ΤΕΥΧΟΣ 18 ΙΟΥΝΙΟΣ 2008 - ΑΘΗΡΟΣΚΛΗΡΩΣΗ

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Δƒπª∏¡π∞π√ ¶∂ƒπ√¢π∫√ §π¶π¢πø¡ Δ∂ÀÃ√™ 18 ñ π√À¡π√™ 2008

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∞Ï¤Í·Ó‰ÚÔ˜ ΔÛÂÏ¤Ë˜ª¤ÏÔ˜

∞¡∞™∫√¶∏™∂π™Δ· Ã·ÌËÏ¿ ∂›Â‰· ÙË˜ √ÏÈÎ‹˜ Î·È LDL ÃÔÏËÛÙÂÚfiÏË˜ ∂ÁÎ˘ÌÔÓÔ‡Ó ∫ÈÓ‰‡ÓÔ˘˜ ∫·ÚÎÈÓÔÁ¤ÓÂÛË˜;∏Ï›·˜ ÃÂÈÌÒÓ·˜, ∫·Ú‰ÈÔÏfiÁÔ˜

∫§π¡π∫∂™ ª∂§∂Δ∂™ªÂÏ¤ÙË ASCOT-LLA. ∞ÒÙÂÚ· AÔÙÂÏ¤ÛÌ·Ù·,2 XÚfiÓÈ· MÂÙ¿ ÙÔ KÏÂ›ÛÈÌÔ ÙË˜ MÂÏ¤ÙË˜.ASCOT Investigators Eur Heart J 2008;29:499-508

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

£EPA¶EIA — ºAPMAKAºÈÌÚ¿ÙÂ˜: ∞ÁˆÁ‹ μ·ÛÈÛÌ¤ÓË ÛÂ ∂Ó‰Â›ÍÂÈ˜ ·fi Ù· ∞ÔÙÂÏ¤ÛÌ·Ù· ªÂÁ¿ÏˆÓ ¶ÚÔÔÙÈÎÒÓ ∫ÏÈÓÈÎÒÓ ªÂÏÂÙÒÓ∂˘¿ÁÁÂÏÔ˜ §˘ÌÂÚfiÔ˘ÏÔ˜, §¤ÎÙÔÚ·˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈÎ‹˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓªˆ˘Û‹˜ ∂ÏÈÛ¿Ê, ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈÎ‹˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ

‚-·ÔÎÏÂÈÛÙ¤˜ Î·È ∫·Ú‰È·Î‹ ∞ÓÂ¿ÚÎÂÈ·.∞. ¶··ı·Ó·Û›Ô˘, ∫·Ú‰ÈÔÏfiÁÔ˜, ∂ÍÂÈ‰ÈÎÂ˘fiÌÂÓÔ˜ ∂ÓÙ·ÙÈÎÔÏÔÁ›·˜, ª∂£ ¶°¡ πˆ·ÓÓ›ÓˆÓπ. °Ô˘‰¤‚ÂÓÔ˜, ∫·ıËÁËÙ‹˜ ∫·Ú‰ÈÔÏÔÁ›·˜, ∫·Ú‰ÈÔÏÔÁÈÎ‹ ∫ÏÈÓÈÎ‹ ¶°¡ πˆ·ÓÓ›ÓˆÓ

∏ ™˘ÌÌfiÚÊˆÛË ÙˆÓ ∞ÛıÂÓÒÓ ÛÙËÓ ÀÔÏÈÈ‰·ÈÌÈÎ‹ ∞ÁˆÁ‹ Î·È ÔÈ ∂ÈÙÒÛÂÈ˜ ÙË˜ ÛÙËÓ ∫·Ú‰È·ÁÁÂÈ·Î‹ ¡ÔÛËÚfiÙËÙ· Î·È £ÓËÙfiÙËÙ·.ª. ºÏˆÚÂÓÙ›Ó, ∂ÈÛÙËÌÔÓÈÎfi˜ ™˘ÓÂÚÁ¿ÙË˜∂. §˘ÌÂÚfiÔ˘ÏÔ˜, §¤ÎÙÔÚ·˜ ¶·ıÔÏÔÁ›·˜, π·ÙÚÈÎ‹˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓªˆ˘Û‹˜ ∂ÏÈÛ¿Ê, ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜, π·ÙÚÈÎ‹˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓΔÔÌ¤·˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈÎ‹˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ

¢π∞Δƒ√º∏¶ÚˆÙÂ˝ÓË ™fiÁÈ·˜, πÛÔÊÏ·‚fiÓÂ˜ Î·È ∫·Ú‰È·ÁÁÂÈ·Î‹ ¡fiÛÔ˜ÃÚ‹ÛÙÔ˜ ¢ÂÚ‰ÂÌ¤˙Ë˜, ∫ÏÈÓÈÎfi˜ ¢È·ÈÙÔÏfiÁÔ˜ -¢È·ÙÚÔÊÔÏfiÁÔ˜, ∂ÈÛÙËÌÔÓÈÎfi˜ Û˘ÓÂÚÁ¿ÙË˜ ÙÔ˘ ∂ÍˆÙÂÚÈÎÔ‡ π·ÙÚÂ›Ô˘ ¢È·Ù·Ú·¯ÒÓ ÙÔ˘ ªÂÙ·‚ÔÏÈÛÌÔ‡ÙˆÓ §ÈÈ‰›ˆÓ Î·È ¶·¯˘Û·ÚÎ›·˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ ¡ÔÛÔÎÔÌÂ›Ô˘ πˆ·ÓÓ›ÓˆÓªˆ˘Û‹˜ ∂ÏÈÛ¿Ê, ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈÎ‹˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓΔÔÌ¤·˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈÎ‹˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ

∏ ∂›‰Ú·ÛË ÙË˜ ∫·Ù·Ó¿ÏˆÛË˜ ∂Ï·ÈÔÏ¿‰Ô˘ ÛÙËÓ ¶Èı·ÓfiÙËÙ· √Í¤Ô˜ ™ÙÂÊ·ÓÈ·›Ô˘ ™˘Ó‰ÚfiÌÔ˘. ªÂÏ¤ÙË ∞ÛıÂÓÒÓ-ª·ÚÙ‡ÚˆÓ CARDIO2000.¢. °ÚËÁÔÚÔÔ‡ÏÔ˘1, ¢. ¶·Ó·ÁÈˆÙ¿ÎÔ˜1, ª. ∫ÔÓÙÔÁÈ¿ÓÓË1, Ã. ÃÚ˘ÛÔ¯fiÔ˘2, Ã. ¶›ÙÛ·‚Ô˜2, Ã. ™ÙÂÊ·Ó¿‰Ë˜2.1 ΔÌ‹Ì· ∂ÈÛÙ‹ÌË˜ ¢È·ÙÚÔÊ‹˜- ¢È·ÈÙÔÏÔÁ›·˜, Ã·ÚÔÎfiÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ2 ∞’ ∫·Ú‰ÈÔÏÔÁÈÎ‹ ∫ÏÈÓÈÎ‹, π·ÙÚÈÎ‹ ™¯ÔÏ‹ ∞ıËÓÒÓ.

∫∞Δ∂À£À¡Δ∏ƒπ∂™ √¢∏°π∂™∫·ÙÂ˘ı˘ÓÙ‹ÚÈÂ˜ √‰ËÁ›Â˜ ÁÈ· ÙËÓ ∞ÛÙ·ı‹ ™ÙËı¿Á¯Ë Î·È ÙÔ ∂ÌÊÚ·ÁÌ·ª˘ÔÎ·Ú‰›Ô˘ ÃˆÚ›˜ ∞Ó¿Û·ÛË ÙÔ˘ ¢È·ÛÙ‹Ì·ÙÔ˜ ST°Ô˘ÓfiÔ˘ÏÔ˜ ¶·ÓÙÂÏ‹˜, ∫·Ú‰ÈÔÏfiÁÔ˜°Ô˘‰¤‚ÂÓÔ˜ °È¿ÓÓË˜, ∫·ıËÁËÙ‹˜ ∫·Ú‰ÈÔÏÔÁ›·˜ π·ÙÚÈÎ‹˜ ™¯ÔÏ‹˜ πˆ·ÓÓ›ÓˆÓ∫·Ú‰ÈÔÏÔÁÈÎ‹ ∫ÏÈÓÈÎ‹ π·ÙÚÈÎ‹ ™¯ÔÏ‹ πˆ·ÓÓ›ÓˆÓ

¶POTEINOMENH BIB§IO°PAºIA

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√È ÓÂfiÙÂÚÂ˜ ÎÏÈÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ıÂ-Ú·Â›·˜ ÙˆÓ ˘ÂÚÏÈÈ‰·ÈÌÈÒÓ ÌÂÛÙ·Ù›ÓÂ˜ ¤¯Ô˘Ó Ô‰ËÁ‹ÛÂÈ ÛÙËÓ·ÓÙ›ÏË„Ë fiÙÈ «fiÛÔ ¯·ÌËÏfiÙÂÚ· ËLDL-¯ÔÏËÛÙÂÚfiÏË, ÙfiÛÔ Î·Ï‡ÙÂ-Ú·». √È ÚfiÛÊ·ÙÂ˜ ∂˘Úˆ·˚Î¤˜Ô‰ËÁ›Â˜ ÚfiÏË„Ë˜ ÙˆÓ Î·Ú‰È·Á-ÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ1 Û˘ÓÈÛÙÔ‡ÓÁÈ· ÙËÓ ‰Â˘ÙÂÚÔÁÂÓ‹ ÚfiÏË„Ë,ÛÂ ¿ÙÔÌ· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, ÙÈÌ‹ÛÙfi¯Ô ÁÈ· ÙËÓ LDL-¯ÔÏËÛÙÂÚfiÏË<80 mg/dl Î·È ÔÈ ·Ó·ıÂˆÚËÌ¤-ÓÂ˜ ÙÔ 2004 ∞ÌÂÚÈÎ¿ÓÈÎÂ˜ Ô‰Ë-Á›Â˜ (NCEP-ATP III)2 ÂÈı˘ÌËÙ‹ÙÈÌ‹ ÁÈ· Ù· ›‰È· ¿ÙÔÌ· <70mg/dl. ∏ ÂÈÛ·ÁˆÁ‹ ÛÙË ıÂÚ·Â˘-ÙÈÎ‹ ÈÛ¯˘ÚÒÓ ˘ÔÏÈÈ‰·ÈÌÈÎÒÓÊ·ÚÌ¿ÎˆÓ ¤¯ÂÈ Î·Ù·ÛÙ‹ÛÂÈ ÂÊÈ-ÎÙÔ‡˜ ÙÔ˘˜ ·ÓˆÙ¤Úˆ ÛÙfi¯Ô˘˜Î·È ÔÏÏ¿ ¿ÙÔÌ· Êı¿ÓÔ˘Ó ÛÂÂÍ·ÈÚÂÙÈÎ¿ ¯·ÌËÏ¤˜ ÙÈÌ¤˜ ÔÏÈÎ‹˜Î·È LDL-¯ÔÏËÛÙÂÚfiÏË˜. ™ÙË ÌÂ-Ï¤ÙË PROVE IT- TIMI 22 ÙÔ41,9% ÙˆÓ ·ÛıÂÓÒÓ ÛÙÔ ÛÎ¤ÏÔ˜ÙË˜ ·ÙÔÚ‚·ÛÙ·Ù›ÓË˜ ¤Êı·ÛÂ ÛÂÙÈÌ¤˜ LDL-¯ÔÏËÛÙÂÚfiÏË˜ ≤60mg/dl Î·È ÙÔ 10,5% ÛÂ ÙÈÌ¤˜ ≤40mg/dl3.

∂ÂÈ‰‹ Ë ¯ÔÏËÛÙÂÚfiÏË Â›Ó·È Ô˘-Û›· ··Ú·›ÙËÙË ÁÈ· ÙË ‰ÔÌ‹ Î·ÈÙË ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ˙ˆÈÎÒÓ Î˘ÙÙ¿-ÚˆÓ, ÛÙ· ÔÔ›· ÂÈÙÂÏÂ› ÛÔ˘-‰·›Â˜ ‚ÈÔÏÔÁÈÎ¤˜ ÏÂÈÙÔ˘ÚÁ›Â˜,ÁÂÓÓ¿Ù·È Ô Êfi‚Ô˜, Ì‹ˆ˜ Ë ÌÂ-Á¿ÏË ÌÂ›ˆÛË ÙË˜ ¯ÔÏËÛÙÂÚfiÏË˜ÌÔÚÂ› Ó· ÚÔÎ·Ï¤ÛÂÈ ‚Ï¿‚Ë

¶ÔÏÏ¤˜ ÂÈ‰ËÌÈÔÏÔÁÈÎ¤˜ ÌÂÏ¤ÙÂ˜¤‰ÂÈÍ·Ó fiÙÈ, ÂÓÒ Ë Û˘Û¯¤ÙÈÛË ¯Ô-ÏËÛÙÂÚfiÏË˜ Î·È ÎÈÓ‰‡ÓÔ˘ Î·Ú-‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ Â›Ó·ÈÁÚ·ÌÌÈÎ‹, ¯ˆÚ›˜ Â˘‰È¿ÎÚÈÙÔ Ô˘-‰fi, Î¿Ùˆ ÙÔ˘ ÔÔ›Ô˘ Ó· ÌË ·-Ú·ÙËÚÂ›Ù·È ÌÂ›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘,Ë Û˘Û¯¤ÙÈÛË ÙË˜ ¯ÔÏËÛÙÂÚfiÏË˜ÌÂ ÙËÓ ÔÏÈÎ‹ ıÓËÛÈÌfiÙËÙ· ¤¯ÂÈÛ¯‹Ì· J ‹ U, ‰ËÏ·‰‹ Ù· ¿ÙÔÌ·Ô˘ Â˘Ú›ÛÎÔÓÙ·È ÛÙ· Î·ÙÒÙÂÚ·ÂÎ·ÙÔÛÙËÌfiÚÈ· ÙË˜ Û˘ÁÎ¤ÓÙÚˆ-ÛË˜ ¯ÔÏËÛÙÂÚfiÏË˜ ¤¯Ô˘Ó ·˘ÍË-Ì¤ÓÔ Î›Ó‰˘ÓÔ ·fi ÌË Î·Ú‰È·ÁÁÂÈ-·Î¿ ÓÔÛ‹Ì·Ù·4,5,6,7,8,9. ŒÓ· Ì¤ÚÔ˜ÙˆÓ ÌË Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ı·Ó¿ÙˆÓÔÊÂ›ÏÔÓÙ·È ÛÂ ‰È·ÊfiÚÔ˘˜ Ù‡-

Ô˘˜ Î·ÚÎ›ÓÔ˘, Î˘Ú›ˆ˜ ÙÔ˘ÓÂ‡ÌÔÓÔ˜, ÙÔ˘ ·ÈÌÔÔÈËÙÈÎÔ‡Û˘ÛÙ‹Ì·ÙÔ˜ Î·È ÙÔ˘ ·¯¤Ô˜ÂÓÙ¤ÚÔ˘. ∏ ÌÂÏ¤ÙË ÙˆÓ 7 ¯ˆÚÒÓ¤‰ÂÈÍÂ ÛËÌ·ÓÙÈÎ¿ ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó-‰˘ÓÔ Î·ÚÎ›ÓÔ˘ ÙÔ˘ ÓÂ‡ÌÔÓÔ˜ÛÙÔ Î·ÙÒÙÂÚÔ 20% ÙË˜ Î·Ù·ÓÔ-Ì‹˜ ÙË˜ ÔÏÈÎ‹˜ ¯ÔÏËÛÙÂÚfiÏË˜Î·È ‰È¤ÎÚÈÓÂ ˆ˜ Î·ÙÒÊÏÈ Î¿ÙˆÙÔ˘ ÔÔ›Ô˘ Ô Î›Ó‰˘ÓÔ˜ Â›Ó·È ·˘ÍË-Ì¤ÓÔ˜ ÙËÓ ÙÈÌ‹ ÙˆÓ 170 mg/dl10.

ÕÏÏÂ˜ ÂÈ‰ËÌÈÔÏÔÁÈÎ¤˜ ÌÂÏ¤ÙÂ˜fiÌˆ˜ ‰ÂÓ ¤‰ÂÈÍ·Ó ·˘ÍËÌ¤ÓË Î·Ú-ÎÈÓÔÁ¤ÓÂÛË ‹ ÂÍˆÎ·Ú‰È·ÎÔ‡˜ı·Ó¿ÙÔ˘˜ ÛÂ ¯·ÌËÏ¤˜ ÙÈÌ¤˜ ¯Ô-ÏËÛÙÂÚfiÏË˜11,12. ∂Í ¿ÏÏÔ˘ ·Ú·-ÙËÚ‹ÛÂÈ˜ ÛÂ ÏËı˘ÛÌÔ‡˜, ÙˆÓÔÔ›ˆÓ Ë ‰›·ÈÙ· Â›Ó·È È‰È·›ÙÂÚ·Ùˆ¯‹ ÛÂ ÏÈ·Ú¿ Î·È ¤¯Ô˘Ó Ì¤ÛËÙÈÌ‹ ÔÏÈÎ‹˜ ¯ÔÏËÛÙÂÚfiÏË˜ Á‡ÚˆÛÙ· 160 mg/dl ‰ÂÓ ¤¯Ô˘Ó ·˘ÍË-Ì¤ÓË ıÓËÛÈÌfiÙËÙ· ·fi Î·ÚÎ›-ÓÔ˘˜13. ™Â Û˘ÁÁÂÓ‹ ÓÔÛ‹Ì·Ù·,fiˆ˜ Ë ˘Ô‚ËÙ·ÏÈÔÚÂˆÙÂ˚Ó·È-Ì›·, ÛÙ· ÔÔ›· Ë ÔÏÈÎ‹ Î·È Ë LDL-¯ÔÏËÛÙÂÚfiÏË ¤¯Ô˘Ó È‰È·›ÙÂÚ·¯·ÌËÏ¤˜ ÙÈÌ¤˜, ‰ÂÓ ·Ú·ÙËÚÔ‡-ÓÙ·È ·˘ÍËÌ¤ÓÔÈ ı¿Ó·ÙÔÈ ·fi Î·Ú-Î›ÓÔ˘˜, ·Ó Î·È ·Ú·ÙËÚÔ‡ÓÙ·ÈÓÂ˘ÚÔÏÔÁÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ Î·È·ı‹ÛÂÈ˜ ·fi ‰˘Û·ÔÚÚfiÊËÛËÙÔ˘ Ï›Ô˘˜14. °È ·˘Ùfi Â› ÔÏÏ¿¯ÚfiÓÈ· ˘‹ÚÍÂ ¤ÓÙÔÓË ‰È¯ÔÁÓˆ-Ì›· Î·È ÔÏÏÔ› ÂÚÂ˘ÓËÙ¤˜ ˘Ô-ÛÙËÚ›˙Ô˘Ó fiÙÈ ‰ÂÓ Â›Ó·È Ë ¯·ÌËÏ‹¯ÔÏËÛÙÂÚfiÏË Ô˘ Â˘ı‡ÓÂÙ·È ÁÈ·ÙÔ˘˜ ·˘ÍËÌ¤ÓÔ˘˜ Î·ÚÎ›ÓÔ˘˜ Ô˘·Ú·ÙËÚÔ‡ÓÙ·È ÛÙÈ˜ ÂÈ‰ËÌÈÔÏÔ-ÁÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ·ÏÏ¿ fiÙÈ Ë ‡·ÚÍËÚÔÎÏÈÓÈÎÔ‡ Î·ÚÎ›ÓÔ˘ ÚÔÎ·ÏÂ›Ù· ÌÂÈˆÌ¤Ó· Â›Â‰· ¯ÔÏËÛÙÂ-ÚfiÏË˜. ™Â ·˘Ùfi Û˘ÓËÁÔÚÂ› Ë ·-Ú·Ù‹ÚËÛË fiÙÈ Ù· ÂÚÈÛÛfiÙÂÚ·ÂÚÈÛÙ·ÙÈÎ¿ Î·ÚÎ›ÓÔ˘ ÂÌÊ·Ó›˙Ô-ÓÙ·È Ù· ÚÒÙ· ¯ÚfiÓÈ· ·fi ÙËÓ¤Ó·ÚÍË Î¿ıÂ ÌÂÏ¤ÙË˜. ∏ MRFIT¤‰ÂÈÍÂ ÛËÌ·ÓÙÈÎ¿ ·˘ÍËÌ¤ÓÔ˘˜ı·Ó¿ÙÔ˘˜ ·fi Î·ÚÎ›ÓÔ ÙÔ˘ ÓÂ‡-ÌÔÓÔ˜ ÛÙ· ¿ÙÔÌ· ÌÂ ¯·ÌËÏ‹ ¯Ô-ÏËÛÙÂÚfiÏË Î·Ù¿ Ù· ÚÒÙ· 5 ¤ÙË·Ú·ÎÔÏÔ‡ıËÛË˜ ÙˆÓ 361.662·ÛıÂÓÒÓ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó ÛÂÚÒÙË ÂÍ¤Ù·ÛË Î·È Ë ‰È·ÊÔÚ¿

ÌÂÈÒıËÎÂ ÌÂ ÙËÓ ¿ÚÔ‰Ô ÙˆÓÂÙÒÓ7.

°È· ‰ÈÂ˘ÎÚ›ÓËÛË ÙË˜ Û‡Á¯˘ÛË˜ÙÔ NHLBI ÔÚÁ¿ÓˆÛÂ ÙÔ 1990 ÌÈ·Û˘Ó‰È¿ÛÎÂ„Ë (conference) ÛÙËÓÔÔ›· ÎÏ‹ıËÎ·Ó ÂÎÚfiÛˆÔÈ ·fiÙÈ˜ ÂÚÂ˘ÓËÙÈÎ¤˜ ÔÌ¿‰Â˜ 20 ÏË-ı˘ÛÌÈ·ÎÒÓ ÂÈ‰ËÌÈÔÏÔÁÈÎÒÓ ÌÂ-ÏÂÙÒÓ Î·È ·ÚÔ˘Û›·Û·Ó Ù· Â˘Ú‹-Ì·Ù· ÙÔ˘˜. ∞ÎÔÏÔ‡ıËÛÂ ·Ó¿Ï˘-ÛË ÙˆÓ ÌÂÏÂÙÒÓ ˘fi ÙË ‰ÈÂ‡ı˘Ó-ÛË ÙÔ˘ D. Jacobs, ÙÔ˘ ¶·ÓÂÈ-ÛÙËÌ›Ô˘ ÙË˜ ªÈÓÂÛÛfiÙ·15. √ ¯Úfi-ÓÔ˜ ·Ú·ÎÔÏÔ‡ıËÛË˜ ÙˆÓ ÏË-ı˘ÛÌÒÓ Î˘Ì·ÈÓfiÙ·Ó ·fi 9 ¤ˆ˜30 ¯ÚfiÓÈ·. °È· Ó· ·ÔÎÏÂÈÛıÂ› ÙÔÂÓ‰Â¯fiÌÂÓÔ ·Ó¿ÛÙÚÔÊË˜ Û˘Û¯¤-ÙÈÛË˜, Ó· ÔÊÂ›ÏÂÙ·È ‰ËÏ·‰‹ Ë ¯·-ÌËÏ‹ ¯ÔÏËÛÙÂÚfiÏË ÛÂ ‡·ÚÍËÚÔÎÏÈÓÈÎÔ‡ Î·ÚÎ›ÓÔ˘ Î·È fi¯È ÔÎ·ÚÎ›ÓÔ˜ ÛÙË ¯·ÌËÏ‹ ¯ÔÏËÛÙÂ-ÚfiÏË, ÂÍ·ÈÚ¤ıËÎ·Ó ·fi ÙËÓ ·Ó¿-Ï˘ÛË ÔÈ ı¿Ó·ÙÔÈ Ô˘ Û˘Ó¤‚ËÛ·ÓÙ· ÚÒÙ· 5 ¯ÚfiÓÈ· Î¿ıÂ ÌÂÏ¤-ÙË˜. ∏ ·Ó¿Ï˘ÛË ¤‰ÂÈÍÂ fiÙÈ ÔÏÈÎ‹¯ÔÏËÛÙÂÚfiÏË < 160 mg/dl Û¯ÂÙ›-˙ÂÙ·È ÌÂ ·‡ÍËÛË Î·Ù¿ 14-22%ÙË˜ ÔÏÈÎ‹˜ ıÓËÛÈÌfiÙËÙ·˜ Î·È Î·-Ù¿ 18-23% ÙˆÓ ı·Ó¿ÙˆÓ ·fiÎ·ÚÎ›ÓÔ˘˜, Û˘ÁÎÚÈÙÈÎ¿ ÌÂ ÙÔ˘˜ı·Ó¿ÙÔ˘˜ ÛÙ· Â›Â‰· ¯ÔÏËÛÙÂ-ÚfiÏË˜ 160-199 mg/dl. √È ÌÔÚÊ¤˜ÙÔ˘ Î·ÚÎ›ÓÔ˘ ‹Ù·Ó ÙÔ˘ ÓÂ‡ÌÔ-Ó·, ÙÔ˘ ‹·ÙÔ˜ Î·È ÙÔ˘ ·ÈÌÔÔÈË-ÙÈÎÔ‡ Î·È ÏÂÌÊÈÎÔ‡ ÈÛÙÔ‡, ÂÓÒ‰ÂÓ ·Ú·ÙËÚ‹ıËÎÂ ‰È·ÊÔÚ¿ÛÙÔ˘˜ Î·ÚÎ›ÓÔ˘˜ Ì·ÛÙÔ‡ ‹ ·-¯¤Ô˜ ÂÓÙ¤ÚÔ˘. ¶·Ú¿ Ù· Â˘Ú‹Ì·-Ù· ·˘Ù¿ ÂÍ·ÎÔÏÔ˘ıÔ‡ÛÂ Ó· ·-Ú·Ì¤ÓÂÈ ÙÔ ÂÚÒÙËÌ· ·Ó Û˘Á¯˘ÙÈ-ÎÔ› ·Ú¿ÁÔÓÙÂ˜ fiˆ˜ Ô ÙÚfiÔ˜˙ˆ‹˜ (Î¿ÓÈÛÌ·, ¯Ú‹ÛË ·ÏÎÔfiÏ),ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎ‹ Î·Ù¿ÛÙ·ÛË,ËÏÈÎ›·, ÌÔÚÂ› Ó· Â˘ı‡ÓÔÓÙ·ÈÙ·˘Ùfi¯ÚÔÓ· ÁÈ· Ù· ¯·ÌËÏ¿ Â›-Â‰· ¯ÔÏËÛÙÂÚfiÏË˜ Î·È ÙËÓ ·˘-ÍËÌ¤ÓË ıÓËÛÈÌfiÙËÙ·16,17.

