ΤΕΥΧΟΣ 14 ΙΟΥΝΙΟΣ 2007 - ΑΘΗΡΟΣΚΛΗΡΩΣΗ

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description

ΤΡΙΜΗΝΙΑΙΟ ΠΕΡΙΟΔΙΚΟ ΛΙΠΙΔΙΩΝ / Υπέυθυνος Σύνταξης : Ηλίας Χειμώνας / Καρδιολόγος - Υποπτέραρχος ε.α. / Εκδίδεται από τις Ιατρικές Εκδόσεις "Βαγιονάκη" με χορηγία της "PFIZER HELLAS"

Transcript of ΤΕΥΧΟΣ 14 ΙΟΥΝΙΟΣ 2007 - ΑΘΗΡΟΣΚΛΗΡΩΣΗ

Page 1: ΤΕΥΧΟΣ 14 ΙΟΥΝΙΟΣ 2007 - ΑΘΗΡΟΣΚΛΗΡΩΣΗ

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IÔÎÚ¿ÙÂÈÔ NÔÛÔÎÔÌÂ›Ô AıËÓÒÓ

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¶A£√ºÀ™π√§√°π∞¶·ıÔÏÔÁÈΤ˜ ∫·Ù·ÛÙ¿ÛÂȘ Ô˘ ™˘Óԉ‡ÔÓÙ·È ·fi ÷ÌËÏ‹ ÃÔÏËÛÙÂÚfiÏËÃÚ‹ÛÙÔ˜ ∞ÓÙÒÓÔÁÏÔ˘, ∂›ÎÔ˘ÚÔ˜ ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜ ΔÌ‹Ì·ÙÔ˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¢ËÌÔÎÚÈÙ›Ԣ ¶·ÓÂÈÛÙËÌ›Ô˘ £Ú¿Î˘

¶∞ƒ∞°√¡Δ∂™ ∫π¡¢À¡√ÀΔÔ ∞ÏÎÔfiÏ ˆ˜ ¶·Ú¿ÁÔÓÙ·˜ ∫ÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ∂ÌÊ¿ÓÈÛË ∫·Ú‰È·ÁÁÂÈ·ÎÒÓ ™˘Ì‚·Ì¿ÙˆÓ∂. ¡¿ÎÔ˘, ∂ÈÛÙËÌÔÓÈÎfi˜ ™˘ÓÂÚÁ¿Ù˘ ÙÔ˘ ∂Í. π·ÙÚ›Ԣ ¢È·Ù·Ú·¯ÒÓ ÙÔ˘ ªÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ §Èȉ›ˆÓª. ∂ÏÈÛ¿Ê, ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ ΔÔ̤·˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ

¶ÚfiÏË„Ë ÙÔ˘ ™·Î¯·ÚÒ‰Ë ¢È·‚‹ÙË Δ‡Ô˘ 2¡›ÎÔ˜ ¢È·ÎÔ˘Ì¿ÎÔ˜, ∫·Ú‰ÈÔÏfiÁÔ˜.¢È·ÁÓˆÛÙÈÎfi ∫·Ú‰ÈÔÏÔÁÈÎfi ∫¤ÓÙÚÔ ¶ÂÈÚ·È¿, ™˘ÓÂÚÁ¿Ù˘ ¡ÔÛÔÎÔÌ›ԢMetropolitan

∫§π¡π∫∂™ ª∂§∂Δ∂™ΔÔ ∂ÈÎÔÛÈÂÓÙ·ÓÔ˚Îfi √͇ ªÂÈÒÓÂÈ Ù· ªÂ›˙ÔÓ· ∫·Ú‰È·ÁÁÂȷο ∂ÂÈÛfi‰È· Û ÀÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌÈÎÔ‡˜ ∞ÛıÂÓ›˜.ªÂϤÙË JELIS (Japan EPA lipid intervention study):Δ˘¯·ÈÔÔÈË̤ÓË, ·ÓÔȯً˜ ¯ÔÚ‹ÁËÛ˘ Î·È Ù˘ÊÏ‹˜ ·Ó¿Ï˘Û˘ ÙÂÏÈÎÒÓ ÛËÌ›ˆÓ ÌÂϤÙË.Yokoyama M, Origasa H, Matsuzaki M, Matsuzawa Y, Saito Y, Ishikawa Y, OikawaS, Sasaki J, Hishida H, Itakura H, Kita T, Kitabatake A, Nakaya N, Sakata T,Shimada K, Shirato K; Japan EPA lipid intervention study (JELIS) Investigators

¶ÏÂÈfiÙÚÔ˜ ¢Ú¿ÛÂȘ Ù˘ ∞ÙÔÚ‚·ÛÙ·Ù›Ó˘∏Ï›·˜ ÃÂÈÌÒÓ·˜, ∫·Ú‰ÈÔÏfiÁÔ˜

£EPA¶EIA — ºAPMAKA∂ÂÌ‚·ÙÈ΋ E·Ó·ÈÌ¿ÙˆÛË ‹ º·Ú̷΢ÙÈ΋ ∞ÁˆÁ‹ ÛÙËÓ ∞Û˘Ìو̷ÙÈ΋ ™Ù·ıÂÚ‹ ™ÙÂÊ·ÓÈ·›· ¡fiÛÔ;μ. ’∞ı˘ÚÔ˜, ∞. ∫·Î·Ê‹Î·, ∂. ¶·ÁÎÔ˘Ú¤ÏÈ·˜,Ã. ∫Ô˘Ì·Ú¿˜, ∞. ™Î·¤Ú‰·˜, ∞. ∫·Ú·ÁÈ¿ÓÓ˘.μ’ ¶ÚÔ·È‰Â˘ÙÈ΋ ¶·ıÔÏÔÁÈ΋ ∫ÏÈÓÈ΋, ∞¶£, πÔÎÚ¿ÙÂÈÔ £ÂÛÛ·ÏÔӛ΢

∏ ∫ÏÈÓÈ΋ ™ËÌ·Û›· Ù˘ ÃÔÚ‹ÁËÛ˘ ™Ù·ÙÈÓÒÓ ¶ÚÈÓ ·fi ∂ÂÌ‚·ÙÈ΋ ∂·Ó·ÈÌ¿ÙˆÛË ÙÔ˘ ª˘Ôηډ›Ô˘.μ. ’∞ı˘ÚÔ˜, ∞. ∫·Î·Ê‹Î·, ∂. ¶·ÓÎÔ˘Ú¤ÏÈ·˜, ™. ™·‚‚·ÙÈ·Ófi˜, ∞. ¶ÈÚ·ÛÔÔ‡ÏÔ˘, Ã. ∫Ô˘Ì·Ú¿˜, ∞. ™Î·¤Ú‰·˜, ∫. Δ˙ÈfiÌ·ÏÔ˜, ∞. ∫·Ú·ÁÈ¿ÓÓ˘.μ ¶ÚÔ. ¶·ıÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ∞¶£, πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌ›Ô, £ÂÛÛ·ÏÔÓ›ÎË.

∂ÈÛÓÂfiÌÂÓË πÓÛÔ˘Ï›ÓË: Δ· ¢Â‰Ô̤ӷ Î·È ÔÈ ¶ÚÔ‚ÏËÌ·ÙÈÛÌÔ›¢Ú. ∞Ó‰Ú¤·˜ ªÂÏȉÒÓ˘ À‡ı˘ÓÔ˜ ¢È·‚ËÙÔÏÔÁÈÎÔ‡ ∫¤ÓÙÚÔ˘, °.¡. ¶ÂÈÚ·È¿

√È ‚-∞ÔÎÏÂÈÛÙ¤˜ ÛÙËÓ ∫ÏÈÓÈ΋ ¶Ú¿Í˪. ºÏˆÚÂÓÙ›Ó, ∂ÈÛÙËÌÔÓÈÎfi˜ ™˘ÓÂÚÁ¿Ù˘ ÙÔ˘ π·ÙÚ›Ԣ §Èȉ›ˆÓª. ∂ÏÈÛ¿Ê, ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓΔÔ̤·˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ

¶POTEINOMENH BIB§IO°PAºIA

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∞. ™˘ÁÁÂÓ›˜ ·ı‹ÛÂȘ

∏ ·‚ËÙÔÏÈÔÚˆÙÂïÓ·ÈÌ›· ›ӷÈÛ¿ÓÈ· ÓfiÛÔ˜, ÎÏËÚÔÓÔÌÔ‡ÌÂ-ÓË Ì ÙÔÓ ˘ÔÏÂÈfiÌÂÓÔ ·˘ÙÔ-ۈ̷ÙÈÎfi ¯·Ú·ÎÙ‹Ú·. X·Ú·ÎÙË-Ú›˙ÂÙ·È ·fi ȉȷ›ÙÂÚ· ¯·ÌËϿ›‰· ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ÙÚÈ-ÁÏ˘ÎÂÚȉ›ˆÓ ÛÙÔ Ï¿ÛÌ·. OÊ›-ÏÂÙ·È ÛÙËÓ ¤ÏÏÂÈ„Ë ÂÓ˙‡ÌÔ˘Ô˘ Â›Ó·È ˘Â‡ı˘ÓÔ ÁÈ· ÙËÓ ÂÓ-‰Ô΢ÙÙ¿ÚÈÔ ÌÂÙ·ÊÔÚ¿ ÙˆÓ ÏÈÈ-‰›ˆÓ ÛÙÔ ¤ÓÙÂÚÔ Î·È ÙÔ ‹·Ú Ì·ÔÙ¤ÏÂÛÌ· ÙÔÓ ÌË Û¯ËÌ·ÙÈÛÌfiÙˆÓ ¯˘ÏÔÌÈÎÚÒÓ Î·È ÙˆÓ Ôχ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆ-ÙÂïÓÒÓ (VLDL). Δ· ·ÚÈ· Û˘-ÌÙÒÌ·Ù· Ù˘ ÓfiÛÔ˘ ÚÔ¤Ú¯Ô-ÓÙ·È ·fi ÙÔ ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfiÛ‡ÛÙËÌ·, ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙË ‰Â‡-ÙÂÚË ‰ÂηÂÙ›· Ù˘ ˙ˆ‹˜ ηÈÔÊ›ÏÔÓÙ·È Î˘Ú›ˆ˜ ÛÙËÓ ·‰˘Ó·-Ì›· ·ÔÚÚfiÊËÛ˘ Î·È ÌÂÙ·ÊÔ-Ú¿˜ ÙˆÓ ÏÈÔ‰È·Ï˘ÙÒÓ ‚ÈÙ·ÌÈ-ÓÒÓ Î·È È‰È·›ÙÂÚ· Ù˘ ‚ÈÙ·Ì›Ó˘∂ ÛÙÔ˘˜ ÈÛÙÔ‡˜. √È ÂÙÂÚfi˙˘ÁÔȉÂÓ ÂÌÊ·Ó›˙Ô˘Ó ¯·ÌËϤ˜ Û˘-ÁÎÂÓÙÚÒÛÂȘ ÏÈȉ›ˆÓ ÛÙÔ ·›Ì·Ô‡ÙÂ Û˘ÌÙÒÌ·Ù·.

∏ ÔÈÎÔÁÂÓ‹˜ ˘Ô‚ËÙ·ÏÈÔÚˆ-ÙÂïÓ·ÈÌ›· ÔÊ›ÏÂÙ·È Û ¤Ó· ·ÚÈ-ıÌfi ÌÂÙ·ÏÏ¿ÍÂˆÓ Ô˘ ·Ú·ÙË-ÚÔ‡ÓÙ·È ÛÙÔ ÁÔÓ›‰ÈÔ Ù˘ ·Ô-ÚˆÙ½Ó˘ μ (ApoB) Î·È ÔÈÔԛ˜ ¤¯Ô˘Ó Û·Ó ·ÔÙ¤ÏÂÛÌ·ÙËÓ ·Ú·ÁˆÁ‹ ÌÔÚ›Ô˘ ApoB-100 ÌÈÎÚfiÙÂÚÔ˘ Ì‹ÎÔ˘˜ ·fi ÙÔÊ˘ÛÈÔÏÔÁÈÎfi. ΔÔ Ï‹ÚÔ˘˜ Ì‹-ÎÔ˘˜ ApoB-100 ÌfiÚÈÔ Â›Ó·È ··-Ú·›ÙËÙÔ ÁÈ· ÙËÓ Û‡ÓıÂÛË Î·È·¤ÎÎÚÈÛË ·fi ÙÔ ‹·Ú Ù˘VLDL. ∂ÈϤÔÓ Ë ÌÈÎÚfiÙÂÚÔ˘Ì‹ÎÔ˘˜ ApoB ÂÌÊ·Ó›˙ÂÈ Ù·¯‡ÙÂ-ÚË Î¿ı·ÚÛË.2,3 ŒÙÛÈ ÔÈ ·ÛıÂÓ›˜·˘ÙÔ› ¤¯Ô˘Ó ¯·ÌËÏ¿ ›‰·ÛÙÔ Ï¿ÛÌ· Ù˘ ÔÏÈ΋˜ (Tc) ηÈÙ˘ ¯ÔÏËÛÙÂÚfiÏ˘ ÙˆÓ ¯·ÌË-Ï‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂïÓÒÓ(LDL), Ù˘ ApoB Î·È Û˘Ó‹ıˆ˜Î·È ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ (TG).

∏ ÓfiÛÔ˜ ÌÂÙ·‰›‰ÂÙ·È Ì ÙÔÓ ·˘-ÙÔۈ̷ÙÈÎfi ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·-

Ú·ÎÙ‹Ú· Ì ·ÔÙ¤ÏÂÛÌ· ÔÈ ÂÙÂ-ÚÔ˙˘ÁÒÙ˜ Ó· ¤¯Ô˘Ó Û˘ÁÎÂ-ÓÙÚÒÛÂȘ ÛÙÔ Ï¿ÛÌ· ÔÏÈ΋˜Î·È LDL ¯ÔÏËÛÙÂÚfiÏ˘ ÛÙÔ 1/3¤ˆ˜ 1/4 ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ (¶›-ӷη˜ 1)4. Δ· ·ÓÙ›ÛÙÔȯ· ›Â-‰· Ù˘ ApoB Â›Ó·È 25-50%. √ÈÔÌÔ˙˘ÁÒÙ˜ ÂÌÊ·Ó›˙Ô˘Ó Ú·-ÎÙÈο ·‚ËÙ·ÏÈÔÚˆÙÂïÓ·ÈÌ›·(ApoB<5%). ™Â ÔÚÈṲ̂ÓÔ˘˜ Ù‡-Ô˘˜ ÔÈÎÔÁÂÓÔ‡˜ ˘Ô‚ËÙ·ÏÈÔ-ÚˆÙÂïÓ·ÈÌ›·˜ fï˜, ‰ÂÓ ·Ú·-ÙËÚÂ›Ù·È Ë ·Ú·ÁˆÁ‹ ‚Ú·¯Â›·˜ApoB Î·È Ë ·ÈÙ›· Ù˘ ÓfiÛÔ˘ Û·˘Ù¤˜ ÙȘ ÂÚÈÙÒÛÂȘ ·Ú·Ì¤-ÓÂÈ ·‰È¢ÎÚ›ÓÈÛÙË.

∏ ÓfiÛÔ˜ ÛÙËÓ ÂÙÂÚfi˙˘ÁË ÌÔÚ-Ê‹ Â›Ó·È Û¯ÂÙÈο Û¿ÓÈ· ·Ó ηȷÓ¢ڛÛÎÔÓÙ·È ÂÚÈÛÙ·ÙÈο ÛÙÔÓ¤ÏÂÁ¯Ô ÚÔ˘Ù›Ó·˜ Ô˘ Á›ÓÂÙ·ÈÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi. Δ· ¿ÙÔ-Ì· ·˘Ù¿ Â›Ó·È Û˘Ó‹ıˆ˜ ·Û˘-Ìو̷ÙÈο Î·È ¤¯Ô˘Ó ¯·ÌËÏfi-ÙÂÚÔ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ÛÙÂ-Ê·ÓÈ·›·˜ ÓfiÛÔ˘ ·fi ÙÔÓ ÁÂÓÈÎfiÏËı˘ÛÌfi6. √ÚÈṲ̂Ó˜ ÊÔÚ¤˜·ÚÔ˘ÛÈ¿˙Ô˘Ó ·Û˘Ìو̷ÙÈ΋·‡ÍËÛË ÙˆÓ ÙÚ·ÓÛ·ÌÈÓ·ÛÒÓ Î·ÈÛ·Ó›ˆ˜ Â˘Ú‹Ì·Ù· ÏÈÒ‰Ô˘˜‰È‹ıËÛ˘ ÙÔ˘ ‹·ÙÔ˜7. ∏ ÂÏ¿Ù-ÙˆÛË Ù˘ ·¤ÎÎÚÈÛ˘ ÙˆÓ ÙÚÈ-ÁÏ˘ÎÂÚȉ›ˆÓ ·fi ÙÔ ‹·Ú, ÏfiÁˆÌÂȈ̤Ó˘ ·Ú·ÁˆÁ‹˜ VLDL,¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂÓ·fi-ıÂÛË ÙÔ˘˜ ÛÙ· Ë·ÙÔ·ÙÙ·Ú·Î·È ÙËÓ ·Ó¿Ù˘ÍË ÏÈÒ‰Ô˘˜‰È‹ıËÛ˘2. ΔÔ ÙÂÏÈÎfi ·ÔÙ¤ÏÂ-ÛÌ· Â›Ó·È Û˘Ó¿ÚÙËÛË Î·È ÙÔ˘

Ú˘ıÌÔ‡ Û‡ÓıÂÛ˘ ÙˆÓ ÙÚÈÁÏ˘-ÎÂÚȉ›ˆÓ. ∏ ·fiÊ·ÛË ‰ÈÂÓ¤Ú-ÁÂÈ·˜ ‚ÈÔ„›·˜ ‹·ÙÔ˜ ÁÈ· ÙËÓÙÂÎÌËÚ›ˆÛË Ù˘ ‰È¿ÁÓˆÛ˘ ÌÔ-Ú› Ó· ÛÙËÚȯı› ÛÙÔÓ ÎÏÈÓÈÎfiÎ·È ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ÁÈ·ÈÔÁÂÓ‹, ·ÓÔÛÔÏÔÁÈ΋ Î·È ÙÔÍÈ΋‚Ï¿‚Ë ÙÔ˘ ‹·ÙÔ˜, ÛÙÔ ¯·Ú·-ÎÙËÚÈÛÙÈÎfi ÏÈȉ·ÈÌÈÎfi ÚÔÊ›ÏÙ˘ ˘Ô‚ËÙ·ÏÈÔÚˆÙÂïÓ·ÈÌ›·˜,ÛÙËÓ ·Ó‡ÚÂÛË ·ÚÔÌÔ›Ô˘ ÏÈÈ-‰·ÈÌÈÎÔ‡ ÚÔÊ›Ï Û ¤Ó· Û˘ÁÁÂ-Ó‹ ÚÒÙÔ˘ ‚·ıÌÔ‡ Î·È ‚¤‚·È·ÌÔÚ› Ó· ÂÍ·ÙÔÌÈ΢ı›8.9.

√È ÔÌfi˙˘Á˜ ÌÔÚʤ˜ Â›Ó·È Û¿-ÓȘ Î·È ÌÔÚÔ‡Ó Ó· ·ÚÔ˘ÛÈ¿-ÛÔ˘Ó Û˘ÌÙÒÌ·Ù· ·Ó¿ÏÔÁ· Ù˘·‚ËÙ·ÏÈÔÚˆÙÂïÓ·ÈÌ›·˜. ∏ ‰È¿-ÎÚÈÛË ·fi ÙËÓ ‰Â‡ÙÂÚË ÌÔÚ›ӷ Á›ÓÂÈ Ì ‚¿ÛË ÙÔ ÏÈȉ·ÈÌÈÎfiÚÔÊ›Ï (LDLc Î·È apoB) ÙˆÓ ÁÔ-Ó¤ˆÓ. ™ÙËÓ ÔÌfi˙˘ÁË ˘Ô‚ËÙ·ÏÈ-ÔÚˆÙÂ˚Ó·ÈÌ›· ·ÌÊfiÙÂÚÔÈ ·-ÚÔ˘ÛÈ¿˙Ô˘Ó ÙÈ̤˜ ¯·ÌËÏfiÙÂÚ˜ÙÔ˘ ‹ÌÈÛ˘ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ.

μ. ∂›ÎÙËÙ˜ ηٷÛÙ¿ÛÂȘ(‰Â˘ÙÂÚÔ·ı›˜)

¶ÔÏϤ˜ ·ı‹ÛÂȘ Ô˘ Û˘Ó‰˘¿-˙ÔÓÙ·È Ì η΋ ıÚ¤„Ë Î·È ÂÈ-‚·Ú˘Ì¤ÓË ÁÂÓÈ΋ ηٿÛÙ·ÛË·ÔÙÂÏÔ‡Ó ·ÈÙ›· ¯·ÌËÏ‹˜ ¯ÔÏË-ÛÙÂÚfiÏ˘ fiˆ˜ Ù· ÓÂÔÏ¿ÛÌ·-Ù·, ÔÈ ‚·ÚȤ˜ ÏÔÈÌÒÍÂȘ, Ë ‚·-ÚÈ¿ Ë·ÙÈ΋ ÓfiÛÔ˜ Î·È Ù· Û‡Ó-‰ÚÔÌ· ‰˘Û·ÔÚÚfiÊËÛ˘. ™Ù·ÙÂÏÂ˘Ù·›· Û ‹È˜ ·‰È¿ÁÓˆ-

π √ À ¡ π √ ™ 2 0 0 7

2

¶·ıÔÏÔÁÈΤ˜ ∫·Ù·ÛÙ¿ÛÂȘ Ô˘™˘Óԉ‡ÔÓÙ·È ·fi ÷ÌËÏ‹ ÃÔÏËÛÙÂÚfiÏË

ÃÚ‹ÛÙÔ˜ ∞ÓÙÒÓÔÁÏÔ˘

∂›ÎÔ˘ÚÔ˜ ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¢ËÌÔÎÚÈÙ›Ԣ ¶·ÓÂÈÛÙËÌ›Ô˘ £Ú¿Î˘

¶›Ó·Î·˜ 1: §Èȉ·ÈÌÈΤ˜ ·Ú¿ÌÂÙÚÔÈ Û ·ÛıÂÓ›˜ Ì ÔÈÎÔÁÂÓ‹ ÂÙÂÚfi-˙˘ÁÔ ˘Ô‚ËÙ·ÏÈÔÚˆÙÂïÓ·ÈÌ›· Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘

¶·Ú¿ÌÂÙÚÔ˜ ∞ÛıÂÓ›˜ √Ì¿‰· ÂϤÁ¯Ô˘ P(n=7) (n=7)

Tc (mg%) 88 ± 12 184 ± 28 <0,001LDL-c (mg%) 28 ± 12 120 ± 24 <0,001HDL-c (mg%) 56 ± 12 52 ± 16 NSTG (mg%) 28 ± 16,3 90 ± 31 <0,001ApoB (mg%) 23,3 ± 6,5 96,3 ± 16,6 <0,001

√È ÙÈ̤˜ ÂÎÊÚ¿˙ÔÓÙ·È ˆ˜ Ë Ì¤ÛË ÙÈÌ‹ ± ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË. Tc: ÔÏÈ΋ ¯ÔÏËÛÙÂÚfi-ÏË, LDL-c: LDL ¯ÔÏËÛÙÂÚfiÏË, HDL-c: HDL ¯ÔÏËÛÙÂÚfiÏË, TG: ΔÚÈÁÏ˘ÎÂÚ›‰È·, ApoB:·ÔÚˆÙ½ÓË μ, NS: ÌË ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿

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ÛÙ˜ ÌÔÚʤ˜ ÔÊÂÈÏfiÌÂÓ˜ ÛÂÎÔÈÏÈÔοÎË ˘¿Ú¯ÂÈ ¯·ÌËÏ‹ ÔÏÈ-΋ ¯ÔÏËÛÙÂÚfiÏË Î·È ¯·ÌËÏ‹HDLc ÔÈ Ôԛ˜ Û˘Û¯ÂÙ›˙ÔÓÙ·ÈÌ ¯·ÌËÏ¿ ›‰· ÏÂ˘ÎˆÌ·Ù›-Ó˘ Î·È ˘fi¯ÚˆÌË ·Ó·ÈÌ›·10. ∏ÛËÌ·ÓÙÈÎfiÙÂÚË fï˜ ·ÈÙ›· ›-ÎÙËÙ˘ ˘Ô‚ËÙ·ÏÈÔÚˆÙÂïÓ·È-Ì›·˜ Â›Ó·È Ô ˘ÂÚı˘ÚÂÔÂȉÈÛÌfi˜.∏ ·Ú·ÙËÚÔ‡ÌÂÓË ÂÏ¿ÙÙˆÛËÙ˘ ÔÏÈ΋˜ Î·È LDL ¯ÔÏËÛÙÂÚfi-Ï˘ ÔÊ›ÏÂÙ·È ÛÙÔÓ ·˘ÍË̤ÓÔηٷ‚ÔÏÈÛÌfi ÙˆÓ LDL ̤ۈ Ù˘ÂÓÂÚÁÔÔ›ËÛ˘ ÙˆÓ LDL ˘Ô-‰Ô¯¤ˆÓ ÛÙÔ ‹·Ú ·fi ÙËÓ ı˘-ÚÔÍ›ÓË. ∏ HDL ¯ÔÏËÛÙÂÚfiÏË ·-ڷ̤ÓÂÈ ·ÌÂÙ¿‚ÏËÙË ‹ ÂÏ·ÙÙÒ-ÓÂÙ·È ÏfiÁˆ Ù˘ ›‰Ú·Û˘ Ù˘

ı˘ÚÔ͛Ӣ ÛÙË ‰Ú·ÛÙËÚÈfiÙËÙ·Ù˘ ÚˆÙ½Ó˘ ÌÂÙ·ÊÔÚ¿˜ ÂÛÙ¤-ÚˆÓ ¯ÔÏËÛÙÂÚfiÏ˘ (CETP), ÙÔ˘

ÂÓ˙‡ÌÔ˘ Ô˘ Â›Ó·È ˘Â‡ı˘ÓÔÁÈ· ÙË ÌÂÙ·ÊÔÚ¿ ÂÛÙ¤ÚˆÓ ¯Ô-ÏËÛÙÂÚfiÏ˘ ·fi Ù˘ ˘„ËÏ‹˜ ˘Î-ÓfiÙËÙ·˜ ÏÈÔÚˆÙ½Ó˜ (HDL)ÛÙȘ VLDL. ΔÔ Â‡ÚÔ˜ ÙˆÓ ÌÂÙ·-‚ÔÏÒÓ Ù˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘ÔÈΛÏÂÈ ·Ó Î·È ‰ÂÓ Â›Ó·È ÙfiÛÔÛËÌ·ÓÙÈÎfi fiÛÔ ÛÙÔÓ ˘Ôı˘ÚÂÔ-ÂȉÈÛÌfi (¶›Ó·Î·˜ 2)12.

™Â οı ¿ÙÔÌÔ Ì ¯·ÌËÏ¿ ÏÈ›-‰È· ÛÙÔ ·›Ì· Î·È Û¯ÂÙÈο ηϋÁÂÓÈ΋ ηٿÛÙ·ÛË Â›Ó·È Èı·Ó‹Ë ‰È¿ÁÓˆÛË Ù˘ ÔÈÎÔÁÂÓÔ‡˜ ˘Ô-‚ËÙ·ÏÈÔÚˆÙÂïÓ·ÈÌ›·˜, ÂÊfiÛÔÓ·ÔÎÏÂÈÛı› Ô ˘ÂÚı˘ÚÂÔÂȉÈ-ÛÌfi˜ Î·È ‹È· Û‡Ó‰ÚÔÌ· ‰˘Û·-ÔÚÚfiÊËÛ˘, ÂÓÒ ÌÈ· ·ÓÂÍ‹ÁË-ÙË ·‡ÍËÛË ÙˆÓ ÙÚ·ÓÛ·ÌÈÓ·ÛÒÓÌ ˘ÂÚ˯ÔÁÚ·ÊÈο Â˘Ú‹Ì·Ù·ÏÈÒ‰Ô˘˜ ‰È‹ıËÛ˘ ÙÔ˘ ‹·-ÙÔ˜ ÌÔÚ› ›Û˘ Ó· ˘ÔÎÚ‡-ÙÂÈ ÙË ÓfiÛÔ.

3

¶∞£√ºÀ™π√§√°π∞

¶›Ó·Î·˜ 2: ªÂÙ·‚ÔϤ˜ ÛÙȘ ÏÈȉ·ÈÌÈΤ˜ ·Ú·Ì¤ÙÚÔ˘˜ ˘ÂÚı˘ÚÂÔÂÈ-‰ÈÎÒÓ ·ÛıÂÓÒÓ (n=47) Ì ÙËÓ ·ÔηٿÛÙ·ÛË Ù˘ ı˘ÚÂÔÂȉÈ΋˜ÏÂÈÙÔ˘ÚÁ›·˜

¶·Ú¿ÌÂÙÚÔÈ ∞ÛıÂÓ›˜ ÚÔ ıÂڷ›·˜ ∞ÛıÂÓ›˜ ÌÂÙ¿ ıÂڷ›· PTSH (mU/l) <0,01 1,0 <0,005Tc (mg%) 179,6 ± 43 232,4 ± 48,4 <0,005LDL-c (mg%) 107 ± 116 148 ± 44 <0,005HDL-c (mg%) 50 ± 13,2 59,2 ± 16,8 <0,005TG (mg%) 100,9 ± 37,2 120 ± 55,4 <0,05ApoB (mg%) 82 ± 27 113 ± 30 <0,005

√È ÙÈ̤˜ ÂÎÊÚ¿˙ÔÓÙ·È ˆ˜ Ë Ì¤ÛË ÙÈÌ‹ ± ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË. Tc: ÔÏÈ΋ ¯ÔÏËÛÙÂÚfi-ÏË, LDL-c: LDL ¯ÔÏËÛÙÂÚfiÏË, HDL-c: HDL ¯ÔÏËÛÙÂÚfiÏË, TG: ΔÚÈÁÏ˘ÎÂÚ›‰È·, ApoB:·ÔÚˆÙ½ÓË μ, TSH: £˘ÚÂÔÂȉÔÙÚfiÔ˜ ÔÚÌfiÓË

1. Rader DJ, Brewer HB Jr: Abetalipoprotei-nemia: new insights in into lipoprotein as-sembly and vitamin E metabolism from arare genetic disease. JAMA 1993; 270: 865

2. Schonfeld G et al.: Familial hypobetalipo-proteinemia: genetics and metabolism.Cell. Mol. Life Sci. 2005 ; 62 :1372

3. Rader DJ: Primary hypolipidemias. In:David Humes, ed Kelley’s Textbook ofInternal Medicine, forth ed. Philadelphia;Lippincott Williams & Wilkins, 2000; 90-92

4. Nizar E, Bruce W, Patterson B, SchonfeldG: Decreased production rates of VLDLTriglycerides and ApoB-100 in subjectsheterozygous for Familial Hypobetalipo-proteinemia. Arterioscler. Thromb. Vasc.Biol., 1999; 19: 2714

5. Marsh JB, Welty FK, Lichtenestein AH etal: Apolipoprotein B metabolism in hu-man: studies with stable isotope-labeledamino acid precursors. Atherosclerosis2002;162: 227

6. Young SG: Recent progress in understan-ding apolipoprotein B. Circulation 1990;82: 1574

7. Ahmed A, Keeffe EB : Asymptomatic ele-vation of aminotransferase levels and fattyliver secondary to heterozygous hypobe-talipoproteinemia. Am J Gastroenterol1998; 93: 2598

8. Bayard M et al: Nonalcoholic fatty liverdisease. Am Fam Physician 2006; 11:1961

9. Castellano G, Garcia C, Gomez-Coro-nado D et al: Diffuse fatty liver in familialheterozygous hypobetalipoproteinemia. JClin Gastroenterology 1997 ; 92 : 379

10. Ciacci C et al; Low plasma cholesterol: acorrelate of nondiagnosed celiac diseasein adults with hypochromic anemia. Am JGastroenterol. 1999; 94: 1888

11. Duntas LH.: Thyroid disease and lipids.Thyroid 2002; 12: 287

12. Diekman M, Angelescu N, Endert E et al:Changes in plasma LDL and HDL chole-sterol in hypo and hyperthyroid patientsare related to changes in free thyroxine,not to polymorphisms in LDL receptor orCETP genes. J Clin Endocrinol Metab.2000; 85: 1857

μμÈÈ‚‚ÏÏÈÈÔÔÁÁÚÚ··ÊÊ››··

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π √ À ¡ π √ ™ 2 0 0 7

4

ΔÔ ∞ÏÎÔfiÏ ˆ˜ ¶·Ú¿ÁÔÓÙ·˜ ∫ÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ∂ÌÊ¿ÓÈÛË ∫·Ú‰È·ÁÁÂÈ·ÎÒÓ ™˘Ì‚·Ì¿ÙˆÓ

∂. ¡¿ÎÔ˘, ∂ÈÛÙËÌÔÓÈÎfi˜ ™˘ÓÂÚÁ¿Ù˘ ÙÔ˘ ∂Í. π·ÙÚ›Ԣ ¢È·Ù·Ú·¯ÒÓ ÙÔ˘ ªÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ §Èȉ›ˆÓ

ª. ∂ÏÈÛ¿Ê, ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ ΔÔ̤·˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ

™‡Ìʈӷ Ì ÚfiÛÊ·Ù· ‚È‚ÏÈÔ-ÁÚ·ÊÈο ‰Â‰Ô̤ӷ Ë Î·Ù·Ó¿Ïˆ-ÛË ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ Û ÌÈ-ÎÚ¤˜ ÔÛfiÙËÙ˜ Û˘Û¯ÂÙ›˙ÂÙ·ÈÌ ÌÂȈ̤ÓË Â›ÙˆÛË Î·Ú‰È·Á-ÁÂȷ΋˜ ÓfiÛÔ˘(1,2) Î·È ‰Ú· ÚÔ-Ûٷ٢ÙÈο ÛÙȘ ÓÔËÙÈΤ˜ ÏÂÈ-ÙÔ˘ÚÁ›Â˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘(3). øÛÙfi-ÛÔ, ÙÔ ·ÏÎÔfiÏ ·˘Í¿ÓÂÈ ÙËÓ ·ÚÙË-Úȷ΋ ›ÂÛË Î·È ÂÈϤÔÓ ‰˘-ÛÎÔχÂÈ ÙËÓ ·ÒÏÂÈ· ‚¿ÚÔ˘˜Û ˘¤Ú‚·Ú· Î·È ·¯‡Û·Úη¿ÙÔÌ·. ∫·È Â›Ó·È ÁÓˆÛÙfi fiÙÈ Ë˘¤ÚÙ·ÛË Â›Ó·È ·ÓÂÍ¿ÚÙËÙÔ˜·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÌ-Ê¿ÓÈÛË Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·-Ì¿ÙˆÓ (ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ ηȷÁÁÂÈ·ÎÒÓ ÂÁÎÂÊ·ÏÈÎÒÓ ÂÂÈÛÔ-‰›ˆÓ).

ΔÔ ·ÏÎÔfiÏ ˆ˜ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ-‰‡ÓÔ˘. H ηٷӿψÛË ·ÏÎÔÔ-ÏÔ‡¯ˆÓ ÔÙÒÓ Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂÌ·ÎÚÔ¯ÚfiÓȘ ÂÈÙÒÛÂȘ ÛÙÔÓ·ÓıÚÒÈÓÔ ÔÚÁ·ÓÈÛÌfi ‰È· ̤-Ûo˘ ÙÚÈÒÓ Ì˯·ÓÈÛÌÒÓ: Ù˘ ÙÔ-͛ΈÛ˘, Ù˘ ÂÍ¿ÚÙËÛ˘ Î·È Ù˘¿ÌÂÛ˘ ‚ÈÔÏÔÁÈ΋˜ ‰Ú¿Û˘(4).∂ȉÈÎfiÙÂÚ·, ÛÙÔÓ ¶›Ó·Î· 1 Ê·›-ÓÔÓÙ·È ÔÈ ÂȉڿÛÂȘ Ù˘ ηٷ-ӿψÛ˘ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ(5),ÂÎÙfi˜ ·fi ÙËÓ Â›‰Ú·Û‹ ÙÔ˘˜ÛÙÔ Î·Ú‰È·ÁÁÂÈ·Îfi Û‡ÛÙËÌ·.°È· ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ·fi ·˘-Ù¤˜ ÙȘ ηٷÛÙ¿ÛÂȘ ˘¿Ú¯ÂÈÌÈ· ‰ÔÛÔÂÍ·ÚÙÒÌÂÓË Û˘Û¯¤ÙÈ-

ÛË, ·ÊÔ‡ Ô Î›Ó‰˘ÓÔ˜ ·˘Í¿ÓÂ-Ù·È Ì ÙËÓ ·‡ÍËÛË Ù˘ Úfi-ÛÏ˄˘ ·ÏÎÔfiÏ.

AÏÎÔfiÏ Î·È ·ÚÙËÚȷ΋ ›ÂÛË.™‡Ìʈӷ Ì ̛· ÌÂÙ·Ó¿Ï˘ÛË(6), ˘¿Ú¯ÂÈ ‰ÔÛÔÂÍ·ÚÙÒÌÂÓËÛ˘Û¯¤ÙÈÛË ·Ó¿ÌÂÛ· ÛÙËÓ ÂÏ¿Ù-ÙˆÛË Ù˘ ηٷӿψÛ˘ ·ÏÎÔÔ-ÏÔ‡¯ˆÓ ÔÙÒÓ Î·È ÙËÓ ·Ú·ÙË-ÚÔ‡ÌÂÓË Ì›ˆÛË Ù˘ Û˘ÛÙÔÏÈ-΋˜ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ (™∞¶)Î·È Ù˘ ‰È·ÛÙÔÏÈ΋˜ ·ÚÙËÚÈ·-΋˜ ›ÂÛ˘ (¢∞¶). ªÂ›ˆÛË Ù˘ηٷӿψÛ˘ ·ÏÎÔÔÏÔ‡¯ˆÓ Ô-ÙÒÓ Î·Ù¿ 76% ·ÓÙÈÛÙÔȯ› ÛÂÌ›ˆÛË Ù˘ ™∞¶ ηٿ 3,3mmHg Î·È Ì›ˆÛË Ù˘ ¢∞¶ η-Ù¿ 2,0 mmHg. Δ· ·ÓÙ›ÛÙÔȯ· ·Ô-ÙÂϤÛÌ·Ù· Û ·ÛıÂÓ›˜ Ì ˘¤Ú-Ù·ÛË Â›Ó·È Ì›ˆÛË Ù˘ ™∞¶ η-Ù¿ 3,9 mmHg Î·È Ù˘ ¢∞¶ ηٿ2,4 mmHg, ÂÓÒ ÛÙÔ˘˜ ·ÛıÂÓ›˜Ô˘ ·›ÚÓÔ˘Ó ·ÓÙÈ˘ÂÚÙ·ÛÈ΋·ÁˆÁ‹ Ì›ˆÛË Ù˘ ™∞¶ ηٿ4,0 mmHg Î·È Ì›ˆÛË Ù˘ ¢∞¶Î·Ù¿ 3,1 mmHg. ∏ Ì›ˆÛË ·˘Ù‹Â›Ó·È ȉȷ›ÙÂÚ· ÛËÌ·ÓÙÈ΋ ·Ó Ï¿-‚ÂÈ Î·Ó›˜ ˘fi„Ë fiÙÈ Û‡ÌʈӷÌ ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ Ì›· ÂÏ¿Ù-ÙˆÛË Ù˘ ¢∞¶ ηٿ 2 mmHg¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ì›ˆÛË Ù˘›وÛ˘ Ù˘ ˘¤ÚÙ·Û˘ ηٿ17%, Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ·ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ (™¡) ηٿ 6%Î·È Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ·Á-

ÁÂȷο ÂÁÎÂÊ·ÏÈο ÂÂÈÛfi‰È·(∞∂∂) ηٿ 15%(7).

¶·ÚfiÌÔÈ· ‹Ù·Ó Ù· ·ÔÙÂϤÛÌ·-Ù· Ù˘ ÌÂϤÙ˘ INTERSALT(8, 9),ÛÙËÓ ÔÔ›· ¿Ó‰Ú˜ Ô˘ ¤ÈÓ·Ó300-400 ml ·ÏÎÔfiÏ/‚‰ÔÌ¿‰·Â›¯·Ó ηٿ ̤ÛÔ fiÚÔ ˘„ËÏfiÙÂÚË™∞¶/¢∞¶ ηٿ 2,7/1,6 mmHgÛ ۇÁÎÚÈÛË Ì ·˘ÙÔ‡˜ Ô˘‰ÂÓ ¤ÈÓ·Ó ·ÏÎÔÔÏÔ‡¯· ÔÙ¿,ÂÓÒ ¿Ó‰Ú˜ Ô˘ ¤ÈÓ·Ó ¿Óˆ·fi 500 ml ·ÏÎÔfiÏ/ ‚‰ÔÌ¿‰·Â›¯·Ó ·ÓÙ›ÛÙÔȯ· ·ÚÙËÚȷΤ˜È¤ÛÂȘ ηٿ 4,6/ 3,0mmHg˘„ËÏfiÙÂÚ˜ ·fi ÙÔ ÁÂÓÈÎfi ÏË-ı˘ÛÌfi. ™ÙËÓ ›‰È· ÌÂϤÙË Ë Î·-ٷӿψÛË ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓÛ Ôχ ÌÂÁ¿Ï˜ ÔÛfiÙËÙ˜(>500 ml ·ÏÎÔfiÏ ÁÈ· ÙÔ˘˜ ¿Ó-‰Ú˜ Î·È >300 ml ÁÈ· ÙȘ Á˘-Ó·›Î˜) Û˘Û¯ÂÙ›ÛıËΠ̠ٷ›‰· Ù˘ ·ÚÙËÚȷ΋˜ ›Â-Û˘ Î·È ÛÙ· ‰‡Ô ʇϷ.

™‡Ìʈӷ Ì ̛· ÌÂÙ··Ó¿Ï˘ÛË61 ÚÔÔÙÈÎÒÓ ÌÂÏÂÙÒÓ(10), Ì›ˆ-ÛË Ù˘ ™∞¶ ηٿ 4 mmHg ηÈÙ˘ ¢∞¶ ηٿ 2 mmHg ¤¯ÂÈ ˆ˜·ÔÙ¤ÏÂÛÌ· Ì›ˆÛË Ù˘ ıÓËÙfi-ÙËÙ·˜ ·fi ∞∂∂ ηٿ 18% ηÈÌ›ˆÛË Ù˘ ıÓËÙfiÙËÙ·˜ ·fi ÛÙÂ-Ê·ÓÈ·›· ÓfiÛÔ Î·Ù¿ 12%. øÛÙfi-ÛÔ, Û ÔÏϤ˜ ÌÂϤÙ˜ ·Ú·ÙË-Ú‹ıËΠ·‡ÍËÛË Ù˘ ıÓËÙfiÙËÙ·˜·fi ™¡ Û ¿ÙÔÌ· Ô˘ ‰ÂÓ ¤È-Ó·Ó ·ÏÎÔÔÏÔ‡¯· ÔÙ¿. ∂ÈϤ-ÔÓ, Û ÔÚÈṲ̂Ó˜ ÂȉËÌÈÔÏÔÁÈ-Τ˜ ÌÂϤÙ˜ ·Ú·ÙËÚ‹ıËΠ̛·Û˘Û¯¤ÙÈÛË, Û¯‹Ì·ÙÔ˜ J, ·Ó¿ÌÂ-Û· ÛÙËÓ Î·Ù·Ó¿ÏˆÛË ·ÏÎÔÔÏÔ‡-¯ˆÓ ÔÙÒÓ Î·È Ù· ›‰· Ù˘·ÚÙËÚȷ΋˜ ›ÂÛ˘(11, 12, 13).

™˘Û¯¤ÙÈÛË Ù˘ ηٷӿψÛ˘ ·Ï-ÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ Ì ÙË ıÓËÙfi-ÙËÙ·. ¶ÔÏϤ˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·ÓÙË Û˘Û¯¤ÙÈÛË Ù˘ ηٷӿψÛ˘·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ Ì ÙË ıÓË-ÙfiÙËÙ·. ™ÙÔÓ ¶›Ó·Î· 2 ÛËÌÂÈÒ-ÓÔÓÙ·È ÔÚÈṲ̂Ó˜ ·fi ·˘Ù¤˜ ÙȘÌÂϤÙ˜, ηıÒ˜ Î·È Ë ÚÔÛÏ·Ì-‚·ÓfiÌÂÓË ÔÛfiÙËÙ· ÙˆÓ ·ÏÎÔÔ-ÏÔ‡¯ˆÓ ÔÙÒÓ Ô˘ Û˘Û¯ÂÙ›˙Â-

¶π¡∞∫∞™ 1. √È ÂȉڿÛÂȘ Ù˘ ηٷӿψÛ˘ ·ÏÎÔÔÏÔ‡¯ˆÓÔÙÒÓ ÛÙÔÓ ·ÓıÚÒÈÓÔ ÔÚÁ·ÓÈÛÌfi, ÂÎÙfi˜ ·fi ÙËÓ Â›‰Ú·Û‹ÙÔ˘˜ ÛÙÔ Î·Ú‰È·ÁÁÂÈ·Îfi Û‡ÛÙËÌ·.

™¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜

2 ÔÙ¿/Ë̤ڷ 8 ÔÙ¿/Ë̤ڷ∫›ÚÚˆÛË ÙÔ˘ ‹·ÙÔ˜ 1,6-3,0 4,4-59,3ΔÚ·˘Ì·ÙÈÛÌÔ› 1,1-1,4 1,3-4,0¶·ÁÎÚ·ٛÙȉ· 1,3 3,2∫·ÚΛÓÔ˜ Ù˘ ÛÙÔÌ·ÙÈ΋˜ ÎÔÈÏfiÙËÙ·˜ 1,9-2,3 6,4-12,5∫·ÚΛÓÔ˜ ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘ 1,5-1,6 4,5-6,0∫·ÚΛÓÔ˜ ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘ 1,0-1,4 1,1-3,6∫·ÚΛÓÔ˜ ÙÔ˘ Ï¿Ú˘ÁÁ· 1,2-1,6 2,1-7,1∫·ÚΛÓÔ˜ ÙÔ˘ Ì·ÛÙÔ‡ 1,2-1,4 2,2-3,4∫·ÚΛÓÔ˜ ÙÔ˘ ÔÚıÔ‡ 1,1-2,3 1,5-25,7

ATHIROSK 14 03-07-07 12:06 ™ÂÏ›‰·4

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¶APA°ONTE™ KIN¢YNOY

5

Ù·È Ì ÙËÓ ÂÏ¿¯ÈÛÙË ıÓËÙfiÙËÙ··fi ™¡, ∞∂∂, ηıÒ˜ Î·È Ì ÙËÓÂÏ¿¯ÈÛÙË ÔÏÈ΋ ıÓËÙfiÙËÙ·.

Y¿Ú¯ÂÈ Ì›· Û˘Û¯¤ÙÈÛË Û¯‹Ì·-ÙÔ˜ J ‹ U ·Ó¿ÌÂÛ· ÛÙËÓ ÔÛfi-ÙËÙ· ÙˆÓ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓÔ˘ ηٷӷÏÒÓÂÙ·È Î·È ÙË ıÓË-ÙfiÙËÙ· ·fi ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ,Ì ÙÔ Î·ÙÒÙÂÚÔ fiÚÈÔ Ù˘ ÁÚ·-ÊÈ΋˜ ·Ú¿ÛÙ·Û˘ Ó· ·Ú·ÙË-ÚÂ›Ù·È ÛÙ· ‰‡Ô ÔÙ¿ ÙËÓ Ë̤ڷÁÈ· ÙÔ˘˜ ¿Ó‰Ú˜ (20-24 g ÔÈÓÔ-Ó‡̷ÙÔ˜) Î·È ÛÙÔ ¤Ó· ÔÙfi ÙËÓË̤ڷ ÁÈ· ÙȘ Á˘Ó·›Î˜ (10-12 gÔÈÓÔÓ‡̷ÙÔ˜)(5).

