ΤΕΥΧΟΣ 18 ΙΟΥΝΙΟΣ 2008 - ΑΘΗΡΟΣΚΛΗΡΩΣΗ

Δƒπª∏¡π∞π√ ¶∂ƒπ√¢π∫√ §π¶π¢πø¡

Δ∂ÀÃ√™ 18 ñ π√À¡π√™ 2008

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∞Ó·ÛÎÔ‹ÛÂȘ

∫ÏÈÓÈΤ˜ ªÂϤÙ˜

£ÂÚ·›· - º¿Ú̷η ¢È·ÙÚÔÊ‹

∫·Ù¢ı˘ÓÙ‹ÚȘ √‰ËÁ›Â˜

¶ÚÔÙÂÈÓfiÌÂÓË μÈ‚ÏÈÔÁÚ·Ê›·

À‡ı˘ÓÔ˜ ™‡ÓÙ·Í˘ HÏ›·˜ XÂÈÌÒÓ·˜ K·Ú‰ÈÔÏfiÁÔ˜ YÔÙ¤Ú·Ú¯Ô˜ Â.·.

∞¡∞™∫√¶∏™∂π™ Δ· ÷ÌËÏ¿ ∂›‰· Ù˘ √ÏÈ΋˜ Î·È LDL ÃÔÏËÛÙÂÚfiÏ˘ ∂Á΢ÌÔÓÔ‡Ó ∫ÈÓ‰‡ÓÔ˘˜ ∫·ÚÎÈÓÔÁ¤ÓÂÛ˘;

2

∏Ï›·˜ ÃÂÈÌÒÓ·˜, ∫·Ú‰ÈÔÏfiÁÔ˜

∫§π¡π∫∂™ ª∂§∂Δ∂™ ªÂϤÙË ASCOT-LLA. ∞ÒÙÂÚ· AÔÙÂϤÛÌ·Ù·, 2 XÚfiÓÈ· MÂÙ¿ ÙÔ KÏ›ÛÈÌÔ Ù˘ MÂϤÙ˘.

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ASCOT Investigators Eur Heart J 2008;29:499-508

ªÂϤÙË ENHANCE ¢ÈÔÈÎËÙÈÎfi ™˘Ì‚Ô‡ÏÈÔ ∂ÏÏËÓÈ΋˜ ∂Ù·ÈÚ›·˜ ∞ıËÚÔÛÎÏ‹ÚˆÛ˘ °ÂÓÔ‚¤Ê· KÔÏÔ‚Ô‡ ¶Úfi‰ÚÔ˜ ªˆ˘Û‹˜ ∂ÏÈÛ¿Ê ∞ÓÙÈÚfi‰ÚÔ˜ HÏ›·˜ XÂÈÌÒÓ·˜ °ÂÓÈÎfi˜ °Ú·ÌÌ·Ù¤·˜ ¢ËÌÔÛı¤Ó˘ ¶·Ó·ÁȈٿÎÔ˜ ∂ȉÈÎfi˜ °Ú·ÌÌ·Ù¤·˜ ∂ϤÓË ªÈÏÈ·ÓÔ‡ Δ·Ì›·˜ μ·Û›Ï˘ Õı˘ÚÔ˜ ª¤ÏÔ˜ ª·ÓÒÏ˘ °·ÓˆÙ¿Î˘ ª¤ÏÔ˜ ∞ÛÙ¤ÚÈÔ˜ ∫·Ú·ÁÈ¿ÓÓ˘ ª¤ÏÔ˜

(Ezetimibe aNd Simvastatin in Hypercholesterolemia EnhANCEs Atherosclerosis Regression) ™ÈÌ‚·ÛÙ·Ù›ÓË Ì ‹ ¯ˆÚ›˜ ∂˙ÂÙÈÌ›ÌË ÛÂ Û˘ÁÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· ENHANCE Investigators. N. Engl J Med 2008 Apr 3;358(14):1431-43.

£EPA¶EIA — ºAPMAKA ºÈÌÚ¿Ù˜: ∞ÁˆÁ‹ μ·ÛÈṲ̂ÓË Û ∂Ӊ›ÍÂȘ ·fi Ù· ∞ÔÙÂϤÛÌ·Ù· ªÂÁ¿ÏˆÓ ¶ÚÔÔÙÈÎÒÓ ∫ÏÈÓÈÎÒÓ ªÂÏÂÙÒÓ

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∂˘¿ÁÁÂÏÔ˜ §˘ÌÂÚfiÔ˘ÏÔ˜, §¤ÎÙÔÚ·˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ ªˆ˘Û‹˜ ∂ÏÈÛ¿Ê, ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ

‚-·ÔÎÏÂÈÛÙ¤˜ Î·È ∫·Ú‰È·Î‹ ∞ÓÂ¿ÚÎÂÈ·.

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∞. ¶··ı·Ó·Û›Ô˘, ∫·Ú‰ÈÔÏfiÁÔ˜, ∂ÍÂȉÈ΢fiÌÂÓÔ˜ ∂ÓÙ·ÙÈÎÔÏÔÁ›·˜, ª∂£ ¶°¡ πˆ·ÓÓ›ÓˆÓ π. °Ô˘‰¤‚ÂÓÔ˜, ∫·ıËÁËÙ‹˜ ∫·Ú‰ÈÔÏÔÁ›·˜, ∫·Ú‰ÈÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ¶°¡ πˆ·ÓÓ›ÓˆÓ

∏ ™˘ÌÌfiÚʈÛË ÙˆÓ ∞ÛıÂÓÒÓ ÛÙËÓ ÀÔÏÈȉ·ÈÌÈ΋ ∞ÁˆÁ‹ Î·È ÔÈ ∂ÈÙÒÛÂȘ Ù˘ ÛÙËÓ ∫·Ú‰È·ÁÁÂȷ΋ ¡ÔÛËÚfiÙËÙ· Î·È £ÓËÙfiÙËÙ·.

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ª. ºÏˆÚÂÓÙ›Ó, ∂ÈÛÙËÌÔÓÈÎfi˜ ™˘ÓÂÚÁ¿Ù˘ ∂. §˘ÌÂÚfiÔ˘ÏÔ˜, §¤ÎÙÔÚ·˜ ¶·ıÔÏÔÁ›·˜, π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ ªˆ˘Û‹˜ ∂ÏÈÛ¿Ê, ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜, π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ ΔÔ̤·˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ

¢π∞Δƒ√º∏ ¶ÚˆÙ½ÓË ™fiÁÈ·˜, πÛÔÊÏ·‚fiÓ˜ Î·È ∫·Ú‰È·ÁÁÂȷ΋ ¡fiÛÔ˜

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ÃÚ‹ÛÙÔ˜ ¢ÂÚ‰Â̤˙˘, ∫ÏÈÓÈÎfi˜ ¢È·ÈÙÔÏfiÁÔ˜ -¢È·ÙÚÔÊÔÏfiÁÔ˜, ∂ÈÛÙËÌÔÓÈÎfi˜ Û˘ÓÂÚÁ¿Ù˘ ÙÔ˘ ∂͈ÙÂÚÈÎÔ‡ π·ÙÚ›Ԣ ¢È·Ù·Ú·¯ÒÓ ÙÔ˘ ªÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ §Èȉ›ˆÓ Î·È ¶·¯˘Û·ÚΛ·˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ πˆ·ÓÓ›ÓˆÓ ªˆ˘Û‹˜ ∂ÏÈÛ¿Ê, ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ ΔÔ̤·˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ

μ·Û›Ï˘ ¡ÈÎÔÏ¿Ô˘ ª¤ÏÔ˜

∏ ∂›‰Ú·ÛË Ù˘ ∫·Ù·Ó¿ÏˆÛ˘ ∂Ï·ÈÔÏ¿‰Ô˘ ÛÙËÓ ¶Èı·ÓfiÙËÙ· √ͤԘ ™ÙÂÊ·ÓÈ·›Ô˘ ™˘Ó‰ÚfiÌÔ˘. ªÂϤÙË ∞ÛıÂÓÒÓ-ª·ÚÙ‡ÚˆÓ CARDIO2000.

ÃÚ‹ÛÙÔ˜ ¶›ÙÛ·‚Ô˜ ª¤ÏÔ˜

¢. °ÚËÁÔÚÔÔ‡ÏÔ˘1, ¢. ¶·Ó·ÁȈٿÎÔ˜1, ª. ∫ÔÓÙÔÁÈ¿ÓÓË1, Ã. ÃÚ˘ÛÔ¯fiÔ˘2, Ã. ¶›ÙÛ·‚Ô˜2, Ã. ™ÙÂÊ·Ó¿‰Ë˜2.

1 ΔÌ‹Ì· ∂ÈÛÙ‹Ì˘ ¢È·ÙÚÔÊ‹˜- ¢È·ÈÙÔÏÔÁ›·˜, ÷ÚÔÎfiÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ 2 ∞’ ∫·Ú‰ÈÔÏÔÁÈ΋ ∫ÏÈÓÈ΋, π·ÙÚÈ΋ ™¯ÔÏ‹ ∞ıËÓÒÓ.

∞ϤͷӉÚÔ˜ ΔÛÂϤ˘ ª¤ÏÔ˜

8

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∫∞Δ∂À£À¡Δ∏ƒπ∂™ √¢∏°π∂™ ∫·Ù¢ı˘ÓÙ‹ÚȘ √‰ËÁ›Â˜ ÁÈ· ÙËÓ ∞ÛÙ·ı‹ ™ÙËı¿Á¯Ë Î·È ÙÔ ∂ÌÊÚ·ÁÌ· ª˘Ôηډ›Ô˘ Èڛ˜ ∞Ó¿Û·ÛË ÙÔ˘ ¢È·ÛÙ‹Ì·ÙÔ˜ ST

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°Ô˘ÓfiÔ˘ÏÔ˜ ¶·ÓÙÂÏ‹˜, ∫·Ú‰ÈÔÏfiÁÔ˜ °Ô˘‰¤‚ÂÓÔ˜ °È¿ÓÓ˘, ∫·ıËÁËÙ‹˜ ∫·Ú‰ÈÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ πˆ·ÓÓ›ÓˆÓ ∫·Ú‰ÈÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ π·ÙÚÈ΋ ™¯ÔÏ‹ πˆ·ÓÓ›ÓˆÓ

¶POTEINOMENH BIB§IO°PAºIA

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È Ì ¯ÂÙ›˙ÔÓÙ· Û ˜ ˆ Ó ¤ Ì . Δ· ÂÓ‰Â¯Ô È΋ ‰Ú¿ÛË ÙÂÚfiÏ˘ Ù Û ˘ Ë Â Ï Ù Ô · ¯ Ù Û L Ô È LD Ó Ú ÎÔ›Ûˆ˜ ¤¯Ô˘ ÔÏÈ΋˜ η ASCOT ÂÍ· ˜ ˜ Ë ˆ Ë Ù Ì Ù ¤ fi Ï Â · ˜ Ì ‰ Â Â Ë ˜ ÛÙ ÛÙ·Ù›Ó ·Ú¿ ¿ Â› ÌÂϤÙ˘, ‚·ÛÙ·Ù›ÓË Î›ÓÔ˘, ÔÈ Δ· ¯·ÌËÏ Ú Ú ˜ Ô · Ë Ù Î Ù · Ë fi ˜ Û Ì È Ë Û Ó È Ù ·Ù›¿Û˘ ÂÚÌ·Ù Ë ÂÌÊ¿ · ·˘Ùfi ÛÙ ÂÙ¿ ÙÔÓ Ù Û˘¯ÓfiÙÂÚ Ù· Ù˘ ‰Ú Ì Ì Ë · Ù Ì Ë Û Û Ù ¤ ¿ ¤ È Ï ‰  2 Ù Ó ÛÙÔ ÈÛÙÔÓ ¿ ·Ô ·Ù›Ó˘ ÂÏ¿Ì‚·Ó· ·È ÙÔ˘Ï¿¯ ¢ÂÚÁÂÙÈÎ -ÛÈÌ‚·ÛÙ Ù Ó Ó Ò ˜ ‡ Ó Ë Ô Â  Ú ı Ì Ë Û › Ù Ì · È · Ó· ‰È ڈٛ˜ ÙˆÓ fi˜ Â˙ÂÙ · ÙˆÓ Î· ÏÔ‡ıËÛ·Ó ‰‡Ô ÔÌ¿‰ Ó Û˘Ó‰˘·ÛÌ Ò È Ù Ô Ô È ¯ È E · C ˆ Î N Û È A ˜ fiÙ ÛÔ˘-¤ ÙÂÚfiË ENH ÙÔ ÁÂÁÔÓfi DL-¯ÔÏËÛ Ô˜ ÙÔ˘ ̤ ™ÙË ÌÂϤ٠L ¯ ¿ . ˜  fi Ë Ù Ù Ô Û Ù Ë Ô Û Û Û Ì›ˆ ÂÏÔ˜ ÈÔ Ô Â ÔÚÈÓ˜ Û ›‰ ÂÁ·Ï‡ÙÂÚË Ï‡ÙÂÚÔ fiÊ ¿Ú̷η Û Ì · Ê Á Ë Â Ù ¿ Ì Î ¿ È È Ú Â Ì È · ›Í ∏ ·  · ‰Â ˘ÔÏÈȉ fiÓË Ù˘, ÛÙÂÚfiÏË. Ì · Ë Ï Ì Ë È Ô Û ·¤Ù˘¯Â Ó ¯ ›Ó ‹ Ù Ú L · ¯ Ù D ÂÏÔ‡Ó ÌËÏ‹ H ËÓ ÛÈÌ‚·Û ÔÙ¤ÏÂÛÌ· Ù˜ ·ÔÙ · Î·È ¯· · ¿ È Ú Â ›‰  Ì ‰ˆÓ ·fi Ù Ú Ì È ,  ˜ Ê Î ‹ ˘ È  Ï È ÂÏÏÈ ˆÓ ¿ ÙÚÈÁ ˘ CRP. √ ÁˆÁ‹ ›ӷ Û˘ÛÙËÌ¿Ù Ó Ì ˘„ËÏ · Ò Ó ‹ Ó ˆ Ï˘ Î·È Ù Î Â Ù È ı Ì Û È Ë · · Û Èȉ ¿Ú˘Ó Ë ÙËÁÔڛ˜ ÛÙËÓ ˘ÔÏ ÌÈ΋ ÂÈ‚ ÙÈÌÂÙÒÈÛ Ô Ó Ó Ó Ò · Ô Ó Â Î Ṳ̂Ó˜ η ‹ È ı Î Ô Û È Ù · Ó ˘ Ë Ó · ÚÌ·ÎÂ Î·È Ù ÛË ÔÏÏÒ Ë ÛÙË Ê· Ù· Â›‰ Û˘ ÙˆÓ Û Û ˆ ¤ Ó È ı Á Â Û˘ÌÌfiÚʈ fi ¯ ‹ Ú ¤ Î  È Ë Ù ›‰Ú·Û ÛËÌ·Ó È›ÓˆÛË Ù˘ ¿¯ÈÛÙË Â ·È ÙˆÓ ÙÚ Î·Ù¤¯Ô˘Ó Ï Î Â ˜ ˜ ¤ ÙËÓ Âȉ ˜ Ë Ù Ï · Û È È fi Á Â Ú fi Ï Â ÔÏËÛÙ Â˝ÓË Û È ‚-·ÔÎ ÌÔÚ› Ó· ˘ HDL-¯ ˜ ∏ ÚˆÙ Ù · ›· È ·   ˘Á›·˜. √ ‰ Ú Î È Â Ú ·  ¿ › Ù   ∂  ÁÈ΋ ÛË ‹ ÛÙ·  ȷ΋˜ ·Ó ∫·Ú‰ÈÔÏÔ ÛÙÈ΋ ¯Ú‹ È Ìˉ·ÌÈÓ ‹ È Â Î · È Ï Ù˘ ηډ Î Ó Î · ˜ Ô Î Ë  È Ï · Ú fi ˘ ¿. ∏ ËÓ ∞Ì ¯ÔÏËÛÙÂÚ ÂÂÈÛÔ‰›Ô ¿ ηٿ Ù ¤Ó· ÏÈ·Ú ˘ Ù Ì ˘ Û ›Ô Ù˘ LDL · · Ú È · Ô Ó Ï Î · fi Ê ˜ ÛÙÂ ÙˆÓ Ï‹˜ Û Ó. ¶·Ú' ËÙ· ÔÍ¤Ô Ê‹˜ ¯·ÌË ÂÚ›ÏË„Ë Ù Ô È fi ÁÏ˘ÎÂÚȉ›ˆ Ú Ó · Ù Ù · ·  ı È È Ó ‰  ¿ ‚ ÈÏ·Ì ÙÂÚË ˆÂÈ ÙÌ‹Ì· Ì ÌÈÎÚfi ‡¯Ô˜ ÂÚ ÈÛÔ‰›ˆÓ ¯  ٠  ·ÔÙÂÏ¤Û Ô Â Î Ù Ë Ó ı fi ›ˆ ›Û Ù · Ù ˘ È Â Û · ÙÂÊ·Ó ˘ Û˘Û¯ ›˜. Δ¤ÏÔ˜ Ó ÔͤˆÓ Û Ó ˆ  ÂÏ·ÈÔÏ¿‰Ô Ù ı Û Ë · Û È ˜  ‡ Ò ÙÈÌÂÙ ÚÙ·ÛÈÎÔ È· ÙËÓ ·Ó Á ÛÙÔ˘˜ ˘Â Ó Ò È Á Ë ‰ ËÚ›ˆÓ Ô Î·Ù¢ı˘ÓÙ ÃÂÈÌÒÓ·˜ ˜ · › .

T Ï S ∏ Ô Ù ·ÛË ˜ Ú›˜ ·Ó¿Û ˜ ™‡ÓÙ·ÍË

Ù·ÍË Ó ‡ ™ ˜ Ë T

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Y‡ı˘ÓÔ

π√À¡π√™ 2008

Δ· ÷ÌËÏ¿ ∂›‰· Ù˘ √ÏÈ΋˜ Î·È LDL ÃÔÏËÛÙÂÚfiÏ˘ ∂Á΢ÌÔÓÔ‡Ó ∫ÈÓ‰‡ÓÔ˘˜ ∫·ÚÎÈÓÔÁ¤ÓÂÛ˘; ∏Ï›·˜ ÃÂÈÌÒÓ·˜, ∫·Ú‰ÈÔÏfiÁÔ˜

√È ÓÂfiÙÂÚ˜ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ ıÂÚ·›·˜ ÙˆÓ ˘ÂÚÏÈȉ·ÈÌÈÒÓ Ì ÛÙ·Ù›Ó˜ ¤¯Ô˘Ó Ô‰ËÁ‹ÛÂÈ ÛÙËÓ ·ÓÙ›ÏË„Ë fiÙÈ «fiÛÔ ¯·ÌËÏfiÙÂÚ· Ë LDL-¯ÔÏËÛÙÂÚfiÏË, ÙfiÛÔ Î·Ï‡ÙÂÚ·». √È ÚfiÛÊ·Ù˜ ∂˘Úˆ·˚Τ˜ Ô‰ËÁ›Â˜ ÚfiÏ˄˘ ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ1 Û˘ÓÈÛÙÔ‡Ó ÁÈ· ÙËÓ ‰Â˘ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë, Û ¿ÙÔÌ· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, ÙÈÌ‹ ÛÙfi¯Ô ÁÈ· ÙËÓ LDL-¯ÔÏËÛÙÂÚfiÏË <80 mg/dl Î·È ÔÈ ·Ó·ıˆÚË̤Ó˜ ÙÔ 2004 ∞ÌÂÚÈοÓÈΘ Ô‰ËÁ›Â˜ (NCEP-ATP III)2 ÂÈı˘ÌËÙ‹ ÙÈÌ‹ ÁÈ· Ù· ›‰È· ¿ÙÔÌ· <70 mg/dl. ∏ ÂÈÛ·ÁˆÁ‹ ÛÙË ıÂÚ·¢ÙÈ΋ ÈÛ¯˘ÚÒÓ ˘ÔÏÈȉ·ÈÌÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ¤¯ÂÈ Î·Ù·ÛÙ‹ÛÂÈ ÂÊÈÎÙÔ‡˜ ÙÔ˘˜ ·ÓˆÙ¤Úˆ ÛÙfi¯Ô˘˜ Î·È ÔÏÏ¿ ¿ÙÔÌ· Êı¿ÓÔ˘Ó Û ÂÍ·ÈÚÂÙÈο ¯·ÌËϤ˜ ÙÈ̤˜ ÔÏÈ΋˜ Î·È LDL-¯ÔÏËÛÙÂÚfiÏ˘. ™ÙË ÌÂϤÙË PROVE IT- TIMI 22 ÙÔ 41,9% ÙˆÓ ·ÛıÂÓÒÓ ÛÙÔ ÛΤÏÔ˜ Ù˘ ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ ¤Êı·Û Û ÙÈ̤˜ LDL-¯ÔÏËÛÙÂÚfiÏ˘ ≤60 mg/dl Î·È ÙÔ 10,5% Û ÙÈ̤˜ ≤40 mg/dl3. ∂Âȉ‹ Ë ¯ÔÏËÛÙÂÚfiÏË Â›Ó·È Ô˘Û›· ··Ú·›ÙËÙË ÁÈ· ÙË ‰ÔÌ‹ Î·È ÙË ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ˙ˆÈÎÒÓ Î˘ÙÙ¿ÚˆÓ, ÛÙ· ÔÔ›· ÂÈÙÂÏ› ÛÔ˘‰·›Â˜ ‚ÈÔÏÔÁÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜, ÁÂÓÓ¿Ù·È Ô Êfi‚Ô˜, Ì‹ˆ˜ Ë ÌÂÁ¿ÏË Ì›ˆÛË Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ÌÔÚ› Ó· ÚÔηϤÛÂÈ ‚Ï¿‚Ë ¶ÔÏϤ˜ ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ, ÂÓÒ Ë Û˘Û¯¤ÙÈÛË ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ÎÈÓ‰‡ÓÔ˘ ηډȷÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ Â›Ó·È ÁÚ·ÌÌÈ΋, ¯ˆÚ›˜ ¢‰È¿ÎÚÈÙÔ Ô˘‰fi, οو ÙÔ˘ ÔÔ›Ô˘ Ó· ÌË ·Ú·ÙËÚÂ›Ù·È Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘, Ë Û˘Û¯¤ÙÈÛË Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ Ì ÙËÓ ÔÏÈ΋ ıÓËÛÈÌfiÙËÙ· ¤¯ÂÈ Û¯‹Ì· J ‹ U, ‰ËÏ·‰‹ Ù· ¿ÙÔÌ· Ô˘ ¢ڛÛÎÔÓÙ·È ÛÙ· ηÙÒÙÂÚ· ÂηÙÔÛÙËÌfiÚÈ· Ù˘ Û˘ÁΤÓÙÚˆÛ˘ ¯ÔÏËÛÙÂÚfiÏ˘ ¤¯Ô˘Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ·fi ÌË Î·Ú‰È·ÁÁÂȷο ÓÔÛ‹Ì·Ù·4,5,6,7,8,9. ŒÓ· ̤ÚÔ˜ ÙˆÓ ÌË Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ı·Ó¿ÙˆÓ ÔÊ›ÏÔÓÙ·È Û ‰È·ÊfiÚÔ˘˜ Ù‡-

2

Ô˘˜ ηÚΛÓÔ˘, ΢ڛˆ˜ ÙÔ˘ Ó‡ÌÔÓÔ˜, ÙÔ˘ ·ÈÌÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘. ∏ ÌÂϤÙË ÙˆÓ 7 ¯ˆÚÒÓ ¤‰ÂÈÍ ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ Î·ÚΛÓÔ˘ ÙÔ˘ Ó‡ÌÔÓÔ˜ ÛÙÔ Î·ÙÒÙÂÚÔ 20% Ù˘ ηٷÓÔÌ‹˜ Ù˘ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ‰È¤ÎÚÈÓ ˆ˜ ηÙÒÊÏÈ Î¿Ùˆ ÙÔ˘ ÔÔ›Ô˘ Ô Î›Ó‰˘ÓÔ˜ Â›Ó·È ·˘ÍË̤ÓÔ˜ ÙËÓ ÙÈÌ‹ ÙˆÓ 170 mg/dl10. ÕÏϘ ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ fï˜ ‰ÂÓ ¤‰ÂÈÍ·Ó ·˘ÍË̤ÓË Î·ÚÎÈÓÔÁ¤ÓÂÛË ‹ Â͈ηډȷÎÔ‡˜ ı·Ó¿ÙÔ˘˜ Û ¯·ÌËϤ˜ ÙÈ̤˜ ¯ÔÏËÛÙÂÚfiÏ˘11,12. ∂Í ¿ÏÏÔ˘ ·Ú·ÙËÚ‹ÛÂȘ Û ÏËı˘ÛÌÔ‡˜, ÙˆÓ ÔÔ›ˆÓ Ë ‰›·ÈÙ· Â›Ó·È È‰È·›ÙÂÚ· Ùˆ¯‹ Û ÏÈ·Ú¿ Î·È ¤¯Ô˘Ó ̤ÛË ÙÈÌ‹ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ Á‡Úˆ ÛÙ· 160 mg/dl ‰ÂÓ ¤¯Ô˘Ó ·˘ÍË̤ÓË ıÓËÛÈÌfiÙËÙ· ·fi ηÚΛÓÔ˘˜13. ™Â Û˘ÁÁÂÓ‹ ÓÔÛ‹Ì·Ù·, fiˆ˜ Ë ˘Ô‚ËÙ·ÏÈÔÚˆÙÂ˚Ó·ÈÌ›·, ÛÙ· ÔÔ›· Ë ÔÏÈ΋ Î·È Ë LDL¯ÔÏËÛÙÂÚfiÏË ¤¯Ô˘Ó ȉȷ›ÙÂÚ· ¯·ÌËϤ˜ ÙÈ̤˜, ‰ÂÓ ·Ú·ÙËÚÔ‡ÓÙ·È ·˘ÍË̤ÓÔÈ ı¿Ó·ÙÔÈ ·fi ηÚΛÓÔ˘˜, ·Ó Î·È ·Ú·ÙËÚÔ‡ÓÙ·È Ó¢ÚÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜ Î·È ·ı‹ÛÂȘ ·fi ‰˘Û·ÔÚÚfiÊËÛË ÙÔ˘ Ï›Ô˘˜14. °È ·˘Ùfi Â› ÔÏÏ¿ ¯ÚfiÓÈ· ˘‹ÚÍ ¤ÓÙÔÓË ‰È¯ÔÁӈ̛· Î·È ÔÏÏÔ› ÂÚ¢ÓËÙ¤˜ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ ‰ÂÓ Â›Ó·È Ë ¯·ÌËÏ‹ ¯ÔÏËÛÙÂÚfiÏË Ô˘ ¢ı‡ÓÂÙ·È ÁÈ· ÙÔ˘˜ ·˘ÍË̤ÓÔ˘˜ ηÚΛÓÔ˘˜ Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙȘ ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ·ÏÏ¿ fiÙÈ Ë ‡·ÚÍË ÚÔÎÏÈÓÈÎÔ‡ ηÚΛÓÔ˘ ÚÔηÏ› Ù· ÌÂȈ̤ӷ Â›‰· ¯ÔÏËÛÙÂÚfiÏ˘. ™Â ·˘Ùfi Û˘ÓËÁÔÚ› Ë ·Ú·Ù‹ÚËÛË fiÙÈ Ù· ÂÚÈÛÛfiÙÂÚ· ÂÚÈÛÙ·ÙÈο ηÚΛÓÔ˘ ÂÌÊ·Ó›˙ÔÓÙ·È Ù· ÚÒÙ· ¯ÚfiÓÈ· ·fi ÙËÓ ¤Ó·ÚÍË Î¿ı ÌÂϤÙ˘. ∏ MRFIT ¤‰ÂÈÍ ÛËÌ·ÓÙÈο ·˘ÍË̤ÓÔ˘˜ ı·Ó¿ÙÔ˘˜ ·fi ηÚΛÓÔ ÙÔ˘ Ó‡ÌÔÓÔ˜ ÛÙ· ¿ÙÔÌ· Ì ¯·ÌËÏ‹ ¯ÔÏËÛÙÂÚfiÏË Î·Ù¿ Ù· ÚÒÙ· 5 ¤ÙË ·Ú·ÎÔÏÔ‡ıËÛ˘ ÙˆÓ 361.662 ·ÛıÂÓÒÓ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û ÚÒÙË ÂͤٷÛË Î·È Ë ‰È·ÊÔÚ¿

ÌÂÈÒıËΠ̠ÙËÓ ¿ÚÔ‰Ô ÙˆÓ ÂÙÒÓ7. °È· ‰È¢ÎÚ›ÓËÛË Ù˘ Û‡Á¯˘Û˘ ÙÔ NHLBI ÔÚÁ¿ÓˆÛ ÙÔ 1990 ÌÈ· Û˘Ó‰È¿ÛÎÂ„Ë (conference) ÛÙËÓ ÔÔ›· ÎÏ‹ıËÎ·Ó ÂÎÚfiÛˆÔÈ ·fi ÙȘ ÂÚ¢ÓËÙÈΤ˜ ÔÌ¿‰Â˜ 20 ÏËı˘ÛÌÈ·ÎÒÓ ÂȉËÌÈÔÏÔÁÈÎÒÓ ÌÂÏÂÙÒÓ Î·È ·ÚÔ˘Û›·Û·Ó Ù· Â˘Ú‹Ì·Ù· ÙÔ˘˜. ∞ÎÔÏÔ‡ıËÛ ·Ó¿Ï˘ÛË ÙˆÓ ÌÂÏÂÙÒÓ ˘fi ÙË ‰È‡ı˘ÓÛË ÙÔ˘ D. Jacobs, ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ Ù˘ ªÈÓÂÛÛfiÙ·15. √ ¯ÚfiÓÔ˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÙˆÓ ÏËı˘ÛÌÒÓ Î˘Ì·ÈÓfiÙ·Ó ·fi 9 ¤ˆ˜ 30 ¯ÚfiÓÈ·. °È· Ó· ·ÔÎÏÂÈÛı› ÙÔ ÂӉ¯fiÌÂÓÔ ·Ó¿ÛÙÚÔÊ˘ Û˘Û¯¤ÙÈÛ˘, Ó· ÔÊ›ÏÂÙ·È ‰ËÏ·‰‹ Ë ¯·ÌËÏ‹ ¯ÔÏËÛÙÂÚfiÏË Û ‡·ÚÍË ÚÔÎÏÈÓÈÎÔ‡ ηÚΛÓÔ˘ Î·È fi¯È Ô Î·ÚΛÓÔ˜ ÛÙË ¯·ÌËÏ‹ ¯ÔÏËÛÙÂÚfiÏË, ÂÍ·ÈÚ¤ıËÎ·Ó ·fi ÙËÓ ·Ó¿Ï˘ÛË ÔÈ ı¿Ó·ÙÔÈ Ô˘ Û˘Ó¤‚ËÛ·Ó Ù· ÚÒÙ· 5 ¯ÚfiÓÈ· οı ÌÂϤÙ˘. ∏ ·Ó¿Ï˘ÛË ¤‰ÂÈÍ fiÙÈ ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË < 160 mg/dl Û¯ÂÙ›˙ÂÙ·È Ì ·‡ÍËÛË Î·Ù¿ 14-22% Ù˘ ÔÏÈ΋˜ ıÓËÛÈÌfiÙËÙ·˜ Î·È Î·Ù¿ 18-23% ÙˆÓ ı·Ó¿ÙˆÓ ·fi ηÚΛÓÔ˘˜, Û˘ÁÎÚÈÙÈο Ì ÙÔ˘˜ ı·Ó¿ÙÔ˘˜ ÛÙ· Â›‰· ¯ÔÏËÛÙÂÚfiÏ˘ 160-199 mg/dl. √È ÌÔÚʤ˜ ÙÔ˘ ηÚΛÓÔ˘ ‹Ù·Ó ÙÔ˘ Ó‡ÌÔÓ·, ÙÔ˘ ‹·ÙÔ˜ Î·È ÙÔ˘ ·ÈÌÔÔÈËÙÈÎÔ‡ Î·È ÏÂÌÊÈÎÔ‡ ÈÛÙÔ‡, ÂÓÒ ‰ÂÓ ·Ú·ÙËÚ‹ıËΠ‰È·ÊÔÚ¿ ÛÙÔ˘˜ ηÚΛÓÔ˘˜ Ì·ÛÙÔ‡ ‹ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘. ¶·Ú¿ Ù· Â˘Ú‹Ì·Ù· ·˘Ù¿ ÂÍ·ÎÔÏÔ˘ıÔ‡Û ӷ ·Ú·Ì¤ÓÂÈ ÙÔ ÂÚÒÙËÌ· ·Ó Û˘Á¯˘ÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ fiˆ˜ Ô ÙÚfiÔ˜ ˙ˆ‹˜ (οÓÈÛÌ·, ¯Ú‹ÛË ·ÏÎÔfiÏ), ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈ΋ ηٿÛÙ·ÛË, ËÏÈΛ·, ÌÔÚ› Ó· ¢ı‡ÓÔÓÙ·È Ù·˘Ùfi¯ÚÔÓ· ÁÈ· Ù· ¯·ÌËÏ¿ Â›‰· ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ÙËÓ ·˘ÍË̤ÓË ıÓËÛÈÌfiÙËÙ·16,17. √È ·Ï·ÈfiÙÂÚ˜, ÚÔ Ù˘ ÂÔ¯‹˜ ÙˆÓ ÛÙ·ÙÈÓÒÓ, ·ÚÂÌ‚·ÙÈΤ˜ ÌÂϤÙ˜ ÂÏ¿ÙÙˆÛ˘ ÙˆÓ ÏÈȉ›ˆÓ18,19,20,21, ·Ú¿ ÙË Ì›ˆÛË ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ı·Ó¿ÙˆÓ, ‰ÂÓ ¤‰ÂÈÍ·Ó Ì›ˆÛË Ù˘ ÔÏÈ΋˜ ıÓË-

∞¡∞™∫√¶∏™∂π™ ÛÈÌfiÙËÙ·˜, ÏfiÁˆ ·‡ÍËÛ˘ ÙˆÓ Â͈ηډȷÁÁÂÈ·ÎÒÓ ı·Ó¿ÙˆÓ. √È ÌÂÁ¿Ï˜ fï˜ Ù˘¯·ÈÔÔÈË̤Ó˜ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ Ì ÛÙ·Ù›Ó˜, fiϘ ÏËÓ Ù˘ PROSPER22 ¤‰ÂÈÍ·Ó Ì›ˆÛË Î·È Ù˘ ÔÏÈ΋˜ ıÓËÛÈÌfiÙËÙ·˜ Î·È ‰ÂÓ ‰È·›ÛÙˆÛ·Ó ‰È·ÊÔÚ¿ ÛÙ· ÂÚÈÛÙ·ÙÈο Ó¤ˆÓ ηÚÎ›ÓˆÓ ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ ıÂÚ·›·˜ Î·È ÂϤÁ¯Ô˘23. ∞ÎfiÌË Î·È ÌÂÙ¿ Ì·ÎÚfi¯ÚÔÓË ·Ú·ÎÔÏÔ‡ıËÛË ÛÙË ÌÂϤÙË WOSCOPS ‰ÂÓ ·Ú·ÙËÚ‹ıËΠ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ηÚΛÓÔ˘ ÛÙËÓ ÔÌ¿‰· ıÂÚ·›·˜ Û˘ÁÎÚÈÙÈο Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘24. ¢ÂÓ ·Ó·˙ËÙ‹ıËΠfï˜ ÛÙȘ ÌÂϤÙ˜ ·˘Ù¤˜ ·Ó ˘‹Ú¯Â ‰È·ÊÔÚ¿ ÛÙË Û˘¯ÓfiÙËÙ· ηÚΛÓÔ˘ ÛÙ· ¿ÙÔÌ· Ì ÙË ¯·ÌËÏfiÙÂÚË ¯ÔÏËÛÙÂÚfiÏË Û˘ÁÎÚÈÙÈο Ì ٷ ¿ÙÔÌ· Ì ÙȘ ˘„ËÏfiÙÂÚ˜ ÙÈ̤˜. ™ÙËÓ ˘ÔÌÂϤÙË Ù˘ PROVE IT- TIMI 223, ÛÙËÓ ÔÔ›· ÂϤÁ¯ıËÎÂ Ë ·ÛÊ¿ÏÂÈ· Ù˘ ÛÙ·Ù›Ó˘, ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ·ÓÂÈı‡ÌËÙ· Û˘Ì‚¿Ì·Ù·, ·Ú¿ ÙË Ì›ˆÛË Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ Û Ôχ ¯·ÌËÏ¿ Â›‰·, ‰ÂÓ ·Ó·Ê¤ÚÔÓÙ·È fï˜ Ù· ÂÚÈÛÙ·ÙÈο Ó¤Ô˘ ηÚΛÓÔ˘. ™Â ÌÈ· ÌÂϤÙË ·Ú·ÎÔÏÔ˘ı‹ıËÎ·Ó ÁÈ· ÂÚ›Ô‰Ô 2 ± 1,4 ÂÙÒÓ ·ÛıÂÓ›˜ Ô˘ ›¯·Ó LDL-¯ÔÏËÛÙÂÚfiÏË < 60 mg/dl Î·È ·Ú¿ ÙË ¯·ÌËÏ‹ ·˘Ù‹ ÙÈÌ‹ ¤Ï·‚·Ó ÛÙ·Ù›ÓË. ¢ÂÓ ·Ú·ÙËÚ‹ıËΠ·‡-

ÍËÛË ÙˆÓ Î·ÎÔËıÂÈÒÓ ÛÙËÓ ÔÌ¿‰· Ô˘ ¤Ï·‚ ÛÙ·Ù›ÓË, ·ÓÙ›ıÂÙ· ·Ú·ÙËÚ‹ıËΠηχÙÂÚË ÂÈ‚›ˆÛË ·fi ÙËÓ ÔÌ¿‰· Ô˘ ¤ÌÂÈÓ ¯ˆÚ›˜ ıÂÚ·›·25. √È ÛÙ·Ù›Ó˜ Â›Ó·È Ô˘‰¤ÙÂÚ˜ ÛÙËÓ Â›ÙˆÛË ÙÔ˘ ηÚΛÓÔ˘26,27 ‹ Èı·ÓÒ˜ ¤¯Ô˘Ó ·ÓÙÈÓÂÔÏ·ÛÌ·ÙÈ΋ ‰Ú¿ÛË. ™Â ÌÈ· ÚfiÛÊ·ÙË ÌÂϤÙË Û˘ÁÎÚ›ıËΠÌÈ· ÔÌ¿‰· 37.248 ·ÛıÂÓÒÓ Ô˘ Ï¿Ì‚·Ó·Ó ÛÙ·Ù›ÓË Ì ÌÈ· ¿ÏÏË ÔÌ¿‰· 25.594 Ô˘ Ï¿Ì‚·Ó·Ó ·ÓÙÈ˘ÂÚÙ·ÛÈο Ê¿Ú̷η28. ΔÔ ÔÛÔÛÙfi ÙˆÓ ·ÙfiÌˆÓ Ô˘ ÂÌÊ¿ÓÈÛ ηÚΛÓÔ ÛÙËÓ ÔÌ¿‰· ÙˆÓ ÛÙ·ÙÈÓÒÓ ‹Ù·Ó 9,4% ÂÓÒ ÛÙËÓ ¿ÏÏË ÔÌ¿‰· 13,2%, ‰È·ÊÔÚ¿ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ (p<0,001). ¶ÚfiÛÊ·Ù· fï˜ ‰ËÌÔÛȇıËΠÌÈ· ÌÂϤÙË Ô˘ Â·Ó¤ÊÂÚ ÛÙÔ ÚÔÛ΋ÓÈÔ ÙÔ˘˜ ·Ï·ÈÔ‡˜ Êfi‚Ô˘˜ ÁÈ· ÙË Û¯¤ÛË ÙˆÓ ¯·ÌËÏÒÓ ÙÈÌÒÓ ¯ÔÏËÛÙÂÚfiÏ˘ Ì ÙÔÓ Î·ÚΛÓÔ29. ∏ ÌÂϤÙË ·˘Ù‹ ÂÚ‡ÓËÛ ·Ó Ë ÂÓÙ·ÙÈ΋ Ì›ˆÛË Ù˘ ÔÏÈ΋˜ Î·È LDL-¯ÔÏËÛÙÂÚfiÏ˘ ·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ Ë·ÙÔÙÔÍÈÎfiÙËÙ·˜, Ì˘ÔÙÔÍÈÎfiÙËÙ·˜ Î·È Î·ÚÎÈÓÔÁ¤ÓÂÛ˘. ∞ӷχıËÎ·Ó ÔÈ ÚÔÔÙÈΤ˜ Ù˘¯·ÈÔÔÈË̤Ó˜ ÌÂϤÙ˜ Ô˘ ›¯·Ó ‰ËÌÔÛÈ¢ı› ̤¯ÚÈ ÙÔÓ ¡Ô¤Ì‚ÚÈÔ 2005. ¢ÂÓ ‰È·ÈÛÙÒıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Û¯¤ÛË ÌÂٷ͇ ÙÔ˘ ÔÛÔÛÙÔ‡ ‹ Ù˘ ·fiÏ˘Ù˘ ÙÈÌ‹˜ Ì›ˆÛ˘ Ù˘ LDL-¯ÔÏËÛÙÂÚfi-

Ï˘ Î·È ÂÌÊ¿ÓÈÛ˘ Ó¤ˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ Î·ÚΛÓÔ˘, ‚Ú¤ıËΠfï˜ ÛËÌ·ÓÙÈ΋ Û¯¤ÛË (p=0,009) ÌÂٷ͇ Ù˘ ÙÈÌ‹˜ Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ Ô˘ ÂÈÙ‡¯ıËÎÂ Î·È ÂÌÊ¿ÓÈÛ˘ Ó¤ˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ Î·ÚΛÓÔ˘. ∂ӉȷʤÚÔÓ ¤¯ÂÈ Ë ·Ú·Ù‹ÚËÛË fiÙÈ ÛÙȘ ÌÂÁ·Ï‡ÙÂÚ˜ ‰fiÛÂȘ ÛÙ·Ù›Ó˘ ÁÈ· ÙËÓ Â›Ù¢ÍË Ù˘ ›‰È·˜ Ì›ˆÛ˘ Ù˘ LDL-¯ÔÏ. Ù· ÂÚÈÛÙ·ÙÈο ηÚΛÓÔ˘ ‹Ù·Ó ÏÈÁfiÙÂÚ·. ∏ ‰È·ÊÔÚ¿ ÛÙÔ˘˜ ‰Â›ÎÙ˜ Â›ÙˆÛ˘ ·Ó Î·È ‰ÂÓ ‹Ù·Ó ÌÂÁ¿ÏË (498/100.000 ÛÙË ÌÈÎÚ‹ ‰fiÛË ¤Ó·ÓÙÈ 408/100.000 ÛÙË ÌÂÁ¿ÏË ‰fiÛË) ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋. √È ÂÚ¢ÓËÙ¤˜ ·Ú·‰¤¯ÔÓÙ·È fiÙÈ Ë ÌÂϤÙË ¤¯ÂÈ ÔÚÈṲ̂ÓÔ˘˜ ÂÚÈÔÚÈÛÌÔ‡˜ (›¯·Ó ÛÙË ‰È¿ıÂÛË ÙÔ˘˜ ÌfiÓÔ Ù· ÂÚÈÏËÙÈο ‰Â‰Ô̤ӷ Ô˘ ‰ËÌÔÛȇıËÎ·Ó Î·È fi¯È Ù· ÏÂÙÔÌÂÚ‹ ÛÙÔȯ›· οı ÌÂϤÙ˘, ‰ÂÓ ˘¿Ú¯ÂÈ ÛÙ¿ıÌÈÛË ÙˆÓ ÌÂÏÂÙÒÓ ÎÏ) Î·È ÂÎÊÚ¿˙Ô˘Ó ÙË ÁÓÒÌË fiÙÈ ‰ÂÓ Ú¤ÂÈ Ó· Á›ÓÂÈ Ë ÌÂϤÙË ·ÈÙ›· Ó· ÌÂÙ·‚ÏËı› Ë ÙÚ¤¯Ô˘Û· Ú·ÎÙÈ΋ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ‰˘ÛÏÈȉ·ÈÌÈÒÓ ·ÏÏ¿ Ó· ·ÔÙÂϤÛÂÈ ÙËÓ ·ÊÔÚÌ‹ ÁÈ· ÂÚ·ÈÙ¤Úˆ ·Ó¿Ï˘ÛË ÙˆÓ ÌÂÏÂÙÒÓ ÒÛÙ ӷ ÂÍ·¯ıÔ‡Ó ·ÛʷϤÛÙÂÚ· Û˘ÌÂÚ¿ÛÌ·Ù·. ¶·ÚfiÌÔÈ· ¿Ô„Ë ÂÎÊÚ¿˙ÂÙ·È Î·È Û ‰‡Ô ¿ÚıÚ· Û‡ÓÙ·Í˘ Ô˘ Û˘ÓÔ‰Â‡Ô˘Ó ÙË ‰ËÌÔÛ›Â˘ÛË ÛÙÔ ›‰ÈÔ Ù‡¯Ô˜ ÙÔ˘ ÂÚÈÔ-

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∫§π¡π∫∂™ ª∂§∂Δ∂™

ªÂϤÙË ASCOT-LLA. ∞ÒÙÂÚ· AÔÙÂϤÛÌ·Ù·, 2 XÚfiÓÈ· MÂÙ¿ ÙÔ KÏ›ÛÈÌÔ Ù˘ MÂϤÙ˘.

The Anglo-Scandinavian Cardiac Outcomes Trial lipid lowering arm: extended observations 2 years after trial closure.

Sever PS, Poulter NR, Dahlof B, Wedel H, Beevers G, Caulfield M, Collins R, Kjeldsen S, Kristinsson A, Mcinnes G, Mehlsen J, Nieminen MS, O'Brien ET, and Östergren J on behalf of the ASCOT Investigators Eur Heart J 2008;29:499-508 H ÌÂϤÙË ASCOT Â›Ó·È ÌÈ· ÌÂÁ¿ÏË ÎÏÈÓÈ΋, Ù˘¯·ÈÔÔÈË̤ÓË, 2Ã2 ·Ú·ÁÔÓÙÈ΋, Ù˘ÊÏ‹ ÌÂϤÙË ÛÙËÓ ÔÔ›· ÂÓÙ¿¯ıËÎ·Ó 19.342 ˘ÂÚÙ·ÛÈÎÔ› ·ÛıÂÓ›˜ Î·È ÙˆÓ ‰‡Ô ʇψÓ, ËÏÈΛ·˜ 40-79 ÂÙÒÓ. Δ· ÎÚÈÙ‹ÚÈ· ÂÈÏÔÁ‹˜ ‹Ù·Ó ™∞¶ ≥160 mmHg ‹/Î·È ¢∞¶ ≥ 100 mmHg ¯ˆÚ›˜ ·ÁˆÁ‹ ‹ ™∞¶ ≥ 140 mmHg ‹/Î·È ¢∞¶ ≥ 90 mmHg ˘fi ·ÓÙÈ˘ÂÚÙ·ÛÈ΋ ·ÁˆÁ‹, Û˘Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ 3 ·fi ÙÔ˘˜ ηو٤ڈ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘: ¿ÚÚÂÓ Ê‡ÏÔ, ËÏÈΛ· ≥ 55 ÂÙÒÓ, οÓÈÛÌ·, ˘ÂÚÙÚÔÊ›· ·ÚÈÛÙÂÚ¿˜ ÎÔÈÏ›·˜, ∏∫°Ú·ÊÈΤ˜

·ÓˆÌ·Ï›Â˜, ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ 2, ÂÚÈÊÂÚÈ΋ ·ÚÙËÚȷ΋ ÓfiÛÔ, ÈÛÙÔÚÈÎfi ·ÁÁÂÈ·ÎÔ‡ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ (Â›ÌÔÓÔ˘ ‹ ·ÚÔ‰ÈÎÔ‡), ÌÈÎÚÔÏÂ˘ÎˆÌ·ÙÈÓÔ˘Ú›· ‹ ÏÂ˘ÎˆÌ·ÙÔ˘Ú›·, ·ıËڈ̷ÙÈÎfi ‰Â›ÎÙË ≥ 6, ‹ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÚÒÈÌ˘ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘. ∞ÔÎÏ›ÛıËÎ·Ó ·ÛıÂÓ›˜ Ì ·Ï·Èfi ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘, ÛÙËı¿Á¯Ë ‹ ·ÁÁÂÈ·Îfi ÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔ ÛÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ 3 ÌËÓÒÓ. ∏ ÌÂϤÙË Â›¯Â ‰‡Ô ÛΤÏË; ÙÔ ÛΤÏÔ˜ Ù˘ ·ÓÙÈ˘ÂÚÙ·ÛÈ΋˜ ·ÁˆÁ‹˜ (BPLA), ÛÙÔ ÔÔ›Ô ‰ÔÎÈ-

LDL-¯ÔÏËÛÙÂÚfiÏË Ì ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ Ù˘ÊÏ‹˜ ÂÚÈfi‰Ô˘ Î·È Ù˘ ·Ú¿Ù·Û˘.

√ÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË Ì ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ Ù˘ÊÏ‹˜ ÂÚÈfi‰Ô˘ Î·È Ù˘ ·Ú¿Ù·Û˘ mmol/L

mg/DI

Ì¿ÛıËÎ·Ó ‰‡Ô ·ÓÙÈ˘ÂÚÙ·ÛÈο ıÂÚ·¢ÙÈο Û¯‹Ì·Ù· Î·È ÛÙÔ ÔÔ›Ô Û˘ÌÌÂÙ›¯·Ó fiÏÔÈ ÔÈ ·ÛıÂÓ›˜ Î·È ÙÔ ÛΤÏÔ˜ Ù˘ ˘ÔÏÈȉ·ÈÌÈ΋˜ ·ÁˆÁ‹˜ (LLA), ÛÙÔ ÔÔ›Ô Û˘ÌÌÂÙ›¯·Ó 10.305 ·ÛıÂÓ›˜. ™ÙÔ ‰Â‡ÙÂÚÔ ÛΤÏÔ˜ ÂÓÙ¿¯ıËÎ·Ó ÔÈ ·ÛıÂÓ›˜ Ì ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË ≤ 155 mg/dl ηٿ ÙËÓ ·Ú¯È΋ Â›ÛÎÂ„Ë ÂÈÏÔÁ‹˜ Î·È ‰ÂÓ ‹Ù·Ó ˘fi ·ÁˆÁ‹ Ì ÛÙ·Ù›Ó˜ ‹ ÊÈÌÚ¿Ù˜. √È ·ÛıÂÓ›˜ ·˘ÙÔ› ηٷÓÂÌ‹ıËÎ·Ó Ù˘¯·›· Ó· Ï¿‚Ô˘Ó Â›Ù 10 mg ·ÙÔÚ‚·ÛÙ·Ù›ÓË ÙËÓ Ë̤ڷ ‹ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ.

mmol/L

mg/DI

Atorvastatin Placebo

Atorvastatin Placebo

ΔÂÏÂ˘Ù·›· Â›Û΄Ë

ŒÙË

HDL-¯ÔÏËÛÙÂÚfiÏË Ì ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ Ù˘ÊÏ‹˜ ÂÚÈfi‰Ô˘ Î·È Ù˘ ·Ú¿Ù·Û˘. mmol/L

mg/DI

ΔÚÈÁÏ˘ÎÂÚ›‰È· Ì ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ Ù˘ÊÏ‹˜ ÂÚÈfi‰Ô˘ Î·È Ù˘ ·Ú¿Ù·Û˘. mmol/L

mg/DI

Atorvastatin Placebo

ŒÙË

ΔÂÏÂ˘Ù·›· Â›Û΄Ë

ŒÙË

Atorvastatin Placebo

ΔÂÏÂ˘Ù·›· Â›Û΄Ë

ŒÙË

ΔÂÏÂ˘Ù·›· Â›Û΄Ë

∂ÈÎfiÓ· 1. ΔÈ̤˜ ÏÈȉ›ˆÓ ·›Ì·ÙÔ˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ‰ÈÏ¿ Ù˘ÊÏ‹˜ ÂÚÈfi‰Ô˘ (Ù· ÚÒÙ· 3,3 ¤ÙË) Î·È Î·Ù¿ ÙË ÂÚ›Ô‰Ô Ù˘ ·Ú¿Ù·Û˘ ·Ú·Ù‹ÚËÛ˘ (2,2 ¤ÙË). (∞): ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË, (μ): LDL-¯ÔÏËÛÙÂÚfiÏË, (C): HDL-¯ÔÏËÛÙÂÚfiÏË Î·È (D): ÙÚÈÁÏ˘ÎÂÚ›‰È·.

5

π√À¡π√™ 2008

ªË ı·Ó·ÙËÊfiÚÔ ∂ª Î·È ı·Ó·ÙËÊfiÚÔ˜ ™¡

£·Ó·ÙËÊfiÚÔ Î·È ÌË ı·Ó·ÙËÊfiÚÔ ∞∂∂

ÂÏ¿ÙÙˆÛË Δ¤ÏÔ˜ LLA

ÂÏ¿ÙÙˆÛË

*∞ÚÈıÌfi˜ ÂÚÈÛÙ·ÙÈÎÒÓ

Δ¤ÏÔ˜ Ù˘ ·Ú¿Ù·Û˘ Ù˘ LLA ∞ıÚÔÈÛÙÈ΋ Â›ÙˆÛË (%)

∞ıÚÔÈÛÙÈ΋ Â›ÙˆÛË (%)

Δ¤ÏÔ˜ Ù˘ ·Ú¿Ù·Û˘ Ù˘ LLA ÂÏ¿ÙÙˆÛË

ÂÏ¿ÙÙˆÛË

*∞ÚÈıÌfi˜ ÂÚÈÛÙ·ÙÈÎÒÓ

ŒÙË.

ŒÙË.

£ÓËÛÈÌfiÙËÙ· ·fi fiÏ· Ù· ·›ÙÈ·

™‡ÓÔÏÔ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÂÂÈÛÔ‰›ˆÓ Î·È ÂÂÌ‚¿ÛˆÓ

Δ¤ÏÔ˜ Ù˘ ·Ú¿Ù·Û˘ Ù˘ LLA Δ¤ÏÔ˜ Ù˘ ·Ú¿Ù·Û˘ Ù˘ LLA

Δ¤ÏÔ˜ LLA

ÂÏ¿ÙÙˆÛË

*∞ÚÈıÌfi˜ ÂÚÈÛÙ·ÙÈÎÒÓ

∞ıÚÔÈÛÙÈ΋ Â›ÙˆÛË (%)

∞ıÚÔÈÛÙÈ΋ Â›ÙˆÛË (%)

ÂÏ¿ÙÙˆÛË

ÂÏ¿ÙÙˆÛË

Δ¤ÏÔ˜ LLA

*∞ÚÈıÌfi˜ ÂÚÈÛÙ·ÙÈÎÒÓ

ŒÙË. ŒÙË.

∂ÈÎfiÓ· 2. ∫ÏÈÓÈο ηٷÏËÎÙÈο ÛËÌ›·. (∞): ÚˆÙ‡ÔÓ Î·Ù·ÏËÎÙÈÎfi ÛËÌÂ›Ô (ÛÙÂÊ·ÓÈ·›ÔÈ ı¿Ó·ÙÔÈ Î·È ÌË ı·Ó·ÙËÊfiÚ· ÂÌÊÚ¿ÁÌ·Ù·), (μ): ı·Ó·ÙËÊfiÚ· Î·È ÌË ı·Ó·ÙËÊfiÚ· ·ÁÁÂȷο ÂÁÎÂÊ·ÏÈο, (C): ™‡ÓÔÏÔ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÂÂÈÛÔ‰›ˆÓ Î·È ÛÙÂÊ·ÓÈ·›ˆÓ ÂÂÌ‚¿ÛˆÓ, (D): £ÓËÛÈÌfiÙËÙ· ·fi ÔÔÈ·‰‹ÔÙ ·ÈÙ›·.

¶ÚˆÙ‡ÔÓ Î·Ù·ÏËÎÙÈÎfi ÛËÌÂ›Ô Ù˘ ÌÂϤÙ˘ ‹Ù·Ó ÙÔ ¿ıÚÔÈÛÌ· ÙˆÓ ı·Ó¿ÙˆÓ ·fi ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ Î·È ÙˆÓ ÌË ı·Ó·ÙËÊfiÚˆÓ ÂÌÊÚ·ÁÌ¿ÙˆÓ ÙÔ˘ Ì˘Ôηډ›Ô˘. ¢Â˘ÙÂÚ‡ÔÓÙ· ηٷÏËÎÙÈο ÛËÌ›· ‹Ù·Ó ÔÏÏ¿: ÙÔ Û‡ÓÔÏÔ ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ Û˘Ì‚·Ì¿ÙˆÓ Î·È ÛÙÂÊ·ÓÈ·›ˆÓ ÂÂÌ‚¿ÛˆÓ, Ù· ı·Ó·ÙËÊfiÚ· Î·È ÌË ı·Ó·ÙËÊfiÚ· ·ÁÁÂȷο ÂÁÎÂÊ·ÏÈο, Ë Î·Ú‰È·ÁÁÂȷ΋ ıÓËÛÈÌfiÙËÙ·, Ë ÔÏÈ΋ ıÓËÛÈÌfiÙËÙ·, Ë Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ·. ∂›Û˘ ˘‹ÚÍÂ Î·È ¤Ó·˜ ·ÚÈıÌfi˜ ÙÚÈÙ¢fiÓÙˆÓ Î·Ù·ÏËÎÙÈÎÒÓ ÛËÌ›ˆÓ (ÛȈËÚfi ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘, Ë ÂÌÊ¿ÓÈÛË ¯ÚfiÓÈ·˜ ÛÙ·ıÂÚ‹˜ ÛÙËı¿Á¯Ë˜, Ë ·ÛÙ·ı‹˜ ÛÙËı¿Á¯Ë, Ë ÂÚÈÊÂÚÈ΋ ·ÚÙËÚÈÔ¿ıÂÈ· Î.Ï.). ΔÔÓ ¢ÂΤ̂ÚÈÔ ÙÔ˘ 2002, (3,3 ¤ÙË ‰È¿ÌÂÛË ‰È¿ÚÎÂÈ· ·fi ÙËÓ ¤Ó·ÚÍË) ÙÔ ÛΤÏÔ˜ Ù˘ ˘ÔÏÈȉ·ÈÌÈ΋˜ ·ÁˆÁ‹˜ (LLA) Ù˘ ÌÂϤÙ˘ ÙÂÚÌ·Ù›ÛıËΠÚfiˆÚ·, ÌÂÙ¿ Áӈ̿Ù¢ÛË Ù˘ ÂÈÙÚÔ‹˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Î·È Ù˘ ·ÛÊ¿ÏÂÈ·˜ (DSMB), ÂÂȉ‹ Ê¿ÓËΠ۷ʋ˜ Î·È ÛËÌ·ÓÙÈ΋ ˘ÂÚÔ¯‹ Ù˘ ıÂÚ·›·˜ Ì ·ÙÔÚ‚·ÛÙ·Ù›ÓË ¤Ó·ÓÙÈ ÙÔ˘ ÂÈÎÔÓÈ-

6

ÎÔ‡ Ê·ÚÌ¿ÎÔ˘. ™ÙÔ˘˜ ıÂÚ¿ÔÓÙ˜ È·ÙÚÔ‡˜ Û˘ÛÙ‹ıËΠӷ ¯ÔÚËÁ‹ÛÔ˘Ó Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ 10 mg ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ ÙËÓ Ë̤ڷ. Δ· ·ÔÙÂϤÛÌ·Ù· ‰ËÌÔÛȇıËÎ·Ó ÛÙÔ Lancet1. ¶·Ú·ÙËÚ‹ıËΠÙfiÙ Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÙÔ˘ ÚˆÙ‡ÔÓÙÔ˜ ηٷÏËÎÙÈÎÔ‡ ÛËÌ›Ԣ ηٿ 36% (HR 0,64; CI: 0,50-0.78; P=0,0005). ∂›Û˘ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ·Ú·ÙËÚ‹ıËÎ·Ó Û ·ÚÎÂÙ¿ ·fi Ù· ‰Â˘ÙÂÚ‡ÔÓÙ· Î·È ÙÚÈÙ‡ÔÓÙ· ηٷÏËÎÙÈο ÛËÌ›·. (Û‡ÓÔÏÔ ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ Û˘Ì‚·Ì¿ÙˆÓ 27%, ƒ=0,0003, Û‡ÓÔÏÔ ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ Û˘Ì‚·Ì¿ÙˆÓ Î·È ÂÂÌ‚¿ÛÂˆÓ -3%, ƒ=0,0001, ÂÌÊ¿ÓÈÛË ¯ÚfiÓÈ·˜ ÛÙ·ıÂÚ‹˜ ÛÙËı¿Á¯Ë˜ -40%, ƒ=0,0072) ™Â ¿ÏÏ· ‰Â˘ÙÂÚ‡ÔÓÙ· ηٷÏËÎÙÈο ÛËÌ›· Ë Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘, ·Ó Î·È ÌÂÁ¿ÏË, ‰ÂÓ ·¤‚Ë ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ÏfiÁˆ ÂÚÈÔÚÈṲ̂ÓÔ˘ ·ÚÈıÌÔ‡ Û˘Ì‚·Ì¿ÙˆÓ. (£·Ó·ÙËÊfiÚ· Î·È ÌË ı·Ó·ÙËÊfiÚ· ·ÁÁÂȷο ÂÁÎÂÊ·ÏÈο -21%, ƒ=0,0575, ηډȷÁÁÂȷ΋ ıÓËÛÈÌfiÙËÙ· -0.26%, ƒ=0,2621, Ë ÔÏÈ΋ ıÓËÛÈÌfiÙËÙ· -13%, ƒ=0,1798. ™ÙÔ ‰È¿ÛÙËÌ· ÙˆÓ 2,2 ÂÙÒÓ Ô˘

·ÎÔÏÔ‡ıËÛ·Ó ·fi ÙÔÓ ÙÂÚÌ·ÙÈÛÌfi ÙÔ˘ LLA ̤¯ÚÈ ÙÔÓ ÙÂÚÌ·ÙÈÛÌfi Î·È ÙÔ˘ BPLA, ÔfiÙ Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ Ë ÙÂÏÂ˘Ù·›· Â›ÛÎÂ„Ë ÂϤÁ¯Ô˘, ·ÚÎÂÙÔ› ·ÛıÂÓ›˜ ÌÂÙ·‹‰ËÛ·Ó ·fi ÙË Ì›· ÔÌ¿‰· ÛÙËÓ ¿ÏÏË. ŒÙÛÈ, ÂÓÒ ÛÙÔ ÎÏ›ÛÈÌÔ ÙÔ˘ LLA, ÙÔ ÔÛÔÛÙfi ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ÂÏ¿Ì‚·Ó ÛÙ·Ù›ÓË ‹Ù·Ó ÛÙËÓ ÔÌ¿‰· Ù˘ ÂÓÂÚÁÔ‡ ıÂÚ·›·˜ 83,7% Î·È ÛÙËÓ ÔÌ¿‰· ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ 12,9%, ÛÙÔ Ù¤ÏÔ˜ Ù· ÔÛÔÛÙ¿ ‹Ù·Ó 66,7% Î·È 62,8% ·ÓÙ›ÛÙÔȯ·, ‰ËÏ·‰‹ ¤Ó· ·ÚÎÂÙfi ÔÛÔÛÙfi Ô˘ ÂÏ¿Ì‚·Ó ÛÙ·Ù›ÓË Ù· ÚÒÙ· 3,3 ¯ÚfiÓÈ· ÙËÓ ‰È¤ÎÔ„Â Î·È ¤Ó· ¿ÏÏÔ ÔÛÔÛÙfi Ô˘ ‰ÂÓ ÂÏ¿Ì‚·Ó ·Ú¯Èο, ¿Ú¯ÈÛ ӷ Ï·Ì‚¿ÓÂÈ. ŒÙÛÈ, ÂÓÒ Ë ‰È·ÊÔÚ¿ ÛÙÔ Â›Â‰Ô Ù˘ ÔÏÈ΋˜ Î·È Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ÛÙ· ÚÒÙ· 3,3 ¯ÚfiÓÈ· ‹Ù·Ó ÂÚ›Ô˘ 40 mg/dl, ÛÙÔ Ù¤ÏÔ˜ ÙˆÓ 2,2 ÂÙÒÓ Ù˘ ·Ú¿Ù·Û˘ ÂÍ·Ê·Ó›ÛıËÎÂ. ∂›Û˘ ‰ÂÓ ˘‹Ú¯Â ‰È·ÊÔÚ¿ Î·È ÛÙȘ ¿ÏϘ ÏÈȉ·ÈÌÈΤ˜ ·Ú·Ì¤ÙÚÔ˘˜ (EÈÎfiÓ· 1). ¶·Ú' fiÏ· ·˘Ù¿ Ë ‰È·ÊÔÚ¿ ÛÙ· ηٷÏËÎÙÈο ÛËÌ›· ‰È·ÙËÚ‹ıËΠÛÙÔ ›‰ÈÔ ÔÛÔÛÙfi (EÈÎfiÓ· 2). ∏ Ì›ˆÛË

∫§π¡π∫∂™ ª∂§∂Δ∂™ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙÔ ÚˆÙ‡ÔÓ Î·Ù·ÏËÎÙÈÎfi ÛËÌÂ›Ô ·Ú¤ÌÂÈÓ ÛÙÔ 36% (ƒ<0.0001) Î·È ÁÈ· Ù· ·ÁÁÂȷο ÂÁÎÂÊ·ÏÈο ·Ó‹Ïı ÛÙÔ 23% (ƒ<0.013). ∏ ÔÏÈ΋ ıÓËÛÈÌfiÙËÙ· ·Ú¤ÌÂÈÓ ÛÙÔ ›‰ÈÔ ÔÛÔÛÙfi ÂÚ›Ô˘ (15%) ·ÏÏ¿ ·¤‚Ë ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ·˘Ù‹ ÙË ÊÔÚ¿, ÏfiÁˆ ÌÂÁ·Ï˘Ù¤ÚÔ˘ ·ÚÈıÌÔ‡ Û˘Ì‚·Ì¿ÙˆÓ.

ªÂ ÙËÓ ÌÂϤÙË ·˘Ù‹ ÂȂ‚·ÈÒÓÂÙ·È ¿ÏÏË ÌÈ· ÊÔÚ¿ fiÙÈ ÙÔ Â˘ÂÚÁÂÙÈÎfi ·ÔÙ¤ÏÂÛÌ· ÙˆÓ ÛÙ·ÙÈÓÒÓ ‰È·ÚΛ ÌÂÚÈο ¤ÙË (ÂÚ›Ô˘ 2 Ì 2,5) ÌÂÙ¿ ÙË ‰È·ÎÔ‹ Ù˘ ÛÙ·Ù›Ó˘, fiˆ˜ Ê¿ÓËÎÂ Î·È ÛÙËÓ ·Ú·ÙÂٷ̤ÓË ·Ú·Ù‹ÚËÛË ÙˆÓ ÌÂÏÂÙÒÓ 4S2, LIPID3, ALERT4 Î·È WOSCOPS5. ÿÛˆ˜ ·˘Ùfi ÔÊ›ÏÂÙ·È ÛÙË ÛÙ·ıÂÚÔÔ›ËÛË Ù˘ Ͽη˜, Ô˘ ‰Ú· ÚÔÛٷ٢ÙÈο ÁÈ·

‚Ú·¯‡ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·. ™Â ·ÒÙÂÚÔ ¯ÚfiÓÔ fï˜, ·Ó·Ì¤ÓÂÙ·È Ó· Û˘ÁÎÏ›ÓÔ˘Ó ÔÈ Â΂¿ÛÂȘ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ Â¿Ó Ï·Ì‚¿ÓÔ˘Ó Û fiÌÔÈÔ ‚·ıÌfi ÛÙ·Ù›ÓË, fiˆ˜ ¿ÏψÛÙ ¤‰ÂÈÍÂ Ë ·Ú·Ù‹ÚËÛË ÙˆÓ ·ÛıÂÓÒÓ Ù˘ 4S ÌÂϤÙ˘ 10 ¯ÚfiÓÈ· ÌÂÙ¿ ÙË Ï‹ÍË Ù˘6.

Wedel H, on behalf of the Scandinavian Simvastatin Survival Study Group. Follow-up study of patients randomised in the Scandinavian Simvastatin Survival Study (4S) of cholesterol lowering. Am J Cardiol (2000) 86:257-262

cardiac outcomes in renal transplant recipients: a multicentre, randomised, placebo-controlled trial. Lancet (2003) 361:2024-2031

EÈ̤ÏÂÈ·: ∏Ï›·˜ ÃÂÈÌÒÓ·˜

μÈ‚ÏÈÔÁÚ·Ê›· 1.

2.

Sever PS, Dahlöf B, Poulter NR, Wedel H, Beevers G, Caulfield M, Collins R, Kjeldsen SE, Kristinsson A, McInnes GT, Mehlsen J, Nieminen M, O'Brien E, Östergren J, for the ASCOT investigators. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial.

Lancet (2003) 361:1149-1158 Pedersen TR, Wilhelmsen L, Faergeman O, Strandberg TE, Thorgeirsson G, Troedsson L, Kristianson J, Berg K, Cook TJ, Haghfelt T, Kjekshus J, Miettinen T, Olsson AG, Pyörälä K,

3.

4.

The LIPID Study Group. Long-term effectiveness and safety of pravastatin in 9014 patients with coronary heart disease and average cholesterol concentrations: the LIPID trial followup. Lancet (2002) 359:1379-1387 Holdaas H, Fellstrom B, Jardine AG, Holme I, Nyberg G, Fauchald P, Grunhagen-Riska C, Madsen S, Neumayer H, Cole E, Maes B, Ambuhl P, Olsson AG, Hartmann A, Solbu DO, Pedersen TR. Effect of fluvastatin on

5.

Ford I, Murray H, Packard CJ, Shepherd J, Macfarlane PW, Cobbe SM. Long-term follow up of the West of Scotland Coronary Prevention Study.

N Engl J Med (2007) 357:1477-1486.

6.

Strandberg TE, Pyörälä K, Cook TJ, Wilhelmsen L, Faergeman O, Thorgeirsson G, Pedersen TR, Kjekshus J, for the 4S Group. Mortality and incidence of cancer during 10-year follow-up of the Scandinavian Simvastatin Survival Study (4S). Lancet (2004) 364:771-777.

7

π√À¡π√™ 2008

ªÂϤÙË ENHANCE (Ezetimibe aNd Simvastatin in Hypercholesterolemia EnhANCEs Atherosclerosis Regression) ™ÈÌ‚·ÛÙ·Ù›ÓË Ì ‹ ¯ˆÚ›˜ ∂˙ÂÙÈÌ›ÌË Û ™˘ÁÁÂÓ‹ ÀÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· Kastelein JJ, Akdim F, Stroes ES, Zwinderman AH, Bots ML, Stalenhoef AF, Vissren FL, Sijbrands EJ, Trip MD, Stein FA, Gaudet D, Duivenvoorden R, Veltri EP, Marais AD, de Groot E, ENHANCE Investigators.

N. Engl J Med 2008 Apr 3;358(14):1431-43. ∏ ENHANCE Â›Ó·È ÌÈ· Ù˘¯·ÈÔÔÈË̤ÓË, ‰ÈÏ¿ - Ù˘ÊÏ‹, ÔÏ˘ÎÂÓÙÚÈ΋ ÌÂϤÙË, ‰È¿ÚÎÂÈ·˜ 2 ÂÙÒÓ, Ô˘ ۯ‰ȿÛıËΠÁÈ· Ó· ÂÚ¢ӋÛÂÈ ·Ó Ô ÛÙ·ıÂÚfi˜ Û˘Ó‰˘·ÛÌfi˜ ÛÈÌ‚·ÛÙ·Ù›Ó˘ Î·È Â˙ÂÙÈÌ›Ì˘ Â›Ó·È Î·Ï‡ÙÂÚÔ˜ ÛÙËÓ ÚfiÏË„Ë Ù˘ ·ıËڈ̿وÛ˘ ·fi ÙËÓ ÛÈÌ‚·ÛÙ·Ù›ÓË ÌfiÓË Ù˘. ø˜ ‰Â›ÁÌ· ÂÂϤÁËÛ·Ó 720 ·ÛıÂÓ›˜ ·ÌÊÔÙ¤ÚˆÓ ÙˆÓ Ê‡ÏˆÓ ÌÂ Û˘ÁÁÂÓ‹ ÂÙÂÚfi˙˘ÁÔ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·, ¯ˆÚ›˜ ¤Ó‰ÂÈÍË ÛÙÂÊ·ÓÈ·›·˜ ‹ ¿ÏÏ˘ ·ıËڈ̷ÙÈ΋˜ ÓfiÛÔ˘ Î·È Î·Ù·ÓÂÌ‹ıËÎ·Ó Ù˘¯·›· Ó· Ï¿‚Ô˘Ó, ÌÂÙ¿ ÌÈ· ÂÚ›Ô‰Ô ¤ÎÏ˘Û˘ Ì ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ, ›Ù ÙÔ Û··ÛÌ· INEGY, ÙÔ ÔÔ›Ô ÂÚȤ¯ÂÈ 80 mg ÛÈÌ‚·ÛÙ·Ù›Ó˘ Î·È 20 mg Â˙ÂÙÈÌ›Ì˘, ›Ù ‰ÈÛÎ›Ô Ì 80 mg ÛÈÌ‚·ÛÙ·Ù›Ó˘ ÌfiÓÔ, οı ̤ڷ. ∏ ÂͤÏÈÍË Ù˘ ·ıËڈ̿وÛ˘ ·Ú·ÎÔÏÔ˘ı‹ıËΠÛÙȘ ηڈٛ‰Â˜ Ì ˘ÂÚ˯ÔÁÚ¿ÊËÌ· M-mode, (EÈÎfiÓ· 1), ÌÈ· ̤ıÔ‰Ô Î·ıÈÂڈ̤ÓË Î·È ÁÂÓÈο ·Ô‰ÂÎÙ‹ ˆ˜ ·ÍÈfiÈÛÙË. ¶ÚˆÙ‡ÔÓ ÙÂÏÈÎfi ÛËÌÂ›Ô Î·ıÔÚ›ÛıËÎÂ Ë Ì¤ÛË ÌÂÙ·‚ÔÏ‹ ÙÔ˘ ¿¯Ô˘˜ ÙÔ˘ ̤ÛÔ˘-¤Ûˆ ¯ÈÙÒÓ· (Intima Media Thiknes - IMT) ÙˆÓ Î·ÚˆÙ›‰ˆÓ (ÎÔÈÓ‹ ηڈٛ‰·, ηڈÙȉÈÎfi˜ ‚ÔÏ‚fi˜ Î·È ¤Ûˆ ηڈٛ‰·) ÛÙÔ ‰È¿ÛÙËÌ· ÙˆÓ 2 ÂÙÒÓ. ¢Â˘ÙÂÚ‡ÔÓÙ· ηٷÏËÎÙÈο ÛËÌ›· ÔÚ›ÛıËÎ·Ó (1) ÙÔ ÔÛÔÛÙfi ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ı· ÂÌÊ·Ó›ÛÂÈ Ì›ˆÛË ÙÔ˘ πªΔ (2) Ë ÌÂÙ·‚ÔÏ‹ ÙÔ˘ ÌÂÁ›ÛÙÔ˘ ¿¯Ô˘˜ ÙÔ˘ ¿ˆ ÙÔȯÒÌ·ÙÔ˜, (3) ÙÔ ÔÛÔÛÙfi ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ı· ·Ó·Ù‡ÍÂÈ Ó¤Â˜ ·ıËڈ̷ÙÈΤ˜ ϿΘ Î·È (4) ÔÈ ÌÂÙ·‚ÔϤ˜ ÛÙȘ ηڈٛ‰Â˜ Û˘Ó ÙȘ ÌÂÙ·‚ÔϤ˜ ÛÙȘ ÎÔÈÓ¤˜ Ï·ÁfiÓȘ ·ÚÙËڛ˜1. ∏ ÌÂϤÙË, ·Ó Î·È Â›¯Â ÙÂÏÂÈÒÛÂÈ ·fi ‰ÈÂÙ›·˜, ‰ÂÓ Â›¯Â ‰ËÌÔÛÈ¢ı› ̤¯ÚÈ ÙÔÓ ÂÚ·Ṳ̂ÓÔ π·ÓÔ˘¿ÚÈÔ. ∞˘Ùfi, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ʋ̘ fiÙÈ Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ‹Ù·Ó ·ÚÓËÙÈο, ÚÔοÏÂÛ ·ÚÎÂ-

8

¶›Ó·Î·˜ 1. ∂›‰· LDL-¯ÔÏËÛÙÂÚfiÏ˘ ÛÙËÓ ¤Ó·ÚÍË Ù˘ ÌÂϤÙ˘ Î·È ÛÙÔ˘˜ 24 Ì‹Ó˜ ªÂÙ·‚ÏËÙ‹

ªÔÓÔıÂÚ·›· Ì Simvastatin Î·È Simvastatin (n=363) ezetimibe (n=357)

p

LDL -¯ÔÏËÛÙÂÚfiÏË ‹ (mg/dL), ¤Ó·ÚÍË

317.8

319.0

NS

LDL-¯ÔÏËÛÙÂÚfiÏË ‹ (mg/dL), 24 Ì‹Ó˜

192.7

141.3

<0.01

ªÂÙ·‚ÔÏ‹ (%)

-39.1

-55.6

<0.01

Ùfi ıfiÚ˘‚Ô Î·È Û¯fiÏÈ· ÛÙÔ˘˜ ÂÈÛÙËÌÔÓÈÎÔ‡˜ ·ÎÏÔ˘˜ ·ÏÏ¿ Î·È ÛÙ· ̤۷ Ì·˙È΋˜ ÂÈÎÔÈÓˆÓ›·˜, ÙfiÛÔ ÛÙËÓ ∞ÌÂÚÈ΋ fiÛÔ Î·È ·ÁÎfiÛÌÈ·. ∞˘Ùfi ·Ó¿ÁηÛ ÙȘ Ê·Ú̷΢ÙÈΤ˜ ÂÙ·ÈÚ›˜ ÛÙȘ Ôԛ˜ ·Ó‹ÎÂÈ ÙÔ Ê¿ÚÌ·ÎÔ Î·È ¯ÚËÌ·ÙÔ‰fiÙËÛ·Ó ÙË ÌÂϤÙË Ó· ÚÔ‚Ô‡Ó Û ·Ó·ÎÔ›ÓˆÛË ÛÙÔÓ Ù‡Ô ÙËÓ 14 π·ÓÔ˘·Ú›Ô˘, ÚÈÓ Ë ÌÂϤÙË ·Ó·ÎÔÈÓˆı› Û ȷÙÚÈÎfi Û˘Ó¤‰ÚÈÔ ‹ ‰ËÌÔÛÈ¢ı› Û ÂÈÛÙËÌÔÓÈÎfi ÂÚÈÔ‰ÈÎfi. ™ÙË Û˘Ó¤¯ÂÈ· ·Ó·ÎÔÈÓÒıËΠÛÙÔ American College of Cardiology (ACC) 57th Annual Scientific Session Î·È ‰ËÌÔÛȇıËΠٷ˘Ùfi¯ÚÔÓ· ÛÙÔ New England Journal of Medicine2. Δ· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ Û‡Ìʈӷ Ì ÙËÓ ·Ó·ÎÔ›ÓˆÛË ·˘Ù‹ Â›Ó·È Ù· ÂÍ‹˜: Ÿˆ˜ ·Ó·ÌÂÓfiÙ·Ó, Ë LDL-¯ÔÏËÛÙÂÚfiÏË ÌÂÈÒıËΠηٿ 16,5% ÂÚÈÛÛfiÙÂÚÔ Ì ÙÔÓ ÛÙ·ıÂÚfi Û˘Ó‰˘·ÛÌfi Û˘ÁÎÚÈÙÈο Ì ÙË ÌÔÓÔıÂÚ·›· Ì ÛÈÌ‚·ÛÙ·Ù›ÓË (ƒ< 0,01, ¶›Ó·Î·˜ 1).

∂›Û˘ ÌÂÈÒıËΠÂÚÈÛÛfiÙÂÚÔ Ë CRP ηٿ 25,7% Î·È Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È· ηٿ 6,6% ÛÙËÓ ÔÌ¿‰· ÙÔ˘ ÛÙ·ıÂÚÔ‡ Û˘Ó‰˘·ÛÌÔ‡ (ƒ< 0,01). √È ÌÂÙ·‚ÔϤ˜ ÙˆÓ ÏÈȉ›ˆÓ Ê·›ÓÔÓÙ·È ÛÙËÓ EÈÎfiÓ· 2. ŸÌˆ˜, ÙÔ ÚˆÙ‡ÔÓ ÙÂÏÈÎfi ÛËÌÂ›Ô ‰ÂÓ ‰È¤ÊÂÚ ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ (¶›Ó·Î·˜ 2). ∂›Û˘ ‰ÂÓ ‰È¤ÊÂÚ·Ó ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ Ù· ‰Â˘ÙÂÚ‡ÔÓÙ· ηٷÏËÎÙÈο ÛËÌ›·. √È ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ‹Ù·Ó ·ÚfiÌÔȘ Î·È ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜. Δ· Â˘Ú‹Ì·Ù· ·˘Ù¿ ÚÔοÏÂÛ·Ó ·ÔÁÔ‹Ù¢ÛË Î·È ‰ÂÓ ‹Ù·Ó Ù· ·Ó·ÌÂÓfiÌÂÓ·, ·ÊÔ‡ ·ÓÙÈ‚·›ÓÔ˘Ó ÛÙË ÁÂÓÈο ·Ú·‰Â‰ÂÈÁ̤ÓË ·Ú¯‹ fiÙÈ fiÛÔ ÂÚÈÛÛfiÙÂÚÔ ÌÂÈÒÓÂÙ·È Ë LDL-¯ÔÏËÛÙÂÚfiÏË, ÙfiÛÔ ÌÂÁ·Ï‡ÙÂÚÔ ÙÔ fiÊÂÏÔ˜ Ô˘ ÚÔ·ÙÂÈ. 줂·È· Ë Ì¤ÙÚËÛË ÙÔ˘ πªΔ Â›Ó·È ˘ÔηٿÛÙ·ÙÔ (surrogate) ÛËÌÂ›Ô ¤Î‚·Û˘ Î·È ‰ÂÓ ÛËÌ·›ÓÂÈ fiÙÈ ÌÔÚ› Ó· ÚԂϤ„ÂÈ Î·Ù¿ 100% ÙËÓ ÎÏÈÓÈ΋ ¤Î‚·ÛË, ·ÔÙÂÏ› fï˜ ¤Ó·Ó ‚ÈÔÏÔÁÈÎfi ‰Â›ÎÙË Ô˘ ‰ÂÓ

¶›Ó·Î·˜ 2. ¶ÚˆÙ‡ÔÓ Î·Ù·ÏËÎÙÈÎfi ÛËÌ›Ô: ̤ÛË ÙÈÌ‹ ÙˆÓ ÌÂÙÚ‹ÛÂˆÓ ÙÔ˘ πªΔ Û ¤ÍÈ ÛËÌ›· ÙˆÓ Î·ÚˆÙ›‰ˆÓ ª¤ÛÔ πªΔ ÙˆÓ Î·ÚˆÙ›‰ˆÓ (mm)

ªÔÓÔıÂÚ·›· Simvastatin

Simvastatin Î·È ezetimibe

p

ŒÓ·ÚÍË Ù˘ ÌÂϤÙ˘*

0.70

0.69

0.64

™ÙÔ˘˜ 24 Ì‹Ó˜*

0.70

0.71

0.29

ªÂÙ·‚ÔÏ‹ (mm)

0.0058

0.0111

0.29

*ª¤ÛÔ˜ fiÚÔ˜ ·fi ÙȘ ÎÔÈÓ¤˜ ηڈٛ‰Â˜, ÙÔ˘˜ ηڈÙȉÈÎÔ‡˜ ‚ÔÏ‚Ô‡˜ Î·È ÙȘ ¤Ûˆ ηڈٛ‰Â˜

∫§π¡π∫∂™ ª∂§∂Δ∂™

¤Ûˆ ηڈٛ‰·

¤Íˆ ηڈٛ‰·

ηڈÙȉÈÎfi˜ ‚ÔÏ‚fi˜

ÛËÌÂ›Ô ‰È¯·ÛÌÔ‡ Ù˘ ÚÔ‹˜

ÎÔÈÓ‹ ηڈٛ‰·

‰È·ÛÙÔÏ‹ Ù˘ ηڈٛ‰·˜

∂ÈÎfiÓ· 1. ∞: ™ËÌ›· ̤ÙÚËÛ˘ ÙÔ˘ πªΔ. μ: ÀÂÚ˯ÔÁÚ·ÊÈ΋ ÂÈÎfiÓ· Ù˘ ÎÔÈÓ‹˜ ηڈٛ‰·˜ ÛÙËÓ ÔÔ›· Ê·›ÓÂÙ·È Ë Ì¤ÙÚËÛË ÙÔ˘ πªΔ ÛÙÔ ¿ˆ ÙÔ›¯ˆÌ·. ΔÔ Ï¢Îfi ‚¤ÏÔ˜ ‰Â›¯ÓÂÈ ÙÔ fiÚÈÔ ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ ÚÔ˜ ÙÔÓ ·˘Ïfi Î·È ÙÔ ÁÎÚ›˙Ô ‚¤ÏÔ˜ ÙÔ fiÚÈÔ Ô˘ ·ÊÔÚ›˙ÂÈ ÙÔÓ ¤Ûˆ ·fi ÙÔ Ì¤ÛÔ ¯ÈÙÒÓ·. ÌÔÚ› ηÓ›˜ Ó· ·ÁÓÔ‹ÛÂÈ. ™ÙË ÌÂϤÙË ASAP3 Ô˘ ¤ÁÈÓ Ì ·ÚfiÌÔÈ· ̤ıÔ‰Ô Û ·ÛıÂÓ›˜ Ì ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·, Ë ÔÌ¿‰· Ô˘ ¤Ï·‚ ·ÙÔÚ‚·ÛÙ·Ù›ÓË 80 mg ÂÌÊ¿ÓÈÛ Ì›ˆÛË Ù˘ LDL¯ÔÏËÛÙÂÚfiÏ˘ ηٿ 9% ÂÚÈÛÛfiÙÂÚÔ ·fi ÙËÓ ÔÌ¿‰· Ô˘ ¤Ï·‚ 40 mg ÛÈÌ‚·ÛÙ·Ù›Ó˘ Î·È ·˘Ùfi Ô‰‹ÁËÛ Û ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙËÓ ÂͤÏÈÍË ÙÔ˘ πªΔ ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜. ™ÙËÓ ÔÌ¿‰· Ô˘ ¤Ï·‚Â

·ÙÔÚ‚·ÛÙ·Ù›ÓË ÙÔ πªΔ ˘Ô¯ÒÚËÛ ηٿ 0,031 mm. ∏ ÂÚ¢ÓËÙÈ΋ ÔÌ¿‰· ·Ô‰›‰ÂÈ ÙËÓ ·ÔÙ˘¯›· Ù˘ ıÂÚ·›·˜ ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ·ÛıÂÓ›˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó ̤¯ÚÈ ÙfiÙ Ôχ ηϿ ıÂÚ·¢fiÌÂÓÔÈ Ì ÌÂÁ¿Ï˜ ‰fiÛÂȘ ÛÙ·ÙÈÓÒÓ ·fi ÙË ÌÈÎÚ‹ ËÏÈΛ· ÙÔ˘˜ Î·È ‰ÂÓ Â›¯·Ó ÛËÌ·ÓÙÈΤ˜ ·ÏÏÔÈÒÛÂȘ ÛÙȘ ηڈٛ‰Â˜ ÙÔ˘˜. ¶Ú¿ÁÌ·ÙÈ ÙÔ πªΔ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó ÌÈÎÚfiÙÂÚÔ ·fi

ÙÔ πªΔ Ù˘ ÌÂϤÙ˘ METEOR4, ÛÙËÓ ÔÔ›· ·Ú·ÙËÚ‹ıËΠ̛ˆÛË Ù˘ ÂͤÏÈ͢ Ù˘ ·ıËڈ̿وÛ˘ Ì ƒÔÛÔ˘‚·ÛÙ·Ù›ÓË (0,70 mm ¤Ó·ÓÙÈ 1,2 mm), ‰ÂÓ ‹Ù·Ó fï˜ ÌÈÎÚfiÙÂÚÔ ·fi ·˘Ùfi ÙˆÓ ·ÛıÂÓÒÓ Ù˘ ÌÂϤÙ˘ ARBITER-1, ÛÙÔ˘˜ ÔÔ›Ô˘˜ ÙÔ πªΔ ÚÈÓ ÙËÓ ¤Ó·ÚÍË Ù˘ ÌÂϤÙ˘ ‹Ù·Ó 0,627 mm. ¶·Ú fiÏ· ·˘Ù¿ ÛÙË ÌÂϤÙË ARBITER-1 ·Ú·ÙËÚ‹ıËΠ˘ÔÛÙÚÔÊ‹ ÙÔ˘ πªΔ ÛÙÔ˘˜ ·ÛıÂÓ›˜

9

π√À¡π√™ 2008

μ: HDL-¯ÔÏËÛÙÂÚfiÏË

∞: LDL-¯ÔÏËÛÙÂÚfiÏË

™ÈÌ‚·ÛÙ·Ù›ÓË

ªÂÙ·‚ÔÏ‹ %

ªÂÙ·‚ÔÏ‹ %

™ÈÌ‚·ÛÙ·Ù›ÓË Û˘Ó Â˙ÂÙÈÌ›ÌË

™ÈÌ‚·ÛÙ·Ù›ÓË

™ÈÌ‚·ÛÙ·Ù›ÓË Û˘Ó Â˙ÂÙÈÌ›ÌË

ª‹Ó˜

ª‹Ó˜

ªÂÙ·‚ÔÏ‹ %

°: √ÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË

™ÈÌ‚·ÛÙ·Ù›ÓË

ªÂÙ·‚ÔÏ‹ %

¢: ΔÚÈÁÏ˘ÎÂÚ›‰È·.

™ÈÌ‚·ÛÙ·Ù›ÓË

™ÈÌ‚·ÛÙ·Ù›ÓË Û˘Ó Â˙ÂÙÈÌ›ÌË

™ÈÌ‚·ÛÙ·Ù›ÓË Û˘Ó Â˙ÂÙÈÌ›ÌË

ª‹Ó˜

ª‹Ó˜

∂ÈÎfiÓ· 2. ªÂÙ·‚ÔϤ˜ ÙˆÓ ÏÈȉ›ˆÓ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂϤÙ˘. ∞: LDL-¯ÔÏËÛÙÂÚfiÏË, μ: HDL-¯ÔÏËÛÙÂÚfiÏË, °: √ÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË, ¢: ÙÚÈÁÏ˘ÎÂÚ›‰È·.

Ô˘ ‹Ú·Ó ÂÓÙ·ÙÈ΋ ıÂÚ·›· Ì ·ÙÔÚ‚·ÛÙ·Ù›ÓË 80 mg ÂÓÒ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ¤Ï·‚·Ó Ú·‚·ÛÙ·Ù›ÓË 40 mg ·Ú¤ÌÂÈÓ ÛÙ·ıÂÚfi5. ¶¤Ú·Ó ·˘ÙÔ‡, ·ÎfiÌË Î·È ÛÙÔ 19% ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ‰ÂÓ ÂÏ¿Ì‚·Ó ÛÙ·Ù›ÓË ÚÈÓ ÙËÓ ¤ÓÙ·ÍË ÙÔ˘˜ ÛÙË ÌÂϤÙË, ‰ÂÓ ·Ú·ÙËÚ‹ıËΠ‰È·ÊÔÚ¿ ÛÙËÓ ÂͤÏÈÍË ÙÔ˘ πªΔ ÌÂٷ͇ ·˘ÙÒÓ Ô˘ ¤Ï·‚·Ó ÙÔÓ Û˘Ó‰˘·ÛÌfi Î·È ·˘ÙÒÓ Ô˘ ¤Ï·‚·Ó ÌfiÓÔ ÛÈÌ‚·ÛÙ·Ù›ÓË. ∞˘Ùfi Ô‰‹ÁËÛ ÌÂÚÈÎÔ‡˜ ÂÚ¢ÓËÙ¤˜ ÌÂٷ͇

ÙˆÓ ÔÔ›ˆÓ ÔÈ Drs Greg Brown (University of Washington School of Medicine, Seattle) Î·È Allen Taylor (Walter Reed Army Medical Center, Washington, DC) Ô˘ ¤ÁÚ·„·Ó ¤Ó· ¿ÚıÚÔ Û‡ÓÙ·Í˘ ÛÙÔ ›‰ÈÔ Ù‡¯Ô˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡6, Ó· ÂÎÊÚ¿ÛÔ˘Ó ÂÈÊ˘Ï¿ÍÂȘ ÁÈ· ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙÔ˘ Ê·ÚÌ¿ÎÔ˘. ÕÏÏÔÈ ÂÚ¢ÓËÙ¤˜ Û˘ÓÈÛÙÔ‡Ó Ó· ÌË ‚È·Ûı› Ë ÂÈÛÙËÌÔÓÈ΋ ÎÔÈÓfiÙËÙ· Ó· ‚Á¿ÏÂÈ ·Ì¤Ûˆ˜ Û˘ÌÂÚ¿ÛÌ·Ù· ·ÏÏ¿ Ó· ·Ó·Ì¤ÓÂÈ

Ù· ·ÔÙÂϤÛÌ·Ù· Î·È ¿ÏÏˆÓ ÌÂÏÂÙÒÓ. ¶¿ÓÙˆ˜ ÙÂÏÈ΋ ·¿ÓÙËÛË ı· ‰Ôı› fiÙ·Ó ÔÏÔÎÏËÚˆı› Ë ÌÂÁ¿ÏË ÎÏÈÓÈ΋ ÌÂϤÙË IMPROVE-IT, Ë ÔÔ›· ı· ÂÚÈÏ¿‚ÂÈ ÂÚÈÛÛfiÙÂÚ· ·fi 10.000 ¿ÙÔÌ· Î·È ¤¯ÂÈ ÛÎÏËÚ¿ ηٷÏËÎÙÈο ÛËÌ›· Î·È Ë ÔÔ›· ·Ó·Ì¤ÓÂÙ·È Ó· ÂÚ·Ùˆı› ÙÔ 2011 ‹ 2012.

3.

5.

∂È̤ÏÂÈ·: ∏Ï›·˜ ÃÂÈÌÒÓ·˜

μÈ‚ÏÈÔÁÚ·Ê›· 1.

2.

10

Kastelein JJ; Sager PT; de Groot E; Veltri E. Comparison of ezetimibe plus simvastatin versus simvastatin monotherapy on atherosclerosis progression in familial hypercholesterolemia. Design and rationale of the Ezetimibe and Simvastatin in Hypercholesterolemia Enhances Atherosclerosis Regression (ENHANCE) trial. Am Heart J 2005;149:234-39 Kastelein JJ, Akdim F, Stroes ES, et al.

Simvastatin with or without ezetimibe in familial hypercholesterolemia. N Engl J Med 2008; 358:1431-1443.

4.

Smilde TJ, van Wissen S, Wollersheim H, et al. Effect of aggressive versus conventional lipid lowering on atherosclerosis progression in familial hypercholesterolaemia (ASAP): a prospective, randomised, double-blind trial. Lancet 2001; 357:577-81 Crouse JR, Raichlen JS, Riley WA, Evans GW, Palmer MK, O'Leary DH, Grobbee DE, Bots ML, for the METEOR Study Group. Effect of Rosuvastatin on progression of carotid Intima-Media Thickness in low-risk individuals with subclinical atherosclerosis The METEOR Trial. JAMA 2007; 297:1344-1353.

6.

