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¶APA°ONTE™ KIN¢YNOY - ∂¶π¢∏ªπ√§√°π∞∂ȉËÌÈÔÏÔÁ›· ¢˘ÛÏÈȉ·ÈÌÈÒÓ Û ∂ÏÏËÓÈÎfi ¢Â›ÁÌ·Ø Ô ƒfiÏÔ˜ ∫ÔÈÓˆÓÈÎÔ‰ËÌÔÁÚ·ÊÈÎÒÓ Î·È ¢È·ÈÙËÙÈÎÒÓ ¶·Ú·ÁfiÓÙˆÓ Î·ıÒ˜ Î·È ÙÔ˘ ∆ÚfiÔ˘ ∑ˆ‹˜: Ë ªÂϤÙË ∞ÙÙÈ΋. ∫·Ù·ÓÔÌ‹ ÙˆÓ §Èȉ›ˆÓ ∞›Ì·ÙÔ˜ ÛÙËÓ ∂ÏÏ¿‰·

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∂π™∞°ø°∏∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ÔÏÏ¿ ÂÈ-ÛÙËÌÔÓÈο ‰Â‰Ô̤ӷ ÂÈ·ڈ۷ÓÙÔÓ ·ÚÓËÙÈÎfi ÚfiÏÔ Ù˘ ˘ÂÚ-/‰˘-ÛÏÈȉ·ÈÌ›·˜ ÛÙËÓ ·ıËÚÔÛÎÏËÚ˘-ÓÙÈ΋ ÓfiÛÔ. √È ÂȉËÌÈÔÏÔÁÈΤ˜·ÏÏ¿ Î·È ÔÈ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ ·Ô-Î¿Ï˘„·Ó, ·Ú¯Èο, ÙË Û¯¤ÛË Ù˘ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ Ì ÙÔÓ Î›Ó-‰˘ÓÔ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘, ÏfiÁˆÙ˘ ¢¯ÂÚÔ‡˜ ÌÂϤÙ˘ Ù˘ ÚÒ-Ù˘, Û ¤Ú¢Ó˜ ‰›Ô˘1. øÛÙfiÛÔ,ÙÒÚ· ϤÔÓ, ˘¿Ú¯ÂÈ ¤Ó·˜ ·ÍÈÔ-ÛËÌ›ˆÙÔ˜ fiÁÎÔ˜ ÏËÚÔÊoÚÈÒÓÛ¯ÂÙÈο Ì ÙËÓ Î·Ù·ÓÔÌ‹ Î·È ÚÔ-ÁÓˆÛÙÈ΋ ·Í›· Î·È ¿ÏÏˆÓ ÏÈȉ›ˆÓÙÔ˘ ·›Ì·ÙÔ˜ Î·È ÏÈÔÚˆÙÂ˚ÓÒÓÛÙË ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ1,4. ™Â ÙÔ‡ÙÔÙÔ ÛËÌ›Ô, Ú¤ÂÈ Ó· ÙÔÓÈÛÙ› fiÙÈ ËÈÛ¯‡˜ ÙˆÓ Û¯¤ÛÂˆÓ ÌÂٷ͇ ÏÈÈ-‰›ˆÓ ·›Ì·ÙÔ˜ Î·È ·ıËÚÔÛÎÏ‹Ú˘Ó-Û˘, Â›Ó·È ‰˘Ó·Ùfi Ó· ÂËÚ·ÛÙ›·fi ‰È¿ÊÔÚÔ˘˜ ¿ÏÏÔ˘˜ ·Ú¿ÁÔ-ÓÙ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ÂÓ Á¤ÓÂÈ ÌÂÙÔÓ ÙÚfiÔ ˙ˆ‹˜. ∏ ÌÂϤÙË Fra-mingham (Framingham Heart Stu-dy) ÚÒÙË ·Ó·ÎÔ›ÓˆÛ fiÙÈ Ë ‰È·-Ù·Ú·Á̤ÓË ·ÓÔ¯‹ ÛÙËÓ ÁÏ˘Îfi˙Ë,Ù· ›‰· Ù˘ ·ÚÙËÚȷ΋˜ ȤÛÂ-ˆ˜ Î·È ÙÔ Î¿ÓÈÛÌ· ÌÔÚÔ‡Ó Ó·ÙÚÔÔÔÈ‹ÛÔ˘Ó ÙËÓ Â›‰Ú·ÛË Ù˘¯ÔÏËÛÙÂÚfiÏ˘ ÛÙÔÓ ÛÙÂÊ·ÓÈ·›ÔΛӉ˘ÓÔ1. ∂ÈÚfiÛıÂÙ·, ÎÔÈÓˆÓÈÎÔ-ÔÈÎÔÓÔÌÈΤ˜ ÌÂϤÙ˜5 ÚÔÙ›ÓÔ˘ÓÌ›· ·Ó¿ÛÙÚÔÊË Û˘Û¯¤ÙÈÛË ÌÂٷ͇Ù˘ ÎÔÈÓˆÓÈ΋˜ ηٿÛÙ·Û˘ ηÈÙÔ˘ ‡„Ô˘˜ ÙˆÓ ‰È·ÊfiÚˆÓ ÏÈȉ›ˆÓ·›Ì·ÙÔ˜. ∂›Ó·È ›Û˘ ÁÓˆÛÙfi, fiÙȉȷÈÙËÙÈΤ˜ Ú·ÎÙÈΤ˜ Û¯ÂÙ›˙ÔÓÙ·ÈÈÛ¯˘Ú¿ ÙfiÛÔ Ì ÙË Û˘¯ÓfiÙËÙ· Ù˘‰˘ÛÏÈȉ·ÈÌ›·˜ fiÛÔ Î·È Ì ÙËÓ ·Ô-ÙÂÏÂÛÌ·ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ù˘1,6-7.°È· ·ÈÒÓ˜, ÔÈ ŒÏÏËÓ˜ ·ÎÔÏÔ˘-ıÔ‡Û·Ó ¤Ó· ·Ú·‰ÔÛÈ·Îfi ÚfiÙ˘-Ô ‰È·ÙÚÔÊ‹˜, ÙË «ªÂÛÔÁÂȷ΋¢È·ÙÚÔÊ‹»8,9. ¶·ÚfiÙÈ ÙÔ ‰È·ÙÚÔÊÈ-Îfi ·˘Ùfi ÚfiÙ˘Ô Û˘ÁΤÓÙÚˆÛ ÙÔ

ÂӉȷʤÚÔÓ ÙˆÓ ÌÂÏÂÙËÙÒÓ Ù· ÙÂ-ÏÂ˘Ù·›· ¯ÚfiÓÈ·10-12, Ë Û¯¤ÛË ÙÔ˘Ì ÙËÓ Û˘¯ÓfiÙËÙ· Î·È ÙËÓ ·ÓÙÈÌÂ-ÙÒÈÛË Ù˘ ‰˘ÛÏÈȉ·ÈÌ›·˜ ‰ÂÓ¤¯ÂÈ Ï‹Úˆ˜ ηٷÓÔËı›.

¢Â‰Ô̤Ó˘ Ù˘ ·Ô˘Û›·˜ Úfi-ÛÊ·ÙˆÓ ÛÙÔȯ›ˆÓ Û¯ÂÙÈο Ì ٷ›‰· ÏÈȉ·ÈÌ›·˜ ÛÙÔÓ ∂ÏÏËÓÈÎfiÏËı˘ÛÌfi, ‰ÈÂÚÂ˘Ó‹Û·Ì ÙËÓ Î·-Ù·ÓÔÌ‹ ÙˆÓ ÂȤ‰ˆÓ Ù˘ ÔÏÈ΋˜-,HDL-, LDL-, ÔÍÂȉˆÌ¤Ó˘ LDL ¯Ô-ÏËÛÙÂÚfiÏ˘, ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ηÈÏÈÔÚˆÙ½Ó˘ (·). ø˜ ÛÎÔfi ›¯·-Ì ›Û˘, ÙËÓ Î·Ù·ÁÚ·Ê‹ ÙˆÓ ıÂ-ڷ¢ÙÈÎÒÓ ¯ÂÈÚÈÛÌÒÓ Ù˘ ‰˘ÛÏÈ-ȉ·ÈÌ›·˜ Î·È ÙÔ˘ ÔÛÔÛÙÔ‡ ›-ÁÓˆÛ˘ ·˘Ù‹˜ ÛÂ Ù˘¯·›Ô ‰Â›ÁÌ·,ÂχıÂÚˆÓ Î·Ú‰È·ÁÁÂȷ΋˜ Ófi-ÛÔ˘, ÂÓËϛΈÓ. ∞ÎfiÌË, ÂÎÙÈÌ‹Û·ÌÂÙËÓ Û¯¤ÛË ÌÂٷ͇ Ù˘ Ù‹ÚËÛ˘ªÂÛÔÁÂȷ΋˜ ‰È·ÙÚÔÊ‹˜ Î·È ÙˆÓÂȤ‰ˆÓ ÏÈȉ›ˆÓ ·›Ì·ÙÔ˜, ηÙfi-ÈÓ ÂϤÁ¯Ô˘ ‰È·ÊfiÚˆÓ ÎÔÈÓˆÓÈÎÔ-‰ËÌÔÁÚ·ÊÈÎÒÓ Î·È Û¯ÂÙÈ˙fiÌÂÓˆÓÌ ÙÔÓ ÙÚfiÔ ˙ˆ‹˜ ·Ú·ÁfiÓÙˆÓ.

ª∂£√¢√π¶ÏËı˘ÛÌfi˜ Ù˘ ÌÂϤÙ˘ ∏ ÌÂϤÙË ‰ÈÂÍ‹¯ıË ÛÙÔ ÓÔÌfi ∞ÙÙÈ-΋˜ (78% Û ·ÛÙÈΤ˜ Î·È 22% Û·ÁÚÔÙÈΤ˜ ÂÚÈÔ¯¤˜). ∆Ô ‰Â›ÁÌ·‹Ù·Ó Ù˘¯·›Ô Ì ÔÏ˘ÛÙ·‰È·Î‹ ‰È·-ÛÙڈ̿وÛË Ô˘ ‚·Û›ÛÙËΠÛÙËÓηٷÓÔÌ‹ ËÏÈΛ·˜ - ʇÏÔ˘ ÙÔ˘ ¡Ô-ÌÔ‡ ∞ÙÙÈ΋˜, Û‡Ìʈӷ Ì ÛÙÔÈ-¯Â›· Ù˘ ∂ıÓÈ΋˜ ™Ù·ÙÈÛÙÈ΋˜ ÀË-ÚÂÛ›·˜ (·ÔÁÚ·Ê‹ ÙÔ˘ 2001). ∞fiÙÔÓ ª¿ÈÔ ÙÔ˘ 2001 ̤¯ÚÈ ÙÔÓ ∞‡-ÁÔ˘ÛÙÔ 2002, 3.355 οÙÔÈÎÔÈ ÂÈ-Ϥ¯ÙËÎ·Ó Ì ÙÚfiÔ Ù˘¯·›Ô ÁÈ· Ó·Û˘ÌÌÂÙ¿Û¯Ô˘Ó ÛÙË ÌÂϤÙË. ∞fi·˘ÙÔ‡˜, 2.282 fiÓÙˆ˜ Û˘ÌÊÒÓË-Û·Ó Ó· Ï¿‚Ô˘Ó Ì¤ÚÔ˜ (ÔÛÔÛÙfiÛ˘ÌÌÂÙÔ¯‹˜ 68%). ∂Î·È‰Â˘Ì¤ÓÔÚÔÛˆÈÎfi (ηډÈÔÏfiÁÔÈ, ‰È·ÈÙÔ-ÏfiÁÔÈ, ÓÔÛËÏÂ˘Ù¤˜) ¤Ï·‚Â Û˘ÓÂ-ÓÙ‡ÍÂȘ Ì ÙË ¯Ú‹ÛË Ù˘ÔÔÈË̤-

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√ ·ÚÈıÌfi˜ ÙˆÓ ·ÙfiÌˆÓ Â›Ó·ÈÈηÓfi˜ Ó· ÂÎÙÈÌ‹ÛÂÈ ‰È·ÊÔÚ¤˜ ·Ó¿-ÌÂÛ· ÛÙȘ ‰ÈÂÚ¢ÓÔ‡ÌÂÓ˜ ·Ú·-̤ÙÚÔ˘˜, ÌÂÁ·Ï‡ÙÂÚ˜ ÙÔ˘ 20%,ÂÈÙ˘Á¯¿ÓÔÓÙ·˜ ÛÙ·ÙÈÛÙÈ΋ ÈÛ¯‡>0,80 Î·È Â›Â‰Ô Èı·ÓfiÙËÙ·˜ <0,05 (ÙÈÌ‹ P).

¢È·ÙÚÔÊÈ΋ ·ÍÈÔÏfiÁËÛË ∏ ̤ÛË Î·Ù·Ó¿ÏˆÛË ÙˆÓ ‰È·Êfi-ÚˆÓ ÙÚÔÊ›ÌˆÓ ˘ÔÏÔÁ›ÛÙËΠ̂¿ÛË ¤Ó· ¤Á΢ÚÔ ÂÚˆÙËÌ·ÙÔÏfi-ÁÈÔ Û˘¯ÓfiÙËÙ·˜ ηٷӿψÛ˘ÙÚÔÊ›ÌˆÓ (FFQ).

°È· ÙËÓ Î·Ù·Ó¿ÏˆÛË ÙÚÔʛ̈ÓÔ˘ ÚÔÛÂÁÁ›˙Ô˘Ó ÙÔ ªÂÛÔÁÂÈ·Îfi‰È·ÙÚÔÊÈÎfi ÚfiÙ˘Ô, ‚·ıÌÔÏÔÁ‹-Û·Ì Ì 0 ÙËÓ Û¿ÓÈ· ‹ η̛· η-ٷӿψÛË ÙÔ˘˜, Ì 1 ÙËÓ Î·Ù·Ó¿-ψÛË ·fi 1 ¤ˆ˜ 4 ÊÔÚ¤˜ ÌËÓÈ·›-ˆ˜, Ì 2 ÙȘ 5 ¤ˆ˜ 8 ÊÔÚ¤˜ ÌËÓÈ·›-ˆ˜, Ì 3 ÙȘ 9 ¤ˆ˜ 12 ÊÔÚ¤˜ ·Ó¿Ì‹Ó·, Ì 4 ÙȘ 13 ¤ˆ˜ 18 ÊÔÚ¤˜·Ó¿ Ì‹Ó· Î·È Ì 5 ÙË Û¯Â‰fiÓ Î·ıË-ÌÂÚÈÓ‹ ηٷӿψÛË Î¿ı ̛·˜ ·fiÙȘ 11 ‚·ÛÈΤ˜ ÔÌ¿‰Â˜ ÙÚÔʛ̈ÓÙ˘ ÎÏ·ÛÛÈ΋˜ ˘Ú·Ì›‰·˜ ªÂ-ÛÔÁÂȷ΋˜ ‰È·ÙÚÔÊ‹˜. ŒÙÛÈ ÚÔ¤-΢„ ̛· ‚·ıÌÔÏÔÁ›· ·fi 0 ¤ˆ˜55. À„ËϤ˜ ÙÈ̤˜ ÛÙÔÓ ÚÔÙÂÈÓfiÌÂ-ÓÔ ›Ó·Î· ‚·ıÌÔÏÔÁ›·˜ ‰ÂÈÎÓ‡Ô˘Ó˘ÈÔı¤ÙËÛË Ù˘ ·Ú·‰ÔÛȷ΋˜ ªÂ-ÛÔÁÂȷ΋˜ ‰È·ÙÚÔÊ‹˜ (Ë ÔÔ›·,ÂÎÙfi˜ ÙˆÓ ¿ÏψÓ, ¯·Ú·ÎÙËÚ›˙ÂÙ·È·fi ̤ÙÚÈ· ηٷӿψÛË Ï›Ô˘˜Î·È ˘„ËÏfi ÏfiÁÔ ÌÔÓÔ·ÎfiÚÂÛÙˆÓÚÔ˜ ÎÔÚÂṲ̂ӷ Ï›Ë), ÂÓÒ ¯·ÌË-ÏfiÙÂÚ˜ ÙÈ̤˜ Â›Ó·È ÂÓ‰ÂÈÎÙÈΤ˜ÌÈ·˜ «¢˘ÙÈÎÔ‡ Ù‡Ô˘» ‰È·ÙÚÔÊ‹˜.

¢ËÌÔÁÚ·ÊÈο, ÎÏÈÓÈο ηÈÛ¯ÂÙÈ˙fiÌÂÓ· Ì ÙÔÓ ÙÚfiÔ˙ˆ‹˜ ¯·Ú·ÎÙËÚÈÛÙÈο ∆Ô ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Ù˘ ·ÚÔ‡-Û·˜ ÌÂϤÙ˘, ÂÎÙfi˜ ÙˆÓ ¿ÏψÓ,ÂÚÈÂÏ¿Ì‚·Ó ‰ËÌÔÁÚ·ÊÈο ¯·-

·ıËÚÔÛÎÏ‹ÚˆÛË¢∂∫∂ªµƒπ√™ 2005

4

∂ȉËÌÈÔÏÔÁ›· ¢˘ÛÏÈȉ·ÈÌÈÒÓ Û ∂ÏÏËÓÈÎfi ¢Â›ÁÌ·Ø Ô ƒfiÏÔ˜ ∫ÔÈÓˆÓÈÎÔ‰ËÌÔÁÚ·ÊÈÎÒÓ Î·È

¢È·ÈÙËÙÈÎÒÓ ¶·Ú·ÁfiÓÙˆÓ Î·ıÒ˜ Î·È ÙÔ˘ ∆ÚfiÔ˘∑ˆ‹˜: Ë ªÂϤÙË ∞ÙÙÈ΋

∫·Ù·ÓÔÌ‹ ÙˆÓ §Èȉ›ˆÓ ∞›Ì·ÙÔ˜ ÛÙËÓ ∂ÏÏ¿‰·

¡. ∆˙‹Ì·1, Ã. ¶›ÙÛ·‚Ô˜2, ¢. ¶·Ó·ÁȈٿÎÔ˜1, Ã. ÃÚ˘ÛÔ¯fiÔ˘2, π. ™Îԇ̷˜2, ∂˘. ¶ÔÏ˘¯ÚÔÓfiÔ˘ÏÔ˜1, ∞. ∑·Ì¤Ï·˜1, Ã. ™ÙÂÊ·Ó¿‰Ë˜2

1. ∆Ì‹Ì· ∂ÈÛÙ‹Ì˘ ¢È·ÈÙÔÏÔÁ›·˜ Î·È ¢È·ÙÚÔÊ‹˜, ÷ÚÔÎfiÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ, ∞ı‹Ó·2. 1Ë ¶·ÓÂÈÛÙËÌȷ΋ ∫·Ú‰ÈÔÏÔÁÈ΋ ∫ÏÈÓÈ΋, π·ÙÚÈ΋ ™¯ÔÏ‹ ∂ıÓÈÎÔ‡ Î·È ∫·Ô‰ÈÛÙÚÈ·ÎÔ‡ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ

Ú·ÎÙËÚÈÛÙÈο fiˆ˜, ʇÏÔ, ËÏÈΛ·,ÔÈÎÔÓÔÌÈ΋ ηٿÛÙ·ÛË (̤ÛÔ ÂÙ‹-ÛÈÔ ÂÈÛfi‰ËÌ· ηٿ ÙËÓ ÙÂÏÂ˘Ù·›·ÙÚÈÂÙ›·), ÙÔ ÌÔÚʈÙÈÎfi ›‰ÔÎ·È ÙÔ Î¿ÓÈÛÌ·.

∏ Ê˘ÛÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ·ÚÔÛ‰ÈÔÚ›ÛÙËΠˆ˜ ¯ÚfiÓÔ˜ ·ÊÈÂ-ڈ̤ÓÔ˜ Û ‰Ú·ÛÙËÚÈfiÙËÙ· ÔÚÈ-Ṳ̂Ó˘ ¤ÓÙ·Û˘ Î·È ‰È¿ÚÎÂÈ·˜. √‰Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ ˘ÔÏÔÁ›-ÛÙËΠˆ˜ ‚¿ÚÔ˜ (Û ¯ÈÏÈfiÁÚ·Ì-Ì·) ‰È· ‡„Ô˜ (Û ̤ÙÚ·)2. ø˜ ·-¯˘Û·ÚΛ· ÔÚ›ÛÙËΠ‰Â›ÎÙ˘ Ì¿-˙·˜ ÛÒÌ·ÙÔ˜ ÌÂÁ·Ï‡ÙÂÚÔ˜ ÙÔ˘ >29,9 Kg/m2.

∏ ·ÚÙËÚȷ΋ ›ÂÛË ÌÂÙÚ‹ıËÎÂÙÚÂȘ ÊÔÚ¤˜ ÛÙÔ ‰ÂÍÈfi ¿Óˆ ¿ÎÚÔ.√È ·ÛıÂÓ›˜ Ì ̤۷ ›‰· ·Ú-ÙËÚȷ΋˜ ȤÛˆ˜ ›Û· ‹ ÌÂÁ·Ï‡-ÙÂÚ· Ì 140/90 mm Hg ηıÒ˜ ηÈÂΛÓÔÈ ˘fi ·ÓÙÈ˘ÂÚÙ·ÛÈ΋ ·Áˆ-Á‹ ηٷٿ¯ıËÎ·Ó ÛÙÔ˘˜ ˘ÂÚÙ·-ÛÈÎÔ‡˜. ø˜ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·ÔÚ›ÛÙËÎ·Ó Â›Â‰· ÔÏÈ΋˜ ¯ÔÏË-ÛÙÂÚfiÏ˘ ÔÚÔ‡ ÌÂÁ·Ï‡ÙÂÚ· ÙˆÓ220 mg/dl ‹ Ë ¯Ú‹ÛË ˘ÔÏÈȉ·È-ÌÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÂÓÒ ˆ˜ Û·Î-¯·Ú҉˘ ‰È·‚‹Ù˘, Ë ÁÏ˘Îfi˙Ë ·›-Ì·ÙÔ˜ ÓËÛÙ›·˜ > 125 mg/dl η-ıÒ˜ Î·È Ë ¯Ú‹ÛË ·ÓÙȉȷ‚ËÙÈ΋˜(‰È·ÈÙËÙÈ΋˜ ‹ Ê·Ú̷΢ÙÈ΋˜)·ÁˆÁ‹˜. ¶ÂÚ·ÈÙ¤Úˆ ÏÂÙÔ̤ÚÂÈÂ˜Ô˘ ·ÊÔÚÔ‡Ó ÙÔ˘˜ ÛÎÔÔ‡˜ ηÈÙÔÓ Û¯Â‰È·ÛÌfi Ù˘ ÌÂϤÙ˘∞∆∆π∫∏, ¤¯Ô˘Ó ‹‰Ë ·ÚÔ˘ÛÈ·ÛÙ›·ÏÏÔ‡11,15.

™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ŸÏ˜ ÔÈ ·Ó·ÊÂÚfiÌÂÓ˜ ÙÈ̤˜ P‚·Û›ÛÙËÎ·Ó Û ‰ÔÎÈ̷ۛ˜ ‰ÈÏ‹˜Î·Ù‡ı˘ÓÛ˘ Î·È Û˘ÁÎÚ›ıËÎ·Ó ÌÂÂ›Â‰Ô ÛËÌ·ÓÙÈÎfiÙËÙ·˜ 5%. °È·fiÏÔ˘˜ ÙÔ˘˜ ÛÙ·ÙÈÛÙÈÎÔ‡˜ ˘ÔÏÔ-ÁÈÛÌÔ‡˜ ¯ÚËÛÈÌÔÔÈ‹ıËΠÙÔ ÛÙ·-ÙÈÛÙÈÎfi ·Î¤ÙÔ SPSS 11.0 soft-ware (SPSS Inc. 2002, Illinois,USA).

∞¶√∆∂§∂™ª∞∆∞¢ËÌÔÁÚ·ÊÈο, ÎÏÈÓÈο Î·È Û˘ÌÂÚÈ-ÊÔÚÈÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓÛ˘ÌÌÂÙ¯fiÓÙˆÓ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·ÈÛÙÔÓ ¶›Ó·Î· 1.

∫·Ù·ÓÔÌ‹ ÏÈȉ›ˆÓ ·›Ì·ÙÔ˜ √È Ì¤Û˜ ÙÈ̤˜ ÙˆÓ ‰ÈÂÚ¢ÓÔ‡ÌÂ-ÓˆÓ ÏÈȉ›ˆÓ ·›Ì·ÙÔ˜ ηıÒ˜ ηÈÙ· ÔÛÔÛÙ¿ ·ıÔÏÔÁÈÎÒÓ ÂȤ-‰ˆÓ ÙÔ˘˜ Û ¿Ó‰Ú˜ Î·È Á˘Ó·›Î˜·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2.™˘ÌÏËڈ̷ÙÈο Û ·˘Ù¤˜ ÙȘÏËÚÔÊÔڛ˜, ÙÔ 5% ÙˆÓ ·Ó‰ÚÒÓÎ·È ÙÔ 13% ÙˆÓ Á˘Ó·ÈÎÒÓ Â›¯·Ó›‰· ¯ÔÏËÛÙÂÚfiÏ˘ ¿Óˆ ·fi240 mg/dl. Ÿˆ˜ ‹Ù·Ó ·Ó·ÌÂÓfi-

ÌÂÓÔ, fiÙ·Ó ÂÛÙÈ¿Û·Ì ÙËÓ ·Ó¿Ï˘-Û‹ Ì·˜ Û ÌÂÁ·Ï‡ÙÂÚ˜ ËÏÈ˘(>50 ÂÙÒÓ) ·Ú·ÙËÚ‹Û·Ì fiÙÈ ÙÔ48% ÙˆÓ ·Ó‰ÚÒÓ Î·È ÙÔ 55% ÙˆÓÁ˘Ó·ÈÎÒÓ Â›¯·Ó ›‰· ÔÏÈ΋˜¯ÔÏËÛÙÂÚfiÏ˘ >200 mg/dl (Ù··ÔÙÂϤÛÌ·Ù· ·˘Ù¿ ‰ÂÓ ·ÚÔ˘-ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2). ¶·Úfi-ÌÔÈ· Ì ٷ ·ÔÙÂϤÛÌ·Ù· Ù˘ ÔÏÈ-΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ ‹Ù·Ó Î·È Ù˘HDL – ¯ÔÏËÛÙÂÚfiÏ˘ (¶›Ó·Î·˜ 2).¶·Ú·ÙËÚ‹Û·ÌÂ, ·ÎfiÌË, fiÙÈ ÙÔ21% ÙˆÓ ·Ó‰ÚÒÓ Î·È ÙÔ 7% ÙˆÓÁ˘Ó·ÈÎÒÓ Â›¯·Ó Ôχ ¯·ÌËÏ‹ HDL– ¯ÔÏËÛÙÂÚfiÏË (<35 mg/dl). ª›·ÔÌ¿‰· Ì ȉȷ›ÙÂÚÔ ÂӉȷʤÚÔÓÂ›Ó·È ·˘Ù‹ ÙˆÓ ·ÙfiÌˆÓ ÌÂ Ê˘ÛÈÔ-ÏÔÁÈ΋ ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË ·ÏÏ¿¯·ÌËÏ‹ HDL ¯ÔÏËÛÙÂÚfiÏË. ™ÙÔÓÏËı˘ÛÌfi Ì·˜, 19% ÙˆÓ ·Ó‰ÚÒÓÎ·È 12% ÙˆÓ Á˘Ó·ÈÎÒÓ Ô˘ ›¯·ÓÊ˘ÛÈÔÏÔÁÈο ›‰· ÔÏÈ΋˜ ¯Ô-ÏËÛÙÂÚfiÏ˘ (ÁÈ· ÙËÓ ·ÎÚ›‚ÂÈ· <200 mg/dl) ›¯·Ó ›‰· HDL ¯Ô-ÏËÛÙÂÚfiÏ˘ ÌÈÎÚfiÙÂÚ· ÙˆÓ 35 ηÈ45 mg/dl, ·ÓÙ›ÛÙÔȯ·. ∆¤ÏÔ˜, ÙÔ52% ÙˆÓ ·Ó‰ÚÒÓ Î·È 48% ÙˆÓ Á˘-Ó·ÈÎÒÓ Â›¯·Ó ›‰· LDL ¯ÔÏË-ÛÙÂÚfiÏ˘ ÌÂÁ·Ï‡ÙÂÚ· ·fi 130mg/dl (Ù· ·ÔÙÂϤÛÌ·Ù· ·˘Ù¿ ‰ÂÓ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2).

