ΤΕΥΧΟΣ 14 ΙΟΥΝΙΟΣ 2007 - ΑΘΗΡΟΣΚΛΗΡΩΣΗ

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03-07-07

12:27

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03-07-07

12:28

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IA

™YNTAKTIKH E¶ITPO¶H ¢È¢ı˘ÓÙ‹˜ ™‡ÓÙ·Í˘ XÂÈÌÒÓ·˜ HÏ›·˜ K·Ú‰ÈÔÏfiÁÔ˜ YÔÙ¤Ú·Ú¯Ô˜ Â.·.

M¤ÏË Õı˘ÚÔ˜ B·Û›ÏÂÈÔ˜ AÓ·ÏËÚˆÙ‹˜ ¢È¢ı˘ÓÙ‹˜ E™Y K·Ú‰ÈÔÏÔÁÈÎfi TÌ‹Ì· B’ ¶ÚÔ·È‰Â˘ÙÈ΋˜ KÏÈÓÈ΋˜ A¶£ IÔÎÚ¿ÙÂÈÔ NÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔӛ΢ ∫·Ú·ÁÈ¿ÓÓ˘ ∞ÛÙ¤ÚÈÔ˜ ∞Ó·ÏËÚˆÙ‹˜ ∫·ıËÁËÙ‹˜

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

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

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

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¶·ıÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜

∫§π¡π∫∂™ ª∂§∂Δ∂™

∞ÚÈÛÙÔÙÂÏ›Ԣ ¶·ÓÂÈÛÙËÌ›Ô˘

ΔÔ ∂ÈÎÔÛÈÂÓÙ·ÓÔ˚Îfi √͇ ªÂÈÒÓÂÈ Ù· ªÂ›˙ÔÓ· ∫·Ú‰È·ÁÁÂȷο ∂ÂÈÛfi‰È· Û ÀÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌÈÎÔ‡˜ ∞ÛıÂÓ›˜. ªÂϤÙË JELIS (Japan EPA lipid intervention study): Δ˘¯·ÈÔÔÈË̤ÓË, ·ÓÔȯً˜ ¯ÔÚ‹ÁËÛ˘ Î·È Ù˘ÊÏ‹˜ ·Ó¿Ï˘Û˘ ÙÂÏÈÎÒÓ ÛËÌ›ˆÓ ÌÂϤÙË.

Yokoyama M, Origasa H, Matsuzaki M, Matsuzawa Y, Saito Y, Ishikawa Y, Oikawa S, Sasaki J, Hishida H, Itakura H, Kita T, Kitabatake A, Nakaya N, Sakata T, Shimada K, Shirato K; Japan EPA lipid intervention study (JELIS) Investigators

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

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£ÂÛÛ·ÏÔӛ΢, πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔӛ΢.

EÏÈÛ¿Ê Mˆ˘Û‹˜ K·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜ I·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ Iˆ·ÓÓ›ÓˆÓ ¶ÂÚÈÊÂÚÂÈ·Îfi ¶·ÓÂÈÛÙËÌÈ·Îfi NÔÛÔÎÔÌÂ›Ô Iˆ·ÓÓ›ÓˆÓ KÔÏÔ‚Ô‡ °ÂÓÔ‚¤Ê· K·Ú‰ÈÔÏfiÁÔ˜ YԉȢı‡ÓÙÚÈ· A’ K·Ú‰ÈÔÏÔÁÈ΋˜ KÏÈÓÈ΋˜ Î·È Y‡ı˘ÓÔ˜ §Èȉ·ÈÌÈÎÔ‡ I·ÙÚ›Ԣ øÓ·Û›Ԣ K·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈÎÔ‡ K¤ÓÙÚÔ˘ °Ô˘‰¤‚ÂÓÔ˜ πˆ¿ÓÓ˘, ∫·ıËÁËÙ‹˜ ∫·Ú‰ÈÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ, ¶ÂÚÈÊÂÚÂÈ·Îfi ¶·ÓÂÈÛÙËÌÈ·Îfi ¡ÔÛÔÎÔÌÂ›Ô πˆ·ÓÓ›ÓˆÓ. ¶›ÙÛ·‚Ô˜ XÚ‹ÛÙÔ˜ AÓ·ÏËÚˆÙ‹˜ K·ıËÁËÙ‹˜ K·Ú‰ÈÔÏÔÁ›·˜, I·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ IÔÎÚ¿ÙÂÈÔ NÔÛÔÎÔÌÂ›Ô AıËÓÒÓ

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

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

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

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√È ‚-∞ÔÎÏÂÈÛÙ¤˜ ÛÙËÓ ∫ÏÈÓÈ΋ ¶Ú¿ÍË ª. ºÏˆÚÂÓÙ›Ó, ∂ÈÛÙËÌÔÓÈÎfi˜ ™˘ÓÂÚÁ¿Ù˘ ÙÔ˘ π·ÙÚ›Ԣ §Èȉ›ˆÓ ª. ∂ÏÈÛ¿Ê, ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ ΔÔ̤·˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ

25

¶POTEINOMENH BIB§IO°PAºIA

31

ATHIROSK 14

03-07-07

12:06

™ÂÏ›‰·1

› ÂȘ, ÌÔÚ Û ‹ ı ·  ›˜ · ÁÁÂÓÂ Ù·È ÛÂ Û˘ ‹ Û‡Ó‰ÚÔÌ Ó Ô Ô Û ›Ï  fi Ó Ê Ô ‹ Î fi Ú› Ó· Ë·ÙÈ ·›Ì· ÌÔ ·Ù‡ÂÈ · Ï¿ÛÌ·Ù·, Ù Ô  Û Ù Ô Ô Û Â Ú Ó  Ó , È fi ›ˆ Ù Ì ‰ ˘ ÂȉÈÛ ÂÙ·È fi È̤˜ ÏÈÈ Ô˘ ÌÂÙÚ›Ô ˘ÂÚı˘ÚÂÔ Ù ·ÙÔ˜ Ê·›Ó Ì Ó ‡ ˆ ˘ ÷ÌËϤ˜ Ù Â Ó Ô Ó ¿  ›Ó Ô · Ë Ó Ì È ÛË Î·È ÚÈψÛË Ô Ó· ˘ÔÛË ›Ó·È Ë  Úȷ΋ ›Â · ηٷӿ Â Ë È Ù Ú fï˜ Î·È ‹ Ú Ù Î ¤ È · Ì Ù Ó  ∏ Ë · · ‚Ï Ù˘ ¿ÓÂÈ Ù fiÊËÛ˘. . π‰È·›ÙÂÚ Ë˜ ‰È·‚‹ ·ÏÏ¿ ·˘Í · ‰ È Ò · ‰ ‰˘Û·ÔÚÚ Ù Ú fi · · Û È Ì ¯  ‹ Î  Û · ÂÈ· ˜. √ Û ·ÏÈο  Âȷο ÓÔ ÙËÓ ·ÒÏ Ó‡̷ÙÔ Î¿ ÂÁÎÂÊ Â Ô · Ì Î·Ú‰È·ÁÁ È Ó È Â Ó Ô Á Ò Á Ó Ó ·  ˆ ÛÔÙ‹Ù ‚·ˆÓ ·Ûı Í¿ÓÂÈ Ù· Á¿ÏˆÓ Ô ·¯‡Û·ÚÎ · Î·È ÙË Â Ù ¯Ú‹ÛË ·˘ Ì fi Ë Ù Ù Ë Û fi Û Ó Ô ¯ Û ˆ ˘ Ï Ô ÙË Û ÙËÓ Á¿ÏÔ  ηٷӿ Ë ÌÂÈÒÓÂÈ ›Ù·È ÚÈÓ ›Ó ı› Û Ì  ٠ÛÙ·Ûȷ΋ Ê Á · Ë Ë Ù Ï Ú Û Ô Ô · Ú ¯ ‚  Ó ·ÙÔÚ ÂÓ‹ , fiÙ· ·ÙfiÓ Ó· Ôηډ›Ô˘ È Ù· ‰˘ÛÌ ¿ÛÎËÛË. ∏ ˘ · Ì Â›Ó·È ‰˘Ó Î ‹ Î ˘ ˜ È Ô Ù Ò Ù ı · Ì · ˜ Î ˆ Ù¿Á¯Ë ¿ÁÌ·ÙÔ ·È ÙË Û Ì Ôͤ· Û ÎÔ‡ ÂÌÊÚ ıÂÚ‹ ÛÙËı È ‚¿ÚÔ˘˜ Î · Ù ›˜ Ù Â · Û Ó ‚ Â Ì Â ı Â Ì Û  Â È Û · ÛÂȘ ˘ ÂÚÈ ÛıÂÓ›˜ ΋ Á›ÓÂÙ·  ÂÁ¯ÂÈÚ‹ È Û ÂÙ·È Û · Ú‡ÙËÙ· ÙÔ Ù Û ˜ ›Ó · ‹ Á Ï Á  ˘ ˘ Ô Ú Ô È  · ·ÁÁ ̷ÚÌ ¤Ú˜ ÛÙÈ΋ ÎÔÏÈ΋˜ ÙÔÓ 7 ËÌ · fiÙ·Ó Ë Û Ù ·ÁÁÂÈÔÏ· È · · È ¯ Ì ‰ ¿ ¿ Ï fi ‚ ˘ Û È Ì Ô Â ˘ Ù  È Ù·  ‹ ‰ÂÓ Ú¯›˙ÂÈ Âȷο Û ÛË Ù˘ · ˘ ÌÂÈÒÓ ÈÔÏ·ÛÙÈΠηډȷÁÁ Ë Û Â › Á Á  ‹ Á ∂ Ú · Ô . ¯ Ë · Ì ÓfiÛÔ Â ˆ˜ Ù·Ó Ë ‡Ó‰ÚÔ ›ˆÛË Ô‡Ù ÂÊ·ÓÈ·›· η̄˘ fi ‚ Ê·ÓÈ·›· Û Ù È ¿ Û  Ú Â · ‹  Ú Ó Â Ë ˜ ı Ù · ÚÔ˜ Ì ÛÙ ‡ ÈÔ Ê·ÓÈ·›· Ô‡Ù ˆ˜ ·ÛıÂÓ›˜ Â›Ó·È ÔÏ ·ÔÚÙÔÛÙ ˜  ‹ · ™ Á Ù Â ˆ . ı Á Ë › · Û Ù Ó · ÙÈ΋˜ ·È Û Â¤Ì‚ ¯Ë). ∞ Ê·Ú̷΢ Ô‚¿ÏÏÔÓÙ ÚÈÓ ÙËÓ Ó ÛÙËı¿Á  Ë ˜ ˘ Ù ‹ Ù ˘ fi Û Ô  ˆ  · Û › Ù˘ ¿ÛÂˆÓ ÛıÂÓ›˜ Ô‡ÊÈÛË ÏÂÔÓÂÎÙ ÌÂÓÒÓ Â΂ Èο Û · ‹˜ (·Ó·Î Ù Û ˆ ˘ Ë ˙ ‰ Ú È · Â Ó Ù ¯ ˆ Ë Á Ù Ù Â ÚÔ ÔÈfi  ÙËÓ Â›ˆÛË ÛÙ·Ù›Ó˘ ÛÌ·ÙÈ΋ Ì ÚÔ˜ ÙËÓ ˘Á¯¿ÓÂÈ Ì Â Ë Ù Ï È Û Â  Ë Ù Â Á Ô ‹  ˜ Ú · Ë Ô „ ›ÛÔ˘ . ∏ ¯ Ú¿Î·Ì ·ÎÙÈ΋ Ë Â›Ó·È ÂÍ ‰··ÓËÚ‹ ÛÂÈ ÂÓ·ÏÏ ÓÈ·›·˜ · ¤ ›Ó · Ï Ï Ê Â ˘ Â Ù Ô Ù Ô Û Û Ó  È Ô · Ù ·ÔÚ › Ó·  ¯ÚfiÂfiÌÂÓË Î·È ÌÔÚ ÂÁ¯Â›ÚËÛË . ∏ ÂÈÛÓ ÛıÂÓ›˜ Ì Ó ¿ · Ò Î Ó È Â Â Ù Û ı Ë È Û Ú È · ·  ٠ÂÙÂÁ¯ Ó Û˘ÛÙ‹Ó √È ‚-·Ô ·ÙËÁÔڛ˜  Π. ¢ ¿ ˜ È .  ·Ì¤Ûˆ˜ Ì ‰ Ë Ú È Ù Â · ‹ Ù  ‚ fi Û Ë ‰È· ·È Û ÙȘ ÂÚÈÛ Û·Î¯·ÚÒ‰ ÓÈÛÙ¤˜ Î Ë Ù˘ ·Ó · Û ˘ Î È Ô  Ù Â Ò ÂÓ¤ÛÈÌË Û Û Ù Ë Â , Û È Ì · È  ¿ÛıÌ Ó ·ÓÙ ·ÓÙÈÌÂÙÒ ıÂÈ· ‹ Ì ‹ ηډȷÏÔÁ‹˜ ÛÙË ¿ È ˜   Ô Ô Â Ó Û Ï‡ÛË ÛÙËÓ ˜ Ô fi Ë Ì Ó Ù ˘ Â Ò ›· Ó ·ÓÈ· ·Î· Ú Ú·ÎÙÈ΋  Ú¯ÂÈ ÛÙÂÊ È ÔÈ ÓÂfiÙ ¤ÔÓ Ê¿ÚÌ ¿ Ï ·   Î ˘ Ó ÓÈ· ·ÔÊ È Ó ˘ · Ò Û Ù Ù Ó Ó Û ‡ È ÔÎÏ Ùfi˜ ¿ ·È ‰ÂÓ ıˆÚÔ ÙˆÓ ‚-· ÔÏfiÏ˘ Î Ù·Û˘, ÂÎ ‡ Ó Ú Í Â ¤ Ù ·  ÎÏÂÈÛÙ¤˜ Ù · ˘ Â Ì ˜ ˜ Ë ‹ ˜ Ù Î Ì·Ù· È·ÊÔÚ¤ ·ÚÙËÚÈ· ¿Ú¯Ô˘Ó ‰ ÌÂÈÔÓÂÎÙ‹  ˘ · ›ÏÂÎÙ˘ Ù ˜ ˆ Ó › ˘ · Ô ‚ Ê·Ó›˙ ÚÎÂÈ·. μÂ Ù·È Ó· ÂÌ Â ›Ó ΋ ·ÓÂ¿ · Ê Ó Â ·˘ÙÔ‡˜ ‰ ÈÌÒÓ·˜ ÚÔÈ ·fi  à ˜ . ˜ · Ë › Ï Ï fi ∏ Ï ÚÔ Ù˘ ÌÂÙÔ Ù·Í˘

Ù·Í˘ T˘ ™‡Ó

˜ ™‡Ó ¢È¢ı˘ÓÙ‹

ATHIROSK 14

03-07-07

12:06

™ÂÏ›‰·2

π√À¡π√™ 2007

¶·ıÔÏÔÁÈΤ˜ ∫·Ù·ÛÙ¿ÛÂȘ Ô˘ ™˘Óԉ‡ÔÓÙ·È ·fi ÷ÌËÏ‹ ÃÔÏËÛÙÂÚfiÏË ÃÚ‹ÛÙÔ˜ ∞ÓÙÒÓÔÁÏÔ˘ ∂›ÎÔ˘ÚÔ˜ ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¢ËÌÔÎÚÈÙ›Ԣ ¶·ÓÂÈÛÙËÌ›Ô˘ £Ú¿Î˘

∞. ™˘ÁÁÂÓ›˜ ·ı‹ÛÂȘ ∏ ·‚ËÙÔÏÈÔÚˆÙÂïÓ·ÈÌ›· Â›Ó·È Û¿ÓÈ· ÓfiÛÔ˜, ÎÏËÚÔÓÔÌÔ‡ÌÂÓË Ì ÙÔÓ ˘ÔÏÂÈfiÌÂÓÔ ·˘ÙÔۈ̷ÙÈÎfi ¯·Ú·ÎÙ‹Ú·. X·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ȉȷ›ÙÂÚ· ¯·ÌËÏ¿ Â›‰· ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ÛÙÔ Ï¿ÛÌ·. OÊ›ÏÂÙ·È ÛÙËÓ ¤ÏÏÂÈ„Ë ÂÓ˙‡ÌÔ˘ Ô˘ Â›Ó·È ˘‡ı˘ÓÔ ÁÈ· ÙËÓ ÂÓ‰Ô΢ÙÙ¿ÚÈÔ ÌÂÙ·ÊÔÚ¿ ÙˆÓ ÏÈȉ›ˆÓ ÛÙÔ ¤ÓÙÂÚÔ Î·È ÙÔ ‹·Ú Ì ·ÔÙ¤ÏÂÛÌ· ÙÔÓ ÌË Û¯ËÌ·ÙÈÛÌfi ÙˆÓ ¯˘ÏÔÌÈÎÚÒÓ Î·È ÙˆÓ Ôχ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂïÓÒÓ (VLDL). Δ· ·ÚÈ· Û˘ÌÙÒÌ·Ù· Ù˘ ÓfiÛÔ˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙÔ ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ·, ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙË ‰Â‡ÙÂÚË ‰ÂηÂÙ›· Ù˘ ˙ˆ‹˜ Î·È ÔÊ›ÏÔÓÙ·È Î˘Ú›ˆ˜ ÛÙËÓ ·‰˘Ó·Ì›· ·ÔÚÚfiÊËÛ˘ Î·È ÌÂÙ·ÊÔÚ¿˜ ÙˆÓ ÏÈÔ‰È·Ï˘ÙÒÓ ‚ÈÙ·ÌÈÓÒÓ Î·È È‰È·›ÙÂÚ· Ù˘ ‚ÈÙ·Ì›Ó˘ ∂ ÛÙÔ˘˜ ÈÛÙÔ‡˜. √È ÂÙÂÚfi˙˘ÁÔÈ ‰ÂÓ ÂÌÊ·Ó›˙Ô˘Ó ¯·ÌËϤ˜ Û˘ÁÎÂÓÙÚÒÛÂȘ ÏÈȉ›ˆÓ ÛÙÔ ·›Ì· Ô‡ÙÂ Û˘ÌÙÒÌ·Ù·. ∏ ÔÈÎÔÁÂÓ‹˜ ˘Ô‚ËÙ·ÏÈÔÚˆÙÂïÓ·ÈÌ›· ÔÊ›ÏÂÙ·È Û ¤Ó· ·ÚÈıÌfi ÌÂÙ·ÏÏ¿ÍÂˆÓ Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙÔ ÁÔÓ›‰ÈÔ Ù˘ ·ÔÚˆÙ½Ó˘ μ (ApoB) Î·È ÔÈ Ôԛ˜ ¤¯Ô˘Ó Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·Ú·ÁˆÁ‹ ÌÔÚ›Ô˘ ApoB100 ÌÈÎÚfiÙÂÚÔ˘ Ì‹ÎÔ˘˜ ·fi ÙÔ Ê˘ÛÈÔÏÔÁÈÎfi. ΔÔ Ï‹ÚÔ˘˜ Ì‹ÎÔ˘˜ ApoB-100 ÌfiÚÈÔ Â›Ó·È ··Ú·›ÙËÙÔ ÁÈ· ÙËÓ Û‡ÓıÂÛË Î·È ·¤ÎÎÚÈÛË ·fi ÙÔ ‹·Ú Ù˘ VLDL. ∂ÈϤÔÓ Ë ÌÈÎÚfiÙÂÚÔ˘ Ì‹ÎÔ˘˜ ApoB ÂÌÊ·Ó›˙ÂÈ Ù·¯‡ÙÂÚË Î¿ı·ÚÛË. 2,3 ŒÙÛÈ ÔÈ ·ÛıÂÓ›˜ ·˘ÙÔ› ¤¯Ô˘Ó ¯·ÌËÏ¿ Â›‰· ÛÙÔ Ï¿ÛÌ· Ù˘ ÔÏÈ΋˜ (Tc) Î·È Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ÙˆÓ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂïÓÒÓ (LDL), Ù˘ ApoB Î·È Û˘Ó‹ıˆ˜ Î·È ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ (TG). ∏ ÓfiÛÔ˜ ÌÂÙ·‰›‰ÂÙ·È Ì ÙÔÓ ·˘ÙÔۈ̷ÙÈÎfi ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·-

2

Ú·ÎÙ‹Ú· Ì ·ÔÙ¤ÏÂÛÌ· ÔÈ ÂÙÂÚÔ˙˘ÁÒÙ˜ Ó· ¤¯Ô˘Ó Û˘ÁÎÂÓÙÚÒÛÂȘ ÛÙÔ Ï¿ÛÌ· ÔÏÈ΋˜ Î·È LDL ¯ÔÏËÛÙÂÚfiÏ˘ ÛÙÔ 1/3 ¤ˆ˜ 1/4 ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ (¶›Ó·Î·˜ 1) 4. Δ· ·ÓÙ›ÛÙÔȯ· Â›‰· Ù˘ ApoB Â›Ó·È 25-50%. √È ÔÌÔ˙˘ÁÒÙ˜ ÂÌÊ·Ó›˙Ô˘Ó Ú·ÎÙÈο ·‚ËÙ·ÏÈÔÚˆÙÂïÓ·ÈÌ›· (ApoB<5%). ™Â ÔÚÈṲ̂ÓÔ˘˜ Ù‡Ô˘˜ ÔÈÎÔÁÂÓÔ‡˜ ˘Ô‚ËÙ·ÏÈÔÚˆÙÂïÓ·ÈÌ›·˜ fï˜, ‰ÂÓ ·Ú·ÙËÚÂ›Ù·È Ë ·Ú·ÁˆÁ‹ ‚Ú·¯Â›·˜ ApoB Î·È Ë ·ÈÙ›· Ù˘ ÓfiÛÔ˘ Û ·˘Ù¤˜ ÙȘ ÂÚÈÙÒÛÂȘ ·Ú·Ì¤ÓÂÈ ·‰È¢ÎÚ›ÓÈÛÙË. ∏ ÓfiÛÔ˜ ÛÙËÓ ÂÙÂÚfi˙˘ÁË ÌÔÚÊ‹ Â›Ó·È Û¯ÂÙÈο Û¿ÓÈ· ·Ó Î·È ·Ó¢ڛÛÎÔÓÙ·È ÂÚÈÛÙ·ÙÈο ÛÙÔÓ ¤ÏÂÁ¯Ô ÚÔ˘Ù›Ó·˜ Ô˘ Á›ÓÂÙ·È ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi. Δ· ¿ÙÔÌ· ·˘Ù¿ Â›Ó·È Û˘Ó‹ıˆ˜ ·Û˘Ìو̷ÙÈο Î·È ¤¯Ô˘Ó ¯·ÌËÏfiÙÂÚÔ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ ·fi ÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi 6. √ÚÈṲ̂Ó˜ ÊÔÚ¤˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·Û˘Ìو̷ÙÈ΋ ·‡ÍËÛË ÙˆÓ ÙÚ·ÓÛ·ÌÈÓ·ÛÒÓ Î·È Û·Ó›ˆ˜ Â˘Ú‹Ì·Ù· ÏÈÒ‰Ô˘˜ ‰È‹ıËÛ˘ ÙÔ˘ ‹·ÙÔ˜ 7. ∏ ÂÏ¿ÙÙˆÛË Ù˘ ·¤ÎÎÚÈÛ˘ ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ·fi ÙÔ ‹·Ú, ÏfiÁˆ ÌÂȈ̤Ó˘ ·Ú·ÁˆÁ‹˜ VLDL, ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂÓ·fiıÂÛË ÙÔ˘˜ ÛÙ· Ë·ÙÔ·ÙÙ·Ú· Î·È ÙËÓ ·Ó¿Ù˘ÍË ÏÈÒ‰Ô˘˜ ‰È‹ıËÛ˘ 2. ΔÔ ÙÂÏÈÎfi ·ÔÙ¤ÏÂÛÌ· Â›Ó·È Û˘Ó¿ÚÙËÛË Î·È ÙÔ˘

Ú˘ıÌÔ‡ Û‡ÓıÂÛ˘ ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ. ∏ ·fiÊ·ÛË ‰ÈÂÓ¤ÚÁÂÈ·˜ ‚ÈÔ„›·˜ ‹·ÙÔ˜ ÁÈ· ÙËÓ ÙÂÎÌËÚ›ˆÛË Ù˘ ‰È¿ÁÓˆÛ˘ ÌÔÚ› Ó· ÛÙËÚȯı› ÛÙÔÓ ÎÏÈÓÈÎfi Î·È ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ÁÈ· ÈÔÁÂÓ‹, ·ÓÔÛÔÏÔÁÈ΋ Î·È ÙÔÍÈ΋ ‚Ï¿‚Ë ÙÔ˘ ‹·ÙÔ˜, ÛÙÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÏÈȉ·ÈÌÈÎfi ÚÔÊ›Ï Ù˘ ˘Ô‚ËÙ·ÏÈÔÚˆÙÂïÓ·ÈÌ›·˜, ÛÙËÓ ·Ó‡ÚÂÛË ·ÚÔÌÔ›Ô˘ ÏÈȉ·ÈÌÈÎÔ‡ ÚÔÊ›Ï Û ¤Ó· Û˘ÁÁÂÓ‹ ÚÒÙÔ˘ ‚·ıÌÔ‡ Î·È ‚¤‚·È· ÌÔÚ› Ó· ÂÍ·ÙÔÌÈ΢ı› 8.9. √È ÔÌfi˙˘Á˜ ÌÔÚʤ˜ Â›Ó·È Û¿ÓȘ Î·È ÌÔÚÔ‡Ó Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó Û˘ÌÙÒÌ·Ù· ·Ó¿ÏÔÁ· Ù˘ ·‚ËÙ·ÏÈÔÚˆÙÂïÓ·ÈÌ›·˜. ∏ ‰È¿ÎÚÈÛË ·fi ÙËÓ ‰Â‡ÙÂÚË ÌÔÚ› Ó· Á›ÓÂÈ Ì ‚¿ÛË ÙÔ ÏÈȉ·ÈÌÈÎfi ÚÔÊ›Ï (LDLc Î·È apoB) ÙˆÓ ÁÔÓ¤ˆÓ. ™ÙËÓ ÔÌfi˙˘ÁË ˘Ô‚ËÙ·ÏÈÔÚˆÙÂ˚Ó·ÈÌ›· ·ÌÊfiÙÂÚÔÈ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÙÈ̤˜ ¯·ÌËÏfiÙÂÚ˜ ÙÔ˘ ‹ÌÈÛ˘ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ.

μ. ∂›ÎÙËÙ˜ ηٷÛÙ¿ÛÂȘ (‰Â˘ÙÂÚÔ·ı›˜) ¶ÔÏϤ˜ ·ı‹ÛÂȘ Ô˘ Û˘Ó‰˘¿˙ÔÓÙ·È Ì η΋ ıÚ¤„Ë Î·È ÂÈ‚·Ú˘Ì¤ÓË ÁÂÓÈ΋ ηٿÛÙ·ÛË ·ÔÙÂÏÔ‡Ó ·ÈÙ›· ¯·ÌËÏ‹˜ ¯ÔÏËÛÙÂÚfiÏ˘ fiˆ˜ Ù· ÓÂÔÏ¿ÛÌ·Ù·, ÔÈ ‚·ÚȤ˜ ÏÔÈÌÒÍÂȘ, Ë ‚·ÚÈ¿ Ë·ÙÈ΋ ÓfiÛÔ˜ Î·È Ù· Û‡Ó‰ÚÔÌ· ‰˘Û·ÔÚÚfiÊËÛ˘. ™Ù· ÙÂÏÂ˘Ù·›· Û ‹Ș ·‰È¿ÁÓˆ-

¶›Ó·Î·˜ 1: §Èȉ·ÈÌÈΤ˜ ·Ú¿ÌÂÙÚÔÈ Û ·ÛıÂÓ›˜ Ì ÔÈÎÔÁÂÓ‹ ÂÙÂÚfi˙˘ÁÔ ˘Ô‚ËÙ·ÏÈÔÚˆÙÂïÓ·ÈÌ›· Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ ¶·Ú¿ÌÂÙÚÔ˜ Tc (mg%) LDL-c (mg%) HDL-c (mg%) TG (mg%) ApoB (mg%)

∞ÛıÂÓ›˜ (n=7) 88 ± 12 28 ± 12 56 ± 12 28 ± 16,3 23,3 ± 6,5

√Ì¿‰· ÂϤÁ¯Ô˘ (n=7) 184 ± 28 120 ± 24 52 ± 16 90 ± 31 96,3 ± 16,6

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

√È ÙÈ̤˜ ÂÎÊÚ¿˙ÔÓÙ·È ˆ˜ Ë Ì¤ÛË ÙÈÌ‹ ± ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË. Tc: ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË, LDL-c: LDL ¯ÔÏËÛÙÂÚfiÏË, HDL-c: HDL ¯ÔÏËÛÙÂÚfiÏË, TG: ΔÚÈÁÏ˘ÎÂÚ›‰È·, ApoB: ·ÔÚˆÙ½ÓË μ, NS: ÌË ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿

ATHIROSK 14

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¶∞£√ºÀ™π√§√°π∞ ÂÓ˙‡ÌÔ˘ Ô˘ Â›Ó·È ˘‡ı˘ÓÔ ÁÈ· ÙË ÌÂÙ·ÊÔÚ¿ ÂÛÙ¤ÚˆÓ ¯ÔÏËÛÙÂÚfiÏ˘ ·fi Ù˘ ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙ½Ó˜ (HDL) ÛÙȘ VLDL. ΔÔ Â‡ÚÔ˜ ÙˆÓ ÌÂÙ·‚ÔÏÒÓ Ù˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘ ÔÈΛÏÂÈ ·Ó Î·È ‰ÂÓ Â›Ó·È ÙfiÛÔ ÛËÌ·ÓÙÈÎfi fiÛÔ ÛÙÔÓ ˘Ôı˘ÚÂÔÂȉÈÛÌfi (¶›Ó·Î·˜ 2) 12.

ÛÙ˜ ÌÔÚʤ˜ ÔÊÂÈÏfiÌÂÓ˜ Û ÎÔÈÏÈÔοÎË ˘¿Ú¯ÂÈ ¯·ÌËÏ‹ ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË Î·È ¯·ÌËÏ‹ HDLc ÔÈ Ôԛ˜ Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ¯·ÌËÏ¿ Â›‰· ÏÂ˘ÎˆÌ·Ù›Ó˘ Î·È ˘fi¯ÚˆÌË ·Ó·ÈÌ›· 10. ∏ ÛËÌ·ÓÙÈÎfiÙÂÚË fï˜ ·ÈÙ›· Â›ÎÙËÙ˘ ˘Ô‚ËÙ·ÏÈÔÚˆÙÂïÓ·ÈÌ›·˜ Â›Ó·È Ô ˘ÂÚı˘ÚÂÔÂȉÈÛÌfi˜. ∏ ·Ú·ÙËÚÔ‡ÌÂÓË ÂÏ¿ÙÙˆÛË Ù˘ ÔÏÈ΋˜ Î·È LDL ¯ÔÏËÛÙÂÚfiÏ˘ ÔÊ›ÏÂÙ·È ÛÙÔÓ ·˘ÍË̤ÓÔ Î·Ù·‚ÔÏÈÛÌfi ÙˆÓ LDL ̤ۈ Ù˘ ÂÓÂÚÁÔÔ›ËÛ˘ ÙˆÓ LDL ˘Ô‰Ô¯¤ˆÓ ÛÙÔ ‹·Ú ·fi ÙËÓ ı˘ÚÔÍ›ÓË. ∏ HDL ¯ÔÏËÛÙÂÚfiÏË ·Ú·Ì¤ÓÂÈ ·ÌÂÙ¿‚ÏËÙË ‹ ÂÏ·ÙÙÒÓÂÙ·È ÏfiÁˆ Ù˘ Â›‰Ú·Û˘ Ù˘

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

™Â οı ¿ÙÔÌÔ Ì ¯·ÌËÏ¿ ÏÈ›‰È· ÛÙÔ ·›Ì· Î·È Û¯ÂÙÈο ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË Â›Ó·È Èı·Ó‹ Ë ‰È¿ÁÓˆÛË Ù˘ ÔÈÎÔÁÂÓÔ‡˜ ˘Ô‚ËÙ·ÏÈÔÚˆÙÂïÓ·ÈÌ›·˜, ÂÊfiÛÔÓ ·ÔÎÏÂÈÛı› Ô ˘ÂÚı˘ÚÂÔÂȉÈÛÌfi˜ Î·È ‹È· Û‡Ó‰ÚÔÌ· ‰˘Û·ÔÚÚfiÊËÛ˘, ÂÓÒ ÌÈ· ·ÓÂÍ‹ÁËÙË ·‡ÍËÛË ÙˆÓ ÙÚ·ÓÛ·ÌÈÓ·ÛÒÓ Ì ˘ÂÚ˯ÔÁÚ·ÊÈο Â˘Ú‹Ì·Ù· ÏÈÒ‰Ô˘˜ ‰È‹ıËÛ˘ ÙÔ˘ ‹·ÙÔ˜ ÌÔÚ› Â›Û˘ Ó· ˘ÔÎÚ‡ÙÂÈ ÙË ÓfiÛÔ.

¶›Ó·Î·˜ 2: ªÂÙ·‚ÔϤ˜ ÛÙȘ ÏÈȉ·ÈÌÈΤ˜ ·Ú·Ì¤ÙÚÔ˘˜ ˘ÂÚı˘ÚÂÔÂȉÈÎÒÓ ·ÛıÂÓÒÓ (n=47) Ì ÙËÓ ·ÔηٿÛÙ·ÛË Ù˘ ı˘ÚÂÔÂȉÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ¶·Ú¿ÌÂÙÚÔÈ TSH (mU/l) Tc (mg%) LDL-c (mg%) HDL-c (mg%) TG (mg%) ApoB (mg%)

∞ÛıÂÓ›˜ ÚÔ ıÂÚ·›·˜ <0,01 179,6 ± 43 107 ± 116 50 ± 13,2 100,9 ± 37,2 82 ± 27

∞ÛıÂÓ›˜ ÌÂÙ¿ ıÂÚ·›· 1,0 232,4 ± 48,4 148 ± 44 59,2 ± 16,8 120 ± 55,4 113 ± 30

P <0,005 <0,005 <0,005 <0,005 <0,05 <0,005

√È ÙÈ̤˜ ÂÎÊÚ¿˙ÔÓÙ·È ˆ˜ Ë Ì¤ÛË ÙÈÌ‹ ± ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË. Tc: ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË, LDL-c: LDL ¯ÔÏËÛÙÂÚfiÏË, HDL-c: HDL ¯ÔÏËÛÙÂÚfiÏË, TG: ΔÚÈÁÏ˘ÎÂÚ›‰È·, ApoB: ·ÔÚˆÙ½ÓË μ, TSH: £˘ÚÂÔÂȉÔÙÚfiÔ˜ ÔÚÌfiÓË

μÈ‚ÏÈÔÁÚ·Ê›· 1.

Rader DJ, Brewer HB Jr: Abetalipoproteinemia: new insights in into lipoprotein assembly and vitamin E metabolism from a rare genetic disease. JAMA 1993; 270: 865

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Schonfeld G et al.: Familial hypobetalipoproteinemia: genetics and metabolism.

Cell. Mol. Life Sci. 2005 ; 62 :1372

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Rader DJ: Primary hypolipidemias. In: David Humes, ed Kelley’s Textbook of Internal Medicine, forth ed. Philadelphia; Lippincott Williams & Wilkins, 2000; 90-92 Nizar E, Bruce W, Patterson B, Schonfeld G: Decreased production rates of VLDL Triglycerides and ApoB-100 in subjects heterozygous for Familial Hypobetalipoproteinemia. Arterioscler. Thromb. Vasc.

Biol., 1999; 19: 2714

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Marsh JB, Welty FK, Lichtenestein AH et al: Apolipoprotein B metabolism in human: studies with stable isotope-labeled amino acid precursors. Atherosclerosis 2002;162: 227

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Young SG: Recent progress in understanding apolipoprotein B. Circulation 1990; 82: 1574

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Ahmed A, Keeffe EB : Asymptomatic elevation of aminotransferase levels and fatty liver secondary to heterozygous hypobetalipoproteinemia. Am J Gastroenterol 1998; 93: 2598

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Bayard M et al: Nonalcoholic fatty liver disease. Am Fam Physician 2006; 11: 1961

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Castellano G, Garcia C, Gomez-Coronado D et al: Diffuse fatty liver in familial heterozygous hypobetalipoproteinemia. J Clin Gastroenterology 1997 ; 92 : 379

10. Ciacci C et al; Low plasma cholesterol: a correlate of nondiagnosed celiac disease in adults with hypochromic anemia. Am J Gastroenterol. 1999; 94: 1888 11. Duntas LH.: Thyroid disease and lipids.

Thyroid 2002; 12: 287 12. Diekman M, Angelescu N, Endert E et al: Changes in plasma LDL and HDL cholesterol in hypo and hyperthyroid patients are related to changes in free thyroxine, not to polymorphisms in LDL receptor or CETP genes. J Clin Endocrinol Metab.

2000; 85: 1857

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™ÂÏ›‰·4

π√À¡π√™ 2007

ΔÔ ∞ÏÎÔfiÏ ˆ˜ ¶·Ú¿ÁÔÓÙ·˜ ∫ÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ∂ÌÊ¿ÓÈÛË ∫·Ú‰È·ÁÁÂÈ·ÎÒÓ ™˘Ì‚·Ì¿ÙˆÓ ∂. ¡¿ÎÔ˘, ∂ÈÛÙËÌÔÓÈÎfi˜ ™˘ÓÂÚÁ¿Ù˘ ÙÔ˘ ∂Í. π·ÙÚ›Ԣ ¢È·Ù·Ú·¯ÒÓ ÙÔ˘ ªÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ §Èȉ›ˆÓ

ª. ∂ÏÈÛ¿Ê, ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ ΔÔ̤·˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ ™‡Ìʈӷ Ì ÚfiÛÊ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ Ë Î·Ù·Ó¿ÏˆÛË ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ Û ÌÈÎÚ¤˜ ÔÛfiÙËÙ˜ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÌÂȈ̤ÓË Â›ÙˆÛË Î·Ú‰È·ÁÁÂȷ΋˜ ÓfiÛÔ˘ (1,2) Î·È ‰Ú· ÚÔÛٷ٢ÙÈο ÛÙȘ ÓÔËÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘(3). øÛÙfiÛÔ, ÙÔ ·ÏÎÔfiÏ ·˘Í¿ÓÂÈ ÙËÓ ·ÚÙËÚȷ΋ ›ÂÛË Î·È ÂÈϤÔÓ ‰˘ÛÎÔχÂÈ ÙËÓ ·ÒÏÂÈ· ‚¿ÚÔ˘˜ Û ˘¤Ú‚·Ú· Î·È ·¯‡Û·Úη ¿ÙÔÌ·. ∫·È Â›Ó·È ÁÓˆÛÙfi fiÙÈ Ë ˘¤ÚÙ·ÛË Â›Ó·È ·ÓÂÍ¿ÚÙËÙÔ˜ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ (ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ Î·È ·ÁÁÂÈ·ÎÒÓ ÂÁÎÂÊ·ÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ). ΔÔ ·ÏÎÔfiÏ ˆ˜ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘. H ηٷӿψÛË ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ̷ÎÚÔ¯ÚfiÓȘ ÂÈÙÒÛÂȘ ÛÙÔÓ ·ÓıÚÒÈÓÔ ÔÚÁ·ÓÈÛÌfi ‰È· ̤Ûo˘ ÙÚÈÒÓ Ì˯·ÓÈÛÌÒÓ: Ù˘ ÙÔ͛ΈÛ˘, Ù˘ ÂÍ¿ÚÙËÛ˘ Î·È Ù˘ ¿ÌÂÛ˘ ‚ÈÔÏÔÁÈ΋˜ ‰Ú¿Û˘ (4). ∂ȉÈÎfiÙÂÚ·, ÛÙÔÓ ¶›Ó·Î· 1 Ê·›ÓÔÓÙ·È ÔÈ ÂȉڿÛÂȘ Ù˘ ηٷӿψÛ˘ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ(5), ÂÎÙfi˜ ·fi ÙËÓ Â›‰Ú·Û‹ ÙÔ˘˜ ÛÙÔ Î·Ú‰È·ÁÁÂÈ·Îfi Û‡ÛÙËÌ·. °È· ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ·fi ·˘Ù¤˜ ÙȘ ηٷÛÙ¿ÛÂȘ ˘¿Ú¯ÂÈ ÌÈ· ‰ÔÛÔÂÍ·ÚÙÒÌÂÓË Û˘Û¯¤ÙÈ-

ÛË, ·ÊÔ‡ Ô Î›Ó‰˘ÓÔ˜ ·˘Í¿ÓÂÙ·È Ì ÙËÓ ·‡ÍËÛË Ù˘ ÚfiÛÏ˄˘ ·ÏÎÔfiÏ.

AÏÎÔfiÏ Î·È ·ÚÙËÚȷ΋ ›ÂÛË. ™‡Ìʈӷ Ì ̛· ÌÂÙ·Ó¿Ï˘ÛË (6), ˘¿Ú¯ÂÈ ‰ÔÛÔÂÍ·ÚÙÒÌÂÓË Û˘Û¯¤ÙÈÛË ·Ó¿ÌÂÛ· ÛÙËÓ ÂÏ¿ÙÙˆÛË Ù˘ ηٷӿψÛ˘ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ Î·È ÙËÓ ·Ú·ÙËÚÔ‡ÌÂÓË Ì›ˆÛË Ù˘ Û˘ÛÙÔÏÈ΋˜ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ (™∞¶) Î·È Ù˘ ‰È·ÛÙÔÏÈ΋˜ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ (¢∞¶). ªÂ›ˆÛË Ù˘ ηٷӿψÛ˘ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ Î·Ù¿ 76% ·ÓÙÈÛÙÔȯ› Û Ì›ˆÛË Ù˘ ™∞¶ ηٿ 3,3 mmHg Î·È Ì›ˆÛË Ù˘ ¢∞¶ ηٿ 2,0 mmHg. Δ· ·ÓÙ›ÛÙÔȯ· ·ÔÙÂϤÛÌ·Ù· Û ·ÛıÂÓ›˜ Ì ˘¤ÚÙ·ÛË Â›Ó·È Ì›ˆÛË Ù˘ ™∞¶ ηٿ 3,9 mmHg Î·È Ù˘ ¢∞¶ ηٿ 2,4 mmHg, ÂÓÒ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ·›ÚÓÔ˘Ó ·ÓÙÈ˘ÂÚÙ·ÛÈ΋ ·ÁˆÁ‹ Ì›ˆÛË Ù˘ ™∞¶ ηٿ 4,0 mmHg Î·È Ì›ˆÛË Ù˘ ¢∞¶ ηٿ 3,1 mmHg. ∏ Ì›ˆÛË ·˘Ù‹ Â›Ó·È È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈ΋ ·Ó Ï¿‚ÂÈ Î·Ó›˜ ˘fi„Ë fiÙÈ Û‡Ìʈӷ Ì ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ Ì›· ÂÏ¿ÙÙˆÛË Ù˘ ¢∞¶ ηٿ 2 mmHg ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ì›ˆÛË Ù˘ Â›ÙˆÛ˘ Ù˘ ˘¤ÚÙ·Û˘ ηٿ 17%, Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ (™¡) ηٿ 6% Î·È Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ·Á-

¶π¡∞∫∞™ 1. √È ÂȉڿÛÂȘ Ù˘ ηٷӿψÛ˘ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ ÛÙÔÓ ·ÓıÚÒÈÓÔ ÔÚÁ·ÓÈÛÌfi, ÂÎÙfi˜ ·fi ÙËÓ Â›‰Ú·Û‹ ÙÔ˘˜ ÛÙÔ Î·Ú‰È·ÁÁÂÈ·Îfi Û‡ÛÙËÌ·. ™¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ ∫›ÚÚˆÛË ÙÔ˘ ‹·ÙÔ˜ ΔÚ·˘Ì·ÙÈÛÌÔ› ¶·ÁÎÚ·ٛÙȉ· ∫·ÚΛÓÔ˜ Ù˘ ÛÙÔÌ·ÙÈ΋˜ ÎÔÈÏfiÙËÙ·˜ ∫·ÚΛÓÔ˜ ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘ ∫·ÚΛÓÔ˜ ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘ ∫·ÚΛÓÔ˜ ÙÔ˘ Ï¿Ú˘ÁÁ· ∫·ÚΛÓÔ˜ ÙÔ˘ Ì·ÛÙÔ‡ ∫·ÚΛÓÔ˜ ÙÔ˘ ÔÚıÔ‡

4

2 ÔÙ¿/Ë̤ڷ 1,6-3,0 1,1-1,4 1,3 1,9-2,3 1,5-1,6 1,0-1,4 1,2-1,6 1,2-1,4 1,1-2,3

8 ÔÙ¿/Ë̤ڷ 4,4-59,3 1,3-4,0 3,2 6,4-12,5 4,5-6,0 1,1-3,6 2,1-7,1 2,2-3,4 1,5-25,7

ÁÂȷο ÂÁÎÂÊ·ÏÈο (∞∂∂) ηٿ 15% (7).

