out 21
05-03-09
12:01
™ÂÏ›‰·3
∆ƒπª∏¡π∞π√ ¶∂ƒπ√¢π∫√ §π¶π¢πø¡
∆∂ÀÃ√™ 21 ñ ª∞ƒ∆IO™ 2009
2 8 14 17 26 32
¶·ıÔÊ˘ÛÈÔÏÔÁ›·
∂ȉËÌÈÔÏÔÁ›· - ¶·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ∫ÏÈÓÈ΋ ¶Ú¿ÍË
£Âڷ›· - º¿Ú̷η
ÀÁÈÂÈÓԉȷÈÙËÙÈ΋ ∞ÁˆÁ‹
¶ÚÔÙÂÈÓfiÌÂÓË µÈ‚ÏÈÔÁÚ·Ê›·
out 21
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12:01
™ÂÏ›‰·4
IA
À‡ı˘ÓÔ˜ ™‡ÓÙ·Í˘ HÏ›·˜ XÂÈÌÒÓ·˜ K·Ú‰ÈÔÏfiÁÔ˜ YÔÙ¤Ú·Ú¯Ô˜ Â.·.
¶∞£√ºÀ™π√§√°π∞ √È Àԉԯ›˜ ∆‡Ô˘ Toll (Toll-like receptors) Î·È Ô ƒfiÏÔ˜ ÙÔ˘˜ ÛÙËÓ ∞ıËÚÔÛÎÏ‹ÚˆÛË ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ Ã. ∆¤ÏÏ˘, ∞ϤͷӉÚÔ˜ ¢. ∆ÛÂϤ˘ ∂ÚÁ·ÛÙ‹ÚÈÔ µÈÔ¯ËÌ›·˜, ∆Ì‹Ì· ÃËÌ›·˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ,
∂¶π¢∏ªπ√§√°π∞ - ¶∞ƒ∞°√¡∆∂™ ∫π¡¢À¡√À
¢ÈÔÈÎËÙÈÎfi ™˘Ì‚Ô‡ÏÈÔ ∂ÏÏËÓÈ΋˜ ∂Ù·ÈÚ›·˜ ∞ıËÚÔÛÎÏ‹ÚˆÛ˘ ªˆ˘Û‹˜ ∂ÏÈÛ¿Ê ¶Úfi‰ÚÔ˜ µ·Û›Ï˘ Õı˘ÚÔ˜ ∞ÓÙÈÚfi‰ÚÔ˜ HÏ›·˜ XÂÈÌÒÓ·˜ °ÂÓÈÎfi˜ °Ú·ÌÌ·Ù¤·˜ ¢ËÌÔÛı¤Ó˘ ¶·Ó·ÁȈٿÎÔ˜ ∂ȉÈÎfi˜ °Ú·ÌÌ·Ù¤·˜ ∂ϤÓË ªÈÏÈ·ÓÔ‡ ∆·Ì›·˜ ª·ÓÒÏ˘ °·ÓˆÙ¿Î˘ ª¤ÏÔ˜ ∞ÛÙ¤ÚÈÔ˜ ∫·Ú·ÁÈ¿ÓÓ˘ ª¤ÏÔ˜ °ÂÓÔ‚¤Ê· KÔÏÔ‚Ô‡ ª¤ÏÔ˜ µ·Û›Ï˘ ¡ÈÎÔÏ¿Ô˘ ª¤ÏÔ˜
∞ϤͷӉÚÔ˜ ∆ÛÂϤ˘ ª¤ÏÔ˜
8
∞ÓÙÈÏ‹„ÂȘ ÙÔ˘ ¶ÏËı˘ÛÌÔ‡ ÁÈ· ÙÔ ƒfiÏÔ Ù˘ ¢È·ÙÚÔÊ‹˜ ÛÙËÓ ∫·Ú‰È·ÁÁÂȷ΋ ¡fiÛÔ ¶ÈÏÔÙÈο ™ÙÔȯ›· ·fi ÙËÓ ¶·ÓÂÏÏ·‰È΋ ŒÚ¢ӷ Ù˘ √Ì¿‰·˜ ∂ÚÁ·Û›·˜ ∂ȉËÌÈÔÏÔÁ›·˜ & ¶ÚfiÏ˄˘ Ù˘ ∞ıËÚÔÛÎÏ‹ÚˆÛ˘ Ù˘ ∂ÏÏËÓÈ΋˜ ∂Ù·ÈÚ›·˜ ∞ıËÚÔÛÎÏ‹ÚˆÛ˘ ∞Ì·Ï›· °ÈˆÙÔÔ‡ÏÔ˘, ∂ο‚Ë °ÂˆÚÁÔ˘ÛÔÔ‡ÏÔ˘, ¢È·ÈÙÔÏfiÁÔÈ ¢È·ÙÚÔÊÔÏfiÁÔÈ ∆Ì‹Ì·ÙÔ˜ ∂ÈÛÙ‹Ì˘ ¢È·ÈÙÔÏÔÁ›·˜ - ¢È·ÙÚÔÊ‹˜, ÷ÚÔÎÔ›Ԣ ¶·ÓÂÈÛÙËÌ›Ô˘
∞ı·Ó¿ÛÈÔ˜ ¶··ı·Ó·Û›Ô˘, π·ÙÚfi˜ - ∫·Ú‰ÈÔÏfiÁÔ˜, π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ ∂˘¿ÁÁÂÏÔ˜ ¶ÔÏ˘¯ÚÔÓfiÔ˘ÏÔ˜, ∂ÈÎ. ∫·ıËÁËÙ‹˜ ∆Ì‹Ì·ÙÔ˜ ∂ÈÛÙ‹Ì˘ ¢È·ÈÙÔÏÔÁ›·˜ ¢È·ÙÚÔÊ‹˜ ÷ÚÔÎÔ›Ԣ ¶·ÓÂÈÛÙËÌ›Ô˘
¢ËÌÔÛı¤Ó˘ ¶·Ó·ÁȈٿÎÔ˜, ∞Ó·Ï. ∫·ıËÁËÙ‹˜ ∆Ì‹Ì·ÙÔ˜ ∂ÈÛÙ‹Ì˘ ¢È·ÈÙÔÏÔÁ›·˜ ¢È·ÙÚÔÊ‹˜ ÷ÚÔÎÔ›Ԣ ¶·ÓÂÈÛÙËÌ›Ô˘
πˆ¿ÓÓ˘ °Ô˘‰¤‚ÂÓÔ˜, ∫·ıËÁËÙ‹˜, π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ
∫§π¡π∫∏ ¶ƒ∞•∏
14
™Ê¿ÏÌ·Ù· Î·È ¶·Ú·Ï›„ÂȘ ÛÙË ¢È¿ÁÓˆÛË Ù˘ ¢˘ÛÏÈȉ·ÈÌ›·˜ ªÈ¯¿Ï˘ ∫ˆÛÙ·¿ÓÔ˜, π·ÙÚfi˜, ∂ÈÛÙËÌÔÓÈÎfi˜ ™˘ÓÂÚÁ¿Ù˘ Ù˘ µ' ¶·ıÔÏÔÁÈ΋˜ ∫ÏÈÓÈ΋˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ πˆ·ÓÓ›ÓˆÓ ªˆ˘Û‹˜ ∂ÏÈÛ¿Ê, ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ
£∂ƒ∞¶∂π∞ - º∞ƒª∞∫∞
17
ÀÔÏÈȉ·ÈÌÈΤ˜ Î·È ¶ÏÂÈÔÙÚÔÈΤ˜ ¢Ú¿ÛÂȘ ÙˆÓ ™Ù·ÙÈÓÒÓ ÛÙ· ∞ÁÁÂȷο ∂ÁÎÂÊ·ÏÈο ∂ÂÈÛfi‰È· £Âfi‰ˆÚÔ˜ ∏. ÃÂÈÌÒÓ·˜, ∂ȉÈ΢fiÌÂÓÔ˜ ¶·ıÔÏÔÁ›·˜, °¡ ÕÚÁÔ˘˜.
∫·Ú‰È·Î‹ ∞Ó¿ÚÎÂÈ· ÁÈ· ÙÔÓ ªË ∫·Ú‰ÈÔÏfiÁÔ ÃÚ‹ÛÙÔ˜ ¶›ÙÛ·‚Ô˜ ª¤ÏÔ˜
2
22
¶··ı·Ó·Û›Ô˘ ∞ı·Ó¿ÛÈÔ˜, ∫·Ú‰ÈÔÏfiÁÔ˜-EÓÙ·ÙÈÎÔÏfiÁÔ˜ °È¿ÓÓ˘ °Ô˘‰¤‚ÂÓÔ˜ ∫·ıËÁËÙ‹˜ K·Ú‰ÈÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ
À°π∂π¡√¢π∞π∆∏∆π∏ ∞°ø°∏
26
ÕÛÎËÛË Î·È ∫·Ú‰È¿ ÃÚÈÛÙ›Ó· ÃÚ˘ÛÔ¯fiÔ˘, ÃÚ‹ÛÙÔ˜ ¶›ÙÛ·‚Ô˜, ÃÚÈÛÙfi‰Ô˘ÏÔ˜ ™ÙÂÊ·Ó¿‰Ë˜ ∞’ ¶·ÓÂÈÛÙËÌȷ΋˜ ∫·Ú‰ÈÔÏÔÁÈ΋˜ ∫ÏÈÓÈ΋˜, π°¡∞
¶POTEINOMENH BIB§IO°PAºIA
32
ATHIROSK 21-
05-03-09
12:24
™ÂÏ›‰·1
, e Receptors ik L ll o (T ll ˘ ‡Ô˘ To ˘ÛÙ‹Ì·ÙÔ˜ Ù ˆÛ˘. ∏ Ï‹Ú Û Ú Ï‹ ‡ Î Ô Û ÈÎ Ô Ù Ú Ë ÈË ı Ô · ÂÈ· Ù˘ ˆÓ ÙÔ˘ ·ÓÔÛÔ ÛÙËÓ ·ıÔÁ¤Ó Ë ÂÍÂȉÈÎÂ˘Ì¤Ó ˘Í ÏÔ Ù fi Ú √È ˘Ô‰Ô¯Â›˜ Ó¿ fi · ÈÎ Ó Ë ÓÙ Ù · ÙËÓ Ëı‹ÛÂÈ Û Ì·Ù›˙Ô˘Ó ÛËÌ ÌÔÚ› Ó· ‚Ô fiÏË„Ë ‹ Î·È Ú ˘˜ Ô TLRs) ‰È·‰Ú· Ó Ù Ë ˜ Ù ›· Á È· Á ÏÔ ‚¿ÛÂˆÓ ÁÈ΋ ˜ ·ıÔÊ˘ÛÈÔ ËÙÈÎÒÓ ·ÚÂÌ ∏ ÂȉËÌÈÔÏÔ ÈÙ È· ˘. ‰ ηٷÓfiËÛË ÙË Ô Û È · Ófi Î ˜ Ó ‹ fi È·ÁÁÂÈ·Î ÚÔÛÂÁÁ›Ûˆ ÚˆÛ˘ Ì ÛÎÔ ·È Ù˘ ηډ Î Ï‹ Î ˜ Û ıÂڷ¢ÙÈÎÒÓ Ë Ô Û Ú Ë ˆ ı Ú ∞ Ï‹ Î ›· ˆ˜ ΋ ∂Ù·ÈÚ Ù˘ ·ıËÚÔÛ ÙË ‰È·ÙÚÔÊ‹ 007 Ë ∂ÏÏËÓÈ È· 2 Á Ô ·ÓÙÈÌÂÙÒÈÛË ‡ Ù Ô Ì fi ˘Û · ı › ÏË ¤¯ÂÈ ËÓÈÎÔ‡ Ú·ÁÌ·ÙÔÔÈ ÂÚˆÙËı¤ÓÙˆÓ ‹„ÂȘ ÙÔ˘ ∂ÏÏ Ó ÈÏ ˆ ¤Ú¢ӷ Ô˘ Ù ÓÙ · ˜ È Ô · Î ¤Ú Ì ˜ ÂÁ¿ÏÔ ÙˆÓ ÙȘ ÁÓÒÛÂÈ ¤‰ÂÈÍ fiÙÈ Ì ÙËÓ ÚfiÏË„Ë ˘, ÓÔ È· Ó· ·ÔÙÈÌ‹ÛÂÈ ‡ Á ‰ ÈÓ Â› Î ˘ı ‡ Ô ÏÔ Ó· ·ÎÔ ÛÙÈ΋ ·Ú‰È·ÁÁÂÈ·Î ˜ Ô˘ Ú¤ÂÈ Ë ÛÙË ‰È·ÁÓˆ ‹ ı Ê ·Ú¿ÁÔÓÙ· Î Ô Ï¿ Ú Ù ¿ È· ÂÙ ‰ Î Ú ˜ · Ë Ù¿›ÓÔÓÙ·È ÙÔ Â›‰Ô˜ Ù ÓÈ΋ Ú¿ÍË Á È ‰›ÓÔÓÙ·È Û˘Û · ÏÈ Î Î ¿ÁÓÔÈ· ÁÈ· È Ó · Ë Ù ÓÙ ™ Ô Ê Ó. ¿ ˆ Ú Ù· ÂÚÈÁ ¿ÚÌ·ÒÓ ÓÔÛËÌ¿Ù ¿ Ù· ÛÊ¿ÏÌ· Ù›Ó˜ Â›Ó·È Ê · ˘Ù ٠ηډȷÁÁÂÈ·Î ∞ Û È Ó. √ ÈÒ . ÈÌ · ›· ÏÈȉ·ÈÌ , ÙfiÛÔ ˆÓ ‰˘ÛÏÈȉ ıÂÓÒÓ Ì ‰˘Û ‡ÓÔ˘ ÁÈ· ∞∂∂ Û ‰ · ÚÔÛ¤ÁÁÈÛË Ù ÈÓ Ó Î ˆ Ù ˘ Ô Ë Ù ÈÛ Ë Ú Û ·ÏÏ¿ Ó ÂÏ¿ÙÙˆ ˆÛÙ‹ ‰È·¯Â› ‹ ÈηÓfiÙËÙ· ËÙ¿ ÙÔ˘˜ ÛÙË Ù ÈÎ fi ÛÂȘ ÁÈ· ÙË Û ÈÌ ÈÌ · Û È‰ Ë Ú ¯ ÏÈ Ô Ë Ù ˘ „Ë. ∏ ·Ûı·ԉ›ÍÂÈ ÂÛÌ·. ¶ÔÏÏÔ› ÂÚÔÁÂÓ‹ ÚfiÏË Ù ¤Ï η Ô˘ ¤¯Ô˘Ó Ù Â˘ Ô ‰ · Ë Ù fi Û ÈÎ È · ·ÎfiÌË Ô Â˘ÂÚÁÂÙ ÂÓ‹ fiÛÔ Î ÎÏÈÓÈΤ˜ Î·È ˘Ì‚¿ÏÏÔ˘Ó ÛÙ Û ÛÙËÓ ÚˆÙÔÁ ¤˜ Ó ˆ ÈÎ Ù Á ˜ ÏÔ ÂÈ Û ÈÔ ‰ ¿ ÛÂ Î·Ú ÏÈÓÈÎÔ‡ ÚÔÈΤ˜ ‰Ú ÓÔÛËχÔÓÙ·È ÓfiËÛË ÙÔ˘ Î · Î·È ÔÈ ÏÂÈÔÙ ÂÓ Ù ‰ · Î · ∏ ÂÈ Î . Ú ˘˜ ¿ ÙËÌ·‰ÈÔÏfiÁÔ È·Î‹ ·Ó ·È ·fi Î·Ú ÈÛË ÙÔ˘. ∏ Û˘Û Ó›˜ Ì ηډ ÓÙ ‡ Ò Ô ÂÙ ˘ı ÈÌ ÏÔ ÓÙ Ô · Î · ‰ÂÓ ·Ú  Ì›ˆÛÙËÓ Î·Ï‹ ÔÓÙ· ÁÈ·ÙÚfi ˘ÓÔ, Ô‰ËÁ› Û ÂÚÈÛÛfiÙÂÚÔÈ ‰ ¿ ›Ó Î ÂÚ ı fi Î Ó · Ô Ù ÂÈ Á ‰È¿ÚηډȷÁ ‚ÔËı‹ÛÂÈ Â‚‰ÔÌ·‰È·›ˆ˜ Ì ‰Â‰Ô̤ÓÔ Û˘Ó‰ÚfiÌÔ˘ ı· · ¤˜ Ì Ú Ô Ô Ù Ê ¿ 5 Â Û Â È Ì · ·ÎfiÌ· Î ÕÛÎËÛË 4 ıÓËÙfiÙËÙ·˜. ÙÈ΋ ¿ÛÎËÛË ˜ ‹ Î · ÂÈ Á Á È· fiÙËÙ·˜. Ù˘ ηډ ˆÛË Ù˘ ıÓËÙ ÛË Î·Ù¿ 50% › Ì Â Ì È · ÂÙ ÒÓ Û¯ÂÙ›˙ ÎÂÈ·˜ 30 ÏÂÙ
˘ T˘ ™‡ÓÙ·Í
·˜ ∏Ï›·˜ ÃÂÈÌÒÓ ÓÙ·Í˘ Y‡ı˘ÓÔ˜ ™‡
EΉ›‰ÂÙ·È Ì ÙËÓ Â˘ÁÂÓÈ΋ ¯ÔÚËÁ›· Ù˘ OÈ ·fi„ÂȘ ÛÙÔ Î›ÌÂÓÔ ÂÎÊÚ¿˙Ô˘Ó ÌfiÓÔ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Î·È ‰ÂÓ ·ÓÙÈÚÔÛˆÂ‡Ô˘Ó ÙË ¯ÔÚËÁfi ÂÙ·ÈÚ›·.
π∞∆ƒπ∫∂™ ∂∫¢√™∂π™
ATHIROSK 21-
05-03-09
12:24
ª ∞ ƒ ∆ π √ ™
™ÂÏ›‰·2
2 0 0 9
√È Àԉԯ›˜ ∆‡Ô˘ Toll (Toll-like receptors) Î·È Ô ƒfiÏÔ˜ ÙÔ˘˜ ÛÙËÓ ∞ıËÚÔÛÎÏ‹ÚˆÛË ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ Ã. ∆¤ÏÏ˘, ∞ϤͷӉÚÔ˜ ¢. ∆ÛÂϤ˘ ∂ÚÁ·ÛÙ‹ÚÈÔ µÈÔ¯ËÌ›·˜, ∆Ì‹Ì· ÃËÌ›·˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ,
∂ÈÛ·ÁˆÁ‹ ∏ ·ıËÚÔÛÎÏ‹ÚˆÛË Â›Ó·È ¯ÚfiÓÈ· ÊÏÂÁÌÔÓ҉˘ ÓfiÛÔ˜ ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ ÙˆÓ ·ÚÙËÚÈÒÓ. ¶ÔÏϤ˜ ÌÂϤÙ˜ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ˘¿Ú¯ÂÈ ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙˆÓ ÂȤ‰ˆÓ ÙˆÓ ‰È·ÌÂÛÔÏ·‚ËÙÒÓ Ù˘ ÊÏÂÁÌÔÓ‹˜ fiˆ˜ Ë C-·ÓÙȉÚÒÛ· ÚˆÙ½ÓË (CRP), Ë ÈÓÙÂÚÏ¢ΛÓË-6 (IL-6), Ù· ‰È·Ï˘Ù¿ ÌfiÚÈ· ÚÔÛÎfiÏÏËÛ˘ (ICAM-1, VCAM-1), Ô ·Ú¿ÁÔÓÙ·˜ Ó¤ÎÚˆÛ˘ fiÁÎˆÓ (TNF-a), Ë E-ÛÂÏÂÎÙ›ÓË, ÎÏ, Î·È ÙÔ˘ ·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ·ıËÚÔÛÎÏ‹ÚˆÛË Î·È Î·Ú‰È·ÁÁÂȷ΋ ÓfiÛÔ. ∆Ô Ï‹Ú˜ Ê¿ÛÌ· fï˜ ÙˆÓ ÊÏÂÁÌÔÓˆ‰ÒÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ÂÌϤÎÔÓÙ·È ÛÙ· ‰È¿ÊÔÚ· ÛÙ¿‰È· ·Ó¿Ù˘Í˘ Ù˘ ·ıËڈ̷ÙÈ΋˜ Ͽη˜ ‚Ú›ÛÎÂÙ·È ·ÎfiÌ· ˘fi ‰ÈÂÚ‡ÓËÛË. ¶ÚÔ˜ ÙËÓ Î·Ù‡ı˘ÓÛË ·˘Ù‹, ¤Ó· Ó¤Ô ÂÚ¢ÓËÙÈÎfi ‰›Ô ·ÓÔ›¯ıËΠÚfiÛÊ·Ù·, Ì ÙËÓ ·Ó·Î¿Ï˘„Ë fiÙÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ·Ó¿Ù˘ÍË Ù˘ ·ıËÚÔÛÎÏ‹ÚˆÛ˘ ‰È·‰Ú·Ì·Ù›˙Ô˘Ó ÔÈ ˘Ô‰Ô¯Â›˜ ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Ù‡Ô˘ Toll (Toll-Like Receptors, TLRs). √È ˘Ô‰Ô¯Â›˜ TLRs ¤ÁÈÓ·Ó ·Ú¯Èο ÁÓˆÛÙÔ› ˆ˜ ÔÈ “·ÈÛıËÙ‹Ú˜” ÙÔ˘ ¤ÌÊ˘ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÁÈ· ÙËÓ ·Ó·ÁÓÒÚÈÛË ·ıÔÁfiÓˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ, Ô‰ËÁÒÓÙ·˜ ÛÙË Û˘Ó¤¯ÂÈ· ÛÙËÓ ·ÓÔÛÔÏÔÁÈ΋ ·¿ÓÙËÛË ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ ηٿ ÙˆÓ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ. √È ∆LRs ÂÌÊ·Ó›˙ÔÓÙ·È Û ‰È¿ÊÔÚ· ·ÙÙ·Ú· fiˆ˜ ÂÈıËÏȷο ·ÙÙ·Ú·, ¡∫ ·ÙÙ·Ú·, ‰ÂÓ‰ÚÈÙÈο ·ÙÙ·Ú·, Ú˘ıÌÈÛÙÈο ∆ ÏÂÌÊÔ·ÙÙ·Ú·, ÌÔÓÔ·ÙÙ·Ú·, Ì·ÎÚÔÊ¿Á·, Ô˘‰ÂÙÂÚfiÊÈÏ·, ‚·ÛÂfiÊÈÏ·, ÂÓ‰ÔıËÏȷο ·ÙÙ·Ú·, ÎÏ [ 1]. ∏ ÔÓÔÌ·Û›· ÙˆÓ TLRs ÙˆÓ ıËÏ·ÛÙÈÎÒÓ ÚÔ¤Ú¯ÂÙ·È ·fi ÙËÓ ÚˆÙ½ÓË Toll Ù˘ Drosophila, Ì ÙËÓ ÔÔ›· ÂÌÊ·Ó›˙Ô˘Ó ÛËÌ·ÓÙÈΤ˜ ‰ÔÌÈΤ˜ ÔÌÔÈfiÙËÙ˜ [2]. ¢ÂηÙÚ›˜ ˘Ô‰Ô¯Â›˜ TLR ΢ÙÙ¿ÚˆÓ ıËÏ·ÛÙÈÎÒÓ ¤¯Ô˘Ó Ù·˘ÙÔÔÈËı› ̤¯ÚÈ Û‹ÌÂÚ·, ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ ÔÈ 11 ÂÎÊÚ¿˙ÔÓÙ·È Û ·ÓıÚÒÈÓ· ·ÙÙ·Ú· [3]. √È ∆LR -1, -2, -4, -5 Î·È -6 ÂÓÙÔ›˙ÔÓÙ·È
2
ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÂÓÒ ÔÈ -3, -7, -8 Î·È -9 Â›Ó·È ÂÓ‰Ô΢ÙÙ¿ÚÈÔÈ (™¯‹Ì·1).
¢ÔÌÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ TLRs √È TLRs Â›Ó·È ‰È·ÌÂÌ‚Ú·ÓÈΤ˜ ÁÏ˘ÎÔÚˆÙ½Ó˜ ÔÈ Ôԛ˜ ·Ó‹ÎÔ˘Ó ÛÙËÓ ˘ÂÚÔÈÎÔÁ¤ÓÂÈ· ÙˆÓ ˘Ô‰Ô¯¤ˆÓ Ù˘ ÈÓÙÂÚÏ¢ΛÓ˘-1 (IL-1Rs), ηıÒ˜ ÙÔ Î˘ÙÙ·ÚÔÏ·ÛÌ·ÙÈÎfi ÙÌ‹Ì· ÙˆÓ TLRs ¤¯ÂÈ ÙËÓ ›‰È· ÔÌÔÏÔÁ›· Ì ·˘Ù‹ ÙˆÓ IL-1Rs Î·È ÔÓÔÌ¿˙ÂÙ·È ∆Ôll/πÓÙÂÚÏ¢ΛÓË-1 (∆πR). ∆Ô Î˘ÙÙ·ÚÔÏ·ÛÌ·ÙÈÎfi ÙÌ‹Ì· TIR ·ÔÙÂÏÂ›Ù·È ·fi ÙÚÂȘ ÂÚÈÔ¯¤˜ (boxes,) ÔÈ Ôԛ˜ ·›˙Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙË ÌÂÙ¿‰ÔÛË ÙÔ˘ ÂÓ‰Ô΢ÙÙ¿ÚÈÔ˘ Û‹Ì·ÙÔ˜. ∆Ô ÂÍˆÎ˘ÙÙ¿ÚÈÔ ÙÌ‹Ì· ÙˆÓ TLRs ‰È·Ê¤ÚÂÈ ÛËÌ·ÓÙÈο ·fi ·˘Ùfi ÙˆÓ IL1Rs ηıÒ˜ Ë ·ÌÈÓÔÍÈ΋ ·ÏÏËÏÔ˘¯›· ÙÔ˘˜ ·ÔÙÂÏÂ›Ù·È ·fi ¤Ó· ·ӷϷ̂·ÓfiÌÂÓÔ ÌÔÙ›‚Ô ÏÔ‡ÛÈÔ Û Ï¢ΛÓË (Leucine-Rich
Repeat, LRR) [4]. ∞Ó·Ï˘ÙÈÎfiÙÂÚ·, ÙÔ ÌÔÙ›‚Ô LRR ÂÚȤ¯ÂÈ 24 - 29 ·ÌÈÓÔͤ· Ù˘ ÌÔÚÊ‹˜ XLXXLXLXX (L = Ï¢ΛÓË Î·È Ã = ·ÌÈÓÔ͇) ÙÔ ÔÔ›Ô ·Ó¿ÏÔÁ· Ì ÙÔÓ TLR ˘Ô‰Ô¯¤· ·ӷϷ̂¿ÓÂÙ·È 19 - 25 ÊÔÚ¤˜. ŒÙÛÈ ÏÔÈfiÓ, οı TLRs ·Ó¿ÏÔÁ· Ì ÙÔ Â·Ó·Ï·Ì‚·ÓfiÌÂÓÔ ÌÔÙ›‚Ô Ô˘ ÂÚȤ¯ÂÈ, ÂÍÂȉÈ·ÂÙ·È ÛÙËÓ ·Ó·ÁÓÒÚÈÛË ÂȉÈÎÒÓ ÌÔÚ›ˆÓ (ÚÔÛ‰ÂÌ¿ÙˆÓ). ∆· ÚÔÛ‰¤Ì·Ù· ·˘Ù¿ ÔÓÔÌ¿˙ÔÓÙ·È ÌÔÚȷο ÚfiÙ˘· ÙˆÓ ·ıÔÁfiÓˆÓ (Pathogen-Associated Molecular Patterns (PAMPs) [5], [6], [7]. √È TLRs ¤¯Ô˘Ó ÔÌ·‰ÔÔÈËı› Û‡Ìʈӷ Ì ÙÔ Â›‰Ô˜ ÙˆÓ ÚÔÛ‰ÂÌ¿ÙˆÓ Ô˘ ·˘ÙÔ› ·Ó·ÁÓˆÚ›˙Ô˘Ó. √ TLR-2, ·Ó·ÁÓˆÚ›˙ÂÈ ÏÈÔÂÙ›‰È· ÙÔ˘ ΢ÙÙ·ÚÈÎÔ‡ ÙÔȯÒÌ·ÙÔ˜ ÙˆÓ Gram (+) Î·È Gram (-) ‚·ÎÙËÚ›ˆÓ, Ì˘ÎÔ‚·ÎÙ‹ÚÈ·, ̇ÎËÙ˜, ·Ú¿ÛÈÙ· Î·È ÈÔ‡˜. √ TLR-4 ·Ó·ÁÓˆÚ›˙ÂÈ ÂȉÈο Û˘ÛÙ·ÙÈο ÙˆÓ Gram (-) ‚·ÎÙËÚ›ˆÓ (ÏÈÔÔÏ˘Û·Î¯·Ú›Ù˘ LPS). √È TLR -3, -7, -8
™¯‹Ì· 1. O ΢ÙÙ·ÚÈÎfi˜ ÂÓÙÔÈÛÌfi˜ ÙˆÓ TLRs, Ù· ÚÔÛ‰¤Ì·Ù¿ ÙÔ˘˜ ηıÒ˜ Î·È Ô Û¯ËÌ·ÙÈÛÌfi˜ ÚÔÊÏÂÁÌÔÓˆ‰ÒÓ ·Ú·ÁfiÓÙˆÓ ‰È·Ì¤ÛÔ˘ Ù˘ ÂÓ‰Ô΢ÙÙ¿ÚÈ·˜ ÌÂÙ·ÁˆÁ‹˜ Û‹Ì·ÙÔ˜ ηٿ ÙË ‰È¤ÁÂÚÛË ÙˆÓ TLRs (Abbas A.K., et al. Cellular and Molecular Immunology, 6th Edition).
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™ÂÏ›‰·3
¶∞£√ºÀ™π√§√°π∞ Î·È -9, fiˆ˜ ·Ó·Ê¤Ú·Ì ÂÓÙÔ›˙ÔÓÙ·È ÂÓ‰Ô΢ÙÙ¿ÚÈ· Î·È ·Ó·ÁÓˆÚ›˙Ô˘Ó ÈÈο Î·È ‚·ÎÙËÚȷο ÓÔ˘ÎÏÂ˚ÓÈο Ôͤ·. ∆Ô ‰›ÎψÓÔ dsRNA ·Ó·ÁÓˆÚ›˙ÂÙ·È ·fi ÙÔÓ TLR-3 ÂÓÒ Ô ∆LR-9 ·Ó·ÁÓˆÚ›˙ÂÈ ‚·ÎÙËÚÈ·Îfi DNA (CpG DNA). ∆¤ÏÔ˜, ÔÈ ∆LR-5 Î·È TLR-11 ·Ó·ÁÓˆÚ›˙Ô˘Ó ÚˆÙ½Ó˜ ·ıÔÁfiÓˆÓ [4] (™¯‹Ì· 1).
ªÂÙ·ÁˆÁ‹ Û‹Ì·ÙÔ˜ ‰È·Ì¤ÛÔ˘ ÙˆÓ TLRs ¢‡Ô Â›Ó·È ÔÈ Î‡ÚȘ ÔÚ›˜ ÌÂÙ¿‰ÔÛ˘ Û‹Ì·ÙÔ˜ ‰È·Ì¤ÛÔ˘ ÙˆÓ TLRs. ∏ ÌÈ· ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ÚˆÙ½ÓË 88 ÙˆÓ ‰È·ÊÔÚÔÔÈËÌ¤ÓˆÓ Ì˘ÂÏÈÎÒÓ Î˘ÙÙ¿ÚˆÓ (MyD88), ÂÓÒ Ë ¿ÏÏË ÔÚ›· Â›Ó·È ·ÓÂÍ¿ÚÙËÙË Ù˘ MyD88. ∏ ‰È¤ÁÂÚÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ ‰È·Ì¤ÛÔ˘ Ù˘ MyD88 ÂÍ·ÚÙÒÌÂÓ˘ ÔÚ›·˜, Ô‰ËÁ› ÛÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘ ·Ú¿ÁÔÓÙ· NF-΂, Ë ÔÔ›· ηٷϋÁÂÈ ÛÙË ÁÔÓȉȷ΋ ¤ÎÊÚ·ÛË Î·È ·Ú·ÁˆÁ‹ ÙˆÓ ÚÔÊÏÂÁÌÔÓˆ‰ÒÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ fiˆ˜ TNF-·, IL-1, IL-6 Î·È Ù˘ ¯ËÌÂÈÔΛÓ˘ IL-8 [8]. ∏ ·ÓˆÙ¤Úˆ ÔÚ›· ÂÓÂÚÁÔÔ›ËÛ˘ ·ÊÔÚ¿ fiÏÔ˘˜ ÙÔ˘˜ TLRs ÂÎÙfi˜ ·fi ÙÔÓ TLR-3. ∏ ·ÓÂÍ¿ÚÙËÙË ·fi ÙËÓ MyD88 ÔÚ›· ÌÂÙ¿‰ÔÛ˘ Û‹Ì·ÙÔ˜ ÂÓÂÚÁÔÔÈ› ÙÔ Ú˘ıÌÈÛÙÈÎfi ·Ú¿ÁÔÓÙ· ÙˆÓ ÈÓÙÂÚÊÂÚÔÓÒÓ (IFN-regulatory factor, IRF3), Ô‰ËÁÒÓÙ·˜ ÛÙËÓ ¤ÎÊÚ·ÛË ÙˆÓ ÁÔÓȉ›ˆÓ ÙˆÓ ÈÓÙÂÚÊÂÚÔÓÒÓ (IFN) [4]. (™¯‹Ì· 2) [4].
ŒÎÊÚ·ÛË ÙˆÓ TLRs ÛÙËÓ ·ıËڈ̷ÙÈ΋ Ͽη √È ˘Ô‰Ô¯Â›˜ TLR Ô˘ ÂÎÊÚ¿˙ÔÓÙ·È ÛÙËÓ ·ıËڈ̷ÙÈ΋ Ͽη Â›Ó·È ÔÈ TLR-1, -2, -4, -5 Î·È -6. √È ˘Ô‰Ô¯Â›˜ ·˘ÙÔ› Â›Ó·È ˘ÂÚÂÎÊÚ·Ṳ̂ÓÔÈ ÛÙÔ ·ıËڈ̷ÙÈÎfi ÛÂ
™¯‹Ì· 2. ∏ ÂÓ‰Ô΢ÙÙ¿ÚÈ· ÌÂÙ·ÁˆÁ‹ Û‹Ì·ÙÔ˜ ηٿ ÙË ‰È¤ÁÂÚÛË ÙˆÓ TLRs (Akira S, et al. Immunology, 4: 499-511, 2004).
Û¯¤ÛË Ì ÙÔ ˘ÁȤ˜ ·ÚÙËÚÈ·Îfi ÙÔ›¯ˆÌ· Î·È Ì¿ÏÈÛÙ· Ë ˘ÂÚ¤ÎÊÚ·ÛË ·˘Ù‹ Û˘Óԉ‡ÂÙ·È ·fi ·˘ÍË̤ÓË ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ÚˆÙÂ˚ÓÒÓ Ô˘ Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ ÂÓ‰Ô΢ÙÙ¿ÚÈ· ÛËÌ·ÙÔ‰fiÙËÛË Î·È ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ ‰È·Ì¤ÛÔ˘ ÙˆÓ TLRs, fiˆ˜ Â›Ó·È Ô NF-΂ [9],[10],[11]. ∏ ˘ÂÚ¤ÎÊÚ·ÛË ÙˆÓ TLRs ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ·ıËڈ̷ÙÈ΋˜ Ͽη˜, ÂÓÙÔ›˙ÂÙ·È Î˘Ú›ˆ˜ ÛÙ· ÂÓ‰ÔıËÏȷο ·ÙÙ·Ú· Î·È ÛÙ· Ì·ÎÚÔÊ¿Á·. ™Â ÂÚÈÔ¯¤˜ ÌÂȈ̤Ó˘ ÚÔ‹˜ ·›Ì·ÙÔ˜, fiÔ˘ ˘¿Ú¯ÂÈ
ÚԉȿıÂÛË ÁÈ· ·Ó¿Ù˘ÍË ·ıËڈ̷ÙÈ΋˜ Ͽη˜, Ë ÂÓ‰ÔıËÏȷ΋ ¤ÎÊÚ·ÛË ÙÔ˘ TLR-2 Â›Ó·È È‰È·›ÙÂÚ· ·˘ÍË̤ÓË, Ô˘ ‰Â›¯ÓÂÈ fiÙÈ Ù· ·ÙÙ·Ú· ·˘Ù¿ Â›Ó·È Â˘·›ÛıËÙ· ÛÙËÓ Â›‰Ú·ÛË ÙˆÓ ÌÔÚÈ·ÎÒÓ ÚÔÙ‡ˆÓ ÙˆÓ ·ıÔÁfiÓˆÓ ‚·ÎÙËÚ›ˆÓ (PAMPs). ∞˘ÍË̤ÓË ¤ÎÊÚ·ÛË ÙÔ˘ TLR-4 ÛÙ· ÌÔÓÔ·ÙÙ·Ú· ÙÔ˘ ·›Ì·ÙÔ˜ ¤¯ÂÈ Â›Û˘ ·Ó·ÊÂÚı› Û ·ÛıÂÓ›˜ Ì ÛÙ·ıÂÚ‹ ÛÙËı¿Á¯Ë ‹ Ô͇ ÛÙÂÊ·ÓÈ·›Ô Û‡Ó‰ÚÔÌÔ [12].
¶›Ó·Î·˜ 1. ƒfiÏÔ˜ ÙˆÓ ÌÔÚÈ·ÎÒÓ ÚÔÙ‡ˆÓ ÙˆÓ ·ıÔÁfiÓˆÓ (PAMPs) Î·È ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ ˘Ô‰Ô¯¤ˆÓ TLRs ÛÙËÓ ·ıËÚÔÁ¤ÓÂÛË PAMPs
ÀÔ‰Ô¯¤·˜
ƒfiÏÔ˜ ÛÙËÓ ·ıËÚÔÁ¤ÓÂÛË
¢È/ÙÚÈ-·Î˘ÏÔÏÈÔÂÙ›‰ÈÔ
TLR-2/1/6
¶ÚÔ¿ÁÂÈ ÙÔ Û¯ËÌ·ÙÈÛÌfi ·ÊÚˆ‰ÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ÂÓÂÚÁÔÔÈ› Ù· ÌÔÓÔ·ÙÙ·Ú· Î·È Ù· ÂÓ‰ÔıËÏȷο ·ÙÙ·Ú· (Cao et al. 2007, Dunzendorfer et al. 2004)
dsRNA
TLR-3
¶ÚÔ¿ÁÂÈ ÙÔ Û¯ËÌ·ÙÈÛÌfi ·ÊÚˆ‰ÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ÂÓÂÚÁÔÔÈ› Ù· ÌÔÓÔ·ÙÙ·Ú· Î·È ÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙˆÓ Ï›ˆÓ Ì˘ÈÎÒÓ Î˘ÙÙ¿ÚˆÓ. (Castrillo et al. 2003, Takeda and Akira 2004)
LPS
TLR-4
¶ÚÔ¿ÁÂÈ ÙÔ Û¯ËÌ·ÙÈÛÌfi ·ÊÚˆ‰ÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ÂÓÂÚÁÔÔÈ› Ù· ÌÔÓÔ·ÙÙ·Ú· Î·È Ù· ÂÓ‰ÔıËÏȷο ·ÙÙ·Ú· (Castrillo et al. 2003, Rice et al. 2003, Juvonen et al 1997)
ºÏ·ÁÂÏ›ÓË
TLR-5
∂ÓÂÚÁÔÔÈ› Ù· ÌÔÓÔ·ÙÙ·Ú· Î·È Ù· ÂÓ‰ÔıËÏȷο ·ÙÙ·Ú· (Takeda and Akira 2004)
πÈÎfi ssRNA
TLR-7/8
∂ÓÂÚÁÔÔÈ› Ù· ÌÔÓÔ·ÙÙ·Ú· Î·È Ù· ÂÓ‰ÔıËÏȷο ·ÙÙ·Ú· (Takeda and Akira 2004)
CpG DNA
TLR-9
BÚ›ÛÎÂÙ·È ÛÙÔ ·ÓıÚÒÈÓÔ ·ı‹ÚˆÌ· (Ott et al. 2006)
¶ÂÙȉÔÁÏ˘Î¿Ó˜
TLR-1/2
¶ÚÔ¿ÁÔ˘Ó ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ÌÔÓÔ΢ÙÙ¿ÚˆÓ, ‚Ú›ÛÎÔÓÙ·È ÛÙÔ ·ÓıÚÒÈÓÔ ·ı‹ÚˆÌ· Î·È Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ʷÈÓfiÙ˘Ô ·ÛÙ·ıÔ‡˜ Ͽη˜ Laman et al. 2002
3
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ª ∞ ƒ ∆ π √ ™
™ÂÏ›‰·4
2 0 0 9
ªÂϤÙ˜ Û ‰È·ÁÔÓȉȷο ÂÈÚ·Ì·Ùfi˙ˆ· ªÂϤÙ˜ Û ‰È¿ÊÔÚ· ÌÔÓ٤Ϸ ‰È·ÁÔÓȉȷÎÒÓ ÔÓÙÈÎÒÓ ¤‰ÂÈÍ·Ó fiÙÈ Ë ÂÍ·ÚÙÒÌÂÓË ·fi ÙËÓ MyD88 ÔÚ›· ÂÓÂÚÁÔÔ›ËÛ˘ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ‰È·Ì¤ÛÔ˘ ÙˆÓ TLRs, ‰È·‰Ú·Ì·Ù›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ·Ó¿Ù˘ÍË Ù˘ ·ıËÚÔÛÎÏ‹ÚˆÛ˘. ŒÙÛÈ, Û apoE Î·È MyD88 ‰ÈÏ¿ ∫/√ ÔÓÙ›ÎÈ·, ·Ú·ÙËÚ‹ıËΠ̛ˆÛË Ù˘ ·ıËڈ̷ÙÈ΋˜ ‚Ï¿‚˘ ηٿ 60% [13], Ì›ˆÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Ì·ÎÚÔÊ¿ÁˆÓ Ù˘ Ͽη˜ Î·È ¯·ÌËÏ¿ ›‰· MCP-1 ÛÙËÓ Î˘ÎÏÔÊÔÚ›· ÙÔ˘ ·›Ì·ÙÔ˜. ∂›Û˘, ¿ÏÏË ÌÂϤÙË ¤‰ÂÈÍ fiÙÈ Û TLR-4 ∫/√ ηıÒ˜ Î·È Û TLR-2 ∫/√ ÔÓÙ›ÎÈ· Ô‰‹ÁËÛ Û Ì›ˆÛË Ù˘ ·ıËڈ̿وÛ˘ Ù˘ ·ÔÚÙ‹˜ ηٿ ÂÚ›Ô˘ 30% ‹ 60% ·ÓÙ›ÛÙÔȯ· [14]. ∞ÓÙ›ıÂÙ·, ÛÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘, ·Ú·ÙËÚ‹ıËΠfiÙÈ Ë Â·Ó·Ï·Ì‚·ÓfiÌÂÓË ¯ÔÚ‹ÁËÛË LPS (ÚfiÛ‰ÂÌ· ÙÔ˘ TLR-4) Î·È Pam3CSK4 (ÚfiÛ‰ÂÌ· ÙÔ˘ TLR-2) ·ÓÙ›ÛÙÔȯ· ›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂÈÙ¿¯˘ÓÛË Ù˘ ·Ó¿Ù˘Í˘ Ù˘ ·ıËڈ̷ÙÈ΋˜ Ͽη˜. ∂ÈϤÔÓ, Ù· TLR-4 ∫/√ ÔÓÙ›ÎÈ· ÂÌÊ¿ÓÈÛ·Ó ÏÈÁfiÙÂÚÔ ÏÈÒ‰Ë ÈÛÙfi Î·È ÈÔ ÈÛ¯˘Úfi ÛÎÂÏÂÙfi Û ۯ¤ÛË Ì ٷ ·ÁÚ›Ô˘ Ù‡Ô˘ ÔÓÙ›ÎÈ· [15]. ∂›Û˘ ¤¯ÂÈ ‰Âȯı› fiÙÈ Ù· TLR-2 Î·È LDL-R ‰ÈÏ¿ ∫/√ ÔÓÙ›ÎÈ·, ·Ó¤Ù˘Í·Ó ÌÈÎÚfiÙÂÚË ‚Ï¿‚Ë ·fi fi,ÙÈ Ù· Ê˘ÛÈÔÏÔÁÈο ÔÓÙ›ÎÈ·. ∂ÈϤÔÓ, Ë ˘ÂÚÏÈȉ·ÈÌ›· ÂÓÂÚÁÔÔÈ› ÙËÓ MyD88 ÔÚ›·, ÂÓÒ Ë ·Ô˘Û›· Ù˘ MyD88 ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙË Ì›ˆÛË Ù˘
ÚÔÛÎfiÏÏËÛ˘ ÙˆÓ Ï¢ÎÔ΢ÙÙ¿ÚˆÓ ÛÙÔ ÂÓ‰Ôı‹ÏÈÔ Ô˘ ÚÔηÏ› Ë ÔÍÂȉˆÌ¤ÓË LDL. ∞fi Ù· ·Ú·¿Óˆ ·ÔÙÂϤÛÌ·Ù· Ê·›ÓÂÙ·È fiÙÈ Ë ÂÍ·ÚÙÒÌÂÓË ·fi MyD88 ÔÚ›· ΢ÙÙ·ÚÈ΋˜ ÂÓÂÚÁÔÔ›ËÛ˘ ‰È·Ì¤ÛÔ˘ ÙˆÓ TLRs ‰È·‰Ú·Ì·Ù›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË. ™˘ÓÂÒ˜, ÔÈ ˘Ô‰Ô¯Â›˜ ÙÔ˘ ¤ÌÊ˘ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ TLR-2 Î·È TLR-4, ηıÒ˜ Î·È Ë ÂÍ·ÚÙÒÌÂÓË ·fi ÙËÓ MyD88 ÔÚ›· ÂÓÂÚÁÔÔ›ËÛ˘ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ‰È·‰Ú·Ì·Ù›˙Ô˘Ó ÛËÌ·ÓÙÈÎfi ·ıËÚÔÁfiÓÔ ÚfiÏÔ, ÚÔ¿ÁÔÓÙ·˜ ÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË [16].
H Û˘Ì‚ÔÏ‹ ÙˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ ÛÙËÓ ·Ó¿Ù˘ÍË Ù˘ ·ıËڈ̷ÙÈ΋˜ Ͽη˜ ∏ ȉ¤· fiÙÈ ÔÈ ÌÔÏ˘ÛÌ·ÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ Û˘ÓÂÈÛʤÚÔ˘Ó ÛËÌ·ÓÙÈο ÛÙȘ ηډÈÔ·ÁÁÂȷΤ˜ ·ı‹ÛÂȘ ÂÏ‹ÊıË ÛÔ‚·Ú¿ ˘fi„Ë ÌÂÙ¿ ÙÔ 1988 fiÙ·Ó ÔÈ Saikku et al. [17] ·ÚÔ˘Û›·Û·Ó ‰Â‰Ô̤ӷ Ô˘ Û˘Ó‰¤Ô˘Ó ÙË ÌfiÏ˘ÓÛË ·fi ÙÔ Clamydia pneumoniae, Û 70 ¿Ó‰Ú˜ ·ÛıÂÓ›˜, Ì ¤ÌÊÚ·ÁÌ· Ì˘Ôηډ›Ô˘ Î·È ¯ÚfiÓÈ· ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ. ∏ ÌÂϤÙË ·˘Ù‹ ÂȂ‚·ÈÒıËÎÂ Î·È Ì ÂfiÌÂÓ˜ ÂÚÁ·Û›Â˜ [18]. πÛÙÔÏÔÁÈΤ˜ Î·È ÌÔÚȷΤ˜ ÌÂϤÙ˜ ÂȂ‚·›ˆÛ·Ó fiÙÈ ÙÔ Clamydia pneumoniae, Û˘ÓÂÈÛʤÚÂÈ ÛËÌ·ÓÙÈο ÛÙËÓ ·Ó¿Ù˘ÍË Ù˘ ·ıËڈ̷ÙÈ΋˜ Ͽη˜, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ËÏÈΛ·. ™‹ÌÂÚ·, ¤Ó·˜ ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ·fi ÌÔÏ˘ÛÌ·ÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ¤¯ÂÈ
Û˘Û¯ÂÙÈÛÙ› Ì ÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË fiˆ˜ ÙÔ ÂÏÈÎÔ‚·ÎÙËÚ›‰ÈÔ ÙÔ˘ ˘ÏˆÚÔ‡, Ô Î˘ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi˜ (CMV), Ô Èfi˜ Ù˘ ÏÔÈÌÒ‰Ô˘˜ ÌÔÓÔ˘Ú‹ÓˆÛ˘ Epstein Barr Virus (EBV), Ô Èfi˜ Ù˘ ·ÓıÚÒÈÓ˘ ·ÓÔÛÔ·Ó¿ÚÎÂÈ·˜ (HIV), Ô Èfi˜ ÙÔ˘ ¤ÚËÙ· 1 (HSV1) Î·È 2, (HSV2), ÔÈ ÈÔ› Ù˘ Ë·Ù›Ùȉ·˜ B, Î·È C, ÎÏ.
∏ ›‰Ú·ÛË ÙˆÓ Â͈ÁÂÓÒÓ ÚÔÛ‰ÂÌ¿ÙˆÓ ÙˆÓ TLRs ÛÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË ∏ ¿Ô„Ë fiÙÈ Ë ÌfiÏ˘ÓÛË ÚÔ¿ÁÂÈ ÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË ¤¯ÂÈ ˘ÔÛÙËÚȯı› ·fi ÌÂÁ¿Ï˜ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ [19]. ∏ ·Ó›¯Ó¢ÛË ‚·ÎÙËÚ›ˆÓ Û ·ıËڈ̷ÙÈΤ˜ ϿΘ, Ô‰‹ÁËÛ·Ó ÛÙËÓ ˘fiıÂÛË fiÙÈ Ë ‚·ÎÙËÚȷ΋ ÌfiÏ˘ÓÛË Ô˘ ÚÔ¤Ú¯ÂÙ·È ·fi ‚·ÎÙËÚȷΤ˜ ·ÔÈ˘ Ô˘ ·Ó·Ù‡ÛÛÔÓÙ·È ÛÙÔ ·ÚÙËÚÈ·Îfi ÙÔ›¯ˆÌ·, ÚÔ¿ÁÔ˘Ó ÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË [20]. ¶·ÚfiÏ· ·˘Ù¿, ÌÂϤÙ˜ ÛÙȘ Ôԛ˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ·ÓÙÈ‚ÈÔÙÈο ‰ÂÓ Â›¯·Ó ıÂÙÈο ·ÔÙÂϤÛÌ·Ù· ˆ˜ ÚÔ˜ ÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË. ™˘ÓÂÒ˜ Ë ˘fiıÂÛË ÁÈ· ÙÔ ÚfiÏÔ ÙˆÓ ‚·ÎÙËÚ›ˆÓ ÛÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË ÂÛÙÈ¿ÛÙËΠÛÙË ‰È·ÌÂÛÔÏ¿‚ËÛË ÙˆÓ PAMPs Î·È fi¯È ÛÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ ÛÙËÓ ·ıËڈ̷ÙÈ΋ Ͽη. ™‡Ìʈӷ Ì ÙËÓ ˘fiıÂÛË ·˘Ù‹, Ù· PAMPs, ·Ú¿ ÙËÓ Î·Ù·ÛÙÚÔÊ‹ ÙˆÓ ‚·ÎÙËÚ›ˆÓ ·fi Ù· ·ÓÙÈ‚ÈÔÙÈο, ÌÔÚÔ‡Ó Ó· ·ÂÏ¢ıÂÚˆıÔ‡Ó ·fi ¿ÏÏÔ˘˜ ·ÓıÂÎÙÈÎÔ‡˜, ‚ÈÒÛÈ-
™¯‹Ì· 4. √ ÚfiÏÔ˜ ÙˆÓ PAMPs ÛÙËÓ ·ıËÚÔÁ¤ÓÂÛË (Erridge C. Trends Cardiovasc Med, 18:52-56, 2008)
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¶∞£√ºÀ™π√§√°π∞ ÌÔ˘˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜. ™‡Ìʈӷ Ì ÙȘ ̤¯ÚÈ Û‹ÌÂÚ· ÌÂϤÙ˜, Ù· PAMPs ÚÔ¿ÁÔ˘Ó ÙËÓ ·ıËÚÔÁ¤ÓÂÛË Ì ÙÚ›˜ ‰È·ÊÔÚÂÙÈÎÔ‡˜ ÙÚfiÔ˘˜: 1. ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ÌÔÓÔ΢ÙÙ¿ÚˆÓ Î·È ÙËÓ ¤ÎÎÚÈÛË ÙˆÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛ˘ VLA-4, LFA-1, Mac-1, uPAR. 2. ∆ËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ÙËÓ ¤ÎÊÚ·ÛË ÙˆÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛ˘ E-ÛÂÏÂÎÙ›ÓË, ICAM-1, VCAM-1, MCP-1, ηıÒ˜ Î·È Ù˘ ¯ËÌÂÈÔΛÓ˘ IL-8, [21]. 3. ∆ËÓ ·Ó·ÛÙÔÏ‹ ÙÔ˘ Ì˯·ÓÈÛÌÔ‡ ÂÎÚÔ‹˜ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ·fi Ù· Ì·ÎÚÔÊ¿Á· ‰È·Ì¤ÛÔ˘ ÙÔ˘ ÂȉÈÎÔ‡ ÌÂÙ·ÊÔÚ¤· ABCA-1 (ATP binding cassette transporter A1) Î·È ÙÔ˘ ˘Ô‰Ô¯¤· ÂÎηı·ÚÈÛÙ‹ SR-B1(scavenger receptor B1), Ì ·ÔÙ¤ÏÂÛÌ· ÙÔ Û¯ËÌ·ÙÈÛÌfi ·ÊÚˆ‰ÒÓ Î˘ÙÙ¿ÚˆÓ (™¯‹Ì· 4).