∂›Ó·È ÁÓˆÛÙfi ˆ˜ Ë ËÏÈΛ· ›-Ó·È ¤Ó·˜ ·Ú¿ÁÔÓÙ·˜ Ô˘ Û¯ÂÙ›-˙ÂÙ·È Î·ÏÒ˜ Ì ٷ ›‰· ÏÈÈ-‰›ˆÓ ·›Ì·ÙÔ˜. ™ÙË ÌÂϤÙË Ì·˜, ËËÏÈΛ· Û¯ÂÙ›ÛÙËΠıÂÙÈο Û ÛÙ·ÙÈ-ÛÙÈο ÛËÌ·ÓÙÈÎfi ‚·ıÌfi Ì ÙȘ ÌÂ-ÙÚ‹ÛÂȘ fiÏˆÓ ÙˆÓ ÏÈȉ›ˆÓ ·›Ì·-ÙÔ˜, ÙfiÛÔ ÛÙÔ˘˜ ¿Ó‰Ú˜ fiÛÔ Î·ÈÛÙȘ Á˘Ó·›Î˜, Ì ÂÍ·›ÚÂÛË ÙȘ ÌÂ-ÙÚ‹ÛÂȘ ÙˆÓ ÂȤ‰ˆÓ Ù˘ HDL-¯ÔÏËÛÙÂÚfiÏ˘ (∂ÈÎfiÓ· 1). ŒÙÛÈ,

ÏÔÈfiÓ, ÂÂÎÙ›ӷÌ ٷ Â˘Ú‹Ì·Ù¿Ì·˜ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·˜ ÙËÓ Î·Ù·ÓÔ-Ì‹ ÙˆÓ ‰ÈÂÚ¢ÓÔ‡ÌÂÓˆÓ ÏÈȉ›ˆÓ·›Ì·ÙÔ˜, ÌÂÙ¿ ·fi ÚÔÛ·ÚÌÔÁ‹ÁÈ· ÙËÓ ËÏÈΛ· Î·È ·ÊÔ‡ ÂϤÁÍ·ÌÂÁÈ· ¿ÏÏÔ˘˜ ÂӉ¯fiÌÂÓÔ˘˜ Û˘Á¯˘-ÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ô˘ Û¯ÂÙ›˙Ô-ÓÙ·È Ì ÙËÓ ËÏÈΛ·, fiˆ˜ ÙÔ Ê‡ÏÔ,ÙÔ Î¿ÓÈÛÌ·, ÙÔ Â›Â‰Ô Ê˘ÛÈ΋˜‰Ú·ÛÙËÚÈfiÙËÙ·˜ Î·È ÙË ‚·ıÌÔÏÔ-Á›·, ÙË Û¯ÂÙÈ΋ Ì ÙËÓ Ù‹ÚËÛË Ù˘ªÂÛÔÁÂȷ΋˜ ‰È·ÙÚÔÊ‹˜). (∆··ÔÙÂϤÛÌ·Ù· ‰ÂÓ ·ÚÔ˘ÛÈ¿˙Ô-ÓÙ·È Û ¶›Ó·Î˜ ‹ ∂ÈÎfiÓ˜). ¶·Ú·-ÙËÚ‹Û·Ì ˆ˜ Ë ÚfiÛıÂÛË Ì›·˜‰ÂηÂÙ›·˜ ÛÙËÓ ËÏÈΛ·, Û¯ÂÙÈ˙fiÙ·ÓÌ ›‰· ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘˘„ËÏfiÙÂÚ· ηٿ 9 mg/dl (95%‰È·ÛÙ‹Ì·Ù· ÂÌÈÛÙÔÛ‡Ó˘ (CI) 8 -11 mg/dl, p < 0,001), Ì ›‰·ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ˘„ËÏfiÙÂÚ· ηٿ13 mg/dl (95% CI: 11-16 mg/dl, p< 0,001), Ì ›‰· LDL ¯ÔÏË-ÛÙÂÚfiÏ˘ ˘„ËÏfiÙÂÚ· ηٿ 7 mg/dl (95% CI:5 - 9 mg/dl, p < 0,001),Ì ›‰· ÏÈÔÚˆÙ½Ó˘ (·)˘„ËÏfiÙÂÚ· ηٿ 1,2 mg/dl (95%CI: 0,2-1,9 mg/dl, p < 0,001), ÂÓÒÌ ›‰· HDL ¯ÔÏËÛÙÂÚfiÏ˘¯·ÌËÏfiÙÂÚ· ÌfiÓÔ Î·Ù¿ 0,02(95% CI: -0,1 - 0,2 mg/dl, p =0,352, ÂÔ̤ӈ˜, ·ÔÙ¤ÏÂÛÌ· ÌËÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈÎfi).

∂ÊfiÛÔÓ ·ÚÎÂÙÔ› ÂÚ¢ÓËÙ¤˜ÈÛ¯˘Ú›˙ÔÓÙ·È fiÙÈ Ë ÎÔÈÓˆÓÈ΋ ηٿ-ÛÙ·ÛË Âȉڿ ÛÙ· ›‰· ÏÈÈ-‰·ÈÌ›·˜, ·ÍÈÔÏÔÁ‹Û·Ì ÙËÓ Î·Ù·-ÓÔÌ‹ ÙˆÓ ÏÈȉ›ˆÓ Û ۯ¤ÛË Ì ÙÔÌÔÚʈÙÈÎfi ›‰Ô, ˆ˜ ÂÎÙÈÌËÙ‹ÙÔ˘ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎÔ‡ ÂȤ-‰Ô˘ ÙˆÓ Û˘ÌÌÂÙ¯fiÓÙˆÓ. ¢È·È-ÛÙÒÛ·Ì fiÙÈ Ë ÌfiÓË Û˘Û¯¤ÙÈÛË

¶∞ƒ∞°√¡∆∂™ ∫π¡¢À¡√À – E¶π¢∏ªπ√§√°π∞

5

¶›Ó·Î·˜ 1: ÷ڷÎÙËÚÈÛÙÈο Û˘ÌÌÂÙ¯fiÓÙˆÓ ÛÙË ÌÂϤÙË (% ηٿ ʇÏÔ)

ÕÓ‰Ú˜ °˘Ó·›Î˜ P(1.128 ‹ 49%) (1.154 ‹ 51%)

∏ÏÈΛ· (¤ÙË) 47 ± 18 47 ± 13 0,197ªÔÚʈÙÈÎfi Â›Â‰Ô 0,098

ñ ¯·ÌËÏfi 245 (22%) 290 (25%)ñ ̤ÛÔ 429 (38%) 440 (38%)ñ ˘„ËÏfi 454 (40%) 424 (37%)

∫¿ÓÈÛÌ· < 0,001ñ √˘‰¤ÔÙ ηÓÈÛÙ‹˜ 357 (32%) 638 (55%)ñ ∫·ÓÈÛÙ‹˜ 544 (48%) 441 (38%)ñ ¶ÚÒËÓ Î·ÓÈÛÙ‹˜ 227 (20%) 75 (7%)

∂›Â‰Ô Ê˘ÛÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ 0,003ñ ∫·ıÈÛÙÈ΋ ˙ˆ‹ 664 (59%) 722 (63%)ñ ◊È· ‹ ̤ÙÚÈ· 234 (21%) 177 (15%)ñ ŒÓÙÔÓË 230 (20%) 255 (22%)

∞ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË 431 (38%) 276 (24%) < 0,001™·Î¯·Ú҉˘ ‰È·‚‹Ù˘ 107 (10%) 82 (7%) 0,039¶·¯˘Û·ÚΛ· 272 (25%) 194 (17%) < 0,001¢È·ÙÚÔÊÈ΋ ‚·ıÌÔÏÔÁ›· (∂‡ÚÔ˜: 0 – 55) 35 ± 12 37 ± 12 < 0,001∫·Ù·Ó¿ÏˆÛË ·ÏÎÔfiÏ (ml/d) 220 ± 55 90 ± 40 < 0,001

Ô˘ ·Ú¤ÌÂÓ ıÂÙÈ΋ Î·È ÛÙ·ÙÈÛÙÈ-ο ÛËÌ·ÓÙÈ΋, ÌÂÙ¿ ·fi ¤ÏÂÁ¯ÔÁÈ· ‰È¿ÊÔÚÔ˘˜ ‰˘ÓËÙÈÎÔ‡˜ Û˘Á-¯˘ÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ fiˆ˜ Ë ËÏÈ-Λ·, ÙÔ Ê‡ÏÔ, Ô ‰Â›ÎÙ˘ Ì¿˙·˜ ÛÒ-Ì·ÙÔ˜, Ù· ›‰· Ê˘ÛÈ΋˜ ‰Ú·-ÛÙËÚÈfiÙËÙ·˜, ÔÈ Î·ÓÈÛÙÈΤ˜ ηȉȷÈÙËÙÈΤ˜ Û˘Ó‹ıÂȘ, ‹Ù·Ó ·˘Ù‹ÙˆÓ ÂȤ‰ˆÓ HDL ¯ÔÏËÛÙÂÚfiÏ˘Ì ÙÔ ÌÔÚʈÙÈÎfi ›‰Ô. (T·ÛÙÔȯ›· ‰ÂÓ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Û¶›Ó·Î˜). ™˘ÁÎÂÎÚÈ̤ӷ, Ë ÔÌ¿‰·Ì ÙÔ ˘„ËÏfiÙÂÚÔ ÌÔÚʈÙÈÎfi ›-Â‰Ô Â›¯Â ηٿ ̤ÛÔ fiÚÔ ÙÈ̤˜HDL ¯ÔÏËÛÙÂÚfiÏË ˘„ËÏfiÙÂÚ˜,Û˘ÁÎÚÈÓfiÌÂÓË Ì ÙËÓ ÔÌ¿‰· ÙˆÓ·ÙfiÌˆÓ ¯·ÌËÏÔ‡ ÌÔÚʈÙÈÎÔ‡ ÂÈ-¤‰Ô˘, ηٿ 2 mg/dl (95% CI: 0,7- 3,3 mg/dl, p = 0,04). ¢ÂÓ ·Ú·-ÙËÚ‹ıËÎ·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜Û¯¤ÛÂȘ ·Ó¿ÌÂÛ· ÛÙ· ÏÈ›‰È· ÙÔ˘·›Ì·ÙÔ˜ Î·È ÙÔ ÂÈÛfi‰ËÌ· ÙˆÓ Û˘Ì-ÌÂÙ¯fiÓÙˆÓ.

∆¤ÏÔ˜, ›¯·Ì ˆ˜ ÛÎÔfi ηÈÙËÓ ÂÎÙ›ÌËÛË Ù˘ ηٷÓÔÌ‹˜ ÙˆÓÙÈÌÒÓ ÙˆÓ ÏÈȉ›ˆÓ ÙÔ˘ ·›Ì·ÙÔ˜ ÛÂÛ¯¤ÛË Ì ÙÔ Â›Â‰Ô Ê˘ÛÈ΋˜ ‰Ú·-ÛÙËÚÈfiÙËÙ·˜ Î·È Ì ÙÔ ‰Â›ÎÙË Ì¿-˙·˜ ÛÒÌ·ÙÔ˜ ÙˆÓ Û˘ÌÌÂÙ¯fiÓÙˆÓ.øÛÙfiÛÔ, Ì ÂÍ·›ÚÂÛË Ù· ›‰·Ù˘ HDL ÛÙȘ Á˘Ó·›Î˜ - fiÔ˘ ÔÈÊ˘ÛÈÎÒ˜ ‰Ú·ÛÙ‹ÚȘ ›¯·Ó ηٿ̤ÛÔ fiÚÔ ÙÈ̤˜ ˘„ËÏfiÙÂÚ˜ ηٿ4 mg/dl Û ۯ¤ÛË Ì ·˘Ù¤˜ Ô˘‰È‹Á·Ó ηıÈÛÙÈ΋ ˙ˆ‹ (p = 0,024),η̛· ¿ÏÏË ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ۯ¤ÛË ‰ÂÓ ‰È·ÈÛÙÒıËΠ·Ó¿ÌÂÛ·ÛÙ· ÏÈ›‰È· ÙÔ˘ ·›Ì·ÙÔ˜ Î·È ÛÙËÊ˘ÛÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ·, ÌÂÙ¿ ·fi¤ÏÂÁ¯Ô ÁÈ· ÙËÓ ËÏÈΛ· Î·È ÙÔÓ ‰Â›-ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜ ÙˆÓ Û˘ÌÌÂÙÂ-¯fiÓÙˆÓ. ∂ÈϤÔÓ, Û˘ÁÎÚÈÓfiÌÂÓÔÈ

Ì ÙÔ˘˜ Ê˘ÛÈÔÏÔÁÈÎÔ‡˜ Î·È ÙÔ˘˜˘¤Ú‚·ÚÔ˘˜, ÔÈ ·¯‡Û·ÚÎÔÈ Û˘Ì-ÌÂÙ¤¯ÔÓÙ˜ ›¯·Ó ηٿ ̤ÛÔ fiÚÔ˘„ËÏfiÙÂÚ· ÙÚÈÁÏ˘ÎÂÚ›‰È· ηٿ 25mg/dl (p < 0,001) Î·È ¯·ÌËÏfiÙÂڷ›‰· HDL ηٿ 4 mg/dl (p <0,001), ÌÂÙ¿ ·fi ¤ÏÂÁ¯Ô ÁÈ· ÙËÓËÏÈΛ·, ÙÔ Ê‡ÏÔ, ÙÔ Â›Â‰Ô Ê˘ÛÈ-΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜, ÙȘ ‰È·ÈÙËÙÈ-Τ˜ Î·È ÙȘ ηÓÈÛÙÈΤ˜ Û˘Ó‹ıÂȘ.ŸÛÔÓ ·ÊÔÚ¿ Ù· ›‰· ÏÈȉ›ˆÓ·›Ì·ÙÔ˜ Û ۯ¤ÛË Ì ÙÔÓ ‰Â›ÎÙËÌ¿˙·˜ ÛÒÌ·ÙÔ˜, η̛· ÛËÌ·ÓÙÈ΋ۯ¤ÛË ‰ÂÓ ÛËÌÂÈÒıËÎÂ, ÌÂÙ¿ ·fiÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ ÚÔ·Ó·ÊÂÚfiÌÂ-ÓˆÓ Û˘Á¯˘ÛÙÒÓ.

£Âڷ¢ÙÈÎÔ› ¯ÂÈÚÈÛÌÔ› Ù˘‰˘ÛÏÈȉ·ÈÌ›·˜ ∞fi ÂΛÓÔ˘˜ Ì ÁÓˆÛÙ¤˜ ‰È·Ù·-Ú·¯¤˜ ÏÈȉ›ˆÓ (‰ËÏ·‰‹, 240 ¿Ó-‰Ú˜ Î·È 280 Á˘Ó·›Î˜), ÙÔ 36%ÙˆÓ ·Ó‰ÚÒÓ Î·È ÙÔ 33% ÙˆÓ Á˘-Ó·ÈÎÒÓ ·ÎÔÏÔ˘ıÔ‡Û·Ó ÌfiÓÔ ‰È·È-ÙËÙÈ΋ ·ÁˆÁ‹ ÂÓÒ ÙÔ 31% ÙˆÓ ·Ó-‰ÚÒÓ Î·È ÙÔ 20% ÙˆÓ Á˘Ó·ÈÎÒÓ‚Ú›ÛÎÔÓÙ·Ó ˘fi Û˘ÌÏËڈ̷ÙÈ΋ʷÚ̷΢ÙÈ΋ ·ÁˆÁ‹. ŒÙÛÈ, ÏÔÈ-fiÓ, 33% ÙˆÓ ·Ó‰ÚÒÓ Î·È 47%ÙˆÓ Á˘Ó·ÈÎÒÓ Ì ÁÓˆÛÙ¤˜ ‰È·Ù·-Ú·¯¤˜ ÏÈȉ›ˆÓ ‰ÂÓ ÂÏ¿Ì‚·Ó Ԣ-‰ÂÌ›· ·ÁˆÁ‹ (‰È·ÈÙËÙÈ΋ ‹ Ê·ÚÌ·-΢ÙÈ΋). ÕÏψÛÙÂ, ·fi ÂΛÓÔ˘˜Ô˘ ‚Ú¤ıËΠӷ ¤¯Ô˘Ó ·ıÔÏÔÁÈ-ο ›‰· ÔÏÈ΋˜ ‹ LDL ¯ÔÏË-ÛÙÂÚfiÏ˘, ηٿ ÙËÓ Û˘Ó¤ÓÙ¢ÍË,ÙÔ 40% ÙˆÓ ·Ó‰ÚÒÓ Î·È ÙÔ 30%ÙˆÓ Á˘Ó·ÈÎÒÓ ·Ó¤ÊÂÚ·Ó ˆ˜ ‰ÂÓ›¯·Ó ›ÁÓˆÛË ·˘Ù‹˜ ÙÔ˘˜ Ù˘ηٿÛÙ·Û˘ Î·È ˆ˜ ÔÙ¤ ÚÔË-ÁÔ˘Ì¤Óˆ˜ ‰ÂÓ Â›¯·Ó ÌÂÙÚ‹ÛÂÈ Ù·Â›Â‰· ÙˆÓ ÏÈȉ›ˆÓ ÛÙÔ ·›Ì·

ÙÔ˘˜. ∂ÈϤÔÓ, Ù· ¿ÙÔÌ· Ô˘ÁÓÒÚÈ˙·Ó fiÙÈ Ù· ›‰· ÙˆÓ ÏÈÈ-‰›ˆÓ ÛÙÔ ·›Ì· ÙÔ˘˜ ‹Ù·Ó ·ıÔÏÔ-ÁÈο, ˆÛÙfiÛÔ ‰ÂÓ ÂÏ¿Ì‚·Ó·Ó ÁÈ’·˘Ùfi Ô˘‰ÂÌ›· ·ÁˆÁ‹, ‹Ù·Ó ¯·ÌË-ÏfiÙÂÚÔ˘ ÌÔÚʈÙÈÎÔ‡ ›‰ԢÛ ۇÁÎÚÈÛË Ì ·˘ÙÔ‡˜ Ô˘ ‚Ú›-ÛÎÔÓÙ·Ó ˘fi ‰È·ÈÙËÙÈ΋ ‹ Ê·ÚÌ·-΢ÙÈ΋ ·ÁˆÁ‹ (10 ± 4 ¤Ó·ÓÙÈ 12± 4 ÂÙÒÓ Âη›‰Â˘Û˘, p <0,001).

√È ÛÙ·Ù›Ó˜ ‹Ù·Ó ÔÈ Î‡ÚÈÔÈ ˘Ô-ÏÈȉ·ÈÌÈÎÔ› ·Ú¿ÁÔÓÙ˜ (55%ÂÏ¿Ì‚·Ó ·ÙÔÚ‚·ÛÙ·Ù›ÓË, 15%Ú·‚·ÛÙ·Ù›ÓË, 12% ÛÈÌ‚·ÛÙ·Ù›ÓËÎ·È 10% οÔÈÔ ¿ÏÏÔ Â›‰Ô˜ ÛÙ·Ù›-Ó˘), ·ÎÔÏÔ˘ıÔ‡ÌÂÓ˜ ·fi ÙȘ ÊÈ-ÌÚ¿Ù˜ (7%) Î·È ¿ÏÏ· ˘ÔÏÈȉ·È-ÌÈο Ê¿Ú̷η (≈1%). ∂ÓÙÔ‡ÙÔȘ,ÌfiÓÔ ÙÔ 49% ÙˆÓ ·Ó‰ÚÒÓ Î·È ÙÔ51% ÙˆÓ Á˘Ó·ÈÎÒÓ ˘fi Ê·Ú̷΢-ÙÈ΋ ·ÁˆÁ‹, ›¯·Ó Ù· ÂÈı˘ÌËٿ›‰· ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ (<200 mg/dl), ηٿ ÙË Û˘Ó¤ÓÙ¢ÍË.

§È›‰È· ·›Ì·ÙÔ˜ Î·È ‰È·ÈÙËÙÈο ¯·Ú·ÎÙËÚÈÛÙÈοŒÓ·˜ ‰Â˘ÙÂÚ‡ˆÓ ÛÙfi¯Ô˜ ·˘Ù‹˜Ù˘ ÂÚÁ·Û›·˜ ‹Ù·Ó Ó· ·ÍÈÔÏÔÁ‹ÛÂÈÙ· ›‰· ÏÈȉ·ÈÌ›·˜ Û ۯ¤ÛËÌ ‰È·ÙÚÔÊÈΤ˜ Û˘Ó‹ıÂȘ. ∫·Ù’·Ú¯‹Ó, ÂÎÙÈÌ‹Û·Ì ÙËÓ Â›‰Ú·ÛËÙ˘ ªÂÛÔÁÂȷ΋˜ ‰›·ÈÙ·˜ ÛÙ· ‰ÈÂ-Ú¢ÓÔ‡ÌÂÓ· ÏÈ›‰È· (¶›Ó·Î·˜ 3).¶·Ú·ÙËÚ‹Û·Ì ˆ˜ –ÌÂÙ¿ ·fi¤ÏÂÁ¯Ô ÁÈ· ·ÚÎÂÙÔ‡˜ ‰˘ÓËÙÈÎÔ‡˜Û˘Á¯˘ÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ (Ô˘·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 3) –ÔÈ Û˘ÌÌÂÙ¤¯ÔÓÙ˜ Ô˘ ÙËÚÔ‡Û·ÓÙË ªÂÛÔÁÂȷ΋ ‰È·ÙÚÔÊ‹ ›¯·Ó·ÚfiÌÔÈÔ ÏÈȉ·ÈÌÈÎfi ÚÔÊ›Ï Ì·˘ÙÔ‡˜ Ô˘ ‚Ú›ÛÎÔÓÙ·Ó «ÂÁÁ‡ÙÂ-

·ıËÚÔÛÎÏ‹ÚˆÛË¢∂∫∂ªµƒπ√™ 2005

6

∏ ÙÈÌ‹ P ÚԤ΢„ ·fi ÙËÓ Û‡ÁÎÚÈÛË ·Ó‰ÚÒÓ- Á˘Ó·ÈÎÒÓ, ·ÊÔ‡ ÂÏ‹ÊıË ˘fi„Ë Ë Â›‰Ú·ÛË Ù˘ ËÏÈΛ·˜, ÙÔ˘ ‰Â›ÎÙËÌ¿˙·˜ ÛÒÌ·ÙÔ˜, Ù˘ Ê˘ÛÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Î·È ÙÔ˘ ηӛÛÌ·ÙÔ˜.

¶›Ó·Î·˜ 2: ∫·Ù·ÓÔÌ‹ ÙÈÌÒÓ ÏÈȉ›ˆÓ ·›Ì·ÙÔ˜ Û ¿Ó‰Ú˜ Î·È Á˘Ó·›Î˜ ¯ˆÚ›˜ ÎÏÈÓÈΤ˜ ÂӉ›ÍÂȘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘

ÕÓ‰Ú˜ (1.128 ‹ 49%) °˘Ó·›Î˜ (1.154 ‹ 51%) P*∂ηÙÔÛÙËÌfiÚÈ· ∂ηÙÔÛÙËÌfiÚÈ·

̤ÛË ± SD 5% 95% ̤Û˱ SD 5% 95%

√ÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË (TC) (mg/dl) 199 ± 42 137 270 195 ± 40 135 266 0,033% ·ÙfiÌˆÓ Ì ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË > 200 mg/dl 46% 40%

∆ÚÈÁÏ˘ÎÂÚ›‰È· (∆g) (mg/dl) 138 ± 57 54 313 103 ± 56 44 207 < 0,001% ·ÙfiÌˆÓ Ì ÙÚÈÁÏ˘ÎÂÚ›‰È· > 150 mg/dl 28% 13%

HDL - ¯ÔÏËÛÙÂÚfiÏË (mg/dl) 44 ± 15 29 66 53 ± 14 33 75 < 0,001% ·Ó‰ÚÒÓ/Á˘Ó·ÈÎÒÓ Ì HDL < 40/50 mg/dl 38% 37%

Non - HDL - ¯ÔÏËÛÙÂÚfiÏË (mg/dl) 156 ± 44 67 237 142 ± 41 60 240 < 0,001% ·Ó‰ÚÒÓ/Á˘Ó·ÈÎÒÓ Ì non-HDL > 190 mg/dl 17% 11%

LDL - ¯ÔÏËÛÙÂÚfiÏË (mg/dl) 128 ± 38 69 189 122 ± 36 70 184 0,003% ·Ó‰ÚÒÓ/Á˘Ó·ÈÎÒÓ Ì LDL > 160 mg/dl 15% 12%

√ÍÂȉˆÌ¤ÓË LDL - ¯ÔÏËÛÙÂÚfiÏË (mg/dl) 68 ± 33 25 128 59 ± 28 27 118 0,002§ÈÔÚˆÙ½ÓË (·)Lp(a) (mg/dl) 18 ± 16 2 57 20 ± 19 2 70 0,012% ·ÙfiÌˆÓ Ì Lp(a) > 30 mg/dl 17% 16%

Ú·» ÛÙËÓ «¢˘ÙÈÎÔ‡ Ù‡Ô˘» ‰›·ÈÙ·.ªfiÓÔ ÔÈ ·Ú·ÙËÚÔ‡ÌÂÓ˜ ‰È·ÊÔ-Ú¤˜ ÛÙ· ›‰· Ù˘ ÔÍÂȉˆÌ¤Ó˘LDL ¯ÔÏËÛÙÂÚfiÏ˘ ¤ÊÙ·Û·Ó ÛÂÛÙ·ÙÈÛÙÈ΋ ÛËÌ·ÓÙÈÎfiÙËÙ· (¶›Ó·-η˜ 3). ¶ÂÚ·ÈÙ¤Úˆ ‰Â, Ë ÔÏ˘·-Ú·ÁÔÓÙÈ΋ ·Ó¿Ï˘ÛË ¤‰ÂÈÍ ˆ˜Ì›· ¿ÓÔ‰Ô˜ 10 ÌÔÓ¿‰ˆÓ ÛÙË ‚·ı-ÌÔÏÔÁ›· Ù‹ÚËÛ˘ ªÂÛÔÁÂȷ΋˜‰È·ÙÚÔÊ‹˜, Û¯ÂÙÈ˙fiÙ·Ó Ì Ì›ˆÛËÙˆÓ ÂȤ‰ˆÓ ÔÍÂȉˆÌ¤Ó˘ LDL¯ÔÏËÛÙÂÚfiÏ˘ ηٿ 22 mg/dl

(95% CI: 8- 36, p = 0,04) Î·È ·Êԇ›¯Â ÚÔËÁËı› ¤ÏÂÁ¯Ô˜ Ù˘ ËÏÈ-Λ·˜, ÙÔ˘ ʇÏÔ˘, ÙÔ˘ ‰Â›ÎÙË Ì¿˙·˜ÛÒÌ·ÙÔ˜, ÙÔ˘ ηӛÛÌ·ÙÔ˜ ηÈÙ˘ Ê˘ÛÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÙˆÓÛ˘ÌÌÂÙ¯fiÓÙˆÓ (ÛÙÔȯ›· Ô˘ ‰ÂÓ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 3).