√È ·Ï·ÈfiÙÂÚÂ˜, ÚÔ ÙË˜ ÂÔ¯‹˜ÙˆÓ ÛÙ·ÙÈÓÒÓ, ·ÚÂÌ‚·ÙÈÎ¤˜ ÌÂ-Ï¤ÙÂ˜ ÂÏ¿ÙÙˆÛË˜ ÙˆÓ ÏÈÈ-‰›ˆÓ18,19,20,21, ·Ú¿ ÙË ÌÂ›ˆÛË ÙˆÓÎ·Ú‰È·ÁÁÂÈ·ÎÒÓ ı·Ó¿ÙˆÓ, ‰ÂÓ¤‰ÂÈÍ·Ó ÌÂ›ˆÛË ÙË˜ ÔÏÈÎ‹˜ ıÓË-

π √ À ¡ π √ ™ 2 0 0 8

2

Δ· Ã·ÌËÏ¿ ∂›Â‰· ÙË˜ √ÏÈÎ‹˜ Î·È LDL ÃÔÏËÛÙÂÚfiÏË˜ ∂ÁÎ˘ÌÔÓÔ‡Ó ∫ÈÓ‰‡ÓÔ˘˜

∫·ÚÎÈÓÔÁ¤ÓÂÛË˜;

∏Ï›·˜ ÃÂÈÌÒÓ·˜, ∫·Ú‰ÈÔÏfiÁÔ˜

∞¡∞™∫√¶∏™∂π™

3

ÛÈÌfiÙËÙ·˜, ÏfiÁˆ ·‡ÍËÛË˜ ÙˆÓÂÍˆÎ·Ú‰È·ÁÁÂÈ·ÎÒÓ ı·Ó¿ÙˆÓ. √ÈÌÂÁ¿ÏÂ˜ fiÌˆ˜ Ù˘¯·ÈÔÔÈËÌ¤ÓÂ˜ÎÏÈÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ÌÂ ÛÙ·Ù›ÓÂ˜,fiÏÂ˜ ÏËÓ ÙË˜ PROSPER22 ¤‰ÂÈ-Í·Ó ÌÂ›ˆÛË Î·È ÙË˜ ÔÏÈÎ‹˜ ıÓËÛÈ-ÌfiÙËÙ·˜ Î·È ‰ÂÓ ‰È·›ÛÙˆÛ·Ó‰È·ÊÔÚ¿ ÛÙ· ÂÚÈÛÙ·ÙÈÎ¿ Ó¤ˆÓÎ·ÚÎ›ÓˆÓ ÌÂÙ·Í‡ ÙˆÓ ÔÌ¿‰ˆÓıÂÚ·Â›·˜ Î·È ÂÏ¤Á¯Ô˘23. ∞ÎfiÌËÎ·È ÌÂÙ¿ Ì·ÎÚfi¯ÚÔÓË ·Ú·ÎÔ-ÏÔ‡ıËÛË ÛÙË ÌÂÏ¤ÙË WOSCOPS‰ÂÓ ·Ú·ÙËÚ‹ıËÎÂ ·˘ÍËÌ¤ÓËÛ˘¯ÓfiÙËÙ· Î·ÚÎ›ÓÔ˘ ÛÙËÓ ÔÌ¿‰·ıÂÚ·Â›·˜ Û˘ÁÎÚÈÙÈÎ¿ ÌÂ ÙËÓÔÌ¿‰· ÂÏ¤Á¯Ô˘24. ¢ÂÓ ·Ó·˙ËÙ‹-ıËÎÂ fiÌˆ˜ ÛÙÈ˜ ÌÂÏ¤ÙÂ˜ ·˘Ù¤˜·Ó ˘‹Ú¯Â ‰È·ÊÔÚ¿ ÛÙË Û˘¯Ófi-ÙËÙ· Î·ÚÎ›ÓÔ˘ ÛÙ· ¿ÙÔÌ· ÌÂ ÙË¯·ÌËÏfiÙÂÚË ¯ÔÏËÛÙÂÚfiÏË Û˘-ÁÎÚÈÙÈÎ¿ ÌÂ Ù· ¿ÙÔÌ· ÌÂ ÙÈ˜ ˘„Ë-ÏfiÙÂÚÂ˜ ÙÈÌ¤˜. ™ÙËÓ ˘ÔÌÂÏ¤ÙËÙË˜ PROVE IT- TIMI 223, ÛÙËÓÔÔ›· ÂÏ¤Á¯ıËÎÂ Ë ·ÛÊ¿ÏÂÈ· ÙË˜ÛÙ·Ù›ÓË˜, ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó·ÓÂÈı‡ÌËÙ· Û˘Ì‚¿Ì·Ù·, ·Ú¿ÙË ÌÂ›ˆÛË ÙË˜ LDL-¯ÔÏËÛÙÂÚfi-ÏË˜ ÛÂ ÔÏ‡ ¯·ÌËÏ¿ Â›Â‰·,‰ÂÓ ·Ó·Ê¤ÚÔÓÙ·È fiÌˆ˜ Ù· Â-ÚÈÛÙ·ÙÈÎ¿ Ó¤Ô˘ Î·ÚÎ›ÓÔ˘. ™ÂÌÈ· ÌÂÏ¤ÙË ·Ú·ÎÔÏÔ˘ı‹ıË-Î·Ó ÁÈ· ÂÚ›Ô‰Ô 2 ± 1,4 ÂÙÒÓ·ÛıÂÓÂ›˜ Ô˘ Â›¯·Ó LDL-¯ÔÏË-ÛÙÂÚfiÏË < 60 mg/dl Î·È ·Ú¿ÙË ¯·ÌËÏ‹ ·˘Ù‹ ÙÈÌ‹ ¤Ï·‚·ÓÛÙ·Ù›ÓË. ¢ÂÓ ·Ú·ÙËÚ‹ıËÎÂ ·‡-

ÍËÛË ÙˆÓ Î·ÎÔËıÂÈÒÓ ÛÙËÓ ÔÌ¿-‰· Ô˘ ¤Ï·‚Â ÛÙ·Ù›ÓË, ·ÓÙ›ıÂÙ··Ú·ÙËÚ‹ıËÎÂ Î·Ï‡ÙÂÚË ÂÈ‚›ˆ-ÛË ·fi ÙËÓ ÔÌ¿‰· Ô˘ ¤ÌÂÈÓÂ¯ˆÚ›˜ ıÂÚ·Â›·25. √È ÛÙ·Ù›ÓÂ˜ Â›-Ó·È Ô˘‰¤ÙÂÚÂ˜ ÛÙËÓ Â›ÙˆÛËÙÔ˘ Î·ÚÎ›ÓÔ˘26,27 ‹ Èı·ÓÒ˜¤¯Ô˘Ó ·ÓÙÈÓÂÔÏ·ÛÌ·ÙÈÎ‹ ‰Ú¿-ÛË. ™Â ÌÈ· ÚfiÛÊ·ÙË ÌÂÏ¤ÙË Û˘-ÁÎÚ›ıËÎÂ ÌÈ· ÔÌ¿‰· 37.248·ÛıÂÓÒÓ Ô˘ Ï¿Ì‚·Ó·Ó ÛÙ·Ù›ÓËÌÂ ÌÈ· ¿ÏÏË ÔÌ¿‰· 25.594 Ô˘Ï¿Ì‚·Ó·Ó ·ÓÙÈ˘ÂÚÙ·ÛÈÎ¿ Ê¿Ú-Ì·Î·28. ΔÔ ÔÛÔÛÙfi ÙˆÓ ·ÙfiÌˆÓÔ˘ ÂÌÊ¿ÓÈÛÂ Î·ÚÎ›ÓÔ ÛÙËÓ ÔÌ¿-‰· ÙˆÓ ÛÙ·ÙÈÓÒÓ ‹Ù·Ó 9,4% ÂÓÒÛÙËÓ ¿ÏÏË ÔÌ¿‰· 13,2%, ‰È·ÊÔÚ¿ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ (p<0,001).

¶ÚfiÛÊ·Ù· fiÌˆ˜ ‰ËÌÔÛÈÂ‡ıËÎÂÌÈ· ÌÂÏ¤ÙË Ô˘ Â·Ó¤ÊÂÚÂ ÛÙÔÚÔÛÎ‹ÓÈÔ ÙÔ˘˜ ·Ï·ÈÔ‡˜ Êfi-‚Ô˘˜ ÁÈ· ÙË Û¯¤ÛË ÙˆÓ ¯·ÌËÏÒÓÙÈÌÒÓ ¯ÔÏËÛÙÂÚfiÏË˜ ÌÂ ÙÔÓ Î·Ú-Î›ÓÔ29. ∏ ÌÂÏ¤ÙË ·˘Ù‹ ÂÚÂ‡ÓËÛÂ·Ó Ë ÂÓÙ·ÙÈÎ‹ ÌÂ›ˆÛË ÙË˜ ÔÏÈÎ‹˜Î·È LDL-¯ÔÏËÛÙÂÚfiÏË˜ ·˘Í¿ÓÂÈÙÔÓ Î›Ó‰˘ÓÔ Ë·ÙÔÙÔÍÈÎfiÙËÙ·˜,Ì˘ÔÙÔÍÈÎfiÙËÙ·˜ Î·È Î·ÚÎÈÓÔÁ¤ÓÂ-ÛË˜. ∞Ó·Ï‡ıËÎ·Ó ÔÈ ÚÔÔÙÈÎ¤˜Ù˘¯·ÈÔÔÈËÌ¤ÓÂ˜ ÌÂÏ¤ÙÂ˜ Ô˘ Â›-¯·Ó ‰ËÌÔÛÈÂ˘ıÂ› Ì¤¯ÚÈ ÙÔÓ ¡Ô¤Ì-‚ÚÈÔ 2005. ¢ÂÓ ‰È·ÈÛÙÒıËÎÂ ÛÙ·-ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ Û¯¤ÛË ÌÂÙ·Í‡ÙÔ˘ ÔÛÔÛÙÔ‡ ‹ ÙË˜ ·fiÏ˘ÙË˜ ÙÈ-Ì‹˜ ÌÂ›ˆÛË˜ ÙË˜ LDL-¯ÔÏËÛÙÂÚfi-

ÏË˜ Î·È ÂÌÊ¿ÓÈÛË˜ Ó¤ˆÓ Â-ÚÈÛÙ·ÙÈÎÒÓ Î·ÚÎ›ÓÔ˘, ‚Ú¤ıËÎÂfiÌˆ˜ ÛËÌ·ÓÙÈÎ‹ Û¯¤ÛË (p=0,009)ÌÂÙ·Í‡ ÙË˜ ÙÈÌ‹˜ ÙË˜ LDL-¯ÔÏË-ÛÙÂÚfiÏË˜ Ô˘ ÂÈÙÂ‡¯ıËÎÂ Î·ÈÂÌÊ¿ÓÈÛË˜ Ó¤ˆÓ ÂÚÈÛÙ·ÙÈÎÒÓÎ·ÚÎ›ÓÔ˘. ∂Ó‰È·Ê¤ÚÔÓ ¤¯ÂÈ Ë ·-Ú·Ù‹ÚËÛË fiÙÈ ÛÙÈ˜ ÌÂÁ·Ï‡ÙÂÚÂ˜‰fiÛÂÈ˜ ÛÙ·Ù›ÓË˜ ÁÈ· ÙËÓ Â›ÙÂ˘ÍËÙË˜ ›‰È·˜ ÌÂ›ˆÛË˜ ÙË˜ LDL-¯ÔÏ.Ù· ÂÚÈÛÙ·ÙÈÎ¿ Î·ÚÎ›ÓÔ˘ ‹Ù·Ó ÏÈ-ÁfiÙÂÚ·. ∏ ‰È·ÊÔÚ¿ ÛÙÔ˘˜ ‰Â›-ÎÙÂ˜ Â›ÙˆÛË˜ ·Ó Î·È ‰ÂÓ ‹Ù·ÓÌÂÁ¿ÏË (498/100.000 ÛÙË ÌÈÎÚ‹‰fiÛË ¤Ó·ÓÙÈ 408/100.000 ÛÙË ÌÂ-Á¿ÏË ‰fiÛË) ‹Ù·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛË-Ì·ÓÙÈÎ‹. √È ÂÚÂ˘ÓËÙ¤˜ ·Ú·‰¤-¯ÔÓÙ·È fiÙÈ Ë ÌÂÏ¤ÙË ¤¯ÂÈ ÔÚÈÛÌ¤-ÓÔ˘˜ ÂÚÈÔÚÈÛÌÔ‡˜ (Â›¯·Ó ÛÙË‰È¿ıÂÛË ÙÔ˘˜ ÌfiÓÔ Ù· ÂÚÈÏËÙÈ-Î¿ ‰Â‰ÔÌ¤Ó· Ô˘ ‰ËÌÔÛÈÂ‡ıË-Î·Ó Î·È fi¯È Ù· ÏÂÙÔÌÂÚ‹ ÛÙÔÈ-¯Â›· Î¿ıÂ ÌÂÏ¤ÙË˜, ‰ÂÓ ˘¿Ú¯ÂÈÛÙ¿ıÌÈÛË ÙˆÓ ÌÂÏÂÙÒÓ ÎÏ) Î·ÈÂÎÊÚ¿˙Ô˘Ó ÙË ÁÓÒÌË fiÙÈ ‰ÂÓÚ¤ÂÈ Ó· Á›ÓÂÈ Ë ÌÂÏ¤ÙË ·ÈÙ›· Ó·ÌÂÙ·‚ÏËıÂ› Ë ÙÚ¤¯Ô˘Û· Ú·ÎÙÈ-Î‹ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ‰˘ÛÏÈ-È‰·ÈÌÈÒÓ ·ÏÏ¿ Ó· ·ÔÙÂÏ¤ÛÂÈÙËÓ ·ÊÔÚÌ‹ ÁÈ· ÂÚ·ÈÙ¤Úˆ ·Ó¿-Ï˘ÛË ÙˆÓ ÌÂÏÂÙÒÓ ÒÛÙÂ Ó· ÂÍ·-¯ıÔ‡Ó ·ÛÊ·Ï¤ÛÙÂÚ· Û˘ÌÂÚ¿-ÛÌ·Ù·. ¶·ÚfiÌÔÈ· ¿Ô„Ë ÂÎÊÚ¿-˙ÂÙ·È Î·È ÛÂ ‰‡Ô ¿ÚıÚ· Û‡ÓÙ·-ÍË˜ Ô˘ Û˘ÓÔ‰Â‡Ô˘Ó ÙË ‰ËÌÔÛ›-Â˘ÛË ÛÙÔ ›‰ÈÔ ÙÂ‡¯Ô˜ ÙÔ˘ ÂÚÈÔ-

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π √ À ¡ π √ ™ 2 0 0 8

4

13. Chen Z, Peto R, Collins R, MacMahonS, Lu J, Li W. Serum cholesterol con-centration and coronary heart diseasein population with low cholesterolconcentrations. BMJ 1991;303:276-82

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5

∫§π¡π∫∂™ ª∂§∂Δ∂™

ªÂÏ¤ÙË ASCOT-LLA. ∞ÒÙÂÚ· AÔÙÂÏ¤ÛÌ·Ù·,

2 XÚfiÓÈ· MÂÙ¿ ÙÔ KÏÂ›ÛÈÌÔ ÙË˜ MÂÏ¤ÙË˜.

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

Sever PS, Poulter NR, Dahlof B, Wedel H, Beevers G, Caulfield M, Collins R, Kjeldsen S,Kristinsson A, Mcinnes G, Mehlsen J, Nieminen MS, O'Brien ET, and Östergren J on behalf of

the ASCOT Investigators

Eur Heart J 2008;29:499-508

H ÌÂÏ¤ÙË ASCOT Â›Ó·È ÌÈ· ÌÂÁ¿-ÏË ÎÏÈÓÈÎ‹, Ù˘¯·ÈÔÔÈËÌ¤ÓË, 2Ã2·Ú·ÁÔÓÙÈÎ‹, Ù˘ÊÏ‹ ÌÂÏ¤ÙË ÛÙËÓÔÔ›· ÂÓÙ¿¯ıËÎ·Ó 19.342 ˘ÂÚ-Ù·ÛÈÎÔ› ·ÛıÂÓÂ›˜ Î·È ÙˆÓ ‰‡ÔÊ‡ÏˆÓ, ËÏÈÎ›·˜ 40-79 ÂÙÒÓ. Δ·ÎÚÈÙ‹ÚÈ· ÂÈÏÔÁ‹˜ ‹Ù·Ó ™∞¶≥160 mmHg ‹/Î·È ¢∞¶ ≥ 100mmHg ¯ˆÚ›˜ ·ÁˆÁ‹ ‹ ™∞¶ ≥140 mmHg ‹/Î·È ¢∞¶ ≥ 90mmHg ˘fi ·ÓÙÈ˘ÂÚÙ·ÛÈÎ‹ ·Áˆ-Á‹, Û˘Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ 3 ·fi ÙÔ˘˜Î·ÙˆÙ¤Úˆ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡-ÓÔ˘: ¿ÚÚÂÓ Ê‡ÏÔ, ËÏÈÎ›· ≥ 55ÂÙÒÓ, Î¿ÓÈÛÌ·, ˘ÂÚÙÚÔÊ›··ÚÈÛÙÂÚ¿˜ ÎÔÈÏ›·˜, ∏∫°Ú·ÊÈÎ¤˜

·ÓˆÌ·Ï›Â˜, Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙËÙ‡Ô˘ 2, ÂÚÈÊÂÚÈÎ‹ ·ÚÙËÚÈ·Î‹ÓfiÛÔ, ÈÛÙÔÚÈÎfi ·ÁÁÂÈ·ÎÔ‡ ÂÁÎÂ-Ê·ÏÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ (Â›ÌÔÓÔ˘ ‹·ÚÔ‰ÈÎÔ‡), ÌÈÎÚÔÏÂ˘ÎˆÌ·ÙÈÓÔ˘-Ú›· ‹ ÏÂ˘ÎˆÌ·ÙÔ˘Ú›·, ·ıËÚˆÌ·-ÙÈÎfi ‰Â›ÎÙË ≥ 6, ‹ ÔÈÎÔÁÂÓÂÈ·ÎfiÈÛÙÔÚÈÎfi ÚÒÈÌË˜ ÛÙÂÊ·ÓÈ·›·˜ÓfiÛÔ˘. ∞ÔÎÏÂ›ÛıËÎ·Ó ·ÛıÂÓÂ›˜ÌÂ ·Ï·Èfi ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ô-Î·Ú‰›Ô˘, ÛÙËı¿Á¯Ë ‹ ·ÁÁÂÈ·ÎfiÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔ ÛÙË ‰È¿Ú-ÎÂÈ· ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ 3 ÌËÓÒÓ.

∏ ÌÂÏ¤ÙË Â›¯Â ‰‡Ô ÛÎ¤ÏË; ÙÔÛÎ¤ÏÔ˜ ÙË˜ ·ÓÙÈ˘ÂÚÙ·ÛÈÎ‹˜·ÁˆÁ‹˜ (BPLA), ÛÙÔ ÔÔ›Ô ‰ÔÎÈ-

Ì¿ÛıËÎ·Ó ‰‡Ô ·ÓÙÈ˘ÂÚÙ·ÛÈÎ¿ıÂÚ·Â˘ÙÈÎ¿ Û¯‹Ì·Ù· Î·È ÛÙÔÔÔ›Ô Û˘ÌÌÂÙÂ›¯·Ó fiÏÔÈ ÔÈ ·ÛıÂ-ÓÂ›˜ Î·È ÙÔ ÛÎ¤ÏÔ˜ ÙË˜ ˘ÔÏÈÈ-‰·ÈÌÈÎ‹˜ ·ÁˆÁ‹˜ (LLA), ÛÙÔÔÔ›Ô Û˘ÌÌÂÙÂ›¯·Ó 10.305 ·ÛıÂ-ÓÂ›˜. ™ÙÔ ‰Â‡ÙÂÚÔ ÛÎ¤ÏÔ˜ ÂÓÙ¿-¯ıËÎ·Ó ÔÈ ·ÛıÂÓÂ›˜ ÌÂ ÔÏÈÎ‹ ¯Ô-ÏËÛÙÂÚfiÏË ≤ 155 mg/dl Î·Ù¿ÙËÓ ·Ú¯ÈÎ‹ Â›ÛÎÂ„Ë ÂÈÏÔÁ‹˜Î·È ‰ÂÓ ‹Ù·Ó ˘fi ·ÁˆÁ‹ ÌÂ ÛÙ·-Ù›ÓÂ˜ ‹ ÊÈÌÚ¿ÙÂ˜. √È ·ÛıÂÓÂ›˜·˘ÙÔ› Î·Ù·ÓÂÌ‹ıËÎ·Ó Ù˘¯·›· Ó·Ï¿‚Ô˘Ó Â›ÙÂ 10 mg ·ÙÔÚ‚·ÛÙ·Ù›-ÓË ÙËÓ ËÌ¤Ú· ‹ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·-ÎÔ.

∂ÈÎfiÓ· 1. ΔÈÌ¤˜ ÏÈÈ‰›ˆÓ ·›Ì·ÙÔ˜ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ‰ÈÏ¿ Ù˘ÊÏ‹˜ ÂÚÈfi‰Ô˘ (Ù· ÚÒÙ· 3,3 ¤ÙË) Î·È Î·Ù¿ ÙË ÂÚ›Ô‰ÔÙË˜ ·Ú¿Ù·ÛË˜ ·Ú·Ù‹ÚËÛË˜ (2,2 ¤ÙË). (∞): ÔÏÈÎ‹ ¯ÔÏËÛÙÂÚfiÏË, (μ): LDL-¯ÔÏËÛÙÂÚfiÏË, (C): HDL-¯ÔÏËÛÙÂÚfiÏË Î·È (D):ÙÚÈÁÏ˘ÎÂÚ›‰È·.

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

ΔÚÈÁÏ˘ÎÂÚ›‰È· ÌÂ ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘ ÛÙË ‰È¿ÚÎÂÈ·ÙË˜ Ù˘ÊÏ‹˜ ÂÚÈfi‰Ô˘ Î·È ÙË˜ ·Ú¿Ù·ÛË˜.

HDL-¯ÔÏËÛÙÂÚfiÏË ÌÂ ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘ÛÙË ‰È¿ÚÎÂÈ· ÙË˜ Ù˘ÊÏ‹˜ ÂÚÈfi‰Ô˘

Î·È ÙË˜ ·Ú¿Ù·ÛË˜.

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√ÏÈÎ‹ ¯ÔÏËÛÙÂÚfiÏË ÌÂ ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘ÛÙË ‰È¿ÚÎÂÈ· ÙË˜ Ù˘ÊÏ‹˜ ÂÚÈfi‰Ô˘

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6

∂ÈÎfiÓ· 2. ∫ÏÈÓÈÎ¿ Î·Ù·ÏËÎÙÈÎ¿ ÛËÌÂ›·. (∞): ÚˆÙÂ‡ÔÓ Î·Ù·ÏËÎÙÈÎfi ÛËÌÂ›Ô (ÛÙÂÊ·ÓÈ·›ÔÈ ı¿Ó·ÙÔÈ Î·È ÌË ı·Ó·ÙËÊfiÚ· ÂÌ-ÊÚ¿ÁÌ·Ù·), (μ): ı·Ó·ÙËÊfiÚ· Î·È ÌË ı·Ó·ÙËÊfiÚ· ·ÁÁÂÈ·Î¿ ÂÁÎÂÊ·ÏÈÎ¿, (C): ™‡ÓÔÏÔ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÂÂÈÛÔ‰›ˆÓ Î·ÈÛÙÂÊ·ÓÈ·›ˆÓ ÂÂÌ‚¿ÛÂˆÓ, (D): £ÓËÛÈÌfiÙËÙ· ·fi ÔÔÈ·‰‹ÔÙÂ ·ÈÙ›·.