¶·Ú¿ÁÔÓÙ˜ Ô˘ ·˘Í¿ÓÔ˘Ó Ù· PAMPs ÛÙÔ ·›Ì· √È ·ÚÙËڛ˜ ÌÔÚÔ‡Ó Ó· ÂÎÙÂıÔ‡Ó Û PAMPs Ì ‰È¿ÊÔÚÔ˘˜ ÙÚfiÔ˘˜. PAMPs fiˆ˜ Ë ÚˆÙ½ÓË Û‡Ó‰ÂÛ˘ ÙÔ˘ ÏÈÔÔÏ˘Û·Î¯·Ú›ÙË (LBP), Ô LPS, Ë Flagellin, ·ÂÏ¢ıÂÚÒÓÔÓÙ·È ·fi Ù· Á·ÛÙÚÂÓÙÂÚÈο ‚·ÎÙ‹ÚÈ·, Ù· ÔÔ›· ˘¿Ú¯Ô˘Ó ÛÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi ۈϋӷ Û ÌÂÁ¿ÏË ‰È·ıÂÛÈÌfiÙËÙ·. ªÈÎÚfi ÔÛÔÛÙfi ·fi ·˘Ù¿, ÌÔÚ› Ó· ÌÂÙ·ÊÂÚı› ÛÙÔ Î˘ÎÏÔÊÔÚÈÎfi ·ÎfiÌË Î·È Û ۯÂÙÈο Ê˘ÛÈÔÏÔÁÈΤ˜ Û˘Óı‹Î˜. ªÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ¤ÛÙˆ Î·È ÌÈÎÚ‹ ·‡ÍËÛË Ù˘ ÂÓ‰ÔÙÔ͛Ӣ ÛÙÔ Î˘ÎÏÔÊÔÚÈÎfi, ÌÔÚ› Ó· ÙÚÈÏ·ÛÈ¿ÛÂÈ ÙËÓ ·‡ÍËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ηڈÙȉÈ΋ ·ıËÚÔÛÎÏ‹ÚˆÛË. ¢È·ÙÚÔÊÈÎÔ› ·Ú¿ÁÔÓÙ˜ ηıÒ˜ Î·È Ô ÙÚfiÔ˜ ˙ˆ‹˜ Ê·›ÓÂÙ·È Ó· ÂËÚ¿˙Ô˘Ó ÙËÓ ¤ÎıÂÛË ÙˆÓ ·ÚÙËÚÈÒÓ Û PAMPs. √ ηÓfi˜ ÙˆÓ ÙÛÈÁ¿ÚˆÓ ÂÚȤ¯ÂÈ ÌÂÁ¿Ï˜ ÔÛfiÙËÙ˜ ÂÓ‰ÔÙÔ͛Ӣ Î·È ¤¯ÂÈ ‰Âȯı› fiÙÈ Ë ÂÓ‰ÔÙÔÍ›ÓË ÛÙÔ Î˘ÎÏÔÊÔÚÈÎfi ÙˆÓ Î·ÓÈÛÙÒÓ Â›Ó·È ˘„ËÏfiÙÂÚË ·fi fiÙÈ ÛÙÔ˘˜ ÌË Î·ÓÈÛÙ¤˜. √È ‰È·ÈÙËÙÈΤ˜ Û˘Ó‹ıÂȘ Ê·›ÓÂÙ·È Ó· ÌÂÙ·‚¿ÏÔ˘Ó ÛËÌ·ÓÙÈο ÙË Û˘ÁΤÓÙÚˆÛË Ù˘ ÂÓ‰ÔÙÔ͛Ӣ ÛÙÔ ·›Ì·. §È·Ú¿ Á‡̷ٷ ·˘Í¿ÓÔ˘Ó ÙËÓ ÂÓ‰ÔÙÔÍ›ÓË ÛÙÔ Ï¿ÛÌ· ÔÓÙÈÎÒÓ ÂÓÒ ·ÓÙ›ıÂÙ·, Û TLR-4 ∫/√ ÔÓÙ›ÎÈ·, ·Ú·ÙËÚÂ›Ù·È ÛËÌ·ÓÙÈ΋ Ì›ˆÛË Ù˘ ÊÏÂÁÌÔÓ‹˜ ÛÙÔ ·ÚÙËÚÈ·Îfi ÙÔ›¯ˆÌ· Ô˘ ÚÔηÏÂ›Ù·È ·fi ÏÈ·Ú‹ ‰›·ÈÙ· ÏÔ‡ÛÈ· Û ÏÈ·Ú¿ (™¯‹Ì· 5). ∏ ·¯˘Û·ÚΛ· Û˘Ó‰¤ÂÙ·È Ì ·˘ÍË̤ÓË
™¯‹Ì· 5. ¶·Ú¿ÁÔÓÙ˜ Ô˘ ÂËÚ¿˙Ô˘Ó ÙËÓ Û˘ÁΤÓÙÚˆÛË Ù˘ ÂÓ‰ÔÙÔ͛Ӣ ÛÙÔ ·›Ì·.
ÂÓ‰ÔÙÔÍÈÓ·ÈÌ›·. ∏ ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË Û˘Óԉ‡ÂÙ·È ·fi ·‡ÍËÛË ÙˆÓ ÂȤ‰ˆÓ ÙÔ˘ LPS ÛÙÔ ·›Ì·, Ô Ì˯·ÓÈÛÌfi˜ fï˜ ‚Ú›ÛÎÂÙ·È ·ÎfiÌ· ˘fi ‰ÈÂÚ‡ÓËÛË. ¶·Ú¿ÏÏËÏ·, ÔÈ ·ÛıÂÓ›˜ Ì ‰È·‚‹ÙË Ù‡Ô˘ ππ ¤¯Ô˘Ó ·˘ÍË̤ӷ ηٿ 75% ›‰· ÂÓ‰ÔÙÔ͛Ӣ Û ۯ¤ÛË Ì ÙÔ˘˜ ˘ÁÈ›˜. ∆¤ÏÔ˜, Ë ·˘ÍË̤ÓË Û˘ÁΤÓÙÚˆÛË LDL ÛÙÔ Ï¿ÛÌ· ·˘Í¿ÓÂÈ ÙËÓ Î˘ÙÙ·ÚÈ΋ ¢·ÈÛıËÛ›· ÛÙÔ LPS ÂÓÒ ·ÓÙ›ıÂÙ· Ë HDL Â›Ó·È ¤Ó·˜ ·ÔÙÂÏÂÛÌ·ÙÈÎfi˜ ÂÎηı·ÚÈÛÙ‹˜ Ù˘ ÂÓ‰ÔÙÔ͛Ӣ [13].
∏ ›‰Ú·ÛË ÙˆÓ ÂÓ‰ÔÁÂÓÒÓ ÚÔÛ‰ÂÌ¿ÙˆÓ ÙˆÓ TLRs ÛÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË ¢È¿ÊÔÚ· ÂÓ‰ÔÁÂÓ‹ ÚÔÛ‰¤Ì·Ù· ÙˆÓ TLRs Ô˘ ÚÔ¿ÁÔ˘Ó ÙË ÊÏÂÁÌÔÓ‹ ¤¯Ô˘Ó ÚÔÙ·ı› ˆ˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ÚÔ¿ÁÔ˘Ó ÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË ‰È·Ì¤ÛÔ˘ ÙˆÓ TLRs. ™Â ·˘Ù¿ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÔÈ ÚˆÙ½Ó˜ ıÂÚÌÈÎÔ‡ shock (∏eat Shock Proteins (HSPs), Ë ÔÍÂȉˆÌ¤ÓË ÌÔÚÊ‹ Ù˘ LDL, Ù· ÔÍÂȉˆÌ¤Ó· ʈÛÊÔÏÈ›‰È·, ÙÔ ÈÓˆ‰ÔÁfiÓÔ, ÙÔ ÂÈϤÔÓ ÙÌ‹Ì· ∞ Ù˘ ÊÈ‚ÚÔÓÂÎÙ›Ó˘ (EDFA) Î·È ÙÔ ‰È·Ï˘Ùfi ˘·ÏÔ˘ÚÔÓÈÎfi [22] [23]. √ Û·Ê‹˜ ηıÔÚÈÛÌfi˜ ÙˆÓ ÂÓ‰ÔÁÂÓÒÓ ÚÔÛ‰ÂÌ¿ÙˆÓ Â›Ó·È ‰‡ÛÎÔÏÔ˜, ÂÍ·ÈÙ›·˜ ÙˆÓ Û˘Ó¯ÒÓ ÌÔχÓÛÂˆÓ ·fi ·ıÔÁfiÓÔ˘˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ Î·È Ù˘ ÈÛ¯˘Ú‹˜ ‰È¤ÁÂÚÛ˘ Ô˘ ÚÔηÏÔ‡Ó Ù· ÚÔÛ‰¤Ì·Ù¿ ÙÔ˘˜. √È
HSPs Â›Ó·È ÌÈ· ÔÌ¿‰· ÚˆÙÂ˚ÓÒÓ Ô˘ ÂÎÊÚ¿˙ÂÙ·È ·fi ÔÏÏ¿ ·ÙÙ·Ú·, ΢ڛˆ˜ ÛÂ Û˘Óı‹Î˜ stress (ÌÂÙ·‚ÔÏÈÎfi, ÂÚÈ‚·ÏÏÔÓÙÈÎfi), Ì ÛÎÔfi ÙËÓ ÚÔÛÙ·Û›· ÙˆÓ Î˘ÙÙ¿ÚˆÓ Î·È ÙËÓ ·ÔÙÚÔ‹ Ù˘ ΢ÙÙ·ÚÈ΋˜ ‚Ï¿‚˘ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂԇψÛ˘ ÙÔ˘ ÙÚ·‡Ì·ÙÔ˜. √È HSPs ÂÎÊÚ¿˙ÔÓÙ·È ÛÙËÓ ·ıËڈ̷ÙÈ΋ Ͽη Î·È ›Ûˆ˜ Û˘ÓÂÈÛʤÚÔ˘Ó ÛÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË Ì ‰È¿ÊÔÚÔ˘˜ Ì˯·ÓÈÛÌÔ‡˜. ªÂٷ͇ ·˘ÙÒÓ ¤¯ÂÈ ÚÔÙ·ı› fiÙÈ Ô Û˘Ó‰˘·ÛÌfi˜ ·ÓıÚÒÈÓˆÓ HSPs Ì HSPs ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ ÂÓÂÚÁÔÔÈ› ÙÔ ·ÁÁÂÈ·Îfi ÂÓ‰Ôı‹ÏÈÔ, Ù· Ì·ÎÚÔÊ¿Á· Î·È Ù· Ï›· Ì˘˚ο ·ÙÙ·Ú· ‰È·Ì¤ÛÔ˘ ÙˆÓ TLR-2 Î·È TLR-4 Î·È Ù˘ MyD88-ÂÍ·ÚÙÒÌÂÓ˘ ÛËÌ·ÙÔ‰ÔÙÈ΋˜ ÔÚ›·˜. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ë ÔÍÂȉˆÌ¤ÓË LDL ‰È·‰Ú·Ì·Ù›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË ·ÛÎÒÓÙ·˜ ÔÈΛϘ ‰Ú¿ÛÂȘ Û ‰È¿ÊÔÚ· ·ÙÙ·Ú· ÙÔ˘ ·ÚÙËÚÈ·ÎÔ‡ ÙÔȯÒÌ·ÙÔ˜. ¶ÂÈÚ·Ì·ÙÈο ‰Â‰Ô̤ӷ ¤‰ÂÈÍ·Ó fiÙÈ Ë ÂÏ¿¯ÈÛÙ· ÔÍÂȉˆÙÈο ÙÚÔÔÔÈË̤ÓË LDL (mmLDL) ÂÓÂÚÁÔÔÈ›: 1. ΢ÙÙ·ÚÔÛÎÂÏÂÙÈΤ˜ ·ÏÏ·Á¤˜ ÛÙ· Ì·ÎÚÔÊ¿Á· ̤ۈ Ù˘ CD14/TLR4/MyD88 ÔÚ›·˜, 2. ÙËÓ ÚÔÛÎfiÏÏËÛË ÙˆÓ Ï¢ÎÔÎÎ˘Ù¿ÚˆÓ ÛÙÔ ÂÓ‰Ôı‹ÏÈÔ Ì¤Ûˆ Ù˘ ÂÍ·ÚÙÒÌÂÓ˘ TLR4 /MyD88 ÔÚ›·˜ Î·È 3. ‰ÈÂÁ›ÚÂÈ ÙËÓ ¤ÎÎÚÈÛË Î˘ÙÙ·ÚÔÎÈÓÒÓ ·fi Ù· Ì·ÎÚÔÊ¿Á· ‰È·Ì¤ÛÔ˘ ÙfiÛÔ Ù˘ ÂÍ·ÚÙÒÌÂÓ˘ fiÛÔ Î·È Ù˘ ·ÓÂÍ¿ÚÙËÙ˘ TLR4/ MyD88 ÔÚ›·˜. ¶·ÚfiÏ· ·˘Ù¿ Ô
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™¯‹Ì· 6. ¶ÔÚ›˜ ÌÂÙ¿‰ÔÛ˘ Û‹Ì·ÙÔ˜ ÙˆÓ TLRs Ô˘ Ï·Ì‚¿ÓÔ˘Ó ¯ÒÚ· ηٿ ÙËÓ ·Ó¿Ù˘ÍË Ù˘ ·ıËÚÔÛÎÏ‹ÚˆÛ˘. √È TLR 2 Î·È 4 ηıÒ˜ Î·È Ë MyD88 ÂÍ·ÚÙÒÌÂÓË ÔÚ›·, Ê·›ÓÂÙ·È Ó· Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ ÂͤÏÈÍË Ù˘ ·ıËÚÔÛÎÏ‹ÚˆÛ˘ Ì ‰È¤ÁÂÚÛË ·fi ÂÓ‰ÔÁÂÓ‹ Î·È Â͈ÁÂÓ‹ ÚÔÛ‰¤Ì·Ù· (Bjorkbacka H. Curr Opin Lipidol, 17:527533, 2006).
·ÎÚÈ‚‹˜ Ì˯·ÓÈÛÌfi˜ ‰Ú¿Û˘ Ù˘ mmLDL ‰È·Ì¤ÛÔ˘ ÙˆÓ TLRs ‰ÂÓ Â›Ó·È ·ÎfiÌ· Ï‹Úˆ˜ ‰È¢ÎÚÈÓÈṲ̂ÓÔ˜ [24], [25], [26]. ∏ TLR ÔÚ›· Ê·›ÓÂÙ·È Ó· Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË Î·È Ì ¿ÏÏÔ ÙÚfiÔ ¤Ú· ·fi ÙË ÊÏÂÁÌÔÓ‹ Î·È ÙËÓ ·ÓÔÛÔÏÔÁÈ΋ ·¿ÓÙËÛË. √È ˘Ô‰Ô¯Â›˜ X ÙÔ˘ ‹·ÙÔ˜ (LXRs) Â›Ó·È ÌÂÙ·ÁÚ·ÊÈÎÔ› Ú˘ıÌÈÛÙ¤˜ Ù˘ Ì›ˆÛ˘ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ·fi Ù· ·ÊÚÒ‰Ë Î‡ÙÙ·Ú·. ∂ÓÂÚÁÔÔÈÔ‡Ó ÙËÓ ·ÓÙ›ÛÙÚÔÊË ÌÂÙ·ÊÔÚ¿ ¯ÔÏËÛÙÂÚfiÏ˘ Ô˘ ‰È·ÌÂÛÔÏ·‚Â›Ù·È ·fi ÌÂÙ·ÊÔÚ›˜ fiˆ˜ Ô ABCA-1. ™˘ÓıÂÙÈο ÚÔÛ‰¤Ì·Ù· Ô˘ ÂÓÂÚÁÔÔÈÔ‡Ó ÙÔ˘˜ LXRs ÌÂÈÒÓÔ˘Ó ÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË, ÂÓÒ Ë ·Ô˘Û›· ¤ÎÊÚ·Û˘ ÙˆÓ LXRs ÛÙ· Ì·ÎÚÔÊ¿Á· ÙËÓ ÂÈÙ·¯‡ÓÔ˘Ó. µ·ÎÙËÚȷ΋ ‹ ÈÈ΋ ÂÓÂÚÁÔÔ›ËÛË Ù˘ IRF3 ÔÚ›·˜ ÙˆÓ TLR-3 Î·È TLR-4 Ê·›ÓÂÙ·È Ó· ·Ó·ÛÙ¤ÏÏÂÈ ÙË ÌÂÙ·ÁÚ·ÊÈ΋ ÂÓÂÚÁfiÙËÙ· ÙÔ˘ LXRs Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·‡ÍËÛË ÙˆÓ ÂȤ‰ˆÓ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ÛÙ· ·ÊÚÒ‰Ë Î‡ÙÙ·Ú· ¿ÁÔÓÙ·˜ ¤ÙÛÈ ÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË (™¯‹Ì· 6) [27].
¶ÔÏ˘ÌÔÚÊÈÛÌÔ› ÙˆÓ ∆LRs Î·È Ë Û¯¤ÛË ÙÔ˘˜ Ì ÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË ¢È¿ÊÔÚÔÈ ÔÏ˘ÌÔÚÊÈÛÌÔ› ÙˆÓ ÁÔÓȉ›ˆÓ ÙˆÓ TLRs ¤¯Ô˘Ó ÌÂÏÂÙËı› Û ۯ¤ÛË Ì ÙËÓ ·ıËÚÔÛÎÏ‹Úˆ-
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ÛË. ªÂٷ͇ ·˘ÙÒÓ ‰‡Ô ÔÏ˘ÌÔÚÊÈÛÌÔ› Ê·›ÓÂÙ·È Ó· ÂËÚ¿˙Ô˘Ó ÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË Î·È ÙËÓ Î·Ú‰È·ÁÁÂȷ΋ ÓfiÛÔ. √ ÔÏ˘ÌÔÚÊÈÛÌfi˜ Asp299Gly ÙÔ˘ TLR-4 ¤¯ÂÈ ÂÎÙÂÓÒ˜ ÌÂÏÂÙËı› Î·È Û‡Ìʈӷ Ì ٷ ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ÌÂÏÂÙÒÓ ·˘ÙÒÓ Û˘Óԉ‡ÂÙ·È ·fi ÌÂȈ̤ÓË ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘ Ì˯·ÓÈÛÌÔ‡ ÌÂÙ¿‰ÔÛ˘ Û‹Ì·ÙÔ˜ ‰È·Ì¤ÛÔ˘ ÙÔ˘ TLR-4 ÁÈ· ÙËÓ ·Ú·ÁˆÁ‹ ΢ÙÙ·ÚÔÎÈÓÒÓ [28]. ™Â ÎÏÈÓÈÎfi ›‰Ô, Ô ÔÏ˘ÌÔÚÊÈÛÌfi˜ ·˘Ùfi˜ Û˘Óԉ‡ÂÙ·È ·fi ÌÂȈ̤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ·ıËÚÔÛÎÏ‹ÚˆÛË Î·È ÁÈ· Ô͇ ÛÙÂÊ·ÓÈ·›Ô Û‡Ó‰ÚÔÌÔ [28]. ŒÓ·˜ ¿ÏÏÔ˜ ÔÏ˘ÌÔÚÊÈÛÌfi˜ Ô˘ ¤¯ÂÈ Èı·ÓÒ˜ ÛËÌ·Û›· ÁÈ· ÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË Î·È ÙËÓ Î·Ú‰È·ÁÁÂȷ΋ ÓfiÛÔ Â›Ó·È Ô ÔÏ˘ÌÔÚÊÈÛÌfi˜ Arg 753Gln ÙÔ˘ ˘Ô‰Ô¯¤· TLR-2 Ô ÔÔ›Ô˜ Ê·›ÓÂÙ·È Ó· Â›Ó·È ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ·ıËڈ̿وÛË Î·È ÛÙ¤ÓˆÛË ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÚÙËÚÈÒÓ [29].
º·ÚÌ·ÎÔÏÔÁÈΤ˜ Î·È ‰È·ÈÙËÙÈΤ˜ ·ÚÂÌ‚¿ÛÂȘ ∏ ÁÓÒÛË ÙˆÓ Ì˯·ÓÈÛÌÒÓ ‰È·Ì¤ÛÔ˘ ÙˆÓ ÔÔ›ˆÓ Ù· PAMPs ‰ÈÂÁ›ÚÔ˘Ó ÙËÓ ·Ó¿Ù˘ÍË Ù˘ ·ıËڈ̷ÙÈ΋˜ Ͽη˜, ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ ÛÙËÓ ·Ó¿Ù˘ÍË ÂÍÂȉÈÎÂ˘Ì¤ÓˆÓ ·ÓÙ·ÁˆÓÈÛÙÒÓ ÙˆÓ TLRs ‹ ·Ó·ÛÙÔϤˆÓ Ù˘ ÛËÌ·ÙÔ‰ÔÙÈ΋˜ ÔÚ›·˜ ‰È·Ì¤ÛÔ˘ Ù˘ ÔÔ›·˜ ·˘-
ÙÔ› ÂÓÂÚÁÔÔÈÔ‡Ó Ù· ·ÙÙ·Ú·. ªÈ· Ù¤ÙÔÈ· ÚÔÛ¤ÁÁÈÛË ı· ÌÔÚÔ‡Û ӷ Ô‰ËÁ‹ÛÂÈ Û Ôχ ηϿ ıÂڷ¢ÙÈο ·ÔÙÂϤÛÌ·Ù· ·ÊÔ‡ Ù· ·ÓÙÈ‚ÈÔÙÈο ¤¯Ô˘Ó ·Ô‰Âȯı› ·Ó·ÔÙÂÏÂÛÌ·ÙÈο, ÂÓÒ Ë Ì·ÎÚÔ¯ÚfiÓÈ· ¯ÔÚ‹ÁËÛË ÙˆÓ ˘·Ú¯fiÓÙˆÓ ·ÓÙÈÊÏÂÁÌÔÓˆ‰ÒÓ Ê·ÚÌ¿ÎˆÓ ÌÔÚ› Ó· ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·Ó·ÛÙÔÏ‹ ÂȉÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Ì Èı·Ófi ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·ÓÔÛÔηٷÛÙÔÏ‹. ∞fi Ù· ˘¿Ú¯ÔÓÙ· Ê¿Ú̷η, ÛËÌ·ÓÙÈ΋ ·Ó·ÛÙ·ÏÙÈ΋ ‰Ú¿ÛË ˆ˜ ÚÔ˜ ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ·ÚÙËÚÈ·ÎÔ‡ ÙÔȯÒÌ·ÙÔ˜ ‰È·Ì¤ÛÔ˘ ÙˆÓ TLRs Ê·›ÓÂÙ·È Ó· ¤¯Ô˘Ó ÔÈ ÛÙ·Ù›Ó˜ fiˆ˜ Ë ·ÙÔÚ‚·ÛÙ·Ù›ÓË Î·È Ë ÏÔ‚ÔÛÙ·Ù›ÓË, ÔÈ Ôԛ˜ Û ÂÈÚ·Ì·ÙÈΤ˜ ÌÂϤÙ˜ ·Ó¤ÛÙÂÈÏ·Ó ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ·ÚÙËÚÈ·ÎÔ‡ ÙÔȯÒÌ·ÙÔ˜ ·fi ÙÔÓ LPS ̤ۈ ÂÓfi˜ Ì˯·ÓÈÛÌÔ‡ ·ÓÂÍ¿ÚÙËÙÔ˘ ·fi ÙË Ì›ˆÛË ÙˆÓ ÂȤ‰ˆÓ Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ ÛÙÔ Ï¿ÛÌ·. ∂›Û˘, ÔÈ ıÈ·˙ÔÏȉÈÓ‰ÈfiÓ˜ Ô˘ ¯ÔÚËÁÔ‡ÓÙ·È Û ·ÛıÂÓ›˜ Ì ‰È·‚‹ÙË Ù‡Ô˘ ππ ÌÂÈÒÓÔ˘Ó Ù· ›‰· ÙÔ˘ LPS Û ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Î·È Â›Û˘ ·Ó·ÛÙ¤ÏÏÔ˘Ó ÙËÓ ÔÚ›· ÛËÌ·ÙÔ‰fiÙËÛ˘ ‰È·Ì¤ÛÔ˘ ÙˆÓ TLRs. ¶¤Ú· fï˜ ·fi Ê·ÚÌ·ÎÔÏÔÁÈΤ˜ ·ÚÂÌ‚¿ÛÂȘ ˘¿Ú¯ÂÈ Î·È Ë ‰È·ÙÚÔÊÈ΋ ÚÔÛ¤ÁÁÈÛË ˆ˜ ÚÔ˜ ÙË Ì›ˆÛË Ù˘ ÊÏÂÁÌÔÓ‹˜ Ô˘ ÚÔηÏÂ›Ù·È ·fi Ù· PAMPs. ¢›·ÈÙ˜ ÏÔ‡ÛȘ Û ˆ-3 ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ· (PUFAs) ¤‰ÂÈÍ·Ó fiÙÈ ÌÂÈÒÓÔ˘Ó ÙËÓ Â˘·ÈÛıËÛ›· ÙˆÓ ÌÔÓÔ΢ÙÙ¿ÚˆÓ ÛÙÔ LPS Û ÌÂϤÙ˜ Ì ·ÓıÚÒÔ˘˜ ηıÒ˜ Î·È fiÙÈ ÙÔ ÂÈÎÔÛ·ÂÓÙ·ÂÓÔ˚Îfi Ô͇ (EPA) Î·È ÙÔ ÂÈÎÔÛȉ˘ÔÂÍ·ÓÔ˚Îfi Ô͇ (DHA) Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈÎÔ› ·Ó·ÛÙÔÏ›˜ Ù˘ ÔÚ›·˜ ÙˆÓ TLR invitro. ∆Ô ÂÏ·ÈfiÏ·‰Ô Î·È Ë ÚÂÛ‚ÂÚ·ÙÚfiÏË Â›Û˘ ·Ó·ÛÙ¤ÏÏÔ˘Ó ÙËÓ Î˘ÙÙ·ÚÈ΋ ÛËÌ·ÙÔ‰fiÙËÛË ‰È·Ì¤ÛÔ˘ ÙÔ˘ LPS in vitro. ∂›Û˘ ‰È·ÙÚÔÊÈΤ˜ ÚÔÛÂÁÁ›ÛÂȘ Ô˘ ÌÂÈÒÓÔ˘Ó ÙËÓ ÂÓ‰ÔÙÔÍ·ÈÌ›· ̤ۈ Ù˘ Ú‡ıÌÈÛ˘ Ù˘ ÌÈÎÚԂȷ΋˜ ¯ÏˆÚ›‰·˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘ ‰ÂÓ Ú¤ÂÈ Ó· ·ÔÎÏ›ÔÓÙ·È. ∆· ÚԂȈÙÈο, ˙ˆÓÙ·Ó‹ ÌÈÎÚԂȷ΋ ÙÚÔÊ‹ Ô˘ ‚ÂÏÙÈÒÓÂÈ ÙË ÌÈÎÚԂȷ΋ ÈÛÔÚÚÔ›· ÛÙÔ ¤ÓÙÂÚÔ, ÌÂÈÒÓÔ˘Ó ÙËÓ ÂÓ‰ÔÙÔÍ›ÓË ÛÙÔ ¤ÓÙÂÚÔ ‚ÂÏÙÈÒÓÔÓÙ·˜ ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘. °È· ·Ú¿‰ÂÈÁÌ· Ô Ï·ÎÙÔ‚¿ÎÈÏÔ˜ ¤‰ÂÈÍ fiÙÈ ÌÂÈÒÓÂÈ ÛËÌ·ÓÙÈο ÙËÓ ÂÓ‰ÔÙÔÍ·ÈÌ›· Û ‰ÈÂÁÂṲ́ÓÔ Ì ·ÏÎÔfiÏË ¤ÓÙÂÚÔ ÔÓÙÈÎÔ‡. ∆· ÚÔ˚fiÓÙ· ˙‡ÌˆÛ˘
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¶∞£√ºÀ™π√§√°π∞ ·fi ÚԂȈÙÈο ›‰Ë ¤‰ÂÈÍ·Ó fiÙÈ ‚ÂÏÙÈÒÓÔ˘Ó ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÂÓÙ¤ÚÔ˘ ÂÓÒ Ë ÔÛfiÙËÙ· Ù˘ ÂÓ‰ÔÙÔ͛Ӣ ÌÂÈÒÓÂÙ·È ÛËÌ·ÓÙÈο. √È Ï·ÎÙÔ‚¿ÎÈÏÔÈ ·fi ÚԂȈÙÈο ‹ Ú‚ȈÙÈο Û˘ÌÏËÚÒÌ·Ù· ‰È·ÙÚÔÊ‹˜ Ê·›ÓÂÙ·È Â›Û˘ fiÙÈ ÌÂÈÒÓÔ˘Ó ÙËÓ ÂÓ‰ÔÙÔÍ·ÈÌ›· ÛÙÔÓ ¿ÓıÚˆÔ.
™˘ÌÂÚ·ÛÌ·ÙÈο, ÔÈ TLRs ‰È·‰Ú·Ì·Ù›˙Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË ÂÓÂÚÁÔÔÈÒÓÙ·˜ ÔχÏÔÎÔ˘˜ ÛËÌ·ÙÔ‰ÔÙÈÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜ Û ·ÙÙ·Ú· ÙÔ˘ ·ÚÙËÚÈ·ÎÔ‡ ÙÔȯÒÌ·ÙÔ˜. ∏ ÂÚ·ÈÙ¤Úˆ ηٷÓfiËÛË ÙˆÓ Ì˯·ÓÈÛÌÒÓ ·˘ÙÒÓ Î·ıÒ˜ Î·È Ë ‰È·Ï‡ηÓÛË ÙˆÓ Û˘ÓıËÎÒÓ Ô˘ ÂË-
Ú¿˙Ô˘Ó Ù· ›‰· ÙˆÓ PAMPs ÛÙÔ Ï¿ÛÌ· ÌÔÚ› Ó· Ô‰ËÁ‹ÛÔ˘Ó ÛÙËÓ ·Ó¿Ù˘ÍË ÂÍÂȉÈÎÂ˘Ì¤ÓˆÓ ıÂڷ¢ÙÈÎÒÓ ÚÔÛÂÁÁ›ÛÂˆÓ Î·ıÒ˜ Î·È ‰È·ÈÙËÙÈÎÒÓ ·ÚÂÌ‚¿ÛÂˆÓ ÁÈ· ÙËÓ ÚfiÏË„Ë ‹ Î·È ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ·ıËÚÔÛÎÏ‹ÚˆÛ˘ Î·È Ù˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘.
13. Michelson K.S., Wong M.H., Shah P.K., Zhang W., Yano J., Doherty T.M., et al. (2004) Lack of Toll-like receptor 4 or myeloid differentiation factor 88 reduces atherosclerosis and alters plaque phenotype in mice deficient in apolipoprotein E. Proc Natl Acad Sci USA 101:10679-10684.
21. Erridge C. (2008) The Roles of Pathogen- Associated Molecular Patterns in Atherosclerosis. Trends Cardiovasc Med 18:52-56.
µÈ‚ÏÈÔÁÚ·Ê›· 1. Hopkins PA, Sriskandan S. (2005) Mammalian Toll-like receptors: to immunity and beyong. Clin. Exp. Immunol. 140:395-407. 2. Medzhitov R, Preston-Hurlburt P, Janeway CA Jr. (1997) A human homologue of the Drosophila Toll protein signals activation of adaptive immunity. Nature 388(6640):394-7. 3. Takeda K, Kaisho T, Akira S. (2003) Toll-like receptors. Annu. Rev. Immunol. 21:335-76. 4. Akira S and Takeda K, (2004) Toll-like receptors signaling. Immunology 4: 499-511. 5. Akira S, Takeda K, Kaiso T (2001). Toll-like receptors; critical proteins linking innate and acquired immunity. Nat. Immunol. 2:675-80. 6. Frantz S, Bauersachs J, Kelly RA. (2005) Innate immunity and the heart. Curr Pharm Des. 11:1279-1290. 7. Akira S et al. (2006) Pathogen recognition and innate immunity. Cell 124: 783-801. 8. Wang C, Deng L, Hong M, Akkaraju GR, Inoue J, Chen ZJ (2001). TAK1 is a ubiquitin-dependent kinase of MKK and IKK. Nature 412:346-51. 9. Edfeldt K., Swedenborg J., Hansson G. K. and Yan Z.-qun (2002) Expression of Toll Like Receptors in Human Atherosclerotic Lesions A Possible Pathway for Plaque Activation Circulation 105:1158-1161 10. Ishikawa Y., Satoh M., Itoh T., Minami Y., Takahashi Y., Akamura M. (2008) Local expression of Toll-like receptor 4 at the site of ruptured plaques in patients with acute myocardial infarction Clinical Science 115:133-140 11. Frantz S., Ertl G. and Bauersachs J. (2007) Mechanisms of Disease: Tolllike receptors in cardiovascular disease Nat Clin Pract Cardiovasc Med. 4: 444-454 12. Methe H, Kim JO, Kofler S, Weis M, Nabauer M, Koglin J. (2005) Expansion of circulating Toll-like receptor 4-positive monocytes in patients with acute coronary syndrome. Circulation. 111(20):265461.
14. Liu X., Ukai T, Yumoto H., Davey M., Goswami S.,. Gibson III F., Genco C. (2008) Toll-like receptor 2 plays a critical role in the progression of atherosclerosis that is independent of dietary lipids. Atherosclerosis 196(1): 146-154. 15. Johnson G.B., Riggs B.L., Platt J.L.. (2004) A genetic basis for the Adonis phenotype of low adiposity and strong bones. FASEB J 18:1282-1284. 16. Schoneveld A.H., Hoefer I., Sluijter J.P.G., Lamanc J.D., de Kleijn D.P.V, Pasterkamp G. (2008) Atherosclerotic lesion development and Toll like receptor 2 and 4 responsiveness. Atherosclerosis 197: 95-104. 17. Saikku, P., Leinonen M., Mattila K., Ekman M.R., Nieminen M.S., Makela P.H., Huttunene J. K., and Valtonen V. (1988) Serological evidence of an association of a novel Chlamydia, TWAR, with chronic heart disease and acute myocardial infarction. Lancet 2:983. 18. Lepper P M., Schumann C., Triantafilou K., Rasche F. M., Schuster T., Frank H., Schneider E. M, Triantafilou M., M. von Eynatten (2007) Association of LipopolysaccharideBinding Protein and Coronary Artery Disease in Men. J Am Coll Cardiol. 50(1) 25-31 19. Kiechl, S., Egger G., Mayr M., Wiedermann C.J., Bonora E., Oberhollenzer F., Muggeo M., Xu Q., Wick G., Poewe W., and Willeir J. (2001) Cronic infections and the risk of carotid atherosclerosis: prospective results from a large population study. Circulation 103:1064. 20. Lynn L. Stoll, Gerene M. Denning, Neal L. Weintraub. (2004) Potential Role of Endotoxin as a Proinflammatory Mediator of Atherosclerosis Arterioscler. Thromb. Vasc. Biol. 24: 2227-2236.
22. Rick de Graaf, Kloppenburg G, Kitslaar P J.H.M.,. Bruggeman C A., Stassen F. (2006) Human heat shock protein 60 stimulates vascular smooth muscle cell proliferation through Toll-like receptors 2 and 4. Microbes and Infection 8(7): 18591865. 23. Okamura Y, Watari M, Jerud ES, Young DW, Ishizaka ST, Rose J, Chow JC, Strauss JF 3rd. (2001) The extra domain A of fibronectin activates Toll-like receptor 4. J Biol Chem. 276(13):10229-33. 24. Binder, C.J.S. Horkko, A. Dewan, M.K. Chang, E.P.Kieu C.S. Goodyear, P.X. Shaw,W. Palinski, JL. Witztum and G J Silverman (2003). Pneumococcal vaccination decreases atherosclerosis lesion formation: molecular mimicry between Streptococcus pneumoniae and oxidized LDL. Nat. Med. 9:736 25. Yeh M., Leitinger N. and R. de Martin et al., (2001) Increased transcription of IL-8 in endothelial cells is differentially regulated by TNF-a and oxidised phospholipids. Arterioscler Thromb Vasc Biol 21:1585-1591 26. Erridge C, Webb D J., Spickett C M. (2007) Toll-like receptor 4 signalling is neither sufficient nor required for oxidised phospholipid mediated induction of interleukin-8 expression Atherosclerosis 193(1): 77-85. 27. Bjorkbacka H. (2006) Multiple roles of Toll-like receptor signaling in atherosclerosis Curr Opin Lipidol 17:527-533 28. Kiechl S, Lorenz E, Reindl M, Wiedermann CJ, Oberhollenzer F, Bonora E, Willeit J, Schwartz DA. (2002) Toll-like receptor-4 polymorphisms and atherosclerosis N Engel J Med 347(3):185-192 29. Hamann L, Gomma A, Schröder NW, Stamme C, Glaeser C, Schulz S, Gross M, Anker SD, Fox K, Schumann RR (2005) A frequent toll-like receptor (TLR)-2 polymorphism is a risk factor for coronary restenosis J Mol Med. 83(6):478-85
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∞ÓÙÈÏ‹„ÂȘ ÙÔ˘ ¶ÏËı˘ÛÌÔ‡ ÁÈ· ÙÔ ƒfiÏÔ Ù˘ ¢È·ÙÚÔÊ‹˜ ÛÙËÓ ∫·Ú‰È·ÁÁÂȷ΋ ¡fiÛÔ. ¶ÈÏÔÙÈο ™ÙÔȯ›· ·fi ÙËÓ ¶·ÓÂÏÏ·‰È΋ ŒÚ¢ӷ Ù˘ √Ì¿‰·˜ ∂ÚÁ·Û›·˜ ∂ȉËÌÈÔÏÔÁ›·˜ & ¶ÚfiÏ˄˘ Ù˘ ∞ıËÚÔÛÎÏ‹ÚˆÛ˘ Ù˘ ∂ÏÏËÓÈ΋˜ ∂Ù·ÈÚ›·˜ ∞ıËÚÔÛÎÏ‹ÚˆÛ˘ ∞Ì·Ï›· °ÈˆÙÔÔ‡ÏÔ˘, ∂ο‚Ë °ÂˆÚÁÔ˘ÛÔÔ‡ÏÔ˘, ¢È·ÈÙÔÏfiÁÔÈ - ¢È·ÙÚÔÊÔÏfiÁÔÈ ∆Ì‹Ì·ÙÔ˜ ∂ÈÛÙ‹Ì˘ ¢È·ÈÙÔÏÔÁ›·˜-¢È·ÙÚÔÊ‹˜, ÷ÚÔÎÔ›Ԣ ¶·ÓÂÈÛÙËÌ›Ô˘
∞ı·Ó¿ÛÈÔ˜ ¶··ı·Ó·Û›Ô˘, π·ÙÚfi˜ - ∫·Ú‰ÈÔÏfiÁÔ˜, π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ ∂˘¿ÁÁÂÏÔ˜ ¶ÔÏ˘¯ÚÔÓfiÔ˘ÏÔ˜, ∂ÈÎ. ∫·ıËÁËÙ‹˜ ∆Ì‹Ì·ÙÔ˜ ∂ÈÛÙ‹Ì˘ ¢È·ÈÙÔÏÔÁ›·˜ ¢È·ÙÚÔÊ‹˜ ÷ÚÔÎÔ›Ԣ ¶·ÓÂÈÛÙËÌ›Ô˘
¢ËÌÔÛı¤Ó˘ ¶·Ó·ÁȈٿÎÔ˜, ∞Ó·Ï. ∫·ıËÁËÙ‹˜ ∆Ì‹Ì·ÙÔ˜ ∂ÈÛÙ‹Ì˘ ¢È·ÈÙÔÏÔÁ›·˜ ¢È·ÙÚÔÊ‹˜ ÷ÚÔÎÔ›Ԣ ¶·ÓÂÈÛÙËÌ›Ô˘
πˆ¿ÓÓ˘ °Ô˘‰¤‚ÂÓÔ˜, ∫·ıËÁËÙ‹˜, π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ ∂ÈÛ·ÁˆÁ‹ ∆· ηډȷÁÁÂȷο ÓÔÛ‹Ì·Ù· ·ÔÙÂÏÔ‡Ó ÙËÓ ÚÒÙË ·ÈÙ›· ı·Ó¿ÙÔ˘ fiÛÔÓ ·ÊÔÚ¿ ÙȘ ÌË ÌÂÙ·‰ÔÙÈΤ˜ ·Ûı¤ÓÂȘ, ηıÒ˜ ·ÔÙÂÏÔ‡Ó ÙÔ 30% fiÏˆÓ ÙˆÓ ı·Ó¿ÙˆÓ ·ÁÎÔÛÌ›ˆ˜ [1,2]. ™‡Ìʈӷ Ì ÙËÓ ∂ıÓÈ΋ ™Ù·ÙÈÛÙÈ΋ ÀËÚÂÛ›· Ù˘ ∂ÏÏ¿‰Ô˜ (∂™À∂) ÂÚ›Ô˘ 51600 ı¿Ó·ÙÔÈ (ÂÚ›Ô˘ 49%) Û ۇÓÔÏÔ 105529 ı·Ó¿ÙˆÓ, ÙÔ 2003 ÔÊ›ÏÔÓÙ·Ó Û ηډȷÁÁÂȷΤ˜ ·ı‹ÛÂȘ [3], ÂÓÒ Û‡Ìʈӷ Ì ÛÙÔȯ›· ÙÔ˘ ¶·ÁÎfiÛÌÈÔ˘ √ÚÁ·ÓÈÛÌÔ‡ ÀÁ›·˜, ÁÈ· ÙÔ ¤ÙÔ˜ 2002 ÔÈ Î·Ú‰È·ÁÁÂȷΤ˜ ·ı‹ÛÂȘ ‹Ù·Ó ÔÈ ÚÒÙ˜ ·Èٛ˜ ı·Ó¿ÙÔ˘ ÛÙËÓ ∂ÏÏ¿‰· Ì ÙÔ 35% ÙˆÓ ı·Ó¿ÙˆÓ Ó· ·Ô‰›‰ÔÓÙ·È Û ·˘Ù¤˜ [4, 5]. √È ¿Ó‰Ú˜ ÂÌÊ·Ó›˙Ô˘Ó ÌÂÁ·Ï‡ÙÂÚË ıÓËÛÈÌfiÙËÙ· ·fi ÙȘ Á˘Ó·›Î˜ Î·È ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ¯ÒÚ˜ Ù˘ ∂˘ÚÒ˘. ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ∂ÏÏ¿‰·, Ô Ú˘ıÌfi˜ ı·Ó¿ÙˆÓ ·Ú·Ì¤ÓÂÈ Û¯ÂÙÈο ÛÙ·ıÂÚfi˜ ·fi ÙÔ 1999 ̤¯ÚÈ ÙÔ 2005, ·ÓÙ›ıÂÙ· Ì ÙÔ Û‡ÓÔÏÔ ÙˆÓ ∂˘Úˆ·˚ÎÒÓ ¯ˆÚÒÓ fiÔ˘ Ô Ú˘ıÌfi˜ Ê·›ÓÂÙ·È Ó· ÌÂÈÒÓÂÙ·È [6]. ¶¿Óˆ ·fi 300 ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛÙ› Ì ٷ ηډȷÁÁÂȷο ÓÔÛ‹Ì·Ù·. ∫¿ÔÈÔÈ ·fi ÙÔ˘˜ ÛËÌ·ÓÙÈÎfiÙÂÚÔ˘˜ ·Ú¿ÁÔÓÙ˜, fiˆ˜ Ë ËÏÈΛ·, Â›Ó·È ÌË ÙÚÔÔÔÈ‹ÛÈÌÔÈ ÂÓÒ Î¿ÔÈÔÈ ¿ÏÏÔÈ Â›Ó·È ÙÚÔÔÔÈ‹ÛÈÌÔÈ Î·È ÌÔÚÔ‡Ó Ó· ÚÔÏËÊıÔ‡Ó ‹ Ó· ·ÓÙÈÌÂÙˆÈÛÙÔ‡Ó Ì ÛÎÔfi ÙË Ì›ˆÛË ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘. ∞fi ÙÔ Û‡ÓÔÏÔ ·˘ÙÒÓ ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÔÈ ÎÏ·ÛÛÈÎÔ› ·Ú¿ÁÔÓÙ˜, fiˆ˜ οÓÈÛÌ·, ˘ÂÚÏÈȉ·ÈÌ›·, ˘¤ÚÙ·ÛË Î·È Û·Î-
8
¯·Ú҉˘ ‰È·‚‹Ù˘ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙË Î·ıÈÛÙÈ΋ ˙ˆ‹ Î·È ÙËÓ ·Óı˘ÁÈÂÈÓ‹ ‰È·ÙÚÔÊ‹, ÈÛÙ‡ÂÙ·È fiÙÈ ÌÔÚÔ‡Ó Ó· ÂÍËÁ‹ÛÔ˘Ó Ì¤¯ÚÈ Î·È ÙÔ 75% ÙˆÓ ÂÂÈÛÔ‰›ˆÓ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ ÛÙ· ¿ÙÔÌ· ÂÓfi˜ ÏËı˘ÛÌÔ‡ [7-9]. ∞Ó·ÊÔÚÈο Ì ÙË ‰È·ÙÚÔÊ‹, ·ÔÙÂÏ› ȉȷ›ÙÂÚ· ÛËÌ·ÓÙÈÎfi ·Ú¿ÁÔÓÙ· ÛÙËÓ Â›ÙˆÛË ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ. ª¿ÏÈÛÙ·, ÔÏÏÔ› ·fi ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· Ù· ηډȷÁÁÂȷο ÓÔÛ‹Ì·Ù· ¤¯ÂÈ Ê·Ó› fiÙÈ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ‰È·ÙÚÔÊ‹ [9]. º·›ÓÂÙ·È, ÏÔÈfiÓ fiÙÈ Ë Â›‰Ú·Û‹ Ù˘ ‰È·ÙÚÔÊ‹˜ ÛÙËÓ Î·Ú‰È·ÁÁÂȷ΋ ÓfiÛÔ Â›Ó·È Ì¤Ûˆ Ù˘ ÙÚÔÔÔ›ËÛ˘ Ô˘ ÚÔηÏ› ÛÙȘ ÙÈ̤˜ ÙˆÓ ÏÈȉ›ˆÓ ÙÔ˘ ÔÚÔ‡, Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ Î·È Ù˘ ·¯˘Û·ÚΛ·˜ [10]. °È· ÂÚÈÛÛfiÙÂÚÔ ·fi 40 ¯ÚfiÓÈ·, ‰È¿ÊÔÚ˜ ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜, Î·È ÎÏÈÓÈΤ˜ ‰ÔÎÈ̤˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ÏËıÒÚ· ‰È·ÙÚÔÊÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÂËÚ¿˙Ô˘Ó Ù· ÏÈ›‰È· ÙÔ˘ ÔÚÔ‡, ÙËÓ ·ıËÚÔÁ¤ÓÂÛË Î·È ÙËÓ Î·Ú‰È·ÁÁÂȷ΋ ÓÔÛËÚfiÙËÙ·. √È Î˘ÚÈfiÙÂÚÔÈ ‰È·ÙÚÔÊÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ô˘ ÌÔÚÔ‡Ó Ó· ·˘Í‹ÛÔ˘Ó ÙÔ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ Â›Ó·È Ù· ÎÔÚÂṲ̂ӷ ÏÈ·Ú¿ Ôͤ·, Ù· trans-ÌÔÓÔ·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ·, Ë ‰È·ÈÙËÙÈ΋ ¯ÔÏËÛÙÂÚfiÏË, Ë ˘„ËÏ‹ ÚfiÛÏË„Ë ˘‰·Ù·ÓıÚ¿ÎˆÓ ¯·ÌËÏÒÓ ÛÂ Ê˘ÙÈΤ˜ ›Ó˜, Ë ˘„ËÏ‹ ÚfiÛÏË„Ë Ó·ÙÚ›Ô˘ Î·È Ë ˘ÂÚ‚ÔÏÈ΋ ηٷӿψÛË ·ÏÎÔfiÏ [1113]. ¶·ÚfiÏ· ·˘Ù¿, ÙËÓ ›‰È· ÛÙÈÁÌ‹ Ô˘ Ë ÂÈÛÙËÌÔÓÈ΋ ¤Ú¢ӷ Î·È ÔÈ ÁÓÒÛÂȘ ÁÈ· ÙË Û¯¤ÛË ‰È·ÙÚÔÊ‹˜ Ì ÙËÓ ˘Á›· ‰È¢ڇÓÔÓÙ·È ‰È·ÚÎÒ˜, Ô ÁÂÓÈÎfi˜ ÏËı˘ÛÌfi˜ ÂÌÊ·-
Ó›˙ÂÙ·È fiÏÔ Î·È ÈÔ ·ÓÂÓË̤ڈÙÔ˜ Û ı¤Ì·Ù· ‰È·ÙÚÔÊ‹˜. ª¿ÏÈÛÙ·, ·Ó Î·È Ë ·Óı˘ÁÈÂÈÓ‹ ‰È·ÙÚÔÊ‹ ¤¯ÂÈ ·Ó·‰Âȯı› ˆ˜ Ì›˙ˆÓ ·Ú¿ÁˆÓ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘, Ë ÛÙ¿ÛË Î·È ÔÈ ·ÓÙÈÏ‹„ÂȘ ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘ÛÌÔ‡ ·¤Ó·ÓÙÈ Û ·˘Ù‹ ÙËÓ ıÂÒÚËÛË ‰ÂÓ ¤¯ÂÈ ‰ÈÂÚ¢ÓËı›, ȉȷ›ÙÂÚ· ÛÙËÓ ∂ÏÏ¿‰·. °È· ÙÔ ÏfiÁÔ ·˘Ùfi Ë ∂ÏÏËÓÈ΋ ∂Ù·ÈÚ›· ∞ıËÚÔÛÎÏ‹ÚˆÛ˘ Ú·ÁÌ·ÙÔÔÈ› ·fi ÙÔ 2007 ÌÈ·, ÌÂÁ¿Ï˘ Îϛ̷η˜, ÂȉËÌÈÔÏÔÁÈ΋ ¤Ú¢ӷ Ì ÛÙfi¯Ô ÙËÓ Î·Ù·ÁÚ·Ê‹ ·ÓÙÈÏ‹„ÂˆÓ Û¯ÂÙÈ˙fiÌÂÓˆÓ Ì ÙÔ˘˜ ÎÏ·ÛÛÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘, ηıÒ˜ Î·È Ì ÙÔÓ Û‡Á¯ÚÔÓÔ ÙÚfiÔ ˙ˆ‹˜ Î·È ÙË ‰È·ÙÚÔÊ‹ ÂȉÈÎfiÙÂÚ·. ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜ Â›Ó·È Ë ·ÔÙ›ÌËÛË ÙˆÓ ÁÓÒÛÂˆÓ Î·È ÙˆÓ ·ÓÙÈÏ‹„ÂˆÓ ÙˆÓ ·ÙfiÌˆÓ ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘ÛÌÔ‡ Û ۯ¤ÛË Ì ÙË ‰È·ÙÚÔÊ‹ ˆ˜ ·Ú¿ÁÔÓÙ· ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘.