∏ ÂÚ·ÈÙ¤Úˆ ·Ó¿Ï˘ÛË ÙˆÓÔÌ¿‰ˆÓ ÙˆÓ ÙÚÔÊ›ÌˆÓ (Ô˘ ‰ÂÓ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÛÙÔÓ ¶›Ó·Î· 3)¤‰ÂÈÍ fiÙÈ Û˘ÁÎÚÈÓfiÌÂÓÔÈ Ì ·˘-ÙÔ‡˜ Ô˘ ·Ó¤ÊÂÚ·Ó ÌˉÂÓÈ΋ η-

ٷӿψÛË ÔÛÚ›ˆÓ, ·˘ÙÔ› Ô˘ ‰‹-ÏˆÓ·Ó Î·Ù·Ó¿ÏˆÛË Û˘¯ÓfiÙÂÚË·fi 3 ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰· (ηȂڛÛÎÔÓÙ·Ó ÏÔÈfiÓ, ÛÙÔ ˘„ËÏfiÙÂ-ÚÔ ÙÂÙ·ÚÙËÌfiÚÈÔ Î·Ù·Ó¿ÏˆÛ˘fiÛÚȈÓ) ›¯·Ó ηٿ 19% ¯·ÌËÏfi-ÙÂÚ· ›‰· LDL ¯ÔÏËÛÙÂÚfiÏ˘(∂ÈÎfiÓ· 2, p = 0,04) Î·È Î·Ù¿ 6%˘„ËÏfiÙÂÚ· ›‰· HDL ¯ÔÏËÛÙÂ-ÚfiÏ˘ (p = 0,03). ∂›Û˘, Ë Úfi-ÛÏË„Ë ÊÚÔ‡ÙˆÓ Î·È Ï·¯·ÓÈÎÒÓ Û˘-Û¯ÂÙ›ÛÙËΠ̛̠ˆÛË ÙˆÓ ÂȤ-‰ˆÓ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ ηٿ13% (p = 0,04), ÙˆÓ ÂȤ‰ˆÓ ÙÚÈ-ÁÏ˘ÎÂÚȉ›ˆÓ ηٿ 20% (p = 0,02)Î·È ¿ÓÔ‰Ô ÙˆÓ ÂȤ‰ˆÓ HDL ¯Ô-ÏËÛÙÂÚfiÏ˘ ηٿ 8% (p = 0,03).

∫·ÙfiÈÓ, ÂÈÎÂÓÙÚÒÛ·Ì ÙÔ ÂÓ-‰È·Ê¤ÚÔÓ Ì·˜ ÛÙÔ˘˜ Û˘ÌÌÂÙ¤¯Ô-ÓÙ˜ ÂΛÓÔ˘˜ Ô˘ ‚Ú›ÛÎÔÓÙ·Ó ˘fi˘ÔÏÈȉ·ÈÌÈ΋ Ê·Ú̷΢ÙÈ΋·ÁˆÁ‹ Î·È ÙËÚÔ‡Û·Ó ·Ú¿ÏÏËÏ·ÙË ªÂÛÔÁÂȷ΋ ‰È·ÙÚÔÊ‹ (Ù· ÛÙÔÈ-¯Â›· ‰ÂÓ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ¶›-ӷη 3). ¢È·ÈÛÙÒÛ·Ì ˆ˜ Ô ÚÔ-·Ó·ÊÂÚfiÌÂÓÔ˜ Û˘Ó‰˘·ÛÌfi˜ Û¯ÂÙÈ-˙fiÙ·Ó Ì Ì›ˆÛË ÙˆÓ ÂȤ‰ˆÓ ÔÏÈ-΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ ηٿ 9% (p =0,04). √È Û˘ÌÌÂÙ¤¯ÔÓÙ˜ Ô˘ ÙË-ÚÔ‡Û·Ó ÙË ªÂÛÔÁÂȷ΋ ‰È·ÙÚÔÊ‹

¶∞ƒ∞°√¡∆∂™ ∫π¡¢À¡√À – E¶π¢∏ªπ√§√°π∞

7

∂ÈÎfiÓ· 1. ∂ÈÏÂÁ̤ӷ ›‰Ë ÏÈȉ›ˆÓ ·›Ì·ÙÔ˜ Î·È ËÏÈΛ· Û˘ÌÌÂÙ¯fiÓÙˆÓ (ÔÈ ÁÚ·Ì̤˜ ·ÚÈÛÙÔ‡Ó ÙËÁÚ·ÌÌ‹ ·ÏÈÓ‰ÚfiÌËÛ˘ Î·È Ù· 95% ‰È·ÛÙ‹Ì·Ù· ÂÌÈÛÙÔÛ‡Ó˘).

500

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g/d

l)r=0,1, p<0,001

√È ÙÈ̤˜ P ÚÔ‹Ïı·Ó ·fi ÙËÓ Û‡ÁÎÚÈÛË ·ÙfiÌˆÓ «ÂÁÁ‡ÙÂÚ·» ÛÙË ªÂÛÔÁÂȷ΋‰È·ÙÚÔÊ‹ ÚÔ˜ ÂΛӷ Ô˘ ˘ÈÔıÂÙÔ‡Ó ¤Ó· ÌÔÓÙ¤ÏÔ ‰È·ÙÚÔÊ‹˜ ÈfiÙÂÚÔ «¢˘ÙÈ-ÎÔ‡ Ù‡Ô˘» Î·È ÂÓÒ ¤¯Ô˘Ó ÏËÊı› ˘fi„Ë ÔÈ ÂȉڿÛÂȘ ÙÔ˘ ʇÏÔ˘, ËÏÈΛ·˜, ‰Â›-ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜, ηӛÛÌ·ÙÔ˜, ÌfiÚʈÛ˘ Î·È Ê˘ÛÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜.

¶›Ó·Î·˜ 3: ∂›Â‰· ÏÈȉ›ˆÓ ·›Ì·ÙÔ˜ Û ۯ¤ÛË Ì ÙËÓ Ù‹ÚËÛË Ù˘ªÂÛÔÁÂȷ΋˜ ‰È·ÙÚÔÊ‹˜

ªÂÛÔÁÂȷ΋ «¢˘ÙÈÎÔ‡ Ù‡Ô˘» ‰È·ÙÚÔÊ‹ ‰È·ÙÚÔÊ‹

ÕÓ‰Ú˜ °˘Ó·›Î˜ ÕÓ‰Ú˜ °˘Ó·›Î˜ p

√ÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË (TC) (mg/dl) 200±44 199±44 197±45 192±39 0,224

∆ÚÈÁÏ˘ÎÂÚ›‰È· Tg (mg/dl) 143±32 107±32 135±36 101±27 0,114

HDL-¯ÔÏËÛÙÂÚfiÏË (mg/dl) 43±15 52±14 44±14 54±13 0,723

LDL-¯ÔÏËÛÙÂÚfiÏË (mg/dl) 130±44 125±44 127±45 120±39 0,233

√ÍÂȉˆÌ¤ÓË LDL (mg/dl) 65±23 56±25 75±26 62±23 0,002

§ÈÔÚˆÙ½ÓË (·) Lp(a) (mg/dl) 19±18 21±17 16±15 17±17 0,569

Î·È ÂÏ¿Ì‚·Ó·Ó ·Ú¿ÏÏËÏ· ÛÙ·Ù›ÓË›¯·Ó ηٿ ̤ÛÔ fiÚÔ 19% ¯·ÌËÏfi-ÙÂÚ· ›‰· LDL ¯ÔÏËÛÙÂÚfiÏ˘(p = 0,021) Î·È 32% ¯·ÌËÏfiÙÂڷ›‰· ÔÍÂȉˆÌ¤Ó˘ LDL ¯ÔÏË-ÛÙÂÚfiÏ˘ (p < 0,001) Û ۇÁÎÚÈÛËÌ ÂΛÓÔ˘˜ Ô˘ ‰ÂÓ ÂÏ¿Ì‚·Ó·Ó·ÁˆÁ‹ Î·È ·ÎÔÏÔ˘ıÔ‡Û·Ó, ηٿو Ï›ÛÙÔÓ, Ì›· « ¢˘ÙÈÎÔ‡ Ù‡Ô˘»‰È·ÙÚÔÊ‹. ∞Í›˙ÂÈ Ó· ÛËÌÂȈı› ˆ˜ÔÈ ·Ú·ÙËÚËı›Û˜ ÌÂÈÒÛÂȘ ‹Ù·ÓÌÂÁ·Ï‡ÙÂÚ˜ Û ۯ¤ÛË Ì ÙȘ ÌÂÈ-ÒÛÂȘ Ô˘ ÂÈÙ‡¯ıËÎ·Ó ÌfiÓÔ Ì‰›·ÈÙ· ‹ ÌfiÓÔ Ì ÛÙ·Ù›ÓË (p <0,05). ∏ ›‰Ú·ÛË ÙÔ˘ ·Ú·¿ÓˆÛ˘Ó‰˘·ÛÌÔ‡ ÛÙ· ˘fiÏÔÈ· ÏÈ›‰È·‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋.

™Â ·˘Ùfi ÙÔ ÛËÌ›Ô, Ú¤ÂÈ Ó·ÙÔÓÈÛÙ› fiÙÈ Ë ·Ó·ÁˆÁ‹ ÙˆÓ Â˘ÚË-Ì¿ÙˆÓ Ì·˜ ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi‰ÂÓ ÌÔÚ› Ó· Û˘Ì‚Â› ¯ˆÚ›˜ ÂÈ-ʇϷÍË. ŒÓ·˜ ·fi ÙÔ˘˜ ‚·ÛÈÎÔ‡˜·Ú¿ÁÔÓÙ˜ Â›Ó·È ÙÔ Ì¤ÙÚÈÔ ÔÛÔ-

ÛÙfi Û˘ÌÌÂÙÔ¯‹˜ (68%), ÙÔ ÔÔ›ÔÂ›Ó·È ÌÂÓ ·Ô‰ÂÎÙfi ÁÈ· ÏËı˘-ÛÌȷΤ˜ ÌÂϤÙ˜, fiˆ˜ Ë ·ÚÔ‡-Û·, ·ÏÏ¿ ÂÈÙÚ¤ÂÈ ÙËÓ ¤ÎÊÚ·ÛˢÔı¤ÛÂˆÓ fiÙÈ Ô ÙÚfiÔ˜ ˙ˆ‹˜ ·˘-ÙÒÓ Ô˘ ·Ô‰¤¯ÙËÎ·Ó Ó· Û˘ÌÌÂ-Ù¿Û¯Ô˘Ó Î·È ·˘ÙÒÓ Ô˘ ‰ÂÓ Û˘Ì-ÊÒÓËÛ·Ó, ÂӉ¯Ô̤ӈ˜ Ó· ›ӷȉȷÊÔÚÂÙÈÎfi˜. ŒÓ·˜ ·ÎfiÌË ÂÚÈÔ-ÚÈÛÌfi˜ Â›Ó·È Ô Û˘Á¯ÚÔÓÈÎfi˜ Û¯Â-‰È·ÛÌfi˜ Ù˘ ÌÂϤÙ˘. ∂Ô̤ӈ˜,Ù· ·Ú·ÙËÚÔ‡ÌÂÓ· ÔʤÏË ·fi Ù˪ÂÛÔÁÂȷ΋ ‰È·ÙÚÔÊ‹ ÛÙ· ›Â-‰· ÔÍÂȉˆÌ¤Ó˘ LDL ¯ÔÏËÛÙÂÚfi-Ï˘, ‹ Ë Â›‰Ú·ÛË Ù˘ Ê˘ÛÈ΋˜‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÛÙ· ›‰· HDL¯ÔÏËÛÙÂÚfiÏ˘ ı· Ú¤ÂÈ ÂÚ·ÈÙ¤-Úˆ Ó· ‰ÈÂÚ¢ÓËıÔ‡Ó ÌÂ Ù˘¯·ÈÔÔÈ-Ë̤Ó˜ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜.

™Àª¶∂ƒ∞™ª∞¶·Ú¿ ÙÔ˘˜ ÚÔ·Ó·ÊÂÚfiÌÂÓÔ˘˜ÂÚÈÔÚÈÛÌÔ‡˜, Ë ·ÚÔ‡Û· ÌÂϤÙË

·ÔÎ¿Ï˘„ fiÙÈ ÛÙË ¯·Ú·˘Á‹ ÙÔ˘21Ô˘ ·ÈÒÓ·, Ì›· ·ÍÈÔÛËÌ›ˆÙËÌÂÚ›‰· ·Ó‰ÚÒÓ Î·È Á˘Ó·ÈÎÒÓ¤¯Ô˘Ó ›‰· ÏÈȉ›ˆÓ ·›Ì·ÙÔ˜¿Óˆ ·fi Ù· Ê˘ÛÈÔÏÔÁÈο fiÚÈ·.µ·ÛÈṲ̂ÓÔÈ ÛÙ· Â˘Ú‹Ì·Ù¿ Ì·˜,ÌÔÚԇ̠ӷ ÂÈοÛÔ˘Ì fiÙÈ ÂÚ›-Ô˘ ÙÚ›· ÂηÙÔÌ̇ÚÈ· ŒÏÏËÓ˜¤¯Ô˘Ó ˘„ËÏ¿ ›‰· ÔÏÈ΋˜ ¯Ô-ÏËÛÙÂÚfiÏ˘. ∂ÈÚfiÛıÂÙ·, Ϥ-ÔÓ ÙÔ˘ ÂÓfi˜ ÛÙÔ˘˜ ÙÚÂȘ Û˘ÌÌÂ-Ù¤¯ÔÓÙ˜ Ì ›‰· ÏÈȉ›ˆÓ ·›-Ì·ÙÔ˜ ¿Óˆ ·fi Ù· Ê˘ÛÈÔÏÔÁÈο,‰ÂÓ Â›¯·Ó ›ÁÓˆÛË Ù˘ ηٿÛÙ·-Û‹˜ ÙÔ˘˜, ÂÓÒ ÌfiÓÔ Ô ¤Ó·˜ÛÙÔ˘˜ ‰‡Ô ·fi fiÛÔ˘˜ ÂÏ¿Ì‚·Ó·Ó˘ÔÏÈȉ·ÈÌÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ÂÙ‡¯·ÈÓ·Ó Ù· ηıÔÚÈṲ̂ӷ ˆ˜ÂÈı˘ÌËÙ¿ ›‰· ÏÈȉ·ÈÌ›·˜.ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ Â›‰Ú·ÛË ÙˆÓ‰È·ÈÙËÙÈÎÒÓ Û˘ÓËıÂÈÒÓ, ·ÚfiÙÈÌfiÓË Ë Ù‹ÚËÛË Ù˘ ªÂÛÔÁÂȷ΋˜‰È·ÙÚÔÊ‹˜ ‰ÂÓ ÂËÚ¤·Û ٷ ÏÈ›-‰È· ·›Ì·ÙÔ˜ (Ì ÂÍ·›ÚÂÛË ÙËÓÔÍÂȉˆÌ¤ÓË LDL ¯ÔÏËÛÙÂÚfiÏË), ÔÛ˘Ó‰˘·ÛÌfi˜ ·˘Ù‹˜ Ì ıÂڷ›·Ì ÛÙ·Ù›ÓË Â¤ÊÂÚ ¤Ó· Û˘ÓÂÚÁÈ-Îfi ˘ÔÏÈȉ·ÈÌÈÎfi ·ÔÙ¤ÏÂÛÌ·.µ·ÛÈ˙fiÌÂÓÔÈ ÛÙËÓ ÈÛ¯˘Ú‹ Èı·Ófi-ÙËÙ·, Ì›· Ù¤ÙÔÈ· ÙÚÔÔÔ›ËÛËÙˆÓ ÂȤ‰ˆÓ ÏÈȉ›ˆÓ ÙÔ˘ ·›Ì·-ÙÔ˜ Ó· Â›Ó·È ÂˆÊÂÏ‹˜, ȉ›ˆ˜, ÁÈ·ÂΛÓÔ˘˜ Ì ˘„ËÏfiÙÂÚÔ Î›Ó‰˘ÓÔÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘, ÚÔÙ›ÓÔ˘Ìˆ˜ Ô˘ÛÈÒ‰Ë ÙË ‰ÈÂÚ‡ÓËÛË ÙÔ˘ÁÂÓÈÎÔ‡ ÏËı˘ÛÌÔ‡ ÁÈ· ÏÈȉ·ÈÌÈ-Τ˜ ·ÓˆÌ·Ï›Â˜ Î·È ıˆÚÔ‡ÌÂÛÎfiÈÌÔ ·˘Ù‹ Ó· ·ÎÔÏÔ˘ıËı›·fi ÂÓÂÚÁËÙÈΤ˜ Î·È ·ÔÙÂÏÂÛÌ·-ÙÈΤ˜ ·ÚÂÌ‚¿ÛÂȘ16.

·ıËÚÔÛÎÏ‹ÚˆÛË¢∂∫∂ªµƒπ√™ 2005

8

1. Gotto AM Jr. Lipid and lipoprotein disord-ers. In: Pearson TA, Criqui MH, LuepkerRV, Oberman A, Wilson M, eds. Primer inPreventive Cardiology. Dallas, Tex: Ame-rican Heart Association; 1994: 107-129.

2. Ginsberg HN. Lipoprotein metabolismand its relationship to atherosclerosis.Med Clin North Am 1994;78:1-20.

3. Wilson PWF, Abbott RD, Castelli WP. Highdensity lipoprotein cholesterol and mor-tality. Arteriosclerosis 1988;8:737-741.

4. Executive summary of the third report ofthe National Cholesterol Educational Pro-gram Expert panel on detection, evalua-tion, and treatment of high blood chole-sterol in adults. JAMA 2001; 285: 19:2486-2497.

5. Gran B. Major differences in cardiovascu-lar risk indicators by educational status.Results from a population based scree-ning program. Scand J Soc Med 1995;23:9-16.

6. Keys A, Menotti A, Karvonen MJ. The dietand 15-year death rate in the SevenCountries Study. Am J Epidemiol 1986;124: 903 – 915

7. Denke M. Cholesterol lowering diets. A re-

view of evidence. Arch Int Med 1995: 155;17-26.

8. Trichopoulou A, Kouris-Blazos A, Wahlq-vist M, Gnardellis C, Lagiou P, Polychro-nopoulos E, Vassilakou T, Lipworth L, Tri-chopoulos D. Diet and overall survival inelderly people. Brit Med J 1995; 311: 1457– 1460.

9. Kafatos A, Diacatou A, Voukiklaris G, Ni-kolakakis N, Vlachonikolis J, Kounali D,Mamalakis G, Dontas A.S. Heart diseaserisk-factor status and dietary changes inthe Cretan population over the past 30years: the Seven Countries Study. Am JClin Nutr 1997; 65:1882-1886.

10. de Lorgeril M., Salen, P., Martin J.-L.,Monjaud I,. Delaye J., Mamelle N., Medi-terranean diet, traditional risk factors andthe rate of cardiovascular complicationsafter myocardial infarction. Final report ofthe Lyon Diet Heart Study. Circulation1999; 99: 779-785.

11. Panagiotakos DB, Pitsavos H, Chryso-hoou C, Skoumas J, Papadimitriou L, Ste-fanadis C, Toutouzas PK. Status and Ma-nagement of Hypertension, in Greece; therole of the adoption of Mediterranean Diet:

the ATTICA study. J Hypertens 2003;21:1483-1489.

12. Trichopoulou A, Costacou T, Bamia C, Tri-chopoulos D. Adherence to a Mediterra-nean diet and survival in a Greek popula-tion. N Engl J Med 2003;348: 2599-2608.

13. Trichopoulou A, From Research to Educa-tion: The Greek experience. Nutrition2000; 16: 528 - 531.

14. Willett WC, Sacks F, Trichopoulou A,Drescher G, Ferro-Luzzi A, Helsing E, Tri-chopoulos D. Mediterranean diet pyramid:a cultural model for healthy eating. Am JClin Nutr 1995; 6:1402S-1406S.

15. Pitsavos C, Chrysohoou C, PanagiotakosDB, Skoumas J, Zeimbekis A, Kokkinos P,Stefanadis C, Toutouzas PK. Associationof Leisure-time Physical Activity on Inflam-mation Markers (C-Reactive Protein, Whi-te-blood Cell count, serum Amyloid A andFibrinogen), in Healthy subjects (from theATTICA Study). Am J Cardiol 2003:91:368-370.

16. Shepherd J. Economics of lipid loweringin primary prevention: lessons from theWest of Scotland Coronary PreventionStudy. Am J Cardiol 2001; 87: 19-22.

µµÈÈ‚‚ÏÏÈÈÔÔÁÁÚÚ··ÊÊ››··

∂ÈÎfiÓ· 2. ∂›Â‰· LDL – ¯ÔÏËÛÙÂÚfiÏ˘ Î·È Î·Ù·Ó¿ÏˆÛË ÔÛÚ›ˆÓ.

150

140

130

120

110

100K·Ì›· 1-2 >3

ºÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰·

LDL

- ¯ÔÏ

ËÛÙÂ

ÚfiÏ

Ë (m

g/d

l)P=0,04

P=0,04

139±

132±

113±

Œ¯ÂÈ ‰È·ÈÛÙˆı› ·fi ÌÂϤ-Ù˜ fiÙÈ Ë È‰ÈÔ·ı‹˜ ˘¤Ú-Ù·ÛË, ·ÎfiÌË Î·È fiÙ·Ó ·ÓÙÈ-

ÌÂÙˆ›˙ÂÙ·È Ê·Ú̷΢ÙÈο, Û˘-Û¯ÂÙ›˙ÂÙ·È ¿ÌÂÛ· Ì ÙËÓ ÂÌÊ¿ÓÈÛ˯ÚfiÓÈ·˜ ÓÂÊÚÈ΋˜ ÓfiÛÔ˘1,2. ™ÙȘ∏.¶.∞. ˘ÔÏÔÁ›˙ÂÙ·È fiÙÈ ÂÚ›Ô˘5,5 ÂηÙÔÌ̇ÚÈ· ¿ÙÔÌ· ÂÌÊ·Ó›-˙Ô˘Ó Î¿ÔÈÔ˘ ‚·ıÌÔ‡ ¤ÎÙˆÛËÙ˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜. ∆Ô70% ·˘ÙÒÓ ÙˆÓ ·ÙfiÌˆÓ ¤¯ÂÈ ·˘-ÍË̤ÓË ·ÚÙËÚȷ΋ ›ÂÛË. Œ¯ÂÈ ÂÓ-‰È·Ê¤ÚÔÓ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÙÔ 27%ÙˆÓ ·ÛıÂÓÒÓ Ì ·ÚÙËÚȷ΋ ˘¤Ú-Ù·ÛË Î·È ¤ÎÙˆÛË Ù˘ ÓÂÊÚÈ΋˜ÏÂÈÙÔ˘ÚÁ›·˜ ›¯·Ó ÛÙÔ ·ÚÂÏıfiÓÚ˘ıÌÈṲ̂ÓË ˘¤ÚÙ·ÛË (·ÚÙËÚÈ·-΋ ›ÂÛË ÌÈÎÚfiÙÂÚË ·fi 140/90mmHg)3.

™‡Ìʈӷ Ì ÙȘ ÓÂfiÙÂÚ˜ η-Ù¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜4 ˆ˜ ¯ÚfiÓÈ·ÓÂÊÚÈ΋ ÓfiÛÔ˜ ÔÚ›˙ÂÙ·È Â›ÙÂ Ë ·-ÚÔ˘Û›· ÓÂÊÚÈ΋˜ ‚Ï¿‚˘ ÁÈ· ¯ÚÔ-ÓÈÎfi ‰È¿ÛÙËÌ· ÌÂÁ·Ï‡ÙÂÚÔ ÙˆÓ 3ÌËÓÒÓ Ì ‹ ¯ˆÚ›˜ Ì›ˆÛË ÙÔ˘Ú˘ıÌÔ‡ Ù˘ ÛÂÈÚ·Ì·ÙÈ΋˜ ‰È‹ıË-Û˘ (GFR), ›ÙÂ Ë ÂÏ¿ÙÙˆÛË ÙÔ˘GFR<60 ml/min/1,73 m2 ÁÈ· ¯ÚÔ-ÓÈÎfi ‰È¿ÛÙËÌ· ÌÂÁ·Ï‡ÙÂÚÔ ÙˆÓ 3ÌËÓÒÓ Ì ‹ ¯ˆÚ›˜ ÓÂÊÚÈ΋ ‚Ï¿‚Ë.∏ ·ÚÔ˘Û›· ÓÂÊÚÈ΋˜ ‚Ï¿‚˘ ÂÈ-‚‚·ÈÒÓÂÙ·È Â›Ù Ì ‚ÈÔ„›· ÓÂ-ÊÚÔ‡, ›Ù Ì ÙËÓ ·ÚÔ˘Û›· ‰È·-Ù·Ú·¯ÒÓ Û ·ÂÈÎÔÓÈÛÙÈΤ˜ ÌÂıfi-‰Ô˘˜, ›Ù Ì ÂÚÁ·ÛÙËÚÈ·ÎÔ‡˜‰Â›ÎÙ˜ (.¯. Ë ·ÚÔ˘Û›· ÚˆÙÂ˚-ÓÔ˘Ú›·˜).

∏ ÂÎÙ›ÌËÛË Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈ-ÙÔ˘ÚÁ›·˜ Á›ÓÂÙ·È Î˘Ú›ˆ˜ Ì ÙÔÓÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘ ‰Â›ÎÙË ÛÂÈÚ·-Ì·ÙÈ΋˜ ‰È‹ıËÛ˘ (GFR), Ë ÔÔ›·ÛÙËÓ Ú¿ÍË ÂÎÙÈÌ¿Ù·È ·fi ÙËÓ Î¿-ı·ÚÛË Ù˘ ÎÚ·ÙÈÓ›Ó˘4. ∏ ÙÂÏ¢-Ù·›· ÌÔÚ› Ó· ˘ÔÏÔÁÈÛı› ›ÙÂÌÂÙ¿ ·fi 24ˆÚË Û˘ÏÏÔÁ‹ Ô‡ÚˆÓ,›Ù Ì ‚¿ÛË ÙËÓ ÎÚ·ÙÈÓ›ÓË ÙÔ˘ÔÚÔ‡ Î·È ÙËÓ Â͛ۈÛË Cockcroft-Gault5 ‹ ÙËÓ Â͛ۈÛË MDRD6 (¶›-ӷη˜ 1).

ªÂ ‚¿ÛË ÙÔ Ú˘ıÌfi ÛÂÈÚ·Ì·-

ÙÈ΋˜ ‰È‹ıËÛ˘, Ô˘ ˘ÔÏÔÁ›˙Â-Ù·È fiˆ˜ ·Ó·Ê¤ÚıËΠ·Ú·¿-Óˆ, Á›ÓÂÙ·È Ë ÛÙ·‰ÈÔÔ›ËÛË Ù˘¯ÚfiÓÈ·˜ ÓÂÊÚÈ΋˜ ÓfiÛÔ˘4 ÛÙ·ÛÙ¿‰È· Ô˘ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·-η 2.

¶ÔÏϤ˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈÔÔÈÔ˘‰‹ÔÙ ‚·ıÌÔ‡ ¤ÎÙˆÛËÙ˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Û˘ÓÔ-‰Â‡ÂÙ·È ·fi ·ÓÙ›ÛÙÔÈ¯Ë ·‡ÍËÛË,ηٿ ÁÚ·ÌÌÈÎfi ÙÚfiÔ, ÙÔ˘ ÎÈÓ‰‡-ÓÔ˘ ÂÌÊ¿ÓÈÛ˘ ηډȷÁÁÂÈ·ÎÔ‡Û˘Ì‚¿Ì·ÙÔ˜7. ∏ ÌÂϤÙË Hyperten-sion Detect and Follow Up Pro-gram8 ¤‰ÂÈÍ ÁÈ· ÚÒÙË ÊÔÚ¿ ÙËÓÈÛ¯˘Ú‹ ÚÔÁÓˆÛÙÈ΋ ·Í›· Ù˘ ·˘-ÍË̤Ó˘ ÎÚ·ÙÈÓ›Ó˘ ÙÔ˘ ÔÚÔ‡fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ÂÓÙ·ÂÙ‹ ηÈÔÎÙ·ÂÙ‹ ıÓËÛÈÌfiÙËÙ·. ÕÏϘ ÌÂ-

ϤÙ˜ Ô˘ ·ÎÔÏÔ‡ıËÛ·Ó ÂȂ‚·›-ˆÛ·Ó ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ô Ú˘ıÌfi˜ÛÂÈÚ·Ì·ÙÈ΋˜ ‰È‹ıËÛ˘ ·ÔÙÂ-Ï› ·ÓÂÍ¿ÚÙËÙÔ ·Ú¿ÁÔÓÙ· ÎÈÓ-‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË Î·Ú-‰È·ÁÁÂÈ·ÎÔ‡ ÂÂÈÛÔ‰›Ô˘ Î·È Û˘-ÁÎÂÎÚÈ̤ӷ ÔÈ ÌÂϤÙ˜ Hyperten-sion Optimal Treatment (HOT)9,Intervention as a Goal in Hyper-tension Treatment (INSIGHT)10,Systolic Hypertension in Europe(SYST-EUR)11, Systolic Hyperten-sion in China (SYST-CHINA)12,Atherosclerosis Risk on Commu-nities (ARIC)13 Î·È HOORN14.