¶ÚˆÙÂ‡ÔÓ Î·Ù·ÏËÎÙÈÎfi ÛËÌÂ›ÔÙË˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó ÙÔ ¿ıÚÔÈÛÌ·ÙˆÓ ı·Ó¿ÙˆÓ ·fi ÛÙÂÊ·ÓÈ·›· Ófi-ÛÔ Î·È ÙˆÓ ÌË ı·Ó·ÙËÊfiÚˆÓ ÂÌ-ÊÚ·ÁÌ¿ÙˆÓ ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘.¢Â˘ÙÂÚÂ‡ÔÓÙ· Î·Ù·ÏËÎÙÈÎ¿ ÛË-ÌÂ›· ‹Ù·Ó ÔÏÏ¿: ÙÔ Û‡ÓÔÏÔ ÙˆÓÛÙÂÊ·ÓÈ·›ˆÓ Û˘Ì‚·Ì¿ÙˆÓ Î·ÈÛÙÂÊ·ÓÈ·›ˆÓ ÂÂÌ‚¿ÛÂˆÓ, Ù· ı·-Ó·ÙËÊfiÚ· Î·È ÌË ı·Ó·ÙËÊfiÚ··ÁÁÂÈ·Î¿ ÂÁÎÂÊ·ÏÈÎ¿, Ë Î·Ú-‰È·ÁÁÂÈ·Î‹ ıÓËÛÈÌfiÙËÙ·, Ë ÔÏÈÎ‹ıÓËÛÈÌfiÙËÙ·, Ë Î·Ú‰È·Î‹ ·ÓÂ-¿ÚÎÂÈ·. ∂›ÛË˜ ˘‹ÚÍÂ Î·È¤Ó·˜ ·ÚÈıÌfi˜ ÙÚÈÙÂ˘fiÓÙˆÓ Î·Ù·-ÏËÎÙÈÎÒÓ ÛËÌÂ›ˆÓ (ÛÈˆËÚfi ¤Ì-ÊÚ·ÁÌ· ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘, Ë ÂÌÊ¿-ÓÈÛË ¯ÚfiÓÈ·˜ ÛÙ·ıÂÚ‹˜ ÛÙËı¿Á-¯Ë˜, Ë ·ÛÙ·ı‹˜ ÛÙËı¿Á¯Ë, Ë Â-ÚÈÊÂÚÈÎ‹ ·ÚÙËÚÈÔ¿ıÂÈ· Î.Ï.).

ΔÔÓ ¢ÂÎ¤Ì‚ÚÈÔ ÙÔ˘ 2002, (3,3¤ÙË ‰È¿ÌÂÛË ‰È¿ÚÎÂÈ· ·fi ÙËÓ¤Ó·ÚÍË) ÙÔ ÛÎ¤ÏÔ˜ ÙË˜ ˘ÔÏÈÈ-‰·ÈÌÈÎ‹˜ ·ÁˆÁ‹˜ (LLA) ÙË˜ ÌÂÏ¤-ÙË˜ ÙÂÚÌ·Ù›ÛıËÎÂ ÚfiˆÚ·, ÌÂÙ¿ÁÓˆÌ¿ÙÂ˘ÛË ÙË˜ ÂÈÙÚÔ‹˜ ·-Ú·ÎÔÏÔ‡ıËÛË˜ ÙˆÓ ·ÔÙÂÏÂÛÌ¿-ÙˆÓ Î·È ÙË˜ ·ÛÊ¿ÏÂÈ·˜ (DSMB),ÂÂÈ‰‹ Ê¿ÓËÎÂ Û·Ê‹˜ Î·È ÛËÌ·-ÓÙÈÎ‹ ˘ÂÚÔ¯‹ ÙË˜ ıÂÚ·Â›·˜ ÌÂ·ÙÔÚ‚·ÛÙ·Ù›ÓË ¤Ó·ÓÙÈ ÙÔ˘ ÂÈÎÔÓÈ-

ÎÔ‡ Ê·ÚÌ¿ÎÔ˘. ™ÙÔ˘˜ ıÂÚ¿Ô-ÓÙÂ˜ È·ÙÚÔ‡˜ Û˘ÛÙ‹ıËÎÂ Ó· ¯Ô-ÚËÁ‹ÛÔ˘Ó ÛÂ fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂ-ÓÂ›˜ 10 mg ·ÙÔÚ‚·ÛÙ·Ù›ÓË˜ ÙËÓËÌ¤Ú·. Δ· ·ÔÙÂÏ¤ÛÌ·Ù· ‰ËÌÔ-ÛÈÂ‡ıËÎ·Ó ÛÙÔ Lancet1. ¶·Ú·ÙË-Ú‹ıËÎÂ ÙfiÙÂ ÌÂ›ˆÛË ÙÔ˘ ÎÈÓ‰‡-ÓÔ˘ ÙÔ˘ ÚˆÙÂ‡ÔÓÙÔ˜ Î·Ù·ÏËÎÙÈ-ÎÔ‡ ÛËÌÂ›Ô˘ Î·Ù¿ 36% (HR 0,64;CI: 0,50-0.78; P=0,0005). ∂›ÛË˜ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¤˜ ‰È·ÊÔÚ¤˜·Ú·ÙËÚ‹ıËÎ·Ó ÛÂ ·ÚÎÂÙ¿ ·fiÙ· ‰Â˘ÙÂÚÂ‡ÔÓÙ· Î·È ÙÚÈÙÂ‡ÔÓÙ·Î·Ù·ÏËÎÙÈÎ¿ ÛËÌÂ›·. (Û‡ÓÔÏÔÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ Û˘Ì‚·Ì¿ÙˆÓ -27%, ƒ=0,0003, Û‡ÓÔÏÔ ÙˆÓÛÙÂÊ·ÓÈ·›ˆÓ Û˘Ì‚·Ì¿ÙˆÓ Î·ÈÂÂÌ‚¿ÛÂˆÓ -3%, ƒ=0,0001, ÂÌ-Ê¿ÓÈÛË ¯ÚfiÓÈ·˜ ÛÙ·ıÂÚ‹˜ ÛÙË-ı¿Á¯Ë˜ -40%, ƒ=0,0072) ™Â ¿Ï-Ï· ‰Â˘ÙÂÚÂ‡ÔÓÙ· Î·Ù·ÏËÎÙÈÎ¿ÛËÌÂ›· Ë ÌÂ›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘,·Ó Î·È ÌÂÁ¿ÏË, ‰ÂÓ ·¤‚Ë ÛÙ·ÙÈ-ÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ÏfiÁˆ ÂÚÈÔÚÈ-ÛÌ¤ÓÔ˘ ·ÚÈıÌÔ‡ Û˘Ì‚·Ì¿ÙˆÓ.(£·Ó·ÙËÊfiÚ· Î·È ÌË ı·Ó·ÙËÊfi-Ú· ·ÁÁÂÈ·Î¿ ÂÁÎÂÊ·ÏÈÎ¿ -21%,ƒ=0,0575, Î·Ú‰È·ÁÁÂÈ·Î‹ ıÓËÛÈ-ÌfiÙËÙ· -0.26%, ƒ=0,2621, Ë ÔÏÈ-Î‹ ıÓËÛÈÌfiÙËÙ· -13%, ƒ=0,1798.

™ÙÔ ‰È¿ÛÙËÌ· ÙˆÓ 2,2 ÂÙÒÓ Ô˘

·ÎÔÏÔ‡ıËÛ·Ó ·fi ÙÔÓ ÙÂÚÌ·ÙÈ-ÛÌfi ÙÔ˘ LLA Ì¤¯ÚÈ ÙÔÓ ÙÂÚÌ·ÙÈ-ÛÌfi Î·È ÙÔ˘ BPLA, ÔfiÙÂ Ú·Á-Ì·ÙÔÔÈ‹ıËÎÂ Ë ÙÂÏÂ˘Ù·›· Â›-ÛÎÂ„Ë ÂÏ¤Á¯Ô˘, ·ÚÎÂÙÔ› ·ÛıÂ-ÓÂ›˜ ÌÂÙ·‹‰ËÛ·Ó ·fi ÙË Ì›·ÔÌ¿‰· ÛÙËÓ ¿ÏÏË. ŒÙÛÈ, ÂÓÒ ÛÙÔÎÏÂ›ÛÈÌÔ ÙÔ˘ LLA, ÙÔ ÔÛÔÛÙfiÙˆÓ ·ÛıÂÓÒÓ Ô˘ ÂÏ¿Ì‚·ÓÂ ÛÙ·-Ù›ÓË ‹Ù·Ó ÛÙËÓ ÔÌ¿‰· ÙË˜ ÂÓÂÚ-ÁÔ‡ ıÂÚ·Â›·˜ 83,7% Î·È ÛÙËÓÔÌ¿‰· ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘12,9%, ÛÙÔ Ù¤ÏÔ˜ Ù· ÔÛÔÛÙ¿‹Ù·Ó 66,7% Î·È 62,8% ·ÓÙ›ÛÙÔÈ-¯·, ‰ËÏ·‰‹ ¤Ó· ·ÚÎÂÙfi ÔÛÔÛÙfiÔ˘ ÂÏ¿Ì‚·ÓÂ ÛÙ·Ù›ÓË Ù· ÚÒÙ·3,3 ¯ÚfiÓÈ· ÙËÓ ‰È¤ÎÔ„Â Î·È ¤Ó·¿ÏÏÔ ÔÛÔÛÙfi Ô˘ ‰ÂÓ ÂÏ¿Ì‚·-ÓÂ ·Ú¯ÈÎ¿, ¿Ú¯ÈÛÂ Ó· Ï·Ì‚¿ÓÂÈ.ŒÙÛÈ, ÂÓÒ Ë ‰È·ÊÔÚ¿ ÛÙÔ Â›Â-‰Ô ÙË˜ ÔÏÈÎ‹˜ Î·È ÙË˜ LDL-¯ÔÏË-ÛÙÂÚfiÏË˜ ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô ÔÌ¿-‰ˆÓ ÛÙ· ÚÒÙ· 3,3 ¯ÚfiÓÈ· ‹Ù·ÓÂÚ›Ô˘ 40 mg/dl, ÛÙÔ Ù¤ÏÔ˜ ÙˆÓ2,2 ÂÙÒÓ ÙË˜ ·Ú¿Ù·ÛË˜ ÂÍ·Ê·-Ó›ÛıËÎÂ. ∂›ÛË˜ ‰ÂÓ ˘‹Ú¯Â ‰È·-ÊÔÚ¿ Î·È ÛÙÈ˜ ¿ÏÏÂ˜ ÏÈÈ‰·ÈÌÈÎ¤˜·Ú·Ì¤ÙÚÔ˘˜ (EÈÎfiÓ· 1). ¶·Ú' fiÏ··˘Ù¿ Ë ‰È·ÊÔÚ¿ ÛÙ· Î·Ù·ÏËÎÙÈ-Î¿ ÛËÌÂ›· ‰È·ÙËÚ‹ıËÎÂ ÛÙÔ ›‰ÈÔÔÛÔÛÙfi (EÈÎfiÓ· 2). ∏ ÌÂ›ˆÛË

ªË ı·Ó·ÙËÊfiÚÔ ∂ª Î·È ı·Ó·ÙËÊfiÚÔ˜ ™¡ £·Ó·ÙËÊfiÚÔ Î·È ÌË ı·Ó·ÙËÊfiÚÔ ∞∂∂

™‡ÓÔÏÔ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÂÂÈÛÔ‰›ˆÓ Î·È ÂÂÌ‚¿ÛÂˆÓ £ÓËÛÈÌfiÙËÙ· ·fi fiÏ· Ù· ·›ÙÈ·

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ŒÙË.ŒÙË.

ŒÙË. ŒÙË.

ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙÔ ÚˆÙÂ‡ÔÓÎ·Ù·ÏËÎÙÈÎfi ÛËÌÂ›Ô ·Ú¤ÌÂÈÓÂÛÙÔ 36% (ƒ<0.0001) Î·È ÁÈ· Ù··ÁÁÂÈ·Î¿ ÂÁÎÂÊ·ÏÈÎ¿ ·Ó‹ÏıÂÛÙÔ 23% (ƒ<0.013). ∏ ÔÏÈÎ‹ıÓËÛÈÌfiÙËÙ· ·Ú¤ÌÂÈÓÂ ÛÙÔ ›‰ÈÔÔÛÔÛÙfi ÂÚ›Ô˘ (15%) ·ÏÏ¿·¤‚Ë ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ·˘-Ù‹ ÙË ÊÔÚ¿, ÏfiÁˆ ÌÂÁ·Ï˘Ù¤ÚÔ˘·ÚÈıÌÔ‡ Û˘Ì‚·Ì¿ÙˆÓ.

ªÂ ÙËÓ ÌÂÏ¤ÙË ·˘Ù‹ ÂÈ‚Â‚·ÈÒ-ÓÂÙ·È ¿ÏÏË ÌÈ· ÊÔÚ¿ fiÙÈ ÙÔ Â˘ÂÚ-ÁÂÙÈÎfi ·ÔÙ¤ÏÂÛÌ· ÙˆÓ ÛÙ·ÙÈÓÒÓ‰È·ÚÎÂ› ÌÂÚÈÎ¿ ¤ÙË (ÂÚ›Ô˘ 2 ÌÂ2,5) ÌÂÙ¿ ÙË ‰È·ÎÔ‹ ÙË˜ ÛÙ·Ù›-ÓË˜, fiˆ˜ Ê¿ÓËÎÂ Î·È ÛÙËÓ ·-Ú·ÙÂÙ·Ì¤ÓË ·Ú·Ù‹ÚËÛË ÙˆÓÌÂÏÂÙÒÓ 4S2, LIPID3, ALERT4 Î·ÈWOSCOPS5. ÿÛˆ˜ ·˘Ùfi ÔÊÂ›ÏÂ-Ù·È ÛÙË ÛÙ·ıÂÚÔÔ›ËÛË ÙË˜ Ï¿-Î·˜, Ô˘ ‰Ú· ÚÔÛÙ·ÙÂ˘ÙÈÎ¿ ÁÈ·

‚Ú·¯‡ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·. ™Â·ÒÙÂÚÔ ¯ÚfiÓÔ fiÌˆ˜, ·Ó·Ì¤ÓÂ-Ù·È Ó· Û˘ÁÎÏ›ÓÔ˘Ó ÔÈ ÂÎ‚¿ÛÂÈ˜ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ Â¿Ó Ï·Ì‚¿ÓÔ˘ÓÛÂ fiÌÔÈÔ ‚·ıÌfi ÛÙ·Ù›ÓË, fiˆ˜¿ÏÏˆÛÙÂ ¤‰ÂÈÍÂ Ë ·Ú·Ù‹ÚËÛËÙˆÓ ·ÛıÂÓÒÓ ÙË˜ 4S ÌÂÏ¤ÙË˜ 10¯ÚfiÓÈ· ÌÂÙ¿ ÙË Ï‹ÍË ÙË˜6.

EÈÌ¤ÏÂÈ·:∏Ï›·˜ ÃÂÈÌÒÓ·˜

7

∫§π¡π∫∂™ ª∂§∂Δ∂™


1. Sever PS, Dahlöf B, Poulter NR,Wedel H, Beevers G, Caulfield M,Collins R, Kjeldsen SE, Kristinsson A,McInnes GT, Mehlsen J, Nieminen M,O'Brien E, Östergren J, for the ASCOTinvestigators. Prevention of coronaryand stroke events with atorvastatin inhypertensive patients who have avera-ge or lower-than-average cholesterolconcentrations, in the Anglo-Scan-dinavian Cardiac Outcomes Trial-LipidLowering Arm (ASCOT-LLA): a multi-centre randomised controlled trial.Lancet (2003) 361:1149-1158

2. Pedersen TR, Wilhelmsen L, Faerge-man O, Strandberg TE, ThorgeirssonG, Troedsson L, Kristianson J, Berg K,Cook TJ, Haghfelt T, Kjekshus J,Miettinen T, Olsson AG, Pyörälä K,

Wedel H, on behalf of the Scandina-vian Simvastatin Survival StudyGroup. Follow-up study of patientsrandomised in the ScandinavianSimvastatin Survival Study (4S) ofcholesterol lowering. Am J Cardiol(2000) 86:257-262

3. The LIPID Study Group. Long-termeffectiveness and safety of pravastatinin 9014 patients with coronary heartdisease and average cholesterolconcentrations: the LIPID trial follow-up. Lancet (2002) 359:1379-1387

4. Holdaas H, Fellstrom B, Jardine AG,Holme I, Nyberg G, Fauchald P,Grunhagen-Riska C, Madsen S,Neumayer H, Cole E, Maes B, AmbuhlP, Olsson AG, Hartmann A, Solbu DO,Pedersen TR. Effect of fluvastatin on

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

5. Ford I, Murray H, Packard CJ,Shepherd J, Macfarlane PW, CobbeSM. Long-term follow up of the Westof Scotland Coronary Prevention Study.N Engl J Med (2007) 357:1477-1486.

6. Strandberg TE, Pyörälä K, Cook TJ,Wilhelmsen L, Faergeman O, Thor-geirsson G, Pedersen TR, Kjekshus J,for the 4S Group. Mortality and inci-dence of cancer during 10-yearfollow-up of the Scandinavian Simva-statin Survival Study (4S). Lancet(2004) 364:771-777.

∏ ENHANCE Â›Ó·È ÌÈ· Ù˘¯·ÈÔÔÈ-ËÌ¤ÓË, ‰ÈÏ¿ - Ù˘ÊÏ‹, ÔÏ˘ÎÂÓÙÚÈ-Î‹ ÌÂÏ¤ÙË, ‰È¿ÚÎÂÈ·˜ 2 ÂÙÒÓ, Ô˘Û¯Â‰È¿ÛıËÎÂ ÁÈ· Ó· ÂÚÂ˘Ó‹ÛÂÈ ·ÓÔ ÛÙ·ıÂÚfi˜ Û˘Ó‰˘·ÛÌfi˜ ÛÈÌ‚·-ÛÙ·Ù›ÓË˜ Î·È Â˙ÂÙÈÌ›ÌË˜ Â›Ó·È Î·-Ï‡ÙÂÚÔ˜ ÛÙËÓ ÚfiÏË„Ë ÙË˜ ·ıË-ÚˆÌ¿ÙˆÛË˜ ·fi ÙËÓ ÛÈÌ‚·ÛÙ·Ù›-ÓË ÌfiÓË ÙË˜. ø˜ ‰Â›ÁÌ· ÂÂÏ¤ÁË-Û·Ó 720 ·ÛıÂÓÂ›˜ ·ÌÊÔÙ¤ÚˆÓ ÙˆÓÊ‡ÏˆÓ ÌÂ Û˘ÁÁÂÓ‹ ÂÙÂÚfi˙˘ÁÔ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·, ¯ˆÚ›˜ ¤Ó-‰ÂÈÍË ÛÙÂÊ·ÓÈ·›·˜ ‹ ¿ÏÏË˜ ·ıË-ÚˆÌ·ÙÈÎ‹˜ ÓfiÛÔ˘ Î·È Î·Ù·ÓÂÌ‹-ıËÎ·Ó Ù˘¯·›· Ó· Ï¿‚Ô˘Ó, ÌÂÙ¿ ÌÈ·ÂÚ›Ô‰Ô ¤ÎÏ˘ÛË˜ ÌÂ ÂÈÎÔÓÈÎfiÊ¿ÚÌ·ÎÔ, Â›ÙÂ ÙÔ ÛÎÂ‡·ÛÌ· INEGY,ÙÔ ÔÔ›Ô ÂÚÈ¤¯ÂÈ 80 mg ÛÈÌ‚·-ÛÙ·Ù›ÓË˜ Î·È 20 mg Â˙ÂÙÈÌ›ÌË˜,Â›ÙÂ ‰ÈÛÎ›Ô ÌÂ 80 mg ÛÈÌ‚·ÛÙ·Ù›-ÓË˜ ÌfiÓÔ, Î¿ıÂ Ì¤Ú·. ∏ ÂÍ¤ÏÈÍËÙË˜ ·ıËÚˆÌ¿ÙˆÛË˜ ·Ú·ÎÔÏÔ˘ı‹-ıËÎÂ ÛÙÈ˜ Î·ÚˆÙ›‰Â˜ ÌÂ ˘ÂÚ-Ë¯ÔÁÚ¿ÊËÌ· M-mode, (EÈÎfiÓ· 1),ÌÈ· Ì¤ıÔ‰Ô Î·ıÈÂÚˆÌ¤ÓË Î·È ÁÂÓÈ-Î¿ ·Ô‰ÂÎÙ‹ ˆ˜ ·ÍÈfiÈÛÙË. ¶Úˆ-ÙÂ‡ÔÓ ÙÂÏÈÎfi ÛËÌÂ›Ô Î·ıÔÚ›ÛıËÎÂË Ì¤ÛË ÌÂÙ·‚ÔÏ‹ ÙÔ˘ ¿¯Ô˘˜ ÙÔ˘Ì¤ÛÔ˘-¤Ûˆ ¯ÈÙÒÓ· (Intima MediaThiknes - IMT) ÙˆÓ Î·ÚˆÙ›‰ˆÓ (ÎÔÈ-Ó‹ Î·ÚˆÙ›‰·, Î·ÚˆÙÈ‰ÈÎfi˜ ‚ÔÏ-‚fi˜ Î·È ¤Ûˆ Î·ÚˆÙ›‰·) ÛÙÔ ‰È¿-ÛÙËÌ· ÙˆÓ 2 ÂÙÒÓ. ¢Â˘ÙÂÚÂ‡ÔÓÙ·Î·Ù·ÏËÎÙÈÎ¿ ÛËÌÂ›· ÔÚ›ÛıËÎ·Ó(1) ÙÔ ÔÛÔÛÙfi ÙˆÓ ·ÛıÂÓÒÓ Ô˘ı· ÂÌÊ·Ó›ÛÂÈ ÌÂ›ˆÛË ÙÔ˘ πªΔ (2)Ë ÌÂÙ·‚ÔÏ‹ ÙÔ˘ ÌÂÁ›ÛÙÔ˘ ¿¯Ô˘˜ÙÔ˘ ¿ˆ ÙÔÈ¯ÒÌ·ÙÔ˜, (3) ÙÔ ÔÛÔ-ÛÙfi ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ı· ·Ó·Ù‡-ÍÂÈ Ó¤Â˜ ·ıËÚˆÌ·ÙÈÎ¤˜ Ï¿ÎÂ˜ Î·È(4) ÔÈ ÌÂÙ·‚ÔÏ¤˜ ÛÙÈ˜ Î·ÚˆÙ›‰Â˜Û˘Ó ÙÈ˜ ÌÂÙ·‚ÔÏ¤˜ ÛÙÈ˜ ÎÔÈÓ¤˜ Ï·-ÁfiÓÈÂ˜ ·ÚÙËÚ›Â˜1.

∏ ÌÂÏ¤ÙË, ·Ó Î·È Â›¯Â ÙÂÏÂÈÒ-ÛÂÈ ·fi ‰ÈÂÙ›·˜, ‰ÂÓ Â›¯Â ‰ËÌÔÛÈ-Â˘ıÂ› Ì¤¯ÚÈ ÙÔÓ ÂÚ·ÛÌ¤ÓÔ π·ÓÔ˘-¿ÚÈÔ. ∞˘Ùfi, ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ Ê‹-ÌÂ˜ fiÙÈ Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜‹Ù·Ó ·ÚÓËÙÈÎ¿, ÚÔÎ¿ÏÂÛÂ ·ÚÎÂ-

Ùfi ıfiÚ˘‚Ô Î·È Û¯fiÏÈ· ÛÙÔ˘˜ ÂÈ-ÛÙËÌÔÓÈÎÔ‡˜ Î‡ÎÏÔ˘˜ ·ÏÏ¿ Î·ÈÛÙ· Ì¤Û· Ì·˙ÈÎ‹˜ ÂÈÎÔÈÓˆÓ›·˜,ÙfiÛÔ ÛÙËÓ ∞ÌÂÚÈÎ‹ fiÛÔ Î·È ·-ÁÎfiÛÌÈ·. ∞˘Ùfi ·Ó¿ÁÎ·ÛÂ ÙÈ˜ Ê·Ú-Ì·ÎÂ˘ÙÈÎ¤˜ ÂÙ·ÈÚÂ›Â˜ ÛÙÈ˜ ÔÔ›Â˜·Ó‹ÎÂÈ ÙÔ Ê¿ÚÌ·ÎÔ Î·È ¯ÚËÌ·ÙÔ-‰fiÙËÛ·Ó ÙË ÌÂÏ¤ÙË Ó· ÚÔ‚Ô‡ÓÛÂ ·Ó·ÎÔ›ÓˆÛË ÛÙÔÓ Ù‡Ô ÙËÓ 14π·ÓÔ˘·Ú›Ô˘, ÚÈÓ Ë ÌÂÏ¤ÙË ·Ó·-ÎÔÈÓˆıÂ› ÛÂ È·ÙÚÈÎfi Û˘Ó¤‰ÚÈÔ ‹‰ËÌÔÛÈÂ˘ıÂ› ÛÂ ÂÈÛÙËÌÔÓÈÎfi Â-ÚÈÔ‰ÈÎfi. ™ÙË Û˘Ó¤¯ÂÈ· ·Ó·ÎÔÈÓÒ-ıËÎÂ ÛÙÔ American College ofCardiology (ACC) 57th AnnualScientific Session Î·È ‰ËÌÔÛÈÂ‡-ıËÎÂ Ù·˘Ùfi¯ÚÔÓ· ÛÙÔ New En-gland Journal of Medicine2.

Δ· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ÌÂÏ¤ÙË˜Û‡ÌÊˆÓ· ÌÂ ÙËÓ ·Ó·ÎÔ›ÓˆÛË ·˘-Ù‹ Â›Ó·È Ù· ÂÍ‹˜: Ÿˆ˜ ·Ó·ÌÂÓfi-Ù·Ó, Ë LDL-¯ÔÏËÛÙÂÚfiÏË ÌÂÈÒıË-ÎÂ Î·Ù¿ 16,5% ÂÚÈÛÛfiÙÂÚÔ ÌÂÙÔÓ ÛÙ·ıÂÚfi Û˘Ó‰˘·ÛÌfi Û˘ÁÎÚÈ-ÙÈÎ¿ ÌÂ ÙË ÌÔÓÔıÂÚ·Â›· ÌÂ ÛÈÌ-‚·ÛÙ·Ù›ÓË (ƒ< 0,01, ¶›Ó·Î·˜ 1).