ªÂıÔ‰ÔÏÔÁ›· ¢Â›ÁÌ· Ù˘ ¤Ú¢ӷ˜ ∫·Ù¿ Ù· ¤ÙË 2007 Î·È 2008, Û˘ÏϤ¯ıËΠÏËÚÔÊÔÚ›· ·fi ¤Ó· Ù˘¯·›· ÂÈÏÂÁ̤ÓÔ ‰Â›ÁÌ· 3218 ÂÓ‹ÏÈÎˆÓ ·ÙfiÌˆÓ ·fi ‰È¿ÊÔÚ˜ fiÏÂȘ Ù˘ ∂ÏÏ¿‰·˜. ∞fi ÙÔ Û‡ÓÔÏÔ ·˘ÙÒÓ ÙˆÓ ·ÙfiÌˆÓ ÙÔ 44,4% (Ó=1428) Â›Ó·È ¿Ó‰Ú˜ ̤Û˘ ËÏÈΛ·˜ 40±16 ÂÙÒÓ Î·È ÙÔ 55,6% (Ó=1790) Â›Ó·È Á˘Ó·›Î˜ ̤Û˘ ËÏÈΛ·˜ 38±15 ÂÙÒÓ. ™˘ÁÎÂÎÚÈ̤ӷ, Ë ·ÚÔ‡Û· ‰ÂÈÁÌ·ÙÔÏË„›· ¤ÁÈÓ ÛÙÔ˘˜ ÓÔÌÔ‡˜: ∞ÙÙÈ΋˜, πˆ·ÓÓ›ÓˆÓ, ÕÚÙ·˜, ∏Ï›·˜, §·ÎˆÓ›·˜, ∞Ú牛·˜, ∞¯·˝·˜, §¿ÚÈÛ·˜, ƒfi‰Ô˘ Î·È Ã›Ô˘. ∆Ô ÙÂÏÈÎfi ‰Â›ÁÌ· Ù˘
ATHIROSK 21-
05-03-09
12:25
™ÂÏ›‰·9
∂¶π¢∏ªπ√§√°π∞ - ¶∞ƒ∞°√¡∆∂™ ∫π¡¢À¡√À ¤Ú¢ӷ˜ ı· ÂÚÈÏ·Ì‚¿ÓÂÈ 5000 ¿ÙÔÌ· ·fi fiÏË ÙË ¯ÒÚ·. ∂ÓÒ, ÙÔ ·ÚfiÓ ‰Â›ÁÌ· ¯ÚËÛÈ̇ÂÈ ÁÈ· ÙËÓ ÈÏÔÙÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ ÛÙÔȯÂÈÒÓ Ù˘ ¤Ú¢ӷ˜. ∏ ¤Ú¢ӷ ‰ÈÂÍ¿ÁÂÙ·È ˘fi ÙËÓ ·ÈÁ›‰· Ù˘ ∂ÏÏËÓÈ΋˜ ∂Ù·ÈÚ›·˜ ∞ıËÚÔÛÎÏ‹ÚˆÛ˘ Î·È Î·Ù¿ ÙË ‰ÂÈÁÌ·ÙÔÏË„›· ÙËÚ‹ıËÎ·Ó ÔÈ ·Ú¯¤˜ µÈÔËıÈ΋˜ Î·È ¢ÂÔÓÙÔÏÔÁ›·˜ ÙÔ˘ ¶·ÁÎfiÛÌÈÔ˘ √ÚÁ·ÓÈÛÌÔ‡ ÀÁ›·˜ (∂ÏÛ›ÓÎÈ 1989). ªÂÙÚ‹ÛÈÌ· ¯·Ú·ÎÙËÚÈÛÙÈο ¶ÂÚÈÁÚ·Ê‹ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ °È· ÙÔ˘˜ ÛÎÔÔ‡˜ Ù˘ ÌÂϤÙ˘ ¯ÚËÛÈÌÔÔÈ‹ıËΠ¤Ó· ÂȉÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÙÔ ÔÔ›Ô ÂÚÈÂÏ¿Ì‚·Ó 10 ÂÚˆÙ‹ÛÂȘ ÁÈ· ÙËÓ ·ÍÈÔÏfiÁËÛË ÙˆÓ ·ÓÙÈÏ‹„ÂˆÓ ÁÈ· ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ‰È·ÙÚÔÊ‹, ÙÔ È·ÙÚÈÎfi ÈÛÙÔÚÈÎfi, ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈο Î·È ¿ÏÏ· ·ÙÔÌÈο ÛÙÔȯ›·. ¶ÈÔ ·Ó·Ï˘ÙÈο: ∫ÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈο Î·È ¿ÏÏ· ·ÙÔÌÈο ÛÙÔȯ›· ŸÛÔÓ ·ÊÔÚ¿ Ù· ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈο Î·È Ù· ˘fiÏÔÈ· ·ÙÔÌÈο ÛÙÔȯ›·, Ì ‰‹ÏˆÛË ÙˆÓ ÂÚˆÙËı¤ÓÙˆÓ Î·Ù·ÁÚ¿ÊËÎÂ Ë ËÏÈΛ·, ÙÔ Ê‡ÏÔ, ηıÒ˜ Î·È ÙÔ ‚¿ÚÔ˜ ÙÔ˘˜ Î·È ÙÔ ‡„Ô˜ ÙÔ˘˜ Î·È Î·ÙfiÈÓ ˘ÔÏÔÁ›ÛÙËÎÂ Ô ¢ª™ (kg/m2). ∂›Û˘, Û˘ÏϤ¯ıËÎ·Ó ÏËÚÔÊÔڛ˜ ÁÈ· ÙËÓ ÔÈÎÔÁÂÓÂȷ΋ ηٿÛÙ·ÛË (¿Á·ÌÔ˜, ¤ÁÁ·ÌÔ˜, ‰È·˙¢Á̤ÓÔ˜, ¯‹ÚÔ˜), ÁÈ· ÙÔ Â¿ÁÁÂÏÌ· Ô˘ οÓÔ˘Ó (‰ËÌfiÛÈÔ˜ ˘¿ÏÏËÏÔ˜, ȉȈÙÈÎfi˜ ˘¿ÏÏËÏÔ˜, ÂχıÂÚÔ˜ ·ÁÁÂÏÌ·Ù›·˜, ËÌÈ··Û¯ÔÏÔ‡ÌÂÓÔ˜, ¿ÓÂÚÁÔ˜/ Ë) Î·È ÁÈ· ÙÔ ÂÙ‹ÛÈÔ ·ÙÔÌÈÎfi ÂÈÛfi‰ËÌ· (<10.000 ∂, 10.001-20.000∂, 20.001-40.000∂, >40000∂). ∆Ô ÌÔÚʈÙÈÎfi Â›Â‰Ô ÙˆÓ ÂÚˆÙËı¤ÓÙˆÓ ÌÂÙÚ‹ıËΠ̠ٷ Û˘ÓÔÏÈο ¤ÙË ÛÔ˘‰ÒÓ. ∞ÎfiÌ·, ηٷÁÚ¿ÊËΠÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi Î·È ·ÙÔÌÈÎfi È·ÙÚÈÎfi ÈÛÙÔÚÈÎfi Û‡Ìʈӷ Ì ÙȘ ‰ËÏÒÛÂȘ ÙˆÓ ÂÚˆÙËı¤ÓÙˆÓ. ∞˘Ùfi ÂÚÈÏ¿Ì‚·Ó ÙËÓ ‡·ÚÍË ‹ fi¯È ‰È·ÁÓˆṲ̂Ó˘ ˘¤ÚÙ·Û˘, ۷ί·ÚÒ‰Ô˘˜ ‰È·‚‹ÙË, ‰˘ÛÏÈȉ·ÈÌ›·˜, ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ ‹ ¿ÏÏ˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘. ∏ ‡·ÚÍË ‹ fi¯È ·¯˘Û·ÚΛ·˜ ηıÔÚ›ÛÙËΠ̤ۈ ÙÔ˘ ¢ª™ (>29,9 kg/m2), Û‡Ìʈӷ Ì ٷ ÎÚÈÙ‹ÚÈ· ÙÔ˘ ¶·ÁÎfiÛÌÈÔ˘ √ÚÁ·ÓÈÛÌÔ‡ ÀÁ›·˜ (WHO, 1997). ∆¤ÏÔ˜, ˆ˜ ηÓÈÛÙ¤˜ ÔÚ›ÛÙËÎ·Ó ·˘ÙÔ› Ô˘ οÓÈ˙·Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ 1 ÙÛÈÁ¿ÚÔ/ Ë̤ڷ ‹ fiÛÔÈ ¤¯Ô˘Ó ‰È·Îfi„ÂÈ ÙÔ Î¿ÓÈÛÌ· ÏÈÁfiÙÂÚÔ ·fi ¤Ó· ¤ÙÔ˜ ÙË ÛÙÈÁÌ‹ Ù˘ Û˘ÌÏ‹-
ÚˆÛ˘ ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘. √È ÚÒËÓ Î·ÓÈÛÙ¤˜ ‹Ù·Ó ¿ÙÔÌ· Ô˘ ›¯·Ó ÛÙ·Ì·Ù‹ÛÂÈ ÙÔ Î¿ÓÈÛÌ· ÁÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 1 ¯ÚfiÓÔ, ÂÓÒ ÔÈ ÌË Î·ÓÈÛÙ¤˜ ‹Ù·Ó ·˘ÙÔ› Ô˘ ‰ÂÓ Â›¯·Ó ηӛÛÂÈ ÔÙ¤. ∑ËÙ‹ıËÎ·Ó ÂÈÚfiÛıÂÙ˜ ÏËÚÔÊÔڛ˜ Û¯ÂÙÈο Ì ÙÔÓ ·ÚÈıÌfi ÙÛÈÁ¿ÚˆÓ ·Ó¿ Ë̤ڷ Î·È ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÂÙÒÓ Ô˘ ηӛ˙Ô˘Ó ‹ ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÂÙÒÓ Ô˘ ‰È¤ÎÔ„·Ó ÙÔ Î¿ÓÈÛÌ· ÁÈ· ÂÚÈÛÛfiÙÂÚÔ ·fi ¤Ó· ¯ÚfiÓÔ. ∞ÓÙÈÏ‹„ÂȘ ÁÈ· ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ‰È·ÙÚÔÊ‹ √È ·ÓÙÈÏ‹„ÂȘ ÙˆÓ ·ÙfiÌˆÓ ÁÈ· ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ‰È·ÙÚÔÊ‹ ·ÍÈÔÏÔÁ‹ıËÎ·Ó Ì ‚¿ÛË 10 ÂȉÈΤ˜ ÂÚˆÙ‹ÛÂȘ. ¶ÈÔ ·Ó·Ï˘ÙÈο: Ë ÚÒÙË ÂÚÒÙËÛË ·ÊÔÚÔ‡Û ÙËÓ ·Óı˘ÁÈÂÈÓ‹ ‰È·ÙÚÔÊ‹ Î·È Î·Ù¿ fiÛÔ ÔÈ «Î·Î¤˜» ‰È·ÙÚÔÊÈΤ˜ Û˘Ó‹ıÂȘ ÌÔÚÔ‡Ó Ó· ıˆÚËıÔ‡Ó ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ηډȷÁÁÂȷΤ˜ ·ı‹ÛÂȘ. √È Èı·Ó¤˜ ··ÓÙ‹ÛÂȘ ‹Ù·Ó: fi¯È ηıfiÏÔ˘, Ó·È ·ÏÏ¿ ¤¯ÂÈ ˘ÂÚÂÎÙÈÌËı› ·fi ÙÔ˘˜ ‰È·ÈÙÔÏfiÁÔ˘˜, Ó·È ·ÏÏ¿ ‰ÂÓ Â›Ì·È Û›ÁÔ˘ÚÔ˜/Ë, Ó·È ·Ó·ÌÊÈÛ‚‹ÙËÙ·. ∏ ‰Â‡ÙÂÚË ÂÚÒÙËÛË ·ÊÔÚÔ‡Û ÙÔ ÂÏ·ÈfiÏ·‰Ô Î·È Î·Ù¿ fiÛÔ ·˘Ùfi ÌÔÚ› Ó· ÌÂÈÒÛÂÈ ÙÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ. √ Ù‡Ô˜ Ù˘ ·¿ÓÙËÛ˘ ‹Ù·Ó ÌÈ· Îϛ̷η ·fi 1 (ηıfiÏÔ˘) ¤ˆ˜ 4 (ÌÔÚ›). ∏ ÙÚ›ÙË ÂÚÒÙËÛË ·ÊÔÚÔ‡Û ٷ ÊÚÔ‡Ù· Î·È Ù· Ï·¯·ÓÈο Î·È Î·Ù¿ fiÛÔ ·˘Ù¿ ÌÔÚÔ‡Ó Ó· ÌÂÈÒÛÔ˘Ó ÙÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ. √ Ù‡Ô˜ Ù˘ ·¿ÓÙËÛ˘ ‹Ù·Ó fiÌÔÈÔ˜ Ì ·˘ÙfiÓ Ù˘ ÚÔËÁÔ‡ÌÂÓ˘ ÂÚÒÙËÛ˘. ∏ ٤ٷÚÙË ÂÚÒÙËÛË ·ÊÔÚÔ‡Û ٷ Û˘ÌÏËÚÒÌ·Ù· ‰È·ÙÚÔÊ‹˜ Î·È Î·Ù¿ fiÛÔ ·˘Ù¿ ÌÔÚÔ‡Ó Ó· ÌÂÈÒÛÔ˘Ó ÙÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ. √ Ù‡Ô˜ Ù˘ ·¿ÓÙËÛ˘ ‹Ù·Ó fiÌÔÈÔ˜ Ì ·˘ÙfiÓ Ù˘ ÚÔËÁÔ‡ÌÂÓ˘ ÂÚÒÙËÛ˘. ∏ ¤ÌÙË ÂÚÒÙËÛË ·ÊÔÚÔ‡Û ÙȘ ÁÓÒÛÂȘ ÁÈ· ÙË Û¯¤ÛË Ù˘ ‰È·ÙÚÔÊ‹˜ Ì ÙËÓ ˘Á›·. √ Ù‡Ô˜ Ù˘ ·¿ÓÙËÛ˘ ‹Ù·Ó ÌÈ· Îϛ̷η ·fi ÙÔ 1 (ηıfiÏÔ˘) ¤ˆ˜ 4 (·ÚÎÂÙ¿). ∏ ¤ÎÙË ÂÚÒÙËÛË ·ÍÈÔÏÔÁÔ‡Û ÔÈÔ ÚfiÙ˘Ô ‰È·ÙÚÔÊ‹˜ ÂÊ·ÚÌfi˙Ô˘Ó ÛÙÔ ÓÔÈÎÔ΢ÚÈfi ÙÔ˘˜ ÔÈ ÂÚˆÙËı¤ÓÙ˜. √È Èı·Ó¤˜ ··ÓÙ‹ÛÂȘ ‹Ù·Ó ÌÂÈÎÙ‹, ÌÂÛÔÁÂȷ΋ ÎÔ˘˙›Ó·, ‰˘ÙÈÎÔ‡ Ù‡Ô˘ (·˘ÍË̤ÓÔ ÎÚ¤·˜), ¿ÏÏË. ∏ ¤‚‰ÔÌË ÂÚÒÙËÛË ·Ó·ÊÂÚfiÙ·Ó ÛÙȘ ‰È¿ÊÔÚ˜ Ì·ÚÁ·Ú›Ó˜ ÌÂ Ê˘ÙÈΤ˜ ÛÙÂÚfiϘ Î·È Î·Ù¿ fiÛÔ ›ÛÙ¢·Ó fiÙÈ ÌÔÚÔ‡Ó Ó· ÌÂÈÒÛÔ˘Ó Ù· ÏÈ›‰È· Î·È ÙÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ. √ Ù‡Ô˜ Ù˘ ·¿ÓÙËÛ˘ ‹Ù·Ó
ÌÈ· Îϛ̷η ·fi ÙÔ 1 (ηıfiÏÔ˘) ¤ˆ˜ 4 (·ÚÎÂÙ¿). ∏ fiÁ‰ÔË ÂÚÒÙËÛË ·ÊÔÚÔ‡Û ÙÔ ÛËÌ·ÓÙÈÎfiÙÂÚÔ Û˘ÛÙ·ÙÈÎfi ÌÈ·˜ ˘ÁÈÂÈÓ‹˜ ‰È·ÙÚÔÊ‹˜ Ì Èı·Ó¤˜ ··ÓÙ‹ÛÂȘ: Ù· ÌÔÓÔ·ÎfiÚÂÛÙ· ÏÈ·Ú¿, ÙȘ Ê˘ÙÈΤ˜ ›Ó˜, ÙȘ ·ÓÙÈÔÍÂȉˆÙÈΤ˜ Ô˘Û›Â˜, Ù· ÌÈÎÚ¿ Î·È Û˘¯Ó¿ Á‡̷ٷ Î·È ÙËÓ ÔÈÎÈÏ›· ÙÚÔÊÒÓ. ∏ ¤Ó·ÙË ÂÚÒÙËÛË ·ÊÔÚÔ‡Û ÙËÓ ·ÁÔÚ¿ ÙÚÔÊ›ÌˆÓ Î·È ÙÔ Ì¤ÚÔ˜ ÙÔ ÔÔ›Ô ıˆÚÂ›Ù·È ÙÔ ·ÛʷϤÛÙÂÚÔ ÁÈ· ÙËÓ ·ÁÔÚ¿ ÙÔ˘˜. √È Èı·Ó¤˜ ··ÓÙ‹ÛÂȘ ‹Ù·Ó Ù· ÛÔ‡ÂÚ Ì¿ÚÎÂÙ, Ë Ï·˚΋, Ù· ÌÈÎÚ¿ ÂÌÔÚÈο Ù˘ ÁÂÈÙÔÓÈ¿˜ Î·È Ë ‰È΋ ÙÔ˘˜ ‹ ÊÈÏÈ΋ ·Ú·ÁˆÁ‹. ∏ ‰¤Î·ÙË Î·È ÙÂÏÂ˘Ù·›· ÂÚÒÙËÛË ·ÊÔÚÔ‡Û ÔÈÔÓ ıˆÚÔ‡Ó ÔÈ ÂÚˆÙÒÌÂÓÔÈ ÙÔÓ ÛËÌ·ÓÙÈÎfiÙÂÚÔ ‰È·ÙÚÔÊÈÎfi ΛӉ˘ÓÔ fiÛÔÓ ·ÊÔÚ¿ Ù· ηډȷÁÁÂȷο ÓÔÛ‹Ì·Ù·. √È Èı·Ó¤˜ ··ÓÙ‹ÛÂȘ ‹Ù·Ó: ·Ï¿ÙÈ, ˙¿¯·ÚË, ÎÔÚÂṲ̂ӷ Ï›Ë, ¿Ì˘ÏÔ, ·ÏÎÔfiÏ. ™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË √È Û˘Ó¯›˜ ÌÂÙ·‚ÏËÙ¤˜ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ˆ˜ ̤ÛÔ˜ fiÚÔ˜ ± ÌÈ· Ù˘È΋ ·fiÎÏÈÛË, ÂÓÒ ÔÈ Î·ÙËÁÔÚÈΤ˜ ÌÂÙ·‚ÏËÙ¤˜ ˆ˜ Û¯ÂÙÈΤ˜ Û˘¯ÓfiÙËÙ˜. ∆Ô Â›Â‰Ô Ù˘ ÛÙ·ÙÈÛÙÈ΋˜ ÛËÌ·ÓÙÈÎfiÙËÙ·˜ ÔÚ›ÛÙËΠÛÙÔ 5%. °È· ÙËÓ Î·Ï‡ÙÂÚË ·ÚÔ˘Û›·ÛË ÙˆÓ ÂÚÈÁÚ·ÊÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙˆÓ ·ÙfiÌˆÓ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ Ù· ·ÔÙÂϤÛÌ·Ù· ‰È·¯ˆÚ›ÛÙËÎ·Ó ÁÈ· ÙÔ˘˜ ¿Ó‰Ú˜ Î·È ÙȘ Á˘Ó·›Î˜. °È· ÙȘ Û˘Û¯ÂÙ›ÛÂȘ ÙÔ˘ ʇÏÔ˘ Î·È ÙˆÓ ÔÛÔÙÈÎÒÓ ÌÂÙ·‚ÏËÙÒÓ (ËÏÈΛ·, ‚¿ÚÔ˜, ‡„Ô˜, ¢ª™) ¯ÚËÛÈÌÔÔÈ‹Û·Ì ÙÔ Student's t-test, ÂÓÒ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ Û¯¤Û˘ ÙÔ˘ ʇÏÔ˘ Î·È ÙˆÓ ÔÈÔÙÈÎÒÓ ÌÂÙ·‚ÏËÙÒÓ (ÔÈÎÔÁÂÓÂȷ΋ ηٿÛÙ·ÛË, ÌÔÚʈÙÈÎfi ›‰Ô, ÂÙ‹ÛÈÔ ·ÙÔÌÈÎfi ÂÈÛfi‰ËÌ·, ȉÈfiÎÙËÙË Î·ÙÔÈΛ·, ¿ÁÁÂÏÌ·) ¯ÚËÛÈÌÔÔÈ‹ıËΠÙÔ ¯2-ÎÚÈÙ‹ÚÈÔ. ∆Ô ÛÙ·ÙÈÛÙÈÎfi ÚfiÁÚ·ÌÌ· SPSS (¤Î‰ÔÛË 13.0) ¯ÚËÛÈÌÔÔÈ‹ıËΠÁÈ· fiÏÔ˘˜ ÙÔ˘˜ ˘ÔÏÔÁÈÛÌÔ‡˜.
∞ÔÙÂϤÛÌ·Ù· √ ¶›Ó·Î·˜ 1 ÂÚÈÁÚ¿ÊÂÈ Ù· ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·ÙfiÌˆÓ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜. ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÔÈÎÔÁÂÓÂȷ΋ ηٿÛÙ·ÛË ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜, Ù· ÔÛÔÛÙ¿ ÌÂٷ͇ ·ÓÙÚÒÓ Î·È Á˘Ó·ÈÎÒÓ ‰ÂÓ ‰È·Ê¤ÚÔ˘Ó Ôχ Ì ÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜ Ó· ‰ËÏÒÓÔ˘Ó ¿Á·ÌÔÈ ‹ ¤ÁÁ·ÌÔÈ. ∞Ó·ÊÔÚÈο Ì ÙÔ ÌÔÚʈÙÈÎfi Â›Â‰Ô ÔÈ ¿Ó‰Ú˜ Ê·›ÓÂÙ·È Ó· ˘ÂÚ¤¯Ô˘Ó ÂÏ·ÊÚ¿ ¤Ó·ÓÙÈ ÙˆÓ Á˘Ó·ÈÎÒÓ. ∂›-
9
ATHIROSK 21-
05-03-09
12:25
ª ∞ ƒ ∆ π √ ™
™ÂÏ›‰·10
2 0 0 9
¶›Ó·Î·˜ 1. ∫ÔÈÓˆÓÈÎfi-‰ËÌÔÁÚ·ÊÈο ÛÙÔȯ›· ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜.
¡ ∏ÏÈΛ· (¤ÙË) ŒÙË ÛÔ˘‰ÒÓ √ÈÎÔÁÂÓÂȷ΋ ηٿÛÙ·ÛË, % ÕÁ·ÌÔÈ ŒÁÁ·ÌÔÈ ¢È·˙¢Á̤ÓÔÈ Ã‹ÚÔÈ ∂Ù‹ÛÈÔ ÂÈÛfi‰ËÌ·, % <10000 10001-20000 20001-40000 >40000 ∂·ÁÁÂÏÌ·ÙÈ΋ ηٿÛÙ·ÛË % ¢ËÌfiÛÈÔ˜ ˘¿ÏÏËÏÔ˜ π‰ÈˆÙÈÎfi˜ ˘¿ÏÏËÏÔ˜ ∂χıÂÚÔ˜ ·ÁÁÂÏÌ·Ù›·˜ ∏ÌÈ··Û¯fiÏËÛË ÕÓÂÚÁÔ˜ Û˘, fiÛÔÓ ·ÊÔÚ¿ ÛÙÔ ÂÙ‹ÛÈÔ ·ÙÔÌÈÎfi ÂÈÛfi‰ËÌ·, ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÙˆÓ Á˘Ó·ÈÎÒÓ Â›Ó·È ¯·ÌËÏfiÌÈÛı˜ Û ۯ¤ÛË Ì ÙÔ˘˜ ¿Ó‰Ú˜, ÂÓÒ ÌÂÁ·Ï‡ÙÂÚÔ Â›Ó·È ÙÔ ÔÛÔÛÙfi ÙˆÓ Á˘Ó·ÈÎÒÓ Ô˘ Â›Ó·È ¿ÓÂÚÁ˜ Û ۯ¤ÛË Ì ÙÔ˘˜ ¿Ó‰Ú˜. ™ÙÔÓ ¶›Ó·Î· 2 Ê·›ÓÂÙ·È Ô ÂÈÔÏ·ÛÌfi˜ ÙˆÓ Î˘ÚÈfiÙÂÚˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ· Ù· ηډȷÁÁÂȷο ÓÔÛ‹Ì·Ù·, ·ÏÏ¿ Î·È ÁÂÓÈÎfiÙÂÚ· ÛÙÔȯ›· ÁÈ· ÙÔ È·ÙÚÈÎfi ÈÛÙÔÚÈÎfi ÙˆÓ Û˘ÌÌÂÙ¯fiÓÙˆÓ. Ÿˆ˜ Ê·›ÓÂÙ·È, ÔÈ ¿Ó‰Ú˜ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ηӛ˙Ô˘Ó ÂÚÈÛÛfiÙÂÚÔ ·fi ÙȘ Á˘Ó·›Î˜ Î·È ÂÌÊ·Ó›˙Ô˘Ó ·¯˘Û·ÚΛ· Û ÌÂÁ·Ï‡ÙÂÚÔ
ÕÓ‰Ú˜
°˘Ó·›Î˜
1428 40±16 13,43±4
1790 38±16 13,32±3,8
42,6% 51,5% 4,7% 1,2%
44,2% 45,9% 4,9% 5,0%
27,7% 38,9% 25,8% 7,7%
46,6% 37,9% 12,9% 2,6%
28,3% 29,7% 24,4% 4,7% 12,9%
22,6% 30,4% 13,0% 9,6% 24,5%
P
<0,001 <0,001 <0,001
<0,001
<0,001
ÔÛÔÛÙfi ·fi ·˘Ù¤˜. ∂›Û˘, ‰ËÏÒÓÔ˘Ó fiÙÈ ¤¯Ô˘Ó ‰È·ÁÓˆṲ̂ÓË ·ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË Î·È ‰˘ÛÏÈȉ·ÈÌ›· Û ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi Û ۯ¤ÛË Ì ÙȘ Á˘Ó·›Î˜. ™ÙÔÓ ¶›Ó·Î· 3 Ê·›ÓÔÓÙ·È ÔÈ ·ÓÙÈÏ‹„ÂȘ Î·È ÔÈ ÛÙ¿ÛÂȘ ÙˆÓ ·ÙfiÌˆÓ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ·Ó·ÊÔÚÈο Ì ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ‰È·ÙÚÔÊ‹. ∞Ú¯Èο, ÙÔ 72,6% ÙˆÓ ·Ó‰ÚÒÓ Î·È ÙÔ 80,5% ÙˆÓ Á˘Ó·ÈÎÒÓ Â›Ó·È ·fiÏ˘Ù· Û›ÁÔ˘ÚÔÈ fiÙÈ Ë ·Óı˘ÁÈÂÈÓ‹ ‰È·ÙÚÔÊ‹ Â›Ó·È ·Ú¿ÁÔÓÙ·˜ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘. ∂›Û˘, Î·È Ù· ‰‡Ô ʇϷ Û˘ÌʈÓÔ‡Ó fiÙÈ ÙfiÛÔ ÙÔ ÂÏ·ÈfiÏ·‰Ô (83,9% ÔÈ ¿Ó‰Ú˜,
¶›Ó·Î·˜ 2. ∫ÏÈÓÈο Î·È ·ÓıÚˆÔÌÂÙÚÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜.
ÕÓ‰Ú˜ ¡ ∫¿ÓÈÛÌ· ÙÒÚ·, % ∆ÛÈÁ¿Ú· / Ë̤ڷ ∞ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË, %
P
1428
1790
43,2%
37,0%
13,7±14,7
8,9±11,4
<0,001
19,3%
12,3%
<0,001
<0,001
™·Î¯·Ú҉˘ ‰È·‚‹Ù˘, %
5,1%
5,3%
0,742
¢˘ÛÏÈȉ·ÈÌ›·, %
12,5%
9,3%
0,003
26,4±3,97
23,95±4,36
<0,001
¶·¯˘Û·ÚΛ·, %
16,2%
10,7%
<0,001
πÛÙÔÚÈÎfi ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘, %
4,1%
1,7%
<0,001
¢Â›ÎÙ˘ ª¿˙·˜ ™ÒÌ·ÙÔ˜ (kg/m2)
10
°˘Ó·›Î˜
ÕÏÏË Î·Ú‰È·ÁÁÂȷ΋ ÓfiÛÔ˜, %
4,4%
4,5%
0,946
√ÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘, %
31,2%
37,5%
<0,001
86,9% ÔÈ Á˘Ó·›Î˜) fiÛÔ Î·È Ù· ÊÚÔ‡Ù· Î·È Ù· Ï·¯·ÓÈο (92,4% ÔÈ ¿Ó‰Ú˜, 94,1% ÔÈ Á˘Ó·›Î˜) ÌÔÚÔ‡Ó Ó· ÌÂÈÒÛÔ˘Ó ÙÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ. ŸÌˆ˜, ÛÙËÓ ÂÚ›ÙˆÛË ÙˆÓ Û˘ÌÏËÚˆÌ¿ÙˆÓ ‰È·ÙÚÔÊ‹˜ (.¯. ‚Èٷ̛Ә), ¤Ó· ÌÂÁ¿ÏÔ ÔÛÔÛÙfi Î·È ÙˆÓ ‰‡Ô Ê‡ÏˆÓ (36,2% ÔÈ ¿Ó‰Ú˜ Î·È 37,1% ÔÈ Á˘Ó·›Î˜) ıˆÚ› Ï·Óı·Ṳ̂ӷ fiÙÈ ·˘Ù¿ ÌÔÚÔ‡Ó Ó· ÌÂÈÒÛÔ˘Ó ÙÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ. ™ËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ‰‡Ô Ê‡ÏˆÓ Ê·›ÓÂÙ·È Ó· ˘¿Ú¯ÂÈ ÛÙËÓ ÂÚÒÙËÛË Ô˘ ·ÊÔÚ¿ ÙȘ ÁÓÒÛÂȘ Ô˘ Ù· ¿ÙÔÌ· ıˆÚÔ‡Ó fiÙÈ ¤¯Ô˘Ó fiÛÔÓ ·ÊÔÚ¿ ÙË Û¯¤ÛË ‰È·ÙÚÔÊ‹˜ Î·È ˘Á›·˜, Ì ÙȘ Á˘Ó·›Î˜ Ó· ˘ÂÚÙÂÚÔ‡Ó Û ۯ¤ÛË Ì ÙÔ˘˜ ¿Ó‰Ú˜ (81,8% ÔÈ Á˘Ó·›Î˜, 69% ÔÈ ¿Ó‰Ú˜). ∂›Û˘, ÔÈ Á˘Ó·›Î˜ ·ÎÔÏÔ˘ıÔ‡Ó Û ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÙÔ ÌÂÛÔÁÂÈ·Îfi ÚfiÙ˘Ô ‰È·ÙÚÔÊ‹˜ (52%) Û ۯ¤ÛË Ì ÙÔ˘˜ ¿Ó‰Ú˜ (39,8%). ∆Ô 55,1% ÙˆÓ ·Ó‰ÚÒÓ Î·È ÙÔ 51% ÙˆÓ Á˘Ó·ÈÎÒÓ ıˆÚÔ‡Ó fiÙÈ ÔÈ ‰È¿ÊÔÚ˜ Ì·ÚÁ·Ú›Ó˜ ÌÂ Ê˘ÙÈΤ˜ ÛÙÂÚfiϘ ‰ÂÓ ÌÔÚÔ‡Ó Ó· ÌÂÈÒÛÔ˘Ó Ù· ÏÈ›‰È· Î·È ÙÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ. ∞ÎfiÌ·, ·Ó ıˆڋÛÔ˘Ì ٷ ÌÔÓÔ·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ·, ÙȘ Ê˘ÙÈΤ˜ ›Ó˜ Î·È ÙȘ ·ÓÙÈÔÍÂȉˆÙÈΤ˜ Ô˘Û›Â˜ ˆ˜ Ù· ÛËÌ·ÓÙÈÎfiÙÂÚ· Û˘ÛÙ·ÙÈο ÌÈ·˜ ˘ÁÈÂÈÓ‹˜ ‰È·ÙÚÔÊ‹˜, ÙÔ 73% ÙˆÓ ·Ó‰ÚÒÓ Î·È ÙÔ 75,1% ÙˆÓ Á˘Ó·ÈÎÒÓ Ê·›ÓÂÙ·È Ó· ··ÓÙ¿ Ï·Óı·Ṳ̂ӷ ÛÙËÓ Û˘ÁÎÂÎÚÈ̤ÓË ÂÚÒÙËÛË. ª¿ÏÈÛÙ·, Ù· ÔÛÔÛÙ¿ ·˘Ù¿ ÙˆÓ ·Ó‰ÚÒÓ Î·È ÙˆÓ Á˘Ó·ÈÎÒÓ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ·ÓÙ›ÛÙÔȯ· ıˆÚÔ‡Ó ÛËÌ·ÓÙÈÎfiÙÂÚ· Ù· ÌÈÎÚ¿ Î·È Û˘¯Ó¿ Á‡̷ٷ Î·È ÙËÓ ÔÈÎÈÏ›· ÙÚÔʛ̈Ó. ŒÓ· ¿ÏÏÔ ÛËÌ·ÓÙÈÎfi ‡ÚËÌ· Â›Ó·È fiÙÈ ÙÔ 68,9% ÙˆÓ ·Ó‰ÚÒÓ Î·È ÙÔ 70% ÙˆÓ Á˘Ó·ÈÎÒÓ ıˆÚÔ‡Ó fiÙÈ Ë ÚÔÛˆÈ΋ ‹ Ë ÊÈÏÈ΋ ·Ú·ÁˆÁ‹ ·ÔÙÂÏ› ÙËÓ ·ÛʷϤÛÙÂÚË ·ÁÔÚ¿ ÙÚÔÊ›ÌˆÓ ∆¤ÏÔ˜, ÙÔ 69,3% ÙˆÓ ·Ó‰ÚÒÓ Î·È ÙÔ 71,6% ÙˆÓ Á˘Ó·ÈÎÒÓ ıˆÚÔ‡Ó ÙÔ ·Ï¿ÙÈ Î·È Ù· ÎÔÚÂṲ̂ӷ Ï›Ë ˆ˜ ÙÔ ÛËÌ·ÓÙÈÎfiÙÂÚÔ ‰È·ÙÚÔÊÈÎfi ΛӉ˘ÓÔ ÁÈ· Ù· ηډȷÁÁÂȷο ÓÔÛ‹Ì·Ù·.
™˘˙‹ÙËÛË ∏ ·ÚÔ‡Û· ‰ÂÈÁÌ·ÙÔÏËÙÈ΋ ¤Ú¢ӷ, ÁÈ· ÚÒÙË ÊÔÚ¿ ÛÙËÓ ∂ÏÏ¿‰·, ÂȯÂÈÚ› ÙËÓ ·ÔÙ‡ˆÛË Ù¿ÛÂˆÓ Î·È ·ÓÙÈÏ‹„ÂˆÓ ·¤Ó·ÓÙÈ ÛÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘. ™ÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ¿ÚıÚÔ ÙÔ ÂӉȷʤÚÔÓ ÂÛÙÈ¿ÛÙËΠÛÙË
ATHIROSK 21-
05-03-09
12:25
™ÂÏ›‰·11
∂¶π¢∏ªπ√§√°π∞ - ¶∞ƒ∞°√¡∆∂™ ∫π¡¢À¡√À
¶›Ó·Î·˜ 3. ∞ÓÙÈÏ‹„ÂȘ ÁÈ· ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ‰È·ÙÚÔÊ‹
ÕÓ‰Ú˜ ¶ÈÛÙ‡ÂÙ fiÙÈ ÔÈ «Î·Î¤˜» ‰È·ÙÚÔÊÈΤ˜ Û˘Ó‹ıÂȘ Â›Ó·È ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ηډȷÁÁÂȷΤ˜ ·ı‹ÛÂȘ; % ∫·ıfiÏÔ˘ ¡·È, ·ÏÏ¿ ¤¯ÂÈ ˘ÂÚÂÎÙÈÌËı› ·fi ‰È·ÈÙÔÏfiÁÔ˘˜ ¡·È, ·ÏÏ¿ ‰ÂÓ Â›Ì·È Ôχ Û›ÁÔ˘ÚÔ˜ ¡·È, ·Ó·ÌÊÈÛ‚‹ÙËÙ· ¶ÈÛÙ‡ÂÙ fiÙÈ Ë Î·Ù·Ó¿ÏˆÛË ÂÏ·ÈÔÏ¿‰Ô˘ ÌÔÚ› Ó· ÌÂÈÒÛÂÈ ÙÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi Û·˜ ΛӉ˘ÓÔ; ∫·ıfiÏÔ˘ §›ÁÔ ∞ÚÎÂÙ¿ ¶Ôχ ¶ÈÛÙ‡ÂÙ fiÙÈ Ë Î·Ù·Ó¿ÏˆÛË ÊÚÔ‡ÙˆÓ & Ï·¯·ÓÈÎÒÓ ÌÔÚ› Ó· ÌÂÈÒÛÂÈ ÙÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi Û·˜ ΛӉ˘ÓÔ; ∫·ıfiÏÔ˘ §›ÁÔ ∞ÚÎÂÙ¿ ¶Ôχ ¶ÈÛÙ‡ÂÙ ·Ó Ù· Û˘ÌÏËÚÒÌ·Ù· ‰È·ÙÚÔÊ‹˜ (.¯. ‚Èٷ̛Ә) ÌÔÚÔ‡Ó Ó· ÌÂÈÒÛÔ˘Ó ÙÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi Û·˜ ΛӉ˘ÓÔ; ∫·ıfiÏÔ˘ §›ÁÔ ∞ÚÎÂÙ¿ ¶Ôχ ¶fiÛÔ ÈÛÙ‡ÂÙ fiÙÈ ÁÓˆÚ›˙ÂÙ ÁÈ· ÙËÓ ‰È·ÙÚÔÊ‹; ∫·ıfiÏÔ˘ §›ÁÔ ∞ÚÎÂÙ¿ ¶Ôχ ∂Ê·ÚÌfi˙ÂÙ οÔÈÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ÚfiÙ˘Ô ‰È·ÙÚÔÊ‹˜ ÛÙÔ ÓÔÈÎÔ΢ÚÈfi Û·˜.% Ÿ¯È, ·ÎÔÏÔ˘ıÒ ÌÈÎÙ‹ ªÂÛÔÁÂȷ΋ ÎÔ˘˙›Ó· ¢˘ÙÈÎÔ‡ Ù‡Ô˘ (·˘ÍË̤ÓÔ ÎÚ¤·˜) ÕÏÏË ¶ÈÛÙ‡ÂÙ fiÙÈ ÔÈ ‰È¿ÊÔÚ˜ Ì·ÚÁ·Ú›Ó˜ ÌÂ Ê˘ÙÈΤ˜ ÛÙÂÚfiϘ ÌÔÚÔ‡Ó Ó· ÌÂÈÒÛÔ˘Ó Ù· ÏÈ›‰È· Î·È ÙÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi Û·˜ ΛӉ˘ÓÔ; ∫·ıfiÏÔ˘ §›ÁÔ ∞ÚÎÂÙ¿ ¶Ôχ ¶ÔÈÔ ÙÔ ÛËÌ·ÓÙÈÎfiÙÂÚÔ Û˘ÛÙ·ÙÈÎfi ÌÈ·˜ ˘ÁÈÂÈÓ‹˜ ‰È·ÙÚÔÊ‹˜;% ªfiÓÔ-·ÎfiÚÂÛÙ· ÏÈ·Ú¿ º˘ÙÈΤ˜ ›Ó˜ ∞ÓÙÈÔÍÂȉˆÙÈΤ˜ Ô˘Û›Â˜ ªÈÎÚ¿ Î·È Û˘¯Ó¿ Á‡̷ٷ ¶ÔÈÎÈÏ›· ÙÚÔÊÒÓ ¶ÈÛÙ‡ÂÙ fiÙÈ Â›Ó·È ÈÔ ·ÛÊ·Ï‹˜ Ë ·ÁÔÚ¿ ÙÚÔʛ̈Ó% ·fi Ù· ™Ô‡ÂÚ Ì¿ÚÎÂÙ ·fi ÙËÓ Ï·˚΋ ·fi Ù· ÌÈÎÚ¿ ÂÌÔÚÈο Ù˘ ÁÂÈÙÔÓÈ¿˜ ·fi ‰È΋ Û·˜ ‹ ÊÈÏÈ΋ ·Ú·ÁˆÁ‹ ¶ÔÈÔ˜ Â›Ó·È Î·Ù¿ ÙËÓ ÁÓÒÌË Û·˜ Ô ÛËÌ·ÓÙÈÎfiÙÂÚÔ˜ ‰È·ÙÚÔÊÈÎfi˜ ΛӉ˘ÓÔ˜;% ∞Ï¿ÙÈ ∑¿¯·ÚË ∫ÔÚÂṲ̂ӷ Ï›Ë ÕÌ˘ÏÔ ∞ÏÎÔfiÏ
°˘Ó·›Î˜
P <0,001
1,2% 9,8% 16,5% 72,6%
0,2% 8,3% 11,0% 80,5%
3,1% 13% 58% 25,9%
1,9 11,1% 62% 24,9%
1,3% 6,3% 53,4% 39%
0,6% 5,3% 53,2% 40,9%
22,2% 41,3% 30,3% 6,2%
22,9% 40% 32,1% 5%
6,4% 24,6% 55,4% 13,6%
2,2% 16% 61,4% 20,4%
38,8% 39,8% 15,2% 6,2%
34,6% 52,0% 9,1% 4,4%
13,9% 41,2% 40,5% 5%
12,6% 38,4% 42,5% 6,5%
4,0% 13,3% 9,7% 27,6% 45,4%
3,1% 13,8% 8,0% 34,8% 40,3%
14,1% 10,7% 6,3% 68,9%
13,1% 12,8% 4,2% 70,0%
17,7% 8,6% 51,6% 0,8% 21,4%
16,5% 7,6% 55,1% 0,8% 19,9%
0,024
0,113
0,358
<0,001
<0,001
0,081
<0,001
0,015
0,380
11
ATHIROSK 21-
05-03-09
12:25
ª ∞ ƒ ∆ π √ ™
™ÂÏ›‰·12
2 0 0 9
‰È·ÙÚÔÊ‹. Ÿˆ˜ Ê¿ÓËΠ·fi ÙËÓ ·Ó¿Ï˘ÛË ÙˆÓ ÛÙÔȯ›ˆÓ, ÌÂÁ¿ÏÔ Ì¤ÚÔ˜ ÙˆÓ ÂÚˆÙËı¤ÓÙˆÓ Â›¯Â ¿ÁÓÔÈ· ÁÈ· ÙȘ ‚·ÛÈΤ˜ ‰È·ÙÚÔÊÈΤ˜ Û˘ÛÙ¿ÛÂȘ, ·Ó·‰ÂÈÎÓ‡ÔÓÙ·˜ ÙÔ ¯·ÌËÏfi Â›Â‰Ô ÁÓÒÛ˘ ÙˆÓ ·ÙfiÌˆÓ fiÛÔÓ ·ÊÔÚ¿ ÙË ÛˆÛÙ‹ ‰È·ÙÚÔÊ‹ Ô˘ Ú¤ÂÈ Ó· ·ÎÔÏÔ˘ı‹ÛÔ˘Ó ÁÈ· ÙËÓ ÚfiÏË„Ë ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ. Ÿˆ˜ Ê·›ÓÂÙ·È ·fi ÙËÓ ·Ó¿Ï˘ÛË ÙˆÓ ÛÙÔȯ›ˆÓ, ÔÈ Á˘Ó·›Î˜ Ù›ÓÔ˘Ó Ó· Â›Ó·È ÈÔ Â˘·ÈÛıËÙÔÔÈË̤Ó˜ ·fi ÙÔ˘˜ ¿Ó‰Ú˜, ηıÒ˜ ‰ËÏÒÓÔ˘Ó Û ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi fiÙÈ ÁÓˆÚ›˙Ô˘Ó ·ÚÎÂÙ¿ ÁÈ· ÙË Û¯¤ÛË ‰È·ÙÚÔÊ‹˜ Î·È ˘Á›·˜. ª¿ÏÈÛÙ·, ÔÈ Á˘Ó·›Î˜ Ê·›ÓÂÙ·È Ó· ˘ÈÔıÂÙÔ‡Ó Û ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÙÔ «ÌÂÛÔÁÂÈ·Îfi ÚfiÙ˘Ô» ‰È·ÙÚÔÊ‹˜ ÛÙÔ ÓÔÈÎÔ΢ÚÈfi ÙÔ˘˜, ¤Ó· ÚfiÙ˘Ô ‰È·ÙÚÔÊ‹˜ Ô˘ fiˆ˜ ¤¯ÂÈ Ê·Ó› ·fi ÏËıÒÚ· ÌÂÏÂÙÒÓ, ¤¯ÂÈ Î·Ú‰ÈÔÚÔÛٷ٢ÙÈ΋ ‰Ú¿ÛË. ™ËÌ·ÓÙÈÎfi Â›Ó·È Î·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Û ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ÙfiÛÔ ÔÈ ¿Ó‰Ú˜ fiÛÔ Î·È ÔÈ Á˘Ó·›Î˜ ‰ÂÓ ÁÓˆÚ›˙Ô˘Ó fiÙÈ ÔÈ Ì·ÚÁ·Ú›Ó˜ ÌÂ Ê˘ÙÈΤ˜ ÛÙÂÚfiϘ ÌÔÚÔ‡Ó Ó· ÌÂÈÒÛÔ˘Ó Ù· ÏÈ›‰È· Î·È ÙÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ. £¤ÏÔÓÙ·˜ Ó· ÂÚÌËÓ‡ÛÔ˘Ì ·˘Ù¿ Ù· ·ÔÙÂϤÛÌ·Ù· ı· ÌÔÚÔ‡Û·Ì ӷ ԇ̠fiÙÈ ·˘Ù¿ Ù· ÚÔ˚fiÓÙ· Â›Ó·È Û¯ÂÙÈο ηÈÓÔ‡ÚÈ· Î·È ÔÈ Ôϛ٘ ›Ù ‰ÂÓ ¤¯Ô˘Ó ÂÓËÌÂÚˆı› ·ÎfiÌ· ÁÈ· ÙË ¯Ú‹ÛË ·˘ÙÒÓ Â›Ù ‰ÂÓ ¤¯Ô˘Ó ÂÓËÌÂÚˆı› ÛˆÛÙ¿ ÁÈ' ·˘Ù¿. ŸÛÔÓ ·ÊÔÚ¿ fï˜ Ù· ÎÔÚÂṲ̂ӷ Ï›Ë Î·È ÙÔ ·Ï¿ÙÈ ÙÔ Û‡ÓÔÏÔ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ Ê·›ÓÂÙ·È Ó· Â›Ó·È ÈÔ ÂÍÔÈÎÂȈ̤ÓÔ Ì ·˘ÙÔ‡˜ ÙÔ˘˜ fiÚÔ˘˜ ˆ˜ ‰È·ÙÚÔÊÈÎÔ‡˜ ÎÈÓ‰‡ÓÔ˘˜, ηıÒ˜ Â‰Ò Î·È ÔÏÏ¿ ¯ÚfiÓÈ· ¤¯ÂÈ ‰ÂȯÙ› Ë Â›‰Ú·Û‹ ÙÔ˘˜ ÛÙ· ηډȷÁÁÂȷο ÓÔÛ‹Ì·Ù·. ∞˘Ùfi ı· ÌÔÚÔ‡Û ӷ ÂÍËÁ› Î·È ÙËÓ ÔÚı‹ ÁÓÒÛË Ô˘ Ê·›ÓÂÙ·È Ó· ¤¯Ô˘Ó ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ÙfiÛÔ ÙˆÓ ·ÓÙÚÒÓ fiÛÔ Î·È ÙˆÓ Á˘Ó·ÈÎÒÓ ÁÈ· ÙËÓ Î·Ú‰ÈÔÚÔÛٷ٢ÙÈ΋ ‰Ú¿ÛË ÙÔ˘ ÂÏ·ÈÔÏ¿‰Ô˘ (ÏÔ‡ÛÈÔ Û ÌÔÓÔ·ÎfiÚÂÛÙ· ÏÈ·Ú¿), ηıÒ˜ Î·È ÙˆÓ ÊÚÔ‡ÙˆÓ Î·È ÙˆÓ Ï·¯·ÓÈÎÒÓ (ÏÔ‡ÛÈ· Û ·ÓÙÈÔÍÂȉˆÙÈο). ∆¤ÏÔ˜, ·Ó·ÊÔÚÈο Ì ÙËÓ ·ÛʷϤÛÙÂÚË ·ÁÔÚ¿ ÙÚÔʛ̈Ó, Â›Ó·È ÂÌÊ·Ó¤˜ fiÙÈ ˘¿Ú¯ÂÈ ÌÈ· Û‡Á¯˘ÛË ÛÙȘ ·fi„ÂȘ ÙÔ˘ Û‡Á¯ÚÔÓÔ˘ ŒÏÏËÓ· ηıÒ˜ ÙÔ 69% ÙˆÓ ·Ó‰ÚÒÓ Î·È ÙÔ 70% ÙˆÓ Á˘Ó·ÈÎÒÓ ‰ËÏÒÓÔ˘Ó ÙËÓ ‰È΋ ÙÔ˘˜ ‹ ÙË ÊÈÏÈ΋ ·Ú·ÁˆÁ‹ ˆ˜ ÙËÓ ÈÔ ·ÛÊ·-
12
Ï‹ ËÁ‹ ·ÁÔÚ¿˜ ÙÚÔʛ̈Ó. ™ÙËÓ Û‡Á¯˘ÛË ·˘Ù‹ Ê·›ÓÂÙ·È Ó· Û˘Ì‚¿ÏÏÔ˘Ó Ù· ̤۷ Ì·˙È΋˜ ÂÓË̤ڈÛ˘ Ô˘ Ê·ÓÂÚÒÓÔ˘Ó Û˘Ó¯Ҙ ηÈÓÔ‡ÚȘ ·Ú·Ù˘›Â˜ ÙˆÓ ‚ÈÔÌ˯·ÓÈÒÓ ÙÚÔÊ›ÌˆÓ Î·ıÒ˜ Î·È ÂÈÌÔχÓÛÂȘ ÙÚÔÊ›ÌˆÓ Â˘Ú›·˜ ηٷӿψÛ˘. ™Ù· ·Ú·¿Óˆ Û˘ÓËÁÔÚ› Î·È ÌÈ· ¿ÏÏË ¤Ú¢ӷ ÙˆÓ ÌÂÏÒÓ Ù˘ BEUC, Ô˘ ‰Â›¯ÓÂÈ fiÙÈ ÔÈ Î·Ù·Ó·ÏˆÙ¤˜ ‰ÂÓ ÁÓˆÚ›˙Ô˘Ó ÔÈÔ Â›‰Ô˜ ‰È·ÙÚÔÊ‹˜ ÌÔÚ› Ó· Â›Ó·È ˘ÁÈÂÈÓfi. ™˘ÁÎÂÎÚÈ̤ӷ, ÔÈ 9 ÛÙÔ˘˜ 10 ıˆÚÔ‡Ó fiÙÈ Í¤ÚÔ˘Ó ÔÈ· Â›Ó·È ˘ÁÈÂÈÓ¿ ÙÚfiÊÈÌ·, ÂÓÒ ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· ÂÏ¿¯ÈÛÙÔÈ ÁÓˆÚ›˙Ô˘Ó ÔȘ ÔÛfiÙËÙ˜ ÏÈ·ÚÒÓ, ۷ί¿ÚˆÓ Î·È ¿Ï·ÙÔ˜ Ú¤ÂÈ Ó· ηٷӷÏÒÓÔ˘Ó Û ηıËÌÂÚÈÓ‹ ‚¿ÛË ÒÛÙ ӷ ÚÔÊ˘Ï¿ÛÛÔ˘Ó ÙËÓ ˘Á›· ÙÔ˘˜. øÛÙfiÛÔ ÙÔ Î˘ÚÈfiÙÂÚÔ Úfi‚ÏËÌ· Ô˘ ‰È·Ê·›ÓÂÙ·È, Â›Ó·È fiÙÈ ÂÓÒ Ô ÎfiÛÌÔ˜ ÁÓˆÚ›˙ÂÈ ÌÂÚÈΤ˜ ‚·ÛÈΤ˜ ‰È·ÙÚÔÊÈΤ˜ ·Ú¯¤˜ ·˘Ù¤˜ Â›Ó·È ÔÏϤ˜ ÊÔÚ¤˜ Û˘Áί˘Ì¤Ó˜. ™ËÌ·ÓÙÈÎfi ·›ÙÈÔ ·˘Ù‹ Ù˘ ηٿÛÙ·Û˘ ı· ϤÁ·Ì fiÙÈ Â›Ó·È ÔÈ ÔÏϷϤ˜ ËÁ¤˜ ÂÓË̤ڈÛ˘, ΢ڛˆ˜ ̤ۈ ÙˆÓ ªª∂, Ô˘ Û˘¯Ó¿ ‰ÂÓ Â›Ó·È ¤Á΢Ú˜. ∂›Û˘, ¤Ó· ‰Â˘ÙÂÚ‡ÔÓ Â‡ÚËÌ· Â›Ó·È fiÙÈ Ô ÂÈÔÏ·ÛÌfi˜ ÙˆÓ ·Ú·ÁfiÓÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘, fiˆ˜ ˘ÔÏÔÁ›ÛıËΠ·fi ÙȘ ‰ËÏÒÛÂȘ ÙˆÓ Û˘ÌÌÂÙ¯fiÓÙˆÓ, Â›Ó·È Û·ÊÒ˜ ÌÈÎÚfiÙÂÚÔ˜ ·fi ¿ÏϘ Û‡Á¯ÚÔÓ˜ ÂȉËÌÈÔÏÔÁÈΤ˜ ¤Ú¢Ó˜ Ô˘ ¯ÚËÛÈÌÔÔ›ËÛ·Ó ÂÁ΢ÚfiÙÂÚ˜ ÌÂıfi‰Ô˘˜ ÁÈ· ÙËÓ ·ÔÙ›ÌËÛË ÙˆÓ ÎÏÈÓÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ. ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi Ô‰ËÁ› ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘ÛÌÔ‡ ¤¯ÂÈ ¿ÁÓÔÈ· Ù˘ Ú·ÁÌ·ÙÈ΋˜ ηٿÛÙ·Û˘ Ù˘ ˘Á›·˜ ÙÔ˘. ∂ȉÈÎfiÙÂÚ·, Û˘ÁÎÚ›ÓÔÓÙ·˜ Ù· ÛÙÔȯ›· ·fi ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË Ì ·˘Ù¿ ·fi ÙËÓ ÂȉËÌÈÔÏÔÁÈ΋ ÌÂϤÙË ATTICA ·Ú·ÙËÚ‹Û·Ì ÛËÌ·ÓÙÈΤ˜ ·ÔÎÏ›ÛÂȘ fiÛÔÓ ·ÊÔÚ¿ ÛÙÔ˘˜ ΢ÚÈfiÙÂÚÔ˘˜ ·Ú¿ÁÔÓÙ˜ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ fiˆ˜ Â›Ó·È Ë ·¯˘Û·ÚΛ·, Ë ·ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË Î·È Ë ‰˘ÛÏÈȉ·ÈÌ›·, Ì ÂÍ·›ÚÂÛË ÙÔ ‰È·‚‹ÙË [14-16]. ∆· ·ÔÙÂϤÛÌ·Ù· ÚÔηÏÔ‡Ó ÙÔ ÂÚÒÙËÌ· ÔÈÔÈ ÌÔÚ› Ó· Â›Ó·È ÔÈ ÏfiÁÔÈ ¿ÁÓÔÈ·˜ Ù˘ ηٿÛÙ·Û˘ ˘Á›·˜ ÙˆÓ Û˘ÌÌÂÙ¯fiÓÙˆÓ. ŒÙÛÈ, ÌÔÚԇ̠ӷ ıˆڋÛÔ˘Ì fiÙÈ ·˘Ùfi Èı·ÓfiÓ Ó· ÔÊ›ÏÂÙ·È ÛÙÔ
ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ÂÈÙÒÛÂȘ ·˘ÙÒÓ ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ‰ÂÓ Â›Ó·È Û˘¯Ó¿ ¿ÌÂÛ· ÔÚ·Ù¤˜, Û ·ÓÙ›ıÂÛË Ì ÙÔ ‰È·‚‹ÙË Ô˘ ¤¯ÂÈ ÈÔ ¿ÌÂÛ· ·ÔÙÂϤÛÌ·Ù· Î·È ÔÈ Ôϛ٘ ›Ûˆ˜ Â›Ó·È ÈÔ ÂÓËÌÂڈ̤ÓÔÈ. ŸÛÔÓ ·ÊÔÚ¿ ÛÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÂÓÈÎfiÙÂÚ·, ÔÏϤ˜ Â›Ó·È ÔÈ ¤Ú¢Ó˜ Ô˘ ·Ô‰ÂÈÎÓ‡Ô˘Ó ÙË ¯·ÌËÏ‹ ÁÓÒÛË ·˘ÙÒÓ ·fi ÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi [17]. ªÈ· Û¯ÂÙÈο ÚfiÛÊ·ÙË ÌÂϤÙË ‰ÈÂÚ‡ÓËÛ ÙËÓ Èı·ÓfiÙËÙ· ‰È·ÊÔÚÔÔ›ËÛ˘ ÙˆÓ ÁÓÒÛÂˆÓ ÁÈ· ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ÌÂٷ͇ ÙˆÓ ·¯‡Û·ÚÎˆÓ ·ÙfiÌˆÓ Î·È ·˘ÙÒÓ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ‚¿ÚÔ˜, ¯ˆÚ›˜ Ó· ‚ÚÂı› ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙÔ˘˜ [18]. ∞ÎfiÌ·, Û ÌÈ· ¿ÏÏË ÌÂϤÙË Ô˘ ¤ÁÈÓ Û ÊÔÈÙËÙ¤˜, ¤‰ÂÈÍ fiÙÈ Ë ÁÓÒÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ‚Ú¤ıËΠӷ Â›Ó·È ¯·ÌËÏ‹. ¶·Ú' fiÏ· ·˘Ù¿, ÛÙËÓ ÂÚ›ÙˆÛË Ô˘ ÔÈ ÂÍÂÙ·˙fiÌÂÓÔÈ ·ÚÔ˘Û›·˙·Ó οÔÈÔ ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ Ë ÁÓÒÛË ÙÔ˘˜ Ê¿ÓËΠӷ ·˘Í¿ÓÂÈ [19]. ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Ë Úfi‚ÏÂ„Ë ÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ̤ۈ Ì·ıËÌ·ÙÈÎÒÓ ÌÔÓÙ¤ÏˆÓ Ô˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÛÙÔȯ›· ÁÈ· ÙÔ˘˜ ΢ÚÈfiÙÂÚÔ˘˜ ·Ú¿ÁÔÓÙ˜ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ (.¯. SCORE project) ·ÔÙÂÏ› ·ÓÙÈΛÌÂÓÔ ·˘ÍË̤Ó˘ ÚÔÛÔ¯‹˜ Î·È ÂÊ·ÚÌfi˙ÂÙ·È ·fi ·ÚÎÂÙÔ‡˜ ÎÏÈÓÈÎÔ‡˜ ÛÙËÓ ÚˆÙÔ‚¿ıÌÈ· ÚfiÏË„Ë. ª¤Ûˆ ·˘ÙÒÓ ÙˆÓ ÌÔÓÙ¤ÏˆÓ Ù· ¿ÙÔÌ· ı· ÌÔÚÔ‡Û·Ó Ó· ÌÂÙÚ‹ÛÔ˘Ó ÙÔÓ ·ÙÔÌÈÎfi ÙÔ˘˜ ΛӉ˘ÓÔ ÁÈ· ÂÌÊ¿ÓÈÛË Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ, ÒÛÙ ӷ ÌÔÚÔ‡Ó Ì ÙË ‚Ô‹ıÂÈ· ÙˆÓ ÂÈÛÙËÌfiÓˆÓ ˘Á›·˜ Ó· ÂÊ·ÚÌfiÛÔ˘Ó ¿ÌÂÛ· ÙÔ ·ÙÔÌÈÎfi ÙÔ˘˜ ÚfiÁÚ·ÌÌ· ÚfiÏ˄˘ Ù˘ ÓfiÛÔ˘. ∏ ÂÊ·ÚÌÔÁ‹ ÙˆÓ ÌÔÓÙ¤ÏˆÓ ·˘ÙÒÓ Û ¢Ú›· Îϛ̷η ı· ÌÔÚÔ‡Û ӷ ¢·ÈÛıËÙÔÔÈ‹ÛÂÈ ÂÚÈÛÛfiÙÂÚÔ ÙÔ˘˜ Ôϛ٘ ·¤Ó·ÓÙÈ ÛÙËÓ Ú·ÁÌ·ÙÈ΋ ηٿÛÙ·ÛË Ù˘ ˘Á›·˜ ÙÔ˘˜.