ÂÂÈÛfi‰È·

¶·ÚfiÌÔÈ· ‹Ù·Ó Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ INTERSALT (8, 9), ÛÙËÓ ÔÔ›· ¿Ó‰Ú˜ Ô˘ ¤ÈÓ·Ó 300-400 ml ·ÏÎÔfiÏ/‚‰ÔÌ¿‰· ›¯·Ó ηٿ ̤ÛÔ fiÚÔ ˘„ËÏfiÙÂÚË ™∞¶/¢∞¶ ηٿ 2,7/1,6 mmHg Û ۇÁÎÚÈÛË Ì ·˘ÙÔ‡˜ Ô˘ ‰ÂÓ ¤ÈÓ·Ó ·ÏÎÔÔÏÔ‡¯· ÔÙ¿, ÂÓÒ ¿Ó‰Ú˜ Ô˘ ¤ÈÓ·Ó ¿Óˆ ·fi 500 ml ·ÏÎÔfiÏ/ ‚‰ÔÌ¿‰· ›¯·Ó ·ÓÙ›ÛÙÔȯ· ·ÚÙËÚȷΤ˜ ȤÛÂȘ ηٿ 4,6/ 3,0mmHg ˘„ËÏfiÙÂÚ˜ ·fi ÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi. ™ÙËÓ ›‰È· ÌÂϤÙË Ë Î·Ù·Ó¿ÏˆÛË ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ Û Ôχ ÌÂÁ¿Ï˜ ÔÛfiÙËÙ˜ (>500 ml ·ÏÎÔfiÏ ÁÈ· ÙÔ˘˜ ¿Ó‰Ú˜ Î·È >300 ml ÁÈ· ÙȘ Á˘Ó·›Î˜) Û˘Û¯ÂÙ›ÛıËΠ̠ٷ Â›‰· Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ Î·È ÛÙ· ‰‡Ô ʇϷ. ™‡Ìʈӷ Ì ̛· ÌÂÙ··Ó¿Ï˘ÛË 61 ÚÔÔÙÈÎÒÓ ÌÂÏÂÙÒÓ(10), Ì›ˆÛË Ù˘ ™∞¶ ηٿ 4 mmHg Î·È Ù˘ ¢∞¶ ηٿ 2 mmHg ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ì›ˆÛË Ù˘ ıÓËÙfiÙËÙ·˜ ·fi ∞∂∂ ηٿ 18% Î·È Ì›ˆÛË Ù˘ ıÓËÙfiÙËÙ·˜ ·fi ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ Î·Ù¿ 12%. øÛÙfiÛÔ, Û ÔÏϤ˜ ÌÂϤÙ˜ ·Ú·ÙËÚ‹ıËΠ·‡ÍËÛË Ù˘ ıÓËÙfiÙËÙ·˜ ·fi ™¡ Û ¿ÙÔÌ· Ô˘ ‰ÂÓ ¤ÈÓ·Ó ·ÏÎÔÔÏÔ‡¯· ÔÙ¿. ∂ÈϤÔÓ, Û ÔÚÈṲ̂Ó˜ ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ·Ú·ÙËÚ‹ıËΠ̛· Û˘Û¯¤ÙÈÛË, Û¯‹Ì·ÙÔ˜ J, ·Ó¿ÌÂÛ· ÛÙËÓ Î·Ù·Ó¿ÏˆÛË ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ Î·È Ù· Â›‰· Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘(11, 12, 13). ™˘Û¯¤ÙÈÛË Ù˘ ηٷӿψÛ˘ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ Ì ÙË ıÓËÙfiÙËÙ·. ¶ÔÏϤ˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó ÙË Û˘Û¯¤ÙÈÛË Ù˘ ηٷӿψÛ˘ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ Ì ÙË ıÓËÙfiÙËÙ·. ™ÙÔÓ ¶›Ó·Î· 2 ÛËÌÂÈÒÓÔÓÙ·È ÔÚÈṲ̂Ó˜ ·fi ·˘Ù¤˜ ÙȘ ÌÂϤÙ˜, ηıÒ˜ Î·È Ë ÚÔÛÏ·Ì‚·ÓfiÌÂÓË ÔÛfiÙËÙ· ÙˆÓ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ Ô˘ Û˘Û¯ÂÙ›˙Â-

ATHIROSK 14

03-07-07

12:06

™ÂÏ›‰·5

¶APA°ONTE™ KIN¢YNOY Ù·È Ì ÙËÓ ÂÏ¿¯ÈÛÙË ıÓËÙfiÙËÙ· ·fi ™¡, ∞∂∂, ηıÒ˜ Î·È Ì ÙËÓ ÂÏ¿¯ÈÛÙË ÔÏÈ΋ ıÓËÙfiÙËÙ·.

Y¿Ú¯ÂÈ Ì›· Û˘Û¯¤ÙÈÛË Û¯‹Ì·ÙÔ˜ J ‹ U ·Ó¿ÌÂÛ· ÛÙËÓ ÔÛfiÙËÙ· ÙˆÓ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ Ô˘ ηٷӷÏÒÓÂÙ·È Î·È ÙË ıÓËÙfiÙËÙ· ·fi ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ, Ì ÙÔ Î·ÙÒÙÂÚÔ fiÚÈÔ Ù˘ ÁÚ·ÊÈ΋˜ ·Ú¿ÛÙ·Û˘ Ó· ·Ú·ÙËÚÂ›Ù·È ÛÙ· ‰‡Ô ÔÙ¿ ÙËÓ Ë̤ڷ ÁÈ· ÙÔ˘˜ ¿Ó‰Ú˜ (20-24 g ÔÈÓÔÓ‡̷ÙÔ˜) Î·È ÛÙÔ ¤Ó· ÔÙfi ÙËÓ Ë̤ڷ ÁÈ· ÙȘ Á˘Ó·›Î˜ (10-12 g ÔÈÓÔÓ‡̷ÙÔ˜)(5). ™Â Ì›· ÌÂϤÙË Ô˘ ¤ÁÈÓ Û ¿Ó‰Ú˜, ¿ÁÁÏÔ˘˜ ÁÈ·ÙÚÔ‡˜ (ÌÂϤÙË Male-British doctors) ÂÎÙÈÌ‹ıËÎÂ Ë ıÓËÙfiÙËÙ· ·fi ™¡(14). ™‡Ìʈӷ Ì ٷ ‰Â‰Ô̤ӷ Ù˘ ÌÂϤÙ˘ ÛÙ· ¿ÙÔÌ· Ô˘ ¤ÈÓ·Ó 8-28 ·ÏÎÔÔÏÔ‡¯· ÔÙ¿/‚‰ÔÌ¿‰· (‰ËÏ·‰‹ ÂÚ›Ô˘ 96-336 ml ·ÏÎÔfiÏ/‚‰ÔÌ¿‰·) Ë ıÓËÙfiÙËÙ· ‹Ù·Ó 7,1-8,5/1000 ¿ÙÔÌ·-¤ÙË, ÂÓÒ ÛÙ· ¿ÙÔÌ· Ô˘ ‰ÂÓ Î·Ù·Ó¿ÏˆÓ·Ó ·ÏÎÔÔÏÔ‡¯· ÔÙ¿ ‹Ù·Ó 10/1000 ¿ÙÔÌ·-¤ÙË. ™ÙÔ˘˜ ‰‡Ô ·Ú·¿Óˆ ÏËı˘ÛÌÔ‡˜, Ë ÔÏÈ΋ ıÓËÙfiÙËÙ· ‹Ù·Ó 24-27/1000 ¿ÙÔÌ·-¤ÙË Î·È 34/1000 ¿ÙÔÌ·-¤ÙË ·ÓÙ›ÛÙÔȯ·. ∏ ıÓËÙfiÙËÙ· ·fi ∞∂∂ ‹Ù·Ó 6/1000 ¿ÙÔÌ·-¤ÙË ÛÙ· Ù· ¿ÙÔÌ· Ô˘ ¤ÈÓ·Ó >43 ÔÙ¿/‚‰ÔÌ¿‰· (>516 ml ·ÏÎÔfiÏ /‚‰ÔÌ¿‰·), 2,6-3,3/1000 ¿ÙÔÌ·¤ÙË ÛÙ· ¿ÙÔÌ· Ô˘ ¤ÈÓ·Ó 1-42 ·ÏÎÔÔÏÔ‡¯· ÔÙ¿/‚‰ÔÌ¿‰·, ÂÓÒ ÛÙ· ¿ÙÔÌ· Ô˘ ‰ÂÓ Î·Ù·Ó¿ÏˆÓ·Ó Î·ıfiÏÔ˘ ·ÏÎÔÔÏÔ‡¯· ÔÙ¿ Ë ıÓËÙfiÙËÙ· ‹Ù·Ó 3,6/1000 ¿ÙÔÌ·-¤ÙË.

AÓÙ›ıÂÙ· Û ̛· ÌÂϤÙË ÛÙË ‰˘ÙÈ΋ ™ÎˆÙ›·, (ÌÂϤÙË Men-Western Scotland) ‰ÂÓ ‰È·ÈÛÙÒıËΠ‰È·ÊÔÚ¿ ÛÙËÓ ÔÏÈ΋ ıÓËÙfiÙËÙ· ·Ó¿ÌÂÛ· ÛÙ· ¿ÙÔÌ· Ô˘ ¤ÈÓ·Ó 1-14 ÔÙ¿/‚‰ÔÌ·‰· Î·È ÛÙÔ

ÁÂÓÈÎfi ÏËı˘ÛÌfi. ∂ÈϤÔÓ Û ·˘Ù‹ ÙË ÌÂϤÙË, Ë Î·Ù·Ó¿ÏˆÛË ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ ‰ÂÓ ÚÔÛٷهÂÈ ·fi ÙË ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ Î·È ÔÈ ¿Ó‰Ú˜ Ô˘ Î·Ù·Ó¿ÏˆÓ·Ó 35 ‹ ÂÚÈÛÛfiÙÂÚ· ·ÏÎÔÔÏÔ‡¯· ÔÙ¿ ÙËÓ Â‚‰ÔÌ¿‰· ›¯·Ó ‰ÈÏ¿ÛÈÔ Î›Ó‰˘ÓÔ ÁÈ· ∞∂∂(15). ¶·ÚfiÌÔÈ· ·ÔÙÂϤÛÌ·Ù· ‚Ú¤ıËÎ·Ó Î·È Û ̛· ÌÂϤÙË Ô˘ ¤ÁÈÓ ÛÙË ƒˆÛ›·,(16), ηıÒ˜ Î·È Û ¿ÏϘ ÌÂϤÙ˜ ÂÚÈÛÙ·Ûȷ΋˜ ηٷӿψÛ˘ ˘ÂÚ‚ÔÏÈο ÌÂÁ¿ÏˆÓ ÔÛÔÙ‹ÙˆÓ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ (binge drinking). ™‡Ìʈӷ Ì ÚfiÛÊ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ, ·˘Ùfi˜ Ô ÙÚfiÔ˜ ηٷӿψÛ˘ ·ÏÎÔÔÏÔ‡¯ˆÓ (binge drinking) ÔÙÒÓ ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ·‡ÍËÛË Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘, ÙÔ˘ ηډȷÎÔ‡ Ú˘ıÌÔ‡ Î·È Ù˘ ËÎÙÈÎfiÙËÙ·˜ ÙÔ˘ ·›Ì·ÙÔ˜(17). ™Â ·ÓÙ›ıÂÛË Ì ٷ ·Ú·¿Óˆ ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ, Ì›· ÌÂϤÙË Û πÙ·ÏÔ‡˜ ·ÁÚfiÙ˜ (ÌÂϤÙË ªen-rural Italy) ¤‰ÂÈÍ fiÙÈ Ë Î·Ù·Ó¿ÏˆÛË ·fi 20 ¤ˆ˜ 54 ·ÏÎÔÔÏÔ‡¯· ÔÙ¿/‚‰ÔÌ¿‰· Û˘Û¯ÂÙ›ÛıËΠ̠ηχÙÂÚ· ÔÛÔÛÙ¿ ÂÈ‚›ˆÛ˘ Î·È Ì ÙË ÌÈÎÚfiÙÂÚË ıÓËÙfiÙËÙ· ·fi ηډȷÁÁÂȷο Û˘Ì‚¿Ì·Ù· (7/1000-10/1000 ¿ÙÔÌ· ÙÔ ¯ÚfiÓÔ) Û ۇÁÎÚÈÛË Ì ÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi(18, 19). ∏ ÌÂϤÙË ·˘Ù‹ ¤‰ÂÈÍ ̛· Û˘Û¯¤ÙÈÛË Û¯‹Ì·ÙÔ˜ J ·Ó¿ÌÂÛ· ÛÙËÓ Î·Ù·Ó¿ÏˆÛË ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ Î·È ÙË ıÓËÙfiÙËÙ· ·fi ηډȷÁÁÂȷο Û˘Ì‚¿Ì·Ù·, ηıÒ˜ Î·È ÙËÓ ÔÏÈ΋ ıÓËÙfiÙËÙ·. ™ÙËÓ ÚÔÛ¿ıÂÈ· Ó· ·ÍÈÔÏÔÁ‹ÛÔ˘Ì ٷ ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ‰È·ÊfiÚˆÓ ÌÂÏÂÙÒÓ Î·È Ó· ÂÍËÁ‹ÛÔ˘Ì ÙȘ ‰È·ÊÔÚÂÙÈΤ˜ ÂȉڿÛÂȘ Ù˘ ηٷӿψÛ˘ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ Û ‰È·ÊÔÚÂÙÈΤ˜ ¯ÒÚ˜ Ú¤ÂÈ Ó· Ï¿‚Ô˘ÌÂ

˘fi„Ë Ù· ÂÍ‹˜: ∞) ¶·Ú¿ÁÔÓÙ˜, fiˆ˜ Ô ÙÚfiÔ˜ Î·È ÔÈ Û˘Ó‹ıÂȘ ηٷӿψÛ˘ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ (‰ËÏ·‰‹ Â¿Ó Â›Ó·È Û˘¯Ó‹ ‹ ÂÚÈÛÙ·Ûȷ΋, Â¿Ó Û˘Óԉ‡ÂÙ·È ·fi Á‡̷ٷ ‹ Â›Ó·È ·ÓÂÍ¿ÚÙËÙË ·fi ÙÔ Ê·ÁËÙfi) ı· ÌÔÚÔ‡Û·Ó Ó· ‰È·ÊÔÚÔÔÈ‹ÛÔ˘Ó ÙȘ ÂȉڿÛÂȘ ÙÔ˘ ·ÏÎÔfiÏ ÛÙË ıÓËÙfiÙËÙ·. ™‡Ìʈӷ Ì ̛· ÌÂÙ·-·Ó¿Ï˘ÛË(20), Ë Î·Ù·Ó¿ÏˆÛË ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ ·ÓÂÍ¿ÚÙËÙ· ·fi ÙÔ Ê·ÁËÙfi Û˘Û¯ÂÙ›˙ÂÙ·È Ì ·˘ÍË̤ÓÔ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ, οÙÈ Ô˘ ‰ÂÓ ÂȂ‚·ÈÒÓÂÙ·È ·fi ¿ÏϘ ÌÂϤÙ˜(21). μ) ÿÛˆ˜ οÔÈÔ ÚfiÏÔ Ó· ‰È·‰Ú·Ì·Ù›˙ÂÈ Î·È ÙÔ Â›‰Ô˜ ÙÔ˘ ·ÏÎÔÔÏÔ‡¯Ô˘ ÔÙÔ‡. ΔÔ ÎÚ·Û› ¤¯ÂÈ ÔÏ˘Ê·ÈÓfiϘ Î·È Â›Ó·È ÂȂ‚·ÈˆÌ¤ÓË Ë Â˘ÂÚÁÂÙÈ΋ ÙÔ˘ Â›‰Ú·ÛË. ΔÈ Á›ÓÂÙ·È fï˜ Ì ٷ ¿ÏÏ· ÔÙ¿, fiˆ˜ Â›Ó·È Ë Ì‡Ú·; ™‡Ìʈӷ Ì ̛· ÌÂÙ··Ó¿Ï˘ÛË(22), ÌÈÎÚ¤˜ ÔÛfiÙËÙ˜ (1-4 ÔÙ¿/Ë̤ڷ) Ì‡Ú·˜, ÎÚ·ÛÈÔ‡ Î·È ¿ÏÏˆÓ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ Â›Ó·È ÂÍ›ÛÔ˘ ˆÊ¤ÏÈ̘ ÁÈ· ÙÔ Î·Ú‰È·ÁÁÂÈ·Îfi Û‡ÛÙËÌ·. °) Δ¤ÏÔ˜ ÛÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ Ú¤ÂÈ ¿ÓÙÔÙ ӷ Ï·Ì‚¿ÓÔ˘Ì ˘fi„Ë Î·È ÙÔ˘˜ ÎÏ·ÛÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ. ™˘ÓÔ„›˙ÔÓÙ·˜, ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ÌÂÏÂÙÒÓ Ë Î·Ù·Ó¿ÏˆÛË 1-30 ÌÔÓ¿‰ˆÓ ·ÏÎÔfiÏ/ ‚‰ÔÌ¿‰· Û˘Û¯ÂÙ›˙ÂÙ·È Ì ٷ ηχÙÂÚ· ÔÛÔÛÙ¿ ÂÈ‚›ˆÛ˘, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙÔ Â›‰Ô˜ ÙÔ˘ ·ÏÎÔÔÏÔ‡¯Ô˘ ÔÙÔ‡. ™ÙÂÊ·ÓÈ·›· ÓfiÛÔ˜ Î·È ·ÏÎÔfiÏ. ™‡Ìʈӷ Ì ̛· ÌÂÙ·-·Ó¿Ï˘ÛË (4) Ë Û˘Û¯¤ÙÈÛË ·Ó¿ÌÂÛ· ÛÙËÓ

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

ª∂§∂Δ∂™ Male-British doctors(14) Men-Western Scotland(15) Men-rural Italy(18,19) ª∂Δ∞-∞¡∞§À™∂π™ Cleophas(21) Rehm et.al.(4) Reynoldw et al.(24)

™Δ∂º∞¡π∞π∞ ¡√™√™ ¶ÔÙ¿/‚‰ÔÌ¿‰· 8-28 0-14

∞∂∂ ¶ÔÙ¿/‚‰ÔÌ¿‰· 1-42 0-14

√§π∫∏ £¡∏Δ√Δ∏Δ∞ ¶ÔÙ¿/‚‰ÔÌ¿‰· 8-21 0-14

23-54 ¶ÔÙ¿/‚‰ÔÌ¿‰· 8-28 1-23(Á˘Ó·›Î˜) 1-35(¿Ó‰Ú˜) -

23-54 ¶ÔÙ¿/‚‰ÔÌ¿‰· 1-23(Á˘Ó·›Î˜) 0 (¿Ó‰Ú˜) 1-14(ÈÛ¯·ÈÌÈο,1-14 ·ÈÌÔÚÚ·ÁÈο)

23-54 ¶ÔÙ¿/‚‰ÔÌ¿‰· 8-28 -

5

ATHIROSK 14

03-07-07

12:06

™ÂÏ›‰·6

π√À¡π√™ 2007

ÚfiÛÏË„Ë ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ Î·È ÙË ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ Â›Ó·È ÂÚ›ÏÔÎË. H Û˘¯Ó‹ ηٷӿψÛË ÌÈÎÚ‹˜ ¤ˆ˜ ̤ÙÚÈ·˜ ÔÛfiÙËÙ·˜ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ ¤¯ÂÈ Û˘Û¯ÂÙÈÛı› Ì ¢ÂÚÁÂÙÈΤ˜ ÂȉڿÛÂȘ ÛÙÔ Î·Ú‰È·ÁÁÂÈ·Îfi Û‡ÛÙËÌ·, ÂÓÒ Ë ÂÚÈÛÙ·Ûȷ΋ ηٷӿψÛË Ôχ ÌÂÁ¿ÏˆÓ ÔÛÔÙ‹ÙˆÓ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ, ·ÎfiÌË Î·È ·Ó Û˘Ó‰˘¿˙ÂÙ·È Ì ̛· ηٿ ̤ÛÔ fiÚÔ ÌÈÎÚ‹ ¤ˆ˜ ̤ÙÚÈ· ηٷӿψÛË Û ٷÎÙÈ΋ ‚¿ÛË, ¤¯ÂÈ Û˘Û¯ÂÙÈÛı› Ì ·˘ÍË̤ÓÔ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ. ™˘ÁÎÂÎÚÈ̤ӷ, Û‡Ìʈӷ Ì ̛· ÌÂÙ·-·Ó¿Ï˘ÛË(22), Ë Î·Ù·Ó¿ÏˆÛË 1 - 4 ÔÙÒÓ/Ë̤ڷ(12 - 48 ml ·ÏÎÔfiÏ) ÌÔÚ› Ó· ÌÂÈÒÛÂÈ ÙË ıÓËÙfiÙËÙ· ·fi ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘ ηٿ 20 - 30%. ™‡Ìʈӷ Ì ̛· ¿ÏÏË ÌÂÙ· - ·Ó¿Ï˘ÛË(4), Ë Î·Ù·Ó¿ÏˆÛË ÏÈÁfiÙÂÚÔ ·fi 3,5 ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ/ Ë̤ڷ ÁÈ· ÙȘ Á˘Ó·›Î˜ Î·È ÏÈÁfiÙÂÚÔ ·fi 5 ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ ÁÈ· ÙÔ˘˜ ¿Ó‰Ú˜ ÌÔÚ› Ó· ÌÂÈÒÛÂÈ ÙËÓ Â›ÙˆÛË Ù˘ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ ηٿ 20%. ™Â Ì›· ÚfiÛÊ·ÙË ÌÂϤÙË(21), ‰È·ÈÛÙÒıËΠfiÙÈ Ë Û˘¯Ó‹ ηٷӿψÛË 1 - 4 ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ/ Ë̤ڷ Û˘Û¯ÂÙ›ÛıËΠ̠ÌÂȈ̤ÓË Â›ÙˆÛË ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ôηډ›Ô˘ Î·È fiÙÈ Ë Î·Ù¿ ¤Ó· ÔÙfi ·‡ÍËÛË Ù˘ ηٷӿψÛ˘ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ Û˘Û¯ÂÙ›˙ÔÓÙ·Ó Ì ۯÂÙÈÎfi ΛӉ˘ÓÔ ÁÈ· ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘ 0,78. ∂›Û˘, Ì›· ¿ÏÏË ÌÂÙ·-·Ó¿Ï˘ÛË(23) ¤‰ÂÈÍ fiÙÈ Ô Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ ÁÈ· ·ÁÁÂȷο ÓÔÛ‹Ì·Ù· Â›Ó·È 0,68 ÁÈ· Ù· ¿ÙÔÌ· Ô˘ ηٷӷÏÒÓÔ˘Ó ÌÈÎÚ¤˜ ÔÛfiÙËÙ˜ ÎÚ·ÛÈÔ‡ Î·È 0,78 ÁÈ· ·˘ÙÔ‡˜ Ô˘ ηٷӷÏÒÓÔ˘Ó ÌÈÎÚ¤˜ ÔÛfiÙËÙ˜ Ì‡Ú·˜. √È ·ıÔÊ˘ÛÈÔÏÔÁÈÎÔ› Ì˯·ÓÈÛÌÔ› Ô˘ ÂÍËÁÔ‡Ó ·˘ÙfiÓ ÙÔÓ ÚÔÛٷ٢ÙÈÎfi ÚfiÏÔ ÙˆÓ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ Â›Ó·È ÔÈ ÂÍ‹˜: ∞) ∏ ÚfiÛÏË„Ë ÌÈÎÚ‹˜ ÔÛfiÙËÙ·˜ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ ÚÔηÏ› ‚ÂÏÙ›ˆÛË ÙÔ˘ ÏÈȉ·ÈÌÈÎÔ‡ ÚÔÊ›Ï, ΢ڛˆ˜ ·‡ÍËÛË Ù˘ ∏DL ¯ÔÏËÛÙÂÚfiÏ˘. Œ¯ÂÈ ÂÎÙÈÌËı› Ì¿ÏÈÛÙ· fiÙÈ ÙÔ 4050% Ù˘ ÚÔÛٷ٢ÙÈ΋˜ ‰Ú¿Û˘ ÙÔ˘ ·ÏÎÔfiÏ ·Ô‰›‰ÂÙ·È Û ·˘Ùfi ÙÔ Ì˯·ÓÈÛÌfi. μ) ∏ Û˘¯Ó‹ ηٷӿψÛË ÌÈÎÚ‹˜ ¤ˆ˜ ̤ÙÚÈ·˜ ÔÛfiÙËÙ·˜ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ ÂËÚ¿˙ÂÈ ÙÔ Ì˯·ÓÈÛÌfi ‹Í˘ ‰È· ̤ÛÔ˘ Ù˘ ‰Ú¿Û˘ Ù˘ ·ÏÎÔfiÏ˘ ÛÙË Û˘Û-

6

ÛÒÚ¢ÛË ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ Î·È ÛÙËÓ ÈÓˆ‰fiÏ˘ÛË. ∏ ÚÔÛٷ٢ÙÈ΋ ÁÈ· ÙÔ Î·Ú‰È·ÁÁÂÈ·Îfi Û‡ÛÙËÌ· ‰Ú¿ÛË Ô˘ ¤¯ÂÈ Ë Î·Ù·Ó¿ÏˆÛË ÌÈÎÚ‹˜ ‹ ̤ÙÚÈ·˜ ÔÛfiÙËÙ·˜ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ ¤¯ÂÈ ·Ô‰Âȯı› ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ÏËı˘ÛÌÒÓ Ù˘ ¢˘ÙÈ΋˜ ∂˘ÚÒ˘ Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ Î·È ÂÎÂ›ÓˆÓ ÙˆÓ ·ÙfiÌˆÓ Ô˘ ¤¯Ô˘Ó ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Î·È Î·Ú‰È·ÁÁÂȷ΋ ÓfiÛÔ (ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ, ∞∂∂). ∞ÓÙ›ıÂÙ·, Ë ÂÚÈÛÙ·Ûȷ΋ ηٷӿψÛË ˘ÂÚ‚ÔÏÈο ÌÂÁ¿ÏˆÓ ÔÛÔÙ‹ÙˆÓ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ·˘ÍË̤ÓÔ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ ‰È· ̤ÛÔ˘ Ù˘ ·‡ÍËÛ˘ Ù˘ ËÎÙÈÎfiÙËÙ·˜ ÙÔ˘ ·›Ì·ÙÔ˜(24). ∞ÏÎÔfiÏ Î·È ·ÁÁÂȷο ÂÁÎÂÊ·ÏÈο ÂÂÈÛfi‰È·. ™‡Ìʈӷ Ì ̛· ÌÂϤÙË(25), Ë ÂÏ¿¯ÈÛÙË ıÓËÙfiÙËÙ· ·fi ∞∂∂ Û˘Û¯ÂÙ›ÛıËΠ̠ÙËÓ Î·Ù·Ó¿ÏˆÛË 1 - 14 ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ/‚‰ÔÌ¿‰·. °ÂÓÈο Ê·›ÓÂÙ·È fiÙÈ ˘¿Ú¯ÂÈ Ì›· ÁÚ·ÌÌÈ΋ Û˘Û¯¤ÙÈÛË ·Ó¿ÌÂÛ· ÛÙËÓ Î·Ù·Ó¿ÏˆÛË ·ÏÎÔfiÏ Î·È ÙËÓ Â›ÙˆÛË ÙˆÓ ·ÈÌÔÚÚ·ÁÈÎÒÓ ∞∂∂, ΢ڛˆ˜ Ù˘ ˘·Ú·¯ÓÔÂȉԇ˜ ·ÈÌÔÚÚ·Á›·˜. ¶Ú¤ÂÈ Î·È Â‰Ò Ó· Ï¿‚Ô˘Ì ˘fi„Ë fiÙÈ Ô ÙÚfiÔ˜ ÚfiÛÏ˄˘ ·ÏÎÔfiÏ (ÂÚÈÛÙ·Ûȷ΋ ‹ Û˘¯Ó‹ ηٷӿψÛË ÌÈÎÚÒÓ ÔÛÔÙ‹ÙˆÓ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ ‹ binge drinking) ‰È·‰Ú·Ì·Ù›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ˆ˜ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· fiÏÔ˘˜ ÙÔ˘˜ Ù‡Ô˘˜ ÙˆÓ ∞∂∂, ΢ڛˆ˜ ÛÙ· Ó·ڿ ¿ÙÔÌ·. ªÂϤÙ˜ Ô˘ ¤ÁÈÓ·Ó ÁÈ· ÙË Û˘Û¯¤ÙÈÛË Ù˘ ηٷӿψÛ˘ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ Ì ٷ ∞∂∂ ¤‰ÂÈÍ·Ó ·ÓÙÈÎÚÔ˘fiÌÂÓ· ·ÔÙÂϤÛÌ·Ù·, Èı·Ó¿ ÁÈ·Ù› Ë Û˘Û¯¤ÙÈÛË ·˘Ù‹ Â›Ó·È ‰È·ÊÔÚÂÙÈ΋ ÁÈ· Ù· ·ÈÌÔÚÚ·ÁÈο ∞∂∂ Î·È ÁÈ· Ù· ÈÛ¯·ÈÌÈο ∞∂∂. ™˘ÁÎÂÎÚÈ̤ӷ, οÔȘ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ Ô Î›Ó‰˘ÓÔ˜ ÁÈ· ·ÈÌÔÚÚ·ÁÈο ∞∂∂ ·˘Í¿ÓÂÙ·È Ì ÙËÓ Î·Ù·Ó¿ÏˆÛË ÙˆÓ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ(26). ∞ÓÙ›ıÂÙ· οÔȘ ¿ÏϘ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó ÌÂȈ̤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ÈÛ¯·ÈÌÈο ∞∂∂ Û ÂÚÈÙÒÛÂȘ Û˘¯Ó‹˜ ηٷӿψÛ˘ ÌÈÎÚÒÓ ÔÛÔÙ‹ÙˆÓ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ Î·È ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ‹ η̛· Â›‰Ú·ÛË(26, 27) Û ÂÚÈÙÒÛÂȘ ÂÚÈÛÙ·Ûȷ΋˜ ηٷӿψÛ˘ Ôχ ÌÂÁ¿ÏˆÓ ÔÛÔÙ‹ÙˆÓ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ. √È

ÂȉڿÛÂȘ ÙÔ˘ ·ÏÎÔfiÏ ÛÙËÓ ·ÚÙËÚȷ΋ ›ÂÛË Î·È ÛÙÔ Ì˯·ÓÈÛÌfi ‹Í˘ ı· ÌÔÚÔ‡Û·Ó Ó· ÂÍËÁ‹ÛÔ˘Ó ÙÔÓ ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ·ÈÌÔÚÚ·ÁÈÎÒÓ ∞∂∂ Û ¿ÙÔÌ· Ô˘ ηٷӷÏÒÓÔ˘Ó ÌÂÁ¿Ï˜ ÔÛfiÙËÙ˜ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ. ™˘ÓÔÙÈο Ê·›ÓÂÙ·È fiÙÈ Ì›· Ôχ ÌÈÎÚ‹ ÔÛfiÙËÙ· ·ÏÎÔfiÏ (1 - 2 ÔÙ¿/Ë̤ڷ) Èı·Ó¿ Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ ÚÔÛÙ·Û›· ·fi Ù· ∞∂∂. ª›· ÌÂϤÙË ÛÙË ™Ô˘Ë‰›·(28) ¤‰ÂÈÍ fiÙÈ Ì¤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 59 ÂÙÒÓ ÔÈ ı¿Ó·ÙÔÈ Ô˘ ÚÔÎÏ‹ıËÎ·Ó ·fi ÙËÓ Î·Ù·Ó¿ÏˆÛË ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ ‹Ù·Ó ÂÚÈÛÛfiÙÂÚÔÈ ·fi ·˘ÙÔ‡˜ Ô˘ ·ÔÙÚ¿ËηÓ, ÂÓÒ Û ¿ÙÔÌ· ËÏÈΛ·˜ >70 ÂÙÒÓ ÙÔ ·ÏÎÔfiÏ ÚÔÏ·Ì‚¿ÓÂÈ ÙÔ 5% ÙˆÓ ı·Ó¿ÙˆÓ ÛÙÔ˘˜ ¿Ó‰Ú˜ Î·È ÙÔ 4.4% ÙˆÓ ı·Ó¿ÙˆÓ ÛÙȘ Á˘Ó·›Î˜. ∞˘Ùfi ÙÔ ÂÍ·ÚÙÒÌÂÓÔ ·fi ÙËÓ ËÏÈΛ· fiÊÂÏÔ˜ ¤¯ÂÈ ˘ÔÛÙËÚȯı› Î·È ·fi ¿ÏÏÔ˘˜ ÌÂÏÂÙËÙ¤˜(29) Ô˘ ¤‰ÂÈÍ·Ó fiÙÈ Ë ÚÔÛٷ٢ÙÈ΋ ‰Ú¿ÛË Ù˘ ÌÈÎÚ‹˜ ¤ˆ˜ ̤ÙÚÈ·˜ ÔÛfiÙËÙ·˜ ·ÏÎÔfiÏ ÛÙË ıÓËÙfiÙËÙ· ˘ÂÚ‚·›ÓÂÈ ÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜ ÁÈ· ÙÔ˘˜ ¿Ó‰Ú˜ ÛÙËÓ ËÏÈΛ· ÙˆÓ 40 ÂÙÒÓ Î·È ÁÈ· ÙȘ Á˘Ó·›Î˜ ÛÙËÓ ËÏÈΛ· ÙˆÓ 50 ÂÙÒÓ. √ ˘ÂÚÙ·ÛÈÎfi˜ ·ÛıÂÓ‹˜. ™ÙËÓ ÚÔÛ¿ıÂÈ· ÂÎÙ›ÌËÛ˘ Ù˘ ÈÛÔÚÚÔ›·˜ ΤډԘ/ΛӉ˘ÓÔ˜ ·fi ÙËÓ Î·Ù·Ó¿ÏˆÛË ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ Û ¤Ó· ˘ÂÚÙ·ÛÈÎfi ·ÛıÂÓ‹ Ú¤ÂÈ Ó· Ï¿‚Ô˘Ì ˘fi„Ë ÙÔ Û˘Ó‰˘·ÛÌfi ÙˆÓ ÂȉڿÛÂˆÓ Ù˘ ·ÚÙËÚȷ΋˜ ˘¤ÚÙ·Û˘ Î·È Ù˘ ÚÔÛÏ·Ì‚·ÓfiÌÂÓ˘ ÔÛfiÙËÙ·˜ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ ÛÙÔ Î·Ú‰È·ÁÁÂÈ·Îfi Û‡ÛÙËÌ·. ª›· ÌÂϤÙË Ô˘ ¤ÁÈÓ Û 14.125 ¿Ó‰Ú˜ Ì ÈÛÙÔÚÈÎfi ˘¤ÚÙ·Û˘ ¤‰ÂÈÍ fiÙÈ Ë Î·Ù·Ó¿ÏˆÛË ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ ÌÂÈÒÓÂÈ ÙËÓ Â›ÙˆÛË ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ Î·È Ù˘ ÔÏÈ΋˜ ıÓËÙfiÙËÙ·˜ Û ۇÁÎÚÈÛË Ì ÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi(30). πÛ¯‡ÂÈ Î¿ÙÈ Ù¤ÙÔÈÔ ÛÙÔÓ ˘ÂÚÙ·ÛÈÎfi ·ÛıÂÓ‹ Ô˘ ηٷӷÏÒÓÂÈ ˘ÂÚ‚ÔÏÈο ÌÂÁ¿Ï˜ ÔÛfiÙËÙ˜ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ; ™‡Ìʈӷ Ì ÚfiÛÊ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ Û ¤Ó· ˘ÂÚÙ·ÛÈÎfi ·ÛıÂÓ‹ Ô˘ ηٷӷÏÒÓÂÈ >64 ·ÏÎÔÔÏÔ‡¯· ÔÙ¿/‚‰ÔÌ¿‰·, Ì›· Ì›ˆÛË Ù˘ ÚÔÛÏ·Ì‚·ÓfiÌÂÓ˘ ÔÛfiÙËÙ·˜ ηٿ 25% ÌÂÈÒÓÂÈ ÙËÓ Â›ÙˆÛË Ù˘ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘. ∂ȉÈÎfiÙÂÚ·, ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ fiÊÂÏÔ˜ fiÛÔÓ ·ÊÔÚ¿

ATHIROSK 14

03-07-07

12:06

™ÂÏ›‰·7

¶APA°ONTE™ KIN¢YNOY ÙËÓ Â›ÙˆÛË Ù˘ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ ·Ú·ÙËÚÂ›Ù·È fiÙ·Ó Ë Î·Ù·Ó¿ÏˆÛË ÙˆÓ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ ÂÏ·ÙÙˆı› ÛÙ· 1 - 16 ÔÙ¿/‚‰ÔÌ¿‰·. ∂›Û˘, Ô ˘ÂÚÙ·ÛÈÎfi˜ ·ÛıÂÓ‹˜ Ô˘ ›ÓÂÈ 17 - 64 ÔÙ¿/‚‰ÔÌ¿‰· ı· ˆÊÂÏËı› (fiÛÔÓ ·ÊÔÚ¿ ÙËÓ Â›ÙˆÛË ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ) ·fi ÙËÓ ÂÏ¿ÙÙˆÛË ÛÙËÓ Î·Ù·Ó¿ÏˆÛË ÙˆÓ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ ÛÙ· 1-16 ÔÙ¿/‚‰ÔÌ¿‰·. ™ÙȘ ‰‡Ô ·Ú·¿Óˆ ÔÌ¿‰Â˜ ·ÛıÂÓÒÓ (·˘ÙÔ› Ô˘ ηٷӷÏÒÓÔ˘Ó >64 ·ÏÎÔÔÏÔ‡¯· ÔÙ¿/‚‰ÔÌ¿‰· Î·È ·˘ÙÔ› Ô˘ ηٷӷÏÒÓÔ˘Ó 17 - 64 ·ÏÎÔÔÏÔ‡¯· ÔÙ¿/ ‚‰ÔÌ¿‰·), Ô Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ ÁÈ· ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ ÂÏ·ÙÙÒÓÂÙ·È ·fi 1 Î·È 0,8 ·ÓÙ›ÛÙÔȯ· ÛÙÔ 0,7. ∞˘Ùfi ÙÔ fiÊÂÏÔ˜ ‰ÂÓ ·Ú·ÙËÚ‹ıË-

ΠÛÙÔ˘˜ ˘ÂÚÙ·ÛÈÎÔ‡˜ ·ÛıÂÓ›˜ Ô˘ ·ÔÙ˘Á¯¿ÓÔ˘Ó Ó· ÂÏ·ÙÙÒÛÔ˘Ó ÙËÓ Â‚‰ÔÌ·‰È·›· ÚfiÛÏË„Ë ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ. ™ÙÔ˘˜ ˘ÂÚÙ·ÛÈÎÔ‡˜ ·ÛıÂÓ›˜ Ô˘ ηٷӷÏÒÓÔ˘Ó ÌfiÓÔ 1 - 4 ·ÏÎÔÔÏÔ‡¯· ÔÙ¿/ ‚‰ÔÌ¿‰· Î·È ‰È·ÎfiÙÔ˘Ó ÙËÓ ÚfiÛÏË„Ë Ë ·ÚÙËÚȷ΋ ÙÔ˘˜ ›ÂÛË ‰ÂÓ ÂÏ·ÙÙÒÓÂÙ·È Ô˘ÛÈ·ÛÙÈο Î·È ·˘Í¿ÓÂÙ·È Ô Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ ÁÈ· ηډȷÁÁÂȷο Û˘Ì‚¿Ì·Ù· ·fi ÙÔ 0,8 ÛÙÔ 1. ™˘ÓÔ„›˙ÔÓÙ·˜, Û‡Ìʈӷ Ì ٷ ÚfiÛÊ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ, ÙÔ ·ÏÎÔfiÏ Û¯ÂÙ›˙ÂÙ·È Ì ÂÚÈÛÛfiÙÂÚ˜ ·fi 60 ÓÔÛËÚ¤˜ ηٷÛÙ¿ÛÂȘ. º·›ÓÂÙ·È fiÙÈ Ë Û˘Û¯¤ÙÈÛË Ù˘ ηٷӿψÛ˘ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ Ì ٷ ηډȷÁÁÂȷο Û˘Ì‚¿Ì·Ù· Î·È ÙË ıÓËÙfiÙËÙ· Â›Ó·È Ô-

χÏÔÎË Î·È ÔÏ˘‰È¿ÛÙ·ÙË. ™Â ˘ÂÚÙ·ÛÈÎÔ‡˜ ·ÛıÂÓ›˜ ÙˆÓ ¢˘ÙÈÎÒÓ ∂˘Úˆ·˚ÎÒÓ ¯ˆÚÒÓ ËÏÈΛ·˜ >60 ÂÙÒÓ Ô˘ ηٷӷÏÒÓÔ˘Ó >16 ·ÏÎÔÔÏÔ‡¯· ÔÙ¿/‚‰ÔÌ¿‰· Ë ÂÏ¿ÙÙˆÛË Î·È fi¯È Ë ‰È·ÎÔ‹ Ù˘ ÚfiÛÏ˄˘ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÌÂȈ̤ÓË Â›ÙˆÛË Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ. ªÂϤÙ˜ ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi ‰Â›¯ÓÔ˘Ó fiÙÈ Û ¿ÙÔÌ· ËÏÈΛ·˜ >60 ÂÙÒÓ ÙÔ fiÊÂÏÔ˜ ·fi ÙËÓ Î·Ù·Ó¿ÏˆÛË ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ ˘ÂÚ‚·›ÓÂÈ ÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜. Δ¤ÏÔ˜, Ï·Ì‚¿ÓÔÓÙ·˜ ˘fi„Ë ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ηډȷÁÁÂȷο Û˘Ì‚¿Ì·Ù·, Ú¤ÂÈ Ó· ÂÍ·ÙÔÌÈ·ÔÓÙ·È ÔÈ Ô‰ËÁ›Â˜ Ô˘ ‰›ÓÔÓÙ·È Û οı ·ÛıÂÓ‹ ̤۷ ÛÙ· Ï·›ÛÈ· Ù˘ ÚˆÙÔÁÂÓÔ‡˜ ÚfiÏ˄˘ Ù˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘.

