ΤΕΥΧΟΣ 5 ΜΑΡΤΙΟΣ 2005 - ΑΘΗΡΟΣΚΛΗΡΩΣΗ

∆ƒπª∏¡π∞π√ ¶∂ƒπ√¢π∫√ §π¶π¢πø¡ ∆∂ÀÃ√™ 5 ñ MAƒ∆π√™ 2005

256

724

¶·Ú¿ÁÔÓÙÂ˜ ∫ÈÓ‰‡ÓÔ˘

¶·ıÔÊ˘ÛÈÔÏÔÁ›·

KÏÈÓÈÎ¤˜ MÂÏ¤ÙÂ˜

£ÂÚ·Â›· - º¿ÚÌ·Î·

™‡Á¯ÚÔÓÂ˜ √‰ËÁ›Â˜

¶ÚÔÙÂÈÓfiÌÂÓË µÈ‚ÏÈÔÁÚ·Ê›·15

™YNTAKTIKH E¶ITPO¶H¢ÈÂ˘ı˘ÓÙ‹˜ ™‡ÓÙ·ÍË˜

XÂÈÌÒÓ·˜ HÏ›·˜

K·Ú‰ÈÔÏfiÁÔ˜

YÔÙ¤Ú·Ú¯Ô˜ Â.·.

M¤ÏË

Õı˘ÚÔ˜ B·Û›ÏÂÈÔ˜

AÓ·ÏËÚˆÙ‹˜ ¢ÈÂ˘ı˘ÓÙ‹˜ E™Y

K·Ú‰ÈÔÏÔÁÈÎfi TÌ‹Ì·

B’ ¶ÚÔ·È‰Â˘ÙÈÎ‹˜ KÏÈÓÈÎ‹˜ A¶£

IÔÎÚ¿ÙÂÈÔ NÔÛÔÎÔÌÂ›Ô

£ÂÛÛ·ÏÔÓ›ÎË˜

°·ÓˆÙ¿ÎË˜ EÌÌ·ÓÔ˘‹Ï

E›ÎÔ˘ÚÔ˜ K·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜

I·ÙÚÈÎ‹˜ ™¯ÔÏ‹˜

¶·ÓÂÈÛÙËÌ›Ô˘ HÚ·ÎÏÂ›Ô˘

¶ÂÚÈÊÂÚÂÈ·Îfi ¶·ÓÂÈÛÙËÌÈ·Îfi

NÔÛÔÎÔÌÂ›Ô HÚ·ÎÏÂ›Ô˘ KÚ‹ÙË˜

EÏÈÛ¿Ê Mˆ˘Û‹˜

K·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜

I·ÙÚÈÎ‹˜ ™¯ÔÏ‹˜

¶·ÓÂÈÛÙËÌ›Ô˘ Iˆ·ÓÓ›ÓˆÓ

¶ÂÚÈÊÂÚÂÈ·Îfi ¶·ÓÂÈÛÙËÌÈ·Îfi

NÔÛÔÎÔÌÂ›Ô Iˆ·ÓÓ›ÓˆÓ

KÔÏÔ‚Ô‡ °ÂÓÔ‚¤Ê·


YÔ‰ÈÂ˘ı‡ÓÙÚÈ· A’ K·Ú‰ÈÔÏÔÁÈÎ‹˜

KÏÈÓÈÎ‹˜ Î·È ˘Â‡ı˘ÓÔ˜ §ÈÈ‰·ÈÌÈÎÔ‡

I·ÙÚÂ›Ô˘ øÓ·ÛÂ›Ô˘ K·Ú‰ÈÔ¯ÂÈÚÔ˘Ú-

ÁÈÎÔ‡ K¤ÓÙÚÔ˘

MÈÏÈ·ÓÔ‡ EÏ¤ÓË


EÈÌÂÏËÙ‹˜ A’ ÙË˜ K·Ú‰ÈÔÏÔÁÈÎ‹˜

KÏÈÓÈÎ‹˜ Î·È ˘Â‡ı˘ÓÔ˜ §ÈÈ‰·ÈÌÈÎÔ‡

I·ÙÚÂ›Ô˘ T˙·ÓÂ›Ô˘ NÔÛÔÎÔÌÂ›Ô˘

¶ÂÈÚ·ÈÒ˜

¶›ÙÛ·‚Ô˜ XÚ‹ÛÙÔ˜

AÓ·ÏËÚˆÙ‹˜ K·ıËÁËÙ‹˜

K·Ú‰ÈÔÏÔÁ›·˜, I·ÙÚÈÎ‹˜ ™¯ÔÏ‹˜

¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ

IÔÎÚ¿ÙÂÈÔ NÔÛÔÎÔÌÂ›Ô AıËÓÒÓ

¶APA°ONTE™ KIN¢YNOY¢È·‚ËÙÈÎ‹ ‰˘ÛÏÈÈ‰·ÈÌ›· Î·È ·ıËÚÔÛÎÏ‹ÚˆÛË¡›ÎÔ˜ ¢È·ÎÔ˘Ì¿ÎÔ˜

¶A£OºY™IO§O°IAÃ·ÌËÏ¿ Â›Â‰· ∏DL ÓËÛÙÂ›·˜ Î·È ÌÂÙ·ÁÂ˘Ì·ÙÈÎ‹ ÏÈ·ÈÌ›·Kolovou GD, Anagnostopoulou KK, Pilatis N, Kafaltis N, Sorodila K, Psarros E, Cokkinos DV.Lipids Health Dis. 2004;23:18∂ÈÌ¤ÏÂÈ·: ∞Ï¤Í·Ó‰ÚÔ˜ ¶·ÓÙÂÏ¿ÎË˜, ∞ÓÙÒÓË˜ ¶·˘Ï›‰Ë˜

K§INIKE™ ME§ETE™PROVE IT: E›Â‰· C-·ÓÙÈ‰ÚÒÛ·˜ ÚˆÙÂ˝ÓË˜ Î·È ÎÏÈÓÈÎ‹ ¤Î‚·ÛË ÌÂÙ¿ıÂÚ·Â›· ÌÂ ÛÙ·Ù›ÓÂ˜Ridker PM, Cannon CP, Morrow D, et al; for the Pravastatin or Atorvastatin Evaluationand Infection Therapy–Thrombolysis in Myocardial Infarction 22 (PROVE IT–TIMI 22)Investigators.N Engl J Med 2005;352:20-8∂ÈÌ¤ÏÂÈ·: µ·Û›ÏÂÈÔ˜ Õı˘ÚÔ˜

£EPA¶EIA — ºAPMAKAÃÔÚ‹ÁËÛË ÛÙ·Ù›ÓË˜ ÚÈÓ ÙË ‰ÈÂÓ¤ÚÁÂÈ· ·ÁÁÂÈÔÏ·ÛÙÈÎ‹˜: Â›‰Ú·ÛË ÛÙËÓÂÚÈÂÂÌ‚·ÙÈÎ‹ ÂÌÊ¿ÓÈÛË ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘Briguori C, Colombo A, Airoldi F, Violante A, Facaccio A, Balestrieri P, Elia PP, Golia B,Lepore S, Rivezzo G, Scarpato P, Libera M, Bonizzoni E, Ricciardelli BEur Heart J 2004;25:1822-28∂ÈÌ¤ÏÂÈ·: ∏Ï›·˜ ÃÂÈÌÒÓ·˜

∏ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ˘¤ÚÙ·ÛË˜ ÌÂÙ¿ ·fi ¤Ó· ÈÛ¯·ÈÌÈÎfi ·ÁÁÂÈ·Îfi ÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔªÈ¯¿ÏË˜ ∫·ÏÔÁ‹ÚÔ˘, ªˆ˘Û‹˜ ∂ÏÈÛ¿Ê

∏ ·ÓÙ·fiÎÚÈÛË ÙË˜ HDL ÛÙËÓ ˘ÔÏÈÈ‰·ÈÌÈÎ‹ ıÂÚ·Â›·°ÂÓÔ‚¤Ê· ¢. KÔÏÔ‚Ô‡, K·ÙÂÚ›Ó· K. AÓ·ÁÓˆÛÙÔÔ‡ÏÔ˘, AÏ¤Í·Ó‰ÚÔ˜ E. ¶·ÓÙÂÏ¿ÎË˜

E›‰Ú·ÛË ÙË˜ ıÂÚ·Â›·˜ ÌÂ ÛÙ·Ù›ÓÂ˜ ÛÙËÓ ÔÌÔÈÔÛÙ·Û›· ÙÔ˘ Ô˘ÚÈÎÔ‡ ÔÍ¤Ô˜ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ÚˆÙÔ·ı‹ ˘ÂÚÏÈÈ‰·ÈÌ›·Milionis H, Kakafika A, Tsouli S, Athyros V, Seferiadis K, Elisaf M.Am Heart J 2004; 148: 635-640

™Y°XPONE™ O¢H°IE™™‡Á¯ÚÔÓÂ˜ ˘ÁÈÂÈÔÓÔ‰È·ÈÙËÙÈÎ¤˜ Ô‰ËÁ›Â˜ ÁÈ· ÙËÓ ÚfiÏË„Ë ÙË˜ Î·Ú‰È·ÁÁÂÈ·Î‹˜ ÓfiÛÔ˘HÏ›·˜ XÂÈÌÒÓ·˜

AÓ·ÛÎfiËÛË ÙˆÓ O‰ËÁÈÒÓ ÁÈ· ÙË ¢Â˘ÙÂÚÔÁÂÓ‹ ¶ÚfiÏË„Ë ÙË˜ K·Ú‰È·ÁÁÂÈ·Î‹˜ NfiÛÔ˘M. KˆÛÙ·¿ÓÔ˜, M. EÏÈÛ¿Ê

¶POTEINOMENH BIB§IO°PAºIA

2

5

6

7

8

11

13

15

18

24

TË˜ ™‡ÓÙ·ÍË˜

∏ ‰È·‚ËÙÈÎ‹ ‰˘ÛÏÈÈ‰

·ÈÌ›· Î·È Ô ÚfiÏÔ˜ Ù

Ë˜ ÛÙËÓ ·ıËÚÔÛÎÏ‹Úˆ

ÛË Â›-

Ó·È ÙÔ ÚÒÙÔ ı¤Ì· ÙÔ

˘ ·ÚfiÓÙÔ˜ ÙÂ‡¯Ô˘˜.

∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ë

·ÓÙ›-

ÛÙ·ÛË ÙˆÓ ÈÛÙÒÓ ÛÙËÓ ÈÓÛÔ˘Ï›ÓË Ô‰Ë

ÁÂ› ÛÙË ‰È·Ù·Ú·¯‹ fi

¯È ÌfiÓÔ ÙÔ˘

ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙË˜ ÁÏ˘

Îfi˙Ë˜ ·ÏÏ¿ Î·È ÙˆÓ ÏÈÈ‰›ˆÓ, ÌÂ ·ÔÙ

¤ÏÂÛÌ· ÙËÓ

ÚÒÈÌË ·ıËÚÔÛÎÏ‹ÚˆÛË ÙˆÓ ·ÚÙËÚÈÒÓ. √È ÌÂÙ·

ÁÂ˘Ì·ÙÈÎ¤˜ ‰È·Ù·Ú·¯¤

˜

ÙˆÓ ÏÈÈ‰›ˆÓ Â›Ó·È ÙÔ ı¤Ì· ÙˆÓ ‰‡Ô ÂÔÌ

¤ÓˆÓ ¿ÚıÚˆÓ. ∞ÎÔÏÔ˘ıÂ› ¤Ó·

ÂÓ‰È·Ê¤ÚÔÓ ¿ÚıÚÔ, ÙÔ ÔÔ›Ô

ÁÂÓÓ¿ ÂÏ›‰Â˜ ÁÈ· ‚Â

ÏÙ›ˆÛË ÙË˜ ÚfiÁÓˆ-

ÛË˜ ÙˆÓ ·ÛıÂÓÒÓ ÌÂÙ¿ ·ÁÁÂÈÔÏ·ÛÙÈÎ

‹: Ë ¤Ó·ÚÍË ¯ÔÚ‹ÁËÛ

Ë˜ ÛÙ·Ù›ÓË˜

ÙÔ˘Ï¿¯ÈÛÙÔÓ ÙÚÂÈ˜ ËÌ

¤ÚÂ˜ ÚÈÓ ÙË ‰ÈÂÓ¤ÚÁ

ÂÈ· ·ÁÁÂÈÔÏ·ÛÙÈÎ‹˜

ÌÂÈÒ-

ÓÂÈ ÙËÓ Èı·ÓfiÙËÙ·

ÂÌÊ¿ÓÈÛË˜ non-Q ÂÌÊÚ¿ÁÌ·ÙÔ˜

ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘

Î·Ù¿ ÙËÓ Â¤Ì‚·ÛË. ∏

·ÓÙ·fiÎÚÈÛË ÙË˜ HD

L-¯ÔÏËÛÙÂÚfiÏË˜ ÛÙËÓ

˘Ô-

ÏÈÈ‰·ÈÌÈÎ‹ ·ÁˆÁ‹ Î·È ÌÈ·

ÂÓ‰È·Ê¤ÚÔ˘Û· Î·È ÏÂÙÔÌÂÚ

‹˜ ·Ó·ÛÎfiËÛË

ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ˘

¤ÚÙ·ÛË˜ ÌÂÙ¿ ÙÔ ÈÛ

¯·ÈÌÈÎfi ÂÁÎÂÊ·ÏÈÎfi

ÂÂÈÛfi‰ÈÔ ·ÔÙÂÏÔ‡Ó

·ÓÙÈÎÂ›ÌÂÓÔ ¿ÏÏˆÓ ¿ÚıÚˆÓ. ¢‡Ô ¿Úı

Ú· ‰È·Ú·Á-

Ì·ÙÂ‡ÔÓÙ·È ÙÈ˜ Û‡Á¯

ÚÔÓÂ˜ Ô‰ËÁ›Â˜ ÁÈ· Ù

ËÓ ˘ÁÈÂÈÓÔ‰È·ÈÙËÙÈÎ‹

·ÁˆÁ‹

Î·È ÁÈ· ÙËÓ ‰Â˘ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë ÙˆÓ Î·Ú‰È·ÁÁÂ

È·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ.

∆¤ÏÔ˜ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È

ÂÓ‰È·Ê¤ÚÔÓÙ· Â˘Ú‹Ì·Ù· ÙË˜

ÌÂÏ¤ÙË˜ PROVE IT

ÁÈ· Ù· Â›Â‰· ÙË˜ C

RP Î·È ÙË ÛËÌ·Û›· ÙË

˜ ÛÙËÓ ÎÏÈÓÈÎ‹ ¤Î‚·ÛË

ÌÂÙ¿

ıÂÚ·Â›· ÌÂ ÛÙ·Ù›ÓÂ˜

HÏ›·˜ ÃÂÈÌÒÓ·˜

¢ÈÂ˘ı˘ÓÙ‹˜ ™‡ÓÙ·ÍË˜

A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·1

∏ ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓËÛ˘Ó‰¤ÂÙ·È ÌÂ Ì›· ÏÂÈ¿‰· ‰È·-Ù·Ú·¯ÒÓ, Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈÙËÓ ˘¤ÚÙ·ÛË, ÙËÓ ˘ÂÚÙÚÈ-ÁÏ˘ÎÂÚÈ‰·ÈÌ›·, ÙËÓ ÂÈÎÚ¿ÙË-ÛË ÌÈÎÚÒÓ ˘ÎÓÒÓ ÛˆÌ·ÙÈ‰›ˆÓÙË˜ ÏÈÔÚˆÙÂ˝ÓË˜ ¯·ÌËÏ‹˜˘ÎÓfiÙËÙ·˜ (LDL), Ù· ¯·ÌËÏ¿Â›Â‰· HDL-¯ÔÏËÛÙÂÚfiÏË˜(HDL-C), Î·ıÒ˜ Î·È ÙËÓ ˘ÂÚ-ËÎÙÈÎfiÙËÙ·. ∏ ·ÓÙ›ÛÙ·ÛËÛÙËÓ ÈÓÛÔ˘Ï›ÓË Â›Ó·È, ‚¤‚·È·,¤Ó·˜ Î‡ÚÈÔ˜ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ-‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ‰È·-‚‹ÙË. ∏ ·¯˘Û·ÚÎ›· ‰È·‰Ú·-Ì·Ù›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ, ÙfiÛÔ‰ÈfiÙÈ ÂÈÙÂ›ÓÂÈ ÙËÓ ·ÓÙ›ÛÙ·ÛËÛÙËÓ ÈÓÛÔ˘Ï›ÓË, fiÛÔ Î·È ‰ÈfiÙÈ·ÔÙÂÏÂ› ·ÓÂÍ¿ÚÙËÙÔ ·Ú¿ÁÔ-ÓÙ· ÎÈÓ‰‡ÓÔ˘ ÁÈ· ·ıËÚÔÛÎÏ‹-ÚˆÛË. ŒÙÛÈ, ÔÈ ·ÛıÂÓÂ›˜ Ô˘·ÚÔ˘ÛÈ¿˙Ô˘Ó ·ÓÙ›ÛÙ·ÛË ÛÙËÓÈÓÛÔ˘Ï›ÓË, ¤¯Ô˘Ó ÔÏÏÔ‡˜ Ïfi-ÁÔ˘˜ Ó· ‰È·ÙÚ¤¯Ô˘Ó ÔÏ‡ ˘„Ë-Ïfi Î›Ó‰˘ÓÔ ÁÈ· ·ıËÚÔÛÎÏËÚˆ-ÙÈÎ‹ Î·Ú‰È·ÁÁÂÈ·Î‹ ÓfiÛÔ(∞£™∫∞¡).

∞fi Ù· ‰Â‰ÔÌ¤Ó· ÙÔ˘ ÈÛÙÔ-ÚÈÎÔ‡, ÙË˜ ÎÏÈÓÈÎ‹˜ ÂÍ¤Ù·ÛË˜Î·È ÙÔ˘ ÂÚÁ·ÛÙËÚÈ·ÎÔ‡ ÂÏ¤Á-¯Ô˘, Ù· ÛÙÔÈ¯Â›· ÁÈ· ÙËÓ ·Ó·-ÁÓÒÚÈÛË ÙˆÓ ˘ÂÚÈÓÛÔ˘ÏÈÓ·È-ÌÈÎÒÓ ·ÛıÂÓÒÓ ÂÚÈÏ·Ì‚¿-ÓÔ˘Ó ÙË ÎÔÈÏÈ·Î‹ ·¯˘Û·ÚÎ›·Î·È ÙË ·ÚÔ˘Û›· ˘ÂÚÙÚÈÁÏ˘-ÎÂÚÈ‰·ÈÌ›·˜ ÌÂ ¯·ÌËÏ‹ HDL-C.ªÂÚÈÎ¤˜ ÊÔÚ¤˜ ÌÔÚÂ› Ó· ·ÓÈ-¯ÓÂ˘ıÂ› ‰˘Û·ÓÂÍ›· ÛÙË ÁÏ˘Îfi-˙Ë ÓËÛÙÂ›·˜ (ÙÈÌ¤˜ ÌÂÙ·Í‡110-126 mg/dL), ÂÓÒ Ù· ¿ÏÏ·¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙˆÓ ·ÙfiÌˆÓ ÌÂ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË ÂÚÈ-Ï·Ì‚¿ÓÔ˘Ó ÙËÓ ˘¤ÚÙ·ÛË Î·ÈÙËÓ ‹‰Ë ÂÁÎ·ÙÂÛÙËÌ¤ÓË∞£™∫∞¡. √ÚÈÛÌ¤ÓÂ˜ ÂıÓÔÏÔ-ÁÈÎ¤˜ ÔÌ¿‰Â˜ (ÁËÁÂÓÂ›˜ ∞ÌÂÚÈ-Î·ÓÔ›, ¿ÙÔÌ· ÚÔÂÚ¯fiÌÂÓ··fi ÙË ¡ÔÙÈ·Ó·ÙÔÏÈÎ‹ ∞Û›·)

·ÚÔ˘ÛÈ¿˙Ô˘Ó ˘„ËÏ‹ ÁÂÓÂÙÈÎ‹ÚÔ‰È¿ıÂÛË ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË·ÓÙ›ÛÙ·ÛË˜ ÛÙËÓ ÈÓÛÔ˘Ï›ÓË.

∏ ‰˘ÛÏÈÈ‰·ÈÌ›· ÙÔ˘ ™˘Ó-‰ÚfiÌÔ˘ ∞ÓÙ›ÛÙ·ÛË˜ ÛÙËÓ πÓ-ÛÔ˘Ï›ÓË ÂÚÈÏ·Ì‚¿ÓÂÈ ·˘ÍËÌ¤-Ó· Â›Â‰· ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ(TG), ÌÂÈˆÌ¤ÓË HDL-C Î·È ÌÂÈ-ˆÌ¤Ó· Â›Â‰· ·ÔÚˆÙÂ˝ÓË˜∞-π (Apo A-I), ·ÚÔ˘Û›· ·˘ÍË-Ì¤ÓË˜ LDL-C (fi¯È ··Ú·›ÙËÙ·)Î·È ·˘ÍËÌ¤ÓË ·Ó·ÏÔÁ›· ÌÈ-ÎÚÒÓ, ˘ÎÓÒÓ, Ùˆ¯ÒÓ ÛÂ ¯Ô-ÏËÛÙÂÚfiÏË ÛˆÌ·ÙÈ‰›ˆÓ LDL,·˘ÍËÌ¤Ó· Â›Â‰· VLDL– ¯Ô-ÏËÛÙÂÚfiÏË˜ (VLDL-C) Î·È ·Ô-ÚˆÙÂ˝ÓË˜ µ (Apo-B).

™Â Ì›· ·Ó¿Ï˘ÛË ÙË˜ Fra-mingham Heart Study, Ô˘ Û˘-Ó¤ÎÚÈÓÂ Ù· ÏÈÈ‰ÈÎ¿ Â›Â‰··Ó‰ÚÒÓ Î·È Á˘Ó·ÈÎÒÓ, ÌÂ ‹ ¯ˆ-Ú›˜ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡-Ô˘ 2 (™¢ 2), ÌÂ Ù· ·ÓÙ›ÛÙÔÈ¯·Ì¤Û· Â›Â‰· ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ÏËı˘ÛÌÔ‡ ÙˆÓ ∏¶∞, ‰È·È-ÛÙÒıËÎÂ fiÙÈ ÁÈ· ÙËÓ ÔÏÈÎ‹ ¯Ô-ÏËÛÙÂÚfiÏË (TC) Î·È ÙËÓ LDL-C‰ÂÓ ˘‹Ú¯·Ó ‰È·ÊÔÚ¤˜ ÌÂÙ·Í‡Ê˘ÛÈÔÏÔÁÈÎÒÓ Î·È ‰È·‚ËÙÈÎÒÓ·Ó‰ÚÒÓ Î·È Á˘Ó·ÈÎÒÓ, ·ÏÏ¿ ÔÈ‰È·‚ËÙÈÎÔ› ·ÛıÂÓÂ›˜ (¿Ó‰ÚÂ˜Î·È Á˘Ó·›ÎÂ˜) ·ÚÔ˘Û›·˙·Ó2Ï¿ÛÈ· Û¯Â‰fiÓ Â›ÙˆÛË ¯·-ÌËÏ‹˜ HDL-C Î·È ˘„ËÏÒÓ TG,ÛÂ Û¯¤ÛË ÌÂ ÙÔ˘˜ ÌË ‰È·‚ËÙÈ-ÎÔ‡˜ ÔÌÔÏfiÁÔ˘˜ ÙÔ˘˜1. ¶·Úfi-ÌÔÈ· ÌÂ ÂÎÂ›Ó· ÙË˜ Framing-ham Heart Study, ‹Ù·Ó Î·È Ù·¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙˆÓ ÏÈÈ‰ÈÎÒÓ·Ú·Ì¤ÙÚˆÓ ÙˆÓ ·ÛıÂÓÒÓ ÌÂ™¢ 2, ÛÂ Ì›· ·Ó¿Ï˘ÛË ÙË˜ Uni-ted Kingdom Prospective Dia-betes Study (UKPDS), ÌÂ ÌfiÓËÙË ‰È·ÊÔÚ¿ ÙË˜ ‹È·˜, ·ÏÏ¿ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹˜, ·‡ÍË-ÛË˜ ÙË˜ LDL-C ÛÙÈ˜ ‰È·‚ËÙÈ-Î¤˜, ¤Ó·ÓÙÈ ÙˆÓ ÌË ‰È·‚ËÙÈÎÒÓÁ˘Ó·ÈÎÒÓ2.

∏ ÈÓÛÔ˘Ï›ÓË Ê˘ÛÈÔÏÔÁÈÎ¿ Î·-Ù·ÛÙ¤ÏÏÂÈ ÙË ‰Ú¿ÛË ÙË˜ ÔÚÌÔ-ÓÔÂ˘·›ÛıËÙË˜ ÏÈ¿ÛË˜, ‰ËÏ·-‰‹ ÙÔ˘ ÂÓ˙‡ÌÔ˘ Ô˘ ‰È·Û¿ Ù·TG ÙÔ˘ ÏÈÒ‰Ô˘˜ ÈÛÙÔ‡ Î·È·ÂÏÂ˘ıÂÚÒÓÂÈ ÏÈ·Ú¿ ÔÍ¤·ÁÈ· ÙÈ˜ ÌÂÙ·‚ÔÏÈÎ¤˜ Î·È ÂÓÂÚ-ÁÂÈ·Î¤˜ ·Ó¿ÁÎÂ˜ ÙÔ˘ ÔÚÁ·ÓÈ-ÛÌÔ‡. ∏ ·Ó·ÛÙÔÏ‹ ‹ ÌÂ›ˆÛËÙË˜ ‰Ú¿ÛË˜ ÙË˜ ÈÓÛÔ˘Ï›ÓË˜,Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÙÔ ™‡Ó-‰ÚÔÌÔ ∞ÓÙ›ÛÙ·ÛË˜ ÛÙËÓπÓÛÔ˘Ï›ÓË, ÂÈÙÚ¤ÂÈ ÛÙÔ ¤Ó˙˘-ÌÔ ·˘Ùfi Ó· Î¿ÓÂÈ ÌÂÁ·Ï‡ÙÂÚË‰È¿Û·ÛË ÙˆÓ ÂÓ·ÔıËÎÂ˘Ì¤-ÓˆÓ ÛÙ· ÏÈÔÎ‡ÙÙ·Ú· TG. ∏·˘ÍËÌ¤ÓË ‰È¿Û·ÛË ÙˆÓ TG·ÎÔÏÔ˘ıÂ›Ù·È ·fi ·˘ÍËÌ¤ÓË·fi‰ÔÛË ÂÏÂ‡ıÂÚˆÓ ÏÈ·ÚÒÓÔÍ¤ˆÓ (FFA) ÛÙË Î˘ÎÏÔÊÔÚ›·.¶ÚfiÎÂÈÙ·È ÁÈ· Ì›· Û˘ÓËıÈÛÌ¤-ÓË ‰È·Ù·Ú·¯‹, Ô˘ ·Ú·ÙËÚÂ›-Ù·È ÙfiÛÔ ÛÂ ·¯‡Û·ÚÎ·, fiÛÔÎ·È ÛÂ ÏÂÙfiÛˆÌ· ¿ÙÔÌ· ÌÂ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË,fiˆ˜ Î·È ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ™¢ 2.∆· ·˘ÍËÌ¤Ó· ÛÙÔ Ï¿ÛÌ· FFAÚÔÛÏ·Ì‚¿ÓÔÓÙ·È ÌÂ ÂÓÙÔÓfi-ÙÂÚÔ Ú˘ıÌfi ·fi ÙÔ ‹·Ú. ™ÂÎ·Ù¿ÛÙ·ÛË ÓËÛÙÂ›·˜ Î·È Â›·ÚÔ˘Û›·˜ Â·ÚÎÒÓ ·ÔıÂ-Ì¿ÙˆÓ ÁÏ˘ÎÔÁfiÓÔ˘, Î·Ù¿ÛÙ·-ÛË Ô˘ ·ÓÙÈÚÔÛˆÂ‡ÂÈ ÙË Û˘-¯ÓfiÙÂÚË ÂÈÎfiÓ· ÛÂ ‰È·‚ËÙÈ-ÎÔ‡˜ ÌÂ ÏÔÁÈÎ¿ ÂÏÂÁ¯fiÌÂÓÔ‰È·‚‹ÙË Î·È ÛÂ ÌË ‰È·‚ËÙÈÎÔ‡˜ÌÂ ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË,ÙÔ ‹·Ú ¯ÚËÛÈÌÔÔÈÂ› Ù· ÚÔ-ÛÏ·Ì‚·ÓfiÌÂÓ· ÏÈ·Ú¿ ÔÍ¤·ÁÈ· ÙË Û‡ÓıÂÛË TG. H ·ÚÔ˘-Û›· ·˘ÍËÌ¤ÓˆÓ TG ‰ÈÂÁÂ›ÚÂÈÙËÓ ¤ÎÎÚÈÛË Apo B Î·È VLDL,ÌÂ Û˘Ó¤ÂÈ· ÙÔÓ ·˘ÍËÌ¤ÓÔ·ÚÈıÌfi ÛˆÌ·ÙÈ‰›ˆÓ VLDL Î·ÈÙËÓ ·‡ÍËÛË ÙÔ˘ ÂÈ¤‰Ô˘ ÙˆÓTG ÛÙÔ Ï¿ÛÌ·.

™Â ·ÚÔ˘Û›· ·˘ÍËÌ¤ÓˆÓ

§ÈÈ‰·ÈÌÈÎ¤˜ ¢È·Ù·Ú·¯¤˜ – ¶·ıÔÊ˘ÛÈoÏÔÁ›·

°ÂÓÈÎfiÙËÙÂ˜

·ıËÚÔÛÎÏ‹ÚˆÛËMAPTIO™ 2005

2

¢È·‚ËÙÈÎ‹ ‰˘ÛÏÈÈ‰·ÈÌ›· Î·È ·ıËÚÔÛÎÏ‹ÚˆÛË

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

A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·2

ÂÈ¤‰ˆÓ VLDL ÛÙÔ Ï¿ÛÌ·Î·È Ê˘ÛÈÔÏÔÁÈÎ‹˜ ‰Ú·ÛÙËÚÈfi-ÙËÙ·˜ ÙË˜ ÚˆÙÂ˝ÓË˜ ÌÂÙ·ÊÔ-Ú¿˜ ÙˆÓ ÂÛÙ¤ÚˆÓ ¯ÔÏËÛÙÂÚfi-ÏË˜ (CETP), Á›ÓÂÙ·È ·ÓÙ·ÏÏ·-Á‹ ÂÓfi˜ ÌÔÚ›Ô˘ ÂÛÙ¤Ú· ¯ÔÏË-ÛÙÂÚfiÏË˜, ÚÔÂÚ¯fiÌÂÓÔ˘ ·fiÙËÓ HDL, ¤Ó·ÓÙÈ ÂÓfi˜ ÌÔÚ›Ô˘TG, ÚÔÂÚ¯fiÌÂÓÔ˘ ·fi ÙËVLDL. ∏ ·ÓÙ·ÏÏ·Á‹ ·˘Ù‹ ¤¯ÂÈ‰‡Ô Û˘Ó¤ÂÈÂ˜: ÚÒÙÔÓ ÙË ‰Ë-ÌÈÔ˘ÚÁ›· ÂÓfi˜ ÏÔ‡ÛÈÔ˘ ÛÂ¯ÔÏËÛÙÂÚfiÏË ˘ÔÏÂÈÌÌ·ÙÈÎÔ‡ÛˆÌ·ÙÈ‰›Ô˘ VLDL, Ô˘ Â›Ó·È·ıËÚÔÁfiÓÔ Î·È ‰Â‡ÙÂÚÔÓ ÙË‰ËÌÈÔ˘ÚÁ›· ÂÓfi˜ Ùˆ¯Ô‡ ÛÂÂÛÙ¤ÚÂ˜ ¯ÔÏËÛÙÂÚfiÏË˜, ·ÏÏ¿ÏÔ‡ÛÈÔ˘ ÛÂ TG ÛˆÌ·ÙÈ‰›Ô˘HDL. ∆Ô ÙÂÏÂ˘Ù·›Ô ·˘Ùfi Ûˆ-Ì·Ù›‰ÈÔ HDL ˘Ê›ÛÙ·Ù·È ÂÚ·È-Ù¤Úˆ ÙÚÔÔÔ›ËÛË, Ô˘ Û˘-ÌÂÚÈÏ·Ì‚¿ÓÂÈ ÙË ÏÈÔÏ˘ÙÈÎ‹Â›‰Ú·ÛË ÙË˜ Ë·ÙÈÎ‹˜ ÏÈ¿-ÛË˜, ‰È·‰ÈÎ·Û›· Ô˘ Ô‰ËÁÂ›ÛÙËÓ ·fiÛ·ÛË ·fi ·˘Ùfi ÙË˜‰ÔÌÈÎ¿ ÛËÌ·ÓÙÈÎ‹˜ Apo A-I. ∏ÂÏÂ‡ıÂÚË ÛÙÔ Ï¿ÛÌ· Apo A-I·Ô‚¿ÏÏÂÙ·È Ù·¯‡ÙÂÚ·, Î‡ÚÈ··fi ÙÔ ÓÂÊÚfi, ÛÂ Û¯¤ÛË ÌÂ ÙËÛ˘Ó‰Â‰ÂÌ¤ÓË ÛÙÔ ÛˆÌ·Ù›‰ÈÔÙË˜ HDL. ∞ÔÙ¤ÏÂÛÌ· Â›Ó·È ËÌÂ›ˆÛË ÙË˜ ÔÛfiÙËÙ·˜ ÙË˜Apo A-I ÛÙË Î˘ÎÏÔÊÔÚ›· Î·È¿Ú· Î·È ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Ûˆ-Ì·ÙÈ‰›ˆÓ HDL.

™Â ·ÚÔ˘Û›· Ê˘ÛÈÔÏÔÁÈÎ‹˜‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÙË˜ CETPÙÔ˘ Ï¿ÛÌ·ÙÔ˜, Ù· ·˘ÍËÌ¤Ó·Â›Â‰· ÙˆÓ TG ÙˆÓ VLDL·ÓÙ·ÏÏ¿ÛÛÔÓÙ·È ÌÂ ÂÛÙ¤ÚÂ˜¯ÔÏËÛÙÂÚfiÏË˜ Î·È ·fi ÙÈ˜LDL. ∆· ÚÔÎ‡ÙÔÓÙ· ÏÔ‡ÛÈ·ÛÂ TG ÛˆÌ·Ù›‰È· LDL ˘Ê›ÛÙ·-ÓÙ·È ÙË ÏÈÔÏ˘ÙÈÎ‹ ‰Ú¿ÛË ÙË˜Ë·ÙÈÎ‹˜ ‹ Î·È ÙË˜ ÏÈÔÚˆ-ÙÂ˝ÓÈÎ‹˜ ÏÈ¿ÛË˜, ÌÂ Û˘Ó¤ÂÈ·ÙË ‰ËÌÈÔ˘ÚÁ›· ÌÈÎÚÒÓ, ˘ÎÓÒÓÎ·È Ùˆ¯ÒÓ ÛÂ ¯ÔÏËÛÙÂÚfiÏËÛˆÌ·ÙÈ‰›ˆÓ LDL.

™ÙÔÈ¯Â›· ·fi ÌÂÏ¤ÙÂ˜ in vitroÎ·È in vivo ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ ÔÈÌÈÎÚ¤˜, ˘ÎÓ¤˜ LDL Â›Ó·È È‰È·›-ÙÂÚ· ·ıËÚÔÁfiÓÂ˜. ™Â ÌÂÏ¤ÙÂ˜in vitro, ‰È·ÈÛÙÒıËÎÂ fiÙÈ ÔÈ ÌÈ-ÎÚ¤˜, ˘ÎÓ¤˜ LDL Â›Ó·È ÂÚÈÛ-

ÛfiÙÂÚÔ Â˘·ıÂ›˜ ÛÂ ÔÍÂÈ‰ˆÙÈ-Î‹ ÙÚÔÔÔ›ËÛË, Î·È ÂÂÈ‰‹ Â›-Ó·È ÌÈÎÚfiÙÂÚÂ˜ ÛÂ Ì¤ÁÂıÔ˜,Ê·›ÓÂÙ·È fiÙÈ ÂÈÛ‰‡Ô˘Ó Â˘ÎÔÏfi-ÙÂÚ· ÛÙËÓ ˘ÂÓ‰ÔıËÏÈ·Î‹ ÛÙÈ-‚¿‰· ÙÔ˘ ·ÚÙËÚÈ·ÎÔ‡ ÙÔÈ¯Ò-Ì·ÙÔ˜. ∆Ô ÌfiÚÈÔ ÙË˜ Apo BÙˆÓ ÌÈÎÚÒÓ, ˘ÎÓÒÓ LDL ˘Ê›-ÛÙ·Ù·È ÙÚÔÔÔ›ËÛË Ô˘ Ô‰Ë-ÁÂ› ÛÂ ÌÂ›ˆÛË ÙË˜ Û˘ÁÁ¤ÓÂÈ¿ÙË˜ ÚÔ˜ ÙÔÓ ˘Ô‰Ô¯¤· ÙË˜LDL, ÂÈÙÚ¤ÔÓÙ·˜ ¤ÙÛÈ ÙË ÌÂ-Á·Ï‡ÙÂÚË, ¯ÚÔÓÈÎ¿, ·Ú·ÌÔÓ‹ÙÔ˘˜ ÛÙË Î˘ÎÏÔÊÔÚ›· Î·È ÛÙÔ·ÁÁÂÈ·Îfi ÙÔ›¯ˆÌ·. ™Â ÌÂÏ¤ÙÂ˜ÏËı˘ÛÌÒÓ Î·È ÛÂ ÌÈÎÚ¤˜ ÎÏÈ-ÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜, Ë ·ÚÔ˘Û›· ÌÈ-ÎÚÒÓ, ˘ÎÓÒÓ LDL Û˘Ó‰¤ıËÎÂÌÂ ÙÔ Û‡Ó‰ÚÔÌÔ ·ÓÙ›ÛÙ·ÛË˜ÛÙËÓ ÈÓÛÔ˘Ï›ÓË, fiˆ˜ Â›ÛË˜Î·È ÌÂ ÙËÓ ·ÚÔ˘Û›· ˘„ËÏÔ‡ÂÈ¤‰Ô˘ TG Î·È ¯·ÌËÏ‹˜HDL-C3.

∞Ó·ÊÔÚÈÎ¿ ÌÂ ÙË Û¯¤ÛË˘ÂÚÈÓÛÔ˘ÏÈÓ·ÈÌ›·˜ Î·È ¯·ÌË-Ï‹˜ HDL-C, Ì›· ÌÂÏ¤ÙË ·fi ÙÔ¶·ÓÂÈÛÙ‹ÌÈÔ Stanford4 ¤‰ÂÈ-ÍÂ fiÙÈ ÙfiÛÔ ÛÙÔ˘˜ ·¯‡Û·Ú-ÎÔ˘˜, fiÛÔ Î·È ÛÙÔ˘˜ ÏÂÙfiÛˆ-ÌÔ˘˜ ·ÛıÂÓÂ›˜, ÂÎÂ›ÓÔÈ Ô˘·ÚÔ˘ÛÈ¿˙Ô˘Ó ˘ÂÚÈÓÛÔ˘ÏÈ-Ó·ÈÌ›· ¤¯Ô˘Ó ¯·ÌËÏfiÙÂÚ· Â›-Â‰· HDL-C, ÛÂ Û¯¤ÛË ÌÂ Ù·¿ÙÔÌ· ÌÂ ÈÓÛÔ˘Ï›ÓË Î¿Ùˆ ÙË˜Ì¤ÛË˜ ÙÈÌ‹˜.

™¯ÂÙÈÎ¿ ÌÂ ÙÔ Â›Ì·¯Ô ˙‹ÙË-Ì· ÙË˜ Û˘Û¯¤ÙÈÛË˜ ÌÂÙ·Í‡ TGÎ·È ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÛÙÂÊ·ÓÈ·›·ÓfiÛÔ (™¡), Ú¤ÂÈ Ó· ÛËÌÂÈˆ-ıÂ› fiÙÈ ˘¿Ú¯Ô˘Ó ·ÚÎÂÙÔ› Ïfi-ÁÔÈ, ÁÈ· ÙÔ˘˜ ÔÔ›Ô˘˜ ı· Ú¤-ÂÈ Ó· ıÂˆÚÂ›Ù·È fiÙÈ Ë ˘ÂÚÙÚÈ-ÁÏ˘ÎÂÚÈ‰·ÈÌ›· ·ÔÙÂÏÂ›, ÙÔ˘-Ï¿¯ÈÛÙÔÓ, ¤Ó· ‰Â›ÎÙË ·˘ÍËÌ¤-ÓË˜ ·ıËÚÔÁfiÓÔ˘ Èı·ÓfiÙËÙ·˜.¶ÚÒÙ· ·fi fiÏ·, Ë ˘ÂÚÙÚÈÁÏ˘-ÎÂÚÈ‰·ÈÌ›· Û˘Ó‰¤ÂÙ·È ÌÂ ·˘ÍË-Ì¤Ó· Â›Â‰· ÙˆÓ ·ıËÚÔÁfiÓˆÓ˘ÔÏÂÈÌÌ¿ÙˆÓ ÙˆÓ ¯˘ÏÔÌÈÎÚÒÓÎ·È ÙˆÓ VLDL, Î·È Ô‰ËÁÂ›, fiˆ˜ÚÔ·Ó·Ê¤ÚıËÎÂ, ÛÙË ·Ú·Áˆ-Á‹ ÌÈÎÚÒÓ, ˘ÎÓÒÓ LDL Î·È·ÔÙÂÏÂ› ÙË ‚¿ÛË ÁÈ· Ù· ¯·ÌË-Ï¿ Â›Â‰· HDL. ∏ ˘ÂÚÙÚÈ-ÁÏ˘ÎÂÚÈ‰·ÈÌ›· Û˘Ó‰¤ÂÙ·È Â›-ÛË˜ ÌÂ ·˘ÍËÌ¤ÓË ËÎÙÈÎfiÙËÙ·Î·È ÌÂÈˆÌ¤ÓË ÈÓˆ‰fiÏ˘ÛË, fiˆ˜Û˘ÌÂÚ·›ÓÂÙ·È ·fi Ù· ·˘ÍËÌ¤-

Ó· Â›Â‰· ÙÔ˘ PAI-I Î·È ÙÔ˘·Ú¿ÁÔÓÙ· VII, Î·È ·fi ÙËÓÂÓÂÚÁÔÔ›ËÛË ÙË˜ ÚÔıÚÔÌ‚›-ÓË˜ ÛÂ ıÚÔÌ‚›ÓË.

ŒÓ· ı¤Ì·, Ô˘ ‰ÂÓ ¤¯ÂÈ Û˘-˙ËÙËıÂ› ·ÚÎÂÙ¿ Â›Ó·È ÔÈ ‰È·Ù·-Ú·¯¤˜ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓTG ÛÙÔ ÏËı˘ÛÌfi ÌÂ ·ÓÙ›ÛÙ·-ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË, Î·È ÔÈ ÔÔ›-Â˜ ÂÌÊ·Ó›˙ÔÓÙ·È fi¯È ÌfiÓÔ fiÙ·ÓÔÈ ·ÛıÂÓÂ›˜ Â›Ó·È ÛÂ Î·Ù¿ÛÙ·-ÛË ÓËÛÙÂ›·˜, ·ÏÏ¿ Î·È ÌÂÙ¿·fi ¤Ó· ÏÈ·Úfi ÁÂ‡Ì·. Œ¯ÂÈ·Ô‰ÂÈ¯ıÂ› fiÙÈ Ë ÌÂÙ·ÁÂ˘Ì·ÙÈ-Î‹ ˘ÂÚÙÚÈÁÏ˘ÎÂÚÈ‰·ÈÌ›· ·Ô-ÙÂÏÂ› ‰Â›ÎÙË ·˘ÍËÌ¤ÓÔ˘ ÎÈÓ‰‡-ÓÔ˘ ™¡. ™Â Ì›· ·ÚÎÂÙ¿ ·ÏÈ¿ÌÂÏ¤ÙË, ÔÈ Patsch et al.5, Û‡-ÁÎÚÈÓ·Ó ·ÛıÂÓÂ›˜ ÌÂ ·ÁÁÂÈÔ-ÁÚ·ÊÈÎ¿ ‚Â‚·ÈˆÌ¤ÓË ™¡, ÌÂÂÎÂ›ÓÔ˘˜ ÌÂ Ê˘ÛÈÔÏÔÁÈÎ‹ ÛÙÂ-Ê·ÓÈÔÁÚ·Ê›·, Î·È ‰È·›ÛÙˆÛ·ÓfiÙÈ ÔÈ ÛÙÂÊ·ÓÈ·›ÔÈ ·ÛıÂÓÂ›˜ ·-ÚÔ˘Û›·˙·Ó ˘„ËÏfiÙÂÚË ˘ÂÚ-ÙÚÈÁÏ˘ÎÂÚÈ‰·ÈÌ›· ÌÂÙ¿ ·fi¤Ó· ÏÈ·Úfi ÁÂ‡Ì·, ÂÓÒ ÛÂ ¿Ï-ÏË ÌÂÏ¤ÙË ‰È·ÈÛÙÒıËÎÂ fiÙÈ Ë‰È·Ù·Ú·¯‹ ÙË˜ ÌÂÙ·ÁÂ˘Ì·ÙÈÎ‹˜ÏÈ·ÈÌ›·˜ ·ÔÙÂÏÂ› ¤Ó· ·ÓÂÍ¿Ú-ÙËÙÔ ·Ú¿ÁÔÓÙ· Úfi‚ÏÂ„Ë˜ÙË˜ ·ÚÔ˘Û›·˜ ∞£™∫∞¡, ·ÓÂ-Í¿ÚÙËÙÔ ·ÎfiÌË Î·È ·fi ÙÔ Â›-Â‰Ô TG ÓËÛÙÂ›·˜.