¶ÂÚÈÔÚÈÛÌÔ› Ù˘ ¤Ú¢ӷ˜ ø˜ ÂÚÈÔÚÈÛÌfi Ù˘ ·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜ ı· ÌÔÚÔ‡Û·Ì ӷ ·Ó·Ê¤ÚÔ˘Ì fiÙÈ Ù· ·ÔÙÂϤÛÌ·Ù· ‚·Û›˙ÔÓÙ·È ÛÙËÓ ÈÏÔÙÈ΋ ·Ó¿Ï˘ÛË, ÂÓÒ Ë ¤Ú¢ӷ Û˘Ó¯›˙ÂÈ Ó· ‰ÈÂÍ¿ÁÂÙ·È Î·È ˆ˜ ·ÒÙÂÚÔ˜ ÛÙfi¯Ô˜ Â›Ó·È Ë Û˘ÏÏÔÁ‹ ‰Â‰ÔÌ¤ÓˆÓ ·fi 10000 ¿ÙÔÌ·, ·fi ÔÏfiÎÏËÚË ÙË ¯ÒÚ·.
ATHIROSK 21-
05-03-09
12:25
™ÂÏ›‰·13
∂¶π¢∏ªπ√§√°π∞ - ¶∞ƒ∞°√¡∆∂™ ∫π¡¢À¡√À ™˘ÌÂÚ¿ÛÌ·Ù· ∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÈÏÔÙÈ΋˜ ·Ó¿Ï˘Û˘ Ù˘ ¤Ú¢ӷ˜ ÁÈ· ÙËÓ Î·Ù·ÁÚ·Ê‹ ÙˆÓ Ù¿ÛÂˆÓ Î·È ÙˆÓ ·ÓÙÈÏ‹„ÂˆÓ ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘ÛÌÔ‡, ·Ó·‰ÂÈÎÓ‡Ô˘Ó ÙËÓ ·Ó·ÁηÈfiÙËÙ· ·‡ÍËÛ˘ ÙˆÓ ÁÓÒÛÂˆÓ ÙÔ˘ ÏËı˘ÛÌÔ‡ ·Ó·ÊÔÚÈο Ì ÙË ˘ÁÈ-
ÂÈÓ‹ ‰È·ÙÚÔÊ‹ Î·È ÙȘ ηډȷÁÁÂȷΤ˜ ·ı‹ÛÂȘ. ∂›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·fi ÔÙ¤ ·Ó·Áη›· Ë ‰È·ÌfiÚʈÛË ÌÈ·˜ ∂ıÓÈ΋˜ ¢È·ÙÚÔÊÈ΋˜ ¶ÔÏÈÙÈ΋˜ Î·È Ë ‰ËÌÈÔ˘ÚÁ›· ÌÈ·˜ ÂÓËÌÂÚˆÙÈ΋˜ η̿ÓÈ·˜ ÁÈ· ı¤Ì·Ù· ‰È·ÙÚÔÊ‹˜-˘Á›·˜. ∏ ÔÏÈÙ›·, ·ÏÏ¿ Î·È ÔÈ ‰È¿ÊÔÚÔÈ ÂÈÛÙË-
ÌÔÓÈÎÔ› ÊÔÚ›˜ ÔÊ›ÏÔ˘Ó Ó· ·Ó·‰Â›ÍÔ˘Ó ÙÔ Úfi‚ÏËÌ· ÙÔ˘ ¯·ÌËÏÔ‡ ÂȤ‰Ô˘ ÁÓÒÛÂˆÓ ÙÔ˘ ÏËı˘ÛÌÔ‡ ·Ó·ÊÔÚÈο Ì ÙË ‰È·ÙÚÔÊ‹ Î·È ÙÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ, Î·È Ó· ‰Ú¿ÛÔ˘Ó ¿ÌÂÛ·, Ì ÛÙfi¯Ô ÙËÓ Ì›ˆÛË Ù˘ ηډȷÁÁÂȷ΋˜ ÓÔÛËÚfiÙËÙ·˜ ÛÙËÓ ¯ÒÚ·.
µÈ‚ÏÈÔÁÚ·Ê›· 1. Mackay J, Measay G. The atlas of heart disease and stroke. World Heart Organisation 2005. 2. ∂˘Úˆ·˚Îfi˜ ¯¿ÚÙ˘ ÁÈ· ÙËÓ ˘Á›· Ù˘ ηډȿ˜. European society of cardiology, European Cardiovascular Disease Statistics - British Heart Foundation and European Heart Network - 2005. 3. ¶·Ó·ÁȈٿÎÔ˜ ¢, ∫Ô˘ÚÏ·Ì¿ °. ∂ȉËÌÈÔÏÔÁ›· ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÛÙËÓ ∂ÏÏ¿‰·, ∫·Ú‰È·ÁÁÂȷ΋ ∂ȉËÌÈÔÏÔÁ›· 2005, ∂™À∂ http://www.statistics.gr/anaz.asp 4. World Heart Organisation 2005, world health statistics 2006 (www.who.int). 5. World Heart Organisation 2005, world health statistics 2007 (www.who.int). 6. Allender S, Scarborough P, Peto V, Rayner M, Leal J, Luengo-Fernandez R, Gray A. European cardiovascular disease statistics, 2nd edition 2008, 11-36. 7. Beaglehole R. Global cardiovascular disease prevention: time to get serious. Lancet 2001; 358:661-663. 8. ¶›ÙÛ·‚Ô˜ Ã, ¶·Ó·ÁȈٿÎÔ˜ ¢, ™ÙÂÊ·Ó¿‰Ë˜ Ã. ∏ ÂȉËÌÈÔÏÔÁ›· Ù˘ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ ÛÙËÓ ∂ÏÏ¿‰·. √ͤ· ÛÙÂÊ·ÓÈ·›· Û‡Ó‰ÚÔÌ·. ∂ΉfiÛÂȘ ∫ˆÛÙ¿ÎË, ∞ı‹Ó· 2004. 9. De Caterina R, Zampolli A, Del Turco S, Madonna R, Massaro M. Nutritional mechanisms that influence cardiovascular disease. Am J Clin Nutr 2006;83:421S-426S.
10. Elisaf M. The treatment of coronary heart disease: an update. Part 1: An overview of the risk factors for cardiovascular disease. Curr Med Res Opin 20014;17:18-26. 11. ∑·Ì¤Ï·˜ ∞. ∫ÏÈÓÈ΋ ¢È·ÈÙÔÏÔÁ›· & ¢È·ÙÚÔÊ‹ Ì ÛÙÔȯ›· ·ıÔÏÔÁ›·˜. π·ÙÚÈΤ˜ ∂ΉfiÛÂȘ ¶.à ¶·Û¯·Ï›‰Ë˜ 2005 12. Groff JL, Gropper SS. ¢È·ÙÚÔÊ‹ Î·È ªÂÙ·‚ÔÏÈÛÌfi˜. π·ÙÚÈΤ˜ ÂΉfiÛÂȘ ¶.Ã. ¶·Û¯·Ï›‰Ë 2004. 13. American Heart Association. Risk Factors and Coronary Heart Disease and Stroke (http://www.americanheart.org/ presenter.jhtml?indetifier=539). 14. Panagiotakos DB, Chrysohoou C, Pitsavos C, Stefanadis C. Association between the prevalence of obesity and adherence to the Mediterranean diet: the ATTICA study. Nutrition. 2006;22:449-56. 15. Panagiotakos DB, Pitsavos CH, Chrysohoou C, Skoumas J, Papadimitriou L, Stefanadis C, Toutouzas PK. Status and management of hypertension in Greece: role of the adoption of a Mediterranean diet: the Attica study. J Hypertens. 2003;21:1483-9.
of glucose homoeostasis: the ATTICA study. J Am Coll Nutr. 2007;26:32-8 17. Kirkland SA, MacLean DR, Langille DB, Joffres MR, MacPherson KM, Andreou P. Knowledge and awareness of risk factors for cardiovascular disease among Canadians 55 to 74 years of age: results from the Canadian Heart Health Surveys, 1986-1992. 18. Andersson P, Sjöberg RL, Ohrvik J, Leppert J. Knowledge about cardiovascular risk factors among obese individuals. Eur J Cardiovasc Nurs. 2006;5:275-9. 19. Danielsson B, Aberg H. The public view on cardiovascular risk factors and changes in lifestyle. Scand J Prim Health Care. 1995;13:74-80. 20. Plous S, Chense R, McDowell A. Nutrition Knowledge and Attitudes of Cardiac Patients. J Am Diet Assoc. 1995;95:442-6. 21. Lynch EB, Liu K, Kiefe CI, Greenland. Cardiovascular disease risk factor knowledge in young adults and 10year change in risk factors: the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am J Epidemiol. 2006;164:1171-9.
16. Panagiotakos DB, Tzima N, Pitsavos C, Chrysohoou C, Zampelas A, Toussoulis D, Stefanadis C. The association between adherence to the Mediterranean diet and fasting indices
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ªˆ˘Û‹˜ ∂ÏÈÛ¿Ê, ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ ∏ ‰˘ÛÏÈȉ·ÈÌ›· Â›Ó·È ¤Ó·˜ ·fi ÙÔ˘˜ ÎÏ·ÛÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘. °È· ·˘Ùfi ÙÔ ÏfiÁÔ, Ë ÛˆÛÙ‹ ‰È¿ÁÓˆÛË Ù˘ ‰˘ÛÏÈȉ·ÈÌ›·˜ ¤¯ÂÈ È‰È·›ÙÂÚË ÛËÌ·Û›· ÁÈ· ÙËÓ ÚfiÏË„Ë Ù˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘. ™ÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË Á›ÓÔÓÙ·È ·ÚÎÂÙ¿ Ï¿ıË ÛÙË ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË ÙˆÓ ‰˘ÛÏÈȉ·ÈÌÈÒÓ. ™ÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ¿ÚıÚÔ ÂÚÈÁÚ¿ÊÔÓÙ·È ·˘Ù¿ Ù· ÛÊ¿ÏÌ·Ù· Î·È ‰›ÓÔÓÙ·È Û˘ÛÙ¿ÛÂȘ ÁÈ· ÙË ÛˆÛÙ‹ ‰È·¯Â›ÚÈÛË ÙˆÓ ·ÛıÂÓÒÓ Ì ‰˘ÛÏÈȉ·ÈÌ›·. ∞’ ™ˆÛÙfi Î·È Ï¿ıÔ˜ ÛÙË ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË ÙˆÓ ˘ÂÚÏÈȉ·ÈÌÈÒÓ 1. ∂›Ó·È Ï¿ıÔ˜ Ó· Á›ÓÂÙ·È Ë ‰È¿ÁÓˆÛË Ù˘ ‰˘ÛÏÈȉ·ÈÌ›·˜ ·fi Ì›· ÌfiÓÔ ÂÚÁ·ÛÙËÚȷ΋ ÂÎÙ›ÌËÛË, ‰ÈfiÙÈ ˘¿Ú¯ÂÈ Ë Èı·ÓfiÙËÙ· ÂÚÁ·ÛÙËÚÈ·ÎÔ‡ ÛÊ¿ÏÌ·ÙÔ˜. ∞·ÈÙÔ‡ÓÙ·È ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰‡Ô ÂÍÂÙ¿ÛÂȘ, Ì ·fiÛÙ·ÛË ‰‡Ô ‚‰ÔÌ¿‰ˆÓ ÌÂٷ͇ ÙÔ˘˜, ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ ‰˘ÛÏÈȉ·ÈÌ›·˜. 2. ∂›Ó·È ··Ú·›ÙËÙÔ Ó· Ï·Ì‚¿ÓÔÓÙ·È ˘fi„Ë ÔÈ Û˘Óı‹Î˜ ÚÔÛ‰ÈÔÚÈÛÌÔ‡ ÙˆÓ ÙÈÌÒÓ ÙˆÓ ÏÈȉ·ÈÌÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ. √ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ÏÈȉ·ÈÌÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÌÂÙ¿ ÓËÛÙ›· ÙÔ˘Ï¿¯ÈÛÙÔÓ 12 ˆÚÒÓ. ∂ÈÚfiÛıÂÙ·, Â›Ó·È ÛËÌ·ÓÙÈÎfi Ó· Ï·Ì‚¿ÓÔÓÙ·È ˘fi„Ë Î·È ¿ÏÏÔÈ ·Ú¿ÁÔÓÙ˜, fiˆ˜ Â›Ó·È Ë ·ÈÌÔÛ˘Ì‡ÎÓˆÛË ÙÔ˘ ·ÛıÂÓ‹, ÁÈ· ·Ú¿‰ÂÈÁÌ· Û ¿ÙÔÌ· Ô˘ ‚Ú›ÛÎÔÓÙ·È Û fiÚıÈ· ı¤ÛË, ηıÒ˜ Î·È Ë ÌÂÙ·‚ÏËÙfiÙËÙ· ÙˆÓ ÙÈÌÒÓ ÙˆÓ ÏÈȉ·ÈÌÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ, ÂÓÒ Â›Ó·È ··Ú·›ÙËÙÔ˜ Î·È Ô ÔÈÔÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ ÂÚÁ·ÛÙËÚ›Ô˘ ÛÙÔ ÔÔ›Ô Á›ÓÔÓÙ·È ÔÈ ÂÚÁ·ÛÙËÚȷΤ˜ ·Ó·Ï‡ÛÂȘ. √È Û˘Óı‹Î˜ Ù˘ ·ÈÌÔÏË„›·˜ Î·È Ô ¯ÂÈÚÈÛÌfi˜ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ¤¯Ô˘Ó ÌÂÁ¿ÏË ÛËÌ·Û›· ÁÈ· ÙËÓ ·ÍÈÔÈÛÙ›· ÙÔ˘ ÂÚÁ·ÛÙËÚÈ·ÎÔ‡ ÚÔÛ‰ÈÔÚÈÛÌÔ‡ ÙÔ˘ ÏÈȉ·ÈÌÈÎÔ‡ ÚÔÊ›Ï. °È· ·Ú¿‰ÂÈÁÌ·, Ë ÔÚıÔÛÙ·Û›· ÁÈ· 5 Î·È 15 ÏÂÙ¿ ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ·ÈÌÔÛ˘Ì‡ÎÓˆÛË Î·È ·‡ÍËÛË ÙˆÓ ÂȤ‰ˆÓ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ηٿ 9% Î·È 16% ·ÓÙ›ÛÙÔȯ·. ¶ÚÈÓ ÙËÓ ·ÈÌÔÏË„›·, Ô ·ÛıÂÓ‹˜ Ú¤ÂÈ Ó· Â›Ó·È Î·ıÈÛÙfi˜ ÁÈ· 5 ÏÂ-
14
Ù¿ ÂÚ›Ô˘, ÂÓÒ Ë ÂÚȯÂÈÚ›‰· ‰ÂÓ Ú¤ÂÈ Ó· ·Ú·Ì¤ÓÂÈ ÁÈ· ÂÚÈÛÛfiÙÂÚÔ ·fi 1 ÏÂÙfi, ·ÊÔ‡ ÌÔÚ› Ó· ÚÔηϤÛÂÈ ÙÔÈ΋ ·ÈÌÔÛ˘Ì‡ÎÓˆÛË Î·È ·‡ÍËÛË Ù˘ ÙÈÌ‹˜ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘. 3. √ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ÏÈȉ›ˆÓ Ú¤ÂÈ Ó· ·Ó·‚¿ÏÏÂÙ·È Û ÂÚÈÙÒÛÂȘ stress, fiˆ˜ Û ·ÛıÂÓ›˜ Ì Ôͤ· ÓÔÛ‹Ì·Ù· (ÙÚ·‡Ì·Ù·, ¯ÂÈÚÔ˘ÚÁÈΤ˜ ÂÂÌ‚¿ÛÂȘ, ÏÔÈÌÒÍÂȘ, ÂÌÊÚ¿ÁÌ·Ù·, ·ÁÁÂȷο ÂÁÎÂÊ·ÏÈο ÂÂÈÛfi‰È·). ∞˘Ù¤˜ ÔÈ Î·Ù·ÛÙ¿ÛÂȘ Û˘Óԉ‡ÔÓÙ·È ·fi ·ÏÏ·Á¤˜ ÛÙË Û‡ÛÙ·ÛË ‹ ÛÙË Û˘ÁΤÓÙÚˆÛË ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ. ∆¤ÙÔȘ ·ÏÏ·Á¤˜ Â›Ó·È Ë Ì›ˆÛË Ù˘ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘, Ë Ì›ˆÛË Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ÙˆÓ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ (LDL-¯ÔÏËÛÙÂÚfiÏ˘) Î·È Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ÙˆÓ ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ (HDL-¯ÔÏËÛÙÂÚfiÏ˘), ηıÒ˜ Î·È Ë ·‡ÍËÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ. 4. ∂›Ó·È Ï¿ıÔ˜ Ó· Ù›ıÂÙ·È Ë ‰È¿ÁÓˆÛË Ù˘ ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›·˜ ÂÍ·ÈÙ›·˜ ·Ó·ÚÎÔ‡˜ ÓËÛÙ›·˜ (<12 ÒÚ˜) ÙÔ˘ ·ÛıÂÓ‹. √ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ÂȤ‰ˆÓ ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÌÂÙ¿ 12ˆÚË ÓËÛÙ›·. ™Â ·ÓÙ›ıÂÛË Ì ٷ ÙÚÈÁÏ˘ÎÂÚ›‰È·, ÔÈ ÙÈ̤˜ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ‰ÂÓ ÂËÚ¿˙ÔÓÙ·È ·fi ÙËÓ ÚfiÛÏË„Ë ÙÚÔÊ‹˜. 5. ∂›Ó·È Ï¿ıÔ˜ Ó· ˘ÔÏÔÁ›˙ÂÙ·È Ë LDL-¯ÔÏËÛÙÂÚfiÏË ·fi ÙËÓ Â͛ۈÛË ÙÔ˘ Friedewald (LDL¯ÔÏËÛÙÂÚfiÏË = ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË - [HDL-¯ÔÏËÛÙÂÚfiÏË+ÙÚÈÁÏ˘ÎÂÚ›‰È·/5]) Û ·ÛıÂÓ›˜ Ì ›‰· ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ >400 mg/dL. ™Â ·˘Ù¿ Ù· ¿ÙÔÌ·, Ô ˘ÔÏÔÁÈÛÌfi˜ ÙˆÓ ÂȤ‰ˆÓ Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ Ú¤ÂÈ Ó· Á›ÓÂÙ·È Â›Ù ÌÂÙ¿ ·fi Ì›ˆÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ, ›Ù Ì ¿ÌÂÛË Ì¤ÙÚËÛË Ù˘ LDL¯ÔÏËÛÙÂÚfiÏ˘ ÛÙÔÓ ÔÚfi. 6. ¢ÂÓ Ú¤ÂÈ Ó· Á›ÓÂÙ·È Î·Ù¿¯ÚËÛË ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙˆÓ ‰˘ÛÏÈȉ·ÈÌÈÒÓ. °È· ÙË ‰È¿ÁÓˆÛË Ù˘ ‰˘ÛÏÈȉ·ÈÌ›·˜, ··ÈÙÂ›Ù·È Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ÎÏ·ÛÈÎÒÓ ÏÈȉ·ÈÌÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ, fiˆ˜
Â›Ó·È Ë ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË, Ë LDL-¯ÔÏËÛÙÂÚfiÏË, Ë HDL-¯ÔÏËÛÙÂÚfiÏË Î·È Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È·. √ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ·ÔÏÈÔÚˆÙÂ˚ÓÒÓ (apo) ‰ÂÓ ‰›ÓÂÈ ÂÚÈÛÛfiÙÂÚ˜ ÏËÚÔÊÔڛ˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË Î·È ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ‰˘ÛÏÈȉ·ÈÌÈÒÓ. ∂Í·›ÚÂÛË ·ÔÙÂÏ› Ë apoB, Ù˘ ÔÔ›·˜ Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÂÓ‰¤¯ÂÙ·È Ó· ¤¯ÂÈ Î¿ÔÈ· ‰È·ÁÓˆÛÙÈ΋ Î·È ÚÔÁÓˆÛÙÈ΋ ·Í›·. √ ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ ÏÈÔÚˆÙ½Ó˘ · [Lp(a)] Ú¤ÂÈ Ó· Á›ÓÂÙ·È Û ÂÍ·ÈÚÂÙÈΤ˜ ÂÚÈÙÒÛÂȘ, fiˆ˜ ÁÈ· ·Ú¿‰ÂÈÁÌ· Û ·ÛıÂÓ›˜ Ì ·ÁÁÂȷ΋ ÓfiÛÔ Ô˘ ‰ÂÓ ¤¯Ô˘Ó ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙ˜ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘, ηıÒ˜ Î·È Û ¿ÙÔÌ· Ì ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· ‹ ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ. 7. ∂›Ó·È Ï¿ıÔ˜ Ó· Ù›ıÂÙ·È Ë ‰È¿ÁÓˆÛË Ù˘ ‰˘ÛÏÈȉ·ÈÌ›·˜ Î·È Ó· ÍÂÎÈÓ¿ Ë ıÂڷ›· Ù˘ ÚÈÓ ÙÔÓ ·ÔÎÏÂÈÛÌfi ÙˆÓ ·ÈÙ›ˆÓ Ù˘ ‰Â˘ÙÂÚÔ·ıÔ‡˜ ‰˘ÛÏÈȉ·ÈÌ›·˜. √ ۷ί·Ú҉˘ ‰È·‚‹Ù˘ Û˘Óԉ‡ÂÙ·È Û˘¯Ó¿ ·fi ‰Â˘ÙÂÚÔ·ı‹ ‰˘ÛÏÈȉ·ÈÌ›·, Ë ÔÔ›· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·˘ÍË̤ӷ ÙÚÈÁÏ˘ÎÂÚ›‰È· Î·È ¯·ÌËÏ‹ HDL-¯ÔÏËÛÙÂÚfiÏË. °È· ·˘Ùfi ÙÔ ÏfiÁÔ, Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ÂȤ‰ˆÓ Ù˘ ÁÏ˘Îfi˙˘ ÓËÛÙ›·˜. ∏ ·¯˘Û·ÚΛ· ›Û˘ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ·˘ÍË̤ӷ ÙÚÈÁÏ˘ÎÂÚ›‰È· Î·È ¯·ÌËÏ‹ HDL-¯ÔÏËÛÙÂÚfiÏË. ¶·Ú¿ÏÏËÏ·, Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ÂȤ‰ˆÓ Ù˘ ı˘ÚÂÔÂȉÔÙÚfiÔ˘ ÔÚÌfiÓ˘ (TSH), ·ÊÔ‡ Ô ˘Ôı˘ÚÂÔÂȉÈÛÌfi˜ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ˘„ËÏ¿ ›‰· ÔÏÈ΋˜ Î·È LDL-¯ÔÏËÛÙÂÚfiÏ˘. ∂ÈÚfiÛıÂÙ·, Ë ÁÂÓÈ΋ ÂͤٷÛË ÙˆÓ Ô‡ÚˆÓ Â›Ó·È ··Ú·›ÙËÙË ÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÌfi ÙÔ˘ ÓÂÊÚˆÛÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘, ÙÔ ÔÔ›Ô Û˘Óԉ‡ÂÙ·È ·fi ·˘ÍË̤ӷ ›‰· ÔÏÈ΋˜ Î·È LDL-¯ÔÏËÛÙÂÚfiÏ˘, ηıÒ˜ Î·È ·fi ·˘ÍË̤ӷ ÙÚÈÁÏ˘ÎÂÚ›‰È·. √ ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ ÎÚ·ÙÈÓ›Ó˘ ÙÔ˘ ÔÚÔ‡ ÌÔÚ› Ó· ·Ôηχ„ÂÈ ÙËÓ ·ÚÔ˘Û›· ¯ÚfiÓÈ·˜ ÓÂÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜, Ë ÔÔ›· Û˘Û¯ÂÙ›˙ÂÙ·È Ì ·˘ÍË̤ӷ ÙÚÈÁÏ˘ÎÂÚ›‰È· Î·È ¯·ÌËÏ‹ HDL-¯ÔÏËÛÙÂÚfiÏË. ∏
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∫§π¡π∫∏ ¶ƒ∞•∏ ÚˆÙÔ·ı‹˜ ¯ÔÏÈ΋ ΛÚÚˆÛË ÌÔÚ› Ó· Û˘Óԉ‡ÂÙ·È ·fi ·˘ÍË̤ӷ ›‰· ¯ÔÏËÛÙÂÚfiÏ˘. °È· ·˘Ùfi ÙÔ ÏfiÁÔ, Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Ú¤ÂÈ Ó· ÚÔÛ‰ÈÔÚ›˙ÔÓÙ·È Ù· ›‰· Ù˘ ·ÏηÏÈ΋˜ ʈÛÊ·Ù¿Û˘ (ALP). ∆¤ÏÔ˜, ÔÚÈṲ̂ӷ Ê¿Ú̷η ÚÔηÏÔ‡Ó ‰È·Ù·Ú·¯¤˜ ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ ÙÔ˘ ÔÚÔ‡. º¿Ú̷η Ô˘ ·˘Í¿ÓÔ˘Ó Ù· ›‰· Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ Â›Ó·È Ù· ‰ÈÔ˘ÚËÙÈο, Ë Î˘ÎÏÔÛÔÚ›ÓË, Ë ·ÌÈÔ‰·ÚfiÓË, Ù· ·ÓÙÈÚÂÙÚÔ˚ο Ê¿Ú̷η, ηıÒ˜ Î·È ÔÈ ÁÏÈÙ·˙fiÓ˜. ∆· ›‰· ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ·˘Í¿ÓÔÓÙ·È ·fi ÙË ¯ÔÚ‹ÁËÛË Ê·Ú̿ΈÓ, fiˆ˜ Â›Ó·È ÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜, Ù· ‰ÈÔ˘ÚËÙÈο, Ë ÈÓÙÂÚÊÂÚfiÓË, Ù· ÚÂÙÈÓÔÂȉ‹, Ù· ¿Ù˘· ·ÓÙÈ„˘¯ˆÛÈο Ê¿Ú̷η, Ù· ÔÈÛÙÚÔÁfiÓ· Î·È Ë Ù·ÌÔÍÈÊ·›ÓË. 8. ™ÙË ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË ÙˆÓ ·ÛıÂÓÒÓ Ì ‰˘ÛÏÈȉ·ÈÌ›· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÛˆÛÙ‹ ·ÍÈÔÏfiÁËÛË fiÏˆÓ ÙˆÓ Â˘ÚËÌ¿ÙˆÓ Ô˘ ÚÔ·ÙÔ˘Ó ·fi ÙÔ ÈÛÙÔÚÈÎfi Î·È ÙË Ê˘ÛÈ΋ ÂͤٷÛË, Ì ÛÙfi¯Ô ÙË ‰È¿ÁÓˆÛË Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÓÔÛÔÏÔÁÈÎÒÓ ÔÓÙÔًوÓ. µ’ ¶ÚˆÙÔ·ı›˜ Î·È ‰Â˘ÙÂÚÔ·ı›˜ ‰˘ÛÏÈȉ·È̛˜ Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË. ŒÓ·˜ ·ÛıÂÓ‹˜ Ì ˘„ËÏ¿ ›‰· ÔÏÈ΋˜ Î·È LDL-¯ÔÏËÛÙÂÚfiÏ˘ ÌÔÚ› Ó· ÂÌÊ·Ó›˙ÂÈ Â›Ù ڈÙÔ·ı›˜ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ ÏÈȉ›ˆÓ, fiˆ˜ Â›Ó·È Ë ÔÈÎÔÁÂÓ‹˜ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·, Ë ÔÏ˘ÁÔÓÈ΋ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· Î·È Ë ÚˆÙÔ·ı‹˜ ÌÈÎÙ‹ ‰˘ÛÏÈȉ·ÈÌ›· ›Ù ‰Â˘ÙÂÚÔ·ı‹ ‰˘ÛÏÈȉ·ÈÌ›·, Ô˘ ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È Û ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ, ˘Ôı˘ÚÂÔÂȉÈÛÌfi ‹ ÚˆÙÔ·ı‹ ¯ÔÏÈ΋ ΛÚÚˆÛË. ∏ ·ÚÔ˘Û›· ıÂÙÈÎÔ‡ ÎÏËÚÔÓÔÌÈÎÔ‡ ÈÛÙÔÚÈÎÔ‡ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜ Î·È Î·Ú‰È·ÁÁÂȷ΋˜ ÓfiÛÔ˘ ‚ÔËı¿ ÛÙË ‰È¿ÁÓˆÛË ÙˆÓ ÚˆÙÔ·ıÒÓ ‰È·Ù·Ú·¯ÒÓ Ô˘ Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·. ∞ÓÙ›ıÂÙ·, ÔÚÈṲ̂ӷ ÛÙÔȯ›· ·fi ÙÔ ÈÛÙÔÚÈÎfi ÛÂ Û˘Ó‰˘·ÛÌfi Ì ٷ Â˘Ú‹Ì·Ù· ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ ÌÔÚÔ‡Ó Ó· ‚ÔËı‹ÛÔ˘Ó ÛÙËÓ ‰È¿ÁÓˆÛË ÙˆÓ ·ÈÙ›ˆÓ Ù˘ ‰Â˘ÙÂÚÔ·ıÔ‡˜ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜. ∏ ÔÈÎÔÁÂÓ‹˜ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· Â›Ó·È Ë ÈÔ Û˘¯Ó‹ ÁÂÓÂÙÈ΋ ‰˘ÛÏÈȉ·ÈÌ›· (ÂÙÂÚÔ˙˘ÁÒÙ˜ 1/500 ¿ÙÔÌ·) Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÌÂȈ̤ÓË ‰Ú·ÛÙËÚÈfiÙËÙ· ÙˆÓ LDL-˘Ô‰Ô¯¤ˆÓ, ·fi ÌÂÁ¿ÏË ·‡ÍËÛË ÙˆÓ ÂȤ‰ˆÓ Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘, ηıÒ˜ Î·È ·fi ÚÒÈÌË ·ıËڈ̿وÛË. ∆Ô ıÂÙÈÎfi ÔÈÎÔÁÂ-
ÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜ Î·È ÚÒÈÌ˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘ ‚ÔËıÔ‡Ó ÛÙË ‰È¿ÁÓˆÛË Ù˘ ÔÈÎÔÁÂÓÔ‡˜ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜. ∂˘Ú‹Ì·Ù· ·fi ÙË Ê˘ÛÈ΋ ÂͤٷÛË Ô˘ Û˘¯Ó¿ ·Ú·ÙËÚÔ‡ÓÙ·È Û ¿ÙÔÌ· Ì ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· Â›Ó·È Ù· ÙÂÓfiÓÙÈ· Í·ÓıÒÌ·Ù·, Ù· Í·ÓıÂÏ¿ÛÌ·Ù·, ÙÔ ÁÂÚÔÓÙfiÙÔÍÔ, ηıÒ˜ Î·È ¤Ó· Û˘ÛÙÔÏÈÎfi ʇÛËÌ· Ô˘ Â›Ó·È ÂÓ‰ÂÈÎÙÈÎfi ·ÔÚÙÈ΋˜ ÛÙ¤ÓˆÛ˘. ∏ ·ÚÔ˘Û›· ÙˆÓ ÙÂÓfiÓÙÈˆÓ Í·ÓıˆÌ¿ÙˆÓ ·ÔÙÂÏ› Î·È ÙÔ ·ıÔÁÓˆÌÔÓÈÎfi ÁÓÒÚÈÛÌ· Ù˘ ÓfiÛÔ˘. ∆· ÙÂÓfiÓÙÈ· Í·ÓıÒÌ·Ù· Â›Ó·È ÏÂ˘Îˆ¤˜ Ô˙Ò‰ÂȘ ‰ÈÔÁÎÒÛÂȘ, Ô˘ Ù˘Èο ·ÊÔÚÔ‡Ó ÙÔÓ ∞¯›ÏÏÂÈÔ Ù¤ÓÔÓÙ·, ηıÒ˜ Î·È ÛÙÔ˘˜ Ù¤ÓÔÓÙ˜ Ù˘ ÎÓ‹Ì˘, ÙÔ˘ ·ÁÎÒÓ· Î·È Ù˘ Ú·¯È·›·˜ ÂÈÊ¿ÓÂÈ·˜ ÙˆÓ ¿ÎÚˆÓ ¯ÂÈÚÒÓ. ∆· Í·ÓıÂÏ¿ÛÌ·Ù· Î·È ÙÔ ÁÂÚÔÓÙfiÙÔÍÔ ·ÔÙÂÏÔ‡Ó ÂÓ·Ôı¤ÛÂȘ ¯ÔÏËÛÙÂÚfiÏ˘ ÛÙ· ‚Ϥʷڷ Î·È ÛÙÔÓ ÎÂÚ·ÙÔÂȉ‹ ·ÓÙ›ÛÙÔȯ·. ∏ ÔÏ˘ÁÔÓÈ΋ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· ·ÔÙÂÏ› ÙËÓ ÈÔ Û˘¯Ó‹ ·ÈÙ›· ·‡ÍËÛ˘ Ù˘ ÔÏÈ΋˜ Î·È LDL-¯ÔÏËÛÙÂÚfiÏ˘ ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi, Ë ÔÔ›· ‰ÂÓ ÔÊ›ÏÂÙ·È Û ÌÂÙ·ÏÏ¿ÍÂȘ Û ¤Ó· Û˘ÁÎÂÎÚÈ̤ÓÔ ÁÔÓ›‰ÈÔ, ·ÏÏ¿ Û ̛· ÔχÏÔÎË ·ÏÏËÏ›‰Ú·ÛË ÔÏÏ·ÏÒÓ ÁÂÓÂÙÈÎÒÓ Î·È ÂÚÈ‚·ÏÏÔÓÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ (.¯. ‰›·ÈÙ·, ·‡ÍËÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜). ∏ ÚˆÙÔ·ı‹˜ ÌÈÎÙ‹ ˘ÂÚÏÈȉ·ÈÌ›· ·ÔÙÂÏ› Ì›· ÁÂÓÂÙÈ΋ ‰È·Ù·Ú·¯‹, Ë ÔÔ›· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÙËÓ ÂÌÊ¿ÓÈÛË ÚÒÈÌ˘ ·ıËڈ̿وÛ˘, ηıÒ˜ Î·È ·fi ·˘ÍË̤ÓË Ë·ÙÈ΋ ·Ú·ÁˆÁ‹ apoB. ∆Ô 1/3 ÙˆÓ ·ÙfiÌˆÓ ÌÈ·˜ ÔÈÎÔÁ¤ÓÂÈ·˜ Ô˘ ÂÌÊ·Ó›˙ÂÈ ·˘Ù‹ ÙË ‰È·Ù·Ú·¯‹ ÂÌÊ·Ó›˙ÂÈ ·˘ÍË̤ӷ ›‰· LDL-¯ÔÏËÛÙÂÚfiÏ˘, ÙÔ 1/3 ˘„ËÏ¿ ÙÚÈÁÏ˘ÎÂÚ›‰È·, ÂÓÒ ÙÔ ˘fiÏÔÈÔ 1/3 Û˘Ó‰˘·ÛÌfi ·˘ÍËÌ¤ÓˆÓ ÂȤ‰ˆÓ LDL-¯ÔÏËÛÙÂÚfiÏ˘ Î·È ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ. ™Â ·ÛıÂÓ›˜ Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ·˘Ùfi ÙÔÓ Ù‡Ô Ù˘ ‰˘ÛÏÈȉ·ÈÌ›·˜, Ô Ê·ÈÓfiÙ˘Ô˜ ÌÔÚ› Ó· ÌÂÙ·‚¿ÏÏÂÙ·È Ì ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘ ‹ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ‰È·ÈÙËÙÈ΋˜ ‹ Ù˘ Ê·Ú̷΢ÙÈ΋˜ ıÂڷ›·˜. √È ·ÛıÂÓ›˜ Ì ·˘ÍË̤ӷ ÙÚÈÁÏ˘ÎÂÚ›‰È· ÓËÛÙ›·˜ ‰È·ÎÚ›ÓÔÓÙ·È Û ‰‡Ô ηÙËÁÔڛ˜ ·Ó¿ÏÔÁ· Ì ٷ ›‰· ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ (>1000 mg/dL ‹ 200-1000 mg/dL). √È ·ÛıÂÓ›˜ Ì ÙÚÈÁÏ˘ÎÂÚ›‰È· ÓËÛÙ›·˜ > 1000 mg/dL ÌÔÚ› Ó· ¿Û¯Ô˘Ó ·fi ÔÈÎÔÁÂÓ‹ ‹ ›ÎÙËÙË ¯˘ÏÔÌÈÎÚÔÓ·ÈÌ›·. ∞˘Ù¤˜ ÔÈ ‰‡Ô ÓÔÛÔÏÔÁÈΤ˜ ÔÓÙfiÙËÙ˜ ·˘-
Í¿ÓÔ˘Ó ÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ·ÁÎÚ·ٛÙȉ·˜, ÂÓÒ ÂӉ¯fiÌÂÓ· ·˘Í¿ÓÂÙ·È Î·È Ô Î›Ó‰˘ÓÔ˜ ÂÌÊ¿ÓÈÛ˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘. ∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ù˘ ÚˆÙÔ·ıÔ‡˜ ¯˘ÏÔÌÈÎÚÔÓ·ÈÌ›·˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ˘ÔÙÚÔÈ¿˙ÔÓÙ· ÎÔÈÏȷο ¿ÏÁË Î·È ÂÂÈÛfi‰È· ÔÍ›·˜ ·ÁÎÚ·ٛÙȉ·˜, ηıÒ˜ Î·È ·fi ÙËÓ ·ÚÔ˘Û›· ÏÈ·ÈÌ›·˜ ÛÙÔ ‚˘ıfi ÙÔ˘ ÔÊı·ÏÌÔ‡ (lipemia retinalis), ÂÍ·ÓıËÌ·ÙÈÎÒÓ Í·ÓıˆÌ¿ÙˆÓ Î·È ÏÈ·ÈÌÈÎÔ‡ ÔÚÔ‡. ∆· ÂÍ·ÓıËÌ·ÙÈο Í·ÓıÒÌ·Ù· Â›Ó·È ÌÈÎÚ¤˜ ÎÈÙÚÈÓˆ¤˜ ÎËÏ›‰Â˜ Ô˘ ÂÚÈ‚¿ÏÏÏÔÓÙ·È ·fi ÂÚ˘ıËÌ·ÙÒ‰Ë ¿Ïˆ Î·È ·Ó¢ڛÛÎÔÓÙ·È ÛÙÔ˘˜ ÁÏÔ˘ÙÔ‡˜, ÛÙË Ú¿¯Ë Î·È ÛÙȘ ÂÎÙ·ÙÈΤ˜ ÂÈÊ¿ÓÂȘ ÙˆÓ ¿ÎÚˆÓ. ∏ ‰È¿ÁÓˆÛË Ù˘ ¯˘ÏÔÌÈÎÚÔÓ·ÈÌ›·˜ Ù›ıÂÙ·È ·fi ÙËÓ ·ÚÔ˘Û›· ÏÈ·ÈÌÈÎÔ‡ ÔÚÔ‡ ‹ Ï¿ÛÌ·ÙÔ˜ Û ·ÈÌÔÏË„›·, ÌÂÙ¿ ÓËÛÙ›· ÙÔ˘Ï¿¯ÈÛÙÔÓ 12 ˆÚÒÓ. ∂›Ó·È Ï¿ıÔ˜ Ó· ÌËÓ ·Ó·ÁÓˆÚ›˙ÔÓÙ·È Ù· ·›ÙÈ· Ù˘ ›ÎÙËÙ˘ ¯˘ÏÔÌÈÎÚÔÓ·ÈÌ›·˜. ∆¤ÙÔÈ· ·›ÙÈ· ›ӷÈ: Ô Û·Î¯·Ú҉˘ ‰È·‚‹Ù˘, Ë ·¯˘Û·ÚΛ·, Ë ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ·, Ë Î·Ù¿¯ÚËÛË ÔÈÓÔÓ‡̷ÙÔ˜, ηıÒ˜ Î·È Ë ¯ÔÚ‹ÁËÛË ÔÚÈÛÌ¤ÓˆÓ Ê·Ú̿ΈÓ. ∆· ¿ÙÔÌ· Ô˘ οÓÔ˘Ó Î·Ù¿¯ÚËÛË ÔÈÓÔÓ‡̷ÙÔ˜ ·Ó·ÁÓˆÚ›˙ÔÓÙ·È ·fi ÙËÓ ·ÚÔ˘Û›· ÔÚÈÛÌ¤ÓˆÓ ÎÏÈÓÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ, fiˆ˜ Â›Ó·È Ë ÂÚ˘ıÚfiÙËÙ· ÙÔ˘ ı¤Ó·ÚÔ˜ Î·È ÙÔ˘ ˘Ôı¤Ó·ÚÔ˜, ÔÈ ÙÂÏ·ÁÁÂÈÂÎٷۛ˜, ÔÈ ·Ï¿Ì˜ Dupuytren, ÙÔ ÂÚ‡ıËÌ· ÙÔ˘ ÚÔÛÒÔ˘, Ë Á˘Ó·ÈÎÔÌ·ÛÙ›·, ηıÒ˜ Î·È Ë ‰ÈfiÁΈÛË ÙˆÓ ·ÚˆÙ›‰ˆÓ. ∂ÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· Ô˘ ˘ÔÛËÌ·›ÓÔ˘Ó ÙËÓ Î·Ù¿¯ÚËÛË ÔÈÓÔÓ‡̷ÙÔ˜ Â›Ó·È Ë ·‡ÍËÛË ÙÔ˘ ̤ÛÔ˘ fiÁÎÔ˘ ÙˆÓ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ (MCV), ηıÒ˜ Î·È Ù· ·˘ÍË̤ӷ ›‰· ÙÔ˘ Ô˘ÚÈÎÔ‡ ÔͤԘ, Ù˘ ÁGT Î·È Ù˘ ·Û·ÚÙÈ΋˜ ·ÌÈÓÔÙÚ·ÓÛÊÂÚ¿Û˘ (AST). ∏ ‰ÈÏ¿ÛÈ· ·‡ÍËÛË Ù˘ AST Û ۇÁÎÚÈÛË Ì ÙËÓ ·ÌÈÓÔÙÚ·ÓÛÊÂÚ¿ÛË Ù˘ ·Ï·Ó›Ó˘ (ALT) ·ÔÙÂÏ› ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÂÚÁ·ÛÙËÚÈ·Îfi ‡ÚËÌ· Û ¿ÙÔÌ· Ô˘ οÓÔ˘Ó Î·Ù¿¯ÚËÛË ÔÈÓÔÓ‡̷ÙÔ˜. ¶Ú¤ÂÈ ¿ÓÙÔÙ ӷ ·Ó·˙ËÙÂ›Ù·È Ë ¯ÔÚ‹ÁËÛË Ê·ÚÌ¿ÎˆÓ Ô˘ ÂËÚ¿˙Ô˘Ó ‰˘ÛÌÂÓÒ˜ ÙÔ ÌÂÙ·‚ÔÏÈÛÌfi ÙˆÓ ÏÔ‡ÛÈˆÓ Û ÙÚÈÁÏ˘ÎÂÚ›‰È· ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È ÚÔηÏÔ‡Ó ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ. ∆¤ÙÔÈ· Ê¿Ú̷η Â›Ó·È ÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜, Ë ÈÓÙÂÚÊÂÚfiÓË, Ù· ÚÂÙÈÓÔÂȉ‹, Ù· ¿Ù˘· ·ÓÙÈ„˘¯ˆÛÈο Ê¿Ú̷η, Ù· ÔÈÛÙÚÔÁfiÓ·, ηıÒ˜ Î·È Ë Ù·ÌÔÍÈÊ·›ÓË.
15
ATHIROSK 21-
05-03-09
12:25
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™ÂÏ›‰·16
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∂›Ó·È Ï¿ıÔ˜ Ó· ÌËÓ Á›ÓÂÙ·È ·ÎÚÈ‚‹˜ ‰È¿ÁÓˆÛË Ù˘ ˘ÔΛÌÂÓ˘ ‰È·Ù·Ú·¯‹˜ Ô˘ Ô‰ËÁ› Û ̤ÙÚÈ· ·‡ÍËÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ (200-1000 mg/dL). ∞˘Ù¤˜ ÔÈ ‰È·Ù·Ú·¯¤˜ ‰È·ÎÚ›ÓÔÓÙ·È Û ڈÙÔ·ı›˜ Î·È ‰Â˘ÙÂÚÔ·ı›˜. √È ÈÔ Û˘Ó‹ıÂȘ ÚˆÙÔ·ı›˜ ‰È·Ù·Ú·¯¤˜ Â›Ó·È Ë ÔÈÎÔÁÂÓ‹˜ ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›·, Ë ÔÔ›· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÌÂÌÔӈ̤ÓË ·‡ÍËÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ Î·È ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›·˜, ηıÒ˜ Î·È Ë ÚˆÙÔ·ı‹˜ ÌÈÎÙ‹ ˘ÂÚÏÈȉ·ÈÌ›·, Ë ÔÔ›· ¯·Ú·ÎÙËÚ›˙ÂÙ·È, fiˆ˜ ·Ó·Ê¤ÚıËÎÂ, ·fi ÔÏÏ·ÏÔ‡˜ ÏÈȉ·ÈÌÈÎÔ‡˜ Ê·ÈÓfiÙ˘Ô˘˜. ∏ ÚˆÙÔ·ı‹˜ ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›· ‰ÂÓ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ·‡ÍËÛË ÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘, Û ·ÓÙ›ıÂÛË Ì ÙËÓ ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›· Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÙ· Ï·›ÛÈ· Ù˘ ÚˆÙÔ·ıÔ‡˜ ÌÈÎÙ‹˜ ˘ÂÚÏÈȉ·ÈÌ›·˜ ‹ ÙÔ˘ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘, Ë ÔÔ›· ·˘Í¿ÓÂÈ ÙÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ. °È· ·˘Ùfi ÙÔ ÏfiÁÔ, Ú¤ÂÈ Û οı ÂÚ›ÙˆÛË Ó· ·ÍÈÔÏÔÁÂ›Ù·È Ë ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›· ˆ˜ ‰˘ÓËÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË Î·Ú‰È·ÁÁÂȷ΋˜ ÓfiÛÔ˘. °È· ÙË ÛˆÛÙ‹ ·ÍÈÔÏfiÁËÛË Ù˘ ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›·˜ ¤¯ÂÈ È‰È·›ÙÂÚË ÛËÌ·Û›· ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi. ∂ÈÚfiÛıÂÙ·, Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ÂȤ‰ˆÓ Ù˘ apoB ÌÔÚ› Ó· Â›Ó·È ·ÚÎÂÙ¿ ¯Ú‹ÛÈÌÔ˜, ·ÊÔ‡ Ù· ›‰· Ù˘ apoB ·ÔÙÂÏÔ‡Ó ¤Ó· Ôχ ηÏfi ‰Â›ÎÙË Ù˘ ·ÚÔ˘Û›·˜ ÙˆÓ ·ıËÚÔÁfiÓˆÓ ÌÈÎÚÒÓ-˘ÎÓÒÓ LDL ۈ̷Ùȉ›ˆÓ. ªÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ Ô Î·Ú‰È·ÁÁÂÈ·Îfi˜ ΛӉ˘ÓÔ˜ Â›Ó·È È‰È·›ÙÂÚ· ·˘ÍË̤ÓÔ˜ fiÙ·Ó Ù· ›‰· Ù˘ apoB Â›Ó·È >120 mg/dL. ¶Ú¿ÁÌ·ÙÈ, Û ·ÛıÂÓ›˜ Ì ÔÈÎÔÁÂÓ‹ ÌÈÎÙ‹ ˘ÂÚÏÈȉ·ÈÌ›· Ù· ›‰· Ù˘ apoB Â›Ó·È ·˘ÍË̤ӷ. ∂›Ó·È Ï¿ıÔ˜ Ë ÌË ÛˆÛÙ‹ ·ÍÈÔÏfiÁËÛË ÙˆÓ ÂȤ‰ˆÓ Ù˘ HDL¯ÔÏËÛÙÂÚfiÏ˘. ∆· ·˘ÍË̤ӷ ›‰· ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ¯·ÌËÏ¿ ›‰· HDL-
¯ÔÏËÛÙÂÚfiÏ˘. ∂ÈÚfiÛıÂÙ·, ¯·ÌËÏ¿ ›‰· HDL-¯ÔÏËÛÙÂÚfiÏ˘ Û˘¯Ó¿ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙ· Ï·›ÛÈ· Ì›·˜ ÁÂÓÂÙÈ΋˜ ‰È·Ù·Ú·¯‹˜, Ù˘ ˘Ô·ÏÊ·ÏÈÔÚˆÙÂ˚Ó·ÈÌ›·˜, Ë ÔÔ›· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·˘ÍË̤ÓÔ Î·Ù·‚ÔÏÈÛÌfi ÙˆÓ HDL Î·È Û˘Û¯ÂÙ›˙ÂÙ·È Ì ·˘ÍË̤ÓÔ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ. ™Â ·ÓÙ›ıÂÛË Ì ÙËÓ ˘Ô·ÏÊ·ÏÈÔÚˆÙÂ˚Ó·ÈÌ›·, Ë ˘ÂÚ·ÏÊ·ÏÈÔÚˆÙÂ˚Ó·ÈÌ›· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÌÂÌÔӈ̤ÓË ·‡ÍËÛË ÙˆÓ ÂȤ‰ˆÓ Ù˘ HDL-¯ÔÏËÛÙÂÚfiÏ˘, ¯ˆÚ›˜ Ó· ÂËÚ¿˙ÔÓÙ·È Ù· ›‰· ÙˆÓ ¿ÏÏˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ. ∆· ¿ÙÔÌ· Ì ˘ÂÚ·ÏÊ·ÏÈÔÚˆÙÂ˚Ó·ÈÌ›· ÂÌÊ·Ó›˙Ô˘Ó ¯·ÌËÏfi ηډȷÁÁÂÈ·Îfi ΛӉ˘ÓÔ. øÛÙfiÛÔ, ÔÚÈṲ̂ӷ ¿ÙÔÌ· Ì ˘„ËÏ¿ ›‰· HDL-¯ÔÏËÛÙÂÚfiÏ˘ ¤¯Ô˘Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘. ™˘ÌÂÚ·ÛÌ·ÙÈο, Û ¿ÙÔÌ· ÙfiÛÔ Ì ÌÂȈ̤ӷ fiÛÔ Î·È Ì ·˘ÍË̤ӷ ›‰· HDL-¯ÔÏËÛÙÂÚfiÏ˘, ¤¯ÂÈ È‰È·›ÙÂÚË ÛËÌ·Û›· ÙÔ ÎÏËÚÔÓÔÌÈÎfi ÈÛÙÔÚÈÎfi ÚÒÈÌ˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘. ∂Í·ÎÔÏÔ˘ıÔ‡Ó Ó· ˘¿Ú¯Ô˘Ó ·ÚÎÂÙ¿ ·Ó·¿ÓÙËÙ· ÂÚˆÙ‹Ì·Ù· fiÛÔÓ ·ÊÔÚ¿ ÙË ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË ÙˆÓ ·ÛıÂÓÒÓ Ì ‰˘ÛÏÈȉ·ÈÌ›·. ŒÓ· ·fi ·˘Ù¿ Ù· ÂÚˆÙ‹Ì·Ù· Â›Ó·È Ë ·ÎÚÈ‚‹˜ ÛËÌ·Û›· ÙÔ˘ ÚÔÛ‰ÈÔÚÈÛÌÔ‡ ÙˆÓ ·ÔÏÈÔÚˆÙÂ˚ÓÒÓ ÙÔ˘ ÔÚÔ‡ (apoB/apoA1). ∏ ÌÂϤÙË INTERHEART ¤‰ÂÈÍ fiÙÈ Ô ·ıËڈ̷ÙÈÎfi˜ ‰Â›ÎÙ˘ apoB/apoA1 ·ÔÙÂÏ› ÙÔÓ Î·Ï‡ÙÂÚÔ ÚÔÁÓˆÛÙÈÎfi ‰Â›ÎÙË ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ôηډ›Ô˘ Û ۇÁÎÚÈÛË Ì ÔÚÈṲ̂ÓÔ˘˜ ÎÏ·ÛÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘, fiˆ˜ Â›Ó·È ÙÔ Î¿ÓÈÛÌ·, Ô Û·Î¯·Ú҉˘ ‰È·‚‹Ù˘, Ë ·ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË Î·È Ë ÎÔÈÏȷ΋ ·¯˘Û·ÚΛ·. ŒÓ· ¿ÏÏÔ ÂÚÒÙËÌ· Â›Ó·È Â¿Ó ··ÈÙÂ›Ù·È Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ Lp(a). ∏ ̤ÙÚËÛË Ù˘ Lp(a), Ì ELISA ‹ ÓÂÊÂÏÔÌÂÙÚ›·, Ú¤ÂÈ Ó· Á›ÓÂÙ·È Û ¿ÙÔÌ· Ì ÁÓˆÛÙ‹ ·ÁÁÂȷ΋ ÓfiÛÔ Ô˘ ‰ÂÓ ¤¯Ô˘Ó ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙ˜ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘. √ ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ Lp(a) ÌÔ-
Ú› Ó· Á›ÓÂÙ·È ÚÔ·ÈÚÂÙÈο Î·È Û ¿ÙÔÌ· Ì ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· ‹ ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ, ηıÒ˜ Î·È Û ¿ÏÏ· ¿ÙÔÌ· ˘„ËÏÔ‡ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘. ™Â ¿ÙÔÌ· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Ì ›‰· Lp(a) >30 mg/dL ··ÈÙÂ›Ù·È Ì›· ÈÔ ÂÈıÂÙÈ΋ Ì›ˆÛË ÙˆÓ ÂȤ‰ˆÓ Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘. ™˘¯Ó¿ ÛÙË ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË ÙˆÓ ˘ÂÚÏÈȉ·ÈÌÈÒÓ Á›ÓÂÙ·È Î·È Ô ˘ÔÏÔÁÈÛÌfi˜ ÙˆÓ ·ıËڈ̷ÙÈÎÒÓ ‰ÂÈÎÙÒÓ: ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË/HDL-¯ÔÏËÛÙÂÚfiÏË, LDL-¯ÔÏËÛÙÂÚfiÏË/HDL-¯ÔÏËÛÙÂÚfiÏË Î·È apoB/apoA1. ™‡Ìʈӷ Ì ÙË ÌÂϤÙË Framingham, Ë ÚÔÁÓˆÛÙÈ΋ ·Í›·, fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ÂÌÊ¿ÓÈÛË Î·Ú‰È·ÁÁÂȷ΋˜ ÓfiÛÔ˘ ÛÙÔ˘˜ ¿Ó‰Ú˜, ÙÔ˘ ÏfiÁÔ˘ ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË/HDL-¯ÔÏËÛÙÂÚfiÏË Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË Û ۇÁÎÚÈÛË Ì ÙÔÓ Î¿ı ·Ú¿ÁÔÓÙ· ͯˆÚÈÛÙ¿. ∂ÈÚfiÛıÂÙ·, Ô ÏfiÁÔ˜ apoB/ apoA1 ıˆÚÂ›Ù·È Ô Î·Ï‡ÙÂÚÔ˜ ·ıËڈ̷ÙÈÎfi˜ ‰Â›ÎÙ˘, ·ÊÔ‡ Ù· ›‰· Ù˘ apoB Î·È Ù˘ apoA1 Â›Ó·È Ôχ ηÏÔ› ‰Â›ÎÙ˜ ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·ıËÚÔÁfiÓˆÓ Î·È ÙˆÓ ·ÓÙÈ·ıËÚÔÁfiÓˆÓ ÛˆÌ·Ùȉ›ˆÓ ·ÓÙ›ÛÙÔȯ·. øÛÙfiÛÔ, Ú¤ÂÈ Ó· ÙÔÓÈÛı› fiÙÈ ·Ú¿ ÙË ÌÂÁ¿ÏË ÚÔÁÓˆÛÙÈ΋ ·Í›· ÙˆÓ ·Ú·¿Óˆ ·ıËڈ̷ÙÈÎÒÓ ‰ÂÈÎÙÒÓ, ÔÈ ÙÂÏÂ˘Ù·›ÔÈ ‰ÂÓ ·ÔÙÂÏÔ‡Ó ÙÔ˘˜ ÛÙfi¯Ô˘˜ Ù˘ ıÂڷ¢ÙÈ΋˜ ·Ú¤Ì‚·Û˘ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ‰˘ÛÏÈȉ·ÈÌ›·˜. ™˘ÌÂÚ·ÛÌ·ÙÈο, ÁÈ· ÙË ÛˆÛÙ‹ ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË ÙˆÓ ˘ÂÚÏÈȉ·ÈÌÈÒÓ Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ÎÏ·ÛÈÎÒÓ ÏÈȉ·ÈÌÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ, Ó· ·ÔÎÏ›ÔÓÙ·È Ù· ·›ÙÈ· Ù˘ ‰Â˘ÙÂÚÔ·ıÔ‡˜ ‰˘ÛÏÈȉ·ÈÌ›·˜, Ó· ·ÍÈÔÏÔÁÔ‡ÓÙ·È ÚÔÛÂÎÙÈο Ù· Â˘Ú‹Ì·Ù· ·fi ÙÔ ÈÛÙÔÚÈÎfi Î·È ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË ÙÔ˘ ·ÛıÂÓ‹ Î·È Ù¤ÏÔ˜ Ó· ÂÎÙÈÌ¿Ù·È Ô Û˘ÓÔÏÈÎfi˜ ηډȷÁÁÂÈ·Îfi˜ ΛӉ˘ÓÔ˜ ÙÔ˘ οı ·ÛıÂÓ‹, Ì ‚¿ÛË ÙÔÓ ÔÔ›Ô Á›ÓÂÙ·È Î·È Ô Î·ıÔÚÈÛÌfi˜ ÙˆÓ ÛÙfi¯ˆÓ Ù˘ ˘ÔÏÈȉ·ÈÌÈ΋˜ ·ÁˆÁ‹˜.