™Â Ì›· ÌÂϤÙË Ô˘ ¤ÁÈÓ Û ¿Ó-‰Ú˜, ¿ÁÁÏÔ˘˜ ÁÈ·ÙÚÔ‡˜ (ÌÂϤ-ÙË Male-British doctors) ÂÎÙÈÌ‹-ıËÎÂ Ë ıÓËÙfiÙËÙ· ·fi ™¡(14).™‡Ìʈӷ Ì ٷ ‰Â‰Ô̤ӷ Ù˘ÌÂϤÙ˘ ÛÙ· ¿ÙÔÌ· Ô˘ ¤ÈÓ·Ó8-28 ·ÏÎÔÔÏÔ‡¯· ÔÙ¿/‚‰ÔÌ¿-‰· (‰ËÏ·‰‹ ÂÚ›Ô˘ 96-336 ml·ÏÎÔfiÏ/‚‰ÔÌ¿‰·) Ë ıÓËÙfiÙËÙ·‹Ù·Ó 7,1-8,5/1000 ¿ÙÔÌ·-¤ÙË, ÂÓÒÛÙ· ¿ÙÔÌ· Ô˘ ‰ÂÓ Î·Ù·Ó¿Ïˆ-Ó·Ó ·ÏÎÔÔÏÔ‡¯· ÔÙ¿ ‹Ù·Ó10/1000 ¿ÙÔÌ·-¤ÙË. ™ÙÔ˘˜ ‰‡Ô·Ú·¿Óˆ ÏËı˘ÛÌÔ‡˜, Ë ÔÏÈ΋ıÓËÙfiÙËÙ· ‹Ù·Ó 24-27/1000 ¿ÙÔ-Ì·-¤ÙË Î·È 34/1000 ¿ÙÔÌ·-¤ÙË·ÓÙ›ÛÙÔȯ·. ∏ ıÓËÙfiÙËÙ· ·fi∞∂∂ ‹Ù·Ó 6/1000 ¿ÙÔÌ·-¤ÙË Ûٷٷ ¿ÙÔÌ· Ô˘ ¤ÈÓ·Ó >43 Ô-Ù¿/‚‰ÔÌ¿‰· (>516 ml ·ÏÎÔfiÏ/‚‰ÔÌ¿‰·), 2,6-3,3/1000 ¿ÙÔÌ·-¤ÙË ÛÙ· ¿ÙÔÌ· Ô˘ ¤ÈÓ·Ó 1-42·ÏÎÔÔÏÔ‡¯· ÔÙ¿/‚‰ÔÌ¿‰·, ÂÓÒÛÙ· ¿ÙÔÌ· Ô˘ ‰ÂÓ Î·Ù·Ó¿Ïˆ-Ó·Ó Î·ıfiÏÔ˘ ·ÏÎÔÔÏÔ‡¯· ÔÙ¿Ë ıÓËÙfiÙËÙ· ‹Ù·Ó 3,6/1000 ¿ÙÔ-Ì·-¤ÙË.

AÓÙ›ıÂÙ· Û ̛· ÌÂϤÙË ÛÙË ‰˘-ÙÈ΋ ™ÎˆÙ›·, (ÌÂϤÙË Men-We-stern Scotland) ‰ÂÓ ‰È·ÈÛÙÒıË-Π‰È·ÊÔÚ¿ ÛÙËÓ ÔÏÈ΋ ıÓËÙfiÙË-Ù· ·Ó¿ÌÂÛ· ÛÙ· ¿ÙÔÌ· Ô˘ ¤È-Ó·Ó 1-14 ÔÙ¿/‚‰ÔÌ·‰· Î·È ÛÙÔ

ÁÂÓÈÎfi ÏËı˘ÛÌfi. ∂ÈϤÔÓ Û·˘Ù‹ ÙË ÌÂϤÙË, Ë Î·Ù·Ó¿ÏˆÛË·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ ‰ÂÓ ÚÔ-ÛٷهÂÈ ·fi ÙË ÛÙÂÊ·ÓÈ·›· Ófi-ÛÔ Î·È ÔÈ ¿Ó‰Ú˜ Ô˘ ηٷӿψ-Ó·Ó 35 ‹ ÂÚÈÛÛfiÙÂÚ· ·ÏÎÔÔ-ÏÔ‡¯· ÔÙ¿ ÙËÓ Â‚‰ÔÌ¿‰· ›¯·Ó‰ÈÏ¿ÛÈÔ Î›Ó‰˘ÓÔ ÁÈ· ∞∂∂(15). ¶·-ÚfiÌÔÈ· ·ÔÙÂϤÛÌ·Ù· ‚Ú¤ıËηÓÎ·È Û ̛· ÌÂϤÙË Ô˘ ¤ÁÈÓ ÛÙ˃ˆÛ›·,(16), ηıÒ˜ Î·È Û ¿ÏϘÌÂϤÙ˜ ÂÚÈÛÙ·Ûȷ΋˜ ηٷӿ-ψÛ˘ ˘ÂÚ‚ÔÏÈο ÌÂÁ¿ÏˆÓ Ô-ÛÔÙ‹ÙˆÓ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ(binge drinking). ™‡Ìʈӷ ÌÂÚfiÛÊ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â-‰Ô̤ӷ, ·˘Ùfi˜ Ô ÙÚfiÔ˜ ηٷ-ӿψÛ˘ ·ÏÎÔÔÏÔ‡¯ˆÓ (bingedrinking) ÔÙÒÓ ¤¯ÂÈ ˆ˜ ·ÔÙ¤-ÏÂÛÌ· ·‡ÍËÛË Ù˘ ·ÚÙËÚȷ΋˜›ÂÛ˘, ÙÔ˘ ηډȷÎÔ‡ Ú˘ıÌÔ‡Î·È Ù˘ ËÎÙÈÎfiÙËÙ·˜ ÙÔ˘ ·›Ì·-ÙÔ˜(17).

™Â ·ÓÙ›ıÂÛË Ì ٷ ·Ú·¿Óˆ ‚È-‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ, Ì›· ÌÂ-ϤÙË Û πÙ·ÏÔ‡˜ ·ÁÚfiÙ˜ (ÌÂϤ-ÙË ªen-rural Italy) ¤‰ÂÈÍ fiÙÈ ËηٷӿψÛË ·fi 20 ¤ˆ˜ 54 ·Ï-ÎÔÔÏÔ‡¯· ÔÙ¿/‚‰ÔÌ¿‰· Û˘Û¯Â-Ù›ÛıËΠ̠ηχÙÂÚ· ÔÛÔÛÙ¿ÂÈ‚›ˆÛ˘ Î·È Ì ÙË ÌÈÎÚfiÙÂÚËıÓËÙfiÙËÙ· ·fi ηډȷÁÁÂÈ·Î¿Û˘Ì‚¿Ì·Ù· (7/1000-10/1000 ¿ÙÔ-Ì· ÙÔ ¯ÚfiÓÔ) Û ۇÁÎÚÈÛË Ì ÙÔÁÂÓÈÎfi ÏËı˘ÛÌfi(18, 19). ∏ ÌÂϤÙË·˘Ù‹ ¤‰ÂÈÍ ̛· Û˘Û¯¤ÙÈÛË Û¯‹-Ì·ÙÔ˜ J ·Ó¿ÌÂÛ· ÛÙËÓ Î·Ù·Ó¿-ψÛË ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ Î·È ÙËıÓËÙfiÙËÙ· ·fi ηډȷÁÁÂÈ·Î¿Û˘Ì‚¿Ì·Ù·, ηıÒ˜ Î·È ÙËÓ ÔÏÈ΋ıÓËÙfiÙËÙ·.

™ÙËÓ ÚÔÛ¿ıÂÈ· Ó· ·ÍÈÔÏÔÁ‹-ÛÔ˘Ì ٷ ·ÔÙÂϤÛÌ·Ù· وӉȷÊfiÚˆÓ ÌÂÏÂÙÒÓ Î·È Ó· ÂÍË-Á‹ÛÔ˘Ì ÙȘ ‰È·ÊÔÚÂÙÈΤ˜ ÂÈ-‰Ú¿ÛÂȘ Ù˘ ηٷӿψÛ˘ ·Ï-ÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ Û ‰È·ÊÔÚÂÙÈ-Τ˜ ¯ÒÚ˜ Ú¤ÂÈ Ó· Ï¿‚Ô˘ÌÂ

˘fi„Ë Ù· ÂÍ‹˜:

∞) ¶·Ú¿ÁÔÓÙ˜, fiˆ˜ Ô ÙÚfiÔ˜Î·È ÔÈ Û˘Ó‹ıÂȘ ηٷӿψÛ˘·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ (‰ËÏ·‰‹Â¿Ó Â›Ó·È Û˘¯Ó‹ ‹ ÂÚÈÛÙ·ÛÈ·-΋, Â¿Ó Û˘Óԉ‡ÂÙ·È ·fi Á‡-Ì·Ù· ‹ Â›Ó·È ·ÓÂÍ¿ÚÙËÙË ·fiÙÔ Ê·ÁËÙfi) ı· ÌÔÚÔ‡Û·Ó Ó·‰È·ÊÔÚÔÔÈ‹ÛÔ˘Ó ÙȘ Âȉڿ-ÛÂȘ ÙÔ˘ ·ÏÎÔfiÏ ÛÙË ıÓËÙfiÙË-Ù·. ™‡Ìʈӷ Ì ̛· ÌÂÙ·-·Ó¿-Ï˘ÛË(20), Ë Î·Ù·Ó¿ÏˆÛË ·ÏÎÔÔ-ÏÔ‡¯ˆÓ ÔÙÒÓ ·ÓÂÍ¿ÚÙËÙ· ·fiÙÔ Ê·ÁËÙfi Û˘Û¯ÂÙ›˙ÂÙ·È Ì ·˘-ÍË̤ÓÔ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ,οÙÈ Ô˘ ‰ÂÓ ÂȂ‚·ÈÒÓÂÙ·È·fi ¿ÏϘ ÌÂϤÙ˜(21).

μ) ÿÛˆ˜ οÔÈÔ ÚfiÏÔ Ó· ‰È·-‰Ú·Ì·Ù›˙ÂÈ Î·È ÙÔ Â›‰Ô˜ ÙÔ˘ ·Ï-ÎÔÔÏÔ‡¯Ô˘ ÔÙÔ‡. ΔÔ ÎÚ·Û›¤¯ÂÈ ÔÏ˘Ê·ÈÓfiϘ Î·È Â›Ó·ÈÂȂ‚·ÈˆÌ¤ÓË Ë Â˘ÂÚÁÂÙÈ΋ÙÔ˘ ›‰Ú·ÛË. ΔÈ Á›ÓÂÙ·È fï˜Ì ٷ ¿ÏÏ· ÔÙ¿, fiˆ˜ Â›Ó·È Ë̇ڷ; ™‡Ìʈӷ Ì ̛· ÌÂÙ·-·Ó¿Ï˘ÛË(22), ÌÈÎÚ¤˜ ÔÛfiÙËÙ˜(1-4 ÔÙ¿/Ë̤ڷ) ̇ڷ˜, ÎÚ·-ÛÈÔ‡ Î·È ¿ÏÏˆÓ ·ÏÎÔÔÏÔ‡¯ˆÓÔÙÒÓ Â›Ó·È ÂÍ›ÛÔ˘ ˆÊ¤ÏÈ̘ÁÈ· ÙÔ Î·Ú‰È·ÁÁÂÈ·Îfi Û‡ÛÙËÌ·.

°) Δ¤ÏÔ˜ ÛÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘Î·Ú‰È·ÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ Ú¤-ÂÈ ¿ÓÙÔÙ ӷ Ï·Ì‚¿ÓÔ˘Ì ˘fi-„Ë Î·È ÙÔ˘˜ ÎÏ·ÛÈÎÔ‡˜ ·Ú¿-ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÌÊ¿-ÓÈÛË Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·-Ì¿ÙˆÓ.

™˘ÓÔ„›˙ÔÓÙ·˜, ÛÙËÓ ÏÂÈÔ„Ë-Ê›· ÙˆÓ ÌÂÏÂÙÒÓ Ë Î·Ù·Ó¿Ïˆ-ÛË 1-30 ÌÔÓ¿‰ˆÓ ·ÏÎÔfiÏ/ ‚‰Ô-Ì¿‰· Û˘Û¯ÂÙ›˙ÂÙ·È Ì ٷ ηχ-ÙÂÚ· ÔÛÔÛÙ¿ ÂÈ‚›ˆÛ˘, ·ÓÂ-Í¿ÚÙËÙ· ·fi ÙÔ Â›‰Ô˜ ÙÔ˘ ·Ï-ÎÔÔÏÔ‡¯Ô˘ ÔÙÔ‡.

™ÙÂÊ·ÓÈ·›· ÓfiÛÔ˜ Î·È ·ÏÎÔfiÏ.™‡Ìʈӷ Ì ̛· ÌÂÙ·-·Ó¿Ï˘-ÛË(4) Ë Û˘Û¯¤ÙÈÛË ·Ó¿ÌÂÛ· ÛÙËÓ

¶π¡∞∫∞™ 2: ∏ Û˘Û¯¤ÙÈÛË Ù˘ ηٷӿψÛ˘ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ (ÔÙ¿/‚‰ÔÌ¿‰·) Ì ÙËÓ ÂÏ¿¯ÈÛÙËıÓËÙfiÙËÙ·.

™Δ∂º∞¡π∞π∞ ¡√™√™ ∞∂∂ √§π∫∏ £¡∏Δ√Δ∏Δ∞ª∂§∂Δ∂™ ¶ÔÙ¿/‚‰ÔÌ¿‰· ¶ÔÙ¿/‚‰ÔÌ¿‰· ¶ÔÙ¿/‚‰ÔÌ¿‰·Male-British doctors(14) 8-28 1-42 8-21Men-Western 0-14 0-14 0-14

Scotland(15)Men-rural Italy(18,19) 23-54 23-54 23-54ª∂Δ∞-∞¡∞§À™∂π™ ¶ÔÙ¿/‚‰ÔÌ¿‰· ¶ÔÙ¿/‚‰ÔÌ¿‰· ¶ÔÙ¿/‚‰ÔÌ¿‰·Cleophas(21) 8-28 - 8-28Rehm et.al.(4) 1-23(Á˘Ó·›Î˜) 1-35(¿Ó‰Ú˜) 1-23(Á˘Ó·›Î˜) 0 (¿Ó‰Ú˜) -Reynoldw et al.(24) - 1-14(ÈÛ¯·ÈÌÈο,1-14 ·ÈÌÔÚÚ·ÁÈο) -

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π √ À ¡ π √ ™ 2 0 0 7

6

ÚfiÛÏË„Ë ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓÎ·È ÙË ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ Â›Ó·È ÂÚ›-ÏÔÎË. H Û˘¯Ó‹ ηٷӿψÛË ÌÈ-ÎÚ‹˜ ¤ˆ˜ ̤ÙÚÈ·˜ ÔÛfiÙËÙ·˜ ·Ï-ÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ ¤¯ÂÈ Û˘Û¯ÂÙÈ-Ûı› Ì ¢ÂÚÁÂÙÈΤ˜ ÂȉڿÛÂȘÛÙÔ Î·Ú‰È·ÁÁÂÈ·Îfi Û‡ÛÙËÌ·, ÂÓÒË ÂÚÈÛÙ·Ûȷ΋ ηٷӿψÛË ÔχÌÂÁ¿ÏˆÓ ÔÛÔÙ‹ÙˆÓ ·ÏÎÔÔÏÔ‡-¯ˆÓ ÔÙÒÓ, ·ÎfiÌË Î·È ·Ó Û˘Ó‰˘¿-˙ÂÙ·È Ì ̛· ηٿ ̤ÛÔ fiÚÔ ÌÈÎÚ‹¤ˆ˜ ̤ÙÚÈ· ηٷӿψÛË Û ٷÎÙÈ-΋ ‚¿ÛË, ¤¯ÂÈ Û˘Û¯ÂÙÈÛı› Ì ·˘-ÍË̤ÓÔ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ.

™˘ÁÎÂÎÚÈ̤ӷ, Û‡Ìʈӷ Ì ̛·ÌÂÙ·-·Ó¿Ï˘ÛË(22), Ë Î·Ù·Ó¿ÏˆÛË 1- 4 ÔÙÒÓ/Ë̤ڷ(12 - 48 ml ·ÏÎÔ-fiÏ) ÌÔÚ› Ó· ÌÂÈÒÛÂÈ ÙË ıÓËÙfiÙË-Ù· ·fi ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›-Ô˘ ηٿ 20 - 30%. ™‡Ìʈӷ Ì ̛·¿ÏÏË ÌÂÙ· - ·Ó¿Ï˘ÛË(4), Ë Î·Ù·Ó¿-ψÛË ÏÈÁfiÙÂÚÔ ·fi 3,5 ·ÏÎÔÔÏÔ‡-¯ˆÓ ÔÙÒÓ/ Ë̤ڷ ÁÈ· ÙȘ Á˘Ó·›-Θ Î·È ÏÈÁfiÙÂÚÔ ·fi 5 ·ÏÎÔÔÏÔ‡-¯ˆÓ ÔÙÒÓ ÁÈ· ÙÔ˘˜ ¿Ó‰Ú˜ ÌÔ-Ú› Ó· ÌÂÈÒÛÂÈ ÙËÓ Â›ÙˆÛË Ù˘ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ ηٿ 20%. ™ÂÌ›· ÚfiÛÊ·ÙË ÌÂϤÙË(21), ‰È·È-ÛÙÒıËΠfiÙÈ Ë Û˘¯Ó‹ ηٷӿψÛË1 - 4 ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ/ ËÌ¤Ú·Û˘Û¯ÂÙ›ÛıËΠ̠ÌÂȈ̤ÓË Â›-ÙˆÛË ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘ÔηÚ-‰›Ô˘ Î·È fiÙÈ Ë Î·Ù¿ ¤Ó· ÔÙfi ·‡-ÍËÛË Ù˘ ηٷӿψÛ˘ ·ÏÎÔÔ-ÏÔ‡¯ˆÓ ÔÙÒÓ Û˘Û¯ÂÙ›˙ÔÓÙ·Ó ÌÂÛ¯ÂÙÈÎfi ΛӉ˘ÓÔ ÁÈ· ¤ÌÊÚ·ÁÌ·ÙÔ˘ Ì˘Ôηډ›Ô˘ 0,78. ∂›Û˘, Ì›·¿ÏÏË ÌÂÙ·-·Ó¿Ï˘ÛË(23) ¤‰ÂÈÍ fiÙÈ ÔÛ¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ ÁÈ· ·ÁÁÂȷοÓÔÛ‹Ì·Ù· Â›Ó·È 0,68 ÁÈ· Ù· ¿ÙÔÌ·Ô˘ ηٷӷÏÒÓÔ˘Ó ÌÈÎÚ¤˜ ÔÛfi-ÙËÙ˜ ÎÚ·ÛÈÔ‡ Î·È 0,78 ÁÈ· ·˘-ÙÔ‡˜ Ô˘ ηٷӷÏÒÓÔ˘Ó ÌÈÎÚ¤˜ÔÛfiÙËÙ˜ ̇ڷ˜.

√È ·ıÔÊ˘ÛÈÔÏÔÁÈÎÔ› Ì˯·ÓÈÛÌÔ›Ô˘ ÂÍËÁÔ‡Ó ·˘ÙfiÓ ÙÔÓ ÚÔÛÙ·-Ù¢ÙÈÎfi ÚfiÏÔ ÙˆÓ ·ÏÎÔÔÏÔ‡¯ˆÓÔÙÒÓ Â›Ó·È ÔÈ ÂÍ‹˜:

∞) ∏ ÚfiÛÏË„Ë ÌÈÎÚ‹˜ ÔÛfiÙË-Ù·˜ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ ÚÔ-ηÏ› ‚ÂÏÙ›ˆÛË ÙÔ˘ ÏÈȉ·ÈÌÈ-ÎÔ‡ ÚÔÊ›Ï, ΢ڛˆ˜ ·‡ÍËÛËÙ˘ ∏DL ¯ÔÏËÛÙÂÚfiÏ˘. Œ¯ÂÈÂÎÙÈÌËı› Ì¿ÏÈÛÙ· fiÙÈ ÙÔ 40-50% Ù˘ ÚÔÛٷ٢ÙÈ΋˜ ‰Ú¿-Û˘ ÙÔ˘ ·ÏÎÔfiÏ ·Ô‰›‰ÂÙ·È Û·˘Ùfi ÙÔ Ì˯·ÓÈÛÌfi.

μ) ∏ Û˘¯Ó‹ ηٷӿψÛË ÌÈÎÚ‹˜¤ˆ˜ ̤ÙÚÈ·˜ ÔÛfiÙËÙ·˜ ·ÏÎÔÔ-ÏÔ‡¯ˆÓ ÔÙÒÓ ÂËÚ¿˙ÂÈ ÙÔ ÌË-¯·ÓÈÛÌfi ‹Í˘ ‰È· ̤ÛÔ˘ Ù˘‰Ú¿Û˘ Ù˘ ·ÏÎÔfiÏ˘ ÛÙË Û˘Û-

ÛÒÚ¢ÛË ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ ηÈÛÙËÓ ÈÓˆ‰fiÏ˘ÛË.

∏ ÚÔÛٷ٢ÙÈ΋ ÁÈ· ÙÔ Î·Ú‰È·Á-ÁÂÈ·Îfi Û‡ÛÙËÌ· ‰Ú¿ÛË Ô˘ ¤¯ÂÈ ËηٷӿψÛË ÌÈÎÚ‹˜ ‹ ̤ÙÚÈ·˜ Ô-ÛfiÙËÙ·˜ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ ¤¯ÂÈ·Ô‰Âȯı› ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓÏËı˘ÛÌÒÓ Ù˘ ¢˘ÙÈ΋˜ ∂˘ÚÒË˜Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ Î·È ÂΛ-ÓˆÓ ÙˆÓ ·ÙfiÌˆÓ Ô˘ ¤¯Ô˘Ó Û·Î-¯·ÚÒ‰Ë ‰È·‚‹ÙË Î·È Î·Ú‰È·ÁÁÂÈ·-΋ ÓfiÛÔ (ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ, ∞∂∂).

∞ÓÙ›ıÂÙ·, Ë ÂÚÈÛÙ·Ûȷ΋ ηٷ-ӿψÛË ˘ÂÚ‚ÔÏÈο ÌÂÁ¿ÏˆÓÔÛÔÙ‹ÙˆÓ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓÛ˘Û¯ÂÙ›˙ÂÙ·È Ì ·˘ÍË̤ÓÔ Î·Ú-‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ ‰È· ̤ÛÔ˘Ù˘ ·‡ÍËÛ˘ Ù˘ ËÎÙÈÎfiÙËÙ·˜ÙÔ˘ ·›Ì·ÙÔ˜(24).

∞ÏÎÔfiÏ Î·È ·ÁÁÂȷο ÂÁÎÂÊ·ÏÈοÂÂÈÛfi‰È·. ™‡Ìʈӷ Ì ̛· ÌÂϤ-ÙË(25), Ë ÂÏ¿¯ÈÛÙË ıÓËÙfiÙËÙ· ·fi∞∂∂ Û˘Û¯ÂÙ›ÛıËΠ̠ÙËÓ Î·Ù·-ӿψÛË 1 - 14 ·ÏÎÔÔÏÔ‡¯ˆÓ Ô-ÙÒÓ/‚‰ÔÌ¿‰·.

°ÂÓÈο Ê·›ÓÂÙ·È fiÙÈ ˘¿Ú¯ÂÈ Ì›·ÁÚ·ÌÌÈ΋ Û˘Û¯¤ÙÈÛË ·Ó¿ÌÂÛ·ÛÙËÓ Î·Ù·Ó¿ÏˆÛË ·ÏÎÔfiÏ Î·ÈÙËÓ Â›ÙˆÛË ÙˆÓ ·ÈÌÔÚÚ·ÁÈÎÒÓ∞∂∂, ΢ڛˆ˜ Ù˘ ˘·Ú·¯ÓÔÂÈ-‰Ô‡˜ ·ÈÌÔÚÚ·Á›·˜. ¶Ú¤ÂÈ Î·ÈÂ‰Ò Ó· Ï¿‚Ô˘Ì ˘fi„Ë fiÙÈ ÔÙÚfiÔ˜ ÚfiÛÏ˄˘ ·ÏÎÔfiÏ (Â-ÚÈÛÙ·Ûȷ΋ ‹ Û˘¯Ó‹ ηٷӿψÛËÌÈÎÚÒÓ ÔÛÔÙ‹ÙˆÓ ·ÏÎÔÔÏÔ‡¯ˆÓÔÙÒÓ ‹ binge drinking) ‰È·‰Ú·-Ì·Ù›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ˆ˜ ·-Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· fiÏÔ˘˜ÙÔ˘˜ Ù‡Ô˘˜ ÙˆÓ ∞∂∂, ΢ڛˆ˜ÛÙ· Ó·ڿ ¿ÙÔÌ·.

ªÂϤÙ˜ Ô˘ ¤ÁÈÓ·Ó ÁÈ· ÙË Û˘-Û¯¤ÙÈÛË Ù˘ ηٷӿψÛ˘ ·ÏÎÔ-ÔÏÔ‡¯ˆÓ ÔÙÒÓ Ì ٷ ∞∂∂ ¤‰ÂÈ-Í·Ó ·ÓÙÈÎÚÔ˘fiÌÂÓ· ·ÔÙÂϤÛÌ·-Ù·, Èı·Ó¿ ÁÈ·Ù› Ë Û˘Û¯¤ÙÈÛË ·˘-Ù‹ Â›Ó·È ‰È·ÊÔÚÂÙÈ΋ ÁÈ· Ù· ·È-ÌÔÚÚ·ÁÈο ∞∂∂ Î·È ÁÈ· Ù· ÈÛ¯·È-ÌÈο ∞∂∂. ™˘ÁÎÂÎÚÈ̤ӷ, οÔȘÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ Ô Î›Ó‰˘ÓÔ˜ÁÈ· ·ÈÌÔÚÚ·ÁÈο ∞∂∂ ·˘Í¿ÓÂÙ·ÈÌ ÙËÓ Î·Ù·Ó¿ÏˆÛË ÙˆÓ ·ÏÎÔÔ-ÏÔ‡¯ˆÓ ÔÙÒÓ(26). ∞ÓÙ›ıÂÙ· οÔÈ-˜ ¿ÏϘ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó ÌÂȈ-̤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ÈÛ¯·ÈÌÈο ∞∂∂Û ÂÚÈÙÒÛÂȘ Û˘¯Ó‹˜ ηٷӿ-ψÛ˘ ÌÈÎÚÒÓ ÔÛÔÙ‹ÙˆÓ ·ÏÎÔÔ-ÏÔ‡¯ˆÓ ÔÙÒÓ Î·È ·˘ÍË̤ÓÔ Î›Ó-‰˘ÓÔ ‹ η̛· ›‰Ú·ÛË(26, 27) ÛÂÂÚÈÙÒÛÂȘ ÂÚÈÛÙ·Ûȷ΋˜ η-ٷӿψÛ˘ Ôχ ÌÂÁ¿ÏˆÓ ÔÛÔ-Ù‹ÙˆÓ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ. √È

ÂȉڿÛÂȘ ÙÔ˘ ·ÏÎÔfiÏ ÛÙËÓ ·Ú-ÙËÚȷ΋ ›ÂÛË Î·È ÛÙÔ Ì˯·ÓÈÛÌfi‹Í˘ ı· ÌÔÚÔ‡Û·Ó Ó· ÂÍËÁ‹-ÛÔ˘Ó ÙÔÓ ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ·È-ÌÔÚÚ·ÁÈÎÒÓ ∞∂∂ Û ¿ÙÔÌ· Ô˘Î·Ù·Ó·ÏÒÓÔ˘Ó ÌÂÁ¿Ï˜ ÔÛfiÙË-Ù˜ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ.

™˘ÓÔÙÈο Ê·›ÓÂÙ·È fiÙÈ Ì›· ÔχÌÈÎÚ‹ ÔÛfiÙËÙ· ·ÏÎÔfiÏ (1 - 2 Ô-Ù¿/Ë̤ڷ) Èı·Ó¿ Û˘Ì‚¿ÏÏÂÈ ÛÙËÓÚÔÛÙ·Û›· ·fi Ù· ∞∂∂.

ª›· ÌÂϤÙË ÛÙË ™Ô˘Ë‰›·(28) ¤‰ÂÈÍÂfiÙÈ Ì¤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 59 ÂÙÒÓ ÔÈı¿Ó·ÙÔÈ Ô˘ ÚÔÎÏ‹ıËÎ·Ó ·fiÙËÓ Î·Ù·Ó¿ÏˆÛË ·ÏÎÔÔÏÔ‡¯ˆÓÔÙÒÓ ‹Ù·Ó ÂÚÈÛÛfiÙÂÚÔÈ ·fi ·˘-ÙÔ‡˜ Ô˘ ·ÔÙÚ¿ËηÓ, ÂÓÒ Û¿ÙÔÌ· ËÏÈΛ·˜ >70 ÂÙÒÓ ÙÔ ·ÏÎÔ-fiÏ ÚÔÏ·Ì‚¿ÓÂÈ ÙÔ 5% ÙˆÓ ı·Ó¿-ÙˆÓ ÛÙÔ˘˜ ¿Ó‰Ú˜ Î·È ÙÔ 4.4% ÙˆÓı·Ó¿ÙˆÓ ÛÙȘ Á˘Ó·›Î˜. ∞˘Ùfi ÙÔÂÍ·ÚÙÒÌÂÓÔ ·fi ÙËÓ ËÏÈΛ· fiÊÂ-ÏÔ˜ ¤¯ÂÈ ˘ÔÛÙËÚȯı› Î·È ·fi ¿Ï-ÏÔ˘˜ ÌÂÏÂÙËÙ¤˜(29) Ô˘ ¤‰ÂÈÍ·Ó fiÙÈË ÚÔÛٷ٢ÙÈ΋ ‰Ú¿ÛË Ù˘ ÌÈ-ÎÚ‹˜ ¤ˆ˜ ̤ÙÚÈ·˜ ÔÛfiÙËÙ·˜ ·Ï-ÎÔfiÏ ÛÙË ıÓËÙfiÙËÙ· ˘ÂÚ‚·›ÓÂÈÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜ ÁÈ· ÙÔ˘˜ ¿Ó‰Ú˜ÛÙËÓ ËÏÈΛ· ÙˆÓ 40 ÂÙÒÓ Î·È ÁÈ· ÙȘÁ˘Ó·›Î˜ ÛÙËÓ ËÏÈΛ· ÙˆÓ 50 ÂÙÒÓ.

√ ˘ÂÚÙ·ÛÈÎfi˜ ·ÛıÂÓ‹˜. ™ÙËÓÚÔÛ¿ıÂÈ· ÂÎÙ›ÌËÛ˘ Ù˘ ÈÛÔÚ-ÚÔ›·˜ ΤډԘ/ΛӉ˘ÓÔ˜ ·fi ÙËÓηٷӿψÛË ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓÛ ¤Ó· ˘ÂÚÙ·ÛÈÎfi ·ÛıÂÓ‹ Ú¤-ÂÈ Ó· Ï¿‚Ô˘Ì ˘fi„Ë ÙÔ Û˘Ó-‰˘·ÛÌfi ÙˆÓ ÂȉڿÛÂˆÓ Ù˘ ·Ú-ÙËÚȷ΋˜ ˘¤ÚÙ·Û˘ Î·È Ù˘ ÚÔ-ÛÏ·Ì‚·ÓfiÌÂÓ˘ ÔÛfiÙËÙ·˜ ·ÏÎÔ-ÔÏÔ‡¯ˆÓ ÔÙÒÓ ÛÙÔ Î·Ú‰È·ÁÁÂÈ·-Îfi Û‡ÛÙËÌ·.

ª›· ÌÂϤÙË Ô˘ ¤ÁÈÓ Û 14.125¿Ó‰Ú˜ Ì ÈÛÙÔÚÈÎfi ˘¤ÚÙ·Û˘¤‰ÂÈÍ fiÙÈ Ë Î·Ù·Ó¿ÏˆÛË ·ÏÎÔÔ-ÏÔ‡¯ˆÓ ÔÙÒÓ ÌÂÈÒÓÂÈ ÙËÓ Â›-ÙˆÛË ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì-‚·Ì¿ÙˆÓ Î·È Ù˘ ÔÏÈ΋˜ ıÓËÙfiÙË-Ù·˜ Û ۇÁÎÚÈÛË Ì ÙÔ ÁÂÓÈÎfiÏËı˘ÛÌfi(30). πÛ¯‡ÂÈ Î¿ÙÈ Ù¤ÙÔÈÔÛÙÔÓ ˘ÂÚÙ·ÛÈÎfi ·ÛıÂÓ‹ Ô˘ η-Ù·Ó·ÏÒÓÂÈ ˘ÂÚ‚ÔÏÈο ÌÂÁ¿Ï˜ÔÛfiÙËÙ˜ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ;™‡Ìʈӷ Ì ÚfiÛÊ·Ù· ‚È‚ÏÈÔ-ÁÚ·ÊÈο ‰Â‰Ô̤ӷ Û ¤Ó· ˘ÂÚ-Ù·ÛÈÎfi ·ÛıÂÓ‹ Ô˘ ηٷӷÏÒÓÂÈ>64 ·ÏÎÔÔÏÔ‡¯· ÔÙ¿/‚‰ÔÌ¿-‰·, Ì›· Ì›ˆÛË Ù˘ ÚÔÛÏ·Ì‚·-ÓfiÌÂÓ˘ ÔÛfiÙËÙ·˜ ηٿ 25%ÌÂÈÒÓÂÈ ÙËÓ Â›ÙˆÛË Ù˘ ÛÙÂÊ·-ÓÈ·›·˜ ÓfiÛÔ˘. ∂ȉÈÎfiÙÂÚ·, ÙÔ ÌÂ-Á·Ï‡ÙÂÚÔ fiÊÂÏÔ˜ fiÛÔÓ ·ÊÔÚ¿

ATHIROSK 14 03-07-07 12:06 ™ÂÏ›‰·6

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ÙËÓ Â›ÙˆÛË Ù˘ ÛÙÂÊ·ÓÈ·›·˜ Ófi-ÛÔ˘ ·Ú·ÙËÚÂ›Ù·È fiÙ·Ó Ë Î·Ù·Ó¿-ψÛË ÙˆÓ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓÂÏ·ÙÙˆı› ÛÙ· 1 - 16 ÔÙ¿/‚‰Ô-Ì¿‰·. ∂›Û˘, Ô ˘ÂÚÙ·ÛÈÎfi˜ ·ÛıÂ-Ó‹˜ Ô˘ ›ÓÂÈ 17 - 64 ÔÙ¿/‚‰Ô-Ì¿‰· ı· ˆÊÂÏËı› (fiÛÔÓ ·ÊÔÚ¿ÙËÓ Â›ÙˆÛË ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓÛ˘Ì‚·Ì¿ÙˆÓ) ·fi ÙËÓ ÂÏ¿ÙÙˆÛËÛÙËÓ Î·Ù·Ó¿ÏˆÛË ÙˆÓ ·ÏÎÔÔÏÔ‡-¯ˆÓ ÔÙÒÓ ÛÙ· 1-16 ÔÙ¿/‚‰ÔÌ¿-‰·. ™ÙȘ ‰‡Ô ·Ú·¿Óˆ ÔÌ¿‰Â˜·ÛıÂÓÒÓ (·˘ÙÔ› Ô˘ ηٷӷÏÒ-ÓÔ˘Ó >64 ·ÏÎÔÔÏÔ‡¯· ÔÙ¿/‚‰Ô-Ì¿‰· Î·È ·˘ÙÔ› Ô˘ ηٷӷÏÒ-ÓÔ˘Ó 17 - 64 ·ÏÎÔÔÏÔ‡¯· ÔÙ¿/‚‰ÔÌ¿‰·), Ô Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ÁÈ· ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ ÂÏ·ÙÙÒÓÂÙ·È·fi 1 Î·È 0,8 ·ÓÙ›ÛÙÔȯ· ÛÙÔ 0,7.∞˘Ùfi ÙÔ fiÊÂÏÔ˜ ‰ÂÓ ·Ú·ÙËÚ‹ıË-

ΠÛÙÔ˘˜ ˘ÂÚÙ·ÛÈÎÔ‡˜ ·ÛıÂÓ›˜Ô˘ ·ÔÙ˘Á¯¿ÓÔ˘Ó Ó· ÂÏ·ÙÙÒ-ÛÔ˘Ó ÙËÓ Â‚‰ÔÌ·‰È·›· ÚfiÛÏË„Ë·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ. ™ÙÔ˘˜ ˘ÂÚ-Ù·ÛÈÎÔ‡˜ ·ÛıÂÓ›˜ Ô˘ ηٷӷÏÒ-ÓÔ˘Ó ÌfiÓÔ 1 - 4 ·ÏÎÔÔÏÔ‡¯· ÔÙ¿/‚‰ÔÌ¿‰· Î·È ‰È·ÎfiÙÔ˘Ó ÙËÓÚfiÛÏË„Ë Ë ·ÚÙËÚȷ΋ ÙÔ˘˜ ›Â-ÛË ‰ÂÓ ÂÏ·ÙÙÒÓÂÙ·È Ô˘ÛÈ·ÛÙÈÎ¿Î·È ·˘Í¿ÓÂÙ·È Ô Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ÁÈ· ηډȷÁÁÂȷο Û˘Ì‚¿Ì·Ù··fi ÙÔ 0,8 ÛÙÔ 1.

™˘ÓÔ„›˙ÔÓÙ·˜, Û‡Ìʈӷ Ì ٷÚfiÛÊ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤-Ó·, ÙÔ ·ÏÎÔfiÏ Û¯ÂÙ›˙ÂÙ·È Ì ÂÚÈÛ-ÛfiÙÂÚ˜ ·fi 60 ÓÔÛËÚ¤˜ ηٷ-ÛÙ¿ÛÂȘ. º·›ÓÂÙ·È fiÙÈ Ë Û˘Û¯¤ÙÈÛËÙ˘ ηٷӿψÛ˘ ·ÏÎÔÔÏÔ‡¯ˆÓÔÙÒÓ Ì ٷ ηډȷÁÁÂȷο Û˘Ì-‚¿Ì·Ù· Î·È ÙË ıÓËÙfiÙËÙ· Â›Ó·È Ô-

χÏÔÎË Î·È ÔÏ˘‰È¿ÛÙ·ÙË. ™Â˘ÂÚÙ·ÛÈÎÔ‡˜ ·ÛıÂÓ›˜ ÙˆÓ ¢˘ÙÈ-ÎÒÓ ∂˘Úˆ·˚ÎÒÓ ¯ˆÚÒÓ ËÏÈΛ·˜>60 ÂÙÒÓ Ô˘ ηٷӷÏÒÓÔ˘Ó >16·ÏÎÔÔÏÔ‡¯· ÔÙ¿/‚‰ÔÌ¿‰· ËÂÏ¿ÙÙˆÛË Î·È fi¯È Ë ‰È·ÎÔ‹ Ù˘ÚfiÛÏ˄˘ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÌÂȈ-̤ÓË Â›ÙˆÛË Î·Ú‰È·ÁÁÂÈ·ÎÒÓÛ˘Ì‚·Ì¿ÙˆÓ. ªÂϤÙ˜ ÛÙÔ ÁÂÓÈÎfiÏËı˘ÛÌfi ‰Â›¯ÓÔ˘Ó fiÙÈ Û ¿ÙÔÌ·ËÏÈΛ·˜ >60 ÂÙÒÓ ÙÔ fiÊÂÏÔ˜ ·fiÙËÓ Î·Ù·Ó¿ÏˆÛË ·ÏÎÔÔÏÔ‡¯ˆÓÔÙÒÓ ˘ÂÚ‚·›ÓÂÈ ÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜.Δ¤ÏÔ˜, Ï·Ì‚¿ÓÔÓÙ·˜ ˘fi„Ë ÙÔ˘˜·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ηÚ-‰È·ÁÁÂȷο Û˘Ì‚¿Ì·Ù·, Ú¤ÂÈ Ó·ÂÍ·ÙÔÌÈ·ÔÓÙ·È ÔÈ Ô‰ËÁ›Â˜ Ô˘‰›ÓÔÓÙ·È Û οı ·ÛıÂÓ‹ ̤۷ ÛÙ·Ï·›ÛÈ· Ù˘ ÚˆÙÔÁÂÓÔ‡˜ ÚfiÏË-„˘ Ù˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘.

μμÈÈ‚‚ÏÏÈÈÔÔÁÁÚÚ··ÊÊ››··

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¶ÚfiÛÊ·Ù· (Ù‡¯Ô˜ π·ÓÔ˘·Ú›Ô˘ÙÔ˘ 2007) ‰ËÌÔÛȇıËÎ·Ó ÔÈ ∫·-Ù¢ı˘ÓÙ‹ÚȘ √‰ËÁ›Â˜ ÁÈ· ÙԢȷ‚‹ÙË, ÙÔ ¶Úԉȷ‚‹ÙË Î·È ÙȘ∫·Ú‰È·ÁÁÂȷΤ˜ ·ı‹ÛÂȘ, Ù˘∂˘Úˆ·˚΋˜ ∫·Ú‰ÈÔÏÔÁÈ΋˜ ∂Ù·È-Ú›·˜ (ESC) Î·È Ù˘ ∂˘Úˆ·˚-΋˜ ∂Ù·ÈÚ›·˜ ÁÈ· ÙË ªÂϤÙËÙÔ˘ ¢È·‚‹ÙË (EASD). ªÂٷ͇¿ÏψÓ, ˘¿Ú¯ÂÈ Ì›· Û‡ÓÙÔÌË·Ó·ÛÎfiËÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ÁÈ·ÙË ÚfiÏË„Ë ÙÔ˘ ™·Î¯·Ú҉ˢȷ‚‹ÙË Ù‡Ô˘ 2 (™¢ 2), Ô˘·ÚÔ˘ÛÈ¿˙ÂÈ ÂӉȷʤÚÔÓ, ·ÊÔ‡·ÔÙÂÏ› Ì›· Ï‹ÚË ÂÚ›ÏË„ËÙˆÓ ÛÙÔȯ›ˆÓ ·fi ÙȘ ̤¯ÚÈ Û‹-ÌÂÚ· ÌÂϤÙ˜.

√ ‰È·‚‹Ù˘ Î·È ÔÈ Î·Ú‰È·ÁÁÂÈ·-Τ˜ ·ı‹ÛÂȘ ÂÌÊ·Ó›˙ÔÓÙ·È Û˘-¯Ó¿ Û·Ó ÔÈ ‰‡Ô fi„ÂȘ ÙÔ˘ ›‰ÈÔ˘ÓÔÌ›ÛÌ·ÙÔ˜. √ ‰È·‚‹Ù˘ ¤¯ÂÈ ıÂ-ˆÚËı› ÈÛÔ‰‡Ó·ÌÔ Ù˘ ÛÙÂÊ·ÓÈ-·›·˜ ÓfiÛÔ˘ (™¡) ηÈ, ·ÓÙ›ÛÙÚÔ-Ê·, ÔÏÏÔ› ·ÛıÂÓ›˜ Ì ÂÁηÙÂ-ÛÙË̤ÓË ™¡ ¿Û¯Ô˘Ó ·fi ‰È·-‚‹ÙË, ‹ ·fi ÚÔ-‰È·‚ËÙÈΤ˜ η-Ù·ÛÙ¿ÛÂȘ, ÂÓÒ Ë Û˘¯ÓfiÙÂÚË ·È-Ù›· ı·Ó¿ÙÔ˘ ÛÙÔ˘˜ ∂˘Úˆ·›Ô˘˜‰È·‚ËÙÈÎÔ‡˜ ÂÓËÏ›ÎÔ˘˜ Â›Ó·È Ë™¡. ∞ÚÎÂÙ¤˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ‰Â›-ÍÂÈ fiÙÈ ÔÈ ·ÛıÂÓ›˜ ·˘ÙÔ› ‰È·ÙÚ¤-¯Ô˘Ó 2Ï¿ÛÈÔ ˆ˜ 3Ï¿ÛÈÔ Î›Ó‰˘-ÓÔ, Û ۯ¤ÛË Ì ٷ ¿ÙÔÌ· ¯ˆÚ›˜‰È·‚‹ÙË1.

¶ÚÈÓ ·fi ÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ ™¢ 2·Ú·ÙËÚÔ‡ÓÙ·È Û˘¯Ó¿ ÌÂÙ·‚Ô-Ϥ˜ ‰È·ÊfiÚˆÓ ÌÂÙ·‚ÔÏÈÎÒÓ ·-ڷ̤ÙÚˆÓ, fiˆ˜ ‰˘Û·ÓÂÍ›· ÛÙËÁÏ˘Îfi˙Ë (IGT-Impaired GlucoseTolerance), ‰˘ÛÏÈȉ·ÈÌ›· ηȷÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË (π∞)2.∞Ó Î·È ‰ÂÓ Î·Ù·Ï‹ÁÔ˘Ó Û ‰È·-‚‹ÙË fiÏÔÈ ÔÈ ·ÛıÂÓ›˜ Ì ·Úfi-ÌÔȘ ÌÂÙ·‚ÔÏÈΤ˜ ‰È·Ù·Ú·¯¤˜,Ô Î›Ó‰˘ÓÔ˜ ÂÌÊ¿ÓÈÛ˘ Ù˘ Ófi-ÛÔ˘ Û ·˘ÙÔ‡˜ Â›Ó·È ÛËÌ·ÓÙÈο·˘ÍË̤ÓÔ˜. ¶ÚÔÛÂÎÙÈο ۯ‰ȷ-Ṳ̂Ó˜ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·ÓfiÙÈ ÔÈ ÛÙÚ·ÙËÁÈΤ˜ ·ÔÙÂÏÂÛÌ·-ÙÈ΋˜ ·Ú¤Ì‚·Û˘ ÛÙÔ ÙÚfiÔ˙ˆ‹˜ Â›Ó·È Û ı¤ÛË Ó· ·ÚÂÌÔ-‰›ÛÔ˘Ó, ‹ ÙÔ˘Ï¿¯ÈÛÙÔÓ, Ó· ÂÈ-‚Ú·‰‡ÓÔ˘Ó ÙËÓ ÂÌÊ¿ÓÈÛË ™¢ 2ÛÙ· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ¿ÙÔÌ·.

™ÙË ™Ô˘Ë‰È΋ ÌÂϤÙË ÙÔ˘ Malmö,Ë ·˘ÍË̤ÓË Ê˘ÛÈ΋ ¿ÛÎËÛË Î·È

Ë ·ÒÏÂÈ· ‚¿ÚÔ˘˜ ·ÚÂÌfi‰È-Û·Ó ‹ ÂÈ‚Ú¿‰˘Ó·Ó ÙËÓ ÂÌÊ¿ÓÈ-ÛË ÙÔ˘ ‰È·‚‹ÙË Û ¿ÙÔÌ· ÌÂIGT. ™ÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘63% ÏÈÁfiÙÂÚ· ¿ÙÔÌ· ÂÌÊ¿ÓÈÛ·Ó™¢ 2 Û˘ÁÎÚÈÙÈο Ì ÙËÓ ÔÌ¿‰·,Û ·Ú·ÎÔÏÔ‡ıËÛË 5 ÂÙÒÓ3.

™Â Ì›· ∫ÈÓÂ˙È΋ ÌÂϤÙË ·fi ÙÔDa Qing, 577 ¿ÙÔÌ· Ì IGT Ù˘-¯·ÈÔÔÈ‹ıËÎ·Ó Û ̛· ·fi ÙȘ 4·ÎfiÏÔ˘ı˜ ÔÌ¿‰Â˜: ÌfiÓÔ ¿ÛÎË-ÛË, ÌfiÓÔ ‰›·ÈÙ·, ‰›·ÈÙ· ηȿÛÎËÛË, η̛· ·Ú¤Ì‚·ÛË (ÔÌ¿-‰· ÂϤÁ¯Ô˘)4. ∏ Û˘ÓÔÏÈ΋ Û˘-¯ÓfiÙËÙ· ÙÔ˘ ™¢ 2, ÛÙË ‰È¿ÚÎÂÈ··Ú·ÎÔÏÔ‡ıËÛ˘ 6 ÂÙÒÓ, ‹Ù·ÓÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚË ÛÙȘ ÙÚÂȘÔÌ¿‰Â˜ ·Ú¤Ì‚·Û˘ (46%), ÛÂÛ¯¤ÛË Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘

™ÙË Finnish Diabetes PreventionStudy (FDPS), Ì›ˆÛË ÙÔ˘ Ûˆ-Ì·ÙÈÎÔ‡ ‚¿ÚÔ˘˜ ≥5%, Ô˘ ÂÈ-Ù‡¯ıËΠ̠¤Ó· ÚfiÁÚ·ÌÌ·ÂÓÙ·ÙÈ΋˜ ‰›·ÈÙ·˜ Î·È ¿ÛÎËÛ˘,Û˘Óԉ¢fiÙ·Ó ·fi Ì›ˆÛË Î·Ù¿58% ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛ˘ ™¢2, Û ˘¤Ú‚·ÚÔ˘˜ ¿Ó‰Ú˜ ηÈÁ˘Ó·›Î˜ Ì IGT5. √ ‚·ıÌfi˜ Ì›-ˆÛ˘ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂͤÏÈ͢ Û™¢ 2 Û¯ÂÙÈ˙fiÙ·Ó ¿ÌÂÛ· Ì ÙËÓ¤ÓÙ·ÛË ÙˆÓ ÌÂÙ·‚ÔÏÒÓ ÙÔ˘ ÙÚfi-Ô˘ ˙ˆ‹˜.

