ΤΕΥΧΟΣ 16 ΔΕΚΕΜΒΡΙΟΣ 2007 - ΑΘΗΡΟΣΚΛΗΡΩΣΗ

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IÔÎÚ¿ÙÂÈÔ NÔÛÔÎÔÌÂ›Ô AıËÓÒÓ

¶Aƒ∞°√¡Δ∂™ ∫π¡¢À¡√À™·Î¯·ÚÒ‰Ë˜ ¢È·‚‹ÙË˜ Î·È ™ÙÂÊ·ÓÈ·›· ¡fiÛÔ˜.√È ¢‡Ô Ÿ„ÂÈ˜ ÙÔ˘ ∞˘ÙÔ‡ ¡ÔÌ›ÛÌ·ÙÔ˜°È¿ÓÓË˜ °Ô˘‰¤‚ÂÓÔ˜: ∫·ıËÁËÙ‹˜ ∫·Ú‰ÈÔÏÔÁ›·˜ ÙË˜ π·ÙÚÈÎ‹˜ ™¯ÔÏ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ

∏ §Â˘ÎˆÌ·ÙÈÓÔ˘Ú›· ˆ˜ ¶·Ú¿ÁˆÓ ŒÓ·ÚÍË˜ Î·È ∂Í¤ÏÈÍË˜ ÙË˜ ∫·ÚˆÙÈ‰ÈÎ‹˜ ∞ıËÚÔÛÎÏ‹ÚˆÛË˜ ÛÂ ÌË ¢È·‚ËÙÈÎ¿ ÕÙÔÌ·. ªÂÏ¤ÙË TromsøJørgensen L, Jenssen T, Johnsen SH, Mathiesen EB, Heuch I, Joakimsen O, Fosse E, and Jacobsen BK.Eur Heart J 2007;28:363-9

¶A£√ºÀ™π√§√°π∞¶·ıÔÊ˘ÛÈÔÏÔÁ›· ÙÔ˘ ™˘Ó‰ÚfiÌÔ˘ ÙË˜ ∫·Ú‰ÈÔÓÂÊÚÈÎ‹˜ ∞Ó·ÈÌ›·˜.∂˘ÛÙ¿ıÈÔ˜ ¶·ÁÎÔ˘Ú¤ÏÈ·˜, Ã·Ú¿Ï·ÌÔ˜ ∫Ô˘Ì·Ú¿˜, ÕÓÓ· ∫·Î·Ê‹Î·, ¶·Ú·ÛÎÂ˘‹ ∑ÒÚÔ˘, μ·Û›ÏÂÈÔ˜ Õı˘ÚÔ˜, ∞ÛÙ¤ÚÈÔ˜ ∫·Ú·ÁÈ¿ÓÓË˜.μ’ ¶ÚÔ·È‰Â˘ÙÈÎ‹ ¶·ıÔÏÔÁÈÎ‹ ∫ÏÈÓÈÎ‹ ∞¶£, πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô,£ÂÛÛ·ÏÔÓ›ÎË.

£EPA¶EIA — ºAPMAKA√È ‚-∞ÔÎÏÂÈÛÙ¤˜ ÛÙËÓ ∫ÏÈÓÈÎ‹ ¶Ú¿ÍËª. ºÏˆÚÂÓÙ›Ó, ∂ÈÛÙËÌÔÓÈÎfi˜ ™˘ÓÂÚÁ¿ÙË˜ ÙÔ˘ π·ÙÚÂ›Ô˘ §ÈÈ‰›ˆÓª. ∂ÏÈÛ¿Ê, ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈÎ‹˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓΔÔÌ¤·˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈÎ‹˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ

√È ™Ù·Ù›ÓÂ˜ Î·È Ë º·ÚÌ·ÎÔÔÈÎÔÓÔÌ›· ÙË˜ ™ÙÂÊ·ÓÈ·›·˜ ¡fiÛÔ˘. μ. ’∞ı˘ÚÔ˜, ∞. ∫·Î·Ê‹Î·, ∂. ¶·ÓÎÔ˘Ú¤ÏÈ·˜, Ã. ∫Ô˘Ì·Ú¿˜, ∫. Δ˙ÈfiÌ·ÏÔ˜, ∞. ∫·Ú·ÁÈ¿ÓÓË˜.

™À°Ãƒ√¡∂™ √¢∏°π∂™ΔÚÔÔÔ›ËÛË ÙˆÓ ¶·Ú·ÁfiÓÙˆÓ ∫ÈÓ‰‡ÓÔ˘ ÛÂ ∞ÛıÂÓÂ›˜ ÌÂ ¶ÂÚÈÊÂÚÈÎ‹ ∞ÚÙËÚÈÔ¿ıÂÈ·Ã·Ú¿Ï·ÌÔ˜ ªËÏÈÒÓË˜*, ∂›ÎÔ˘ÚÔ˜ ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜,π·ÙÚÈÎ‹ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓªÈÏÙÈ¿‰Ë˜ ª·ÙÛ¿ÁÎ·˜, ∂›ÎÔ˘ÚÔ˜ ∫·ıËÁËÙ‹˜ ∞ÁÁÂÈÔ¯ÂÈÚÔ˘ÚÁÈÎ‹˜,π·ÙÚÈÎ‹ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ

¶ÚÔÏËÙÈÎ‹ EÍ¤Ù·ÛË (screening) N¤ˆÓ AÙfiÌˆÓ ÁÈ· ¢È·Ù·Ú·¯¤˜ ÙˆÓ §ÈÈ‰›ˆÓ:°ÓˆÌÔ‰fiÙËÛË ÙË˜ ∂ÈÙÚÔ‹˜ ÙˆÓ ∂È‰ÈÎÒÓ ÙˆÓ ∏¶∞ ÁÈ· ÙËÓ ¶ÚfiÏË„Ë ∏Ï›·˜ ÃÂÈÌÒÓ·˜, ∫·Ú‰ÈÔÏfiÁÔ˜.

¢π∞Δƒ√º∏ΔÂÏÈÎ¿ ¶ÚÔ˚fiÓÙ· ¶ÚÔ¯ˆÚËÌ¤ÓË˜ °Ï˘ÎÔ˙˘Ï›ˆÛË˜ (AGEs) Î·È ¢È·ÙÚÔÊ‹∞. •¿ÓıË˜, ∞. Ã·Ù˙ËÙfiÏÈÔ˜, ¶. °È·ÓÓÔ˘Ï¿ÎË*, º. ∏ÏÈ¿‰Ë˜, μ. Õı˘ÚÔ˜**.∞’ ¶ÚÔ·È‰Â˘ÙÈÎ‹ ¶·ıÔÏÔÁÈÎ‹ ∫ÏÈÓÈÎ‹ ∞¶£, ∞Ã∂¶∞, £ÂÛÛ·ÏÔÓ›ÎË* ΔÌ‹Ì· ¢È·ÙÚÔÊ‹˜, ¡ÔÛÔÎÔÌÂ›Ô ∞Ã∂¶∞, £ÂÛÛ·ÏÔÓ›ÎË** B’ ¶ÚÔ·È‰Â˘ÙÈÎ‹ ¶·ıÔÏÔÁÈÎ‹ ∫ÏÈÓÈÎ‹ ∞¶£, πÔÎÚ¿ÙÂÈÔ, £ÂÛÛ·ÏÔÓ›ÎË

¶POTEINOMENH BIB§IO°PAºIA

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√ Û·Î¯·ÚÒ‰Ë˜ ‰È·‚‹ÙË˜ (™¢)¤¯ÂÈ ·Ó·ÁÓˆÚÈÛıÂ› ˆ˜ ·ÓÂÍ¿ÚÙË-ÙÔ˜ ÚÔÁÓˆÛÙÈÎfi˜ ·Ú¿ÁˆÓ ÎÈÓ-‰‡ÓÔ˘ ÁÈ· Î·Ú‰È·ÁÁÂÈ·Î¿ ÓÔÛ‹-Ì·Ù· ·ÊÔ‡ ÔÈ ‰È·‚ËÙÈÎÔ› ·ÛıÂ-ÓÂ›˜ ‰È·ÙÚ¤¯Ô˘Ó 2-3 ÊÔÚ¤˜ ÌÂ-Á·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ ·fi ÙÔ˘˜ ÌË‰È·‚ËÙÈÎÔ‡˜ Ó· Âı¿ÓÔ˘Ó ·fi∫∞¡. ∂ÈÏ¤ÔÓ, fiÙ·Ó ˘ÔÛÙÔ‡ÓÎ·Ú‰È·ÁÁÂÈ·Îfi Û˘Ì‚¿Ó (ÔÍ‡ ÛÙÂ-Ê·ÓÈ·›Ô Û‡Ó‰ÚÔÌÔ, ·ÁÁÂÈ·Îfi ÂÁÎÂ-Ê·ÏÈÎfi, ÂÚÈÊÂÚÈÎ‹ ·ÚÙËÚÈÔ¿-ıÂÈ·) ‹ ˘Ô‚ÏËıÔ‡Ó ÛÂ Â¤Ì‚·-ÛË Â·Ó·ÁÁÂ›ˆÛË˜, ‰È·ÙÚ¤¯Ô˘ÓÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ ÁÈ· ÂÈÏÔ-Î¤˜ ‹ ı¿Ó·ÙÔ, Û˘ÁÎÚÈÙÈÎ¿ ÌÂÙÔ˘˜ ÌË ‰È·‚ËÙÈÎÔ‡˜

√ ™¢ Î·È Ù· Î·Ú‰È·ÁÁÂÈ·Î¿ ÓÔ-Û‹Ì·Ù· ÂÌÊ·Ó›˙ÔÓÙ·È ˆ˜ ÔÈ ‰‡Ôfi„ÂÈ˜ ÙÔ˘ ›‰ÈÔ˘ ÓÔÌ›ÛÌ·ÙÔ˜: √™¢ ıÂˆÚÂ›Ù·È fiÙÈ Â›Ó·È ÈÛÔ‰‡Ó·-ÌÔ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ ·ÏÏ¿ Î·ÈÔÏÏÔ› ·ÛıÂÓÂ›˜ ÌÂ ÛÙÂÊ·ÓÈ·›·ÓfiÛÔ (ÂÚ›Ô˘ 30%) ¤¯Ô˘Ó Î·È™¢ ‹ Ù· ÚÔÛÙ¿‰È· ÙÔ˘. ΔÔ Û›-ÁÔ˘ÚÔ Â›Ó·È fiÙÈ ÔÈ ‰‡Ô ·ı‹ÛÂÈ˜Ì·˙› ¤¯Ô˘Ó ¯ÂÈÚfiÙÂÚË ÚfiÁÓˆÛË·fi ÙËÓ Î¿ıÂ Ì›· ¯ˆÚÈÛÙ¿.

√È ÚfiÛÊ·ÙÂ˜ Î·ÙÂ˘ı˘ÓÙ‹ÚÈÂ˜Ô‰ËÁ›Â˜ ÙË˜ ESC/ EASD (∫·Ú-‰ÈÔÏÔÁÈÎ‹ Î·È ¢È·‚ËÙÔÏÔÁÈÎ‹ ∂˘-Úˆ·˚Î‹ ∂Ù·ÈÚÂ›· ·ÓÙ›ÛÙÔÈ¯·)1

(EÈÎfiÓ· 1) ÚÔÙÂ›ÓÔ˘Ó ¤Ó·Ó ·Ï-ÁfiÚÈıÌÔ Ô˘ ı· ‚ÔËı‹ÛÂÈ Ó·

·Ó·Î·Ï‡ÙÔ˘ÌÂ ™¡ ÛÙÔ˘˜ ‰È·-‚ËÙÈÎÔ‡˜ ·ÛıÂÓÂ›˜ Î·È ÙÔ ·ÓÙ›ıÂ-ÙÔ (EÈÎfiÓ· 2). μÚ·¯Â›· ·Ó·ÛÎfi-ËÛË ·˘ÙÒÓ ÙˆÓ Ô‰ËÁÈÒÓ ‰ËÌÔ-ÛÈÂ‡ÙËÎ·Ó ÛÙÔ ÚÔËÁÔ‡ÌÂÓÔ ÙÂ‡-¯Ô˜ ÙË˜ ∞ıËÚÔÛÎÏ‹ÚˆÛË˜, ÙÔ˘™ÂÙÂÌ‚Ú›Ô˘ 2007.

Δ· ‚·ÛÈÎfi ‰›ÏËÌÌ· Î¿ıÂ ÁÈ·ÙÚÔ‡Ô˘ ÂÌÏ¤ÎÂÙ·È ÛÙËÓ ÊÚÔÓÙ›‰·‰È·‚ËÙÈÎÔ‡ ·ÛıÂÓÔ‡˜ ¯ˆÚ›˜ ÈÛÙÔ-ÚÈÎfi ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘, Â›Ó·ÈÓ· ·ÍÈÔÏÔÁ‹ÛÂÈ ÙÈ Î›Ó‰˘ÓÔ ‰È·-ÙÚ¤¯ÂÈ Ô ·ÛıÂÓ‹˜ ÙÔ˘ Ó· ÂÎ‰Ë-ÏÒÛÂÈ ÛÙÔ ÂÁÁ‡˜ ‹ ÛÙÔ ·ÒÙÂÚÔÌ¤ÏÏÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi Û‡Ì‚·Ì·.∏ ÚfiÎÏËÛË ‰ÂÓ Â›Ó·È ÌfiÓÔ Ó·ÂÓÙÔ›ÛÔ˘ÌÂ ·ıËÚÔÛÎÏ‹ÚˆÛË (¿-¯Ô˜ Ì¤ÛÔ˘ ¤Ûˆ ¯ÈÙÒÓ· ·ÚÙË-ÚÈÒÓ, ÛÊ˘ÚÔ‚Ú·¯ÈfiÓÈÔ˜ ‰Â›ÎÙË˜,·Û‚¤ÛÙÈÔ ÛÙÈ˜ ÛÙÂÊ·ÓÈ·›Â˜ ·Ú-ÙËÚ›Â˜) Î¿ÙÈ Ô˘ Û¯Â‰fiÓ ˘¿Ú¯ÂÈ¿ÓÙ· ·ÏÏ¿ Î·È Ó· ÚÔ‚Ï¤„Ô˘ÌÂÔÈ· ¿ÙÔÌ· ı· ÂÎ‰ËÏÒÛÔ˘Ó ÔÍ‡Î·Ú‰È·ÁÁÂÈ·Îfi Û‡Ì‚·Ì·. ∂›Ó·ÈÛËÌ·ÓÙÈÎfi Ó· ÂÈÛËÌ¿ÓÔ˘ÌÂ fiÙÈÔ Î›Ó‰˘ÓÔ˜ ·fi ÙËÓ ·ıËÚÔÛÎÏ‹-ÚˆÛË Â›Ó·È ‰È·ÊÔÚÂÙÈÎfi˜ ·fiÙÔÓ Î›Ó‰˘ÓÔ ÙˆÓ ÔÍ¤ˆÓ Û˘Ì‚·-Ì¿ÙˆÓ. ™ÙË Î·Ù·ÓfiËÛË ÙÔ˘ ÎÈÓ-‰‡ÓÔ˘ Ú¤ÂÈ Ó· Á›ÓÂÈ Û·Ê‹˜ Ô‰È·¯ˆÚÈÛÌfi˜ ÌÂÙ·Í‡ ‰È¿ÁÓˆ-ÛË˜ Î·È ÚfiÁÓˆÛË˜. ¶·Ú’ fiÙÈ·˘Ùfi ·Ú·Ì¤ÓÂÈ ÙÔ ÈÔ ÛÔ‚·Úfi·Ó·¿ÓÙËÙÔ ÂÚÒÙËÌ·, È‰È·›ÙÂÚ·ÛÙÈ˜ ÂÚÈÙÒÛÂÈ˜ Ô˘ ·ÊÔÚ¿

·Û˘ÌÙˆÌ·ÙÈÎfi ‰È·‚ËÙÈÎfi, ¤¯ÂÈ‰ÔÎÈÌ·ÛıÂ› ¤Ó·˜ ·ÚÈıÌfi˜ ·ÂÈ-ÎÔÓÈÛÙÈÎÒÓ ÂÍÂÙ¿ÛÂˆÓ (¶›Ó·Î·˜ 1).ΔÔ ÛÈÓıËÚÔÁÚ¿ÊËÌ· ·ÈÌ¿Ùˆ-ÛË˜ ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘ (SPECT)·fi ÙÈ˜ ÏÂÈÙÔ˘ÚÁÈÎ¤˜ ‰ÔÎÈÌ·Û›Â˜Î·È Ô ˘ÔÏÔÁÈÛÌfi˜ ·Û‚ÂÛÙ›Ô˘ÛÙÈ˜ ÛÙÂÊ·ÓÈ·›Â˜ ·ÚÙËÚ›Â˜ ÌÂ·Ó·›Ì·ÎÙË ·ÁÁÂÈÔÁÚ·Ê›· ·fi ÙÈ˜·Ó·ÙÔÌÈÎ¤˜ ·ÂÈÎÔÓÈÛÙÈÎ¤˜ ÌÂıfi-‰Ô˘˜ Ê·›ÓÂÙ·È ÁÈ· ÙËÓ ÒÚ· Ó·¤¯Ô˘Ó ÙËÓ Î·Ï‡ÙÂÚË ÚÔÁÓˆÛÙÈ-Î‹ ·Í›· (∂ÈÎfiÓ· 3). ∏ È‰·ÓÈÎ‹ÂÍ¤Ù·ÛË Â›Ó·È Ô Û˘Ó‰˘·ÛÌfi˜SPECT Î·È CCTA (multidetectorcoronary computed tomography)Î·È ÌÂÏÏÔÓÙÈÎ¿ Ô Û˘Ó‰˘·ÛÌfi˜PET/ CCT∞

Ÿˆ˜ ·Ó·Ê¤ÚıËÎÂ, Ô Û¯ÂÙÈÎfi˜Î›Ó‰˘ÓÔ˜ ÛÙÔ˘˜ ‰È·‚ËÙÈÎÔ‡˜ ÁÈ·ÂÌÊ¿ÓÈÛË Î·Ú‰È·ÁÁÂÈ·ÎÔ‡ ÓÔÛ‹-Ì·ÙÔ˜ Â›Ó·È 2-4 ÊÔÚ¤˜ ÌÂÁ·Ï‡-ÙÂÚÔ˜ ÂÓÒ Ô ÂÙ‹ÛÈÔ˜ ·fiÏ˘ÙÔ˜Î›Ó‰˘ÓÔ˜ Î˘Ì·›ÓÂÙ·È ·fi 2% ÌÂ4%. √ Î›Ó‰˘ÓÔ˜ ÂÍ·ÚÙ¿Ù·È ·fiÙËÓ ËÏÈÎ›·, ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ™¢,ÙËÓ ·ÚÔ˘Û›· ‹ ÌË ÁÓˆÛÙ‹˜∫∞¡ Î·È ÙËÓ ·ÚÔ˘Û›· ¿ÏÏˆÓ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘. ∞˘Ùfi ÛË-Ì·›ÓÂÈ fiÙÈ ·fi ÙÔ˘˜ 100 ‰È·‚ËÙÈ-ÎÔ‡˜ Ú¤ÂÈ Ó· ÂÓÙÔ›ÛÔ˘ÌÂ Ù·2-4 ¿ÙÔÌ· Ô˘ ı· ÂÎ‰ËÏÒÛÔ˘ÓÔÍ‡ Î·Ú‰È·ÁÁÂÈ·Îfi Û‡Ì‚·Ì·. √Î·Ú‰ÈÔÏfiÁÔ˜ Û˘Ó‹ıˆ˜ ·ÓÙÈÌÂ-Ùˆ›˙ÂÈ ÙÔ ‰ÂÍÈfi ÛÎ¤ÏÔ˜ ÙÔ˘ ·Ï-ÁfiÚÈıÌÔ˘ ÙË˜ ∂ÈÎfiÓ·˜ 2: ·ÛıÂ-Ó‹˜ ÌÂ ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ Î·ÈÁÓˆÛÙfi ‰È·‚‹ÙË.

∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ë Î·ÙËÁÔÚ›··˘ÙÒÓ ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ‰È·‚ËÙÈ-ÎÒÓ ¤¯ÂÈ ¯ÂÈÚfiÙÂÚË ÚfiÁÓˆÛË·fi ÙÔ˘˜ ÌË ‰È·‚ËÙÈÎÔ‡˜ ÛÙÂÊ·-ÓÈ·›Ô˘˜, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙË ıÂ-Ú·Â˘ÙÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË Ô˘ ı·ÂÊ·ÚÌÔÛıÂ›. ∞fi ÙÔ˘˜ ·ÛıÂÓÂ›˜Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÌÂ ÔÍ‡ ÛÙÂÊ·-ÓÈ·›Ô Û‡Ó‰ÚÔÌÔ ÙÔ 25-30% ¤¯ÂÈÁÓˆÛÙfi ÈÛÙÔÚÈÎfi ™¢. ŒÓ· ÔÛÔ-ÛÙfi 4% ¤¯ÂÈ ·‰È¿ÁÓˆÛÙÔ ™¢(ÁÏ˘Îfi˙Ë ÓËÛÙÂ›·˜ >200 mg/dL)Î·È ¤Ó· ÂÚ›Ô˘ 33 % ¤¯ÂÈ ·˘ÍË-Ì¤ÓË ÁÏ˘Îfi˙Ë ÓËÛÙÂ›·˜. ¶Ú¤ÂÈÓ· ·Ó·ÊÂÚıÂ› fiÙÈ ·ÓÙ›ÛÙÔÈ¯· Ô-ÛÔÛÙ¿ (ÁÓˆÛÙÔ‡ Î·È ÓÂÔ‰È·ÁÓˆ-Ûı¤ÓÙ· ™¢) Î·Ù·ÁÚ¿ÊÔÓÙ·È Î·È

¢ ∂ ∫ ∂ ª μ ƒ π √ ™ 2 0 0 7

2

™·Î¯·ÚÒ‰Ë˜ ¢È·‚‹ÙË˜ Î·È ™ÙÂÊ·ÓÈ·›· ¡fiÛÔ˜.√È ¢‡Ô Ÿ„ÂÈ˜ ÙÔ˘ ∞˘ÙÔ‡ ¡ÔÌ›ÛÌ·ÙÔ˜

°È¿ÓÓË˜ °Ô˘‰¤‚ÂÓÔ˜: ∫·ıËÁËÙ‹˜ ∫·Ú‰ÈÔÏÔÁ›·˜ ÙË˜ π·ÙÚÈÎ‹˜ ™¯ÔÏ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ

∂ÈÎfiÓ· 1. ∫ÔÈÓ¤˜ Ô‰ËÁ›Â˜ ÙˆÓ ESC/ EASD ÁÈ· ÙËÓ ÚfiÏË„Ë Î·ÈıÂÚ·Â›· ÙË˜ Û˘ÓÔÛËÚfiÙËÙ·˜ ™¢ Î·È ∫∞¡

ÛÂ ·ÛıÂÓÂ›˜ Ô˘ ·ÚÔ˘ÛÈ¿˙Ô-ÓÙ·È ÌÂ ÔÍ‡ ÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi-‰ÈÔ ‹ ·ÚÔ‰ÈÎfi ÈÛ¯·ÈÌÈÎfi ÂÂÈ-Ûfi‰ÈÔ.

¶ÚfiÛÊ·Ù· ‰ËÌÔÛÈÂ‡ıËÎ·Ó ‰‡ÔÌÂÏ¤ÙÂ˜ Ô˘ ¤ÚÈÍ·Ó ÂÚÈÛÛfiÙÂ-ÚÔ Êˆ˜ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ÔÍ¤·ÛÙÂÊ·ÓÈ·›· Û‡Ó‰ÚÔÌ· Î·È ™¢. ∏

ÚÒÙË ÌÂÏ¤ÙË2 ·Ó·ÛÎfiËÛÂ 11ÌÂÁ¿ÏÂ˜ Ù˘¯·ÈÔÔÈËÌ¤ÓÂ˜ ÎÏÈÓÈ-Î¤˜ ÌÂÏ¤ÙÂ˜ ÙË˜ ÂÚÈfi‰Ô˘ 1996- 2006 ÛÂ Û‡ÓÔÏÔ 62.000 ·ÛıÂ-ÓÒÓ (17% ‰È·‚ËÙÈÎÔ›) ÌÂ Î·È ¯ˆ-Ú›˜ ·Ó¿Û·ÛË ÙÔ˘ ST ‰È·ÛÙ‹Ì·-ÙÔ˜ (STEMI - NSTEMI) Î·È ˘Ô-ÏfiÁÈÛÂ ÙË ıÓËÙfiÙËÙ· ÙˆÓ ÚÒ-

ÙˆÓ 30 ËÌÂÚÒÓ Î·È ÙÔ˘ ÚÒÙÔ˘¤ÙÔ˘˜, ÛÂ ‰È·‚ËÙÈÎÔ‡˜ Î·È ÌË ‰È·-‚ËÙÈÎÔ‡˜ ·ÓÙ›ÛÙÔÈ¯· (¶›Ó·Î·˜ 2).ΔÔ Î‡ÚÈÔ Û˘Ì¤Ú·ÛÌ· ·fi ·˘Ù‹ÙË ÌÂÏ¤ÙË Â›Ó·È fiÙÈ ·Ú¿ ÙËÛ‡Á¯ÚÔÓË ·ÓÙÈÌÂÙÒÈÛË ÙˆÓÔÍ¤ˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ Û˘Ó‰ÚfiÌˆÓÙÔ ¯¿ÛÌ· ÛÙËÓ ¤Î‚·ÛË ÌÂÙ·Í‡‰È·‚ËÙÈÎÒÓ Î·È ÌË ‰È·‚ËÙÈÎÒÓ‰ÂÓ ¤¯ÂÈ ÁÂÊ˘ÚˆıÂ›.

OÛÔÓ ·ÊÔÚ¿ ÙÔ Ê‡ÏÔ ·fi ÙËÓÈ‰È· ÌÂÏ¤ÙË Ù· ÔÛÔÛÙ¿ ÙˆÓ ‰È·-‚ËÙÈÎÒÓ ·Ó‰ÚÒÓ - Á˘Ó·ÈÎÒÓ ÛÙ·STEªπ ‹Ù·Ó 20 % Î·È 28% ÂÓÒÛÙ· NSTEMI 13% Î·È 21.4%·ÓÙ›ÛÙÔÈ¯·. ∏ ıÓËÙfiÙËÙ· ÙˆÓNSTEMI ÛÙÈ˜ 30 ËÌ¤ÚÂ˜ ‹Ù·Ó2.3% ÛÙÔ˘˜ ‰È·‚ËÙÈÎÔ‡˜ ¿Ó-‰ÚÂ˜ ¤Ó·ÓÙÈ 1.9% ÛÙÈ˜ Á˘Ó·›ÎÂ˜ÂÓÒ ÙˆÓ STEMI 6.5% Î·È 12.6%·ÓÙ›ÛÙÔÈ¯·

∞Ó ·˘Ù¿ Û˘Ì‚·›ÓÔ˘Ó ÛÙÔ˘˜ ‰È·-‚ËÙÈÎÔ‡˜ ÌÂ ÔÍ¤· ÛÙÂÊ·ÓÈ·›·Û‡Ó‰ÚÔÌ· Ô˘ ÌÂÙÂ›¯·Ó ÛÙÈ˜ ÎÏÈ-ÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜, ÙÔ ÔÛÔÛÙfi ÙˆÓÂÙ‹ÛÈˆÓ ı·Ó¿ÙˆÓ ÛÙÔÓ ÏËı˘-ÛÌfi ÙˆÓ ∏¶∞ (‚·ÛÈÛÌ¤ÓÂ˜ ÛÙÈ˜‰ËÌÔÛÎÔ‹ÛÂÈ˜ ÙË˜ NHANES)Î·Ù¿ ÙËÓ ÂÚ›Ô‰Ô 1988 - 2000ÛÙÔ˘˜ ‰È·‚ËÙÈÎÔ‡˜ ¿Ó‰ÚÂ˜ ‹Ù·Ó24.4/1000 ¿ÙÔÌ· Î·È ÛÙÈ˜ Á˘Ó·›-ÎÂ˜ 42.6/1000 ¿ÙÔÌ· ¤Ó·ÓÙÈ25.9/1000 ¿ÙÔÌ· ÛÙÔ˘˜ ¿Ó‰ÚÂ˜Î·Ù¿ ÙËÓ ÚÔËÁÔ‡ÌÂÓË ÂÚ›Ô‰Ô1971-1986 Î·È 18.4/1000 ¿ÙÔÌ·ÛÙÈ˜ Á˘Ó·›ÎÂ˜3. ¶·Ú·ÙËÚÔ‡ÌÂfiÙÈ ÂÓÒ Ë ıÓËÙfiÙËÙ· ÛÙÔ˘˜ ¿Ó-‰ÚÂ˜ ÌÂÈÒıËÎÂ ·ÈÛıËÙ¿ ÛÙÈ˜ Á˘-Ó·›ÎÂ˜ ‰ÈÏ·ÛÈ¿ÛıËÎÂ

ªÈ· ¿ÏÏË ÌÂÏ¤ÙË4 ·ÊÔÚ¿ 8.291·ÛıÂÓÂ›˜ ¯ˆÚ›˜ ÈÛÙÔÚÈÎfi ™¢(ÚfiÎÂÈÙ·È ÁÈ· ÙËÓ πÙ·ÏÈÎ‹ ÌÂÏ¤-ÙË GISSI Ô˘ ÚÒÙË ¤‰ÂÈÍÂ ÙËÓ·Í›· ÙË˜ ıÚÔÌ‚fiÏ˘ÛË˜ ÛÂ ·ÛıÂ-ÓÂ›˜ ÌÂ STEMπ) ÌÂÏ¤ÙËÛÂ ÙËÓÂ›ÙˆÛË ÓÂÔÂÌÊ·ÓÈÛı¤ÓÙÔ˜ ™¢.™ÙË ‰È¿ÚÎÂÈ· ·Ú·ÎÔÏÔ‡ıËÛË˜ÙˆÓ 3.2 ÂÙÒÓ ÙÔ 12% ÙˆÓ ·ÛıÂ-ÓÒÓ ÌÂ STEMI ÂÌÊ¿ÓÈÛÂ ™¢. ∞fiÙÔ˘˜ 7.533 ·ÛıÂÓÂ›˜ ¯ˆÚ›˜ ‰È·-Ù·Ú·ÁÌ¤ÓË ÁÏ˘Îfi˙Ë ÓËÛÙÂ›·˜

* ·˘ÙÔ‡˜ Ô˘ ÂÈ‚›ˆÛ·Ó 30 ËÌ¤ÚÂ˜. ¶·Ú·ÙËÚÔ‡ÌÂ fiÙÈ Ë ÂÙ‹ÛÈ· ıÓËÙfiÙËÙ· ÁÈ· ÙÔ˘˜ ‰È·‚ËÙÈÎÔ‡˜ ÌÂ NSTEMI ‹Ù·Ó ·ÚfiÌÔÈ·(·Ó fi¯È Î·Ï‡ÙÂÚË ) ·fi ÙË ÂÙ‹ÛÈ· ıÓËÙfiÙËÙ· ÙˆÓ ÌË ‰È·‚ËÙÈÎÒÓ ÌÂ STEMI

¶∞ƒ∞°√¡Δ∂™ ∫π¡¢À¡√À

3

¶›Ó·Î·˜ 1. ∞ÂÈÎÔÓÈÛÙÈÎ¤˜ ÂÍÂÙ¿ÛÂÈ˜ ÁÈ· ÙËÓ ÂÓÙfiÈÛË ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ ÛÂ ·Û˘ÌÙˆÌ·ÙÈÎÔ‡˜ ‰È·‚ËÙÈÎÔ‡˜

§ÂÈÙÔ˘ÚÁÈÎ¤˜

¢ÔÎÈÌ·Û›· ÎfiˆÛË˜

Stress Ë¯ˆÎ·Ú‰ÈÔÁÚ·Ê›· ÌÂ ‰Ô‚Ô˘Ù·Ì›ÓË ‹ ‰È˘ÚÈ‰·ÌfiÏË

Contrast Ë¯ˆÎ·Ú‰ÈÔÁÚ·Ê›· Ì˘ÔÎ·Ú‰›Ô˘

™ÈÓıËÚÔÁÚ¿ÊËÌ· ·ÈÌ¿ÙˆÛË˜ ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘ (SPECT)

∞Ó·ÙÔÌÈÎ¤˜

∞Ó·›Ì·ÎÙË ·ÁÁÂÈÔÁÚ·Ê›· ÌÂ ªRI

CCTA

™ÙÂÊ·ÓÈÔÁÚ·Ê›·

∏ ÂÍ¤Ù·ÛË ÙÔ˘ Ì¤ÏÏÔÓÙÔ˜ PET/CCTA

¶›Ó·Î·˜ 2. ™·Î¯·ÚÒ‰Ë˜ ¢È·‚‹ÙË˜ Î·È √Í¤· ™ÙÂÊ·ÓÈ·›· ™‡Ó‰ÚÔÌ·;

NSTEMI :15.459) STEMI (N:46.577)

¢È·‚ËÙÈÎÔ› ªË ¢È·‚ËÙÈÎÔ› ¢È·‚ËÙÈÎÔ› ªË ¢È·‚ËÙÈÎÔ›

£ÓËÙfiÙËÙ· 30 ËÌÂÚÒÓ 2.1 % 1.1% 8.5% 5.4%

£ÓËÙfiÙËÙ· 1Ô˘ ¤ÙÔ˘˜* 7.2 % 3.1 % 13.2 % 8.1%

™¡ Î·È ™¢

∫‡ÚÈ· ‰È¿ÁÓˆÛË™¢±™N

∫‡ÚÈ· ‰È¿ÁÓˆÛË™¡±™¢

ÕÁÓˆÛÙÔ ·Ó ™¡∏∫°

∏¯ˆÎ·Ú‰ÈÔÁÚ¿ÊËÌ·ΔÂÛÙ ÎÔÒÛÂˆ˜

°ÓˆÛÙ‹ ™¡∏∫°

∏¯ˆÎ·Ú‰ÈÔÁÚ¿ÊËÌ·ΔÂÛÙ ÎÔÒÛÂˆ˜

∞¡ (+) Â˘Ú‹Ì·Ù··Ú·ÔÌ‹ ÛÂ

Î·Ú‰ÈÔÏfiÁÔ

°ÓˆÛÙfi˜ ™¢ŒÏÂÁ¯Ô˜ ÁÈ·ÓÂÊÚÔ¿ıÂÈ·

∞Ó Ùˆ¯‹ Ú‡ıÌÈÛËÛ·Î¯¿ÚÔ˘

(HbA1C>7%)·Ú·ÔÌ‹ ÛÂ‰È·‚ËÙÔÏfiÁÔ

¢È¿ÁÓˆÛË ™¢ ‹¢È·Ù·Ú·¯‹˜

√ÌÔÈÔÛÙ·Û›·˜°Ï˘Îfi˙Ë˜ (±ª™)

¶·Ú·ÔÌ‹ ÛÂ‰È·‚ËÙÔÏfiÁÔ

ªË Ê˘ÛÈÔÏÔÁÈÎ¿¶·Ú·ÔÌ‹ ÛÂ

Î·Ú‰ÈÔÏfiÁÔ,ıÂÚ·Â›· ÈÛ¯·ÈÌ›·˜,

·Ó·›Ì·ÎÙÔ˜ ‹ ·ÚÂÌ‚·ÙÈÎ‹

Î.Ê.·Ú·ÎÔÏÔ‡ıËÛË

Î.Ê.·Ú·ÎÔÏÔ‡ıËÛË

ÕÁÓˆÛÙÔ ·Ó ™¢¢ÔÎÈÌ·Û›· ∞ÓÔ¯‹˜

°Ï˘Îfi˙Ë˜§È›‰È· ·›Ì·ÙÔ˜,

Û¿Î¯·ÚÔ ·›Ì·ÙÔ˜HbA1C

∂ÈÎfiÓ· 2. ∞ÏÁfiÚÈıÌÔ˜ ‰ÈÂÚÂ‡ÓËÛË˜ ·ÛıÂÓÒÓ ÌÂ ÛÙÂÊ·ÓÈ·›·ÓfiÛÔ (™¡) ‹ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË (™¢)

(IFG) ÙÔ 33% ÂÌÊ¿ÓÈÛÂ ‰È·Ù·Ú·-¯‹ ÙË˜ ÁÏ˘Îfi˙Ë˜ ÓËÛÙÂ›·˜ (IFG)‹ ™¢. ∏ ÂÙ‹ÛÈ· Â›ÙˆÛË ÂÌÊ¿-ÓÈÛË˜ ™¢ (ÁÏ˘Îfi˙Ë ·›Ì·ÙÔ˜>126 mg/dl) ˘ÔÏÔÁ›ÛıËÎÂ ÛÂ3.7% Î·È ÙË˜ IFG (100-126mg/dl) ÛÂ 27.5%. √È ·ÓÙ›ÛÙÔÈ¯Â˜ÂÙ‹ÛÈÂ˜ ÂÈÙÒÛÂÈ˜ ÛÙÔ ÁÂÓÈÎfiÏËı˘ÛÌfi Â›Ó·È 0.8-1.6% Î·È1.8%. ™˘ÓÂÒ˜ ‰ÂÓ ÈÛ¯‡ÂÈ ÌfiÓÔfiÙÈ Ô ™¢ Â›Ó·È ÈÛÔ‰‡Ó·ÌÔ ™¡ ·Ï-Ï¿ fiÙÈ Î·È ÙÔ ¤ÌÊÚ·ÁÌ· Ì˘ÔÎ·Ú-‰›Ô˘ (Î‡ÚÈ· ÂÎ‰‹ÏˆÛË ™¡) Â›Ó·ÈÈÛÔ‰‡Ó·ÌÔ ÙÔ˘ ™¢.

ΔÔ fiÙÈ Ù· 2/3 ÙˆÓ ·ÙfiÌˆÓ ÌÂSTEMI ¤¯Ô˘Ó ·ıÔÏÔÁÈÎfi ÌÂÙ·-‚ÔÏÈÛÌfi ÙË˜ ÁÏ˘Îfi˙Ë˜ Â›Ó·ÈÁÓˆÛÙfi ·fi Û˘Á¯ÚÔÓÈÎ¤˜ (cross-sectional) ÌÂÏ¤ÙÂ˜. ™Â Ì›· ·fi·˘Ù¤˜ ÙÔ 25% Â›¯Â ·‰È¿ÁÓˆÛÙÔ™¢ Î·È ÙÔ 40% ÂËÚÂ·ÛÌ¤ÓË·ÓÔ¯‹ ÛÙË ÁÏ˘Îfi˙Ë (IGT)5. ∞ÚÎÂ-Ù¤˜ ·Ú·ÙËÚ‹ÛÂÈ˜ ÛÙÔ ·ÚÂÏ-ıfiÓ ÙÔÓ›˙Ô˘Ó ÙË ÛËÌ·Û›· ÙË˜ ·-ıÔÏÔÁÈÎÔ‡ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÁÏ˘Îfi-˙Ë˜ ÛÙ· ¿ÙÔÌ· ÌÂ ÔÍ‡ ÛÙÂÊ·ÓÈ-·›Ô Û‡Ó‰ÚÔÌÔ Î·È ·Ó·ÁÓˆÚ›˙Ô˘ÓÂ˘Î·ÈÚ›Â˜ ÁÈ· ‚ÂÏÙ›ˆÛË ÙË˜ ÓÔ-

ÛËÏÂ›·˜. ∂Ï¿¯ÈÛÙÔÈ ÓÔÛËÏÂ˘fiÌÂ-ÓÔÈ ‰È·‚ËÙÈÎÔ› ÛÙË ÂÚÈÔ¯‹ Ì·˜¤¯Ô˘Ó ÌÂÙÚËÌ¤ÓË ÁÏ˘ÎÔ˙˘ÏÈˆÌ¤-ÓË HbA1c Î·È ·ÎfiÌË ÏÈÁfiÙÂÚÔÈÙËÓ ¤¯Ô˘Ó ¤ÛÙˆ Î·È ˘ÔÊÂÚÙ¿Ú˘ıÌÈÛÌ¤ÓË.

∏ ˘ÂÚÁÏ˘Î·ÈÌ›· ÛÙËÓ ÔÍÂ›· Ê¿-ÛË ÙˆÓ ÔÍ¤ˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ Û˘Ó-‰ÚfiÌˆÓ ·Ó·ÁÓˆÚ›˙ÂÈ ·ÛıÂÓÂ›˜ÌÂ ·‰È¿ÁÓˆÛÙÔ ™¢ ‹ ·ÓÙ·Ó·ÎÏ¿˘ÂÚÁÏ˘Î·ÈÌ›· ÏfiÁˆ stress Î·ÈÛ¯ÂÙ›˙ÂÙ·È ÌÂ ·˘ÍËÌ¤ÓË ÂÓ‰ÔÓÔ-ÛÔÎÔÌÂÈ·Î‹ Î·È ÌÂÙ¿ ÙËÓ ¤ÍÔ‰ÔıÓËÙfiÙËÙ·. ∏ Û˘Ì‚ÔÏ‹ ÙˆÓ ‰È·-ÊÔÚÂÙÈÎÒÓ Î·ÙËÁÔÚÈÒÓ ÌÂÙ·‚Ô-ÏÈÛÌÔ‡ ÙË˜ ÁÏ˘Îfi˙Ë˜ (ÁÓˆÛÙfi˜™¢, ÓÂÔ‰È·ÁÓˆÛıÂ›˜ ™¢, πGT,IFG), ÛÙÔÓ Î›Ó‰˘ÓÔ Û˘ÓÔÏÈÎ‹˜Î·È Î·Ú‰È·ÁÁÂÈ·Î‹˜ ıÓËÙfiÙËÙ·˜ÌÂÏÂÙ‹ıËÎÂ ÛÂ ÌÈ· ÌÂÁ¿ÏË ÏË-ı˘ÛÌÈ·Î‹ ÌÂÏ¤ÙË (n: 10.428)·fi ÙËÓ ∞˘ÛÙÚ·Ï›·6. ªÂÙ¿ 5¯ÚfiÓÈ· ·Ú·ÎÔÏÔ‡ıËÛË˜ ÙÔ Ô-ÛÔÛÙfi ı·Ó¿ÙˆÓ ·fi fiÏ· Ù· ·›-ÙÈ· ‹Ù·Ó 11,8%, 6,2%, 5,25% Î·È3,9% ·ÓÙ›ÛÙÔÈ¯·. ∏ ıÓËÙfiÙËÙ·ÁÈ· Ù· ¿ÙÔÌ· ¯ˆÚ›˜ ÌÂÙ·‚ÔÏÈÎ‹‰È·Ù·Ú·¯‹ ÙË˜ ÁÏ˘Îfi˙Ë˜ ‹Ù·Ó1.7%. √ Î›Ó‰˘ÓÔ˜ ÁÈ· ∫∞ ıÓËÙfi-ÙËÙ· ‹Ù·Ó Â›ÛË˜ ÛËÌ·ÓÙÈÎfiÙÂ-ÚÔ˜ ÛÙ· ¿ÙÔÌ· ÌÂ ÁÓˆÛÙfi ™¢ ‹IFG (fi¯È ÁÈ· ÂÎÂ›ÓÔ˘˜ ÌÂ IGT),

¢ ∂ ∫ ∂ ª μ ƒ π √ ™ 2 0 0 7

4

∂ÈÎfiÓ· 3. ∞ÏÁfiÚÈıÌÔ˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ·Û˘ÌÙˆÌ·ÙÈÎÔ‡ ‰È·‚ËÙÈÎÔ‡ ·ÛıÂÓÔ‡˜.ΔÔ ÛÈÓıËÚÔÁÚ¿ÊËÌ· Ê·›ÓÂÙ·È fiÙÈ ·›˙ÂÈ ÎÂÓÙÚÈÎfi ÚfiÏÔ ÛÙË ‰È·‚¿ıÌÈÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘

∂ÈÎfiÓ· 4. ¶ÂÓÙ·ÂÙ‹˜ ÂÈ‚›ˆÛË ·ÛıÂÓÒÓ ÌÂ ‰È·‚‹ÙË

∞ÛıÂÓ‹˜ ÌÂ ™¢ Î·È ¯ˆÚ›˜ Û˘ÌÙÒÌ·Ù· ™¡

<40 ËÏÈÎ›·

∫·ÌÈ¿ ◊ÈÂ˜ ª¤ÙÚÈÂ˜ ‹ÛÔ‚·Ú¤˜

¶ÂÚÈÔ‰ÈÎ‹ ·Ú·ÎÔÏÔ‡ıËÛËÎ·Ú‰È·ÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘

£ÂÚ·Â›·™ÙÂÓ‹ ·Ú·ÎÔÏÔ‡ıËÛË ™ÙÂÊ·ÓÈÔÁÚ·Ê›·

ªÈÎÚfi˜∫·Ú‰È·ÁÁÂÈ·Îfi˜

Î›Ó‰˘ÓÔ˜

ª¤ÙÚÈÔ˜ ‹ ÛÔ‚·Úfi˜

™ÈÓıËÚÔÁÚ¿ÊËÌ· Ì˘ÔÎ·Ú‰›Ô˘

¢È·Ù·Ú·¯¤˜ ·ÈÌ¿ÙˆÛË˜

≥40

ªÂÏ¤ÙË,¤ÙÔ˜,(‚È‚ÏÈÔÁÚ.∞Ó·ÊÔÚ¿)

™‡ÓÔÏÔ

∫·Ï‡ÙÂÚË ÂÈ‚›ˆÛË ÌÂ CABG

∫·Ï‡ÙÂÚË ÂÈ‚›ˆÛË ÌÂ PCI

∂È˙ÒÓÙÂ˜·ÛıÂÓÂ›˜,/™‡ÓÔÏÔ ·ÛıÂÓÒÓ,

n/n

¢È·ÊÔÚ¿ ÎÈÓ‰‡ÓÔ˘ (95% CI)

Û˘ÁÎÚÈÙÈÎ¿ ÌÂ ÂÎÂ›ÓÔ˘˜ ÌÂ Ê˘-ÛÈÔÏÔÁÈÎ‹ ·ÓÔ¯‹ ÛÙË ÁÏ˘Îfi˙Ë.ΔÔ 65% fiÏˆÓ ÙˆÓ ∫∞ ı·Ó¿ÙˆÓÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ÏËı˘ÛÌÔ‡ Û˘-Ó¤‚Ë ÛÙ· ¿ÙÔÌ· ÌÂ ÁÓˆÛÙfi ‹ ÓÂ-Ô‰È·ÁÓˆÛı¤ÓÙ· ™¢ Î·È πGT ‹ πFGÛÙË ·Ú¯‹ ÙË˜ ÌÂÏ¤ÙË˜. ∞˘Ù¿ Ù·

Â˘Ú‹Ì·Ù· ˘Ô‰ËÏÔ‡Ó fiÙÈ ¤Ó·˜ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ∫∞¡ Û˘Ì‚·›-ÓÂÈ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ·ıÔÏÔÁÈÎ‹‰È·Ù·Ú·¯‹ ÙË˜ ÁÏ˘Îfi˙Ë˜ Î·È fiÙÈÔÈ ÛÙÚ·ÙËÁÈÎ¤˜ ÚfiÏË„Ë˜ ‰ÂÓÚ¤ÂÈ Ó· ÛÙÔ¯Â‡Ô˘Ó ÌfiÓÔÛÙÔ˘˜ ‰È·‚ËÙÈÎÔ‡˜ ·ÏÏ¿ Î·È

ÛÙÔ ÏËı˘ÛÌÔ‡˜ ÌÂ ËÈfiÙÂÚÂ˜ÌÔÚÊ¤˜ ·ıÔÏÔÁÈÎÔ‡ ÌÂÙ·‚ÔÏÈ-ÛÌÔ‡ ÁÏ˘Îfi˙Ë˜.

