË ñ ∫·Ù Ô›ÎÔÓ ÓÔÛËÏ›· Î·È Û˘Ì‚Ô˘Ï¢ÙÈ΋ ™˘ÛÙ¿ÛÂȘ ÁÈ· ÕÛÎËÛË ÛÙËÓ Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ· ñ ™˘ÌÌÂÙÔ¯‹ Û ¿ÛÎËÛË ÌÔÚ› Ó· Û˘ÛÙËı› Û ·ÛıÂÓ›˜ ÛÂ

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ATHIROSK 21-

05-03-09

12:25

ª ∞ ƒ ∆ π √ ™

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ÛÙ¿‰ÈÔ π-ππ, ÂÊfiÛÔÓ ·Ú·Ì¤ÓÔ˘Ó ÛÙ·ıÂÚÔ›, Û ηٿ ÚÔÙ›ÌËÛË Û˘ÁÎÂÎÚÈ̤ÓÔ ÚfiÁÚ·ÌÌ· ¿ÛÎËÛ˘, ηٿ ÙÔ ÔÔ›Ô Ë Î·Ú‰È·Î‹ Û˘¯ÓfiÙËÙ· Ó· Î˘Ì·›ÓÂÙ·È ¤ˆ˜ 70-85% Ù˘ ̤ÁÈÛÙ˘ ‹ ¤ˆ˜ ÙËÓ ÂÌÊ¿ÓÈÛË Ì¤ÙÚÈ·˜ ‰‡ÛÓÔÈ·˜. √È ·ÛıÂÓ›˜ Ì ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· ÌÔÚ› Ó· ¢ÂÚÁÂÙËıÔ‡Ó Î·È ·fi Û˘ÌÌÂÙÔ¯‹ Û ÚÔÁÚ¿ÌÌ·Ù· ¿ÛÎËÛ˘ ·ÓÙ›ÛÙ·Û˘ Ô˘ ÂÓ‰˘Ó·ÌÒÓÔ˘Ó ÙÔ Ì˘˚Îfi Û‡ÛÙËÌ·. ñ √È ·ÛıÂÓ›˜ ÌÂ Û˘ÌÙÒÌ·Ù· ËÚÂÌ›·˜ (NYHA class IV) Î·È ÔÈ ·ÛıÂÓ›˜ Û ÚÔ¯ˆÚË̤ÓÔ ÛÙ¿‰ÈÔ NYHA class III ‰ÂÓ Ú¤ÂÈ Ó· ÂÓ·Û¯ÔÏËıÔ‡Ó Ì ¿ÛÎËÛË Ì¤¯ÚÈ ÂÚÈÔÚÈÛÌÔ‡ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙÔ˘˜. °È·Ù› ·Ú·ÙËÚÂ›Ù·È ·˘ÍË̤ÓÔ˜ ΛӉ˘ÓÔ˜ ηډȷÁÁÂÈ·ÎÒÓ ˘Ì‚·Ì¿ÙˆÓ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙËÓ ¿ÛÎËÛË. ∫·Ù¿ ÙËÓ ¿ÛÎËÛË Ù· ΢ÎÏÔÊÔÚÔ‡ÓÙ· Â›‰· ηÙ¯ÔÏ·ÌÈÓÒÓ ÌÔÚ› Ó· ‰ÂηÂÓÙ·Ï·ÛÈ·ÛÙÔ‡Ó Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ¿ÛÎËÛ˘, Ù· Â›‰· Ï¿ÛÌ·ÙÔ˜ Î·Ï›Ô˘ Ó· ‰ÈÏ·ÛÈ·ÛÙÔ‡Ó Î·È ÙÔ p∏ ·›Ì·ÙÔ˜ Ó· ÌÂȈı› ηٿ 0,4. ∏ ·‰ÚÂÓÂÚÁÈ΋ ‰È¤ÁÂÚÛË Ô˘ Û˘Ì‚·›ÓÂÈ Î·Ù¿ ÙËÓ ¿ÛÎËÛË ·˘Í¿ÓÂÈ ÙËÓ Â›ÛÔ‰Ô Ca ηٿ ÙËÓ ·Ó·fiψÛË ÌÂÈÒÓÔÓÙ·˜ ÙÔ ‰˘Ó·ÌÈÎfi ÂÓÂÚÁ›·˜ Û ˘„ËÏ‹ ÂÍˆÎ˘ÙÙ¿ÚÈ· Û˘ÁΤÓÙÚˆÛË ∫, ÌÂÈÒÓÔÓÙ·˜ ÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ·Û‚ÂÛÙÈÔ-ÂÍ·ÚÙÒÌÂÓˆÓ ÌÂÙ·-ÂÎÔÏÒÛˆÓ. √ ΛӉ˘ÓÔ˜ ÂÌÊ¿ÓÈÛ˘ ·ÚÚ˘ıÌÈÒÓ ˘¿Ú¯ÂÈ Ì ÙË ‰È·ÎÔ‹ Ù˘ ¿ÛÎËÛ˘ ηıÒ˜ Ù· Â›‰· ∫ Ï¿ÛÌ·ÙÔ˜ ÂÈÛÙÚ¤ÊÔ˘Ó ÛÂ Ê˘ÛÈÔÏÔÁÈ-

