ΤΕΥΧΟΣ 4 ΔΕΚΕΜΒΡΙΟΣ 2004 - ΑΘΗΡΟΣΚΛΗΡΩΣΗ

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∏ ™ÙÂÊ·ÓÈ·›· ¡fiÛÔ˜ Û ۯ¤ÛË Ì ÙËÓ ÎÔÈÓˆÓÈ΋ ÛÙ‹ÚÈÍË Î·È ÙËÓ ÎÔÈÓˆÓÈ΋ Ù¿ÍË Û ™Ô˘Ë‰Ô‡˜ ¿Ó‰Ú˜. ªÈ· 15ÂÙ‹˜ ·Ú·ÎÔÏÔ‡ıËÛË ÛÙË ÌÂϤÙË ÙˆÓ ·Ó‰ÚÒÓ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÙÔ 1933 Rosengren A., Wilhelmsen L., Orth-Gomér K. – Eur Heart J 2004; 25:56-63 EÈ̤ÏÂÈ·: HÏ›·˜ XÂÈÌÒÓ·˜

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KÔÏÔ‚Ô‡ °ÂÓÔ‚¤Ê· K·Ú‰ÈÔÏfiÁÔ˜ YԉȢı‡ÓÙÚÈ· A’ K·Ú‰ÈÔÏÔÁÈ΋˜

¶A£OºY™IO§O°IA ÕÓ‰Ú˜ ∂ÙÂÚÔ˙˘ÁÒÙ˜ ˆ˜ ÚÔ˜ ÙËÓ √ÈÎÔÁÂÓ‹ ÀÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· (FH) ÌÔÚ› Ó· ¤¯Ô˘Ó ¶·ıÔÏÔÁÈ΋ ªÂÙ·ÁÂ˘Ì·ÙÈ΋ ∞¿ÓÙËÛË ∆ÚÈÁÏ˘ÎÂÚȉ›ˆÓ: ŒÓ·˜ ¿ÏÏÔ˜ ÚÔÁÓˆÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÛÙËÓ FH Kolovou G, Anagnostopoulou K, Pilatis N, Iraklianou S, Hoursalas I, Liberi S, Pavlidis A, Dritsas A, Mikhailidis D, Cokkinos D.V. – Int J Clin Pract 2004 (in press)

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ªÂÙ·‚ÔÏÈÛÌfi˜ Ù˘ HDL °ÂÓÔ‚¤Ê· ¢. ∫ÔÏÔ‚Ô‡, ∫·ÙÂÚ›Ó· ∫. ∞Ó·ÁÓˆÛÙÔÔ‡ÏÔ˘, ∞ÓÙÒÓ˘ ¡. ¶·˘Ï›‰Ë˜

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∏ ÈηÓfiÙËÙ· ¿ÛÎËÛ˘ Î·È Ë Â¿ÓÔ‰Ô˜ Ù˘ ηډȷ΋˜ Û˘¯ÓfiÙËÙ·˜ ˆ˜ ÚÔÁÓˆÛÙÈÎÔ› ‰Â›ÎÙ˜ ÛÙÂÊ·ÓÈ·›ˆÓ ÂÂÈÛÔ‰›ˆÓ Û ·ÛıÂÓ›˜ Ì ÂÙÂÚfi˙˘ÁÔ ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· Pitsavos CH, Chrysohoou C, Panagiotakos DB, Kokkinos P, Skoumas J, Papaioannou I, Michaelides AP, Singh S, Stefanadis CI. – Atherosclerosis 2004;173:347-352 – EÈ̤ÏÂÈ·: HÏ›·˜ XÂÈÌÒÓ·˜

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¶ÚÔÁÓˆÛÙÈ΋ ·Í›· ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ˘ÔÏÂÈÌÌ·ÙÔÂȉÒÓ ÏÈÔÚˆÙÂ˚ÓÈÎÒÓ ÌÔÚ›ˆÓ Û ·ÛıÂÓ›˜ Ì ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ Î·È Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ ππ Fukushima H. MD, Sugiyama S. MD, PHD, Honda O. MD, Koide S. MD, Nakamura S. MD, Sakamoto T. MD, PHD, Yoshimura M. MD, PHD, Ogawa H. MD, PHD, Fujioka D. MD, Kugiyama K. MD. PHD. J Am Coll Cardiol 2004;43:2219-24 – EÈ̤ÏÂÈ·: HÏ›·˜ XÂÈÌÒÓ·˜

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∏ ÌÂȈ̤ÓË ÂÓ‰·ÁÁÂȷ΋ ÏÈfiÏ˘ÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ Û˘ÓÈÛÙ¿ ¤Ó· ‰Â›ÎÙË Ù˘ ÎÏÈÓÈ΋˜ ¤Î‚·Û˘ ÙˆÓ ·ÛıÂÓÒÓ Ì ÛÙ·ıÂÚ‹ ÛÙËı¿Á¯Ë ˘fi ·ÁˆÁ‹ ‰Â˘ÙÂÚÔ·ıÔ‡˜ ÚfiÏ˄˘. ªÈ· ÌÂϤÙË Ì·ÎÚÔ¯ÚfiÓÈ·˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ Sopito AC, Lemos PA, Santos RD, Hueb W, Vinagre CGC, Quintella E, Carneiro O, Chapman MJ, Ramires AF, Maranhao RC. – J Am Coll Cardiol 2004;43:2225-32 – EÈ̤ÏÂÈ·: HÏ›·˜ XÂÈÌÒÓ·˜

K§INIKE™ ME§ETE™

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¶ÚˆÙÔ·ı‹˜ ÚfiÏË„Ë ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ Ì ·ÙÔÚ‚·ÛÙ·Ù›ÓË Û ‰È·‚ËÙÈÎÔ‡˜ Ù‡Ô˘ 2 ÛÙËÓ Collaborative Atorvastatin Diabetes Study (CARDS): ÔÏ˘ÎÂÓÙÚÈ΋, Ù˘¯·ÈÔÔÈË̤ÓË, ÂÏÂÁ¯fiÌÂÓË Ì ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ ÌÂϤÙË Colhoun HM, Betteridge DJ, Durrington PN, Hitman GA, Neil HAW, Livingstone SJ, Thomason MJ, Mackness MI, Charlton-Menys V, Fuller JH, ÂΠ̤ÚÔ˘˜ ÙˆÓ ÂÚ¢ÓËÙÒÓ Ù˘ ÌÂϤÙ˘ CARDS Lancet 2004;364:685-96 – EÈ̤ÏÂÈ· HÏ›·˜ XÂÈÌÒÓ·˜

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∏ ¶·È‰È·ÙÚÈ΋ ªÂϤÙË. ∞ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Î·È ∞ÛÊ¿ÏÂÈ· Ù˘ ∞ÙÔÚ‚·ÛÙ·Ù›Ó˘ Û ¶·È‰È¿ Î·È ∂Ê‹‚Ô˘˜ Ì √ÈÎÔÁÂÓ‹ ÀÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· ‹ ™Ô‚·Ú‹ ÀÂÚÏÈȉ·ÈÌ›· McCrindle BW, Ose L, Marais AD. – THE JOURNAL OF PEDIATRICS 2003;143 Number 1 EÈ̤ÏÂÈ·: EϤÓË MÈÏÈ·ÓÔ‡

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KÏÈÓÈ΋˜ Î·È ˘‡ı˘ÓÔ˜ §Èȉ·ÈÌÈÎÔ‡ I·ÙÚ›Ԣ øÓ·Û›Ԣ K·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈÎÔ‡ K¤ÓÙÚÔ˘

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¶›ÙÛ·‚Ô˜ XÚ‹ÛÙÔ˜ AÓ·ÏËÚˆÙ‹˜ K·ıËÁËÙ‹˜ K·Ú‰ÈÔÏÔÁ›·˜, I·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ IÔÎÚ¿ÙÂÈÔ NÔÛÔÎÔÌÂ›Ô AıËÓÒÓ

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O ÚfiÏÔ˜ ÙˆÓ Ê˘ÙÈÎÒÓ ÈÓÒÓ ÛÙËÓ ÚfiÏË„Ë Ù˘ ™ÙÂÊ·ÓÈ·›·˜ ¡fiÛÔ˘ µ·Û›ÏÂÈÔ˜ ∆˙Ô‚¿Ú·˜, ∂ÏÈÛ¿Ê ªˆ˘Û‹˜

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£EPA¶EIA — ºAPMAKA ™˘ÁÎÚÈÙÈ΋ ªÂϤÙË Ù˘ ∞ÙÔÚ‚·ÛÙ·Ù›Ó˘, Ù˘ ™ÈÌ‚·ÛÙ·Ù›Ó˘ Î·È Ù˘ º·ÈÓÔÊÈÌÚ¿Ù˘ ÛÙ· ∂›‰· Ù˘ √ÌÔ΢ÛÙ½Ó˘ ÙÔ˘ √ÚÔ‡ Û ∞ÛıÂÓ›˜ Ì ¶ÚˆÙÔ·ı‹ ÀÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· ªËÏÈÒÓ˘ ÷ڿϷÌÔ˜, ∫·Î·Ê‹Î· ÕÓÓ·, ÷ÛÈÒÙ˘ °ÂÒÚÁÈÔ˜, ™ÂÊÂÚÈ¿‰Ë˜ ∫ˆÓÛÙ·ÓÙ›ÓÔ˜, ∂ÏÈÛ¿Ê ªˆ˘Û‹˜ J Clin Pharmacol 2003; 43: 825-830

™Y°XPONE™ O¢H°IE™

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™˘Ó¤ÂȘ ÙˆÓ ÚfiÛÊ·ÙˆÓ ÎÏÈÓÈÎÒÓ ÌÂÏÂÙÒÓ ÁÈ· ÙȘ Ô‰ËÁ›Â˜ Ù˘ 3˘ ¤Î‰ÔÛ˘ (∞∆ƒ πππ) ÙÔ˘ ∂ıÓÈÎÔ‡ ¶ÚÔÁÚ¿ÌÌ·ÙÔ˜ ∂ÈÌfiÚʈÛ˘ ÁÈ· ÙË ÃÔÏËÛÙÂÚfiÏË (NCEP) Grundy SM, Cleeman JI, Merz CNB, Brewer HB, Clark LT, Hunninghake DB, Pasternak RC, Smith SC, Stone NJ, for the Coordinating Committee of the National Cholesterol Education Program.

J Am Coll Cardiol 2004;44:720-32 – EÈ̤ÏÂÈ·: HÏ›·˜ XÂÈÌÒÓ·˜

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∞ÔÙÂϤÛÌ·Ù· ÙˆÓ ‰˘ÓËÙÈο ÙÚÔÔÔÈ‹ÛÈÌˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘, Û 52 ¯ÒÚ˜ (Ë ÌÂϤÙË INTERHART): ÌÂϤÙË ·ÛıÂÓÒÓ – Ì·ÚÙ‡ÚˆÓ Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, McQueen M, Budaj A, Pais P, Varigos J, Lisheng L, on behalf of the INTERHART Study Investigators Lancet 2004;364:937– 52

2

Τ˜ ÂÚÈÔ¯¤˜, ·Ó¿ÏÔÁ· Ì ÙËÓ ÂıÓÈ΋ ÚԤϢÛË ÙˆÓ ÏËı˘ÛÌÒÓ ‹ ·Ó¿ÌÂÛ· ÛÙ· ‰‡Ô ʇϷ ‹ ÛÙȘ ‰È¿ÊÔÚ˜ ËÏÈÎȷΤ˜ ÔÌ¿‰Â˜. µ·ÛÈÎfi˜ ‰Â˘ÙÂÚ‡ˆÓ ÛÎÔfi˜ ‹Ù·Ó Ë ÂÎÙ›ÌËÛË ÙÔ˘ ·ԉȉfiÌÂÓÔ˘ ÎÈÓ‰‡ÓÔ˘ Û ÏËı˘ÛÌÈ·Îfi Â›Â‰Ô (Population Attributable Risk – PAR) ÁÈ· οı ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ¯ˆÚÈÛÙ¿ Î·È ÁÈ· ÙÔÓ Û˘Ó‰˘·ÛÌfi ÙÔ˘˜ Û fiÏÔÓ ÙÔÓ ÏËı˘ÛÌfi Î·È ÛÙȘ ˘Ô-ÔÌ¿‰Â˜. ∏ ÌÂϤÙË ÂÈÎÂÓÙÚÒıËΠ۠9 ‡ÎÔÏ· ÌÂÙÚ›ÛÈÌÔ˘˜ ÂÈ‚·Ú˘ÓÙÈÎÔ‡˜ ‹ ÚÔÛٷ٢ÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ (οÓÈÛÌ·, ÏÈ›‰È·, ˘¤ÚÙ·ÛË, ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË, ·¯˘Û·ÚΛ·, ‰›·ÈÙ·, Ê˘ÛÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ·, ηٷӿψÛË

ÔÈÓÔÓ‡̷ÙÔ˜ Î·È „˘¯ÔÎÔÈÓˆÓÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜). ¢È·ÈÛÙÒıËΠfiÙÈ ÁÂÓÈο ÙÔ ÚÒÙÔ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘ Û˘Ì‚·›ÓÂÈ 9 ¯ÚfiÓÈ· ÂÓˆÚ›ÙÂÚ· ÛÙÔ˘˜ ¿Ó‰Ú˜ Û ۇÁÎÚÈÛË Ì ÙȘ Á˘Ó·›Î˜. ™ÙËÓ ∞Û›· Ë ‰È¿ÌÂÛË ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ Â›Ó·È 53 ÂÙÒÓ, ÛÙË ª¤ÛË ∞Ó·ÙÔÏ‹ 51 ÂÓÒ ÛÙË ∂˘ÚÒË Î·È ÙËÓ ∫›Ó· 63. ∏ ·Ó·ÏÔÁ›· ·Ó‰ÚÒÓ ÚÔ˜ Á˘Ó·›Î˜ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË ÛÙȘ ¯ÒÚ˜ Ô˘ ÙÔ ¤ÌÊÚ·ÁÌ· ÂÌÊ·Ó›˙ÂÙ·È Û ÓÂfiÙÂÚË ËÏÈΛ·: 85% ÙË ¡fiÙÈ· ∞Û›·, 86% ÛÙË ª¤ÛË ∞Ó·ÙÔÏ‹, 74% ÛÙË ¢˘ÙÈ΋ ∂˘ÚÒË, 68% ÛÙËÓ ∫ÂÓÙÚÈ΋ Î·È ∞Ó·ÙÔÏÈ΋ ∂˘ÚÒË Î·È 70% ÛÙËÓ ∫›Ó·. ∏ ÌÂÁ·Ï‡ÙÂÚË ·Ó·ÏÔÁ›· Ó¤ˆÓ ÌÂ

8 §fiÁÔ˜ Èı·ÓÔÙ‹ÙˆÓ ÎÈÓ‰‡ÓÔ˘ (99% Cl)

√È ÁÓÒÛÂȘ Ô˘ ¤¯Ô˘Ì ̤¯ÚÈ Û‹ÌÂÚ· ÁÈ· ÙËÓ ÚfiÏË„Ë ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÌÂϤÙ˜ Ô˘ ¤ÁÈÓ·Ó Û ÏËı˘ÛÌÔ‡˜ Ù˘ ∂˘ÚÒ˘ Î·È Ù˘ µfiÚÂÈ·˜ ∞ÌÂÚÈ΋˜ Î·È ‰ÂÓ Â›Ó·È ‚¤‚·ÈÔ ·Ó Ù· Â˘Ú‹Ì·Ù· ÙˆÓ ÌÂÏÂÙÒÓ ·˘ÙÒÓ ÈÛ¯‡Ô˘Ó ÁÈ· ÏËı˘ÛÌÔ‡˜ ¿ÏÏˆÓ ¯ˆÚÒÓ. ∫¿ÔÈ· Â˘Ú‹Ì·Ù· ‰Â›¯ÓÔ˘Ó fiÙÈ ÔÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ ‰È·Ê¤ÚÔ˘Ó ÌÂٷ͇ ÙˆÓ Ï·ÒÓ. À¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ fiÙÈ ‰È·Ù·Ú·¯¤˜ ÙˆÓ ÏÈȉ›ˆÓ ‰ÂÓ Â›Ó·È ‚Ï·ÙÈΤ˜ Û ηÙÔ›ÎÔ˘˜ Ù˘ ¡fiÙÈ·˜ ∞Û›·˜ Î·È fiÙÈ Ë ·ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË ÌÔÚ› Ó· ·›˙ÂÈ Ôχ ÈÔ ÛÔ˘‰·›Ô ÚfiÏÔ ÛÙÔ˘˜ ∫ÈÓ¤˙Ô˘˜ ·fi fiÙÈ Û ¿ÏÏÔ˘˜ Ï·Ô‡˜. °È· ‰ÈÂÚ‡ÓËÛË Ù˘ ÛËÌ·Û›·˜ ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÛÙÔ˘˜ ‰È¿ÊÔÚÔ˘˜ ÏËı˘ÛÌÔ‡˜ Ù˘ Á˘ ¤ÁÈÓ ÌÈ· ÌÂÁ¿ÏË ÌÂϤÙË Û 262 ΤÓÙÚ·, Û 52 ¯ÒÚ˜ Î·È ÛÙȘ 5 Ë›ÚÔ˘˜. ∂›Ó·È ÌÂϤÙË ·ÛıÂÓÒÓ – Ì·ÚÙ‡ÚˆÓ Ô˘ ÂÚȤϷ‚ 15.152 ·ÛıÂÓ›˜ Ì ÚÒÙÔ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘ Î·È 14.820 Ì¿ÚÙ˘Ú˜ ›‰È·˜ ËÏÈΛ·˜ Î·È Ê‡ÏÔ˘ Ì ÙÔ˘˜ ·ÛıÂÓ›˜ ·ÏÏ¿ ¯ˆÚ›˜ ÈÛÙÔÚÈÎfi ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘. ¶ÚˆÙ‡ˆÓ ÛÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ó· ‰ÈÂÚ¢ӋÛÂÈ fiÛÔ ÈÛ¯˘Ú‹ Â›Ó·È Ë Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙˆÓ ‰È·ÊfiÚˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ Î·È ÙÔ˘ ÔͤԘ ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ôηډ›Ô˘ Û fiÏÔÓ ÙÔÓ ÏËı˘ÛÌfi Ù˘ ÌÂϤÙ˘ Î·È ·Ó Ë Û¯¤ÛË ·˘Ù‹ ‰È·Ê¤ÚÂÈ ÛÙȘ ‰È¿ÊÔÚ˜ ÁˆÁÚ·ÊÈ-

4

2

1 0,75 1

2

3

4

5

6

7

8

9

10

∫Ï¿ÛÌ· ApoB/A1 ratio (‰ÂηÙËÌfiÚÈ·) ∞ÚÈıÌfi˜ ·ÙfiÌˆÓ ÂϤÁ¯Ô˘ 1210 1206 1208 1207 1210 1209 1207 1208 1208 1209 ∞ÚÈıÌfi˜ ·ÛıÂÓÒÓ 435 496 610 720 790 893 1063 1196 1366 1757 ¢È¿ÌÂÛË ÙÈÌ‹ 0,43 0,53 0,60 0,66 0,72 0,78 0,85 0,93 1,04 1,28

∂ÈÎfiÓ· 1: ™˘Û¯¤ÙÈÛË ÙÔ˘ ÏfiÁÔ˘ ApoB/ApoA1 Î·È ÙÔ˘ ÏfiÁÔ˘ Èı·ÓÔÙ‹ÙˆÓ ÎÈÓ‰‡ÓÔ˘ (Odds ratio).

§fiÁÔ˜ Èı·ÓÔÙ‹ÙˆÓ ÎÈÓ‰‡ÓÔ˘ (99% Cl)

E¶I¢HMIO§O°IA – ¶APA°ONTE™ KIN¢YNOY 16

8

4

2

1 ∫·ıfiÏÔ˘ 1-5

6-10 11-15 16-20

21-25 26-30 31-40

>41

∞ÚÈıÌfi˜ ÙÛÈÁ¿ÚˆÓ ·Ó¿ Ë̤ڷ ∞ÚÈıÌfi˜ ·ÙfiÌˆÓ ÂϤÁ¯Ô˘ 7489 ∞ÚÈıÌfi˜ ·ÛıÂÓÒÓ 4223 §fiÁÔ˜ Èı·ÓÔÙ‹ÙˆÓ ÎÈÓ‰‡ÓÔ˘ 1

727 469

1031 1021

1,38

2,10

446 623

1058 1832

2,99

96 254

3,83

230 538

5,80

168 459

5,26

6,34

56 218 9,16

∂ÈÎfiÓ· 2: ™˘Û¯¤ÙÈÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÙÛÈÁ¿ÚˆÓ Ô˘ ηÓ›˙ÔÓÙ·È ·Ó¿ Ë̤ڷ Ì ÙÔÓ ÏfiÁÔ Èı·ÓÔÙ‹ÙˆÓ ÎÈÓ‰‡ÓÔ˘.

¤ÌÊÚ·ÁÌ· ·Ú·ÙËÚÂ›Ù·È ÛÙËÓ ∞ÊÚÈ΋, ÙË ª¤ÛË ∞Ó·ÙÔÏ‹ Î·È ÛÙË ¡fiÙÈ· ∞Û›·. ŸÏÔÈ ÔÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ¤¯Ô˘Ó ÛÙ·ÙÈÛÙÈο Ôχ ÛËÌ·ÓÙÈ΋ Û¯¤ÛË Ì ÙÔ Ô͇ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘ ÛÙÔ Â›Â‰Ô ÙÔ˘ ƒ<0,0001, ÂÎÙfi˜ ·fi ÙËÓ Î·Ù·Ó¿ÏˆÛË ·ÏÎÔfiÏ Ô˘

¶·Ú¿ÁˆÓ ÎÈÓ‰‡ÓÔ˘

º‡ÏÔ √Ì¿‰Â˜

√Ì¿‰·

¤¯ÂÈ ·ÛıÂÓ¤ÛÙÂÚË Û˘Û¯¤ÙÈÛË (ƒ=0,03). √ ÈÛ¯˘ÚfiÙÂÚÔ˜ ·Ú¿ÁˆÓ ÎÈÓ‰‡ÓÔ˘ Â›Ó·È Ô ÏfiÁÔ˜ ApoB/ApoA1 Ì ÏfiÁÔ Èı·ÓÔÙ‹ÙˆÓ ÎÈÓ‰‡ÓÔ˘ (odds ratio) 3,25 (ÙÔ 5Ô ÚÔ˜ ÙÔ 1Ô ÂÌÙËÌfiÚÈÔ). ∏ Û˘Û¯¤ÙÈÛË ÙÔ˘ ÏfiÁÔ˘ ApoB/ ApoA1 Ì ÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊÚ¿ÁÌ·ÙÔ˜ Â›Ó·È ÁÚ·ÌÌÈ΋,

§fiÁÔ˜ ÎÈÓ‰‡ÓÔ˘

¯ˆÚ›˜ ¤Ó‰ÂÈÍË ‡·Ú͢ Ô˘‰Ô‡ (EÈÎfiÓ· 1). ∞ÎÔÏÔ˘ı› ÙÔ Î¿ÓÈÛÌ· Ì ÏfiÁÔ Èı·ÓÔÙ‹ÙˆÓ 2,87. ∆Ô Î¿ÓÈÛÌ· 1–5 ÙÛÈÁ¿ÚˆÓ ÙËÓ Ë̤ڷ ·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊÚ¿ÁÌ·ÙÔ˜ ηٿ 40%. ∞˘Ùfi ÌÔÚ› Ó· ·Î˘ÚÒÛÂÈ ÙÔ Â˘ÂÚÁÂÙÈÎfi ·ÔÙ¤ÏÂÛÌ· Ù˘ ‰Â˘ÙÂÚÔ·ıÔ‡˜ ÚfiÏ˄˘ fiˆ˜ Ù˘ ·ÛÈÚ›Ó˘ Ô˘ ÌÂÈÒÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ Î·Ù¿ 20% ‹ Ó· ÂÍ·Ê·Ó›ÛÂÈ ÙÔ 75% Ù˘ ˆÊ¤ÏÂÈ· ·fi ÙË Ï‹„Ë ÛÙ·Ù›Ó˘. √ ΛӉ˘ÓÔ˜ ·˘Í¿ÓÂÈ ·Ó¿ÏÔÁ· Ì ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÙÛÈÁ¿ÚˆÓ (EÈÎfiÓ· 2) Î·È Á›ÓÂÙ·È 9,2 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔ˜ ÛÙÔ˘˜ ηÓÈÛÙ¤˜ > 40 ÙÛÈÁ¿ÚˆÓ ÙËÓ Ë̤ڷ. √ ΛӉ˘ÓÔ˜ ÛÙÔ˘˜ ‰È·‚ËÙÈÎÔ‡˜ Â›Ó·È 2,37 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔ˜ Î·È ÛÙÔ˘˜ ˘ÂÚÙ·ÛÈÎÔ‡˜ 1,91 ÊÔÚ¤˜. √ ¢Â›ÎÙ˘ ª¿˙·˜ ™ÒÌ·ÙÔ˜ Û¯ÂÙ›˙ÂÙ·È Â›Û˘ ÛËÌ·ÓÙÈο Ì ÙÔ ¤ÌÊÚ·ÁÌ·, Ë Û˘Û¯¤ÙÈÛË ÙÔ˘ fï˜ Â›Ó·È ·ÛıÂÓ¤ÛÙÂÚË ·fi ·˘Ù‹Ó Ù˘ ÎÔÈÏȷ΋˜ ·¯˘Û·ÚΛ·˜ (ÏfiÁÔ˜ ÂÚÈ̤ÙÚÔ˘ ̤Û˘ ÚÔ˜ ÂÚ›ÌÂÙÚÔ ÁÔÊÒÓ). ∏ ËÌÂÚ‹ÛÈ· ηٷӿψÛË ÊÚÔ‡ÙˆÓ Î·È Ï·¯·ÓÈÎÒÓ, Ë Ì¤ÙÚÈ· ‹

PAR (99% Cl)

ÂϤÁ¯Ô˘ (%) ·ÛıÂÓÒÓ (%) (99% Cl) ∫¿ÓÈÛÌ·

¢È·‚‹Ù˘

À¤ÚÙ·ÛË

F

9,3

20,1

2,86 (2,36-3,48)

15,8% (12,9-19,3)

M

33,0

53,1

3,05 (2,78-3,33)

44,0% (40,9-47,2)

F

7,9

25,5

4,26 (3,51-5,18)

19,1% (16,8-21,7)

M

7,4

16,2

2,67 (2,36-3,02)

10,1% (8,9-11,4)

F

28,3

53,0

2,95 (2,57-3,39)

35,8% (32,1-39,6) 19,5% (17,7-21,5)

M

19,7

34,6

2,32 (2,12-2,53)

∫ÔÈÏȷ΋

F

33,3

45,6

2,26 (1,90-2,68)

35,9% (28,9-43,6)

·¯˘Û·ÚΛ·

M

33,3

46,5

2,24 (2,03-2,47)

32,1% (28,0-36,5)

æ˘¯ÔÎÔÈÓˆÓÈÎfi˜

F

–

–

3,49 (2,41-5,04)

40,0% (28,6-52,6)

‰Â›ÎÙ˘

M

–

–

2,58 (2,11-3,14)

25,3% (18,2-34,0)

ºÚÔ‡Ù·/Ï·¯·ÓÈο

ÕÛÎËÛË

∞ÏÎÔfiÏ

F

50,3

39,4

0,58 (0,48-0,71)

17,8% (12,9-24,1)

M

39,6

34,7

0,74 (0,66-0,83)

10,3% (6,9-15,2)

F

16,5

9,3

0,48 (0,39-0,59)

37,3% (26,1-50,0)

M

20,3

15,8

0,77 (0,69-0,85)

22,9% (16,9-30,2)

F

11,2

6,3

0,41 (0,32-0,53)

46,9% (34,3-60,0)

M

29,1

29,6

0,88 (0,81-0,96)

10,5% (6,1-17,5)

∫Ï¿ÛÌ· ApoB/ApoA1 F

14,1

27,0

4,42 (3,43-5,70)

52,1% (44,0-60,2)

ratio

21,9

35,5

3,76 (3,23-4,38)

53,8% (48,3-59,2)

M

0,25

0,5

1

2

4

8

§fiÁÔ˜ Èı·ÓÔÙ‹ÙˆÓ ÎÈÓ‰‡ÓÔ˘ (99% Cl)

∂ÈÎfiÓ· 3: ™˘Û¯¤ÙÈÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ Ì ÙÔ Ô͇ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘, ÌÂÙ¿ ÚÔÛ·ÚÌÔÁ‹ ˆ˜ ÚÔ˜ ÙËÓ ËÏÈΛ·, ÙÔ Ê‡ÏÔ Î·È ÙËÓ ÁˆÁÚ·ÊÈ΋ ÂÚÈÔ¯‹.