ΔÔ ÔÈ· Â›Ó·È Ë Î·Ï‡ÙÂÚË Ì¤ıÔ-‰Ô˜ Â·Ó·ÁÁÂ›ˆÛË˜ (·ÁÁÂÈÔÏ·-ÛÙÈÎ‹ ‹ bypass) ÛÙÔ˘˜ ‰È·‚ËÙÈ-ÎÔ‡˜ Û˘ÓÂ¯›˙ÂÈ Ó· ·ÔÙÂÏÂ› ı¤Ì··ÓÙÈ·Ú¿ıÂÛË˜ (debate). ¶ÂÚÈÛ-ÛfiÙÂÚ· ‰Â‰ÔÌ¤Ó· ı· ¤¯Ô˘ÌÂ·fi 3 ÌÂÁ¿ÏÂ˜ ÌÂÏ¤ÙÂ˜ Ô˘ ÙÚ¤-¯Ô˘Ó (FREEDOM, VA CARDS,CARDIA). T· ÙÚ¤¯ÔÓÙ· ‰Â‰ÔÌ¤-Ó· (˘ÔÔÌ¿‰Â˜ ÏËı˘ÛÌÒÓ) ·fi7 Ù˘¯·ÈÔÔÈËÌ¤ÓÂ˜ ÌÂÏ¤ÙÂ˜ ‰Â›-¯ÓÔ˘Ó ÌÈ· ÌÈÎÚ‹ ˘ÂÚÔ¯‹ ÙÔ˘Bypass (0.9%) ‰È·ÊÔÚ¿ Ô˘ ‰ÂÓ¤¯ÂÈ ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ‰È·-ÊÔÚ¿ Î·È ÌÂ Â˘Ú¤· fiÚÈ· ÂÌÈ-ÛÙÔÛ‡ÓË˜ (∂ÈÎfiÓ· 4)7. ªÂ ·˘Ù¿Ù· ·ÔÙÂÏ¤ÛÌ·Ù· Û˘ÌÊˆÓÔ‡ÓÎ·È Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÌÂÁ¿ÏˆÓÎ·Ù·ÁÚ·ÊÒÓ (registries) fiÙÈ ‰ËÏË ÂÈ‚›ˆÛË ÛÙÔ˘˜ ‰È·‚ËÙÈÎÔ‡˜Ô˘ ˘Ô‚Ï‹ıËÎ·Ó ÛÂ ·ÁÁÂÈÔ-Ï·ÛÙÈÎ‹ Î·È Bypass Â›Ó·È Û˘-ÁÎÚ›ÛÈÌË

∂ÎÙfi˜ ·fi Ù· Î·Ú‰È·ÁÁÂÈ·Î¿ ÓÔ-Û‹Ì·Ù· Ô ™¢ Â›Ó·È ÌÈ· ·fi ÙÈ˜Î‡ÚÈÂ˜ ·ÈÙ›Â˜ Ù‡ÊÏˆÛË˜ Î·È ËÈÔ Û˘¯Ó‹ ·ÈÙ›· ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ÓÂÊÚÈÎ‹˜ ·ÓÂ¿ÚÎÂÈ·˜ (∂ÈÎfiÓ· 5).ŸÏ· Ù· ·Ú·¿Óˆ ÂÓÈÛ¯‡Ô˘ÓÙËÓ ¿Ô„Ë fiÙÈ Ë ıÂÚ·Â›· ÙˆÓ‰È·‚ËÙÈÎÒÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÛıÂ-ÓÒÓ Â›Ó·È ÔÏ‡ÏÔÎË, ˘„ËÏÔ‡ÎfiÛÙÔ˘˜ Î·È ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈ-ÛË ÙÔ˘˜ Ú¤ÂÈ Ó· ÂÓÒÛÔ˘Ó ÙÈ˜‰˘Ó¿ÌÂÈ˜ ÙÔ˘˜ fiÏÂ˜ ÔÈ ÂÌÏÂÎfi-ÌÂÓÂ˜ ÂÈ‰ÈÎfiÙËÙÂ˜ (∂ÈÎfiÓ· 6) ÁÈ·Ó· ‚ÂÏÙÈˆıÂ› Ë ÔÈfiÙËÙ· ÛÙË‰È¿ÁÓˆÛË Î·È Ë ·ÓÙÈÌÂÙÒÈÛËÂÎ·ÙÔÌÌ˘Ú›ˆÓ ·ÛıÂÓÒÓ Ô˘ ¿-Û¯Ô˘Ó ·fi Ù· ‰‡Ô ·˘Ù¿ ÓÔÛ‹Ì·-Ù· Ì·˙›.

¶∞ƒ∞°√¡Δ∂™ ∫π¡¢À¡√À

5

∂ÈÎfiÓ· 5. ∂ÈÏÔÎ¤˜ ™¢

1. Ryden L, Standl E, Bartnik M, et al., TaskForce on Diabetes and CardiovascularDiseases of the European Society ofcardiology(ESC); European Associationfor the Study of Diabetes(EASD).Guidelines on diabetes, pre-diabetes, andcardiovascular diseases: executivesummary. Eur Heart J 2007;28:88-136

2. Donahoe SM, Garrick C. Stewart CG,McCabe HC et al. Diabetes and MortalityFollowing Acute Coronary Syndromes.JAMA.2007;298:765-775.

3. Gregg EW, Gu Q, Cheng YJ, Narayan V,Cowie Cl. Mortality trends in men and

women with diabetes, 1971 to 2000. AnnIntern Med. 2007;147:149-155.

4. Mozaffarian D, Marfi R, Levantesi G, et al.Incidence of new-onset diabetes andimpaired fasting glucose in patients withrecent myocardial infarction and the effectof clinical and lifestyle risk factors. Lancet2007; 370:667-75

5. Norhammar A, Tenerz A, Nilsson G, et al.Glucose metabolism in patients with acutemyocardial infarction and no previousdiagnosis of diabetes mellitus: aprospective study. Lancet 2002; 359:2140-44.

6. Barr ELM, Zimmet PZ, Welborn TA et al.Risk of cardiovascular and all -causemortality in individuals with diabetesmellitus, impaired fasting glucose, andimpaired glucose tolerance. Circulation2007;116:151-7

7. Bravata DM, Gienger BA, McDonald KM, etal. Systemic Review: The comparativeeffectiveness of percutaneous interventionand Coronary Artery Bypass Graft Surgery.Ann Intern Med 2007;147:10(ËÏÂÎÙÚÔÓÈÎ‹ÌÔÚÊ‹)

μμÈÈ‚‚ÏÏÈÈÔÔÁÁÚÚ··ÊÊ››··

∂ÈÎfiÓ· 6. √Ì¿‰· ·ÓÙÈÌÂÙÒÈÛË˜ ÛÙÂÊ·ÓÈ·›ˆÓ ‰È·‚ËÙÈÎÒÓ ·ÛıÂÓÒÓ.∏ ÂÈÏÔÁ‹ ÙˆÓ ı¤ÛÂˆÓ ÙˆÓ «·È¯ÙÒÓ» Â›Ó·È Ù˘¯·›·

∂Ó‰ÔÎÚÈÓÔÏfiÁÔ˜

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∫ÔÈÓˆÓÈÎ‹ §ÂÈÙÔ˘ÚÁfi˜

∞ÁÁÂÈÔ¯ÂÈÚÔ˘ÚÁfi˜

¢È·‚ËÙÔÏfiÁÔ˜

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∂ÁÎ¤Ê·ÏÔ˜ √Êı·ÏÌÔ›

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ªÈÎÚÔÏÂ˘ÎˆÌ·ÙÈÓÔ˘Ú›·,NÂÊÚÔ¿ıÂÈ·¡ÂÊÚÈÎ‹ AÓÂ¿ÚÎÂÈ·TÂÏÈÎÔ‡ SÙ·‰›Ô˘

NÂ˘Úo¿ıÂÈ·AN™

AÌÊÈ‚ÏËÛÙÚÔÂÈ‰Ô¿ıÂÈ·°Ï·‡ÎˆÌ·K·Ù·Ú¿ÎÙË˜

∫·Ú‰È¿

√™™

™∫∞

¶ÂÚÈÊÂÚÈÎ‹ AÚÙËÚÈÔ¿ıÂÈ·

TIA, CVA, ÕÓÓÔÈ·

MÈÎÚÔ·ÁÁÂÈ·Î¤˜

H ÌÈÎÚÔÏÂ˘ÎˆÌ·ÙÈÓÔ˘Ú›· ıÂˆ-ÚÂ›Ù·È ˆ˜ ‰Â›ÎÙË˜ ÁÂÓÈÎÂ˘Ì¤ÓË˜ÂÓ‰ÔıËÏÈ·Î‹˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜ÛÂ fiÏÔ ÙÔ ·ÁÁÂÈ·Îfi ‰¤Ó‰ÚÔ, Û˘-ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ ÓÂÊÚÈ-ÎÒÓ ÛÂÈÚ·Ì¿ÙˆÓ. ªÂÁ¿ÏÔ˜·ÚÈıÌfi˜ ÌÂÏÂÙÒÓ ¤¯Ô˘Ó ‰Â›ÍÂÈfiÙÈ ˘ÂÚÙ·ÛÈÎÔ› Î·È ‰È·‚ËÙÈÎÔ›·ÛıÂÓÂ›˜ ÌÂ ÌÈÎÚÔÏÂ˘ÎˆÌ·ÙÈ-ÓÔ˘Ú›· ¤¯Ô˘Ó ·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔÁÈ· Î·Ú‰È·ÁÁÂÈ·Î¿ ÓÔÛ‹Ì·Ù· Î·Èı¿Ó·ÙÔ. ∞ÎfiÌË, ÛÂ ÏËı˘ÛÌÈ·-Î¤˜ Û˘Á¯ÚÔÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ¤¯ÂÈ‰È·ÈÛÙˆıÂ› fiÙÈ Ë ÌÈÎÚÔÏÂ˘Îˆ-Ì·ÙÈÓÔ˘Ú›· Û¯ÂÙ›˙ÂÙ·È fi¯È ÌfiÓÔÌÂ Û˘ÌÙˆÌ·ÙÈÎ¤˜ ·ÁÁÂÈ·Î¤˜·ı‹ÛÂÈ˜ ·ÏÏ¿ Î·È ÌÂ Ù· ÚÒÈÌ·ÛÙ¿‰È· ÙË˜ ·ıËÚˆÌ¿ÙˆÛË˜.

™ÙË ÌÂÏ¤ÙË ÙˆÓ Jørgensen Î·ÈÛ˘Ó. ÌÈ· ÚÔÔÙÈÎ‹ ÂÈ‰ËÌÈÔÏÔ-

ÁÈÎ‹ ÌÂÏ¤ÙË Ô˘ ¤Ï·‚Â ¯ÒÚÔÛÙÔ Tromsø ÙË˜ ¡ÔÚ‚ËÁ›·˜, ‰ÈÂ-ÚÂ˘Ó‹ıËÎÂ Ë Û¯¤ÛË ÙÔ˘ ÏfiÁÔ˘ÏÂ˘ÎˆÌ·Ù›ÓË˜ ÚÔ˜ ÎÚÂ·ÙÈÓ›ÓËÛÙ· Ô‡Ú· (albumin to creatinineratio – ACR) ÌÂ ÙËÓ ·Ó¿Ù˘ÍË Ó¤-ˆÓ ·ıËÚˆÌ·ÙÈÎÒÓ Ï·ÎÒÓ ÛÙÈ˜Î·ÚˆÙ›‰Â˜ ‹ ÌÂ ÙËÓ ÂÍ¤ÏÈÍË ÙˆÓ‹‰Ë ˘·Ú¯Ô˘ÛÒÓ ·fi ÙËÓ ·Ú¯‹ÙË˜ ÌÂÏ¤ÙË˜ Ï·ÎÒÓ. 6.902 ¿ÙÔ-Ì· ËÏÈÎ›·˜ 25-84 ÂÙÒÓ Ô˘ ‰È·-Ì¤ÓÔ˘Ó ÛÙËÓ ÂÓ ÏfiÁˆ ÂÚÈÔ¯‹˘Ô‚Ï‹ıËÎ·Ó ÛÂ ˘ÂÚË¯ÔÁÚ·ÊÈ-Îfi ¤ÏÂÁ¯Ô ÙˆÓ Î·ÚˆÙ›‰ˆÓ Î·Ù¿Ù· ¤ÙË 1994-95. ¶·Ú¿ÏÏËÏ· ÌÂ-ÙÚ‹ıËÎ·Ó ÙÔ ÏÂ‡ÎˆÌ· Î·È Ë ÎÚÂ-·ÙÈÓ›ÓË ÙˆÓ Ô‡ÚˆÓ ÛÂ ÚˆÈÓ¿‰Â›ÁÌ·Ù· ÙÚÈÒÓ Û˘ÓÂ¯fiÌÂÓˆÓËÌÂÚÒÓ. ÀÔÏÔÁ›ÛıËÎÂ Ô ÏfiÁÔ˜ÏÂ˘ÎˆÌ·Ù›ÓË˜ ÚÔ˜ ÎÚÂ·ÙÈÓ›ÓË(ACR) ÛÂ ÌÔÓ¿‰Â˜ mg/mmol Î·È

ÁÈ· ÙËÓ ·Ó¿Ï˘ÛË ¯ÚËÛÈÌÔÔÈ‹-ıËÎÂ Ô Ì¤ÛÔ˜ fiÚÔ˜ ÙˆÓ ÙÚÈÒÓËÌÂÚÒÓ. ∂›ÛË˜ Î·Ù·ÁÚ¿ÊËÎ·ÓÔÈ Î·ÓÈÛÙÈÎ¤˜ Û˘Ó‹ıÂÈÂ˜, Ë Ù˘-¯fiÓ ‡·ÚÍË Û·Î¯·ÚÒ‰Ô˘˜ ‰È·-‚‹ÙË, ÛÙËı¿Á¯Ë˜, ·Ï·ÈÔ‡ ÂÌ-ÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘ ‹·ÁÁÂÈ·ÎÔ‡ ÂÁÎÂÊ·ÏÈÎÔ‡, Ë Ï‹„Ë·ÓÙÈ˘ÂÚÙ·ÛÈÎ‹˜ ·ÁˆÁ‹˜, Ë Ûˆ-Ì·ÙÈÎ‹ ‰Ú·ÛÙËÚÈfiÙËÙ· Î·È ÌÂ-ÙÚ‹ıËÎ·Ó ÙÔ ‡„Ô˜, ÙÔ ‚¿ÚÔ˜, Ë∞¶, ÔÈ ÙÈÌ¤˜ ÙˆÓ ÏÈÈ‰›ˆÓ, Ô·ÚÈıÌfi˜ ÙˆÓ ÏÂ˘ÎÒÓ ·ÈÌÔÛÊ·È-Ú›ˆÓ Î·È ÙˆÓ ÌÔÓÔÎ˘ÙÙ¿ÚˆÓ Î·ÈÙÔ ÈÓˆ‰ÔÁfiÓÔ.

∂Ù¿ ¯ÚfiÓÈ· ·ÚÁfiÙÂÚ· Â·ÓÂÍÂ-Ù¿ÛıËÎ·Ó ˘ÂÚË¯ÔÁÚ·ÊÈÎ¿ 4.858(ÙÔ 72% ÙÔ˘ ·Ú¯ÈÎÔ‡ ÏËı˘ÛÌÈ·-ÎÔ‡ ‰Â›ÁÌ·ÙÔ˜). ∞fi ·˘ÙÔ‡˜ ÔÈ2.610 ‰ÂÓ Â›¯·Ó Ï¿ÎÂ˜ ÛÙËÓ ·Ú-¯ÈÎ‹ ÂÍ¤Ù·ÛË ÂÓÒ ÔÈ ˘fiÏÔÈÔÈ2.248 Â›¯·Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ ÌÈ·Ï¿Î·. 821 ·ÛıÂÓÂ›˜ ·ÔÎÏÂ›-ÛıËÎ·Ó ·fi ÙËÓ ·Ó¿Ï˘ÛË ÁÈ·‰È·ÊfiÚÔ˘˜ ÏfiÁÔ˘˜ (ÂÎ‰‹ÏˆÛËÛ·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË, ÂÏÏÈ‹ÛÙÔÈ¯Â›·, ·fiÛ˘ÚÛË ·fi ÙË ÌÂ-Ï¤ÙË ÏfiÁˆ ÂÈı˘Ì›·˜ ÙˆÓ ·ÛıÂ-ÓÒÓ ÎÏ) Î·È ¤ÙÛÈ ÙÂÏÈÎ¿ Û˘ÌÂ-ÚÈÏ‹ÊıËÎ·Ó 4.037 ¿ÙÔÌ· (2.203¯ˆÚ›˜ Î·È 1.834 ÌÂ Ï¿ÎÂ˜ ÛÙËÓ¤Ó·ÚÍË ÙË˜ ·Ú·Ù‹ÚËÛË˜).

∞fi Ù· ¿ÙÔÌ· ¯ˆÚ›˜ ÚÔ¸¿Ú-¯Ô˘ÛÂ˜ ·ıËÚˆÌ·ÙÈÎ¤˜ Ï¿ÎÂ˜,884 ·Ó¤Ù˘Í·Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì›·Ù¤ÙÔÈ· ÛÙË ‰È¿ÚÎÂÈ· ÙË˜ ÂÙ·Â-Ù›·˜. ∏ ·Ó¿Ù˘ÍË Î·È Ë ¤ÎÙ·ÛËÙË˜ ·ıËÚˆÌ¿ÙˆÛË˜ ‚Ú¤ıËÎÂ fiÙÈÛ¯ÂÙ›˙ÂÙ·È ÌÂ ÙËÓ ËÏÈÎ›·, ÙÔ Ê‡-ÏÔ, ÙË Û˘ÛÙÔÏÈÎ‹ Î·È ‰È·ÛÙÔÏÈÎ‹·ÚÙËÚÈ·Î‹ ›ÂÛË, ÙË ¯ÔÏËÛÙÂÚfi-ÏË ÔÚÔ‡, ÙÔ Î¿ÓÈÛÌ· ÙÔ ÏfiÁÔÏÂ˘ÎˆÌ·Ù›ÓË˜/ÎÚÂ·ÙÈÓ›ÓË˜ Ô‡-ÚˆÓ (ACR), ÙÔ ÈÓˆ‰ÔÁfiÓÔ Î·ÈÙÔÓ ·ÚÈıÌfi ÙˆÓ ÌÔÓÔÎ˘ÙÙ¿ÚˆÓÎ·È ÏÂ˘ÎÔÎ˘ÙÙ¿ÚˆÓ ·›Ì·ÙÔ˜. ªÂ-Ù¿ ÛÙ¿ıÌÈÛË ˆ˜ ÚÔ˜ ÙÔ˘˜ ¿Ï-ÏÔ˘˜ ·Ú¿ÁÔÓÙÂ˜, o ACR ‚Ú¤ıË-ÎÂ fiÙÈ Û¯ÂÙ›˙ÂÙ·È ÁÚ·ÌÌÈÎ¿ ÌÂ

¢ ∂ ∫ ∂ ª μ ƒ π √ ™ 2 0 0 7

6

∏ §Â˘ÎˆÌ·ÙÈÓÔ˘Ú›· ˆ˜ ¶·Ú¿ÁˆÓ ŒÓ·ÚÍË˜ Î·È ∂Í¤ÏÈÍË˜ ÙË˜ ∫·ÚˆÙÈ‰ÈÎ‹˜ ∞ıËÚÔÛÎÏ‹ÚˆÛË˜ ÛÂ

ÌË ¢È·‚ËÙÈÎ¿ ÕÙÔÌ·. ªÂÏ¤ÙË TromsøJørgensen L, Jenssen T, Johnsen SH, Mathiesen EB, Heuch I,

Joakimsen O, Fosse E, and Jacobsen BK.

Eur Heart J 2007;28:363-9

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Ó (m

m2 )

§ÔÁ¿ÚÈıÌÔ˜ ÙË˜ ÙÈÌ‹˜ ÙÔ˘ ACR.

∂ÈÎfiÓ· 1. ™˘Û¯¤ÙÈÛË ÙÔ˘ ÏÔÁ·Ú›ıÌÔ˘ ÙˆÓ ÙÈÌÒÓ ÙÔ˘ ÏfiÁÔ˘ ÏÂ˘ÎˆÌ·Ù›ÓË˜/ÎÚÂ·-ÙÈÓ›ÓË˜ Ô‡ÚˆÓ (ACR) ÌÂ ÙËÓ ¤ÎÙ·ÛË ÙˆÓ Ó¤ˆÓ ·ıËÚˆÌ·ÙÈÎÒÓ ‚Ï·‚ÒÓ, ÛÂ ¿ÙÔÌ·¯ˆÚ›˜ ÚÔ¸¿Ú¯Ô˘ÛÂ˜ Ï¿ÎÂ˜.

ÙËÓ ·Ó¿Ù˘ÍË ÙÔ Ì¤ÁÂıÔ˜ ÙˆÓÓ¤ˆÓ Ï·ÎÒÓ (ƒ=0,009) Î·ıÒ˜Î·È ÌÂ ÙËÓ ÂÍ¤ÏÈÍË ÙˆÓ ÚÔ¸·Ú-¯Ô˘ÛÒÓ Ï·ÎÒÓ (ƒ=0,026). ™ÙËÓ∂ÈÎfiÓ· 1 Ê·›ÓÂÙ·È Ë Û¯¤ÛË ÙË˜·ıËÚˆÌ·ÙÈÎ‹˜ ÂÚÈÔ¯‹˜ ÌÂ ÙÔÓÏÔÁ¿ÚÈıÌÔ ÙÔ˘ ACR ÛÙ· ¿ÙÔÌ·¯ˆÚ›˜ ÚÔ¸¿Ú¯Ô˘ÛÂ˜ Ï¿ÎÂ˜

Î·È ÛÙËÓ ∂ÈÎfiÓ· 2 Ë ›‰È· Û¯¤ÛËÙË˜ ÌÂÙ·‚ÔÏ‹˜ ÙˆÓ ÚÔ¸·Ú-¯Ô˘ÛÒÓ Ï·ÎÒÓ ÌÂ ÙÔÓ ÏÔÁ¿ÚÈı-ÌÔ ÙÔ˘ ACR. À„ËÏ¤˜ ÙÈÌ¤˜ ÈÓˆ-‰ÔÁfiÓÔ˘ ÂÈÙ·¯‡ÓÔ˘Ó ÙËÓ ·Ó¿-Ù˘ÍË ÙˆÓ Ó¤ˆÓ Ï·ÎÒÓ Î·ıÒ˜Î·È ÙˆÓ ÌÈÎÚÒÓ ÚÔ¸·Ú¯Ô˘ÛÒÓÏ·ÎÒÓ, ÂÓÒ ¤¯Ô˘Ó ÌÈÎÚfiÙÂÚË

Â›‰Ú·ÛË ÛÙÈ˜ ÌÂÁ·Ï‡ÙÂÚÂ˜ Ï¿-ÎÂ˜.

√ ÌË¯·ÓÈÛÌfi˜, Ì¤Ûˆ ÙÔ˘ ÔÔ›Ô˘Ô ·˘ÍËÌ¤ÓÔ ACR Û¯ÂÙ›˙ÂÙ·È ÌÂÙËÓ ·Ó¿Ù˘ÍË ÙË˜ ·ıËÚˆÌ¿Ùˆ-ÛË˜, ‰ÂÓ Â›Ó·È ·ÎfiÌË ·fiÏ˘Ù·ÁÓˆÛÙfi˜, ›Ûˆ˜ fiÌˆ˜ Ó· ¤ÁÎÂÈÙ·ÈÛÙËÓ ·ıÔÏÔÁÈÎ‹ ‰È·ÂÚ·ÙfiÙË-Ù· ÙÔ˘ ÂÓ‰ÔıËÏ›Ô˘, ÏfiÁˆ ÙË˜ÔÔ›·˜ ‰ÈÂ˘ÎÔÏ‡ÓÂÙ·È Ë Â›ÛÔ‰Ô˜ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È ¿ÏÏˆÓ ·ıË-ÚÔÁfiÓˆÓ ÛˆÌ·ÙÈ‰›ˆÓ ÛÙÔ ·ÁÁÂÈ-·Îfi ÙÔ›¯ˆÌ·. ΔÔ ÈÓˆ‰ÔÁfiÓÔ Â›-Ó·È ÚˆÙÂ˝ÓË ÔÍÂ›·˜ Ê¿ÛÂˆ˜ Î·È‰Â›ÎÙË˜ ÊÏÂÁÌÔÓ‹˜, ¤¯ÂÈ fiÌˆ˜Î·È ¿ÏÏÂ˜ È‰ÈfiÙËÙÂ˜ Ô˘ ÌÔÚÂ›Ó· ÚÔ¿ÁÔ˘Ó ÙËÓ ·ıËÚˆÌ·ÙÈÎ‹‰È·‰ÈÎ·Û›·, fiˆ˜ ·˘Í¿ÓÂÈ ÙËÁÏÔÈfiÙËÙ· ÙÔ˘ ·›Ì·ÙÔ˜, ¤¯ÂÈ ¯Ë-ÌÂÈÔÙ·ÎÙÈÎ¤˜ È‰ÈfiÙËÙÂ˜ Î·È ‰ÈÂ-ÁÂ›ÚÂÈ Ù· ·ÈÌÔÂÙ¿ÏÈ·.

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, ·ÎfiÌË Î·È ÛÂ¿ÙÔÌ· ¯ˆÚ›˜ Û·Î¯·ÚÒ‰Ë ‰È·‚‹-ÙË Î·È ¯ˆÚ›˜ Ì·ÎÚÔÏÂ˘ÎˆÌ·ÙÈ-ÓÔ˘Ú›·, ˘¿Ú¯ÂÈ ÁÚ·ÌÌÈÎ‹ Û˘-Û¯¤ÙÈÛË ÙÔ˘ ÏfiÁÔ˘ ÏÂ˘ÎˆÌ·Ù›-ÓË/ÎÚÂ·ÙÈÓ›ÓË Ô‡ÚˆÓ ÌÂ ÙËÓ¤Ó·ÚÍË Î·È ÙËÓ ÂÍ¤ÏÈÍË ÙË˜ ·ıË-ÚˆÌ¿ÙˆÛË˜ Î·È Ë Û˘Û¯¤ÙÈÛË ·˘-Ù‹ ÂÈÙÂ›ÓÂÙ·È ·fi ÙÔ ÈÓˆ‰ÔÁfiÓÔÛÂ ¿ÙÔÌ· ¯ˆÚ›˜ ‹ ÌÂ ÌÈÎÚ¤˜·ıËÚˆÌ·ÙÈÎ¤˜ Ï¿ÎÂ˜

∂ÈÌ¤ÏÂÈ·: ∏Ï›·˜ ÃÂÈÌÒÓ·˜

¶∞ƒ∞°√¡Δ∂™ ∫π¡¢À¡√À

7

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∂ÈÎfiÓ· 2. ™˘Û¯¤ÙÈÛË ÙÔ˘ ÏÔÁ·Ú›ıÌÔ˘ ÙˆÓ ÙÈÌÒÓ ÙÔ˘ ÏfiÁÔ˘ ÏÂ˘ÎˆÌ·Ù›ÓË˜/ÎÚÂ·-ÙÈÓ›ÓË˜ Ô‡ÚˆÓ (ACR) ÌÂ ÙË ÌÂÙ·‚ÔÏ‹ ÙË˜ ¤ÎÙ·ÛË˜ ÙˆÓ ·ıËÚˆÌ·ÙÈÎÒÓ ‚Ï·‚ÒÓÛÂ ¿ÙÔÌ· ÌÂ ÚÔ¸¿Ú¯Ô˘ÛÂ˜ Ï¿ÎÂ˜.

§ÔÁ¿ÚÈıÌÔ˜ ÙË˜ ÙÈÌ‹˜ ÙÔ˘ ACR.

¢ ∂ ∫ ∂ ª μ ƒ π √ ™ 2 0 0 7

8

∂ÈÛ·ÁˆÁ‹

∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ë ·Ó·ÈÌ›· Â›Ó·È‰˘Ó·Ùfi Ó· ÚÔÎ·Ï¤ÛÂÈ Û˘Óı‹-ÎÂ˜ ˘ÂÚ‰˘Ó·ÌÈÎ‹˜ Î˘ÎÏÔÊÔ-Ú›·˜ Î·È Î·Ú‰È·Î‹˜ ·ÓÂ¿ÚÎÂÈ-·˜ (∫∞) ·ÎfiÌË Î·È ÛÂ ·ÛıÂÓÂ›˜¯ˆÚ›˜ ˘ÔÎÂ›ÌÂÓË Î·Ú‰È·Î‹ Ófi-ÛÔ1. ™ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ·˘Ù¤˜, Ë‰ÈfiÚıˆÛË ÙË˜ ·Ó·ÈÌ›·˜ ÌÂ ÌÂ-Ù·ÁÁ›ÛÂÈ˜ Â›Ó·È ‰˘Ó·Ùfi Ó· Ô‰Ë-Á‹ÛÂÈ ÛÙËÓ ·ÔÎ·Ù¿ÛÙ·ÛË ÙË˜∫∞. ∏ ÂÈÛ·ÁˆÁ‹ ·fi ÙÔ˘˜Silverberg Î·È Û˘Ó., ÙÔ 2002,ÙÔ˘ fiÚÔ˘ cardiorenal anemiasyndrome (Û‡Ó‰ÚÔÌÔ Î·Ú‰ÈÔÓÂ-ÊÚÈÎ‹˜ ·Ó·ÈÌ›·˜)2 ÂÈ‚Â‚·›ˆÛÂÌÂÚÈÎ¤˜ ÌÂÏ¤ÙÂ˜ Ô˘ ÈÛ¯˘Ú›-ÛÙËÎ·Ó Î·È ÙÔ ·ÓÙ›ıÂÙÔ: fiÙÈ ‰Ë-Ï·‰‹ Ë ·Ó·ÈÌ›· ‰ÂÓ ·ÔÙÂÏÂ›ÌfiÓÔ ÙÔ ·›ÙÈÔ ·ÏÏ¿ Î·È ÙÔ ·ÈÙÈ·-Ùfi ÙË˜ Û˘ÌÊÔÚËÙÈÎ‹˜ ∫∞. √Û˘Ó‰˘·ÛÌfi˜ ÙË˜ Ì¿ÏÈÛÙ· ÌÂÙËÓ ¤ÎÙˆÛË ÙË˜ ÓÂÊÚÈÎ‹˜ ÏÂÈ-ÙÔ˘ÚÁ›·˜ Ô‰ËÁÂ› ÛÂ ¤Ó· Ê·‡ÏÔÎ‡ÎÏÔ ·ÏÏËÏÂ›‰Ú·ÛË˜ Î·È·ÔÚÚ‡ıÌÈÛË˜ ÙË˜ ∫∞ Î·È Â›Ó·È‰˘Ó·Ùfi Ó· ÂÍËÁ‹ÛÂÈ ¤Ó· ÌÂÁ¿ÏÔÔÛÔÛÙfi ÙË˜ ÓÔÛËÚfiÙËÙ·˜,ıÓËÙfiÙËÙ·˜ Î·È ÙˆÓ Û˘¯ÓÒÓÂ·ÓÂÈÛ·ÁˆÁÒÓ ÛÙ· ÓÔÛÔÎÔ-ÌÂ›· ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ∫∞3, 4.

∂ÈÔÏ·ÛÌfi˜ ÙË˜ ·Ó·ÈÌ›·˜ÌÂÙ·Í‡ ·ÛıÂÓÒÓ ÌÂ ∫∞

ªÂ ‚¿ÛË ÙÔÓ ÔÚÈÛÌfi ÙÔ˘ ¶·-ÁÎfiÛÌÈÔ˘ √ÚÁ·ÓÈÛÌÔ‡ ÀÁÂ›·˜ÁÈ· ÙËÓ ·Ó·ÈÌ›· (Â›Â‰· ·ÈÌÔ-ÛÊ·ÈÚ›ÓË˜ (Hb) <13 g/dL ÁÈ·ÙÔ˘˜ ¿Ó‰ÚÂ˜ Î·È <12 g/dL ÁÈ·ÙÈ˜ Á˘Ó·›ÎÂ˜) ÂÚ›Ô˘ ¤Ó· Ô-ÛÔÛÙfi 10% ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘-ÛÌÔ‡ ıÂˆÚÂ›Ù·È fiÙÈ ¿Û¯ÂÈ ·fi·Ó·ÈÌ›·5. √ ÂÈÔÏ·ÛÌfi˜ ÙË˜·Ó·ÈÌ›·˜ ÌÂÙ·Í‡ ·ÛıÂÓÒÓ ÌÂ∫∞ ÔÈÎ›ÏÂÈ ÛÙÈ˜ ‰È¿ÊÔÚÂ˜ ÎÏÈ-ÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜, Î˘Ì·ÈÓfiÌÂÓÔ˜·fi 2,7% ¤ˆ˜ Î·È 61%6-11, Èı·-ÓfiÓ ÏfiÁˆ ÙˆÓ ‰È·ÊÔÚÂÙÈÎÒÓÎÏÈÓÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙˆÓ·ÛıÂÓÒÓ ÙË˜ Î¿ıÂ ÌÂÏ¤ÙË˜.ªÈ· post hoc ·Ó¿Ï˘ÛË Ì¿ÏÈÛÙ·

·˘ÙÒÓ ÙˆÓ ÌÂÏÂÙÒÓ ¤‰ÂÈÍÂ fiÙÈÙ· Â›Â‰· ÙË˜ ∏b Â›Ó·È Û·ÊÒ˜¯·ÌËÏfiÙÂÚ· ÌÂÙ·Í‡ ÈÔ ËÏÈÎÈˆ-Ì¤ÓˆÓ ·ÛıÂÓÒÓ ÌÂ ‚·Ú‡ÙÂÚË∫∞, Î·ıÒ˜ Î·È ÌÂÙ·Í‡ ·˘ÙÒÓÔ˘ ¿Û¯Ô˘Ó ·fi Û·Î¯·ÚÒ‰Ë‰È·‚‹ÙË ‹ ¯ÚfiÓÈ· ÓÂÊÚÈÎ‹ ·ÓÂ-¿ÚÎÂÈ· (Ã¡∞) Î·ıÒ˜ Î·È ·˘-ÙÒÓ Ô˘ ÓÔÛËÏÂ‡ÔÓÙ·È ‰È·ÚÎÒ˜ÛÂ ÓÔÛÔÎÔÌÂÈ·Î‹ ‚¿ÛË12.

∞Ó ıÂˆÚËıÂ› fiÙÈ ·Ó·ÈÌÈÎÔ› Â›Ó·ÈÔÈ ·ÛıÂÓÂ›˜ ÌÂ Ì¤ÛÔ fiÚÔ Hb <12 g/dL ÙfiÙÂ ÙÔ ÔÛÔÛÙfi ÙË˜·Ó·ÈÌ›·˜ ÌÂÙ·Í‡ ·ÛıÂÓÒÓ ÌÂ∫∞ ·ÁÁ›˙ÂÈ ÙÔ 55%10. À¿Ú¯ÂÈÌ¿ÏÈÛÙ· ÌÈ· ÎÏÈÌ¿ÎˆÛË ÙÔ˘ ·-Ú·¿Óˆ ÔÛÔÛÙÔ‡ ·Ú¿ÏÏËÏ·ÌÂ ÙËÓ ÚfiÔ‰Ô ÙÔ˘ ÛÙ·‰›Ô˘Î·Ú‰È·Î‹˜ ·ÓÂ¿ÚÎÂÈ·˜ Î·Ù¿¡À∏A (New York Heart Asso-ciation) ·fi I ¤ˆ˜ Î·È IV. ŒÙÛÈ,ÂÓÒ ÌfiÏÈ˜ ÙÔ 9,1% ÙˆÓ ·ÛıÂ-ÓÒÓ ÌÂ ÛÙ¿‰ÈÔ ¡À∏∞ π ıÂˆÚÔ‡-ÓÙ·È ·Ó·ÈÌÈÎÔ›, Ù· ÔÛÔÛÙ¿ ·˘-Ù¿ ·Ó¤Ú¯ÔÓÙ·È ÛÙÔ 19,2%,52,6% Î·È 79,1% ÁÈ· Ù· ÛÙ¿‰È·II, III, Î·È IV, ·ÓÙ›ÛÙÔÈ¯·10, 13.

∂ÈÏ¤ÔÓ, ÛËÌ·ÓÙÈÎ‹ ıÂˆÚÂ›Ù·ÈË Û˘ÌÌÂÙÔ¯‹ ÙË˜ ·Ó·ÈÌ›·˜ ÛÙËÓ·‡ÍËÛË ÙË˜ Û˘ÓÔÏÈÎ‹˜ ÓÔÛËÚfi-ÙËÙ·˜, ıÓËÙfiÙËÙ·˜ Î·È ·Ó¿ÁÎË˜ÂÈÛ·ÁˆÁ‹˜ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÙˆÓ·ÛıÂÓÒÓ ÌÂ ∫∞. ¢È·ÈÛÙÒıËÎÂfiÙÈ ·‡ÍËÛË ÙË˜ Hb Î·Ù¿ 1g/dL,ÛÂ Û¯¤ÛË ÌÂ Ù· ‚·ÛÈÎ¿ Â›Â-‰·, ·ÎÔÏÔ˘ıÔ‡ÓÙ·Ó ·fi ÌÈ·ÂÏ¿ÙÙˆÛË ÙË˜ ıÓËÙfiÙËÙ·˜ ·fi∫∞ Î·Ù¿ 15,8%, ÂÓÒ Ô Û˘Ó‰˘·-ÛÌfi˜ ıÓËÙfiÙËÙ·˜ Î·È ÓÔÛÔÎÔ-ÌÂÈ·Î‹˜ ÓÔÛËÏÂ›·˜ ÂÌÊ¿ÓÈ˙Â ÂÏ¿Ù-ÙˆÛË ÙË˜ Ù¿ÍË˜ ÙÔ˘ 12,4%14. ™ÂÔÏ˘ÎÂÓÙÚÈÎ‹ ÌÂÏ¤ÙË 21 ÓÔÛÔ-ÎÔÌÂ›ˆÓ ÙˆÓ ∏¶∞ Ô˘ ÂÚÈ¤Ï·-‚Â 9.107 ·ÛıÂÓÂ›˜ ÌÂ ∫∞, ÁÈ·Î¿ıÂ 1g/dL ·‡ÍËÛË ÙË˜ Hb ‰È·-ÈÛÙÒıËÎÂ ÌÂ›ˆÛË Î·Ù¿ 10,2%ÙË˜ ıÓËÙfiÙËÙ·˜ Î·È ÌÈ· ·Ó¿ÏÔ-ÁË ÌÂ›ˆÛË Î·Ù¿ 5,1% ÙÔ˘ Û˘ÓÔ-ÏÈÎÔ‡ ·ÚÈıÌÔ‡ ËÌÂÚÒÓ ÓÔÛËÏÂ›-·˜15. ™Â ·Ó¿ÏÔÁÂ˜ ÌÂÏ¤ÙÂ˜, ‰È·-ÈÛÙÒıËÎÂ fiÙÈ ˘¿Ú¯ÂÈ ÛÙ·ÙÈ-

ÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ fiÛÔÓ·ÊÔÚ¿ ÛÙËÓ ·Ó¿ÁÎË ÓÔÛËÏÂ›·˜ÌÂÙ·Í‡ ·Ó·ÈÌÈÎÒÓ Î·È ÌË ·Ó·ÈÌÈ-ÎÒÓ ·ÛıÂÓÒÓ ÌÂ ∫∞ (50% ÛÙËÓÚÒÙË ÔÌ¿‰·, 15% ÛÙË ‰Â‡ÙÂ-ÚË)16, 17.

∂Ï¿¯ÈÛÙÂ˜ Â›Ó·È ÔÈ ÌÂÏ¤ÙÂ˜ Ô˘‰ÂÓ ˘ÔÛÙËÚ›˙Ô˘Ó Û·Ê‹ Û˘Û¯¤-ÙÈÛË ÌÂÙ·Í‡ ÙË˜ ·Ó·ÈÌ›·˜ Î·ÈÙË˜ ıÓËÙfiÙËÙ·˜ ·fi ∫∞. ™Â ÌÈ·ÌÂÏ¤ÙË Ô˘ ÂÚÈ¤Ï·‚Â 174·ÛıÂÓÂ›˜ ÌÂ ∫∞ ÛÙ·‰›Ô˘ III Î·ÈIV Î·Ù¿ ¡À∏∞, ·fi ÙÔ˘˜ ÔÔ›-Ô˘˜ ÙÔ 82% Â›¯Â Î¿ÔÈÔ˘ ‚·ı-ÌÔ‡ ¤ÎÙˆÛË ÙË˜ ÓÂÊÚÈÎ‹˜ ÏÂÈ-ÙÔ˘ÚÁ›·˜, ÙÔ ÔÛÔÛÙfi ıÓËÙfiÙË-Ù·˜ ÌÂÙ·Í‡ ·Ó·ÈÌÈÎÒÓ ·ÛıÂÓÒÓÌÂ ∫∞ ‰Â ‰È¤ÊÂÚÂ ÛÙ·ÙÈÛÙÈÎ¿ÛËÌ·ÓÙÈÎ¿ ·fi ÙÔ ·ÓÙ›ÛÙÔÈ¯ÔÔÛÔÛÙfi ÙˆÓ ÌË ·Ó·ÈÌÈÎÒÓ(12,4% vs 8,3%, p=0,31), ÂÓÒ Ô‚·ıÌfi˜ ¤ÎÙˆÛË˜ ÙË˜ ÓÂÊÚÈ-Î‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ Î·È ÙÔ ÎÏ¿ÛÌ·ÂÍÒıËÛË˜ ıÂˆÚ‹ıËÎ·Ó ÔÈ ÈÔÛËÌ·ÓÙÈÎÔ› ÚÔÁÓˆÛÙÈÎÔ› ‰Â›-ÎÙÂ˜ ıÓËÙfiÙËÙ·˜18.

∞Ó Î·È ÙÔ 50% ÙˆÓ ·ÛıÂÓÒÓ ÌÂKA ¤¯ÂÈ Î¿ÔÈÔ ‚·ıÌfi ·Ó·ÈÌ›·˜,ÂÓÙ˘ˆÛÈ·Îfi Â›Ó·È ÙÔ ÔÛÔÛÙfi˘ÔıÂÚ·Â›·˜ ÙˆÓ ·ÛıÂÓÒÓ ·˘-ÙÒÓ. ™Â ÂÈ‰ËÌÈÔÏÔÁÈÎ‹ ÌÂÏ¤ÙËÔ˘ ÂÚÈ¤Ï·‚Â 2.000 ·ÛıÂÓÂ›˜ÌÂ ·ÓÙÈÚÚÔÔ‡ÌÂÓË ∫∞, ÂÚ›-Ô˘ 29% ÙˆÓ ·ÛıÂÓÒÓ ·Ó¤Ù˘-Í·Ó ·Ó·ÈÌ›· Î·Ù¿ ÙÔ ‰È¿ÛÙËÌ··Ú·ÎÔÏÔ‡ıËÛË˜, fiÌˆ˜ ÌfiÏÈ˜10% ¤Ï·‚Â Ê·ÚÌ·ÎÂ˘ÙÈÎ‹ ·Áˆ-Á‹19.

¶·ıÔÊ˘ÛÈÔÏÔÁÈÎÔ› ÌË¯·ÓÈÛÌÔ› ÛÙËÓ ·Ó·ÈÌ›·

ÙË˜ ∫∞

¢È¿ÊÔÚÔÈ ·Ú¿ÁÔÓÙÂ˜ Ê·›ÓÂÙ·ÈÓ· Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ ÂÁÎ·Ù¿-ÛÙ·ÛË ÙË˜ ·Ó·ÈÌ›·˜ ÛÙÔ˘˜·ÛıÂÓÂ›˜ ÌÂ ∫∞ :

1) ∞˘ÍËÌ¤ÓË ‰Ú·ÛÙËÚÈfiÙËÙ·Î˘ÙÔÎÈÓÒÓ, ÌÂÙ·Í‡ ÙˆÓ ÔÔ›ˆÓË ÈÓÙÂÚÏÂ˘Î›ÓË 6 (Interleukin-6,IL-6), Ô ·Ú¿ÁÔÓÙ·˜ Ó¤ÎÚˆÛË˜

¶·ıÔÊ˘ÛÈÔÏÔÁ›· ÙÔ˘ ™˘Ó‰ÚfiÌÔ˘ ÙË˜ ∫·Ú‰ÈÔÓÂÊÚÈÎ‹˜ ∞Ó·ÈÌ›·˜.