Τ˜ ¤ˆ˜ ¯·ÌËϤ˜ ÙÈ̤˜, ÂÓÒ Ù· Â›‰· ηÙ¯ÔÏ·ÌÈÓÒÓ ·Ú·Ì¤ÓÔ˘Ó ˘„ËÏ¿. ™Â ·Á‡ÌÓ·ÛÙ· ¿ÙÔÌ· Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È Û ¤ÓÙÔÓË ¿ÛÎËÛË ·Ú·ÙËÚÂ›Ù·È ·˘ÍË̤ÓË Û˘ÁÎÔÏÏËÙÈÎfiÙËÙ· ·ÈÌÔÂÙ·Ï›ˆÓ, Ì›ˆÛË ÂÈ¤‰ˆÓ Ì·ÁÓËÛ›Ô˘, ·‡ÍËÛË ÙˆÓ Î·Ù¯ÔÏ·ÌÈÓÒÓ Î·È ‰È·Ù·Ú·Á̤ÓË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· ·Ú·Û˘Ì·ıËÙÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ηıÒ˜ Î·È Û·ÛÌfi˜ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÚÙËÚÈÒÓ. ∆· ·Ú·¿Óˆ Á›ÓÔÓÙ·È ÈÔ ¤ÓÙÔÓ· Â¿Ó ˘¿Ú¯ÂÈ Ì˘Ôηډȷ΋ ÈÛ¯·ÈÌ›·, ·˘Í¿ÓÔÓÙ·˜ ÙËÓ Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ Î·È ÔͤԘ ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ôηډ›Ô˘ [79, 80]. ÕıÏËÛË Î·È ·ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜ ∏ ÂÙ‹ÛÈ· Â›ÙˆÛË ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ ηٿ ÙËÓ ¿ıÏËÛË ˘ÔÏÔÁ›˙ÂÙ·È Û ÂÚ›Ô˘ 2.1 ·Ó¿ 100000 ·ıÏÔ‡ÌÂÓÔ˘˜ (Veneto region) Ì ηٷÓÔÌ‹ ¿Ó‰Ú˜/Á˘Ó·›Î˜: 10/1 ∞fi Ù· 1,5 ÂÎ ÔͤԘ ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ôηډ›Ô˘ Ô˘ ηٷÁÚ¿ÊÔÓÙ·È ÙÔ ¯ÚfiÓÔ Ù· 75.000 ¤¯Ô˘Ó Û˘Ì‚Â› Û‡ÓÙÔÌ· ÌÂÙ¿ ¿ÛÎËÛË. ™Â ËÏÈ˘ <30 ÂÙÒÓ Ê·›ÓÂÙ·È Ó· ÔÊ›ÏÂÙ·È Û ‰ÔÌÈΤ˜ ÓfiÛÔ˘˜, ÂÓÒ >30 ÂÙÒÓ Û ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ ∏ HCM ¢ı‡ÓÂÙ·È ÁÈ· ÙÔ 1/3 ÙˆÓ ı·Ó¿ÙˆÓ Û ·ıÏËÙ¤˜ ÛÙȘ ∏¶∞, ÂÓÒ ¿ÏÏ· ·›ÙÈ· Â›Ó·È Ë ·ÓÒÌ·ÏË ¤ÎÊ˘ÛË \ÔÚ›· ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÚÙËÚÈÒÓ, Ë Ì˘Ôηډ›Ùȉ·, Ë ·ÚÚ˘ıÌÈÔÁfiÓÔ˜ ‰˘ÛÏ·Û›· ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜, Ë ÚÒÈÌË ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ˜ Î·È ÙÔ Û‡Ó‰ÚÔÌÔ Marfan. ∆Ô Úfi‚ÏËÌ· Ô˘ ‰ËÌÈÔ˘ÚÁÂ›Ù·È Â›Ó·È fiÙÈ ·Ú·ÙËÚÔ‡ÓÙ·È ÔÌÔÈfiÙËÙ˜ Û ·Ú·Ì¤ÙÚÔ˘˜ Ù˘ ηډÈÔ·Ó·Ó¢ÛÙÈ΋˜ ¿ÛÎËÛ˘ ÌÂٷ͇