∂›ÛË˜ ÌÂÈÒıËÎÂ ÂÚÈÛÛfiÙÂÚÔ ËCRP Î·Ù¿ 25,7% Î·È Ù· ÙÚÈÁÏ˘ÎÂ-Ú›‰È· Î·Ù¿ 6,6% ÛÙËÓ ÔÌ¿‰· ÙÔ˘ÛÙ·ıÂÚÔ‡ Û˘Ó‰˘·ÛÌÔ‡ (ƒ< 0,01).√È ÌÂÙ·‚ÔÏ¤˜ ÙˆÓ ÏÈÈ‰›ˆÓ Ê·›ÓÔ-ÓÙ·È ÛÙËÓ EÈÎfiÓ· 2. ŸÌˆ˜, ÙÔ Úˆ-ÙÂ‡ÔÓ ÙÂÏÈÎfi ÛËÌÂ›Ô ‰ÂÓ ‰È¤ÊÂÚÂÛÙÈ˜ ‰‡Ô ÔÌ¿‰Â˜ (¶›Ó·Î·˜ 2). ∂›-ÛË˜ ‰ÂÓ ‰È¤ÊÂÚ·Ó ÌÂÙ·Í‡ ÙˆÓ‰‡Ô ÔÌ¿‰ˆÓ Ù· ‰Â˘ÙÂÚÂ‡ÔÓÙ· Î·-Ù·ÏËÎÙÈÎ¿ ÛËÌÂ›·. √È ·ÓÂÈı‡ÌË-ÙÂ˜ ÂÓ¤ÚÁÂÈÂ˜ ‹Ù·Ó ·ÚfiÌÔÈÂ˜ Î·ÈÛÙÈ˜ ‰‡Ô ÔÌ¿‰Â˜.

Δ· Â˘Ú‹Ì·Ù· ·˘Ù¿ ÚÔÎ¿ÏÂ-Û·Ó ·ÔÁÔ‹ÙÂ˘ÛË Î·È ‰ÂÓ ‹Ù·Ó Ù··Ó·ÌÂÓfiÌÂÓ·, ·ÊÔ‡ ·ÓÙÈ‚·›ÓÔ˘ÓÛÙË ÁÂÓÈÎ¿ ·Ú·‰Â‰ÂÈÁÌ¤ÓË ·Ú¯‹fiÙÈ fiÛÔ ÂÚÈÛÛfiÙÂÚÔ ÌÂÈÒÓÂÙ·È ËLDL-¯ÔÏËÛÙÂÚfiÏË, ÙfiÛÔ ÌÂÁ·Ï‡-ÙÂÚÔ ÙÔ fiÊÂÏÔ˜ Ô˘ ÚÔÎ‡ÙÂÈ.μ¤‚·È· Ë Ì¤ÙÚËÛË ÙÔ˘ πªΔ Â›Ó·È˘ÔÎ·Ù¿ÛÙ·ÙÔ (surrogate) ÛËÌÂ›Ô¤Î‚·ÛË˜ Î·È ‰ÂÓ ÛËÌ·›ÓÂÈ fiÙÈ ÌÔ-ÚÂ› Ó· ÚÔ‚Ï¤„ÂÈ Î·Ù¿ 100% ÙËÓÎÏÈÓÈÎ‹ ¤Î‚·ÛË, ·ÔÙÂÏÂ› fiÌˆ˜¤Ó·Ó ‚ÈÔÏÔÁÈÎfi ‰Â›ÎÙË Ô˘ ‰ÂÓ

π √ À ¡ π √ ™ 2 0 0 8

8

ªÂÏ¤ÙË ENHANCE (Ezetimibe aNd Simvastatin in Hypercholesterolemia EnhANCEs

Atherosclerosis Regression)

™ÈÌ‚·ÛÙ·Ù›ÓË ÌÂ ‹ ¯ˆÚ›˜ ∂˙ÂÙÈÌ›ÌË ÛÂ ™˘ÁÁÂÓ‹ ÀÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·

Kastelein JJ, Akdim F, Stroes ES, Zwinderman AH, Bots ML, Stalenhoef AF, Vissren FL,Sijbrands EJ, Trip MD, Stein FA, Gaudet D, Duivenvoorden R, Veltri EP, Marais AD,

de Groot E, ENHANCE Investigators.

N. Engl J Med 2008 Apr 3;358(14):1431-43.

ªÂÙ·‚ÏËÙ‹ ªÔÓÔıÂÚ·Â›· ÌÂ Simvastatin Î·È pSimvastatin (n=363) ezetimibe (n=357)

LDL -¯ÔÏËÛÙÂÚfiÏË 317.8 319.0 NS ‹ (mg/dL), ¤Ó·ÚÍË

LDL-¯ÔÏËÛÙÂÚfiÏË 192.7 141.3 <0.01‹ (mg/dL), 24 Ì‹ÓÂ˜

ªÂÙ·‚ÔÏ‹ (%) -39.1 -55.6 <0.01

¶›Ó·Î·˜ 1. ∂›Â‰· LDL-¯ÔÏËÛÙÂÚfiÏË˜ ÛÙËÓ ¤Ó·ÚÍË ÙË˜ ÌÂÏ¤ÙË˜ Î·È ÛÙÔ˘˜ 24 Ì‹ÓÂ˜

ª¤ÛÔ πªΔ ÙˆÓ ªÔÓÔıÂÚ·Â›· Simvastatin pÎ·ÚˆÙ›‰ˆÓ (mm) Simvastatin Î·È ezetimibe

ŒÓ·ÚÍË ÙË˜ ÌÂÏ¤ÙË˜* 0.70 0.69 0.64

™ÙÔ˘˜ 24 Ì‹ÓÂ˜* 0.70 0.71 0.29

ªÂÙ·‚ÔÏ‹ (mm) 0.0058 0.0111 0.29

¶›Ó·Î·˜ 2. ¶ÚˆÙÂ‡ÔÓ Î·Ù·ÏËÎÙÈÎfi ÛËÌÂ›Ô: Ì¤ÛË ÙÈÌ‹ ÙˆÓ ÌÂÙÚ‹ÛÂˆÓ ÙÔ˘ πªΔ ÛÂ ¤ÍÈÛËÌÂ›· ÙˆÓ Î·ÚˆÙ›‰ˆÓ

*ª¤ÛÔ˜ fiÚÔ˜ ·fi ÙÈ˜ ÎÔÈÓ¤˜ Î·ÚˆÙ›‰Â˜, ÙÔ˘˜ Î·ÚˆÙÈ‰ÈÎÔ‡˜ ‚ÔÏ‚Ô‡˜ Î·È ÙÈ˜ ¤Ûˆ Î·ÚˆÙ›‰Â˜

9

∫§π¡π∫∂™ ª∂§∂Δ∂™

ÌÔÚÂ› Î·ÓÂ›˜ Ó· ·ÁÓÔ‹ÛÂÈ. ™ÙËÌÂÏ¤ÙË ASAP3 Ô˘ ¤ÁÈÓÂ ÌÂ ·Úfi-ÌÔÈ· Ì¤ıÔ‰Ô ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ÔÈÎÔ-ÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·, ËÔÌ¿‰· Ô˘ ¤Ï·‚Â ·ÙÔÚ‚·ÛÙ·Ù›ÓË80 mg ÂÌÊ¿ÓÈÛÂ ÌÂ›ˆÛË ÙË˜ LDL-¯ÔÏËÛÙÂÚfiÏË˜ Î·Ù¿ 9% ÂÚÈÛÛfi-ÙÂÚÔ ·fi ÙËÓ ÔÌ¿‰· Ô˘ ¤Ï·‚Â40 mg ÛÈÌ‚·ÛÙ·Ù›ÓË˜ Î·È ·˘ÙfiÔ‰‹ÁËÛÂ ÛÂ ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ÛÙËÓ ÂÍ¤ÏÈÍË ÙÔ˘ πªΔ ÛÙÈ˜ ‰‡ÔÔÌ¿‰Â˜. ™ÙËÓ ÔÌ¿‰· Ô˘ ¤Ï·‚Â

·ÙÔÚ‚·ÛÙ·Ù›ÓË ÙÔ πªΔ ˘Ô¯ÒÚË-ÛÂ Î·Ù¿ 0,031 mm.

∏ ÂÚÂ˘ÓËÙÈÎ‹ ÔÌ¿‰· ·Ô‰›‰ÂÈÙËÓ ·ÔÙ˘¯›· ÙË˜ ıÂÚ·Â›·˜ ÛÙÔÁÂÁÔÓfi˜ fiÙÈ ÔÈ ·ÛıÂÓÂ›˜ ÙË˜ ÌÂÏ¤-ÙË˜ ‹Ù·Ó Ì¤¯ÚÈ ÙfiÙÂ ÔÏ‡ Î·Ï¿ıÂÚ·Â˘fiÌÂÓÔÈ ÌÂ ÌÂÁ¿ÏÂ˜ ‰fi-ÛÂÈ˜ ÛÙ·ÙÈÓÒÓ ·fi ÙË ÌÈÎÚ‹ ËÏÈÎ›·ÙÔ˘˜ Î·È ‰ÂÓ Â›¯·Ó ÛËÌ·ÓÙÈÎ¤˜ ·Ï-ÏÔÈÒÛÂÈ˜ ÛÙÈ˜ Î·ÚˆÙ›‰Â˜ ÙÔ˘˜.¶Ú¿ÁÌ·ÙÈ ÙÔ πªΔ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ÙË˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó ÌÈÎÚfiÙÂÚÔ ·fi

ÙÔ πªΔ ÙË˜ ÌÂÏ¤ÙË˜ METEOR4,ÛÙËÓ ÔÔ›· ·Ú·ÙËÚ‹ıËÎÂ ÌÂ›ˆ-ÛË ÙË˜ ÂÍ¤ÏÈÍË˜ ÙË˜ ·ıËÚˆÌ¿Ùˆ-ÛË˜ ÌÂ ƒÔÛÔ˘‚·ÛÙ·Ù›ÓË (0,70mm ¤Ó·ÓÙÈ 1,2 mm), ‰ÂÓ ‹Ù·ÓfiÌˆ˜ ÌÈÎÚfiÙÂÚÔ ·fi ·˘Ùfi ÙˆÓ·ÛıÂÓÒÓ ÙË˜ ÌÂÏ¤ÙË˜ ARBITER-1,ÛÙÔ˘˜ ÔÔ›Ô˘˜ ÙÔ πªΔ ÚÈÓ ÙËÓ¤Ó·ÚÍË ÙË˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó 0,627mm. ¶·Ú fiÏ· ·˘Ù¿ ÛÙË ÌÂÏ¤ÙËARBITER-1 ·Ú·ÙËÚ‹ıËÎÂ ˘Ô-ÛÙÚÔÊ‹ ÙÔ˘ πªΔ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜

∂ÈÎfiÓ· 1. ∞: ™ËÌÂ›· Ì¤ÙÚËÛË˜ ÙÔ˘ πªΔ. μ: ÀÂÚË¯ÔÁÚ·ÊÈÎ‹ ÂÈÎfiÓ· ÙË˜ ÎÔÈÓ‹˜ Î·ÚˆÙ›‰·˜ ÛÙËÓ ÔÔ›· Ê·›ÓÂ-Ù·È Ë Ì¤ÙÚËÛË ÙÔ˘ πªΔ ÛÙÔ ¿ˆ ÙÔ›¯ˆÌ·. ΔÔ ÏÂ˘Îfi ‚¤ÏÔ˜ ‰Â›¯ÓÂÈ ÙÔ fiÚÈÔ ÙÔ˘ ÙÔÈ¯ÒÌ·ÙÔ˜ ÚÔ˜ ÙÔÓ ·˘Ïfi Î·ÈÙÔ ÁÎÚ›˙Ô ‚¤ÏÔ˜ ÙÔ fiÚÈÔ Ô˘ ·ÊÔÚ›˙ÂÈ ÙÔÓ ¤Ûˆ ·fi ÙÔ Ì¤ÛÔ ¯ÈÙÒÓ·.

¤Ûˆ Î·ÚˆÙ›‰·

Î·ÚˆÙÈ‰ÈÎfi˜ ‚ÔÏ‚fi˜

ÎÔÈÓ‹ Î·ÚˆÙ›‰·

¤Íˆ Î·ÚˆÙ›‰·ÛËÌÂ›Ô ‰È¯·ÛÌÔ‡

ÙË˜ ÚÔ‹˜

‰È·ÛÙÔÏ‹ ÙË˜Î·ÚˆÙ›‰·˜

π √ À ¡ π √ ™ 2 0 0 8

10


1. Kastelein JJ; Sager PT; de Groot E;Veltri E. Comparison of ezetimibe plussimvastatin versus simvastatin mono-therapy on atherosclerosis progressionin familial hypercholesterolemia. Designand rationale of the Ezetimibe and Sim-vastatin in Hypercholesterolemia Enha-nces Atherosclerosis Regression (ENHA-NCE) trial. Am Heart J 2005;149:234-39

2. Kastelein JJ, Akdim F, Stroes ES, et al.Simvastatin with or without ezetimibe infamilial hypercholesterolemia. N Engl JMed 2008; 358:1431-1443.

3. Smilde TJ, van Wissen S, WollersheimH, et al. Effect of aggressive versusconventional lipid lowering on athero-sclerosis progression in familial hyper-cholesterolaemia (ASAP): a prospective,randomised, double-blind trial. Lancet2001; 357:577-81

4. Crouse JR, Raichlen JS, Riley WA,Evans GW, Palmer MK, O'Leary DH,Grobbee DE, Bots ML, for the METEORStudy Group. Effect of Rosuvastatin onprogression of carotid Intima-MediaThickness in low-risk individuals withsubclinical atherosclerosis The METEORTrial. JAMA 2007; 297:1344-1353.

5. Taylor AJ, Kent SM, Flaherty PJ, CoyleLC, Markwood TT, Vernalis MN.ARBITER: Arterial Biology for theInvestigation of the Treatment Effects ofReducing Cholesterol. A RandomizedTrial Comparing the Effects of Atorva-statin and Pravastatin on Carotid IntimaMedial Thickness. Circulation. 2002;106: 2055-60.

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

Ô˘ ‹Ú·Ó ÂÓÙ·ÙÈÎ‹ ıÂÚ·Â›· ÌÂ·ÙÔÚ‚·ÛÙ·Ù›ÓË 80 mg ÂÓÒ ÛÙÔ˘˜·ÛıÂÓÂ›˜ Ô˘ ¤Ï·‚·Ó Ú·‚·ÛÙ·-Ù›ÓË 40 mg ·Ú¤ÌÂÈÓÂ ÛÙ·ıÂÚfi5.¶¤Ú·Ó ·˘ÙÔ‡, ·ÎfiÌË Î·È ÛÙÔ 19%ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ‰ÂÓ ÂÏ¿Ì‚·ÓÂÛÙ·Ù›ÓË ÚÈÓ ÙËÓ ¤ÓÙ·ÍË ÙÔ˘˜ ÛÙËÌÂÏ¤ÙË, ‰ÂÓ ·Ú·ÙËÚ‹ıËÎÂ ‰È·-ÊÔÚ¿ ÛÙËÓ ÂÍ¤ÏÈÍË ÙÔ˘ πªΔ ÌÂÙ·-Í‡ ·˘ÙÒÓ Ô˘ ¤Ï·‚·Ó ÙÔÓ Û˘Ó-‰˘·ÛÌfi Î·È ·˘ÙÒÓ Ô˘ ¤Ï·‚·ÓÌfiÓÔ ÛÈÌ‚·ÛÙ·Ù›ÓË. ∞˘Ùfi Ô‰‹ÁË-ÛÂ ÌÂÚÈÎÔ‡˜ ÂÚÂ˘ÓËÙ¤˜ ÌÂÙ·Í‡

ÙˆÓ ÔÔ›ˆÓ ÔÈ Drs Greg Brown(University of Washington Schoolof Medicine, Seattle) Î·È AllenTaylor (Walter Reed Army MedicalCenter, Washington, DC) Ô˘¤ÁÚ·„·Ó ¤Ó· ¿ÚıÚÔ Û‡ÓÙ·ÍË˜ÛÙÔ ›‰ÈÔ ÙÂ‡¯Ô˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡6,Ó· ÂÎÊÚ¿ÛÔ˘Ó ÂÈÊ˘Ï¿ÍÂÈ˜ ÁÈ·ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙÔ˘Ê·ÚÌ¿ÎÔ˘. ÕÏÏÔÈ ÂÚÂ˘ÓËÙ¤˜ Û˘ÓÈ-ÛÙÔ‡Ó Ó· ÌË ‚È·ÛıÂ› Ë ÂÈÛÙËÌÔÓÈ-Î‹ ÎÔÈÓfiÙËÙ· Ó· ‚Á¿ÏÂÈ ·Ì¤Ûˆ˜Û˘ÌÂÚ¿ÛÌ·Ù· ·ÏÏ¿ Ó· ·Ó·Ì¤ÓÂÈ

Ù· ·ÔÙÂÏ¤ÛÌ·Ù· Î·È ¿ÏÏˆÓ ÌÂÏÂ-ÙÒÓ. ¶¿ÓÙˆ˜ ÙÂÏÈÎ‹ ·¿ÓÙËÛË ı·‰ÔıÂ› fiÙ·Ó ÔÏÔÎÏËÚˆıÂ› Ë ÌÂÁ¿-ÏË ÎÏÈÓÈÎ‹ ÌÂÏ¤ÙË IMPROVE-IT, ËÔÔ›· ı· ÂÚÈÏ¿‚ÂÈ ÂÚÈÛÛfiÙÂÚ··fi 10.000 ¿ÙÔÌ· Î·È ¤¯ÂÈ ÛÎÏË-Ú¿ Î·Ù·ÏËÎÙÈÎ¿ ÛËÌÂ›· Î·È ËÔÔ›· ·Ó·Ì¤ÓÂÙ·È Ó· ÂÚ·ÙˆıÂ›ÙÔ 2011 ‹ 2012.

∂ÈÌ¤ÏÂÈ·: ∏Ï›·˜ ÃÂÈÌÒÓ·˜

∂ÈÎfiÓ· 2. ªÂÙ·‚ÔÏ¤˜ ÙˆÓ ÏÈÈ‰›ˆÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÌÂÏ¤ÙË˜. ∞: LDL-¯ÔÏËÛÙÂÚfiÏË, μ: HDL-¯ÔÏËÛÙÂÚfiÏË,°: √ÏÈÎ‹ ¯ÔÏËÛÙÂÚfiÏË, ¢: ÙÚÈÁÏ˘ÎÂÚ›‰È·.

ª‹ÓÂ˜

™ÈÌ‚·ÛÙ·Ù›ÓË

™ÈÌ‚·ÛÙ·Ù›ÓË™ÈÌ‚·ÛÙ·Ù›ÓË

™ÈÌ‚·ÛÙ·Ù›ÓË

™ÈÌ‚·ÛÙ·Ù›ÓË Û˘ÓÂ˙ÂÙÈÌ›ÌË




ª‹ÓÂ˜

¢: ΔÚÈÁÏ˘ÎÂÚ›‰È·.

μ: HDL-¯ÔÏËÛÙÂÚfiÏË∞: LDL-¯ÔÏËÛÙÂÚfiÏË

°: √ÏÈÎ‹ ¯ÔÏËÛÙÂÚfiÏË

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£EPA¶EIA - ºAPMAKA

11

∂π™∞°ø°∏

√È ‰È¿ÊÔÚÂ˜ ÎÏÈÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ÌÂÛÙ·Ù›ÓÂ˜ ÂÈÎ¤ÓÙÚˆÛ·Ó ÙÔ ÂÓ‰È·-Ê¤ÚÔÓ ÙÔ˘˜ ÛÙÔ ıÂÚ·Â˘ÙÈÎfi·ÔÙ¤ÏÂÛÌ· ÙË˜ ÌÂ›ˆÛË˜ ÙˆÓÂÈ¤‰ˆÓ ÙË˜ ¯ÔÏËÛÙÂÚfiÏË˜ ÙˆÓ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ-˚ÓÒÓ (LDL ¯ÔÏËÛÙÂÚfiÏË). øÛÙfi-ÛÔ, ÂÈ‰ËÌÈÔÏÔÁÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ÛÂ˘ÁÈÂ›˜ ÏËı˘ÛÌÔ‡˜ ¤‰ÂÈÍ·Ó fiÙÈÎ·È ¿ÏÏÂ˜ ÏÈÈ‰·ÈÌÈÎ¤˜ ·Ú¿ÌÂ-ÙÚÔÈ, fiˆ˜ Ù· ¯·ÌËÏ¿ Â›Â‰·ÙË˜ ¯ÔÏËÛÙÂÚfiÏË˜ ÙˆÓ ˘„ËÏ‹˜˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ (HDL¯ÔÏËÛÙÂÚfiÏË), Ù· ˘„ËÏ¿ ÙÚÈÁÏ˘-ÎÂÚ›‰È· (TG), Ë ·ÚÔ˘Û›· ÌÈ-ÎÚÒÓ-˘ÎÓÒÓ ˘ÔÎÏ·ÛÌ¿ÙˆÓ ÙˆÓLDL Î·È Ë ·˘ÍËÌ¤ÓË ÏÈÔÚˆ-ÙÂ˝ÓË (·) [Lp(a)] Û˘ÓÈÛÙÔ‡Ó Â›-ÛË˜ ÚÔÁÓˆÛÙÈÎÔ‡˜ ‰Â›ÎÙÂ˜ ÁÈ·ÙËÓ ÂÌÊ¿ÓÈÛË ·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·-Ì¿ÙˆÓ. ∏ ÙÚÔÔÔ›ËÛË ·˘ÙÒÓÙˆÓ ‰ÂÈÎÙÒÓ ÛÂ ·ÛıÂÓÂ›˜ ÌÂÂÁÎ·ÙÂÛÙËÌ¤ÓË ÈÛ¯·ÈÌÈÎ‹ Î·Ú-‰ÈÔ¿ıÂÈ· Â›Ó·È Èı·Ófi Ó· ¤¯ÂÈÂ˘ÓÔ˚Î‹ Â›‰Ú·ÛË ÛÙËÓ Î·Ú‰È·Á-ÁÂÈ·Î‹ ÓÔÛËÚfiÙËÙ· Î·È ıÓËÙfiÙË-Ù·. ∂ÈÚfiÛıÂÙ·, Ë ·ÁˆÁ‹ ÌÂÛÙ·Ù›ÓÂ˜ ÌÂÈÒÓÂÈ ÌÂÓ ÛËÌ·ÓÙÈÎ¿Ù· ·ÁÁÂÈ·Î¿ Û˘Ì‚¿Ì·Ù·, ˆÛÙfiÛÔÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ·ÛıÂÓÂ›˜ ÂÍ·-ÎÔÏÔ˘ıÔ‡Ó Ó· ÂÌÊ·Ó›˙Ô˘Ó Û˘Ì-‚¿Ì·Ù·, ·ÎfiÌË Î·È fiÙ·Ó Ù· Â›-Â‰· ÙË˜ LDL ¯ÔÏËÛÙÂÚfiÏË˜ Â›-Ó·È ÔÏ‡ ¯·ÌËÏ¿. ŒÓ· Ì¤ÚÔ˜ ·˘-ÙÔ‡ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ Ô˘ ÂÍ·ÎÔÏÔ˘-ıÂ› Ó· ˘¿Ú¯ÂÈ ·ÎfiÌË Î·È ÌÂÙ¿ÙË ÌÂ›ˆÛË ÙË˜ LDL ¯ÔÏËÛÙÂÚfi-ÏË˜ ÔÊÂ›ÏÂÙ·È ÛÙ· ·˘ÍËÌ¤Ó· ÙÚÈ-ÁÏ˘ÎÂÚ›‰È· Î·È Ù· ¯·ÌËÏ¿ Â›Â-‰· HDL ¯ÔÏËÛÙÂÚfiÏË˜.

Δ· ·Ú¿ÁˆÁ· ÙÔ˘ ÊÈÌÚÈÎÔ‡ÔÍ¤Ô˜ (ÊÈÌÚ¿ÙÂ˜) ÂÈ‰ÚÔ‡Ó ÛÂfiÏÂ˜ ·˘Ù¤˜ ÙÈ˜ ÌÂÙ·‚ÏËÙ¤˜ Ô˘‰ÂÓ Û˘Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙËÓ LDL¯ÔÏËÛÙÂÚfiÏË. ™˘ÁÎÂÎÚÈÌ¤Ó·, ÔÈÊÈÌÚ¿ÙÂ˜ ÌÂÈÒÓÔ˘Ó Ù· Â›Â‰·ÙˆÓ TG Î·È ÙˆÓ ÌÈÎÚÒÓ-˘ÎÓÒÓLDL, ·˘Í¿ÓÔ˘Ó Ù· Â›Â‰· ÙË˜HDL ¯ÔÏËÛÙÂÚfiÏË˜, ÂÓÒ ‰ÂÓ

ÂËÚÂ¿˙Ô˘Ó ÛËÌ·ÓÙÈÎ¿ Ù· Â›Â-‰· ÙË˜ LDL ¯ÔÏËÛÙÂÚfiÏË˜ (ÌÂ ÙËÂÍ·›ÚÂÛË ÙË˜ Ê·ÈÓÔÊÈÌÚ¿ÙË˜Ô˘ ÚÔÎ·ÏÂ› Ì›· ÌÈÎÚ‹ ÌÂ›ˆÛËÙË˜ LDL ¯ÔÏËÛÙÂÚfiÏË˜). ∂È-ÚfiÛıÂÙ·, ÌÂÚÈÎ¤˜ ÊÈÌÚ¿ÙÂ˜(Ê·ÈÓÔÊÈÌÚ¿ÙË, ÛÈÚÔÊÈÌÚ¿ÙËÎ·È ÌÂ˙·ÊÈÌÚ¿ÙË) ¤¯Ô˘Ó ÙËÓÈÎ·ÓfiÙËÙ· Ó· ÌÂÈÒÓÔ˘Ó Ù· Â›Â-‰· ÙÔ˘ ÈÓˆ‰ÔÁfiÓÔ˘ ÛÙÔ Ï¿ÛÌ·.ΔÔ ÁÂÁÔÓfi˜ ·˘Ùfi ¤¯ÂÈ ÌÂÁ¿ÏËÛËÌ·Û›·, ·ÊÔ‡ ÙÔ ÈÓˆ‰ÔÁfiÓÔ Â›-Ó·È ¤Ó·˜ ÈÛ¯˘Úfi˜ ÚÔÁÓˆÛÙÈÎfi˜‰Â›ÎÙË˜ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ·ÁÁÂÈ-·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ, ·ÓÂÍ¿ÚÙËÙ··fi ÙËÓ ·ÚÔ˘Û›· ‹ ÌË ÎÏÈÓÈÎÒÓÂÓ‰Â›ÍÂˆÓ ·ÁÁÂÈ·Î‹˜ ÓfiÛÔ˘. ∞Í›-˙ÂÈ Ó· ÛËÌÂÈˆıÂ› fiÙÈ Ë Ê·ÈÓÔÊÈ-ÌÚ¿ÙË ¤¯ÂÈ ÙË ÌÔÓ·‰ÈÎ‹ È‰ÈfiÙË-Ù· Ó· ÌÂÈÒÓÂÈ Ù· Â›Â‰· ÙÔ˘ Ô˘-ÚÈÎÔ‡ ÔÍ¤Ô˜ ÙÔ˘ ÔÚÔ‡, Ù· ÔÔ›·fiÙ·Ó Â›Ó·È ·˘ÍËÌ¤Ó· ·ÔÙÂÏÔ‡Ó¤Ó· ‰Â›ÎÙË ·˘ÍËÌ¤ÓÔ˘ Î·Ú‰È·Á-ÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘.