∂˘ÛÙ¿ıÈÔ˜ ¶·ÁÎÔ˘Ú¤ÏÈ·˜, Ã·Ú¿Ï·ÌÔ˜ ∫Ô˘Ì·Ú¿˜, ÕÓÓ· ∫·Î·Ê‹Î·, ¶·Ú·ÛÎÂ˘‹ ∑ÒÚÔ˘, μ·Û›ÏÂÈÔ˜ Õı˘ÚÔ˜, ∞ÛÙ¤ÚÈÔ˜ ∫·Ú·ÁÈ¿ÓÓË˜.

μ’ ¶ÚÔ·È‰Â˘ÙÈÎ‹ ¶·ıÔÏÔÁÈÎ‹ ∫ÏÈÓÈÎ‹ ∞¶£, πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô, £ÂÛÛ·ÏÔÓ›ÎË.

9

¶∞£√ºÀ™π√§√°π∞

fiÁÎÔ˘ (TNFa, Tumor Necrosisfactor a), Î·ıÒ˜ Î·È ÔÈ ‰È·Ï˘ÙÔ›˘Ô‰Ô¯Â›˜ ÙÔ˘ TNF 1 Î·È 2 20-22.∏ ‰Ú¿ÛË ÙˆÓ ·Ú·¿Óˆ Î˘ÙÔ-ÎÈÓÒÓ ¤ÁÎÂÈÙ·È ÛÙË ‚Ú¿¯˘ÓÛËÙË˜ ‰È¿ÚÎÂÈ·˜ ˙ˆ‹˜ ÙˆÓ ÂÚ˘-ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ, ÛÙË ÌÂ›ˆ-ÛË ÙË˜ ·Ú·ÁˆÁ‹˜ ÂÚ˘ıÚÔÔÈ-ËÙ›ÓË˜ (∂ƒ√, erythropoietin)·fi Ù· ‰È¿ÌÂÛ· Î‡ÙÙ·Ú· ÙÔ˘ÓÂÊÚÈÎÔ‡ ·ÚÂÁ¯‡Ì·ÙÔ˜, ÛÙËÓ·ÓÙ›ÛÙ·ÛË ÛÙË ‰Ú¿ÛË ÙË˜ ∂ƒ√ÛÙ· ÚÔÁÔÓÈÎ¿ Î‡ÙÙ·Ú· ÙÔ˘Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ23 Î·ıÒ˜ Î·ÈÛÙËÓ ·ÚÂÌfi‰ÈÛË ÙË˜ ·ÂÏÂ˘-ı¤ÚˆÛË˜ ÛÈ‰‹ÚÔ˘ ÁÈ· ÙËÓ Â·-Ó·¯ÚËÛÈÌÔÔ›ËÛ‹ ÙÔ˘ ·fi Ù·Î‡ÙÙ·Ú· ÙÔ˘ ‰ÈÎÙ˘ÔÂÓ‰ÔıËÏÈ·-ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜20, 22. À¿Ú¯ÂÈÌ¿ÏÈÛÙ· ıÂÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂ-Ù·Í‡ ÙÔ˘ ‚·ıÌÔ‡ ∫∞ Î·È ÙˆÓÂÈ¤‰ˆÓ ÙˆÓ Î˘ÎÏÔÊÔÚÔ‡ÓÙˆÓÎ˘ÙÔÎÈÓÒÓ24, ·Ú·¤ÌÔÓÙ·˜ÛÙËÓ ·Ó¿ÏÔÁË Û˘Û¯¤ÙÈÛË ÙÔ˘‚·ıÌÔ‡ ·Ó·ÈÌ›·˜ Î·È ÙÔ˘ ÛÙ·‰›-Ô˘ ∫∞24. ∂ÈÏ¤ÔÓ, ¿ÏÏË ‰Ú¿ÛËÙË˜ πL-6 ıÂˆÚÂ›Ù·È Ë ‰ÈÂ˘ÎfiÏ˘Ó-ÛË ÙË˜ ·ÂÏÂ˘ı¤ÚˆÛË˜ ·fi ÙÔ‹·Ú ÙË˜ ¯Â„È‰›ÓË˜ (hepcidin).∏ ÙÂÏÂ˘Ù·›· ·ÔÙÂÏÂ› ¤Ó· Â-Ù›‰ÈÔ Ô˘ ‰Ú· ·ÊÂÓfi˜ ÛÙÔ ¤Ó-ÙÂÚÔ ÂÌÔ‰›˙ÔÓÙ·˜ ÙËÓ ·ÔÚ-ÚfiÊËÛË ÛÈ‰‹ÚÔ˘ ·fi ÙÔ ÂÓÙÂ-ÚÈÎfi ÂÈı‹ÏÈÔ22, 25-27, ·ÊÂÙ¤ÚÔ˘ÛÙ· Ì·ÎÚÔÊ¿Á· Î·È Ù· Ë·ÙÔ-Î‡ÙÙ·Ú· ÂÌÔ‰›˙ÔÓÙ·˜ ÙËÓ ·Â-ÏÂ˘ı¤ÚˆÛË ÛÈ‰‹ÚÔ˘ Î·È ÙËÓ Î·-ı‹ÏˆÛ‹ ÙÔ˘ ÛÙ· ·Ú·¿ÓˆÎ‡ÙÙ·Ú·26-28.

2) ∏ ¤ÎÙˆÛË ÙË˜ ÓÂÊÚÈÎ‹˜ ÏÂÈ-ÙÔ˘ÚÁ›·˜ Î·È Ë ÂÁÎ·Ù¿ÛÙ·ÛË¿ÏÏÔÙÂ ¿ÏÏÔ˘ ‚·ıÌÔ‡ ÓÂÊÚÈ-Î‹˜ ·ÓÂ¿ÚÎÂÈ·˜ ·ÔÙÂÏÂ› ÌÂ›-˙ÔÓ· ·Ú¿ÁÔÓÙ· ÂÌÊ¿ÓÈÛË˜·Ó·ÈÌ›·˜ ÌÂÙ·Í‡ ·ÛıÂÓÒÓ ÌÂ∫∞. ∏ Ã¡∞ ··ÓÙ¿ Û˘¯Ó¿ ÌÂÙ·-Í‡ ·ÛıÂÓÒÓ ÌÂ ∫∞29, ÂÓÒ Ô Ì¤-ÛÔ˜ fiÚÔ˜ ÙË˜ ÎÚÂ·ÙÈÓ›ÓË˜ ÔÚÔ‡Â›Ó·È Û·ÊÒ˜ ÂËÚÂ·ÛÌ¤ÓÔ˜ ÛÂÛ˘Óı‹ÎÂ˜ ∫∞ Î·È ·Ó·ÈÌ›·˜9. ∞È-Ù›Â˜ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ¤ÎÙˆ-ÛË˜ ÙË˜ ÓÂÊÚÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ÛÂ Û˘Óı‹ÎÂ˜ ∫∞ ·ÔÙÂÏÔ‡Ó ËÂÏ¿ÙÙˆÛË ÙÔ˘ ÂÓÂÚÁÔ‡ ÂÓ‰·Á-ÁÂÈ·ÎÔ‡ fiÁÎÔ˘ ÌÂ ·ÔÙ¤ÏÂÛÌ·ÙË ÌÂ›ˆÛË ÙÔ˘ Ú˘ıÌÔ‡ ÛÂÈÚ·-Ì·ÙÈÎ‹˜ ‰È‹ıËÛË˜30, Ë ·ÓÙÈÚÚÔ-ÈÛÙÈÎ‹ ·‡ÍËÛË ÙÔ˘ ÙfiÓÔ˘ ÙÔ˘Û˘Ì·ıËÙÈÎÔ‡ ÓÂ˘ÚÈÎÔ‡ Û˘ÛÙ‹-Ì·ÙÔ˜ Î·È Ë ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘Û˘ÛÙ‹Ì·ÙÔ˜ ÚÂÓ›ÓË˜-·ÁÁÂÈÔ-ÙÂÓÛ›ÓË˜ -·Ï‰ÔÛÙÂÚfiÓË˜31 Ô˘Ô‰ËÁÔ‡Ó ÛÂ Û˘Óı‹ÎÂ˜ ·Ú·ÙÂ-

Ù·Ì¤ÓË˜ ÈÛ¯·ÈÌ›·˜ ÙÔ˘ ÓÂÊÚÈ-ÎÔ‡ ·ÚÂÁ¯‡Ì·ÙÔ˜. ™ÙÈ˜ Û˘Ó-ı‹ÎÂ˜ ·˘Ù¤˜ Î·È ÌÂ ÙËÓ ˘Ô-‚ÔËıËÙÈÎ‹ ‰Ú¿ÛË Î˘ÙÔÎÈÓÒÓ·Ú·ÙËÚÂ›Ù·È ÚÔÔ‰Â˘ÙÈÎ‹ ›Óˆ-ÛË Î·È Î·Ù·ÛÙÚÔÊ‹ ÙˆÓ ÓÂÊÚÒ-ÓˆÓ, ÌÂ ‚·ıÌÈ·›· ÌÂ›ˆÛË ÙË˜·Ú·ÁˆÁ‹˜ EPO ·fi ÙÔ˘˜ ÓÂ-ÊÚÔ‡˜29. ™ÙËÓ ‹‰Ë ÌÂÈˆÌ¤ÓË·Ú·ÁˆÁ‹ EPO ¤Ú¯ÂÙ·È Ó·ÚÔÛÙÂıÂ› Ë ·ÒÏÂÈ· ÛÙ· Ô‡Ú·ÛËÌ·ÓÙÈÎÒÓ ÚˆÙÂ˚ÓÈÎÒÓ Î·È ÌËÛÙÔÈ¯Â›ˆÓ ÙË˜ ·ÈÌÔÔ›ËÛË˜fiˆ˜ Ë ∂ƒ√, Ë ÙÚ·ÓÛÊÂÚÚ›ÓËÎ·È Ô Û›‰ËÚÔ˜32, 33, ·ÏÏ¿ Î·È ËÂÈ‚·Ú˘ÓÙÈÎ‹ ‰Ú¿ÛË ÙˆÓ Ô˘-Ú·ÈÌÈÎÒÓ ÙÔÍÈÓÒÓ ·Â˘ıÂ›·˜ÛÙ· ·ÈÌÔÔÈËÙÈÎ¿ Î‡ÙÙ·Ú· ÙÔ˘Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ32.

3) ∏ ¯Ú‹ÛË ÛÙËÓ ∫∞ ÙˆÓ ·Ó·-ÛÙÔÏ¤ˆÓ ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ-˙‡ÌÔ˘ (ACEπs, Angiotensin Con-verting Enzyme Inhibitors) ·ÏÏ¿Î·È ÙˆÓ ·ÔÎÏÂÈÛÙÒÓ ÙˆÓ ˘Ô-‰Ô¯¤ˆÓ AT1 ÙË˜ ·ÁÁÂÈÔÙÂÓÛ›-ÓË˜ ππ (ARBs, Angiotensin Re-ceptor Blockers) Ê·›ÓÂÙ·È fiÙÈÛ˘Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙËÓ ÂÌÊ¿ÓÈÛËÎ·È ÂÈ‰Â›ÓˆÛË ÙË˜ ·Ó·ÈÌ›·˜34.¶ÈÔ Û˘ÁÎÂÎÚÈÌ¤Ó·, ÛÂ ˘ÂÚÙ·-ÛÈÎÔ‡˜ ·ÛıÂÓÂ›˜ ¯ˆÚ›˜ ¿ÏÏ·ÚÔ‚Ï‹Ì·Ù· ˘ÁÂ›·˜, Ô˘ ¯ÚË-ÛÈÌÔÔÈÔ‡Ó ÌÈ· ·fi ÙÈ˜ ‰˘Ô ·-Ú·¿Óˆ Î·ÙËÁÔÚ›Â˜ Ê·ÚÌ¿ÎˆÓ,·Ú·ÙËÚ‹ıËÎÂ ÌÈ· Ì¤ÛË ÂÏ¿Ù-ÙˆÛË ÙË˜ Hb Î·Ù¿ 0,3 g/dL, ÌÂ-Ù·‚ÔÏ‹ Ô˘ ‰ÂÓ ÂÈÊ¤ÚÂÈ ÂÈ-ÙÒÛÂÈ˜ Ô‡ÙÂ ··ÈÙÂ› ‰È·ÎÔ‹ÙË˜ Ê·ÚÌ·ÎÂ˘ÙÈÎ‹˜ ·ÁˆÁ‹˜39.∂›ÛË˜, ÛÂ ÌÈ· post hoc ·Ó¿Ï˘-ÛË ÙË˜ ÌÂÏ¤ÙË˜ SOLVD (Stu-dies of Left Ventricular Dys-function) ÁÈ· ÙË ¯Ú‹ÛË ÙˆÓACEI ÛÙËÓ ∫∞, ‰È·ÈÛÙÒıËÎÂÌÈ· ÌÂ›ˆÛË Î·Ù¿ 4% ÙÔ˘ ·ÈÌ·-ÙÔÎÚ›ÙË ÛÙÔ 14,5% ÙˆÓ ·ÛıÂ-ÓÒÓ ÙË˜ ÔÌ¿‰·˜ Ô˘ ÂÏ¿Ì‚·ÓÂÂÓ·Ï·Ú›ÏË ÛÂ Û¯¤ÛË ÌÂ ÙÔ9,5% ÙË˜ ÔÌ¿‰·˜ ÂÏ¤Á¯Ô˘36.ŸÛÔÓ ·ÊÔÚ¿ ÛÙÔÓ ·ıÔÊ˘ÛÈÔ-ÏÔÁÈÎfi ÌË¯·ÓÈÛÌfi ÚfiÎÏËÛË˜·Ó·ÈÌ›·˜ ·fi ÙÔ˘˜ ACEIs Î·ÈÙÔ˘˜ ARBs, Ê·›ÓÂÙ·È fiÙÈ Ë ·Ó·-ÛÙÔÏ‹ ·Ú·ÁˆÁ‹˜ ÙË˜ ·ÁÁÂÈÔ-ÙÂÓÛ›ÓË˜ ππ ÚÔÎ·ÏÂ› ÌÂ›ˆÛËÎ·È ÙË˜ ·Ú·ÁˆÁ‹˜ IGF I(Insulin-like Growth factor I)·fi ÙÔ ‹·Ú. ∫·È ÔÈ ‰‡Ô ·Ú·-¿Óˆ Ô˘Û›Â˜ ÚÔÎ·ÏÔ‡Ó ‰È¤-ÁÂÚÛË ÙË˜ ·ÈÌÔÔ›ËÛË˜ ‰ÚÒ-ÓÙ·˜ ÛÙ· ÚÔÁÔÓÈÎ¿ Î‡ÙÙ·Ú·ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ36,37. ∞Îfi-ÌË, Ë ·ÁÁÂÈÔÙÂÓÛ›ÓË ππ ‰Ú· ÛÙÔ

Ì˘ÂÏfi ÙˆÓ ÂÈÓÂÊÚÈ‰›ˆÓ Î·ÈÚÔ¿ÁÂÈ ÙËÓ ·ÂÏÂ˘ı¤ÚˆÛË ·Ó-‰ÚÔÁfiÓˆÓ38 Ô˘ ·Ó‹ÎÔ˘Ó Â›-ÛË˜ ÛÙÔ˘˜ ·˘ÍËÙÈÎÔ‡˜ ·Ú¿ÁÔ-ÓÙÂ˜ ÙË˜ ÂÚ˘ıÚÔÔ›ËÛË˜. ∂È-Ï¤ÔÓ, ÔÈ ACEIs ÚÔÎ·ÏÔ‡Ó ·Â˘-ıÂ›·˜ ·‡ÍËÛË ÙÔ˘ Ê˘ÛÈÎÔ‡ ÂÙÈ-‰›Ô˘ ¡ ·ÎÂÙ˘Ï-ÛÂÚ˘Ï-·Û·ÚÙ˘Ï-Ï˘Û˘Ï-ÚÔÏ›ÓË Ô˘ ‰Ú· Î·Ù·-ÛÙ·ÏÙÈÎ¿ ÛÙËÓ ·ÈÌÔÔ›ËÛË36, 39.

4) ∏ ·ÓÂ¿ÚÎÂÈ· ÛÈ‰‹ÚÔ˘ ·Ô-ÙÂÏÂ› ÌÂ›˙ÔÓ· ·Ú¿ÁÔÓÙ· ‰È·-Ù·Ú·¯ÒÓ ÙË˜ ÂÚ˘ıÚÔÔ›ËÛË˜ÛÙËÓ ∫∞. ∂ÎÙfi˜ ·fi ÙËÓ ·Ò-ÏÂÈ· ÛÈ‰ËÚÔ‰ÂÛÌÂ˘ÙÈÎÒÓ Úˆ-ÙÂ˚ÓÒÓ ÌÂ Ù· Ô‡Ú· ÛÂ Û˘Óı‹ÎÂ˜∫∞ Î·È ÓÂÊÚÈÎ‹˜ ·ÓÂ¿ÚÎÂÈ·˜Ô˘ ·Ó·Ê¤ÚıËÎ·Ó ·Ú·¿Óˆ,·ÒÏÂÈ· ÛÈ‰‹ÚÔ˘ ÌÔÚÂ› Ó·ÂÈÛ˘Ì‚Â› Î·È ˆ˜ Û˘Ó¤ÂÈ· ¯Úfi-ÓÈ·˜ ·ÒÏÂÈ·˜ ·›Ì·ÙÔ˜ ·fi ÙÔÂÙÈÎfi Û‡ÛÙËÌ· ÏfiÁˆ ¯Ú‹ÛË˜ÌÈÎÚÒÓ ‰fiÛÂˆÓ ·ÛÈÚ›ÓË˜ ÛÙÔ˘˜Î·Ú‰ÈÔ·ıÂ›˜40. ∂ÈÚfiÛıÂÙ·,Ë Û˘ÌÊfiÚËÛË ÙÔ˘ ÂÓÙÂÚÈÎÔ‡‚ÏÂÓÓÔÁfiÓÔ˘ ÛÙÔ Ï·›ÛÈÔ ÙË˜∫∞ Î·È ÙÔ Û˘ÓÔ‰fi Ô›‰ËÌ· ÂË-ÚÂ¿˙Ô˘Ó ÙËÓ ·ÔÚÚfiÊËÛË ÙfiÛÔÙÔ˘ ÛÈ‰‹ÚÔ˘ fiÛÔ Î·È ¿ÏÏˆÓ··Ú·›ÙËÙˆÓ ÛÙÔÈ¯Â›ˆÓ ÙË˜ ·È-ÌÔÔ›ËÛË˜, fiˆ˜ Ë ‚ÈÙ·Ì›ÓËμ12 Î·È ÙÔ Ê˘ÏÏÈÎfi ÔÍ‡40. ∂Ï·Ù-ÙˆÌ¤ÓË ÚfiÛÏË„Ë ÛÈ‰‹ÚÔ˘ÌÔÚÂ› Ó· Â›Ó·È ·ÔÙ¤ÏÂÛÌ·Â›ÛË˜ ÙË˜ ˘ÔıÚÂ„›·˜ Ô˘··ÓÙ¿ ÛÂ ÌÂÁ¿ÏË Û˘¯ÓfiÙËÙ·ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ÙÂÏÈÎÔ‡ ÛÙ·‰›-Ô˘ ∫∞41. Δ¤ÏÔ˜, ·Í›˙ÂÈ Ó· ·Ó·-ÊÂÚıÂ› fiÙÈ Ë ·ÈÌÔ·Ú·›ˆÛË Ô˘·Ú¯ÈÎ¿ ıÂˆÚÔ‡ÓÙ·Ó ˆ˜ ‚·ÛÈÎ‹·ÈÙ›· ·Ó·ÈÌ›·˜1, 42 ÛÂ Û˘Óı‹ÎÂ˜∫∞ ‰ÂÓ ˘ÔÛÙËÚ›˙ÂÙ·È ÙfiÛÔ·fi ÚfiÛÊ·ÙÂ˜ ÌÂÏ¤ÙÂ˜42, 43.∞˘Ùfi ÁÈ·Ù› Ë ¤ÎÙ˘ÍË ÙÔ˘ ÂÍˆ-Î˘ÙÙ·Ú›Ô˘ ¯ÒÚÔ˘ ÛÙËÓ ∫∞ ÏfiÁˆÎ·Ù·ÎÚ¿ÙËÛË˜ Ó·ÙÚ›Ô˘ Î·È ‡‰·-ÙÔ˜ ·ÊÔÚ¿ ˆ˜ Â› ÙÔ ÏÂ›ÛÙÔÓÙÔÓ ÂÍˆ·ÁÁÂÈ·Îfi ¯ÒÚÔ Î·È fi¯ÈÙÔÓ ÂÓ‰·ÁÁÂÈ·Îfi fiÁÎÔ, ÂÓÒ Ô-Ï‡ Û˘¯Ó¿ ¿ÏÏÂ˜ ·ÈÙ›Â˜ ·Ó·ÈÌ›·˜˘ÔÎÚ‡ÙÔÓÙ·È ›Ûˆ ·fi Ê·ÈÓÔ-ÌÂÓÈÎ‹ ·ÈÌÔ·Ú·›ˆÛË43. ™Â ÌÈ·ÔÌ¿‰·, Ì¿ÏÈÛÙ·, 37 ·ÛıÂÓÒÓ ÌÂÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ ∫∞ Î·È ·Ó·ÈÌ›·,ÂÚ›Ô˘ ÙÔ 73% ÙˆÓ ÂÚÈÙÒÛÂ-ˆÓ ·Ô‰fiıËÎÂ ÛÂ ÛÈ‰ËÚÔÂÓÈÎ‹·Ó·ÈÌ›·, ÙÔ 18,9% ÛÂ ·Ó·ÈÌ›·¯ÚfiÓÈ·˜ ÓfiÛÔ˘ (ÛÙËÓ ÔÔ›· Ë‰Ú¿ÛË ÙˆÓ Î˘ÙÔÎÈÓÒÓ Ô˘ ·Ó·-Ê¤ÚıËÎÂ ·Ú·¿Óˆ ¤¯ÂÈ È‰È·›ÙÂ-ÚË ÛËÌ·Û›·), ÙÔ 5,4% ÛÂ ·ÈÌÔ·-Ú·›ˆÛË, ÂÓÒ ÙÔ 2,7% ÛÂ ‰Ú¿ÛËÊ·ÚÌ¿ÎˆÓ43.

¢ ∂ ∫ ∂ ª μ ƒ π √ ™ 2 0 0 7

10

™˘ÓÔÏÈÎ¿, ÌÂÙ··Ó·Ï‡ÛÂÈ˜ ÌÂÁ¿-ÏˆÓ ÎÏÈÓÈÎÒÓ ÌÂÏÂÙÒÓ, fiˆ˜ ËELITE II (Evaluation of Losartanin the Elderly II), Ë PRAISE(Prospective Randomized Am-lodipine Survival Evaluation), ËRENAISSANCE (RandomizedEtanercept North AmericanStrategy to Study Antagonismof Cytokines), ·ÏÏ¿ Î·È ËSOLVD Ô˘ ·Ó·Ê¤ÚıËÎÂ ÚÔË-ÁÔ˘Ì¤Óˆ˜, Î·Ù¤‰ÂÈÍ·Ó ÙËÓ ·Ó·È-Ì›· ·ÓÂÍ¿ÚÙËÙÔ Î·È ÈÛ¯˘ÚfiÚÔÁÓˆÛÙÈÎfi ‰Â›ÎÙË ÎÈÓ‰‡ÓÔ˘

ÁÈ· ÙË Û˘ÓÔÏÈÎ‹ ÓÔÛËÚfiÙËÙ·Î·È ıÓËÙfiÙËÙ· ·ÛıÂÓÒÓ ÌÂ ∫∞14,

44-50. ∏ Û˘Û¯¤ÙÈÛË Ì¿ÏÈÛÙ· ·˘Ù‹ÌÂÙ·Í‡ ÙË˜ ·Ó·ÈÌ›·˜ Î·È ÙË˜·˘ÍËÌ¤ÓË˜ ıÓËÙfiÙËÙ·˜ Ê·›ÓÂ-Ù·È Ó· ·ÊÔÚ¿ fi¯È ÌfiÓÔ ·ÛıÂ-ÓÂ›˜ ÌÂ ÚÔ¯ˆÚËÌ¤ÓË ∫∞ Î·Ù¿¡À∏∞, ·ÏÏ¿ Î·È ·ÛıÂÓÂ›˜ ÛÂÚÒÈÌ· ÛÙ¿‰È·, ‰ËÏ·‰‹ ÙÔ˘˜·Û˘ÌÙˆÌ·ÙÈÎÔ‡˜ Î·ıÒ˜ Î·È·˘ÙÔ‡˜ ÌÂ ‹È· ÚÔ˜ ÌÂÙÚ›Ô˘‚·ıÌÔ‡ ∫∞, fiˆ˜ Â›ÛË˜ ÙÔ˘˜·ÛıÂÓÂ›˜ ÌÂ ∫∞ ÚfiÛÊ·ÙË˜¤Ó·ÚÍË˜51, 52.

™˘Ì¤Ú·ÛÌ·

ΔÔ Û‡Ó‰ÚÔÌÔ ÙË˜ Î·Ú‰ÈÔÓÂÊÚÈ-Î‹˜ ·Ó·ÈÌ›·˜ ·ÔÙÂÏÂ› ÌÈ· ÎÏÈ-ÓÈÎ‹ ÔÓÙfiÙËÙ· Ô˘ ÂËÚÂ¿˙ÂÈ‰˘ÛÌÂÓÒ˜ ÙËÓ ÔÈfiÙËÙ· ˙ˆ‹˜Î·È ÙË Û˘ÓÔÏÈÎ‹ ÂÈ‚›ˆÛË ÙˆÓ·ÛıÂÓÒÓ ÌÂ ∫∞. ∏ Î·Ù·ÓfiËÛËÙˆÓ ·ıÔÊ˘ÛÈÔÏÔÁÈÎÒÓ ÌË¯·ÓÈ-ÛÌÒÓ Ô˘ Â˘ı‡ÓÔÓÙ·È ÁÈ· ÙËÓÂÁÎ·Ù¿ÛÙ·ÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘‰ËÌÈÔ˘ÚÁÂ› ÙÈ˜ ÚÔ¸Ôı¤ÛÂÈ˜ÁÈ· ÙËÓ ¤ÁÎ·ÈÚË ‰È¿ÁÓˆÛË Î·ÈÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ·ÓÙÈÌÂÙÒ-ÈÛ‹ ÙÔ˘.


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12

∂ÈÛ·ÁˆÁ‹

√È ‚-·ÔÎÏÂÈÛÙ¤˜ ¯ÚËÛÈÌÔÔÈÔ‡-ÓÙ·È Â˘Ú‡Ù·Ù· Â‰Ò Î·È 4 ‰ÂÎ·Â-Ù›Â˜ Î·È ıÂˆÚÔ‡ÓÙ·È Ì¤¯ÚÈ Û‹ÌÂ-Ú·, Û‡ÌÊˆÓ· ÌÂ ÙÈ˜ Î·ÙÂ˘ı˘ÓÙ‹-ÚÈÂ˜ Ô‰ËÁ›Â˜, Ê¿ÚÌ·Î· ÚÒÙË˜ÁÚ·ÌÌ‹˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛËÙË˜ ·ÚÙËÚÈ·Î‹˜ ˘¤ÚÙ·ÛË˜ (∞À).øÛÙfiÛÔ, Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ··ÌÊÈÛ‚ËÙÂ›Ù·È ·fi ÔÏÏÔ‡˜ ÂÚÂ˘-ÓËÙ¤˜ Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿ ÙÔ˘˜fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ÚfiÏË„Ë ÙˆÓÌÂÈ˙fiÓˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì-‚·Ì¿ÙˆÓ. ªÂÙ·-·Ó·Ï‡ÛÂÈ˜ Ô˘ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙËÓ ÏÂÈÔ„ËÊ›·ÙˆÓ Ù˘¯·ÈÔÔÈËÌ¤ÓˆÓ ÎÏÈÓÈÎÒÓÌÂÏÂÙÒÓ, ÔÈ ÔÔ›Â˜ Û˘Ó¤ÎÚÈÓ·ÓÙÔ˘˜ ‚-·ÔÎÏÂÈÛÙ¤˜ ÌÂ ÂÈÎÔÓÈÎfi‹ ¿ÏÏÔ Ê¿ÚÌ·ÎÔ, ‰ÂÓ Û˘ÓËÁÔ-ÚÔ‡Ó ˘¤Ú ÙË˜ ‰È·Ù‹ÚËÛ‹˜ ÙÔ˘˜ˆ˜ ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ Ê·ÚÌ¿ÎˆÓÚÒÙË˜ ÂÈÏÔÁ‹˜. ¶Ú¤ÂÈ Ó·ÂÈÛËÌ·ÓıÂ›, ˆÛÙfiÛÔ, fiÙÈ Ë ·Ô-ÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿ ÙÔ˘˜ ‰È·Ê¤ÚÂÈ,ÙfiÛÔ ÌÂÙ·Í‡ ÙˆÓ ‰È·ÊÔÚÂÙÈÎÒÓÊ·ÚÌ¿ÎˆÓ ·˘Ù‹˜ ÙË˜ ÔÌ¿‰·˜,fiÛÔ Î·È ÛÙÈ˜ ‰È¿ÊÔÚÂ˜ ËÏÈÎÈ·Î¤˜ÔÌ¿‰Â˜. ™ÙÔ ¿ÚıÚÔ ·˘Ùfi ı· ·-ÚÔ˘ÛÈ·ÛıÔ‡Ó Û˘ÓÔÙÈÎ¿ ÔÈ ÛË-Ì·ÓÙÈÎfiÙÂÚÂ˜ ÌÂÙ·-·Ó·Ï‡ÛÂÈ˜ÌÂÏÂÙÒÓ ¯ÔÚ‹ÁËÛË˜ ÙˆÓ ‚-·Ô-ÎÏÂÈÛÙÒÓ Î·È ı· Û˘˙ËÙËıÂ› ‰ÈÂ-ÍÔ‰ÈÎ¿ Ô ÚfiÏÔ˜ ÙÔ˘˜ ÛÙË ıÂÚ·-Â›· ÙË˜ ÚˆÙÔ·ıÔ‡˜ ∞À.

√È ÛËÌ·ÓÙÈÎfiÙÂÚÂ˜ ÌÂÙ·-·Ó·Ï‡ÛÂÈ˜ ÌÂÏÂÙÒÓ

¯ÔÚ‹ÁËÛË˜ ‚-·ÔÎÏÂÈÛÙÒÓ

√È ‚-·ÔÎÏÂÈÛÙ¤˜ ¤¯Ô˘Ó ¯ÚËÛÈ-ÌÔÔÈËıÂ› ÛÂ ÔÏÏ¤˜ Ù˘¯·ÈÔÔÈ-ËÌ¤ÓÂ˜ ÎÏÈÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ÛÂ Û‡-ÁÎÚÈÛË, ÙfiÛÔ ÌÂ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·-ÎÔ, fiÛÔ Î·È ÌÂ ¿ÏÏ· ·ÓÙÈ˘ÂÚÙ·-ÛÈÎ¿ Ê¿ÚÌ·Î·.1-24 √È ÌÂÏ¤ÙÂ˜ ·˘-Ù¤˜ ¤¯Ô˘Ó Û˘ÌÂÚÈÏ¿‚ÂÈ ˘ÂÚÙ·-ÛÈÎÔ‡˜ ·ÛıÂÓÂ›˜ ÌÂ ÌÂÁ¿ÏÔ ËÏÈ-ÎÈ·Îfi Â‡ÚÔ˜, ÂÓÒ Û˘¯Ó¿ ¯ÚËÛÈ-ÌÔÔÈ‹ıËÎ·Ó Û˘Ó‰˘·ÛÌÔ› Ê·Ú-Ì¿ÎˆÓ ÁÈ· Ó· ÂÈÙÂ˘¯ıÔ‡Ó Ù·ÂÈı˘ÌËÙ¿ Â›Â‰· ·ÚÙËÚÈ·Î‹˜›ÂÛË˜ (∞¶).1, 4, 7, 16, 17 ¶·Ú¿ ÙËÓ

ÂÙÂÚÔÁ¤ÓÂÈ· ÌÂÙ·Í‡ ÙˆÓ ‰È·Êfi-ÚˆÓ ÌÂÏÂÙÒÓ, ÔÚÈÛÌ¤ÓÂ˜ ÛËÌ·-ÓÙÈÎ¤˜ ÌÂÙ·-·Ó·Ï‡ÛÂÈ˜ ÚÔÛ¿-ıËÛ·Ó Ó· ·ÔÛ·ÊËÓ›ÛÔ˘Ó ÙÔÓ·ÎÚÈ‚‹ ÚfiÏÔ ÙˆÓ ‚-·ÔÎÏÂÈÛÙÒÓÛÙË ıÂÚ·Â˘ÙÈÎ‹ ·ÓÙÈÌÂÙÒÈÛËÙË˜ ÚˆÙÔ·ıÔ‡˜ ∞À.25-28

√ Lindholm Î·È ÔÈ Û˘ÓÂÚÁ¿ÙÂ˜ÙÔ˘ ÛÂ Ì›· ÌÂÙ·-·Ó¿Ï˘ÛË 18 Ù˘-¯·ÈÔÔÈËÌ¤ÓˆÓ ÎÏÈÓÈÎÒÓ ÌÂÏÂ-ÙÒÓ25 ·Ú·Ù‹ÚËÛ·Ó fiÙÈ Ë ¯ÔÚ‹-ÁËÛË ‚-·ÔÎÏÂÈÛÙÒÓ Û˘ÓÔ‰Â‡-ÔÓÙ·Ó ·fi ·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔÁÈ· ·ÁÁÂÈ·Îfi ÂÁÎÂÊ·ÏÈÎfi ÂÂÈ-Ûfi‰ÈÔ (∞∂∂) ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙË¯ÔÚ‹ÁËÛË ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ Ê·Ú-Ì¿ÎˆÓ ¿ÏÏˆÓ Î·ÙËÁÔÚÈÒÓ (re-lative risk [RR] 1.16, 95% CI1.04-1.30; p=0.009), ÂÓÒ ‰ÂÓ˘‹Ú¯·Ó ‰È·ÊÔÚ¤˜ fiÛÔÓ ·ÊÔÚ¿ÙËÓ Â›ÙˆÛË ÙÔ˘ ÔÍ¤Ô˜ ÂÌÊÚ¿Á-Ì·ÙÔ˜ ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘ (√∂ª) ‹ÙËÓ Û˘ÓÔÏÈÎ‹ ıÓËÛÈÌfiÙËÙ·. Δ··ÔÙÂÏ¤ÛÌ·Ù· ‹Ù·Ó ·ÚfiÌÔÈ·,ÙfiÛÔ ÛÙÈ˜ ÌÂÏ¤ÙÂ˜ ÛÙÈ˜ ÔÔ›Â˜¯ÔÚËÁ‹ıËÎÂ ·ÙÂÓÔÏfiÏË (RR1.26, 1.15-1.38; p<0.0001), fiÛÔÎ·È ÛÂ ÂÎÂ›ÓÂ˜ ÛÙÈ˜ ÔÔ›Â˜ ÛÙËÓ·ÁˆÁ‹ Û˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·Ó Û˘Ó-‰˘·ÛÌfi˜ ‚-·ÔÎÏÂÈÛÙ‹ ÌÂ ‰ÈÔ˘-ÚËÙÈÎfi (RR 1.09, 0.98-1.21), ÂÓÒ‰ÂÓ ÌÔÚÔ‡Û·Ó Ó· ÂÍ·¯ıÔ‡Ó·ÛÊ·Ï‹ Û˘ÌÂÚ¿ÛÌ·Ù· ÁÈ· ÙÈ˜ÌÂÏ¤ÙÂ˜ Ô˘ Û˘Ó¤ÎÚÈÓ·Ó ‚-·Ô-ÎÏÂÈÛÙ¤˜, ÂÎÙfi˜ ÙË˜ ·ÙÂÓÔÏfiÏË˜,ÌÂ ¿ÏÏ· Ê¿ÚÌ·Î·, ÂÍ·ÈÙ›·˜ ÙÔ˘ÂÚÈÔÚÈÛÌ¤ÓÔ˘ ·ÚÈıÌÔ‡ Û˘Ì‚·-Ì¿ÙˆÓ. ™Â Û‡ÁÎÚÈÛË ÌÂ ÙÔ ÂÈÎÔ-ÓÈÎfi Ê¿ÚÌ·ÎÔ ÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜Ê·›ÓÂÙ·È fiÙÈ ÌÂÈÒÓÔ˘Ó ÙÔÓ Î›Ó-‰˘ÓÔ ÂÌÊ¿ÓÈÛË˜ ∞∂∂ (RR 0.81,0.71-0.93), ÂÓÒ ‰ÂÓ ˘‹Ú¯Â‰È·ÊÔÚ¿ fiÛÔÓ ·ÊÔÚ¿ Ù· √∂ª‹ ÙË Û˘ÓÔÏÈÎ‹ ıÓËÛÈÌfiÙËÙ·. Δ·Â˘Ú‹Ì·Ù· ·˘Ù¿ ·ÊÔÚÔ‡Û·Ó Ùfi-ÛÔ ÙËÓ ·ÙÂÓÔÏfiÏË (RR 0.85,0.72-1.01), fiÛÔ Î·È Ù· ˘fiÏÔÈ·Ê¿ÚÌ·Î· ·˘Ù‹˜ ÙË˜ ÔÌ¿‰·˜ Ô˘¯ÔÚËÁ‹ıËÎ·Ó (RR 0.84, 0.64-1.10). ¶Ú¤ÂÈ fiÌˆ˜ Ó· ·Ó·ÊÂÚ-ıÂ› fiÙÈ Ë ÌÂ›ˆÛË ·˘Ù‹ ·ÓÙÈÛÙÔÈ-¯Â› ÂÚ›Ô˘ ÛÙÔ 50% ÙË˜ ·Ó·ÌÂ-

ÓfiÌÂÓË˜ ÌÂ›ˆÛË˜ ÙˆÓ Û˘Ì‚·Ì¿-ÙˆÓ ÌÂ ‚¿ÛË ÚÔËÁÔ‡ÌÂÓÂ˜ ÂÈ-‰ËÌÈÔÏÔÁÈÎ¤˜ ÌÂÏ¤ÙÂ˜.29

ΔËÓ ·Ú·¿Óˆ ÌÂÙ·-·Ó¿Ï˘ÛË·ÎÔÏÔ‡ıËÛÂ ·˘Ù‹ ÙˆÓ Khan Î·ÈMacAlister, ÔÈ ÔÔ›ÔÈ ‰ÂÓ ÂÈ‚Â-‚·›ˆÛ·Ó ·fiÏ˘Ù· Ù· Û˘ÌÂÚ¿-ÛÌ·Ù· ÙˆÓ ÚÔËÁÔ‡ÌÂÓˆÓ ÂÚÂ˘-ÓËÙÒÓ. ∏ ÌÂÙ·-·Ó¿Ï˘Û‹ ÙÔ˘˜ Â-ÚÈÏ·Ì‚¿ÓÂÈ ‰Â‰ÔÌ¤Ó· ·fi 21 Ù˘-¯·ÈÔÔÈËÌ¤ÓÂ˜ ÎÏÈÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜¯ÔÚ‹ÁËÛË˜ ‚-·ÔÎÏÂÈÛÙÒÓ ÛÂÛ‡ÁÎÚÈÛË ÌÂ ÂÈÎÔÓÈÎfi ‹ ¿ÏÏÔÊ¿ÚÌ·ÎÔ ˆ˜ ÚÒÙË˜ ÂÈÏÔÁ‹˜·ÓÙÈ˘ÂÚÙ·ÛÈÎ‹ ·ÁˆÁ‹ ÁÈ· ÙËÓÚfiÏË„Ë ÙˆÓ ÌÂÈ˙fiÓˆÓ Î·Ú‰È·Á-ÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ. ∏ È‰È·ÈÙÂ-ÚfiÙËÙ· ·˘Ù‹˜ ÙË˜ ÌÂÙ·-·Ó¿Ï˘-ÛË˜ ¤ÁÎÂÈÙ·È ÛÙËÓ ÂÍ·ÁˆÁ‹ ‰È·-ÊÔÚÂÙÈÎÒÓ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ ÌÂ‚¿ÛË ÙËÓ ËÏÈÎ›· ÙˆÓ ·ÛıÂÓÒÓ. ™˘-ÁÎÂÎÚÈÌ¤Ó·, ÔÈ ÂÚÂ˘ÓËÙ¤˜ ¯ÒÚÈ-Û·Ó ÙÈ˜ 21 ÌÂÏ¤ÙÂ˜ ÛÂ 2 ÔÌ¿‰Â˜¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ˆ˜ fiÚÈÔ ËÏÈ-Î›·˜ Ù· 60 ¤ÙË. ∏ ¯ÔÚ‹ÁËÛË ‚-·ÔÎÏÂÈÛÙÒÓ ¤Ó·ÓÙÈ ÙÔ˘ ÂÈÎÔÓÈ-ÎÔ‡ Ê·ÚÌ¿ÎÔ˘ ˘ÂÚÙÂÚÔ‡ÛÂÛÙÔ˘˜ Ó¤Ô˘˜ ·ÛıÂÓÂ›˜ (ËÏÈÎ›·˜<60 ÂÙÒÓ) fiÛÔÓ ·ÊÔÚ¿ ÙÔ ÙÂÏÈ-Îfi Î·Ù·ÏËÎÙÈÎfi ÛËÌÂ›Ô (∞∂∂,√∂ª, ı¿Ó·ÙÔ˜) (RR 0.86, 0.74-0.99), Ù· √∂ª (RR 0.85, 0.71-1.03), Ù· ∞∂∂ (RR 0.84, 0.65-1.10) Î·È ÙÔ˘˜ ı·Ó¿ÙÔ˘˜ (RR0.94, 0.79-1.10), fi¯È fiÌˆ˜ Î·ÈÙËÓ Â›ÙˆÛË ÙË˜ Î·Ú‰È·Î‹˜·ÓÂ¿ÚÎÂÈ·˜ (∫∞). ∞ÓÙ›ıÂÙ·,ÛÂ ·ÛıÂÓÂ›˜ ËÏÈÎ›·˜ >60 ÂÙÒÓ·Ú·ÙËÚ‹ıËÎÂ ÌÈ· ÛÙ·ÙÈÛÙÈÎ¿ÛËÌ·ÓÙÈÎ‹ ÌÂ›ˆÛË ÛÂ Û‡ÁÎÚÈÛËÌÂ ÙÔ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ ÌfiÓÔÙˆÓ ∞∂∂ (RR 0.78, 0.63-0.98)Î·È ÙË˜ ∫∞ (RR 0.54, 0.37-0.81). ™Â Û‡ÁÎÚÈÛË ÌÂ Ê¿ÚÌ·Î·¿ÏÏˆÓ Î·ÙËÁÔÚÈÒÓ, ÔÈ ‚-·Ô-ÎÏÂÈÛÙ¤˜ ‰ÂÓ ˘ÂÚÙÂÚÔ‡Û·Ó ÛÂÎ·Ó¤Ó· ·fi Ù· ·Ú·¿Óˆ Î·-Ù·ÏËÎÙÈÎ¿ ÛËÌÂ›· ÛÙÔ˘˜ Ó¤Ô˘˜·ÛıÂÓÂ›˜ (ËÏÈÎ›·˜ <60 ÂÙÒÓ).øÛÙfiÛÔ, ÛÙ· ËÏÈÎÈˆÌ¤Ó· ¿ÙÔÌ·Ë ¯ÔÚ‹ÁËÛË ÙˆÓ ‚-·ÔÎÏÂÈ-ÛÙÒÓ Û˘Û¯ÂÙ›ÛıËÎÂ ÌÂ ·˘ÍËÌ¤-

√È ‚-∞ÔÎÏÂÈÛÙ¤˜ ÛÙËÓ ∫ÏÈÓÈÎ‹ ¶Ú¿ÍË

ª. ºÏˆÚÂÓÙ›Ó, ∂ÈÛÙËÌÔÓÈÎfi˜ ™˘ÓÂÚÁ¿ÙË˜ ÙÔ˘ π·ÙÚÂ›Ô˘ §ÈÈ‰›ˆÓª. ∂ÏÈÛ¿Ê, ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈÎ‹˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ

ΔÔÌ¤·˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈÎ‹˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ

£EPA¶EIA - ºAPMAKA

13

ÓÔ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛË˜ Î·Ú-‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ (RR1.06, 1.01-1.10), ÂÍ·ÈÙ›·˜ ÙË˜ÌÂÁ·Ï‡ÙÂÚË˜ Â›ÙˆÛË˜ ∞∂∂(RR 1.18, 1.07-1.30).

∞Ó Î·È ÙÔ fiÊÂÏÔ˜ ÙË˜ ¯ÔÚ‹ÁË-ÛË˜ ‚-·ÔÎÏÂÈÛÙÒÓ ÛÂ Û‡ÁÎÚÈ-ÛË ÌÂ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ ÛÙÔ˘˜Ó¤Ô˘˜ ·ÛıÂÓÂ›˜ ‹Ù·Ó Î·È ÛÂ ·˘-Ù‹ ÙË ÌÂÙ·-·Ó¿Ï˘ÛË ÌÈÎÚfiÙÂÚÔ·fi ÙÔ ·Ó·ÌÂÓfiÌÂÓÔ ÌÂ ‚¿ÛËÂÈ‰ËÌÈÔÏÔÁÈÎ¤˜ ÌÂÏ¤ÙÂ˜,29 Ê·›-ÓÂÙ·È fiÙÈ Ë ¯ÔÚ‹ÁËÛË ÂÓfi˜ ‚-·ÔÎÏÂÈÛÙ‹ ÌÔÚÂ› Ó· Â˘ÓÔ‹ÛÂÈÓ¤Ô˘˜ ·ÛıÂÓÂ›˜ ÌÂ ·ÓÂ›ÏÂÎÙË∞À. ∂ÔÌ¤Óˆ˜, ÔÊÂ›ÏÔ˘ÌÂ Ó··ÍÈÔÏÔÁ‹ÛÔ˘ÌÂ ÌÂ ÎÚÈÙÈÎ‹ ÛÎ¤-„Ë ÙËÓ ÚfiÙ·ÛË ÔÚÈÛÌ¤ÓˆÓÂÚÂ˘ÓËÙÒÓ ÁÈ· ÔÚÈÛÙÈÎ‹ Î·Ù¿Ú-ÁËÛË ÙˆÓ ‚-·ÔÎÏÂÈÛÙÒÓ ˆ˜·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ Ê·ÚÌ¿ÎˆÓ.