µÈ‚ÏÈÔÁÚ·Ê›· 1. ∂ÏÈÛ¿Ê ª. ¢˘ÛÏÈȉ·ÈÌ›·, ‰È¿ÁÓˆÛË Î·È ·ÓÙÈÌÂÙÒÈÛË. ∂ΉfiÛÂȘ µ·ÁÈÔÓ¿Î˘, 2003. 2. Durrington PN, Sniderman A. Hyperlipidaemia. Oxford: Health Press, 2000. 3. Hobbs H, White AL. Lipoprotein (a): intrigues and insights. Curr Opin Lipidol 1999;4:107-113. 4. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The
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National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001;285:2486-2497. 5. Grundy SM, Cleeman JI, Merz CN, Brewer HB Jr, Clark LT, Hunninghake DB, Pasternak RC, Smith SC Jr, Stone NJ; National Heart, Lung, and Blood Institute; American College of Cardiology Foundation; American Heart Association. Implications of
recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation. 2004;110:227-239. 6. Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, McQueen M, Budaj A, Pais P, Varigos J, Lisheng L; INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364:937-952.
ATHIROSK 21-
05-03-09
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£∂ƒ∞¶∂π∞ - º∞ƒª∞∫∞
ÀÔÏÈȉ·ÈÌÈΤ˜ Î·È ¶ÏÂÈÔÙÚÔÈΤ˜ ¢Ú¿ÛÂȘ ÙˆÓ ™Ù·ÙÈÓÒÓ ÛÙ· ∞ÁÁÂȷο ∂ÁÎÂÊ·ÏÈο ∂ÂÈÛfi‰È· £Âfi‰ˆÚÔ˜ ∏. ÃÂÈÌÒÓ·˜, ∂ȉÈ΢fiÌÂÓÔ˜ ¶·ıÔÏÔÁ›·˜, °¡ ÕÚÁÔ˘˜.
∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ÔÈ ÛÙ·Ù›Ó˜ ·ÔÎÙÔ‡Ó ÔÏÔ¤Ó· Î·È ÌÂÁ·Ï‡ÙÂÚË ÛËÌ·Û›· ÛÙËÓ ÚfiÏË„Ë Î·È ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·ÁÁÂÈ·ÎÒÓ ÂÁÎÂÊ·ÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ (∞∂∂). ¢ÚÔ˘Ó ÚˆÙ·Ú¯Èο ÛÙÔ ÌÂÙ·‚ÔÏÈÛÌfi ÙˆÓ ÏÈȉ›ˆÓ Î·È ÂÏ·ÙÙÒÓÔ˘Ó Ù· ›‰· Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘, Ë ÔÔ›· ÂÓÔ¯ÔÔÈÂ›Ù·È ÁÈ· ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÂÂÈÛÔ‰›ˆÓ. ¶¤Ú·Ó ÙÔ˘ ‚·ÛÈÎÔ‡ ·˘ÙÔ‡ Ì˯·ÓÈÛÌÔ‡, Ë ¤Ú¢ӷ ¤¯ÂÈ ·Ôηχ„ÂÈ Î·È ÌÈ· ÛÂÈÚ¿ ·fi ‰Â˘ÙÂÚ‡ԢÛ˜ ¢ÂÚÁÂÙÈΤ˜ ȉÈfiÙËÙ˜, ÔÈ Ôԛ˜ Â›Ó·È ÁÓˆÛÙ¤˜ ˆ˜ «ÏÂÈÔÙÚÔÈΤ˜». ∞˘Ù¤˜ ÔÈ ÏÂÈÔÙÚÔÈΤ˜ ‰Ú¿ÛÂȘ ·ÊÂÓfi˜ ‚ÔËıÔ‡Ó ÛÙËÓ ÚfiÏË„Ë ÙˆÓ ∞∂∂, ·ÊÂÙ¤ÚÔ˘ ·ÛÎÔ‡Ó Ó¢ÚÔÚÔÛٷ٢ÙÈ΋ ‰Ú¿ÛË ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ÔÍ›·˜ Ê¿Û˘ Ù˘ ÂÁÎÂÊ·ÏÈ΋˜ ÈÛ¯·ÈÌ›·˜.
ªË¯·ÓÈÛÌÔ› ‰Ú¿Û˘ ÙˆÓ ÛÙ·ÙÈÓÒÓ ∂›‰Ú·ÛË ÛÙÔ ÌÂÙ·‚ÔÏÈÛÌfi Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ∏ ¯ÔÏËÛÙÂÚfiÏË ·Ó‹ÎÂÈ ·fi ¯ËÌÈ΋˜ ·fi„ˆ˜ ÛÙ· ÛÙÂÚÔÂȉ‹ Î·È ·ÔÙÂÏ› ‚·ÛÈÎfi ÌfiÚÈÔ ÁÈ· ÙË ‰ÔÌ‹ Î·È ÌÂÙ·‚ÔÏÈÛÌfi ÙˆÓ Â˘Î·Ú˘ˆÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ. ∂›Ó·È ··Ú·›ÙËÙÔ Û˘ÛÙ·ÙÈÎfi ÙˆÓ Î˘ÙÙ·ÚÈÎÒÓ ÌÂÌ‚Ú·ÓÒÓ, ÙˆÓ ÔÔ›ˆÓ Ú˘ıÌ›˙ÂÈ ÙË Ú¢ÛÙfiÙËÙ·, ÂÓÒ ·ÔÙÂÏ› Î·È Úfi‰ÚÔÌË Ô˘Û›· ÙˆÓ ÛÙÂÚÔÂȉÈÎÒÓ ÔÚÌÔÓÒÓ, fiˆ˜ Ë ÎÔÚÙÈ˙fiÏË, Ë ÚÔÁÂÛÙÂÚfiÓË, Ë ÙÂÛÙÔÛÙÂÚfiÓË, Ù· ÔÈÛÙÚÔÁfiÓ· Î·È Ë ·Ï‰ÔÛÙÂÚfiÓË, ηıÒ˜ Î·È ÙˆÓ ¯ÔÏÈÎÒÓ ·Ï¿ÙˆÓ. ™˘ÌÌÂÙ¤¯ÂÈ Â›Û˘ Î·È Û ÂÓ‰Ô΢ÙÙ¿ÚȘ Ô‰Ô‡˜ ÌÂÙ·ÁˆÁ‹˜ ÌËÓ˘Ì¿ÙˆÓ, ˆ˜ Û˘ÛÙ·ÙÈÎfi ÌÂÌ‚Ú·ÓÈÎÒÓ ÌÈÎÚÔÂÚÈÔ¯ÒÓ, ÁÓˆÛÙÒÓ ˆ˜ ÏÈȉȷΤ˜ ۯ‰›Â˜ (lipid rafts) [1]. ∏ ¯ÔÏËÛÙÂÚfiÏË ÛÙÔÓ ·ÓıÚÒÈÓÔ ÔÚÁ·ÓÈÛÌfi ÚÔ¤Ú¯ÂÙ·È ·fi ‰‡Ô ËÁ¤˜: ¤Ó· ̤ÚÔ˜ Û˘ÓÙ›ıÂÙ·È ÂÓ‰ÔÁÂÓÒ˜ ÛÙÔ ‹·Ú ·fi ·Î¤Ù˘ÏÔ-CoA, ÂÓÒ ¤Ó· ¿ÏÏÔ Ì¤ÚÔ˜ ÚÔÛÏ·Ì‚¿ÓÂÙ·È Â͈ÁÂÓÒ˜, Ì ÙȘ ÙÚÔʤ˜. ∏ ÂÓ‰ÔÁÂÓ‹˜ ·Ú·ÁˆÁ‹ ηχÙÂÈ ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ
̤ÚÔ˜ ÙˆÓ ·Ó·ÁÎÒÓ Û ¯ÔÏËÛÙÂÚfiÏË, ÂÚ›Ô˘ 900 mg/Ë̤ڷ, ÂÓÒ Ë ‰È·ÈÙËÙÈ΋ ÚfiÛÏË„Ë ·Ú¤¯ÂÈ, ·Ó¿ÏÔÁ· ‚¤‚·È· Ì ÙÔ ‰È·ÈÙÔÏfiÁÈÔ, ÂÚ›Ô˘ 300 mg/Ë̤ڷ [2]. ∏ ¯ÔÏËÛÙÂÚfiÏË ÌÂٷʤÚÂÙ·È ·fi ÙÔ ‹·Ú ÚÔ˜ ÙÔ˘˜ ÈÛÙÔ‡˜ ΢ڛˆ˜ ̤ۈ Ù˘ ÏÈÔÚˆÙ½Ó˘ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ (LDL), ÂÓÒ ÂÈÛÙÚ¤ÊÂÈ ÛÙÔ ‹·Ú ̤ۈ Ù˘ ÏÈÔÚˆÙ½Ó˘ ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ (HDL). ∆Ô Î·ıÔÚÈÛÙÈÎfi ‚‹Ì· ÛÙË ‚ÈÔÛ‡ÓıÂÛË Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ Â›Ó·È Ë ÌÂÙ·ÙÚÔ‹ ÙÔ˘ HMG-CoA Û Ì‚·ÏÔÓÈÎfi Ô͇, ·ÓÙ›‰Ú·ÛË Ë ÔÔ›· ηٷχÂÙ·È ·fi ÙËÓ ·Ó·ÁˆÁ¿ÛË ÙÔ˘ HMG-CoA. √È ÛÙ·Ù›Ó˜ ·Ó·ÛÙ¤ÏÏÔ˘Ó ÙÔ ¤Ó˙˘ÌÔ ·˘Ùfi ÌÂ Û˘Ó·ÁˆÓÈÛÙÈÎfi ÙÚfiÔ, ηٷϷ̂¿ÓÔÓÙ·˜ ÙË ı¤ÛË ‰¤ÛÌ¢Û˘ ÙÔ˘ ˘ÔÛÙÚÒÌ·ÙÔ˜ ÛÙÔ ÂÓÂÚÁfi ΤÓÙÚÔ ÙÔ˘ ÂÓ˙‡ÌÔ˘ [3]. ªÂ ÙÔÓ ÙÚfiÔ ·˘Ùfi, ÂÏ·ÙÙÒÓÂÙ·È Ë Û˘ÁΤÓÙÚˆÛË ¯ÔÏËÛÙÂÚfiÏ˘ ÂÓÙfi˜ ÙˆÓ Ë·ÙÔ΢ÙÙ¿ÚˆÓ. ∆· ·ÙÙ·Ú· ·ÓÙȉÚÔ‡Ó Û ·˘Ù‹Ó ÙËÓ ·Ó·ÛÙÔÏ‹ Ù˘ ·Ú·ÁˆÁ‹˜ ¯ÔÏËÛÙÂÚfiÏ˘ ·˘Í¿ÓÔÓÙ·˜ ÙË Û‡ÓıÂÛË HMG-CoA Î·È ÙÔÓ ·ÚÈıÌfi ÙˆÓ LDL ˘Ô‰Ô¯¤ˆÓ ÛÙËÓ ÂÈÊ¿ÓÂÈ¿ ÙÔ˘˜. ∆ÂÏÈÎfi ·ÔÙ¤ÏÂÛÌ· Â›Ó·È Ó· ‰È¢ÎÔχÓÂÙ·È Ë ÚfiÛÏË„Ë ÌÔÚ›ˆÓ LDL ·fi ÙÔ ·›Ì· Î·È Ó· ÂÏ·ÙÙÒÓÔÓÙ·È Ù· ›‰· LDL¯ÔÏËÛÙÂÚfiÏ˘ ÛÙÔÓ ÔÚfi ηٿ 20-55% [4]. ¶ÏÂÈÔÙÚÔÈΤ˜ ‰Ú¿ÛÂȘ ÙˆÓ ÛÙ·ÙÈÓÒÓ ¶¤Ú·Ó Ù˘ ÂÏ¿ÙÙˆÛ˘ ÙˆÓ ÂȤ‰ˆÓ LDL-¯ÔÏËÛÙÂÚfiÏ˘, ‰Ú¿ÛË ÁÈ· ÙËÓ ÔÔ›· Î·È Û¯Â‰È¿ÛÙËηÓ, ÔÈ ÛÙ·Ù›Ó˜ ·ÛÎÔ‡Ó, fiˆ˜ ÚԷӷʤÚıËÎÂ, Î·È ÌÈ· ÛÂÈÚ¿ ¿ÏÏˆÓ ÂȉڿÛˆÓ, ÙȘ ÏÂÁfiÌÂÓ˜ ÏÂÈÔÙÚÔÈΤ˜. ¶·ÚfiÙÈ ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ·fi ·˘Ù¤˜ ÙȘ ‰Ú¿ÛÂȘ ÔÊ›ÏÔÓÙ·È ÛÙËÓ ·Ó·ÛÙÔÏ‹ Ù˘ HMGCoA ·Ó·ÁˆÁ¿Û˘, Ë ¯ÔÚ‹ÁËÛË ÛÙ·ÙÈÓÒÓ Ê·›ÓÂÙ·È Ó· ÂËÚ¿˙ÂÈ Î·È ¿ÏÏÔ˘˜ Ì˯·ÓÈÛÌÔ‡˜, fiˆ˜ ÙÔ ÌÂÙ·‚ÔÏÈÛÌfi ÙÔ˘ ÌÔÓÔÍÂȉ›Ô˘ ÙÔ˘ ·˙ÒÙÔ˘ (¡√) Î·È ÙÔ˘ ÁÏÔ˘Ù·-
ÌÈÓÈÎÔ‡, ÙË ÊÏÂÁÌÔÓ‹, ÙËÓ ·ÁÁÂÈÔÁ¤ÓÂÛË, ÙË Û˘ÛÛÒÚ¢ÛË ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ, ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È ÙËÓ ·fiÙˆÛË. ∏ ·Ó·ÛÙÔÏ‹ Ù˘ HMG-CoA ·Ó·ÁˆÁ¿Û˘ ÂÌÔ‰›˙ÂÈ ÙË Û‡ÓıÂÛË fi¯È ÌfiÓÔ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘, ·ÏÏ¿ Î·È ·ÚÎÂÙÒÓ ÈÛÔÚÂÓÔÂȉÒÓ ÂӉȿÌÂÛˆÓ ÂÓÒÛˆÓ, fiˆ˜ ÙÔ ÊˆÛÊÔÚÈÎfi Ê·ÚÓÂÛ‡ÏÈÔ Î·È ÙÔ ÊˆÛÊÔÚÈÎfi ÁÂÚ·Ó‡Ï-ÁÂÚ·Ó‡ÏÈÔ. √È Ô˘Û›Â˜ ·˘Ù¤˜ Û˘ÌÌÂÙ¤¯Ô˘Ó Û ÌÂÙ·‚ÔÏÈΤ˜ Ô‰Ô‡˜, Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ·˘ÙÒÓ ÙˆÓ GTP-‰ÂÛÌ¢ÙÈÎÒÓ ÚˆÙÂ˚ÓÒÓ Rho Î·È Rac, ÔÈ Ôԛ˜ ηٷÛÙ¤ÏÏÔ˘Ó ÙËÓ ·Ú·ÁˆÁ‹ ¡√ Î·È ÂÓÂÚÁÔÔÈÔ‡Ó ÙËÓ NAD(P)H ÔÍÂȉ¿ÛË, ·ÓÙ›ÛÙÔȯ· [5]. ∆Ô NO Û˘ÓÙ›ıÂÙ·È ÛÙ· ÂÓ‰ÔıËÏȷο ·ÙÙ·Ú· ·fi ÙËÓ ÂÓ‰ÔıËÏȷ΋ Û˘ÓıÂÙ¿ÛË ÙÔ˘ ÌÔÓÔÍÂȉ›Ô˘ ÙÔ˘ ·˙ÒÙÔ˘ (eNOS). Œ¯ÂÈ ÈÛ¯˘Ú‹ ·ÁÁÂÈԉȷÛÙ·ÏÙÈ΋ ‰Ú¿ÛË Î·È ÂÌϤÎÂÙ·È ÛÙË Û˘ÛÛÒÚ¢ÛË ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ, ÛÙË ıÚÔÌ‚ÔÁ¤ÓÂÛË, ÛÙË ÌÂÙ·Ó¿ÛÙ¢ÛË Î·È ÚÔÛÎfiÏÏËÛË ÙˆÓ Ï¢ÎÔ΢ÙÙ¿ÚˆÓ, ηıÒ˜ Î·È ÛÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙˆÓ Ï›ˆÓ Ì˘˚ÎÒÓ Î˘ÙÙ¿ÚˆÓ. √È ÛÙ·Ù›Ó˜ ·˘Í¿ÓÔ˘Ó Ù· ›‰· ¡√ ̤ۈ Ì˯·ÓÈÛÌÒÓ ·ÓÂÍ¿ÚÙËÙˆÓ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ [6, 7]. ™ÙË ‰È¿ÚÎÂÈ· ÂÁÎÂÊ·ÏÈ΋˜ ÈÛ¯·ÈÌ›·˜, ÙÔ ¡√ Ô˘ ·Ú¿ÁÂÙ·È ·fi ÙËÓ ÂÓ‰ÔıËÏȷ΋ ÈÛÔÌÔÚÊ‹ Ù˘ Û˘ÓıÂÙ¿Û˘ ÙÔ˘ ¡√ (eNOS) ¤¯ÂÈ ·ÓÙÈıÚÔÌ‚ˆÙÈ΋, ·ÁÁÂÈԉȷÛÙ·ÏÙÈ΋ Î·È ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë ‰Ú¿ÛË, Û ·ÓÙ›ıÂÛË Ì ÙÔ ¡√ Ô˘ ·Ú¿ÁÂÙ·È ·fi ÙȘ ÓÂ˘ÚˆÓÈΤ˜ (nNOS) Î·È Â·ÁÒÁÈ̘ (iNOS) ÈÛÔÌÔÚʤ˜ ÙÔ˘ ÂÓ˙‡ÌÔ˘, ÔÈ Ôԛ˜ ÚÔηÏÔ‡Ó Î·Ù·ÛÙÚÔÊ‹ ÙˆÓ Ó¢ÚÒÓˆÓ Ì¤Ûˆ ·Ú·ÁˆÁ‹˜ ÂÏ¢ı¤ÚˆÓ ÚÈ˙ÒÓ Î·È ÚÔÊÏÂÁÌÔÓˆ‰ÒÓ Î˘ÙÔÎÈÓÒÓ. ∏ ¯ÔÚ‹ÁËÛË ÛÙ·ÙÈÓÒÓ Û ÂÈÚ·Ì·Ùfi˙ˆ· ¤¯ÂÈ ‚ÚÂı› fiÙÈ ·˘Í¿ÓÂÈ ÙËÓ ¤ÎÊÚ·ÛË Ù˘ eNOS, Èı·Ófiٷٷ ̤ۈ Ù˘ ÚÔ·Ó·ÊÂÚı›۷˜ ÂÏ¿ÙÙˆÛ˘ ÛÙ· ›‰· ÈÛÔÚÂÓÔÂȉÒÓ, Ë ÔÔ›· Û˘ÓÔ-
17
ATHIROSK 21-
05-03-09
12:25
ª ∞ ƒ ∆ π √ ™
™ÂÏ›‰·18
2 0 0 9
‰Â‡ÂÙ·È ·fi ·‡ÍËÛË Ù˘ ÂÁÎÂÊ·ÏÈ΋˜ ·ÈÌ·ÙÈ΋˜ ÚÔ‹˜ Î·È ÂÏ¿ÙÙˆÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙÔ˘ ÂÌÊÚ¿ÎÙÔ˘ [8]. √È ÛÙ·Ù›Ó˜ ‚ÂÏÙÈÒÓÔ˘Ó ÙËÓ ÂÓ‰ÔıËÏȷ΋ ÏÂÈÙÔ˘ÚÁ›· ̤ۈ Î·È Ù˘ ·ÓÙÈÔÍÂȉˆÙÈ΋˜ ÙÔ˘˜ ‰Ú¿Û˘. ∂Ï·ÙÙÒÓÔ˘Ó ÙËÓ Â·ÁfiÌÂÓË ·fi ÙËÓ ·ÁÁÂÈÔÙÂÓÛ›ÓË ππ ·Ú·ÁˆÁ‹ ‚Ï·‚ÂÚÒÓ ÂχıÂÚˆÓ ÚÈ˙ÒÓ, ηٷÛÙ¤ÏÏÔÓÙ·˜ ÙËÓ ÂÓÂÚÁfiÙËÙ· Ù˘ NAD(P)H-ÔÍÂȉ¿Û˘ Î·È ÙËÓ ¤ÎÊÚ·ÛË ÙˆÓ ˘Ô‰Ô¯¤ˆÓ AT1 [5]. ª›· ·ÎfiÌË Â˘ÂÚÁÂÙÈ΋ ‰Ú¿ÛË ÙˆÓ ÛÙ·ÙÈÓÒÓ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ÔÍ›·˜ Ê¿Û˘ ÙÔ˘ ∞∂∂ Â›Ó·È Ë ÂÏ¿ÙÙˆÛË Ù˘ Ó¢ÚÔÙÔÍÈ΋˜ ‰ÈÂÁÂÚÙÈ΋˜ ‰Ú¿Û˘ (excitotoxicity) ÙÔ˘ ÁÏÔ˘Ù·ÌÈÓÈÎÔ‡ ÔͤԘ. ªÂϤÙ˜ Û ·ÙÙ·Ú· ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ë ¯ÔÚ‹ÁËÛË ÛÙ·ÙÈÓÒÓ ÂÏ·ÙÙÒÓÂÈ ÙÔ ÓÂ˘ÚˆÓÈÎfi ı¿Ó·ÙÔ Ô˘ ÚÔηÏÔ‡Ó ÔÈ ·ÁˆÓÈÛÙ¤˜ ÙˆÓ N-methylD-aspartate (NMDA) ˘Ô‰Ô¯¤ˆÓ [9]. ŒÓ·˜ Èı·Ófi˜ Ì˯·ÓÈÛÌfi˜ ·˘Ù‹˜ Ù˘ Ó¢ÚÔÚÔÛٷ٢ÙÈ΋˜ ‰Ú¿Û˘ ÙˆÓ ÛÙ·ÙÈÓÒÓ Â›Ó·È Ë ÂÍ·Ûı¤ÓËÛË Ù˘ Û‡Ó‰ÂÛ˘ ÌÂٷ͇ ÙˆÓ NMDA ˘Ô‰Ô¯¤ˆÓ Î·È ÙÔ˘ ÁÏÔ˘Ù·ÌÈÓÈÎÔ‡, Èı·Ófiٷٷ ÏfiÁˆ ÂÏ¿ÙÙˆÛ˘ Ù˘ ‰¤ÛÌ¢Û˘ ÙˆÓ NMDA ˘Ô‰Ô¯¤ˆÓ ÛÙȘ ÏÈȉȷΤ˜ ۯ‰›Â˜ [10]. ªÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ÔÈ ÛÙ·Ù›Ó˜ ÂÏ·ÙÙÒÓÔ˘Ó ÙËÓ ¤ÎÊÚ·ÛË ÊÏÂÁÌÔÓˆ‰ÒÓ ÌÂÛÔÏ·‚ËÙÒÓ fiˆ˜ C-·ÓÙȉÚÒÛ· ÚˆÙ½ÓË, CD40, IL-1, IL-6, TNF-a [11, 12] Î·È ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛ˘ fiˆ˜ ICAM1, VCAM1, E-ÛÂÏÂÎÙ›ÓË Î·È LFA-1 [13-15]. ™ÙËÓ ÚfiÛÊ·ÙË ÌÂϤÙË JUPITER, Ë ¯ÔÚ‹ÁËÛË ÛÙ·Ù›Ó˘ Û ¿ÙÔÌ· Ì ÂχıÂÚÔ Î·Ú‰ÈÔÏÔÁÈÎfi ÈÛÙÔÚÈÎfi, ¯ˆÚ›˜ ‰˘ÛÏÈȉ·ÈÌ›·, ·ÏÏ¿ Ì ·˘ÍË̤ӷ ›‰· CRP, ¤Ù˘¯Â ÂÏ¿ÙÙˆÛË ÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘, Ì ٷ ∞∂∂ Ó· ÌÂÈÒÓÔÓÙ·È Î·Ù¿ 48% [16]. Œ¯ÂÈ ·Ó·ÊÂÚı› ›Û˘ ·ÓÙÈÊÏÂÁÌÔÓ҉˘ ‰Ú¿ÛË ÙˆÓ ÛÙ·ÙÈÓÒÓ Ì¤Ûˆ ÂÏ¿ÙÙˆÛ˘ Ù˘ ÂÓÂÚÁÔÔ›ËÛ˘ ÙÔ˘ ·Ú¿ÁÔÓÙ· NF-kappa-B [17], ÙÚÔÔÔ›ËÛ˘ Ù˘ ·Ú·ÁˆÁ‹˜ ΢ÙÔÎÈÓÒÓ, ηıÒ˜ Î·È ÂÚÈÔÚÈÛÌÔ‡ Ù˘ ÔÍ›‰ˆÛ˘ ÙˆÓ ÏÈȉ›ˆÓ Î·È Ù˘ ‚Ï·‚ÂÚ‹˜ ›‰Ú·Û˘ ÙˆÓ ÂχıÂÚˆÓ ÚÈ˙ÒÓ, ̤ۈ ‰È·Ù‹ÚËÛ˘ Ù˘ ‰ÈÛÌÔ˘Ù¿Û˘ ÙÔ˘ ˘ÂÚÔÍÂȉ›Ô˘ [18]. √È ÛÙ·Ù›Ó˜ ÂÏ·ÙÙÒÓÔ˘Ó Â›Û˘ ÙË ‰Ú·ÛÙÈÎfiÙËÙ· ÙˆÓ ÌÂÙ·ÏÏÔÚˆÙÂ˚Ó·ÛÒÓ (MMPs), ÌÔÚ›ˆÓ Ô˘ ÂÎÎÚ›ÓÔÓÙ·È ·fi Ù· Ì·ÎÚÔÊ¿Á· Î·È ·‰˘Ó·Ù›˙Ô˘Ó ÙËÓ ÈÓÒ‰Ë
18
ο„· ÙˆÓ ·ıËÚÔÛÎÏËÚˆÙÈÎÒÓ Ï·ÎÒÓ. ∏ ·ÎfiÏÔ˘ıË ÛÙ·ıÂÚÔÔ›ËÛË ÙˆÓ Â˘¿ÏˆÙˆÓ Ï·ÎÒÓ ÂÚÈÔÚ›˙ÂÈ ÙÔÓ Î›Ó‰˘ÓÔ Ú‹Í˘ ÙÔ˘˜ [19]. √È ÛÙ·Ù›Ó˜ Ê·›ÓÂÙ·È Ó· ÚÔ¿ÁÔ˘Ó ÙËÓ ·ÁÁÂÈÔÁ¤ÓÂÛË, Ó¢ÚÔÁ¤ÓÂÛË Î·È Û˘Ó·ÙÔÁ¤ÓÂÛË ÌÂÙ¿ ·fi ∞∂∂ Û ÂÈÚ·Ì·Ùfi˙ˆ· [20]. ¢ÚÔ˘Ó ·ÊÂÓfi˜ ÂÓÂÚÁÔÔÈÒÓÙ·˜ ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Akt Î·È KLF2 Î·È ·˘Í¿ÓÔÓÙ·˜ ÙÔ ¡√ [21, 22] Î·È ·ÊÂÙ¤ÚÔ˘ ·˘Í¿ÓÔÓÙ·˜ ÙËÓ ÎÈÓËÙÔÔ›ËÛË Î·È ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· ÙˆÓ ÚÔÁÔÓÈÎÒÓ ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ (endothelial progenitor cells - EPCs) [23, 24]. ∏ ·ÓÙÈıÚÔÌ‚ˆÙÈ΋ ‰Ú¿ÛË ÙˆÓ ÛÙ·ÙÈÓÒÓ ¤¯ÂÈ ‰ÈÂÚ¢ÓËı› ·fi ·ÚÎÂÙ¤˜ ÌÂϤÙ˜. √È ÛÙ·Ù›Ó˜ ηٷÛÙ¤ÏÏÔ˘Ó ÙË ÌÂÙ·ÙÚÔ‹ Ù˘ ÚÔıÚÔÌ‚›Ó˘ Û ıÚÔÌ‚›ÓË ÂÏ·ÙÙÒÓÔÓÙ·˜ ÙË ‰Ú·ÛÙÈÎfiÙËÙ· ÙˆÓ ·Ú·ÁfiÓÙˆÓ V Î·È VIIa [25, 26], ÂÓÒ ·Ó·ÛÙ¤ÏÏÔ˘Ó Â›Û˘ ÙËÓ ¤ÎÊÚ·ÛË ÙÔ˘ ÈÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· (tissue factor - TF) [27], ÙËÓ ÂÍ·ÚÙÒÌÂÓË ·fi ÙÔÓ TF ÂÓÂÚÁÔÔ›ËÛË Ù˘ ÚÔıÚÔÌ‚›Ó˘ [28] Î·È ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ [29]. √È ÛÙ·Ù›Ó˜ ÂȉÚÔ‡Ó ÛÙÔ ·ÓÔÛÔÔÈËÙÈÎfi Û‡ÛÙËÌ· ÂÏ·ÙÙÒÓÔÓÙ·˜ ÙËÓ Â·ÁfiÌÂÓË ·fi ÙȘ ÈÓÙÂÚÊÂÚfiÓ˜ ¤ÎÊÚ·ÛË ÙÔ˘ Ì›˙ÔÓÔ˜ Û˘ÛÙ‹Ì·ÙÔ˜ ÈÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜ ππ (MHC-II) Û ·ÙÙ·Ú· fiˆ˜ Ù· Ì·ÎÚÔÊ¿Á· Î·È ÙÔ ÂÓ‰Ôı‹ÏÈÔ [30]. ∂›Û˘ ÂÏ·ÙÙÒÓÔ˘Ó ÙËÓ ·fiÙˆÛË, ·ÊÂÓfi˜ ηٷÛÙ¤ÏÏÔÓÙ·˜ ÙË ÊÏÂÁÌÔÓ‹, ·ÊÂÙ¤ÚÔ˘ ÂȉÚÒÓÙ·˜ ·Â˘ı›·˜ ÛÙÔ˘˜ ·ÔÙˆÙÈÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜. Œ¯ÂÈ ‚ÚÂı› fiÙÈ Ë Ï‹„Ë ·ÙÔÚ‚·ÛÙ·Ù›Ó˘, ÏÔ‚·ÛÙ·Ù›Ó˘ Î·È ÛÈÌ‚·ÛÙ·Ù›Ó˘ Û¯ÂÙ›˙ÂÙ·È Ì ÂÏ¿ÙÙˆÛË Ù˘ ÚÂÓ˘Ï›ˆÛ˘ Ù˘ p21-Rho B, ÌÈ·˜ ÚˆÙ½Ó˘ Ô˘ Û˘ÌÌÂÙ¤¯ÂÈ ÛÙË Ú‡ıÌÈÛË Ù˘ ·fiÙˆÛ˘ [31]. ™Â ÌÈ· ¿ÏÏË ÌÂϤÙË, Ë ¯ÔÚ‹ÁËÛË Ú·‚·ÛÙ·Ù›Ó˘ ÂÏ¿ÙÙˆÛ ÙËÓ ·fiÙˆÛË ÙˆÓ Ï›ˆÓ Ì˘˚ÎÒÓ Î˘ÙÙ¿ÚˆÓ ÛÙȘ ·ıËڈ̷ÙÈΤ˜ ϿΘ ÙˆÓ Î·ÚˆÙ›‰ˆÓ [32].
√ ÚfiÏÔ˜ ÙˆÓ ÛÙ·ÙÈÓÒÓ ÛÙËÓ ÚfiÏË„Ë ÙˆÓ ∞∂∂ ∏ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· ·ÔÙÂÏ› Ì›˙ÔÓ· ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ (™¡). √ ÚfiÏÔ˜ Ù˘ fï˜ ÛÙËÓ ÂΉ‹ÏˆÛË ÈÛ¯·ÈÌÈÎÒÓ ∞∂∂ ‰ÂÓ ¤¯ÂÈ ·ÎfiÌË ÍÂηı·ÚÈÛÙ› Ì ·ÎÚ›‚ÂÈ·. √È ÎÏ·ÛÈΤ˜ ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ›¯·Ó ۯ‰ȷÛÙ› Ì ÙË ™¡ η-
Ù¿ ÓÔ˘ ηÈ, ˆ˜ ÂÎ ÙÔ‡ÙÔ˘, Û˘ÌÂÚȤϷ‚·Ó ËÏÈÎȷΤ˜ ÔÌ¿‰Â˜ Ô˘ ÎÈÓ‰‡Ó¢·Ó ÂÚÈÛÛfiÙÂÚÔ ·fi ™¡ Î·È ÏÈÁfiÙÂÚÔ ·fi ∞∂∂. ∆· ∞∂∂ ›¯·Ó ıˆÚËı› ‰Â˘ÙÂÚÂ‡Ô˘Û· ÌÂÙ·‚ÏËÙ‹, Î·È ‰ÂÓ ‰È·¯ˆÚÈ˙fiÙ·Ó Û ÈÛ¯·ÈÌÈο Î·È ·ÈÌÔÚÚ·ÁÈο. ªÈ· ÌÂÙ·-·Ó¿Ï˘ÛË ÚÔÔÙÈÎÒÓ ÂȉËÌÈÔÏÔÁÈÎÒÓ ÌÂÏÂÙÒÓ ÌÂ Û˘ÓÔÏÈο 450.000 ¿ÙÔÌ· › 16 ¯ÚfiÓÈ· ·Ú·ÎÔÏÔ‡ıËÛ˘ ‰ÂÓ ·Ó¤‰ÂÈÍÂ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÂȤ‰ˆÓ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ÎÈÓ‰‡ÓÔ˘ ÁÈ· ∞∂∂ [33]. √È ÂÚÈÛÛfiÙÂÚ˜ fï˜ ·fi ÙȘ ÌÂϤÙ˜ Ô˘ Û˘ÌÂÚÈÏ‹ÊıËÛ·Ó Âͤٷ˙·Ó ÌfiÓÔ Ù· ı·Ó·ÙËÊfiÚ· ∞∂∂, ˆ˜ ÂÎ ÙÔ‡ÙÔ˘ Ë Û¯¤ÛË ÌÂٷ͇ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ∞∂∂ ÌÔÚ› Ó· ˘ÔÂÎÙÈÌ‹ıËÎÂ. ¶ÈÔ ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ ·Ó·‰ÂÈÎÓ‡Ô˘Ó fiÓÙˆ˜ Û¯¤ÛË ÌÂٷ͇ ˘„ËÏÒÓ ÂȤ‰ˆÓ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÈÛ¯·ÈÌÈο ∞∂∂ [34]. ∏ ¯ÔÚ‹ÁËÛË ÛÙ·ÙÈÓÒÓ Û ·ÛıÂÓ›˜ Ì ™¡ ÂÏ·ÙÙÒÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ∞∂∂, ˆ˜ Î·È 30% [35, 36], ÌÈ· ÂÏ¿ÙÙˆÛË Ô˘ ·ÊÔÚ¿ ¿ÙÔÌ· ÙfiÛÔ Ì ˘„ËÏ¿, fiÛÔ Î·È Ì ̤ÙÚÈ· ›‰· ¯ÔÏËÛÙÂÚfiÏ˘. ∂›Û˘, Ë ÌÂϤÙË ASCOTT-LLA ¤‰ÂÈÍ fiÙÈ Ë ¯ÔÚ‹ÁËÛË ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ Û ˘ÂÚÙ·ÛÈÎÔ‡˜ ·ÛıÂÓ›˜ ¯ˆÚ›˜ ÈÛÙÔÚÈÎfi ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘ ÂÏ¿ÙÙˆÛ ٷ ∞∂∂ Î·È Ù· ¿ÏÏ· Ì›˙ÔÓ· ηډȷÁÁÂȷο Û˘Ì‚¿Ì·Ù· [37]. ªÈ· ÌÂÙ·-·Ó¿Ï˘ÛË ¿Óˆ ÙˆÓ 90.000 Û˘ÓÔÏÈο ·ÛıÂÓÒÓ ¤‰ÂÈÍ ÂÏ¿ÙÙˆÛË ÙÔ˘ Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ∞∂∂ ηٿ 21% (odds-ratio: 0,79; 95% CI: 0,73-0,85). ∆· ı·Ó·ÙËÊfiÚ· ∞∂∂ ÂÏ·ÙÙÒıËÎ·Ó Û ÌË ÛËÌ·ÓÙÈÎfi ‚·ıÌfi, ηٿ 9%. ∆Ô ·Ú·ÙËÚËı¤Ó fiÊÂÏÔ˜ ÌÔÚÔ‡Û ӷ ÂÍËÁËı› ηٿ 34-80% ·fi ÙËÓ ÂÈÙ¢¯ı›۷ Ì›ˆÛË Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘. ∆Ô ˘fiÏÔÈÔ fiÊÂÏÔ˜ Èı·ÓfiÓ Ó· ÔÊ›ÏÂÙ·È Û ÏÂÈÔÙÚÔÈΤ˜ ‰Ú¿ÛÂȘ ÙˆÓ ÛÙ·ÙÈÓÒÓ [38]. ªÂ Ù· ·Ú·¿Óˆ ·ÔÙÂϤÛÌ·Ù· Û˘ÌʈÓÔ‡Ó Î·È ¿ÏϘ ‰‡Ô ÚfiÛÊ·Ù˜ ÌÂÙ·-·Ó·Ï‡ÛÂȘ [39, 40]. ªÂ ‚¿ÛË ·˘Ù¿ Ù· Â˘Ú‹Ì·Ù· ¤¯Ô˘Ó ÂΉÔı› Î·È ‰ÈÂıÓ›˜ ηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ Ô˘ Û˘ÓÈÛÙÔ‡Ó ÙËÓ ÂÏ¿ÙÙˆÛË Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ Û ›‰· οو ÙˆÓ 160 mg/dl Û ·ÛıÂÓ›˜ ¯ˆÚ›˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘, οو ÙˆÓ 130 mg/dl Û ¿ÙÔÌ· Ì ÔÏÏ·ÏÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Î·È Î¿Ùˆ ÙˆÓ 100 mg/dl Û ·ÛıÂÓ›˜ Ì ÈÛÙÔÚÈÎfi ™¢, ™¡ ‹ ÂÚÈÊÂÚÈ΋˜ ·ÚÙËÚÈÔ¿ıÂÈ·˜ [41, 42].
ATHIROSK 21-
05-03-09
12:25
™ÂÏ›‰·19
£∂ƒ∞¶∂π∞ - º∞ƒª∞∫∞ ƒfiÏÔ˜ ÙˆÓ ÛÙ·ÙÈÓÒÓ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÔÍ›·˜ Ê¿Û˘ Ù˘ ÂÁÎÂÊ·ÏÈ΋˜ ÈÛ¯·ÈÌ›·˜
™¯‹Ì· 1 ∂Ï¿ÙÙˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂΉ‹ÏˆÛ˘ ∞∂∂ ·Ó¿ÏÔÁ· Ì ÙËÓ ÂÏ¿ÙÙˆÛË Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ Û ‰È¿ÊÔÚ˜ ÌÂϤÙ˜ ¯ÔÚ‹ÁËÛ˘ ÛÙ·ÙÈÓÒÓ. ¶ÚÔÛ·ÚÌÔṲ̂ÓÔ ·fi Amarenco P. et al. Future Lipidol. 2008;3(3):319-325.
∏ ÌÂϤÙË SPARCL (Stroke Prevention by Aggressive Reduction in Cholesterol Levels) Â›Ó·È Ë ÌfiÓË Ô˘ ۯ‰ȿÛÙËΠÂȉÈο Ì ÛÙfi¯Ô Ó· ·ÍÈÔÏÔÁËı› Ë ¯Ú‹ÛË ÛÙ·ÙÈÓÒÓ ÛÙË ‰Â˘ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë ÙˆÓ ∞∂∂. ™˘ÌÂÚÈÏ‹ÊıËÛ·Ó 4731 ·ÛıÂÓ›˜ Ì ÈÛÙÔÚÈÎfi ∞∂∂ ÌË-ηډÈÔÂÌ‚ÔÏÈ΋˜ ·ÈÙÈÔÏÔÁ›·˜ ‹ ·ÚÔ‰ÈÎÔ‡ ÈÛ¯·ÈÌÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ (¶π∂), ¯ˆÚ›˜ fï˜ ™¡, ÔÈ ÔÔ›ÔÈ Ù˘¯·ÈÔÔÈ‹ıËÎ·Ó Ó· Ï¿‚Ô˘Ó 80 mg ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ ‹ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ. ªÂÙ¿ ·fi ·Ú·ÎÔÏÔ‡ıËÛË 5 ÂÙÒÓ, Ë ¯ÔÚ‹ÁËÛË ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ ‚Ú¤ıËΠӷ ÂÈÙ˘Á¯¿ÓÂÈ ÂÏ¿ÙÙˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· fiÏ· Ù· ∞∂∂ ηٿ 16%, ÁÈ· ÈÛ¯·ÈÌÈο ∞∂∂ ηٿ 23%, ÁÈ· ¶π∂ ηٿ 26%, ÁÈ· ı·Ó·ÙËÊfiÚ· ∞∂∂ ηٿ 43% Î·È ÁÈ· Ì›˙ÔÓ· ÛÙÂÊ·ÓÈ·›· Û˘Ì‚·Ì¿Ù· ηٿ 35%. £· ·Ó¤ÌÂÓ ηÓ›˜ Ë ÂÏ¿ÙÙˆÛË ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ∞∂∂ Ó· Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË, ‰Â‰Ô̤Ó˘ Ù˘ ÂÏ¿ÙÙˆÛ˘ ÙˆÓ ÂȤ‰ˆÓ ¯ÔÏËÛÙÂÚfiÏ˘ ηٿ 35%. ªÈ· ÂÍ‹ÁËÛË ÁÈ' ·˘Ù‹Ó ÙËÓ ·Ú·Ù‹ÚËÛË Â›Ó·È Ô ÙÚfiÔ˜ ÂÈÏÔÁ‹˜ ÙˆÓ ·ÛıÂÓÒÓ Ù˘ SPARCL. ™˘ÌÂÚÈÏ‹ÊıËΠ¤Ó·˜ ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ·ÙfiÌˆÓ Ì ÎÂÓÔÙÔÈÒ‰Ë (lacunar) ∞∂∂, ÔÈ ÔÔ›ÔÈ ˆÊÂÏ‹ıËÎ·Ó ÏÈÁfiÙÂÚÔ ·fi ·˘ÙÔ‡˜ Ì ÈÛÙÔÚÈÎfi ·ıËÚÔıÚÔÌ‚ˆÙÈÎÔ‡ ∞∂∂. ™˘ÌÌÂÙ›¯·Ó
›Û˘ ·ÚÎÂÙÔ› Ì ·ÈÌÔÚÚ·ÁÈÎfi ∞∂∂, fiÔ˘ Ë ˆÊ¤ÏÂÈ· ÙˆÓ ÛÙ·ÙÈÓÒÓ Â›Ó·È ·ÌÊÈÛ‚ËÙÔ‡ÌÂÓË. ªÂÙ¿ ÙËÓ SPARCL, ÔÈ Î·Ù¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ ·Ó·ıˆڋıËÎ·Ó Î·È Û˘ÓÈÛÙÔ‡Ó Ï¤ÔÓ ¯ÔÚ‹ÁËÛË ÛÙ·ÙÈÓÒÓ Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÈÛÙÔÚÈÎfi ∞∂∂ ‹ ¶π∂ Î·È ˘„ËÏ¿ ›‰· LDL-¯ÔÏËÛÙÂÚfiÏ˘, Ì ÛÙfi¯Ô ›‰· <100 mg/dl (‹ <70 mg/dl ÛÙÔ˘˜ ·ÛıÂÓ›˜ ˘„ËÏfiÙÂÚÔ˘ ÎÈÓ‰‡ÓÔ˘) [43]. ™Â post-hoc ·Ó·Ï‡ÛÂȘ ˘ÔÔÌ¿‰ˆÓ Ù˘ SPARCL, ‚Ú¤ıËΠfiÙÈ ÔÈ ·ÛıÂÓ›˜ Ô˘ ¤Ù˘¯·Ó ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚË Ì›ˆÛË Ù˘ LDL¯ÔÏËÛÙÂÚfiÏ˘ (≥50%) ·ÚÔ˘Û›·Û·Ó ÂÏ¿ÙÙˆÛË ÙˆÓ ∞∂∂ ηٿ 31%, ¯ˆÚ›˜ ·‡ÍËÛË ÙˆÓ ·ÈÌÔÚÚ·ÁÈÎÒÓ ∞∂∂, ¤Ó·ÓÙÈ ÙˆÓ ·ÛıÂÓÒÓ ¯ˆÚ›˜ ÌÂÙ·‚ÔÏ‹ ‹ Î·È Ì ·‡ÍËÛË Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ [44]. ∂›Û˘, Î·È ÔÈ ·ÛıÂÓ›˜ ¿Óˆ ÙˆÓ 65 ÂÙÒÓ ˆÊÂÏ‹ıËÎ·Ó ·fi ÙË Ï‹„Ë ·ÙÔÚ‚·ÛÙ·Ù›Ó˘, Û ÌÈÎÚfiÙÂÚÔ ‚·ıÌfi fï˜ ·fi ÙÔ˘˜ ÓÂfiÙÂÚÔ˘˜. ∏ ÂÏ¿ÙÙˆÛË Ù˘ ›وÛ˘ ı·Ó·ÙËÊfiÚˆÓ Î·È ÌË ∞∂∂ ‹Ù·Ó 10% (ÌË ÛËÌ·ÓÙÈ΋), ¤Ó·ÓÙÈ 26% ÛÙÔ˘˜ ÓÂfiÙÂÚÔ˘˜. √ ηډȷÁÁÂÈ·Îfi˜ ΛӉ˘ÓÔ˜ ÂÏ·ÙÙÒıËΠ¿ÓÙˆ˜ ÛËÌ·ÓÙÈο, Û˘ÓËÁÔÚÒÓÙ·˜ ˘¤Ú Ù˘ ¯ÔÚ‹ÁËÛ˘ ÛÙ·ÙÈÓÒÓ Î·È ÛÙÔ˘˜ ËÏÈÎȈ̤ÓÔ˘˜ [45]. ¢ÂÓ ·Ú·ÙËÚ‹ıËΠ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ Ê‡ÏˆÓ [46].