ªÂ ·ÊÔÚÌ‹ ÚfiÛÊ·ÙÂ˜ ÌÂÏ¤ÙÂ˜Ô˘ ·Ó·˙ˆ‡ÚˆÛ·Ó ÙÔ ÂÓ‰È·Ê¤-ÚÔÓ ÁÈ· ÙÈ˜ ÊÈÌÚ¿ÙÂ˜, ı· ÂÈ¯ÂÈ-Ú‹ÛÔ˘ÌÂ ·Ú·Î¿Ùˆ ÌÈ· Û‡ÓÙÔÌË·Ó·ÊÔÚ¿ ÛÙÔ ÚfiÏÔ ·˘Ù‹˜ ÙË˜Î·ÙËÁÔÚ›·˜ ÙˆÓ ˘ÔÏÈÈ‰·ÈÌÈÎÒÓÊ·ÚÌ¿ÎˆÓ.

ª∂°∞§∂™ ∫§π¡π∫∂™ª∂§∂Δ∂™ ª∂ ºπª¶ƒ∞Δ∂™

1. ∏ ÌÂÏ¤ÙË BECAIT (μEza-fibrate Coronary Atheroscle-rosis Intervention Trial)

™ÙËÓ ·ÁÁÂÈÔÁÚ·ÊÈÎ‹ ÌÂÏ¤ÙËBECAIT Û˘ÌÌÂÙÂ›¯·Ó ·ÛıÂÓÂ›˜ÌÂ ·ÏÈfi ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘ÔÎ·Ú-‰›Ô˘ (n=92, ËÏÈÎ›· <45 ÂÙÒÓ)Î·È ‰˘ÛÏÈÈ‰·ÈÌ›·, ÛÙÔ˘˜ ÔÔ›-Ô˘˜ ¯ÔÚËÁ‹ıËÎÂ Â›ÙÂ ÌÂ˙·ÊÈ-ÌÚ¿ÙË (200 mg 3 ÊÔÚ¤˜ ËÌÂÚË-Û›ˆ˜) Â›ÙÂ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ. √ÈÛÙÂÊ·ÓÈÔÁÚ·Ê›Â˜ Ú·ÁÌ·ÙÔÔÈ-‹ıËÎ·Ó ÛÙËÓ ·Ú¯‹ ÙË˜ ÌÂÏ¤ÙË˜,Î·ıÒ˜ Î·È ÌÂÙ¿ ·fi 1 Î·È 5 ¤ÙË.√ ·Ú¯ÈÎfi˜ ÛÙfi¯Ô˜ ÙË˜ ÌÂÏ¤ÙË˜‹Ù·Ó Ë ÂÎÙ›ÌËÛË ÙË˜ ÌÂÙ·‚ÔÏ‹˜

ÙË˜ ‰È·Ì¤ÙÚÔ˘ ÙÔ˘ ·˘ÏÔ‡ ÙˆÓÛÙÂÊ·ÓÈ·›ˆÓ ·ÁÁÂ›ˆÓ. ∏ ıÂÚ·-Â›· Â›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ì›· ÛË-Ì·ÓÙÈÎ‹ ‚ÂÏÙ›ˆÛË ÙˆÓ ·ÁÁÂÈÔ-ÁÚ·ÊÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ, Ë ÔÔ›·‹Ù·Ó Û˘ÁÎÚ›ÛÈÌË ÌÂ ÂÎÂ›ÓË Ô˘·Ú·ÙËÚ‹ıËÎÂ ÛÙÈ˜ ÌÂÏ¤ÙÂ˜ Ô˘¯ÚËÛÈÌÔÔ›ËÛ·Ó ÛÙ·Ù›ÓÂ˜. √ Û˘-ÓÔÏÈÎfi˜ ·ÚÈıÌfi˜ ÙˆÓ ÛÙÂÊ·ÓÈ·›-ˆÓ ÂÂÈÛÔ‰›ˆÓ ‹Ù·Ó ÛËÌ·ÓÙÈÎ¿ÌÈÎÚfiÙÂÚÔ˜ ÛÙËÓ ÔÌ¿‰· ÙˆÓ·ÛıÂÓÒÓ Ô˘ ‹ÚÂ ıÂÚ·Â›· ÌÂÌÂ˙·ÊÈÌÚ¿ÙË ÛÂ Û‡ÁÎÚÈÛË ÌÂÙËÓ ÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ‹-ÚÂ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ (3 Î·È 11ÂÂÈÛfi‰È·, ·ÓÙ›ÛÙÔÈ¯·). ∏ ˆÊ¤-ÏÂÈ· ÙË˜ ıÂÚ·Â›·˜ ‰ÂÓ ·Ô‰fi-ıËÎÂ ÛÙÈ˜ ÔÛÔÙÈÎ¤˜ ÌÂÙ·‚ÔÏ¤˜ÙË˜ LDL ¯ÔÏËÛÙÂÚfiÏË˜, ·ÊÔ‡ ËÌÂ›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ LDL¯ÔÏËÛÙÂÚfiÏË˜ ‰ÂÓ ‹Ù·Ó ÛËÌ·-ÓÙÈÎ‹ (ÌÂ˙·ÊÈÌÚ¿ÙË 3,5%, ÂÈ-ÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ 2,2%). øÛÙfiÛÔ,Ë ÌÂ˙·ÊÈÌÚ¿ÙË ÌÂ›ˆÛÂ Ù· Â›-Â‰· ÙË˜ ÔÏÈÎ‹˜ ¯ÔÏËÛÙÂÚfiÏË˜Î·Ù¿ 9% (p<0,001), ÙˆÓ TG Î·-Ù¿ 37% (p<0,001) Î·È ÙÔ˘ ÈÓˆ‰Ô-ÁfiÓÔ˘ Î·Ù¿ 12% (p=0,001). ∂›-ÛË˜ ·Ú·ÙËÚ‹ıËÎÂ ÛËÌ·ÓÙÈÎ‹·‡ÍËÛË ÙË˜ HDL ¯ÔÏËÛÙÂÚfiÏË˜(9%, p =0,02).

2. ∏ ÌÂÏ¤ÙË SIHDPS (Stockho-lm Ischemic Heart DiseasePrevention Study)

™ÙË ÌÂÏ¤ÙË ·˘Ù‹ Û˘ÌÌÂÙÂ›¯·Ó·ÛıÂÓÂ›˜ ÌÂ ÈÛÙÔÚÈÎfi ÂÌÊÚ¿ÁÌ·-ÙÔ˜ ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘, ÛÙÔ˘˜ÔÔ›Ô˘˜ ¯ÔÚËÁ‹ıËÎÂ Â›ÙÂ ÂÈÎÔÓÈ-Îfi Ê¿ÚÌ·ÎÔ (n=276) Â›ÙÂ Û˘Ó-‰˘·ÛÌfi˜ ÎÏÔÊÈÌÚ¿ÙË˜ ÌÂ ÓÈÎÔ-ÙÈÓÈÎfi ÔÍ‡ (n=279). ªÂÙ¿ ·fi·Ú·ÎÔÏÔ‡ıËÛË 5 ¯ÚfiÓˆÓ, ·-Ú·ÙËÚ‹ıËÎÂ ÛËÌ·ÓÙÈÎ‹ ÌÂ›ˆÛËÙË˜ ÔÏÈÎ‹˜ ıÓËÙfiÙËÙ·˜, Î·ıÒ˜Î·È ÙË˜ Î·Ú‰È·ÁÁÂÈ·Î‹˜ ıÓËÙfi-ÙËÙ·˜ ÛÙËÓ ÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓÔ˘ ‹ÚÂ ˘ÔÏÈÈ‰·ÈÌÈÎ‹ ıÂÚ·-Â›· (-26%, p<0,05 Î·È -36%,p<0,01, ·ÓÙ›ÛÙÔÈ¯·). ΔÔ Â˘ÂÚÁÂ-ÙÈÎfi ·˘Ùfi ·ÔÙ¤ÏÂÛÌ· ÌÔÚÂ› Ó·

ºÈÌÚ¿ÙÂ˜: ∞ÁˆÁ‹ μ·ÛÈÛÌ¤ÓË ÛÂ ∂Ó‰Â›ÍÂÈ˜ ·fi Ù· ∞ÔÙÂÏ¤ÛÌ·Ù· ªÂÁ¿ÏˆÓ ¶ÚÔÔÙÈÎÒÓ

∫ÏÈÓÈÎÒÓ ªÂÏÂÙÒÓ∂˘¿ÁÁÂÏÔ˜ §˘ÌÂÚfiÔ˘ÏÔ˜,

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

ªˆ˘Û‹˜ ∂ÏÈÛ¿Ê,∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈÎ‹˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ

π √ À ¡ π √ ™ 2 0 0 8

12

·Ô‰ÔıÂ› ÛÙË ÌÂ›ˆÛË ÙˆÓ TGÙÔ˘ ÔÚÔ‡, ·ÊÔ‡ ÛËÌ·ÓÙÈÎ‹ ÌÂ›ˆ-ÛË ÙË˜ ıÓËÙfiÙËÙ·˜ ·Ú·ÙËÚ‹-ıËÎÂ ÛÂ ¿ÙÔÌ· ÌÂ Â›Â‰· TG>133 mg/dL Î·È ‹Ù·Ó ÌÂÁ·Ï‡ÙÂ-ÚË ÛÙ· ¿ÙÔÌ· ÂÎÂ›Ó· ÛÙ· ÔÔ›··Ú·ÙËÚ‹ıËÎÂ ÌÂ›ˆÛË ÙˆÓ ÂÈ-¤‰ˆÓ ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ Î·Ù¿30% ‹ Î·È ÂÚÈÛÛfiÙÂÚÔ (Î·Ù¿ 60%ÌÂ›ˆÛË ÙË˜ ıÓËÙfiÙËÙ·˜ ·fi ÛÙÂ-Ê·ÓÈ·›· ÓfiÛÔ, p<0,01). øÛÙfiÛÔ,Ú¤ÂÈ Ó· ·Ó·ÊÂÚıÂ› fiÙÈ Ë ÌÂÏ¤-ÙË ·˘Ù‹ Â›¯Â ·ÚÎÂÙÔ‡˜ ÂÚÈÔÚÈ-ÛÌÔ‡˜ (‰ÂÓ ‹Ù·Ó Ù˘ÊÏ‹, Û˘ÌÌÂ-ÙÂ›¯Â ÌÈÎÚfi˜ ·ÚÈıÌfi˜ ·ÛıÂÓÒÓÎ·È Ë Î‡ÚÈ· ÏÈÈ‰·ÈÌÈÎ‹ ‰È·Ù·Ú·-¯‹ ‹Ù·Ó Ë ˘ÂÚÙÚÈÁÏ˘ÎÂÚÈ‰·È-Ì›·).

3. ∏ ÌÂÏ¤ÙË LOCAT (LOpid Co-ronary Angiography Trial)

™ÙË ÌÂÏ¤ÙË LOCAT Û˘ÌÌÂÙÂ›¯·Ó¿Ó‰ÚÂ˜ ÌÂ ÈÛÙÔÚÈÎfi ·ÔÚÙÔÛÙÂ-Ê·ÓÈ·›·˜ ·Ú¿Î·Ì„Ë˜ Î·È Â›Â-‰· HDL ¯ÔÏËÛÙÂÚfiÏË˜ <43mg/dL Î·È LDL ¯ÔÏËÛÙÂÚfiÏË˜<173 mg/dL. ™ÙÔ˘˜ ·ÛıÂÓÂ›˜¯ÔÚËÁ‹ıËÎÂ Â›ÙÂ ÁÂÌÊÈÌÚÔ˙›ÏË(1200 mg ËÌÂÚËÛ›ˆ˜) Â›ÙÂ ÂÈÎÔ-ÓÈÎfi Ê¿ÚÌ·ÎÔ. √È ÛÙÂÊ·ÓÈÔÁÚ·-Ê›Â˜ Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó Î·È·Ó·Ï‡ıËÎ·Ó ÛÙËÓ ·Ú¯‹ ÙË˜ ÌÂ-Ï¤ÙË˜ Î·È ÌÂÙ¿ ·fi ¤Ó· Ì¤ÛÔ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· 32 ÌËÓÒÓ. ∏¯ÔÚ‹ÁËÛË ÙË˜ ÁÂÌÊÈÌÚÔ˙›ÏË˜Â›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ì›· ÛËÌ·-ÓÙÈÎ‹ ÌÂ›ˆÛË ÙÔ˘ Ú˘ıÌÔ‡ ÂÍ¤ÏÈ-ÍË˜ ÙˆÓ ·ıËÚˆÌ·ÙÈÎÒÓ ‚Ï·‚ÒÓÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÁÁÂ›ˆÓ ÛÂ Û‡-ÁÎÚÈÛË ÌÂ ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ ÂÈ-ÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘. ¶·ÚfiÌÔÈ·Â˘Ú‹Ì·Ù· ·Ú·ÙËÚ‹ıËÎ·Ó Î·ÈÛÂ ÙÌ‹Ì·Ù· ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·Á-ÁÂ›ˆÓ Ô˘ ‚Ú›ÛÎÔÓÙ·Ó Ì·ÎÚÈ¿·fi ÙÔ ÌfiÛ¯Â˘Ì·. ∂ÈÚfiÛıÂÙ·,ÔÈ ·ÛıÂÓÂ›˜ Ô˘ ¤Ï·‚·Ó ÁÂÌÊÈ-ÌÚÔ˙›ÏË ·ÚÔ˘Û›·Û·Ó ÌÈÎÚfiÙÂ-ÚÔ ·ÚÈıÌfi Ó¤ˆÓ ‚Ï·‚ÒÓ ÛÂ Û‡-ÁÎÚÈÛË ÌÂ ÂÎÂ›ÓÔ˘˜ Ô˘ ¤Ï·‚·ÓÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ (2% ¤Ó·ÓÙÈ14%, p<0,001).

√È ÌÂÙ·‚ÔÏ¤˜ ·˘Ù¤˜ ·Ú·ÙËÚ‹-ıËÎ·Ó ·Ú¿ ÙËÓ ·Ô˘Û›· ÛËÌ·-ÓÙÈÎ‹˜ ÌÂ›ˆÛË˜ ÙˆÓ ÂÈ¤‰ˆÓÙË˜ LDL ¯ÔÏËÛÙÂÚfiÏË˜ (Î·Ù¿4,5%). ∞ÓÙ›ıÂÙ·, ÌÂÙ¿ ÙË ¯ÔÚ‹-ÁËÛË ÙË˜ ÁÂÌÊÈÌÚÔ˙›ÏË˜ Ù·Â›Â‰· ÙˆÓ TG ÌÂÈÒıËÎ·Ó Î·Ù¿36% Î·È Ù· Â›Â‰· ÙË˜ HDL ¯Ô-ÏËÛÙÂÚfiÏË˜ ·˘Í‹ıËÎ·Ó Î·Ù¿21%. ∏ ÛËÌ·Û›· ÙË˜ ÌÂ›ˆÛË˜ÙˆÓ TG Î·È ÙË˜ ·‡ÍËÛË˜ ÙË˜HDL ¯ÔÏËÛÙÂÚfiÏË˜ ·Ó·‰ÂÈÎÓ‡Â-Ù·È Î·È ·fi Ù· Â˘Ú‹Ì·Ù· ‰‡Ô

ÚfiÛÊ·ÙˆÓ ÌÂÏÂÙÒÓ Ô˘ ¯ÚËÛÈ-ÌÔÔ›ËÛ·Ó ÊÈÌÚ¿ÙÂ˜: ÙË ÌÂÏ¤-ÙË Bezafibrate Infarction Preven-tion (BIP) Î·È ÙË ÌÂÏ¤ÙË Vete-rans Administration HDL Inter-vention Trial (VA-HIT).

4. ∏ ÌÂÏ¤ÙË BIP (BezafibrateInfarction Prevention)

™ÙË ÌÂÏ¤ÙË ·˘Ù‹ Û˘ÌÌÂÙÂ›¯·Ó3.090 ·ÛıÂÓÂ›˜ ÌÂ ÛÙÂÊ·ÓÈ·›·ÓfiÛÔ (70% ÌÂ ·Ï·ÈfiÙÂÚÔ ¤Ì-ÊÚ·ÁÌ· ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘, 10%ÌÂ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË), ËÏÈÎ›·˜45-74 ÂÙÒÓ. ™ÙÔ˘˜ ·ÛıÂÓÂ›˜ ¯Ô-ÚËÁ‹ıËÎÂ ÌÂ˙·ÊÈÌÚ¿ÙË ‹ ÂÈ-ÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ. √È ·ÛıÂÓÂ›˜ Ô˘Û˘ÌÌÂÙÂ›¯·Ó ÛÙË ÌÂÏ¤ÙË Â›¯·ÓÛ¯ÂÙÈÎ¿ ˘„ËÏ¿ Â›Â‰· ÔÏÈÎ‹˜¯ÔÏËÛÙÂÚfiÏË˜ (180-250 mg/dL),Û¯ÂÙÈÎ¿ ¯·ÌËÏ¿ Â›Â‰· HDL¯ÔÏËÛÙÂÚfiÏË˜ (<45 mg/dL) Î·ÈÂ›Â‰· ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ ≤ 300mg/dL.

∏ ÌÂÏ¤ÙË ·˘Ù‹ Û¯Â‰È¿ÛÙËÎÂ ÁÈ·Ó· ÂÚÂ˘Ó‹ÛÂÈ Â¿Ó Ë ·‡ÍËÛË ÙË˜HDL ¯ÔÏËÛÙÂÚfiÏË˜ Î·È Ë ÌÂ›ˆ-ÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ TG ÌÂÈÒ-ÓÔ˘Ó ÙËÓ Â›ÙˆÛË ÙˆÓ ÚÒÈ-ÌˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ÂÂÈÛÔ‰›ˆÓ(ı·Ó·ÙËÊfiÚÔ Î·È ÌË ı·Ó·ÙËÊfi-ÚÔ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘Î·È ·ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜). ∂ÈÚfi-ÛıÂÙ·, ÛÙËÓ ¤ÚÂ˘Ó· ·˘Ù‹ ÂÎÙÈ-Ì‹ıËÎÂ Ë Â›‰Ú·ÛË ÙË˜ ˘ÔÏÈÈ-‰·ÈÌÈÎ‹˜ ·ÁˆÁ‹˜ ÛÙËÓ Â›Ùˆ-ÛË ÙË˜ ÛÙËı¿Á¯Ë˜, ÙˆÓ ·ÁÁÂÈ·-ÎÒÓ ÂÁÎÂÊ·ÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓÎ·È ÙˆÓ ÂÂÌ‚¿ÛÂˆÓ Â·Ó·ÁÁÂ›ˆ-ÛË˜. ™ÙËÓ ÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓÔ˘ ¤Ï·‚Â ÌÂ˙·ÊÈÌÚ¿ÙË ‰ÂÓ·Ú·ÙËÚ‹ıËÎÂ ÛËÌ·ÓÙÈÎ‹ ÌÂ›ˆ-ÛË fiÛÔÓ ·ÊÔÚ¿ ÙÔ˘˜ Î‡ÚÈÔ˘˜ÛÙfi¯Ô˘˜ ÙË˜ ÌÂÏ¤ÙË˜. øÛÙfiÛÔ,Ë ¯ÔÚ‹ÁËÛË ÙË˜ ÌÂ˙·ÊÈÌÚ¿-ÙË˜ ÚÔÎ¿ÏÂÛÂ Ì›· ÛËÌ·ÓÙÈÎ‹Î·Ù¿ 40% ÌÂ›ˆÛË ÙˆÓ ÛÙÂÊ·ÓÈ-·›ˆÓ ÂÂÈÛÔ‰›ˆÓ (p=0,03) ÛÂ·ÛıÂÓÂ›˜ ÌÂ ˘„ËÏ¿ Â›Â‰· ÙÚÈ-ÁÏ˘ÎÂÚÈ‰›ˆÓ (TG ≥ 200 mg/dL)ÚÈÓ ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜.™ÙË ÌÂÏ¤ÙË μπƒ, Ë ˘ÔÔÌ¿‰·ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ˘ÂÚÙÚÈÁÏ˘ÎÂ-ÚÈ‰·ÈÌ›· ·ÔÙ¤ÏÂÛÂ ÂÚ›Ô˘ ÙÔ15% ÙÔ˘ ÏËı˘ÛÌÔ‡ ÙË˜ ÌÂÏ¤-ÙË˜. ∏ ÌÂ›ˆÛË ÙˆÓ ·ÁÁÂÈ·ÎÒÓÛ˘Ì‚·Ì¿ÙˆÓ ÛÙ· ¿ÙÔÌ· Ô˘ÏËÚÔ‡Û·Ó Ù· ÎÚÈÙ‹ÚÈ· ÁÈ· ÙË‰È¿ÁÓˆÛË ÙÔ˘ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó-‰ÚfiÌÔ˘ Î·È ‹Ú·Ó ÌÂ˙·ÊÈ-ÌÚ¿ÙË ‹Ù·Ó 25% (p=0,03) ÛÂÛ‡ÁÎÚÈÛË ÌÂ ÙÔ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·-ÎÔ.

¶·ÚfiÏÔ Ô˘ Ù· ˘ÔÎÏ¿ÛÌ·Ù·ÙË˜ LDL ‰ÂÓ ÂÎÙÈÌ‹ıËÎ·Ó, ÌÔ-ÚÔ‡ÌÂ Ó· ˘Ôı¤ÛÔ˘ÌÂ fiÙÈ ÔÈ·ÛıÂÓÂ›˜ ÌÂ ˘ÂÚÙÚÈÁÏ˘ÎÂÚÈ‰·È-Ì›· Â›¯·Ó ·˘ÍËÌ¤ÓË Û˘ÁÎ¤ÓÙÚˆ-ÛË ÙˆÓ ÌÈÎÚÒÓ-˘ÎÓÒÓ LDL Ûˆ-Ì·ÙÈ‰›ˆÓ. ªÂ ‰Â‰ÔÌ¤ÓË ÙËÓ Â›-‰Ú·ÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÛÙ· TGÎ·È ÙËÓ HDL ¯ÔÏËÛÙÂÚfiÏË, ıÂˆ-ÚÂ›Ù·È Èı·Ó‹ Î·È Ë ·ÏÏ·Á‹ ÙÔ˘Ê·ÈÓÔÙ‡Ô˘ ÙË˜ LDL Î·È ÙË˜ Î·-Ù·ÓÔÌ‹˜ ÙˆÓ LDL ÛˆÌ·ÙÈ‰›ˆÓÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ÙË˜ ÌÂ˙·ÊÈ-ÌÚ¿ÙË˜.

∏ ÌÂ›ˆÛË ÙÔ˘ ÈÓˆ‰ÔÁfiÓÔ˘ ÙÔ˘Ï¿ÛÌ·ÙÔ˜ Ô˘ ·Ú·ÙËÚ‹ıËÎÂÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ÙË˜ ÌÂ˙·ÊÈ-ÌÚ¿ÙË˜ ÌÔÚÂ› Ó· Û˘ÓÂÈÛ¤ÊÂÚÂÛÙÔ ÎÏÈÓÈÎfi fiÊÂÏÔ˜, ·ÊÔ‡ ÔÈ·ÛıÂÓÂ›˜ ÌÂ ·˘ÍËÌ¤Ó· Â›Â‰·ÈÓˆ‰ÔÁfiÓÔ˘ ÂÌÊ¿ÓÈÛ·Ó ÂÚÈÛÛfi-ÙÂÚ· ·ÁÁÂÈ·Î¿ ÂÂÈÛfi‰È·. ∂›-ÛË˜, Ë ÂÚ·ÈÙ¤Úˆ ·Ó¿Ï˘ÛË ÙˆÓ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÙË˜ ÌÂÏ¤ÙË˜¤‰ÂÈÍÂ fiÙÈ ÌÂÙ·Í‡ ÙˆÓ ·ÛıÂÓÒÓÌÂ ÔÏ‡ ˘„ËÏ¤˜ ÙÈÌ¤˜ ÈÓˆ‰ÔÁfi-ÓÔ˘, ÂÎÂ›ÓÔÈ Ô˘ ÂÌÊ¿ÓÈÛ·Ó ÌÂ›-ˆÛË ·˘ÙÔ‡ ÙÔ˘ ıÚÔÌ‚ˆÙÈÎÔ‡ ·-Ú¿ÁÔÓÙ· Â›¯·Ó ÏÈÁfiÙÂÚ· ·ÁÁÂÈ·-Î¿ ÂÂÈÛfi‰È· ÛÂ Û‡ÁÎÚÈÛË ÌÂÙÔ˘˜ ·ÛıÂÓÂ›˜ ÛÙÔ˘˜ ÔÔ›Ô˘˜ Ù·Â›Â‰· ÙÔ˘ ÈÓˆ‰ÔÁfiÓÔ˘ Â›ÙÂ·˘Í‹ıËÎ·Ó Â›ÙÂ ‰ÂÓ ÌÂÈÒıËÎ·Ó.