3

·ıËÚÔÛÎÏ‹ÚˆÛË ¢EKEMBPπ√™ 2004

¤ÓÙÔÓË Ê˘ÛÈ΋ ¿ÛÎËÛË Î·È Ë Î·Ù·Ó¿ÏˆÛË ÔÈÓÔÓ‡̷ÙÔ˜ 3 ‹ ÂÚÈÛÛfiÙÂÚ˜ ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰· Â›Ó·È ÚÔÛٷ٢ÙÈΤ˜. ∞ÓÙ›ıÂÙ· ÔÈ „˘¯ÔÎÔÈÓˆÓÈÎÔ› ·Ú¿ÁÔÓÙ˜ (ÛÙÚ˜ ÛÙËÓ ÂÚÁ·Û›· ‹ ÛÙÔ Û›ÙÈ, ηٿıÏÈ„Ë, ÔÈÎÔÓÔÌÈΤ˜ ‰˘ÛÎÔϛ˜, ‰˘Û¿ÚÂÛÙ· ÁÂÁÔÓfiÙ· Î·È ¤ÏÏÂÈ„Ë ÂϤÁ¯Ô˘) ·˘Í¿ÓÔ˘Ó ÙÔÓ Î›Ó‰˘ÓÔ Î·Ù¿ 2,67 ÊÔÚ¤˜. √ ÏfiÁÔ˜ ÙˆÓ Èı·ÓÔÙ‹ÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ· οı ·Ú¿ÁÔÓÙ· Ê·›ÓÂÙ·È ÛÙËÓ EÈÎfiÓ· 3. ∏ Û˘Û¯¤ÙÈÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ Ì ÙÔ Ô͇ ¤ÌÊÚ·ÁÌ· ‰È·ÈÛÙÒıËΠfiÙÈ

ÈÛ¯‡ÂÈ Û fiϘ ÙȘ ˘Ô-ÔÌ¿‰Â˜: ¿Ó‰Ú˜, Á˘Ó·›Î˜, Ó¤Ô˘˜, ËÏÈÎȈ̤ÓÔ˘˜ (·Ó Î·È Ô Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ˜ ÛÙÔ˘˜ Ó¤Ô˘˜ ηٿ 2,5 ÊÔÚ¤˜), Î·È Û fiϘ ÙȘ ÂÚÈÔ¯¤˜ ÙÔ˘ ÎfiÛÌÔ˘, ·Ú¿ ÙÔ fiÙÈ Ô ÂÈÔÏ·ÛÌfi˜ ÙˆÓ ‰È·ÊfiÚˆÓ ·Ú·ÁfiÓÙˆÓ ÌÔÚ› Ó· ‰È·Ê¤ÚÂÈ ÛÙÔ˘˜ ‰È¿ÊÔÚÔ˘˜ ÏËı˘ÛÌÔ‡˜. √ ˘ÔÏÔÁÈÛÌfi˜ ÙÔ˘ ·ԉȉfiÌÂÓÔ˘ ÎÈÓ‰‡ÓÔ˘ Û ÏËı˘ÛÌÈ·Îfi Â›Â‰Ô Á›ÓÂÙ·È Ï·Ì‚¿ÓÔÓÙ·˜ ˘fi„Ë ÙfiÛÔ ÙÔÓ ÏfiÁÔ Èı·ÓÔÙ‹ÙˆÓ ÎÈÓ‰‡ÓÔ˘ (odds

ratio) fiÛÔ Î·È ÙÔÓ ÂÈÔÏ·ÛÌfi ÙÔ˘ ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘. ∞ıÚÔÈÛÙÈο ÔÈ 9 ·Ú¿ÁÔÓÙ˜ Ì·˙› ÂÍËÁÔ‡Ó ÙÔ 90,4% ÙÔ˘ ÎÈÓ‰‡ÓÔ˘. ∆Ô Â‡ÚËÌ· ·˘Ùfi ·Ó·ÙÚ¤ÂÈ ÙËÓ ÎÚ·ÙÔ‡Û· ·ÓÙ›ÏË„Ë fiÙÈ ÔÈ ÎÏ·ÛÛÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÂÍËÁÔ‡Ó ÌfiÓÔ ÙÔ 50% ÙˆÓ ÂÌÊÚ·ÁÌ¿ÙˆÓ Î·È ÂÈÙÚ¤ÂÈ ÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ Ì ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ηٷÔϤÌËÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ ·˘ÙÒÓ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÚÔÏËÊıÔ‡Ó Ú·ÎÙÈο fiÏ· Ù· ÂÌÊÚ¿ÁÌ·Ù·. ∂È̤ÏÂÈ·: ∏Ï›·˜ ÃÂÈÌÒÓ·˜

∏ ™ÙÂÊ·ÓÈ·›· ¡fiÛÔ˜ Û ۯ¤ÛË Ì ÙËÓ ÎÔÈÓˆÓÈ΋ ÛÙ‹ÚÈÍË Î·È ÙËÓ ÎÔÈÓˆÓÈ΋ Ù¿ÍË Û ™Ô˘Ë‰Ô‡˜ ¿Ó‰Ú˜. ªÈ· 15ÂÙ‹˜ ·Ú·ÎÔÏÔ‡ıËÛË ÛÙË ÌÂϤÙË ÙˆÓ ·Ó‰ÚÒÓ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÙÔ 1933 Rosengren A., Wilhelmsen L., Orth-Gomér K. Eur Heart J 2004; 25:56-63

∏ ¯·ÌËÏ‹ ÎÔÈÓˆÓÈÎÔ-ÔÈÎÔÓÔÌÈ΋ ηٿÛÙ·ÛË Â›Ó·È Î·Ï¿ ÁÓˆÛÙfi˜ ·Ú¿ÁˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ ·ÏÏ¿ Ù· ÛÙÔȯ›· Ô˘ ·ÊÔÚÔ‡Ó ÙÔÓ ÎÔÈÓˆÓÈÎfi ÈÛÙfi Â›Ó·È ÏÈÁfiÙÂÚÔ ÛÙ·ıÂÚ¿. ™Â ·˘Ù‹ ÙËÓ ÚÔÔÙÈ΋ ÏËı˘ÛÌȷ΋ ÌÂϤÙË ¤ÁÈÓ ÚÔÛ¿ıÂÈ· Ó· ÂÎÙÈÌËı› Ë Â›‰Ú·ÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÙÔ˘ ÎÔÈÓˆÓÈÎÔ‡ ÈÛÙÔ‡ ÛÙËÓ Â›ÙˆÛË Ù˘ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ Î·È ÛÙËÓ ıÓËÛÈÌfiÙËÙ· ·fi fiÏ· Ù· ·›ÙÈ·. ™Â ¤Ó· ÏËı˘ÛÌfi 741 ·Ó‰ÚÒÓ ËÏÈΛ·˜ 50 ÂÙÒÓ ÛÙËÓ ¤Ó·ÚÍË Ù˘ ÌÂϤÙ˘ ·Ú·ÙËÚ‹ıËÎ·Ó 92 Ó¤· ÂÚÈÛÙ·ÙÈο ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ 15 ÂÙÒÓ ·Ú·ÎÔÏÔ‡ıËÛ˘. √È ÎÔÈÓˆÓÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ô˘ ÂÍÂÙ¿ÛıËÎ·Ó ‹Ù·Ó Ë Â·ÁÁÂÏÌ·ÙÈ΋ Ù¿ÍË, ‰‡Ô ‰Â›ÎÙ˜ Ù˘ ÎÔÈÓˆÓÈ΋˜ ÛÙ‹ÚÈ͢ 4

(Ë «Û˘Ó·ÈÛıËÌ·ÙÈ΋ Â·Ê‹» Ô˘ ÂÚÈÁÚ¿ÊÂÈ ÙËÓ ‰È·ıÂÛÈÌfiÙËÙ· ÛÙÂÓ‹˜ Û˘Ó·ÈÛıËÌ·ÙÈ΋˜ ÛÙ‹ÚÈ͢ Î·È Ë «ÎÔÈÓˆÓÈ΋ ÂÓۈ̿وÛË» Ô˘ ÂÚÈÁÚ¿ÊÂÈ ÙËÓ ‡·ÚÍË ÂÎÙ›ÌËÛ˘ Î·È ¯ÂÈÚÔÈ·ÛÙ‹ ˘ÔÛÙ‹ÚÈÍË) Î·È ÙÔ Û˘ÓÔÏÈÎfi ¿Á¯Ô˜ (ÛÙÚ˜). ªÂٷ͇ ÙˆÓ ·Ó‰ÚÒÓ Ô˘ ηٷٿ¯ıËÎ·Ó ÛÙÔ Î·ÙÒÙÂÚÔ ÙÂÙ·ÚÙËÌfiÚÈÔ Ù˘ ÎÔÈÓˆÓÈ΋˜ ÂÓۈ̿وÛ˘ ·Ú·ÙËÚ‹ıËÎ·Ó 13,6 ÂÚÈÛÙ·ÙÈο ·Ó¿ 1000 ¿ÙÔÌ· x ¤ÙË ·Ú·ÎÔÏÔ‡ıËÛ˘ ÂÓÒ ÛÙ· ÂӉȿÌÂÛ· 2 ÙÂÙ·ÚÙËÌfiÚÈ· ·Ú·ÙËÚ‹ıËÎ·Ó 8,9 Î·È ÛÙÔ ˘„ËÏfiÙÂÚÔ ÙÂÙ·ÚÙËÌfiÚÈÔ 6,0 ÂÚÈÛÙ·ÙÈο (P= 0,003). ªÂÙ¿ ‰ÈfiÚıˆÛË Ì fiÏÔ˘˜ ÙÔ˘˜ Û¯ÂÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ (οÓÈÛÌ·, ηıÈÛÙÈ΋ ˙ˆ‹, Û˘ÛÙÔÏÈ΋ ·ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË, ˘„ËÏ‹ ¯ÔÏËÛÙÂÚfiÏË, ·˘ÍË̤ӷ ÙÚÈÁÏ˘ÎÂÚ›‰È·,

˘„ËÏfi˜ ‰Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜, ۷ί·Ú҉˘ ‰È·‚‹Ù˘ Î·È ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi) Ô ÏfiÁÔ˜ ÎÈÓ‰‡ÓÔ˘ (HR) ÁÈ· ÙÔ ˘„ËÏfiÙÂÚÔ ÙÂÙ·ÚÙËÌfiÚÈÔ ÚÔ˜ ÙÔ ¯·ÌËÏfiÙÂÚÔ ‹Ù·Ó 0,45 (0,24-0,84) P= 0,013. ∏ Û˘Ó·ÈÛıËÌ·ÙÈ΋ Â·Ê‹ Û¯ÂÙÈ˙fiÙ·Ó Â›Û˘ Ì ÌÂȈ̤ÓÔ Î›Ó‰˘ÓÔ. √ ‰ÈÔÚıˆÌ¤ÓÔ˜ ÏfiÁÔ˜ ÎÈÓ‰‡ÓÔ˘ ‹Ù·Ó 0,58 (0,37-0,91) P= 0,019. ∞ÓÙ›ıÂÙ· ‰ÂÓ ‚Ú¤ıËÎÂ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÛÙÚ˜ Î·È ÎÈÓ‰‡ÓÔ˘ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ Ô‡Ù ÌÂٷ͇ Â·ÁÁÂÏÌ·ÙÈ΋˜ Ù¿Í˘ Î·È ÎÈÓ‰‡ÓÔ˘ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘. µÚ¤ıËΠfï˜ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Â·ÁÁÂÏÌ·ÙÈ΋˜ Ù¿Í˘ Î·È ıÓËÛÈÌfiÙËÙ·˜ ·fi fiÏ· Ù· ·›ÙÈ·. ∂È̤ÏÂÈ·: ∏Ï›·˜ ÃÂÈÌÒÓ·˜

¶A£OºY™IO§O°IA

ÕÓ‰Ú˜ ∂ÙÂÚÔ˙˘ÁÒÙ˜ ˆ˜ ÚÔ˜ ÙËÓ √ÈÎÔÁÂÓ‹ ÀÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· (FH) ÌÔÚ› Ó· ¤¯Ô˘Ó ¶·ıÔÏÔÁÈ΋ ªÂÙ·ÁÂ˘Ì·ÙÈ΋ ∞¿ÓÙËÛË ∆ÚÈÁÏ˘ÎÂÚȉ›ˆÓ: ŒÓ·˜ ¿ÏÏÔ˜ ÚÔÁÓˆÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÛÙËÓ FH Kolovou G, Anagnostopoulou K, Pilatis N, Iraklianou S, Hoursalas I, Liberi S, Pavlidis A, Dritsas A, Mikhailidis D, Cokkinos D.V. Int J Clin Pract 2004 (in press)

™ÙË ÌÂϤÙË ·˘Ù‹ ‰ÈÂÚ¢ӋıËÎÂ Ë ·¿ÓÙËÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ (∆°§) ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË ÏÈ·ÚÔ‡ Á‡̷ÙÔ˜ Û ¿Ó‰Ú˜ ÂÙÂÚÔ˙˘ÁÒÙ˜ ˆ˜ ÚÔ˜ ÙËÓ ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· (FH). ∂›ÎÔÛÈ ¤ÍÈ (26) ¿Ó‰Ú˜ ‰È·ÈÚ¤ıËÎ·Ó Û ‰‡Ô ÔÌ¿‰Â˜: ÙËÓ ÔÌ¿‰· ÙˆÓ ÂÙÂÚÔ˙˘ÁˆÙÒÓ FH (hFH) [n= 14, ̤ÛË ËÏÈΛ· 39 (SD=11)] Î·È ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ [n=12, ̤ÛË ËÏÈΛ· 43(SD=5)]. ªÂ ‚¿ÛË ·Ï·ÈfiÙÂÚ˜ ÌÂϤÙ˜ Ì·˜, ıˆڋıËΠfiÙÈ ÙÈ̤˜ ∆°§ > 219 mg/dl ÛÙȘ 4, 6, Î·È 8

ÒÚ˜ ÌÂÙ·ÁÂ˘Ì·ÙÈο Û˘ÓÈÛÙÔ‡Ó ·ıÔÏÔÁÈ΋ ·¿ÓÙËÛË ÛÙË ÊfiÚÙˆÛË Ì ϛÔ˜. ŸÏÔÈ ÔÈ hFH ·ÛıÂÓ›˜ ›¯·Ó Ê˘ÛÈÔÏÔÁÈο Â›‰· ∆°§ ÓËÛÙ›·˜. ªÈÛÔ› ·fi ÙÔ˘˜ hFH ·ÛıÂÓ›˜ ÂÌÊ¿ÓÈÛ·Ó ·ıÔÏÔÁÈ΋ ·¿ÓÙËÛË ∆°§ ÌÂÙ¿ ÙË ÊfiÚÙˆÛË Ì ÏÈ·Úfi Á‡̷ [235(±51), 255(±30) mg/dl ÛÙȘ 4 Î·È 6 ÒÚ˜, ·ÓÙÈÛÙÔ›¯ˆ˜]. √È ·ÛıÂÓ›˜ ·˘ÙÔ› ›¯·Ó ˘„ËÏfiÙÂÚ· Â›‰· ∆°§ ÓËÛÙ›·˜ (ÛÙ· Ê˘ÛÈÔÏÔÁÈο fï˜ Ï·›ÛÈ·) Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ ˘fiÏÔÈÔ˘˜ ·ÛıÂÓ›˜ Ù˘

›‰È·˜ ÔÌ¿‰·˜ [135(+/-17) vs.

89(+/-32) mg/dl], p=0.005]. √È ÌÂÙ·‚ÔϤ˜ Ê·›ÓÔÓÙ·È ÛÙËÓ EÈÎfiÓ· 1. ™˘ÓÂÒ˜ Ë ÌÂȈ̤ÓË ‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘ ˘Ô‰Ô¯¤· Ù˘ LDL ÛÂ Û˘Ó‰˘·ÛÌfi Ì ¿ÏϘ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ ∆°§ Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙËÓ ÂÙÂÚfi˙˘ÁË ÌÔÚÊ‹ Ù˘ FH Èı·ÓfiÓ Ó· ÂÍËÁÔ‡Ó ÙËÓ ·ıÔÏÔÁÈ΋ ·¿ÓÙËÛË ÙˆÓ ·ÛıÂÓÒÓ ·˘ÙÒÓ ÛÙË ¯ÔÚ‹ÁËÛË ÏÈ·ÚÔ‡ Á‡̷ÙÔ˜.

300 250 200 ∆°§ (mg/dl)

150 100 50 8 0 4 AlllhFH

hFH-A

hFH-N

flÚ˜

√Ì¿‰· ÂϤÁ¯Ô˘

√Ì¿‰Â˜

∂ÈÎfiÓ· 1: ªÂÙ·‚ÔÏ‹ ÙˆÓ ÂÈ¤‰ˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ (AUC) fiÏˆÓ ÙˆÓ hFH ·ÛıÂÓÒÓ (All Hfh), ÙˆÓ hFH ·ÛıÂÓÒÓ Ì ·ıÔÏÔÁÈ΋ ·¿ÓÙËÛË (hFH-A), ÙˆÓ hFH ·ÛıÂÓÒÓ ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ ·¿ÓÙËÛË (hFH-N) Î·È Ù˘ ÔÌ¿‰·˜ ÂϤÁ¯Ô˘ (controls).

5

·ıËÚÔÛÎÏ‹ÚˆÛË ¢EKEMBPπ√™ 2004

ªÂÙ·‚ÔÏÈÛÌfi˜ Ù˘ HDL °ÂÓÔ‚¤Ê· ¢. ∫ÔÏÔ‚Ô‡, ∫·ÙÂÚ›Ó· ∫. ∞Ó·ÁÓˆÛÙÔÔ‡ÏÔ˘, ∞ÓÙÒÓ˘ ¡. ¶·˘Ï›‰Ë˜ ∞’ ∫·Ú‰ÈÔÏÔÁÈ΋ ∫ÏÈÓÈ΋, øÓ¿ÛÂÈÔ ∫·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈÎfi ∫¤ÓÙÚÔ

∏ ÏÈÔÚˆÙ½ÓË ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ (HDL) ·Ó‹ÎÂÈ ÛÙȘ ÏÈÔÚˆÙ½Ó˜ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ Î·È ¤¯ÂÈ ÛËÌ·ÓÙÈ΋ ·ÓÙÈ·ıËÚÔÁfiÓÔ ‰Ú¿ÛË Û˘ÌÌÂÙ¤¯ÔÓÙ·˜ ÛÙË ‰È·‰Èηۛ· Ù˘ ·Ó¿ÛÙÚÔÊ˘ ÌÂÙ·ÊÔÚ¿˜ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ·fi ÙÔ˘˜ ÂÚÈÊÂÚÈÎÔ‡˜ ÈÛÙÔ‡˜ ÛÙÔ ‹·Ú. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ù· ¯·ÌËÏ¿ Â›‰· HDL ÛÙÔ Ï¿ÛÌ· Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ·Ó¿Ù˘ÍË ·ıËÚÔÛÎÏ‹ÚˆÛ˘. √È HDL ·ÔÙÂÏÔ‡Ó Ì›· ÂÙÂÚÔÁÂÓ‹ ÔÌ¿‰· ÏÈÔÚˆÙÂ˚ÓÒÓ Ô˘ ÂÎÎÚ›ÓÔÓÙ·È ·fi Ù· Ë·ÙÔ·ÙÙ·Ú· Î·È Ù· ·ÙÙ·Ú· ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ÂÈıËÏ›Ô˘ Î·È ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ·ÚfiÌÔÈ· ÌÔÚȷ΋ ˘ÎÓfiÙËÙ· (1.063 < d <1,21 g/ml) Î·È Ì¤ÁÂıÔ˜ (5-17 nm). ∂Í·ÈÙ›·˜ ÙˆÓ ÔÈÔÙÈÎÒÓ Î·È ÔÛÔÙÈÎÒÓ ‰È·ÊÔÚÒÓ ÛÙË Û‡ÛÙ·ÛË ÙÔ˘˜ Û ÏÈ›‰È·, ÚˆÙ½Ó˜ Î·È ¤Ó˙˘Ì·, Ù· ÌfiÚÈ· ÙˆÓ HDL ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÔÈÎÈÏ›· fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ‰È·Ï˘ÙfiÙËÙ·, ÙÔ ÊÔÚÙ›Ô Î·È ÙËÓ ·ÓÙÈÁÔÓÈÎfiÙËÙ·. ∏ ÈÛfi˘ÎÓË ˘ÂÚÊ˘ÁÔΤÓÙÚËÛË ‰È·¯ˆÚ›˙ÂÈ ‰‡Ô ·ÚÈ· ÎÏ¿ÛÌ·Ù· Ù˘ HDL, ÙËÓ HDL2 Î·È ÙËÓ HDL3. ™˘Ó›ÛÙ·Ù·È ·fi ÚˆÙ½Ó˜, ÂÛÙÂÚÔÔÈË̤ÓË Î·È ÂχıÂÚË ¯ÔÏËÛÙÂÚfiÏË, ÙÚÈÁÏ˘ÎÂÚ›‰È· Î·È ÊˆÛÊÔÏÈ›‰È·. ∏ ÌË ÂÛÙÂÚÔÔÈË̤ÓË ¯ÔÏËÛÙÂÚfiÏË Î·Ù·Ó¤ÌÂÙ·È ÌÂٷ͇ Ù˘ ÂÈÊ¿ÓÂÈ·˜ Î·È ÙÔ˘ ˘Ú‹Ó· ÙˆÓ HDL ۈ̷Ùȉ›ˆÓ, ÂÓÒ Ù· ʈÛÊÔÏÈ›‰È·, ÔÈ ÚˆÙ½Ó˜ Î·È Ù· ÊÔÚÙÈṲ̂ӷ ÏÈ›‰È· ÂÓÙÔ›˙ÔÓÙ·È Î˘Ú›ˆ˜ ÛÙ· Â͈ÙÂÚÈο ÙÌ‹Ì·Ù· Ù˘ ÏÈÔÚˆÙ½Ó˘. ™ÙÔ ÎÂÓÙÚÈÎfi ÙÌ‹Ì· ÙÔ˘ ÌÔÚ›Ô˘ ‚Ú›ÛÎÔÓÙ·È Ù· ÌË ÔÏÈο ÛÙÔȯ›·, fiˆ˜ Ë ÂÛÙÂÚÔÔÈË̤ÓË ¯ÔÏËÛÙÂÚfiÏË Î·È Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È·. ∆· ÚˆÙÂ˚ÓÈο ÛÙÔȯ›· Ù˘ HDL ·ÔÙÂÏÔ‡Ó Î·Ù¿ ·ÚÈÔ ÏfiÁÔ Ë ·ÔÏÈÔÚˆÙ½ÓË A-I (apo A-I) Î·È Û ÌÈÎÚfiÙÂÚÔ ÔÛÔÛÙfi ÔÈ ·ÔÏÈÔÚˆÙ½Ó˜ A-II, ∞-IV, C, E Î·È J. √È ÚˆÙ½Ó˜ Ô˘ ‰È·ı¤ÙÔ˘Ó ÂÓ˙˘ÌÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· Î·È Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ HDL Â›Ó·È Ë ÏÂÎÈı›-

6

ÓË-¯ÔÏËÛÙÂÚ›ÓË-·Î˘ÏÔÙÚ·ÓÛÊÂÚ¿ÛË (LCAT), Ë ÚˆÙ½ÓË ÌÂÙ·ÊÔÚ¿˜ ÂÛÙ¤ÚˆÓ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ (CETP), Ë ÚˆÙ½ÓË ÌÂÙ·ÊÔÚ¿˜ ÙˆÓ ÊˆÛÊÔÏÈȉ›ˆÓ, Ë ·Î¤Ù˘ÏÔ-PAF ˘‰ÚÔÏ¿ÛË Î·È Ë ·Ú·ÔÍÔÓ¿ÛË. ∏ HDL2 Î·È Ë HDL3 ¤¯Ô˘Ó Û¯‹Ì· ÛÊ·ÈÚÈÎfi Î·È Î·Ù¿ ÙËÓ ËÏÂÎÙÚÔÊfiÚËÛË ÌÂÙ·Ó·ÛÙÂ‡Ô˘Ó Û·Ó ÎÏ¿ÛÌ· Ì ·-ËÏÂÎÙÚÔÊÔÚËÙÈ΋ ÎÈÓËÙÈÎfiÙËÙ·1,2. ∆· ÓÂÔÛ¯ËÌ·ÙÈṲ̂ӷ ÌfiÚÈ· Ù˘ HDL ‰ÂÓ ‰È·ı¤ÙÔ˘Ó ÌË ÔÏÈÎfi ˘Ú‹Ó·, ¤¯Ô˘Ó Û¯‹Ì· ‰ÈÛÎÔÂȉ¤˜, ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi pre-· ‹ pre-‚ ËÏÂÎÙÚÔÊÔÚËÙÈ΋ ÎÈÓËÙÈÎfiÙËÙ·. Î·È ·Ó¢ڛÛÎÔÓÙ·È ÛÙÔ Ï¿ÛÌ· Î·È ÙÔ ÂÓÙÂÚÈÎfi ˘ÁÚfi3,4. √È ·Ú¿ÁÔÓÙ˜ Ô˘ ηıÔÚ›˙Ô˘Ó ÙË Û˘ÁΤÓÙÚˆÛË ÙÔ˘˜ ÛÙÔ Ï¿ÛÌ· ·Ú·Ì¤ÓÔ˘Ó ¿ÁÓˆÛÙÔÈ. ∆· pre-‚ ۈ̷ٛ‰È· ÂÚȤ¯Ô˘Ó Û˘Ó‹ıˆ˜ apo A-I ›ÙÂ Û·Ó ÂχıÂÚÔ ÌfiÚÈÔ Â›Ù ̷˙› Ì ÌfiÚÈ· ÛÊÈÁÁÔÌ˘ÂÏ›Ó˘ Î·È ÊˆÛÊ·Ùȉ˘ÏÔ¯ÔÏ›Ó˘1. ŸÏ· Ù· ·ÙÙ·Ú· ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ ¤¯Ô˘Ó ÙËÓ ÈηÓfiÙËÙ· Ó· Û˘Óı¤ÙÔ˘Ó ¯ÔÏËÛÙÂÚfiÏË ·ÏÏ¿ Î·È Ó· ÙËÓ ÚÔÛÏ·Ì‚¿ÓÔ˘Ó ·fi ÙȘ ÏÈÔÚˆÙ½Ó˜ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ Î·È Ù· ÁËÚ·Ṳ̂ӷ ÂÚ˘ıÚÔ·ÙÙ·Ú·. ∏ Û˘ÛÛÒÚ¢ÛË Ù˘ ÂχıÂÚ˘ ¯ÔÏËÛÙÂÚfiÏ˘ ̤۷ ÛÙÔ Î‡ÙÙ·ÚÔ ÌÔÚ› Ó· ¤¯ÂÈ ÙÔÍÈ΋ ‰Ú¿ÛË, ÚÔηÏÒÓÙ·˜ ‰È·Ù·Ú·¯¤˜ Ù˘ ‚ÈÔÛ‡ÓıÂÛ˘ ÙˆÓ ÂÙȉ›ˆÓ ÛÙÔ ÂÓ‰ÔÏ·ÛÌ·ÙÈÎfi ‰›ÎÙ˘Ô5. ¶ÚÔÎÂÈ̤ÓÔ˘ Ó· ÚÔÏËÊı› Ë ˘ÂÚÊfiÚÙˆÛË ÙÔ˘ Û ¯ÔÏËÛÙÂÚfiÏË, ÙÔ Î‡ÙÙ·ÚÔ ¤¯ÂÈ ÙËÓ ÈηÓfiÙËÙ· Ó· ·Ô‚¿ÏÏÂÈ ÙËÓ ÂÚ›ÛÛÂÈ· Ù˘ Ì ̛· ÏËıÒÚ· ·ÓÙÈÚÚÔÈÛÙÈÎÒÓ Ì˯·ÓÈÛÌÒÓ. ∆Ô ‹·Ú Â›Ó·È ÙÔ fiÚÁ·ÓÔ Ì ÙË ÌÂÁ·Ï‡ÙÂÚË ‰˘Ó·ÙfiÙËÙ· ·ÔÌ¿ÎÚ˘ÓÛ˘ Ù˘ ÂÚ›ÛÛÂÈ·˜ ¯ÔÏËÛÙÂÚfiÏ˘, ̤ۈ Ù˘ Û‡ÓıÂÛ˘ ÙˆÓ ¯ÔÏÈÎÒÓ ·Ï¿ÙˆÓ Î·È ÙËÓ ·Ô‚ÔÏ‹ ÙÔ˘˜ Ì ÙË ¯ÔÏ‹. ¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ fiÏ· Ù· HDL ۈ̷ٛ‰È· Â›Ó·È ‰¤ÎÙ˜ ¯ÔÏËÛÙÂÚfiÏ˘, Ô ˘ÔÏËı˘ÛÌfi˜ ÙˆÓ ÌÈÎÚÒÓ pre-‚ ۈ̷Ùȉ›ˆÓ Ô˘ ÂÚȤ¯Ô˘Ó apo A-I, Â›Ó·È Ô

·ÚÈÔ˜ ·Ô‰¤ÎÙ˘ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ Ô˘ ·ÔÌ·ÎÚ‡ÓÂÙ·È ·fi Ù· ·ÙÙ·Ú·3,6. ∏ ‰È·‰Èηۛ· ·˘Ù‹ ÂÈÙ˘Á¯¿ÓÂÙ·È Ì¤Ûˆ ÙÔ˘ ATP ÂÍ·ÚÙÒÌÂÓÔ˘ ÚˆÙÂ˚ÓÈÎÔ‡ ÌÂÙ·ÊÔÚ¤· ABCA1. √ ABCA1 ·Ó‹ÎÂÈ ÛÙË ˘ÂÚÔÈÎÔÁ¤ÓÂÈ· ÙˆÓ ABC ÚˆÙÂ˚ÓÈÎÒÓ ÌÂÙ·ÊÔÚ¤ˆÓ Ô˘ Â›Ó·È ˘‡ı˘ÓÔÈ ÁÈ· ÙË ‰È·ÌÂÌ‚Ú·ÓÈ΋ ÌÂÙ·ÊÔÚ¿ ÚˆÙÂ˚ÓÒÓ, ÈfiÓÙˆÓ Î·È ÏÈȉ›ˆÓ7-9. √ ABCA1 ÂÎÊÚ¿˙ÂÙ·È Û fiÏÔ˘˜ ÙÔ˘˜ ÈÛÙÔ‡˜ ̤ۈ ÙÔ˘ cAMP Î·È ‰È¿ÊÔÚˆÓ ˘ÚËÓÈÎÒÓ ˘Ô‰Ô¯¤ˆÓ, ÂÓÒ Ô ÚfiÏÔ˜ ÙÔ˘ Â›Ó·È Ó· ÌÂÛÔÏ·‚› ÛÙË ÌÂÙ·ÊÔÚ¿ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ÙˆÓ ÊˆÛÊÔÏÈȉ›ˆÓ, ‰È·Ì¤ÛÔ˘ Ù˘ ΢ÙÙ·ÚÈ΋˜ ÌÂÌ‚Ú¿Ó˘, ÛÙȘ ÏÈÔÚˆÙ½Ó˜ Ì ÙȘ Ôԛ˜ Î·È ·ÔÌ·ÎÚ‡ÓÔÓÙ·È10-13. √ ÚfiÏÔ˜ ·˘Ùfi˜ ÙÔ˘ ABCA1 ·ԉ›¯ÙËΠfiÙ·Ó ‰È·ÈÛÙÒıËΠfiÙÈ Û˘ÁÎÂÎÚÈ̤Ó˜ ÌÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘ ÁÔÓȉ›Ô˘ Ô˘ ÙÔÓ Îˆ‰ÈÎÔÔÈ› ‹Ù·Ó ˘‡ı˘Ó˜ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ÓfiÛÔ˘ Ù˘ ∆·ÁÁ¤Ú˘5,14,15. ∏ ÓfiÛÔ˜ Ù˘ ∆·ÁÁ¤Ú˘ Â›Ó·È Ì›· Û¿ÓÈ· ÎÏËÚÔÓÔÌÈ΋ ÓfiÛÔ˜ Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi Ôχ ¯·ÌËÏ¿ Â›‰· HDL Î·È ÂÓ·fiıÂÛË ÛÙÂÚÔÏÒÓ ÛÙ· ÈÛÙÈο Ì·ÎÚÔÊ¿Á·. ∏ ·Ó·Î¿Ï˘„Ë ·˘Ù‹ ¤ÁÈÓ ÙÔ 1999 ·fi ÙÚ›· ‰È·ÊÔÚÂÙÈο ÂÚÁ·ÛÙ‹ÚÈ· Î·È Û˘Ó¤‚·ÏÏ Û ÌÂÁ¿ÏÔ ‚·ıÌfi ÛÙËÓ Î·Ù·ÓfiËÛË ÙÔ˘ Ì˯·ÓÈÛÌÔ‡ Ù˘ ΢ÙÙ·ÚÈ΋˜ ÂÎÚÔ‹˜ Î·È Ù˘ ·Ó¿ÛÙÚÔÊ˘ ÌÂÙ·ÊÔÚ¿˜ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘16-18. ∏ ·Ó¿ÛÙÚÔÊË ÌÂÙ·ÊÔÚ¿ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ÈηÓfiÙËÙ· Ù˘ HDL Ó· ·ÔÌ·ÎÚ‡ÓÂÈ ÙËÓ ¯ÔÏËÛÙÂÚfiÏË ·fi ÙËÓ ÂÚÈʤÚÂÈ· Î·È Ó· ÙË ÌÂٷʤÚÂÈ ÛÙÔ ‹·Ú, ·’ fiÔ˘ Î·È ÂÎÎÚ›ÓÂÙ·È ÛÙË ¯ÔÏ‹19. ∏ ‰È·Ù·Ú·¯‹ Ù˘ ÌÂÙ·ÊÔÚ¿˜ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ÙˆÓ ÊˆÛÊÔÏÈȉ›ˆÓ ÛÙȘ ·ÔÏÈÔÚˆÙ½Ó˜ Â›Ó·È ˘‡ı˘ÓË ÁÈ· ÙËÓ ÂΉ‹ÏˆÛË Ù˘ ÓfiÛÔ˘ Ù˘ ∆·ÁÁ¤Ú˘20. º˘ÛÈÔÏÔÁÈο, Ë ÂÎÚÔ‹ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ÙˆÓ ÊˆÛÊÔÏÈȉ›ˆÓ Á›ÓÂÙ·È ÚÔ˜ ÙËÓ ÂχıÂÚË