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ATHIROSK 14

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™ÂÏ›‰·8

π√À¡π√™ 2007

¶ÚfiÏË„Ë ÙÔ˘ ™·Î¯·ÚÒ‰Ë ¢È·‚‹ÙË Δ‡Ô˘ 2 ¡›ÎÔ˜ ¢È·ÎÔ˘Ì¿ÎÔ˜, ∫·Ú‰ÈÔÏfiÁÔ˜. ¢È·ÁÓˆÛÙÈÎfi ∫·Ú‰ÈÔÏÔÁÈÎfi ∫¤ÓÙÚÔ ¶ÂÈÚ·È¿, ™˘ÓÂÚÁ¿Ù˘ ¡ÔÛÔÎÔÌ›Ԣ Metropolitan ¶ÚfiÛÊ·Ù· (Ù‡¯Ô˜ π·ÓÔ˘·Ú›Ô˘ ÙÔ˘ 2007) ‰ËÌÔÛȇıËÎ·Ó ÔÈ ∫·Ù¢ı˘ÓÙ‹ÚȘ √‰ËÁ›Â˜ ÁÈ· ÙÔ ¢È·‚‹ÙË, ÙÔ ¶Úԉȷ‚‹ÙË Î·È ÙȘ ∫·Ú‰È·ÁÁÂȷΤ˜ ·ı‹ÛÂȘ, Ù˘ ∂˘Úˆ·˚΋˜ ∫·Ú‰ÈÔÏÔÁÈ΋˜ ∂Ù·ÈÚ›·˜ (ESC) Î·È Ù˘ ∂˘Úˆ·˚΋˜ ∂Ù·ÈÚ›·˜ ÁÈ· ÙË ªÂϤÙË ÙÔ˘ ¢È·‚‹ÙË (EASD). ªÂٷ͇ ¿ÏψÓ, ˘¿Ú¯ÂÈ Ì›· Û‡ÓÙÔÌË ·Ó·ÛÎfiËÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ÁÈ· ÙË ÚfiÏË„Ë ÙÔ˘ ™·Î¯·ÚÒ‰Ë ¢È·‚‹ÙË Ù‡Ô˘ 2 (™¢ 2), Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ÂӉȷʤÚÔÓ, ·ÊÔ‡ ·ÔÙÂÏ› Ì›· Ï‹ÚË ÂÚ›ÏË„Ë ÙˆÓ ÛÙÔȯ›ˆÓ ·fi ÙȘ ̤¯ÚÈ Û‹ÌÂÚ· ÌÂϤÙ˜. √ ‰È·‚‹Ù˘ Î·È ÔÈ Î·Ú‰È·ÁÁÂȷΤ˜ ·ı‹ÛÂȘ ÂÌÊ·Ó›˙ÔÓÙ·È Û˘¯Ó¿ Û·Ó ÔÈ ‰‡Ô fi„ÂȘ ÙÔ˘ ›‰ÈÔ˘ ÓÔÌ›ÛÌ·ÙÔ˜. √ ‰È·‚‹Ù˘ ¤¯ÂÈ ıˆÚËı› ÈÛÔ‰‡Ó·ÌÔ Ù˘ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ (™¡) ηÈ, ·ÓÙ›ÛÙÚÔÊ·, ÔÏÏÔ› ·ÛıÂÓ›˜ Ì ÂÁηÙÂÛÙË̤ÓË ™¡ ¿Û¯Ô˘Ó ·fi ‰È·‚‹ÙË, ‹ ·fi ÚÔ-‰È·‚ËÙÈΤ˜ ηٷÛÙ¿ÛÂȘ, ÂÓÒ Ë Û˘¯ÓfiÙÂÚË ·ÈÙ›· ı·Ó¿ÙÔ˘ ÛÙÔ˘˜ ∂˘Úˆ·›Ô˘˜ ‰È·‚ËÙÈÎÔ‡˜ ÂÓËÏ›ÎÔ˘˜ Â›Ó·È Ë ™¡. ∞ÚÎÂÙ¤˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ÔÈ ·ÛıÂÓ›˜ ·˘ÙÔ› ‰È·ÙÚ¤¯Ô˘Ó 2Ï¿ÛÈÔ ˆ˜ 3Ï¿ÛÈÔ Î›Ó‰˘ÓÔ, Û ۯ¤ÛË Ì ٷ ¿ÙÔÌ· ¯ˆÚ›˜ ‰È·‚‹ÙË1. ¶ÚÈÓ ·fi ÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ ™¢ 2 ·Ú·ÙËÚÔ‡ÓÙ·È Û˘¯Ó¿ ÌÂÙ·‚ÔϤ˜ ‰È·ÊfiÚˆÓ ÌÂÙ·‚ÔÏÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ, fiˆ˜ ‰˘Û·ÓÂÍ›· ÛÙË ÁÏ˘Îfi˙Ë (IGT-Impaired Glucose Tolerance), ‰˘ÛÏÈȉ·ÈÌ›· Î·È ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË (π∞)2. ∞Ó Î·È ‰ÂÓ Î·Ù·Ï‹ÁÔ˘Ó Û ‰È·‚‹ÙË fiÏÔÈ ÔÈ ·ÛıÂÓ›˜ Ì ·ÚfiÌÔȘ ÌÂÙ·‚ÔÏÈΤ˜ ‰È·Ù·Ú·¯¤˜, Ô Î›Ó‰˘ÓÔ˜ ÂÌÊ¿ÓÈÛ˘ Ù˘ ÓfiÛÔ˘ Û ·˘ÙÔ‡˜ Â›Ó·È ÛËÌ·ÓÙÈο ·˘ÍË̤ÓÔ˜. ¶ÚÔÛÂÎÙÈο ۯ‰ȷṲ̂Ó˜ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ ÔÈ ÛÙÚ·ÙËÁÈΤ˜ ·ÔÙÂÏÂÛÌ·ÙÈ΋˜ ·Ú¤Ì‚·Û˘ ÛÙÔ ÙÚfiÔ ˙ˆ‹˜ Â›Ó·È Û ı¤ÛË Ó· ·ÚÂÌÔ‰›ÛÔ˘Ó, ‹ ÙÔ˘Ï¿¯ÈÛÙÔÓ, Ó· ÂÈ‚Ú·‰‡ÓÔ˘Ó ÙËÓ ÂÌÊ¿ÓÈÛË ™¢ 2 ÛÙ· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ¿ÙÔÌ·. ™ÙË ™Ô˘Ë‰È΋ ÌÂϤÙË ÙÔ˘ Malmö, Ë ·˘ÍË̤ÓË Ê˘ÛÈ΋ ¿ÛÎËÛË Î·È

8

Ë ·ÒÏÂÈ· ‚¿ÚÔ˘˜ ·ÚÂÌfi‰ÈÛ·Ó ‹ ÂÈ‚Ú¿‰˘Ó·Ó ÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ ‰È·‚‹ÙË Û ¿ÙÔÌ· Ì IGT. ™ÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ 63% ÏÈÁfiÙÂÚ· ¿ÙÔÌ· ÂÌÊ¿ÓÈÛ·Ó ™¢ 2 Û˘ÁÎÚÈÙÈο Ì ÙËÓ ÔÌ¿‰·, Û ·Ú·ÎÔÏÔ‡ıËÛË 5 ÂÙÒÓ3. ™Â Ì›· ∫ÈÓÂ˙È΋ ÌÂϤÙË ·fi ÙÔ Da Qing, 577 ¿ÙÔÌ· Ì IGT Ù˘¯·ÈÔÔÈ‹ıËÎ·Ó Û ̛· ·fi ÙȘ 4 ·ÎfiÏÔ˘ı˜ ÔÌ¿‰Â˜: ÌfiÓÔ ¿ÛÎËÛË, ÌfiÓÔ ‰›·ÈÙ·, ‰›·ÈÙ· Î·È ¿ÛÎËÛË, η̛· ·Ú¤Ì‚·ÛË (ÔÌ¿‰· ÂϤÁ¯Ô˘)4. ∏ Û˘ÓÔÏÈ΋ Û˘¯ÓfiÙËÙ· ÙÔ˘ ™¢ 2, ÛÙË ‰È¿ÚÎÂÈ· ·Ú·ÎÔÏÔ‡ıËÛ˘ 6 ÂÙÒÓ, ‹Ù·Ó ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚË ÛÙȘ ÙÚÂȘ ÔÌ¿‰Â˜ ·Ú¤Ì‚·Û˘ (46%), Û ۯ¤ÛË Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ ™ÙË Finnish Diabetes Prevention Study (FDPS), Ì›ˆÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜ ≥5%, Ô˘ ÂÈÙ‡¯ıËΠ̠¤Ó· ÚfiÁÚ·ÌÌ· ÂÓÙ·ÙÈ΋˜ ‰›·ÈÙ·˜ Î·È ¿ÛÎËÛ˘, Û˘Óԉ¢fiÙ·Ó ·fi Ì›ˆÛË Î·Ù¿ 58% ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛ˘ ™¢ 2, Û ˘¤Ú‚·ÚÔ˘˜ ¿Ó‰Ú˜ Î·È Á˘Ó·›Î˜ Ì IGT5. √ ‚·ıÌfi˜ Ì›ˆÛ˘ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂͤÏÈ͢ Û ™¢ 2 Û¯ÂÙÈ˙fiÙ·Ó ¿ÌÂÛ· Ì ÙËÓ ¤ÓÙ·ÛË ÙˆÓ ÌÂÙ·‚ÔÏÒÓ ÙÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜. ΔÔ Diabetes Prevention Programme (DPP), ÛÙȘ ∏¶∞, Ô˘ Û‡ÁÎÚÈÓ ÙËÓ ÂÓÂÚÁfi ÌÂÙ·‚ÔÏ‹ ÙÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜, ‹ ÙË ÌÂÙÊÔÚÌ›ÓË, Ì ÙË ÎÏ·ÛÈ΋ ·ÚÔ¯‹ Û˘Ì‚Ô˘ÏÒÓ ÁÈ· ÙÔÓ ÙÚfiÔ ˙ˆ‹˜ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ, ‰È·›ÛÙˆÛ fiÙÈ Ë ÂÓÂÚÁfi˜ ÌÂÙ·‚ÔÏ‹ ÙÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜ Ì›ˆÛ ÙË Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ™¢ 2 ηٿ 58%, Û ¤Ó· ÏËı˘-

ÛÌfi ˘¤Ú‚·ÚˆÓ ∞ÌÂÚÈηÓÒÓ ÌÂÛËÏ›ÎˆÓ Ì IGT6. O ÛÙfi¯Ô˜ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ‹Ù·Ó Ó· ÂÈÙ¢¯ı› Ì›ˆÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜ ≥7% Î·È Ê˘ÛÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· ̤Û˘ ¤ÓÙ·Û˘ ÁÈ· 150 ÙÔ˘Ï¿¯ÈÛÙÔÓ ÏÂÙ¿ ÙËÓ Â‚‰ÔÌ¿‰·. ∏ Û˘ÓÔÏÈ΋ Â›ÙˆÛË ÙÔ˘ ‰È·‚‹ÙË ‹Ù·Ó 4.8, 7.8 Î·È 11.0 ÂÚÈÙÒÛÂȘ ·Ó¿ 100 ·ÓıÚˆÔ/¤ÙË, ÛÙȘ ÔÌ¿‰Â˜ Ù˘ ÂÓÂÚÁÔ‡ ÌÂÙ·‚ÔÏ‹˜ ÙÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜, Ù˘ ÌÂÙÊÔÚÌ›Ó˘ Î·È ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘, ·ÓÙ›ÛÙÔȯ·. ∞˘Ù‹ Ë Ì›ˆÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÂÌÊ¿ÓÈÛ˘ ™¢ 2 ·ÓÙÈÛÙÔȯ› Û ÚfiÏË„Ë 1 ÂÚ›ÙˆÛ˘ Ó¤Ô˘ ‰È·‚‹ÙË ÁÈ· οı 7 ıÂÚ·¢fiÌÂÓ· ¿ÙÔÌ· Ì IGT Â› 3 ¯ÚfiÓÈ·, ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ ÛÙÔ ÙÚfiÔ ˙ˆ‹˜, Û ۇÁÎÚÈÛË Ì 14 ¿ÙÔÌ· ÛÙËÓ ÔÌ¿‰· Ù˘ ÌÂÙÊÔÚÌ›Ó˘. Œ¯ÔÓÙ·˜ ˘fi„Ë ·˘Ù¿ Ù· ÂÓÙ˘ˆÛȷο ·ÔÙÂϤÛÌ·Ù·, Ë ∞merican Diabetes Association (ADA) Î·È ÙÔ National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK) Û˘ÓÈÛÙÔ‡Ó ¤ÏÂÁ¯Ô ÁÈ· ÂӉ¯fiÌÂÓÔ ˘„ËÏfi Â›Â‰Ô ÁÏ˘Îfi˙˘ ÛÙÔ ·›Ì·, Û ¿ÙÔÌ· >45 ÂÙÒÓ Ì μªπ ≥25 Kg/m2. ™Ù· ¿ÙÔÌ· Ì ÛÙÔȯ›· ÚÔ-‰È·‚ËÙÈ΋˜ ηٿÛÙ·Û˘ ı· Ú¤ÂÈ Ó· ·Ú¤¯ÂÙ·È Î·Ù¿ÏÏËÏË Û˘Ì‚Ô˘Ï¢ÙÈ΋ ‚Ô‹ıÂÈ· ÁÈ· ÙËÓ ·ÒÏÂÈ· ‚¿ÚÔ˘˜, ‰È·Ì¤ÛÔ˘ ÚÔÁÚ·ÌÌ¿ÙˆÓ ‰È·ÈÙËÙÈ΋˜ ÙÚÔÔÔ›ËÛ˘ Î·È ¿ÛÎËÛ˘7. √ ·ÚÈıÌfi˜ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ¯ÚÂÈ¿˙ÂÙ·È Ó· ıÂÚ·¢ıÔ‡Ó (¡¡Δ) ÁÈ· Ó· ÚÔÏËÊı› Ì›· ÂÚ›ÙˆÛË ™¢ 2, Ì ·Ú¤Ì‚·ÛË ÛÙÔ ÙÚfiÔ ˙ˆ‹˜, Û ¿ÙÔÌ· Ì IGT, Â›Ó·È ÂÍ·ÈÚÂÙÈο ¯·ÌËÏfi˜ (¶›Ó·Î·˜ 1).

¶π¡∞∫∞™ 1 ªÂϤÙË

ª¤ÁÂıÔ˜ √Ì¿‰·˜

ª¤ÛÔ˜ μªπ

¢È¿ÚÎÂÈ· (¤ÙË)

Malmö FDPS DPP DaQing

217 523 2161 500

26.6 31.0 34.0 25.8

5 3 3 6

RRR (%)

ARR (%)

NNT

63 58 58 46

18 12 15 27

28 22 21 25

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

ATHIROSK 14

03-07-07

12:06

™ÂÏ›‰·9

¶APA°ONTE™ KIN¢YNOY ™ÙË ÌÂϤÙË Indian Diabetes Prevention Programme (IDPP), Ô˘ ·Ó·ÎÔÈÓÒıËΠÚfiÛÊ·Ù· 8, ÔÈ ÌÂÙ·‚ÔϤ˜ ÙÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜ Î·È Ë ÌÂÙÊÔÚÌ›ÓË ·ÚÔ˘Û›·Û·Ó ·ÚfiÌÔÈ· ÌÂٷ͇ ÙÔ˘˜ ‰˘Ó·ÙfiÙËÙ· Ì›ˆÛ˘ Ù˘ Û˘¯ÓfiÙËÙ·˜ ÂÌÊ¿ÓÈÛ˘ ‰È·‚‹ÙË, Û ¿ÙÔÌ· Ì IGT, ·ÏÏ¿ Ô Û˘Ó‰˘·ÛÌfi˜ ÙˆÓ ‰‡Ô ıÂÚ·¢ÙÈÎÒÓ ÙÚfiˆÓ ‰ÂÓ ‚ÂÏÙ›ˆÛ ÙËÓ ¤Î‚·ÛË. ∏ ÌÂϤÙË Diabetes REduction Assessment with ramipril and rosiglitazone Medication (DREAM), ÂÚ‡ÓËÛ ·Ó ·˘Ù¿ Ë Ú·ÌÈÚ›ÏË ‹ Ë ÚÔÛÈÁÏ˘Ù·˙fiÓË ÌÔÚÔ‡Ó Ó· ÌÂÈÒÛÔ˘Ó ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ‰È·‚‹ÙË, Û ¿ÙÔÌ· Ì IGT, ·ıÔÏÔÁÈ΋ ÁÏ˘Îfi˙Ë ÓËÛÙ›·˜ (IFG), ‹ Î·È Ù· ‰‡Ô. ΔÔ Î‡ÚÈÔ ÙÂÏÈÎfi ÛËÌÂ›Ô Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ë ÂÌÊ¿ÓÈÛË ™¢ 2 ‹ ı¿Ó·ÙÔ˜ ÔÔÈ·Û‰‹ÔÙ ·ÈÙÈÔÏÔÁ›·˜. ªÂÙ¿ ·fi ·Ú·ÎÔÏÔ‡ıËÛË 3 ÂÙÒÓ, Ë ÂÌÊ¿ÓÈÛË ÙÔ˘ ·ÚÈÔ˘ ηٷÏËÎÙÈÎÔ‡ ÛËÌ›Ԣ ‰ÂÓ ‰È¤ÊÂÚ ÛËÌ·ÓÙÈο ÌÂٷ͇ Ú·ÌÈÚ›Ï˘ Î·È ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ (18.1% ¤Ó·ÓÙÈ 19.5%, HR 0.91), ‰ËÏ., Ì›ˆÛË ÙÔ˘ Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ηٿ 9% 9. ∏ ÚÔÛÈÁÏÈÙ·˙fiÓË Ì›ˆÛ ÛËÌ·ÓÙÈο ÙÔ Î‡ÚÈÔ ÙÂÏÈÎfi ÛËÌ›Ô, ¤Ó·ÓÙÈ ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ (11.6% ¤Ó·ÓÙÈ 26%, HR 0.40 ), ‰ËÏ. Ì›ˆÛË ÙÔ˘ Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ηٿ 60% 10. √ Û˘ÓÔÏÈÎfi˜ ·ÚÈıÌfi˜ ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÂÂÈÛÔ‰›ˆÓ ‰ÂÓ ‰È¤ÊÂÚ ÛËÌ·ÓÙÈο ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ Ù˘ ÚÔÛÈÁÏÈÙ·˙fiÓ˘ Î·È ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘, ·ÏÏ¿ ÛÙËÓ ÔÌ¿‰· Ù˘ ÚÔÛÈÁÏÈÙ·˙fi-

Ó˘ ·Ú·ÙËÚ‹ıËÎ·Ó ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜ (p<0.0001) Î·È ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ηډȷ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ (0.5% ¤Ó·ÓÙÈ 0.1%, p<0.01). ¶Ú¤ÂÈ, fï˜, Ó· ÛËÌÂȈı› fiÙÈ Ë ÌÂϤÙË DREAM ‰ÂÓ Û¯Â‰È¿ÛıËÎÂ, Ô‡Ù ›¯Â ÙËÓ ··Ú·›ÙËÙË ÈÛ¯‡ Ó· ÂÎÙÈÌ‹ÛÂÈ, ÙË Î·Ú‰È·ÁÁÂȷ΋ ¤Î‚·ÛË. ŒÙÛÈ, Ë ÚÔÛÈÁÏÈÙ·˙fiÓË ‰ÂÓ ÌÔÚ›, ˆ˜ fiÙÔ˘ ˘¿ÚÍÔ˘Ó Î·È ¿ÏÏ· ÛÙÔȯ›·, Ó· ıˆÚËı› ηٿÏÏËÏË ıÂÚ·›· ÁÈ· ÙË Ì›ˆÛË Ù˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘ (∫∞¡) Û ¿ÙÔÌ· Ì ‰È·Ù·Ú·¯¤˜ Ù˘ ÔÌÔÈfiÛÙ·Û˘ Ù˘ ÁÏ˘Îfi˙˘ (IGH). Δ· ÚfiÛÊ·Ù· ÛÙÔȯ›· ·fi ÙË Study TO Prevent Non-InsulinDependent Diabetes Mellitus (STOP-NIDDM), ¤‰ÂÈÍ·Ó ÁÈ· ÚÒÙË ÊÔÚ¿, ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ÌÂÈÒÛÂȘ ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÂÂÈÛÔ‰›ˆÓ Û ¿ÙÔÌ·

Ì IGT, ¤Ó·ÓÙÈ ÙˆÓ Ì·ÚÙ‡ÚˆÓ, ‰È·Ì¤ÛÔ˘ Ù˘ Ì›ˆÛ˘ ÙˆÓ ÌÂÙ·ÁÂ˘Ì·ÙÈÎÒÓ ÂÈ¤‰ˆÓ Ù˘ ÁÏ˘Îfi˙˘ Ì ·Î·Ú‚fi˙Ë 11 ∂ÈÚfiÛıÂÙ·, ÛÙÔȯ›· ·fi ÙË NHANES III, ¤‰ÂÈÍ·Ó fiÙÈ Ô ¤ÏÂÁ¯Ô˜ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ÙˆÓ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ (LDL-C), Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ÙˆÓ ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ (HDL-C), Î·È Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ÛÂ Ê˘ÛÈÔÏÔÁÈο Â›‰·, Û ·ÛıÂÓ›˜ Ì ª™ (¯ˆÚ›˜ ‰È·‚‹ÙË, ‹ ™¡), Ô‰ËÁÔ‡Ó Û Ì›ˆÛË ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ÂÂÈÛÔ‰›ˆÓ ηٿ 51% ÛÙÔ˘˜ ¿Ó‰Ú˜ Î·È Î·Ù¿ 43% ÛÙȘ Á˘Ó·›Î˜, ÂÓÒ Ô ¤ÏÂÁ¯Ô˜ ·˘ÙÒÓ ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÛÙ· ¿ÚÈÛÙ· Â›‰· Ô‰ËÁ› Û ÚfiÏË„Ë ÙÔ˘ 81% Î·È 82% ÙˆÓ ÂÂÈÛÔ‰›ˆÓ, ·ÓÙ›ÛÙÔȯ· 12

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Knowler WC, et al. Reduction in the incidence of type 2 diabetes with life style intervention or metformin. N Engl J Med 2002; 346: 393-403.

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American Diabetes Association. The prevention or delay of type 2 diabetes.

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Pan X et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose Tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care 1997; 20: 537-544.

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Lindstrom J et al. The Finnish Diabetes Prevention Study (DPS): life style intervention and 3-year results on diet

25: 742-749.

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Ramanchandran A, et al. Indian Diabetes Prevention Programme (IDPP). Diabetologia 2006; 49:289-297.

The DREAM Trial Investigators. Effect of ramipril on the incidence of diabetes. N Engl J Med 2006; 355: 1551-1562.

10. The DREAM Trial Investigators. Effect of rosiglitazone on the frequency of diabetes in patients with impaired glucose tolerance or impaired fasting glucose: a randomized controlled trial.

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11. Chiasson JL, et al. Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance: the STPNIDDM trial. JAMA 2003; 290: 486494.

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9

ATHIROSK 14

03-07-07

12:06

™ÂÏ›‰·10

π√À¡π√™ 2007

ΔÔ ∂ÈÎÔÛÈÂÓÙ·ÓÔ˚Îfi √͇ ªÂÈÒÓÂÈ Ù· ªÂ›˙ÔÓ· ∫·Ú‰È·ÁÁÂȷο ∂ÂÈÛfi‰È· Û ÀÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌÈÎÔ‡˜ ∞ÛıÂÓ›˜. ªÂϤÙË JELIS (Japan EPA lipid intervention study): Δ˘¯·ÈÔÔÈË̤ÓË, ·ÓÔȯً˜ ¯ÔÚ‹ÁËÛ˘ Î·È Ù˘ÊÏ‹˜ ·Ó¿Ï˘Û˘ ÙÂÏÈÎÒÓ ÛËÌ›ˆÓ ÌÂϤÙË.

Yokoyama M, Origasa H, Matsuzaki M, Matsuzawa Y, Saito Y, Ishikawa Y, Oikawa S, Sasaki J, Hishida H, Itakura H, Kita T, Kitabatake A, Nakaya N, Sakata T, Shimada K, Shirato K; Japan EPA lipid intervention study (JELIS) Investigators Lancet 2007 Mar 31;369(9567):1090-8 ¶·Ï·ÈfiÙÂÚ˜ ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ÏËı˘ÛÌÔ›, fiˆ˜ ÔÈ ∂ÛÎÈÌÒÔÈ ÙÔ˘ μ. ∫·Ó·‰¿ Î·È Ù˘ ∞Ï¿Ûη˜ Î·È ÔÈ °È·ˆÓ¤˙ÔÈ Ô˘ ηٷӷÏÒÓÔ˘Ó ·ÚÎÂÙ‹ ÔÛfiÙËÙ· ÏÈ·ÚÒÓ „·ÚÈÒÓ ¤¯Ô˘Ó ÌÂȈ̤ÓÔ Î›Ó‰˘ÓÔ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ. ∂›Û˘ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ Û ·ÛıÂÓ›˜ ÌÂÙ¿ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘ ¤‰ÂÈÍ·Ó Â›Û˘ fiÊÂÏÔ˜ ™ÙË ÌÂϤÙË DART Û˘ÛÙ‹ıËΠÚfiÛÏË„Ë Ì ÙËÓ ÙÚÔÊ‹ „·ÚÈÒÓ 2 ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰· ‹ ‰fiıËÎ·Ó Î¿„Ô˘Ï˜ ȯı˘ÂÏ·›Ô˘. ™Ù· 2 ¯ÚfiÓÈ· ·Ú·ÙËÚ‹ıËΠ̛ˆÛË ÙˆÓ ı·Ó¿ÙˆÓ ·fi fiÏ· Ù· ·›ÙÈ· ηٿ 29%. ™ÙË ÌÂϤÙË GISSI-P ‰fiıËÎ·Ó 850 mg ηı·ÚÒÓ ˆ-3 ÏÈ·ÚÒÓ ÔͤˆÓ ·fi ȯı˘¤Ï·È· Û ÌÂÙÂÌÊÚ·ÁÌ·ÙÈÎÔ‡˜ ·ÛıÂÓ›˜. ¶·Ú·ÙËÚ‹ıËΠ̛ˆÛË ÙˆÓ ı·Ó¿ÙˆÓ ·fi οı ·ÈÙ›· ηٿ 20%, ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ı·Ó¿ÙˆÓ ηٿ 30% Î·È ÙˆÓ ·ÈÊÓȉ›ˆÓ ı·Ó¿ÙˆÓ ηٿ 45%. ¢ÂÓ ·Ú·ÙËÚ‹ıËΠfï˜ Ì›ˆÛË ÙˆÓ ÌË ı·Ó·ÙËÊfiÚˆÓ ÂÌÊÚ·ÁÌ¿ÙˆÓ Ô‡Ù Û ·˘Ù‹ ÙË ÌÂϤÙË Ô‡Ù ÛÙËÓ DART. ∏ ÌÂϤÙË JELIS, Ë ÔÔ›· ‰ÈÂÍ‹¯ıË ÛÙÔ Kobe University Graduate School of Medicine ÛÙÔ Kobe Ù˘ π·ˆÓ›·˜, ÛÎÔfi ›¯Â Ó· ÌÂÏÂÙ‹ÛÂÈ ·Ó Ë Û˘ÌÏËڈ̷ÙÈ΋ ¯ÔÚ‹ÁËÛË ÂÈÎÔÛÈÂÓÙ·ÓÔ˚ÎÔ‡ ÔͤԘ (∂ƒ∞) Û ¤Ó·Ó ÏËı˘ÛÌfi Ô˘ οÓÂÈ ·ÚÎÂÙ‹ ηٷӿψÛË „·ÚÈÒÓ ¤¯ÂÈ Î¿ÙÈ ÂÚÈÛÛfiÙÂÚÔ Ó· ÚÔÛʤÚÂÈ ÛÙËÓ ÚfiÏË„Ë ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ. ¶ÂÚȤϷ‚ 19.466 ·ÛıÂÓ›˜ (5.859 ¿Ó‰Ú˜ ËÏÈΛ·˜ 40-59 ÂÙÒÓ Î·È 12.786 Á˘Ó·›Î˜ ÌÂÙÂÌËÓÔ·˘Ûȷ΋˜ ËÏÈΛ·˜ ̤-

10

¯ÚÈ 75 ÂÙÒÓ) Ì ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· (ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË > 250 mg% Î·È LDL-¯ÔÏËÛÙÂÚfiÏË > 175 mg%). ΔÔ 90% ÙˆÓ ·ÛıÂÓÒÓ ¤Ï·‚ ÌÈÎÚ‹ ‰fiÛË ÛÙ·Ù›Ó˘ (Ú·‚·ÛÙ·Ù›ÓË 10 mg/ËÌÂÚËÛ›ˆ˜ ‹ ÛÈÌ‚·ÛÙ·Ù›ÓË 5 mg/ËÌÂÚ.) √È ÌÈÛÔ› ·ÛıÂÓ›˜ (9.326) ¤Ï·‚·Ó ο„Ô˘Ï˜ ˘„ËÏ‹˜ ηı·ÚfiÙËÙ·˜ ∂ƒ∞ Û ‰fiÛË 600 mg ÙÚÂȘ ÊÔÚ¤˜ ÙËÓ Ë̤ڷ (ËÌÂÚ‹ÛÈ· ‰fiÛË 1.800 mg). ¶ÚˆÙ‡ÔÓ ÙÂÏÈÎfi Û˘Ì‚¿Ó ÔÚ›ÛÙËΠÔÔÈÔ‰‹ÔÙ Ì›˙ÔÓ ÛÙÂÊ·ÓÈ·›Ô ÂÂÈÛfi‰ÈÔ, ÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ ·ÈÊÓȉ›ˆÓ ηډȷÎÒÓ ı·Ó¿ÙˆÓ, ı·Ó·ÙËÊfiÚˆÓ Î·È ÌË ı·Ó·ÙËÊfiÚˆÓ ÂÌÊÚ·ÁÌ¿ÙˆÓ, Ù˘ ·ÛÙ·ıÔ‡˜ ÛÙËı¿Á¯Ë˜ Î·È ÙˆÓ ÂÂÌ‚¿ÛÂˆÓ ‰È·‰ÂÚÌÈ΋˜ ·ÁÁÂÈÔÏ·ÛÙÈ΋˜ ‹ ·ÔÚÙÔÛÙÂÊ·ÓÈ·›·˜ ·Ú¿Î·Ì„˘. ∏ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ·ÛıÂÓÒÓ ÎÚ¿ÙËÛ ηٿ ̤ÛÔ fiÚÔ 4,6 ¯ÚfiÓÈ·. ΔÔ ÚˆÙ‡ˆÓ ÙÂÏÈÎfi Û˘Ì‚¿Ó ·Ú·ÙËÚ‹ıËΠ۠2,8% ÙˆÓ ·ÛıÂÓÒÓ Ù˘ ÔÌ¿‰·˜ Ô˘ ¤Ï·‚ ∂ƒ∞ Î·È ÛÙÔ 3,5% Ù˘ ÔÌ¿‰·˜ ÂϤÁ¯Ô˘, Ì›ˆÛË Ì ÙËÓ ·ÁˆÁ‹ ÙÔ˘ Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ηٿ 19% (p=0,011). ™ÙËÓ ÔÌ¿‰· ÙˆÓ ·ÙfiÌˆÓ Ô˘ ‰ÂÓ Â›¯·Ó ¤Î‰ËÏË ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ ÚÈÓ ÙËÓ ¤Ó·ÚÍË Ù˘ ·ÁˆÁ‹˜ (ÚˆÙÔÁÂÓ‹˜ ÚfiÏË„Ë) Ë Ì›ˆÛË ÙÔ˘ Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ‹Ù·Ó 18% (1,4% ÛÙËÓ ÔÌ¿‰· ıÂÚ·›·˜ ¤Ó·ÓÙÈ 1,7% ÛÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘) ·ÏÏ¿ ÙÔ ·ÔÙ¤ÏÂÛÌ· ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈÎfi (p=0,132). ∞ÓÙ›ıÂÙ·, ÛÙËÓ ÔÌ¿‰· Ù˘ ‰Â˘ÙÂÚÔÁÂÓÔ‡˜ ÚfiÏ˄˘ ÙÔ ·ÔÙ¤ÏÂÛÌ· ‹Ù·Ó ÛËÌ·ÓÙÈÎfi (8,7% ¤Ó·ÓÙÈ 10,7%, Ì›ˆÛË ÎÈÓ‰‡ÓÔ˘ ηٿ 19%). ∏ Ì›ˆÛË ·Ú·ÙËÚ‹ıËÎÂ

΢ڛˆ˜ ÛÙ· ÂÚÈÛÙ·ÙÈο ·ÛÙ·ıÔ‡˜ ÛÙËı¿Á¯Ë˜ Î·È ÌË ı·Ó·ÙËÊfiÚˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ÂÂÈÛÔ‰›ˆÓ, ÂÓÒ Ù· ÂÚÈÛÙ·ÙÈο ·ÈÊÓȉ›Ô˘ ı·Ó¿ÙÔ˘ ‹ ı·Ó·ÙËÊfiÚˆÓ ÂÌÊÚ·ÁÌ¿ÙˆÓ ‰ÂÓ ÌÂÈÒıËηÓ. ∞˘Ùfi Â›Ó·È Û ·ÓÙ›ıÂÛË Ì ÙË ÌÂϤÙË GISSI-P Î·È ÙË ÌÂϤÙË DART, ÛÙȘ Ôԛ˜ ·Ú·ÙËÚ‹ıËΠ̛ˆÛË ÙˆÓ ı·Ó·ÙËÊfiÚˆÓ ÂÂÈÛÔ‰›ˆÓ ·ÏÏ¿ fi¯È ÙˆÓ ÌË ı·Ó·ÙËÊfiÚˆÓ. ∞˘Ùfi ÂÓ‰¤¯ÂÙ·È Ó· ÔÊ›ÏÂÙ·È ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ô °È·ˆÓ¤˙ÈÎÔ˜ ÏËı˘ÛÌfi˜ ÚÔÛÏ·Ì‚¿ÓÂÈ Ì ÙËÓ ÙÚÔÊ‹ ÙÔ˘ ÌÂÁ¿ÏË ÔÛfiÙËÙ· ˆ-3 ÏÈ·ÚÒÓ ÔͤˆÓ Î·È Û˘ÓÂÒ˜ ·ÔÏ·Ì‚¿ÓÂÈ ‹‰Ë ÙËÓ ·ÓÙÈ·ÚÚ˘ıÌÈ΋ ÚÔÛÙ·Û›· Ô˘ ÚÔÛʤÚÂÈ Ë ¯·ÌËÏ‹ ‰fiÛË ÙˆÓ ˆ-3 ÏÈ·ÚÒÓ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÈÛÙÔÚÈÎfi ·Ï·ÈÔ‡ ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ôηډ›Ô˘. ™Â ÌÂÁ·Ï‡ÙÂÚ˜ ‰fiÛÂȘ ÂÌÊ·Ó›˙ÂÙ·È ÙÔ ÚÔÛٷ٢ÙÈÎfi ·ÔÙ¤ÏÂÛÌ· ÁÈ· Ù· ÌË ı·Ó·ÙËÊfiÚ· ÂÂÈÛfi‰È·, ¯¿ÚȘ ÛÙËÓ ·ÓÙÈ˘ÂÚÙ·ÛÈ΋ ‹ ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë ‰Ú¿ÛË ÙˆÓ ˆ-3 ÏÈ·ÚÒÓ ÔͤˆÓ. ΔÔ Â˘ÓÔ˚Îfi ·ÔÙ¤ÏÂÛÌ· ÛÙË ÌÂϤÙË JELIS, ηٿ ÙÔ˘˜ ÂÚ¢ÓËÙ¤˜ ‰ÂÓ ÔÊ›ÏÂÙ·È Û ˘Ô¯ÔÏËÛÙÂÚÔÏ·ÈÌÈ΋ ‰Ú¿ÛË ÙˆÓ ˆ-3 ÏÈ·ÚÒÓ ÔͤˆÓ, ‰Â‰Ô̤ÓÔ˘ fiÙÈ Ë ÔÏÈ΋ Î·È Ë LDL-¯ÔÏËÛÙÂÚfiÏË ÌÂÈÒıËÎ·Ó Î·Ù¿ 19% Î·È 25% ·ÓÙ›ÛÙÔȯ· Î·È ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ ÂÓÒ Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È· ÌÂÈÒıËÎ·Ó Î·Ù¿ 9% ÛÙËÓ ÔÌ¿‰· Ô˘ ¤Ï·‚ ∂ƒ∞ Î·È 4% ÛÙËÓ ÔÌ¿‰· Ô˘ ‹Ú·Ó ÌfiÓÔ ¯·ÌËÏ‹ ‰fiÛË ÛÙ·Ù›Ó˘ (p<0,0001). Δ· ˆ-3 ÏÈ·Ú¿ Ôͤ· ¤¯Ô˘Ó ¤Ó· ¢ڇ Ê¿ÛÌ· ‚ÈÔÏÔÁÈÎÒÓ ‰Ú¿ÛˆÓ, ÌÂٷ͇ ÙˆÓ ÔÔ›ˆÓ ·ÓÙÈıÚÔÌ‚ˆÙÈ΋, ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë, ·ÓÙÈ-

ATHIROSK 14

03-07-07

12:06

™ÂÏ›‰·11

K§INIKE™ ME§ETE™ ·ÚÚ˘ıÌÈ΋ Î·È ·ÓÙÈ·ıËÚÔÁfiÓÔ, ¤Ú·Ó Ù˘ ÙÚÔÔÔÈËÙÈ΋˜ ÙˆÓ ÏÈȉ›ˆÓ ‰Ú¿Ûˆ˜ ÙˆÓ. ™Â ¿ÚıÚÔ Ù˘ ™‡ÓÙ·Í˘ (editorial) Ô˘ ‰ËÌÔÛȇÂÙ·È ÛÙÔ ›‰ÈÔ Ù‡¯Ô˜ ÙÔ˘ Lancet ÙÔÓ›˙ÂÙ·È fiÙÈ, ÌÔÏÔÓfiÙÈ Ë ÌÂϤÙË ‰ÂÓ

Â›Ó·È ‰ÈÏ¿-Ù˘ÊÏ‹ Î·È Ù· ÙÂÏÈο Û˘Ì‚¿ÓÙ· Ô˘ ·Ú·ÙËÚ‹ıËÎ·Ó Â›Ó·È fi¯È ÛÎÏËÚ¿, Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Ù˘ ‰ÂÓ Ú¤ÂÈ Ó· ·ÁÓÔËıÔ‡Ó. ™Â ÌÈ· ÂÔ¯‹ Ô˘ Ë Ìfi‰· ÂÓÙÔ›˙ÂÙ·È ÛÙ· ·ÎÚÈ‚¿ Ê¿Ú̷η, ÙȘ ·ÈÌ·ÙËÚ¤˜ ÂÂÌ‚¿ÛÂȘ Î·È ÛÙȘ ÂÍÂÏÈÁ̤Ó˜ Û˘-

Û΢¤˜, ̤ÙÚȘ ‰È·ÈÙËÙÈΤ˜ ·ÏÏ·Á¤˜, ÔÈ Ôԛ˜ Â›Ó·È ·Î›Ó‰˘Ó˜, ¯·ÌËÏÔ‡ ÎfiÛÙÔ˘˜ Î·È Â˘Ú¤ˆ˜ ÂÊ·ÚÌfiÛÈ̘, ‰˘Ó·ÙfiÓ Ó· ·Ô‚Ô‡Ó È‰È·›ÙÂÚ· ˆÊ¤ÏÈ̘. ∂È̤ÏÂÈ·: ∏Ï›·˜ ÃÂÈÌÒÓ·˜

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

1. Atorvastatin for Reduction of MYocardial Damage during Angioplasty (ARMYDA) trial(12). ¢ÈÏ¿-Ù˘ÊÏ‹, ÌÂ Ù˘¯·›· ηٷÓÔÌ‹ ÙˆÓ ·ÛıÂÓÒÓ, ÂÏÂÁ¯fiÌÂÓË Ì ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ, ÚÔÔÙÈ΋ ÎÏÈÓÈ΋ ÌÂϤÙË. ¶ÂÚȤϷ‚ 153 ·ÛıÂÓ›˜ Ì ¯ÚÔÓ›· ÛÙ·ıÂÚ‹ ÛÙËı¿Á¯Ë, ÁÈ· ÙÔ˘˜ ÔÔ›Ô˘˜ ˘‹Ú¯Â ¤Ó‰ÂÈÍË ·ÁÁÂÈÔÏ·ÛÙÈ΋˜ Î·È ÔÈ ÔÔ›ÔÈ ‰ÂÓ Ï¿Ì‚·Ó·Ó ÛÙ·Ù›ÓË Ì¤¯ÚÈ ÙËÓ ¤ÓÙ·ÍË ÙÔ˘˜ ÛÙË ÌÂϤÙË. √È ·ÛıÂÓ›˜ ηٷÓÂÌ‹ıËÎ·Ó Ù˘¯·›· Û ‰‡Ô ÔÌ¿‰Â˜, ·ÓÂÍ¿ÚÙËÙ· ·fi Ù· Â›‰· ÏÈȉ›ˆÓ ÙÔ˘˜ Î·È Ë Ì›· ÔÌ¿‰· (76 ·ÛıÂÓ›˜) ¤Ï·‚ ·ÙÔÚ‚·ÛÙ·Ù›ÓË

Û˘ Î·È Â› ¤Ó· Ì‹Ó·. ΔÔ ÚˆÙ‡ÔÓ ÙÂÏÈÎfi ÛËÌÂ›Ô ·Ú·ÙËÚ‹ıËΠ۠ÔÛÔÛÙfi 5% ÙˆÓ ·ÛıÂÓÒÓ Ù˘ ÔÌ¿‰·˜ ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ Î·È Û 18% ÛÙËÓ ÔÌ¿‰· ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ (ƒ=0,025). ∞‡ÍËÛË Ù˘ CK-MB ¿Óˆ ·fi ÙÔ Ê˘ÛÈÔÏÔÁÈÎfi ·Ú·ÙËÚ‹ıËΠÛÙÔ 12% Ù˘ ÔÌ¿‰·˜ Ô˘ ¤Ï·‚ ·ÙÔÚ‚·ÛÙ·Ù›ÓË Î·È ÛÙÔ 35% ÛÙËÓ ÔÌ¿‰· ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ (ƒ=0,001). ∂›Û˘ ·Ú·ÙËÚ‹ıËΠÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙËÓ ·‡ÍËÛË Î·È ÙˆÓ ¿ÏÏˆÓ ÂÓ˙‡ÌˆÓ: ÙÚÔÔÓ›Ó˘-π 20% ¤Ó·ÓÙÈ 48% (ƒ=0,0004) Î·È Ì˘ÔÛÊ·ÈÚ›Ó˘ 22% ¤Ó·ÓÙÈ 51% (ƒ=0,0005). ∏ ηٷÓÔÌ‹ Ù˘ CK-MB Î·È Ù˘ ÙÚÔÔÓ›Ó˘-π ηٿ Â›‰· ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË Ê·›ÓÂÙ·È ÛÙËÓ ∂ÈÎfiÓ· 1. √ ̤ÛÔ˜ fiÚÔ˜ ÙˆÓ Ì¤ÁÈÛÙˆÓ ·˘Í‹ÛÂˆÓ ÙˆÓ ÙÈÌÒÓ ÂÓ˙‡ÌˆÓ ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË Ê·›ÓÂÙ·È ÛÙËÓ ∂ÈÎfiÓ· 2. ∫·Ù¿ ÙÔÓ ¤Ó· Ì‹Ó· ·Ú·ÎÔÏÔ‡ıËÛ˘ ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ¿ÏÏ· Ì›˙ÔÓ· ηډȷÁÁÂȷο ÂÂÈÛfi‰È· ¤Ú·Ó ÙÔ˘ ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ôηډ›Ô˘. ¶ÔÏ˘·Ú·ÁÔÓÙÈ΋ ·Ó¿Ï˘ÛË ¤‰ÂÈÍ fiÙÈ Ë Ì›ˆÛË ÙÔ˘ ÂÚÈÂÂÌ‚·ÙÈÎÔ‡ ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘ÔηÚ-

40

50 P=0.001

40

30

ΔÚÔÔÓ›ÓË-π (%)

¶ÚfiÛÊ·Ù· ‰ËÌÔÛȇıËΠÌÈ· ÛÂÈÚ¿ ÎÏÈÓÈÎÒÓ ÌÂÏÂÙÒÓ Ô˘ ·ÊÔÚÔ‡Ó ÛÙËÓ ·ÙÔÚ‚·ÛÙ·Ù›ÓË Î·È ‰È¢ڇÓÔ˘Ó ÙÔ Ê¿ÛÌ· ÙˆÓ ÏÂÈfiÙÚÔˆÓ ‰Ú¿ÛÂˆÓ Ù˘ ÛÙ·Ù›Ó˘ ·˘Ù‹˜ Ì ÎÏÈÓÈÎfi ÂӉȷʤÚÔÓ

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

CK-MB (%)

¶ÏÂÈfiÙÚÔ˜ ‰Ú¿ÛÂȘ (pleiotropic effects) ÙˆÓ ÛÙ·ÙÈÓÒÓ ¤¯Ô˘Ó ÔÓÔÌ·Ûı› Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ¯ÔÚ‹ÁËÛ˘ ÙˆÓ Ê·ÚÌ¿ÎˆÓ ·˘ÙÒÓ Ô˘ ‰ÂÓ ÔÊ›ÏÔÓÙ·È ¿ÌÂÛ· ÛÙËÓ ˘ÔÏÈȉ·ÈÌÈ΋ ÙÔ˘˜ ‰Ú¿ÛË Î·È ¤¯Ô˘Ó ‰È·ÈÛÙˆı› ›Ù ÎÏÈÓÈο ÛÙȘ ÌÂÁ¿Ï˜ Ù˘¯·ÈÔÔÈË̤Ó˜ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜, ›Ù ÂÈÚ·Ì·ÙÈο ÛÙÔ ÂÚÁ·ÛÙ‹ÚÈÔ, in vitro ‹ in vivo. ∞ÔÙÂÏÔ‡Ó ¤Ó· ¢ڇ Ê¿ÛÌ· ÂΉËÏÒÛÂˆÓ Î·È Û ·˘Ù¤˜ ÂÚÈÏ·Ì‚¿ÓÂÙ·È Ë ·ÓÙÈÔÍÂȉˆÙÈ΋ ‰Ú¿ÛË(1, 2, 3), Ë ‚ÂÏÙ›ˆÛË Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ÂÓ‰ÔıËÏ›Ô˘(4, 5), Ë ·ÓÙÈÊÏÂÁÌÔÓ҉˘(6, 7) Î·È Ë ·ÓÙÈıÚÔÌ‚ˆÙÈ΋(8) ‰Ú¿ÛË, Ë ‰Ú¿ÛË ÛÙ· Ï›· Ì˘˚ο(9) Î·È ÛÙ· Ì˘Ôηډȷο ·ÙÙ·Ú·(10), Ë ·ÁÁÂÈԉȷÛÙ·ÏÙÈ΋ ‰Ú¿ÛË ÛÙ· ÌÈÎÚ¿ ·ÁÁ›·(11) ÎÏ. ¶ÔÏϤ˜ ·fi ÙȘ ·Ú·¿Óˆ ‰Ú¿ÛÂȘ Â›Ó·È ÎÔÈÓ¤˜ ÁÈ· fiϘ; ÙȘ ÛÙ·Ù›Ó˜, ÔÚÈṲ̂Ó˜ fï˜ ·ÔÙÂÏÔ‡Ó ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÌÈ·˜ ‹ ÌÂÚÈÎÒÓ ÌfiÓÔ ÛÙ·ÙÈÓÒÓ.