ΔÔ Diabetes Prevention Pro-gramme (DPP), ÛÙȘ ∏¶∞, Ô˘Û‡ÁÎÚÈÓ ÙËÓ ÂÓÂÚÁfi ÌÂÙ·‚ÔÏ‹ÙÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜, ‹ ÙË ÌÂÙÊÔÚ-Ì›ÓË, Ì ÙË ÎÏ·ÛÈ΋ ·ÚÔ¯‹ Û˘Ì-‚Ô˘ÏÒÓ ÁÈ· ÙÔÓ ÙÚfiÔ ˙ˆ‹˜ ÛÂÛ˘Ó‰˘·ÛÌfi Ì ÂÈÎÔÓÈÎfi Ê¿ÚÌ·-ÎÔ, ‰È·›ÛÙˆÛ fiÙÈ Ë ÂÓÂÚÁfi˜ÌÂÙ·‚ÔÏ‹ ÙÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜ Ì›-ˆÛ ÙË Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘™¢ 2 ηٿ 58%, Û ¤Ó· ÏËı˘-

ÛÌfi ˘¤Ú‚·ÚˆÓ ∞ÌÂÚÈηÓÒÓ ÌÂ-ÛËÏ›ÎˆÓ Ì IGT6. O ÛÙfi¯Ô˜ ÙÔ˘ÚÔÁÚ¿ÌÌ·ÙÔ˜ ‹Ù·Ó Ó· ÂÈÙ¢-¯ı› Ì›ˆÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿-ÚÔ˘˜ ≥7% Î·È Ê˘ÛÈ΋ ‰Ú·ÛÙË-ÚÈfiÙËÙ· ̤Û˘ ¤ÓÙ·Û˘ ÁÈ· 150ÙÔ˘Ï¿¯ÈÛÙÔÓ ÏÂÙ¿ ÙËÓ Â‚‰ÔÌ¿-‰·. ∏ Û˘ÓÔÏÈ΋ ›وÛË ÙÔ˘‰È·‚‹ÙË ‹Ù·Ó 4.8, 7.8 Î·È 11.0 Â-ÚÈÙÒÛÂȘ ·Ó¿ 100 ·ÓıÚˆÔ/¤ÙË,ÛÙȘ ÔÌ¿‰Â˜ Ù˘ ÂÓÂÚÁÔ‡ ÌÂÙ·-‚ÔÏ‹˜ ÙÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜, Ù˘ ÌÂÙ-ÊÔÚÌ›Ó˘ Î·È ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·Ú-Ì¿ÎÔ˘, ·ÓÙ›ÛÙÔȯ·. ∞˘Ù‹ Ë Ì›ˆ-ÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÂÌÊ¿ÓÈÛ˘™¢ 2 ·ÓÙÈÛÙÔȯ› Û ÚfiÏË„Ë 1ÂÚ›ÙˆÛ˘ Ó¤Ô˘ ‰È·‚‹ÙË ÁÈ· ο-ı 7 ıÂڷ¢fiÌÂÓ· ¿ÙÔÌ· ÌÂIGT › 3 ¯ÚfiÓÈ·, ÛÙËÓ ÔÌ¿‰· ·-ڤ̂·Û˘ ÛÙÔ ÙÚfiÔ ˙ˆ‹˜, ÛÂÛ‡ÁÎÚÈÛË Ì 14 ¿ÙÔÌ· ÛÙËÓ ÔÌ¿-‰· Ù˘ ÌÂÙÊÔÚÌ›Ó˘.

Œ¯ÔÓÙ·˜ ˘fi„Ë ·˘Ù¿ Ù· ÂÓÙ˘-ˆÛȷο ·ÔÙÂϤÛÌ·Ù·, Ë∞merican Diabetes Association(ADA) Î·È ÙÔ National Institute ofDiabetes, Digestive and KidneyDiseases (NIDDK) Û˘ÓÈÛÙÔ‡Ó¤ÏÂÁ¯Ô ÁÈ· ÂӉ¯fiÌÂÓÔ ˘„ËÏfiÂ›Â‰Ô ÁÏ˘Îfi˙˘ ÛÙÔ ·›Ì·, Û¿ÙÔÌ· >45 ÂÙÒÓ Ì μªπ ≥25Kg/m2. ™Ù· ¿ÙÔÌ· Ì ÛÙÔȯ›·ÚÔ-‰È·‚ËÙÈ΋˜ ηٿÛÙ·Û˘ ı·Ú¤ÂÈ Ó· ·Ú¤¯ÂÙ·È Î·Ù¿ÏÏËÏËÛ˘Ì‚Ô˘Ï¢ÙÈ΋ ‚Ô‹ıÂÈ· ÁÈ· ÙËÓ·ÒÏÂÈ· ‚¿ÚÔ˘˜, ‰È·Ì¤ÛÔ˘ ÚÔ-ÁÚ·ÌÌ¿ÙˆÓ ‰È·ÈÙËÙÈ΋˜ ÙÚÔÔ-Ô›ËÛ˘ Î·È ¿ÛÎËÛ˘7. √ ·ÚÈı-Ìfi˜ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ¯ÚÂÈ¿˙Â-Ù·È Ó· ıÂڷ¢ıÔ‡Ó (¡¡Δ) ÁÈ·Ó· ÚÔÏËÊı› Ì›· ÂÚ›ÙˆÛË ™¢2, Ì ·Ú¤Ì‚·ÛË ÛÙÔ ÙÚfiÔ ˙ˆ-‹˜, Û ¿ÙÔÌ· Ì IGT, Â›Ó·È ÂÍ·È-ÚÂÙÈο ¯·ÌËÏfi˜ (¶›Ó·Î·˜ 1).

¶ÚfiÏË„Ë ÙÔ˘ ™·Î¯·ÚÒ‰Ë ¢È·‚‹ÙË Δ‡Ô˘ 2

¡›ÎÔ˜ ¢È·ÎÔ˘Ì¿ÎÔ˜, ∫·Ú‰ÈÔÏfiÁÔ˜.¢È·ÁÓˆÛÙÈÎfi ∫·Ú‰ÈÔÏÔÁÈÎfi ∫¤ÓÙÚÔ ¶ÂÈÚ·È¿, ™˘ÓÂÚÁ¿Ù˘ ¡ÔÛÔÎÔÌ›Ԣ Metropolitan

¶π¡∞∫∞™ 1

ªÂϤÙË ª¤ÁÂıÔ˜ ª¤ÛÔ˜ ¢È¿ÚÎÂÈ· RRR ARR NNT √Ì¿‰·˜ μªπ (¤ÙË) (%) (%)

Malmö 217 26.6 5 63 18 28 FDPS 523 31.0 3 58 12 22 DPP 2161 34.0 3 58 15 21 DaQing 500 25.8 6 46 27 25

RRR= Ì›ˆÛË ÙÔ˘ Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘, ∞RR=Ì›ˆÛË ÙÔ˘ ·fiÏ˘ÙÔ˘ ÎÈÓ‰‡ÓÔ˘/100·ÓıÚˆÔ-¤ÙË, ¡¡Δ = ·ÚÈıÌfi˜ ·ÙfiÌˆÓ Ô˘ Ú¤ÂÈ Ó· ıÂڷ¢ıÔ‡Ó ÁÈ· Ó· ÚÔÏË-Êı› Ì›· ÂÚ›ÙˆÛË ‰È·‚‹ÙÔ˘ Û ‰È¿ÛÙËÌ· 12 ÌËÓÒÓ.

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¶APA°ONTE™ KIN¢YNOY

™ÙË ÌÂϤÙË Indian DiabetesPrevention Programme (IDPP),Ô˘ ·Ó·ÎÔÈÓÒıËΠÚfiÛÊ·Ù·8,ÔÈ ÌÂÙ·‚ÔϤ˜ ÙÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜Î·È Ë ÌÂÙÊÔÚÌ›ÓË ·ÚÔ˘Û›·Û·Ó·ÚfiÌÔÈ· ÌÂٷ͇ ÙÔ˘˜ ‰˘Ó·Ùfi-ÙËÙ· Ì›ˆÛ˘ Ù˘ Û˘¯ÓfiÙËÙ·˜ÂÌÊ¿ÓÈÛ˘ ‰È·‚‹ÙË, Û ¿ÙÔÌ·Ì IGT, ·ÏÏ¿ Ô Û˘Ó‰˘·ÛÌfi˜ÙˆÓ ‰‡Ô ıÂڷ¢ÙÈÎÒÓ ÙÚfiˆÓ‰ÂÓ ‚ÂÏÙ›ˆÛ ÙËÓ ¤Î‚·ÛË.

∏ ÌÂϤÙË Diabetes REductionAssessment with ramipril androsiglitazone Medication (DREAM),ÂÚ‡ÓËÛ ·Ó ·˘Ù¿ Ë Ú·ÌÈÚ›ÏË‹ Ë ÚÔÛÈÁÏ˘Ù·˙fiÓË ÌÔÚÔ‡Ó Ó·ÌÂÈÒÛÔ˘Ó ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ‰È·-‚‹ÙË, Û ¿ÙÔÌ· Ì IGT, ·ıÔ-ÏÔÁÈ΋ ÁÏ˘Îfi˙Ë ÓËÛÙ›·˜ (IFG),‹ Î·È Ù· ‰‡Ô. ΔÔ Î‡ÚÈÔ ÙÂÏÈÎfiÛËÌÂ›Ô Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ë ÂÌ-Ê¿ÓÈÛË ™¢ 2 ‹ ı¿Ó·ÙÔ˜ ÔÔÈ·Û-‰‹ÔÙ ·ÈÙÈÔÏÔÁ›·˜. ªÂÙ¿ ·fi·Ú·ÎÔÏÔ‡ıËÛË 3 ÂÙÒÓ, Ë ÂÌ-Ê¿ÓÈÛË ÙÔ˘ ·ÚÈÔ˘ ηٷÏËÎÙÈ-ÎÔ‡ ÛËÌ›Ԣ ‰ÂÓ ‰È¤ÊÂÚ ÛËÌ·-ÓÙÈο ÌÂٷ͇ Ú·ÌÈÚ›Ï˘ Î·È ÂÈ-ÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ (18.1% ¤Ó·-ÓÙÈ 19.5%, HR 0.91), ‰ËÏ., Ì›ˆ-ÛË ÙÔ˘ Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ηٿ9%9. ∏ ÚÔÛÈÁÏÈÙ·˙fiÓË Ì›ˆÛÂÛËÌ·ÓÙÈο ÙÔ Î‡ÚÈÔ ÙÂÏÈÎfi ÛË-Ì›Ô, ¤Ó·ÓÙÈ ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·Ú-Ì¿ÎÔ˘ (11.6% ¤Ó·ÓÙÈ 26%, HR0.40 ), ‰ËÏ. Ì›ˆÛË ÙÔ˘ Û¯ÂÙÈ-ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ηٿ 60%10. √ Û˘-ÓÔÏÈÎfi˜ ·ÚÈıÌfi˜ ÙˆÓ Î·Ú‰È·Á-ÁÂÈ·ÎÒÓ ÂÂÈÛÔ‰›ˆÓ ‰ÂÓ ‰È¤ÊÂ-Ú ÛËÌ·ÓÙÈο ÌÂٷ͇ ÙˆÓ ÔÌ¿-‰ˆÓ Ù˘ ÚÔÛÈÁÏÈÙ·˙fiÓ˘ ηÈÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘, ·ÏÏ¿ÛÙËÓ ÔÌ¿‰· Ù˘ ÚÔÛÈÁÏÈÙ·˙fi-

Ó˘ ·Ú·ÙËÚ‹ıËÎ·Ó ÛËÌ·ÓÙÈ΋·‡ÍËÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜(p<0.0001) Î·È ÂÚÈÛÛfiÙÂÚ˜ÂÚÈÙÒÛÂȘ ηډȷ΋˜ ·ÓÂ-¿ÚÎÂÈ·˜ (0.5% ¤Ó·ÓÙÈ 0.1%,p<0.01). ¶Ú¤ÂÈ, fï˜, Ó· ÛË-ÌÂȈı› fiÙÈ Ë ÌÂϤÙË DREAM ‰ÂÓۯ‰ȿÛıËÎÂ, Ô‡Ù ›¯Â ÙËÓ ··-Ú·›ÙËÙË ÈÛ¯‡ Ó· ÂÎÙÈÌ‹ÛÂÈ, ÙËηډȷÁÁÂȷ΋ ¤Î‚·ÛË. ŒÙÛÈ, ËÚÔÛÈÁÏÈÙ·˙fiÓË ‰ÂÓ ÌÔÚ›, ˆ˜fiÙÔ˘ ˘¿ÚÍÔ˘Ó Î·È ¿ÏÏ· ÛÙÔÈ-¯Â›·, Ó· ıˆÚËı› ηٿÏÏËÏËıÂڷ›· ÁÈ· ÙË Ì›ˆÛË Ù˘ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘ (∫∞¡) Û¿ÙÔÌ· Ì ‰È·Ù·Ú·¯¤˜ Ù˘ ÔÌÔÈfi-ÛÙ·Û˘ Ù˘ ÁÏ˘Îfi˙˘ (IGH).

Δ· ÚfiÛÊ·Ù· ÛÙÔȯ›· ·fi ÙËStudy TO Prevent Non-Insulin-Dependent Diabetes Mellitus(STOP-NIDDM), ¤‰ÂÈÍ·Ó ÁÈ·ÚÒÙË ÊÔÚ¿, ÛÙ·ÙÈÛÙÈο ÛËÌ·-ÓÙÈΤ˜ ÌÂÈÒÛÂȘ ÙˆÓ Î·Ú‰È·Á-ÁÂÈ·ÎÒÓ ÂÂÈÛÔ‰›ˆÓ Û ¿ÙÔÌ·

Ì IGT, ¤Ó·ÓÙÈ ÙˆÓ Ì·ÚÙ‡ÚˆÓ,‰È·Ì¤ÛÔ˘ Ù˘ Ì›ˆÛ˘ ÙˆÓ ÌÂ-Ù·ÁÂ˘Ì·ÙÈÎÒÓ ÂȤ‰ˆÓ Ù˘ÁÏ˘Îfi˙˘ Ì ·Î·Ú‚fi˙Ë11

∂ÈÚfiÛıÂÙ·, ÛÙÔȯ›· ·fi ÙËNHANES III, ¤‰ÂÈÍ·Ó fiÙÈ Ô ¤ÏÂÁ-¯Ô˜ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ÙˆÓ ¯·-ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˚-ÓÒÓ (LDL-C), Ù˘ ¯ÔÏËÛÙÂÚfi-Ï˘ ÙˆÓ ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈ-ÔÚˆÙÂ˚ÓÒÓ (HDL-C), Î·È Ù˘·ÚÙËÚȷ΋˜ ›ÂÛ˘ ÛÂ Ê˘ÛÈÔ-ÏÔÁÈο ›‰·, Û ·ÛıÂÓ›˜ ̪™ (¯ˆÚ›˜ ‰È·‚‹ÙË, ‹ ™¡), Ô‰Ë-ÁÔ‡Ó Û Ì›ˆÛË ÙˆÓ ÛÙÂÊ·ÓÈ·›-ˆÓ ÂÂÈÛÔ‰›ˆÓ ηٿ 51% ÛÙÔ˘˜¿Ó‰Ú˜ Î·È Î·Ù¿ 43% ÛÙȘ Á˘-Ó·›Î˜, ÂÓÒ Ô ¤ÏÂÁ¯Ô˜ ·˘ÙÒÓÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÛÙ·¿ÚÈÛÙ· ›‰· Ô‰ËÁ› Û Úfi-ÏË„Ë ÙÔ˘ 81% Î·È 82% ÙˆÓÂÂÈÛÔ‰›ˆÓ, ·ÓÙ›ÛÙÔȯ·12

1. LLaaaakkssoo MM.. Hyperglycaemia and cardio-vascular disease in type 2 diabetes.Dia-betes 1999; 48: 937-942.

2. KKnnoowwlleerr WWCC,, eett aall. Preventing non-insulin-dependent diabetes. Diabetes1995; 44:483-488.

3. EErriikkssssoonn KKFF,, eett aall. Prevention of type 2(non-insulin-dependent) diabetes mellitusby diet and physical exercise. The 6-year Malmö feasibility study. Diabe-tologia 1991;-34: 891-898.

4. PPaann XX eett aall.. Effects of diet and exercisein preventing NIDDM in people withimpaired glucose Tolerance. The DaQing IGT and Diabetes Study. DiabetesCare 1997; 20: 537-544.

5. LLiinnddssttrroomm JJ eett aall.. The Finnish DiabetesPrevention Study (DPS): life styleintervention and 3-year results on diet

and physical activity. Diabetes Care2003; 26: 3230-3236.

6. KKnnoowwlleerr WWCC,, eett aall.. Reduction in the in-cidence of type 2 diabetes with life styleintervention or metformin. N Engl JMed 2002; 346: 393-403.

7. AAmmeerriiccaann DDiiaabbeetteess AAssssoocciiaattiioonn.. Theprevention or delay of type 2 diabetes.Diabetes Care 2002;

25: 742-749.

8. RRaammaanncchhaannddrraann AA,, eett aall.. IndianDiabetes Prevention Programme(IDPP). Diabetologia 2006; 49:289-297.

9. TThhee DDRREEAAMM TTrriiaall IInnvveessttiiggaattoorrss.. Effect oframipril on the incidence of diabetes. NEngl J Med 2006; 355: 1551-1562.

10. TThhee DDRREEAAMM TTrriiaall IInnvveessttiiggaattoorrss.. Effect ofrosiglitazone on the frequency ofdiabetes in patients with impairedglucose tolerance or impaired fastingglucose: a randomized controlled trial.Lancet 2006; 68: 1096-1105.

11. CChhiiaassssoonn JJLL,, eett aall.. Acarbose treatmentand the risk of cardiovascular diseaseand hypertension in patients withimpaired glucose tolerance: the STP-NIDDM trial. JAMA 2003; 290: 486-494.

12. WWoonngg NNDD,, eett aall.. Preventing coronaryeve-nts by optimal control of bloodpressure and lipids in patients with themetabolic syndrome. Am J Cardiol2003; 91: 1421-1426.

μμÈÈ‚‚ÏÏÈÈÔÔÁÁÚÚ··ÊÊ››··

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π √ À ¡ π √ ™ 2 0 0 7

10

¶·Ï·ÈfiÙÂÚ˜ ÂȉËÌÈÔÏÔÁÈΤ˜ÌÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ÏË-ı˘ÛÌÔ›, fiˆ˜ ÔÈ ∂ÛÎÈÌÒÔÈ ÙÔ˘μ. ∫·Ó·‰¿ Î·È Ù˘ ∞Ï¿Ûη˜ ηÈÔÈ °È·ˆÓ¤˙ÔÈ Ô˘ ηٷӷÏÒ-ÓÔ˘Ó ·ÚÎÂÙ‹ ÔÛfiÙËÙ· ÏÈ·-ÚÒÓ „·ÚÈÒÓ ¤¯Ô˘Ó ÌÂȈ̤ÓÔΛӉ˘ÓÔ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛË-Ì¿ÙˆÓ. ∂›Û˘ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜Û ·ÛıÂÓ›˜ ÌÂÙ¿ ¤ÌÊÚ·ÁÌ·ÙÔ˘ Ì˘Ôηډ›Ô˘ ¤‰ÂÈÍ·Ó Â›Û˘fiÊÂÏÔ˜ ™ÙË ÌÂϤÙË DART Û˘-ÛÙ‹ıËΠÚfiÛÏË„Ë Ì ÙËÓ ÙÚÔ-Ê‹ „·ÚÈÒÓ 2 ÊÔÚ¤˜ ÙËÓ Â‚‰Ô-Ì¿‰· ‹ ‰fiıËÎ·Ó Î¿„Ô˘Ï˜ ȯ-ı˘ÂÏ·›Ô˘. ™Ù· 2 ¯ÚfiÓÈ· ·Ú·-ÙËÚ‹ıËΠ̛ˆÛË ÙˆÓ ı·Ó¿ÙˆÓ·fi fiÏ· Ù· ·›ÙÈ· ηٿ 29%. ™ÙËÌÂϤÙË GISSI-P ‰fiıËÎ·Ó 850mg ηı·ÚÒÓ ˆ-3 ÏÈ·ÚÒÓ Ôͤ-ˆÓ ·fi ȯı˘¤Ï·È· Û ÌÂÙÂÌ-ÊÚ·ÁÌ·ÙÈÎÔ‡˜ ·ÛıÂÓ›˜. ¶·Ú·-ÙËÚ‹ıËΠ̛ˆÛË ÙˆÓ ı·Ó¿ÙˆÓ·fi οı ·ÈÙ›· ηٿ 20%, ÙˆÓηډȷÁÁÂÈ·ÎÒÓ ı·Ó¿ÙˆÓ ηٿ30% Î·È ÙˆÓ ·ÈÊÓȉ›ˆÓ ı·Ó¿ÙˆÓηٿ 45%. ¢ÂÓ ·Ú·ÙËÚ‹ıËÎÂfï˜ Ì›ˆÛË ÙˆÓ ÌË ı·Ó·ÙË-ÊfiÚˆÓ ÂÌÊÚ·ÁÌ¿ÙˆÓ Ô‡Ù Û·˘Ù‹ ÙË ÌÂϤÙË Ô‡Ù ÛÙËÓDART.

∏ ÌÂϤÙË JELIS, Ë ÔÔ›· ‰ÈÂÍ‹-¯ıË ÛÙÔ Kobe University Gra-duate School of Medicine ÛÙÔKobe Ù˘ π·ˆÓ›·˜, ÛÎÔfi ›¯ÂÓ· ÌÂÏÂÙ‹ÛÂÈ ·Ó Ë Û˘ÌÏËÚˆ-Ì·ÙÈ΋ ¯ÔÚ‹ÁËÛË ÂÈÎÔÛÈÂÓÙ·-ÓÔ˚ÎÔ‡ ÔͤԘ (∂ƒ∞) Û ¤Ó·ÓÏËı˘ÛÌfi Ô˘ οÓÂÈ ·ÚÎÂÙ‹ η-ٷӿψÛË „·ÚÈÒÓ ¤¯ÂÈ Î¿ÙÈ Â-ÚÈÛÛfiÙÂÚÔ Ó· ÚÔÛʤÚÂÈ ÛÙËÓÚfiÏË„Ë ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓÓÔÛËÌ¿ÙˆÓ. ¶ÂÚȤϷ‚ 19.466·ÛıÂÓ›˜ (5.859 ¿Ó‰Ú˜ ËÏÈΛ·˜40-59 ÂÙÒÓ Î·È 12.786 Á˘Ó·›Î˜ÌÂÙÂÌËÓÔ·˘Ûȷ΋˜ ËÏÈΛ·˜ ̤-

¯ÚÈ 75 ÂÙÒÓ) Ì ˘ÂÚ¯ÔÏËÛÙÂ-ÚÔÏ·ÈÌ›· (ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË> 250 mg% Î·È LDL-¯ÔÏËÛÙÂ-ÚfiÏË > 175 mg%). ΔÔ 90% ÙˆÓ·ÛıÂÓÒÓ ¤Ï·‚ ÌÈÎÚ‹ ‰fiÛËÛÙ·Ù›Ó˘ (Ú·‚·ÛÙ·Ù›ÓË 10mg/ËÌÂÚËÛ›ˆ˜ ‹ ÛÈÌ‚·ÛÙ·Ù›ÓË5 mg/ËÌÂÚ.) √È ÌÈÛÔ› ·ÛıÂÓ›˜(9.326) ¤Ï·‚·Ó ο„Ô˘Ï˜ ˘„Ë-Ï‹˜ ηı·ÚfiÙËÙ·˜ ∂ƒ∞ Û ‰fiÛË600 mg ÙÚÂȘ ÊÔÚ¤˜ ÙËÓ Ë̤ڷ(ËÌÂÚ‹ÛÈ· ‰fiÛË 1.800 mg).¶ÚˆÙ‡ÔÓ ÙÂÏÈÎfi Û˘Ì‚¿Ó ÔÚ›-ÛÙËΠÔÔÈÔ‰‹ÔÙ Ì›˙ÔÓ ÛÙÂ-Ê·ÓÈ·›Ô ÂÂÈÛfi‰ÈÔ, ÂÚÈÏ·Ì‚·-ÓÔÌ¤ÓˆÓ ÙˆÓ ·ÈÊÓȉ›ˆÓ ηډȷ-ÎÒÓ ı·Ó¿ÙˆÓ, ı·Ó·ÙËÊfiÚˆÓ Î·ÈÌË ı·Ó·ÙËÊfiÚˆÓ ÂÌÊÚ·ÁÌ¿-ÙˆÓ, Ù˘ ·ÛÙ·ıÔ‡˜ ÛÙËı¿Á¯Ë˜Î·È ÙˆÓ ÂÂÌ‚¿ÛÂˆÓ ‰È·‰ÂÚÌÈ-΋˜ ·ÁÁÂÈÔÏ·ÛÙÈ΋˜ ‹ ·ÔÚÙÔ-ÛÙÂÊ·ÓÈ·›·˜ ·Ú¿Î·Ì„˘.

∏ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ·ÛıÂ-ÓÒÓ ÎÚ¿ÙËÛ ηٿ ̤ÛÔ fiÚÔ4,6 ¯ÚfiÓÈ·. ΔÔ ÚˆÙ‡ˆÓ ÙÂÏÈ-Îfi Û˘Ì‚¿Ó ·Ú·ÙËÚ‹ıËΠÛÂ2,8% ÙˆÓ ·ÛıÂÓÒÓ Ù˘ ÔÌ¿‰·˜Ô˘ ¤Ï·‚ ∂ƒ∞ Î·È ÛÙÔ 3,5%Ù˘ ÔÌ¿‰·˜ ÂϤÁ¯Ô˘, Ì›ˆÛËÌ ÙËÓ ·ÁˆÁ‹ ÙÔ˘ Û¯ÂÙÈÎÔ‡ ÎÈÓ-‰‡ÓÔ˘ ηٿ 19% (p=0,011).™ÙËÓ ÔÌ¿‰· ÙˆÓ ·ÙfiÌˆÓ Ô˘‰ÂÓ Â›¯·Ó ¤Î‰ËÏË ÛÙÂÊ·ÓÈ·›·ÓfiÛÔ ÚÈÓ ÙËÓ ¤Ó·ÚÍË Ù˘ ·Áˆ-Á‹˜ (ÚˆÙÔÁÂÓ‹˜ ÚfiÏË„Ë) ËÌ›ˆÛË ÙÔ˘ Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘‹Ù·Ó 18% (1,4% ÛÙËÓ ÔÌ¿‰·ıÂڷ›·˜ ¤Ó·ÓÙÈ 1,7% ÛÙËÓÔÌ¿‰· ÂϤÁ¯Ô˘) ·ÏÏ¿ ÙÔ ·Ô-Ù¤ÏÂÛÌ· ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈοÛËÌ·ÓÙÈÎfi (p=0,132). ∞ÓÙ›ıÂÙ·,ÛÙËÓ ÔÌ¿‰· Ù˘ ‰Â˘ÙÂÚÔÁÂ-ÓÔ‡˜ ÚfiÏ˄˘ ÙÔ ·ÔÙ¤ÏÂÛÌ·‹Ù·Ó ÛËÌ·ÓÙÈÎfi (8,7% ¤Ó·ÓÙÈ10,7%, Ì›ˆÛË ÎÈÓ‰‡ÓÔ˘ ηٿ19%). ∏ Ì›ˆÛË ·Ú·ÙËÚ‹ıËÎÂ

΢ڛˆ˜ ÛÙ· ÂÚÈÛÙ·ÙÈο ·ÛÙ·-ıÔ‡˜ ÛÙËı¿Á¯Ë˜ Î·È ÌË ı·Ó·-ÙËÊfiÚˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ÂÂÈÛÔ-‰›ˆÓ, ÂÓÒ Ù· ÂÚÈÛÙ·ÙÈο ·ÈÊÓÈ-‰›Ô˘ ı·Ó¿ÙÔ˘ ‹ ı·Ó·ÙËÊfiÚˆÓÂÌÊÚ·ÁÌ¿ÙˆÓ ‰ÂÓ ÌÂÈÒıËηÓ.∞˘Ùfi Â›Ó·È Û ·ÓÙ›ıÂÛË Ì ÙËÌÂϤÙË GISSI-P Î·È ÙË ÌÂϤÙËDART, ÛÙȘ Ôԛ˜ ·Ú·ÙËÚ‹-ıËΠ̛ˆÛË ÙˆÓ ı·Ó·ÙËÊfiÚˆÓÂÂÈÛÔ‰›ˆÓ ·ÏÏ¿ fi¯È ÙˆÓ ÌËı·Ó·ÙËÊfiÚˆÓ. ∞˘Ùfi ÂÓ‰¤¯ÂÙ·ÈÓ· ÔÊ›ÏÂÙ·È ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ô°È·ˆÓ¤˙ÈÎÔ˜ ÏËı˘ÛÌfi˜ ÚÔ-ÛÏ·Ì‚¿ÓÂÈ Ì ÙËÓ ÙÚÔÊ‹ ÙÔ˘ÌÂÁ¿ÏË ÔÛfiÙËÙ· ˆ-3 ÏÈ·ÚÒÓÔͤˆÓ Î·È Û˘ÓÂÒ˜ ·ÔÏ·Ì‚¿-ÓÂÈ ‹‰Ë ÙËÓ ·ÓÙÈ·ÚÚ˘ıÌÈ΋ ÚÔ-ÛÙ·Û›· Ô˘ ÚÔÛʤÚÂÈ Ë ¯·ÌË-Ï‹ ‰fiÛË ÙˆÓ ˆ-3 ÏÈ·ÚÒÓÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÈÛÙÔÚÈÎfi ·-Ï·ÈÔ‡ ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ô-ηډ›Ô˘. ™Â ÌÂÁ·Ï‡ÙÂÚ˜ ‰fi-ÛÂȘ ÂÌÊ·Ó›˙ÂÙ·È ÙÔ ÚÔÛÙ·-Ù¢ÙÈÎfi ·ÔÙ¤ÏÂÛÌ· ÁÈ· Ù· ÌËı·Ó·ÙËÊfiÚ· ÂÂÈÛfi‰È·, ¯¿ÚȘÛÙËÓ ·ÓÙÈ˘ÂÚÙ·ÛÈ΋ ‹ ·ÓÙÈ-ÊÏÂÁÌÔÓÒ‰Ë ‰Ú¿ÛË ÙˆÓ ˆ-3 ÏÈ-·ÚÒÓ ÔͤˆÓ.

ΔÔ Â˘ÓÔ˚Îfi ·ÔÙ¤ÏÂÛÌ· ÛÙË ÌÂ-ϤÙË JELIS, ηٿ ÙÔ˘˜ ÂÚ¢ÓË-Ù¤˜ ‰ÂÓ ÔÊ›ÏÂÙ·È Û ˘Ô¯ÔÏË-ÛÙÂÚÔÏ·ÈÌÈ΋ ‰Ú¿ÛË ÙˆÓ ˆ-3ÏÈ·ÚÒÓ ÔͤˆÓ, ‰Â‰Ô̤ÓÔ˘ fiÙÈË ÔÏÈ΋ Î·È Ë LDL-¯ÔÏËÛÙÂÚfiÏËÌÂÈÒıËÎ·Ó Î·Ù¿ 19% Î·È 25%·ÓÙ›ÛÙÔȯ· Î·È ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ÂÓÒ Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È· ÌÂÈÒıË-Î·Ó Î·Ù¿ 9% ÛÙËÓ ÔÌ¿‰· Ô˘¤Ï·‚ ∂ƒ∞ Î·È 4% ÛÙËÓ ÔÌ¿‰·Ô˘ ‹Ú·Ó ÌfiÓÔ ¯·ÌËÏ‹ ‰fiÛËÛÙ·Ù›Ó˘ (p<0,0001). Δ· ˆ-3ÏÈ·Ú¿ Ôͤ· ¤¯Ô˘Ó ¤Ó· Â˘Ú‡Ê¿ÛÌ· ‚ÈÔÏÔÁÈÎÒÓ ‰Ú¿ÛˆÓ,ÌÂٷ͇ ÙˆÓ ÔÔ›ˆÓ ·ÓÙÈıÚÔÌ-‚ˆÙÈ΋, ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë, ·ÓÙÈ-

ΔÔ ∂ÈÎÔÛÈÂÓÙ·ÓÔ˚Îfi √͇ ªÂÈÒÓÂÈ Ù· ªÂ›˙ÔÓ· ∫·Ú‰È·ÁÁÂȷο ∂ÂÈÛfi‰È· Û ÀÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌÈÎÔ‡˜ ∞ÛıÂÓ›˜.

ªÂϤÙË JELIS (Japan EPA lipid intervention study):Δ˘¯·ÈÔÔÈË̤ÓË, ·ÓÔȯً˜ ¯ÔÚ‹ÁËÛ˘ ηÈ

Ù˘ÊÏ‹˜ ·Ó¿Ï˘Û˘ ÙÂÏÈÎÒÓ ÛËÌ›ˆÓ ÌÂϤÙË.

Yokoyama M, Origasa H, Matsuzaki M, Matsuzawa Y, Saito Y, Ishikawa Y, Oikawa S, Sasaki J,Hishida H, Itakura H, Kita T, Kitabatake A, Nakaya N, Sakata T, Shimada K, Shirato K;

Japan EPA lipid intervention study (JELIS) Investigators

Lancet 2007 Mar 31;369(9567):1090-8

ATHIROSK 14 03-07-07 12:06 ™ÂÏ›‰·10

Page 13: ΤΕΥΧΟΣ 14 ΙΟΥΝΙΟΣ 2007 - ΑΘΗΡΟΣΚΛΗΡΩΣΗ

K§INIKE™ ME§ETE™

11

·ÚÚ˘ıÌÈ΋ Î·È ·ÓÙÈ·ıËÚÔÁfiÓÔ,¤Ú·Ó Ù˘ ÙÚÔÔÔÈËÙÈ΋˜ ÙˆÓÏÈȉ›ˆÓ ‰Ú¿Ûˆ˜ ÙˆÓ.

™Â ¿ÚıÚÔ Ù˘ ™‡ÓÙ·Í˘ (edi-torial) Ô˘ ‰ËÌÔÛȇÂÙ·È ÛÙÔ›‰ÈÔ Ù‡¯Ô˜ ÙÔ˘ Lancet ÙÔÓ›˙Â-Ù·È fiÙÈ, ÌÔÏÔÓfiÙÈ Ë ÌÂϤÙË ‰ÂÓ

Â›Ó·È ‰ÈÏ¿-Ù˘ÊÏ‹ Î·È Ù· ÙÂÏÈÎ¿Û˘Ì‚¿ÓÙ· Ô˘ ·Ú·ÙËÚ‹ıËηÓÂ›Ó·È fi¯È ÛÎÏËÚ¿, Ù· Û˘ÌÂÚ¿-ÛÌ·Ù· Ù˘ ‰ÂÓ Ú¤ÂÈ Ó··ÁÓÔËıÔ‡Ó. ™Â ÌÈ· ÂÔ¯‹ Ô˘ ËÌfi‰· ÂÓÙÔ›˙ÂÙ·È ÛÙ· ·ÎÚÈ‚¿Ê¿Ú̷η, ÙȘ ·ÈÌ·ÙËÚ¤˜ ÂÂÌ-‚¿ÛÂȘ Î·È ÛÙȘ ÂÍÂÏÈÁ̤Ó˜ Û˘-

Û΢¤˜, ̤ÙÚȘ ‰È·ÈÙËÙÈΤ˜ ·Ï-Ï·Á¤˜, ÔÈ Ôԛ˜ Â›Ó·È ·Î›Ó‰˘-Ó˜, ¯·ÌËÏÔ‡ ÎfiÛÙÔ˘˜ Î·È Â˘-Ú¤ˆ˜ ÂÊ·ÚÌfiÛÈ̘, ‰˘Ó·ÙfiÓ Ó··Ô‚Ô‡Ó È‰È·›ÙÂÚ· ˆÊ¤ÏÈ̘.

∂È̤ÏÂÈ·: ∏Ï›·˜ ÃÂÈÌÒÓ·˜

¶ÏÂÈfiÙÚÔ˜ ‰Ú¿ÛÂȘ (pleiotropiceffects) ÙˆÓ ÛÙ·ÙÈÓÒÓ ¤¯Ô˘Ó ÔÓÔ-Ì·Ûı› Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ¯Ô-Ú‹ÁËÛ˘ ÙˆÓ Ê·ÚÌ¿ÎˆÓ ·˘ÙÒÓÔ˘ ‰ÂÓ ÔÊ›ÏÔÓÙ·È ¿ÌÂÛ· ÛÙËÓ˘ÔÏÈȉ·ÈÌÈ΋ ÙÔ˘˜ ‰Ú¿ÛË Î·È¤¯Ô˘Ó ‰È·ÈÛÙˆı› ›Ù ÎÏÈÓÈοÛÙȘ ÌÂÁ¿Ï˜ Ù˘¯·ÈÔÔÈË̤Ó˜ÎÏÈÓÈΤ˜ ÌÂϤÙ˜, ›Ù ÂÈÚ·Ì·ÙÈ-ο ÛÙÔ ÂÚÁ·ÛÙ‹ÚÈÔ, in vitro ‹ invivo. ∞ÔÙÂÏÔ‡Ó ¤Ó· ¢ڇ Ê¿-ÛÌ· ÂΉËÏÒÛÂˆÓ Î·È Û ·˘Ù¤˜ÂÚÈÏ·Ì‚¿ÓÂÙ·È Ë ·ÓÙÈÔÍÂȉˆÙÈ-΋ ‰Ú¿ÛË(1, 2, 3), Ë ‚ÂÏÙ›ˆÛË Ù˘ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ÂÓ‰ÔıËÏ›Ô˘(4, 5),Ë ·ÓÙÈÊÏÂÁÌÔÓ҉˘(6, 7) Î·È Ë·ÓÙÈıÚÔÌ‚ˆÙÈ΋(8) ‰Ú¿ÛË, Ë ‰Ú¿-ÛË ÛÙ· Ï›· Ì˘˚ο(9) Î·È ÛÙ· Ì˘Ô-ηډȷο ·ÙÙ·Ú·(10), Ë ·ÁÁÂÈÔ-‰È·ÛÙ·ÏÙÈ΋ ‰Ú¿ÛË ÛÙ· ÌÈÎÚ¿·ÁÁ›·(11) ÎÏ. ¶ÔÏϤ˜ ·fi ÙȘ·Ú·¿Óˆ ‰Ú¿ÛÂȘ Â›Ó·È ÎÔÈÓ¤˜ÁÈ· fiϘ; ÙȘ ÛÙ·Ù›Ó˜, ÔÚÈṲ̂-Ó˜ fï˜ ·ÔÙÂÏÔ‡Ó ¯·Ú·ÎÙËÚÈ-ÛÙÈÎfi ÌÈ·˜ ‹ ÌÂÚÈÎÒÓ ÌfiÓÔ ÛÙ·ÙÈ-ÓÒÓ.

¶ÚfiÛÊ·Ù· ‰ËÌÔÛȇıËΠÌÈ·ÛÂÈÚ¿ ÎÏÈÓÈÎÒÓ ÌÂÏÂÙÒÓ Ô˘ ·ÊÔ-ÚÔ‡Ó ÛÙËÓ ·ÙÔÚ‚·ÛÙ·Ù›ÓË Î·È ‰È-¢ڇÓÔ˘Ó ÙÔ Ê¿ÛÌ· ÙˆÓ ÏÂÈfi-ÙÚÔˆÓ ‰Ú¿ÛÂˆÓ Ù˘ ÛÙ·Ù›Ó˘·˘Ù‹˜ Ì ÎÏÈÓÈÎfi ÂӉȷʤÚÔÓ

1. Atorvastatin for Reduction ofMYocardial Damage duringAngioplasty (ARMYDA) trial(12).¢ÈÏ¿-Ù˘ÊÏ‹, ÌÂ Ù˘¯·›· ηٷÓÔ-Ì‹ ÙˆÓ ·ÛıÂÓÒÓ, ÂÏÂÁ¯fiÌÂÓË ÌÂÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ, ÚÔÔÙÈ΋ÎÏÈÓÈ΋ ÌÂϤÙË. ¶ÂÚȤϷ‚ 153·ÛıÂÓ›˜ Ì ¯ÚÔÓ›· ÛÙ·ıÂÚ‹ÛÙËı¿Á¯Ë, ÁÈ· ÙÔ˘˜ ÔÔ›Ô˘˜˘‹Ú¯Â ¤Ó‰ÂÈÍË ·ÁÁÂÈÔÏ·ÛÙÈ-΋˜ Î·È ÔÈ ÔÔ›ÔÈ ‰ÂÓ Ï¿Ì‚·Ó·ÓÛÙ·Ù›ÓË Ì¤¯ÚÈ ÙËÓ ¤ÓÙ·ÍË ÙÔ˘˜ÛÙË ÌÂϤÙË. √È ·ÛıÂÓ›˜ ηٷÓÂ-Ì‹ıËÎ·Ó Ù˘¯·›· Û ‰‡Ô ÔÌ¿‰Â˜,·ÓÂÍ¿ÚÙËÙ· ·fi Ù· ›‰· ÏÈÈ-‰›ˆÓ ÙÔ˘˜ Î·È Ë Ì›· ÔÌ¿‰· (76·ÛıÂÓ›˜) ¤Ï·‚ ·ÙÔÚ‚·ÛÙ·Ù›ÓË

Û ‰fiÛË 40 mg ËÌÂÚËÛ›ˆ˜ Î·È Ë¿ÏÏË (77 ·ÛıÂÓ›˜) ÂÈÎÔÓÈÎfiÊ¿ÚÌ·ÎÔ. ª›· ‚‰ÔÌ¿‰· ÌÂÙ¿ÙËÓ ¤Ó·ÚÍË Ù˘ Ê·Ú̷΢ÙÈ΋˜·ÁˆÁ‹˜ ‰ÈÂÓÂÚÁ‹ıËΠ۠fiÏÔ˘˜·ÁÁÂÈÔÏ·ÛÙÈ΋, Û‡Ìʈӷ Ì ÙÔηıÈÂڈ̤ÓÔ ÚˆÙfiÎÔÏÏÔ Î¿ıÂΤÓÙÚÔ˘. ªÂÙ¿ ÙËÓ ·ÁÁÂÈÔÏ·-ÛÙÈ΋ fiÏÔÈ ÔÈ ·ÛıÂÓ›˜ Î·È ÙˆÓ‰‡Ô ÔÌ¿‰ˆÓ ¤Ï·‚·Ó 40 mg·ÙÔÚ‚·ÛÙ·Ù›Ó˘. ∏ ‰È¿ÚÎÂÈ· Ù˘ÌÂϤÙ˘ ‹Ù·Ó ¤Ó·˜ Ì‹Ó·˜. ¶Úˆ-Ù‡ÔÓ ÙÂÏÈÎfi ÛËÌÂ›Ô ‹Ù·Ó Ë ·‡-ÍËÛË, ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙËÓ Â¤Ì‚·-ÛË, Ù˘ CK-MB ¿Óˆ ·fi ÙÔ ‰È-Ï¿ÛÈÔ Ù˘ ·Ú¯È΋˜ ÙÈÌ‹˜, ‰Ëψ-ÙÈ΋˜ ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ô-ηډ›Ô˘. ¢Â˘ÙÂÚ‡ÔÓÙ· ÙÂÏÈοÛËÌ›· ‹Ù·Ó (·) ÔÔÈ·‰‹ÔÙ·‡ÍËÛË, ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË, ÙˆÓÌ˘ÔηډȷÎÒÓ ÂÓ˙‡ÌˆÓ (CK-MB,ÙÚÔÔÓ›Ó˘-π, Ì˘ÔÛÊ·ÈÚ›Ó˘) ¿-Óˆ ·fi Ù· Ê˘ÛÈÔÏÔÁÈο fiÚÈ· (‚)Ô Ì¤ÛÔ˜ fiÚÔ˜ ÙˆÓ Ì¤ÁÈÛÙˆÓ ·˘-Í‹ÛÂˆÓ ÙˆÓ ·ÓˆÙ¤Úˆ ÂÓ˙‡ÌˆÓÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË Î·È (Á) Ë ÂÌ-Ê¿ÓÈÛË fiÏˆÓ ÙˆÓ ÌÂÈ˙fiÓˆÓ ‰˘-ÛÌÂÓÒÓ Î·Ú‰È·ÎÒÓ Û˘Ì‚¿ÓÙˆÓ(ı¿Ó·ÙÔ˜, ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ô-ηډ›Ô˘ ‹ ·Ó¿ÁÎË Â·Ó·ÁÁ›ˆ-Û˘) ·fi ÙË ÛÙÈÁÌ‹ Ù˘ ¤̂·-

Û˘ Î·È Â› ¤Ó· Ì‹Ó·. ΔÔ Úˆ-Ù‡ÔÓ ÙÂÏÈÎfi ÛËÌÂ›Ô ·Ú·ÙËÚ‹-ıËΠ۠ÔÛÔÛÙfi 5% ÙˆÓ ·ÛıÂ-ÓÒÓ Ù˘ ÔÌ¿‰·˜ ·ÙÔÚ‚·ÛÙ·Ù›ÓË˜Î·È Û 18% ÛÙËÓ ÔÌ¿‰· ÙÔ˘ ÂÈÎÔ-ÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ (ƒ=0,025). ∞‡-ÍËÛË Ù˘ CK-MB ¿Óˆ ·fi ÙÔÊ˘ÛÈÔÏÔÁÈÎfi ·Ú·ÙËÚ‹ıËΠÛÙÔ12% Ù˘ ÔÌ¿‰·˜ Ô˘ ¤Ï·‚·ÙÔÚ‚·ÛÙ·Ù›ÓË Î·È ÛÙÔ 35%ÛÙËÓ ÔÌ¿‰· ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘(ƒ=0,001). ∂›Û˘ ·Ú·ÙËÚ‹ıË-ΠÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙËÓ ·‡-ÍËÛË Î·È ÙˆÓ ¿ÏÏˆÓ ÂÓ˙‡ÌˆÓ:ÙÚÔÔÓ›Ó˘-π 20% ¤Ó·ÓÙÈ 48%(ƒ=0,0004) Î·È Ì˘ÔÛÊ·ÈÚ›Ó˘22% ¤Ó·ÓÙÈ 51% (ƒ=0,0005). ∏ηٷÓÔÌ‹ Ù˘ CK-MB Î·È Ù˘ÙÚÔÔÓ›Ó˘-π ηٿ ›‰· ÌÂÙ¿ÙËÓ Â¤Ì‚·ÛË Ê·›ÓÂÙ·È ÛÙËÓ ∂È-ÎfiÓ· 1. √ ̤ÛÔ˜ fiÚÔ˜ ÙˆÓ Ì¤ÁÈ-ÛÙˆÓ ·˘Í‹ÛÂˆÓ ÙˆÓ ÙÈÌÒÓ ÂÓ˙‡-ÌˆÓ ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË Ê·›ÓÂÙ·ÈÛÙËÓ ∂ÈÎfiÓ· 2. ∫·Ù¿ ÙÔÓ ¤Ó· Ì‹-Ó· ·Ú·ÎÔÏÔ‡ıËÛ˘ ‰ÂÓ ·Ú·-ÙËÚ‹ıËÎ·Ó ¿ÏÏ· Ì›˙ÔÓ· ηÚ-‰È·ÁÁÂȷο ÂÂÈÛfi‰È· ¤Ú·Ó ÙÔ˘ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ôηډ›Ô˘.¶ÔÏ˘·Ú·ÁÔÓÙÈ΋ ·Ó¿Ï˘ÛË ¤‰ÂÈ-Í fiÙÈ Ë Ì›ˆÛË ÙÔ˘ ÂÚÈÂÂÌ‚·-ÙÈÎÔ‡ ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘ÔηÚ-

¶ÏÂÈfiÙÚÔ˜ ¢Ú¿ÛÂȘ Ù˘ ∞ÙÔÚ‚·ÛÙ·Ù›Ó˘

∏Ï›·˜ ÃÂÈÌÒÓ·˜, ∫·Ú‰ÈÔÏfiÁÔ˜

∂ÈÎfiÓ· 1. ¶ÔÛÔÛÙfi ·‡ÍËÛ˘ Ù˘ CK-MB Î·È Ù˘ ÙÚÔÔÓ›Ó˘-π ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛËηٿ >1, 2-5 Î·È >5 ÊÔÚ¤˜ ¿Óˆ ·fi ÙÔ Ê˘ÛÈÔÏÔÁÈÎfi fiÚÈÔ ÛÙËÓ Î¿ı ÔÌ¿‰·.

ΔÚÔ

ÔÓ›Ó

Ë-π (

%)

CK

-MB

(%

)

∞ÙÔÚ‚·ÛÙ·Ù›ÓË∞ÙÔÚ‚·ÛÙ·Ù›ÓË

P=0.006

P=0.001

∂ÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ

1 ÊÔÚ¿

50

40

40

30

30

2020

1010

00

2-5 ÊÔÚ¤˜ > 5 ÊÔÚ¤˜ ∞ÓÒÙÂÚÔÊ˘ÛÈÔÏÔÁÈÎfi fiÚÈÔ

∂ÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ

ATHIROSK 14 03-07-07 12:06 ™ÂÏ›‰·11

Page 14: ΤΕΥΧΟΣ 14 ΙΟΥΝΙΟΣ 2007 - ΑΘΗΡΟΣΚΛΗΡΩΣΗ

‰›Ô˘ ‰ÂÓ ÔÊ›ÏÂÙ·È Û ¿ÏÏÔ˘˜·Ú¿ÁÔÓÙ˜ ÏËÓ Ù˘ ¯ÔÚ‹ÁË-Û˘ ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ Î·È fiÙÈ Ë¯Ú‹ÛË ‚-·Ó·ÛÙÔϤˆÓ, ·Ó·ÛÙÔϤ-ˆÓ ÙˆÓ ˘Ô‰Ô¯¤ˆÓ ππb/IIIa ÁÏ˘-ÎÔÚˆÙ½Ó˘ ‹ ∞ª∂∞ ‰ÂÓ Ì›ˆÛÂÙÔÓ Î›Ó‰˘ÓÔ.

∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ë ·‡ÍËÛË Ù˘CK-MB ÌÂÙ¿ ÙËÓ ·ÁÁÂÈÔÏ·ÛÙÈ΋·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ Î·Ú‰È·ÎÔ‡ı·Ó¿ÙÔ˘. ªÈ· ÌÂÙ·-·Ó¿Ï˘ÛË Ô˘ÂÚȤϷ‚ 23.230 ·ÛıÂÓ›˜ ¤‰ÂÈ-Í fiÙÈ ·‡ÍËÛË Ù˘ CK-MB ηٿ 1- 3 ÊÔÚ¤˜ ¿Óˆ ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ÔÚ›Ô˘ ·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ı·Ó¿-ÙÔ˘ Û ¤Ó· ¯ÚfiÓÔ Î·Ù¿ 1,7%,·‡ÍËÛË Î·Ù¿ 3 - 5 ÊÔÚ¤˜ ·˘Í¿-ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ Î·Ù¿ 2,8% ηȷ‡ÍËÛË Î·Ù¿ > 5 ÊÔÚ¤˜ ·˘Í¿ÓÂÈÙÔÓ Î›Ó‰˘ÓÔ Î·Ù¿ 7,4%(13).

2. Atorvastatin for Reduction ofMYocardial Damage during An-gioplasty - Acute Coronary Syn-dromes (ARMYDA-ACS) trial(14).™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ·˘Ù‹˜ ‹Ù·ÓÓ· ÂÚ¢ӋÛÂÈ ÙË ‰Ú¿ÛË Ù˘·ÙÔÚ‚·ÛÙ·Ù›Ó˘ Û ·ÛıÂÓ›˜ ÌÂÔ͇ ÛÙÂÊ·ÓÈ·›Ô Û‡Ó‰ÚÔÌÔ Ô˘˘Ô‚¿ÏÏÔÓÙ·È Û ·ÁÁÂÈÔÏ·ÛÙÈ-΋, ·Ó ‰Ôı› Ï›Á˜ ÒÚ˜ ÚÈÓ ÙËÓ¤̂·ÛË. ¶ÚfiÎÂÈÙ·È ÁÈ· ÌÈ· Ô-Ï˘ÎÂÓÙÚÈ΋ (ÙÚ›· ΤÓÙÚ· ÛÙËÓπÙ·Ï›·), Ù˘¯·ÈÔÔÈË̤ÓË, ‰ÈÏ¿Ù˘ÊÏ‹, ÚÔÔÙÈ΋, ÂÏÂÁ¯fiÌÂÓËÌ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ ÌÂϤÙË.191 ·ÛıÂÓ›˜ Ì Ô͇ ÛÙÂÊ·ÓÈ·›ÔÛ‡Ó‰ÚÔÌÔ ¯ˆÚ›˜ ·Ó¿Û·ÛË ÙÔ˘ST (non-ST elevation ACS) Ô˘‰ÂÓ ÂÏ¿Ì‚·Ó·Ó ÛÙ·Ù›ÓË Ì¤¯ÚÈ ÙËÓ¤Ó·ÚÍË Ù˘ ÌÂϤÙ˘ Î·È ‰ÂÓ Â›-¯·Ó ¤Ó‰ÂÈÍË Â›ÁÔ˘Û·˜ ·ÁÁÂÈÔ-Ï·ÛÙÈ΋˜ ηٷÓÂÌ‹ıËÎ·Ó Ù˘-¯·›· Ó· Ï¿‚Ô˘Ó ·ÙÔÚ‚·ÛÙ·Ù›ÓË

80 mg 12 ÒÚ˜ ÚÈÓ ÙËÓ ·ÁÁÂÈÔ-ÁÚ·Ê›· Î·È ·ÏÏ¿ 40 mg ÂÚ›Ô˘2 ÒÚ˜ ÚÈÓ ÙËÓ Â¤Ì‚·ÛË ‹ ÂÈ-ÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ ÙȘ ›‰È˜ ÒÚ˜.ªÂÙ¿ ÙËÓ Ù˘¯·ÈÔÔ›ËÛË ·ÔÎÏ›-ÛıËÎ·Ó 10 ·ÛıÂÓ›˜ ·fi οıÂÔÌ¿‰·, ÁÈ·Ù› Ë ÛÙÂÊ·ÓÈÔÁÚ·Ê›·¤‰ÂÈÍ fiÙÈ ‰ÂÓ ‹Ù·Ó ηٿÏÏËÏÔÈÁÈ· ·ÁÁÂÈÔÏ·ÛÙÈ΋. ŒÙÛÈ ÂÚÈÂ-Ï‹ÊıËÎ·Ó 86 ·ÛıÂÓ›˜ ÛÙËÓ ÔÌ¿-‰· Ù˘ ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ Î·È 85·ÛıÂÓ›˜ ÛÙËÓ ÔÌ¿‰· placebo.ªÂÙ¿ ÙËÓ Â¤Ì‚·ÛË fiÏÔÈ ÔÈ ·ÛıÂ-Ó›˜ ¤Ï·‚·Ó 40 mg ·ÙÔÚ‚·ÛÙ·Ù›-Ó˘ ËÌÂÚËÛ›ˆ˜, ·ÓÂÍ¿ÚÙËÙ· ·fiÙËÓ ÔÌ¿‰· ÛÙËÓ ÔÔ›· Ù˘¯·ÈÔÔÈ-‹ıËηÓ.

¶ÚˆÙ‡ÔÓ ÙÂÏÈÎfi ÛËÌÂ›Ô ÔÚ›ÛıË-ΠÙÔ Û‡ÓÔÏÔ ÙˆÓ ÌÂÈ˙fiÓˆÓ ‰˘-ÛÌÂÓÒÓ Î·Ú‰È·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ(ı¿Ó·ÙÔ˜, ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ô-ηډ›Ô˘ Î·È ·Ó¿ÁÎË Â·Ó·ÁÁ›ˆ-Û˘ ÛÙÔ ›‰ÈÔ ·ÁÁ›Ô) ̤۷ ÛÙÔÓÚÒÙÔ Ì‹Ó· ·fi ÙËÓ ·ÁÁÂÈÔÏ·-ÛÙÈ΋. ¢È·ÁÓˆÛÙÈÎfi ÎÚÈÙ‹ÚÈÔ Ôͤ-Ô˜ ÂÌÊÚ¿ÁÌ·ÙÔ˜ ηıÔÚ›ÛıËΠ˷‡ÍËÛË Ù˘ CK-MB ‰‡Ô ÊÔÚ¤˜¿Óˆ ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ÔÚ›Ô˘ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ Ë ÙÈÌ‹ ÙÔ˘ÂÓ˙‡ÌÔ˘ ‹Ù·Ó ÂÓÙfi˜ ÙˆÓ Ê˘ÛÈÔ-ÏÔÁÈÎÒÓ ÔÚ›ˆÓ ÚÈÓ ÙËÓ ·ÁÁÂÈÔ-Ï·ÛÙÈ΋ ‹ Ô ‰ÈÏ·ÛÈ·ÛÌfi˜ Ù˘·Ó ‹Ù·Ó ·˘ÍË̤ÓË ‹‰Ë ÚÈÓ ÙËÓ·ÁÁÂÈÔÏ·ÛÙÈ΋. ∂·Ó·ÁÁ›ˆÛËÛÙÔ ›‰ÈÔ ·ÁÁÂ›Ô ÂÚÈÂÏ¿Ì‚·ÓÂÙËÓ ·ÔÚÙÔÛÙÂÊ·ÓÈ·›· ·Ú¿Î·Ì-„Ë ‹ ÙËÓ ·ÁÁÂÈÔÏ·ÛÙÈ΋ ÛÙÔ›‰ÈÔ ÛËÌÂ›Ô ÙÔ˘ ·ÁÁ›Ԣ. ∏ ·Á-ÁÂÈÔÏ·ÛÙÈ΋ ‹Ù·Ó ÂÈÙ˘¯‹˜ ÛÂfiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜. ¢Â˘ÙÂÚ‡-ÔÓÙ· ÙÂÏÈο ÛËÌ›· ‹Ù·Ó (·) οı·‡ÍËÛË ÙˆÓ ‰ÂÈÎÙÒÓ Ì˘Ôηډȷ-΋˜ ‚Ï¿‚˘ (CK-MB, ÙÚÔÔÓ›ÓË-π,

Ì˘ÔÛÊ·ÈÚ›ÓË) ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛËÎ·È (‚) ÌÂÙ·‚ÔϤ˜ Ù˘ ÙÈÌ‹˜ Ù˘CRP ÌÂÙ¿ ÙËÓ ·ÁÁÂÈÔÏ·ÛÙÈ΋.

ªÂ›˙ÔÓ· ‰˘ÛÌÂÓ‹ ηډȷο Û˘Ì-‚¿Ì·Ù· ·Ú·ÙËÚ‹ıËÎ·Ó Û 5%ÙˆÓ ·ÛıÂÓÒÓ Ù˘ ·ÙÔÚ‚·ÛÙ·Ù›-Ó˘ Î·È Û 17% ÙˆÓ ·ÛıÂÓÒÓ ÙÔ˘ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ (ƒ=0,01)Î·È ·ÊÔÚÔ‡Û·Ó Î˘Ú›ˆ˜ ¤ÌÊÚ·Á-Ì· ÙÔ˘ Ì˘Ôηډ›Ô˘. ¢ÂÓ Û˘Ó¤‚ËηӤӷ˜ ı¿Ó·ÙÔ˜ ÛÙȘ 30 Ë̤-Ú˜. √È Î·Ì‡Ï˜ ÂÈ‚›ˆÛ˘ ÙˆÓ‰‡Ô ÔÌ¿‰ˆÓ (Kaplan-Meier) Ê·›-ÓÔÓÙ·È ÛÙËÓ ∂ÈÎfiÓ· 3. ΔÔ ÔÛÔ-ÛÙfi ÙˆÓ ·ÛıÂÓÒÓ, ÛÙÔ˘˜ ÔÔ›-Ô˘˜ ·˘Í‹ıËÎ·Ó Ù· Ì˘Ôηډȷο¤Ó˙˘Ì· ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË ‹Ù·ÓÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚÔ ÛÙËÓ ÔÌ¿-‰· Ù˘ ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ Û˘ÁÎÚÈ-ÙÈο Ì ÙËÓ ÔÌ¿‰· ÙÔ˘ ÂÈÎÔÓÈÎԇʷÚÌ¿ÎÔ˘ (CK-MB 7% ¤Ó·ÓÙÈ27%, ƒ=0,001 Î·È ÙÚÔÔÓ›ÓË-π41% ¤Ó·ÓÙÈ 58%, ƒ=0,039)

Δ· ›‰· Ù˘ CRP ÛÙÔÓ ÔÚfi·˘Í‹ıËÎ·Ó Î·È ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ÌÂÙ¿ ÙËÓ ·ÁÁÂÈÔÏ·ÛÙÈ΋, Ë ·‡-ÍËÛË fï˜ ‹Ù·Ó ÛËÌ·ÓÙÈο ÌÂ-Á·Ï‡ÙÂÚË ÛÙËÓ ÔÌ¿‰· ÙÔ˘ ÂÈÎÔÓÈ-ÎÔ‡ Ê·ÚÌ¿ÎÔ˘ (63±114% ÛÙËÓÔÌ¿‰· Ô˘ ¤Ï·‚ ·ÙÔÚ‚·ÛÙ·Ù›ÓËÎ·È 147±274% ÛÙËÓ ÔÌ¿‰· Ô˘‰ÂÓ ¤Ï·‚Â). ∏ ÔÏ˘·Ú·ÁÔÓÙÈ΋·Ó¿Ï˘ÛË ¤‰ÂÈÍ fiÙÈ Ë ¯ÔÚ‹ÁËÛË·ÙÔÚ‚·ÛÙ·Ù›Ó˘ ÚÈÓ ÙËÓ Â¤Ì-‚·ÛË Ì›ˆÛ ÙÔÓ Î›Ó‰˘ÓÔ Û˘Ì‚·-Ì¿ÙˆÓ ÛÙȘ 30 Ë̤Ú˜ (oddsratio 0,12, fiÚÈ· ·ÍÈÔÈÛÙ›·˜ 95%·fi 0,05 ̤¯ÚÈ 0,50, ƒ=0,004).∞ÛıÂÓ›˜ Ô˘ ¯ÚÂÈ¿ÛıËÎ·Ó ·Ó·-ÛÙÔÏ›˜ Ù˘ ÁÏ˘ÎÔÚˆÙ½Ó˘IIb/IIIa ‹ ›¯·Ó ÎÏ¿ÛÌ· Â͈ı‹ÛÂ-ˆ˜ ≤ 40% ÂÌÊ¿ÓÈÛ·Ó ÌÂÁ·Ï‡ÙÂ-ÚÔ Î›Ó‰˘ÓÔ. £Âڷ›· Ì ∞ª∂∞

π √ À ¡ π √ ™ 2 0 0 7

12

∂ÈÎfiÓ· 2. ª¤ÛÔ˜ fiÚÔ˜ ̤ÁÈÛÙˆÓ ·˘Í‹ÛÂˆÓ ÙˆÓ ÙÈÌÒÓ ÙˆÓ ÂÓ˙‡ÌˆÓ ÌÂÙ¿ ÙËÓ ·ÁÁÂÈÔÏ·ÛÙÈ΋ ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ ÙˆÓ ·ÛıÂÓÒÓ.

ª¤Á

ÈÛÙË

ÙÈÌ

‹ Tr

opon

in-I

ng

/mL

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ÈÛÙË

ÙÈÌ

‹ m

yog

lob

in n

g/m

L

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ÈÛÙË

ÙÈÌ

‹ C

K-M

B n

g/m

L

∞ÙÔÚ‚·ÛÙ·Ù›ÓË

P=0.007 P=0.0008

P=0.0002

∂ÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ

40

60

80

100

20

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0,2

0,4

0,6

0,8

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2

4

6

8

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ATHIROSK 14 03-07-07 12:06 ™ÂÏ›‰·12

Page 15: ΤΕΥΧΟΣ 14 ΙΟΥΝΙΟΣ 2007 - ΑΘΗΡΟΣΚΛΗΡΩΣΗ

‹ ‚-·Ó·ÛÙÔÏ›˜ ηٿ ÙÔ ¯ÚfiÓÔÙ˘ ·ÁÁÂÈÔÏ·ÛÙÈ΋˜ ‰ÂÓ Ì›ˆÛÂÙÔÓ Î›Ó‰˘ÓÔ.

3. Atorvastatin for Reduction ofMYocardial Dysrhythmia Aftercardiac surgery - (ARMYDA-3)Study (15). H ÌÂϤÙË ·˘Ù‹ ÂͤٷÛÂÙË ‰˘Ó·ÙfiÙËÙ· Ù˘ ·ÙÔÚ‚·ÛÙ·Ù›-Ó˘, fiÙ·Ó ¯ÔÚËÁÂ›Ù·È ÚÔÂÁ¯ÂÈ-ÚËÙÈο Û ηډÈÔ¯ÂÈÚÔ˘ÚÁÈΤ˜ÂÂÌ‚¿ÛÂȘ ·ÓÔÈÎÙ‹˜ ηډȿ˜,Ó· ÚÔÏ·Ì‚¿ÓÂÈ ÙË ÌÂÙÂÁ¯ÂÈÚËÙÈ-΋ ÎÔÏÈ΋ Ì·ÚÌ·Ú˘Á‹, Ë ÔÔ›·ˆ˜ ÁÓˆÛÙfiÓ Â›Ó·È Û˘¯Ó‹ Û ·˘-Ù¤˜ ÙȘ ÂÚÈÙÒÛÂȘ Î·È Ô‰ËÁ›Û ·Ú¿Ù·ÛË Ù˘ ÓÔÛËÏ›·˜, ·‡-ÍËÛË ÙÔ˘ ÎfiÛÙÔ˘˜ Î·È ÙˆÓ ÂÈ-ÏÔÎÒÓ. ∂Ӊ›ÍÂȘ fiÙÈ ÔÈ ÛÙ·Ù›-Ó˜ ÂÓ‰¤¯ÂÙ·È Ó· ÚÔÏ·Ì‚¿ÓÔ˘ÓÙËÓ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ÎÔÏÈ΋ Ì·Ú-Ì·Ú˘Á‹ ˘‹Ú¯·Ó ·fi ÌÂϤÙ˜

·Ú·Ù‹ÚËÛ˘. ∞ÛıÂÓ›˜ Ô˘‹Û·Ó ˘fi ·ÁˆÁ‹ Ì ÛÙ·Ù›Ó˜ÚÈÓ ÙËÓ ÂÁ¯Â›ÚËÛË ÂÌÊ¿ÓÈ˙·Ó ÏÈ-ÁfiÙÂÚÔ Û˘¯Ó¿ ÂÂÈÛfi‰È· ÎÔÏÈ-΋˜ Ì·ÚÌ·Ú˘Á‹˜ ÌÂÙ¿ ·ÔÚÙÔ-ÛÙÂÊ·ÓÈ·›· ·Ú¿Î·Ì„Ë(16).

∏ ARMYDA-3 Â›Ó·È ÚÔÔÙÈ΋,Ù˘¯·ÈÔÔÈË̤ÓË, ‰ÈÏ¿-Ù˘ÊÏ‹,ÂÏÂÁ¯fiÌÂÓË Ì ÂÈÎÔÓÈÎfi Ê¿ÚÌ·-ÎÔ ÌÂϤÙË, ÛÙËÓ ÔÔ›· ÂÓÙ¿¯ıË-Î·Ó 200 ·ÛıÂÓ›˜ Ô˘ ›¯·Ó ¤Ó-‰ÂÈÍË Ó· ˘Ô‚ÏËıÔ‡Ó Û ÚÔ-ÁÚ·ÌÌ·ÙÈṲ̂ÓË ÂÁ¯Â›ÚËÛË ·ÓÔÈ-ÎÙ‹˜ ηډȿ˜ (·ÔÚÙÔÛÙÂÊ·ÓÈ·›··Ú¿Î·Ì„Ë ‹ ‰ÈfiÚıˆÛË ‚·Ï‚È-‰Ô¿ıÂÈ·˜) Î·È ‰ÂÓ Â›¯·Ó ÈÛÙÔÚÈ-Îfi ÎÔÏÈ΋˜ Ì·ÚÌ·Ú˘Á‹˜ Ô‡ÙÂÏ¿Ì‚·Ó·Ó ÛÙ·Ù›Ó˜ ̤¯ÚÈ ÙËÓ¤ÓÙ·ÍË ÛÙË ÌÂϤÙË. ∫·Ù·ÓÂÌ‹ıË-Î·Ó Î·Ù¿ Ù˘¯·›Ô ÙÚfiÔ Û ‰‡ÔÔÌ¿‰Â˜, ·ÓÂÍ¿ÚÙËÙ· ·fi Ù· ›-

‰· ÏÈȉ›ˆÓ Î·È Ë Ì›· ÔÌ¿‰·(101 ¿ÙÔÌ·) ¤Ï·‚ ·ÙÔÚ‚·ÛÙ·Ù›-ÓË 40 mg ÙËÓ Ë̤ڷ, ·Ú¯›˙ÔÓÙ·˜7 Ë̤Ú˜ ÚÈÓ ÙËÓ ÂÁ¯Â›ÚËÛË Î·ÈË ¿ÏÏË ÔÌ¿‰· (99 ¿ÙÔÌ·) ¤Ï·‚ÂÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ. ∏ ›‰È· ·ÁˆÁ‹Û˘Ó¯›ÛıËΠÁÈ· fiÛÔ ‰È¿ÛÙËÌ·ÔÈ ·ÛıÂÓ›˜ ·Ú¤ÌÂÈÓ·Ó ÛÙÔ ÓÔ-ÛÔÎÔÌ›Ô, ÂÓÒ ÌÂÙ¿ ÙËÓ ¤ÍÔ‰ÔÛ˘ÓÙ·ÁÔÁÚ·Ê‹ıËΠ۠fiÏÔ˘˜·ÙÔÚ‚·ÛÙ·Ù›ÓË.

¶ÚˆÙ‡ÔÓ ÙÂÏÈÎfi ÛËÌÂ›Ô ‹Ù·Ó ËÂÌÊ¿ÓÈÛË ÛÙÔ ∏∫° ·Ú·ÎÔÏÔ‡-ıËÛ˘ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋˜ ÎÔÏÈ΋˜Ì·ÚÌ·Ú˘Á‹˜ Ô˘ ‰È‹ÚÎÂÛ Â-ÚÈÛÛfiÙÂÚÔ ·fi 5 ÏÂÙ¿ ‹ Ô˘¯ÚÂÈ¿ÛıËΠ·Ú¤Ì‚·ÛË ÏfiÁˆ ÛÙË-ı¿Á¯Ë˜ ‹ ·ÈÌÔ‰˘Ó·ÌÈ΋˜ ·ÛÙ¿-ıÂÈ·˜. ¢Â˘ÙÂÚ‡ÔÓÙ· ÙÂÏÈο ÛË-Ì›· ‹Ù·Ó Ë ‰È¿ÚÎÂÈ· Ù˘ ÌÂÙÂÁ-¯ÂÈÚËÙÈ΋˜ ÓÔÛËÏ›·˜, Ù· Ì›˙Ô-Ó· ηډȷÁÁÂȷο Û˘Ì‚¿ÓÙ· Û‰ȿÛÙËÌ· 30 ËÌÂÚÒÓ Î·È Ë ‰È·Î‡-Ì·ÓÛË Ù˘ ÙÈÌ‹˜ Ù˘ CRP.

∏ ·ÙÔÚ‚·ÛÙ·Ù›ÓË Ì›ˆÛ ÛËÌ·-ÓÙÈο ÙËÓ Â›ÙˆÛË Ù˘ ÎÔÏÈ΋˜Ì·ÚÌ·Ú˘Á‹˜ (35% ¤Ó·ÓÙÈ 57%,ƒ=0.003, ∂ÈÎfiÓ· 4) Î·È Î·Ù¿ Û˘-Ó¤ÂÈ· Î·È ÙË ‰È¿ÚÎÂÈ· ÓÔÛËÏ›-·˜ (6,3±1,2 ¤Ó·ÓÙÈ 6,9±1,4 Ë̤-Ú˜ ·ÓÙ›ÛÙÔȯ·, ƒ = 0,001). ΔÔfiÊÂÏÔ˜ ÂÚÈÔÚ›ÛıËΠÛÙ· ÂÚÈ-ÛÙ·ÙÈο Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û·ÔÚÙÔÛÙÂÊ·ÓÈ·›· ·Ú¿Î·Ì„Ë Î·È‰ÂÓ ·Ú·ÙËÚ‹ıËΠ۠ÂÁ¯ÂÈÚ‹-ÛÂȘ ‚·Ï‚›‰ˆÓ. ∂›Û˘ Ë ·ÙÔÚ-‚·ÛÙ·Ù›ÓË ‰ÂÓ ÚÔÛٿ٢۠ÙÔ˘˜·ÛıÂÓ›˜ Û ÂÚ›ÙˆÛË Ô˘ ›¯·Ó‰È·ÙÂٷ̤ÓÔ ·ÚÈÛÙÂÚfi ÎfiÏÔ. Δ·Â›Â‰· Ù˘ CRP ‹Ù·Ó ¯·ÌËÏfiÙÂ-Ú· ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ‰ÂÓ ÂÌ-Ê¿ÓÈÛ·Ó ÎÔÏÈ΋ Ì·ÚÌ·Ú˘Á‹, ·Ó-ÂÍ¿ÚÙËÙ· ·fi ÙËÓ Ï‹„Ë ‹ ÌË·ÙÔÚ‚·ÛÙ·Ù›Ó˘. (ƒ=0,01). ∏ÎÔÏÈ΋ Ì·ÚÌ·Ú˘Á‹ ‹Ù·Ó ÈÔ Û˘-¯Ó‹ ÛÙ· ÂÚÈÛÛfiÙÂÚÔ ËÏÈÎȈ̤ӷ¿ÙÔÌ· (>65 ÂÙÒÓ), Û ˘ÂÚÙ·ÛÈ-ο ¿ÙÔÌ· Î·È Û ·ıËÚÔÛÎÏ‹ÚˆÛËÙ˘ ·ÔÚÙ‹˜. ∞ÓÙ›ıÂÙ· Ë Ï‹„Ë ‚-·Ó·ÛÙÔϤˆÓ Ì›ˆÛ ÙÔÓ Î›Ó‰˘ÓÔÎÔÏÈ΋˜ Ì·ÚÌ·Ú˘Á‹˜ ηٿ 90%.¶ÔÏ˘·Ú·ÁÔÓÙÈ΋ ·Ó¿Ï˘ÛË ¤‰ÂÈ-Í fiÙÈ Ë ·ÙÔÚ‚·ÛÙ·Ù›ÓË ÌÂÈÒÓÂÈÙÔÓ Î›Ó‰˘ÓÔ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋˜ ÎÔÏ-È΋˜ Ì·ÚÌ·Ú˘Á‹˜ ηٿ 61% (OR0,39, fiÚÈÔ ·ÍÈÔÈÛÙ›·˜ 95% ·fi0,18 ̤¯ÚÈ 0,85, ƒ = 0,017), ·ÓÂ-Í¿ÚÙËÙ· ·fi ËÏÈΛ·, ʇÏÔ, ‡·Ú-ÍË ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ‹ ۷ί·-ÚÒ‰Ë ‰È·‚‹ÙË. ∏ Ù·˘Ùfi¯ÚÔÓË Ï‹-„Ë ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ Î·È ‚-·Ó·-ÛÙÔϤˆÓ ÌÂÈÒÓÂÈ ·ÎfiÌË ÂÚÈÛÛfi-ÙÂÚÔ ÙÔÓ Î›Ó‰˘ÓÔ (∂ÈÎfiÓ· 5).

∫§π¡π∫∂™ ª∂§∂Δ∂™

13

∂ÈÎfiÓ· 3. ∫·Ì‡Ï˜ ÂÈ‚›ˆÛ˘ ¯ˆÚ›˜ Ì›˙ÔÓ· ηډȷο Û˘Ì‚¿Ì·Ù·, ÌÂÙ¿ ÙËÓÙ˘¯·ÈÔÔ›ËÛË.

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)

∞ÙÔÚ‚·ÛÙ·Ù›ÓË

∏̤Ú˜ ÌÂÙ¿ ÙËÓ ·ÁÁÂÈÔÏ·ÛÙÈ΋

P=0.01

∂ÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ

40

60

80

100

20

01 2 3 7 14 21 30

∂ÈÎfiÓ· 4. ∫·Ì‡Ï˜ ÂÈ‚›ˆÛ˘ ¯ˆÚ›˜ ÂÂÈÛfi‰ÈÔ ÎÔÏÈ΋˜ Ì·ÚÌ·Ú˘Á‹˜ ÛÂοı ÔÌ¿‰·.

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P=0.003

∂ÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ

40

60

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01 2 3 7 14 21 30

ATHIROSK 14 03-07-07 12:06 ™ÂÏ›‰·13

Page 16: ΤΕΥΧΟΣ 14 ΙΟΥΝΙΟΣ 2007 - ΑΘΗΡΟΣΚΛΗΡΩΣΗ

ªÂ Ù· ̤¯ÚÈ ÙÒÚ· ‰Â‰Ô̤ӷ ÌfiÓÔÔÈ ‚-·Ó·ÛÙÔÏ›˜ Î·È Ë ·ÌȈ‰·Úfi-ÓË ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ÚÔÛٷهԢӷfi ÙË ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ÎÔÏÈ΋̷ÚÌ·Ú˘Á‹. √È ·ÓÙ·ÁˆÓÈÛÙ¤˜·Û‚ÂÛÙ›Ô˘, Ù· ·ÓÙÈ·ÚÚ˘ıÌÈο η-ÙËÁÔÚ›·˜ π, Ë ‰·ÎÙ˘Ï›Ùȉ·, ÙÔ Ì·-ÁÓ‹ÛÈÔ Î·È Ë ¤Á¯˘ÛË ‰È·Ï‡Ì·ÙÔ˜ÁÏ˘Îfi˙˘-ÈÓÛÔ˘Ï›Ó˘-Î·Ï›Ô˘ ‰ÂÓ‹Ù·Ó ·ÔÙÂÏÂÛÌ·ÙÈο. ™‡ÌʈӷÌ ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË Ë ÚÔıÂ-ڷ›· Ì ·ÙÔÚ‚·ÛÙ·Ù›ÓË Â›Ó·ÈÂÍ·ÈÚÂÙÈο ·ÔÙÂÏÂÛÌ·ÙÈ΋. ÃÚÂÈ-¿˙ÂÙ·È Ó· ¿ÚÔ˘Ó ıÂڷ›· ÌfiÓÔ4,5 ·ÛıÂÓ›˜ ÁÈ· Ó· ÚÔÏËÊı›¤Ó· ÂÂÈÛfi‰ÈÔ ÎÔÏÈ΋˜ Ì·ÚÌ·-Ú˘Á‹˜ Î·È 8 ·ÛıÂÓ›˜ ÁÈ· Ó· ÚÔ-ÏËÊı› ·Ú¿Ù·ÛË Ù˘ ÓÔÛËÏ›·˜¤Ú·Ó ÙˆÓ 7 ËÌÂÚÒÓ. ¢Â‰Ô̤ÓÔ˘fiÙÈ Ë ıÂڷ›· Ì ·ÙÔÚ‚·ÛÙ·Ù›ÓËÂ›Ó·È ·ÛÊ·Ï‹˜ Î·È ¯·ÌËÏÔ‡ Îfi-ÛÙÔ˘˜, Ë ¯ÔÚ‹ÁËÛË Ù˘ ÚÔÏË-ÙÈο Û ÂÁ¯ÂÈÚ‹ÛÂȘ ·ÔÚÙÔÛÙÂ-Ê·ÓÈ·›·˜ ·Ú¿Î·Ì„˘ ÌÔÚ› Ó·¤¯ÂÈ ÛËÌ·ÓÙÈΤ˜ ÔÈÎÔÓÔÌÈΤ˜ ÂÈ-ÙÒÛÂȘ.

√ Ì˯·ÓÈÛÌfi˜ Ì ÙÔÓ ÔÔ›Ô Ë·ÙÔÚ‚·ÛÙ·Ù›ÓË ÌÔÚ› Ó· ÚÔ-Ï·Ì‚¿ÓÂÈ ÙË Ì˘Ôηډȷ΋ Ó¤-ÎÚˆÛË Ô˘ Û˘¯Ó¿ Û˘Ì‚·›ÓÂÈÛÙËÓ ·ÁÁÂÈÔÏ·ÛÙÈ΋ (›Ù ÁÈ·

¯ÚfiÓÈ· ÛÙ·ıÂÚ‹ ÛÙËı¿Á¯Ë ›ÙÂÁÈ· Ôͤ· ÛÙÂÊ·ÓÈ·›· Û‡Ó‰ÚÔÌ·)ηıÒ˜ Î·È ÙËÓ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ÎÔÏÈ΋ Ì·ÚÌ·Ú˘Á‹ ‰ÂÓ Â›Ó·È·ÎÚÈ‚Ò˜ ÁÓˆÛÙfi˜, ‰ÂÓ ÌÔÚ›fï˜ Ó· Â›Ó·È Ë ˘ÔÏÈȉ·ÈÌÈ΋‰Ú¿ÛË, Ë ÔÔ›· ¯ÚÂÈ¿˙ÂÙ·È ·ÚÎÂ-Ùfi ¯ÚfiÓÔ ÁÈ· Ó· Á›ÓÂÈ ÂÌÊ·Ó‹˜. ∏·ÓÙÈÊÏÂÁÌÔÓ҉˘ ‰Ú¿ÛË ÂÓ‰¤-¯ÂÙ·È Ó· Â›Ó·È ¤Ó·˜ Ì˯·ÓÈÛÌfi˜Î·È Û ·˘Ùfi Û˘ÓËÁÔÚ› ÙÔ ÁÂÁÔ-Ófi˜ fiÙÈ Ù· ÂÂÈÛfi‰È· ‹Ù·Ó ÈÔÛ˘¯Ó¿ ÛÙ· ¿ÙÔÌ· Ì ˘„ËϤ˜ ÙÈ-̤˜ CRP Î·È fiÙÈ Ë ·ÙÔÚ‚·ÛÙ·Ù›-ÓË ÌÂÈÒÓÂÈ ÙËÓ ÙÈÌ‹ Ù˘ CRP.À¿Ú¯Ô˘Ó ÂÈÚ·Ì·ÙÈΤ˜ ÂӉ›-ÍÂȘ fiÙÈ ÔÈ ÛÙ·Ù›Ó˜ ÚÔÛٷه-Ô˘Ó ·fi ÙË ‚Ï¿‚Ë Â·Ó·ÁÁ›ˆ-Û˘ Î·È ÂËÚ¿˙Ô˘Ó ÙË ÌÈÎÚÔ΢-ÎÏÔÊÔÚ›·, ÌÂÈÒÓÔ˘Ó Ù· ÚÔ-ÛÎÔÏÏËÙÈο ÌfiÚÈ· Î·È ‚ÂÏÙÈÒ-ÓÔ˘Ó ÙË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· ÙˆÓ ·È-ÌÔÂÙ·Ï›ˆÓ. ∂›Û˘, ·ÎfiÌË Î·È‚Ú·¯˘¯ÚfiÓÈ· ıÂڷ›· Ì ÛÙ·Ù›-Ó˜ ¤¯ÂÈ ÛËÌ·ÓÙÈο ·ÔÙÂϤÛÌ·-Ù· ÛÙË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· ÙÔ˘ ÂÓ-‰ÔıËÏ›Ô˘, ÛÙË ÊÏÂÁÌÔÓ‹, ÛÙËÓ·ÁÁÂÈԉȷÛÙÔÏ‹ ÙˆÓ ÌÈÎÚÒÓ ·Á-Á›ˆÓ Î·È ÛÙË ıÚfiÌ‚ˆÛË. ™ÙËÌÂϤÙË ARMYDA-ACS Ë ·ÙÔÚ‚·-ÛÙ·Ù›ÓË ÂÚÈfiÚÈÛ ÙËÓ ·‡ÍËÛË

Ù˘ CRP Ô˘ ·Ú·ÙËÚÂ›Ù·È Â-ÚÈÂÂÌ‚·ÙÈο, ΢ڛˆ˜ ÛÙ· ¿ÙÔÌ·Ì ˘„ËϤ˜ ÙÈ̤˜ ÚÈÓ ÙËÓ Â¤Ì-‚·ÛË. ™ÙËÓ ARMYDA-3 ÎÔÏÈ΋̷ÚÌ·Ú˘Á‹ ¤·ı·Ó Ù· ¿ÙÔÌ· Ì¢„ËÏ‹ CRP, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËıÂڷ›·.

4. √È ÏÂÈfiÙÚÔ˜ ‰Ú¿ÛÂȘ ‰ÂÓ·ÎÔÏÔ˘ıÔ‡Ó ··Ú·›ÙËÙ· ÙË Ì›ˆ-ÛË Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘. ™‡Ì-ʈӷ Ì ÌÈ· ÚfiÛÊ·ÙË ÂÚÁ·Û›·,Ô ›‰ÈÔ˜ ‚·ıÌfi˜ Ì›ˆÛ˘ Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ Ì ·ÙÔÚ‚·ÛÙ·Ù›ÓËÛ ̤ÙÚÈ· ‰fiÛË ‹ Ì ·ÙÔÚ‚·ÛÙ·-Ù›ÓË Û ÌÈÎÚ‹ ‰fiÛË Û˘Ó Â˙ÂÙÈÌ›-ÌË ‰ÂÓ Â›¯Â ÙȘ ›‰È˜ ÏÂÈfiÙÚÔ-˜ ‰Ú¿ÛÂȘ ÛÙ· ·ÈÌÔÂÙ¿ÏÈ· ηÈÛÙË ÊÏÂÁÌÔÓÒ‰Ë ‰ÈÂÚÁ·Û›·(17). 56·ÛıÂÓ›˜ Ì ·ÁÁÂÈÔÁÚ·ÊÈο ÂÈ-‚‚·ÈˆÌ¤ÓË ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ Î·ÈLDL-¯ÔÏËÛÙÂÚfiÏË > 100 mg%·Ú¿ ÙË Ï‹„Ë 10-20 mg ·ÙÔÚ‚·-ÛÙ·Ù›Ó˘, ηٷÓÂÌ‹ıËÎ·Ó Ù˘¯·›·Ó· Ï¿‚Ô˘Ó Â›Ù ·ÙÔÚ‚·ÛÙ·Ù›ÓË 40mg ÙËÓ Ë̤ڷ ›Ù Â˙ÂÙÈÌ›ÌË 10mg Î·È ·ÙÔÚ‚·ÛÙ·Ù›ÓË 10 mg ÙËÓË̤ڷ. ªÂÙ¿ 4 ‚‰ÔÌ¿‰Â˜ Ë Ì›-ˆÛË Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ ‹Ù·ÓÈηÓÔÔÈËÙÈ΋ Î·È ÛÙÔÓ ›‰ÈÔ ‚·ı-Ìfi ÂÚ›Ô˘ Î·È Ì ٷ ‰‡Ô Û¯‹Ì·-Ù· (- 40±7 mg % Ì ·ÙÔÚ‚·ÛÙ·-

π √ À ¡ π √ ™ 2 0 0 7

14

∏ÏÈΛ· > 65 ÂÙÒÓ.

∞ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË.

™·Î¯·Ú҉˘ ‰È·‚‹Ù˘.

™˘ÌÊÔÚËÙÈ΋ ηډȷ΋ ·Ó¿ÚÎÂÈ·.

∞ıËÚÔÛÎÏ‹ÚˆÛË ·ÔÚÙ‹˜.

¢È¿Ù·ÛË ·ÚÈÛÙÂÚÔ‡ ÎfiÏÔ˘.

£Âڷ›· Ì ‚-·Ó·ÛÙÔÏ›˜

πÓfiÙÚÔÔÈ ·Ú¿ÁÔÓÙ˜.

¢È·ÛˆÏ‹ÓˆÛË Î·È ÙˆÓ ‰‡Ô ÎÔ›ÏˆÓ ÊÏ‚ÒÓ.

£Âڷ›· Ì ·ÙÔÚ‚·ÛÙ·Ù›ÓË.

CRP>166 mg/L

∞ÙÔÚ‚·ÛÙ·Ù›ÓË+‚-·Ó·ÛÙÔÏ›˜)

∂ÈÎfiÓ· 5. ∞Ó·ÏÔÁÈ΋ ¶Èı·ÓfiÙËÙ· (odds ratio) ÂÌÊ¿ÓÈÛ˘ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋˜ ÎÔÏÈ΋˜ Ì·ÚÌ·Ú˘Á‹˜ Û ÔÌ¿‰Â˜ Î·È ·Ó¿ÏÔÁ·Ì ÙË ıÂڷ¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË.

∞Ó·ÏÔÁÈ΋ ¶Èı·ÓfiÙËÙ· ÁÈ· ªÂÙÂÁ¯ÂÈÚËÙÈ΋ ∫ÔÏÈ΋ ª·ÚÌ·Ú˘Á‹.

OR 95% CI P

2.5 (1.2-5.0) 0.02

3.9 (1.1-14) 0.039

1.2 (0.50-2.7) 0.074

1.6 (0.21-12.7) 0.65

2.6 (1.1-6.0) 0.023

1.6 (0.73-3.3) 0.26

0.19 (0.08-0.44) 0.0001

1.4 (0.59-3.2) 0.46

2.4 (0.90-6.0) 0.08

0.39 (018-0.85) 0.017

2.0 (1.2-7.0) 0.01

0.10 (0.02-0.0.25) <0.0001

0 0.5 1 2 3 4 5

ATHIROSK 14 03-07-07 12:06 ™ÂÏ›‰·14

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Ù›ÓË Î·È -53±8,6 mg% Ì ÙË ‰È-Ï‹ ·ÁˆÁ‹, ‰È·ÊÔÚ¿ ÌË ÛËÌ·ÓÙÈ-΋ ÛÙ·ÙÈÛÙÈο) ·ÏÏ¿ ÔÈ ‰Â›ÎÙ˜Ù˘ ·ÈÌÔÂÙ·Ïȷ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜Î·È Ù˘ ÊÏÂÁÌÔÓÒ‰Ô˘˜ ‰ÈÂÚÁ·-Û›·˜ ÂÌÊ¿ÓÈ˙·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·-ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜. ∏ ƒ-ÛÂÏÂÎÙ›ÓË(‰Â›ÎÙ˘ ÂÓÂÚÁfiÙËÙ·˜ ÙˆÓ ·ÈÌÔ-ÂÙ·Ï›ˆÓ) ÌÂÙ¿ ‰È¤ÁÂÚÛË Ì ADP‹Ù·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚË ÛÙËÓÔÌ¿‰· Ù˘ ÌÔÓÔıÂڷ›·˜ Û˘-ÁÎÚÈÙÈο Ì ÙËÓ ÔÌ¿‰· Ù˘ Û˘Ó-‰˘·Ṳ̂Ó˘ ·ÁˆÁ‹˜ (ƒ<0,005, ∂È-ÎfiÓ· 6). ∂›Û˘ Ë Û˘ÛÛÒÚ¢ÛËÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ ÌÂÙ¿ ‰È¤ÁÂÚÛËÌ TRAP (Thrombin Receptor-Activating Peptide) ‹Ù·Ó ÛËÌ·ÓÙÈ-ο ¯·ÌËÏfiÙÂÚË Ì ÙËÓ ·ÙÔÚ‚·-ÛÙ·Ù›ÓË. Δ· ›‰· ÙˆÓ ¯˘ÌÔÎÈ-ÓÒÓ ÛÙ· Ï¿ÛÌ· (Regulated onActivation Normally T-cell Expres-sed and Secreted - RANTES) ÌÂÈ-ÒıËÎ·Ó Ì ٷ 40 mg ·ÙÔÚ‚·ÛÙ·-Ù›Ó˘, fi¯È fï˜ Ì ÙË ‰ÈÏ‹ ·Áˆ-Á‹. √È ¤ÎÊÚ·ÛË ÙˆÓ ¯˘ÌÔÎÈÓÒÓ,ÂÎÙfi˜ ·fi ‰Â›ÎÙ˘ ‰È¤ÁÂÚÛ˘ ÙˆÓ·ÈÌÔÂÙ·Ï›ˆÓ, Ê·›ÓÂÙ·È fiÙÈ ‰È·-‰Ú·Ì·Ù›˙ÂÈ ÚfiÏÔ ÛÙËÓ ·Ú·ÁˆÁ‹Ù˘ MCP-1 Î·È ÛÙËÓ ·ıËڈ̷ÙÈ΋‰È·‰Èηۛ·.

∏ ·ÓÙ·ÈÌÔÂÙ·Ïȷ΋ ‰Ú¿ÛË ÙˆÓ

ÛÙ·ÙÈÓÒÓ Â›Ó·È ‰ÔÛÔÂÍ·ÚÙÒÌÂÓË,ÙÔ ›‰ÈÔ Î·È Ë ·ÓÙÈÊÏÂÁÌÔÓ҉˘‰Ú¿ÛË. ∫·Ù¿ Û˘Ó¤ÂÈ·, fiˆ˜ÚÔ·ÙÂÈ Î·È ·fi ÙËÓ ·ÚÔ‡Û·ÌÂϤÙË, ÔÈ ÌÈÎÚ¤˜ ‰fiÛÂȘ ÙˆÓÛÙ·ÙÈÓÒÓ Û˘Ó‰˘·˙fiÌÂÓ˜ Ì Â˙Â-ÙÈÌ›ÌË, ·Ú¿ ÙÔ fiÙÈ ¤¯Ô˘Ó ÂÍ

›ÛÔ˘ ηÏfi ˘ÔÏÈȉ·ÈÌÈÎfi ·ÔÙ¤-ÏÂÛÌ· Ì ÙȘ ÌÂÁ·Ï‡ÙÂÚ˜ ‰fi-ÛÂȘ ÙˆÓ ÛÙ·ÙÈÓÒÓ, ›Ûˆ˜ ‰ÂÓ¤¯Ô˘Ó ÙÔ ›‰ÈÔ Î·Ïfi ÎÏÈÓÈÎfi ·Ô-Ù¤ÏÂÛÌ·, ÂÂȉ‹ ‰ÂÓ ÂÍ·ÛÊ·Ï›-˙Ô˘Ó ÛÙÔÓ ›‰ÈÔ ‚·ıÌfi ÙȘ ÏÂÈfi-ÙÚÔ˜ ‰Ú¿ÛÂȘ.

∫§π¡π∫∂™ ª∂§∂Δ∂™

15

∂ÈÎfiÓ· 6. ¢È·ÊÔÚ¤˜ ÛÙËÓ ¤ÎÊÚ·ÛË Ù˘ ÌÂÙ¿ ‰È¤ÁÂÚÛË Ì ADP ƒ-ÛÂÏÂÎÙ›Ó˘ÛÙ· ·ÈÌÔÂÙ¿ÏÏÈ·. (∞) ƒ-ÛÂÏÂÎÙ›ÓË ÌÂÙ¿ ‰È¤ÁÂÚÛË Ì ADP ÚÈÓ ÙËÓ ¤Ó·ÚÍË Î·ÈÌÂÙ¿ 4 ‚‰ÔÌ¿‰Â˜ ıÂڷ›·˜ Ì ·ÙÔÚ‚·ÛÙ·Ù›ÓË ÌfiÓÔ (ÎÂÓ¤˜ ÛًϘ) Î·È ÌÂÂ˙ÂÙÈÌ›ÌË+·ÙÔÚ‚·ÛÙ·Ù›ÓË (ÁÂÌ¿Ù˜ ÛًϘ). (μ) ¢È·ÊÔÚ¤˜ ÛÙËÓ ÛÙË Ì¤ÛË ˘-ÎÓfiÙËÙ· ·ÓÔÛÔÊıÔÚÈÛÌÔ‡ (¢MFI) Ù˘ ƒ-ÛÂÏÂÎÙ›Ó˘ (›‰· ÌÂÙ¿ 4 ‚‰ÔÌ¿‰Â˜˘ÔÏÈȉ·ÈÌÈ΋˜ ·ÁˆÁ‹˜ Ì›ÔÓ Â›Â‰· ÚÈÓ ÙËÓ ¤Ó·ÚÍË Ù˘ ·ÁˆÁ‹˜) AU= ·˘-ı·›ÚÂÙ˜ ÌÔÓ¿‰Â˜.

μμÈÈ‚‚ÏÏÈÈÔÔÁÁÚÚ··ÊÊ››··

1. Giroux LM, Davignon J, Naruszewicz M.Simvastatin inhibits the oxidation of low-density lipoproteins by activated humanrnonocyte-derived macrophages. Bio-chim Biophys Acta 1993;1165 :335-8.

2. Hussein O, Schlezinger S, Rosenblat M,Keidar S, Aviram M. Reducedsusceptibility of low density lipoprolein(LDL) to lipid peroxidation after fluva-statin therapy is associated with thehypocholesterolemic effect of the drugand its binding to the LDL. Athero-sclerosis 1997;28:11 - 18.

3. Fuhrman B, Koren L, Volkova N, KeidarS, Hayek T, Aviram M. Atorvastatintherapy in hypercholeslerolemic patientssuppresses cellular uptake of oxidized-LDL by differentiating monocytes. Athe-rosclerosis 2002;164:179-85.

4. Wassmann S, Faul A, Hennen B, ShellerB, Bohm M, Nickenig G. Rapid effect of3-hydroxy-3-methylglutaryl coenzyme Areductase inhibition on coronary endo-thelial function. Circ Res 2003;93:e98-103.

5. Treasure CB, Klein JL, Weintraub WS,Talley JD, Stillabower ME, Kosinski AS,Zhang J, Boccuzzi SJ, Cedarholm JC,Alexander RW. Beneficial effects ofcholesterol-lowering ther¬apy on thecoronary endothelium in patients withcoronary artery disease. N Engl J Med1995;332:481-7.

6. Pasceri V, Cheng JS, Willerson JT, YehET. Modulation of C-reactive protein-mediated monocyte chemoattractantprotein-1 induction in endothelial cellsby anti-atherosclerotic drugs. Circulation2001;103: 2531-34.

7. Albert MA, Danielson E, Rifai N, RidkerPM, PRINCE Investigators. Effect of statintherapy on C-reactive protein levels: thepravastatin inflammation/ CRP evaluation(PRINCE): a randomized trial and cohortstudy. JAMA 2001; 86: 64-70.

8. Sanguigni V, Pignatelli P, Lenti L, ct al.Short-term treatment with atorvastatinreduces platelet CD40 ligand andthrombin generation in hypercho-lesterolemic patients. Circulation2005;111:412-9.

9. Negre-Aminou P, van Vliet AK, van ErckM, van Thiel GC, van Leeuwen RE, CohenLH. Inhibition of proliferation of humansmooth muscle cells by various HMG-CoA reductase inhibitors; comparisonwith other human cell types. BiochimBiophys Acta 1997; 1345: 259-68.

10. Bell RM, Yellon DM. Atorvastatin,administered at the onset of reperfusion,and independent of lipid lowering,protects the myocar¬dium by up-regulating a pro-survival pathway. J AmColl Cardiol 2003;41:S08-15.

11. Hinoi T, Matsuo S, Tadehara F, Tsuji-yama S, Yamakido M. Acute effect ofatorvastatin on coronary circulationmeasured by transthoracic Dopplerechocardiography in patients withoutcoronary artery disease by angiography.Am J Cardiol 2005;96:89-91.

12. Pasceri V, Patti G, Nusca A, Pristipino C,Richichi G, Di Sciascio G, ARMYDAInvestigators. Randomized trial ofatorvastatm for reduction of myocardialdamage during coronary intervention:results from the ARMYDA (Atorvastatinfor Reduction of Myocardial DamageDuring Angioplasty) study. Circulation2004;110:674-8.

13. Ioannidis JPA, Karvouni E, Katritis DG.Mortality risk conferred by smallelevations of creatine kinase-MB isoen-zyme after percutaneous intervention. JAm Coll Cardiol 2003;42:1412-14.