Taylor AJ, Kent SM, Flaherty PJ, Coyle LC, Markwood TT, Vernalis MN. ARBITER: Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol. A Randomized Trial Comparing the Effects of Atorvastatin and Pravastatin on Carotid Intima Medial Thickness. Circulation. 2002; 106: 2055-60.

Brown GB, Taylor AJ. Does ENHANCE diminish confidence in lowering LDL or in ezetimibe? N Engl J Med 2008; 358:1504-1507.

£EPA¶EIA - ºAPMAKA

ºÈÌÚ¿Ù˜: ∞ÁˆÁ‹ μ·ÛÈṲ̂ÓË Û ∂Ӊ›ÍÂȘ ·fi Ù· ∞ÔÙÂϤÛÌ·Ù· ªÂÁ¿ÏˆÓ ¶ÚÔÔÙÈÎÒÓ ∫ÏÈÓÈÎÒÓ ªÂÏÂÙÒÓ ∂˘¿ÁÁÂÏÔ˜ §˘ÌÂÚfiÔ˘ÏÔ˜, §¤ÎÙÔÚ·˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ

ªˆ˘Û‹˜ ∂ÏÈÛ¿Ê, ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ ∂π™∞°ø°∏ √È ‰È¿ÊÔÚ˜ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ Ì ÛÙ·Ù›Ó˜ ÂÈΤÓÙÚˆÛ·Ó ÙÔ ÂӉȷʤÚÔÓ ÙÔ˘˜ ÛÙÔ ıÂÚ·¢ÙÈÎfi ·ÔÙ¤ÏÂÛÌ· Ù˘ Ì›ˆÛ˘ ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ÙˆÓ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ (LDL ¯ÔÏËÛÙÂÚfiÏË). øÛÙfiÛÔ, ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ Û ˘ÁÈ›˜ ÏËı˘ÛÌÔ‡˜ ¤‰ÂÈÍ·Ó fiÙÈ Î·È ¿ÏϘ ÏÈȉ·ÈÌÈΤ˜ ·Ú¿ÌÂÙÚÔÈ, fiˆ˜ Ù· ¯·ÌËÏ¿ Â›‰· Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ÙˆÓ ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ (HDL ¯ÔÏËÛÙÂÚfiÏË), Ù· ˘„ËÏ¿ ÙÚÈÁÏ˘ÎÂÚ›‰È· (TG), Ë ·ÚÔ˘Û›· ÌÈÎÚÒÓ-˘ÎÓÒÓ ˘ÔÎÏ·ÛÌ¿ÙˆÓ ÙˆÓ LDL Î·È Ë ·˘ÍË̤ÓË ÏÈÔÚˆÙ½ÓË (·) [Lp(a)] Û˘ÓÈÛÙÔ‡Ó Â›Û˘ ÚÔÁÓˆÛÙÈÎÔ‡˜ ‰Â›ÎÙ˜ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ. ∏ ÙÚÔÔÔ›ËÛË ·˘ÙÒÓ ÙˆÓ ‰ÂÈÎÙÒÓ Û ·ÛıÂÓ›˜ Ì ÂÁηÙÂÛÙË̤ÓË ÈÛ¯·ÈÌÈ΋ ηډÈÔ¿ıÂÈ· Â›Ó·È Èı·Ófi Ó· ¤¯ÂÈ Â˘ÓÔ˚΋ Â›‰Ú·ÛË ÛÙËÓ Î·Ú‰È·ÁÁÂȷ΋ ÓÔÛËÚfiÙËÙ· Î·È ıÓËÙfiÙËÙ·. ∂ÈÚfiÛıÂÙ·, Ë ·ÁˆÁ‹ Ì ÛÙ·Ù›Ó˜ ÌÂÈÒÓÂÈ ÌÂÓ ÛËÌ·ÓÙÈο Ù· ·ÁÁÂȷο Û˘Ì‚¿Ì·Ù·, ˆÛÙfiÛÔ ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ·ÛıÂÓ›˜ ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Ó· ÂÌÊ·Ó›˙Ô˘Ó Û˘Ì‚¿Ì·Ù·, ·ÎfiÌË Î·È fiÙ·Ó Ù· Â›‰· Ù˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘ Â›Ó·È Ôχ ¯·ÌËÏ¿. ŒÓ· ̤ÚÔ˜ ·˘ÙÔ‡ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ Ô˘ ÂÍ·ÎÔÏÔ˘ı› Ó· ˘¿Ú¯ÂÈ ·ÎfiÌË Î·È ÌÂÙ¿ ÙË Ì›ˆÛË Ù˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘ ÔÊ›ÏÂÙ·È ÛÙ· ·˘ÍË̤ӷ ÙÚÈÁÏ˘ÎÂÚ›‰È· Î·È Ù· ¯·ÌËÏ¿ Â›‰· HDL ¯ÔÏËÛÙÂÚfiÏ˘. Δ· ·Ú¿ÁˆÁ· ÙÔ˘ ÊÈÌÚÈÎÔ‡ ÔͤԘ (ÊÈÌÚ¿Ù˜) ÂȉÚÔ‡Ó Û fiϘ ·˘Ù¤˜ ÙȘ ÌÂÙ·‚ÏËÙ¤˜ Ô˘ ‰ÂÓ Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ LDL ¯ÔÏËÛÙÂÚfiÏË. ™˘ÁÎÂÎÚÈ̤ӷ, ÔÈ ÊÈÌÚ¿Ù˜ ÌÂÈÒÓÔ˘Ó Ù· Â›‰· ÙˆÓ TG Î·È ÙˆÓ ÌÈÎÚÒÓ-˘ÎÓÒÓ LDL, ·˘Í¿ÓÔ˘Ó Ù· Â›‰· Ù˘ HDL ¯ÔÏËÛÙÂÚfiÏ˘, ÂÓÒ ‰ÂÓ

ÂËÚ¿˙Ô˘Ó ÛËÌ·ÓÙÈο Ù· Â›‰· Ù˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘ (Ì ÙË ÂÍ·›ÚÂÛË Ù˘ Ê·ÈÓÔÊÈÌÚ¿Ù˘ Ô˘ ÚÔηÏ› Ì›· ÌÈÎÚ‹ Ì›ˆÛË Ù˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘). ∂ÈÚfiÛıÂÙ·, ÌÂÚÈΤ˜ ÊÈÌÚ¿Ù˜ (Ê·ÈÓÔÊÈÌÚ¿ÙË, ÛÈÚÔÊÈÌÚ¿ÙË Î·È ÌÂ˙·ÊÈÌÚ¿ÙË) ¤¯Ô˘Ó ÙËÓ ÈηÓfiÙËÙ· Ó· ÌÂÈÒÓÔ˘Ó Ù· Â›‰· ÙÔ˘ ÈÓˆ‰ÔÁfiÓÔ˘ ÛÙÔ Ï¿ÛÌ·. ΔÔ ÁÂÁÔÓfi˜ ·˘Ùfi ¤¯ÂÈ ÌÂÁ¿ÏË ÛËÌ·Û›·, ·ÊÔ‡ ÙÔ ÈÓˆ‰ÔÁfiÓÔ Â›Ó·È ¤Ó·˜ ÈÛ¯˘Úfi˜ ÚÔÁÓˆÛÙÈÎfi˜ ‰Â›ÎÙ˘ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ·ÚÔ˘Û›· ‹ ÌË ÎÏÈÓÈÎÒÓ ÂӉ›ÍÂˆÓ ·ÁÁÂȷ΋˜ ÓfiÛÔ˘. ∞Í›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈ Ë Ê·ÈÓÔÊÈÌÚ¿ÙË ¤¯ÂÈ ÙË ÌÔÓ·‰È΋ ȉÈfiÙËÙ· Ó· ÌÂÈÒÓÂÈ Ù· Â›‰· ÙÔ˘ Ô˘ÚÈÎÔ‡ ÔͤԘ ÙÔ˘ ÔÚÔ‡, Ù· ÔÔ›· fiÙ·Ó Â›Ó·È ·˘ÍË̤ӷ ·ÔÙÂÏÔ‡Ó ¤Ó· ‰Â›ÎÙË ·˘ÍË̤ÓÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘. ªÂ ·ÊÔÚÌ‹ ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ Ô˘ ·Ó·˙ˆ‡ÚˆÛ·Ó ÙÔ ÂӉȷʤÚÔÓ ÁÈ· ÙȘ ÊÈÌÚ¿Ù˜, ı· ÂȯÂÈÚ‹ÛÔ˘Ì ·Ú·Î¿Ùˆ ÌÈ· Û‡ÓÙÔÌË ·Ó·ÊÔÚ¿ ÛÙÔ ÚfiÏÔ ·˘Ù‹˜ Ù˘ ηÙËÁÔÚ›·˜ ÙˆÓ ˘ÔÏÈȉ·ÈÌÈÎÒÓ Ê·Ú̿ΈÓ.

Ù˘ ‰È·Ì¤ÙÚÔ˘ ÙÔ˘ ·˘ÏÔ‡ ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÁÁ›ˆÓ. ∏ ıÂÚ·›· ›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ì›· ÛËÌ·ÓÙÈ΋ ‚ÂÏÙ›ˆÛË ÙˆÓ ·ÁÁÂÈÔÁÚ·ÊÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ, Ë ÔÔ›· ‹Ù·Ó Û˘ÁÎÚ›ÛÈÌË Ì ÂΛÓË Ô˘ ·Ú·ÙËÚ‹ıËΠÛÙȘ ÌÂϤÙ˜ Ô˘ ¯ÚËÛÈÌÔÔ›ËÛ·Ó ÛÙ·Ù›Ó˜. √ Û˘ÓÔÏÈÎfi˜ ·ÚÈıÌfi˜ ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ÂÂÈÛÔ‰›ˆÓ ‹Ù·Ó ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚÔ˜ ÛÙËÓ ÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ‹Ú ıÂÚ·›· Ì ÌÂ˙·ÊÈÌÚ¿ÙË Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ‹Ú ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ (3 Î·È 11 ÂÂÈÛfi‰È·, ·ÓÙ›ÛÙÔȯ·). ∏ ˆÊ¤ÏÂÈ· Ù˘ ıÂÚ·›·˜ ‰ÂÓ ·Ô‰fiıËΠÛÙȘ ÔÛÔÙÈΤ˜ ÌÂÙ·‚ÔϤ˜ Ù˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘, ·ÊÔ‡ Ë Ì›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘ ‰ÂÓ ‹Ù·Ó ÛËÌ·ÓÙÈ΋ (ÌÂ˙·ÊÈÌÚ¿ÙË 3,5%, ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ 2,2%). øÛÙfiÛÔ, Ë ÌÂ˙·ÊÈÌÚ¿ÙË Ì›ˆÛ ٷ Â›‰· Ù˘ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ ηٿ 9% (p<0,001), ÙˆÓ TG ηٿ 37% (p<0,001) Î·È ÙÔ˘ ÈÓˆ‰ÔÁfiÓÔ˘ ηٿ 12% (p=0,001). ∂›Û˘ ·Ú·ÙËÚ‹ıËΠÛËÌ·ÓÙÈ΋ ·‡ÍËÛË Ù˘ HDL ¯ÔÏËÛÙÂÚfiÏ˘ (9%, p =0,02).

ª∂°∞§∂™ ∫§π¡π∫∂™ ª∂§∂Δ∂™ ª∂ ºπª¶ƒ∞Δ∂™

2. ∏ ÌÂϤÙË SIHDPS (Stockholm Ischemic Heart Disease Prevention Study)

1. ∏ ÌÂϤÙË BECAIT (μEzafibrate Coronary Atherosclerosis Intervention Trial)

™ÙË ÌÂϤÙË ·˘Ù‹ Û˘ÌÌÂÙ›¯·Ó ·ÛıÂÓ›˜ Ì ÈÛÙÔÚÈÎfi ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ôηډ›Ô˘, ÛÙÔ˘˜ ÔÔ›Ô˘˜ ¯ÔÚËÁ‹ıËΠ›Ù ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ (n=276) ›ÙÂ Û˘Ó‰˘·ÛÌfi˜ ÎÏÔÊÈÌÚ¿Ù˘ Ì ÓÈÎÔÙÈÓÈÎfi Ô͇ (n=279). ªÂÙ¿ ·fi ·Ú·ÎÔÏÔ‡ıËÛË 5 ¯ÚfiÓˆÓ, ·Ú·ÙËÚ‹ıËΠÛËÌ·ÓÙÈ΋ Ì›ˆÛË Ù˘ ÔÏÈ΋˜ ıÓËÙfiÙËÙ·˜, ηıÒ˜ Î·È Ù˘ ηډȷÁÁÂȷ΋˜ ıÓËÙfiÙËÙ·˜ ÛÙËÓ ÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ‹Ú ˘ÔÏÈȉ·ÈÌÈ΋ ıÂÚ·›· (-26%, p<0,05 Î·È -36%, p<0,01, ·ÓÙ›ÛÙÔȯ·). ΔÔ Â˘ÂÚÁÂÙÈÎfi ·˘Ùfi ·ÔÙ¤ÏÂÛÌ· ÌÔÚ› Ó·

™ÙËÓ ·ÁÁÂÈÔÁÚ·ÊÈ΋ ÌÂϤÙË BECAIT Û˘ÌÌÂÙ›¯·Ó ·ÛıÂÓ›˜ Ì ·ÏÈfi ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘ (n=92, ËÏÈΛ· <45 ÂÙÒÓ) Î·È ‰˘ÛÏÈȉ·ÈÌ›·, ÛÙÔ˘˜ ÔÔ›Ô˘˜ ¯ÔÚËÁ‹ıËΠ›Ù ÌÂ˙·ÊÈÌÚ¿ÙË (200 mg 3 ÊÔÚ¤˜ ËÌÂÚËÛ›ˆ˜) ›Ù ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ. √È ÛÙÂÊ·ÓÈÔÁڷʛ˜ Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó ÛÙËÓ ·Ú¯‹ Ù˘ ÌÂϤÙ˘, ηıÒ˜ Î·È ÌÂÙ¿ ·fi 1 Î·È 5 ¤ÙË. √ ·Ú¯ÈÎfi˜ ÛÙfi¯Ô˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ë ÂÎÙ›ÌËÛË Ù˘ ÌÂÙ·‚ÔÏ‹˜

11

π√À¡π√™ 2008

·Ô‰Ôı› ÛÙË Ì›ˆÛË ÙˆÓ TG ÙÔ˘ ÔÚÔ‡, ·ÊÔ‡ ÛËÌ·ÓÙÈ΋ Ì›ˆÛË Ù˘ ıÓËÙfiÙËÙ·˜ ·Ú·ÙËÚ‹ıËΠ۠¿ÙÔÌ· Ì Â›‰· TG >133 mg/dL Î·È ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚË ÛÙ· ¿ÙÔÌ· ÂΛӷ ÛÙ· ÔÔ›· ·Ú·ÙËÚ‹ıËΠ̛ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ηٿ 30% ‹ Î·È ÂÚÈÛÛfiÙÂÚÔ (ηٿ 60% Ì›ˆÛË Ù˘ ıÓËÙfiÙËÙ·˜ ·fi ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ, p<0,01). øÛÙfiÛÔ, Ú¤ÂÈ Ó· ·Ó·ÊÂÚı› fiÙÈ Ë ÌÂϤÙË ·˘Ù‹ ›¯Â ·ÚÎÂÙÔ‡˜ ÂÚÈÔÚÈÛÌÔ‡˜ (‰ÂÓ ‹Ù·Ó Ù˘ÊÏ‹, Û˘ÌÌÂÙ›¯Â ÌÈÎÚfi˜ ·ÚÈıÌfi˜ ·ÛıÂÓÒÓ Î·È Ë Î‡ÚÈ· ÏÈȉ·ÈÌÈ΋ ‰È·Ù·Ú·¯‹ ‹Ù·Ó Ë ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›·).

3. ∏ ÌÂϤÙË LOCAT (LOpid Coronary Angiography Trial) ™ÙË ÌÂϤÙË LOCAT Û˘ÌÌÂÙ›¯·Ó ¿Ó‰Ú˜ Ì ÈÛÙÔÚÈÎfi ·ÔÚÙÔÛÙÂÊ·ÓÈ·›·˜ ·Ú¿Î·Ì„˘ Î·È Â›‰· HDL ¯ÔÏËÛÙÂÚfiÏ˘ <43 mg/dL Î·È LDL ¯ÔÏËÛÙÂÚfiÏ˘ <173 mg/dL. ™ÙÔ˘˜ ·ÛıÂÓ›˜ ¯ÔÚËÁ‹ıËΠ›Ù ÁÂÌÊÈÌÚÔ˙›ÏË (1200 mg ËÌÂÚËÛ›ˆ˜) ›Ù ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ. √È ÛÙÂÊ·ÓÈÔÁڷʛ˜ Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó Î·È ·Ó·Ï‡ıËÎ·Ó ÛÙËÓ ·Ú¯‹ Ù˘ ÌÂϤÙ˘ Î·È ÌÂÙ¿ ·fi ¤Ó· ̤ÛÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· 32 ÌËÓÒÓ. ∏ ¯ÔÚ‹ÁËÛË Ù˘ ÁÂÌÊÈÌÚÔ˙›Ï˘ ›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ì›· ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÙÔ˘ Ú˘ıÌÔ‡ ÂͤÏÈ͢ ÙˆÓ ·ıËڈ̷ÙÈÎÒÓ ‚Ï·‚ÒÓ ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÁÁ›ˆÓ Û ۇÁÎÚÈÛË Ì ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘. ¶·ÚfiÌÔÈ· Â˘Ú‹Ì·Ù· ·Ú·ÙËÚ‹ıËÎ·Ó Î·È Û ÙÌ‹Ì·Ù· ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÁÁ›ˆÓ Ô˘ ‚Ú›ÛÎÔÓÙ·Ó Ì·ÎÚÈ¿ ·fi ÙÔ ÌfiÛ¯Â˘Ì·. ∂ÈÚfiÛıÂÙ·, ÔÈ ·ÛıÂÓ›˜ Ô˘ ¤Ï·‚·Ó ÁÂÌÊÈÌÚÔ˙›ÏË ·ÚÔ˘Û›·Û·Ó ÌÈÎÚfiÙÂÚÔ ·ÚÈıÌfi Ó¤ˆÓ ‚Ï·‚ÒÓ Û ۇÁÎÚÈÛË Ì ÂΛÓÔ˘˜ Ô˘ ¤Ï·‚·Ó ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ (2% ¤Ó·ÓÙÈ 14%, p<0,001). √È ÌÂÙ·‚ÔϤ˜ ·˘Ù¤˜ ·Ú·ÙËÚ‹ıËÎ·Ó ·Ú¿ ÙËÓ ·Ô˘Û›· ÛËÌ·ÓÙÈ΋˜ Ì›ˆÛ˘ ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘ (ηٿ 4,5%). ∞ÓÙ›ıÂÙ·, ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË Ù˘ ÁÂÌÊÈÌÚÔ˙›Ï˘ Ù· Â›‰· ÙˆÓ TG ÌÂÈÒıËÎ·Ó Î·Ù¿ 36% Î·È Ù· Â›‰· Ù˘ HDL ¯ÔÏËÛÙÂÚfiÏ˘ ·˘Í‹ıËÎ·Ó Î·Ù¿ 21%. ∏ ÛËÌ·Û›· Ù˘ Ì›ˆÛ˘ ÙˆÓ TG Î·È Ù˘ ·‡ÍËÛ˘ Ù˘ HDL ¯ÔÏËÛÙÂÚfiÏ˘ ·Ó·‰ÂÈÎÓ‡ÂÙ·È Î·È ·fi Ù· Â˘Ú‹Ì·Ù· ‰‡Ô

12

ÚfiÛÊ·ÙˆÓ ÌÂÏÂÙÒÓ Ô˘ ¯ÚËÛÈÌÔÔ›ËÛ·Ó ÊÈÌÚ¿Ù˜: ÙË ÌÂϤÙË Bezafibrate Infarction Prevention (BIP) Î·È ÙË ÌÂϤÙË Veterans Administration HDL Intervention Trial (VA-HIT).

4. ∏ ÌÂϤÙË BIP (Bezafibrate Infarction Prevention) ™ÙË ÌÂϤÙË ·˘Ù‹ Û˘ÌÌÂÙ›¯·Ó 3.090 ·ÛıÂÓ›˜ Ì ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ (70% Ì ·Ï·ÈfiÙÂÚÔ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘, 10% Ì ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË), ËÏÈΛ·˜ 45-74 ÂÙÒÓ. ™ÙÔ˘˜ ·ÛıÂÓ›˜ ¯ÔÚËÁ‹ıËΠÌÂ˙·ÊÈÌÚ¿ÙË ‹ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ. √È ·ÛıÂÓ›˜ Ô˘ Û˘ÌÌÂÙ›¯·Ó ÛÙË ÌÂϤÙË Â›¯·Ó Û¯ÂÙÈο ˘„ËÏ¿ Â›‰· ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ (180-250 mg/dL), Û¯ÂÙÈο ¯·ÌËÏ¿ Â›‰· HDL ¯ÔÏËÛÙÂÚfiÏ˘ (<45 mg/dL) Î·È Â›‰· ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ≤ 300 mg/dL. ∏ ÌÂϤÙË ·˘Ù‹ ۯ‰ȿÛÙËΠÁÈ· Ó· ÂÚ¢ӋÛÂÈ Â¿Ó Ë ·‡ÍËÛË Ù˘ HDL ¯ÔÏËÛÙÂÚfiÏ˘ Î·È Ë Ì›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ TG ÌÂÈÒÓÔ˘Ó ÙËÓ Â›ÙˆÛË ÙˆÓ ÚÒÈÌˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ÂÂÈÛÔ‰›ˆÓ (ı·Ó·ÙËÊfiÚÔ Î·È ÌË ı·Ó·ÙËÊfiÚÔ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘ Î·È ·ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜). ∂ÈÚfiÛıÂÙ·, ÛÙËÓ ¤Ú¢ӷ ·˘Ù‹ ÂÎÙÈÌ‹ıËÎÂ Ë Â›‰Ú·ÛË Ù˘ ˘ÔÏÈȉ·ÈÌÈ΋˜ ·ÁˆÁ‹˜ ÛÙËÓ Â›ÙˆÛË Ù˘ ÛÙËı¿Á¯Ë˜, ÙˆÓ ·ÁÁÂÈ·ÎÒÓ ÂÁÎÂÊ·ÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ Î·È ÙˆÓ ÂÂÌ‚¿ÛÂˆÓ Â·Ó·ÁÁ›ˆÛ˘. ™ÙËÓ ÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ¤Ï·‚ ÌÂ˙·ÊÈÌÚ¿ÙË ‰ÂÓ ·Ú·ÙËÚ‹ıËΠÛËÌ·ÓÙÈ΋ Ì›ˆÛË fiÛÔÓ ·ÊÔÚ¿ ÙÔ˘˜ ·ÚÈÔ˘˜ ÛÙfi¯Ô˘˜ Ù˘ ÌÂϤÙ˘. øÛÙfiÛÔ, Ë ¯ÔÚ‹ÁËÛË Ù˘ ÌÂ˙·ÊÈÌÚ¿Ù˘ ÚÔοÏÂÛ ̛· ÛËÌ·ÓÙÈ΋ ηٿ 40% Ì›ˆÛË ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ÂÂÈÛÔ‰›ˆÓ (p=0,03) Û ·ÛıÂÓ›˜ Ì ˘„ËÏ¿ Â›‰· ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ (TG ≥ 200 mg/dL) ÚÈÓ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜. ™ÙË ÌÂϤÙË μπƒ, Ë ˘ÔÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ Ì ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›· ·ÔÙ¤ÏÂÛ ÂÚ›Ô˘ ÙÔ 15% ÙÔ˘ ÏËı˘ÛÌÔ‡ Ù˘ ÌÂϤÙ˘. ∏ Ì›ˆÛË ÙˆÓ ·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ ÛÙ· ¿ÙÔÌ· Ô˘ ÏËÚÔ‡Û·Ó Ù· ÎÚÈÙ‹ÚÈ· ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙÔ˘ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ Î·È ‹Ú·Ó ÌÂ˙·ÊÈÌÚ¿ÙË ‹Ù·Ó 25% (p=0,03) Û ۇÁÎÚÈÛË Ì ÙÔ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ.

¶·ÚfiÏÔ Ô˘ Ù· ˘ÔÎÏ¿ÛÌ·Ù· Ù˘ LDL ‰ÂÓ ÂÎÙÈÌ‹ıËηÓ, ÌÔÚԇ̠ӷ ˘Ôı¤ÛÔ˘Ì fiÙÈ ÔÈ ·ÛıÂÓ›˜ Ì ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›· ›¯·Ó ·˘ÍË̤ÓË Û˘ÁΤÓÙÚˆÛË ÙˆÓ ÌÈÎÚÒÓ-˘ÎÓÒÓ LDL ۈ̷Ùȉ›ˆÓ. ªÂ ‰Â‰Ô̤ÓË ÙËÓ Â›‰Ú·ÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÛÙ· TG Î·È ÙËÓ HDL ¯ÔÏËÛÙÂÚfiÏË, ıˆÚÂ›Ù·È Èı·Ó‹ Î·È Ë ·ÏÏ·Á‹ ÙÔ˘ Ê·ÈÓÔÙ‡Ô˘ Ù˘ LDL Î·È Ù˘ ηٷÓÔÌ‹˜ ÙˆÓ LDL ۈ̷Ùȉ›ˆÓ ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË Ù˘ ÌÂ˙·ÊÈÌÚ¿Ù˘. ∏ Ì›ˆÛË ÙÔ˘ ÈÓˆ‰ÔÁfiÓÔ˘ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ Ô˘ ·Ú·ÙËÚ‹ıËΠÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË Ù˘ ÌÂ˙·ÊÈÌÚ¿Ù˘ ÌÔÚ› Ó· Û˘ÓÂÈÛ¤ÊÂÚ ÛÙÔ ÎÏÈÓÈÎfi fiÊÂÏÔ˜, ·ÊÔ‡ ÔÈ ·ÛıÂÓ›˜ Ì ·˘ÍË̤ӷ Â›‰· ÈÓˆ‰ÔÁfiÓÔ˘ ÂÌÊ¿ÓÈÛ·Ó ÂÚÈÛÛfiÙÂÚ· ·ÁÁÂȷο ÂÂÈÛfi‰È·. ∂›Û˘, Ë ÂÚ·ÈÙ¤Úˆ ·Ó¿Ï˘ÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Ù˘ ÌÂϤÙ˘ ¤‰ÂÈÍ fiÙÈ ÌÂٷ͇ ÙˆÓ ·ÛıÂÓÒÓ Ì Ôχ ˘„ËϤ˜ ÙÈ̤˜ ÈÓˆ‰ÔÁfiÓÔ˘, ÂΛÓÔÈ Ô˘ ÂÌÊ¿ÓÈÛ·Ó Ì›ˆÛË ·˘ÙÔ‡ ÙÔ˘ ıÚÔÌ‚ˆÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ›¯·Ó ÏÈÁfiÙÂÚ· ·ÁÁÂȷο ÂÂÈÛfi‰È· Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ ·ÛıÂÓ›˜ ÛÙÔ˘˜ ÔÔ›Ô˘˜ Ù· Â›‰· ÙÔ˘ ÈÓˆ‰ÔÁfiÓÔ˘ ›Ù ·˘Í‹ıËÎ·Ó Â›Ù ‰ÂÓ ÌÂÈÒıËηÓ. ∞Í›˙ÂÈ Ó· ·Ó·ÊÂÚı› fiÙÈ Ì›· ÂÎ ÙˆÓ ˘ÛÙ¤ÚˆÓ ·Ó¿Ï˘ÛË Ù˘ ÌÂϤÙ˘ μπƒ ÂÚȤϷ‚ 303 ¿ÙÔÌ· Ì Úԉȷ‚‹ÙË (‰È·Ù·Ú·¯‹ ·ÓÔ¯‹˜ ÛÙË ÁÏ˘Îfi˙Ë ‹ ‰È·Ù·Ú·¯‹ ÁÏ˘Îfi˙˘ ÓËÛÙ›·˜). ™Ù· ¿ÙÔÌ· ·˘Ù¿ Ë ¯ÔÚ‹ÁËÛË ÌÂ˙·ÊÈÌÚ¿Ù˘ Ì›ˆÛ ÙËÓ ÂÌÊ¿ÓÈÛË Ó¤Ô˘ ‰È·‚‹ÙË Î·Ù¿ 30% (p=0,009). ™ÙÔ Û‡ÓÔÏÔ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ Û˘ÌÌÂÙ›¯·Ó ÛÙË ÌÂϤÙË μπƒ Ë ¯ÔÚ‹ÁËÛË ÌÂ˙·ÊÈÌÚ¿Ù˘ ÂÈ‚Ú¿‰˘Ó ÙËÓ ·‡ÍËÛË ÙÔ˘ ‰Â›ÎÙË ÈÓÛÔ˘ÏÈÓÔ·ÓÙ›ÛÙ·Û˘ ∏√ª∞ (homeostasis model assessment) ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂϤÙ˘ (·‡ÍËÛË Î·Ù¿ 34,4% ÛÙËÓ ÔÌ¿‰· ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ Û ۇÁÎÚÈÛË Ì ·‡ÍËÛË Î·Ù¿ 6,6% ÛÙËÓ ÔÌ¿‰· Ù˘ ÌÂ˙·ÊÈÌÚ¿Ù˘, p<0,001). √È Â˘ÓÔ˚Τ˜ ·˘Ù¤˜ ÂȉڿÛÂȘ Ù˘ ÌÂ˙·ÊÈÌÚ¿Ù˘ ÛÙÔ ÌÂÙ·‚ÔÏÈÛÌfi ÙˆÓ ˘‰·Ù·ÓıÚ¿ÎˆÓ Èı·Ó¿ Ó· Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ÈηÓfiÙËÙ· ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Ó· ÂÓÂÚÁÔÔÈ› ÌÂÚÈο Î·È ÙÔ˘˜ PP∞RÁ ˘ԉԯ›˜, ÂÎÙfi˜ ·fi ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ PP∞R· ˘Ô‰Ô¯¤ˆÓ.

£EPA¶EIA - ºAPMAKA 5. ∏ ÌÂϤÙË VA-HIT (Veterans Administration HDL Intervention Trial) ™ÙË ‰ÈÏ¿ - Ù˘ÊÏ‹ ·˘Ù‹ ÌÂϤÙË ‰È¿ÚÎÂÈ·˜ 7 ÂÙÒÓ Û˘ÌÌÂÙ›¯·Ó 2.531 ¿Ó‰Ú˜ ËÏÈΛ·˜ ̤¯ÚÈ 74 ÂÙÒÓ Ì ÈÛÙÔÚÈÎfi ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ (ÈÛÙÔÚÈÎfi ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ôηډ›Ô˘ ‹ Â¤Ì‚·Û˘ Â·Ó·ÁÁ›ˆÛ˘, ÈÛÙÔÚÈÎfi ÛÙËı¿Á¯Ë˜ Ì ÂȂ‚·ÈˆÌ¤ÓË ÈÛ¯·ÈÌ›· ‹ ıÂÙÈο Â˘Ú‹Ì·Ù· ÛÙË ÛÙÂÊ·ÓÈÔÁÚ·Ê›·). Δ· Â›‰· ÙˆÓ ÏÈȉ›ˆÓ ÙˆÓ ·ÛıÂÓÒÓ ‹Ù·Ó HDL ¯ÔÏËÛÙÂÚfiÏË <40 mg/dL, LDL ¯ÔÏËÛÙÂÚfiÏË <140 mg/dL Î·È TG <300 mg/dL. ™ÙÔ˘˜ ·ÛıÂÓ›˜ ¯ÔÚËÁ‹ıËΠ›Ù ÁÂÌÊÈÌÚÔ˙›ÏË (1200 mg ÙËÓ Ë̤ڷ) ›Ù ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ. ∏ ¯ÔÚ‹ÁËÛË Ù˘ ÁÂÌÊÈÌÚÔ˙›Ï˘ ›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ì›· ÛËÌ·ÓÙÈ΋ ηٿ 22% (p=0,006) Ì›ˆÛË ÙˆÓ ı·Ó¿ÙˆÓ Ô˘ ÔÊ›ÏÔÓÙ·Ó Û ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ Î·È ÙˆÓ ÂÌÊÚ·ÁÌ¿ÙˆÓ ÙÔ˘ Ì˘Ôηډ›Ô˘ Û ۇÁÎÚÈÛË Ì ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘. ∂ÈÚfiÛıÂÙ·, ÛÙË ÌÂϤÙË VA-HIT ·Ú·ÙËÚ‹ıËΠÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÙˆÓ ·ÁÁÂÈ·ÎÒÓ ÂÁÎÂÊ·ÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ (6,9% ¤Ó·ÓÙÈ 5,1%, p=0,04), ÙˆÓ ·ÚÔ‰ÈÎÒÓ ÈÛ¯·ÈÌÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ (4,2% ¤Ó·ÓÙÈ 1,7%, p<0,001) Î·È ÙˆÓ ÂÂÌ‚¿ÛÂˆÓ Î·ÚˆÙȉÈ΋˜ ÂÓ‰·ÚÙËÚÂÎÙÔÌ‹˜ (1,3% ¤Ó·ÓÙÈ 3,5%, p<0,001) ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË Ù˘ ÁÂÌÊÈÌÚÔ˙›Ï˘. ™ÙË ÌÂϤÙË ·˘Ù‹ ‰ÂÓ ·Ú·ÙËÚ‹ıËΠÛËÌ·ÓÙÈ΋ ÌÂÙ·‚ÔÏ‹ ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘ Û η̛· ·fi ÙȘ 2 ÔÌ¿‰Â˜. ŒÙÛÈ, Ù· ıÂÚ·¢ÙÈο ·ÔÙÂϤÛÌ·Ù· ‰ÂÓ ÌÔÚÔ‡Ó Ó· ·Ô‰ÔıÔ‡Ó ÛÙË Ì›ˆÛË Ù˘ Û˘ÁΤÓÙÚˆÛ˘ Ù˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘. ∏ VA-HIT Â›Ó·È Ë ÚÒÙË ÌÂÁ¿ÏË ÎÏÈÓÈ΋ ÌÂϤÙË Ô˘ ¤‰ÂÈÍ ÙÔ ÎÏÈÓÈÎfi fiÊÂÏÔ˜ Ô˘ ÚÔ·ÙÂÈ ·fi ÙËÓ ·‡ÍËÛË Ù˘ HDL ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ÙË Ì›ˆÛË ÙˆÓ TG ¯ˆÚ›˜ Ó· Û˘Ó˘¿Ú¯ÂÈ Ì›ˆÛË Ù˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘. ™˘ÁÎÂÎÚÈ̤ӷ ·Ú·ÙËÚ‹ıËΠ̛· ηٿ 11% Ì›ˆÛË ÙˆÓ Û˘Ì‚·Ì¿ÙˆÓ ÁÈ· οı ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ HDLC ηٿ 5 mg/dL. øÛÙfiÛÔ, Â›Ó·È Ôχ Èı·Ófi Ó· ·Ú·ÙËÚ‹ıËΠ̛ˆÛË ÙˆÓ ÌÈÎÚÒÓ-˘ÎÓÒÓ LDL, Ë ÔÔ›· Èı·Ó¿ ‰È·‰Ú·Ì¿ÙÈÛ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙË Ì›ˆÛË ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ.

∞Í›˙ÂÈ Ó· ·Ó·ÊÂÚı› fiÙÈ Ë Ì›ˆÛË ÙˆÓ ·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ ‹Ù·Ó ȉȷ›ÙÂÚ· ÌÂÁ¿ÏË ÛÙËÓ ÔÌ¿‰· ÙˆÓ ‰È·‚ËÙÈÎÒÓ ·ÛıÂÓÒÓ (n=627) Ô˘ Û˘ÌÌÂÙ›¯·Ó ÛÙË ÌÂϤÙË (Ì›ˆÛË ÛÙÂÊ·ÓÈ·›ˆÓ ı·Ó¿ÙˆÓ ηٿ 41% Î·È ÙˆÓ ·ÁÁÂÈ·ÎÒÓ ÂÁÎÂÊ·ÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ ηٿ 40%). ∂ÈÚfiÛıÂÙ·, Ë ¯ÔÚ‹ÁËÛË ÁÂÌÊÈÌÚÔ˙›Ï˘ ˆÊ¤ÏËÛ ȉȷ›ÙÂÚ· Ù· ¿ÙÔÌ· Ì ˘ÂÚÈÓÛÔ˘ÏÈÓ·ÈÌ›· (‰ËÏ·‰‹ Ù· ¿ÙÔÌ· Ì ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ) ·ÎfiÌË Î·È ·Ó ‰ÂÓ Â›¯·Ó ‰È·‚‹ÙË. ª¿ÏÈÛÙ·, fiÛÔ ·˘Í¿ÓÔÓÙ·Ó Ù· Â›‰· Ù˘ ÈÓÛÔ˘Ï›Ó˘ ÓËÛÙ›·˜ ÙfiÛÔ ÌÂÈÒÓÔÓÙ·Ó Ô Î·Ú‰È·ÁÁÂÈ·Îfi˜ ΛӉ˘ÓÔ˜. ∂Ô̤ӈ˜, Ê·›ÓÂÙ·È fiÙÈ Ë ¯ÔÚ‹ÁËÛË ÁÂÌÊÈÌÚÔ˙›Ï˘ Â›Ó·È È‰È·›ÙÂÚ· ¢ÂÚÁÂÙÈ΋ ÛÙ· ¿ÙÔÌ· Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ÙËÓ ·ıËÚÔÁfiÓÔ ‰˘ÛÏÈȉ·ÈÌ›· (·˘ÍË̤ӷ ÙÚÈÁÏ˘ÎÂÚ›‰È·, ·˘ÍË̤Ó˜ ÌÈÎÚ¤˜-˘ÎÓ¤˜ LDL Î·È ÌÂȈ̤ӷ Â›‰· ∏DL ¯ÔÏËÛÙÂÚfiÏ˘). Δ¤ÏÔ˜, Ì›· ¿ÏÏË ÂÎ ÙˆÓ ˘ÛÙ¤ÚˆÓ ·Ó¿Ï˘ÛË Ù˘ VA-HIT ¤‰ÂÈÍ Ì›ˆÛË ÙÔ˘ ÚˆÙÔÁÂÓÔ‡˜ ηٷÏËÎÙÈÎÔ‡ ÛËÌ›Ԣ ηٿ 27% (ÁÂÌÊÈÌÚÔ˙›ÏË Û ۇÁÎÚÈÛË Ì ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ, p=0,02) ÛÙ· ¿ÙÔÌ· ÂΛӷ Ô˘ ÂÌÊ¿ÓÈ˙·Ó ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ÓfiÛÔ (n=1.046, ˘ÔÏÔÁÈ˙fiÌÂÓË Î¿ı·ÚÛË ÎÚ·ÙÈÓ›Ó˘ < 75 mL/min).

6. ∏ ÌÂϤÙË ÙÔ˘ ∂ÏÛ›ÓÎÈ (Helsinki Heart Study, HHS) H HHS ‹Ù·Ó Ì›· ‰ÈÏ¿ - Ù˘ÊÏ‹ ÂÏÂÁ¯fiÌÂÓË Ì ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ ÎÏÈÓÈ΋ ‰ÔÎÈÌ‹ ÚˆÙÔÁÂÓÔ‡˜ ÚfiÏ˄˘ ÛÙËÓ ÔÔ›· Û˘ÌÌÂÙ›¯·Ó 4.081 ¿Ó‰Ú˜ ̤Û˘ ËÏÈΛ·˜ Ì ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·. √È ·ÛıÂÓ›˜ Ù˘¯·ÈÔÔÈ‹ıËÎ·Ó Û ÁÂÌÊÈÌÚÔ˙›ÏË (1200 mg ÙËÓ Ë̤ڷ) ‹ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ Î·È ·Ú·ÎÔÏÔ˘ı‹ıËÎ·Ó ÁÈ· 5 ¤ÙË. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·Ú·ÎÔÏÔ‡ıËÛ˘ ·Ú·ÙËÚ‹ıËΠ̛· ηٿ 34% ÛËÌ·ÓÙÈ΋ (p=0,02) Ì›ˆÛË ÙˆÓ ·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ ¯ˆÚ›˜ Ó· ÌÂÙ·‚ÏËı› Ë ÔÏÈ΋ ıÓËÙfiÙËÙ·. øÛÙfiÛÔ, Ë Ì›ˆÛË ÙˆÓ Û˘Ì‚·Ì¿ÙˆÓ ‹Ù·Ó Ôχ ÌÂÁ·Ï‡ÙÂÚË (71%) ÛÙ· ¿ÙÔÌ· Ì ‰È·‚‹ÙË, ηıÒ˜ Î·È ÛÙ· ¿ÙÔÌ· Ì ¯·ÌËÏ¿ Â›‰· ∏DL ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ·˘ÍË̤ӷ ÙÚÈÁÏ˘ÎÂÚ›‰È·. ∂ÈÚfiÛıÂÙ·, ÛÙ· ¿ÙÔÌ· Ì ·˘ÍË̤ÓÔ ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (>26 Kg/m2) Ë Ì›ˆÛË ÙˆÓ Û˘Ì‚·Ì¿ÙˆÓ ‹Ù·Ó 48%. ∞Í›˙ÂÈ Ó· ·Ó·ÊÂÚı› fiÙÈ Ë ·Ú·ÎÔÏÔ‡ıË-

ÛË ÙˆÓ ·ÙfiÌˆÓ Ô˘ Û˘ÌÌÂÙ›¯·Ó ÛÙËÓ HHS ÁÈ· 18 ¤ÙË ¤‰ÂÈÍ fiÙÈ ·ÛıÂÓ›˜ Ì ·˘ÍË̤ӷ ÙÚÈÁÏ˘ÎÂÚ›‰È· Î·È ·˘ÍË̤ÓÔ ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜ Ô˘ ‹Ú·Ó ÁÂÌÊÈÌÚÔ˙›ÏË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ 5 ÂÙÒÓ Ù˘ ÌÂϤÙ˘ ÂÌÊ¿ÓÈÛ·Ó ÌÈ· ηٿ 71% ÌÈÎÚfiÙÂÚË ÛÙÂÊ·ÓÈ·›· ıÓËÙfiÙËÙ· (p<0,001) Î·È ÌÈ· ηٿ 33% ÌÈÎÚfiÙÂÚË ÔÏÈ΋ ıÓËÙfiÙËÙ· (p=0,03) Û ۇÁÎÚÈÛË Ì ٷ ¿ÙÔÌ· Ô˘ ‹Ú·Ó ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ.

7. ∏ ÌÂϤÙË DAIS (Diabetes Atherosclerosis Intervention Study) ™ÙËÓ ·ÁÁÂÈÔÁÚ·ÊÈ΋ ÌÂϤÙË DAIS Û˘ÌÌÂÙ›¯·Ó 418 ‰È·‚ËÙÈÎÔ› ·ÛıÂÓ›˜. ∏ ÌÂϤÙË ¤‰ÂÈÍ fiÙÈ Ë ¯ÔÚ‹ÁËÛË Ê·ÈÓÔÊÈÌÚ¿Ù˘ (200 mg/Ë̤ڷ) ÁÈ· 3 ¤ÙË Û ·ÛıÂÓ›˜ Ì ÁÓˆÛÙ‹ ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ Â›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ì›· ÛËÌ·ÓÙÈ΋ ÂÈ‚Ú¿‰˘ÓÛË Ù˘ ÂͤÏÈ͢ Ù˘ ·ıËڈ̷ÙÈ΋˜ ÓfiÛÔ˘ ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÁÁ›ˆÓ (-40%, p=0,029). ™ÙËÓ ›‰È· ÌÂϤÙË ·Ú·ÙËÚ‹ıËΠ̛· ηٿ 23% Ì›ˆÛË ÙˆÓ ÎÏÈÓÈÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ, Ë ÔÔ›· ˆÛÙfiÛÔ ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋, Èı·Ó¿ ÂÍ·ÈÙ›·˜ ÙÔ˘ ÌÈÎÚÔ‡ ·ÚÈıÌÔ‡ ·ÛıÂÓÒÓ Ô˘ Û˘ÌÌÂÙ›¯·Ó ÛÙË ÌÂϤÙË. ŒÓ· ÂӉȷʤÚÔÓ Â‡ÚËÌ· ·˘Ù‹˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó fiÙÈ Ë ¯ÔÚ‹ÁËÛË Ê·ÈÓÔÊÈÌÚ¿Ù˘ ÌÔÚ› Ó· ‚ÂÏÙÈÒÛÂÈ Ì›· ÌÈÎÚÔ·ÁÁÂȷ΋ ÂÈÏÔ΋ ÙÔ˘ ‰È·‚‹ÙË, ÙË ‰È·‚ËÙÈ΋ ÓÂÊÚÔ¿ıÂÈ·. ™˘ÁÎÂÎÚÈ̤ӷ, Ë ¯ÔÚ‹ÁËÛË Ù˘ Ê·ÈÓÔÊÈÌÚ¿Ù˘ ›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ì›· ÛËÌ·ÓÙÈ΋ (p=0,031) Ì›ˆÛË Ù˘ ÂÌÊ¿ÓÈÛ˘ ÌÈÎÚÔ·Ï‚Ô˘ÌÈÓÔ˘Ú›·˜ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂϤÙ˘.