∏ ηıÔÏÈ΋ ·Ô‰Ô¯‹ Ù˘ ÌÂÈ-ˆÌ¤Ó˘ GFR ˆ˜ ·Ú¿ÁÔÓÙ· ηÚ-‰È·ÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ÚÔ·ÙÂÈ›Û˘ Î·È ·fi ÙËÓ ÂÓۈ̿وÛË

¶A£OºY™IO§O°IA

9

∏ ∂ÌÊ¿ÓÈÛË ÃÚfiÓÈ·˜ ¡ÂÊÚÈ΋˜ ¡fiÛÔ˘ Û ∞ÛıÂÓ›˜ Ì π‰ÈÔ·ı‹ À¤ÚÙ·ÛË ˘fi ∞ÁˆÁ‹

µ∞™π§∂π√™ ™∞√À°∫√™, ∂ÈÛÙËÌÔÓÈÎfi˜ ™˘ÓÂÚÁ¿Ù˘ µ’ ¶·ıÔÏÔÁÈ΋˜ ∫ÏÈÓÈ΋˜ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ πˆ·ÓÓ›ÓˆÓ

ªøÀ™∏™ ∂§π™∞º, ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜, ¢È¢ı˘ÓÙ‹˜ µ’ ¶·ıÔÏÔÁÈ΋˜ ∫ÏÈÓÈ΋˜ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ πˆ·ÓÓ›ÓˆÓ

ñ ∂͛ۈÛË Cockcroft-Gault:

(140-ËÏÈΛ·) à ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ Ccr(ml/min)= X (0,85, Û Á˘Ó·›Î˜)

72 Ã Scr

ñ ∂͛ۈÛË MDRD:

GFR(ml/min/1,73 m2) =186 X (Scr)1.154 X (∏ÏÈΛ·) 0.203 X (0.742 Û Á˘Ó·›Î˜)

Scr = ÎÚ·ÙÈÓ›ÓË ÔÚÔ‡, Ccr = οı·ÚÛË ÎÚ·ÙÈÓ›Ó˘* ™ÙȘ ·Ú·¿Óˆ ÂÍÈÛÒÛÂȘ, Ë Scr Â›Ó·È Û mg/dl, Ë ËÏÈΛ· Û ¤ÙË Î·È ÙÔ ‚¿ÚÔ˜ Û kg

¶›Ó·Î·˜ 1: ÀÔÏÔÁÈÛÌfi˜ ÙÔ˘ Ú˘ıÌÔ‡ ÛÂÈÚ·Ì·ÙÈ΋˜ ‰È‹ıËÛ˘ Ì‚¿ÛË ÙËÓ ÎÚ·ÙÈÓ›ÓË ÙÔ˘ ÔÚÔ‡*

¶›Ó·Î·˜ 2: ™Ù¿‰È· ¯ÚfiÓÈ·˜ ÓÂÊÚÈ΋˜ ÓfiÛÔ˘.

™Ù¿‰ÈÔ ¯ÚfiÓÈ·˜ÓÂÊÚÈ΋˜ ÓfiÛÔ˘ ¶ÂÚÈÁÚ·Ê‹ GFR(ml/min/1,73 m2)

1 ¡ÂÊÚÈ΋ ‚Ï¿‚Ë ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ≥90‹ ·˘ÍË̤ÓÔ GFR

2 ¡ÂÊÚÈ΋ ‚Ï¿‚Ë Ì ‹È· Ì›ˆÛË ÙÔ˘ GFR 60-89

3 ª¤ÙÚÈ· Ì›ˆÛË ÙÔ˘ GFR 30-59

4 ™Ô‚·Ú‹ Ì›ˆÛË ÙÔ˘ GFR 15-29

5 ¡ÂÊÚÈ΋ ·Ó¿ÚÎÂÈ· <15 ‹ ·ÈÌÔοı·ÚÛË

GFR = Ú˘ıÌfi˜ ÛÂÈÚ·Ì·ÙÈ΋˜ ‰È‹ıËÛ˘

Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ˆ˜ ‚·-ÛÈ΋˜ ·Ú·Ì¤ÙÚÔ˘ ÁÈ· ÙËÓ ·Ó›-¯Ó¢ÛË ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË Î·Ú‰È·ÁÁÂÈ·-΋˜ ÓfiÛÔ˘ ÛÙȘ ÚfiÛÊ·Ù˜ η-Ù¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ ÁÈ· ÙËÓ·ÓÙÈÌÂÙÒÈÛË Ù˘ ˘¤ÚÙ·Û˘.™‡Ìʈӷ Ì ÙËÓ ¤‚‰ÔÌË ·Ó·ÊÔ-Ú¿ Ù˘ Joint National Committee(JNC-7), Ë ÌÈÎÚÔ·Ï‚Ô˘ÌÈÓÔ˘Ú›·Î·È Ë Ì›ˆÛË ÙÔ˘ Ú˘ıÌÔ‡ Ù˘ÛÂÈÚ·Ì·ÙÈ΋˜ ‰È‹ıËÛ˘ (GFR <60 ml/min/1,73 m2) Â›Ó·È ·Ú¿ÌÂ-ÙÚÔÈ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÌ-Ê¿ÓÈÛË Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÂÂÈÛÔ-‰›ˆÓ15.

∂›Û˘, Ú¤ÂÈ Ó· ÂÈÛËÌ·Ó-ı› fiÙÈ Ë ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ÓfiÛÔ˜Û˘Ó˘¿Ú¯ÂÈ Û˘¯Ó¿ Î·È Û˘Û¯ÂÙ›˙Â-Ù·È Ì ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙ˜ ηÚ-‰È·ÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ (¶›Ó·Î·˜3)16-27.

∂ÈÚfiÛıÂÙ·, Ë Ì›ˆÛË Ù˘ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ·ÔÙÂÏ›ÈÛ¯˘Úfi ·Ú¿ÁÔÓÙ· Úfi‚Ï„˘Ù˘ ÎÏÈÓÈ΋˜ ÔÚ›·˜ ·ÛıÂÓÒÓ ÌÂηډȷο ÂÂÈÛfi‰È· Î·È Û˘ÁÎÂÎÚÈ-̤ӷ Û ·ÛıÂÓ›˜ Ì Ôͤ· ÛÙÂÊ·-ÓÈ·›· Û‡Ó‰ÚÔÌ·28, ηډȷ΋ ·ÓÂ-¿ÚÎÂÈ·29, ÌÂÙ¿ ÛÙÂÊ·ÓÈÔÁÚ·-Ê›·30, Û ¯ÂÈÚÔ˘ÚÁÈΤ˜ ÂÂÌ‚¿-ÛÂȘ31, ηıÒ˜ Î·È Û ·ÛıÂÓ›˜ Ô˘ÂÈÛ¿ÁÔÓÙ·È Û ÌÔÓ¿‰Â˜ ÂÓÙ·ÙÈ΋˜ıÂڷ›·˜32.

ŸÛÔÓ ·ÊÔÚ¿ ÙËÓ ·ÓÙÈÌÂÙÒ-ÈÛË Ù˘ ¯ÚfiÓÈ·˜ ÓÂÊÚÈ΋˜ Ófi-ÛÔ˘ Î·È Î·Ù¿ Û˘Ó¤ÂÈ· Î·È ÙÔ˘·˘ÍË̤ÓÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ-‰‡ÓÔ˘ Ô˘ ·˘Ù‹ Û˘Ó¿ÁÂÙ·ÈÛ˘ÓÈÛÙ¿Ù·È ˘ÁÈÂÈÓԉȷÈÙËÙÈ΋·Ú¤Ì‚·ÛË, Ë ÔÔ›· ÂÚÈÏ·Ì-‚¿ÓÂÈ ÙËÓ ¿ÌÂÛË ‰È·ÎÔ‹ ÙԢηӛÛÌ·ÙÔ˜, ÙËÓ ·ÒÏÂÈ· Ûˆ-Ì·ÙÈÎÔ‡ ‚¿ÚÔ˘˜ Î·È ÙËÓ ÂÏ·¯È-ÛÙÔÔ›ËÛË Ù˘ ηٷӿψÛ˘·Ï·ÙÈÔ‡.

∞·ÈÙ›ٷÈ, ›Û˘, ·˘ÛÙËÚfi˜¤ÏÂÁ¯Ô˜ Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘(Èı·ÓÒ˜ Û ›‰· < 125/75mmHg) Ì ÙË ¯Ú‹ÛË Û˘Ó‰˘·ÛÌÔ‡

·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ Ê·Ú̿ΈÓ15,33.À¿Ú¯Ô˘Ó ‚¿ÛÈ̘ ÂӉ›ÍÂȘ fiÙÈÛ ·˘Ù¤˜ ÙȘ ÂÚÈÙÒÛÂȘ ··ÈÙ›-Ù·È Ë ¯ÔÚ‹ÁËÛË ÂÓfi˜ ·Ó·ÛÙÔϤ·ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ ‹ÂÓ·ÏÏ·ÎÙÈο ÂÓfi˜ ·ÓÙ·ÁˆÓÈÛÙ‹ÙˆÓ ˘Ô‰Ô¯¤ˆÓ Ù˘ ·ÁÁÂÈÔÙ·Û›-Ó˘ II, ηıÒ˜ ·˘Ù¤˜ ÔÈ Î·ÙËÁÔڛ˜ʷÚÌ¿ÎˆÓ ‚ÂÏÙÈÒÓÔ˘Ó ÙË ÓÂÊÚÈ΋ÏÂÈÙÔ˘ÚÁ›· Û ·ÛıÂÓ›˜ Ì ÓÂÊÚÔ-ÛÎÏ‹Ú˘ÓÛË34,35.

∂ÈÚfiÛıÂÙ·, Û‡Ìʈӷ ηÈÌ ÙȘ ÓÂfiÙÂÚ˜ ηÙ¢ı˘ÓÙ‹ÚȘԉËÁ›Â˜ Î·È ÂÊfiÛÔÓ ÔÈ ·ÛıÂÓ›˜Ì ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ÓfiÛÔ Â›Ó·È¿ÙÔÌ· ·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ·ÙËÓ ÂÌÊ¿ÓÈÛË Î·Ú‰È·ÁÁÂÈ·ÎÒÓÛ˘Ì‚·Ì¿ÙˆÓ, ıˆÚÂ›Ù·È ‰fiÎÈÌËË Ì›ˆÛË Ù˘ ÙÈÌ‹˜ ÛÙfi¯Ô˘ ÙfiÛÔÁÈ· ÙËÓ ·ÚÙËÚȷ΋ ›ÂÛË, fiÛÔÎ·È ÁÈ· ÙËÓ LDL ¯ÔÏËÛÙÂÚfiÏË.™˘ÁÎÂÎÚÈ̤ӷ, fiÛÔÓ ·ÊÔÚ¿ ÙËÓ·ÚÙËÚȷ΋ ›ÂÛË Ú¤ÂÈ Ù· ›-‰¿ Ù˘ Ó· Â›Ó·È ÌÈÎÚfiÙÂÚ··fi 130/80 mmHg, ÂÎÙfi˜ Î·È ·ÓÛ˘Ó˘¿Ú¯ÂÈ ÚˆÙÂ˚ÓÔ˘Ú›· ÌÂÁ·-χÙÂÚË ÙÔ˘ 1 gr/ 24ˆÚÔ, ÔfiÙ ÔÛÙfi¯Ô˜ Ù˘ ·ÁˆÁ‹˜ Ú¤ÂÈ Ó·Â›Ó·È Â›Â‰· ·ÚÙËÚȷ΋˜ ›ÂÛ˘<125/75 mm Hg4. ∆· ÂÈı˘ÌËٿ›‰· Ù˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘ηıÔÚ›˙ÔÓÙ·È Û οı ÂÚ›ÙˆÛË·fi ÙË Û˘Ó‡·ÚÍË Î·È ¿ÏÏˆÓ ·-Ú·ÁfiÓÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡-ÓÔ˘, ÛÙ· Ï·›ÛÈ· ÂÎÙ›ÌËÛ˘ ÙÔ˘Û˘ÓÔÏÈÎÔ‡ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ-

‰‡ÓÔ˘ ÙÔ˘ ·ÛıÂÓ‹. øÛÙfiÛÔ, ËÛ˘¯Ó‹ ·ÚÔ˘Û›· ÔÏÏ·ÏÒÓ ·-Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÛÙÔ˘˜ ·ÛıÂ-Ó›˜ Ì ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ÓfiÛÔ Î·-ıÈÛÙ¿ ÂÈı˘ÌËÙ‹ ÙË Ì›ˆÛË Ù˘LDL ¯ÔÏËÛÙÂÚfiÏ˘ Û ›‰·ÌÈÎÚfiÙÂÚ· ·fi 100 mg4.

™Â ·ÛıÂÓ›˜ ˘„ËÏÔ‡ ηډȷÁ-ÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ηıÒ˜ Î·È Û·ÛıÂÓ›˜ Ì ÂÁηÙÂÛÙË̤ÓË Î·Ú-‰È·ÁÁÂȷ΋ ÓfiÛÔ Ú¤ÂÈ ÛÙÔÓ ÂÚ-Á·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ÚÔ˘Ù›Ó·˜ Ó·Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÙ·È Î·È Ë ÂÎÙ›ÌË-ÛË Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÌÂÙË Ì¤ÙÚËÛË Û ‰Â›ÁÌ· Ô‡ÚˆÓ ÙÔ˘ÏfiÁÔ˘ ·Ï‚Ô˘Ì›ÓË/ÎÚ·ÙÈÓ›ÓË ‹ÔÏÈ΋ ÚˆÙ½ÓË/ÎÚ·ÙÈÓ›ÓË Î·È ÌÂÙÔÓ ˘ÔÏÔÁÈÛÌfi ÙÔ˘ Ú˘ıÌÔ‡ ÛÂÈ-Ú·Ì·ÙÈ΋˜ ‰È‹ıËÛ˘ ÙÔ˘ ·ÛıÂÓ‹Ì ÙË Ì¤ÙÚËÛË Ù˘ ÎÚ·ÙÈÓ›Ó˘ÙÔ˘ ÔÚÔ‡ Î·È ÙȘ ÂÍÈÛÒÛÂȘ Ô˘ÚԷӷʤÚıËηÓ7 (¶›Ó·Î·˜ 1).¶Ú¤ÂÈ Ó· ·Ó·ÊÂÚı› fiÙÈ ÈÛ¯˘Ú‹ÚÔÁÓˆÛÙÈ΋ ·Í›· ¤¯ÂÈ fi¯È ÌfiÓÔ Ë·Ï‚Ô˘ÌÈÓÔ˘Ú›· Û ·ÛıÂÓ›˜ ̯ÚfiÓÈ· ÓÂÊÚÈ΋ ÓfiÛÔ Î·È È‰ÈÔ·ı‹˘¤ÚÙ·ÛË ·ÏÏ¿ Î·È Ë ÔÛÔÛÙÈ·›·Ì›ˆÛ‹ Ù˘ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ıÂڷ›·˜. ¶Ú¿ÁÌ·ÙÈ, ÌÂϤÙ˜¤‰ÂÈÍ·Ó fiÙÈ ÔÔÈÔ˘‰‹ÔÙ ‚·ıÌԇ̛ˆÛË Ù˘ ·Ï‚Ô˘ÌÈÓÔ˘Ú›·˜ ÌÂÙ·-ÊÚ¿˙ÂÙ·È Û ·ÓÙ›ÛÙÔÈ¯Ô˘ ‚·ıÌԇ̛ˆÛË ÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ-‰‡ÓÔ˘36.

·ıËÚÔÛÎÏ‹ÚˆÛË¢∂∫∂ªµƒπ√™ 2005

10

1. Vuppputuri S, Batuman V, Muntner P, etal. Effect of blood pressure on early de-cline in kidney function among hyper-tensive men. Hypertension 2003;42:1144-1149

2. The HOPE investigators. Renal insuffi-ciency as a predictor of cardiovascularoutcomes and the impact of Ramipril:The HOPE randomized trial. Ann InternMed 2001;134:629-636

3. Coresh J, Wei GL, McQuillan G, Bran-cati FL, Levey AS, Jones C, et al. Preva-lence of high blood pressure and eleva-ted serum creatinine level in the UnitedStates: Findings from the third NationalHealth and Nutrition Examination Sur-vey (1988-1994). Arch Intern Med2001;161:1207-1216

4. National Kidney Foundation. K/DOQIclinical practice guidelines for chronickidney disease: evaluation, classifica-tion and stratification. Am J Kidney Dis2002; 39(2 suppl 1):S1-S266

5. Cockroft DW, Gault MH. Prediction ofcreatinine clearance from serum creati-nine. Nephron 1976;16:31-41

µµÈÈ‚‚ÏÏÈÈÔÔÁÁÚÚ··ÊÊ››··

ñ ∞˘ÍË̤Ó˜ Û˘ÁÎÂÓÙÚÒÛÂȘ Lp(a)

ñ ∞ÓÙ›ÛÙ·ÛË ÛÙË ‰Ú¿ÛË Ù˘ ÈÓÛÔ˘Ï›Ó˘

ñ ∞˘ÍË̤ÓÔ ÔÍÂȉˆÙÈÎfi stress

ñ ∞˘ÍË̤ӷ ›‰· Ô˘ÚÈÎÔ‡ ÔͤԘ ÛÙÔÓ ÔÚfi

ñ ∞˘ÍË̤ÓË ‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘ Û˘Ì·ıËÙÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜

ñ ∞‡ÍËÛË ÙˆÓ ÂȤ‰ˆÓ ÙˆÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ¢ԉÒÓÔ˘Ó ÙË ÊÏÂÁÌÔÓ‹(CRP, IL-6, ÈÓˆ‰ÔÁfiÓÔ)

ñ ¶·¯˘Û·ÚΛ·

¶›Ó·Î·˜ 3: ¶·Ú¿ÁÔÓÙ˜ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ Ô˘ Û˘Û¯ÂÙ›˙ÔÓÙ·ÈÌ ÙËÓ ÂÏ¿ÙÙˆÛË ÙÔ˘ Ú˘ıÌÔ‡ ÛÂÈÚ·Ì·ÙÈ΋˜ ‰È‹ıËÛ˘.

¶∞£√ºÀ™π√§√°π∞

11

6. Levey AS, Bosch JP, Lewis JB, et al. Amore accurate method to estimate glo-merular filtration rate from serum creati-nine: a new prediction equation. Modifi-cation of Diet in Renal Disease StudyGroup. Ann Intern Med 1999;130:461-470

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8. Shulman NB, Ford CE, Hall WD, et al.Prognostic value of serum creatinine andeffect of treatment of hypertension on re-nal function. Results from the Hyperten-sion Detection and Follow-up Program.Hypertension 1989;13(5 suppl.):180-193

9. Ruilope LM, Salvetti A, Jamerson K, etal. Renal function and intensive lowe-ring of blood pressure in the hypertensi-ve subjects of the Hypertension Opti-mal Treatment (HOT) study. J Am SocNephrol 2001;12:219-225

10. Ruilope LM, Palmer C, de Leeuw P, etal. Evaluation of different parameters ofrenal function as predictors of primaryoutcome in the INSIGHT study (Ab-stract). J Hypertens 2001;19(Suppl.2):S223

11. De Leeuw P, Thijs L, Birkenhager WH,et al. Prognostic significance of renalfunction in elderly patients with isolatedsystolic hypertension: results from Syst-Eur trial. J Am Soc Nephrol 2002;13:2213-2222

12. Wang JG, Staessen JA, Fagard RH, etal. Prognostic significance of serumcreatinine and uric acid in older Chine-se patients with isolated systolic hyper-tension. Hypertension 2001;37:1069-1074

13. Manjunath G, Tighiouart H, Ibrahim H,et al. Level of kidney function as a riskfactor for atherosclerotic cardiovascularoutcomes in the community. J Am CollCardiol 2003;41:47-55

14. Henry RM, Kostense PJ, Bos G, et al.Mild renal insufficiency is associatedwith increased cardiovascular mortality:The HOORN Study. Kidney Int 2002;62:1402-1407

15. Chobanian A, Bakris GL, Black HR, etal. The Seventh Report of the JointNational Committee on Prevention,Detection, Evaluation, and Treatment ofHigh Blood Pressure. The JNC 7Report. JAMA 2003; 289:2560-2572

16. Kronenberg F, Kuen E, Ritz E, et al. Li-poprotein(a) serum concentrations andapolipoprotein(a) phenotypes in mildand moderate renal failure. J Am SocNephrol 2000;11:105-115

17. Fliser D, Pacini G, Engelleiter R, et al.Insulin resistance and hyperinsulinemiaare already present in patients withincipient renal disease. Kidney Int1998;53:1343-1347

18. Kato Y, Hayashi M, Ohno Y, et al. Mildrenal dysfunction is associated with in-sulin resistance in chronic glomerulone-phritis. Clin Nephrol 2000;54:366-373

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21. Minuz P, Patrignani P, Gaino S, et al. In-creased oxidative stress and plateletactivation in patients with hypertensionand renovascular disease. Circulation2002;106:2800-2805

22. Johnson RJ, Kang DH, Feig D, et al. Isthere a pathogenetic role for uric acid inhypertension and cardiovascular andrenal disease? Hypertension 2003;41:1183-1190

23. Tinnuci T, Abrahao SB, Santello JL,Mion D Jr. Mild chronic renal insuffi-ciency induces sympathetic overacti-vity. J Hum Hypertens 2001;15:401-406

24. Shlipak MG, Fried LF, Crump C, et al.Elevations of inflammatory and procoa-gulant biomarkers in elderly personswith renal insufficiency. Circulation2003;107: 87-92

25. Zoccali C, Menon V, Wang X, et al. Re-lationship between C-reactive protein,albumin and cardiovascular disease inpatients with chronic kidney disease.Am J Kidney Dis 2003;42:44-52

26. De Jong PE, Verhave JC, Pinto-SietsmaSJ, Hillege HL, for the PREVEND study

group. Obesity and target organ dama-ge: the kidney. Int J Obesity 2002; 26(Suppl. 4):S21-S24

27. Pinto-Sietsma SJ, Navis G, JanssenWMT, et al. for the PREVEND studygroup. A central body fat distribution isrelated to renal function impairment,even in lean subjects. Am J Kidney Dis2003;41:733-741

28. Mc Cullough PA. Why is chronic kidneydisease the "spoiler" for cardiovascularoutcomes? J Am Coll Cardiol 2003;41:725-728

29. Mahom NJ, Blackstone EH, Francis GS,et al. The prognostic value of estimatedcreatinine clearance alongside functio-nal capacity in ambulatory patients withchronic congestive heart failure. J AmColl Cardiol 2002;40:1106-1113

30. Reis SE, Olson MB, Fried L, et al. Mildrenal insufficiency is associated withangiographic coronary artery disease inwomen. Circulation 2002;105:2826-2829

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32. Clermont G, Acker CG, Angus DC, et al.Renal failure in the ICU:comparison ofthe impact of acute renal failure andend-stage renal disease on ICUoutcomes. Kidney Int 2002;62:986-996

33. Guidelines Committee. 2003 EuropeanSociety of Hypertension – European So-ciety of Cardiology guidelines for themanagement of arterial hypertension. JHypertens 2003;21:1011-1053

34. Wright JT Jr, Bakris G, Greene T, et al.for the African-American Study of Kid-ney Disease and Hypertension StudyGroup. Effect of blood pressure lowe-ring and antihypertensive drug class onprogression of hypertensive kidneydisease: results from the AASK trial.JAMA 2002; 288:2421-2431

35. Segura J, Campo C, Rodicio JL, Ruilo-pe LM. ACE inhibitors and appearanceof renal events in hypertensive nephro-sclerosis. Hypertension 2001;38:645-649

36. The Losartan Intervention for EndpointReduction in Hypertension Study group.Reduction in Albuminuria Translates toReduction in Cardiovascular Events inHypertensive Patients. Hypertension2005; 45:198-202

¶ÚfiÛÊ·Ù· ‰ËÌÔÛȇÙËΠÙÔ·ÓÙÈ˘ÂÚÙ·ÛÈÎfi ÛΤÏÔ˜Ù˘ ÌÂϤÙ˘ Anglo-Scandi-

navian Cardiac Outcomes TrialÙÔ ASCOT-BPLA1. To ˘ÔÏÈÈ-‰·ÈÌÎfi ÛΤÏÔ˜ Ù˘ ›‰È·˜ ÌÂϤÙ˘(ASCOT- LLA) ›¯Â ‰Â›ÍÂÈ fiÙÈ Ë¯ÔÚ‹ÁËÛË ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ 10mg Û ˘ÂÚÙ·ÛÈο ¿ÙÔÌ· ÌÂ Ê˘-ÛÈÔÏÔÁÈο ‹ ÂÏ·ÊÚ¿ ·˘ÍË̤ӷ›‰· ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘(≤250 mg/dL) ÌÂÈÒÓÂÈ ÛËÌ·ÓÙÈοٷ ηډȷÁÁÂȷο ÂÂÈÛfi‰È·.2

™ÙÔ ·ÓÙÈ˘ÂÚÙ·ÛÈÎfi ÛΤÏÔ˜Ù˘ ASCOT Û˘ÁÎÚ›ıËÎ·Ó ‰‡ÔÊ·Ú̷΢ÙÈΤ˜ ÛÙÚ·ÙËÁÈΤ˜. ∏ÚÒÙË ÛÙÚ·ÙËÁÈ΋ ¯ÚËÛÈÌÔÔ›Ë-Û ηÈÓÔ‡ÚÁÈ· Ê¿Ú̷η Ô˘ Â-ÚÈÂÏ¿Ì‚·Ó ·ÌÏԉțÓË (5-10mg) Î·È ·Ó ¯ÚÂÈ·˙fiÙ·Ó ÂÚÈÓ‰Ô-Ú›ÏË (4-8 mg) Î·È Ë ‰Â‡ÙÂÚË·ÙÂÓÔÏfiÏË (50-100 mg) Î·È ·Ó¯ÚÂÈ·˙fiÙ·Ó ‰ÈÔ˘ÚËÙÈο.

¶ÂÚ›Ô˘ 20.000 ˘ÂÚÙ·ÛÈÎÔ›(›‰· ∞¶ ≥ 160/100 mmHg¯ˆÚ›˜ ıÂڷ›· ‹ - ≥ 140/90mmHg ˘fi ıÂڷ›·) ËÏÈΛ·˜ 40¤ˆ˜ 79 ÂÙÒÓ Î·È ˘„ËÏÔ‡ ÎÈÓ‰‡-ÓÔ˘ ·ÛıÂÓ›˜ (Ì ÙÔ˘Ï¿¯ÈÛÙÔÓ 3·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘) ηٷÓÂÌ‹-ıËÎ·Ó Ù˘¯·›· ÛÙ· ÚÔ·Ó·ÊÂÚı¤-ÓÙ· ıÂڷ¢ÙÈο Û¯‹Ì·Ù·. ∏ ÌÂ-ϤÙË ‰È‹ÚÎÂÛ 5,4 ¯ÚfiÓÈ· Î·È ÏÈ-ÁfiÙÂÚÔ ÙÔ˘ 2% ¯¿ıËÎ·Ó ÛÙË ·-Ú·ÎÔÏÔ‡ıËÛË. ∫ÚÈÙ‹ÚÈ· ·ÔÎÏÂÈ-ÛÌÔ‡ ·fi ÙËÓ ÌÂϤÙË ‹Ù·Ó ·ÛıÂ-Ó›˜ Ì ÈÛÙÔÚÈÎfi ÂÌÊÚ¿ÁÌ·ÙÔ˜ÙÔ˘ Ì˘Ôηډ›Ô˘, ÛÙËı¿Á¯Ë ˘fiıÂڷ›·, ÚfiÛÊ·ÙÔ ÂÁÎÂÊ·ÏÈÎfiÌË ÂÏÂÁ¯fiÌÂÓ˜ ·ÚÚ˘ı̛˜ ηÈηډȷ΋ ·Ó¿ÚÎÂÈ·.