∞Í›˙ÂÈ ÛÙÔ ÛËÌÂ›Ô ·˘Ùfi Ó· ‰ÈÂ˘-ÎÚÈÓÈÛıÂ› fiÙÈ Ë ·ıÔÊ˘ÛÈÔÏÔÁ›·ÙË˜ ∞À ‰ÂÓ Â›Ó·È Ë ›‰È· ÛÂ Î¿ıÂËÏÈÎ›·. ™Ù· Ó¤· ¿ÙÔÌ· Ë ∞ÀÔÊÂ›ÏÂÙ·È ÛÂ ·˘ÍËÌ¤ÓË Î·Ú‰È·-

Î‹ ·ÚÔ¯‹ ·ÚÔ˘Û›· Ê˘ÛÈÔÏÔ-ÁÈÎÒÓ ‹ ÌÂÈˆÌ¤ÓˆÓ ·ÁÁÂÈ·ÎÒÓ·ÓÙÈÛÙ¿ÛÂˆÓ,30-32 ÂÓÒ Ë ∞À ÙˆÓËÏÈÎÈˆÌ¤ÓˆÓ ·ÙfiÌˆÓ ¯·Ú·ÎÙË-Ú›˙ÂÙ·È ·fi ·‡ÍËÛË ÙˆÓ ÂÚÈÊÂ-ÚÈÎÒÓ ·ÓÙÈÛÙ¿ÛÂˆÓ Î·È ¯·ÌËÏ‹·ÚÙËÚÈ·Î‹ ÂÓ‰ÔÙÈÎfiÙËÙ· (com-pliance).30, 31 ∂ÔÌ¤Óˆ˜, Ë ¯ÔÚ‹-ÁËÛË ÙˆÓ ‚-·ÔÎÏÂÈÛÙÒÓ ÛÙÔ˘˜Ó¤Ô˘˜ ·ÛıÂÓÂ›˜ ÌÔÚÂ› Ó· ‰ÈÎ·È-ÔÏÔÁËıÂ› ·fi ÙÂÎÌËÚÈˆÌ¤Ó· ·-ıÔÊ˘ÛÈÔÏÔÁÈÎ¿ ‰Â‰ÔÌ¤Ó·.

∏ ·ÙÂÓÔÏfiÏË Î·È ÔÈ ¿ÏÏÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜: ˘¿Ú¯ÂÈ ‰È·ÊÔÚ¿ ÌÂÙ·Í‡ ÙÔ˘˜;

√ ÈÔ ‰È·‰Â‰ÔÌ¤ÓÔ˜ ‚-·ÔÎÏÂÈ-ÛÙ‹˜ Â›Ó·È Ë ·ÙÂÓÔÏfiÏË Î·È ÛÂ·˘Ùfi ÙÔ Ê¿ÚÌ·ÎÔ ·Ô‰›‰ÔÓÙ·ÈÙ· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ÏÂÈÔÓfi-ÙËÙ·˜ ÙˆÓ ÌÂÏÂÙÒÓ Ô˘ ¤¯Ô˘Ó‰ÈÂÍ·¯ıÂ› ÌÂ ‚-·ÔÎÏÂÈÛÙ¤˜. ¢Â-‰ÔÌ¤ÓË˜ ÙË˜ ‰È·ÊÔÚÂÙÈÎ‹˜ Ê·Ú-Ì·ÎÔÎÈÓËÙÈÎ‹˜ ÙË˜ ·ÙÂÓÔÏfiÏË˜ÛÂ Û‡ÁÎÚÈÛË ÌÂ Ù· ˘fiÏÔÈ·Ê¿ÚÌ·Î· ÙË˜ ›‰È·˜ Î·ÙËÁÔÚ›·˜,Ù¤ıËÎÂ ÙÔ ÂÚÒÙËÌ· Î·Ù¿ fiÛÔ

ÔÈ Ô˘‰¤ÙÂÚÂ˜ ‹ ·ÚÓËÙÈÎ¤˜ ÂÈ-ÙÒÛÂÈ˜ Ô˘ ·Ú·ÙËÚ‹ıËÎ·ÓÛÂ ÔÚÈÛÌ¤ÓÂ˜ ÌÂÏ¤ÙÂ˜ ÌÂ ‚-·Ô-ÎÏÂÈÛÙ¤˜ ÔÊÂ›ÏÔÓÙ·Ó ÛÙËÓ ·ÙÂ-ÓÔÏfiÏË Î·È ·Ó Ë ÂÓ‰Â¯fiÌÂÓË ¯Ô-Ú‹ÁËÛË ¿ÏÏˆÓ ‚-·ÔÎÏÂÈÛÙÒÓı· Â›¯Â ÈÔ Â˘ÓÔ˚Î¿ ·ÔÙÂÏ¤-ÛÌ·Ù·.

√ Carlberg Î·È ÔÈ Û˘ÓÂÚÁ¿ÙÂ˜ÙÔ˘ ·Ó¤Ï˘Û·Ó Ù· ‰Â‰ÔÌ¤Ó· 9ÌÂÏÂÙÒÓ ÌÂ ·ÙÂÓÔÏfiÏË (4 ¤Ó·-ÓÙÈ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ Î·È 5¤Ó·ÓÙÈ ¿ÏÏÔ˘ ·ÓÙÈ˘ÂÚÙ·ÛÈÎÔ‡Ê·ÚÌ¿ÎÔ˘).27 ¶·Ú¿ ÙË ÌÂÁ·Ï‡-ÙÂÚË ÌÂ›ˆÛË ÙË˜ ∞¶ Ô˘ ÂÈ-ÙÂ‡¯ıËÎÂ ÌÂ ÙËÓ ·ÙÂÓÔÏfiÏË,‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ÛÙ·ÙÈÛÙÈ-Î¿ ÛËÌ·ÓÙÈÎ¤˜ ‰È·ÊÔÚ¤˜ ÛÂÛ‡ÁÎÚÈÛË ÌÂ ÙÔ ÂÈÎÔÓÈÎfi Ê¿Ú-Ì·ÎÔ fiÛÔÓ ·ÊÔÚ¿ Ù· √∂ª, ÙËÓÎ·Ú‰È·ÁÁÂÈ·Î‹ Î·È ÔÏÈÎ‹ ıÓË-ÛÈÌfiÙËÙ·, ÂÓÒ Ë ·ÙÂÓÔÏfiÏËÊ¿ÓËÎÂ fiÙÈ ÂÏ·ÙÙÒÓÂÈ ÙÔÓ Î›Ó-‰˘ÓÔ ÙˆÓ ∞∂∂ (RR 0.85, 0.72-1.01). ™Â Û‡ÁÎÚÈÛË ÌÂ Ê¿ÚÌ·-Î· ¿ÏÏˆÓ Î·ÙËÁÔÚÈÒÓ, Ë ·ÙÂ-ÓÔÏfiÏË Û˘Û¯ÂÙ›ÛıËÎÂ ÌÂ ÛÙ·-

¶›Ó·Î·˜ 1. ‚-·ÔÎÏÂÈÛÙ¤˜ ¤Ó·ÓÙÈ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘

ªÂÏ¤ÙË Lindholm et al25 Khan et al26

RR (95% CI) RR (95% CI) RR (95% CI)N¤ÔÈ ·ÛıÂÓÂ›˜ ∏ÏÈÎÈˆÌ¤ÓÔÈ ·ÛıÂÓÂ›˜

TÂÏÈÎfi Î·Ù·ÏËÎÙÈÎfi 0.86 (0.74-0.99) 0.89 (0.75-1.05)ÛËÌÂ›Ô (∞∂∂, √∂ª, ı¿Ó·ÙÔ˜)

AEE 0.81 (0.71-0.93) 0.84 (0.65-1.10) 0.78 (0.63-0.98)

OEM 0.93 (0.83-1.05) 0.85 (0.71-1.03) 0.98 (0.83-1.16)

KA 1.05 (0.72-1.54) 0.54 (0.37-0.81)

√ÏÈÎ‹ ıÓËÛÈÌfiÙËÙ· 0.95 (0.86-1.04) 0.94 (0.79-1.10) 0.91 (0.74-1.12)

*√∂ª: ÔÍ‡ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘, ∞∂∂: ·ÁÁÂÈ·Îfi ÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔ, ∫∞: Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ·RR: relative risk (Û¯ÂÙÈÎfi˜ Î›Ó‰˘ÓÔ˜), CI: confidence interval (‰È¿ÛÙËÌ· ÂÌÈÛÙÔÛ‡ÓË˜)

¶›Ó·Î·˜ 2. ‚-·ÔÎÏÂÈÛÙ¤˜ ¤Ó·ÓÙÈ ¿ÏÏˆÓ Ê·ÚÌ¿ÎˆÓ

ªÂÏ¤ÙË Lindholm et al25 Khan et al26

RR (95% CI) RR (95% CI) RR (95% CI)N¤ÔÈ ·ÛıÂÓÂ›˜ ∏ÏÈÎÈˆÌ¤ÓÔÈ ·ÛıÂÓÂ›˜

TÂÏÈÎfi Î·Ù·ÏËÎÙÈÎfi 0.97 (0.88-1.07) 1.06 (1.01-1.10)ÛËÌÂ›Ô (∞∂∂, √∂ª, ı¿Ó·ÙÔ˜)

AEE 1.16 (1.04-1.30) 0.99 (0.67-1.44) 1.18 (1.07-1.30)

OEM 1.02 (0.93-1.12) 0.97 (0.86-1.10) 1.06 (0.94-1.20)

KA 0.93 (0.64-1.34) 0.98 (0.87-1.11)

√ÏÈÎ‹ ıÓËÛÈÌfiÙËÙ· 1.03 (0.99-1.08) 0.97 (0.83-1.14) 1.05 (0.99-1.11)

*√∂ª: ÔÍ‡ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘, ∞∂∂: ·ÁÁÂÈ·Îfi ÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔ, ∫∞: Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ·RR: relative risk (Û¯ÂÙÈÎfi˜ Î›Ó‰˘ÓÔ˜), CI: confidence interval (‰È¿ÛÙËÌ· ÂÌÈÛÙÔÛ‡ÓË˜)

¢ ∂ ∫ ∂ ª μ ƒ π √ ™ 2 0 0 7

14

ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ÌÂÁ·Ï‡ÙÂÚËÔÏÈÎ‹ ıÓËÛÈÌfiÙËÙ· (RR 1.13,1.02-1.25), Î·Ú‰È·ÁÁÂÈ·Î‹ ıÓË-ÛÈÌfiÙËÙ· (RR 1.16, 1.00-1.34)Î·È ÌÂ ·˘ÍËÌ¤ÓË Â›ÙˆÛË∞∂∂ (RR 1.30, 1.12-1.50), ·-Ú¿ ÙËÓ Â›ÙÂ˘ÍË ·ÚfiÌÔÈˆÓÂÈ¤‰ˆÓ ∞¶.

¶·ÚfiÌÔÈ· ·ÔÙÂÏ¤ÛÌ·Ù· ÚÔ-¤Î˘„·Ó Î·È ·fi ÌÈ· ÌÂÙ·-·Ó¿-Ï˘ÛË 10 Ù˘¯·ÈÔÔÈËÌ¤ÓˆÓ ÎÏÈ-ÓÈÎÒÓ ÌÂÏÂÙÒÓ (4 ÌÂÙ·Í‡ ·ÙÂ-ÓÔÏfiÏË˜ Î·È ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿-ÎÔ˘, 5 ÌÂÙ·Í‡ ·ÙÂÓÔÏfiÏË˜ Î·È¿ÏÏÔ˘ ·ÓÙÈ˘ÂÚÙ·ÛÈÎÔ‡ Ê·Ú-Ì¿ÎÔ˘ Î·È ÌÈ· ÌÂÏ¤ÙË Ô˘ Û˘-Ó¤ÎÚÈÓÂ ÙËÓ ·ÙÂÓÔÏfiÏË ÙfiÛÔ ÌÂÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ, fiÛÔ Î·È ÌÂÊ¿ÚÌ·ÎÔ ¿ÏÏË˜ Î·ÙËÁÔÚ›·˜).28

¢ÂÓ ·Ú·ÙËÚ‹ıËÎÂ ÛÙ·ÙÈÛÙÈÎ¿ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ ÌÂÙ·Í‡ ÙË˜·ÙÂÓÔÏfiÏË˜ Î·È ÙÔ˘ ÂÈÎÔÓÈÎÔ‡Ê·ÚÌ¿ÎÔ˘ ÛÂ Î·Ó¤Ó· ·fi Ù·ÙÂÏÈÎ¿ Î·Ù·ÏËÎÙÈÎ¿ ÛËÌÂ›·(∞∂∂, √∂ª, Î·Ú‰È·ÁÁÂÈ·Î‹ ‹ÔÏÈÎ‹ ıÓËÛÈÌfiÙËÙ·), ÂÓÒ ·ÓÙ›-ıÂÙ· Ë ¯ÔÚ‹ÁËÛË ÙË˜ ·ÙÂÓÔÏfi-ÏË˜ ¤Ó·ÓÙÈ Ê·ÚÌ¿ÎˆÓ ¿ÏÏˆÓÎ·ÙËÁÔÚÈÒÓ Û˘Û¯ÂÙ›ÛıËÎÂ ÌÂ·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ ∞∂∂ (RR1.27, 1.16-1.38; p=0.0004), Î·-ıÒ˜ Î·È Î·Ú‰È·ÁÁÂÈ·Î‹˜ Î·ÈÔÏÈÎ‹˜ ıÓËÛÈÌfiÙËÙ·˜ (RR 1.13,1.03-1.23; p=0.008 Î·È RR1.07, 1.01-1.14; p=0.02, ·ÓÙ›-ÛÙÔÈ¯·). Δ¤ÏÔ˜, ·Ú·ÙËÚ‹ıËÎÂÌÈ· ·˘ÍËÙÈÎ‹ Ù¿ÛË fiÛÔÓ ·ÊÔÚ¿Î·È Ù· √∂ª ÌÂ ÙË ¯ÔÚ‹ÁËÛËÙË˜ ·ÙÂÓÔÏfiÏË˜ (RR 1.02, 0.95-1.11; p=0.55).

°È· ÙËÓ ÂÚÌËÓÂ›· ÙˆÓ ‰È·ÊÔÚÂÙÈ-ÎÒÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Ô˘ ·Ú·-ÙËÚ‹ıËÎ·Ó ÌÂÙ·Í‡ ÙË˜ ·ÙÂÓÔÏfi-ÏË˜ Î·È ÙˆÓ ˘fiÏÔÈˆÓ ·ÓÙÈ˘-ÂÚÙ·ÛÈÎÒÓ Ú¤ÂÈ Ó· ‰ÈÂ˘ÎÚÈÓÈ-ÛıÔ‡Ó ÔÈ ‰È·ÊÔÚ¤˜ Ô˘ ˘¿Ú-¯Ô˘Ó ÌÂÙ·Í‡ ÙˆÓ Ê·ÚÌ¿ÎˆÓ.

∏ ·ÙÂÓÔÏfiÏË ÌÂÈÒÓÂÈ Ù· Â›Â‰·ÙË˜ ∞¶ Î·È Ì¿ÏÈÛÙ· ÛÙÔÓ ›‰ÈÔ‚·ıÌfi ÌÂ Ê¿ÚÌ·Î· ¿ÏÏˆÓ Î·ÙË-ÁÔÚÈÒÓ, fiˆ˜ ÚÔÎ‡ÙÂÈ ·fiÌÂÙÚ‹ÛÂÈ˜ ÙË˜ ∞¶ ÛÙÔ ‚Ú·¯›Ô-Ó·. øÛÙfiÛÔ Â›Ó·È ÁÓˆÛÙfi fiÙÈ Ë∞¶ ÛÙË ‚Ú·¯ÈfiÓÈ· ·ÚÙËÚ›· ‰ÂÓ·ÓÙÈÎ·ÙÔÙÚ›˙ÂÈ ÌÂ ·ÎÚ›‚ÂÈ· ÙËÛ˘ÛÙÔÏÈÎ‹ ∞¶, Ô‡ÙÂ ·ÔÙÂÏÂ›Î·Ïfi ‰Â›ÎÙË ÙË˜ ÎÂÓÙÚÈÎ‹˜ ·ÔÚ-ÙÈÎ‹˜ Û˘ÛÙÔÏÈÎ‹˜ ›ÂÛË˜.33 ∂È-ÚfiÛıÂÙ·, ÛÙ· Ó¤· ¿ÙÔÌ· Ë ÎÂ-ÓÙÚÈÎ‹ ·ÔÚÙÈÎ‹ Û˘ÛÙÔÏÈÎ‹ ›ÂÛËÂ›Ó·È ÔÏ‡ ¯·ÌËÏfiÙÂÚË ·fi ÙË‚Ú·¯ÈfiÓÈ· ·ÚÙËÚÈ·Î‹ Û˘ÛÙÔÏÈÎ‹

›ÂÛË.34 ¶·Ú¿ ÙË ÌÂ›ˆÛË ÙË˜‚Ú·¯ÈfiÓÈ·˜ ∞¶, Ë ·ÙÂÓÔÏfiÏË‰ÂÓ ÂÏ·ÙÙÒÓÂÈ ÙËÓ ÎÂÓÙÚÈÎ‹·ÔÚÙÈÎ‹ Û˘ÛÙÔÏÈÎ‹ ›ÂÛË ÛÙÔÓ›‰ÈÔ ‚·ıÌfi ÌÂ ÙÔ˘˜ ·ÓÙ·ÁˆÓÈ-ÛÙ¤˜ ·Û‚ÂÛÙ›Ô˘, ÙÔ˘˜ ·Ó·ÛÙÔ-ÏÂ›˜ ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡-ÌÔ˘ ÙË˜ ·ÁÁÂÈÔÙÂÓÛ›ÓË˜ ππ Î·ÈÙËÓ ˘‰ÚÔ¯ÏˆÚÔıÂÈ·˙›‰Ë.35 ªÂ-Ï¤ÙÂ˜ ¤‰ÂÈÍ·Ó fiÙÈ Ë ÌÂ›ˆÛË ÙË˜ÎÂÓÙÚÈÎ‹˜ Î·È fi¯È ÙË˜ ‚Ú·¯Èfi-ÓÈ·˜ ∞¶, ·ÚÔ˘ÛÈ¿˙ÂÈ ÛËÌ·ÓÙÈÎ‹Û˘Û¯¤ÙÈÛË ÌÂ ÙËÓ ˘ÔÛÙÚÔÊ‹ÙË˜ ˘ÂÚÙÚÔÊ›·˜ ÙË˜ ·ÚÈÛÙÂÚ‹˜ÎÔÈÏ›·˜.36 ∂ÔÌ¤Óˆ˜, Ë ÌÂÁ·Ï‡-ÙÂÚË ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙˆÓ·Ú·¿Óˆ Ê·ÚÌ¿ÎˆÓ ¤Ó·ÓÙÈÙË˜ ·ÙÂÓÔÏfiÏË˜ fiÛÔÓ ·ÊÔÚ¿ÙËÓ ÂÏ¿ÙÙˆÛË ÙË˜ ˘ÂÚÙÚÔÊ›·˜ÙË˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜37 ı· ÌÔ-ÚÔ‡ÛÂ Ó· ·Ô‰ÔıÂ› ÛÂ ·˘Ù‹ ÙËÓ·Ú·Ù‹ÚËÛË.

ªÈ· ‰È·ÊÔÚ¿ ÙË˜ ·ÙÂÓÔÏfiÏË˜·fi ÙÔ˘˜ ˘fiÏÔÈÔ˘˜ ‚-·Ô-ÎÏÂÈÛÙ¤˜ Â›Ó·È Ë ˘‰ÚfiÊÈÏË Ê‡-ÛË ÙË˜ Î·È Ë ÔÏ‡ ¯·ÌËÏ‹ ‰È·-ÂÚ·ÙfiÙËÙ¿ ÙË˜ ÛÙÔ ÎÂÓÙÚÈÎfiÓÂ˘ÚÈÎfi Û‡ÛÙËÌ·. ¶ÂÈÚ·Ì·ÙÈ-Î¤˜ ÌÂÏ¤ÙÂ˜ ¤‰ÂÈÍ·Ó fiÙÈ Ë ÈÎ·-ÓfiÙËÙ· ÙˆÓ ‚-·ÔÎÏÂÈÛÙÒÓ Ó·ÚÔÏ·Ì‚¿ÓÔ˘Ó ÙËÓ ÎÔÏÈÎ‹Ì·ÚÌ·Ú˘Á‹ ÂÍ·ÚÙ¿Ù·È ·fi Ù·Â›Â‰¿ ÙÔ˘˜ ÛÙÔ ÎÂÓÙÚÈÎfiÓÂ˘ÚÈÎfi Û‡ÛÙËÌ·.38

™Â ·ÓÙ›ıÂÛË ÌÂ ¿ÏÏÔ˘˜ ‚-·Ô-ÎÏÂÈÛÙ¤˜ (.¯. ÌÂÙÔÚÔÏfiÏË,·ÎÂ‚Ô˘ÙÔÏfiÏË), Ë ·ÙÂÓÔÏfiÏË‰ÂÓ Ê·›ÓÂÙ·È Ó· ¤¯ÂÈ ÈÎ·ÓÔÔÈ-ËÙÈÎ‹ 24ˆÚË ‰Ú¿ÛË fiÙ·Ó ¯ÔÚË-ÁÂ›Ù·È ÌÈ· ÊÔÚ¿ ÙË Ì¤Ú·.39 Δ¤-ÏÔ˜, ÌÂÏ¤ÙÂ˜ ¤‰ÂÈÍ·Ó fiÙÈ ÔÚÈ-ÛÌ¤Ó· ·ÓÙÈ˘ÂÚÙ·ÛÈÎ¿ Ê¿ÚÌ·-Î· ‚ÂÏÙÈÒÓÔ˘Ó ÙËÓ ·Ó·‰È·ÌfiÚ-ÊˆÛË (remodelling) Î·È ÙËÓ ÂÓ-‰ÔıËÏÈ·Î‹ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÙˆÓÌÈÎÚÒÓ ·ÚÙËÚÈÒÓ Ô˘ ·Ú·ÙË-ÚÔ‡ÓÙ·È ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ∞À, Â˘-

Ú‹Ì·Ù· Ô˘ ‰ÂÓ ·Ú·ÙËÚ‹ıË-Î·Ó ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ·ÙÂÓÔ-ÏfiÏË˜.40-42 ∫·ı›ÛÙ·Ù·È ÂÔÌ¤Óˆ˜Û·Ê¤˜ fiÙÈ ˘¿Ú¯Ô˘Ó ÔÈÎ›ÏÂ˜Î·È ·ÍÈÔÛËÌÂ›ˆÙÂ˜ ‰È·ÊÔÚ¤˜ ÌÂ-Ù·Í‡ ÙË˜ ·ÙÂÓÔÏfiÏË˜ Î·È ÙfiÛÔ¿ÏÏˆÓ Ê·ÚÌ¿ÎˆÓ ÙË˜ ›‰È·˜ Î·-ÙËÁÔÚ›·˜, fiÛÔ Î·È Ê·ÚÌ¿ÎˆÓÔ˘ ·Ó‹ÎÔ˘Ó ÛÂ ¿ÏÏÂ˜ Î·ÙËÁÔ-Ú›Â˜, ÁÂÁÔÓfi˜ Ô˘ ÌÔÚÂ› Ó· ÂÚ-ÌËÓÂ‡ÛÂÈ, ÙÔ˘Ï¿¯ÈÛÙÔÓ ˆ˜ ¤Ó·‚·ıÌfi, ÙË ‰È·ÊÔÚÂÙÈÎ‹ ·ÔÙÂÏÂ-ÛÌ·ÙÈÎfiÙËÙ¿ ÙÔ˘˜, fiˆ˜ ·˘Ù‹Î·Ù·ÁÚ¿ÊÂÙ·È ÛÙÈ˜ ‰È¿ÊÔÚÂ˜ÌÂÏ¤ÙÂ˜.

¶ÏÂÔÓÂÎÙ‹Ì·Ù· Î·È ÌÂÈÔÓÂÎÙ‹Ì·Ù· ÙˆÓ

‚-·ÔÎÏÂÈÛÙÒÓ

¶·Ú¿ ÙÈ˜ ‰ÈÊÔÚÔ‡ÌÂÓÂ˜ ·fi-„ÂÈ˜ fiÛÔÓ ·ÊÔÚ¿ ÙË ¯ÔÚ‹ÁËÛËÙˆÓ ‚-·ÔÎÏÂÈÛÙÒÓ ÛÙËÓ ÚˆÙÔ-·ı‹ ∞À, ˘¿Ú¯Ô˘Ó ÔÚÈÛÌ¤ÓÂ˜ÎÏÈÓÈÎ¤˜ ÔÓÙfiÙËÙÂ˜ ÛÙÈ˜ ÔÔ›Â˜ÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜ ¤¯Ô˘Ó ·Ô‰Â-‰ÂÈÁÌ¤ÓË ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·.√È ÂÚÈÛÛfiÙÂÚÔÈ ‚-·ÔÎÏÂÈ-ÛÙ¤˜ ÌÂÈÒÓÔ˘Ó ÛËÌ·ÓÙÈÎ¿ ÙËÌÂÙÂÌÊÚ·ÁÌ·ÙÈÎ‹ ıÓËÛÈÌfiÙËÙ·Ì·ÎÚÔÚfiıÂÛÌ·, fiˆ˜ Ê¿ÓË-ÎÂ ·fi ÌÈ· ÌÂÁ¿ÏË ÌÂÙ·-·Ó¿Ï˘-ÛË 31 ÌÂÏÂÙÒÓ (RR 0.77, 0.69-0.85).43 ∂›ÛË˜ ÚÔÛÊ¤ÚÔ˘Ó Û˘-ÌÙˆÌ·ÙÈÎ‹ ·Ó·ÎÔ‡ÊÈÛË ·fi Ù·ÛÙËı·Á¯ÈÎ¿ ÂÓÔ¯Ï‹Ì·Ù· Î·È¤¯Ô˘Ó ·ÓÙÈ·ıËÚÔÛÎÏËÚˆÙÈÎ‹‰Ú¿ÛË,44 ÂÓÒ Â›Ó·È È‰È·›ÙÂÚ·¯Ú‹ÛÈÌ· Ê¿ÚÌ·Î· ÛÂ ·ÛıÂÓÂ›˜ÌÂ ∫∞, ·ÊÔ‡ ÂÏ·ÙÙÒÓÔ˘Ó ÙËÓÎ·Ú‰È·ÁÁÂÈ·Î‹ Î·È ÙËÓ ÔÏÈÎ‹ıÓËÛÈÌfiÙËÙ·, ÙÔ˘˜ ·ÈÊÓ›‰ÈÔ˘˜ı·Ó¿ÙÔ˘˜ Î·È ÙÈ˜ ÓÔÛËÏÂ›Â˜ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô.45-48 ∂ÔÌ¤Óˆ˜,Ë ‰Â˘ÙÂÚÔÁÂÓ‹˜ ÚfiÏË„Ë ÙË˜ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ (™¡) Î·È Ë∫∞ ·ÔÙÂÏÔ‡Ó Û·ÊÂ›˜ ÂÓ‰Â›-ÍÂÈ˜ ¯ÔÚ‹ÁËÛË˜ ÙˆÓ ‚-·Ô-ÎÏÂÈÛÙÒÓ. ∞ÎfiÌ· Ë ¯ÔÚ‹ÁËÛË

¶›Ó·Î·˜ 3. ∞ÙÂÓÔÏfiÏË ¤Ó·ÓÙÈ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘

ªÂÏ¤ÙË Carlberg et al27 Karagiannis et al28

RR (95% CI)

√ÏÈÎ‹ ıÓËÛÈÌfiÙËÙ· 1.01 (0.89-1.15) 1.01 (0.84-1.15)

∫·Ú‰È·ÁÁÂÈ·Î‹ 0.99 (0.83-1.18) 0.99 (0.83-1.18) ıÓËÛÈÌfiÙËÙ·

√∂ª 0.99 (0.83-1.19) 0.99 (0.83-1.19)

∞∂∂ 0.85 (0.72-1.01) 0.96 (0.80-1.16)

*√∂ª: ÔÍ‡ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘, ∞∂∂: ·ÁÁÂÈ·Îfi ÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔ, RR: relative risk (Û¯ÂÙÈÎfi˜ Î›Ó‰˘ÓÔ˜), CI: confidence interval (‰È¿ÛÙËÌ· ÂÌÈÛÙÔÛ‡ÓË˜)


15

ÙˆÓ ‚-·ÔÎÏÂÈÛÙÒÓ ÌÔÚÂ› Ó·Â›Ó·È È‰È·›ÙÂÚ· ¯Ú‹ÛÈÌË ÛÂ¿ÙÔÌ· ÌÂ ˘ÂÚ‰Ú·ÛÙËÚÈfiÙËÙ·ÙÔ˘ Û˘Ì·ıËÙÈÎÔ‡ ÓÂ˘ÚÈÎÔ‡Û˘ÛÙ‹Ì·ÙÔ˜ ‹ ÔÏ‡ ·Á¯Ò‰Ë,·ÊÔ‡ ·Ú¿ÏÏËÏ· ÌÂ ÙË ÌÂ›ˆÛËÙË˜ ∞¶ ·˘Ù¿ Ù· Ê¿ÚÌ·Î· ·-Ú¤¯Ô˘Ó Û˘ÌÙˆÌ·ÙÈÎ‹ ·Ó·ÎÔ‡-ÊÈÛË. Δ¤ÏÔ˜, Ë ¯ÔÚ‹ÁËÛ‹ ÙÔ˘˜ÚÈÓ ·fi ÌÂ›˙ÔÓÂ˜ ·ÁÁÂÈ·Î¤˜ÂÂÌ‚¿ÛÂÈ˜ ÛÂ ·ÛıÂÓÂ›˜ ÌÂÎÏÈÓÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡-ÓÔ˘ Î·È ·ıÔÏÔÁÈÎfi ˘ÂÚË¯Ô-ÁÚ¿ÊËÌ· Î·Ú‰È¿˜ ÌÂÙ¿ ·fi¯ÔÚ‹ÁËÛË ‰Ô‚Ô˘Ù·Ì›ÓË˜ ÌÂÈÒ-ÓÂÈ Ù· Î·Ú‰È·ÁÁÂÈ·Î¿ Û˘Ì‚¿-Ì·Ù·,49 ÂÓÒ Ë Û˘Ó¤¯ÈÛË ÙË˜·ÁˆÁ‹˜ ÌÂ ‚ÈÛÔÚÔÏfiÏË ÁÈ· 2¤ÙË ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË ÂÏ·Ù-ÙÒÓÂÈ ÂÚ·ÈÙ¤Úˆ ÙÔ ı¿Ó·ÙÔÎ·Ú‰È·Î‹˜ ·ÈÙÈÔÏÔÁ›·˜ Î·È Ù·√∂ª.50

π‰È·›ÙÂÚË ·ÓËÛ˘¯›· ¤¯ÂÈ ÚÔÎ·-Ï¤ÛÂÈ Ë Èı·Ó‹ Û˘Û¯¤ÙÈÛË ÙˆÓ‚-·ÔÎÏÂÈÛÙÒÓ ÌÂ ÙËÓ ÂÌÊ¿ÓÈÛËÛ·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË (™¢) Ù‡Ô˘2. ªÂÁ¿ÏÂ˜ ÌÂÏ¤ÙÂ˜ Ô˘ Û˘Ó¤-ÎÚÈÓ·Ó ÙÔ˘˜ ‚-·ÔÎÏÂÈÛÙ¤˜ Ùfi-ÛÔ ÌÂ Ê¿ÚÌ·Î· ¿ÏÏˆÓ Î·ÙËÁÔ-ÚÈÒÓ (·ÓÙ·ÁˆÓÈÛÙ¤˜ ·Û‚ÂÛÙ›-Ô˘, ·ÓÙ·ÁˆÓÈÛÙ¤˜ ÙˆÓ ˘Ô‰Ô-¯¤ˆÓ ÙË˜ ·ÁÁÂÈÔÙÂÓÛ›ÓË˜ ππ,·Ó·ÛÙÔÏÂ›˜ ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ÂÓ˙‡ÌÔ˘ ÙË˜ ·ÁÁÂÈÔÙÂÓÛ›ÓË˜),fiÛÔ Î·È ÌÂ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ¤‰ÂÈÍ·Ó ·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ ÁÈ·ÓÂÔÂÌÊ·ÓÈ˙fiÌÂÓÔ ™¢ ÌÂ ÙÔ˘˜‚-·ÔÎÏÂÈÛÙ¤˜.14, 15, 51, 52 øÛÙfiÛÔ‰ÂÓ ¤¯ÂÈ ‰ÈÂ˘ÎÚÈÓÈÛıÂ› ·Ó Ù·˘fiÏÔÈ· Ê¿ÚÌ·Î· ÚÔÏ·Ì‚¿-ÓÔ˘Ó ÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ ™¢ ‹·Ó fiÓÙˆ˜ ÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜‰È·Ù·Ú¿ÛÛÔ˘Ó ÙËÓ ÔÌÔÈÔÛÙ·-Û›· ÙË˜ ÁÏ˘Îfi˙Ë˜, È‰È·›ÙÂÚ·fiÙ·Ó Û˘Ó‰˘¿˙ÔÓÙ·È ÌÂ ıÂÈ·˙È-‰ÈÎ¿ ‰ÈÔ˘ÚËÙÈÎ¿.53

∞ÚÓËÙÈÎ‹ Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È Ë

Â›‰Ú·ÛË ÙˆÓ ‚-·ÔÎÏÂÈÛÙÒÓÎ·È ÛÙÔ ÌÂÙ·‚ÔÏÈÛÌfi ÙˆÓ ÏÈÈ-‰›ˆÓ.54 √È ‚-·ÔÎÏÂÈÛÙ¤˜ ¯ˆÚ›˜ÂÓ‰ÔÁÂÓ‹ Û˘Ì·ıËÙÈÎÔÌÈÌËÙÈÎ‹‰Ú·ÛÙËÚÈfiÙËÙ· ·˘Í¿ÓÔ˘Ó Ù·Â›Â‰· ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ Î·ÈÌÂÈÒÓÔ˘Ó ÙË ¯ÔÏËÛÙÂÚfiÏË ÙˆÓÏÈÔÚˆÙÂ˚ÓÒÓ ˘„ËÏ‹˜ ˘ÎÓfi-ÙËÙ·˜ [high-density lipoprotein(HDL)], ¯ˆÚ›˜ Ó· ÂËÚÂ¿˙Ô˘ÓÛËÌ·ÓÙÈÎ¿ Ù· Â›Â‰· ÙË˜ ÔÏÈ-Î‹˜ ¯ÔÏËÛÙÂÚfiÏË˜ Î·È ÙË˜ ¯Ô-ÏËÛÙÂÚfiÏË˜ ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ [low-den-sity lipoprotein (LDL)].55 √È Î·Ú-‰ÈÔÂÎÏÂÎÙÈÎÔ› ‚-·ÔÎÏÂÈÛÙ¤˜ ¤¯Ô˘ÓÏÈÁfiÙÂÚÔ ·ÚÓËÙÈÎ‹ Â›‰Ú·ÛËÛÙÔ ÏÈÈ‰·ÈÌÈÎfi ÚÔÊ›Ï,56 ÂÓÒ ÔÈ‚-·ÔÎÏÂÈÛÙ¤˜ ÌÂ ÂÓ‰ÔÁÂÓ‹ Û˘-Ì·ıËÙÈÎÔÌÈÌËÙÈÎ‹ ‰Ú·ÛÙËÚÈfi-ÙËÙ· (ÈÓ‰ÔÏfiÏË) ‹ ·ÁÁÂÈÔ‰È·-ÛÙ·ÏÙÈÎ¤˜ È‰ÈfiÙËÙÂ˜ (ÛÂÏÈÚÔÏfi-ÏË) ‰ÂÓ ÂËÚÂ¿˙Ô˘Ó ÙÔ ÌÂÙ·‚Ô-ÏÈÛÌfi ÙˆÓ ÏÈÈ‰›ˆÓ.57, 58 ¶Èı·ÓÒ˜ÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜ ‰È·Ù·Ú¿ÛÛÔ˘ÓÙËÓ Ë·ÙÈÎ‹ Û‡ÓıÂÛË ÙˆÓ ÏÈÔ-ÚˆÙÂ˚ÓÒÓ ‹ ÂÏ·ÙÙÒÓÔ˘Ó ÙË‰Ú·ÛÙËÚÈfiÙËÙ· ÙË˜ ÏÈÔÚˆÙÂ˚-ÓÈÎ‹˜ ÏÈ¿ÛË˜, ÌÂÈÒÓÔÓÙ·˜ ¤ÙÛÈÙÔÓ Î·Ù·‚ÔÏÈÛÌfi ÙˆÓ ÏÈÔÚˆ-ÙÂ˚ÓÒÓ.59, 60 ∏ ·ÓÂÈı‡ÌËÙË ·˘Ù‹ÂÓ¤ÚÁÂÈ· ¤¯ÂÈ È‰È·›ÙÂÚË ÎÏÈÓÈÎ‹ÛËÌ·Û›·, ·ÊÔ‡ ÔÏÏÔ› ·ÛıÂ-ÓÂ›˜ ¤¯Ô˘Ó ÙfiÛÔ ∞À, fiÛÔ Î·È‰˘ÛÏÈÈ‰·ÈÌ›·, ÁÂÁÔÓfi˜ Ô˘ÙÔ˘˜ Î·ıÈÛÙ¿ ¿ÙÔÌ· ˘„ËÏÔ‡Î·Ú‰È·ÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘. ∂Ô-Ì¤Óˆ˜, ÔÊÂ›ÏÔ˘ÌÂ Ó· ÂÈÏ¤-ÍÔ˘ÌÂ ÙËÓ Î·Ù¿ÏÏËÏË ·ÁˆÁ‹, ËÔÔ›· ı· ÂÍ·ÛÊ·Ï›ÛÂÈ Ù· ÂÈ-ı˘ÌËÙ¿ Â›Â‰· ∞À Î·È LDL-¯ÔÏËÛÙÂÚfiÏË˜ Î·È ÂÔÌ¤Óˆ˜ı· ÂÏ·ÙÙÒÛÂÈ ÙÔÓ Î›Ó‰˘ÓÔ Î·Ú-‰È·ÁÁÂÈ·Î‹˜ ÓfiÛÔ˘.

™ÙËÓ Î·ÙËÁÔÚ›· ÙˆÓ ‚-·ÔÎÏÂÈ-ÛÙÒÓ ·Ó‹ÎÔ˘Ó Î¿ÔÈ· ÓÂfiÙÂÚ·Ê¿ÚÌ·Î· ÌÂ ¿ÌÂÛË ·ÁÁÂÈÔ‰È·-ÛÙ·ÏÙÈÎ‹ ‰Ú¿ÛË (ÓÂÌÈ‚ÔÏfiÏË,

Î·Ú‚ÂÓÙÈÏfiÏË, ÛÂÏÈÚÔÏfiÏË). ∞ÓÎ·È ‰ÂÓ ¤¯Ô˘Ó Á›ÓÂÈ Ù˘¯·ÈÔÔÈË-Ì¤ÓÂ˜ ÎÏÈÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ÁÈ· ÙËÓ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ∞À ÌÂ Ù· Û˘-ÁÎÂÎÚÈÌ¤Ó· ÛÎÂ˘¿ÛÌ·Ù·, Ê·›ÓÂ-Ù·È fiÙÈ ·ÔÙÂÏÔ‡Ó ·ÛÊ·Ï‹ Î·È·ÔÙÂÏÂÛÌ·ÙÈÎ¿ Ê¿ÚÌ·Î·, Î˘-Ú›ˆ˜ fiÌˆ˜ ÁÈ· ÙË ıÂÚ·Â›· ÙË˜∫∞ (È‰È·›ÙÂÚ· Ë Î·Ú‚ÂÓÙÈÏfiÏË).∂Í·ÈÙ›·˜ ÙË˜ ˘ÂÚÔ¯‹˜ ÙˆÓ ˘fi-ÏÔÈˆÓ ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ Ê·ÚÌ¿-ÎˆÓ ¤Ó·ÓÙÈ ÙˆÓ ‚-·ÔÎÏÂÈÛÙÒÓÂ›Ó·È ·›ı·ÓÔ Ó· Û¯Â‰È·ÛıÔ‡ÓÌÂÏ¤ÙÂ˜ Û‡ÁÎÚÈÛË˜ ·˘ÙÒÓ ÙˆÓÊ·ÚÌ¿ÎˆÓ ÌÂ ÂÈÎÔÓÈÎfi ‹ ¿ÏÏÔÊ¿ÚÌ·ÎÔ. ¶·ÚfiÏ· ·˘Ù¿ Ê·›ÓÂ-Ù·È fiÙÈ ·˘ÙÔ› ÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜Û˘ÓÂÈÛÊ¤ÚÔ˘Ó ıÂÙÈÎ¿ ÛÂ ‰Â˘ÙÂ-ÚÂ‡ÔÓÙ· Î·Ù·ÏËÎÙÈÎ¿ ÛËÌÂ›·,fiˆ˜ Ë ˘ÂÚÙÚÔÊ›· ÙË˜ ·ÚÈÛÙÂ-Ú‹˜ ÎÔÈÏ›·˜.61

Δ¤ÏÔ˜, Â›Ó·È ÛÎfiÈÌÔ Ó· ÙÔÓÈ-ÛıÔ‡Ó ÔÚÈÛÌ¤ÓÂ˜ È‰È·ÈÙÂÚfiÙËÙÂ˜Ô˘ ·ÊÔÚÔ‡Ó ÙÔÓ ÙÚfiÔ ¯ÔÚ‹-ÁËÛË˜ ÙˆÓ ‚-·ÔÎÏÂÈÛÙÒÓ. ∏·fiÙÔÌË ‰È·ÎÔ‹ ÙÔ˘˜ ··ÈÙÂ›È‰È·›ÙÂÚË ÚÔÛÔ¯‹, ÂÍ·ÈÙ›·˜ÙÔ˘ Ê·ÈÓÔÌ¤ÓÔ˘ ˘ÂÚ·ÎfiÓÙÈ-ÛË˜ (rebound phenomenon)Ô˘ ·˘Ù‹ ÌÔÚÂ› Ó· ÚÔÎ·Ï¤-ÛÂÈ, È‰È·›ÙÂÚ· fiÙ·Ó Ù· Ê¿ÚÌ·-Î· ¯ÔÚËÁÔ‡ÓÙ·È ÛÂ ˘„ËÏ¤˜ ‰fi-ÛÂÈ˜, To Ê·ÈÓfiÌÂÓÔ Û˘Ó›ÛÙ·Ù·ÈÛÙËÓ ÂÌÊ¿ÓÈÛË ÊÏÂ‚ÔÎÔÌ‚ÈÎ‹˜Ù·¯˘Î·Ú‰›·˜ ‹/Î·È ·‡ÍËÛË˜ÙË˜ ∞¶ ÛÂ Â›Â‰· ˘„ËÏfiÙÂÚ·ÂÎÂ›ÓˆÓ Ô˘ Â›¯Â Ô ·ÛıÂÓ‹˜ÚÈÓ ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ‚-·Ó·ÛÙÔ-Ï¤·, ÌÂ ·ÔÙ¤ÏÂÛÌ· ·ÎfiÌ· Î·ÈÙËÓ ÂÌÊ¿ÓÈÛË ÂÓfi˜ √∂ª. ∞ÓÁÈ· ÔÔÈÔ‰‹ÔÙÂ ÏfiÁÔ Ú¤ÂÈÓ· ÛÙ·Ì·Ù‹ÛÂÈ Ë ¯ÔÚ‹ÁËÛ‹ÙÔ˘˜, ··ÈÙÂ›Ù·È Ë ÛÙ·‰È·Î‹ ÌÂ›-ˆÛË ÙË˜ ‰fiÛË˜ ÙÔ˘˜ Î·È Ë ·-Ú¿ÏÏËÏË ˘ÔÎ·Ù¿ÛÙ·ÛË ÌÂ ¿Ï-ÏÔ ·ÓÙÈ˘ÂÚÙ·ÛÈÎfi Ê¿ÚÌ·ÎÔ.Δ¤ÏÔ˜, Ú¤ÂÈ Ó· Â›Ì·ÛÙÂ È‰È·›-ÙÂÚ· ÚÔÛÂÎÙÈÎÔ›, Î·ıfiÛÔÓ ÌÈ·ÌË ÎÏÈÓÈÎ¿ ¤Î‰ËÏË ™¡ ÌÔÚÂ› Ó·Û˘ÁÎ·Ï˘ÊıÂ› ·fi ÙË ¯ÔÚ‹ÁËÛËÂÓfi˜ ‚-·ÔÎÏÂÈÛÙ‹.