∞Í›˙ÂÈ Ó· ·Ó·ÊÂÚıÂ› fiÙÈ Ì›· ÂÎÙˆÓ ˘ÛÙ¤ÚˆÓ ·Ó¿Ï˘ÛË ÙË˜ ÌÂ-Ï¤ÙË˜ μπƒ ÂÚÈ¤Ï·‚Â 303 ¿ÙÔ-Ì· ÌÂ ÚÔ‰È·‚‹ÙË (‰È·Ù·Ú·¯‹·ÓÔ¯‹˜ ÛÙË ÁÏ˘Îfi˙Ë ‹ ‰È·Ù·-Ú·¯‹ ÁÏ˘Îfi˙Ë˜ ÓËÛÙÂ›·˜). ™Ù·¿ÙÔÌ· ·˘Ù¿ Ë ¯ÔÚ‹ÁËÛË ÌÂ-˙·ÊÈÌÚ¿ÙË˜ ÌÂ›ˆÛÂ ÙËÓ ÂÌ-Ê¿ÓÈÛË Ó¤Ô˘ ‰È·‚‹ÙË Î·Ù¿30% (p=0,009). ™ÙÔ Û‡ÓÔÏÔÙˆÓ ·ÛıÂÓÒÓ Ô˘ Û˘ÌÌÂÙÂ›¯·ÓÛÙË ÌÂÏ¤ÙË μπƒ Ë ¯ÔÚ‹ÁËÛËÌÂ˙·ÊÈÌÚ¿ÙË˜ ÂÈ‚Ú¿‰˘ÓÂÙËÓ ·‡ÍËÛË ÙÔ˘ ‰Â›ÎÙË ÈÓÛÔ˘-ÏÈÓÔ·ÓÙ›ÛÙ·ÛË˜ ∏√ª∞ (homeo-stasis model assessment) Î·Ù¿ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÌÂÏ¤ÙË˜ (·‡ÍË-ÛË Î·Ù¿ 34,4% ÛÙËÓ ÔÌ¿‰· ÙÔ˘ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ ÛÂ Û‡ÁÎÚÈ-ÛË ÌÂ ·‡ÍËÛË Î·Ù¿ 6,6% ÛÙËÓÔÌ¿‰· ÙË˜ ÌÂ˙·ÊÈÌÚ¿ÙË˜,p<0,001). √È Â˘ÓÔ˚Î¤˜ ·˘Ù¤˜ÂÈ‰Ú¿ÛÂÈ˜ ÙË˜ ÌÂ˙·ÊÈÌÚ¿ÙË˜ÛÙÔ ÌÂÙ·‚ÔÏÈÛÌfi ÙˆÓ ˘‰·Ù·Ó-ıÚ¿ÎˆÓ Èı·Ó¿ Ó· Û¯ÂÙ›˙ÔÓÙ·ÈÌÂ ÙËÓ ÈÎ·ÓfiÙËÙ· ÙÔ˘ Ê·ÚÌ¿ÎÔ˘Ó· ÂÓÂÚÁÔÔÈÂ› ÌÂÚÈÎ¿ Î·È ÙÔ˘˜PP∞RÁ ˘Ô‰Ô¯Â›˜, ÂÎÙfi˜ ·fiÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ PP∞R·˘Ô‰Ô¯¤ˆÓ.


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5. ∏ ÌÂÏ¤ÙË VA-HIT (VeteransAdministration HDL Interven-tion Trial)

™ÙË ‰ÈÏ¿ - Ù˘ÊÏ‹ ·˘Ù‹ ÌÂÏ¤ÙË‰È¿ÚÎÂÈ·˜ 7 ÂÙÒÓ Û˘ÌÌÂÙÂ›¯·Ó2.531 ¿Ó‰ÚÂ˜ ËÏÈÎ›·˜ Ì¤¯ÚÈ 74ÂÙÒÓ ÌÂ ÈÛÙÔÚÈÎfi ÛÙÂÊ·ÓÈ·›·˜ÓfiÛÔ˘ (ÈÛÙÔÚÈÎfi ÂÌÊÚ¿ÁÌ·ÙÔ˜ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘ ‹ Â¤Ì‚·ÛË˜Â·Ó·ÁÁÂ›ˆÛË˜, ÈÛÙÔÚÈÎfi ÛÙË-ı¿Á¯Ë˜ ÌÂ ÂÈ‚Â‚·ÈˆÌ¤ÓË ÈÛ¯·È-Ì›· ‹ ıÂÙÈÎ¿ Â˘Ú‹Ì·Ù· ÛÙË ÛÙÂ-Ê·ÓÈÔÁÚ·Ê›·). Δ· Â›Â‰· ÙˆÓÏÈÈ‰›ˆÓ ÙˆÓ ·ÛıÂÓÒÓ ‹Ù·Ó HDL¯ÔÏËÛÙÂÚfiÏË <40 mg/dL, LDL¯ÔÏËÛÙÂÚfiÏË <140 mg/dL Î·ÈTG <300 mg/dL. ™ÙÔ˘˜ ·ÛıÂÓÂ›˜¯ÔÚËÁ‹ıËÎÂ Â›ÙÂ ÁÂÌÊÈÌÚÔ˙›ÏË(1200 mg ÙËÓ ËÌ¤Ú·) Â›ÙÂ ÂÈÎÔÓÈ-Îfi Ê¿ÚÌ·ÎÔ. ∏ ¯ÔÚ‹ÁËÛË ÙË˜ÁÂÌÊÈÌÚÔ˙›ÏË˜ Â›¯Â ˆ˜ ·ÔÙ¤-ÏÂÛÌ· Ì›· ÛËÌ·ÓÙÈÎ‹ Î·Ù¿ 22%(p=0,006) ÌÂ›ˆÛË ÙˆÓ ı·Ó¿ÙˆÓÔ˘ ÔÊÂ›ÏÔÓÙ·Ó ÛÂ ÛÙÂÊ·ÓÈ·›·ÓfiÛÔ Î·È ÙˆÓ ÂÌÊÚ·ÁÌ¿ÙˆÓ ÙÔ˘Ì˘ÔÎ·Ú‰›Ô˘ ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙË¯ÔÚ‹ÁËÛË ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿-ÎÔ˘. ∂ÈÚfiÛıÂÙ·, ÛÙË ÌÂÏ¤ÙËVA-HIT ·Ú·ÙËÚ‹ıËÎÂ ÛËÌ·ÓÙÈ-Î‹ ÌÂ›ˆÛË ÙˆÓ ·ÁÁÂÈ·ÎÒÓ ÂÁÎÂ-Ê·ÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ (6,9% ¤Ó·ÓÙÈ5,1%, p=0,04), ÙˆÓ ·ÚÔ‰ÈÎÒÓÈÛ¯·ÈÌÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ (4,2%¤Ó·ÓÙÈ 1,7%, p<0,001) Î·È ÙˆÓÂÂÌ‚¿ÛÂˆÓ Î·ÚˆÙÈ‰ÈÎ‹˜ ÂÓ‰·Ú-ÙËÚÂÎÙÔÌ‹˜ (1,3% ¤Ó·ÓÙÈ 3,5%,p<0,001) ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ÙË˜ÁÂÌÊÈÌÚÔ˙›ÏË˜. ™ÙË ÌÂÏ¤ÙË ·˘-Ù‹ ‰ÂÓ ·Ú·ÙËÚ‹ıËÎÂ ÛËÌ·ÓÙÈÎ‹ÌÂÙ·‚ÔÏ‹ ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ LDL¯ÔÏËÛÙÂÚfiÏË˜ ÛÂ Î·Ì›· ·fi ÙÈ˜2 ÔÌ¿‰Â˜. ŒÙÛÈ, Ù· ıÂÚ·Â˘ÙÈÎ¿·ÔÙÂÏ¤ÛÌ·Ù· ‰ÂÓ ÌÔÚÔ‡Ó Ó··Ô‰ÔıÔ‡Ó ÛÙË ÌÂ›ˆÛË ÙË˜ Û˘-ÁÎ¤ÓÙÚˆÛË˜ ÙË˜ LDL ¯ÔÏËÛÙÂ-ÚfiÏË˜.

∏ VA-HIT Â›Ó·È Ë ÚÒÙË ÌÂÁ¿ÏËÎÏÈÓÈÎ‹ ÌÂÏ¤ÙË Ô˘ ¤‰ÂÈÍÂ ÙÔ ÎÏÈ-ÓÈÎfi fiÊÂÏÔ˜ Ô˘ ÚÔÎ‡ÙÂÈ ·fiÙËÓ ·‡ÍËÛË ÙË˜ HDL ¯ÔÏËÛÙÂÚfi-ÏË˜ Î·È ÙË ÌÂ›ˆÛË ÙˆÓ TG ¯ˆÚ›˜Ó· Û˘Ó˘¿Ú¯ÂÈ ÌÂ›ˆÛË ÙË˜ LDL¯ÔÏËÛÙÂÚfiÏË˜. ™˘ÁÎÂÎÚÈÌ¤Ó· ·-Ú·ÙËÚ‹ıËÎÂ Ì›· Î·Ù¿ 11% ÌÂ›ˆ-ÛË ÙˆÓ Û˘Ì‚·Ì¿ÙˆÓ ÁÈ· Î¿ıÂ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ HDL-C Î·Ù¿ 5 mg/dL. øÛÙfiÛÔ, Â›Ó·ÈÔÏ‡ Èı·Ófi Ó· ·Ú·ÙËÚ‹ıËÎÂÌÂ›ˆÛË ÙˆÓ ÌÈÎÚÒÓ-˘ÎÓÒÓ LDL,Ë ÔÔ›· Èı·Ó¿ ‰È·‰Ú·Ì¿ÙÈÛÂÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙË ÌÂ›ˆÛË ÙˆÓÎ·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ.

∞Í›˙ÂÈ Ó· ·Ó·ÊÂÚıÂ› fiÙÈ Ë ÌÂ›ˆ-ÛË ÙˆÓ ·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ‹Ù·Ó È‰È·›ÙÂÚ· ÌÂÁ¿ÏË ÛÙËÓ ÔÌ¿-‰· ÙˆÓ ‰È·‚ËÙÈÎÒÓ ·ÛıÂÓÒÓ(n=627) Ô˘ Û˘ÌÌÂÙÂ›¯·Ó ÛÙËÌÂÏ¤ÙË (ÌÂ›ˆÛË ÛÙÂÊ·ÓÈ·›ˆÓ ı·-Ó¿ÙˆÓ Î·Ù¿ 41% Î·È ÙˆÓ ·ÁÁÂÈ·-ÎÒÓ ÂÁÎÂÊ·ÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ Î·-Ù¿ 40%). ∂ÈÚfiÛıÂÙ·, Ë ¯ÔÚ‹-ÁËÛË ÁÂÌÊÈÌÚÔ˙›ÏË˜ ˆÊ¤ÏËÛÂÈ‰È·›ÙÂÚ· Ù· ¿ÙÔÌ· ÌÂ ˘ÂÚÈÓ-ÛÔ˘ÏÈÓ·ÈÌ›· (‰ËÏ·‰‹ Ù· ¿ÙÔÌ·ÌÂ ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ) ·ÎfiÌËÎ·È ·Ó ‰ÂÓ Â›¯·Ó ‰È·‚‹ÙË. ª¿ÏÈ-ÛÙ·, fiÛÔ ·˘Í¿ÓÔÓÙ·Ó Ù· Â›Â‰·ÙË˜ ÈÓÛÔ˘Ï›ÓË˜ ÓËÛÙÂ›·˜ ÙfiÛÔÌÂÈÒÓÔÓÙ·Ó Ô Î·Ú‰È·ÁÁÂÈ·Îfi˜Î›Ó‰˘ÓÔ˜. ∂ÔÌ¤Óˆ˜, Ê·›ÓÂÙ·ÈfiÙÈ Ë ¯ÔÚ‹ÁËÛË ÁÂÌÊÈÌÚÔ˙›ÏË˜Â›Ó·È È‰È·›ÙÂÚ· Â˘ÂÚÁÂÙÈÎ‹ ÛÙ·¿ÙÔÌ· Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ÙËÓ ·ıË-ÚÔÁfiÓÔ ‰˘ÛÏÈÈ‰·ÈÌ›· (·˘ÍËÌ¤Ó·ÙÚÈÁÏ˘ÎÂÚ›‰È·, ·˘ÍËÌ¤ÓÂ˜ ÌÈ-ÎÚ¤˜-˘ÎÓ¤˜ LDL Î·È ÌÂÈˆÌ¤Ó·Â›Â‰· ∏DL ¯ÔÏËÛÙÂÚfiÏË˜).Δ¤ÏÔ˜, Ì›· ¿ÏÏË ÂÎ ÙˆÓ ˘ÛÙ¤ÚˆÓ·Ó¿Ï˘ÛË ÙË˜ VA-HIT ¤‰ÂÈÍÂ ÌÂ›-ˆÛË ÙÔ˘ ÚˆÙÔÁÂÓÔ‡˜ Î·Ù·ÏË-ÎÙÈÎÔ‡ ÛËÌÂ›Ô˘ Î·Ù¿ 27% (ÁÂÌ-ÊÈÌÚÔ˙›ÏË ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÂÈÎÔ-ÓÈÎfi Ê¿ÚÌ·ÎÔ, p=0,02) ÛÙ· ¿ÙÔ-Ì· ÂÎÂ›Ó· Ô˘ ÂÌÊ¿ÓÈ˙·Ó ¯ÚfiÓÈ·ÓÂÊÚÈÎ‹ ÓfiÛÔ (n=1.046, ˘ÔÏÔ-ÁÈ˙fiÌÂÓË Î¿ı·ÚÛË ÎÚÂ·ÙÈÓ›ÓË˜ <75 mL/min).

6. ∏ ÌÂÏ¤ÙË ÙÔ˘ ∂ÏÛ›ÓÎÈ(Helsinki Heart Study, HHS)

H HHS ‹Ù·Ó Ì›· ‰ÈÏ¿ - Ù˘ÊÏ‹ÂÏÂÁ¯fiÌÂÓË ÌÂ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·-ÎÔ ÎÏÈÓÈÎ‹ ‰ÔÎÈÌ‹ ÚˆÙÔÁÂÓÔ‡˜ÚfiÏË„Ë˜ ÛÙËÓ ÔÔ›· Û˘ÌÌÂÙÂ›-¯·Ó 4.081 ¿Ó‰ÚÂ˜ Ì¤ÛË˜ ËÏÈÎ›·˜ÌÂ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·. √È ·Û-ıÂÓÂ›˜ Ù˘¯·ÈÔÔÈ‹ıËÎ·Ó ÛÂ ÁÂÌ-ÊÈÌÚÔ˙›ÏË (1200 mg ÙËÓ ËÌ¤Ú·)‹ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ Î·È ·Ú·ÎÔ-ÏÔ˘ı‹ıËÎ·Ó ÁÈ· 5 ¤ÙË. ∫·Ù¿ ÙË‰È¿ÚÎÂÈ· ÙË˜ ·Ú·ÎÔÏÔ‡ıËÛË˜·Ú·ÙËÚ‹ıËÎÂ Ì›· Î·Ù¿ 34% ÛË-Ì·ÓÙÈÎ‹ (p=0,02) ÌÂ›ˆÛË ÙˆÓ·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ ¯ˆÚ›˜Ó· ÌÂÙ·‚ÏËıÂ› Ë ÔÏÈÎ‹ ıÓËÙfiÙË-Ù·. øÛÙfiÛÔ, Ë ÌÂ›ˆÛË ÙˆÓ Û˘Ì-‚·Ì¿ÙˆÓ ‹Ù·Ó ÔÏ‡ ÌÂÁ·Ï‡ÙÂÚË(71%) ÛÙ· ¿ÙÔÌ· ÌÂ ‰È·‚‹ÙË, Î·-ıÒ˜ Î·È ÛÙ· ¿ÙÔÌ· ÌÂ ¯·ÌËÏ¿Â›Â‰· ∏DL ¯ÔÏËÛÙÂÚfiÏË˜ Î·È·˘ÍËÌ¤Ó· ÙÚÈÁÏ˘ÎÂÚ›‰È·. ∂È-ÚfiÛıÂÙ·, ÛÙ· ¿ÙÔÌ· ÌÂ ·˘ÍË-Ì¤ÓÔ ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜(>26 Kg/m2) Ë ÌÂ›ˆÛË ÙˆÓ Û˘Ì-‚·Ì¿ÙˆÓ ‹Ù·Ó 48%. ∞Í›˙ÂÈ Ó··Ó·ÊÂÚıÂ› fiÙÈ Ë ·Ú·ÎÔÏÔ‡ıË-

ÛË ÙˆÓ ·ÙfiÌˆÓ Ô˘ Û˘ÌÌÂÙÂ›¯·ÓÛÙËÓ HHS ÁÈ· 18 ¤ÙË ¤‰ÂÈÍÂ fiÙÈ·ÛıÂÓÂ›˜ ÌÂ ·˘ÍËÌ¤Ó· ÙÚÈÁÏ˘ÎÂ-Ú›‰È· Î·È ·˘ÍËÌ¤ÓÔ ‰Â›ÎÙË Ì¿˙·˜ÛÒÌ·ÙÔ˜ Ô˘ ‹Ú·Ó ÁÂÌÊÈÌÚÔ-˙›ÏË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ 5 ÂÙÒÓÙË˜ ÌÂÏ¤ÙË˜ ÂÌÊ¿ÓÈÛ·Ó ÌÈ· Î·Ù¿71% ÌÈÎÚfiÙÂÚË ÛÙÂÊ·ÓÈ·›· ıÓË-ÙfiÙËÙ· (p<0,001) Î·È ÌÈ· Î·Ù¿33% ÌÈÎÚfiÙÂÚË ÔÏÈÎ‹ ıÓËÙfiÙËÙ·(p=0,03) ÛÂ Û‡ÁÎÚÈÛË ÌÂ Ù· ¿ÙÔ-Ì· Ô˘ ‹Ú·Ó ÂÈÎÔÓÈÎfi Ê¿ÚÌ·-ÎÔ.

7. ∏ ÌÂÏ¤ÙË DAIS (DiabetesAtherosclerosis InterventionStudy)

™ÙËÓ ·ÁÁÂÈÔÁÚ·ÊÈÎ‹ ÌÂÏ¤ÙËDAIS Û˘ÌÌÂÙÂ›¯·Ó 418 ‰È·‚ËÙÈ-ÎÔ› ·ÛıÂÓÂ›˜. ∏ ÌÂÏ¤ÙË ¤‰ÂÈÍÂfiÙÈ Ë ¯ÔÚ‹ÁËÛË Ê·ÈÓÔÊÈÌÚ¿ÙË˜(200 mg/ËÌ¤Ú·) ÁÈ· 3 ¤ÙË ÛÂ·ÛıÂÓÂ›˜ ÌÂ ÁÓˆÛÙ‹ ÛÙÂÊ·ÓÈ·›·ÓfiÛÔ Â›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ì›·ÛËÌ·ÓÙÈÎ‹ ÂÈ‚Ú¿‰˘ÓÛË ÙË˜ ÂÍ¤-ÏÈÍË˜ ÙË˜ ·ıËÚˆÌ·ÙÈÎ‹˜ ÓfiÛÔ˘ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÁÁÂ›ˆÓ (-40%,p=0,029). ™ÙËÓ ›‰È· ÌÂÏ¤ÙË ·-Ú·ÙËÚ‹ıËÎÂ Ì›· Î·Ù¿ 23% ÌÂ›ˆ-ÛË ÙˆÓ ÎÏÈÓÈÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ, ËÔÔ›· ˆÛÙfiÛÔ ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈ-ÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹, Èı·Ó¿ ÂÍ·È-Ù›·˜ ÙÔ˘ ÌÈÎÚÔ‡ ·ÚÈıÌÔ‡ ·ÛıÂ-ÓÒÓ Ô˘ Û˘ÌÌÂÙÂ›¯·Ó ÛÙË ÌÂÏ¤-ÙË. ŒÓ· ÂÓ‰È·Ê¤ÚÔÓ Â‡ÚËÌ· ·˘-Ù‹˜ ÙË˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó fiÙÈ Ë ¯Ô-Ú‹ÁËÛË Ê·ÈÓÔÊÈÌÚ¿ÙË˜ ÌÔÚÂ›Ó· ‚ÂÏÙÈÒÛÂÈ Ì›· ÌÈÎÚÔ·ÁÁÂÈ·Î‹ÂÈÏÔÎ‹ ÙÔ˘ ‰È·‚‹ÙË, ÙË ‰È·‚Ë-ÙÈÎ‹ ÓÂÊÚÔ¿ıÂÈ·. ™˘ÁÎÂÎÚÈÌ¤-Ó·, Ë ¯ÔÚ‹ÁËÛË ÙË˜ Ê·ÈÓÔÊÈ-ÌÚ¿ÙË˜ Â›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ·Ì›· ÛËÌ·ÓÙÈÎ‹ (p=0,031) ÌÂ›ˆÛËÙË˜ ÂÌÊ¿ÓÈÛË˜ ÌÈÎÚÔ·Ï‚Ô˘ÌÈ-ÓÔ˘Ú›·˜ ÛÙË ‰È¿ÚÎÂÈ· ÙË˜ ÌÂÏ¤-ÙË˜.

8. ∏ ÌÂÏ¤ÙË FIELD (FenofibrateIntervention and Event Lowe-ring in Diabetes)

¶ÚÈÓ 2,5 ¤ÙË ‰ËÌÔÛÈÂ‡ıËÎ·Ó Ù··ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ÌÂÁ·Ï‡ÙÂÚË˜ÌÂÏ¤ÙË˜ Ô˘ ÂÎÙ›ÌËÛÂ ÙËÓ Â›-‰Ú·ÛË ÙË˜ Ê·ÈÓÔÊÈÌÚ¿ÙË˜ ÛÂ·ÛıÂÓÂ›˜ ÌÂ ‰È·‚‹ÙË. ¶ÚfiÎÂÈÙ·ÈÁÈ· ÙË ÌÂÏ¤ÙË FIELD ÛÙËÓ ÔÔ›·9.795 ·ÛıÂÓÂ›˜ ÌÂ ‰È·‚‹ÙË Ù‡-Ô˘ 2, ÔÏÈÎ‹ ¯ÔÏËÛÙÂÚfiÏË 116-251 mg/dL Î·È ÏfiÁˆ ÔÏÈÎ‹˜ ¯Ô-ÏËÛÙÂÚfiÏË˜/HDL ¯ÔÏËÛÙÂÚfiÏË≥4.0 ‹ ÙÚÈÁÏ˘ÎÂÚ›‰È· >89 mg/dLÙ˘¯·ÈÔÔÈ‹ıËÎ·Ó ÛÂ Ê·ÈÓÔÊÈ-ÌÚ¿ÙË (200 mg/ËÌ¤Ú·) ‹ ÂÈÎÔÓÈ-Îfi Ê¿ÚÌ·ÎÔ. ªÂÙ¿ ·fi 5 ¤ÙË ·-