8. ∏ ÌÂϤÙË FIELD (Fenofibrate Intervention and Event Lowering in Diabetes) ¶ÚÈÓ 2,5 ¤ÙË ‰ËÌÔÛȇıËÎ·Ó Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂÁ·Ï‡ÙÂÚ˘ ÌÂϤÙ˘ Ô˘ ÂÎÙ›ÌËÛ ÙËÓ Â›‰Ú·ÛË Ù˘ Ê·ÈÓÔÊÈÌÚ¿Ù˘ Û ·ÛıÂÓ›˜ Ì ‰È·‚‹ÙË. ¶ÚfiÎÂÈÙ·È ÁÈ· ÙË ÌÂϤÙË FIELD ÛÙËÓ ÔÔ›· 9.795 ·ÛıÂÓ›˜ Ì ‰È·‚‹ÙË Ù‡Ô˘ 2, ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË 116251 mg/dL Î·È ÏfiÁˆ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘/HDL ¯ÔÏËÛÙÂÚfiÏË ≥4.0 ‹ ÙÚÈÁÏ˘ÎÂÚ›‰È· >89 mg/dL Ù˘¯·ÈÔÔÈ‹ıËÎ·Ó Û ʷÈÓÔÊÈÌÚ¿ÙË (200 mg/Ë̤ڷ) ‹ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ. ªÂÙ¿ ·fi 5 ¤ÙË ·-

13

π√À¡π√™ 2008

Ú·ÎÔÏÔ‡ıËÛ˘ ÙÔ ÚˆÙÔÁÂÓ¤˜ ηٷÏËÎÙÈÎfi ÛËÌÂ›Ô (ÛÙÂÊ·ÓÈ·›Ô˜ ı¿Ó·ÙÔ˜ ‹ ÌË ı·Ó·ÙËÊfiÚÔ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘) ÌÂÈÒıËΠηٿ 11% ÛÙËÓ ÔÌ¿‰· Ù˘ Ê·ÈÓÔÊÈÌÚ¿Ù˘, ·ÏÏ¿ Ë Ì›ˆÛË ·˘Ù‹ ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ (p=0,16). øÛÙfiÛÔ, Ë Ì›ˆÛË ÙˆÓ ÌË ı·Ó·ÙËÊfiÚˆÓ ÂÌÊÚ·ÁÌ¿ÙˆÓ ÙÔ˘ Ì˘Ôηډ›Ô˘ ‹Ù·Ó 24% Î·È ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ (p=0,01). ∂ÈÚfiÛıÂÙ·, ÌÂÈÒıËÎ·Ó ÛËÌ·ÓÙÈο Ù· Û˘ÓÔÏÈο ηډȷÁÁÂȷο Û˘Ì‚¿Ì·Ù· (ÛÙ· ÔÔ›· Û˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·Ó Ù· ·ÁÁÂȷο ÂÁÎÂÊ·ÏÈο ÂÂÈÛfi‰È·) ηٿ 11% (p=0,035) Î·È ÔÈ ÂÂÌ‚¿ÛÂȘ ÛÙÂÊ·ÓÈ·›·˜ Â·Ó·ÁÁ›ˆÛ˘ ηٿ 21% (p=0,003). ∞Í›˙ÂÈ Ó· ·Ó·ÊÂÚı› fiÙÈ Ë ¯Ú‹ÛË ÛÙ·ÙÈÓÒÓ [ÌÂÁ·Ï‡ÙÂÚË ÛÙËÓ ÔÌ¿‰· ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ (36%) Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· Ù˘ Ê·ÈÓÔÊÈÌÚ¿Ù˘ (19%)] Èı·Ó¿ Ófiı¢Û ٷ ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ FIELD Î·È ÂÈÛΛ·Û ٷ ÔʤÏË ·fi ÙË ¯ÔÚ‹ÁËÛË Ê·ÈÓÔÊÈÌÚ¿Ù˘. ŒÙÛÈ, ÌÂÙ¿ ·fi ÛÙ·ÙÈÛÙÈ΋ ‰ÈfiÚıˆÛË ÁÈ· ÙË ¯ÔÚ‹ÁËÛË ÛÙ·ÙÈÓÒÓ Ë Ì›ˆÛË ÙÔ˘ ÚˆÙÔÁÂÓÔ‡˜ ηٷÏËÎÙÈÎÔ‡ ÛËÌ›Ԣ ‹Ù·Ó 19% Î·È ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ (p=0,01). ∞fi ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ Û˘ÌÌÂÙ›¯·Ó ÛÙË FIELD Ë ÌÂÁ¿ÏË ÏÂÈÔ„ËÊ›· (n=7.664) ‰ÂÓ Â›¯·Ó ÁÓˆÛÙ‹ ηډȷÁÁÂȷ΋ ÓfiÛÔ (ÚˆÙÔÁÂÓ‹˜ ÚfiÏË„Ë). ™Â ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Ë Ì›ˆÛË ÙˆÓ Û˘ÓÔÏÈÎÒÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ ‹Ù·Ó 19% Î·È ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ (p=0,004), Û ·ÓÙ›ıÂÛË Ì ÙÔ˘˜ ·ÛıÂÓ›˜ ‰Â˘ÙÂÚÔÁÂÓÔ‡˜ ÚfiÏ˄˘, ÛÙÔ˘˜ ÔÔ›Ô˘˜ ‰ÂÓ ˘‹Ú¯Â ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÌÂٷ͇ Ê·ÈÓÔÊÈÌÚ¿Ù˘ Î·È ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘. ™ÙË ÌÂϤÙË FIELD ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ 2 ÔÌ¿‰ˆÓ fiÛÔÓ ·ÊÔÚ¿ ÙË Î·Ú‰È·ÁÁÂȷ΋ Î·È ÙËÓ ÔÏÈ΋ ıÓËÙfiÙËÙ·. ∞Í›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈ Ô ÏËı˘ÛÌfi˜ ÙˆÓ ·ÙfiÌˆÓ Ô˘ Û˘ÌÌÂÙ›¯Â ÛÙË ÌÂϤÙË ‹Ù·Ó ¯·ÌËÏÔ‡ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ (1%/¤ÙÔ˜ ηډȷÁÁÂȷο Û˘Ì‚¿Ì·Ù· ÛÙËÓ ÔÌ¿‰· ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘) Î·È ÙÔ ÁÂÁÔÓfi˜ ·˘Ùfi Èı·Ó¿ Ó· Ì›ˆÛ ÙË ÛÙ·ÙÈÛÙÈ΋ ‰‡Ó·ÌË Ù˘ ÌÂϤÙ˘. ™ÙȘ ÚÔËÁÔ‡ÌÂÓ˜ ÌÂÁ¿Ï˜ ÌÂϤÙ˜ Ì ÊÈÌÚ¿Ù˜ (HHS, BIP, VA-HIT) Ê¿ÓËΠfiÙÈ Ë ıÂÚ·›· Ì ·˘Ù¿ Ù· Ê¿Ú̷η ‚ÔËı¿ÂÈ È‰È·›ÙÂÚ·

14

Û ·ÛıÂÓ›˜ Ì ·ıËÚÔÁfiÓÔ ‰˘ÛÏÈȉ·ÈÌ›· (¯·ÌËÏ‹ HDL ¯ÔÏËÛÙÂÚfiÏË Î·È ˘„ËÏ¿ TG). ∞ÓÙ›ıÂÙ·, ÛÙË ÌÂϤÙË FIELD Ù· ·Ú¯Èο Â›‰· ÙˆÓ ÏÈȉ·ÈÌÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ (HDL ¯ÔÏËÛÙÂÚfiÏË 43 mg/dL, LDL ¯ÔÏËÛÙÂÚfiÏË 119 mg/dL Î·È TG 153 mg/dL) ‰ÂÓ ·Ú·¤ÌÔ˘Ó ÛÙËÓ ·ÚÔ˘Û›· ·ıËÚÔÁfiÓÔ˘ ‰˘ÛÏÈȉ·ÈÌ›·˜. ∏ ·Ó¿Ï˘ÛË ˘ÔÔÌ¿‰ˆÓ Ù˘ FIELD ¤‰ÂÈÍ fiÙÈ È‰È·›ÙÂÚ· ˆÊÂÏ‹ıËÎ·Ó ÔÈ ÓÂfiÙÂÚÔÈ ·ÛıÂÓ›˜ (<65 ÂÙÒÓ) Î·È ÔÈ ·ÛıÂÓ›˜ Ô˘ ›¯·Ó ¯·ÌËÏ¿ Â›‰· ∏DL ¯ÔÏËÛÙÂÚfiÏ˘. ª›· Ôχ ÂӉȷʤÚÔ˘Û· ·Ú·Ù‹ÚËÛË ·fi ÙË ÌÂϤÙË FIELD ·ÊÔÚ¿ ÙËÓ Â›‰Ú·ÛË Ù˘ Ê·ÈÓÔÊÈÌÚ¿Ù˘ ÛÙȘ ÌÈÎÚÔ·ÁÁÂȷΤ˜ ÂÈÏÔΤ˜ ÙÔ˘ ‰È·‚‹ÙË, ÔÈ Ôԛ˜ Î·È ·ÔÙÂÏÔ‡Ó ÛËÌ·ÓÙÈÎfi Úfi‚ÏËÌ· ÁÈ· ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓ›˜. ™˘ÁÎÂÎÚÈ̤ӷ, Ë ¯ÔÚ‹ÁËÛË Ù˘ Ê·ÈÓÔÊÈÌÚ¿Ù˘ ›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ì›· Ôχ ÛËÌ·ÓÙÈ΋ ηٿ 30% (p=0,0001) Ì›ˆÛË ÙˆÓ ÂÂÌ‚¿ÛÂˆÓ ÊˆÙÔËÍ›·˜ (laser) ÂÍ·ÈÙ›·˜ ‰È·‚ËÙÈ΋˜ ·ÌÊÈ‚ÏËÛÙÚÔÂȉÔ¿ıÂÈ·˜, Ì›· ηٿ 11% Ì›ˆÛË Ù˘ ÂͤÏÈ͢ Û ÌÈÎÚÔ·Ï‚Ô˘ÌÈÓÔ˘Ú›· (p=0,002), ηıÒ˜ Î·È Ì›· ηٿ 31% Ì›ˆÛË ÙˆÓ ÂÂÌ‚¿ÛÂˆÓ ·ÎÚˆÙËÚÈ·ÛÌÔ‡ ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ (p=0,04). ™Â Ì›· ˘ÔÔÌ¿‰· (n=1.012) ÙˆÓ ·ÙfiÌˆÓ Ù˘ ÌÂϤÙ˘ FIELD ÂÏ‹ÊıËÛ·Ó ÊˆÙÔÁڷʛ˜ ÙÔ˘ ‚˘ıÔ‡ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂϤÙ˘. ™Ù· ¿ÙÔÌ· Ì ÚÔ¸¿Ú¯Ô˘Û· ·ÌÊÈ‚ÏËÛÙÚÔÂȉÔ¿ıÂÈ· Ë ¯ÔÚ‹ÁËÛË Ê·ÈÓÔÊÈÌÚ¿Ù˘ ›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ì›· ÛËÌ·ÓÙÈ΋ Ì›ˆÛË Ù˘ ÂͤÏÈ͢ Ù˘ ‰È·‚ËÙÈ΋˜ ·ÌÊÈ‚ÏËÛÙÚÔÂȉÔ¿ıÂÈ·˜ Û ۇÁÎÚÈÛË Ì ÙÔ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ (3 ¤Ó·ÓÙÈ 14 ¿ÙÔÌ·, p=0,004). ŒÙÛÈ, Ë Ê·ÈÓÔÊÈÌÚ¿ÙË, fiˆ˜ Î·È ÛÙË ÌÂϤÙË DAIS, Ê·›ÓÂÙ·È fiÙÈ ÂÎÙfi˜ ·fi ÙË Ì›ˆÛË ÙˆÓ Ì·ÎÚÔ·ÁÁÂÈ·ÎÒÓ ÂÈÏÔÎÒÓ ÙÔ˘ ‰È·‚‹ÙË (΢ڛˆ˜ ÙˆÓ ÌË ı·Ó·ÙËÊfiÚˆÓ ÂÌÊÚ·ÁÌ¿ÙˆÓ ÛÙËÓ ÚˆÙÔÁÂÓ‹ ÚfiÏË„Ë) ‚ÂÏÙÈÒÓÂÈ Î·È ÙȘ ÌÈÎÚÔ·ÁÁÂȷΤ˜ ÂÈÏÔΤ˜ Ù˘ ÓfiÛÔ˘.

™À¡¢À∞™ª∂¡∏ £∂ƒ∞¶∂π∞ ™Δ∞Δπ¡∏™-ºπª¶ƒ∞Δ∏™ ™Â ÔÏÏÔ‡˜ ·ÛıÂÓ›˜ Ì ÌÈÎÙ‹ ‰˘ÛÏÈȉ·ÈÌ›·, Ë ÌÔÓÔıÂÚ·›· Ì ÛÙ·Ù›Ó˜ ‹ ÊÈÌÚ¿Ù˜ ‰ÂÓ ÂÈÙ˘Á¯¿ÓÂÈ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ‰ÈfiÚıˆÛË ÙˆÓ ÛÔ‚·ÚÒÓ Î·È ÔÈÎÈÏfi-

ÌÔÚÊˆÓ ‰È·Ù·Ú·¯ÒÓ ÙˆÓ ÏÈȉ›ˆÓ. ™Â ·˘Ù¤˜ ÙȘ ÂÚÈÙÒÛÂȘ Ë Û˘Ó‰˘·Ṳ̂ÓË ıÂÚ·›· (ÛÙ·Ù›ÓË + ÊÈÌÚ¿ÙË) ·ÔÙÂÏ› Ì›· ÂÓ·ÏÏ·ÎÙÈ΋ χÛË. ∏ ¢Ú›· ·Ô‰Ô¯‹ Ù˘ Û˘Ó‰˘·Ṳ̂Ó˘ ıÂÚ·›·˜ ÂÚÈÔÚ›˙ÂÙ·È ·fi ÙÔÓ Èı·Ófi ΛӉ˘ÓÔ ÂÌÊ¿ÓÈÛ˘ Ì˘ÔÛ›Ùȉ·˜ ‹ ·ÎfiÌË Î·È Ú·‚‰ÔÌ˘fiÏ˘Û˘. øÛÙfiÛÔ, Ô Î›Ó‰˘ÓÔ˜ ·˘Ùfi˜ ‰ÂÓ ÂȂ‚·ÈÒıËΠ·fi ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÌÂϤÙ˜ Ô˘ ¯ÚËÛÈÌÔÔ›ËÛ·Ó Û˘Ó‰˘·Ṳ̂ÓË ˘ÔÏÈȉ·ÈÌÈ΋ ·ÁˆÁ‹. °È· ·Ú¿‰ÂÈÁÌ·, ÛÙË ÌÂϤÙË FIELD ۯ‰fiÓ 1.000 ·ÛıÂÓ›˜ ¤Ï·‚·Ó Û˘Ó‰˘·Ṳ̂ÓË ıÂÚ·›· ÛÙ·Ù›Ó˘ Ì ʷÈÓÔÊÈÌÚ¿ÙË ¯ˆÚ›˜ Ó· ·Ó·ÊÂÚı› ·˘ÍË̤ÓË Â›ÙˆÛË ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ. ŒÙÛÈ, Ë Û˘Ó‰˘·Ṳ̂ÓË ˘ÔÏÈȉ·ÈÌÈ΋ ·ÁˆÁ‹ ÌÔÚ› Ó· ¯ÔÚËÁËı› Û ÔÚÈṲ̂ÓÔ˘˜ ·ÛıÂÓ›˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Ì ·ÓıÂÎÙÈ΋ ÌÈÎÙ‹ ‰˘ÛÏÈȉ·ÈÌ›·. ∏ ·ÛÊ¿ÏÂÈ· Î·È Ë Û¯¤ÛË ÎfiÛÙÔ˘˜-·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ Ù˘ Û˘Ó‰˘·Ṳ̂Ó˘ ıÂÚ·›·˜ ‚Ú›ÛÎÔÓÙ·È ·ÎfiÌË ˘fi ¤Ú¢ӷ. ∏ ÊÈÌÚ¿ÙË Ô˘ Ú¤ÂÈ Ó· ¯ÔÚËÁÂ›Ù·È Û ÂÚÈÙÒÛÂȘ Û˘Ó‰˘·Ṳ̂Ó˘ ıÂÚ·›·˜ Â›Ó·È Ë Ê·ÈÓÔÊÈÌÚ¿ÙË (ÔÙ¤ Ë ÁÂÌÊÈÌÚÔ˙›ÏË), ÂÓÒ Ô Û˘Ó‰˘·ÛÌfi˜ Ú¤ÂÈ Ó· ·ÔʇÁÂÙ·È Û ËÏÈÎȈ̤ӷ ¿ÙÔÌ·, ηıÒ˜ Î·È Û ¿ÙÔÌ· Ì ¤ÎÙˆÛË Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ‹ ˘Ôı˘ÚÂÔÂȉÈÛÌfi. ∏ ÌÂϤÙË ACCORD (Action to Control Cardiovascular Risk in Diabetes) Û˘ÁÎÚ›ÓÂÈ ÙË ¯ÔÚ‹ÁËÛË ÛÈÌ‚·ÛÙ·Ù›Ó˘ ¤Ó·ÓÙÈ Ù˘ ¯ÔÚ‹ÁËÛ˘ ÙÔ˘ Û˘Ó‰˘·ÛÌÔ‡ ÛÈÌ‚·ÛÙ·Ù›Ó˘ Ì ʷÈÓÔÊÈÌÚ¿ÙË fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ÂÌÊ¿ÓÈÛË Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ Û ‰È·‚ËÙÈο ¿ÙÔÌ· Î·È ·Ó·Ì¤ÓÂÙ·È Ó· ÔÏÔÎÏËÚˆı› ÙÔ 2009.

™Àª¶∂ƒ∞™ª∞Δ∞ Δ· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ÌÂÁ¿ÏˆÓ ÚÔÔÙÈÎÒÓ ÌÂÏÂÙÒÓ Ì ÊÈÌÚ¿Ù˜ ‰Â›¯ÓÔ˘Ó fiÙÈ Ù· Ê¿Ú̷η ·˘Ù‹˜ Ù˘ ηÙËÁÔÚ›·˜ Â›Ó·È È‰È·›ÙÂÚ· ¯Ú‹ÛÈÌ· ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ·ÛıÂÓÒÓ Ì ˘„ËÏ¿ ÙÚÈÁÏ˘ÎÂÚ›‰È· Î·È ¯·ÌËÏ¿ Â›‰· ∏DL ¯ÔÏËÛÙÂÚfiÏ˘. ™Â ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓ›˜ ·Ó·Ì¤ÓÂÙ·È Ë ¯ÔÚ‹ÁËÛË ÊÈÌÚ·ÙÒÓ Ó· Ô‰ËÁ‹ÛÂÈ Û ÛËÌ·ÓÙÈο ÎÏÈÓÈο ÔʤÏË. ŒÙÛÈ, ÔÈ ÊÈÌÚ¿Ù˜ Â›Ó·È Ê¿Ú̷η ÚÒÙ˘ ÂÈÏÔÁ‹˜ ÁÈ· ¿ÙÔÌ· Ì Ôχ ˘„ËÏ¿ ÙÚÈÁÏ˘ÎÂÚ›‰È· (>500 mg/dL) ÁÈ· ÙË Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛ˘ ÔÍ›·˜ ·ÁÎÚ·ٛÙȉ·˜.

£EPA¶EIA - ºAPMAKA ∂ÈÚfiÛıÂÙ·, ÔÈ ÊÈÌÚ¿Ù˜ ÌÔÚÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ˆ˜ ÌÔÓÔıÂÚ·›· Û ¿ÙÔÌ· Ì LDL ¯ÔÏËÛÙÂÚfiÏË ÎÔÓÙ¿ ÛÙÔ ÛÙfi¯Ô Ù˘ ıÂÚ·›·˜ Ô˘ Ù·˘Ùfi¯ÚÔÓ· ÂÌÊ·Ó›˙Ô˘Ó ˘„ËÏ¿ ÙÚÈÁÏ˘ÎÂÚ›‰È· Î·È ¯·ÌËÏ¿ Â›‰· ∏DL ¯ÔÏËÛÙÂÚfiÏ˘. Δ¤ÏÔ˜, ȉȷ›ÙÂÚ· ÛËÌ·ÓÙÈ΋ Â›Ó·È Ë ı¤ÛË ÙˆÓ ÊÈ-

ÌÚ·ÙÒÓ ÁÈ· ÙË Ì›ˆÛË ÙÔ˘ ˘ÔÏÂÈÔ̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ ÌÂÙ¿ ÙËÓ Â›Ù¢ÍË Ì ÙË ¯ÔÚ‹ÁËÛË ÛÙ·Ù›Ó˘ ÙˆÓ ÛÙfi¯ˆÓ ÁÈ· ÙËÓ LDL ¯ÔÏËÛÙÂÚfiÏË, Ë ÔÔ›· ÂÍ·ÎÔÏÔ˘ı› Ó· ·ÔÙÂÏ› ÙÔÓ Î‡ÚÈÔ ÛÙfi¯Ô Ù˘ ˘ÔÏÈȉ·ÈÌÈ΋˜ ·ÁˆÁ‹˜. ™Â ·˘Ùfi ÙÔ Ï·›ÛÈÔ Ô ÚÔÛÂÎÙÈÎfi˜ Û˘Ó‰˘·ÛÌfi˜ Û¯ÂÙÈο ¯·ÌËÏ‹˜

‰fiÛ˘ ÛÙ·Ù›Ó˘ Ì ʷÈÓÔÊÈÌÚ¿ÙË Û ÂÈÏÂÁ̤ӷ ¿ÙÔÌ· ·Ó·Ì¤ÓÂÙ·È Ó· Û˘ÓÂÈÛʤÚÂÈ ÛÙËÓ ÂÚ·ÈÙ¤Úˆ Ì›ˆÛË ÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘.

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9.

Diabetes Atherosclerosis Intervention Study Investigators: Effect of fenofibrate on progression of coronaryartery disease in type 2 diabetes. The Diabetes Atherosclerosis Intervention Study, a randomized study. Lancet 2001; 357: 905-910.

10. The FIELD study investigators. Effect of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomized controlled trial. Lancet 2005; 366: 1849-1861 11. Keech AC, Mitchell P, Sumannen PA, et al. Effect of fenofibrate on the need for laser treatment for diabetic retinopathy (FIELD study): a randomized controlled trial. Lancet 2007; 370: 1687-1697.

12. Florentin M, Liberopoulos EN, Mikhailidis DP, Elisaf M. Fibrateassociated adverse effects beyond muscle and liver toxicity. Curr Pharmaceut Des 2008; 14: in press.

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π√À¡π√™ 2008

‚-·ÔÎÏÂÈÛÙ¤˜ Î·È ∫·Ú‰È·Î‹ ∞ÓÂ¿ÚÎÂÈ·. ∞. ¶··ı·Ó·Û›Ô˘ ∫·Ú‰ÈÔÏfiÁÔ˜, ∂ÍÂȉÈ΢fiÌÂÓÔ˜ ∂ÓÙ·ÙÈÎÔÏÔÁ›·˜, ª∂£ ¶°¡ πˆ·ÓÓ›ÓˆÓ

π. °Ô˘‰¤‚ÂÓÔ˜ ∫·ıËÁËÙ‹˜ ∫·Ú‰ÈÔÏÔÁ›·˜, ∫·Ú‰ÈÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ¶°¡ πˆ·ÓÓ›ÓˆÓ ™‹ÌÂÚ· Â›Ó·È Î·Ï¿ ÙÂÎÌËÚȈ̤ÓÔ˜ Ô ÚfiÏÔ˜ ÙÔ˘ Û˘Ì·ıËÙÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÛÙËÓ ·ıÔÁ¤ÓÂÈ· Î·È ÙËÓ ÂͤÏÈÍË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Ù˘ ηډȷ΋˜ ·ÓÂ¿ÚÎÂÈ·˜.(1) ¶Ú¿ÁÌ·ÙÈ ÙÔ ·˘ÍË̤ÓÔ ÊÔÚÙ›Ô Ù˘ ·ÓÂ·ÚÎÔ‡Û·˜ ·ÚÈÛÙÂÚ¿˜ ÎÔÈÏ›·˜ Ô‰ËÁ› Û ÌÈ· ·˘ÍË̤ÓË ‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘ Û˘Ì·ıËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ∏ ·˘ÍË̤ÓË ·˘Ù‹ ‰Ú·ÛÙËÚÈfiÙËÙ· Î·È Ë ·ÏÏËÏÂ›‰Ú·Û‹ ÙÔ˘ Ì ÙÔ Û‡ÛÙËÌ· ÚÂÓ›Ó˘-·ÁÁÂÈÔÙÂÓÛ›Ó˘ ·Ï‰ÔÛÙÂÚfiÓ˘ Î·È ¿ÏÏÔ˘˜ ‰È·‚È‚·ÛÙ¤˜, ÔÈ ÔÔ›ÔÈ ÂÎÎÚ›ÓÔÓÙ·È ·fi Ù· Ì˘Ôηډȷο ·ÙÙ·Ú· Î·È ¤¯Ô˘Ó ÂÓ‰ÔÎÚÈÓ‹ Î·È ·Ú·ÎÚÈÓ‹ ‰Ú¿ÛË, Â›Ó·È ˘‡ı˘ÓË ÁÈ· ÙËÓ ·ÁÁÂÈÔÛ‡Û·ÛË, ÙËÓ Ù·¯˘Î·Ú‰›· Î·È ÙȘ ‰ÔÌÈΤ˜ ·ÏÏ·Á¤˜ ÛÙ· Ì˘Ôηډȷο ·ÙÙ·Ú· ÔÈ Ôԛ˜ Ô‰ËÁÔ‡Ó ÛÙËÓ ·ÚÓËÙÈ΋ ·Ó·‰È·ÌfiÚʈÛË Ù˘ ·ÚÈÛÙÂÚ¿˜ ÎÔÈÏ›·˜ Î·È ÛÙȘ ·ÚÓËÙÈΤ˜ ÂÈÙÒÛÂȘ Ù˘ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· (∂ÈÎfiÓ· 1).(1) Δ· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¤¯ÂÈ Â‰Ú·Èˆı› Ë ·Í›· Ù˘ ·Ó·ÛÙÔÏ‹˜ ÙÔ˘ ·‰ÚÂÓÂÚÁÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜

ÛÙËÓ ‚ÂÏÙ›ˆÛË Ù˘ ÚfiÁÓˆÛ˘ ÙˆÓ ·ÛıÂÓÒÓ Ì ηډȷ΋ ·ÓÂ¿ÚÎÂÈ·. (2) √È ‚-·ÔÎÏÂÈÛÙ¤˜ η٤¯Ô˘Ó ÛËÌ·ÓÙÈ΋ ı¤ÛË ÛÙË Ê·Ú̷΢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ηډȷ΋˜ ·ÓÂ¿ÚÎÂÈ·˜.(2) °È· ÔÏÏ¿ ¯ÚfiÓÈ· ÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜ ¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈËı› Î·È ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛÙËÓ ÛÙ·ıÂÚ‹ ÛÙËı¿Á¯Ë, ÛÙËÓ ˘¤ÚÙ·ÛË, ÌÂÙ¿ ·fi ¤ÌÊÚ·ÁÌ· Ì˘Ôηډ›Ô˘ Î·È Û ‰È¿ÊÔÚ˜ ·ÚÚ˘ı̛˜. Δ· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¤¯ÂÈ ÙÂÎÌËÚȈı› Ì ÔÏϤ˜ Ù˘¯·ÈÔÔÈË̤Ó˜ Ù˘ÊϤ˜ ÌÂϤÙ˜ Ô ÚfiÏÔ˜ ÙÔ˘˜ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ·ÛıÂÓÒÓ Ì ηډȷ΋ ·ÓÂ¿ÚÎÂÈ·. √È ‚-·ÔÎÏÂÈÛÙ¤˜ ÌÔÚÔ‡Ó Ó· ‰È·ÎÚÈıÔ‡Ó ·‰Ú¿ ÛÙÔ˘˜ ÌË ÂÎÏÂÎÙÈÎÔ‡˜ (·ÔÎÏÂ›Ô˘Ó ÙÔ˘˜ ‚1 Î·È ÙÔ˘˜ ‚2 ·‰ÚÂÓÂÚÁÈÎÔ‡˜ ˘ԉԯ›˜) Î·È Û ·˘ÙÔ‡˜ ÔÈ ÔÔ›ÔÈ ÂÌÊ·Ó›˙Ô˘Ó ÌÂÁ·Ï‡ÙÂÚË Û˘ÁÁ¤ÓÂÈ· Ì ÙÔ˘˜ ‚1 ˘ԉԯ›˜. ∂ÈÚfiÛıÂÙ· ÔÚÈṲ̂ÓÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜ ÂÌÊ·Ó›˙Ô˘Ó ÂÚÈÊÂÚÈ΋ ·ÁÁÂÈԉȷÛÙÔÏ‹ ›Ù ‰È· ̤ÛÔ˘ ·1 ·‰ÚÂÓÂÚÁÈ΋˜ ·Ó·ÛÙÔÏ‹˜ (ηڂ‰ÈÏfiÏË, Ï·‚ÂÙ·Ïfi-

ÂÓÂÚÁÔÔ›ËÛË Û˘Ì·ıËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (™¡™)

‰Ú·ÛÙËÚÈfiÙËÙ·˜ Û˘Ì·ıËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÛÙÔ Î·Ú‰È·ÁÁÂÈ·Îfi

Û˘Ì·ıËÙÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÛÙÔ ÓÂÊÚfi

Û˘Ì·ıËÙÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÛÙÔÓ ∫∞ƒ¢π∞∫√ ªÀ

∂ÓÂÚÁÔÔ›ËÛË ™˘ÛÙ‹Ì·ÙÔ˜ PAA

ÀÂÚÙÚÔÊ›· Ì˘Ô΢ÙÙ¿ÚˆÓ μÏ·‚Ë - ·fiÙˆÛË Ì˘Ô΢ÙÙ¿ÚˆÓ ·ÚÚ˘ı̛˜

∞ÁÁÂÈÔÛ‡Û·ÛË

∫·Ù·ÎÚ¿ÙËÛË

∂ͤÏÈÍË Ù˘ ÓfiÛÔ˘

∂ÈÎfiÓ· 1. √ ÚfiÏÔ˜ ÙÔ˘ Û˘Ì·ıËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÛÙËÓ ÂͤÏÈÍË Ù˘ ηډȷ΋˜ ·ÓÂ¿ÚÎÂÈ·˜. (™¡™: Û˘Ì·ıËÙÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ·, ƒ∞∞: Û‡ÛÙËÌ· ÚÂÓ›Ó˘-·ÁÁÂÈÔÙÂÓÛ›Ó˘-·Ï‰ÔÛÙÂÚfiÓ˘).

16

ÏË) ›Ù ‰È·Ì¤ÛÔ˘ ‚2 ·‰ÚÂÓÂÚÁÈ΋˜ ‰È¤ÁÂÚÛ˘ (ÛÂÏÈÚÔÏfiÏË), ›Ù ‰È· ̤ÛÔ˘ Ì˯·ÓÈÛÌÒÓ ·ÓÂÍ¿ÚÙËÙˆÓ ·fi ÙÔÓ ·ÔÎÏÂÈÛÌfi ÙˆÓ ·‰ÚÂÓÂÚÁÈÎÒÓ ˘Ô‰Ô¯¤ˆÓ (‚Ô˘ÛÈÓ‰ÔÏfiÏË, ÓÂÌÈ‚ÔÏfiÏË).(2) Δ· ÔʤÏË ·fi ÙË ¯ÔÚ‹ÁËÛË ‚-·ÔÎÏÂÈÛÙÒÓ Û ·ÛıÂÓ›˜ ÌÂ Û˘ÛÙÔÏÈ΋ ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· ¤¯Ô˘Ó ÙÂÎÌËÚȈı› ·fi ÔÏϤ˜ ÌÈÎÚ¤˜ ÌÂϤÙ˜ Î·È ·ÚÎÂÙ¤˜ ÌÂÁ¿Ï˜ ÚÔÔÙÈΤ˜ ‰ÈÏ¿ - Ù˘ÊϤ˜ Ù˘¯·ÈÔÔÈË̤Ó˜ ÌÂϤÙ˜ Ì ÙË ‚Ô‹ıÂÈ· ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘. ™˘ÓÔÏÈο, ÛÙȘ ÌÂϤÙ˜ ·˘Ù¤˜ Û˘ÌÂÚÈÂÏ‹ÊıËÎ·Ó 15.000 ·ÛıÂÓ›˜. ™ÙȘ ΢ÚÈfiÙÂÚ˜ ·fi ·˘Ù¤˜ Ô˘ ·ÊÔÚÔ‡Û·Ó ÙË ¯ÔÚ‹ÁËÛË Î·Ú‚Â‰ÈÏfiÏ˘ (5 ÌÂϤÙ˜), ‚ÈÛÔÚÔÏfiÏ˘ (1 ÌÂϤÙË) Î·È ÌÂÙÔÚÔÏfiÏ˘ CR/XL (2 ÌÂϤÙ˜), Ë ¯ÔÚ‹ÁËÛË ÙÔ˘ ‚-·ÔÎÏÂÈÛÙ‹ Û ۇÁÎÚÈÛË Ì ÙÔ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ Û ·ÛıÂÓ›˜ Ì ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· ÛÙ·‰›Ô˘ ¡À∏∞ ππ-πV, ›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÛÙË Û˘ÓÔÏÈ΋ Î·È Î·Ú‰È·ÁÁÂȷ΋ ıÓËÙfiÙËÙ·, Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ ·ÈÊÓ›‰ÈˆÓ ηډȷÎÒÓ ı·Ó¿ÙˆÓ Î·È ÙˆÓ ı·Ó¿ÙˆÓ Ô˘ ÔÊ›ÏÔÓÙ·È Û ÚÔԉ¢ÙÈ΋ Âȉ›ӈÛË Ù˘ ÓfiÛÔ˘. ∂ÈÚfiÛıÂÙ· ÔʤÏË ·fi ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ ‚-·ÔÎÏÂÈÛÙ‹ ·ÊÔÚÔ‡Û·Ó ÙË Ì›ˆÛË ÙˆÓ ÓÔÛËÏÂÈÒÓ ·fi ηډȷÁÁÂȷο Î·È ÌË ·›ÙÈ·, ÙË ‚ÂÏÙ›ˆÛË Ù˘ ÏÂÈÙÔ˘ÚÁÈ΋˜ ηٿÛÙ·Û˘ Î·È ÙËÓ ÂÈ‚Ú¿‰˘ÓÛË Ù˘ ÂͤÏÈ͢ Ù˘ ÓfiÛÔ˘. Δ· ÔʤÏË ·˘Ù¿ ‹Ù·Ó ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ËÏÈΛ·, ÙÔ Ê‡ÏÔ, ÙËÓ ‡·ÚÍË Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË, ÙËÓ ·ÈÙÈÔÏÔÁ›· (ÈÛ¯·ÈÌÈ΋ ‹ fi¯È) Î·È ÙËÓ ·Ú¯È΋ ÏÂÈÙÔ˘ÚÁÈ΋ ηٿÛÙ·ÛË.(2) ™˘ÓÔÏÈο, Û‡Ìʈӷ Ì ٷ ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ‰È·ÊfiÚˆÓ ÌÂÏÂÙÒÓ, Ú¤ÂÈ Ó· ıÂÚ·‡ÔÓÙ·È 15-43 ·ÛıÂÓ›˜ Ì ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· ÒÛÙ ӷ ·ÔÊ¢¯ı› ¤Ó·˜ ı¿Ó·ÙÔ˜ (∂ÈÎfiÓ· 2). (3) ∂˘Ú‹Ì·Ù· ·fi ÌÂÁ¿Ï˜ ‰ËÌÔÛÎÔ‹ÛÂȘ (surveys) ‰Â›¯ÓÔ˘Ó fiÙÈ Ë Û˘¯ÓfiÙËÙ· Û˘ÓÙ·ÁÔÁÚ¿ÊË-

∞ÚÈıÌfi˜ ·ÛıÂÓÒÓ

£EPA¶EIA - ºAPMAKA

∂ÈÎfiÓ· 2. ∞ÚÈıÌfi˜ ·ÛıÂÓÒÓ Ì ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· Ô˘ Ú¤ÂÈ Ó· ıÂÚ·¢ÙÔ‡Ó ÒÛÙ ӷ ·ÔÊ¢¯ı› 1 ı¿Ó·ÙÔ˜.

(CAPRICORN: CArvedilol Post infaRction SurvIval COntRol in left ventricular dysfunctioN, CIBIS: Cardiac Insufficiency Bisoprolol Study, COPERNICUS: CarvedilOl ProspEctive RaNdomIzed CUmulative Survival Trial, MERIT-HF: MEtoprololCR/XL Randomized Intervention Trial in chronic Heart Failure).

ÛËÏÂÈÒÓ (∂ÈÎfiÓ· 3).(5) ΔÔ ı‹Ï˘ ʇÏÔ Â›Û˘ ‰ÂÓ Ú¤ÂÈ ·ÔÙÂÏ› ÊÚ·ÁÌfi ÛÙË Û˘ÓÙ·ÁÔÁÚ¿ÊËÛË ‚-·ÔÎÏÂÈÛÙÒÓ. ∏ ÌÔÓ·‰È΋ ÌÂϤÙË ·¢ı›·˜ Û‡ÁÎÚÈÛ˘ ‰‡Ô ‚-·ÔÎÏÂÈÛÙÒÓ (ÌÂÙÔÚÔÏfiÏ˘ ¤Ó·ÓÙÈ Î·Ú‚Â‰ÈÏfiÏ˘) Â›Ó·È Ì¤¯ÚÈ Û‹ÌÂÚ· Ë Carvedilol Or Metoprolol European Trial (COMET).(6) ™ÙË ÌÂϤÙË ·˘Ù‹ Û˘ÌÂÚÈÂÏ‹ÊıËÎ·Ó 3029 ·ÛıÂÓ›˜ ·fi 317 ΤÓÙÚ· 15 ∂˘Úˆ·˚ÎÒÓ ¯ˆÚÒÓ, Ì ÂËÚ·Ṳ̂ÓÔ ÎÏ¿ÛÌ· ÂÍÒıËÛ˘ Î·È ÔÈ ÔÔ›ÔÈ Ù˘¯·ÈÔÔÈ‹ıËÎ·Ó Ó· Ï¿‚Ô˘Ó Â›Ù ηڂ‰ÈÏfiÏË (25 mg x 2) ›Ù ÙÚ˘ÁÈ΋ ÌÂÙÔÚÔÏfiÏË (ÂӉȿÌÂÛ˘ ·ÂÏ¢ı¤ÚˆÛ˘ ÌÂÙÔ¶Èı·ÓfiÙËÙ· Ó· ÂΉËψı› Û˘Ì‚¿Ó (%)

Û˘ ‚-·ÔÎÏÂÈÛÙÒÓ Û ËÏÈÎȈ̤ÓÔ˘˜, Á˘Ó·›Î˜ Î·È ¿ÙÔÌ· ÌÂ Û˘Ó˘¿Ú¯Ô˘Û˜ ·ı‹ÛÂȘ (Ó¢ÌÔÓÔ¿ıÂȘ, ‰È·‚‹ÙË ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ·) Â›Ó·È ÂÚÈÔÚÈṲ̂ÓË. ∂Âȉ‹ Ë Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ· Â›Ó·È Û˘¯Ó‹ ÛÙÔ˘˜ ËÏÈÎȈ̤ÓÔ˘˜ Î·È ÂÂȉ‹ Ë ıÓËÙfiÙËÙ· ·˘Í¿ÓÂÈ ·fiÙÔÌ· ÛÙÔ˘˜ ËÏÈÎȈ̤ÓÔ˘˜, ÙÔ ‰˘ÓËÙÈÎfi fiÊÂÏÔ˜ Û ·˘Ù‹ ÙËÓ ËÏÈÎȷ΋ ÔÌ¿‰· Â›Ó·È „ËÏfi. ∏ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ·˘Ù‹ ‰Â›¯ıËΠ۠ÌÈ· ÌÂÙ·-·Ó¿Ï˘ÛË Ô˘ Û˘ÌÂÚȤϷ‚ >12.000 ·ÛıÂÓ›˜ ·fi 5 ÌÂϤÙ˜. ™‡Ìʈӷ Ì ٷ ·ÔÙÂϤÛÌ·Ù· Ù˘ Û˘ÁÎÂÎÚÈ̤Ó˘ ÌÂÙ·-·Ó¿Ï˘Û˘ Ù· ÔʤÏË ·fi ÙË ¯ÔÚ‹ÁËÛË ÙˆÓ ‚-·ÔÎÏÂÈÛÙÒÓ Û ËÏÈÎȈ̤ÓÔ˘˜ ·ÛıÂÓ›˜ Ì ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· Â›Ó·È ·ÚfiÌÔÈ· Ì ·˘Ù¿ ÛÙÔ˘˜ ÌË ËÏÈÎȈ̤ÓÔ˘˜. (4) ∏ ·ÛÊ¿ÏÂÈ· Î·È Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ¯ÔÚ‹ÁËÛ˘ ÓÂÌÈ‚ÔÏfiÏ˘ Û ËÏÈÎȈ̤ÓÔ˘˜ ·ÛıÂÓ›˜ ÌÂÏÂÙ‹ıËÎÂ Î·È ÛÙË ÌÂϤÙË SENIORS.(5) ™ÙË Û˘ÁÎÂÎÚÈ̤ÓË Ù˘¯·ÈÔÔÈË̤ÓË ÔÏ˘ÎÂÓÙÚÈ΋ ÌÂϤÙË Û˘ÌÌÂÙ›¯·Ó 2135 ·ÛıÂÓ›˜ ËÏÈΛ·˜ ¿Óˆ ÙˆÓ 70 ÂÙÒÓ Ì ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· ÔÈ ÔÔ›ÔÈ Ù˘¯·ÈÔÔÈ‹ıËÎ·Ó Ó· Ï¿‚Ô˘Ó ÓÂÌÈ‚ÔÏfiÏË ‹ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ. ™‡Ìʈӷ Ì ٷ ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ Ë ¯ÔÚ‹ÁËÛË ÓÂÌÈ‚ÔÏfiÏ˘ Û¯ÂÙ›ÛÙËΠ̛̠ˆÛË Ù˘ ηډȷÁÁÂȷ΋˜ ıÓËÙfiÙËÙ·˜ Î·È ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÓÔ-

ÚÔÏfiÏË Û ‰fiÛË 50 mg x 2). ªÂÙ¿ ·fi ‰È¿ÚÎÂÈ· ·Ú·ÎÔÏÔ‡ıËÛ˘ 58 ÌËÓÒÓ Ë Û˘ÓÔÏÈ΋ ıÓËÙfiÙËÙ· ÛÙËÓ ÔÌ¿‰· Ù˘ ηڂ‰ÈÏfiÏ˘ ‹Ù·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚË (34% ¤Ó·ÓÙÈ 40% ÛÙËÓ ÔÌ¿‰· Ù˘ ÌÂÙÔÚÔÏfiÏ˘ ·ÓÙ›ÛÙÔȯ·).(6) ¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë Û˘ÁÎÂÎÚÈ̤ÓË ÌÂϤÙË ·Ó¤‰ÂÈÍ ÙËÓ ·ÓˆÙÂÚfiÙËÙ· Ù˘ ηڂ‰ÈÏfiÏ˘ ¤Ó·ÓÙÈ Ù˘ ÂӉȿÌÂÛ˘ ·Ô‰¤ÛÌ¢Û˘ ÌÂÙÔÚÔÏfiÏ˘ Û ·ÛıÂÓ›˜ Ì ηډȷ΋ ·ÓÂ¿ÚÎÂÈ·, ‰¤¯ıËΠ¤ÓÙÔÓË ÎÚÈÙÈ΋ Ë ÔÔ›· ·ÊÔÚÔ‡Û ÛÙË ¯Ú‹ÛË ‰È·ÊÔÚÂÙÈÎÔ‡ Û΢¿ÛÌ·ÙÔ˜ ÌÂÙÔÚÔÏfiÏ˘ Û ۇÁÎÚÈÛË Ì ÂΛÓÔ Ô˘ ¤¯ÂÈ ¯ÚËÛÈÌÔÔÈËı› Î·È ÁÈ· ÙÔ ÔÔ›Ô

¡ÂÌÈ‚ÔÏfiÏË ∂ÈÎÔÓÈÎfi º¿ÚÌ·ÎÔ

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∂ÈÎfiÓ· 3. ¶ÚˆÙ‡ÔÓ Î·Ù·ÏËÎÙÈÎfi ÛËÌÂ›Ô (Û˘ÓÔÏÈ΋ ıÓËÙfiÙËÙ· Î·È Û˘ÓÔÏÈΤ˜ ÂÈÛ·ÁˆÁ¤˜ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÏfiÁˆ ηډȷÁÁÂȷ΋˜ ·ÈÙÈÔÏÔÁ›·˜ ) ÛÙË ÌÂϤÙË SENIORS (̤ÛË ÂÚ›Ô‰Ô˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ 21 Ì‹Ó˜).