™˘ÌÂÚ¿ÛÌ·Ù·

√È ‚-·ÔÎÏÂÈÛÙ¤˜ ¤¯Ô˘Ó ¯ÚËÛÈ-ÌÔÔÈËıÂ› ÁÈ· ÔÏÏ¿ ¯ÚfiÓÈ· ˆ˜·ÓÙÈ˘ÂÚÙ·ÛÈÎ¿ Ê¿ÚÌ·Î· ÚÒ-ÙË˜ ÂÈÏÔÁ‹˜. øÛÙfiÛÔ Ù· ÙÂÏÂ˘-Ù·›· ¤ÙË ¿Ú¯ÈÛÂ Ó· ·ÌÊÈÛ‚ËÙÂ›-Ù·È Ë ·Í›· ÙÔ˘˜, Î˘Ú›ˆ˜ ÂÍ·ÈÙ›·˜ÙË˜ ˘ÂÚÔ¯‹˜ ÙˆÓ ÓÂfiÙÂÚˆÓ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ Ê·ÚÌ¿ÎˆÓ. ¶·-ÚfiÏ· ·˘Ù¿, Ë ÔÚÈÛÙÈÎ‹ Î·È Ï‹-

¶›Ó·Î·˜ 3. ∞ÙÂÓÔÏfiÏË ¤Ó·ÓÙÈ ¿ÏÏˆÓ Ê·ÚÌ¿ÎˆÓ

ªÂÏ¤ÙË Carlberg et al27 Karagiannis et al28

RR (95% CI)

√ÏÈÎ‹ ıÓËÛÈÌfiÙËÙ· 1.13 (1.02-1.25) 1.07 (1.01-1.14)

∫·Ú‰È·ÁÁÂÈ·Î‹ 1.16 (1.00-1.34) 1.13 (1.03-1.23) ıÓËÛÈÌfiÙËÙ·

√∂ª 1.04 (0.89-1.20) 1.02 (0.95-1.11)

∞∂∂ 1.30 (1.12-1.50) 1.27 (1.16-1.38)

*√∂ª: ÔÍ‡ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘, ∞∂∂: ·ÁÁÂÈ·Îfi ÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔ, RR: relative risk (Û¯ÂÙÈÎfi˜ Î›Ó‰˘ÓÔ˜), CI: confidence interval (‰È¿ÛÙËÌ· ÂÌÈÛÙÔÛ‡ÓË˜)

¢ ∂ ∫ ∂ ª μ ƒ π √ ™ 2 0 0 7

16

ÚË˜ ·fiÛ˘ÚÛ‹ ÙÔ˘˜ ·fi ÙË ıÂ-Ú·Â˘ÙÈÎ‹ Ê·Ú¤ÙÚ· ÁÈ· ÙËÓ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ∞À ‰ÂÓ Ê·›ÓÂ-Ù·È Ó· ·ÔÙÂÏÂ› ÙË ÛˆÛÙ‹ ÂÈÏÔ-Á‹. À¿Ú¯Ô˘Ó Û˘ÁÎÂÎÚÈÌ¤ÓÂ˜ÔÌ¿‰Â˜ ·ÛıÂÓÒÓ ÔÈ ÔÔ›Â˜ ÌÔ-ÚÔ‡Ó Ó· ·ÔÎÔÌ›ÛÔ˘Ó ÔÊ¤ÏË·fi ÙË ıÂÚ·Â›· ÌÂ ‚-·ÔÎÏÂÈ-ÛÙ¤˜, fiˆ˜ ÔÈ ·ÛıÂÓÂ›˜ ÌÂ ™¡‹/Î·È ∫∞, Î·ıÒ˜ Î·È Ó¤· ‹ ·Á¯Ò-

‰Ë ¿ÙÔÌ· ÌÂ ·ÓÂ›ÏÂÎÙË ∞À.¢ÂÓ Ú¤ÂÈ Ó· ÍÂ¯Ó¿ÌÂ ¿ÏÏˆÛÙÂÙÔ ¯·ÌËÏfi ÎfiÛÙÔ˜ ÙˆÓ Û˘ÁÎÂ-ÎÚÈÌ¤ÓˆÓ Ê·ÚÌ¿ÎˆÓ, ÁÂÁÔÓfi˜Ô˘ ¤¯ÂÈ ÌÂÁ¿ÏË ÛËÌ·Û›·, ·ÊÔ‡Ë ·ÓÙÈ˘ÂÚÙ·ÛÈÎ‹ ·ÁˆÁ‹ ¯ÔÚË-ÁÂ›Ù·È ‰È· ‚›Ô˘. ™˘ÌÂÚ·ÛÌ·ÙÈ-Î¿, Ë ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ˘ÂÚÙ·-ÛÈÎÔ‡ ·ÛıÂÓ‹, fiˆ˜ ‚¤‚·È· Î·ÈÎ¿ıÂ È·ÙÚÈÎ‹ Ú¿ÍË, ÔÊÂ›ÏÂÈ Ó·

Á›ÓÂÙ·È ÌÂ ‚¿ÛË ÙÈ˜ È‰È·ÈÙÂÚfiÙË-ÙÂ˜ ÙÔ˘ Î¿ıÂ ·ÙfiÌÔ˘, ÒÛÙÂ Ù·ÔÊ¤ÏË Ó· ˘ÂÚ‚·›ÓÔ˘Ó ÙÔ˘˜ ÎÈÓ-‰‡ÓÔ˘˜. Δ¤ÏÔ˜ ÔÊÂ›ÏÂÈ Ó· ÙÔÓÈ-ÛıÂ› fiÙÈ ÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜ ·ÔÙÂ-ÏÔ‡Ó ÂÙÂÚÔÁÂÓ‹ ÔÌ¿‰· Ê·ÚÌ¿-ÎˆÓ Î·È ÂÓ‰¤¯ÂÙ·È Ù· Â˘Ú‹Ì·Ù·ÁÈ· ÙËÓ ·ÙÂÓÔÏfiÏË Ó· ÌË ÈÛ¯‡-Ô˘Ó ÁÈ· ÙÔ˘˜ ¿ÏÏÔ˜ ‚-·Ó·ÛÙÔ-ÏÂ›˜.

1. Hansson L, Lindholm LH, Niskanen L,Lanke J, Hedner T, Niklason A, Luoman-maki K, Dahlof B, de Faire U, Morlin C,Karlberg BE, Wester PO and Bjorck JE.Effect of angiotensin-converting-enzymeinhibition compared with conventional the-rapy on cardiovascular morbidity and mor-tality in hypertension: the Captopril Pre-vention Project (CAPPP) randomised trial.Lancet 1999; 353: 611-616.

2. Veterans Administration Cooperative StudyGroup on Antihypertensive Agents. Com-parison of propranolol and hydrochlo-rothiazide for the initial treatment of hyper-tension. II. Results of long-term therapy.JAMA 1982; 248: 2004-2011.

3. Wright JT, Jr., Bakris G, Greene T, AgodoaLY, Appel LJ, Charleston J, Cheek D,Douglas-Baltimore JG, Gassman J, Glas-sock R, Hebert L, Jamerson K, Lewis J,Phillips RA, Toto RD, Middleton JP andRostand SG. Effect of blood pressurelowering and antihypertensive drug classon progression of hypertensive kidneydisease: results from the AASK trial.JAMA 2002; 288: 2421-2431.

4. Wilhelmsen L, Berglund G, Elmfeldt D,Fitzsimons T, Holzgreve H, Hosie J,Hornkvist PE, Pennert K, Tuomilehto J andWedel H. Beta-blockers versus diuretics inhypertensive men: main results from theHAPPHY trial. J Hypertens 1987; 5: 561-572.

5. Black HR, Elliott WJ, Grandits G,Grambsch P, Lucente T, White WB,Neaton JD, Grimm RH, Jr., Hansson L, La-courciere Y, Muller J, Sleight P, Weber MA,Williams G, Wittes J, Zanchetti A andAnders RJ. Principal results of theControlled Onset Verapamil Investigationof Cardiovascular End Points (CONVINCE)trial. JAMA 2003; 289: 2073-2082.

6. Dahlof B, Lindholm LH, Hansson L,Schersten B, Ekbom T and Wester PO.Morbidity and mortality in the Swedish Trialin Old Patients with Hypertension (STOP-Hypertension). Lancet 1991; 338: 1281-1285.

7. Hansson L, Hedner T, Lund-Johansen P,Kjeldsen SE, Lindholm LH, Syvertsen JO,Lanke J, de Faire U, Dahlof B and KarlbergBE. Randomised trial of effects of calciumantagonists compared with diuretics andbeta-blockers on cardiovascular morbidityand mortality in hypertension: the NordicDiltiazem (NORDIL) study. Lancet 2000;356: 359-365.

8. Hansson L, Lindholm LH, Ekbom T, DahlofB, Lanke J, Schersten B, Wester PO,Hedner T and de Faire U. Randomised trialof old and new antihypertensive drugs in

elderly patients: cardiovascular mortalityand morbidity the Swedish Trial in OldPatients with Hypertension-2 study. Lancet1999; 354: 1751-1756.

9. Zanchetti A, Bond MG, Hennig M, Neiss A,Mancia G, Dal Palu C, Hansson L,Magnani B, Rahn KH, Reid JL, Rodicio J,Safar M, Eckes L and Rizzini P. Calciumantagonist lacidipine slows down pro-gression of asymptomatic carotid athero-sclerosis: principal results of the EuropeanLacidipine Study on Atherosclerosis(ELSA), a randomized, double-blind, long-term trial. Circulation 2002; 106: 2422-2427.

10. Berglund G, Andersson O and Widgren B.Low-dose antihypertensive treatment witha thiazide diuretic is not diabetogenic. A10-year controlled trial with bendroflume-thiazide. Acta Med Scand 1986; 220: 419-424.

11. MRC trial of treatment of mildhypertension: principal results. MedicalResearch Council Working Party. BMJ1985; 291: 97-104.

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™Δ∂º∞¡π∞πø¡™À¡¢ƒ√ªø¡ (√™™)

ΔÔ ÛÙ·Ù›ÓÂ˜ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·ÈÂÎÙÂÙ·Ì¤Ó· ÛÙË ÛÙ·ıÂÚ‹ ÛÙÂÊ·-ÓÈ·›· ÓfiÛÔ (™™¡) Î·È ˘¿Ú¯ÂÈ‹‰Ë ·˘Í·ÓfiÌÂÓË ¯Ú‹ÛË ˘„ËÏÒÓ‰fiÛÂˆÓ ÛÙ·ÙÈÓÒÓ (Î˘Ú›ˆ˜ ·ÙÔÚ-‚·ÛÙ·Ù›ÓË˜) ÛÙ· ÔÍ¤· ÛÙÂÊ·ÓÈ-·›· Û‡Ó‰ÚÔÌ· (√™™), Ë ÔÔ›·‚·Û›˙ÂÙ·È ÛÙ· ·ÔÙÂÏ¤ÛÌ·Ù·ÙˆÓ ÌÂÏÂÙÒÓ MIRACL[4] Î·ÈPROVE IT-TIMI 22.[5] Δ· ·ÔÙÂÏ¤-ÛÌ·Ù· ÙË˜ MIRACL ¤‰ÂÈÍ·Ó fiÙÈÙÔ ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÚÔ˜ ÙÔ˘ ¿ÌÂ-ÛÔ˘ ÎfiÛÙÔ˘˜ ÙË˜ ·ÙÔÚ‚·ÛÙ·Ù›-ÓË˜ 80 mg ·ÓÙÈÛÙ·ıÌ›ÛÙËÎÂ ·fiÙÈ˜ ¯·ÌËÏfiÙÂÚÂ˜ ‰·¿ÓÂ˜ ÂÈÛ·-ÁˆÁ‹˜ ÛÂ ÓÔÛÔÎÔÌÂ›Ô ÏfiÁˆ ÏÈ-ÁfiÙÂÚˆÓ Û˘Ì‚·Ì¿ÙˆÓ ¤Ó·ÓÙÈÙË˜ ÔÌ¿‰·˜ ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·Ú-Ì¿ÎÔ˘. ŸÙ·Ó ÂÚÈÏ‹ÊıËÎÂ ÙÔ·Ó·ÌÂÓfiÌÂÓÔ ÎfiÛÙÔ˜ ÙˆÓ Û˘Ì-‚·Ì¿ÙˆÓ Ô˘ ·ÔÙÂÏÔ‡Û·Ó ÙÔÙÂÏÈÎfi ÛËÌÂ›Ô, ÙÔ ÁÂÓÈÎfi ÎfiÛÙÔ˜ÙË˜ ıÂÚ·Â›·˜ ÁÈ· ÙÔ˘˜ ·ÛıÂ-ÓÂ›˜ ÛÙÔ ‚Ú·¯›ÔÓ· ÙË˜ ·ÙÔÚ‚·-ÛÙ·Ù›ÓË˜ ‹Ù·Ó $4.824/·ÛıÂÓ‹¤Ó·ÓÙÈ $4.667/·ÛıÂÓ‹ ÁÈ· ÙÔ‚Ú·¯›ÔÓ· ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿-

ÎÔ˘. ∫·Ù¿ Û˘Ó¤ÂÈ·, ÙÔ Â·˘ÍË-ÙÈÎfi ÎfiÛÙÔ˜ ÙË˜ ÂÓÙ·ÙÈÎ‹˜ ıÂÚ·-Â›·˜ ÌÂ ·ÙÔÚ‚·ÛÙ·Ù›ÓË 80 mgÂ›Ó·È ¤Ó· $157/·ÛıÂÓ‹, ÙÔ ÔÔ›Ô·ÓÙÈÛÙÔÈ¯Â› ÛÂ ¤Ó· ÎfiÛÙÔ˜ ·Ó¿ÂÂÈÛfi‰ÈÔ Ô˘ ·ÔÊÂ‡¯ıËÎÂ ›ÛÔÌÂ $4.086.[6] ∂ÈÏ¤ÔÓ, ÌÈ· ·Ó¿-Ï˘ÛË Â˘·ÈÛıËÛ›·˜ ÁÈ· ÙËPROVE πΔ ·ÚÂ›¯Â ¤Ó· ÎfiÛÙÔ˜·Ó¿ ÔÈÔÙÈÎfi ¤ÙÔ˜ Ûˆ˙fiÌÂÓË˜˙ˆ‹˜ $12.900.[7]

°. ∞¶√Δ∂§∂™ª∞Δπ∫∏∞¡Δπª∂Δø¶π™∏ Ãƒ√¡π∞™

™Δ∂º∞¡π∞π∞™ ¡√™√À(™™¡)

Œ¯Ô˘ÌÂ ‰ËÌÔÛÈÂ‡ÛÂÈ ÛÙÔÈ¯Â›·ÛÙÔ ·ÚÂÏıfiÓ Ô˘ ‰Â›¯ÓÔ˘Ó fiÙÈÙÔ ÎfiÛÙÔ˜ ·Ó¿ ÔÈÔÙÈÎfi ¤ÙÔ˜Ûˆ˙fiÌÂÓË˜ ˙ˆ‹˜ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ™™¡ ÛÙËÓ ∂ÏÏ¿‰· ‹Ù·Ó $8.350ÌÂ ‚¤ÏÙÈÛÙË Ê·ÚÌ·ÎÂ˘ÙÈÎ‹ ·Áˆ-Á‹, Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓË˜ ÙË˜·ÙÔÚ‚·ÛÙ·Ù›ÓË˜ ÛÂ Ì¤ÛË ËÌÂÚ‹-ÛÈ· ‰fiÛË 24 mg. [8] Δ· ÛÙÔÈ¯Â›··˘Ù¿ Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙËÌÂÏ¤ÙË GREACE [8] ¤¯Ô˘Ó ÂÓ‰È·-Ê¤ÚÔÓ ÁÈ·Ù› ·ÊÔÚÔ‡Ó ÛÂ ∂ÏÏËÓÈ-Îfi ÏËı˘ÛÌfi Î·È ÁÈ·Ù› ‰Â›¯ÓÔ˘ÓÙË Û¯¤ÛË ÎfiÛÙÔ˘˜ ·ÔÙÂÏÂÛÌ·-ÙÈÎfiÙËÙÔ˜ ÛÂ Û˘Óı‹ÎÂ˜ ÙË˜

Ú·ÁÌ·ÙÈÎ‹˜ ˙ˆ‹˜. ™Â ˘ÔÔÌ¿-‰· ÙˆÓ ·ÛıÂÓÒÓ ÙË˜ GREACEÔ˘ Â›¯·Ó ™¡ Î·È Û·Î¯·ÚÒ‰Ë‰È·‚‹ÙË ÙÔ ÎfiÛÙÔ˜ ·Ó¿ ÔÈÔÙÈÎfi¤ÙÔ˜ Ûˆ˙fiÌÂÓË˜ ˙ˆ‹˜ ‹Ù·Ó ·Îfi-ÌË ¯·ÌËÏfiÙÂÚÔ ($6.200) [9]

¶ÚfiÛÊ·Ù· Ù· ·ÔÙÂÏ¤ÛÌ·Ù·ÙË˜ ÌÂÏ¤ÙË˜ COURAGE (ClinicalOutcomes Utilizing Revasculari-zation and Aggressive Drug Eva-luation),[10] ¤‰ÂÈÍ·Ó fiÙÈ ÛÂ ·ÛıÂ-ÓÂ›˜ ÌÂ ·Û˘ÌÙˆÌ·ÙÈÎ‹ ™™¡ Ë·ÁÁÂÈÔÏ·ÛÙÈÎ‹ ÌÂ ÙÔÔı¤ÙËÛËstend (PCI) Û˘Ó ‚¤ÏÙÈÛÙË Ê·Ú-Ì·ÎÂ˘ÙÈÎ‹ ·ÁˆÁ‹ ‰ÂÓ Â›Ó·È Â-ÚÈÛÛfiÙÂÚÔ ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ÛÙËÚfiÏË„Ë Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì-‚·Ì¿ÙˆÓ ·’ fiÙÈ Ë ‚¤ÏÙÈÛÙË Ê·Ú-Ì·ÎÂ˘ÙÈÎ‹ ·ÁˆÁ‹ ÌfiÓË ÙË˜.[10] ΔÔÛ˘Ì¤Ú·ÛÌ· ·˘Ùfi, Â¿Ó ÂÈ‚Â-‚·ÈˆıÂ› Î·È ÛÂ ¿ÏÏÂ˜ ÌÂÏ¤ÙÂ˜,ÌÔÚÂ› Ó· ÛËÌ·ÙÔ‰ÔÙ‹ÛÂÈ ÙÔ Ù¤-ÏÔ˜ ÌÈ·˜ ÂÔ¯‹˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂ-ÙÒÈÛË ÙË˜ ™™¡. √È ÂÚÂ˘ÓËÙ¤˜ÙË˜ ÌÂÏ¤ÙË˜ COURAGE Î·Ù¤ÓÂÈ-Ì·Ó Ù˘¯·›· 2.287 ·ÛıÂÓÂ›˜ Â›ÙÂÛÂ ıÂÚ·Â›· ÌÂ PCI Î·È ‚¤ÏÙÈÛÙËÊ·ÚÌ·ÎÂ˘ÙÈÎ‹ ·ÁˆÁ‹ Â›ÙÂ ÌfiÓÔÛÂ ‚¤ÏÙÈÛÙË Ê·ÚÌ·ÎÂ˘ÙÈÎ‹ ·Áˆ-Á‹. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ·Ú·ÎÔ-ÏÔ‡ıËÛË˜ (Ì¤ÛÔ˜ ¯ÚfiÓÔ˜ 4,6

∂ÈÎfiÓ· 2. ∫·Ì‡ÏÂ˜ ÂÈ‚›ˆÛË˜ ÛÙÈ˜ ‰‡Ô ÔÌ¿‰Â˜ ÙË˜ ÌÂÏ¤ÙË˜ COURAGE. ∞: ∂È‚›ˆÛË ¯ˆÚ›˜ ı¿Ó·ÙÔ ·fi ÔÔÈ·‰‹ÔÙÂ·ÈÙ›· ‹ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘. μ: ™˘ÓÔÏÈÎ‹ ÂÈ‚›ˆÛË. C: ∂È‚›ˆÛË ¯ˆÚ›˜ √Í‡ ÛÙÂÊ·ÓÈ·›Ô ÂÂÈÛfi‰ÈÔ. D: ∂È‚›ˆÛË¯ˆÚ›˜ Ì˘ÔÎ·Ú‰È·Îfi ¤ÌÊÚ·ÁÌ·.

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PCI PCI

PCI



¯ÚfiÓÈ·) Î·ÙÂÁÚ¿ÊËÛ·Ó Û˘ÓÔÏÈÎ¿211 ı¿Ó·ÙÔÈ ‹ ÌË ı·Ó·ÙËÊfiÚ·ÂÌÊÚ¿ÁÌ·Ù· ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘,·ÚÈıÌfi˜ ·ÚfiÌÔÈÔ˜ ÌÂ ·˘ÙfiÓ(202) ÙË˜ ÔÌ¿‰·˜ ÌÂ ÌfiÓÔ ‚¤ÏÙÈ-ÛÙË Ê·ÚÌ·ÎÂ˘ÙÈÎ‹ ·ÁˆÁ‹ (∂ÈÎfi-Ó· 2) [10] ŸÙ·Ó ÚÔÛÙ¤ıËÎ·Ó Ù··ÁÁÂÈ·Î¿ ÂÁÎÂÊ·ÏÈÎ¿ ÂÂÈÛfi‰È·Ë ‰È·ÊÔÚ¿ ÂÍ·ÎÔÏÔ˘ıÔ‡ÛÂ Ó·ÌËÓ Â›Ó·È ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹(∂ÈÎfiÓ· 2). ∏ ÌfiÓË ÛËÌ·ÓÙÈÎ‹‰È·ÊÔÚ¿ ÌÂÙ·Í‡ ÙˆÓ 2 ÔÌ¿‰ˆÓıÂÚ·Â›·˜ ‹Ù·Ó Ë ÌÂÈˆÌ¤ÓË Â›-ÙˆÛË ÙË˜ ÛÙËı¿Á¯Ë˜ ÛÙËÓ ÔÌ¿-‰· PCI ÛÙ· 1 Î·È 3 ¤ÙË. ∂ÓÙÔ‡-ÙÔÈ˜, ÛÙ· 5 ¤ÙË ‰ÂÓ ˘‹ÚÍÂ Î·Ì›·ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ ÛÙÔ ÔÛÔ-ÛÙfi ·˘ÙÒÓ Ô˘ ‹Ù·Ó ÂÏÂ‡ıÂÚÔÈ·fi ÛÙËı¿Á¯Ë. Δ· ·ÔÙÂÏ¤ÛÌ·-Ù· ·˘Ù¿ ·Ú¤ÂÌ·Ó ÛÂ ÂÏ¿ÙÙˆ-ÛË ÙË˜ PCI ÛÂ ·Û˘ÌÙˆÌ·ÙÈÎÔ‡˜·ÛıÂÓÂ›˜ ÌÂ ™™¡ Î·Ù¿ 30%-40%.∏ ÌÂÏ¤ÙË ·˘Ù‹ ˘¤ÛÙË ÎÚÈÙÈÎ‹,Î˘Ú›ˆ˜ fiÛÔÓ ·ÊÔÚ¿ ÙÔÓ ÙÚfiÔÂÈÏÔÁ‹˜ ·ÛıÂÓÒÓ Î·È ÙÔ fiÏÔ ı¤-Ì· ‰ÂÓ ¤¯ÂÈ Ï‹ÍÂÈ ·ÎfiÌË. ∂›Ó·ÈfiÌˆ˜ ÚÔÊ·Ó¤˜ ÛÂ fiÏÔ˘˜ fiÙÈÌ¿ÏÏÔÓ Á›ÓÔÓÙ·È ÂÚÈÛÛfiÙÂÚÂ˜PCI ·' fiÙÈ ¯ÚÂÈ¿˙ÔÓÙ·È Î·È ·˘Ùfi·ÓÂ‚¿˙ÂÈ ÛËÌ·ÓÙÈÎ¿ ÙÔ ÎfiÛÙÔ˜·ÓÙÈÌÂÙÒÈÛË˜ ÙË˜ ™¡.

Δ· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ÌÂÏ¤ÙË˜ARMYDA (Atorvastatin for Re-duction of Myocardial DamageDuring Angioplasty) [11] ¤‰ÂÈÍ·ÓfiÙÈ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ™™¡ Ë ¯ÔÚ‹-ÁËÛË 40 mg/ËÌ. ·ÙÔÚ‚·ÛÙ·Ù›ÓË˜ÁÈ· 7 ËÌ¤ÚÂ˜ ÚÈÓ ÙË PCI ÌÂÈÒÓÂÈÛËÌ·ÓÙÈÎ¿ ÙÔ Ì˘ÔÎ·Ú‰È·Îfi ÙÚ·˘-Ì·ÙÈÛÌfi Ô˘ ÚÔÎ·ÏÂ›ÙÂ ·fi ÙËPCI. ∏ CK-ªμ, Ë ÙÚÔÔÓ›ÓË π, Î·ÈË Ì˘ÔÛÊ·ÈÚ›ÓË ÛÙÈ˜ 8 Î·È 24ÒÚÂ˜ ÌÂÙ¿ ·fi ÙËÓ PCI ‹Ù·Ó ÛÂ

ÔÏ‡ ¯·ÌËÏfiÙÂÚ· Â›Â‰· ·’fiÙÈ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ Ô˘ ‹Ú·ÓÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ. √ Î›Ó‰˘ÓÔ˜ÁÈ· Ù· Û˘ÓÔÏÈÎ¿ Î·Ú‰È·ÁÁÂÈ·Î¿Û˘Ì‚¿Ì·Ù· ÂÏ·ÙÙÒıËÎ·Ó Î·Ù¿81% ÌÂ ÙËÓ ·ÙÔÚ‚·ÛÙ·Ù›ÓË, ÂÓÒÙ· ÂÌÊÚ¿ÁÌ·Ù· ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘‹Ù·Ó 5% ÛÙË ÔÌ¿‰· ÙˆÓ ·ÛıÂ-ÓÒÓ Ô˘ ¤·ÈÚÓ·Ó ·ÙÔÚ‚·ÛÙ·Ù›-ÓË Î·È 18% ÛÙËÓ ÔÌ¿‰· ÙÔ˘ ÂÈÎÔ-ÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ (p=0.025).[11]

∂›Ó·È ÚÔÊ·Ó¤˜ ÙÔ È·ÙÚÈÎfi Î·ÈÔÈÎÔÓÔÌÈÎfi fiÊÂÏÔ˜ ·fi ÙË ¯Ú‹-ÛË 7 ‰ÈÛÎ›ˆÓ ·ÙÔÚ‚·ÛÙ·Ù›ÓË˜ 40mg ÁÈ· Ó· ÁÏÈÙÒÛÂÈ Î·ÓÂ›˜ ÙÔ81% ÙˆÓ ÂÈÏÔÎÒÓ ÙË˜ PCI.

™ÙËÓ ÚfiÛÊ·Ù· ‰ËÌÔÛÈÂ˘Ì¤ÓËÌÂÏ¤ÙË ARMYDA ACS (Atorva-statin for Reduction of Myocar-dial Damage during Angioplastyin Patients with Acute CoronarySyndromes)[12] ·ÛıÂÓÂ›˜ ÌÂ √™™Ù˘¯·ÈÔÔÈ‹ıËÎ·Ó ÛÂ ıÂÚ·Â›· ÌÂ·ÙÔÚ‚·ÛÙ·Ù›ÓË (80 mg 12 ÒÚÂ˜Î·È 40 mg 2 ÒÚÂ˜ ÚÈÓ ·fi ÙËÓPCI ‹ ÛÂ ıÂÚ·Â›· ÌÂ ÂÈÎÔÓÈÎfiÊ¿ÚÌ·ÎÔ. ™Â fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂ-ÓÂ›˜ ¯ÔÚËÁ‹ıËÎÂ ÌÈ· ‰fiÛË 600mg ÎÏÔÈ‰ÔÁÚ¤ÏË˜. ΔÔ Û˘Ó‰˘·-ÛÌ¤ÓÔ ÙÂÏÈÎfi ÛËÌÂ›Ô (ı¿Ó·ÙÔ˜,Ì˘ÔÎ·Ú‰È·Îfi ¤ÌÊÚ·ÁÌ·, ‹ ÌËÚÔÁÚ·ÌÌ·ÙÈÛÌ¤ÓË Â·Ó·ÈÌ¿Ùˆ-ÛË) ÂÌÊ·Ó›ÛÙËÎÂ ÛÂ 5% ÙˆÓ·ÛıÂÓÒÓ ÛÙÔ ‚Ú·¯›ÔÓ· ÙË˜ ·ÙÔÚ-‚·ÛÙ·Ù›ÓË˜ Î·È ÛÂ 17% ÙˆÓ·ÛıÂÓÒÓ ÛÙÔ ‚Ú·¯›ÔÓ· ÂÈÎÔÓÈÎÔ‡Ê·ÚÌ¿ÎÔ˘ (p=0.01). ∞˘Ù‹ Ë ‰È·-ÊÔÚ¿ ÔÊÂÈÏfiÙ·Ó Î˘Ú›ˆ˜ ÛÙË ÌÂ›-ˆÛË ÙË˜ Â›ÙˆÛË˜ ÙÔ˘ ÂÌÊÚ¿Á-Ì·ÙÔ˜ Ì˘ÔÎ·Ú‰›Ô˘ (5% ¤Ó·ÓÙÈ15%, p=0.04). ™˘ÓÔÏÈÎ¿, Ë ÂÏ¿Ù-ÙˆÛË ÙˆÓ Û˘Ì‚·Ì¿ÙˆÓ ÛÙËÓÔÌ¿‰· ÙË˜ ·ÙÔÚ‚·ÛÙ·Ù›ÓË˜ ‹Ù·Ó

88% (∂ÈÎfiÓ· 3). ∂ÈÏ¤ÔÓ, ÌÂÙ¿·fi PCI, ÙÔ ÔÛÔÛÙfi ÙˆÓ ·ÛıÂ-ÓÒÓ ÌÂ ·˘ÍËÌ¤ÓË CK-ªμ ‹ ÙÚÔ-ÔÓ›ÓË π ‹Ù·Ó ÛËÌ·ÓÙÈÎ¿ ¯·ÌËÏfi-ÙÂÚÔ ·fi ·˘Ùfi ÙË˜ ÔÌ¿‰·˜ ÙÔ˘ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘.[12] ΔÔ ›‰ÈÔÛ˘Ó¤‚Ë Î·È ÌÂ Ù· Â›Â‰· ÙË˜CRP.[12] ∞˘Ù¿ Ù· ÛÙÔÈ¯Â›· ÌÔ-ÚÔ‡Ó Ó· ˘ÔÛÙËÚ›ÍÔ˘Ó ÙË ¯Ú‹ÛË˘„ËÏ‹˜ ‰fiÛË˜ ÛÙ·Ù›ÓË˜ (40 mg·ÙÔÚ‚·ÛÙ·Ù›ÓË˜) ÚÈÓ ·fi ÙËPCI ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ √™™. ∂›-Ó·È ÚÔÊ·Ó¤˜ ÙÔ È·ÙÚÈÎfi Î·È ÔÈ-ÎÔÓÔÌÈÎfi fiÊÂÏÔ˜ ·fi ÙË ¯Ú‹ÛË3 ‰ÈÛÎ›ˆÓ ·ÙÔÚ‚·ÛÙ·Ù›ÓË˜ 40 mgÁÈ· Ó· ÁÏÈÙÒÛÂÈ Î·ÓÂ›˜ ÙÔ 88%ÙˆÓ ÂÈÏÔÎÒÓ ÙË˜ PCI.

Δ¤ÏÔ˜ ÛÙ· Ï·›ÛÈ· ÔÈÎÔÓÔÌ›·˜ÛÙË Ê·ÚÌ·ÎÂ˘ÙÈÎ‹ ·ÓÙÈÌÂÙÒÈÛËÙË˜ ™™¡ Á›ÓÂÙ·È ÂÎÙÂÙ·Ì¤ÓË ¯Ú‹-ÛË ·ÓÙÈÁÚ¿ÊˆÓ ÛÙ·ÙÈÓÒÓ. ∏ ÌÂ-Ï¤ÙË THIN (The Health Improve-ment Network) ·fi ÙÔ ∏ÓˆÌ¤ÓÔμ·Û›ÏÂÈÔ, [13] ÌÂÏ¤ÙËÛÂ ÙÔ Î·Ù¿fiÛÔ ·˘Ùfi Â›Ó·È ÔÈÎÔÓÔÌÈÎ¿ Û˘Ì-Ê¤ÚÔÓ. ™ÙË ÌÂÏ¤ÙË Û˘ÌÌÂÙÂ›¯·Ó11.520 ·ÛıÂÓÂ›˜, 9.009 ·ÛıÂÓÂ›˜Ô˘ ¤·ÈÚÓ·Ó ·ÙÔÚ‚·ÛÙ·Ù›ÓË Î·È2.511 ·ÛıÂÓÂ›˜ Ô˘ ¤·ÈÚÓ·Ó·Ï·ÈfiÙÂÚ· ·ÙÔÚ‚·ÛÙ·Ù›ÓË ·ÏÏ¿ÙÔ˘˜ ¯ÔÚËÁ‹ıËÎÂ ·ÓÙ›ÁÚ·ÊÔ ÛÈÌ-‚·ÛÙ·Ù›ÓË˜ Â› 2 ÂÚ›Ô˘ ¯Úfi-ÓÈ·.[13] Δ· ·ÔÙÂÏ¤ÛÌ·Ù· ¤‰ÂÈÍ·ÓfiÙÈ Ô Û¯ÂÙÈÎfi˜ Î›Ó‰‡ÓÔ˜ (HR) ÂÌ-Ê¿ÓÈÛË˜ ÙÔ˘ ÚˆÙÔÁÂÓÔ‡˜ Î·ÈÙˆÓ ‰Â˘ÙÂÚÔÁÂÓÒÓ ÎÏÈÓÈÎÒÓ ÛË-ÌÂ›ˆÓ ÙË˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó ÌÂÁ·Ï‡-ÙÂÚÔ˜ ÛÙËÓ ÔÌ¿‰· 1 (·ÓÙ›ÁÚ·ÊÔÛÈÌ‚·ÛÙ·Ù›ÓË˜) ÛÂ Û‡ÁÎÚÈÛË ÌÂÙËÓ ÔÌ¿‰· 2 (Û˘Ó¤¯ÈÛË ·ÙÔÚ‚·-ÛÙ·Ù›ÓË˜). º·›ÓÂÙ·È ÏÔÈfiÓ fiÙÈ ÔÎ›Ó‰˘ÓÔ˜ ı·Ó¿ÙÔ˘ ‹ ÌÂ›˙ÔÓÔ˜Î·Ú‰È·ÁÁÂÈ·ÎÔ‡ Û˘Ì‚¿Ì·ÙÔ˜(Û‡ÓıÂÙÔ ÚˆÙÔÁÂÓ¤˜ ÙÂÏÈÎfi ÛË-ÌÂ›Ô) ·˘Í‹ıËÎÂ ÛÙËÓ ÔÌ¿‰· ÙÔ˘·ÓÙÈÁÚ¿ÊÔ˘ Î·Ù¿ 30% ÛÂ Û‡-ÁÎÚÈÛË ÌÂ ÙËÓ ÔÌ¿‰· ÙË˜ ·ÙÔÚ-‚·ÛÙ·Ù›ÓË˜. ∂›ÛË˜, Ô Î›Ó‰‡ÓÔ˜ÙÔ˘ ÌÂ›˙ÔÓÔ˜ Î·Ú‰È·ÁÁÂÈ·ÎÔ‡Û˘Ì‚¿Ì·ÙÔ˜ ·˘Í‹ıËÎÂ Î·Ù¿43%, ÙÔ˘ ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ô-Î·Ú‰›Ô˘ Î·Ù¿ 36%, ÙÔ˘ ·ÁÁÂÈ·-ÎÔ‡ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ Î·-Ù¿ 114% Î·È ÙË˜ ÂÂÌ‚·ÙÈÎ‹˜Â·Ó·ÈÌ¿ÙˆÛË˜ Î·Ù¿ 23% (¶›Ó·-Î·˜ 1).[13] £· Ú¤ÂÈ Ó· ÏËÊıÂ›˘fi„Ë fiÙÈ Ë Î·Ù·ÁÚ·Ê‹ ·˘Ù‹ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ·ÊÔÚ¿ ¯ÚÔÓÈÎfi‰È¿ÛÙËÌ· ÌfiÓÔ 2 ÂÙÒÓ ÂÚ›Ô˘Î·È fiÙÈ ¤ÁÈÓÂ Û‡ÁÎÚÈÛË 2 ÂÓÂÚ-ÁÒÓ ıÂÚ·ÂÈÒÓ ÌÂ ÛÙ·Ù›ÓÂ˜ Î·Èfi¯È Û‡ÁÎÚÈÛË ÛÙ·Ù›ÓË˜ ÌÂ ÂÈÎÔÓÈ-Îfi Ê¿ÚÌ·ÎÔ.

¢ ∂ ∫ ∂ ª μ ƒ π √ ™ 2 0 0 7

20

∂ÈÎfiÓ· 3. ªÂ›˙ÔÓ· Î·Ú‰È·ÁÁÂÈ·Î¿ ÂÂÈÛfi‰È· ÛÂ ‰È¿ÛÙËÌ· 30 ËÌÂÚÒÓÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÙË˜ ÌÂÏ¤ÙË˜ ARMYDA-ACS.

‚-·Ó·ÛÙÔÏÂ›˜

·-ª∂∞

∞ÙÔÚ‚·ÛÙ·Ù›ÓË


21

Δ· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ÌÂÏ¤ÙË˜·˘Ù‹˜ [13], Ô˘ Â›Ó·È Ë ÚÒÙË ÛÙÔÂ›‰Ô˜ ÙË˜ ‰Â›¯ÓÔ˘Ó fiÙÈ Ë ¯Ú‹ÛË·ÓÙÈÁÚ¿ÊÔ˘ ÛÈÌ‚·ÛÙ·Ù›ÓË˜, ÌÂ¯·ÌËÏfiÙÂÚÔ ÌËÓÈ·›Ô ÎfiÛÙÔ˜ ıÂ-Ú·Â›·˜ ·’ fiÙÈ Ë ÚˆÙfiÙ˘Ë·ÙÔÚ‚·ÛÙ·Ù›ÓË, fi¯È ÌfiÓÔ ‰ÂÓ Â›-Ó·È Ë ÈÔ ÔÈÎÔÓÔÌÈÎ‹ Ï‡ÛË ·ÏÏ¿Ê·›ÓÂÙ·È fiÙÈ ÙËÓ ÏËÚÒÓÔ˘ÌÂÔÏ‡ ·ÎÚÈ‚¿. ∞˘Ùfi Û˘Ì‚·›ÓÂÈÁÈ·Ù› ÂÓÒ ÚÔÛ·ıÔ‡ÌÂ Ó· Î¿-ÓÔ˘ÌÂ ÔÈÎÔÓÔÌ›· Î·Ù¿ 20% ÛÂÙÌ‹Ì· ÙË˜ Ê·ÚÌ·ÎÂ˘ÙÈÎ‹˜ ·Áˆ-

Á‹˜ Ô˘ Â›Ó·È ÔÈ ÛÙ·Ù›ÓÂ˜ (∂ÈÎfi-Ó· 1), 17% Ë Û˘ÓÔÏÈÎ‹ Ê·ÚÌ·-ÎÂ˘ÙÈÎ‹ ·ÁˆÁ‹, 7% ÙÔ ÎfiÛÙÔ˜ÙˆÓ ÛÙ·ÙÈÓÒÓ ˘ÔÏÔÁÈ˙fiÌÂÓÔ˘Â› ÙÔ˘ Û˘ÓfiÏÔ˘ ÙÔ˘ ÎfiÛÙÔ˘˜ÙË˜ ™¡ Û‡ÓÔÏÔ ÔÈÎÔÓÔÌ›·˜ -1,4%ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ ÎfiÛÙÔ˘˜) ÂÈ‚·-Ú‡ÓÔ˘ÌÂ Î·Ù¿ 30% ¤ˆ˜ 114%(¶›Ó·Î·˜ 1) ÙÔ˘˜ ı·Ó¿ÙÔ˘˜, ÓÔ-ÛËÏÂ›Â˜ Î·È ·ÒÏÂÈ· ·Ú·ÁˆÁÈ-ÎfiÙËÙ·˜, ‰ËÏ·‰‹ ÙÔ ˘fiÏÔÈÔ93% ÙÔ˘ ÎfiÛÙÔ˘˜ (Û˘ÓÔÏÈÎfi -7%ÙÔ ÎfiÛÙÔ˜ ÙˆÓ ÛÙ·ÙÈÓÒÓ). ∞˘Ùfi

‰ÂÓ ¤¯ÂÈ È·ÙÚÈÎfi, ·ÓıÚˆÈÛÙÈÎfi,ÏÔÁÈÎfi ‹ ÔÈÎÔÓÔÌÈÎfi ¤ÚÂÈÛÌ·.

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿ ÌÔÚÔ‡ÌÂ Ó·Ô‡ÌÂ fiÙÈ ÔÈ ÛÙ·Ù›ÓÂ˜ Â›Ó·È ·Ô-ÙÂÏÂÛÌ·ÙÈÎ¿ Ê¿ÚÌ·Î· ÌÂ Î·Ï‹Û¯¤ÛË ÎfiÛÙÔ˘˜ - ·ÔÙÂÏÂÛÌ·ÙÈ-ÎfiÙËÙ·˜ ÙfiÛÔ ÛÙË ÚˆÙÔÁÂÓ‹fiÛÔ Î·È ÛÙË ‰Â˘ÙÂÚÔÁÂÓ‹ Úfi-ÏË„Ë ÙË˜ ™¡ Â›ÙÂ ·˘Ù‹ ‚·Û›˙ÂÙ·ÈÛÂ Û˘ÓÙËÚËÙÈÎ‹ ·ÁˆÁ‹ Â›ÙÂ ÛÂÂÂÌ‚·ÙÈÎ‹ Â·Ó·ÈÌ¿ÙˆÛË.

£¿Ó·ÙÔ˜ ·fi ÔÔÈ·‰‹ÔÙÂ ·ÈÙ›·‹ ÌÂ›˙ÔÓ ∫∞ Û˘Ì‚¿Ó**

ªÂ›˙ÔÓ ∫∞ Û˘Ì‚¿Ó

ŒÌÊÚ·ÁÌ· ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘

∞ÁÁÂÈ·Îfi ÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔ

∂ÂÌ‚¿ÛÂÈ˜ Â·Ó·ÁÁÂ›ˆÛË˜

£¿Ó·ÙÔ˜ ·fi ÔÔÈ·‰‹ÔÙÂ ·ÈÙ›·

* ™Ù·ıÌÈÛÌ¤ÓÔ˜ ˆ˜ ÚÔ˜ ÙËÓ ËÏÈÎ›·, ÙÔ Ê‡ÏÔ, ÚÔËÁÔ‡ÌÂÓÔ ∂ª, ™¢, ¯ÚfiÓÔ ·fi ÙËÓ ÙÂÏÂ˘Ù·›· Ï‹„ËÛÙ·Ù›ÓË˜, Û˘ÓÔÏÈÎfi ¯ÚfiÓÔ ıÂÚ·Â›·˜ ÌÂ ÛÙ·Ù›ÓË ÚÈÓ ÙËÓ ·ÏÏ·Á‹ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘.

**∂ª, ∞∂∂, ∂¤Ì‚·ÛË Â·Ó·ÁÂ›ˆÛË˜.

√Ì¿‰· ·ÓÙÈÁÚ¿ÊÔ˘ (N=2.511) ¤Ó·ÓÙÈ ÔÌ¿‰·˜ÂÏ¤Á¯Ô˘ (N=9.009)

™Ù·ıÌÈÛÌ¤ÓÔ˜ P∞Ó·ÏÔÁÈÎfi˜ ∫›Ó‰˘ÓÔ˜*

(95% CI) _

1,30 (1,02-1,64 0,030

1,43 (1,10-1,87) 0,006

1,36 (0,80-2,32) 0,258

2,14 (1,21-3,81) 0,009

1,23 (0,87-1,73) 0,240

0,80 (0,49-1,30) 0,369

¶›Ó·Î·˜ 1. ∫›Ó‰˘ÓÔ˜ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ (∫∞) Û˘Ì‚·Ì¿ÙˆÓ ÛÂ ·ÛıÂÓÂ›˜ ÙË˜ ÔÌ¿‰·˜ ·ÓÙÈÁÚ¿ÊÔ˘ Ê·ÚÌ¿ÎÔ˘ ÌÂ ÙÔ˘˜ ·ÛıÂÓÂ›˜ Ô˘ Û˘Ó¤¯ÈÛ·Ó Ó· Ï·Ì‚¿ÓÔ˘Ó ·ÙÔÚ‚·ÛÙ·Ù›ÓË


1. American Heart Association. CardiovascularDisease Statistics [online]. Available fromURL: http://www.americanheart.org[Accessed 2007 Oct 12]

2. American Heart Association. CardiovascularDisease Cost [online]. Available from URL:http://www.americanheart.org [Accessed2007 Oct 12]

3. Leal J, Luengo-Fernãandez R, Gray A, et al.Economic burden of cardiovascular disea-ses in the enlarged European Union. EurHeart J 2006; 27: 1610-1619.

4. Schwartz GG, Olsson AG, Ezekowitz MD, etal. Effects of atorvastatin on early recurrentischemic events in acute corona ry syn-dromes, the MIRACL study. a randomizedcontrolled trial. JAMA 2001; 285: 1711-8

5. Cannon CP, Braunwald E, McCabe CH, etal; Pravastatin or Atorvastatin Evaluationand Infection Therapy-Thrombolysis inMyocardial Infarction 22 Investigators.Intensive versus moderate lipid loweringwith statins after acute coronary syn-dromes.N Engl J Med 2004;350:1495-1504.

6. Schwartz GG, Ganz P, Waters D, Arikian S.Pharmacoeconomic evaluation of theeffects of atorvastatin on early recurrentischemic events in acute coronary syn-dromes. Am J Cardiol 2003;92:1109-1112

7. Chan PS, Nallamothu BK, Gurm HS, et al.Incremental benefit and cost-effectivenessof high-dose statin therapy in high-riskpatients with coronary artery disease.Circulation 2007;115:2398-2409.

8. Athyros VG, Papageorgiou AA, MercourisBR, et al. Treatment with atorvastatin to theNational Cholesterol Educational Programgoals versus usual care in secondaryCoronary Heart Disease prevention. TheGREek Atorvastatin and Coronary-heart-disease Evaluation (GREACE) Study. CurrMed Res Opin 2002;18:220-228.

9. Athyros VG, Papageorgiou AA, SymeonidisAN, et al; GREACE Study CollaborativeGroup. Early benefit from structured carewith atorvastatin in patients with coronaryheart disease and diabetes mellitus.Angiology 2003;54:679-690.

10. Boden WE, O'Rourke RA, Teo KK, et al;COURAGE Trial Research Group. Optimalmedical therapy with or without PCI forstable coronary disease. N Engl J Med2007;356:1503-1516.