14. Giuseppe P, Pasceri V, Colonna G,Miglionico M, Fischetti D, Sardella G,Montinaro A, Di Sciascio G. Atorva-statine pretreatment improves outcomesin patients with acute coronary syndro-mes undergoing early percutaneouscoronary interventions. Results of theARMYDA-ACS randomized trial. JACC2007;49:1272-78.

15. Patti G, Chello M, Candura D, Pasceri V,D'Ambrosio A, Covino E, Di Sciasco G.Randomized trial of atorvastatin forreduction of postoperative atrial fibrilla-tion in patients undergoing cardiac sur-gery. Results of the ARMYDA-3(Atorvastatine for Reduction of MyocardialDysrhythmia After cardiac surgery) study.Circulation 2006;114:1455-61

16. Marin F, Pascual DA, Roldan V, ArribasJM, Ahumada M, Tornel PL, Oliver C,Gomez-Plana J, Lip GYH, Valdes M.Statins and postoperative risk of atrialfibrillation following coronary arterybypass grafting. Am J Cardiol 2006;97:55-60

17. Piorkowski M, Fischer S, Stellbaum C,Jaster M, Martus P, Morguet AJ,Schultheiss H-P, Rauch U. Treatmentwith Ezetimibe plus low-dose Atorva-statin compared with higher doseAtorvastatin alone. Is sufficient chole-sterol-lowering enough to inhibit plate-lets? J Am Coll Cardiol 2007;49:1035-42.

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ATHIROSK 14 03-07-07 12:06 ™ÂÏ›‰·15

Page 18: ΤΕΥΧΟΣ 14 ΙΟΥΝΙΟΣ 2007 - ΑΘΗΡΟΣΚΛΗΡΩΣΗ

π √ À ¡ π √ ™ 2 0 0 7

16

∂ÂÌ‚·ÙÈ΋ E·Ó·ÈÌ¿ÙˆÛË ‹ º·Ú̷΢ÙÈ΋ ∞ÁˆÁ‹ ÛÙËÓ ∞Û˘Ìو̷ÙÈ΋

™Ù·ıÂÚ‹ ™ÙÂÊ·ÓÈ·›· ¡fiÛÔ;

μ. ’∞ı˘ÚÔ˜, ∞. ∫·Î·Ê‹Î·, ∂. ¶·ÁÎÔ˘Ú¤ÏÈ·˜,Ã. ∫Ô˘Ì·Ú¿˜, ∞. ™Î·¤Ú‰·˜, ∞. ∫·Ú·ÁÈ¿ÓÓ˘.

μ’ ¶ÚÔ·È‰Â˘ÙÈ΋ ¶·ıÔÏÔÁÈ΋ ∫ÏÈÓÈ΋, ∞¶£, πÔÎÚ¿ÙÂÈÔ £ÂÛÛ·ÏÔӛ΢

À¿Ú¯ÂÈ ÌÈ· Ì·ÎÚÔ¯ÚfiÓÈ· ‰È·-ÊÔÚ¿ ·fi„ÂˆÓ fiÛÔÓ ·ÊÔÚ¿ÛÙË ‚¤ÏÙÈÛÙË ·ÓÙÈÌÂÙÒÈÛË Ù˘ÛÙ·ıÂÚ‹˜ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘(™™¡). £· Ú¤ÂÈ Ë ·ÓÙÈÌÂÙÒÈ-ÛË Ó· Â›Ó·È ÂÂÌ‚·ÙÈ΋ Î·È Ó·Û˘ÌÏËÚÒÓÂÙ·È ·fi Ê·Ú̷΢-ÙÈ΋ ·ÁˆÁ‹ ‹ Ë ‚¤ÏÙÈÛÙË Ê·Ú-̷΢ÙÈ΋ ·ÁˆÁ‹ ÌfiÓË Ù˘ ›ӷȷÚÎÂÙ‹ ÙfiÛÔ ÛÙËÓ ÚfiÏË„Ë Ó¤-ˆÓ ÛÎÏËÚÒÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓÛ˘Ì‚·Ì¿ÙˆÓ (ı¿Ó·ÙÔ˜, ¤ÌÊÚ·-ÁÌ· Ì˘Ôηډ›Ô˘) fiÛÔ Î·È ÛÙËÓ·Ó·ÎÔ‡ÊÈÛË ·fi ÙË ÛÙËı¿Á¯ËÚÔÛ¿ıÂÈ·˜ ÁÈ· fiÛÔ˘˜ ·ÛıÂ-Ó›˜ ˘ÔʤÚÔ˘Ó ·fi ·˘Ù‹?

ΔÔ 1997 ‰ËÌÔÛȇÙËÎÂ Ë ÌÂϤÙËRandomised Intervention Treat-ment of Angina (RITA-2), ËÔÔ›· ¤‰ÂÈÍ fiÙÈ Ë ‰È·‰ÂÚÌ·ÙÈ΋ÛÙÂÊ·ÓÈ·›· ¤̂·ÛË (PCI)ÚÔηÏ› ·Ó·ÎÔ‡ÊÈÛË ·fi ÙËÛÙËı¿Á¯Ë Û ·ÛıÂÓ›˜ Ì ™™¡·ÏÏ¿ ‰ÂÓ ÂÏ·ÙÙÒÓÂÈ Ù· ÛÎÏËڿηډȷÁÁÂȷο Û˘Ì‚¿Ì·Ù·[1]. ªÈ·ÈÔ ÏÂÙÔÌÂÚ‹˜ ·Ó¿ÁÓˆÛË Ù˘RITA-2 ‰Â›¯ÓÂÈ fiÙÈ ·ÚfiÏÔ fiÙÈÙ· ÔÛÔÛÙ¿ ·ÛıÂÓÒÓ Ì ÛÙË-ı¿Á¯Ë ‹Ù·Ó Ôχ ¯·ÌËÏfiÙÂÚ·ÛÙËÓ ÔÌ¿‰· PCI ·' fiÙÈ ÛÙËÓÔÌ¿‰· Ù˘ Ê·Ú̷΢ÙÈ΋˜ ·Áˆ-Á‹˜ (15% ¤Ó·ÓÙÈ 21,4%, p=0.01),Ù· fiÚÈ· ·˘Ù¿ ÛÙ¤Ó¢·Ó Ì ÙË¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘. ∞˘Ùfi ÌÔ-Ú› Ó· ÛËÌ·›ÓÂÈ fiÙÈ Ë ‚ÂÏÙÈÛÙÔ-Ô›ËÛË Ù˘ Ê·Ú̷΢ÙÈ΋˜ ·Áˆ-Á‹˜, Ô˘ ‰È·ÈÛÙÒıËΠÛÙËÓ·Ú·ÙÂٷ̤ÓË ·Ú·ÎÔÏÔ‡ıËÛËÙˆÓ ·ÛıÂÓÒÓ Ù˘ RITA-2 (7 ¯Úfi-ÓÈ·), ı· ÌÔÚÔ‡Û ›Ûˆ˜ Ó· ¤¯ÂÈ·ÚfiÌÔÈ· ·ÔÙÂϤÛÌ·Ù· ·fiÙËÓ ¿Ô„Ë Ù˘ ·Ó·ÎÔ‡ÊÈÛ˘fiÓÔ˘ Û ÙËÓ PCI[2].

¶ÚfiÛÊ·Ù· ·Ó·ÎÔÈÓÒıËÎ·Ó Ù··ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ Cli-nical Outcomes Utilizing Revas-cularization and AggressiveDrug Evaluation (COURAGE).[3]

∞˘Ù¿, Û˘Ó˘ÔÏÔÁÈ˙fiÌÂÓ· Ì ÚÔ-¸¿Ú¯ÔÓÙ· ÛÙÔȯ›· ÁÈ· ÙË

ÂÂÌ‚·ÙÈ΋ Ë Ê·Ú̷΢ÙÈ΋ ıÂ-ڷ›· Ù˘ ™™¡, ÌÔÚÔ‡Ó Ó·ÛËÌ·ÙÔ‰ÔÙ‹ÛÔ˘Ó ÙÔ Ù¤ÏÔ˜ ÌÈ·˜ÂÔ¯‹˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛËÙ˘ ™™¡. ∏ COURAGE ¤‰ÂÈÍÂfiÙÈ Ë PCI Ì ÙË ¯ÚËÛÈÌÔÔ›ËÛËstent Î·È ‚¤ÏÙÈÛÙË Ê·Ú̷΢ÙÈ-΋ ·ÁˆÁ‹ ‰ÂÓ Â›Ó·È ÂÚÈÛÛfiÙÂ-ÚÔ ·ÔÙÂÏÂÛÌ·ÙÈΤ˜ ÛÙËÓ Úfi-ÏË„Ë ÌÂÏÏÔÓÙÈÎÒÓ Î·Ú‰È·ÁÁÂÈ·-ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ ·fi ÙË ‚¤ÏÙÈ-ÛÙË Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ ÌfiÓËÙ˘ Û ·ÛıÂÓ›˜ Ì ™™¡.[3] √ÈÂÚ¢ÓËÙ¤˜ Ù˘ ÌÂϤÙ˘ COU-RAGE Ù˘¯·ÈÔÔ›ËÛ·Ó 2.287 ·Û-ıÂÓ›˜ (ÌÂٷ͇ 1999 Î·È 2004)›Ù Û ıÂڷ›· Ì PCI Û˘Ó‚¤ÏÙÈÛÙË Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹Â›Ù ÛÙË ‚¤ÏÙÈÛÙË Ê·Ú̷΢ÙÈ-΋ ·ÁˆÁ‹ ÌfiÓÔ. ∫·Ù¿ ÙË ‰È¿Ú-ÎÂÈ· ·Ú·ÎÔÏÔ‡ıËÛ˘ (̤ÛÔ˜¯ÚfiÓÔ˜ 4,6 ¯ÚfiÓÈ·) ηÙÂÁÚ¿ÊË-Û·Ó Û˘ÓÔÏÈο 211 ı¿Ó·ÙÔÈ ‹ ÌËı·Ó·ÙËÊfiÚ· ÂÌÊÚ¿ÁÌ·Ù· ÙÔ˘Ì˘Ôηډ›Ô˘, ·ÚÈıÌfi˜ ·ÚfiÌÔÈ-Ô˜ Ì ·˘ÙfiÓ (202) Ù˘ ÔÌ¿‰·˜Ì ‚¤ÏÙÈÛÙË Ê·Ú̷΢ÙÈ΋ ·Áˆ-Á‹ ÌfiÓÔ.[3] ŸÙ·Ó ÚÔÛÙ¤ıËηÓÙ· ·ÁÁÂȷο ÂÁÎÂÊ·ÏÈο ÂÂÈ-Ûfi‰È· Ë ‰È·ÊÔÚ¿ ÂÍ·ÎÔÏÔ˘ıÔ‡-Û ӷ ÌËÓ Â›Ó·È ÛÙ·ÙÈÛÙÈο ÛË-Ì·ÓÙÈ΋. ∏ ÌfiÓË ÛËÌ·ÓÙÈ΋ ‰È·-ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓıÂڷ›·˜ ‹Ù·Ó Ë ÌÂȈ̤ÓË Â›-ÙˆÛË Ù˘ ÛÙËı¿Á¯Ë˜ ÛÙËÓÔÌ¿‰· PCI ÛÙ· 1 Î·È 3 ¤ÙË.∂ÓÙÔ‡ÙÔȘ, ÛÙ· 5 ¤ÙË ‰ÂÓ ˘‹Ú-Í η̛· ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ÛÙÔ ÔÛÔÛÙfi ·˘ÙÒÓ Ô˘ ‹Ù·ÓÂχıÂÚÔÈ ·fi ÛÙËı¿Á¯Ë (73%ÙˆÓ ·ÛıÂÓÒÓ Î¿ı ÔÌ¿‰·˜). ∞˘-Ù¿ Ù· ·ÔÙÂϤÛÌ·Ù· ¤¯Ô˘Ó ÂÈ-ÙÒÛÂȘ Û ¤Ó·Ó ÛËÌ·ÓÙÈÎfi·ÚÈıÌfi ·ÛıÂÓÒÓ Ì ™™¡ Ô˘˘Ô‚¿ÏÏÔÓÙ·È Û PCI. ÀÔÏÔÁ›-˙ÂÙ·È fiÙÈ 30% ¤ˆ˜ 40% ÙˆÓ·ÛıÂÓÒÓ Ì ™™¡ ·ÓÙÈÌÂÙˆ›˙Ô-ÓÙ·È Ì PCI. ∂¿Ó Ù· ·ÔÙÂϤ-ÛÌ·Ù· Ù˘ ÌÂϤÙ˘ COURAGEÂÊ·ÚÌÔÛÙÔ‡Ó ÛÙËÓ ÎÏÈÓÈ΋ Ú¿-ÍË, ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ·fi ·˘ÙÔ‡˜ÙÔ˘˜ ·ÛıÂÓ›˜ ÌÔÚÔ‡Ó ÙÒÚ·

Ó· ıÂڷ¢ıÔ‡Ó Ì ٷ Ê¿ÚÌ·-η ÌfiÓÔ. ∞˘Ùfi ÛËÌ·›ÓÂÈ Ô˘ÛÈ·-ÛÙÈ΋ ÂÍÔÈÎÔÓfiÌËÛË fiÚˆÓ ÁÈ·ÙËÓ ˘ÁÂÈÔÓÔÌÈ΋ ÂÚ›ı·Ï„Ë.[4]

Δ· ÛÙÔȯ›· ¿Óˆ ÛÙÔ ˙‹ÙËÌ··˘Ùfi ‹Ù·Ó ‰È·ı¤ÛÈÌ· ·fi ÙÔ1999. ∏ ÌÂϤÙË Atorvastatin Ver-sus Revascularization Treat-ment (AVERT) ¤‰ÂÈÍ fiÙÈ ÛÙÔ˘˜¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ·ÛıÂÓ›˜ Ì™™¡ Ë ÂÈıÂÙÈ΋ ˘ÔÏÈȉ·ÈÌÈ΋ʷÚ̷΢ÙÈ΋ ·ÁˆÁ‹ ‹Ù·Ó ÙÔ˘-Ï¿¯ÈÛÙÔÓ ÙfiÛÔ ·ÔÙÂÏÂÛÌ·ÙÈ΋fiÛÔ Ë PCI (Û˘Ó Û˘Ó‹ıË È·ÙÚÈ΋ÊÚÔÓÙ›‰·) ÛÙË Ì›ˆÛË Ù˘ ›-ÙˆÛ˘ ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓÛ˘Ì‚·Ì¿ÙˆÓ.[5] ªÂÙ¿ ·fi ÙȘÌÂϤÙ˜ AVERT Î·È RITA-2 Ë ıÂ-ڷ›· Ù˘ ™™¡ ı· Ú¤ÂÈ Ó·Â›Ó·È Ôχ ÂÚÈÛÛfiÙÂÚÔ ‘ÌÂÙ·-‚ÔÏÈ΋’ Î·È Ôχ ÏÈÁfiÙÂÚÔ ‘Ì˯·-ÓÈ΋’.[6] ªÔÏÔÓfiÙÈ ÛÙËÓ AVERT ˉȷÊÔÚ¿ ÛÙËÓ ¤Î‚·ÛË ÌÂÙ·Í‡ÙˆÓ 2 ÔÌ¿‰ˆÓ ıÂڷ›·˜ ‰ÂÓÔÊÂÈÏfiÙ·Ó ÚÒÙÈÛÙ· Û ·ӷ-ÛÙ¤ÓˆÛË (ÙÔ ÎÏÈÓÈο ·ÓȯÓÂ˘Ì¤-ÓÔ ÔÛÔÛÙfi ·ӷÛÙ¤ÓˆÛ˘ÛÙËÓ ÔÌ¿‰· PCI ‹Ù·Ó ÌfiÓÔ10,2%) Ë ÚÔÛ¤ÁÁÈÛË Ù˘ Ê·Ú-̷΢ÙÈ΋˜ ·ÁˆÁ‹˜ ‰ÂÓ ˘ÈÔıÂ-Ù‹ıËΠ·fi ÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ

ATHIROSK 14 03-07-07 12:06 ™ÂÏ›‰·16

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£∂ƒ∞¶∂π∞ - º∞ƒª∞∫∞

17

ηډÈÔÏfiÁˆÓ ÂÂȉ‹ ˘‹ÚÍ ÂÏ-›‰· ÁÈ· ·ÎfiÌ· ηχÙÂÚ· ·ÔÙÂ-ϤÛÌ·Ù· Ì PCI fiÙ·Ó ¤ÁÈÓ·Ó ‰È·-ı¤ÛÈÌ· Ù· drug eluding stents(DES) Ô˘ ˘Ôη٤ÛÙËÛ·Ó Ù·bare metal stents (BMS).

∂ÓÙÔ‡ÙÔȘ, Ë ¯Ú‹ÛË DES ÂÓ·-ÓÙ›ÔÓ BMS ·ÔÙÂÏ› ·ÓÙÈΛÌÂÓÔ¤ÓÙÔÓ˘ ‰È·Ì¿¯Ë˜, ‰Â‰Ô̤ÓÔ˘fiÙÈ Ù· DES Û˘Ó‰¤ÔÓÙ·È Ï¤ÔÓÌ fi„ÈÌË ıÚfiÌ‚ˆÛË.[7] ∂ÈÛ‹¯ıˤÙÛÈ ÌÈ· Ó¤· ¤ÓÓÔÈ· ÛÙËÓ ÂÂÌ-‚·ÙÈ΋ ηډÈÔÏÔÁ›· ÌÈ· Û¯¤ÛËJ-curve ÌÂٷ͇ Ù˘ ÚfiÛÊ·Ù˘-·ÒÙÂÚ˘ ıÚfiÌ‚ˆÛ˘ Î·È ÎÏÈÓÈ-ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ.[8-10] ∂ÈϤÔÓ,Ù· DES Â›Ó·È ·ÎÚÈ‚fiÙÂÚ· ·fiBMS Î·È ··ÈÙÔ‡Ó Ì·ÎÚÔ¯ÚfiÓÈ·ıÂڷ›· (›Ûˆ˜ ÌÂÚÈÎÒÓ ÂÙÒÓ) ÌÂÎÏÔȉÔÁÚ¤ÏË Ô˘ ›Û˘ ¤¯ÂÈ˘„ËÏfi ÎfiÛÙÔ˜ ıÂڷ›·˜.[8-10]

™Â ÌÈ· ÔÈÎÔÓÔÌÈ΋ ·Ó¿Ï˘ÛË Ù˘COURAGE,[11] Ê¿ÓËΠfiÙÈ ÙÔ Îfi-ÛÙÔ˜ ‹Ù·Ó Ôχ ¯·ÌËÏfiÙÂÚÔÛÙËÓ ÔÌ¿‰· Ê·Ú̷΢ÙÈ΋˜ ıÂ-ڷ›·˜ (¶›Ó·Î·˜).

∂ÈϤÔÓ, ÙÔ ÎfiÛÙÔ˜ ·Ó¿ ÔÈÔ-ÙÈÎfi ¤ÙÔ˜ Ûˆ˙fiÌÂÓ˘ ˙ˆ‹˜ ‹Ù·Ó$217.000 Ì ÙËÓ PCI.[11] ∂Ô̤-Óˆ˜, Ë ·Ó¿Ï˘ÛË ÎfiÛÙÔ˘˜ ·Ô-ÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ¤‰ÂÈÍ fiÙÈ ÙÔ99% ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ˘Ô‚¿Ï-ÏÔÓÙ·È Û PCI ÍÂÂÚÓÔ‡Ó ÙÔfiÚÈÔ ÙˆÓ $50.000 Ô˘ ıˆÚ›-Ù·È ·Ô‰ÂÎÙfi.[11] Œ¯Ô˘Ì ‰ËÌÔ-ÛȇÛÂÈ ÛÙÔȯ›· ÛÙÔ ·ÚÂÏıfiÓÔ˘ ‰Â›¯ÓÔ˘Ó fiÙÈ ÙÔ ÎfiÛÙÔ˜ ·Ó¿ÔÈÔÙÈÎfi ¤ÙÔ˜ Ûˆ˙fiÌÂÓ˘ ˙ˆ‹˜Û ·ÛıÂÓ›˜ Ì ™™¡ ‹Ù·Ó$8.350 Ì ‚¤ÏÙÈÛÙË Ê·Ú̷΢-ÙÈ΋ ·ÁˆÁ‹.[12] √È ‰È·ÊÔÚ¤˜ ›ӷÈÙÂÚ¿ÛÙȘ.

∂¿Ó Ô ÛÙfi¯Ô˜ Â›Ó·È Ó· ·Ó·ÎÔ˘-ÊÈÛÙÔ‡Ó Ù· Û˘ÌÙÒÌ·Ù· ÛÙÔ˘˜·ÛıÂÓ›˜ Ì ™™¡ (›ÌÔÓË ÛÙË-ı¿Á¯Ë), ·Ú¿ Ó· ·ÔÙÚ·Ô‡ÓÙ· ÌÂÏÏÔÓÙÈο ηډȷÁÁÂÈ·Î¿Û˘Ì‚¿Ì·Ù·, Ë PCI Ê·›ÓÂÙ·È Ó··ÔÙÂÏ› ÌÈ· ·Ô‰ÂÎÙ‹ ıÂÚ·-¢ÙÈ΋ ̤ıÔ‰Ô.

¶Èı·ÓÒ˜ ‹ÚıÂ Ô Î·ÈÚfi˜ Ó· ·ÓÙÈ-ÌÂÙˆ›ÛÔ˘Ì Ì ʷÚ̷΢ÙÈ΋·ÁˆÁ‹ ÙË Û˘ÓÙÚÈÙÈ΋ ÏÂÈÔ„Ë-

Ê›· ÙˆÓ ·ÛıÂÓÒÓ Ì ·Û˘ÙˆÌ·-ÙÈ΋ ™™¡. ∞˘Ùfi ı· ÂÍÔÈÎÔÓÔÌ‹-ÛÂÈ ÛËÌ·ÓÙÈÎÔ‡˜ fiÚÔ˘˜ (·Ó-ıÚÒÈÓÔ˘˜ Î·È ¯ÚËÌ·ÙÈÎÔ‡˜) ÁÈ·Ó· ÂÂÓ‰˘ıÔ‡Ó ÛÙ· Ì·ÎÚÔÚfi-ıÂÛÌ· ÔʤÏË ·fi ÙËÓ È·ÙÚÈ΋ÂÚ›ı·Ï„Ë Ì ʷÚ̷΢ÙÈ΋·ÁˆÁ‹, fiˆ˜ Ë ÂÊ·ÚÌÔÁ‹ ÙˆÓηÙ¢ı˘ÓÙ‹ÚÈˆÓ Ô‰ËÁÈÒÓ ÛÙËÎÏÈÓÈ΋ Ú¿ÍË Î·È Ë ·Ó¿Ù˘ÍËÓ¤ˆÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚˆÓ Ê·Ú-Ì¿ÎˆÓ ÁÈ· ÙË ‰Â˘ÙÂÚÔÁÂÓ‹ Úfi-ÏË„Ë Û ·ÛıÂÓ›˜ Ì ™™¡.

μμÈÈ‚‚ÏÏÈÈÔÔÁÁÚÚ··ÊÊ››··

1. No authors listed. Coronary angioplastyversus medical therapy for angina: thesecond Randomised Intervention Treat-ment of Angina (RITA-2) trial. RITA-2 trialparticipants. Lancet 1997; 350: 461-8.

2. Henderson RA, Pocock SJ, Clayton TC,Knight R, Fox KA, Julian DG, et al.Second Randomized InterventionTreatment of Angina (RITA-2) TrialParticipants. Seven-year outcome in theRITA-2 trial: coronary angioplasty versusmedical therapy. J Am Coll Cardiol2003; 42: 1161-70.

3. Boden WE, O'rourke RA, Teo KK, et al.Optimal Medical Therapy with or withoutPCI for Stable Coronary Disease. N EnglJ Med. 2007 Mar 26; [Epub ahead ofprint]

4. Hochman JS, Steg PG. Does preventivePCI work? N Engl J Med. 2007 Mar 26;[Epub ahead of print]

5. Pitt B, Waters D, Brown WV, et al. for theAtorvastatin Versus RevascularizationTreatment Investigators. N Engl J Med1999;341:70-6

6. Waters D. Is a mechanical or ametabolic approach superior in thetreatment of coronary disease? Resultsof the Atorvastatin Versus Revasculari-zation (AVERT) Trial. Eur Heart J 2000;21:1029-31

7. Camenzind E, Steg PG, Wijns W. Stentthrombosis late after implantation offirst-generation drug-eluting stents. Acause for concern. Circulation2007;115:1440-55

8. Kastrati A, Mehilli J, Pache J, et al.Analysis of 14 trials comparingsirolimus-eluting stents with bare-metalstents. N Engl J Med 2007;356:1030-9

9. Spaulding C, Daemen J, Boersma E, etal. A pooled analysis of data comparing

sirolimus-eluting stents with bare-metalstents. N Engl J Med 2007;356:989-97

10. Mauri L, Hsieh W, Massaro JM, et al.Stent thrombosis in randomized clinicaltrials of drug-eluting stents. N Engl JMed 2007; 356:1020-9

11. Weintraub WS. Quality-of-life andeconomic outcomes analyses of theCOURAGE trial. ACC ScientificSessions, New Orle-ans, 2007.

12. Athyros VG, Papageorgiou AA,Mercouris BR, et al. Treatment withatorvastatin to the National CholesterolEducational Program goals versus usualcare in secondary Coronary HeartDisease prevention. The GREek Atorva-statin and Coronary-heart-disease Eval-uation (GREACE) Study. Curr Med ResOpin 2002;18:220-8

¶π¡∞∫∞™

ÃÚfiÓÔ˜ PCI ($) º·Ú̷΢ÙÈ΋ p·ÁˆÁ‹ ($)

ŒÓ·ÚÍË 7.771 1,751 <0.00011 ¤ÙÔ˜ 10.051 4,153 <0.00013 ¤ÙË 19.605 6,661 <0.0001

ATHIROSK 14 03-07-07 12:06 ™ÂÏ›‰·17

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π √ À ¡ π √ ™ 2 0 0 7

18

ΔÔ ÛÙ·Ù›Ó˜ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·ÈÂÎÙÂÓÒ˜ ÛÙË ÛÙ·ıÂÚ‹ ÛÙÂÊ·ÓÈ-·›· ÓfiÛÔ (™™¡) Î·È ˘¿Ú¯ÂÈ ‹‰Ë·˘Í·ÓfiÌÂÓË ¯Ú‹ÛË ˘„ËÏÒÓ ‰fi-ÛÂˆÓ ÛÙ·ÙÈÓÒÓ (΢ڛˆ˜ ·ÙÔÚ-‚·ÛÙ·Ù›Ó˘) ÛÙ· Ôͤ· ÛÙÂÊ·ÓÈ-·›· Û‡Ó‰ÚÔÌ· (√™™), Ë ÔÔ›·‚·Û›˙ÂÙ·È ÛÙ· ·ÔÙÂϤÛÌ·Ù·Ù˘ ÌÂϤÙ˘ PROVE IT-TIMI 22(Pravastatin or Atorvastatin Eva-luation and Infection Therapy-Thrombolysis in Myocardial In-farction 22).[1] À¿Ú¯Ô˘Ó ›Û˘ÛÙÔȯ›· Ô˘ ‰Â›¯ÓÔ˘Ó fiÙÈ Ë ¯Ô-Ú‹ÁËÛË ÌÈ·˜ ÛÙ·Ù›Ó˘ ÌÂÙ¿·fi ·ÁÁÂÈÔÏ·ÛÙÈ΋ ÛÙÂÊ·ÓÈ·›-ˆÓ (PCI)[2] ‹ ÌÂÙ¿ ·fi ·ÔÚÙÔ-ÛÙÂÊ·ÓÈ·›· ·Ú¿Î·Ì„Ë (CABG)[3]

ÂÏ·ÙÙÒÓÂÈ ÛËÌ·ÓÙÈο Ù· ηÚ-‰È·ÁÁÂȷο Û˘Ì‚¿Ì·Ù· Î·È ÙËıÓËÙfiÙËÙ·.

¶ÚfiÛÊ·Ù· Ù· ·ÔÙÂϤÛÌ·Ù·Ù˘ ÌÂϤÙ˘ COURAGE (Clini-cal Outcomes Utilizing Revas-cularization and AggressiveDrug Evaluation),[4] ¤‰ÂÈÍ·Ó fiÙÈÛ ·ÛıÂÓ›˜ Ì ™™¡ Ë PCI Ì·˙›Ì ‚¤ÏÙÈÛÙË Ê·Ú̷΢ÙÈ΋ ·Áˆ-Á‹ ‰ÂÓ Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·Ô-ÙÂÏÂÛÌ·ÙÈ΋ ÛÙË ÚfiÏË„Ë Î·Ú-‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ ·fiÙË ‚¤ÏÙÈÛÙË Ê·Ú̷΢ÙÈ΋ ·Áˆ-Á‹ ÌfiÓË Ù˘.[4] ∂ÓÙÔ‡ÙÔȘ, ·Îfi-Ì· ÎÈ ·Ó Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘

COURAGE ÂÊ·ÚÌÔÛÙÔ‡Ó ÂÍ ÔÏÔ-ÎÏ‹ÚÔ˘ ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË,¤Ó·˜ ÛËÌ·ÓÙÈÎfi˜ ·ÚÈıÌfi˜ ·Û-ıÂÓÒÓ Ì √™™ ‹ Ì ›ÌÔÓËÛÙËı¿Á¯Ë ÛÙË ™™¡ ı· Ú¤ÂÈÓ· ˘Ô‚ÏËı› Û PCI ‹ CABG.[4]

À¿Ú¯Ô˘Ó οÔÈ· ÛÙÔȯ›· ÁÈ·ÙÔ fiÊÂÏÔ˜ Ù˘ ıÂڷ›·˜ ÌÂÛÙ·Ù›ÓË ÚÈÓ ·fi PCI ‹ CABG,[5,6]

·ÏÏ¿ ÚfiÛÊ·Ù· Ë ÌÂϤÙË AR-MYDA ACS (Atorvastatin for Re-duction of Myocardial Damageduring Angioplasty in patientswith Acute Coronary Syndro-mes)[7] ÚfiÛıÂÛ ÂÚÈÛÛfiÙÂÚ·ÛÙÔȯ›· fiÛÔÓ ·ÊÔÚ¿ ÙÔ ˙‹ÙË-Ì· ·˘Ùfi.

1. £Âڷ›· Ì ÛÙ·Ù›ÓË ÚÈÓ·fi CABG.

∏ Multicenter Study of Periope-rative Ischemia Epidemiology II[8] ‹Ù·Ó ÌÈ· ÚÔÔÙÈ΋ ÌÂϤÙËÛ 5.436 ·ÛıÂÓ›˜ Ô˘ ÂÚfi-ÎÂÈÙÔ Ó· ˘Ô‚ÏËıÔ‡Ó Û CABGÛ 70 ΤÓÙÚ· Û 17 ¯ÒÚ˜.À¿Ú¯Ô˘Ó ÛÙÔȯ›· ÁÈ· ·ÛıÂ-Ó›˜ Ô˘ ÂÏ¿Ì‚·Ó·Ó (n=1.352)Î·È ÁÈ· ·˘ÙÔ‡˜ Ô˘ ‰ÂÓ ÂÏ¿Ì-‚·Ó·Ó (n=1.314) ÚÔÂÁ¯ÂÈÚËÙÈ-΋ ıÂڷ›· Ì ÛÙ·Ù›ÓË. ∏ Ô-Ï˘·Ú·ÁÔÓÙÈ΋ ·Ó¿Ï˘ÛË ¤‰ÂÈÍÂfiÙÈ Ë ÚÔÂÁ¯ÂÈÚËÙÈ΋ ıÂڷ›·Ì ÛÙ·Ù›ÓË Û˘Ó‰¤ıËΠ·ÓÂÍ¿Ú-ÙËÙ· Ì ÌÈ· ÛËÌ·ÓÙÈ΋ Ì›ˆÛËηٿ 75% ÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ı·Ó¿ÙÔ˘ ÌÂÙ¿ ·fi CABG (0,3%¤Ó·ÓÙÈ 1,4% p<0.03). ∞ÓÙ›ıÂÙ·Ë ‰È·ÎÔ‹ Ù˘ ıÂڷ›·˜ Ì ÛÙ·-Ù›ÓË ÌÂÙ¿ ·fi ÙË CABG Û˘Ó‰¤-ıËΠ·ÓÂÍ¿ÚÙËÙ· Ì ÌÈ· ÛËÌ·-ÓÙÈ΋ ·‡ÍËÛË ÛÙËÓ fi„ÈÌË ÔÏÈ΋ıÓËÙfiÙËÙ· ηٿ 2,6 ÊÔÚ¤˜ ηÈÛÙËÓ fi„ÈÌË Î·Ú‰È·Î‹ ıÓËÙfiÙË-Ù· ηٿ 2,9 ÊÔÚ¤˜ (2,64% ¤Ó·-ÓÙÈ 0,60% 1,91% ¤Ó·ÓÙÈ 0,45%,·ÓÙ›ÛÙÔȯ·, p<0.01 Î·È ÁÈ· ÙȘ‰‡Ô). ™Â ÌÈ· ·Ó·‰ÚÔÌÈ΋ ÌÂϤ-ÙË Ë ÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ Ô˘˘Ô‚Ï‹ıËΠ۠CABG (n=1.663)¯ˆÚ›ÛÙËΠ۠2 ÔÌ¿‰Â˜: ·ÛıÂ-

Ó›˜ Ô˘ ÂÏ¿Ì‚·Ó·Ó ÚÔÂÁ¯ÂÈ-ÚËÙÈ΋ ıÂڷ›· Ì ÛÙ·Ù›ÓË(n=943) Î·È ÂΛÓÔ˘˜ Ô˘ ‰ÂÓÂÏ¿Ì‚·Ó·Ó (n=720).[9] ∏ ÔÏ˘-·Ú·ÁÔÓÙÈ΋ ·Ó¿Ï˘ÛË ¤‰ÂÈÍÂfiÙÈ Ë ÚÔÂÁ¯ÂÈÚÈÙÈ΋ ıÂڷ›·Ì ÛÙ·Ù›ÓË Û˘Ó‰¤ıËΠ·ÓÂÍ¿Ú-ÙËÙ· Ì ÌÈ· ÛËÌ·ÓÙÈ΋ Ì›ˆÛËÙ˘ ÔÏÈ΋˜ ıÓËÙfiÙËÙ·˜ Î·È ÙÔ˘Û‡ÓıÂÙÔ˘ ÙÂÏÈÎÔ‡ ÛËÌ›Ԣ (ıÓË-ÙfiÙËÙ·˜ Û˘Ó ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ô-ηډ›Ô˘) ÛÙȘ 30 Ë̤Ú˜ (3,75%¤Ó·ÓÙÈ 1,80% Î·È 7,1% ¤Ó·ÓÙÈ4,6%, ·ÓÙ›ÛÙÔȯ·, p<0.05 ηÈÁÈ· ÙȘ ‰‡Ô).[9] ∂›Û˘, Ë ÚÔÂÁ-¯ÂÈÚËÙÈ΋ ıÂڷ›· Ì ÛÙ·Ù›ÓËÛ ·ÛıÂÓ›˜ Ô˘ ˘Ô‚Ï‹ıËηÓÛ CABG Û˘Û¯ÂÙ›ÛÙËΠ̠¯·-ÌËÏfi ÔÛÔÛÙfi ıÓËÙfiÙËÙ·˜ ÙÔÓÚÒÙÔ ¯ÚfiÓÔ ÌÂÙ¿ ÙËÓ ÂÁ¯Â›ÚË-ÛË ¤Ó·ÓÙÈ ÙˆÓ ÌË ıÂڷ¢fiÌÂ-ÓˆÓ ÚÔÂÁ¯ÂÈÚËÙÈο Ì ÛÙ·Ù›ÓË·ÛıÂÓÒÓ[10] Δ¤ÏÔ˜, Ù· ›‰È· ·Ô-ÙÂϤÛÌ·Ù· ¤‰ÂÈÍ ÌÈ· ¿ÏÏË·Ó·‰ÚÔÌÈ΋ ÌÂϤÙË Ì ·ÛıÂ-Ó›˜ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È Û ÚÔ-ÂÁ¯ÂÈÚËÙÈ΋ ıÂڷ›· Ì ÛÙ·Ù›-ÓË, Ë ÔÔ›· Û˘Ó‰¤ıËΠ̠ÏÈÁfi-ÙÂÚ˜ ÂÚÈÂÁ¯ÂÈÚËÙÈΤ˜ ηډȷ-Τ˜ Î·È ÛËÌ·ÓÙÈΤ˜ ·ÁÁÂȷΤ˜ÂÈÏÔΤ˜ (-64%, p=0.035) ÌÂ-Ù¿ ÙË CABG, Ì ÌÈÎÚfiÙÂÚÔ ¯Úfi-ÓÔ ·Ú·ÌÔÓ‹˜ ÛÙÔ ÓÔÛÔÎÔÌ›Ô(p=0.003) Î·È Ì ‚ÂÏÙȈ̤ÓËÌ·ÎÚÔ¯ÚfiÓÈ· (5,5 ¤ÙË) ÂÈ‚›ˆÛË(p<0.004) Û ۇÁÎÚÈÛË Ì ÂΛ-ÓÔ˘˜ Ô˘ ‰ÂÓ ‹Ú·Ó ÚÔÂÁ¯ÂÈ-ÚËÙÈο ÛÙ·Ù›ÓË[11].

∞˘Ù¿ Ù· ÛÙÔȯ›· ‰ÂÓ ·Ê‹ÓÔ˘Óη̛· ·ÌÊÈ‚ÔÏ›· fiÙÈ ˘¿Ú¯ÂÈ Ô˘-ÛÈ·ÛÙÈÎfi fiÊÂÏÔ˜ ÛÙË ¯ÔÚ‹ÁËÛËÛÙ·Ù›Ó˘ ÚÔÂÁ¯ÂÈÚËÙÈο Û ·Û-ıÂÓ›˜ Ô˘ ı· ˘Ô‚ÏËıÔ‡Ó ÛÂCABG fiÛÔÓ ·ÊÔÚ¿ ÙË Ì›ˆÛËÙ˘ ‚Ú·¯Â›·˜, ÌÂÛÔÚfiıÂÛÌË˜Î·È Ì·ÎÚÔÚfiıÂÛÌ˘ ηډȷÁ-ÁÂȷ΋˜ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓË-ÙfiÙËÙ·˜ Î·È ÛÙËÓ Ô˘ÛÈ·ÛÙÈ΋ÂÍÔÈÎÔÓfiÌËÛË fiÚˆÓ ÁÈ· ÙËÓ˘ÁÂÈÔÓÔÌÈ΋ ÂÚ›ı·Ï„Ë.

∏ ∫ÏÈÓÈ΋ ™ËÌ·Û›· Ù˘ ÃÔÚ‹ÁËÛ˘ ™Ù·ÙÈÓÒÓ¶ÚÈÓ ·fi ∂ÂÌ‚·ÙÈ΋ ∂·Ó·ÈÌ¿ÙˆÛË ÙÔ˘

ª˘Ôηډ›Ô˘.

μ. ’∞ı˘ÚÔ˜, ∞. ∫·Î·Ê‹Î·, ∂. ¶·ÓÎÔ˘Ú¤ÏÈ·˜, ™. ™·‚‚·ÙÈ·Ófi˜, ∞. ¶ÈÚ·ÛÔÔ‡ÏÔ˘, Ã. ∫Ô˘Ì·Ú¿˜, ∞. ™Î·¤Ú‰·˜, ∫. Δ˙ÈfiÌ·ÏÔ˜, ∞. ∫·Ú·ÁÈ¿ÓÓ˘.

μ’ ¶ÚÔ. ¶·ıÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ∞¶£, πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌ›Ô, £ÂÛÛ·ÏÔÓ›ÎË.

ATHIROSK 14 03-07-07 12:06 ™ÂÏ›‰·18

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£∂ƒ∞¶∂π∞ - º∞ƒª∞∫∞

19

2. £Âڷ›· Ì ÛÙ·Ù›Ó˜ÚÈÓ ·fi PCI.

ªÈ· ÌÂÁ¿ÏË ÌÂϤÙË ÂÓfi˜ ÙÚÈÙÔ-‚¿ıÌÈÔ˘ ȉڇ̷ÙÔ˜ ‰ÈÂÚ‡ÓËÛÂηٿ fiÛÔÓ Ë ˘ÂÚÏÈȉ·ÈÌ›·, ˯ڋÛË ÛÙ·Ù›Ó˘ Û ·ÛıÂÓ›˜ Ì¢ÂÚÏÈȉ·ÈÌ›· ‹ Ë ÓÔÚÌÔÏÈÈ-‰·ÈÌ›· Û˘Ó‰¤ÔÓÙ·È Ì ÙËÓ ¤Î‚·-ÛË ·ÛıÂÓÒÓ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·ÈÛ PCI.[12] ∏ ÂÓ‰ÔÓÔÛÔÎÔÌÂÈ·-Τ˜ ÂÈÏÔΤ˜ Î·È Ë Ì·ÎÚÔÚfi-ıÂÛÌË ¤Î‚·ÛË ÙˆÓ ·ÛıÂÓÒÓ Ì¢ÂÚÏÈȉ·ÈÌ›· (Â›Â‰Ô ÔÏÈ΋˜¯ÔÏËÛÙÂÚfiÏ˘ > 240 mg/dl)ıÂڷ¢fiÌÂÓË Ì ÛÙ·Ù›Ó˜(n=2.052) Î·È Ì ˘ÂÚÏÈȉ·È-Ì›· ÌË ıÂڷ¢fiÌÂÓË Ì ÛÙ·Ù›-Ó˜ (n=1.650) Û˘ÁÎÚ›ıËÎ·Ó Ì·˘Ù¤˜ 726 ·ÛıÂÓÒÓ ÌÂ Ê˘ÛÈÔ-ÏÔÁÈο ›‰· ¯ÔÏËÛÙÂÚfiÏ˘.Δ· ·ÔÙÂϤÛÌ·Ù· ¤‰ÂÈÍ·Ó fiÙÈ Ë˘ÂÚÏÈȉ·ÈÌ›· ·˘Ù‹ ηı' ·˘-Ù‹ ‰ÂÓ Û˘Ó‰¤ÂÙ·È Ì ÙȘ ÂÓ‰Ô-ÓÔÛÔÎÔÌÂȷΤ˜ ÂÈÏÔΤ˜ ÌÂÙ¿·fi PCI. ΔÔ fiÊÂÏÔ˜ ÂÚÈÔÚ›-ÛÙËΠÌfiÓÔ ÛÙÔ˘˜ ıÂڷ¢fiÌÂ-ÓÔ˘˜ Ì ÛÙ·Ù›Ó˜ ·ÛıÂÓ›˜.À‹ÚÍ ÌÈ· ÌÈÎÚfiÙÂÚË ÂÓ‰ÔÓÔ-ÛÔÎÔÌÂȷ΋ ıÓËÙfiÙËÙ· (0% ÂÓ·-ÓÙ›ÔÓ 2% ÛÙȘ ¿ÏϘ 2 ÔÌ¿‰Â˜,p<0.001), ÌÈ· ¯·ÌËÏfiÙÂÚË ·‡-ÍËÛË Ù˘ CK-ªμ (14% ÂÓ·ÓÙ›ÔÓ27% Î·È 28% ÛÙȘ ¿ÏϘ ÔÌ¿-‰Â˜, p<0.001) Î·È ÏÈÁfiÙÂÚ˜ ÂÈ-ÏÔΤ˜ Ù˘ PCI (15% ÂÓ·ÓÙ›ÔÓ30% ÙˆÓ 2 ¿ÏÏˆÓ ÔÌ¿‰ˆÓ,p<0.001).[12] ªÂÙ¿ ‰ÈÂÚ‡ÓËÛËÙ˘ Èı·ÓfiÙËÙ·˜ Ï‹„˘ ÛÙ·Ù›-Ó˘ Ô˘ ‚·Û›ÛÙËΠÛÙ· ÎÏÈÓÈÎ¿Î·È ·ÁÁÂÈÔÁÚ·ÊÈο ¯·Ú·ÎÙËÚÈ-ÛÙÈο, ÔÈ ·ÛıÂÓ›˜ Ô˘ ¤·ÈÚ-Ó·Ó ÛÙ·Ù›Ó˜ ›¯·Ó ·ÎfiÌ· ÏÈÁfi-ÙÂÚ˜ ÂÓ‰ÔÓÔÛÔÎÔÌÂȷΤ˜ ÂÈ-ÏÔΤ˜ Î·È ÌÂÁ·Ï‡ÙÂÚË ‰È·ÊÔ-Ú¿ ÛÙËÓ ÂÓ‰ÔÓÔÛÔÎÔÌÂȷ΋ ıÓË-ÙfiÙËÙ·.[12]

Δ· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ARMYDA (Atorvastatin for Reduc-tion of Myocardial Damage Du-ring Angioplasty)[5] ¤‰ÂÈÍ·Ó fiÙÈÛ ·ÛıÂÓ›˜ Ì ™™¡ Ë ¯ÔÚ‹ÁË-ÛË 40 mg/ËÌ. ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ÁÈ· 7 Ë̤Ú˜ ÚÈÓ ÙË PCI ÌÂÈÒ-ÓÂÈ ÛËÌ·ÓÙÈο ÙÔ Ì˘ÔηډȷÎfiÙÚ·˘Ì·ÙÈÛÌfi Ô˘ ÚÔηÏ›ٷȷfi ÙË PCI. ∏ CK-ªμ, Ë ÙÚÔÔ-Ó›ÓË π, Î·È Ë Ì˘ÔÛÊ·ÈÚ›ÓË ÛÙȘ 8Î·È 24 ÒÚ˜ ÌÂÙ¿ ·fi ÙËÓ PCI‹Ù·Ó Û Ôχ ¯·ÌËÏfiÙÂÚ· ›-‰· ·fi fiÙÈ ÛÙÔ˘˜ ·ÛıÂÓ›˜Ô˘ ‹Ú·Ó ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ.√ ΛӉ˘ÓÔ˜ ÁÈ· Ù· Û˘ÓÔÏÈο ηÚ-

‰È·ÁÁÂȷο Û˘Ì‚¿Ì·Ù· ÂÏ·ÙÙÒ-ıËΠηٿ 81% Ì ÙËÓ ·ÙÔÚ‚·-ÛÙ·Ù›ÓË, ÂÓÒ Ù· ÂÌÊÚ¿ÁÌ·Ù·ÙÔ˘ Ì˘Ôηډ›Ô˘ ‹Ù·Ó 5% ÛÙËÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ¤·ÈÚ-Ó·Ó ·ÙÔÚ‚·ÛÙ·Ù›ÓË Î·È 18%ÛÙËÓ ÔÌ¿‰· ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·Ú-Ì¿ÎÔ˘ (p=0.025).[5]

∏ ÌÂϤÙË ARMYDA CAMS [6] ‰ÈÂ-Ú‡ÓËÛÂ Â¿Ó Ë ÚÔÛÙ·Û›· Ù˘·ÙÔÚ‚·ÛÙ·Ù›Ó˘ ·fi ÙÔ Ì˘ÔηÚ-‰È·Îfi ÙÚ·˘Ì·ÙÈÛÌfi ηٿ ÙË ‰È¿Ú-ÎÂÈ· Ù˘ PCI Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÙËÌ›ˆÛË Ù˘ ÊÏÂÁÌÔÓÒ‰Ô˘˜ ·¿-ÓÙËÛ˘ ÙÔ˘ ÂÓ‰ÔıËÏ›Ô˘. ™Â ÌÈ·ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓË ˘Ô·Ó¿Ï˘-ÛË Ù˘ ÌÂϤÙ˘ ARMYDA, ÌÈ·˘ÔÔÌ¿‰· 76 ·ÛıÂÓÒÓ ÂÍÂÙ¿-ÛÙËΠÁÈ· ÙË Ì¤ÙÚËÛË ÙˆÓ ÂÈ-¤‰ˆÓ ÛÙÔ Ï¿ÛÌ· ÙÔ˘ vas-cular cell adhesion molecule-1(VCAM-1), ÙÔ˘ intercellular celladhesion molecule-1 (ICAM-1),Î·È Ù˘ E-selectin. ∞fi ·˘ÙÔ‡˜ÔÈ 38 ·ÛıÂÓ›˜ ·Ó‹Î·Ó ÛÙËÓÔÌ¿‰· Ù˘ ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ (40mg/ËÌ.) Î·È 38 ÛÙËÓ ÔÌ¿‰· ÙÔ˘ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘. Δ· ÌfiÚÈ·ÚÔÛÎfiÏÏËÛ˘ ·ÍÈÔÏÔÁ‹ıËηÓ7 Ë̤Ú˜ ÚÈÓ ·fi ÙËÓ Â¤Ì‚·-ÛË, ·Ì¤Ûˆ˜ ÚÈÓ ·fi ÙËÓ PCI,Î·È 8 Î·È 24 ÒÚ˜ ÌÂÙ¿ ÙËÓ PCI.¢È·ÈÛÙÒıËÎ·Ó ÛËÌ·ÓÙÈο ¯·-ÌËÏfiÙÂÚ· ›‰· ÙˆÓ Ô˘ÛÈÒÓ·˘ÙÒÓ ÛÙËÓ ÔÌ¿‰· Ù˘ ·ÙÔÚ‚·-ÛÙ·Ù›Ó˘. ∏ PCI Ì ÙÔÔı¤ÙËÛËstent Ê·›ÓÂÙ·È fiÙÈ ÚÔηÏ›ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘ Ì˯·ÓÈÛÌÔ‡‹Í˘ Î·È ˘ÚÔ‰ÔÙ› ÊÏÂÁÌÔÓ‹ÙÔ˘ ·ÁÁ›Ԣ. Δ· ÔʤÏË Ù˘ ¯Ô-

Ú‹ÁËÛ˘ ÛÙ·Ù›Ó˘ ı· ÌÔÚÔ‡-Û ӷ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÙˆÓ Â˘-ÓÔ˚ÎÒÓ Ù˘ ‰Ú¿ÛÂˆÓ ÛÙË ÚÔ-ÛÎfiÏÏËÛË ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ,ÛÙË ıÚfiÌ‚ˆÛË, ÛÙË ÛÙ·ıÂÚfi-ÙËÙ· ÙˆÓ ·ıËڈ̷ÙÈÎÒÓ Ï·-ÎÒÓ Î·È ÛÙË ÊÏÂÁÌÔÓ‹. Δ· ·Óˆ-Ù¤Úˆ ÛÙÔȯ›· ‰Â›¯ÓÔ˘Ó fiÙÈ ËÌ›ˆÛË Ù˘ ÂÓ‰ÔıËÏȷ΋˜ ÊÏÂÁ-ÌÔÓÒ‰Ô˘˜ ·¿ÓÙËÛ˘ ÛÙËÓ PCIÌÔÚ› Ó· ÂÍËÁ‹ÛÂÈ ÙËÓ ÚÔ-Ûٷ٢ÙÈ΋ ›‰Ú·ÛË ÙˆÓ ÛÙ·-ÙÈÓÒÓ Ô˘ ¯ÔÚËÁÔ‡ÓÙ·È ÚÈÓ ÙˉÈÂÓ¤ÚÁÂÈ¿ Ù˘.[6] ∞˘Ù¿ Ù· ÛÙÔÈ-¯Â›· ¤‰ÂÈÍ·Ó fiÙÈ ÔÈ ÏÂÈÔÙÚÔÈ-Τ˜ ‰Ú¿ÛÂȘ ÙˆÓ ÛÙ·ÙÈÓÒÓ Â›Ó·È·˘Ù¤˜ Ô˘ ÚÔηÏÔ‡Ó Ù· ¢ÂÚ-ÁÂÙÈο ·˘Ù¿ ·ÔÙÂϤÛÌ·Ù·,fiˆ˜ ˘Ô‰ËÏÒÓÂÈ Î·È Ô Û‡ÓÙÔ-ÌÔ˜ ¯ÚfiÓÔ˜ ̤۷ ÛÙÔÓ ÔÔ›ÔÂΉËÏÒıËηÓ.