√È ıÂڷ¢ÙÈÎÔ› ÛÙfi¯ÔÈ ‹Ù·Ó›‰· ∞¶ <140/90 mmHg ÁÈ··ÛıÂÓ›˜ ¯ˆÚ›˜ ‰È·‚‹ÙË Î·È<130/80 ÁÈ· ·ÛıÂÓ›˜ Ì ‰È·‚‹-ÙË.

∏ ÌÂϤÙË ÛÙ·Ì¿ÙËÛ ÚfiˆÚ·(fiˆ˜ Î·È Ë ASCOT–LLA) ÛÙ·903 ÂÂÈÛfi‰È· Î·È fi¯È ÛÙ· 1.150Ô˘ ›¯·Ó ۯ‰ȷÛı› ÏfiÁˆ ·˘-ÍË̤Ó˘ Û˘¯ÓfiÙËÙ·˜ ı·Ó¿ÙˆÓÛÙËÓ ÔÌ¿‰· Ù˘ ·ÙÂÓÔÏfiÏ˘. ™ÙÔ

Ù¤ÏÔ˜ Ù˘ ÌÂϤÙ˘ Ë ÏÂÈÔ„ËÊ›·ÙˆÓ ·ÛıÂÓÒÓ (78%) ¤·ÈÚÓ ÙÔ˘-Ï¿¯ÈÛÙÔÓ ‰‡Ô Ê¿Ú̷η Î·È ÌfiÓÔ15% Î·È 9% ¤·ÈÚÓ ·ÌÏԉțÓË‹ ·ÙÂÓÔÏfiÏË Û·Ó ÌÔÓÔıÂڷ›··ÓÙ›ÛÙÔȯ·.

™ÙËÓ ÙÂÏÈ΋ ·Ó¿Ï˘ÛË Ù˘ ÌÂ-ϤÙ˘ Ù· ı·Ó·ÙËÊfiÚ· Î·È ÌË ı·-Ó·ÙËÊfiÚ· ÂÂÈÛfi‰È· (ÚˆÙÔÁÂ-Ó¤˜ ÙÂÏÈÎfi ÛËÌ›Ô) ÌÂÈÒıËÎ·Ó Î·-Ù¿ 10% ÛÙËÓ ÔÌ¿‰· Ù˘ ·ÌÏÔ‰È-›Ó˘ ·ÏÏ¿ ·˘Ùfi ‰ÂÓ ‹Ù·Ó ÛËÌ·-ÓÙÈο ÛÙ·ÙÈÛÙÈÎfi. ™ÙËÓ ÔÚ›·Ù˘ ÌÂϤÙ˘ ÔÈ ÂÚ¢ÓËÙ¤˜ –ÏfiÁˆ·˘ÍË̤Ó˘ Û˘¯ÓfiÙËÙ·˜ ÂÂÌ‚¿-ÛÂˆÓ ÛÙ· ÛÙÂÊ·ÓÈ·›·– ÚÔÛ¤ıÂ-Û·Ó Î·È ¿ÏÏÔ ¤Ó· ÚˆÙÔÁÂÓ¤˜ ÙÂ-ÏÈÎfi ÛËÌÂ›Ô ·˘Ùfi Ù˘ ·ӷÁÁ›-ˆÛ˘ ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ. ∆Ô ÙÚÔ-ÔÔÈË̤ÓÔ ÙÂÏÈÎfi ÛËÌÂ›Ô ÌÂÈÒ-ıËΠÛËÌ·ÓÙÈο ηٿ 14%. ∂›-Û˘ ÌÂÈÒıËÎ·Ó ÛËÌ·ÓÙÈο Ë Î·Ú-‰È·ÁÁÂȷ΋ Î·È ÔÏÈ΋ ıÓËÙfiÙËٷηٿ 24% Î·È 11% ·ÓÙ›ÛÙÔȯ·,Î·È Ù· ı·Ó·ÙËÊfiÚ· Î·È ÌË ı·Ó·-ÙËÊfiÚ· ÂÁÎÂÊ·ÏÈο ηٿ 23%.¶·ÚÔÌÔ›ˆ˜ ¤Ó· Û˘Ó‰˘·Ṳ̂ÓÔ ÙÂ-ÏÈÎfi ÛËÌÂ›Ô Û‡ÓËı˜ Û ÎÏÈÓÈΤ˜ÌÂϤÙ˜ ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ ÂΛÓÔÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ ı·Ó¿ÙÔ˘, ÌËı·Ó·ÙËÊfiÚÔ˘ ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘Ì˘Ôηډ›Ô˘ Î·È ÂÁÎÂÊ·ÏÈÎÔ‡ ÌÂÈ-ÒıËΠÛÙËÓ ÔÌ¿‰· Ù˘ ·ÌÏԉț-Ó˘ ηٿ 16%.

∆Ô fiÊÂÏÔ˜ Ê·›ÓÂÙ·È Ó· ÔÊ›-ÏÂÙ·È ÛÙË ÌÂÁ·Ï‡ÙÂÚË Ì›ˆÛËÙ˘ ›ÂÛ˘ Ô˘ ÛËÌÂÈÒıËΠÛÙËÓÔÌ¿‰· Ù˘ ·ÌÏԉțÓ˘ Î·È ‹Ù·Ó5,9/2,4 mmHg ÛÙÔ˘˜ 3 Ì‹Ó˜ ηÈÌ›· ̤ÛË ‰È·ÊÔÚ¿ ›ÂÛ˘ 2,7/1,9mmHg ÛÙÔ Ù¤ÏÔ˜ Ù˘ ÌÂϤÙ˘.∆Ô ÛËÌ·ÓÙÈÎfi fiÊÂÏÔ˜ Ô˘ ·Ú·-ÙËÚ‹ıËΠÛÙÔ˘˜ ˘ÂÚÙ·ÛÈÎÔ‡˜·ÛıÂÓ›˜ ÛÙËÓ ÔÌ¿‰· Ù˘ ·ÌÏÔ-‰È›Ó˘ ÙÔÓ›ÛıËÎÂ Î·È Û ¿ÏÏËÌÂϤÙË Ô˘ Û˘Ófi‰Â˘Â ÙÔ Î‡ÚÈ·ÌÂϤÙË3. ™’ ·˘Ù‹ ÙË ‰Â‡ÙÂÚË ÌÂ-ϤÙË ÔÈ ÂÚ¢ÓËÙ¤˜ ‰ÂÓ Û˘Ìʈ-ÓÔ‡Ó Ì ÙËÓ ÂÍ‹ÁËÛË fiÙÈ ÙÔ fiÊÂ-ÏÔ˜ ·Ô‰›‰ÂÙ·È ÛÙË Ì›ˆÛË Ù˘·ÚÙËÚȷ΋˜ ›ÂÛ˘. ÿÛˆ˜ Ë ‰È·-ÊÔÚÂÙÈ΋ ·ÏÏËÏ·ÓÙ›‰Ú·ÛË Ù˘·ÌÏԉțÓ˘ Ì ÙË ÛÙ·Ù›ÓË Â›Ó·È¤Ó·˜ Èı·Ófi˜ ·Ú¿ÁÔÓÙ·˜ Ô˘Ó· ÌÔÚ› Ó· ÂÍËÁ› ¤Ó· ̤ÚÔ˜·fi ÙÔ fiÊÂÏÔ˜.

ŒÓ· ¿ÏÏÔ ‰˘ÓËÙÈÎfi fiÊÂÏÔ˜Ô˘ ÚԤ΢„ ÛÙË ÌÂϤÙË AS-COT–µPLA ‹Ù·Ó Ë Î·Ù¿ 30% ÛË-Ì·ÓÙÈ΋ Ì›ˆÛË ÂÌÊ¿ÓÈÛ˘ Û·Î-¯·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ 2 ÛÙËÓÔÌ¿‰· Ù˘ ·ÌÏԉțÓ˘. ∆Ô ÂÚÒ-ÙËÌ· ·Ó ·˘Ùfi ÔÊ›ÏÂÙ·È ÛÙÔÓÛ˘Ó‰˘·ÛÌfi ·ÌÏԉțÓ˘ ÂÚÈÓ-‰ÔÚ›Ï˘ ‹ Û Âȉ›ӈÛË ·fiÙÔÓ Û˘Ó‰˘·ÛÌfi ·ÙÂÓÔÏfiÏ˘ ‰È-Ô˘ÚËÙÈÎÒÓ ‰ÂÓ ÌÔÚ› Ó· ··-ÓÙËı›. ∆Ô ›‰ÈÔ ÂÚÒÙËÌ· ÂÍ¿ÏÏԢ›¯Â ÙÂı› Î·È ÛÙËÓ ÂÚÌËÓ›· ·-ÚÔÌÔ›Ô˘ Â˘Ú‹Ì·ÙÔ˜ Ì ÙË Û‡-ÁÎÚÈÛË ·ÙÂÓÔÏfiÏ˘ Î·È ÏÔÛ·ÚÙ¿-Ó˘ ÛÙË ÌÂϤÙË LIFE.

√ ·ÚÈıÌfi˜ ÙˆÓ ·ÛıÂÓÒÓ Ô˘Ú¤ÂÈ Ó· ıÂڷ¢ı› ÁÈ· ¤Ó·¤ÙÔ˜ ÁÈ· Ó· ÚÔÏËÊı› 1 ηÚ-‰È·ÁÁÂÈ·Îfi Û˘Ì‚¿Ó ‹ 1 ı¿Ó·ÙÔ˜Â›Ó·È 220 Î·È 650 ·ÓÙ›ÛÙÔȯ·. √·ÚÈıÌfi˜ Ê·›ÓÂÙ·È ÌÈÎÚfi˜ ÁÈ· Ù· 5¯ÚfiÓÈ· ·ÏÏ¿ ·Ó ηÓ›˜ Ï¿‚ÂÈ ˘fifi„ÈÓ ÙÔ˘ fiÙÈ ÚfiÎÂÈÙ·È ÁÈ· Ì·-ÎÚÔ¯ÚfiÓÈ· ıÂڷ›· ·ÔÎÙ¿ ÌÂ-Á·Ï‡ÙÂÚË ·Í›·.

√ ÛÙfi¯Ô˜ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛËÙ˘ ∞¶ ηıÔÚ›˙ÂÙ·È ·fi ÙË ·-ÚÔ˘Û›· ‹ ÌË ‚Ï¿‚˘ ÛÙ· fiÚÁ·Ó·ÛÙfi¯Ô˘˜, ‰È·‚‹ÙË ‹ ¿ÏÏˆÓ Î·Ú-

·ıËÚÔÛÎÏ‹ÚˆÛË¢∂∫∂ªµƒπ√™ 2005

12

¶ÔÈfi ı· ∂›Ó·È ÙÔ ∞ÓÙÈ˘ÂÚÙ·ÛÈÎfi ¶ÚÒÙ˘∂ÈÏÔÁ‹˜;

πˆ¿ÓÓ˘ °Ô˘‰¤‚ÂÓÔ˜, ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜-∫·Ú‰ÈÔÏÔÁ›·˜, π·ÙÚÈ΋ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ

‰È·ÁÁÂÈ·ÎÒÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡-ÓÔ˘ Î·È ÔÈ Û˘ÛÙ¿ÛÂȘ ‚·Û›˙ÔÓÙ·ÈÛ ·ÔÙÂϤÛÌ·Ù· ÌÂÁ¿ÏˆÓ ÎÏÈÓÈ-ÎÒÓ ÌÂÏÂÙÒÓ Î·È Û˘ÛÙ¿ÛÂˆÓ ÙˆÓÂÈÙÚÔÒÓ Ô‰ËÁÈÒÓ. ∆ÒÚ·, ·Ó ËÌÂϤÙË ASCOT ı· ·ÏÏ¿ÍÂÈ ÙȘηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ Î·È ı·Û˘ÛÙ‹ÛÂÈ ·ÓÙ·ÁˆÓÈÛÙ‹ ·Û‚ÂÛÙ›-Ô˘ Ì ‹ ¯ˆÚ›˜ ·ÓÙ·ÁˆÓÈÛÙ‹ ÙÔ˘¿ÍÔÓ· ÚÂÓ›Ó˘- ·ÁÁÂÈÔÙ·Û›ÓË˜Û·Ó ÚÒÙË ÂÈÏÔÁ‹, ·Ú·Ì¤ÓÂÈ

¿ÁÓˆÛÙÔ. ∆· ‰ÈÔ˘ÚËÙÈο Û›ÁÔ˘Ú·ı· ·Ú·Ì›ÓÔ˘Ó Û·Ó Û˘ÌÏËÚˆ-Ì·ÙÈ΋ ıÂڷ›·. ∏ ·Í›· ÙˆÓ ‚-·Ó·ÛÙÔϤˆÓ ÛÙÔ˘˜ ·ÛıÂÓ›˜ ̤ÌÊÚ·ÁÌ· Ì˘Ôηډ›Ô˘ Â›Ó·È Î·-Ï¿ ÙÂÎÌËÚȈ̤ÓË. ¢ÂÓ Ú¤ÂÈ Ó·Ì·˜ ‰È·Ê‡ÁÂÈ fiÙÈ ÔÈ ˘ÂÚÙ·ÛÈÎԛ̠¤ÌÊÚ·ÁÌ· ‹ ÛÙËı¿Á¯Ë ·ÔÙÂ-ÏÔ‡Û·Ó ÎÚÈÙ‹ÚÈ· ·ÔÎÏÂÈÛÌÔ‡Ù˘ ÌÂϤÙ˘ ASCOT Î·È Û˘ÓÂÒ˜Ë ÂÚÌËÓ›· ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ

Ú¤ÂÈ Ó· Á›ÓÂÙ·È Ì ÚÔÛÔ¯‹ Û·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓ›˜. ∏ ·Í›·fï˜ Ù˘ ·ÙÂÓÔÏfiÏ˘ (ÛÂ Û˘Ó-‰˘·ÛÌfi Ì ‰ÈÔ˘ÚËÙÈο Â›Ó·È ·fiÙ· ÈÔ Û˘¯Ó¿ Û˘ÓÙ·ÁÔÁÚ·ÊÔ‡ÌÂ-Ó· ·ÓÙÈ˘ÂÚÙ·ÛÈο Û¯‹Ì·Ù·) ¤¯ÂÈ·ÌÊÈÛ‚ËÙËı› ÚfiÛÊ·Ù· 4 Î·È ËÙ‡¯Ë Ù˘ ÌÂÙ¿ Î·È ·fi ·˘Ù‹ ÙËÌÂϤÙË Á›ÓÂÙ·È ÚÔ‚ÏËÌ·ÙÈÎfiÙÂ-ÚË.

13

∫§π¡π∫∂™ ª∂§∂∆∂™

1. Sever PS, Dahlof B, Poulter NR, et al.Prevention of coronary and strokeevents with atorvastatin in hypertensivepatients who have average or lower-than-average cholesterol concentra-tions, in the Anglo-Scandinavian CardiacOutcomes Trial-Lipid Lowering Arm(ASCOT-LLA): a multicentre randomisedcontrolled trial. Lancet 2003; 336611:1149–58.

2. Dahlff B, Sever PS, Poulter NR, et al.Prevention of cardiovascular events withan antihypertensive regimen of am-lodipine adding perindopril as requiredversus atendol adding bendroflume-thiazide as required, in the Anglo-Scan-dinavian Cardiac Outcomes Trial-BloodPressure Lowering arm (ASCOT-BPLA):a multicentre randomised controlledtrial. Lancet 2005; 336666: 895–906

3. Poulter NR, Wedel H, Dahlfif B, et al. Ro-le of blood pressure and other variablesin the differential cardiovascular eventrates noted in the Anglo-ScandinavianCardiac Outcomes Trial-Blood PressureLowering Arm (ASCOT-BPLA). Lancet2005; 336666: 907–13

4. Carlberg B, Samuelsson O, LindholmLH. Atenolol in hypertension: is it a wisechoice? Lancet 2004; 336644: 1684–89.

µµÈÈ‚‚ÏÏÈÈÔÔÁÁÚÚ··ÊÊ››··

ÕÓ‰Ú·˜ ËÏÈΛ·˜ 44 ÂÙÒÓ ÚÔ-Û‹Ïı ÛÙÔ È·ÙÚÂ›Ô ÏÈȉ›ˆÓÌÂ Û˘ÌÙÒÌ·Ù· ÂÚÈÊÂÚÈ΋˜

·ÁÁÂÈÔ¿ıÂÈ·˜. ™ÙË Ê˘ÛÈ΋ Âͤٷ-ÛË ‰È·ÈÛÙÒıËÎÂ Ë ‡·ÚÍË Ô˙ˆ-‰ÒÓ Í·ÓıˆÌ¿ÙˆÓ ÛÙÔ˘˜ ·ÁÎÒÓÂ˜Î·È ·Ï·ÌÈ·›ˆÓ Í·ÓıˆÌ¿ÙˆÓ (∂ÈÎfi-Ó˜ 1, 2). √ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ-¯Ô˜ ¤‰ÂÈÍÂ: ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË1.055 mg/dl, TRG 2.900 mg/dl,HDL-¯ÔÏËÛÙÂÚfiÏË 18 mg/dl ηÈÁÏ˘Îfi˙Ë 300 mg/dl.

¢ÔÎÈÌ¿ÛÙ ÙȘ ÁÓÒÛÂȘ ÚÈӉȷ‚¿ÛÂÙ ٷ Û¯fiÏÈ·.

1. H ·Ó‡ÚÂÛË ·Ï·ÌÈ·›ˆÓ Í·Ó-ıˆÌ¿ÙˆÓ Â›Ó·È ¯·Ú·ÎÙËÚÈÛÙÈ-Îfi ‡ÚËÌ· Ù˘·) ÔÈÎÔÁÂÓÔ‡˜ ˘ÂÚ¯ÔÏËÛÙÂ-

ÚÔÏ·ÈÌ›·˜‚) ÔÈÎÔÁÂÓÔ‡˜ ¯˘ÏÔÌÈÎÚÔÓ·È-

Ì›·˜Á) ‰˘Û‚ËÙ·ÏÈÔÚˆÙÂïÓ·ÈÌ›·˜‰) ÔÈÎÔÁÂÓÔ‡˜ Û˘Ó‰˘·Ṳ̂Ó˘

˘ÂÚÏÈȉ·ÈÌ›·˜

2. ™Â fiÏ· Ù· ·Ú·Î¿Ùˆ Â›Ó·È ‰˘-Ó·ÙfiÓ Ó· ·Ú·ÙËÚËıÔ‡Ó ·-Ï·ÌÈ·›· Í·ÓıÒÌ·Ù· ÂÎÙfi˜ ·fi·) ÚˆÙÔ·ı‹ ¯ÔÏÈ΋ ΛÚÚˆÛË‚) ·Ú·ÚˆÙÂïÓ·ÈÌ›·Á) ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ‰) ˘ÂÚÏÈȉ·ÈÌ›· Ù‡Ô˘ πππ

3. ŸÏ· Ù· ·Ú·Î¿Ùˆ ‚ÔËıÔ‡ÓÛÙË ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘,ÂÎÙfi˜ ·fi·) ‰˘ÛÏÈȉ·ÈÌ›· Ì TRG/TC =

2/1‚) ÂÚÈÊÂÚÈ΋ ·ÁÁÂÈÔ¿ıÂÈ·Á) Í·ÓıÒÌ·Ù·‰) Û˘ÁΤÓÙÚˆÛË ÁÏ˘Îfi˙˘

ÓËÛÙ›·˜Â) ·˘ÍË̤ӷ ›‰· LDL

¯ÔÏËÛÙÂÚfiÏ˘

4. °È· ÙË Ê·ÈÓÔÙ˘È΋ ¤ÎÊÚ·ÛËÙ˘ ÓfiÛÔ˘ Â›Ó·È ··Ú·›ÙËÙË·) ÁÂÓÂÙÈ΋ Ì›ˆÛË Ù˘ ‰Ú·-

ÛÙËÚÈfiÙËÙ·˜ ÙˆÓ LDL ˘Ô-‰Ô¯¤ˆÓ

‚) ›ÎÙËÙË ‰È·Ù·Ú·¯‹ Ô˘ÂËÚ¿˙ÂÈ ÙËÓ Ë·ÙÈ΋ ·-Ú·ÁˆÁ‹ ÙˆÓ ÏÈÔÚˆÙÂïÓÒÓ‹ ÙÔÓ Î·Ù·‚ÔÏÈÛÌfi ÙÔ˘˜

Á) ÁÂÓÂÙÈ΋ ‰È·Ù·Ú·¯‹ Ô˘Ô‰ËÁ› Û Ì›ˆÛË Ù˘ ‰Ú·-ÛÙËÚÈfiÙËÙ·˜ Ù˘ ÏÈÔÚˆ-ÙÂïÓÈ΋˜ ÏÈ¿Û˘

‰) ÁÂÓÂÙÈ΋ ‰È·Ù·Ú·¯‹ Ô˘Ô‰ËÁ› Û Ì›ˆÛË Ù˘ Ë·-ÙÈ΋˜ ·Ú·ÁˆÁ‹˜ ÙˆÓ ÏÈÔ-ÚˆÙÂïÓÒÓ

5. ŸÏ˜ ÔÈ ·Ú·Î¿Ùˆ ·ıÔÏÔÁÈ-Τ˜ ÔÓÙfiÙËÙ˜ ÌÔÚÔ‡Ó Ó·ÂËÚ¿ÛÔ˘Ó ÙÔ ÌÂÙ·‚ÔÏÈÛÌfiÙˆÓ ÏÈÔÚˆÙÂïÓÈÎÒÓ Î·Ù·-ÏÔ›ˆÓ, ÂÎÙfi˜ ·fi·) ˘Ôı˘ÚÂÔÂȉÈÛÌfi˜ ‚) ·¯˘Û·ÚΛ· Á) ·ÏÎÔÔÏÈÛÌfi˜‰) ¯ÔÏfiÛÙ·ÛË

6. ŸÛÔÓ ·ÊÔÚ¿ ÙËÓ ˘ÔΛÌÂÓËÁÂÓÂÙÈ΋ ‰È·Ù·Ú·¯‹ Ô˘ ¯·-Ú·ÎÙËÚ›˙ÂÈ ÙË ÓfiÛÔ·) ÔÈ ·ÛıÂÓ›˜ Â›Ó·È ÔÌÔ˙˘ÁÒ-

Ù˜ ∂2∂2‚) ÔÈ ·ÛıÂÓ›˜ ¤¯Ô˘Ó ÌÂÙ¿ÏÏ·-

ÍË ÙÔ˘ ÁÔÓȉ›Ô˘ Ô˘ Έ‰È-ÎÔÔÈ› ÙËÓ Ë·ÙÈ΋ ÏÈ¿ÛË

Á) ÔÈ ·ÛıÂÓ›˜ ¤¯Ô˘Ó ÌÂÙ¿ÏÏ·-ÍË ÙÔ˘ ÁÔÓȉ›Ô˘ Ô˘ Έ‰È-ÎÔÔÈ› ÙËÓ LCAT

‰) ÔÈ ·ÛıÂÓ›˜ ¤¯Ô˘Ó ÌÂÙ¿ÏÏ·-ÍË ÙÔ˘ ÁÔÓȉ›Ô˘ Ô˘ Έ‰È-ÎÔÔÈ› ÙËÓ ·ÔÏÈÔÚˆÙÂ˚-ÓË ∞-IV

7. √È ·ÛıÂÓ›˜ Ì ‰˘Û‚ËÙ·ÏÈÔ-ÚˆÙÂïÓ·ÈÌ›· ÂÌÊ·Ó›˙Ô˘Ó Û˘-Ó‹ıˆ˜ ·) ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ·ÁÎÚÂ-

·Ù›Ùȉ·˜‚) ȉȷ›ÙÂÚ· ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ

ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ÂÚÈÊÂÚÈ-΋˜ ·ÁÁÂÈÔ¿ıÂÈ·˜

Á) ȉȷ›ÙÂÚ· ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ·ÚÔ‰È-ÎÔ‡ ÈÛ¯·ÈÌÈÎÔ‡ ÂÁÎÂÊ·ÏÈ-ÎÔ‡ ÂÂÈÛÔ‰›Ô˘

‰) ȉȷ›ÙÂÚ· ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ıÚfiÌ‚ˆ-Û˘ ÙˆÓ ·ÁÁ›ˆÓ ÙÔ˘ ·ÌÊÈ-‚ÏËÛÙÚÔÂȉԇ˜

8. ŸÏ· Ù· ·Ú·Î¿Ùˆ ·ÔÙÂÏÔ‡ÓıÂڷ¢ÙÈο ̤۷ ÁÈ· ÙËÓ·ÓÙÈÌÂÙÒÈÛË Ù˘ ˘ÂÚÏÈÈ-‰·ÈÌ›·˜ Ù‡Ô˘ πππ ÂÎÙfi˜ ·fi·) ·ÓÙÈÌÂÙÒÈÛË Ù˘ ˘ÔΛÌÂ-

Ó˘ ÓfiÛÔ˘‚) ‰›·ÈÙ· Á) ÊÈÌÚ¿Ù˜ ± ÛÙ·Ù›Ó˜‰) ¯ÔÏÂÛÙ˘Ú·Ì›ÓË

™¯fiÏÈ·∏ ÔÈÎÔÁÂÓ‹˜ ˘ÂÚÏÈÔÚˆÙÂïÓ·ÈÌ›·Ù‡Ô˘ πππ (‰˘Û‚ËÙ·ÏÈÔÚˆÙÂïÓ·È-Ì›·) ·ÔÙÂÏ› Ì›· ÁÂÓÂÙÈ΋ ‰È·Ù·-Ú·¯‹ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ ÏÈÔ-ÚˆÙÂïÓÒÓ, Ë ÔÔ›· ¯·Ú·ÎÙËÚ›˙Â-Ù·È ·fi ÙË Û˘ÛÛÒÚ¢ÛË ÏÈÔÚˆ-ÙÂïÓÈÎÒÓ Î·Ù·ÏÔ›ˆÓ (remnants)ÛÙÔ Ï¿ÛÌ· Î·È ÙËÓ ·Ó¿Ù˘ÍËÚÒÈÌ˘ ·ıËڈ̷ÙÈ΋˜ ÓfiÛÔ˘.

∏ ·ÚÈ· ÌÔÚȷ΋ ‰È·Ù·Ú·¯‹ Ù˘ÓfiÛÔ˘ ·ÊÔÚ¿ ÙËÓ ·ÚÔ˘Û›· ÂÏ·Ù-و̷ÙÈ΋˜ ˆ˜ ÚÔ˜ ÙËÓ ÈηÓfiÙËÙ·Û‡Ó‰ÂÛ˘ Ì ÙÔ˘˜ ÏÈÔÚˆÙÂïÓÈ-ÎÔ‡˜ ˘Ô‰Ô¯Â›˜ ·ÔÏÈÔÚˆÙÂ˚Ó˘(Apo) E (∂ÈÎfiÓ· 3). ∏ ApoE ‚Ú›ÛÎÂ-Ù·È Ê˘ÛÈÔÏÔÁÈο ÛÙ· ηٿÏÔÈ· ÙˆÓ¯˘ÏÔÌÈÎÚÒÓ Î·È ÙˆÓ VLDL (IDL) ηÈÛ˘Ó‰¤ÂÙ·È Ì ÙÔ˘˜ Ë·ÙÈÎÔ‡˜ ˘Ô-‰Ô¯Â›˜ Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÚfiÛÏË-„Ë ·˘ÙÒÓ ÙˆÓ Î·Ù·ÏÔ›ˆÓ ·fi ÙÔ‹·Ú. À¿Ú¯Ô˘Ó ÙÚÂȘ ÈÛÔÌÔÚʤ˜Ù˘ ApoE (∂2, ∂3, ∂4) Ô˘ ‰È·Ê¤-ÚÔ˘Ó ˆ˜ ÚÔ˜ ÙËÓ ÈηÓfiÙËÙ· Û‡Ó-‰ÂÛ˘ Ì ÙÔÓ ˘Ô‰Ô¯¤·. ™˘ÁÎÂÎÚÈ-̤ӷ, Ë ÈÛÔÌÔÚÊ‹ ∂2 ¤¯ÂÈ ÙË ÌÈÎÚfi-ÙÂÚË ÈηÓfiÙËÙ· Û‡Ó‰ÂÛ˘ Ì ÙÔÓ˘Ô‰Ô¯¤· Î·È Ë ÈÛÔÌÔÚÊ‹ ∂4 ÙËÌÂÁ·Ï‡ÙÂÚË. ŒÙÛÈ, ÔÈ ·ÛıÂÓ›˜Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ˘ÂÚÏÈȉ·ÈÌ›·Ù‡Ô˘ πππ Â›Ó·È ÔÌÔ˙˘ÁÒÙ˜ ˆ˜ÚÔ˜ ÙËÓ ∂2 (∂2∂2). ∏ ·ÚÔ˘Û›··˘Ù‹˜ Ù˘ ÁÂÓÂÙÈ΋˜ ‰È·Ù·Ú·¯‹˜¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙË ÌÂȈ̤ÓËÚfiÛÏË„Ë ÙˆÓ Î·Ù·ÏÔ›ˆÓ ÙˆÓ ¯˘-ÏÔÌÈÎÚÒÓ Î·È ÙˆÓ VLDL ·fi ÙÔ‹·Ú Î·È Û˘ÓÂÒ˜ ÙË Û˘ÛÛÒÚÂ˘Û‹ÙÔ˘˜ ÛÙÔ Ï¿ÛÌ·.