¶¤Ú·Ó Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿˜ ÙÔ˘˜ ÛÙËÓ ÚˆÙÔÁÂÓ‹ Î·È ‰Â˘ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë, ÔÈ ÛÙ·Ù›Ó˜ ‚ÔËıÔ‡Ó Î·È ÛÙËÓ ÔÍ›· Ê¿ÛË Ù˘ ÂÁÎÂÊ·ÏÈ΋˜ ÈÛ¯·ÈÌ›·˜. Ÿˆ˜ ÚԷӷʤÚıËÎÂ, Ù· Ê¿Ú̷η ·˘Ù¿ ÙÚÔÔÔÈÔ‡Ó ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÂÓ‰ÔıËÏ›Ô˘, ÛÙ·ıÂÚÔÔÈÔ‡Ó ÙËÓ ·ıËڈ̷ÙÈ΋ Ͽη Î·È Î·Ù·ÛÙ¤ÏÏÔ˘Ó ÙË ÊÏÂÁÌÔÓÒ‰Ë ·¿ÓÙËÛË [47]. ¶ÚfiÛÊ·Ù˜ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ Û˘ÓËÁÔÚÔ‡Ó ˘¤Ú Ù˘ ‡·Ú͢ Ó¢ÚÔÚÔÛٷ٢ÙÈ΋˜ ‰Ú¿Û˘ ÙˆÓ ÛÙ·ÙÈÓÒÓ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ÔÍ›·˜ Ê¿Û˘ ÙˆÓ ∞∂∂. Œ¯ÂÈ ‚ÚÂı› fiÙÈ ÔÈ ·ÛıÂÓ›˜ Ô˘ Ï¿Ì‚·Ó·Ó ‹‰Ë ·ÁˆÁ‹ ÚÔÙÔ‡ ˘ÔÛÙÔ‡Ó ∞∂∂ ›¯·Ó ηχÙÂÚË ¤Î‚·ÛË ÛÙÔ˘˜ ÙÚÂȘ Ì‹Ó˜ ·fi ·˘ÙÔ‡˜ Ô˘ ‰ÂÓ Â›¯·Ó Ï¿‚ÂÈ ÔÙ¤ ÛÙ·Ù›ÓË, ·Ú¿ ÙËÓ ·ÚfiÌÔÈ· ‚·Ú‡ÙËÙ· ÙÔ˘ ∞∂∂ ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ [48]. ∆Ô fiÊÂÏÔ˜ ·˘Ùfi ·Ú¤ÌÂÓÂ Î·È ÛÙËÓ ÂÚ›ÙˆÛË ·ÛıÂÓÒÓ Ô˘ ›¯·Ó ˘ÔÛÙ› ıÚÔÌ‚fiÏ˘ÛË Ì rtPA [49]. ªÂϤÙ˜ Û ÂÈÚ·Ì·Ùfi˙ˆ· ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ë Û˘Á¯ÔÚ‹ÁËÛË rtPA Î·È ÛÙ·ÙÈÓÒÓ ÂÏ·ÙÙÒÓÂÈ ÙËÓ ¤ÎÊÚ·ÛË ÙÔ˘ ·Ú¿ÁÔÓÙ· von Willebrand, ÙˆÓ ÌÔÚ›ˆÓ ΢ÙÙ·ÚÈ΋˜ ÚÔÛÎfiÏÏËÛ˘ Î·È ÙˆÓ ÌÂÙ·ÏÏÔÚˆÙÂ˚Ó·ÛÒÓ, ÂÚÈÔÚ›˙ÔÓÙ·˜ Ù· ıÚÔÌ‚ˆÙÈο Ê·ÈÓfiÌÂÓ· ÛÙÔ Â›Â‰Ô Ù˘ ÌÈÎÚÔ΢ÎÏÔÊÔÚ›·˜ Î·È ÂÓÈÛ¯‡ÔÓÙ·˜ ÙË ‰ÔÌÈ΋ ·ÎÂÚ·ÈfiÙËÙ· ÙˆÓ ·ÁÁ›ˆÓ [50]. ∞ÓÙ›ıÂÙ·, Ë ‰È·ÎÔ‹ ÙˆÓ ÛÙ·ÙÈÓÒÓ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ÔÍ›·˜ Ê¿Û˘ ÙÔ˘ ∞∂∂ ·˘Í¿ÓÂÈ ÙËÓ ÂÁÎÂÊ·ÏÈ΋ ‚Ï¿‚Ë. ∞˘Ùfi ÔÊ›ÏÂÙ·È ·ÊÂÓfi˜ ÛÙËÓ ·ÒÏÂÈ· Ù˘ Ó¢ÚÔÚÔÛٷ٢ÙÈ΋˜ ‰Ú¿Û˘ ÙÔ˘˜, ·ÊÂÙ¤ÚÔ˘ ÛÙËÓ Âȉ›ӈÛË Ù˘ ·ÁÁÂȷ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÂÍ·ÈÙ›·˜ ÌÈ·˜ ·fiÙÔÌ˘ ÂÏ¿ÙÙˆÛ˘ Ù˘ ÂÓ‰ÔıËÏȷ΋˜ ·Ú·ÁˆÁ‹˜ ¡√ Î·È ·‡ÍËÛ˘ ÙˆÓ ÊÏÂÁÌÔÓˆ‰ÒÓ Î·È ıÚÔÌ‚ˆÙÈÎÒÓ ‰ÈÂÚÁ·ÛÈÒÓ [51]. ªÈ· ÚfiÛÊ·ÙË ÌÂϤÙË ÂͤٷÛ ÙËÓ Â›‰Ú·ÛË Ù˘ ‰È·ÎÔ‹˜ ÙˆÓ ÛÙ·ÙÈÓÒÓ ÛÙËÓ ÔÍ›· Ê¿ÛË ÂÓfi˜ ∞∂∂. ªÂٷ͇ 89 ·ÛıÂÓÒÓ Ì ÈÛ¯·ÈÌÈÎfi ∞∂∂ Ô˘ Ï¿Ì‚·Ó·Ó ÛÙ·Ù›ÓË, ÔÈ 46 Ù˘¯·ÈÔÔÈ‹ıËÎ·Ó Ó· ‰È·Îfi„Ô˘Ó ÙËÓ ·ÁˆÁ‹ ÁÈ· ÙȘ 3 ÚÒÙ˜ Ë̤Ú˜ ÓÔÛËÏ›·˜, ÂÓÒ ÔÈ 43 Ó· Ï¿‚Ô˘Ó 20 mg/Ë̤ڷ ·ÙÔÚ‚·ÛÙ·Ù›Ó˘. ªÂÙ¿ ·fi ÙÔ ‰È¿ÛÙËÌ· ·˘Ùfi, fiÏÔÈ ¤Ï·‚·Ó
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·ÙÔÚ‚·ÛÙ·Ù›ÓË. √È ·ÛıÂÓ›˜ Ô˘ ‰È¤ÎÔ„·Ó ÙË ÛÙ·Ù›ÓË Â›¯·Ó ¯ÂÈÚfiÙÂÚË ÏÂÈÙÔ˘ÚÁÈ΋ ¤Î‚·ÛË ÛÙÔ˘˜ ÙÚÂȘ Ì‹Ó˜, ·ÚÔ˘Û›·Û·Ó Û˘¯ÓfiÙÂÚ· Ó¢ÚÔÏÔÁÈ΋ Âȉ›ӈÛË Î·È ·Ó¤Ù˘Í·Ó ÌÂÁ·Ï‡ÙÂÚÔ fiÁÎÔ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘ Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· Ô˘ Û˘Ó¤¯ÈÛ ÙËÓ ·ÁˆÁ‹ [52]. ™˘ÛÙ‹ÓÂÙ·È Û˘ÓÂÒ˜ Ó· ·ÔʇÁÂÙ·È Ë ‰È·ÎÔ‹ ÙˆÓ ÛÙ·ÙÈÓÒÓ Û ·ÛıÂÓ›˜ Ô˘ ˘Ê›ÛÙ·ÓÙ·È ÈÛ¯·ÈÌÈÎfi ∞∂∂. ªÂÚÈΤ˜ ηٷÁÚ·ÊÈΤ˜ ÌÂϤÙ˜ ·Ú·Ù‹ÚËÛ˘ ¤‰ÂÈÍ·Ó Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ¯·ÌËÏÒÓ ÂȤ‰ˆÓ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ˘„ËÏfiÙÂÚÔ˘ ÎÈÓ‰‡ÓÔ˘ ÌÂٿوÛ˘ ÙÔ˘ ∞∂∂ Û ·ÈÌÔÚÚ·ÁÈÎfi [53]. ™Â ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ fï˜ Ô˘ Û˘ÌÂÚȤϷ‚·Ó ·ÛıÂÓ›˜ Ì LDL-¯ÔÏËÛÙÂÚfiÏË Î¿Ùˆ ÙˆÓ 70 mg/dl Î·È ¯ˆÚ›˜ ÚÔËÁÔ‡ÌÂÓÔ ÈÛÙÔÚÈÎfi ∞∂∂, ‰ÂÓ ·Ú·ÙËÚ‹ıËΠ·˘ÍË̤ÓÔ˜ ΛӉ˘ÓÔ˜ ÂÁÎÂÊ·ÏÈ΋˜ ·ÈÌÔÚÚ·Á›·˜ [54, 55]. ¶·ÚÔÌÔ›ˆ˜, ÂÓÒ Î¿ÔȘ ÚÒÈ̘ ÌÂϤÙ˜ ·Ó¤ÊÂÚ·Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÌÂٿوÛ˘ ÙÔ˘ ∞∂∂ Û ·ÈÌÔÚÚ·ÁÈÎfi ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË rtPA Û ·ÛıÂÓ›˜ Ì ¯·ÌËÏ‹ ¯ÔÏËÛÙÂÚfiÏË, ÂfiÌÂÓ˜ ÌÂϤÙ˜ ‰ÂÓ ‚Ú‹Î·Ó ·ÓÂÍ¿ÚÙËÙË Û¯¤ÛË ÌÂٷ͇ Ù˘ ÚÔËÁÔ‡ÌÂÓ˘ Ï‹„˘ ÛÙ·ÙÈÓÒÓ Î·È ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ·˘ÙÔ‡ [56]. ∞ÓÙ›ıÂÙ·, ÛÙËÓ ˘·Ú·¯ÓÔÂȉ‹ ·ÈÌÔÚÚ·Á›·, ÔÈ ÛÙ·Ù›Ó˜ Ê·›ÓÂÙ·È
Ó· ‚ÔËıÔ‡Ó ÛÙËÓ ÚfiÏË„Ë Î·È ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÂÁÎÂÊ·ÏÈÎÔ‡ ·ÁÁÂÈfiÛ·ÛÌÔ˘ Ô˘ ÙËÓ ·ÎÔÏÔ˘ı›, ̤ۈ Ù˘ ‰Ú¿Û˘ ÙÔ˘˜ ÛÙËÓ eNOS Î·È ÙËÓ ·Ú·ÁˆÁ‹ ÂÏ¢ı¤ÚˆÓ ÚÈ˙ÒÓ [57, 58].
Ê·ÏÈ΋ ÈÛ¯·ÈÌ›· [59].
™˘ÌÂÚ¿ÛÌ·Ù·
√È ÏÂÈÔÙÚÔÈΤ˜ ‰Ú¿ÛÂȘ ÙˆÓ ÛÙ·ÙÈÓÒÓ ÂÓ‰¤¯ÂÙ·È Ó· ‚ÔËıÔ‡Ó ÛÙËÓ Ó¢ÚÔÏÔÁÈ΋ ÂȉÈfiÚıˆÛË ÌÂÙ¿ ·fi ¤Ó· ÈÛ¯·ÈÌÈÎfi ∞∂∂. ™Â ÂÈÚ·Ì·Ùfi˙ˆ·, Ë ¯ÔÚ‹ÁËÛË ÛÙ·ÙÈÓÒÓ Ô‰‹ÁËÛ Û ·‡ÍËÛË Ù˘ ·ÁÁÂÈÔÁ¤ÓÂÛ˘, Û ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙˆÓ ÂÓ‰ÔÁÂÓÒÓ Î˘ÙÙ¿ÚˆÓ, Ó¢ÚÔÁ¤ÓÂÛË Î·È Û¯ËÌ·ÙÈÛÌfi Ó¤ˆÓ Û˘Ó¿„ÂˆÓ [20]. ∞˘Ù‹ Ë Â·ÁfiÌÂÓË ·fi ÛÙ·Ù›Ó˜ ÓÂ˘ÚˆÓÈ΋ Ï·ÛÙÈÎfiÙËÙ· Û¯ÂÙ›˙ÂÙ·È Ì ÙË Ú‡ıÌÈÛË ·ÚÎÂÙÒÓ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, fiˆ˜ ÙÔ˘ VEGF (vascular endothelial growth factor) Î·È ÙÔ˘ BDNF (brain derived neurotrophic factor), ÔÈ ÔÔ›ÔÈ ÚÔ¿ÁÔ˘Ó ÙË ÌÂÙ·Ó¿ÛÙ¢ÛË ÙˆÓ Ó¢ÚÒÓˆÓ Î·È ÙËÓ ·Ó¿Ù˘ÍË Ó¤ˆÓ Ó¢ÚÒÓˆÓ Î·È Û˘Ó¿„ˆÓ. ™Â ÌÈ· ¿ÏÏË ÌÂϤÙË, Ë ¯ÔÚ‹ÁËÛË ÂÓ‰ÔÊϤ‚È·˜ ÚÔÛÔ˘‚·ÛÙ·Ù›Ó˘ ÂÓÙfi˜ 4 ˆÚÒÓ ·fi ÙËÓ ÚfiÎÏËÛË ∞∂∂ Û ÂÈÚ·Ì·Ùfi˙ˆ· ¤Ù˘¯Â ηχÙÂÚË ÏÂÈÙÔ˘ÚÁÈ΋ Î·È ·Ó·ÙÔÌÈ΋ ¤Î‚·ÛË, ÚÔÛٷهÔÓÙ·˜ ·fi ÙËÓ ÔÍ›· ÂÁÎÂ-
√È ÛÙ·Ù›Ó˜ Â›Ó·È Ê¿Ú̷η Ô˘ ¤¯Ô˘Ó ·Ô‰Â›ÍÂÈ ÙË ¯ÚËÛÈÌfiÙËÙ¿ ÙÔ˘˜ ÛÙËÓ ÂÏ¿ÙÙˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ∞∂∂, ÙfiÛÔ ÛÙËÓ ÚˆÙÔÁÂÓ‹ fiÛÔ Î·È ÛÙË ‰Â˘ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë. ¶ÔÏϤ˜ ·fi ·˘Ù¤˜ ÙȘ ÂȉڿÛÂȘ ÌÔÚÔ‡Ó Ó· ÂÍËÁËıÔ‡Ó ·fi ÙËÓ ÂÏ¿ÙÙˆÛË Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ·˘Ù‹˜ ηı' ·˘Ù‹˜, ¿ÏϘ fï˜ ÔÊ›ÏÔÓÙ·È Û ·ÓÂÍ¿ÚÙËÙÔ˘˜ Ì˯·ÓÈÛÌÔ‡˜, ÙȘ ÏÂÁfiÌÂÓ˜ ÏÂÈÔÙÚÔÈΤ˜ ‰Ú¿ÛÂȘ. √È ÛÙ·Ù›Ó˜ Ê·›ÓÂÙ·È Ó· ÂÈÙ˘Á¯¿ÓÔ˘Ó ÔʤÏË ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ÔÍ›·˜ Ê¿Û˘ ÂÓfi˜ ÈÛ¯·ÈÌÈÎÔ‡ ∞∂∂, Èı·ÓÒ˜ ̤ۈ Ù˘ Ó¢ÚÔÚÔÛٷ٢ÙÈ΋˜ ÙÔ˘˜ ‰Ú¿Û˘. ¶·Ú¿ÏÏËÏ·, Ë ‰È·ÎÔ‹ ÙˆÓ ÛÙ·ÙÈÓÒÓ Û¯ÂÙ›˙ÂÙ·È Ì ‰˘ÛÌÂÓ¤ÛÙÂÚË ÏÂÈÙÔ˘ÚÁÈ΋ ¤Î‚·ÛË. °È· Ó· ÂȂ‚·ÈˆıÔ‡Ó Ù· ·Ú·¿Óˆ ı· ¯ÚÂÈ·ÛÙÔ‡Ó ‚¤‚·È· Ù˘¯·ÈÔÔÈË̤Ó˜ ÌÂϤÙ˜ Ô˘ Ó· Û˘ÁÎÚ›ÓÔ˘Ó ÙȘ ÛÙ·Ù›Ó˜ ÌÂ Û˘Ì‚·ÙÈ΋ ·ÁˆÁ‹. ∆¤ÏÔ˜, ÌÈ· ÔÏÏ¿ ˘ÔÛ¯fiÌÂÓË ‰Ú¿ÛË ÙˆÓ ÛÙ·ÙÈÓÒÓ Â›Ó·È Ë ‰È¤ÁÂÚÛË Ì˯·ÓÈÛÌÒÓ Ó¢ÚÔÂȉÈfiÚıˆÛ˘ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ¯ÚfiÓÈ·˜ Ê¿Û˘ Ù˘ ÂÁÎÂÊ·ÏÈ΋˜ ÈÛ¯·Ì›·˜, Ë ÔÔ›· ÌÔÚ› Ó· ÚÔ¿ÁÂÈ ÙË ÏÂÈÙÔ˘ÚÁÈ΋ ·ÔηٿÛÙ·ÛË ÙˆÓ ·ÛıÂÓÒÓ.
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∆Ô Ì¤ÏÏÔÓ Ù˘ ıÂڷ›·˜ Ì ÛÙ·Ù›Ó˜ ÛÙ· ÈÛ¯·ÈÌÈο ∞∂∂
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∫·Ú‰È·Î‹ ∞Ó¿ÚÎÂÈ· ÁÈ· ÙÔÓ ªË ∫·Ú‰ÈÔÏfiÁÔ ¶··ı·Ó·Û›Ô˘ ∞ı·Ó¿ÛÈÔ˜, ∫·Ú‰ÈÔÏfiÁÔ˜-∂ÓÙ·ÙÈÎÔÏfiÁÔ˜ °È¿ÓÓ˘ °Ô˘‰¤‚ÂÓÔ˜ ∫·ıËÁËÙ‹˜ ∫·Ú‰ÈÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ ¶ÔÏÏÔ› ·ÛıÂÓ›˜ Ì ηډȷ΋ ·Ó¿ÚÎÂÈ· ‰ÂÓ ÓÔÛËχÔÓÙ·È Û ηډÈÔÏÔÁÈΤ˜ ÎÏÈÓÈΤ˜ Î·È ·ÎfiÌË ÂÚÈÛÛfiÙÂÚÔÈ ‰ÂÓ ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È ·fi ηډÈÔÏfiÁÔ˘˜. ™ÙË Û‡ÓÙÔÌË ·˘Ù‹ ·Ó·ÛÎfiËÛË ·Ú·ı¤ÙÔ˘ÌÂ Û˘ÓÔÙÈο ÛÙÔȯ›· Ô˘ ı· ‚ÔËı‹ÛÔ˘Ó ÙÔÓ ÌË Î·Ú‰ÈÔÏfiÁÔ Ó· ηٷÓÔ‹ÛÂÈ ÙÔ Úfi‚ÏËÌ· Î·È Ó· ÌÔÚ› Ó· ÂÚÌËÓ‡ÂÈ ÙȘ ·Ú·ÎÏÈÓÈΤ˜ ÂÍÂÙ¿ÛÂȘ Ú¤ÂÈ Ó· Á›ÓÔÓÙ·È ÁÈ· ÙË Î·Ï‡ÙÂÚË ·ÓÙÈÌÂÙÒÈÛË Î·È ·Ú·ÎÔÏÔ‡ıËÛË ÙÔ˘ ·ÛıÂÓÔ‡˜. ¶¤Ú·Ó ·fi ÙËÓ ÏÂÈÙÔ˘ÚÁÈ΋ ηٿÛÙ·ÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ Ô˘ÛÈ·ÛÙÈ΋ Â›Ó·È Ë ÁÓÒÛË Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ Î·È Ë ÛˆÛÙ‹ ¯ÔÚ‹ÁËÛË Ù˘ Ê·Ú̷΢ÙÈ΋˜ ·ÁˆÁ‹˜. ∏ ηډȷ΋ ·Ó¿ÚÎÂÈ· (∫∞) Â›Ó·È ÙÔ ÈÔ ÛËÌ·ÓÙÈÎfi Î·È Û˘Ó¯Ҙ ÂȉÂÈÓÔ‡ÌÂÓÔ Úfi‚ÏËÌ· ‰ËÌfiÛÈ·˜ ˘Á›·˜ ÛÙȘ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜. ¶ÚfiÎÂÈÙ·È ÁÈ· Û˘¯Ó‹ ÌÈ· ÎÏÈÓÈ΋ ÔÓÙfiÙËÙ· Û˘Ó‹ıˆ˜ ÙˆÓ ËÏÈÎÈˆÌ¤ÓˆÓ (̤ÛË ËÏÈΛ· 72 ¯ÚfiÓÈ·), Ì ÊÙˆ¯‹ ÚfiÁÓˆÛË (›‰È· Ì ÔÚÈÛÌ¤ÓˆÓ ÓÂÔÏ·ÛÈÒÓ), Ì fi¯È ηϋ ÔÈfiÙËÙ· ˙ˆ‹˜ Î·È ÌÂÁ¿ÏÔ ÎfiÛÙÔ˜
∫ÏÈÓÈ΋ ÂÈÎfiÓ· ∏ ∫∞ Â›Ó·È ¤Ó· Û‡ÓıÂÙÔ ÎÏÈÓÈÎfi Û‡Ó‰ÚÔÌÔ Ô˘ ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È Û ‰ÔÌÈΤ˜ ‹ ÏÂÈÙÔ˘ÚÁÈΤ˜ ηډȷΤ˜ ‰È·Ù·Ú·¯¤˜ Ô˘ ÂÌÔ‰›˙Ô˘Ó ÙËÓ Î·Ú‰È¿ Ó· ·ÓÙÏ› ‹ Ó· Â͈ı› ·›Ì·. √È Î‡ÚȘ ÂΉËÏÒÛÂȘ Ù˘ Â›Ó·È ‰‡ÛÓÔÈ· ÛÙËÓ ÚÔÛ¿ıÂÈ· Î·È ÙËÓ ËÚÂÌ›·, ‡ÎÔÏË ÎfiˆÛË (ÌÂȈ̤ÓË ÈηÓfiÙËÙ· ÁÈ·
¿ÛÎËÛË) Î·È Î·Ù·ÎÚ¿ÙËÛË ˘ÁÚÒÓ Ô˘ Ô‰ËÁ› Û Ó¢ÌÔÓÈ΋ Û˘ÌÊfiÚËÛË Î·È ÂÚÈÊÂÚÈÎfi Ô›‰ËÌ·. ∏ ‰‡ÛÓÔÈ· Î·È Ë Â‡ÎÔÏË ÎfiˆÛË ÌÔÚ› Ó· ÂËÚ¿˙Ô˘Ó ÙËÓ ÏÂÈÙÔ˘ÚÁÈ΋ ÈηÓfiÙËÙ· Î·È ÙËÓ ÔÈfiÙËÙ· ˙ˆ‹˜ ·ÏÏ¿ ‰ÂÓ ˘¿Ú¯Ô˘Ó ¿ÓÙ· ÛÙË ÎÏÈÓÈ΋ ÂÈÎfiÓ·, ÛÙÔÓ ›‰ÈÔ ¯ÚfiÓÔ. ªÂÚÈÎÔ› ·ÛıÂÓ›˜ ¤¯Ô˘Ó ÊÙˆ¯‹ ·ÓÔ¯‹ ÛÙËÓ ¿ÛÎËÛË ·ÏÏ¿ ‰ÂÓ ¤¯Ô˘Ó ηٷÎÚ¿ÙËÛË ˘ÁÚÒÓ (Ôȉ‹Ì·Ù·, ÙÚ›˙ÔÓÙ˜ ÛÙÔ˘˜ Ó‡ÌÔÓ˜) Î·È ¿ÏÏÔÈ ·Ú·ÔÓÈÔ‡ÓÙ·È Û˘¯ÓfiÙÂÚ· ÁÈ· Ôȉ‹Ì·Ù· Î·È fi¯È ÁÈ· ‰‡ÛÓÔÈ· ‹ ‡ÎÔÏË ÎfiˆÛË. ∞ÚÎÂÙÔ› ·ÛıÂÓ›˜ ÚÈÓ ·ÚÔ˘ÛÈ·ÛıÔ‡Ó Ì Ó¢ÌÔÓÈÎfi Ô›‰ËÌ· (ÂÈÎfiÓ· 1) Ô˘ Â›Ó·È Ë ÈÔ ·ÎÚ·›· ÌÔÚÊ‹ ÂÌÊ¿ÓÈÛ˘ Ù˘ ∫∞ ÌÔÚ› Ó· ·Ú·ÔÓÔ‡ÓÙ·È ÁÈ· ·ÚÔ͢ÓÙÈ΋ Ó˘¯ÙÂÚÈÓ‹ ‰‡ÛÓÔÈ· (·Ê‡ÓÈÛË 2-3 ÒÚ˜ ÌÂÙ¿ ÙË Î·Ù¿ÎÏÈÛË Ì ‰‡ÛÓÔÈ· Î·È ·›ÛıËÌ· ÓÈÁÌÔ‡. ªfiÏȘ ÛËΈıÔ‡Ó ·fi ÙÔ ÎÚ‚¿ÙÈ Ë ‰‡ÛÓÔÈ· ‚ÂÏÙÈÒÓÂÙ·È). √ ·ÛıÂÓ‹˜ ÛÙËÓ ∂ÈÎfiÓ· 1 ·ÚÈÛÙÂÚ¿ ¤¯ÂÈ ÛËÌ›· ‰ÂÍÈ¿˜ ∫∞ (Ôȉ‹Ì·Ù·, ·˘ÍË̤Ó˜ ÛÊ·Á›Ùȉ˜, Ë·ÙÔÌÂÁ·Ï›·, ·ÛΛÙË) Ô˘ Â›Ó·È Û˘Ó¤ÂÈ· ·ÚÈÛÙÂÚ‹˜ ∫∞.
∂›ÙˆÛË, ÂÈÔÏ·ÛÌfi˜ √ ÂÈÔÏ·ÛÌfi˜ ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi Â›Ó·È 1-2% Î·È Ë Â›ÙˆÛË 5 -10/1000 ¿ÙÔÌ· ÙÔ ¯ÚfiÓÔ. ∏ ÈÔ ÛÙ·ıÂÚ‹ Î·È ÂÓÙ˘ˆÛȷ΋ ÂȉËÌÈÔÏÔÁÈ΋ ·Ú·Ù‹ÚËÛË Â›Ó·È Ë ‰Ú·Ì·ÙÈ΋ Û¯¤ÛË ÌÂٷ͇ ËÏÈΛ·˜ Î·È ÂÌÊ¿ÓÈÛ˘ ∫∞. ∞fi Ù· Ìˉ·ÌÈÓ¿ ›‰· ÛÙËÓ ËÏÈΛ· <45
ÂÙÒÓ ·ÁÁ›˙ÂÈ ÙÔ 2%-5% ÌÂÙ¿ Ù· 70 Î·È ÏËÛÈ¿˙ÂÈ ÙÔ 10% ÌÂÙ¿ ÙËÓ ËÏÈΛ· ÙˆÓ 80 ÂÙÒÓ. √ ÂÈÔÏ·ÛÌfi˜ Ù˘ ∫∞ ÛÙËÓ ∂ÏÏ¿‰· ˘ÔÏÔÁ›˙ÂÙ·È Û 110.000 ·ÛıÂÓ›˜ Î·È Ë Â›ÙˆÛË 20.000 Ӥ˜ ÂÚÈÙÒÛÂȘ ÙÔ ¯ÚfiÓÔ. ∆¤ÏÔ˜ 4.500 ı¿Ó·ÙÔÈ ÙÔ ¯ÚfiÓÔ ÔÊ›ÏÔÓÙ·È Û ∫∞. ∞Ó¿Ï˘ÛË ÈÛÙÔÔÈËÙÈÎÒÓ ı·Ó¿ÙˆÓ ·fi ÙË ÂÚÈÔ¯‹ Ù˘ µ¢ ∂ÏÏ¿‰·˜ Ì ËÏÈÎȈ̤ÓÔ ÏËı˘ÛÌfi >75 ÂÙÒÓ ÛÙÔ7%, ¤‰ÂÈÍ fiÙÈ ÛÙÔ 22% Û·Ó ·ÈÙ›· ı·Ó¿ÙÔ˘ ‹Ù·Ó ηډȷ΋ ·Ó¿ÚÎÂÈ· Î·È Û¯Â‰fiÓ fiÏÔÈ (98%) ‹Ù·Ó ËÏÈΛ·˜ ¿Óˆ ÙˆÓ 75 ÂÙÒÓ
∞Èٛ˜: ∏ ÈÔ Û˘¯Ó‹ ·ÈÙ›· KA Â›Ó·È Ë ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ˜ (2/3 ÙˆÓ ÂÚÈÙÒÛˆÓ) Î·È È‰È·›ÙÂÚ· ÙÔ ÈÛÙÔÚÈÎfi ÔͤԘ ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ôηډ›Ô˘. ∞ÎÔÏÔ˘ı› Ë ˘¤ÚÙ·ÛË (ÈÛÙÔÚÈÎfi ÛÔ‚·Ú‹˜ ˘¤ÚÙ·Û˘ ¯ˆÚ›˜ ıÂڷ›·), ÔÈ ‚·Ï‚ȉԿıÂȘ (ÛÙ¤ÓˆÛË ·ÔÚÙ‹˜ Û ËÏÈÎȈ̤ÓÔ˘˜, ·Ó¿ÚÎÂÈ· Ì˘ÍˆÌ·ÙÒ‰Ô˘˜ ÌÈÙÚÔÂȉԇ˜ Û ÌÂÛ‹ÏÈΘ) Î·È ÔÈ Ì˘ÔηډÈÔ¿ıÂȘ. ∆ÂÏÂ˘Ù·›· ·Ó·ÁÓˆÚ›˙ÔÓÙ·È Û·Ó ·Èٛ˜ Î·È Ô ‰È·‚‹Ù˘ Ì ÙËÓ ·¯˘Û·ÚΛ·. ∏ ∂ÈÎfiÓ· 2 ‰Â›¯ÓÂÈ ˆ˜ ÔÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÚÔηÏÔ‡Ó ¤ÌÊÚ·ÁÌ· Î·È ·˘Ùfi Ì ÛÂÈÚ¿ ÙÔ˘ ∫∞ ÌÂ Û˘ÛÙÔÏÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· (ÂËÚ·Ṳ̂ÓÔ ÎÏ¿ÛÌ· ÂÍÒıËÛ˘) Î·È ı¿Ó·ÙÔ. ¶·Ú·ÙËÚԇ̠fï˜ fiÙÈ Ë ˘¤ÚÙ·ÛË ÌÔÚ› Ó· ÚÔηϤÛÂÈ ∫∞ Ì ηÏfi ÎÏ¿ÛÌ· ÂÍÒıËÛ˘ (ÁÓˆÛÙ‹ Û·Ó ‰È·ÛÙÔÏÈ΋ ∫∞ ‚Ϥ ·Ú·Î¿Ùˆ ÛÙÔ Î›ÌÂÓÔ)
∫·Ù¿Ù·ÍË:
∂ÈÎfiÓ· 1
22
∏ ∫∞ ηχÙÂÈ ¤Ó· ¢ڇ Ê¿ÛÌ· ·ÛıÂÓÒÓ Î·È ÙÔ˘˜ ¯·Ú·ÎÙËÚ›˙ÂÈ ·Ó¿ÏÔÁ· Ì ¤Ó· ·fi Ù· 4 ÛÙ¿‰È· Ô˘ ÂÌϤÎÔÓÙ·È ÛÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Ù˘ ∫∞. ∏ ∂ÈÎfiÓ· 3 ‰Â›¯ÓÂÈ ÙËÓ Û‡Á¯ÚÔÓË Î·Ù¿Ù·ÍË Ù˘ Û‡Ìʈӷ Ì ÙËÓ ACC/AHA. ª¤¯ÚÈ ÚfiÛÊ·Ù· Ë Î·Ù¿Ù·ÍË ‹Ù·Ó Û‡Ìʈӷ Ì ÙË NYHA. ∏ ∂ÈÎfiÓ· 4 ‰Â›¯ÓÂÈ ÙË Û¯¤ÛË Ù˘ ·ÏÈ¿˜ ηٿٷ͢ ηٿ NHA Ì ÙËÓ Û‡Á¯ÚÔÓË. ∆· ÚÒÙ· 2 ÛÙ¿‰È· (∞ Î·È µ) Û›ÁÔ˘Ú· ‰ÂÓ Â›Ó·È ∫∞ ·ÏÏ¿ ÌÈ· ÚÔÛ¿ıÂÈ· Ó· ‚ÔËı‹ÛÂÈ ÙÔ˘˜ ¯ÔÚËÁÔ‡˜ ˘Á›·˜ Ó· ·Ó·ÁÓˆÚ›ÛÔ˘Ó ¤ÁηÈÚ· ·ÛıÂÓ›˜ Ô˘
ATHIROSK 21-
05-03-09
12:25
™ÂÏ›‰·23
£∂ƒ∞¶∂π∞ - º∞ƒª∞∫∞ Ô˘ÚËÙÈο ‹ ÂÏÂÚÂÓfiÓË. ∏ ˘ÔÓ·ÙÚÈ·ÈÌ›· Â›Ó·È ‰Â›ÎÙ˘ ÛÔ‚·Ú‹˜ ¯ÚfiÓÈ·˜ ∫∞.
¡·ÙÚÈÔ˘ÚËÙÈο ÂÙ›‰È·:
∂ÈÎfiÓ· 2 Â›Ó·È Û ΛӉ˘ÓÔ Ó· ·Ó·Ù‡ÍÔ˘Ó ∫∞. ∆· ÛÙ¿‰È· ∞ Î·È µ ÔÚ›˙ÔÓÙ·È Î·Ï‡ÙÂÚ· Û ÂΛÓÔ˘˜ Ì ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Ô˘ Û·ÊÒ˜ Úԉȷı¤ÙÔ˘Ó ÚÔ˜ ·Ó¿Ù˘ÍË ∫∞. °È· ·Ú¿‰ÂÈÁÌ· ·ÛıÂÓ›˜ Ì ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ, ˘¤ÚÙ·ÛË ‹ ‰È·‚‹ÙË Ô˘ ‰ÂÓ ¤¯Ô˘Ó ÂËÚ·Ṳ̂ÓË ÏÂÈÙÔ˘ÚÁ›· ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ ‹ ˘ÂÚÙÚÔÊ›· ı· ıˆÚËıÔ‡Ó ÛÙ·‰›Ô˘ ∞, ÂÓÒ ·ÛıÂÓ›˜ ·Û˘Ìو̷ÙÈÎÔ› ·ÏÏ¿ Ì ˘ÂÚÙÚÔÊ›· ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ ηÈ/‹ ÂËÚ·Ṳ̂ÓË ÏÂÈÙÔ˘ÚÁ›· ı· ¯·Ú·ÎÙËÚÈÛıÔ‡Ó ÛÙ·‰›Ô˘ µ. ∆Ô ÛÙ¿‰ÈÔ ° ¯·Ú·ÎÙËÚ›˙ÂÈ ·ÛıÂÓ›˜ ÌÂ Û˘ÌÙÒÌ·Ù· (·ÚÂÏıfiÓ ‹ ·ÚfiÓ) Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ‰ÔÌÈΤ˜ ‰È·Ù·Ú·¯¤˜ (Ô Î‡ÚÈÔ˜ fiÁÎÔ˜ ·ÛıÂÓÒÓ Ì ∫∞) Î·È ÙÔ ÛÙ¿‰ÈÔ ¢ ¯·Ú·ÎÙËÚ›˙ÂÈ ·ÛıÂÓ›˜ Ì ·ÏËıÒ˜ ·ÓıÂÎÙÈ΋ ∫∞ Ô˘ ÌÔÚ› Ó· Â›Ó·È Î·Ù¿ÏÏËÏÔÈ ÁÈ· Ì˯·ÓÈ΋ ˘Ô‚Ô‹ıËÛË, Û˘Û΢¤˜ Ô˘ ·Ê·ÈÚÔ‡Ó ˘ÁÚ¿, Û˘Ó¯‹ ¤Á¯˘ÛË ÈÓÔÙÚfiˆÓ ‹ ¯ÂÈÚÔ˘ÚÁÈΤ˜ ‰ÈÔÚıÒÛÂȘ.
Ù¿ÛÙ·ÛË) ÌÔÚ› Ó· ÔÊ›ÏÔÓÙ·È Î·È Û ¿ÏϘ ηٷÛÙ¿ÛÂȘ fiˆ˜ ·fi Ê¿Ú̷η (‰È˘‰ÚÔ˘Úȉ›Ó˜, ÁÏÈÙ·˙fiÓ˜).
∞ÈÌ·ÙÔÏÔÁÈΤ˜ Î·È ‚ÈÔ¯ËÌÈΤ˜ ÂÍÂÙ¿ÛÂȘ ∞fi ÙȘ ÂÚÁ·ÛÙËÚȷΤ˜ ÂÍÂÙ¿ÛÂȘ Ú¤ÂÈ Ó· ·ÔÎÏÂÈÛı› Ë ·Ó·ÈÌ›· Ô˘ Â›Ó·È ÌÈ· ·fi ÙȘ ·Èٛ˜ ‰‡ÛÓÔÈ·˜ ·ÏÏ¿ Î·È Û˘Ó˘¿Ú¯ÂÈ Û ÌÂÁ¿ÏÔ ‚·ıÌfi. ™ÙËÓ ‹È· Î·È Ì¤ÙÚÈ· ∫∞ ÔÈ ËÏÂÎÙÚÔχÙ˜ Î·È Ë ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· Â›Ó·È Û˘Ó‹ıˆ˜ Ê˘ÛÈÔÏÔÁÈο. ¶Ú¤ÂÈ Ó· ÁÓˆÚ›˙Ô˘Ì ÙËÓ ·Ú¯È΋ ÙÈÌ‹ ÎÚ·ÙÈÓ›Ó˘ ÁÈ·Ù› ÌÔÚ› Ó· ·˘ÍËı› ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ıÂڷ›·˜ (·˘Í¿ÓÂÈ Ì AMEA Î·È Ì ÌÂÁ¿Ï˜ ‰fiÛÂȘ ‰ÈÔ˘ÚËÙÈÎÒÓ). ∆· ‰ÈÔ˘ÚËÙÈο, ‚·ÛÈ΋ ıÂڷ›· Ù˘ ∫∞, ÌÔÚÔ‡Ó Ó· ÚÔηϤÛÔ˘Ó ˘ÔÓ·ÙÚÈ·ÈÌ›· Î·È ˘ÔηÏÈ·ÈÌ›·. ÀÂÚηÏÈ·ÈÌ›· ÌÔÚ› Ó· ·Ú·ÙËÚËı› Û ÛÔ‚·Ú‹ ∫∞ Ì ÂËÚ·Ṳ̂ÓË ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· Î·È Î·ÏÈÔÛ˘ÓÙËÚËÙÈο ‰È-
√È Ù‡ÔÈ ÙˆÓ Ó·ÙÚÈÔ˘ÚËÙÈÎÒÓ ÂÙȉ›ˆÓ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ ∫∞ Â›Ó·È ÙÔ µ¡P Î·È ÙÔ NT-proBNP. T· Ú·ÁÌ·ÙÈο Ê˘ÛÈÔÏÔÁÈο ›‰· ÙˆÓ ÂÙȉ›ˆÓ ‰ÂÓ Â›Ó·È ÁÓˆÛÙfi ·ÏÏ¿ ÂËÚ¿˙ÔÓÙ·È ·fi ÔÏϤ˜ ηٷÛÙ¿ÛÂȘ. ∆Ô ı‡ÏË Ê‡ÏÔ Î·È Ë ËÏÈΛ· Â›Ó·È ‰‡Ô ·fi ·˘Ù¤˜ Ô˘ ÙÔ ·˘Í¿ÓÔ˘Ó. ™·Ó ÁÂÓÈ΋ ·Ú¯‹ ηϿ Â›Ó·È Ó· ÁÓˆÚ›˙Ô˘Ì fiÙÈ ÙÔ 90% ÙˆÓ Ó¤ˆÓ ˘ÁÈÒÓ ·ÙfiÌˆÓ ¤¯ÂÈ BNP <25 pg/ml Î·È ÙÔ Pro BNP <70 pg/ml. ™Â ·ÛıÂÓ›˜ Ì ÔÍ›· ‰‡ÛÓÔÈ· Ù· ÚÔÙÂÈÓfiÌÂÓ· ηÙÒÙÂÚ· fiÚÈ· ÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÌfi ∫∞ Â›Ó·È ÁÈ· ÙÔ ÌÂÓ BNP <100 pg/ml Î·È ÁÈ· ÙÔ NT-proBNP <340 pg/ml. ∏ ÂÈÎfiÓ· 5 ‰Â›¯ÓÂÈ ·ÏÁfiÚÈıÌÔ ¯Ú‹Û˘ Ó·ÙÚÈÔ˘ÚËÙÈÎÒÓ ÂÙȉ›ˆÓ Û ·ÛıÂÓ‹ Ì ‰‡ÛÓÔÈ·.
∏∫° ∆o HK° ‰ÂÓ ‚ÔËı¿ÂÈ Ôχ. °È· ·Ú¿‰ÂÈÁÌ· Û ÛÔ‚·Ú‹ ·Ó¿ÚÎÂÈ· Ù˘ ÌÈÙÚÔÂȉԇ˜ ÌÔÚ› Ó· Â›Ó·È Î·È Ê˘ÛÈÔÏÔÁÈÎfi. ∏ ·ÚÔ˘Û›· Î˘Ì¿ÙˆÓ Q Â›Ó·È ‰ËψÙÈο ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ (·Ï·Èfi ¤ÌÊÚ·ÁÌ·) Î·È Ù· ÛËÌ›· ˘ÂÚÙÚÔÊ›·˜ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ ‰ËψÙÈο ÛÔ‚·Ú‹˜ ˘¤ÚÙ·Û˘ ‹ ÛÙ¤ÓˆÛ˘ ·ÔÚÙ‹˜. §ÈÁfiÙÂÚÔ Û˘¯Ó¿ ÙÔ ∏∫° ‰Â›¯ÓÂÈ ·ÔÎÏÂÈÛÌfi ·ÚÈÛÙÂÚÔ‡ ÛΤÏÔ˘˜ (Ì˘ÔηډÈÔ¿ıÂÈ·) ‹ /Î·È ÎÔÏÈ΋ Ì·ÚÌ·Ú˘Á‹. ™Â ·ÛıÂÓ›˜ Ì ·›ÛıËÌ· ·ÏÌÒÓ, ˙¿ÏË, ı· ¯ÚÂÈ·ÛÙ› 24ˆÚË Î·Ù·ÁÚ·Ê‹ (Holter). ∞ÚÎÂÙÔ› ·ÛıÂÓ›˜ Ì ∫∞ ¤¯Ô˘Ó ÔχÏÔΘ ÎÔÈÏȷΤ˜ ·ÚÚ˘ı̛˜ ÛÙË 24ˆÚË Î·Ù·ÁÚ·Ê‹.
¢È¿ÁÓˆÛË ¢ÂÓ ˘¿Ú¯ÂÈ ÌÔÓ·‰È΋ ‰È·ÁÓˆÛÙÈ΋ ‰ÔÎÈÌ·Û›· (¯Ú˘Ûfi standard) ‰ÈfiÙÈ Î·Ù¿ ‚¿ÛË ÚfiÎÂÈÙ·È ÁÈ· ÎÏÈÓÈ΋ ‰È¿ÁÓˆÛË Ô˘ ‚·Û›˙ÂÙ·È ÛÙÔ ÚÔÛÂÎÙÈÎfi ÈÛÙÔÚÈÎfi Î·È Ê˘ÛÈ΋ ÂͤٷÛË ˘Ô‚ÔËıÔ‡ÌÂÓ· ·fi ÂÚÁ·ÛÙËÚȷΤ˜ ÂÍÂÙ¿ÛÂȘ Î·È ÌÈ· ÔÈÎÈÏ›· ‰È·ÁÓˆÛÙÈÎÒÓ ÂÍÂÙ¿ÛˆÓ. ∆· Û˘ÌÙÒÌ·Ù· (‰‡ÛÓÔÈ· ÚÔÛ·ı›·˜ ·fi 4-6 ‚‰ÔÌ¿‰Â˜, ‡ÎÔÏË ÎfiˆÛË) Â›Ó·È Û˘¯Ó¿ ·ÏÏ¿ fi¯È ¢·›ÛıËÙ·. ∞fi ÙË º˘ÛÈ΋ ÂͤٷÛË Ù· ÛËÌ›· (ÙÚ›ÙÔ˜ ÙfiÓÔ˜, ÛÊ·Á›Ùȉ˜) ‰ÂÓ ˘¿Ú¯Ô˘Ó Î·È fiÙ·Ó ˘¿Ú¯Ô˘Ó ‰‡ÛÎÔÏ· ÂÓÙÔ›˙ÔÓÙ·È. √ȉ‹Ì·Ù· ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ ÂÎÙfi˜ ·fi ∫∞ (ÚÔ¯ˆÚË̤ÓË Î·-
∂ÈÎfiÓ· 3
23
ATHIROSK 21-
05-03-09
12:25
ª ∞ ƒ ∆ π √ ™
™ÂÏ›‰·24
2 0 0 9
∞ÓÒÙÂÚ˜ º˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜ (Û mm) ˘ÂÚ˯ÔÁÚ·Ê‹Ì·ÙÔ˜ ηډȿ˜ ∞ÔÚÙÈ΋ Ú›˙·
38
∞ÚÈÛÙÂÚfi˜ ÎfiÏÔ˜
38
¶¿¯Ô˜ ÙÔȯˆÌ¿ÙˆÓ
11
∆ÂÏԉȷÛÙÔÏÈ΋ ‰È¿ÌÂÙÚo˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜
58
¢ÂÍÈ¿˜ ÎÔÈÏ›·˜
33
∫Ï¿ÛÌ· ÂÍÒıËÛ˘ (%)
∂ÈÎfiÓ· 4
·/· ıÒڷη ∏ ·/· ıÒڷη ÌÔÚ› Ó· ‰Â›ÍÂÈ ·˘ÍË̤ÓÔ Ì¤ÁÂıÔ˜ ηډȿ˜ (ηډÈÔıˆÚ·ÎÈÎfi˜ ‰Â›ÎÙ˘ >50%) ‹ Û˘ÌÊfiÚËÛË Ó¢ÌÔÓÈÎÒÓ ÊÏ‚ÒÓ ÛÙȘ ÎÔÚ˘Ê¤˜ (Û˘Ó‹ıˆ˜ ˘Ô‰ËÏÔ‡Ó ›ÂÛË ÂÓÛÊ‹ÓˆÛ˘ ÛÙ· ÙÚȯÔÂȉ‹ >20 mmHg). AÓ Ë ›ÂÛË ÂÓÛÊ‹ÓˆÛ˘ (ÁÓˆÛÙ‹ Î·È wedge pressure) ÍÂÂÚ¿ÛÂÈ Ù· 18-25 mmHg ı· Û˘Ì‚Â› Ó¢ÌÔÓÈÎfi Ô›‰ËÌ·, ÂÍ·ÈÚÂÙÈο ›ÁÔ˘Û· ηٿÛÙ·ÛË. ¶Ó¢ÌÔÓÈÎfi Ô›‰ËÌ· ÌÔÚ› Ó· Û˘Ì‚Â› Î·È ·fi ÌË Î·Ú‰È·Î¿ ·›ÙÈ· fiˆ˜ ‰È¿ÊÔÚ· Ê¿Ú̷η, ÛË„·ÈÌ›·. ∞ÎfiÌË Ë ·/· ıÒڷη ÌÔÚ› Ó· ‰Â›ÍÂÈ Ï¢ÚÈÙÈΤ˜ Û˘ÏÏÔÁ¤˜ ¿Ìʈ (·Ó ÌÔÓfiÏ¢ڷ, Û˘Ó‹ıˆ˜ ‰ÂÍÈ¿) ‹ ·Èٛ˜ ‰‡ÛÓÔÈ·˜ ÌË Î·Ú‰È·Î‹˜ ·ÈÙÈÔÏÔÁ›·˜. ∞Û‚ÂÛÙÒÛÂȘ ÛÙȘ ‚·Ï‚›‰Â˜ Î·È ÛÙÔ ÂÚÈοډÈÔ ‰›ÓÔ˘Ó ÔχÙÈ̘ ÏËÚÔÊÔڛ˜ ÁÈ· ‚·Ï‚ȉԿıÂȘ Î·È Ì˘ÔηډÈÔ¿ıÂȘ. ∏ ·ÚÔ˘Û›· ·Û‚ÂÛÙ›Ô˘ ÛÙË ·/· ıÒڷη ‰ÂÓ ÛËÌ·›ÓÂÈ Î·Ù' ·Ó¿ÁÎË ‚·Ï‚ȉԿıÂÈ· ‹ ÂÚÈÔÚÈÛÙÈ΋ ÂÚÈηډ›Ùȉ· ·ÏÏ¿ ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙÔ˘˜ ··ÈÙÂ›Ù·È ·Û‚¤ÛÙÈÔ ÛÙË ‚·Ï‚›‰· ‹ ÙÔ ÂÚÈοډÈÔ. º˘ÛÈÔÏÔÁÈ΋ ·/· ıÒڷη Î·È Ê˘ÛÈÔÏÔÁÈÎfi ∏∫° οÓÔ˘Ó ÙËÓ ∫∞ ·›ı·ÓË Û·Ó ·ÈÙ›· ‰‡ÛÓÔÈ·˜
∏¯ÔηډÈÔÁÚ¿ÊËÌ· ∆o ˯ÔηډÈÔÁÚ¿ÊËÌ· Â›Ó·È Ë ÈÔ ¯Ú‹ÛÈÌË ·Ó·›Ì·ÎÙË ÂͤٷÛË ÁÈ· ÂÎÙ›ÌËÛË Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜. √ ˘ÔÏÔÁÈÛÌfi˜ ÙÔ˘ ∫Ï¿ÛÌ·ÙÔ˜ ∂ÍÒıËÛ˘ Î·È ÙˆÓ ‰È·ÛÙ¿ÛÂˆÓ ÙˆÓ ÎÔÈÏÔÙ‹ÙˆÓ ·Ú¤¯Ô˘Ó ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂÈÎfiÓ· Ù˘ ηډȷ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜. ∫∂ <40 % ÙÂÏԉȷÛÙÔÏÈ΋ ‰È¿ÌÂÙÚÔ˜ >60 mm ‹ >34 mm/m2 Â›Ó·È ‰È·ÁÓˆÛÙÈο ∫∞. √È ·ı‹ÛÂȘ ÙˆÓ ‚·Ï‚›‰ˆÓ ı·
24
ÂÎÙÈÌËıÔ‡Ó ÁÈ· ÙË ÛÔ‚·ÚfiÙËÙ· ÙÔ˘˜ Ì ÙË ¯Ú‹ÛË ÙÔ˘ Doppler ∏ ÈÔ Û˘¯Ó‹ ·ÈÙ›· ‰ÂÍÈ¿˜ ηډȷ΋˜ ·Ó¿ÚÎÂÈ·˜ Ë ·ÚÈÛÙÂÚ‹ ∫∞ Î·È ÔÈ ÂΉËÏÒÛÂȘ Ù˘ Â›Ó·È Ôȉ‹Ì·Ù· Î·È ‰È·ÙÂٷ̤Ó˜ ÛÊ·Á›Ùȉ˜. ∂ÎÙfi˜ ·fi ÙÔ ÎÏ¿ÛÌ· ÂÍÒıËÛ˘ Ô ÈÔ ·ÎÚÈ‚‹˜ ‰Â›ÎÙ˘ ÂÎÙ›ÌËÛ˘ Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ Â›Ó·È Ô Î·Ú‰È·Îfi˜ ‰Â›ÎÙ˘. ∆È̤˜ <2.5l/min/M2 Â›Ó·È ‰È·ÁÓˆÛÙÈΤ˜ ∫∞.
™˘Ó˘¿Ú¯Ô˘Û˜ ·ı‹ÛÂȘ. ∆ËÓ ∫∞, Û·Ó ÓfiÛÔ ÙˆÓ ËÏÈÎȈ̤ӈÓ, ‰ÂÓ Ú¤ÂÈ Ó· ÙËÓ ‚Ï¤Ô˘Ì ÌÔÓÔÌÂÚÒ˜. √È ÈÔ Û˘¯Ó¤˜ Û˘Ó˘¿Ú¯Ô˘Û˜ ·ı‹ÛÂȘ Â›Ó·È Ë ÓÂÊÚÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· (̤¯ÚÈ 20%), Ë ·Ó·ÈÌ›·, Ë ·Ó·Ó¢ÛÙÈ΋ ·Ó¿ÚÎÂÈ·, ÙÔ Û‡Ó‰ÚÔÌÔ ‡ÓÔ˘ ¿ÓÔÈ·˜, Ë ÌÂÏ·Á¯ÔÏ›· Î·È ÔÈ ÁÓˆÛÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ Ì fiϘ ÙȘ ÁÓˆÛÙ¤˜ Û˘Ó¤ÂȘ
¶ÚfiÁÓˆÛË, ·ӷÓÔÛËÏ›˜. ∏ ÈÔ Û˘¯Ó‹ ·ÈÙ›· ÁÈ· ÓÔÛËÏ›· Â›Ó·È Ë ÌË ·ÓÙÈÚÚÔÔ‡ÌÂÓË ∫∞. OÈ
∂ÈÎfiÓ· 5
55-70
·ÚȘ ·Èٛ˜ ÁÈ· ·ӷÓÔÛËÏ›· Â›Ó·È Ë ÂͤÏÈÍË (Âȉ›ӈÛË) Ù˘ ÓfiÛÔ˘, ·Î·Ù¿ÏÏËÏ· ıÂڷ¢ÙÈο Ï¿Ó·, ÌË Û˘ÌÌfiÚʈÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ Ì ÙË ıÂڷ›· Î·È Ë ¯Ú‹ÛË Ê·ÚÌ¿ÎˆÓ Ô˘ ÙËÓ ÂȉÂÈÓÒÓÔ˘Ó (NSAIDs, ÁÏÈÙ·˙fiÓ˜) ∏ ıÓËÙfiÙËÙ· ÛÙË ∫∞ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔÓ ˘fi ÌÂϤÙË ÏËı˘ÛÌfi. ∆o 4% Âı·›ÓÂÈ ÂÓ‰ÔÓÔÛÔÎÔÌÂȷο. ∆Ô 20% Ô˘ ‚Á·›ÓÂÈ ·fi ÙÔ ÓÔÛÔÎÔÌÂ›Ô Â·ÓÂÈÛ¿ÁÂÙ·È Û 30 Ë̤Ú˜. ŒÓ·˜ ÛËÌ·ÓÙÈÎfi ·ÏÏ¿ fi¯È ηϿ ‰È¢ÎÚÈÓÈṲ̂ÓÔ ÔÛÔÛÙfi ·ÛıÂÓÒÓ (Û ÌÂÚÈΤ˜ ÌÂϤÙ˜ ̤¯ÚÈ 50%) Âı·›ÓÂÈ ·ÈÊÓ›‰È·. ¶ÂÚÈÛÛfiÙÂÚÔÈ ·fi ¤Ó·˜ ÛÙÔ˘˜ ÙÚÂȘ ı· Âı¿ÓÔ˘Ó Ì¤Û· ÛÙÔ˘˜ 6 Ì‹Ó˜ ·fi ÙË ‰È¿ÁÓˆÛË. ™Â ·ÛıÂÓ›˜ Ì ¡YHA IV Ë ıÓËÙfiÙËÙ· ÍÂÂÚÓ¿ÂÈ ÙÔ 50% ÙÔ ÚÒÙÔ ¯ÚfiÓÔ ÌÂÙ¿ ÙË ‰È¿ÁÓˆÛË, ÍÂÂÚÓÒÓÙ·˜ ¤ÙÛÈ Î·È ÙË ıÓËÙfiÙËÙ· ÙˆÓ ÈÔ Û˘ÓËıÈÛÌ¤ÓˆÓ Î·ÎÔËıÂÈÒÓ. ∏ ıÓËÙfiÙËÙ· Û ·ÛıÂÓ›˜ Ì ¤ÌÊÚ·ÁÌ· Ì˘Ôηډ›Ô˘ Ô˘ ÂÈϤÎÂÙ·È Ì ÛÔ‚·Ú‹ ∫∞ ·Ó¤Ú¯ÂÙ·È ÛÙÔ 30% ÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ. O ΛӉ˘ÓÔ˜ Â›Ó·È È‰È·›ÙÂÚ· ˘„ËÏfi˜ ÙÔÓ ÚÒÙÔ Ì‹Ó· ÌÂÙ¿ ÙÔ ¤ÌÊÚ·ÁÌ·, ÂÏ·ÙÙÒÓÂÙ·È Ì¤Û· ÛÙÔ˘˜ ÂfiÌÂÓÔ˘˜ Ì‹Ó˜ ·ÏÏ¿ ·Ú·Ì¤ÓÂÈ ÛËÌ·ÓÙÈÎfi˜ ÁÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 15 ¯ÚfiÓÈ·. ¶·ÚÔÌÔ›ˆ˜ Ë
ATHIROSK 21-
05-03-09
12:25
™ÂÏ›‰·25
£∂ƒ∞¶∂π∞ - º∞ƒª∞∫∞
∂ÈÎfiÓ· 6 ıÓËÙfiÙËÙ· ÛÙÔ Ô͇ Ó¢ÌÔÓÈÎfi Ô›‰ËÌ· Â›Ó·È 12% ÂÓ‰ÔÓÔÛÔÎÔÌÂȷο Î·È 40% ÛÙÔ 1 ¯ÚfiÓÔ
∫·Ú‰È·Î‹ ·Ó¿ÚÎÂÈ· Ì ‰È·ÙËÚË̤ÓÔ ÎÏ¿ÛÌ· ÂÍÒıËÛ˘ (‰È·ÛÙÔÏÈ΋ ∫∞) ™¯Â‰fiÓ ÔÈ ÌÈÛÔ› ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ∫∞ ¤¯ÂÈ ÎÏ¿ÛÌ· ÂÍÒıËÛ˘ ¿Óˆ ÙÔ˘ 50%. ∏ ÏÂÈÔ„ËÊ›· ·˘ÙÒÓ ÙˆÓ ·ÛıÂÓÒÓ Â›Ó·È ËÏÈÎȈ̤Ó˜ Á˘Ó·›Î˜, ·¯‡Û·ÚΘ, Ì ÈÛÙÔÚÈÎfi Û˘ÛÙÔÏÈ΋˜ ˘¤ÚÙ·Û˘ Î·È Ì ˘ÂÚÙÚÔÊ›· ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ ( LVH :116 gr/m2 ¿Ó‰Ú˜, 104 gr /m2 Á˘Ó·›Î˜).