√ Û·Î¯·ÚÒ‰Ë˜ ‰È·‚‹ÙË˜Û˘Ó‰˘¿˙ÂÙ·È, Â›ÛË˜, ÌÂ ˘ÂÚ-ËÎÙÈÎfiÙËÙ· Î·È ÚÔ‰È¿ıÂÛËÁÈ· ıÚÔÌ‚ÔÂÌ‚ÔÏÈÎ¿ Ê·ÈÓfiÌÂ-Ó·. ∆· ‰È·‚ËÙÈÎ¿ ¿ÙÔÌ· ·-ÚÔ˘ÛÈ¿˙Ô˘Ó ·˘ÍËÌ¤Ó· Â›Â‰·ÈÓˆ‰ÔÁfiÓÔ˘ Î·È PAI-I Ï¿ÛÌ·-ÙÔ˜, Î·È ·˘ÍËÌ¤ÓË Ù¿ÛË Û˘Û-ÛÒÚÂ˘ÛË˜ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ6.∏ ÚÔ‰È¿ıÂÛË ÁÈ· ıÚfiÌ‚ˆÛËÔÊÂ›ÏÂÙ·È ÛÙËÓ ·˘ÍËÌ¤ÓË Û˘Û-ÛˆÚÂ˘ÙÈÎfiÙËÙ· ÙˆÓ ·ÈÌÔÂÙ·-Ï›ˆÓ, ÙÈ˜ ·˘ÍËÌ¤ÓÂ˜ Û˘ÁÎÂ-ÓÙÚÒÛÂÈ˜ ÚÔËÎÙÈÎÒÓ ·Ú·-ÁfiÓÙˆÓ, fiˆ˜ Î·È ÛÙË ÌÂÈˆÌ¤-ÓË Û˘ÁÎ¤ÓÙÚˆÛË Î·È ‰Ú·ÛÙË-ÚÈfiÙËÙ· ÙˆÓ ·ÓÙÈıÚÔÌ‚ˆÙÈÎÒÓ·Ú·ÁfiÓÙˆÓ, ÂÓÒ ÔÈ ·Ú¿ÁÔ-ÓÙÂ˜ Ô˘ ÚÔ‰È·ı¤ÙÔ˘Ó ÛÙËÓÂÍ·Ûı¤ÓËÛË ÙË˜ Ê˘ÛÈÔÏÔÁÈÎ‹˜ÈÓˆ‰fiÏ˘ÛË˜ Â›Ó·È Ë ÌÂÈˆÌ¤ÓË‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘ t-PA, Ù··˘ÍËÌ¤Ó· Â›Â‰· ÙÔ˘ ƒ∞π-πÎ·È Ë ·˘ÍËÌ¤ÓË Û˘ÁÎ¤ÓÙÚˆÛËÙË˜ ·2 ·ÓÙÈÏ·ÛÌ›ÓË˜7.

∂ÈÙÒÛÂÈ˜

¶∞ƒ∞°√¡∆∂™ ∫π¡¢À¡√À

3

A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·3

∏ ‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘ ƒ∞π-πÂ›Ó·È ·˘ÍËÌ¤ÓË ÛÙÔ Ï¿ÛÌ·ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ™¢ 2, ·ÓÂÍ¿Ú-ÙËÙ· ·fi ÙÔ ÛˆÌ·ÙÈÎfi ÙÔ˘˜‚¿ÚÔ˜ (·¯‡Û·ÚÎÔÈ ‹ ÏÂÙfi-ÛˆÌÔÈ), ·ÏÏ¿ Ù· ·¯‡Û·ÚÎ·¿ÙÔÌ·, ÌÂ ‹ ¯ˆÚ›˜ ‰È·‚‹ÙË,·ÚÔ˘ÛÈ¿˙Ô˘Ó ˘„ËÏfiÙÂÚ· Â›-Â‰· ƒ∞π-π, ÛÂ Û¯¤ÛË ÌÂ Ù·¿ÙÔÌ· Î·ÓÔÓÈÎÔ‡ ‚¿ÚÔ˘˜. ∆·Â›Â‰· ÙÔ˘ ƒ∞π-π ·˘Í¿ÓÔÓÙ·ÈÙfiÛÔ ÛÂ ˘ÂÚÈÓÛÔ˘ÏÈÓ·ÈÌ›·,fiÛÔ Î·È ÛÂ ˘ÂÚÙÚÈÁÏ˘ÎÂÚÈ‰·È-Ì›·8. ∞ÎfiÌË Î·È ÛÂ Ê˘ÛÈÔÏÔÁÈ-Î¿ ¿ÙÔÌ·, Ë ÂÈÚ·Ì·ÙÈÎ‹ Úfi-ÎÏËÛË ˘ÂÚÈÓÛÔ˘ÏÈÓ·ÈÌ›·˜ Î·È˘ÂÚÁÏ˘Î·ÈÌ›·˜ (ÌÂ ÙË ¯ÔÚ‹-ÁËÛË ÁÏ˘Îfi˙Ë˜ Î·È intralipid),Ì·˙› ÌÂ ·˘ÍËÌ¤Ó· Â›Â‰·ÂÏÂ‡ıÂÚˆÓ ÏÈ·ÚÒÓ ÔÍ¤ˆÓ,Ô‰‹ÁËÛÂ ÛÂ ÛËÌ·ÓÙÈÎ‹ ·‡ÍË-ÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙÔ˘ ƒ∞π-π ÛÙÔÏ¿ÛÌ·, ÁÈ· ·ÚÎÂÙ¤˜ ÒÚÂ˜ 9.

√È ÚÔÙÂÚ·ÈfiÙËÙÂ˜ ·ÓÙÈÌÂÙÒ-ÈÛË˜ ÙˆÓ ‰È·Ù·Ú·¯ÒÓ ÙÔ˘ ÌÂ-Ù·‚ÔÏÈÛÌÔ‡ ÙˆÓ ÏÈÈ‰›ˆÓÛÙÔ˘˜ ‰È·‚ËÙÈÎÔ‡˜ ·ÛıÂÓÂ›˜

¤¯Ô˘Ó ÙÂıÂ› ·fi ÙËÓ ∞ÌÂÚÈÎ·-ÓÈÎ‹ ¢È·‚ËÙÔÏÔÁÈÎ‹ ∂Ù·ÈÚÂ›·(ADA)10. ∂ÙÛÈ, Ë ÌÂ›ˆÛË ÙË˜LDL-C ·ÔÙÂÏÂ› ÙË ÚÒÙËÚÔÙÂÚ·ÈfiÙËÙ·, ÌÂ ‚¿ÛË ÙÈ˜ÎÏÈÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜, Ô˘ ¤‰ÂÈÍ·ÓÛËÌ·ÓÙÈÎ¤˜ ÌÂÈÒÛÂÈ˜ ÙË˜ ÓÔ-ÛËÚfiÙËÙ·˜ Î·È ÙË˜ ıÓËÙfiÙË-Ù·˜ ÛÙÈ˜ ˘Ô-ÔÌ¿‰Â˜ ÙˆÓ ‰È·-‚ËÙÈÎÒÓ ·ÛıÂÓÒÓ. ∏ ·‡ÍËÛËÙË˜ HDL-C ·ÔÙÂÏÂ› ÙË ‰Â‡ÙÂ-ÚË ÚÔÙÂÚ·ÈfiÙËÙ·, Ô˘ ·ÎÔ-ÏÔ˘ıÂ›Ù·È ·fi ÙË ÚÔÛ¿ıÂÈ·ÌÂ›ˆÛË˜ ÙˆÓ TG.

√È ÛÙ·Ù›ÓÂ˜, Ô˘ ·ÔÙÂ-ÏÔ‡Ó ÙÔ˘˜ ·Ú¿ÁÔÓÙÂ˜ ÚÒ-ÙË˜ ÂÈÏÔÁ‹˜, Â›Ó·È ÔÏ‡ ·Ô-ÙÂÏÂÛÌ·ÙÈÎ¤˜ ÁÈ· ÙË ÌÂ›ˆÛËÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ LDL-CÛÙÔ˘˜ ‰È·‚ËÙÈÎÔ‡˜ ·ÛıÂÓÂ›˜Î·È ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÔÈÎ›ÏÂ˜ ·Ï-Ï¿ Û˘¯Ó¿ ÛËÌ·ÓÙÈÎ¤˜ ÂÈ‰Ú¿-ÛÂÈ˜ ÛÙ· TG. ∏ ÌÂ›ˆÛË ÙˆÓ TGÂÍ·ÚÙ¿Ù·È ·fi ÙË ÈÛ¯‡ ÙË˜¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓË˜ ÛÙ·Ù›ÓË˜Î·È Â›Ó·È ‰ÔÛÔÂÍ·ÚÙÒÌÂÓË. ∏‰˘Ó·ÙfiÙËÙ· ·‡ÍËÛË˜ ÙˆÓ ÂÈ-¤‰ˆÓ ÙË˜ HDL-C Â›Ó·È Ì¤ÙÚÈ·,·Ó Î·È ÂÓ‰Â¯fiÌÂÓ· ÛËÌ·ÓÙÈÎ‹.

√È ÊÈÌÚ¿ÙÂ˜ Â›Ó·È ÔÏ‡·ÔÙÂÏÂÛÌ·ÙÈÎ¤˜ ÁÈ· ÙËÓ ·‡-ÍËÛË ÙË˜ HDL-C Î·È ÙË ÌÂ›ˆÛË

ÙˆÓ TG, ·ÏÏ¿ ÌÈÎÚ‹ ÌfiÓÔ Â›-‰Ú·ÛË ·ÛÎÔ‡Ó ÛÙ· Â›Â‰·ÙË˜ LDL-C, ÙËÓ ÔÔ›· ÂÓ‰¤¯Â-Ù·È Î·È Ó· ·˘Í‹ÛÔ˘Ó ÛÂ ·ÛıÂ-ÓÂ›˜ ÌÂ ÛÔ‚·Ú‹ ˘ÂÚÙÚÈÁÏ˘ÎÂ-ÚÈ‰·ÈÌ›· .

√È ÚËÙ›ÓÂ˜ ‰¤ÛÌÂ˘ÛË˜ ÙˆÓ¯ÔÏÈÎÒÓ ·Ï¿ÙˆÓ ÂÈÙ˘Á¯¿ÓÔ˘ÓÂÈÚfiÛıÂÙË ÌÂ›ˆÛË ÙË˜ LDL-C, fiÙ·Ó ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛÂÛ˘Ó‰˘·ÛÌfi ÌÂ ÛÙ·Ù›ÓÂ˜, ·ÏÏ¿Ë ¯ÚËÛÈÌÔÔ›ËÛ‹ ÙÔ˘˜ ÂÚÈÔ-Ú›˙ÂÙ·È ·fi ÙÈ˜ Á·ÛÙÚÂÓÙÂÚÈ-Î¤˜ ÙÔ˘˜ ·ÚÂÓ¤ÚÁÂÈÂ˜. ™Ù·Ê¿ÚÌ·Î· Ô˘ ÌÂÈÒÓÔ˘Ó ÙËÓ·ÔÚÚfiÊËÛË ÙË˜ ¯ÔÏËÛÙÂÚfi-ÏË˜ ·fi ÙÔ ÏÂÙfi ¤ÓÙÂÚÔ Ú¤-ÂÈ Ó· ·Ó·ÊÂÚıÂ› Î·È Ô ÚÒ-ÙÔ˜, ÚÔ˜ ÙÔ ·ÚfiÓ, ÂÎÚfiÛˆ-fi ÙÔ˘˜, Ë Â˙ÂÙÈÌ›ÌË.

∏ ÓÈ·Û›ÓË Â›Ó·È Ô ÂÚÈÛÛfi-ÙÂÚÔ ·ÔÙÂÏÂÛÌ·ÙÈÎfi˜ ·Ú¿-ÁÔÓÙ·˜ ÁÈ· ÙËÓ ·‡ÍËÛË ÙË˜HDL-C, ÂÓÒ ÚÔÎ·ÏÂ›, Â›ÛË˜,ÛËÌ·ÓÙÈÎ‹ ÌÂ›ˆÛË ÙˆÓ TG, Î·ÈÌ¤ÙÚÈ· ÌÂ›ˆÛË ÙË˜ LDL-C, ·Ï-Ï¿ Ë ¯ÚËÛÈÌÔÔ›ËÛ‹ ÙË˜ Â›Ó·ÈÚÔ‚ÏËÌ·ÙÈÎ‹ ÛÙÔ˘˜ ‰È·‚ËÙÈ-ÎÔ‡˜ ·ÛıÂÓÂ›˜, ‰ÈfiÙÈ Ê·›ÓÂÙ·ÈfiÙÈ ·˘Í¿ÓÂÈ ÙËÓ ·ÓÙ›ÛÙ·ÛËÛÙËÓ ÈÓÛÔ˘Ï›ÓË.

∞ÓÙÈÌÂÙÒÈÛË ÙË˜¢È·‚ËÙÈÎ‹˜ ¢˘ÛÏÈÈ‰·ÈÌ›·˜


4

1. Garg A, Grundy SM. Manegement ofdyslipidemia in NIDDM. Diabetes Care1990 ; 13: 153- 169.

2. UK Prospective Diabetes Study Group.U. K Prospective Diabetes Study 27 : pla-sma lipids and lipoproteins at diagnosisof NIDDM by age and sex. Diabetes Care1997 ; 20: 1683-1687.

3. Austin MA, Edwards KL. Curr Opin Lipi-dol 1996 ; 7: 167-171

4. Reaven GM, Insulin resistance and itsconsequences : non-insulin dependentdiabetes mellitus and coronary heart di-sease. In LeRoith D, Taylor SI, OlefskyJM, eds. Diabetes Mellitus : a Fundame-ntal and Clinical Text. Philadelphia : Lip-pincot-Raven, 1996 : 509-519.

5. Patsch JR, Miesenbock G, HopferwieserT, Muhiberger V, Knapp E, Dunn JK, Got-to AM Jr, Patsch W. Relation of trigly-ceride metabolism and coronary arterydisease : studies in the postprandial state.Atheroscler Thromb 1992 ; 12: 1336-1345.

6. Thompson SG, Kienast J, Pyke SD, Ha-verkate F, van de Loo JC, for the Euro-pean Concerted Action on Thrombosisand Diasabilities Angina Pectoris StudyGroup. Hemostatic factors and the risk ofmyocardial infarction or sudden death inpatients with angina pectoris. N Engl JMed 1995 ; 332: 635-641.

7. Sobel BE. Potentiation of vasculopathyby insulin : implications from an NHLBIclinical alert. Circulation 1996 ; 93 : 1613-1615.

8. McGill JB, Schneider DJ, Arfken CL,Lucore CL, Sobel BE. Factors responsi-ble for impaired fibrinolysis in obese sub-jects and NIDDM patients. Diabetes1994 ; 43: 104-109.

9. Calles-Escandon J, Mirza SA, Sobel BE,Schneider DJ. Induction of hyperinsuline-mia combined with hyperglycemia andhypertriglyceridemia increases plasmino-gen activator inhibitor 1 in blood in nor-mal human subjects. Diabetes 1998 ; 47:290-293.

10. American Diabetes Association. Mana-gement of dyslipidemia in adults withdiabetes. Diabetes Care 2000; 23 (suppl1) : S57-S60.

µµÈÈ‚‚ÏÏÈÈÔÔÁÁÚÚ··ÊÊ››··

A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·4

∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ù· ¯·ÌËÏ¿ Â›-Â‰· ÙË˜ HDL ¯ÔÏËÛÙÂÚfiÏË˜Î·ıÒ˜ Î·È Ë ‰È·Ù·Ú·ÁÌ¤ÓË ÌÂ-Ù·ÁÂ˘Ì·ÙÈÎ‹ ÏÈ·ÈÌ›· Û¯ÂÙ›˙Ô-ÓÙ·È ÌÂ ·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ ÂÌÊ¿-ÓÈÛË˜ Î·Ú‰È·ÁÁÂÈ·Î‹˜ ÓfiÛÔ˘.™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ‰ÈÂÚÂ˘-Ó‹ıËÎÂ Ë ÌÂÙ·ÁÂ˘Ì·ÙÈÎ‹ ·¿-ÓÙËÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ (∆°§)ÛÂ Û¯¤ÛË ÌÂ Ù· Â›Â‰· ÙË˜HDL. ¶ÂÚÈÂÏ‹ÊıËÛ·Ó 52 ŒÏÏË-ÓÂ˜ ¿ÓÙÚÂ˜ ÔÈ ÔÔ›ÔÈ ¯ˆÚ›ÛÙË-Î·Ó ÛÂ ‰‡Ô ÔÌ¿‰Â˜: ÙËÓ ÔÌ¿‰·ÌÂ ¯·ÌËÏ‹ HDL (<40 mg/dl) Î·ÈÙËÓ ÔÌ¿‰· ÂÏ¤Á¯Ô˘. ∆· Â›Â‰·∆°§ ÓËÛÙÂ›·˜ ‹Ù·Ó ˘„ËÏfiÙÂÚ·ÛÙËÓ ÔÌ¿‰· ÌÂ ¯·ÌËÏ‹ HDL Û˘-

ÁÎÚÈÙÈÎ¿ ÌÂ ÙËÓ ÔÌ¿‰· ÂÏ¤Á¯Ô˘(p = 0,002). H ÔÌ¿‰· ÌÂ ¯·ÌË-Ï‹ HDL ÂÌÊ¿ÓÈÛÂ ˘„ËÏfiÙÂÚ·Â›Â‰· ∆°§ ÛÙÈ˜ 4, 6 Î·È 8ÒÚÂ˜ ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙËÓ ÔÌ¿-‰· ÂÏ¤Á¯Ô˘ (p = 0,006, p =0,002 Î·È p < 0,001 ·ÓÙ›ÛÙÔÈ¯·).øÛÙfiÛÔ, ÌÂÙ¿ ÙËÓ ÂÍÔÌÔ›ˆÛËÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ˆ˜ ÚÔ˜ Ù·Â›Â‰· ∆°§ ÓËÛÙÂ›·˜, Ë ÔÌ¿‰·ÌÂ ¯·ÌËÏ‹ HDL ·ÚÔ˘Û›·ÛÂ˘„ËÏfiÙÂÚ· Â›Â‰· ∆°§ ÌfiÓÔÛÙÈ˜ 8 ÒÚÂ˜ ÌÂÙ¿ ·fi ÙË Ï‹„ËÙÔ˘ ÏÈ·ÚÔ‡ ÁÂ‡Ì·ÙÔ˜ (p =0,0017) [∂ÈÎfiÓ· 1]. ∏ ·Ó¿Ï˘ÛËROC ¤‰ÂÈÍÂ fiÙÈ Â›Â‰· ∆°§ ÓË-ÛÙÂ›·˜ ≥ 121 mg/dl ÚÔ‚Ï¤-

Ô˘Ó ÌÂ Â˘·ÈÛıËÛ›· 100% Î·ÈÂÈ‰ÈÎfiÙËÙ· 81% Ì›· ·ıÔÏÔÁÈÎ‹ÌÂÙ·ÁÂ˘Ì·ÙÈÎ‹ ·¿ÓÙËÛË (auc= 0,962, p < 0,001). ™˘ÌÂÚ·›-ÓÂÙ·È fiÙÈ Ë Î·ı˘ÛÙÂÚËÌ¤ÓË ÌÂ-Ù·ÁÂ˘Ì·ÙÈÎ‹ Î¿ı·ÚÛË ÙˆÓ ∆°§Ô‰ËÁÂ› ÛÂ ¯·ÌËÏ¿ Â›Â‰· HDL·ÎfiÌ· Î·È ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ¯·ÌË-Ï¿ Â›Â‰· ∆°§ ÓËÛÙÂ›·˜. ∂›-Â‰· ∆°§ ÓËÛÙÂ›·˜ > 121 mg/dlÚÔ‰È·ı¤ÙÔ˘Ó ÛÂ ·ıÔÏÔÁÈÎ‹·¿ÓÙËÛË ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛËÏÈ·ÚÔ‡ ÁÂ‡Ì·ÙÔ˜.

∂ÈÌ¤ÏÂÈ·: ∞Ï¤Í·Ó‰ÚÔ˜ ¶·ÓÙÂÏ¿ÎË˜,

∞ÓÙÒÓË˜ ¶·˘Ï›‰Ë˜

¶A£OºY™IO§O°IA

5

Ã·ÌËÏ¿ Â›Â‰· HDL ÓËÛÙÂ›·˜ Î·È

ÌÂÙ·ÁÂ˘Ì·ÙÈÎ‹ ÏÈ·ÈÌ›·

Kolovou GD, Anagnostopoulou KK, Pilatis N, Kafaltis N, Sorodila ∫,Psarros E, Cokkinos DV.

Lipids Health Dis. 2004;23:18

∂ÈÎfiÓ· 1: ªÂÙ·‚ÔÏ‹ ÙˆÓ ÂÈ¤‰ˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ ÛÂ Û˘Ó¿ÚÙËÛË ÌÂ ÙÔÓ ¯ÚfiÓÔ (AUC) ÛÂ fiÏÂ˜ ÙÈ˜ ÔÌ¿‰Â˜. √È ˘„ËÏfiÙÂÚÂ˜ÙÈÌ¤˜ AUC ‚Ú¤ıËÎ·Ó ÛÙÈ˜ ÔÌ¿‰Â˜ low HDL Î·È low HDL-A Ô˘ Â›¯·Ó ¯·ÌËÏ¿ Â›Â‰· HDL Î·È Ù· ˘„ËÏfiÙÂÚ· Â›Â‰· ∆°§ÓËÛÙÂ›·˜ ÛÂ Û¯¤ÛË ÌÂ ÙÈ˜ ¿ÏÏÂ˜ ÔÌ¿‰Â˜. √È ¯·ÌËÏfiÙÂÚÂ˜ ÙÈÌ¤˜ AUC ‚Ú¤ıËÎ·Ó ÛÙÈ˜ ÔÌ¿‰Â˜ matched-low HDL, matched-controls, low HDL-N Î·È ÛÙËÓ ÔÌ¿‰· ÂÏ¤Á¯Ô˘. ∞˘Ù¤˜ Â›¯·Ó ¯·ÌËÏfiÙÂÚ· Â›Â‰· ∆°§ ÓËÛÙÂ›·˜ ·ÏÏ¿ Î·È ÔÈÎ›Ï· Â›Â‰·HDL [·fi 30(9) Ì¤¯ÚÈ 55(20) mg/dl]. TG-AUC: triglyceride-area under the curve, Low HDL-A: ÔÌ¿‰· ÌÂ ¯·ÌËÏ‹ HDL Î·È ·ıÔÏÔÁÈÎfi ÁÂ‡Ì·, Low HDL-N: ÔÌ¿‰·ÌÂ ¯·ÌËÏ‹ HDL Î·È Ê˘ÛÈÔÏÔÁÈÎfi ÁÂ‡Ì·, Controls: ÔÌ¿‰· ÂÏ¤Á¯Ô˘, Matched-Low HDL: ÂÍÔÌÔÈˆÌ¤ÓË ÔÌ¿‰· ÌÂ ¯·ÌËÏ‹HDL, Matched Controls: ÂÍÔÌÔÈˆÌ¤ÓË ÔÌ¿‰· ÂÏ¤Á¯Ô˘.

TÚÈÁÏ˘ÎÂÚ›‰È·(mg/dl)

XÚfiÓÔ˜ (ÒÚÂ˜)

Groups

Low

HD

L

Mat

ched

Low

HD

L

Mat

ched

cont

rols

Low

HD

L-A

Low

HD

L-N

Con

trol

s

350

300

250

200

150

100

50

08

64

0

A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·5

√È ÛÙ·Ù›ÓÂ˜ ÂÏ·ÙÙÒÓÔ˘Ó ÙËÓLDL-Ã Î·È ÙËÓ (˘„ËÏ‹˜ Â˘·ÈÛıË-Û›·˜) C-·ÓÙÈ‰ÚÒÛ· ÚˆÙÂ˝ÓË(hsCRP), ÙÔ Î·Ù¿ fiÛÔ fiÌˆ˜ ÔÛ˘Ó‰˘·ÛÌfi˜ ·˘ÙÒÓ ÙˆÓ ‰Ú¿ÛÂ-ˆÓ ÙÔ˘˜ ÂËÚÂ¿˙ÂÈ ÙË ÎÏÈÓÈÎ‹¤Î‚·ÛË ÙˆÓ ·ÛıÂÓÒÓ ‰ÂÓ Â›Ó·ÈÁÓˆÛÙfi. ∂ÎÙÈÌ‹ıËÎÂ Ë Û˘Û¯¤ÙÈ-ÛË ÙË˜ ÂÏ¿ÙÙˆÛË˜ ÙË˜ LDL-ÃÎ·È ÙË˜ CRP Ô˘ ÂÂÙÂ‡¯ıËÛ·ÓÌÂÙ¿ ıÂÚ·Â›· ÌÂ 80 mg ·ÙÔÚ-‚·ÛÙ·Ù›ÓË˜ ‹ 40 mg Ú·‚·ÛÙ·-Ù›ÓË˜ Î·È Ë Â›‰Ú·ÛË˜ ÙË˜ Û˘-Û¯¤ÙÈÛË˜ ·˘Ù‹˜ ÛÙËÓ ÂÌÊ¿ÓÈÛËÓ¤Ô˘ ÂÌÊÚ¿ÁÌ·ÙÔ˜ Ì˘ÔÎ·Ú‰›Ô˘‹ Î·Ú‰È·ÁÁÂÈ·ÎÔ‡ ı·Ó¿ÙÔ˘ ÛÂ3.745 ·ÛıÂÓÂ›˜ ÌÂ ÔÍ¤· ÛÙÂÊ·-

ÓÈ·›· Û‡Ó‰ÚÔÌ· ÛÙ· Ï·›ÛÈ·ÙË˜ ÌÂÏ¤ÙË˜ PROVE IT.

∞ÔÙÂÏ¤ÛÌ·Ù·:™ÙËÓ EÈÎfiÓ· 1 Ê·›ÓÔÓÙ·È Ù·

Â›Â‰· ÙË˜ CRP Î·Ù¿ ÙË ‰È¿Ú-ÎÂÈ· ÙË˜ ıÂÚ·Â›·˜ ÌÂ ·ÙÔÚ‚·-ÛÙ·Ù›ÓË ‹ Ú·‚·ÛÙ·Ù›ÓË Î·Ù¿ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÌÂÏ¤ÙË˜ (2 ¯Úfi-ÓÈ·).

™ÙËÓ EÈÎfiÓ· 2 Ê·›ÓÂÙ·È Ë·ıÚÔÈÛÙÈÎ‹ Û˘¯ÓfiÙËÙ· Û˘Ì‚·-Ì¿ÙˆÓ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ‰È¿ÊÔ-ÚÔ˘˜ Û˘Ó‰˘·ÛÌÔ‡˜ ÂÈ¤‰ˆÓLDL-X Î·È CRP. ∆· ¿ÙÔÌ· ÌÂLDL-X <70 mg/dl Î·È CRP <2mg/L Â›¯·Ó 50% ÏÈÁfiÙÂÚ· Û˘Ì-‚¿Ì·Ù· ·fi ·˘ÙÔ‡˜ Ô˘ Â›¯·Ó

LDL-X ≥70 mg/dl Î·ÈCRP ≥2 mg/L Î·È 32%ÏÈÁfiÙÂÚ· Û˘Ì‚¿Ì·Ù··fi Ù· ¿ÙÔÌ· ÌÂ Ì›··fi ÙÈ˜ ‰‡Ô ÙÈÌ¤˜˘„ËÏ‹ Î·È ÙËÓ ¿ÏÏË¯·ÌËÏ‹.

™ÙÔÓ ¶›Ó·Î· 1 Ê·›-ÓÂÙ·È Ë Û˘¯ÓfiÙËÙ·Û˘Ì‚·Ì¿ÙˆÓ/100 ·Ó-ıÚˆÔÂÙ‹ ÛÂ ‰È¿ÊÔ-ÚÔ˘˜ Û˘Ó‰˘·ÛÌÔ‡˜Â›¤‰ˆÓ LDL-X Î·ÈCRP (Â‰Ò ¯ÚËÛÈÌÔÔÈ-‹ıËÎÂ ˆ˜ fiÚÈÔ Ë ÙÈÌ‹1 mg/L - post hoc ·Ó¿-Ï˘ÛË). ∆· ¿ÙÔÌ· ÌÂ

LDL-X <70 mg/dl CRP <1 mg/LÂ›¯·Ó 58% ÏÈÁfiÙÂÚ· Û˘Ì‚¿Ì·Ù··fi ·˘ÙÔ‡˜ Ô˘ Â›¯·Ó LDL-X≥70 mg/dl Î·È CRP ≥ 1 mg/L,39% ÏÈÁfiÙÂÚ· Û˘Ì‚¿Ì·Ù· ·fiÙ· ¿ÙÔÌ· ÌÂ <70 mg/dl Î·È CRP≥1 mg/L Î·È 17% ÏÈÁfiÙÂÚ· Û˘Ì-‚¿Ì·Ù· ·fi Ù· ¿ÙÔÌ· ÌÂ ≥70mg/dl Î·È CRP <1 mg/L. √È·ÛıÂÓÂ›˜ ÌÂ ÙÈ˜ ÌÈÎÚfiÙÂÚÂ˜ ÙÈ-Ì¤˜ CRP Â›¯·Ó ÙË Î·Ï‡ÙÂÚËÚfiÁÓˆÛË ·fi fiÏÔ˘˜, ·ÓÂÍ¿Ú-ÙËÙ· ÌÂ Ù· Â›Â‰· LDL-X. ∞˘Ùfi‚¿˙ÂÈ ÙËÓ ¤Ó‰ÂÈÍË fiÙÈ Ë CRPÚ¤ÂÈ Ó· ·ÔÙÂÏÂ› ÛÙfi¯Ô ÙË˜˘ÔÏÈÈ‰·ÈÌÈÎ‹˜ Ê·ÚÌ·ÎÂ˘ÙÈ-Î‹˜ ·ÁˆÁ‹˜, ÙÔ˘Ï¿¯ÈÛÙÔÓ ÛÂ·ÛıÂÓÂ›˜ ÌÂ ÔÍ¤· ÛÙÂÊ·ÓÈ·›·Û˘Ì‚¿Ì·Ù·.

™˘ÌÂÚ¿ÛÌ·Ù·: ∏ ÂÈıÂÙÈÎ‹˘ÔÏÈÈ‰·ÈÌÈÎ‹ Ê·ÚÌ·ÎÂ˘ÙÈÎ‹·ÁˆÁ‹ ÌÂ ÛÙ·Ù›ÓÂ˜ ÁÈ· ÙËÓ Â›-ÙÂ˘ÍË ÂÏ¿ÙÙˆÛË˜ ÙfiÛÔ ÙË˜LDL-Ã ·ÏÏ¿ Î·È ÙË˜ CRP ÂÏ·Ù-ÙÒÓÂÈ ÛËÌ·ÓÙÈÎ¿ ÙÔÓ Î›Ó‰˘ÓÔÁÈ· Î·Ú‰È·ÁÁÂÈ·Î¿ Û˘Ì‚¿Ì·Ù·ÛÂ ·ÛıÂÓÂ›˜ ÌÂÙ¿ ·fi ÔÍ¤·ÛÙÂÊ·ÓÈ·›· Û‡Ó‰ÚÔÌ·. ∏ ÂÈÏÔ-Á‹ ˘ÔÏÈÈ‰·ÈÌÈÎ‹˜ Ê·ÚÌ·ÎÂ˘-ÙÈÎ‹˜ ·ÁˆÁ‹˜ Ô˘ ÂÏ·ÙÙÒÓÂÈ ÙËÊÏÂÁÌÔÓ‹ (CRP) ÌÔÚÂ› Ó· ‚ÂÏ-ÙÈÒÛÂÈ ÂÚ·ÈÙ¤Úˆ ÙËÓ ÎÏÈÓÈÎ‹¤Î‚·ÛË ÙˆÓ ·ÛıÂÓÒÓ ·˘ÙÒÓ.

∂ÈÌ¤ÏÂÈ·: µ·Û›ÏÂÈÔ˜ Õı˘ÚÔ˜


6

PROVE IT: ∂›Â‰· C-·ÓÙÈ‰ÚÒÛ·˜ ÚˆÙÂ˝ÓË˜ Î·È

ÎÏÈÓÈÎ‹ ¤Î‚·ÛË ÌÂÙ¿ ıÂÚ·Â›· ÌÂ ÛÙ·Ù›ÓÂ˜

Ridker PM, Cannon CP, Morrow D, et al; for the Pravastatin or AtorvastatinEvaluation and Infection Therapy–Thrombolysis in Myocardial Infarction 22

(PROVE IT–TIMI 22) Investigators.

N Engl J Med 2005;352:20-8

∂ÈÎfiÓ· 2

∂ÈÎfiÓ· 1

¶›Ó·Î·˜ 1

∂›Â‰Ô LDL ∂›Â‰Ô CRP ™˘¯ÓfiÙËÙ· Û˘Ì‚·Ì¿ÙˆÓ/ 100 ·ÓıÚˆÔÂÙ‹

LDL ≥70 mg/dl, CRP ≥1 mg/liter 4.5

LDL <70 mg/dl, CRP ≥1 m g/liter 3.1

LDL ≥70 mg/dl CRP <1 mg/liter 2.3

LDL <70 mg/dl, CRP <1 mg/liter 1.9

∫§π¡π∫∂™ ª∂§∂∆∂™

P=0,60

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

M¤Û

Ë Ù

ÈÌ‹

CR

P m

g/1

AıÚ

ÔÈÛ

ÙÈÎ‹

Û

˘¯Ófi

ÙËÙ·

˘

ÔÙÚ

Ô

‹˜

ÂÌÊ

Ú¿

ÁÌ·

ÙÔ˜

ÙÔ˘

Ì˘Ô

Î·Ú

‰›Ô

˘ ‹

ı·

Ó¿ÙÔ

˘ Û

ÙÂÊ

·ÓÈ

·›·

˜ ·

ÈÙÈÔ

ÏÔÁ›

·˜

100

10

1

¶Ú·‚·ÛÙ·Ù›ÓË (n=1873)

AÙÔÚ‚·ÛÙ·Ù›ÓË (n=1873)

∆˘¯·ÈÔÔ›ËÛË 30 ËÌ¤ÚÂ˜ 4 Ì‹ÓÂ˜ ∆¤ÏÔ˜ ÌÂÏ¤ÙË˜

0,10

0,08

0,06

0,04

0,02

0,00

¶·Ú·ÎÔÏÔ‡ıËÛË (¤ÙË)

0,0 0,5 1,0 1,5 2,0 2,5

LDL-¯ÔÏËÛÙÂÚfiÏË≥ 70 mg/dl,

CRP ≥ 2 mg/liter

LDL-¯ÔÏËÛÙÂÚfiÏË< 70 mg/dl,

CRP ≥ 2 mg/liter

LDL-¯ÔÏËÛÙÂÚfiÏË≥ 70 mg/dl,

CRP < 2 mg/liter

LDL-¯ÔÏËÛÙÂÚfiÏË< 70 mg/dl,

CRP < 2 mg/liter

A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·6

Œ¯ÂÈ ·Ú·ÙËÚËıÂ› fiÙÈ ÌÂÙ¿ ·fiÌ›· ÂÈÙ˘¯ËÌ¤ÓË Î·Ù¿ Ù· ¿ÏÏ··ÁÁÂÈÔÏ·ÛÙÈÎ‹ ÂÌÊ·Ó›˙ÂÙ·È ·‡-ÍËÛË ÙˆÓ Ì˘ÔÎ·Ú‰È·ÎÒÓ ÂÓ˙‡-ÌˆÓ (CK-MB Î·È Î·Ú‰È·ÎÒÓ ÙÚÔ-ÔÓÈÓÒÓ) ÛÂ Û˘¯ÓfiÙËÙ· 5 – 30%.∏ ·‡ÍËÛË ·˘Ù‹ ˘Ô‰ËÏÒÓÂÈ Ó¤-ÎÚˆÛË Ì˘ÔÎ·Ú‰È·ÎÒÓ Î˘ÙÙ¿ÚˆÓÎ·È fiˆ˜ ¤¯ÂÈ ·Ô‰ÂÈ¯ıÂ› ·fiÌÂÏ¤ÙÂ˜ ¤¯ÂÈ ÎÏÈÓÈÎ‹ ÛËÌ·Û›·.™‡ÌÊˆÓ· ÌÂ Ù· Ó¤· ‰È·ÁÓˆÛÙÈÎ¿ÎÚÈÙ‹ÚÈ· ÔÈ Î·Ù·ÛÙ¿ÛÂÈ˜ ·˘Ù¤˜¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ˆ˜ ÂÌÊÚ¿ÁÌ·-Ù· ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘ (non-Q).∞ÛıÂÓÂ›˜ ÌÂ ·‡ÍËÛË ÙË˜ CK-MB> 5 ÊÔÚ¤˜ ¿Óˆ ÙˆÓ Ê˘ÛÈÔÏÔÁÈ-ÎÒÓ ÔÚ›ˆÓ (∞Ùº√) ÂÌÊ·Ó›˙Ô˘Ó˘„ËÏfiÙÂÚË ·ÒÙÂÚË ıÓËÛÈÌfiÙË-Ù· Î·È ‰˘ÛÌÂÓ¤ÛÙÂÚË Î·Ì‡ÏËÂÈ‚›ˆÛË˜ ¯ˆÚ›˜ Û˘Ì‚¿Ì·Ù·.

Œ¯ÂÈ ÂÈ¯ÂÈÚËıÂ› Ë ÂÊ·ÚÌÔÁ‹‰È·ÊfiÚˆÓ ÛÙÚ·ÙËÁÈÎÒÓ ÁÈ· ÙËÓÚfiÏË„Ë ÙË˜ ÂÈÏÔÎ‹˜ ·˘Ù‹˜.√È ÛÙ·Ù›ÓÂ˜, Û‡ÌÊˆÓ· ÌÂ ÔÚÈ-ÛÌ¤ÓÂ˜ ÎÏÈÓÈÎ¤˜ Î·È ÂÈÚ·Ì·ÙÈ-Î¤˜ ÌÂÏ¤ÙÂ˜, ¤¯Ô˘Ó, ¤Ú·Ó ÙË˜˘ÔÏÈÈ‰·ÈÌÈÎ‹˜ Î·È ·ÓÙÈıÚÔÌ-‚ˆÙÈÎ‹ ‰Ú¿ÛË (ÏÂÈÔÙÚÔÈÎ‹‰Ú¿ÛË ÙˆÓ ÛÙ·ÙÈÓÒÓ). ª›· ÌÂÏ¤-ÙË ·Ú·Ù‹ÚËÛË˜ Ô˘ ‰ËÌÔÛÈÂ‡-ıËÎÂ ÙÔ 2002 ‰È·›ÛÙˆÛÂ fiÙÈ Ë

¯ÔÚ‹ÁËÛË ÛÙ·Ù›ÓË˜ ÚÈÓ ÙËÓ ÙÔ-Ôı¤ÙËÛË stent Û¯ÂÙ›˙ÂÙ·È ÌÂ ÌÈ-ÎÚfiÙÂÚÔ Î›Ó‰˘ÓÔ ·‡ÍËÛË˜ ÙË˜CK-MB ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË.

°È· ‰ÈÂÚÂ‡ÓËÛË ÙË˜ Èı·Ófi-ÙËÙ·˜ ÚfiÏË„Ë˜ ÙÔ˘ ÂÚÈÂÂÌ-‚·ÙÈÎÔ‡ non-Q ÂÌÊÚ¿ÁÌ·ÙÔ˜,¤ÁÈÓÂ Ì›· Ù˘¯·ÈÔÔÈËÌ¤ÓË ÚÔÔ-ÙÈÎ‹ ÌÂÏ¤ÙË ÛÂ 451 ·ÛıÂÓÂ›˜Ô˘ ˘Ô‚Ï‹ıËÎ·Ó ÛÂ ÂÈÏÂÎÙÈÎ‹ÙÔÔı¤ÙËÛË stent ÛÂ Ó¤Â˜ ‚Ï¿-‚Â˜ ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ Î·È ‰ÂÓÂÏ¿Ì‚·Ó·Ó Ì¤¯ÚÈ ÙfiÙÂ ÛÙ·Ù›ÓË.ŸÛÔÈ Ù˘¯·ÈÔÔÈ‹ıËÎ·Ó Ó· ¿-ÚÔ˘Ó ÛÙ·Ù›ÓË ¿Ú¯ÈÛ·Ó ÙËÓ ·Áˆ-Á‹ ÌÂ ·˘Ù‹Ó ≥ 3 ËÌ¤ÚÂ˜ ÚÈÓÙËÓ Â¤Ì‚·ÛË. √ Ù‡Ô˜ Î·È Ë‰fiÛË ÙË˜ ÛÙ·Ù›ÓË˜ ·Ê¤ıËÎÂÛÙËÓ ÂÈÏÔÁ‹ ÙÔ˘ ıÂÚ¿ÔÓÙÔ˜È·ÙÚÔ‡. ŸÏÔÈ ¤Ï·‚·Ó ·ÛÈÚ›ÓËÎ·È ÙÈÎÏÔÈ‰›ÓË ‹ ÎÏÔÈ‰ÔÁÚ¤ÏË.ªÂÙ¿ ÙËÓ Â¤Ì‚·ÛË ¯ÔÚËÁ‹ıË-ÎÂ ÛÙ·Ù›ÓË ÛÂ fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂ-ÓÂ›˜.

∏ Ì¤ÛË ÙÈÌ‹ ÙË˜ Ì¤ÁÈÛÙË˜ ·‡-ÍËÛË˜ ÙË˜ CK-MB ÌÂÙ¿ ÙËÓ ·Á-ÁÂÈÔÏ·ÛÙÈÎ‹ ‹Ù·Ó 1,70 ng/mlÛÙËÓ ÔÌ¿‰· ÙË˜ ÛÙ·Ù›ÓË˜ Î·È2,20 ng/ml ÛÙËÓ ÔÌ¿‰· ÂÏ¤Á¯Ô˘(ƒ=0,015). ∏ Ì¤ÛË ÙÈÌ‹ ÙË˜ Î·Ú-‰È·Î‹˜ ÙÚÔÔÓ›ÓË˜ π (cTnI) ‹Ù·Ó

0,13 ng/ml ÛÙËÓ ÔÌ¿‰· ÙË˜ ÛÙ·-Ù›ÓË˜ Î·È 0,21 ng/ml ÛÙËÓ ÔÌ¿‰·ÂÏ¤Á¯Ô˘ (ƒ=0,033). ∏ Â›ÙˆÛËÌÂÁ¿ÏÔ˘ non-Q ÂÌÊÚ¿ÁÌ·ÙÔ˜ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘ (C∫-MB > 5ÊÔÚ¤˜ ∞Ùº√) ‹Ù·Ó 8% ÛÙËÓÔÌ¿‰· ÙË˜ ÛÙ·Ù›ÓË˜ Î·È 15,6%ÛÙËÓ ÔÌ¿‰· ÂÏ¤Á¯Ô˘ (ƒ=0,012).∏ ·‡ÍËÛË ÙË˜ cTnI > 5 ÊÔÚ¤˜∞Ùº√ ‹Ù·Ó 23,5% ÛÙËÓ ÔÌ¿‰·ÙË˜ ÛÙ·Ù›ÓË˜ Î·È 32% ÛÙËÓ ÔÌ¿-‰· ÂÏ¤Á¯Ô˘ (ƒ=0,043) (∂ÈÎfiÓ·1). ªÂ ÙËÓ ÏÔÁÈÛÙÈÎ‹ ·Ó¿Ï˘ÛËÛ˘Û¯¤ÙÈÛË˜ ‚Ú¤ıËÎÂ fiÙÈ Ë ·‡-ÍËÛË ÙË˜ CK-MB >5 ÊÔÚ¤˜∞Ùº√ Û¯ÂÙ›˙ÂÙ·È ÛËÌ·ÓÙÈÎ¿ ÌÂÙÈ˜ ·ÁÁÂÈÔÁÚ·ÊÈÎ¤˜ ÂÈÏÔÎ¤˜ÙË˜ Â¤Ì‚·ÛË˜ (OR = 9,36ƒ<0,001), ÌÂ ÙËÓ ÚÔıÂÚ·Â›·ÌÂ ÛÙ·Ù›ÓË (OR = 0,33 ƒ=0,023) Î·È ÌÂ ÙËÓ ËÏÈÎ›· > 65ÂÙÒÓ (OR = 2,58 ƒ= 0,031).

™˘ÌÂÚ·›ÓÂÙ·È fiÙÈ Ë ¤Ó·ÚÍË¯ÔÚ‹ÁËÛË˜ ÛÙ·Ù›ÓË˜ ÚÈÓ ÙËÓÂ¤Ì‚·ÛË (ÙÔ˘Ï¿¯ÈÛÙÔÓ 3 ËÌ¤-ÚÂ˜ ÂÓˆÚ›ÙÂÚ·) ÌÂÈÒÓÂÈ ÙËÓ Â›-ÙˆÛË non-Q ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘Ì˘ÔÎ·Ú‰›Ô˘ ÌÂÙ¿ ÙËÓ ·ÁÁÂÈÔ-Ï·ÛÙÈÎ‹.