17

π√À¡π√™ 2008

¶›Ó·Î·˜ 1. ∂Ӊ›ÍÂȘ ¯ÔÚ‹ÁËÛ˘ ‚-·ÔÎÏÂÈÛÙÒÓ Û ·ÛıÂÓ›˜ Ì ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· [ÙÚÔÔÔÈË̤ÓÔ ·fi (2)] Δ¿ÍË

∂›Â‰Ô ÙÂÎÌËÚ›ˆÛ˘

ŸÏÔÈ ÔÈ ÛÙ·ıÂÚÔÔÈË̤ÓÔÈ ·ÛıÂÓ›˜ Ì NYHA II-IV

π

∞

∞Û˘Ìو̷ÙÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ·ÚÈÛÙÂÚ¿˜ ÎÔÈÏ›·˜ ÌÂÙ¿ ·fi √∂ª

π

∞

∞Û˘Ìو̷ÙÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ·ÚÈÛÙÂÚ¿˜ ÎÔÈÏ›·˜ ¯ˆÚ›˜ √∂ª

π

μ

ÃÚfiÓÈ· ∫∞ Ì ‰È·ÙËÚË̤ÓÔ ÎÏ¿ÛÌ· ÂÍÒıËÛ˘ (Ì›ˆÛË Û˘¯ÓfiÙËÙ·˜)

ππa

C

√Í›· ·ÓÙÈÚÚÔÔ‡ÌÂÓË Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ· ÌÂÙ¿ ·fi √∂ª

IIa

B

π

∞

∞ÛıÂÓ›˜ Ì ÔÍ›· ∫∞ ÌÂÙ¿ ÙË ÛÙ·ıÂÚÔÔ›ËÛË ∫∞: ηډȷ΋ ·ÓÂ¿ÚÎÂÈ·, √∂ª: Ô͇ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘ ›¯Â ÙÂÎÌËÚȈı› Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿ ÙÔ˘ Û ·Ï·ÈfiÙÂÚ˜ ÌÂϤÙ˜, fiˆ˜ Ë MERIT-HF. ∂ÈÚfiÛıÂÙ· ÛÙË ÌÂϤÙË COMET Ë ‰fiÛË Ù˘ ÌÂÙÔÚÔÏfiÏ˘ ‹Ù·Ó ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚË ·fi ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÛÙËÓ MERIT-HF (50 mg x 2 ¤Ó·ÓÙÈ 100 mg x 2 ·ÓÙ›ÛÙÔȯ·).(2) ¶·Ú¿ ÙË ÎÚÈÙÈ΋ Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ COMET ‰Â›¯ÓÔ˘Ó fiÙÈ Û ·ÛıÂÓ›˜ Ì ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙˆÓ ‚-·ÔÎÏÂÈÛÙÒÓ ‰È·Ê¤ÚÂÈ ·Ó¿ÏÔÁ· Ì ÙÔ Û··ÛÌ· Î·È ÙÔ Â›‰Ô˜ ÙÔ˘ ‚-·ÔÎÏÂÈÛÙ‹ Î·È ÁÈ· ÙÔÓ ÏfiÁÔ ·˘Ùfi ı· Ú¤ÂÈ Ó· ¯ÔÚËÁÔ‡ÓÙ·È ÌfiÓÔ ÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜ ÙˆÓ ÔÔ›ˆÓ Ë ·ÛÊ¿ÏÂÈ· Î·È Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ¤¯ÂÈ ÙÂÎÌËÚȈı› ·fi Ù˘¯·ÈÔÔÈË̤Ó˜ ÌÂϤÙ˜. ∏ ¯ÔÚ‹ÁËÛË ‚-·ÔÎÏÂÈÛÙÒÓ ÂӉ›ÎÓ˘Ù·È ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ·ÛıÂÓÒÓ Ì ÛÙ·ıÂÚ‹ ‹È·, ̤ÙÚÈ· ‹ ÛÔ‚·Ú‹ ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· ÈÛ¯·ÈÌÈ΋˜ ‹ ÌË ·ÈÙÈÔÏÔÁ›·˜, ¿ÓÙ· ˆ˜ ̤ÚÔ˜ Ù˘ ÎÏ·ÛÛÈ΋˜ ıÂÚ·¢ÙÈ΋˜ ·ÓÙÈÌÂÙÒÈÛ˘ Ë ÔÔ›· Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ·Ó·ÛÙÔÏ›˜ ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ Î·È ‰ÈÔ˘ÚËÙÈο. ∏ ·Ú·¿Óˆ Ô‰ËÁ›· ¯·Ú·ÎÙËÚ›˙ÂÙ·È Ì ‚·ıÌfi ÛËÌ·ÓÙÈÎfiÙËÙ·˜ Ù¿Í˘ π Î·È Â›Â‰Ô ÙÂÎÌËÚ›ˆÛ˘

∞. ¶Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ ‰Â‰Ô̤ӷ ·fi ÙȘ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ ˘ÔÛÙËÚ›˙Ô˘Ó ÙË ¯ÔÚ‹ÁËÛË ‚ÈÛÔÚÔÏfiÏ˘, ηڂ‰ÈÏfiÏ˘, ÓÂÌÈ‚ÔÏfiÏ˘ Î·È ÌÂÙÔÚÔÏfiÏ˘ CR. H ÙÚ˘ÁÈ΋ ÌÂÙÔÚÔÏfiÏË (tartrate) ‰ÂÓ Û˘ÓÈÛٿٷÈ.(7) √È ÂӉ›ÍÂȘ ¯ÔÚ‹ÁËÛ˘ ‚-·ÔÎÏÂÈÛÙÒÓ Û ·ÛıÂÓ›˜ Ì ÛÙ·ıÂÚÔÔÈË̤ÓË Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ· Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1, ÂÓÒ ÛÙÔÓ ¶›Ó·Î· 2 ·Ó·Ê¤ÚÔÓÙ·È ÔÈ ·ÓÙ›ÛÙÔȯ˜ ‰fiÛÂȘ ÙÈÙÏÔÔ›ËÛ˘. Δ· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ȉȷ›ÙÂÚË ÚÔÛÔ¯‹ ¤¯ÂÈ ‰Ôı› ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· Î·È ‰È·ÙËÚË̤ÓÔ ÎÏ¿ÛÌ· ÂÍÒıËÛ˘. ∞ÔÙÂϤÛÌ·Ù· ÌÂÏÂÙÒÓ Î·Ù·ÁÚ·Ê‹˜ ¤‰ÂÈÍ·Ó fiÙÈ ÔÈ ÌÈÛÔ› ÂÚ›Ô˘ ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· ›Ù ÛÙË ÎÔÈÓfiÙËÙ· (8), ›Ù ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô (9) ¤¯Ô˘Ó ‰È·ÙËÚË̤ÓÔ ÎÏ¿ÛÌ· ÂÍÒıËÛ˘ Î·È ·ÚfiÌÔÈ· ÓÔÛËÚfiÙËÙ· Î·È ıÓËÙfiÙËÙ· Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ ·ÓÙ›ÛÙÔÈ¯Ô˘˜ ·ÛıÂÓ›˜ Ì ÌÂȈ̤ÓÔ ÎÏ¿ÛÌ· ÂÍÒıËÛ˘. (8-10) ¢Â‰Ô̤ӷ Ù˘¯·ÈÔÔÈËÌ¤ÓˆÓ ÌÂÏÂÙÒÓ ÁÈ· ÙË ¯ÔÚ‹ÁËÛË ‚-·ÔÎÏÂÈÛÙÒÓ Û ·ÛıÂÓ›˜ Ì ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· Î·È ‰È·ÙËÚË̤ÓÔ ÎÏ¿ÛÌ· ÂÍÒıËÛ˘ Â›Ó·È Û¿ÓÈ·. £ÂÙÈο Â›Ó·È Ù· ·ÔÙÂϤÛÌ·Ù· ·fi

ÙË ¯ÔÚ‹ÁËÛË ‚-·ÔÎÏÂÈÛÙÒÓ Û ËÏÈÎȈ̤ÓÔ˘˜ ·ÛıÂÓ›˜ Ì ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· Î·È ‰È·ÙËÚË̤ÓÔ ÎÏ¿ÛÌ· ÂÍÒıËÛ˘ fiˆ˜ ·Ó¤‰ÂÈÍÂ Ë ÌÂϤÙË SENIORS. (5) √È Û˘ÛÙ¿ÛÂȘ ÁÈ· ÙË ¯ÔÚ‹ÁËÛË ‚-·ÔÎÏÂÈÛÙÒÓ Û ·ÛıÂÓ›˜ Ì ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· Î·È ‰È·ÙËÚË̤ÓÔ ÎÏ¿ÛÌ· ÂÍÒıËÛ˘ Â›Ó·È ÂÌÂÈÚÈΤ˜ Î·È ‚·Û›˙ÔÓÙ·È ÛÙ· ıˆÚËÙÈο ÔʤÏË Ô˘ ËÁ¿˙Ô˘Ó ·fi ÙËÓ Ì›ˆÛË Ù˘ ηډȷ΋˜ Û˘¯ÓfiÙËÙ·˜, ÙËÓ ·‡ÍËÛË Ù˘ ‰È·ÛÙÔÏÈ΋˜ ÂÚÈfi‰Ô˘ Î·È ÙËÓ ‚ÂÏÙ›ˆÛË Ù˘ ÈÛ¯·ÈÌ›·˜ Ô˘ Ù· Ê¿Ú̷η ·˘Ù¿ ÚÔηÏÔ‡Ó. ¶·ÚÔÌÔ›ˆ˜ ‰Â‰Ô̤ӷ Ù˘¯·ÈÔÔÈËÌ¤ÓˆÓ ÌÂÏÂÙÒÓ ‰ÂÓ ˘¿Ú¯Ô˘Ó Ô‡Ù fiÛÔÓ ·ÊÔÚ¿ ÙË ¯ÔÚ‹ÁËÛË ‚-·ÔÎÏÂÈÛÙÒÓ Û ÔÍ›· ηډȷ΋ ·ÓÂ¿ÚÎÂÈ·. º·›ÓÂÙ·È fiÙÈ Ë ¯ÔÚ‹ÁËÛË ÙˆÓ Ê·ÚÌ¿ÎˆÓ ·˘ÙÒÓ ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È Ì Ôχ ÚÔÛÔ¯‹ Û ·ÛıÂÓ›˜ Ì ˘ÁÚÔ‡˜ ÚfiÁ¯Ô˘˜ Î·È ˘fiÙ·ÛË, ÂÓÒ ›Ûˆ˜ Ó· ˆÊÂÏÔ‡Ó ·ÛıÂÓ›˜ Ì ÔÍ›· ηډȷ΋ ·ÓÂ¿ÚÎÂÈ·, Ù·¯˘Î·Ú‰›· Î·È Ì˘Ôηډȷ΋ ÈÛ¯·ÈÌ›·. (11). ¶¿ÓÙˆ˜ ‚-·ÔÎÏÂÈÛÙ¤˜ ı· Ú¤ÂÈ Ó· ¯ÔÚËÁÔ‡ÓÙ·È ¿ÌÂÛ· ÌÂÙ¿ ÙË ÛÙ·ıÂÚÔÔ›ËÛË ÙˆÓ ·ÛıÂÓÒÓ ·˘ÙÒÓ.(11) ™ÙËÓ ÌÂϤÙË COMMIT (ClOpidogrel and Metoprolol in Myocardial Infarc-

¶›Ó·Î·˜ 2. ¢fiÛÂȘ ÙÈÙÏÔÔ›ËÛ˘ ‚-·ÔÎÏÂÈÛÙÒÓ Û ·ÛıÂÓ›˜ Ì ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· ·Ó¿ Û··ÛÌ· [ÙÚÔÔÔÈË̤ÓÔ ·fi (7)] ™Î‡·ÛÌ·

∞Ú¯È΋ ‰fiÛË (mg)

∞˘Í‹ÛÂȘ (mg/̤ڷ)

¢fiÛË ÛÙfi¯Ô˜ (mg/̤ڷ)

1,25

2,5 - 3,75 - 5 - 7,5 - 10

10

12,5/25

25 - 50 - 100 -200

200

∫·Ú‚‰ÈÏfiÏË

3,125

6,25 - 12,5 -25 - 50

50

¡ÂÌÈ‚ÔÏfiÏË

1,25

2,5 - 5 - 10

10

μÈÛÔÚÔÏfiÏË ªÂÙÔÚÔÏfiÏË CR/XL

18

£EPA¶EIA - ºAPMAKA tion) Ë ¿ÌÂÛË ¯ÔÚ‹ÁËÛË ÌÂÙÔÚÔÏfiÏ˘ Û¯ÂÙ›ÛÙËΠ̠ÌÂȈ̤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· Â·Ó¤ÌÊÚ·ÁÌ· Î·È ÂÌÊ¿ÓÈÛË ÎÔÈÏȷ΋˜ Ù·¯˘Î·Ú‰›·˜, ·ÏÏ¿ Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ÂΉ‹ÏˆÛË Î·Ú‰ÈÔÁÂÓÔ‡˜ ηٷÏËÍ›·˜ ηٿ 30%, ΢ڛˆ˜ ηٿ ÙÔ ÚÒÙÔ 24ˆÚÔ ·fi ÙËÓ ¤Ó·ÚÍË ÙˆÓ Û˘Ìو̿وÓ. (12) √ ΛӉ˘ÓÔ˜ ·˘Ùfi˜ ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚÔ˜ Û ·ÛıÂÓ›˜ ËÏÈΛ·˜ >70 ÂÙÒÓ, Û ·˘ÙÔ‡˜ ÌÂ Û˘ÛÙÔÏÈ΋ ›ÂÛË <120 mmHg, ηډȷ΋ Û˘¯ÓfiÙËÙ· >110 ÛʇÍÂȘ/ÏÂÙfi, Î·È Û ·˘ÙÔ‡˜ Ô˘ Ì ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· Ù¿Í˘ III ηٿ Killip ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹. (12) °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi Ë ¯ÔÚ‹ÁËÛË ‚-·ÔÎÏÂÈÛÙÒÓ Û ·ÛıÂÓ›˜ Ì ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· Î·È Ô͇ ÛÙÂÊ·ÓÈ·›Ô Û‡Ó‰ÚÔÌÔ Î·Ù¿ ÙËÓ ÔÍ›· Ê¿ÛË ı· Ú¤ÂÈ Ó· ·ÔʇÁÂÙ·È ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì¤¯ÚÈ Ó· ÂÈÙ¢¯ı› Ë ·ÈÌÔ‰˘Ó·ÌÈ΋ ÛÙ·ıÂÚfiÙËÙ· Î·È Ó· ˘Ô¯ˆÚ‹ÛÔ˘Ó Ù· Û˘ÌÙÒÌ·Ù· Ù˘ ÔÍ›·˜ ηډȷ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ ÛÙÔ˘˜

·ÛıÂÓ›˜ ·˘ÙÔ‡˜. (12) √È ‚-·ÔÎÏÂÈÛÙ¤˜ Â›Ó·È Ë 4Ë Î·Ù¿ ÛÂÈÚ¿ ÈÔ Û˘¯Ó¿ Û˘ÓÙ·ÁÔÁÚ·ÊÔ‡ÌÂÓË Î·ÙËÁÔÚ›· Ê·ÚÌ¿ÎˆÓ (΢ڛˆ˜ Ë ·ÙÂÓÔÏfiÏË) ÛÙȘ H¶∞ ·ÏÏ¿ Ë ¯Ú‹ÛË ÙÔ˘˜ ÛÙË ıÂÚ·›· Ù˘ ·ÓÂ›ÏÂÎÙ˘ ˘¤ÚÙ·Û˘ ˘Ê›ÛÙ·Ù·È ÌÂÁ¿ÏË ÎÚÈÙÈ΋ (3). ΔÔÓ›˙ÂÙ·È fiÙÈ ıÂÚ·›· 1000 ·ÛıÂÓÒÓ Ì ‚-·ÔÎÏÂÈÛÙ¤˜ ÁÈ· 4.4 ¯ÚfiÓÈ· ı· ηٷϋÍÂÈ Û 14 Ӥ˜ ÂÚÈÙÒÛÂȘ ‰È·‚‹ÙË, 3 ÂÈϤÔÓ ı·Ó¿ÙÔ˘˜ Î·È 5 ÂÈϤÔÓ ÂÁÎÂÊ·ÏÈο. ŸÛÔÓ ·ÊÔÚ¿ ÛÙË ÚˆÙÔÁÂÓ‹ ÚfiÏË„Ë Ù˘ ηډȷ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ Ì ‚-·ÔÎÏÂÈÛÙ¤˜ ÚfiÛÊ·ÙË ÌÂÙ·-·Ó¿Ï˘ÛË (12 Ù˘¯·ÈÔÔÈË̤Ó˜ ÌÂϤÙ˜, 112,177 ˘ÂÚÙ·ÛÈÎÔ›) ¤‰ÂÈÍ fiÙÈ ÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜ ‰ÂÓ ˘ÂÚ¤¯Ô˘Ó ÙˆÓ ¿ÏÏˆÓ ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ Î·È ÌfiÓÔ ÛÙȘ ËÏÈ˘ <60 ÂÙÒÓ. ™ÙȘ ÌÂÁ·Ï‡ÙÂÚ˜ ËÏÈ˘ Ë ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ÙˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ ‰ÂÓ Ù· ‰ÈηÈÔÏÔÁ› Û·Ó Ê¿Ú̷η ÚÒÙ˘ ÂÎÏÔÁ‹˜ ÛÙË ÚˆÙÔÁÂÓ‹

ÚfiÏË„Ë Ù˘ ηډȷ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ (13) ™Â ·ÓÙ›ıÂÛË fï˜ Ì ÙËÓ ˘¤ÚÙ·ÛË ÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜ ıˆÚÔ‡ÓÙ·È ÙÔ ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈÎfi Ê¿ÚÌ·ÎÔ ÛÙË ıÂÚ·›· Ù˘ ηډȷ΋˜ ·ÓÂ¿ÚÎÂÈ·˜. ∞Ù˘¯Ò˜ Û ÈηÓfi ÔÛÔÛÙfi ·˘ÙÒÓ ÙˆÓ ·ÛıÂÓÒÓ ‰ÂÓ ¯ÔÚËÁÔ‡ÓÙ·È ‚-·ÔÎÏÂÈÛÙ¤˜ ·ÏÏ¿ Î·È Ë Û˘ÌÌfiÚʈÛË ÙˆÓ ·ÛıÂÓÒÓ (fiˆ˜ Ì fiϘ ÙȘ ¯ÚfiÓȘ ıÂÚ·›˜) ‰ÂÓ Â›Ó·È Ë ·Ó·ÌÂÓfiÌÂÓË. •ÂΛÓËÌ· Ì ÌÈÎÚ¤˜ ‰fiÛÂȘ Î·È ·ÚÁ¤˜ ÚÔ˜ Ù· ¿Óˆ ÙÈÙÏÔÔÈ‹ÛÂȘ (οı 2 -4 ‚‰ÔÌ¿‰Â˜), ·Ú·ÎÔÏÔ‡ıËÛË Ûʇ͈Ó, ›ÂÛ˘ Î·È ¿ÏÏˆÓ ·ÚÂÓÂÚÁÂÈÒÓ ı· ‚ÂÏÙÈÒÛÔ˘Ó ÙËÓ Û˘ÌÌfiÚʈÛË. ∞ÎfiÌË Ú¤ÂÈ Ó· ‰È‰¿ÍÔ˘Ì ÙÔ˘˜ ·ÛıÂÓ›˜ ÁÈ· ·Ú·ÎÔÏÔ‡ıËÛË ÙÔ˘ ‚¿ÚÔ˘˜ ÙˆÓ Î·È ÂӉ¯fiÌÂÓË Âȉ›ӈÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Î·Ù¿ ÙËÓ ¤Ó·ÚÍË Î·È ÙÈÙÏÔÔ›ËÛË Ù˘ ‰fiÛ˘.

6.

10. Hildebrandt, P. Systolic and nonsystolic heart failure: equally serious threats. Jama 2006, 296:2259-60.

11. Nieminen, MS, Bohm, M, Cowie, MR, et al. Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: the Task Force on Acute Heart Failure of the European Society of Cardiology.

Eur Heart J 2005, 26:384-416.

12. Chen, ZM, Pan, HC, Chen, YP, et al.

Early intravenous then oral metoprolol in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet 2005, 366:1622-32.

13. μangalore S, Wild D, Sanobar P, Kukin M, Messerli FH. Beta-blockers for primary prevention of heart failure in patients with hypertension: A Metaanalysis of randomized controlled trials. Circulation 2007, II -457 2110 (abstract)

μÈ‚ÏÈÔÁÚ·Ê›· 1.

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4.

5.

Jessup, M Brozena, S. Heart failure. N Engl J Med 2003, 348:2007-18.

Lopez-Sendon, J, Swedberg, K, Mc Murray, J, et al. Expert consensus document on beta-adrenergic receptor blockers. Eur Heart J 2004, 25:1341-62.

Bangalore, S, Messerli, FH, Kostis, JB Pepine, CJ. Cardiovascular protection using beta-blockers: a critical review of the evidence. J Am Coll Cardiol 2007, 50:563-72.

Dulin, BR, Haas, SJ, Abraham, WT Krum, H. Do elderly systolic heart failure patients benefit from beta blockers to the same extent as the non-elderly? Meta-analysis of >12,000 patients in large-scale clinical trials.

Am J Cardiol 2005, 95:896-8.

Flather, MD, Shibata, MC, Coats, AJ, et al. Randomized trial to determine the effect of nebivolol on mortality and cardiovascular hospital admission in elderly patients with heart failure (SENIORS). Eur Heart J 2005, 26:21525.

7.

8.

9.

Poole-Wilson, PA, Swedberg, K, Cleland, JG, et al. Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the Carvedilol Or Metoprolol European Trial (COMET): randomised controlled trial. Lancet 2003, 362:7-13.

Swedberg, K, Cleland, J, Dargie, H, et al. Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005): The Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology.

Eur Heart J 2005, 26:1115-40.

Bursi, F, Weston, SA, Redfield, MM, et al. Systolic and diastolic heart failure in the community. Jama 2006, 296: 2209-16.

Gheorghiade, M, Abraham, WT, Albert, NM, et al. Systolic blood pressure at admission, clinical characteristics, and outcomes in patients hospitalized with acute heart failure. Jama 2006, 296:2217-26.

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π√À¡π√™ 2008

∏ ™˘ÌÌfiÚʈÛË ÙˆÓ ∞ÛıÂÓÒÓ ÛÙËÓ ÀÔÏÈȉ·ÈÌÈ΋ ∞ÁˆÁ‹ Î·È ÔÈ ∂ÈÙÒÛÂȘ Ù˘ ÛÙËÓ ∫·Ú‰È·ÁÁÂȷ΋ ¡ÔÛËÚfiÙËÙ· Î·È £ÓËÙfiÙËÙ·. ª. ºÏˆÚÂÓÙ›Ó, ∂ÈÛÙËÌÔÓÈÎfi˜ ™˘ÓÂÚÁ¿Ù˘ ∂. §˘ÌÂÚfiÔ˘ÏÔ˜, §¤ÎÙÔÚ·˜ ¶·ıÔÏÔÁ›·˜, π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ ªˆ˘Û‹˜ ∂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‹ Δ· ηډȷÁÁÂȷο ÓÔÛ‹Ì·Ù· ·Ô-ÙÂÏÔ‡Ó ÙËÓ Î˘ÚÈfiÙÂÚË ·ÈÙ›· ı·Ó¿ÙÔ˘ Û ·ÁÎfiÛÌÈ· Îϛ̷η.[1] √È ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË Î·Ú‰È·ÁÁÂȷ΋˜ ÓfiÛÔ˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙË ‰˘ÛÏÈȉ·ÈÌ›·, ÙËÓ ·ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË, ÙÔ Î¿ÓÈÛÌ·, ÙËÓ ·‡ÍËÛË Ù˘ ËÏÈΛ·˜, ÙÔ ·Ó‰ÚÈÎfi ʇÏÔ, ÙÔ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË, ÙËÓ ·¯˘Û·ÚΛ· Î·È ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÚÒÈÌ˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘. ªÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ÎÏÈÓÈÎÒÓ ÌÂÏÂÙÒÓ Î·È ÌÂÙ·-·Ó·Ï‡ÛÂˆÓ ¤‰ÂÈÍ·Ó fiÙÈ Ë ·ÓÙÈ˘ÂÚÙ·ÛÈ΋ Î·È Ë ˘ÔÏÈȉ·ÈÌÈ΋ ·ÁˆÁ‹ ÂÏ·ÙÙÒÓÔ˘Ó ÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ (™¡), ·ÁÁÂÈ·ÎÔ‡ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ (∞∂∂) Î·È ı·Ó¿ÙÔ˘ Û ·ÛıÂÓ›˜ Ì ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ηډȷÁÁÂȷ΋ ÓfiÛÔ, ηıÒ˜ Î·È Û ·ÛıÂÓ›˜ Ì ÁÓˆÛÙ‹ ηډȷÁÁÂȷ΋ ÓfiÛÔ.[2-4] øÛÙfiÛÔ, Ë Û˘ÌÌfiÚʈÛË ÙˆÓ ·ÛıÂÓÒÓ ÛÙË Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË ‰ÂÓ Â›Ó·È ÈηÓÔÔÈËÙÈ΋. ™ÎÔfi˜ ·˘Ù‹˜ Ù˘ Û‡ÓÙÔÌ˘ ·Ó·ÛÎfiËÛ˘ Â›Ó·È Ó· ÂÈÛËÌ¿ÓÂÈ ÙÔ Úfi‚ÏËÌ· Ù˘ ¤ÏÏÂȄ˘ Û˘ÌÌfiÚʈÛ˘ ÙˆÓ ·ÛıÂÓÒÓ ÛÙËÓ ÚÔÙÂÈÓfiÌÂÓË ·fi ÙÔ˘˜ ÁÈ·ÙÚÔ‡˜ ÙÔ˘˜ Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ Î·È ÙȘ ÂÈÙÒÛÂȘ Ô˘ ·˘Ù‹ Ë ¤ÏÏÂÈ„Ë Û˘ÌÌfiÚʈÛ˘ ¤¯ÂÈ ÛÙËÓ Î·Ú‰È·ÁÁÂȷ΋ ÓÔÛËÚfiÙËÙ· Î·È ıÓËÙfiÙËÙ·. ∏ Û˘ÌÌfiÚʈÛË ÙˆÓ ·ÛıÂÓÒÓ ÛÙË ıÂÚ·›· ÛÙ· Ï·›ÛÈ· Ù˘ ÚˆÙÔÁÂÓÔ‡˜ ÚfiÏ˄˘ ¶·Ú¿ Ù· ÂȂ‚·ÈˆÌ¤Ó· ÔʤÏË Ù˘ ˘ÔÏÈȉ·ÈÌÈ΋˜ ·ÁˆÁ‹˜ ÛÙËÓ Î·Ú‰È·ÁÁÂȷ΋ ÓÔÛËÚfiÙËÙ· Î·È ıÓËÙfiÙËÙ·, ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË Ë Û˘ÌÌfiÚʈÛË ÙˆÓ ·ÛıÂÓÒÓ ÛÙË Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ ‰ÂÓ Â›Ó·È

20

ÈηÓÔÔÈËÙÈ΋, ȉȷ›ÙÂÚ· ÛÙËÓ ÚˆÙÔÁÂÓ‹ ÚfiÏË„Ë.[5,6] √È ·ÛıÂÓ›˜, ÂÊfiÛÔÓ ‰ÂÓ ÂÌÊ·Ó›˙Ô˘Ó ¤Î‰ËÏ· Û˘ÌÙÒÌ·Ù· Ù˘ ÓfiÛÔ˘ ÁÈ· ÙËÓ ÔÔ›· ıÂÚ·‡ÔÓÙ·È, Û˘¯Ó¿ ‰ÂÓ Â›Ó·È Úfiı˘ÌÔÈ Ó· ‰Â¯ıÔ‡Ó ÌÈ· Ì·ÎÚÔ¯ÚfiÓÈ· Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹. ∂ÈÚfiÛıÂÙ·, ‰‡ÛÎÔÏ· ·Ô‰¤¯ÔÓÙ·È ·ÎfiÌ· Î·È ÙȘ ‹Ș ·ÚÂÓ¤ÚÁÂȘ ÙˆÓ Ê·ÚÌ¿ÎˆÓ Ù· ÔÔ›· ÙÔ˘˜ ¯ÔÚËÁÔ‡ÓÙ·È. ∞Í›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈ Ù· ÔÛÔÛÙ¿ ‰È·ÎÔ‹˜ ÙˆÓ ÛÙ·ÙÈÓÒÓ ÌÂÙ¿ ·fi ¤Ó· ¯ÚfiÓÔ ıÂÚ·›·˜ Î˘Ì·›ÓÔÓÙ·È ·fi 15% ˆ˜ 60%.[5, 7, 8] ªÈ· ˘Ô·Ó¿Ï˘ÛË Ù˘ ÌÂϤÙ˘ WOSCOPS (West of Scotland Prevention Study) ¤‰ÂÈÍ fiÙÈ Ì›· Û˘ÌÌfiÚʈÛË ≥75% ÛÙË ıÂÚ·›· Ì Ú·‚·ÛÙ·Ù›ÓË Ô‰‹ÁËÛ Û 38% Ì›ˆÛË Ù˘ ıÓËÙfiÙËÙ·˜ ·fi ™¡, ÙˆÓ ÌË ı·Ó·ÙËÊfiÚˆÓ ÂÌÊÚ·ÁÌ¿ÙˆÓ ÙÔ˘ Ì˘Ôηډ›Ô˘ Î·È Ù˘ ηډȷÁÁÂȷ΋˜ ıÓËÙfiÙËÙ·˜ (p=0,0001), Û ̛· ηٿ 46% Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÛÙÂÊ·ÓÈ·›·˜ Â·Ó·ÈÌ¿ÙˆÛ˘ (p=0,003), ηıÒ˜ Î·È Û ̛· ηٿ 32% Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ıÓËÙfiÙËÙ·˜ ·fi ÔÔÈÔ‰‹ÔÙ ·›ÙÈÔ (p=0,015), ÂÓÒ Ù· ·ÓÙ›ÛÙÔȯ· ÔÛÔÛÙ¿ ÛÙÔ Û˘ÓÔÏÈÎfi ÏËı˘ÛÌfi Ù˘ ÌÂϤÙ˘ [intention-to-treat (ITT)] ‹Ù·Ó 31% (p=0,0001), 37% (p=0,009) Î·È 22% (p=0,05).[9] √È ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ ·ÛıÂÓÒÓ ÛÙÔ ı¤Ì· Ù˘ Û˘ÌÌfiÚʈÛ˘ ÌÔÚ› Ó· Â›Ó·È ·ÔÙ¤ÏÂÛÌ· Ù˘ ›‰È·˜ Ù˘ Ê·Ú̷΢ÙÈ΋˜ ·ÁˆÁ‹˜, ηıÒ˜ Î·È ÎÔÈÓˆÓÈÎÒÓ ‹ ¿ÏÏˆÓ ·Ú·ÁfiÓÙˆÓ. °È· ·Ú¿‰ÂÈÁÌ·, ÔÈ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ÙˆÓ Ê·ÚÌ¿ÎˆÓ Èı·Ó¿ ÂÏ·ÙÙÒÓÔ˘Ó ÙË Û˘ÌÌfiÚʈÛË, ÂÓÒ Ù· ÚÔÛ‰ÔÎÒÌÂÓ· ÔʤÏË Ù˘ ıÂÚ·›·˜ ÙËÓ ·˘Í¿ÓÔ˘Ó. ∂ÈÚfiÛıÂÙ·, ÔÈ ·ÛıÂÓ›˜ ÔÈ ÔÔ›ÔÈ ·›ÚÓÔ˘Ó Ê¿Ú̷η ÁÈ· ¿ÏÏ· ·›ÙÈ· Û˘¯Ó¿ ÂÌÊ·Ó›˙Ô˘Ó Î·Ï‡ÙÂÚË Û˘Ì-

ÌfiÚʈÛË, ÂÂȉ‹ ¤¯Ô˘Ó ‹‰Ë ·ԉ¯ı› ÙËÓ È‰¤· Ù˘ Ì·ÎÚÔ¯ÚfiÓÈ·˜ Ê·Ú̷΢ÙÈ΋˜ ·ÁˆÁ‹˜. ªÈ· ÚfiÛÊ·ÙË ÌÂϤÙË ÂͤٷÛ ÙËÓ Â›‰Ú·ÛË Ù˘ Û˘ÌÌfiÚʈÛ˘ ÛÙËÓ ·ÁˆÁ‹ Ì ÛÙ·Ù›Ó˜ ÛÙËÓ ÂÌÊ¿ÓÈÛË Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ ÛÙ· Ï·›ÛÈ· Ù˘ ÚˆÙÔÁÂÓÔ‡˜ ÚfiÏ˄˘. ∞˘Ù‹ Ë ÌÂϤÙË ¤‰ÂÈÍ fiÙÈ Ì›· Û˘ÌÌfiÚʈÛË ≥90% Û˘Û¯ÂÙ›ÛıËΠ̠19% ÏÈÁfiÙÂÚ· ÌË ı·Ó·ÙËÊfiÚ· ηډȷÁÁÂȷο Û˘Ì‚¿Ì·Ù· [Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ =0,81; 95% ‰È¿ÛÙËÌ· ÂÌÈÛÙÔÛ‡Ó˘ (¢∂) 0,67-0,97] Û ۇÁÎÚÈÛË ÌÂ Û˘ÌÌfiÚʈÛË <90%.[10] ∞Í›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈ ÌfiÓÔ ¤Ó· ÌÈÎÚfi Û¯ÂÙÈο ÔÛÔÛÙfi ·ÛıÂÓÒÓ ÂÈÙ˘Á¯¿ÓÂÈ Ù· ÂÈı˘ÌËÙ¿ Â›‰· ¯ÔÏËÛÙÂÚfiÏ˘ ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË,[11-13] ÁÂÁÔÓfi˜ Ô˘ ¤¯ÂÈ Û˘Û¯ÂÙÈÛı› Ì ·˘ÍË̤ÓË Î·Ú‰È·ÁÁÂȷ΋ ÓÔÛËÚfiÙËÙ· Î·È ıÓËÙfiÙËÙ·.[14,15] ªÈ· ÂӉȷʤÚÔ˘Û· ÌÂϤÙË ¤‰ÂÈÍ fiÙÈ ÌfiÓÔ ÙÔ 25% ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ¤·ÈÚÓ ˘ÔÏÈȉ·ÈÌÈ΋ ·ÁˆÁ‹ ¤Ù˘¯Â Ù· ÂÈı˘ÌËÙ¿ Â›‰· ¯ÔÏËÛÙÂÚfiÏ˘ ÌÂÙ¿ ·fi 3 ¤ÙË ·Ú·ÎÔÏÔ‡ıËÛ˘.[16] √ ΛӉ˘ÓÔ˜ ηډȷÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ ‹Ù·Ó ÛËÌ·ÓÙÈο ·˘ÍË̤ÓÔ˜ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ¤Ù˘¯·Ó Ù· Â›‰·-ÛÙfi¯Ô Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ Û ÔÚÈṲ̂ӷ ÌfiÓÔ ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂϤÙ˘ (Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜=2,34, 95% ¢∂=1,015,39), ηıÒ˜ Î·È Û fiÛÔ˘˜ ‰ÂÓ ¤Ù˘¯·Ó ÔÙ¤ ·˘Ù¿ Ù· Â›‰· (Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜=2,99; 95% ¢∂=1,26-7,08) Û ۇÁÎÚÈÛË Ì fiÛÔ˘˜ ¤Ù˘¯·Ó Ù· ÂÈı˘ÌËÙ¿ Â›‰· ¯ÔÏËÛÙÂÚfiÏ˘ Û fiÏË ÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂϤÙ˘.[16] ∞Ó Î·È Ë ·Ú·¿Óˆ ÌÂϤÙË ‰ÂÓ Û¯Â‰È¿ÛıËΠÁÈ· Ó· ÂÎÙÈÌ‹ÛÂÈ ÙË Û˘ÌÌfiÚʈÛË ÙˆÓ ·ÛıÂÓÒÓ ÛÙË Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹, Èı·Ó¿ Ë ¤ÏÏÂÈ„Ë Û˘ÌÌfiÚʈÛ˘ Ó· ·Ô-

£EPA¶EIA - ºAPMAKA ÙÂÏ› ¤Ó·Ó ·fi ÙÔ˘˜ ÏfiÁÔ˘˜ ÁÈ· ÙÔ˘˜ ÔÔ›Ô˘˜ Ù· ÂÈı˘ÌËÙ¿ Â›‰· ¯ÔÏËÛÙÂÚfiÏ˘ ÂÈÙ˘Á¯¿ÓÔÓÙ·È Û ÙfiÛÔ ÌÈÎÚfi ÔÛÔÛÙfi ·ÛıÂÓÒÓ. Ÿˆ˜ ‹‰Ë ·Ó·Ê¤ÚıËÎÂ, Ë Û˘ÌÌfiÚʈÛË ÙˆÓ ·ÛıÂÓÒÓ ÛÙËÓ ˘ÔÏÈȉ·ÈÌÈ΋ ·ÁˆÁ‹ Â›Ó·È ÌÈÎÚfiÙÂÚË ÛÙËÓ ÚˆÙÔÁÂÓ‹ Û ۇÁÎÚÈÛË Ì ÙË ‰Â˘ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë. ªÈ· ÌÂϤÙË ¤‰ÂÈÍ fiÙÈ Ë Û˘ÌÌfiÚʈÛË ÛÙËÓ ·ÁˆÁ‹ Ì ÛÙ·Ù›Ó˜ ‹Ù·Ó 71% ÌÂÙ¿ ·fi 6 Ì‹Ó˜ Î·È 45% ÌÂÙ¿ ·fi 3 ¯ÚfiÓÈ· ıÂÚ·›·˜ Û ·ÛıÂÓ›˜ ‰Â˘ÙÂÚÔÁÂÓÔ‡˜ ÚfiÏ˄˘, ÂÓÒ Ù· ·ÓÙ›ÛÙÔȯ· ÔÛÔÛÙ¿ Û ¿ÙÔÌ· ÚˆÙÔÁÂÓÔ‡˜ ÚfiÏ˄˘ ‹Ù·Ó 65% Î·È 35%.[17] ªÈ· ¿ÏÏË ÌÂϤÙË ÂͤٷÛ ÙË Û˘ÌÌfiÚʈÛË ·ÛıÂÓÒÓ Ì ÚˆÙԉȷÁÓˆṲ̂ÓË ·ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË Î·È ‰˘ÛÏÈȉ·ÈÌ›· ÛÙË ¯ÔÚËÁÔ‡ÌÂÓË ·ÓÙÈ˘ÂÚÙ·ÛÈ΋ Î·È ˘ÔÏÈȉ·ÈÌÈ΋ ·ÁˆÁ‹.[18] ΔÔ ÔÛÔÛÙfi ÙˆÓ ·ÛıÂÓÒÓ Ô˘ Û˘ÌÌÔÚÊÒıËΠÙfiÛÔ ÛÙËÓ ·ÓÙÈ˘ÂÚÙ·ÛÈ΋, fiÛÔ Î·È ÛÙËÓ ˘ÔÏÈȉ·ÈÌÈ΋ ·ÁˆÁ‹ ÂÏ·ÙÙÒıËΠÛËÌ·ÓÙÈο ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ·ÁˆÁ‹˜. ™˘ÁÎÂÎÚÈ̤ӷ, Û˘ÌÌfiÚʈÛË ≥80% ÂÌÊ¿ÓÈ˙ ÙÔ 44,7%, 35,9% Î·È 35,8% ÙˆÓ ·ÛıÂÓÒÓ Û 3, 6 Î·È 12 Ì‹Ó˜, ·ÓÙ›ÛÙÔȯ·.[18] ∏ Û˘ÌÌfiÚʈÛË ÙˆÓ ·ÛıÂÓÒÓ ÛÙËÓ ˘ÔÏÈȉ·ÈÌÈ΋ ·ÁˆÁ‹ ÛÙ· Ï·›ÛÈ· Ù˘ ‰Â˘ÙÂÚÔÁÂÓÔ‡˜ ÚfiÏ˄˘ ∏ Ì·ÎÚÔ¯ÚfiÓÈ· ·ÁˆÁ‹ Ì ÛÙ·Ù›Ó˜ ¤¯ÂÈ È‰È·›ÙÂÚË ÛËÌ·Û›· Û ·ÛıÂÓ›˜ Ô˘ ¤¯Ô˘Ó ‹‰Ë ÂÌÊ·Ó›ÛÂÈ ¤Ó· ηډȷÁÁÂÈ·Îfi ÓfiÛËÌ·.[19,20] ªÈ· ÌÂϤÙË Ë ÔÔ›· ÂÎÙ›ÌËÛ ÙË Û˘ÌÌfiÚʈÛË ·ÛıÂÓÒÓ Ì ÈÛÙÔÚÈÎfi ∞∂∂ ÛÙËÓ ·ÁˆÁ‹ Ì ÛÙ·Ù›Ó˜ ¤‰ÂÈÍ ÌÈ· ÛÙ·‰È·Î‹ ·‡ÍËÛË Ù˘ ‰È·ÎÔ‹˜ ÙˆÓ ÛÙ·ÙÈÓÒÓ Û ÔÛÔÛÙfi Ô˘ ¤Êı·Û ÙÔ 39% ¤Ó· ¯ÚfiÓÔ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜.[21] ∏ ‰È·ÎÔ‹ Ù˘ Ê·Ú̷΢ÙÈ΋˜ ·ÁˆÁ‹˜ ‹Ù·Ó ·ÓÂÍ¿ÚÙËÙÔ˜ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ı¿Ó·ÙÔ ·fi ÔÔÈ·‰‹ÔÙ ·ÈÙÈÔÏÔÁ›· ÌÂÙ¿ ·fi ¤Ó· ¯ÚfiÓÔ ·Ú·ÎÔÏÔ‡ıËÛ˘ (Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜=2,78; 95% ¢∂ 1,963,72, p=0,03).[21] ∂›Û˘, Ë ‰È·ÎÔ‹ Ù˘ ·ÓÙÈ·ÈÌÔÂÙ·Ïȷ΋˜ ·ÁˆÁ‹˜ Û˘Û¯ÂÙ›ÛıËΠ̠·‡ÍËÛË ıÓËÙfiÙËÙ·˜ ·fi fiÏ· Ù· ·›ÙÈ· ηٿ 81% (Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜=1,81; 95% ¢∂ 1,23-4,27, p=0,008).[21] øÛÙfiÛÔ, Ô Î›Ó‰˘ÓÔ˜

·˘Ùfi˜ ‹Ù·Ó ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚÔ˜ ·fi ÙÔÓ Î›Ó‰˘ÓÔ Ô˘ ·Ú·ÙËÚ‹ıËΠÌÂÙ¿ ÙË ‰È·ÎÔ‹ ÙˆÓ ÛÙ·ÙÈÓÒÓ. π‰È·›ÙÂÚÔ ÚfiÏÔ Ê·›ÓÂÙ·È fiÙÈ ‰È·‰Ú·Ì·Ù›˙ÂÈ Ë Î·Ù·ÓfiËÛË ·fi ÙÔÓ ·ÛıÂÓ‹ Ù˘ ÛËÌ·Û›·˜ Ù˘ ηıËÌÂÚÈÓ‹˜ Ï‹„˘ Ù˘ ˘ÔÏÈȉ·ÈÌÈ΋˜ ·ÁˆÁ‹˜ ÌÂÙ¿ ·fi ¤Ó· ηډȷÁÁÂÈ·Îfi ۇ̂·Ì·. ªÈ· Ôχ ÚfiÛÊ·ÙË ÌÂϤÙË ¤‰ÂÈÍ fiÙÈ ÌfiÓÔ ÙÔ 74% ÙˆÓ ·ÛıÂÓÒÓ ¤·ÈÚÓ fiÏ· Ù· Û˘ÓÙ·ÁÔÁÚ·ÊÔ‡ÌÂÓ· Ê¿Ú̷η ÌfiÏȘ 120 Ë̤Ú˜ ÌÂÙ¿ ·fi ¤Ó· Ô͇ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘ (√∂ª).[22] ™ÙËÓ ›‰È· ÌÂϤÙË Ë ıÓËÙfiÙËÙ· ÌÂÙ¿ ·fi ¤Ó· ¯ÚfiÓÔ ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚË ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ¤·ÈÚÓ·Ó ÌfiÓÔ ÔÚÈṲ̂ӷ Ê¿Ú̷η (Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ =1,44; 95% ¢∂ 1,151,79, p=0,001) ‹ ηӤӷ Ê¿ÚÌ·ÎÔ (Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ =1,80; 95% ¢∂ 1,35-2,42, p<0,0001) Û ۇÁÎÚÈÛË Ì ٷ ¿ÙÔÌ· Ô˘ ¤·ÈÚÓ·Ó fiÏ· Ù· Û˘ÓÙ·ÁÔÁÚ·ÊÔ‡ÌÂÓ· Ê¿Ú̷η.[22] ™Â ÌÈ· ¿ÏÏË ÌÂϤÙË ÂÎÙÈÌ‹ıËÎ·Ó ÔÈ Û˘Ó¤ÂȘ Ù˘ ÚfiˆÚ˘ ‰È·ÎÔ‹˜ ÙˆÓ ‚-·ÔÎÏÂÈÛÙÒÓ, Ù˘ ·ÛÈÚ›Ó˘ Î·È ÙˆÓ ÛÙ·ÙÈÓÒÓ ÛÙË ıÓËÙfiÙËÙ· ·ÛıÂÓÒÓ ¤Ó· ¯ÚfiÓÔ ÌÂÙ¿ ·fi ¤Ó· √∂ª.[23] ∞fi ÙÔ˘˜ 1521 ·ÛıÂÓ›˜ Ù˘ ÌÂϤÙ˘ 184 ·ÛıÂÓ›˜ (12,1%) ‰È¤ÎÔ„·Ó Î·È Ù· 3 Ê¿Ú̷η, 56 ·ÛıÂÓ›˜ (3,7%) Ù· ‰‡Ô Ê¿Ú̷η Î·È 272 ·ÛıÂÓ›˜ (17,9%) ÙÔ ¤Ó· Ê¿ÚÌ·ÎÔ, ÂÓÒ 1009 ·ÛıÂÓ›˜ (66,3%) Û˘Ó¤¯ÈÛ·Ó ÙË Ï‹„Ë Î·È ÙˆÓ 3 Ê·ÚÌ¿ÎˆÓ ¤Ó· Ì‹Ó· ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ·ÁˆÁ‹˜. √È ·ÛıÂÓ›˜ Ô˘ ‰È¤ÎÔ„·Ó fiÏ· Ù· Ê¿Ú̷η ›¯·Ó ¯ÂÈÚfiÙÂÚË ÂÈ‚›ˆÛË ÌÂÙ¿ ·fi ¤Ó· ¯ÚfiÓÔ Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ Û˘Ó¤¯ÈÛ·Ó Ó· ·›ÚÓÔ˘Ó ¤Ó· ‹ ÂÚÈÛÛfiÙÂÚ· Ê¿Ú̷η (97,7% ¤Ó·ÓÙÈ 88,5%, ·ÓÙ›ÛÙÔȯ·, p<0,001). Δ· ·ÔÙÂϤÛÌ·Ù· ‹Ù·Ó ·ÚfiÌÔÈ· fiÙ·Ó ÂÎÙÈÌ‹ıËÎÂ Ë ‰È·ÎÔ‹ ηıÂÓfi˜ ·fi Ù· 3 Ê¿Ú̷η ¯ˆÚÈÛÙ¿.[23] Œ¯ÂÈ ÏÔÈfiÓ È‰È·›ÙÂÚË ÛËÌ·Û›· Ë Ù·ÎÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ·ÛıÂÓÒÓ ÌÂÙ¿ ·fi ¤Ó· √∂ª, ÒÛÙ ӷ ÂȂ‚·ÈÒÓÂÙ·È Ë ÛˆÛÙ‹ Ï‹„Ë Ù˘ Ê·Ú̷΢ÙÈ΋˜ ÙÔ˘˜ ·ÁˆÁ‹˜. º·›ÓÂÙ·È Â›Û˘ fiÙÈ ÔÈ ·ÛıÂÓ›˜ Ô˘ Û˘ÌÌÔÚÊÒÓÔÓÙ·È Ì ÙË Ï‹„Ë ÙˆÓ Ê·ÚÌ¿ÎˆÓ Ô˘ ÙÔ˘˜ Û˘ÓÙ·ÁÔÁÚ·ÊÔ‡ÓÙ·È ˘ÈÔıÂÙÔ‡Ó Î·È ÙȘ ˘ÁÈÂÈÓԉȷÈÙËÙÈΤ˜ Ô‰ËÁ›Â˜ Ô˘ Û˘ÓÈÛÙÒÓÙ·È. ∏ ÛËÌ·Û›· Ù˘ ·ÁˆÁ‹˜ Ì ‚-·Ô-

ÎÏÂÈÛÙ¤˜ Î·È ÛÙ·Ù›Ó˜ ÌÂÙ¿ ·fi ¤Ó· √∂ª ¤¯ÂÈ ÂȂ‚·Èˆı› ·fi ÌÂÁ¿ÏÔ ·ÚÈıÌfi ÎÏÈÓÈÎÒÓ ÌÂÏÂÙÒÓ.[24,25] ∂ÈÚfiÛıÂÙ·, Ë ıÓËÙfiÙËÙ· ·˘Í¿ÓÂÙ·È fiÛÔ ÌÂÈÒÓÂÙ·È Ë Û˘ÌÌfiÚʈÛË ÛÙË Ï‹„Ë ÛÙ·ÙÈÓÒÓ ‹ ‚-·ÔÎÏÂÈÛÙÒÓ. ŒÙÛÈ, ÌÈ· ÌÂϤÙË Û ÌÂÙÂÌÊÚ·ÁÌ·ÙÈÎÔ‡˜ ·ÛıÂÓ›˜ ¤‰ÂÈÍ ̛· ηٿ 25% ·‡ÍËÛË Ù˘ ıÓËÙfiÙËÙ·˜ Û ·ÛıÂÓ›˜ Ì ¯·ÌËÏ‹ Û˘ÌÌfiÚʈÛË (<40%) ÛÙË Ï‹„Ë ÛÙ·ÙÈÓÒÓ Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ÂÌÊ¿ÓÈ˙·Ó Û˘ÌÌfiÚʈÛË ≥80%.[26] ¶·ÚfiÌÔÈ· Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ Û˘ÌÌfiÚʈÛ˘ Î·È Ù˘ ÔÏÈ΋˜ ıÓËÙfiÙËÙ·˜ ‰È·ÈÛÙÒıËÎÂ Î·È ÁÈ· ÙÔ˘˜ ‚-·ÔÎÏÂÈÛÙ¤˜.[26] ªÈ· ¿ÏÏË ÌÂϤÙË ‰ÈÂÚ‡ÓËÛ ÙË Û¯¤ÛË Ù˘ Û˘ÌÌfiÚʈÛ˘ ÛÙËÓ ·ÁˆÁ‹ Ì ÛÙ·Ù›Ó˜ ÌÂÙ¿ ·fi ¤Ó· √∂ª Ì ÙËÓ ÂÌÊ¿ÓÈÛË Ó¤Ô˘ √∂ª Î·È ı·Ó¿ÙÔ˘ ÔÔÈ·Û‰‹ÔÙ ·ÈÙÈÔÏÔÁ›·˜ ÌÂÙ¿ ·fi ηٿ ̤ÛÔ fiÚÔ 2,4 ¤ÙË ·Ú·ÎÔÏÔ‡ıËÛ˘.[27] ∞fi ÙÔ˘˜ 5,590 ·ÛıÂÓ›˜ Ì √∂ª ÌfiÓÔ ÙÔ 7,7% ¤·ÈÚÓ ÛÙ·Ù›ÓË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂϤÙ˘ Î·È ÙÔ 12,8% ÂÌÊ¿ÓÈÛ ÙÔ˘Ï¿¯ÈÛÙÔÓ ¤Ó· Ó¤Ô √∂ª. ∏ ≥80% Û˘ÌÌfiÚʈÛË ÛÙËÓ ·ÁˆÁ‹ Ì ÛÙ·Ù›Ó˜ Û˘Û¯ÂÙ›ÛıËΠ̠¤Ó· ηٿ 81% ÌÈÎÚfiÙÂÚÔ Î›Ó‰˘ÓÔ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË Ó¤Ô˘ √∂ª (Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜=0,19; 95% ¢∂ 0,08-0,47) Î·È Ì›· ηٿ 53% Ì›ˆÛË Ù˘ ıÓËÙfiÙËÙ·˜ ÔÔÈ·Û‰‹ÔÙ ·ÈÙÈÔÏÔÁ›·˜ (Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜=0,47; 95% ¢∂ 0,22-0,99) Û ۇÁÎÚÈÛË Ì ÙË ÌË Û˘ÌÌfiÚʈÛË ÛÙË ıÂÚ·›·.[27] ™ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ·fi ÙȘ ÌÂÁ¿Ï˜ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ ‰ÂÓ Û˘ÌÌÂÙ›¯Â ÛËÌ·ÓÙÈÎfi˜ ·ÚÈıÌfi˜ ËÏÈÎÈˆÌ¤ÓˆÓ ·ÛıÂÓÒÓ, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ÌËÓ ˘¿Ú¯Ô˘Ó ÔÏÏ¿ ‰È·ı¤ÛÈÌ· ÛÙÔȯ›· ÁÈ· ÙË Û˘ÌÌfiÚʈÛË ·˘ÙÒÓ ÙˆÓ ·ÙfiÌˆÓ ÛÙË Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹. ™Â ÌÈ· ÌÂϤÙË ÂÎÙÈÌ‹ıËÎÂ Ë Ì·ÎÚÔ¯ÚfiÓÈ· Û˘ÌÌfiÚʈÛË ·ÛıÂÓÒÓ ËÏÈΛ·˜ ≥65 ÂÙÒÓ ÛÙËÓ ·ÁˆÁ‹ Ì ÛÙ·Ù›Ó˜ Î·È ‚Ú¤ıËΠfiÙÈ ÌfiÓÔ ÙÔ 26% ÂÌÊ¿ÓÈÛÂ Û˘ÌÌfiÚʈÛË ≥80% 5 ¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜.[28] ∏ Û˘ÌÌfiÚʈÛË ÙˆÓ ·ÛıÂÓÒÓ ÌÂÈÒÓÔÓÙ·Ó ÛÙ·‰È·Î¿ Ì ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘, ÁÂÁÔÓfi˜ Ô˘ ‹Ù·Ó ȉȷ›ÙÂÚ· ÂÌÊ·Ó¤˜ ÙÔ˘˜ ÚÒÙÔ˘˜ 6 Ì‹Ó˜ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ Ê·Ú̷΢ÙÈ΋˜ ·ÁˆÁ‹˜. ªÈ· ¿ÏÏË ÌÂϤÙË Û ¿ÙÔÌ· ≥66 ÂÙÒÓ ¤‰ÂÈÍ fiÙÈ Ë ‰ÈÂÙ‹˜ Û˘ÌÌfiÚ-