¶A£OºY™IO§O°IA apo A-I Î·È fi¯È ÚÔ˜ ÙËÓ ÒÚÈÌË HDL21. ∏ ÂχıÂÚË ·˘Ù‹ apo A-1 ÌÔÚ› Ó· ÂÎÎÚÈı› ›Ù ·fi ÙÔ ‹·Ú Î·È ÙÔ ÏÂÙfi ¤ÓÙÂÚÔ, ›Ù ӷ ·Ó·ÁÂÓÓËı› ÛÙËÓ Î˘ÎÏÔÊÔÚ›· Û·Ó ·ÔÙ¤ÏÂÛÌ· Ù˘ ·Ó·‰È·ÌfiÚʈÛ˘ Ù˘ HDL ·fi ÙËÓ ÚˆÙ½ÓË ÌÂÙ·ÊÔÚ¿˜ ÂÛÙ¤ÚˆÓ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘. ∏ ÂÏ·Ùو̤ÓË ¤ÎÊÚ·ÛË ÙÔ˘ ABCA1 ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂÏ·Ùو̤ÓË ÚfiÛÏË„Ë ÏÈȉ›ˆÓ ·fi ÙËÓ apo A-1 Ì ·ÔÙ¤ÏÂÛÌ· ÙÔÓ ˘ÂÚηٷ‚ÔÏÈÛÌfi Ù˘ ÛÙÔ˘˜ ÓÂÊÚÔ‡˜. ™ÙË ÓfiÛÔ Ù˘ ∆·ÁÁ¤Ú˘, Ë ÂÎÚÔ‹ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ·fi ÙÔ˘˜ ÈÓÔ‚Ï¿ÛÙ˜ ̤ۈ Ù˘ apo A-1 Â›Ó·È ‰È·Ù·Ú·Á̤ÓË, ÂÓÒ Ë ÚfiÛÏË„Ë Ù˘ ·fi ÙËÓ Î˘ÙÙ·ÚÈ΋ ÌÂÌ‚Ú¿ÓË ÙˆÓ Î˘ÙÙ¿ÚˆÓ ·Ú·Ì¤ÓÂÈ Ê˘ÛÈÔÏÔÁÈ΋. ∏ ·‰˘Ó·Ì›· ÌÂÙ¿ıÂÛ˘ ÙˆÓ ÏÈȉ›ˆÓ ·fi ÙȘ ÂÓ‰Ô΢ÙÙ·ÚÈΤ˜ ·Ôı‹Î˜ ÛÙËÓ ÂÈÊ¿ÓÂÈ· Ù˘ ÌÂÌ‚Ú¿Ó˘ ÂÍËÁ› ÙËÓ ÂÍÂÛËÌ·Ṳ̂ÓË ÂÓ·fiıÂÛË ÙÔ˘˜ ÛÙÔ˘˜ ÈÛÙÔ‡˜. ¶·ÚÔÏ’·˘Ù¿, ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë Û˘ÛÛÒÚ¢ÛË ÂÛÙÂÚÔÔÈË̤Ó˘ ¯ÔÏËÛÙÂÚfiÏ˘ ‰ÂÓ ·Ú·ÙËÚÂ›Ù·È Û fiÏÔ˘˜ ÙÔ˘˜ ÈÛÙÔ‡˜ ÙÔ˘ ÛÒÌ·ÙÔ˜, Èı·ÓÔÏÔÁ› ÙËÓ ‡·ÚÍË Î·È ¿ÏÏˆÓ Ì˯·ÓÈÛÌÒÓ ÂÎÚÔ‹˜ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘, Ô˘ ‰ÂÓ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ABCA122. ªÂÚÈÎÔ› ·fi ÙÔ˘˜ ‹‰Ë ÁÓˆÛÙÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó: 1) ÙËÓ ‰È¿¯˘ÛË Û ¤Ó·Ó ˘Ô‰Ô¯¤· Ô˘ ‰È·ı¤ÙÂÈ ÊˆÛÊÔÏÈȉÈΤ˜ ÔÌ¿‰Â˜23,24, 2) ÙËÓ ‰È¢ÎÔÏÔ‡ÌÂÓË ÂÎÚÔ‹ ‰È·Ì¤ÛÔ˘ ˘Ô‰Ô¯¤ˆÓ Ù˘ ΢ÙÙ·ÚÈ΋˜ ÂÈÊ¿ÓÂÈ·˜, fiˆ˜ Ô scavenger ˘Ô‰Ô¯¤·˜ Ù‡Ô˘

µ123 Î·È 3) ÙË Û˘ÌÌÂÙÔ¯‹ Î·È ¿ÏÏˆÓ ÁÔÓȉ›ˆÓ Ô˘ ·›˙Ô˘Ó ÚfiÏÔ ÛÙËÓ ÔÌÔÈfiÛÙ·ÛË Ù˘ HDL, ÏËÓ ÙÔ˘ ABCA1, fiˆ˜ ÙˆÓ ABCG1, ABCG5 Î·È ABCG825. ∏ ÌÂÙ·‚ÔÏÈ΋ Ô‰fi˜ Ù˘ ÂÎÚÔ‹˜ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ‰È·Ì¤ÛÔ˘ ÙÔ˘ ABCA1 Ô˘ ‰È·Ù·Ú¿ÛÛÂÙ·È ÛÙË ÓfiÛÔ Ù˘ ∆·ÁÁ¤Ú˘ ÌÔÚ› ›Ù ӷ ·Ú·Î·ÌÊı›, ›Ù ӷ ÙÚÔÔÔÈËı› ÌÂÙ¿ ·fi ‰È¤ÁÂÚÛË Ì ÚÔ˚fiÓÙ· ˘‰ÚfiÏ˘Û˘ Ù˘ ʈÛÊ·Ùȉ˘ÏÔ¯ÔÏ›Ó˘, Ù˘ ‰È·Î˘ÏÔÁÏ˘ÎÂÚfiÏ˘ Î·È ÙˆÓ ÊˆÛÊÔÏÈ·ÛÒÓ. ™˘ÓÂÒ˜, Ë ÂÓ›Û¯˘ÛË ¿ÏÏˆÓ ÌÂÙ·‚ÔÏÈÎÒÓ Ô‰ÒÓ ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı› Û·Ó Èı·Ó‹ ıÂÚ·¢ÙÈ΋ ÚÔÛ¤ÁÁÈÛË ÙˆÓ ÓÔÛËÌ¿ÙˆÓ Ô˘ ÚÔηÏÔ‡ÓÙ·È ·fi ‰È·Ù·Ú·¯¤˜ ÛÙÔÓ ABCA1 (ÓfiÛÔ˜ Ù˘ ∆·ÁÁ¤Ú˘, ·ÓÂ¿ÚÎÂÈ· apo A). ¶·Ú¿ÏÏËÏ·, Ù· ˘„ËÏ¿ Â›‰· pre-‚ HDL Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È Û ÓÔÛ‹Ì·Ù· Ì ·ÓÂ¿ÚÎÂÈ· HDL, ˘Ô‰ÂÈÎÓ‡Ô˘Ó fiÙÈ Ù· ۈ̷ٛ‰È· ·˘Ù¿ ·ÔÙÂÏÔ‡Ó ÙÔÓ ÚÒÙÔ ÎÚ›ÎÔ ÛÙÔÓ Î‡ÎÏÔ ˙ˆ‹˜ Ù˘ HDL. ∆· ʈÛÊÔÏÈ›‰È· ÙˆÓ HDL ۈ̷Ùȉ›ˆÓ ÚÔ·ÙÔ˘Ó Î·Ù¿ ÙË ÏÈfiÏ˘ÛË ÙˆÓ ÏÔ‡ÛÈˆÓ Û ÙÚÈÁÏ˘ÎÂÚ›‰È· ÏÈÔÚˆÙÂ˚ÓÒÓ, fiˆ˜ Â›Ó·È Ù· ¯˘ÏÔÌÈÎÚ¿ Î·È ÔÈ VLDL. ∏ Â·Ú΋˜ ÚfiÛÏË„Ë ÏÈȉ›ˆÓ Â›Ó·È ·Ó·Áη›· ÁÈ· ÙË ÛÙ·ıÂÚfiÙËÙ· ÙˆÓ HDL ۈ̷Ùȉ›ˆÓ.

ÚÔÔÈË̤Ó˘ ¯ÔÏËÛÙÂÚfiÏ˘ ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙˆÓ HDL ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÌÂÙ·ÊÔÚ¿ ¯ÔÏËÛÙÂÚfiÏ˘ ·fi ÙȘ ΢ÙÙ·ÚÈΤ˜ ÌÂÌ‚Ú¿Ó˜ ÛÙËÓ HDL ÏfiÁˆ ‰È·ÊÔÚ¿˜ Û˘ÁÎÂÓÙÚÒÛˆÓ. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ù· Â›‰· Ù˘ LCAT ÛÙÔ Ï¿ÛÌ· Û¯ÂÙ›˙ÔÓÙ·È ·ÓÙÈÛÙÚfiʈ˜ ·Ó¿ÏÔÁ· Ì ٷ Â›‰· Ù˘ HDL27. °È’ ·˘Ùfi, ¿ÙÔÌ· Ì ¯·ÌËÏ¿ Â›‰· HDL, ȉȷ›ÙÂÚ· fiÙ·Ó ·˘Ù¿ Û˘Ó‰˘¿˙ÔÓÙ·È Ì ·˘ÍË̤ӷ ÙÚÈÁÏ˘ÎÂÚ›‰È·, ÂÌÊ·Ó›˙Ô˘Ó ˘„ËÏfiÙÂÚ· Â›‰· ÂÛÙÂÚÔÔÈË̤Ó˘ ¯ÔÏËÛÙÂÚfiÏ˘ ÛÙÔ Ï¿ÛÌ· Î·È ÂÔ̤ӈ˜ ˘„ËÏfiÙÂÚÔ˘˜ Ú˘ıÌÔ‡˜ ·Ó¿ÛÙÚÔÊ˘ ÌÂÙ·ÊÔÚ¿˜ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘28.

∆Ô ‰Â‡ÙÂÚÔ ‚‹Ì· ÛÙËÓ ·Ó¿ÛÙÚÔÊË ÌÂÙ·ÊÔÚ¿ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ Â›Ó·È Ë ÂÛÙÂÚÔÔ›ËÛË Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙˆÓ HDL Ë ÔÔ›· ηٷχÂÙ·È ·fi ÙËÓ LCAT26. ∏ ÂÏ¿ÙÙˆÛË Ù˘ ÌË ÂÛÙÂ-

∏ ·ÔÎÚ˘ÙÔÁÚ¿ÊËÛË ÙÔ˘ Ì˯·ÓÈÛÌÔ‡ ·Ó¿ÛÙÚÔÊ˘ ÌÂÙ·ÊÔÚ¿˜ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ·Ú¤¯ÂÈ ÙÔ Î·Ù¿ÏÏËÏÔ ıˆÚËÙÈÎfi ˘fi‚·ıÚÔ ÁÈ· ÙËÓ Î·Ù·ÓfiËÛË Ù˘ ÔÌÔÈfiÛÙ·Û˘ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ÛÙÔÓ ÔÚÁ·ÓÈÛÌfi. ¶ÂÚ›Ô˘ 9 mg ¯ÔÏËÛÙÂÚfiÏ˘ ·Ó¿ kg ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜ Ô˘ Û˘ÓÙ›ıÂÙ·È Î·ıËÌÂÚÈÓ¿ ÛÙÔ˘˜ ÂÚÈÊÂÚÈÎÔ‡˜ ÈÛÙÔ‡˜ Ú¤ÂÈ Ó· ·ÔÌ·ÎÚ˘ÓıÔ‡Ó ·fi ÙÔ ‹·Ú29. √È HDLs ·ÔÌ·ÎÚ‡ÓÔ˘Ó ÙËÓ ¯ÔÏËÛÙÂÚfiÏË ·fi ÙÔÓ ¤Ûˆ ¯ÈÙÒÓ· ÙˆÓ ·ÚÙËÚÈÒÓ ·ÔÙÚ¤ÔÓÙ·˜ ÙÔÓ Û¯ËÌ·ÙÈÛÌfi ÙˆÓ ·ÊÚˆ‰ÒÓ Ì·ÎÚÔÊ¿ÁˆÓ ΢ÙÙ¿ÚˆÓ30-32. √ÔÈ·‰‹ÔÙ ‰È·Ù·Ú·¯‹ ÛÙË ‰È·‰Èηۛ· Ù˘ ·Ó¿ÛÙÚÔÊ˘ ÌÂÙ·ÊÔÚ¿˜ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ÌÔÚ› Ó· ¢ÓÔ‹ÛÂÈ ÙËÓ ÂÓ·fiıÂÛË ¯ÔÏËÛÙÂÚfiÏ˘ ÛÙÔ ÙÔ›¯ˆÌ· ÙˆÓ ·ÁÁ›ˆÓ Î·È Ó· Ô‰ËÁ‹ÛÂÈ ÛÙËÓ ·Ó¿Ù˘ÍË ·ıËÚÔÛÎÏ‹ÚˆÛ˘.

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7

·ıËÚÔÛÎÏ‹ÚˆÛË ¢EKEMBPπ√™ 2004

∏ ÈηÓfiÙËÙ· ¿ÛÎËÛ˘ Î·È Ë Â¿ÓÔ‰Ô˜ Ù˘ ηډȷ΋˜ Û˘¯ÓfiÙËÙ·˜ ˆ˜ ÚÔÁÓˆÛÙÈÎÔ› ‰Â›ÎÙ˜ ÛÙÂÊ·ÓÈ·›ˆÓ ÂÂÈÛÔ‰›ˆÓ Û ·ÛıÂÓ›˜ Ì ÂÙÂÚfi˙˘ÁÔ ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· Pitsavos CH, Chrysohoou C, Panagiotakos DB, Kokkinos P, Skoumas J, Papaioannou I, Michaelides AP, Singh S, Stefanadis CI. Atherosclerosis 2004;173:347-352

∏ ÂÙÂÚfi˙˘ÁÔ˜ ÔÈÎÔÁÂÓ‹˜ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÙÈ̤˜ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ Ï¿ÛÌ·ÙÔ˜ 350-500 mg/dl Î·È Û¯ÂÙ›˙ÂÙ·È Ì ÚÒÈÌË Î·Ú‰È·ÁÁÂȷ΋ ıÓËÛÈÌfiÙËÙ·. ∏ ÓÔÛËÚfiÙËÙ· Û˘Ó‹ıˆ˜ ÂΉËÏÒÓÂÙ·È Ì¤¯ÚÈ ÙËÓ 4Ë ‹ ÙËÓ 5Ë ‰ÂηÂÙ›· Ù˘ ˙ˆ‹˜. ∏ ‰ÔÎÈÌ·Û›· ÎÔÒÛˆ˜ Â›Ó·È Î·ıÈÂڈ̤ÓË Ì¤ıÔ‰Ô˜ ‰È¿ÁÓˆÛ˘ Î·È ÚfiÁÓˆÛ˘ Ù˘ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘. ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ó· ‰ÈÂÚ¢ӋÛÂÈ ·Ó Ë ‰ÔÎÈÌ·Û›· ÎÔÒÛˆ˜ ÌÔÚ› Ó· ÚÔÁÓÒÛÂÈ ÙËÓ ÔÚ›· ·ÛıÂÓÒÓ Ì ÂÙÂÚfi˙˘ÁÔ ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·. ∞fi ÙÔÓ π·ÓÔ˘¿ÚÈÔ 1987 ̤¯ÚÈ ÙÔ ª¿ÚÙÈÔ 1997 ηٷÁÚ¿ÊÙËÎ·Ó 639 ·ÛıÂÓ›˜ Ì ÙË ÓfiÛÔ ·˘Ù‹, ËÏÈΛ·˜ 41±12 ÔÈ ¿Ó‰Ú˜ Î·È 43±13 ÔÈ Á˘Ó·›Î˜. ™Â fiÏÔ˘˜ ¤ÁÈÓ ‰ÔÎÈÌ·Û›·

ÎÔÒÛˆ˜ Ì ÙÔ ÚˆÙfiÎÔÏÏÔ Bruce. ™ÙË ÌÂϤÙË ÂÚÈÂÏ‹ÊıËÛ·Ó fiÛÔÈ ‰ÂÓ ÂÌÊ¿ÓÈ˙·Ó ÈÛ¯·ÈÌ›· ÛÙËÓ ÎfiˆÛË. √È ·ÛıÂÓ›˜ ·Ú·ÎÔÏÔ˘ı‹ıËÎ·Ó Ì¤¯ÚÈ ÙÔÓ ¢ÂΤ̂ÚÈÔ 2002 ̤ÛË ‰È¿ÚÎÂÈ· 6±3 ¤ÙË. ∆ÂÏÈο ÛËÌ›· ıˆڋıËÎ·Ó Ë ÂÌÊ¿ÓÈÛË ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ôηډ›Ô˘ (ı·Ó·ÙËÊfiÚÔ˘ ‹ ÌË), ·ÛÙ·ıÔ‡˜ ÛÙËı¿Á¯Ë˜ ‹ ·ÈÊÓ›‰ÈÔ˘ ηډȷÎÔ‡ ı·Ó¿ÙÔ˘. ∞fi ÙÔ˘˜ 581 ·ÛıÂÓ›˜ Ô˘ ·Ú·ÎÔÏÔ˘ı‹ıËÎ·Ó ÔÈ 87 (53 ¿Ó‰Ú˜ Î·È 34 Á˘Ó·›Î˜) ÂÌÊ¿ÓÈÛ·Ó ™¡ (ÔÛÔÛÙfi Â› ÙÔ˘ Û˘ÓfiÏÔ˘ 14,9%, ÔÛÔÛÙfi 18% ÙˆÓ ·Ó‰ÚÒÓ Î·È 10% ÙˆÓ Á˘Ó·ÈÎÒÓ). 11 ÂÚÈÙÒÛÂȘ ‹Ù·Ó ı·Ó·ÙËÊfiÚ˜. √ Ú˘ıÌfi˜ ÂÌÊ¿ÓÈÛ˘ ™¡ ‹Ù·Ó 3% ÙÔÓ ¯ÚfiÓÔ. ªÂ ÙËÓ ÔÏ˘·Ú·ÌÂÙÚÈ΋ ·Ó¿Ï˘ÛË Î·È ÌÂÙ¿ ‰ÈfiÚıˆÛË Ì ·ÚÎÂÙÔ‡˜

Û˘Á¯˘ÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, ‰È·ÈÛÙÒıËΠfiÙÈ Ë ÈηÓfiÙËÙ· ÚÔ˜ ¿ÛÎËÛË (Èı·ÓfiÙËÙ· ÎÈÓ‰‡ÓÔ˘ 0,82 P<0,001) Ë Â·Ó·ÊÔÚ¿ Ù˘ ∫™ ÛÙÔ 1Ô ÏÂÙfi Èı·ÓfiÙËÙ· ÎÈÓ‰‡ÓÔ˘ 0,9 P<0,05) Î·È Ë Ì¤ÁÈÛÙË ›ÂÛË ÛÊ˘ÁÌÔ‡ (Èı·ÓfiÙËÙ· ÎÈÓ‰‡ÓÔ˘ 4,13 P<0,001) ‹Ù·Ó ÚÔÁÓˆÛÙÈÎÔ› ‰Â›ÎÙ˜ ÌÂÏÏÔÓÙÈÎÒÓ ÛÙÂÊ·ÓÈ·›ˆÓ ÂÂÈÛÔ‰›ˆÓ. ™˘ÌÂÚ·ÛÌ·ÙÈο Ë ÌÂȈ̤ÓË ÈηÓfiÙËÙ· ¿ÛÎËÛ˘, Ë Î·ı˘ÛÙ¤ÚËÛË ·ÔηٿÛÙ·Û˘ Ù˘ ∫™ ÌÂÙ¿ ÎfiˆÛË Î·È Ë ·˘ÍË̤ÓË ›ÂÛË ÛÊ˘ÁÌÔ‡ ÛÙË ÌÂÁ›ÛÙË ÎfiˆÛË Â›Ó·È ÈÛ¯˘ÚÔ› ÚÔÁÓˆÛÙÈÎÔ‡ ‰Â›ÎÙ˜ ™¡ Û ¿ÙÔÌ· Ì ÔÈÎÔÁÂÓ‹ ÂÙÂÚfi˙˘ÁÔ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·. ∂È̤ÏÂÈ·: ∏Ï›·˜ ÃÂÈÌÒÓ·˜

TÔ ‚Ú·‚Â›Ô NfiÌÂÏ I·ÙÚÈ΋˜ ‹ º˘ÛÈÔÏÔÁ›·˜ ÙÔ˘ 1924 ‰fiıËΠÛÙÔÓ OÏÏ·Ó‰fi È·ÙÚfi Î·È Ê˘ÛÈÔÏfiÁÔ B›ÏÂÌ A˚ÓÙ¯fiÊÂÓ ÁÈ· ÙËÓ ·Ó·Î¿Ï˘„Ë ÙÔ˘ Ì˯·ÓÈÛÌÔ‡ ÙÔ˘ ËÏÂÎÙÚÔηډÈÔÁÚ·Ê‹Ì·ÙÔ˜.

O A˚ÓÙ¯fiÊÂÓ ÂÈÓfiËÛ ÌÂıfi‰Ô˘˜ ηٷÁÚ·Ê‹˜ ÙˆÓ ‹¯ˆÓ Ù˘ ηډȿ˜ Î·È Î·Ù·Û··Û ٷ ηٿÏÏËÏ· fiÚÁ·Ó· ÁÈ· ÙÔ ÛÎÔfi ·˘Ùfi. TÔ 1903 Î·È ‡ÛÙÂÚ· ·fi ÚÔÛ¿ıÂȘ ÔÏÏÒÓ ¯ÚfiÓˆÓ ÂÈÓfiËÛ ¤Ó· fiÚÁ·ÓÔ Ô˘ ÁÈ· ÚÒÙË ÊÔÚ¿ ÌÔÚÔ‡Û ӷ ηٷÁÚ¿„ÂÈ ÙȘ ËÏÂÎÙÚÈΤ˜ ‰ÈÂÁ¤ÚÛÂȘ, Ù· ËÏÂÎÙÚÈο ‰˘Ó·ÌÈο ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ηډȿ˜, Ì ·ÚÎÂÙ‹ ·ÎÚ›‚ÂÈ·. A˘Ùfi fï˜ ‰ÂÓ ÙÔÓ ÂÊËÛ‡¯·ÛÂ. °ÓˆÚ›˙ÔÓÙ·˜ ˆ˜ ÛÙËÓ ÎÏÈÓÈ΋ I·ÙÚÈ΋ ··ÈÙÂ›Ù·È ÌÂÁ¿ÏË ·ÎÚ›‚ÂÈ· Î·È Ì ÙË ‚Ô‹ıÂÈ· ÙˆÓ ÁÓÒÛÂÒÓ ÙÔ˘ Á‡Úˆ ·fi ÙËÓ ÂÈÛÙ‹ÌË Ù˘ º˘ÛÈ΋˜, ÌÂÙ¤ÙÚ„ ÙÔ ·Ú¯ÈÎfi ·˘Ùfi «Á·Ï‚·ÓfiÌÂÙÚÔ ¯ÔÚ‰‹˜» Û ¤Ó· Û‡Á¯ÚÔÓÔ fiÚÁ·ÓÔ, Ù·¯‡Ù·ÙÔ Î·È Î·Ù¿ÏÏËÏÔ ÁÈ· ·ÎÚȂ›˜ ÌÂÙÚ‹ÛÂȘ, ÙÔÓ ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊÔ. H ̤Á·ÏË ÙÔ˘ ·˘Ù‹ ·Ó·Î¿Ï˘„Ë ¤Î·Ó ÙÔ ÂÚÁ·ÛÙ‹ÚÈfi ÙÔ˘, ÛÙÔ ¶·ÓÂÈÛÙ‹ÌÈÔ ÙÔ˘ §¤ÈÓÙÂÓ, ÙfiÔ Û˘ÁΤÓÙÚˆÛ˘ È·ÙÚÒÓ ·’ fiÏÔ ÙÔÓ ÎfiÛÌÔ, ÔÈ ÔÔ›ÔÈ Û˘Ó¤ÚÚÂ·Ó ÂΛ ÁÈ· Ó· ÂÓËÌÂÚˆıÔ‡Ó ÁÈ· ÙÔ Ó¤Ô fiÚÁ·ÓÔ, Ì ÙÔ ÔÔ›Ô Ë ‰È¿ÁÓˆÛË Î·È Ë ·ÓÙÈÌÂÙÒÈÛË ÔÏÏÒÓ ·ÓˆÌ·ÏÈÒÓ Ù˘ ηډȿ˜ ‹Ù·Ó ϤÔÓ Ôχ ÈÔ Â‡ÎÔÏË. ¶¤ı·Ó ÛÙȘ 25 ™ÂÙÂÌ‚Ú›Ô˘ ÙÔ˘ 1927 ÛÙÔ §›ÓÙÂÓ, OÏÏ·Ó‰›·˜.

8

¶A£OºY™IO§O°IA

¶ÚÔÁÓˆÛÙÈ΋ ·Í›· ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ˘ÔÏÂÈÌÌ·ÙÔÂȉÒÓ ÏÈÔÚˆÙÂ˚ÓÈÎÒÓ ÌÔÚ›ˆÓ Û ·ÛıÂÓ›˜ Ì ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ Î·È Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ ππ Fukushima H. MD, Sugiyama S. MD, PHD, Honda O. MD, Koide S. MD, Nakamura S. MD, Sakamoto T. MD, PHD, Yoshimura M. MD, PHD, Ogawa H. MD, PHD, Fujioka D. MD, Kugiyama K. MD. PHD. J Am Coll Cardiol 2004;43:2219-24

¶ÔÏϤ˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ÔÈ ÏÔ‡ÛȘ Û ÙÚÈÁÏ˘ÎÂÚ›‰È· ÏÈÔÚˆÙ½Ó˜ ‰È·‰Ú·Ì·Ù›˙Ô˘Ó Î·ıÔÚÈÛÙÈÎfi ÚfiÏÔ ÛÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ ‰È·‚ËÙÈ΋˜ Ì·ÎÚÔ·ÁÁÂÈÔ¿ıÂÈ·˜. ¢ÂÓ Â›Ó·È fï˜ ‰È¢ÎÚÈÓÈṲ̂ÓÔ ÔȘ ·ÎÚÈ‚Ò˜ ·fi ·˘Ù¤˜ ÙȘ ÏÈÔÚˆÙ½Ó˜ Â›Ó·È ˘‡ı˘Ó˜ ÁÈ· ÙÔÓ ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ. ∆· ˘ÔÏ›ÌÌ·Ù· ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ, ȉ›ˆ˜ ÙˆÓ ·Ú·ÁÔÌ¤ÓˆÓ ·fi ÙÔ VLDL ıˆÚÔ‡ÓÙ·È ·ıËÚÔÁfiÓ·. ∏ ÂÎÙ›ÌËÛË ÙÔ˘ ÂÈ¤‰Ô˘ ÙˆÓ ˘ÔÏÂÈÌÌ¿ÙˆÓ ÙˆÓ ÚˆÙÂ˚ÓÒÓ ÛÙÔÓ ÔÚfi ÎÏ·ÛÛÈο Á›ÓÂÙ·È Ì ˘ÂÚÊ˘ÁÔΤÓÙÚÈÛË Î·È Ì ËÏÂÎÙÚÔÊfiÚËÛË. ŒÌÌÂÛÔ˜ ·ÏÏ¿ ÌË ·ÎÚÈ‚‹˜ ÙÚfiÔ˜ Â›Ó·È Ô ˘ÔÏÔÁÈÛÌfi˜ Ù˘ ÌËHDL ¯ÔÏËÛÙÂÚfiÏ˘. ¶ÚfiÛÊ·Ù· ¤¯ÂÈ ÂÈÓÔËı› ÌÈ· Û¯ÂÙÈο ‡ÎÔÏË ·ÓÔÛÔ‚ÈÔÏÔÁÈ΋ ̤ıÔ‰Ô˜ ̤ÙÚËÛ˘ Ù˘ ÂÚȯfiÌÂÓ˘ ÛÙ· ˘ÔÏÂÈÌÌ·ÙÔÂȉ‹ ÏÈÔÚˆÙÂ˚ÓÈο ÌfiÚÈ· ¯ÔÏËÛÙÂÚfiÏ˘. ™Â ÌÈ· Û˘Á¯ÚÔÓÈ΋ ÌÂϤÙË ¤¯ÂÈ ‰È·ÈÛÙˆı› fiÙÈ Ë ¯ÔÏËÛÙÂÚfiÏË ·˘Ù‹ (Remnant-like Lipoprotein Particles Cholesterol, RLP-C) Â›Ó·È ·˘ÍË̤ÓË ÛÙÔÓ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË (™¢) Ù‡Ô˘ ππ. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ÂÚ¢ӋıËΠÚÔÔÙÈο ·Ó Ù· Â›‰· Ù˘ RLP-C ÌÔÚÔ‡Ó Ó·

ÚԂϤ„Ô˘Ó ÌÂÏÏÔÓÙÈο ÛÙÂÊ·ÓÈ·›· ÂÂÈÛfi‰È· Û ·ÛıÂÓ›˜ Ì ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ Î·È Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ ππ. ∂ÍÂÙ¿ÛıËÎ·Ó 240 ·ÛıÂÓ›˜ Ì ™¢ Ù‡Ô˘ ππ, ÂÎ ÙˆÓ ÔÔ›ˆÓ ÔÈ 120 ›¯·Ó ·ÁÁÂÈÔÁÚ·ÊÈο ·ԉ‰ÂÈÁ̤ÓË ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ Î·È ÔÈ ¿ÏÏÔÈ 120 ›¯·Ó ·ÁÁÂÈÔÁÚ·ÊÈο Ê˘ÛÈÔÏÔÁÈο ÛÙÂÊ·ÓÈ·›· ·ÁÁ›·. √È ·ÛıÂÓ›˜ Ì ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ ·Ú·ÎÔÏÔ˘ı‹ıËÎ·Ó ÁÈ· ≤24 Ì‹Ó˜ Î·È Î·Ù·ÁÚ¿ÊËÎÂ Ô ¯ÚfiÓÔ˜ ̤¯ÚÈ ÙÔ ÚÒÙÔ ·fi Ù· ηو٤ڈ ÎÏÈÓÈο Û˘Ì‚¿ÓÙ·: Â·ÓÂÈÛ·ÁˆÁ‹ ÛÙÔ ¡ÔÛÔÎÔÌ›Ô, ·ÔÚÙÔÛÙÂÊ·ÓÈ·›· ·Ú¿Î·Ì„Ë ÏfiÁˆ ˘ÔÙÚÔÈ¿˙Ô˘Û·˜ ‹ ·ÓıÂÎÙÈ΋˜ ÛÙËı¿Á¯Ë˜, ÌË ı·Ó·ÙËÊfiÚÔ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘ ‹ ηډȷÎfi˜ ı¿Ó·ÙÔ˜. ¢È·ÈÛÙÒıËΠfiÙÈ ÔÈ ·ÛıÂÓ›˜ Ì ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ Â›¯·Ó ˘„ËÏfiÙÂÚ· Â›‰· RLP-C ÛÙÔÓ ÔÚfi Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ ÌË ÛÙÂÊ·ÓÈ·›Ô˘˜. ∏ ÔÏ˘·Ú·ÌÂÙÚÈ΋ ÏÔÁÈÛÙÈ΋ ·Ó¿Ï˘ÛË Ù˘ Û˘Û¯¤ÙÈÛ˘ ¤‰ÂÈÍ fiÙÈ Ù· ˘„ËÏ¿ Â›‰· Ù˘ RLP-C (> 4,7mg %, Ô˘ ·ÚÈÛÙ¿ ÙÔ 75Ô ÂηÙÔÛÙËÌfiÚÈÔ Ù˘ ηٷÓÔÌ‹˜ Ù˘ RLPC ÛÙ· ÌË ÛÙÂÊ·ÓÈ·›· ¿ÙÔÌ·) ‹Ù·Ó ÛËÌ·ÓÙÈÎfi˜ ·Ú¿ÁˆÓ ÁÈ· ‡·ÚÍË ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘, ·ÓÂÍ¿ÚÙËÙÔ˜ ·fi ÙÔ˘˜ ÎÏ·ÛÛÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ-