£Âڷ›· √ ·ÎÚÔÁˆÓÈ·›Ô˜ Ï›ıÔ˜ ÛÙË ıÂڷ›· Ù˘ ∫∞ Â›Ó·È Ù· ‰ÈÔ˘ÚËÙÈο ÙË ·Á·Ï˘ (∂ÈÎfiÓ· 7). ∏ ∂ÈÎfiÓ· 8 ·ÚÈÛÙ¿ÓÂÈ Û¯ËÌ·ÙÈο ÙÔ˘˜ ‰È¿ÊÔÚÔ˘˜ ÙÚfiÔ˘˜ ·ÓÙÈÌÂÙÒÈÛ˘ Ù˘ ∫∞. ∏ ÈÔ Û‡Á¯ÚÔÓË ıÂڷ›· Ù˘ ∫∞ ıˆÚÂ›Ù·È Ë ¯Ú‹ÛË ‚-·ÔÎÏÂÈÛÙÒÓ (ηڂ‰ÈÏfiÏË). (µÏ Ù‡¯Ô˜ ·ıËÚÔÛÎÏ‹ÚˆÛË πÔ˘Ó›Ô˘ 2008) √È ·ª∂∞ Ú¤ÂÈ Ó· ·Ú¯›˙Ô˘Ó ÌÂ
∂ÈÎfiÓ· 7
ÌÈÎÚ¤˜ ‰fiÛÂȘ ÙÈÙÏÔÔÈÔ‡ÌÂÓ˜ ÚÔ˜ Ù· ¿Óˆ ‚·ıÌÈ·›·. ™Â ÂÚ›ÙˆÛË ‰˘Û·ÓÂÍ›·˜ ÛÙÔ˘˜ ·ª∂∞ ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ÔÈ ·ÓÙ·ÁˆÓÈÛÙ¤˜ Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘. ™Â ˘ÔÔÁηÈÌÈÎÔ‡˜ ·ÛıÂÓ›˜ (fiˆ˜ ÔÈ ˘ÂÚ‰ÈÔ˘ÚË̤ÓÔÈ) ÌÔÚ› Ó· ÚÔηϤÛÔ˘Ó ÔÚıÔÛÙ·ÙÈ΋ ˘fiÙ·ÛË. ∏ ‰·ÎÙÈÏ›Ùȉ· ÌÂÈÒÓÂÈ ÙȘ ·ӷÓÔÛËÏ›˜ Î·È ¤¯ÂÈ Û›ÁÔ˘ÚË ¤Ó‰ÂÈÍË ·Ó Û˘Ó˘¿Ú¯ÂÈ ÎÔÏÈ΋ Ì·ÚÌ·Ú˘Á‹. ™ËÌ·ÓÙÈ΋ ‚Ô‹ıÂÈ· ÚÔÛʤÚÔ˘Ó Î·È Ù· ÓÈÙÚÒ‰Ë Û ÂÈÌÔÓ‹ Û˘Ìو̿وÓ. ™Â ·ÓıÂÎÙÈΤ˜ ÂÚÈÙÒÛÂȘ ∫∞ ·Ú¿ ÙËÓ Ï‹ÚË ·ÁˆÁ‹ Ì ¢ڤ· QRS (>120 msecs) fiˆ˜ Ô ·ÔÎÏÂÈÛÌfi˜ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÛΤÏÔ˘˜, ›Ûˆ˜ ¯ÚÂÈ·ÛıÔ‡Ó ÈÔ ÚÔ¯ˆÚË̤Ó˜ ÌÔÚʤ˜ ·ÓÙÈÌÂÙÒÈÛ˘ fiˆ˜ ·ÌÊÈÎÔÈÏȷ΋ ‚ËÌ·ÙÔ‰fiÙËÛË, ÂÌʇÙ¢ÛË ·˘ÙfiÌ·ÙÔ˘ ·ÈÓȉˆÙ‹ ‹ ˘Ô‚ÔËıËÙÈΤ˜ Û˘Û΢¤˜ (Û¯‹Ì· 5) Î·È Ù¤ÏÔ˜ Ë ÌÂÙ·ÌfiÛ¯Â˘ÛË. ∂ÚˆÙ‹ÛÂȘ ÁÈ· ÙË ÏÂÈÙÔ˘ÚÁÈ΋ ÈηÓfiÙËÙ· (·Ó ¢¯·ÚÈÛÙÈ¤Ù·È ÙËÓ ·Ó·ÓÔ‹, fiÛ· Ì·ÍÈÏ¿ÚÈ· ¯ÚËÛÈÌÔÔÈ› ÛÙÔ ‡ÓÔ) Î·È ·Ú·ÎÔÏÔ‡-
ıËÛË ÙÔ˘ ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜ Â›Ó·È ‚·ÛÈΤ˜ ∏ Ú·Á‰·›· ·‡ÍËÛË ÙÔ˘ ÂÈÔÏ·ÛÌÔ‡ Ù˘ ∫∞ ·ÔÙÂÏ› ÙÔ ÈÔ ÛËÌ·ÓÙÈÎfi ‰ËÌfiÛÈÔ Úfi‚ÏËÌ· ˘Á›·˜ ÛÙË Î·Ú‰È·ÁÁÂȷ΋ π·ÙÚÈ΋. √È Î‡ÚȘ ·Èٛ˜ ÁÈ· ·˘Ù‹ ÙË ¤ÎÚËÍË Â›Ó·È Ô Û˘Ó‰˘·ÛÌfi˜ ÙÔ˘ ÁËÚ·Ṳ̂ÓÔ˘ ÏËı˘ÛÌÔ‡ Î·È Ù˘ ·˘ÍË̤Ó˘ ÂÈ‚›ˆÛ˘ ÌÂÙ¿ ÙÔ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘. ∂›Ó·È Ê·ÓÂÚfi fiÙÈ Ë Ì›ˆÛË Ù˘ ÌÔÚ› Ó· ÂÈÙ¢¯ı› ÌfiÓÔ Ì ÚfiÏË„Ë Î˘Ú›ˆ˜ Ù˘ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ ‰ËÏ Ù˘ ·ıËÚÔÛÎÏ‹ÚˆÛ˘ οÙÈ ÂÍ¿ÏÏÔ˘ Ô˘ ÙÔ ·Ó¤ÊÂÚ 70 ¯ÚfiÓÈ· ÚÈÓ Ô Sir Thomas Lewis: “∆he very essence of cardiovascular practice is the early detection of heart failure”.
√Í›· ηډȷ΋ ·Ó¿ÚÎÂÈ· √Í›· ·ÔÚ‡ıÌÈÛË Ã∫∞ (70%) ÀÂÚÙ·ÛÈ΋ √∫∞ √͇ Ó¢ÌÔÓÈÎfi Ô›‰ËÌ· (√¶√) ∫·Ù·ÏËÍ›· ¢ÂÍÈ¿ ∫∞ ∂Ó‰ÔÓÔÛÔÎÔÌÂȷ΋ ıÓËÙfiÙËÙ· 47% 27% ÚÒÙÔ ¤ÙÔ˜ 24% ·ÓÂÈÛ·ÁˆÁ¤˜ ÙÔ 1 ÙÚ›ÌËÓÔ ∏ ÔÍ›· ·ÔÚÚ‡ıÌÈÛË Ù˘ ¯ÚfiÓÈ·˜ ∫∞ ·ÔÙÂÏ› ÙË ÈÔ Û˘¯Ó‹ ÌÔÚÊ‹ Ù˘ ÔÍ›·˜ ηډȷ΋˜ ·Ó¿ÚÎÂÈ·˜. √È ‚·ÛÈÎÔ› ÛÙfi¯ÔÈ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË Â›Ó·È Ë ¿ÌÂÛË ·Ó·ÎÔ‡ÊÈÛË ·fi Ù· Û˘ÌÙÒÌ·Ù·, Ë ÛÙ·ıÂÚÔÔ›ËÛË ÙˆÓ ·ÛıÂÓÒÓ Î·È Ë ¤Ó·ÚÍË ıÂڷ›·˜ Ô˘ ‚ÂÏÙÈÒÓÂÈ ÙËÓ ÂÈ‚›ˆÛË Î·È ÙËÓ ÚfiÁÓˆÛË ÙˆÓ ·ÛıÂÓÒÓ. ∏ ÔÍ›· ∫∞ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ˘„ËÏ‹ ıÓËÙfiÙËÙ·, ÙfiÛÔ Î·Ù¿ ÙË ÓÔÛËÏ›· (3-7%) fiÛÔ Î·È ÙÔ˘˜ ÂfiÌÂÓÔ˘˜ 2-3 Ì‹Ó˜ (1016%), ηıÒ˜ Î·È ˘„ËÏ‹ Û˘¯ÓfiÙËÙ· ·ÓÂÈÛ·ÁˆÁÒÓ Ô˘ ÊÙ¿ÓÂÈ ÙÔ 25% ηٿ ÙÔ ÚÒÙÔ ÙÚ›ÌËÓÔ
∂ÈÎfiÓ· 8
25
ATHIROSK 21-
05-03-09
12:25
ª ∞ ƒ ∆ π √ ™
™ÂÏ›‰·26
2 0 0 9
ÕÛÎËÛË Î·È ∫·Ú‰È¿ ÃÚÈÛÙ›Ó· ÃÚ˘ÛÔ¯fiÔ˘, ÃÚ‹ÛÙÔ˜ ¶›ÙÛ·‚Ô˜, ÃÚÈÛÙfi‰Ô˘ÏÔ˜ ™ÙÂÊ·Ó¿‰Ë˜ ∞’ ¶·ÓÂÈÛÙËÌȷ΋˜ ∫·Ú‰ÈÔÏÔÁÈ΋˜ ∫ÏÈÓÈ΋˜, π°¡∞ ¶ÔÏϤ˜ ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ·Ó·‰Â›ÍÂÈ ÙÔÓ Â˘ÂÚÁÂÙÈÎfi ÚfiÏÔ Ù˘ ¿ÛÎËÛ˘ ÛÙËÓ ÚˆÙÔÁÂÓ‹ Î·È ‰Â˘ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ [1,2]. ∞Ó¿ÌÂÛ· Û ¿ÏÏÔ˘˜ ‰Â›ÎÙ˜ ¿ÛÎËÛ˘ Ë ·ÓÔ¯‹ ÛÙËÓ ¿ÛÎËÛË ¤¯ÂÈ ·Ó·ÁÓˆÚÈÛÙ› ˆ˜ Ô ÈÔ ÈÛ¯˘Úfi˜ ÚÔÁÓˆÛÙÈÎfi˜ ‰Â›ÎÙ˘ ıÓËÙfiÙËÙ·˜ ÌÂٷ͇ ¿ÏÏˆÓ Î·ıÈÂÚˆÌ¤ÓˆÓ ·Ú·ÁfiÓÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ [3]. π‰È·›ÙÂÚ·, ÈηÓfiÙËÙ· ¿ÛÎËÛ˘ ¿Óˆ ÙˆÓ 10 ª∂∆s ¯·Ú·ÎÙËÚ›˙ÂÈ Ù· ¿ÙÔÌ· Ì ηϋ ÂÈ‚›ˆÛË Û ۇÁÎÚÈÛË Ì ÌÈÎÚfiÙÂÚË ÙˆÓ 5ª∂∆s, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ˘ÔΛÌÂÓË Î·Ú‰È·ÁÁÂȷ΋ ÓfiÛÔ, ÂÓÒ ·‡ÍËÛË Î·Ù¿ 1 ª∂∆ ÛÙËÓ ÈηÓfiÙËÙ· ¿ÛÎËÛ˘ Ô‰ËÁ› Û 8-17% Ì›ˆÛË Ù˘ ıÓËÙfiÙËÙ·˜ [4]. ∏ Û˘ÛÙËÌ·ÙÈ΋ ¿ÛÎËÛË ·ÎfiÌ· Î·È Û ¿ÙÔÌ· Ì ‰Â‰Ô̤ÓÔ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ, Ô‰ËÁ› Û Ì›ˆÛË Î·Ù¿ 50% Ù˘ ηډȷÁÁÂȷ΋˜ ıÓËÙfiÙËÙ·˜, ÂÓÒ Ë ‰È¿ÚÎÂÈ· Ù˘ ¿ÛÎËÛ˘ Ô˘ Û¯ÂÙ›ÛÙËΠ̛̠ˆÛË Ù˘ ıÓËÙfiÙËÙ·˜ ‹Ù·Ó 4 Ì 5 ÊÔÚ¤˜ ‚‰ÔÌ·‰È·›ˆ˜ ‰È¿ÚÎÂÈ·˜ 30 ÏÂÙÒÓ, ‰ËÏ·‰‹ Û˘ÓÔÏÈο 130 Ì 138 ÏÂÙ¿ ¿ÛÎËÛ˘ ÙËÓ Â‚‰ÔÌ¿‰· [5]. ™ÙÔÓ ∂ÏÏËÓÈÎfi ÏËı˘ÛÌfi, Ë ÌÂϤÙË CARDIO 2000 ¤‰ÂÈÍ fiÙÈ Ë Û˘ÛÙËÌ·ÙÈ΋ ¿ÛÎËÛË ÁÈ· ÌÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ ÊÔÚ¿ ÙËÓ Â‚‰ÔÌ¿‰· Î·È ÁÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ ÌÈ· ÒÚ· Ô‰ËÁ› Û Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂΉ‹ÏˆÛ˘ ÔͤԘ ÛÙÂÊ·ÓÈ·›Ô˘ Û˘Ó‰ÚfiÌÔ˘ ηٿ 10% [6]. ∏ ÌÂϤÙË ÙˆÓ ∂Ù¿ ÈÚÒÓ ÛÙ· ·Ú¯¤˜ Ù˘ ‰ÂηÂٛ˜ ÙÔ˘ 1960 ·Ó¤‰ÂÈÍ ·Ó¿ÌÂÛ· ÛÙÔ˘˜ ÚÔÁÓˆÛÙÈÎÔ‡˜ ‰Â›ÎÙ˜ ÁÈ· ·˘ÍË̤ÓË ÔÏÈ΋ ıÓËÙfiÙËÙ· ÛÙ· 40 ¤ÙË ·Ú·ÎÔÏÔ‡ıËÛ˘ ÙÔ˘ ∂ÏÏËÓÈÎÔ‡ ˘ÔÏËı˘ÛÌÔ‡, ÙËÓ ¤ÏÏÂÈ„Ë Ê˘ÛÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ [7]. ¢˘ÛÙ˘¯Ò˜ Ù· ›‰· ηıÈÛÙÈ΋˜ ˙ˆ‹˜ Û‹ÌÂÚ· Ê·›ÓÂÙ·È Ó· Â›Ó·È ˘„ËÏ¿ ÛÙÔÓ ∂ÏÏËÓÈÎfi ÏËı˘ÛÌfi, Ù˘ Ù¿Í˘ ÙÔ˘ 58% [8]. º˘ÛÈÔÏÔÁÈΤ˜ ÂȉڿÛÂȘ Ù˘ ¿ÛÎËÛ˘ ÛÙËÓ Î·Ú‰È¿ ∏ ¿ÛÎËÛË ·˘Í¿ÓÂÈ ÙȘ ·Ó¿ÁΘ ÙÔ˘ ÛÒÌ·ÙÔ˜ Û Ô͢ÁfiÓÔ. ∏ ÈηÓÔÔ›ËÛË ÙˆÓ ·Ó·ÁÎÒÓ ·˘ÙÒÓ ÂÈÙ˘Á¯¿ÓÂÙ·È Ì¤Ûˆ ñ ∞‡ÍËÛ˘ Ù˘ ∫·Ú‰È·Î‹˜ ¶·ÚÔ¯‹˜ (fiÁÎÔ˘ ·ÏÌÔ‡ Î·È Î·Ú‰È·Î‹˜ Û˘¯ÓfiÙËÙ·˜) ñ ∞‡ÍËÛ˘ Ù˘ ·ÚÙËÚÈÔÊÏ‚È΋˜
26
‰È·ÊÔÚ¿˜ Ô͢ÁfiÓÔ˘ Î·È ñ ∞ӷηٷÓÔÌ‹˜ Ù˘ ÚÔ‹˜ ÙÔ˘ ·›Ì·ÙÔ˜ ·fi ÏÈÁfiÙÂÚÔ ÂÓÂÚÁÔ‡˜ ÌÂÙ·‚ÔÏÈο ÈÛÙÔ‡˜ ÛÙÔ˘˜ ·ÛÎÔ‡ÌÂÓÔ˘˜ ̇˜. π‰È·›ÙÂÚ· Ë ÈÛÔÙÔÓÈ΋ ¿ÛÎËÛË ÂÈʤÚÂÈ ñ ∞‡ÍËÛË Ù˘ ηډȷ΋˜ Û˘¯ÓfiÙËÙ·˜, Ù˘ Û˘Û·ÛÙÈÎfiÙËÙ·˜ Î·È Ù˘ ηډȷ΋˜ ·ÚÔ¯‹˜. (ÏfiÁˆ ·fiÛ˘ÚÛ˘ ÙÔ˘ ·Ú·Û˘Ì·ıËÙÈÎÔ‡ Î·È ‰È¤ÁÂÚÛ˘ ÙÔ˘ Û˘Ì·ıËÙÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ·‡ÍËÛ˘ Ù˘ ÊÏ‚È΋˜ ÂÈÛÙÚÔÊ‹˜- ÂÓÂÚÁÔÔ›ËÛ˘ ÙÔ˘ ·ÓÙ·Ó·ÎÏ·ÛÙÈÎÔ‡ Bainbridge - ¯ÚËÛÈÌÔÔ›ËÛ˘ ÙÔ˘ Ì˯·ÓÈÛÌÔ‡ ÙÔ˘ Starling Î·È Bowditch staircase Ê·ÈÓÔ̤ÓÔ˘ fiÔ˘ Ë ·‡ÍËÛË Ù˘ ηډȷ΋˜ Û˘¯ÓfiÙËÙ·˜ ÂÈʤÚÂÈ ÂÚ·ÈÙ¤Úˆ ÂÈÙ¿¯˘ÓÛË ÙÔ˘ ηډȷÎÔ‡ Ú˘ıÌÔ‡) ñ ªÂ›ˆÛË ÂÚÈÊÂÚÈÎÒÓ ·ÓÙÈÛÙ¿ÛÂˆÓ ñ ∞‡ÍËÛË Ù˘ ›ÂÛ˘ ÛÊ˘ÁÌÔ‡ ñ ∞‡ÍËÛË ÛÏ·¯ÓÈ΋˜ ·ÁÁÂÈÔÛ‡Û·Û˘ ™ÙË ÛÙ·ÙÈ΋ ‹ ÈÛÔÌÂÙÚÈ΋ ¿ÛÎËÛË ·Ú·ÙËÚÂ›Ù·È ñ ∞‡ÍËÛË Û˘ÛÙÔÏÈ΋˜ Î·È ‰È·ÛÙÔÏÈ΋˜ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ñ ªÈÎÚ‹ ·‡ÍËÛË Î·Ú‰È·Î‹˜ Û˘¯ÓfiÙËÙ·˜ ñ √ fiÁÎÔ˜ ·ÏÌÔ‡ ·Ú·Ì¤ÓÂÈ ·ÌÂÙ¿‚ÏËÙÔ˜ ·ÏÏ¿ ·Ú·ÙËÚÂ›Ù·È ÌÈÎÚ‹ ·‡ÍËÛË Ù˘ ηډȷ΋˜ ·ÚÔ¯‹˜ ñ √È ÂÚÈÊÂÚÈΤ˜ ·ÓÙÈÛÙ¿ÛÂȘ ·˘Í¿ÓÔÓÙ·È ·Ó·ÏfiÁˆ˜ ¤ÚÁÔ˘ [9] ∏ Û˘ÛÙËÌ·ÙÈ΋ ¿ÛÎËÛË ‚ÂÏÙÈÒÓÂÈ ÙË Ì˘Ôηډȷ΋ ÏÂÈÙÔ˘ÚÁ›·, ·˘Í¿ÓÔÓÙ·˜ ÙË Ì¤ÁÈÛÙË Î·Ù·Ó¿ÏˆÛË Ô͢ÁfiÓÔ˘ Î·È ÙȘ ‰È·ÛÙ¿ÛÂȘ ÙˆÓ Ì˘ÔηډȷÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ‚ÂÏÙÈÒÓÔÓÙ·˜ ÙË Û˘Û·ÛÙÈÎfiÙËÙ· Î·È ÙË ‰È·¯Â›ÚÈÛË ÙÔ˘ Ì˘ÔηډȷÎÔ‡ ·Û‚ÂÛÙ›Ô˘. ™Â ÂÈÚ·Ì·ÙÈο ÌÔÓ٤Ϸ Ë ÂÈÌ‹Î˘ÓÛË ÙˆÓ Ì˘ÔηډȷÎÒÓ ÈÓÒÓ Ô˘ ·Ú·ÙËÚÂ›Ù·È Â›Ó·È Ù˘ Ù¿Í˘ ÙˆÓ 20-22%, ÂÓÒ Ë ·‡ÍËÛË ÙÔ˘ fiÁÎÔ˘ ÙÔ˘˜ Â›Ó·È Î·Ù¿ 46%. º·›ÓÂÙ·È fiÙÈ Ë ‰È·ÎÔ‹ Ù˘ ¿ÛÎËÛ˘ Ô‰ËÁ› Û ˘ÔÛÙÚÔÊ‹ ÙˆÓ ·Ú·¿Óˆ ·Ó·ÊÂÚfiÌÂÓˆÓ Î˘ÙÙ·ÚÈÎÒÓ ÂȉڿÛÂˆÓ Ì¤Û· Û ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÙÂÛÛ¿ÚˆÓ Â‚‰ÔÌ¿‰ˆÓ [10].
ÕÛÎËÛË Î·È ·ÚÙËÚȷ΋ ›ÂÛË ∏ Û˘ÛÙËÌ·ÙÈ΋ ·ÂÚfi‚ÈÔ˜ ¿ÛÎËÛË ÁÈ· 3 Ì‹Ó˜ ÌÂÈÒÓÂÈ Ù· ›‰· ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ηٿ 8-10 mmHg ÁÈ· ÙË Û˘ÛÙÔÏÈ΋ Î·È 7-8 mmHg ÁÈ· ÙË ‰È·ÛÙÔÏÈ΋ ∞¶. ∂›Û˘ ‚ÂÏÙÈÒÓÂÈ ÙËÓ ˘¤ÚÌÂÙÚË ÈÓfiÙÚÔÔ ·¿ÓÙËÛË ÛÙËÓ ÎfiˆÛË Ì¤Ûˆ Ì›ˆÛ˘ ÙˆÓ ÂÚÈÊÂÚÈÎÒÓ ·ÓÙÈÛÙ¿ÛˆÓ, Ì›ˆÛ˘ Ù˘ Û˘Ì·ıËÙÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Î·È ÙˆÓ ÂȤ‰ˆÓ ÓÔÚ·‰ÚÂÓ·Ï›Ó˘ Î·È ·‡ÍËÛË Ù˘ ηډȷ΋˜ ·ÚÔ¯‹˜. ∏ ̤ÙÚÈ·˜ ¤ÓÙ·Û˘ ¿ÛÎËÛË, ‰È¿ÚÎÂÈ·˜ ÙÔ˘Ï¿¯ÈÛÙÔÓ 16 ‚‰ÔÌ¿‰ˆÓ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û Ì›ˆÛË Ù˘ ˘ÂÚÙÚÔÊ›·˜ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ [11, 12]. ∏ ÌÂϤÙË TOMHS ¤‰ÂÈÍ ‚ÂÏÙ›ˆÛË Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜ Û ˘ÂÚÙ·ÛÈο ¿ÙÔÌ· ·fi ÙËÓ ˘ÈÔı¤ÙËÛË Ê˘ÛÈ΋ ¿ÛÎËÛ˘ ·Ú¿ÏÏËÏ· Ì ÙË ¯ÔÚËÁÔ‡ÌÂÓË Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹, Ô˘ Ô‰‹ÁËÛÂ Î·È Û ηχÙÂÚË Ú‡ıÌÈÛË Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ Î·È Ì Ì›ˆÛË Ù˘ ·ÁˆÁ‹˜ [13, 14]. ∞ÎfiÌ· Î·È Ë ¿ÛÎËÛË ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ Ô‰ËÁ› Û Ì›ˆÛË Ù˘ ‰È·ÛÙÔÏÈ΋˜ ·ÚÙËÚȷ΋˜ ›ÂÛ˘, Ì›ˆÛË ÙˆÓ ÔÏÈÎÒÓ ÂÚÈÊÂÚÈÎÒÓ ·ÓÙÈÛÙ¿ÛˆÓ, ·‡ÍËÛË Ù˘ ηډȷ΋˜ ·ÚÔ¯‹˜ Î·È ÚfiÎÏËÛË ·ÁÁÂÈԉȷÛÙÔÏ‹˜ ÛÙ· ¿Óˆ ¿ÎÚ·. ∞˘Ùfi Ê·›ÓÂÙ·È fiÙÈ ˘Ô‰ËÏÒÓÂÈ ÁÂÓÈÎÂ˘Ì¤ÓË ·ÁÁÂÈԉȷÛÙ·ÏÙÈ΋ ›‰Ú·ÛË, ΢ڛˆ˜ ÌÂÙ¿ ·fi ÂÓÙ·ÙÈ΋ ¿ÛÎËÛË. ŸÙ·Ó ·ÛÎÔ‡ÓÙ·È Ù· οو ¿ÎÚ· ÚÔηÏÂ›Ù·È ÁÚ‹ÁÔÚË Ì›ˆÛË Ù˘ Ì˘˚΋˜ ÚÔ‹˜ ÛÙÔ ·ÓÙÈ‚Ú¿¯ÈÔ, Ô˘ ·Ì¤Ûˆ˜ ÂϤÁ¯ÂÙ·È ·fi ·‡ÍËÛË ÙÔ˘ ·‰ÚÂÓÂÚÁÈÎÔ‡ ·ÁÁÂÈÔÛ˘ÛÙ·ÏÙÈÎÔ‡ ÙfiÓÔ˘. ∫·ıÒ˜ Ë ¿ÛÎËÛË Û˘Ó¯›˙ÂÙ·È ·˘Í¿ÓÂÈ Û˘Ó¯Ҙ Ë ·ÈÌ·ÙÈ΋ ÚÔ‹ ÛÙÔ ·ÓÙÈ‚Ú¿¯ÈÔ Ô˘ ·Ú·Ì¤ÓÂÈ Î·È ÌÂÙ¿ ÙË ‰È·ÎÔ‹ Ù˘ ¿ÛÎËÛ˘. √È ÌÂÙ·‚ÔϤ˜ ·˘Ù¤˜ Ê·›ÓÂÙ·È Ó· ·Ú·Ì¤ÓÔ˘Ó ÁÈ· ÌÂÙ¿ ·fi 1 ÒÚ· ·fi ÙË ‰È·ÎÔ‹ Ù˘ ¿ÛÎËÛ˘ Î·È ÂÍ·ÚÙÒÓÙ·È ·fi ÙÔ ÊÔÚÙ›Ô Ù˘ ¿ÛÎËÛ˘ ηıÒ˜ ¤¯Ô˘Ó ·Ú·ÙËÚËı› Û ˘ÂÚÙ·ÛÈο ¿ÙÔÌ· Ô˘ ·ÛÎÔ‡ÓÙ·È ÛÙÔ 70% Ù˘ ̤ÁÈÛÙ˘ ηٷӿψÛ˘ Ô͢ÁfiÓÔ˘, ·ÏÏ¿ ‰ÂÓ ¤¯Ô˘Ó ·Ú·ÙËÚËı› Û ¿ÛÎËÛË ÛÙÔ 50% Ù˘ ÌÂÁ›ÛÙ˘ ηٷӿψÛ˘ Ô͢ÁfiÓÔ˘ [15]. ∞fi ÙË ÌÂϤÙË ÛÙÔÓ ∂ÏÏËÓÈÎfi ÏËı˘ÛÌfi Ê·›ÓÂÙ·È fiÙÈ ·ÎfiÌ· ηÈ
ATHIROSK 21-
05-03-09
12:25
™ÂÏ›‰·27
À°π∂π¡√¢π∞π∆∏∆π∫∏ ∞°ø°∏ ÂÏ·ÊÚ¿ ¤ˆ˜ ̤ÙÚÈ· Ê˘ÛÈ΋ ¿ÛÎËÛË Ô‰ËÁ› Û Ì›ˆÛË Î·Ù¿ 12% ÙÔ˘ ÛÙÂÊ·ÓÈ·›Ô˘ ÎÈÓ‰‡ÓÔ˘ Û ˘ÂÚÙ·ÛÈο ¿ÙÔÌ· Ì ڢıÌÈṲ̂ӷ ›‰· ·ÚÙËÚȷ΋˜ ›ÂÛ˘, 5% Û ÌË Î·ÏÒ˜ Ú˘ıÌÈṲ̂ÓÔ˘˜ ˘ÂÚÙ·ÛÈÎÔ‡˜ Î·È 9% Û ¿ÙÔÌ· Ô˘ ‰ÂÓ Ï·Ì‚¿ÓÔ˘Ó Î·Ì›· ·ÁˆÁ‹ ÁÈ· ÙËÓ ·ÚÙËÚȷ΋ ›ÂÛË [16]. ∂ÓÒ Ô Û˘Ó‰˘·ÛÌfi˜ ¿ÛÎËÛ˘ Î·È ÌÂÛÔÁÂÈ·ÎÔ‡ Ù‡Ô˘ ‰È·ÙÚÔÊ‹ Ô‰ËÁ› Û 25% Ì›ˆÛË ÙÔ˘ ÛÙÂÊ·ÓÈ·›Ô˘ ÎÈÓ‰‡ÓÔ˘ Û ˘ÂÚÙ·ÛÈÎÔ‡˜ Ô˘ ¤¯Ô˘Ó Ú˘ıÌ›ÛÂÈ Ù· ›‰· ·ÚÙËÚȷ΋˜ ›ÂÛ˘, 11% Ì›ˆÛË ÙÔ˘ ÛÙÂÊ·ÓÈ·›Ô˘ ÎÈÓ‰‡ÓÔ˘ Û Ì ıÂڷ¢fiÌÂÓÔ˘˜, Î·È 17% Ì›ˆÛË Û ÌË ÂÏÂÁ¯fiÌÂÓÔ˘˜ ˘ÂÚÙ·ÛÈÎÔ‡˜ [17]. ŸÛÔ ·ÊÔÚ¿ ÙË ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ·ÚÙËÚÈÒÓ Ë Û˘ÛÙËÌ·ÙÈ΋ ·ÂÚfi‚ÈÔ˜ ¿ÛÎËÛË ÌÔÚ› Ó· ÂÈ‚Ú·‰‡ÓÂÈ Î·È ÌÂÚÈÎÒ˜ Ó· ·ÔηٷÛÙ‹ÛÂÈ ÙË Ì›ˆÛË Ù˘ ÂÓ‰ÔÙÈÎfiÙËÙ·˜ ÙˆÓ ·ÚÙËÚÈÒÓ Ô˘ ÚÔηÏÂ›Ù·È Ì ÙË ¿ÚÔ‰Ô Ù˘ ËÏÈΛ·˜ [18]. ∂ÓÒ ·ÎfiÌ· Î·È Ë ÈÛÔÌÂÙÚÈ΋ ¿ÛÎËÛË ¤¯ÂÈ Â˘ÂÚÁÂÙÈÎfi ÚfiÏÔ ÛÙË Ú‡ıÌÈÛË Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ηıÒ˜ ‚Ú·¯Â›˜ Û˘Ó‰ڛ˜ ÈÛÔÌÂÙÚÈ΋˜ ÚÔfiÓËÛ˘ Ê·›ÓÂÙ·È Ó· ÙÚÔÔÔÈÔ‡Ó ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ·˘ÙfiÓÔÌÔ˘ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, Ô‰ËÁÒÓÙ·˜ Û Ì›ˆÛË Ù˘ ηډȷ΋˜ Û˘¯ÓfiÙËÙ·˜ ËÚÂÌ›·˜, ·‡ÍËÛË Ù˘ ÌÂÙ·‚ÏËÙfiÙËÙ·˜ Ù˘ Î·È Ì›ˆÛË Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ Û ËÏÈÎȈ̤ӷ ¿ÙÔÌ· [19]. °È ·˘ÙÔ‡˜ ÙÔ˘˜ ÏfiÁÔ˘˜ Ë ∞ÌÂÚÈηÓÈ΋ ∫·Ú‰ÈÔÏÔÁÈ΋ ∂Ù·ÈÚ›· Û˘ÓÈÛÙ¿ ÛÙȘ ÙÂÏÂ˘Ù·›Â˜ ηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ ÁÈ· ÙË Ú‡ıÌÈÛË Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ Û˘ÛÙËÌ·ÙÈ΋ ¿ÛÎËÛË 7 ÊÔÚ¤˜ ‹ ÙÔ˘Ï¿¯ÈÛÙÔÓ 150 ÏÂÙ¿ ÙËÓ Â‚‰ÔÌ¿‰· [20]. ∏ ¯Ú‹ÛË ÙˆÓ ‚-·ÔÎÏÂÈÛÙÒÓ ÂËÚ¿˙ÂÈ ÙËÓ ·ÓÔ¯‹ ÛÙËÓ ÎfiˆÛË; ∏ ›‰Ú·ÛË Ù˘ ·ÓÙÈ-Ù·¯˘Î·Ú‰È·Î‹˜ ‰Ú¿Û˘ ÙˆÓ Ì·ÎÚ¿˜ ‰Ú¿Ûˆ˜ ‚-·ÔÎÏÂÈÛÙÒÓ Â›Ó·È ¤ÓÙÔÓË Ì›· ÒÚ· ÌÂÙ¿ ÙË Ï‹„Ë, ÂÓÒ ·Ú·Ì¤ÓÂÈ ÁÈ· ̤ÁÈÛÙÔ 2 Ì 4 ÒÚ˜ ÌÂÙ¿. ∞ÓÙ›ıÂÙ· Ë ·ÓÙÈ˘ÂÚÙ·ÛÈ΋ ‰Ú·ÛË Î·È o ‚-·ÔÎÏÂÈÛÌfi˜ ·Ú·Ì¤ÓÔ˘Ó ÁÈ· fiÏÔ ÙÔ 24ˆÚÔ [21, 22]. ŒÙÛÈ Ë ¯Ú‹ÛË ÎÏÈÓÈÎÒÓ ‰fiÛˆ˜ ÙˆÓ ‚·ÔÎÏÂÈÛÙÒÓ ‰ÂÓ ·ÔÎÏ›ÂÈ ÙË ‰Ú¿ÛË ÙÔ˘ Û˘Ì·ıËÙÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ηٿ ÙËÓ ¿ÛÎËÛË, ÏfiÁˆ Ù˘ ‡·Ú͢ ÌÈÎÚÔ‡ ÔÛÔÛÙÔ‡ · ˘Ô‰Ô¯¤ˆÓ ÛÙÔ Ì˘ÔοډÈÔ Ô˘ ÂÓÂÚÁÔÔÈÔ‡ÓÙ·È Î·È ·˘Í¿ÓÔ˘Ó ÙË Û˘Û·ÛÙÈÎfiÙËÙ· ̤ۈ ·‡ÍËÛ˘ ÂÓ‰Ô΢ÙÙ¿ÚÈÔ˘ ·Û‚ÂÛÙ›Ô˘. ∂›Û˘ Ì ÙËÓ ¿ÛÎËÛË ·˘Í¿ÓÔ˘Ó ÔÈ ÌË ·‰ÚÂÓÂÚÁÈΤ˜ ÔÚÌfiÓ˜, fiˆ˜ ÙÔ ÁÏԢηÁfiÓÔ Î·È Ë
·ÁÁÂÈÔÙÂÓÛ›ÓË ππ Ô˘ ÚÔ¿ÁÔ˘Ó ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘ Û˘Ì·ıËÙÈÎÔ‡ [22]. ™Â ÌÂϤÙË Ô˘ Û˘ÌÂÚȤϷ‚ 2.318 ˘ÂÚÙ·ÛÈÎÔ‡˜ ¿Ó‰Ú˜ Ë Ï‹„Ë ‚-·ÔÎÏÂÈÛÙÒÓ ¤‰ÂÈÍ ӷ ÚÔηÏ› 68% ÌÈÎÚfiÙÂÚË Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ˘ÂÚÙ·ÛÈ΋˜ ·¿ÓÙËÛ˘ ÛÙËÓ ÎfiˆÛË, ÂÓÒ Ù· ›‰· ·ÚÙËÚȷ΋˜ ›ÂÛ˘ Î·È Î·Ú‰È·Î‹˜ Û˘¯ÓfiÙËÙ·˜ ‹Ù·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚ· Û fiÏ· Ù· ÛÙ¿‰È·. ∏ ›‰Ú·ÛË ·˘Ù‹ ‹Ù·Ó ÛËÌ·ÓÙÈÎfiÙÂÚË ÛÙÔ˘˜ η˘Î¿ÛÈÔ˘˜ [23]. ÕÛÎËÛË Î·È ÂÓ‰ÔıËÏȷ΋ ÏÂÈÙÔ˘ÚÁ›· ∏ Û˘ÛÙËÌ·ÙÈ΋ ¿ÛÎËÛË ¤¯ÂÈ ÌÈÎÚ‹ ›‰Ú·ÛË ÛÙËÓ ÂÓ‰ÔıËÏȷ΋ ÏÂÈÙÔ˘ÚÁ›· ÛÂ Ê˘ÛÈÔÏÔÁÈο ¿ÙÔÌ·, ·ÏÏ¿ ÚÔηÏ› ÛËÌ·ÓÙÈ΋ ‚ÂÏÙ›ˆÛË Û ·ÛıÂÓ›˜ Ì ÂËÚ·Ṳ̂ÓË ÂÓ‰ÔıËÏȷ΋ ÏÂÈÙÔ˘ÚÁ›·, fiˆ˜ ¤¯ÂÈ ‰Âȯı› Ì ÂÁ¯‡ÛÂȘ ·ÎÂÙ˘ÏÔ¯ÔÏ›Ó˘. ŒÙÛÈ Ë Û˘ÛÙËÌ·ÙÈ΋ ·ÂÚfi‚ÈÔ˜ ¿ÛÎËÛË, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙÈ̤˜ ¯ÔÏËÛÙÂÚfiÏ˘, ‰ÂÓ ‚ÂÏÙÈÒÓÂÈ ÙËÓ ÂÓ‰ÔıËÏÈÔÂÍ·ÚÙÒÌÂÓË ·ÁÁÂÈԉȷÛÙÔÏ‹ Û ӤԢ˜ ˘ÁÈ›˜ ÂÓ‹ÏÈΘ, ·ÏÏ¿ ÌÔÚ› Ó· ¤¯ÂÈ Â˘ÂÚÁÂÙÈÎfi ÚfiÏÔ Û ӤԢ˜ Ì ÂËÚ·Ṳ̂ÓË ÂÓ‰ÔıËÏȷ΋ ÏÂÈÙÔ˘ÚÁ›·, fiˆ˜ ·ÚÔ˘Û›· ·ÚÙËÚȷ΋˜ ˘¤ÚÙ·Û˘ [24, 25]. ™ÙÔ˘˜ ¿Ó‰Ú˜, Ë ÂÓ‰ÔıËÏÈÔÂÍ·ÚÙÒÌÂË ·ÁÁÂÈԉȷÛÙÔÏ‹, fiˆ˜ ¤¯ÂÈ ÌÂÏÂÙËı› ÛÙË ‚Ú·¯ÈfiÓÈÔ ·ÚÙËÚ›· Î·È ÛÙȘ ÛÙÂÊ·ÓÈ·›Â˜ ·ÚÙËڛ˜, ÌÂÈÒÓÂÙ·È ÚÔԉ¢ÙÈο Ì ÙËÓ ·‡ÍËÛË Ù˘ ËÏÈΛ·˜, ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 20 ÂÙÒÓ. H Û˘ÛÙËÌ·ÙÈ΋ ¿ÛÎËÛË Ê·›ÓÂÙ·È Ó· ‚ÂÏÙÈÒÓÂÈ ÙË ÂÓ‰ÔıËÏȷ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ù˘ Á‹Ú·ÓÛ˘ ̤ۈ ·‡ÍËÛ˘ ·Ú·ÁˆÁ‹˜ Î·È ·ÂÏ¢ı¤ÚˆÛ˘ ¡√, ·‡ÍËÛ˘ Ù˘ ¤ÎÊÚ·Û˘ ÙÔ˘ ÁÔÓȉ›Ô˘ Ù˘ ÂÓ‰ÔıËÏȷ΋˜ Û˘Óı¿Û˘ ÙÔ˘ ¡√ (eNOS), ‚ÂÏÙ›ˆÛ˘ Ù˘ ¢·ÈÛıËÛ›·˜ ÙˆÓ ÂÓ‰ÔıËÏÈ·ÎÒÓ ÌÔ˘ÛηÚÈÓÈÎÒÓ ˘Ô‰Ô¯¤ˆÓ, ·‡ÍËÛ˘ ·ÂÏ¢ı¤ÚˆÛ˘ ÚÔÛÙ·ÁÏ·Ó‰ÈÓÒÓ, Ì›ˆÛ˘ ηٷ‚ÔÏÈÛÌÔ‡ ÙÔ˘ ¡√ ·fi ÂχıÂÚ˜ Ú›˙˜ ÔÍ›‰ˆÛ˘ Î·È Ì›ˆÛ˘ ÙÔ˘ Û˘Ì·ıËÙÈÎÔ‡ ·ÁÁÂÈÔÛ˘Û·ÛÙÈÎÔ‡ ÙfiÓÔ˘ [26-30]. ÕÛÎËÛË Î·È ‰ÈÂÚÁ·Û›· ÔÍ›‰ˆÛ˘-ÊÏÂÁÌÔÓ‹˜ H ˘„ËÏ‹˜ ¤ÓÙ·Û˘ ¿ÛÎËÛË Ê·›ÓÂÙ·È Ó· ·˘Í¿ÓÂÈ ÙȘ Û˘ÁÎÂÓÙÚÒÛÂȘ Ï¿ÛÌ·ÙÔ˜ ‰ÂÈÎÙÒÓ ÙÔ˘ ÔÍÂȉˆÙÈÎÔ‡ ÛÙÚ˜ [31]. ™ÙËÓ National Health and Nutrition Examination Survey III, Û ‰Â›ÁÌ· 13748 ÂÓËÏ›ÎˆÓ Ê¿ÓËΠfiÙÈ Ô ¯ÚfiÓÔ˜ ÂÓ·Û¯fiÏËÛ˘ ÛÙË Ê˘ÛÈ΋ ¿ÛÎËÛË ‹Ù·Ó ·ÓÙ›ÛÙÚÔÊ· ·Ó¿-
ÏÔÁÔ˜ Ì ٷ ›‰· CRP, ÈÓˆ‰ÔÁfiÓÔ˘ Î·È ÙÔÓ ·ÚÈıÌfi ÙˆÓ Ï¢ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ [32]. ™ÙË ÌÂϤÙË ∞∆∆π∫∏ Ë Ì¤ÙÚÈ· ÂÓ·Û¯fiÏËÛË Ì ¿ÛÎËÛË Ô‰‹ÁËÛ Û 33% ÌÈÎÚfiÙÂÚË Û˘ÁΤÓÙÚˆÛË hsCRP, 10% ÌÈÎÚfiÙÂÚË Û˘ÁΤÓÙÚˆÛË Ï¢ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ, 17% ÌÈÎÚfiÙÂÚË Û˘ÁΤÓÙÚˆÛË ·Ì˘ÏÔÂȉԇ˜ ∞ Î·È 3% ÌÈÎÚfiÙÂÚË Û˘ÁΤÓÙÚˆÛË ÈÓˆ‰ÔÁfiÓÔ˘ [33]. ÕÛÎËÛË Î·È ıÚÔÌ‚ÔÁ¤ÓÂÛË ∂ÓÒ Ë ‚Ú·¯Â›· ¤ÓÙÔÓË ¿ÛÎËÛË ¤¯ÂÈ ıÚÔÌ‚ÔÁfiÓ˜ ȉÈfiÙËÙ˜, ηıÒ˜ ·˘Í¿ÓÂÈ ÙÔÓ ·ÚÈıÌfi Î·È ÙË ‰Ú·ÛÙËÚÈfiÙËÙ· ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ, Ë Û˘ÛÙËÌ·ÙÈ΋ ¿ÛÎËÛË ÌÂÙÚÈ¿˙ÂÈ ÙËÓ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ Î·È ·˘Í¿ÓÂÈ ÙËÓ ·ÈÌÔÂÙ·Ïȷ΋ Û˘ÁΤÓÙÚˆÛË Û cGMP. ∏ Ê˘ÛÈ΋ ¿ÛÎËÛË Î·Ù·ÛÙ¤ÏÏÂÈ ÙËÓ ˘ÂÚËÎÙÈÎfiÙËÙ·, ÌÂÈÒÓÔÓÙ·˜ ÙÔ ÈÓˆ‰ÔÁfiÓÔ, ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ‹Í˘ VIII, von Willebrand, VII, ÙÔ Û‡ÌÏÂÁÌ· ıÚÔÌ‚›Ó˘-·ÓÙÈıÚÔÌ‚›Ó˘ πππ, ÂÓÒ ·Ú·Ù›ÓÂÈ ÙÔÓ ¯ÚfiÓÔ ÌÂÚÈ΋˜ ıÚÔÌ‚ÔÏ·ÛÙ›Ó˘. ŒÙÛÈ Ë ·Ú·ÙËÚÔ‡ÌÂÓË Ì›ˆÛË ·ÓÙÈËÎÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ fiˆ˜ ÙÔ˘ Ï·ÛÌÈÓÔÁfiÓÔ˘, ÙÔ˘ ·ÓÙÈÁfiÓÔ˘ ÙÔ˘ ÈÛÙÈÎÔ‡ ÂÓÂÚÁÔÔÈËÙ‹ ÙÔ˘ Ï·ÛÌÈÓÔÁfiÓÔ˘, ÙÔ˘ ·Ó·ÛÙÔϤ· Ù˘ Ï·ÛÌ›Ó˘ a2, ÙÔ˘ ·Ó·ÛÙÔϤ· ÙÔ˘ ÂÓÂÚÁÔÔÈËÙ‹ ÙÔ˘ Ï·ÛÌÈÓÔÁfiÓÔ˘ -1 Î·È ÙÔ˘ Û˘ÌϤÁÌ·ÙÔ˜ Ï·ÛÌ›Ó˘-a 2PI ÌÂÙ¿ Ê˘ÛÈ΋ ¿ÛÎËÛË Èı·ÓÒ˜ ÔÊ›ÏÂÙ·È ÛÙËÓ ÌÂȈ̤ÓË ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ‹Í˘/ÈÓˆ‰fiÏ˘Û˘ [34, 35]. º˘ÛÈ΋ ¿ÛÎËÛË Î·È ÏÈ›‰È· ¶·Ú fiÏÔ Ô˘ Ù· ›‰· ÏÈȉ›ˆÓ Û¯ÂÙ›˙ÔÓÙ·È ·ÓÙ›ÛÙÚÔÊ· Ì ÙËÓ ·ÚÔ˘Û›· Ê˘ÛÈ΋˜ ¿ÛÎËÛ˘, ÌfiÓÔ Ë HDL-C Î·È Ë apolipoprotein-A1 ÂËÚ¿˙ÔÓÙ·È ÛËÌ·ÓÙÈο ·fi ÙËÓ ¿ÛÎËÛË ÛÙȘ Á˘Ó·›Î˜, ·ÏÏ¿ fi¯È ÛÙÔ˘˜ ¿Ó‰Ú˜ [36, 37]. ™Â ·ÛıÂÓ›˜ Ì ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· ·fi ÙÔ˘˜ ·ÚÈÔ˘˜ ÚÔÁÓˆÛÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ ÛÙ· 15 ÂÚ›Ô˘ ¤ÙË ·Ú·ÎÔÏÔ‡ıËÛ˘ Â›Ó·È Ë ÌÂȈ̤ÓË ·ÓÔ¯‹ ÛÙËÓ ÎfiˆÛË, Ë Î·ı˘ÛÙÂÚË̤ÓË ÙÒÛË ÙÔ˘ ηډȷÎÔ‡ Ú˘ıÌÔ‡ ηٿ ÙÔ 1Ô ÏÂÙfi Ù˘ ·ÔηٿÛÙ·Û˘ Î·È Ë ·˘ÍË̤ÓË ›ÂÛË ÛÊ˘ÁÌÔ‡ ÛÙÔ Ì¤ÁÈÛÙÔ Ù˘ ÎfiˆÛ˘. [38]. ÕÛÎËÛË Î·È Û·Î¯·Ú҉˘ ‰È·‚‹Ù˘ ∏ ̤ÙÚÈ· ¿ÛÎËÛ˘ Ù˘ Ù¿Í˘ ÙˆÓ 4-7 Kcal/ÏÂÙfi Ê·›ÓÂÙ·È Ó· ÌÂÈÒÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ Î·Ù¿ 65% ÛÙËÓ ÂÌÊ¿ÓÈÛË ÔͤԘ ÛÙÂÊ·ÓÈ·›Ô˘ ÂÂÈÛÔ‰›Ô˘ ÛÙÔ˘˜ ‰È·‚ËÙÈÎÔ‡˜ [39].