21

π√À¡π√™ 2008

ʈÛË ÛÙËÓ ·ÁˆÁ‹ Ì ÛÙ·Ù›Ó˜ ‹Ù·Ó 40,1% ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÚfiÛÊ·ÙÔ Ô͇ ÛÙÂÊ·ÓÈ·›Ô ۇ̂·Ì·, 36,1% Û ·ÛıÂÓ›˜ Ì ¯ÚfiÓÈ· ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ Î·È 25,4% Û ·ÛıÂÓ›˜ ÚˆÙÔÁÂÓÔ‡˜ ÚfiÏ˄˘.[29] ∂Ȃ‚·ÈÒÓÔÓÙ·È ‰ËÏ·‰‹ Ù· ¯·ÌËÏ¿ ÔÛÔÛÙ¿ Û˘ÌÌfiÚʈÛ˘ ÛÙËÓ ÚˆÙÔÁÂÓ‹ ÚfiÏË„Ë Î·È ÛÙȘ ÌÂÁ·Ï‡ÙÂÚ˜ ËÏÈ˘. ¶Èı·Ó¿ ÔÈ ·ÛıÂÓ›˜ Ì ÁÓˆÛÙ‹ ηډȷÁÁÂȷ΋ ÓfiÛÔ Ó· Û˘ÌÌÔÚÊÒÓÔÓÙ·È Î·Ï‡ÙÂÚ· ÛÙËÓ ·ÁˆÁ‹ Ì ÛÙ·Ù›Ó˜ ÂÂȉ‹ ·ÓÙÈÏ·Ì‚¿ÓÔÓÙ·È ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘. ∞ÓÙ›ıÂÙ·, ¿ÙÔÌ· Ô˘ ˘Ê›ÛÙ·ÓÙ·È Î¿ÔÈÔ Û‡Ì‚·Ì· ÂÓÒ ‹‰Ë ¤·ÈÚÓ·Ó ÛÙ·Ù›Ó˜ Â›Ó·È ÈÔ ÂÈÚÚÂ‹ ÛÙÔ Ó· ‰È·Îfi„Ô˘Ó ÙËÓ ·ÁˆÁ‹ ıˆÚÒÓÙ·˜ ÙË Ê·Ú̷΢ÙÈ΋ ıÂÚ·›· ·Ó·ÔÙÂÏÂÛÌ·ÙÈ΋. ∞Í›˙ÂÈ Ó· ·Ó·ÊÂÚı› fiÙÈ Ë ‰È·ÎÔ‹ Ù˘ Ê·Ú̷΢ÙÈ΋˜ ·ÁˆÁ‹˜ Û ÌÈÎÚfi ÌfiÓÔ ‚·ıÌfi ·Ô‰›‰ÂÙ·È ÛÙȘ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ÙˆÓ Ê·Ú̿ΈÓ. °È· ·Ú¿‰ÂÈÁÌ·, ÛÙË ÌÂϤÙË 4S (Scandinavian Simvastatin Survival Study) ÙÔ ÔÛÔÛÙfi ‰È·ÎÔ‹˜ Ù˘ ÛÈÌ‚·ÛÙ·Ù›Ó˘ ÂÍ·ÈÙ›·˜ ·ÚÂÓÂÚÁÂÈÒÓ ‹Ù·Ó 6%[30] Î·È ÛÙË ÌÂϤÙË WOSCOPS ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi ‰È·ÎÔ‹˜ Ù˘ Ú·‚·ÛÙ·Ù›Ó˘ ‹Ù·Ó 2%, ÂÓÒ Û˘ÓÔÏÈο ÙÔ 30% ÙˆÓ ·ÛıÂÓÒÓ ‰È¤ÎÔ„Â ÙË Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ ÛÙ· 5 ¤ÙË.[9] ¶ÔÏÏÔ› ·ÛıÂÓ›˜ ‰È·ÎfiÙÔ˘Ó ÙË Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ ÂÂȉ‹ ÈÛÙÂ‡Ô˘Ó fiÙÈ ‰ÂÓ ÙË ¯ÚÂÈ¿˙ÔÓÙ·È ‹ Â›Ó·È ·Ó·ÔÙÂÏÂÛÌ·ÙÈ΋, ÂÍ·ÈÙ›·˜ Ù˘ ÔÏ˘ÏÔÎfiÙËÙ·˜ ÙÔ˘ ıÂÚ·¢ÙÈÎÔ‡ Û¯‹Ì·ÙÔ˜ ‹ ÙÔ˘ ˘„ËÏÔ‡ ÎfiÛÙÔ˘˜ ÙˆÓ Ê·Ú̿ΈÓ.[31, 32] ¶Ú¤ÂÈ Û ·˘Ùfi ÙÔ ÛËÌÂ›Ô Ó· ÂÈÛËÌ·Óı› fiÙÈ Ë ÚÒÈÌË ‰È·ÎÔ‹ Ù˘ Ï‹„˘ ÛÙ·ÙÈÓÒÓ ÌÂÙ¿ ·fi ¤Ó· Ô͇ ÛÙÂÊ·ÓÈ·›Ô ۇ̂·Ì· ¤¯ÂÈ ÂÚÈÛÛfiÙÂÚ˜ ‰˘ÛÌÂÓ›˜ ÂÈÙÒÛÂȘ Û ۇÁÎÚÈÛË Ì ÙË ÌË Ï‹„Ë ÛÙ·Ù›Ó˘ ÚÈÓ ·fi ·˘Ùfi ÙÔ Û‡Ì‚·Ì·. ™˘ÁÎÂÎÚÈ̤ӷ, ‰Â‰Ô̤ӷ ·fi ÙË ÌÂϤÙË PRISM (Platelet Receptor Inhibition in Ischemic Syndrome Management) ¤‰ÂÈÍ·Ó fiÙÈ Ë ·‡ÍËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· Ó¤Ô Ô͇ ÛÙÂÊ·ÓÈ·›Ô ۇ̂·Ì· ‹Ù·Ó ÙÚÈÏ¿ÛÈ· ÌÂÙ¿ ÙË ‰È·ÎÔ‹ Ï‹„˘ ÛÙ·Ù›Ó˘,

22

ÂÓÒ Ô Î›Ó‰˘ÓÔ˜ ·˘Ùfi˜ ‹Ù·Ó 1,6 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔ˜ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ‰ÂÓ ¤·ÈÚÓ·Ó Î·ıfiÏÔ˘ ·ÁˆÁ‹ Ì ÛÙ·Ù›ÓË.[33] ∂›Û˘, Ë ‰È·ÎÔ‹ Ù˘ Ì·ÎÚÔ¯ÚfiÓÈ·˜ ·ÁˆÁ‹˜ Ì ÛÙ·Ù›Ó˜ ÌÂÙ¿ ·fi ¤Ó· ∞∂∂ Ê·›ÓÂÙ·È fiÙÈ ÂȉÂÈÓÒÓÂÈ ÙËÓ ÚfiÁÓˆÛË ÙˆÓ ·ÛıÂÓÒÓ. ™˘ÁÎÂÎÚÈ̤ӷ, ·ÛıÂÓ›˜ Ô˘ ‰È¤ÎÔ„·Ó ÙË Ï‹„Ë ÛÙ·Ù›Ó˘ ·Ì¤Ûˆ˜ ÌÂÙ¿ ·fi ¤Ó· ∞∂∂ ÂÌÊ¿ÓÈÛ·Ó ·˘ÍË̤ÓË ıÓËÙfiÙËÙ· Î·È ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÚÒÈÌ˘ Ó¢ÚÔÏÔÁÈ΋˜ Âȉ›ӈÛ˘, ηıÒ˜ Î·È ·‡ÍËÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙÔ˘ ÈÛ¯·ÈÌÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘ Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ Û˘Ó¤¯ÈÛ·Ó Ó· ·›ÚÓÔ˘Ó ÛÙ·Ù›ÓË.[34] ª¤ÙÚ· ÁÈ· ÙË ‚ÂÏÙ›ˆÛË Ù˘ Û˘ÌÌfiÚʈÛ˘ ÙˆÓ ·ÛıÂÓÒÓ ÛÙËÓ ˘ÔÏÈȉ·ÈÌÈ΋ ıÂÚ·›· ™ÙËÓ ÚÔÛ¿ıÂÈ· ‚ÂÏÙ›ˆÛ˘ Ù˘ Û˘ÌÌfiÚʈÛ˘ ÙˆÓ ·ÛıÂÓÒÓ ÛÙË Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ ¤¯ÂÈ ÌÂÏÂÙËı› Ë Â›‰Ú·ÛË ‰È¿ÊÔÚˆÓ ·ÏÒÓ Ì¤ÙÚˆÓ. °È· ·Ú¿‰ÂÈÁÌ·, Ë ¤ÁηÈÚË ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ·ÛıÂÓÒÓ (̤۷ Û ¤Ó· Ì‹Ó·) ÌÂÙ¿ ·fi ¤Ó· √∂ª Û˘Û¯ÂÙ›ÛıËΠ̠ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi Ï‹„˘ ‚-·ÔÎÏÂÈÛÙÒÓ, ·ÛÈÚ›Ó˘ Î·È ÛÙ·ÙÈÓÒÓ ÛÙÔ˘˜ 6 Ì‹Ó˜ Û ۇÁÎÚÈÛË Ì ÙË ÌË ·Ú·ÎÔÏÔ‡ıËÛ‹ ÙÔ˘˜ [(80,1% ¤Ó·ÓÙÈ 71,3%; p=0,001), (82,9% ¤Ó·ÓÙÈ 77,1%; p=0,01) Î·È (75,9% ¤Ó·ÓÙÈ 68,6%; p=0,005), ·ÓÙ›ÛÙÔȯ·].[35] ∂ÈÚfiÛıÂÙ·, Ë ÂÈÎÔÈÓˆÓ›· ÙˆÓ ıÂÚ·fiÓÙˆÓ È·ÙÚÒÓ Ì ÙÔ˘˜ ·ÛıÂÓ›˜, ·ÎfiÌ· Î·È ‰È·Ì¤ÛÔ˘ ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘, Ê·›ÓÂÙ·È fiÙÈ ‚ÂÏÙÈÒÓÂÈ ÙË Û˘ÌÌfiÚʈÛË ÙˆÓ ·ÛıÂÓÒÓ ÛÙË Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹. ™˘ÁÎÂÎÚÈ̤ӷ, Ë ÂÈÎÔÈÓˆÓ›· ÙÔ˘ ÁÈ·ÙÚÔ‡ Ì ·ÛıÂÓ›˜ Ô˘ ›¯·Ó ˘ÔÛÙ› √∂ª Ì ‰‡Ô ÌËӇ̷ٷ ‰È·Ì¤ÛÔ˘ ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘ Û˘Û¯ÂÙ›ÛıËΠ̠ÌÈ· ηٿ 17% ·‡ÍËÛË Ù˘ Ï‹„˘ ‚-·ÔÎÏÂÈÛÙÒÓ 9 Ì‹Ó˜ ÌÂÙ¿ ÙÔ √∂ª.[36] ∏ ÌË Û˘ÌÌfiÚʈÛË ÙˆÓ ·ÛıÂÓÒÓ ÛÙËÓ ÂÓ‰ÂÈÎÓ˘fiÌÂÓË Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ ÂÈ‚·Ú‡ÓÂÈ ÛËÌ·ÓÙÈο Ù· Û˘ÛÙ‹Ì·Ù· ˘Á›·˜ Î·È fiÛÔÓ ·ÊÔÚ¿ ÙÔÓ ÔÈÎÔÓÔÌÈÎfi ÙÔ̤· ÂÍ·ÈÙ›·˜ ·‡ÍËÛ˘ Ù˘ ¯Ú‹Û˘ ÙˆÓ ˘ËÚÂÛÈÒÓ ˘Á›·˜ (.¯. ÓÔ-

ÛËÏ›˜, È·ÙÚÈΤ˜ ÂÈÛΤ„ÂȘ, ¯Ú‹ÛË ÙˆÓ ÌÔÓ¿‰ˆÓ ÂÓÙ·ÙÈ΋˜ ıÂÚ·›·˜).[37, 38] ∞ÓÙ›ıÂÙ·, Ë Î·Ï‹ Û˘ÌÌfiÚʈÛË ÛÙËÓ ˘ÔÏÈȉ·ÈÌÈ΋ ·ÁˆÁ‹ ¤¯ÂÈ Û˘Û¯ÂÙÈÛı› Ì ÌÈÎÚfiÙÂÚÔ ÎfiÛÙÔ˜ ˘ËÚÂÛÈÒÓ ˘Á›·˜.[39] ΔÔ ˘„ËÏfiÙÂÚÔ ÎfiÛÙÔ˜ ·fi ÙË ¯ÔÚ‹ÁËÛË ÙˆÓ Ê·ÚÌ¿ÎˆÓ ˘ÂÚÎÂÚ¿˙ÂÙ·È ·fi ÙË Ì›ˆÛË ÙÔ˘ ÎfiÛÙÔ˘˜ Ô˘ ¤¯ÂÈ Û¯¤ÛË Ì ÙȘ ˘ËÚÂۛ˜ ˘Á›·˜. ∂ÈÚfiÛıÂÙ·, Ë ‰ˆÚÂ¿Ó ·ÚÔ¯‹ ˘ÔÏÈȉ·ÈÌÈÎÒÓ Ê·ÚÌ¿ÎˆÓ Û ·ÛıÂÓ›˜ ˘„ËÏÔ‡ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ Î·È Ë Ù·˘Ùfi¯ÚÔÓË ·‡ÍËÛË ÙÔ˘ ÎfiÛÙÔ˘˜ ÙÔ˘˜ ÁÈ· ÙÔ˘˜ ·ÛıÂÓ›˜ ¯·ÌËÏÔ‡ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ Ê·›ÓÂÙ·È fiÙÈ ÂÏ·ÙÙÒÓÂÈ ÙȘ ÓÔÛËÏ›˜ Î·È ÙË ¯Ú‹ÛË ÙˆÓ ÌÔÓ¿‰ˆÓ ÂÓÙ·ÙÈ΋˜ ıÂÚ·›·˜.[40] Δ¤ÙÔÈÔ˘ ›‰Ô˘˜ Ú˘ıÌ›ÛÂȘ ‚¤‚·È· ‰ÂÓ ·ÊÔÚÔ‡Ó ÙÔÓ ÎÏÈÓÈÎfi ÁÈ·ÙÚfi, ·ÏÏ¿ ÙÔ Û‡ÛÙËÌ· ˘Á›·˜ οı ¯ÒÚ·˜. ∞˘Ùfi ˆÛÙfiÛÔ Ô˘ ÔÊ›ÏÔ˘Ì ӷ ÁÓˆÚ›˙Ô˘ÌÂ Â›Ó·È fiÙÈ Û˘¯Ó¿ ÙÔ ˘„ËÏfi ÎfiÛÙÔ˜ ÙˆÓ Ê·ÚÌ¿ÎˆÓ Ô‰ËÁ› Û ¯·ÌËÏ‹ Û˘ÌÌfiÚʈÛË ÙˆÓ ·ÛıÂÓÒÓ ÛÙË Ê·Ú̷΢ÙÈ΋ ÙÔ˘˜ ·ÁˆÁ‹.[41-44]

™˘Ì¤Ú·ÛÌ· ¶·Ú¿ Ù· ·ԉ‰ÂÈÁ̤ӷ ÔʤÏË Ù˘ ˘ÔÏÈȉ·ÈÌÈ΋˜ ·ÁˆÁ‹˜ ÛÙËÓ ÚˆÙÔÁÂÓ‹ Î·È ‰Â˘ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ Ë Û˘ÌÌfiÚʈÛË ÙˆÓ ·ÛıÂÓÒÓ Â›Ó·È Û˘¯Ó¿ ·ÔÁÔËÙ¢ÙÈ΋. ∂›Ó·È ÂÓ‰ÂÈÎÙÈÎfi fiÙÈ ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ·ÛıÂÓ›˜ ÛÙ·Ì·ÙÔ‡Ó ÙË ıÂÚ·›· Ì ÛÙ·Ù›Ó˜ 6 Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍ‹ Ù˘. ∏ ‰È·ÎÔ‹ Ù˘ ·ÁˆÁ‹˜ Ô‰ËÁ› ÛÙËÓ ÂÏ¿ÙÙˆÛË Ù˘ ¢ÂÚÁÂÙÈ΋˜ Â›‰Ú·Û˘ ÙˆÓ Ê·Ú̿ΈÓ, ÛÙËÓ Âȉ›ӈÛË Ù˘ ÚfiÁÓˆÛ˘ ÙˆÓ ·ÛıÂÓÒÓ, ηıÒ˜ Î·È ÛÙËÓ ÔÈÎÔÓÔÌÈ΋ ÂÈ‚¿Ú˘ÓÛË ÙˆÓ Û˘ÛÙËÌ¿ÙˆÓ ˘Á›·˜. √È ÁÈ·ÙÚÔ› ÔÊ›ÏÔ˘Ó Ó· ·ÊÈÂÚÒÓÔ˘Ó ÂÚÈÛÛfiÙÂÚÔ ¯ÚfiÓÔ ÁÈ· Ó· ÂÍËÁÔ‡Ó ÙËÓ ·Ó·ÁηÈfiÙËÙ· Ù˘ ηıËÌÂÚÈÓ‹˜ Ï‹„˘ Ù˘ Ê·Ú̷΢ÙÈ΋˜ ·ÁˆÁ‹˜, ηıÒ˜ Î·È ÁÈ· ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ·ÛıÂÓÒÓ Û ٷÎÙ¿ ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù· ÌÂÙ¿ ÙËÓ ·Ú¯È΋ Û˘ÓÙ·ÁÔÁÚ¿ÊËÛË.

£EPA¶EIA - ºAPMAKA μÈ‚ÏÈÔÁÚ·Ê›· 1. World Health Organization. World health report [online].

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43. Tamblyn R, Laprise R, Hanley JA et al.

Adverse events associated with prescription drug cost-sharing among poor and elderly persons. JAMA 2001; 285:421-9.

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π√À¡π√™ 2008

¶ÚˆÙ½ÓË ™fiÁÈ·˜, πÛÔÊÏ·‚fiÓ˜ Î·È ∫·Ú‰È·ÁÁÂȷ΋ ¡fiÛÔ˜ ÃÚ‹ÛÙÔ˜ ¢ÂÚ‰Â̤˙˘, ∫ÏÈÓÈÎfi˜ ¢È·ÈÙÔÏfiÁÔ˜ - ¢È·ÙÚÔÊÔÏfiÁÔ˜, ∂ÈÛÙËÌÔÓÈÎfi˜ ™˘ÓÂÚÁ¿Ù˘ ÙÔ˘ ∂͈ÙÂÚÈÎÔ‡ π·ÙÚ›Ԣ ¢È·Ù·Ú·¯ÒÓ ÙÔ˘ ªÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ §Èȉ›ˆÓ Î·È ¶·¯˘Û·ÚΛ·˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ πˆ·ÓÓ›ÓˆÓ ªˆ˘Û‹˜ ∂ÏÈÛ¿Ê, ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ ΔÔ̤·˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ √ ÚfiÏÔ˜ Ù˘ ‰È·ÙÚÔÊ‹˜ ÛÙËÓ ÚfiÏË„Ë Ù˘ ηډÈÔ·ÁÁÂȷ΋˜ ÓfiÛÔ˘ (∫∞¡) Â›Ó·È È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈÎfi˜. ¢È¿ÊÔÚ· ıÚÂÙÈο Û˘ÛÙ·ÙÈο, fiˆ˜ Ë ÚˆÙ½ÓË ÛfiÁÈ·˜, ¤¯Ô˘Ó ÌÂÏÂÙËı› fiÛÔÓ ·ÊÔÚ¿ ÙÔ ÚfiÏÔ ÙÔ˘˜ ÛÙËÓ ÂÌÊ¿ÓÈÛË ∫∞¡. ΔÔ 1999 Ô ∞ÌÂÚÈηÓÈÎfi˜ √ÚÁ·ÓÈÛÌfi˜ ΔÚÔÊ›ÌˆÓ Î·È º·ÚÌ¿ÎˆÓ ¤‰ˆÛ ¤ÁÎÚÈÛË ÁÈ· ÂÈÛ‹Ì·ÓÛË Û ÂÙÈΤÙ˜ ÙÚÔÊ›ÌˆÓ ÏÔ‡ÛÈˆÓ Û ÚˆÙ½ÓË ÛfiÁÈ·˜ fiÙÈ ·˘Ù¤˜ ÔÈ ÙÚÔʤ˜ ÌÔÚÔ‡Ó Ó· ÚÔÛٷهÛÔ˘Ó ·fi ηډȷÁÁÂȷο ÓÔÛ‹Ì·Ù·. ∏ ·fiÊ·ÛË ·˘Ù‹ ‚·Û›ÛÙËΠ۠ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ Ô˘ ¤‰ÂÈÍ·Ó fiÙÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ 25 ÁÚ·ÌÌ¿ÚÈ· ÚˆÙ½Ó˘ ÛfiÁÈ·˜ ÙËÓ Ë̤ڷ Ì›ˆÛ·Ó ÙËÓ ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË Î·È ÙË ¯ÔÏËÛÙÂÚfiÏË ÙˆÓ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ (LDL-¯ÔÏËÛÙÂÚfiÏË). ΔËÓ ÂfiÌÂÓË ¯ÚÔÓÈ¿ Ë ∞ÌÂÚÈηÓÈ΋ ∫·Ú‰ÈÔÏÔÁÈ΋ ∂Ù·ÈÚ›· (∞∫∂) Âͤ‰ˆÛ ·Ó·ÎÔ›ÓˆÛË Ô˘ ˘ÔÛÙ‹ÚÈ˙ ÙËÓ ÚÔÛı‹ÎË ÚˆÙ½Ó˘ ÛfiÁÈ·˜ Û ̛· ‰›·ÈÙ· ¯·ÌËÏÒÓ ÏÈ·ÚÒÓ Î·È ¯ÔÏËÛÙÂÚfiÏ˘. ŒÎÙÔÙÂ, ·ÚÎÂÙ¤˜ ÌÂϤÙ˜ ÚÔÛÙ¤ıËÎ·Ó ÛÙȘ ˘¿Ú¯Ô˘Û˜ Î·È Ì›· Ó¤· ·Ó·ÎÔ›ÓˆÛË Ô˘ Û˘Ófi„È˙ ٷ ÓÂfiÙÂÚ· ‰Â‰Ô̤ӷ ÂΉfiıËΠ·fi ÙËÓ ∞∫∂ ÙÔ 2006. √È ÚˆÙ½Ó˜ ˙ˆÈ΋˜ ÚÔ¤Ï¢Û˘ ·˘Í¿ÓÔ˘Ó ÙËÓ ¯ÔÏËÛÙÂÚfiÏË fiÙ·Ó ¯ÔÚËÁÔ‡ÓÙ·È Ì·˙› Ì ÙÚÔÊ‹ Ô˘ ‰ÂÓ ÂÚȤ¯ÂÈ ¯ÔÏËÛÙÂÚfiÏË Û ‰È¿ÊÔÚ· ›‰Ë ˙ÒˆÓ. ™ÙȘ ·Ú¯¤˜ Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ 1980 ¤ÁÈÓÂ Ë ·Ú·Ù‹ÚËÛË Û ÂÈÚ·Ì·Ùfi˙ˆ· fiÙÈ Ë ·ÓÙÈηٿÛÙ·ÛË Ù˘ η˙½Ó˘ ÙÔ˘ Á¿Ï·ÎÙÔ˜ ·fi ÚˆÙ½ÓË ÛfiÁÈ·˜ ‰ÂÓ Û˘Óԉ‡ÂÙ·È ·fi ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·. ∞˘Ù¿ Ù· ·ÔÙÂϤÛÌ·Ù· ‰ÂÓ Â·ÏËı‡ıËÎ·Ó Û ˘ÁÈ›˜ ÂıÂÏÔÓÙ¤˜, ηıÒ˜ Ë ÚԤϢÛË Ù˘ ÚˆÙ½Ó˘ Ù˘ ÙÚÔÊ‹˜ ‰ÂÓ ÂËÚ¤·Û ٷ Â›‰· Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ÙÔ˘ ÔÚÔ‡. ŸÌˆ˜ ÔÈ Sirtori Î·È Û˘ÓÂÚÁ¿Ù˜ ¤‰ÂÈÍ·Ó Û ¿ÙÔÌ· Ì ˘ÂÚ-

24

ÏÈȉ·ÈÌ›· Ù‡Ô˘ ππ ∞ Î·È ππ μ fiÙÈ ‰›·ÈÙ˜ ÛÙȘ Ôԛ˜ ÔÈ ˙ˆÈΤ˜ ÚˆÙ½Ó˜ ›¯·Ó ·ÓÙÈηٷÛÙ·ı› Û ÌÂÁ¿ÏÔ ‚·ıÌfi ·fi ÚˆÙ½ÓË ÛfiÁÈ·˜ Ì›ˆÛ·Ó ÙËÓ ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË ÙÔ˘ ÔÚÔ‡ ηٿ 20% 30%. ŸÌˆ˜, Ë Ì›ˆÛË Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ÙÔ˘ ÔÚÔ‡ Èı·Ó¿ ÔÊÂÈÏfiÙ·Ó ¤ˆ˜ ¤Ó· ‚·ıÌfi ÛÙËÓ Ù·˘Ùfi¯ÚÔÓË ·ÒÏÂÈ· ‚¿ÚÔ˘˜, ÙË Ì›ˆÛË Ù˘ ÚfiÛÏ˄˘ ÎÔÚÂÛÌ¤ÓˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ Î·È ¯ÔÏËÛÙÂÚfiÏ˘, ηıÒ˜ Î·È ÙËÓ ·‡ÍËÛË ÙˆÓ ÔÏ˘·ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ Ù˘ ‰È·ÙÚÔÊ‹˜. ª›· ÌÂÙ··Ó¿Ï˘ÛË Ô˘ ‰ËÌÔÛȇıËΠÙÔ 1995, ¤‰ÂÈÍ fiÙÈ Ë Ì›ˆÛË Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ·fi ÚˆÙ½ÓË ÛfiÁÈ·˜ Â›Ó·È ·Ó¿ÏÔÁË ÙÔ˘ ‚·ıÌÔ‡ Ù˘ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜: ¶Ú¿ÁÌ·ÙÈ ¿ÙÔÌ· Ì Â›‰· ¯ÔÏËÛÙÂÚfiÏ˘ ÔÚÔ‡ >335 mg/dL ÂÌÊ¿ÓÈÛ·Ó Ì›ˆÛË Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ÙÔ˘ ÔÚÔ‡ ηٿ 20%, ÂÓÒ Û ¿ÙÔÌ· Ì Â›‰· ¯ÔÏËÛÙÂÚfiÏ˘ ÔÚÔ‡ <255 mg/dL, Ë Â›‰Ú·Û‹ Ù˘ ‰ÂÓ ‹Ù·Ó ÛËÌ·ÓÙÈ΋. √È Ì˯·ÓÈÛÌÔ› ‰Ú¿ÛÂȘ Ù˘ ÚˆÙ½Ó˘ ÛfiÁÈ·˜ ¤¯Ô˘Ó ‰ÈÂÚ¢ÓËı› Û ÔÏϤ˜ ÌÂϤÙ˜ Î·È Ê·›ÓÂÙ·È fiÙÈ ÔÚÈṲ̂ӷ ıÚÂÙÈο Û˘ÛÙ·ÙÈο Ù˘ ÚˆÙ½Ó˘ ÛfiÁÈ·˜, fiˆ˜ ÔÈ ÈÛÔÊÏ·‚fiÓ˜, ÌÔÚ› Ó· Â›Ó·È ˘‡ı˘Ó· ÁÈ· ÙËÓ Èı·Ó‹ ¢ÂÚÁÂÙÈ΋ ‰Ú¿ÛË Ù˘. √È ÈÛÔÊÏ·‚fiÓ˜ Â›Ó·È ÔÏ˘Ê·ÈÓÔÏÈΤ˜ ÂÓÒÛÂȘ Ô˘ ‚Ú›ÛÎÔÓÙ·È ÛÙ· fiÛÚÈ·, ΢ڛˆ˜ ÛÙ· Ê·ÛfiÏÈ· ÛfiÁÈ·˜. Œ¯ÂÈ ·Ó·ÊÂÚı› fiÙÈ ·˘Ù¤˜ ÔÈ Ô˘Û›Â˜ ¤¯Ô˘Ó ÙfiÛÔ ÔÈÛÙÚÔÁÔÓÈΤ˜, fiÛÔ Î·È ·ÓÙÈÔÈÛÙÚÔÁÔÓÈΤ˜ ‰Ú¿ÛÂȘ. √È ÈÛÔÊÏ·‚fiÓ˜ Ô˘ ··ÓÙÒÓÙ·È Û˘¯ÓfiÙÂÚ· ÛÙË Ê‡ÛË Â›Ó·È Ë ÁÂÓÈÛÙ½ÓË, Ë ÓÙ·˚Ù˙½ÓË Î·È Ë ÁÏ˘ÛÈÙ›ÓË. ∏ ÂÚÈÂÎÙÈÎfiÙËÙ· Ù˘ ÚˆÙ½Ó˘ ÛfiÁÈ·˜ Û ÈÛÔÊÏ·‚fiÓ˜ ÔÈΛÏÏÂÈ Î·È ÂÍ·ÚÙ¿Ù·È ·fi ÙȘ ÌÂıfi‰Ô˘˜ ÂÂÍÂÚÁ·Û›·˜ ηٿ ÙËÓ ·Ú·ÁˆÁ‹. ΔÔ ÁÂÁÔÓfi˜ ·˘Ùfi ÂÈ‚¿ÏÏÂÈ ÙÔ ‰È·¯ˆÚÈÛÌfi ÙˆÓ ÌÂÏÂÙÒÓ Ì ‚¿ÛË ÙËÓ

ÂÚÈÂÎÙÈÎfiÙËÙ· Ù˘ ÚˆÙ½Ó˘ ÛfiÁÈ·˜ Û ÈÛÔÊÏ·‚fiÓ˜.

∂›‰Ú·ÛË Ù˘ ÚˆÙ½Ó˘ ÛfiÁÈ·˜ Ì ÈÛÔÊÏ·‚fiÓ˜ ™Â 22 Ù˘¯·ÈÔÔÈË̤Ó˜ ÌÂϤÙ˜, Ë ÚˆÙ½ÓË ÛfiÁÈ·˜ Ì ÈÛÔÊÏ·‚fiÓ˜ Û˘ÁÎÚ›ıËΠ̠ÙËÓ Î·˙½ÓË ‹ ÙËÓ ÚˆÙ½ÓË ÙÔ˘ ÛÈÙ¿Ï¢ÚÔ˘ ‹ Ì ˙ˆÈ΋ ÚˆÙ½ÓË. ∏ ËÌÂÚ‹ÛÈ· ÚfiÛÏË„Ë ÚˆÙ½Ó˘ ÛfiÁÈ·˜ Î˘Ì·ÈÓfiÙ·Ó ·fi 25-135 ÁÚ·ÌÌ¿ÚÈ· Î·È ÙˆÓ ÈÛÔÊÏ·‚ÔÓÒÓ ·fi 40318 mg. ¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ·Ú·ÙËÚ‹ıËΠ̛ˆÛË ÂÚ›Ô˘ ηٿ 3% Ù˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘ ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ÌÂÏÂÙÒÓ, ÌfiÓÔ Û 6 ÌÂϤÙ˜ ·˘Ù‹ Ë Ì›ˆÛË ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋. ª›· ÚfiÛÊ·ÙË ÌÂÙ·-·Ó¿Ï˘ÛË 10 Ù˘¯·ÈÔÔÈËÌ¤ÓˆÓ ÌÂÏÂÙÒÓ Ô˘ ‰ËÌÔÛȇıËÎ·Ó ·fi ÙÔ 1995 ¤ˆ˜ ÙÔ 2002, ¤‰ÂÈÍ ·ÚfiÌÔÈ· Ì›ˆÛË Ù˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘, Ë ÔÔ›· ‰ÂÓ ‹Ù·Ó ‰ÔÛÔÂÍ·ÚÙÒÌÂÓË.

∂›‰Ú·ÛË Ù˘ ÚˆÙ½Ó˘ ÛfiÁÈ·˜ ¯ˆÚ›˜ ÈÛÔÊÏ·‚fiÓ˜ ™Â 7 ÌÂϤÙ˜ ÛÙȘ Ôԛ˜ ·Ê·ÈÚ¤ıËÎ·Ó ÔÈ ÈÛÔÊÏ·‚fiÓ˜ ·fi ÙËÓ ÚˆÙ½ÓË ÛfiÁÈ·˜, Ë ÙÂÏÂ˘Ù·›· Û˘ÁÎÚ›ıËΠ̠ÙËÓ Î·˙½ÓË ‹ Ì ˙ˆÈ΋ ÚˆÙ½ÓË. ™Â 2 ·fi ·˘Ù¤˜ ÙȘ ÌÂϤÙ˜, ‚Ú¤ıËΠ̛· ÌÈÎÚ‹ ·ÏÏ¿ ÛËÌ·ÓÙÈ΋ Ì›ˆÛË Ù˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘. ∞˘Ù¤˜ ÔÈ ÌÂϤÙ˜ ‹Ù·Ó Ôχ ηϿ ۯ‰ȷṲ̂Ó˜ fiÛÔÓ ·ÊÔÚ¿ ÙË ¯ÔÚ‹ÁËÛË Ù˘ ÙÚÔÊ‹˜, ηıÒ˜ fiÏ· Ù· Á‡̷ٷ Ô˘ ¯ÔÚËÁÔ‡ÓÙ·Ó ÛÙÔ˘˜ Û˘ÌÌÂÙ¤¯ÔÓÙ˜ ‹Ù·Ó Ï‹Úˆ˜ ˘ÔÏÔÁÈṲ̂ӷ ÁÈ· fiÏ· Ù· ıÚÂÙÈο Û˘ÛÙ·ÙÈο. ¶·Ú·ÙËÚ‹ıËΠ̛ˆÛË Ù˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘ ηٿ 2% - 7%, Ë ÔÔ›· fï˜ ÎÚ›ÓÂÙ·È Û¯ÂÙÈο ÌÈÎÚ‹ Û ۯ¤ÛË Ì ÙËÓ ÔÛfiÙËÙ· ÙˆÓ 50 ÁÚ·ÌÌ·Ú›ˆÓ ÚˆÙ½Ó˘ ÛfiÁÈ·˜ Ô˘ Û˘ÓÈÛÙ¿Ù·È Î·ıËÌÂÚÈÓ¿ Î·È Ë ÔÔ›· ·Ó¤Ú¯ÂÙ·È ÛÙÔ ÌÈÛfi ‹ Î·È ÂÚÈÛÛfiÙÂÚÔ Ù˘ ̤Û˘ ËÌÂÚ‹ÛÈ·˜ ÚfiÛÏË-

¢IATPOºH „˘ ÚˆÙ½Ó˘ Û ̛· ¢˘ÙÈÎÔ‡ Ù‡Ô˘ ‰È·ÙÚÔÊ‹. ∂ÈÚfiÛıÂÙ·, Û ¿ÏϘ ÌÂϤÙ˜ ‰ÂÓ ‚Ú¤ıËΠÛËÌ·ÓÙÈ΋ Â›‰Ú·ÛË Ù˘ ÚˆÙ½Ó˘ ÛfiÁÈ·˜, Ô˘ ‰ÂÓ ÂÚÈ›¯Â ÈÛÔÊÏ·‚fiÓ˜, ÛÙ· Â›‰· Ù˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘.

∂›‰Ú·ÛË ÙˆÓ ÈÛÔÊÏ·‚ÔÓÒÓ √ÚÈṲ̂Ó˜ ÌÂϤÙ˜ Û˘Ó¤ÎÚÈÓ·Ó ÙËÓ ÚˆÙ½ÓË ÛfiÁÈ·˜ Ô˘ ÂÚȤ¯ÂÈ ‹ fi¯È ÈÛÔÊÏ·‚fiÓ˜, ÂÓÒ ¿ÏϘ ÌÂϤÙ˜ ‰ÈÂÚ‡ÓËÛ·Ó ÙËÓ Â›‰Ú·ÛË Ù˘ ¯ÔÚ‹ÁËÛ˘ ÙˆÓ ÈÛÔÊÏ·‚ÔÓÒÓ Û ÌÔÚÊ‹ ¯·ÈÔ‡ ¤Ó·ÓÙÈ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘. ∞fi ÙȘ 19 Û˘ÓÔÏÈο ÌÂϤÙ˜, ÌfiÓÔ Û 3 ÌÂϤÙ˜ Ë ¯ÔÚ‹ÁËÛË ÈÛÔÊÏ·‚ÔÓÒÓ Ô‰‹ÁËÛ Û ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Ì›ˆÛË Ù˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘. ™ÙȘ ÌÂϤÙ˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ‰È·ÊÔÚÂÙÈΤ˜ ÔÛfiÙËÙ˜ ÈÛÔÊÏ·‚ÔÓÒÓ ¯ˆÚ›˜ Ó· ˘¿Ú¯ÂÈ ‰ÔÛÔÂÍ·ÚÙÒÌÂÓÔ ·ÔÙ¤ÏÂÛÌ·. ∂ÈÚfiÛıÂÙ·, Ì›· ÌÂÙ·-·Ó¿Ï˘ÛË ‰ÂÓ ¤‰ÂÈÍ Â›‰Ú·ÛË ÙˆÓ ÈÛÔÊÏ·‚ÔÓÒÓ ÛÙ· Â›‰· ÙˆÓ ÏÈȉ›ˆÓ.

∂›‰Ú·ÛË ÛÙ· Â›‰· Ù˘ HDL ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ™Â η̛· ÌÂϤÙË Ô˘ ¯ÔÚËÁ‹ıËΠÚˆÙ½ÓË ÛfiÁÈ·˜, Ì ‹ ¯ˆÚ›˜ ÈÛÔÊÏ·‚fiÓ˜, ‹ Û˘ÌÏËÚÒÌ·Ù· ÈÛÔÊÏ·‚ÔÓÒÓ ‰ÂÓ ·Ú·ÙËÚ‹ıËΠÛËÌ·ÓÙÈ΋ Â›‰Ú·ÛË ÛÙ· Â›‰· Ù˘ HDL ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ.

∂›‰Ú·ÛË ÙˆÓ ·Ú¯ÈÎÒÓ ÂÈ¤‰ˆÓ LDL ¯ÔÏËÛÙÂÚfiÏ˘ √È Lichtenstein Î·È Û˘ÓÂÚÁ¿Ù˜ Î·È ÔÈ Crouse Î·È Û˘ÓÂÚÁ¿Ù˜ ¤‰ÂÈÍ·Ó ÌÂÁ·Ï‡ÙÂÚË ÔÛÔÛÙÈ·›· Ì›ˆÛË Ù˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘ Û ¿ÙÔÌ· Ì Â›‰· LDL ¯ÔÏËÛÙÂÚfiÏ˘ > 160 mg/dL Û ۇÁÎÚÈÛË Ì ¿ÙÔÌ· Ì ¯·ÌËÏfiÙÂÚ· Â›‰· LDL ¯ÔÏËÛÙÂÚfiÏ˘. øÛÙfiÛÔ, ÔÈ Dent Î·È Û˘ÓÂÚÁ¿Ù˜ ‰ÂÓ ·Ú·Ù‹ÚËÛ·Ó ·Ó¿ÏÔÁÔ ·ÔÙ¤ÏÂÛÌ· Û Á˘Ó·›Î˜ Ì ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·, ÔÈ Ôԛ˜ Û˘ÁÎÚ›ıËÎ·Ó Ì ÓÔÚÌÔÏÈȉ·ÈÌÈΤ˜ Á˘Ó·›Î˜. °ÂÓÈο ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÌÂϤÙ˜ ‰ÂÓ ·Ú·ÙËÚ‹ıËΠÌÂÁ·Ï‡ÙÂÚË Ì›ˆÛË Ù˘ LDL ¯Ô-

ÏËÛÙÂÚfiÏ˘ Û ¿ÙÔÌ· Ì ˘„ËÏ¿ ·Ú¯Èο Â›‰· ¯ÔÏËÛÙÂÚfiÏ˘.

∂›‰Ú·ÛË Ù˘ ‰È·ÙÚÔÊ‹˜ ™Â 11 ÌÂϤÙ˜, ÛÙȘ Ôԛ˜ ÌÂÏÂÙ‹ıËÎÂ Ô Û˘Ó‰˘·ÛÌfi˜ Ù˘ ÚˆÙ½Ó˘ ÛfiÁÈ·˜ ‹ ÙˆÓ ÈÛÔÊÏ·‚ÔÓÒÓ Ì ‰È·ÙÚÔÊ‹ Ô˘ ÌÂÈÒÓÂÈ Ù· Â›‰· Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘, ·Ú·ÙËÚ‹ıËΠ̛ˆÛË Ù˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘ ηٿ ÂÚ›Ô˘ 2%. ∂Ô̤ӈ˜, Ë Â›‰Ú·ÛË Ù˘ ÚˆÙ½Ó˘ ÛfiÁÈ·˜ ‹ ÙˆÓ ÈÛÔÊÏ·‚ÔÓÒÓ ÛÙ· Â›‰· Ù˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘, Èı·Ó¿ ‰ÂÓ ÂËÚ¿˙ÂÙ·È ·fi ÙËÓ ÂÚÈÂÎÙÈÎfiÙËÙ· Ù˘ ‰È·ÙÚÔÊ‹˜ Û ÎÂÎÔÚÂṲ̂ӷ ÏÈ·Ú¿ ‹ ¯ÔÏËÛÙÂÚfiÏË.

∂›‰Ú·ÛË ÛÙË ÏÈÔÚˆÙ½ÓË Lp(a). ∏ ÏÈÔÚˆÙ½ÓË Lp(a) Â›Ó·È ·ÓÂÍ¿ÚÙËÙÔ˜ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ. ∞fi ÙȘ 11 ÌÂϤÙ˜ Ô˘ ‰ÈÂÚ‡ÓËÛ·Ó ÙËÓ Èı·Ó‹ Â›‰Ú·ÛË Ù˘ ÚˆÙ½Ó˘ ÛfiÁÈ·˜ ‹ ÙˆÓ ÈÛÔÊÏ·‚ÔÓÒÓ ÛÙËÓ ÏÈÔÚˆÙ½ÓË Lp(a), ÌfiÓÔ 2 ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ ·˘Ù¿ Ù· ıÚÂÙÈο Û˘ÛÙ·ÙÈο ÌÔÚ› Ó· ÚÔηÏÔ‡Ó ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘.

∂›‰Ú·ÛË ÛÙËÓ ·ÚÙËÚȷ΋ ›ÂÛË ™Â ÔÏϤ˜ ÌÂϤÙ˜ ‰ÈÂÚ¢ӋıËÎÂ Ë Â›‰Ú·ÛË ÛÙËÓ ·ÚÙËÚȷ΋ ›ÂÛË Ù˘ ÚˆÙ½Ó˘ ÛfiÁÈ·˜ Ì ÈÛÔÊÏ·‚fiÓ˜ Û ۇÁÎÚÈÛË Ì ÙË ¯ÔÚ‹ÁËÛË Î·˙½Ó˘. ™Â 1 ÌfiÓÔ ÌÂϤÙË ·Ú·ÙËÚ‹ıËΠÌÈÎÚ‹ Ì›ˆÛË Ù˘ Û˘ÛÙÔÏÈ΋˜ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ηٿ 1 mmHg. √È ÈÛÔÊÏ·‚fiÓ˜ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ¤¯Ô˘Ó η̛· Â›‰Ú·ÛË ÛÙËÓ ·ÚÙËÚȷ΋ ›ÂÛË.