‰‡ÓÔ˘. ∏ ·Ó¿Ï˘ÛË Î·Ù¿ Kaplan-Meier ¤‰ÂÈÍ fiÙÈ Ù· ˘„ËÏfiÙÂÚ· Â›‰· Ù˘ RLP-C ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ Â›¯·Ó ·ÔÙ¤ÏÂÛÌ· ÙËÓ ˘„ËÏfiÙÂÚË Èı·ÓfiÙËÙ· ÁÈ· ÂÌÊ¿ÓÈÛË ÛÙÂÊ·ÓÈ·›ˆÓ ÂÂÈÛÔ‰›ˆÓ. ∏ ÔÏ˘·Ú·ÁÔÓÙÈ΋ ·Ó¿Ï˘ÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ηٿ Cox ¤‰ÂÈÍ fiÙÈ ˘„ËÏ¿ Â›‰· RLP-C Û ·ÛıÂÓ›˜ Ì ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ ‹Ù·Ó ÛËÌ·ÓÙÈÎfi˜ ·Ú¿ÁˆÓ Úfi‚Ï„˘ ÌÂÏÏÔÓÙÈÎÒÓ ÛÙÂÊ·ÓÈ·›ˆÓ ÂÂÈÛÔ‰›ˆÓ, ·ÓÂÍ¿ÚÙËÙ· ·fi ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘. ∆· ˘ÔÏÂÈÌÌ·ÙÔÂȉ‹ ÏÈÔÚˆÙÂ˚ÓÈο ÌfiÚÈ· ¤¯ÂÈ ‰È·ÈÛÙˆı› ·fi ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜ fiÙÈ ·˘Í¿ÓÔ˘Ó ÙËÓ ¤ÎÊÚ·ÛË ÙÔ˘ ICAM-1 Î·È VCAM-1 Î·È ÚÔ¿ÁÔ˘Ó ÙËÓ ·Ú·ÁˆÁ‹ ÈÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· Î·È ÙËÓ Û˘ÁÎÔÏÏËÙÈÎfiÙËÙ· ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ. ªÂ ·˘ÙÔ‡˜ ÙÔ˘˜ Ì˯·ÓÈÛÌÔ‡˜ ›Ûˆ˜ ÚÔ¿ÁÔ˘Ó ÙËÓ ·ıËÚÔÁ¤ÓÂÛË Î·È Ù· Ôͤ· ÛÙÂÊ·ÓÈ·›· ÂÂÈÛfi‰È·. ∂È̤ÏÂÈ· ∏Ï›·˜ ÃÂÈÌÒÓ·˜

9

·ıËÚÔÛÎÏ‹ÚˆÛË ¢EKEMBPπ√™ 2004

∏ ÌÂȈ̤ÓË ÂÓ‰·ÁÁÂȷ΋ ÏÈfiÏ˘ÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ Û˘ÓÈÛÙ¿ ¤Ó· ‰Â›ÎÙË Ù˘ ÎÏÈÓÈ΋˜ ¤Î‚·Û˘ ÙˆÓ ·ÛıÂÓÒÓ Ì ÛÙ·ıÂÚ‹ ÛÙËı¿Á¯Ë ˘fi ·ÁˆÁ‹ ‰Â˘ÙÂÚÔ·ıÔ‡˜ ÚfiÏ˄˘. ªÈ· ÌÂϤÙË Ì·ÎÚÔ¯ÚfiÓÈ·˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ Sopito AC, Lemos PA, Santos RD, Hueb W, Vinagre CGC, Quintella E, Carneiro O, Chapman MJ, Ramires AF, Maranhao RC. J Am Coll Cardiol 2004;43:2225-32

∏ ÂÓ‰·ÁÁÂȷ΋ ÏÈfiÏ˘ÛË Â›Ó·È ÙÔ Î·ıÔÚÈÛÙÈÎfi ‚‹Ì· ÁÈ· ÙÔ Ú˘ıÌfi ˘‰ÚfiÏ˘Û˘ Î·È ·ÔÌ¿ÎÚ˘ÓÛ˘ ·fi ÙËÓ Î˘ÎÏÔÊÔÚ›· ÙˆÓ ÏÔ‡ÛÈˆÓ Û ÙÚÈÁÏ˘ÎÂÚ›‰È· ÏÈÔÚˆÙÂ˚ÓÒÓ, ¯˘ÏÔÌÈÎÚÒÓ Î·È VLDL. ∆Ô ¤Ó˙˘ÌÔ ÎÏÂȉ› ÛÙË ‰È·‰Èηۛ· ·˘Ù‹ Â›Ó·È Ë LPL, Ë ÔÔ›· ¢ڛÛÎÂÙ·È ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙˆÓ ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ ÙˆÓ Â͈Ë·ÙÈÎÒÓ ÙÚȯÔÂȉÒÓ Î·È ·ÂÏ¢ıÂÚÒÓÂÈ ÌÂÁ¿Ï˜ ÔÛfiÙËÙ˜ ÏÈ·ÚÒÓ ÔͤˆÓ ·fi ÙȘ ÏÔ‡ÛȘ Û ÙÚÈÁÏ˘ÎÂÚ›‰È· ÏÈÔÚˆÙ½Ó˜, ÁÈ· Ó· ÚÔÛÏËÊıÔ‡Ó ·fi Ù· ·ÙÙ·Ú· ÙˆÓ ÁÂÈÙÔÓÈÎÒÓ ÈÛÙÒÓ ÚÔ˜ ·Ú·ÁˆÁ‹ ÂÓ¤ÚÁÂÈ·˜ ‹ ·Ôı‹Î¢ÛË. ∏ ηı˘ÛÙ¤ÚËÛË Ù˘ ÂÓ‰·ÁÁÂȷ΋˜ ÏÈfiÏ˘Û˘ ·˘Í¿ÓÂÈ ÙËÓ ¤ÎıÂÛË ÙÔ˘ ·ÚÙËÚÈ·ÎÔ‡ ÙÔȯÒÌ·ÙÔ˜ ÛÙȘ ·ıËÚÔÁfiÓ˜ ÏÈÔÚˆÙ½Ó˜ Î·È Â˘ÓÔ› ÙË Û˘ÛÛÒÚ¢ÛË ÙÔ˘˜ ÛÙÔÓ ˘ÂÓ‰ÔıËÏÈ·Îfi ¯ÒÚÔ. ™Â ÔÚÈṲ̂Ó˜ ÌÂϤÙ˜ ·ÛıÂÓÒÓ Ì·ÚÙ‡ÚˆÓ (case control) ¤¯ÂÈ ·Ú·ÙËÚËı› fiÙÈ ÔÈ ·ÛıÂÓ›˜ Ì ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ ¤¯Ô˘Ó ‚Ú·‰‡ÙÂÚË ÂÓ‰·ÁÁÂȷ΋ ÏÈfiÏ˘ÛË Û ۇÁÎÚÈÛË Ì ٷ ¿ÙÔÌ· ¯ˆÚ›˜ ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ Î·È Û ÌÈ· ÌÂÙ··Ó¿Ï˘ÛË ÌÂÏÂÙÒÓ, ÊÔÚ›˜ ÌÈ·˜ ÌÂÙ¿ÏÏ·Í˘ Ù˘ LPL Ô˘ ÌÂÈÒÓÂÈ ÙË ÏÈÔÏ˘ÙÈ΋ Ù˘ ÈηÓfiÙËÙ· ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ ·fi ·ÛıÂÓ›˜ ¯ˆÚ›˜ ÌÂÙ¿ÏÏ·ÍË. √È ÛÙ·Ù›Ó˜ ·˘Í¿ÓÔ˘Ó ÙÔ Ú˘ı-

10

Ìfi ÎÏ·ÛÌ·ÙÈ΋˜ οı·ÚÛ˘ (fractional clearance rate) Ù˘ LDL Î·È ÙˆÓ ¯˘ÏÔÌÈÎÚÒÓ Ì¤Ûˆ Ù˘ Ô‰Ô‡ ÙˆÓ LDL ˘Ô‰Ô¯¤ˆÓ, ‰ÂÓ ÂËÚ¿˙Ô˘Ó fï˜ ÙÔÓ Ú˘ıÌfi Ù˘ ÂÓ‰·ÁÁÂȷ΋˜ ÏÈfiÏ˘Û˘. °È· ÙÔ ÏfiÁÔ ·˘Ùfi ¤¯ÂÈ ÂӉȷʤÚÔÓ Ó· ‰ÈÂÚ¢ÓËı› ·Ó ÔÈ ·ÛıÂÓ›˜ Ì ‚Ú·‰Â›· ÂÓ‰·ÁÁÂȷ΋ ÏÈfiÏ˘ÛË ÚÔÛٷهÔÓÙ·È ·fi ÙȘ ÛÙ·Ù›Ó˜.

63 ·ÛıÂÓ›˜ Ì ÛÙÂÊ·ÓÈÔÁÚ·ÊÈο ‚‚·ÈˆÌ¤ÓË ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ Î·È ÛÙ·ıÂÚ‹ ÛÙËı¿Á¯Ë Î·È 35 Ì¿ÚÙ˘Ú˜ ·ÔÙ¤ÏÂÛ·Ó ÙÔ ˘ÏÈÎfi Ù˘ ÌÂϤÙ˘. √È ·ÛıÂÓ›˜ ÂÏ¿Ì‚·Ó·Ó ÙËÓ Ì¤ÁÈÛÙË ·ÓÙÈÛÙËı·Á¯È΋ ·ÁˆÁ‹ Î·È ÛÙ·Ù›Ó˜ Û ‰fiÛË Î·Ù¿ÏÏËÏË Ó· ÂÈÙ¢¯ı› LDL-¯ÔÏËÛÙÂÚfiÏË < 100 mg%. ™Â fiÏÔ˘˜ ¤ÁÈÓ IV ¤Á¯˘ÛË ÂÓfi˜ ‰È·Ï‡Ì·ÙÔ˜ ·ÚfiÌÔÈÔ˘ Ì Á·Ï¿Îو̷ ¯˘ÏÔÌÈÎÚÒÓ Î·È Ú·‰ÈÔÛÂÛËÌ·Ṳ̂ӷ Ì 3∏ ÙÚÈÁ˘ÎÂÚ›‰È· Î·È 14C ÂÛÙ¤Ú˜ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ÂÍÂÙ¿ÛıËÎÂ Ë Î¿ı·ÚÛË ÙÔ˘˜ ·fi ÙÔ ·›Ì·. ∏ ÂÍ·Ê¿ÓÈÛË ÙÔ˘ 14C ‰Â›¯ÓÂÈ ÙËÓ Î¿ı·ÚÛË ÙˆÓ ÂÛÙ¤ÚˆÓ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È Û˘ÓÂÒ˜ ÙËÓ ÚfiÛÏË„Ë ÙˆÓ ÌÔÚ›ˆÓ ·fi ÙÔ˘˜ ˘ԉԯ›˜ ÂÓÒ Ë ÂÍ·Ê¿ÓÈÛË ÙÔ˘ 3∏ ÙËÓ Î¿ı·ÚÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ Î·È Û˘ÓÂÒ˜ ÙËÓ ÏÈfiÏ˘ÛË Û˘Ó ÙËÓ ÚfiÛÏË„Ë ÙˆÓ ÌÔÚ›ˆÓ. ∞fi ÙȘ ‰‡Ô ·˘Ù¤˜ ÙÈ̤˜ ˘ÔÏÔÁ›˙ÂÙ·È Ô ‰Â›ÎÙ˘ ·ÔÏ›ˆÛ˘ (delipidation index) Ô˘ ÂÎÙÈÌ¿ ÙÔ Ú˘ıÌfi ÏÈfiÏ˘Û˘.

√È ÛÙÂÊ·ÓÈ·›ÔÈ ·ÛıÂÓ›˜ ›¯·Ó ÌÂȈ̤ÓÔ Ú˘ıÌfi ÎÏ·ÛÌ·ÙÈ΋˜ οı·ÚÛ˘ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ (-26%, ƒ=0,027), ÂÛÙ¤ÚˆÓ ¯ÔÏËÛÙÂÚfiÏ˘ (-37%, ƒ=0,015) Î·È ‰Â›ÎÙË ·ÔÏ›ˆÛ˘ (-26%, ƒ=0,02) Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ 35 Ì¿ÚÙ˘Ú˜. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· 4,5±0,9 ÂÙÒÓ ·Ú·ÎÔÏÔ‡ıËÛ˘ 21 ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ (33%) ÂÌÊ¿ÓÈÛ·Ó ·ÓıÂÎÙÈ΋ ÛÙËı¿Á¯Ë Î·È ·ÁÁÂÈÔÁÚ·ÊÈ΋ Âȉ›ӈÛË ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ‚Ï·‚ÒÓ. √ Ú˘ıÌfi˜ ÎÏ·ÛÌ·ÙÈ΋˜ οı·ÚÛ˘ ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ Î·È Ô ‰Â›ÎÙ˘ ·ÔÏ›ˆÛ˘ ‹Ù·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚÔÈ Û ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓ›˜ (–44%, ƒ=0,005 Î·È –41%, ƒ=0,006 ·ÓÙ›ÛÙÔȯ·) Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ·Ú¤ÌÂÈÓ·Ó Û ÛÙ·ıÂÚ‹ ηٿÛÙ·ÛË. ∂ÈϤÔÓ Ë ÔÏ˘·Ú·ÌÂÙÚÈ΋ ·Ó¿Ï˘ÛË Û˘Û¯¤ÙÈÛ˘ ηٿ Cox ¤‰ÂÈÍ fiÙÈ ‰Â›ÎÙ˘ ·ÔÏ›ˆÛ˘ ÌÈÎÚfiÙÂÚÔ˜ ·fi ÙË ‰È¿ÌÂÛË ÙÈÌ‹ ‹Ù·Ó ·ÓÂÍ¿ÚÙËÙÔ˜ ‰Â›ÎÙ˘ ‰˘ÛÌÂÓÔ‡˜ ÎÏÈÓÈ΋˜ ¤Î‚·Û˘ (ÏfiÁÔ˜ ÎÈÓ‰‡ÓÔ˘ 3,32 ƒ=0,02) ™˘ÌÂÚ·›ÓÂÙ·È fiÙÈ Ë ÂÈ‚Ú·‰˘Ṳ̂ÓË ÂÓ‰·ÁÁÂȷ΋ ÏÈfiÏ˘ÛË Â›Ó·È ÈÛ¯˘Úfi˜ Î·È ·ÓÂÍ¿ÚÙËÙÔ˜ ÚÔÁÓˆÛÙÈÎfi˜ ‰Â›ÎÙ˘ Ù˘ ÎÏÈÓÈ΋˜ ÔÚ›·˜ Ù˘ ÛÙËı¿Á¯Ë˜, ·Ú¿ Ù· ̤ÙÚ· ‰Â˘ÙÂÚÔÁÂÓÔ‡˜ ÚfiÏ˄˘. ∂È̤ÏÂÈ·: ∏Ï›·˜ ÃÂÈÌÒÓ·˜

∫§π¡π∫∂™ ª∂§∂∆∂™

¶ÚˆÙÔ·ı‹˜ ÚfiÏË„Ë ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ Ì ·ÙÔÚ‚·ÛÙ·Ù›ÓË Û ‰È·‚ËÙÈÎÔ‡˜ Ù‡Ô˘ 2 ÛÙËÓ Collaborative Atorvastatin Diabetes Study (CARDS): ÔÏ˘ÎÂÓÙÚÈ΋, Ù˘¯·ÈÔÔÈË̤ÓË, ÂÏÂÁ¯fiÌÂÓË Ì ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ ÌÂϤÙË Colhoun HM, Betteridge DJ, Durrington PN, Hitman GA, Neil HAW, Livingstone SJ, Thomason MJ, Mackness MI, Charlton-Menys V, Fuller JH, ÂΠ̤ÚÔ˘˜ ÙˆÓ ÂÚ¢ÓËÙÒÓ Ù˘ ÌÂϤÙ˘ CARDS Lancet 2004;364:685-96

√ ™·Î¯·Ú҉˘ ‰È·‚‹Ù˘ (™¢) Ù‡Ô˘ 2 Û¯ÂÙ›˙ÂÙ·È Ì ‰ÈÏ¿ÛÈ· ¤ˆ˜ ÙÂÙÚ·Ï¿ÛÈ· ·‡ÍËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÙfiÛÔ ÁÈ· ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ (™¡) fiÛÔ Î·È ÁÈ· ·ÁÁÂȷο ÂÁÎÂÊ·ÏÈο ÂÂÈÛfi‰È· (∞∂∂). ∂ÈÚfiÛıÂÙ· Ë ıÓËÙfiÙËÙ· ÙˆÓ ·ı‹ÛÂˆÓ ·˘ÙÒÓ ÛÙÔ˘˜ ‰È·‚ËÙÈÎÔ‡˜ ·ÛıÂÓ›˜ Â›Ó·È Ôχ ·˘ÍË̤ÓË, Ú¿ÁÌ· Ô˘ ÂÈÙ›ÓÂÈ ÙËÓ ·Ó¿ÁÎË ÁÈ· ÚˆÙÔ·ı‹ ÚfiÏË„Ë. ∏ LDL¯ÔÏËÛÙÂÚfiÏË, ·Ó Î·È Û˘Ó‹ıˆ˜ ‰ÂÓ Â›Ó·È È‰È·›ÙÂÚ· ·˘ÍË̤ÓË

ÛÙ· ¿ÙÔÌ· ·˘Ù¿, ·ÔÙÂÏ› ÈÛ¯˘Úfi ‰Â›ÎÙË Úfi‚Ï„˘ ™¡ Î·È ∞∂∂. ™ÙË ÌÂϤÙË UKPDS ‰È·ÈÛÙÒıËΠfiÙÈ ÁÈ· οı 1 mmol/L ·‡ÍËÛ˘ Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ ·˘Í¿ÓÂÙ·È Ô Î›Ó‰˘ÓÔ˜ ÁÈ· ÙË ™¡ ηٿ 1,57 ÊÔÚ¤˜. ™ÙȘ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ Ì ÛÙ·Ù›Ó˜ ‰È·ÈÛÙÒıËΠfiÙÈ Ù· Ê¿Ú̷η ·˘Ù¿ ÌÂÈÒÓÔ˘Ó ÛÙ·ıÂÚ¿ ÙÔÓ Î›Ó‰˘ÓÔ Û ‰È·‚ËÙÈÎÔ‡˜ ·ÛıÂÓ›˜ Ì ™¡ (‰Â˘ÙÂÚÔ·ı‹˜ ÚfiÏË„Ë) fiÛÔ Î·È Û ‰È·‚ËÙÈο ¿ÙÔÌ· ¯ˆÚ›˜ ¤Î‰Ë-

ÏË ·ıËÚÔÛÎÏËÚˆÙÈ΋ ¿ıËÛË (ÚˆÙÔ·ı‹˜ ÚfiÏË„Ë). ¶·ÚfiÏ· ·˘Ù¿ Ë ¯ÔÚ‹ÁËÛË ˘ÔÏÈȉ·ÈÌÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ÛÙÔ˘˜ ‰È·‚ËÙÈÎÔ‡˜ ·Ú·Ì¤ÓÂÈ ¯·ÌËÏ‹ Î·È ÛÙË ÌÂϤÙË AUDIT Ô˘ ‰ÈÂÚ‡ÓËÛ ÙË ÛÙ¿ÛË ÙˆÓ ÁÈ·ÙÚÒÓ ÛÙË ‰È·‚ËÙÈ΋ ‰˘ÛÏÈȉ·ÈÌ›· (Diabetes 2004;53 (suppl 2): A285) ‰È·ÈÛÙÒıËΠfiÙÈ ÔÏÏÔ› ÂȉÈÎÔ› ÂÚ› ÙÔÓ ‰È·‚‹ÙË ‰ÂÓ Â›Ó·È ÂÂÈṲ̂ÓÔÈ ÁÈ· ÙËÓ ·Ó·ÁηÈfiÙËÙ· Ù˘ Ì›ˆÛ˘ ÙˆÓ ÏÈȉ›ˆÓ ÛÙÔ˘˜ ‰È·‚ËÙÈÎÔ‡˜ ̤-

∞ÚÈıÌfi˜ ·ÛıÂÓÒÓ Ì ¤Ó· Û˘Ì‚¿Ó (%) p

∂ÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ

∞ÙÔÚ‚·ÛÙ·Ù›ÓË 10 mg

∞Ó·ÏÔÁÈÎfi˜ ΛӉ˘ÓÔ˜ (95% CI)

¶ÚˆÙ‡ÔÓ Î·Ù·ÏËÎÙÈÎfi ÛËÌ›Ô

127 (9,0%)

83 (5,8%)

0,63 (0,48-0,83)

√͇ ÛÙÂÊ·ÓÈ·›Ô Û˘Ì‚¿Ó

77 (5,5%)

51 (3,6%)

0,64 (0,45-0,91)

∂¤Ì‚·ÛË Â·Ó·ÁÁ›ˆÛ˘

34 (2,4%)

24 (1,7%)

0,69 (0,41-1,16)

∞ÁÁÂÈ·Îfi ÂÁÎÂÊ·ÏÈÎfi

39 (2,8%)

21 (1,5%)

0,52 (0,31-0,89)

£¿Ó·ÙÔ˜ ·fi ÔÔÈ·‰‹ÔÙ ·ÈÙ›·

82 (5,8%)

61 (4,3%)

0,73 (0,52-1,01)

0,059

√ÔÈÔ‰‹ÔÙ Ô͇ ηډȷÁÁÂÈ·Îfi ÂÂÈÛfi‰ÈÔ

189 (13,4%)

134 (9,4%)

0,68 (0,55-0,85)

0,001

0,001

¢Â˘ÙÂÚ‡ÔÓ Î·Ù·ÏËÎÙÈÎfi ÛËÌ›Ô

0,2

0,4

0,6

0,8

1,0

1,2

∂ÈÎfiÓ· 1: ∞ÔÙ¤ÏÂÛÌ· Ù˘ ıÂÚ·›·˜ ÛÙÔ ÚˆÙ‡ÔÓ Î·È Ù· ‰Â˘ÙÂÚ‡ÔÓÙ· ηٷÏËÎÙÈο ÛËÌ›·.

11

·ıËÚÔÛÎÏ‹ÚˆÛË ¢EKEMBPπ√™ 2004

¶ÚˆÙ‡ÔÓ Î·Ù·ÏËÎÙÈÎfi ÛËÌ›Ô: Ì›˙ÔÓ· ηډȷÁÁÂȷο Û˘Ì‚¿Ì·Ù· 20

™¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ – 37% (95% Cl – 52 to – 17), p = 0,001 ∂ÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ ∞ÙÔÚ‚·ÛÙ·Ù›ÓË

15

10

5

0

∞ÚÈıÌfi˜ Û ΛӉ˘ÓÔ ∂ÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ 1410 ∞ÙÔÚ‚·ÛÙ·Ù›ÓË 1428

1351 1392

1306 1361

1022 1074

651 694

305 328

£ÓËÛÈÌfiÙËÙ· ·fi fiÏ· Ù· ·›ÙÈ· 20

™¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ – 27% (95% Cl – 48 to – 17), p = 0,059

15

10

5

0

∞ÚÈıÌfi˜ Û ΛӉ˘ÓÔ ∂ÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ 1410 ∞ÙÔÚ‚·ÛÙ·Ù›ÓË 1428

1395 1418

1370 1401

1094 1110

709 730

332 351

√ÔÈÔ‰‹ÔÙ ηډȷÁÁÂÈ·Îfi ηٷÏËÎÙÈÎfi ÛËÌ›Ô

™¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ – 32% (95% Cl – 45 to – 15), p = 0,001

20

15

10

5

0 0

1

2

3

4

4,75

ŒÙË

∞ÚÈıÌfi˜ Û ΛӉ˘ÓÔ ∂ÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ 1410 ∞ÙÔÚ‚·ÛÙ·Ù›ÓË 1428

1334 1372

1275 1337

992 1040

621 663

287 306

∂ÈÎfiÓ· 2: ∞ıÚÔÈÛÙÈÎfi˜ ΛӉ˘ÓÔ˜ ÁÈ· ÙÔ ÚˆÙ‡ÔÓ Î·Ù·ÏËÎÙÈÎfi ÛËÌ›Ô, ÙË ıÓËÛÈÌfiÙËÙ· ·fi ÔÔÈ·‰‹ÔÙ ·ÈÙ›· Î·È ÔÔÈÔ‰‹ÔÙ ηډȷÁÁÂÈ·Îfi ηٷÏËÎÙÈÎfi ÛËÌ›Ô.

12

¯ÚÈ ÙȘ ÙÈ̤˜ ÛÙfi¯Ô˘˜ Ô˘ Û˘ÛÙ‹ÓÔÓÙ·È ·fi ÙȘ ÙÚ¤¯Ô˘Û˜ Ô‰ËÁ›Â˜. ∏ ÌÂϤÙË CARDS ‰ÈÂÚ‡ÓËÛ ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙˆÓ 10 mg ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ ËÌÂÚËÛ›ˆ˜ ÛÙËÓ ÚˆÙÔ·ı‹ ÚfiÏË„Ë ÌÂÈ˙fiÓˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÂÂÈÛÔ‰›ˆÓ Û ·ÛıÂÓ›˜ Ì ™¢ Ù‡Ô˘ 2 ¯ˆÚ›˜ ˘„ËϤ˜ Û˘ÁÎÂÓÙÚÒÛÂȘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ ÛÙÔÓ ÔÚfi. 2.838 ·ÛıÂÓ›˜ ËÏÈΛ·˜ 40-75 ÂÙÒÓ (ÂÎ ÙˆÓ ÔÔ›ˆÓ 68% ¿Ó‰Ú˜), ¯ˆÚ›˜ ÈÛÙÔÚÈÎfi ηډȷÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ Î·È Ì ÙÈ̤˜ LDL¯ÔÏËÛÙÂÚfiÏ˘ ≤ 160 mg % Î·È ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ÓËÛÙ›·˜ ≤ 600 mg%, ·fi 132 ΤÓÙÚ· ÛÙÔ ∏ӈ̤ÓÔ µ·Û›ÏÂÈÔ Î·È ÙËÓ πÚÏ·Ó‰›·, Ù˘¯·ÈÔÔÈ‹ıËÎ·Ó Ó· Ï¿‚Ô˘Ó ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ (n= 1410) ‹ 10 mg ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ ÙËÓ Ë̤ڷ (n=1428). √È ·ÛıÂÓ›˜, ÁÈ· Ó· ÂÓÙ·¯ıÔ‡Ó ÛÙË ÌÂϤÙË, ¤ÚÂ ӷ ¤¯Ô˘Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ ¤Ó·Ó ·fi ÙÔ˘˜ ηو٤ڈ ·Ú¿ÁÔÓÙ˜: ·ÌÊÈ‚ÏËÛÙÚÔÂȉÔ¿ıÂÈ·, ÏÂ˘ÎˆÌ·ÙÈÓÔ˘Ú›· (ÌÈÎÚÔ- ‹ Ì·ÎÚÔ-), ÈÛÙÔÚÈÎfi ˘¤ÚÙ·Û˘ ‹ οÓÈÛÌ·. ∆Ô Î‡ÚÈÔ Î·Ù·ÏËÎÙÈÎfi ÛËÌÂ›Ô ‹Ù·Ó Ô ¯ÚfiÓÔ˜ ̤¯ÚÈ ÙËÓ ÚÒÙË ÂÌÊ¿ÓÈÛË ÔͤԘ ÛÙÂÊ·ÓÈ·›Ô˘ ÂÂÈÛÔ‰›Ô˘, Â¤Ì‚·Û˘ Â·Ó·ÁÁ›ˆÛ˘ ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ‹ ∞∂∂ (fiÔÈÔ ‹Ù·Ó ÚÒÙÔ). ¢Â˘ÙÂÚ‡ÔÓÙ· ηٷÏËÎÙÈο ÛËÌ›· ‹Ù·Ó Ë ÔÏÈ΋ ıÓËÛÈÌfiÙËÙ· Î·È ÔÔÈÔ‰‹ÔÙ ÓÔÛÔÎÔÌÂȷο ‚‚·ÈˆÌ¤ÓÔ Ô͇ ηډȷÁÁÂÈ·Îfi ÂÂÈÛfi‰ÈÔ. ∏ ·Ó¿Ï˘ÛË ¤ÁÈÓ Ì ‚¿ÛË ÙËÓ ÚfiıÂÛË ıÂÚ·›·˜. ∏ Ù˘¯·ÈÔÔ›ËÛË ¿Ú¯ÈÛ ¡Ô¤Ì‚ÚÈÔ 1997 Î·È ÙÂÏ›ˆÛ πÔ‡ÓÈÔ 2001. ∏ ÌÂϤÙË ÙÂÚÌ·Ù›ÛıËΠ2 ¯ÚfiÓÈ· ÂÓˆÚ›ÙÂÚ· ·fi ÙÔ ¯ÚfiÓÔ Ô˘ ˘ÔÏÔÁÈ˙fiÙ·Ó, ÂÂȉ‹ ÛÙË ‰Â‡ÙÂÚË ÂӉȿÌÂÛË ·Ó¿Ï˘ÛË Ô˘ ¤ÁÈÓ ۇÌʈӷ Ì ÙÔ ÚfiÁÚ·ÌÌ·, ‰È·ÈÛÙÒıËΠfiÙÈ Â›¯Â ÂÎÏËÚˆı› ÙÔ ÚÔ·ÔÊ·ÛÈṲ̂ÓÔ ÎÚÈÙ‹ÚÈÔ ÚÒÈÌ˘ ‰È·ÎÔ‹˜ ÏfiÁˆ ÂÈÙ˘¯›·˜. √ ‰È¿ÌÂÛÔ˜ ¯ÚfiÓÔ˜ ·Ú·ÎÔÏÔ‡ıË-