∂ÈÌ¤ÏÂÈ·: ∏Ï›·˜ ÃÂÈÌÒÓ·˜

7

£∂ƒ∞¶∂π∞ – º∞ƒª∞∫∞

ÃÔÚ‹ÁËÛË ÛÙ·Ù›ÓË˜ ÚÈÓ ÙË ‰ÈÂÓ¤ÚÁÂÈ·

·ÁÁÂÈÔÏ·ÛÙÈÎ‹˜: Â›‰Ú·ÛË ÛÙËÓ ÂÚÈÂÂÌ‚·ÙÈÎ‹

ÂÌÊ¿ÓÈÛË ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘

Briguori C, Colombo A, Airoldi F, Violante A, Facaccio A, Balestrieri P, Elia PP, GoliaB, Lepore S, Rivezzo G, Scarpato P, Libera M, Bonizzoni E, Ricciardelli B

Eur Heart J 2004;25:1822-28

∂ÈÎfiÓÂ˜: ·) ∂›ÙˆÛË ÙË˜ ·‡ÍËÛË˜ ÙË˜ CK-MB>5 ÊÔÚ¤˜ ¿Óˆ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ (∞Ùº√)ÛÙÈ˜ ÔÌ¿‰Â˜ ÛÙ·Ù›ÓË˜ Î·È ÂÏ¤Á¯Ô˘. ‚) ∂›ÙˆÛË ÙË˜ ·‡ÍËÛË˜ ÙË˜ cTnI > 5x∞Ùº√.

p = 0,012 p = 0,043

√Ì¿‰Â˜ ÛÙ·Ù›ÓË˜ √Ì¿‰Â˜ ÂÏ¤Á¯Ô˘√Ì¿‰Â˜ ÛÙ·Ù›ÓË˜ √Ì¿‰Â˜ ÂÏ¤Á¯Ô˘

8,0

15,6

23,5

3235

30

25

20

15

10

5

0

1816141210

86420

∞‡Í

ËÛ

Ë C

K-M

B>

5x∞

Ùº√

(%

Ùˆ

Ó

ÂÚÈ

ÙÒÛ

ÂˆÓ)

∞‡Í

ËÛ

Ë c

TnI>

5¯∞

ÙºÔ

(%

Ùˆ

Ó

ÂÚÈ

ÙÒÛ

ÂˆÓ)

A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·7

∏ ˘¤ÚÙ·ÛË ·ÔÙÂÏÂ› ¤Ó· È‰È·›ÙÂ-Ú· ÛËÌ·ÓÙÈÎfi ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡-ÓÔ˘ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ÈÛ¯·ÈÌÈÎ‹˜ÓfiÛÔ˘ ÙˆÓ ·ÁÁÂ›ˆÓ ÙÔ˘ ÂÁÎÂÊ¿-ÏÔ˘. ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi ¤¯ÂÈ ÈÛÙÔ-ÔÈËıÂ› ·fi ÔÏÏ¤˜ ÂÈ‰ËÌÈÔÏÔ-ÁÈÎ¤˜ Î·È ÎÏÈÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜, ÔÈÔÔ›Â˜ ¤‰ÂÈÍ·Ó fiÙÈ fiÏÂ˜ ÔÈ ÌÔÚ-Ê¤˜ ÙË˜ ˘¤ÚÙ·ÛË˜ (Ë ÌÂÌÔÓˆ-Ì¤ÓË Û˘ÛÙÔÏÈÎ‹, Ë ‰È·ÛÙÔÏÈÎ‹,Î·ıÒ˜ Î·È Ë ·‡ÍËÛË ÙfiÛÔ ÙË˜Û˘ÛÙÔÏÈÎ‹˜ fiÛÔ Î·È ÙË˜ ‰È·ÛÙÔ-ÏÈÎ‹˜ ·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜) Û˘Û¯Â-Ù›˙ÔÓÙ·È ÌÂ ·‡ÍËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ÂÌÊ¿ÓÈÛË˜ ÈÛ¯·ÈÌÈÎÒÓ ·ÁÁÂÈ·ÎÒÓÂÁÎÂÊ·ÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ (∞∂∂)[1]. ª¿ÏÈÛÙ· ÔÈ ·Ó·ÌÊÈÛ‚‹ÙËÙÂ˜ÂÓ‰Â›ÍÂÈ˜ Ô˘ ÚÔ·Ó·Ê¤ÚıËÎ·ÓÈÛ¯‡Ô˘Ó ÙfiÛÔ ÁÈ· ÙËÓ ÚˆÙÔÁÂÓ‹fiÛÔ Î·È ÁÈ· ÙË ‰Â˘ÙÂÚÔÁÂÓ‹ Úfi-ÏË„Ë ÙË˜ ÈÛ¯·ÈÌÈÎ‹˜ ÓfiÛÔ˘ ÙˆÓ·ÁÁÂ›ˆÓ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ [2,3]. ∫·Ù¿Û˘Ó¤ÂÈ·, ÛÂ ¤Ó· ˘ÂÚÙ·ÛÈÎfi·ÛıÂÓ‹ Ô˘ ‰ÂÓ Ï·Ì‚¿ÓÂÈ ·ÓÙÈ˘-ÂÚÙ·ÛÈÎ‹ ıÂÚ·Â›· Î·È Ô ÔÔ›Ô˜¤¯ÂÈ ˘ÔÛÙÂ› ¤Ó· ÈÛ¯·ÈÌÈÎfi ∞∂∂Ú¤ÂÈ Ó· ¯ÔÚËÁËıÂ› Ë Î·Ù¿ÏÏË-ÏË ·ÓÙÈ˘ÂÚÙ·ÛÈÎ‹ ·ÁˆÁ‹, ¤ÙÛÈÒÛÙÂ Ó· ·ÔÊÂ˘¯ıÂ› Ë ÂÌÊ¿ÓÈÛËÂÓfi˜ Ó¤Ô˘ ∞∂∂. øÛÙfiÛÔ, ·˘Ù‹ ËÊ·ÈÓÔÌÂÓÈÎ¿ ·Ï‹ ‰È·›ÛÙˆÛËÂÁÂ›ÚÂÈ ÔÚÈÛÌ¤Ó· Ú·ÎÙÈÎ¿ ÂÚˆ-Ù‹Ì·Ù· ÛÙÔÓ ÎÏÈÓÈÎfi ÁÈ·ÙÚfi: ¶fi-ÙÂ ÌÔÚÂ› Ó· ÍÂÎÈÓ‹ÛÂÈ ÌÂ ·ÛÊ¿-ÏÂÈ· Ë ·ÓÙÈ˘ÂÚÙ·ÛÈÎ‹ ·ÁˆÁ‹ ÛÂ¤Ó· ·ÛıÂÓ‹ Ô˘ ¤¯ÂÈ ˘ÔÛÙÂ›¤Ó· ÈÛ¯·ÈÌÈÎfi ∞∂∂; ¶ÔÈÔ˜ Â›Ó·È ÔÛÙfi¯Ô˜ ÙË˜ ∞¶ ÛÂ ·˘ÙfiÓ ÙÔÓ·ÛıÂÓ‹; À¿Ú¯Ô˘Ó ÂÓ‰Â›ÍÂÈ˜ fiÙÈÎ¿ÔÈ· Î·ÙËÁÔÚ›· ·ÓÙÈ˘ÂÚÙ·ÛÈ-ÎÒÓ Ê·ÚÌ¿ÎˆÓ ˘ÂÚ¤¯ÂÈ fiÛÔÓ·ÊÔÚ¿ ÙË ‰Â˘ÙÂÚÔÁÂÓ‹ ÚfiÏË„ËÙˆÓ ÈÛ¯·ÈÌÈÎÒÓ ∞∂∂; ∏ ÌÂ›ˆÛËÙË˜ ∞¶ ÛÂ ¤Ó· ËÏÈÎÈˆÌ¤ÓÔ ·ÛıÂ-Ó‹ ÌÂÙ¿ ·fi ¤Ó· ÔÍ‡ ÈÛ¯·ÈÌÈÎfi∞∂∂ Â›Ó·È Ì›· ·ÛÊ·Ï‹˜ ÛÙÚ·ÙËÁÈ-Î‹ ‹ ÂÓ‰¤¯ÂÙ·È Ó· Ô‰ËÁ‹ÛÂÈ ÛÂ¤Ó· Ó¤Ô ∞∂∂; ∂¿Ó ¤Ó·˜ ·ÛıÂÓ‹˜¿Û¯ÂÈ ·fi ¿ÓÔÈ·, ÙfiÙÂ ÛÂ ÔÈ·Â›Â‰· Ú¤ÂÈ Ó· Î˘Ì·›ÓÂÙ·È Ë·ÚÙËÚÈ·Î‹ ÙÔ˘ ›ÂÛË;

¶fiÙÂ Â›Ó·È ·ÛÊ·Ï‹˜ Ë ¤Ó·ÚÍËÙË˜ ·ÓÙÈ˘ÂÚÙ·ÛÈÎ‹˜ ·ÁˆÁ‹˜ÛÂ ¤Ó· ·ÛıÂÓ‹ Ô˘ ¤¯ÂÈ ˘Ô-ÛÙÂ› ¤Ó· ÔÍ‡ ÈÛ¯·ÈÌÈÎfi ∞∂∂;

¢ÂÓ ˘¿Ú¯Ô˘Ó Û·Ê‹ ‰Â‰ÔÌ¤-Ó· ·fi ÎÏÈÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜ fiÛÔÓ·ÊÔÚ¿ ÙÔ ¯ÚfiÓÔ ¤Ó·ÚÍË˜ ÙË˜·ÓÙÈ˘ÂÚÙ·ÛÈÎ‹˜ ·ÁˆÁ‹˜ ÌÂÙ¿·fi ¤Ó· ∞∂∂. Œ¯ÂÈ ‰È·Ù˘ˆıÂ› Ë¿Ô„Ë fiÙÈ Ë ·ÓÙÈ˘ÂÚÙ·ÛÈÎ‹ ·Áˆ-Á‹ Ú¤ÂÈ Ó· ÍÂÎÈÓ¿ 7 ËÌ¤ÚÂ˜(›Ûˆ˜ Î·È ÓˆÚ›ÙÂÚ·) ¤ˆ˜ Î·È 30ËÌ¤ÚÂ˜ ÌÂÙ¿ ÙÔ Û‡Ì‚·Ì· [1,4]. ¶Ú¤-ÂÈ Ó· ÛËÌÂÈˆıÂ› fiÙÈ fiÛÔ ÓˆÚ›ÙÂ-Ú· ÌÂÙ¿ ÙÔ Û‡Ì‚·Ì· ¯ÔÚËÁÂ›Ù·È Ë·ÁˆÁ‹ ÙfiÛÔ Î·Ï‡ÙÂÚË ·Ó·Ì¤ÓÂ-Ù·È Ó· Â›Ó·È Î·È Ë Û˘ÌÌfiÚÊˆÛËÙÔ˘ ·ÛıÂÓ‹.

¶ÔÈÔ˜ Â›Ó·È Ô ÛÙfi¯Ô˜ ÙË˜ ∞¶ Î·ÈÔÈfi Â›Ó·È ÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·Ì¤Û· ÛÙÔ ÔÔ›Ô Ú¤ÂÈ Ó· ÂÈ-ÙÂ˘¯ıÂ›;

ªÂÁ¿ÏÂ˜ ÂÈ‰ËÌÈÔÏÔÁÈÎ¤˜ Î·ÈÙ˘¯·ÈÔÔÈËÌ¤ÓÂ˜ ÎÏÈÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜¤‰ÂÈÍ·Ó: ·) fiÙÈ Ô Î›Ó‰˘ÓÔ˜ ÂÌÊ¿ÓÈ-ÛË˜ ÂÓfi˜ ∞∂∂ Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂ Ù·Â›Â‰· ÙË˜ ∞¶ Î·È ‚) fiÙÈ ‰ÂÓ˘¿Ú¯ÂÈ Î¿ÔÈ· ÙÈÌ‹ ÙË˜ ∞¶ ¿-Óˆ ·fi ÙËÓ ÔÔ›· Ó· ·˘Í¿ÓÂÙ·È·fiÙÔÌ· Ô Î›Ó‰˘ÓÔ˜ ÂÌÊ¿ÓÈÛË˜ÙË˜ ÈÛ¯·ÈÌÈÎ‹˜ ÓfiÛÔ˘ ÙˆÓ ÂÁÎÂ-Ê·ÏÈÎÒÓ ·ÁÁÂ›ˆÓ. ™ÙËÓ Ú·ÁÌ·ÙÈ-ÎfiÙËÙ· ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfiÙˆÓ ·ÙfiÌˆÓ Ô˘ ÂÌÊ·Ó›˙ÂÈ ¤Ó·∞∂∂ ¤¯ÂÈ ˘¤ÚÙ·ÛË ÛÙ·‰›Ô˘ π ‹·Ï¿ «˘„ËÏ‹ Ê˘ÛÈÔÏÔÁÈÎ‹» ∞¶(Û‡ÌÊˆÓ· ÌÂ ÙËÓ Î·Ù¿Ù·ÍË ÙË˜JNC VI). ™Â Ì›· ÚfiÛÊ·ÙË ‰ËÌÔ-Û›Â˘ÛË ÔÈ Lewington Î·È Û˘ÓÂÚÁ¿-ÙÂ˜ ¤‰ÂÈÍ·Ó fiÙÈ Ë ıÓËÙfiÙËÙ· ·fi∞∂∂ Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂ Ù· Â›Â‰·ÙË˜ ∞¶ Î·È fiÙÈ ·˘Ù‹ Ë Û˘Û¯¤ÙÈÛËÍÂÎÈÓ¿ ·fi ÔÏ‡ ¯·ÌËÏ¤˜ ÙÈÌ¤˜·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜ (Ù· 115/75mmHg ‹Ù·Ó Ë ¯·ÌËÏfiÙÂÚË ÙÈÌ‹Ô˘ Û˘ÌÂÚÈÏ‹ÊıËÎÂ ÛÙË ÌÂÏ¤-ÙË). ™˘ÁÎÂÎÚÈÌ¤Ó·, ÁÈ· Î¿ıÂ ·‡ÍË-ÛË ÙË˜ ™∞¶ Î·Ù¿ 20 mmHg ‹ Î·ÈÙË˜ ¢∞¶ Î·Ù¿ 10 mmHg, ·Ú¯‹˜ÁÂÓÔÌ¤ÓË˜ ·fi Ù· 115/75 mmHg,

‰ÈÏ·ÛÈ¿˙ÂÙ·È Ë ıÓËÙfiÙËÙ· ·fi∞∂∂ [5].

∂ÎÙfi˜ ·fi ÙË ÌÂÏ¤ÙË PRO-GRESS (Perindopril ProtectionAgainst Recurrent Stroke Study)Ì¤¯ÚÈ Û‹ÌÂÚ· ‰ÂÓ ¤¯Ô˘Ó ‰ÈÂÍ·-¯ıÂ› ÌÂÁ¿ÏÂ˜ Ù˘¯·ÈÔÔÈËÌ¤ÓÂ˜ÎÏÈÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ÔÈ ÔÔ›Â˜ Ó· ÛÙÔ-¯Â‡Ô˘Ó ÛÙËÓ ÚfiÏË„Ë ÙË˜ ˘Ô-ÙÚÔ‹˜ ÙˆÓ ÈÛ¯·ÈÌÈÎÒÓ ∞∂∂. ™ÙËÌÂÏ¤ÙË PROGRESS Û˘ÌÌÂÙÂ›¯·Ó6.105 ¿ÙÔÌ· Ô˘ Â›¯·Ó ˘ÔÛÙÂ›¤Ó· ÈÛ¯·ÈÌÈÎfi ∞∂∂ ‹ ¤Ó· ·ÚÔ‰È-Îfi ÈÛ¯·ÈÌÈÎfi ∞∂∂. ∏ Û˘ÁÎÂÎÚÈÌ¤-ÓË ÌÂÏ¤ÙË ¤‰ÂÈÍÂ fiÙÈ Ë ÂÈıÂÙÈÎ‹ÌÂ›ˆÛË ÙË˜ ∞¶, Ë ÔÔ›· ÛÙËÓÚÔÎÂÈÌ¤ÓË ÂÚ›ÙˆÛË ÂÈÙÂ‡-¯ıËÎÂ ÌÂ ÙË Û˘Á¯ÔÚ‹ÁËÛË ÂÓfi˜·Ó·ÛÙÔÏ¤· ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ-˙‡ÌÔ˘ ÙË˜ ·ÁÁÂÈÔÙÂÓÛ›ÓË˜ (ÂÚÈ-ÓÙÔÚ›ÏË) Î·È ÂÓfi˜ ıÂÈ·˙È‰ÈÎÔ‡ ‰È-Ô˘ÚËÙÈÎÔ‡ (ÈÓ‰··Ì›‰Ë), Ô‰ËÁÂ›ÛÂ ÛËÌ·ÓÙÈÎ‹ ÌÂ›ˆÛË ÙˆÓ ı·Ó·ÙË-ÊfiÚˆÓ Î·È ÌË ı·Ó·ÙËÊfiÚˆÓ ∞∂∂Î·ıÒ˜ Î·È ÙˆÓ ÌË ı·Ó·ÙËÊfiÚˆÓÂÌÊÚ·ÁÌ¿ÙˆÓ ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘.ª¿ÏÈÛÙ·, Ù· ıÂÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·-Ù· ·ÊÔÚÔ‡Û·Ó ÙfiÛÔ ÙÔ˘˜ ˘ÂÚ-Ù·ÛÈÎÔ‡˜ ·ÛıÂÓÂ›˜ fiÛÔ Î·È Ù·ÓÔÚÌÔÙ·ÛÈÎ¿ ¿ÙÔÌ· [6].

∏ ÌÂÏ¤ÙË HOPE (Heart Outco-me Prevention Study) Û¯Â‰È¿ÛıË-ÎÂ ÁÈ· Ó· ÂÎÙÈÌ‹ÛÂÈ ÙËÓ ·ÔÙÂÏÂ-ÛÌ·ÙÈÎfiÙËÙ· ÙÔ˘ ·Ó·ÛÙÔÏ¤· ÙÔ˘ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ ÙË˜ ·Á-ÁÂÈÔÙÂÓÛ›ÓË˜ (Ú·ÌÈÚ›ÏË) ÛÂ·ÛıÂÓÂ›˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ·ÙËÓ ÂÌÊ¿ÓÈÛË Î·Ú‰È·ÁÁÂÈ·Î‹˜ Ófi-ÛÔ˘. ™ÙÔ˘˜ ·ÛıÂÓÂ›˜ Ô˘ ¤·ÈÚ-Ó·Ó Ú·ÌÈÚ›ÏË Ë ∞¶ ÌÂÈÒıËÎÂ Î·-Ù¿ ÂÚ›Ô˘ 3/2 mmHg ÛÂ Û‡ÁÎÚÈ-ÛË ÌÂ ÙÔ˘˜ ·ÛıÂÓÂ›˜ Ô˘ ¤·ÈÚ-Ó·Ó ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ. ∞˘Ù‹ ËÌÂ›ˆÛË Û˘Û¯ÂÙ›ÛıËÎÂ ÌÂ ÛËÌ·ÓÙÈ-Î‹ ÌÂ›ˆÛË ÙË˜ Â›ÙˆÛË˜ ÔÏÏÒÓÎ·Ù·ÏËÎÙÈÎÒÓ ÛËÌÂ›ˆÓ, Û˘ÌÂÚÈ-Ï·Ì‚·ÓÔÌ¤ÓˆÓ Î·È ÙˆÓ ÈÛ¯·ÈÌÈ-ÎÒÓ ∞∂∂. ª¿ÏÈÛÙ· ·˘Ù¿ Ù· ıÂÙÈÎ¿·ÔÙÂÏ¤ÛÌ·Ù· ·ÊÔÚÔ‡Û·Ó ÙfiÛÔÙÔ˘˜ ˘ÂÚÙ·ÛÈÎÔ‡˜ ·ÛıÂÓÂ›˜ fiÛÔÙ· ÓÔÚÌÔÙ·ÛÈÎ¿ ¿ÙÔÌ·. ∂ÈÚfi-ÛıÂÙ·, ÛÙËÓ ˘Ô-ÔÌ¿‰· ÙˆÓ ·ÛıÂ-


8

∏ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ˘¤ÚÙ·ÛË˜ ÌÂÙ¿ ·fi ¤Ó·

ÈÛ¯·ÈÌÈÎfi ·ÁÁÂÈ·Îfi ÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔ

ªÈ¯¿ÏË˜ ∫·ÏÔÁ‹ÚÔ˘, ∂ÈÛÙËÌÔÓÈÎfi˜ ™˘ÓÂÚÁ¿ÙË˜ π·ÙÚÂ›Ô˘ §ÈÈ‰›ˆÓªˆ˘Û‹˜ ∂ÏÈÛ¿Ê, ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜

A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·8

ÓÒÓ Ô˘ ÂÌÊ¿ÓÈÛ·Ó ÛÙÔ ·ÚÂÏ-ıfiÓ ÈÛ¯·ÈÌÈÎ‹ ÓfiÛÔ ÙˆÓ ·ÁÁÂ›ˆÓÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ (∞∂∂ ‹ ·ÚÔ‰ÈÎfi∞∂∂) Î·È ÔÈ ÔÔ›ÔÈ ¤Ï·‚·Ó Ú·ÌÈ-Ú›ÏË ·Ú·ÙËÚ‹ıËÎÂ Ì›· Ù¿ÛËÌÂ›ˆÛË˜ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ Â·ÓÂÌÊ¿-ÓÈÛË˜ ∞∂∂, Ë ÔÔ›· fiÌˆ˜ ‰ÂÓ‹Ù·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ [7].

¢ÂÓ ˘¿Ú¯Ô˘Ó ·ÚÎÂÙ¿ ‰Â‰Ô-Ì¤Ó· ·fi ÌÂÁ¿ÏÂ˜ Ù˘¯·ÈÔÔÈËÌ¤-ÓÂ˜ ÌÂÏ¤ÙÂ˜ Ù· ÔÔ›· Ó· ÛÙÔÈ¯ÂÈÔ-ıÂÙÔ‡Ó ÙË ¯Ú‹ÛË ÂÓfi˜ Û˘ÁÎÂÎÚÈ-Ì¤ÓÔ˘ ÔÚ›Ô˘-ÛÙfi¯Ô˘ ÙË˜ ∞¶, fiÛÔÓ·ÊÔÚ¿ ÙË ‰Â˘ÙÂÚÔÁÂÓ‹ ÚfiÏË„ËÙˆÓ ∞∂∂. ø˜ ÂÎ ÙÔ‡ÙÔ˘, ÌÈ· ÏÔÁÈ-Î‹ ÂÓ·ÏÏ·ÎÙÈÎ‹ Ï‡ÛË Â›Ó·È Ë ÙÔÔ-ı¤ÙËÛË ÙˆÓ ÛÙfi¯ˆÓ ÙË˜ ∞¶ Ô˘ÚÔÙÂ›ÓÔÓÙ·È ·fi ÙËÓ 7Ë ·Ó·ÊÔ-Ú¿ ÙË˜ JNC. ™‡ÌÊˆÓ· ÌÂ ·˘Ù¤˜ÙÈ˜ Ô‰ËÁ›Â˜, ÛÂ ¤Ó· ·ÛıÂÓ‹ Ô˘¤¯ÂÈ ‹‰Ë ˘ÔÛÙÂ› ¤Ó· ÈÛ¯·ÈÌÈÎfi∞∂∂ Ô ÛÙfi¯Ô˜ ÙË˜ ·ÓÙÈ˘ÂÚÙ·ÛÈ-Î‹˜ ·ÁˆÁ‹˜ Â›Ó·È Ë ÌÂ›ˆÛË ÙË˜∞¶ Î¿Ùˆ ·fi 140/90 mmHg, ÂÓÒÂ¿Ó Û˘Ó˘¿Ú¯ÂÈ ‰È·‚‹ÙË˜ Ù‡Ô˘ππ ‹ Î·È ¯ÚfiÓÈ· ÓÂÊÚÈÎ‹ ÓfiÛÔ˜ ÙfiÙÂÔ ÛÙfi¯Ô˜ ÙË˜ ·ÁˆÁ‹˜ Ú¤ÂÈ Ó·Â›Ó·È Ë ÌÂ›ˆÛË ÙË˜ ∞¶ <130/80mmHg [8]. ¢ÂÓ Â›Ó·È ÁÓˆÛÙfi Â¿Ó ËÂÚ·ÈÙ¤Úˆ ÌÂ›ˆÛË ÙË˜ ∞¶ Â›Ó·È·ÛÊ·Ï‹˜ Î·È ·ÔÙÂÏÂÛÌ·ÙÈÎ‹. ∏ÌÂÏ¤ÙË HOT (Hypertensive Opti-mal Treatment), Ô˘ Û¯Â‰È¿ÛıËÎÂÁÈ· ·˘Ùfi ÙÔ ÛÎÔfi, ¤‰ÂÈÍÂ fiÙÈ ËÌÂ›ˆÛË ÙË˜ ∞¶ ÛÂ Â›Â‰· 140/85mmHg Û˘Û¯ÂÙ›ÛıËÎÂ ÌÂ ÌÂ›ˆÛËÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿-ÙˆÓ, ÂÓÒ Ë ÂÚ·ÈÙ¤Úˆ ÌÂ›ˆÛË ÙË˜∞¶ ÛÂ Â›Â‰· 120/70 mmHgÚfiÛıÂÛÂ ÌÈÎÚfi ÌfiÓÔ fiÊÂÏÔ˜ [9].

ŸÛÔÓ ·ÊÔÚ¿ ÙÔ ˙‹ÙËÌ· ÙÔ˘¯ÚÔÓÈÎÔ‡ ‰È·ÛÙ‹Ì·ÙÔ˜ Ì¤Û· ÛÙÔÔÔ›Ô Ú¤ÂÈ Ó· ÂÈÙÂ˘¯ıÂ› ÔÛÙfi¯Ô˜ ÙË˜ ∞¶, ‰ÂÓ ˘¿Ú¯Ô˘Ó ‰Â-‰ÔÌ¤Ó· ·fi ÎÏÈÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜.∂ÔÌ¤Óˆ˜ Î·È ÁÈ· ·˘Ùfi ÙÔ ı¤Ì·Û˘ÓÈÛÙ¿Ù·È Ë ˘ÈÔı¤ÙËÛË ÙˆÓ Î·-ÙÂ˘ı˘ÓÙ‹ÚÈˆÓ Ô‰ËÁÈÒÓ ÙË˜ 7Ë˜·Ó·ÊÔÚ¿˜ ÙË˜ JNC. ™‡ÌÊˆÓ· ÌÂ·˘Ù¤˜ ÙÈ˜ Ô‰ËÁ›Â˜, ÛÂ ˘ÂÚÙ·ÛÈ-ÎÔ‡˜ ·ÛıÂÓÂ›˜ Ô˘ ‰ÂÓ ¤¯Ô˘Ó ¿Ï-ÏÔ˘˜ ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ Ë Â›-ÙÂ˘ÍË ÙÔ˘ ÛÙfi¯Ô˘ ÙË˜ ·ÁˆÁ‹˜Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÛÂ 3 ¤ˆ˜ 6 Ì‹-ÓÂ˜ Î·È ÛÙË Û˘Ó¤¯ÂÈ· ÔÈ ·ÛıÂÓÂ›˜Ú¤ÂÈ Ó· ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È Î¿-ıÂ 3 ¤ˆ˜ 6 Ì‹ÓÂ˜. √È ·ÛıÂÓÂ›˜Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ˘¤ÚÙ·ÛË ÛÙ·‰›-Ô˘ ππ ‹ ÂÎÂ›ÓÔÈ Ô˘ ¤¯Ô˘Ó Î·È ¿Ï-ÏÔ˘˜ ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ¯ÚÂÈ¿-˙ÔÓÙ·È Ù·ÎÙÈÎfiÙÂÚË ·Ú·ÎÔÏÔ‡-ıËÛË.

À¿Ú¯Ô˘Ó ÂÓ‰Â›ÍÂÈ˜ fiÙÈ Î¿ÔÈ·Î·ÙËÁÔÚ›· ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓÊ·ÚÌ¿ÎˆÓ ˘ÂÚ¤¯ÂÈ fiÛÔÓ ·ÊÔ-Ú¿ ÙË ‰Â˘ÙÂÚÔÁÂÓ‹ ÚfiÏË„ËÙˆÓ ÈÛ¯·ÈÌÈÎÒÓ ∞∂∂;

∆· ‰Â‰ÔÌ¤Ó· Ô˘ ˘¿Ú¯Ô˘ÓÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ‰Â›¯ÓÔ˘Ó fiÙÈfiÏÂ˜ ÔÈ Î·ÙËÁÔÚ›Â˜ ÙˆÓ ·ÓÙÈ˘ÂÚ-Ù·ÛÈÎÒÓ Ê·ÚÌ¿ÎˆÓ (.¯. Ù· ‰ÈÔ˘-ÚËÙÈÎ¿, ÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜, ÔÈ ·Ó·-ÛÙÔÏÂ›˜ ÙÔ˘ ª∂∞ Î.Ï) ÌÂÈÒÓÔ˘ÓÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛË˜ ÙË˜ ÈÛ¯·È-ÌÈÎ‹˜ ÓfiÛÔ˘ ÙˆÓ ·ÁÁÂ›ˆÓ ÙÔ˘ÂÁÎÂÊ¿ÏÔ˘ [10]. Œ¯ÂÈ ‰È·Ù˘ˆıÂ› Ë¿Ô„Ë fiÙÈ ÔÈ ·ÔÎÏÂÈÛÙ¤˜ ÙˆÓ ‰È-·‡ÏˆÓ ÙÔ˘ ·Û‚ÂÛÙ›Ô˘ ÂÓ‰Â¯fiÌÂ-Ó· ·Ú¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚË ÚÔ-ÛÙ·Û›· fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ÚˆÙÔ-ÁÂÓ‹ ÚfiÏË„Ë ÙˆÓ ÈÛ¯·ÈÌÈÎÒÓ∞∂∂. ∏ ÌÂÏ¤ÙË CAPPP ¤‰ÂÈÍÂ fiÙÈÙ· ı·Ó·ÙËÊfiÚ· Î·È ÌË ı·Ó·ÙËÊfi-Ú· ∞∂∂ ‹Ù·Ó ÈÔ Û˘¯Ó¿ ÌÂÙ¿ ÙË¯ÔÚ‹ÁËÛË ÙË˜ Î·ÙÔÙÚ›ÏË˜ ÛÂÛ‡ÁÎÚÈÛË ÌÂ ÙË ¯ÔÚ‹ÁËÛË ÂÓfi˜‰ÈÔ˘ÚËÙÈÎÔ‡ ‹ ÂÓfi˜ ‚-·ÔÎÏÂÈÛÙ‹[11]. øÛÙfiÛÔ ·˘Ù¿ Ù· ·ÔÙÂÏ¤ÛÌ·-Ù· ÌÔÚÂ› Ó· ÔÊÂ›ÏÔÓÙ·È ÛÙÔ ÁÂ-ÁÔÓfi˜ fiÙÈ ÛÙËÓ ÔÌ¿‰· ÙË˜ Î·ÙÔ-ÙÚ›ÏË˜ Ë Ì¤ÛË ∞¶ ÚÈÓ ÙËÓ ¤Ó·Ú-ÍË Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ·Áˆ-Á‹˜ ‹Ù·Ó ˘„ËÏfiÙÂÚË ÛÂ Û‡ÁÎÚÈÛËÌÂ ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÙˆÓ ¿ÏÏˆÓ ‰‡ÔÔÌ¿‰ˆÓ [2]. √È Chapman Î·È Neal [2]

‰È·Ù‡ˆÛ·Ó ÙËÓ ¿Ô„Ë fiÙÈ fiÛÔÓ·ÊÔÚ¿ ÙËÓ ÚˆÙÔÁÂÓ‹ ÚfiÏË„ËÙˆÓ ÈÛ¯·ÈÌÈÎÒÓ ∞∂∂ Ë ÂÈÏÔÁ‹ ÙÔ˘·ÓÙÈ˘ÂÚÙ·ÛÈÎÔ‡ ·Ú¿ÁÔÓÙ· ‰ÂÓ‰È·‰Ú·Ì·Ù›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ.∞ÓÙ›ıÂÙ·, Ê·›ÓÂÙ·È fiÙÈ ¤¯ÂÈ ÌÂÁ·-Ï‡ÙÂÚË ÛËÌ·Û›· Ë ·ÔÙÂÏÂÛÌ·ÙÈ-Î‹ ÌÂ›ˆÛË ÙË˜ ·ÚÙËÚÈ·Î‹˜ ›Â-ÛË˜. ªÂÏ¤ÙÂ˜ Ô˘ ‰ËÌÔÛÈÂ‡ıËÎ·ÓÚfiÛÊ·Ù· ¤‰ÂÈÍ·Ó fiÙÈ ÔÈ ·Ó·ÛÙÔ-ÏÂ›˜ ÙÔ˘ ª∂∞ Î·È ÔÈ ·ÔÎÏÂÈÛÙ¤˜ÙˆÓ ˘Ô‰Ô¯¤ˆÓ ÙË˜ ·ÁÁÂÈÔÙÂÓÛ›-ÓË˜ ˘ÂÚ¤¯Ô˘Ó ÛÂ Û‡ÁÎÚÈÛË ÌÂÙÈ˜ ¿ÏÏÂ˜ ÔÌ¿‰Â˜ ·ÓÙÈ˘ÂÚÙ·ÛÈ-ÎÒÓ Ê·ÚÌ¿ÎˆÓ fiÛÔÓ ·ÊÔÚ¿ ÙËÓÚfiÏË„Ë ÙË˜ Î·Ú‰È·ÁÁÂÈ·Î‹˜ Ófi-ÛÔ˘. ∏ ·Ú·Ù‹ÚËÛË ·˘Ù‹ Ô‰‹ÁË-ÛÂ ÛÙËÓ ˘fiıÂÛË fiÙÈ ›Ûˆ˜ ·˘ÙÔ›ÔÈ ·Ú¿ÁÔÓÙÂ˜ ‰È·ı¤ÙÔ˘Ó Î¿ÔÈÂ˜Â˘ÂÚÁÂÙÈÎ¤˜ È‰ÈfiÙËÙÂ˜ Ô˘ Â›Ó·È·ÓÂÍ¿ÚÙËÙÂ˜ ÙË˜ ·ÓÙÈ˘ÂÚÙ·ÛÈ-Î‹˜ ÙÔ˘˜ ‰Ú¿ÛË˜ Î·È ÔÈ ÔÔ›Â˜‰È·‰Ú·Ì·Ù›˙Ô˘Ó ÔÏ‡ ÛËÌ·ÓÙÈÎfiÚfiÏÔ ÛÙËÓ ÚfiÏË„Ë ÙË˜ Î·Ú‰È·Á-ÁÂÈ·Î‹˜ ÓfiÛÔ˘ [12-14]. øÛÙfiÛÔ ÌÈ·Ù¤ÙÔÈ· ˘fiıÂÛË ‰ÂÓ ÌÔÚÂ› Ó·ÛÙÔÈ¯ÂÈÔıÂÙËıÂ› ÌÂ ‚Â‚·ÈfiÙËÙ··fi Ù· Ì¤¯ÚÈ Û‹ÌÂÚ· ‰Â‰ÔÌ¤Ó·.ÕÏÏˆÛÙÂ, Ì›· ÚfiÛÊ·ÙË ÌÂÙ·-·Ó¿Ï˘ÛË ¤‰ÂÈÍÂ fiÙÈ fiÏÂ˜ ÔÈ Î·ÙË-

ÁÔÚ›Â˜ ÙˆÓ ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ Ê·Ú-Ì¿ÎˆÓ ÌÂÈÒÓÔ˘Ó ÛËÌ·ÓÙÈÎ¿ ÙÔÓÎ›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛË˜ ÙˆÓ ÈÛ¯·ÈÌÈ-ÎÒÓ ∞∂∂, Î·ıÒ˜ Î·È ÙˆÓ ¿ÏÏˆÓÎ·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ [15].∫·Ù¿ Û˘Ó¤ÂÈ·, Ë ÂÈıÂÙÈÎ‹ ÌÂ›ˆ-ÛË ÙË˜ ∞¶ ·Ú·Ì¤ÓÂÈ Ô ·ÎÚÔÁˆÓÈ-·›Ô˜ Ï›ıÔ˜ ÁÈ· ÙË ‰Â˘ÙÂÚÔÁÂÓ‹ÚfiÏË„Ë ÙˆÓ ÈÛ¯·ÈÌÈÎÒÓ ∞∂∂.

∏ ÌÂ›ˆÛË ÙË˜ ∞¶ ÛÂ ¤Ó· ËÏÈÎÈˆ-Ì¤ÓÔ ·ÛıÂÓ‹ ÌÂÙ¿ ·fi ¤Ó· ÔÍ‡ÈÛ¯·ÈÌÈÎfi ∞∂∂ Â›Ó·È Ì›· ·ÛÊ·-Ï‹˜ ÛÙÚ·ÙËÁÈÎ‹ ‹ ÂÓ‰¤¯ÂÙ·È Ó·Ô‰ËÁ‹ÛÂÈ ÛÂ Ó¤Ô ∞∂∂;

√ÚÈÛÌ¤ÓÔÈ ÁÈ·ÙÚÔ› ¤¯Ô˘Ó ÂÎ-ÊÚ¿ÛÂÈ ÙÔ Êfi‚Ô fiÙÈ Ë ÌÂ›ˆÛË ÙË˜∞¶ ÛÂ ¤Ó· ËÏÈÎÈˆÌ¤ÓÔ ·ÛıÂÓ‹ÌÔÚÂ› Ó· Ô‰ËÁ‹ÛÂÈ ÛÂ ÂÁÎÂÊ·ÏÈ-Î‹ ÈÛ¯·ÈÌ›· Î·È ∞∂∂, È‰È·›ÙÂÚ· Â¿ÓÛ˘Ó˘¿Ú¯ÂÈ ÂÛÙÈ·Î‹ ‹ ÔÏ˘ÂÛÙÈ·-Î‹ ÓfiÛÔ˜ ÙˆÓ ·ÁÁÂ›ˆÓ ÙÔ˘ ÂÁÎÂ-Ê¿ÏÔ˘. ™Â ·ÓÙ›ıÂÛË ÌÂ ·˘Ù¤˜ ÙÈ˜‰˘ÛÌÂÓÂ›˜ ÚÔ‚Ï¤„ÂÈ˜, ÙÚÂÈ˜ ÌÂ-Á¿ÏÂ˜ ÌÂÏ¤ÙÂ˜ (Ë SHEP, Ë SystEur Î·È Ë STOP [16-18]) ¤‰ÂÈÍ·Ó fiÙÈ ËÌÂ›ˆÛË ÙË˜ ∞¶ Ô‰ËÁÂ› ÛÂ ÌÂ›ˆÛËÙˆÓ ÈÛ¯·ÈÌÈÎÒÓ ∞∂∂ ÛÂ ËÏÈÎÈˆÌ¤-Ó· ¿ÙÔÌ·. øÛÙfiÛÔ, ‰ÂÓ Ú¤ÂÈ Ó·‰È·ÊÂ‡ÁÂÈ ÙË˜ ÚÔÛÔ¯‹˜ Ì·˜ fiÙÈÛÂ ·˘Ù‹ ÙËÓ Â˘·›ÛıËÙË ÔÌ¿‰··ÛıÂÓÒÓ Ë ÙÈÙÏÔÔ›ËÛË ÙË˜ ‰fiÛË˜ÙˆÓ Ê·ÚÌ¿ÎˆÓ Ú¤ÂÈ Ó· Á›ÓÂÙ·ÈÌÂ ÌÂÁ¿ÏË ÚÔÛÔ¯‹. ∂›ÛË˜, Û˘-¯Ó¿ ÔÈ ËÏÈÎÈˆÌ¤ÓÔÈ ·ÛıÂÓÂ›˜ ÂÌÊ·-Ó›˙Ô˘Ó ·ÓÂ¿ÚÎÂÈ· ÙÔ˘ ·˘ÙfiÓÔÌÔ˘ÓÂ˘ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, Ì›· Î·Ù¿-ÛÙ·ÛË Ô˘ Ô‰ËÁÂ› ÛÂ ÌÂÁ¿ÏÂ˜ ÌÂ-Ù·‚ÔÏ¤˜ ÙË˜ ∞¶ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ·ÙÔ˘ 24ÒÚÔ˘. ∏ 24ˆÚË Î·Ù·ÁÚ·Ê‹ÙË˜ ∞¶ ÌÔÚÂ› Ó· ·Ó·‰Â›ÍÂÈ ·˘Ù‹ÙË ‰È·Ù·Ú·¯‹ Î·È Ó· Û˘Ì‚¿ÏÏÂÈÛÙËÓ Î·Ï‡ÙÂÚË ·ÓÙÈÌÂÙÒÈÛË ÙË˜˘¤ÚÙ·ÛË˜ ÛÙÔ˘˜ ËÏÈÎÈˆÌ¤ÓÔ˘˜·ÛıÂÓÂ›˜.

∂¿Ó ¤Ó·˜ ·ÛıÂÓ‹˜ ¿Û¯ÂÈ ·fi¿ÓÔÈ·, ÙfiÙÂ ÛÂ ÔÈ¿ Â›Â‰·Ú¤ÂÈ Ó· Î˘Ì·›ÓÂÙ·È Ë ·ÚÙË-ÚÈ·Î‹ ÙÔ˘ ›ÂÛË;

∞ÚÎÂÙ¤˜ ÌÂÏ¤ÙÂ˜ ¤‰ÂÈÍ·Ó fiÙÈ ËÌÂ›ˆÛË ÙË˜ ∞¶ Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂÌÂ›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛË˜ÙË˜ ¿ÓÔÈ·˜. ∏ ÌÂÏ¤ÙË Syst Eur¤‰ÂÈÍÂ fiÙÈ Ë Ì·ÎÚÔ¯ÚfiÓÈ· ¯ÔÚ‹-ÁËÛË ÂÓfi˜ Ì·ÎÚ¿˜ ‰Ú¿ÛË˜ ·Ô-ÎÏÂÈÛÙ‹ ÙˆÓ ‰È·‡ÏˆÓ ·Û‚ÂÛÙ›Ô˘Â›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙË ÌÂ›ˆÛËÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛË˜ ÙË˜¿ÓÔÈ·˜ Î·Ù¿ 55% [19]. ª¿ÏÈÛÙ· ÙÔıÂÙÈÎfi ·ÔÙ¤ÏÂÛÌ· ·ÊÔÚÔ‡ÛÂÙfiÛÔ ÙË ÓfiÛÔ ÙÔ˘ Alzheimer fiÛÔ

£∂ƒ∞¶∂π∞ – º∞ƒª∞∫∞

9

A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·9

Î·È ÙËÓ ¿ÓÔÈ· ·ÁÁÂÈ·Î‹˜ ·ÈÙÈÔÏÔ-Á›·˜.

™Â ÂÚ›ÙˆÛË Ô˘ ÚÔ¸¿Ú-¯ÂÈ ¿ÓÔÈ· Ë ¯ÔÚ‹ÁËÛË ·ÓÙÈ˘ÂÚ-Ù·ÛÈÎ‹˜ ·ÁˆÁ‹˜ ‰ÂÓ Ê·›ÓÂÙ·È Ó·Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂ ‚ÂÏÙ›ˆÛË ÙË˜ÁÓˆÛÈ·Î‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ·ÛıÂ-Ó‹. ª›· ÌÂÏ¤ÙË ·Ú·Ù‹ÚËÛË˜ ÛÂ·ÛıÂÓÂ›˜ ÌÂ ÔÏÏ·Ï¿ ÂÁÎÂÊ·ÏÈ-Î¿ ¤ÌÊÚ·ÎÙ· (ÌÂ ‹ ¯ˆÚ›˜ ÙË Û˘-Ó‡·ÚÍË ¿ÓÔÈ·˜) ¤‰ÂÈÍÂ fiÙÈ Ë ‰È·-Ù‹ÚËÛË ·˘ÍËÌ¤ÓˆÓ ÂÈ¤‰ˆÓ ÙË˜™∞¶ ÂÌfi‰ÈÛÂ ÙËÓ ÂÚ·ÈÙ¤Úˆ ÂÈ-‰Â›ÓˆÛË ÙË˜ ÁÓˆÛÈ·Î‹˜ ÏÂÈÙÔ˘Ú-Á›·˜ ÛÂ fiÛÔ˘˜ ÂÌÊ¿ÓÈ˙·Ó ¿ÓÔÈ·[20]. ª›· ¿ÏÏË ÌÂÏ¤ÙË ÛÂ ·ÛıÂÓÂ›˜ÌÂ ¿ÓÔÈ· ·ÁÁÂÈ·Î‹˜ ·ÈÙÈÔÏÔÁ›·˜¤‰ÂÈÍÂ fiÙÈ Ù· ·˘ÍËÌ¤Ó· Â›Â‰·ÙË˜ ™∞¶ (·fi 135 ¤ˆ˜ 150mmHg) Û˘Û¯ÂÙ›ÛıËÎ·Ó ÌÂ ‚ÂÏ-Ù›ˆÛË ÙË˜ ÁÓˆÛÈ·Î‹˜ ÏÂÈÙÔ˘Ú-Á›·˜, ÂÓÒ Ë ÌÂ›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓÙË˜ ™∞¶ Û˘Û¯ÂÙ›ÛıËÎÂ ÌÂ ÂÈ‰Â›-ÓˆÛË ÙË˜ ÁÓˆÛÈ·Î‹˜ ÏÂÈÙÔ˘ÚÁ›·˜[21].

À¿Ú¯Ô˘Ó Û‹ÌÂÚ· ·Ó·ÌÊÈÛ‚‹ÙË-ÙÂ˜ ÂÓ‰Â›ÍÂÈ˜ fiÙÈ Ë ÌÂ›ˆÛË ÙË˜ ∞¶‰È·‰Ú·Ì·Ù›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔÛÙËÓ ÚˆÙÔÁÂÓ‹ Î·È ÙË ‰Â˘ÙÂÚÔ-ÁÂÓ‹ ÚfiÏË„Ë ÙˆÓ ÈÛ¯·ÈÌÈÎÒÓ∞∂∂, Î·ıÒ˜ Î·È ¿ÏÏˆÓ Î·Ú‰È·Á-ÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ. ∂ÈÚfi-ÛıÂÙ· Ë ÌÂ›ˆÛË ÙË˜ ∞¶ Ê·›ÓÂÙ·ÈfiÙÈ Û˘Û¯ÂÙ›˙ÂÙ·È Î·È ÌÂ ÌÂ›ˆÛËÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛË˜ ¿ÓÔÈ·˜(ÙfiÛÔ ·ÁÁÂÈ·Î‹˜ fiÛÔ Î·È ÌË ·Á-ÁÂÈ·Î‹˜ ·ÈÙÈÔÏÔÁ›·˜). Œ¯ÂÈ ‰È·Ù˘-ˆıÂ› Ë ¿Ô„Ë fiÙÈ ÔÈ ÏÂÈÔÙÚÔÈ-Î¤˜ ‰Ú¿ÛÂÈ˜ ÔÚÈÛÌ¤ÓˆÓ ·ÓÙÈ-˘ÂÚÙ·ÛÈÎÒÓ Ê·ÚÌ¿ÎˆÓ (·Ó·-ÛÙÔÏÂ›˜ ÙÔ˘ ª∂∞ Î·È ·ÔÎÏÂÈÛÙ¤˜ÙˆÓ ˘Ô‰Ô¯¤ˆÓ ÙË˜ ·ÁÁÂÈÔÙÂÓÛ›-ÓË˜) ‰È·‰Ú·Ì·Ù›˙Ô˘Ó ¤Ó·Ó ÂÈ-ÚfiÛıÂÙÔ ÚfiÏÔ (·ÓÂÍ¿ÚÙËÙÔ ÙË˜·ÓÙÈ˘ÂÚÙ·ÛÈÎ‹˜ ÙÔ˘˜ ‰Ú¿ÛË˜)ÛÙËÓ ÂÌÊ¿ÓÈÛË ÙˆÓ ıÂÙÈÎÒÓ ·Ô-ÙÂÏÂÛÌ¿ÙˆÓ Ô˘ ‹‰Ë ÂÚÈÁÚ¿ÊË-

Î·Ó. øÛÙfiÛÔ, ·˘Ù‹ Ë ·Ú·Ù‹ÚË-ÛË ‰ÂÓ ¤¯ÂÈ ·ÎfiÌË ÂÈ‚Â‚·ÈˆıÂ›Î·È ÂÔÌ¤Óˆ˜ fiÏÂ˜ ÔÈ ÔÌ¿‰Â˜ ÙˆÓ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ Ê·ÚÌ¿ÎˆÓ Â›Ó·ÈÊ¿ÚÌ·Î· ÚÒÙË˜ ÂÈÏÔÁ‹˜ ÁÈ·ÙËÓ ÚfiÏË„Ë ÙË˜ ÈÛ¯·ÈÌÈÎ‹˜ Ófi-ÛÔ˘ ÙˆÓ ·ÁÁÂ›ˆÓ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘.∂Í·ÈÙ›·˜ ÙË˜ ·Ô˘Û›·˜ ‰Â‰ÔÌ¤-ÓˆÓ ·fi Ù˘¯·ÈÔÔÈËÌ¤ÓÂ˜ ÎÏÈÓÈ-Î¤˜ ÌÂÏ¤ÙÂ˜ ‰ÂÓ ¤¯ÂÈ Î·ıÔÚÈÛıÂ›Û˘ÁÎÂÎÚÈÌ¤ÓÔ˜ ÛÙfi¯Ô˜ ÙË˜ ∞¶ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ Ô˘ ¤¯Ô˘Ó ˘Ô-ÛÙÂ› ¤Ó· ÈÛ¯·ÈÌÈÎfi ∞∂∂. ∫·Ù¿ Û˘-Ó¤ÂÈ· Ë ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ˘¤Ú-Ù·ÛË˜ ÛÂ ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜Ú¤ÂÈ Ó· Á›ÓÂÙ·È Û‡ÌÊˆÓ· ÌÂ ÙÈ˜Î·ÙÂ˘ı˘ÓÙ‹ÚÈÂ˜ Ô‰ËÁ›Â˜ ÙË˜ 7Ë˜·Ó·ÊÔÚ¿˜ ÙË˜ JNC. øÛÙfiÛÔ ·fiÙ· ÂÚÈÔÚÈÛÌ¤Ó· ‰Â‰ÔÌ¤Ó· Ô˘¤¯Ô˘Ó ‰ËÌÔÛÈÂ˘ıÂ› Ê·›ÓÂÙ·È fiÙÈ¯·ÌËÏfiÙÂÚ· Â›Â‰· ÙË˜ ∞¶ Û˘-Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ·ÎfiÌË ÌÂÁ·Ï‡ÙÂ-ÚÔ fiÊÂÏÔ˜ Î·È ÌÈÎÚfi ÌfiÓÔ ÂÈ-ÚfiÛıÂÙÔ Î›Ó‰˘ÓÔ.