™˘ÌÂÚ¿ÛÌ·Ù· Δ· ÚÒÈÌ· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ÌÂÏÂÙÒÓ ÁÈ· ÙË ıÂÙÈ΋ Â›‰Ú·ÛË Ù˘ ÚˆÙ½Ó˘ ÛfiÁÈ·˜ ÛÙ· Â›‰· Ù˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘ Î·È Û ¿ÏÏÔ˘˜ ηډȷÁÁÂÈ·ÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ‰ÂÓ ÂȂ‚·ÈÒıËÎ·Ó ·fi ÌÂÙ·ÁÂÓ¤ÛÙÂÚ˜ ÌÂϤÙ˜ ÙˆÓ 10 ÙÂÏÂ˘Ù·›ˆÓ ¯ÚfiÓˆÓ. ∏ ÚˆÙ½ÓË ÛfiÁÈ·˜ Û Ô-

ÛfiÙËÙ· ›ÛË ‹ ÌÂÁ·Ï‡ÙÂÚË ·fi ÙË ÌÈÛ‹ ËÌÂÚ‹ÛÈ· ÚfiÛÏË„Ë ÔÏÈ΋˜ ÚˆÙ½Ó˘ ÌÔÚ› Ó· ÌÂÈÒÛÂÈ Ù· Â›‰· LDL ¯ÔÏËÛÙÂÚfiÏ˘ Û ÌÈÎÚfi fï˜ ÔÛÔÛÙfi, fiÙ·Ó ·ÓÙÈηıÈÛÙ¿ ÙËÓ ÚˆÙ½ÓË ÙˆÓ Á·Ï·ÎÙÔÎÔÌÈÎÒÓ ÚÔ˚fiÓÙˆÓ ‹ ÙËÓ ÚˆÙ½ÓË ˙ˆÈ΋˜ ÚÔ¤Ï¢Û˘. ∏ Â›‰Ú·ÛË ÛÙ· Â›‰· Ù˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘ ÔÊ›ÏÂÙ·È ÛÙËÓ ÚˆÙ½ÓË ÛfiÁÈ·˜ ·˘Ù‹ ηı·˘Ù‹ Î·È fi¯È ÛÙȘ ÈÛÔÊÏ·‚fiÓ˜, ¯ˆÚ›˜ fï˜ Ó· ÌÔÚ› Ó· ·ÔÎÏÂÈÛı› Ë Â›‰Ú·ÛË Î¿ÔÈÔ˘ ¿ÏÏÔ˘ ıÚÂÙÈÎÔ‡ Û˘ÛÙ·ÙÈÎÔ‡ Ù˘ ÚˆÙ½Ó˘ ÛfiÁÈ·˜. ¢ÂÓ ˘¿Ú¯ÂÈ ıÂÙÈ΋ Â›‰Ú·ÛË ÛÙ· Â›‰· Ù˘ HDL ¯ÔÏËÛÙÂÚfiÏ˘, ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ, Ù˘ Lp(a) Î·È Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘. ∏ ÚˆÙ½ÓË ÛfiÁÈ·˜ Î·È ÔÈ ÈÛÔÊÏ·‚fiÓ˜ ‰ÂÓ ‚ÂÏÙÈÒÓÔ˘Ó Ù· ·ÁÁÂÈÔÎÈÓËÙÈο Û˘ÌÙÒÌ·Ù· Ù˘ ÂÌÌËÓfi·˘Û˘ Î·È Ù· ‰Â‰Ô̤ӷ ÁÈ· ÙË ÌÂÙÂÌÌËÓÔ·˘Ûȷ΋ ·ÒÏÂÈ· ÔÛÙÈ΋˜ Ì¿˙·˜ Â›Ó·È ·ÓÙÈÊ·ÙÈο. ∂ÈÚfiÛıÂÙ·, ‰ÂÓ ¤¯ÂÈ ·Ô‰Âȯı› Ë Â›‰Ú·ÛË Î·È Ë ·ÛÊ¿ÏÂÈ· ÙˆÓ ÈÛÔÊÏ·‚ÔÓÒÓ ÛÙËÓ ÚfiÏË„Ë ‹ ıÂÚ·›· ÙÔ˘ ηÚΛÓÔ˘ ÙÔ˘ Ì·ÛÙÔ‡, ÙÔ˘ ÂÓ‰ÔÌËÙÚ›Ô˘ Î·È ÙÔ˘ ÚÔÛÙ¿ÙË. °È· ·˘Ùfi ÙÔ ÏfiÁÔ ‰ÂÓ Û˘ÓÈÛÙ¿Ù·È Ë ¯Ú‹ÛË Û˘ÌÏËÚˆÌ¿ÙˆÓ ÈÛÔÊÏ·‚ÔÓÒÓ. ∞ÓÙ›ıÂÙ·, Ù· ÚÔ˚fiÓÙ· ÚˆÙ½Ó˘ ÛfiÁÈ·˜, fiˆ˜ ÙÔ Á¿Ï· ÛfiÁÈ·˜ ‹ Ô ÎÈÌ¿˜ ÛfiÁÈ·˜, ÌÔÚ› Ó· Â›Ó·È Â˘ÂÚÁÂÙÈο ÛÙËÓ Î·Ú‰È·ÁÁÂȷ΋ Î·È Û˘ÓÔÏÈ΋ ˘Á›· ÂÍ·ÈÙ›·˜ Ù˘ ˘„ËÏ‹˜ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ ÙÔ˘˜ Û ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ·, Ê˘ÙÈΤ˜ ›Ó˜, ‚Èٷ̛Ә Î·È Ì¤Ù·ÏÏ· Î·È Ù˘ ¯·ÌËÏ‹˜ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ ÙÔ˘˜ Û ÎÂÎÔÚÂṲ̂ӷ ÏÈ·Ú¿ Ôͤ·. ∏ ηٷӿψÛË ÚÔ˚fiÓÙˆÓ ÚˆÙ½Ó˘ ÛfiÁÈ·˜ Û ·ÓÙÈηٿÛÙ·ÛË ÙÚÔÊ›ÌˆÓ ˘„ËÏ‹˜ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ Û ˙ˆÈ΋ ÚˆÙ½ÓË Ô˘ ÂÚȤ¯Ô˘Ó ·Ú¿ÏÏËÏ· ÎÂÎÔÚÂṲ̂ӷ ÏÈ·Ú¿ Î·È ¯ÔÏËÛÙÂÚfiÏË ÌÔÚ› Ó· ‚ÂÏÙÈÒÛÂÈ ÙËÓ Î·Ú‰È·ÁÁÂȷ΋ ˘Á›·. ™˘ÓÔ„›˙ÔÓÙ·˜, Û‡Ìʈӷ Ì ÙËÓ ∞∫∂, Ë ÚˆÙ½ÓË ÛfiÁÈ·˜ ÌÔÚ› Ó· ·ÔÙÂϤÛÂÈ ¤Ó· ·Ó·fiÛ·ÛÙÔ ÙÌ‹Ì· Ì›·˜ ‰È·ÙÚÔÊ‹˜ ¯·ÌËÏ‹˜ Û ÎÔÚÂṲ̂ӷ ÏÈ·Ú¿ Î·È ¯ÔÏËÛÙÂÚfiÏË.

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π√À¡π√™ 2008

μÈ‚ÏÈÔÁÚ·Ê›· 1.

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2.

Sacks FM, Lichtenstein A, Van Horn L, Harris W, Kris-Etherton P, Winston M. Soy protein, isoflavones, and cardiovascular health: an American Heart Association Science Advisory for professionals from the Nutrition Committee. Circulation 2006;113: 1034-44.

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Sirtori CR, Gatti E, Mantero O, Conti F, Agradi E, Tremoli E, et al. Clinical experience with the soybean protein diet in the treatment of hypercholesterolemia.

Am J Clin Nutr 1979;32:1645-58.

Anderson JW, Johnstone BM, CookNewell ME. Meta-analysis of the effects of soy protein intake on serum lipids. N Engl J Med 1995;333:276-82.

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Teixeira SR, Potter SM, Weigel R, Hannum S, Erdman JW, Jr., Hasler CM. Effects of feeding 4 levels of soy protein for 3 and 6 wk on blood lipids and apolipoproteins in moderately hypercholesterolemic men. Am J Clin Nutr 2000;71:1077-84.

7.

Meinertz H, Nilausen K, Hilden J. Alcohol-extracted, but not intact, dietary soy protein lowers lipoprotein(a) markedly. Arterioscler Thromb Vasc Biol 2002;22:312-6.

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JW, et al. Effect of soy protein containing isoflavones on cognitive function, bone mineral density, and plasma lipids in postmenopausal women: a randomized controlled trial. JAMA 2004;292:65-74.

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10. Weggemans RM, Trautwein EA. Relation between soy-associated isoflavones and LDL and HDL cholesterol concentrations in humans: a metaanalysis. Eur J Clin Nutr 2003;57:940-6.

∏ ∂›‰Ú·ÛË Ù˘ ∫·Ù·Ó¿ÏˆÛ˘ ∂Ï·ÈÔÏ¿‰Ô˘ ÛÙËÓ ¶Èı·ÓfiÙËÙ· √ͤԘ ™ÙÂÊ·ÓÈ·›Ô˘ ™˘Ó‰ÚfiÌÔ˘. ªÂϤÙË ∞ÛıÂÓÒÓ-ª·ÚÙ‡ÚˆÓ CARDIO2000. ¢. °ÚËÁÔÚÔÔ‡ÏÔ˘1, ¢. ¶·Ó·ÁȈٿÎÔ˜1, ª. ∫ÔÓÙÔÁÈ¿ÓÓË1, Ã. ÃÚ˘ÛÔ¯fiÔ˘2, Ã. ¶›ÙÛ·‚Ô˜2, Ã. ™ÙÂÊ·Ó¿‰Ë˜2.

1

ΔÌ‹Ì· ∂ÈÛÙ‹Ì˘ ¢È·ÙÚÔÊ‹˜ - ¢È·ÈÙÔÏÔÁ›·˜, ÷ÚÔÎfiÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ 2 ∞’ ∫·Ú‰ÈÔÏÔÁÈ΋ ∫ÏÈÓÈ΋, π·ÙÚÈ΋ ™¯ÔÏ‹ ∞ıËÓÒÓ.

§¤ÍÂȘ ÎÏÂȉȿ: ÂÏ·ÈfiÏ·‰Ô, Ôͤ· ÛÙÂÊ·ÓÈ·›· Û‡Ó‰ÚÔÌ·, ¤ÌÊÚ·ÁÌ· Ì˘Ôηډ›Ô˘

∂π™∞°ø°∏ Δ· ‰È·ÈÙËÙÈο ÏÈ›‰È· ÂÌϤÎÔÓÙ·È fiÏÔ Î·È ÂÚÈÛÛfiÙÂÚÔ ÛÙËÓ ·ÈÙÈÔÏÔÁ›· ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ·ı‹ÛÂˆÓ Î·ıÒ˜ ·ÔÎÙԇ̠ÂÚÈÛÛfiÙÂÚË ÁÓÒÛË ÁÈ· ÙËÓ ÌÂÙ·‚ÔÏÈ΋ Â›‰Ú·ÛË ÙÔ˘ οı ÏÈ·ÚÔ‡ ÔͤԘ ͯˆÚÈÛÙ¿ ÛÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ·˘ÙÒÓ ÙˆÓ ·ı‹ÛˆÓ. .¯., Ù· ÎÔÚÂṲ̂ӷ ÏÈ·Ú¿ Ôͤ· ¤¯Ô˘Ó Û¯ÂÙÈÛı› Ì ˘„ËÏfiÙÂÚÔ Î›Ó‰˘ÓÔ ÁÈ· ηډȷο ÓÔÛ‹Ì·Ù· ÂÓÒ Ù· ÌÔÓÔ·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ· Î·È Ù· ˆ-3 ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ· Ê·›ÓÔÓÙ·È Ó· ¤¯Ô˘Ó ÚÔÛٷ٢ÙÈ΋ ‰Ú¿ÛË[1]. ŒÓ· ·fi Ù· ÛËÌ·ÓÙÈÎfiÙÂÚ· ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ÌÂÛÔÁÂȷ΋˜ ‰È·ÙÚÔÊ‹˜ Â›Ó·È Ë ¯Ú‹ÛË ·Úı¤ÓÔ˘ ÂÏ·ÈfiÏ·‰Ô˘ ˆ˜ ‚·ÛÈ΋˜ ËÁ‹˜ ÂÓ¤ÚÁÂÈ·˜ ÚÔÂÚ¯fiÌÂÓ˘ ·fi Ï›Ô˜, ÙÔ ÔÔ›Ô Â›Ó·È Î·Ï‹ ËÁ‹ ÌÔÓÔ·ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ ηıÒ˜ Î·È ÂηÙÔÓÙ¿‰ˆÓ ÌÈÎÚÔıÚÂÙÈÎÒÓ Û˘-

26

ÛÙ·ÙÈÎÒÓ[2-8]. ∏ ¤Ú¢ӷ ÙˆÓ ∂Ù¿ ÈÚÒÓ ¤‰ÂÈÍ ٷ ÚÒÙ· ÂȉËÌÈÔÏÔÁÈο ÛÙÔȯ›· ÁÈ· ·ÚÓËÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ ‰È·ÈÙËÙÈ΋˜ ÚfiÛÏ˄˘ ÌÔÓÔ·ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ Î·È Ù˘ ıÓËÛÈÌfiÙËÙ·˜ ·fi ηډȷο ÓÔÛ‹Ì·Ù·[3]. ∂›Û˘, ÌÈ· ¿ÏÏË ÂȉËÌÈÔÏÔÁÈ΋ ¤Ú¢ӷ Ì ÓÔÛËχÙÚȘ (Nurse's Health study) ÂȂ‚·›ˆÛ ÙËÓ ÚÔÛٷ٢ÙÈ΋ ‰Ú¿ÛË ÙˆÓ ÌÔÓÔ·ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ ÂÓ¿ÓÙÈ· ÛÙȘ ηډȷΤ˜ ·ı‹ÛÂȘ[4]. √ ÚÔÛٷ٢ÙÈÎfi˜ ÚfiÏÔ˜ ÙÔ˘ ÂÏ·ÈÔÏ¿‰Ô˘ fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ıÓËÛÈÌfiÙËÙ· ·ÛıÂÓÒÓ Ì ÚÔËÁÔ‡ÌÂÓÔ ÂÂÈÛfi‰ÈÔ ÔͤԘ ÂÌÊÚ¿ÁÌ·ÙÔ˜ Ì˘Ôηډ›Ô˘ ÂȂ‚·ÈÒıËÎÂ Î·È ÛÙËÓ ÎÏÈÓÈ΋ ÌÂϤÙË GISSI[5]. ¶·ÚfiÏ· ·˘Ù¿ Ú¤ÂÈ Ó· ÂÈÛËÌ·Óı› fiÙÈ ¤Ú¢Ó˜ ·ÛıÂÓÒÓ-Ì·ÚÙ‡ÚˆÓ ÂÌÊ¿ÓÈÛ·Ó ·ÓÙÈÎÚÔ˘fiÌÂÓ· ·ÔÙÂϤÛÌ·Ù·, ‰Â›¯ÓÔÓÙ·˜ Ó· ÌËÓ ˘¿Ú¯ÂÈ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÂÏ·ÈÔÏ¿‰Ô˘ Î·È Î›Ó‰˘ÓÔ˘ ÁÈ· ηډȷÁÁÂȷο ÓÔ-

Û‹Ì·Ù·[6,7]. ™Â ÌÈ· ÂÏÏËÓÈ΋ ¤Ú¢ӷ ·ÛıÂÓÒÓ-Ì·ÚÙ‡ÚˆÓ[9] Ë ÔÔ›· ÂÈÎÂÓÙÚÒıËΠÛÙÔÓ Ù‡Ô ÙÔ˘ Ï·‰ÈÔ‡ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·Ó ÛÙÔ Ì·Á›ÚÂÌ·, ‰ÂÓ ‚Ú¤ıËΠοÔÈ· ÛËÌ·ÓÙÈ΋ Û¯¤ÛË ÌÂٷ͇ ηٷӿψÛ˘ ÌÔÓÔ·ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ Î·È Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ·ı‹ÛˆÓ, ÂÓÒ ·ÓÙ›ıÂÙ· ÂÚ¢ÓËÙ¤˜ ·fi ÙËÓ ÌÂϤÙË EPIC ¤‰ÂÈÍ·Ó fiÙÈ Ë Î·Ù¿ ÎÂÊ·Ï‹ ÚfiÛÏË„Ë ÂÏ·ÈfiÏ·‰Ô˘ Û¯ÂÙÈ˙fiÙ·Ó ·ÓÙ›ÛÙÚÔÊ· Ì ÙËÓ Û˘ÛÙÔÏÈ΋ Î·È ÙËÓ ‰È·ÛÙÔÏÈ΋ ›ÂÛË, Ô˘ Â›Ó·È ‰˘Ó·ÙÔ› ‰Â›ÎÙ˜ ·˘ÙÒÓ ÙˆÓ ·ı‹ÛˆÓ[10]. √ ÛÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜ ‹Ù·Ó Ó· ·ÍÈÔÏÔÁ‹ÛÂÈ ÙË Û¯¤ÛË ÌÂٷ͇ Ù˘ Û˘Ó‹ıÂÈ·˜ ηٷӿψÛ˘ ÂÏ·ÈÔÏ¿‰Ô˘ Î·È ¿ÏÏˆÓ ÏÈÒÓ Î·È ÂÏ·›ˆÓ ÛÙÔ Î·ıËÌÂÚÈÓfi Ì·Á›ÚÂÌ·, Ì ÙËÓ Èı·ÓfiÙËÙ· ÚˆÙÔÂÌÊ·ÓÈ˙fiÌÂÓÔ˘ ÌË ı·Ó·ÙËÊfiÚÔ˘ ÔͤԘ ÛÙÂÊ·ÓÈ·›Ô˘ Û˘Ó‰ÚfiÌÔ˘ (¤ÌÊÚ·ÁÌ· Ì˘Ô-

¢IATPOºH ηډ›Ô˘ ‹ ·ÛÙ·ı‹˜ ÛÙËı¿Á¯Ë) Û ÂÏÏËÓÈÎfi ‰Â›ÁÌ· ÙÔ˘ ÏËı˘ÛÌÔ‡.

À§π∫√-ª∂£√¢√™ ∞ÛıÂÓ›˜ Î·È Ì¿ÚÙ˘Ú˜ Ù˘ ÌÂϤÙ˘ ∏ CARDIO2000 Â›Ó·È ÌÈ· ÂȉËÌÈÔÏÔÁÈ΋ ¤Ú¢ӷ ·ÛıÂÓÒÓ-Ì·ÚÙ‡ÚˆÓ Ô˘ ¤Ï·‚ ¯ÒÚ· Û ÔÏÏ¿ ΤÓÙÚ· Î·È Ë ÔÔ›· ÌÂϤÙËÛ ÙË Û¯¤ÛË ÌÂٷ͇ ‰È·ÊfiÚˆÓ ·Ú·ÁfiÓÙˆÓ fiˆ˜ Â›Ó·È Ë ‰È·ÙÚÔÊ‹, Ô ÙÚfiÔ˜ ˙ˆ‹˜, ‰È¿ÊÔÚÔÈ ÎÔÈÓˆÓÈÎÔ-‰ËÌÔÁÚ·ÊÈÎÔ› Î·È ÎÏÈÓÈÎÔ› ·Ú¿ÁÔÓÙ˜, Ì ÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ÌË ı·Ó·ÙËÊfiÚÔ˘ ÛÙÂÊ·ÓÈ·›Ô˘ Û˘Ó‰ÚfiÌÔ˘. ™ÙËÓ ¤Ú¢ӷ Û˘ÌÌÂÙ›¯·Ó 848 ·fi ÙÔ˘˜ 956 ·ÛıÂÓ›˜, Ù˘¯·›· ÂÈÏÂÁ̤ÓÔÈ ·fi ÓÔÛÔÎÔÌ›·, ÔÈ ÔÔ›ÔÈ ÂÌÊ¿ÓÈÛ·Ó Û‡Ìو̷ ηډȷ΋˜ ÓfiÛÔ˘ ÁÈ· ÚÒÙË ÊÔÚ¿ ÛÙËÓ ˙ˆ‹ ÙÔ˘˜. Δ· ÎÚÈÙ‹ÚÈ· ÂÈÛ·ÁˆÁ‹˜ ÙˆÓ ·ÛıÂÓÒÓ ÛÙËÓ ¤Ú¢ӷ ‹Ù·Ó: 1. ‰È¿ÁÓˆÛË ÚÒÙÔ˘ ÂÂÈÛÔ‰›Ô˘ ÔͤԘ ÂÌÊÚ¿ÁÌ·ÙÔ˜ Ì˘Ôηډ›Ô˘ Ì ‰‡Ô ÔÈ ÂÚÈÛÛfiÙÂÚ· ·fi ÙÔ˘˜ ÂfiÌÂÓ· ÎÚÈÙ‹ÚÈ·: ·ÏÏ·Á¤˜ ÛÙÔ ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ·, Â›ÌÔÓ· ÎÏÈÓÈο Û˘ÌÙÒÌ·Ù·, ·‡ÍËÛË Û ÂȉÈο ‰È·ÁÓˆÛÙÈο ¤Ó˙˘Ì·, 2. ÚÒÙË ‰È¿ÁÓˆÛË ·ÛÙ·ıÔ‡˜ ÛÙËı¿Á¯Ë˜ (Ù¿ÍË πππ Ù˘ ηٿٷ͢ ηٿ Braunwald). ™ÙË Û˘Ó¤¯ÂÈ· ÂÈϤ¯ıËÎ·Ó Ù˘¯·›· 1078 ÂıÂÏÔÓÙ¤˜ (830 ¿Ó‰Ú˜ Î·È 248 Á˘Ó·›Î˜) ÂÍÔÌÔȈ̤ÓÔÈ Ì ÙÔ˘˜ ·ÛıÂÓ›˜ ˆ˜ ÚÔ˜ ÙËÓ ËÏÈΛ· (± 3 ¤ÙË), ÙÔ Ê‡ÏÔ Î·È ÙÔÓ ÙfiÔ Î·ÙÔÈΛ·˜, Î·È ¯ˆÚ›˜ ηӤӷ Û‡Ìو̷ ‹ ˘Ô„›· ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘ ÛÙÔ È·ÙÚÈÎfi ÈÛÙÔÚÈÎfi ÙÔ˘˜. ªÂÙÚ‹ÛÂȘ ŸÛÔÓ ·ÊÔÚ¿ ÙȘ ÏËÚÔÊÔڛ˜ ÁÈ· ÎÏÈÓÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, ·˘Ù¤˜ ‚Ú¤ıËÎ·Ó ·fi ÙÔ˘˜ È·ÙÚÈÎÔ‡˜ ʷΤÏÔ˘˜ ÙˆÓ Û˘ÌÌÂÙ¯fiÓÙˆÓ, ÂÓÒ ÏËÚÔÊÔڛ˜ ÁÈ· ÙÔÓ ÙÚfiÔ ˙ˆ‹˜ Û˘ÏϤ¯ıËÎ·Ó Ì¤Û· ·fi ÏÂÙÔÌÂÚ¤˜ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ. √È ‰È·ÙÚÔÊÈΤ˜ Û˘Ó‹ıÂȘ ·ÍÈÔÏÔÁ‹ıËÎ·Ó Ì ËÌÈÔÛÔÙÈÎÔÔÈË̤ÓÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Û˘¯ÓfiÙËÙ·˜ ηٷӿψÛ˘ ÙÚÔʛ̈Ó. ∂ȉÈÎfiÙÂÚ· Ë Î·Ù·Ó¿ÏˆÛË ÂÏ·ÈÔÏ¿‰Ô˘, ÂÏ·›ˆÓ ·fi ηÚÔ‡˜, ‚Ô˘Ù‡ÚÔ˘ Î·È Ì·ÚÁ·Ú›Ó˘ ·ÍÈÔÏÔÁ‹ıËΠڈÙÒÓÙ·˜ fiÏÔ˘˜ ÙÔ˘˜ Û˘ÌÌÂÙ¤¯ÔÓÙ˜ Û¯ÂÙÈο Ì ÙËÓ ¯Ú‹ÛË ·˘ÙÒÓ ÛÙÔ Î·ıËÌÂÚÈÓfi Ì·Á›ÚÂÌ· Î·È ÙËÓ ÚÔÂÙÔÈÌ·Û›· Ê·ÁËÙÔ‡

(¯ ÚÔÛı‹ÎË Û ۷ϿÙ˜ ÎÏ). ∂›Û˘ ηٷÁÚ¿ÊËÎ·Ó ÙÔ ‡„Ô˜, ÙÔ ‚¿ÚÔ˜ ηıÒ˜ Î·È ÛÙÔȯ›· Ô˘ ·ÊÔÚÔ‡Û·Ó ÙËÓ Î·Ù·Ó¿ÏˆÛË ·ÏÎÔfiÏ, ÙÔ Î¿ÓÈÛÌ·, ÙË Ê˘ÛÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ·, ÙÔ ÌÔÚʈÙÈÎfi Â›Â‰Ô Î·È ÙËÓ ‡·ÚÍË ÚÒÈÌ˘ ηډȷ΋˜ ÓfiÛÔ˘ ÌÂٷ͇ ÙˆÓ Û˘ÁÁÂÓÒÓ ÚÒÙÔ˘ ‚·ıÌÔ‡. ø˜ ˘¤ÚÙ·ÛË ÔÚ›ÛÙËÎÂ Ë ÂÌÊ¿ÓÈÛË ÙÈÌÒÓ Û˘ÛÙÔÏÈ΋˜ /‰È·ÛÙÔÏÈ΋˜ ›ÂÛ˘ ·›Ì·ÙÔ˜ >140/90 mmHg ‹ Ë Ï‹„Ë ·ÓÙÈ˘ÂÚÙ·ÛÈ΋˜ ·ÁˆÁ‹˜, ˆ˜ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·, Ë ÂÌÊ¿ÓÈÛË ÙÈÌÒÓ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ >200 mg/dl ‹ Ë ¯Ú‹ÛË ˘ÔÏÈȉ·ÈÌÈÎÒÓ Ê·ÚÌ¿ÎˆÓ Î·È ˆ˜ ‰È·‚‹Ù˘, Ë ÂÌÊ¿ÓÈÛË ÙÈÌÒÓ ÁÏ˘Îfi˙˘ ÓËÛÙ›·˜>125 mg/dl ‹ Ë ¯Ú‹ÛË ·ÓÙȉȷ‚ËÙÈÎÒÓ Ê·Ú̿ΈÓ. ∏ ÌÂϤÙË CARDIO2000 ÂÁÎÚ›ıËΠ·fi ÙËÓ ÂÈÙÚÔ‹ ËıÈ΋˜ Î·È ‰ÂÔÓÙÔÏÔÁ›·˜ ÙÔ˘ ΔÌ‹Ì·ÙÔ˜. ¶ÂÚÈÛÛfiÙÂÚ˜ ÏÂÙÔ̤ÚÂȘ fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ¤Ú¢ӷ ¤¯Ô˘Ó ·ÚÔ˘ÛÈ·ÛÙ› Î·È ÛÙÔ ·ÚÂÏıfiÓ[13].

∞¶√Δ∂§∂™ª∞Δ∞ ΔÔ 65,2% ÙˆÓ ·ÙfiÌˆÓ ÛÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ Î·È ÙÔ 58,6% ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ ·Ó¤ÊÂÚ·Ó ·ÔÎÏÂÈÛÙÈ΋ ¯Ú‹ÛË ÂÏ·ÈÔÏ¿‰Ô˘ (p= 0.002), ÂÓÒ ÙÔ 16,3% Ù˘ ÔÌ¿‰·˜ ÂϤÁ¯Ô˘ Î·È ÙÔ 22,4% ÙˆÓ ·ÛıÂÓÒÓ ‰ÂÓ ¯ÚËÛÈÌÔÔÈÔ‡Û·Ó Î·ıfiÏÔ˘ ÂÏ·ÈfiÏ¿‰Ô (p= 0.002). ∂Ï·ÈfiÏ·‰Ô ÛÂ Û˘Ó‰˘·ÛÌfi Ì ¿ÏÏ· Ï›Ë Î·Ù·Ó¿ÏˆÓ·Ó ÙÔ 18,5% ·fi ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ Î·È ÙÔ 19% ÙˆÓ ·ÛıÂÓÒÓ (p= 0.002). ¶ÂÚÈÁÚ·ÊÈ΋ ·Ó¿Ï˘ÛË ¤‰ÂÈÍ fiÙÈ ÛÙËÓ ÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ ‰ÂÓ ·Ú·ÙËÚ‹ıËΠοÔÈ· ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ Û˘Ó‹ıÂÈ·˜ ηٷӿψÛ˘ ÂÏ·›ˆÓ Ì ÙÔ˘˜ ‰È¿ÊÔÚÔ˘˜ ‰ËÌÔÁÚ·ÊÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ·ÏÏ¿ Ô‡ÙÂ Î·È Ì ÙÔ˘˜ ÎÏÈÓÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜. øÛÙfiÛÔ ÛÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ Ë Û˘Ó‹ıÂÈ· ηٷӿψÛ˘ ÂÏ·›ˆÓ Û˘Û¯ÂÙ›ÛıËΠ̠ÙËÓ ËÏÈΛ·, ÙÔ Ê‡ÏÔ, ÙÔÓ ¢ª™, ÙÔ Î¿ÓÈÛÌ·, ÙËÓ Â›ÙˆÛË Ù˘ ˘¤ÚÙ·Û˘ Î·È Ù˘ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜. ŸÏÔÈ ·˘ÙÔ› ÔÈ ·Ú¿ÁÔÓÙ˜ Ï‹ÊıËÎ·Ó ˘fi fi„ÈÓ Î·Ù¿ ÙËÓ ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË. ∂ÈϤÔÓ, ÙfiÛÔ ÛÙÔ˘˜ ·ÛıÂÓ›˜ fiÛÔ Î·È ÛÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘, ·Ú·ÙËÚ‹Û·Ì fiÙÈ Ù· ¿ÙÔÌ· Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡Û·Ó ÂÏ·ÈfiÏ·‰Ô ›¯·Ó ¯·ÌËÏfiÙÂÚË ÚfiÛÏË„Ë Ï¢ÎÔ‡ ÎÚ¤·ÙÔ˜ (p < 0.001) Î·È ÌÂÁ·Ï‡ÙÂÚË Î·Ù·Ó¿ÏˆÛË „·ÚÈÒÓ (p<0.001), ÔÛÚ›ˆÓ (p=0.002), ÊÚÔ‡ÙˆÓ Î·È Ï·¯·ÓÈÎÒÓ (p < 0.001),

Û ۯ¤ÛË Ì ٷ ¿ÙÔÌ· Ô˘ ‰ÂÓ Î·Ù·Ó¿ÏˆÓ·Ó Î·ıfiÏÔ˘ ÂÏ·ÈfiÏ·‰Ô. √È Èı·ÓfiÙËÙ˜ ÂÌÊ¿ÓÈÛ˘ ÔͤԘ ÛÙÂÊ·ÓÈ·›Ô˘ Û˘Ó‰ÚfiÌÔ˘ ‹Ù·Ó 0.66 ÊÔÚ¤˜ ÏÈÁfiÙÂÚ˜ (95% ¢∂ 0.52 ˆ˜ 0.84) ÁÈ· ·˘ÙÔ‡˜ Ô˘ Î·Ù·Ó¿ÏˆÓ·Ó ·ÔÎÏÂÈÛÙÈο ÂÏ·ÈfiÏ·‰Ô, Û˘ÁÎÚÈÓfiÌÂÓÔÈ Ì ·˘ÙÔ‡˜ Ô˘ ‰ÂÓ ¯ÚËÛÈÌÔÔÈÔ‡Û·Ó Î·ıfiÏÔ˘ ÂÏ·ÈfiÏ·‰Ô. ∏ Û˘Ó‰˘·Ṳ̂ÓË Î·Ù·Ó¿ÏˆÛË ÂÏ·ÈÔÏ¿‰Ô˘ Ì·˙› Ì ¿ÏÏ· Ï›Ë Î·È ¤Ï·È· ‰ÂÓ ¤‰ÂÈÍ η̛· ÛËÌ·ÓÙÈ΋ Û¯¤ÛË. ∂ÈϤÔÓ Ë ·Ó¿Ï˘ÛË ¤‰ÂÈÍ fiÙÈ Ë ·ÔÎÏÂÈÛÙÈ΋ ¯Ú‹ÛË ÂÏ·ÈÔÏ¿‰Ô˘ Û¯ÂÙÈ˙fiÙ·Ó Ì 47% ¯·ÌËÏfiÙÂÚË Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ÔͤԘ ÛÙÂÊ·ÓÈ·›Ô˘ Û˘Ó‰ÚfiÌÔ˘ (95% ¢∂ 0.4 ˆ˜ 0.71), Ï·Ì‚¿ÓÔÓÙ·˜ ˘fi„Ë ‰È¿ÊÔÚ· ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·ÙfiÌˆÓ (.¯. ¢ª™, οÓÈÛÌ·, Â›Â‰Ô Ê˘ÛÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜, ÌÔÚʈÙÈÎfi Â›‰Ô, ‡·ÚÍË ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÈÛÙÔÚÈÎÔ‡, ηډȷÎÒÓ ·ı‹ÛÂˆÓ Î·ıÒ˜ Î·È ÁÈ· ˘¤ÚÙ·ÛË, ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· Î·È ‰È·‚‹ÙË). ∏ Û¯¤ÛË ÌÂٷ͇ ηٷӿψÛ˘ ÂÏ·ÈÔÏ¿‰Ô˘ Î·È Èı·ÓfiÙËÙ·˜ ÂÌÊ¿ÓÈÛ˘ ÔͤԘ ÛÙÂÊ·ÓÈ·›Ô˘ Û˘Ó‰ÚfiÌÔ˘ ‰ÂÓ ¿ÏÏ·Í ԇÙ ÌÂÙ¿ ·fi ÛÙ¿ıÌÈÛË ÁÈ· ÙËÓ Î·Ù·Ó¿ÏˆÛË ‰È·ÊfiÚˆÓ ÔÌ¿‰ˆÓ ÙÚÔÊ›ÌˆÓ Î·È ·ÏÎÔfiÏ (¶›Ó·Î·˜ 1). Δ¤ÏÔ˜, η̛· ¿ÏÏË ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË ‰ÂÓ ·Ú·ÙËÚ‹ıËΠÌÂٷ͇ Ù˘ Û˘Ó‹ıÂÈ·˜ ηٷӿψÛ˘ ÂÏ·ÈÔÏ¿‰Ô˘ Î·È ÙˆÓ ‰È¿ÊÔÚˆÓ ÎÔÈÓˆÓÈÎfi-‰ËÌÔÁÚ·ÊÈÎÒÓ, ÎÏÈÓÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ‹ ÙÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜, fiÛÔÓ ·ÊÔÚ¿ ÙËÓ Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ÔͤԘ ÛÙÂÊ·ÓÈ·›Ô˘ Û˘Ó‰ÚfiÌÔ˘.

™À∑∏Δ∏™∏ ∏ ·ÚÔ‡Û· ¤Ú¢ӷ ‰Â›¯ÓÂÈ fiÙÈ Ë ·ÔÎÏÂÈÛÙÈ΋ ¯Ú‹ÛË ÂÏ·ÈÔÏ¿‰Ô˘ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ Ì·ÁÂÈڤ̷ÙÔ˜ ‹ ˆ˜ ÚÔÛÙÈı¤ÌÂÓÔ˘ ÂÏ·›Ô˘ Û˘Û¯ÂÙ›˙ÂÙ·È ÛËÌ·ÓÙÈο Ì ¯·ÌËÏfiÙÂÚ˜ Èı·ÓfiÙËÙ˜ ÂÌÊ¿ÓÈÛ˘ ÔͤԘ ÛÙÂÊ·ÓÈ·›Ô˘ Û˘Ó‰ÚfiÌÔ˘, ·ÎfiÌ· Î·È ÌÂÙ¿ ·fi ¤ÏÂÁ¯Ô ·ÚÎÂÙÒÓ Û˘Á¯˘ÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘. ∏ ∂ÏÏ¿‰· Â›Ó·È ÌÈ· ¯ÒÚ· ÛÙËÓ ÔÔ›· ·Ú·‰ÔÛȷο ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÂÏ·ÈfiÏ·‰Ô ηٿ ÙËÓ ÚÔÂÙÔÈÌ·Û›· ÙÔ˘ Ê·ÁËÙÔ‡. ™ÙËÓ ¤Ú¢ӷ EPIC Ë ÌÂÁ·Ï‡ÙÂÚË Î·Ù·Ó¿ÏˆÛË ÂÏ·ÈÔÏ¿‰Ô˘ ηٷÁÚ¿ÊËΠÛÙËÓ ∂ÏÏ¿‰·[14] Î·È Û‡Ìʈӷ Ì ÙËÓ ÌÂϤÙË DAFNE, ÙÔ ÂÏ·ÈfiÏ·‰Ô ‹Ù·Ó ÙÔ ÚˆÙ·Ú¯ÈÎfi ¤Ï·ÈÔ Ô˘ ‹Ù·Ó ‰È·ı¤ÛÈÌÔ Û ∂ÏÏ¿‰· Î·È πÛ·Ó›·[15]. °ÂÓÈο ÔÈ ÌÂÛÔÁÂȷΤ˜ ¯ÒÚ˜ ›¯·Ó ÙË ÌÈ-

27

π√À¡π√™ 2008

¶›Ó·Î·˜ 1. ∫·Ù·Ó¿ÏˆÛË ÂÏ·ÈÔÏ¿‰Ô˘ Î·È Ô͇ ÛÙÂÊ·ÓÈ·›Ô Û‡Ó‰ÚÔÌÔ. ™¯ÂÙÈÎfi˜ ÏfiÁÔ˜ ∫·ÙËÁÔÚ›· ÂÏ·›Ô˘ ªË ¯Ú‹ÛË ÂÏ·ÈÔÏ¿‰Ô˘ (ηÙËÁÔÚ›· ·Ó·ÊÔÚ¿˜) ∞ÔÎÏÂÈÛÙÈ΋ ¯Ú‹ÛË ÂÏ·ÈÔÏ¿‰Ô˘ ∂Ï·ÈfiÏ·‰Ô ÛÂ Û˘Ó‰˘·ÛÌfi Ì ¿ÏÏ· ¤Ï·È· ∏ÏÈΛ· (·Ó¿ 1 ¤ÙÔ˜) ÕÓ‰Ú˜ / °˘Ó·›Î˜ √ÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ηډȷÁÁÂÈ·ÎÒÓ ·ı‹ÛÂˆÓ (¡·È / Ÿ¯È) ¶·ÚÔ‡Û· Û˘Ó‹ıÂÈ· ηÓ›ÛÌ·ÙÔ˜ (¡·È / Ÿ¯È) À¤ÚÙ·ÛË (¡·È / Ÿ¯È) ÀÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· (¡·È / Ÿ¯È) ¢È·‚‹Ù˘ (¡·È / Ÿ¯È) ¢Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (·Ó¿ 1 kg/m2) ∫·ıÈÛÙÈ΋ ˙ˆ‹ (¡·È / Ÿ¯È) ∞ÓÒÙÂÚË / ̤ÙÚÈ· ‹ ¯·ÌËÏfiÙÂÚË ÌfiÚʈÛË ¶ÚfiÛÏË„Ë ÎfiÎÎÈÓÔ˘ ÎÚ¤·ÙÔ˜ (ÌÂÚ›‰Â˜ / ‚‰ÔÌ¿‰·) ¶ÚfiÛÏË„Ë ÊÚÔ‡ÙˆÓ Î·È Ï·¯·ÓÈÎÒÓ (ÌÂÚ›‰Â˜ / ‚‰ÔÌ¿‰·) ¶ÚfiÛÏË„Ë ‰ËÌËÙÚÈ·ÎÒÓ (ÌÂÚ›‰Â˜ / ‚‰ÔÌ¿‰·) ¶ÚfiÛÏË„Ë ·ÏÎÔfiÏ (ÔÙ‹ÚÈ· ÎÚ·Û›/ Ë̤ڷ)

ÎÚfiÙÂÚË ‰È·ıÂÛÈÌfiÙËÙ· Û ÚÔÛÙÈı¤ÌÂÓÔ ˙ˆÈÎfi Î·È Ê˘ÙÈÎfi Ï›Ô˜. ™ÙËÓ ·ÚÔ‡Û· ¤Ú¢ӷ ÙÔ 65% Ù˘ ÔÌ¿‰· ÂϤÁ¯Ô˘ Î·È ÙÔ 59% ÙˆÓ ·ÛıÂÓÒÓ ·Ó¤ÊÂÚ·Ó ·ÔÎÏÂÈÛÙÈ΋ ¯Ú‹ÛË ÂÏ·ÈÔÏ¿‰Ô˘ ÂÓÒ ÙÔ 16% Ù˘ ÔÌ¿‰·˜ ÂϤÁ¯Ô˘ Î·È ÙÔ 22% ÙˆÓ ·ÛıÂÓÒÓ ‰ÂÓ ¯ÚËÛÈÌÔÔÈÔ‡Û·Ó Î·ıfiÏÔ˘ ÂÏ·ÈfiÏ·‰Ô. ∞ÎfiÌ·, ·˘ÙÔ› Ô˘ ·Ó¤ÊÂÚ·Ó ·ÔÎÏÂÈÛÙÈ΋ ¯Ú‹ÛË ÂÏ·ÈÔÏ¿‰Ô˘, ·Ó¤ÊÂÚ·Ó Î·È ÌÂÁ·Ï‡ÙÂÚË Î·Ù·Ó¿ÏˆÛË „·ÚÈÒÓ, ÔÛÚ›ˆÓ ÊÚÔ‡ÙˆÓ Î·È Ï·¯·ÓÈÎÒÓ ·ÓÙÈηÙÔÙÚ›˙ÔÓÙ·˜ ‰È·ÙÚÔÊÈΤ˜ Û˘Ó‹ıÂȘ ÎÔÓÙ¿ ÛÙË ÌÂÛÔÁÂȷ΋ ‰È·ÙÚÔÊ‹. øÛÙfiÛÔ Ë Â›‰Ú·ÛË ÙÔ˘ ÂÏ·ÈÔÏ¿‰Ô˘ ÛÙË Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ηډȷÎÒÓ ÓÔÛËÌ¿ÙˆÓ ‹Ù·Ó ·ÓÂÍ¿ÚÙËÙË ·fi ·˘Ù¤˜ ÙȘ ÔÌ¿‰Â˜ ÙÚÔʛ̈Ó. ∞ÓÙ›ÛÙÚÔÊË Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ηٷӿψÛ˘ ÂÏ·ÈÔÏ¿‰Ô˘ Î·È ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛ˘ ÔͤԘ ÂÌÊÚ¿ÁÌ·ÙÔ˜ Ì˘Ôηډ›Ô˘ ‚Ú¤ıËÎÂ Î·È Û ̛· ¤Ú¢ӷ ·ÛıÂÓÒÓÌ·ÚÙ‡ÚˆÓ ·fi ÙËÓ πÛ·Ó›·[8], fiÔ˘ ÛÙÔ ·ÓÒÙÂÚÔ ÙÂÙ·ÚÙËÌfiÚÈÔ Î·Ù·Ó¿ÏˆÛ˘ ÙÔ ÂÏ·ÈfiÏ·‰Ô Û˘Û¯ÂÙ›ÛıËΠÛËÌ·ÓÙÈο Ì 82% Û¯ÂÙÈ΋ Ì›ˆÛË ÛÙÔÓ Î›Ó‰˘ÓÔ ÁÈ· ÂÌÊ¿ÓÈÛË ÔͤԘ ÂÌÊÚ¿ÁÌ·ÙÔ˜ Ì˘Ôηډ›Ô˘, ÌÂÙ¿ ·fi Ú‡ıÌÈÛË ÁÈ· ·ÚÎÂÙÔ‡˜ Û˘Á¯˘ÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜. ¢˘ÛÙ˘¯Ò˜ Ù· ÛÙÔȯ›· Ô˘ ¤¯Ô˘Ì ‰ÂÓ ÂÈÙÚ¤Ô˘Ó Ô‡Ù ӷ ÔÛÔÙÈÎÔÔÈ‹ÛÔ˘Ì ÙËÓ Î·Ù·Ó¿ÏˆÛË ÂÏ·›ˆÓ Î·È ÏÈÒÓ Ô‡Ù ӷ ˘ÔÏÔÁ›ÛÔ˘Ì ÙËÓ ÔÛfiÙËÙ· ÌÔÓÔ·ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ Ô˘ ηٷӷÏÒÓÔÓÙ·Ó. øÛÙfiÛÔ Ë Î·Ù·ÁÚ·Ê‹ ÙÔ˘ Ù‡Ô˘ ÙÔ˘ ÂÏ·ÈÔÏ¿‰Ô˘ ηٿ ÙËÓ ·Ú·Û΢‹ ÙÔ˘

28

1.00 0.53 0.77 1.03 2.73 4.07 1.79 1.94 3.76 2.39 0.97 0.81 0.94 1.68 0.66 1.15 1.09

Ê·ÁËÙÔ‡ (¯ Ì·Á›ÚÂÌ·, ÙËÁ¿ÓÈÛÌ· ÚÔÛı‹ÎË Û ۷ϿÙ˜) ı· ÌÔÚÔ‡Û ӷ ÂÚÈÏ·Ì‚¿ÓÂÈ ÏÈÁfiÙÂÚ¿ ÛÊ¿ÏÌ·Ù· ·Ó¿ÎÏËÛ˘ ·fi fiÙÈ ÌÈ· ÔÛÔÙÈÎÔÔÈË̤ÓË ÚÔÛ¤ÁÁÈÛË Î·È Ì·˜ ¤‰ˆÛ ÛËÌ·ÓÙÈΤ˜ ÏËÚÔÊÔڛ˜ Ô˘ ÂÈÙÚ¤Ô˘Ó ÙËÓ ÂÍ·ÁˆÁ‹ ÌËÓ˘Ì¿ÙˆÓ ÁÈ· ÙË ‰ËÌfiÛÈ· ˘Á›·. ∏ Â›‰Ú·ÛË ÙÔ˘ ÂÏ·ÈÔÏ¿‰Ô˘ ÛÙÔÓ Î›Ó‰˘ÓÔ ÁÈ· ηډȷο ÓÔÛ‹Ì·Ù· ÌÔÚ› Ó· ·Ô‰Ôı› ÛÙȘ ‰È¿ÊÔÚ˜ ÂȉڿÛÂȘ ÙÔ˘ ÂÏ·ÈfiÏ·‰Ô˘ Û ·Ú¿ÁÔÓÙ˜ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘, .¯. ÛÙË Ì›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ÔÏÈ΋˜ Î·È LDL ¯ÔÏËÛÙÂÚfiÏ˘ ηıÒ˜ Î·È ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ[16-18]. ∂ÈÚÔÛı¤Ùˆ˜ ÌÈ· ‰›·ÈÙ· ÏÔ‡ÛÈ· Û ÂÏ·ÈfiÏ·‰Ô ÌÂÈÒÓÂÈ ÙËÓ Ù¿ÛË ÁÈ· ıÚÔÌ‚ˆÙÈο ÂÂÈÛfi‰È·[19] Î·È ›Ûˆ˜ ÂÈ‚Ú·‰‡ÓÂÈ ÙËÓ ÂÌÊ¿ÓÈÛË ·ıËÚÔÛÎÏ‹ÚˆÛ˘[20]. Δ· ÌÔÓÔ·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ· Â›Û˘ ·ÛÎÔ‡Ó ÚÔÛٷ٢ÙÈ΋ ‰Ú¿ÛË ÂÓ¿ÓÙÈ· ÛÙË ÔÍ›‰ˆÛË Ù˘ LDL[20], ÂÓÒ ÙÔ ÂÏ·˚Îfi Ô͇ ÂÌÊ·Ó›˙ÂÙ·È Ó· ·ÏÏËÏÂȉڿ ηÙ¢ı›·Ó ÛÙËÓ ÊÏÂÁÌÔÓÒ‰Ë ·ÓÙ›‰Ú·ÛË Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÈ ÙË ·ıËÚÔÁ¤ÓÂÛË [21]. ÷ڷÎÙËÚÈÛÙÈο, ÛÙÔ˘˜ ·ÛıÂÓ›˜ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ Ì·˜ Ì ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·, Ë ·ÔÎÏÂÈÛÙÈ΋ ηٷӿψÛË ÂÏ·ÈÔÏ¿‰Ô˘ Û¯ÂÙ›ÛÙËΠ̠0.55 ÊÔÚ¤˜ Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ÔͤԘ ÛÙÂÊ·ÓÈ·›Ô˘ Û˘Ó‰ÚfiÌÔ˘ Î·È ·˘Ùfi ÙÔ ·ÔÙ¤ÏÂÛÌ· Â›Ó·È Û‡ÌʈÓÔ Î·È Ì ÔÏϤ˜ ÌÂÙ·‚ÔÏÈΤ˜ ¤Ú¢Ó˜[16,17]. ∂ÈÚfiÛıÂÙ· ÔÈ Ô‰ËÁ›Â˜ Ù˘ EıÓÈ΋˜ ∂ÈÙÚÔ‹˜ ÁÈ· ÙË ¯ÔÏËÛÙÂÚfiÏË ÙˆÓ ∏.¶.∞. (Third Report of the NCEP Adult Treatment Panel)

95% ‰È¿ÛÙËÌ· ÂÌÈÛÙÔÛ‡Ó˘ 0.34 0.54 1.01 2.10 3.20 1.41 1.54 3.01 1.76 0.94 0.65 0.70 1.40 0.57 0.98 0.97

0.71 1. 09 1.04 3.63 5.19 2.27 2.45 4.69 3.25 1.00 1.00 1.20 2.03 0.76 1.33 1.22

P

<0.001 0.14 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 0.07 0.05 0.68 <0.001 0.001 0.06 0.14

Û˘ÛÙ‹ÓÔ˘Ó ¤Ó· ÚfiÁÚ·ÌÌ· ·fi ·ÏÏ·Á¤˜ ÛÙÔ ÙÚfiÔ ˙ˆ‹˜, Ô ÔÔ›Ô˜ ‰›ÓÂÈ ÂÚÈÛÛfiÙÂÚÔ ¤ÌÊ·ÛË ÛÙËÓ ÔÈfiÙËÙ· ÙÔ˘ Ï›Ô˘˜, ÚÔˆıÒÓÙ·˜ ÙËÓ Î·Ù·Ó¿ÏˆÛË ÌÔÓÔ·ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ, ·Ú¿ ÛÙËÓ ÔÛfiÙËÙ¿ ÙÔ˘[22]. ∞Ó Î·È ÌÂÙ·‚ÔÏÈΤ˜ ¤Ú¢Ó˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ÙÔ ÂÏ·ÈfiÏ·‰Ô ‚ÂÏÙÈÒÓÂÈ ÙÔ ÏÈȉ·ÈÌÈÎfi ÚÔÊ›Ï Î·È ÙÔ ÁÏ˘Î·ÈÌÈÎfi ¤ÏÂÁ¯Ô Û ‰È·‚ËÙÈÎÔ‡˜ ·ÛıÂÓ›˜[23] ÛÙËÓ ‰È΋ Ì·˜ ¤Ú¢ӷ ‰ÂÓ ‚Ú¤ıËΠοÔÈ· ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË Û ·˘Ù‹ ÙËÓ ÔÌ¿‰· ·ÛıÂÓÒÓ, Èı·ÓÒ˜ ÏfiÁˆ ÙÔ˘ ÌÈÎÚÔ‡ ·ÚÈıÌÔ‡ ‰È·‚ËÙÈÎÒÓ ·ÛıÂÓÒÓ Ô˘ Û˘ÌÂÚÈÏ‹ÊıËÎ·Ó ÛÙÔ ‰Â›ÁÌ· Ì·˜. ∞ÓÙ›ıÂÙ· ·Ú·ÙËÚ‹Û·Ì fiÙÈ Ë ·ÔÎÏÂÈÛÙÈ΋ ¯Ú‹ÛË ÂÏ·ÈÔÏ¿‰Ô˘ Û˘Û¯ÂÙ›ÛıËΠ̠48% ¯·ÌËÏfiÙÂÚË Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ÔͤԘ ÛÙÂÊ·ÓÈ·›Ô˘ Û˘Ó‰ÚfiÌÔ˘ ÌÂٷ͇ ÙˆÓ ˘ÂÚÙ·ÛÈÎÒÓ ·ÛıÂÓÒÓ. ∂ÈÚfiÛıÂÙ·, Û ¿ÏϘ ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜, ÙÔ ÂÏ·ÈfiÏ·‰Ô ¤¯ÂÈ ·ÓÙ›ÛÙÚÔÊ· Û˘Û¯ÂÙÈÛı› Ì ÙËÓ ›ÂÛË ÙÔ˘ ·›Ì·ÙÔ˜[10] Î·È ÂÌÊ·Ó›˙ÂÙ·È Ó· ÌÂÈÒÓÂÈ ÙËÓ Î·ıËÌÂÚÈÓ‹ ‰fiÛË ÙˆÓ ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ Ê·ÚÌ¿ÎˆÓ [24].