11. Pasceri V, Patti G, Nusca A, Pristipino C,Richichi G, Di Sciascio G, ARMYDAInvestigators. Randomized trial of atorva-statin for reduction of myocardial damageduring coronary intervention: results fromthe ARMYDA (Atorvastatin for Reduction ofMyocardial Damage During Angioplasty)study. Circulation 2004; 110:674-678.

12. Patti G, Pasceri V, Colonna G, et al.Atorvastatin pretreatment improves out-comes in patients with acute coronarysyndromes undergoing early percuta-neous coronary intervention. Results of theARMYDA-ACS Randomized Trial. J AmColl Cardiol 2007;49:1272-1278.

13. Phillips B, Roberts G, Rudolph AE, MorantS, Aziz F, O’Regan CP. Switching Statins:The Impact on Patient Outcomes. Euro-pean Society of Cardiology Congress,Vienna, 4 Sept 2007.

ªÂ ÙÔÓ fiÚÔ ÂÚÈÊÂÚÈÎ‹ ·ÚÙËÚÈÔ-¿ıÂÈ· ‹ ÂÚÈÊÂÚÈÎ‹ ·ÚÙËÚÈ·Î‹ÓfiÛÔ˜ (¶∞¡) ·Ó·ÊÂÚfiÌ·ÛÙÂÛÙËÓ ·ıËÚÔÛÎÏËÚˆÙÈÎ‹˜ ·ÈÙÈÔ-ÏÔÁ›·˜ ‘·ÔÊÚ·ÎÙÈÎ‹’ ÓfiÛÔ ÙˆÓ·ÚÙËÚÈÒÓ ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ Î·ÈÙË˜ ÎÔÈÏÈ·Î‹˜ ·ÔÚÙ‹˜. √ ÂÎÙÈÌÒ-ÌÂÓÔ˜ ÂÈÔÏ·ÛÌfi˜ ÙË˜ ÓfiÛÔ˘ÂÍ·ÚÙ¿Ù·È ·fi ‰ËÌÔÁÚ·ÊÈÎÔ‡˜·Ú¿ÁÔÓÙÂ˜ ÙˆÓ ˘fi ÌÂÏ¤ÙËÏËı˘ÛÌÒÓ, Î·ıÒ˜ Î·È ·fi ÙÈ˜ÌÂıfi‰Ô˘˜ ÙË˜ ‰È¿ÁÓˆÛË˜. °È··Ú¿‰ÂÈÁÌ·, Ô ÂÈÔÏ·ÛÌfi˜ ÙË˜¶∞¡ Â›Ó·È ‰ÈÏ¿ÛÈÔ˜ ÛÙÔ˘˜∞ÊÚÈÎ·ÓÈÎ‹˜ Î·Ù·ÁˆÁ‹˜ ∞ÌÂÚÈ-Î·ÓÔ‡˜ ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙÔ˘˜ ÌËÈÛ·ÓfiÊˆÓÔ˘˜ ÏÂ˘ÎÔ‡˜, ÁÂÁÔ-Ófi˜ Ô˘ ÌÔÚÂ› Ó· ÂÍËÁËıÂ› ÌÂ-ÚÈÎÒ˜ ·fi ÙËÓ ÌÂÁ·Ï‡ÙÂÚË Â›-ÙˆÛË ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘Î·Ú‰È·ÁÁÂÈ·Î‹˜ ÓfiÛÔ˘ (∫∞¡),fiˆ˜ Ô Û·Î¯·ÚÒ‰Ë˜ ‰È·‚‹ÙË˜, Ë˘¤ÚÙ·ÛË Î·È Ë ·¯˘Û·ÚÎ›·.[1]

°ÂÓÈÎ¿, Ë Û˘¯ÓfiÙËÙ· ÙË˜ ÓfiÛÔ˘Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË ÛÙÔ˘˜ ¿Ó‰ÚÂ˜Î·È ·˘Í¿ÓÂÙ·È ÌÂ ÙËÓ ËÏÈÎ›·.[1]

∏ ¶∞¡ ıÂˆÚÂ›Ù·È ˆ˜ ÂÎ‰‹ÏˆÛËÙË˜ Û˘ÛÙËÌ·ÙÈÎ‹˜ ·ıËÚÔÛÎÏË-Ú˘ÓÙÈÎ‹˜ ÓfiÛÔ˘ Ô˘ ¤¯ÂÈ ÂÍÂÏÈ-

¯ıÂ› ÛÙË ‰È¿ÚÎÂÈ· ·ÚÎÂÙÒÓ ¯Úfi-ÓˆÓ. √ ÛÊ˘ÚÔ‚Ú·¯ÈfiÓÈÔ˜ ‰Â›-ÎÙË˜ (∞μπ, ankle-brachial index)¤¯ÂÈ ·ÍÈÔÏÔÁËıÂ› ˆ˜ È‰È·›ÙÂÚ·Â˘·›ÛıËÙË Î·È ÂÈ‰ÈÎ‹ Ì¤ıÔ‰Ô˜ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙË˜ ¶∞¡ Î·È ıÂ-ˆÚÂ›Ù·È ‰Â›ÎÙË˜ ÁÂÓÈÎÂ˘Ì¤ÓË˜·ıËÚˆÌ¿ÙˆÛË˜.[2] ¶ÚfiÛÊ·Ù· ‰Â-‰ÔÌ¤Ó· ·fi ÙËÓ ÂÈ‰ËÌÈÔÏÔÁÈÎ‹Î·Ù·ÁÚ·Ê‹ REACH ÂÈÛËÌ·›-ÓÔ˘Ó fiÙÈ ÂÚÈÛÛfiÙÂÚÔÈ ·fi ÙÔ60% ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ¶∞¡ Â›¯·ÓÎÏÈÓÈÎ¤˜ ÂÓ‰Â›ÍÂÈ˜ ÛÙÂÊ·ÓÈ·›·˜ ‹ÂÁÎÂÊ·ÏÔ·ÁÁÂÈ·Î‹˜ ÓfiÛÔ˘[3] (™¯‹-Ì· 1). ™ËÌ·ÓÙÈÎfi˜ ·ÚÈıÌfi˜ ÙˆÓ·ÛıÂÓÒÓ ÌÂ ¶∞¡ ·Ú·Ì¤ÓÔ˘Ó·‰È¿ÁÓˆÛÙÔÈ[4], ÂÓÒ ÛËÌ·ÓÙÈÎfiÔÛÔÛÙfi ·ÛıÂÓÒÓ ÌÂ ÙÂÎÌËÚÈˆ-Ì¤ÓË ¶∞¡ ‰ÂÓ Ï·Ì‚¿ÓÂÈ Î·Ù¿Ï-ÏËÏË ıÂÚ·Â˘ÙÈÎ‹ ·ÁˆÁ‹ ÌÂ ·-Ú¿ÁÔÓÙÂ˜ Ô˘ ÌÂÈÒÓÔ˘Ó ÙÔÓ Î›Ó-‰˘ÓÔ ÂÌÊ¿ÓÈÛË˜ Î·Ú‰È·ÁÁÂÈ·ÎÒÓÛ˘Ì‚·Ì¿ÙˆÓ[5, 6].

1. º˘ÛÈÎ‹ ÈÛÙÔÚ›· ·ÛıÂÓÒÓ ÌÂ ¶∞¡ (™¯‹Ì· 2)

™ÙËÓ ÏÂÈÔÓfiÙËÙ¿ ÙÔ˘˜ ÔÈ ·ÛıÂ-ÓÂ›˜ ÌÂ ¶∞¡ Â›Ó·È ·Û˘ÌÙˆÌ·ÙÈ-ÎÔ›. ªÂÏ¤ÙÂ˜ ¤‰ÂÈÍ·Ó fiÙÈ ÛÙÈ˜

ÂÚÈÛÛfiÙÂÚÂ˜ÂÚÈÙÒÛÂÈ˜·ÛıÂÓÒÓ ÌÂ‰È·ÏÂ›Ô˘Û·¯ˆÏfiÙËÙ· Ë Ô-ÚÂ›· Â›Ó·È ÛÙ·-ıÂÚ‹ Î·È ÌfiÓÔ¤Ó· ÌÈÎÚfi Ô-ÛÔÛÙfi ÂÌÊ·Ó›-˙ÂÈ ÂÈ‰Â›ÓˆÛËÙË˜ Û˘ÌÙˆÌ·-ÙÔÏÔÁ›·˜ ÙˆÓÎ¿Ùˆ ¿ÎÚˆÓ[5, 6].¶ÚfiÎÂÈÙ·È ÁÈ·ÌÈ· ÂÍÂÏÈÎÙÈÎ‹‰È·‰ÈÎ·Û›· Ô˘ÂÈ‚¿ÏÏÂÈ ÙËÓ·Ú¤Ì‚·ÛËÚÈÓ ·fi ÙËÓÂÌÊ¿ÓÈÛË Û˘-ÌÙˆÌ¿ÙˆÓ Î·ÈÛËÌÂ›ˆÓ ÎÚ›ÛÈ-

ÌË˜ ÈÛ¯·ÈÌ›·˜ ÙÔ˘ ÛÎ¤ÏÔ˘˜.

2. ∏ ¶∞¡ ˆ˜ ÈÛÔ‰‡Ó·ÌÔ ÛÙÂÊ·ÓÈ·›Ô˘ ÎÈÓ‰‡ÓÔ˘

∏ Èı·ÓfiÙËÙ· ÂÎ‰‹ÏˆÛË˜ ·ıË-ÚÔÛÎÏËÚˆÙÈÎÒÓ ÂÈÏÔÎÒÓ Â›Ó·È·˘ÍËÌ¤ÓË ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ¶∞¡. √ Î›Ó‰˘ÓÔ˜ ÂÌÊ¿ÓÈÛË˜ ÂÌ-ÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘ Â›-Ó·È ÙÂÙÚ·Ï¿ÛÈÔ˜, ÂÓÒ Ô Î›Ó‰˘-ÓÔ˜ ·ÁÁÂÈ·ÎÔ‡ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÂÈ-ÛÔ‰›Ô˘ 2-3 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔ˜ÛÂ Û‡ÁÎÚÈÛË ÌÂ ¿ÙÔÌ· Ô˘ ‰ÂÓ¤¯Ô˘Ó ÂÚÈÊÂÚÈÎ‹ ·ÚÙËÚÈÔ¿-ıÂÈ·. √È ·ÛıÂÓÂ›˜ ÌÂ ¶∞¡ ‰È·-ÙÚ¤¯Ô˘Ó 2-4 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔÎ›Ó‰˘ÓÔ Û˘ÓÔÏÈÎ‹˜ ıÓËÛÈÌfiÙËÙ·˜Î·È 3-6 ÊÔÚ¤˜ ÈÔ ·˘ÍËÌ¤ÓÔ Î›Ó-‰˘ÓÔ ıÓËÙfiÙËÙ·˜ ÂÍ·ÈÙ›·˜ Î·Ú-‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ ÛÂ Û‡-ÁÎÚÈÛË ÌÂ ·ÛıÂÓÂ›˜ Ô˘ ‰ÂÓ¤¯Ô˘Ó ¶∞¡[1, 2, 9].

√ Î›Ó‰˘ÓÔ˜ ÌÂ›˙ÔÓÔ˜ Î·Ú‰È·ÁÁÂÈ-·ÎÔ‡ Û˘Ì‚¿Ì·ÙÔ˜ Â›Ó·È ·ÓÂÍ¿Ú-ÙËÙÔ˜ ·fi ÙËÓ ·ÚÔ˘Û›· ‹ fi¯ÈÛ˘ÌÙˆÌ¿ÙˆÓ ‰È·ÏÂ›Ô˘Û·˜ ¯ˆ-ÏfiÙËÙ·˜ Î·È Â›Ó·È ·˘ÍËÌ¤ÓÔ˜·ÎfiÌË Î·È ÛÙÈ˜ ÂÚÈÙÒÛÂÈ˜·ÛıÂÓÒÓ ¯ˆÚ›˜ Û˘ÌÙÒÌ·Ù· Ô˘‰È·ÁÈÁÓÒÛÎÔÓÙ·È ÌÂ ‚¿ÛË ÙË Ì¤-ÙÚËÛË ÙÔ˘ ∞μπ. ∫·Ù¿ Û˘Ó¤ÂÈ·,ÔÈ ·ÛıÂÓÂ›˜ ÌÂ ¶∞¡ Ú¤ÂÈ Ó··ÓÙÈÌÂÙˆ›˙ÔÓÙ·È ˆ˜ ·ÛıÂÓÂ›˜ÙË˜ ‰Â˘ÙÂÚÔÁÂÓÔ‡˜ ÚfiÏË„Ë˜,fiˆ˜ Î·È ÔÈ ·ÛıÂÓÂ›˜ ÌÂ ÙÂÎÌË-ÚÈˆÌ¤ÓË ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ[10].

3. £ÂÚ·Â˘ÙÈÎ‹ ÚÔÛ¤ÁÁÈÛË·ÛıÂÓÒÓ ÌÂ ¶∞¡

∂ÎÙfi˜ ·fi ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ÙˆÓ·ÛıÂÓÒÓ Ô˘ Ú¤ÂÈ Ó· ·ÓÙÈÌÂ-ÙˆÈÛıÔ‡Ó ÂÂÈÁfiÓÙˆ˜ ·fi ÙÔÓ·ÁÁÂÈÔ¯ÂÈÚÔ˘ÚÁfi, Ô È·ÙÚfi˜ ÙË˜ÚˆÙÔÁÂÓÔ‡˜ ÊÚÔÓÙ›‰·˜ ÔÊÂ›ÏÂÈÓ· ·Ú·¤ÌÂÈ ÛÙÔÓ ÂÈ‰ÈÎfi ·Á-ÁÂÈÔ¯ÂÈÚÔ˘ÚÁfi Î¿ıÂ ÂÚ›ÙˆÛË·ÛıÂÓÔ‡˜ ÌÂ ÂÌÌÔÓ‹ ÙˆÓ Û˘-ÌÙˆÌ¿ÙˆÓ ·Ú¿ ÙËÓ Î·Ù¿ÏÏËÏËıÂÚ·Â›·, ·ÛıÂÓÒÓ Ô˘ ÂÌÊ·Ó›-

™ ∂ ¶ Δ ∂ ª μ ƒ π √ ™ 2 0 0 7

22

ΔÚÔÔÔ›ËÛË ÙˆÓ ¶·Ú·ÁfiÓÙˆÓ∫ÈÓ‰‡ÓÔ˘ ÛÂ ∞ÛıÂÓÂ›˜ ÌÂ

¶ÂÚÈÊÂÚÈÎ‹ ∞ÚÙËÚÈÔ¿ıÂÈ·Ã·Ú¿Ï·ÌÔ˜ ªËÏÈÒÓË˜*, ∂›ÎÔ˘ÚÔ˜ ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜,

π·ÙÚÈÎ‹ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓªÈÏÙÈ¿‰Ë˜ ª·ÙÛ¿ÁÎ·˜, ∂›ÎÔ˘ÚÔ˜ ∫·ıËÁËÙ‹˜ ∞ÁÁÂÈÔ¯ÂÈÚÔ˘ÚÁÈÎ‹˜,

π·ÙÚÈÎ‹ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ

™ÙÂÊ·ÓÈ·›· ÓfiÛÔ˜∂ÁÎÂÊ·ÏÔ·ÁÁÂÈ·Î‹ÓfiÛÔ˜

¶ÂÚÈÊÂÚÈÎ‹ ·ÚÙËÚÈÔ¿ıÂÈ·

™¯‹Ì· 1. ™˘Ó‡·ÚÍË ÙˆÓ ÂÎ‰ËÏÒÛÂˆÓ ÙË˜ ·ıËÚÔ-ÎÏËÚˆÙÈÎ‹˜ ·ÈÙÈÔÏÔÁ›·˜ Î·Ú‰È·ÁÁÂÈ·Î‹˜ ÓfiÛÔ˘[3].

™À°Ãƒ√¡∂™ √¢∏°π∂™

23

˙Ô˘Ó ÌÂ›ˆÛË ‹ ·Ô˘Û›· ÛÊ‡ÍÂˆÓÛÙÈ˜ ÌËÚÈ·›Â˜ ·ÚÙËÚ›Â˜, Î·ıÒ˜Î·È fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ Û·Î-¯·ÚÒ‰Ë ‰È·‚‹ÙË[11] (¶›Ó·Î·˜ 1).

∏ ÂÈıÂÙÈÎ‹ ·Ú¤Ì‚·ÛË ÌÂ ÙÚÔ-ÔÔ›ËÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ Î·Ú-‰È·ÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ Ô˘ ÙÂÎ-ÌËÚÈˆÌ¤Ó· ·˘Í¿ÓÔ˘Ó ÙÔÓ Î›Ó‰˘-ÓÔ ¶∞¡ Â›Ó·È ÂÈ‚Â‚ÏËÌ¤ÓË Î·È‰ÂÓ ÂÈ‰¤¯ÂÙ·È ¯ÚÔÓÔÙÚÈ‚‹˜[2, 9]

(™¯‹Ì· 3).

3.1. ¢È·ÎÔ‹ ÙÔ˘ Î·Ó›ÛÌ·ÙÔ˜

ΔÔ Î¿ÓÈÛÌ· ‰ÈÏ·ÛÈ¿˙ÂÈ ÙÔÓ Î›Ó-‰˘ÓÔ ÂÌÊ¿ÓÈÛË˜ ¶∞¡, ÂÓÒ Ë ÂÈ-ÌÔÓ‹ ÙˆÓ ·ÛıÂÓÒÓ ÛÂ ·˘Ù‹ ÙËÓÂÈ˙‹ÌÈ· Û˘Ó‹ıÂÈ· ˘ÂÚÙÚÈÏ·-ÛÈ¿˙ÂÈ ÙÔ Î›Ó‰˘ÓÔ ÂÈ‰Â›ÓˆÛË˜ÙË˜ ‹‰Ë ˘¿Ú¯Ô˘Û·˜ ·ÚÙËÚÈÔ-¿ıÂÈ·˜[13] ·˘Í¿ÓÔÓÙ·˜ ÙÔÓ Î›Ó-‰˘ÓÔ ÂÎ‰‹ÏˆÛË˜ ÎÚÈÙÈÎ‹˜ ÈÛ¯·È-Ì›·˜ ÙÔ˘ ÛÎ¤ÏÔ˘˜ ‹/Î·È ·ÎÚˆÙË-ÚÈ·ÛÌÔ‡. ™Â ÌÈ· ÌÂÏ¤ÙË ·Ú·Ù‹-ÚËÛË˜ ‚Ú¤ıËÎÂ ÌÈ· ‰ÔÛÔ-ÂÍ·Ú-ÙÒÌÂÓË Û˘Û¯¤ÙÈÛË ÙÔ˘ Î·Ó›-ÛÌ·ÙÔ˜ Î·È ÙˆÓ ·ÎÚˆÙËÚÈ·ÛÌÒÓÛÂ ·ÛıÂÓÂ›˜ ÌÂ ¶∞¡[14]. ∞ÓÙ›ıÂÙ·,Ë ‰È·ÎÔ‹ ÙÔ˘ Î·Ó›ÛÌ·ÙÔ˜ ·˘-Í¿ÓÂÈ ÙËÓ ÂÈ‚›ˆÛË[15].

°È· ÙË ‰È·ÎÔ‹ ÙÔ˘ Î·Ó›ÛÌ·-ÙÔ˜ Û˘ÓÈÛÙ¿Ù·È Ë Û˘ÌÌÂÙÔ¯‹ÙˆÓ ·ÛıÂÓÒÓ ÛÂ Û˘Ì‚Ô˘ÏÂ˘ÙÈÎ¿ÚÔÁÚ¿ÌÌ·Ù· ‚Ô‹ıÂÈ·˜ ‹/Î·È¯Ú‹ÛË Ê·ÚÌ·ÎÂ˘ÙÈÎÒÓ ·Ú·Áfi-ÓÙˆÓ, fiˆ˜ ÙÔ ‚Ô˘ÚfiÈÔ, Ù·˘ÔÎ·Ù¿ÛÙ·Ù· ÓÈÎÔÙ›ÓË˜, Î·ıÒ˜Î·È ÓÂfiÙÂÚ· Ê¿ÚÌ·Î· fiˆ˜ Ë‚·ÚÂÓÈÎÏ›ÓË[16].

3.2. ÕÛÎËÛË

∞fi Ù· ÌË Ê·ÚÌ·ÎÂ˘ÙÈÎ¿ Ì¤ÙÚ·,Ë ·‡ÍËÛË ÙË˜ ÛˆÌ·ÙÈÎ‹˜ ‰Ú·-ÛÙËÚÈfiÙËÙ·˜ ¤¯ÂÈ ·Ô‰ÂÈ¯ıÂ› fiÙÈ‚ÂÏÙÈÒÓÂÈ ÙË Û˘ÌÙˆÌ·ÙÔÏÔÁ›·ÙˆÓ ·ÛıÂÓÒÓ, Èı·ÓfiÓ ‰È·Ì¤ÛÔ˘

ÙË˜ ‚ÂÏÙ›ˆÛË˜ ÙË˜ ÏÂÈÙÔ˘ÚÁÈÎfi-ÙËÙ·˜ ÙÔ˘ ÂÓ‰ÔıËÏ›Ô˘, ÙË˜ ÌÂ›ˆ-ÛË˜ ÙË˜ ÊÏÂÁÌÔÓÒ‰Ô˘˜ ‰ÈÂÚÁ·-Û›·˜, ÙË˜ Â˘ÓÔ˚Î‹˜ Â›‰Ú·ÛË˜ÛÙÔ ÌÂÙ·‚ÔÏÈÛÌfi ÙˆÓ Ì˘ÒÓ Î·ÈÛÙÔ˘˜ ·ÈÌÔÚÚÂÔÏÔÁÈÎÔ‡˜ ·Ú¿-ÁÔÓÙÂ˜[17]. ™ÙÈ˜ Û‡Á¯ÚÔÓÂ˜ Û˘ÛÙ¿-ÛÂÈ˜ ·ÓÙÈÌÂÙÒÈÛË˜ ÙˆÓ ·ÛıÂÓÒÓÌÂ ¶∞¡ Ë ¿ÛÎËÛË ·ÔÙÂÏÂ› Úˆ-Ù·Ú¯ÈÎfi Ì¤ÙÚÔ ·Ú¤Ì‚·ÛË˜[2, 9].

™ÙÈ˜ Î·ÙÂ˘ı˘ÓÙ‹ÚÈÂ˜ Ô‰ËÁ›Â˜ Û˘-ÛÙ‹ÓÂÙ·È Â›ÙÂ ¤Ó· ÚfiÁÚ·ÌÌ·¿ÛÎËÛË˜ ˘fi Â›‚ÏÂ„Ë ÂÏ¿¯È-ÛÙË˜ ‰È¿ÚÎÂÈ·˜ 30-45 min, ÙÔ˘-Ï¿¯ÈÛÙÔÓ 3 ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰·ÁÈ· ÂÚÈÛÛfiÙÂÚÂ˜ ·fi 12 Â‚‰Ô-Ì¿‰Â˜ Â›ÙÂ ·ÙÔÌÈÎfi ÚfiÁÚ·ÌÌ·¿ÛÎËÛË˜ (‚¿‰ÈÛÌ·) ¯ˆÚ›˜ Â›-‚ÏÂ„Ë ÙÔ˘Ï¿¯ÈÛÙÔÓ 3 ÊÔÚ¤˜ ÙËÓÂ‚‰ÔÌ¿‰·.

™Â ÌÈ· Ù˘¯·ÈÔÔÈËÌ¤ÓË ÌÂÏ¤ÙËÛÙËÓ ÔÔ›· Û˘ÌÌÂÙÂ›¯·Ó 882 ¿Ó-‰ÚÂ˜ ·ÛıÂÓÂ›˜ ÌÂ ·Û˘ÌÙˆÌ·ÙÈ-Î‹ ¶∞¡, Ì¤ÛË˜ ËÏÈÎ›·˜ 73 ÂÙÒÓ,ÂÊ·ÚÌfiÛÙËÎÂ Â›ÙÂ ¤Ó· ‰ÔÌËÌ¤ÓÔÚfiÁÚ·ÌÌ· ‰È·ÎÔ‹˜ ÙÔ˘ Î·Ó›-ÛÌ·ÙÔ˜ ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ÙËÓ·‡ÍËÛË ÛˆÌ·ÙÈÎ‹˜ ‰Ú·ÛÙËÚÈfi-ÙËÙ·˜ (ÔÌ¿‰· ·Ú¤Ì‚·ÛË˜,n=441) Â›ÙÂ ÔÈ ·ÛıÂÓÂ›˜ ·Ê¤ıË-Î·Ó ÛÙËÓ Î·ıÈÂÚˆÌ¤ÓË ÊÚÔÓÙ›‰·ÙÔ˘ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÁÈ·ÙÚÔ‡ (ÔÌ¿-‰· ÂÏ¤Á¯Ô˘, n=441). ™‡ÌÊˆÓ·ÌÂ Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ÌÂÏ¤-ÙË˜, ÛÙËÓ ÔÌ¿‰· ÙË˜ ·Ú¤Ì‚·-ÛË˜ ·Ú·ÙËÚ‹ıËÎ·Ó ÌÂÁ·Ï‡ÙÂ-Ú· ÔÛÔÛÙ¿ ‚ÂÏÙ›ˆÛË˜ ÙË˜ Ì¤ÁÈ-ÛÙË˜ ‰È·Ó˘fiÌÂÓË˜ ·fiÛÙ·ÛË˜(maximum walking distance, Ô-ÛÔÛÙfi ‚ÂÏÙ›ˆÛË˜ ÛÂ Û‡ÁÎÚÈÛËÌÂ ÙËÓ ÔÌ¿‰· ÂÏ¤Á¯Ô˘ (23% vs15%; P=0.008). ∞˘Ùfi ·Ô‰fiıË-ÎÂ Î˘Ú›ˆ˜ ÛÙËÓ ·‡ÍËÛË ÙË˜ Ûˆ-Ì·ÙÈÎ‹˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ [34%ÙˆÓ ·ÛıÂÓÒÓ ÛÙËÓ ÔÌ¿‰· ÙË˜·Ú¤Ì‚·ÛË˜ ÂÚ·ÙÔ‡Û·Ó Â-

ÚÈÛÛfiÙÂÚÂ˜ ·fi3 ÊÔÚ¤˜ ÙËÓ Â‚-‰ÔÌ¿‰· vs 25%ÛÙËÓ ÔÌ¿‰· ÂÏ¤-Á¯Ô˘ (P=0.01)].∞Í›˙ÂÈ Ó· ÛËÌÂÈˆ-ıÂ› fiÙÈ ÛÙËÓ ÔÌ¿-‰· ÙË˜ ·Ú¤Ì‚·-ÛË˜ 12% ÙˆÓ Î·-ÓÈÛÙÒÓ Î·ÙfiÚ-ıˆÛÂ Ó· ‰È·Îfi-„ÂÈ ÙÔ Î¿ÓÈÛÌ·¤Ó·ÓÙÈ 8% ÛÙËÓÔÌ¿‰· ÂÏ¤Á¯Ô˘(P=0.43)

3.3. ∞ÓÙÈ·ÈÌÔÂÙ·ÏÈ·Î‹ ·ÁˆÁ‹

ªÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ÌÂÏÂÙÒÓ ¤‰ÂÈ-ÍÂ fiÙÈ Ë ¯ÔÚ‹ÁËÛË ·ÓÙÈ·ÈÌÔÂÙ·-ÏÈ·Î‹˜ ·ÁˆÁ‹˜ (Ù˘ÈÎ¿ ÌÂ ·ÛÈ-Ú›ÓË) ÌÂÈÒÓÂÈ ÙË ıÓËÛÈÌfiÙËÙ· Î·ÈÙ· Î·Ú‰È·ÁÁÂÈ·Î¿ Û˘Ì‚¿Ì·Ù· ÛÂ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ·ÛıÂÓÂ›˜ ÌÂ¶∞¡. ™Â ÌÈ· ÌÂÙ·-·Ó¿Ï˘ÛË 42Ù˘¯·ÈÔÔÈËÌ¤ÓˆÓ ÌÂÏÂÙÒÓ, Ô˘Û˘ÌÂÚÈ¤Ï·‚·Ó Û˘ÓÔÏÈÎ¿ 9700·ÛıÂÓÂ›˜ ÌÂ Û˘ÌÙˆÌ·ÙÈÎ‹ ¶∞¡,Ë ¯ÔÚ‹ÁËÛË ·ÓÙÈ·ÈÌÔÂÙ·ÏÈ·Î‹˜·ÁˆÁ‹˜ Û˘Û¯ÂÙ›˙ÔÓÙ·Ó ÌÂ ÌÂ›ˆ-ÛË Î·Ù¿ 23% ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌ-ÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘, ·Á-ÁÂÈ·ÎÔ‡ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘‹ Î·Ú‰È·ÁÁÂÈ·Î‹˜ ıÓËÛÈÌfiÙËÙ·˜ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙË Ï‹„Ë ÂÈÎÔÓÈ-ÎÔ‡ Ê·ÚÌ¿ÎÔ˘[19].

™ÙË ÌÂÏ¤ÙË CAPRIE (Clopidogrelversus Aspirin in Patients at Riskof Ischemic Events), ÌÂÙ·Í‡ ÙˆÓ19185 ·ÛıÂÓÒÓ Û˘ÌÂÚÈÏ‹ÊıË-Î·Ó Î·È 6400 ·ÛıÂÓÂ›˜ ÌÂ ¶∞¡, ÔÈÔÔ›ÔÈ Ù˘¯·ÈÔÔÈ‹ıËÎ·Ó Â›ÙÂ ÛÂ·ÛÈÚ›ÓË (325 mg/ËÌ¤Ú·) Â›ÙÂ ÛÂÎÏÔÈ‰ÔÁÚ¤ÏË (·ÓÙ·ÁˆÓÈÛÙ‹ ÙˆÓ˘Ô‰Ô¯¤ˆÓ ÙË˜ ‰ÈÊÔÛÊˆÚÈÎ‹˜·‰ÂÓÔÛ›ÓË˜, 75 mg/ËÌ¤Ú·) . ∏post-hoc ·Ó¿Ï˘ÛË ÙˆÓ ·ÛıÂÓÒÓÌÂ ¶∞¡ ¤‰ÂÈÍÂ fiÙÈ ÛÂ Û‡ÁÎÚÈÛËÌÂ ÙËÓ ·ÛÈÚ›ÓË ÛÙÔ˘˜ ·ÛıÂÓÂ›˜Ô˘ ‹Ú·Ó ÎÏÔÈ‰ÔÁÚ¤ÏË ·Ú·-ÙËÚ‹ıËÎÂ ÌÂ›ˆÛË Î·Ù¿ 23.8%ÙÔ˘ Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈ-ÛË˜ ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘ÔÎ·Ú‰›-Ô˘, ÈÛ¯·ÈÌÈÎÔ‡ ·ÁÁÂÈ·ÎÔ‡ ÂÁÎÂ-Ê·ÏÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ ‹ ı·Ó·ÙËÊfi-ÚˆÓ Û˘Ì‚·Ì¿ÙˆÓ ·ÁÁÂÈ·Î‹˜ ·È-ÙÈÔÏÔÁ›·˜ (P=0.0028). ∏ Û˘Á¯Ô-Ú‹ÁËÛË ·ÛÈÚ›ÓË˜ ÌÂ ÎÏÔÈ‰Ô-ÁÚ¤ÏË ÛÂ ·ÁÁÂÈ·ÎÔ‡˜ ·ÛıÂÓÂ›˜ÌÂ ÔÏÏ·ÏÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ-‰‡ÓÔ˘ ‰ÂÓ ‚Ú¤ıËÎÂ fiÙÈ ˘ÂÚ¤¯ÂÈÛÙË ÌÂ›ˆÛË ÙˆÓ Û˘Ì‚·Ì¿ÙˆÓ,ÂÓÒ ·˘Í¿ÓÂÈ ÙÔ ÔÛÔÛÙfi ÙˆÓ ·È-ÌÔÚÚ·ÁÈÎÒÓ ÂÈÏÔÎÒÓ[21]. ∏ ¯Ô-Ú‹ÁËÛË ·ÓÙÈ·ÈÌÔÂÙ·ÏÈ·ÎÒÓ ÛÂ·ÛıÂÓÂ›˜ ÌÂ ¶∞¡ ¤¯ÂÈ Â˘ÓÔ˚Î‹Â›‰Ú·ÛË ÛÙË ‚·ÙfiÙËÙ· ÙˆÓ ·Á-ÁÂÈ·ÎÒÓ ÌÔÛ¯Â˘Ì¿ÙˆÓ, ÙˆÓ ÂÓ-‰·ÁÁÂÈ·ÎÒÓ ÚÔı¤ÛÂˆÓ Î·È ÙË˜·ÁÁÂÈÔÏ·ÛÙÈÎ‹˜[22].

™ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ¶∞¡ ÚÔÙÂ›-ÓÂÙ·È Ë ¯ÔÚ‹ÁËÛË ·ÛÈÚ›ÓË˜ 75mg-325 mg/ËÌ¤Ú· ‹ ÂÓ·ÏÏ·ÎÙÈ-Î¿ ÎÏÔÈ‰ÔÁÚ¤ÏË˜ 75 mg/ËÌ¤Ú·.∏ ÂÈÏÔÁ‹ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Ú¤ÂÈÓ· Á›ÓÂÙ·È ÂÍ·ÙÔÌÈÎÂ˘Ì¤Ó· ÌÂ‚¿ÛË Û˘Ì·ÚÔÌ·ÚÙÔ‡ÛÂ˜ Î·Ù·-

¶ÚˆÙÔÁÂÓ‹˜ ÊÚÔÓÙ›‰·- ‘∞‰˘Ó·Ì›·’ ‰È¿ÁÓˆÛË˜- ¢˘Û¯¤ÚÂÈ· ÛÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË- ∂ÌÌÔÓ‹ Û˘ÌÙˆÌ¿ÙˆÓ ·Ú¿ ÙË ıÂÚ·Â›·- ªÂ›ˆÛË ‹ ·Ô˘Û›· ÛÊ‡ÍÂˆÓ ÛÙÈ˜ ÌËÚÈ·›Â˜ ·ÚÙËÚ›Â˜- ™·Î¯·ÚÒ‰Ë˜ ‰È·‚‹ÙË˜

∂Â›ÁÔ˘Û·:- ∫Ú›ÛÈÌË ÈÛ¯·ÈÌ›· / ¶fiÓÔ˜ ÛÙËÓ ·Ó¿·˘ÛË- ŒÏÎÔ˜ ‹ °¿ÁÁÚ·ÈÓ·- ÀÔ„›· ∞∫∞ / Δπ∞ / Amaurosis Fugax

¶›Ó·Î·˜ 1. ∞Ó¿ÁÎË ∞ÁÁÂÈÔ¯ÂÈÚÔ˘ÚÁÈÎ‹˜ ∂ÎÙ›ÌËÛË˜∞ÛıÂÓÒÓ ÌÂ ¶ÂÚÈÊÂÚÈÎ‹ ∞ÚÙËÚÈÔ¿ıÂÈ·[2,9].

ÛÙ¿ÛÂÈ˜, ÙËÓ ·ÓÔ¯‹ ÙÔ˘ ·ÛıÂ-ÓÔ‡˜ Î·È ÙÔ ÎfiÛÙÔ˜[2, 9].

3.4. ÀÔÏÈÈ‰·ÈÌÈÎ‹ ·ÁˆÁ‹

∂È‰ËÌÈÔÏÔÁÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ¤‰ÂÈÍ·ÓfiÙÈ ˘¿Ú¯ÂÈ ıÂÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂ-Ù·Í‡ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ¶∞¡ Î·È ÙˆÓÂÈ¤‰ˆÓ ÙË˜ ÔÏÈÎ‹˜, ÙË˜ LDL-¯ÔÏËÛÙÂÚfiÏË˜, Î·È ÙˆÓ ÙÚÈÁÏ˘ÎÂ-ÚÈ‰›ˆÓ Î·È ·ÚÓËÙÈÎ‹ ÌÂÙ·Í‡ ¶∞¡Î·È ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ HDL-¯ÔÏË-ÛÙÂÚfiÏË˜. ¶Ú¿ÁÌ·ÙÈ ÁÈ· Î¿ıÂ ·‡-ÍËÛË ÙË˜ ÔÏÈÎ‹˜ ¯ÔÏËÛÙÂÚfiÏË˜Î·Ù¿ 10 mg/dL Ô Î›Ó‰˘ÓÔ˜ ÂÌÊ¿-ÓÈÛË˜ ¶∞¡ ·˘Í¿ÓÂÙ·È Î·Ù¿ 5% -10%[23], ÂÓÒ ÁÈ· Î¿ıÂ ÌÔÓ¿‰· ·‡-ÍËÛË˜ ÙÔ˘ ËÏ›ÎÔ˘ ÔÏÈÎ‹/ HDL-¯ÔÏËÛÙÂÚfiÏË Ô Û¯ÂÙÈÎfi˜ Î›Ó‰˘-ÓÔ˜ ¶∞¡ ·˘Í¿ÓÂÙ·È Î·Ù¿ 35%[13].

◊‰Ë ÚÈÓ ·fi ÙËÓ ÂÌÊ¿ÓÈÛË ÙˆÓÛÙ·ÙÈÓÒÓ, Ë ÌÂ›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓÙË˜ ¯ÔÏËÛÙÂÚfiÏË˜ ÌÂ ˘ÔÏÈÈ‰·È-ÌÈÎ¿ Ê¿ÚÌ·Î· ‹ ÌÂ ÙË ¯ÂÈÚÔ˘ÚÁÈ-Î‹ ÌÂÚÈÎ‹ ·Ú¿Î·Ì„Ë ÙÔ˘ ÂÈÏÂÔ‡Â›¯Â ·Ô‰ÂÈ¯ıÂ› fiÙÈ ÌÂÈÒÓÂÈ ‹ ÂÈ-‚Ú·‰‡ÓÂÈ ÙËÓ ÂÍ¤ÏÈÍË ÙˆÓ ·ıËÚÔ-ÛÎÏËÚˆÙÈÎÒÓ ‚Ï·‚ÒÓ ÛÙÈ˜ ÌËÚÈ-·›Â˜ ·ÚÙËÚ›Â˜[24]. ªÈ· post-hoc·Ó¿Ï˘ÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÙË˜ÌÂÏ¤ÙË˜ 4S (Simvastatin Scandi-navian Survival Study) ¤‰ÂÈÍÂ fiÙÈË ¯ÔÚ‹ÁËÛË ÛÈÌ‚·ÛÙ·Ù›ÓË˜ ÛÂÛÙÂÊ·ÓÈ·›Ô˘˜ ·ÛıÂÓÂ›˜ ÌÂ ˘ÂÚ-¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· ÌÂ›ˆÛÂ Î·Ù¿38% ÙËÓ ÂÌÊ¿ÓÈÛË Ó¤·˜ ‹ ÙËÓÂÈ‰Â›ÓˆÛË ÚÔ¸¿Ú¯Ô˘Û·˜ ‰È·-ÏÂ›Ô˘Û·˜ ¯ˆÏfiÙËÙ·˜[25]. ¢Â‰Ô-Ì¤Ó· ·fi ÙË ÌÂÏ¤ÙË HeartProtection Study ¤‰ÂÈÍ·Ó fiÙÈ ÔÈ·ÛıÂÓÂ›˜ ÌÂ ¶∞N ˆÊÂÏÔ‡ÓÙ·ÈÛÙÔÓ ›‰ÈÔ ‚·ıÌfi ÌÂ ÙÔ˘˜ ·ÛıÂ-ÓÂ›˜ Ô˘ ¤¯Ô˘Ó ¿ÏÏÔ˘ Â›‰Ô˘˜ ·Á-ÁÂÈ·Î‹ ÓfiÛÔ (ÌÂ›ˆÛË Î·Ù¿ 24%ÙˆÓ ÌÂÈ˙fiÓˆÓ ·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·-

Ì¿ÙˆÓ), ·ÓÂÍ¿ÚÙËÙ· ·fi Ù· Â›-Â‰· ÙˆÓ ÏÈÈ‰›ˆÓ Î·È ·ÓÂÍ¿ÚÙË-Ù· ·fi ÙËÓ ·ÚÔ˘Û›· Û·Î¯·ÚÒ-‰Ë ‰È·‚‹ÙË[26].

™¯ÂÙÈÎ¿ ÚfiÛÊ·ÙÂ˜ ÌÂÏ¤ÙÂ˜ ¤¯Ô˘ÓÂÈ‚Â‚·ÈÒÛÂÈ ÙË ÛËÌ·ÓÙÈÎ‹ ı¤ÛËÙË˜ ıÂÚ·Â›·˜ ÌÂ ÛÙ·Ù›ÓÂ˜ ÛÙËÓ·ÓÙÈÌÂÙÒÈÛË ·ÛıÂÓÒÓ ÌÂ ¶∞¡Î·È ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· ÙfiÛÔÁÈ· ÙË ‚ÂÏÙ›ˆÛË ÙˆÓ Û˘ÌÙˆÌ¿-ÙˆÓ[27] fiÛÔ Î·È ÁÈ· ÙËÓ ·‡ÍËÛË ÙË˜Û˘ÓÔÏÈÎ‹˜ ÂÈ‚›ˆÛË˜[28].

∞Í›˙ÂÈ Ó· ÛËÌÂÈˆıÂ› fiÙÈ Ë ıÂÚ·-Â›· ÌÂ ÙË ¯ÔÚ‹ÁËÛË ÛÙ·ÙÈÓÒÓÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ¶∞¡ ¤¯ÂÈ Â˘-ÓÔ˚Î‹ Â›‰Ú·ÛË ÛÙÔ˘˜ ‰Â›ÎÙÂ˜ÙË˜ ÊÏÂÁÌÔÓ‹˜, Î·È È‰È·›ÙÂÚ· ÛÙÈ˜Û˘ÁÎÂÓÙÚÒÛÂÈ˜ ÙË˜ C-·ÓÙÈ‰ÚÒ-Û·˜ ÚˆÙÂ˝ÓË˜ (CRP). ∞˘Ù‹ Ë·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë˜ ‰Ú¿ÛË ÙˆÓÛÙ·ÙÈÓÒÓ ¤¯ÂÈ ‚ÚÂıÂ› fiÙÈ Û˘Û¯ÂÙ›-˙ÂÙ·È ÌÂ ÌÂ›ˆÛË ÙË˜ Û˘ÓÔÏÈÎ‹˜ıÓËÛÈÌfiÙËÙ·˜ Î·È ÙËÓ ·‡ÍËÛË ÙË˜ÂÏÂ‡ıÂÚË˜ Û˘ÌÙˆÌ¿ÙˆÓ ÂÈ‚›ˆ-ÛË˜ ·˘ÙÒÓ ÙˆÓ ·ÛıÂÓÒÓ[28].

Ÿˆ˜ Î·È ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ÛÙÂ-Ê·ÓÈ·›· ÓfiÛÔ, Î‡ÚÈÔ˜ ÛÙfi¯Ô˜ ÙË˜˘ÔÏÈÈ‰·ÈÌÈÎ‹˜ ·ÁˆÁ‹˜ Â›Ó·È ËÌÂ›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ LDL-¯Ô-ÏËÛÙÂÚfiÏË˜ Î¿Ùˆ ·fi 100 mg/dL‹ Î·È Î¿Ùˆ ·fi 70 mg/dL ÛÂ·ÛıÂÓÂ›˜ ÌÂ ÔÏ‡ ·˘ÍËÌ¤ÓÔ Î·Ú-‰È·ÁÁÂÈ·Îfi Î›Ó‰˘ÓÔ[29].

3.5. ŒÏÂÁ¯Ô˜ ÙË˜ ˘¤ÚÙ·ÛË˜

∏ Û˘Û¯¤ÙÈÛË ˘¤ÚÙ·ÛË˜ Î·È ¶∞¡ıÂˆÚÂ›Ù·È ÏÈÁfiÙÂÚÔ ÈÛ¯˘Ú‹ ÛÂÛ‡ÁÎÚÈÛË ÌÂ ÙË Û˘Û¯¤ÙÈÛË ¶∞¡Î·È Î·Ú‰È·ÁÁÂÈ·Î‹˜ ‹ ÛÙÂÊ·ÓÈ·›-·˜ ÓfiÛÔ˘. ™ÙË ÌÂÏ¤ÙË ÙÔ˘Framingham, Ë ˘¤ÚÙ·ÛË ·Ô-‰Â›¯ıËÎÂ fiÙÈ ·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ

‰È·ÏÂ›Ô˘Û·˜ ¯ˆÏfiÙËÙ·˜ Î·Ù¿‰˘fiÌÈÛÈ ÊÔÚ¤˜ ÂÚÈÛÛfiÙÂÚÔÛÙÔ˘˜ ¿Ó‰ÚÂ˜ Î·È Î·Ù¿ 4 ÊÔÚ¤˜ÂÚÈÛÛfiÙÂÚÔ ÛÙÈ˜ Á˘Ó·›ÎÂ˜ ÛÂÛ‡ÁÎÚÈÛË ÌÂ ÙÔ˘˜ ÓÔÚÌÔÙ·ÛÈ-ÎÔ‡˜ ·ÛıÂÓÂ›˜[30]. ¡ÂfiÙÂÚ· ÂÈ-‰ËÌÈÔÏÔÁÈÎ¿ ‰Â‰ÔÌ¤Ó· ÂÈ‚Â‚·È-ÒÓÔ˘Ó fiÙÈ ÔÈ ˘ÂÚÙ·ÛÈÎÔ› ¤¯Ô˘Ó‰ÈÏ¿ÛÈ· Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛË˜¶∞¡[12].

ŸÏÔÈ ÔÈ ·ÓÙÈ˘ÂÚÙ·ÛÈÎÔ› ·Ú¿-ÁÔÓÙÂ˜ ÌÔÚÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈ-ËıÔ‡Ó ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ¶∞¡.¶·Ú¿ ÙËÓ ·ÓËÛ˘¯›· Û¯ÂÙÈÎ¿ ÌÂÙË ‰˘ÛÌÂÓ‹ Â›‰Ú·ÛË ÙˆÓ ‚-·Ô-ÎÏÂÈÛÙÒÓ, ÛËÌ·ÓÙÈÎfi˜ ·ÚÈıÌfi˜ÌÂÏÂÙÒÓ Î·È ÌÂÙ·-·Ó·Ï‡ÛÂˆÓ¤¯ÂÈ ·ÔÎ·Ù·ÛÙ‹ÛÂÈ ÙË ı¤ÛËÙÔ˘˜ Î·È ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË˘ÂÚÙ·ÛÈÎÒÓ ·ÛıÂÓÒÓ ÌÂ ¶∞¡[31].