∏ Û˘¯ÓfiÙËÙ· ÙÔ˘ ÁÔÓÔÙ‡Ô˘∂2∂2 ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi ›ӷÈ1/100, ÂÓÒ Ë Â›ÙˆÛË Ù˘ ˘ÂÚÏÈ-ȉ·ÈÌ›·˜ Ù‡Ô˘ πππ ÂÎÙÈÌ¿Ù·È ÛÂ1/10000. ∞˘Ùfi ÛËÌ·›ÓÂÈ fiÙÈ ÌfiÓÔÙÔ 1% ÙˆÓ ÔÌÔ˙˘ÁˆÙÒÓ ∂2∂2 ÂÎ-ÊÚ¿˙Ô˘Ó ÎÏÈÓÈο ÙË ÓfiÛÔ. ÃÚÂÈ¿˙Â-Ù·È Ì›· ÂÈÚfiÛıÂÙË ‰È·Ù·Ú·¯‹Ô˘ ı· ·˘Í‹ÛÂÈ ÙËÓ ·Ú·ÁˆÁ‹ÙˆÓ ÏÈÔÚˆÙÂïÓÈÎÒÓ Î·Ù·ÏÔ›-ˆÓ Î·È Ë ÔÔ›· ÛÂ Û˘Ó‰˘·ÛÌfiÌ ÙÔÓ ÂÏ·Ùو̤ÓÔ Î·Ù·‚ÔÏÈÛÌfiÙÔ˘˜ ı· ÚÔηϤÛÂÈ ÙË Ê·ÈÓÔÙ˘-È΋ ÂΉ‹ÏˆÛË Ù˘ ÓfiÛÔ˘. √È ÈÔÛ˘¯Ó¤˜ ‰È·Ù·Ú·¯¤˜ Ô˘ ‰È·‰Ú·Ì·-Ù›˙Ô˘Ó Î·ıÔÚÈÛÙÈÎfi ÚfiÏÔ ÛÙËÓ ÎÏÈ-ÓÈ΋ ÂÌÊ¿ÓÈÛË Ù˘ ˘ÂÚÏÈȉ·ÈÌ›·˜Ù‡Ô˘ πππ Â›Ó·È Ô Û·Î¯·Ú҉˘ ‰È·-

·ıËÚÔÛÎÏ‹ÚˆÛË¢∂∫∂ªµƒπ√™ 2005

14

∂ӉȷʤÚÔÓ ¶ÂÚÈÛÙ·ÙÈÎfi

∂ÈÚ‹ÓË °·˙‹, ∂ÈÛÙËÌoÓÈÎfi˜ ™˘ÓÂÚÁ¿Ù˘ π·ÙÚ›Ԣ §Èȉ›ˆÓ

∂˘¿ÁÁÂÏÔ˜ §˘ÌÂÚfiÔ˘ÏÔ˜, ¶·ıÔÏfiÁÔ˜, ¢È‰¿ÎÙˆÚ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜

ªˆ˘Û‹˜ ∂ÏÈÛ¿Ê, ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜

∂¡¢π∞º∂ƒ√¡ ¶∂ƒπ™∆∞∆π∫√

15

‚‹Ù˘, Ë ·¯˘Û·ÚΛ·, Ô ˘Ôı˘-ÚÂÔÂȉÈÛÌfi˜, Ë ÂÌÌËÓfi·˘ÛË, Ô·ÏÎÔÔÏÈÛÌfi˜, ηıÒ˜ Î·È ¿ÏϘÁÂÓÂÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ÌÂÙ·-‚ÔÏÈÛÌÔ‡ ÙˆÓ ÏÈȉ›ˆÓ.

¶Ú¤ÂÈ Ó· ÂÈÛËÌ·Óı› fiÙÈ Ì›·Û¿ÓÈ· ·ÈÙ›· Û˘ÛÛÒÚ¢Û˘ ÙˆÓ ÏÈ-ÔÚˆÙÂïÓÈÎÒÓ Î·Ù·ÏÔ›ˆÓ (Ê·È-ÓfiÙ˘Ô˜ Ù‡Ô˘ πππ) Â›Ó·È Ë ·Ó¿Ú-ÎÂÈ· Ù˘ Ë·ÙÈ΋˜ ÏÈ¿Û˘ (¤Ó˙˘ÌÔ··Ú·›ÙËÙÔ ÁÈ· ÙË ÌÂÙ·ÙÚÔ‹ ÙˆÓηٷÏÔ›ˆÓ ÙˆÓ VLDL Û LDL). ™Â·˘Ù‹ ÙËÓ ÂÚ›ÙˆÛË fï˜ Ù· ›-‰· Ù˘ HDL ¯ÔÏËÛÙÂÚfiÏ˘ ›ӷȷ˘ÍË̤ӷ, Û ·ÓÙ›ıÂÛË Ì ÙÔ˘˜·ÛıÂÓ›˜ Ô˘ ¤¯Ô˘Ó Ù˘È΋ ˘ÂÚÏÈ-ȉ·ÈÌ›· Ù‡Ô˘ πππ, ÔÈ ÔÔ›ÔÈ ¤¯Ô˘ÓÛ˘¯Ó¿ ÌÂȈ̤ӷ ›‰· HDL ¯Ô-ÏËÛÙÂÚfiÏ˘.

∏ ÓfiÛÔ˜ ÂΉËÏÒÓÂÙ·È ÎÏÈÓÈοÌÂÙ¿ ÙËÓ ËÏÈΛ· ÙˆÓ 20 ÂÙÒÓ Î·ÈÓˆÚ›ÙÂÚ· ÛÙÔ˘˜ ¿Ó‰Ú˜ Û ۇÁÎÚÈ-ÛË Ì ÙȘ Á˘Ó·›Î˜, ÛÙȘ Ôԛ˜ ËÓfiÛÔ˜ ÌÔÚ› Ó· ÂÌÊ·ÓÈÛı› ÌÂÙ¿ÙËÓ ÂÌÌËÓfi·˘ÛË.

∆Ô ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÎÏÈÓÈÎfiÁÓÒÚÈÛÌ· Ù˘ ÓfiÛÔ˘ Â›Ó·È Ù· Ù·È-ÓÈÔÂȉ‹ Í·ÓıÒÌ·Ù· ÙˆÓ ·Ï·ÌÒÓ(striata palmaris) Î·È Ù· Ô˙Ò‰ËÍ·ÓıÒÌ·Ù· (tuberous). ∆· ·Ï·ÌÈ-·›· Í·ÓıÒÌ·Ù· ·ÓÙÈÛÙÔÈ¯Ô‡Ó Û ÎÈ-ÙÚÈÓˆfi ‹ ÔÚÙÔηÏfi¯ÚÔÔ ·Ô-¯ÚˆÌ·ÙÈÛÌfi ÙˆÓ Ù˘¯ÒÓ ÙˆÓ ·Ï·-ÌÒÓ Î·È ÙˆÓ ‰·ÎÙ‡ÏˆÓ ÙˆÓ ¯ÂÚÈÒÓÎ·È ÌÔÚ› Ó· Â›Ó·È Â›Â‰· ‹ ˘Â-ÁÂṲ́ӷ (∂ÈÎfiÓ· 1). ∆· Ô˙Ò‰Ë Í·Ó-ıÒÌ·Ù· Â›Ó·È ÌÂÁ¿Ï· (>2 ÂÎ) ‰ÂÚ-Ì·ÙÈο Í·ÓıÒÌ·Ù·, Ô˘ Û˘Ó‹ıˆ˜ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ˘˜ ·ÁÎÒÓ˜ Î·È Ù·ÁfiÓ·Ù· ‹ Û·ÓÈfiÙÂÚ· ÛÙȘ ı¤ÛÂȘ›ÂÛ˘ ÙˆÓ Ô‰ÈÒÓ ·fi Ù· ˘Ô‰‹-Ì·Ù·. ¶·ÚfiÌÔÈ· Í·ÓıÒÌ·Ù· ÌÔ-Ú› Ó· ÂÌÊ·ÓÈÛıÔ‡Ó Î·È Û ÔÚÈṲ̂-Ó˜ ‰Â˘ÙÂÚÔ·ı›˜ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ ÏÈȉ›ˆÓ, fiˆ˜Û ·ÔÊÚ·ÎÙÈ΋ Ë·ÙÈ΋ ÓfiÛÔ,·Ú·ÚˆÙÂïÓ·È̛˜ Î·È ÛÂ Û˘ÛÙË-Ì·ÙÈÎfi ÂÚ˘ıËÌ·ÙÒ‰Ë Ï‡ÎÔ.

√È ·ÛıÂÓ›˜ Ì ˘ÂÚÏÈȉ·ÈÌ›·Ù‡Ô˘ πππ ¤¯Ô˘Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔÂÌÊ¿ÓÈÛ˘ ÚÒÈÌ˘ ·ıËڈ̷ÙÈ΋˜ÓfiÛÔ˘ ÂÍ·ÈÙ›·˜ Ù˘ ·ÚÔ˘Û›·˜ ÙˆÓÂÍ·ÈÚÂÙÈο ·ıËÚÔÁfiÓˆÓ ‚-VLDL(·Ú¿ Ù· Û¯ÂÙÈο ¯·ÌËÏ¿ ›‰·Ù˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘). ∏ ·ıËÚˆ-Ì¿ÙˆÛË Û ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓ›˜‰ÂÓ ·ÊÔÚ¿ ÌfiÓÔ Ù· ÛÙÂÊ·ÓÈ·›··ÁÁ›·, ·ÏÏ¿ ΢ڛˆ˜ Ù· ÂÚÈÊÂÚÈ-ο ·ÁÁ›·, fiˆ˜ ÙȘ ¤Ûˆ ηڈٛ-‰Â˜, ÙËÓ ÎÔÈÏȷ΋ ·ÔÚÙ‹ Î·È ÎÏ¿-‰Ô˘˜ Ù˘. ŒÙÛÈ, Ë ÓfiÛÔ˜ Û˘¯Ó¿ ÂÈ-ϤÎÂÙ·È Ì ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ô-ηډ›Ô˘, ·ÁÁÂȷο ÂÁÎÂÊ·ÏÈοÂÂÈÛfi‰È·, ‰È·ÏÂ›Ô˘Û· ¯ˆÏfiÙËÙ·Î·È Á¿ÁÁÚ·ÈÓ· ÙˆÓ Î¿ÙˆÓ ¿ÎÚˆÓ.

√ È·ÙÚfi˜ Ú¤ÂÈ Ó· ˘Ô„È·Ûı›ÙË ÓfiÛÔ Û ·ÛıÂÓ›˜ Ì ˘ÂÚÏÈÈ-

‰·ÈÌ›· Ô˘ ÂÌÊ·Ó›˙Ô˘Ó Ù·¯·Ú·ÎÙËÚÈÛÙÈο Í·ÓıÒÌ·-Ù·. ∂›Û˘, Ë ‰È¿ÁÓˆÛË Ù˘ÓfiÛÔ˘ ˘Ô‚ÔËıÂ›Ù·È fiÙ·Ó˘¿Ú¯Ô˘Ó ·˘ÍË̤ӷ ›Â-‰· ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ Î·È ¯ÔÏË-ÛÙÂÚfiÏ˘ ÛÙÔ Ï¿ÛÌ· ηÈÌ¿ÏÈÛÙ· fiÙ·Ó ÔÈ ·fiÏ˘ÙÂ˜Û˘ÁÎÂÓÙÚÒÛÂȘ ÙÔ˘˜ ÛÂmmol/l Â›Ó·È ›Û˜ Î·È ÛÂmg/dl Ë Û˘ÁΤÓÙÚˆÛË ÙˆÓÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ Â›Ó·È ‰ÈÏ¿-ÛÈ· ·fi ÙË Û˘ÁΤÓÙÚˆÛËÙ˘ ¯ÔÏËÛÙÂÚfiÏ˘. ™ÙËÓËÏÂÎÙÚÔÊfiÚËÛË ÙˆÓ ÏÈÔ-ÚˆÙÂïÓÒÓ Û ·Á·Úfi˙Ë ·-Ú·ÙËÚÂ›Ù·È Ì›· ¢Ú›· ÚÔ-‚˙ÒÓË (‚-VLDL) Ô˘ ·ÓÙÈÛÙÔÈ-¯Â› ÛÙȘ ÏÔ‡ÛȘ Û ÙÚÈÁÏ˘-ÎÂÚ›‰È· Î·È ¯ÔÏËÛÙÂÚfiÏË ·-ıÔÏÔÁÈΤ˜ ÏÈÔÚˆÙÂ˚Ó˜. H‰È¿ÁÓˆÛË ÂȂ‚·ÈÒÓÂÙ·È ÌÂÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘ Ïfi-ÁÔ˘ Ù˘ VLDL ¯ÔÏËÛÙÂÚfi-Ï˘ ÚÔ˜ Ù· ÔÏÈο ÙÚÈÁÏ˘ÎÂ-Ú›‰È· ÙÔ˘ ÔÚÔ‡: ¤Ó·˜ ÏfiÁÔ˜ÌÂÁ·Ï‡ÙÂÚÔ˜ ·fi 0,3 (fiÙ·ÓÔÈ Û˘ÁÎÂÓÙÚÒÛÂȘ ÙˆÓ ÏÈÈ-‰›ˆÓ ÂÎÊÚ¿˙ÔÓÙ·È Û mg/dl)‹ 0,68 (fiÙ·Ó ÔÈ Û˘ÁÎÂÓÙÚÒ-ÛÂȘ ÙˆÓ ÏÈȉ›ˆÓ ÂÎÊÚ¿˙Ô-ÓÙ·È Û mmol/l) Â›Ó·È ·ıÔ-ÁÓˆÌÈÎfi˜ Ù˘ ÓfiÛÔ˘. ∆¤ÏÔ˜,ÛÙËÓ ÈÛÔËÏÂÎÙÚÈ΋ ÂÛÙ›·ÛËÙˆÓ ÚˆÙÂïÓÒÓ ÙˆÓ VLDL‰È·ÈÛÙÒÓÂÙ·È Ô Ê·ÈÓfiÙ˘Ô˜∂2∂2 (∂ÈÎfiÓ· 4).

ŸÛÔÓ ·ÊÔÚ¿ ÙË ıÂÚ·-¢ÙÈ΋ ÚÔÛ¤ÁÁÈÛË Ù˘˘ÂÚÏÈȉ·ÈÌ›·˜ Ù‡Ô˘ πππ,¤¯ÂÈ È‰È·›ÙÂÚË ÛËÌ·Û›· Ë·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ˘ÔΛ-ÌÂÓˆÓ ‰È·Ù·Ú·¯ÒÓ: ·Ò-ÏÂÈ· ‚¿ÚÔ˘˜ Û ·¯‡Û·Ú-ÎÔ˘˜ ·ÛıÂÓ›˜, Ú‡ıÌÈÛËÙÔ˘ ۷ί¿ÚÔ˘ Û ‰È·‚Ë-ÙÈÎÔ‡˜ ·ÛıÂÓ›˜ Î·È ¯Ô-Ú‹ÁËÛË ı˘ÚÔ͛Ӣ Û·ÛıÂÓ›˜ Ì ˘Ôı˘ÚÂÔ-ÂȉÈÛÌfi. ™˘¯Ó¿ Â›Ó·È ·Ó·-Áη›· Ë ¯ÔÚ‹ÁËÛË ˘ÔÏÈÈ-‰·ÈÌÈ΋˜ ·ÁˆÁ‹˜. ∆· Ê¿Ú-̷η ÚÒÙ˘ ÂÈÏÔÁ‹˜ ›-Ó·È ÔÈ ÊÈÌÚ¿Ù˜, Ô˘ÂÎÙfi˜ ·fi ÙË ÛËÌ·ÓÙÈ΋‚ÂÏÙ›ˆÛË ÙÔ˘ ÏÈȉ·ÈÌÈÎÔ‡ÚÔÊ›Ï, Û˘¯Ó¿ Û˘Ì‚¿ÏÏÔ˘ÓÎ·È ÛÙËÓ ˘ÔÛÙÚÔÊ‹ ÙˆÓÍ·ÓıˆÌ¿ÙˆÓ. ∂Ó·ÏÏ·ÎÙÈοʿÚ̷η ·ÔÙÂÏÔ‡Ó ÔÈÛÙ·Ù›Ó˜ Î·È ÙÔ ÓÈÎÔÙÈÓÈÎfiÔ͇, ÂÓÒ Û ÔÚÈṲ̂Ó˜ Â-ÚÈÙÒÛÂȘ ÌÔÚ› Ó· ··È-ÙËı› Ë ¯ÔÚ‹ÁËÛË Û˘Ó‰˘·-ÛÌÔ‡ ˘ÔÏÈȉ·ÈÌÈÎÒÓ Ê·Ú-̿ΈÓ.

∂ÈÎfiÓ· 1. √˙Ò‰Ë Í·ÓıÒÌ·Ù· ÛÙÔ˘˜ ·ÁÎÒÓ˜Û ·ÛıÂÓ‹ Ì ‰˘Û‚ËÙ·ÏÈÔÚˆÙÂïÓ·ÈÌ›·(˘ÂÚÏÈÔÚˆÙÂïÓ·ÈÌ›· Ù‡Ô˘ πππ)

∂ÈÎfiÓ· 2. ¶·Ï·ÌÈ·›· Í·ÓıÒÌ·Ù· Û ·ÛıÂÓ‹Ì ‰˘Û‚ËÙ·ÏÈÔÚˆÙÂïÓ·ÈÌ›· (˘ÂÚÏÈÔÚˆ-ÙÂïÓ·ÈÌ›· Ù‡Ô˘ πππ)

∂ÈÎfiÓ· 3. ™¯ËÌ·ÙÈ΋ ·ÂÈÎfiÓÈÛË Ù˘ ‰È·Ù·Ú·-¯‹˜ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÛÙË ‰˘Û‚ËÙ·ÏÈÔÚˆ-ÙÂïÓ·ÈÌ›· (˘ÂÚÏÈÔÚˆÙÂïÓ·ÈÌ›· Ù‡Ô˘ πππ)

∂ÈÎfiÓ· 4. IÛÔËÏÂÎÙÚÈ΋ ÂÛÙ›·ÛË ÙˆÓ ÚˆÙÂ˚-ÓÒÓ ÙˆÓ Ôχ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆ-ÙÂ˚ÓÒÓ (apoVLDL’s)

∏ÙÚÔÔÔ›ËÛË ÙˆÓ ÏÈȉ·È-ÌÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ Ô˘ÂÈÙ˘Á¯¿ÓÂÙ·È Ì ÙË ¯ÔÚ‹-

ÁËÛË ÙˆÓ ÛÙ·ÙÈÓÒÓ ¤¯ÂÈ ˆ˜ ·Ô-Ù¤ÏÂÛÌ· ÛËÌ·ÓÙÈ΋ Ì›ˆÛË Ù˘ηډȷÁÁÂȷ΋˜ ÓÔÛËÚfiÙËÙ·˜Î·È ıÓËÙfiÙËÙ·˜ ÙfiÛÔ ÛÙËÓ Úˆ-ÙÔÁÂÓ‹ fiÛÔ Î·È ÛÙË ‰Â˘ÙÂÚÔÁÂÓ‹ÚfiÏË„Ë1-5. ∂ÈÚfiÛıÂÙ·, Ë ¯Ô-Ú‹ÁËÛË ·ÛÈÚ›Ó˘ (Ê¿ÚÌ·ÎÔ Ô˘·Ó·ÛÙ¤ÏÏÂÈ ÙË Û˘ÁÎfiÏÏËÛË ÙˆÓ·ÈÌÔÂÙ·Ï›ˆÓ) Û ·ÛıÂÓ›˜ ˘„Ë-ÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Ô‰ËÁ› ›Û˘ ÛÂÌ›ˆÛË ÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ-‰‡ÓÔ˘6-7.

ªÂϤÙ˜ ‰Â˘ÙÂÚÔÁÂÓÔ‡˜ Úfi-Ï˄˘ ¤‰ÂÈÍ·Ó fiÙÈ Ë ·ÓÙÈ·ıËÚÔ-ÁfiÓÔ˜ ‰Ú¿ÛË ÙˆÓ ÛÙ·ÙÈÓÒÓ ·-Ú·ÙËÚÂ›Ù·È Î·Ù¿ ηÓfiÓ· ÙÔ˘Ï¿-¯ÈÛÙÔÓ ¤Ó· ¯ÚfiÓÔ ÌÂÙ¿ ÙËÓ ¤Ó·Ú-ÍË Ù˘ ıÂڷ›·˜2-4,8. ∞ÓÙ›ıÂÙ·, Ë·ÓÙÈ·ÈÌÔÂÙ·Ïȷ΋ ‰Ú¿ÛË Ù˘·ÛÈÚ›Ó˘ Â›Ó·È ¿ÌÂÛË6-8. ∆· ·-Ú·¿Óˆ ‰Â‰Ô̤ӷ Ô‰‹ÁËÛ·ÓÛÙËÓ ˘fiıÂÛË fiÙÈ Ë Û˘Á¯ÔÚ‹ÁË-ÛË ÌÈ·˜ ÛÙ·Ù›Ó˘ Ì ·ÛÈÚ›ÓË ı·¤¯ÂÈ –ÙÔ˘Ï¿¯ÈÛÙÔÓ – ·ıÚÔÈÛÙÈÎfi·ÔÙ¤ÏÂÛÌ· fiÛÔÓ ·ÊÔÚ¿ ÙË Ì›-ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛ˘ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘8. ¶Ú¿Á-Ì·ÙÈ, ÔÈ ÚfiÛÊ·Ù˜ Ô‰ËÁ›Â˜ ÁÈ·ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ˘ÂÚ¯Ô-ÏËÛÙÂÚÔÏ·ÈÌ›·˜ (NCEP ATPIII,National Cholesterol EducationProgram Adult Treatment PanelIII) ˘Ô‰ÂÈÎÓ‡Ô˘Ó ÙË Û˘Á¯ÔÚ‹-ÁËÛË ÛÙ·ÙÈÓÒÓ Î·È ·ÛÈÚ›Ó˘Û ·ÛıÂÓ›˜ Ì ÁÓˆÛÙ‹ ηÚ-‰È·ÁÁÂȷ΋ ÓfiÛÔ9-11. ¶·ÚfiÏ··˘Ù¿ Ë Û˘Á¯ÔÚ‹ÁËÛË ÛÙ·ÙÈÓÒÓÌ ·ÛÈÚ›ÓË Û ·ÛıÂÓ›˜ ˘„Ë-ÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛËηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘ ‰ÂÓ Â›-Ó·È ·ÎfiÌË È‰È·›ÙÂÚ· ‰È·‰Â‰Ô̤-ÓË12,13.

¢Â‰Ô̤ÓÔ˘ fiÙÈ Ù˘¯·ÈÔÔÈË̤-Ó˜ ‰ÈϤ˜-Ù˘ÊϤ˜ ÌÂϤÙ˜ Û˘Á-¯ÔÚ‹ÁËÛ˘ ÛÙ·ÙÈÓÒÓ Ì ·ÛÈÚ›ÓˉÂÓ Â›Ó·È ‰˘Ó·Ùfi Ó· Ú·ÁÌ·ÙÔ-ÔÈËıÔ‡Ó ÁÈ· ËıÈÎÔ‡˜ ÏfiÁÔ˘˜, ÔÈÂӉ›ÍÂȘ ÁÈ· ÙËÓ ·ÛÊ¿ÏÂÈ· ηÈÙËÓ ˘ÂÚÔ¯‹ Ù˘ Û˘Á¯ÔÚ‹ÁËÛ‹˜

ÙÔ˘˜ - ¤Ó·ÓÙÈ ÙÔ˘ οı ·Ú¿ÁÔ-ÓÙ· ¯ˆÚÈÛÙ¿ - fiÛÔÓ ·ÊÔÚ¿ ÙËÌ›ˆÛË ÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ-‰‡ÓÔ˘ ÚÔ·ÙÔ˘Ó ·fi ÌÂÙ·-·Ó·Ï‡ÛÂȘ ‹ ·Ó·Ï‡ÛÂȘ ˘ÔÔÌ¿-‰ˆÓ ÌÂÏÂÙÒÓ Ô˘ ¤¯Ô˘Ó ‹‰Ë ‰Ë-ÌÔÛÈ¢ı›14.