P=0.006

20 10

0

30 20 10 0

∂ÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ

∞ÙÔÚ‚·ÛÙ·Ù›ÓË

1 ÊÔÚ¿

2-5 ÊÔÚ¤˜

∂ÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ

∞ÙÔÚ‚·ÛÙ·Ù›ÓË

> 5 ÊÔÚ¤˜ ∞ÓÒÙÂÚÔ Ê˘ÛÈÔÏÔÁÈÎfi fiÚÈÔ

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

11

03-07-07

12:06

™ÂÏ›‰·12

π√À¡π√™ 2007

10

0,8

6 4

2 0

100 ª¤ÁÈÛÙË ÙÈÌ‹ myoglobin ng/mL

P=0.007 8

ª¤ÁÈÛÙË ÙÈÌ‹ Troponin-I ng/mL

ª¤ÁÈÛÙË ÙÈÌ‹ CK-MB ng/mL

ATHIROSK 14

P=0.0008 0,6

0,4

0,2

0

∂ÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ

P=0.0002

80 60 40 20

0

∞ÙÔÚ‚·ÛÙ·Ù›ÓË

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

‰›Ô˘ ‰ÂÓ ÔÊ›ÏÂÙ·È Û ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÏËÓ Ù˘ ¯ÔÚ‹ÁËÛ˘ ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ Î·È fiÙÈ Ë ¯Ú‹ÛË ‚-·Ó·ÛÙÔϤˆÓ, ·Ó·ÛÙÔϤˆÓ ÙˆÓ ˘Ô‰Ô¯¤ˆÓ ππb/IIIa ÁÏ˘ÎÔÚˆÙ½Ó˘ ‹ ∞ª∂∞ ‰ÂÓ Ì›ˆÛ ÙÔÓ Î›Ó‰˘ÓÔ. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ë ·‡ÍËÛË Ù˘ CK-MB ÌÂÙ¿ ÙËÓ ·ÁÁÂÈÔÏ·ÛÙÈ΋ ·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ Î·Ú‰È·ÎÔ‡ ı·Ó¿ÙÔ˘. ªÈ· ÌÂÙ·-·Ó¿Ï˘ÛË Ô˘ ÂÚȤϷ‚ 23.230 ·ÛıÂÓ›˜ ¤‰ÂÈÍ fiÙÈ ·‡ÍËÛË Ù˘ CK-MB ηٿ 1 - 3 ÊÔÚ¤˜ ¿Óˆ ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ÔÚ›Ô˘ ·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ı·Ó¿ÙÔ˘ Û ¤Ó· ¯ÚfiÓÔ Î·Ù¿ 1,7%, ·‡ÍËÛË Î·Ù¿ 3 - 5 ÊÔÚ¤˜ ·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ Î·Ù¿ 2,8% Î·È ·‡ÍËÛË Î·Ù¿ > 5 ÊÔÚ¤˜ ·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ Î·Ù¿ 7,4%(13).

2. Atorvastatin for Reduction of MYocardial Damage during Angioplasty - Acute Coronary Syndromes (ARMYDA-ACS) trial(14). ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ·˘Ù‹˜ ‹Ù·Ó Ó· ÂÚ¢ӋÛÂÈ ÙË ‰Ú¿ÛË Ù˘ ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ Û ·ÛıÂÓ›˜ Ì Ô͇ ÛÙÂÊ·ÓÈ·›Ô Û‡Ó‰ÚÔÌÔ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È Û ·ÁÁÂÈÔÏ·ÛÙÈ΋, ·Ó ‰Ôı› Ï›Á˜ ÒÚ˜ ÚÈÓ ÙËÓ Â¤Ì‚·ÛË. ¶ÚfiÎÂÈÙ·È ÁÈ· ÌÈ· ÔÏ˘ÎÂÓÙÚÈ΋ (ÙÚ›· ΤÓÙÚ· ÛÙËÓ πÙ·Ï›·), Ù˘¯·ÈÔÔÈË̤ÓË, ‰ÈÏ¿ Ù˘ÊÏ‹, ÚÔÔÙÈ΋, ÂÏÂÁ¯fiÌÂÓË Ì ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ ÌÂϤÙË.

191 ·ÛıÂÓ›˜ Ì Ô͇ ÛÙÂÊ·ÓÈ·›Ô Û‡Ó‰ÚÔÌÔ ¯ˆÚ›˜ ·Ó¿Û·ÛË ÙÔ˘ ST (non-ST elevation ACS) Ô˘ ‰ÂÓ ÂÏ¿Ì‚·Ó·Ó ÛÙ·Ù›ÓË Ì¤¯ÚÈ ÙËÓ ¤Ó·ÚÍË Ù˘ ÌÂϤÙ˘ Î·È ‰ÂÓ Â›¯·Ó ¤Ó‰ÂÈÍË Â›ÁÔ˘Û·˜ ·ÁÁÂÈÔÏ·ÛÙÈ΋˜ ηٷÓÂÌ‹ıËÎ·Ó Ù˘¯·›· Ó· Ï¿‚Ô˘Ó ·ÙÔÚ‚·ÛÙ·Ù›ÓË

12

80 mg 12 ÒÚ˜ ÚÈÓ ÙËÓ ·ÁÁÂÈÔÁÚ·Ê›· Î·È ·ÏÏ¿ 40 mg ÂÚ›Ô˘ 2 ÒÚ˜ ÚÈÓ ÙËÓ Â¤Ì‚·ÛË ‹ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ ÙȘ ›‰È˜ ÒÚ˜. ªÂÙ¿ ÙËÓ Ù˘¯·ÈÔÔ›ËÛË ·ÔÎÏ›ÛıËÎ·Ó 10 ·ÛıÂÓ›˜ ·fi οı ÔÌ¿‰·, ÁÈ·Ù› Ë ÛÙÂÊ·ÓÈÔÁÚ·Ê›· ¤‰ÂÈÍ fiÙÈ ‰ÂÓ ‹Ù·Ó ηٿÏÏËÏÔÈ ÁÈ· ·ÁÁÂÈÔÏ·ÛÙÈ΋. ŒÙÛÈ ÂÚÈÂÏ‹ÊıËÎ·Ó 86 ·ÛıÂÓ›˜ ÛÙËÓ ÔÌ¿‰· Ù˘ ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ Î·È 85 ·ÛıÂÓ›˜ ÛÙËÓ ÔÌ¿‰· placebo. ªÂÙ¿ ÙËÓ Â¤Ì‚·ÛË fiÏÔÈ ÔÈ ·ÛıÂÓ›˜ ¤Ï·‚·Ó 40 mg ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ ËÌÂÚËÛ›ˆ˜, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ÔÌ¿‰· ÛÙËÓ ÔÔ›· Ù˘¯·ÈÔÔÈ‹ıËηÓ. ¶ÚˆÙ‡ÔÓ ÙÂÏÈÎfi ÛËÌÂ›Ô ÔÚ›ÛıËΠÙÔ Û‡ÓÔÏÔ ÙˆÓ ÌÂÈ˙fiÓˆÓ ‰˘ÛÌÂÓÒÓ Î·Ú‰È·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ (ı¿Ó·ÙÔ˜, ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘ Î·È ·Ó¿ÁÎË Â·Ó·ÁÁ›ˆÛ˘ ÛÙÔ ›‰ÈÔ ·ÁÁ›Ô) ̤۷ ÛÙÔÓ ÚÒÙÔ Ì‹Ó· ·fi ÙËÓ ·ÁÁÂÈÔÏ·ÛÙÈ΋. ¢È·ÁÓˆÛÙÈÎfi ÎÚÈÙ‹ÚÈÔ ÔͤԘ ÂÌÊÚ¿ÁÌ·ÙÔ˜ ηıÔÚ›ÛıËÎÂ Ë ·‡ÍËÛË Ù˘ CK-MB ‰‡Ô ÊÔÚ¤˜ ¿Óˆ ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ÔÚ›Ô˘ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ Ë ÙÈÌ‹ ÙÔ˘ ÂÓ˙‡ÌÔ˘ ‹Ù·Ó ÂÓÙfi˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ ÚÈÓ ÙËÓ ·ÁÁÂÈÔÏ·ÛÙÈ΋ ‹ Ô ‰ÈÏ·ÛÈ·ÛÌfi˜ Ù˘ ·Ó ‹Ù·Ó ·˘ÍË̤ÓË ‹‰Ë ÚÈÓ ÙËÓ ·ÁÁÂÈÔÏ·ÛÙÈ΋. ∂·Ó·ÁÁ›ˆÛË ÛÙÔ ›‰ÈÔ ·ÁÁÂ›Ô ÂÚÈÂÏ¿Ì‚·Ó ÙËÓ ·ÔÚÙÔÛÙÂÊ·ÓÈ·›· ·Ú¿Î·Ì„Ë ‹ ÙËÓ ·ÁÁÂÈÔÏ·ÛÙÈ΋ ÛÙÔ ›‰ÈÔ ÛËÌÂ›Ô ÙÔ˘ ·ÁÁ›Ԣ. ∏ ·ÁÁÂÈÔÏ·ÛÙÈ΋ ‹Ù·Ó ÂÈÙ˘¯‹˜ Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜. ¢Â˘ÙÂÚ‡ÔÓÙ· ÙÂÏÈο ÛËÌ›· ‹Ù·Ó (·) οı ·‡ÍËÛË ÙˆÓ ‰ÂÈÎÙÒÓ Ì˘Ôηډȷ΋˜ ‚Ï¿‚˘ (CK-MB, ÙÚÔÔÓ›ÓË-π,

Ì˘ÔÛÊ·ÈÚ›ÓË) ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË Î·È (‚) ÌÂÙ·‚ÔϤ˜ Ù˘ ÙÈÌ‹˜ Ù˘ CRP ÌÂÙ¿ ÙËÓ ·ÁÁÂÈÔÏ·ÛÙÈ΋. ªÂ›˙ÔÓ· ‰˘ÛÌÂÓ‹ ηډȷο Û˘Ì‚¿Ì·Ù· ·Ú·ÙËÚ‹ıËÎ·Ó Û 5% ÙˆÓ ·ÛıÂÓÒÓ Ù˘ ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ Î·È Û 17% ÙˆÓ ·ÛıÂÓÒÓ ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ (ƒ=0,01) Î·È ·ÊÔÚÔ‡Û·Ó Î˘Ú›ˆ˜ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘. ¢ÂÓ Û˘Ó¤‚Ë Î·Ó¤Ó·˜ ı¿Ó·ÙÔ˜ ÛÙȘ 30 Ë̤Ú˜. √È Î·Ì‡Ï˜ ÂÈ‚›ˆÛ˘ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ (Kaplan-Meier) Ê·›ÓÔÓÙ·È ÛÙËÓ ∂ÈÎfiÓ· 3. ΔÔ ÔÛÔÛÙfi ÙˆÓ ·ÛıÂÓÒÓ, ÛÙÔ˘˜ ÔÔ›Ô˘˜ ·˘Í‹ıËÎ·Ó Ù· Ì˘Ôηډȷο ¤Ó˙˘Ì· ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË ‹Ù·Ó ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚÔ ÛÙËÓ ÔÌ¿‰· Ù˘ ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ Û˘ÁÎÚÈÙÈο Ì ÙËÓ ÔÌ¿‰· ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ (CK-MB 7% ¤Ó·ÓÙÈ 27%, ƒ=0,001 Î·È ÙÚÔÔÓ›ÓË-π 41% ¤Ó·ÓÙÈ 58%, ƒ=0,039) Δ· Â›‰· Ù˘ CRP ÛÙÔÓ ÔÚfi ·˘Í‹ıËÎ·Ó Î·È ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ ÌÂÙ¿ ÙËÓ ·ÁÁÂÈÔÏ·ÛÙÈ΋, Ë ·‡ÍËÛË fï˜ ‹Ù·Ó ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË ÛÙËÓ ÔÌ¿‰· ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ (63±114% ÛÙËÓ ÔÌ¿‰· Ô˘ ¤Ï·‚ ·ÙÔÚ‚·ÛÙ·Ù›ÓË Î·È 147±274% ÛÙËÓ ÔÌ¿‰· Ô˘ ‰ÂÓ ¤Ï·‚Â). ∏ ÔÏ˘·Ú·ÁÔÓÙÈ΋ ·Ó¿Ï˘ÛË ¤‰ÂÈÍ fiÙÈ Ë ¯ÔÚ‹ÁËÛË ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ ÚÈÓ ÙËÓ Â¤Ì‚·ÛË Ì›ˆÛ ÙÔÓ Î›Ó‰˘ÓÔ Û˘Ì‚·Ì¿ÙˆÓ ÛÙȘ 30 Ë̤Ú˜ (odds ratio 0,12, fiÚÈ· ·ÍÈÔÈÛÙ›·˜ 95% ·fi 0,05 ̤¯ÚÈ 0,50, ƒ=0,004). ∞ÛıÂÓ›˜ Ô˘ ¯ÚÂÈ¿ÛıËÎ·Ó ·Ó·ÛÙÔÏ›˜ Ù˘ ÁÏ˘ÎÔÚˆÙ½Ó˘ IIb/IIIa ‹ ›¯·Ó ÎÏ¿ÛÌ· Â͈ı‹Ûˆ˜ ≤ 40% ÂÌÊ¿ÓÈÛ·Ó ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ. £ÂÚ·›· Ì ∞ª∂∞

ATHIROSK 14

03-07-07

12:06

™ÂÏ›‰·13

∫§π¡π∫∂™ ª∂§∂Δ∂™

EÈ‚›ˆÛË ¯ˆÚ›˜ Ì›˙ÔÓ· Û˘Ì‚¿Ì·Ù· (%)

∞ÙÔÚ‚·ÛÙ·Ù›ÓË

∂ÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ

100 80

60 P=0.01

40 20

0 1

2

3

7

14

21

30

∏̤Ú˜ ÌÂÙ¿ ÙËÓ ·ÁÁÂÈÔÏ·ÛÙÈ΋ ∂ÈÎfiÓ· 3. ∫·Ì‡Ï˜ ÂÈ‚›ˆÛ˘ ¯ˆÚ›˜ Ì›˙ÔÓ· ηډȷο Û˘Ì‚¿Ì·Ù·, ÌÂÙ¿ ÙËÓ Ù˘¯·ÈÔÔ›ËÛË.

‹ ‚-·Ó·ÛÙÔÏ›˜ ηٿ ÙÔ ¯ÚfiÓÔ Ù˘ ·ÁÁÂÈÔÏ·ÛÙÈ΋˜ ‰ÂÓ Ì›ˆÛ ÙÔÓ Î›Ó‰˘ÓÔ.

∂È‚›ˆÛË ¯ˆÚ›˜ ÎÔÏÈ΋ Ì·ÚÌ·Ú˘Á‹ (%).

3. Atorvastatin for Reduction of MYocardial Dysrhythmia After cardiac surgery - (ARMYDA-3) Study (15). H ÌÂϤÙË ·˘Ù‹ ÂͤٷÛ ÙË ‰˘Ó·ÙfiÙËÙ· Ù˘ ·ÙÔÚ‚·ÛÙ·Ù›Ó˘, fiÙ·Ó ¯ÔÚËÁÂ›Ù·È ÚÔÂÁ¯ÂÈÚËÙÈο Û ηډÈÔ¯ÂÈÚÔ˘ÚÁÈΤ˜ ÂÂÌ‚¿ÛÂȘ ·ÓÔÈÎÙ‹˜ ηډȿ˜, Ó· ÚÔÏ·Ì‚¿ÓÂÈ ÙË ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ÎÔÏÈ΋ Ì·ÚÌ·Ú˘Á‹, Ë ÔÔ›· ˆ˜ ÁÓˆÛÙfiÓ Â›Ó·È Û˘¯Ó‹ Û ·˘Ù¤˜ ÙȘ ÂÚÈÙÒÛÂȘ Î·È Ô‰ËÁ› Û ·Ú¿Ù·ÛË Ù˘ ÓÔÛËÏ›·˜, ·‡ÍËÛË ÙÔ˘ ÎfiÛÙÔ˘˜ Î·È ÙˆÓ ÂÈÏÔÎÒÓ. ∂Ӊ›ÍÂȘ fiÙÈ ÔÈ ÛÙ·Ù›Ó˜ ÂÓ‰¤¯ÂÙ·È Ó· ÚÔÏ·Ì‚¿ÓÔ˘Ó ÙËÓ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ÎÔÏÈ΋ Ì·ÚÌ·Ú˘Á‹ ˘‹Ú¯·Ó ·fi ÌÂϤÙ˜

·Ú·Ù‹ÚËÛ˘. ∞ÛıÂÓ›˜ Ô˘ ‹Û·Ó ˘fi ·ÁˆÁ‹ Ì ÛÙ·Ù›Ó˜ ÚÈÓ ÙËÓ ÂÁ¯Â›ÚËÛË ÂÌÊ¿ÓÈ˙·Ó ÏÈÁfiÙÂÚÔ Û˘¯Ó¿ ÂÂÈÛfi‰È· ÎÔÏÈ΋˜ Ì·ÚÌ·Ú˘Á‹˜ ÌÂÙ¿ ·ÔÚÙÔÛÙÂÊ·ÓÈ·›· ·Ú¿Î·Ì„Ë(16). ∏ ARMYDA-3 Â›Ó·È ÚÔÔÙÈ΋, Ù˘¯·ÈÔÔÈË̤ÓË, ‰ÈÏ¿-Ù˘ÊÏ‹, ÂÏÂÁ¯fiÌÂÓË Ì ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ ÌÂϤÙË, ÛÙËÓ ÔÔ›· ÂÓÙ¿¯ıËÎ·Ó 200 ·ÛıÂÓ›˜ Ô˘ ›¯·Ó ¤Ó‰ÂÈÍË Ó· ˘Ô‚ÏËıÔ‡Ó Û ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓË ÂÁ¯Â›ÚËÛË ·ÓÔÈÎÙ‹˜ ηډȿ˜ (·ÔÚÙÔÛÙÂÊ·ÓÈ·›· ·Ú¿Î·Ì„Ë ‹ ‰ÈfiÚıˆÛË ‚·Ï‚ȉÔ¿ıÂÈ·˜) Î·È ‰ÂÓ Â›¯·Ó ÈÛÙÔÚÈÎfi ÎÔÏÈ΋˜ Ì·ÚÌ·Ú˘Á‹˜ Ô‡Ù Ͽ̂·Ó·Ó ÛÙ·Ù›Ó˜ ̤¯ÚÈ ÙËÓ ¤ÓÙ·ÍË ÛÙË ÌÂϤÙË. ∫·Ù·ÓÂÌ‹ıËÎ·Ó Î·Ù¿ Ù˘¯·›Ô ÙÚfiÔ Û ‰‡Ô ÔÌ¿‰Â˜, ·ÓÂÍ¿ÚÙËÙ· ·fi Ù· Â›-

∞ÙÔÚ‚·ÛÙ·Ù›ÓË

∂ÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ

100 80 60 40 20 0

P=0.003

1

2

3

7

14

21

30

MÂÙÂÁ¯ÂÈÚËÙÈ΋ Ë̤ڷ ∂ÈÎfiÓ· 4. ∫·Ì‡Ï˜ ÂÈ‚›ˆÛ˘ ¯ˆÚ›˜ ÂÂÈÛfi‰ÈÔ ÎÔÏÈ΋˜ Ì·ÚÌ·Ú˘Á‹˜ Û οı ÔÌ¿‰·.

‰· ÏÈȉ›ˆÓ Î·È Ë Ì›· ÔÌ¿‰· (101 ¿ÙÔÌ·) ¤Ï·‚ ·ÙÔÚ‚·ÛÙ·Ù›ÓË 40 mg ÙËÓ Ë̤ڷ, ·Ú¯›˙ÔÓÙ·˜ 7 Ë̤Ú˜ ÚÈÓ ÙËÓ ÂÁ¯Â›ÚËÛË Î·È Ë ¿ÏÏË ÔÌ¿‰· (99 ¿ÙÔÌ·) ¤Ï·‚ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ. ∏ ›‰È· ·ÁˆÁ‹ Û˘Ó¯›ÛıËΠÁÈ· fiÛÔ ‰È¿ÛÙËÌ· ÔÈ ·ÛıÂÓ›˜ ·Ú¤ÌÂÈÓ·Ó ÛÙÔ ÓÔÛÔÎÔÌ›Ô, ÂÓÒ ÌÂÙ¿ ÙËÓ ¤ÍÔ‰Ô Û˘ÓÙ·ÁÔÁÚ·Ê‹ıËΠ۠fiÏÔ˘˜ ·ÙÔÚ‚·ÛÙ·Ù›ÓË. ¶ÚˆÙ‡ÔÓ ÙÂÏÈÎfi ÛËÌÂ›Ô ‹Ù·Ó Ë ÂÌÊ¿ÓÈÛË ÛÙÔ ∏∫° ·Ú·ÎÔÏÔ‡ıËÛ˘ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋˜ ÎÔÏÈ΋˜ Ì·ÚÌ·Ú˘Á‹˜ Ô˘ ‰È‹ÚÎÂÛ ÂÚÈÛÛfiÙÂÚÔ ·fi 5 ÏÂÙ¿ ‹ Ô˘ ¯ÚÂÈ¿ÛıËΠ·Ú¤Ì‚·ÛË ÏfiÁˆ ÛÙËı¿Á¯Ë˜ ‹ ·ÈÌÔ‰˘Ó·ÌÈ΋˜ ·ÛÙ¿ıÂÈ·˜. ¢Â˘ÙÂÚ‡ÔÓÙ· ÙÂÏÈο ÛËÌ›· ‹Ù·Ó Ë ‰È¿ÚÎÂÈ· Ù˘ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋˜ ÓÔÛËÏ›·˜, Ù· Ì›˙ÔÓ· ηډȷÁÁÂȷο Û˘Ì‚¿ÓÙ· Û ‰È¿ÛÙËÌ· 30 ËÌÂÚÒÓ Î·È Ë ‰È·Î‡Ì·ÓÛË Ù˘ ÙÈÌ‹˜ Ù˘ CRP. ∏ ·ÙÔÚ‚·ÛÙ·Ù›ÓË Ì›ˆÛ ÛËÌ·ÓÙÈο ÙËÓ Â›ÙˆÛË Ù˘ ÎÔÏÈ΋˜ Ì·ÚÌ·Ú˘Á‹˜ (35% ¤Ó·ÓÙÈ 57%, ƒ=0.003, ∂ÈÎfiÓ· 4) Î·È Î·Ù¿ Û˘Ó¤ÂÈ· Î·È ÙË ‰È¿ÚÎÂÈ· ÓÔÛËÏ›·˜ (6,3±1,2 ¤Ó·ÓÙÈ 6,9±1,4 Ë̤Ú˜ ·ÓÙ›ÛÙÔȯ·, ƒ = 0,001). ΔÔ fiÊÂÏÔ˜ ÂÚÈÔÚ›ÛıËΠÛÙ· ÂÚÈÛÙ·ÙÈο Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û ·ÔÚÙÔÛÙÂÊ·ÓÈ·›· ·Ú¿Î·Ì„Ë Î·È ‰ÂÓ ·Ú·ÙËÚ‹ıËΠ۠ÂÁ¯ÂÈÚ‹ÛÂȘ ‚·Ï‚›‰ˆÓ. ∂›Û˘ Ë ·ÙÔÚ‚·ÛÙ·Ù›ÓË ‰ÂÓ ÚÔÛٿ٢۠ÙÔ˘˜ ·ÛıÂÓ›˜ Û ÂÚ›ÙˆÛË Ô˘ ›¯·Ó ‰È·ÙÂٷ̤ÓÔ ·ÚÈÛÙÂÚfi ÎfiÏÔ. Δ· Â›‰· Ù˘ CRP ‹Ù·Ó ¯·ÌËÏfiÙÂÚ· ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ‰ÂÓ ÂÌÊ¿ÓÈÛ·Ó ÎÔÏÈ΋ Ì·ÚÌ·Ú˘Á‹, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ Ï‹„Ë ‹ ÌË ·ÙÔÚ‚·ÛÙ·Ù›Ó˘. (ƒ=0,01). ∏ ÎÔÏÈ΋ Ì·ÚÌ·Ú˘Á‹ ‹Ù·Ó ÈÔ Û˘¯Ó‹ ÛÙ· ÂÚÈÛÛfiÙÂÚÔ ËÏÈÎȈ̤ӷ ¿ÙÔÌ· (>65 ÂÙÒÓ), Û ˘ÂÚÙ·ÛÈο ¿ÙÔÌ· Î·È Û ·ıËÚÔÛÎÏ‹ÚˆÛË Ù˘ ·ÔÚÙ‹˜. ∞ÓÙ›ıÂÙ· Ë Ï‹„Ë ‚·Ó·ÛÙÔϤˆÓ Ì›ˆÛ ÙÔÓ Î›Ó‰˘ÓÔ ÎÔÏÈ΋˜ Ì·ÚÌ·Ú˘Á‹˜ ηٿ 90%. ¶ÔÏ˘·Ú·ÁÔÓÙÈ΋ ·Ó¿Ï˘ÛË ¤‰ÂÈÍ fiÙÈ Ë ·ÙÔÚ‚·ÛÙ·Ù›ÓË ÌÂÈÒÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋˜ ÎÔÏÈ΋˜ Ì·ÚÌ·Ú˘Á‹˜ ηٿ 61% (OR 0,39, fiÚÈÔ ·ÍÈÔÈÛÙ›·˜ 95% ·fi 0,18 ̤¯ÚÈ 0,85, ƒ = 0,017), ·ÓÂÍ¿ÚÙËÙ· ·fi ËÏÈΛ·, ʇÏÔ, ‡·ÚÍË ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ‹ ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË. ∏ Ù·˘Ùfi¯ÚÔÓË Ï‹„Ë ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ Î·È ‚-·Ó·ÛÙÔϤˆÓ ÌÂÈÒÓÂÈ ·ÎfiÌË ÂÚÈÛÛfiÙÂÚÔ ÙÔÓ Î›Ó‰˘ÓÔ (∂ÈÎfiÓ· 5).

13

ATHIROSK 14

03-07-07

12:06

™ÂÏ›‰·14

π√À¡π√™ 2007

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

0

0.5

1

2

3

4

5 OR

95% CI

P

∏ÏÈΛ· > 65 ÂÙÒÓ.

2.5

∞ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË.

3.9 (1.1-14)

0.039

™·Î¯·Ú҉˘ ‰È·‚‹Ù˘.

1.2 (0.50-2.7)

0.074

™˘ÌÊÔÚËÙÈ΋ ηډȷ΋ ·ÓÂ¿ÚÎÂÈ·. ∞ıËÚÔÛÎÏ‹ÚˆÛË ·ÔÚÙ‹˜.

1.6 (0.21-12.7)

¢È¿Ù·ÛË ·ÚÈÛÙÂÚÔ‡ ÎfiÏÔ˘.

1.6 (0.73-3.3)

(1.2-5.0)

2.6 (1.1-6.0)

0.19 (0.08-0.44)

£ÂÚ·›· Ì ‚-·Ó·ÛÙÔÏ›˜ πÓfiÙÚÔÔÈ ·Ú¿ÁÔÓÙ˜. ¢È·ÛˆÏ‹ÓˆÛË Î·È ÙˆÓ ‰‡Ô ÎÔ›ÏˆÓ ÊÏ‚ÒÓ. £ÂÚ·›· Ì ·ÙÔÚ‚·ÛÙ·Ù›ÓË.

0.65 0.023 0.26 0.0001

1.4 (0.59-3.2)

0.46

2.4 (0.90-6.0)

0.08

0.39 (018-0.85)

0.017

2.0 (1.2-7.0)

CRP>166 mg/L

0.02

0.01

0.10 (0.02-0.0.25) <0.0001

∞ÙÔÚ‚·ÛÙ·Ù›ÓË +‚-·Ó·ÛÙÔÏ›˜)

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

ªÂ Ù· ̤¯ÚÈ ÙÒÚ· ‰Â‰Ô̤ӷ ÌfiÓÔ ÔÈ ‚-·Ó·ÛÙÔÏ›˜ Î·È Ë ·ÌȈ‰·ÚfiÓË ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ÚÔÛÙ·ÙÂ‡Ô˘Ó ·fi ÙË ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ÎÔÏÈ΋ Ì·ÚÌ·Ú˘Á‹. √È ·ÓÙ·ÁˆÓÈÛÙ¤˜ ·Û‚ÂÛÙ›Ô˘, Ù· ·ÓÙÈ·ÚÚ˘ıÌÈο ηÙËÁÔÚ›·˜ π, Ë ‰·ÎÙ˘Ï›Ùȉ·, ÙÔ Ì·ÁÓ‹ÛÈÔ Î·È Ë ¤Á¯˘ÛË ‰È·Ï‡Ì·ÙÔ˜ ÁÏ˘Îfi˙˘-ÈÓÛÔ˘Ï›Ó˘-Î·Ï›Ô˘ ‰ÂÓ ‹Ù·Ó ·ÔÙÂÏÂÛÌ·ÙÈο. ™‡Ìʈӷ Ì ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË Ë ÚÔıÂÚ·›· Ì ·ÙÔÚ‚·ÛÙ·Ù›ÓË Â›Ó·È ÂÍ·ÈÚÂÙÈο ·ÔÙÂÏÂÛÌ·ÙÈ΋. ÃÚÂÈ¿˙ÂÙ·È Ó· ¿ÚÔ˘Ó ıÂÚ·›· ÌfiÓÔ 4,5 ·ÛıÂÓ›˜ ÁÈ· Ó· ÚÔÏËÊı› ¤Ó· ÂÂÈÛfi‰ÈÔ ÎÔÏÈ΋˜ Ì·ÚÌ·Ú˘Á‹˜ Î·È 8 ·ÛıÂÓ›˜ ÁÈ· Ó· ÚÔÏËÊı› ·Ú¿Ù·ÛË Ù˘ ÓÔÛËÏ›·˜ ¤Ú·Ó ÙˆÓ 7 ËÌÂÚÒÓ. ¢Â‰Ô̤ÓÔ˘ fiÙÈ Ë ıÂÚ·›· Ì ·ÙÔÚ‚·ÛÙ·Ù›ÓË Â›Ó·È ·ÛÊ·Ï‹˜ Î·È ¯·ÌËÏÔ‡ ÎfiÛÙÔ˘˜, Ë ¯ÔÚ‹ÁËÛË Ù˘ ÚÔÏËÙÈο Û ÂÁ¯ÂÈÚ‹ÛÂȘ ·ÔÚÙÔÛÙÂÊ·ÓÈ·›·˜ ·Ú¿Î·Ì„˘ ÌÔÚ› Ó· ¤¯ÂÈ ÛËÌ·ÓÙÈΤ˜ ÔÈÎÔÓÔÌÈΤ˜ ÂÈÙÒÛÂȘ. √ Ì˯·ÓÈÛÌfi˜ Ì ÙÔÓ ÔÔ›Ô Ë ·ÙÔÚ‚·ÛÙ·Ù›ÓË ÌÔÚ› Ó· ÚÔÏ·Ì‚¿ÓÂÈ ÙË Ì˘Ôηډȷ΋ Ó¤ÎÚˆÛË Ô˘ Û˘¯Ó¿ Û˘Ì‚·›ÓÂÈ ÛÙËÓ ·ÁÁÂÈÔÏ·ÛÙÈ΋ (›Ù ÁÈ·

14

¯ÚfiÓÈ· ÛÙ·ıÂÚ‹ ÛÙËı¿Á¯Ë ›Ù ÁÈ· Ôͤ· ÛÙÂÊ·ÓÈ·›· Û‡Ó‰ÚÔÌ·) ηıÒ˜ Î·È ÙËÓ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ÎÔÏÈ΋ Ì·ÚÌ·Ú˘Á‹ ‰ÂÓ Â›Ó·È Â·ÎÚÈ‚Ò˜ ÁÓˆÛÙfi˜, ‰ÂÓ ÌÔÚ› fï˜ Ó· Â›Ó·È Ë ˘ÔÏÈȉ·ÈÌÈ΋ ‰Ú¿ÛË, Ë ÔÔ›· ¯ÚÂÈ¿˙ÂÙ·È ·ÚÎÂÙfi ¯ÚfiÓÔ ÁÈ· Ó· Á›ÓÂÈ ÂÌÊ·Ó‹˜. ∏ ·ÓÙÈÊÏÂÁÌÔÓ҉˘ ‰Ú¿ÛË ÂÓ‰¤¯ÂÙ·È Ó· Â›Ó·È ¤Ó·˜ Ì˯·ÓÈÛÌfi˜ Î·È Û ·˘Ùfi Û˘ÓËÁÔÚ› ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ù· ÂÂÈÛfi‰È· ‹Ù·Ó ÈÔ Û˘¯Ó¿ ÛÙ· ¿ÙÔÌ· Ì ˘„ËϤ˜ ÙÈ̤˜ CRP Î·È fiÙÈ Ë ·ÙÔÚ‚·ÛÙ·Ù›ÓË ÌÂÈÒÓÂÈ ÙËÓ ÙÈÌ‹ Ù˘ CRP. À¿Ú¯Ô˘Ó ÂÈÚ·Ì·ÙÈΤ˜ ÂӉ›ÍÂȘ fiÙÈ ÔÈ ÛÙ·Ù›Ó˜ ÚÔÛÙ·ÙÂ‡Ô˘Ó ·fi ÙË ‚Ï¿‚Ë Â·Ó·ÁÁ›ˆÛ˘ Î·È ÂËÚ¿˙Ô˘Ó ÙË ÌÈÎÚÔ΢ÎÏÔÊÔÚ›·, ÌÂÈÒÓÔ˘Ó Ù· ÚÔÛÎÔÏÏËÙÈο ÌfiÚÈ· Î·È ‚ÂÏÙÈÒÓÔ˘Ó ÙË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ. ∂›Û˘, ·ÎfiÌË Î·È ‚Ú·¯˘¯ÚfiÓÈ· ıÂÚ·›· Ì ÛÙ·Ù›Ó˜ ¤¯ÂÈ ÛËÌ·ÓÙÈο ·ÔÙÂϤÛÌ·Ù· ÛÙË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· ÙÔ˘ ÂÓ‰ÔıËÏ›Ô˘, ÛÙË ÊÏÂÁÌÔÓ‹, ÛÙËÓ ·ÁÁÂÈԉȷÛÙÔÏ‹ ÙˆÓ ÌÈÎÚÒÓ ·ÁÁ›ˆÓ Î·È ÛÙË ıÚfiÌ‚ˆÛË. ™ÙË ÌÂϤÙË ARMYDA-ACS Ë ·ÙÔÚ‚·ÛÙ·Ù›ÓË ÂÚÈfiÚÈÛ ÙËÓ ·‡ÍËÛË

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

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

ATHIROSK 14

03-07-07

12:06

™ÂÏ›‰·15

∫§π¡π∫∂™ ª∂§∂Δ∂™

∏ ·ÓÙ·ÈÌÔÂÙ·Ïȷ΋ ‰Ú¿ÛË ÙˆÓ

A

B P<0.005

P<0.005

P<n.s. ƒ-ÛÂÏÂÎÙ›ÓË ¢ªFi in AU

25 ƒ-ÛÂÏÂÎÙ›ÓË ªFi in AU

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

20 15 10 5 0 ¶ÚÈÓ ÙËÓ ·ÁˆÁ‹

ªÂÙ¿ 4 ‚‰ÔÌ¿‰Â˜

MfiÓÔ ™Ù·Ù›ÓË

∂˙ÂÙÈÌ›ÌË+™Ù·Ù›ÓË

5

0

-5

-10

∂˙ÂÙÈÌ›ÌË +™Ù·Ù›ÓË MfiÓÔ ™Ù·Ù›ÓË

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

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

›ÛÔ˘ ηÏfi ˘ÔÏÈȉ·ÈÌÈÎfi ·ÔÙ¤ÏÂÛÌ· Ì ÙȘ ÌÂÁ·Ï‡ÙÂÚ˜ ‰fiÛÂȘ ÙˆÓ ÛÙ·ÙÈÓÒÓ, ›Ûˆ˜ ‰ÂÓ ¤¯Ô˘Ó ÙÔ ›‰ÈÔ Î·Ïfi ÎÏÈÓÈÎfi ·ÔÙ¤ÏÂÛÌ·, ÂÂȉ‹ ‰ÂÓ ÂÍ·ÛÊ·Ï›˙Ô˘Ó ÛÙÔÓ ›‰ÈÔ ‚·ıÌfi ÙȘ ÏÂÈfiÙÚÔ˜ ‰Ú¿ÛÂȘ.

7.

Albert MA, Danielson E, Rifai N, Ridker PM, PRINCE Investigators. Effect of statin therapy on C-reactive protein levels: the pravastatin inflammation/ CRP evaluation (PRINCE): a randomized trial and cohort study. JAMA 2001; 86: 64-70.

13. Ioannidis JPA, Karvouni E, Katritis DG. Mortality risk conferred by small elevations of creatine kinase-MB isoenzyme after percutaneous intervention. J Am Coll Cardiol 2003;42:1412-14.

8.

Sanguigni V, Pignatelli P, Lenti L, ct al.

Short-term treatment with atorvastatin reduces platelet CD40 ligand and thrombin generation in hypercholesterolemic patients.

Circulation 2005;111:412-9.

9.

Negre-Aminou P, van Vliet AK, van Erck M, van Thiel GC, van Leeuwen RE, Cohen LH. Inhibition of proliferation of human smooth muscle cells by various HMGCoA reductase inhibitors; comparison with other human cell types. Biochim Biophys Acta 1997; 1345: 259-68.

μÈ‚ÏÈÔÁÚ·Ê›· 1.

Giroux LM, Davignon J, Naruszewicz M. Simvastatin inhibits the oxidation of lowdensity lipoproteins by activated human rnonocyte-derived macrophages. Biochim Biophys Acta 1993;1165 :335-8.

2.

Hussein O, Schlezinger S, Rosenblat M, Keidar S, Aviram M. Reduced susceptibility of low density lipoprolein (LDL) to lipid peroxidation after fluvastatin therapy is associated with the hypocholesterolemic effect of the drug and its binding to the LDL. Atherosclerosis 1997;28:11 - 18.

3.