∫§π¡π∫∂™ ª∂§∂∆∂™ Û˘ ‹Ù·Ó 3,9 ¯ÚfiÓÈ·. ™ÙË ‰È¿ÚÎÂÈ· ·˘Ù‹ 127 ·ÛıÂÓ›˜ Ù˘ ÔÌ¿‰·˜ placebo (2,46 ·Ó¿ 100 ¿ÙÔÌ·-¤ÙË) Î·È 83 Ù˘ ÔÌ¿‰·˜ ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ (1,54 ·Ó¿ 100 ¿ÙÔÌ·-¤ÙË) ÂÌÊ¿ÓÈÛ·Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ ¤Ó· Ì›˙ÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi Û˘Ì‚¿Ó. ∞˘Ùfi ÛËÌ·›ÓÂÈ Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ηٿ 37% (95% CI –52 ̤¯ÚÈ –17, p=0,001). ∂ÎÙÈÌ¿Ù·È fiÙÈ Ë ıÂÚ·›· Ì 10 mg ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ Â› 4 ¯ÚfiÓÈ· ÚÔÏ·Ì‚¿ÓÂÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ 37 Ì›˙ÔÓ· ηډȷÁÁÂȷο Û˘Ì‚¿Ì·Ù· ·Ó¿ 1000 Ù¤ÙÔÈÔ˘˜ ·ÛıÂÓ›˜. ∞Ó Ù· Â˘Ú‹Ì·Ù· ·Ó·Ï˘ıÔ‡Ó ¯ˆÚÈÛÙ¿ ÚÔ·ÙÂÈ fiÙÈ Ù· Ôͤ· ÛÙÂÊ·ÓÈ·›· ÂÂÈÛfi‰È· ÌÂÈÒıËÎ·Ó Î·Ù¿ 36% (-55 Ì –9), ÔÈ ÂÂÌ‚¿ÛÂȘ Â·Ó·ÁÁ›ˆÛ˘ ηٿ 31% (–59 Ì –16) Î·È Ù· ∞∂∂ ηٿ 48% (–69 Ì –11). √ ‰Â›ÎÙ˘ ıÓËÛÈÌfiÙËÙ·˜ ÌÂÈÒıËΠ̠ÙËÓ ·ÙÔÚ‚·ÛÙ·Ù›ÓË Î·Ù¿ 27%. ∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ ıÂÚ·›·˜ ÛÙÔ ÚˆÙ‡ÔÓ Î·È ÛÙ· ‰Â˘ÙÂÚ‡ÔÓÙ· ηٷÏËÎÙÈο ÛËÌ›· Ê·›ÓÔÓÙ·È ÛÙËÓ EÈÎfiÓ· 1. √È Î·Ì‡Ï˜ ÁÈ· Ù· Ì›˙ÔÓ·

ηډȷÁÁÂȷο Û˘Ì‚¿ÓÙ·, ÙËÓ ıÓËÛÈÌfiÙËÙ· ·fi ÔÔÈ·‰‹ÔÙ ·ÈÙ›· Î·È ÁÈ· ÔÔÈÔ‰‹ÔÙ ηډȷÁÁÂÈ·Îfi ÂÂÈÛfi‰ÈÔ ÛÂ Û˘Ó¿ÚÙËÛË Ì ÙÔÓ ¯ÚfiÓÔ Ê·›ÓÔÓÙ·È ÛÙËÓ ∂ÈÎfiÓ· 2. √È Î·Ì‡Ï˜ ‰È·¯ˆÚ›˙ÔÓÙ·È ·fi ÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ Ù˘ ÌÂϤÙ˘. ∆· ·ÔÙÂϤÛÌ·Ù· ‹Ù·Ó ÙÔ ›‰ÈÔ ÛËÌ·ÓÙÈο ·ÓÂÍ¿ÚÙËÙ· ·fi ÙȘ ·Ú¯ÈΤ˜ ÙÈ̤˜ Ù˘ ÔÏÈ΋˜ Î·È Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘. ∏ ÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ Ì LDL¯ÔÏËÛÙÂÚfiÏË < 120 mg% ›¯Â ÙÔ ›‰ÈÔ Â˘ÂÚÁÂÙÈο ·ÔÙÂϤÛÌ·Ù·, fiÛÔ Î·È Ë ÔÌ¿‰· Ì LDL-¯ÔÏËÛÙÂÚfiÏË ≥ 120 mg%. ∆Ô ›‰ÈÔ ·Ú·ÙËÚ‹ıËÎÂ Î·È ÁÈ· ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ˘„ËÏfiÙÂÚË ‹ ¯·ÌËÏfiÙÂÚË HDL-¯ÔÏËÛÙÂÚfiÏË, ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË ‹ ÙÚÈÁÏ˘ÎÂÚ›‰È· (EÈÎfiÓ· 3). √È ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ÛÙËÓ ÔÌ¿‰· Ù˘ ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ ‰ÂÓ ‰È¤ÊÂÚ·Ó ·fi ·˘Ù¤˜ Ù˘ ÔÌ¿‰·˜ ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘. ¢ÂÓ ·Ú·ÙËÚ‹ıËΠÂÚÈÛÙ·ÙÈÎfi Ú·‚‰ÔÌ˘fiÏ˘Û˘ Û ηÌÈ¿ ÔÌ¿‰·, ˘‹ÚÍ ·fi ¤Ó· ÂÚÈÛÙ·ÙÈÎfi Ì˘Ô¿ıÂÈ·˜ ÛÂ

οı ÔÌ¿‰· Î·È ·Ó·Ê¤ÚıËÎÂ Ì˘·ÏÁ›· Û 72 ·ÛıÂÓ›˜ Ù˘ ÔÌ¿‰·˜ ÂϤÁ¯Ô˘ Î·È Û 61 Ù˘ ÔÌ¿‰·˜ Ù˘ ·ÙÔÚ‚·ÛÙ·Ù›Ó˘. ÿ‰ÈÔ ÔÛÔÛÙfi ·ÛıÂÓÒÓ Î·È ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ ÂÌÊ¿ÓÈÛ ÂÓ˙˘ÌÈΤ˜ ‰È·Ù·Ú·¯¤˜. ∆· Û˘ÌÂÚ¿ÛÌ·Ù· Ô˘ ‚Á·›ÓÔ˘Ó ·fi ÙË ÌÂϤÙË Â›Ó·È fiÙÈ Ë ·ÙÔÚ‚·ÛÙ·Ù›ÓË Û ‰fiÛË 10 mg Â›Ó·È ·ÛÊ·Ï‹˜ Î·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ Û ·ÛıÂÓ›˜ Ì ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ 2 ¯ˆÚ›˜ ˘„ËÏ‹ LDL-¯ÔÏËÛÙÂÚfiÏË Î·È fiÙÈ ÂÏ·ÙÙÒÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÁÈ· ÂΉ‹ÏˆÛË ÚÒÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ ÂÂÈÛÔ‰›Ô˘, Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤ÓÔ˘ ∞∂∂. ¢ÂÓ ÚÔ·ÙÂÈ Î·ÌÈ¿ ‰ÈηÈÔÏÔÁË̤ÓË ¤Ó‰ÂÈÍË fiÙÈ ˘¿Ú¯ÂÈ ¤Ó·˜ Ô˘‰fi˜ ÛÙË Û˘ÁΤÓÙÚˆÛË Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ οوıÂÓ ÙÔ˘ ÔÔ›Ô˘ ‰ÂÓ ··ÈÙÂ›Ù·È ¯ÔÚ‹ÁËÛË ÛÙ·Ù›Ó˘ Û ·ÛıÂÓ›˜ Ì ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ 2. ∂È̤ÏÂÈ·: ∏Ï›·˜ ÃÂÈÌÒÓ·˜

∞ÚÈıÌfi˜ ·ÛıÂÓÒÓ Ì ¤Ó· ۇ̂·Ì· (%) ∂ÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ

∞Ó·ÏÔÁÈÎfi˜ ΛӉ˘ÓÔ˜ (95% CI)

∞ÙÔÚ‚·ÛÙ·Ù›ÓË

LDL-¯ÔÏÈÛÙÂÚfiÏË (mmol/L) ≥3,1

66 (9,5%)

44 (6,1%)

0,62 (0,43-0,91)

<3,1

61 (8,5%)

39 (5,6%)

0,63 (0,42-0,94)

≥1,4

62 (8,5%)

36 (5,2%)

0,59 (0,39-0,89)

<1,4

65 (9,6%)

47 (6,4%)

0,66 (0,45-0,95)

≥1,7

67 (9,6%)

40 (5,5%)

0,56 (0,38-0,82)

<1,7

60 (8,4%)

43 (6,1%)

0,71 (0,48-1,05)

≥5,4

71 (10,1%)

44 (6,2%)

0,59 (0,41-0,86)

<5,4

56 (7,9%)

39 (5,5%)

0,67 (0,45-1,01)

p*

0,96

HDL-¯ÔÏÈÛÙÂÚfiÏË (mmol/L)

0,70

∆ÚÈÁÏ˘ÎÂÚ›‰È· (mmol/L)

0,40

√ÏÈ΋ ¯ÔÏÈÛÙÂÚfiÏË (mmol/L)

0,2

0,4

0,6 0,8

1,0

0,67

1,2

∂ÈÎfiÓ· 3: ∞ÔÙÂϤÛÌ·Ù· Ù˘ ıÂÚ·›·˜ ÛÙÔ Î‡ÚÈÔ Î·Ù·ÏËÎÙÈÎfi ÛËÌÂ›Ô ·Ó¿ÏÔÁ· Ì ÙÈÌ‹ ÙˆÓ ÏÈȉ›ˆÓ ÚÈÓ ÙËÓ ¤Ó·ÚÍË Ù˘ ·ÁˆÁ‹˜.

13

·ıËÚÔÛÎÏ‹ÚˆÛË ¢EKEMBPπ√™ 2004

∏ ¶·È‰È·ÙÚÈ΋ ªÂϤÙË. ∞ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Î·È ∞ÛÊ¿ÏÂÈ· Ù˘ ∞ÙÔÚ‚·ÛÙ·Ù›Ó˘ Û ¶·È‰È¿ Î·È ∂Ê‹‚Ô˘˜ Ì √ÈÎÔÁÂÓ‹ ÀÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· ‹ ™Ô‚·Ú‹ ÀÂÚÏÈȉ·ÈÌ›· McCrindle BW, Ose L, Marais AD. THE JOURNAL OF PEDIATRICS 2003;143 Number 1

∏ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· ¤¯ÂÈ ·Ó·ÁÓˆÚÈÛı› ˆ˜ ÚˆÙ‡ˆÓ ·Ú¿ÁˆÓ ÎÈÓ‰‡ÓÔ˘ (¶∫) ÁÈ· ηډȷÁÁÂȷ΋ ÓfiÛÔ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ. ∞Ó Î·È Ô ·fiÏ˘ÙÔ˜ ΛӉ˘ÓÔ˜ ÁÈ· ÙÔ ÂÓ ÏfiÁˆ ÓfiÛËÌ· ÛÙ· ·È‰È¿ Â›Ó·È ¯·ÌËÏfi˜, ˘¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ fiÙÈ Ù· Â›‰· Ï¿ÛÌ·ÙÔ˜ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ Û˘Ó‰¤ÔÓÙ·È Ì ÙÔ Û¯ËÌ·ÙÈÛÌfi ÏÈˆ‰ÒÓ ÁÚ·ÌÌÒÛÂˆÓ Î·È Ì ·˘ÍË̤ÓË Â›ÙˆÛË ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ (™¡) ÛÙËÓ ÂÓ‹ÏÈÎÔ ˙ˆ‹. ™ÙÔȯ›·, ‰ÈÂıÓÒ˜, ‰È·ÎÚ›ÓÔ˘Ó ÛÙ· ·È‰È¿ ÌÈ· ·˘Í·ÓfiÌÂÓË Â›ÙˆÛË ·ıÔÏÔÁÈÎÒÓ Î·Ù·ÛÙ¿ÛÂˆÓ Ô˘ Â›Ó·È ‰˘ÓËÙÈο ·ıËÚÔÌ·ÙÔÁfiÓ˜ fiˆ˜ Ô ‰È·‚‹Ù˘, Ë ·˘ÍË̤ÓË ·ÚÙËÚȷ΋ ›ÂÛË Î·È Ë ˘ÂÚÏÈȉ·ÈÌ›·. º·›ÓÂÙ·È fiÙÈ Ë Ê·Ú̷΢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ˘ÂÚÏÈȉ·ÈÌ›·˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ· ·ÔÎÙ¿ ·˘Í·ÓfiÌÂÓÔ ÂӉȷʤÚÔÓ. ∏ Ù·¯Â›· ÂͤÏÈÍË Ù˘ ·ıËÚÔÛÎÏ‹ÚˆÛ˘ Â›Ó·È È‰È·›ÙÂÚ· ÂÌÊ·Ó‹˜ Û ·È‰È¿ Î·È ÂÓ‹ÏÈΘ Ì ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·. ¶ÚfiÎÂÈÙ·È ÁÈ· ÁÂÓÂÙÈÎfi ÓfiÛËÌ· Ì ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú· Ô˘ ÔÊ›ÏÂÙ·È Û ÌÂÙ·ÏÏ¿ÍÂȘ ÙˆÓ LDL ˘Ô‰Ô¯¤ˆÓ Î·È ¤¯ÂÈ Û˘¯ÓfiÙËÙ· ÁÈ· ÙÔ˘˜ ÂÙÂÚÔ˙˘ÁfiÙ˜ 1:500. ™ÙÔ˘˜ ¿Ó‰Ú˜ ¯ˆÚ›˜ ıÂÚ·›· Ô Î›Ó‰˘ÓÔ˜ ÁÈ· ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ Â›Ó·È 50% ÛÙËÓ ËÏÈΛ· ÙˆÓ 50 ÂÙÒÓ. ∆· ·Ú·¿Óˆ ÛÙÔȯ›· Î·È Ù· ‰˘ÓËÙÈο ÛÔ‚·Ú¿ Â·ÎfiÏÔ˘ı· Ù˘ ˘ÂÚÏÈȉ·ÈÌ›·˜ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ ÂÓÈÛ¯‡Ô˘Ó ÙËÓ ¿Ô„Ë fiÙÈ Ù· ·È‰È¿ Ì ‚·ÚÈ¿ ˘ÂÚÏÈȉ·ÈÌ›· ‹ ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·, Ú¤ÂÈ Ó· ¤¯Ô˘Ó Ô‰ËÁ›Â˜ ÁÈ· ˘ÔÏÈȉ·ÈÌÈ΋ ıÂÚ·›·. √È ÙÚ¤¯Ô˘Û˜ ·È‰È·ÙÚÈΤ˜ Ô‰ËÁ›Â˜ Û˘ÛÙ‹ÓÔ˘Ó ˘ÔÏÈȉ·ÈÌÈ΋ ıÂÚ·›· Ì ʿÚ̷η Û ·È‰È¿ ÌÂ-

14

Á·Ï‡ÙÂÚ· ÙˆÓ ‰¤Î· ÂÙÒÓ, Â¿Ó ÌÂÙ¿ ·fi ‰›·ÈÙ· Ë LDL-C ·Ú·Ì¤ÓÂÈ ≥190 mg/dl ‹ ≥160 mg/dl Î·È ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÚÒÈÌ˘ ™¡ ‹ ‰‡Ô ¶∫ ÁÈ· ηډȷÁÁÂȷο ÓÔÛ‹Ì·Ù·. ∏ ·È‰È·ÙÚÈ΋ ÌÂϤÙË Â›¯Â ÛÙfi¯Ô Ó· ·ԉ›ÍÂÈ ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Î·È ·ÛÊ¿ÏÂÈ· Ù˘ ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ 10-20 mg ËÌÂÚËÛ›ˆ˜ Û ·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ· ËÏÈΛ·˜ 10-17 ÂÙÒÓ Ì ÔÈÎÔÁÂÓ‹ ‹ ¿ÏÏ˘ ÌÔÚÊ‹˜ ‚·ÚÈ¿ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·. ∏ ÌÂϤÙË ‹Ù·Ó ÔÏ˘ÎÂÓÙÚÈ΋ (20 ΤÓÙÚ·), Ù˘¯·ÈÔÔÈË̤ÓË, ‰ÈÏ‹-Ù˘ÊÏ‹, ·ÓÔÈÎÙ‹. ∂ηÙfiÓ ÔÁ‰fiÓÙ· ÂÙ¿ ·È‰È¿ ‹Ú·Ó ·Ú¯Èο ÁÈ· 4 ‚‰ÔÌ¿‰Â˜ Ô‰ËÁ›Â˜ ÁÈ· ‰›·ÈÙ·, NCEP ÛÙ·‰›Ô˘ 1 Î·È ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ.T· ¿ÙÔÌ· Ô˘ ›¯·Ó LDL-C ≥ 160 mg/dl Î·È ÙÚÈÁÏ˘ÎÂÚ›‰È· ≤ 400 mg/dl Ù˘¯·ÈÔÔÈ‹ıËÎ·Ó 3:1 Ó· ¿ÚÔ˘Ó ÁÈ· 26 ‚‰ÔÌ¿‰Â˜ ·ÙÔÚ‚·ÛÙ·Ù›ÓË 10 mg ËÌÂÚËÛ›ˆ˜ ‹ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ. ∂¿Ó ÛÙËÓ Ù¤Ù·ÚÙË Â‚‰ÔÌ¿‰· ÔÈ ·ÛıÂÓ›˜ ‰ÂÓ Â›¯·Ó ÂÈÙ‡¯ÂÈ ÙÔ ÛÙfi¯Ô ÙˆÓ 130 mg/dl ÁÈ· ÙËÓ LDL-C Ë ‰fiÛË Ù˘ ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ ‰ÈÏ·ÛÈ·˙fiÙ·Ó ÛÙ· 20 mg ËÌÂÚËÛ›ˆ˜. ŸÏ· Ù· ¿ÙÔÌ· Ô˘ Û˘ÌÏ‹ÚˆÛ·Ó ÙËÓ ÂÚ›Ô‰Ô Ù˘ ‰ÈÏ‹˜-Ù˘ÊÏ‹˜ ·ÁˆÁ‹˜ ÌÔÚÔ‡Û·Ó Ó· Û˘Ó¯›ÛÔ˘Ó ·ÓÔȯٿ Ì ·ÙÔÚ‚·ÛÙ·Ù›ÓË 10 mg ÁÈ· ¿ÏϘ 26 ‚‰ÔÌ¿‰Â˜. ∞ÔÙÂϤÛÌ·Ù·: ∏ LDL-C, Ô˘ ·ÔÙÂÏÔ‡ÛÂ Î·È ÙÔÓ Î‡ÚÈÔ ÛÙfi¯Ô Ù˘ ÌÂϤÙ˘, ÌÂÈÒıËΠÛÙËÓ ÔÌ¿‰· Ô˘ ‹Ú ·ÙÔÚ‚·ÛÙ·Ù›ÓË Î·Ù¿ 77,9 mg%, ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÂÚÈÛÛfiÙÂÚÔ Û ۇÁÎÚÈÛË Ì ÙÔ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ (-39,6 ±1% ¤Ó·ÓÙÈ -0,4±1,9%). ∂›Û˘ ÛÙËÓ ›‰È· ÔÌ¿‰· Ù˘ ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ ÌÂÈÒıËÎ·Ó ÛËÌ·ÓÙÈο Ë

ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË (-31,4± 1,0%), Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È· (-12,0± 2,9%) Î·È Ë ApoB (-34,0±1,1) Û˘ÁÎÚÈÙÈο Ì ÙËÓ ÔÌ¿‰· ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ (-1,5±1,5%, +1,0±6,2%, +0,7±1,6 ·ÓÙ›ÛÙÔȯ·) Î·È ·˘Í‹ıËÎÂ Ë HDL-C (2,8± 1,3% ¤Ó·ÓÙÈ -1,9±1,9% ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘). °È· ÙËÓ ApoA ‰ÂÓ ˘‹ÚÍ·Ó ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ. ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·ÛÊ¿ÏÂÈ· ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ˘‹ÚÍ·Ó ÌfiÓÔÓ ‹Ș ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ. ∆Ú›· ·fi Ù· ·È‰È¿ ·ÚÔ˘Û›·Û·Ó ·‡ÍËÛË ÙˆÓ ÙÚ·ÓÛ·ÌÈÓ·ÛÒÓ > 3 ULN ÂÓÒ ÌfiÓÔ ¤Ó· ·È‰› ‚Á‹Î ·fi ÙË ÌÂϤÙË ÏfiÁˆ Âȉ›ӈÛ˘ Ù˘ ηٿıÏȄ˘ ·fi ÙËÓ ÔÔ›· ¤·Û¯Â. °ÂÓÈÎÒ˜ ÔÈ ÂÚÁ·ÛÙËÚȷΤ˜ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ‹Ù·Ó ·ÚfiÌÔȘ ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ ÂÎÙfi˜ ·fi Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È· Ô˘ ‹Ù·Ó ˘„ËÏfiÙÂÚ· ÛÙËÓ ÔÌ¿‰· ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘. π‰È·›ÙÂÚ˘ ÛËÌ·Û›·˜ (ÁÈ· ÙËÓ ËÏÈΛ·) Â›Ó·È Ë ‰Ú¿ÛË Ù˘ ˘ÔÏÈȉ·ÈÌÈ΋˜ ıÂÚ·›·˜ ÛÙËÓ ÛÂÍÔ˘·ÏÈ΋ ·Ó¿Ù˘ÍË ÙˆÓ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ (Ù· ÛÙÂÚÔÂȉ‹ ÚÔ¤Ú¯ÔÓÙ·È fiÏ· ·fi ÙË ¯ÔÏËÛÙÂÚfiÏË). ∏ ·È‰È·ÙÚÈ΋ ÌÂϤÙË ¤‰ÂÈÍ fiÙÈ Ë ıÂÚ·›· Ì ·ÙÔÚ‚·ÛÙ·Ù›ÓË 10 ‹ 20 mg ËÌÂÚËÛ›ˆ˜ ÁÈ· 26 ‚‰ÔÌ¿‰Â˜ ‰ÂÓ Â›¯Â ‰˘ÛÌÂÓ‹ Â›‰Ú·ÛË ÛÙËÓ ÛÂÍÔ˘·ÏÈ΋ ·Ó¿Ù˘ÍË ÙˆÓ ·È‰ÈÒÓ Ô˘ ‹Ú·Ó ̤ÚÔ˜ ÛÙË ÌÂϤÙË (ÛÙ·‰ÈÔÔ›ËÛË Î·Ù¿ Tanner). ™˘ÌÂÚ·ÛÌ·ÙÈο Ë ·ÙÔÚ‚·ÛÙ·Ù›ÓË Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈÎfi Î·È ·ÛʷϤ˜ Ê¿ÚÌ·ÎÔ ÁÈ· ÙËÓ ÔÈÎÔÁÂÓ‹ ‹ ¿ÏÏ˘ ·ÈÙÈÔÏÔÁ›·˜ ÛÔ‚·Ú‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· ÁÈ· ·È‰È¿ ËÏÈΛ·˜ 10-17 ÂÙÒÓ. ∂È̤ÏÂÈ·: ∂ϤÓË ªÈÏÈ·ÓÔ‡

¢IAITA

√ ƒfiÏÔ˜ ÙˆÓ º˘ÙÈÎÒÓ ™ÙÂÚÔÏÒÓ / ™Ù·ÓÔÏÒÓ ÛÙËÓ AÓÙÈÌÂÙÒÈÛË Ù˘ YÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜ ªˆ˘Û‹˜ ∂ÏÈÛ¿Ê, ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ

™‡Ìʈӷ Ì ÙȘ Ô‰ËÁ›Â˜ Ù˘ ∂ıÓÈ΋˜ ∂ÈÙÚÔ‹˜ ÁÈ· ÙË ¯ÔÏËÛÙÂÚfiÏË ÙˆÓ ∏¶∞ (NCET, ATP III) Ô˘ ‰È·Ù˘ÒıËÎ·Ó ÙÔ 2001, Ô ‚·ÛÈÎfi˜ ÛÙfi¯Ô˜ Ù˘ ˘ÔÏÈȉ·ÈÌÈ΋˜ ·ÁˆÁ‹˜ Â›Ó·È Ë Ì›ˆÛË Ù˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘ (LDL CHOL). ∏ ·fiÊ·ÛË ÁÈ· ÙËÓ ¤Ó·ÚÍË ˘ÁÈÂÈÓԉȷÈÙËÙÈ΋˜ ‹ Ê·Ú̷΢ÙÈ΋˜ ·ÁˆÁ‹˜ Î·È ÔÈ ÛÙfi¯ÔÈ Ù˘ ·ÁˆÁ‹˜ ÂÍ·ÚÙÒÓÙ·È Û οı ÂÚ›ÙˆÛË ·fi ÙÔ Û˘ÓÔÏÈÎfi ΛӉ˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ÚÒÈÌ˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘. ¶Ú¿ÁÌ·ÙÈ Û ¿ÙÔÌ· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ (.¯. Û ·ÛıÂÓ›˜ Ì ÂÁηÙÂÛÙË̤ÓË ·ÁÁÂȷ΋ ÓfiÛÔ ‹ Û ‰È·‚ËÙÈÎÔ‡˜ ·ÛıÂÓ›˜), Ô ÛÙfi¯Ô˜ Ù˘ ˘ÔÏÈȉ·ÈÌÈ΋˜ ·ÁˆÁ‹˜ Â›Ó·È Ë Ì›ˆÛË Ù˘ LDL CHOL < 100 mg/dl. ¶Ôχ ÚfiÛÊ·Ù· ·fi ÙÔ ›‰ÈÔ ÂÈÛÙËÌÔÓÈÎfi ÛÒÌ· (NCEP ÙˆÓ ∏¶∞) ‰È·Ù˘ÒıËÎÂ Ë ¿Ô„Ë fiÙÈ ··ÈÙÂ›Ù·È ÌÈ· ÈÔ ÂÈıÂÙÈ΋ ÛÙÚ·ÙËÁÈ΋ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ‰˘ÛÏÈȉ·ÈÌ›·˜ Û ¿ÙÔÌ· Ôχ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘. √È Û˘ÁÁÚ·Ê›˜ ÌÂÙ¿ ·fi ÂÓ‰Âϯ‹ ·Ó¿Ï˘ÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÙˆÓ ÌÂÏÂÙÒÓ Ô˘ ‰ËÌÔÛȇıËÎ·Ó ÚfiÛÊ·Ù· (ÌÂϤÙ˜ GREACE, PROVE-IT, REVERSAL, CARDS, HPS) η٤ÏËÍ·Ó ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ Û ¿ÙÔÌ· ȉȷ›ÙÂÚ· ·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ Ô ÛÙfi¯Ô˜ Ù˘ ·ÁˆÁ‹˜ Ú¤ÂÈ Ó· Â›Ó·È Ë Ì›ˆÛË Ù˘ LDL CHOL<70 mg/dl. ¶·Ú¿ÏÏËÏ· ÂÈÛËÌ¿ÓıËÎÂ Ë ·Ó¿ÁÎË ÁÈ· ÌÈ· ÛËÌ·ÓÙÈ΋ Ì›ˆÛË (Ù˘ ٿ͈˜ ÙÔ˘ 30-40%) ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ LDL CHOL ·ÓÂÍ¿ÚÙËÙ· ·fi Ù· ·Ú¯Èο Ù˘ Â›‰· Û ¿ÙÔÌ· Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘ (ÙfiÛÔ ÛÙË ‰Â˘ÙÂÚÔÁÂÓ‹ fiÛÔ Î·È ÛÙËÓ ÚˆÙÔÁÂÓ‹ ÚfiÏË„Ë). °È· ÙËÓ Â›Ù¢ÍË ·˘ÙÒÓ ÙˆÓ ÛÙfi¯ˆÓ ··ÈÙÂ›Ù·È Ë ¯ÔÚ‹ÁËÛË ·ÔÙÂÏÂÛÌ·ÙÈÎÒÓ ÛÙ·ÙÈÓÒÓ Û ۯÂÙÈο ˘„ËϤ˜ ‰fiÛÂȘ ‹ Ë ¯ÔÚ‹ÁËÛË Û˘Ó‰˘·ÛÌÔ‡ ˘ÔÏÈȉ·ÈÌÈÎÒÓ Ê·ÚÌ¿ÎˆÓ (ÁÈ· ·Ú¿‰ÂÈÁÌ· Ë

ÚÔÛı‹ÎË ezetimibe Û ·ÛıÂÓ›˜ Ô˘ ‹‰Ë ‚Ú›ÛÎÔÓÙ·È Û ıÂÚ·›· ÌÂ Û˘Ì‚·ÙÈΤ˜ ‰fiÛÂȘ ÛÙ·ÙÈÓÒÓ). ™Â ·˘Ùfi ÙÔ ÛËÌÂ›Ô Ú¤ÂÈ Ó· ÙÔÓÈÛı› Ë ÛËÌ·Û›· Ù˘ ˘ÁÈÂÈÓԉȷÈÙËÙÈ΋˜ ·Ú¤Ì‚·Û˘ ÁÈ· ÙËÓ Â›Ù¢ÍË ÙˆÓ ÛÙfi¯ˆÓ Ù˘ ˘ÔÏÈȉ·ÈÌÈ΋˜ ·ÁˆÁ‹˜. ¶Ú¿ÁÌ·ÙÈ, ÔÈ Ô‰ËÁ›Â˜ Ù˘ NCEP ‰›ÓÔ˘Ó È‰È·›ÙÂÚË ¤ÌÊ·ÛË ÛÙËÓ ˘ÁÈÂÈÓԉȷÈÙËÙÈ΋ ·ÁˆÁ‹. ∂ÈÚfiÛıÂÙ· ÙÔÓ›˙ÂÙ·È fiÙÈ ÛÙËÓ ÚˆÙÔÁÂÓ‹ ÚfiÏË„Ë Ù˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘ Ú¤ÂÈ Ó· ¯ÔÚËÁÔ‡ÓÙ·È ˘ÔÏÈȉ·ÈÌÈο Ê¿Ú̷η ÌfiÓÔ fiÙ·Ó ÔÈ ÛÙfi¯ÔÈ Ù˘ ·ÁˆÁ‹˜ ‰ÂÓ ÂÈÙ¢¯ıÔ‡Ó ÌÂÙ¿ ÙÔ˘Ï¿¯ÈÛÙÔÓ 3 ÌËÓÒÓ ˘ÁÈÂÈÓԉȷÈÙËÙÈ΋ ·Ú¤Ì‚·ÛË.

√È Ê˘ÙÈΤ˜ ÛÙÂÚfiϘ / ÛÙ·ÓfiϘ ¤¯Ô˘Ó ¯ËÌÈ΋ ‰ÔÌ‹ Ô˘ ÚÔÛÔÌÔÈ¿˙ÂÈ Ì ÙË ¯ÔÏËÛÙÂÚfiÏË, ÚÔÛÏ·Ì‚¿ÓÔÓÙ·È Û ÌÈÎÚ¤˜ ÔÛfiÙËÙ˜ Ì ÙȘ ÙÚÔʤ˜ Î·È ¤¯Ô˘Ó ÙËÓ ÈηÓfiÙËÙ· Ó· ÌÂÈÒÓÔ˘Ó ÙËÓ ·ÔÚÚfiÊËÛË Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ·fi ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi ۈϋӷ Ì ·ÔÙ¤ÏÂÛÌ· ÙË Ì›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ LDL CHOL ηٿ 10%. ™˘ÓÈÛÙ¿Ù·È Ë ÚfiÛÏË„Ë 2 g/ Ë̤ڷ Ê˘ÙÈÎÒÓ ÛÙÂÚÔÏÒÓ/ ÛÙ·ÓÔÏÒÓ. ∞˘Ùfi ÛËÌ·›ÓÂÈ fiÙÈ ÁÈ· ÙËÓ ÚfiÛÏË„Ë Ù˘ ··Ú·›ÙËÙ˘ ÔÛfiÙËÙ·˜ Ê˘ÙÈÎÒÓ ÛÙÂÚÔÏÒÓ ‹ ÛÙ·ÓÔÏÒÓ ··ÈÙÂ›Ù·È Ë Î·Ù·Ó¿ÏˆÛË 30g Ì·ÚÁ·Ú›Ó˘, 3 ÔÙËÚÈÒÓ Á¿Ï·ÎÙÔ˜ ‹ 3 ÁÈ·Ô˘ÚÙÈÒÓ ÙËÓ Ë̤ڷ.