™˘Ì¤Ú·ÛÌ·


10

1. Gorelick PB. New horizons for stroke preve-ntion: PROGRESS and HOPE. Lancet Neu-rology. 2002;1:149-156.

2. Chapman N, Neal B. Blood pressure lowe-ring for the prevention of first stroke. In:Chalmers J, ed.:Clinician's Manual onBlood Pressure and Stroke Prevention. 3rded. London, UK: Science Press; 2002:21-31.

3. Chalmers J. Progress with blood pressurelowering in the secondary prevention ofstroke. In: Chalmers J, ed. Clinician's Ma-nual on Blood Pressure and Stroke Pre-vention. 3rd ed. London, UK: SciencePress; 2002:33-53.

4. Goldstein, LB. Blood pressure mana-gement in patients with acute ischemicstroke. Hypertension 2004;43:137-141.

5. Lewington S, Clarke R, Qizilbash N, Peto R,Collins R; Prospective Studies Collabora-tion. Age-specific relevance or usual bloodpressure to vascular mortality: a meta-analysis of individual data for one millionadults in 61 prospective studies. Lancet2002;360:1903-1913.

6. PROGRESS Collaborative Study Group.Randomized trial of a perindopril-basedblood-pressure-lowering regimen among6105 individuals with previous stroke ortransient ischemic attack. Lancet 2001;358:1033-1041.

7. Bosch J. Yusuf S. Pogue J. Sleight P. LonnE. Rangoonwala B. Davies R. Ostergren J.Probstfield J. HOPE Investigators. Heartoutcomes prevention evaluation. Use of ra-mipril in preventing stroke: double blindrandomized trial. BMJ 2002;324:1-5.

8. Chobanian AV, Bakris GL, Black HR, Cush-man W, Lee A, Izzo JL, Jones DW, Ma-terson BJ, Oparil S, Wright JT, Roccella EJ.The seventh report of the Joint NationalCommittee on Prevention, Detection, Eva-luation, and Treatment of High Blood Pres-sure. The JNC 7 Report. JAMA 2003;289:2560-2572.

9. Hansson L, Zanchetti A, Carruthers SG,

Dahlof B, Elmfeldt D, Julius S, Menard J,Rahn KH, Wedel H, Westerling S. Effects ofintensive blood pressure lowering and low-dose aspirin in patients with hypertension:principal results of the HypertensionOptimal Treatment (HOT) randomized trial.Lancet 1998;351:1755-1762.

10. Staessen JA, Wang J-G, Thijs I. Cardiovas-cular protection and blood pressure redu-ction: a meta-analysis. Lancet 2001;358:1305-1315.

11. Hansson L, Lindholm LH, Niskanen L, Lan-ke J, Hedner T, Niklason A, Luomanmaki K,Dahlof B, de Faire U, Morlin C, Karlberg BE,Wester PO, Bjorck JE. Effect of angiotensin-converting enzyme inhibition comparedwith conventional therapy on cardiovascularmorbidity and mortality in hypertension: theCaptopril Prevention Project (CAPPP)randomized trial. Lancet 1999;353:611-616.

12. Psaty BM, Lumley T, Furberg CD, Schellen-baum G, Pahor M, Alderman MH, WeissNS. Health outcomes associated withvarious antihypertensive therapies used asfirst-line agents. A network meta-analysis.JAMA 2003;289:2534-2544.

13. Dahlof B, Devereux RB, Kjeldsen SE, JuliusS, Beevers G, de Faire U, Fyhrquist F, IbsenH, Kristiansson K, Lederballe-Pedersen O,Lindholm LH, Nieminen MS, Omvik P,Oparil S, Wedel H; LIFE Study Group. Car-diovascular morbidity and mortality in theLosartan Intervention for Endpoint Redu-ction in Hypertension study (LIFE). Lancet2002;359:995-1003.

14. ALLHAT officers and coordinators for theALLHAT Collaborative Research Group.Major outcomes in high-risk hypertensivepatients randomized to angiotensin-conver-ting enzyme inhibitor or calcium channelblocker vs. diuretic. JAMA 2002;288: 2981-2997.

15. Blood Pressure Lowering Treatment Tria-lists' Collaboration. Effects of differentblood-pressure lowering regimens on ma-jor cardiovascular events: results of prospe-

ctively-designed overviews of randomizedtrials. Lancet 2003;362:1527-1535.

16. SHEP Cooperative Research Group. Pre-vention of stroke by antihypertensive drugtreatment in older persons with isolatedhypertension: final results of the SystolicHypertension in the Elderly Program. JAMA1991;265:3255-3264.

17. Staessen JA. Fagard R. Thijs L. Celis H.Arabidze GG. Birkenhager WH. Bulpitt CJ.de Leeuw PW. Dollery CT. Fletcher AE. Fo-rette F. Leonetti G. Nachev C. O'Brien ET.Rosenfeld J. Rodicio JL. Tuomilehto J.Zanchetti A. The Systolic Hypertension inEurope (Syst-Eur) Trial Investigators. Ran-domized double-blind comparison ofplacebo and active treatment for older per-sons with isolated systolic hypertension.Lancet 1997;350:757-764.

18. Dahlof B. Lindholm LH. Hansson L. Scher-sten B. Ekbom T. Wester PO. Morbidity andmortality in Swedish Trial in Old Patientswith Hypertension (STOP-Hypertension).Lancet 1991;338:1281-1285.

19. Forette F. Seux ML. Staessen JA. Thijs L.Babarskiene MR. Babeanu S. Bossini A.Fagard R. Gil-Extremera B. Laks T. Kobala-va Z. Sarti C. Tuomilehto J. Vanhanen H.Webster J. Yodfat Y. Birkenhager WH; Sy-stolic Hypertension in Europe Investigators.The prevention of dementia with antihy-pertensive treatment: new evidence fromthe Systolic Hypertension in Europe (Syst-Eur) study. Arch Intern Med 2002;162:2046-2052.

20. Gorelick PB, Brody J, Cohen D, Freels S,Levy P, Dollear W, Forman H, Harris Y. Riskfactors for dementia associated with mul-tiple cerebral infarcts. A case-control ana-lysis in predominantly African-Americanhospital-based patients. Arch Neurol1993;50:714-720.

21. Meyer JS, Judd BW, Tawaklna T, RogersRL, Martel KF. Improved cognition aftercontrol of risk factors for multi-infarct deme-ntia. JAMA 1986;256:2203-2209


A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·10

∞) ¢›·ÈÙ·Œ¯ÂÈ ‹‰Ë ·Ó·ÊÂÚıÂ› ·fi ÙËÓ

NCEP ATP III fiÙÈ Ë ÚÔÙÂÈÓfiÌÂÓË‰›·ÈÙ· Ô˘ ·ÔÛÎÔÂ› ÛÂ ÌÂ›ˆÛËÙˆÓ ÏÈÈ‰›ˆÓ1-2 fi¯È ÌfiÓÔ ÌÂÈÒÓÂÈ ÙËÓÔÏÈÎ‹ ¯ÔÏËÛÙÂÚfiÏË ·ÏÏ¿ Î·È Ù·Â›Â‰· ÙË˜ HDL ¯ÔÏËÛÙÂÚfiÏË˜ÙÔ˘ Ï¿ÛÌ·ÙÔ˜3-5.

Œ¯Ô˘ÌÂ ‰Â›ÍÂÈ fiÙÈ Ë ·ÓÙ·fiÎÚÈ-ÛË ÙË˜ HDL ÛÙË ˘ÔÏÈÈ‰·ÈÌÈÎ‹ ‰›-·ÈÙ· ÂÍ·ÚÙ¿Ù·È ·fi Ù· ·Ú¯ÈÎ¿ ÙË˜Â›Â‰·6. ™Â ·ÛıÂÓÂ›˜ ÌÂ ·Ú¯ÈÎ‹ ÙÈ-Ì‹ ∏DL < 39 mg/dl, Ë ˘ÔÏÈÈ‰·ÈÌÈ-Î‹ ‰›·ÈÙ· ÌÂÈÒÓÂÈ ÙËÓ ÔÏÈÎ‹ ¯ÔÏË-ÛÙÂÚfiÏË Î·È Ù· Â›Â‰· ÙˆÓ ÙÚÈ-ÁÏ˘ÎÂÚÈ‰›ˆÓ, ·˘Í¿ÓÔÓÙ·˜ ÙËÓ HDL¯ÔÏËÛÙÂÚfiÏË, ÂÓÒ ÛÂ ·ÛıÂÓÂ›˜ ÌÂHDL ≥ 39 mg/dl Ë ÌÂ›ˆÛË ÙË˜ LDL¯ÔÏËÛÙÂÚfiÏË˜ Î·È ÙˆÓ ÂÈ¤‰ˆÓÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ ‰ÂÓ Û˘ÓÔ‰Â‡Â-Ù·È ·fi ·‡ÍËÛË ÙË˜ HDL6.

¶·ÚfiÌÔÈÔ ·ÔÙ¤ÏÂÛÌ· Â›¯Â Î·ÈÌ›· ¿ÏÏË ÌÂÏ¤ÙË ÌÂ ‰ÈÏ¿ÛÈ· Û˘Ì-ÌÂÙÔ¯‹ ·ÛıÂÓÒÓ fiÔ˘ ‰È·ÈÛÙÒıË-ÎÂ ÌÂ›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ HDLÌÂÙ¿ ·fi ˘ÔÏÈÈ‰·ÈÌÈÎ‹ ‰›·ÈÙ·fiÙ·Ó Ù· ·Ú¯ÈÎ¿ ÙË˜ Â›Â‰· ‹Ù·Ó ≥39 mg/dl7 (¶›Ó·Î·˜ 1). ∞Ó¿ÏÔÁËÌÂ›ˆÛË ÙË˜ HDL ÌÂÙ¿ ·fi ˘ÔÏÈÈ-‰·ÈÌÈÎ‹ ‰›·ÈÙ· ¤¯ÂÈ ·Ó·ÊÂÚıÂ› ·fiÙÔ˘˜ Maki et al8, ·fi ÙÈ˜ ÌÂÏ¤ÙÂ˜beFIT Î·È DAS9 Î·ıÒ˜ Î·È ·fi ¿Ï-ÏÔ˘˜10-12 (¶›Ó·Î·˜ 2).

µ) ºÈ‚Ú¿ÙÂ˜√È ÊÈ‚Ú¿ÙÂ˜ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È

ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ‰˘ÛÏÈÈ‰·È-ÌÈÒÓ 13 Â‰Ò Î·È ÔÏÏ¤˜ ‰ÂÎ·ÂÙ›Â˜(¶›Ó·Î·˜ 2). ¶ÂÚÈÛÛfiÙÂÚÔ ¤¯Ô˘Ó¯ÚËÛÈÌÔÔÈËıÂ› ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛËÙË˜ ˘ÂÚÙÚÈÁÏ˘ÎÂÚÈ‰·ÈÌ›·˜14.

√È ÌÂÁ¿ÏÂ˜ ÌÂÏ¤ÙÂ˜ ÌÂ ÊÈ‚Ú¿-ÙÂ˜ ¤‰ÂÈÍ·Ó Ì›· ·‡ÍËÛË ÙË˜ ∏DL·fi 6% 15 ¤ˆ˜ 10%16 Î·È 18%17 ÌÂ·Ú¿ÏÏËÏË ÌÂ›ˆÛË ÙË˜ LDL ÙË˜ Ù¿-ÍÂˆ˜ ÙÔ˘ 10%16, ‹ Î·Ì›· ÌÂÙ·‚Ô-Ï‹15, Î·ıÒ˜ Î·È ÌÂ›ˆÛË ÙˆÓ ÙÚÈÁÏ˘-ÎÂÚÈ‰›ˆÓ (∆°§) ÙË˜ Ù¿ÍÂˆ˜ ÙÔ˘21%17, 31% 15 ‹ 43%16.

∏ Veterans Affairs High-DensityLipoprotein Cholesterol InterventionTrial Î·È ÔÈ ÌÂÏ¤ÙÂ˜ BezafibrateInfraction Prevention ‰Â›¯ÓÔ˘Ó fiÙÈ ËıÂÚ·Â›· ÌÂ ÊÈ‚Ú¿ÙÂ˜ Â›Ó·È ·ÔÙÂ-ÏÂÛÌ·ÙÈÎ‹ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ¯·-ÌËÏ¿ Â›Â‰· HDL Î·È ˘ÂÚÙÚÈÁÏ˘-ÎÂÚÈ‰·ÈÌ›·15,17.

ªÂÏ¤ÙÂ˜ Ì·˜ ¤‰ÂÈÍ·Ó fiÙÈ ÔÈ ÊÈ-‚Ú¿ÙÂ˜ ‰ÂÓ ¤¯Ô˘Ó Î·Ì›· ·ÚÓËÙÈÎ‹Â›‰Ú·ÛË ÛÙ· Â›Â‰· ÙË˜ HDL,·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ·Ú¯ÈÎ‹ ÙË˜Û˘ÁÎ¤ÓÙÚˆÛË7 (¶›Ó·Î·˜ 1). ¶·Ú¿Ï-ÏËÏ·, ·Ú·ÙËÚÂ›Ù·È ·‡ÍËÛË ÙË˜HDL (+18%) fiÙ·Ó Ë ·Ú¯ÈÎ‹ ÙË˜ ÙÈ-Ì‹ Â›Ó·È ¯·ÌËÏ‹ Î·È ·ÚÂÌÊÂÚ‹˜ÌÂ ·˘Ù‹ Ô˘ ·Ó·Ê¤ÚÂÙ·È ÛÙË ÌÂÏ¤-ÙË BIP (+18%) 15.

°) ¡ÈÎÔÙÈÓÈÎfi ÔÍ‡ Î·È ·Ú¿ÁˆÁ·∆Ô ÓÈÎÔÙÈÓÈÎfi ÔÍ‡ ¤¯ÂÈ Â›Ó·È

ÁÓˆÛÙfi fiÙÈ ÌÂÈÒÓÂÈ ÙË ¯ÔÏËÛÙÂÚfi-ÏË Î·È Ù· Â›Â‰· ÙˆÓ ∆°§, ÂÏ·Ù-

ÙÒÓÔÓÙ·˜ ÙÈ˜ VLDL Î·-ıÒ˜ Î·È Ù· Â›Â‰·ÙË˜ LDL, ÂÓÒ Â›ÛË˜¤¯ÂÈ ÙËÓ ÈÎ·ÓfiÙËÙ· Ó··˘Í¿ÓÂÈ Ù· Â›Â‰·ÙË˜ HDL17-19 (¶›Ó·Î·˜2). ∂ÈÚfiÛıÂÙ·, ËıÂÚ·Â›· ÌÂ ÓÈÎÔÙÈÓÈ-Îfi ÔÍ‡ ÌÂÈÒÓÂÈ ÙÔÓÎ›Ó‰˘ÓÔ ÁÈ· ÛÙÂÊ·ÓÈ-·›· ÓfiÛÔ Î·È ÙËÓ È-ı·ÓfiÙËÙ· Â·ÓÂÌÊ¿-ÓÈÛË˜ ÂÌÊÚ¿ÁÌ·ÙÔ˜ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘ 20,21.√ ÌË¯·ÓÈÛÌfi˜ ‰Ú¿-ÛË˜ ÙÔ˘ ÓÈÎÔÙÈÓÈÎÔ‡ÔÍ¤Ô˜ ‰ÂÓ ¤¯ÂÈ Ï‹-Úˆ˜ ·ÔÛ·ÊËÓÈÛıÂ›.º·›ÓÂÙ·È fiÌˆ˜ Ó· ÌÂÈ-ÒÓÂÈ ÙËÓ ·Ú·ÁˆÁ‹ÙˆÓ ÂÏÂ‡ıÂÚˆÓ ÏÈ·-

ÚÒÓ ÔÍ¤ˆÓ ·Ó·ÛÙ¤ÏÏÔÓÙ·˜ ÙËÓ ÏÈ-fiÏ˘ÛË ÛÙÔ ÏÈÒ‰Ë ÈÛÙfi ÌÂ ·ÔÙ¤-ÏÂÛÌ· ÙËÓ ÌÂÈˆÌ¤ÓË ‰È·ıÂÛÈÌfiÙËÙ·ÙˆÓ ˘ÔÛÙÚˆÌ¿ÙˆÓ ÙË˜ VLDL Ô˘Û˘ÓÙ›ıÂÓÙ·È ÛÙÔ ‹·Ú. Œ¯ÂÈ Â›ÛË˜·Ó·ÊÂÚıÂ› fiÙÈ ÙÔ ÓÈÎÔÙÈÓÈÎfi ÔÍ‡·Ó·ÛÙ¤ÏÏÂÈ ·Â˘ıÂ›·˜ ÙËÓ Ë·ÙÈÎ‹Û‡ÓıÂÛË ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ Ô˘ÂÚÈ¤¯Ô˘Ó ·ÔÏÈÔÚˆÙÂ˝ÓË ‚.17,18,22

∆Ô ÓÈÎÔÙÈÓÈÎfi ÔÍ‡ ¤¯ÂÈ ‚ÚÂıÂ› Ó·ÚÔÎ·ÏÂ› ÙËÓ ÌÂÁ·Ï‡ÙÂÚË ·‡ÍËÛË(17-31%) ÙË˜ HDL ÌÂ ·Ú¿ÏÏËÏ·ÛËÌ·ÓÙÈÎ‹ ÌÂ›ˆÛË ÙfiÛÔ ÙË˜ LDL(12-20%), fiÛÔ Î·È ÙˆÓ ÂÈ¤‰ˆÓÙˆÓ ∆°§23. ∆· Â˘Ú‹Ì·Ù· Ì·˜ fiÛÔÓ·ÊÔÚ¿ ÙÔ ÓÈÎÔÙÈÓÈÎfi ÔÍ‡ Î·È Ù··Ó¿ÏÔÁ· ÙÔ˘ (acipimox) Â›Ó·È ·-ÚÂÌÊÂÚ‹. øÛÙfiÛÔ, ·ÛıÂÓÂ›˜ ÌÂ ·Ú-¯ÈÎ‹ HDL ≥ 39 mg/dl ·ÚÔ˘Û›·Û·ÓÌÂÁ·Ï‡ÙÂÚË ÌÂ›ˆÛË ÙË˜ LDL Î·ÈÙˆÓ ∆°§7. √È ·ÛıÂÓÂ›˜ ÌÂ ·Ú¯ÈÎ‹∏DL < 39 mg/dl ÂÌÊ¿ÓÈÛ·Ó ÌÂÁ·-Ï‡ÙÂÚË ·‡ÍËÛË ÙË˜ HDL ÛÂ Û‡ÁÎÚÈ-ÛË ÌÂ ·ÛıÂÓÂ›˜ Ô˘ Â›¯·Ó ·Ú¯ÈÎ‹HDL ≥ 39 mg/dl Î·ıÒ˜ Î·È ÛÂ Û‡-ÁÎÚÈÛË ÌÂ fiÏÂ˜ ÙÈ˜ ¿ÏÏÂ˜ ÔÌ¿‰Â˜7

(¶›Ó·Î·˜ 1).

¢. ™Ù·Ù›ÓÂ˜∏ ÂÈÛ·ÁˆÁ‹ ÙˆÓ ·Ó·ÛÙÔÏ¤ˆÓ

ÙÔ˘ 3-‡‰ÚÔÍ˘-3-ÌÂı˘ÏÔÁÏÔ˘Ù¿Ú˘-ÏÔ Û˘Ó¤Ó˙˘ÌÔ ∞ (HMG-CoA) (ÛÙ·-Ù›ÓÂ˜) ¤ÊÂÚÂ Â·Ó¿ÛÙ·ÛË ÛÙËÓ ıÂ-Ú·Â›· ÙˆÓ ‰˘ÛÏÈÈ‰·ÈÌÈÒÓ24,2,25,26. ∏¯ÔÚ‹ÁËÛË ÙˆÓ ÛÙ·ÙÈÓÒÓ ¤¯ÂÈ ˆ˜·ÔÙ¤ÏÂÛÌ· ÙËÓ ·Ó·‚¿ıÌÈÛË ÙˆÓË·ÙÈÎÒÓ LDL ˘Ô‰Ô¯¤ˆÓ, ‰È·ÙË-ÚÒÓÙ·˜ Ù· ÂÓ‰ÔÎ˘ÙÙ·ÚÈÎ¿ Â›Â‰·ÙË˜ ¯ÔÏËÛÙÂÚfiÏË˜. ∞ÔÙÂÏÔ‡Ó Ù·Û˘¯ÓfiÙÂÚ· Û˘ÓÙ·ÁÔÁÚ·ÊÔ‡ÌÂÓ·˘ÔÏÈÈ‰·ÈÌÈÎ¿ Ê¿ÚÌ·Î· ÂÍ·ÈÙ›·˜ÙË˜ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ÙÔ˘˜ÛÙË ÌÂ›ˆÛË ÙË˜ LDL, Î·ıÒ˜ Î·È ÙÔ˘ÁÂÁÔÓfiÙÔ˜ fiÙÈ ÚfiÎÂÈÙ·È ÁÈ· Ê¿Ú-Ì·Î· Î·Ï¿ ·ÓÂÎÙ¿ Î·È ·ÛÊ·Ï‹27.

√È ÛÙ·Ù›ÓÂ˜ ¤¯Ô˘Ó ·Ô‰Â‰ÂÈÁ-Ì¤Ó· ÙËÓ ÈÎ·ÓfiÙËÙ· Ó· ÌÂÈÒÓÔ˘ÓÙËÓ ÔÏÈÎ‹ ıÓËÙfiÙËÙ·, ÙÔ Î›Ó‰˘ÓÔÂÌÊ¿ÓÈÛË˜ ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ô-Î·Ú‰›Ô˘ Î·È ·ÁÁÂÈ·ÎÔ‡ ÂÁÎÂÊ·ÏÈ-ÎÔ‡ ÂÂÈÛÔ‰›Ô˘, Î·ıÒ˜ Î·È ÙËÓ·Ó¿ÁÎË ÁÈ· Â·Ó·ÁÁÂ›ˆÛË28-34. ∏ Û˘-Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜LDL Î·È ÙÔ˘ Î·Ú‰È·ÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡-ÓÔ˘ ÚÈÓ Î·È ÌÂÙ¿ ÙËÓ ıÂÚ·Â›· ÌÂÛÙ·Ù›ÓÂ˜ ¤¯Ô˘Ó ÂÎÙÈÌËıÂ› ÛÂ ÔÏ-Ï¤˜ ÎÏÈÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜28,30,33,35. ™ÙÈ˜ ÌÂ-

£∂ƒ∞¶∂π∞ – º∞ƒª∞∫∞

11

∏ ·ÓÙ·fiÎÚÈÛË ÙË˜ HDL

ÛÙËÓ ˘ÔÏÈÈ‰·ÈÌÈÎ‹ ıÂÚ·Â›·

°ÂÓÔ‚¤Ê· ¢. ∫ÔÏÔ‚Ô‡, ∫·ÙÂÚ›Ó· ∫. ∞Ó·ÁÓˆÛÙÔÔ‡ÏÔ˘, ∞Ï¤Í·Ó‰ÚÔ˜ ∂. ¶·ÓÙÂÏ¿ÎË˜∞’ ∫·Ú‰ÈÔÏÔÁÈÎ‹ ∫ÏÈÓÈÎ‹, øÓ¿ÛÂÈÔ ∫·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈÎfi ∫¤ÓÙÚÔ

≥39 mg/dl <39 mg/dl

¢›·ÈÙ· n=149 n=92HDL (·Ú¯ÈÎ¿ Â›Â‰·) 52 32ªÂÙ·‚ÔÏ‹ (%) -12* +19*

™Ù·Ù›ÓÂ˜ n=206 n=106HDL (·Ú¯ÈÎ¿ Â›Â‰·) 54 32ªÂÙ·‚ÔÏ‹ (%) -7* +22*

ºÈ‚Ú¿ÙÂ˜ n=86 n=79HDL (·Ú¯ÈÎ¿ Â›Â‰·) 51 31ªÂÙ·‚ÔÏ‹ (%) +2 +19*

¡ÈÎÔÙÈÓÈÎfi √Í‡/Acipimox n=50 n=33HDL (·Ú¯ÈÎ¿ Â›Â‰·) 48 30ªÂÙ·‚ÔÏ‹ (%) +6 +27*

*p<0.001 Û‡ÁÎÚÈÛË ÚÈÓ Î·È ÌÂÙ¿ ÙË ıÂÚ·Â›·.

¶›Ó·Î·˜ 1: ∏ Â›‰Ú·ÛË ÙË˜ ‰›·ÈÙ·˜, ÙˆÓ ÛÙ·ÙÈÓÒÓ,ÙˆÓ ÊÈ‚Ú·ÙÒÓ Î·È ÙÔ˘ ÓÈÎÔÙÈÓÈÎÔ‡ ÔÍ¤ˆ˜ ‹ ÙÔ˘·Ó·ÏfiÁÔ˘ ÙÔ˘ (Acipimox) ÛÙ· Â›Â‰· ÙË˜ HDL

A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·11

Ï¤ÙÂ˜ Ì·˜, ÔÈ ÛÙ·Ù›ÓÂ˜ ÌÂ›ˆÛ·Ó ÙËÓÔÏÈÎ‹ Î·È ÙËÓ LDL ¯ÔÏËÛÙÂÚfiÏË Î·-ıÒ˜ Î·È Ù· Â›Â‰· ÙˆÓ ∆°§, ÌÂÈÒ-ÓÔÓÙ·˜ fiÌˆ˜ ÛËÌ·ÓÙÈÎ¿ Ù· Â›Â‰·ÙË˜ HDL (¶›Ó·Î·˜ 1).

∂›Ó·È ‰‡ÛÎÔÏÔ Ó· ÚÔ‚ÏÂÊıÂ›·Ó Ì›· Ù¤ÙÔÈ· ÌÂ›ˆÛË ÙË˜ HDL ı·Â›¯Â Î¿ÔÈ· ·ÚÓËÙÈÎ‹ Â›‰Ú·ÛËÛÙÔÓ Î·Ú‰ÈÔ·ÁÁÂÈ·Îfi Î›Ó‰˘ÓÔ ÙÔ˘·ÛıÂÓÔ‡˜ ‰Â‰ÔÌ¤ÓÔ˘ fi,ÙÈ Ù¤ÙÔÈÔ˘Â›‰Ô˘˜ ‰Â‰ÔÌ¤Ó· ·Ô˘ÛÈ¿˙Ô˘Ó.øÛÙfiÛÔ, ÛÙË ÌÂÏ¤ÙË Air Force / Te-xas Coronary Atherosclerosis Pre-vention Study ·ÛıÂÓÂ›˜ ÌÂ ·Ú¯ÈÎ¿

Â›Â‰· HDL ÛÙ· ¯·ÌËÏfiÙÂÚ· 2/3ÙÔÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÙÈÌÒÓ Î·È ÔÚÈ·Î¿Â›Â‰· LDL Î·È ÔÏÈÎ‹˜ ¯ÔÏËÛÙÂÚfi-ÏË˜ ÂÌÊ·Ó›˙Ô˘Ó ÌÂÁ·Ï‡ÙÂÚË ÌÂ›ˆ-ÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÌÂÙ¿ ·fi ÙË ¯ÔÚ‹-ÁËÛË ÛÙ·ÙÈÓÒÓ (45% Î·È 44%) 36-38.∂›ÛË˜, Ë ÌÂÁ·Ï‡ÙÂÚË ·ÁÁÂÈÔÁÚ·-ÊÈÎ‹ ‚ÂÏÙ›ˆÛË ÌÂÙ¿ ·fi ıÂÚ·Â›·ÌÂ ÛÙ·Ù›ÓÂ˜ ¤¯ÂÈ ·Ó·ÊÂÚıÂ› ·fiÙÔ˘˜ Ballantne et al, ÛÂ ·ÛıÂÓÂ›˜ ÌÂ·Ú¯ÈÎ‹ ÙÈÌ‹ HDL < 35 mg/dl39.

√È ÛÙ·Ù›ÓÂ˜ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡-ÓÙ·È Ì¤¯ÚÈ Û‹ÌÂÚ· ¤¯Ô˘Ó ‰Â›ÍÂÈ Â˘-ÂÚÁÂÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù· Î˘Ú›ˆ˜ ÛÂ

·ÛıÂÓÂ›˜ ÌÂ ˘„ËÏ¤˜ ‹ Ì¤-ÙÚÈÂ˜ ÙÈÌ¤˜ LDL ¯ÔÏËÛÙÂÚfi-ÏË˜41. ∏ ‰Ú¿ÛË ÙˆÓ ÛÙ·ÙÈ-ÓÒÓ ÛÙË Û˘ÁÎ¤ÓÙÚˆÛË ÙË˜HDL ¯ÔÏËÛÙÂÚfiÏË˜ ‰ÂÓ Â›-Ó·È ·fiÏ˘Ù· Û·Ê‹˜. ∂›Ó·ÈÈı·Ófi fiÙÈ ÚÔÎ·ÏÔ‡Ó ÂÈ-ÏÂÎÙÈÎ‹ ·‡ÍËÛË ÙˆÓ ˘Ô‰Ô-¯¤ˆÓ (ScavengerReceptors) Ù‡Ô˘ B1, ¤¯Ô-ÓÙ·˜ Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙËÓ·˘ÍËÌ¤ÓË ·ÔÌ¿ÎÚ˘ÓÛËÙˆÓ HDL2 ·fi ÙÔ ‹·Ú Î·ÈÙË ÌÂ›ˆÛË ÙË˜ HDL ¯ÔÏË-ÛÙÂÚfiÏË˜41. ∞fi ÙËÓ ¿ÏÏËÌÂÚÈ¿ ÔÈ ÛÙ·Ù›ÓÂ˜ Â›Ó·È ÈÎ·-Ó¤˜ Ó· ·˘Í‹ÛÔ˘Ó ÙËÓ HDLÌ¤Ûˆ ·˘ÍËÌ¤ÓË˜ Û‡ÓıÂÛË˜ÙˆÓ ·ÔÏÈÔÚˆÙÂ˚ÓÒÓ A-I41. ∂›Ó·È Â›ÛË˜ Èı·Ófi ‰È·-ÊÔÚÂÙÈÎ¤˜ ÛÙ·Ù›ÓÂ˜ Ó·¤¯Ô˘Ó ‰È·ÊÔÚÂÙÈÎ‹ Â›‰Ú·-ÛË ÛÙ· Â›Â‰· ÙË˜ HDL41

(¶›Ó·Î·˜ 2). ∏ ÚÔËÁÔ‡ÌÂ-ÓË ÌÂÏ¤ÙË6 ·Ó·Ê¤ÚÂÈ fiÙÈ ÔÈÛÙ·Ù›ÓÂ˜ ‰ÂÓ ¤¯Ô˘Ó Î·Ì›·Â›‰Ú·ÛË ÛÙËÓ HDL fiÙ·Ó Ù·Â›Â‰· ÙË˜ Â›Ó·È ≥ 39mg/dl. ™ÙËÓ ›‰È· ÌÂÏ¤ÙË ÛÙÔ11% ÙˆÓ ·ÛıÂÓÒÓ ·fi ÙËÓÔÌ¿‰· ÙˆÓ ÛÙ·ÙÈÓÒÓ ¯ÔÚË-Á‹ıËÎÂ ÛÈÌ‚·ÛÙ·Ù›ÓË Î·È ÛÂÎ·Ó¤Ó·Ó ·ÛıÂÓ‹ ‰Â ¯ÔÚËÁ‹-ıËÎÂ ·ÙÔÚ‚·ÛÙ·Ù›ÓË, ÂÓÒÛÙË ‰ÈÎÈ¿ Ì·˜ ÌÂÏ¤ÙË ÛÙÔ21% ÙˆÓ ·ÛıÂÓÒÓ ¯ÔÚËÁ‹-ıËÎÂ ÛÈÌ‚·ÛÙ·Ù›ÓË Î·È ÛÙÔ18% ·ÙÔÚ‚·ÛÙ·Ù›ÓË.

Œ¯ÂÈ ·Ó·ÊÂÚıÂ› fiÙÈ ËÛÈÌ‚·ÛÙ·Ù›ÓË ÌÔÚÂ› ‰ÔÛÔ-ÂÍ·ÚÙÒÌÂÓ· Ó· ·˘Í‹ÛÂÈ ÙËÓHDL ÂÓÒ ÌÂ ÙËÓ ·ÙÔÚ‚·-ÛÙ·Ù›ÓË fiÛÔ Ë ‰fiÛË ·˘Í¿-ÓÂÙ·È ÙfiÛÔ ÂÚÈÔÚ›˙ÂÙ·È ËıÂÙÈÎ‹ ÙË˜ Â›‰Ú·ÛË ÛÙ·Â›Â‰· ÙË˜ HDL (·ÚÓËÙÈÎ‹‰ÔÛÔÂÍ¿ÚÙËÛË)42. ¢ÂÓ ÂÎÙÈ-Ì‹Û·ÌÂ ÙËÓ Â›‰Ú·ÛË ÙË˜Î¿ıÂ ÛÙ·Ù›ÓË˜ ÍÂ¯ˆÚÈÛÙ¿ÛÙ· Â›Â‰· ÙË˜ HDL ÂÍ’ ·È-Ù›·˜ ÙÔ˘ ÌÈÎÚÔ‡ ·ÚÈıÌÔ‡ÙÔÓ ·ÛıÂÓÒÓ ·Ó¿ Ê¿ÚÌ·ÎÔ.∂ÈÏ¤ÔÓ Ë ÌÂÏ¤ÙË ‰ÂÓ Û¯Â-

‰È¿ÛÙËÎÂ ÁÈ· Ó· ‰ÈÂÚÂ˘Ó‹ÛÂÈ ‰È·-ÊÔÚ¤˜ ÌÂÙ·Í‡ ÛÙ·ÙÈÓÒÓ Ô˘ ·ÊÔ-ÚÔ‡Ó Ù· Â›Â‰· ÙË˜ HDL ¯ÔÏËÛÙÂ-ÚfiÏË˜.

¶·ÚÔÏ’·˘Ù¿, Ë ÌÂÏ¤ÙË ·˘Ù‹˘Ô‰ÂÈÎÓ‡ÂÈ fiÙÈ Ë ¯ÔÚ‹ÁËÛË ÛÙ·ÙÈ-ÓÒÓ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ·Ú¯ÈÎ¿ Â›Â‰·HDL ¯ÔÏËÛÙÂÚfiÏË˜ ≥ 39 mg/dl,ÂÎÙfi˜ ·fi ÙËÓ ÚÔÛ‰ÔÎÔ‡ÌÂÓË ÌÂ›-ˆÛË ÙË˜ ÔÏÈÎ‹˜ ¯ÔÏËÛÙÂÚfiÏË˜, ÙË˜LDL Î·È ÙˆÓ ∆°§, Û˘ÓÔ‰Â‡ÂÙ·È Î·È·fi Ì›· ·ÓÂÈı‡ÌËÙË ÂÏ¿ÙÙˆÛË ÙË˜HDL ¯ÔÏËÛÙÂÚfiÏË˜7.


12

∞Ú¯ÈÎ¿ ∂›‰Ô˜ ªÂÏ¤ÙÂ˜ (¤ÙÔ˜) ∞ÚÈıÌfi˜ Â›Â‰· ˘ÔÏÈÈ‰·ÈÌÈÎ‹˜ ªÂÙ·‚ÔÏ‹[‚È‚ÏÈÔÁÚ·Ê›·] ·ÛıÂÓÒÓ HDL (mg/dl) ıÂÚ·Â›·˜ (%)

¢›·ÈÙ·Kolovou et al (1994) [6] 129 44 Step I -2Azen et al (1996) [12] 162 42 Step I +2De Lorgeril et al (1999) [43] 219 45 mediterranean +10Knopp et al (2000) [9] 792 41 Step II -2.5Knopp et al (2000) [9] 792 58 Step II -8Obarzanek et al (2001) [11] 436 49 DASH diet -3Maki et al (2001) [8] 75 52 Step I + low sterols -4Maki et al (2001) [8] 35 52 Step I + high sterols -7Kolovou et al (2003) [7] 241 45 Step I -4

ºÈ‚Ú¿ÙÂ˜Manttari et al (1987) [44] 4081 50 Gemfibrozil +10Steiner (1996) [45] 418 39 Fenofibrate +7.5Frick et al (1997) [16] 372 32 Gemfibrozil +15Rubins et al (1999) [46] 2531 32 Gemfibrozil +6BIP Study Group (2000) [15] 2825 35 Bezafibrate +18Sakai et al (2001) [47] 65 31 Gemfibrozil +13Kolovou et al (2003) [7] 165 41 Fibratesa +10

¡ÈÎÔÙÈÓÈÎfi √Í‡Sakai et al (2001) [47] 69 31 N-SL +22Cheung et al (2001) [48] 146 31 N+Simvastatin +26Kolovou et al (2003) [7] 83 41 N or Acipimox +10

™Ù·Ù›ÓÂ˜Sacks et al (1991) [49] 4159 38 Pravastatin +4Shepherd et al (1995) [50] 6595 43 Pravastatin +54S Study Group (1995) [51] 4444 46 Simvastatin +8Bruschke et al (1995) [52] 450 36 Pravastatin +9Herd et al (1994) [53] 339 34 Fluvastatin +9Herd et al (1994 [53] 339 48 Fluvastatin +4Downs et al (1997) [38] 5742 38 Lovastatin +6LIPID Study Group (1998) [54] 7684 36 Pravastatin +5Schwartz et al (2001) [55] 3086 46 Atorvastatin NCShepherd et al (2002) [56] 5804 50 Pravastatin +5Colhoun et al (2002) [57] 1421 52 Atorvastatin +1Sever et al (2003) [58] 19342 51 Pravastatin NCKolovou et al (2003) [7] 312 47 Statinsb -2McKenney et al (2003) [59] 313 51 Rosuvastatin +10McKenney et al (2003) [59] 323 50 Atorvastatin +2McKenney et al (2003) [59] 328 51 Simvastatin +7McKenney et al (2003) [59] 321 50 Pravastatin +6Prove-it (2004) [34] 2099 39 Atorvastatin +6.5Prove-it (2004) [34] 2063 39 Pravastatin +8

a√È ÊÈ‚Ú¿ÙÂ˜ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÂÚÈÏ·Ì‚¿ÓÔ˘Ó: Gemfibrozil, Bezafibrate Î·È Fenofibrateb√È ÛÙ·Ù›ÓÂ˜ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÂÚÈÏ·Ì‚¿ÓÔ˘Ó: Lovastatin, Simvastatin, Pravastatin Î·È AtorvastatinHDL: high density lipoprotein cholesterol, N-SL: slow release, N: nicotinic acid, NC: no change Step I & II dietsaccording to NCEP ATP II guidelines (1)

¶›Ó·Î·˜ 2. ªÂÙ·‚ÔÏ¤˜ ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ HDL ÛÂ ‰È¿ÊÔÚÂ˜ ÌÂÏ¤ÙÂ˜ ˘ÔÏÈ-È‰·ÈÌÈÎ‹˜ ıÂÚ·Â›·˜.

A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·12

£EPA¶EIA – ºAPMAKA

13

1. JAMA 1993 269, 3015-3023.2. JAMA 2001 285, 2486-2497.3. Ehnholm C, et al. N Engl J Med 1982

307, 850-855.4. Arntzenius AC, et al. N Engl J Med 1985

312, 805-811.5. Ornish D, et al. Lance, 1990 336, 129-133.6. Kolovou G, et al. Coronary Arter Dis 1994

5, 359-364.7. Kolovou G, et al. Am J Cardio 2003 92,

1339-1342.8. Maki KC, et al. Am J Clin Nut 2001 74,

33-43.9. Knopp, et al. Proc Soc Exp Biol Me 2000

225, 191-199.10. Watts GF, et al. Lancet 1992 339, 563-

569.11. Obarzanek E, et al. Am J Clin Nutr 2001

74, 80-89.12. Azen SP, et al. Circulation 1996 93, 34-41.13. Lancet 2001 357, 905-910.14. Todd PA, et al. Drugs 1988 36, 314-39.15. Circulation 2000 102, 21-27.16. Frick MH, et al. N Engl J Med, 1987 317,

1237-1245.17. Walldius G et al. Affecting Lipid Metabo-

lism VIII Drugs. New York: Plenum Publi-shing Corporation; 1985; 281-293.

18. Carlson LA. Treatment of Hyperlipopro-teinemia. Raven Press; 1984; 115.

19. Blum CB, et al. JAMA 1989 261, 3582-3587.

20. Canner PL, et al. J Am Coll Cardiol 19868, 1245-1255.

21. J Am Med Assoc 1975 231, 360-381.22. Tat_ F, et al. Am J Cardiol 1998 81, 805-

808.

23. Superko HR, et al. Atherosclerosis 199295, 69-76.

24. Kolovou G, Am J Cardiol 1995 75, 293-295.

25. Smith SC. Am J Cardiol 2000 85(12A),1E-2E.

26. Kolovou G. Curr Med Res Opin 2001 17,34-37.

27. Maron DJ, et al. Circulation 2000 101,207-213.

28. The Scandinavian Simvastatin SurvivalStudy Group. Lancet 1994 344, 1383-1389.

29. Waters D, et al. Circulation 1994 89, 959-968.

30. Sacks FM, et al. N Engl J Med 1996 335,1001-1009.

31. de Groot E, et al. J Am Coll Cardiol 199831, 1561-1567.

32. West of Scotland Coronary PreventionStudy Group. Circulation 1998 97, 1440-1445.

33. Heart Protection Study CollaborativeGroup. Lancet 2002 360, 7-22.

34. Harrington RA. Curr Cardiol Rep 2004 6,272.

35. Am J Cardiol 1995 76, 474-479.36. Boden WE, Am J Cardiol 2000 85, 645-

650.37. GottoAM Jr, et al. Circulation 2000 101,

477-484.38. Downs JR, et al. Am J Cardio 1997 80,

287-293.39. Ballantyne CM, et al. Circulation 1999 99,

736-743.40. Gotto A Circulation 2001 103, 2213-2218.41. Assmann G. Am J Cardiol 2001 87, 2B-

7B.42. Mikhailidis DP, et al. Curr Med Res Opin

2000 16, 139-146.43. de Lorgeril M, et al. Circulation 1999 99,

779-785. 44. Manttari M, et al. Eur Heart J 1987 8, I1-

I29.45. Steiner G. et al. Diabetologia 1996 39,

1655-1661.46. Rubins HB, et al. N Engl J Med 1999

341, 410-418.47. Sakai T, et al. Arteriosclerosis, Thrombo-

sis, and Vascular Biology 2001 21, 1783-1789.

48. Cheung M, et al. Arteriosclerosis, Throm-bosis, and Vascular Biology 2001 21,1320-1326.

49. Sacks FM, et al. Am J Cardiol 1991 68,1436-1446.

50. Shepherd J, et al. N Engl J Med 1995333, 1301-1307.

51. Lancet, 1995 345, 1274-1275.52. Bruschke J, et al. Circulation 1995 91,

2528-2540. 53. Herd JA, et al. Am J Cardiol 1994 73,

42D-49D.54. N Engl J Med 1998 339, 1349-1357.55. Schwartz GG, et al. JAMA 2001 285,

1711-1718.56. Shepherd J, et al. Lancet 2002 360,

1623-1630.57. Colhoun HM, et al. Diabet Med 2002 19,

201-211.58. Sever PS, et al. Lancet 2003 61, 1149-

1158.59. McKenney JM, et al. Curr Med Res Opin

2003 19, 689-698.


∂›‰Ú·ÛË ÙË˜ ıÂÚ·Â›·˜ ÌÂ ÛÙ·Ù›ÓÂ˜

ÛÙËÓ ÔÌÔÈÔÛÙ·Û›· ÙÔ˘ Ô˘ÚÈÎÔ‡ ÔÍ¤Ô˜

ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ÚˆÙÔ·ı‹ ˘ÂÚÏÈÈ‰·ÈÌ›·

Milionis H, Kakafika A, Tsouli S, Athyros V, Seferiadis K, Elisaf M.

Am Heart J 2004; 148: 635-640

ªÂÏ¤ÙÂ˜ ¤‰ÂÈÍ·Ó fiÙÈ Ù· ·˘ÍËÌ¤Ó·Â›Â‰· ÙË˜ Ô˘ÚÈÎÔ‡ ÔÍ¤Ô˜ ·Ô-ÙÂÏÔ‡Ó ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÁÈ·ÙËÓ ÂÌÊ¿ÓÈÛË Î·Ú‰È·ÁÁÂÈ·Î‹˜ Ófi-ÛÔ˘. øÛÙfiÛÔ, ÔÈ ·ıÔÊ˘ÛÈÔÏÔÁÈ-ÎÔ› ÌË¯·ÓÈÛÌÔ› Ô˘ ‰È¤Ô˘Ó ÙËÛ˘Û¯¤ÙÈÛË ÙÔ˘ Ô˘ÚÈÎÔ‡ ÔÍ¤Ô˜ ÌÂÙË ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ ‰ÂÓ ¤¯Ô˘ÓÏ‹Úˆ˜ ‰ÈÂ˘ÎÚÈÓÈÛıÂ›. À¿Ú¯Ô˘ÓÂÓ‰Â›ÍÂÈ˜ fiÙÈ Ë ¯ÔÚ‹ÁËÛË ˘ÔÏÈÈ-‰·ÈÌÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, Î·È È‰È·›ÙÂ-Ú· ÙË˜ Ê·ÈÓÔÊÈÌÚ¿ÙË˜, ÌÂÈÒÓÂÈÙ· Â›Â‰· Ô˘ÚÈÎÔ‡ ÔÍ¤Ô˜. ∞ÓÙ›-ıÂÙ·, Ô ·ÚÈıÌfi˜ ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓÛ¯ÂÙÈÎ¿ ÌÂ ÙËÓ Â›‰Ú·ÛË ÙˆÓ ÛÙ·-ÙÈÓÒÓ ÛÙ· Â›Â‰· ÙÔ˘ Ô˘ÚÈÎÔ‡ÔÍ¤Ô˜ Â›Ó·È ÂÚÈÔÚÈÛÌ¤ÓÔ˜.

™ÎÔfi˜ ÙË˜ ÌÂÏ¤ÙË˜: ∏ ÂÎÙ›ÌËÛË ÙË˜ Â›‰Ú·ÛË˜

ÌÈ·˜ Ê˘ÛÈÎ‹˜ ÛÙ·Ù›ÓË˜ (ÛÈÌ‚·ÛÙ·-Ù›ÓË˜) Î·È ÌÈ·˜ Û˘ÓıÂÙÈÎ‹˜ ÛÙ·Ù›-ÓË˜ (·ÙÔÚ‚·ÛÙ·Ù›ÓË˜) ÛÙ· Â›Â-‰· Ô˘ÚÈÎÔ‡ ÔÍ¤Ô˜ ÙÔ˘ ÔÚÔ‡ ÛÂ·ÛıÂÓÂ›˜ ÌÂ ÚˆÙÔ·ı‹ ˘ÂÚ¯Ô-ÏËÛÙÂÚÔÏ·ÈÌ›·.