Fuhrman B, Koren L, Volkova N, Keidar S, Hayek T, Aviram M. Atorvastatin therapy in hypercholeslerolemic patients suppresses cellular uptake of oxidizedLDL by differentiating monocytes. Atherosclerosis 2002;164:179-85.

4.

Wassmann S, Faul A, Hennen B, Sheller B, Bohm M, Nickenig G. Rapid effect of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibition on coronary endothelial function. Circ Res 2003;93:e98-103.

5.

Treasure CB, Klein JL, Weintraub WS, Talley JD, Stillabower ME, Kosinski AS, Zhang J, Boccuzzi SJ, Cedarholm JC, Alexander RW. Beneficial effects of cholesterol-lowering ther¬apy on the coronary endothelium in patients with coronary artery disease. N Engl J Med 1995;332:481-7.

6.

Pasceri V, Cheng JS, Willerson JT, Yeh ET. Modulation of C-reactive proteinmediated monocyte chemoattractant protein-1 induction in endothelial cells by anti-atherosclerotic drugs. Circulation 2001;103: 2531-34.

14. Giuseppe P, Pasceri V, Colonna G, Miglionico M, Fischetti D, Sardella G, Montinaro A, Di Sciascio G. Atorvastatine pretreatment improves outcomes in patients with acute coronary syndromes undergoing early percutaneous coronary interventions. Results of the ARMYDA-ACS randomized trial. JACC 2007;49:1272-78.

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

15. Patti G, Chello M, Candura D, Pasceri V, D'Ambrosio A, Covino E, Di Sciasco G. Randomized trial of atorvastatin for reduction of postoperative atrial fibrillation in patients undergoing cardiac surgery. Results of the ARMYDA-3 (Atorvastatine for Reduction of Myocardial Dysrhythmia After cardiac surgery) study.

Circulation 2006;114:1455-61

11. Hinoi T, Matsuo S, Tadehara F, Tsujiyama S, Yamakido M. Acute effect of atorvastatin on coronary circulation measured by transthoracic Doppler echocardiography in patients without coronary artery disease by angiography.

Am J Cardiol 2005;96:89-91.

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

12. Pasceri V, Patti G, Nusca A, Pristipino C, Richichi G, Di Sciascio G, ARMYDA Investigators. Randomized trial of atorvastatm for reduction of myocardial damage during coronary intervention: results from the ARMYDA (Atorvastatin for Reduction of Myocardial Damage During Angioplasty) study. Circulation 2004;110:674-8.

17. Piorkowski M, Fischer S, Stellbaum C, Jaster M, Martus P, Morguet AJ, Schultheiss H-P, Rauch U. Treatment with Ezetimibe plus low-dose Atorvastatin compared with higher dose Atorvastatin alone. Is sufficient cholesterol-lowering enough to inhibit platelets? J Am Coll Cardiol 2007;49:1035-42.

15

ATHIROSK 14

03-07-07

12:06

™ÂÏ›‰·16

π√À¡π√™ 2007

∂ÂÌ‚·ÙÈ΋ E·Ó·ÈÌ¿ÙˆÛË ‹ º·Ú̷΢ÙÈ΋ ∞ÁˆÁ‹ ÛÙËÓ ∞Û˘Ìو̷ÙÈ΋ ™Ù·ıÂÚ‹ ™ÙÂÊ·ÓÈ·›· ¡fiÛÔ; μ. ’∞ı˘ÚÔ˜, ∞. ∫·Î·Ê‹Î·, ∂. ¶·ÁÎÔ˘Ú¤ÏÈ·˜, Ã. ∫Ô˘Ì·Ú¿˜, ∞. ™Î·¤Ú‰·˜, ∞. ∫·Ú·ÁÈ¿ÓÓ˘. μ’ ¶ÚÔ·È‰Â˘ÙÈ΋ ¶·ıÔÏÔÁÈ΋ ∫ÏÈÓÈ΋, ∞¶£, πÔÎÚ¿ÙÂÈÔ £ÂÛÛ·ÏÔӛ΢ À¿Ú¯ÂÈ ÌÈ· Ì·ÎÚÔ¯ÚfiÓÈ· ‰È·ÊÔÚ¿ ·fi„ÂˆÓ fiÛÔÓ ·ÊÔÚ¿ ÛÙË ‚¤ÏÙÈÛÙË ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÛÙ·ıÂÚ‹˜ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ (™™¡). £· Ú¤ÂÈ Ë ·ÓÙÈÌÂÙÒÈÛË Ó· Â›Ó·È ÂÂÌ‚·ÙÈ΋ Î·È Ó· Û˘ÌÏËÚÒÓÂÙ·È ·fi Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ ‹ Ë ‚¤ÏÙÈÛÙË Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ ÌfiÓË Ù˘ Â›Ó·È ·ÚÎÂÙ‹ ÙfiÛÔ ÛÙËÓ ÚfiÏË„Ë Ó¤ˆÓ ÛÎÏËÚÒÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ (ı¿Ó·ÙÔ˜, ¤ÌÊÚ·ÁÌ· Ì˘Ôηډ›Ô˘) fiÛÔ Î·È ÛÙËÓ ·Ó·ÎÔ‡ÊÈÛË ·fi ÙË ÛÙËı¿Á¯Ë ÚÔÛ¿ıÂÈ·˜ ÁÈ· fiÛÔ˘˜ ·ÛıÂÓ›˜ ˘ÔʤÚÔ˘Ó ·fi ·˘Ù‹? ΔÔ 1997 ‰ËÌÔÛȇÙËÎÂ Ë ÌÂϤÙË Randomised Intervention Treatment of Angina (RITA-2), Ë ÔÔ›· ¤‰ÂÈÍ fiÙÈ Ë ‰È·‰ÂÚÌ·ÙÈ΋ ÛÙÂÊ·ÓÈ·›· Â¤Ì‚·ÛË (PCI) ÚÔηÏ› ·Ó·ÎÔ‡ÊÈÛË ·fi ÙË ÛÙËı¿Á¯Ë Û ·ÛıÂÓ›˜ Ì ™™¡ ·ÏÏ¿ ‰ÂÓ ÂÏ·ÙÙÒÓÂÈ Ù· ÛÎÏËÚ¿ ηډȷÁÁÂȷο Û˘Ì‚¿Ì·Ù·[1]. ªÈ· ÈÔ ÏÂÙÔÌÂÚ‹˜ ·Ó¿ÁÓˆÛË Ù˘ RITA-2 ‰Â›¯ÓÂÈ fiÙÈ ·ÚfiÏÔ fiÙÈ Ù· ÔÛÔÛÙ¿ ·ÛıÂÓÒÓ Ì ÛÙËı¿Á¯Ë ‹Ù·Ó Ôχ ¯·ÌËÏfiÙÂÚ· ÛÙËÓ ÔÌ¿‰· PCI ·' fiÙÈ ÛÙËÓ ÔÌ¿‰· Ù˘ Ê·Ú̷΢ÙÈ΋˜ ·ÁˆÁ‹˜ (15% ¤Ó·ÓÙÈ 21,4%, p=0.01), Ù· fiÚÈ· ·˘Ù¿ ÛÙ¤Ó¢·Ó Ì ÙË ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘. ∞˘Ùfi ÌÔÚ› Ó· ÛËÌ·›ÓÂÈ fiÙÈ Ë ‚ÂÏÙÈÛÙÔÔ›ËÛË Ù˘ Ê·Ú̷΢ÙÈ΋˜ ·ÁˆÁ‹˜, Ô˘ ‰È·ÈÛÙÒıËΠÛÙËÓ ·Ú·ÙÂٷ̤ÓË ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ·ÛıÂÓÒÓ Ù˘ RITA-2 (7 ¯ÚfiÓÈ·), ı· ÌÔÚÔ‡Û ›Ûˆ˜ Ó· ¤¯ÂÈ ·ÚfiÌÔÈ· ·ÔÙÂϤÛÌ·Ù· ·fi ÙËÓ ¿Ô„Ë Ù˘ ·Ó·ÎÔ‡ÊÈÛ˘ fiÓÔ˘ Û ÙËÓ PCI [2]. ¶ÚfiÛÊ·Ù· ·Ó·ÎÔÈÓÒıËÎ·Ó Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE). [3] ∞˘Ù¿, Û˘Ó˘ÔÏÔÁÈ˙fiÌÂÓ· Ì ÚÔ¸¿Ú¯ÔÓÙ· ÛÙÔȯ›· ÁÈ· ÙË

16

ÂÂÌ‚·ÙÈ΋ Ë Ê·Ú̷΢ÙÈ΋ ıÂÚ·›· Ù˘ ™™¡, ÌÔÚÔ‡Ó Ó· ÛËÌ·ÙÔ‰ÔÙ‹ÛÔ˘Ó ÙÔ Ù¤ÏÔ˜ ÌÈ·˜ ÂÔ¯‹˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ™™¡. ∏ COURAGE ¤‰ÂÈÍ fiÙÈ Ë PCI Ì ÙË ¯ÚËÛÈÌÔÔ›ËÛË stent Î·È ‚¤ÏÙÈÛÙË Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ ‰ÂÓ Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·ÔÙÂÏÂÛÌ·ÙÈΤ˜ ÛÙËÓ ÚfiÏË„Ë ÌÂÏÏÔÓÙÈÎÒÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ ·fi ÙË ‚¤ÏÙÈÛÙË Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ ÌfiÓË Ù˘ Û ·ÛıÂÓ›˜ Ì ™™¡. [3] √È ÂÚ¢ÓËÙ¤˜ Ù˘ ÌÂϤÙ˘ COURAGE Ù˘¯·ÈÔÔ›ËÛ·Ó 2.287 ·ÛıÂÓ›˜ (ÌÂٷ͇ 1999 Î·È 2004) ›Ù Û ıÂÚ·›· Ì PCI Û˘Ó ‚¤ÏÙÈÛÙË Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ ›Ù ÛÙË ‚¤ÏÙÈÛÙË Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ ÌfiÓÔ. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ·Ú·ÎÔÏÔ‡ıËÛ˘ (̤ÛÔ˜ ¯ÚfiÓÔ˜ 4,6 ¯ÚfiÓÈ·) ηÙÂÁÚ¿ÊËÛ·Ó Û˘ÓÔÏÈο 211 ı¿Ó·ÙÔÈ ‹ ÌË ı·Ó·ÙËÊfiÚ· ÂÌÊÚ¿ÁÌ·Ù· ÙÔ˘ Ì˘Ôηډ›Ô˘, ·ÚÈıÌfi˜ ·ÚfiÌÔÈÔ˜ Ì ·˘ÙfiÓ (202) Ù˘ ÔÌ¿‰·˜ Ì ‚¤ÏÙÈÛÙË Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ ÌfiÓÔ. [3] ŸÙ·Ó ÚÔÛÙ¤ıËÎ·Ó Ù· ·ÁÁÂȷο ÂÁÎÂÊ·ÏÈο ÂÂÈÛfi‰È· Ë ‰È·ÊÔÚ¿ ÂÍ·ÎÔÏÔ˘ıÔ‡Û ӷ ÌËÓ Â›Ó·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋. ∏ ÌfiÓË ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ıÂÚ·›·˜ ‹Ù·Ó Ë ÌÂȈ̤ÓË Â›ÙˆÛË Ù˘ ÛÙËı¿Á¯Ë˜ ÛÙËÓ ÔÌ¿‰· PCI ÛÙ· 1 Î·È 3 ¤ÙË. ∂ÓÙÔ‡ÙÔȘ, ÛÙ· 5 ¤ÙË ‰ÂÓ ˘‹ÚÍ η̛· ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙÔ ÔÛÔÛÙfi ·˘ÙÒÓ Ô˘ ‹Ù·Ó ÂχıÂÚÔÈ ·fi ÛÙËı¿Á¯Ë (73% ÙˆÓ ·ÛıÂÓÒÓ Î¿ı ÔÌ¿‰·˜). ∞˘Ù¿ Ù· ·ÔÙÂϤÛÌ·Ù· ¤¯Ô˘Ó ÂÈÙÒÛÂȘ Û ¤Ó·Ó ÛËÌ·ÓÙÈÎfi ·ÚÈıÌfi ·ÛıÂÓÒÓ Ì ™™¡ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È Û PCI. ÀÔÏÔÁ›˙ÂÙ·È fiÙÈ 30% ¤ˆ˜ 40% ÙˆÓ ·ÛıÂÓÒÓ Ì ™™¡ ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È Ì PCI. ∂¿Ó Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ COURAGE ÂÊ·ÚÌÔÛÙÔ‡Ó ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË, ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ·fi ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓ›˜ ÌÔÚÔ‡Ó ÙÒÚ·

Ó· ıÂÚ·¢ıÔ‡Ó Ì ٷ Ê¿Ú̷η ÌfiÓÔ. ∞˘Ùfi ÛËÌ·›ÓÂÈ Ô˘ÛÈ·ÛÙÈ΋ ÂÍÔÈÎÔÓfiÌËÛË fiÚˆÓ ÁÈ· ÙËÓ ˘ÁÂÈÔÓÔÌÈ΋ ÂÚ›ı·Ï„Ë. [4] Δ· ÛÙÔȯ›· ¿Óˆ ÛÙÔ ˙‹ÙËÌ· ·˘Ùfi ‹Ù·Ó ‰È·ı¤ÛÈÌ· ·fi ÙÔ 1999. ∏ ÌÂϤÙË Atorvastatin Versus Revascularization Treatment (AVERT) ¤‰ÂÈÍ fiÙÈ ÛÙÔ˘˜ ¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ·ÛıÂÓ›˜ Ì ™™¡ Ë ÂÈıÂÙÈ΋ ˘ÔÏÈȉ·ÈÌÈ΋ Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ ‹Ù·Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ ÙfiÛÔ ·ÔÙÂÏÂÛÌ·ÙÈ΋ fiÛÔ Ë PCI (Û˘Ó Û˘Ó‹ıË È·ÙÚÈ΋ ÊÚÔÓÙ›‰·) ÛÙË Ì›ˆÛË Ù˘ Â›ÙˆÛ˘ ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ. [5] ªÂÙ¿ ·fi ÙȘ ÌÂϤÙ˜ AVERT Î·È RITA-2 Ë ıÂÚ·›· Ù˘ ™™¡ ı· Ú¤ÂÈ Ó· Â›Ó·È Ôχ ÂÚÈÛÛfiÙÂÚÔ ‘ÌÂÙ·‚ÔÏÈ΋’ Î·È Ôχ ÏÈÁfiÙÂÚÔ ‘Ì˯·ÓÈ΋’. [6] ªÔÏÔÓfiÙÈ ÛÙËÓ AVERT Ë ‰È·ÊÔÚ¿ ÛÙËÓ ¤Î‚·ÛË ÌÂٷ͇ ÙˆÓ 2 ÔÌ¿‰ˆÓ ıÂÚ·›·˜ ‰ÂÓ ÔÊÂÈÏfiÙ·Ó ÚÒÙÈÛÙ· Û Â·Ó·ÛÙ¤ÓˆÛË (ÙÔ ÎÏÈÓÈο ·ÓȯÓÂ˘Ì¤ÓÔ ÔÛÔÛÙfi Â·Ó·ÛÙ¤ÓˆÛ˘ ÛÙËÓ ÔÌ¿‰· PCI ‹Ù·Ó ÌfiÓÔ 10,2%) Ë ÚÔÛ¤ÁÁÈÛË Ù˘ Ê·Ú̷΢ÙÈ΋˜ ·ÁˆÁ‹˜ ‰ÂÓ ˘ÈÔıÂÙ‹ıËΠ·fi ÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ

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£∂ƒ∞¶∂π∞ - º∞ƒª∞∫∞ ¶π¡∞∫∞™ ÃÚfiÓÔ˜

PCI ($)

º·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ ($)

p

ŒÓ·ÚÍË 1 ¤ÙÔ˜ 3 ¤ÙË

7.771 10.051 19.605

1,751 4,153 6,661

<0.0001 <0.0001 <0.0001

ηډÈÔÏfiÁˆÓ ÂÂȉ‹ ˘‹ÚÍ ÂÏ›‰· ÁÈ· ·ÎfiÌ· ηχÙÂÚ· ·ÔÙÂϤÛÌ·Ù· Ì PCI fiÙ·Ó ¤ÁÈÓ·Ó ‰È·ı¤ÛÈÌ· Ù· drug eluding stents (DES) Ô˘ ˘Ôη٤ÛÙËÛ·Ó Ù· bare metal stents (BMS). ∂ÓÙÔ‡ÙÔȘ, Ë ¯Ú‹ÛË DES ÂÓ·ÓÙ›ÔÓ BMS ·ÔÙÂÏ› ·ÓÙÈΛÌÂÓÔ ¤ÓÙÔÓ˘ ‰È·Ì¿¯Ë˜, ‰Â‰Ô̤ÓÔ˘ fiÙÈ Ù· DES Û˘Ó‰¤ÔÓÙ·È ϤÔÓ Ì fi„ÈÌË ıÚfiÌ‚ˆÛË. [7] ∂ÈÛ‹¯ıË ¤ÙÛÈ ÌÈ· Ó¤· ¤ÓÓÔÈ· ÛÙËÓ ÂÂÌ‚·ÙÈ΋ ηډÈÔÏÔÁ›· ÌÈ· Û¯¤ÛË J-curve ÌÂٷ͇ Ù˘ ÚfiÛÊ·Ù˘·ÒÙÂÚ˘ ıÚfiÌ‚ˆÛ˘ Î·È ÎÏÈÓÈÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ.[8-10] ∂ÈϤÔÓ, Ù· DES Â›Ó·È ·ÎÚÈ‚fiÙÂÚ· ·fi BMS Î·È ··ÈÙÔ‡Ó Ì·ÎÚÔ¯ÚfiÓÈ· ıÂÚ·›· (›Ûˆ˜ ÌÂÚÈÎÒÓ ÂÙÒÓ) Ì ÎÏÔȉÔÁÚ¤ÏË Ô˘ Â›Û˘ ¤¯ÂÈ ˘„ËÏfi ÎfiÛÙÔ˜ ıÂÚ·›·˜.[8-10] ™Â ÌÈ· ÔÈÎÔÓÔÌÈ΋ ·Ó¿Ï˘ÛË Ù˘ COURAGE, [11] Ê¿ÓËΠfiÙÈ ÙÔ ÎfiÛÙÔ˜ ‹Ù·Ó Ôχ ¯·ÌËÏfiÙÂÚÔ ÛÙËÓ ÔÌ¿‰· Ê·Ú̷΢ÙÈ΋˜ ıÂÚ·›·˜ (¶›Ó·Î·˜).

∂ÈϤÔÓ, ÙÔ ÎfiÛÙÔ˜ ·Ó¿ ÔÈÔÙÈÎfi ¤ÙÔ˜ Ûˆ˙fiÌÂÓ˘ ˙ˆ‹˜ ‹Ù·Ó $217.000 Ì ÙËÓ PCI. [11] ∂Ô̤ӈ˜, Ë ·Ó¿Ï˘ÛË ÎfiÛÙÔ˘˜ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ¤‰ÂÈÍ fiÙÈ ÙÔ 99% ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È Û PCI ÍÂÂÚÓÔ‡Ó ÙÔ fiÚÈÔ ÙˆÓ $50.000 Ô˘ ıˆÚÂ›Ù·È ·Ô‰ÂÎÙfi. [11] Œ¯Ô˘Ì ‰ËÌÔÛȇÛÂÈ ÛÙÔȯ›· ÛÙÔ ·ÚÂÏıfiÓ Ô˘ ‰Â›¯ÓÔ˘Ó fiÙÈ ÙÔ ÎfiÛÙÔ˜ ·Ó¿ ÔÈÔÙÈÎfi ¤ÙÔ˜ Ûˆ˙fiÌÂÓ˘ ˙ˆ‹˜ Û ·ÛıÂÓ›˜ Ì ™™¡ ‹Ù·Ó $8.350 Ì ‚¤ÏÙÈÛÙË Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹. [12] √È ‰È·ÊÔÚ¤˜ Â›Ó·È ÙÂÚ¿ÛÙȘ.

Ê›· ÙˆÓ ·ÛıÂÓÒÓ Ì ·Û˘و̷ÙÈ΋ ™™¡. ∞˘Ùfi ı· ÂÍÔÈÎÔÓÔÌ‹ÛÂÈ ÛËÌ·ÓÙÈÎÔ‡˜ fiÚÔ˘˜ (·ÓıÚÒÈÓÔ˘˜ Î·È ¯ÚËÌ·ÙÈÎÔ‡˜) ÁÈ· Ó· ÂÂÓ‰˘ıÔ‡Ó ÛÙ· Ì·ÎÚÔÚfiıÂÛÌ· ÔʤÏË ·fi ÙËÓ È·ÙÚÈ΋ ÂÚ›ı·Ï„Ë Ì ʷÚ̷΢ÙÈ΋ ·ÁˆÁ‹, fiˆ˜ Ë ÂÊ·ÚÌÔÁ‹ ÙˆÓ Î·Ù¢ı˘ÓÙ‹ÚÈˆÓ Ô‰ËÁÈÒÓ ÛÙË ÎÏÈÓÈ΋ Ú¿ÍË Î·È Ë ·Ó¿Ù˘ÍË Ó¤ˆÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚˆÓ Ê·ÚÌ¿ÎˆÓ ÁÈ· ÙË ‰Â˘ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë Û ·ÛıÂÓ›˜ Ì ™™¡.

∂¿Ó Ô ÛÙfi¯Ô˜ Â›Ó·È Ó· ·Ó·ÎÔ˘ÊÈÛÙÔ‡Ó Ù· Û˘ÌÙÒÌ·Ù· ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ™™¡ (Â›ÌÔÓË ÛÙËı¿Á¯Ë), ·Ú¿ Ó· ·ÔÙÚ·Ô‡Ó Ù· ÌÂÏÏÔÓÙÈο ηډȷÁÁÂȷο Û˘Ì‚¿Ì·Ù·, Ë PCI Ê·›ÓÂÙ·È Ó· ·ÔÙÂÏ› ÌÈ· ·Ô‰ÂÎÙ‹ ıÂÚ·¢ÙÈ΋ ̤ıÔ‰Ô. ¶Èı·ÓÒ˜ ‹ÚıÂ Ô Î·ÈÚfi˜ Ó· ·ÓÙÈÌÂÙˆ›ÛÔ˘Ì Ì ʷÚ̷΢ÙÈ΋ ·ÁˆÁ‹ ÙË Û˘ÓÙÚÈÙÈ΋ ÏÂÈÔ„Ë-

μÈ‚ÏÈÔÁÚ·Ê›· 1.

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No authors listed. Coronary angioplasty versus medical therapy for angina: the second Randomised Intervention Treatment of Angina (RITA-2) trial. RITA-2 trial participants. Lancet 1997; 350: 461-8.

Henderson RA, Pocock SJ, Clayton TC, Knight R, Fox KA, Julian DG, et al.

Second Randomized Intervention Treatment of Angina (RITA-2) Trial Participants. Seven-year outcome in the RITA-2 trial: coronary angioplasty versus medical therapy. J Am Coll Cardiol 2003; 42: 1161-70.

Boden WE, O'rourke RA, Teo KK, et al.

Optimal Medical Therapy with or without PCI for Stable Coronary Disease. N Engl J Med. 2007 Mar 26; [Epub ahead of print] Hochman JS, Steg PG. Does preventive PCI work? N Engl J Med. 2007 Mar 26; [Epub ahead of print]

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Pitt B, Waters D, Brown WV, et al. for the Atorvastatin Versus Revascularization Treatment Investigators. N Engl J Med 1999;341:70-6 Waters D. Is a mechanical or a metabolic approach superior in the treatment of coronary disease? Results of the Atorvastatin Versus Revascularization (AVERT) Trial. Eur Heart J 2000; 21:1029-31 Camenzind E, Steg PG, Wijns W. Stent thrombosis late after implantation of first-generation drug-eluting stents. A cause for concern.

Circulation 2007;115:1440-55

8. Kastrati A, Mehilli J, Pache J, et al.

Analysis of 14 trials comparing sirolimus-eluting stents with bare-metal stents. N Engl J Med 2007;356:1030-9 9.

sirolimus-eluting stents with bare-metal stents. N Engl J Med 2007;356:989-97 10. Mauri L, Hsieh W, Massaro JM, et al.

Stent thrombosis in randomized clinical trials of drug-eluting stents. N Engl J Med 2007; 356:1020-9 11. Weintraub WS. Quality-of-life and economic outcomes analyses of the COURAGE trial.

ACC Scientific Sessions, New Orle-ans, 2007.

12. Athyros VG, Papageorgiou AA, Mercouris BR, et al. Treatment with atorvastatin to the National Cholesterol Educational Program goals versus usual care in secondary Coronary Heart Disease prevention. The GREek Atorvastatin and Coronary-heart-disease Evaluation (GREACE) Study. Curr Med Res Opin 2002;18:220-8

Spaulding C, Daemen J, Boersma E, et al. A pooled analysis of data comparing

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™ÂÏ›‰·18

π√À¡π√™ 2007

∏ ∫ÏÈÓÈ΋ ™ËÌ·Û›· Ù˘ ÃÔÚ‹ÁËÛ˘ ™Ù·ÙÈÓÒÓ ¶ÚÈÓ ·fi ∂ÂÌ‚·ÙÈ΋ ∂·Ó·ÈÌ¿ÙˆÛË ÙÔ˘ ª˘Ôηډ›Ô˘. μ. ’∞ı˘ÚÔ˜, ∞. ∫·Î·Ê‹Î·, ∂. ¶·ÓÎÔ˘Ú¤ÏÈ·˜, ™. ™·‚‚·ÙÈ·Ófi˜, ∞. ¶ÈÚ·ÛÔÔ‡ÏÔ˘, Ã. ∫Ô˘Ì·Ú¿˜, ∞. ™Î·¤Ú‰·˜, ∫. Δ˙ÈfiÌ·ÏÔ˜, ∞. ∫·Ú·ÁÈ¿ÓÓ˘. μ’ ¶ÚÔ. ¶·ıÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ∞¶£, πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌ›Ô, £ÂÛÛ·ÏÔÓ›ÎË. ΔÔ ÛÙ·Ù›Ó˜ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÂÎÙÂÓÒ˜ ÛÙË ÛÙ·ıÂÚ‹ ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ (™™¡) Î·È ˘¿Ú¯ÂÈ ‹‰Ë ·˘Í·ÓfiÌÂÓË ¯Ú‹ÛË ˘„ËÏÒÓ ‰fiÛÂˆÓ ÛÙ·ÙÈÓÒÓ (΢ڛˆ˜ ·ÙÔÚ‚·ÛÙ·Ù›Ó˘) ÛÙ· Ôͤ· ÛÙÂÊ·ÓÈ·›· Û‡Ó‰ÚÔÌ· (√™™), Ë ÔÔ›· ‚·Û›˙ÂÙ·È ÛÙ· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ PROVE IT-TIMI 22 (Pravastatin or Atorvastatin Evaluation and Infection TherapyThrombolysis in Myocardial Infarction 22). [1] À¿Ú¯Ô˘Ó Â›Û˘ ÛÙÔȯ›· Ô˘ ‰Â›¯ÓÔ˘Ó fiÙÈ Ë ¯ÔÚ‹ÁËÛË ÌÈ·˜ ÛÙ·Ù›Ó˘ ÌÂÙ¿ ·fi ·ÁÁÂÈÔÏ·ÛÙÈ΋ ÛÙÂÊ·ÓÈ·›ˆÓ (PCI) [2] ‹ ÌÂÙ¿ ·fi ·ÔÚÙÔÛÙÂÊ·ÓÈ·›· ·Ú¿Î·Ì„Ë (CABG)[3] ÂÏ·ÙÙÒÓÂÈ ÛËÌ·ÓÙÈο Ù· ηډȷÁÁÂȷο Û˘Ì‚¿Ì·Ù· Î·È ÙË ıÓËÙfiÙËÙ·. ¶ÚfiÛÊ·Ù· Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation), [4] ¤‰ÂÈÍ·Ó fiÙÈ Û ·ÛıÂÓ›˜ Ì ™™¡ Ë PCI Ì·˙› Ì ‚¤ÏÙÈÛÙË Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ ‰ÂÓ Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ÛÙË ÚfiÏË„Ë Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ ·fi ÙË ‚¤ÏÙÈÛÙË Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ ÌfiÓË Ù˘. [4] ∂ÓÙÔ‡ÙÔȘ, ·ÎfiÌ· ÎÈ ·Ó Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘

18

COURAGE ÂÊ·ÚÌÔÛÙÔ‡Ó ÂÍ ÔÏÔÎÏ‹ÚÔ˘ ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË, ¤Ó·˜ ÛËÌ·ÓÙÈÎfi˜ ·ÚÈıÌfi˜ ·ÛıÂÓÒÓ Ì √™™ ‹ Ì Â›ÌÔÓË ÛÙËı¿Á¯Ë ÛÙË ™™¡ ı· Ú¤ÂÈ Ó· ˘Ô‚ÏËı› Û PCI ‹ CABG. [4] À¿Ú¯Ô˘Ó οÔÈ· ÛÙÔȯ›· ÁÈ· ÙÔ fiÊÂÏÔ˜ Ù˘ ıÂÚ·›·˜ Ì ÛÙ·Ù›ÓË ÚÈÓ ·fi PCI ‹ CABG,[5,6] ·ÏÏ¿ ÚfiÛÊ·Ù· Ë ÌÂϤÙË ARMYDA ACS (Atorvastatin for Reduction of Myocardial Damage during Angioplasty in patients with Acute Coronary Syndromes) [7] ÚfiÛıÂÛ ÂÚÈÛÛfiÙÂÚ· ÛÙÔȯ›· fiÛÔÓ ·ÊÔÚ¿ ÙÔ ˙‹ÙËÌ· ·˘Ùfi.

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

Ó›˜ Ô˘ ÂÏ¿Ì‚·Ó·Ó ÚÔÂÁ¯ÂÈÚËÙÈ΋ ıÂÚ·›· Ì ÛÙ·Ù›ÓË (n=943) Î·È ÂΛÓÔ˘˜ Ô˘ ‰ÂÓ ÂÏ¿Ì‚·Ó·Ó (n=720). [9] ∏ ÔÏ˘·Ú·ÁÔÓÙÈ΋ ·Ó¿Ï˘ÛË ¤‰ÂÈÍ fiÙÈ Ë ÚÔÂÁ¯ÂÈÚÈÙÈ΋ ıÂÚ·›· Ì ÛÙ·Ù›ÓË Û˘Ó‰¤ıËΠ·ÓÂÍ¿ÚÙËÙ· Ì ÌÈ· ÛËÌ·ÓÙÈ΋ Ì›ˆÛË Ù˘ ÔÏÈ΋˜ ıÓËÙfiÙËÙ·˜ Î·È ÙÔ˘ Û‡ÓıÂÙÔ˘ ÙÂÏÈÎÔ‡ ÛËÌ›Ԣ (ıÓËÙfiÙËÙ·˜ Û˘Ó ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘) ÛÙȘ 30 Ë̤Ú˜ (3,75% ¤Ó·ÓÙÈ 1,80% Î·È 7,1% ¤Ó·ÓÙÈ 4,6%, ·ÓÙ›ÛÙÔȯ·, p<0.05 Î·È ÁÈ· ÙȘ ‰‡Ô). [9] ∂›Û˘, Ë ÚÔÂÁ¯ÂÈÚËÙÈ΋ ıÂÚ·›· Ì ÛÙ·Ù›ÓË Û ·ÛıÂÓ›˜ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û CABG Û˘Û¯ÂÙ›ÛÙËΠ̠¯·ÌËÏfi ÔÛÔÛÙfi ıÓËÙfiÙËÙ·˜ ÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ ÌÂÙ¿ ÙËÓ ÂÁ¯Â›ÚËÛË ¤Ó·ÓÙÈ ÙˆÓ ÌË ıÂÚ·¢fiÌÂÓˆÓ ÚÔÂÁ¯ÂÈÚËÙÈο Ì ÛÙ·Ù›ÓË ·ÛıÂÓÒÓ [10] Δ¤ÏÔ˜, Ù· ›‰È· ·ÔÙÂϤÛÌ·Ù· ¤‰ÂÈÍ ÌÈ· ¿ÏÏË ·Ó·‰ÚÔÌÈ΋ ÌÂϤÙË Ì ·ÛıÂÓ›˜ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È Û ÚÔÂÁ¯ÂÈÚËÙÈ΋ ıÂÚ·›· Ì ÛÙ·Ù›ÓË, Ë ÔÔ›· Û˘Ó‰¤ıËΠ̠ÏÈÁfiÙÂÚ˜ ÂÚÈÂÁ¯ÂÈÚËÙÈΤ˜ ηډȷΤ˜ Î·È ÛËÌ·ÓÙÈΤ˜ ·ÁÁÂȷΤ˜ ÂÈÏÔΤ˜ (-64%, p=0.035) ÌÂÙ¿ ÙË CABG, Ì ÌÈÎÚfiÙÂÚÔ ¯ÚfiÓÔ ·Ú·ÌÔÓ‹˜ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô (p=0.003) Î·È Ì ‚ÂÏÙȈ̤ÓË Ì·ÎÚÔ¯ÚfiÓÈ· (5,5 ¤ÙË) ÂÈ‚›ˆÛË (p<0.004) Û ۇÁÎÚÈÛË Ì ÂΛÓÔ˘˜ Ô˘ ‰ÂÓ ‹Ú·Ó ÚÔÂÁ¯ÂÈÚËÙÈο ÛÙ·Ù›ÓË [11]. ∞˘Ù¿ Ù· ÛÙÔȯ›· ‰ÂÓ ·Ê‹ÓÔ˘Ó Î·Ì›· ·ÌÊÈ‚ÔÏ›· fiÙÈ ˘¿Ú¯ÂÈ Ô˘ÛÈ·ÛÙÈÎfi fiÊÂÏÔ˜ ÛÙË ¯ÔÚ‹ÁËÛË ÛÙ·Ù›Ó˘ ÚÔÂÁ¯ÂÈÚËÙÈο Û ·ÛıÂÓ›˜ Ô˘ ı· ˘Ô‚ÏËıÔ‡Ó Û CABG fiÛÔÓ ·ÊÔÚ¿ ÙË Ì›ˆÛË Ù˘ ‚Ú·¯Â›·˜, ÌÂÛÔÚfiıÂÛÌ˘ Î·È Ì·ÎÚÔÚfiıÂÛÌ˘ ηډȷÁÁÂȷ΋˜ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÙfiÙËÙ·˜ Î·È ÛÙËÓ Ô˘ÛÈ·ÛÙÈ΋ ÂÍÔÈÎÔÓfiÌËÛË fiÚˆÓ ÁÈ· ÙËÓ ˘ÁÂÈÔÓÔÌÈ΋ ÂÚ›ı·Ï„Ë.

ATHIROSK 14

03-07-07

12:06

™ÂÏ›‰·19

£∂ƒ∞¶∂π∞ - º∞ƒª∞∫∞ 2. £ÂÚ·›· Ì ÛÙ·Ù›Ó˜ ÚÈÓ ·fi PCI. ªÈ· ÌÂÁ¿ÏË ÌÂϤÙË ÂÓfi˜ ÙÚÈÙÔ‚¿ıÌÈÔ˘ ȉڇ̷ÙÔ˜ ‰ÈÂÚ‡ÓËÛ ηٿ fiÛÔÓ Ë ˘ÂÚÏÈȉ·ÈÌ›·, Ë ¯Ú‹ÛË ÛÙ·Ù›Ó˘ Û ·ÛıÂÓ›˜ Ì ˘ÂÚÏÈȉ·ÈÌ›· ‹ Ë ÓÔÚÌÔÏÈȉ·ÈÌ›· Û˘Ó‰¤ÔÓÙ·È Ì ÙËÓ ¤Î‚·ÛË ·ÛıÂÓÒÓ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È Û PCI. [12] ∏ ÂÓ‰ÔÓÔÛÔÎÔÌÂȷΤ˜ ÂÈÏÔΤ˜ Î·È Ë Ì·ÎÚÔÚfiıÂÛÌË ¤Î‚·ÛË ÙˆÓ ·ÛıÂÓÒÓ Ì ˘ÂÚÏÈȉ·ÈÌ›· (Â›Â‰Ô ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ > 240 mg/dl) ıÂÚ·¢fiÌÂÓË Ì ÛÙ·Ù›Ó˜ (n=2.052) Î·È Ì ˘ÂÚÏÈȉ·ÈÌ›· ÌË ıÂÚ·¢fiÌÂÓË Ì ÛÙ·Ù›Ó˜ (n=1.650) Û˘ÁÎÚ›ıËÎ·Ó Ì ·˘Ù¤˜ 726 ·ÛıÂÓÒÓ ÌÂ Ê˘ÛÈÔÏÔÁÈο Â›‰· ¯ÔÏËÛÙÂÚfiÏ˘. Δ· ·ÔÙÂϤÛÌ·Ù· ¤‰ÂÈÍ·Ó fiÙÈ Ë ˘ÂÚÏÈȉ·ÈÌ›· ·˘Ù‹ ηı' ·˘Ù‹ ‰ÂÓ Û˘Ó‰¤ÂÙ·È Ì ÙȘ ÂÓ‰ÔÓÔÛÔÎÔÌÂȷΤ˜ ÂÈÏÔΤ˜ ÌÂÙ¿ ·fi PCI. ΔÔ fiÊÂÏÔ˜ ÂÚÈÔÚ›ÛÙËΠÌfiÓÔ ÛÙÔ˘˜ ıÂÚ·¢fiÌÂÓÔ˘˜ Ì ÛÙ·Ù›Ó˜ ·ÛıÂÓ›˜. À‹ÚÍ ÌÈ· ÌÈÎÚfiÙÂÚË ÂÓ‰ÔÓÔÛÔÎÔÌÂȷ΋ ıÓËÙfiÙËÙ· (0% ÂÓ·ÓÙ›ÔÓ 2% ÛÙȘ ¿ÏϘ 2 ÔÌ¿‰Â˜, p<0.001), ÌÈ· ¯·ÌËÏfiÙÂÚË ·‡ÍËÛË Ù˘ CK-ªμ (14% ÂÓ·ÓÙ›ÔÓ 27% Î·È 28% ÛÙȘ ¿ÏϘ ÔÌ¿‰Â˜, p<0.001) Î·È ÏÈÁfiÙÂÚ˜ ÂÈÏÔΤ˜ Ù˘ PCI (15% ÂÓ·ÓÙ›ÔÓ 30% ÙˆÓ 2 ¿ÏÏˆÓ ÔÌ¿‰ˆÓ, p<0.001). [12] ªÂÙ¿ ‰ÈÂÚ‡ÓËÛË Ù˘ Èı·ÓfiÙËÙ·˜ Ï‹„˘ ÛÙ·Ù›Ó˘ Ô˘ ‚·Û›ÛÙËΠÛÙ· ÎÏÈÓÈο Î·È ·ÁÁÂÈÔÁÚ·ÊÈο ¯·Ú·ÎÙËÚÈÛÙÈο, ÔÈ ·ÛıÂÓ›˜ Ô˘ ¤·ÈÚÓ·Ó ÛÙ·Ù›Ó˜ ›¯·Ó ·ÎfiÌ· ÏÈÁfiÙÂÚ˜ ÂÓ‰ÔÓÔÛÔÎÔÌÂȷΤ˜ ÂÈÏÔΤ˜ Î·È ÌÂÁ·Ï‡ÙÂÚË ‰È·ÊÔÚ¿ ÛÙËÓ ÂÓ‰ÔÓÔÛÔÎÔÌÂȷ΋ ıÓËÙfiÙËÙ·. [12] Δ· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ ARMYDA (Atorvastatin for Reduction of Myocardial Damage During Angioplasty) [5] ¤‰ÂÈÍ·Ó fiÙÈ Û ·ÛıÂÓ›˜ Ì ™™¡ Ë ¯ÔÚ‹ÁËÛË 40 mg/ËÌ. ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ ÁÈ· 7 Ë̤Ú˜ ÚÈÓ ÙË PCI ÌÂÈÒÓÂÈ ÛËÌ·ÓÙÈο ÙÔ Ì˘ÔηډȷÎfi ÙÚ·˘Ì·ÙÈÛÌfi Ô˘ ÚÔηÏÂ›Ù·È ·fi ÙË PCI. ∏ CK-ªμ, Ë ÙÚÔÔÓ›ÓË π, Î·È Ë Ì˘ÔÛÊ·ÈÚ›ÓË ÛÙȘ 8 Î·È 24 ÒÚ˜ ÌÂÙ¿ ·fi ÙËÓ PCI ‹Ù·Ó Û Ôχ ¯·ÌËÏfiÙÂÚ· Â›‰· ·fi fiÙÈ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ‹Ú·Ó ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ. √ ΛӉ˘ÓÔ˜ ÁÈ· Ù· Û˘ÓÔÏÈο ηÚ-

‰È·ÁÁÂȷο Û˘Ì‚¿Ì·Ù· ÂÏ·ÙÙÒıËΠηٿ 81% Ì ÙËÓ ·ÙÔÚ‚·ÛÙ·Ù›ÓË, ÂÓÒ Ù· ÂÌÊÚ¿ÁÌ·Ù· ÙÔ˘ Ì˘Ôηډ›Ô˘ ‹Ù·Ó 5% ÛÙË ÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ¤·ÈÚÓ·Ó ·ÙÔÚ‚·ÛÙ·Ù›ÓË Î·È 18% ÛÙËÓ ÔÌ¿‰· ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ (p=0.025). [5] ∏ ÌÂϤÙË ARMYDA CAMS [6] ‰ÈÂÚ‡ÓËÛÂ Â¿Ó Ë ÚÔÛÙ·Û›· Ù˘ ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ ·fi ÙÔ Ì˘ÔηډȷÎfi ÙÚ·˘Ì·ÙÈÛÌfi ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ PCI Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÙË Ì›ˆÛË Ù˘ ÊÏÂÁÌÔÓÒ‰Ô˘˜ ·¿ÓÙËÛ˘ ÙÔ˘ ÂÓ‰ÔıËÏ›Ô˘. ™Â ÌÈ· ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓË ˘Ô·Ó¿Ï˘ÛË Ù˘ ÌÂϤÙ˘ ARMYDA, ÌÈ· ˘ÔÔÌ¿‰· 76 ·ÛıÂÓÒÓ ÂÍÂÙ¿ÛÙËΠÁÈ· ÙË Ì¤ÙÚËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÛÙÔ Ï¿ÛÌ· ÙÔ˘ vascular cell adhesion molecule-1 (VCAM-1), ÙÔ˘ intercellular cell adhesion molecule-1 (ICAM-1), Î·È Ù˘ E-selectin. ∞fi ·˘ÙÔ‡˜ ÔÈ 38 ·ÛıÂÓ›˜ ·Ó‹Î·Ó ÛÙËÓ ÔÌ¿‰· Ù˘ ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ (40 mg/ËÌ.) Î·È 38 ÛÙËÓ ÔÌ¿‰· ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘. Δ· ÌfiÚÈ· ÚÔÛÎfiÏÏËÛ˘ ·ÍÈÔÏÔÁ‹ıËÎ·Ó 7 Ë̤Ú˜ ÚÈÓ ·fi ÙËÓ Â¤Ì‚·ÛË, ·Ì¤Ûˆ˜ ÚÈÓ ·fi ÙËÓ PCI, Î·È 8 Î·È 24 ÒÚ˜ ÌÂÙ¿ ÙËÓ PCI. ¢È·ÈÛÙÒıËÎ·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚ· Â›‰· ÙˆÓ Ô˘ÛÈÒÓ ·˘ÙÒÓ ÛÙËÓ ÔÌ¿‰· Ù˘ ·ÙÔÚ‚·ÛÙ·Ù›Ó˘. ∏ PCI Ì ÙÔÔı¤ÙËÛË stent Ê·›ÓÂÙ·È fiÙÈ ÚÔηÏ› ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘ Ì˯·ÓÈÛÌÔ‡ ‹Í˘ Î·È ˘ÚÔ‰ÔÙ› ÊÏÂÁÌÔÓ‹ ÙÔ˘ ·ÁÁ›Ԣ. Δ· ÔʤÏË Ù˘ ¯Ô-