™ÙÔÓ ¶›Ó·Î· 1 Ê·›ÓÔÓÙ·È 5 ˘ÁÈÂÈÓԉȷÈÙËÙÈΤ˜ ÚÔÛÂÁÁ›ÛÂȘ ÁÈ· ÙË Ì›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘, ÔÈ Ôԛ˜ ÌÔÚÔ‡Ó Ó· ‚ÔËı‹ÛÔ˘Ó ÛÙËÓ Â›Ù¢ÍË ÙˆÓ ÛÙfi¯ˆÓ Ù˘ ˘ÔÏÈȉ·ÈÌÈ΋˜ ·ÁˆÁ‹˜.

¶Ú¤ÂÈ Ó· ÂÈÛËÌ·Óı› fiÙÈ ÔÈ ÂÌÏÔ˘ÙÈṲ̂Ó˜ ÌÂ Ê˘ÙÈΤ˜ ÛÙÂÚfiϘ ÙÚÔʤ˜ ÂÚȤ¯Ô˘Ó ÌÈÎÚ‹ ÔÛfiÙËÙ· ÎÂÎÔÚÂÛÌ¤ÓˆÓ (˙ˆÈÎÒÓ) ÏÈÒÓ Î·È ¤¯Ô˘Ó Ï›Á˜ ıÂÚÌ›‰Â˜ (¶›Ó·Î·˜ 2). ∏ ··Ú·›ÙËÙË ÔÛfiÙËÙ· ÙˆÓ Ê˘ÙÈÎÒÓ ÛÙÂÚÔÏÒÓ ÌÔÚ› Ó· ¯ÔÚËÁËı› ÌÈ· ÊÔÚ¿ ÙËÓ Ë̤ڷ (.¯. Ì ÙÔ ÚfiÁÂ˘Ì·) ‹ Û 2-3 ‰È·ÈÚÂ̤Ó˜ ‰fiÛÂȘ (‰ËÏ. Ì οı Á‡̷). √È ÂÌÏÔ˘ÙÈṲ̂Ó˜ ÌÂ Ê˘ÙÈΤ˜ ÛÙÂÚfiϘ / ÛÙ·ÓfiϘ ÙÚÔʤ˜ ÚÔηÏÔ‡Ó ·ÚfiÌÔÈ· Ì›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ LDL CHOL, ·Ó Î·È Ì›· ÚfiÛÊ·ÙË ÌÂϤÙË ¤‰ÂÈÍ fiÙÈ Ë Î·Ù·Ó¿ÏˆÛË ÁÈ·Ô˘ÚÙÈÒÓ ÂÌÏÔ˘ÙÈÛÌ¤ÓˆÓ ÌÂ Ê˘ÙÈΤ˜ ÛÙÂÚfiϘ ›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÌÂÁ·Ï‡ÙÂÚË Ì›ˆÛË Ù˘ LDL CHOL Û ۇÁÎÚÈÛË Ì ·˘Ù‹ Ô˘ ·Ú·ÙËÚ‹ıËΠÌÂÙ¿ ÙËÓ Î·Ù·Ó¿ÏˆÛË ¿ÏÏˆÓ ÂÌÏÔ˘ÙÈÛÌ¤ÓˆÓ Ì ÛÙÂÚfiϘ ÙÚÔÊÒÓ (Ì·ÚÁ·Ú›ÓË, Á¿Ï·, ÎÏ).

∏ Ì›ˆÛË Ù˘ ÚfiÛÏ˄˘ ÎÂÎÔÚÂÛÌ¤ÓˆÓ (˙ˆ˚ÎÒÓ) ÏÈÒÓ <7% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ıÂÚÌ›‰ˆÓ ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ì›· Ì›ˆÛË Ù˘ LDL CHOL ηٿ 5-10%. ¶·Ú¿ÏÏËÏ· Ë Ì›ˆÛË Ù˘ ‰È·ÈÙËÙÈ΋˜ ÚfiÛÏ˄˘ ¯ÔÏËÛÙÂÚfiÏ˘ <200 mg/Ë̤ڷ Â›Û˘ ÚÔηÏ› Ì›ˆÛË Ù˘ LDL CHOL ηٿ 1-3%. ∏ Ì›ˆÛË ÙˆÓ ÚÔÛÏ·Ì‚·ÓÔÌ¤ÓˆÓ ıÂÚÌ›‰ˆÓ Î·È Ë ·Ú¿ÏÏËÏË Ì›ˆÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜ ÂËÚ¿˙Ô˘Ó ÛËÌ·ÓÙÈο ÙÔ ÏÈȉ·ÈÌÈÎfi ÚÔÊ›Ï Î·È ÌÔÚÔ‡Ó Â›Û˘ Ó· ÌÂÈÒÛÔ˘Ó Ù· Â›‰· Ù˘ LDL CHOL ηٿ 5-20%. ∏ ·‡ÍËÛË Ù˘ ÚfiÛÏ˄˘ ÙÚÔÊÒÓ ÏÔ‡ÛÈˆÓ ÛÂ Ê˘ÙÈΤ˜ ›Ó˜ ·ÛΛ ¢ÓÔ˚΋ Â›‰Ú·ÛË ÛÙÔ ÌÂÙ·‚ÔÏÈÛÌfi ÙˆÓ ˘‰·Ù·ÓıÚ¿ÎˆÓ Î·È ÏÈȉ›ˆÓ Î·È ÌÂÈÒÓÂÈ Ù· Â›‰· Ù˘ LDL CHOL ÂÚ›Ô˘ ηٿ 3%. ∆¤ÏÔ˜, Ë ·‡ÍËÛË Ù˘ ÚfiÛÏ˄˘ ÙÚÔÊÒÓ ÏÔ‡ÛÈˆÓ ÛÂ Ê˘ÙÈΤ˜ ÛÙÂÚfiϘ /ÛÙ·ÓfiϘ ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÌÈ· ÛËÌ·ÓÙÈ΋ ηٿ 10% Ì›ˆÛË Ù˘ LDL CHOL.

∞Ó Î·È ‰ÂÓ ˘¿Ú¯Ô˘Ó ÛÙÔȯ›· ÁÈ· ÙËÓ Â›‰Ú·ÛË ÙˆÓ Ê˘ÙÈÎÒÓ ÛÙÂÚÔÏÒÓ / ÛÙ·ÓÔÏÒÓ ÛÙËÓ Î·Ú‰È·ÁÁÂȷ΋ ÓÔÛËÚfiÙËÙ· Î·È ıÓËÙfiÙËÙ·, ÌÔÚ› ηÓ›˜ Ó· ˘Ôı¤ÛÂÈ Û‡Ìʈӷ Ì ٷ ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ÌÂÁ¿ÏˆÓ ·ÚÂÌ‚·ÙÈÎÒÓ ÌÂÏÂÙÒÓ fiÙÈ Ì›· Ì›ˆÛË Î·Ù¿ 10% ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ LDL

15

·ıËÚÔÛÎÏ‹ÚˆÛË ¢EKEMBPπ√™ 2004

¶›Ó·Î·˜ 1 ¢π∞π∆∏∆π∫∏ ¶ƒ√™∂°°π™∏ °π∞ ∆∏ ª∂πø™∏ ∆∏™ LDL CHOL 1. ªÂ›ˆÛË Ù˘ ÚfiÛÏ˄˘ ˙ˆÈÎÒÓ (ÎÂÎÔÚÂÛÌ¤ÓˆÓ ÏÈÒÓ) [< 7% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ıÂÚÌ›‰ˆÓ] ªÂ›ˆÛË Ù˘ ÔÏÈ΋˜ ÚfiÛÏ˄˘ Ï›Ô˘˜ (<30% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ıÂÚÌ›‰ˆÓ) 2. ªÂ›ˆÛË Ù˘ ‰È·ÈÙËÙÈ΋˜ ÚfiÛÏ˄˘ ¯ÔÏËÛÙÂÚfiÏ˘ (<200mg/ Ë̤ڷ) 3. ªÂ›ˆÛË ÙˆÓ ÚÔÛÏ·Ì‚·ÓÔÌ¤ÓˆÓ ıÂÚÌ›‰ˆÓ Î·È ·ÒÏÂÈ· ‚¿ÚÔ˘˜ 4. ∫·Ù·Ó¿ÏˆÛË ÙÚÔÊÒÓ ÏÔ‡ÛÈˆÓ Û ‰È·Ï˘Ù¤˜ Ê˘ÙÈΤ˜ ›Ó˜ 5. ∫·Ù·Ó¿ÏˆÛË ÙÚÔÊÒÓ ÏÔ‡ÛÈˆÓ ÛÂ Ê˘ÙÈΤ˜ ÛÙÂÚfiϘ / ÛÙ·ÓfiϘ

¶›Ó·Î·˜ 2 ™À™∆∞™∏ ∆ø¡ ∂ª¶§√À∆π™ª∂¡ø¡ ª∂ ºÀ∆π∫∂™ ™∆∂ƒ√§∂™ ∆ƒ√ºø¡ √ÏÈÎfi Ï›Ô˜

∫ÂÎÔÚÂṲ̂ÓÔ Ï›Ô˜ £ÂÚÌ›‰Â˜

(g/Ë̤ڷ)

(g/Ë̤ڷ)

10

2,5

100

13,5

9

360

°È·Ô‡ÚÙÈ ¿ÛÚÔ

2

0,5

168

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2

0,5

300

ª·ÚÁ·Ú›ÓË °¿Ï·

∞ÊÔÚ¿ ÙËÓ ËÌÂÚ‹ÛÈ· ÚfiÛÏË„Ë 30 g Ì·ÚÁ·Ú›Ó˘, 3 ÁÈ·Ô˘ÚÙÈÒÓ (ÙˆÓ 125 g) Î·È 3 ÔÙËÚÈÒÓ Á¿Ï·ÎÙÔ˜ (ÙˆÓ 250 ml)

CHOL ·Ó·Ì¤ÓÂÙ·È Ó· Ô‰ËÁ‹ÛÂÈ Û ̛· Â›Û˘ ηٿ 10% Ì›ˆÛË ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ. À¤Ú ·˘Ù‹˜ Ù˘ ¿Ԅ˘ Û˘ÓËÁÔÚÔ‡Ó Ù· ‰Â‰Ô̤ӷ ÚfiÛÊ·Ù˘ ÂÈÚ·Ì·ÙÈ΋˜ ÌÂϤÙ˘ Ô˘ ¤‰ÂÈÍ fiÙÈ Ë ¯ÔÚ‹ÁËÛË Ê˘ÙÈÎÒÓ ÛÙÂÚÔÏÒÓ Â›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ì›· ÛËÌ·ÓÙÈ΋ ÂÈ‚Ú¿‰˘ÓÛË Ù˘ ÂͤÏÈ͢ Ù˘ ·ıËڈ̷ÙÈ΋˜ ÓfiÛÔ˘. ¶Ú¤ÂÈ Â›Û˘ Ó· ·Ó·ÊÂÚı› fiÙÈ ÔÈ Ê˘ÙÈΤ˜ ÛÙÂÚfiϘ / ÛÙ·ÓfiϘ Â›Ó·È ·Ôχو˜ ·ÛÊ·Ï›˜ Î·È ÁÈ· ·˘Ùfi ÙÔ ÏfiÁÔ ÔÈ Ô‰ËÁ›Â˜ Ù˘ ∂ıÓÈ΋˜ ∂ÈÙÚÔ‹˜ ÁÈ· ÙË ¯ÔÏËÛÙÂÚfiÏË ÙˆÓ ∏¶∞ Û˘ÓÈÛÙÔ‡Ó ÙËÓ ÚfiÛÏË„Ë 2 g/Ë̤ڷ Ê˘ÙÈÎÒÓ ÛÙÂÚÔÏÒÓ/ÛÙ·ÓÔÏÒÓ ÁÈ· ÙË Ì›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ LDL CHOL. Œ¯ÂÈ ‰È·Ù˘ˆı› Ë ¿Ô„Ë fiÙÈ Ë ¯ÔÚ‹ÁËÛË Û˘Ì‚·ÙÈÎÒÓ ‰fiÛÂˆÓ ÛÙ·ÙÈÓÒÓ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ˘ÁÈÂÈÔÓԉȷÈÙËÙÈ΋ ·Ú¤Ì‚·ÛË, ÛÙËÓ ÔÔ›· ηıÔÚÈÛÙÈÎfi ÚfiÏÔ ‰È·‰Ú·Ì·Ù›˙Ô˘Ó ÔÈ Ê˘ÙÈΤ˜ ÛÙÂÚfiϘ / ÛÙ·ÓfiϘ, ·Ó·Ì¤ÓÂÙ·È Ó· ÚÔηϤÛÂÈ ÌÈ· ÛËÌ·ÓÙÈ΋ (Ù˘ ٿ͈˜ ÙÔ˘ 40%) Ì›ˆÛË Ù˘ LDL CHOL, ÌÈ· Ì›ˆÛË Ô˘ ·Ó·Ì¤ÓÂÙ·È Ó· ‚ÔËı‹ÛÂÈ ÛÙËÓ Â›Ù¢ÍË ÙˆÓ ÛÙfi¯ˆÓ Ù˘ ˘ÔÏÈȉ·ÈÌÈ΋˜ ·ÁˆÁ‹˜ Î·È ÛÙË Ì›ˆÛË Ù˘ ηډȷÁÁÂȷ΋˜ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÙfiÙËÙ·˜.

µÈ‚ÏÈÔÁÚ·Ê›· 1.

2.

3.

4.

5.

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Clifton PM, Noakes M, Sullivan D, Erichsen N, Ross D, Annison G, Fassoulakis A. Cehum M, Nestel P. Cholesterol-lowering effects of plant sterol esters differ in milk, yoghurt, bread and cereal. Eur J Clin Nutr 2004;58:503-9 Darkes MJ, Poole RM, Goa KL. Ezetimibe. Am J Cardiovasc Drugs 2003;3:67-76 Field FJ, Born E, Mathur SN. Dietary stanol esters decrease plasma cholesterol independently of changes in gene expression of intestinal ABC sterol transporters and Niemann-Pick C1 Like 1 protein in hamster. J Lipid Res 2004 (in press) Hendriks HF, Brink EJ, Meijer GW, Princen HM, Ntanios FY. Safety of longterm consumption of plant sterol estersenriched spread. Eur J Clin Nutr 2003;57:681-92 Jekins DJ, Kendall CW, Marchie A, Faulkner DA, Wong JM, de Souza R, Eman A, Parker TL, Vidgen E, Lapsley KG, Trautwein EA, Josse RG, Leiter LA, Connely PW. Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C-reactive protein. JAMA 2003;290:502-10

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Katan MB, Grundy SM, Jones P, Law M, Miettinen T, Paoletti R, Stresa Workshop Participants. Efficacy and safety of plant stanols and sterols in the management of blood cholesterol levels. Mayo Clin Proc 2003;78:965-78 7. Ketomaki AM, Gylling H, Antikainen M, Siimes MA, Miettinen TA. Red cell and plasma plant sterols are related during consumption of plant stanol and sterol ester spreads in children with hypercholesterolemia.

J Pediatr 2003;142:524-31 8.

Kramer W, Girbig F, Corsiero D, Burger K, Fahrenholz F, Jung C, Muller G. Intestinal cholesterol absorption: identification of different binding proteins for cholesterol and cholesterol absorption inhibitors in the enterocyte brush border membrane. Biochim Biophys Acta 2003;1633:13-26 9. Noakes M, Clifton PM, Doornbos AM, Trautwein EA. Plant sterol ester-enriched milk and yoghurt effectively reduce serum cholesterol in modestly hypercholesterolemic subjects. Eur J Nutr 2004 (in press) 10. Ntanios FY, van de Kooij AJ, de Deckere EA, Duchateau GS, Trautwein EA. Effects

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Eur J Clin Nutr 2004;58:860-70 Turley SD, Dietschy JM. Sterol absorption by the small intestine. Curr Opin Lipidol 2003;14:233-40

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∏ ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ˜ ·ÔÙÂÏ› ÙËÓ Î˘ÚÈfiÙÂÚË ·ÈÙ›· ıÓËÙfiÙËÙ·˜ Î·È ÓÔÛËÚfiÙËÙ·˜ ÛÙȘ ·Ó·Ù˘Á̤Ó˜ ¯ÒÚ˜1. ∆· ÙÂÏÂ˘Ù·›· ¤ÙË Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó ÔÏϤ˜ ÎÏÈÓÈΤ˜ Î·È ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ Ì ÛÎÔfi Ó· ‰ÈÂÚ¢ÓËıÔ‡Ó ÔÈ ·ÈÙÈÔÏÔÁÈÎÔ› Î·È ·ıÔÁÂÓÂÙÈÎÔ› Ì˯·ÓÈÛÌÔ› Ù˘ ÓfiÛÔ˘. ™Â ·˘Ùfi ÙÔ Ï·›ÛÈÔ ¤¯ÂÈ ÌÂÏÂÙËı› Î·È Ô ÚfiÏÔ˜ Ù˘ ‰È·ÙÚÔÊ‹˜ ÛÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ·ıËڈ̷ÙÈ΋˜ ÓfiÛÔ˘2. ∞Ú¯Èο, ÙÔ 1972 Ô Trowell ‰È·›ÛÙˆÛ ÙÔÓ ÚÔÛٷ٢ÙÈÎfi ÚfiÏÔ Ê˘ÙÈÎÒÓ ÈÓÒÓ Î·È ÙË Ì›ˆÛË Ù˘ Â›ÙˆÛ˘ Ù˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘ ÌÂÙ¿ ·fi ‰›·ÈÙ· ÏÔ‡ÛÈ· ÛÂ Ê˘ÙÈΤ˜ ›Ó˜3. ŒÎÙÔÙÂ, ÌÂÁ¿Ï˜ ÚÔÔÙÈΤ˜ ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó ÙÔ fiÊÂÏÔ˜ ·fi ÙËÓ Î·Ù·Ó¿ÏˆÛË Ê˘ÙÈÎÒÓ ÈÓÒÓ fiÛÔÓ ·ÊÔÚ¿ ÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘. ªÂ ‚¿ÛË ·˘Ù¿ Ù· ‰Â‰Ô̤ӷ ‰È·Ù˘ÒıËÎ·Ó ÔÈ Ô‰ËÁ›Â˜ Ù˘ ¢ÈÂıÓÔ‡˜ ∞η‰ËÌ›·˜ ∂ÈÛÙËÌÒÓ (N.A.S.) Û‡Ìʈӷ Ì ÙȘ Ôԛ˜ Û˘ÓÈÛÙ¿Ù·È Ë ÚfiÛÏË„Ë 38ÁÚ Î·È 25ÁÚ Ê˘ÙÈÎÒÓ ÈÓÒÓ ËÌÂÚËÛ›ˆ˜ ÁÈ· ¿Ó‰Ú˜ Î·È Á˘Ó·›Î˜ ·ÓÙ›ÛÙÔȯ· Ì ÂÈı˘ÌËÙ‹ ·Ó·ÏÔÁ›· Ê˘ÙÈÎÒÓ ÈÓÒÓ Û ۯ¤ÛË Ì ÙËÓ ÚfiÛÏË„Ë ÂÓ¤ÚÁÂÈ·˜ 14gr/1000 kcal4. ºÀ∆π∫∂™ π¡∂™: ∆π ∂π¡∞π ∫∞π ¶√À µƒπ™∫√¡∆∞π √È Ê˘ÙÈΤ˜ ›Ó˜ Â›Ó·È Û˘ÛÙ·ÙÈο Ê˘ÙÈ΋˜ ÚÔ¤Ï¢Û˘ Ô˘ Â›Ó·È ·ÓıÂÎÙÈο ÛÙË ‰È¿Û·ÛË ·fi Ù· ·ÁÎÚ·ÙÈο Î·È Ù· ÂÓÙÂÚÈο ¤Ó˙˘Ì· Î·È ÁÈ· ·˘Ùfi ÙÔ ÏfiÁÔ ‰È·Ê‡ÁÔ˘Ó ÙËÓ ÂÓ˙˘ÌÈ΋ ‰È¿Û·ÛË ÛÙÔ ÏÂÙfi ¤ÓÙÂÚÔ. √È Ê˘ÙÈΤ˜ ›Ó˜ ·Ó¿ÏÔ-

Á· Ì ÙË ‰È·Ï˘ÙfiÙËÙ· ÙÔ˘˜ ÛÙÔ ÓÂÚfi ‰È·¯ˆÚ›˙ÔÓÙ·È Û ‰È·Ï˘Ù¤˜ ›Ó˜, fiˆ˜ Ë ÂÎÙ›ÓË, Ë ËÌÈÛÂÏÏÔ˘Ïfi˙Ë, Ù· ÎfiÌÌ· Î·È ÔÈ ‚ÏÂÓÓ›Ó˜ Î·È Û ·‰È¿Ï˘Ù˜ ›Ó˜, fiˆ˜ Ë ÛÂÏÏÔ˘Ïfi˙Ë (΢ÙÙ·Ú›ÓË), ÔÚÈṲ̂Ó˜ ËÌÈÛÂÏÏÔ˘Ïfi˙˜ Î·È Ë ÏÈÁÓ›ÓË5. ∫‡ÚȘ ËÁ¤˜ ÙˆÓ Ê˘ÙÈÎÒÓ ÈÓÒÓ Â›Ó·È Ù· Ï·¯·ÓÈο, ÔÈ ÛfiÚÔÈ, Ù· ‰ËÌËÙÚȷο, Ù· ÊÚÔ‡Ù·, ÔÈ ÍËÚÔ› ηÚÔ›, ÙÔ ›ÙÔ˘ÚÔ, ÙÔ „‡ÏÏÈÔ Î.¿. ∆· ‰ËÌËÙÚȷο ÂÚȤ¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ‰È·Ï˘ÙÒÓ Ê˘ÙÈÎÒÓ ÈÓÒÓ Û ۇÁÎÚÈÛË Ì ÙȘ ¿ÏϘ ηÙËÁÔڛ˜ ÙÚÔʛ̈Ó6. ∆· ‰ËÌËÙÚȷο ÔÏÈ΋˜ ·Ï¤Ûˆ˜ Â›Ó·È ÌË ÂÂÍÂÚÁ·Ṳ̂Ó˜ ÙÚÔʤ˜ Î·È ¤ÙÛÈ ‰È·ÙËÚÔ‡Ó fiϘ ÙȘ Ê˘ÙÈΤ˜ ›Ó˜ Ô˘ ÂÚȤ¯Ô˘Ó. ™Ù· ÂÂÍÂÚÁ·Ṳ̂ӷ ‰ËÌËÙÚȷο ·Ê·ÈÚÂ›Ù·È Ô ÊÏÔÈfi˜ ÁÈ· ÙË ‚ÂÏÙ›ˆÛË Ù˘ ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ ÚÔ˚fiÓÙÔ˜. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ·˘Ù‹˜ Ù˘ ‰È·‰Èηۛ·˜ ·Ê·ÈÚÔ‡ÓÙ·È ÔÈ Ê˘ÙÈΤ˜ ›Ó˜ Î·È ·Ú¿ÏÏËÏ· ·˘Í¿ÓÂÙ·È Ë Û˘ÁΤÓÙÚˆÛË ÙˆÓ ˘‰·Ù·ÓıڿΈÓ. ∞¶√∆∂§∂™ª∞∆∞ ª∂§∂∆ø¡ ¶ÚfiÛÊ·Ù· ‰ËÌÔÛȇıËÎ·Ó Ù· ·ÔÙÂϤÛÌ·Ù· ÌÈ·˜ ÚÔÔÙÈ΋˜ ÌÂϤÙ˘ 86.190 ·Ó‰ÚÒÓ ËÏÈΛ·˜ 40-84 ÂÙÒÓ, Ô˘ ·Ú·ÎÔÏÔ˘ı‹ıËÎ·Ó ÁÈ· ÂÚ›Ô˘ 6 ¯ÚfiÓÈ·, Ë ÔÔ›· ¤‰ÂÈÍ fiÙÈ ÔÈ ¿Ó‰Ú˜ ÂΛÓÔÈ Ô˘ ÙÔ ÚfiÁÂ˘Ì· ÙÔ˘˜ ÂÚÈ›¯Â ÌÂÁ·Ï‡ÙÂÚ˜ ÔÛfiÙËÙ˜ ‰ËÌËÙÚÈ·ÎÒÓ ÔÏÈ΋˜ ·Ï¤Ûˆ˜ ÂÌÊ¿ÓÈÛ·Ó Ì›· ηٿ 20% Ì›ˆÛË Ù˘ ıÓËÙfiÙËÙ·˜ ·fi ÔÔÈÔ‰‹ÔÙ ·›ÙÈÔ Î·È Ì›· ηٿ 17% Ì›ˆÛË ÙˆÓ ı·Ó¿ÙˆÓ ·fi ηډȷÁÁÂȷο ÓÔÛ‹Ì·Ù· Û ۇÁÎÚÈÛË ÌÂ

Ù· ¿ÙÔÌ· Ô˘ Î·Ù·Ó¿ÏˆÓ·Ó ÂÂÍÂÚÁ·Ṳ̂ӷ ‰ËÌËÙÚȷο Ì ÌÈÎÚ‹ ÂÚÈÂÎÙÈÎfiÙËÙ· ÛÂ Ê˘ÙÈΤ˜ ›Ó˜7. Œ¯ÂÈ È‰È·›ÙÂÚÔ ÂӉȷʤÚÔÓ Ë ‰È·›ÛÙˆÛË fiÙÈ Ë Î·Ù·Ó¿ÏˆÛË ÚÔ˚fiÓÙˆÓ ÔÏÈ΋˜ ·Ï¤Ûˆ˜ Â›Ó·È ·˘ÍË̤ÓË Û ÌË Î·ÓÈÛÙ¤˜, Û ËÏÈÎȈ̤ӷ ¿ÙÔÌ· Î·È Û ¿ÙÔÌ· ˘„ËÏÔ‡ ÎÔÈÓˆÓÈÎÔ-ÔÈÎÔÓÔÌÈÎÔ‡ ÂÈ¤‰Ô˘. øÛÙfiÛÔ, Ë Î·Ù·Ó¿ÏˆÛË Ê˘ÙÈÎÒÓ ÈÓÒÓ ÛÙȘ ·Ó·Ù˘Á̤Ó˜ ÎÔÈӈӛ˜ ‚Ú›ÛÎÂÙ·È ÛÙÔ ÌÈÛfi ÂÚ›Ô˘ Ù˘ ÔÛfiÙËÙ·˜ Ô˘ ÚÔÙ›ÓÂÙ·È ·fi ÙË ¢ÈÂıÓ‹ ∞η‰ËÌ›· ∂ÈÛÙËÌÒÓ8. ¶ÚfiÛÊ·Ù· ‰ËÌÔÛȇıËΠ·fi ÙÔ˘˜ Pereira et al ÌÈ· ÌÂÙ··Ó¿Ï˘ÛË ÙˆÓ ÛËÌ·ÓÙÈÎfiÙÂÚˆÓ Î·È ÌÂÁ·Ï‡ÙÂÚˆÓ ÚÔÔÙÈÎÒÓ ÌÂÏÂÙÒÓ ·fi ÙȘ ∏¶∞ Î·È ÙËÓ ∂˘ÚÒË, Ë ÔÔ›· ¤‰ÂÈÍ ÌÈ· ·ÓÙ›ÛÙÚÔÊË Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ ηٷӿψÛ˘ Ê˘ÙÈÎÒÓ ÈÓÒÓ ·fi ÊÚÔ‡Ù· Î·È ‰ËÌËÙÚȷο Î·È ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛ˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘. ∞Ó·Ï˘ÙÈÎfiÙÂÚ· ÛÙË ÌÂÙ·-·Ó¿Ï˘ÛË ·˘Ù‹ Û˘ÌÂÚÈÏ‹ÊıËÛ·Ó 10 ÚÔÔÙÈΤ˜ ÌÂϤÙ˜ ÌÂ Û˘ÓÔÏÈÎfi ·ÚÈıÌfi 345.244 ·ÙfiÌˆÓ (91.058 ¿Ó‰Ú˜ Î·È 254.186 Á˘Ó·›Î˜) ÔÈ ÔÔ›ÔÈ ·Ú·ÎÔÏÔ˘ı‹ıËÎ·Ó ÁÈ· 6 ¤ˆ˜ 10 ¤ÙË. ªÂÙ¿ ·fi ‰ÈfiÚıˆÛË ÁÈ· Ù· ‰ËÌÔÁÚ·ÊÈο ÛÙÔȯ›·, ÙÔ ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜, ÙÔÓ ÙÚfiÔ ˙ˆ‹˜ Î·È ÙË Û˘ÓÔÏÈ΋ ÚÔÛÏ·Ì‚·ÓfiÌÂÓË ÂÓ¤ÚÁÂÈ· Ì ÙË ‰È·ÙÚÔÊ‹ ‰È·ÈÛÙÒıËΠÌÈ· ηٿ 14% Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛ˘ ÛÙÂÊ·ÓÈ·›ˆÓ Û˘Ì‚·Ì¿ÙˆÓ (RR: 0,86, 95% CI 0,78-0,96), ηıÒ˜ Î·È ÌÈ· ηٿ 27% (RR: 0,73, 95% CI 0,61-0,87) Ì›ˆÛË Ù˘ ıÓËÙfiÙËÙ·˜ ·fi ηډȷÁÁÂȷο ·›ÙÈ· ÁÈ· οı ·‡ÍËÛË Ù˘ ηٷ17