π √ À ¡ π √ ™ 2 0 0 8

14

Ú·ÎÔÏÔ‡ıËÛË˜ ÙÔ ÚˆÙÔÁÂÓ¤˜Î·Ù·ÏËÎÙÈÎfi ÛËÌÂ›Ô (ÛÙÂÊ·ÓÈ·›-Ô˜ ı¿Ó·ÙÔ˜ ‹ ÌË ı·Ó·ÙËÊfiÚÔ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘) ÌÂÈ-ÒıËÎÂ Î·Ù¿ 11% ÛÙËÓ ÔÌ¿‰· ÙË˜Ê·ÈÓÔÊÈÌÚ¿ÙË˜, ·ÏÏ¿ Ë ÌÂ›ˆÛË·˘Ù‹ ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·-ÓÙÈÎ‹ (p=0,16). øÛÙfiÛÔ, Ë ÌÂ›ˆ-ÛË ÙˆÓ ÌË ı·Ó·ÙËÊfiÚˆÓ ÂÌ-ÊÚ·ÁÌ¿ÙˆÓ ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘ ‹Ù·Ó24% Î·È ‹Ù·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·-ÓÙÈÎ‹ (p=0,01). ∂ÈÚfiÛıÂÙ·,ÌÂÈÒıËÎ·Ó ÛËÌ·ÓÙÈÎ¿ Ù· Û˘ÓÔÏÈ-Î¿ Î·Ú‰È·ÁÁÂÈ·Î¿ Û˘Ì‚¿Ì·Ù·(ÛÙ· ÔÔ›· Û˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·ÓÙ· ·ÁÁÂÈ·Î¿ ÂÁÎÂÊ·ÏÈÎ¿ ÂÂÈÛfi-‰È·) Î·Ù¿ 11% (p=0,035) Î·È ÔÈÂÂÌ‚¿ÛÂÈ˜ ÛÙÂÊ·ÓÈ·›·˜ Â·Ó·Á-ÁÂ›ˆÛË˜ Î·Ù¿ 21% (p=0,003).∞Í›˙ÂÈ Ó· ·Ó·ÊÂÚıÂ› fiÙÈ Ë ¯Ú‹ÛËÛÙ·ÙÈÓÒÓ [ÌÂÁ·Ï‡ÙÂÚË ÛÙËÓ ÔÌ¿-‰· ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘(36%) ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙËÓ ÔÌ¿‰·ÙË˜ Ê·ÈÓÔÊÈÌÚ¿ÙË˜ (19%)] È-ı·Ó¿ ÓfiıÂ˘ÛÂ Ù· ·ÔÙÂÏ¤ÛÌ·Ù·ÙË˜ ÌÂÏ¤ÙË˜ FIELD Î·È ÂÈÛÎ›·ÛÂÙ· ÔÊ¤ÏË ·fi ÙË ¯ÔÚ‹ÁËÛË Ê·È-ÓÔÊÈÌÚ¿ÙË˜. ŒÙÛÈ, ÌÂÙ¿ ·fiÛÙ·ÙÈÛÙÈÎ‹ ‰ÈfiÚıˆÛË ÁÈ· ÙË ¯Ô-Ú‹ÁËÛË ÛÙ·ÙÈÓÒÓ Ë ÌÂ›ˆÛË ÙÔ˘ÚˆÙÔÁÂÓÔ‡˜ Î·Ù·ÏËÎÙÈÎÔ‡ ÛË-ÌÂ›Ô˘ ‹Ù·Ó 19% Î·È ‹Ù·Ó ÛÙ·ÙÈ-ÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ (p=0,01). ∞fiÙÔ˘˜ ·ÛıÂÓÂ›˜ Ô˘ Û˘ÌÌÂÙÂ›¯·ÓÛÙË FIELD Ë ÌÂÁ¿ÏË ÏÂÈÔ„ËÊ›·(n=7.664) ‰ÂÓ Â›¯·Ó ÁÓˆÛÙ‹ Î·Ú-‰È·ÁÁÂÈ·Î‹ ÓfiÛÔ (ÚˆÙÔÁÂÓ‹˜ÚfiÏË„Ë). ™Â ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂ-ÓÂ›˜ Ë ÌÂ›ˆÛË ÙˆÓ Û˘ÓÔÏÈÎÒÓÎ·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ ‹Ù·Ó19% Î·È ‹Ù·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·-ÓÙÈÎ‹ (p=0,004), ÛÂ ·ÓÙ›ıÂÛË ÌÂÙÔ˘˜ ·ÛıÂÓÂ›˜ ‰Â˘ÙÂÚÔÁÂÓÔ‡˜ÚfiÏË„Ë˜, ÛÙÔ˘˜ ÔÔ›Ô˘˜ ‰ÂÓ˘‹Ú¯Â ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ ÌÂ-Ù·Í‡ Ê·ÈÓÔÊÈÌÚ¿ÙË˜ Î·È ÂÈÎÔÓÈ-ÎÔ‡ Ê·ÚÌ¿ÎÔ˘. ™ÙË ÌÂÏ¤ÙËFIELD ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ÛË-Ì·ÓÙÈÎ¤˜ ‰È·ÊÔÚ¤˜ ÌÂÙ·Í‡ ÙˆÓ 2ÔÌ¿‰ˆÓ fiÛÔÓ ·ÊÔÚ¿ ÙË Î·Ú-‰È·ÁÁÂÈ·Î‹ Î·È ÙËÓ ÔÏÈÎ‹ ıÓËÙfi-ÙËÙ·. ∞Í›˙ÂÈ Ó· ÛËÌÂÈˆıÂ› fiÙÈ ÔÏËı˘ÛÌfi˜ ÙˆÓ ·ÙfiÌˆÓ Ô˘Û˘ÌÌÂÙÂ›¯Â ÛÙË ÌÂÏ¤ÙË ‹Ù·Ó ¯·-ÌËÏÔ‡ Î·Ú‰È·ÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘(1%/¤ÙÔ˜ Î·Ú‰È·ÁÁÂÈ·Î¿ Û˘Ì‚¿-Ì·Ù· ÛÙËÓ ÔÌ¿‰· ÙÔ˘ ÂÈÎÔÓÈÎÔ‡Ê·ÚÌ¿ÎÔ˘) Î·È ÙÔ ÁÂÁÔÓfi˜ ·˘ÙfiÈı·Ó¿ Ó· ÌÂ›ˆÛÂ ÙË ÛÙ·ÙÈÛÙÈÎ‹‰‡Ó·ÌË ÙË˜ ÌÂÏ¤ÙË˜. ™ÙÈ˜ ÚÔË-ÁÔ‡ÌÂÓÂ˜ ÌÂÁ¿ÏÂ˜ ÌÂÏ¤ÙÂ˜ ÌÂÊÈÌÚ¿ÙÂ˜ (HHS, BIP, VA-HIT)Ê¿ÓËÎÂ fiÙÈ Ë ıÂÚ·Â›· ÌÂ ·˘Ù¿Ù· Ê¿ÚÌ·Î· ‚ÔËı¿ÂÈ È‰È·›ÙÂÚ·

ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ·ıËÚÔÁfiÓÔ ‰˘-ÛÏÈÈ‰·ÈÌ›· (¯·ÌËÏ‹ HDL ¯ÔÏË-ÛÙÂÚfiÏË Î·È ˘„ËÏ¿ TG). ∞ÓÙ›ıÂ-Ù·, ÛÙË ÌÂÏ¤ÙË FIELD Ù· ·Ú¯ÈÎ¿Â›Â‰· ÙˆÓ ÏÈÈ‰·ÈÌÈÎÒÓ ·Ú·-Ì¤ÙÚˆÓ (HDL ¯ÔÏËÛÙÂÚfiÏË 43mg/dL, LDL ¯ÔÏËÛÙÂÚfiÏË 119mg/dL Î·È TG 153 mg/dL) ‰ÂÓ·Ú·¤ÌÔ˘Ó ÛÙËÓ ·ÚÔ˘Û›··ıËÚÔÁfiÓÔ˘ ‰˘ÛÏÈÈ‰·ÈÌ›·˜. ∏·Ó¿Ï˘ÛË ˘ÔÔÌ¿‰ˆÓ ÙË˜ FIELD¤‰ÂÈÍÂ fiÙÈ È‰È·›ÙÂÚ· ˆÊÂÏ‹ıËÎ·ÓÔÈ ÓÂfiÙÂÚÔÈ ·ÛıÂÓÂ›˜ (<65 ÂÙÒÓ)Î·È ÔÈ ·ÛıÂÓÂ›˜ Ô˘ Â›¯·Ó ¯·ÌË-Ï¿ Â›Â‰· ∏DL ¯ÔÏËÛÙÂÚfiÏË˜.

ª›· ÔÏ‡ ÂÓ‰È·Ê¤ÚÔ˘Û· ·Ú·-Ù‹ÚËÛË ·fi ÙË ÌÂÏ¤ÙË FIELD·ÊÔÚ¿ ÙËÓ Â›‰Ú·ÛË ÙË˜ Ê·ÈÓÔ-ÊÈÌÚ¿ÙË˜ ÛÙÈ˜ ÌÈÎÚÔ·ÁÁÂÈ·Î¤˜ÂÈÏÔÎ¤˜ ÙÔ˘ ‰È·‚‹ÙË, ÔÈ ÔÔ›-Â˜ Î·È ·ÔÙÂÏÔ‡Ó ÛËÌ·ÓÙÈÎfi Úfi-‚ÏËÌ· ÁÈ· ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂ-ÓÂ›˜. ™˘ÁÎÂÎÚÈÌ¤Ó·, Ë ¯ÔÚ‹ÁËÛËÙË˜ Ê·ÈÓÔÊÈÌÚ¿ÙË˜ Â›¯Â ˆ˜·ÔÙ¤ÏÂÛÌ· Ì›· ÔÏ‡ ÛËÌ·ÓÙÈÎ‹Î·Ù¿ 30% (p=0,0001) ÌÂ›ˆÛËÙˆÓ ÂÂÌ‚¿ÛÂˆÓ ÊˆÙÔËÍ›·˜(laser) ÂÍ·ÈÙ›·˜ ‰È·‚ËÙÈÎ‹˜ ·ÌÊÈ-‚ÏËÛÙÚÔÂÈ‰Ô¿ıÂÈ·˜, Ì›· Î·Ù¿11% ÌÂ›ˆÛË ÙË˜ ÂÍ¤ÏÈÍË˜ ÛÂ ÌÈ-ÎÚÔ·Ï‚Ô˘ÌÈÓÔ˘Ú›· (p=0,002),Î·ıÒ˜ Î·È Ì›· Î·Ù¿ 31% ÌÂ›ˆÛËÙˆÓ ÂÂÌ‚¿ÛÂˆÓ ·ÎÚˆÙËÚÈ·ÛÌÔ‡ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ (p=0,04). ™ÂÌ›· ˘ÔÔÌ¿‰· (n=1.012) ÙˆÓ·ÙfiÌˆÓ ÙË˜ ÌÂÏ¤ÙË˜ FIELD ÂÏ‹-ÊıËÛ·Ó ÊˆÙÔÁÚ·Ê›Â˜ ÙÔ˘ ‚˘ıÔ‡ÛÙË ‰È¿ÚÎÂÈ· ÙË˜ ÌÂÏ¤ÙË˜. ™Ù·¿ÙÔÌ· ÌÂ ÚÔ¸¿Ú¯Ô˘Û· ·ÌÊÈ-‚ÏËÛÙÚÔÂÈ‰Ô¿ıÂÈ· Ë ¯ÔÚ‹ÁËÛËÊ·ÈÓÔÊÈÌÚ¿ÙË˜ Â›¯Â ˆ˜ ·ÔÙ¤-ÏÂÛÌ· Ì›· ÛËÌ·ÓÙÈÎ‹ ÌÂ›ˆÛË ÙË˜ÂÍ¤ÏÈÍË˜ ÙË˜ ‰È·‚ËÙÈÎ‹˜ ·ÌÊÈ-‚ÏËÛÙÚÔÂÈ‰Ô¿ıÂÈ·˜ ÛÂ Û‡ÁÎÚÈ-ÛË ÌÂ ÙÔ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ (3¤Ó·ÓÙÈ 14 ¿ÙÔÌ·, p=0,004). ŒÙÛÈ,Ë Ê·ÈÓÔÊÈÌÚ¿ÙË, fiˆ˜ Î·È ÛÙËÌÂÏ¤ÙË DAIS, Ê·›ÓÂÙ·È fiÙÈ ÂÎÙfi˜·fi ÙË ÌÂ›ˆÛË ÙˆÓ Ì·ÎÚÔ·ÁÁÂÈ-·ÎÒÓ ÂÈÏÔÎÒÓ ÙÔ˘ ‰È·‚‹ÙË(Î˘Ú›ˆ˜ ÙˆÓ ÌË ı·Ó·ÙËÊfiÚˆÓÂÌÊÚ·ÁÌ¿ÙˆÓ ÛÙËÓ ÚˆÙÔÁÂÓ‹ÚfiÏË„Ë) ‚ÂÏÙÈÒÓÂÈ Î·È ÙÈ˜ ÌÈ-ÎÚÔ·ÁÁÂÈ·Î¤˜ ÂÈÏÔÎ¤˜ ÙË˜ Ófi-ÛÔ˘.

™À¡¢À∞™ª∂¡∏ £∂ƒ∞¶∂π∞™Δ∞Δπ¡∏™-ºπª¶ƒ∞Δ∏™

™Â ÔÏÏÔ‡˜ ·ÛıÂÓÂ›˜ ÌÂ ÌÈÎÙ‹‰˘ÛÏÈÈ‰·ÈÌ›·, Ë ÌÔÓÔıÂÚ·Â›·ÌÂ ÛÙ·Ù›ÓÂ˜ ‹ ÊÈÌÚ¿ÙÂ˜ ‰ÂÓ ÂÈ-Ù˘Á¯¿ÓÂÈ ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ‰ÈfiÚ-ıˆÛË ÙˆÓ ÛÔ‚·ÚÒÓ Î·È ÔÈÎÈÏfi-

ÌÔÚÊˆÓ ‰È·Ù·Ú·¯ÒÓ ÙˆÓ ÏÈÈ-‰›ˆÓ. ™Â ·˘Ù¤˜ ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ËÛ˘Ó‰˘·ÛÌ¤ÓË ıÂÚ·Â›· (ÛÙ·Ù›ÓË+ ÊÈÌÚ¿ÙË) ·ÔÙÂÏÂ› Ì›· ÂÓ·Ï-Ï·ÎÙÈÎ‹ Ï‡ÛË. ∏ Â˘ÚÂ›· ·Ô‰Ô¯‹ÙË˜ Û˘Ó‰˘·ÛÌ¤ÓË˜ ıÂÚ·Â›·˜ Â-ÚÈÔÚ›˙ÂÙ·È ·fi ÙÔÓ Èı·Ófi Î›Ó‰˘-ÓÔ ÂÌÊ¿ÓÈÛË˜ Ì˘ÔÛ›ÙÈ‰·˜ ‹ ·Îfi-ÌË Î·È Ú·‚‰ÔÌ˘fiÏ˘ÛË˜. øÛÙfiÛÔ,Ô Î›Ó‰˘ÓÔ˜ ·˘Ùfi˜ ‰ÂÓ ÂÈ‚Â‚·ÈÒ-ıËÎÂ ·fi ÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ ÌÂ-Ï¤ÙÂ˜ Ô˘ ¯ÚËÛÈÌÔÔ›ËÛ·Ó Û˘Ó-‰˘·ÛÌ¤ÓË ˘ÔÏÈÈ‰·ÈÌÈÎ‹ ·Áˆ-Á‹. °È· ·Ú¿‰ÂÈÁÌ·, ÛÙË ÌÂÏ¤ÙËFIELD Û¯Â‰fiÓ 1.000 ·ÛıÂÓÂ›˜¤Ï·‚·Ó Û˘Ó‰˘·ÛÌ¤ÓË ıÂÚ·Â›·ÛÙ·Ù›ÓË˜ ÌÂ Ê·ÈÓÔÊÈÌÚ¿ÙË ¯ˆ-Ú›˜ Ó· ·Ó·ÊÂÚıÂ› ·˘ÍËÌ¤ÓË Â›-ÙˆÛË ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ.ŒÙÛÈ, Ë Û˘Ó‰˘·ÛÌ¤ÓË ˘ÔÏÈÈ-‰·ÈÌÈÎ‹ ·ÁˆÁ‹ ÌÔÚÂ› Ó· ¯ÔÚË-ÁËıÂ› ÛÂ ÔÚÈÛÌ¤ÓÔ˘˜ ·ÛıÂÓÂ›˜˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÌÂ ·ÓıÂÎÙÈÎ‹ÌÈÎÙ‹ ‰˘ÛÏÈÈ‰·ÈÌ›·. ∏ ·ÛÊ¿ÏÂÈ·Î·È Ë Û¯¤ÛË ÎfiÛÙÔ˘˜-·ÔÙÂÏÂ-ÛÌ·ÙÈÎfiÙËÙ·˜ ÙË˜ Û˘Ó‰˘·ÛÌ¤ÓË˜ıÂÚ·Â›·˜ ‚Ú›ÛÎÔÓÙ·È ·ÎfiÌË ˘fi¤ÚÂ˘Ó·. ∏ ÊÈÌÚ¿ÙË Ô˘ Ú¤ÂÈÓ· ¯ÔÚËÁÂ›Ù·È ÛÂ ÂÚÈÙÒÛÂÈ˜Û˘Ó‰˘·ÛÌ¤ÓË˜ ıÂÚ·Â›·˜ Â›Ó·È ËÊ·ÈÓÔÊÈÌÚ¿ÙË (ÔÙ¤ Ë ÁÂÌÊÈ-ÌÚÔ˙›ÏË), ÂÓÒ Ô Û˘Ó‰˘·ÛÌfi˜Ú¤ÂÈ Ó· ·ÔÊÂ‡ÁÂÙ·È ÛÂ ËÏÈ-ÎÈˆÌ¤Ó· ¿ÙÔÌ·, Î·ıÒ˜ Î·È ÛÂ¿ÙÔÌ· ÌÂ ¤ÎÙˆÛË ÙË˜ ÓÂÊÚÈÎ‹˜ÏÂÈÙÔ˘ÚÁ›·˜ ‹ ˘Ôı˘ÚÂÔÂÈ‰ÈÛÌfi.∏ ÌÂÏ¤ÙË ACCORD (Action toControl Cardiovascular Risk inDiabetes) Û˘ÁÎÚ›ÓÂÈ ÙË ¯ÔÚ‹ÁË-ÛË ÛÈÌ‚·ÛÙ·Ù›ÓË˜ ¤Ó·ÓÙÈ ÙË˜ ¯Ô-Ú‹ÁËÛË˜ ÙÔ˘ Û˘Ó‰˘·ÛÌÔ‡ ÛÈÌ-‚·ÛÙ·Ù›ÓË˜ ÌÂ Ê·ÈÓÔÊÈÌÚ¿ÙËfiÛÔÓ ·ÊÔÚ¿ ÙËÓ ÂÌÊ¿ÓÈÛË Î·Ú-‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ ÛÂ‰È·‚ËÙÈÎ¿ ¿ÙÔÌ· Î·È ·Ó·Ì¤ÓÂÙ·ÈÓ· ÔÏÔÎÏËÚˆıÂ› ÙÔ 2009.

™Àª¶∂ƒ∞™ª∞Δ∞

Δ· ·ÔÙÂÏ¤ÛÌ·Ù· ÙˆÓ ÌÂÁ¿ÏˆÓÚÔÔÙÈÎÒÓ ÌÂÏÂÙÒÓ ÌÂ ÊÈÌÚ¿-ÙÂ˜ ‰Â›¯ÓÔ˘Ó fiÙÈ Ù· Ê¿ÚÌ·Î· ·˘-Ù‹˜ ÙË˜ Î·ÙËÁÔÚ›·˜ Â›Ó·È È‰È·›ÙÂ-Ú· ¯Ú‹ÛÈÌ· ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈ-ÛË ·ÛıÂÓÒÓ ÌÂ ˘„ËÏ¿ ÙÚÈÁÏ˘ÎÂ-Ú›‰È· Î·È ¯·ÌËÏ¿ Â›Â‰· ∏DL¯ÔÏËÛÙÂÚfiÏË˜. ™Â ·˘ÙÔ‡˜ ÙÔ˘˜·ÛıÂÓÂ›˜ ·Ó·Ì¤ÓÂÙ·È Ë ¯ÔÚ‹ÁË-ÛË ÊÈÌÚ·ÙÒÓ Ó· Ô‰ËÁ‹ÛÂÈ ÛÂÛËÌ·ÓÙÈÎ¿ ÎÏÈÓÈÎ¿ ÔÊ¤ÏË. ŒÙÛÈ,ÔÈ ÊÈÌÚ¿ÙÂ˜ Â›Ó·È Ê¿ÚÌ·Î· ÚÒ-ÙË˜ ÂÈÏÔÁ‹˜ ÁÈ· ¿ÙÔÌ· ÌÂ ÔÏ‡˘„ËÏ¿ ÙÚÈÁÏ˘ÎÂÚ›‰È· (>500 mg/dL)ÁÈ· ÙË ÌÂ›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌ-Ê¿ÓÈÛË˜ ÔÍÂ›·˜ ·ÁÎÚÂ·Ù›ÙÈ‰·˜.


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∂ÈÚfiÛıÂÙ·, ÔÈ ÊÈÌÚ¿ÙÂ˜ ÌÔ-ÚÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ˆ˜ÌÔÓÔıÂÚ·Â›· ÛÂ ¿ÙÔÌ· ÌÂ LDL¯ÔÏËÛÙÂÚfiÏË ÎÔÓÙ¿ ÛÙÔ ÛÙfi¯ÔÙË˜ ıÂÚ·Â›·˜ Ô˘ Ù·˘Ùfi¯ÚÔÓ·ÂÌÊ·Ó›˙Ô˘Ó ˘„ËÏ¿ ÙÚÈÁÏ˘ÎÂÚ›-‰È· Î·È ¯·ÌËÏ¿ Â›Â‰· ∏DL ¯Ô-ÏËÛÙÂÚfiÏË˜. Δ¤ÏÔ˜, È‰È·›ÙÂÚ·ÛËÌ·ÓÙÈÎ‹ Â›Ó·È Ë ı¤ÛË ÙˆÓ ÊÈ-

ÌÚ·ÙÒÓ ÁÈ· ÙË ÌÂ›ˆÛË ÙÔ˘ ˘Ô-ÏÂÈÔÌ¤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ ÌÂÙ¿ ÙËÓÂ›ÙÂ˘ÍË ÌÂ ÙË ¯ÔÚ‹ÁËÛË ÛÙ·Ù›-ÓË˜ ÙˆÓ ÛÙfi¯ˆÓ ÁÈ· ÙËÓ LDL ¯Ô-ÏËÛÙÂÚfiÏË, Ë ÔÔ›· ÂÍ·ÎÔÏÔ˘-ıÂ› Ó· ·ÔÙÂÏÂ› ÙÔÓ Î‡ÚÈÔ ÛÙfi¯ÔÙË˜ ˘ÔÏÈÈ‰·ÈÌÈÎ‹˜ ·ÁˆÁ‹˜. ™Â·˘Ùfi ÙÔ Ï·›ÛÈÔ Ô ÚÔÛÂÎÙÈÎfi˜Û˘Ó‰˘·ÛÌfi˜ Û¯ÂÙÈÎ¿ ¯·ÌËÏ‹˜

‰fiÛË˜ ÛÙ·Ù›ÓË˜ ÌÂ Ê·ÈÓÔÊÈ-ÌÚ¿ÙË ÛÂ ÂÈÏÂÁÌ¤Ó· ¿ÙÔÌ··Ó·Ì¤ÓÂÙ·È Ó· Û˘ÓÂÈÛÊ¤ÚÂÈ ÛÙËÓÂÚ·ÈÙ¤Úˆ ÌÂ›ˆÛË ÙÔ˘ Î·Ú‰È·Á-ÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘.

™‹ÌÂÚ· Â›Ó·È Î·Ï¿ ÙÂÎÌËÚÈˆÌ¤-ÓÔ˜ Ô ÚfiÏÔ˜ ÙÔ˘ Û˘Ì·ıËÙÈÎÔ‡ÓÂ˘ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÛÙËÓ ·-ıÔÁ¤ÓÂÈ· Î·È ÙËÓ ÂÍ¤ÏÈÍË ÙÔ˘Û˘Ó‰ÚfiÌÔ˘ ÙË˜ Î·Ú‰È·Î‹˜ ·ÓÂ-¿ÚÎÂÈ·˜.(1) ¶Ú¿ÁÌ·ÙÈ ÙÔ ·˘ÍË-Ì¤ÓÔ ÊÔÚÙ›Ô ÙË˜ ·ÓÂ·ÚÎÔ‡Û·˜·ÚÈÛÙÂÚ¿˜ ÎÔÈÏ›·˜ Ô‰ËÁÂ› ÛÂ ÌÈ··˘ÍËÌ¤ÓË ‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘Û˘Ì·ıËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ∏·˘ÍËÌ¤ÓË ·˘Ù‹ ‰Ú·ÛÙËÚÈfiÙËÙ·Î·È Ë ·ÏÏËÏÂ›‰Ú·Û‹ ÙÔ˘ ÌÂ ÙÔÛ‡ÛÙËÌ· ÚÂÓ›ÓË˜-·ÁÁÂÈÔÙÂÓÛ›ÓË˜·Ï‰ÔÛÙÂÚfiÓË˜ Î·È ¿ÏÏÔ˘˜ ‰È·‚È-‚·ÛÙ¤˜, ÔÈ ÔÔ›ÔÈ ÂÎÎÚ›ÓÔÓÙ·È·fi Ù· Ì˘ÔÎ·Ú‰È·Î¿ Î‡ÙÙ·Ú·Î·È ¤¯Ô˘Ó ÂÓ‰ÔÎÚÈÓ‹ Î·È ·Ú·-ÎÚÈÓ‹ ‰Ú¿ÛË, Â›Ó·È ˘Â‡ı˘ÓË ÁÈ·ÙËÓ ·ÁÁÂÈÔÛ‡Û·ÛË, ÙËÓ Ù·¯˘-Î·Ú‰›· Î·È ÙÈ˜ ‰ÔÌÈÎ¤˜ ·ÏÏ·Á¤˜ÛÙ· Ì˘ÔÎ·Ú‰È·Î¿ Î‡ÙÙ·Ú· ÔÈÔÔ›Â˜ Ô‰ËÁÔ‡Ó ÛÙËÓ ·ÚÓËÙÈÎ‹·Ó·‰È·ÌfiÚÊˆÛË ÙË˜ ·ÚÈÛÙÂÚ¿˜ÎÔÈÏ›·˜ Î·È ÛÙÈ˜ ·ÚÓËÙÈÎ¤˜ ÂÈ-ÙÒÛÂÈ˜ ÙË˜ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂÎ·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ· (∂ÈÎfiÓ·1).(1) Δ· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¤¯ÂÈÂ‰Ú·ÈˆıÂ› Ë ·Í›· ÙË˜ ·Ó·ÛÙÔÏ‹˜ÙÔ˘ ·‰ÚÂÓÂÚÁÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜

ÛÙËÓ ‚ÂÏÙ›ˆÛË ÙË˜ ÚfiÁÓˆÛË˜ÙˆÓ ·ÛıÂÓÒÓ ÌÂ Î·Ú‰È·Î‹ ·ÓÂ-¿ÚÎÂÈ·. (2)