Ú‹ÁËÛ˘ ÛÙ·Ù›Ó˘ ı· ÌÔÚÔ‡Û ӷ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÙˆÓ Â˘ÓÔ˚ÎÒÓ Ù˘ ‰Ú¿ÛÂˆÓ ÛÙË ÚÔÛÎfiÏÏËÛË ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ, ÛÙË ıÚfiÌ‚ˆÛË, ÛÙË ÛÙ·ıÂÚfiÙËÙ· ÙˆÓ ·ıËڈ̷ÙÈÎÒÓ Ï·ÎÒÓ Î·È ÛÙË ÊÏÂÁÌÔÓ‹. Δ· ·ÓˆÙ¤Úˆ ÛÙÔȯ›· ‰Â›¯ÓÔ˘Ó fiÙÈ Ë Ì›ˆÛË Ù˘ ÂÓ‰ÔıËÏȷ΋˜ ÊÏÂÁÌÔÓÒ‰Ô˘˜ ·¿ÓÙËÛ˘ ÛÙËÓ PCI ÌÔÚ› Ó· ÂÍËÁ‹ÛÂÈ ÙËÓ ÚÔÛٷ٢ÙÈ΋ Â›‰Ú·ÛË ÙˆÓ ÛÙ·ÙÈÓÒÓ Ô˘ ¯ÔÚËÁÔ‡ÓÙ·È ÚÈÓ ÙË ‰ÈÂÓ¤ÚÁÂÈ¿ Ù˘. [6] ∞˘Ù¿ Ù· ÛÙÔȯ›· ¤‰ÂÈÍ·Ó fiÙÈ ÔÈ ÏÂÈÔÙÚÔÈΤ˜ ‰Ú¿ÛÂȘ ÙˆÓ ÛÙ·ÙÈÓÒÓ Â›Ó·È ·˘Ù¤˜ Ô˘ ÚÔηÏÔ‡Ó Ù· ¢ÂÚÁÂÙÈο ·˘Ù¿ ·ÔÙÂϤÛÌ·Ù·, fiˆ˜ ˘Ô‰ËÏÒÓÂÈ Î·È Ô Û‡ÓÙÔÌÔ˜ ¯ÚfiÓÔ˜ ̤۷ ÛÙÔÓ ÔÔ›Ô ÂΉËÏÒıËηÓ. Œ¯ÂÈ ·Ô‰Âȯı› fiÙÈ Ë ıÂÚ·›· Ì ·ÙÔÚ‚·ÛÙ·Ù›ÓË ÚÈÓ ÙËÓ PCI ÌÔÚ› Ó· ÌÂÈÒÛÂÈ ÙÔ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘ Î·È ¿ÏÏ· Û˘Ì‚¿Ì·Ù· Û ·ÛıÂÓ›˜ Ì ™™¡ ηٿ ‹ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË ‰ÈÂÓ¤ÚÁÂÈ· ÂÎÏÂÎÙÈ΋˜ PCI Î·È ÙÔÔı¤ÙËÛ˘ stent. ∂ÓÙÔ‡ÙÔȘ, ·˘Ù‹ Ë ıÂÚ·›· ‰ÂÓ Â›¯Â ‰ÈÂÚ¢ÓËı› Û ·ÛıÂÓ›˜ Ì √™™. ™ÙË ÚfiÛÊ·Ù· ‰ËÌÔÛÈÂ˘Ì¤ÓË ÌÂϤÙË ARMYDA ACS (Atorvastatin for Reduction of Myocardial Damage during Angioplasty in patients with Acute Coronary Syndromes) [7] Û˘ÓÔÏÈο 171 ·ÛıÂÓ›˜ Ì √™™ Ù˘¯·ÈÔÔÈ‹ıËÎ·Ó Û ıÂÚ·›· Ì ·ÙÔÚ‚·ÛÙ·Ù›ÓË (80 mg 12 ÒÚ˜ Î·È 40 mg 2

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ÒÚ˜ ÚÈÓ ·fi ÙË PCI [n=86]) ‹ Û ıÂÚ·›· Ì ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ (n=85). ™Â fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ ¯ÔÚËÁ‹ıËΠÌÈ· ‰fiÛË 600 mg ÎÏÔȉÔÁÚ¤Ï˘. ΔÔ Û˘Ó‰˘·Ṳ̂ÓÔ ÙÂÏÈÎfi ÛËÌÂ›Ô (ı¿Ó·ÙÔ˜, Ì˘ÔηډȷÎfi ¤ÌÊÚ·ÁÌ·, ‹ ÌË ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓË Â·Ó·ÈÌ¿ÙˆÛË) ÂÌÊ·Ó›ÛÙËΠ۠5% ÙˆÓ ·ÛıÂÓÒÓ ÛÙÔ ÛΤÏÔ˜ Ù˘ ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ Î·È Û 17% ÙˆÓ ·ÛıÂÓÒÓ ÛÙÔ ÛΤÏÔ˜ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ (p=0.01). ∞˘Ù‹ Ë ‰È·ÊÔÚ¿ ÔÊÂÈÏfiÙ·Ó Î˘Ú›ˆ˜ ÛÙË Ì›ˆÛË Ù˘ Â›ÙˆÛ˘ ÙÔ˘ ÂÌÊÚ¿ÁÌ·ÙÔ˜ Ì˘Ôηډ›Ô˘ (5% ¤Ó·ÓÙÈ 15%, p=0.04). ™˘ÓÔÏÈο, Ë ÂÏ¿ÙÙˆÛË ÙˆÓ Û˘Ì‚·Ì¿ÙˆÓ

ÛÙËÓ ÔÌ¿‰· Ù˘ ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ ‹Ù·Ó 88%. ∂ÈϤÔÓ, ÌÂÙ¿ ·fi PCI, ÙÔ ÔÛÔÛÙfi ÙˆÓ ·ÛıÂÓÒÓ Ì ·˘ÍË̤ÓË CK-ªμ ‹ ÙÚÔÔÓ›ÓË π ÛÙËÓ ÔÌ¿‰· Ù˘ ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ ‹Ù·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚÔ ·fi ·˘Ùfi Ù˘ ÔÌ¿‰·˜ ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘. [7] ΔÔ ›‰ÈÔ Û˘Ó¤‚Ë Î·È Ì ٷ Â›‰· Ù˘ CRP. [7] ∞˘Ù¿ Ù· ÛÙÔȯ›· ÌÔÚÔ‡Ó Ó· ˘ÔÛÙËÚ›ÍÔ˘Ó ÙË ¯Ú‹ÛË ˘„ËÏ‹˜ ‰fiÛ˘ ÛÙ·Ù›Ó˘ ÚÈÓ ·fi ÙËÓ PCI ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì √™™.

ÛË ÛÙ·Ù›Ó˘ ÚÈÓ ·fi CABG ‹ PCI, ÙËÓ ÔÔ›· Ô‡Ùˆ˜ ‹ ¿Ïψ˜ ı· ¿ÚÔ˘Ó ÌÂÙ¿ ÙËÓ ÂÂÌ‚·ÙÈ΋ Â·Ó·ÈÌ¿ÙˆÛË. ∞˘Ù‹ Ë Ú·ÎÙÈ΋ Â¿Ó ÁÂÓÈ΢ı› ı· ÛÒÛÂÈ ·ÓıÚÒÈÓ˜ ˙ˆ¤˜, ı· ‚ÂÏÙÈÒÛÂÈ ÙË ÔÈfiÙËÙ· ˙ˆ‹˜ ÙˆÓ ·ÛıÂÓÒÓ ÌÂÙ¿ ÙËÓ Â·Ó·ÈÌ¿ÙˆÛË Î·È ı· ÂÍÔÈÎÔÓÔÌ‹ÛÂÈ ÛËÌ·ÓÙÈÎÔ‡˜ fiÚÔ˘˜ ÁÈ· ÙËÓ ˘Á›· Ô˘ Ô‡Ùˆ˜ ‹ ¿Ïψ˜ Â›Ó·È ‰˘Û‡ÚÂÙÔÈ.

™˘ÌÂÚ·ÛÌ·ÙÈο, ·fi Ù· ·Ú·¿Óˆ ‰È·ÈÛÙÒÓÂÙ·È Ôχ ÌÂÁ¿ÏÔ fiÊÂÏÔ˜ ·fi ÙË ¯ÔÚ‹ÁË-

μÈ‚ÏÈÔÁÚ·Ê›· 1.

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statin for reduction of myocardial damage during coronary intervention: results from the ARMYDA (Atorvastatin for Reduction of Myocardial Damage During Angioplasty) study. Circulation 2004;110:674–8.

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Kasai T, Miyauchi K, Kurata T, et al.

Long-term (11-year) statin therapy following percutaneous coronary intervention improves clinical outcome and is not associated with increased malignancy. Int J Cardiol 2007;114:210-217.

Knatterud GL, Rosenberg Y, Campeau L, et al. Long-term effects on clinical outcomes of aggressive lowering of lowdensity lipoprotein cholesterol levels and low-dose anticoagulation in the post coronary artery bypass graft trial. Post CABG Investigators. Circulation 2000; 102:157-65.

Boden WE, O'rourke RA, Teo KK, et al.

Optimal Medical Therapy with or without PCI for Stable Coronary Disease. N Engl J Med. 2007 Mar 26; [Epub ahead of print] Pasceri V, Patti G, Nusca A, Pristipino C, Richichi G, Di Sciascio G, ARMYDA Investigators. Randomized trial of atorva-

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Patti G, Chello M, Pasceri V, et al. Protection from procedural myocardial injury by atorvastatin is associated with lower levels of adhesion molecules after percutaneous coronary intervention: results from the ARMYDACAMs (Atorvastatin for Reduction of Myocardial Damage During Angioplasty-Cell Adhesion Molecules) substudy. J Am Coll Cardiol 2006;48: 1560-6.

Patti G, Pasceri V, Colonna G, et al. Atorvastatin pretreatment improves outcomes in patients with acute coronary syndromes undergoing early percutaneous coronary intervention. Results of the ARMYDA-ACS Randomized Trial. J Am Coll Cardiol 2007; 49:1272-1278.

Collard CD, Body SC, Shernan SK, Wang S, Mangano DT; Multicenter Study of Perioperative Ischemia (MCSPI) Research Group, Inc; Ischemia Research and Education Foundation (IREF) Investigators. Preoperative statin therapy is associated with reduced cardiac

mortality after coronary artery bypass graft surgery. J Thorac Cardiovasc Surg 2006;132:392-400.

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Pan W, Pintar T, Anton J, Lee VV, Vaughn WK, Collard CD. Statins are associated with a reduced incidence of perioperative mortality after coronary artery bypass graft surgery. Circulation 2004;110 (11 Suppl 1):II45-9.

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Effect of preoperative statin therapy and cardiac outcomes after coronary artery bypass grafting. Am J Cardiol 2000;86: 1128-1130.

11. Ward RP, Leeper NJ, Kirkpatrick JN, et al. The effect of preoperative statin therapy on cardiovascular outcomes in patients undergoing infrainguinal vascular surgery. Int J Cardiol 2005;104: 264-268.

12. Singh M, Lennon RJ, Roger VL, et al. Relation of preprocedural statin therapy to inhospital procedural complications following percutaneous coronary interventions in patients with hyperlipidemia.

Am J Cardiol 2006;98: 325-330.

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£∂ƒ∞¶∂π∞ - º∞ƒª∞∫∞

∂ÈÛÓÂfiÌÂÓË πÓÛÔ˘Ï›ÓË: Δ· ¢Â‰Ô̤ӷ Î·È ÔÈ ¶ÚÔ‚ÏËÌ·ÙÈÛÌÔ› ¢Ú. ∞Ó‰Ú¤·˜ ªÂÏȉÒÓ˘ À‡ı˘ÓÔ˜ ¢È·‚ËÙÔÏÔÁÈÎÔ‡ ∫¤ÓÙÚÔ˘, °.¡. ¶ÂÈÚ·È¿ ∏ Â›Ù¢ÍË Â˘ÁÏ˘Î·ÈÌ›·˜ Û ¿ÙÔÌ· Ì ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË, ·ÔÙÂÏ› ÚˆÙ·Ú¯ÈÎfi ıÂÚ·¢ÙÈÎfi ÛÙfi¯Ô, Ì ÛÎÔfi ÙËÓ Ì›ˆÛË Ù˘ Â›ÙˆÛ˘ ÙˆÓ ÌÈÎÚÔ·ÁÁÂÈ·ÎÒÓ Î·È Ì·ÎÚÔ·ÁÁÂÈ·ÎÒÓ ÂÈÏÔÎÒÓ ·ÏÏ¿ Î·È Ù˘ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÛÈÌfiÙËÙ·˜. ∏ ·ÓÂ·Ú΋˜ fï˜ ÁÏ˘Î·ÈÌÈ΋ Ú‡ıÌÈÛË ·ÔÙÂÏ›, ‰˘ÛÙ˘¯Ò˜, ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÛÙÔÈ¯Â›Ô ÙˆÓ ÚÔÛ·ıÂÈÒÓ Ô˘ Á›ÓÔÓÙ·È ·ÁÎfiÛÌÈ·. ¢Â‰Ô̤ӷ ‰È·ÊfiÚˆÓ ÌÂÏÂÙÒÓ ‰Â›¯ÓÔ˘Ó fiÙÈ ÌfiÓÔ ÙÔ 31% ÙˆÓ ‰È·‚ËÙÈÎÒÓ ÛÙȘ ∏¶∞ Î·È ÙÔ 39% ÛÙËÓ ∂˘ÚÒË ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÈηÓÔÔÈËÙÈ΋ ÁÏ˘Î·ÈÌÈ΋ Ú‡ıÌÈÛË (∏bA1C <7%). ™’ ·˘ÙfiÓ ÙÔÓ ·ÔÁÔËÙ¢ÙÈÎfi Û¯ÂÙÈο ·ÔÏÔÁÈÛÌfi ›Ûˆ˜ Û˘Ì‚¿ÏÏÂÈ Î·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ, fiˆ˜ ‰Â›¯ÓÔ˘Ó ÌÂϤÙ˜ ÛÙȘ ∏¶∞, Ë ¯Ú‹ÛË Ù˘ ÈÓÛÔ˘Ï›Ó˘ (Ô˘ Â›Ó·È ÔˆÛ‰‹ÔÙ ÙÔ Î·Ï‡ÙÂÚÔ ıÂÚ·¢ÙÈÎfi fiÏÔ Ì·˜ ÁÈ· ÙËÓ Ú‡ıÌÈÛË ÙÔ˘ ‰È·‚‹ÙË) ‰ÂÓ ¿ÏÏ·ÍÂ, ‰ÂÓ ·˘Í‹ıËΠÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÙ›· (ÙÔ 27% ÙˆÓ ‰È·‚ËÙÈÎÒÓ ÙÔ 1992 ¤Î·Ó ÈÓÛÔ˘Ï›ÓË ‹ ÂÏ¿Ì‚·Ó ÈÓÛÔ˘Ï›ÓË Î·È ‰ÈÛΛ·, ÙÔ ›‰ÈÔ ÔÛÔÛÙfi ‰È·ÈÛÙÒıËÎÂ Î·È ÙÔ 2000- 2002). À¿Ú¯ÂÈ Î·ı˘ÛÙ¤ÚËÛË ‹ Î·È ·ÓÙ›ÛÙ·ÛË ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ ÛÙËÓ ¤Ó·ÚÍË ÈÓÛÔ˘ÏÈÓÔıÂÚ·›·˜ ÛÙÔ˘˜ ‰È·‚ËÙÈÎÔ‡˜ Ù‡Ô˘ ππ. ∏ ÂÚ¢ÓËÙÈ΋ ÚÔÛ¿ıÂÈ· ÂÈÎÂÓÙÚÒıËΠ۠ÂÓ·ÏÏ·ÎÙÈΤ˜ ÌÔÚʤ˜ ¯ÔÚ‹ÁËÛ˘ ÈÓÛÔ˘Ï›Ó˘, ‰È· Ù˘ ÚÈÓÈ΋˜, ÛÙÔÌ·ÙÈ΋˜ Î·È Ó¢ÌÔÓÈ΋˜ Ô‰Ô‡, ÒÛÙÂ Ë ıÂÚ·¢ÙÈ΋ ·ÁˆÁ‹ Ó· Á›ÓÂÈ ϤÔÓ ·Ô‰ÂÎÙ‹ ·fi ÙÔ˘˜ ·ÛıÂÓ›˜. Δ· ‰Â‰Ô̤ӷ ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ ÂÙÒÓ ÚÔÎÚ›ÓÔ˘Ó Û·Ó È‰È·›ÙÂÚ· ˆÊ¤ÏÈÌË Î·È ·ÛÊ·Ï‹ ÙËÓ ˘fi ÚÔ¸Ôı¤ÛÂȘ ¯ÔÚ‹ÁËÛË ÈÓÛÔ˘Ï›Ó˘ ‰È· Ù˘ Ó¢ÌÔÓÈ΋˜ Ô‰Ô‡, ÙËÓ ¯ÔÚ‹ÁËÛË ‰ËÏ·‰‹ ÂÈÛÓÂfiÌÂÓ˘ ÈÓÛÔ˘Ï›Ó˘. ∏ ¯ÔÚ‹ÁËÛË ÈÓÛÔ˘Ï›Ó˘ ‰È· Ù˘ Ó¢ÌÔÓÈ΋˜ Ô‰Ô‡ ·ÍÈÔÔÈ› ÙÔ ÏÂÔÓ¤ÎÙËÌ· Ù˘ ÂÍ·ÈÚÂÙÈο ÌÂ-

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

¯ÓÈ΋ ÂÈÛÓÔ‹˜ ÙÔ˘˜, ·ÎfiÌË Î·È ·fi ‰fiÛË Û ‰fiÛË ÛÙÔ ›‰ÈÔ ¿ÙÔÌÔ. ™˘ÛÙ‹Ì·Ù· Î·È Û˘Û΢¤˜ ¯ÔÚ‹ÁËÛ˘ ÂÈÛÓÂfiÌÂÓ˘ ÈÓÛÔ˘Ï›Ó˘ ÂÚ¢ÓÒÓÙ·È Î·È ‰ÔÎÈÌ¿˙ÔÓÙ·È ·fi ‰È¿ÊÔÚ˜ Ê·Ú̷΢ÙÈΤ˜ ÂÙ·ÈÚ›˜. (‚Ï. ¶›Ó·Î· 1). ∏ ÂÈÛÓ¢ÛÙÈ΋ Û˘Û΢‹ ÙÔ˘ Exubera (¡ectar Pulmonary Inhaler) Ë ÌfiÓË ÚÔ˜ ÙÔ ·ÚfiÓ ÂÁÎÚÈı›۷ ·fi ÙÔ FDA Î·È ÙÔ˘˜ ·ÓÙ›ÛÙÔÈ¯Ô˘˜ ∂˘Úˆ·˚ÎÔ‡˜ √ÚÁ·ÓÈÛÌÔ‡˜, ÂÚȤ¯ÂÈ ÙËÓ ÛÎfiÓË ÈÓÛÔ˘Ï›Ó˘ Û ·Ϥ˜ Û˘Û΢·Û›Â˜ ÙÔ˘ ÂÓfi˜ ‹ ÙˆÓ 3 mg (ÈÛÔ‰‡Ó·Ì˜ ·fi ÏÂ˘Ú¿˜ ‰Ú¿Û˘ Ì 3 ‹ 9 ÌÔÓ¿‰Â˜ ˘Ô‰fiÚÈ·˜ Ù·¯Â›·˜ ‰Ú¿Ûˆ˜ ÈÓÛÔ˘Ï›Ó˘ ·ÓÙ›ÛÙÔȯ·). √ ı¿Ï·ÌÔ˜ Ù˘ Û˘Û΢‹˜ ‰ËÌÈÔ˘ÚÁ› ·fi ÙËÓ ÛÎfiÓË Ô˘ ‰È·Ï‡ÂÙ·È ¤Ó· ‘Ó¤ÊÔ˜ „ÂηÛÌÔ‡’ Ô˘ ÂÈÛÓ¤ÂÙ·È ·fi ÙÔ ¿ÙÔÌÔ, ÙÔ ÔÔ›Ô Ï·Ì‚¿ÓÂÈ ‰È· Ù˘ ÂÈÛÓÔ‹˜ ÙËÓ ·Ó¿ÏÔÁ· ··ÈÙÔ‡ÌÂÓË ‰fiÛË ÈÓÛÔ˘Ï›Ó˘. ∏ ηٷÛ΢‹ Î·È Ë ÏÂÈÙÔ˘ÚÁ›· Ù˘ ÂÈÛÓ¢ÛÙÈ΋˜ Û˘Û΢‹˜ Â›Ó·È Ù¤ÙÔÈ· ÒÛÙ ӷ ÂÏ·¯ÈÛÙÔÔÈ› ÙË ÌÂÙ·‚ÏËÙfiÙËÙ· ÙÔ˘ ÂÈÛÓ¢ÛÙÈÎÔ‡ ·ÔÙÂϤÛÌ·ÙÔ˜ Î·È ÙÔ Ì¤ÁÂıÔ˜ ÙˆÓ ÂÈÛÓÂfiÌÂÓˆÓ ÌÔÚ›ˆÓ. ∏ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Î·È Ë ·ÛÊ¿ÏÂÈ· ÙÔ˘ Exubera ¤¯ÂÈ ÌÂÏÂÙËı› Û ÂÚÈÛÛfiÙÂÚ· ·fi 3500 ¿ÙÔÌ·, Û ·ÚÎÂÙÔ‡˜ ‰Â ÂÍ ·˘ÙÒÓ ÁÈ· ÂÚÈÛÛfiÙÂÚ· ·fi 7 ¯ÚfiÓÈ·. º·ÚÌ·ÎÔÎÈÓËÙÈ΋: ∏ ÂÈÛÓÂfiÌÂÓË ÈÓÛÔ˘Ï›ÓË Û˘ÁÎÚÈÓfiÌÂÓË Ì ÙËÓ ˘Ô‰fiÚÈ· ¯ÔÚ‹ÁËÛË ÎÚ˘ÛÙ·ÏÏÈ΋˜ ÈÓÛÔ˘Ï›Ó˘ ‹ ·ÎfiÌË Î·È Ì ÂÓ‰ÔÊϤ‚È· ¯ÔÚËÁÔ‡ÌÂÓË ÈÓÛÔ˘Ï›ÓË, ·ÚÔ˘ÛÈ¿˙ÂÈ fi¯È ÌfiÓÔÓ Ù·¯‡ÙÂÚË ¤Ó·ÚÍË ‰Ú¿Û˘ ·ÏÏ¿ Î·È Ù·¯‡ÙÂÚË Â›Ù¢ÍË Ì¤ÁÈÛÙ˘ Û˘ÁΤÓÙÚˆÛ˘ ÈÓÛÔ˘Ï›Ó˘ ÔÚÔ‡. ™˘ÁÎÚÈÓfiÌÂÓË Ì ˘Ô‰fiÚÈ· ¯ÔÚËÁÔ‡ÌÂÓÔ Ù·¯‡ ·Ó¿ÏÔÁÔ ÈÓÛÔ˘Ï›Ó˘ (Lispro) Ë ÂÈÛÓÂfiÌÂÓË ÈÓÛÔ˘Ï›ÓË ·ÚÔ˘ÛÈ¿˙ÂÈ Ù·¯‡ÙÂÚË ¤Ó·ÚÍË ‰Ú¿Û˘ (28 min vs. 40 min), ·ÏÏ¿

21

ATHIROSK 14

03-07-07

12:06

™ÂÏ›‰·22

π√À¡π√™ 2007

ÛËÌ·ÓÙÈο ‚Ú·‰‡ÙÂÚË Â›Ù¢ÍË Ù˘ ̤ÁÈÛÙ˘ ÌÂÙ·‚ÔÏÈ΋˜ ‰Ú¿Û˘ (∂ÈÎfiÓ· 1). ∏ ‰È¿ÚÎÂÈ· ‰Ú¿Û˘ Ù˘ Â›Ó·È Û˘ÁÎÚ›ÛÈÌË Ì ÂΛÓË Ù˘ ˘Ô‰ÔÚ›ˆ˜ ¯ÔÚËÁÔ‡ÌÂÓ˘ Ù·¯Â›·˜ ‰Ú¿Û˘ ÈÓÛÔ˘Ï›Ó˘ ηٿ Û˘Ó¤ÂÈ· ÌÔÚ› Ó· ¯ÔÚËÁËı› ˆ˜ ÚÔÁÂ˘Ì·ÙÈ΋ ÈÓÛÔ˘Ï›ÓË, Î·È Ó· ·ÓÙÈηٷÛÙ‹ÛÂÈ ÙËÓ ˘Ô‰fiÚÈ· ¯ÔÚËÁÔ‡ÌÂÓË ÎÚ˘ÛÙ·ÏÏÈ΋ Ù·¯Â›· ÈÓÛÔ˘Ï›ÓË ‹ ÙÔ Ù·¯‡ ·Ó¿ÏÔÁÔ ÈÓÛÔ˘Ï›Ó˘, ÂÂȉ‹ ¤¯ÂÈ ÁÚ‹ÁÔÚË ¤Ó·ÚÍË ‰Ú¿Û˘ Î·È ‰È¿ÚÎÂÈ· ‰Ú¿Û˘ ¿Óˆ ÙˆÓ 3 ˆÚÒÓ. ∏ Èı·ÓfiÙËÙ· ˘ÔÁÏ˘Î·ÈÌÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ ·fi ÙËÓ ¯ÔÚ‹ÁËÛË ÂÈÛÓÂfiÌÂÓ˘ ÈÓÛÔ˘Ï›Ó˘ Â›Ó·È ·ÚfiÌÔÈ· Ì ·˘Ù‹Ó Ô˘ ÚÔ·ÙÂÈ ·fi ÙËÓ ¯ÔÚ‹ÁËÛË ˘Ô‰fiÚÈ· Ù·¯Â›·˜ ‰Ú¿Û˘ ÈÓÛÔ˘Ï›Ó˘. ¢Ú·ÛÙÈÎfiÙËÙ·: ¶ÏÂÈ¿‰· ÌÂÏÂÙÒÓ ¤¯Ô˘Ó ·ԉ›ÍÂÈ ÙËÓ ‚Ú·¯˘ÚfiıÂÛÌË Î·È Ì·ÎÚÔÚfiıÂÛÌË ‰Ú·ÛÙÈÎfiÙËÙ· Ù˘ ÂÈÛÓÂfiÌÂÓ˘ ÈÓÛÔ˘Ï›Ó˘ Î·È ÛÙÔ˘˜ 2 Ù‡Ô˘˜ ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË. ™Â ·ÛıÂÓ›˜ Ì ‰È·‚‹ÙË Ù‡Ô˘ 2, ÌË ·ÓÙ·ÔÎÚÈÓfiÌÂÓÔ˘˜ Û ÎÏ·ÛÛÈ΋ ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ·ÓÙȉȷ‚ËÙÈ΋ ·ÁˆÁ‹, Ë ÂÈÛÓÂfiÌÂÓË ÈÓÛÔ˘Ï›ÓË ¯ÔÚËÁÔ‡ÌÂÓË ÛÂ Û˘Ó‰˘·ÛÌfi Ì ·ÓÙȉȷ‚ËÙÈο ‰ÈÛΛ·, ‚ÂÏÙ›ˆÛ ÛËÌ·ÓÙÈο ÙËÓ HbA 1C, Û ۯ¤ÛË Ì ÙËÓ ÔÌ¿‰· ·ÛıÂÓÒÓ Ô˘ ÂÏ¿Ì‚·Ó ÌfiÓÔÓ ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ·ÁˆÁ‹. ∂›Û˘ Û˘ÁÎÚ›ÓÔÓÙ·˜ ·ÛıÂÓ›˜ Ì ‰È·‚‹ÙË Ù‡Ô˘ 2 Ô˘ ÂÏ¿Ì‚·Ó·Ó ÂÈÛÓÂfiÌÂÓË ÈÓÛÔ˘Ï›ÓË Î·È Ultralente, Ì ·ÛıÂÓ›˜ Ô˘ ÂÏ¿Ì‚·Ó·Ó Û¯‹Ì·Ù· ÔÏÏ·ÏÒÓ ‰fiÛÂˆÓ Ì regular Î·È NPH, ‰ÂÓ ·Ú·ÙËÚ‹ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙȘ ÌÂÈÒÛÂȘ ÙˆÓ HBA1C ÛÙËÓ 12Ë Î·È ÙËÓ 24Ë Â‚‰ÔÌ¿‰· ıÂÚ·›·˜. ŸÌˆ˜ Ë ÔÌ¿‰· Ô˘ ÂÏ¿Ì‚·Ó ÂÈÛÓÂfiÌÂÓË ÈÓÛÔ˘Ï›ÓË ÂÌÊ¿ÓÈÛ Û ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi HBA 1C <7%. (47% vs 32%). ™Â ‰È·‚ËÙÈÎÔ‡˜ Ì ‰È·‚‹ÙË Ù‡Ô˘ 1, Ô˘ ÂÏ¿Ì‚·Ó·Ó Û˘Ó‰˘·ÛÌfi ÂÈÛÓÂfiÌÂÓ˘ ÈÓÛÔ˘Ï›Ó˘ Î·È Ultralente, ‹ Ì›ÁÌ· regular Î·È NPH ˘Ô‰ÔÚ›ˆ˜, ·Ú·ÙËÚ‹ıËÎ·Ó ·ÚfiÌÔȘ ÌÂÈÒÛÂȘ ÛÙËÓ HbA 1C. Δ¤ÏÔ˜ ·ÛıÂÓ›˜ Ì ‰È·‚‹ÙË Ù‡Ô˘ π, ËÏÈΛ·˜ 12-65 ÂÙÒÓ Ô˘

22

ÂÏ¿Ì‚·Ó·Ó NPH Ì ÂÈÛÓÂfiÌÂÓË ÈÓÛÔ˘Ï›ÓË ‹ regular ˘Ô‰ÔÚ›ˆ˜ Û ÂÓÙ·ÙÈÎÔÔÈË̤ÓÔ Û¯‹Ì· ·ÚÔ˘Û›·Û·Ó ·ÚfiÌÔȘ ÌÂÈÒÛÂȘ Ù˘ HbA 1C , ·ÏÏ¿ Î·È ·ÚfiÌÔÈÔ ÔÛÔÛÙfi Â›Ù¢Í˘ HbA1C<7% Î·È Û˘ÁÎÚ›ÛÈ̘ ÌÂÈÒÛÂȘ ÛÙȘ ÌÂÙ·ÁÂ˘Ì·ÙÈΤ˜ ÙÈ̤˜ ÁÏ˘Îfi˙˘. ∞ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ: ΔÔ ·˙Ï ÙˆÓ ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ Ù˘ ÂÈÛÓÂfiÌÂÓ˘ ÈÓÛÔ˘Ï›Ó˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ·‡ÍËÛË ÛˆÌ·ÙÈÎÔ‡ ‚¿ÚÔ˘˜, Ù· ˘ÔÁÏ˘Î·ÈÌÈο ÂÂÈÛfi‰È·, ÙÔÓ ‚‹¯· Î·È ÙËÓ ·‡ÍËÛË Ù›ÙÏÔ˘ ·ÓÙÈ˚ÓÛÔ˘ÏÈÓÈÎÒÓ ·ÓÙÈۈ̿وÓ. ∏ ÂÈÛÓÂfiÌÂÓË ÈÓÛÔ˘Ï›ÓË Û˘Óԉ‡ÂÙ·È Ì ·ÚfiÌÔÈ· ·‡ÍËÛË ÛˆÌ·ÙÈÎÔ‡ ‚¿ÚÔ˘˜ Û ۯ¤ÛË Ì ÂΛÓË Ô˘ ·Ú·ÙËÚÂ›Ù·È Û ˘Ô‰fiÚÈ· ¯ÔÚ‹ÁËÛË. Δ· ÔÛÔÛÙ¿ ˘ÔÁÏ˘Î·ÈÌÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ Û ·ÛıÂÓ›˜ Ì ‰È·‚‹ÙË Ù‡Ô˘ 1 Î·È 2 Ô˘ ÂÏ¿Ì‚·Ó·Ó ÂÈÛÓÂfiÌÂÓË ÈÓÛÔ˘Ï›ÓË, ‹Ù·Ó Û ‰È¿ÊÔÚ˜ ÌÂϤÙ˜, Û˘ÁÎÚ›ÛÈÌ· Ì ÂΛӷ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ÂÏ¿Ì‚·Ó·Ó ˘Ô‰ÔÚ›ˆ˜ ÙËÓ ÈÓÛÔ˘Ï›ÓË. ŸÌˆ˜ Ô Î›Ó‰˘ÓÔ˜ ˘ÔÁÏ˘Î·ÈÌ›·˜ ·fi ¯ÔÚ‹ÁËÛË ÂÈÛÓÂfiÌÂÓ˘ ÈÓÛÔ˘Ï›Ó˘ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ˜ ·fi ÙÔÓ ·ÓÙ›ÛÙÔÈ¯Ô ·ÛıÂÓÒÓ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ·ÓÙȉȷ‚ËÙÈο ‰ÈÛΛ·. ∫·Ù¿ Û˘Ó¤ÂÈ· Ô Î›Ó‰˘ÓÔ˜ ˘ÔÁÏ˘Î·ÈÌ›·˜ Â›Ó·È ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚÔ˜ fiÙ·Ó ¯ÔÚËÁÂ›Ù·È Û˘Ó‰˘·ÛÌfi˜ ÂÈÛÓÂfiÌÂÓ˘ ÈÓÛÔ˘Ï›Ó˘ Î·È ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ‰ÈÛΛˆÓ. ∞˘ÍË̤ÓË Â›ÙˆÛË ‚‹¯· ·Ú·ÙËÚ‹ıËΠ۠·ÛıÂÓ›˜ Ì ÂÈÛÓÂfiÌÂÓË ÈÓÛÔ˘Ï›ÓË, Û˘ÁÎÚÈÙÈο Ì ÙËÓ ˘Ô‰fiÚÈ· ¯ÔÚ‹ÁËÛË Ù˘ (15%-20% vs 5% ·ÓÙ›ÛÙÔȯ·) Û ηϿ ÙÂÎÌËÚȈ̤Ó˜ ÌÂϤÙ˜. √ ‚‹¯·˜ ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ï›Á· ÏÂÙ¿ ÌÂÙ¿ ÙËÓ ÂÈÛÓÔ‹ Ù˘ ÈÓÛÔ˘Ï›Ó˘, Â›Ó·È ·Ïfi˜ Î·È fi¯È ·Ú·ÁˆÁÈÎfi˜ Î·È ÌÂÈÒÓÂÙ·È Ë Â›ÙˆÛË ÙÔ˘ Ì ÙËÓ Û˘Ó¤¯ÈÛË Ù˘ ·ÁˆÁ‹˜ Ì ÙËÓ ÂÈÛÓÂfiÌÂÓË ÈÓÛÔ˘Ï›ÓË. ¢ÂÓ Û˘Óԉ‡ÂÙ·È Ì ÔÔÈ·‰‹ÔÙ ÏÂÈÙÔ˘ÚÁÈ΋ Ó¢ÌÔÓÈ΋ ‰È·Ù·Ú·¯‹.

∞˘ÍË̤ÓË ·Ú·ÁˆÁ‹ ·ÓÙÈ˚ÓÛÔ˘ÏÈÓÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ·Ú·ÙËÚ‹ıËΠ۠·ÛıÂÓ›˜ Ì ‰È·‚‹ÙË Ù‡Ô˘ 1 Î·È 2 Ô˘ ¤Ï·‚·Ó ÂÈÛÓÂfiÌÂÓË ÈÓÛÔ˘Ï›ÓË. ∏ ·‡ÍËÛË ·˘Ù‹ ÛÙÂÚÂ›Ù·È ÎÏÈÓÈ΋˜ ÛËÌ·Û›·˜, fiÛÔÓ ·ÊÔÚ¿ ÙȘ ÂȉڿÛÂȘ ÛÙËÓ HbA 1C, ÛÙȘ ‰fiÛÂȘ ÈÓÛÔ˘Ï›Ó˘, ÛÙËÓ Â›ÙˆÛË ˘ÔÁÏ˘Î·ÈÌÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ Î·È ÛÙËÓ ÂÌÊ¿ÓÈÛË ·ÏÏÂÚÁÈÎÒÓ ·ÓÙȉڿÛˆÓ. ª·ÎÚÔ¯ÚfiÓÈ· ‰Â‰Ô̤ӷ Û¯ÂÙÈο Ì ÙËÓ ‰Ú·ÛÙÈÎfiÙËÙ· Î·È ÙȘ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ √È Ì¤¯ÚÈ Û‹ÌÂÚ· ‰ËÌÔÛȇÛÂȘ ‚‚·›ˆ˜ ·ÊÔÚÔ‡Û·Ó ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ·Ú·ÎÔÏÔ‡ıËÛ˘ ̤¯ÚÈ 6 Ì‹Ó˜ Î·È ¤ÙÛÈ Ù· Ì·ÎÚÔ¯ÚfiÓÈ· ‰Â‰Ô̤ӷ ·Ó·Ì¤ÓÔÓÙ·Ó Ì ÂÍ·ÈÚÂÙÈÎfi ÂӉȷʤÚÔÓ. ™ÙÔ ∞ÌÂÚÈοÓÈÎÔ ¢È·‚ËÙÔÏÔÁÈÎfi ™˘Ó¤‰ÚÈÔ ÙÔ 2006 Ë ÔÌ¿‰· ÙÔ˘ JovanÔvic ·ÚÔ˘Û›·Û ‰Â‰Ô̤ӷ 2 ¯ÚfiÓˆÓ ·Ú·ÎÔÏÔ‡ıËÛ˘. ŒÙÛÈ ÌÂÙ¿ 24 Ì‹Ó˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ 291 ·ÙfiÌˆÓ Ì ™¢ Ù‡Ô˘ π, Ô˘ Ù˘¯·ÈÔÔÈ‹ıËÎ·Ó Û ÂÈÛÓÂfiÌÂÓË ÈÓÛÔ˘Ï›ÓË (∂.π.)

-Exubera- ¤Ó·ÓÙÈ 291 ·ÙfiÌˆÓ Ô˘ Ù˘¯·ÈÔÔÈ‹ıËÎ·Ó Û ˘Ô‰fiÚÈ· (À¢) Ù·¯Â›· ÈÓÛÔ˘Ï›ÓË ‰È·ÈÛÙÒıËΠfiÙÈ: ·) Ë ÔÌ¿‰· ∂.π. ·ÚÔ˘Û›·Û ·ÚfiÌÔÈ· ÁÏ˘Î·ÈÌÈ΋ Ú‡ıÌÈÛË Ì ÙËÓ À¢ (HbA1C 7.5% vs. 7.3%), ‚) Û˘ÓÔÏÈο ÔÈ ˘ÔÁÏ˘Î·È̛˜ ‹Ù·Ó Û˘ÁÎÚ›ÛÈ̘ ÌÂٷ͇ ÙˆÓ 2 ·ÙfiÌˆÓ (∂π vs. À¢: 4 vs. 3.8 Û˘Ì‚¿Ì·Ù·/ ¿ÙÔÌÔ/ Ì‹Ó·), ÂÓÒ ÛÔ‚·Ú¤˜ ˘ÔÁÏ˘Î·È̛˜ ‹Ù·Ó ÛËÌ·ÓÙÈο ÏÈÁfiÙÂÚ˜ ÛÙËÓ ÔÌ¿‰· ∂π (∂π vs. À¢: 2.8 vs. 4.1 Û˘Ì‚¿Ì·Ù·/ 100 ¿ÙÔÌ·/ Ì‹Ó˜), Á) Ù· ۿί·Ú· ÓËÛÙ›·˜ ÌÂÈÒıËÎ·Ó ÂÚÈÛÛfiÙÂÚÔ Ì ÙËÓ ∂π (·fi 170 Û 156 mg% vs. 167 Û 173 mg% ÛÙËÓ À¢ ÔÌ¿‰·), ‰) Ë ÚfiÛÎÙËÛË ‚¿ÚÔ˘˜ ‹Ù·Ó Û·ÊÒ˜ ÏÈÁfiÙÂÚË Ì ÙËÓ ∂π (0.8 kg ÛÙËÓ ∂π vs. 2 kg ÛÙËÓ À¢ ÔÌ¿‰·). ∏ ÔÌ¿‰· ÙÔ˘ Rosenstock ·fi ÙÔ ¡Ù¿Ï·˜ ÛÙÔ ›‰ÈÔ Û˘Ó¤‰ÚÈÔ ·ÚÔ˘Û›·Û Â›Û˘ Ù· ‰Â‰Ô̤ӷ ·fi ·Ú·ÎÔÏÔ‡ıËÛË 2 ÂÙÒÓ, 635 ·ÙfiÌˆÓ Ì ™¢ Ù‡Ô˘ ππ Ô˘ Ù˘¯·ÈÔÔÈ‹ıËÎ·Ó Û ÂÈÛÓÂfiÌÂÓË ÈÓÛÔ˘Ï›ÓË (∂.π.) ‹ ˘Ô‰fiÚÈ· (À¢) ÈÓÛÔ˘Ï›ÓË. ΔÔ ÚˆÙÔÁÂÓ¤˜ ÙÂÏÈÎfi ÛËÌÂ›Ô ÛÙËÓ ÌÂϤÙË ‹Ù·Ó Ë Ó¢ÌÔÓÈ΋

ATHIROSK 14

03-07-07

12:06

™ÂÏ›‰·23

£∂ƒ∞¶∂π∞ - º∞ƒª∞∫∞

EXUBERA PD Profile ŒÓ·ÚÍË ‰Ú¿Û˘:

Mean GR (Percentage Maximum)

100

Exubera: 32 min Lispro: 41 min Soluble: 48 min

80

¢È¿ÚÎÂÈ· ‰Ú¿Û˘:

60

Exubera: 387 min Lispro: 313 min Soluble: 415 min

40 20 0

0

120

240

360

480

600

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

Care, Vol. 28, 2005 1077 - 1082 Modified

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

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

ÏÂÈÙÔ˘ÚÁ›· Î·È Ù· ‰Â˘ÙÂÚÔÁÂÓ‹ ‹Ù·Ó Ë HbA 1C, Ë ˘ÔÁÏ˘Î·ÈÌ›·, ÙÔ Û¿Î¯·ÚÔ ÓËÛÙ›·˜ Î·È ÙÔ ÛˆÌ·ÙÈÎfi ‚¿ÚÔ˜. ∏ ÔÌ¿‰· Ù˘ ∂.π ·ÚÔ˘Û›·Û Ôχ ÌÈÎÚ¤˜ ·ÏÏ·Á¤˜ ÛÙ· ÙÂÛÙ Ù˘ Ó¢ÌÔÓÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ (FEV 1 -ÂÎÓÂfiÌÂÓÔ˜ fiÁÎÔ˜ ·¤Ú· ÛÙÔ 1’’- Î·È DLCO -ÈηÓfiÙËÙ· ‰È¿¯˘Û˘ C√-). OÈ ·ÏÏ·Á¤˜ ·˘Ù¤˜ ‹Ù·Ó ÌÈÎÚfiÙÂÚ˜ ÙÔ˘ 1.5% Ù˘ ̤Û˘ ÙÈÌ‹˜ ÙˆÓ ‰ÂÈÎÙÒÓ ·˘ÙÒÓ, Û˘Ó¤‚ËÛ·Ó ÓˆÚ›˜ Î·È ·Ú¤ÌÂÈÓ·Ó ÛÙ·ıÂÚ¤˜, ¯ˆÚ›˜ ÂͤÏÈÍË Î·Ù¿ ÙËÓ ‰È¿ÚÎÂÈ· Ù˘ 2¯ÚÔÓ˘ ·Ú·ÎÔÏÔ‡ıËÛ˘. √È ‰‡Ô ÔÌ¿‰Â˜ ·ÚÔ˘Û›·Û·Ó ÙËÓ ›‰È· ‚ÂÏÙ›ˆÛË ÛÙË ÁÏ˘Î·ÈÌÈ΋ Ú‡ıÌÈÛË, ÂÓÒ Ë ÔÌ¿‰· Ù˘ ∂.π ·ÚÔ˘Û›·Û ÛËÌ·ÓÙÈο ÏÈÁfiÙÂÚ˜ ˘ÔÁÏ˘Î·È̛˜ (0.4 vs.