·ıËÚÔÛÎÏ‹ÚˆÛË ¢EKEMBPπ√™ 2004

ӿψÛ˘ Ù˘ ÔÏÈ΋˜ ÔÛfiÙËÙ·˜ Ê˘ÙÈÎÒÓ ÈÓÒÓ Î·Ù¿ 10 g/ Ë̤ڷ. ¶·ÚfiÏÔ Ô˘ ÛÙË ÌÂÙ··Ó¿Ï˘ÛË ·˘Ù‹ Ë ÚfiÛÏË„Ë Ê˘ÙÈÎÒÓ ÈÓÒÓ ·fi ÊÚÔ‡Ù· Î·È ‰ËÌËÙÚȷο ÂÌÊ¿ÓÈÛ ÌÈ· ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ·ÓÙ›ÛÙÚÔÊË Û˘Û¯¤ÙÈÛË Ì ÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘ (Ì›ˆÛË Î·Ù¿ 16% Î·È 10% ÙÔ˘ Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛ˘ ÛÙÂÊ·ÓÈ·›ˆÓ Û˘Ì‚·Ì¿ÙˆÓ Î·È Ì›ˆÛË Î·Ù¿ 30% Î·È 25% Ù˘ ıÓËÙfiÙËÙ·˜ ·fi ηډȷÁÁÂȷο ·›ÙÈ· ÁÈ· ηٷӿψÛË ÊÚÔ‡ÙˆÓ Î·È ‰ËÌËÙÚÈ·ÎÒÓ ·ÓÙ›ÛÙÔȯ·), Ë ·˘ÍË̤ÓË ÚfiÛÏË„Ë Ê˘ÙÈÎÒÓ ÈÓÒÓ ·fi Ï·¯·ÓÈο ‰ÂÓ Û˘Û¯ÂÙ›ÛıËΠ̠ÙË Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛ˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘9. ¶Ú¤ÂÈ Ó· ÂÈÛËÌ·Óı› fiÙÈ ÔÏϤ˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ ÙfiÛÔ Ë Î·Ù·Ó¿ÏˆÛË ÙˆÓ ·‰È¿Ï˘ÙˆÓ fiÛÔ Î·È ÙˆÓ ‰È·Ï˘ÙÒÓ Ê˘ÙÈÎÒÓ ÈÓÒÓ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÌÂȈ̤ÓÔ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘10-13 øÛÙfiÛÔ, ÛÙË ÌÂÙ·-·Ó¿Ï˘ÛË ÙÔ˘ Pereira et al., ‰È·ÈÛÙÒıËΠÌÂÁ·Ï‡ÙÂÚÔ fiÊÂÏÔ˜ ·fi ÙËÓ ÚfiÛÏË„Ë ‰È·Ï˘ÙÒÓ Ê˘ÙÈÎÒÓ ÈÓÒÓ (Ì›ˆÛË Î·Ù¿ 54% Ù˘ ıÓËÙfiÙËÙ·˜ ·fi ηډȷÁÁÂȷο ·›ÙÈ· fiÙ·Ó ·˘Í‹ıËÎÂ Ë Î·Ù·Ó¿ÏˆÛË ‰È·Ï˘ÙÒÓ Ê˘ÙÈÎÒÓ ÈÓÒÓ vs Ì›ˆÛË Î·Ù¿ 20% fiÙ·Ó ·˘Í‹ıËÎÂ Ë Î·Ù·Ó¿ÏˆÛË ·‰È¿Ï˘ÙˆÓ Ê˘ÙÈÎÒÓ ÈÓÒÓ)9. ∞˘Ù‹ Ë ·ÚÓËÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ ηٷӿψÛ˘ Ê˘ÙÈÎÒÓ ÈÓÒÓ Î·È ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛ˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘ ‰È·ÈÛÙÒıËΠ۠ÙÔ˘Ï¿¯ÈÛÙÔÓ 10 ÂȉËÌÈÔÏÔÁÈΤ˜ ÚÔÔÙÈΤ˜ ÌÂϤÙ˜ ÛÙÔ ·ÚÂÏıfiÓ14-18. øÛÙfiÛÔ, ÂÍ·›ÚÂÛË ·ÔÙÂÏÔ‡Ó Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ ÙˆÓ Mann et al ÙÔ 1997, Ë ÔÔ›· ¤‰ÂÈÍ ÌÈ· ÌË ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛ˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘ Û ÂÚÈÙÒÛÂȘ ·˘ÍË̤Ó˘ ηٷӿψÛ˘ Ê˘ÙÈÎÒÓ ÈÓÒÓ19. ∆· ·ÔÙÂϤÛÌ·Ù· ·Ï·ÈfiÙÂÚˆÓ ÌÂÏÂÙÒÓ Ô˘ Û˘Û¯ÂÙ›˙Ô˘Ó 18

ÙËÓ ËÁ‹ ÚfiÛÏ˄˘ Ê˘ÙÈÎÒÓ ÈÓÒÓ Ì ÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘ ‰ÂÓ ‚Ú›ÛÎÔÓÙ·È Û Ï‹ÚË ÔÌÔʈӛ·. ™˘ÁÎÂÎÚÈ̤ӷ Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ ATBC13 ¤‰ÂÈÍ·Ó ›‰ÈÔ fiÊÂÏÔ˜ ·fi ÙËÓ ÚfiÛÏË„Ë Ê˘ÙÈÎÒÓ ÈÓÒÓ ·fi ÊÚÔ‡Ù·, Ï·¯·ÓÈο Î·È ‰ËÌËÙÚȷο. ∞ÓÙ›ıÂÙ·, ÔÈ ÌÂϤÙ˜ NHS11 Î·È HPFS12 ¤‰ÂÈÍ·Ó ÌÂÁ·Ï‡ÙÂÚÔ fiÊÂÏÔ˜ ·fi ÙËÓ Î·Ù·Ó¿ÏˆÛË Î˘Ú›ˆ˜ ÙˆÓ ‰ËÌËÙÚÈ·ÎÒÓ, ÂÓÒ Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ WHS10 ¤‰ÂÈÍ·Ó Ì›ˆÛË ÙÔ˘ Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛ˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘ ·fi ÙËÓ Î·Ù·Ó¿ÏˆÛË Î˘Ú›ˆ˜ ÙˆÓ ÊÚÔ‡ÙˆÓ. ª∏Ã∞¡π™ª√π ¢ƒ∞™∏™ √È Ì˯·ÓÈÛÌÔ› Ì ÙÔ˘˜ ÔÔ›Ô˘˜ ÔÈ Ê˘ÙÈΤ˜ ›Ó˜ ÚÔÛÙ·ÙÂ‡Ô˘Ó ·fi ÙËÓ ÂÌÊ¿ÓÈÛË Î·Ú‰È·ÁÁÂȷ΋˜ ÓfiÛÔ˘ ‰ÂÓ ¤¯Ô˘Ó Ï‹Úˆ˜ ‰È¢ÎÚÈÓÈÛı›. øÛÙfiÛÔ, ÛÙÔ ·ÚÂÏıfiÓ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ‰È¿ÊÔÚ˜ ȉÈfiÙËÙ˜ ÙˆÓ Ê˘ÙÈÎÒÓ ÈÓÒÓ Ô˘ ÌÔÚÔ‡Ó Ó· ÂÍËÁ‹ÛÔ˘Ó ÙËÓ Â˘ÓÔ˚΋ Â›‰Ú·ÛË ÙÔ˘˜ ÛÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘, fiˆ˜ Ë ‚ÂÏÙ›ˆÛË ÙÔ˘ ÏÈȉ·ÈÌÈÎÔ‡ ÚÔÊ›Ï20-22, Ë ÂÏ¿ÙÙˆÛË Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘, ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜23 Î·È ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ C-·ÓÙȉÚÒÛ·˜ ÚˆÙ½Ó˘, ηıÒ˜ Î·È Ë Â˘ÓÔ˚΋ Â›‰Ú·ÛË ÙÔ˘˜ ÙfiÛÔ ÛÙË ‰Ú¿ÛË Ù˘ ÈÓÛÔ˘Ï›Ó˘ fiÛÔ Î·È ÛÙÔÓ ÈÓÔ‰ˆÏ˘ÙÈÎfi Ì˯·ÓÈÛÌfi24-27. ™ÙȘ Ô‰ËÁ›Â˜ Ù˘ EıÓÈ΋˜ ∂ÈÙÚÔ‹˜ ÁÈ· ÙË ¯ÔÏËÛÙÂÚfiÏË ÙˆÓ ∏.¶.∞., (NCEP-ATP) ÂȂ‚·ÈÒÓÂÙ·È Ë ÛËÌ·Û›· Ù˘ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜ ÛÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ ·ıËڈ̷ÙÈ΋˜ ÓfiÛÔ˘ Î·È Ô Î·ıÔÚÈÛÙÈÎfi˜ ÚfiÏÔ˜ Ô˘ ‰È·‰Ú·Ì·Ù›˙ÂÈ Ë ˘ÁÈÂÈÓԉȷÈÙËÙÈ΋ ·ÁˆÁ‹ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ‰È·Ù·Ú·¯ÒÓ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ ÏÈȉ›ˆÓ. ¶Ú¤ÂÈ Ó· ÂÈÛËÌ·Óı› fiÙÈ Ë ·‡ÍËÛË Ù˘ ηٷӿψÛ˘ ÙÚÔÊÒÓ ÏÔ‡ÛÈˆÓ ÛÂ Ê˘ÙÈΤ˜ ›Ó˜ ·ÔÙÂÏ› ̤ÚÔ˜ ÙˆÓ

˘ÁÈÂÈԉȷÈÙËÙÈÎÒÓ Ô‰ËÁÈÒÓ ÙÔ˘ NCEP. ™˘ÁÎÂÎÚÈ̤ӷ Û˘ÓÈÛÙ¿Ù·È Ë ÚfiÛÏË„Ë 20-30 g ÙËÓ Ë̤ڷ Ê˘ÙÈÎÒÓ ÈÓÒÓ28. ∏ ηٷӿψÛË Ê˘ÙÈÎÒÓ ÈÓÒÓ ‚ÂÏÙÈÒÓÂÈ ÙÔ ÏÈȉ·ÈÌÈÎfi ÚÔÊ›Ï, ·ÊÔ‡ ÌÂÈÒÓÂÈ Ù· Â›‰· Ù˘ ÔÏÈ΋˜ Î·È LDL ¯ÔÏËÛÙÂÚfiÏ˘, ÂÓÒ ‰ÂÓ ÂËÚ¿˙ÂÈ ÛËÌ·ÓÙÈο Ù· Â›‰· ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ29,30. π‰È·›ÙÂÚÔ ÂӉȷʤÚÔÓ ¤¯Ô˘Ó Ù· ·ÔÙÂϤÛÌ·Ù· ÌÈ·˜ ÌÂÙ·-·Ó¿Ï˘Û˘ 67 ÌÂÏÂÙÒÓ ÛÙȘ Ôԛ˜ ÂÎÙÈÌ‹ıËÎÂ Ë Â›‰Ú·ÛË Ù˘ ηٷӿψÛ˘ Ê˘ÙÈÎÒÓ ÈÓÒÓ ÛÙ· Â›‰· ÙˆÓ ÏÈȉ›ˆÓ . ¶Ú¿ÁÌ·ÙÈ, ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ÔÏÈ΋˜ Î·È LDL-¯ÔÏËÛÙÂÚfiÏ˘ ·fi ÙËÓ ·˘ÍË̤ÓË Î·Ù·Ó¿ÏˆÛË Î˘Ú›ˆ˜ ‰È·Ï˘ÙÒÓ Ê˘ÙÈÎÒÓ ÈÓÒÓ. ™˘ÁÎÂÎÚÈ̤ӷ, ‰È·ÈÛÙÒıËΠ̛ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ÔÏÈ΋˜ Î·È Ù˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘ ηٿ 1,73 mg/dl Î·È 2,21 mg/dl ·ÓÙ›ÛÙÔȯ· ·fi ÙËÓ ·‡ÍËÛË Ù˘ ηٷӿψÛ˘ ‰È·Ï˘ÙÒÓ Ê˘ÙÈÎÒÓ ÈÓÒÓ Î·Ù¿ 1 g/ Ë̤ڷ. °È· ·Ú¿‰ÂÈÁÌ·, Ë Î·Ù·Ó¿ÏˆÛË 3 Ì‹ÏˆÓ ÙËÓ Ë̤ڷ, Ë ÔÔ›· ÈÛÔ‰˘Ó·Ì› Ì 3 g ‰È·Ï˘Ù¤˜ Ê˘ÙÈΤ˜ ›Ó˜, ›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙË Ì›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘ ηٿ 6,6 mg/dl31. ∏ ¢ÂÚÁÂÙÈ΋ Â›‰Ú·ÛË ÙˆÓ Ê˘ÙÈÎÒÓ ÈÓÒÓ ÛÙ· ÏÈ›‰È· ÙÔ˘ ÔÚÔ‡ ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È ÛÙËÓ ÈηÓfiÙËÙ· ÙÔ˘˜ Ó· ÂÓÒÓÔÓÙ·È Ì ٷ ¯ÔÏÈο Ôͤ· ÛÙÔ ÏÂÙfi ¤ÓÙÂÚÔ, ÛÙËÓ ·‡ÍËÛË Ù˘ ÎÈÓËÙÈÎfiÙËÙ·˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘ Ô˘ ÚÔηÏÔ‡Ó, ηıÒ˜ Î·È ÛÙËÓ Î·Ù·ÛÙÔÏ‹ Ù˘ Ë·ÙÈ΋˜ Û‡ÓıÂÛ˘ ÏÈ·ÚÒÓ ÔͤˆÓ32-34. øÛÙfiÛÔ, Ê·›ÓÂÙ·È ÙÂÏÈο fiÙÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙË Ì›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ‰È·‰Ú·Ì·Ù›˙ÂÈ Ë Û˘ÌÌfiÚʈÛË ÙˆÓ ·ÙfiÌˆÓ ÛÙÔ ‰È·ÈÙÔÏfiÁÈÔ Ô˘ Û˘¯Ó¿ Û˘Óԉ‡ÂÈ ÙȘ ‰›·ÈÙ˜ Ì ˘„ËÏ‹ ÂÚÈÂÎÙÈÎfiÙËÙ· ÛÂ Ê˘ÙÈΤ˜ ›Ó˜, ‰ËÏ·‰‹ Ë ÌÂȈ̤ÓË Î·Ù·Ó¿ÏˆÛË ÙÚÔÊÒÓ ÏÔ‡ÛÈˆÓ Û ÎÂÎÔÚÂṲ̂ӷ, trans-ÏÈ·Ú¿ Ôͤ· Î·È ¯ÔÏËÛÙÂÚfiÏË, ηıÒ˜ Î·È Ë ·‡-

¢IAITA ÍËÛË Ù˘ ÚfiÛÏ˄˘ ÔÏ˘·ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ , Ê˘ÏÏÈÎÔ‡ Ôͤˆ˜ Î·È ‚ÈÙ·ÌÈÓÒÓ Ì ·ÓÙÈÔÍÂȉˆÙÈΤ˜ ȉÈfiÙËÙ˜.30,35 ∆¤ÏÔ˜, Ôχ ÛËÌ·ÓÙÈ΋ Â›Ó·È Ë È‰ÈfiÙËÙ· ÙˆÓ Ê˘ÙÈÎÒÓ ÈÓÒÓ Ó· ÂÈ‚Ú·‰‡ÓÔ˘Ó ÙËÓ ·ÔÚÚfiÊËÛË ÙˆÓ ˘‰·Ù·ÓıÚ¿ÎˆÓ ·fi ÙÔ ÏÂÙfi ¤ÓÙÂÚÔ. ŒÙÛÈ, ÔÈ Ê˘ÙÈΤ˜

›Ó˜ ÌÂÈÒÓÔ˘Ó Ù· ÌÂÙ·ÁÂ˘Ì·ÙÈο Â›‰· ÁÏ˘Îfi˙˘ Î·È ÙËÓ ¤ÎÎÚÈÛË Ù˘ ÈÓÛÔ˘Ï›Ó˘, ‚ÂÏÙÈÒÓÔ˘Ó ÙÔ ÁÏ˘Î·ÈÌÈÎfi ¤ÏÂÁ¯Ô ηıÒ˜ Î·È ÙËÓ ÈÓÛÔ˘ÏÈÓÔ·ÓÙÔ¯‹36. ™˘ÌÂÚ·ÛÌ·ÙÈο, Â›Ó·È ϤÔÓ Û·Ê¤˜ fiÙÈ Ë ·˘ÍË̤ÓË Î·Ù·Ó¿ÏˆÛË Ê˘ÙÈÎÒÓ ÈÓÒÓ Û˘Û¯ÂÙ›˙ÂÙ·È ·ÓÙ›ÛÙÚÔÊ· Ì ÙÔÓ Î›Ó‰˘ÓÔ

ÂÌÊ¿ÓÈÛ˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘. ∞·ÈÙÔ‡ÓÙ·È, ÂÚÈÛÛfiÙÂÚ˜ ÌÂϤÙ˜ ÁÈ· Ó· ‰È¢ÎÚÈÓÈÛıÔ‡Ó Ï‹Úˆ˜ ÔÈ Ì˯·ÓÈÛÌÔ› Ô˘ ÌÔÚÔ‡Ó Ó· ÂÍËÁ‹ÛÔ˘Ó ÙËÓ Â˘ÓÔ˚΋ Â›‰Ú·ÛË ÙˆÓ Ê˘ÙÈÎÒÓ ÈÓÒÓ ÛÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘.

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20. Jenkins DJA, Kendall CWC, Vuksan V, et al. Soluble fiber intake at a dose approved by the US Food and Drug Administration for a claim of health benefits: serum lipid risk factors for cardiovascular disease assessed in a randomized controlled crossover trial.

Am J Clin Nutr 2002;75:834-839 21. Jenkins DJA, Newton AC, Leeds AR, Cummings JH. Effect of pectin, guar gum, and wheat fibre on serum cholesterol. Lancet 1975;1:116-117.

22. Olsen BH, Anderson SM, Becker MP, et al. Psyllium-enriched cereals lower blood total cholesterol and LDL cholesterol, but not HDL cholesterol, in hypercholesterolemic adults: results from a meta-analysis. J Nutr 1997; 127:1973-1980.

23. Keenan JM, Pins JJ, Frazel C, Moran A, Turnquist L. Oat ingestion reduces systolic and diastolic blood pressure among moderate hypertensives: a pilot trial. J Fam Pract 2002;51:369.

24. Fukagawa NK, Anderson JW, Hageman G, Young VR, Minaker KL. Highcarbohydrate, high-fiber diets increase peripheral insulin sensitivity in healthy young and old adults. Am J Clin Nutr 1990;52:524-528.

19

·ıËÚÔÛÎÏ‹ÚˆÛË ¢EKEMBPπ√™ 2004

™˘ÁÎÚÈÙÈ΋ ªÂϤÙË Ù˘ ∞ÙÔÚ‚·ÛÙ·Ù›Ó˘, Ù˘ ™ÈÌ‚·ÛÙ·Ù›Ó˘ Î·È Ù˘ º·ÈÓÔÊÈÌÚ¿Ù˘ ÛÙ· ∂›‰· Ù˘ √ÌÔ΢ÛÙ½Ó˘ ÙÔ˘ √ÚÔ‡ Û ∞ÛıÂÓ›˜ Ì ¶ÚˆÙÔ·ı‹ ÀÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· ªËÏÈÒÓ˘ ÷ڿϷÌÔ˜*, ∫·Î·Ê‹Î· ÕÓÓ·*, ÷ÛÈÒÙ˘ °ÂÒÚÁÈÔ˜**, ™ÂÊÂÚÈ¿‰Ë˜ ∫ˆÓÛÙ·ÓÙ›ÓÔ˜**, ∂ÏÈÛ¿Ê ªˆ˘Û‹˜* *∆Ô̤·˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈ΋ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ, **µÈÔ¯ËÌÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ πˆ·ÓÓ›ÓˆÓ J Clin Pharmacol 2003; 43: 825-830

∂π™∞°ø°∏: ∆· ·˘ÍË̤ӷ Â›‰· Ù˘ ÔÌÔ΢ÛÙ½Ó˘ (Hcy) ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ ·ÔÙÂÏÔ‡Ó ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ÚÒÈÌ˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘. ªÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ ÔÈ ÊÈÌÚ¿Ù˜ ·˘Í¿ÓÔ˘Ó Ù· Â›‰· Ù˘ Hcy. ∞ÓÙ›ıÂÙ·, ˘¿Ú¯ÂÈ ÂÚÈÔÚÈṲ̂ÓÔ˜ ·ÚÈıÌfi˜ ‰Â‰ÔÌ¤ÓˆÓ Û¯ÂÙÈο Ì ÙËÓ Â›‰Ú·ÛË ÙˆÓ ÛÙ·ÙÈÓÒÓ ÛÙ· Â›‰· Ù˘ Hcy.

™∫√¶√™ ∆∏™ ª∂§∂∆∏™: ∏ ÂÎÙ›ÌËÛË Ù˘ Â›‰Ú·Û˘ ÌÈ·˜ Ê˘ÛÈ΋˜ ÛÙ·Ù›Ó˘ (ÛÈÌ‚·ÛÙ·Ù›ÓË), ÌÈ·˜ Û˘ÓıÂÙÈ΋˜ ÛÙ·Ù›Ó˘ (·ÙÔÚ‚·ÛÙ·Ù›ÓË) Î·È ÌÈ·˜ ÊÈÌÚ¿Ù˘ (Ê·ÈÓÔÊÈÌÚ¿ÙË) ÛÙ· Â›‰· Ù˘ Hcy ÙÔ˘ ÔÚÔ‡ Û ·ÛıÂÓ›˜ Ì ÚˆÙÔ·ı‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·. À§π∫√ ∫∞π ª∂£√¢√π: 128 ·ÛıÂÓ›˜ (73 ¿Ó‰Ú˜ Î·È 58 Á˘-

Ó·›Î˜, ËÏÈΛ·˜ 58,1±8,3 ÂÙÒÓ) Ù˘¯·ÈÔÔÈ‹ıËÎ·Ó Ó· Ï¿‚Ô˘Ó ·ÙÔÚ‚·ÛÙ·Ù›ÓË 40 mg/ ËÌÂÚËÛ›ˆ˜ (n=64) ÛÈÌ‚·ÛÙ·Ù›ÓË 40 mg/ËÌÂÚËÛ›ˆ˜ (n=42) ‹ Ê·ÈÓÔÊÈÌÚ¿ÙË 200 mg/ËÌÂÚËÛ›ˆ˜ (n=22). ™Â fiÏ· Ù· ¿ÙÔÌ· Ù˘ ÌÂϤÙ˘ ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó ÔÈ ÏÈȉ·ÈÌÈΤ˜ ·Ú¿ÌÂÙÚÔÈ, Ë ÎÚ·ÙÈÓ›ÓË (Cre) ÙÔ˘ ÔÚÔ‡ Î·È Ù· Â›‰· Ù˘ Hcy, Ù˘ ‚ÈÙ·Ì›Ó˘ µ12 Î·È ÙÔ˘ Ê˘ÏÏÈÎÔ‡

∞ÔÙÂϤÛÌ·Ù· Ù˘ ·ÙÔÚ‚·ÛÙ·Ù›Ó˘, ÛÈÌ‚·ÛÙ·Ù›Ó˘ Î·È Ê·ÈÓÔÊÈÌÚ¿Ù˘ ÛÙ· ÏÈ›‰È· ÙÔ˘ ÔÚÔ‡ ∞ÙÔÚ‚·ÛÙ·Ù›ÓË 40 mg/Ë̤ڷ (n=64)

350

º·ÈÓÔÊÈÌÚ¿ÙË 200 mg/Ë̤ڷ (n=22)

™ÈÌ‚·ÛÙ·Ù›ÓË 40 mg/Ë̤ڷ (n=42)

300

mg/dl

250 200 150 100 50 0 OX

LDL

TG

HDL

OX

¶ÚÔ ıÂÚ·›·˜

™¯‹Ì· 1

20

LDL

TG

6 ‚‰ÔÌ¿‰Â˜

HDL

OX

12 ‚‰ÔÌ¿‰Â˜

LDL

TG

HDL

£EPA¶EIA – ºAPMAKA

∞ÔÙÂϤÛÌ·Ù· ·ÙÔÚ‚·ÛÙ·Ù›Ó˘, ÛÈÌ‚·ÛÙ·Ù›Ó˘ Î·È Ê·ÈÓÔÊÈÌÚ¿Ù˘ ÛÙ· Â›‰· ÔÌÔ΢ÛÙ½Ó˘, µÈÙ·Ì›Ó˘ µ12 Î·È Ê˘ÏÏÈÎÔ‡ ÔͤԘ ÙÔ˘ ÔÚÔ‡

16

º·ÈÓÔÊÈÌÚ¿ÙË 200 mg/Ë̤ڷ (n=22)

™ÈÌ‚·ÛÙ·Ù›ÓË 40 mg/Ë̤ڷ (n=42)

∞ÙÔÚ‚·ÛÙ·Ù›ÓË 40 mg/Ë̤ڷ (n=64)

14

U/L

12 10 8 6 4 2 0

√ÌÔ΢ÛÙ½ÓË

‚ÈÙ·Ì›ÓË µ12

Ê˘ÏÏÈÎfi Ô͇ √ÌÔ΢ÛÙ½ÓË ¶ÚÔ ıÂÚ·›·˜

‚ÈÙ·Ì›ÓË µ12 6 ‚‰ÔÌ¿‰Â˜

Ê˘ÏÏÈÎfi Ô͇

√ÌÔ΢ÛÙ½ÓË ‚ÈÙ·Ì›ÓË µ12

Ê˘ÏÏÈÎfi Ô͇

12 ‚‰ÔÌ¿‰Â˜

pg/dL

ng/mL

™¯‹Ì· 2

ÔͤԘ ÚÈÓ Î·È 6 Î·È 12 ‚‰ÔÌ¿‰Â˜ ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ÙˆÓ ˘ÔÏÈȉ·ÈÌÈÎÒÓ ·Ú·ÁfiÓÙˆÓ. ∂ÈÚfiÛıÂÙ·, ÚÔÛ‰ÈÔÚ›ÛÙËÎÂ Ë Î¿ı·ÚÛË Ù˘ ÎÚ·ÙÈÓ›Ó˘ (Clcre) ÛÂ Û˘Ó¿ÚÙËÛË Ì ÙËÓ ËÏÈΛ·, ÙÔ Ê‡ÏÔ Î·È ÙÔ ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜. ∞¶√∆∂§∂™ª∞∆∞: ∆· Â›‰· Ù˘ Hcy ÙÔ˘ ÔÚÔ‡ Û˘Û¯ÂÙ›˙ÔÓÙ·Ó ıÂÙÈο Ì ٷ Â›‰· Ù˘ ÎÚ·ÙÈÓ›Ó˘ Î·È ÙÔ˘ Ô˘ÚÈÎÔ‡ ÔͤԘ Î·È ·ÚÓËÙÈο Ì ٷ Â›‰· ÙÔ˘ Ê˘ÏÏÈÎÔ‡ ÔͤԘ ÙÔ˘ ÔÚÔ‡. ∏ ¯ÔÚ‹ÁËÛË ÙfiÛÔ ÙˆÓ ÛÙ·ÙÈÓÒÓ fiÛÔ Î·È Ù˘ Ê·ÈÓÔÊÈÌÚ¿Ù˘ ‚ÂÏÙ›ˆÛ ÛËÌ·ÓÙÈο ÙÔ ÏÈȉ·ÈÌÈÎfi ÚÔÊ›Ï: ÂȉÈÎfiÙÂÚ·, ·Ú·ÙËÚ‹ıËΠÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ÔÏÈ΋˜, Ù˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ. øÛÙfiÛÔ, ÌfiÓÔ Ë Ê·ÈÓÔÊÈÌÚ¿ÙË ÚÔοÏÂÛ ÛËÌ·ÓÙÈ΋ ·‡-

ÍËÛË Ù˘ HDL ¯ÔÏËÛÙÂÚfiÏ˘ (47,9 ± 12,5 vs. 50,7 ± 12,6 vs 51,2 ± 12,8 mg/dL, p < 0,01) (™¯‹Ì· 1). ¢ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÛÙ· Â›‰· Ù˘ Cre Î·È Ù˘ Clcre ÚÈÓ Î·È ÌÂÙ¿ ÙË ıÂÚ·›· Ì ÙȘ ÛÙ·Ù›Ó˜. ∞ÓÙ›ıÂÙ·, Ë ¯ÔÚ‹ÁËÛË Ê·ÈÓÔÊÈÌÚ¿Ù˘ ÚÔοÏÂÛ ÌÈÎÚ‹ ·‡ÍËÛË Ù˘ Cre (0,9 ± 0,12 vs.

1,03 ± 0,14 vs. 1,04 ± 0,12 mg/dl, p< 0,0001) Î·È Ì›ˆÛË Ù˘ Clcre (84,8 ± 23,5 vs. 71,4 ± 18.3 vs. 73,1 ± 16,9 mL/ min, p< 0,01) ∆· Â›‰· Ù˘ Hcy ÙÔ˘ ÔÚÔ‡ ‰ÂÓ ÌÂÙ·‚Ï‹ıËÎ·Ó ÌÂÙ¿ ÙË ıÂÚ·›· Ì ÙȘ ÛÙ·Ù›Ó˜, ÂÓÒ ·˘Í‹ıËÎ·Ó ÛËÌ·ÓÙÈο ÛÙËÓ ÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ‹Ú·Ó Ê·ÈÓÔÊÈÌÚ¿ÙË (10,3 ± 3,3 vs. 14,1 ± 3,8 vs. 14,2 ± 3,6 ÌU/L, p < 0,001) ∏ ¯ÔÚ‹ÁËÛË ÙˆÓ ˘ÔÏÈȉ·ÈÌÈÎÒÓ ·-

Ú·ÁfiÓÙˆÓ ‰ÂÓ ÂËÚ¤·Û ٷ Â›‰· Ù˘ ‚ÈÙ·Ì›Ó˘ µ12 Î·È ÙÔ˘ Ê˘ÏÏÈÎÔ‡ ÔͤԘ (™¯‹Ì· 2). ™Àª¶∂ƒ∞™ª∞∆∞: ™Â ·ÓÙ›ıÂÛË Ì ÙË Ê·ÈÓÔÊÈÌÚ¿ÙË, ÔÈ ıÂÚ·¢ÙÈΤ˜ ‰fiÛÂȘ Ù˘ ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ ‹ Ù˘ ÛÈÌ‚·ÛÙ·Ù›Ó˘: ñ ¢ÂÓ ÂËÚ¿˙Ô˘Ó Ù· Â›‰· Ù˘ ÎÚ·ÙÈÓ›Ó˘ ÙÔ˘ ÔÚÔ‡, ηıÒ˜ Î·È ÙËÓ Î¿ı·ÚÛË Ù˘ ÎÚ·ÙÈÓ›Ó˘ ñ Œ¯Ô˘Ó Ô˘‰¤ÙÂÚË ‰Ú¿ÛË ÛÙ· Â›‰· Ù˘ ÔÌÔ΢ÛÙ½Ó˘ ÙÔ˘ ÔÚÔ‡, Î·È ñ ¢ÂÓ ÌÂÙ·‚¿ÏÏÔ˘Ó ÙȘ ÙÈ̤˜ Ù˘ ‚ÈÙ·Ì›Ó˘ µ12 Î·È ÙÔ˘ Ê˘ÏÏÈÎÔ‡ ÔͤԘ ∞˘Ù‹ Ë È‰ÈfiÙËÙ· ÙˆÓ ‰‡Ô ÛÙ·ÙÈÓÒÓ Â›Ó·È È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈ΋ ÁÈ· ÙËÓ ÚfiÏË„Ë Ù˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘.

21

·ıËÚÔÛÎÏ‹ÚˆÛË ¢EKEMBPπ√™ 2004

™˘Ó¤ÂȘ ÙˆÓ ÚfiÛÊ·ÙˆÓ ÎÏÈÓÈÎÒÓ ÌÂÏÂÙÒÓ ÁÈ· ÙȘ Ô‰ËÁ›Â˜ Ù˘ 3˘ ¤Î‰ÔÛ˘ (∞∆ƒ πππ) ÙÔ˘ ∂ıÓÈÎÔ‡ ¶ÚÔÁÚ¿ÌÌ·ÙÔ˜ ∂ÈÌfiÚʈÛ˘ ÁÈ· ÙË ÃÔÏËÛÙÂÚfiÏË (NCEP) Grundy SM, Cleeman JI, Merz CNB, Brewer HB, Clark LT, Hunninghake DB, Pasternak RC, Smith SC, Stone NJ, for the Coordinating Committee of the National Cholesterol Education Program.