Œ¯ÂÈ ·Ô‰Âȯı› fiÙÈ Ë ıÂڷ›·Ì ·ÙÔÚ‚·ÛÙ·Ù›ÓË ÚÈÓ ÙËÓ PCIÌÔÚ› Ó· ÌÂÈÒÛÂÈ ÙÔ ¤ÌÊÚ·Á-Ì· ÙÔ˘ Ì˘Ôηډ›Ô˘ Î·È ¿ÏÏ·Û˘Ì‚¿Ì·Ù· Û ·ÛıÂÓ›˜ Ì ™™¡Î·Ù¿ ‹ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË ‰ÈÂÓ¤Ú-ÁÂÈ· ÂÎÏÂÎÙÈ΋˜ PCI Î·È ÙÔÔ-ı¤ÙËÛ˘ stent. ∂ÓÙÔ‡ÙÔȘ, ·˘Ù‹Ë ıÂڷ›· ‰ÂÓ Â›¯Â ‰ÈÂÚ¢ÓË-ı› Û ·ÛıÂÓ›˜ Ì √™™. ™ÙËÚfiÛÊ·Ù· ‰ËÌÔÛÈÂ˘Ì¤ÓË ÌÂϤ-ÙË ARMYDA ACS (Atorvastatinfor Reduction of Myocardial Da-mage during Angioplasty in pa-tients with Acute Coronary Syn-dromes)[7] Û˘ÓÔÏÈο 171 ·ÛıÂ-Ó›˜ Ì √™™ Ù˘¯·ÈÔÔÈ‹ıËηÓÛ ıÂڷ›· Ì ·ÙÔÚ‚·ÛÙ·Ù›ÓË(80 mg 12 ÒÚ˜ Î·È 40 mg 2

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20

μμÈÈ‚‚ÏÏÈÈÔÔÁÁÚÚ··ÊÊ››··

1. Cannon CP, Braunwald E, McCabe CH,et al; Pravastatin or Atorvastatin Evalua-tion and Infection Therapy-Thrombolysisin Myocardial Infarction 22 Investigators.Intensive versus moderate lipid loweringwith statins after acute coronary syn-dromes.N Engl J Med 2004;350:1495-1504.

2. Kasai T, Miyauchi K, Kurata T, et al.Long-term (11-year) statin therapyfollowing percutaneous coronary inter-vention improves clinical outcome and isnot associated with increased mali-gnancy. Int J Cardiol 2007;114:210-217.

3. Knatterud GL, Rosenberg Y, Campeau L,et al. Long-term effects on clinical outco-mes of aggressive lowering of low-density lipoprotein cholesterol levels andlow-dose anticoagulation in the postcoronary artery bypass graft trial. PostCABG Investigators. Circulation 2000;102:157-65.

4. Boden WE, O'rourke RA, Teo KK, et al.Optimal Medical Therapy with or withoutPCI for Stable Coronary Disease. N EnglJ Med. 2007 Mar 26; [Epub ahead ofprint]

5. Pasceri V, Patti G, Nusca A, Pristipino C,Richichi G, Di Sciascio G, ARMYDA Inve-stigators. Randomized trial of atorva-

statin for reduction of myocardial da-mage during coronary intervention:results from the ARMYDA (Atorvastatinfor Reduction of Myocardial DamageDuring Angioplasty) study. Circulation2004;110:674–8.

6. Patti G, Chello M, Pasceri V, et al. Prote-ction from procedural myocardial injuryby atorvastatin is associated with lowerlevels of adhesion molecules afterpercutaneous coronary intervention:results from the ARMYDACAMs (Atorva-statin for Reduction of MyocardialDamage During Angioplasty-Cell Adhe-sion Molecules) substudy. J Am CollCardiol 2006;48: 1560-6.

7. Patti G, Pasceri V, Colonna G, et al. Ator-vastatin pretreatment improves outco-mes in patients with acute coronarysyndromes undergoing early percu-taneous coronary intervention. Results ofthe ARMYDA-ACS Randomized Trial. JAm Coll Cardiol 2007; 49:1272-1278.

8. Collard CD, Body SC, Shernan SK, WangS, Mangano DT; Multicenter Study ofPerioperative Ischemia (MCSPI)Research Group, Inc; Ischemia Researchand Education Foundation (IREF)Investigators. Preoperative statin therapyis associated with reduced cardiac

mortality after coronary artery bypassgraft surgery. J Thorac Cardiovasc Surg2006;132:392-400.

9. Pan W, Pintar T, Anton J, Lee VV, VaughnWK, Collard CD. Statins are associatedwith a reduced incidence of perioperativemortality after coronary artery bypassgraft surgery. Circulation 2004;110 (11Suppl 1):II45-9.

10. Dotani MI, Elnicki DM, Jain AC et al.Effect of preoperative statin therapy andcardiac outcomes after coronary arterybypass grafting. Am J Cardiol 2000;86:1128-1130.

11. Ward RP, Leeper NJ, Kirkpatrick JN, etal. The effect of preoperative statintherapy on cardiovascular outcomes inpatients undergoing infrainguinal vas-cular surgery. Int J Cardiol 2005;104:264-268.

12. Singh M, Lennon RJ, Roger VL, et al. Re-lation of preprocedural statin therapy toinhospital procedural complicationsfollowing percutaneous coronary inter-ventions in patients with hyperlipidemia.Am J Cardiol 2006;98: 325-330.

ÒÚ˜ ÚÈÓ ·fi ÙË PCI [n=86])‹ Û ıÂڷ›· Ì ÂÈÎÔÓÈÎfi Ê¿Ú-Ì·ÎÔ (n=85). ™Â fiÏÔ˘˜ ÙÔ˘˜·ÛıÂÓ›˜ ¯ÔÚËÁ‹ıËΠÌÈ· ‰fiÛË600 mg ÎÏÔȉÔÁÚ¤Ï˘. ΔÔ Û˘Ó-‰˘·Ṳ̂ÓÔ ÙÂÏÈÎfi ÛËÌÂ›Ô (ı¿Ó·-ÙÔ˜, Ì˘ÔηډȷÎfi ¤ÌÊÚ·ÁÌ·, ‹ÌË ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓË Â·Ó·È-Ì¿ÙˆÛË) ÂÌÊ·Ó›ÛÙËΠ۠5%ÙˆÓ ·ÛıÂÓÒÓ ÛÙÔ ÛΤÏÔ˜ Ù˘·ÙÔÚ‚·ÛÙ·Ù›Ó˘ Î·È Û 17% ÙˆÓ·ÛıÂÓÒÓ ÛÙÔ ÛΤÏÔ˜ ÂÈÎÔÓÈÎԇʷÚÌ¿ÎÔ˘ (p=0.01). ∞˘Ù‹ Ë ‰È·-ÊÔÚ¿ ÔÊÂÈÏfiÙ·Ó Î˘Ú›ˆ˜ ÛÙËÌ›ˆÛË Ù˘ ›وÛ˘ ÙÔ˘ ÂÌ-ÊÚ¿ÁÌ·ÙÔ˜ Ì˘Ôηډ›Ô˘ (5%¤Ó·ÓÙÈ 15%, p=0.04). ™˘ÓÔÏÈο,Ë ÂÏ¿ÙÙˆÛË ÙˆÓ Û˘Ì‚·Ì¿ÙˆÓ

ÛÙËÓ ÔÌ¿‰· Ù˘ ·ÙÔÚ‚·ÛÙ·Ù›-Ó˘ ‹Ù·Ó 88%. ∂ÈϤÔÓ, ÌÂÙ¿·fi PCI, ÙÔ ÔÛÔÛÙfi ÙˆÓ ·ÛıÂ-ÓÒÓ Ì ·˘ÍË̤ÓË CK-ªμ ‹ ÙÚÔ-ÔÓ›ÓË π ÛÙËÓ ÔÌ¿‰· Ù˘ ·ÙÔÚ-‚·ÛÙ·Ù›Ó˘ ‹Ù·Ó ÛËÌ·ÓÙÈο ¯·-ÌËÏfiÙÂÚÔ ·fi ·˘Ùfi Ù˘ ÔÌ¿-‰·˜ ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘.[7]

ΔÔ ›‰ÈÔ Û˘Ó¤‚Ë Î·È Ì ٷ ›Â-‰· Ù˘ CRP.[7] ∞˘Ù¿ Ù· ÛÙÔȯ›·ÌÔÚÔ‡Ó Ó· ˘ÔÛÙËÚ›ÍÔ˘Ó Ù˯ڋÛË ˘„ËÏ‹˜ ‰fiÛ˘ ÛÙ·Ù›Ó˘ÚÈÓ ·fi ÙËÓ PCI ÛÙÔ˘˜ ·ÛıÂ-Ó›˜ Ì √™™.

™˘ÌÂÚ·ÛÌ·ÙÈο, ·fi Ù· ·-Ú·¿Óˆ ‰È·ÈÛÙÒÓÂÙ·È ÔχÌÂÁ¿ÏÔ fiÊÂÏÔ˜ ·fi ÙË ¯ÔÚ‹ÁË-

ÛË ÛÙ·Ù›Ó˘ ÚÈÓ ·fi CABG ‹PCI, ÙËÓ ÔÔ›· Ô‡Ùˆ˜ ‹ ¿Ïψ˜ı· ¿ÚÔ˘Ó ÌÂÙ¿ ÙËÓ ÂÂÌ‚·ÙÈ-΋ ·ӷÈÌ¿ÙˆÛË. ∞˘Ù‹ Ë Ú·-ÎÙÈ΋ Â¿Ó ÁÂÓÈ΢ı› ı· ÛÒÛÂÈ·ÓıÚÒÈÓ˜ ˙ˆ¤˜, ı· ‚ÂÏÙÈÒÛÂÈÙË ÔÈfiÙËÙ· ˙ˆ‹˜ ÙˆÓ ·ÛıÂÓÒÓÌÂÙ¿ ÙËÓ Â·Ó·ÈÌ¿ÙˆÛË Î·È ı·ÂÍÔÈÎÔÓÔÌ‹ÛÂÈ ÛËÌ·ÓÙÈÎÔ‡˜ fi-ÚÔ˘˜ ÁÈ· ÙËÓ ˘Á›· Ô˘ Ô‡Ùˆ˜‹ ¿Ïψ˜ Â›Ó·È ‰˘Û‡ÚÂÙÔÈ.

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21

∂ÈÛÓÂfiÌÂÓË πÓÛÔ˘Ï›ÓË: Δ· ¢Â‰Ô̤ӷ Î·È ÔÈ ¶ÚÔ‚ÏËÌ·ÙÈÛÌÔ›

¢Ú. ∞Ó‰Ú¤·˜ ªÂÏȉÒÓ˘ À‡ı˘ÓÔ˜ ¢È·‚ËÙÔÏÔÁÈÎÔ‡ ∫¤ÓÙÚÔ˘, °.¡. ¶ÂÈÚ·È¿

∏ ›Ù¢ÍË Â˘ÁÏ˘Î·ÈÌ›·˜ Û¿ÙÔÌ· Ì ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË,·ÔÙÂÏ› ÚˆÙ·Ú¯ÈÎfi ıÂڷ¢-ÙÈÎfi ÛÙfi¯Ô, Ì ÛÎÔfi ÙËÓ Ì›ˆ-ÛË Ù˘ ›وÛ˘ ÙˆÓ ÌÈÎÚÔ·Á-ÁÂÈ·ÎÒÓ Î·È Ì·ÎÚÔ·ÁÁÂÈ·ÎÒÓÂÈÏÔÎÒÓ ·ÏÏ¿ Î·È Ù˘ ÓÔÛË-ÚfiÙËÙ·˜ Î·È ıÓËÛÈÌfiÙËÙ·˜.

∏ ·Ó·Ú΋˜ fï˜ ÁÏ˘Î·ÈÌÈ΋ڇıÌÈÛË ·ÔÙÂÏ›, ‰˘ÛÙ˘¯Ò˜, ¯·-Ú·ÎÙËÚÈÛÙÈÎfi ÛÙÔÈ¯Â›Ô ÙˆÓ ÚÔ-Û·ıÂÈÒÓ Ô˘ Á›ÓÔÓÙ·È ·ÁÎfi-ÛÌÈ·. ¢Â‰Ô̤ӷ ‰È·ÊfiÚˆÓ ÌÂ-ÏÂÙÒÓ ‰Â›¯ÓÔ˘Ó fiÙÈ ÌfiÓÔ ÙÔ31% ÙˆÓ ‰È·‚ËÙÈÎÒÓ ÛÙȘ ∏¶∞Î·È ÙÔ 39% ÛÙËÓ ∂˘ÚÒË ·-ÚÔ˘ÛÈ¿˙Ô˘Ó ÈηÓÔÔÈËÙÈ΋ ÁÏ˘-ηÈÌÈ΋ Ú‡ıÌÈÛË (∏bA1C <7%).™’ ·˘ÙfiÓ ÙÔÓ ·ÔÁÔËÙ¢ÙÈÎfi Û¯Â-ÙÈο ·ÔÏÔÁÈÛÌfi ›Ûˆ˜ Û˘Ì‚¿Ï-ÏÂÈ Î·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ, fiˆ˜‰Â›¯ÓÔ˘Ó ÌÂϤÙ˜ ÛÙȘ ∏¶∞, ˯ڋÛË Ù˘ ÈÓÛÔ˘Ï›Ó˘ (Ô˘ ›-Ó·È ÔˆÛ‰‹ÔÙ ÙÔ Î·Ï‡ÙÂÚÔıÂڷ¢ÙÈÎfi fiÏÔ Ì·˜ ÁÈ· ÙËÓÚ‡ıÌÈÛË ÙÔ˘ ‰È·‚‹ÙË) ‰ÂÓ ¿Ï-Ï·ÍÂ, ‰ÂÓ ·˘Í‹ıËΠÙËÓ ÙÂÏ¢-Ù·›· ‰ÂηÂÙ›· (ÙÔ 27% ÙˆÓ ‰È·-‚ËÙÈÎÒÓ ÙÔ 1992 ¤Î·Ó ÈÓÛÔ˘Ï›-ÓË ‹ ÂÏ¿Ì‚·Ó ÈÓÛÔ˘Ï›ÓË Î·È ‰È-ÛΛ·, ÙÔ ›‰ÈÔ ÔÛÔÛÙfi ‰È·ÈÛÙÒ-ıËÎÂ Î·È ÙÔ 2000- 2002). À¿Ú¯ÂÈηı˘ÛÙ¤ÚËÛË ‹ Î·È ·ÓÙ›ÛÙ·ÛË·fi ÙÔ˘˜ ·ÛıÂÓ›˜ ÛÙËÓ ¤Ó·ÚÍËÈÓÛÔ˘ÏÈÓÔıÂڷ›·˜ ÛÙÔ˘˜ ‰È·-‚ËÙÈÎÔ‡˜ Ù‡Ô˘ ππ.

∏ ÂÚ¢ÓËÙÈ΋ ÚÔÛ¿ıÂÈ· ÂÈ-ÎÂÓÙÚÒıËΠ۠ÂÓ·ÏÏ·ÎÙÈΤ˜ ÌÔÚ-ʤ˜ ¯ÔÚ‹ÁËÛ˘ ÈÓÛÔ˘Ï›Ó˘, ‰È·Ù˘ ÚÈÓÈ΋˜, ÛÙÔÌ·ÙÈ΋˜ Î·È Ó¢-ÌÔÓÈ΋˜ Ô‰Ô‡, ÒÛÙÂ Ë ıÂڷ¢-ÙÈ΋ ·ÁˆÁ‹ Ó· Á›ÓÂÈ Ï¤ÔÓ ·Ô-‰ÂÎÙ‹ ·fi ÙÔ˘˜ ·ÛıÂÓ›˜. Δ·‰Â‰Ô̤ӷ ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ ÂÙÒÓÚÔÎÚ›ÓÔ˘Ó Û·Ó È‰È·›ÙÂÚ· ˆÊ¤-ÏÈÌË Î·È ·ÛÊ·Ï‹ ÙËÓ ˘fi ÚÔ¸-Ôı¤ÛÂȘ ¯ÔÚ‹ÁËÛË ÈÓÛÔ˘Ï›Ó˘‰È· Ù˘ Ó¢ÌÔÓÈ΋˜ Ô‰Ô‡, ÙËÓ¯ÔÚ‹ÁËÛË ‰ËÏ·‰‹ ÂÈÛÓÂfiÌÂ-Ó˘ ÈÓÛÔ˘Ï›Ó˘.

∏ ¯ÔÚ‹ÁËÛË ÈÓÛÔ˘Ï›Ó˘ ‰È· Ù˘Ó¢ÌÔÓÈ΋˜ Ô‰Ô‡ ·ÍÈÔÔÈ› ÙÔÏÂÔÓ¤ÎÙËÌ· Ù˘ ÂÍ·ÈÚÂÙÈο ÌÂ-

Á¿Ï˘ ΢„ÂÏȉÈ΋˜-ÂÈıËÏȷ΋˜ÂÈÊ¿ÓÂÈ·˜ ·ÔÚÚfiÊËÛ˘ (100m2)ÙˆÓ Ó¢ÌfiÓˆÓ, Ë ÔÔ›· Û˘Ó-‰˘¿˙ÂÙ·È Ì ÏÔ‡ÛÈÔ ÙÚȯÔÂȉÈ-Îfi ‰›ÎÙ˘Ô ·ÈÌ¿ÙˆÛ˘. ¶ÚÔ¸fi-ıÂÛË ·ÔÚÚfiÊËÛ˘ οÔÈ·˜‰Ú·ÛÙÈ΋˜ Ô˘Û›·˜ ‰È·Ì¤ÛÔ˘ Ù˘Ó¢ÌÔÓÈ΋˜ Ô‰Ô‡ Â›Ó·È Ó·Êı¿ÛÔ˘Ó ÛˆÌ·Ù›‰È· ·˘Ù‹˜ ÙË˜Ô˘Û›·˜ ¤ˆ˜ ÙȘ ΢„ÂÏ›‰Â˜. ∏ÚÔ¸fiıÂÛË ·˘Ù‹ Â›Ó·È ÂÊÈÎÙ‹ÌfiÓÔÓ fiÙ·Ó Ù· ۈ̷ٛ‰È· ¤¯Ô˘Ó¤Ó· ȉ·ÓÈÎfi ̤ÁÂıÔ˜ Ù˘ Ù¿Í˘ÙÔ˘ 1.5 - 5 Ìm. H ÚfiÔ‰Ô˜ Ô˘Û˘ÓÙÂϤÛıËΠۋÌÂÚ·, ÒÛÙÂ Ó·Â›Ó·È ‰È·ı¤ÛÈÌË ·fi Ê·ÚÌ·ÎÔ-Ù¯ÓÈ΋˜ ÏÂ˘Ú¿˜ Ë ÂÈÛÓÂfiÌÂ-ÓË ÈÓÛÔ˘Ï›ÓË, ·ÊÔÚ¿ ΢ڛˆ˜ÛÙËÓ ÂͤÏÈÍË ÙˆÓ Û˘Û΢ÒÓ ¯Ô-Ú‹ÁËÛ˘ Ù˘, ÒÛÙ ӷ ‰È·ÛÊ·-Ï›˙ÂÙ·È Ë Â›Ù¢ÍË ·˘ÙÔ‡ ÙÔ˘È‰·ÓÈÎÔ‡ ÌÂÁ¤ıÔ˘˜ ۈ̷Ùȉ›ˆÓÈÓÛÔ˘Ï›Ó˘. Δ· ۈ̷ٛ‰È· ·˘Ù¿ÛÙËÓ Û˘Ó¤¯ÂÈ· ‰È¤Ú¯ÔÓÙ·È ÙËÓ΢„ÂÏȉÔÙÚȯÔÂȉÈ΋ ÌÂÌ‚Ú¿ÓËÎ·È ·ÔÚÚÔÊÔ‡ÌÂÓ· ̤ۈ ÙÔ˘ÏÔ‡ÛÈÔ˘ ÙÚȯÔÂȉÈÎÔ‡ ‰ÈÎÙ‡Ô˘Êı¿ÓÔ˘Ó ÛÙËÓ Û˘ÛÙËÌ·ÙÈ΋ ΢-ÎÏÔÊÔÚ›·. ΔÂÏÈο fï˜ ÌfiÓÔÓÙÔ 40% Ù˘ ÂÈÛÓ¢Ûı›۷˜ ÈÓ-ÛÔ˘Ï›Ó˘ Êı¿ÓÂÈ ÛÙËÓ Û˘ÛÙËÌ·-ÙÈ΋ ΢ÎÏÔÊÔÚ›·, fiÛÔ Â›Ó·È ÛÂÌÔÚÊ‹ ۈ̷Ùȉ›ˆÓ ‰È·Ì¤ÙÚÔ˘1-5 Ìm, Ù· ÔÔ›· ÂÈÙ˘Á¯¿ÓÔ˘ÓÓ· Êı¿ÛÔ˘Ó ÛÙȘ ΢„ÂÏ›‰Â˜.™ˆÌ·Ù›‰È· ÌÂÁ·Ï‡ÙÂÚÔ˘ ÌÂÁ¤-ıÔ˘˜ (5-10 Ìm.) ÂÓ·ÔÙ›ıÂÓÙ·È΢ڛˆ˜ ÛÙÔ ÙÚ·¯ÂÈÔ‚ÚÔÁ¯ÈÎfi‰¤Ó‰ÚÔ (10% Ù˘ ÂÈÛÓÂfiÌÂÓ˘ÈÓÛÔ˘Ï›Ó˘), ÂÓÒ ÛˆÌ·Ù›‰È· ÈÓ-ÛÔ˘Ï›Ó˘ ·ÎfiÌ· ÌÂÁ·Ï‡ÙÂÚÔ˘ÌÂÁ¤ıÔ˘˜ (>10 Ìm.) ÂÓ·ÔÙ›ıÂ-ÓÙ·È ÛÙËÓ ÛÙÔÌ·ÙÈ΋ ÎÔÈÏfiÙËÙ·(20% Ù˘ ÂÈÛÓÂfiÌÂÓ˘ ÈÓÛÔ˘Ï›-Ó˘). Δ¤ÏÔ˜ ˘¿Ú¯Ô˘Ó Î·È ‘·Ò-ÏÂȘ’ Ù˘ Ù¿Í˘ ÙÔ˘ 30% ÙË˜Û˘ÓÔÏÈ΋˜ ÂÈÛÓÂfiÌÂÓ˘ ÈÓÛÔ˘-Ï›Ó˘ ÛÙË Û˘Û΢‹ ¯ÔÚ‹ÁËÛ˘.ŒÙÛÈ Ë ÙÂÏÈ΋ ‚ÈԉȷıÂÛÈÌfiÙËÙ·Ù˘ ÂÈÛÓÂfiÌÂÓ˘ ÈÓÛÔ˘Ï›Ó˘ (Ô˘ÚÔÛÂÁÁ›˙ÂÈ ÙÔ 10- 20% Ù˘ ·ÓÙ›-ÛÙÔȯ˘ ˘Ô‰fiÚÈ·˜ ¯ÔÚËÁÔ‡-ÌÂÓ˘ ÈÓÛÔ˘Ï›Ó˘) ÔÈΛÏÏÂÈ,ÂÍ·ÚÙÒÌÂÓË ·fi Ù· Û˘ÛÙ‹Ì·Ù·¯ÔÚ‹ÁËÛ˘ ÂÈÛÓÂfiÌÂÓ˘ ÈÓ-ÛÔ˘Ï›Ó˘, Ù· ¿ÙÔÌ· Î·È ÙËÓ ÙÂ-

¯ÓÈ΋ ÂÈÛÓÔ‹˜ ÙÔ˘˜, ·ÎfiÌË Î·È·fi ‰fiÛË Û ‰fiÛË ÛÙÔ ›‰ÈÔ ¿ÙÔ-ÌÔ.

™˘ÛÙ‹Ì·Ù· Î·È Û˘Û΢¤˜ ¯ÔÚ‹-ÁËÛ˘ ÂÈÛÓÂfiÌÂÓ˘ ÈÓÛÔ˘Ï›Ó˘ÂÚ¢ÓÒÓÙ·È Î·È ‰ÔÎÈÌ¿˙ÔÓÙ·È ·fi‰È¿ÊÔÚ˜ Ê·Ú̷΢ÙÈΤ˜ ÂÙ·È-Ú›˜. (‚Ï. ¶›Ó·Î· 1).

∏ ÂÈÛÓ¢ÛÙÈ΋ Û˘Û΢‹ ÙÔ˘Exubera (¡ectar Pulmonary Inha-ler) Ë ÌfiÓË ÚÔ˜ ÙÔ ·ÚfiÓ ÂÁ-ÎÚÈı›۷ ·fi ÙÔ FDA Î·È ÙÔ˘˜·ÓÙ›ÛÙÔÈ¯Ô˘˜ ∂˘Úˆ·˚ÎÔ‡˜ √Ú-Á·ÓÈÛÌÔ‡˜, ÂÚȤ¯ÂÈ ÙËÓ ÛÎfiÓËÈÓÛÔ˘Ï›Ó˘ Û ·Ï¤˜ Û˘Û΢·-ۛ˜ ÙÔ˘ ÂÓfi˜ ‹ ÙˆÓ 3 mg (ÈÛÔ-‰‡Ó·Ì˜ ·fi ÏÂ˘Ú¿˜ ‰Ú¿Û˘Ì 3 ‹ 9 ÌÔÓ¿‰Â˜ ˘Ô‰fiÚÈ·˜Ù·¯Â›·˜ ‰Ú¿Ûˆ˜ ÈÓÛÔ˘Ï›Ó˘·ÓÙ›ÛÙÔȯ·). √ ı¿Ï·ÌÔ˜ Ù˘ Û˘-Û΢‹˜ ‰ËÌÈÔ˘ÚÁ› ·fi ÙËÓÛÎfiÓË Ô˘ ‰È·Ï‡ÂÙ·È ¤Ó· ‘Ó¤-ÊÔ˜ „ÂηÛÌÔ‡’ Ô˘ ÂÈÛÓ¤ÂÙ·È·fi ÙÔ ¿ÙÔÌÔ, ÙÔ ÔÔ›Ô Ï·Ì‚¿-ÓÂÈ ‰È· Ù˘ ÂÈÛÓÔ‹˜ ÙËÓ ·Ó¿-ÏÔÁ· ··ÈÙÔ‡ÌÂÓË ‰fiÛË ÈÓÛÔ˘-Ï›Ó˘. ∏ ηٷÛ΢‹ Î·È Ë ÏÂÈ-ÙÔ˘ÚÁ›· Ù˘ ÂÈÛÓ¢ÛÙÈ΋˜ Û˘-Û΢‹˜ Â›Ó·È Ù¤ÙÔÈ· ÒÛÙ ӷÂÏ·¯ÈÛÙÔÔÈ› ÙË ÌÂÙ·‚ÏËÙfiÙË-Ù· ÙÔ˘ ÂÈÛÓ¢ÛÙÈÎÔ‡ ·ÔÙÂϤ-ÛÌ·ÙÔ˜ Î·È ÙÔ Ì¤ÁÂıÔ˜ ÙˆÓ ÂÈ-ÛÓÂfiÌÂÓˆÓ ÌÔÚ›ˆÓ. ∏ ·ÔÙÂ-ÏÂÛÌ·ÙÈÎfiÙËÙ· Î·È Ë ·ÛÊ¿ÏÂÈ·ÙÔ˘ Exubera ¤¯ÂÈ ÌÂÏÂÙËı› ÛÂÂÚÈÛÛfiÙÂÚ· ·fi 3500 ¿ÙÔÌ·,Û ·ÚÎÂÙÔ‡˜ ‰Â ÂÍ ·˘ÙÒÓ ÁÈ·ÂÚÈÛÛfiÙÂÚ· ·fi 7 ¯ÚfiÓÈ·.

º·ÚÌ·ÎÔÎÈÓËÙÈ΋: ∏ ÂÈÛÓÂfiÌÂ-ÓË ÈÓÛÔ˘Ï›ÓË Û˘ÁÎÚÈÓfiÌÂÓË ÌÂÙËÓ ˘Ô‰fiÚÈ· ¯ÔÚ‹ÁËÛË ÎÚ˘-ÛÙ·ÏÏÈ΋˜ ÈÓÛÔ˘Ï›Ó˘ ‹ ·ÎfiÌËÎ·È Ì ÂÓ‰ÔÊϤ‚È· ¯ÔÚËÁÔ‡ÌÂ-ÓË ÈÓÛÔ˘Ï›ÓË, ·ÚÔ˘ÛÈ¿˙ÂÈ fi¯ÈÌfiÓÔÓ Ù·¯‡ÙÂÚË ¤Ó·ÚÍË ‰Ú¿-Û˘ ·ÏÏ¿ Î·È Ù·¯‡ÙÂÚË Â›Ù¢-ÍË Ì¤ÁÈÛÙ˘ Û˘ÁΤÓÙÚˆÛ˘ ÈÓ-ÛÔ˘Ï›Ó˘ ÔÚÔ‡. ™˘ÁÎÚÈÓfiÌÂÓËÌ ˘Ô‰fiÚÈ· ¯ÔÚËÁÔ‡ÌÂÓÔ Ù·-¯‡ ·Ó¿ÏÔÁÔ ÈÓÛÔ˘Ï›Ó˘ (Lispro)Ë ÂÈÛÓÂfiÌÂÓË ÈÓÛÔ˘Ï›ÓË ·-ÚÔ˘ÛÈ¿˙ÂÈ Ù·¯‡ÙÂÚË ¤Ó·ÚÍË ‰Ú¿-Û˘ (28 min vs. 40 min), ·ÏÏ¿

ATHIROSK 14 03-07-07 12:06 ™ÂÏ›‰·21

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22

ÛËÌ·ÓÙÈο ‚Ú·‰‡ÙÂÚË Â›Ù¢ÍËÙ˘ ̤ÁÈÛÙ˘ ÌÂÙ·‚ÔÏÈ΋˜ ‰Ú¿-Û˘ (∂ÈÎfiÓ· 1).

∏ ‰È¿ÚÎÂÈ· ‰Ú¿Û˘ Ù˘ ›ӷÈÛ˘ÁÎÚ›ÛÈÌË Ì ÂΛÓË Ù˘ ˘Ô-‰ÔÚ›ˆ˜ ¯ÔÚËÁÔ‡ÌÂÓ˘ Ù·¯Â›·˜‰Ú¿Û˘ ÈÓÛÔ˘Ï›Ó˘ ηٿ Û˘Ó¤-ÂÈ· ÌÔÚ› Ó· ¯ÔÚËÁËı› ˆ˜ÚÔÁÂ˘Ì·ÙÈ΋ ÈÓÛÔ˘Ï›ÓË, Î·È Ó··ÓÙÈηٷÛÙ‹ÛÂÈ ÙËÓ ˘Ô‰fiÚÈ·¯ÔÚËÁÔ‡ÌÂÓË ÎÚ˘ÛÙ·ÏÏÈ΋ Ù·-¯Â›· ÈÓÛÔ˘Ï›ÓË ‹ ÙÔ Ù·¯‡ ·Ó¿-ÏÔÁÔ ÈÓÛÔ˘Ï›Ó˘, ÂÂȉ‹ ¤¯ÂÈÁÚ‹ÁÔÚË ¤Ó·ÚÍË ‰Ú¿Û˘ ηȉȿÚÎÂÈ· ‰Ú¿Û˘ ¿Óˆ ÙˆÓ 3ˆÚÒÓ. ∏ Èı·ÓfiÙËÙ· ˘ÔÁÏ˘-ηÈÌÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ ·fi ÙËÓ¯ÔÚ‹ÁËÛË ÂÈÛÓÂfiÌÂÓ˘ ÈÓÛÔ˘-Ï›Ó˘ Â›Ó·È ·ÚfiÌÔÈ· Ì ·˘Ù‹ÓÔ˘ ÚÔ·ÙÂÈ ·fi ÙËÓ ¯ÔÚ‹-ÁËÛË ˘Ô‰fiÚÈ· Ù·¯Â›·˜ ‰Ú¿-Û˘ ÈÓÛÔ˘Ï›Ó˘.

¢Ú·ÛÙÈÎfiÙËÙ·: ¶ÏÂÈ¿‰· ÌÂÏÂ-ÙÒÓ ¤¯Ô˘Ó ·Ô‰Â›ÍÂÈ ÙËÓ ‚Ú·-¯˘ÚfiıÂÛÌË Î·È Ì·ÎÚÔÚfiıÂ-ÛÌË ‰Ú·ÛÙÈÎfiÙËÙ· Ù˘ ÂÈÛÓÂfi-ÌÂÓ˘ ÈÓÛÔ˘Ï›Ó˘ Î·È ÛÙÔ˘˜ 2Ù‡Ô˘˜ ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË.™Â ·ÛıÂÓ›˜ Ì ‰È·‚‹ÙË Ù‡Ô˘2, ÌË ·ÓÙ·ÔÎÚÈÓfiÌÂÓÔ˘˜ ÛÂÎÏ·ÛÛÈ΋ ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜·ÓÙȉȷ‚ËÙÈ΋ ·ÁˆÁ‹, Ë ÂÈÛÓÂ-fiÌÂÓË ÈÓÛÔ˘Ï›ÓË ¯ÔÚËÁÔ‡ÌÂÓËÛÂ Û˘Ó‰˘·ÛÌfi Ì ·ÓÙȉȷ‚ËÙÈο‰ÈÛΛ·, ‚ÂÏÙ›ˆÛ ÛËÌ·ÓÙÈο ÙËÓHbA1C, Û ۯ¤ÛË Ì ÙËÓ ÔÌ¿‰··ÛıÂÓÒÓ Ô˘ ÂÏ¿Ì‚·Ó ÌfiÓÔÓ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ·ÁˆÁ‹. ∂›-Û˘ Û˘ÁÎÚ›ÓÔÓÙ·˜ ·ÛıÂÓ›˜ ̉ȷ‚‹ÙË Ù‡Ô˘ 2 Ô˘ ÂÏ¿Ì‚·-Ó·Ó ÂÈÛÓÂfiÌÂÓË ÈÓÛÔ˘Ï›ÓË Î·ÈUltralente, Ì ·ÛıÂÓ›˜ Ô˘ ÂÏ¿Ì-‚·Ó·Ó Û¯‹Ì·Ù· ÔÏÏ·ÏÒÓ ‰fi-ÛÂˆÓ Ì regular Î·È NPH, ‰ÂÓ·Ú·ÙËÚ‹ıËΠÛÙ·ÙÈÛÙÈο ÛË-Ì·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙȘ ÌÂÈÒÛÂÈ˜ÙˆÓ HBA1C ÛÙËÓ 12Ë Î·È ÙËÓ 24Ë

‚‰ÔÌ¿‰· ıÂڷ›·˜. ŸÌˆ˜ ËÔÌ¿‰· Ô˘ ÂÏ¿Ì‚·Ó ÂÈÛÓÂfi-ÌÂÓË ÈÓÛÔ˘Ï›ÓË ÂÌÊ¿ÓÈÛ ÛÂÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi HBA1C

<7%. (47% vs 32%).

™Â ‰È·‚ËÙÈÎÔ‡˜ Ì ‰È·‚‹ÙË Ù‡-Ô˘ 1, Ô˘ ÂÏ¿Ì‚·Ó·Ó Û˘Ó‰˘·-ÛÌfi ÂÈÛÓÂfiÌÂÓ˘ ÈÓÛÔ˘Ï›ÓË˜Î·È Ultralente, ‹ Ì›ÁÌ· regularÎ·È NPH ˘Ô‰ÔÚ›ˆ˜, ·Ú·ÙË-Ú‹ıËÎ·Ó ·ÚfiÌÔȘ ÌÂÈÒÛÂȘÛÙËÓ HbA1C.

Δ¤ÏÔ˜ ·ÛıÂÓ›˜ Ì ‰È·‚‹ÙË Ù‡-Ô˘ π, ËÏÈΛ·˜ 12-65 ÂÙÒÓ Ô˘

ÂÏ¿Ì‚·Ó·Ó NPH Ì ÂÈÛÓÂfiÌÂ-ÓË ÈÓÛÔ˘Ï›ÓË ‹ regular ˘Ô‰Ô-Ú›ˆ˜ Û ÂÓÙ·ÙÈÎÔÔÈË̤ÓÔ Û¯‹-Ì· ·ÚÔ˘Û›·Û·Ó ·ÚfiÌÔȘ ÌÂÈ-ÒÛÂȘ Ù˘ HbA1C, ·ÏÏ¿ Î·È ·-ÚfiÌÔÈÔ ÔÛÔÛÙfi ›Ù¢Í˘HbA1C<7% Î·È Û˘ÁÎÚ›ÛÈ̘ ÌÂÈ-ÒÛÂȘ ÛÙȘ ÌÂÙ·ÁÂ˘Ì·ÙÈΤ˜ ÙÈ-̤˜ ÁÏ˘Îfi˙˘.

∞ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ: ΔÔ ·˙ÏÙˆÓ ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓÙ˘ ÂÈÛÓÂfiÌÂÓ˘ ÈÓÛÔ˘Ï›Ó˘ Â-ÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ·‡ÍËÛË ÛˆÌ·ÙÈ-ÎÔ‡ ‚¿ÚÔ˘˜, Ù· ˘ÔÁÏ˘Î·ÈÌÈοÂÂÈÛfi‰È·, ÙÔÓ ‚‹¯· Î·È ÙËÓ ·‡-ÍËÛË Ù›ÙÏÔ˘ ·ÓÙÈ˚ÓÛÔ˘ÏÈÓÈÎÒÓ·ÓÙÈۈ̿وÓ.

∏ ÂÈÛÓÂfiÌÂÓË ÈÓÛÔ˘Ï›ÓË Û˘ÓÔ-‰Â‡ÂÙ·È Ì ·ÚfiÌÔÈ· ·‡ÍËÛËۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜ Û ۯ¤ÛËÌ ÂΛÓË Ô˘ ·Ú·ÙËÚÂ›Ù·È Û¢ԉfiÚÈ· ¯ÔÚ‹ÁËÛË.

Δ· ÔÛÔÛÙ¿ ˘ÔÁÏ˘Î·ÈÌÈÎÒÓÂÂÈÛÔ‰›ˆÓ Û ·ÛıÂÓ›˜ Ì ‰È·-‚‹ÙË Ù‡Ô˘ 1 Î·È 2 Ô˘ ÂÏ¿Ì-‚·Ó·Ó ÂÈÛÓÂfiÌÂÓË ÈÓÛÔ˘Ï›ÓË,‹Ù·Ó Û ‰È¿ÊÔÚ˜ ÌÂϤÙ˜, Û˘-ÁÎÚ›ÛÈÌ· Ì ÂΛӷ ÙˆÓ ·ÛıÂ-ÓÒÓ Ô˘ ÂÏ¿Ì‚·Ó·Ó ˘Ô‰ÔÚ›ˆ˜ÙËÓ ÈÓÛÔ˘Ï›ÓË.

ŸÌˆ˜ Ô Î›Ó‰˘ÓÔ˜ ˘ÔÁÏ˘Î·È-Ì›·˜ ·fi ¯ÔÚ‹ÁËÛË ÂÈÛÓÂfiÌÂ-Ó˘ ÈÓÛÔ˘Ï›Ó˘ Â›Ó·È ÌÂÁ·Ï‡ÙÂ-ÚÔ˜ ·fi ÙÔÓ ·ÓÙ›ÛÙÔÈ¯Ô ·ÛıÂ-ÓÒÓ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ·fi ÙÔ˘ÛÙfiÌ·ÙÔ˜ ·ÓÙȉȷ‚ËÙÈο ‰ÈÛΛ·.∫·Ù¿ Û˘Ó¤ÂÈ· Ô Î›Ó‰˘ÓÔ˜ ˘Ô-ÁÏ˘Î·ÈÌ›·˜ Â›Ó·È ÛËÌ·ÓÙÈο ÌÂ-Á·Ï‡ÙÂÚÔ˜ fiÙ·Ó ¯ÔÚËÁÂ›Ù·È Û˘Ó-‰˘·ÛÌfi˜ ÂÈÛÓÂfiÌÂÓ˘ ÈÓÛÔ˘-Ï›Ó˘ Î·È ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ‰È-ÛΛˆÓ.

∞˘ÍË̤ÓË Â›ÙˆÛË ‚‹¯· ·-Ú·ÙËÚ‹ıËΠ۠·ÛıÂÓ›˜ Ì ÂÈ-ÛÓÂfiÌÂÓË ÈÓÛÔ˘Ï›ÓË, Û˘ÁÎÚÈÙÈ-ο Ì ÙËÓ ˘Ô‰fiÚÈ· ¯ÔÚ‹ÁËÛËÙ˘ (15%-20% vs 5% ·ÓÙ›ÛÙÔÈ-¯·) Û ηϿ ÙÂÎÌËÚȈ̤Ó˜ ÌÂ-ϤÙ˜.

√ ‚‹¯·˜ ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ï›Á·ÏÂÙ¿ ÌÂÙ¿ ÙËÓ ÂÈÛÓÔ‹ Ù˘ ÈÓ-ÛÔ˘Ï›Ó˘, Â›Ó·È ·Ïfi˜ Î·È fi¯È·Ú·ÁˆÁÈÎfi˜ Î·È ÌÂÈÒÓÂÙ·È Ë›وÛË ÙÔ˘ Ì ÙËÓ Û˘Ó¤¯ÈÛËÙ˘ ·ÁˆÁ‹˜ Ì ÙËÓ ÂÈÛÓÂfiÌÂ-ÓË ÈÓÛÔ˘Ï›ÓË. ¢ÂÓ Û˘Óԉ‡ÂÙ·ÈÌ ÔÔÈ·‰‹ÔÙ ÏÂÈÙÔ˘ÚÁÈ΋Ó¢ÌÔÓÈ΋ ‰È·Ù·Ú·¯‹.

∞˘ÍË̤ÓË ·Ú·ÁˆÁ‹ ·ÓÙÈ˚ÓÛÔ˘-ÏÈÓÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ·Ú·ÙË-Ú‹ıËΠ۠·ÛıÂÓ›˜ Ì ‰È·‚‹ÙËÙ‡Ô˘ 1 Î·È 2 Ô˘ ¤Ï·‚·Ó ÂÈ-ÛÓÂfiÌÂÓË ÈÓÛÔ˘Ï›ÓË. ∏ ·‡ÍË-ÛË ·˘Ù‹ ÛÙÂÚÂ›Ù·È ÎÏÈÓÈ΋˜ ÛË-Ì·Û›·˜, fiÛÔÓ ·ÊÔÚ¿ ÙȘ ÂÈ-‰Ú¿ÛÂȘ ÛÙËÓ HbA1C, ÛÙȘ ‰fi-ÛÂȘ ÈÓÛÔ˘Ï›Ó˘, ÛÙËÓ Â›ÙˆÛˢÔÁÏ˘Î·ÈÌÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ ηÈÛÙËÓ ÂÌÊ¿ÓÈÛË ·ÏÏÂÚÁÈÎÒÓ ·ÓÙÈ-‰Ú¿ÛˆÓ.

ª·ÎÚÔ¯ÚfiÓÈ· ‰Â‰Ô̤ӷ Û¯ÂÙÈ-ο Ì ÙËÓ ‰Ú·ÛÙÈÎfiÙËÙ· ηÈÙȘ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ

√È Ì¤¯ÚÈ Û‹ÌÂÚ· ‰ËÌÔÛȇÛÂȘ‚‚·›ˆ˜ ·ÊÔÚÔ‡Û·Ó ¯ÚÔÓÈÎfi‰È¿ÛÙËÌ· ·Ú·ÎÔÏÔ‡ıËÛ˘ ̤-¯ÚÈ 6 Ì‹Ó˜ Î·È ¤ÙÛÈ Ù· Ì·ÎÚÔ-¯ÚfiÓÈ· ‰Â‰Ô̤ӷ ·Ó·Ì¤ÓÔÓÙ·ÓÌ ÂÍ·ÈÚÂÙÈÎfi ÂӉȷʤÚÔÓ. ™ÙÔ∞ÌÂÚÈοÓÈÎÔ ¢È·‚ËÙÔÏÔÁÈÎfi ™˘-Ó¤‰ÚÈÔ ÙÔ 2006 Ë ÔÌ¿‰· ÙÔ˘JovanÔvic ·ÚÔ˘Û›·Û ‰Â‰Ô̤-Ó· 2 ¯ÚfiÓˆÓ ·Ú·ÎÔÏÔ‡ıËÛ˘.ŒÙÛÈ ÌÂÙ¿ 24 Ì‹Ó˜ ·Ú·ÎÔ-ÏÔ‡ıËÛ˘ 291 ·ÙfiÌˆÓ Ì ™¢Ù‡Ô˘ π, Ô˘ Ù˘¯·ÈÔÔÈ‹ıËηÓÛ ÂÈÛÓÂfiÌÂÓË ÈÓÛÔ˘Ï›ÓË (∂.π.)-Exubera- ¤Ó·ÓÙÈ 291 ·ÙfïÓÔ˘ Ù˘¯·ÈÔÔÈ‹ıËÎ·Ó Û ˘Ô-‰fiÚÈ· (À¢) Ù·¯Â›· ÈÓÛÔ˘Ï›ÓˉȷÈÛÙÒıËΠfiÙÈ: ·) Ë ÔÌ¿‰·∂.π. ·ÚÔ˘Û›·Û ·ÚfiÌÔÈ· ÁÏ˘-ηÈÌÈ΋ Ú‡ıÌÈÛË Ì ÙËÓ À¢(HbA1C 7.5% vs. 7.3%), ‚) Û˘-ÓÔÏÈο ÔÈ ˘ÔÁÏ˘Î·È̛˜ ‹Ù·ÓÛ˘ÁÎÚ›ÛÈ̘ ÌÂٷ͇ ÙˆÓ 2 ·Ùfi-ÌˆÓ (∂π vs. À¢: 4 vs. 3.8 Û˘Ì‚¿-Ì·Ù·/ ¿ÙÔÌÔ/ Ì‹Ó·), ÂÓÒ ÛÔ‚·-Ú¤˜ ˘ÔÁÏ˘Î·È̛˜ ‹Ù·Ó ÛËÌ·-ÓÙÈο ÏÈÁfiÙÂÚ˜ ÛÙËÓ ÔÌ¿‰· ∂π(∂π vs. À¢: 2.8 vs. 4.1 Û˘Ì‚¿Ì·-Ù·/ 100 ¿ÙÔÌ·/ Ì‹Ó˜), Á) ٷۿί·Ú· ÓËÛÙ›·˜ ÌÂÈÒıËηÓÂÚÈÛÛfiÙÂÚÔ Ì ÙËÓ ∂π (·fi170 Û 156 mg% vs. 167 Û 173mg% ÛÙËÓ À¢ ÔÌ¿‰·), ‰) ËÚfiÛÎÙËÛË ‚¿ÚÔ˘˜ ‹Ù·Ó Û·-ÊÒ˜ ÏÈÁfiÙÂÚË Ì ÙËÓ ∂π (0.8 kgÛÙËÓ ∂π vs. 2 kg ÛÙËÓ À¢ ÔÌ¿‰·).