0.6 Û˘Ì‚¿Ì·Ù·/ 100 ·ÛıÂÓ›˜/ Ì‹Ó˜), ÌÂÁ·Ï‡ÙÂÚ˜ ‚ÂÏÙÈÒÛÂȘ ÛÙ· ۿί·Ú· ÓËÛÙ›·˜ (·fi 151 Û 135 vs. 148 Û 147 mg%) Î·È ÌÈÎÚfiÙÂÚË ÚfiÛÎÙËÛË ‚¿ÚÔ˘˜ ÛÙËÓ ‰ÈÂÙ›· (·fi 87 Û 88.8. Kg vs. 88 Û 91.5 ÛÙËÓ ÔÌ¿‰· Ù˘ À.π).

∞ÛÊ¿ÏÂÈ·: ¢ÂÓ ¤¯ÂÈ ‰È·ÈÛÙˆı› Û ·ÛıÂÓ›˜ Ì ‰È·‚‹ÙË Ù‡Ô˘ 1 ‹ 2, ·fi ÙȘ ÚÔ‚ÏÂfiÌÂÓ˜ ÏÂÈÙÔ˘ÚÁÈΤ˜ ‰ÔÎÈ̷ۛ˜ ÙˆÓ Ó¢ÌfiÓˆÓ (ÛÈÚÔ̤ÙÚËÛË Î·È Ì¤ÙÚËÛË ‰È·¯˘ÙÈ΋˜ ÈηÓfiÙËÙ·˜ Ó¢ÌfiÓˆÓ) ‰˘ÛÌÂÓ‹˜ Â›‰Ú·ÛË Ù˘ ÂÈÛÓÂfiÌÂÓ˘ ÈÓÛÔ˘Ï›Ó˘. ŸÌˆ˜ ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ÌÂÏÂÙÒÓ, ‰ÂÓ ÂÌÂÚȤ¯ÂÙ·È Û˘ÓÂÎÙ›ÌËÛË fiÏˆÓ ÙˆÓ ··Ú·›ÙËÙˆÓ ‰ÔÎÈÌ·ÛÈÒÓ ÚÔÎÂÈ̤ÓÔ˘ ÂÍ·¯ıÔ‡Ó ·ÛÊ·Ï‹ Û˘ÌÂÚ¿ÛÌ·Ù·. ∂Ú¢ÓËÙÈο ‰Â‰Ô̤ӷ ¤¯Ô˘Ó ÙÂÎÌËÚÈÒÛÂÈ ÙËÓ ·ÛÊ¿ÏÂÈ· ¯ÔÚ‹ÁËÛ˘ ÂÈÛÓÂfiÌÂÓ˘ ÈÓÛÔ˘Ï›Ó˘ ÌÂÙ¿ Û˘Ó¯‹ ¯ÔÚ‹ÁËÛË 4 ÂÙÒÓ. ¶·Ú’ fiÏ· ·˘Ù¿ Û˘ÓÈÛÙ¿Ù·È Ó· Á›ÓÂÙ·È Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ ÛÈÚÔ̤ÙÚËÛË Î·È ÂÎÙ›ÌËÛË Î˘Ú›ˆ˜ ÙÔ˘ FEV 1 ÚÈÓ ÙËÓ ¤Ó·ÚÍË ·ÁˆÁ‹˜ Ì ÂÈÛÓÂfiÌÂÓË ÈÓÛÔ˘Ï›ÓË. FEVI >70% ·ÔÙÂÏ› ·ÛʷϤ˜ ¯¤ÁÁ˘Ô ÁÈ· ÙËÓ ¤Ó·ÚÍË ÙÔ˘ Exubera. ∂·Ó·ÏËÙÈ΋ ÛÈÚÔ̤ÙÚËÛË Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÛÙÔ˘˜ 6 Ì‹Ó˜. ∂¿Ó ˘¿Ú¯ÂÈ

Ì›ˆÛË Ì¤¯ÚÈ 15% ÙÔ˘ FEVπ, Û˘ÓÈÛÙ¿Ù·È Â·Ó¿ÏË„Ë ÂÙ‹ÛÈ· Ù˘ ÛÈÚÔ̤ÙÚËÛ˘. ∂¿Ó Ë Ì›ˆÛË Â›Ó·È 15-20%, ÙfiÙ Ӥ· ÛÈÚÔ̤ÙÚËÛË Ú¤ÂÈ Ó· Á›ÓÂÈ Û 3 Ì‹Ó˜. ∂¿Ó fï˜ Ë Ì›ˆÛË ÙÔ˘ FEVπ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË ÙÔ˘ 20%, ÙfiÙ ı· Ú¤ÂÈ Ó· Á›ÓÂÈ ¿ÌÂÛË ‰È·ÎÔ‹ ÙÔ˘ Exubera. ™Â η̛· ÌÂϤÙË ¤ˆ˜ Û‹ÌÂÚ· ‰ÂÓ ¤¯ÂÈ ¯ÔÚËÁËı› ÂÈÛÓÂfiÌÂÓË ÈÓÛÔ˘Ï›ÓË Û ‰È·‚ËÙÈÎÔ‡˜ ÌÂ Û˘Ó˘¿Ú¯Ô˘Û· Ó¢ÌÔÓÈ΋ ÓfiÛÔ. ™˘ÓÂÒ˜ ‰ÂÓ ÚÔÙ›ÓÂÙ·È Ë ¯ÔÚ‹ÁËÛË Ù˘ Û ¿ÙÔÌ· ÌÂ Û˘ÓÔ‰¿ Ó¢ÌÔÓÈο ÓÔÛ‹Ì·Ù·. ∏ Û¯¤ÛË ÙÔ˘ ηÓ›ÛÌ·ÙÔ˜ Ì ÙËÓ ·ÔÚÚfiÊËÛË Ù˘ ÂÈÛÓÂfiÌÂÓ˘ ÈÓÛÔ˘Ï›Ó˘ ·ÔÙÂÏ› ‰›Ô ÂÎÙÂٷ̤Ó˘ ¤Ú¢ӷ˜ ·ÏÏ¿ Î·È ÂÈÛÙËÌÔÓÈ΋˜ Û˘˙‹ÙËÛ˘. ªÂϤÙ˜ Û ÂÈÚ·Ì·Ùfi˙ˆ· ·ÏÏ¿ Î·È Û ·ÓıÚÒÔ˘˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ô Î·Ófi˜ ÙÔ˘ ÙÛÈÁ¿ÚÔ˘ ·˘Í¿ÓÂÈ ÙËÓ ‰È·ÂÚ·ÙfiÙËÙ· ÙÔ˘ ΢„ÂÏȉÔÙÚȯÔÂȉÈÎÔ‡ ÊÚ·ÁÌÔ‡, Ì ·ÔÙ¤ÏÂÛÌ· ÔÈ

23

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π√À¡π√™ 2007

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

MÔÚÊ‹ ÈÓÛÔ˘Ï›Ó˘

ª¤ÁÂıÔ˜ ™ˆÌ·Ùȉ›ˆÓ (ÌÈÎÚ¿)

ŒÓ·ÚÍË ‰Ú¿Û˘ (ÏÂÙ¿)

ÃÚfiÓÔ˜ ·È¯Ì‹˜ (ÏÂÙ¿)

¢È¿ÚÎÂÈ· ‰Ú¿Û˘ (ÒÚ˜)

º·Ú̷΢ÙÈ΋ ÂÙ·ÈÚ›·

Exubera*

•ËÚ¿ ÎfiÓȘ

3

7

60

4-6

Pfizer, Necktar

AIR

•ËÚ¿ ÎfiÓȘ

10-20

15

30-45

3-5

Eli Lilly, Alkermes

Technosphere

•ËÚ¿ ÎfiÓȘ

2-5

5

39

3-4

MannKind

ÀÁÚ¿ ÌÔÚÊ‹

2-3

5

49-65

4-6

Novo-Nordisk

AERx iDMS

∂ÓÂÎÚ›ıË ·fi ÙÔ FDA, fiÏ· Ù· ¿ÏÏ· Û ʿÛË 3

¶›Ó·Î·˜ 1. ™˘ÛÙ‹Ì·Ù· Î·È Û˘Û΢¤˜ ¯ÔÚ‹ÁËÛ˘ ÂÈÛÓÂfiÌÂÓ˘ ÈÓÛÔ˘Ï›Ó˘ ··ÈÙÔ‡ÌÂÓ˜ ‰fiÛÂȘ ÂÈÛÓÂfiÌÂÓ˘ ÈÓÛÔ˘Ï›Ó˘ Èı·ÓfiÓ Ó· Â›Ó·È ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚ˜. ¶Ú·ÁÌ·ÙÈο ÌÂϤÙ˜ Û ηÓÈÛÙ¤˜ ÌË ‰È·‚ËÙÈÎÔ‡˜ ¤‰ÂÈÍ·Ó fiÙÈ, Ë Ì¤ÁÈÛÙË Û˘ÁΤÓÙÚˆÛË ÈÓÛÔ˘Ï›Ó˘ fi¯È ÌfiÓÔÓ ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚË (¤ˆ˜ Î·È 5 ÊÔÚ¤˜) ÂΛӢ ÙˆÓ ÌË Î·ÓÈÛÙÒÓ, ·ÏÏ¿ ÂÈÛ˘Ì‚·›ÓÂÈ Î·È Ù·¯‡ÙÂÚ· (31 vs 53 min). ∞Ó·fiÊ¢ÎÙ· ¤ÙÛÈ ‰ÂÓ ÚÔÙ›ÓÂÙ·È Ë ¯ÔÚ‹ÁËÛË ÂÈÛÓÂfiÌÂÓ˘ ÈÓÛÔ˘Ï›Ó˘ Û ηÓÈÛÙ¤˜ ‰È·‚ËÙÈÎÔ‡˜ ·ÊÔ‡ ‰ÂÓ Â›Ó·È ÚԂϤ„È̘ ÔÈ ÌÂÙ·‚ÔϤ˜ ÛÙËÓ ·ÔÚÚfiÊËÛË Ù˘ ÛÙËÓ Û˘ÛÙËÌ·ÙÈ΋ ΢ÎÏÔÊÔÚ›·. ∫·Ù¿ Û˘Ó¤ÂÈ· ÔÈ ‰È·‚ËÙÈÎÔ› ÚÔ Ù˘ ¯ÔÚ‹ÁËÛ˘ ÂÈÛÓÂfiÌÂÓ˘ ÈÓÛÔ˘Ï›Ó˘ ÂÓı·ÚÚ‡ÓÔÓÙ·È ÁÈ· ‰È·ÎÔ‹ ηÓ›ÛÌ·ÙÔ˜. ŒÍÈ Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ‰È·ÎÔ‹ ηÓ›ÛÌ·ÙÔ˜ Â›Ó·È ‰˘Ó·Ù‹ Ë ¤Ó·ÚÍË ¯ÔÚ‹ÁËÛ˘ ÂÈÛÓÂfiÌÂÓ˘ ÈÓÛÔ˘Ï›Ó˘. ¢ÂÓ ÚÔÙ›ÓÂÙ·È Â›Û˘ Ë ¯ÔÚ‹ÁËÛË Ù˘ ∂π Â› ÙÔ˘ ·ÚfiÓÙÔ˜ ÛÙ· ·È‰È¿ Î·È ÛÙȘ ΢ÔÊÔÚÔ‡Û˜ ‰È·‚ËÙÈΤ˜ Á˘Ó·›Î˜, ÏfiÁˆ ¤ÏÏÂȄ˘ Û¯ÂÙÈÎÒÓ ÌÂÏÂÙÒÓ.

∞Ô‰Ô¯‹ Î·È Û˘ÌÌfiÚʈÛË ÙˆÓ ·ÛıÂÓÒÓ √È ‰È·‚ËÙÈÎÔ› ·ÛıÂÓ›˜ ÚÔÙÈÌÔ‡Ó ·Ó·ÌÊÈÛ‚‹ÙËÙ· ÙËÓ ÂÈÛÓÂfiÌÂÓË Û˘ÁÎÚÈÙÈο Ì ÙËÓ ˘Ô‰fiÚÈ· ÈÓÛÔ˘Ï›ÓË. ™ËÌ·ÓÙÈο ÂÚÈÛÛfiÙÂÚÔÈ ‰È·‚ËÙÈÎÔ› Ù‡Ô˘ π Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡Û·Ó ÂÈÛÓÂ-

24

fiÌÂÓË ÈÓÛÔ˘Ï›ÓË ‹Ù·Ó Û˘ÓÔÏÈο ÈηÓÔÔÈË̤ÓÔÈ ¤Ó·ÓÙÈ ·˘ÙÒÓ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡Û·Ó ˘Ô‰fiÚÈ· (35.1% vs. 10.6%, p<0.001).

T· Â˘Ú‹Ì·Ù· ÛÙÔ˘˜ ‰È·‚ËÙÈÎÔ‡˜ Ù‡Ô˘ ππ ‹Ù·Ó ·ÚfiÌÔÈ·. ∏ Û˘ÌÌfiÚʈÛË ÙˆÓ ·ÛıÂÓÒÓ Â›Û˘ ‹Ù·Ó ÔˆÛ‰‹ÔÙ Ôχ ÌÂÁ·Ï‡ÙÂÚË Ì ÙËÓ ÂÈÛÓÂfiÌÂÓË ÈÓÛÔ˘Ï›ÓË Û˘ÁÎÚÈÙÈο Ì ÙËÓ ˘Ô‰fiÚÈ· (3ÌËÓË ÌÂϤÙË Û ‰È·‚ËÙÈÎÔ‡˜ Ù‡Ô˘ ππ Û˘ÌÌfiÚʈÛË 94% vs. 64%, p<0.001). ™Â ¿ÏÏË Â›Û˘ ÌÂϤÙË ‰Â›¯ıËΠfiÙÈ Ë ÂÈÛÓÂfiÌÂÓË ÈÓÛÔ˘Ï›ÓË ·˘Í¿ÓÂÈ Î·Ù¿ ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚÔ ‚·ıÌfi ÙËÓ Èı·ÓfiÙËÙ· ·Ô‰Ô¯‹˜ Ù˘ ÈÓÛÔ˘ÏÈÓÔıÂÚ·›·˜ Û˘ÁÎÚÈÙÈο Ì ÙËÓ ÚfiÙ·ÛË ÙËÓ ˘Ô‰fiÚÈ·˜ ÈÓÛÔ˘Ï›Ó˘ (43.2% vs. 10.5%).

¶ÚÔ‚ÏËÌ·ÙÈÛÌÔ›, ÂÚˆÙËÌ·ÙÈο √ˆÛ‰‹ÔÙ ÙÔ ÙÔ›Ô Ù˘ ÂÈÛÓÂfiÌÂÓ˘ ÈÓÛÔ˘Ï›Ó˘ ‰ÂÓ Â›Ó·È ·Ôχو˜ ۷ʤ˜ Î·È ÍÂηı·ÚÈṲ̂ÓÔ. ∂ÚˆÙËÌ·ÙÈο ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Ó· ˘¿Ú¯Ô˘Ó, ÚÔ‚ÏËÌ·ÙÈÛÌÔ› Ô˘ ·Ó·˙ËÙÔ‡Ó ÙÂÎÌËÚȈ̤Ó˜ ··ÓÙ‹ÛÂȘ: ·) Y¿Ú¯Ô˘Ó ÂӉ¯fiÌÂÓ˜ ·ÚÂÓ¤ÚÁÂȘ ÛÙÔ ·Ó·Ó¢ÛÙÈÎfi ÂÈı‹ÏÈÔ Î·È Û ‚¿ıÔ˜ ¯ÚfiÓÔ˘ Ù˘ ¯ÔÚ‹ÁËÛ˘ ۯ‰fiÓ 3 ÊÔÚ¤˜ ÂÚÈÛÛfiÙÂÚ˘ ÈÓÛÔ˘Ï›Ó˘ Ì ÙËÓ ÂÈÛÓ¢ÛÙÈ΋ Û˘ÁÎÚÈÙÈο Ì ÙËÓ ÂÓ¤ÛÈÌË Ì¤ıÔ‰Ô; Δ· ̤¯ÚȘ ÛÙÈÁÌ‹˜ ‰Â‰Ô̤ӷ ‰ÂÓ

ÂÌÓ¤Ô˘Ó ·ÓËÛ˘¯›·, fï˜, Ë È‰È·›ÙÂÚ· Ì·ÎÚfi¯ÚÔÓË ·Ú·ÎÔÏÔ‡ıËÛË ı· ‰ÒÛÂÈ ÔÚÈÛÙÈΤ˜ ··ÓÙ‹ÛÂȘ. ‚) ∏ ¯ÔÚ‹ÁËÛË ÈÓÛÔ˘Ï›Ó˘ ÛÙ· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ ·ÏÏ¿˙ÂÈ, ÙÚÔÔÔÈ›, ‰È·ÊÔÚÔÔÈ› ÙËÓ Ó¢ÌÔÓÈ΋ ·Ó¿Ù˘ÍË; Á) ∞˘Í¿ÓÂÈ Ë ÂÈÛÓÂfiÌÂÓË ÈÓÛÔ˘Ï›ÓË ÙËÓ ÂͤÏÈÍË ÂӉ¯fiÌÂÓ˘ ·Ó·Ù˘ÛÛfiÌÂÓ˘ ηÎÔ‹ıÂÈ·˜ ÛÙÔÓ Ó‡ÌÔÓ· ‹ ÂÈ‚·Ú‡ÓÂÈ ÙËÓ ·ıÔÊ˘ÛÈÔÏÔÁ›· Î·È ÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ˘ÔΛÌÂÓ˘ Ó¢ÌÔÓÈ΋˜ ›ÓˆÛ˘; ‰) £· ˘¿ÚÍÂÈ ÌÂÏÏÔÓÙÈο ·ÔÙÂÏÂÛÌ·ÙÈ΋ ÂÈÛÓÂfiÌÂÓË ÈÓÛÔ˘Ï›ÓË Ì·ÎÚ¿˜ ‰Ú¿Ûˆ˜; Â) ¶ÔÈÔ ÙÔ Â‡ÚÔ˜ Ù˘ ÌÂÙ·‚ÏËÙfiÙËÙ·˜ ·ÔÚÚfiÊËÛ˘ Ù˘ ÂÈÛÓÂfiÌÂÓ˘ ÈÓÛÔ˘Ï›Ó˘ οو ·fi ÙËÓ Â›‰Ú·ÛË ‰È·ÊfiÚˆÓ ÌÔÚÊÒÓ ¿ÛÎËÛ˘, ·Ó¿ÏÔÁ· Ì ÙËÓ Û˘Û΢‹ ¯ÔÚ‹ÁËÛ˘ Î·È ·Ó¿ÏÔÁ· Ì ÙËÓ Ù¯ÓÈ΋ Ù˘ ÂÈÛÓÔ‹˜;

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£∂ƒ∞¶∂π∞ - º∞ƒª∞∫∞ ™˘ÌÂÚ·ÛÌ·ÙÈο ∏ ÂÈÛÓÂfiÌÂÓË ÈÓÛÔ˘Ï›ÓË ÌÔÚ› Ó· ·ÔÙÂϤÛÂÈ ÂÓ·ÏÏ·ÎÙÈ΋ χÛË ÛÙËÓ Ù·¯Â›·˜ ‰Ú¿Û˘ ÈÓÛÔ˘Ï›ÓË Ì ÈÛ¿ÍÈ· ‰Ú·ÛÙÈÎfiÙËÙ· Î·È ·ÛÊ¿ÏÂÈ·, Û˘Á¯ÔÚËÁÔ‡ÌÂÓË Ì ÂӉȿÌÂÛ˘ ‰Ú¿Û˘ ÈÓÛÔ˘Ï›ÓË ‹ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ·ÓÙȉȷ‚ËÙÈο ‰ÈÛΛ·. ¢ÂÓ Ê·›ÓÂÙ·È Ó· ÂËÚ¿˙ÂÈ

ÙËÓ Ó¢ÌÔÓÈ΋ ÏÂÈÙÔ˘ÚÁ›·, ·ÏÏ¿ ‰ÂÓ Û˘ÛÙ‹ÓÂÙ·È Û ‰È·‚ËÙÈÎÔ‡˜ Ì ¯ÚfiÓÈ· ·ÔÊÚ·ÎÙÈ΋ Ó¢ÌÔÓÔ¿ıÂÈ·, ¿ÛıÌ· Û ·È‰È¿ Î·È Û ηÓÈÛÙ¤˜. ∏ ·Ô‰Ô¯‹ Ù˘ Î·È Ë ÈηÓÔÔ›ËÛË ÙˆÓ ‰È·‚ËÙÈÎÒÓ ·fi ÙËÓ ¯ÔÚ‹ÁËÛË Ù˘, (ÁÂÁÔÓfi˜ Ô˘ ‰È·ÈÛÙÒıËΠ۠fiϘ ÙȘ ÌÂϤÙ˜), ÌÔÚ› Ó· ·ÔÙÂϤÛÂÈ ¤Ó·˘ÛÌ·

ÁÈ· ÙËÓ ¯ÔÚ‹ÁËÛË Ù˘ ÛÙ· ¿ÙÔÌ· Ì ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË. ¶¿ÓÙ· fï˜ ı· Ú¤ÂÈ Ó· Û˘ÓÂÎÙÈÌÒÓÙ·È ÔÈ Û¯ÂÙÈΤ˜ ·ÓÙÂӉ›ÍÂȘ fiˆ˜ Î·È ÔÈ ·Ó·Áη›Â˜ ÚÔ¸Ôı¤ÛÂȘ ÒÛÙÂ Ë ¯ÔÚ‹ÁËÛË Ù˘ ÂÈÛÓÂfiÌÂÓ˘ ÈÓÛÔ˘Ï›Ó˘ Ó· Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ Î·È ·ÛÊ·Ï‹˜.

™˘ÓÈÛÙÒÌÂÓË μÈ‚ÏÈÔÁÚ·Ê›· Davidson M. B., Mehta A.E., Siraj E.S., et al: Inhaled Human Insulin: An Inspiration For Patients With Diabetes Mellitus? Cleveland Clinic Journal Of Medicine. 2006; 73, Num. 6. 569-78

4.

2.

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

5.

3.

Reinhard H.A. Becker, Sue Sha, Annke D. Frick, et al. The Effect of Smoking Cessation and Subsequent Resumption on Absorption of Inhaled Insulin.

Diabetes Care 2006; 29: 277-282

1.

Freemantle N, Blonde L, Duhot D, et al.

Availability of inhaled insulin promotes greater perceived acceptance of insulin therapy in patients with type 2 diabetes.

Diabetes Care 2005; 28:427–428. ∞. ªÂÏȉÒÓ˘: ∂ÈÛÓÂfiÌÂÓË ÈÓÛÔ˘Ï›ÓË ÛÂÏ. 741-756 ·fi «∫·Ú‰ÈÔÌÂÙ·‚ÔÏÈÎfi˜ ΛӉ˘ÓÔ˜». ∞. ªÂÏȉÒÓ˘ 2007, ÂΉfiÛÂȘ π. ¶·ÚÈÛÈ¿ÓÔ˜.

6.

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

7.

Skyler J.S., Jovanovic L., Klioze S. et al.

Two-Year Safety and Efficacy of Inhaled

Human Insulin (Exubera) in Adult Patients With Type 1 Diabetes.

Diabetes Care 2007; 30: 579-585 8.

Nathan David M.. Counterpoint: No Time to Inhale: Arguments Against Inhaled Insulin in 2007 Diabetes Care 2007; 30: 442- 444

9.

Cefalu W.T.: Point: Pulmonary Inhalation of Insulin: Another "Brick in the Wall". Diabetes Care 2007; 30/

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

√È ‚-∞ÔÎÏÂÈÛÙ¤˜ ÛÙËÓ ∫ÏÈÓÈ΋ ¶Ú¿ÍË ª. ºÏˆÚÂÓÙ›Ó, ∂ÈÛÙËÌÔÓÈÎfi˜ ™˘ÓÂÚÁ¿Ù˘ ÙÔ˘ π·ÙÚ›Ԣ §Èȉ›ˆÓ ª. ∂ÏÈÛ¿Ê, ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ ΔÔ̤·˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ ∂ÈÛ·ÁˆÁ‹ √È ‚-·ÔÎÏÂÈÛÙ¤˜ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Â˘Ú‡Ù·Ù· Â‰Ò Î·È 4 ‰ÂηÂٛ˜ Î·È ıˆÚÔ‡ÓÙ·È Ì¤¯ÚÈ Û‹ÌÂÚ·, Û‡Ìʈӷ Ì ÙȘ ηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜, Ê¿Ú̷η ÚÒÙ˘ ÁÚ·ÌÌ‹˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ·ÚÙËÚȷ΋˜ ˘¤ÚÙ·Û˘ (∞À). øÛÙfiÛÔ, Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ·ÌÊÈÛ‚ËÙÂ›Ù·È ·fi ÔÏÏÔ‡˜ ÂÚ¢ÓËÙ¤˜ Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿ ÙÔ˘˜ fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ÚfiÏË„Ë ÙˆÓ ÌÂÈ˙fiÓˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ. ªÂÙ·-·Ó·Ï‡ÛÂȘ Ô˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ Ù˘¯·ÈÔÔÈËÌ¤ÓˆÓ ÎÏÈÓÈÎÒÓ ÌÂÏÂÙÒÓ, ÔÈ Ôԛ˜ Û˘Ó¤ÎÚÈÓ·Ó ÙÔ˘˜ ‚·ÔÎÏÂÈÛÙ¤˜ Ì ÂÈÎÔÓÈÎfi ‹ ¿ÏÏÔ Ê¿ÚÌ·ÎÔ, ·Ú¤¯Ô˘Ó ÂӉ›ÍÂȘ ηٿ Ù˘ ‰È·Ù‹ÚËÛ‹˜ ÙÔ˘˜ ˆ˜ ·ÓÙÈ˘ÂÚÙ·ÛÈο Ê¿Ú̷η ÚÒÙ˘ ÂÈÏÔÁ‹˜. ¶Ú¤ÂÈ Ó· ÂÈÛËÌ·Óı›, ˆÛÙfiÛÔ, fiÙÈ Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿ ÙÔ˘˜ ‰È·Ê¤ÚÂÈ, ÙfiÛÔ ÌÂٷ͇ ÙˆÓ ‰È·ÊÔÚÂÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ·˘Ù‹˜ Ù˘ ÔÌ¿‰·˜, ηıÒ˜ Î·È fiÛÔÓ ·ÊÔÚ¿ ÙȘ ‰È¿ÊÔÚ˜ ËÏÈÎȷΤ˜

ÔÌ¿‰Â˜. ™ÙÔ ¿ÚıÚÔ ·˘Ùfi ı· ·ÚÔ˘ÛÈ·ÛıÔ‡Ó Û˘ÓÔÙÈο ÔÈ ÛËÌ·ÓÙÈÎfiÙÂÚ˜ ÌÂÙ·-·Ó·Ï‡ÛÂȘ ÌÂÏÂÙÒÓ ¯ÔÚ‹ÁËÛ˘ ÙˆÓ ‚-·ÔÎÏÂÈÛÙÒÓ Î·È ı· Û˘˙ËÙËı› ‰ÈÂÍÔ‰Èο Ô ÚfiÏÔ˜ ÙÔ˘˜ ÛÙË ıÂÚ·›· Ù˘ ÚˆÙÔ·ıÔ‡˜ ∞À.

√È ÛËÌ·ÓÙÈÎfiÙÂÚ˜ ÌÂÙ·-·Ó·Ï‡ÛÂȘ ¯ÔÚ‹ÁËÛ˘ ‚-·ÔÎÏÂÈÛÙÒÓ √È ‚-·ÔÎÏÂÈÛÙ¤˜ ¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈËı› Û ÔÏϤ˜ Ù˘¯·ÈÔÔÈË̤Ó˜ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ Û ۇÁÎÚÈÛË, ÙfiÛÔ Ì ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ, fiÛÔ Î·È Ì ¿ÏÏ· ·ÓÙÈ˘ÂÚÙ·ÛÈο Ê¿Ú̷η.1-24 √È ÌÂϤÙ˜ ·˘Ù¤˜ ¤¯Ô˘Ó Û˘ÌÂÚÈÏ¿‚ÂÈ ˘ÂÚÙ·ÛÈÎÔ‡˜ ·ÛıÂÓ›˜ Ì ÌÂÁ¿ÏÔ ËÏÈÎÈ·Îfi ‡ÚÔ˜, ÂÓÒ Û˘¯Ó¿ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó Û˘Ó‰˘·ÛÌÔ› Ê·ÚÌ¿ÎˆÓ ÁÈ· Ó· ÂÈÙ¢¯ıÔ‡Ó Ù· ÂÈı˘ÌËÙ¿ Â›‰· ·ÚÙËÚȷ΋˜ ›ÂÛ˘ (∞¶).1, 4, 7, 16, 17 ¶·Ú¿ ÙËÓ ÂÙÂÚÔÁ¤ÓÂÈ· ÌÂٷ͇ ÙˆÓ ‰È·ÊfiÚˆÓ ÌÂÏÂÙÒÓ, ÔÚÈṲ̂Ó˜ ÛËÌ·ÓÙÈΤ˜ ÌÂÙ·-·Ó·Ï‡ÛÂȘ ÚÔÛ¿ıËÛ·Ó Ó· ·ÔÛ·ÊËÓ›ÛÔ˘Ó ÙÔÓ ·ÎÚÈ‚‹ ÚfiÏÔ ÙˆÓ ‚-·ÔÎÏÂÈ-

ÛÙÒÓ ÛÙË ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÚˆÙÔ·ıÔ‡˜ ∞À.25-28 √ Lindholm Î·È ÔÈ Û˘ÓÂÚÁ¿Ù˜ ÙÔ˘ Û ̛· ÌÂÙ·-·Ó¿Ï˘ÛË 18 Ù˘¯·ÈÔÔÈËÌ¤ÓˆÓ ÎÏÈÓÈÎÒÓ ÌÂÏÂÙÒÓ25 ·Ú·Ù‹ÚËÛ·Ó fiÙÈ Ë ¯ÔÚ‹ÁËÛË ‚-·ÔÎÏÂÈÛÙÒÓ Û˘Óԉ‡ÔÓÙ·Ó ·fi ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ·ÁÁÂÈ·Îfi ÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔ (∞∂∂) Û ۇÁÎÚÈÛË Ì ÙË ¯ÔÚ‹ÁËÛË ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ¿ÏÏˆÓ Î·ÙËÁÔÚÈÒÓ (relative risk [RR] 1.16, 95% CI 1.04-1.30; p=0.009), ÂÓÒ ‰ÂÓ ˘‹Ú¯·Ó ‰È·ÊÔÚ¤˜ fiÛÔÓ ·ÊÔÚ¿ ÙËÓ Â›ÙˆÛË ÙÔ˘ ÔͤԘ ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ôηډ›Ô˘ (√∂ª) ‹ Ù˘ Û˘ÓÔÏÈ΋˜ ıÓËÛÈÌfiÙËÙ·˜ (¶›Ó·Î·˜ 1). Δ· ·ÔÙÂϤÛÌ·Ù· ‹Ù·Ó ·ÚfiÌÔÈ·, ÙfiÛÔ ÛÙȘ ÌÂϤÙ˜ ÛÙȘ Ôԛ˜ ¯ÔÚËÁ‹ıËΠ·ÙÂÓÔÏfiÏË (RR 1.26, 1.15-1.38; p<0.0001), fiÛÔ Î·È Û ÂΛӘ ÛÙȘ Ôԛ˜ ÛÙËÓ ·ÁˆÁ‹ Û˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·Ó Û˘Ó‰˘·ÛÌfi˜ ‚-·ÔÎÏÂÈÛÙ‹ Ì ‰ÈÔ˘ÚËÙÈÎfi (RR 1.09, 0.98-1.21), ÂÓÒ ‰ÂÓ ÌÔÚÔ‡Û·Ó Ó· ÂÍ·¯ıÔ‡Ó ·ÛÊ·Ï‹ Û˘ÌÂ-

25

ATHIROSK 14

03-07-07

12:06

™ÂÏ›‰·26

π√À¡π√™ 2007

¶›Ó·Î·˜ 1: ‚-·ÔÎÏÂÈÛÙ¤˜ ¤Ó·ÓÙÈ ¿ÏÏˆÓ Ê·ÚÌ¿ÎˆÓ ªÂϤÙË

ΔÂÏÈÎfi ηٷÏËÎÙÈÎfi ÛËÌÂ›Ô (∞∂∂, √∂ª, ı¿Ó·ÙÔ˜)

Lindholm et al25 Khan et al26 RR (95% CI) RR (95% CI) ¡¤ÔÈ ·ÛıÂÓ›˜

RR (95% CI) ∏ÏÈÎȈ̤ÓÔÈ ·ÛıÂÓ›˜

0.97 (0.88-1.07) 1.06 (1.01-1.10)

∞∂∂

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

√∂ª

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

∫∞ √ÏÈ΋ ıÓËÛÈÌfiÙËÙ·

0.93 (0.64-1.34) 0.98 (0.87-1.11) 1.03 (0.99-1.08) 0.97 (0.83-1.14) 1.05 (0.99-1.11)

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

Ú¿ÛÌ·Ù· ÁÈ· ÙȘ ÌÂϤÙ˜ Ô˘ Û˘Ó¤ÎÚÈÓ·Ó ‚-·ÔÎÏÂÈÛÙ¤˜, ÂÎÙfi˜ Ù˘ ·ÙÂÓÔÏfiÏ˘, Ì ¿ÏÏ· Ê¿Ú̷η, ÂÍ·ÈÙ›·˜ ÙÔ˘ ÂÚÈÔÚÈṲ̂ÓÔ˘ ·ÚÈıÌÔ‡ Û˘Ì‚·Ì¿ÙˆÓ. ™Â Û‡ÁÎÚÈÛË Ì ÙÔ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ ÔÈ ‚·ÔÎÏÂÈÛÙ¤˜ Ê·›ÓÂÙ·È fiÙÈ ÌÂÈÒÓÔ˘Ó ÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ∞∂∂ (RR 0.81, 0.71-0.93), ÂÓÒ ‰ÂÓ ˘‹Ú¯Â ‰È·ÊÔÚ¿ fiÛÔÓ ·ÊÔÚ¿ Ù· √∂ª ‹ ÙË Û˘ÓÔÏÈ΋ ıÓËÛÈÌfiÙËÙ· (¶›Ó·Î·˜ 2). Δ· Â˘Ú‹Ì·Ù· ·˘Ù¿ ·ÊÔÚÔ‡Û·Ó ÙfiÛÔ ÙËÓ ·ÙÂÓÔÏfiÏË (RR 0.85, 0.72-1.01), fiÛÔ Î·È Ù· ˘fiÏÔÈ· Ê¿Ú̷η ·˘Ù‹˜ Ù˘ ÔÌ¿‰·˜ Ô˘ ¯ÔÚËÁ‹ıËÎ·Ó (RR 0.84, 0.64-1.10). ¶Ú¤ÂÈ fï˜ Ó· ·Ó·ÊÂÚı› fiÙÈ Ë Ì›ˆÛË ·˘Ù‹ ·ÓÙÈÛÙÔȯ› ÂÚ›Ô˘ ÛÙÔ 50% Ù˘ ·Ó·ÌÂÓfiÌÂÓ˘ Ì›ˆÛ˘ ÙˆÓ Û˘Ì‚·Ì¿ÙˆÓ Ì ‚¿ÛË ÚÔËÁÔ‡ÌÂÓ˜ ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜.29 ΔËÓ ·Ú·¿Óˆ ÌÂÙ·-·Ó¿Ï˘ÛË ·ÎÔÏÔ‡ıËÛ ·˘Ù‹ ÙˆÓ Khan Î·È MacAlister,26 Ë ÔÔ›· ÂÚÈÏ·Ì‚¿-

ÓÂÈ ‰Â‰Ô̤ӷ ·fi 21 Ù˘¯·ÈÔÔÈË̤Ó˜ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ ¯ÔÚ‹ÁËÛ˘ ‚-·ÔÎÏÂÈÛÙÒÓ Û ۇÁÎÚÈÛË Ì ÂÈÎÔÓÈÎfi ‹ ¿ÏÏÔ Ê¿ÚÌ·ÎÔ ˆ˜ ÚÒÙ˘ ÂÈÏÔÁ‹˜ ·ÓÙÈ˘ÂÚÙ·ÛÈ΋ ·ÁˆÁ‹ ÁÈ· ÙËÓ ÚfiÏË„Ë ÙˆÓ ÌÂÈ˙fiÓˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ (¶›Ó·Î˜ 1 Î·È 2). ∏ ȉȷÈÙÂÚfiÙËÙ· ·˘Ù‹˜ Ù˘ ÌÂÙ·-·Ó¿Ï˘Û˘ ¤ÁÎÂÈÙ·È ÛÙÔ fiÙÈ ÔÈ ÂÚ¢ÓËÙ¤˜ ¯ÒÚÈÛ·Ó ÙȘ 21 ÌÂϤÙ˜ Û 2 ÔÌ¿‰Â˜, ·Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ˆ˜ fiÚÈÔ Ù· 60 ¤ÙË. Δ· Û˘ÌÂÚ¿ÛÌ·Ù· ‹Ù·Ó ‰È·ÊÔÚÂÙÈο ÁÈ· ÙȘ ÔÌ¿‰Â˜ ÙˆÓ ·ÛıÂÓÒÓ. ™˘ÁÎÂÎÚÈ̤ӷ. ∏ ¯ÔÚ‹ÁËÛË ‚-·ÔÎÏÂÈÛÙÒÓ ¤Ó·ÓÙÈ ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ ˘ÂÚÙÂÚÔ‡Û ÛÙÔ˘˜ Ó¤Ô˘˜ ·ÛıÂÓ›˜ (ËÏÈΛ·˜ <60 ÂÙÒÓ) fiÛÔÓ ·ÊÔÚ¿ ÙÔ ÙÂÏÈÎfi ηٷÏËÎÙÈÎfi ÛËÌÂ›Ô (∞∂∂, √∂ª, ı¿Ó·ÙÔ˜) (RR 0.86, 0.74-0.99), Ù· √∂ª (RR 0.85, 0.71-1.03), Ù· ∞∂∂ (RR 0.84, 0.65-1.10) Î·È ÙÔ˘˜ ı·Ó¿ÙÔ˘˜

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

ΔÂÏÈÎfi ηٷÏËÎÙÈÎfi ÛËÌÂ›Ô (∞∂∂, √∂ª, ı¿Ó·ÙÔ˜)

Lindholm et al25 Khan et al26 RR (95% CI) RR (95% CI) ¡¤ÔÈ ·ÛıÂÓ›˜

RR (95% CI) ∏ÏÈÎȈ̤ÓÔÈ ·ÛıÂÓ›˜

0.86 (0.74-0.99) 0.89 (0.75-1.05)

∞∂∂

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

√∂ª

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

∫∞ √ÏÈ΋ ıÓËÛÈÌfiÙËÙ·

1.05 (0.72-1.54) 0.54 (0.37-0.81) 0.95 (0.86-1.04) 0.94 (0.79-1.10) 0.91 (0.74-1.12)

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

26

(RR 0.94, 0.79-1.10), fi¯È fï˜ Î·È ÙËÓ Â›ÙˆÛË Ù˘ ηډȷ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ (∫∞). ∞ÓÙ›ıÂÙ·, Û ·ÛıÂÓ›˜ ËÏÈΛ·˜ >60 ÂÙÒÓ ·Ú·ÙËÚ‹ıËΠÌÈ· ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Ì›ˆÛË Û ۇÁÎÚÈÛË Ì ÙÔ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ ÌfiÓÔ ÙˆÓ ∞∂∂ (RR 0.78, 0.63-0.98) Î·È Ù˘ ∫∞ (RR 0.54, 0.37-0.81). ™Â Û‡ÁÎÚÈÛË Ì ʿÚ̷η ¿ÏÏˆÓ Î·ÙËÁÔÚÈÒÓ, ÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜ ‰ÂÓ ˘ÂÚÙÂÚÔ‡Û·Ó Û ηӤӷ ·fi Ù· ·Ú·¿Óˆ ηٷÏËÎÙÈο ÛËÌ›· ÛÙÔ˘˜ Ó¤Ô˘˜ ·ÛıÂÓ›˜ (ËÏÈΛ·˜ <60 ÂÙÒÓ). øÛÙfiÛÔ, ÛÙ· ËÏÈÎȈ̤ӷ ¿ÙÔÌ· Ë ¯ÔÚ‹ÁËÛË ÙˆÓ ‚-·ÔÎÏÂÈÛÙÒÓ Û˘Û¯ÂÙ›ÛıËΠ̠·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ηډȷÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ (RR 1.06, 1.01-1.10), ÂÍ·ÈÙ›·˜ Ù˘ ÌÂÁ·Ï‡ÙÂÚ˘ Â›ÙˆÛ˘ ∞∂∂ (RR 1.18, 1.07-1.30). ∞Ó Î·È ÙÔ fiÊÂÏÔ˜ Ô˘ ÚԤ΢„ ·fi ÙȘ ÌÂϤÙ˜ ¯ÔÚ‹ÁËÛ˘ ÛÙÔ˘˜ Ó¤Ô˘˜ ·ÛıÂÓ›˜ ‚-·ÔÎÏÂÈÛÙÒÓ Û ۇÁÎÚÈÛË Ì ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ ‹Ù·Ó Î·È Û ·˘Ù‹ ÙË ÌÂÙ·-·Ó¿Ï˘ÛË ÌÈÎÚfiÙÂÚÔ ·fi ÙÔ ·Ó·ÌÂÓfiÌÂÓÔ Ì ‚¿ÛË ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜,29 Ê·›ÓÂÙ·È fiÙÈ Ë ¯ÔÚ‹ÁËÛË ÂÓfi˜ ‚-·ÔÎÏÂÈÛÙ‹ ÌÔÚ› Ó· ¢ÓÔ‹ÛÂÈ Ó¤Ô˘˜ ·ÛıÂÓ›˜ Ì ·ÓÂ›ÏÂÎÙË ∞À. ∂Ô̤ӈ˜, ÔÊ›ÏÔ˘Ì ӷ ·ÍÈÔÏÔÁ‹ÛÔ˘Ì Ì ÎÚÈÙÈ΋ ÛΤ„Ë ÙËÓ ÚfiÙ·ÛË ÔÚÈÛÌ¤ÓˆÓ ÂÚ¢ÓËÙÒÓ ÁÈ· ÔÚÈÛÙÈ΋ ηٿÚÁËÛË ÙˆÓ ‚-·ÔÎÏÂÈÛÙÒÓ ˆ˜ ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ Ê·Ú̿ΈÓ. ∞Í›˙ÂÈ ÛÙÔ ÛËÌÂ›Ô ·˘Ùfi Ó· ‰È¢ÎÚÈÓÈÛı› fiÙÈ Ë ·ıÔÊ˘ÛÈÔÏÔÁ›· Ù˘ ∞À ‰ÂÓ Â›Ó·È Ë ›‰È· Û οı ËÏÈΛ·. ™Ù· Ó¤· ¿ÙÔÌ· Ë ∞À ÔÊ›ÏÂÙ·È Û ·˘ÍË̤ÓË Î·Ú‰È·Î‹ ·ÚÔ¯‹ ·ÚÔ˘Û›· Ê˘ÛÈÔÏÔÁÈÎÒÓ ‹ ÌÂÈˆÌ¤ÓˆÓ ·ÁÁÂÈ·ÎÒÓ ·ÓÙÈÛÙ¿ÛˆÓ,30-32 ÂÓÒ Ë ∞À ÙˆÓ ËÏÈÎÈˆÌ¤ÓˆÓ ·ÙfiÌˆÓ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·‡ÍËÛË ÙˆÓ ÂÚÈÊÂÚÈÎÒÓ ·ÓÙÈÛÙ¿ÛÂˆÓ Î·È ¯·ÌËÏ‹ ·ÚÙËÚȷ΋ ÂÓ‰ÔÙÈÎfiÙËÙ· (compliance).30, 31 ∂Ô̤ӈ˜, Ë ¯ÔÚ‹ÁËÛË ÙˆÓ ‚-·ÔÎÏÂÈÛÙÒÓ ÛÙÔ˘˜ Ó¤Ô˘˜ ·ÛıÂÓ›˜ ÌÔÚ› Ó· ‰ÈηÈÔÏÔÁËı› ·fi ÙÂÎÌËÚȈ̤ӷ ·ıÔÊ˘ÛÈÔÏÔÁÈο ‰Â‰Ô̤ӷ.