™¯Â‰È·ÛÌfi˜ ÙË˜ ÌÂÏ¤ÙË˜: ªÂ-ÏÂÙ‹ıËÎ·Ó 180 ·ÛıÂÓÂ›˜ ÌÂ Úˆ-ÙÔ·ı‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·, ÔÈÔÔ›ÔÈ Ù˘¯·ÈÔÔÈ‹ıËÎ·Ó Ó· ¿-ÚÔ˘Ó ·ÁˆÁ‹ Â›ÙÂ ÌÂ ·ÙÔÚ‚·ÛÙ·Ù›-ÓË 40 mg ËÌÂÚËÛ›ˆ˜ (52 ¿Ó‰ÚÂ˜Î·È 38 Á˘Ó·›ÎÂ˜, ËÏÈÎ›·˜ 58,0±8,7ÂÙÒÓ, BMI 27,7±4,0 kg/m2) Â›ÙÂÌÂ ÛÈÌ‚·ÛÙ·Ù›ÓË 40 mg ËÌÂÚË-

Û›ˆ˜ (54 ¿Ó‰ÚÂ˜ Î·È 36 Á˘Ó·›ÎÂ˜,ËÏÈÎ›·˜ 58,6±9. ÂÙÒÓ, BMI 27,3±4,4 kg/m2). ™Â fiÏ· Ù· ¿ÙÔÌ· ÙË˜ÌÂÏ¤ÙË˜ ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó ÔÈ ÏÈÈ-‰·ÈÌÈÎ¤˜ Î·È ÔÈ ÌÂÙ·‚ÔÏÈÎ¤˜ ·Ú¿-ÌÂÙÚÔÈ ÙÔ˘ ÔÚÔ‡ ÚÈÓ, 6 Î·È 12Â‚‰ÔÌ¿‰Â˜ ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ıÂ-Ú·Â›·˜ ÌÂ ÛÙ·Ù›ÓË. ∂ÈÚfiÛıÂ-Ù·, ÛÂ ‰Â›ÁÌ· Ô‡ÚˆÓ ÚÔÛ‰ÈÔÚ›-ÛÙËÎ·Ó ÔÈ ÎÏ·ÛÌ·ÙÈÎ¤˜ ·ÂÎÎÚ›-ÛÂÈ˜ ÙÔ˘ Ó·ÙÚ›Ô˘ Î·È ÙÔ˘ Ô˘ÚÈÎÔ‡ÔÍ¤Ô˜.

∞ÔÙÂÏ¤ÛÌ·Ù·: ∆· Â›Â‰· ÙÔ˘ Ô˘ÚÈÎÔ‡ ÔÍ¤Ô˜

Û˘Û¯ÂÙ›˙ÔÓÙ·Ó ıÂÙÈÎ¿ ÌÂ ÙÔ ‰Â›-ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜, ÌÂ Ù· Â›Â-

A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·13


14

‰· ÙË˜ ÈÓÛÔ˘Ï›ÓË˜, ÙË˜ ÎÚÂ·ÙÈÓ›-ÓË˜ Î·È ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ, Î·È·ÚÓËÙÈÎ¿ ÌÂ ÙÈ˜ Û˘ÁÎÂÓÙÚÒÛÂÈ˜ÙË˜ HDL ¯ÔÏËÛÙÂÚfiÏË˜ Î·È ÙÈ˜ ÙÈ-Ì¤˜ ÙË˜ ÎÏ·ÛÌ·ÙÈÎ‹˜ ·¤ÎÎÚÈÛË˜ÙÔ˘ Ô˘ÚÈÎÔ‡ ÔÍ¤Ô˜ (FEUA). ∏ ¯Ô-Ú‹ÁËÛË Â›ÙÂ ·ÙÔÚ‚·ÛÙ·Ù›ÓË˜ Â›ÙÂÛÈÌ‚·ÛÙ·Ù›ÓË˜ ‚ÂÏÙ›ˆÛÂ ÛËÌ·ÓÙÈ-Î¿ ÙÈ˜ ÙÈÌ¤˜ ÙˆÓ ÏÈÈ‰›ˆÓ ÙÔ˘ÔÚÔ‡ (™¯‹Ì· 1) Î·È ÚÔÎ¿ÏÂÛÂÛËÌ·ÓÙÈÎ‹ ÌÂ›ˆÛË ÙˆÓ ÙÈÌÒÓ ÙÔ˘ÈÓˆ‰ÔÁfiÓÔ˘ Î·È ÙË˜ C-·ÓÙÈ‰ÚÒ-Û·˜ ÚˆÙÂ˝ÓË˜ (™¯‹Ì· 2). ∂›Ó·ÈÈ‰È·›ÙÂÚ· ÂÓ‰È·Ê¤ÚÔÓ ÙÔ Â‡ÚËÌ·fiÙÈ ÌfiÓÔ Ë ·ÙÔÚ‚·ÛÙ·Ù›ÓË ÌÂ›ˆÛÂÛËÌ·ÓÙÈÎ¿ Ù· Â›Â‰· ÙÔ˘ Ô˘ÚÈ-ÎÔ‡ ÔÍ¤Ô˜ ÙÔ˘ (·fi 5,6±1,7 ÛÂ4,9±1,5 mg/dl, p<0,0001) Î·È ·‡-ÍËÛÂ ÛËÌ·ÓÙÈÎ¿ ÙÈ˜ ÎÏ·ÛÌ·ÙÈÎ¤˜·ÂÎÎÚ›ÛÂÈ˜ ÙÔ˘ Ó·ÙÚ›Ô˘ (·fi1,0±0,6 ÛÂ 1.4±0,7, p<0,01) Î·ÈÙÔ˘ Ô˘ÚÈÎÔ‡ (·fi 10,4±7,9 ÛÂ12,0±7,4, p<0,01) (™¯‹Ì· 3).

™Â ÔÏ˘·Ú·ÁÔÓÙÈÎ‹ ·Ó¿Ï˘ÛËÏÔÁÈÛÙÈÎ‹˜ ·ÏÈÓ‰ÚfiÌËÛË˜ (multi-variate logistic regression analy-sis), ÂÍÂÙ¿ÛıËÎ·Ó ÔÈ ÌÂÙ·‚ÏËÙ¤˜Ô˘ ‰˘ÓËÙÈÎ¿ ÌÔÚÔ‡Ó Ó· ÚÔÎ·-Ï¤ÛÔ˘Ó ÌÂ›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙÔ˘Ô˘ÚÈÎÔ‡ ÔÍ¤Ô˜ ÙË˜ Ù¿ÍÂˆ˜ ÙˆÓ0,2 mg/dl ‹ ÂÚÈÛÛfiÙÂÚÔ. √È ÌÂ-Ù·‚ÏËÙ¤˜ Ô˘ Û˘ÌÂÚÈÂÏ‹ÊıËÛ·ÓÛÙÔ ÛÙ·ÙÈÛÙÈÎfi ÌÔÓÙ¤ÏÔ ‹Ù·Ó ËËÏÈÎ›·, ÙÔ Ê‡ÏÔ, Ô ‰Â›ÎÙË˜ Ì¿˙·˜ÛÒÌ·ÙÔ˜, Ë ·ÚÔ˘Û›· ˘¤ÚÙ·-ÛË˜, Ù· ·Ú¯ÈÎ¿ Â›Â‰· ÙÔ˘ Ô˘ÚÈ-ÎÔ‡ ÔÍ¤Ô˜, Î·ıÒ˜ Î·È ÔÈ ÌÂÙ·‚Ô-Ï¤˜ ÙË˜ ÎÚÂ·ÙÈÓ›ÓË˜ ÙË˜ ÁÏ˘Îfi-˙Ë˜, ÙË˜ ÈÓÛÔ˘Ï›ÓË˜ Î·È ÙˆÓ ÏÈÈ-‰·ÈÌÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ ÌÂÙ¿ ÙË ıÂ-Ú·Â›· ÌÂ ·ÙÔÚ‚·ÛÙ·Ù›ÓË. ∆· ·Ú-¯ÈÎ¿ Â›Â‰· ÙÔ˘ Ô˘ÚÈÎÔ‡ ÔÍ¤Ô˜ÙÔ˘ ÔÚÔ‡ ‹Ù·Ó Ë ÌÔÓ·‰ÈÎ‹ ·ÓÂ-Í¿ÚÙËÙË ·Ú¿ÌÂÙÚÔ˜ Ô˘ Û˘Û¯Â-Ù›˙ÔÓÙ·Ó ÌÂ ÙËÓ ˘ÔÔ˘ÚÈ¯·ÈÌÈÎ‹‰Ú¿ÛË ÙË˜ ·ÙÔÚ‚·ÛÙ·Ù›ÓË˜ (oddsratio, OR = 1,65, 95% CI = 1,14-2,40, p=0,008).

™˘Ì¤Ú·ÛÌ·: ∏ ¯ÔÚ‹ÁËÛË ·ÙÔÚ‚·ÛÙ·Ù›ÓË˜

(Î·È fi¯È ÛÈÌ‚·ÛÙ·Ù›ÓË˜) ÛÂ ˘„ËÏ‹‰fiÛË ÚÔÎ·ÏÂ› ÛËÌ·ÓÙÈÎ‹ ÌÂ›ˆÛËÙˆÓ ÂÈ¤‰ˆÓ ÙÔ˘ Ô˘ÚÈÎÔ‡ ÔÍ¤Ô˜ÙÔ˘ ÔÚÔ‡ ·˘Í¿ÓÔÓÙ·˜ ÙËÓ ·¤Î-ÎÚÈÛ‹ ÙÔ˘. ∞˘Ù‹ Ë È‰ÈfiÙËÙ· ÙË˜·ÙÔÚ‚·ÛÙ·Ù›ÓË˜ Â›Ó·È È‰È·›ÙÂÚ·ÛËÌ·ÓÙÈÎ‹ ÛÙËÓ ÂÈÏÔÁ‹ ÙË˜ ˘Ô-ÏÈÈ‰·ÈÌÈÎ‹˜ ·ÁˆÁ‹˜ ÁÈ· ÙË ıÂÚ·-Â›· ˘ÂÚÏÈÈ‰·ÈÌÈÎÒÓ ·ÛıÂÓÒÓÌÂ ·˘ÍËÌ¤Ó· Â›Â‰· Ô˘ÚÈÎÔ‡ÔÍ¤Ô˜.

∞ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ·ÙÔÚ‚·ÛÙ·Ù›ÓË˜ Î·È ÙË˜ ÛÈÌ‚·ÛÙ·Ù›ÓË˜ ÛÙ· Â›Â‰·ÙÔ˘ ÈÓˆ‰ÔÁfiÓÔ˘ Î·È ÙË˜ C-·ÓÙÈ‰ÚÒÛ·˜ ÚˆÙÂ˚ÓË˜ ·ÛıÂÓÒÓ ÌÂ

ÚˆÙÔ·ı‹ ˘ÂÚÏÈÈ‰·ÈÌ›·

∞ÙÔÚ‚·ÛÙ·Ù›ÓË ™ÈÌ‚·ÛÙ·Ù›ÓË40 mg/ËÌÂÚ. 40 mg/ËÌÂÚ.

¶ÚÈÓ ÙËÓ ·ÁˆÁ‹6 Â‚‰ÔÌ¿‰Â˜12 Â‚‰ÔÌ¿‰Â˜

∞ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ·ÙÔÚ‚·ÛÙ·Ù›ÓË˜ Î·È ÙË˜ ÛÈÌ‚·ÛÙ·Ù›ÓË˜ ÛÙ· Â›Â‰· ÙÔ˘ Ô˘ÚÈÎÔ‡ ÔÍ¤Ô˜ ÛÙÔÓ ÔÚfi (SUA)

Î·È ÛÙËÓ ·¤ÎÎÚÈÛ‹ ÙÔ˘ ÛÙ· Ô‡Ú· (FEUA)



∞ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ·ÙÔÚ‚·ÛÙ·Ù›ÓË˜ Î·È ÙË˜ ÛÈÌ‚·ÛÙ·Ù›ÓË˜ ÛÙÈ˜ ÏÈÈ‰·ÈÌÈÎ¤˜ ·Ú·Ì¤ÙÚÔ˘˜ ·ÛıÂÓÒÓ ÌÂ ÚˆÙÔ·ı‹ ˘ÂÚÏÈÈ‰·ÈÌ›·



A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·14

ªÂÙ·Í‡ ÙˆÓ Ì¤ÙÚˆÓ Ô˘ Û˘-ÓÈÛÙÔ‡Ó ÔÈ Û‡Á¯ÚÔÓÂ˜ Ô‰Ë-Á›Â˜ ÁÈ· ÙËÓ ÚfiÏË„Ë ÙˆÓ

Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ 1,2 Ë˘ÁÈÂÈÓÔ‰È·ÈÙËÙÈÎ‹ ·ÁˆÁ‹ ·ÔÙÂÏÂ›ÙÔ ıÂÌ¤ÏÈÔ Ï›ıÔ. ∏ ·ÁˆÁ‹ ·˘Ù‹ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ Î·Ù¿ÏÏËÏË ‰›·È-Ù·, ÙË ÛˆÌ·ÙÈÎ‹ ¿ÛÎËÛË, ÙËÓ ·Ò-ÏÂÈ· ‚¿ÚÔ˘˜ ·fi Ù· ˘¤Ú‚·Ú·¿ÙÔÌ· Î·È ÙË ‰È·ÎÔ‹ ÙÔ˘ Î·Ó›-ÛÌ·ÙÔ˜.

∏ ÛËÌ·Û›· ÙË˜ ‰›·ÈÙ·˜ ÁÈ· ÙËÓ˘ÁÂ›· ÙÔ˘ ·ÓıÚÒÔ˘ ÁÂÓÈÎ¿ ‹Ù·ÓÁÓˆÛÙ‹ ·fi ÙËÓ ·Ú¯·ÈfiÙËÙ·, ËÛ¯¤ÛË fiÌˆ˜ ÙË˜ ‰È·ÙÚÔÊ‹˜ ÌÂ Ù·Â›Â‰· ÙˆÓ ÏÈÈ‰›ˆÓ ÙÔ˘ ·›Ì·ÙÔ˜,ÙËÓ ·ÚÙËÚÈ·Î‹ ˘¤ÚÙ·ÛË Î·È Ù·Î·Ú‰È·ÁÁÂÈ·Î¿ ÓÔÛ‹Ì·Ù· ¤ÁÈÓÂÎ·Ù·ÓÔËÙ‹ ÙÈ˜ ÙÂÏÂ˘Ù·›Â˜ ‰ÂÎ·Â-Ù›Â˜, ÌÂÙ¿ ·fi ÔÏÏ¤˜ ÂÈ‰ËÌÈÔÏÔ-ÁÈÎ¤˜, ÂÈÚ·Ì·ÙÈÎ¤˜ Î·È ÎÏÈÓÈÎ¤˜ÌÂÏ¤ÙÂ˜. ∏ ÌÂÏ¤ÙË ÙˆÓ 7 ¯ˆÚÒÓ¤‰ÂÈÍÂ fiÙÈ Ô ÂÈÔÏ·ÛÌfi˜ Î·È ËıÓËÛÈÌfiÙËÙ· ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓÓÔÛËÌ¿ÙˆÓ ÛÂ Î¿ıÂ ÏËı˘ÛÌfi Â›-Ó·È ·Ó¿ÏÔÁ· ÙÔ˘ ‡„Ô˘˜ ÙË˜ ¯ÔÏË-ÛÙÂÚfiÏË˜ ÛÙÔ ·›Ì· Î·È fiÙÈ Û¯ÂÙ›-˙ÔÓÙ·È ÌÂ ÙÔ ÔÛÔÛÙfi ÙˆÓ ÎÔÚÂ-ÛÌ¤ÓˆÓ ÏÈ·ÚÒÓ ÔÍ¤ˆÓ ÙË˜ ÙÚÔ-Ê‹˜3. ∞ÚÎÂÙ¤˜ ÌÂÙ·-·Ó·Ï‡ÛÂÈ˜¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ÁÈ· Î¿ıÂ 1% ·‡ÍË-ÛË ÙÔ˘ ÔÛÔÛÙÔ‡ ÙˆÓ ıÂÚÌ›‰ˆÓÛÂ ÎÔÚÂÛÌ¤ÓÔ Ï›Ô˜ Ô‰ËÁÂ› ÛÂ ·‡-ÍËÛË ÙË˜ LDL-¯ÔÏËÛÙÂÚfiÏË˜ Î·Ù¿2%4. ÕÏÏÂ˜ ÌÂÏ¤ÙÂ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈfiÙÈ Ë ÌÂ›ˆÛË ÙË˜ Î·Ù·Ó¿ÏˆÛË˜ÎÔÚÂÛÌ¤ÓˆÓ ÏÈ·ÚÒÓ ÔÍ¤ˆÓ Î·Ù¿1% ÚÔÎ·ÏÂ› ÌÂ›ˆÛË ÙË˜ LDL Î·-Ù¿ 2%. ∞ÎfiÌË Î·È ÛÙ· ·È‰È¿ ËÌÂ›ˆÛË ÙˆÓ ÎÔÚÂÛÌ¤ÓˆÓ ÏÈ·ÚÒÓÔÍ¤ˆÓ ‰ÂÓ ¤¯ÂÈ ‰˘ÛÌÂÓ‹ Â›‰Ú·ÛËÛÙËÓ ·Ó¿Ù˘ÍË.

√È Û˘ÛÙ¿ÛÂÈ˜ ÙˆÓ ∂˘Úˆ·˚ÎÒÓÔ‰ËÁÈÒÓ ÁÈ· ÙË ‰›·ÈÙ· ÂÚÈÏËÙÈÎ¿Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1.

√È Û˘ÛÙ¿ÛÂÈ˜ ÙˆÓ ∞ÌÂÚÈÎ¿ÓÈ-ÎˆÓ Ô‰ËÁÈÒÓ (NCEP - ATP III) ÁÈ·ÙË ‰›·ÈÙ· ÂÚÈÏËÙÈÎ¿ Ê·›ÓÔÓÙ·ÈÛÙÔÓ ¶›Ó·Î· 2.

∏ ÛÔ˘‰·ÈfiÙÂÚË ËÁ‹ ÎÔÚÂ-ÛÌ¤ÓˆÓ ÏÈ·ÚÒÓ ÔÍ¤ˆÓ Â›Ó·È Ù·Á·Ï·ÎÙÔÎÔÌÈÎ¿ ÚÔ˚fiÓÙ· (Ï‹ÚÂ˜Á¿Ï·, Ù˘Ú› ‚Ô‡Ù˘ÚÔ, ÎÚ¤Ì· Á¿Ï·-ÎÙÔ˜ Î·È ·Ú·ÛÎÂ˘¿ÛÌ·Ù· ÎÚ¤-Ì·˜ Á¿Ï·ÎÙÔ˜ fiˆ˜ ·ÁˆÙ¿, ÁÏ˘-

Î¿ Î.Ï), ÙÔ ÎÚ¤·˜ Î·È ·Ú¿ÁˆÁ·ÙÔ˘ (ÏÔ˘Î¿ÓÈÎ·, ÎÈÌ¿˜ Î.Ï) Î·ÈÔÚÈÛÌ¤Ó· ÙÚÔÈÎ¿ ¤Ï·È·, fiˆ˜ ÙÔÊÔÈÓÈÎ¤Ï·ÈÔ. ∆Ô Â˘ÓÔ˚Îfi ·ÔÙ¤ÏÂ-ÛÌ· ÙË˜ ÌÂÈˆÌ¤ÓË˜ ÚfiÛÏË„Ë˜ÎÔÚÂÛÌ¤ÓˆÓ ÏÈ·ÚÒÓ ÔÍ¤ˆÓ ÌÔ-ÚÂ› Ó· ÂÓÈÛ¯˘ıÂ› fiÙ·Ó Û˘ÓÔ‰Â‡ÂÙ·È·fi ÌÂ›ˆÛË ÙÔ˘ ÛˆÌ·ÙÈÎÔ‡ ‚¿-ÚÔ˘˜ ÛÙ· ˘¤Ú‚·Ú· ¿ÙÔÌ·. ¶Ú¿Á-Ì·ÙÈ ÌÂ›ˆÛË ÙÔ˘ ‚¿ÚÔ˘˜ ÛÒÌ·-ÙÔ˜, ·ÎfiÌË Î·È Ï›Á· ÎÈÏ¿, ÚÔÎ·ÏÂ›ÌÂ›ˆÛË ÙË˜ LDL ·ÓÂÍ¿ÚÙËÙ· ·fiÙËÓ Û‡ÛÙ·ÛË ÙË˜ ÙÚÔÊ‹˜. ∞ÓfiÌˆ˜ Ë ÙÚÔÊ‹ Â›Ó·È ¯·ÌËÏ‹ ÛÂ ÏÈ-·Ú¿ ÔÍ¤· Ë ÌÂ›ˆÛË Â›Ó·È ÌÂÁ·Ï‡-ÙÂÚË Î·È ‰È·ÚÎ¤ÛÙÂÚË. ∆· trans-ÏÈ-·Ú¿ ÔÍ¤· Â›Ó·È ·ÎfiÚÂÛÙ· ÏÈ·Ú¿ÔÍ¤· ÌÂ ‰ÈÏÔ‡˜ ‰ÂÛÌÔ‡˜ trans-ÌÔÚÊ‹˜. µÚ›ÛÎÔÓÙ·È ÛÙÈ˜ Ê˘ÛÈÎ¤˜ÙÚÔÊ¤˜ (ÎÚ¤·˜, Á·Ï·ÎÙÔÎÔÌÈÎ¿),Î˘Ú›ˆ˜ fiÌˆ˜ ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È Î·-Ù¿ ÙË ‚ÈÔÌË¯·ÓÈÎ‹ ÂÂÍÂÚÁ·Û›·

ÙˆÓ ÙÚÔÊ›ÌˆÓ, fiˆ˜ Ë ˘‰ÚÔÁfiÓˆ-ÛË ÔÏ˘·ÎfiÚÂÛÙˆÓ Ê˘ÙÈÎÒÓ ÂÏ·›-ˆÓ ÌÂ ÛÎÔfi Ó· ÌÂÙ·‚ÏËıÔ‡Ó ÛÂÛÙÂÚÂ¿ Î·È Ó· ˘ÔÎ·Ù·ÛÙ‹ÛÔ˘ÓÙÔ ‚Ô‡Ù˘ÚÔ. ÃÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛÂÛ¿ÏÙÛÂ˜, ÌÈÛÎfiÙ· Î·È ÛÂ ÙËÁ·ÓÈ-ÛÌ¤ÓÂ˜ ÙÚÔÊ¤˜. Œ¯ÂÈ ‰È·ÈÛÙˆıÂ›fiÙÈ ·˘Ù¿ Ù· ÏÈ·Ú¿ ÔÍ¤· ·˘Í¿ÓÔ˘ÓÙËÓ LDL-¯ÔÏËÛÙÂÚfiÏË fiÛÔ Î·È Ù·ÎÔÚÂÛÌ¤Ó· Î·È ÌÂÈÒÓÔ˘Ó ÙËÓ HDL-¯ÔÏËÛÙÂÚfiÏË. √È ÛÎÏËÚ¤˜ Ì·ÚÁ·-Ú›ÓÂ˜ Î·È ÙÚÔÊ¤˜ ·Ú·ÛÎÂ˘·ÛÌ¤-ÓÂ˜ (ÙËÁ·ÓÈÛÌ¤ÓÂ˜ ‹ „ËÌ¤ÓÂ˜) ÌÂtrans-ÏÈ·Ú¿ ÔÍ¤· Ú¤ÂÈ Ó· ·Ô-ÊÂ‡ÁÔÓÙ·È, ÂÎÙfi˜ Â¿Ó ÛÙË Û˘ÛÎÂ˘-·Û›· ÙÔ˘˜ ·Ó·Ê¤ÚÔ˘Ó fiÙÈ Â›Ó·ÈÂÏÂ‡ıÂÚÂ˜ ·fi Ù¤ÙÔÈ· ÏÈ·Ú¿ÔÍ¤·.

∏ ¯ÔÏËÛÙÂÚfiÏË ÙË˜ ÙÚÔÊ‹˜ÚÔÎ·ÏÂ› ÛËÌ·ÓÙÈÎ‹ ˘ÂÚ¯ÔÏË-ÛÙÂÚÔÏ·ÈÌ›· ÛÂ ÂÈÚ·Ì·Ùfi˙ˆ·.™ÙÔÓ ¿ÓıÚˆÔ Â›ÛË˜ ·˘Í¿ÓÂÈ ÙË

™Y°XPONE™ O¢H°IE™

15

™‡Á¯ÚÔÓÂ˜ ˘ÁÈÂÈÔÓÔ‰È·ÈÙËÙÈÎ¤˜ Ô‰ËÁ›Â˜ ÁÈ· ÙËÓ

ÚfiÏË„Ë ÙË˜ Î·Ú‰È·ÁÁÂÈ·Î‹˜ ÓfiÛÔ˘

∏Ï›·˜ ÃÂÈÌÒÓ·˜, ∫·Ú‰ÈÔÏfiÁÔ˜ , ÀÔÙ¤Ú·Ú¯Ô˜ Â.·.

·. πÛ¯˘Ú¤˜ ÂÓ‰Â›ÍÂÈ˜ Î·È ÌÂÁ¿ÏÔ fiÊÂÏÔ˜ ÁÈ· ÙËÓ ‰ËÌfiÛÈ· ˘ÁÂ›·.1. ∫ÔÚÂÛÌ¤Ó· Î·È trans ÏÈ·Ú¿ ÔÍ¤·

ñ ∫¿Ùˆ ÙˆÓ 10% ÙˆÓ ıÂÚÌ›‰ˆÓ ÛÂ ÎÔÚÂÛÌ¤ÓÔ Ï›Ô˜ñ ∫¿Ùˆ ÙÔ˘ 2% ÙˆÓ ıÂÚÌ›‰ˆÓ ÛÂ trans ÏÈ·Ú¿ ÔÍ¤·

2. ºÚÔ‡Ù· Î·È Ï·¯·ÓÈÎ¿ñ ¶¿Óˆ ·fi 400 gr/ËÌÂÚËÛ›ˆ˜

3. ∞Ï¿ÙÈñ §ÈÁfiÙÂÚÔ ·fi 6 gr/ËÌÂÚËÛ›ˆ˜

4. ¶·¯˘Û·ÚÎ›· Î·È ˘ÂÚ‚¿ÏÏÔÓ ÛˆÌ·ÙÈÎfi ‚¿ÚÔ˜ñ ¢ª™ < 25 kg/m2

ñ ∂º¢ ¿Óˆ ·fi 1,75*

‚. ∂Ó‰Â›ÍÂÈ˜ Ì¤ÙÚÈÂ˜ Î·È Ì¤ÙÚÈÔ fiÊÂÏÔ˜ ÁÈ· ÙË ‰ËÌfiÛÈ· ˘ÁÂ›·5. √ÏÈÎfi Ï›Ô˜

ñ ∫¿Ùˆ ÙˆÓ 30% ÙˆÓ ÚÔÛÏ·Ì‚·ÓÔÌ¤ÓˆÓ ıÂÚÌ›‰ˆÓ6. ¶ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ ÔÍ¤·

ñ ˆ-6 ÔÏ˘·ÎfiÚÂÛÙ·: 4-8% ÙˆÓ ıÂÚÌ›‰ˆÓñ ˆ-3 ÔÏ˘·ÎfiÚÂÛÙ·: 2 gr/ËÌÂÚ. ÏÈÓÔÏÂÓÈÎfi Î·È 200 mg/ËÌÂÚ.

ˆ-3 ÏÈ·ÚÒÓ ÔÍ¤ˆÓ ÔÏ‡ Ì·ÎÚ¿˜ ·Ï‡ÛÔ˘.

Á. ∞ÛıÂÓÂ›˜ ÂÓ‰Â›ÍÂÈ˜ Î·È ÌÈÎÚfi fiÊÂÏÔ˜ ÁÈ· ÙËÓ ‰ËÌfiÛÈ· ˘ÁÂ›· 7. º˘ÙÈÎ¤˜ ›ÓÂ˜ ¿Óˆ ·fi 25 gr/ËÌÂÚ Î·È ¿Óˆ ·fi 55% ÙˆÓ ıÂÚ-

Ì›‰ˆÓ Û‡ÌÏÔÎÔÈ ˘‰·Ù¿ÓıÚ·ÎÂ˜8. º˘ÏÏÈÎfi ÔÍ‡ ÌÂ ÙÈ˜ ÙÚÔÊ¤˜ ¿Óˆ ·fi 400 Ìg/ËÌÂÚ.9. ™·Î¯·ÚÒ‰ÂÈ˜ ÙÚÔÊ¤˜ Ù¤ÛÛÂÚÈ˜ ‹ ÏÈÁfiÙÂÚÂ˜ 2 ÊÔÚ¤˜ ÙËÓ ËÌ¤Ú·

* ∂º¢ §fiÁÔ˜ ÙÔ˘ ÔÛÔ‡ ÙˆÓ ÚÔÛÏ·Ì‚·ÓÔÌ¤ÓˆÓ ıÂÚÌ›‰ˆÓ ÚÔ˜ ÙÔ ‚·ÛÈÎfi ÌÂ-Ù·‚ÔÏÈÛÌfi ÙÔ˘ ·ÙfiÌÔ˘. 1,75 ∂º¢ Â›Ó·È ÈÛÔ‰‡Ó·ÌÔ ÌÂ 60 ÏÂÙ¿ ÙËÓ ËÌ¤Ú· Ì¤-ÙÚÈ·˜ ¿ÛÎËÛË˜ ‹ 30 ÏÂÙ¿ ¤ÓÙÔÓË˜ ¿ÛÎËÛË˜.

¶›Ó·Î·˜ 1. ™‡ÛÙ·ÛË ÙË˜ ‰›·ÈÙ·˜ ÛÂ ÏËı˘ÛÌÈ·Îfi Â›Â‰Ô.

A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·15

¯ÔÏËÛÙÂÚfiÏË ÙÔ˘ ·›Ì·ÙÔ˜, fi¯ÈfiÌˆ˜ ÛÂ ÌÂÁ¿ÏÔ ‚·ıÌfi. √ ‚·ı-Ìfi˜ ÙË˜ ·‡ÍËÛË˜ ÔÈÎ›ÏÂÈ ·fi¿ÙÔÌÔ ÛÂ ¿ÙÔÌÔ, Î·Ù¿ Ì¤ÛÔ fiÚÔfiÌˆ˜ ·Ó¤Ú¯ÂÙ·È ÛÂ 10 mg % ·Ó¿100 mg ‰È·ÈÙËÙÈÎ‹˜ ¯ÔÏËÛÙÂÚfiÏË˜·Ó¿ 1000 ıÂÚÌ›‰Â˜ ÙÚÔÊ‹˜. ÃÔÏË-ÛÙÂÚfiÏË ÂÚÈ¤¯ÂÈ Ô ÎÚfiÎÔ˜ ÙÔ˘·˘ÁÔ‡, Ù· ÏÈ·Ú¿ ÎÚ¤·Ù·, Ù· ÌË·Ô‚Ô˘Ù˘ÚˆÌ¤Ó· Á·Ï·ÎÙÔÎÔÌÈÎ¿,Ù· Ô˘ÏÂÚÈÎ¿ Î·È Ù· ÔÛÙÚ·ÎÔÂÈ‰‹ı·Ï·ÛÛÈÓ¿. ∏ ËÌÂÚ‹ÛÈ· ÚfiÛÏË-„Ë ¯ÔÏËÛÙÂÚfiÏË˜ Ú¤ÂÈ Ó· Â›Ó·ÈÎ¿Ùˆ ·fi Ù· 200-300 mg, Ú¿ÁÌ·Ô˘ ÛËÌ·›ÓÂÈ fiÙÈ ‰ÂÓ Ú¤ÂÈ Ó· Î·-Ù·Ó·ÏÒÓÔÓÙ·È ¿Óˆ ·fi ‰‡Ô ÎÚfi-ÎÔÈ ·˘ÁÔ‡ ÙËÓ Â‚‰ÔÌ¿‰·.

∆· ÌÔÓÔ·ÎfiÚÂÛÙ· ÏÈ·Ú¿ ÔÍ¤·,Î˘ÚÈfiÙÂÚÔ˜ ÂÎÚfiÛˆÔ˜ ÙˆÓ ÔÔ›-ˆÓ Â›Ó·È ÙÔ ÔÏÂ˚Îfi ÔÍ‡ Ô˘ ··-ÓÙ¿Ù·È ÛÙË cis ÌÔÚÊ‹, ÌÂÈÒÓÔ˘ÓÙËÓ LDL-¯ÔÏËÛÙÂÚfiÏË ¯ˆÚ›˜ Ó·ÌÂÈÒÓÔ˘Ó ÙËÓ HDL-¯ÔÏËÛÙÂÚfiÏËÎ·È ¯ˆÚ›˜ Ó· ·˘Í¿ÓÔ˘Ó Ù· ÙÚÈÁÏ˘-ÎÂÚ›‰È·. ™˘ÓÈÛÙ¿Ù·È Ó· Î·Ù·Ó·ÏÒ-ÓÔÓÙ·È Ì¤¯ÚÈ ÙÔ 20% ÙˆÓ Û˘ÓÔÏÈ-ÎÒÓ ıÂÚÌ›‰ˆÓ. ∫‡ÚÈ· ËÁ‹ ÙÔ˘ÔÏÂ˚ÎÔ‡ ÔÍ¤Ô˜ Â›Ó·È ÙÔ ÂÏ·ÈfiÏ·‰Ô,ÙÔ ÔÔ›Ô ÂÚÈ¤¯ÂÈ Â›ÛË˜ ·ÓÙÈÔÍÂÈ-‰ˆÙÈÎ¤˜ Ô˘Û›Â˜ Î·È ‚ÈÙ·Ì›ÓÂ˜ Î·È¤ÙÛÈ ¤¯ÂÈ ÌÂÁ·Ï‡ÙÂÚË Â˘ÂÚÁÂÙÈÎ‹‰Ú¿ÛË. ÕÏÏÂ˜ ËÁ¤˜ ÌÔÓÔ·ÎfiÚÂ-ÛÙˆÓ ÏÈ·ÚÒÓ ÔÍ¤ˆÓ Â›Ó·È ÔÈ ÍËÚÔ›Î·ÚÔ› Î·È Ê˘ÙÈÎ¿ ¤Ï·È·.

∆· ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ÔÍ¤·, Î˘ÚÈfiÙÂÚÔ˜ ÂÎÚfiÛˆÔ˜ÙˆÓ ÔÔ›ˆÓ Â›Ó·È ÙÔ ˆ-6 ÏÈÓÔÏÂ˚ÎfiÔÍ‡, ÌÂÈÒÓÔ˘Ó ÙËÓ LDL-¯ÔÏËÛÙÂ-ÚfiÏË ·ÏÏ¿ ÌÔÚÔ‡Ó Ó· ÚÔÎ·Ï¤-ÛÔ˘Ó Î·È ÌÈÎÚ‹ ÌÂ›ˆÛË ÙË˜ HDL-

¯ÔÏËÛÙÂÚfiÏË˜ Î·È ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ-‰›ˆÓ. º·›ÓÂÙ·È fiÙÈ Ù· ÔÏ˘·ÎfiÚÂ-ÛÙ· ÏÈ·Ú¿ ÔÍ¤· Â›Ó·È Â˘·›ÛıËÙ·ÛÙËÓ ÔÍÂ›‰ˆÛË. ¶·ÚfiÏ· ·˘Ù¿¤¯Ô˘Ó Â˘Ú¤ˆ˜ ÌÂÏÂÙËıÂ› Î·È ¤¯ÂÈ‰È·ÈÛÙˆıÂ› fiÙÈ ÚÔÎ·ÏÔ‡Ó ÌÂ›ˆ-ÛË ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿-ÙˆÓ. ™˘ÓÈÛÙ¿Ù·È Ó· Î·Ù·Ó·ÏÒÓÔ-ÓÙ·È Ì¤¯ÚÈ ÙÔ 10% ÙˆÓ Û˘ÓÔÏÈÎÒÓËÌÂÚ‹ÛÈˆÓ ıÂÚÌ›‰ˆÓ.

∆· ˆ-3 ÏÈ·Ú¿ ÔÍ¤· Â›Ó·È Ô-Ï˘·ÎfiÚÂÛÙ· Î·È ÂÚÈ¤¯ÔÓÙ·È ÛÂÔÚÈÛÌ¤Ó· Ê˘ÙÈÎ¿ ¤Ï·È·, fiˆ˜ ÙÔÛÔÁ¤Ï·ÈÔ Î·È ÙÔ ÊÔ˘ÓÙÔ˘Î¤Ï·ÈÔ,ÛÙ· ÔÔ›· Î‡ÚÈÔ Û˘ÛÙ·ÙÈÎfi Â›Ó·ÈÙÔ ·-ÏÈÓÔÏÂ˚Îfi ÔÍ‡ Î·È ÛÙ· „¿ÚÈ·,ÛÙ· ÔÔ›· Î˘ÚÈ·Ú¯Ô‡Ó ÙÔ ÂÈÎÔÛÈ-ÂÓÙ·ÓÔ˚Îfi Î·È ÙÔ ‰ÔÎÔÛÔÂÍ·ÓÔ˚-Îfi ÔÍ‡. ∏ Ì¤ÙÚÈ· Î·Ù·Ó¿ÏˆÛË ˆ-3ÏÈ·ÚÒÓ ÔÍ¤ˆÓ ÌÂÈÒÓÂÈ ÙÔÓ Î›Ó‰˘-ÓÔ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓÌ¤Ûˆ Â˘ÓÔ˚Î‹˜ ÙÚÔÔÔ›ËÛË˜ ÙË˜ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ Î·ÈÙË˜ ÊÏÂÁÌÔÓÒ‰Ô˘˜ ·fiÎÚÈÛË˜5.ªÂÁ·Ï‡ÙÂÚË Î·Ù·Ó¿ÏˆÛË ÚÔÎ·-ÏÂ› ÌÂ›ˆÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ‰Â˘ÙÂÚÔÁÂÓÒ˜ ÏfiÁˆ ÌÂ›ˆÛË˜ ÙË˜·Ú·ÁˆÁ‹˜ VLDL. ™ÙËÓ LDL ÁÂÓÈ-Î¿ ‰ÂÓ ÂÈÊ¤ÚÔ˘Ó ÌÂÙ·‚ÔÏ‹ ·ÏÏ¿ÛÂ ÌÂÁ¿ÏÂ˜ ‰fiÛÂÈ˜ ÌÔÚÂ› Ó· ÙËÓ·˘Í‹ÛÔ˘Ó ÛÙ· ¿ÙÔÌ· ÌÂ ˘„ËÏ¿ÙÚÈÁÏ˘ÎÂÚ›‰È·.

∆Ô Û˘ÓÔÏÈÎfi Ï›Ô˜ ÙˆÓ ıÂÚÌ›-‰ˆÓ Ú¤ÂÈ Ó· ·ÔÙÂÏÂ› ÙÔ 25%-35% ÙˆÓ Û˘ÓÔÏÈÎÒÓ ËÌÂÚ‹ÛÈˆÓıÂÚÌ›‰ˆÓ. √È ·Ï·ÈfiÙÂÚÂ˜ Ô‰Ë-Á›Â˜ ÙÔ˘ ¡C∂ƒ (∞∆ƒ π Î·È ∞∆ƒ II)Û˘ÓÈÛÙÔ‡Û·Ó ÂÚÈÔÚÈÛÌfi ÙÔ˘ ÔÏÈ-ÎÔ‡ Ï›Ô˘˜ ÛÂ ÏÈÁfiÙÂÚÔ ·fi ÙÔ30% ÙˆÓ ËÌÂÚËÛ›ˆÓ ıÂÚÌ›‰ˆÓ,

‰È·ÈÛÙÒıËÎÂ fiÌˆ˜ fiÙÈ ·˘Ùfi ÌÔ-ÚÔ‡ÛÂ Ó· Â›¯Â ‰˘ÛÌÂÓÂ›˜ ÂÈ‰Ú¿-ÛÂÈ˜ ÛÂ ÂÚÈÙÒÛÂÈ˜ ÔÏ˘ÌÂÙ·‚Ô-ÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘, fiÔ˘ ¯ÔÚ‹ÁË-ÛË ˘‰·Ù·ÓıÚ¿ÎˆÓ ÛÂ ÔÛÔÛÙfi>60% ÚÔÎ·ÏÂ› ·‡ÍËÛË ÙˆÓ ÙÚÈ-ÁÏ˘ÎÂÚÈ‰›ˆÓ, ÌÂÙ·ÙÚÔ‹ ÙˆÓ LDLÛÂ ÌÈÎÚ¿ Î·È ˘ÎÓ¿ ÌfiÚÈ·, ÌÂ›ˆÛËÙË˜ ∏DL Î·È ·‡ÍËÛË ÙË˜ ·ÓÙÔ¯‹˜ÛÙËÓ ÈÓÛÔ˘Ï›ÓË. ¶·Ï·ÈfiÙÂÚÂ˜ ·fi-„ÂÈ˜ fiÙÈ ·‡ÍËÛË ÙÔ˘ ÔÛÔÛÙÔ‡ÙÔ˘ Ï›Ô˘˜ ÙË˜ ÙÚÔÊ‹˜ ÚÔÎ·ÏÂ›·¯˘Û·ÚÎ›· ‰ÂÓ ÂÈ‚Â‚·ÈÒıËÎ·Ó.∞ÓÙ›ıÂÙ· Î·Ù·Ó¿ÏˆÛË ˘‰·Ù·ÓıÚ¿-ÎˆÓ ÛÂ ÔÛÔÛÙfi >60% Ô‰ËÁÂ› ÛÂ·¯˘Û·ÚÎ›·.

√È ˘‰·Ù¿ÓıÚ·ÎÂ˜, fiÙ·Ó ·ÓÙÈÎ·-ıÈÛÙÔ‡Ó Ù· ÎÔÚÂÛÌ¤Ó· ÏÈ·Ú¿ÔÍ¤· ÙË˜ ÙÚÔÊ‹˜ ÚÔÎ·ÏÔ‡Ó ÙÒ-ÛË ÙË˜ LDL-¯ÔÏËÛÙÂÚfiÏË˜ fiÛËÚÔÎ·ÏÔ‡Ó Î·È Ù· ÌÔÓÔ·ÎfiÚÂÛÙ·ÏÈ·Ú¿ ÔÍ¤·. ŸÌˆ˜ ÚÔÎ·ÏÔ‡ÓÎ·È ÙÒÛË ÙË˜ ∏DL-¯ÔÏËÛÙÂÚfiÏË˜Î·È ¿ÓÔ‰Ô ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ.ŸÙ·Ó ‚¤‚·È· Î·Ù·Ó·ÏÒÓÔÓÙ·È Ì·˙›ÌÂ Ê˘ÙÈÎ¤˜ ›ÓÂ˜ Ë ÙÒÛË ÙË˜ ∏DLÎ·È Ë ·‡ÍËÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓÌÂÙÚÈ¿˙ÔÓÙ·È. À‰·Ù¿ÓıÚ·ÎÂ˜ Â›Ó·ÈÙ· ¿Ì˘Ï· Î·È Ù· Û¿Î¯·Ú· Î·È˘¿Ú¯Ô˘Ó ÛÂ ÔÏÏ¤˜ ÙÚÔÊ¤˜, Î˘-Ú›ˆ˜ Ê˘ÙÈÎ¤˜ fiˆ˜ Ù· ‰ËÌËÙÚÈ·-Î¿, Ù· fiÛÚÈ·, Ù· Ï·¯·ÓÈÎ¿, Ù· ÁÂ-ÒÌËÏ· Î.Ï. ∂Ó‰È·Ê¤ÚÔÓ ¤¯ÂÈ ÔÁÏ˘Î·ÈÌÈÎfi˜ ‰Â›ÎÙË˜ Î¿ıÂ ÙÚÔÊ‹˜,ÂÂÈ‰‹ ÚÔÛ‰ÈÔÚ›˙ÂÈ ÙËÓ ·‡ÍËÛËÙÔ˘ Û·Î¯¿ÚÔ˘ ·›Ì·ÙÔ˜ Ô˘ Ë ÙÚÔ-Ê‹ ÚÔÎ·ÏÂ›, fiÌˆ˜ Ô ˘ÔÏÔÁÈ-ÛÌfi˜ ÙÔ˘ Â›Ó·È ÔÏ‡ÏÔÎÔ˜ Î·È ‰‡-ÛÎÔÏ· ˘ÔÏÔÁ›˙ÂÙ·È ÛÙËÓ Î·ıËÌÂ-ÚÈÓ‹ Ú¿ÍË. √È Û‡ÌÏÔÎÔÈ ˘‰·Ù¿Ó-ıÚ·ÎÂ˜ ÌÂÁ¿ÏË˜ ·Ï‡ÛÔ˘ Ô˘ Â-ÚÈ¤¯ÔÓÙ·È ÛÙ· ‰ËÌËÙÚÈ·Î¿ ¤¯Ô˘ÓÌÈÎÚfi ÁÏ˘Î·ÈÌÈÎfi ‰Â›ÎÙË ÂÓÒ Ù·Û¿Î¯·Ú· Î·È ÔÈ ·Ù¿ÙÂ˜ ¤¯Ô˘Ó ÌÂ-Á·Ï‡ÙÂÚÔ. ∆Ô „ˆÌ›, ÏfiÁˆ ÙË˜ ˙‡-ÌˆÛË˜ Î·È ÙË˜ „‹ÛË˜, ·ÔÎÙ¿ ¯·-ÌËÏfi ÁÏ˘Î·ÈÌÈÎfi ‰Â›ÎÙË6. ∏ ËÌÂÚ‹-ÛÈ· ÚfiÛÏË„Ë ˘‰·Ù·ÓıÚ¿ÎˆÓÚ¤ÂÈ Ó· ÂÚÈÔÚ›˙ÂÙ·È ÛÂ ÔÛÔ-ÛÙfi Î¿Ùˆ ÙˆÓ 60% ÙˆÓ ıÂÚÌ›‰ˆÓÎ·È ÛÂ ¿ÙÔÌ· ÌÂ ˘„ËÏ¿ ÙÚÈÁÏ˘ÎÂÚ›-‰È· Î¿Ùˆ ÙˆÓ 50%.