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™ÂÏ›‰·28
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∏ Ê˘ÛÈ΋ ¿ÛÎËÛË Ê·›ÓÂÙ·È Ó· ‰Ú· ÛÙËÓ Ì›ˆÛË Ù˘ ·ÓÙ›ÛÙ·Û˘ ÛÙËÓ ÈÓÛÔ˘Ï›ÓË Ì¤Ûˆ – Ì›ˆÛ˘ Ù˘ ÎÂÓÙÚÈ΋˜ ·¯˘Û·ÚΛ·˜ – ‚ÂÏÙ›ˆÛ˘ Ù˘ ηډÈÔ·Ó·Ó¢ÛÙÈ΋˜ ηٿÛÙ·Û˘, ·ÏÏ¿ Î·È – ÕÌÂÛ˘ ‰Ú¿Û˘ Ô˘ ÂËÚ¿˙ÂÙ·È ·fi ÙÔ ÁÔÓfiÙ˘Ô ÙÔ˘ ·ÙfiÌÔ˘ [40] ∏ Èı·ÓfiÙËÙ· ÂΉ‹ÏˆÛ˘ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ Ì ÙËÓ Î·Ù·Ó¿ÏˆÛË ˘ÁÈÂÈÓ‹˜ ‰È·ÙÚÔÊ‹˜ ÌÂÈÒÓÂÙ·È 19%, ÂÓÒ ·Ó Û˘Ó‰˘¿˙ÂÙ·È Ì ¤ÛÙˆ ‹È· Ê˘ÛÈ΋ ¿ÛÎËÛË (< 7 Kcal/min) ÌÂÈÒÓÂÙ·È Î·Ù¿ 25%. ÕÛÎËÛË Î·È ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ˜ ªÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ë ÂÊ·ÚÌÔÁ‹ Û˘ÛÙËÌ·ÙÈ΋˜ ¿ÛÎËÛ˘ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ˘ÔÛÙÚÔÊ‹ Ù˘ ÛÙÂÊ·ÓÈ·›·˜ ·ıËÚÔÛÎÏ‹ÚˆÛ˘ [41, 42]. ∏ Û˘ÛÙËÌ·ÙÈ΋ ¿ÛÎËÛË Ê·›ÓÂÙ·È Ó· ÚÔ¿ÁÂÈ ÙË ‰ËÌÈÔ˘ÚÁ›· ·Ú¿Ï¢Ú˘ ΢ÎÏÔÊÔÚ›·˜. ∏ Û˘ÛÙËÌ·ÙÈ΋ ¿ÛÎËÛË 16 ‚‰ÔÌ¿‰ˆÓ Û ÂÈÚ·Ì·Ùfi˙ˆ· ¤‰ÂÈÍ ·‡ÍËÛË Ù˘ ÙÚȯÔÂȉÈ΋˜ ˘ÎÓfiÙËÙ·˜ ηٿ 37%, ÌÂ Û˘ÓÔ‰fi Ì›ˆÛË ÙˆÓ ÂÚÈÊÂÚÈÎÒÓ ·ÓÙÈÛÙ¿ÛÂˆÓ Î·È ·‡ÍËÛË Ù˘ ÛÙÂÊ·ÓÈ·›·˜ Âʉڛ·˜. ∞Ó¿ÏÔÁË ·Ú·Ù‹ÚËÛË Û ·ÛıÂÓ›˜ ¤‰ÂÈÍ fiÙÈ Ë Û˘ÛÙËÌ·ÙÈ΋ ¿ÛÎËÛË ·˘Í¿ÓÂÈ ÙË ÛÙÂÊ·ÓÈ·›· Âʉڛ· Î·È ÙËÓ ·ÓÙ›‰Ú·ÛË ÛÙËÓ ·‰ÂÓÔÛ›ÓË [43-46]. ∏ Ê˘ÛÈ΋ ¿ÛÎËÛË Û ·ÛıÂÓ›˜ Ì ÁÓˆÛÙ‹ ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ [47-54]. ñ ∞˘Í¿ÓÂÈ ÙËÓ ·ÓÔ¯‹ ÛÙËÓ ¿ÛÎËÛË ñ ªÂÈÒÓÂÈ ÙË Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ Î·È ÙËÓ ¤ÎÙ·ÛË Ù˘ Ì˘Ôηډȷ΋˜ ÈÛ¯·ÈÌ›·˜, ñ µÂÏÙÈÒÓÂÈ ÙËÓ ÂÓ‰ÔıËÏȷ΋ ÏÂÈÙÔ˘ÚÁ›· ñ ∞fi ÚfiÛÊ·ÙË ÌÂÙ·-·Ó¿Ï˘ÛË Ê·›ÓÂÙ·È Ó· ÌÂÈÒÓÂÈ ÙËÓ Î·Ú‰È·ÁÁÂȷ΋ ıÓËÙfiÙËÙ· √È Ì˯·ÓÈÛÌÔ› ›‰Ú·Û˘ Ù˘ ¿ÛÎËÛ˘ ÛÙË ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ Â›Ó·È: ñ µÔËı¿ ÙËÓ ÈÛ¯·ÈÌÈ΋ ÚÔÂÙÔÈÌ·Û›· ÙÔ˘ Ì˘Ôηډ›Ô˘ ÏfiÁˆ ‚Ú·¯Â›·˜ ·‰ÚÂÓÂÚÁÈ΋˜ ‰È¤ÁÂÚÛ˘ Î·È ·Ú·ÁˆÁ‹˜ COX-2 [55, 56] ñ ∞˘Í¿ÓÂÈ ÙËÓ ‰ÈÛÌÔ˘Ù¿ÛË ÙÔ˘ ˘ÂÚÔÍÂȉ›Ô˘ Ô˘ Ê·›ÓÂÙ·È Ó· Û¯ÂÙ›˙ÂÙ·È Ì ‚ÂÏÙ›ˆÛË ·ÓÔ¯‹˜ ÛÙËÓ ¿ÛÎËÛË [57]. ∏ Û˘ÛÙËÌ·ÙÈ΋ ¿ÛÎËÛË 4 ‚‰ÔÌ¿‰ˆÓ Û ·ÛıÂÓ›˜ Ì ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ ·˘Í¿ÓÂÈ ÙËÓ ¤ÎÊÚ·-
28
ÛË ÙÔ˘ eNOS Î·È ÙËÓ ·Ú·ÁˆÁ‹ ¡√ ηıÒ˜ ‚ÂÏÙÈÒÓÂÈ ÙËÓ ÂÓ‰ÔıËÏÈÔÂÍ·ÚÙÒÌÂÓË ·ÁÁÂÈԉȷÛÙÔÏ‹. ∂›Û˘ ÔÈ ÛÙÂÊ·ÓÈ·›ÔÈ ·ÛıÂÓ›˜ Â›Ó·È Û˘¯Ó¿ Û η΋ Ê˘ÛÈ΋ ηٿÛÙ·ÛË, ÔfiÙ ·Ú·ÙËÚÔ‡Ó ‚ÂÏÙ›ˆÛË ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ‰Ú·ÛÙËÚÈfiÙËÙ· ÌÂÙ¿ ·fi Û˘ÛÙËÌ·ÙÈ΋ ¿ÛÎËÛË. ∞ÎfiÌ· Î·È ·ÛıÂÓ›˜ Ì ÂËÚ·Ṳ̂ÓË ·fi‰ÔÛË Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ ·˘Í¿ÓÔ˘Ó ÙËÓ ·ÚÙËÚÈÔÊÏ‚È΋ ‰È·ÊÔÚ¿ O2 Î·È ÙËÓ ·ÓÔ¯‹ ÛÙËÓ ¿ÛÎËÛË. ∏ ·‡ÍËÛË ÙÔ˘ Ô˘‰Ô‡ ·ÂÚÈÛÌÔ‡ ·˘Í¿ÓÂÈ ÙËÓ ˘ÔÌÂÁ›ÛÙË ÈηÓfiÙËÙ· ¿ÛÎËÛ˘, ÌÂÈÒÓÔÓÙ·˜ ÙÔ ·›ÛıËÌ· ‰‡ÛÓÔÈ·˜ ÛÙËÓ ˘ÔÌÂÁ›ÛÙË ¿ÛÎËÛË, ÂÓÒ Ë Ì›ˆÛË Ù˘ ˘ÔÌÂÁ›ÛÙ˘ ηډȷ΋˜ Û˘¯ÓfiÙËÙ·˜ Î·È Û˘ÛÙÔÏÈ΋˜ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ÌÂÈÒÓÔ˘Ó ÙȘ ·Ó¿ÁΘ ÙÔ˘ Ì˘Ôηډ›Ô˘ Û Ô͢ÁfiÓÔ, ÂÈ‚Ú·‰‡ÓÔÓÙ·˜ ÙËÓ ÂÌÊ¿ÓÈÛË ÛÙËı¿Á¯Ë˜. ™Â ·ÓÙ›ıÂÛË Ì ÙËÓ ·ÂÚfi‚È· ¿ÛÎËÛË Ô˘ ·˘Í¿ÓÂÈ ÙËÓ Î˘ÎÏÔÊÔÚÈ΋ Âʉڛ·, Ë ·Ó·ÂÚfi‚ÈÔ˜ ¿ÛÎËÛË ·˘Í¿ÓÂÈ ÙËÓ Ì˘˚΋ ‰‡Ó·ÌË. ∏ ¿ÛÎËÛË ·ÓÙ›ÛÙ·Û˘ ‰ÂÓ ¤¯ÂÈ ÌÂÏÂÙËı› ·ÚÎÒ˜ Û ÛÙÂÊ·ÓÈ·›Ô˘˜ ·ÛıÂÓ›˜, ·ÏÏ¿ ÂÓ‰˘Ó·ÌÒÓÂÈ ÙÔ Ì˘ÈÎfi Û‡ÛÙËÌ· ÛÙËÓ ÂÈÙ¤ÏÂÛË Î·ıËÌÂÚÈÓÒÓ ‰Ú·ÛÙËÚÈÔÙ‹ÙˆÓ ·‰‡Ó·ÌˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ Á˘Ó·ÈÎÒÓ [58]. ∞‡ÍËÛË ÛÙËÓ ÏÂÈÙÔ˘ÚÁÈ΋ ÈηÓfiÙËÙ· ηٿ 10-60% Î·È Ì›ˆÛË ÙˆÓ ·Ó·ÁÎÒÓ ÙÔ˘ Ì˘Ôηډ›Ô˘ ηٿ 10-25% ¤¯Ô˘Ó ·Ú·ÙËÚËı› Û ÛÙÂÊ·ÓÈ·›Ô˘˜ ·ÛıÂÓ›˜ Ô˘ ¤¯Ô˘Ó ·ÎÔÏÔ˘ı‹ÛÂÈ ÚÔÁÚ¿ÌÌ·Ù· ·ÔηٿÛÙ·Û˘. º·›ÓÂÙ·È fiÙÈ Ë ·‡ÍËÛË Ù˘ ÏÂÈÙÔ˘ÚÁÈ΋˜ ÈηÓfiÙËÙ·˜ (V√2 max) ÌÂÙ¿ 3 Ì‹Ó˜ ·fi ÙÔ Ô͇ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘, ÔÊ›ÏÂÙ·È Û ·‡ÍËÛË Ù˘ ·ÚÙËÚÈÔÊÏ‚È΋˜ ‰È·ÊÔÚ¿˜, ÂÓÒ Ë Î·Ú‰È·Î‹ ·ÚÔ¯‹ ÛÙËÓ ˘ÔÌÂÁ›ÛÙË ¿ÛÎËÛË ·˘Í¿ÓÂÈ ÌÂÙ¿ ·fi ·Ú·ÙÂٷ̤ÓË ÚÔfiÓËÛË (12 Ì‹Ó˜) [59-61]. °È ·˘Ùfi Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÛÙ·ıÂÚÔÔÈË̤ÓË ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ ÌÔÚ› Ó· Û˘ÛÙËı› ÂÓ·Û¯fiÏËÛË ÌÂ Ê˘ÛÈ΋ ¿ÛÎËÛË. ∫·Ì›· Ù˘¯·ÈÔÔÈË̤ÓË ÎÏÈÓÈ΋ ÌÂϤÙË ‰ÂÓ ¤‰ÂÈÍ ÈηӋ ÛÙ·ÙÈÛÙÈ΋ ÈÛ¯‡ ÁÈ· Ó· ·Ó·‰Â›ÍÂÈ Ì›ˆÛË ÙˆÓ ˘ÔÙÚÔÒÓ Û ηډȷο Û˘Ì‚¿Ì·Ù·, ÂÓÒ ÔÈ ÌÂٷӷχÛÂȘ ¤¯Ô˘Ó ‰Â›ÍÂÈ Ì›ˆÛË Ù˘ ıÓËÙfiÙËÙ·˜ [6264]. º˘ÛÈ΋ ·ÔηٿÛÙ·ÛË Û ÛÙÂÊ·ÓÈ·›Ô˘˜ ·ÛıÂÓ›˜ ŸÏÔÈ ÔÈ ÛÙÂÊ·ÓÈ·›ÔÈ ·ÛıÂÓ›˜ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÏÔÓÙ·È Û ‰ÔÎÈ-
Ì·Û›· ÎfiˆÛ˘ ÚÈÓ ÙËÓ ¤ÓÙ·ÍË ÙÔ˘˜ Û ÚfiÁÚ·ÌÌ· ¿ÛÎËÛ˘, ÁÈ· ηıÔÚÈÛÌfi ̤ÁÈÛÙ˘ ηډȷ΋˜ Û˘¯ÓfiÙËÙ·˜, ÂÌÊ¿ÓÈÛ˘ Û˘ÌÙˆÌ¿ÙˆÓ ‹ ·ÚÚ˘ıÌÈÒÓ, ˘fi Ï‹ÚË Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹. √È ·ÛıÂÓ›˜ Ú¤ÂÈ Ó· Ô‰ËÁÔ‡ÓÙ·È Û ÂȉÈο ÚÔÁÚ¿ÌÌ·Ù· ¿ÛÎËÛ˘, ÛÙ· ÔÔ›· Û˘Ó‹ıˆ˜ ·ÛÎÔ‡ÓÙ·È 3 ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰· ÁÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 30 ÏÂÙ¿, ÛÙ· ÔÔ›· ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È 5 ÏÂÙ¿ ÚÔı¤ÚÌ·ÓÛ˘, 5 ÏÂÙ¿ ·ÔηٿÛÙ·Û˘ Î·È 20 ÏÂÙ¿ ¿ÛÎËÛ˘ ÛÙÔ 70-85% Ù˘ ÚÔηıÔÚÈṲ̂Ó˘ ̤ÁÈÛÙ˘ ηډȷ΋˜ Û˘¯ÓfiÙËÙ·˜ ‹ ÛÙÔ 60-75% Ù˘ ̤ÁÈÛÙ˘ VO2 [65]. ¶ÚfiÛÊ·ÙË ÌÂÙ·Ó¿Ï˘ÛË Ô˘ Û˘ÌÂÚȤϷ‚ 48 ÌÂϤÙ˜ Ì 8940 ·ÛıÂÓ›˜ ¤‰ÂÈÍ fiÙÈ Ë Î·Ú‰È·Î‹ ·ÔηٿÛÙ·ÛË Ì›ˆÛ ÙËÓ ÔÏÈ΋ Î·È ÙËÓ Î·Ú‰È·Î‹ ıÓËÙfiÙËÙ· ηٿ 20 Î·È 26% ·ÓÙ›ÛÙÔȯ·, ÂÓÒ Ë Î·Ú‰È·Î‹ ÓÔÛËÚfiÙËÙ· ‰ÂÓ ÌÂÈÒıËΠÛËÌ·ÓÙÈο. ∏ Ì›ˆÛË Ù˘ ıÓËÙfiÙËÙ·˜ ÌÔÚ› Ó· ·Ô‰Ôı› Û Ì›ˆÛË Ù˘ ÂÌÊ¿ÓÈÛ˘ ÎÔÈÏȷ΋˜ Ì·ÚÌ·Ú˘Á‹˜ ÏfiÁˆ ·‡ÍËÛ˘ Ù˘ ·Ú·Û˘Ì·ıËÙÈÎÔÙÔÓ›·˜ ‹ ÏfiÁˆ ÈÛ¯·ÈÌÈ΋˜ ÚÔÂÙÔÈÌ·Û›·˜ ÙÔ˘ Ì˘Ôηډ›Ô˘ [66]. ∂›Û˘ Ë ÂÓ·Û¯fiÏËÛË Î·Ù¿ÏÏËÏ· ÂÎ·È‰Â˘Ì¤ÓÔ˘ ÚÔÛˆÈÎÔ‡ ÌÔÚ› Ó· ·Ó·ÁÓˆÚ›ÛÂÈ Î·È Ó· ·ÓÙÈÌÂÙˆ›ÛÂÈ ¿ÌÂÛ· Ù· Û˘ÌÙÒÌ·Ù· ÂÌÊ¿ÓÈÛ˘ ·ÈÊÓȉ›Ô˘ ı·Ó¿ÙÔ˘. ∞ӷʤÚÂÙ·È 1 ÂÂÈÛfi‰È· ηډȷ΋˜ ·Ó·ÎÔ‹˜ ·Ó¿ 120 000 ÒÚ˜-·ÛıÂÓÒÓ Û ηډȷ΋ ·ÔηٿÛÙ·ÛË, ·ÏÏ¿ ÌfiÓÔ 1 ı¿Ó·ÙÔ˜ ·Ó¿ 750 000 ÒÚ˜-·ÛıÂÓÒÓ [21]. ∞ÓÙÂӉ›ÍÂȘ ¿ÛÎËÛ˘ Û ÛÙÂÊ·ÓÈ·›Ô˘˜ ·ÛıÂÓ›˜ ñ ¢ÂÓ ÂÈÙÚ¤ÂÙ·È ¿ÛÎËÛË ÙËÓ ÚÒÙË Â‚‰ÔÌ¿‰· ÌÂÙ¿ ·fi Ô͇ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘, ηıÒ˜ Î·È Û fiÛÔ˘˜ ÂÌÊ·Ó›˙Ô˘Ó ÛÙ·‰È·Î¿ ÂȉÂÈÓÔ‡ÌÂÓË ·ÛÙ·ı‹ ÛÙËı¿Á¯Ë. ñ ∂›Û˘ Û ·ÛıÂÓ›˜ Ô˘ ÂÌÊ·Ó›˙Ô˘Ó Î·Ù¿ ÙËÓ ¿ÛÎËÛË ÎÔÏÈ΋ ‹ ÎÔÈÏȷ΋ ·ÚÚ˘ıÌ›·. ñ ªÂÙ¿ ·fi ·ÔÚÙÔÛÙÂÊ·ÓÈ·›· ·Ú¿Î·Ì„Ë, ¿ÛÎËÛË ÌÔÚ› Ó· Û˘ÛÙËı› ÌÂÙ¿ ÙËÓ ·Ú¤Ï¢ÛË 2 ‚‰ÔÌ¿‰ˆÓ, ÂÊ fiÛˆÓ Ô ·ÛıÂÓ‹˜ Â›Ó·È Û ·Ó›ÏÂÎÙË ÔÚ›·, ÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Î·È Ù˘ ηϋ˜ Ô˘ÏÔÔ›ËÛ˘ ÙÔ˘ ÙÚ·‡Ì·ÙÔ˜. ñ ∞ÛıÂÓ›˜ Ì ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ıÚÔÌ‚ÔÊÏ‚›Ùȉ· Ú¤ÂÈ Ó· Ï¿‚Ô˘Ó Â·Ú΋ ·ÓÙÈËÎÙÈ΋ ·ÁˆÁ‹ ÁÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 2 ‚‰ÔÌ¿-
ATHIROSK 21-
05-03-09
12:25
™ÂÏ›‰·29
À°π∂π¡√¢π∞π∆∏∆π∫∏ ∞°ø°∏ ‰Â˜ ÚÈÓ ÍÂÎÈÓ‹ÛÔ˘Ó ¿ÛÎËÛË [52]. ÕÛÎËÛË ÌÂÙ¿ ‰ÈÂÓ¤ÚÁÂÈ· ·ÁÁÂÈÔÏ·ÛÙÈ΋˜ ñ ∞Ú¯ÈΤ˜ ÌÂÌÔӈ̤Ó˜ ·Ó·ÊÔÚ¤˜ Ì ÂÌÊ¿ÓÈÛË Â·Ó·ıÚfiÌ‚ˆÛ˘ ÌÂÙ¿ ·fi ·ÁÁÂÈÔÏ·ÛÙÈ΋ ¤ıÂÛ ·ÌÊÈ‚Ôϛ˜ ÁÈ· ÙËÓ ·ÛÊ¿ÏÂÈ· Ù˘ ¿ÛÎËÛ˘ [67]. ñ ∏ ÌÂϤÙË Exercise Training Intervention After Coronary Angioplasty (ETICA) [68] trial Ù˘¯·ÈÔÔ›ËÛ 130 ·ÛıÂÓ›˜ ÌÂÙ¿ ·ÁÁÂÈÔÏ·ÛÙÈ΋ Û 6ÌËÓÔ ÚfiÁÚ·ÌÌ· Û˘ÛÙËÌ·ÙÈ΋˜ ¿ÛÎËÛË ‹ fi¯È. ∏ ̤ÁÈÛÙË Î·Ù·Ó¿ÏˆÛË O2 ·˘Í‹ıËΠηٿ 26%, ÌfiÓÔ ÛÙËÓ ÔÌ¿‰· Ù˘ ·Ú¤Ì‚·Û˘ ÂÓÒ Ù· ÔÛÔÛÙ¿ ·ӷÛÙ¤ÓˆÛ˘ ‹Ù·Ó 29% Î·È 32% ÛÙËÓ ÔÌ¿‰· Ù˘ ·Ú¤Ì‚·Û˘ Î·È ÙÔ˘ ÂϤÁ¯Ô˘, ·ÓÙ›ÛÙÔȯ·. ∏ ÂÓ‰Ô·˘ÏÈ΋ ÛÙ¤ÓˆÛË ÛÙÔ ÛËÌÂ›Ô Ù˘ ·ÁÁÂÈÔÏ·ÛÙÈ΋˜ ‹Ù·Ó Û˘¯ÓfiÙÂÚË ÛÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘, Ë ÔÔ›· ÂÌÊ¿ÓÈ˙Â Î·È ˘„ËÏfiÙÂÚ· ÔÛÔÛÙ¿ ηډȷÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ, ·ӷϷ̂·ÓfiÌÂÓˆÓ ÓÔÛËÏÂÈÒÓ Î·È ‰ÈÂÓÂÚÁÂÈÒÓ ·ÁÁÂÈÔÏ·ÛÙÈ΋˜ ‹ ·ÔÚÙÔÛÙÂÊ·ÓÈ·›·˜ ·Ú¿Î·Ì„˘. – OÈ ·ÛıÂÓ›˜ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È Û ·ÁÁÂÈÔÏ·ÛÙÈ΋ Ì ‹ ¯ˆÚ›˜ ÙÔÔı¤ÙËÛË stent ÌÔÚÔ‡Ó Ó· ˘Ô‚ÏËıÔ‡Ó ¿ÌÂÛ· Û ‰ÔÎÈÌ·Û›· ÎfiˆÛ˘ ÁÈ· ÙËÓ ¤Ó·ÚÍË Ê˘ÛÈ΋˜ ¿ÛÎËÛ˘ ‹ 7-14 Ë̤Ú˜ ÌÂÙ¿ ·fi ·ÁÁÂÈÔÏ·ÛÙÈ΋ [69]. – ªfiÓÔ ÛÙÔ 21% ÙˆÓ ·ÛıÂÓÒÓ Ì Ô͇ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘ Ô˘ ¤¯Ô˘Ó ˘Ô‚ÏËı› Û ·ÁÁÂÈÔÏ·ÛÙÈ΋ Û˘ÛÙ‹ÓÂÙ·È Î·Ú‰È·Î‹ ·ÔηٿÛÙ·ÛË. ÕÛÎËÛË Î·È Î·Ú‰È·Î‹ ·Ó¿ÚÎÂÈ· ¢ÂÓ ˘¿Ú¯ÂÈ ÌÂÁ¿ÏË ÔÏ˘ÎÂÓÙÚÈ΋ ÌÂϤÙË Ô˘ Ó· ·ÍÈÔÏÔÁ› ÙËÓ Â›‰Ú·ÛË Ù˘ ¿ÛÎËÛ˘ Û ·ÛıÂÓ›˜ Ì ηډȷ΋ ·Ó¿ÚÎÂÈ·, ηıÒ˜ ·Ó·Ì¤ÓÔÓÙ·È Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂÁ¿Ï˘ ÔÏ˘ÎÂÓÙÚÈ΋˜ ÌÂϤÙ˘ HF-ACTION. ∞fi ÌÂÙ·Ó¿Ï˘ÛË 81 ÌÂÏÂÙÒÓ Ô˘ Û˘ÌÂÚȤϷ‚·Ó 2387 ·ÛıÂÓ›˜ Ê·›ÓÂÙ·È fiÙÈ Ë Ì¤ÁÈÛÙË Î·Ù·Ó¿ÏˆÛË Ô͢ÁfiÓÔ˘ ·˘Í¿ÓÂÈ Ì ÙËÓ ¿ÛÎËÛË Î·Ù¿ 16%, ÂÓÒ ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ı¿Ó·ÙÔÈ ÔÊÂÈÏfiÌÂÓÔÈ ÛÙËÓ ¿ÛÎËÛË Û 60.000 ·ÓıÚˆÔÒÚ˜ ¿ÛÎËÛ˘. ∫·Ù¿ ÙË Ì¤ÛË ÚÔÔÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ 5,9 ÌËÓÒÓ, ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ‰È·ÊÔÚ¤˜ ÛÙË ÓÔÛËÚfiÙËÙ· ·ÏÏ¿ Ë ıÓËÙfiÙËÙ· ‹Ù·Ó 29% ¯·ÌËÏfiÙÂÚË ÛÙËÓ ÔÌ¿‰· Ù˘ ¿ÛÎËÛ˘ [70].
ª˘˚΋ ˘fiıÂÛË Ù˘ ηډȷ΋˜ ·Ó¿ÚÎÂÈ·˜ ∏ Ì›ˆÛË Ù˘ Û˘ÛÙÔÏÈ΋˜ ·fi‰ÔÛ˘ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ ÎÈÓËÙÔÔÈ› ηٷ‚ÔÏÈÎÔ‡˜ Î·È ÂÏ·ÙÙÒÓÂÈ ·Ó·‚ÔÏÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, Ô‰ËÁÒÓÙ·˜ Û ÛÎÂÏÂÙÈ΋ Ì˘Ô¿ıÂÈ·. ™ÙË Û˘Ó¤¯ÂÈ· ¢·ÈÛıËÙÔÔÈÔ‡ÓÙ·È ÂÚÁÔ-˘Ô‰Ô¯Â›˜ Ô˘ Ô‰ËÁÔ‡Ó Û ÌÂȈ̤ÓË ·ÓÔ¯‹ ÛÙËÓ ¿ÛÎËÛË Î·È Â˘·ÈÛıËÙÔÔ›ËÛË Û˘Ì·ıËÙÈÎÔ‡. √ Û˘Ó‰˘·ÛÌfi˜ ÙÔ˘ Û˘Ó¯ԇ˜ ηٷ‚ÔÏÈÛÌÔ‡ Î·È Ù˘ ÌÂȈ̤Ó˘ Ê˘ÛÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÂÈ‚·Ú‡ÓÂÈ ÂÚ·ÈÙ¤Úˆ ÙÔ˘˜ ÛÎÂÏÂÙÈÎÔ‡˜ ̇˜ Î·È Âȉڿ Î·È ÛÙË ÚfiÔ‰Ô Ù˘ ·Ó·‰È·ÌfiÚʈÛ˘ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ [71]. ∂›‰Ú·ÛË ·ÂÚfi‚È·˜ ¿ÛÎËÛ˘ ÛÙË Ì˘Ôηډȷ΋ ·fi‰ÔÛË ñ ∞ÏÏ·Á‹ ÈÛÔÌÔÚÊÒÓ ÙÚÔÔÓ›Ó˘ π ñ ∞‡ÍËÛË Ù˘ ¤ÎÊÚ·Û˘ Ù˘ ·-‚·Ú›·˜ ·Ï‡ÛÔ˘ Ì˘ÔÛ›Ó˘, Ë ÔÔ›· Ô‰ËÁ› Û ·‡ÍËÛË Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ∞∆ƒ¿Û˘ Î·È ·‡ÍËÛË Ù˘ Û˘Û·ÛÙÈÎfiÙËÙ·˜. ñ ∞‡ÍËÛË SERCA-2 Ô‰ËÁ› Û ·‡ÍËÛË Ù˘ ·ÂÏ¢ı¤ÚˆÛ˘ Ca++ ·fi ÙÔ Û·ÚÎÔÏ·ÛÌ·ÙÈÎfi ‰›ÎÙ˘Ô ñ ¶ÂÚÈÔÚÈÛÌfi˜ Ù˘ ˘ÂÚÙÚÔÊ›·˜ ñ ∞ÔηٿÛÙ·ÛË ÌÂÚÈÎÒ˜ Ù˘ Û˘Û·ÛÙÈÎfiÙËÙ·˜ ÌÂÙ¿ ·fi Ô͇ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘, ‚ÂÏÙÈÒÓÔÓÙ·˜ ÙÔ ¯ÂÈÚÈÛÌfi ÙÔ˘ ÂÓ‰Ô΢ÙÙ·ÚÈÎÔ‡ ·Û‚ÂÛÙ›Ô˘ [72]. ∏ ›‰Ú·ÛË Ù˘ ¿ÛÎËÛ˘ ÛÙË ‚ÂÏÙ›ˆÛË Ù˘ ·Ó·‰È·ÌfiÚʈÛ˘ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ Û ·ÛıÂÓ›˜ Ì ηډȷ΋ ·Ó¿ÚÎÂÈ· ∏ Û˘ÛÙËÌ·ÙÈ΋ ̤ÙÚÈ· ¿ÛÎËÛË (60% ªVO2) Û ·ÛıÂÓ›˜ Ì ÛÙ·ıÂÚ‹ ¯ÚfiÓÈ· ηډȷ΋ ·Ó¿ÚÎÂÈ· ÚÔηÏ› ÌÈÎÚ‹ ·ÏÏ¿ ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÛÙÔ˘˜ fiÁÎÔ˘˜ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ Î·È ‚ÂÏÙÈÒÓÂÈ ÙÔ ÎÏ¿ÛÌ· ÂÍÒıËÛ˘ Ù˘. ∏ Û˘ÛÙËÌ·ÙÈ΋ ¿ÛÎËÛË ‚ÂÏÙÈÒÓÂÈ ÙËÓ ÔÍÂȉˆÙÈ΋ ÈηÓfiÙËÙ· ÙÔ˘ Ì˘ÈÎÔ‡ ΢ÎÏÔÊÔÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È ÙËÓ ÂÓ‰ÔıËÏȷ΋ ÏÂÈÙÔ˘ÚÁ›· ÙfiÛÔ ÛÙËÓ ÈÛ¯·ÈÌÈ΋ fiÛÔ Î·È ÛÙËÓ ÌË-ÈÛ¯·ÈÌÈ΋ ηډÈÔÌ˘Ô¿ıÂÈ·. ∞˘Ùfi Ô‰ËÁ› Û Ì›ˆÛË ÙˆÓ ÂÚÈÊÂÚÈÎÒÓ ·ÓÙÈÛÙ¿ÛˆÓ, ·‡ÍËÛË Ù˘ ηډȷ΋˜ ·ÚÔ¯‹˜ Î·È ‚ÂÏÙ›ˆÛË Ù˘ Ì˘Ôηډȷ΋˜ ·ÈÌ¿ÙˆÛ˘, ÚÔηÏÒÓÙ·˜ ‚ÂÏÙ›ˆÛË Ù˘ ÔÏÈ΋˜ Î·È ÙÌËÌ·ÙÈ΋˜ ·fi‰ÔÛ˘ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜. ∏ Û˘ÛÙËÌ·ÙÈ΋ ¿ÛÎËÛË ÌÂÈÒÓÂÈ Ù· ΢ÎÏÔÊÔÚÔ‡ÓÙ· ›‰· ÊÏÂÁÌÔÓˆ‰ÒÓ Î˘ÙÔÎÈÓÒÓ Î·È ÙˆÓ ‰È·Ï˘ÙÒÓ ˘Ô‰Ô¯¤ˆÓ ÙÔ˘˜, Ù·
ÔÔ›· Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ÂͤÏÈÍË Ù˘ ·Ó·‰È·ÌfiÚʈÛ˘ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ [73, 74]. ∂›Û˘ ‚ÂÏÙÈÒÓÂÈ ÙËÓ ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ·˘ÙfiÓÔÌÔ˘ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È ÌÂÈÒÓÂÈ ÛËÌ·ÓÙÈο Ù· ›‰· ÊÏÂÁÌÔÓˆ‰ÒÓ Î˘ÙÔÎÈÓÒÓ Ô˘ ÂÎÚÔÛˆÔ‡Ó ÙËÓ ·ÏÏËÏ›‰Ú·ÛË ÌÔÓÔ΢ÙÙ¿ÚˆÓ/ÂÓ‰ÔıËÏ›Ô˘, ·˘Í¿ÓÔÓÙ·˜ ·Ú¿ÏÏËÏ· ÙËÓ ·ÓÔ¯‹ ÛÙËÓ ÎfiˆÛË. º·›ÓÂÙ·È fiÙÈ Ë ·ÚÔ˘Û›· ˘ÔÎÏÈÓÈ΋˜ ÊÏÂÁÌÔÓ‹˜ ¤¯ÂÈ ·ıÔÁÂÓÂÙÈÎfi ÚfiÏÔ ÛÙË ÌÂȈ̤ÓË ·ÓÔ¯‹ ÛÙËÓ ¿ÛÎËÛË [75, 76]. ∏ ÚÔfiÓËÛË ÌÂ Û˘Ó‰ڛ˜ ¯ÂÈÚfiÛÊÈ͢ ÌÂÈÒÓÂÈ ÙÔ ·ÓÙ·Ó·ÎÏ·ÛÙÈÎfi ÙˆÓ ÂÚÁÔ-˘Ô‰Ô¯¤ˆÓ ÌÂÈÒÓÔÓÙ·˜ ÙËÓ ·¿ÓÙËÛË Ù˘ Û˘ÛÙÔÏÈ΋˜ Î·È ‰È·ÛÙÔÏÈ΋˜ ·ÚÙËÚȷ΋˜ ›ÂÛ˘, ÙËÓ Î·Ù·Ó¿ÏˆÛË Ô͢ÁfiÓÔ˘ Î·È ÙȘ ÂÚÈÊÂÚÂȷΤ˜ ·ÓÙÈÛÙ¿ÛÂȘ, ·˘Í¿ÓÔÓÙ·˜ ÙËÓ ·ÈÌ·ÙÈ΋ ÚÔ‹ ÛÙ· οو ¿ÎÚ·, ÂÓÒ ÌÂÈÒÓÂÙ·È Ë ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘ Û˘Ì·ıËÙÈÎÔ‡ [77]. µ·ÛÈÎÔ› ÛÙfi¯ÔÈ Î·Ú‰È·Î‹˜ ·ÔηٿÛÙ·Û˘ ÛÙËÓ Î·Ú‰È·Î‹ ·Ó¿ÚÎÂÈ· [78]. ñ ∫·ıÔÚÈÛÌfi˜ ÎÏÈÓÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ Î·È Î·ÙËÁÔÚ›·˜ ÎÈÓ‰‡ÓÔ˘ ñ £Âڷ›· Ù˘ ˘ÔΛÌÂÓ˘ ÓfiÛÔ˘ Ù˘ ηډȷ΋˜ ·Ó¿ÚÎÂÈ·˜ (˘¤ÚÙ·ÛË, ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ˜, ÎÔÏÈ΋ Ì·ÚÌ·Ú˘Á‹, ‚·Ï‚ȉÈ΋ ÓfiÛÔ˜) Î·È ‰ÈfiÚıˆÛË Û˘Ó·ÊÒÓ ÂÈ‚·Ú˘ÓÙÈÎÒÓ Î·Ù·ÛÙ¿ÛÂˆÓ (¤ÏÏÂÈ„Ë Û˘ÌÌfiÚʈÛ˘ ÛÙË Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹, ¯Ú‹ÛË ÌË ÛÙÂÚÔÂȉÒÓ ·ÓÙÈÊÏÂÁÌÔÓˆ‰ÒÓ Ê·ÚÌ¿ÎˆÓ Î·È COX-2 ·Ó·ÛÙÔϤˆÓ, ÏÔÈÌÒ͈Ó, Ó¢ÌÔÓÈ΋˜ ÂÌ‚ÔÏ‹˜, ‰È·ÈÙÔÏÔÁÈÎÒÓ Û˘ÓËıÂÈÒÓ, ¤ÏÏÂÈ„Ë Ê˘ÛÈ΋˜ ¿ÛÎËÛ˘, ˘ÂÚı˘ÚÂÔÂȉÈÛÌÔ‡) ñ ∫·Ù¿ÏÏËÏË Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ Û‡Ìʈӷ Ì ÙȘ ηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ ñ ∞ÓÙÈÌÂÙÒÈÛË ÙˆÓ Û¯ÂÙÈ˙fiÌÂÓˆÓ Ì ÙËÓ Î·Ú‰È·Î‹ ·Ó¿ÚÎÂÈ· ÓfiÛˆÓ ñ ŒÓÙ·ÍË Û˘Ó¯ԇ˜ ÚÔÁÚ¿ÌÌ·ÙÔ˜ Ê˘ÛÈ΋˜ ¿ÛÎËÛ˘ Î·È ·ÔηٿÛÙ·Û˘. ñ ŒÓÙ·ÍË ÛÂ Û˘Ó¯¤˜ ÚfiÁÚ·ÌÌ· ÂÈÌfiÚʈÛ˘ Î·È Û˘Ì‚Ô˘Ï¢ÙÈ΋˜ ÓÔÛËÏ¢ÙÈ΋˜ ñ æ˘¯ÔÏÔÁÈ΋ ˘ÔÛÙ‹ÚÈÍË ñ ∫·Ù Ô›ÎÔÓ ÓÔÛËÏ›· Î·È Û˘Ì‚Ô˘Ï¢ÙÈ΋ ™˘ÛÙ¿ÛÂȘ ÁÈ· ÕÛÎËÛË ÛÙËÓ Î·Ú‰È·Î‹ ·Ó¿ÚÎÂÈ· ñ ™˘ÌÌÂÙÔ¯‹ Û ¿ÛÎËÛË ÌÔÚ› Ó· Û˘ÛÙËı› Û ·ÛıÂÓ›˜ ÛÂ
29
ATHIROSK 21-
05-03-09
12:25
ª ∞ ƒ ∆ π √ ™
™ÂÏ›‰·30
2 0 0 9
ÛÙ¿‰ÈÔ π-ππ, ÂÊfiÛÔÓ ·Ú·Ì¤ÓÔ˘Ó ÛÙ·ıÂÚÔ›, Û ηٿ ÚÔÙ›ÌËÛË Û˘ÁÎÂÎÚÈ̤ÓÔ ÚfiÁÚ·ÌÌ· ¿ÛÎËÛ˘, ηٿ ÙÔ ÔÔ›Ô Ë Î·Ú‰È·Î‹ Û˘¯ÓfiÙËÙ· Ó· Î˘Ì·›ÓÂÙ·È ¤ˆ˜ 70-85% Ù˘ ̤ÁÈÛÙ˘ ‹ ¤ˆ˜ ÙËÓ ÂÌÊ¿ÓÈÛË Ì¤ÙÚÈ·˜ ‰‡ÛÓÔÈ·˜. √È ·ÛıÂÓ›˜ Ì ηډȷ΋ ·Ó¿ÚÎÂÈ· ÌÔÚ› Ó· ¢ÂÚÁÂÙËıÔ‡Ó Î·È ·fi Û˘ÌÌÂÙÔ¯‹ Û ÚÔÁÚ¿ÌÌ·Ù· ¿ÛÎËÛ˘ ·ÓÙ›ÛÙ·Û˘ Ô˘ ÂÓ‰˘Ó·ÌÒÓÔ˘Ó ÙÔ Ì˘˚Îfi Û‡ÛÙËÌ·. ñ √È ·ÛıÂÓ›˜ ÌÂ Û˘ÌÙÒÌ·Ù· ËÚÂÌ›·˜ (NYHA class IV) Î·È ÔÈ ·ÛıÂÓ›˜ Û ÚÔ¯ˆÚË̤ÓÔ ÛÙ¿‰ÈÔ NYHA class III ‰ÂÓ Ú¤ÂÈ Ó· ÂÓ·Û¯ÔÏËıÔ‡Ó Ì ¿ÛÎËÛË Ì¤¯ÚÈ ÂÚÈÔÚÈÛÌÔ‡ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙÔ˘˜. °È·Ù› ·Ú·ÙËÚÂ›Ù·È ·˘ÍË̤ÓÔ˜ ΛӉ˘ÓÔ˜ ηډȷÁÁÂÈ·ÎÒÓ ˘Ì‚·Ì¿ÙˆÓ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙËÓ ¿ÛÎËÛË. ∫·Ù¿ ÙËÓ ¿ÛÎËÛË Ù· ΢ÎÏÔÊÔÚÔ‡ÓÙ· ›‰· ηÙ¯ÔÏ·ÌÈÓÒÓ ÌÔÚ› Ó· ‰ÂηÂÓÙ·Ï·ÛÈ·ÛÙÔ‡Ó Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ¿ÛÎËÛ˘, Ù· ›‰· Ï¿ÛÌ·ÙÔ˜ Î·Ï›Ô˘ Ó· ‰ÈÏ·ÛÈ·ÛÙÔ‡Ó Î·È ÙÔ p∏ ·›Ì·ÙÔ˜ Ó· ÌÂȈı› ηٿ 0,4. ∏ ·‰ÚÂÓÂÚÁÈ΋ ‰È¤ÁÂÚÛË Ô˘ Û˘Ì‚·›ÓÂÈ Î·Ù¿ ÙËÓ ¿ÛÎËÛË ·˘Í¿ÓÂÈ ÙËÓ Â›ÛÔ‰Ô Ca ηٿ ÙËÓ ·Ó·fiψÛË ÌÂÈÒÓÔÓÙ·˜ ÙÔ ‰˘Ó·ÌÈÎfi ÂÓÂÚÁ›·˜ Û ˘„ËÏ‹ ÂÍˆÎ˘ÙÙ¿ÚÈ· Û˘ÁΤÓÙÚˆÛË ∫, ÌÂÈÒÓÔÓÙ·˜ ÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ·Û‚ÂÛÙÈÔ-ÂÍ·ÚÙÒÌÂÓˆÓ ÌÂÙ·-ÂÎÔÏÒÛˆÓ. √ ΛӉ˘ÓÔ˜ ÂÌÊ¿ÓÈÛ˘ ·ÚÚ˘ıÌÈÒÓ ˘¿Ú¯ÂÈ Ì ÙË ‰È·ÎÔ‹ Ù˘ ¿ÛÎËÛ˘ ηıÒ˜ Ù· ›‰· ∫ Ï¿ÛÌ·ÙÔ˜ ÂÈÛÙÚ¤ÊÔ˘Ó ÛÂ Ê˘ÛÈÔÏÔÁÈ-
Τ˜ ¤ˆ˜ ¯·ÌËϤ˜ ÙÈ̤˜, ÂÓÒ Ù· ›‰· ηÙ¯ÔÏ·ÌÈÓÒÓ ·Ú·Ì¤ÓÔ˘Ó ˘„ËÏ¿. ™Â ·Á‡ÌÓ·ÛÙ· ¿ÙÔÌ· Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È Û ¤ÓÙÔÓË ¿ÛÎËÛË ·Ú·ÙËÚÂ›Ù·È ·˘ÍË̤ÓË Û˘ÁÎÔÏÏËÙÈÎfiÙËÙ· ·ÈÌÔÂÙ·Ï›ˆÓ, Ì›ˆÛË ÂȤ‰ˆÓ Ì·ÁÓËÛ›Ô˘, ·‡ÍËÛË ÙˆÓ Î·Ù¯ÔÏ·ÌÈÓÒÓ Î·È ‰È·Ù·Ú·Á̤ÓË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· ·Ú·Û˘Ì·ıËÙÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ηıÒ˜ Î·È Û·ÛÌfi˜ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÚÙËÚÈÒÓ. ∆· ·Ú·¿Óˆ Á›ÓÔÓÙ·È ÈÔ ¤ÓÙÔÓ· Â¿Ó ˘¿Ú¯ÂÈ Ì˘Ôηډȷ΋ ÈÛ¯·ÈÌ›·, ·˘Í¿ÓÔÓÙ·˜ ÙËÓ Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ Î·È ÔͤԘ ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ôηډ›Ô˘ [79, 80]. ÕıÏËÛË Î·È ·ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜ ∏ ÂÙ‹ÛÈ· ›وÛË ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ ηٿ ÙËÓ ¿ıÏËÛË ˘ÔÏÔÁ›˙ÂÙ·È Û ÂÚ›Ô˘ 2.1 ·Ó¿ 100000 ·ıÏÔ‡ÌÂÓÔ˘˜ (Veneto region) Ì ηٷÓÔÌ‹ ¿Ó‰Ú˜/Á˘Ó·›Î˜: 10/1 ∞fi Ù· 1,5 ÂÎ ÔͤԘ ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ôηډ›Ô˘ Ô˘ ηٷÁÚ¿ÊÔÓÙ·È ÙÔ ¯ÚfiÓÔ Ù· 75.000 ¤¯Ô˘Ó Û˘Ì‚Â› Û‡ÓÙÔÌ· ÌÂÙ¿ ¿ÛÎËÛË. ™Â ËÏÈ˘ <30 ÂÙÒÓ Ê·›ÓÂÙ·È Ó· ÔÊ›ÏÂÙ·È Û ‰ÔÌÈΤ˜ ÓfiÛÔ˘˜, ÂÓÒ >30 ÂÙÒÓ Û ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ ∏ HCM ¢ı‡ÓÂÙ·È ÁÈ· ÙÔ 1/3 ÙˆÓ ı·Ó¿ÙˆÓ Û ·ıÏËÙ¤˜ ÛÙȘ ∏¶∞, ÂÓÒ ¿ÏÏ· ·›ÙÈ· Â›Ó·È Ë ·ÓÒÌ·ÏË ¤ÎÊ˘ÛË \ÔÚ›· ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÚÙËÚÈÒÓ, Ë Ì˘Ôηډ›Ùȉ·, Ë ·ÚÚ˘ıÌÈÔÁfiÓÔ˜ ‰˘ÛÏ·Û›· ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜, Ë ÚÒÈÌË ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ˜ Î·È ÙÔ Û‡Ó‰ÚÔÌÔ Marfan. ∆Ô Úfi‚ÏËÌ· Ô˘ ‰ËÌÈÔ˘ÚÁÂ›Ù·È Â›Ó·È fiÙÈ ·Ú·ÙËÚÔ‡ÓÙ·È ÔÌÔÈfiÙËÙ˜ Û ·Ú·Ì¤ÙÚÔ˘˜ Ù˘ ηډÈÔ·Ó·Ó¢ÛÙÈ΋˜ ¿ÛÎËÛ˘ ÌÂٷ͇
·ÛıÂÓÒÓ Ì HCM Î·È ·ıÏËÙÒÓ ‰˘Ó·ÌÈ΋˜ ¿ÛÎËÛ˘ [81-83]. ÃÚÂÈ¿˙ÂÙ·È È‰È·›ÙÂÚË ÚÔÛÔ¯‹ ÛÙÔÓ Î·Ú‰ÈÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô ·ÙfiÌˆÓ Ô˘ ÛÎÔÂ‡Ô˘Ó Ó· ·Û¯ÔÏËıÔ‡Ó Ì ¿ıÏËÛË. √ ¤ÏÂÁ¯Ô˜ Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ Ï‹ÚË Î·Ú‰ÈÔÏÔÁÈ΋ ÂͤٷÛË Ì ϋ„Ë ·ÙÔÌÈÎÔ‡ Î·È ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÈÛÙÔÚÈÎÔ‡ ÁÈ· ·ÚÔ˘Û›· ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ ‹ ÚÒÈÌ˘ ÂΉ‹ÏˆÛ˘ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘, Ê˘ÛÈ΋ ÂͤٷÛË ÁÈ· ·Ó¿‰ÂÈÍË Ê˘ÛËÌ¿ÙˆÓ ‹ ÂÈÚfiÛıÂÙˆÓ ·ıÔÏÔÁÈÎÒÓ ÙfiÓˆÓ, ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ· ÁÈ· ηٷÁÚ·Ê‹ ‰È·Ù·Ú·¯ÒÓ Ú˘ıÌÔ‡ ‹ ·ÁˆÁ‹˜ Î·È ÂÚ·ÈÙ¤Úˆ ‰È·ÁÓˆÛÙÈÎfi ¤ÏÂÁ¯Ô Ì ˘ÂÚ˯ÔηډÈÔÁÚ¿ÊËÌ· Î·È ‰ÔÎÈÌ·Û›· ÎfiˆÛ˘, fiÔ˘ ÎÚ›ÓÂÙ·È ··Ú·›ÙËÙÔ [84]. ™‡Ìʈӷ Ì ÙËÓ ¶·ÁÎfiÛÌÈ· √ÚÁ¿ÓˆÛË ÀÁ›·˜ Ë Ê˘ÛÈ΋ ¿ÛÎËÛË ·ÎfiÌ· Î·È Ì¤ÙÚÈ·˜ ¤ÓÙ·Û˘ (30 ÏÂÙ¿ ÙËÓ Ë̤ڷ ‚¿‰ÈÛË, ÎËÔ˘ÚÈ΋, ‰Ô˘ÏÂȤ˜ ÛÈÙÈÔ‡, ¯ÔÚfi˜) Û˘ÓÈÛÙ¿Ù·È Î·ıÒ˜: – ªÂÈÒÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ·Ó¿Ù˘Í˘ ‰È·‚‹ÙË – ƒ˘ıÌ›˙ÂÈ Ù· ›‰· Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘, – ¶ÂÚÈÔÚ›˙ÂÈ ÙÔ ·›ÛıËÌ· ηٿıÏȄ˘ Î·È ¿Á¯Ô˘˜, – µÔËı¿ ÛÙÔÓ ¤ÏÂÁ¯Ô˜ ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜, – µÔËı¿ ÛÙË ‰È·Ù‹ÚËÛË ˘ÁÈÔ‡˜ Ì˘ÔÛÎÂÏÂÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È ·ÚıÚÒÛˆÓ. – µÔËı¿ ÛÙËÓ ·ÚÌÔÓÈ΋ ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ·˘ÙfiÓÔÌÔ˘ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ – µÂÏÙÈÒÓÂÈ ÙË ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ Ì˯·ÓÈÛÌÒÓ ‹Í˘-ÈÓˆ‰fiÏ˘Û˘
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¶ƒ√∆∂π¡√ª∂¡∏ µπµ§π√°ƒ∞ºπ∞ 1. Bloomfield D, Carlson GL, Sapre A, Tribble D, McKenney JM, Littlejohn TW 3rd, Sisk CM, Mitchel Y, Pasternak RC. Efficacy and safety of the cholesteryl ester transfer protein inhibitor anacetrapib as monotherapy and coadministered with atorvastatin in dyslipidemic patients. Am Heart J. 2009 Feb;157(2):352-360.e2. 2. Almroth H, Höglund N, Boman K, Englund A, Jensen S, Kjellman B, Tornvall P, Rosenqvist M. Atorvastatin and persistent atrial fibrillation following cardioversion: a randomized placebocontrolled multicentre study. Eur Heart J. 2009 Feb 6. [Epub ahead of print] 3. Mahajan N, Bahl A, Dhawan V. Creactive protein (CRP) up-regulates expression of receptor for advanced glycation end products (RAGE) and its inflammatory ligand EN-RAGE in THP-1 cells: Inhibitory effects of atorvastatin. Int J Cardiol. 2009 Feb 5. [Epub ahead of print] 4. Goldberg AC, Bays HE, Ballantyne CM, Kelly MT, Buttler SM, Setze CM, Sleep DJ, Stolzenbach JC. Efficacy and safety of ABT-335 (fenofibric acid) in combination with atorvastatin in patients with mixed dyslipidemia. Am J Cardiol. 2009 Feb 15;103(4):515-22. 5. Charlton-Menys V, Betteridge DJ, Colhoun H, Fuller J, France M, Hitman GA, Livingstone SJ, Neil HA, Newman CB, Szarek M, Demicco DA, Durrington PN. Targets of Statin Therapy: LDL Cholesterol, Non-HDL Cholesterol, and Apolipoprotein B in Type 2 Diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS). Clin Chem. 2009 Jan 15. [Epub ahead of print] 6. Wolf MS, Shekelle P, Choudhry NK, Agnew-Blais J, Parker RM, Shrank WH. Variability in Pharmacy Interpretations of Physician Prescriptions. Med Care. 2009 Feb 4. [Epub ahead of print] 7. Brousseau ME, Millar JS, Diffenderfer MR, Nartsupha C, Asztalos BF, Wolfe ML, Mancuso JP, Digenio AG, Rader DJ, Schaefer EJ. Effects of sholesteryl ester transfer protein inhibition on apolipoprotein (apo) A-II-containing HDL dubspecies and ApoA-II metabolism. J Lipid Res. 2009 Feb 3. [Epub ahead of print] 9. Ito B, Zhang BH, Cable E, Song X, Fujitaki J, Mackenna D, Wilker C, Chi B, van Poelje P, Linemeyer D, Erion M. Thyroid hormone beta receptor activation has additive cholesterol lowering activity in combination with atorvastatin in rabbits, dogs and monkeys. Br J Pharmacol. 2009 Jan 22. [Epub ahead of print] 10. Stangier J, Rathgen K, Stähle H, Reseski K, Körnicke T, Roth W. Coadministration of dabigatran etexilate and atorvastatin: assessment of potential impact on pharmacokinetics and pharmacodynamics. Am J Cardiovasc Drugs. 2009;9(1):59-68. 11.Collins RT 2nd, Hanna B, Shaddy RE. Letter to editor in response to "Prevention of pediatric graft coronary artery disease: atorvastatin", by Chin et al. Pediatr Transplant. 2009 Feb;13(1):141. 12. Baldassarre D, Porta B, Camera M, Amato M, Arquati M, Brusoni B, Fiorentini C, Montorsi P, Romano S, Veglia F, Tremoli E, Cortellaro M; on behalf of the MIAMI Study Group. Markers of inflammation, thrombosis and endothelial activation correlate with carotid IMT regression in stable coronary disease after atorvastatin treatment. Nutr Me-
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25. Satoh M, Minami Y, Takahashi Y, Tabuchi T, Itoh T, Nakamura M. Effect of intensive lipid-lowering therapy on telomere erosion in endothelial progenitor cells obtained from patients with coronary artery disease. Clin Sci (Lond). 2008 Dec 17. [Epub ahead of print] 26. Kotyla PJ. Atorvastatin pleiotropic effects mediated via suppression of TNF-alpha in congestive heart failure patients with initial normal TNF-alpha levels. J Heart Lung Transplant. 2009 Jan;28(1):114-5. 27. Chen Z, Peng IC, Sun W, Su MI, Hsu PH, Fu Y, Zhu Y, Defea K, Pan S, Tsai MD, Shyy JY. AMP-Activated Protein Kinase Functionally Phosphorylates Endothelial Nitric Oxide Synthase Ser633. Circ Res. 2009 Jan 8. [Epub ahead of print] 28. Neutel JM, Bestermann WH, Dyess EM, Graff A, Kursun A, Sutradhar S, Yunis C. The use of a single-pill calcium channel blocker/statin combination in the management of hypertension and dyslipidemia: a randomized, placebo-controlled, multicenter study. J Clin Hypertens (Greenwich). 2009 Jan;11(1):22-30. 29. Seo M, Inoue I, Ikeda M, Nakano T, Takahashi S, Katayama S, Komoda T. Statins Activate Human PPARalpha Promoter and Increase PPARalpha mRNA Expression and Activation in HepG2 Cells. PPAR Res. 2008;2008:316306. Epub 2008 Dec 24. 30. Ray KK, Cannon CP, Cairns R, Morrow DA, Ridker PM, Braunwald E. Prognostic Utility of ApoB/AI, Total Cholesterol/HDL, Non-HDL Cholesterol, or hs-CRP as Predictors of Clinical Risk in Patients Receiving Statin Therapy After Acute Coronary Syndromes. Results From PROVE IT-TIMI 22. Arterioscler Thromb Vasc Biol. 2009 Jan 2. [Epub ahead of print] 31. Stanworth RD, Kapoor D, Channer KS, Jones TH. Statin therapy is associated with lower total but not bioavailable or free testosterone in men with type 2 diabetes. Diabetes Care. 2008 Dec 29. [Epub ahead of print] 32. Gros M, Petrovi_ M, Barcel_ D. Tracing pharmaceutical residues of different therapeutic classes in environmental waters by using liquid chromatography/ quadrupole-linear ion trap mass spectrometry and automated library searching. Anal Chem. 2009 Feb 1;81(3):898-912. 33. Nagassaki S, Herculano RD, Graeff CF, Tanus-Santos JE. eNOS T-786C polymorphism affects atorvastatin-induced changes in erythrocyte membrane fluidity. Eur J Clin Pharmacol. 2008 Dec 23. [Epub ahead of print] 34. Aliabadi AZ, Mahr S, Dunkler D, Grömmer M, Zimpfer D, Wolner E, Grimm M, Zuckermann AO. Safety and efficacy of statin therapy in patients switched from cyclosporine a to sirolimus after cardiac transplantation. Transplantation. 2008 Dec 27;86(12):1771-6. 35. Williams B, Lacy PS, Cruickshank JK, Collier D, Hughes AD, Stanton A, Thom S, Thurston H; CAFE and ASCOT Investigators. Impact of statin therapy on central aortic pressures and hemodynamics: principal results of the Conduit Artery Function Evaluation-Lipid-Lowering Arm (CAFE-LLA) Study. Circulation. 2009 Jan 6;119(1):53-61.
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