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

ATHIROSK 14

03-07-07

12:06

™ÂÏ›‰·27

£∂ƒ∞¶∂π∞ - º∞ƒª∞∫∞ ‰È·ÊÔÚÂÙÈ΋˜ Ê·ÚÌ·ÎÔÎÈÓËÙÈ΋˜ Ù˘ ·ÙÂÓÔÏfiÏ˘ Û ۇÁÎÚÈÛË Ì ٷ ˘fiÏÔÈ· Ê¿Ú̷η Ù˘ ›‰È·˜ ηÙËÁÔÚ›·˜, Ù¤ıËΠÙÔ ÂÚÒÙËÌ· ηٿ fiÛÔ ÔÈ Ô˘‰¤ÙÂÚ˜ ‹ ·ÚÓËÙÈΤ˜ ÂÈÙÒÛÂȘ Ô˘ ·Ú·ÙËÚ‹ıËÎ·Ó Û ÔÚÈṲ̂Ó˜ ÌÂϤÙ˜ Ì ‚·ÔÎÏÂÈÛÙ¤˜ ÔÊ›ÏÔÓÙ·Ó ÛÙËÓ ·ÙÂÓÔÏfiÏË Î·È ·Ó Ë ÂӉ¯fiÌÂÓË ¯ÔÚ‹ÁËÛË ¿ÏÏˆÓ ‚-·ÔÎÏÂÈÛÙÒÓ ı· ›¯Â ÈÔ Â˘ÓÔ˚ο ·ÔÙÂϤÛÌ·Ù·. √ Carlberg Î·È ÔÈ Û˘ÓÂÚÁ¿Ù˜ ÙÔ˘ ·Ó¤Ï˘Û·Ó Ù· ‰Â‰Ô̤ӷ 9 ÌÂÏÂÙÒÓ Ì ·ÙÂÓÔÏfiÏË: 4 ¤Ó·ÓÙÈ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ (¶›Ó·Î·˜ 3) Î·È 5 ¤Ó·ÓÙÈ ¿ÏÏÔ˘ ·ÓÙÈ˘ÂÚÙ·ÛÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ (¶›Ó·Î·˜ 4).27 ¶·Ú¿ ÙË ÌÂÁ·Ï‡ÙÂÚË Ì›ˆÛË Ù˘ ∞¶ Ô˘ ÂÈÙ‡¯ıËΠ̠ÙËÓ ·ÙÂÓÔÏfiÏË, ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ Û ۇÁÎÚÈÛË Ì ÙÔ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ fiÛÔÓ ·ÊÔÚ¿ Ù· √∂ª, ÙËÓ Î·Ú‰È·ÁÁÂȷ΋ Î·È ÔÏÈ΋ ıÓËÛÈÌfiÙËÙ·, ÂÓÒ Ë ·ÙÂÓÔÏfiÏË Ê·›ÓÂÙ·È fiÙÈ ÂÏ·ÙÙÒÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÙˆÓ ∞∂∂ (RR 0.85, 0.72-1.01). ™Â Û‡ÁÎÚÈÛË Ì ʿÚ̷η ¿ÏÏˆÓ Î·ÙËÁÔÚÈÒÓ Î·È ·Ú¿ ÙËÓ Â›Ù¢ÍË ·ÚfiÌÔÈˆÓ ÂÈ¤‰ˆÓ ∞¶, Ë ·ÙÂÓÔÏfiÏË Û˘Û¯ÂÙ›ÛıËΠ̠ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ÌÂÁ·Ï‡ÙÂÚË ıÓËÛÈÌfiÙËÙ· (RR 1.13, 1.021.25), ·ÏÏ¿ Î·È Î·Ú‰È·ÁÁÂȷ΋ ıÓËÛÈÌfiÙËÙ· (RR 1.16, 1.001.34) Î·È ·˘ÍË̤ÓË Â›ÙˆÛË ∞∂∂ (RR 1.30, 1.12-1.50). ¶·ÚfiÌÔÈ· ·ÔÙÂϤÛÌ·Ù· ÚÔ¤-

΢„·Ó Î·È ·fi ÌÈ· ÌÂÙ·-·Ó¿Ï˘ÛË 10 Ù˘¯·ÈÔÔÈËÌ¤ÓˆÓ ÎÏÈÓÈÎÒÓ ÌÂÏÂÙÒÓ (4 ÌÂٷ͇ ·ÙÂÓÔÏfiÏ˘ Î·È ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘, 5 ÌÂٷ͇ ·ÙÂÓÔÏfiÏ˘ Î·È ¿ÏÏÔ˘ ·ÓÙÈ˘ÂÚÙ·ÛÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ Î·È ÌÈ· ÌÂϤÙË Ô˘ Û˘Ó¤ÎÚÈÓ ÙËÓ ·ÙÂÓÔÏfiÏË ÙfiÛÔ Ì ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ, fiÛÔ Î·È Ì ʿÚÌ·ÎÔ ¿ÏÏ˘ ηÙËÁÔÚ›·˜).28 ¢ÂÓ ·Ú·ÙËÚ‹ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÌÂٷ͇ Ù˘ ·ÙÂÓÔÏfiÏ˘ Î·È ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ Û ηӤӷ ·fi Ù· ÙÂÏÈο ηٷÏËÎÙÈο ÛËÌ›· (∞∂∂, √∂ª, ηډȷÁÁÂȷ΋ ‹ ÔÏÈ΋ ıÓËÛÈÌfiÙËÙ·), ÂÓÒ ·ÓÙ›ıÂÙ· Ë ¯ÔÚ‹ÁËÛË Ù˘ ·ÙÂÓÔÏfiÏ˘ ¤Ó·ÓÙÈ Ê·ÚÌ¿ÎˆÓ ¿ÏÏˆÓ Î·ÙËÁÔÚÈÒÓ Û˘Û¯ÂÙ›ÛıËΠ̠·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ∞∂∂ (RR 1.27, 1.16-1.38; p=0.0004), ηıÒ˜ Î·È Î·Ú‰È·ÁÁÂȷ΋˜ Î·È ÔÏÈ΋˜ ıÓËÛÈÌfiÙËÙ·˜ (RR 1.13, 1.03-1.23; p=0.008 Î·È RR 1.07, 1.01-1.14; p=0.02, ·ÓÙ›ÛÙÔȯ·). Δ¤ÏÔ˜, ·Ú·ÙËÚ‹ıËΠÌÈ· ·˘ÍËÙÈ΋ Ù¿ÛË fiÛÔÓ ·ÊÔÚ¿ Î·È Ù· √∂ª Ì ÙË ¯ÔÚ‹ÁËÛË Ù˘ ·ÙÂÓÔÏfiÏ˘ (RR 1.02, 0.95-1.11; p=0.55). °È· ÙËÓ ÂÚÌËÓ›· ÙˆÓ ‰È·ÊÔÚÂÙÈÎÒÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Ô˘ ·Ú·ÙËÚ‹ıËÎ·Ó ÌÂٷ͇ Ù˘ ·ÙÂÓÔÏfiÏ˘ Î·È ÙˆÓ ˘fiÏÔÈˆÓ ‚-·ÔÎÏÂÈÛÙÒÓ Ú¤ÂÈ Ó· ‰È¢ÎÚÈÓÈÛıÔ‡Ó ÔÈ ‰È·ÊÔÚ¤˜ Ô˘ ˘¿Ú¯Ô˘Ó ÌÂٷ͇ ÙˆÓ Ê·Ú̿ΈÓ. ∏ ·ÙÂÓÔÏfiÏË ÌÂÈÒÓÂÈ Ù· Â›‰·

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

Carlberg et al27 RR (95% CI)

Karagiannis et al28

√ÏÈ΋ ıÓËÛÈÌfiÙËÙ·

1.01 (0.89-1.15)

1.01 (0.84-1.15)

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

0.99 (0.83-1.18)

√∂ª

0.99 (0.83-1.19)

0.99 (0.83-1.19)

∞∂∂

0.85 (0.72-1.01)

0.96 (0.80-1.16)

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

¶›Ó·Î·˜ 4: ∞ÙÂÓÔÏfiÏË ¤Ó·ÓÙÈ ¿ÏÏˆÓ Ê·ÚÌ¿ÎˆÓ ªÂϤÙË

Carlberg et al27 RR (95% CI)

Karagiannis et al28

√ÏÈ΋ ıÓËÛÈÌfiÙËÙ·

1.13 (1.02-1.25)

1.07 (1.01-1.14)

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

1.13 (1.03-1.23)

√∂ª

1.04 (0.89-1.20)

1.02 (0.95-1.11)

∞∂∂

1.30 (1.12-1.50)

1.27 (1.16-1.38)

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

Ù˘ ∞¶ Î·È Ì¿ÏÈÛÙ· ÛÙÔÓ ›‰ÈÔ ‚·ıÌfi Ì ʿÚ̷η ¿ÏÏˆÓ Î·ÙËÁÔÚÈÒÓ, fiˆ˜ ÚÔ·ÙÂÈ ·fi ÌÂÙÚ‹ÛÂȘ Ù˘ ∞¶ ÛÙÔ ‚Ú·¯›ÔÓ·. øÛÙfiÛÔ Â›Ó·È ÁÓˆÛÙfi fiÙÈ Ë ∞¶ ÛÙË ‚Ú·¯ÈfiÓÈ· ·ÚÙËÚ›· ‰ÂÓ ·ÓÙÈηÙÔÙÚ›˙ÂÈ Ì ·ÎÚ›‚ÂÈ· ÙË Û˘ÛÙÔÏÈ΋ ∞¶, Ô‡Ù ·ÔÙÂÏ› ηÏfi ‰Â›ÎÙË Ù˘ ÎÂÓÙÚÈ΋˜ ·ÔÚÙÈ΋˜ Û˘ÛÙÔÏÈ΋˜ ›ÂÛ˘.33 ∂ÈÚfiÛıÂÙ·, ÛÙ· Ó¤· ¿ÙÔÌ· Ë ÎÂÓÙÚÈ΋ ·ÔÚÙÈ΋ Û˘ÛÙÔÏÈ΋ ›ÂÛË Â›Ó·È Ôχ ¯·ÌËÏfiÙÂÚË ·fi ÙË ‚Ú·¯ÈfiÓÈ· ·ÚÙËÚȷ΋ Û˘ÛÙÔÏÈ΋ ›ÂÛË.34 ¶·Ú¿ ÙË Ì›ˆÛË Ù˘ ‚Ú·¯ÈfiÓÈ·˜ ∞¶, Ë ·ÙÂÓÔÏfiÏË ‰ÂÓ ÂÏ·ÙÙÒÓÂÈ ÙËÓ ÎÂÓÙÚÈ΋ ·ÔÚÙÈ΋ Û˘ÛÙÔÏÈ΋ ›ÂÛË ÛÙÔÓ ›‰ÈÔ ‚·ıÌfi Ì ÙÔ˘˜ ·ÓÙ·ÁˆÓÈÛÙ¤˜ ·Û‚ÂÛÙ›Ô˘, ÙÔ˘˜ ·Ó·ÛÙÔÏ›˜ ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘ ππ Î·È ÙËÓ ˘‰ÚԯψÚÔıÂÈ·˙›‰Ë.35 ªÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ Ë Ì›ˆÛË Ù˘ ÎÂÓÙÚÈ΋˜ Î·È fi¯È Ù˘ ‚Ú·¯ÈfiÓÈ·˜ ∞¶, ·ÚÔ˘ÛÈ¿˙ÂÈ ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙËÓ ˘ÔÛÙÚÔÊ‹ Ù˘ ˘ÂÚÙÚÔÊ›·˜ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜.36 ∂Ô̤ӈ˜, Ë ÌÂÁ·Ï‡ÙÂÚË ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙˆÓ ·Ú·¿Óˆ Ê·ÚÌ¿ÎˆÓ ¤Ó·ÓÙÈ Ù˘ ·ÙÂÓÔÏfiÏ˘ fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ÂÏ¿ÙÙˆÛË Ù˘ ˘ÂÚÙÚÔÊ›·˜ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜37 ı· ÌÔÚÔ‡Û ӷ ·Ô‰Ôı› Û ·˘Ù‹ ÙËÓ ·Ú·Ù‹ÚËÛË. ªÈ· ¿ÏÏË ‰È·ÊÔÚ¿ Ù˘ ·ÙÂÓÔÏfiÏ˘ ·fi ÙÔ˘˜ ˘fiÏÔÈÔ˘˜ ‚·ÔÎÏÂÈÛÙ¤˜ Â›Ó·È Ë ˘‰ÚfiÊÈÏË Ê‡ÛË Ù˘ Î·È Ë Ôχ ¯·ÌËÏ‹ ‰È·ÂÚ·ÙfiÙËÙ¿ Ù˘ ÛÙÔ ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ·. ¶ÂÈÚ·Ì·ÙÈΤ˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ Ë ÈηÓfiÙËÙ· ÙˆÓ ‚-·ÔÎÏÂÈÛÙÒÓ Ó· ÚÔÏ·Ì‚¿ÓÔ˘Ó ÙËÓ ÎÔÏÈ΋ Ì·ÚÌ·Ú˘Á‹ ÂÍ·ÚÙ¿Ù·È ·fi Ù· Â›‰¿ ÙÔ˘˜ ÛÙÔ ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ·.38 ™Â ·ÓÙ›ıÂÛË Ì ¿ÏÏÔ˘˜ ‚-·ÔÎÏÂÈÛÙ¤˜ (.¯. ÌÂÙÔÚÔÏfiÏË, ·Î‚ԢÙÔÏfiÏË), Ë ·ÙÂÓÔÏfiÏË ‰ÂÓ Ê·›ÓÂÙ·È Ó· ¤¯ÂÈ ÈηÓÔÔÈËÙÈ΋ 24ˆÚË ‰Ú¿ÛË fiÙ·Ó ¯ÔÚËÁÂ›Ù·È ÌÈ· ÊÔÚ¿ ÙËÓ Ë̤ڷ.39 Δ¤ÏÔ˜, ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ ÔÚÈṲ̂ӷ ·ÓÙÈ˘ÂÚÙ·ÛÈο Ê¿Ú̷η ‚ÂÏÙÈÒÓÔ˘Ó ÙËÓ ·Ó·‰È·ÌfiÚʈÛË (remodelling) Î·È ÙËÓ ÂÓ‰ÔıËÏȷ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ÌÈÎÚÒÓ ·ÚÙËÚÈÒÓ Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È Û ·ÛıÂÓ›˜ Ì ∞À, Â˘Ú‹Ì·Ù· Ô˘ ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ·ÙÂÓÔÏfiÏ˘.40-42 ∫·ı›ÛÙ·Ù·È ÂÔ̤ӈ˜ ۷ʤ˜ fiÙÈ ˘¿Ú¯Ô˘Ó ÔÈΛϘ Î·È ·ÍÈÔÛËÌ›ˆÙ˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ Ù˘ ·ÙÂÓÔÏfiÏ˘ Î·È ÙfiÛÔ ÙˆÓ ¿ÏÏˆÓ Ê·Ú-

27

ATHIROSK 14

03-07-07

12:06

™ÂÏ›‰·28

π√À¡π√™ 2007

Ì¿ÎˆÓ Ù˘ ›‰È·˜ ηÙËÁÔÚ›·˜, fiÛÔ Î·È Ê·ÚÌ¿ÎˆÓ Ô˘ ·Ó‹ÎÔ˘Ó Û ¿ÏϘ ηÙËÁÔڛ˜, ÁÂÁÔÓfi˜ Ô˘ ÌÔÚ› Ó· ÂÚÌËÓ‡ÛÂÈ, ÙÔ˘Ï¿¯ÈÛÙÔÓ ˆ˜ ¤Ó· ‚·ıÌfi, ÙË ‰È·ÊÔÚÂÙÈ΋ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿ ÙÔ˘˜, fiˆ˜ ·˘Ù‹ ηٷÁÚ¿ÊÂÙ·È ÛÙȘ ‰È¿ÊÔÚ˜ ÌÂϤÙ˜.

¶ÏÂÔÓÂÎÙ‹Ì·Ù· Î·È ÌÂÈÔÓÂÎÙ‹Ì·Ù· ÙˆÓ ‚-·ÔÎÏÂÈÛÙÒÓ ¶·Ú¿ ÙȘ ‰ÈÊÔÚÔ‡ÌÂÓ˜ ·fi„ÂȘ fiÛÔÓ ·ÊÔÚ¿ ÙË ¯ÔÚ‹ÁËÛË ÙˆÓ ‚·ÔÎÏÂÈÛÙÒÓ ÛÙËÓ ÚˆÙÔ·ı‹ ∞À, ˘¿Ú¯Ô˘Ó ÔÚÈṲ̂Ó˜ ÎÏÈÓÈΤ˜ ÔÓÙfiÙËÙ˜ ÛÙȘ Ôԛ˜ ÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜ ¤¯Ô˘Ó ·ԉ‰ÂÈÁ̤ÓË ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·. √È ÂÚÈÛÛfiÙÂÚÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜ ÌÂÈÒÓÔ˘Ó ÛËÌ·ÓÙÈο ÙË ÌÂÙÂÌÊÚ·ÁÌ·ÙÈ΋ ıÓËÛÈÌfiÙËÙ· Ì·ÎÚÔÚfiıÂÛÌ·, fiˆ˜ Ê¿ÓËΠ·fi ÌÈ· ÌÂÁ¿ÏË ÌÂÙ·-·Ó¿Ï˘ÛË 31 ÌÂÏÂÙÒÓ (RR 0.77, 0.69-0.85).43 ∂›Û˘ ÚÔÛʤÚÔ˘Ó Û˘Ìو̷ÙÈ΋ ·Ó·ÎÔ‡ÊÈÛË ·fi Ù· ÛÙËı·Á¯Èο ÂÓԯϋ̷ٷ Î·È ¤¯Ô˘Ó ·ÓÙÈ·ıËÚÔÛÎÏËÚˆÙÈ΋ ‰Ú¿ÛË,44 ÂÓÒ Â›Ó·È È‰È·›ÙÂÚ· ¯Ú‹ÛÈÌ· Ê¿Ú̷η Û ·ÛıÂÓ›˜ Ì ∫∞, ·ÊÔ‡ ÂÏ·ÙÙÒÓÔ˘Ó ÙËÓ Î·Ú‰È·ÁÁÂȷ΋ Î·È ÙËÓ ÔÏÈ΋ ıÓËÛÈÌfiÙËÙ·, ÙÔ˘˜ ·ÈÊÓ›‰ÈÔ˘˜ ı·Ó¿ÙÔ˘˜ Î·È ÙȘ ÓÔÛËÏ›˜ ÛÙÔ ÓÔÛÔÎÔÌ›Ô.45-48 ∂Ô̤ӈ˜, Ë ‰Â˘ÙÂÚÔÁÂÓ‹˜ ÚfiÏË„Ë Ù˘ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ (™¡) Î·È Ë ∫∞ ·ÔÙÂÏÔ‡Ó Û·Ê›˜ ÂӉ›ÍÂȘ ¯ÔÚ‹ÁËÛ˘ ÙˆÓ ‚-·ÔÎÏÂÈÛÙÒÓ. ∞ÎfiÌ· Ë ¯ÔÚ‹ÁËÛË ÙˆÓ ‚-·ÔÎÏÂÈÛÙÒÓ ÌÔÚ› Ó· Â›Ó·È È‰È·›ÙÂÚ· ¯Ú‹ÛÈÌË Û ¿ÙÔÌ· Ì ˘ÂÚ‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘ Û˘Ì·ıËÙÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ‹ Ôχ ·Á¯Ò‰Ë, ·ÊÔ‡ ·Ú¿ÏÏËÏ· Ì ÙË Ì›ˆÛË Ù˘ ∞¶ ·˘Ù¿ Ù· Ê¿Ú̷η ·Ú¤¯Ô˘Ó Û˘Ìو̷ÙÈ΋ ·Ó·ÎÔ‡ÊÈÛË. Δ¤ÏÔ˜, Ë ¯ÔÚ‹ÁËÛ‹ ÙÔ˘˜ ÚÈÓ ·fi Ì›˙ÔÓ˜ ·ÁÁÂȷΤ˜ ÂÂÌ‚¿ÛÂȘ Û ·ÛıÂÓ›˜ Ì ÎÏÈÓÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Î·È ·ıÔÏÔÁÈÎfi ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ηډȿ˜ ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË ‰Ô‚Ô˘Ù·Ì›Ó˘ ÌÂÈÒÓÂÈ Ù· ηډȷÁÁÂȷο Û˘Ì‚¿Ì·Ù·,49 ÂÓÒ Ë Û˘Ó¤¯ÈÛË Ù˘ ·ÁˆÁ‹˜ Ì ‚ÈÛÔÚÔÏfiÏË ÁÈ· 2 ¤ÙË ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË ÂÏ·ÙÙÒÓÂÈ ÂÚ·ÈÙ¤Úˆ ÙÔ ı¿Ó·ÙÔ Î·Ú‰È·Î‹˜ ·ÈÙÈÔÏÔÁ›·˜ Î·È Ù· √∂ª.50 π‰È·›ÙÂÚË ·ÓËÛ˘¯›· ¤¯ÂÈ ÚÔηϤÛÂÈ Ë Èı·Ó‹ Û˘Û¯¤ÙÈÛË Ù˘ ·ÁˆÁ‹˜ Ì ‚-·ÔÎÏÂÈÛÙ¤˜ Ì ÙËÓ ÂÌÊ¿ÓÈÛË Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË (™¢) Ù‡Ô˘2. ªÂÁ¿Ï˜ ÌÂϤÙ˜ Ô˘

28

Û˘Ó¤ÎÚÈÓ·Ó ÙÔ˘˜ ‚-·ÔÎÏÂÈÛÙ¤˜ ÙfiÛÔ Ì ʿÚ̷η ¿ÏÏˆÓ Î·ÙËÁÔÚÈÒÓ (·ÓÙ·ÁˆÓÈÛÙ¤˜ ·Û‚ÂÛÙ›Ô˘, ·ÓÙ·ÁˆÓÈÛÙ¤˜ ÙˆÓ ˘Ô‰Ô¯¤ˆÓ Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘ ππ, ·Ó·ÛÙÔÏ›˜ ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘), fiÛÔ Î·È Ì ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ ¤‰ÂÈÍ·Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ÓÂÔÂÌÊ·ÓÈ˙fiÌÂÓÔ ™¢ Ì ÙÔ˘˜ ‚-·ÔÎÏÂÈÛÙ¤˜.14, 15, 51, 52 øÛÙfiÛÔ ‰ÂÓ ¤¯ÂÈ ‰È¢ÎÚÈÓÈÛı› ·Ó Ù· ˘fiÏÔÈ· Ê¿Ú̷η ÚÔÏ·Ì‚¿ÓÔ˘Ó ÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ ™¢ ‹ ·Ó fiÓÙˆ˜ ÔÈ ‚·ÔÎÏÂÈÛÙ¤˜ ‰È·Ù·Ú¿ÛÛÔ˘Ó ÙËÓ ÔÌÔÈÔÛÙ·Û›· Ù˘ ÁÏ˘Îfi˙˘, ȉȷ›ÙÂÚ· fiÙ·Ó Û˘Ó‰˘¿˙ÔÓÙ·È Ì ıÂÈ·˙ȉÈο ‰ÈÔ˘ÚËÙÈο.53 ∞ÚÓËÙÈ΋ Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È Ë Â›‰Ú·ÛË ÙˆÓ ‚-·ÔÎÏÂÈÛÙÒÓ Î·È ÛÙÔ ÌÂÙ·‚ÔÏÈÛÌfi ÙˆÓ ÏÈȉ›ˆÓ.54 √È ‚·ÔÎÏÂÈÛÙ¤˜ ¯ˆÚ›˜ ÂÓ‰ÔÁÂÓ‹ Û˘Ì·ıËÙÈÎÔÌÈÌËÙÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· ·˘Í¿ÓÔ˘Ó Ù· Â›‰· ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ Î·È ÌÂÈÒÓÔ˘Ó ÙË ¯ÔÏËÛÙÂÚfiÏË ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ [high-density lipoprotein (HDL)], ¯ˆÚ›˜ Ó· ÂËÚ¿˙Ô˘Ó ÛËÌ·ÓÙÈο Ù· Â›‰· Ù˘ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ [lowdensity lipoprotein (LDL)].55 √È Î·Ú‰ÈÔÂÎÏÂÎÙÈÎÔ› ‚-·ÔÎÏÂÈÛÙ¤˜ ¤¯Ô˘Ó ÏÈÁfiÙÂÚÔ ·ÚÓËÙÈ΋ Â›‰Ú·ÛË ÛÙÔ ÏÈȉ·ÈÌÈÎfi ÚÔÊ›Ï,56 ÂÓÒ ÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜ Ì ÂÓ‰ÔÁÂÓ‹ Û˘Ì·ıËÙÈÎÔÌÈÌËÙÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· (ÈÓ‰ÔÏfiÏË) ‹ ·ÁÁÂÈԉȷÛÙ·ÏÙÈΤ˜ ȉÈfiÙËÙ˜ (ÛÂÏÈÚÔÏfiÏË) ‰ÂÓ ÂËÚ¿˙Ô˘Ó ÙÔ ÌÂÙ·‚ÔÏÈÛÌfi ÙˆÓ ÏÈȉ›ˆÓ.57, 58 ¶Èı·ÓÒ˜ ÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜ ‰È·Ù·Ú¿ÛÛÔ˘Ó ÙËÓ Ë·ÙÈ΋ Û‡ÓıÂÛË ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ ‹ ÂÏ·ÙÙÒÓÔ˘Ó ÙË ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ÏÈÔÚˆÙÂ˚ÓÈ΋˜ ÏÈ¿Û˘, ÌÂÈÒÓÔÓÙ·˜ ¤ÙÛÈ ÙÔÓ Î·Ù·‚ÔÏÈÛÌfi ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ.59, 60 ∏ ·ÓÂÈı‡ÌËÙË ·˘Ù‹ ÂÓ¤ÚÁÂÈ· ¤¯ÂÈ È‰È·›ÙÂÚË ÎÏÈÓÈ΋ ÛËÌ·Û›·, ·ÊÔ‡ ÔÏÏÔ› ·ÛıÂÓ›˜ ¤¯Ô˘Ó ÙfiÛÔ ∞À, fiÛÔ Î·È ‰˘ÛÏÈȉ·ÈÌ›·, ÁÂÁÔÓfi˜ Ô˘ ÙÔ˘˜ ηıÈÛÙ¿ ¿ÙÔÌ· ˘„ËÏÔ‡ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘. ∂Ô̤ӈ˜, ÔÊ›ÏÔ˘Ì ӷ ÂÈϤÍÔ˘Ì ÙËÓ Î·Ù¿ÏÏËÏË ·ÁˆÁ‹, Ë ÔÔ›· ı· ÂÍ·ÛÊ·Ï›ÛÂÈ Ù· ÂÈı˘ÌËÙ¿ Â›‰· ∞À Î·È LDL-¯ÔÏËÛÙÂÚfiÏ˘ Î·È ÂÔ̤ӈ˜ ı· ÂÏ·ÙÙÒÛÂÈ ÙÔÓ Î›Ó‰˘ÓÔ Î·Ú‰È·ÁÁÂȷ΋˜ ÓfiÛÔ˘. ™ÙËÓ Î·ÙËÁÔÚ›· ÙˆÓ ‚-·ÔÎÏÂÈÛÙÒÓ ·Ó‹ÎÔ˘Ó Î¿ÔÈ· ÓÂfiÙÂÚ· Ê¿Ú̷η Ì ¿ÌÂÛË ·ÁÁÂÈԉȷ-

ÛÙ·ÏÙÈ΋ ‰Ú¿ÛË (ÓÂÌÈ‚ÔÏfiÏË, ηڂÂÓÙÈÏfiÏË, ÛÂÏÈÚÔÏfiÏË). ∞Ó Î·È ‰ÂÓ ¤¯Ô˘Ó Á›ÓÂÈ Ù˘¯·ÈÔÔÈË̤Ó˜ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ∞À Ì ٷ Û˘ÁÎÂÎÚÈ̤ӷ Û΢¿ÛÌ·Ù·, Ê·›ÓÂÙ·È fiÙÈ ·ÔÙÂÏÔ‡Ó ·ÛÊ·Ï‹ Î·È ·ÔÙÂÏÂÛÌ·ÙÈο Ê¿Ú̷η, ΢ڛˆ˜ fï˜ ÁÈ· ÙË ıÂÚ·›· Ù˘ ∫∞ (ȉȷ›ÙÂÚ· Ë Î·Ú‚ÂÓÙÈÏfiÏË). ∂Í·ÈÙ›·˜ Ù˘ ˘ÂÚÔ¯‹˜ ÙˆÓ ˘fiÏÔÈˆÓ ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ¤Ó·ÓÙÈ ÙˆÓ ‚-·ÔÎÏÂÈÛÙÒÓ Â›Ó·È ·›ı·ÓÔ Ó· ۯ‰ȷÛıÔ‡Ó ÌÂϤÙ˜ Û‡ÁÎÚÈÛ˘ ·˘ÙÒÓ ÙˆÓ Ê·ÚÌ¿ÎˆÓ Ì ÂÈÎÔÓÈÎfi ‹ ¿ÏÏÔ Ê¿ÚÌ·ÎÔ. ¶·ÚfiÏ· ·˘Ù¿ Ê·›ÓÂÙ·È fiÙÈ ·˘ÙÔ› ÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜ Û˘ÓÂÈÛʤÚÔ˘Ó ıÂÙÈο Û ‰Â˘ÙÂÚ‡ÔÓÙ· ηٷÏËÎÙÈο ÛËÌ›·, fiˆ˜ Ë ˘ÂÚÙÚÔÊ›· Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜.61 Δ¤ÏÔ˜, Â›Ó·È ÛÎfiÈÌÔ Ó· ÙÔÓÈÛıÔ‡Ó ÔÚÈṲ̂Ó˜ ȉȷÈÙÂÚfiÙËÙ˜ Ô˘ ·ÊÔÚÔ‡Ó ÙÔÓ ÙÚfiÔ ¯ÔÚ‹ÁËÛ˘ ÙˆÓ ‚-·ÔÎÏÂÈÛÙÒÓ. ∏ ·fiÙÔÌË ‰È·ÎÔ‹ ÙÔ˘˜ ··ÈÙ› ȉȷ›ÙÂÚË ÚÔÛÔ¯‹, ÂÍ·ÈÙ›·˜ Ù˘ ·ÓÙ·Ó·ÎÏ·ÛÙÈ΋˜ Ù·¯˘Î·Ú‰›·˜ ‹/Î·È Ù˘ ·‡ÍËÛ˘ Ù˘ ∞¶ Ô˘ ·˘Ù‹ ÌÔÚ› Ó· ÚÔηϤÛÂÈ, ȉȷ›ÙÂÚ· fiÙ·Ó Ù· Ê¿Ú̷η ¯ÔÚËÁÔ‡ÓÙ·È Û ˘„ËϤ˜ ‰fiÛÂȘ, Ì ·ÔÙ¤ÏÂÛÌ· ·ÎfiÌ· Î·È ÙËÓ ÂÌÊ¿ÓÈÛË ÂÓfi˜ √∂ª. ∞Ó ÁÈ· ÔÔÈÔ‰‹ÔÙ ÏfiÁÔ Ú¤ÂÈ Ó· ÛÙ·Ì·Ù‹ÛÂÈ Ë ¯ÔÚ‹ÁËÛ‹ ÙÔ˘˜, ··ÈÙÂ›Ù·È Ë ÛÙ·‰È·Î‹ Ì›ˆÛË Ù˘ ‰fiÛ˘ ÙÔ˘˜ Î·È Ë ·Ú¿ÏÏËÏË ˘ÔηٿÛÙ·ÛË Ì ¿ÏÏÔ ·ÓÙÈ˘ÂÚÙ·ÛÈÎfi Ê¿ÚÌ·ÎÔ. Δ¤ÏÔ˜, Ú¤ÂÈ Ó· ›̷ÛÙ ȉȷ›ÙÂÚ· ÚÔÛÂÎÙÈÎÔ›, ηıfiÛÔÓ ÌÈ· ÌË ÎÏÈÓÈο ¤Î‰ËÏË ™¡ ÌÔÚ› Ó· Û˘ÁÎ·Ï˘Êı› ·fi ÙË ¯ÔÚ‹ÁËÛË ÂÓfi˜ ‚-·ÔÎÏÂÈÛÙ‹.

™˘ÌÂÚ¿ÛÌ·Ù· √È ‚-·ÔÎÏÂÈÛÙ¤˜ ¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈËı› ÁÈ· ÔÏÏ¿ ¯ÚfiÓÈ· ˆ˜ ·ÓÙÈ˘ÂÚÙ·ÛÈο Ê¿Ú̷η ÚÒÙ˘ ÂÈÏÔÁ‹˜. øÛÙfiÛÔ Ù· ÙÂÏÂ˘Ù·›· ¤ÙË ¿Ú¯ÈÛ ӷ ·ÌÊÈÛ‚ËÙÂ›Ù·È Ë ÛËÌ·Û›· ÙÔ˘˜, ΢ڛˆ˜ ÂÍ·ÈÙ›·˜ Ù˘ ˘ÂÚÔ¯‹˜ ÙˆÓ ÓÂfiÙÂÚˆÓ ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ Ê·Ú̿ΈÓ. ¶·ÚfiÏ· ·˘Ù¿, Ë ÔÚÈÛÙÈ΋ Î·È Ï‹Ú˘ ·fiÛ˘ÚÛ‹ ÙÔ˘˜ ·fi ÙË ıÂÚ·¢ÙÈ΋ Ê·Ú¤ÙÚ· ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ∞À ‰ÂÓ Ê·›ÓÂÙ·È Ó· ·ÔÙÂÏ› ÙË ÛˆÛÙ‹ ÂÈÏÔÁ‹. À¿Ú¯Ô˘Ó Û˘ÁÎÂÎÚÈ̤Ó˜ ÔÌ¿‰Â˜ ·ÛıÂÓÒÓ ÔÈ Ôԛ˜ ÌÔÚÔ‡Ó Ó· ·ÔÎÔÌ›ÛÔ˘Ó ÔʤÏË ·fi ÙË ıÂÚ·›· Ì ‚-·ÔÎÏÂÈÛÙ¤˜, fiˆ˜ ÔÈ ·ÛıÂÓ›˜ Ì ™¡ ‹/Î·È ∫∞, ηıÒ˜ Î·È Ó¤· ‹ ·Á¯Ò‰Ë ¿ÙÔÌ· Ì ·ÓÂ›ÏÂÎÙË

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£∂ƒ∞¶∂π∞ - º∞ƒª∞∫∞ ∞À. ¢ÂÓ Ú¤ÂÈ Ó· ͯӿÌ ¿ÏψÛÙ ÙÔ ¯·ÌËÏfi ÎfiÛÙÔ˜ ÙˆÓ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ Ê·Ú̿ΈÓ, ÁÂÁÔÓfi˜ Ô˘ ¤¯ÂÈ ÌÂÁ¿ÏË ÛËÌ·Û›·, ·ÊÔ‡ Ë

·ÓÙÈ˘ÂÚÙ·ÛÈ΋ ·ÁˆÁ‹ ¯ÔÚËÁÂ›Ù·È ‰È· ‚›Ô˘. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ˘ÂÚÙ·ÛÈÎÔ‡ ·ÛıÂÓ‹, fiˆ˜ ‚¤‚·È· Î·È Î¿ı ȷ-

ÙÚÈ΋ Ú¿ÍË, ÔÊ›ÏÂÈ Ó· Á›ÓÂÙ·È Ì ‚¿ÛË ÙȘ ȉȷÈÙÂÚfiÙËÙ˜ ÙÔ˘ οı ·ÙfiÌÔ˘, ÒÛÙ ٷ ÔʤÏË Ó· ˘ÂÚ‚·›ÓÔ˘Ó ÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜.

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O ™ˆÙ‹Ú˘ ¶Ú¿·˜ Â›Ó·È K·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁfi˜, ¢È¢ı˘ÓÙ‹˜ ÙÔ˘ K·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈÎÔ‡ TÌ‹Ì·ÙÔ˜ ÙÔ˘ NÔÛÔÎÔÌ›Ԣ EÚÚ›ÎÔ˜ NÙ˘Ó¿Ó ·fi ÙÔ 2001. °ÂÓÓ‹ıËΠÙÔ 1954 ÛÙÔ ™˘ÎÔ‡ÚÈÔ §¿ÚÈÛ·˜. ™Ô‡‰·Û ÛÙË £ÂÛÛ·ÏÔÓ›ÎË fiÔ˘ Î·È ÔÏÔÎÏ‹ÚˆÛ ÙËÓ ÂȉÈÎfiÙËÙ· Ù˘ K·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈ΋˜ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô «°. ¶··ÓÈÎÔÏ¿Ô˘». MÂÙÂÎ·È‰Â‡ıËΠÛÙÔ Brompton ÙÔ˘ §ÔÓ‰›ÓÔ˘ ηٿ ÙË ‰ÈÂÙ›· 1990-1992 Î·È ÂÚÁ¿ÛÙËΠÛÙÔ øÓ¿ÛÂÈÔ K·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈÎfi K¤ÓÙÚÔ (øKK) ˆ˜ ÂÈÌÂÏËÙ‹˜ A’ ÙËÓ ÔÎÙ·ÂÙ›· 1993-2001.

H ʈÙÔÁÚ·Ê›· ·ÔÙÂÏ› ÁÈ’·˘ÙfiÓ ÌÓ‹ÌË, ·ÊÔ‡ ‹Ïı Û Â·Ê‹ Ì·˙› Ù˘ ·fi Ù· ·È‰Èο ÙÔ˘ ¯ÚfiÓÈ·, ‚ÔËıÒÓÙ·˜ ÙÔÓ ÔÈÎÔ‰fiÌÔ ·Ù¤Ú· Ô˘ ÁÈ· ‚ÈÔÔÚÈÛÙÈÎÔ‡˜ ÏfiÁÔ˘˜ ·ÛÎÔ‡ÛÂ Î·È ÙÔ Â¿ÁÁÂÏÌ· ÙÔ˘ Ï·Ófi‰ÈÔ˘ ʈÙÔÁÚ¿ÊÔ˘. K·Ù¿ ‰Â‡ÙÂÚÔ ÏfiÁÔ ·ÔÙÂÏ› ¯·Ú¿ ‰ËÌÈÔ˘ÚÁ›·˜, ·ÊÔ‡ ‰›ÓÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· ¤ÎÊÚ·Û˘ Ì ٷ ¯ÚÒÌ·Ù·, ÙÔ Êˆ˜, ÙËÓ ·ÈÛıËÙÈ΋ ÙÔ˘ ı¤Ì·ÙÔ˜ Î·È ÙÔ fiÔÈÔ Ì‹Ó˘Ì· ÌÔÚ› Ó· ‰ÒÛÂÈ. Œ¯ÂÈ Û˘ÌÌÂÙ¿Û¯ÂÈ ÛÙËÓ ¤ÎıÂÛË ÊˆÙÔÁÚ·Ê›·˜ ÙˆÓ ÂÚÁ·˙ÔÌ¤ÓˆÓ ÙÔ˘ øKK ÙÔÓ AÚ›ÏÈÔ ÙÔ˘ 1998. ºˆÙÔÁڷʛ˜ ÙÔ˘ ˘¿Ú¯Ô˘Ó ÛÙ· ¤ÓıÂÙ· ÌÔ˘ÛÈÎÒÓ ¤ÚÁˆÓ ÙÔ˘ §. M·¯·ÈÚ›ÙÛ· (TÔ ‰È¿ÏÂÈÌÌ· ÎÚ·Ù¿ÂÈ ‰˘Ô ˙ˆ¤˜) Î·È ÙÔ˘ A. MÈÙ˙¤ÏÔ˘ (BڢͤÏϘ - Live).

out14t

03-07-07

12:28

™ÂÏ›‰·2

EΉ›‰ÂÙ·È ·fi ÙȘ È·ÙÚÈΤ˜ ÂΉfiÛÂȘ “B·ÁÈÔÓ¿ÎË” Ì ¯ÔÚËÁ›· Ù˘ PFIZER HELLAS. OÈ ·fi„ÂȘ ÛÙÔ Î›ÌÂÓÔ ÂÎÊÚ¿˙Ô˘Ó ÌfiÓÔ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Î·È ‰ÂÓ ·ÓÙÈÚÔÛˆÂ‡Ô˘Ó ÙË ¯ÔÚËÁfi ÂÙ·ÈÚ›·.