∆· ÏÂ˘ÎÒÌ·Ù· ‰ÂÓ ¤¯Ô˘Ó Â›-‰Ú·ÛË ÛÙ· ÏÈ›‰È·. ∆· ˙ˆÈÎ‹˜ ÚÔ-¤ÏÂ˘ÛË˜ ÏÂ˘ÎÒÌ·Ù· Â›Ó·È ˘„ËÏfi-ÙÂÚË ıÂÚÌÈ‰ÈÎ‹ ·Í›· ÁÈ·Ù› ÂÚÈ¤-¯Ô˘Ó ·Ó·ÓÙÈÎ·Ù¿ÛÙ·Ù· ·ÌÈÓÔÍ¤·,ÂÚÈ¤¯ÔÓÙ·È fiÌˆ˜ ÛÂ ÙÚfiÊÈÌ· Ô˘ÂÚÈ¤¯Ô˘Ó Â›ÛË˜ ÎÔÚÂÛÌ¤Ó· Ï›Ë(ÎÚ¤·˜, Á·Ï·ÎÙÔÎÔÌÈÎ¿, ·˘Á¿) Î·È·˘Ù¿ Ù· ÙÚfiÊÈÌ· ¯ÚÂÈ¿˙ÔÓÙ·È ÚÔ-ÛÔ¯‹. Ã·ÌËÏfiÙÂÚË˜ ÔÈfiÙËÙ·˜ÏÂ˘ÎÒÌ·Ù· ÂÚÈ¤¯ÔÓÙ·È ÛÂ Ê˘ÙÈ-Î¤˜ ÙÚÔÊ¤˜ (fiÛÚÈ·, ‰ËÌËÙÚÈ·Î¿).∏ Û˘ÓÔÏÈÎ‹ ÔÛfiÙËÙ· ÏÂ˘ÎˆÌ¿-


16

ñ ∫ÔÚÂÛÌ¤Ó· Ï›Ë < 7% ÙˆÓ Û˘ÓÔÏÈÎÒÓ ıÂÚÌ›‰ˆÓ*ñ ¶ÔÏ˘·ÎfiÚÂÛÙ· Ï›Ë Ì¤¯ÚÈ ÙÔ 10% ÙˆÓ Û˘ÓÔÏÈÎÒÓ ıÂÚÌ›‰ˆÓñ ªÔÓÔ·ÎfiÚÂÛÙ· Ï›Ë Ì¤¯ÚÈ ÙÔ 20% ÙˆÓ Û˘ÓÔÏÈÎÒÓ ıÂÚÌ›‰ˆÓñ ™˘ÓÔÏÈÎfi Ï›Ô˜ 25% - 35% ÙˆÓ Û˘ÓÔÏÈÎÒÓ ıÂÚÌ›‰ˆÓñ À‰·Ù¿ÓıÚ·ÎÂ˜ 50% - 60% ÙˆÓ Û˘ÓÔÏÈÎÒÓ ıÂÚÌ›‰ˆÓ#

ñ º˘ÙÈÎ¤˜ ›ÓÂ˜ 20 – 30 gr/ËÌÂÚ.ñ §Â˘ÎÒÌ·Ù· ÂÚ›Ô˘ 15% ÙˆÓ Û˘ÓÔÏÈÎÒÓ ıÂÚÌ›‰ˆÓñ ÃÔÏËÛÙÂÚfiÏË < 200 gr/ËÌÂÚ.ñ ™˘ÓÔÏÈÎ¤˜ ıÂÚÌ›‰Â˜+ πÛÔÚÚÔ›· ÌÂÙ·Í‡ ÚÔÛÏ·Ì‚·ÓÔÌ¤ÓˆÓ Î·È

Î·Ù·Ó·ÏÈÛÎÔÌ¤ÓˆÓ ıÂÚÌ›‰ˆÓ ÁÈ· ·fiÎÙËÛË Î·È ‰È·Ù‹ÚËÚÛË ÂÈı˘-ÌËÙÔ‡ ÛˆÌ·ÙÈÎÔ‡ ‚¿ÚÔ˘˜/·ÔÊ˘Á‹ ˘ÂÚ‚¿ÏÏÔÓÙÔ˜ ‚¿ÚÔ˘˜ ÛÒ-Ì·ÙÔ˜

* ∆· trans-ÏÈ·Ú¿ ÔÍ¤· ·˘Í¿ÓÔ˘Ó ÙËÓ LDL Î·È Ú¤ÂÈ Ó· Î·Ù·Ó·ÏÒÓÔÓÙ·È fiÛÔÙÔ ‰˘Ó·Ùfi ÏÈÁfiÙÂÚÔ

# √È ˘‰·Ù¿ÓıÚ·ÎÂ˜ Ú¤ÂÈ Ó· ÚÔ¤Ú¯ÔÓÙ·È Î·Ù¿ Î‡ÚÈÔ ÏfiÁÔ ·fi ÙÚÔÊ¤˜ÏÔ‡ÛÈÂ˜ ÛÂ Û‡ÌÏÔÎÔ˘˜ ˘‰·Ù¿ÓıÚ·ÎÂ˜, fiˆ˜ ‰ËÌËÙÚÈ·Î¿, ÊÚÔ‡Ù· Î·È Ï·-¯·ÓÈÎ¿

+ ™ÙÈ˜ ËÌÂÚ‹ÛÈÂ˜ Î·‡ÛÂÈ˜ ıÂÚÌ›‰ˆÓ Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÙ·È ÙÔ˘Ï¿¯ÈÛÙÔÓÌ¤ÙÚÈ· ÛˆÌ·ÙÈÎ‹ ¿ÛÎËÛË (200 kcal/ËÌÂÚ)

¶›Ó·Î·˜ 2. ∫‡ÚÈ· Û˘ÛÙ·ÙÈÎ¿ ÙË˜ ‰È·ÙÚÔÊ‹˜ ÛÙËÓ ˘ÁÈÂÈÓÔ‰È·ÙËÙÈÎ‹·ÁˆÁ‹.

A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·16

ÙˆÓ Û˘ÓÈÛÙ¿Ù·È Ó· ·ÔÙÂÏÂ› ÙÔ15% ÙˆÓ ËÌÂÚ‹ÛÈˆÓ ıÂÚÌ›‰ˆÓ. √ÈÊ˘ÙÈÎ¤˜ ›ÓÂ˜ Â›Ó·È ÔÏ˘Û·Î¯·ÚÈÙÈ-‰ÈÎ¤˜ ¿Ï˘ÛÛÔÈ (˘‰·Ù¿ÓıÚ·ÎÂ˜) ÌË·ÔÚÚÔÊ‹ÛÈÌÂ˜ fiÌˆ˜. ¶ÂÚÈ¤¯Ô-ÓÙ·È ÛÂ ÔÏÏ¿ ÙÚfiÊÈÌ· Ê˘ÙÈÎ‹˜ÚÔ¤ÏÂ˘ÛË˜ (‚ÚÒÌË, Ê·ÛfiÏÈ·,ÊÚÔ‡Ù·). ∂›Ó·È ¯Ú‹ÛÈÌ· Û˘ÛÙ·ÙÈÎ¿ÙË˜ ÙÚÔÊ‹˜, Î˘Ú›ˆ˜ ÔÈ ‰È·Ï˘Ù¤˜·fi ·˘Ù¤˜ ÁÈ·Ù› ÂÌÔ‰›˙Ô˘Ó ÙËÓ·ÔÚÚfiÊËÛË ÙˆÓ ÏÈÒÓ Î·È ÚÔ-Î·ÏÔ‡Ó ÌÂ›ˆÛË ÙË˜ LDL. ∂›ÛË˜‰ÈÂ˘ÎÔÏ‡ÓÔ˘Ó ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ÂÓÙ¤ÚÔ˘. ¶Ú¤ÂÈ Ó· ÚÔÛÏ·Ì‚¿-ÓÔÓÙ·È ÛÂ ÔÛfiÙËÙ· ¿Óˆ ·fi 25gr ÙËÓ ËÌ¤Ú·, ÂÎ ÙˆÓ ÔÔ›ˆÓ Ù· 5-10 gr Ú¤ÂÈ Ó· Â›Ó·È ‰È·Ï˘Ù¤˜.

√È ‚ÈÙ·Ì›ÓÂ˜ Î·È Ù· ·ÓÙÈÔÍÂÈ‰ˆ-ÙÈÎ¿ ÙˆÓ ÙÚÔÊÒÓ Ê·›ÓÂÙ·È fiÙÈˆÊÂÏÔ‡Ó. ∆Ô Ê˘ÏÏÈÎfi ÔÍ‡, Ë µ6Î·È Ë µ12 ‰È·‰Ú·Ì·Ù›˙Ô˘Ó ÚfiÏÔÛÙÔ ÌÂÙ·‚ÔÏÈÛÌfi ÙË˜ ÔÌÔÎ˘-ÛÙÂ˝ÓË˜. ∆Ô Ê˘ÏÏÈÎfi ÔÍ‡ Ú¤ÂÈ Ó·ÚÔÛÏ·Ì‚¿ÓÂÙ·È Î·ıËÌÂÚÈÓ¿ ÛÂÔÛfiÙËÙÂ˜ ·fi 400 ¤ˆ˜ 1000 ÌÈ-ÎÚÔÁÚ·ÌÌ¿ÚÈ· ÌÂ ÙËÓ ÙÚÔÊ‹, ‰ÂÓ˘¿Ú¯Ô˘Ó fiÌˆ˜ ÂÓ‰Â›ÍÂÈ˜ Ô˘ Ó·˘ÔÛÙËÚ›˙Ô˘Ó ÙËÓ Û˘ÌÏËÚˆÌ·ÙÈ-Î‹ ¯ÔÚ‹ÁËÛË. ∆Ô ›‰ÈÔ ÈÛ¯‡ÂÈ Î·ÈÁÈ· ÙËÓ ‚ÈÙ·Ì›ÓË ∂, ÙÔ ·ÛÎÔÚ‚ÈÎfiÔÍ‡, ÙËÓ ‚-Î·ÚÔÙ¤ÓË Î·È ¿ÏÏ·ÔÍÂÈ‰ˆÙÈÎ¿ fiˆ˜ Ù· ‚ÈÔÊÏ·‚ÈÓÔÂÈ-‰‹, ÙÔ ÛÂÏ‹ÓÈÔ Î·È Ë Ô˘ÌÈÎÈÓfiÓË(Û˘Ó¤Ó˙˘ÌÔ Q10). ∂È‰ËÌÈÔÏÔÁÈ-Î¤˜ ÌÂÏ¤ÙÂ˜ ÛÂ ÏËı˘ÛÌÔ‡˜ Î·ÈÂÈÚ·Ì·ÙÈÎ¤˜ ÛÂ ˙Ò· ¤‰ÂÈÍ·Ó fiÙÈ ËÚfiÛÏË„Ë ÙˆÓ Ô˘ÛÈÒÓ ·˘ÙÒÓÚÔÛÙ·ÙÂ‡ÂÈ ·fi ÙËÓ ·ıËÚÔÛÎÏ‹-ÚˆÛË, ÔÈ ÎÏÈÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜ fiÌˆ˜ÛÙÔ˘˜ ·ÓıÚÒÔ˘˜ ‰ÂÓ ¤‰ÂÈÍ·ÓˆÊ¤ÏÂÈ· ·fi ÙË Û˘ÌÏËÚˆÌ·ÙÈÎ‹¯ÔÚ‹ÁËÛË ÙÔ˘˜. ¢ÂÓ ÂËÚÂ¿˙Ô˘ÓÙÈ˜ ÙÈÌ¤˜ ÙˆÓ ÏÈÈ‰›ˆÓ, ÚÔÛÙ·ÙÂ‡-Ô˘Ó fiÌˆ˜ ÙËÓ LDL ·fi ÔÍÂ›‰ˆÛË.

∏ Ì¤ÙÚÈ· ÚfiÛÏË„Ë ÔÈÓÔÓÂ‡-Ì·ÙÔ˜ (Ì¤¯ÚÈ ÙÚ›· ÔÙ¿ ÙËÓ ËÌ¤Ú··fi ÙÔ˘˜ ¿Ó‰ÚÂ˜ Î·È ¤Ó· ÌÂ ÂÓ¿ÌÈ-Û˘ ·fi ÙÈ˜ Á˘Ó·›ÎÂ˜) Â›Ó·È Â˘ÂÚÁÂ-ÙÈÎ‹ ÁÈ· ÙËÓ ÚfiÏË„Ë ı·Ó¿ÙˆÓ Î·È

·ıËÚÔÛÎÏ‹ÚˆÛË˜. ªÂÙ·Í‡ ÙˆÓÌË¯·ÓÈÛÌÒÓ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ·Ô‰›-‰ÂÙ·È Ë ˆÊ¤ÏÂÈ· Â›Ó·È Î·È Ë ·‡ÍË-ÛË ÙË˜ HDL ÙËÓ ÔÔ›· ÙÔ ÔÈÓfi-ÓÂ˘Ì· ÂÈÙ˘Á¯¿ÓÂÈ. ¶ÚÔÛÔ¯‹¯ÚÂÈ¿˙ÂÙ·È fiÌˆ˜ ÁÈ·Ù› ÌÂÁ·Ï‡ÙÂÚËÎ·Ù·Ó¿ÏˆÛË ÔÈÓÔÓÂ‡Ì·ÙÔ˜ ÚÔ-Î·ÏÂ› ·‡ÍËÛË ÙË˜ ·ÚÙËÚÈ·Î‹˜ ›Â-ÛË˜, ÙˆÓ ·ÁÁÂÈ·ÎÒÓ ÂÁÎÂÊ·ÏÈÎÒÓÂÂÈÛÔ‰›ˆÓ Î·È ÙˆÓ ı·Ó¿ÙˆÓ. ™Â¿ÙÔÌ· ÌÂ ˘ÂÚÙÚÈÁÏ˘ÎÂÚÈ‰ËÌ›·ÌÔÚÂ› ÙÔ ÔÈÓfiÓÂ˘Ì· Ó· ·˘Í‹ÛÂÈÙ· ÙÚÈÁÏ˘ÎÂÚ›‰È· ÂÚÈÛÛfiÙÂÚÔ Î·ÈÓ· ÚÔÎ·Ï¤ÛÂÈ ·ÁÎÚÂ·Ù›ÙÈ‰·.

ŸÏÂ˜ ÙÈ˜ ··ÈÙ‹ÛÂÈ˜ ÙË˜ ·Óˆ-Ù¤Úˆ ‰È·ÙÚÔÊ‹˜ ÌÔÚÂ› Ó· ÙÈ˜ ÈÎ·-ÓÔÔÈ‹ÛÂÈ Ë ªÂÛÔÁÂÈ·Î‹ ‰›·ÈÙ·,fiˆ˜ ¤¯ÂÈ ÔÓÔÌ·ÛıÂ› Ë ·Ú·‰Ô-ÛÈ·Î‹ ‰›·ÈÙ· ÙˆÓ ªÂÛÔÁÂÈ·ÎÒÓ Ï·-ÒÓ Î·È È‰›ˆ˜ ÙˆÓ ∂ÏÏ‹ÓˆÓ. √È Ô-ÛfiÙËÙÂ˜ Î·È Ë Û˘¯ÓfiÙËÙ· Ô˘Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È Î¿ıÂ ÙÚfiÊÈ-ÌÔ Ê·›ÓÂÙ·È ÛÙËÓ ˘Ú·Ì›‰· ÙË˜ªÂÛÔÁÂÈ·Î‹˜ ‰È·ÙÚÔÊ‹˜ Ô˘ ‰È·-ÌÔÚÊÒıËÎÂ ·fi Ì›· ÂÚÂ˘ÓËÙÈÎ‹ÔÌ¿‰· ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ÙÔ˘Harvard ÌÂ ÛËÌ·ÓÙÈÎ‹ Û˘Ì‚ÔÏ‹·fi ŒÏÏËÓÂ˜ ÂÈÛÙ‹ÌÔÓÂ˜. ∏ ˘-Ú·Ì›‰· ·˘Ù‹ ÚÔÛ·ÚÌfiÛıËÎÂ ÛÙ·∂ÏÏËÓÈÎ¿ ‰Â‰ÔÌ¤Ó· ·fi ÙÔ ∞ÓÒ-Ù·ÙÔ ∂È‰ÈÎfi ∂ÈÛÙËÌÔÓÈÎfi ™˘Ì‚Ô‡-ÏÈÔ ÀÁÂ›·˜ ÙÔ˘ ÀÀ¶6.

∏ Ê˘ÛÈÎ‹ ‰Ú·ÛÙËÚÈfiÙËÙ· Ú¤-ÂÈ Ó· ÚÔ¿ÁÂÙ·È ÛÂ fiÏÂ˜ ÙÈ˜ ËÏÈ-ÎÈ·Î¤˜ ÔÌ¿‰Â˜. ™˘ÓÈÛÙ¿Ù·È ÙÔ˘Ï¿-¯ÈÛÙÔÓ ÌÈÛ‹ ÒÚ· ¿ÛÎËÛË˜ ÙËÓ ËÌ¤-Ú·, ÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ ËÌ¤ÚÂ˜ ÙË˜Â‚‰ÔÌ¿‰·˜, ·ÏÏ¿ Î·È ÏÈÁfiÙÂÚË¿ÛÎËÛË Â›Ó·È ÂˆÊÂÏ‹˜. √È ¿-Û¯ÔÓÙÂ˜ Ó· ·ÛÎÔ‡ÓÙ·È Ì¤¯ÚÈ ÙÔ ÛË-ÌÂ›Ô Ô˘ ¤¯Ô˘Ó ÙÔÓ ÌÈÎÚfiÙÂÚÔ Î›Ó-‰˘ÓÔ. ¶ÚÔ˜ ÙÔ‡ÙÔ ¯ÚÂÈ¿˙ÂÙ·È Î·Ï‹ÎÏÈÓÈÎ‹ ÂÎÙ›ÌËÛË, ÛÙËÓ ÔÔ›· ÂÚÈ-Ï·Ì‚¿ÓÂÙ·È Ë ‰ÔÎÈÌ·Û›· ÎÔÒÛÂ-ˆ˜. √È ˘ÁÈÂ›˜ ÌÔÚÔ‡Ó Ó· ÂÈÏ¤-ÁÔ˘Ó ÙÈ˜ ‰Ú·ÛÙËÚÈfiÙËÙÂ˜ Ô˘ ÙÔ˘˜Â˘¯·ÚÈÛÙÔ‡Ó Î·È ÙÔ˘˜ Ù·ÈÚÈ¿˙Ô˘ÓÛÙÈ˜ Î·ıËÌÂÚÈÓ¤˜ ·Û¯ÔÏ›Â˜ ÙÔ˘˜,·ÚÎÂ› Ó· ·ÛÎÔ‡ÓÙ·È 30-45 ÏÂÙ¿, 4

ÌÂ 5 ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰·, ÛÙÔ 60-70% ÙË˜ ÌÂÁ›ÛÙË˜ ÙÔ˘˜ Î·Ú‰È·Î‹˜Û˘¯ÓfiÙËÙ·˜.

∏ ·¯˘Û·ÚÎ›· (¢ª™ > 30km/m2) Î·È ÙÔ ˘ÂÚ‚¿ÏÏÔÓ ÛˆÌ·-ÙÈÎfi ‚¿ÚÔ˜ (¢ª™ > 25 Î·È < 30km/m2) Ú¤ÂÈ Ó· ·ÔÊÂ‡ÁÔÓÙ·ÈÎ·È Ó· ‰ÈÔÚıÒÓÔÓÙ·È fiÔ˘ ˘¿Ú-¯Ô˘Ó. ÕÓ‰ÚÂ˜ ÌÂ ÂÚ›ÌÂÙÚÔ Ì¤ÛË˜> 102 cm Î·È Á˘Ó·›ÎÂ˜ ÌÂ Ì¤ÛË >88 cm ¤¯Ô˘Ó ·˘ÍËÌ¤ÓÔ ÛÏ·¯ÓÈÎfiÏ›Ô˜ Î·È Ú¤ÂÈ Ó· ¯¿ÓÔ˘Ó ‚¿-ÚÔ˜. ∏ ÂÈÙ˘¯›· Â›Ó·È ÂÚÈÛÛfiÙÂÚÔÈı·Ó‹ fiÙ·Ó Ë ÚÔÛ¿ıÂÈ· ˘Ô-ÛÙËÚ›˙ÂÙ·È Â·ÁÁÂÏÌ·ÙÈÎ¿ ·ÏÏ¿¯ÚÂÈ¿˙ÂÙ·È Î·È ÙÔ ¿ÙÔÌÔ Ó· ¤¯ÂÈÈÛ¯˘Úfi Î›ÓËÙÚÔ.

∆¤ÏÔ˜ Ë ÌfiÓÈÌË ‰È·ÎÔ‹ ÙË˜¯Ú‹ÛË˜ fiÏˆÓ ÙˆÓ ÌÔÚÊÒÓ Î·ÓÔ‡Ú¤ÂÈ Ó· ·ÔÙÂÏÂ› ÛÙ·ıÂÚ‹ ÂÈ-‰›ˆÍË ÛÂ fiÏÔ˘˜ ÙÔ˘˜ Î·ÓÈÛÙ¤˜,ÁÈ· ·ÔÊ˘Á‹ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ Ô˘‰È·ÙÚ¤¯Ô˘Ó ÔÈ ›‰ÈÔÈ ·ÏÏ¿ Î·È Ù·¿ÙÔÌ· ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÙÔ˘˜ˆ˜ ·ıËÙÈÎÔ› Î·ÓÈÛÙ¤˜. ∆· Ì¤ÙÚ·Ô˘ ÌÔÚÂ› Ó· ‚ÔËı‹ÛÔ˘Ó Â›Ó·ÈÂÚÈÏËÙÈÎ¿ Ù· Î·ÙˆÙ¤Úˆ (ÌÓËÌÔ-ÙÂ¯ÓÈÎ¿ 5 ∞’s ÛÙ· ∞ÁÁÏÈÎ¿)ñ ∂ÚÒÙËÛË (ask): Ó· ÂÓÙÔ›˙Ô-

ÓÙ·È ÔÈ Î·ÓÈÛÙ¤˜ Û˘ÛÙËÌ·ÙÈÎ¿ÛÂ Î¿ıÂ Â˘Î·ÈÚ›·

ñ ∂ÎÙ›ÌËÛË (asses): Ó· ÂÎÙÈÌ¿-Ù·È ÛÂ ÙÈ ‚·ıÌfi Â›Ó·È Ô ·ÛıÂ-Ó‹˜ ÂıÈÛÌ¤ÓÔ˜ Î·È fiÛÔ ¤ÙÔÈ-ÌÔ˜ Â›Ó·È Ó· ‰È·Îfi„ÂÈ ÙÔ Î¿ÓÈ-ÛÌ·

ñ ™˘Ì‚Ô˘Ï‹ (advise): Ó· Û˘ÓÈ-ÛÙ¿Ù·È ÌÂ Î¿ıÂ ÂÈÛÙÈÎfiÙËÙ· Ë‰È·ÎÔ‹ ÙÔ˘ Î·Ó›ÛÌ·ÙÔ˜

ñ µÔ‹ıÂÈ· (assist): Ó· ·Ú¤¯Â-Ù·È ‚Ô‹ıÂÈ· Â›ÙÂ ÌÂ ÙË ÌÔÚÊ‹„˘¯ÔÏÔÁÈÎ‹˜ ˘ÔÛÙ‹ÚÈÍË˜ ‹Î·È Ê·ÚÌ·ÎÂ˘ÙÈÎ¿ ÌÂ ˘ÔÎ·Ù¿-ÛÙ·Ù· ÓÈÎÔÙ›ÓË˜ ‹ ¿ÏÏ· Ê¿Ú-Ì·Î·

ñ ¶ÚÔÁÚ·ÌÌ·ÙÈÛÌfi˜ (arrange):Ó· ÚÔÁÚ·ÌÌ·Ù›˙ÔÓÙ·È ÔÈ ÂÈ-ÛÎ¤„ÂÈ˜ ÁÈ· ·Ú·ÎÔÏÔ‡ıËÛË.


17

1. European guidelines on cardiovascu-lar disease prevention in clinical practi-ce. Third Joint Task Force of Europeanand other Societies on CardiovascularDisease Prevention in Clinical Practice(constituted by representatives ofeight societies and by invited experts).De Backer G et al. Eur J of CardiovascPrev and Rehab 2003 ;10(Suppl 1) :S1-S78.

2. The Third Report of the National Cho-lesterol Education Program (NCEP)Expert Panel on Detection, Evaluation,and Treatment of High Blood Chole-

sterol in Adults (Adult Treatment PanelIII). Available online on the NHLBI Website at WWW.nhlbi.nih.gov.

3. Keys A, Menotti A, Karvonen MJ, Ara-vanis C, Blackburn H, Buzina R, Djord-jevic BS, Dontas AS, Fidanza F, KeysMH, Kromhout D, Nedeljkovic S, Pun-sar S, Seccareccia F, Toshima H. Thediet and 15-year death rate in the se-ven countries study. Am J Epedmiol1986; 124:903-15.

4. Kris- Etheron PM, Yu S. Individual fattyacid effects on plasma lipids and lipo-proteins: human studies. Am J Clin

Nutr 1997, 65 (suppl 5): 1628S-44S. 5. Stamler J, Briefel RR, Milas C, Gran-

dits GA, Caggiula AW. Relation ofchanges in dietary lipids and weight,trial years 1-6, to change in blood li-pids in the special intervention andusual care groups in the Multiple RiskFactor Intervention Trial. Am J ClinNutr 1997;65:272S-88S.

6. ÀÔ˘ÚÁÂ›Ô ÀÁÂ›·˜ Î·È ¶ÚfiÓÔÈ·˜. ∞ÓÒ-Ù·ÙÔ ∂È‰ÈÎfi ∂ÈÛÙËÌÔÓÈÎfi ™˘Ì‚Ô‡ÏÈÔÀÁÂ›·˜. ¢È·ÙÚÔÊÈÎ¤˜ Ô‰ËÁ›Â˜ ÁÈ· ÂÓ‹-ÏÈÎÂ˜ ÛÙËÓ ∂ÏÏ¿‰·. 1999.


A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·17

∏ ÛˆÛÙ‹ ÂÊ·ÚÌÔÁ‹ ÙˆÓ Ô-Ï˘¿ÚÈıÌˆÓ Ê·ÚÌ·ÎÂ˘ÙÈÎÒÓ Î·È˘ÁÈÂÈÓÔ‰È·ÈÙËÙÈÎÒÓ ‰˘Ó·ÙÔÙ‹-ÙˆÓ ÁÈ· ÙË ‰Â˘ÙÂÚÔÁÂÓ‹ Úfi-ÏË„Ë ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔ-ÛËÌ¿ÙˆÓ ·ÔÙÂÏÂ› ÚˆÙ·Ú¯È-Îfi ÛÙfi¯Ô ÙfiÛÔ ÙË˜ ÚˆÙÔ‚¿ı-ÌÈ·˜ ÊÚÔÓÙ›‰·˜ ˘ÁÂ›·˜ fiÛÔ Î·ÈÙˆÓ ÂÈ‰ÈÎÒÓ È·ÙÚÒÓ. ¶·Ú¿ ÙËÓ‡·ÚÍË Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ Î·ÙÂ˘-ı˘ÓÙ‹ÚÈˆÓ Ô‰ËÁÈÒÓ ÁÈ· ÙËÓÚfiÏË„Ë ÙË˜ Î·Ú‰È·ÁÁÂÈ·Î‹˜ÓfiÛÔ˘, Ù· Ê¿ÚÌ·Î· Ô˘ Â›Ó·ÈÁÓˆÛÙfi fiÙÈ ÂÏ·ÙÙÒÓÔ˘Ó ÙËÓıÓËÛÈÌfiÙËÙ· Î·È ÓÔÛËÚfiÙËÙ·‰ÂÓ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ·fiÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜ ·ÛıÂÓÂ›˜.™Ùfi¯Ô˜ ÙË˜ ·ÚÔ‡Û·˜ ·Ó·-ÛÎfiËÛË˜ Â›Ó·È Ë Û‡ÓÔ„Ë ÙˆÓÔ‰ËÁÈÒÓ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË·ÛıÂÓÒÓ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘.

∞¡∆π∞πª√¶∂∆∞§π∞∫√π¶∞ƒ∞°√¡∆∂™

∞™¶πƒπ¡∏∏ ·ÛÈÚ›ÓË ·Ó·ÛÙ¤ÏÏÂÈ ÌË

·Ó·ÛÙÚ¤„ÈÌ· ÙÔ ¤Ó˙˘ÌÔ Î˘ÎÏÔ-ÔÍ˘ÁÂÓ¿ÛË, ÙÔ ÔÔ›Ô ÂÌÏ¤ÎÂ-Ù·È ÛÙËÓ ·Ú·ÁˆÁ‹ ÙË˜ ıÚÔÌ-‚ÔÍ¿ÓË˜, Ë ÔÔ›· Â¿ÁÂÈ ÙËÛ˘ÛÛÒÚÂ˘ÛË ÙˆÓ ·ÈÌÔÂÙ·-Ï›ˆÓ. ∫¿ıÂ ·ÛıÂÓ‹˜ ÌÂ ÈÛÙÔ-ÚÈÎfi Î·Ú‰È·ÁÁÂÈ·Î‹˜ ÓfiÛÔ˘Î·È/‹ ™¢ Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÈ75 ¤ˆ˜ 325 mg ·ÛÈÚ›ÓË˜ËÌÂÚËÛ›ˆ˜. √È Î‡ÚÈÂ˜ ·ÓÂÈ-ı‡ÌËÙÂ˜ ÂÓ¤ÚÁÂÈÂ˜ ÙË˜ ·ÛÈÚ›-ÓË˜ Â›Ó·È ÔÈ ‰ÔÛÔ-ÂÍ·ÚÙÒÌÂÓÂ˜·ÈÌÔÚÚ·ÁÈÎ¤˜ ÂÈÏÔÎ¤˜, ÔÈÁ·ÛÙÚÂÓÙÂÚÈÎ¤˜ ‰È·Ù·Ú·¯¤˜(ÛÙÔ 2-10% ÙˆÓ ·ÛıÂÓÒÓ), ÔÈÂÌ‚Ô¤˜ Î·È Ë ·ÒÏÂÈ· ÙË˜·ÎÔ‹˜ (ÛÙÔ 0,3% ÙˆÓ ·ÛıÂÓÒÓÛÂ ˘„ËÏfiÙÂÚÂ˜ ‰fiÛÂÈ˜), Î·-ıÒ˜ Î·È ÔÈ ·ÓÙÈ‰Ú¿ÛÂÈ˜ ˘Â-ÚÂ˘·ÈÛıËÛ›·˜, fiˆ˜ Ô ‚ÚÔÁ-¯fiÛ·ÛÌÔ˜, Ë ÎÓ›‰ˆÛË Î·È ÙÔ

·ÁÁÂÈÔÔ›‰ËÌ· (ÛÙÔ 0,3% ÙˆÓ·ÛıÂÓÒÓ).

ªÂÁ¿ÏË˜ ÎÏ›Ì·Î·˜ ÌÂÙ·-·Ó·Ï‡ÛÂÈ˜ ¤‰ÂÈÍ·Ó ÙÔ ÛËÌ·ÓÙÈ-Îfi ÚfiÏÔ ÙË˜ ·ÛÈÚ›ÓË˜ ÛÙË‰Â˘ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë ÙˆÓÎ·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ,Î·ıÒ˜ ·Ô‰Â›¯ıËÎÂ fiÙÈ Ë ¯Ô-Ú‹ÁËÛ‹ ÙË˜ ÌÂ›ˆÛÂ ÛËÌ·ÓÙÈÎ¿ÙfiÛÔ ÙËÓ Î·Ú‰È·ÁÁÂÈ·Î‹ ıÓËÛÈ-ÌfiÙËÙ·, fiÛÔ Î·È Ù· Î·Ú‰È·Á-ÁÂÈ·Î¿ Û˘Ì‚¿Ì·Ù·1.

∫§√¶π¢√°ƒ∂§∏∏ ÎÏÔÈ‰ÔÁÚ¤ÏË ·Ó·ÛÙ¤Ï-

ÏÂÈ ÙË Û‡Ó‰ÂÛË ÙË˜ ‰ÈÊˆÛÊÔ-ÚÈÎ‹˜ ·‰ÂÓÔÛ›ÓË˜ ÛÙÔÓ ˘Ô‰Ô-¯¤· ÙË˜ ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙˆÓ ·È-ÌÔÂÙ·Ï›ˆÓ Î·È ¤ÙÛÈ ÂÌÔ‰›˙ÂÈÙËÓ ÂÓÂÚÁÔÔ›ËÛ‹ ÙÔ˘˜. ∆ÔÊ¿ÚÌ·ÎÔ ·˘Ùfi Ú¤ÂÈ Ó· ¯Ô-ÚËÁÂ›Ù·È ·ÓÙ› ÙË˜ ·ÛÈÚ›ÓË˜ÛÂ ·ÛıÂÓÂ›˜ Ô˘ ‰ÂÓ ·Ó¤¯Ô-ÓÙ·È ‹ Â›Ó·È ·ÓıÂÎÙÈÎÔ› ÛÙË‰Ú¿ÛË ÙË˜ ·ÛÈÚ›ÓË˜. ∂›-ÛË˜, Ú¤ÂÈ Ó· ¯ÔÚËÁÂ›Ù·È ÛÂ‰fiÛË 75 mg ËÌÂÚËÛ›ˆ˜ ÛÂÛ˘Ó‰˘·ÛÌfi ÌÂ ÙËÓ ·ÛÈÚ›ÓË(75-325 mg ËÌÂÚËÛ›ˆ˜) ÁÈ·ÙÔ˘Ï¿¯ÈÛÙÔÓ 8-12 Ì‹ÓÂ˜ ÛÂ·ÛıÂÓÂ›˜ ÌÂ ÔÍ¤· ÛÙÂÊ·ÓÈ·›·Û‡Ó‰ÚÔÌ· Î·È È‰È·›ÙÂÚ· ÛÂ¿ÙÔÌ· Ô˘ ˘Ô‚Ï‹ıËÎ·Ó ÛÂ·ÁÁÂÈÔÏ·ÛÙÈÎ‹ ÙˆÓ ÛÙÂÊ·ÓÈ-·›ˆÓ ·ÁÁÂ›ˆÓ. √È Î‡ÚÈÂ˜ ·ÓÂ-Èı‡ÌËÙÂ˜ ÂÓ¤ÚÁÂÈÂ˜ ÙË˜ ÎÏÔ-È‰ÔÁÚ¤ÏË˜ Â›Ó·È ÙÔ ÂÍ¿ÓıË-Ì· (ÛÙÔ 4,2% ÙˆÓ ·ÛıÂÓÒÓ)Î·È Ë ·ÈÌÔÚÚ·Á›· ·fi ÙÔ Á·-ÛÙÚÂÓÙÂÚÈÎfi (ÛÙÔ 2% ÙˆÓ·ÛıÂÓÒÓ).

ªÂÏ¤ÙÂ˜ Ô˘ Û˘Ó¤ÎÚÈÓ·ÓÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙË˜ÎÏÔÈ‰ÔÁÚ¤ÏË˜ ÌÂ ÙËÓ ·ÓÙ›-ÛÙÔÈ¯Ë ÙË˜ ·ÛÈÚ›ÓË˜2 ÛÙË ‰Â˘-ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë ÙˆÓ Î·Ú-‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ ¤‰ÂÈ-Í·Ó ¤Ó· ÌÈÎÚfi, ·ÏÏ¿ ÛÙ·ÙÈÛÙÈ-

Î¿ ÛËÌ·ÓÙÈÎfi ÏÂÔÓ¤ÎÙËÌ· ÙË˜ÎÏÔÈ‰ÔÁÚ¤ÏË˜ fiÛÔÓ ·ÊÔÚ¿ÙÔ Î‡ÚÈÔ Î·Ù·ÏËÎÙÈÎfi ÛËÌÂ›Ô·˘ÙÒÓ ÙˆÓ ÌÂÏÂÙÒÓ, ÂÓÒ ‰ÂÓ·Ó¤‰ÂÈÍ·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈ-Î¤˜ ‰È·ÊÔÚ¤˜ fiÛÔÓ ·ÊÔÚ¿ ÙÈ˜·ÓÂÈı‡ÌËÙÂ˜ ÂÓ¤ÚÁÂÈÂ˜ ÙˆÓ‰‡Ô Ê·ÚÌ¿ÎˆÓ3.

∞¡∆π¶∏∫∆π∫∏ ∞°ø°∏

µ∞ƒº∞ƒπ¡∏∏ ‚·ÚÊ·Ú›ÓË ÔÊÂ›ÏÂÈ ÙËÓ

·ÓÙÈËÎÙÈÎ‹ ÙË˜ ‰Ú¿ÛË Î˘Ú›ˆ˜ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ ·ÓÙ·ÁˆÓ›˙ÂÙ·ÈÙËÓ ÂÍ·ÚÙÒÌÂÓË ·fi ÙË ‚ÈÙ·Ì›-ÓË ∫ Î·Ú‚ÔÍ˘Ï›ˆÛË ÔÚÈÛÌ¤ÓˆÓ·Ú·ÁfiÓÙˆÓ ‹ÍË˜ (II, VII, IX,X). ∏ ·ÓÙÈËÎÙÈÎ‹ ıÂÚ·Â›·ÌÂ ‚·ÚÊ·Ú›ÓË ÂÓ‰Â›ÎÓ˘Ù·È ÛÂ·ÛıÂÓÂ›˜ ÌÂ ÎÔÏÈÎ‹ Ì·ÚÌ·-Ú˘Á‹ Î·È/‹ ıÚfiÌ‚Ô˘˜ ÛÙËÓ·ÚÈÛÙÂÚ¿ ÎÔÈÏ›·, fiˆ˜ Â›-ÛË˜ Î·È ÛÂ ¿ÙÔÌ· ÛÙ· ÔÔ›··ÓÙÂÓ‰Â›ÎÓ˘Ù·È Ë ¯ÔÚ‹ÁËÛË·ÛÈÚ›ÓË˜ ÌÂÙ¿ ·fi ¤ÌÊÚ·Á-Ì· ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘. √È Î‡ÚÈÂ˜·ÓÂÈı‡ÌËÙÂ˜ ÂÓ¤ÚÁÂÈÂ˜ ÙˆÓÎÔ˘Ì·ÚÈÓÈÎÒÓ ·ÓÙÈËÎÙÈÎÒÓÂ›Ó·È ÔÈ ‰ÔÛÔ-ÂÍ·ÚÙÒÌÂÓÂ˜ ·È-ÌÔÚÚ·ÁÈÎ¤˜ ÂÈÏÔÎ¤˜ Î·È Ë·ÏÏËÏÂ›‰Ú·ÛË ÙÔ˘˜ ÌÂ Ê¿Ú-Ì·Î·, ÂÈ‰ÈÎ¿ ÌÂ ÂÎÂ›Ó· Ô˘ÌÂÙ·‚ÔÏ›˙ÔÓÙ·È ·fi Ù· Ë·ÙÈ-Î¿ ÈÛÔ¤Ó˙˘Ì· CYP2C9 Î·ÈCYP3A4.

∞ÚÎÂÙ¤˜ ‰È·ÊˆÓ›Â˜ ˘¿Ú-¯Ô˘Ó Û¯ÂÙÈÎ¿ ÌÂ ÙÔ ·Ó ¯·ÌËÏ¤˜‰fiÛÂÈ˜ ·ÛÈÚ›ÓË˜ Ú¤ÂÈ Ó·Û˘Á¯ÔÚËÁÔ‡ÓÙ·È ÌÂ ‚·ÚÊ·Ú›-ÓË. ¶ÚfiÛÊ·ÙÂ˜ ÌÂÏ¤ÙÂ˜ ¤‰ÂÈ-Í·Ó Î·Ï‡ÙÂÚË ÚfiÁÓˆÛË ÛÂ·ÛıÂÓÂ›˜ ÌÂ ÁÓˆÛÙ‹ Î·Ú‰È·Á-ÁÂÈ·Î‹ ÓfiÛÔ Ô˘ ¤·ÈÚÓ·ÓÛ˘Ó‰˘·ÛÌ¤ÓË ·ÁˆÁ‹4.

ª›· ÌÂÙ·-·Ó¿Ï˘ÛË 31 ÌÂÏÂ-ÙÒÓ5 Ô˘ Û˘Ó¤ÎÚÈÓ·Ó ÙË ¯ÔÚ‹-ÁËÛË ‚·ÚÊ·Ú›ÓË˜, ÌfiÓË˜ ‹ ÛÂ


18

∞Ó·ÛÎfiËÛË ÙˆÓ √‰ËÁÈÒÓ ÁÈ· ÙË ¢Â˘ÙÂÚÔÁÂÓ‹

¶ÚfiÏË„Ë ÙË˜ ∫·Ú‰È·ÁÁÂÈ·Î‹˜ ¡fiÛÔ˘

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

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

A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·18

Û˘Ó‰˘·ÛÌfi ÌÂ ·ÛÈÚ›ÓË, ÌÂ ÙË¯ÔÚ‹ÁËÛË ·ÛÈÚ›ÓË˜ ‹ ÂÈÎÔÓÈ-ÎÔ‡ Ê·ÚÌ¿ÎÔ˘, ¤‰ÂÈÍÂ fiÙÈ Ì¤-ÙÚÈÂ˜ ‹ ˘„ËÏ¤˜ ‰fiÛÂÈ˜ ‚·ÚÊ·-Ú›ÓË˜ ÏÂÔÓÂÎÙÔ‡Û·Ó ¤Ó·ÓÙÈÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ fiÛÔÓ·ÊÔÚ¿ ÙË ÌÂ›ˆÛË ÙÔ˘ Î·Ú‰È·Á-ÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘, ÂÓÒ ‰ÂÓ ·-Ú·ÙËÚ‹ıËÎ·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛË-Ì·ÓÙÈÎ¤˜ ‰È·ÊÔÚ¤˜ ÛÂ Û‡ÁÎÚÈ-ÛË ÌÂ ÙËÓ ·ÛÈÚ›ÓË. ∂›ÛË˜,ÛËÌÂÈÒıËÎÂ Ì›· ÛÙ·ÙÈÛÙÈÎ¿ ÛË-Ì·ÓÙÈÎ‹ ·‡ÍËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ÛËÌ·ÓÙÈÎ‹˜ ·ÈÌÔÚÚ·Á›·˜ ÛÂ·ÛıÂÓÂ›˜ Ô˘ ¤·ÈÚÓ·Ó Ì¤-ÙÚÈÂ˜ ‹ ˘„ËÏ¤˜ ‰fiÛÂÈ˜ ‚·ÚÊ·-Ú›ÓË˜, ÛÂ Û‡ÁÎÚÈÛË ÌÂ ·ÛıÂ-ÓÂ›˜ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ¯ÔÚËÁ‹ıË-ÎÂ ·ÛÈÚ›ÓË ‹ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·-ÎÔ.

∞¡∞™∆√§∂π™ ∆√Àª∂∆∞∆ƒ∂¶∆π∫√À ∂¡∑Àª√À∆∏™ ∞°°∂π√∆∂¡™π¡∏™(∞ª∂∞)

√È ∞ª∂∞ ÂËÚÂ¿˙Ô˘Ó ÙË‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘ ¿ÍÔÓ· ÚÂ-Ó›ÓË˜ ·ÁÁÂÈÔÙÂÓÛ›ÓË˜ ·ÊÔ‡·Ó·ÛÙ¤ÏÏÔ˘Ó ÙË ÌÂÙ·ÙÚÔ‹ÙË˜ ·ÁÁÂÈÔÙÂÓÛ›ÓË˜ I ÛÂ ·ÁÁÂÈ-ÔÙÂÓÛ›ÓË II, ÂÓÒ ·Ú¿ÏÏËÏ··Ó·ÛÙ¤ÏÏÔ˘Ó ÙÔÓ Î·Ù·‚ÔÏÈÛÌfiÙË˜ ‚Ú·‰˘ÎÈÓ›ÓË˜. ∆· Ê¿ÚÌ·Î··˘Ù¿ ÂÓ‰Â›ÎÓ˘ÓÙ·È ÛÂ ·ÛıÂ-ÓÂ›˜ ÌÂ Î·Ú‰È·ÁÁÂÈ·Î‹ ÓfiÛÔÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ Î·Ú‰È·Î‹·ÓÂ¿ÚÎÂÈ·, Û˘ÛÙÔÏÈÎ‹ ‰˘-ÛÏÂÈÙÔ˘ÚÁ›· ÙË˜ ·ÚÈÛÙÂÚ¿˜ÎÔÈÏ›·˜ Î·È/‹ ÚfiÛÊ·ÙÔ ¤Ì-ÊÚ·ÁÌ· ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘, Î·-ıÒ˜ Â›ÛË˜ Î·È ÛÂ ·ÛıÂÓÂ›˜ÌÂ Î·Ú‰È·ÁÁÂÈ·Î‹ ÓfiÛÔ Î·È/‹™¢ ·ÓÂÍ¿ÚÙËÙ· ·fi ÙË ÏÂÈ-ÙÔ˘ÚÁ›· ÙË˜ ·ÚÈÛÙÂÚ¿˜ ÎÔÈ-Ï›·˜, ÂÊfiÛÔÓ Ë Û˘ÛÙÔÏÈÎ‹ ·Ú-ÙËÚÈ·Î‹ ›ÂÛË (™∞¶) ˘ÂÚ-‚·›ÓÂÈ Ù· 120 mm Hg. √È Î‡-ÚÈÂ˜ ·ÓÂÈı‡ÌËÙÂ˜ ÂÓ¤ÚÁÂÈ¤˜ÙÔ˘˜ Â›Ó·È Ë ÓÂÊÚÈÎ‹ ·ÓÂ¿Ú-ÎÂÈ· (ÛÂ ÔÛÔÛÙfi ¤ˆ˜ Î·È 50%ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ·ÌÊÔÙÂÚfi-ÏÂ˘ÚË ÛÙ¤ÓˆÛË ÙˆÓ ÓÂÊÚÈÎÒÓ·ÁÁÂ›ˆÓ), Ô ‚‹¯·˜ (ÛÙÔ 20%ÙˆÓ ·ÛıÂÓÒÓ), Ë ˘ÂÚÎ·ÏÈ·ÈÌ›·(ÛÙÔ 10%) Î·È ÙÔ ·ÁÁÂÈÔÔ›‰ËÌ·.

™‡ÌÊˆÓ· ÌÂ ·ÚÎÂÙ¤˜ ÌÂÏ¤-ÙÂ˜6,7,8 (AIRE, TRACE, SAVE) Ë¯ÔÚ‹ÁËÛË ∞ª∂∞ ÛÙË ‰Â˘ÙÂÚÔ-ÁÂÓ‹ ÚfiÏË„Ë ÙË˜ Î·Ú‰È·Á-

ÁÂÈ·Î‹˜ ÓfiÛÔ˘ Â›¯Â Â˘ÂÚÁÂÙÈÎ¿·ÔÙÂÏ¤ÛÌ·Ù· fiÛÔÓ ·ÊÔÚ¿ÙfiÛÔ ÙÔ Î‡ÚÈÔ Î·Ù·ÏËÎÙÈÎfi ÛË-ÌÂ›Ô fiÛÔ Î·È ÙËÓ Î·Ú‰È·ÁÁÂÈ·-Î‹ ıÓËÛÈÌfiÙËÙ·.