¶∂ƒπ√ƒπ™ª√π ™ÙȘ ¤Ú¢Ó˜ ·ÛıÂÓÒÓ-Ì·ÚÙ‡ÚˆÓ ‰‡Ô ‚·ÛÈΤ˜ ËÁ¤˜ Û˘ÛÙËÌ·ÙÈÎÒÓ ÛÊ·ÏÌ¿ÙˆÓ ÌÔÚÔ‡Ó Ó· ˘¿ÚÍÔ˘Ó: Ù· ÛÊ¿ÏÌ·Ù· ÂÈÏÔÁ‹˜ Î·È Ù· ÛÊ¿ÏÌ·Ù· ·Ó¿ÎÏËÛ˘. ¶ÚÔÎÂÈ̤ÓÔ˘ Ó· ÌÂȈıÔ‡Ó Ù· ÛÊ¿ÏÌ·Ù· ÂÈÏÔÁ‹˜ ÚÔÛ·ı‹Û·Ì ӷ ı¤ÛÔ˘Ì ·ÓÙÈÎÂÈÌÂÓÈο ÎÚÈÙ‹ÚÈ· ÙfiÛÔ ÁÈ· ÙÔ˘˜ ·ÛıÂÓ›˜ fiÛÔ Î·È ÁÈ· ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘. ŒÓ·˜ ·ÎfiÌ· ÂÚÈÔÚÈÛÌfi˜

¢IATPOºH Â›Ó·È fiÙÈ Ù· ÛÙÔȯ›·, ‰ÂÓ Ì·˜ ÂÈÙÚ¤Ô˘Ó Ó· ÔÛÔÙÈÎÔÔÈ‹ÛÔ˘Ì ٷ Ï›Ë Î·È Ù· ¤Ï·È· Î·È Ô‡Ù ӷ ˘ÔÏÔÁ›ÛÔ˘Ì ÙÔ ÔÛfi ÙˆÓ ÌÔÓÔ·ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ Ô˘ ηٷӷÏÒÓÔÓÙ·Ó, ˆÛÙfiÛÔ Ë Î·Ù·ÁÚ·Ê‹ ÙÔ˘ Ù‡Ô˘ ÙÔ˘ ÚÔÛÙÈı¤ÌÂÓÔ˘ ÂÏ·›Ô˘ Î·È Ï›Ô˘˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÚÔÂÙÔÈÌ·Û›·˜ ÙÔ˘ Ê·ÁËÙÔ‡ (¯ Ì·Á›ÚÂÌ·, ÙËÁ¿ÓÈÛÌ·, ÚÔÛı‹ÎË ÛÙȘ Û·Ï¿Ù˜) ı· ÌÔÚÔ‡Û ӷ ÂÚÈÏ·Ì‚¿ÓÂÈ ÏÈÁfiÙÂÚ¿ ÛÊ¿ÏÌ·Ù· ·Ó¿ÎÏËÛ˘ ·fi fiÙÈ ÌÈ· ÔÛÔÙÈÎÔÔÈË̤ÓË ÚÔÛ¤ÁÁÈÛË Î·È Ì·˜ ¤‰ˆÛ ÛËÌ·ÓÙÈΤ˜ ÏËÚÔÊÔڛ˜ Ô˘ ÂÈÙÚ¤Ô˘Ó ÙËÓ ÂÍ·ÁˆÁ‹ ÌËÓ˘Ì¿ÙˆÓ ÁÈ· ÙË ‰ËÌfiÛÈ· ˘Á›·. ŸÛÔÓ ·ÊÔÚ¿ Ù· ÛÊ¿ÏÌ·Ù· ÛÙË Û˘ÏÏÔÁ‹ ÙˆÓ ÏËÚÔÊÔÚÈÒÓ, ÚÔÛ·ı‹Û·Ì ӷ Ù· ·ÔʇÁÔ˘ÌÂ

̤ۈ ÏÂÙÔÌÂÚÔ‡˜ ηٷÁÚ·Ê‹˜ ÙˆÓ ÛÙÔȯ›ˆÓ ·fi ÙÔ˘˜ È·ÙÚÈÎÔ‡˜ ʷΤÏÔ˘˜ ÙˆÓ ·ÛıÂÓÒÓ. Δ¤ÏÔ˜, ÔÈ ·ÛıÂÓ›˜ Ì ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ Ô˘ η٤ÏËÍ·Ó Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘˜ ‹ ÙËÓ ÂfiÌÂÓË Ì¤Ú· ‰ÂÓ Û˘ÌÂÚÈÏ‹ÊıËÎ·Ó ÛÙËÓ ¤Ú¢ӷ. ∞˘Ù¿ Ù· ÛÊ¿ÏÌ·Ù· ı· ÌÔÚÔ‡Û·Ó Ó· ÂËÚ¿ÛÔ˘Ó ÙËÓ ¤Ú¢ӷ Ì·˜.

™Àª¶∂ƒ∞™ª∞ ™‡Ìʈӷ Ì ٷ Â˘Ú‹Ì·Ù¿ Ì·˜, Ë ·ÔÎÏÂÈÛÙÈ΋ ¯Ú‹ÛË ÂÏ·ÈÔÏ¿‰Ô˘ ηٿ ÙÔ Ì·Á›ÚÂÌ· Î·È ÙËÓ ÚÔÂÙÔÈÌ·Û›· ÙÔ˘ Ê·ÁËÙÔ‡ Û¯ÂÙ›˙ÂÙ·È ÛËÌ·ÓÙÈο Ì ÌÈÎÚfiÙÂÚË Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ÔͤԘ ÛÙÂÊ·ÓÈ·›Ô˘ Û˘Ó‰ÚfiÌÔ˘ Î·È ı· Ú¤ÂÈ Ó· ÚÔˆıÂ›Ù·È Ì¤Ûˆ ÚÔÁÚ·ÌÌ¿ÙˆÓ ÚfiÏ˄˘ ηډȷÁÁÂÈ·ÎÒÓ ·ÛıÂÓÂÈÒÓ.

∂ÀÃ∞ƒπ™Δπ∂™ √È Û˘ÁÁÚ·Ê›˜ ı· ‹ıÂÏ·Ó Ó· ¢¯·ÚÈÛÙ‹ÛÔ˘Ó ÙÔ˘˜ È·ÙÚÔ‡˜ Ô˘ Û˘ÓÙfiÓÈÛ·Ó ÙË Û˘ÏÏÔÁ‹ ‰Â‰Ô̤ӈÓ: ∫. Δ˙ÈÔ‡Ì˘ (∞ı‹Ó·, ∫Ú‹ÙË, ¶ÂÏÔfiÓÓËÛÔ˜), π. ™Îԇ̷˜ (∞ı‹Ó·), ¡. ¶··Èˆ¿ÓÓÔ˘ (∞ı‹Ó·, £ÂÛÛ·Ï›·), ¶. ™ÙÚ·‚Ôfi‰Ë˜ (¡ËÛÈ¿ πÔÓ›Ô˘), §. ∫·ÚÚ¿ (¡ËÛÈ¿ ∞ÈÁ·›Ô˘), ¢. ∞ÓÙˆÓÈ¿‰Ë˜ (ª·Î‰ÔÓ›·), °. ƒ¤ÌÂÏÔ˜ (¡ËÛÈ¿ ∞ÈÁ·›Ô˘), ¢. ª¿ÚÎÔ˘ (∞ı‹Ó·), ∞. ªÔÚ·˝ÙË (∞ı‹Ó·), ¢. ∂˘·ÁÁ¤ÏÔ˘ (∫Ú‹ÙË), ™. μ¤ÏÏ·˜ (∞ÙÙÈ΋, ◊ÂÈÚÔ˜), °. ™ÎÔ˘ÌÔ˘Ú‰‹˜ (™ÙÂÚ·È¿ ∂ÏÏ¿‰·), μ. ªÂ˚‰¿Ó˘ (ª·Î‰ÔÓ›·, ™ÙÂÚ¿ ∂ÏÏ¿‰·, £ÂÛÛ·Ï›·), ™. §fiÁÁÔ˜ (∞ÙÙÈ΋), π. ∂Ï¢ÛÈÓÈÒÙ˘ (∞ı‹Ó·), ¡. ª·ÚÈÓ¿Î˘ (¡ËÛÈ¿ ∞ÈÁ·›Ô˘), °. ∫Ô˘ÙÛÈÌ¿Ó˘ (£Ú¿ÎË), ™. ∑fiÌÔÏÔ˜ (¶ÂÏÔfiÓÓËÛÔ˜).

μÈ‚ÏÈÔÁÚ·Ê›· 1. Wahrburg U. What are the health effects of fat? Eur J Nutr 2004;43 Suppl 1:I/6-11.

2. Owen RW, Mier W, Giacosa A, Hule WE, Spiegelhalder B, Bartsch H. Phenolic compounds and squalene in olive oils: the concentration and antioxidant potential of total phenols, simple phenols, secoroids, lignans and squalene. Food Chem Toxicol 2000; 38: 647-659.

3. Keys A, Menotti A, Karvonen MJ, et al.

The diet and 15-year death rate in the Seven Countries Study. Am J Epidemiol 1986;124:903-915.

4. Hu FB, Stampfer MJ, Manson JE, Rimm E, Colditz GA, Rosner BA, Hennekens CH, Willett WC. Dietary fat intake and the risk of coronary heart disease in women.

New Engl J Med 1997;337:1491-1499.

5. Barzi F, Woodward M, Marsi RM, Tavazzi L, Valagussa F, Marchioli R, GISSI-Prevenzione Investigators. Mediterranean diet and all-causes mortality after myocardial infarction: Results from the GISSIPrevenzione trial. Eur J Clin Nutr 2003;57:604-611.

6. Gramenzi A, Gentile A, Fasoli M, Negri E, Parazzini F, La Vecchia C. Association between certain foods and risk of acute myocardial infarction in women. BMJ 1990;300:771-773.

7. Bertuzzi M, Tavani A, Negri E, La Vecchia C. Olive oil consumption and risk of nonfatal myocardial infarction in Italy. Int J Epidemiol 2002;31:1274-1275.

8. Fernandez-Jarne E, Martinez-Losa E, Prado-Santamaria M, Brugarolas-Brufau C, Serrano-Martinez M, MartinezGonzalez MA. Risk of first non-fatal myocardial infarction negatively associated with olive oil consumption: A case-control study in Spain. Int J Epidemiol 2002;31:474-480.

9. Tzonou A, Kalandidi A, Trichopoulou A Hsieh CC, Toupadaki N, Willett W, Trichopoulos D. Diet and coronary heart disease: a case-control study in Athens, Greece. Epidemiology 1993; 4:511-516.

10. Psaltopoulou T, Naska A, Orfanos P, Trichopoulos D, Mountokalakis T, Trichopoulou A. Olive oil, the Mediterranean diet, and arterial blood pressure: the Greek European Prospective Investigation into Cancer and Nutrition (EPIC) study. Am J Clin Nutr 2004;80:1012-1018.

11. Myocardial infarction redefined-a consensus document of The Joint European Society of Cardiology/ American College of Cardiology Committee for the redefinition of myocardial infarction.

Eur Heart J 2000;21:1502-1513.

12. Trichopoulou A, Kouris-Blazos A, Wahlqvist M, Gnardellis C, Lagiou P, Polychronopoulos E, Vassilakou T, Lipworth L, Trichopoulos D. Diet and overall survival in elderly people. Br Med J 1995;311:1457- 1460.

13. Panagiotakos DB, Pitsavos C, Chrysohoou C, Stefanadis C, Toutouzas PK. Risk stratification of coronary heart disease, in Greece: Final results from CARDIO2000 epidemiological study.

Prev Med 2002;35:548-556.

14. Linseisen J, Bergstrom E, Gafa L, et al.

Consumption of added fats and oils in the European Prospective Investigation into Cancer and Nutrition (EPIC) centres across 10 European countries as assessed by 24-hour dietary recalls.

Public Health Nutr 2002;5(6B) :1227-1242.

15. Byrd-Bredbenner C, Lagiou P, Trichopoulou A. A comparison of household food availability in 11 countries. J Hum Nutr Diet 2000;13:197-204.

16. Gardner CD, Kraemer HC. Monounsaturated versus polyunsaturated dietary fat and serum lipids: a metaanalysis.

Arterioscler Throm Vasc Biol 1995;15: 1918-1927.

17. Mata P, Alvarezsala LA, Ubio MJ, Nuno J, Oya M de. Effects of long-term monounsaturated-enriched vs polyunsaturated- enriched diets on lipoproteins in healthy men and women. Am J Clin Nutr 1992; 55:846-850.

18. Pieke B, Eckardstein A von, Gulbahce E, Chirazi A, Schulte H, Assmann G, Wahrburg U. Treatment of hypertriglyceridemia by two diets rich either in unsaturated fatty acids or in carbohydrates: effects on lipoprotein subclasses, lipolytic enzymes, lipid transfer proteins, insulin and leptin. Int J Obes Rel Metab Dis 2000;24:1286-1296.

19. Frost Larsen L, Jespersen J, Marckmann P. Are olive oil diets antithrombotic? Diets enriched with olive, rapeseed, or sunflower oil affect postprandial factor VII differently1-3.

Am J Clin Nutr 1999;70:976-982.

20. Mata P, Varela O, Alonso R, Lahoz C, de Oya M, Badimon L. Monounsaturated and polyunsaturated n-6 fatty acid-enriched diets modify LDL oxidation and decrease human coronary smooth muscle cell DNA synthesis.

Arterioscler Thromb Vasc Biol 1997;17:2088-2095.

21. Massaro M, Carluccio MA, De Caterina R. Direct vascular antiatherogenic effects of oleic acid: a clue to the cardioprotective effects of the Mediterranean diet. Cardiologia 1999; 44:507-513.

22. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA 2001;285:2486-2497.

23. Garg A. High-monounsaturatedfat diets for patients with diabetes mellitus: a meta-analysis. Am J Clin Nutr 1998;67(Suppl 3):577S-582S. 24. Ferrara LA, Raimondi AS, d'Episcopo L, Guida L, Dello Russo A, Marotta T. Olive oil and reduced need for antihypertensive medications. Arch Intern Med 2000;160:837-842.

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π√À¡π√™ 2008

∫·Ù¢ı˘ÓÙ‹ÚȘ √‰ËÁ›Â˜ ÁÈ· ÙËÓ ∞ÛÙ·ı‹ ™ÙËı¿Á¯Ë Î·È ÙÔ ∂ÌÊÚ·ÁÌ· ª˘Ôηډ›Ô˘ Èڛ˜ ∞Ó¿Û·ÛË ÙÔ˘ ¢È·ÛÙ‹Ì·ÙÔ˜ ST ¶·ÓÙÂÏ‹˜ °Ô˘ÓfiÔ˘ÏÔ˜, ∫·Ú‰ÈÔÏfiÁÔ˜ °È¿ÓÓ˘ °Ô˘‰¤‚ÂÓÔ˜, ∫·ıËÁËÙ‹˜ ∫·Ú‰ÈÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ πˆ·ÓÓ›ÓˆÓ ∫·Ú‰ÈÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ π·ÙÚÈ΋ ™¯ÔÏ‹ πˆ·ÓÓ›ÓˆÓ ª¤Û· ÛÙÔ Î·ÏÔη›ÚÈ ÙÔ˘ 2007 ‰ËÌÔÛȇÙËÎ·Ó ·Ó·Óˆ̤Ó˜ ÔÈ Î·Ù¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ Ù˘ ∂˘Úˆ·È΋˜ ∫·Ú‰ÈÔÏÔÁÈ΋˜ ∂Ù·ÈÚ›·˜(1) ηıÒ˜ Î·È ÔÈ ÎÔÈÓ¤˜ Ô‰ËÁ›Â˜ Ù˘ ∞ÌÂÚÈηÓÈ΋˜ ∫·Ú‰ÈÔÏÔÁÈ΋˜ ∂Ù·ÈÚ›·˜ Î·È ÙÔ˘ ∞ÌÂÚÈηÓÈÎÔ‡ ∫ÔÏÂÁ›Ô˘ ∫·Ú‰ÈÔÏÔÁ›·˜ ÁÈ· ÙËÓ ∞ÛÙ·ı‹ ™ÙËı¿Á¯Ë Î·È ÙÔ ŒÌÊÚ·ÁÌ· ÙÔ˘ ª˘Ôηډ›Ô˘ ¯ˆÚ›˜ ·Ó¿Û·ÛË ÙÔ˘ ST (NSTEMI)(2). √È Ô‰ËÁ›Â˜ Û˘ÌʈÓÔ‡Ó ÛÙÔ ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÚÔ˜ ÙÔ˘˜, ·Ó·ÓÂÒÓÔ˘Ó ÙȘ ÚÔÁÂÓ¤ÛÙÂÚ˜ Î·È ÂÓۈ̷ÙÒÓÔ˘Ó Ù· Â˘Ú‹Ì·Ù· ÙˆÓ ÓÂˆÙ¤ÚˆÓ ÌÂÏÂÙÒÓ. Δ· ÛËÌ·ÓÙÈÎfiÙÂÚ· ÛËÌ›· ÙˆÓ ÓÂÒÙÂÚˆÓ Ô‰ËÁÈÒÓ Û˘ÓÔ„›˙ÔÓÙ·È ·Ú·Î¿Ùˆ: ∞Ú¯È΋ ∂ÎÙ›ÌËÛË 1. ™ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÛÙËı¿Á¯Ë Ô˘ ‰ÂÓ ÂÌÊ·Ó›˙ÂÈ ‡ÊÂÛË ÙÔ˘ fiÓÔ˘ ÌÂÙ¿ 5 ÏÂÙ¿ ·fi ÙË Ï‹„Ë ÓÈÙÚˆ‰ÒÓ Û˘ÓÈÛÙ¿Ù·È ÎÏ‹ÛË ÕÌÂÛ˘ μÔ‹ıÂÈ·˜ ÚÈÓ ÙË Ï‹„Ë ÂÈϤÔÓ ÓÈÙÚˆ‰ÒÓ. √È ·ÛıÂÓ›˜ Ì ¯ÚfiÓÈ· ÛÙ·ıÂÚ‹ ÛÙËı¿Á¯Ë ÌÔÚÔ‡Ó Ó· Ï¿‚Ô˘Ó ¤ˆ˜ 3 ‰fiÛÂȘ ÓÈÙÚˆ‰ÒÓ, Ì ‰È¿ÛÙËÌ· 5 ÏÂÙÒÓ ÌÂٷ͇ ÙÔ˘˜ ÂÊfiÛÔÓ Ù· Û˘ÌÙÒÌ·Ù· ÂÌÊ·Ó›˙Ô˘Ó ÚÔԉ¢ÙÈ΋ ‡ÊÂÛË. ™Â ·ÓÙ›ıÂÙË ÂÚ›ÙˆÛË Û˘ÓÈÛÙ¿Ù·È ÎÏ‹ÛË ‚Ô‹ıÂÈ·˜.

2. ™Â οı ·ÛıÂÓ‹ Ì ÛÙËı¿Á¯Ë ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ∏∫° ̤۷ Û 10 ÏÂÙ¿ ·fi ÙËÓ ¿ÊÈÍË ÛÙÔ ÙÌ‹Ì· ÂÂÈÁfiÓÙˆÓ. √È ·ÛıÂÓ›˜ Ì ÛÙËı¿Á¯Ë Ú¤ÂÈ Ó· ηٷӤÌÔÓÙ·È Û 4 ηÙËÁÔڛ˜: Â͈ηډȷο ·›ÙÈ·, ‚¤‚·ÈÔ Ô͇ ÛÙÂÊ·ÓÈ·›Ô Û‡Ó‰ÚÔÌÔ (√™™), Èı·Ófi √™™ Î·È ¯ÚfiÓÈ· ÛÙ·ıÂÚ‹ ÛÙËı¿Á¯Ë.

3. ∏ ÙÚÔÔÓ›ÓË Â›Ó·È Ô ‚ÈÔ¯ËÌÈÎfi˜ ‰Â›ÎÙ˘ Ô˘ ÚÔÙÈÌ¿Ù·È Û ·ÛıÂÓ›˜ Ô˘ ÚÔÛ¤Ú¯ÔÓÙ·È ÌÂ Û˘ÌˆÌ·ÙÔÏÔÁ›· Û˘Ì‚·Ù‹ Ì √™™.

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4. √È ·ÛıÂÓ›˜ Ì Èı·Ófi √™™, ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ∏∫° Î·È ·ÚÓËÙÈ΋ ÙÚÔÔÓ›ÓË ÁÈ· ÂÚÈÛÛfiÙÂÚÔ ·fi 12 ¤ˆ˜ 16 ÒÚ˜ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÏÔÓÙ·È Û ‰ÔÎÈÌ·Û›· ÎfiˆÛ˘ ÚÈÓ ÙËÓ ¤ÍÔ‰fi ÙÔ˘˜ ·fi ÙÔ ÙÌ‹Ì·, ›Ù ̤۷ Û 72 ÒÚ˜ ·fi ÙÔ ÂÍÈÙ‹ÚÈfi ÙÔ˘˜. √È ·ÛıÂÓ›˜ ·˘ÙÔ› ı· Ú¤ÂÈ Ó· ηχÙÔÓÙ·È ·fi Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ ̤¯ÚÈ ÙË ‰ÔÎÈÌ·Û›· ÎfiˆÛ˘.

5. √È ·ÛıÂÓ›˜ Ì ¯·ÌËÏ‹ Èı·ÓfiÙËÙ· ÁÈ· ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ Î·È Èı·Ófi √™™ ÌÔÚÔ‡Ó Ó· ÂÎÙÈÌËıÔ‡Ó Ì ÔÏ˘ÙÔÌÈ΋ ˘ÔÏÔÁÈÛÙÈ΋ ÙÔÌÔÁÚ·Ê›· (MSCT) ·ÓÙ› Ù˘ ‰ÔÎÈÌ·Û›·˜ ÎÔÒÛˆ˜.

6. ¶ÚÔÛÔ¯‹ ÛÙȘ ˘ÔÔÌ¿‰Â˜ ÏËı˘ÛÌÔ‡: ∏ÏÈÎȈ̤ÓÔ˘˜, °˘Ó·›Î˜, ¢È·‚ËÙÈÎÔ‡˜, ·ÛıÂÓ›˜ Ì ÓÂÊÚÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ¶ÚÒÈÌË ∞ÓÙÈÌÂÙÒÈÛË 1. √È ·ÛıÂÓ›˜ Ì ·ÈÌÔ‰˘Ó·ÌÈ΋ ·ÛÙ¿ıÂÈ· ‹ ÌÂ Û˘ÌÙÒÌ·Ù· Ô˘ ÂÈ̤ÓÔ˘Ó ı· Ú¤ÂÈ Ó· ÓÔÛËχÔÓÙ·È Û ηډÈÔÏÔÁÈ΋ ÌÔÓ¿‰·, ÂÓÒ ÔÈ ˘fiÏÔÈÔÈ Ú¤ÂÈ Ó· ÂÈÛ¿ÁÔÓÙ·È Û ÌÔÓ¿‰Â˜ ·˘ÍË̤Ó˘ ÊÚÔÓÙ›‰·˜.

2. √È ‚-·ÔÎÏÂÈÛÙ¤˜ Ú¤ÂÈ Ó· ¯ÔÚËÁÔ‡ÓÙ·È ·fi ÙÔ ÛÙfiÌ· ̤۷ ÛÙȘ ÚÒÙ˜ 24 ÒÚ˜ Û ·Ô˘Û›· ·ÓÙÂӉ›ÍˆÓ. ∂Ó‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË Û˘ÓÈÛÙ¿Ù·È ÌfiÓÔ Â› Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÂӉ›ÍÂˆÓ Î·È fi¯È Û·Ó ıÂÚ·›· ÚÔ˘Ù›Ó·˜.

3. Δ· ÌË ÛÙÂÚÔÂȉ‹ ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë Ê¿Ú̷η (·Ó·ÛÙÔÏ›˜ COX-1 Î·È COX-2) ÂÎÙfi˜ ·fi ÙËÓ ·ÛÈÚ›ÓË ı· Ú¤ÂÈ Ó· ‰È·ÎfiÙÔÓÙ·È Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙˆÓ ·ÛıÂÓÒÓ Ì √™™.

4. ∏ ¯Ú‹ÛË ÌÔÚÊ›Ó˘ Û·Ó ·Ó·ÏÁËÙÈÎfi ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› Ì ¯ÂÈÚfiÙÂÚ· ·ÔÙÂϤÛÌ·Ù· Û ÌÂϤÙ˜ ·Ú·Ù‹ÚËÛ˘. ™ÙȘ Ô‰ËÁ›Â˜ Ë ¯ÚËÛÈÌÔÔ›ËÛ‹ Ù˘ ˘Ô‚È‚¿ÛÙËΠ·fi Class I Û Class IIa Û‡ÛÙ·ÛË.

5. ∞ÓÙÈ·ÈÌÔÂÙ·Ïȷ΋ ıÂÚ·›· ·) ∏ ·ÛÈÚ›ÓË ı· Ú¤ÂÈ Ó· ¯ÔÚËÁÂ›Ù·È ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì √™™ ÙÔ Û˘ÓÙÔÌfiÙÂÚÔ ‰˘Ó·Ùfi Î·È ı· Ú¤ÂÈ Ó· ‰È·ÙËÚÂ›Ù·È ‰È¿ ‚›Ô˘. √È ·ÛıÂÓ›˜ Ì ·ÏÏÂÚÁ›· ‹ ‰˘Û·ÓÂÍ›· ÛÙËÓ ·ÛÈÚ›ÓË ı· Ú¤ÂÈ Ó· ıÂÚ·‡ÔÓÙ·È Ì ÎÏÔȉÔÁÚ¤ÏË. ‚) ∏ ÎÏÔȉÔÁÚ¤ÏË ı· Ú¤ÂÈ Ó· ÚÔÛÙ›ıÂÙ·È ÛÙËÓ ·ÛÈÚ›ÓË, ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ÂÓ‰‡ÎÓ˘Ù·È Â›ÙÂ Û˘ÓÙËÚËÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Â›Ù ÎÚ›ÓÔÓÙ·È ˘Ô„‹ÊÈÔÈ ÁÈ· ÚÒÈÌË ÂÂÌ‚·ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË, ·ÏÏ¿ ÂÊfiÛÔÓ Ë Èı·ÓfiÙËÙ· ÁÈ· ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ì ·ÔÚÙÔÛÙÂÊ·ÓÈ·›· ·Ú¿Î·Ì„Ë Â›Ó·È ¯·ÌËÏ‹. Á) ∏ ¯ÔÚ‹ÁËÛË ·Ó·ÛÙÔϤˆÓ GP IIb/IIIa (ÂÙ·ÊÈÌ·Ù›‰Ë˜ ‹ ÙÈÚÔÊÈÌ¿Ó˘) ı· Ú¤ÂÈ Ó· ÂÍÂÙ¿˙ÂÙ·È ÛÙÔ˘˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ·ÛıÂÓ›˜ Î·È Û ÂΛÓÔ˘˜ Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ¿ÓÔ‰Ô ÙÚÔÔÓ›Ó˘, ȉȷ›ÙÂÚ· ÛÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ۯ‰ȿ˙ÂÙ·È ·ÁÁÂÈÔÏ·ÛÙÈ΋. ∞ÌÛÈÍÈÌ¿ÌË ‰ÂÓ ı· Ú¤ÂÈ Ó· ¯ÔÚËÁ›ٷÈ, ·Ú¿ ÌfiÓÔÓ Â¿Ó ‰ÂÓ ˘¿Ú¯ÂÈ ·Ó·ÌÂÓfiÌÂÓË Î·ı˘ÛÙ¤ÚËÛË ÁÈ· ·ÁÁÂÈÔÏ·ÛÙÈ΋. ∏ ·ÌÛÈÍÈÌ¿ÌË ÌÔÚ› Ó· ¯ÔÚËÁËı› Ì ·ÛÊ¿ÏÂÈ· Û ·ÁÁÂÈÔÏ·ÛÙÈ΋ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ‰ÂÓ ¤¯Ô˘Ó Ï¿‚ÂÈ ÂÓ‰ÔÊϤ‚È· ·Ó·ÛÙÔÏ›˜ GP IIb/IIIa Î·È ÌÔÚ› Ó· Â›Ó·È Î·Ï‡ÙÂÚË Ù˘ ÙÈÚÔÊÈÌ¿Ó˘. √È ·Ó·ÛÙÔÏ›˜ GP IIb/IIIa ·Ú¤¯Ô˘Ó ÂÈϤÔÓ fiÊÂÏÔ˜ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ·˘ÍË̤ÓË ÙÚÔÔÓ›ÓË Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È Û ·ÁÁÂÈÔÏ·ÛÙÈ΋, ·ÎfiÌ· Î·È ·Ó¿ÌÂÛ· Û ÂΛÓÔ˘˜ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ÎÏÔȉÔÁÚ¤ÏË.

6. ∞ÓÙÈËÎÙÈ΋ £ÂÚ·›· ·) ™ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È Û˘ÓÙËÚËÙÈο, Ë ·ÓÙÈËÎÙÈ΋ ·ÁˆÁ‹ Ô˘ ÚÔÙÈÌ¿Ù·È Â›Ó·È Ì ÛÂÈÚ¿ ÚÔÙÂÚ·ÈfiÙËÙ·˜: fondaparinux, ÂÓÔÍ·-

∫∞Δ∂À£À¡Δ∏ƒπ∂™ √¢∏°π∂™ ·Ú›ÓË (ÁÈ· 5 Ë̤Ú˜ ‹ ÁÈ· ÙË ‰È¿ÚÎÂÈ· Ù˘ ÓÔÛËÏ›·˜) ‹ ÎÏ·ÛÛÈ΋ Ë·Ú›ÓË (ÁÈ· 48 ÒÚ˜).

ÓÙ·È Û ÌË ÂÂÌ‚·ÙÈ΋ ‰ÔÎÈÌ·Û›· ÎÔÒÛˆ˜ ÚÈÓ ÙËÓ ¤ÍÔ‰fi ÙÔ˘˜ ·fi ÙÔ ÓÔÛÔÎÔÌ›Ô.

‚) ™ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ı· ˘Ô‚ÏËıÔ‡Ó Û ·ÁÁÂÈÔÏ·ÛÙÈ΋ Û˘ÓÈÛÙÒÓÙ·È ÂÓÔÍ··Ú›ÓË ‹ ÎÏ·ÛÛÈ΋ Ë·Ú›ÓË Ô˘ ¤¯Ô˘Ó ÙȘ ÈÔ ÙÂÎÌËÚȈ̤Ó˜ ÂӉ›ÍÂȘ.

9. ∏ ÂÈÏÔÁ‹ Ù˘ ¯ÂÈÚÔ˘ÚÁÈ΋˜ Â·Ó·ÁÁ›ˆÛ˘ ¤Ó·ÓÙÈ Ù˘ ‰È·‰ÂÚÌÈ΋˜ Â·Ó·ÁÁ›ˆÛ˘ (fiˆ˜ Î·È ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÛÙ·ıÂÚ‹ ÛÙËı¿Á¯Ë), ı· ·ÔÊ·Û›˙ÂÙ·È Ì ÎÚÈÙ‹ÚÈ· ÙËÓ ·Ó·ÙÔÌ›· ÙÔ˘ ·ÛıÂÓ‹, ÙË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ Î·È ÙËÓ ·ÚÔ˘Û›· ‹ ·Ô˘Û›· ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Î·È ¿ÏÏˆÓ ÓÔÛËÌ¿ÙˆÓ.

Á) ™ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ı· ˘Ô‚ÏËıÔ‡Ó Û ·ÔÚÙÔÛÙÂÊ·ÓÈ·›· ·Ú¿Î·Ì„Ë Ë ·ÛÈÚ›ÓË ı· Ú¤ÂÈ Ó· ÂÍ·ÎÔÏÔ˘ı› Ó· ¯ÔÚËÁ›ٷÈ, Ë ÎÏÔȉÔÁÚ¤ÏË ·ÓÙ›ıÂÙ· ı· Ú¤ÂÈ Ó· ‰È·ÎfiÙÂÙ·È 5-7 Ë̤Ú˜ ÚÈÓ, ÂÓÒ ÔÈ ·Ó·ÛÙÔÏ›˜ GP IIb/IIIa 4 ÒÚ˜ ÚÈÓ ÙÔ ¯ÂÈÚÔ˘ÚÁ›Ô. ∏ ÂÓÔÍ··Ú›ÓË ‰È·ÎfiÙÂÙ·È 12-24 ÒÚ˜ ÚÈÓ, Î·È ÙÔ fondaparinux 24 ÒÚ˜ ÚÈÓ ÙÔ ¯ÂÈÚÔ˘ÚÁÂ›Ô Î·È ·Ú¿ÏÏËÏ· ÍÂÎÈÓ¿ Ë ¯ÔÚ‹ÁËÛË ÎÏ·ÛÛÈ΋˜ Ë·Ú›Ó˘. ‰) ™Â fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ¯ÔÚËÁÔ‡ÓÙ·È ·Ó·ÛÙÔÏ›˜ GP IIb/IIIa Ú¤ÂÈ Ó· Û˘Á¯ÔÚËÁÂ›Ù·È ÎÏ·ÛÛÈ΋ Ë·Ú›ÓË ‹ ¿ÏÏ· ·ÓÙÈËÎÙÈο.

7. √È ·ÛıÂÓ›˜ Ì NSTEMI, Ô˘ ÛÙË ÛÙÂÊ·ÓÈÔÁÚ·Ê›· ‚Ú¤ıËΠӷ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÔÏÈο ·fiÊÚ·Á̤ӷ ·ÁÁ›·, ‰ÂÓ ˆÊÂÏ‹ıËÎ·Ó ·fi ·ÁÁÂÈÔÏ·ÛÙÈ΋ ÛÙË ÌÂϤÙË OAT (fiˆ˜ Î·È ÂΛÓÔÈ Ì STEMI) Î·È ‰ÂÓ ı· Ú¤ÂÈ Ó· ˘Ô‚¿ÏÏÔÓÙ·È Û ÂÚ·ÈÙ¤Úˆ ·Ú¤Ì‚·ÛË.

8. ∏ ÚÒÈÌË ÂÂÌ‚·ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÚÔÙÈÌ¿Ù·È ÛÙÔ˘˜ ˘„ËÏÔ‡ ÎÓ‰‡ÓÔ˘ ·ÛıÂÓ›˜ Ì ÂÌ̤ÓÔÓÙ· Û˘ÌÙÒÌ·Ù· ‹ Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ·ÈÌÔ‰˘Ó·ÌÈ΋ ·ÛÙ¿ıÂÈ·, ÂÓÒ ÁÈ· ÙÔ˘˜ ˘fiÏÔÈÔ˘˜ ·ÛıÂÓ›˜ ÂÈϤÁÂÙ·È Â›ÙÂ Ë Û˘ÓÙËÚËÙÈ΋ ›ÙÂ Ë ÚÒÈÌË ÂÂÌ‚·ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ·Ó¿ÏÔÁ· Ì ÙȘ ÚÔÙÈÌ‹ÛÂȘ ÙÔ˘ ÁÈ·ÙÚÔ‡ Î·È ÙÔ˘ ·ÛıÂÓ‹. √È ·ÛıÂÓ›˜ Ô˘ ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Û˘ÓÙËÚËÙÈο Î·È ·Ú¤ÌÂÈÓ·Ó ÛÙ·ıÂÚÔ› ÁÈ· 12-24 ÒÚ˜ ı· Ú¤ÂÈ Ó· ˘Ô‚¿ÏÏÔ-

10. √ ΛӉ˘ÓÔ˜ ÁÈ· ı¿Ó·ÙÔ ‹ ÁÈ· Ó¤Ô ¤ÌÊÚ·ÁÌ· Ì˘Ôηډ›Ô˘ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì NSTEMI Â›Ó·È ˘„ËÏfiÙÂÚÔ˜ ÙÔ˘˜ ÚÒÙÔ˘˜ 2 Ì‹Ó˜ Î·È Â·Ó¤Ú¯ÂÙ·È ÛÙÔ ‚·ÛÈÎfi ΛӉ˘ÓÔ ÙˆÓ ·ÛıÂÓÒÓ Ì ÛÙ·ıÂÚ‹ ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ Û 3 Ì‹Ó˜. √È ¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ·ÛıÂÓ›˜ (Î·È ÔÈ ·ÛıÂÓ›˜ Ô˘ Â·Ó·ÈÌ·ÙÒÓÔÓÙ·È Ï‹Úˆ˜) Ú¤ÂÈ Ó· ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È ÁÈ· ‰È¿ÛÙËÌ· 2-6 ‚‰ÔÌ¿‰ˆÓ, ÂÓÒ ÔÈ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ·ÛıÂÓ›˜ ı· Ú¤ÂÈ Ó· Â·ÓÂÎÙÈÌËıÔ‡Ó Ì¤Û· Û 2 ‚‰ÔÌ¿‰Â˜.

11. ŸÏÔÈ ÔÈ ·ÛıÂÓ›˜ Ì √™™ ı· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÔ˘Ó ·ÛÈÚ›ÓË, ÛÙ·Ù›Ó˜, ‚-·ÔÎÏÂÈÛÙ¤˜ Î·È ÎÏÔȉÔÁÚ¤ÏË. ∞Ó·ÛÙÔÏ›˜ ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ ‹ ·ÓÙ·ÁˆÓÈÛÙ¤˜ ÙˆÓ ˘Ô‰Ô¯¤ˆÓ ·ÁÁÂÈÔÙÂÓÛ›Ó˘ II ı· Ú¤ÂÈ Ó· ¯ÔÚËÁËıÔ‡Ó ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÂËÚ·Ṳ̂ÓÔ ÎÏ¿ÛÌ· ÂÍÒıËÛ˘ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜, ˘¤ÚÙ·ÛË, ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Î·È Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ·. ∏ Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ ı· Ú¤ÂÈ Ó· ÍÂÎÈÓ¿ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Î·ıÒ˜ Ë Èı·ÓfiÙËÙ· Ó· ‰È·ÙËÚËı› ‰È· ‚›Ô˘ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË. √ ÛÙfi¯Ô˜ Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ Â›Ó·È Ó· ‰È·ÙËÚÂ›Ù·È ¯·ÌËÏfiÙÂÚË ·fi 140/90 mmHg ÁÈ· fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Î·È ¯·ÌËÏfiÙÂÚË ·fi 130/80 mmHg ÁÈ· ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Î·È ¯ÚfiÓÈ· ÓÂÊÚÔ¿ıÂÈ·.

12. £ÂÚ·›· ÔÚÌÔÓÈ΋˜ ˘ÔηٿÛÙ·Û˘ ‰ÂÓ ı· Ú¤ÂÈ Ó· ÍÂÎÈÓ¿ Û ·ÛıÂÓ›˜ Ì √™™, ÂÓÒ ÔÈ ·ÛıÂÓ›˜ Ô˘ Â›Ó·È ‹‰Ë Û ıÂÚ·›· ˘ÔηٿÛÙ·Û˘ ı· Ú¤ÂÈ Ó· ÙËÓ ‰È·ÎfiÙÔ˘Ó.

13. √È ·ÛıÂÓ›˜ Ì ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË ı· Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È ÂÈıÂÙÈο ÁÈ· ÙË Ú‡ıÌÈÛË ÙÔ˘ ۷ί¿ÚÔ˘ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÓÔÛËÏ›·˜. √È ˘fiÏÔÈ˜ ‰È·ÁÓˆÛÙÈΤ˜ Î·È ıÂÚ·¢ÙÈΤ˜ ·ÚÂÌ‚¿ÛÂȘ Â›Ó·È ›‰È˜ Ì ÂΛӘ ÙˆÓ ÌË ‰È·‚ËÙÈÎÒÓ.

14. ∂ȉÈ΋ ÚÔÛÔ¯‹ ··ÈÙÂ›Ù·È ÛÙË ‰ÔÛÔÏÔÁ›· (ȉȷ›ÙÂÚ· Ù˘ ÂÓÔÍÔ·Ú›Ó˘) Î·È ÛÙËÓ ÙÚÔÔÔÈË̤ÓË Ê·ÚÌ·ÎÔ‰˘Ó·ÌÈ΋, ÛÙË ıÂÚ·›· ËÏÈÎÈˆÌ¤ÓˆÓ Î·È ·ÛıÂÓÒÓ Ì ÂËÚ·Ṳ̂ÓË ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· (GFR < 50 ml/min) ÁÈ· ÙÔÓ Î›Ó‰˘ÓÔ ·ÈÌÔÚÚ·ÁÈÒÓ. ∞fi ·ÈÌÔÚÚ·Á›· ÎÈÓ‰˘ÓÂ‡Ô˘Ó ÔÈ ËÏÈÎȈ̤ÓÔÈ Ì ÂËÚ·Ṳ̂ÓË ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· Î·È ·˘ÙÔ› Ô˘ ı· ˘Ô‚ÏËıÔ‡Ó Û ·ÁÁÂÈÔÏ·ÛÙÈ΋ Ì ¯Ú‹Û˘ ·Ó·ÛÙÔϤˆÓ GP IIb/IIIa 15. ∏ ÂÈÛÙÚÔÊ‹ ÛÙË ‰Ô˘ÏÂÈ¿ ı· Ú¤ÂÈ Ó· ηıÔ‰ËÁÂ›Ù·È ·fi ÙË ‰ÔÎÈÌ·Û›· ·ÓÔ¯‹˜ ÛÙËÓ ¿ÛÎËÛË. ∏ ÚÔÁ‡ÌÓ·ÛË ÛÙËÓ ¿ÛÎËÛË ÌÔÚ› Ó· ÍÂÎÈÓ‹ÛÂÈ Ì¤Û· Û 1-2 ‚‰ÔÌ¿‰Â˜ ÌÂÙ¿ ·fi ÙË ÛÙÂÊ·ÓÈ·›· Â·Ó·ÁÁ›ˆÛË. √È ·ÛıÂÓ›˜ ı· Ú¤ÂÈ Ó· ÂÓı·ÚÚ‡ÓÔÓÙ·È Ó· ‚·‰›˙Ô˘Ó (‹ Ó· Âȉ›‰ÔÓÙ·È Û ¿ÏÏË Ê˘ÛÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ·) ÁÈ· 30-60 ÏÂÙ¿ ηıËÌÂÚÈÓ¿. √È ·ÛıÂÓ›˜ Ì ÌË ÂÈÏÂÁ̤ÓÔ NSTEMI ÌÔÚÔ‡Ó Ó· ÂÈÛÙÚ¤„Ô˘Ó ÛÙËÓ Ô‰‹ÁËÛË Ì¤Û· Û 1 ‚‰ÔÌ¿‰· ·fi ÙËÓ ¤ÍÔ‰fi ÙÔ˘˜ ·fi ÙÔ ÓÔÛÔÎÔÌ›Ô.√È ·ÛıÂÓ›˜ Ì ÂÈÏÂÁ̤ÓÔ ¤ÌÊÚ·ÁÌ· Ì˘Ôηډ›Ô˘ ı· Ú¤ÂÈ Ó· ηı˘ÛÙÂÚÔ‡Ó ÙËÓ Ô‰‹ÁËÛË ÁÈ· 2-3 ‚‰ÔÌ¿‰Â˜.

μÈ‚ÏÈÔÁÚ·Ê›· 1.

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ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: Executive Summary. A Report of the American College of Cardiology /American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction). J Am Coll Cardiol, 2007; 50:652-726,

31

π√À¡π√™ 2008

¶ƒ√Δ∂π¡√ª∂¡∏ μπμ§π√°ƒ∞ºπ∞ 1: Wenger NK, Lewis SJ, Welty FK, Herrington DM, Bittner V; TNT Steering Committee and Investigators. Beneficial effects of aggressive low-density lipoprotein cholesterol lowering in women with stable coronary heart disease in the Treating to New Targets (TNT) study. Heart 2008 Apr;94(4):434-9.

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14: Athyros VG, Kakafika A, Tziomalos K, Karagiannis A, Mikhailidis DP.

32

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15: Harley CR, Gandhi SK, Heien H, McDonough K, Nelson SP. Lipid levels and low-density lipoprotein cholesterol goal attainment in diabetic patients: rosuvastatin compared with other statins in usual care. Expert Opin Pharmacother 2008 Apr;9(5):669-76.

16: Breland UM, Halvorsen B, Hol J, et al. A potential role of the CXC chemokine GROalpha in atherosclerosis and plaque destabilization: downregulatory effects of statins. Arterioscler Thromb Vasc Biol. 2008 May;28(5):1005-11.

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19: Meuwese MC, Trip MD, van Wissen S, van Miert JN, Kastelein JJ, Stroes ES. Myeloperoxidase levels are not associated with carotid atherosclerosis progression in patients with familial hypercholesterolemia. Atherosclerosis 2008 Apr;197(2):916-21.

20. Athyros VG, Kakafika AI, Karagiannis A, Mikhailidis DP. Do we need to consider inflammatory markers when we treat atherosclerotic disease? Atherosclerosis 2008 Mar 6. [Epub ahead of print] 21. Pagourelias E, Koumaras C, Kakafika A, Tziomalos K, Zorou P, Athyros VG, Karagiannis A. Cardiorenal Anemia Syndrome: Do Erythropoietin and Iron Therapy Have a Place in the Treatment of Heart Failure? Angiology. 2008 Apr 14. [Epub ahead of print] 22.

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24: Pitsavos C, Panagiotakos DB, Skoumas J, Papadimitriou L, Stefanadis C. Risk Stratification of Apolipoprotein B, A1, and B/AI Ratio on the Prevalence of Metabolic Syndrome: The ATTICA Study. Angiology. 2008 Apr 2. [Epub ahead of print] 25: Panagiotakos DB, Pitsavos C, Chrysohoou C, Stefanadis C. Hierarchical analysis of cardiovascular risk factors in relation to the development of acute coronary syndromes, in different parts of Greece: the CARDIO2000 study.

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26: Panagiotakos DB, Pitsavos C, Skoumas Y, Lentzas Y, Papadimitriou L, Chrysohoou C, Stefanadis C. Abdominal obesity, blood glucose and apolipoprotein B levels are the best predictors of the incidence of hypercholesterolemia (2001-2006) among healthy adults: the ATTICA study. Lipids Health Dis. 2008 Mar 31;7:11.

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