·ÛıÂÓÒÓ Ì HCM Î·È ·ıÏËÙÒÓ ‰˘Ó·ÌÈ΋˜ ¿ÛÎËÛ˘ [81-83]. ÃÚÂÈ¿˙ÂÙ·È È‰È·›ÙÂÚË ÚÔÛÔ¯‹ ÛÙÔÓ Î·Ú‰ÈÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô ·ÙfiÌˆÓ Ô˘ ÛÎÔÂ‡Ô˘Ó Ó· ·Û¯ÔÏËıÔ‡Ó Ì ¿ıÏËÛË. √ ¤ÏÂÁ¯Ô˜ Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ Ï‹ÚË Î·Ú‰ÈÔÏÔÁÈ΋ ÂͤٷÛË Ì ϋ„Ë ·ÙÔÌÈÎÔ‡ Î·È ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÈÛÙÔÚÈÎÔ‡ ÁÈ· ·ÚÔ˘Û›· ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ ‹ ÚÒÈÌ˘ ÂΉ‹ÏˆÛ˘ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘, Ê˘ÛÈ΋ ÂͤٷÛË ÁÈ· ·Ó¿‰ÂÈÍË Ê˘ÛËÌ¿ÙˆÓ ‹ ÂÈÚfiÛıÂÙˆÓ ·ıÔÏÔÁÈÎÒÓ ÙfiÓˆÓ, ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ· ÁÈ· ηٷÁÚ·Ê‹ ‰È·Ù·Ú·¯ÒÓ Ú˘ıÌÔ‡ ‹ ·ÁˆÁ‹˜ Î·È ÂÚ·ÈÙ¤Úˆ ‰È·ÁÓˆÛÙÈÎfi ¤ÏÂÁ¯Ô Ì ˘ÂÚ˯ÔηډÈÔÁÚ¿ÊËÌ· Î·È ‰ÔÎÈÌ·Û›· ÎfiˆÛ˘, fiÔ˘ ÎÚ›ÓÂÙ·È ··Ú·›ÙËÙÔ [84]. ™‡Ìʈӷ Ì ÙËÓ ¶·ÁÎfiÛÌÈ· √ÚÁ¿ÓˆÛË ÀÁ›·˜ Ë Ê˘ÛÈ΋ ¿ÛÎËÛË ·ÎfiÌ· Î·È Ì¤ÙÚÈ·˜ ¤ÓÙ·Û˘ (30 ÏÂÙ¿ ÙËÓ Ë̤ڷ ‚¿‰ÈÛË, ÎËÔ˘ÚÈ΋, ‰Ô˘ÏÂȤ˜ ÛÈÙÈÔ‡, ¯ÔÚfi˜) Û˘ÓÈÛÙ¿Ù·È Î·ıÒ˜: – ªÂÈÒÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ·Ó¿Ù˘Í˘ ‰È·‚‹ÙË – ƒ˘ıÌ›˙ÂÈ Ù· Â›‰· Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘, – ¶ÂÚÈÔÚ›˙ÂÈ ÙÔ ·›ÛıËÌ· ηٿıÏȄ˘ Î·È ¿Á¯Ô˘˜, – µÔËı¿ ÛÙÔÓ ¤ÏÂÁ¯Ô˜ ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜, – µÔËı¿ ÛÙË ‰È·Ù‹ÚËÛË ˘ÁÈÔ‡˜ Ì˘ÔÛÎÂÏÂÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È ·ÚıÚÒÛˆÓ. – µÔËı¿ ÛÙËÓ ·ÚÌÔÓÈ΋ ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ·˘ÙfiÓÔÌÔ˘ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ – µÂÏÙÈÒÓÂÈ ÙË ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ Ì˯·ÓÈÛÌÒÓ ‹Í˘-ÈÓˆ‰fiÏ˘Û˘