∞¶√∫§∂π™∆∂™ ∆ø¡ ∞∆1À¶√¢√Ã∂ø¡ ∆∏™∞°°∂π√∆∂¡™π¡∏™ ππ

√È ·ÔÎÏÂÈÛÙ¤˜ ÙˆÓ ∞∆1˘Ô‰Ô¯¤ˆÓ ÙË˜ ·ÁÁÂÈÔÙÂÓÛ›-ÓË˜ ππ ·Ó·ÛÙ¤ÏÏÔ˘Ó ÙË ‰Ú¿ÛËÙË˜ ·ÁÁÂÈÔÙÂÓÛ›ÓË˜ ππ ÛÙÔÂ›Â‰Ô ÙÔ˘ ˘Ô‰Ô¯¤· ÙË˜.∆· Ê¿ÚÌ·Î· ·˘Ù¿ ÂÓ‰Â›ÎÓ˘-ÓÙ·È ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ‰È·‚ËÙÈ-Î‹ ÓÂÊÚÔ¿ıÂÈ·, ˘¤ÚÙ·ÛË ‹Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ·. øÛÙfi-ÛÔ ‰ÂÓ ¤¯ÂÈ ·Ô‰ÂÈ¯ıÂ› fiÙÈÏÂÔÓÂÎÙÔ‡Ó ¤Ó·ÓÙÈ ÙˆÓ ∞ª∂∞fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ÚfiÏË„Ë ÙˆÓÎ·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓÎ·È ÁÈ· ·˘Ùfi ÙÔ ÏfiÁÔ ¯ÚËÛÈÌÔ-ÔÈÔ‡ÓÙ·È ˆ˜ ÚˆÙ·Ú¯ÈÎ‹ ıÂ-Ú·Â›· ÌfiÓÔ ÛÂ ·ÛıÂÓÂ›˜ÛÙÔ˘˜ ÔÔ›Ô˘˜ ÔÈ ∞ª∂∞ ‰ÂÓ Â›-Ó·È Î·Ï¿ ·ÓÂÎÙÔ›. √ Û˘Ó‰˘·-ÛÌfi˜ ∞∆1 ·ÔÎÏÂÈÛÙÒÓ Î·È∞ª∂∞ Ê·›ÓÂÙ·È fiÙÈ ·Ú¤¯ÂÈ Î·-Ï‡ÙÂÚÔ ·ÔÎÏÂÈÛÌfi ÙÔ˘ ¿ÍÔÓ·ÚÂÓ›ÓË˜-·ÁÁÂÈÔÙÂÓÛ›ÓË˜. √È Î‡-ÚÈÂ˜ ·ÓÂÈı‡ÌËÙÂ˜ ÂÓ¤ÚÁÂÈÂ˜ÙˆÓ ∞∆1 ·ÔÎÏÂÈÛÙÒÓ Â›Ó·È ·-ÚfiÌÔÈÂ˜ ÌÂ ÙÈ˜ ·ÓÙ›ÛÙÔÈ¯Â˜ ÙˆÓ∞ª∂∞ ÌÂ ÂÍ·›ÚÂÛË ÂÎÂ›ÓÂ˜Ô˘ Û˘Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙË ‚Ú·-‰˘ÎÈÓ›ÓË (.¯. Ô ‚‹¯·˜).

∞ÚÎÂÙ¤˜ ÌÂÏ¤ÙÂ˜ ¤‰ÂÈÍ·ÓÙË ÓÂÊÚÔÚÔÛÙ·ÙÂ˘ÙÈÎ‹ ‰Ú¿-ÛË ÙˆÓ ∞∆1 ·ÔÎÏÂÈÛÙÒÓ.9 ª›·ÌÂÙ·-·Ó¿Ï˘ÛË 17 Ù˘¯·ÈÔÔÈË-Ì¤ÓˆÓ, ‰ÈÏÒÓ-Ù˘ÊÏÒÓ ÌÂÏÂ-ÙÒÓ ÌÂ ÙË ¯ÔÚ‹ÁËÛË ÂÈÎÔÓÈÎÔ‡Ê·ÚÌ¿ÎÔ˘ ¤‰ÂÈÍÂ fiÙÈ ‰ÂÓ˘‹Ú¯Â ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ÌÂ›ˆÛË ÙË˜ ÔÏÈÎ‹˜ ıÓËÛÈÌfiÙË-Ù·˜ ÛÂ ·ÛıÂÓÂ›˜ Ô˘ ¤·ÈÚÓ·Ó∞∆1 ·ÔÎÏÂÈÛÙ¤˜, fiˆ˜ Â›-ÛË˜ Î·È ÛÂ ·ÛıÂÓÂ›˜ ÛÙÔ˘˜ÔÔ›Ô˘˜ ¯ÔÚËÁ‹ıËÎÂ Û˘Ó‰˘·-ÛÌfi˜ ∞∆1 ·ÔÎÏÂÈÛÙ‹ Î·È∞ª∂∞. øÛÙfiÛÔ, ·Ô‰Â›¯ıËÎÂfiÙÈ Ô Û˘Ó‰˘·ÛÌfi˜ ∞∆1 ·Ô-ÎÏÂÈÛÙÒÓ Î·È ∞ª∂∞ ÏÂÔÓÂÎÙÂ›¤Ó·ÓÙÈ ÙË˜ ÌÔÓÔıÂÚ·Â›·˜ ÌÂ∞ª∂∞ fiÛÔÓ ·ÊÔÚ¿ ÙÈ˜ ÂÈÛ·Áˆ-Á¤˜ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÁÈ· Î·Ú-‰È·Î‹ ·ÓÂ¿ÚÎÂÈ·10.

ƒÀ£ªπ™∏ ∆∏™ ∞ƒ∆∏ƒπ∞∫∏™¶π∂™∏™ (∞¶)

™‡ÌÊˆÓ· ÌÂ ÙÈ˜ Ô‰ËÁ›Â˜ÙË˜ 7Ë˜ ∂ıÓÈÎ‹˜ ∂ÈÙÚÔ‹˜ ÙˆÓ∏¶∞ ÁÈ· ÙËÓ ÚfiÏË„Ë, ‰È¿ÁÓˆ-ÛË Î·È ıÂÚ·Â›· ÙË˜ ·ÚÙËÚÈ·-Î‹˜ ˘¤ÚÙ·ÛË˜ Ô ÛÙfi¯Ô˜ ÙË˜∞¶ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ™¢ ‹ ¯Úfi-ÓÈ· ÓÂÊÚÈÎ‹ ÓfiÛÔ Â›Ó·È Ë ÌÂ›ˆ-ÛË ÙË˜ ∞¶ ÛÂ ÙÈÌ¤˜ ÌÈÎÚfiÙÂ-ÚÂ˜ ·fi 130/80 mm Hg. √ÛÙfi¯Ô˜ ·˘Ùfi˜ ÙÚÔÔÔÈÂ›Ù·ÈfiÙ·Ó Û˘Ó˘¿Ú¯ÂÈ ÛËÌ·ÓÙÈÎÔ‡‚·ıÌÔ‡ ÚˆÙÂ˚ÓÔ˘Ú›·, ÌÂÁ·-Ï‡ÙÂÚË ·fi 1 g ·Ó¿ 24ˆÚÔ, ÛÂ∞¶ ¯·ÌËÏfiÙÂÚË ·fi 125/75mm Hg. øÛÙfiÛÔ ÔÈ Ô‰ËÁ›Â˜·˘Ù¤˜ ‰ÂÓ Û˘ÌÂÚÈÏ·Ì‚¿ÓÔ˘Ó·ÛıÂÓÂ›˜ ÌÂ Î·Ú‰È·ÁÁÂÈ·Î‹ Ófi-ÛÔ Î·È/‹ Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ·,ÁÈ· ÙÔ˘˜ ÔÔ›Ô˘˜ Û˘ÓÈÛÙ¿Ù·ÈÛ¯ÔÏ·ÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙË˜ ∞¶Î·È ¤Ó·ÚÍË ·ÓÙÈ¸ÂÚÙ·ÛÈÎ‹˜·ÁˆÁ‹˜ ÂÊfiÛÔÓ ÔÈ ÙÈÌ¤˜ ÙË˜∞¶ ˘ÂÚ‚·›ÓÔ˘Ó Ù· 140/90mm Hg. ªÔÏÔÓfiÙÈ ˆ˜ Ê¿ÚÌ·-Î· ÚÒÙË˜ ÂÈÏÔÁ‹˜ ÁÈ· ÙËÚ‡ıÌÈÛË ÙË˜ ∞¶ ıÂˆÚÔ‡ÓÙ·È ÔÈ∞ª∂∞, ÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜ Î·È Ù·ıÂÈ·˙È‰ÈÎ¿ ‰ÈÔ˘ÚËÙÈÎ¿, ÔÈ ∞∆1·ÔÎÏÂÈÛÙ¤˜, ÔÈ ·ÓÙ·ÁˆÓÈÛÙ¤˜ÙË˜ ·Ï‰ÔÛÙÂÚfiÓË˜ Î·È ÔÈ Ì·-ÎÚ¿˜ ‰È¿ÚÎÂÈ·˜ ‰Ú¿ÛË˜ ·ÓÙ·-ÁˆÓÈÛÙ¤˜ ·Û‚ÂÛÙ›Ô˘ Ú¤ÂÈÂ›ÛË˜ Ó· Ï·Ì‚¿ÓÔÓÙ·È ÛÔ‚·-Ú¿ ˘fi„Ë ÂÈ‰ÈÎ¿ ÛÂ ·ÛıÂÓÂ›˜ÌÂ Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ· Î·È/‹ÛÙ·ıÂÚ‹ ÛÙËı¿Á¯Ë. °È· ÙÔ˘˜ÂÚÈÛÛfiÙÂÚÔ˘˜ ˘ÂÚÙ·ÛÈÎÔ‡˜··ÈÙÔ‡ÓÙ·È ÙÔ˘Ï¿¯ÈÛÙÔÓ 2·ÓÙÈ¸ÂÚÙ·ÛÈÎ¿ ÛÎÂ˘¿ÛÌ·Ù·ÁÈ· ÙËÓ Â›ÙÂ˘ÍË ÙˆÓ ÛÙfi¯ˆÓÙË˜ ·ÓÙÈ¸ÂÚÙ·ÛÈÎ‹˜ ·ÁˆÁ‹˜.

ªÂÏ¤ÙÂ˜ ¤‰ÂÈÍ·Ó fiÙÈ Ë ¯ÔÚ‹-ÁËÛË ‚-·ÔÎÏÂÈÛÙÒÓ ‹ ‰ÈÔ˘ÚË-ÙÈÎÒÓ ÏÂÔÓÂÎÙÔ‡ÛÂ ÙË˜ ¯ÔÚ‹-ÁËÛË˜ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ Î·-ıÒ˜ ÌÂ›ˆÛÂ ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·-ÓÙÈÎ¿ ÙfiÛÔ ÙËÓ Â›ÙˆÛË ÙˆÓ·ÁÁÂÈ·ÎÒÓ ÂÁÎÂÊ·ÏÈÎÒÓ ÂÂÈ-ÛÔ‰›ˆÓ fiÛÔ Î·È ÙˆÓ ÌÂÈ˙fiÓˆÓÛÙÂÊ·ÓÈ·›ˆÓ Û˘Ì‚·Ì¿ÙˆÓ11.∂›ÛË˜, Ì›· ÌÂÏ¤ÙË (Ë ALL-HAT)12 ¤‰ÂÈÍÂ fiÙÈ ‰ÂÓ ˘‹Ú¯ÂÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ÌÂÙ·Í‡ ÙˆÓ ıÂÈ·˙È‰ÈÎÒÓ ‰ÈÔ˘-ÚËÙÈÎÒÓ, ÙˆÓ ·ÓÙ·ÁˆÓÈÛÙÒÓ·Û‚ÂÛÙ›Ô˘ Î·È ÙˆÓ ∞ª∂∞ fiÛÔÓ·ÊÔÚ¿ ÙËÓ ÚfiÏË„Ë ÙˆÓ Î·Ú-


19

A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·19

‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ, ÁÂ-ÁÔÓfi˜ ÙÔ ÔÔ›Ô Î·ıÈ¤ÚˆÛÂ Ù·ıÂÈ·˙È‰ÈÎ¿ ‰ÈÔ˘ÚËÙÈÎ¿ ˆ˜ Ê¿Ú-Ì·Î· ÚÒÙË˜ ÂÈÏÔÁ‹˜ ÁÈ· ÙËÓ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ·ÚÙËÚÈ·Î‹˜˘¤ÚÙ·ÛË˜ ÂÍ·ÈÙ›·˜ ÙÔ˘ ¯·ÌË-ÏfiÙÂÚÔ˘ ÎfiÛÙÔ˘˜ ÙÔ˘˜. ∆¤ÏÔ˜fiÛÔÓ ·ÊÔÚ¿ ÙÔ˘˜ ‚-·ÔÎÏÂÈ-ÛÙ¤˜, ÙÔ˘˜ ∞∆1 ·ÔÎÏÂÈÛÙ¤˜Î·È ÙÔ˘˜ ·ÓÙ·ÁˆÓÈÛÙ¤˜ ÙË˜·Ï‰ÔÛÙÂÚfiÓË˜, Û˘ÓÈÛÙÒÓÙ·Èˆ˜ ·ÓÙÈ¸ÂÚÙ·ÛÈÎÔ› ·Ú¿ÁÔ-ÓÙÂ˜ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ Î·Ú‰È·Á-ÁÂÈ·Î‹ ÓfiÛÔ, Î·Ú‰È·Î‹ ·ÓÂ-¿ÚÎÂÈ· Î·È/‹ ™¢.

µ-∞¶√∫§∂π™∆∂™√È ‚-·ÔÎÏÂÈÛÙ¤˜ ÂÌÔ‰›-

˙Ô˘Ó ·ÓÙ·ÁˆÓÈÛÙÈÎ¿ ÙË ‰Ú¿ÛËÙˆÓ Î·ÙÂ¯ÔÏ·ÌÈÓÒÓ ÛÙÔ˘˜ ‚·‰ÚÂÓÂÚÁÈÎÔ‡˜ ˘Ô‰Ô¯Â›˜ Î·È¤¯Ô˘Ó ·ÓÙÈ·ÚÚ˘ıÌÈÎ‹, ·ÓÙÈÛÙË-ı·Á¯ÈÎ‹ Î·È ·ÚÓËÙÈÎ‹ ÈÓfiÙÚÔ-Ô, ¯ÚÔÓfiÙÚÔÔ Î·È ‰ÚÔÌfi-ÙÚÔÔ ‰Ú¿ÛË. ∞˘Ù¿ Ù· Ê¿Ú-Ì·Î· ÂÓ‰Â›ÎÓ˘ÓÙ·È ÁÈ· ÙË ‰Â˘-ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë ÙˆÓ Î·Ú-‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ ÛÂ·ÛıÂÓÂ›˜ ÌÂ ¤ÌÊÚ·ÁÌ· ÙÔ˘Ì˘ÔÎ·Ú‰›Ô˘, Î·Ú‰È·Î‹ ·ÓÂ-¿ÚÎÂÈ· / ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÙË˜·ÚÈÛÙÂÚ¿˜ ÎÔÈÏ›·˜ Î·È/‹˘¤ÚÙ·ÛË. √È Î‡ÚÈÂ˜ ·ÓÂÈı‡-ÌËÙÂ˜ ÂÓ¤ÚÁÂÈ¤˜ ÙÔ˘˜ Â›Ó·È ËÈı·Ó‹ ÂÈ‰Â›ÓˆÛË ÙˆÓ Û˘-ÌÙˆÌ¿ÙˆÓ ÙË˜ Î·Ú‰È·Î‹˜·ÓÂ¿ÚÎÂÈ·˜, Ë ÎfiˆÛË(1,8%) Î·È Ë ÛÂÍÔ˘·ÏÈÎ‹ ‰˘-ÛÏÂÈÙÔ˘ÚÁ›· (0,5%).

ªÂÏ¤ÙÂ˜ ¤‰ÂÈÍ·Ó fiÙÈ Ë ¯Ô-Ú‹ÁËÛË ‚-·ÔÎÏÂÈÛÙÒÓ ÛÂÌÂÏ¤ÙÂ˜ ‰Â˘ÙÂÚÔÁÂÓÔ‡˜ Úfi-ÏË„Ë˜ ÌÂ›ˆÛÂ ÛËÌ·ÓÙÈÎ¿ ÙËÓÎ·Ú‰È·ÁÁÂÈ·Î‹ ıÓËÛÈÌfiÙË-Ù·13,14. ¢‡Ô ÌÂÁ¿ÏÂ˜ ÌÂÙ·-·Ó·-Ï‡ÛÂÈ˜ ¤‰ÂÈÍ·Ó ÙËÓ Â˘ÂÚÁÂÙÈÎ‹Â›‰Ú·ÛË ÙˆÓ ‚-·ÔÎÏÂÈÛÙÒÓfiÛÔÓ ·ÊÔÚ¿ ÙË Ì·ÎÚÔ¯ÚfiÓÈ·ÂÈ‚›ˆÛË ·ÛıÂÓÒÓ ÌÂ ÚÔËÁË-ı¤Ó ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘ÔÎ·Ú‰›-Ô˘ Î·È ÙÔ˘˜ Î·ıÈ¤ÚˆÛ·Ó ˆ˜Ê¿ÚÌ·Î· ÚÒÙË˜ ÁÚ·ÌÌ‹˜ ÁÈ·ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ·ÚÙËÚÈ·-Î‹˜ ˘¤ÚÙ·ÛË˜ ÛÂ ·ÛıÂÓÂ›˜ ÌÂÎ·Ú‰È·ÁÁÂÈ·Î‹ ÓfiÛÔ15.

ƒÀ£ªπ™∏ ∆∏™Ã√§∏™∆∂ƒ√§∏™ ∆√À √ƒ√À

™‡ÌÊˆÓ· ÌÂ ÚfiÛÊ·ÙÂ˜

Ô‰ËÁ›Â˜16, ÛÙfi¯Ô˜ ÙË˜ ˘ÔÏÈ-È‰·ÈÌÈÎ‹˜ ·ÁˆÁ‹˜ ÛÂ ¿ÙÔÌ·ÌÂ ÂÁÎ·ÙÂÛÙËÌ¤ÓË Î·Ú‰È·Á-ÁÂÈ·Î‹ ÓfiÛÔ, ™¢ Î·È/‹ 10ÂÙ‹Î·Ù¿ Framingham Î›Ó‰˘ÓÔı·Ó¿ÙÔ˘ ·fi ÛÙÂÊ·ÓÈ·›· Ófi-ÛÔ ÌÂÁ·Ï‡ÙÂÚÔ ·fi 20% Â›Ó·ÈË ÌÂ›ˆÛË ÙË˜ LDL CHOL ÛÂÂ›Â‰· ÌÈÎÚfiÙÂÚ· ·fi 100mg/dl. øÛÙfiÛÔ, ÚfiÛÊ·ÙÂ˜ÌÂÏ¤ÙÂ˜17 ÚÔÙÂ›ÓÔ˘Ó Ì›· Â-Ú·ÈÙ¤Úˆ ÌÂ›ˆÛË ÙÔ˘ ÛÙfi¯Ô˘ÙË˜ ˘ÔÏÈÈ‰·ÈÌÈÎ‹˜ ·ÁˆÁ‹˜ÛÂ Â›Â‰· ¯·ÌËÏfiÙÂÚ· ·fi100 mg/dl, ·Ó Î·È ··ÈÙÔ‡ÓÙ·ÈÂÚÈÛÛfiÙÂÚ· ‰Â‰ÔÌ¤Ó· ÁÈ·ÙÔÓ ÙÂÏÈÎfi Î·ıÔÚÈÛÌfi ·˘ÙÔ‡ÙÔ˘ ÛÙfi¯Ô˘. √È ›‰ÈÂ˜ Ô‰ËÁ›Â˜Î·ıÔÚ›˙Ô˘Ó Â›ÛË˜ ˆ˜ ÛÙfi-¯Ô˘˜ ÙË˜ ˘ÔÏÈÈ‰·ÈÌÈÎ‹˜·ÁˆÁ‹˜ ÙË ÌÂ›ˆÛË ÙˆÓ TRGÛÂ Â›Â‰· ¯·ÌËÏfiÙÂÚ· ·fi150 mg/dl Î·È ÙËÓ ·‡ÍËÛË ÙË˜HDL CHOL ÛÂ Â›Â‰· ÌÂÁ·-Ï‡ÙÂÚ· ·fi 40 mg/dl ÁÈ· ÙÔ˘˜¿Ó‰ÚÂ˜ Î·È 50 mg/dl ÁÈ· ÙÈ˜Á˘Ó·›ÎÂ˜.

∞¡∞™∆√§∂π™ ∆∏™ HMG CoA∞¡∞°ø°∞™∏™ (™∆∞∆π¡∂™)

√ ÛÙ·Ù›ÓÂ˜ ·ÔÙÂÏÔ‡Ó ÙÔÓÈÛ¯˘ÚfiÙÂÚÔ ·Ú¿ÁÔÓÙ· ÌÂ›ˆ-ÛË˜ ÙË˜ LDL CHOL, ÂÓÒ ·-Ú¿ÏÏËÏ· Û˘Ì‚¿ÏÏÔ˘Ó Î·È ÛÙËÓ·‡ÍËÛË ÙË˜ HDL CHOL Î·È ÙËÌÂ›ˆÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ. √ÈÛÙ·Ù›ÓÂ˜ Â›Ó·È ˘ÔÏÈÈ‰·ÈÌÈÎ¿Ê¿ÚÌ·Î· ÚÒÙË˜ ÂÈÏÔÁ‹˜ÛÂ ·ÛıÂÓÂ›˜ ÌÂ Î·Ú‰È·ÁÁÂÈ·-Î‹ ÓfiÛÔ Î·È/‹ ™¢. √È Î‡ÚÈÂ˜·ÓÂÈı‡ÌËÙÂ˜ ÂÓ¤ÚÁÂÈ¤˜ ÙÔ˘˜Â›Ó·È ÔÈ Ì˘·ÏÁ›Â˜ (1-6%), Ë ÛË-Ì·ÓÙÈÎ‹ Î·È ‰ÔÛÔ-ÂÍ·ÚÙÒÌÂÓË·‡ÍËÛË ÙˆÓ ÙÚ·ÓÛ·ÌÈÓ·ÛÒÓÙÔ˘ ÔÚÔ‡ (0,1-0,3%), Ë Ì˘Ô¿-ıÂÈ· (0,7%) Î·È Ë Ú·‚‰ÔÌ˘fiÏ˘-ÛË (<0,0002%).

∞ÚÎÂÙ¤˜ ÌÂÁ¿ÏÂ˜ ÌÂÏ¤-ÙÂ˜18,19,20,17 (4S, CARE, LIPID,HPS) ¤¯Ô˘Ó ÙÂÎÌËÚÈÒÛÂÈ ÙÔÓÈ‰È·›ÙÂÚ· ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÙˆÓÛÙ·ÙÈÓÒÓ ÛÙË ‰Â˘ÙÂÚÔÁÂÓ‹ÚfiÏË„Ë ÙË˜ Î·Ú‰È·ÁÁÂÈ·Î‹˜ÓfiÛÔ˘.

ºπª¶ƒ∞∆∂™√È ÊÈÌÚ¿ÙÂ˜ ÂÓÂÚÁÔÔÈ-

Ô‡Ó ÙË ÏÈÔÚˆÙÂ˚ÓÈÎ‹ ÏÈ¿ÛË

(LPL) Î·È ¤ÙÛÈ Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÌÂ›ˆÛË ÙˆÓ TRG Î·È ÙËÓ ·‡ÍË-ÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ HDLCHOL. ∞ÔÙÂÏÔ‡Ó Ê¿ÚÌ·Î·ÚÒÙË˜ ÂÈÏÔÁ‹˜ ÛÂ ·ÛıÂ-ÓÂ›˜ ÌÂ ÌÂÌÔÓˆÌ¤ÓË ˘ÂÚÙÚÈ-ÁÏ˘ÎÂÚÈ‰·ÈÌ›·. √ Û˘Ó‰˘·-ÛÌfi˜ ÙÔ˘˜ ÌÂ ÛÙ·Ù›ÓÂ˜ ‰ÈÎ·È-ÔÏÔÁÂ›Ù·È ÛÂ ·ÛıÂÓÂ›˜ ˘„Ë-ÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÌÂ ˘„ËÏ¿ Â›-Â‰· LDL CHOL Î·È Â›ÙÂ ¯·-ÌËÏ¿ Â›Â‰· HDL CHOL, Â›-ÙÂ ˘„ËÏ¿ Â›Â‰· TRG. ∏ Î‡-ÚÈ· ·ÓÂÈı‡ÌËÙË ÂÓ¤ÚÁÂÈ¿ÙÔ˘˜ Â›Ó·È Ë Ì˘Ô¿ıÂÈ· Ô˘·Ú·ÙËÚÂ›Ù·È Û˘¯ÓfiÙÂÚ· ÛÂÂÚÈÙÒÛÂÈ˜ Û˘Á¯ÔÚ‹ÁËÛË˜ÌÂ ÛÙ·Ù›ÓÂ˜. ∏ ÊÈÌÚ¿ÙË Ô˘Ê·›ÓÂÙ·È Ó· ·ÏÏËÏÂÈ‰Ú¿ Â-ÚÈÛÛfiÙÂÚÔ ÌÂ ÙÈ˜ ÛÙ·Ù›ÓÂ˜ Â›-Ó·È Ë ÁÂÌÊÈÌÚÔ˙›ÏË.21

ª›· ÌÂÏ¤ÙË22 (Ë VA-HIT)¤‰ÂÈÍÂ ÙÔÓ Â˘ÂÚÁÂÙÈÎfi ÚfiÏÔÙË˜ ÁÂÌÊÈÌÚÔ˙›ÏË˜ ÛÙË ‰Â˘-ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë ÙË˜ Î·Ú-‰È·ÁÁÂÈ·Î‹˜ ÓfiÛÔ˘.

¡π∫√∆π¡π∫√ √•À∆Ô ÓÈÎÔÙÈÓÈÎfi ÔÍ‡ ·˘Í¿ÓÂÈ

ÙËÓ HDL CHOL, ÂÓÒ ·Ú¿ÏÏË-Ï· ·Ó·ÛÙ¤ÏÏÂÈ ÙËÓ Ë·ÙÈÎ‹ ·-Ú·ÁˆÁ‹ ÏÈÔÚˆÙÂ˚ÓÒÓ. ∆ÔÊ¿ÚÌ·ÎÔ ·˘Ùfi ÂÓ‰Â›ÎÓ˘Ù·È ÛÂÛ˘Ó‰˘·ÛÌfi ÌÂ ÛÙ·Ù›ÓÂ˜ ÁÈ·ÙË ıÂÚ·Â›· ÙË˜ ‰˘ÛÏÈÈ‰·È-Ì›·˜ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ Ê˘ÛÈÔÏÔ-ÁÈÎ¿ ‹ ¯·ÌËÏ¿ Â›Â‰· HDLCHOL. √È Î‡ÚÈÂ˜ ·ÓÂÈı‡ÌË-ÙÂ˜ ÂÓ¤ÚÁÂÈ¤˜ ÙÔ˘ Â›Ó·È Ë ¤Í·-„Ë (ÛÂ ¤ˆ˜ Î·È 80% ÙˆÓ ·ÛıÂ-ÓÒÓ ÛÙËÓ ÎÚ˘ÛÙ·ÏÏÈÎ‹ ÌÔÚÊ‹),Ë ÔÚÊ‡Ú·, ÔÈ ·Ú·ÈÛıËÛ›Â˜,Ë Ó·˘Ù›·, Ë Ë·ÙÔÙÔÍÈÎfiÙËÙ·,Ë ˘ÂÚÁÏ˘Î·ÈÌ›·, Ë ˘ÂÚÔ˘ÚÈ-¯·ÈÌ›·, Ë ˘fiÙ·ÛË Î·È Ë ·‡ÍË-ÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ ÔÌÔÎ˘-ÛÙÂ˚ÓË˜ ÙÔ˘ ÔÚÔ‡.

¢π∞∫√¶∏ ∆√À∫∞¶¡π™ª∞∆√™

∆Ô Î¿ÓÈÛÌ· ·ÔÙÂÏÂ› ·ÓÂ-Í¿ÚÙËÙÔ ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË Î·Ú‰È·ÁÁÂÈ·-Î‹˜ ÓfiÛÔ˘. √ Û˘Ó‰˘·ÛÌfi˜ÙË˜ Û˘Ì‚Ô˘ÏÂ˘ÙÈÎ‹˜ ·Ú¤Ì-‚·ÛË˜ ÌÂ Ê·ÚÌ·ÎÔÏÔÁÈÎ‹ ıÂ-Ú·Â›· ÌÂ ‚Ô˘ÚÔÚÈfiÓË ÌÂ‹ ¯ˆÚ›˜ ÙË ¯Ú‹ÛË ˘ÔÎ·Ù¿-ÛÙ·ÙˆÓ ÓÈÎÔÙ›ÓË˜ ¤¯ÂÈ È‰È·›ÙÂ-


20

A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·20

ÚË ÛËÌ·Û›· ÁÈ· ÙË ‰È·ÎÔ‹ÙÔ˘ Î·Ó›ÛÌ·ÙÔ˜ ÛÂ ·ÛıÂÓÂ›˜ÌÂ ÂÁÎ·ÙÂÛÙËÌ¤ÓË Î·Ú‰È·Á-ÁÂÈ·Î‹ ÓfiÛÔ.

ªÂÏ¤ÙÂ˜ ¤‰ÂÈÍ·Ó ÙÔ ÛËÌ·-ÓÙÈÎfi ÚfiÏÔ ÙfiÛÔ ÙË˜ Û˘ÌÂÚÈ-ÊÔÚÈÔÏÔÁÈÎ‹˜ ÙÚÔÔÔ›ËÛË˜,fiÛÔ Î·È ÙË˜ Ê·ÚÌ·ÎÂ˘ÙÈÎ‹˜ıÂÚ·Â›·˜ ÌÂ ‚Ô˘ÚÔÚÈfiÓË23

ÌÂ ‹ ¯ˆÚ›˜ ‰ÂÚÌ·ÙÈÎ¿ ·˘ÙÔ-ÎfiÏÏËÙ· ÓÈÎÔÙ›ÓË˜ ÁÈ· ÙË ‰È·-ÎÔ‹ ÙÔ˘ Î·Ó›ÛÌ·ÙÔ˜.

¢π∞π∆∞ ∫∞π ƒÀ£ªπ™∏ ∆√À™øª∞∆π∫√À µ∞ƒ√À™

√ ¢Â›ÎÙË˜ ª¿˙·˜ ™ÒÌ·ÙÔ˜(µªπ), Ô ÔÔ›Ô˜ ÔÚ›˙ÂÙ·È ˆ˜ ÔÏfiÁÔ˜ ÙÔ˘ ™µ (ÛÂ kg) ÚÔ˜ ÙÔÙÂÙÚ¿ÁˆÓÔ ÙÔ˘ ‡„Ô˘˜ (ÛÂ m),Î·ÙËÁÔÚÈÔÔÈÂ› Ù· ¿ÙÔÌ· ÛÂ˘ÁÈ‹ (µªπ, 19-25), ÛÂ ˘¤Ú‚·-Ú· (µªπ, 25-30) Î·È ·¯‡Û·Ú-Î· (µªπ >30) Î·È Û˘Û¯ÂÙ›˙ÂÙ·È¿ÌÂÛ· ÌÂ ÙÔÓ Î·Ú‰È·ÁÁÂÈ·ÎfiÎ›Ó‰˘ÓÔ. ∂ÈÏ¤ÔÓ, ÂÚÈÊ¤ÚÂÈ·Ì¤ÛË˜ ÌÂÁ·Ï‡ÙÂÚË ÙˆÓ 102 cmÁÈ· ÙÔ˘˜ ¿Ó‰ÚÂ˜ ‹ 88 cm ÁÈ·ÙÈ˜ Á˘Ó·›ÎÂ˜ ·ÔÙÂÏÂ› ¤Ó‰ÂÈÍËÎÂÓÙÚÔÌÂÏÈÎ‹˜ ·¯˘Û·ÚÎ›·˜Ô˘ Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂ ·˘ÍËÌ¤ÓÔÎ·Ú‰È·ÁÁÂÈ·Îfi Î›Ó‰˘ÓÔ.

™Â fiÏÔ˘˜ ÙÔ˘˜ ˘¤Ú‚·-ÚÔ˘˜ ·ÛıÂÓÂ›˜ Û˘ÓÈÛÙ¿Ù·ÈÌÂ›ˆÛË ÙÔ˘ ıÂÚÌÈ‰ÈÎÔ‡ ÊÔÚ-Ù›Ô˘ Î·Ù¿ 500kcal/d Ì¤¯ÚÈ˜fiÙÔ˘ ·ÔÎÙ‹ÛÔ˘Ó È‰·ÓÈÎfi ™µ.∂›ÛË˜, ÛÂ ·ÛıÂÓÂ›˜ ÌÂ Î·Ú-‰È·ÁÁÂÈ·Î‹ ÓfiÛÔ Û˘ÓÈÛÙ¿Ù·È‰›·ÈÙ· ÏÔ‡ÛÈ· ÛÂ ÚˆÙÂ˝ÓÂ˜,Û‡ÌÏÔÎÔ˘˜ ˘‰·Ù¿ÓıÚ·ÎÂ˜,ˆ-3 ÏÈ·Ú¿ ÔÍ¤·, ÊÚÔ‡Ù·, Ï·-¯·ÓÈÎ¿, ÍËÚÔ‡˜ Î·ÚÔ‡˜ Î·ÈÛÈÙËÚ¿ ÔÏÈÎ‹˜ ·Ï¤ÛÂˆ˜ Î·ÈÙˆ¯‹ ÛÂ ÎÂÎÔÚÂÛÌ¤Ó· Ï›ËÎ·È ¯ÔÏËÛÙÂÚfiÏË.

ªÂÏ¤ÙÂ˜ ¤‰ÂÈÍ·Ó Ù· ÛËÌ·-ÓÙÈÎ¿ ÏÂÔÓÂÎÙ‹Ì·Ù· ÙË˜ ªÂ-ÛÔÁÂÈ·Î‹˜ ‰›·ÈÙ·˜24 Î·È ÙË˜ ‰›-·ÈÙ·˜ Ô˘ Â›Ó·È ÏÔ‡ÛÈ· ÛÂ Ê˘-ÙÈÎ¤˜ ›ÓÂ˜ Î·È ÔÏ˘·ÎfiÚÂÛÙ·Ï›Ë ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙË ¢˘ÙÈ-ÎÔ‡ Ù‡Ô˘ ‰›·ÈÙ· Ô˘ Â›Ó·ÈÏÔ‡ÛÈ· ÛÂ ˙ˆÈÎ¿ Ï›Ë fiÛÔÓ·ÊÔÚ¿ ÙË ÌÂ›ˆÛË ÙÔ˘ ÛˆÌ·ÙÈ-ÎÔ‡ ‚¿ÚÔ˘˜.

¶ƒ√§∏æ∏ ∫∞π £∂ƒ∞¶∂π∞∆√À ™∞∫Ã∞ƒø¢∏¢π∞µ∏∆∏ (™¢)

ø˜ ™¢ ÔÚ›˙ÂÙ·È Ë ·‡ÍËÛËÙˆÓ ÂÈ¤‰ˆÓ ÁÏ˘Îfi˙Ë˜ ÓË-ÛÙÂ›·˜ ≥ 126 mg/dl Î·È/‹ ÙÈÌ¤˜ÁÏ˘Îfi˙Ë˜ ÌÂÙ¿ ·fi ÊfiÚÙÈÛËÌÂ ÁÏ˘Îfi˙Ë ≥ 200 mg/dl. √ ™¢Ù‡Ô˘ 2 ·ÔÙÂÏÂ› ÙÔ 90% fiÏˆÓÙˆÓ ÂÚÈÙÒÛÂˆÓ ™¢. ∫·Ù¿ ÙËÌÂÙ¿‚·ÛË ·fi ÙË ÓÔÚÌÔÁÏ˘-Î·ÈÌ›· ÛÙËÓ Ï‹ÚË ÂÌÊ¿ÓÈÛËÙÔ˘ ™¢ ¤Ó·˜ ·ÛıÂÓ‹˜ ÂÓ‰¤¯Â-Ù·È Ó· ÌÂÙ·¤ÛÂÈ Î·È ÛÂ ÂÓ‰È¿-ÌÂÛÂ˜ ÌÔÚÊ¤˜ ·ÓÙ›ÛÙ·ÛË˜ ÛÙË‰Ú¿ÛË ÙË˜ ÈÓÛÔ˘Ï›ÓË˜, fiˆ˜Â›Ó·È Ë ‰È·Ù·Ú·¯‹ ·ÓÔ¯‹˜ ÁÏ˘-Îfi˙Ë˜ (IGT) Î·È Ë ‰È·Ù·Ú·¯‹ÁÏ˘Îfi˙Ë˜ ÓËÛÙÂ›·˜ (IGF). ø˜‰È·Ù·Ú·¯‹ ·ÓÔ¯‹˜ ÁÏ˘Îfi˙Ë˜ÔÚ›˙ÔÓÙ·È ÙÈÌ¤˜ ÁÏ˘Îfi˙Ë˜ 140-199 mg/dl ÌÂÙ¿ ·fi Ì›· ·fiÙÔ˘ ÛÙfiÌ·ÙÔ˜ ÊfiÚÙÈÛË ÌÂ ÁÏ˘-Îfi˙Ë Î·È ˆ˜ ‰È·Ù·Ú·¯‹ ÁÏ˘Îfi-˙Ë˜ ÓËÛÙÂ›·˜ ÔÚ›˙ÔÓÙ·È Â›Â-‰· ÁÏ˘Îfi˙Ë˜ ÓËÛÙÂ›·˜ 110-125mg/dl. ŸÏÔÈ ÔÈ ·ÛıÂÓÂ›˜ ÌÂÎ·Ú‰È·ÁÁÂÈ·Î‹ ÓfiÛÔ ÛÙÔ˘˜ÔÔ›Ô˘˜ Û˘Ó˘¿Ú¯Ô˘Ó ÔÈ ·-Ú·¿Óˆ ‰È·Ù·Ú·¯¤˜ Ú¤ÂÈÓ· ˘Ô‚¿ÏÏÔÓÙ·È ÛÂ ˘ÁÈÂÈÓÔ-‰È·ÈÙËÙÈÎ‹ ·ÁˆÁ‹ ÌÂ ÛÙfi¯Ô ÙËÌÂ›ˆÛË ÙÔ˘ ÛˆÌ·ÙÈÎÔ‡ ‚¿-ÚÔ˘˜, ÙËÓ ·‡ÍËÛË ÙË˜ ÛˆÌ·ÙÈ-Î‹˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Î·È ÙÔÓÂÚÈÔÚÈÛÌfi ÙË˜ ‰È·ÈÙËÙÈÎ‹˜ÚfiÛÏË„Ë˜ ÎÂÎÔÚÂÛÌ¤ÓÔ˘ Ï›-Ô˘˜.

√ ™¢ Ù‡Ô˘ 2 Â›Ó·È ¤Ó·˜ È‰È-·›ÙÂÚ· ÛËÌ·ÓÙÈÎfi˜ ·Ú¿ÁÔ-ÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈ-ÛË Î·Ú‰È·ÁÁÂÈ·Î‹˜ ÓfiÛÔ˘ Î·ÈÛ˘Û¯ÂÙ›˙ÂÙ·È ÌÂ ÂÈÙ¿¯˘ÓÛËÙË˜ ·ıËÚˆÌ·ÙÈÎ‹˜ ‰È·‰ÈÎ·-Û›·˜25. ∏ ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ˜ Â˘-ı‡ÓÂÙ·È ÁÈ· ÙÔ 65% ÙˆÓ ı·Ó¿-ÙˆÓ ÙˆÓ ‰È·‚ËÙÈÎÒÓ ·ÛıÂÓÒÓ.∞ÛıÂÓÂ›˜ ÌÂ Î·Ú‰È·ÁÁÂÈ·Î‹ÓfiÛÔ Î·È ™¢ Ú¤ÂÈ Ó· ˘Ô-‚¿ÏÏÔÓÙ·È ÛÂ Û¯ÔÏ·ÛÙÈÎfi ÁÏ˘-Î·ÈÌÈÎfi ¤ÏÂÁ¯Ô ÌÂ ÛÙfi¯Ô ÙËÌÂ›ˆÛË ÙË˜ ÁÏ˘ÎÔ˙˘ÏÈˆÌ¤ÓË˜·ÈÌÔÛÊ·ÈÚ›ÓË˜ (HbA1c) ÛÂÔÛÔÛÙfi ¯·ÌËÏfiÙÂÚÔ ÙÔ˘7%26.

ª›· ÌÂÏ¤ÙË (Ë UKPDS) ¤‰ÂÈ-ÍÂ ˆ˜ fiÛÔ Î·Ï‡ÙÂÚÔ˜ Â›Ó·È Ô

ÁÏ˘Î·ÈÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙfiÛÔ Â-ÚÈÛÛfiÙÂÚÔ ÂÏ·ÙÙÒÓÂÙ·È Ô Î·Ú-‰È·ÁÁÂÈ·Îfi˜ Î›Ó‰˘ÓÔ˜ ÙˆÓ ‰È·-‚ËÙÈÎÒÓ ·ÛıÂÓÒÓ27.

∞™∫∏™∏

∏ ·ÂÚfi‚È· Î·È ·Ó·ÂÚfi‚È·¿ÛÎËÛË Ê·›ÓÂÙ·È fiÙÈ ÂÏ·ÙÙÒ-ÓÔ˘Ó ÛËÌ·ÓÙÈÎ¿ ÙËÓ Î·Ú‰È·Á-ÁÂÈ·Î‹ ÓÔÛËÚfiÙËÙ· Î·È ıÓËÛÈ-ÌfiÙËÙ· ÛÂ ·ÛıÂÓÂ›˜ ÌÂ Î·Ú-‰È·ÁÁÂÈ·Î‹ ÓfiÛÔ. ™˘ÓÈÛÙÒÓÙ·ÈÙÔ˘Ï¿¯ÈÛÙÔÓ 30 ÏÂÙ¿ Á˘ÌÓ·-ÛÙÈÎ‹˜ ËÌÂÚËÛ›ˆ˜ ÙÈ˜ ÂÚÈÛ-ÛfiÙÂÚÂ˜ ËÌ¤ÚÂ˜ ÙË˜ Â‚‰ÔÌ¿-‰·˜. ∂›ÛË˜, ¿ÛÎËÛË Û˘ÓÈÛÙ¿-Ù·È Î·È ÛÙ· Ï·›ÛÈ· ÚÔÁÚ¿Ì-Ì·ÙÔ˜ ·ÔÎ·Ù¿ÛÙ·ÛË˜ ·ÛıÂ-ÓÒÓ ÌÂ ¯ÚfiÓÈ· ÛÙ·ıÂÚ‹ ÛÙË-ı¿Á¯Ë, ÚfiÛÊ·ÙÔ ¤ÌÊÚ·ÁÌ·ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘, by passÎ·È/‹ Û˘ÛÙÔÏÈÎ‹ ‰˘ÛÏÂÈÙÔ˘Ú-Á›· ÙË˜ ·ÚÈÛÙÂÚ¿˜ ÎÔÈÏ›·˜28.

∞ÚÎÂÙ¤˜ ÌÂÏ¤ÙÂ˜ ¤‰ÂÈÍ·Ó ÙÔÚfiÏÔ ÙË˜ ¿ÛÎËÛË˜ ÛÙËÓ ÂÈ-‚Ú¿‰˘ÓÛË ÙË˜ ·ıËÚÔÛÎÏËÚ˘-ÓÙÈÎ‹˜ ‰È·‰ÈÎ·Û›·˜ Î·È ÙË ÌÂ›ˆ-ÛË ÙË˜ Î·Ú‰È·ÁÁÂÈ·Î‹˜ ıÓËÛÈ-ÌfiÙËÙ·˜ Î·È ÓÔÛËÚfiÙËÙ·˜29.

∫§∞™ª∞ ∂•ø£∏™∏™

∫¿ıÂ ·ÛıÂÓ‹˜ ÌÂ ÁÓˆÛÙ‹Î·Ú‰È·ÁÁÂÈ·Î‹ ÓfiÛÔ Ú¤ÂÈÓ· ˘Ô‚¿ÏÏÂÙ·È ÛÂ ÂÎÙ›ÌËÛËÙË˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙË˜ ·ÚÈÛÙÂ-Ú¿˜ ÎÔÈÏ›·˜ ÌÂ ÙË Ì¤ÙÚËÛËÙÔ˘ ÎÏ¿ÛÌ·ÙÔ˜ ÂÍÒıËÛË˜. ∆ÔÌÂÈˆÌ¤ÓÔ ÎÏ¿ÛÌ· ÂÍÒıËÛË˜Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂ ·˘ÍËÌ¤ÓÔ Î›Ó-‰˘ÓÔ ·ÂÈÏËÙÈÎÒÓ ÁÈ· ÙË ˙ˆ‹·ÚÚ˘ıÌÈÒÓ, Î·Ú‰È·Î‹˜ ·ÓÂ-¿ÚÎÂÈ·˜ Î·È ı·Ó¿ÙÔ˘.

∞ª∂∞: ∆Ô ¯·ÌËÏfi ÎÏ¿ÛÌ·ÂÍÒıËÛË˜, È‰È·›ÙÂÚ· ÌÂÙ¿·fi ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘ÔÎ·Ú‰›-Ô˘ ·ÔÙÂÏÂ› ÈÛ¯˘Ú‹ ¤Ó‰ÂÈÍËÁÈ· ÙË ¯ÔÚ‹ÁËÛË ∞ª∂∞, Î·-ıÒ˜ ÌÂÏ¤ÙÂ˜ Î·È ÌÂÙ·-·Ó·Ï‡-ÛÂÈ˜ ¤‰ÂÈÍ·Ó fiÙÈ Ë ¯ÔÚ‹ÁËÛË∞ª∂∞ Û˘Ì‚¿ÏÏÂÈ ÛËÌ·ÓÙÈÎ¿ÛÙË ÌÂ›ˆÛË ÙË˜ Î·Ú‰È·ÁÁÂÈ·-Î‹˜ ıÓËÛÈÌfiÙËÙ·˜ ÛÂ ·˘ÙÔ‡˜ÙÔ˘˜ ·ÛıÂÓÂ›˜30.

µ-·ÔÎÏÂÈÛÙ¤˜: ∆Ô ¯·ÌËÏfiÎÏ¿ÛÌ· ÂÍÒıËÛË˜, È‰È·›ÙÂÚ·ÌÂÙ¿ ·fi ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ô-


21

A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·21

Î·Ú‰›Ô˘, ·ÔÙÂÏÂ› ÈÛ¯˘Ú‹ ¤Ó-‰ÂÈÍË ÁÈ· ÙË ¯ÔÚ‹ÁËÛË ‚-·Ô-ÎÏÂÈÛÙÒÓ, Î·ıÒ˜ ÔÏÏ¤˜ ÌÂÏ¤-ÙÂ˜ ¤‰ÂÈÍ·Ó fiÙÈ Ë ¯ÔÚ‹ÁËÛË·˘ÙÒÓ ÙˆÓ Ê·ÚÌ¿ÎˆÓ ÌÂÈÒÓÂÈÛËÌ·ÓÙÈÎ¿ ÙËÓ Î·Ú‰È·ÁÁÂÈ·Î‹ıÓËÛÈÌfiÙËÙ· 31.