™ÙË ÌÂÏ¤ÙË ∏√ƒ∂ (Heart Out-comes Prevention Evaluation), ÙÔÂÈÚfiÛıÂÙÔ fiÊÂÏÔ˜ ÛÙË ÌÂ›ˆÛËÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿-ÙˆÓ ·fi ÙË ¯ÔÚ‹ÁËÛË ÂÓfi˜ ·ÓÙ·-ÁˆÓÈÛÙ‹ ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡-ÌÔ˘ ÙË˜ ·ÁÁÂÈÔÙÂÓÛ›ÓË˜ (·-ª∂∞),ÙË˜ Ú·ÌÈÚ›ÏË˜, ‹Ù·Ó ÙÔ ›‰ÈÔ ÛË-Ì·ÓÙÈÎfi ÙfiÛÔ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ¶∞¡ fiÛÔ Î·È ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ¿ÏÏÂ˜ ÂÎ‰ËÏÒÛÂÈ˜ ·ÁÁÂÈ·Î‹˜ Ófi-ÛÔ˘[32]. ™ÙË ÌÂÏ¤ÙË ·˘Ù‹ Ù˘¯·ÈÔ-ÔÈ‹ıËÎ·Ó 4051 ·ÛıÂÓÂ›˜ ÌÂ¶∞¡, ÛÙÔ˘˜ ÔÔ›Ô˘˜ Ë ¯ÔÚ‹ÁËÛËÚ·ÌÈÚ›ÏË˜ ÌÂ›ˆÛÂ Î·Ù¿ 22% ÙÔÛ¯ÂÙÈÎfi Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛË˜ ÂÌ-ÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘, ·Á-ÁÂÈ·ÎÔ‡ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘‹ ÙË˜ ıÓËÙfiÙËÙ·˜ ·fi Î·Ú‰È·Á-ÁÂÈ·Î‹ ÓfiÛÔ[32].

√È ÛÙfi¯ÔÈ ÙË˜ ·ÓÙÈ˘ÂÚÙ·ÛÈÎ‹˜·ÁˆÁ‹˜ Î·ıÔÚ›˙ÔÓÙ·È ÛÙËÓ Â›-ÙÂ˘ÍË ÂÈ¤‰ˆÓ ¯·ÌËÏfiÙÂÚˆÓ·fi 140/90 mmHg ‹ ¯·ÌËÏfiÙÂ-ÚˆÓ ·fi 130/80 mmHg ÛÂ ·ÛıÂ-ÓÂ›˜ ÌÂ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË Î·È¯ÚfiÓÈ· ÓÂÊÚÈÎ‹ ÓfiÛÔ[2, 9]. ∏ ÌÂÏ¤-ÙË ABCD (Appropriate BloodPressure Control in Diabetics)¤‰ÂÈÍÂ fiÙÈ Ë ¯ÔÚ‹ÁËÛË ÂÈıÂÙÈ-Î‹˜ ıÂÚ·Â›·˜ (ÌÂ ¤Ó·Ó ·-ª∂∞,ÙËÓ ÂÓ·Ï·Ú›ÏË, ‹ ÌÂ ¤Ó·Ó ·ÓÙ·-ÁˆÓÈÛÙ‹ ÙˆÓ ‰È·‡ÏˆÓ ·Û‚ÂÛÙ›Ô˘,ÙËÓ ÓÈÛÔÏ‰È›ÓË) ÁÈ· ÙËÓ Â›ÙÂ˘ÍËÙˆÓ ÛÙfi¯ˆÓ ÙË˜ ·ÓÙÈ˘ÂÚÙ·ÛÈ-Î‹˜ ·ÁˆÁ‹˜ Î·Ù·ÚÁÂ› ÙËÓ ·ÚÓË-ÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÙÔ˘ ∞μπÎ·È ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛË˜ ÂÌ-ÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘, ·Á-ÁÂÈ·ÎÔ‡ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘‹ ÙË˜ ıÓËÙfiÙËÙ·˜ ·fi Î·Ú‰È·Á-

¢ ∂ ∫ ∂ ª μ ƒ π √ ™ 2 0 0 7

24

™¯‹Ì· 2. º˘ÛÈÎ‹ ÈÛÙÔÚ›· ÙË˜ ÂÚÈÊÂÚÈÎ‹˜ ·ÚÙËÚÈ·Î‹˜ ÓfiÛÔ˘[2,9].

ÁÂÈ·Î‹ ÓfiÛÔ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ¶∞¡[33].

3.6. ŒÏÂÁ¯Ô˜ ÙË˜ ÁÏ˘¯·ÈÌ›·˜

¢Â‰ÔÌ¤Ó· ÌÂÏÂÙÒÓ ·Ú·Ù‹ÚË-ÛË˜ ¤‰ÂÈÍ·Ó fiÙÈ Ë ·ÚÔ˘Û›· Û·Î-¯·ÚÒ‰Ë ‰È·‚‹ÙË ·˘Í¿ÓÂÈ ÛËÌ·-ÓÙÈÎ¿ ÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛË˜¶∞¡ È‰È·›ÙÂÚ· ÛÂ ËÏÈÎÈˆÌ¤ÓÔ˘˜(¿Óˆ ÙˆÓ 60 ¯ÚfiÓˆÓ) Î·ÓÈÛÙ¤˜ÌÂ ˘¤ÚÙ·ÛË Î·È ˘ÂÚ¯ÔÏËÛÙÂ-ÚÔÏ·ÈÌ›·[12, 23].

¢ÂÓ ¤¯ÂÈ ·Ô‰ÂÈ¯ıÂ› ÌÂ Û·Ê‹-ÓÂÈ· fiÙÈ Ë ÂÈıÂÙÈÎ‹ ·ÓÙÈÌÂÙÒÈ-ÛË ÙÔ˘ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡-Ô˘ 1 Î·È Ù‡Ô˘ 2 ÌÂÈÒÓÂÈ ÙÔÓÎ›Ó‰˘ÓÔ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·-Ì¿ÙˆÓ ÛÂ ·ÛıÂÓÂ›˜ ¶∞¡[34, 35].øÛÙfiÛÔ, ÛÂ fiÏÔ˘˜ ÙÔ˘˜ ‰È·‚ËÙÈ-ÎÔ‡˜ ·ÛıÂÓÂ›˜ Û˘ÓÈÛÙ¿Ù·È Ë ‰È·-Ù‹ÚËÛË ÙË˜ ÁÏ˘ÎÔ˙˘ÏÈˆÌ¤ÓË˜·ÈÌÔÛÊ·ÈÚ›ÓË˜ (HbA1C) ÛÂ Â›-Â‰· ÌÈÎÚfiÙÂÚ· ·fi 7%, Î·ıÒ˜Î·È Ë Û¯ÔÏ·ÛÙÈÎ‹ ÊÚÔÓÙ›‰· ÙˆÓ¿ÎÚˆÓ Ô‰ÈÒÓ ÁÈ· ÙË ÌÂ›ˆÛËÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛË˜ ÂÏÎÒÓ,

Á¿ÁÁÚ·ÈÓ·˜ Î·È ÙË˜·Ó·ÁÎ·ÈfiÙËÙ·˜ ·ÎÚˆ-ÙËÚÈ·ÛÌÔ‡[2, 9].

3.7. ÕÏÏ· ıÂÚ·Â˘-ÙÈÎ¿ Ì¤ÙÚ·

™Â fiÏÔ˘˜ ÙÔ˘˜ ˘¤Ú-‚·ÚÔ˘˜ ‹ ·¯‡Û·Ú-ÎÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ¶∞¡‰›ÓÔÓÙ·È Û˘Ì‚Ô˘Ï¤˜ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÙÔ˘ÛˆÌ·ÙÈÎÔ‡ ‚¿ÚÔ˘˜.∞ÓÙÈËÎÙÈÎ‹ ·ÁˆÁ‹·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ Û˘-ÓÈÛÙ¿Ù·È ÌfiÓÔ ÛÙÈ˜ Â-

ÚÈÙÒÛÂÈ˜ ·ÛıÂÓÒÓ ÌÂ ÎÔÏÈÎ‹Ì·ÚÌ·Ú˘Á‹, ‚·Ï‚È‰Ô¿ıÂÈ·, ÂÓÙˆ ‚¿ıÂÈ ÊÏÂ‚ÔıÚfiÌ‚ˆÛË, Î·-ıÒ˜ Î·È ÛÂ ·ÛıÂÓÂ›˜ ˘„ËÏÔ‡ ÎÈÓ-‰‡ÓÔ˘ ·fiÊÚ·ÍË˜ ÙˆÓ ·ÚÙËÚÈ·-ÎÒÓ ÌÔÛ¯Â˘Ì¿ÙˆÓ.

¢ÂÓ ˘¿Ú¯Ô˘Ó ÚÔÔÙÈÎ¤˜, Ù˘-¯·ÈÔÔÈËÌ¤ÓÂ˜ ÌÂÏ¤ÙË˜ ÂÎÙ›ÌË-ÛË˜ ÙÔ˘ ÔÊ¤ÏÔ˘˜ ¯ÔÚ‹ÁËÛË˜ ‚È-Ù·ÌÈÓÒÓ, fiˆ˜ ÙÔ Ê˘ÏÏÈÎfi ÔÍ‡Î·È Ë ‚ÈÙ·Ì›ÓË μ12 Ô˘ ÌÂÈÒÓÔ˘ÓÙ· Â›Â‰· ÙË˜ ÔÌÔÎ˘ÛÙÂ˝ÓË˜ÛÙÔÓ ÔÚfi, ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ¶∞¡.™Â ÌÈ· ÂÓ‰È·Ê¤ÚÔ˘Û· ÌÂÏ¤ÙË ÌÂÙËÓ ÔÓÔÌ·Û›· Health Professio-nals Follow-up Study, Û˘ÌÌÂÙÂ›-¯·Ó 46036 ¿Ó‰ÚÂ˜ ¯ˆÚ›˜ ¶∞¡,Î·Ú‰È·ÁÁÂÈ·Î‹ ÓfiÛÔ ‹ Û·Î¯·ÚÒ-‰Ë ‰È·‚‹ÙË Î·È ·Ú·ÎÔÏÔ˘ı‹ıË-Î·Ó ÁÈ· 12 ¯ÚfiÓÈ· ÛÙË ‰È¿ÚÎÂÈ·ÙˆÓ ÔÔ›ˆÓ Î·Ù·ÁÚ¿ÊËÎ·Ó 308ÂÚÈÙÒÛÂÈ˜ ¶∞¡. ™ÙË ÌÂÏ¤ÙË·˘Ù‹ ‰È·ÈÛÙÒıËÎÂ ÌÈ· ·ÓÙ›-ÛÙÚÔÊË Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÙË˜Î·ıËÌÂÚÈÓ‹˜ ÚfiÛÏË„Ë˜ Ê˘ÏÏÈ-ÎÔ‡ ÔÍ¤Ô˜ (400 mg/ËÌ¤Ú·) Î·È

ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛË˜ ¶∞¡(ÌÂ›ˆÛË Î·Ù¿ 21%)[36].

4. ªÂ›ˆÛË ÙÔ˘ Î·Ú‰È·ÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘

ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ¶∞¡: ÂÎÙ›ÌËÛË ÙÔ˘

Û˘ÓÔÏÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ Î·È ÂÈıÂÙÈÎ‹ ÂÊ·ÚÌÔÁ‹ ıÂÚ·Â˘ÙÈÎÒÓ Ì¤ÙÚˆÓ

ªÈ· ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ÛÙÚ·ÙËÁÈÎ‹ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ·ÛıÂÓÒÓ ÌÂ¶∞¡ ÂÈ‚¿ÏÏÂÈ ÙËÓ ¤ÁÎ·ÈÚË ‰È¿-ÁÓˆÛË, ÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ Û˘ÓÔÏÈ-ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ Î·È ÙËÓ ÂÈıÂÙÈÎ‹·Ú¤Ì‚·ÛË ÁÈ· ÙËÓ ÙÚÔÔÔ›Ë-ÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘[2, 9].À¿Ú¯Ô˘Ó ÂÓ‰Â›ÍÂÈ˜ fiÙÈ Ë ÂÈıÂ-ÙÈÎ‹ ÙÚÔÔÔ›ËÛË ÙˆÓ ·Ú·Áfi-ÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ¶∞¡ ÚÔÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÌÊ¿ÓÈÛËÂÌÊÚ¿ÁÌ·ÙÔ˜, ·ÁÁÂÈ·ÎÔ‡ ÂÁÎÂ-Ê·ÏÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ Î·È ÌÂÈÒÓÂÈÙÔÓ Î›Ó‰˘ÓÔ ı·Ó·ÙËÊfiÚˆÓ Û˘Ì-‚·Ì¿ÙˆÓ. ™Â ÌÈ· ÚfiÛÊ·ÙË ÌÂ-Ï¤ÙË 2420 ·ÛıÂÓÒÓ ÌÂ ¶∞¡,‰È¿ÚÎÂÈ·˜ 8 ÂÙÒÓ, ‚Ú¤ıËÎÂ fiÙÈ ËıÂÚ·Â›· ÌÂ ·ÛÈÚ›ÓË, ÛÙ·Ù›ÓÂ˜,‚-·ÔÎÏÂÈÛÙ¤˜ Î·È ·-ª∂∞ Û˘Û¯Â-Ù›˙ÔÓÙ·Ó ·ÓÂÍ¿ÚÙËÙ· ÌÂ ·‡ÍËÛËÙË˜ ÂÈ‚›ˆÛË˜[37]. Δ· Â˘Ú‹Ì·Ù··˘Ù¿ Û˘ÓËÁÔÚÔ‡Ó ÛÙÔ fiÙÈ ÌÈ·ÔÏ˘‰È¿ÛÙ·ÙË ıÂÚ·Â›· ÛÂ Û˘Ó-‰˘·ÛÌfi ÌÂ ÙËÓ ÂÊ·ÚÌÔÁ‹ ˘ÁÈÂÈ-ÓÔ‰È·ÈÙËÙÈÎÒÓ ÌË Ê·ÚÌ·ÎÂ˘ÙÈ-ÎÒÓ Ì¤ÙÚˆÓ (¿ÛÎËÛË, ‰È·ÎÔ‹ÙÔ˘ Î·Ó›ÛÌ·ÙÔ˜, ÌÂ›ˆÛË ÙÔ˘ÛˆÌ·ÙÈÎÔ‡ ‚¿ÚÔ˘˜) ¤¯ÂÈ ·ıÚÔÈ-ÛÙÈÎfi fiÊÂÏÔ˜ ÛÙË ÌÂ›ˆÛË ÙÔ˘Î·Ú‰È·ÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ Î·ÈÛÙË ıÓËÛÈÌfiÙËÙ· ÙˆÓ ·ÛıÂÓÒÓÌÂ ¶∞¡.

™À°Ãƒ√¡∂™ √¢∏°π∂™

25

™¯ÂÙÈÎfi˜ ∫›Ó‰˘ÓÔ˜ (RR)

™¯‹Ì· 3. ¶·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ¶ÂÚÈÊÂÚÈÎ‹˜∞ÚÙËÚÈÔ¿ıÂÈ·˜ – ¢Â‰ÔÌ¤Ó· ∂È‰ËÌÈÔÏÔÁÈ-ÎÒÓ ªÂÏÂÙÒÓ[5].


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¢ ∂ ∫ ∂ ª μ ƒ π √ ™ 2 0 0 7

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Δ· ÏÂÔÓÂÎÙ‹Ì·Ù· Î·È ÌÂÈÔÓÂ-ÎÙ‹Ì·Ù· ÙË˜ ÚÔÏËÙÈÎ‹˜ ÂÍ¤Ù·-ÛË˜ ÁÈ· ·ÓÂ‡ÚÂÛË ‰È·Ù·Ú·¯ÒÓÙˆÓ ÏÈÈ‰›ˆÓ ÛÂ ·È‰È¿, ¤ÊË‚Ô˘˜Î·È ÓÂ·ÚÔ‡˜ ÂÓ‹ÏÈÎÂ˜ Ì¤¯ÚÈ 20ÂÙÒÓ ‰ÂÓ Â›Ó·È ·ÎfiÌË ·fiÏ˘Ù·Û·Ê‹. ¶ÚfiÛÊ·Ù· Ë ∂ÈÙÚÔ‹ ÂÈ-‰ÈÎÒÓ ÁÈ· ÙËÓ ÚfiÏË„Ë (USPreventive Services Task Force -

USPSTF), ÂÍ¤‰ˆÛÂ ÁÓˆÌÔ‰fiÙË-ÛË (statement) Ë ÔÔ›· ‰ËÌÔÛÈ-Â‡ıËÎÂ ÛÙÔ ÙÂ‡¯Ô˜ ÙÔ˘ πÔ˘Ï›Ô˘ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ Pediatrics(2007;101e189-e219) Î·È ÌÂ ÙËÓÔÔ›·, ·Ó Î·È ‰ÂÓ ‰›ÓÂÈ Û·ÊÂ›˜Ô‰ËÁ›Â˜ ˘¤Ú ‹ Î·Ù¿ ÙË˜ ÚÔÏË-ÙÈÎ‹˜ ÂÍ¤Ù·ÛË˜, ÏfiÁˆ ¤ÏÏÂÈ„Ë˜ÛÙÔÈ¯Â›ˆÓ ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·-

Ê›·, ÚÔÛÊ¤ÚÂÈ ÌÂÚÈÎ¤˜ ¯Ú‹ÛÈ-ÌÂ˜ ÎÏÈÓÈÎ¤˜ ·fi„ÂÈ˜ ¿Óˆ ÛÂ·˘Ùfi ÙÔ ı¤Ì·.

∏ ÁÓˆÌÔ‰fiÙËÛË ÛÙËÚ›¯ıËÎÂ ÛÙËÛ˘ÛÙËÌ·ÙÈÎ‹ ·Ó·ÛÎfiËÛË ÙË˜‰ÈÂıÓÔ‡˜ ‚È‚ÏÈÔÁÚ·Ê›·˜. ∏ ·Ó·-˙‹ÙËÛË ‰ËÌÔÛÈÂ˘Ì¤ÓˆÓ ÂÚÁ·-ÛÈÒÓ Ô˘ ¤¯Ô˘Ó ‰ÈÂÚÂ˘Ó‹ÛÂÈ ÙËÓ

¶ÚÔÏËÙÈÎ‹ EÍ¤Ù·ÛË (screening) N¤ˆÓ AÙfiÌˆÓ ÁÈ· ¢È·Ù·Ú·¯¤˜ ÙˆÓ §ÈÈ‰›ˆÓ:

°ÓˆÌÔ‰fiÙËÛË ÙË˜ ∂ÈÙÚÔ‹˜ ÙˆÓ ∂È‰ÈÎÒÓ ÙˆÓ∏¶∞ ÁÈ· ÙËÓ ¶ÚfiÏË„Ë

∏Ï›·˜ ÃÂÈÌÒÓ·˜, ∫·Ú‰ÈÔÏfiÁÔ˜.

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27

·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙË˜ ÂÈÏÔ-Á‹˜, ‰ÈÂÚÂ‡ÓËÛË˜ Î·È ıÂÚ·Â›·˜·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ ÌÂ ‰˘ÛÏÈÈ-‰·ÈÌ›· ÂÚÈ¤¯ÂÈ ¤ÁÈÓÂ ·fi ÙËÓElizabeth M. Haney, MD, ·fi ÙÔOregon Health and ScienceUniversity ÙÔ˘ Portland Î·È ÙÔ˘˜Û˘ÓÂÚÁ¿ÙÂ˜ ÙË˜. √È ÂÚÂ˘ÓËÙ¤˜·˘ÙÔ› ÂÓÙfiÈÛ·Ó Î·È ·Ó¤Ï˘Û·Ó144 ¿ÚıÚ· ·Ó·ÊÂÚfiÌÂÓ· ÛÙËÓÚÔÏËÙÈÎ‹ ÂÍ¤Ù·ÛË Î·È ‰ÈÂÚÂ‡-ÓËÛË, 43 ÛÙËÓ ıÂÚ·Â˘ÙÈÎ‹ ·-Ú¤Ì‚·ÛË Î·È ·Ú·ÎÔÏÔ‡ıËÛË, 6ÛÙÈ˜ ‰˘ÛÌÂÓÂ›˜ ÂÈÙÒÛÂÈ˜ ÙË˜ÚÔÏËÙÈÎ‹˜ ÂÍ¤Ù·ÛË˜ Î·È 84ÛÙÈ˜ ·ÓÂÈı‡ÌËÙÂ˜ ÂÓ¤ÚÁÂÈÂ˜ ÙË˜ıÂÚ·Â›·˜.

Δ· Î‡ÚÈ· ÛËÌÂ›· ÙË˜ ÁÓˆÌÔ‰fiÙËÛË˜ Â›Ó·È Ù· ÂÍ‹˜

ñ ¶ÚÔÏËÙÈÎ‹ ÂÍ¤Ù·ÛË(screening)

-Δ· Â›Â‰· ÙË˜ ÔÏÈÎ‹˜ ¯ÔÏËÛÙÂ-ÚfiÏË˜ ·˘Í¿ÓÔ˘Ó ·fi ÙË Á¤ÓÓËÛËÌ¤¯ÚÈ ÙËÓ ËÏÈÎ›· ÙˆÓ 2 ÂÙÒÓ,Êı¿ÓÔ˘Ó ÙË Ì¤ÁÈÛÙË ÙÈÌ‹ ÚÈÓÙËÓ ÂÊË‚Â›· Î·È ÌÂÈÒÓÔÓÙ·È Î·Ù¿ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÂÊË‚ÈÎ‹˜ ËÏÈ-Î›·˜.

-Δ· Û˘Ó‹ıË fiÚÈ· ÙË˜ ‰˘ÛÏÈÈ‰·È-Ì›·˜ ¿Óˆ ÙÔ˘ 95Ô˘ ÂÎ·ÙÔÛÙËÌÔ-Ú›Ô˘ (√ÏÈÎ‹ ¯ÔÏËÛÙÂÚfiÏË > 200mg/dL Î·È LDL-¯ÔÏ > 130 mg/dL)ÌÔÚÂ› Ó· ÌÂÙ·‚¿ÏÏÔÓÙ·È, ·Ó¿-ÏÔÁ· ÌÂ ÙËÓ ËÏÈÎ›·, ÙÔ Ê‡ÏÔ Î·ÈÙËÓ ÂıÓÈÎ‹ ÚÔ¤ÏÂ˘ÛË ÙÔ˘ ·Ùfi-ÌÔ˘.

-∫·Ù¿ ÙËÓ ∞ÌÂÚÈÎ·ÓÈÎ‹ ∞Î·‰ËÌ›·¶·È‰È·ÙÚÈÎ‹˜ Î·È ÙÈ˜ Ô‰ËÁ›Â˜ ÙÔ˘NCEP, ÛÙ· ·È‰È¿ ÌÂ ÔÈÎÔÁÂÓÂÈ·-Îfi ÈÛÙÔÚÈÎfi ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·È-Ì›·˜ ‹ ·ÁÁÂÈ·Î‹˜ ¿ıËÛË˜ ÌÔ-ÚÂ› Ó· ÂÏ¤Á¯ÔÓÙ·È ÌÂ Ì¤ÙÚËÛËÙË˜ ÔÏÈÎ‹˜ ¯ÔÏËÛÙÂÚfiÏË˜ Î·È ·Ó·˘Ù‹ Â›Ó·È ·˘ÍËÌ¤ÓË, Ó· ·ÎÔÏÔ˘-ıÂ› ÏÈÔÚˆÙÂ˚ÓÈÎ‹ ·Ó¿Ï˘ÛË.

-¢‡Ô ‹ ÂÚÈÛÛfiÙÂÚÂ˜ ÌÂÙÚ‹ÛÂÈ˜ÙˆÓ ÏÈÈ‰›ˆÓ Â›Ó·È ··Ú·›ÙËÙÂ˜ÁÈ· Ó· ÂÈ‚Â‚·ÈˆıÔ‡Ó Ù· ·ÔÙÂ-Ï¤ÛÌ·Ù·.

ñ ΔÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÌÔ-ÚÂ› Ó· Â›Ó·È ¯ÚÔÓÔ‚fiÚÔ Ó· ·Ô-ÎÙËıÂ›, ·Ó·ÎÚÈ‚¤˜ Î·È ÛÙÈ˜ ‰È¿-ÊÔÚÂ˜ ÌÂÏ¤ÙÂ˜ ÔÚ›˙ÂÙ·È ÌÂ ‰È·-ÊÔÚÂÙÈÎfi ÙÚfiÔ.

ñ ∏ ÚÔÏËÙÈÎ‹ ÂÍ¤Ù·ÛË Ô˘ Á›-ÓÂÙ·È ÌÂ ‚¿ÛË ÙÔ ÔÈÎÔÁÂÓÂÈ·ÎfiÈÛÙÔÚÈÎfi ¯¿ÓÂÈ ÙÔ 30% ¤ˆ˜ 60%ÙˆÓ ÂÚÈÙÒÛÂˆÓ ‰˘ÛÏÈÈ‰·È-Ì›·˜

ñ ∞fi Ù· ·È‰È¿ Ô˘ ¤¯Ô˘Ó ·˘-

ÍËÌ¤ÓË ÔÏÈÎ‹ Î·È LDL-¯ÔÏËÛÙÂ-ÚfiÏË, ¤Ó· ÔÛÔÛÙfi 40-55% ı·ÂÍ·ÎÔÏÔ˘ı‹ÛÂÈ Ó· ¤¯ÂÈ ‰˘ÛÏÈÈ-‰·ÈÌ›· ÛÙËÓ ÂÊË‚ÈÎ‹ Î·È ÙËÓ ÚÒ-ÈÌË ÂÓ‹ÏÈÎË ˙ˆ‹.

ñ √ Î·Ï‡ÙÂÚÔ˜ ÚÔÁÓˆÛÙÈÎfi˜‰Â›ÎÙË˜ ÁÈ· ‰˘ÛÏÈÈ‰·ÈÌ›· ÛÙËÓÂÓ‹ÏÈÎÔ ˙ˆ‹ Â›Ó·È Ù· Â›Â‰· ÙË˜LDL-¯ÔÏËÛÙÂÚfiÏË˜ Î·È ·ÎÔÏÔ˘ıÂ›ÙÔ ˘ÂÚ‚¿ÏÏÔÓ ÛˆÌ·ÙÈÎfi ‚¿ÚÔ˜ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·.

ñ ∞ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙË˜ ıÂÚ·Â›·˜

-√È ÛÙ·Ù›ÓÂ˜ ÌÂÈÒÓÔ˘Ó ÙËÓ ÔÏÈÎ‹¯ÔÏËÛÙÂÚfiÏË Ì¤¯ÚÈ 24,4% Î·È ÙËÓLDL-¯ÔÏËÛÙÂÚfiÏË Ì¤¯ÚÈ 30,8%ÛÙÈ˜ ÌÔÓÔÁÔÓÈ‰È·Î¤˜ ÌÔÚÊ¤˜ ÙË˜˘ÂÚÏÈÈ‰·ÈÌ›·˜

-√È ÚËÙ›ÓÂ˜ ‰¤ÛÌÂ˘ÛË˜ ¯ÔÏÈÎÒÓÌÂÈÒÓÔ˘Ó Ù· Â›Â‰· ÙˆÓ ÏÈÈ‰›ˆÓÛÙÈ˜ ÌÔÓÔÁÔÓÈ‰È·Î¤˜ ÌÔÚÊ¤˜ ÙË˜˘ÂÚÏÈÈ‰·ÈÌ›·˜

-Δ· ‰È·ÈÙËÙÈÎ¿ Û˘ÌÏËÚÒÌ·Ù·(„‡ÏÏÈÔ, ‚ÚÒÌË, Ì·ÚÁ·Ú›ÓÂ˜ ÌÂÛÙÂÚfiÏÂ˜) ¤¯Ô˘Ó ÌfiÓÔ ÔÚÈ·Î¿·ÔÙÂÏ¤ÛÌ·Ù· ‹ Î·È Î·Ó¤Ó· ·Ô-Ù¤ÏÂÛÌ· (ÂÎ¯‡ÏÈÛÌ· ÛÎfiÚ‰Ô˘)ÛÙÈ˜ ÌÔÓÔÁÔÓÈ‰È·Î¤˜ ÌÔÚÊ¤˜ ÙË˜˘ÂÚÏÈÈ‰·ÈÌ›·˜

-√È ‰È·ÈÙËÙÈÎ¤˜ Û˘Ì‚Ô˘Ï¤˜ Â›ÙÚ›· ¯ÚfiÓÈ· Ô‰‹ÁËÛ·Ó ÛÂ ÌÈÎÚ‹(8%) ·ÏÏ¿ ÚfiÛÎ·ÈÚË (<5 ¯Úfi-ÓÈ·) ÌÂ›ˆÛË ÙË˜ LDL-¯ÔÏËÛÙÂÚfi-ÏË˜ ÛÙ· ¿ÙÔÌ· ÌÂ ÌÔÓÔÁÔÓÈ‰È·Î‹‹ ÔÏ˘ÁÔÓÈ‰È·Î‹ ÌÔÚÊ‹ ˘ÂÚÏÈÈ-‰·ÈÌ›·˜.

-∏ Ê˘ÛÈÎ‹ ‰Ú·ÛÙËÚÈfiÙËÙ· ‰ÂÓ Â›-¯Â ·ÔÙ¤ÏÂÛÌ· ÛÙ· Â›Â‰· ÙË˜ÔÏÈÎ‹˜ ¯ÔÏËÛÙÂÚfiÏË˜ Î·È ¤Ù˘¯ÂÌÈÎÚ‹ ÌfiÓÔ ÌÂ›ˆÛË ÙË˜ LDL-¯ÔÏË-ÛÙÂÚfiÏË˜ (3,1%) ÛÙËÓ ÔÏ˘ÁÔÓÈ-‰È·Î‹ ÌÔÚÊ‹. ¢ÂÓ ¤¯ÂÈ ÌÂÏÂÙËıÂ›ÛÙÔÓ ÌÔÓÔÁÔÓÈ‰È·Î‹ ÌÔÚÊ‹ ˘ÂÚ-ÏÈÈ‰·ÈÌ›·˜

-√ Û˘Ó‰˘·ÛÌfi˜ ¿ÛÎËÛË˜, ‰›·ÈÙ·˜Î·È Û˘ÌÂÚÈÊÔÚÈÎ‹˜ ıÂÚ·Â›·˜¤Ù˘¯Â ·‡ÍËÛË ÙË˜ HDL-¯ÔÏËÛÙÂ-ÚfiÏË˜ Ì¤¯ÚÈ 23% ÂÚÈÛÛfiÙÂÚÔ·fi ÙËÓ ÔÌ¿‰· ÂÏ¤Á¯Ô˘ ‹ ÙË ‰›·È-Ù· Û˘Ó Û˘ÌÂÚÈÊÔÚÈÎ‹ ıÂÚ·Â›·

ñ Δ· ÛÙÔÈ¯Â›· ÁÈ· ÙÈ˜ ‰˘ÛÌÂÓÂ›˜ÂÈÙÒÛÂÈ˜ ÙË˜ ÚÔÏËÙÈÎ‹˜ ÂÍ¤-Ù·ÛË˜ Â›Ó·È Ùˆ¯¿ ·fi ÏÂ˘Ú¿˜ÔÈfiÙËÙ·˜

-√È ÛÙ·Ù›ÓÂ˜ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ·‡ÍË-ÛË ÙË˜ ÎÚÂ·ÙÈÓÈÎ‹˜ ÎÈÓ¿ÛË˜ Î·ÈÙˆÓ Ë·ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ

-√È ÚËÙ›ÓÂ˜ ‰¤ÛÌÂ˘ÛË˜ ¯ÔÏÈÎÒÓÛ˘Ó‰¤ÔÓÙ·È ÌÂ Á·ÛÙÚÂÓÙÂÚÈÎ¿ ÂÓÔ-¯Ï‹Ì·Ù· Î·È ÌÂ›ˆÛË ÙË˜ ·ÔÚÚfi-ÊËÛË˜ ‚ÈÙ·ÌÈÓÒÓ Î·È È¯ÓÔÛÙÔÈ¯Â›ˆÓ

-ΔÔ ÓÈÎÔÙÈÓÈÎfi ÔÍ‡ Û˘Ó‰¤ÂÙ·È ÌÂ·‡ÍËÛË ÙˆÓ Ë·ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ,Ë·ÙÔÙÔÍÈÎfiÙËÙ·, ÎÂÊ·Ï·ÏÁ›·,ÎÔÈÏÈ·Î¿ ¿ÏÁË Î·È Ó·˘Ù›·

-ΔÚ›· ·È‰È¿ ÌÂ ‰›·ÈÙÂ˜ ¯ˆÚ›˜ ·-Ú·ÎÔÏÔ‡ıËÛË ÂÌÊ¿ÓÈÛ·Ó Î·ı˘-ÛÙ¤ÚËÛË ÙË˜ ·Ó¿Ù˘ÍË˜ ·ÏÏ¿·È‰È¿ ÌÂ ‰›·ÈÙÂ˜ ¯·ÌËÏÒÓ ÏÈ·-ÚÒÓ Î·È ÛÙÂÓ‹ ·Ú·ÎÔÏÔ‡ıËÛËÂ›¯·Ó Î·ÓÔÓÈÎ‹ ·Ó¿Ù˘ÍË

-™Â ÌÈ· ÌÈÎÚ‹ ·ÓÂÈ‚Â‚·›ˆÙË ÌÂ-Ï¤ÙË ÛËÌÂÈÒıËÎÂ ·‡ÍËÛË ÙˆÓÚÔ‚ÏËÌ¿ÙˆÓ Û˘ÌÂÚÈÊÔÚ¿˜ ÛÂ·È‰È¿ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó ÛÂÚÔÏËÙÈÎ¤˜ ÂÍÂÙ¿ÛÂÈ˜.

-¢ÂÓ ·Ó·Ê¤ÚıËÎÂ ·‡ÍËÛË ¿Á-¯Ô˘˜ ‹ Î·Ù¿ıÏÈ„Ë˜

-Δ· Ì·ÎÚÔ¯ÚfiÓÈ· ·ÔÙÂÏ¤ÛÌ·Ù·ÙˆÓ ˘ÔÏÈÈ‰·ÈÌÈÎÒÓ Ê·ÚÌ¿ÎˆÓ‰ÂÓ ¤¯Ô˘Ó ÌÂÏÂÙËıÂ›

-∏ Ê˘ÛÈÎ‹ ‰Ú·ÛÙËÚÈfiÙËÙ· ¤¯ÂÈÛ˘Ó‰ÂıÂ› ÌÂ ˘ÂÚ‚ÔÏÈÎ‹ ·ÓÙ·fi-ÎÚÈÛË ÙË˜ ·ÚÙËÚÈ·Î‹ ›ÂÛË˜ÛÙËÓ ÌÔÓÔÁÔÓÈ‰È·Î‹ ˘ÂÚÏÈÈ‰·È-Ì›· ·ÏÏ¿ ‰ÂÓ Â›¯Â ·ÓÂÈı‡ÌËÙ··ÔÙÂÏ¤ÛÌ·Ù· ÛÙËÓ ÔÏ˘ÁÔÓÈ-‰È·Î‹ ÌÔÚÊ‹.

ñ ¶ÚÔÏËÙÈÎ‹ ÂÍ¤Ù·ÛË ÛÂ fiÏÔ˘˜·ÓÂÍ·ÈÚ¤Ùˆ˜ ‰ÂÓ Û˘ÓÈÛÙ¿Ù·È ·fiÎ·Ó¤Ó· ÂÈÛÙËÌÔÓÈÎfi ÊÔÚ¤·

ñ ∏ ∂ÈÙÚÔ‹ ∂È‰ÈÎÒÓ ÁÈ· Ù··È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ ÙÔ˘NCEP, ˘ÔÛÙËÚÈ˙fiÌÂÓË ·fi ÙËÓ∞ÌÂÚÈÎ·ÓÈÎ‹ ∞Î·‰ËÌ›· ¶·È‰È·ÙÚÈ-Î‹˜ Î·È ÙÔ ∞ÌÂÚÈÎ·ÓÈÎfi ∫ÔÏ¤ÁÈÔª·ÈÂ˘ÙÈÎ‹˜ Î·È °˘Ó·ÈÎÔÏÔÁ›·˜,Û˘ÓÈÛÙ¿ ÙÔÓ ÚÔÏËÙÈÎfi ¤ÏÂÁ¯ÔfiÙ·Ó ˘¿Ú¯ÂÈ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔ-ÚÈÎfi ÚÒÈÌË˜ ÛÙÂÊ·ÓÈ·›·˜ Ófi-ÛÔ˘ ‹ fiÙ·Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ Ô ¤Ó·˜ÁÔÓÈfi˜ ¤¯ÂÈ ÔÏÈÎ‹ ¯ÔÏËÛÙÂÚfiÏË> 240 mg/dL.

ñ ¶ÚÔÏËÙÈÎ‹ ÂÍ¤Ù·ÛË ›Ûˆ˜ Â›-Ó·È Î·Ïfi Ó· Á›ÓÂÙ·È ÛÂ ·È‰È¿˘¤Ú‚·Ú· ‹ ·È‰È¿ Ô˘ ·ÎÔÏÔ˘-ıÔ‡Ó ‰›·ÈÙÂ˜ ÌÂ ÔÏÏ¿ ÏÈ·Ú¿.

ñ ∏ ∞ÌÂÚÈÎ·ÓÈÎ‹ ∫·Ú‰ÈÔÏÔÁÈÎ‹∂Ù·ÈÚÂ›· Û˘ÓÈÛÙ¿ ÙËÓ ÚÔÏËÙÈ-Î‹ ÂÍ¤Ù·ÛË ·È‰ÈÒÓ ¿Óˆ ÙˆÓ 2ÂÙÒÓ Ô˘ ¤¯Ô˘Ó ÔÈÎÔÁÂÓÂÈ·ÎfiÈÛÙÔÚÈÎfi ‰˘ÛÏÈÈ‰·ÈÌ›·˜ ‹ ÚÒÈ-ÌË˜ Î·Ú‰È·ÁÁÂÈ·Î‹˜ ÓfiÛÔ˘, Ô˘¤¯Ô˘Ó ¿ÁÓˆÛÙÔ ÔÈÎÔÁÂÓÂÈ·ÎfiÈÛÙÔÚÈÎfi Û˘Ó ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡-ÓÔ˘ ‹ Ô˘ Â›Ó·È ˘¤Ú‚·Ú·

ñ ∫·ÌÈ¿ ÌÂÏ¤ÙË ‰ÂÓ ¤¯ÂÈ ÂÚÂ˘Ó‹-ÛÂÈ ÙË ÛËÌ·Û›· ÙË˜ ÚÔÏËÙÈÎ‹˜ÂÍ¤Ù·ÛË˜ Î·Ù¿ ÙËÓ ·È‰ÈÎ‹ ËÏÈ-Î›· ÛÙËÓ ÏÈÈ‰·ÈÌÈÎ‹ ÂÈÎfiÓ· ‹ ÙËÓÂÌÊ¿ÓÈÛË ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ Î·-Ù¿ ÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹.

¢ ∂ ∫ ∂ ª μ ƒ π √ ™ 2 0 0 7

28

∂ÈÛ·ÁˆÁ‹

T· ∞GEs (advanced glycationend products) ·ÔÙÂÏÔ‡Ó Ô˘Û›Â˜Ô˘ Û¯ËÌ·Ù›˙ÔÓÙ·È ·fi ÙË ÌË-ÂÓ-˙˘Ì·ÙÈÎ‹ ÁÏ˘ÎÔ˙˘Ï›ˆÛË, ‰ËÏ·‰‹ÙËÓ ·ÓÙ›‰Ú·ÛË ·Ó·ÁˆÁ‹˜ ÙË˜ÁÏ˘Îfi˙Ë˜ ÌÂ Ù· ÂÏÂ‡ıÂÚ· ·ÌÈÓÔ-Í¤· ÚˆÙÂ˚ÓÒÓ, ÏÈÈ‰›ˆÓ Î·È ÓÔ˘-ÎÏÂ˚ÓÈÎÒÓ ÔÍ¤ˆÓ.(1) ªÈ· ¿ÏÏËÔ‰fi˜ ·Ú·ÁˆÁ‹˜ Â›Ó·È fiÙ·Ó ËÁÏ˘Îfi˙Ë - ÛÂ Û˘Óı‹ÎÂ˜ ÔÍÂÈ‰ˆÙÈ-ÎÔ‡ ÛÙÚÂ˜ - Û¯ËÌ·Ù›˙ÂÈ ‰ÈÎ·Ú‚Ô-Ó˘ÏÈÎ¿ ·Ú¿ÁˆÁ· Ù· ÔÔ›· Û˘Ó-‰¤ÔÓÙ·È ÌÂ ·ÌÈÓÔÍ¤· Î·È Û¯ËÌ·Ù›-˙Ô˘Ó AGEs. ∂›ÛË˜, Ë ÁÏ˘Îfi˙ËÂ›Ó·È ‰˘Ó·Ùfi Ó· Û¯ËÌ·Ù›ÛÂÈ ·Â˘-ıÂ›·˜ AGEs Ì¤Ûˆ ÙË˜ Ô‰Ô‡ ÙˆÓÔÏ˘ÔÏÒÓ Î·È ÙÔ˘ ÂÓ˙‡ÌÔ˘ ·Ó·-

ÁˆÁ¿ÛË ÙË˜ ·Ï‰fi˙Ë˜.(2) H ·ÚÔ˘-Û›· ÔÏÏ·ÏÒÓ ÌË¯·ÓÈÛÌÒÓ ·-Ú·ÁˆÁ‹˜ ˘Ô‰ËÏÒÓÂÈ fiÙÈ Ù·AGEs ·ÔÙÂÏÔ‡Ó ÂÙÂÚÔÁÂÓ‹ ÔÌ¿-‰· ÌÂ ‰È·ÊÔÚÂÙÈÎ¤˜ Ê˘ÛÈÎÔ¯ËÌÈ-Î¤˜ È‰ÈfiÙËÙÂ˜, ·ÏÏ¿ ÌÂ ÎÔÈÓ‹ ·-ıÔÊ˘ÛÈÔÏÔÁ›· ÙË Û‡Ó‰ÂÛË ‰È·-ÊfiÚˆÓ Ô˘ÛÈÒÓ ÌÂ ÙË ÁÏ˘Îfi˙Ë.(3)

∏ Ì·ÎÚÔ¯ÚfiÓÈ· ¿ıÚÔÈÛË Î·È Â›-‰Ú·ÛË ÙˆÓ AGEs ÛÙÔ ÂÓ‰Ôı‹ÏÈÔÙˆÓ ·ÁÁÂ›ˆÓ ÂÈÙ·¯‡ÓÂÈ ÙËÓ ·ıË-ÚˆÌ¿ÙˆÛË ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ, ÙˆÓÂÁÎÂÊ·ÏÈÎÒÓ Î·È ÙˆÓ ÂÚÈÊÂÚÈ-ÎÒÓ ·ÚÙËÚÈÒÓ. ™˘ÁÎÂÎÚÈÌ¤Ó·, Ù·AGEs ÚÔÛÂÏÎ‡Ô˘Ó Ì·ÎÚÔÊ¿Á·,‰ÈÂÁÂ›ÚÔ˘Ó Ù· ÏÂ›· Ì˘˚Î¿ Î‡ÙÙ·-Ú· Î·È ÙÚÔÔÔÈÔ‡Ó ÙËÓ LDL,ÒÛÙÂ Ó· ÔÍÂÈ‰ÒÓÂÙ·È Â˘ÎÔÏfiÙÂ-Ú·, ÂÓÒ Ë Û‡Ó‰ÂÛË ÙÔ˘˜ ÌÂ ÙÔ

ÎÔÏÏ·ÁfiÓÔ ÙˆÓ ·ÁÁÂ›ˆÓ ÚÔÎ·-ÏÂ› ÌÂÈˆÌ¤ÓË Â˘ÂÓ‰fiÙËÙ· ÙˆÓ ·Ú-ÙËÚÈÒÓ (™¯‹Ì· 1).