™˘ÁÎÂÎÚÈ̤ӷ, ‰‡Ô ÌÂÁ¿ÏÂ˜Ù˘¯·ÈÔÔÈË̤Ó˜ ÌÂϤÙ˜ ‰Â˘ÙÂ-ÚÔÁÂÓÔ‡˜ ÚfiÏ˄˘ ÛÙȘ Ôԛ˜¯ÚËÛÈÌÔÔÈ‹ıËΠڷ‚·ÛÙ·Ù›ÓËÂ›Ó·È Ë LIPID (Long-term Interven-tion with Pravastatin in IschemicDisease study) Î·È Ë CARE (theCholesterol and Recurrent Eventstrial)2,3. ™ÙË ÌÂϤÙË LIPID Û˘ÌÌÂ-Ù›¯·Ó ÂÚ›Ô˘ 9000 ·ÛıÂÓ›˜ ÌÂÈÛÙÔÚÈÎfi ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ô-ηډ›Ô˘ ‹ ·ÛÙ·ıÔ‡˜ ÛÙËı¿Á¯Ë˜,ÔÈ ÔÔ›ÔÈ Ù˘¯·ÈÔÔÈ‹ıËÎ·Ó Û 40

mg Ú·‚·ÛÙ·Ù›Ó˘ ‹ Û ÂÈÎÔÓÈÎfiÊ¿ÚÌ·ÎÔ. ∫·Ù¿ ÙËÓ ¤Ó·ÚÍË Ù˘ÌÂϤÙ˘ ÙÔ 83% ÙˆÓ ·ÛıÂÓÒÓ¤·ÈÚÓ ·ÛÈÚ›ÓË. ™ÙË ÌÂϤÙËCARE Û˘ÌÌÂÙ›¯·Ó ÂÚ›Ô˘4.200 ·ÛıÂÓ›˜ Ì ÈÛÙÔÚÈÎfi ÂÌ-ÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ôηډ›Ô˘, ÔÈÔÔ›ÔÈ Â›Û˘ Ù˘¯·ÈÔÔÈ‹ıËηÓÛ 40 mg Ú·‚·ÛÙ·Ù›Ó˘ ‹ Û ÂÈ-ÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ. ∫·Ù¿ ÙËÓ ¤Ó·Ú-ÍË Ù˘ ÌÂϤÙ˘ ÙÔ 84% ÙˆÓ·ÛıÂÓÒÓ ¤·ÈÚÓ ·ÛÈÚ›ÓË. ∂È-ÚfiÛıÂÙ·, ÙÚÂȘ ÌÈÎÚfiÙÂÚ˜ ·Á-ÁÂÈÔÁÚ·ÊÈΤ˜ ÌÂϤÙ˜ ‰Â˘ÙÂÚÔ-ÁÂÓÔ‡˜ ÚfiÏ˄˘ ÛÙȘ Ôԛ˜›Û˘ ¯ÔÚËÁ‹ıËΠڷ‚·ÛÙ·Ù›-ÓË Â›Ó·È Ë REGRESS (RegressionGrowth Evaluation Statin Study,885 ·ÛıÂÓ›˜), Ë PLAC-I (Prava-statin Limitation of Atherosclero-

·ıËÚÔÛÎÏ‹ÚˆÛË¢∂∫∂ªµƒπ√™ 2005

16

™˘Á¯ÔÚ‹ÁËÛË ™Ù·Ù›Ó˘ Ì ∞ÛÈÚ›ÓË Î·È ¢Â˘ÙÂÚÔÁÂÓ‹˜ ¶ÚfiÏË„Ë

∂ÈÚ‹ÓË °·˙‹, ∂ÈÛÙËÌÔÓÈÎfi˜ ™˘ÓÂÚÁ¿Ù˘ ÙÔ˘ π·ÙÚ›Ԣ §Èȉ›ˆÓ

ªˆ¸Û‹˜ ∂ÏÈÛ¿Ê, ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜

Å: √͇ ŒÌÊÚ·ÁÌ· ÙÔ˘ ª˘Ôηډ›Ô˘Ç: ∞ÁÁÂÈ·Îfi ∂ÁÎÂÊ·ÏÈÎfi ∂ÂÈÛfi‰ÈÔÑ: ¶ÂÚÈÏ·Ì‚¿ÓÂÈ Û˘ÓÔÏÈο ÙÔ˘˜ ηډȷÁÁÂÈ·ÎÔ‡˜ ı·Ó¿ÙÔ˘˜, Ù· ÌË ı·Ó·ÙË-ÊfiÚ· ÂÌÊÚ¿ÁÌ·Ù· ÙÔ˘ Ì˘Ôηډ›Ô˘, Ù· ·ÁÁÂȷο ÂÁÎÂÊ·ÏÈο ÂÂÈÛfi‰È·ÈÛ¯·ÈÌÈÎÔ‡ Ù‡Ô˘, ηıÒ˜ Î·È ÙȘ ‰È·‰ÂÚÌÈΤ˜ ·ÁÁÂÈÔÏ·ÛÙÈΤ˜ ÙˆÓ ÛÙÂÊ·-ÓÈ·›ˆÓ Î·È ÙȘ ÂÂÌ‚¿ÛÂȘ ÛÙÂÊ·ÓÈ·›·˜ ·Ú·Î¿Ì„˘Prava: ¶Ú·‚·ÛÙ·Ù›ÓË, ASA: ∞ÛÈÚ›ÓË, LIPID: Long-term Intervention WithPravastatin in Ischaemic Stroke, CARE: Cholesterol and Recurrent Events,∞ÁÁÂÈÔÁÚ·ÊÈΤ˜ ÌÂϤÙ˜ ÛÙȘ Ôԛ˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÔÈ ÌÂϤÙ˜ RE-GRESS, PLAC-I Î·È PLAC-II.

¶›Ó·Î·˜: ªÂ›ˆÛË ÙÔ˘ Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛ˘ ηډȷÁÁÂÈ·ÎÒÓÛ˘Ì‚·Ì¿ÙˆÓ ÛÙȘ ÌÂϤÙ˜ LIPID, CARE Î·È Û ·ÁÁÂÈÔÁÚ·ÊÈΤ˜ ÌÂϤÙ˜

ªÂ›ˆÛË ÙÔ˘ Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ (ÙÈÌ‹ p)

∞ÁˆÁ‹ £·Ó·ÙËÊfiÚÔ πÛ¯·ÈÌÈÎfi ∞∂∂Ç ™‡ÓıÂÙÔ‹ ÌË √∂ªÅ ηٷÏËÎÙÈÎfi

ÛËÌ›ÔÑ

Prava+ASA vs Prava alone 28% (.01) 25.9% (.16) 14.1% (.049)(LIPID)

Prava+ASA vs ASA alone 34.7% (<.001) 29.7% (.008) 23.9% (<.001)(LIPID)

Prava+ASA vs Prava alone 17.6% (.27) 51.3% (.02) 22.5% (.03)(CARE)

Prava+ASA vs ASA alone 20.6% (.02) 28.9% (.13) 23.6% (<.001)(CARE)

Prava+ASA vs Prava alone 64.5% (.04) -81.8% (.63) -14.5%(.52)(∞ÁÁÂÈÔÁÚ·ÊÈΤ˜ ÌÂϤÙ˜)

Prava+ASA vs ASA alone 75.2% (.002) -7.9% (.94) 29.4% (.04)(∞ÁÁÂÈÔÁÚ·ÊÈΤ˜ ÌÂϤÙ˜)

sis in the Carotid Arteries trial,408 ·ÛıÂÓ›˜) Î·È Ë PLAC-II (Pra-vastatin, Lipids and Atherosclero-sis in the Carotid Arteries trial,151 ·ÛıÂÓ›˜)15-17. ∫·È Û ·˘Ù¤˜ÙȘ ÌÂϤÙ˜ ÔÈ ·ÛıÂÓ›˜ Ù˘¯·ÈÔ-ÔÈ‹ıËÎ·Ó Û 40 mg Ú·‚·ÛÙ·-Ù›Ó˘ ‹ Û ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ Î·ÈÙ· ÔÛÔÛÙ¿ ÙˆÓ ·ÛıÂÓÒÓ Ô˘¤·ÈÚÓ·Ó ·ÛÈÚ›ÓË Î·Ù¿ ÙËÓ¤Ó·ÚÍË Ù˘ ÌÂϤÙ˘ ‹Ù·Ó 54%ÛÙË REGRESS, 68% ÛÙËÓ PLAC-IÎ·È 43% ÛÙËÓ PLAC-II.

ª›· ÚfiÛÊ·ÙË ÌÂÙ·-·Ó¿Ï˘ÛËÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ·˘ÙÒÓ ÙˆÓÌÂÏÂÙÒÓ ¤‰ÂÈÍ ÛËÌ·ÓÙÈ΋ ˘Â-ÚÔ¯‹ ÙÔ˘ Û˘Ó‰˘·ÛÌÔ‡ ·ÛÈÚ›-Ó˘- Ú·‚·ÛÙ·Ù›Ó˘ fiÛÔÓ ·ÊÔÚ¿ÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ηډȷÁ-ÁÂȷ΋˜ ÓfiÛÔ˘ (¶›Ó·Î·˜)8. ™˘-

ÁÎÂÎÚÈ̤ӷ, ·Ú·ÙËÚ‹ıËΠ̛-ˆÛË ÙÔ˘ Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ·ÙËÓ ÂÌÊ¿ÓÈÛË ı·Ó·ÙËÊfiÚÔ˘ ‹ÌË ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ôηډ›-Ô˘ ηٿ 31% Û ·ÛıÂÓ›˜ Ô˘¤·ÈÚÓ·Ó Û˘Ó‰˘·ÛÌfi ·ÛÈÚ›Ó˘Ì ڷ‚·ÛÙ·Ù›ÓË Û ۇÁÎÚÈÛËÌ ٷ ¿ÙÔÌ· Ô˘ ¤·ÈÚÓ·Ó ÌfiÓÔ·ÛÈÚ›ÓË Î·È Î·Ù¿ 26% Û ۇ-ÁÎÚÈÛË Ì ÂΛӷ Ù· ¿ÙÔÌ· Ô˘¤·ÈÚÓ·Ó ÌfiÓÔ Ú·‚·ÛÙ·Ù›ÓË.∂ÈϤÔÓ, ·Ú·ÙËÚ‹ıËΠ̛ˆ-ÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛ˘ÈÛ¯·ÈÌÈÎÒÓ ·ÁÁÂÈ·ÎÒÓ ÂÁÎÂÊ·ÏÈ-ÎÒÓ ÂÂÈÛÔ‰›ˆÓ ηٿ 29% ηÈ31% ·ÓÙ›ÛÙÔȯ·. ¶Ú¤ÂÈ Ó· ÂÈ-ÛËÌ·Óı› fiÙÈ Ô Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ÂÌÊ¿ÓÈÛ˘ ηډȷÁÁÂÈ·ÎÔ‡ ı·-Ó¿ÙÔ˘, ÌË ı·Ó·ÙËÊfiÚÔ˘ ÂÌÊÚ¿Á-Ì·ÙÔ˜ ÙÔ˘ Ì˘Ôηډ›Ô˘, ÈÛ¯·ÈÌÈ-

ÎÔ‡ ·ÁÁÂÈ·ÎÔ‡ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÂÈ-ÛÔ‰›Ô˘ ‹ Ú·ÁÌ·ÙÔÔ›ËÛ˘ ÛÙÂ-Ê·ÓÈ·›·˜ ·Ú¿Î·Ì„˘ ‹ ‰È·‰ÂÚ-ÌÈ΋˜ ·ÁÁÂÈÔÏ·ÛÙÈ΋˜ ÌÂÈÒıËÎÂηٿ 24% ÛÙËÓ ÔÌ¿‰· Ô˘¤·ÈÚÓÂ Û˘Ó‰˘·Ṳ̂ÓË ·ÁˆÁ‹ ÛÂÛ‡ÁÎÚÈÛË Ì ÂΛӷ Ù· ¿ÙÔÌ·Ô˘ ¤·ÈÚÓ·Ó ÌfiÓÔ ·ÛÈÚ›ÓË Î·Èηٿ 13% Û ۇÁÎÚÈÛË Ì ٷ¿ÙÔÌ· Ô˘ ¤·ÈÚÓ·Ó ÌfiÓÔ Ú·-‚·ÛÙ·Ù›ÓË8.

™˘ÌÂÚ·ÛÌ·ÙÈο, Ë Û˘Á¯Ô-Ú‹ÁËÛË ÛÙ·ÙÈÓÒÓ Ì ·ÛÈÚ›ÓËÛ ·ÛıÂÓ›˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË Î·Ú‰È·ÁÁÂÈ·-΋˜ ÓfiÛÔ˘ ·Ó·Ì¤ÓÂÙ·È Ó· Ô‰Ë-Á‹ÛÂÈ Û ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÙˆÓηډȷÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ.

£∂ƒ∞¶∂π∞ – º∞ƒª∞∫∞

17

1. Shepherd J, Cobbe M, Ford I et al, forthe WOSCOPS study group. Preventionof coronary heart disease with prava-statin in men with hypercholesterole-mia. N Engl J Med 1995;333:1301-1307

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4. The 4S study group. Randomized trialof cholesterol lowering in 4444 patientswith coronary heart disease: The Scan-dinavian Simvastatin survival study.Lancet 1994;344:1383-1389

5. The HPS study group. MRC/BHF HeartProtection Study of cholesterol loweringwith simvastatin in 20536 high-risk indi-viduals. Lancet 2002;360:7-22

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8. Hennekens CH, Sacks FM, Tonkin A etal. Additive effects of pravastatin andaspirin to decrease risks of cardiovas-cular disease: Randomized and obser-vational comparisons of secondary pre-vention trials and their meta-analyses.Arch Intern Med 2004;164:40-44

9. Executive summary of the Third Reportof the National Cholesterol EducationalProgram (NCEP) Expert Panel onDetection, Evaluation and Treatment ofHigh Blood Cholesterol in Adults (AdultTreatment Panel III). JAMA 2001;285:2486-2497

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of cardiovascular disease. MedGenMed (serial online). November 22,1999; e1. Available at:http://www.medscape.com

13. Califf RM, Delong ER, Ostbye T et al.Underuse of aspirin in a referral popu-lation with documented coronary arterydisease. Am J Cardiol 2002;89:653-661

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15. Jukema W, Bruschke AVG, van BovenAJ et al. Effects of lipid lowering by pra-vastatin on progression and regressionof coronary artery disease in sympto-matic men with normal to moderatelyelevateed serum cholesterol levels: theRegression Growth Evaluation StatinStudy (REGRESS). Circulation 1995;91:2528-2540

16. Pitt B, Mancini GB, Ellis SG et al. Prava-statin Limitation of Atherosclerosis inthe the Coronary Arteries (PLAC-I): re-duction in atherosclerosis progressionand clinical events. J Am Coll Cardiol1995;26: 1133-1139

17. Crouse JR, Byington RP, Bond MG etal. Pravastatin, Lipids and Atheroscle-rosis in the Carotid Arteries (PLAC-II).Am J Cardiol 1995;75:455-459

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∏ÈÛ¯·ÈÌÈ΋ ηډȷ΋ ÓfiÛÔ˜·ÔÙÂÏ› ÙË ÛËÌ·ÓÙÈÎfiÙÂÚË·ÈÙ›· ıÓËÙfiÙËÙ·˜ Î·È ÓÔÛË-

ÚfiÙËÙ·˜ ÛÙȘ ·Ó·Ù˘Á̤Ó˜ ÎÔÈ-ӈӛ˜1. ∏ Û‡Á¯ÚÔÓË ¤Ú¢ӷ ¤¯Âȷԉ›ÍÂÈ fiÙÈ Ë ·ıËÚÔÛÎÏ‹ÚˆÛËÂ›Ó·È Ì›· ÊÏÂÁÌÔÓ҉˘ ‰È·‰Èη-Û›· ÛÙËÓ ÔÔ›· Û˘ÌÌÂÙ¤¯Ô˘Ó ηÈ·ÙÙ·Ú· ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘-ÛÙ‹Ì·ÙÔ˜, fiˆ˜ Ù· Ì·ÎÚÔÊ¿Á·Î·È Ù· ∆-ÏÂÌÊÔ·ÙÙ·Ú·2,3. ∏ Û˘-Û¯¤ÙÈÛË ÌÂٷ͇ ¯ÚÔÓ›ˆÓ ‚Ú·‰Â›-·˜ ÂͤÏÈ͢ ÏÔÈÌÒÍÂˆÓ Î·È ÈÛ¯·È-ÌÈ΋˜ ηډȷ΋˜ ÓfiÛÔ˘ ÂÚÈÁÚ¿-ÊËΠÁÈ· ÚÒÙË ÊÔÚ¿ ·fi ÙÔÓRudolf Ludwig Karl Virchow4, ÂÓÒÙÔ ¯Ï·Ì‡‰ÈÔ Ù˘ Ó¢ÌÔÓ›·˜ ¤¯ÂÈ·Ó·ÁÓˆÚÈÛı› ˆ˜ ÙÔ ‚·ÎÙËÚ›‰ÈÔÔ˘ Û˘Û¯ÂÙ›˙ÂÙ·È ÂÚÈÛÛfiÙÂÚÔ ÌÂÙËÓ ÈÛ¯·ÈÌÈ΋ ηډȷ΋ ÓfiÛÔ.¶Ú¿ÁÌ·ÙÈ, ¤¯ÂÈ ·Ô‰Âȯı› Ë Èη-ÓfiÙËÙ· ÙÔ˘ ¯Ï·Ì˘‰›Ô˘ Ù˘ Ó¢-ÌÔÓ›·˜ Ó· ÚÔÛ‚¿ÏÂÈ Ù· Ì·ÎÚÔ-Ê¿Á·, ÙȘ Ï›˜ Ì˘˚Τ˜ ›Ó˜ Î·È Ù·ÂÓ‰ÔıËÏȷο ·ÙÙ·Ú· ÙˆÓ ·ÁÁ›-ˆÓ5 , ÂÓÒ ·Ú¿ÏÏËÏ· ¤¯ÂÈ ÙÂÎÌË-ÚȈı› Ë Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙˆÓ˘„ËÏÒÓ Ù›ÙÏˆÓ IgG ·ÓÙÈۈ̿وÓηٿ ÙÔ˘ ¯Ï·Ì˘‰›Ô˘ Ù˘ Ó¢ÌÔ-Ó›·˜ Î·È Ù˘ ÂÌÊ¿ÓÈÛ˘ ÔͤˆÓ ÂÌ-ÊÚ·ÁÌ¿ÙˆÓ ÙÔ˘ Ì˘Ôηډ›Ô˘6. ∂È-ÚfiÛıÂÙ·, ÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ‚·-ÎÙËÚ›‰ÈÔ ·ÓȯÓ‡ıËΠ۠·Ú·-Û΢¿ÛÌ·Ù· ·ıËÚÔÛÎÏËÚˆÙÈÎÒÓ‚Ï·‚ÒÓ7,8, ÂÓÒ Ô ÂÓÔÊı·ÏÌÈÛÌfi˜ÙÔ˘ ¯Ï·Ì˘‰›Ô˘ Ù˘ Ó¢ÌÔÓ›·˜ ÛÂÎÔ˘Ó¤ÏÈ· Ô‰‹ÁËÛ Û ̛· ÂÈÙ¿-¯˘ÓÛË Ù˘ ·ıËÚÔÛÎÏ‹ÚˆÛ˘ ÛÙ·ÛÙÂÊ·ÓÈ·›· ·ÁÁ›· ÙˆÓ ÎÔ˘ÓÂ-ÏÈÒÓ, ÁÂÁÔÓfi˜ ÙÔ ÔÔ›Ô ÌÔÚÔ‡ÛÂÓ· ÚÔÏËÊı› Ì ÙË ¯ÔÚ‹ÁËÛË·˙ÈıÚÔÌ˘Î›Ó˘9.

™‹ÌÂÚ· ˘¿Ú¯Ô˘Ó ·ÚÎÂÙ¿·ÓÙÈ‚ÈÔÙÈο ÁÈ· ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈ-΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÏÔÈÌÒ͈ӷfi ÙÔ ¯Ï·Ì‡‰ÈÔ Ù˘ Ó¢ÌÔÓ›·˜.øÛÙfiÛÔ, Ë Â›‰Ú·ÛË Ù˘ ¯ÔÚ‹ÁË-Û‹˜ ÙÔ˘˜ ÛÙËÓ ÂͤÏÈÍË Ù˘ ÈÛ¯·È-ÌÈ΋˜ ηډȷ΋˜ ÓfiÛÔ˘ ‰ÂÓ Â›Ó·ÈηϿ ÁÓˆÛÙ‹. ∆˘¯·ÈÔÔÈË̤Ó˜ÎÏÈÓÈΤ˜ ‰ÔÎÈ̤˜ Ô˘ ۯ‰ȿÛıË-Î·Ó ÁÈ· Ó· ÌÂÏÂÙ‹ÛÔ˘Ó ÙËÓ Â›-

‰Ú·ÛË ·˘Ù‹ ¤‰ÂÈÍ·Ó ·ÓÙÈÎÚÔ˘fi-ÌÂÓ· ·ÔÙÂϤÛÌ·Ù·. ™Ùfi¯Ô˜ Ù˘·ÚÔ‡Û·˜ ÌÂÙ·-·Ó¿Ï˘Û˘ Â›Ó·È ËÂÎÙ›ÌËÛË Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙË-Ù·˜ Ù˘ ¯ÔÚ‹ÁËÛ˘ ·ÓÙÈ‚ÈÔÙÈÎÒÓÛÙË ‰Â˘ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë Ù˘ÈÛ¯·ÈÌÈ΋˜ ηډȷ΋˜ ÓfiÛÔ˘.

∞ÚÎÂÙ¤˜ Û˘Á¯ÚÔÓÈΤ˜ ÌÂϤÙÂ˜Î·È ÌÂϤÙ˜ ·ÛıÂÓÒÓ-Ì·ÚÙ‡ÚˆÓ(case-control)10,11,12,13,14 ¤¯Ô˘ÓÚ·ÁÌ·ÙÔÔÈËı› ÁÈ· ÙËÓ ÂÎÙ›ÌË-ÛË Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ Ù˘¯ÔÚ‹ÁËÛ˘ ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÛÙË ‰Â˘-ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë Ù˘ ÈÛ¯·ÈÌÈ-΋˜ ηډȷ΋˜ ÓfiÛÔ˘. øÛÙfiÛÔ,Ù· ·ÓÙÈÎÚÔ˘fiÌÂÓ· ·ÔÙÂϤÛÌ·Ù·Î·È Ù· ÌÂıÔ‰ÔÏÔÁÈο ÛÊ¿ÏÌ·Ù¿ÙÔ˘˜, ¤ÛÙÚ„·Ó ÙÔ ÂӉȷʤÚÔÓÚÔ˜ ÙȘ Ù˘¯·ÈÔÔÈË̤Ó˜ ÎÏÈÓÈ-Τ˜ ‰ÔÎÈ̤˜ ÔÈ Ôԛ˜ ÂÈÚfiÛıÂ-Ù· ÌÔÚÔ‡Û·Ó Ó· ·ÍÈÔÏÔÁ‹ÛÔ˘ÓÎ·È ÙËÓ Â›‰Ú·ÛË ÙˆÓ ·ÓÙÈ‚ÈÔÙÈ-ÎÒÓ Û ‰Â›ÎÙ˜ ÊÏÂÁÌÔÓ‹˜, fiˆ˜Ë C-·ÓÙȉÚÒÛ· ÚˆÙ½ÓË, ÙÔ ÈÓˆ-‰ÔÁfiÓÔ Î·È Ë ÈÓÙÂÚÏ¢ΛÓË-6.ŒÙÛÈ, Ë ·ÚÔ‡Û· ÌÂÙ·-·Ó¿Ï˘ÛËÂÚÈÏ·Ì‚¿ÓÂÈ Ù˘¯·ÈÔÔÈË̤Ó˜ÎÏÈÓÈΤ˜ ‰ÔÎÈ̤˜ Ô˘ ¤ÁÈÓ·Ó Ì ÙËÛ˘ÌÌÂÙÔ¯‹ ·ÛıÂÓÒÓ Ì ÁÓˆÛÙ‹ÈÛ¯·ÈÌÈ΋ ηډȷ΋ ÓfiÛÔ Î·È ÛÙȘÔԛ˜ ·ÍÈÔÏÔÁ‹ıËÎÂ Ë Â›‰Ú·ÛËÙ˘ ¯ÔÚ‹ÁËÛ˘ ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÛÙËÓÂÌÊ¿ÓÈÛË Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·-Ì¿ÙˆÓ.

∏ ‚È‚ÏÈÔÁÚ·ÊÈ΋ ¤Ú¢ӷڷÁÌ·ÙÔÔÈ‹ıËΠ‰È·Ì¤ÛÔ˘Ù˘ ‡Ï˘ ÙÔ˘ MEDLINE Î·È Û˘-ÌÂÚȤϷ‚ ÌÂϤÙ˜ Ô˘ Ú·Á-Ì·ÙÔÔÈ‹ıËÎ·Ó Î·Ù¿ ÙÔ ¯ÚÔÓÈÎfi‰È¿ÛÙËÌ· ·fi ÙÔ 1966 ¤ˆ˜ ÙÔ2003 Ì ÛÙfi¯Ô ÙËÓ ·ÍÈÔÏfiÁËÛËÙ˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ Ù˘¯ÔÚ‹ÁËÛ˘ ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÛÙˉ¢ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë Ù˘ÈÛ¯·ÈÌÈ΋˜ ηډȷ΋˜ ÓfiÛÔ˘ ηÈÔÈ Ôԛ˜ ‰ËÌÔÛȇıËÎ·Ó ÛÙËÓ·ÁÁÏÈ΋ ÁÏÒÛÛ·.

∞·Ú·›ÙËÙ· ÎÚÈÙ‹ÚÈ· ¤ÓÙ·ÍË˜ÙˆÓ Ù˘¯·ÈÔÔÈËÌ¤ÓˆÓ ÎÏÈÓÈÎÒÓ‰ÔÎÈÌÒÓ ÛÙËÓ ·ÚÔ‡Û· ÌÂÙ·-·Ó¿-Ï˘ÛË ‹Ù·Ó ·ÊÂÓfi˜ Ë Û˘ÌÌÂÙÔ¯‹·ÙfiÌˆÓ Ì ÁÓˆÛÙ‹ ÈÛ¯·ÈÌÈ΋ ηÚ-

‰È·Î‹ ÓfiÛÔ Î·È ·Ê’ ÂÙ¤ÚÔ˘ Ë ·Ó·-Ï˘ÙÈ΋ ηٷÁÚ·Ê‹ ÙˆÓ Î·Ú‰È·Á-ÁÂÈ·ÎÒÓ ÂÂÈÛÔ‰›ˆÓ. ∏ ·Ú·¿Óˆ‚È‚ÏÈÔÁÚ·ÊÈ΋ ¤Ú¢ӷ η٤ÏËÍÂÛÙËÓ ·Ó‡ÚÂÛË 9 ‰ËÌÔÛÈÂ˘Ì¤ÓˆÓÌÂÏÂÙÒÓ Ô˘ ÏËÚÔ‡Û·Ó Ù· ·-Ú·¿Óˆ ÎÚÈÙ‹ÚÈ· (¶›Ó·Î·˜ 1).

Ÿˆ˜ Ê·›ÓÂÙ·È ·fi ÙÔÓ ·Ú·-¿Óˆ ›Ó·Î· ÛÙȘ Ù˘¯·ÈÔÔÈË̤-Ó˜ ÎÏÈÓÈΤ˜ ‰ÔÎÈ̤˜ Ù˘ ÌÂÙ·-·Ó¿Ï˘Û˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ‰È·-ÊÔÚÂÙÈο ·ÓÙÈ‚ÈÔÙÈο Î·È Û ‰È·-ÊÔÚÂÙÈο ‰ÔÛÔÏÔÁÈο Û¯‹Ì·Ù·.¶Ú¿ÁÌ·ÙÈ ˘¿Ú¯Ô˘Ó ·ÚÎÂÙ¤˜ ‰È·-ʈӛ˜ ÙfiÛÔ ÁÈ· ÙË ¯ÚÔÓÈ΋ ‰È¿Ú-ÎÂÈ· Ù˘ ·ÁˆÁ‹˜ fiÛÔ Î·È ÁÈ· ÙˉfiÛË ÙÔ˘ ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓÔ˘·ÓÙÈ‚ÈÔÙÈÎÔ‡ Ô˘ ··ÈÙÂ›Ù·È ÁÈ·ÙËÓ Ï‹ÚË ÂÎÚ›˙ˆÛË ÙÔ˘ ¯Ï·Ì˘‰›-Ô˘ Ù˘ Ó¢ÌÔÓ›·˜ ·fi ÙȘ ÛÙÂÊ·-ÓÈ·›Â˜ ·ÚÙËڛ˜. Œ¯ÂÈ ‰È·Ù˘ˆıÂ›Ë ¿Ô„Ë fiÙÈ Ë ‰È¿ÚÎÂÈ· Ù˘ ·Áˆ-Á‹˜ Ú¤ÂÈ Ó· ÍÂÂÚÓ¿ ÙÔÓ ¤Ó·Ì‹Ó·. øÛÙfiÛÔ Û ·ÚÎÂÙ¤˜ ÌÂϤ-Ù˜ Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó ÌÂÙË ¯ÔÚ‹ÁËÛË ·˙ÈıÚÔÌ˘Î›Ó˘, ÎÏ·-ÚÈıÚÔÌ˘Î›Ó˘ 15 Î·È ÚÔÍÈıÚÔÌ˘Î›-Ó˘ 16 ¯ÔÚËÁ‹ıËÎ·Ó ‰ÔÛÔÏÔÁÈοۯ‹Ì·Ù· ÙˆÓ 5, ÙˆÓ 7-14 Î·È ÙˆÓ10-14 ËÌÂÚÒÓ ·ÓÙ›ÛÙÔȯ·. ∂È-ÚfiÛıÂÙ·, ÔÈ Schneider Î·È Û˘Ó.17

¤‰ÂÈÍ·Ó fiÙÈ Ë ·˙ÈıÚÔÌ˘Î›ÓË Û˘Û-ÛˆÚ‡ÂÙ·È ÛÙȘ ÛÙÂÊ·ÓÈ·›Â˜ ·ıË-ڈ̷ÙÈΤ˜ ϿΘ Û ıÂڷ¢ÙÈ-Τ˜ Û˘ÁÎÂÓÙÚÒÛÂȘ ÌfiÏȘ Û 3Ë̤Ú˜ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ¯ÔÚ‹-ÁËÛ‹˜ Ù˘ ·fi ÙÔ ÛÙfiÌ·.