∞ÓÙ·ÁˆÓÈÛÙ¤˜ ÙË˜ ·Ï‰Ô-ÛÙÂÚfiÓË˜: ∏ ÛÂÈÚÔÓÔÏ·ÎÙfi-ÓË Î·È Ë ÂÏÂÚÂÓfiÓË ·ÓÙ·ÁˆÓ›-˙ÔÓÙ·È ÙË ‰Ú¿ÛË ÙË˜ ·Ï‰ÔÛÙÂ-ÚfiÓË˜ ÛÙËÓ Î·Ú‰È¿, ÂÓÒ ·˘Í¿-ÓÔ˘Ó ÙËÓ ·¤ÎÎÚÈÛË ÙÔ˘ Ó·ÙÚ›-Ô˘ Î·È ÌÂÈÒÓÔ˘Ó ÙËÓ ·¤ÎÎÚÈ-ÛË ÙÔ˘ Î·Ï›Ô˘. ∞ÛıÂÓÂ›˜ ÌÂ3Ô˘ ‹ 4Ô˘ ‚·ıÌÔ‡ Î·Ú‰È·Î‹·ÓÂ¿ÚÎÂÈ· Î·È/‹ Û˘ÛÙÔÏÈÎ‹‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÙË˜ ·ÚÈÛÙÂÚ¿˜ÎÔÈÏ›·˜ (ÎÏ¿ÛÌ· ÂÍÒıËÛË˜ ≤40%) Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÔ˘ÓÛÂÈÚÔÓÔÏ·ÎÙfiÓË (¤ˆ˜ Î·È 25mg/d) ‹ ÂÏÂÚÂÓfiÓË (¤ˆ˜ Î·È50 mg/d), ÂÎÙfi˜ ·Ó ˘¿Ú¯Ô˘Ó·ÓÙÂÓ‰Â›ÍÂÈ˜. √È Î‡ÚÈÂ˜ ·ÓÂÈ-ı‡ÌËÙÂ˜ ÂÓ¤ÚÁÂÈ¤˜ ÙÔ˘˜ Â›Ó·ÈË Á˘Ó·ÈÎÔÌ·ÛÙ›· Î·È Ô fiÓÔ˜ÛÙÔ ÛÙ‹ıÔ˜ (Î˘Ú›ˆ˜ ÌÂ ÙËÛÂÈÚÔÓÔÏ·ÎÙfiÓË) Î·È Ë ÛÔ‚·-

Ú‹ ˘ÂÚÎ·ÏÈ·ÈÌ›· ÙË˜ Ù¿ÍË˜ÙˆÓ 6,0 mEq/L‹ Î·È ÌÂÁ·Ï‡ÙÂ-ÚË (Î˘Ú›ˆ˜ ÌÂ ÂÏÂÚÂÓfiÓË).

¢·ÎÙ˘Ï›ÙÈ‰·: ∏ ‰·ÎÙ˘Ï›ÙÈ-‰· Ú¤ÂÈ Ó· ¯ÔÚËÁÂ›Ù·È ÛÂ·ÛıÂÓÂ›˜ ÌÂ Î·Ú‰È·Î‹ ·ÓÂ-¿ÚÎÂÈ· ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓÛ˘ÌÙˆÌ¿ÙˆÓ. √È Î‡ÚÈÂ˜ ·ÓÂ-Èı‡ÌËÙÂ˜ ÂÓ¤ÚÁÂÈÂ˜ ÙË˜ ‰·-ÎÙ˘Ï›ÙÈ‰·˜ Â›Ó·È ÔÈ ‰ÔÛÔ-ÂÍ·Ú-ÙÒÌÂÓÂ˜ ·ÚÚ˘ıÌ›Â˜, Ô ÎÔÏÔ-ÎÔÈÏÈ·Îfi˜ ·ÔÎÏÂÈÛÌfi˜ Ô˘Î·ı›ÛÙ·Ù·È Èı·ÓfiÙÂÚÔ˜ fiÙ·ÓÛ˘Ó˘¿Ú¯ÂÈ Î·È ˘ÔÎ·ÏÈ·ÈÌ›·Î·È/‹ ˘ÔÌ·ÁÓËÛÈ·ÈÌ›·, Ô ›ÏÈÁ-ÁÔ˜ (ÛÙÔ 5% ÙˆÓ ·ÛıÂÓÒÓ), ËÎÂÊ·Ï·ÏÁ›· (ÛÙÔ 3%), ÔÈ ‰È·-Ù·Ú·¯¤˜ ÙË˜ fiÚ·ÛË˜, ÔÈ Á·-ÛÙÚÂÓÙÂÚÈÎ¤˜ ‰È·Ù·Ú·¯¤˜, ÙÔÂÍ¿ÓıËÌ· Î·È Ë Èı·Ó‹ ·ÏÏË-ÏÂ›‰Ú·ÛË ÌÂ ¿ÏÏ· Ê¿ÚÌ·Î·.

∂ÌÊ˘ÙÂ˘fiÌÂÓÔ˜ ·˘ÙfiÌ·-ÙÔ˜ ·ÈÓÈ‰ˆÙ‹˜: ∂ÂÈ‰‹ ÔÈ·ÛıÂÓÂ›˜ ÌÂ ¤ÌÊÚ·ÁÌ· ÙÔ˘Ì˘ÔÎ·Ú‰›Ô˘ Î·È ÛËÌ·ÓÙÈÎÔ‡‚·ıÌÔ‡ Û˘ÛÙÔÏÈÎ‹ ‰˘ÛÏÂÈ-ÙÔ˘ÚÁ›· ÙË˜ ·ÚÈÛÙÂÚ¿˜ ÎÔÈÏ›·˜‰È·ÙÚ¤¯Ô˘Ó ·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ

·ÈÊÓÈ‰›Ô˘ Î·Ú‰È·ÎÔ‡ ı·Ó¿ÙÔ˘Ô˘ ÔÊÂ›ÏÂÙ·È ÛÂ ·ÚÚ˘ıÌ›Â˜, ËÂÌÊ‡ÙÂ˘ÛË ·˘ÙfiÌ·ÙÔ˘ ·ÈÓÈ-‰ˆÙ‹ ı· ÌÔÚÔ‡ÛÂ Ó· ·ÔÙÂ-Ï¤ÛÂÈ Ì›· ·Ô‰ÂÎÙ‹ Ï‡ÛË.

™Àª¶∂ƒ∞™ª∞∆∞

∏ ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ‰Â˘ÙÂ-ÚÔÁÂÓ‹˜ ÚfiÏË„Ë Î·Ú‰È·Á-ÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ Â›Ó·È ÎÂ-Ê·Ï·ÈÒ‰Ô˘˜ ÛËÌ·Û›·˜ ÁÈ· ÙËÌÂ›ˆÛË ÙÔ˘ Î·Ú‰È·ÁÁÂÈ·ÎÔ‡ÎÈÓ‰‡ÓÔ˘. ÃˆÚ›˜ ·ÔÙÂÏÂÛÌ·-ÙÈÎ¤˜ ÛÙÚ·ÙËÁÈÎ¤˜ ÚfiÏË„Ë˜,Ë Î·Ú‰È·ÁÁÂÈ·Î‹ ıÓËÛÈÌfiÙËÙ·ÌÔÚÂ› Ó· Êı¿ÛÂÈ ÙÔ 10% ·Ó¿¤ÙÔ˜. ¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ¤¯Ô˘Ó ·Ó·Ù˘¯ıÂ› ·ÚÎÂÙ¿ÚÔÁÚ¿ÌÌ·Ù· Ô˘ ¤¯Ô˘Ó ÛÙfi-¯Ô ÙËÓ ·ÏÔ‡ÛÙÂ˘ÛË ÙË˜ Ô-Ï˘·Ú·ÁÔÓÙÈÎ‹˜ ÚÔÛ¤ÁÁÈÛË˜ÙÔ˘ Î·Ú‰È·ÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘,¤Ó·˜ ·ÛıÂÓ‹˜ ÌÂ Î·Ú‰È·ÁÁÂÈ-·Î‹ ÓfiÛÔ Ú¤ÂÈ Û‹ÌÂÚ· Ó·¿ÚÂÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ 5 ÛÎÂ˘¿-ÛÌ·Ù· ÁÈ· ÙËÓ fiÛÔ ÙÔ ‰˘Ó·ÙfiÓÌÂÁ·Ï‡ÙÂÚË ÌÂ›ˆÛË ÙÔ˘ Î·Ú-


22

A

AÓÙÈ·ÈÌÔÂÙ·ÏÈ·Î¿ Ê¿ÚÌ·Î·:ñ ∞ÛÈÚ›ÓËñ ∫ÏÔÈ‰ÔÁÚ¤ÏË

∞ª∂∞ Î·È ∞ÔÎÏÂÈÛÙ¤˜ ÙˆÓ ∞∆1 ˘Ô‰Ô¯¤ˆÓ ÛÂ:ñ ∫∞ñ ¢˘ÛÏÂÈÙÔ˘ÚÁ›·

∞∫ñ ¶ÚfiÛÊ·ÙÔ

√∂ª

∞ÓÙÈËÎÙÈÎ‹ ·ÁˆÁ‹ ÛÂ:ñ ∫ÔÏÈÎ‹ Ì·ÚÌ·-

Ú˘Á‹ñ ªÂÙ¿ ·fi √∂ª

fiÙ·Ó ·ÓÙÂÓ‰Â›-ÎÓ˘Ù·È Ë ·ÛÈÚ›-ÓË

B

BP control(ƒ‡ıÌÈÛË ∞¶) ÌÂ:ñ ∞ª∂∞ñ µ-·ÔÎÏÂÈÛÙ¤˜ñ ¢ÈÔ˘ÚËÙÈÎ¿ñ ∞ÓÙ·ÁˆÓÈÛÙ¤˜

ALDOñ ∞ÔÎÏÂÈÛÙ¤˜ ÙˆÓ

∞∆1 ˘Ô‰Ô¯¤ˆÓñ ∞ÓÙ·ÁˆÓÈÛÙ¤˜

·Û‚ÂÛÙ›Ô˘

B-·ÔÎÏÂÈÛÙ¤˜ ÛÂ:ñ √∂ªñ ∫∞ñ À¤ÚÙ·ÛË

C

Cholesterol management(ƒ‡ıÌÈÛË ¯ÔÏËÛÙÂÚfiÏË˜) ÌÂ:ñ ™Ù·Ù›ÓÂ˜ ñ ºÈÌÚ¿ÙÂ˜ñ ¡ÈÎÔÙÈÓÈÎfi ÔÍ‡

Smoking Cessation(¢È·ÎÔ‹ Î·Ó›ÛÌ·ÙÔ˜) ÌÂ:ñ ™˘Ì‚Ô˘ÏÂ˘ÙÈÎ‹

·Ú¤Ì‚·ÛËñ º·ÚÌ·ÎÂ˘ÙÈÎ‹

‚Ô‹ıÂÈ· (‚Ô˘-ÚÔÚÈfiÓË, ‰ÂÚ-Ì·ÙÈÎ¿ ·˘ÙÔÎfiÏ-ÏËÙ· ÓÈÎÔÙ›ÓË˜)

D

Diet and weightmanagement(¢›·ÈÙ· Î·È Ú‡ıÌÈÛË ™.µ.) ÌÂ:ñ ∞ÒÏÂÈ· 500

kcal/d

Diabetes mellitus™·Î¯·ÚÒ‰Ë˜ ¢È·‚‹ÙË˜¶ÚfiÏË„Ë (˘ÁÈÂÈÓÔ‰È·ÈÙËÙÈÎ‹ ·ÁˆÁ‹)£ÂÚ·Â›· (™Ùfi¯Ô˜:HbA1c <7%)

E

∂xercise(ÕÛÎËÛË)ñ ∞ÂÚfi‚È·ñ ∞Ó·ÂÚfi‚È·

∫Ï¿ÛÌ· ∂ÍÒıËÛË˜ŸÙ·Ó Â›Ó·È ¯·ÌËÏfi:ñ ∞ª∂∞ñ µ-·ÔÎÏÂÈÛÙ¤˜ñ ¢·ÎÙ˘Ï›ÙÈ‰·ñ ∞˘ÙfiÌ·ÙÔ˜

·ÈÓÈ‰ˆÙ‹˜ñ ∞ÓÙ·ÁˆÓÈÛÙ¤˜

ALDO

¶π¡∞∫∞™. √¢∏°π∂™ °π∞ ∆∏ ¢∂À∆∂ƒ√°∂¡∏ ¶ƒ√§∏æ∏ ∆∏™ ∫∞ƒ¢π∞°°∂π∞∫∏™ ¡√™√À

™˘ÓÙÔÌÔÁÚ·Ê›Â˜:∫∞ = Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ·∞ª∂∞ = ·Ó·ÛÙÔÏÂ›˜ ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ ÙË˜ ·ÁÁÂÈ-

ÔÙÂÓÛ›ÓË˜

√∂ª = ÔÍ‡ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘ALDO = ·Ï‰ÔÛÙÂÚfiÓË∞∫ = ·ÚÈÛÙÂÚ¿ ÎÔÈÏ›·

A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·22

‰È·ÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘. ∆Ô Îfi-ÛÙÔ˜, Ë ·ÓËÛ˘¯›· Û¯ÂÙÈÎ¿ ÌÂÙË Û˘Ì‚·ÙfiÙËÙ· ÙˆÓ ıÂÚ·-Â˘ÙÈÎÒÓ Û¯ËÌ¿ÙˆÓ Î·È ÙÈ˜ È-ı·Ó¤˜ ·ÏÏËÏÂÈ‰Ú¿ÛÂÈ˜ ÌÂÙ·-Í‡ ÙˆÓ Ê·ÚÌ¿ÎˆÓ Î¿ÓÔ˘Ó ·Ú-ÎÂÙÔ‡˜ ÁÈ·ÙÚÔ‡˜ ÙË˜ ÚˆÙÔ-

‚¿ıÌÈ·˜ ÊÚÔÓÙ›‰·˜ ˘ÁÂ›·˜ Ó·ÚÔ‚ÏËÌ·Ù›˙ÔÓÙ·È ÁÈ· Ù· ÔÊ¤-ÏË Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi ·˘Ù‹ÙËÓ ÔÏ˘Ê·ÚÌ·Î›·. ∏ ‡·ÚÍËÛ˘ÁÎÂÎÚÈÌ¤ÓˆÓ Î·ÙÂ˘ı˘ÓÙ‹-ÚÈˆÓ Ô‰ËÁÈÒÓ Â›Ó·È ÂÍ·ÈÚÂÙÈ-Î‹˜ ÛËÌ·Û›·˜, Î·ıÒ˜ ÌÔ-

ÚÔ‡Ó Ó· ÏÂÈÙÔ˘ÚÁ‹ÛÔ˘Ó ˆ˜¤Ó· Ï·›ÛÈÔ ¿Óˆ ÛÙÔ ÔÔ›ÔÌÔÚÂ› Ó· ‚·ÛÈÛıÂ› ¤Ó· ÂÍ·-ÙÔÌÈÎÂ˘Ì¤ÓÔ Û¯¤‰ÈÔ ‰Ú¿ÛË˜ÌÂ ÛÙfi¯Ô ÙË ÌÂ›ˆÛË ÙË˜ Î·Ú-‰È·ÁÁÂÈ·Î‹˜ ıÓËÛÈÌfiÙËÙ·˜ Î·ÈÓÔÛËÚfiÙËÙ·˜.


23

1. Antiplatelet Trialists' Collaboration. Se-condary prevention of vascular disea-se by prolonged antiplatelet treatment.Br Med J (Clin Res Ed). 1988;296:320-331.

2. CAPRIE Steering Committee. A rando-mised, blinded, trial of clopidogrel ver-sus aspirin in patients at risk of ischae-mic events (CAPRIE). Lancet. 1996;348:1329-1339.

3. Peters RJ, Zhao F, Lewis BS, et al.Aspirin dose and bleeding events inthe CURE study. Eur Heart J. 2002;4(suppl):S510.

4. Hurlen M, Abdelnoor M, Smith P,Erikssen J, Arnesen H. Warfarin, aspi-rin, or both after myocardial infarction.N Engl J Med. 2002;347:969-974.

5. Anand SS, Yusuf S. Oral anticoagulanttherapy in patients with coronary arterydisease: a meta-analysis. JAMA. 1999;282:2058-2067.

6. The Acute Infarction Ramipril Efficacy(AIRE) study investigators. Effect oframipril on mortality and morbidity ofsurvivors of acute myocardial infar-ction with clinical evidence of heartfailure. Lancet. 1993;342:821-828.

7. Kober L, Torp-Pedersen C, CarlsenJE, et al, for the Trandolapril CardiacEvaluation (TRACE) Study Group. Aclinical trial of the angiotensin-conver-ting-enzyme inhibitor trandolapril inpatients with left ventricular dysfun-ction after myocardial infarction. NEngl J Med. 1995;333:1670-1676.

8. Pfeffer MA, Braunwald E, Moye LA, etal, for the SAVE Investigators. Effect ofcaptopril on mortality and morbidity inpatients with left ventricular dysfun-ction after myocardial infarction: re-sults of the survival and ventricularenlargement trial. N Engl J Med. 1992;327:669-677.

9. Lewis EJ, Hunsicker LG, Clarke WR, etal. Renoprotective effect of the angio-tensin-receptor antagonist irbesartanin patients with nephropathy due to ty-pe 2 diabetes. N Engl J Med. 2001;345:851-860.

10. Jong P, Demers C, McKelvie RS, LiuPP. Angiotensin receptor blockers inheart failure: meta-analysis of rando-mized controlled trials. J Am Coll Car-diol. 2002;39:463-470.

11. Gueyffier F, Boutitie F, Boissel JP, etal, for the INDANA Investigators. Effectof antihypertensive drug treatment oncardiovascular outcomes in womenand men: a meta-analysis of individualpatient data from randomized,

controlled trials. Ann Intern Med.1997;126:761-767.

12. ALLHAT Officers and Coordinators forthe ALLHAT Collaborative ResearchGroup. Major outcomes in high-riskhypertensive patients randomized toangiotensin-converting enzyme inhibi-tor or calcium channel blocker vs diu-retic: the Antihypertensive and Lipid-Lowering Treatment to Prevent HeartAttack Trial (ALLHAT). JAMA. 2002;288:2981-2997.

13. Timolol-induced reduction in mortalityand reinfarction in patients survivingacute myocardial infarction. N Engl JMed. 1981;304:801-807.

14. A randomized trial of propranolol inpatients with acute myocardial infar-ction ,II: morbidity results. JAMA.1983; 250:2814-2819.

15. Freemantle N, Cleland J, Young P,Mason J, Harrison J. Beta Blockadeafter myocardial infarction: systematicreview and meta regression analysis.BMJ. 1999;318:1730-1737.

16. Executive Summary of the Third Re-port of the National Cholesterol Edu-cation Program (NCEP) Expert Panelon Detection, Evaluation, and Treat-ment of High Blood Cholesterol inAdults (Adult Treatment Panel III).JAMA. 2001;285:2486-2497.

17. Heart Protection Study CollaborativeGroup. MRC/BHF Heart ProtectionStudy of cholesterol lowering with sim-vastatin in 20,536 high-risk individuals:a randomised placebo-controlled trial.Lancet. 2002;360:7-22.

18. Randomised trial of cholesterol lowe-ring in 4444 patients with coronaryheart disease: the Scandinavian Sim-vastatin Survival Study (4S). Lancet.1994;344:1383-1389.

19. Sacks FM, Pfeffer MA, Moye LA, et al,for the Cholesterol and RecurrentEvents Trial investigators. The effect ofpravastatin on coronary events aftermyocardial infarction in patients withaverage cholesterol levels. N Engl JMed. 1996;335:1001-1009.

20. The Long-Term Intervention With Pra-vastatin in Ischaemic Disease (LIPID)Study Group. Prevention of cardiova-scular events and death with pravasta-tin in patients with coronary heart di-sease and a broad range of initial cho-lesterol levels. N Engl J Med.1998;339:1349-1357.

21. Pierce LR, Wysowski DK, Gross TP.Myopathy and rhabdomyolysis asso-ciated with lovastatin-gemfibrozil com-

bination therapy. JAMA. 1990;264:71-75.

22. Rubins HB, Robins SJ, Collins D, et al,for the Veterans Affairs High-DensityLipoprotein Cholesterol InterventionTrial Study Group. Gemfibrozil for thesecondary prevention of coronaryheart disease in men with low levels ofhigh-density lipoprotein cholesterol. NEngl J Med. 1999;341:408-418.

23. Jorenby DE, Leischow SJ, Nides MA,et al. A controlled trial of sustained-release bupropion, a nicotine patch, orboth for smoking cessation. N Engl JMed. 1999;340:685-691.

24. de Lorgeril M, Salen P, Martin JL, Mon-jaud I, Delaye J, Mamelle N. Mediterra-nean diet, traditional risk factors, andthe rate of cardiovascular complica-tions after myocardial infarction: finalreport of the Lyon Diet Heart Study.Circulation. 1999;99:779-785.

25. Wilson P. Epidemiology of hyperglyce-mia and atherosclerosis. In: RudermanN, ed. Hyperglycemia, Diabetes andthe Vascular Disease. New York, NY:Oxford University Press; 1992:21-29.

26. American Diabetes Association. Posi-tion statement: standards of medicalcare for patients with diabetes melli-tus. Diabetes Care. 2003;26(suppl):S33-S50.

27. Stratton IM, Adler AI, Neil HA, et al. As-sociation of glycaemia with macrovas-cular and microvascular complicationsof type 2 diabetes (UKPDS 35): pro-spective observational study. BMJ.2000;321:405-412.

28. Ades PA. Cardiac rehabilitation andsecondary prevention of coronaryheart disease. N Engl J Med. 2001;345:892-902.

29. Manson JE, Greenland P, LaCroix AZ,et al. Walking compared with vigorousexercise for the prevention of cardiova-scular events in women. N Engl J Med.2002;347:716-725.

30. The CONSENSUS Trial Study Group.Effects of enalapril on mortality in se-vere congestive heart failure: results ofthe Cooperative North ScandinavianEnalapril Survival Study (CONSEN-SUS). N Engl J Med. 1987;316:1429-1435.

31. Brophy JM, Joseph L, Rouleau JL.Beta-blockers in congestive heartfailure: a Bayesian meta-analysis. AnnIntern Med. 2001;134:550-560.


A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·23

1: Dorval JF, Anderson T, Buithieu J, ChanS, Hutchison S, Huynh T, Jobin J, Lonn E,Poirier P, Title L, Walling A, Tran T, Boud-reau G, Charbonneau F, Genest J. Rea-ching recommended lipid and bloodpressure targets with amlodipine/atorva-statin combination in patients with coro-nary heart disease. Am J Cardiol. 2005Jan 15;95(2):249-53.

2: Nissen SE, Tuzcu EM, Schoenhagen P,Crowe T, Sasiela WJ, Tsai J, Orazem J,Magorien RD, O'Shaughnessy C, Ganz P;Reversal of Atherosclerosis with Aggres-sive Lipid Lowering (REVERSAL) Investiga-tors. Statin therapy, LDL cholesterol, C-rea-ctive protein, and coronary artery disease.N Engl J Med. 2005 Jan 6;352(1):29-38.

3: Ridker PM, Cannon CP, Morrow D, RifaiN, Rose LM, McCabe CH, Pfeffer MA,Braunwald E; Pravastatin or AtorvastatinEvaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22(PROVE IT-TIMI 22) Investigators. C-reactive protein levels and outcomes afterstatin therapy. N Engl J Med. 2005 Jan6;352(1):20-8.

4: Davidson MH. High-dose statins in acutecoronary syndromes. JAMA. 2005 Jan5;293(1):38; author reply 38-9.

5: Schachter M. Chemical, pharmacokineticand pharmacodynamic properties of sta-tins: an update. Fundam Clin Pharmacol.2005 Feb;19(1):117-125.

6: Jones PH, McKenney JM, Karalis DG,Downey J. Comparison of the efficacy andsafety of atorvastatin initiated at differentstarting doses in patients with dysli-pidemia. Am Heart J. 2005 Jan; 149(1):e1.

7: Saito M, Hirata-Koizumi M, Urano T, Miya-ke S, Hasegawa R. A literature search onpharmacokinetic drug interactions ofstatins and analysis of how suchinteractions are reflected in packageinserts in Japan. J Clin Pharm Ther. 2005Feb;30(1):21-37.

8: Orem C, Uydu HA, Yilmaz R, Gokce M,Baykan M, Eminagaoglu S, Orem A. Theeffects of atorvastatin treatment on the fi-brinolytic system in dyslipidemic patients.Jpn Heart J. 2004 Nov;45(6):977-87.

9: Okopien B, Huzarska M, Kulach A, Sta-chura-Kulach A, Madej A, Belowski D, Zie-linski M, Herman ZS. HypolipidemicDrugs Affect Monocyte IL-1beta Gene Ex-pression and Release in Patients with IIaand IIb Dyslipidemia. J Cardiovasc Phar-macol. 2005 Feb;45(2):160-4.

10: Bennett S, Sager P, Lipka L, Melani L, Su-resh R, Veltri E. Consistency in efficacyand safety of ezetimibe coadministeredwith statins for treatment of hyperchole-sterolemia in women and men. J WomensHealth (Larchmt). 2004 Dec; 13(10):1101-7.

11: Nash MS, Johnson BM, Jacobs PL. Com-bined hyperlipidemia in a single subjectwith tetraplegia: ineffective risk reductionafter atorvastatin monotherapy. J SpinalCord Med. 2004;27(5):484-7.

12: van Wissen S, Smilde TJ, Trip MD, Stalen-hoef AF, Kastelein JJ. Long-term safetyand efficacy of high-dose atorvastatintreatment in patients with familial hyper-cholesterolemia. Am J Cardiol. 2005 Jan15;95(2):264-6.

13: Ohkawara H, Ishibashi T, Sakamoto T,Sugimoto K, Nagata K, Yokoyama K, Sa-kamoto N, Kamioka M, Matsuoka I, Fuku-hara S, Sugimoto N, Takuwa Y, Maruya-

ma Y. Thrombin-induced rapid geranylge-ranylation of RhoA as an essential pro-cess for RhoA activation in endothelialcells. J Biol Chem. 2005 Jan 7; [Epubahead of print]

14: Strandberg TE, Feely J, Sigurdsson EL;DISCOVERY study group. Twelve-week,multicenter, randomized, open-label com-parison of the effects of rosuvastatin 10mg/d and atorvastatin 10 mg/d in high-risk adults: a DISCOVERY study. ClinTher. 2004 Nov;26(11):1821-33.

15: Birnbaum Y, Ye Y, Rosanio S, Tavackoli S,Hu ZY, Schwarz ER, Uretsky BF. Prostag-landins mediate the cardioprotective ef-fects of atorvastatin against ischemia-re-perfusion injury. Cardiovasc Res. 2005Feb 1;65(2):345-55.

16: Puccetti L, Sawamura T, Pasqui AL, Pasto-relli M, Auteri A, Bruni F. Atorvastatin redu-ces platelet-oxidized-LDL receptor expres-sion in hypercholesterolaemic patients.Eur J Clin Invest. 2005 Jan; 35(1):47-51.

17: Deedwania PC; Study Assessing Goals inthe Elderly steering committee andinvestigators. Effect of aggressive versusmoderate lipid-lowering therapy on myo-cardial ischemia: the rationale, design,and baseline characteristics of the StudyAssessing Goals in the Elderly (SAGE).Am Heart J. 2004 Dec;148(6): 1053-9.

18: Lipka L, Sager P, Strony J, Yang B, SureshR, Veltri E. Efficacy and safety of coadmi-nistration of ezetimibe and statins in elder-ly patients with primary hypercholestero-laemia. Drugs Aging. 2004;21(15):1025-32.

19: Takechi R, Hiramatsu N, Mamo JC, Pal S.Red wine polyphenolics suppress thesecretion and the synthesis of Apo B48from human intestinal CaCo-2 cells.Biofactors. 2004;22(1-4):181-3.

20: Lorkowska B, Chlopicki S. Statins ascoronary vasodilators in isolated bovinecoronary arteries-involvement of PGI(2)and NO. Prostaglandins Leukot EssentFatty Acids. 2005 Feb;72(2):133-8.

21: Muck AO, Seeger H, Wallwiener D. Inhibi-tory effect of statins on the proliferation ofhuman breast cancer cells. Int J Clin Phar-macol Ther. 2004 Dec;42(12): 695-700.

22: Croom KF, Plosker GL. Atorvastatin: a re-view of its use in the primary prevention ofcardiovascular events in patients with type2 diabetes mellitus. Drugs. 2005;65(1):137-52.

23: Kushiya F, Wada H, Ooi K, Sakurai Y,Sakaguchi A, Noda M, Abe Y, Nakasaki T,Tsukada T, Shiku H, Nobori T. Effects ofatorvastatin on serum lipids, lipoproteins,and hemostasis. Am J Hematol. 2005Jan;78(1):1-6.

24: Pannu R, Barbosa E, Singh AK, Singh I.Attenuation of acute inflammatory respon-se by atorvastatin after spinal cord injuryin rats. J Neurosci Res. 2005 Feb1;79(3):340-50.

25: Tousoulis D, Antoniades C, Bosinakou E,Kotsopoulou M, Tsioufis C, Tentolouris C,Trikas A, Pitsavos C, Stefanadis C. Effectsof atorvastatin on reactive hyperaemiaand the thrombosis-fibrinolysis system inpatients with heart failure. Heart. 2005Jan;91(1):27-31.

26: Palmer G, Chobaz V, Talabot-Ayer D, Tay-lor S, So A, Gabay C, Busso N. Assess-ment of the efficacy of different statins inmurine collagen-induced arthritis. ArthritisRheum. 2004 Dec;50(12):4051-9.

27: Soliman MF, Ibrahim MM. Antischistoso-mal action of atorvastatin alone and con-currently with medroxyprogesterone ace-tate on Schistosoma haematobium har-boured in hamster: surface ultrastructureand parasitological study. Acta Trop.2005 Jan;93(1):1-9.

28: Lawman S, Mauri C, Jury EC, Cook HT,Ehrenstein MR. Atorvastatin inhibits auto-reactive B cell activation and delays lupusdevelopment in New Zealand black/whiteF1 mice. J Immunol. 2004 Dec15;173(12):7641-6.

29: Castro Cabezas M, Verseyden C, Meijs-sen S, Jansen H, Erkelens DW. Effects ofatorvastatin on the clearance of triglyceri-de-rich lipoproteins in familial combinedhyperlipidemia. J Clin Endocrinol Metab.2004 Dec; 89(12):5972-80.

30: Chan KY, Boucher ES, Gandhi PJ, SilvaMA. HMG-CoA reductase inhibitors forlowering elevated levels of C-reactiveprotein. Am J Health Syst Pharm. 2004Aug 15;61(16):1676-81.

31: Psaty BM, Furberg CD, Ray WA, WeissNS. Potential for conflict of interest in theevaluation of suspected adverse drugreactions: use of cerivastatin and risk ofrhabdomyolysis. JAMA. 2004 Dec1;292(21):2622-31.

32: Graham DJ, Staffa JA, Shatin D, AndradeSE, Schech SD, La Grenade L, GurwitzJH, Chan KA, Goodman MJ, Platt R.Incidence of hospitalized rhabdomyolysisin patients treated with lipid-loweringdrugs. JAMA. 2004 Dec 1;292(21):2585-90. Epub 2004 Nov 22.

33: McGirt MJ, Woodworth GF, Lynch JR,Laskowitz DT. Synthes Award for ResidentResearch in Spinal Cord & Spinal ColumnInjury: Statins for the treatment of neurolo-gical injury: a role beyond cholesterol lo-wering. Clin Neurosurg. 2004;51:320-8.No abstract available.

34: Pimpinella G, Bertini Malgarini R, MartiniN. Statins for patients with type 2 diabetes.Lancet. 2004 Nov 27;364(9449): 1933.

35: Wagner AM, Ordonez-Llanos J, Jorba O,Perez A. Predictors of change in low-den-sity lipoprotein size during lipid-loweringtreatment in type 2 diabetes. Metabolism.2004 Nov;53(11):1516.

36: Kida Y. Statins and rheumatoid arthritis.Lancet. 2004 Nov 20;364(9448):1854-5.

37: Van Doornum S, McColl G, Wicks IP. Ator-vastatin reduces arterial stiffness in pa-tients with rheumatoid arthritis. AnnRheum Dis. 2004 Dec;63(12):1571-5.

38: Silver MA, Langsjoen PH, Szabo S, PatilH, Zelinger A. Effect of atorvastatin on leftventricular diastolic function and ability ofcoenzyme Q10 to reverse that dysfun-ction. Am J Cardiol. 2004 Nov15;94(10):1306-10.

39: Lu D, Mahmood A, Qu C, Goussev A, LuM, Chopp M. Atorvastatin reduction ofintracranial hematoma volume in ratssubjected to controlled cortical impact. JNeurosurg. 2004 Nov;101(5):822-5.

40: Lu D, Mahmood A, Goussev A, SchallertT, Qu C, Zhang ZG, Li Y, Lu M, Chopp M.Atorvastatin reduction of intravascularthrombosis, increase in cerebralmicrovascular patency and integrity, andenhancement of spatial learning in ratssubjected to traumatic brain injury. JNeurosurg. 2004 Nov;101(5):813-21.

∂ÈÌ¤ÏÂÈ·: µ·Û›ÏÂÈÔ˜ Õı˘ÚÔ˜


24

¶ƒ√∆∂π¡√ª∂¡∏ µπµ§π√°ƒ∞ºπ∞

A£HPO™K§HPø™H 5 22-02-05 20:44 ™ÂÏ›‰·24

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

£Âfi‰ˆÚÔ˜ ¡ÙfiÏ·Ù˙·˜

√ £Âfi‰ˆÚÔ˜ ¡ÙfiÏ·Ù˙·˜ ÁÂÓÓ‹ıËÎÂ ÛÙËÓ ∞ı‹Ó· ÙÔ 1946 (24-2-1946). ∞fi ÙËÓ ·È‰ÈÎ‹ ÙÔ˘ ËÏÈÎ›· ·Û¯ÔÏÂ›Ù·È ÌÂ ÙËÓ Ù¤-¯ÓË. ™Â ËÏÈÎ›· ‰ÂÎ·ÙÂÛÛ¿ÚˆÓ (14) ÂÙÒÓ, 1960, ˙ˆÁÚ·Ê›˙ÂÈ ÚÔÛˆÔÁÚ·Ê›Â˜ ÌÂ ÌÔÏ‡‚È. ∆ÂÏÂÈÒÓÂÈ ÙÔ °˘ÌÓ¿ÛÈÔ ÙÔ˘ ¢‹-ÌÔ˘ ∆·‡ÚÔ˘ Î·È ¤‰ˆÛÂ ÂÍÂÙ¿ÛÂÈ˜, 1964, ÛÙË ™¯ÔÏ‹ ∫·ÏÒÓ ∆Â¯ÓÒÓ, ÛÙËÓ π·ÙÚÈÎ‹, ÛÙË º·ÚÌ·ÎÂ˘ÙÈÎ‹ Î·È ÛÙÔ ÃËÌÈÎfiÙÌ‹Ì·. ∂¤Ú·ÛÂ ÛÂ fiÏÂ˜ ÙÈ˜ Û¯ÔÏ¤˜, ÙÔÓ ·ÔÚÚfiÊËÛÂ, fiÌˆ˜, Ë π·ÙÚÈÎ‹. ∆Ô 1970 Ù¤ÏÂÈˆÛÂ ÙËÓ π·ÙÚÈÎ‹ Û¯ÔÏ‹ ÙÔ˘ ¶·ÓÂ-ÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ Î·È ÛÙË Û˘Ó¤¯ÂÈ· ÂÍÂÈ‰ÈÎÂ‡ÙËÎÂ ÛÙË ¯ÂÈÚÔ˘ÚÁÈÎ‹ Î·È È‰È·›ÙÂÚ· ÛÙËÓ ·È‰Ô¯ÂÈÚÔ˘ÚÁÈÎ‹. ŒÏ·‚Â ÙÔÓÙ›ÙÏÔ ÙË˜ ÂÈ‰ÈÎfiÙËÙ·˜ ÙÔ 1980. ∆ÒÚ· ˘ËÚÂÙÂ› ÛÙÔ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ ∞Á›· ™ÔÊ›· (¢/ÓÙ‹˜ ∞’ ¶·È‰Ô¯ÂÈÚÔ˘ÚÁÈÎ‹˜ ∫ÏÈ-ÓÈÎ‹˜).

∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÌÂÙÂÎ·›‰Â˘Û‹˜ ÙÔ˘ ÛÙÔ ÂÍˆÙÂÚÈÎfi ·Ú·ÎÔÏÔ‡ıËÛÂ Ì·ı‹Ì·Ù· ˙ˆÁÚ·ÊÈÎ‹˜ ÛÂ ÂÏÂ‡ıÂÚ·ÂÚÁ·ÛÙ‹ÚÈ· ˙ˆÁÚ·ÊÈÎ‹˜ (πÙ·Ï›·˜ - πÛ·Ó›·˜) Î·ıÒ˜ Î·È ÎÔÓÙ¿ ÛÂ ¤ÌÂÈÚÔ˘˜ ˙ˆÁÚ¿ÊÔ˘˜ ÛÙËÓ ∂ÏÏ¿‰· Î·È ÛÙÔ ÂÍˆÙÂ-ÚÈÎfi.

∂› Û·Ú¿ÓÙ· (40) Û˘Ó·Ù¿ ¤ÙË ‰ÂÓ ÛÙ·Ì¿ÙËÛÂ Ó· ˙ˆÁÚ·Ê›˙ÂÈ. ∞ÎfiÌ· Î·È ÙÈ˜ ‰‡ÛÎÔÏÂ˜ ÒÚÂ˜ ÙË˜ ÂÊËÌÂÚ›·˜ ÙÔ˘ ÛÙ·‰È¿ÊÔÚ· ÓÔÛÔÎÔÌÂ›· ˙ˆÁÚ¿ÊÈ˙Â ÌÂ ·ÎÔ˘·Ú¤ÏÂ˜, Ù¤ÌÂÚÂ˜ ‹ ‰ËÌÈÔ˘ÚÁÔ‡ÛÂ ‰È¿ÊÔÚÂ˜ Û˘Óı¤ÛÂÈ˜ ‹ ÁÂÏÔÈÔÁÚ·Ê›Â˜.

⁄ÛÙÂÚ· ·fi ÌÂÏ¤ÙË Î·È ·ÚÎÂÙ‹ ÂÌÂÈÚ›· ¿Óˆ ÛÙË ˙ˆÁÚ·ÊÈÎ‹ ÛÂ Î¿ıÂ ˘ÏÈÎfi, ÂÌÓÂ‡ÛÙËÎÂ Î·È ·Ó·Î¿Ï˘„Â ÙË˙ˆÁÚ·ÊÈÎ‹ ÌÂ È·ÙÚÈÎ¿ - ·Ó·ÏÒÛÈÌ· ˘ÏÈÎ¿ Ô˘ ÙËÓ ÔÓfiÌ·ÛÂ “medical art”. ª¤¯ÚÈ Û‹ÌÂÚ· ¤¯ÂÈ ˙ˆÁÚ·Ê›ÛÂÈ ¿Óˆ ·fi4.000 ›Ó·ÎÂ˜ (ÂÏ·ÈÔÁÚ·Ê›Â˜ - ·ÂÚÔÁÚ·Ê›Â˜ - ·ÁÈÔÁÚ·Ê›Â˜ - Û˘Óı¤ÛÂÈ˜ - ·ÎÔ˘·Ú¤ÏÂ˜ - Ù¤ÌÂÚÂ˜ - Û¯¤‰È· - ·ÛÙ¤Ï -·ÎÚ˘ÏÈÎ¿ Î.¿.). Œ¯ÂÈ Â›ÛË˜ Î·Ù·ÛÎÂ˘¿ÛÂÈ ‰È¿ÊÔÚÂ˜ ÁÏ˘ÙÈÎ¤˜ Û˘Óı¤ÛÂÈ˜ ÌÂ Í‡ÏÔ, Ì¤Ù·ÏÏÔ, Á˘„ÔÙ·ÈÓ›Â˜ Î.¿.. Œ¯ÂÈÂ›ÛË˜ ÂÈÎÔÓÔÁÚ·Ê‹ÛÂÈ ‰‡Ô ÌÂÁ¿ÏÂ˜ È·ÙÚÈÎ¤˜ ÂÁÎ˘ÎÏÔ·›‰ÂÈÂ˜, Î·È ¤¯ÂÈ ‰ËÌÈÔ˘ÚÁ‹ÛÂÈ ·È‰ÈÎ¿ ·Ú·Ì‡ıÈ· (ÎÂ›ÌÂÓÔ Î·ÈÂÈÎÔÓÔÁÚ¿ÊËÛË). Œ¯ÂÈ Û˘ÓÙ¿ÍÂÈ ÙÔ Î·Ù·ÛÙ·ÙÈÎfi ÙË˜ ∂ÏÏËÓÈÎ‹˜ ∂Ù·ÈÚ›·˜ π·ÙÚÒÓ ∫·ÏÏÈÙÂ¯ÓÒÓ Î·È ¤¯ÂÈ ÔÚÁ·ÓÒÛÂÈ ‰ÂÎ·-ÂÓÓ¤· (19) –Ì¤¯ÚÈ Û‹ÌÂÚ·– ·ÓÂÏÏ‹ÓÈÂ˜ ÂÎı¤ÛÂÈ˜ ÌÂ ÙËÓ ∂.∂.π.∫..

√ £Âfi‰ˆÚÔ˜ ¡ÙfiÏ·Ù˙·˜ Â›Ó·È ·ÈÚÂÙfi˜ ÚfiÂ‰ÚÔ˜ ÙË˜ ∂.∂.π.∫. ·fi ÙÔ 1990 Ô˘ ‰ËÌÈÔ˘ÚÁ‹ıËÎÂ Ë ∂.∂.π.∫.. ∂›Ó·È Â›-ÛË˜ ÁÂÓÈÎfi˜ ÁÚ·ÌÌ·Ù¤·˜ ÙË˜ UMAM (Union Artist Medecin).

Œ¯ÂÈ ÁÚ¿„ÂÈ Î·È ¤¯ÂÈ ÂÈÎÔÓÔÁÚ·Ê‹ÛÂÈ ÔÏÏ¿ ‚È‚Ï›· Ù¤¯ÓË˜ Î·È ÔÏÏ¿ Û¯ÂÙÈÎ¿ ¿ÚıÚ· Ô˘ ¤¯Ô˘Ó ‰ËÌÔÛÈÂ˘ıÂ› ÛÂ¤ÁÎ˘Ú· ÂÚÈÔ‰ÈÎ¿. Œ¯ÂÈ ¿ÚÂÈ ¤ÍÈ (6) Î·ÏÏÈÙÂ¯ÓÈÎ¿ ‚Ú·‚Â›·. ŒÚÁ· ÙÔ˘ ˘¿Ú¯Ô˘Ó ÛÂ ÔÏÏ¤˜ È‰ÈˆÙÈÎ¤˜ Û˘ÏÏÔÁ¤˜, ‰ËÌfi-ÛÈ· ÎÙ›ÚÈ·, ÈÓ·ÎÔı‹ÎÂ˜ ÛÙËÓ ∂ÏÏ¿‰· Î·È ÛÙÔ ÂÍˆÙÂÚÈÎfi.

Œ¯ÂÈ Î¿ÓÂÈ ÂÚ›Ô˘ ÂÎ·Ùfi (100) ÂÎı¤ÛÂÈ˜ ÛÙËÓ ∂ÏÏ¿‰· Î·È ÛÙÔ ÂÍˆÙÂÚÈÎfi –Û·Ú¿ÓÙ· (40) ·ÙÔÌÈÎ¤˜ Î·È ÂÍ‹ÓÙ· (60)ÔÌ·‰ÈÎ¤˜– ÛÂ ‰È¿ÊÔÚÂ˜ ÁÎ·ÏÂÚ›, ÍÂÓÔ‰Ô¯Â›·, ·ÓÂÈÛÙ‹ÌÈ·, ÓÔÛÔÎÔÌÂ›·, ÔÏÈÙÈÛÙÈÎ¿ Î¤ÓÙÚ·, ‰ËÌ·Ú¯Â›· Î.¿., ·fi ÙÔ1984 - 2000.

ªÂ ÙÔ ¤ÚÁÔ ÙÔ˘ ¤¯Ô˘Ó ·Û¯ÔÏËıÂ› Â·ÓÂÈÏËÌÌ¤Ó· Ô Ù‡Ô˜ –ËÌÂÚ‹ÛÈÔ˜ Î·È Â‚‰ÔÌ·‰È·›Ô˜– Î·È Ë ÙËÏÂfiÚ·ÛË. ∆ÔfiÓÔÌ¿ ÙÔ˘ -who is who- ÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÂ ÔÏÏÔ‡˜ Â›ÛËÌÔ˘˜ Î·Ù·ÏfiÁÔ˘˜ Î·È ÂÈÎ·ÛÙÈÎ¿ ÏÂ˘ÎÒÌ·Ù·. ∫ÚÈÙÈÎ¤˜ ÙË˜Ù¤¯ÓË˜ ÙÔ˘ ¤¯ÂÈ ·ÔÛ¿ÛÂÈ ·fi ÔÏÏÔ‡˜ ÂÈ‰ÈÎÔ‡˜ Ù¤¯ÓË˜ ÛÙËÓ ∂ÏÏ¿‰· Î·È ÙÔ ÂÍˆÙÂÚÈÎfi. ¶ÔÏÏ¿ ¤ÚÁ· ÙÔ˘ ¤¯Ô˘Ó Á›ÓÂÈÂÍÒÊ˘ÏÏ·, ·Ê›ÛÂ˜, Î¿ÚÙÂ˜ ÙÔ˘ √∆∂ (ÙËÏÂÎ¿ÚÙÂ˜), ÂÍÒÊ˘ÏÏ· ÛÂ CD-ROM Î·È ÔÏÏ¿ ¿ÏÏ·.

¢È¿ÊÔÚ· ¤ÚÁ· ÙÔ˘ ˘¿Ú¯Ô˘Ó ÛÂ ªÔ˘ÛÂ›·, ÈÓ·ÎÔı‹ÎÂ˜, ‰ËÌfiÛÈ· ÎÙ›ÚÈ·, È‰ÈˆÙÈÎ¤˜ Û˘ÏÏÔÁ¤˜, ÛÙËÓ ∂ÏÏ¿‰· Î·È ÛÙÔÂÍˆÙÂÚÈÎfi.

EÎ‰›‰ÂÙ·È ·fi ÙÈ˜ È·ÙÚÈÎ¤˜ ÂÎ‰fiÛÂÈ˜ “B·ÁÈÔÓ¿ÎË”ÌÂ ¯ÔÚËÁ›· ÙË˜ PFIZER HELLAS.

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

ΤΕΥΧΟΣ 5 ΜΑΡΤΙΟΣ 2005 - ΑΘΗΡΟΣΚΛΗΡΩΣΗ

Documents

Transcript of ΤΕΥΧΟΣ 5 ΜΑΡΤΙΟΣ 2005 - ΑΘΗΡΟΣΚΛΗΡΩΣΗ