∏ ÔÌ¿‰· ÙÔ˘ Rosenstock ·fiÙÔ ¡Ù¿Ï·˜ ÛÙÔ ›‰ÈÔ Û˘Ó¤‰ÚÈÔ·ÚÔ˘Û›·Û ›Û˘ Ù· ‰Â‰Ô̤-Ó· ·fi ·Ú·ÎÔÏÔ‡ıËÛË 2 ÂÙÒÓ,635 ·ÙfiÌˆÓ Ì ™¢ Ù‡Ô˘ ππ Ô˘Ù˘¯·ÈÔÔÈ‹ıËÎ·Ó Û ÂÈÛÓÂfiÌÂ-ÓË ÈÓÛÔ˘Ï›ÓË (∂.π.) ‹ ˘Ô‰fiÚÈ·(À¢) ÈÓÛÔ˘Ï›ÓË.

ΔÔ ÚˆÙÔÁÂÓ¤˜ ÙÂÏÈÎfi ÛËÌ›ÔÛÙËÓ ÌÂϤÙË ‹Ù·Ó Ë Ó¢ÌÔÓÈ΋

ATHIROSK 14 03-07-07 12:06 ™ÂÏ›‰·22

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£∂ƒ∞¶∂π∞ - º∞ƒª∞∫∞

23

ÏÂÈÙÔ˘ÚÁ›· Î·È Ù· ‰Â˘ÙÂÚÔÁÂÓ‹‹Ù·Ó Ë HbA1C, Ë ˘ÔÁÏ˘Î·ÈÌ›·,ÙÔ Û¿Î¯·ÚÔ ÓËÛÙ›·˜ Î·È ÙÔۈ̷ÙÈÎfi ‚¿ÚÔ˜. ∏ ÔÌ¿‰· Ù˘∂.π ·ÚÔ˘Û›·Û Ôχ ÌÈÎÚ¤˜·ÏÏ·Á¤˜ ÛÙ· ÙÂÛÙ Ù˘ Ó¢ÌÔ-ÓÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ (FEV1 -ÂÎÓÂ-fiÌÂÓÔ˜ fiÁÎÔ˜ ·¤Ú· ÛÙÔ 1’’- ηÈDLCO -ÈηÓfiÙËÙ· ‰È¿¯˘Û˘C√-). OÈ ·ÏÏ·Á¤˜ ·˘Ù¤˜ ‹Ù·ÓÌÈÎÚfiÙÂÚ˜ ÙÔ˘ 1.5% Ù˘ ̤Û˘ÙÈÌ‹˜ ÙˆÓ ‰ÂÈÎÙÒÓ ·˘ÙÒÓ, Û˘Ó¤-‚ËÛ·Ó ÓˆÚ›˜ Î·È ·Ú¤ÌÂÈÓ·ÓÛÙ·ıÂÚ¤˜, ¯ˆÚ›˜ ÂͤÏÈÍË Î·Ù¿ÙËÓ ‰È¿ÚÎÂÈ· Ù˘ 2¯ÚÔÓ˘ ·-Ú·ÎÔÏÔ‡ıËÛ˘.

√È ‰‡Ô ÔÌ¿‰Â˜ ·ÚÔ˘Û›·Û·ÓÙËÓ ›‰È· ‚ÂÏÙ›ˆÛË ÛÙË ÁÏ˘Î·ÈÌÈ-΋ Ú‡ıÌÈÛË, ÂÓÒ Ë ÔÌ¿‰· Ù˘∂.π ·ÚÔ˘Û›·Û ÛËÌ·ÓÙÈο ÏÈ-ÁfiÙÂÚ˜ ˘ÔÁÏ˘Î·È̛˜ (0.4 vs.0.6 Û˘Ì‚¿Ì·Ù·/ 100 ·ÛıÂÓ›˜/Ì‹Ó˜), ÌÂÁ·Ï‡ÙÂÚ˜ ‚ÂÏÙÈÒÛÂȘÛÙ· ۿί·Ú· ÓËÛÙ›·˜ (·fi151 Û 135 vs. 148 Û 147 mg%)Î·È ÌÈÎÚfiÙÂÚË ÚfiÛÎÙËÛË ‚¿-ÚÔ˘˜ ÛÙËÓ ‰ÈÂÙ›· (·fi 87 ÛÂ88.8. Kg vs. 88 Û 91.5 ÛÙËÓÔÌ¿‰· Ù˘ À.π).

∞ÛÊ¿ÏÂÈ·: ¢ÂÓ ¤¯ÂÈ ‰È·ÈÛÙˆ-ı› Û ·ÛıÂÓ›˜ Ì ‰È·‚‹ÙË Ù‡-Ô˘ 1 ‹ 2, ·fi ÙȘ ÚÔ‚ÏÂfiÌÂ-Ó˜ ÏÂÈÙÔ˘ÚÁÈΤ˜ ‰ÔÎÈÌ·Û›Â˜ÙˆÓ Ó¢ÌfiÓˆÓ (ÛÈÚÔ̤ÙÚËÛËÎ·È Ì¤ÙÚËÛË ‰È·¯˘ÙÈ΋˜ ÈηÓfi-ÙËÙ·˜ Ó¢ÌfiÓˆÓ) ‰˘ÛÌÂÓ‹˜Â›‰Ú·ÛË Ù˘ ÂÈÛÓÂfiÌÂÓ˘ ÈÓ-ÛÔ˘Ï›Ó˘. ŸÌˆ˜ ÛÙËÓ ÏÂÈÔ„Ë-Ê›· ÙˆÓ ÌÂÏÂÙÒÓ, ‰ÂÓ ÂÌÂÚȤ-¯ÂÙ·È Û˘ÓÂÎÙ›ÌËÛË fiÏˆÓ ÙˆÓ··Ú·›ÙËÙˆÓ ‰ÔÎÈÌ·ÛÈÒÓ ÚÔ-ÎÂÈ̤ÓÔ˘ ÂÍ·¯ıÔ‡Ó ·ÛÊ·Ï‹ Û˘-ÌÂÚ¿ÛÌ·Ù·. ∂Ú¢ÓËÙÈο ‰Â‰Ô-̤ӷ ¤¯Ô˘Ó ÙÂÎÌËÚÈÒÛÂÈ ÙËÓ·ÛÊ¿ÏÂÈ· ¯ÔÚ‹ÁËÛ˘ ÂÈÛÓÂfi-ÌÂÓ˘ ÈÓÛÔ˘Ï›Ó˘ ÌÂÙ¿ Û˘Ó¯‹¯ÔÚ‹ÁËÛË 4 ÂÙÒÓ.

¶·Ú’ fiÏ· ·˘Ù¿ Û˘ÓÈÛÙ¿Ù·È Ó·Á›ÓÂÙ·È Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ÛÈÚÔ̤ÙÚËÛË Î·È ÂÎÙ›ÌËÛË Î˘-Ú›ˆ˜ ÙÔ˘ FEV1 ÚÈÓ ÙËÓ ¤Ó·ÚÍË·ÁˆÁ‹˜ Ì ÂÈÛÓÂfiÌÂÓË ÈÓÛÔ˘-Ï›ÓË. FEVI >70% ·ÔÙÂÏ› ·ÛÊ·-Ϥ˜ ¯¤ÁÁ˘Ô ÁÈ· ÙËÓ ¤Ó·ÚÍËÙÔ˘ Exubera. ∂·Ó·ÏËÙÈ΋ ÛÈ-ÚÔ̤ÙÚËÛË Ú¤ÂÈ Ó· Á›ÓÂÙ·ÈÛÙÔ˘˜ 6 Ì‹Ó˜. ∂¿Ó ˘¿Ú¯ÂÈ

Ì›ˆÛË Ì¤¯ÚÈ 15% ÙÔ˘ FEVπ,Û˘ÓÈÛÙ¿Ù·È Â·Ó¿ÏË„Ë ÂÙ‹ÛÈ·Ù˘ ÛÈÚÔ̤ÙÚËÛ˘. ∂¿Ó Ë Ì›-ˆÛË Â›Ó·È 15-20%, ÙfiÙ Ӥ· ÛÈ-ÚÔ̤ÙÚËÛË Ú¤ÂÈ Ó· Á›ÓÂÈ Û 3Ì‹Ó˜. ∂¿Ó fï˜ Ë Ì›ˆÛË ÙÔ˘FEVπ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË ÙÔ˘ 20%,ÙfiÙ ı· Ú¤ÂÈ Ó· Á›ÓÂÈ ¿ÌÂÛˉȷÎÔ‹ ÙÔ˘ Exubera.

™Â η̛· ÌÂϤÙË ¤ˆ˜ Û‹ÌÂÚ·‰ÂÓ ¤¯ÂÈ ¯ÔÚËÁËı› ÂÈÛÓÂfiÌÂ-ÓË ÈÓÛÔ˘Ï›ÓË Û ‰È·‚ËÙÈÎÔ‡˜ ÌÂÛ˘Ó˘¿Ú¯Ô˘Û· Ó¢ÌÔÓÈ΋ Ófi-ÛÔ. ™˘ÓÂÒ˜ ‰ÂÓ ÚÔÙ›ÓÂÙ·È Ë¯ÔÚ‹ÁËÛË Ù˘ Û ¿ÙÔÌ· ÌÂ Û˘-ÓÔ‰¿ Ó¢ÌÔÓÈο ÓÔÛ‹Ì·Ù·.

∏ Û¯¤ÛË ÙÔ˘ ηӛÛÌ·ÙÔ˜ ÌÂÙËÓ ·ÔÚÚfiÊËÛË Ù˘ ÂÈÛÓÂfi-ÌÂÓ˘ ÈÓÛÔ˘Ï›Ó˘ ·ÔÙÂÏ› Â-‰›Ô ÂÎÙÂٷ̤Ó˘ ¤Ú¢ӷ˜ ·ÏÏ¿Î·È ÂÈÛÙËÌÔÓÈ΋˜ Û˘˙‹ÙËÛ˘.ªÂϤÙ˜ Û ÂÈÚ·Ì·Ùfi˙ˆ· ·Ï-Ï¿ Î·È Û ·ÓıÚÒÔ˘˜ ¤¯Ô˘Ó‰Â›ÍÂÈ fiÙÈ Ô Î·Ófi˜ ÙÔ˘ ÙÛÈÁ¿-ÚÔ˘ ·˘Í¿ÓÂÈ ÙËÓ ‰È·ÂÚ·ÙfiÙË-Ù· ÙÔ˘ ΢„ÂÏȉÔÙÚȯÔÂȉÈÎÔ‡ÊÚ·ÁÌÔ‡, Ì ·ÔÙ¤ÏÂÛÌ· ÔÈ

∂ÈÎfiÓ· 1. ŒÓ·ÚÍË Î·È ‰È¿ÚÎÂÈ· ‰Ú¿Û˘ ÂÈÛÓÂfiÌÂÓ˘ ÈÓÛÔ˘Ï›Ó˘ (Exubera), ˘Ô‰fiÚÈ· ¯ÔÚËÁÔ‡ÌÂ-ÓÔ˘ Ù·¯¤Ô˜ ·Ó¿ÏÔÁÔ˘ ÈÓÛÔ˘Ï›Ó˘ (Lispro) Î·È ÂÓ‰ÔÊϤ‚È· ¯ÔÚËÁÔ‡ÌÂÓ˘ ÈÓÛÔ˘Ï›Ó˘

EXUBERA PD Profile

Mea

n G

R(P

erce

ntag

e M

axim

um)100

80

60

40

20

00 120 240 360 480 600

Time (min)PD= pharmacodynamic GIR= glucose infusion rate.copyright ® 2005 American Diadetes Association from Rate K, et al. Diadetes

with permission from The American Diadetes AssociationPfizer Inc 2006 All rightsre served Version 1

ŒÓ·ÚÍË ‰Ú¿Û˘:

Exubera: 32 minLispro: 41 minSoluble: 48 min

¢È¿ÚÎÂÈ· ‰Ú¿Û˘:

Exubera: 387 minLispro: 313 minSoluble: 415 min

Care, Vol. 28, 2005 1077 - 1082 Modified

ATHIROSK 14 03-07-07 12:06 ™ÂÏ›‰·23

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··ÈÙÔ‡ÌÂÓ˜ ‰fiÛÂȘ ÂÈÛÓÂfi-ÌÂÓ˘ ÈÓÛÔ˘Ï›Ó˘ Èı·ÓfiÓ Ó·Â›Ó·È ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚ˜.

¶Ú·ÁÌ·ÙÈο ÌÂϤÙ˜ Û ηÓÈ-ÛÙ¤˜ ÌË ‰È·‚ËÙÈÎÔ‡˜ ¤‰ÂÈÍ·ÓfiÙÈ, Ë Ì¤ÁÈÛÙË Û˘ÁΤÓÙÚˆÛË ÈÓ-ÛÔ˘Ï›Ó˘ fi¯È ÌfiÓÔÓ ‹Ù·Ó ÌÂÁ·-χÙÂÚË (¤ˆ˜ Î·È 5 ÊÔÚ¤˜) ÂΛ-Ó˘ ÙˆÓ ÌË Î·ÓÈÛÙÒÓ, ·ÏÏ¿ÂÈÛ˘Ì‚·›ÓÂÈ Î·È Ù·¯‡ÙÂÚ· (31vs 53 min). ∞Ó·fiÊ¢ÎÙ· ¤ÙÛȉÂÓ ÚÔÙ›ÓÂÙ·È Ë ¯ÔÚ‹ÁËÛË ÂÈ-ÛÓÂfiÌÂÓ˘ ÈÓÛÔ˘Ï›Ó˘ Û η-ÓÈÛÙ¤˜ ‰È·‚ËÙÈÎÔ‡˜ ·ÊÔ‡ ‰ÂÓÂ›Ó·È ÚԂϤ„È̘ ÔÈ ÌÂÙ·‚Ô-Ϥ˜ ÛÙËÓ ·ÔÚÚfiÊËÛË Ù˘ÛÙËÓ Û˘ÛÙËÌ·ÙÈ΋ ΢ÎÏÔÊÔÚ›·.∫·Ù¿ Û˘Ó¤ÂÈ· ÔÈ ‰È·‚ËÙÈÎÔ›ÚÔ Ù˘ ¯ÔÚ‹ÁËÛ˘ ÂÈÛÓÂfiÌÂ-Ó˘ ÈÓÛÔ˘Ï›Ó˘ ÂÓı·ÚÚ‡ÓÔÓÙ·ÈÁÈ· ‰È·ÎÔ‹ ηӛÛÌ·ÙÔ˜. ŒÍÈÌ‹Ó˜ ÌÂÙ¿ ÙËÓ ‰È·ÎÔ‹ ηӛ-ÛÌ·ÙÔ˜ Â›Ó·È ‰˘Ó·Ù‹ Ë ¤Ó·ÚÍ˯ÔÚ‹ÁËÛ˘ ÂÈÛÓÂfiÌÂÓ˘ ÈÓ-ÛÔ˘Ï›Ó˘.

¢ÂÓ ÚÔÙ›ÓÂÙ·È Â›Û˘ Ë ¯ÔÚ‹-ÁËÛË Ù˘ ∂π › ÙÔ˘ ·ÚfiÓÙÔ˜ÛÙ· ·È‰È¿ Î·È ÛÙȘ ΢ÔÊÔÚÔ‡-Û˜ ‰È·‚ËÙÈΤ˜ Á˘Ó·›Î˜, ÏfiÁˆ¤ÏÏÂȄ˘ Û¯ÂÙÈÎÒÓ ÌÂÏÂÙÒÓ.

∞Ô‰Ô¯‹ Î·È Û˘ÌÌfiÚʈÛËÙˆÓ ·ÛıÂÓÒÓ

√È ‰È·‚ËÙÈÎÔ› ·ÛıÂÓ›˜ ÚÔÙÈ-ÌÔ‡Ó ·Ó·ÌÊÈÛ‚‹ÙËÙ· ÙËÓ ÂÈ-ÛÓÂfiÌÂÓË Û˘ÁÎÚÈÙÈο Ì ÙËÓ˘Ô‰fiÚÈ· ÈÓÛÔ˘Ï›ÓË. ™ËÌ·ÓÙÈοÂÚÈÛÛfiÙÂÚÔÈ ‰È·‚ËÙÈÎÔ› Ù‡Ô˘π Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡Û·Ó ÂÈÛÓÂ-

fiÌÂÓË ÈÓÛÔ˘Ï›ÓË ‹Ù·Ó Û˘ÓÔÏÈοÈηÓÔÔÈË̤ÓÔÈ ¤Ó·ÓÙÈ ·˘ÙÒÓÔ˘ ¯ÚËÛÈÌÔÔÈÔ‡Û·Ó ˘Ô‰fi-ÚÈ· (35.1% vs. 10.6%, p<0.001).T· Â˘Ú‹Ì·Ù· ÛÙÔ˘˜ ‰È·‚ËÙÈ-ÎÔ‡˜ Ù‡Ô˘ ππ ‹Ù·Ó ·ÚfiÌÔÈ·.

∏ Û˘ÌÌfiÚʈÛË ÙˆÓ ·ÛıÂÓÒÓ›Û˘ ‹Ù·Ó ÔˆÛ‰‹ÔÙ ÔχÌÂÁ·Ï‡ÙÂÚË Ì ÙËÓ ÂÈÛÓÂfiÌÂ-ÓË ÈÓÛÔ˘Ï›ÓË Û˘ÁÎÚÈÙÈο Ì ÙËÓ˘Ô‰fiÚÈ· (3ÌËÓË ÌÂϤÙË Û‰ȷ‚ËÙÈÎÔ‡˜ Ù‡Ô˘ ππ Û˘ÌÌfiÚ-ʈÛË 94% vs. 64%, p<0.001).

™Â ¿ÏÏË Â›Û˘ ÌÂϤÙË ‰Â›¯ıË-ΠfiÙÈ Ë ÂÈÛÓÂfiÌÂÓË ÈÓÛÔ˘Ï›ÓË·˘Í¿ÓÂÈ Î·Ù¿ ÛËÌ·ÓÙÈο ÌÂÁ·-χÙÂÚÔ ‚·ıÌfi ÙËÓ Èı·ÓfiÙËÙ··Ô‰Ô¯‹˜ Ù˘ ÈÓÛÔ˘ÏÈÓÔıÂÚ·-›·˜ Û˘ÁÎÚÈÙÈο Ì ÙËÓ ÚfiÙ·-ÛË ÙËÓ ˘Ô‰fiÚÈ·˜ ÈÓÛÔ˘Ï›Ó˘(43.2% vs. 10.5%).

¶ÚÔ‚ÏËÌ·ÙÈÛÌÔ›,ÂÚˆÙËÌ·ÙÈο

√ˆÛ‰‹ÔÙ ÙÔ ÙÔ›Ô Ù˘ ÂÈ-ÛÓÂfiÌÂÓ˘ ÈÓÛÔ˘Ï›Ó˘ ‰ÂÓ Â›-Ó·È ·Ôχو˜ ۷ʤ˜ Î·È ÍÂη-ı·ÚÈṲ̂ÓÔ. ∂ÚˆÙËÌ·ÙÈο ÂÍ·-ÎÔÏÔ˘ıÔ‡Ó Ó· ˘¿Ú¯Ô˘Ó, ÚÔ-‚ÏËÌ·ÙÈÛÌÔ› Ô˘ ·Ó·˙ËÙÔ‡ÓÙÂÎÌËÚȈ̤Ó˜ ··ÓÙ‹ÛÂȘ:

·) Y¿Ú¯Ô˘Ó ÂӉ¯fiÌÂÓ˜ ·-ÚÂÓ¤ÚÁÂȘ ÛÙÔ ·Ó·Ó¢ÛÙÈÎfiÂÈı‹ÏÈÔ Î·È Û ‚¿ıÔ˜ ¯ÚfiÓÔ˘Ù˘ ¯ÔÚ‹ÁËÛ˘ ۯ‰fiÓ 3 ÊÔ-Ú¤˜ ÂÚÈÛÛfiÙÂÚ˘ ÈÓÛÔ˘Ï›Ó˘Ì ÙËÓ ÂÈÛÓ¢ÛÙÈ΋ Û˘ÁÎÚÈÙÈοÌ ÙËÓ ÂÓ¤ÛÈÌË Ì¤ıÔ‰Ô; Δ· ̤-¯ÚȘ ÛÙÈÁÌ‹˜ ‰Â‰Ô̤ӷ ‰ÂÓ

ÂÌÓ¤Ô˘Ó ·ÓËÛ˘¯›·, fï˜, Ëȉȷ›ÙÂÚ· Ì·ÎÚfi¯ÚÔÓË ·Ú·ÎÔ-ÏÔ‡ıËÛË ı· ‰ÒÛÂÈ ÔÚÈÛÙÈΤ˜··ÓÙ‹ÛÂȘ.

‚) ∏ ¯ÔÚ‹ÁËÛË ÈÓÛÔ˘Ï›Ó˘ ÛÙ··È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ ·ÏÏ¿-˙ÂÈ, ÙÚÔÔÔÈ›, ‰È·ÊÔÚÔÔÈ›ÙËÓ Ó¢ÌÔÓÈ΋ ·Ó¿Ù˘ÍË;

Á) ∞˘Í¿ÓÂÈ Ë ÂÈÛÓÂfiÌÂÓË ÈÓ-ÛÔ˘Ï›ÓË ÙËÓ ÂͤÏÈÍË ÂӉ¯fiÌÂ-Ó˘ ·Ó·Ù˘ÛÛfiÌÂÓ˘ ηÎÔ‹ıÂÈ-·˜ ÛÙÔÓ Ó‡ÌÔÓ· ‹ ÂÈ‚·Ú‡ÓÂÈÙËÓ ·ıÔÊ˘ÛÈÔÏÔÁ›· Î·È ÙËÓÎÏÈÓÈ΋ ÂÈÎfiÓ· ˘ÔΛÌÂÓ˘ Ó¢-ÌÔÓÈ΋˜ ›ÓˆÛ˘;

‰) £· ˘¿ÚÍÂÈ ÌÂÏÏÔÓÙÈο ·Ô-ÙÂÏÂÛÌ·ÙÈ΋ ÂÈÛÓÂfiÌÂÓË ÈÓÛÔ˘-Ï›ÓË Ì·ÎÚ¿˜ ‰Ú¿Ûˆ˜;

Â) ¶ÔÈÔ ÙÔ Â‡ÚÔ˜ Ù˘ ÌÂÙ·‚ÏË-ÙfiÙËÙ·˜ ·ÔÚÚfiÊËÛ˘ Ù˘ ÂÈ-ÛÓÂfiÌÂÓ˘ ÈÓÛÔ˘Ï›Ó˘ οو·fi ÙËÓ Â›‰Ú·ÛË ‰È·ÊfiÚˆÓÌÔÚÊÒÓ ¿ÛÎËÛ˘, ·Ó¿ÏÔÁ· ÌÂÙËÓ Û˘Û΢‹ ¯ÔÚ‹ÁËÛ˘ ηȷӿÏÔÁ· Ì ÙËÓ Ù¯ÓÈ΋ Ù˘ ÂÈ-ÛÓÔ‹˜;

π √ À ¡ π √ ™ 2 0 0 7

24

∂π™¶¡∂√ª∂¡∏ π¡™√À§π¡∏: ª√ƒº∂™ ∫∞π π¢π√Δ∏Δ∂™ Δø¡ ¢π∞º√ƒø¡ º∞ƒª∞∫∂ÀΔπ∫ø¡ ∂∫¢√Ãø¡

ŸÓÔÌ· MÔÚÊ‹ÈÓÛÔ˘Ï›Ó˘

ŒÓ·ÚÍˉڿÛ˘(ÏÂÙ¿)

ÃÚfiÓÔ˜·È¯Ì‹˜(ÏÂÙ¿)

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¶›Ó·Î·˜ 1. ™˘ÛÙ‹Ì·Ù· Î·È Û˘Û΢¤˜ ¯ÔÚ‹ÁËÛ˘ ÂÈÛÓÂfiÌÂÓ˘ ÈÓÛÔ˘Ï›Ó˘

ATHIROSK 14 03-07-07 12:06 ™ÂÏ›‰·24

Page 27: ΤΕΥΧΟΣ 14 ΙΟΥΝΙΟΣ 2007 - ΑΘΗΡΟΣΚΛΗΡΩΣΗ

™˘ÌÂÚ·ÛÌ·ÙÈο

∏ ÂÈÛÓÂfiÌÂÓË ÈÓÛÔ˘Ï›ÓË ÌÔ-Ú› Ó· ·ÔÙÂϤÛÂÈ ÂÓ·ÏÏ·ÎÙÈ-΋ χÛË ÛÙËÓ Ù·¯Â›·˜ ‰Ú¿Û˘ÈÓÛÔ˘Ï›ÓË Ì ÈÛ¿ÍÈ· ‰Ú·ÛÙÈÎfi-ÙËÙ· Î·È ·ÛÊ¿ÏÂÈ·, Û˘Á¯ÔÚË-ÁÔ‡ÌÂÓË Ì ÂӉȿÌÂÛ˘ ‰Ú¿-Û˘ ÈÓÛÔ˘Ï›ÓË ‹ ÛÂ Û˘Ó‰˘·-ÛÌfi Ì ·ÓÙȉȷ‚ËÙÈο ‰ÈÛΛ·.¢ÂÓ Ê·›ÓÂÙ·È Ó· ÂËÚ¿˙ÂÈ

ÙËÓ Ó¢ÌÔÓÈ΋ ÏÂÈÙÔ˘ÚÁ›·,·ÏÏ¿ ‰ÂÓ Û˘ÛÙ‹ÓÂÙ·È Û ‰È·-‚ËÙÈÎÔ‡˜ Ì ¯ÚfiÓÈ· ·ÔÊÚ·-ÎÙÈ΋ Ó¢ÌÔÓÔ¿ıÂÈ·, ¿ÛıÌ·Û ·È‰È¿ Î·È Û ηÓÈÛÙ¤˜. ∏·Ô‰Ô¯‹ Ù˘ Î·È Ë ÈηÓÔÔ›ËÛËÙˆÓ ‰È·‚ËÙÈÎÒÓ ·fi ÙËÓ ¯ÔÚ‹-ÁËÛË Ù˘, (ÁÂÁÔÓfi˜ Ô˘ ‰È·È-ÛÙÒıËΠ۠fiϘ ÙȘ ÌÂϤÙ˜),ÌÔÚ› Ó· ·ÔÙÂϤÛÂÈ ¤Ó·˘ÛÌ·

ÁÈ· ÙËÓ ¯ÔÚ‹ÁËÛË Ù˘ ÛÙ· ¿ÙÔ-Ì· Ì ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË.

¶¿ÓÙ· fï˜ ı· Ú¤ÂÈ Ó· Û˘-ÓÂÎÙÈÌÒÓÙ·È ÔÈ Û¯ÂÙÈΤ˜ ·ÓÙÂÓ-‰Â›ÍÂȘ fiˆ˜ Î·È ÔÈ ·Ó·Áη›Â˜ÚÔ¸Ôı¤ÛÂȘ ÒÛÙÂ Ë ¯ÔÚ‹ÁË-ÛË Ù˘ ÂÈÛÓÂfiÌÂÓ˘ ÈÓÛÔ˘Ï›-Ó˘ Ó· Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈÎ‹Î·È ·ÛÊ·Ï‹˜.

£∂ƒ∞¶∂π∞ - º∞ƒª∞∫∞

25

1. Davidson M. B., Mehta A.E., Siraj E.S.,et al: Inhaled Human Insulin: AnInspiration For Patients With DiabetesMellitus? Cleveland Clinic Journal OfMedicine. 2006; 73, Num. 6. 569-78

2. Barnett AH. Exubera inhaled insulin: areview. J Clin P 2004; 58: 394-401).

3. Reinhard H.A. Becker, Sue Sha, AnnkeD. Frick, et al. The Effect of SmokingCessation and Subsequent Resumptionon Absorption of Inhaled Insulin.Diabetes Care 2006; 29: 277-282

4. Freemantle N, Blonde L, Duhot D, et al.Availability of inhaled insulin promotesgreater perceived acceptance of insulintherapy in patients with type 2 diabetes.Diabetes Care 2005; 28:427–428.

5. ∞. ªÂÏȉÒÓ˘: ∂ÈÛÓÂfiÌÂÓË ÈÓÛÔ˘Ï›ÓËÛÂÏ. 741-756 ·fi «∫·Ú‰ÈÔÌÂÙ·‚ÔÏÈÎfi˜Î›Ó‰˘ÓÔ˜». ∞. ªÂÏȉÒÓ˘ 2007, ÂΉfi-ÛÂȘ π. ¶·ÚÈÛÈ¿ÓÔ˜.

6. Barnett AH. Exubera inhaled insulin: areview. J Clin P 2004; 58: 394-401).

7. Skyler J.S., Jovanovic L., Klioze S. et al.Two-Year Safety and Efficacy of Inhaled

Human Insulin (Exubera) in AdultPatients With Type 1 Diabetes.Diabetes Care 2007; 30: 579-585

8. Nathan David M.. Counterpoint: NoTime to Inhale: Arguments AgainstInhaled Insulin in 2007 Diabetes Care2007; 30: 442- 444

9. Cefalu W.T.: Point: PulmonaryInhalation of Insulin: Another "Brick inthe Wall". Diabetes Care 2007; 30/

10. McMahon G.R. A. Inhaled Insulin forDiabetes Mellitus .: NEJM 2007; 356:497- 502

™™˘̆ÓÓÈÈÛÛÙÙÒÒÌÌÂÂÓÓËË μμÈÈ‚‚ÏÏÈÈÔÔÁÁÚÚ··ÊÊ››··

√È ‚-∞ÔÎÏÂÈÛÙ¤˜ ÛÙËÓ ∫ÏÈÓÈ΋ ¶Ú¿ÍË

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

ΔÔ̤·˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ

∂ÈÛ·ÁˆÁ‹√È ‚-·ÔÎÏÂÈÛÙ¤˜ ¯ÚËÛÈÌÔÔÈÔ‡-ÓÙ·È Â˘Ú‡Ù·Ù· Â‰Ò Î·È 4 ‰ÂηÂ-ٛ˜ Î·È ıˆÚÔ‡ÓÙ·È Ì¤¯ÚÈ Û‹ÌÂ-Ú·, Û‡Ìʈӷ Ì ÙȘ ηÙ¢ı˘ÓÙ‹-ÚȘ Ô‰ËÁ›Â˜, Ê¿Ú̷η ÚÒÙ˘ÁÚ·ÌÌ‹˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛËÙ˘ ·ÚÙËÚȷ΋˜ ˘¤ÚÙ·Û˘ (∞À).øÛÙfiÛÔ, Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ·Ì-ÊÈÛ‚ËÙÂ›Ù·È ·fi ÔÏÏÔ‡˜ ÂÚ¢ÓË-Ù¤˜ Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿ ÙÔ˘˜fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ÚfiÏË„Ë ÙˆÓÌÂÈ˙fiÓˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·-Ì¿ÙˆÓ. ªÂÙ·-·Ó·Ï‡ÛÂȘ Ô˘ ÂÚÈ-Ï·Ì‚¿ÓÔ˘Ó ÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓÙ˘¯·ÈÔÔÈËÌ¤ÓˆÓ ÎÏÈÓÈÎÒÓ ÌÂÏÂ-ÙÒÓ, ÔÈ Ôԛ˜ Û˘Ó¤ÎÚÈÓ·Ó ÙÔ˘˜ ‚-·ÔÎÏÂÈÛÙ¤˜ Ì ÂÈÎÔÓÈÎfi ‹ ¿ÏÏÔÊ¿ÚÌ·ÎÔ, ·Ú¤¯Ô˘Ó ÂӉ›ÍÂȘ η-Ù¿ Ù˘ ‰È·Ù‹ÚËÛ‹˜ ÙÔ˘˜ ˆ˜ ·ÓÙÈ˘-ÂÚÙ·ÛÈο Ê¿Ú̷η ÚÒÙ˘ ÂÈ-ÏÔÁ‹˜. ¶Ú¤ÂÈ Ó· ÂÈÛËÌ·Óı›,ˆÛÙfiÛÔ, fiÙÈ Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙË-Ù¿ ÙÔ˘˜ ‰È·Ê¤ÚÂÈ, ÙfiÛÔ ÌÂÙ·Í‡ÙˆÓ ‰È·ÊÔÚÂÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ·˘-Ù‹˜ Ù˘ ÔÌ¿‰·˜, ηıÒ˜ Î·È fiÛÔÓ·ÊÔÚ¿ ÙȘ ‰È¿ÊÔÚ˜ ËÏÈÎȷΤ˜

ÔÌ¿‰Â˜. ™ÙÔ ¿ÚıÚÔ ·˘Ùfi ı· ·-ÚÔ˘ÛÈ·ÛıÔ‡Ó Û˘ÓÔÙÈο ÔÈ ÛËÌ·-ÓÙÈÎfiÙÂÚ˜ ÌÂÙ·-·Ó·Ï‡ÛÂȘ ÌÂÏÂ-ÙÒÓ ¯ÔÚ‹ÁËÛ˘ ÙˆÓ ‚-·ÔÎÏÂÈ-ÛÙÒÓ Î·È ı· Û˘˙ËÙËı› ‰ÈÂÍÔ‰ÈÎ¿Ô ÚfiÏÔ˜ ÙÔ˘˜ ÛÙË ıÂڷ›· Ù˘ڈÙÔ·ıÔ‡˜ ∞À.

√È ÛËÌ·ÓÙÈÎfiÙÂÚ˜ ÌÂÙ·-·Ó·Ï‡ÛÂȘ ¯ÔÚ‹ÁËÛ˘‚-·ÔÎÏÂÈÛÙÒÓ√È ‚-·ÔÎÏÂÈÛÙ¤˜ ¤¯Ô˘Ó ¯ÚËÛÈÌÔ-ÔÈËı› Û ÔÏϤ˜ Ù˘¯·ÈÔÔÈË̤-Ó˜ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ Û ۇÁÎÚÈÛË,ÙfiÛÔ Ì ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ, fiÛÔÎ·È Ì ¿ÏÏ· ·ÓÙÈ˘ÂÚÙ·ÛÈο Ê¿Ú-̷η.1-24 √È ÌÂϤÙ˜ ·˘Ù¤˜ ¤¯Ô˘ÓÛ˘ÌÂÚÈÏ¿‚ÂÈ ˘ÂÚÙ·ÛÈÎÔ‡˜ ·ÛıÂ-Ó›˜ Ì ÌÂÁ¿ÏÔ ËÏÈÎÈ·Îfi ‡ÚÔ˜,ÂÓÒ Û˘¯Ó¿ ¯ÚËÛÈÌÔÔÈ‹ıËηÓÛ˘Ó‰˘·ÛÌÔ› Ê·ÚÌ¿ÎˆÓ ÁÈ· Ó· ÂÈ-Ù¢¯ıÔ‡Ó Ù· ÂÈı˘ÌËÙ¿ ›‰··ÚÙËÚȷ΋˜ ›ÂÛ˘ (∞¶).1, 4, 7, 16, 17

¶·Ú¿ ÙËÓ ÂÙÂÚÔÁ¤ÓÂÈ· ÌÂÙ·Í‡ÙˆÓ ‰È·ÊfiÚˆÓ ÌÂÏÂÙÒÓ, ÔÚÈṲ̂-Ó˜ ÛËÌ·ÓÙÈΤ˜ ÌÂÙ·-·Ó·Ï‡ÛÂȘÚÔÛ¿ıËÛ·Ó Ó· ·ÔÛ·ÊËÓ›ÛÔ˘ÓÙÔÓ ·ÎÚÈ‚‹ ÚfiÏÔ ÙˆÓ ‚-·ÔÎÏÂÈ-

ÛÙÒÓ ÛÙË ıÂڷ¢ÙÈ΋ ·ÓÙÈÌÂÙÒ-ÈÛË Ù˘ ÚˆÙÔ·ıÔ‡˜ ∞À.25-28

√ Lindholm Î·È ÔÈ Û˘ÓÂÚÁ¿Ù˜ÙÔ˘ Û ̛· ÌÂÙ·-·Ó¿Ï˘ÛË 18 Ù˘-¯·ÈÔÔÈËÌ¤ÓˆÓ ÎÏÈÓÈÎÒÓ ÌÂÏÂ-ÙÒÓ25 ·Ú·Ù‹ÚËÛ·Ó fiÙÈ Ë ¯ÔÚ‹-ÁËÛË ‚-·ÔÎÏÂÈÛÙÒÓ Û˘Óԉ‡Ô-ÓÙ·Ó ·fi ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÁÈ··ÁÁÂÈ·Îfi ÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔ(∞∂∂) Û ۇÁÎÚÈÛË Ì ÙË ¯ÔÚ‹-ÁËÛË ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ Ê·ÚÌ¿-ÎˆÓ ¿ÏÏˆÓ Î·ÙËÁÔÚÈÒÓ (relativerisk [RR] 1.16, 95% CI 1.04-1.30;p=0.009), ÂÓÒ ‰ÂÓ ˘‹Ú¯·Ó ‰È·-ÊÔÚ¤˜ fiÛÔÓ ·ÊÔÚ¿ ÙËÓ Â›Ùˆ-ÛË ÙÔ˘ ÔͤԘ ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘Ì˘Ôηډ›Ô˘ (√∂ª) ‹ Ù˘ Û˘ÓÔ-ÏÈ΋˜ ıÓËÛÈÌfiÙËÙ·˜ (¶›Ó·Î·˜ 1).Δ· ·ÔÙÂϤÛÌ·Ù· ‹Ù·Ó ·ÚfiÌÔÈ·,ÙfiÛÔ ÛÙȘ ÌÂϤÙ˜ ÛÙȘ Ôԛ˜ ¯Ô-ÚËÁ‹ıËΠ·ÙÂÓÔÏfiÏË (RR 1.26,1.15-1.38; p<0.0001), fiÛÔ Î·È ÛÂÂΛӘ ÛÙȘ Ôԛ˜ ÛÙËÓ ·ÁˆÁ‹Û˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·Ó Û˘Ó‰˘·ÛÌfi˜‚-·ÔÎÏÂÈÛÙ‹ Ì ‰ÈÔ˘ÚËÙÈÎfi (RR1.09, 0.98-1.21), ÂÓÒ ‰ÂÓ ÌÔÚÔ‡-Û·Ó Ó· ÂÍ·¯ıÔ‡Ó ·ÛÊ·Ï‹ Û˘ÌÂ-

ATHIROSK 14 03-07-07 12:06 ™ÂÏ›‰·25

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Ú¿ÛÌ·Ù· ÁÈ· ÙȘ ÌÂϤÙ˜ Ô˘ Û˘-Ó¤ÎÚÈÓ·Ó ‚-·ÔÎÏÂÈÛÙ¤˜, ÂÎÙfi˜Ù˘ ·ÙÂÓÔÏfiÏ˘, Ì ¿ÏÏ· Ê¿ÚÌ·-η, ÂÍ·ÈÙ›·˜ ÙÔ˘ ÂÚÈÔÚÈṲ̂ÓÔ˘·ÚÈıÌÔ‡ Û˘Ì‚·Ì¿ÙˆÓ. ™Â Û‡ÁÎÚÈ-ÛË Ì ÙÔ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ ÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜ Ê·›ÓÂÙ·È fiÙÈ ÌÂÈÒ-ÓÔ˘Ó ÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘∞∂∂ (RR 0.81, 0.71-0.93), ÂÓÒ‰ÂÓ ˘‹Ú¯Â ‰È·ÊÔÚ¿ fiÛÔÓ ·ÊÔ-Ú¿ Ù· √∂ª ‹ ÙË Û˘ÓÔÏÈ΋ ıÓËÛÈ-ÌfiÙËÙ· (¶›Ó·Î·˜ 2). Δ· Â˘Ú‹Ì·Ù··˘Ù¿ ·ÊÔÚÔ‡Û·Ó ÙfiÛÔ ÙËÓ ·ÙÂ-ÓÔÏfiÏË (RR 0.85, 0.72-1.01), fiÛÔÎ·È Ù· ˘fiÏÔÈ· Ê¿Ú̷η ·˘Ù‹˜Ù˘ ÔÌ¿‰·˜ Ô˘ ¯ÔÚËÁ‹ıËηÓ(RR 0.84, 0.64-1.10). ¶Ú¤ÂÈ fï˜Ó· ·Ó·ÊÂÚı› fiÙÈ Ë Ì›ˆÛË ·˘Ù‹·ÓÙÈÛÙÔȯ› ÂÚ›Ô˘ ÛÙÔ 50% Ù˘·Ó·ÌÂÓfiÌÂÓ˘ Ì›ˆÛ˘ ÙˆÓ Û˘Ì-‚·Ì¿ÙˆÓ Ì ‚¿ÛË ÚÔËÁÔ‡ÌÂÓ˜ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜.29

ΔËÓ ·Ú·¿Óˆ ÌÂÙ·-·Ó¿Ï˘ÛË·ÎÔÏÔ‡ıËÛ ·˘Ù‹ ÙˆÓ Khan ηÈMacAlister,26 Ë ÔÔ›· ÂÚÈÏ·Ì‚¿-

ÓÂÈ ‰Â‰Ô̤ӷ ·fi 21 Ù˘¯·ÈÔÔÈË-̤Ó˜ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ ¯ÔÚ‹ÁË-Û˘ ‚-·ÔÎÏÂÈÛÙÒÓ Û ۇÁÎÚÈÛËÌ ÂÈÎÔÓÈÎfi ‹ ¿ÏÏÔ Ê¿ÚÌ·ÎÔ ˆ˜ÚÒÙ˘ ÂÈÏÔÁ‹˜ ·ÓÙÈ˘ÂÚÙ·ÛÈ΋·ÁˆÁ‹ ÁÈ· ÙËÓ ÚfiÏË„Ë ÙˆÓ ÌÂÈ-˙fiÓˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿-ÙˆÓ (¶›Ó·Î˜ 1 Î·È 2). ∏ ȉȷÈÙÂÚfi-ÙËÙ· ·˘Ù‹˜ Ù˘ ÌÂÙ·-·Ó¿Ï˘Û˘¤ÁÎÂÈÙ·È ÛÙÔ fiÙÈ ÔÈ ÂÚ¢ÓËÙ¤˜ ¯Ò-ÚÈÛ·Ó ÙȘ 21 ÌÂϤÙ˜ Û 2 ÔÌ¿‰Â˜,·Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈΛ· ÙˆÓ ·ÛıÂ-ÓÒÓ, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ˆ˜ fiÚÈÔ Ù·60 ¤ÙË. Δ· Û˘ÌÂÚ¿ÛÌ·Ù· ‹Ù·Ó‰È·ÊÔÚÂÙÈο ÁÈ· ÙȘ ÔÌ¿‰Â˜ ÙˆÓ·ÛıÂÓÒÓ. ™˘ÁÎÂÎÚÈ̤ӷ. ∏ ¯ÔÚ‹-ÁËÛË ‚-·ÔÎÏÂÈÛÙÒÓ ¤Ó·ÓÙÈ ÙÔ˘ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ ˘ÂÚÙÂ-ÚÔ‡Û ÛÙÔ˘˜ Ó¤Ô˘˜ ·ÛıÂÓ›˜(ËÏÈΛ·˜ <60 ÂÙÒÓ) fiÛÔÓ ·ÊÔÚ¿ÙÔ ÙÂÏÈÎfi ηٷÏËÎÙÈÎfi ÛËÌ›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˘˜

(RR 0.94, 0.79-1.10), fi¯È fï˜Î·È ÙËÓ Â›ÙˆÛË Ù˘ ηډȷ΋˜·Ó¿ÚÎÂÈ·˜ (∫∞). ∞ÓÙ›ıÂÙ·, Û·ÛıÂÓ›˜ ËÏÈΛ·˜ >60 ÂÙÒÓ ·-Ú·ÙËÚ‹ıËΠÌÈ· ÛÙ·ÙÈÛÙÈο ÛË-Ì·ÓÙÈ΋ Ì›ˆÛË Û ۇÁÎÚÈÛË ÌÂÙÔ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ ÌfiÓÔ ÙˆÓ∞∂∂ (RR 0.78, 0.63-0.98) Î·È Ù˘∫∞ (RR 0.54, 0.37-0.81). ™Â Û‡-ÁÎÚÈÛË Ì ʿÚ̷η ¿ÏÏˆÓ Î·ÙË-ÁÔÚÈÒÓ, ÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜ ‰ÂÓ˘ÂÚÙÂÚÔ‡Û·Ó Û ηӤӷ ·fiÙ· ·Ú·¿Óˆ ηٷÏËÎÙÈο ÛË-Ì›· ÛÙÔ˘˜ Ó¤Ô˘˜ ·ÛıÂÓ›˜ (ËÏÈ-Λ·˜ <60 ÂÙÒÓ). øÛÙfiÛÔ, ÛÙ·ËÏÈÎȈ̤ӷ ¿ÙÔÌ· Ë ¯ÔÚ‹ÁËÛËÙˆÓ ‚-·ÔÎÏÂÈÛÙÒÓ Û˘Û¯ÂÙ›ÛıË-Π̠·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈ-Û˘ ηډȷÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿-ÙˆÓ (RR 1.06, 1.01-1.10), ÂÍ·È-Ù›·˜ Ù˘ ÌÂÁ·Ï‡ÙÂÚ˘ ›و-Û˘ ∞∂∂ (RR 1.18, 1.07-1.30).∞Ó Î·È ÙÔ fiÊÂÏÔ˜ Ô˘ ÚԤ΢„·fi ÙȘ ÌÂϤÙ˜ ¯ÔÚ‹ÁËÛ˘ÛÙÔ˘˜ Ó¤Ô˘˜ ·ÛıÂÓ›˜ ‚-·ÔÎÏÂÈ-ÛÙÒÓ Û ۇÁÎÚÈÛË Ì ÂÈÎÔÓÈÎfiÊ¿ÚÌ·ÎÔ ‹Ù·Ó Î·È Û ·˘Ù‹ ÙË ÌÂ-Ù·-·Ó¿Ï˘ÛË ÌÈÎÚfiÙÂÚÔ ·fi ÙÔ·Ó·ÌÂÓfiÌÂÓÔ Ì ‚¿ÛË ÂȉËÌÈÔ-ÏÔÁÈΤ˜ ÌÂϤÙ˜,29 Ê·›ÓÂÙ·È fiÙÈ Ë¯ÔÚ‹ÁËÛË ÂÓfi˜ ‚-·ÔÎÏÂÈÛÙ‹ÌÔÚ› Ó· ¢ÓÔ‹ÛÂÈ Ó¤Ô˘˜ ·ÛıÂ-Ó›˜ Ì ·Ó›ÏÂÎÙË ∞À. ∂Ô̤-Óˆ˜, ÔÊ›ÏÔ˘Ì ӷ ·ÍÈÔÏÔÁ‹ÛÔ˘-Ì Ì ÎÚÈÙÈ΋ ÛΤ„Ë ÙËÓ ÚfiÙ·ÛËÔÚÈÛÌ¤ÓˆÓ ÂÚ¢ÓËÙÒÓ ÁÈ· ÔÚÈÛÙÈ-΋ ηٿÚÁËÛË ÙˆÓ ‚-·ÔÎÏÂÈÛÙÒÓˆ˜ ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ Ê·Ú̿ΈÓ.

∞Í›˙ÂÈ ÛÙÔ ÛËÌÂ›Ô ·˘Ùfi Ó· ‰È¢ÎÚÈ-ÓÈÛı› fiÙÈ Ë ·ıÔÊ˘ÛÈÔÏÔÁ›· Ù˘∞À ‰ÂÓ Â›Ó·È Ë ›‰È· Û οı ËÏÈΛ·.™Ù· Ó¤· ¿ÙÔÌ· Ë ∞À ÔÊ›ÏÂÙ·È Û·˘ÍË̤ÓË Î·Ú‰È·Î‹ ·ÚÔ¯‹ ·-ÚÔ˘Û›· Ê˘ÛÈÔÏÔÁÈÎÒÓ ‹ ÌÂȈ̤-ÓˆÓ ·ÁÁÂÈ·ÎÒÓ ·ÓÙÈÛÙ¿ÛˆÓ,30-32

ÂÓÒ Ë ∞À ÙˆÓ ËÏÈÎÈˆÌ¤ÓˆÓ ·Ùfïӯ·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·‡ÍËÛË ÙˆÓÂÚÈÊÂÚÈÎÒÓ ·ÓÙÈÛÙ¿ÛÂˆÓ Î·È ¯·-ÌËÏ‹ ·ÚÙËÚȷ΋ ÂÓ‰ÔÙÈÎfiÙËÙ·(compliance).30, 31 ∂Ô̤ӈ˜, Ë ¯Ô-Ú‹ÁËÛË ÙˆÓ ‚-·ÔÎÏÂÈÛÙÒÓ ÛÙÔ˘˜Ó¤Ô˘˜ ·ÛıÂÓ›˜ ÌÔÚ› Ó· ‰ÈηÈÔ-ÏÔÁËı› ·fi ÙÂÎÌËÚȈ̤ӷ ·ıÔ-Ê˘ÛÈÔÏÔÁÈο ‰Â‰Ô̤ӷ.