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¶ƒ√∆∂π¡√ª∂¡∏ µπµ§π√°ƒ∞ºπ∞ 1. Bloomfield D, Carlson GL, Sapre A, Tribble D, McKenney JM, Littlejohn TW 3rd, Sisk CM, Mitchel Y, Pasternak RC. Efficacy and safety of the cholesteryl ester transfer protein inhibitor anacetrapib as monotherapy and coadministered with atorvastatin in dyslipidemic patients. Am Heart J. 2009 Feb;157(2):352-360.e2. 2. Almroth H, Höglund N, Boman K, Englund A, Jensen S, Kjellman B, Tornvall P, Rosenqvist M. Atorvastatin and persistent atrial fibrillation following cardioversion: a randomized placebocontrolled multicentre study. Eur Heart J. 2009 Feb 6. [Epub ahead of print] 3. Mahajan N, Bahl A, Dhawan V. Creactive protein (CRP) up-regulates expression of receptor for advanced glycation end products (RAGE) and its inflammatory ligand EN-RAGE in THP-1 cells: Inhibitory effects of atorvastatin. Int J Cardiol. 2009 Feb 5. [Epub ahead of print] 4. Goldberg AC, Bays HE, Ballantyne CM, Kelly MT, Buttler SM, Setze CM, Sleep DJ, Stolzenbach JC. Efficacy and safety of ABT-335 (fenofibric acid) in combination with atorvastatin in patients with mixed dyslipidemia. Am J Cardiol. 2009 Feb 15;103(4):515-22. 5. Charlton-Menys V, Betteridge DJ, Colhoun H, Fuller J, France M, Hitman GA, Livingstone SJ, Neil HA, Newman CB, Szarek M, Demicco DA, Durrington PN. Targets of Statin Therapy: LDL Cholesterol, Non-HDL Cholesterol, and Apolipoprotein B in Type 2 Diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS). Clin Chem. 2009 Jan 15. [Epub ahead of print] 6. Wolf MS, Shekelle P, Choudhry NK, Agnew-Blais J, Parker RM, Shrank WH. Variability in Pharmacy Interpretations of Physician Prescriptions. Med Care. 2009 Feb 4. [Epub ahead of print] 7. Brousseau ME, Millar JS, Diffenderfer MR, Nartsupha C, Asztalos BF, Wolfe ML, Mancuso JP, Digenio AG, Rader DJ, Schaefer EJ. Effects of sholesteryl ester transfer protein inhibition on apolipoprotein (apo) A-II-containing HDL dubspecies and ApoA-II metabolism. J Lipid Res. 2009 Feb 3. [Epub ahead of print] 9. Ito B, Zhang BH, Cable E, Song X, Fujitaki J, Mackenna D, Wilker C, Chi B, van Poelje P, Linemeyer D, Erion M. Thyroid hormone beta receptor activation has additive cholesterol lowering activity in combination with atorvastatin in rabbits, dogs and monkeys. Br J Pharmacol. 2009 Jan 22. [Epub ahead of print] 10. Stangier J, Rathgen K, Stähle H, Reseski K, Körnicke T, Roth W. Coadministration of dabigatran etexilate and atorvastatin: assessment of potential impact on pharmacokinetics and pharmacodynamics. Am J Cardiovasc Drugs. 2009;9(1):59-68. 11.Collins RT 2nd, Hanna B, Shaddy RE. Letter to editor in response to "Prevention of pediatric graft coronary artery disease: atorvastatin", by Chin et al. Pediatr Transplant. 2009 Feb;13(1):141. 12. Baldassarre D, Porta B, Camera M, Amato M, Arquati M, Brusoni B, Fiorentini C, Montorsi P, Romano S, Veglia F, Tremoli E, Cortellaro M; on behalf of the MIAMI Study Group. Markers of inflammation, thrombosis and endothelial activation correlate with carotid IMT regression in stable coronary disease after atorvastatin treatment. Nutr Me-

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