AGEs fiÌˆ˜, ÌÔÚÂ› Ó· ÚÔ¤Ú¯Ô-ÓÙ·È Î·È ·fi ÙË ‰È·ÙÚÔÊ‹. μÚ¤-ıËÎÂ fiÙÈ ‚Ú›ÛÎÔÓÙ·È ÛÂ ÔÏ‡ ÌÂ-Á¿ÏË ÂÚÈÂÎÙÈÎfiÙËÙ· ÛÙÈ˜ ÙÚÔ-Ê¤˜ Ô˘ Ì·ÁÂÈÚÂ‡ÔÓÙ·È ÛÂ ˘„Ë-Ï¤˜ ıÂÚÌÔÎÚ·Û›Â˜ Î·È ÁÈ· ÌÂÁ¿-ÏÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·. Δ· AGEsÙˆÓ ÙÚÔÊÒÓ ¤¯Ô˘Ó ·ÚfiÌÔÈÂ˜ÔÍÂÈ‰ˆÙÈÎ¤˜ Î·È ÊÏÂÁÌÔÓÒ‰ÂÈ˜È‰ÈfiÙËÙÂ˜ ÌÂ Ù· ∞GEs Ô˘ ·Ú¿-ÁÔÓÙ·È ÂÓ‰ÔÁÂÓÒ˜ Î·È ÌÔÚÂ› Ó·Û˘ÓÂÈÛÊ¤ÚÔ˘Ó ÛËÌ·ÓÙÈÎ¿ ÛÙËÓ·‡ÍËÛË Û˘ÛÛÒÚÂ˘ÛË˜ ÙˆÓ AGEsÛÙÔ Ï¿ÛÌ· Î·È ÙÔ˘˜ ÈÛÙÔ‡˜, ÁÂ-ÁÔÓfi˜ Ô˘ ÌÔÚÂ› Ó· Ô‰ËÁ‹ÛÂÈ

ΔÂÏÈÎ¿ ¶ÚÔ˚fiÓÙ· ¶ÚÔ¯ˆÚËÌ¤ÓË˜ °Ï˘ÎÔ˙˘Ï›ˆÛË˜ (AGEs) Î·È ¢È·ÙÚÔÊ‹

∞. •¿ÓıË˜, ∞. Ã·Ù˙ËÙfiÏÈÔ˜, ¶. °È·ÓÓÔ˘Ï¿ÎË*, º. ∏ÏÈ¿‰Ë˜, μ. Õı˘ÚÔ˜**.∞’ ¶ÚÔ·È‰Â˘ÙÈÎ‹ ¶·ıÔÏÔÁÈÎ‹ ∫ÏÈÓÈÎ‹ ∞¶£, ∞Ã∂¶∞, £ÂÛÛ·ÏÔÓ›ÎË

* ΔÌ‹Ì· ¢È·ÙÚÔÊ‹˜, ¡ÔÛÔÎÔÌÂ›Ô ∞Ã∂¶∞, £ÂÛÛ·ÏÔÓ›ÎË** B’ ¶ÚÔ·È‰Â˘ÙÈÎ‹ ¶·ıÔÏÔÁÈÎ‹ ∫ÏÈÓÈÎ‹ ∞¶£, πÔÎÚ¿ÙÂÈÔ, £ÂÛÛ·ÏÔÓ›ÎË

™¯‹Ì· 1. O ¿ÍÔÓ·˜ AGEs-RAGE ÛÙ· ÂÓ‰ÔıËÏÈ·Î¿ Î‡ÙÙ·Ú· Î·È Ë ÚÔ·ÁˆÁ‹ ÙË˜ ·ıËÚˆÌ¿ÙˆÛË˜. (VCAM= vascular cell adhesion molecule, IL-6= interleukin-6, TNF=tumor necrosis factor, NF-ÎB= nuclear factor ÎB)

¢π∞Δƒ√º∏

29

ÌÂ ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘ ÛÙËÓ·Ó¿Ù˘ÍË ÌÈÎÚÔ- Î·È Ì·ÎÚÔ·ÁÁÂÈ-·ÎÒÓ ÂÈÏÔÎÒÓ(4). ™ÙËÓ ·Ú·Î¿-Ùˆ ÂÚÁ·Û›· ·Ó·Ï‡ÂÙ·È Ë Û¯¤ÛËÙˆÓ AGEs ÌÂ ÙË ‰È·ÙÚÔÊ‹ ÛÂÙÚ›· Â›Â‰·. ∞Ú¯ÈÎ¿, ı· ·Ó·-ÊÂÚıÂ› Ë Û¯¤ÛË ÙˆÓ AGEs ÌÂ Û˘-ÁÎÂÎÚÈÌ¤Ó· ÙÚfiÊÈÌ· (Û˘ÁÎÂÎÚÈ-Ì¤Ó· ıÚÂÙÈÎ¿ Û˘ÛÙ·ÙÈÎ¿), ÛÙËÛ˘Ó¤¯ÂÈ· Ë Û¯¤ÛË ÌÂ ÙÔÓ ÙÚfiÔÌ·ÁÂÈÚÈÎ‹˜ ·Ú·ÛÎÂ˘‹˜ Î·È Ù¤-ÏÔ˜, Ô ÚfiÏÔ˜ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓıÚÂÙÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ ‹ ÙÚÔÊ›-ÌˆÓ ÁÈ· Ù· ÔÔ›· ·fi ÌÂÏ¤ÙÂ˜ÚÔÎ‡ÙÔ˘Ó ÂÓ‰Â›ÍÂÈ˜ fiÙÈ ÌÂÈÒ-ÓÔ˘Ó ÙË Û˘ÛÛÒÚÂ˘ÛË AGEs ÛÙÔÏ¿ÛÌ· Î·È ÙÔ˘˜ ÈÛÙÔ‡˜.

AGEs Î·È Â›‰Ô˜ ÙÚÔÊ›ÌˆÓ

Δ· AGEs ÙˆÓ ÙÚÔÊ›ÌˆÓ ·Ú¿ÁÔ-ÓÙ·È Î˘Ú›ˆ˜ ·fi ÙÔÓ ÙÚfiÔ Ì·-ÁÂÈÚÈÎ‹˜ ·Ú·ÛÎÂ˘‹˜, ÙË ‚ÈÔÌË-¯·ÓÈÎ‹ ÂÂÍÂÚÁ·Û›· Ô˘ Èı·ÓÒ˜¤¯ÂÈ ˘ÔÛÙÂ› ÙÔ ÙÚfiÊÈÌÔ, Î·ıÒ˜Î·È ÙÈ˜ ·ÏÏËÏÂÈ‰Ú¿ÛÂÈ˜ ÌÂÙ·Í‡ÔÍÂÈ‰ˆÌ¤ÓˆÓ ÏÈÈ‰›ˆÓ Î·È ÚˆÙÂ-˚ÓÒÓ ÙÔ˘ ÙÚÔÊ›ÌÔ˘(5). ΔÚÔÊ¤˜ÏÔ‡ÛÈÂ˜ ÛÂ ÚˆÙÂ˝ÓË Î·È Ï›Ô˜Î·È Ì·ÁÂÈÚÂÌ¤ÓÂ˜ ÛÂ ˘„ËÏ‹ ıÂÚ-ÌÔÎÚ·Û›·, ÙÂ›ÓÔ˘Ó Ó· Â›Ó·È ÏÔ‡-ÛÈÂ˜ ËÁ¤˜ ÛÂ AGEs, ÂÓÒ ÙÚÔÊ¤˜¯·ÌËÏ¤˜ ÛÂ Ï›Ô˜ Î·È ÏÔ‡ÛÈÂ˜ÛÂ ˘‰·Ù¿ÓıÚ·ÎÂ˜ ÙÂ›ÓÔ˘Ó Ó· Â›-Ó·È Û¯ÂÙÈÎ¿ ¯·ÌËÏ¤˜ ÛÂ AGEs.™ÙÔÓ ¶›Ó·Î· 1 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·ÈÂÓ‰ÂÈÎÙÈÎ¿ ÙÚfiÊÈÌ· ÌÂ ÙËÓ ÂÚÈÂ-ÎÙÈÎfiÙËÙ· ÙÔ˘˜ ÛÂ AGEs(6).

ΔÔ ¯·ÌËÏfi ÂÚÈÂ¯fiÌÂÓÔ ÛÂ AGEsÌÈ·˜ ‰›·ÈÙ·˜ Ê˘ÙÈÎ‹˜ ÚÔ¤ÏÂ˘-ÛË˜ Î·È ¯·ÌËÏ‹˜ ÛÂ Ï›Ô˜, Ê·›ÓÂ-Ù·È Ó· ÚÔÛÊ¤ÚÂÈ ÔÏÏ¿ ÏÂÔÓÂ-ÎÙ‹Ì·Ù· ÛÙÔ˘˜ ‰È·‚ËÙÈÎÔ‡˜. ¶·-ÚfiÏ· ·˘Ù¿, ÛÂ ¤ÚÂ˘ÓÂ˜ ¤¯ÂÈ Î·-Ù·ÁÚ·ÊÂ› fiÙÈ Ë Û˘ÁÎ¤ÓÙÚˆÛË ÙˆÓAGEs ÛÙÔ Ï¿ÛÌ· ÙÔ˘ ·›Ì·ÙÔ˜ÛÂ ˘ÁÈÂ›˜ ¯ÔÚÙÔÊ¿ÁÔ˘˜ Â›Ó·È˘„ËÏfiÙÂÚË ·fi ÙË Û˘ÁÎ¤ÓÙÚˆÛËÔ˘ ÂÌÊ·Ó›˙Ô˘Ó Ù· ·ÌÊ¿Á·¿ÙÔÌ·, ÁÂÁÔÓfi˜ Ô˘ ÂÁÂ›ÚÂÈ ÙËÓ˘fiıÂÛË fiÙÈ Î¿ÔÈÔ˜ ·Ú¿ÁÔ-ÓÙ·˜ ÛÙÈ˜ ¯ÔÚÙÔÊ·ÁÈÎ¤˜ ‰›·ÈÙÂ˜Èı·ÓÒ˜ Ó· Â˘ÓÔÂ› ÙËÓ ÂÓ‰ÔÁÂÓ‹·Ú·ÁˆÁ‹ ÙˆÓ AGEs. ∫¿ÔÈÔÈÂÚÂ˘ÓËÙ¤˜ ¤¯Ô˘Ó ÚÔÙÂ›ÓÂÈ fiÙÈ ÙÔÛ¯ÂÙÈÎ¿ ˘„ËÏfi ÂÚÈÂ¯fiÌÂÓÔÊÚÔ˘ÎÙfi˙Ë˜ ÛÙÈ˜ ¯ÔÚÙÔÊ·ÁÈÎ¤˜‰›·ÈÙÂ˜ Èı·ÓÒ˜ Ó· ÂÍËÁÂ› ·˘ÙfiÙÔ Ê·ÈÓfiÌÂÓÔ, ·ÏÏ¿ Ì¤¯ÚÈ ÛÙÈÁ-Ì‹˜ ‰ÂÓ ˘¿Ú¯ÂÈ ÎÏÈÓÈÎ‹ ·fi‰ÂÈ-ÍË fiÙÈ Ë Ê˘ÛÈÔÏÔÁÈÎ‹ ÚfiÛÏË„ËÊÚÔ˘ÎÙfi˙Ë˜ ¤¯ÂÈ ÛËÌ·ÓÙÈÎfi ·ÓÙ›-ÎÙ˘Ô ÛÙËÓ ·Ú·ÁˆÁ‹ AGEs.ªÈ· ÂÓ·ÏÏ·ÎÙÈÎ‹ ‹ ÂÈÚfiÛıÂÙËÈı·ÓfiÙËÙ· Â›Ó·È fiÙÈ Ù· Û¯ÂÙÈÎÒ˜¯·ÌËÏ¿ Â›Â‰· Ù·˘Ú›ÓË˜ ÛÙÔ˘˜¯ÔÚÙÔÊ¿ÁÔ˘˜ (Ë ÔÔ›·, Ú˘ıÌ›˙ÂÈÙÔ ÚfiÏÔ ÙˆÓ ÔÍÂÈ‰ˆÙÈÎÒÓ ·Ú·-ÁfiÓÙˆÓ Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fiÙËÓ Ì˘ÂÏÔÂÚÔÍÈ‰¿ÛË, ÛÙË Û‡Ó-ıÂÛË ÙˆÓ AGEs) ·˘Í¿ÓÔ˘Ó Ù·Â›Â‰· ÙˆÓ AGEs ÛÙÔ ·›Ì· ÙˆÓ¯ÔÚÙÔÊ¿ÁˆÓ. ™‡ÌÊˆÓ· ÌÂ ÙËÓÂÎ‰Ô¯‹ ·˘Ù‹, Ë ÚÔÛı‹ÎË Ù·˘Ú›-ÓË˜ ·Ó·Ì¤ÓÂÙ·È Èı·ÓÒ˜ Ó· ÌÂÈÒ-ÛÂÈ ÙËÓ ·˘ÍËÌ¤ÓË ·Ú·ÁˆÁ‹ ÙˆÓ

AGEs ÛÙÔ˘˜ ¯ÔÚÙÔÊ¿ÁÔ˘˜.

ŒÙÛÈ, ÚÔÙÂ›ÓÂÙ·È fiÙÈ ÌÈ· ¯ÔÚÙÔ-Ê·ÁÈÎ‹ ‰›·ÈÙ· ¯·ÌËÏÔ‡ Ï›Ô˘˜ ÌÂÊ˘ÛÈÔÏÔÁÈÎ‹ ÚfiÛÏË„Ë ÊÚÔ˘-ÎÙfi˙Ë˜, Î·ıÒ˜ Î·È ÂÓÈÛ¯˘Ì¤ÓË ÌÂÙ·˘Ú›ÓË Â›Ó·È Ë ÈÔ Î·Ù¿ÏÏËÏËÁÈ· ÙË ÌÂ›ˆÛË ÙˆÓ ÂÈÏÔÎÒÓ ÙÔ˘‰È·‚‹ÙË Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙËÛ˘ÛÛÒÚÂ˘ÛË ÙˆÓ AGEs ÛÙÔ Ï¿-ÛÌ· Î·È ÙÔ˘˜ ÈÛÙÔ‡˜(7). ∂ÈÏ¤ÔÓ,ÌÂÏ¤ÙÂ˜ Ô˘ ¤ÁÈÓ·Ó ÛÂ Â›Ì˘Â˜ÂÚÂ‡ÓËÛ·Ó ÙËÓ Â›‰Ú·ÛË ÙÔ˘ıÂÚÌÈ‰ÈÎÔ‡ ÂÚÈÂ¯ÔÌ¤ÓÔ˘ ÙË˜‰È·ÙÚÔÊ‹˜ Î·È ÙÔ˘ Â›‰Ô˘˜ ÙÔ˘˘‰·Ù¿ÓıÚ·Î·, ÛÙË Û˘ÛÛÒÚÂ˘ÛËÙˆÓ AGEs. ΔÔ Û˘Ì¤Ú·ÛÌ· ‹Ù·ÓfiÙÈ Ë Ì·ÎÚ¿˜ ‰È¿ÚÎÂÈ·˜ ‰È·ÙÚÔÊ‹ÛÂ Â›Ì˘Â˜ ÌÂ Û˘ÁÎÂÎÚÈÌ¤ÓÔ Â›-‰Ô˜ ˘‰·Ù·ÓıÚ¿ÎˆÓ, ‰ÂÓ ÌÂÙ·‚¿-ÏÂÈ ÙÈ˜ Û˘ÁÎÂÓÙÚÒÛÂÈ˜ ÁÏ˘Îfi˙Ë˜ÛÙÔ ·›Ì· Î·È ‰ÂÓ ÂËÚÂ¿˙ÂÈ ÙÔÔÍÂÈ‰ˆÙÈÎfi ÛÙÚÂ˜, ¿Ú· Ô‡ÙÂ ÂË-ÚÂ¿˙ÂÈ ÙË Û˘ÛÛÒÚÂ˘ÛË ÙˆÓ AGEsÛÙÔ Ï¿ÛÌ· Î·È ÙÔ˘˜ ÈÛÙÔ‡˜.∞ÓÙ›ıÂÙ·, Ô ÂÚÈÔÚÈÛÌfi˜ ÙˆÓıÂÚÌ›‰ˆÓ ÙË˜ ‰È·ÙÚÔÊ‹˜ ¤‰ÂÈÍÂfiÙÈ ÌÂÈÒÓÂÈ ÙË Û˘ÛÛÒÚÂ˘ÛË ÙˆÓAGEs ÛÙÔ˘˜ ÈÛÙÔ‡˜. ¶ÚÔÎ‡ÙÂÈ¤ÙÛÈ, fiÙÈ Ë ÚfiÛÏË„Ë ıÂÚÌ›‰ˆÓÂËÚÂ¿˙ÂÈ ÈÔ ÈÛ¯˘Ú¿ ÙË Û˘ÛÛÒ-ÚÂ˘ÛË ÙˆÓ AGEs ·fi ÙÔ Â›‰Ô˜ÙÔ˘ ‰È·ÙÚÔÊÈÎÔ‡ ˘‰·Ù¿ÓıÚ·Î·Ô˘ Î·Ù·Ó·ÏÒÓÂÙ·È. π‰È·›ÙÂÚÔÚfiÏÔ ÛÙËÓ ·Ú·¿Óˆ ·Ú·Ù‹ÚË-ÛË ·›˙ÂÈ Ë ËÏÈÎ›· ÙÔ˘ ÂÈÚ·Ì·Ùfi-˙ˆÔ˘ Î·ıÒ˜ Î·È Ë ‰È¿ÚÎÂÈ· Û›ÙÈ-ÛË˜ ÌÈ·˜ Û˘ÁÎÂÎÚÈÌ¤ÓË˜ ‰È·ÙÚÔ-Ê‹˜(8,9).

Δƒ√ºπª∞ AGES (KU /gr) Δƒ√ºπª∞ AGES (KU /gr)

μÔ‡Ù˘ÚÔ 26,4 º·ÛfiÏÈ· ‚Ú·ÛÌ¤Ó· ÁÈ· 1 h 2,9

ª·ÚÁ·Ú›ÓË 175,2 ™·ÁÁ¤ÙÈ ‚Ú·ÛÌ¤Ó· ÁÈ· 12 min 2,42

∂Ï·ÈfiÏ·‰Ô 16,68 °Ï˘ÎÔ·Ù¿ÙÂ˜ ÙËÁ·ÓÈÙ¤˜ ÁÈ· 10 min 0,72

μÔ‰ÈÓfi (fast-food) 54,17 μÚ·ÛÙ¤˜ ·Ù¿ÙÂ˜ ÁÈ· 30 min 0,17

ª¤ÈÎÔÓ 90,22 ΔËÁ·ÓÈÙ¤˜ ·Ù¿ÙÂ˜ (fast-food) 15,2

™Ù‹ıÔ˜ ÎÔÙfiÔ˘ÏÔ ÙËÁ¿ÓÈ 61,22 ªÈÎÚ¤˜ ÙËÁ·ÓÈÙ¤˜ ·Ù¿ÙÂ˜ 28,8

™Ù‹ıÔ˜ ÎÔÙfiÔ˘ÏÔ-‚Ú·ÛÙfi 11,23 ∫Ï·Ì-Û·ÓÙÔ˘ÈÙ˜ 12,2

∫·ÓÈÛÙfi˜ ™ÔÏˆÌfi˜ 5,71 ¶Ô-ÎÔÚÓ 1,34

ΔfiÓÔ˜ ÛÂ Ï¿‰È 17,4 ª‹ÏÔ 0,12

Δ˘Ú› Ê¤Ù· 84,23 ª·Ó¿Ó· 0,08

∫›ÙÚÈÓÔ Ù˘Ú› ¯ˆÚ›˜ Ï›Ô˜ 14,5 ªÚfiÎÔÏÔ 2,20

∞˘Áfi ‚Ú·ÛÌ¤ÓÔ ÁÈ· 10 min 18,6 ΔËÁ·ÓÈÙ¿ Î·ÚfiÙ· 0,10

∞˘Áfi ÙËÁ·ÓÈÙfi ÌÂ Ì·ÚÁ·Ú›ÓË 41,1 øÌ¿ ª·ÓÈÙ¿ÚÈ· 2,6

§Â˘Îfi „ˆÌ› 1,51 øÌfi ∫ÚÂÌÌ‡‰È 0,35

æˆÌ› ÔÏÈÎ‹˜ ·Ï¤ÛÂˆ˜ 1,10 ΔÔÌ¿Ù· 0,23

ºÚ˘Á·ÓÈÛÌ¤ÓÔ „ˆÌ› 6,07 ¶·ÁˆÙfi ‚·Ó›ÏÈ· 0,35

¶›Ó·Î·˜ 1. ¶ÂÚÈÂ¯fiÌÂÓ· ÛÂ AGEs Û˘ÓËıÈÛÌ¤ÓˆÓ ÙÚÔÊ›ÌˆÓ (Ë Ì¤ÙÚËÛË ¤ÁÈÓÂ ÌÂ ∂LISA ÁÈ· ·Ó›¯ÓÂ˘ÛË ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙË˜ CML)

¢ ∂ ∫ ∂ ª μ ƒ π √ ™ 2 0 0 7

30

AGEs Î·È ÙÚfiÔ˜ Ì·ÁÂÈÚÈÎ‹˜·Ú·ÛÎÂ˘‹˜

∞ÚÎÂÙ¤˜ ÌÂÏ¤ÙÂ˜ ¤¯Ô˘Ó Ï¿‚ÂÈ¯ÒÚ· ÙfiÛÔ ÛÂ ÂÈÚ·Ì·Ùfi˙ˆ·,fiÛÔ Î·È ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ‰È·‚‹ÙËÙ‡Ô˘ 2, ÔÈ ÔÔ›Â˜ ÂÚÂ˘ÓÔ‡Ó ÙËÓÂ›‰Ú·ÛË ÁÂ‡Ì·ÙÔ˜ ¯·ÌËÏÔ‡ Â-ÚÈÂ¯ÔÌ¤ÓÔ˘ ÛÂ AGEs (LAGE) Î·ÈÁÂ‡Ì·ÙÔ˜ ˘„ËÏÔ‡ ÂÚÈÂ¯ÔÌ¤ÓÔ˘ÛÂ AGEs (HAGE) ÛÙÔ ÔÍÂÈ‰ˆÙÈÎfiÛÙÚÂ˜ Î·È ÙËÓ ·ÁÁÂÈ·Î‹ ÏÂÈÙÔ˘Ú-Á›·. ™Â fiÏÂ˜ ÙÈ˜ ÂÚÈÙÒÛÂÈ˜, Ù·‰˘Ô ÁÂ‡Ì·Ù· ¤¯Ô˘Ó ·ÎÚÈ‚Ò˜ ÙËÓ›‰È· Û‡ÛÙ·ÛË ÛÂ ıÂÚÌ›‰Â˜ Î·ÈıÚÂÙÈÎ¿ Û˘ÛÙ·ÙÈÎ¿ (˘‰·Ù¿ÓıÚ·-ÎÂ˜, ÚˆÙÂ˝ÓÂ˜, Ï›Ë) Î·È ‰È·Ê¤-ÚÔ˘Ó ·ÔÎÏÂÈÛÙÈÎ¿ ÛÙÔÓ ÙÚfiÔÌ·ÁÂÈÚÈÎ‹˜ ·Ú·ÛÎÂ˘‹˜ ÙÔ˘˜.ªÂ ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ Ë ÂÚÈÂÎÙÈ-ÎfiÙËÙ· ÙˆÓ AGEs ÛÙÔ HAGE ÁÂ‡-Ì· Â›Ó·È ÙÚÂÈ˜ ÌÂ ¤ÓÙÂ ÊÔÚ¤˜ÌÂÁ·Ï‡ÙÂÚË ·fi ÙËÓ ÂÚÈÂÎÙÈÎfi-ÙËÙ· ÙˆÓ AGEs ÛÙÔ LAGE ÁÂ‡-Ì·, ÛÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ ÂÚÈÙÒ-ÛÂÈ˜ (10). ΔÔ fiÛÔ ÂËÚÂ¿˙ÂÈ Ë Ì·-ÁÂÈÚÈÎ‹ ÂÂÍÂÚÁ·Û›· ÙÔ˘ ÙÚÔÊ›-ÌÔ˘ ÙËÓ Û˘ÁÎ¤ÓÙÚˆÛË ÙˆÓ AGEsÁ›ÓÂÙ·È ÂÌÊ·Ó‹˜ ÌÂ ÙÔ ·Ú¿‰ÂÈÁ-Ì· ‰›·ÈÙ·˜ Ô˘ ·Ú·Ù›ıÂÙ·È ÛÙÔÓ¶›Ó·Î· 2.

√È ÂÚÈÛÛfiÙÂÚÂ˜ ÌÂÏ¤ÙÂ˜ ¤¯Ô˘Ó‰Â›ÍÂÈ fiÙÈ ÙÔ ›‰ÈÔ ÁÂ‡Ì· Ì·ÁÂÈÚÂ-

Ì¤ÓÔ Î¿Ùˆ ·fi ‰È·ÊÔÚÂÙÈÎ¤˜Û˘Óı‹ÎÂ˜ ¤¯ÂÈ ‰È·ÊÔÚÂÙÈÎ¤˜ ÂÈ-‰Ú¿ÛÂÈ˜ ÛÙÔ ÔÍÂÈ‰ˆÙÈÎfi ÛÙÚÂ˜Î·È ÙËÓ ·ÁÁÂÈ·Î‹ ÏÂÈÙÔ˘ÚÁ›· ÛÂ·ÛıÂÓÂ›˜ ÌÂ ‰È·‚‹ÙË Ù‡Ô˘ 2. ™ÂÎ¿ÔÈÂ˜ ÌÂÏ¤ÙÂ˜ Ì¿ÏÈÛÙ·, Î·Ù·-ÁÚ¿ÊËÎÂ fiÙÈ ¤Ó· ÌÔÓ·‰ÈÎfi ÁÂ‡Ì·˘„ËÏfi ÛÂ AGEs ·˘Í¿ÓÂÈ ÙÔ ÔÍÂÈ-‰ˆÙÈÎfi ÛÙÚÂ˜ Î·È ÚÔÎ·ÏÂ› Ù·-¯Â›· Î·È ÛËÌ·ÓÙÈÎ‹ ÂÓ‰ÔıËÏÈ·Î‹‰˘ÛÏÂÈÙÔ˘ÚÁ›·. ™˘ÌÂÚ·›ÓÂÙ·È¤ÙÛÈ, fiÙÈ ¯ÚfiÓÈ· ‰›·ÈÙ· ˘„ËÏ‹ ÛÂAGEs, fiˆ˜ Â›Ó·È ÔÈ ÂÚÈÛÛfiÙÂ-ÚÂ˜ ‰›·ÈÙÂ˜ ¢˘ÙÈÎÔ‡ Ù‡Ô˘, ÌÔ-ÚÂ› Ó· Ô‰ËÁ‹ÛÂÈ ÌÂÙ¿ ·fi Â‚‰Ô-Ì¿‰Â˜ ‹ Ì‹ÓÂ˜ ÛÂ Â›ÌÔÓË ÂÓ‰Ô-ıËÏÈ·Î‹ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Î·È ÛÙËÛ˘Ó¤¯ÂÈ· ÛÂ ·Ó¿Ù˘ÍË ÌÈÎÚÔ-‹/Î·È Ì·ÎÚÔ·ÁÁÂÈ·ÎÒÓ ÂÈÏÔ-ÎÒÓ ÙÔ˘ ‰È·‚‹ÙË. ŸÏÂ˜ ÔÈ ÌÂÏ¤-ÙÂ˜ ¤‰ÂÈÍ·Ó fiÙÈ ÙÔ ‚Ú¿ÛÈÌÔ Î·È ÙÔÌ·ÁÂ›ÚÂÌ· ÛÙÔÓ ·ÙÌfi ÛÂ Û˘Ó‰˘·-ÛÌfi ÌÂ fiÛÔ ÙÔ ‰˘Ó·Ùfi ¯·ÌËÏfiÙÂ-ÚÂ˜ ıÂÚÌÔÎÚ·Û›Â˜ Ì·ÁÂÈÚ¤Ì·ÙÔ˜(.¯. 100 oC) Î·È ÌÈÎÚfiÙÂÚÔ˘˜¯ÚfiÓÔ˘˜ Ì·ÁÂÈÚ¤Ì·ÙÔ˜ (.¯.10 ÏÂÙ¿) ‰›ÓÔ˘Ó ÁÂ‡Ì·Ù· ÌÂÔÏ‡ ¯·ÌËÏ‹ ÂÚÈÂÎÙÈÎfiÙËÙ· ÛÂAGEs (8,9). ™˘ÓÂÒ˜, ÌÈ· ·Ï‹ ‰È·-ÙÚÔÊÈÎ‹ ·Ú¤Ì‚·ÛË, Ë ÔÔ›· ‰ÂÓÛËÌ·›ÓÂÈ ··Ú·›ÙËÙ· ÙË ÛÙ¤ÚËÛËÛ˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÙÚÔÊ›ÌˆÓ, ·ÏÏ¿ÌfiÓÔ ÙËÓ ÚÔÙÂÈÓfiÌÂÓË ¯Ú‹ÛË

Ì·ÁÂÈÚÈÎÒÓ ÙÂ¯ÓÈÎÒÓ Ô˘ ‰ÂÓ ·˘-Í¿ÓÔ˘Ó Ù· AGEs ÛÙÈ˜ ÙÚÔÊ¤˜,ÌÔÚÂ› Ó· ·ÔÙÂÏ¤ÛÂÈ ÌÈ· ÂÏÎ˘-ÛÙÈÎ‹ ÂÓ·ÏÏ·ÎÙÈÎ‹ Ï‡ÛË ÛÙËÓÚfiÏË„Ë ÙˆÓ ÂÈÏÔÎÒÓ ÙÔ˘ ‰È·-‚‹ÙË (11,12).

AGEs Î·È ÔÈ ‰È·ÙÚÔÊÈÎÔ›·ÓÙ·ÁˆÓÈÛÙ¤˜ ÙÔ˘˜

ŒÚÂ˘ÓÂ˜ ¤‰ÂÈÍ·Ó fiÙÈ ÙÔ Ú¿ÛÈÓÔÙÛ¿È Èı·ÓÒ˜ Ó· ¤¯ÂÈ ıÂÚ·Â˘ÙÈ-Î‹ Â›‰Ú·ÛË ÛÙËÓ ıÂÚ·Â›· ÙˆÓÎ·Ú‰È·ÁÁÂÈ·ÎÒÓ ÂÈÏÔÎÒÓ ÙÔ˘‰È·‚‹ÙË, Ô˘ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È·fi ·˘ÍËÌ¤ÓË Û˘ÛÛÒÚÂ˘ÛË ÙˆÓAGEs ÛÙÔ˘˜ ÈÛÙÔ‡˜(13). ∂ÈÚfi-ÛıÂÙ·, ¿ÏÏÂ˜ ÌÂÏ¤ÙÂ˜ Î·Ù¤ÁÚ·-„·Ó fiÙÈ Ë Ù·˘Ú›ÓË ·›˙ÂÈ Î¿ÔÈÔÚfiÏÔ ÛÙËÓ Î·ı˘ÛÙ¤ÚËÛË ÂÌÊ¿ÓÈ-ÛË˜ ÙˆÓ ÂÈÏÔÎÒÓ ÙÔ˘ ‰È·‚‹ÙËÎ·È Èı·ÓÒ˜ Ó· ÌÔÚÂ› Ó· ¯ÚËÛÈ-ÌÔÔÈËıÂ› ˆ˜ ¤Ó· ‚ÔËıËÙÈÎfi ıÂ-Ú·Â˘ÙÈÎfi Ì¤ÛÔ ÛÙËÓ ·ÓÙÈÌÂÙÒ-ÈÛË ÙÔ˘ ‰È·‚‹ÙË Î·È ÙˆÓ ÂÈÏÔ-ÎÒÓ ÙÔ˘(14). ∂Í¿ÏÏÔ˘, Ë ‚ÂÓÊÔÙÈ·-Ì›ÓË (·Ú¿ÁˆÁÔ ÙË˜ ıÂÈ·Ì›ÓË˜)Î·È Ë ‚ÈÙ·Ì›ÓË C ·¤ÙÚÂ„·Ó ÙËÓ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÙfiÛÔ ÌÂÁ¿ÏˆÓfiÛÔ Î·È ÌÈÎÚÒÓ ·ÁÁÂ›ˆÓ ÛÂ ‰È·-‚ËÙÈÎÔ‡˜ ·ÛıÂÓÂ›˜ Ô˘ Î·Ù·Ó¿-ÏˆÛ·Ó ÁÂ‡Ì· ÏÔ‡ÛÈÔ ÛÂAGEs.(15) E›ÛË˜, Ô ¯˘Ìfi˜ ÁÎÚÂ˚-ÊÚÔ˘Ù ÂÚÈ¤¯ÂÈ ÔÏ˘Ê·ÈÓfiÏÂ˜, ÔÈÔÔ›Â˜ Â›Ó·È ÈÛ¯˘Ú¿ ·ÓÙÈÔÍÂÈ‰ˆÙÈ-Î¤˜ ÂÓÒÛÂÈ˜ Î·È ÌÂÈÒÓÔ˘Ó ÙËÓ ·-Ú·ÁˆÁ‹ ÂÏÂ˘ı¤ÚˆÓ ÚÈ˙ÒÓ ÔÍ˘Áfi-ÓÔ˘.(16) ªÈ· ¿ÏÏË Ê˘ÛÈÎ‹ Ô˘Û›·, ËÚ˘Ù›ÓË, Ë ÔÔ›· Â›Ó·È ¤Ó· ÊÏ·‚Ô-ÓÔÂÈ‰¤˜ Ô˘ ˘¿Ú¯ÂÈ ÛÂ ÌÂÁ¿ÏËÛ˘ÁÎ¤ÓÙÚˆÛË ÛÙË ÓÙÔÌ¿Ù· ·Ó·-ÛÙ¤ÏÏÂÈ ÙÔ Û¯ËÌ·ÙÈÛÌfi AGEs invitro ÁÈ· ÌÂÁ¿ÏÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙË-Ì·.(17) ∞Ó·ÊÔÚÈÎ¿ Î·È ÌÂ ÙÔÓ ÙÚfi-Ô Ì·ÁÂÈÚÈÎ‹˜ ·Ú·ÛÎÂ˘‹˜, ÚÔ-ÙÂ›ÓÂÙ·È ÂÍ¿ÏÏÔ˘ fiÙÈ Ô Û˘Ó‰˘·-ÛÌfi˜ ÚˆÙÂ˚ÓÒÓ ÌÂ ÌÔÓÔ·ÎfiÚÂ-ÛÙ· ÏÈ·Ú¿ ÔÍ¤·, fiˆ˜ ÙÔ ÂÏ·Èfi-Ï·‰Ô ÂÈ‚Ú·‰‡ÓÂÈ ÙËÓ ·ÔÚÚfi-ÊËÛË ÙˆÓ ˘‰·Ù·ÓıÚ¿ÎˆÓ. Δ¤ÏÔ˜,ÂÚÂ˘ÓËÙ¤˜ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ ÙÔ·- ÏÈÔ˚Îfi ÔÍ‡, ˆ˜ ÈÛ¯˘Úfi ·ÓÙÈÔ-ÍÂÈ‰ˆÙÈÎfi, Î·ı˘ÛÙÂÚÂ› ÙÈ˜ ÂÈ-ÏÔÎ¤˜ ÙÔ˘ ‰È·‚‹ÙË Ì¤Ûˆ ÙË˜ÌÂ›ˆÛË˜ ÙË˜ ‰Ú¿ÛË˜ ÙˆÓAGEs(18).

™˘ÌÂÚ¿ÛÌ·Ù·

MÂ ‚¿ÛË Ù· ·Ú·¿Óˆ ÛÙÔÈ¯Â›·,Á›ÓÂÙ·È Û·Ê¤˜ fiÙÈ Ë ÌÂ›ˆÛË ÙˆÓAGEs Ô˘ Ï·Ì‚¿ÓÔÓÙ·È ·fi ÙÈ˜ÙÚÔÊ¤˜ ÌÔÚÂ› Ó· Á›ÓÂÈ ÌÂ 3 ÙÚfi-Ô˘˜: ·) ÙËÓ ÂÈÏÔÁ‹ ÙÚÔÊÒÓ ÌÂ

LAGE = 433,74 KU

¶ÚˆÈÓfi- 250 ml Á¿Ï· 0% (1 ÔÙ‹ÚÈ)- 30 ÁÚ. ÏÂ˘Îfi „ˆÌ›- 1 ÌÈÎÚfi Ì‹ÏÔ (100 ÁÚ)

‰ÂÎ·ÙÈ·Ófi- 150ÁÚ. Ì‹ÏÔ

ÌÂÛËÌÂÚÈ·Ófi- 60ÁÚ. ÎÔÙfiÔ˘ÏÔ ÛÙ‹ıÔ˜ ¯ˆÚ›˜ ¤ÙÛ·, ‚Ú·ÛÌ¤ÓÔ ÁÈ· 1 ÒÚ·

- 200ÁÚ. ·Ù¿ÙÂ˜ „ËÙ¤˜ ÁÈ· 45 ÏÂÙ¿ ÌÂ 10 ml ÂÏ·ÈÔÏ¿‰Ô (2 Î. ÙÔ˘ ÁÏ˘ÎÔ‡)- 200ÁÚ. Î·ÚfiÙ· ÛÙÔ ÁÎÚÈÏ

·ÔÁÂ˘Ì·ÙÈÓfi- 150ÁÚ Ì‹ÏÔ

‚Ú·‰ÈÓfi- 30ÁÚ. ÎÔÙfiÔ˘ÏÔ ÛÙ‹ıÔ˜ ¯ˆÚ›˜ ¤ÙÛ·, ‚Ú·ÛÌ¤ÓÔ ÁÈ· 1 ÒÚ·

- 200ÁÚ. ·Ù¿ÙÂ˜ „ËÙ¤˜ ÁÈ· 45 ÏÂÙ¿ ÌÂ 10 ml ÂÏ·ÈfiÏ·‰Ô (2 Î. ÙÔ˘ ÁÏ˘ÎÔ‡)

- 200ÁÚ. Î·ÚfiÙ· ÛÙÔ ÁÎÚÈÏ

HAGE = 1117 ∫U

¶ÚˆÈÓfi- 250 ml Á¿Ï· 0% (1 ÔÙ‹ÚÈ) ÛÙÔ ÊÔ‡ÚÓÔ ÌÈÎÚÔÎ˘Ì¿ÙˆÓ ÁÈ· 3 ÏÂÙ¿

- 30ÁÚ. „ˆÌ› ÊÚ˘Á·ÓÈÛÌ¤ÓÔ - 1 ÌÈÎÚfi Ì‹ÏÔ „ËÙfi ÛÙÔ ÊÔ‡ÚÓÔ

(100ÁÚ)

‰ÂÎ·ÙÈ·Ófi- 150ÁÚ. Ì‹ÏÔ „ËÙfi ÛÙÔ ÊÔ‡ÚÓÔ

ÌÂÛËÌÂÚÈ·Ófi- 60ÁÚ. ÎÔÙfiÔ˘ÏÔ ÛÙ‹ıÔ˜ ¯ˆÚ›˜ ¤ÙÛ·, ÙËÁ·ÓÈÙfi ÁÈ· 8 ÏÂÙ¿

- 200ÁÚ.·Ù¿ÙÂ˜ „ËÙ¤˜ ÁÈ· 1 ÒÚ·- 200ÁÚ. Î·ÚfiÙ· ÛÂ ÎÔÓÛ¤Ú‚·- 2 Î. ÙÔ˘ ÁÏ˘ÎÔ‡ ÂÏ·ÈfiÏ·‰Ô

·ÔÁÂ˘Ì·ÙÈÓfi- 150ÁÚ Ì‹ÏÔ „ËÙfi ÛÙÔ ÊÔ‡ÚÓÔ

‚Ú·‰ÈÓfi- 30ÁÚ. ÎÔÙfiÔ˘ÏÔ ÛÙ‹ıÔ˜ ¯ˆÚ›˜ ¤ÙÛ·, ÙËÁ·ÓÈÙfi ÁÈ· 8 ÏÂÙ¿

- 200ÁÚ. ÁÏ˘ÎÔ·Ù¿ÙÂ˜ „ËÙ¤˜ ÁÈ· 1 ÒÚ·

- 200ÁÚ. Î·ÚfiÙ· ÎÔÓÛ¤Ú‚·- 2 Î. ÙÔ˘ ÁÏ˘ÎÔ‡ ÂÏ·ÈfiÏ·‰Ô

¶›Ó·Î·˜ 2. ¢›·ÈÙ· ™¢- 1200 ∫cal (55% ˘‰·Ù.-17% ÚˆÙ.-28% Ï›Ô˜)

¢π∞Δƒ√º∏

31

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¯·ÌËÏ‹ ÂÚÈÂÎÙÈÎfiÙËÙ· ÛÂ AGEs,‚) ÙËÓ ·Ú·ÛÎÂ˘‹ ÁÂ˘Ì¿ÙˆÓ ÌÂÈÔ ˘ÁÈÂÈÓfi ÙÚfiÔ ÒÛÙÂ Ó· ÌÂÈˆ-ıÂ› Ë ·Ú·ÁˆÁ‹ AGEs Î·È Á) ÙËÏ‹„Ë ·ÓÙÈÔÍÂÈ‰ˆÙÈÎÒÓ Ô˘ÛÈÒÓ,·ÊÔ‡ Ë ÌÂ›ˆÛË ÙÔ˘ ÔÍÂÈ‰ˆÙÈÎÔ‡ÛÙÚÂ˜ ÂÈ‚Ú·‰‡ÓÂÈ ÙÔ Ú˘ıÌfi Û¯Ë-Ì·ÙÈÛÌÔ‡ AGEs. (19) ¢ÂÓ Û˘ÓÈ-ÛÙÒÓÙ·È ÂÈ‰ÈÎ¤˜ Î·È ÂÍ·ÓÙÏËÙÈÎ¤˜‰›·ÈÙÂ˜ ¤Ú·Ó ÙˆÓ Î·ıÈÂÚˆÌ¤ÓˆÓ‰È·ÈÙËÙÈÎÒÓ Û˘Ì‚Ô˘ÏÒÓ Ô˘ ‰›ÓÔ-ÓÙ·È ÛÂ Î¿ıÂ ‰È·‚ËÙÈÎfi ¿ÙÔÌÔ, ÁÂ-ÁÔÓfi˜ ÙÔ ÔÔ›Ô Î·ıÈÛÙ¿ ÙÈ˜ ‰È·È-ÙËÙÈÎ¤˜ ·ÚÂÌ‚¿ÛÂÈ˜ ÚÂ·ÏÈÛÙÈÎ¤˜Î·È ·˘Í¿ÓÂÈ ÙË Û˘ÌÌfiÚÊˆÛË ÙÔ˘·ÛıÂÓÔ‡˜. √È ÎÏÈÓÈÎÔ› È·ÙÚÔ› ı·Ú¤ÂÈ Ó· ÂÓı·ÚÚ‡ÓÔ˘Ó ÙÔ˘˜·ÛıÂÓÂ›˜ ÙÔ˘˜ Ó· Ï¿‚Ô˘Ó ÛÔ‚·Ú¿

˘fi„Ë Ù· AGEs, ÂÊfiÛÔÓ ÙÔ˘˜ÂÍËÁ‹ÛÔ˘Ó ÙË ıÂÙÈÎ‹ Û˘Û¯¤ÙÈÛËÙÔ˘˜ ÌÂ ÙË ‰È¿¯˘ÙË ·ıËÚˆÌ¿Ùˆ-ÛË ÙˆÓ ·ÚÙËÚÈÒÓ ÙÔ˘˜ ·ÓÂÍ¿ÚÙË-Ù· ·fi ÙË Ú‡ıÌÈÛË ÙÔ˘ ‰È·‚‹ÙË. ∏ Ê·ÚÌ·ÎÂ˘ÙÈÎ‹ ‚ÈÔÌË¯·Ó›· Ù·ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¤¯ÂÈ ·Ó·Î·Ï‡-„ÂÈ Î·È ÌÂÏÂÙ‹ÛÂÈ ·ÚÎÂÙ¿ Ê¿ÚÌ·-Î· Ô˘ ·Ô‚Ï¤Ô˘Ó ÛÙË ÌÂ›ˆÛËÙˆÓ ·Ú·ÁfiÌÂÓˆÓ AGEs, ÙËÓ·Ó·ÛÙÔÏ‹ Û‡Ó‰ÂÛË˜ ÙÔ˘˜ ÌÂ ÙÔÓ˘Ô‰Ô¯¤· ÙÔ˘˜ ÛÙ· Î‡ÙÙ·Ú· Î·ÈÙËÓ ‰È¿Û·ÛË ÙÔ˘˜ ÛÂ ·‰Ú·ÓÂ›˜Ô˘Û›Â˜, ·ÏÏ¿ Ì¤¯ÚÈ ÛÙÈÁÌ‹˜ ‰ÂÓ¤¯ÂÈ Ï¿‚ÂÈ ÔÚÈÛÙÈÎ‹ ¤ÁÎÚÈÛË Î˘-ÎÏÔÊÔÚ›·˜ Î¿ÔÈÔ Ê¿ÚÌ·ÎÔ, Ïfi-Áˆ ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ Ô˘ÂÌÊ¿ÓÈÛ·Ó ÛÙË Ê¿ÛË ÙˆÓ ÎÏÈÓÈ-

ÎÒÓ ÌÂÏÂÙÒÓ. Δ· ÌfiÓ· ·fi Ù· Î˘-ÎÏÔÊÔÚÔ‡ÓÙ· Ê¿ÚÌ·Î· Ô˘ ÂÓ-‰Â¯ÔÌ¤Óˆ˜ ÌÂÈÒÓÔ˘Ó Ù· AGEs Â›-Ó·È ÔÈ ·ÔÎÏÂÈÛÙ¤˜ ÙˆÓ ˘Ô‰Ô¯¤-ˆÓ ÙË˜ ·ÁÁÂÈÔÙÂÓÛ›ÓË˜ ππ, ÛÙ·Ï·›ÛÈ· ÙˆÓ ÏÂÈÔÙÚÔÈÎÒÓ ÙÔ˘˜‰Ú¿ÛÂˆÓ. ª¤¯ÚÈ Ó· Î˘ÎÏÔÊÔÚ‹-ÛÔ˘Ó ·ÛÊ·Ï‹ Ê¿ÚÌ·Î·, Ë ÂÈÏÔ-Á‹ ÌË ÂÂÍÂÚÁ·ÛÌ¤ÓˆÓ Î·È ¯·ÌË-ÏÒÓ ÛÂ AGEs ÙÚÔÊ›ÌˆÓ, ÙÔ Ì·ÁÂ›-ÚÂÌ· ÛÂ ·ÙÌfi, ‹ ÓÂÚfi Î·È ÙÔ „‹-ÛÈÌÔ ‹ ÙËÁ¿ÓÈÛÌ· ÙÚÔÊÒÓ ÛÂ ¯·-ÌËÏfiÙÂÚÂ˜ ıÂÚÌÔÎÚ·Û›Â˜ Î·È ÁÈ·fiÛÔ ÙÔ ‰˘Ó·Ùfi ÌÈÎÚfiÙÂÚÔ ¯ÚfiÓÔ,ÌÔÚÔ‡Ó Ó· Û˘Ì‚¿ÏÔ˘Ó -ÂÓ Ì¤-ÚÂÈ- ÛÙËÓ ÚfiÏË„Ë ÙˆÓ ·ÁÁÂÈ·-ÎÒÓ ÂÈÏÔÎÒÓ ÙÔ˘ ‰È·‚‹ÙË

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ΤΕΥΧΟΣ 16 ΔΕΚΕΜΒΡΙΟΣ 2007 - ΑΘΗΡΟΣΚΛΗΡΩΣΗ

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