¶Ú¤ÂÈ Ó· ÂÈÛËÌ·Óı› fiÙÈ˘¿Ú¯Ô˘Ó ·ÚÎÂÙ¤˜ ‰È·ÊˆÓ›Â˜ ηÈfiÛÔÓ ·ÊÔÚ¿ ÙË Ì¤ıÔ‰Ô ‰È¿ÁÓˆ-Û˘ Ù˘ ¯ÚfiÓÈ·˜ ‚Ú·‰Â›·˜ ÂͤÏÈ-͢ Ïԛ̈͢ ·fi ÙÔ ¯Ï·Ì‡‰ÈÔÙ˘ Ó¢ÌÔÓ›·˜. √È ˘„ËÏÔ› Ù›ÙÏÔÈIgG ·ÓÙÈÛˆÌ¿ÙˆÓ ‰ÂÓ Ê·›ÓÂÙ·È fiÙÈÂ›Ó·È ·ÍÈfiÈÛÙÔ˜ ‰Â›ÎÙ˘, ηıÒ˜·˘ÙÔ› ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Ó· ·Ú·Ì¤-ÓÔ˘Ó ˘„ËÏÔ› ÁÈ· ·ÚÎÂÙfi ηÈÚfi·ÎfiÌË Î·È ÌÂÙ¿ ÙËÓ ›·ÛË ÙÔ˘·ÛıÂÓ‹. ™ÙË Û˘ÁÎÂÎÚÈ̤ÓË ÌÂÙ·-·Ó¿Ï˘ÛË, Ï·Ì‚¿ÓÔÓÙ·˜ ˘fi„ËÎ·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë Û˘¯ÓfiÙËÙ·¤ÎıÂÛ˘ ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘ÛÌÔ‡

·ıËÚÔÛÎÏ‹ÚˆÛË¢∂∫∂ªµƒπ√™ 2005

18

ÃÔÚ‹ÁËÛË ∞ÓÙÈ‚ÈÔÙÈÎÒÓ ÛÙË ¢Â˘ÙÂÚÔÁÂÓ‹ ¶ÚfiÏË„Ë Ù˘ πÛ¯·ÈÌÈ΋˜ ∫·Ú‰È·Î‹˜ ¡fiÛÔ˘

ª. ∫ˆÛÙ·¿ÓÔ˜, ∂ÈÛÙËÌÔÓÈÎfi˜ ™˘ÓÂÚÁ¿Ù˘ ÙÔ˘ π·ÙÚ›Ԣ §Èȉ›ˆÓª. ∂ÏÈÛ¿Ê, ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ

ÛÙÔ ¯Ï·Ì‡‰ÈÔ Ù˘ Ó¢ÌÔÓ›·˜ ›-Ó·È ÂÚ›Ô˘ 50%18, ·ÔÊ·Û›ÛıËÎÂÓ· ÌËÓ ÂÍ·ÈÚÂı› η̛· ÌÂϤÙË ÌÂÎÚÈÙ‹ÚÈÔ ÙËÓ ÔÚÔÏÔÁÈ΋ ‰È¿ÁÓˆÛËÙ˘ Ïԛ̈͢.

∆¤ÏÔ˜, ÂÍ·ÈÙ›·˜ ÙÔ˘ ÁÂÁÔÓfiÙÔ˜fiÙÈ Ù· ‰Â‰Ô̤ӷ Ô˘ Û˘Û¯ÂÙ›˙Ô˘ÓÙËÓ ÌË Î·Ú‰È·Î‹ ·ÁÁÂȷ΋ ÓfiÛÔ(ÂÚÈÊÂÚÈ΋ ·ÚÙËÚÈÔ¿ıÂÈ· ηÈÂÁÎÂÊ·ÏÈ΋ ·ÁÁÂȷ΋ ÓfiÛÔ) Ì ÙËÏԛ̈ÍË ·fi ÙÔ ¯Ï·Ì‡‰ÈÔ Ù˘Ó¢ÌÔÓ›·˜ Â›Ó·È ·Ó·Ú΋, Ë ÌÂ-Ù·-·Ó¿Ï˘ÛË ÂÈÎÂÓÙÚÒıËΠ۠ÌÂ-ϤÙ˜ ÛÙȘ Ôԛ˜ Û˘ÌÌÂÙ›¯·Ó¿ÙÔÌ· Ì ÁÓˆÛÙ‹ ÌfiÓÔ ÈÛ¯·ÈÌÈ΋ηډȷ΋ ÓfiÛÔ Î·È ÛÙȘ Ôԛ˜ ٷ·ÚÈ· ηٷÏËÎÙÈο ÛËÌ›· ·ÔÙÂ-ÏÔ‡Û·Ó ÌfiÓÔ Ù· ÛÙÂÊ·ÓÈ·›· ÎÏÈÓÈ-ο Û‡Ó‰ÚÔÌ·, fiˆ˜ ÙÔ Ô͇ ¤Ì-ÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘, Ë ·ÛÙ·-ı‹˜ ÛÙËı¿Á¯Ë Î·È Ô ·ÈÊÓ›‰ÈԘηډȷÎfi˜ ı¿Ó·ÙÔ˜.

∂ÓÓ¤· ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÌÂϤÙ˜ÛÙȘ Ôԛ˜ Û˘ÌÌÂÙ›¯·Ó Û˘ÓÔÏÈ-ο 11.015 ¿ÙÔÌ·, ÏËÚÔ‡Û·Ó Ù·ÎÚÈÙ‹ÚÈ· ¤ÓÙ·Í˘ ÛÙË Û˘ÁÎÂÎÚÈ̤-ÓË ÌÂÙ·-·Ó¿Ï˘ÛË. ™ÙÔÓ ¶›Ó·Î· 2Ê·›ÓÔÓÙ·È Ù· ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ·ÙfiÌˆÓ Ô˘ Û˘ÌÌÂÙ›¯·Ó Û ·˘-Ù¤˜ ÙȘ Ù˘¯·ÈÔÔÈË̤Ó˜ ÎÏÈÓÈΤ˜‰ÔÎÈ̤˜.

™Â ¤ÍÈ ·fi ÙȘ ÌÂϤÙ˜ ·Ú·-ÙËÚÂ›Ù·È Ì›· Û·Ê‹˜ ˘ÂÚÔ¯‹ ÙÔ˘·ÚÈıÌÔ‡ ÙˆÓ ·Ó‰ÚÒÓ Û ۇÁÎÚÈÛËÌ ÙȘ Á˘Ó·›Î˜, ÂÓÒ Û ·ÚÎÂÙ¤˜ÌÂϤÙ˜ ‰ÂÓ ·Ú¤¯ÔÓÙ·Ó ·ÚÎÂÙ¿ÛÙÔȯ›· fiÛÔÓ ·ÊÔÚ¿ ÙÔ Ê‡ÏÔÙˆÓ ·ÙfiÌˆÓ Ô˘ Û˘ÌÌÂÙ›¯·Ó Û·˘Ù¤˜.

∞Ó·ÊÔÚÈο Ì ٷ ·ÔÙÂϤÛÌ·-Ù·, Ù¤ÛÛÂÚȘ ·fi ÙȘ ·Ú·¿ÓˆÌÂϤÙ˜ ¤‰ÂÈÍ·Ó ¤Ó· ÛÙ·ÙÈÛÙÈοÛËÌ·ÓÙÈÎfi ÏÂÔÓ¤ÎÙËÌ· Ù˘ ¯Ô-Ú‹ÁËÛ˘ ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÛÙËÓ Úfi-ÏË„Ë ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·-Ì¿ÙˆÓ. øÛÙfiÛÔ, ¤ÓÙÂ Ù˘¯·ÈÔÔÈ-Ë̤Ó˜ ÎÏÈÓÈΤ˜ ‰ÔÎÈ̤˜ ‰ÂÓ ¤‰ÂÈ-Í·Ó Î·Ó¤Ó· fiÊÂÏÔ˜ ·fi ÙË ¯ÔÚ‹-ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ fiÛÔÓ ·ÊÔÚ¿ÙËÓ ÚfiÏË„Ë ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓÛ˘Ì‚·Ì¿ÙˆÓ Î·È ÙˆÓ ·ÈÊÓ›‰ÈˆÓηډȷÎÒÓ ı·Ó¿ÙˆÓ. ∞Ó¿ÌÂÛ· Û·˘Ù¤˜, Û˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Î·È ÔÈÌÂϤÙ˜ WIZARD27, AZACS24 ηÈANTIBIO25 ÔÈ Ôԛ˜, ÂÍ·ÈÙ›·˜ ÙÔ˘ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·ÙfïÓÔ˘ Û˘ÌÌÂÙ›¯·Ó Û ·˘Ù¤˜ (72%ÙÔ˘ Û˘ÓfiÏÔ˘ ÁÈ· ÙË ÌÂϤÙË WI-ZARD Î·È 14% ÁÈ· ÙȘ ÌÂϤÙ˜AZACS Î·È ANTIBIO), ›¯·Ó Î·È ÙËÌÂÁ·Ï‡ÙÂÚË ‚·Ú‡ÙËÙ· ÛÙË ‰È·-ÌfiÚʈÛË ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ ·ÔÙÂ-ϤÛÌ·ÙÔ˜ Ù˘ ÌÂÙ·-·Ó¿Ï˘Û˘.

£EPA¶EIA – °∂¡π∫∞

19

™˘ÓÙÔÌÔÁڷʛ˜:√∂ª = Ô͇ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘√™™ = Ô͇ ÛÙÂÊ·ÓÈ·›Ô Û‡Ó‰ÚÔÌÔπ∫¡ = ÈÛ¯·ÈÌÈ΋ ηډȷ΋ ÓfiÛԘö = ¯Ï·Ì‡‰ÈÔ Ù˘ Ó¢ÌÔÓ›·˜Bid = 2 ÊÔÚ¤˜ ÙËÓ Ë̤ڷ

¶›Ó·Î·˜ 1: ªÂϤÙ˜ ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÁÈ· ÙË ‰Â˘ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë Ù˘π∫¡

¢ËÌÔÛÈÂ˘Ì¤Ó˜ ™˘ÌÌÂÙ¤¯ÔÓÙ˜ ∞ÓÙÈ‚ÈÔÙÈοMÂϤÙ˜

ACADEMIC,19 2000 ∞ÛıÂÓ›˜ Ì ÁÓˆÛÙ‹ π∫¡ ∞˙ÈıÚÔÌ˘Î›ÓË 500 mg/d po Î·È ÔÚÔıÂÙÈÎfiÙËÙ· ÁÈ· 3 Ë̤Ú˜ Î·È ÌÂÙ¿ ÁÈ· ÙÔ Ã¶ ·˙ÈıÚÔÌ˘Î›ÓË 500 mg/wk

po ÁÈ· 3 Ì‹Ó˜

ROXIS,20 1999 ∞ÛıÂÓ›˜ Ì ·ÛÙ·ı‹ ƒÔÍÈıÚÔÌ˘Î›ÓË 150 mg poÛÙËı¿Á¯Ë ‹ non-Q √∂ª bid ÁÈ· 30 Ë̤Ú˜

Gupta et al,21 1997 ÕÓ‰Ú˜ Ì ÌË ∞˙ÈıÚÔÌ˘Î›ÓË 500 mg/d poı·Ó·ÙËÊfiÚÔ √∂ª Î·È ÁÈ· 3 Ë̤Ú˜ ‹ ÔÚÔıÂÙÈÎfiÙËÙ· ÁÈ· ÙÔ Ã¶ ·˙ÈıÚÔÌ˘Î›ÓË 500 mg/d po

ÁÈ· 6 Ë̤Ú˜

STAMINA,22 2002 ∞ÛıÂÓ›˜ Ì √∂ª ‹ √™™ ªÂÙÚÔÓȉ·˙fiÏË 400 mg pobid ÁÈ· 7 Ë̤Ú˜ + ·˙ÈıÚÔÌ˘Î›ÓË 500 mg/d poÁÈ· 7 Ë̤Ú˜

CLARIFY,23 2002 ∞ÛıÂÓ›˜ Ì ·ÛÙ·ı‹ ∫Ï·ÚÈıÚÔÌ˘Î›ÓË 500 mg/dÛÙËı¿Á¯Ë ‹ non-Q √∂ª po ÁÈ· 85 Ë̤Ú˜

AZACS,24 2003 ∞ÛıÂÓ›˜ Ì ·ÛÙ·ı‹ ∞˙ÈıÚÔÌ˘Î›ÓË 500 mg/d poÛÙËı¿Á¯Ë ‹ √∂ª ÁÈ· 1 Ë̤ڷ Î·È ÌÂÙ¿ 250

mg/d ÁÈ· 4 Ë̤Ú˜

ANTIBIO,25 2003 ∞ÛıÂÓ›˜ Ì √∂ª ƒÔÍÈıÚÔÌ˘Î›ÓË 300 mg/dpo ÁÈ· 6 ‚‰ÔÌ¿‰Â˜

Leowattana et al,26 2001 ∞ÛıÂÓ›˜ Ì √™™ ƒÔÍÈıÚÔÌ˘Î›ÓË 150 mg pobid ÁÈ· 30 Ë̤Ú˜

WIZARD,27 2003 ∞ÛıÂÓ›˜ Ì ÈÛÙÔÚÈÎfi ∞˙ÈıÚÔÌ˘Î›ÓË 600 mg/d po√∂ª Î·È ÔÚÔıÂÙÈÎfiÙËÙ· ÁÈ· 3 Ë̤Ú˜ Î·È ÌÂÙ¿ 600 ÁÈ· ÙÔ Ã¶ mg/wk po ÁÈ· 11

‚‰ÔÌ¿‰Â˜

* ∂Í·ÈÚÔ‡ÓÙ·È ÔÈ ÌÂϤÙ˜ WIZARD27 Î·È ANTIBIO25

** ∂Í·ÈÚÔ‡ÓÙ·È ÔÈ ÌÂϤÙ˜ ACADEMIC19 Î·È ANTIBIO25

™˘ÓÙÔÌÔÁڷʛ˜:∆∫¢ = Ù˘¯·ÈÔÔÈË̤Ó˜ ÎÏÈÓÈΤ˜ ‰ÔÎÈ̤˜SD = ÛÙ·ıÂÚ¿ ·fiÎÏÈÛË

¶›Ó·Î·˜ 2: ÷ڷÎÙËÚÈÛÙÈο ÙˆÓ ·ÛıÂÓÒÓ ÙˆÓ ÌÂÏÂÙÒÓ

÷ڷÎÙËÚÈÛÙÈÎfi ÕÙÔÌ· Ô˘ Û˘ÌÌÂÙ›¯·Ó ÛÙȘ ∆∫¢

∏ÏÈΛ·, ̤ÛË ÙÈÌ‹ ± SD, ¤ÙË 64,2±12,2*

ÕÓ‰Ú˜ 80,1 %

°˘Ó·›Î˜ 19,9 %

∫·ÓÈÛÙ¤˜ 21,0 %

ÀÂÚÙ·ÛÈÎÔ› ·ÛıÂÓ›˜ 46,7 %

¢È·‚ËÙÈÎÔ› ·ÛıÂÓ›˜ 21,2 %

∞ÛıÂÓ›˜ Ì ˘ÂÚÏÈȉ·ÈÌ›· 60,8 %**

∫·Ù¿ Û˘Ó¤ÂÈ·, ÙÔ Û˘ÓÔÏÈÎfi ·Ô-Ù¤ÏÂÛÌ· Ù˘ ÌÂÙ·-·Ó¿Ï˘Û˘ ‰ÂÓÛ˘ÓËÁÔÚ› ˘¤Ú οÔÈÔ˘ ÏÂÔÓÂ-ÎÙ‹Ì·ÙÔ˜ Ù˘ ¯ÔÚ‹ÁËÛ˘ ·ÓÙÈ‚ÈÔ-ÙÈÎÒÓ fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ÚfiÏË„ËÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ(Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ 0,94 [95%fiÚÈ· ·ÍÈÔÈÛÙ›·˜, 0,86-1,03]) ‹ ÙËÌ›ˆÛË Ù˘ ηډȷÁÁÂȷ΋˜ ıÓË-ÙfiÙËÙ·˜ (Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ 0,94[95% fiÚÈ· ·ÍÈÔÈÛÙ›·˜, 0,79-1,12]).

∆· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ÂÓÓ¤·Ù˘¯·ÈÔÔÈËÌ¤ÓˆÓ ÎÏÈÓÈÎÒÓ ‰ÔÎÈ-ÌÒÓ, ηıÒ˜ Î·È ÙÔ Û˘ÓÔÏÈÎfi ·Ô-Ù¤ÏÂÛÌ· Ù˘ ÌÂÙ·-·Ó¿Ï˘Û˘ Ê·›-ÓÔÓÙ·È ‰È·ÁÚ·ÌÌ·ÙÈο ÛÙ· ™¯‹Ì·-Ù· 1 Î·È 2.

Ÿˆ˜ Ê·›ÓÂÙ·È ÛÙ· ™¯‹Ì·Ù· 1Î·È 2 Ë ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ Û·ÛıÂÓ›˜ Ì ÁÓˆÛÙ‹ ÈÛ¯·ÈÌÈ΋ηډȷ΋ ÓfiÛÔ ‰ÂÓ Ô‰‹ÁËÛ ÛÂÌ›ˆÛË ÙˆÓ Î·Ú‰È·ÎÒÓ Û˘Ì‚·Ì¿-ÙˆÓ ‹ Ù˘ ıÓËÙfiÙËÙ·˜. √È ÌÂϤÙ˜ÔÈ Ôԛ˜ ¤‰ÂÈÍ·Ó ¤Ó· Û˘ÁÎÚÈÙÈÎfiÏÂÔÓ¤ÎÙËÌ· Ù˘ ¯ÔÚ‹ÁËÛ˘·ÓÙÈ‚ÈÔÙÈÎÒÓ Â›¯·Ó ÛËÌ·ÓÙÈο ÌÂ-ıÔ‰ÔÏÔÁÈο ÛÊ¿ÏÌ·Ù· Î·È ¤Ó·ÂÍ·ÈÚÂÙÈο ÛËÌ·ÓÙÈÎfi ÛÊ¿ÏÌ· Ù‡-Ô˘ π ÂÍ·ÈÙ›·˜ ÙÔ˘ ÌÈÎÚÔ‡ ·ÚÈı-ÌÔ‡ ·ÙfiÌˆÓ Ô˘ Û˘ÌÌÂÙ›¯·Ó Û·˘Ù¤˜. ™˘ÓÔÏÈο, Ë ÌÂÙ·-·Ó¿Ï˘ÛË·˘Ù‹ ¤‰ÂÈÍ fiÙÈ Ù· ·ÓÙÈ‚ÈÔÙÈο ‰ÂÓ¤¯Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙË ‰Â˘ÙÂ-ÚÔÁÂÓ‹ ÚfiÏË„Ë Ù˘ ÈÛ¯·ÈÌÈ΋˜Î·Ú‰È·Î‹˜ ÓfiÛÔ˘. øÛÙfiÛÔ, οÙÈÙ¤ÙÔÈÔ ‰ÂÓ ÛËÌ·›ÓÂÈ fiÙÈ ÔÈ ÏÔÈÌÒ-ÍÂȘ ‰ÂÓ ‰È·‰Ú·Ì·Ù›˙Ô˘Ó ÛËÌ·ÓÙÈ-Îfi ÚfiÏÔ ÛÙËÓ ÂͤÏÈÍË Ù˘ ÛÙÂÊ·-ÓÈ·›·˜ ·ıËÚÔÛÎÏ‹ÚˆÛ˘, Ô‡ÙÂÎ·È fiÙÈ Ù· ·ÓÙÈ‚ÈÔÙÈο ‰ÂÓ ÂÓ‰¤¯Â-Ù·È Ó· ·ÔÎÙ‹ÛÔ˘Ó ÛÙÔ Ì¤ÏÏÔÓοÔÈÔ ÚfiÏÔ ÛÙËÓ ÚfiÏË„Ë Ù˘ÈÛ¯·ÈÌÈ΋˜ ηډȷ΋˜ ÓfiÛÔ˘. ¶È-ı·ÓÒ˜, ‰È·ÊÔÚÂÙÈο ·ÓÙÈ‚ÈÔÙÈο ‹¤ÛÙˆ ‰È·ÊÔÚÂÙÈο ‰ÔÛÔÏÔÁÈοۯ‹Ì·Ù· Ó· ·Ô‰ÂȯÙÔ‡Ó ÛÙÔ Ì¤Ï-ÏÔÓ ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈο.

∂›Û˘, Ë ÌÂÙ·-·Ó¿Ï˘ÛË ·˘Ù‹‰ÂÓ ·ÍÈÔÏfiÁËÛ ÙËÓ ÈηÓfiÙËÙ·ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ Ô˘ ¯ÚËÛÈÌÔÔÈ-‹ıËÎ·Ó Ó· ÂÈ‚Ú·‰‡ÓÔ˘Ó ÙËÓ Âͤ-ÏÈÍË ÙˆÓ ·ıËڈ̷ÙÈÎÒÓ ‚Ï·‚ÒÓ,Ô‡Ù ÙÔÓ Èı·Ófi ÚfiÏÔ Ô˘ ÌÔÚ›·˘Ù¿ Ó· ‰È·‰Ú·Ì·Ù›˙Ô˘Ó ÛÙËÓÚˆÙÔÁÂÓ‹ ÚfiÏË„Ë Ù˘ ÈÛ¯·ÈÌÈ-΋˜ ηډȷ΋˜ ÓfiÛÔ˘. ∂Èο˙ÂÙ·ÈfiÙÈ Ë ¯Ú‹ÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ Û ÌÈ-ÎÚfiÙÂÚ˜ ËÏÈ˘ Â›Ó·È ‰˘Ó·Ùfi Ó·Û˘Ì‚¿ÏÂÈ ÛÙËÓ ÚfiÏË„Ë Ù˘ ÛÙÂ-Ê·ÓÈ·›·˜ ·ıËÚÔÛÎÏ‹ÚˆÛ˘. ∂È-ÚfiÛıÂÙ·, Û οÔȘ ·fi ÙȘ ÌÂ-

ϤÙ˜ Ê¿ÓËΠfiÙÈ Î¿ÔȘ ÏËı˘-ÛÌȷΤ˜ ÔÌ¿‰Â˜ ¢ÓÔ‹ıËÎ·Ó Â-ÚÈÛÛfiÙÂÚÔ ·fi ÙË ¯ÔÚ‹ÁËÛË ·ÓÙÈ-‚ÈÔÙÈÎÒÓ Û ۇÁÎÚÈÛË Ì ÔÚÈṲ̂-Ó˜ ¿ÏϘ. °È· ·Ú¿‰ÂÈÁÌ·, ÛÙËÌÂϤÙË WIZARD27 ÔÈ ‰È·‚ËÙÈÎÔ›·ÛıÂÓ›˜ ¢ÓÔ‹ıËÎ·Ó ÂÚÈÛÛfiÙÂ-ÚÔ ·fi ÙË ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓÛ ۇÁÎÚÈÛË Ì ÙÔ˘˜ ÌË ‰È·‚ËÙÈ-ÎÔ‡˜ ·ÛıÂÓ›˜.

ª¤Û· ÛÙ· ÂfiÌÂÓ· 2 ¯ÚfiÓȷ›ÎÂÈÙ·È Ë ‰ËÌÔÛ›Â˘ÛË Î·È ¿ÏψÓ

ÌÂÁ¿ÏˆÓ ÌÂÏÂÙÒÓ ÁÈ· ÙËÓ ·ÍÈÔÏfi-ÁËÛË ÙÔ˘ Èı·ÓÔ‡ ÚfiÏÔ˘ ÙˆÓ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÛÙËÓ ÚfiÏË„Ë Ù˘ÈÛ¯·ÈÌÈ΋˜ ηډȷ΋˜ ÓfiÛÔ˘. ∂È-ϤÔÓ, ÂÚÂ˘Ó¿Ù·È Ô Èı·Ófi˜ Úfi-ÏÔ˜ ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÛÙËÓ ÂÈ-‚Ú¿‰˘ÓÛË Ù˘ ¤ÎÙ·Û˘ ÙˆÓ·Ó¢ڢÛÌ¿ÙˆÓ Ù˘ ÎÔÈÏȷ΋˜·ÔÚÙ‹˜28 Î·È Ù˘ ÂͤÏÈ͢ Ù˘·ıËÚÔÛÎÏ‹ÚˆÛ˘ ÙˆÓ Î·ÚˆÙ›-‰ˆÓ29.

·ıËÚÔÛÎÏ‹ÚˆÛË¢∂∫∂ªµƒπ√™ 2005

20

™˘ÓÙÔÌÔÁڷʛ˜:CI : fiÚÈ· ·ÍÈÔÈÛÙ›·˜RR: Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜

™¯‹Ì· 1. ∞ÔÙ¤ÏÂÛÌ· Ù˘ ¯ÔÚ‹ÁËÛ˘ ·ÓÙÈ‚ÈÔÙÈÎÒÓ fiÛÔÓ ·ÊÔÚ¿ ÙË Ì›ˆ-ÛË ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ (·ÛÙ·ı‹˜ ÛÙËı¿Á¯Ë, Ô͇ ¤ÌÊÚ·Á-Ì· ÙÔ˘ Ì˘Ôηډ›Ô˘ ‹ ·ÈÊÓ›‰ÈÔ˜ ηډȷÎfi˜ ı¿Ó·ÙÔ˜).

™˘ÓÙÔÌÔÁڷʛ˜:CI : fiÚÈ· ·ÍÈÔÈÛÙ›·˜RR: Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜

™¯‹Ì· 2. ∞ÔÙ¤ÏÂÛÌ· Ù˘ ¯ÔÚ‹ÁËÛ˘ ·ÓÙÈ‚ÈÔÙÈÎÒÓ fiÛÔÓ ·ÊÔÚ¿ ÙËÓ Î·Ú‰È·ÁÁÂȷ΋ ıÓËÙfiÙËÙ·

∂ÚÁ·Û›·™¯ÂÙÈ΋ µ·Ú‡ÙËÙ·

™‡ÓÔÏÔ (95% Cl)

À¤Ú Ù˘ ıÂڷ›·˜ À¤Ú Ù˘ ÔÌ¿‰·˜ ÂϤÁ¯Ô˘

∂ÚÁ·Û›·™¯ÂÙÈ΋ µ·Ú‡ÙËÙ·

™‡ÓÔÏÔ (95% Cl)

À¤Ú Ù˘ ıÂڷ›·˜ À¤Ú Ù˘ ÔÌ¿‰·˜ ÂϤÁ¯Ô˘

£EPA¶EIA – °∂¡π∫∞

21

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µµÈÈ‚‚ÏÏÈÈÔÔÁÁÚÚ··ÊÊ››··

·ıËÚÔÛÎÏ‹ÚˆÛË¢∂∫∂ªµƒπ√™ 2005

22

1: Djaldetti M, Salman H, Bergman M,Bessler H. Effect of pravastatin, simva-statin and atorvastatin on the phagocy-tic activity of mouse peritoneal macro-phages. Exp Mol Pathol. 2005 Oct 31;[Epub ahead of print]

2: Thiebaud P, Patel BV, Nichol MB, Be-renbeim DM. The effect of switching oncompliance and persistence: the caseof statin treatment. Am J Manag Care.2005 Nov;11(11):670-4.

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4: [No authors listed] Increased clinicalbenefit of atorvastatin at high doses instable coronary heart disease. Nat ClinPract Cardiovasc Med. 2005 May24;2(6):272 [Epub ahead of print]

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6: Matzno S, Yasuda S, Juman S, Yama-moto Y, Nagareya-Ishida N, Tazuya-Murayama K, Nakabayashi T, Matsuya-ma K. Statin-induced apoptosis linkedwith membrane farnesylated Ras smallG protein depletion, rather than gerany-lated Rho protein. J Pharm Pharmacol.2005 Nov;57(11):1475-84.

7: Nesto RW. Beyond low-density lipopro-tein: addressing the atherogenic lipidtriad in type 2 diabetes mellitus and themetabolic syndrome. Am J CardiovascDrugs. 2005;5(6):379-87.

8: Lau YY, Okochi H, Huang Y, Benet LZ.Multiple transporters affect the disposi-tion of atorvastatin and its two activehydroxy metabolites: application of invitro and ex situ systems. J PharmacolExp Ther. 2005 Oct 28; [Epub ahead ofprint]

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