∏ ·ÙÂÓÔÏfiÏË Î·È ÔÈ ¿ÏÏÔÈ‚-·ÔÎÏÂÈÛÙ¤˜: ˘¿Ú¯ÂȉȷÊÔÚ¿ ÌÂٷ͇ ÙÔ˘˜;√ ÈÔ ‰È·‰Â‰Ô̤ÓÔ˜ ‚-·ÔÎÏÂÈ-ÛÙ‹˜ Â›Ó·È Ë ·ÙÂÓÔÏfiÏË Î·È Û ·˘-Ùfi ÙÔ Ê¿ÚÌ·ÎÔ ·Ô‰›‰ÔÓÙ·È Ù··ÔÙÂϤÛÌ·Ù· Ù˘ ÏÂÈÔÓfiÙËÙ·˜ÙˆÓ ÌÂÏÂÙÒÓ Ô˘ ¤¯Ô˘Ó ‰ÈÂÍ·¯ı›Ì ‚-·ÔÎÏÂÈÛÙ¤˜. ¢Â‰Ô̤Ó˘ Ù˘

π √ À ¡ π √ ™ 2 0 0 7

26

¶›Ó·Î·˜ 2: ‚-·ÔÎÏÂÈÛÙ¤˜ ¤Ó·ÓÙÈ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘

√∂ª: O͇ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘, ∞∂∂: ·ÁÁÂÈ·Îfi ÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔ, ∫∞: ηډȷ΋ ·Ó¿ÚÎÂÈ·, RR: relative risk (Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜), CI: confidence interval (‰È¿ÛÙËÌ· ÂÌÈÛÙÔÛ‡Ó˘)

ªÂϤÙË Lindholm et al25 Khan et al26

RR (95% CI) RR (95% CI) RR (95% CI) ¡¤ÔÈ ·ÛıÂÓ›˜ ∏ÏÈÎȈ̤ÓÔÈ ·ÛıÂÓ›˜

ΔÂÏÈÎfi 0.86 (0.74-0.99) 0.89 (0.75-1.05)ηٷÏËÎÙÈÎfi ÛËÌÂ›Ô (∞∂∂, √∂ª, ı¿Ó·ÙÔ˜)∞∂∂ 0.81 (0.71-0.93) 0.84 (0.65-1.10) 0.78 (0.63-0.98)

√∂ª 0.93 (0.83-1.05) 0.85 (0.71-1.03) 0.98 (0.83-1.16)

∫∞ 1.05 (0.72-1.54) 0.54 (0.37-0.81)

√ÏÈ΋ 0.95 (0.86-1.04) 0.94 (0.79-1.10) 0.91 (0.74-1.12)ıÓËÛÈÌfiÙËÙ·

ªÂϤÙË Lindholm et al25 Khan et al26

RR (95% CI) RR (95% CI) RR (95% CI) ¡¤ÔÈ ·ÛıÂÓ›˜ ∏ÏÈÎȈ̤ÓÔÈ ·ÛıÂÓ›˜

ΔÂÏÈÎfi 0.97 (0.88-1.07) 1.06 (1.01-1.10)ηٷÏËÎÙÈÎfi ÛËÌÂ›Ô (∞∂∂, √∂ª, ı¿Ó·ÙÔ˜)∞∂∂ 1.16 (1.04-1.30) 0.99 (0.67-1.44) 1.18 (1.07-1.30)

√∂ª 1.02 (0.93-1.12) 0.97 (0.86-1.10) 1.06 (0.94-1.20)

∫∞ 0.93 (0.64-1.34) 0.98 (0.87-1.11)

√ÏÈ΋ 1.03 (0.99-1.08) 0.97 (0.83-1.14) 1.05 (0.99-1.11)ıÓËÛÈÌfiÙËÙ·

¶›Ó·Î·˜ 1: ‚-·ÔÎÏÂÈÛÙ¤˜ ¤Ó·ÓÙÈ ¿ÏÏˆÓ Ê·Ú̿ΈÓ

√∂ª: O͇ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘, ∞∂∂: ·ÁÁÂÈ·Îfi ÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔ, ∫∞: ηډȷ΋ ·Ó¿ÚÎÂÈ·, RR: relative risk (Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜), CI: confidence interval (‰È¿ÛÙËÌ· ÂÌÈÛÙÔÛ‡Ó˘)

ATHIROSK 14 03-07-07 12:06 ™ÂÏ›‰·26

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£∂ƒ∞¶∂π∞ - º∞ƒª∞∫∞

27

‰È·ÊÔÚÂÙÈ΋˜ Ê·ÚÌ·ÎÔÎÈÓËÙÈ΋˜Ù˘ ·ÙÂÓÔÏfiÏ˘ Û ۇÁÎÚÈÛË ÌÂÙ· ˘fiÏÔÈ· Ê¿Ú̷η Ù˘ ›‰È·˜Î·ÙËÁÔÚ›·˜, Ù¤ıËΠÙÔ ÂÚÒÙË̷ηٿ fiÛÔ ÔÈ Ô˘‰¤ÙÂÚ˜ ‹ ·ÚÓËÙÈ-Τ˜ ÂÈÙÒÛÂȘ Ô˘ ·Ú·ÙËÚ‹ıË-Î·Ó Û ÔÚÈṲ̂Ó˜ ÌÂϤÙ˜ Ì ‚-·ÔÎÏÂÈÛÙ¤˜ ÔÊ›ÏÔÓÙ·Ó ÛÙËÓ ·ÙÂ-ÓÔÏfiÏË Î·È ·Ó Ë ÂӉ¯fiÌÂÓË ¯ÔÚ‹-ÁËÛË ¿ÏÏˆÓ ‚-·ÔÎÏÂÈÛÙÒÓ ı· ›-¯Â ÈÔ Â˘ÓÔ˚ο ·ÔÙÂϤÛÌ·Ù·.

√ Carlberg Î·È ÔÈ Û˘ÓÂÚÁ¿Ù˜ÙÔ˘ ·Ó¤Ï˘Û·Ó Ù· ‰Â‰Ô̤ӷ 9 ÌÂ-ÏÂÙÒÓ Ì ·ÙÂÓÔÏfiÏË: 4 ¤Ó·ÓÙÈ ÂÈ-ÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ (¶›Ó·Î·˜ 3)Î·È 5 ¤Ó·ÓÙÈ ¿ÏÏÔ˘ ·ÓÙÈ˘ÂÚÙ·ÛÈ-ÎÔ‡ Ê·ÚÌ¿ÎÔ˘ (¶›Ó·Î·˜ 4).27 ¶·-Ú¿ ÙË ÌÂÁ·Ï‡ÙÂÚË Ì›ˆÛË Ù˘∞¶ Ô˘ ÂÈÙ‡¯ıËΠ̠ÙËÓ·ÙÂÓÔÏfiÏË, ‰ÂÓ ·Ú·ÙËÚ‹ıËηÓÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜Û ۇÁÎÚÈÛË Ì ÙÔ ÂÈÎÔÓÈÎfi Ê¿Ú-Ì·ÎÔ fiÛÔÓ ·ÊÔÚ¿ Ù· √∂ª, ÙËÓηډȷÁÁÂȷ΋ Î·È ÔÏÈ΋ ıÓËÛÈ-ÌfiÙËÙ·, ÂÓÒ Ë ·ÙÂÓÔÏfiÏË Ê·›ÓÂ-Ù·È fiÙÈ ÂÏ·ÙÙÒÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔÙˆÓ ∞∂∂ (RR 0.85, 0.72-1.01). ™ÂÛ‡ÁÎÚÈÛË Ì ʿÚ̷η ¿ÏÏˆÓ Î·-ÙËÁÔÚÈÒÓ Î·È ·Ú¿ ÙËÓ Â›Ù¢ÍË·ÚfiÌÔÈˆÓ ÂȤ‰ˆÓ ∞¶, Ë ·ÙÂ-ÓÔÏfiÏË Û˘Û¯ÂÙ›ÛıËΠ̠ÛÙ·ÙÈ-ÛÙÈο ÛËÌ·ÓÙÈ΋ ÌÂÁ·Ï‡ÙÂÚËıÓËÛÈÌfiÙËÙ· (RR 1.13, 1.02-1.25), ·ÏÏ¿ Î·È Î·Ú‰È·ÁÁÂȷ΋ıÓËÛÈÌfiÙËÙ· (RR 1.16, 1.00-1.34) Î·È ·˘ÍË̤ÓË Â›ÙˆÛË∞∂∂ (RR 1.30, 1.12-1.50).¶·ÚfiÌÔÈ· ·ÔÙÂϤÛÌ·Ù· ÚÔ¤-

΢„·Ó Î·È ·fi ÌÈ· ÌÂÙ·-·Ó¿Ï˘-ÛË 10 Ù˘¯·ÈÔÔÈËÌ¤ÓˆÓ ÎÏÈÓÈÎÒÓÌÂÏÂÙÒÓ (4 ÌÂٷ͇ ·ÙÂÓÔÏfiÏË˜Î·È ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘, 5 ÌÂÙ·-͇ ·ÙÂÓÔÏfiÏ˘ Î·È ¿ÏÏÔ˘ ·ÓÙÈ˘-ÂÚÙ·ÛÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ Î·È ÌÈ·ÌÂϤÙË Ô˘ Û˘Ó¤ÎÚÈÓ ÙËÓ ·ÙÂ-ÓÔÏfiÏË ÙfiÛÔ Ì ÂÈÎÔÓÈÎfi Ê¿ÚÌ·-ÎÔ, fiÛÔ Î·È Ì ʿÚÌ·ÎÔ ¿ÏÏ˘ηÙËÁÔÚ›·˜).28 ¢ÂÓ ·Ú·ÙËÚ‹ıË-ΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔ-Ú¿ ÌÂٷ͇ Ù˘ ·ÙÂÓÔÏfiÏ˘ ηÈÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ Û η-Ó¤Ó· ·fi Ù· ÙÂÏÈο ηٷÏËÎÙÈοÛËÌ›· (∞∂∂, √∂ª, ηډȷÁÁÂÈ·-΋ ‹ ÔÏÈ΋ ıÓËÛÈÌfiÙËÙ·), ÂÓÒ·ÓÙ›ıÂÙ· Ë ¯ÔÚ‹ÁËÛË Ù˘ ·ÙÂÓÔ-ÏfiÏ˘ ¤Ó·ÓÙÈ Ê·ÚÌ¿ÎˆÓ ¿ÏψÓηÙËÁÔÚÈÒÓ Û˘Û¯ÂÙ›ÛıËΠ̷˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ∞∂∂ (RR1.27, 1.16-1.38; p=0.0004), η-ıÒ˜ Î·È Î·Ú‰È·ÁÁÂȷ΋˜ Î·È ÔÏÈ-΋˜ ıÓËÛÈÌfiÙËÙ·˜ (RR 1.13,1.03-1.23; p=0.008 Î·È RR 1.07,1.01-1.14; p=0.02, ·ÓÙ›ÛÙÔȯ·).Δ¤ÏÔ˜, ·Ú·ÙËÚ‹ıËΠÌÈ· ·˘ÍË-ÙÈ΋ Ù¿ÛË fiÛÔÓ ·ÊÔÚ¿ Î·È Ù·√∂ª Ì ÙË ¯ÔÚ‹ÁËÛË Ù˘ ·ÙÂÓÔ-ÏfiÏ˘ (RR 1.02, 0.95-1.11;p=0.55). °È· ÙËÓ ÂÚÌËÓ›· ÙˆÓ ‰È·ÊÔÚÂÙÈ-ÎÒÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Ô˘ ·Ú·ÙË-Ú‹ıËÎ·Ó ÌÂٷ͇ Ù˘ ·ÙÂÓÔÏfiÏË˜Î·È ÙˆÓ ˘fiÏÔÈˆÓ ‚-·ÔÎÏÂÈ-ÛÙÒÓ Ú¤ÂÈ Ó· ‰È¢ÎÚÈÓÈÛıÔ‡Ó ÔȉȷÊÔÚ¤˜ Ô˘ ˘¿Ú¯Ô˘Ó ÌÂÙ·Í‡ÙˆÓ Ê·Ú̿ΈÓ.

∏ ·ÙÂÓÔÏfiÏË ÌÂÈÒÓÂÈ Ù· ›‰·

Ù˘ ∞¶ Î·È Ì¿ÏÈÛÙ· ÛÙÔÓ ›‰ÈÔ ‚·ı-Ìfi Ì ʿÚ̷η ¿ÏÏˆÓ Î·ÙËÁÔ-ÚÈÒÓ, fiˆ˜ ÚÔ·ÙÂÈ ·fi ÌÂÙÚ‹-ÛÂȘ Ù˘ ∞¶ ÛÙÔ ‚Ú·¯›ÔÓ·. øÛÙfi-ÛÔ Â›Ó·È ÁÓˆÛÙfi fiÙÈ Ë ∞¶ ÛÙË‚Ú·¯ÈfiÓÈ· ·ÚÙËÚ›· ‰ÂÓ ·ÓÙÈηÙÔ-ÙÚ›˙ÂÈ Ì ·ÎÚ›‚ÂÈ· ÙË Û˘ÛÙÔÏÈ΋∞¶, Ô‡Ù ·ÔÙÂÏ› ηÏfi ‰Â›ÎÙËÙ˘ ÎÂÓÙÚÈ΋˜ ·ÔÚÙÈ΋˜ Û˘ÛÙÔÏÈ-΋˜ ›ÂÛ˘.33 ∂ÈÚfiÛıÂÙ·, ÛÙ·Ó¤· ¿ÙÔÌ· Ë ÎÂÓÙÚÈ΋ ·ÔÚÙÈ΋ Û˘-ÛÙÔÏÈ΋ ›ÂÛË Â›Ó·È Ôχ ¯·ÌËÏfi-ÙÂÚË ·fi ÙË ‚Ú·¯ÈfiÓÈ· ·ÚÙËÚÈ·Î‹Û˘ÛÙÔÏÈ΋ ›ÂÛË.34 ¶·Ú¿ ÙË Ì›ˆ-ÛË Ù˘ ‚Ú·¯ÈfiÓÈ·˜ ∞¶, Ë ·ÙÂÓÔ-ÏfiÏË ‰ÂÓ ÂÏ·ÙÙÒÓÂÈ ÙËÓ ÎÂÓÙÚÈ΋·ÔÚÙÈ΋ Û˘ÛÙÔÏÈ΋ ›ÂÛË ÛÙÔÓ›‰ÈÔ ‚·ıÌfi Ì ÙÔ˘˜ ·ÓÙ·ÁˆÓÈ-ÛÙ¤˜ ·Û‚ÂÛÙ›Ô˘, ÙÔ˘˜ ·Ó·ÛÙÔ-Ï›˜ ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘ ππ Î·È ÙËÓ˘‰ÚԯψÚÔıÂÈ·˙›‰Ë.35 ªÂϤÙ˜¤‰ÂÈÍ·Ó fiÙÈ Ë Ì›ˆÛË Ù˘ ÎÂÓÙÚÈ-΋˜ Î·È fi¯È Ù˘ ‚Ú·¯ÈfiÓÈ·˜ ∞¶,·ÚÔ˘ÛÈ¿˙ÂÈ ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈ-ÛË Ì ÙËÓ ˘ÔÛÙÚÔÊ‹ Ù˘ ˘ÂÚ-ÙÚÔÊ›·˜ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜.36

∂Ô̤ӈ˜, Ë ÌÂÁ·Ï‡ÙÂÚË ·ÔÙÂ-ÏÂÛÌ·ÙÈÎfiÙËÙ· ÙˆÓ ·Ú·¿ÓˆÊ·ÚÌ¿ÎˆÓ ¤Ó·ÓÙÈ Ù˘ ·ÙÂÓÔÏfiÏ˘fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ÂÏ¿ÙÙˆÛË Ù˘˘ÂÚÙÚÔÊ›·˜ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈ-Ï›·˜37 ı· ÌÔÚÔ‡Û ӷ ·Ô‰Ôı›Û ·˘Ù‹ ÙËÓ ·Ú·Ù‹ÚËÛË.

ªÈ· ¿ÏÏË ‰È·ÊÔÚ¿ Ù˘ ·ÙÂÓÔÏfi-Ï˘ ·fi ÙÔ˘˜ ˘fiÏÔÈÔ˘˜ ‚-·ÔÎÏÂÈÛÙ¤˜ Â›Ó·È Ë ˘‰ÚfiÊÈÏËʇÛË Ù˘ Î·È Ë Ôχ ¯·ÌËÏ‹‰È·ÂÚ·ÙfiÙËÙ¿ Ù˘ ÛÙÔ ÎÂÓÙÚÈÎfiÓ¢ÚÈÎfi Û‡ÛÙËÌ·. ¶ÂÈÚ·Ì·ÙÈΤ˜ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ Ë ÈηÓfiÙËÙ·ÙˆÓ ‚-·ÔÎÏÂÈÛÙÒÓ Ó· ÚÔÏ·Ì-‚¿ÓÔ˘Ó ÙËÓ ÎÔÏÈ΋ Ì·ÚÌ·Ú˘Á‹ÂÍ·ÚÙ¿Ù·È ·fi Ù· ›‰¿ ÙÔ˘˜ÛÙÔ ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ·.38

™Â ·ÓÙ›ıÂÛË Ì ¿ÏÏÔ˘˜ ‚-·Ô-ÎÏÂÈÛÙ¤˜ (.¯. ÌÂÙÔÚÔÏfiÏË,·Î‚ԢÙÔÏfiÏË), Ë ·ÙÂÓÔÏfiÏˉÂÓ Ê·›ÓÂÙ·È Ó· ¤¯ÂÈ ÈηÓÔÔÈË-ÙÈ΋ 24ˆÚË ‰Ú¿ÛË fiÙ·Ó ¯ÔÚËÁ›-Ù·È ÌÈ· ÊÔÚ¿ ÙËÓ Ë̤ڷ.39 Δ¤ÏÔ˜,ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ ÔÚÈṲ̂ӷ·ÓÙÈ˘ÂÚÙ·ÛÈο Ê¿Ú̷η ‚ÂÏ-ÙÈÒÓÔ˘Ó ÙËÓ ·Ó·‰È·ÌfiÚʈÛË(remodelling) Î·È ÙËÓ ÂÓ‰ÔıË-Ïȷ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ÌÈÎÚÒÓ·ÚÙËÚÈÒÓ Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·ÈÛ ·ÛıÂÓ›˜ Ì ∞À, Â˘Ú‹Ì·Ù·Ô˘ ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ÌÂÙ¿ÙË ¯ÔÚ‹ÁËÛË ·ÙÂÓÔÏfiÏ˘.40-42

∫·ı›ÛÙ·Ù·È ÂÔ̤ӈ˜ ۷ʤ˜ fiÙÈ˘¿Ú¯Ô˘Ó ÔÈΛϘ Î·È ·ÍÈÔÛËÌ›-ˆÙ˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ Ù˘ ·ÙÂÓÔ-ÏfiÏ˘ Î·È ÙfiÛÔ ÙˆÓ ¿ÏÏˆÓ Ê·Ú-

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

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

ªÂϤÙË Carlberg et al27 Karagiannis et al28

RR (95% CI)

√ÏÈ΋ ıÓËÛÈÌfiÙËÙ· 1.01 (0.89-1.15) 1.01 (0.84-1.15)

∫·Ú‰È·ÁÁÂȷ΋ ıÓËÛÈÌfiÙËÙ· 0.99 (0.83-1.18) 0.99 (0.83-1.18)

√∂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)

¶›Ó·Î·˜ 4: ∞ÙÂÓÔÏfiÏË ¤Ó·ÓÙÈ ¿ÏÏˆÓ Ê·Ú̿ΈÓ

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

ªÂϤÙË Carlberg et al27 Karagiannis et al28

RR (95% CI)

√ÏÈ΋ ıÓËÛÈÌfiÙËÙ· 1.13 (1.02-1.25) 1.07 (1.01-1.14)

∫·Ú‰È·ÁÁÂȷ΋ ıÓËÛÈÌfiÙËÙ· 1.16 (1.00-1.34) 1.13 (1.03-1.23)

√∂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)

ATHIROSK 14 03-07-07 12:06 ™ÂÏ›‰·27

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Ì¿ÎˆÓ Ù˘ ›‰È·˜ ηÙËÁÔÚ›·˜, fiÛÔÎ·È Ê·ÚÌ¿ÎˆÓ Ô˘ ·Ó‹ÎÔ˘Ó Û¿ÏϘ ηÙËÁÔڛ˜, ÁÂÁÔÓfi˜ Ô˘ÌÔÚ› Ó· ÂÚÌËÓ‡ÛÂÈ, ÙÔ˘Ï¿¯È-ÛÙÔÓ ˆ˜ ¤Ó· ‚·ıÌfi, ÙË ‰È·ÊÔÚÂÙÈ-΋ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿ ÙÔ˘˜,fiˆ˜ ·˘Ù‹ ηٷÁÚ¿ÊÂÙ·È ÛÙȘ‰È¿ÊÔÚ˜ ÌÂϤÙ˜.

¶ÏÂÔÓÂÎÙ‹Ì·Ù· ηÈÌÂÈÔÓÂÎÙ‹Ì·Ù· ÙˆÓ‚-·ÔÎÏÂÈÛÙÒÓ¶·Ú¿ ÙȘ ‰ÈÊÔÚÔ‡ÌÂÓ˜ ·fi„ÂȘfiÛÔÓ ·ÊÔÚ¿ ÙË ¯ÔÚ‹ÁËÛË ÙˆÓ ‚-·ÔÎÏÂÈÛÙÒÓ ÛÙËÓ ÚˆÙÔ·ı‹∞À, ˘¿Ú¯Ô˘Ó ÔÚÈṲ̂Ó˜ ÎÏÈÓÈΤ˜ÔÓÙfiÙËÙ˜ ÛÙȘ Ôԛ˜ ÔÈ ‚-·Ô-ÎÏÂÈÛÙ¤˜ ¤¯Ô˘Ó ·Ô‰Â‰ÂÈÁ̤ÓË·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·. √È ÂÚÈÛ-ÛfiÙÂÚÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜ ÌÂÈÒ-ÓÔ˘Ó ÛËÌ·ÓÙÈο ÙË ÌÂÙÂÌÊÚ·Á-Ì·ÙÈ΋ ıÓËÛÈÌfiÙËÙ· Ì·ÎÚÔÚfi-ıÂÛÌ·, fiˆ˜ Ê¿ÓËΠ·fi ÌÈ·ÌÂÁ¿ÏË ÌÂÙ·-·Ó¿Ï˘ÛË 31 ÌÂÏÂ-ÙÒÓ (RR 0.77, 0.69-0.85).43 ∂›-Û˘ ÚÔÛʤÚÔ˘Ó Û˘Ìو̷ÙÈ΋·Ó·ÎÔ‡ÊÈÛË ·fi Ù· ÛÙËı·Á¯ÈοÂÓԯϋ̷ٷ Î·È ¤¯Ô˘Ó ·ÓÙÈ·ıË-ÚÔÛÎÏËÚˆÙÈ΋ ‰Ú¿ÛË,44 ÂÓÒ Â›-Ó·È È‰È·›ÙÂÚ· ¯Ú‹ÛÈÌ· Ê¿Ú̷ηÛ ·ÛıÂÓ›˜ Ì ∫∞, ·ÊÔ‡ ÂÏ·Ù-ÙÒÓÔ˘Ó ÙËÓ Î·Ú‰È·ÁÁÂȷ΋ ηÈÙËÓ ÔÏÈ΋ ıÓËÛÈÌfiÙËÙ·, ÙÔ˘˜·ÈÊÓ›‰ÈÔ˘˜ ı·Ó¿ÙÔ˘˜ Î·È ÙȘ ÓÔ-ÛËÏ›˜ ÛÙÔ ÓÔÛÔÎÔÌ›Ô.45-48 ∂Ô-̤ӈ˜, Ë ‰Â˘ÙÂÚÔÁÂÓ‹˜ ÚfiÏË-„Ë Ù˘ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ (™¡)Î·È Ë ∫∞ ·ÔÙÂÏÔ‡Ó Û·Ê›˜ ÂÓ-‰Â›ÍÂȘ ¯ÔÚ‹ÁËÛ˘ ÙˆÓ ‚-·Ô-ÎÏÂÈÛÙÒÓ. ∞ÎfiÌ· Ë ¯ÔÚ‹ÁËÛËÙˆÓ ‚-·ÔÎÏÂÈÛÙÒÓ ÌÔÚ› Ó·Â›Ó·È È‰È·›ÙÂÚ· ¯Ú‹ÛÈÌË Û ¿ÙÔÌ·Ì ˘ÂÚ‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘ Û˘-Ì·ıËÙÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·-ÙÔ˜ ‹ Ôχ ·Á¯Ò‰Ë, ·ÊÔ‡ ·-Ú¿ÏÏËÏ· Ì ÙË Ì›ˆÛË Ù˘ ∞¶·˘Ù¿ Ù· Ê¿Ú̷η ·Ú¤¯Ô˘Ó Û˘-Ìو̷ÙÈ΋ ·Ó·ÎÔ‡ÊÈÛË. Δ¤ÏÔ˜,Ë ¯ÔÚ‹ÁËÛ‹ ÙÔ˘˜ ÚÈÓ ·fi Ì›-˙ÔÓ˜ ·ÁÁÂȷΤ˜ ÂÂÌ‚¿ÛÂȘ Û·ÛıÂÓ›˜ Ì ÎÏÈÓÈÎÔ‡˜ ·Ú¿ÁÔ-ÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Î·È ·ıÔÏÔÁÈÎfi˘ÂÚ˯ÔÁÚ¿ÊËÌ· ηډȿ˜ ÌÂÙ¿·fi ¯ÔÚ‹ÁËÛË ‰Ô‚Ô˘Ù·Ì›Ó˘ÌÂÈÒÓÂÈ Ù· ηډȷÁÁÂȷο Û˘Ì-‚¿Ì·Ù·,49 ÂÓÒ Ë Û˘Ó¤¯ÈÛË Ù˘·ÁˆÁ‹˜ Ì ‚ÈÛÔÚÔÏfiÏË ÁÈ· 2¤ÙË ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË ÂÏ·ÙÙÒ-ÓÂÈ ÂÚ·ÈÙ¤Úˆ ÙÔ ı¿Ó·ÙÔ Î·Ú-‰È·Î‹˜ ·ÈÙÈÔÏÔÁ›·˜ Î·È Ù· √∂ª.50

π‰È·›ÙÂÚË ·ÓËÛ˘¯›· ¤¯ÂÈ ÚÔηϤ-ÛÂÈ Ë Èı·Ó‹ Û˘Û¯¤ÙÈÛË Ù˘ ·Áˆ-Á‹˜ Ì ‚-·ÔÎÏÂÈÛÙ¤˜ Ì ÙËÓ ÂÌ-Ê¿ÓÈÛË Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË (™¢)Ù‡Ô˘2. ªÂÁ¿Ï˜ ÌÂϤÙ˜ Ô˘

Û˘Ó¤ÎÚÈÓ·Ó ÙÔ˘˜ ‚-·ÔÎÏÂÈÛÙ¤˜ÙfiÛÔ Ì ʿÚ̷η ¿ÏÏˆÓ Î·ÙËÁÔ-ÚÈÒÓ (·ÓÙ·ÁˆÓÈÛÙ¤˜ ·Û‚ÂÛÙ›Ô˘,·ÓÙ·ÁˆÓÈÛÙ¤˜ ÙˆÓ ˘Ô‰Ô¯¤ˆÓÙ˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘ ππ, ·Ó·ÛÙÔ-Ï›˜ ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘), fiÛÔ Î·È ÌÂÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ ¤‰ÂÈÍ·Ó ·˘ÍË-̤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ÓÂÔÂÌÊ·ÓÈ˙fi-ÌÂÓÔ ™¢ Ì ÙÔ˘˜ ‚-·ÔÎÏÂÈ-ÛÙ¤˜.14, 15, 51, 52 øÛÙfiÛÔ ‰ÂÓ ¤¯ÂÈ ‰È-¢ÎÚÈÓÈÛı› ·Ó Ù· ˘fiÏÔÈ·Ê¿Ú̷η ÚÔÏ·Ì‚¿ÓÔ˘Ó ÙËÓ ÂÌ-Ê¿ÓÈÛË ÙÔ˘ ™¢ ‹ ·Ó fiÓÙˆ˜ ÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜ ‰È·Ù·Ú¿ÛÛÔ˘Ó ÙËÓÔÌÔÈÔÛÙ·Û›· Ù˘ ÁÏ˘Îfi˙˘, ȉȷ›-ÙÂÚ· fiÙ·Ó Û˘Ó‰˘¿˙ÔÓÙ·È Ì ıÂÈ-·˙ȉÈο ‰ÈÔ˘ÚËÙÈο.53

∞ÚÓËÙÈ΋ Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È Ë Â›-‰Ú·ÛË ÙˆÓ ‚-·ÔÎÏÂÈÛÙÒÓ Î·È ÛÙÔÌÂÙ·‚ÔÏÈÛÌfi ÙˆÓ ÏÈȉ›ˆÓ.54 √È ‚-·ÔÎÏÂÈÛÙ¤˜ ¯ˆÚ›˜ ÂÓ‰ÔÁÂÓ‹ Û˘-Ì·ıËÙÈÎÔÌÈÌËÙÈ΋ ‰Ú·ÛÙËÚÈfiÙË-Ù· ·˘Í¿ÓÔ˘Ó Ù· ›‰· ÙˆÓ ÙÚÈ-ÁÏ˘ÎÂÚȉ›ˆÓ Î·È ÌÂÈÒÓÔ˘Ó ÙË ¯Ô-ÏËÛÙÂÚfiÏË ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ [high-densitylipoprotein (HDL)], ¯ˆÚ›˜ Ó· ÂË-Ú¿˙Ô˘Ó ÛËÌ·ÓÙÈο Ù· ›‰·Ù˘ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È Ù˘¯ÔÏËÛÙÂÚfiÏ˘ ÙˆÓ ÏÈÔÚˆÙÂ˚-ÓÒÓ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ [low-density lipoprotein (LDL)].55 √ÈηډÈÔÂÎÏÂÎÙÈÎÔ› ‚-·ÔÎÏÂÈÛÙ¤˜¤¯Ô˘Ó ÏÈÁfiÙÂÚÔ ·ÚÓËÙÈ΋ ›‰Ú·-ÛË ÛÙÔ ÏÈȉ·ÈÌÈÎfi ÚÔÊ›Ï,56 ÂÓÒÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜ Ì ÂÓ‰ÔÁÂÓ‹ Û˘-Ì·ıËÙÈÎÔÌÈÌËÙÈ΋ ‰Ú·ÛÙËÚÈfiÙË-Ù· (ÈÓ‰ÔÏfiÏË) ‹ ·ÁÁÂÈԉȷÛÙ·ÏÙÈ-Τ˜ ȉÈfiÙËÙ˜ (ÛÂÏÈÚÔÏfiÏË) ‰ÂÓÂËÚ¿˙Ô˘Ó ÙÔ ÌÂÙ·‚ÔÏÈÛÌfi ÙˆÓÏÈȉ›ˆÓ.57, 58 ¶Èı·ÓÒ˜ ÔÈ ‚-·Ô-ÎÏÂÈÛÙ¤˜ ‰È·Ù·Ú¿ÛÛÔ˘Ó ÙËÓ Ë·-ÙÈ΋ Û‡ÓıÂÛË ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ‹ ÂÏ·ÙÙÒÓÔ˘Ó ÙË ‰Ú·ÛÙËÚÈfiÙËÙ·Ù˘ ÏÈÔÚˆÙÂ˚ÓÈ΋˜ ÏÈ¿Û˘, ÌÂÈ-ÒÓÔÓÙ·˜ ¤ÙÛÈ ÙÔÓ Î·Ù·‚ÔÏÈÛÌfiÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ.59, 60 ∏ ·ÓÂÈ-ı‡ÌËÙË ·˘Ù‹ ÂÓ¤ÚÁÂÈ· ¤¯ÂÈ È‰È·›-ÙÂÚË ÎÏÈÓÈ΋ ÛËÌ·Û›·, ·ÊÔ‡ÔÏÏÔ› ·ÛıÂÓ›˜ ¤¯Ô˘Ó ÙfiÛÔ ∞À,fiÛÔ Î·È ‰˘ÛÏÈȉ·ÈÌ›·, ÁÂÁÔÓfi˜Ô˘ ÙÔ˘˜ ηıÈÛÙ¿ ¿ÙÔÌ· ˘„ËÏԇηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘. ∂Ô-̤ӈ˜, ÔÊ›ÏÔ˘Ì ӷ ÂÈϤÍÔ˘-Ì ÙËÓ Î·Ù¿ÏÏËÏË ·ÁˆÁ‹, ËÔÔ›· ı· ÂÍ·ÛÊ·Ï›ÛÂÈ Ù· ÂÈı˘-ÌËÙ¿ ›‰· ∞À Î·È LDL-¯ÔÏË-ÛÙÂÚfiÏ˘ Î·È ÂÔ̤ӈ˜ ı· ÂÏ·Ù-ÙÒÛÂÈ ÙÔÓ Î›Ó‰˘ÓÔ Î·Ú‰È·ÁÁÂÈ·-΋˜ ÓfiÛÔ˘.™ÙËÓ Î·ÙËÁÔÚ›· ÙˆÓ ‚-·ÔÎÏÂÈ-ÛÙÒÓ ·Ó‹ÎÔ˘Ó Î¿ÔÈ· ÓÂfiÙÂÚ·Ê¿Ú̷η Ì ¿ÌÂÛË ·ÁÁÂÈԉȷ-

ÛÙ·ÏÙÈ΋ ‰Ú¿ÛË (ÓÂÌÈ‚ÔÏfiÏË,ηڂÂÓÙÈÏfiÏË, ÛÂÏÈÚÔÏfiÏË). ∞ÓÎ·È ‰ÂÓ ¤¯Ô˘Ó Á›ÓÂÈ Ù˘¯·ÈÔÔÈË̤-Ó˜ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ ÁÈ· ÙËÓ ·ÓÙÈ-ÌÂÙÒÈÛË Ù˘ ∞À Ì ٷ Û˘ÁÎÂÎÚÈ-̤ӷ Û΢¿ÛÌ·Ù·, Ê·›ÓÂÙ·È fiÙÈ·ÔÙÂÏÔ‡Ó ·ÛÊ·Ï‹ Î·È ·ÔÙÂÏÂ-ÛÌ·ÙÈο Ê¿Ú̷η, ΢ڛˆ˜ fï˜ÁÈ· ÙË ıÂڷ›· Ù˘ ∫∞ (ȉȷ›ÙÂÚ·Ë Î·Ú‚ÂÓÙÈÏfiÏË). ∂Í·ÈÙ›·˜ Ù˘˘ÂÚÔ¯‹˜ ÙˆÓ ˘fiÏÔÈˆÓ ·ÓÙÈ˘-ÂÚÙ·ÛÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ¤Ó·ÓÙÈ ÙˆÓ‚-·ÔÎÏÂÈÛÙÒÓ Â›Ó·È ·›ı·ÓÔ Ó·Û¯Â‰È·ÛıÔ‡Ó ÌÂϤÙ˜ Û‡ÁÎÚÈÛ˘·˘ÙÒÓ ÙˆÓ Ê·ÚÌ¿ÎˆÓ Ì ÂÈÎÔÓÈÎfi‹ ¿ÏÏÔ Ê¿ÚÌ·ÎÔ. ¶·ÚfiÏ· ·˘Ù¿Ê·›ÓÂÙ·È fiÙÈ ·˘ÙÔ› ÔÈ ‚-·ÔÎÏÂÈ-ÛÙ¤˜ Û˘ÓÂÈÛʤÚÔ˘Ó ıÂÙÈο Û‰¢ÙÂÚ‡ÔÓÙ· ηٷÏËÎÙÈο ÛË-Ì›·, fiˆ˜ Ë ˘ÂÚÙÚÔÊ›· Ù˘ ·ÚÈ-ÛÙÂÚ‹˜ ÎÔÈÏ›·˜.61

Δ¤ÏÔ˜, Â›Ó·È ÛÎfiÈÌÔ Ó· ÙÔÓÈ-ÛıÔ‡Ó ÔÚÈṲ̂Ó˜ ȉȷÈÙÂÚfiÙËÙÂ˜Ô˘ ·ÊÔÚÔ‡Ó ÙÔÓ ÙÚfiÔ ¯ÔÚ‹ÁË-Û˘ ÙˆÓ ‚-·ÔÎÏÂÈÛÙÒÓ. ∏ ·fi-ÙÔÌË ‰È·ÎÔ‹ ÙÔ˘˜ ··ÈÙ› ȉȷ›-ÙÂÚË ÚÔÛÔ¯‹, ÂÍ·ÈÙ›·˜ Ù˘·ÓÙ·Ó·ÎÏ·ÛÙÈ΋˜ Ù·¯˘Î·Ú‰›·˜‹/Î·È Ù˘ ·‡ÍËÛ˘ Ù˘ ∞¶ Ô˘·˘Ù‹ ÌÔÚ› Ó· ÚÔηϤÛÂÈ, ȉÈ-·›ÙÂÚ· fiÙ·Ó Ù· Ê¿Ú̷η ¯ÔÚË-ÁÔ‡ÓÙ·È Û ˘„ËϤ˜ ‰fiÛÂȘ, Ì·ÔÙ¤ÏÂÛÌ· ·ÎfiÌ· Î·È ÙËÓ ÂÌ-Ê¿ÓÈÛË ÂÓfi˜ √∂ª. ∞Ó ÁÈ· ÔÔÈÔ-‰‹ÔÙ ÏfiÁÔ Ú¤ÂÈ Ó· ÛÙ·Ì·Ù‹-ÛÂÈ Ë ¯ÔÚ‹ÁËÛ‹ ÙÔ˘˜, ··ÈÙÂ›Ù·È ËÛÙ·‰È·Î‹ Ì›ˆÛË Ù˘ ‰fiÛ˘ ÙÔ˘˜Î·È Ë ·Ú¿ÏÏËÏË ˘ÔηٿÛÙ·ÛËÌ ¿ÏÏÔ ·ÓÙÈ˘ÂÚÙ·ÛÈÎfi Ê¿ÚÌ·-ÎÔ. Δ¤ÏÔ˜, Ú¤ÂÈ Ó· ›̷ÛÙ ȉÈ-·›ÙÂÚ· ÚÔÛÂÎÙÈÎÔ›, ηıfiÛÔÓ ÌÈ·ÌË ÎÏÈÓÈο ¤Î‰ËÏË ™¡ ÌÔÚ› Ó·Û˘ÁÎ·Ï˘Êı› ·fi ÙË ¯ÔÚ‹ÁËÛËÂÓfi˜ ‚-·ÔÎÏÂÈÛÙ‹.

™˘ÌÂÚ¿ÛÌ·Ù·√È ‚-·ÔÎÏÂÈÛÙ¤˜ ¤¯Ô˘Ó ¯ÚËÛÈÌÔ-ÔÈËı› ÁÈ· ÔÏÏ¿ ¯ÚfiÓÈ· ˆ˜·ÓÙÈ˘ÂÚÙ·ÛÈο Ê¿Ú̷η ÚÒÙ˘ÂÈÏÔÁ‹˜. øÛÙfiÛÔ Ù· ÙÂÏÂ˘Ù·›·¤ÙË ¿Ú¯ÈÛ ӷ ·ÌÊÈÛ‚ËÙÂ›Ù·È ËÛËÌ·Û›· ÙÔ˘˜, ΢ڛˆ˜ ÂÍ·ÈÙ›·˜Ù˘ ˘ÂÚÔ¯‹˜ ÙˆÓ ÓÂfiÙÂÚˆÓ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ Ê·Ú̿ΈÓ. ¶·-ÚfiÏ· ·˘Ù¿, Ë ÔÚÈÛÙÈ΋ Î·È Ï‹Ú˘·fiÛ˘ÚÛ‹ ÙÔ˘˜ ·fi ÙË ıÂڷ¢-ÙÈ΋ Ê·Ú¤ÙÚ· ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈ-ÛË Ù˘ ∞À ‰ÂÓ Ê·›ÓÂÙ·È Ó· ·ÔÙÂ-Ï› ÙË ÛˆÛÙ‹ ÂÈÏÔÁ‹. À¿Ú¯Ô˘ÓÛ˘ÁÎÂÎÚÈ̤Ó˜ ÔÌ¿‰Â˜ ·ÛıÂÓÒÓÔÈ Ôԛ˜ ÌÔÚÔ‡Ó Ó· ·ÔÎÔÌ›-ÛÔ˘Ó ÔʤÏË ·fi ÙË ıÂڷ›· Ì‚-·ÔÎÏÂÈÛÙ¤˜, fiˆ˜ ÔÈ ·ÛıÂÓ›˜Ì ™¡ ‹/Î·È ∫∞, ηıÒ˜ Î·È Ó¤· ‹·Á¯Ò‰Ë ¿ÙÔÌ· Ì ·Ó›ÏÂÎÙË

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1. Hansson L, Lindholm LH, Niskanen L,Lanke J, Hedner T, Niklason A,Luomanmaki K, Dahlof B, de Faire U,Morlin C, Karlberg BE, Wester PO andBjorck JE. Effect of angiotensin-converting-enzyme inhibition comparedwith conventional therapy on cardio-vascular morbidity and mortality in hy-pertension: the Captopril PreventionProject (CAPPP) randomised trial.Lancet 1999; 353: 611-616.

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10. ¶··ı·Ó·Û›Ô˘ ∞, °Ô˘‰¤‚ÂÓÔ˜ π, ΔÛÂ-Ϥ˘ ∞¢ .∞ÓÙ›ÛÙ·ÛË ÛÙËÓ ·ÛÈÚ›ÓË Î·ÈÙËÓ ÎÏÔȉÔÁÚ¤ÏË. ¶Èı·ÓÔ› Ì˯·ÓÈÛÌÔ›,ÂÚÁ·ÛÙËÚȷ΋ ‰ÈÂÚ‡ÓËÛË Î·È ÎÏÈÓÈ΋ÛËÌ·Û›·. ∂ÏÏ ∫·Ú‰ÈÔÏ ∂Èı. Àfi ‰ËÌÔ-Û›Â˘ÛË

™™˘̆ÓÓ‰‰˘̆··ÛÛÌÌfifi˜̃ ∞∞ÓÓÙÙÈÈ··ÈÈÌÌÔÔÂÂÙÙ··ÏÏÈÈ··ÎÎÒÒÓÓ Îη·ÈÈ ∞∞ÓÓÙÙÈÈııÚÚÔÔÌÌ‚‚ˆ̂ÙÙÈÈÎÎÒÒÓÓ

1. Hallas J, Dall M, Andries A, et al. Use ofsingle and combined antithrombotictherapy and risk of serious uppergastrointestinal bleeding: populationbased case-control study. BMJ 2006

2. Dentaly F, Douketis JD, Lim W,Crowther M. Combined aspirin-oralanticoagulant therapy compared withoral anticoagulant therapy alone amongpatients at risk for cardiovascular disea-se. A meta-analysis of randomized trials.Arch Intern Med 2007;167:117-124

3. Karjalainen PP, Porela P, Ytalo A et al.Safety and efficacy of combined antiplate-let-warfarin therapy after coronary stent-ing. Eur Heart J 2007;28: 726-32

4. Sinaeve PR. The good, the bad, and theugly: triple therapy after PCI in patientsrequiring chronic anticoagualtion.(Editorial). Eur Heart J 2007;28:657-8

5. ¢È¿ÎÔ˘ ª·Ú›·, ∂ÏÈÛ¿Ê ªˆ˘Û‹˜. ¶Ú¤ÂÈÓ· Û˘Ó¯›˙ÂÙ·È Ë ¯ÔÚ‹ÁËÛË ·ÛÈÚ›Ó˘Û ·ÛıÂÓ›˜ Ô˘ ·›ÚÓÔ˘Ó ÎÔ˘Ì·ÚÈÓÈο·ÓÙÈËÎÙÈο;. ∞ıËÚÔÛÎÏ‹ÚˆÛË 2006;Ù‡¯Ô˜ 9,30-31

¶ƒ√Δ∂π¡√ª∂¡∏ μπμ§π√°ƒ∞ºπ∞ °π∞ Δ∞ ∞¡Δπ∞πª√¶∂Δ∞§π∞∫∞

∂∂ÈÈÌ̤¤ÏÏÂÂÈÈ·· °°ÈÈ¿¿ÓÓÓÓˢ̃ °°ÔÔ˘̆‰‰¤¤‚‚ÂÂÓÓÔÔ˜̃∫∫··ııËËÁÁËËÙÙ‹‹˜̃ ∫∫··ÚÚ‰‰ÈÈÔÔÏÏÔÔÁÁ››··˜̃ ¶¶··ÓÓÂÂÈÈÛÛÙÙËËÌÌ››ÔÔ˘̆ ππˆ̂··ÓÓÓÓ››ÓÓˆ̂ÓÓ

ATHIROSK 14 03-07-07 12:06 ™ÂÏ›‰·32

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IATPOI KA§§ITEXNE™ IATPOI KA§§ITEXNE™ IATPOI KA§§ITEXNE™

™øTHPH™ ¶PA¶A™

I·ÙÚfi˜ K·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁfi˜

O ™ˆÙ‹Ú˘ ¶Ú¿·˜ Â›Ó·È K·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁfi˜, ¢È¢ı˘ÓÙ‹˜ ÙÔ˘ K·Ú‰ÈÔ¯ÂÈ-

ÚÔ˘ÚÁÈÎÔ‡ TÌ‹Ì·ÙÔ˜ ÙÔ˘ NÔÛÔÎÔÌ›Ԣ EÚÚ›ÎÔ˜ NÙ˘Ó¿Ó ·fi ÙÔ 2001. °ÂÓ-

Ó‹ıËΠÙÔ 1954 ÛÙÔ ™˘ÎÔ‡ÚÈÔ §¿ÚÈÛ·˜. ™Ô‡‰·Û ÛÙË £ÂÛÛ·ÏÔÓ›ÎË fiÔ˘

Î·È ÔÏÔÎÏ‹ÚˆÛ ÙËÓ ÂȉÈÎfiÙËÙ· Ù˘ K·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈ΋˜ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô «°.

¶··ÓÈÎÔÏ¿Ô˘». MÂÙÂηȉ‡ıËΠÛÙÔ Brompton ÙÔ˘ §ÔÓ‰›ÓÔ˘ ηٿ ÙË ‰ÈÂ-

Ù›· 1990-1992 Î·È ÂÚÁ¿ÛÙËΠÛÙÔ øÓ¿ÛÂÈÔ K·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈÎfi K¤ÓÙÚÔ (øKK)

ˆ˜ ÂÈÌÂÏËÙ‹˜ A’ ÙËÓ ÔÎÙ·ÂÙ›· 1993-2001.

H ʈÙÔÁÚ·Ê›· ·ÔÙÂÏ› ÁÈ’·˘ÙfiÓ ÌÓ‹ÌË, ·ÊÔ‡ ‹Ïı Û ·ʋ Ì·˙› Ù˘ ·fi Ù· ·È‰Èο ÙÔ˘

¯ÚfiÓÈ·, ‚ÔËıÒÓÙ·˜ ÙÔÓ ÔÈÎÔ‰fiÌÔ ·Ù¤Ú· Ô˘ ÁÈ· ‚ÈÔÔÚÈÛÙÈÎÔ‡˜ ÏfiÁÔ˘˜ ·ÛÎÔ‡ÛÂ Î·È ÙÔ

¿ÁÁÂÏÌ· ÙÔ˘ Ï·Ófi‰ÈÔ˘ ʈÙÔÁÚ¿ÊÔ˘. K·Ù¿ ‰Â‡ÙÂÚÔ ÏfiÁÔ ·ÔÙÂÏ› ¯·Ú¿ ‰ËÌÈÔ˘ÚÁ›·˜,

·ÊÔ‡ ‰›ÓÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· ¤ÎÊÚ·Û˘ Ì ٷ ¯ÚÒÌ·Ù·, ÙÔ Êˆ˜, ÙËÓ ·ÈÛıËÙÈ΋ ÙÔ˘ ı¤Ì·ÙÔ˜ ηÈ

ÙÔ fiÔÈÔ Ì‹Ó˘Ì· ÌÔÚ› Ó· ‰ÒÛÂÈ.

Œ¯ÂÈ Û˘ÌÌÂÙ¿Û¯ÂÈ ÛÙËÓ ¤ÎıÂÛË ÊˆÙÔÁÚ·Ê›·˜ ÙˆÓ ÂÚÁ·˙ÔÌ¤ÓˆÓ ÙÔ˘ øKK ÙÔÓ AÚ›ÏÈÔ ÙÔ˘

1998. ºˆÙÔÁڷʛ˜ ÙÔ˘ ˘¿Ú¯Ô˘Ó ÛÙ· ¤ÓıÂÙ· ÌÔ˘ÛÈÎÒÓ ¤ÚÁˆÓ ÙÔ˘ §. M·¯·ÈÚ›ÙÛ· (TÔ ‰È¿-

ÏÂÈÌÌ· ÎÚ·Ù¿ÂÈ ‰˘Ô ˙ˆ¤˜) Î·È ÙÔ˘ A. MÈÙ˙¤ÏÔ˘ (BڢͤÏϘ - Live).

out14t 03-07-07 12:41 ™ÂÏ›‰·5

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EΉ›‰ÂÙ·È ·fi ÙȘ È·ÙÚÈΤ˜ ÂΉfiÛÂȘ “B·ÁÈÔÓ¿Î˔̠¯ÔÚËÁ›· Ù˘ PFIZER HELLAS.

OÈ ·fi„ÂȘ ÛÙÔ Î›ÌÂÓÔ ÂÎÊÚ¿˙Ô˘Ó ÌfiÓÔ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Î·È ‰ÂÓ ·ÓÙÈÚÔÛˆÂ‡Ô˘Ó ÙË ¯ÔÚËÁfi ÂÙ·ÈÚ›·.

out14t 03-07-07 12:28 ™ÂÏ›‰·2