J Am Coll Cardiol 2004;44:720-32

∏ 3Ë ¤Î‰ÔÛË ÙˆÓ Ô‰ËÁÈÒÓ ÙÔ˘ NCEP ‰ËÌÔÛȇıËΠˆ˜ ÂÚ›ÏË„Ë ÙÔÓ ª¿ÈÔ ÙÔ˘ 2001 Î·È ˆ˜ Ï‹Ú˜ ΛÌÂÓÔ ÙÔÓ ¢ÂΤ̂ÚÈÔ ÙÔ˘ 2002. ∞fi ÙfiÙ ÚÔÛÙ¤ıËÎ·Ó ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ¤ÓÙ ÌÂÁ¿Ï˜ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ Ì ÛÙ·Ù›Ó˜ Ô˘ ÚÔÛÎfiÌÈÛ·Ó Ó¤· ‰Â‰Ô̤ӷ ÁÈ· ÙËÓ ÚfiÏË„Ë ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ Î·È Î·Ù¤ÛÙËÛ·Ó ·Ó·Áη›· ÙËÓ ·Ó·ıÂÒÚËÛË ÔÚÈÛÌ¤ÓˆÓ ·fi„ÂˆÓ ÙˆÓ Ô‰ËÁÈÒÓ ·˘ÙÒÓ: Ë Heart Protection Study (HPS), Ë Prospective Study of Pravastatin in the Elderly at Risk (PROSPER), Ë Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial – Lipid-Lowering Treatment (ALLHAT-LLT), Ë Anglo-Scadinavian Cardiac Outcomes Trial – Lipid Lowering Arm (ASCOT-LLA), Î·È Ë Pravastatine or Atorvastatin Evaluation and Infection – Thrombolysis in Myocardial Infarction 22 (PROVE IT – TIMI 22). ∞˘Ù¤˜ ÔÈ ÌÂϤÙ˜ ‰ÈÂÚ‡ÓËÛ·Ó ı¤Ì·Ù· Ô˘ ‰ÂÓ Â›¯·Ó Â·ÚÎÒ˜ ‰È¢ÎÚÈÓÈÛı› ·fi ÙȘ ÚÔÁÂÓ¤ÛÙÂÚ˜ ÌÂϤÙ˜ Î·È ÂÚȤϷ‚·Ó ÂȉÈΤ˜ ÔÌ¿‰Â˜ ÏËı˘ÛÌÔ‡. ∆· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ٷ ·ÔÙÂϤÛÌ·Ù· ¿ÏÏˆÓ ÌÈÎÚÔÙ¤ÚˆÓ ÌÂÏÂÙÒÓ Î·È Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ·Ó¿Ï˘Û˘ ˘ÔÔÌ¿‰ˆÓ ÙˆÓ ÌÂÁ·Ï˘Ù¤ÚˆÓ ·Ï·ÈÔÙ¤ÚˆÓ ÌÂÏÂÙÒÓ, ‰›‰Ô˘Ó Â·Ú΋ ÛÙÔȯ›· ÁÈ· ÙËÓ Â·ÓÂͤٷÛË ÙˆÓ ÙÈÌÒÓ ÛÙfi¯ˆÓ Î·È ÙˆÓ ÙÈÌÒÓÔÚ›ˆÓ ¤Ó·Ú͢ Ù˘ ıÂÚ·›·˜.

22

∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ HPS ÂȂ‚·ÈÒÓÔ˘Ó Ù· Â˘Ú‹Ì·Ù· ÂȉËÌÈÔÏÔÁÈÎÒÓ ÌÂÏÂÙÒÓ fiÙÈ Ë Û¯¤ÛË Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ Î·È ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ηډȷÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ Â›Ó·È ÏÔÁ·ÚÈıÌÈ΋ (™¯‹Ì· 1), ·ÎfiÌË Î·È Û Ôχ ¯·ÌËϤ˜ ÙÈ̤˜ LDL-¯ÔÏËÛÙÂÚfiÏ˘. ¢ÂÓ ‰È·ÈÛÙÒıËΠ·fi η̛· ÌÂϤÙË fiÙÈ ˘¿Ú¯ÂÈ Î·ÙÒÙÂÚÔ˜ Ô˘‰fi˜, ¤Ú·Ó ÙÔ˘ ÔÔ›Ô˘ Ë Ì›ˆÛË Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ ‰ÂÓ Â›Ó·È ˆÊ¤ÏÈÌË. °È· οı 1 mg/dl Ì›ˆÛË Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ ÌÂÈÒÓÂÙ·È Ô Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ ηٿ 1%. ŒÙÛÈ Ì›ˆÛË Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ ηٿ 30 mg/dl ÂÙ˘¯·›ÓÂÈ Ì›ˆÛË ÙÔ˘ Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ηٿ ÂÚ›Ô˘ 30%. ∞ÎfiÌË Î·È ÛÙËÓ

˘ÔÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ Ì LDL-¯ÔÏËÛÙÂÚfiÏË <100mg/dl Ë ÚÔÛı‹ÎË ÛÙ·Ù›Ó˘ ÌÂÈÒÓÂÈ ÙÔÓ Û¯ÂÙÈÎfi ΛӉ˘ÓÔ ÛÙÔ ›‰ÈÔ ÔÛÔÛÙfi. ™Â ˘ÔÔÌ¿‰Â˜ ·ÛıÂÓÒÓ Ì ÌÂÁ¿ÏÔ ·fiÏ˘ÙÔ Î›Ó‰˘ÓÔ ÙÔ fiÊÂÏÔ˜ Â›Ó·È ÌÂÁ¿ÏÔ, ·ÓÙ›ıÂÙ· Û ˘ÔÔÌ¿‰Â˜ Ô˘ ¤¯Ô˘Ó ÌÈÎÚfi ·fiÏ˘ÙÔ Î›Ó‰˘ÓÔ ÙÔ fiÊÂÏÔ˜ Â›Ó·È ÌÈÎÚfi. Àfi ÙÔ Êˆ˜ ÙˆÓ ÓÂfiÙÂÚˆÓ ·˘ÙÒÓ ÌÂÏÂÙÒÓ: ñ ∂Ȃ‚·ÈÒÓÂÙ·È Ë ·Í›· Ù˘ ˘ÁÈÂÈÓԉȷÈÙËÙÈ΋˜ ·ÁˆÁ‹˜, Ë ÔÔ›· ·Ú·Ì¤ÓÂÈ Ô ·ÎÚÔÁˆÓÈ·›Ô˜ Ï›ıÔ˜ ·ÓÙÈÌÂÙÒÈÛ˘ ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘. ñ ∂Ȃ‚·ÈÒÓÂÙ·È fiÙÈ Ë Ì›ˆÛË Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘

3,7 ™¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ ™N (§ÔÁ·ÚÈıÌÈ΋ Îϛ̷η)

2,9 2,2 1,7 1,3 1,0

40

70

100

130

160

190

LDL-XÔÏËÛÙÂÚfiÏË (mg/dL) ∂ÈÎfiÓ· 1: §ÔÁ·ÚÈıÌÈ΋-ÁÚ·ÌÌÈ΋ Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ Ì ÙÔÓ Û¯ÂÙÈÎfi ΛӉ˘ÓÔ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘. ∏ Û˘Û¯¤ÙÈÛË ·˘Ù‹ ˘ÔÛÙËÚ›˙ÂÙ·È ·fi ÂȉËÌÈÔÏÔÁÈΤ˜ ·ÏÏ¿ Î·È ·fi ÎÏÈÓÈΤ˜ ÌÂϤÙ˜. °È· οı ÌÂÙ·‚ÔÏ‹ Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ ηٿ 30 mg/dL ÌÂÙ·‚¿ÏÏÂÙ·È Ô Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ ηٿ 30% ÂÚ›Ô˘. √ Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ ıˆڋıËΠ1 Û ÙÈÌ‹ LDL- ¯ÔÏËÛÙÂÚfiÏ˘ = 40 mg/dL

™Y°XPONE™ O¢H°IE™ ÌÂÈÒÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ Î·È fiÙÈ ÛÙfi¯Ô˜ Ù˘ ıÂÚ·›·˜ ÛÙ· ¿ÙÔÌ· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Â›Ó·È ÙÈÌ‹ < 100 mg/dl. ¶ÚÔÛÙ›ıÂÙ·È fï˜ fiÙÈ fiÙ·Ó Ô Î›Ó‰˘ÓÔ˜ Â›Ó·È È‰È·›ÙÂÚ· ÌÂÁ¿ÏÔ˜, Ë ÙÈÌ‹ – ÛÙfi¯Ô˜ < 70 mg/dl Â›Ó·È ÌÈ· ıÂÚ·¢ÙÈ΋ ÂÈÏÔÁ‹. ∆¤ÙÔȘ ÂÚÈÙÒÛÂȘ Â›Ó·È Ë ÂÁηÙÂÛÙË̤ÓË Î·Ú‰È·ÁÁÂȷ΋ ÓfiÛÔ˜ ·ıËڈ̷ÙÈ΋˜ ·ÈÙÈÔÏÔÁ›·˜ Î·È ÔÏÏ·ÏÔ› ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ (ÚÔ·ÓÙfi˜ ۷ί·Ú҉˘ ‰È·‚‹Ù˘), ÌË ÂÏÂÁ¯fiÌÂÓÔÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ (fiˆ˜ οÓÈÛÌ·), ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ Î·ıÒ˜ Î·È Ôͤ· ÛÙÂÊ·ÓÈ·›· Û‡Ó‰ÚÔÌ·

ñ ŸÙ·Ó ¤Ó· ¿ÙÔÌÔ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ¤¯ÂÈ ˘„ËÏ¿ ÙÚÈÁÏ˘ÎÂÚ›‰È· ‹ ¯·ÌËÏ‹ HDL¯ÔÏËÛÙÂÚfiÏË Ú¤ÂÈ Ó· ÂÍÂÙ¿˙ÂÙ·È Ë ¯ÔÚ‹ÁËÛË ¤Ú·Ó Ù˘ ÛÙ·Ù›Ó˘ Î·È ÊÈÌÚ¿ÙË (Ê·ÈÓÔÊÔÌÚ¿ÙË) ‹ ÓÈÎÔÙÈÓÈÎfi Ô͇.

‰È·, ¯·ÌËÏ‹ HDL-¯ÔÏËÛÙÂÚfiÏË ‹ ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ Ú¤ÂÈ Ó· ·ÎÔÏÔ˘ı› ˘ÁÈÂÈÓԉȷÈÙËÙÈ΋ ·ÁˆÁ‹ ÁÈ· ‰ÈfiÚıˆÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ ·˘ÙÒÓ, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙÔ Â›Â‰Ô Ù˘ LDL¯ÔÏËÛÙÂÚfiÏ˘.

ñ ™Ù· ¿ÙÔÌ· ÌÂÙÚ›ˆ˜ ·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ (2+ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Î·È ‰ÂηÂÙ‹ ΛӉ˘ÓÔ 10-20%) ÛÙfi¯Ô˜ Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ Â›Ó·È < 130 mg/dl ·ÏÏ¿ Î·È Ë ÙÈÌ‹ ÛÙfi¯Ô˜ < 100 mg/dl ·ÔÙÂÏ› ıÂÚ·¢ÙÈ΋ ÂÈÏÔÁ‹. ∏ ¤Ó·ÚÍË Ê·Ú̷΢ÙÈ΋˜ ·ÁˆÁ‹˜ Á›ÓÂÙ·È ·Ó Ë LDL-¯ÔÏËÛÙÂÚfiÏË Â›Ó·È >130 mg/dl.

ñ ∆¤ÏÔ˜ ‰È¢ÎÚÈÓ›˙ÂÙ·È fiÙÈ ÁÈ· Ù· ¿ÙÔÌ· ¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ‰ÂÓ ÙÚÔÔÔÈÔ‡ÓÙ·È ÔÈ ÙÈ̤˜ ÛÙfi¯ÔÈ Ô‡Ù ÔÈ ÙÈ̤˜ ÔÚfiÛËÌ· ÁÈ· ıÂÚ·›·.

ñ ™˘ÓÈÛÙ¿Ù·È Ó· ¯ÔÚËÁÂ›Ù·È ÛÙ·Ù›ÓË ÛÙ· ¿ÙÔÌ· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Ì LDL-¯ÔÏËÛÙÂÚfiÏË < 100 mg/dl ÒÛÙÂ Ë LDL-¯ÔÏËÛÙÂÚfiÏË Ó· ÌÂȈı› < 70 mg/dl.

ñ ŸÙ·Ó ÂÊ·ÚÌfi˙ÂÙ·È Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ ÁÈ· Ì›ˆÛË Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ ÛÙ· ¿ÙÔÌ· ÌÂÙÚ›Ô˘ ‹ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, Ë ¤ÓÙ·ÛË Ù˘ ·ÁˆÁ‹˜ Ú¤ÂÈ Ó· Â›Ó·È Ù¤ÙÔÈ· Ô˘ Ó· ÂÈÙ˘Á¯¿ÓÂÈ Ì›ˆÛË Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ ηٿ 30 - 40%, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ÙÈÌ‹ ¤Ó·Ú͢.

ñ ∂Ȃ‚·ÈÒÓÂÙ·È Î·Ù¿Ù·ÍË ÙˆÓ ‰È·‚ËÙÈÎÒÓ ÛÙËÓ ÔÌ¿‰· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Î·È ÙÔ ÌÂÁ¿ÏÔ fiÊÂÏÔ˜ ·fi ÙËÓ Ì›ˆÛË Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ ÛÙ· ¿ÙÔÌ· ·˘Ù¿. ñ ∂Ȃ‚·ÈÒÓÂÙ·È fiÙÈ Ë Ì›ˆÛË Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ Â›Ó·È ˆÊ¤ÏÈÌË Î·È ÛÙ· ËÏÈÎȈ̤ӷ ¿ÙÔÌ·.

ñ ∫¿ı ¿ÙÔÌÔ ˘„ËÏÔ‡ ‹ ÌÂÙÚ›Ô˘ ÎÈÓ‰‡ÓÔ˘ Ô˘ ÂÌÊ·Ó›˙ÂÈ ·¯˘Û·ÚΛ·, ¤ÏÏÂÈ„Ë ÛˆÌ·ÙÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜, ·˘ÍË̤ӷ ÙÚÈÁÏ˘ÎÂÚ›-

™ÙÔ ·ÚÂÏıfiÓ Â›¯·Ó ÂÎÊÚ·Ûı› ·ÓËÛ˘¯›Â˜ ÁÈ· ÂӉ¯fiÌÂÓÔ Î›Ó‰˘ÓÔ ·fi ÙË ÌÂÁ¿ÏË ÂÏ¿ÙÙˆÛË Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ Î·È Û˘ÁÎÂÎÚÈ̤ӷ ÁÈ· ÙË Û¯¤ÛË ¯·ÌËÏ‹˜ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ·ÈÌÔÚÚ·ÁÈÎÒÓ ÂÁÎÂÊ·ÏÈÎÒÓ. ∆ÔÓ›˙ÂÙ·È fiÙÈ ·fi ÙȘ ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ ‰ÂÓ ‰È·ÈÛÙÒıËΠ٤ÙÔÈÔ˜ ΛӉ˘ÓÔ˜. ∏ ‰˘ÛÎÔÏ›· Â›Ó·È ÛÙËÓ Â›Ù¢ÍË ÙÔ˘ ÛÙfi¯Ô˘ ÙˆÓ 70 mg/dl, ÛÙ· ¿ÙÔÌ· Ô˘ ¤¯Ô˘Ó ˘„ËϤ˜ ·Ú¯ÈΤ˜ ÙÈ̤˜ LDL-¯ÔÏËÛÙÂÚfiÏ˘ (.¯. ¿ÙÔÌ· Ì LDL-¯ÔÏËÛÙÂÚfiÏË > 150 mg/dl). ∏ ÚÔÛı‹ÎË ‰Â˘Ù¤ÚÔ˘ Ê·ÚÌ¿ÎÔ˘ fiˆ˜ Â˙ÂÙÈÌ›Ì˘, ÚËÙ›Ó˘ ‹ ÓÈÎÔÙÈÓÈÎÔ‡ ÔͤԘ ÌÔÚ› Ó· Â›Ó·È ··Ú·›ÙËÙË ÛÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜ ∂È̤ÏÂÈ·: ∏Ï›·˜ ÃÂÈÌÒÓ·˜

23

·ıËÚÔÛÎÏ‹ÚˆÛË ¢EKEMBPπ√™ 2004

¶ƒ√∆∂π¡√ª∂¡∏ µπµ§π√°ƒ∞ºπ∞ 1: Meigs JB. Metabolic Syndrome: In search of a clinical role. Diabetes Care.

2004 Nov;27(11):2761-3.

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3: Bruno G, Merletti F, Biggeri A, Bargero G, Ferrero S, Runzo C, Prina Cerai S, Pagano G, Cavallo-Perin P. Metabolic syndrome as a predictor of all-cause and cardiovascular mortality in type 2 diabetes: the casale monferrato study.

Diabetes Care. 2004 Nov;27(11):268994.

4: Kaushal K, Heald AH, Siddals KW, Sandhu MS, Dunger DB, Gibson JM, Wareham NJ. The Impact of Abnormalities in IGF and Inflammatory Systems on the Metabolic Syndrome.

Diabetes Care. 2004 Nov;27(11):26822688.

5: Stern MP, Williams K, GonzalezVillalpando C, Hunt KJ, Haffner SM. Does the Metabolic Syndrome Improve Identification of Individuals at Risk of Type 2 Diabetes and/or Cardiovascular Disease?

Diabetes Care.

2004 Nov;27(11):2676-81.

6: Lewis GF, Murdoch S, Uffelman K, Naples M, Szeto L, Albers A, Adeli K, Brunzell JD. Hepatic lipase mRNA, protein, and plasma enzyme activity is increased in the insulin-resistant, fructose-fed Syrian golden hamster and is partially normalized by the insulin sensitizer rosiglitazone. Diabetes. 2004 Nov;53(11):2893-900.

7: Sattar N, Scherbakova O, Ford I, O'reilly DS, Stanley A, Forrest E, Macfarlane PW, Packard CJ, Cobbe SM, Shepherd J. Elevated alanine aminotransferase predicts new-onset type 2 diabetes independently of classical risk factors, metabolic syndrome, and C-reactive protein in the west of Scotland coronary prevention study. Diabetes. 2004 Nov;53(11):2855-60.

8: Wang CC, Goalstone ML, Draznin B. Molecular mechanisms of insulin resistance that impact cardiovascular biology. Diabetes. 2004 Nov;53(11): 2735-40.

9: El-Atat FA, Stas SN, McFarlane SI, Sowers JR. The Relationship between Hyperinsulinemia, Hypertension and Progressive Renal Disease. J Am Soc Nephrol. 2004 Nov;15(11):2816-27.

10: Guan Y. Peroxisome proliferator-activated receptor family and its relationship to renal complications of the metabolic syndrome. J Am Soc Nephrol. 2004 Nov;15(11):2801-15.

11: Wisse BE. The inflammatory syndrome: the role of adipose tissue cytokines in metabolic disorders linked to obesity. J Am Soc Nephrol. 2004 Nov;15(11):2792800.

12: Bagby SP. Obesity-initiated metabolic syndrome and the kidney: a recipe for chronic kidney disease? J Am Soc Nephrol. 2004 Nov;15(11):2775-91.

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13: Schelling JR, Sedor JR. The metabolic syndrome as a risk factor for chronic kidney disease: more than a fat chance?

J Am Soc Nephrol.

2004 Nov;15(11):2773-4.

14: Fernandez AZ. PPARs as targets for the modulation of cardiovascular risk factors associated with the metabolic syndrome.

Curr Opin Investig Drugs. 2004 Sep;5(9):936-40.

15: Kosinovsky B, Hermon S, Yoran-Hegesh R, Golomb A, Senecky Y, Goez H, Kramer U. The yield of laboratory investigations in children with infantile autism. J Neural Transm. 2004 Oct 22 [Epub ahead of print] 16: Garris DR. Estrogenic stimulation of ovarian follicular maturation in diabetes (db/db) mutant mice: restoration of euglycemia prevents hyperlipidemic cytoatrophy. Cell Tissue Res. 2004 Nov;318(2):365-373.

17: Ryo M, Nakamura T, Kihara S, Kumada M, Shibazaki S, Takahashi M, Nagai M, Matsuzawa Y, Funahashi T. Adiponectin as a Biomarker of the Metabolic Syndrome. Circ J. 2004;68(11):975-981.

18: Mensah GA, Mokdad AH, Ford E, Narayan KM, Giles WH, Vinicor F, Deedwania PC. Obesity, metabolic syndrome, and type 2 diabetes: emerging epidemics and their cardiovascular implications. Cardiol Clin.

2004 Nov;22(4):485-504.

19: Kerner A, Avizohar O, Sella R, Bartha P, Zinder O, Markiewicz W, Levy Y, Brook GJ, Aronson D. Association Between Elevated Liver Enzymes and C-Reactive Protein. Possible Hepatic Contribution to Systemic Inflammation in the Metabolic Syndrome. Arterioscler Thromb Vasc Biol.

2004 Oct 21 [Epub ahead of print] 20: Wilson FH, Hariri A, Farhi A, Zhao H, Petersen KF, Toka HR, Nelson-Williams C, Raja KM, Kashgarian M, Shulman GI, Scheinman SJ, Lifton RP. A Cluster of Metabolic Defects Caused by Mutation in a Mitochondrial tRNA. Science. 2004 Oct 21 [Epub ahead of print] 21: Kale SD, Yajnik CS, Kulkarni SR, Meenakumari K, Joglekar AA, Khorsand N, Ladkat RS, Ramdas LV, Lubree HG. High risk of diabetes and metabolic syndrome in Indian women with gestational diabetes mellitus. Diabet Med. 2004 Nov;21(11):1257-8.

22: Jorgensen ME, Bjerregaard P, Gyntelberg F, Borch-Johnsen K; the Greenland Population Study section sign.

Prevalence of the metabolic syndrome among the Inuit in Greenland. A comparison between two proposed definitions.

Diabet Med. 2004 Nov;21(11):1237-1242.

23: van Raalte DH, Li M, Pritchard PH, Wasan KM. Peroxisome proliferatoractivated receptor (PPAR)-alpha: a pharmacological target with a promising future. Pharm Res. 2004 Sep;21(9):15318.

24: Fletcher B, Lamendola C. Insulin resistance syndrome. J Cardiovasc Nurs.

2004 Sep-Oct;19(5):339-45.

25: Eisenmann JC, Welk GJ, Wickel EE, Blair SN. Stability of variables associated with the metabolic syndrome from adolescence to adulthood: The Aerobics Center Longitudinal Study. Am J Hum Biol. 2004 Nov-Dec;16(6):690-6.

26: Godsland IF, Crook D, Proudler AJ, Stevenson JC. Hemostatic risk factors and insulin sensitivity, regional body fat distribution and the metabolic syndrome.

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28: Liangpunsakul S, Chalasani N. Relationship Between Unexplained Elevations in Alanine Aminotransferase and Serum Leptin in U.S. Adults: Results From the Third National Health and Nutrition Examination Survey (NHANES III).

J Clin Gastroenterol.

2004 Nov;38(10):891-7.

29: Sattar N, Williams K, Sniderman AD, D'Agostino R Jr, Haffner SM. Comparison of the associations of apolipoprotein B and non-high-density lipoprotein cholesterol with other cardiovascular risk factors in patients with the metabolic syndrome in the Insulin Resistance Atherosclerosis Study. Circulation. 2004 Oct 26;110(17):2687-93.

30: Lee WJ, Huang MT, Wang W, Lin CM, Chen TC, Lai IR. Effects of obesity surgery on the metabolic syndrome. Arch Surg. 2004 Oct;139(10):1088-92.

31: Niskanen L, Laaksonen DE, Nyyssonen K, Punnonen K, Valkonen VP, Fuentes R, Tuomainen TP, Salonen R, Salonen JT. Inflammation, Abdominal Obesity, and Smoking as Predictors of Hypertension.

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2004 Sep;24(5):423-5.

33: You T, Ryan AS, Nicklas BJ. The metabolic syndrome in obese postmenopausal women: relationship to body composition, visceral fat, and inflammation. J Clin Endocrinol Metab.

2004 Oct 14;89(11):5517-5522 [Epub ahead of print] 34: Konstantoulas CJ, Cooper J, Warnock G, Miller GJ, Humphries SE, Ireland H. A combination of two common thrombomodulin gene variants (-12081209TTdelTT and A455V) influence risk of coronary heart disease: a prospective study in men. Atherosclerosis. 2004 Nov;177(1):97-104.

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2004 Sep 15;61(18):1938-49.

IATPOI KA§§ITEXNE™

IATPOI KA§§ITEXNE™

IATPOI KA§§ITEXNE™

∆˙ÈÔ‚¿ÓÓÈ ∞ÏÌ›ÓÔ √ ηÏÏÈÙ¤¯Ó˘ ÁÂÓÓ‹ıËΠÛÙÔ ºÂÚÚ·Ù˙¿ÓÔ Ù˘ πÙ·Ï›·˜, ÚÈÓ ·fi ÂÓÙ‹ÓÙ·-ÔÎÙÒ ¯ÚfiÓÈ·. ™Ô‡‰·Û ȷÙÚÈ΋ ÛÙÔ ¶·ÓÂÈÛÙ‹ÌÈÔ Ù˘ ƒÒÌ˘ Î·È ÂȉÈ·ÙËΠÛÙËÓ ∂ÏÏ¿‰· °ÂÓÈ΋ π·ÙÚÈ΋. ∏ ÚÒÙË ÙÔ˘ Â·Ê‹ Ì ÙËÓ ∂ÏÏ¿‰· ¤ÁÈÓ ÛÙ· 1972. °ÔËÙÂ˘Ì¤ÓÔ˜ ·fi ÙȘ ÔÌÔÚÊȤ˜ Ù˘ ·ÔÊ·Û›˙ÂÈ ÙË ÌfiÓÈÌË ‰È·ÌÔÓ‹ ÙÔ˘, ϤÔÓ, Û’ ·˘Ù‹ ÙË ¯ÒÚ·. ∆· ÙÂÏÂ˘Ù·›· ›ÎÔÛÈ ¯ÚfiÓÈ·, ·Û¯ÔÏ‹ıËΠ̠ÙËÓ ÁÏ˘ÙÈ΋ Î·È ÙË ˙ˆÁÚ·ÊÈ΋. ∏ ‰ÂηÙÂÙÚ¿¯ÚÔÓË ·Ú·ÌÔÓ‹ ÙÔ˘ ÛÙË ∑·ÁÔÚ¿ ÙÔÓ ‚Ô‹ıËÛ ӷ ·Ó·Ù‡ÍÂÈ ÙÔ Î·ÏÏÈÙ¯ÓÈÎfi ÙÔ˘ ٷϤÓÙÔ ÛÙË ˙ˆÁÚ·ÊÈ΋ Î·È ÁÏ˘ÙÈ΋, ηıÒ˜ ¢ÓfiËÛÂ Î·È ÙÔ ¤ÚÁÔ ÙÔ˘ ÛÙË Í˘ÏÔÁÏ˘ÙÈ΋ ·fi ¿Ô„Ë Â˘ÎÔÏfiÙÂÚ˘ ‡ÚÂÛ˘ ˘ÏÈÎÔ‡. ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Ô ∆˙ÈÔ‚¿ÓÓÈ ∞ÏÌ›ÓÔ, Ì·˙› Ì ÙËÓ ŸÏÁ· ™Ù·ÚÔÔ‡ÏÔ˘ Î·È ÙËÓ µÈÎÙˆÚ›· ∆¤Á·, ›‰Ú˘Û·Ó ÙËÓ Î·ÏÏÈÙ¯ÓÈ΋ ÔÌ¿‰· «∂π¢ø§√». ∏ ÔÌ¿‰· ÙÔ˘˜ Â› ÙÚ›· Û˘Ó¯‹ ¯ÚfiÓÈ· ÔÚÁ¿ÓˆÓ ÙÔ Î·ÚÓ·‚¿ÏÈ ÙÔ˘ ¢‹ÌÔ˘ ∑·ÁÔÚ¿˜, Û˘ÌÌÂÙ¤¯ÔÓÙ·˜ Ì ηٷÛ΢¤˜ ·ÚÌ¿ÙˆÓ ·fi Á‡„Ô Î·È ¯·ÚÙÔÔÏÙfi ηıÒ˜ Î·È Ì ÙÔ Û¯Â‰È·ÛÌfi ·ÔÎÚÈ¿ÙÈÎˆÓ ÛÙÔÏÒÓ. ∆Ô ºÂ‚ÚÔ˘¿ÚÈÔ ÙÔ˘ 2004, Ë ÔÌ¿‰· «∂π¢ø§√» οÓÂÈ ÙËÓ ÚÒÙË Ù˘ ¤ÎıÂÛË Ì ̿ÛΘ ηٷÛ΢·Ṳ̂Ó˜ ·fi Á‡„Ô Î·È ‰È¿ÊÔÚ· ˘ÏÈο Ù˘ ʇÛ˘ (͇ÏÔ, ʇÏÏ·, ÏÔ˘ÏÔ‡‰È·, ÍËÚÔ‡˜ ηÚÔ‡˜ Î.¿.), ÛÙ· Ï·›ÛÈ· ÙˆÓ Î·ÏÏÈÙ¯ÓÈÎÒÓ ÂΉËÏÒÛÂˆÓ ÁÈ· ÙÔ ∫·ÚÓ·‚¿ÏÈ 2004 ÙÔ˘ ¢‹ÌÔ˘ µfiÏÔ˘, Ô˘ ÔÚÁ·ÓÒıËΠ·fi ÙË ¢ËÌÔÙÈ΋ ∆Ô˘ÚÈÛÙÈ΋ ∂ȯ›ÚËÛË µfiÏÔ˘. ∞ÙÔÌÈΤ˜ ÂÎı¤ÛÂȘ: ∞‡ÁÔ˘ÛÙÔ˜ 1997:

«•‡ÏÔ. ∂ÈÎfiÓ· Î·È ¢ËÌÈÔ˘ÚÁ›·», ∫ÔÈÓfiÙËÙ· ∑·ÁÔÚ¿˜

πÔ‡ÓÈÔ˜ 1998:

«°˘Ó·›Î˜, Á˘Ó·›Î˜, Á˘Ó·›Î˜», ŒÎıÂÛË ˙ˆÁÚ·ÊÈ΋˜, ∑·ÁÔÚ¿˜ ∞Û‡ÏÏËÙÔ Ó· ‰È·ÓÔËı› ηÓ›˜ ÙÔÓ ÎfiÛÌÔ ¯ˆÚ›˜ Á˘Ó·›Î˜. ∫·Ì‡Ï˜ Î·È ÂÏÈÎÔÂȉ‹˜ ÌÔÚʤ˜, ÁÏ˘Î¤˜ Î·È ·ÚÌÔÓÈΤ˜. ∆Ô ¯¤ÚÈ ÁÏÈÛÙÚ¿ÂÈ ÛÙ· Á˘Ó·ÈΛ· Û¯¤‰È· Û·Ó ¤Ó· ¯¿‰È. ™Ù¤ÎÂÙ·È Î·Ù¿ÎÔÔ ÁÈ· ÌÈ· ÛÙÈÁÌ‹ Û˘ÏÏÔÁÈÛÌÔ‡ Î·È ÌÂÙ¿ Û˘Ó¯›˙ÂÈ Ó· ¯·˚‰Â‡ÂÈ ¿ÏϘ ηÌ‡Ï˜. ∞Ù¤ÏÂȈÙ˜ ηÌ‡Ï˜ Ô˘ ÁÏ˘ÛÙÚ¿ÓÂ Î·È ·Ó·Î·Ù‡ÔÓÙ·È Ì ÙȘ ÛΤ„ÂȘ ÁÈ· Ó· ·Ú¯›˙Ô˘Ó ¿ÏÈ ·’ ÙËÓ ·Ú¯‹.

πÔ‡ÏÈÔ˜ 1999:

«Brovocazione», ŒÎıÂÛË ˙ˆÁÚ·ÊÈ΋˜-͢ÏÔÁÏ˘ÙÈ΋˜, ∑·ÁÔÚ¿˜

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