√È ‚-·ÔÎÏÂÈÛÙ¤˜ Î·Ù¤¯Ô˘ÓÛËÌ·ÓÙÈÎ‹ ı¤ÛË ÛÙË Ê·ÚÌ·ÎÂ˘-ÙÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ Î·Ú‰È·Î‹˜·ÓÂ¿ÚÎÂÈ·˜.(2) °È· ÔÏÏ¿ ¯Úfi-ÓÈ· ÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜ ¤¯Ô˘Ó ¯ÚË-ÛÈÌÔÔÈËıÂ› Î·È ¯ÚËÛÈÌÔÔÈÔ‡-ÓÙ·È ÛÙËÓ ÛÙ·ıÂÚ‹ ÛÙËı¿Á¯Ë,ÛÙËÓ ˘¤ÚÙ·ÛË, ÌÂÙ¿ ·fi ¤Ì-ÊÚ·ÁÌ· Ì˘ÔÎ·Ú‰›Ô˘ Î·È ÛÂ ‰È¿-ÊÔÚÂ˜ ·ÚÚ˘ıÌ›Â˜. Δ· ÙÂÏÂ˘Ù·›·¯ÚfiÓÈ· ¤¯ÂÈ ÙÂÎÌËÚÈˆıÂ› ÌÂ ÔÏ-Ï¤˜ Ù˘¯·ÈÔÔÈËÌ¤ÓÂ˜ Ù˘ÊÏ¤˜ ÌÂ-Ï¤ÙÂ˜ Ô ÚfiÏÔ˜ ÙÔ˘˜ ÛÙËÓ ·ÓÙÈÌÂ-ÙÒÈÛË ·ÛıÂÓÒÓ ÌÂ Î·Ú‰È·Î‹·ÓÂ¿ÚÎÂÈ·. √È ‚-·ÔÎÏÂÈÛÙ¤˜ÌÔÚÔ‡Ó Ó· ‰È·ÎÚÈıÔ‡Ó ·‰Ú¿ÛÙÔ˘˜ ÌË ÂÎÏÂÎÙÈÎÔ‡˜ (·ÔÎÏÂ›-Ô˘Ó ÙÔ˘˜ ‚1 Î·È ÙÔ˘˜ ‚2 ·‰ÚÂ-ÓÂÚÁÈÎÔ‡˜ ˘Ô‰Ô¯Â›˜) Î·È ÛÂ ·˘-ÙÔ‡˜ ÔÈ ÔÔ›ÔÈ ÂÌÊ·Ó›˙Ô˘Ó ÌÂÁ·-Ï‡ÙÂÚË Û˘ÁÁ¤ÓÂÈ· ÌÂ ÙÔ˘˜ ‚1˘Ô‰Ô¯Â›˜. ∂ÈÚfiÛıÂÙ· ÔÚÈÛÌ¤-ÓÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜ ÂÌÊ·Ó›˙Ô˘ÓÂÚÈÊÂÚÈÎ‹ ·ÁÁÂÈÔ‰È·ÛÙÔÏ‹ Â›ÙÂ‰È· Ì¤ÛÔ˘ ·1 ·‰ÚÂÓÂÚÁÈÎ‹˜ ·Ó·-ÛÙÔÏ‹˜ (Î·Ú‚Â‰ÈÏfiÏË, Ï·‚ÂÙ·Ïfi-

ÏË) Â›ÙÂ ‰È·Ì¤ÛÔ˘ ‚2 ·‰ÚÂÓÂÚÁÈ-Î‹˜ ‰È¤ÁÂÚÛË˜ (ÛÂÏÈÚÔÏfiÏË),Â›ÙÂ ‰È· Ì¤ÛÔ˘ ÌË¯·ÓÈÛÌÒÓ ·ÓÂ-Í¿ÚÙËÙˆÓ ·fi ÙÔÓ ·ÔÎÏÂÈÛÌfiÙˆÓ ·‰ÚÂÓÂÚÁÈÎÒÓ ˘Ô‰Ô¯¤ˆÓ(‚Ô˘ÛÈÓ‰ÔÏfiÏË, ÓÂÌÈ‚ÔÏfiÏË).(2)

Δ· ÔÊ¤ÏË ·fi ÙË ¯ÔÚ‹ÁËÛË‚-·ÔÎÏÂÈÛÙÒÓ ÛÂ ·ÛıÂÓÂ›˜ ÌÂÛ˘ÛÙÔÏÈÎ‹ Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ·¤¯Ô˘Ó ÙÂÎÌËÚÈˆıÂ› ·fi ÔÏÏ¤˜ÌÈÎÚ¤˜ ÌÂÏ¤ÙÂ˜ Î·È ·ÚÎÂÙ¤˜ ÌÂ-Á¿ÏÂ˜ ÚÔÔÙÈÎ¤˜ ‰ÈÏ¿ - Ù˘ÊÏ¤˜Ù˘¯·ÈÔÔÈËÌ¤ÓÂ˜ ÌÂÏ¤ÙÂ˜ ÌÂ ÙË‚Ô‹ıÂÈ· ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘.™˘ÓÔÏÈÎ¿, ÛÙÈ˜ ÌÂÏ¤ÙÂ˜ ·˘Ù¤˜Û˘ÌÂÚÈÂÏ‹ÊıËÎ·Ó 15.000 ·ÛıÂ-ÓÂ›˜. ™ÙÈ˜ Î˘ÚÈfiÙÂÚÂ˜ ·fi ·˘Ù¤˜Ô˘ ·ÊÔÚÔ‡Û·Ó ÙË ¯ÔÚ‹ÁËÛËÎ·Ú‚Â‰ÈÏfiÏË˜ (5 ÌÂÏ¤ÙÂ˜), ‚ÈÛÔ-ÚÔÏfiÏË˜ (1 ÌÂÏ¤ÙË) Î·È ÌÂÙÔ-ÚÔÏfiÏË˜ CR/XL (2 ÌÂÏ¤ÙÂ˜), Ë¯ÔÚ‹ÁËÛË ÙÔ˘ ‚-·ÔÎÏÂÈÛÙ‹ ÛÂÛ‡ÁÎÚÈÛË ÌÂ ÙÔ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·-ÎÔ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ Î·Ú‰È·Î‹ ·ÓÂ-¿ÚÎÂÈ· ÛÙ·‰›Ô˘ ¡À∏∞ ππ-πV, Â›¯Âˆ˜ ·ÔÙ¤ÏÂÛÌ· ÛÙ·ÙÈÛÙÈÎ¿ ÛË-Ì·ÓÙÈÎ‹ ÌÂ›ˆÛË ÛÙË Û˘ÓÔÏÈÎ‹ Î·ÈÎ·Ú‰È·ÁÁÂÈ·Î‹ ıÓËÙfiÙËÙ·, Û˘-ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ ·ÈÊÓ›-‰ÈˆÓ Î·Ú‰È·ÎÒÓ ı·Ó¿ÙˆÓ Î·È ÙˆÓı·Ó¿ÙˆÓ Ô˘ ÔÊÂ›ÏÔÓÙ·È ÛÂ ÚÔ-Ô‰Â˘ÙÈÎ‹ ÂÈ‰Â›ÓˆÛË ÙË˜ ÓfiÛÔ˘.∂ÈÚfiÛıÂÙ· ÔÊ¤ÏË ·fi ÙË ¯Ô-Ú‹ÁËÛË ÙÔ˘ ‚-·ÔÎÏÂÈÛÙ‹ ·ÊÔ-ÚÔ‡Û·Ó ÙË ÌÂ›ˆÛË ÙˆÓ ÓÔÛËÏÂÈ-ÒÓ ·fi Î·Ú‰È·ÁÁÂÈ·Î¿ Î·È ÌË ·›-ÙÈ·, ÙË ‚ÂÏÙ›ˆÛË ÙË˜ ÏÂÈÙÔ˘ÚÁÈ-Î‹˜ Î·Ù¿ÛÙ·ÛË˜ Î·È ÙËÓ ÂÈ‚Ú¿-‰˘ÓÛË ÙË˜ ÂÍ¤ÏÈÍË˜ ÙË˜ ÓfiÛÔ˘.Δ· ÔÊ¤ÏË ·˘Ù¿ ‹Ù·Ó ·ÓÂÍ¿ÚÙËÙ··fi ÙËÓ ËÏÈÎ›·, ÙÔ Ê‡ÏÔ, ÙËÓ‡·ÚÍË Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË, ÙËÓ·ÈÙÈÔÏÔÁ›· (ÈÛ¯·ÈÌÈÎ‹ ‹ fi¯È) Î·ÈÙËÓ ·Ú¯ÈÎ‹ ÏÂÈÙÔ˘ÚÁÈÎ‹ Î·Ù¿ÛÙ·-ÛË.(2) ™˘ÓÔÏÈÎ¿, Û‡ÌÊˆÓ· ÌÂ Ù··ÔÙÂÏ¤ÛÌ·Ù· ÙˆÓ ‰È·ÊfiÚˆÓ ÌÂ-ÏÂÙÒÓ, Ú¤ÂÈ Ó· ıÂÚ·Â‡ÔÓÙ·È15-43 ·ÛıÂÓÂ›˜ ÌÂ Î·Ú‰È·Î‹ ·ÓÂ-¿ÚÎÂÈ· ÒÛÙÂ Ó· ·ÔÊÂ˘¯ıÂ›¤Ó·˜ ı¿Ó·ÙÔ˜ (∂ÈÎfiÓ· 2). (3)

∂˘Ú‹Ì·Ù· ·fi ÌÂÁ¿ÏÂ˜ ‰Ë-ÌÔÛÎÔ‹ÛÂÈ˜ (surveys) ‰Â›¯ÓÔ˘ÓfiÙÈ Ë Û˘¯ÓfiÙËÙ· Û˘ÓÙ·ÁÔÁÚ¿ÊË-

π √ À ¡ π √ ™ 2 0 0 8

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‚-·ÔÎÏÂÈÛÙ¤˜ Î·È ∫·Ú‰È·Î‹ ∞ÓÂ¿ÚÎÂÈ·.

∞. ¶··ı·Ó·Û›Ô˘∫·Ú‰ÈÔÏfiÁÔ˜, ∂ÍÂÈ‰ÈÎÂ˘fiÌÂÓÔ˜ ∂ÓÙ·ÙÈÎÔÏÔÁ›·˜, ª∂£ ¶°¡ πˆ·ÓÓ›ÓˆÓ

π. °Ô˘‰¤‚ÂÓÔ˜∫·ıËÁËÙ‹˜ ∫·Ú‰ÈÔÏÔÁ›·˜, ∫·Ú‰ÈÔÏÔÁÈÎ‹ ∫ÏÈÓÈÎ‹ ¶°¡ πˆ·ÓÓ›ÓˆÓ

∂ÈÎfiÓ· 1. √ ÚfiÏÔ˜ ÙÔ˘ Û˘Ì·ıËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÛÙËÓ ÂÍ¤ÏÈÍË ÙË˜ Î·Ú‰È·-Î‹˜ ·ÓÂ¿ÚÎÂÈ·˜. (™¡™: Û˘Ì·ıËÙÈÎfi ÓÂ˘ÚÈÎfi Û‡ÛÙËÌ·, ƒ∞∞: Û‡ÛÙËÌ· ÚÂÓ›-ÓË˜-·ÁÁÂÈÔÙÂÓÛ›ÓË˜-·Ï‰ÔÛÙÂÚfiÓË˜).

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

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ÛË˜ ‚-·ÔÎÏÂÈÛÙÒÓ ÛÂ ËÏÈÎÈˆÌ¤-ÓÔ˘˜, Á˘Ó·›ÎÂ˜ Î·È ¿ÙÔÌ· ÌÂ Û˘-Ó˘¿Ú¯Ô˘ÛÂ˜ ·ı‹ÛÂÈ˜ (ÓÂ˘ÌÔ-ÓÔ¿ıÂÈÂ˜, ‰È·‚‹ÙË ÓÂÊÚÈÎ‹ ·ÓÂ-¿ÚÎÂÈ·) Â›Ó·È ÂÚÈÔÚÈÛÌ¤ÓË. ∂-ÂÈ‰‹ Ë Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ· Â›-Ó·È Û˘¯Ó‹ ÛÙÔ˘˜ ËÏÈÎÈˆÌ¤ÓÔ˘˜Î·È ÂÂÈ‰‹ Ë ıÓËÙfiÙËÙ· ·˘Í¿ÓÂÈ·fiÙÔÌ· ÛÙÔ˘˜ ËÏÈÎÈˆÌ¤ÓÔ˘˜, ÙÔ‰˘ÓËÙÈÎfi fiÊÂÏÔ˜ ÛÂ ·˘Ù‹ ÙËÓËÏÈÎÈ·Î‹ ÔÌ¿‰· Â›Ó·È „ËÏfi. ∏·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ·˘Ù‹ ‰Â›-¯ıËÎÂ ÛÂ ÌÈ· ÌÂÙ·-·Ó¿Ï˘ÛË Ô˘Û˘ÌÂÚÈ¤Ï·‚Â >12.000 ·ÛıÂÓÂ›˜·fi 5 ÌÂÏ¤ÙÂ˜. ™‡ÌÊˆÓ· ÌÂ Ù··ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ Û˘ÁÎÂÎÚÈÌ¤-ÓË˜ ÌÂÙ·-·Ó¿Ï˘ÛË˜ Ù· ÔÊ¤ÏË·fi ÙË ¯ÔÚ‹ÁËÛË ÙˆÓ ‚-·ÔÎÏÂÈ-ÛÙÒÓ ÛÂ ËÏÈÎÈˆÌ¤ÓÔ˘˜ ·ÛıÂÓÂ›˜ÌÂ Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ· Â›Ó·È·ÚfiÌÔÈ· ÌÂ ·˘Ù¿ ÛÙÔ˘˜ ÌË ËÏÈ-ÎÈˆÌ¤ÓÔ˘˜. (4) ∏ ·ÛÊ¿ÏÂÈ· Î·È Ë·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙË˜ ¯ÔÚ‹-ÁËÛË˜ ÓÂÌÈ‚ÔÏfiÏË˜ ÛÂ ËÏÈÎÈˆ-Ì¤ÓÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂÏÂÙ‹ıËÎÂ Î·ÈÛÙË ÌÂÏ¤ÙË SENIORS.(5) ™ÙË Û˘-ÁÎÂÎÚÈÌ¤ÓË Ù˘¯·ÈÔÔÈËÌ¤ÓË Ô-Ï˘ÎÂÓÙÚÈÎ‹ ÌÂÏ¤ÙË Û˘ÌÌÂÙÂ›¯·Ó2135 ·ÛıÂÓÂ›˜ ËÏÈÎ›·˜ ¿Óˆ ÙˆÓ70 ÂÙÒÓ ÌÂ Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ·ÔÈ ÔÔ›ÔÈ Ù˘¯·ÈÔÔÈ‹ıËÎ·Ó Ó·Ï¿‚Ô˘Ó ÓÂÌÈ‚ÔÏfiÏË ‹ ÂÈÎÔÓÈÎfiÊ¿ÚÌ·ÎÔ. ™‡ÌÊˆÓ· ÌÂ Ù· ·ÔÙÂ-Ï¤ÛÌ·Ù· ÙË˜ ÌÂÏ¤ÙË˜ Ë ¯ÔÚ‹ÁË-ÛË ÓÂÌÈ‚ÔÏfiÏË˜ Û¯ÂÙ›ÛÙËÎÂ ÌÂÌÂ›ˆÛË ÙË˜ Î·Ú‰È·ÁÁÂÈ·Î‹˜ ıÓË-ÙfiÙËÙ·˜ Î·È ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÓÔ-

ÛËÏÂÈÒÓ (∂ÈÎfiÓ· 3).(5)

ΔÔ ı‹Ï˘ Ê‡ÏÔ Â›ÛË˜ ‰ÂÓ Ú¤-ÂÈ ·ÔÙÂÏÂ› ÊÚ·ÁÌfi ÛÙË Û˘-ÓÙ·ÁÔÁÚ¿ÊËÛË ‚-·ÔÎÏÂÈÛÙÒÓ.

∏ ÌÔÓ·‰ÈÎ‹ ÌÂÏ¤ÙË ·Â˘ıÂ›·˜Û‡ÁÎÚÈÛË˜ ‰‡Ô ‚-·ÔÎÏÂÈÛÙÒÓ(ÌÂÙÔÚÔÏfiÏË˜ ¤Ó·ÓÙÈ Î·Ú‚Â‰È-ÏfiÏË˜) Â›Ó·È Ì¤¯ÚÈ Û‹ÌÂÚ· ËCarvedilol Or Metoprolol Europe-an Trial (COMET).(6) ™ÙË ÌÂÏ¤ÙË·˘Ù‹ Û˘ÌÂÚÈÂÏ‹ÊıËÎ·Ó 3029·ÛıÂÓÂ›˜ ·fi 317 Î¤ÓÙÚ· 15 ∂˘-Úˆ·˚ÎÒÓ ¯ˆÚÒÓ, ÌÂ ÂËÚÂ·-ÛÌ¤ÓÔ ÎÏ¿ÛÌ· ÂÍÒıËÛË˜ Î·È ÔÈÔÔ›ÔÈ Ù˘¯·ÈÔÔÈ‹ıËÎ·Ó Ó· Ï¿-‚Ô˘Ó Â›ÙÂ Î·Ú‚Â‰ÈÏfiÏË (25 mg x2) Â›ÙÂ ÙÚ˘ÁÈÎ‹ ÌÂÙÔÚÔÏfiÏË (ÂÓ-‰È¿ÌÂÛË˜ ·ÂÏÂ˘ı¤ÚˆÛË˜ ÌÂÙÔ-

ÚÔÏfiÏË ÛÂ ‰fiÛË 50 mg x 2).ªÂÙ¿ ·fi ‰È¿ÚÎÂÈ· ·Ú·ÎÔÏÔ‡-ıËÛË˜ 58 ÌËÓÒÓ Ë Û˘ÓÔÏÈÎ‹ ıÓË-ÙfiÙËÙ· ÛÙËÓ ÔÌ¿‰· ÙË˜ Î·Ú‚Â‰È-ÏfiÏË˜ ‹Ù·Ó ÛËÌ·ÓÙÈÎ¿ ¯·ÌËÏfiÙÂ-ÚË (34% ¤Ó·ÓÙÈ 40% ÛÙËÓ ÔÌ¿‰·ÙË˜ ÌÂÙÔÚÔÏfiÏË˜ ·ÓÙ›ÛÙÔÈ¯·).(6)¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë Û˘ÁÎÂÎÚÈ-Ì¤ÓË ÌÂÏ¤ÙË ·Ó¤‰ÂÈÍÂ ÙËÓ ·ÓˆÙÂ-ÚfiÙËÙ· ÙË˜ Î·Ú‚Â‰ÈÏfiÏË˜ ¤Ó·ÓÙÈÙË˜ ÂÓ‰È¿ÌÂÛË˜ ·Ô‰¤ÛÌÂ˘ÛË˜ÌÂÙÔÚÔÏfiÏË˜ ÛÂ ·ÛıÂÓÂ›˜ ÌÂÎ·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ·, ‰¤¯ıËÎÂ¤ÓÙÔÓË ÎÚÈÙÈÎ‹ Ë ÔÔ›· ·ÊÔÚÔ‡-ÛÂ ÛÙË ¯Ú‹ÛË ‰È·ÊÔÚÂÙÈÎÔ‡ÛÎÂ˘¿ÛÌ·ÙÔ˜ ÌÂÙÔÚÔÏfiÏË˜ ÛÂÛ‡ÁÎÚÈÛË ÌÂ ÂÎÂ›ÓÔ Ô˘ ¤¯ÂÈ¯ÚËÛÈÌÔÔÈËıÂ› Î·È ÁÈ· ÙÔ ÔÔ›Ô


17

∂ÈÎfiÓ· 3. ¶ÚˆÙÂ‡ÔÓ Î·Ù·ÏËÎÙÈÎfi ÛËÌÂ›Ô (Û˘ÓÔÏÈÎ‹ ıÓËÙfiÙËÙ· Î·È Û˘ÓÔÏÈÎ¤˜ÂÈÛ·ÁˆÁ¤˜ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÏfiÁˆ Î·Ú‰È·ÁÁÂÈ·Î‹˜ ·ÈÙÈÔÏÔÁ›·˜ ) ÛÙË ÌÂÏ¤ÙËSENIORS (Ì¤ÛË ÂÚ›Ô‰Ô˜ ·Ú·ÎÔÏÔ‡ıËÛË˜ 21 Ì‹ÓÂ˜).

∂ÈÎfiÓ· 2. ∞ÚÈıÌfi˜ ·ÛıÂÓÒÓ ÌÂ Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ· Ô˘ Ú¤ÂÈ Ó· ıÂÚ·Â˘ÙÔ‡Ó ÒÛÙÂ Ó· ·ÔÊÂ˘¯ıÂ› 1 ı¿Ó·ÙÔ˜.(CAPRICORN: CArvedilol Post infaRction SurvIval COntRol in left ventricular dysfunctioN, CIBIS: Cardiac InsufficiencyBisoprolol Study, COPERNICUS: CarvedilOl ProspEctive RaNdomIzed CUmulative Survival Trial, MERIT-HF:MEtoprololCR/XL Randomized Intervention Trial in chronic Heart Failure).

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Â›¯Â ÙÂÎÌËÚÈˆıÂ› Ë ·ÔÙÂÏÂÛÌ·-ÙÈÎfiÙËÙ¿ ÙÔ˘ ÛÂ ·Ï·ÈfiÙÂÚÂ˜ ÌÂ-Ï¤ÙÂ˜, fiˆ˜ Ë MERIT-HF. ∂È-ÚfiÛıÂÙ· ÛÙË ÌÂÏ¤ÙË COMET Ë‰fiÛË ÙË˜ ÌÂÙÔÚÔÏfiÏË˜ ‹Ù·Ó ÛË-Ì·ÓÙÈÎ¿ ÌÈÎÚfiÙÂÚË ·fi ÙËÓ ·ÓÙ›-ÛÙÔÈ¯Ë ÛÙËÓ MERIT-HF (50 mg x 2¤Ó·ÓÙÈ 100 mg x 2 ·ÓÙ›ÛÙÔÈ¯·).(2)¶·Ú¿ ÙË ÎÚÈÙÈÎ‹ Ù· ·ÔÙÂÏ¤ÛÌ·-Ù· ÙË˜ ÌÂÏ¤ÙË˜ COMET ‰Â›¯ÓÔ˘ÓfiÙÈ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ Î·Ú‰È·Î‹·ÓÂ¿ÚÎÂÈ· Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfi-ÙËÙ· ÙˆÓ ‚-·ÔÎÏÂÈÛÙÒÓ ‰È·Ê¤-ÚÂÈ ·Ó¿ÏÔÁ· ÌÂ ÙÔ ÛÎÂ‡·ÛÌ· Î·ÈÙÔ Â›‰Ô˜ ÙÔ˘ ‚-·ÔÎÏÂÈÛÙ‹ Î·ÈÁÈ· ÙÔÓ ÏfiÁÔ ·˘Ùfi ı· Ú¤ÂÈ Ó·¯ÔÚËÁÔ‡ÓÙ·È ÌfiÓÔ ÔÈ ‚-·ÔÎÏÂÈ-ÛÙ¤˜ ÙˆÓ ÔÔ›ˆÓ Ë ·ÛÊ¿ÏÂÈ· Î·ÈË ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ¤¯ÂÈ ÙÂÎ-ÌËÚÈˆıÂ› ·fi Ù˘¯·ÈÔÔÈËÌ¤ÓÂ˜ÌÂÏ¤ÙÂ˜.

∏ ¯ÔÚ‹ÁËÛË ‚-·ÔÎÏÂÈÛÙÒÓÂÓ‰Â›ÎÓ˘Ù·È ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈ-ÛË ·ÛıÂÓÒÓ ÌÂ ÛÙ·ıÂÚ‹ ‹È·,Ì¤ÙÚÈ· ‹ ÛÔ‚·Ú‹ Î·Ú‰È·Î‹ ·ÓÂ-¿ÚÎÂÈ· ÈÛ¯·ÈÌÈÎ‹˜ ‹ ÌË ·ÈÙÈÔÏÔ-Á›·˜, ¿ÓÙ· ˆ˜ Ì¤ÚÔ˜ ÙË˜ ÎÏ·Û-ÛÈÎ‹˜ ıÂÚ·Â˘ÙÈÎ‹˜ ·ÓÙÈÌÂÙÒÈ-ÛË˜ Ë ÔÔ›· Ú¤ÂÈ Ó· ÂÚÈÏ·Ì-‚¿ÓÂÈ ·Ó·ÛÙÔÏÂ›˜ ÙÔ˘ ÌÂÙ·ÙÚÂ-ÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ Î·È ‰ÈÔ˘ÚËÙÈÎ¿.∏ ·Ú·¿Óˆ Ô‰ËÁ›· ¯·Ú·ÎÙËÚ›-˙ÂÙ·È ÌÂ ‚·ıÌfi ÛËÌ·ÓÙÈÎfiÙËÙ·˜Ù¿ÍË˜ π Î·È Â›Â‰Ô ÙÂÎÌËÚ›ˆÛË˜

∞. ¶Ú¤ÂÈ Ó· ÛËÌÂÈˆıÂ› fiÙÈ ‰Â-‰ÔÌ¤Ó· ·fi ÙÈ˜ ÎÏÈÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜˘ÔÛÙËÚ›˙Ô˘Ó ÙË ¯ÔÚ‹ÁËÛË ‚È-ÛÔÚÔÏfiÏË˜, Î·Ú‚Â‰ÈÏfiÏË˜, ÓÂ-ÌÈ‚ÔÏfiÏË˜ Î·È ÌÂÙÔÚÔÏfiÏË˜CR. H ÙÚ˘ÁÈÎ‹ ÌÂÙÔÚÔÏfiÏË (tar-trate) ‰ÂÓ Û˘ÓÈÛÙ¿Ù·È.(7) √È ÂÓ‰Â›-ÍÂÈ˜ ¯ÔÚ‹ÁËÛË˜ ‚-·ÔÎÏÂÈÛÙÒÓ ÛÂ·ÛıÂÓÂ›˜ ÌÂ ÛÙ·ıÂÚÔÔÈËÌ¤ÓËÎ·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ· Ê·›ÓÔÓÙ·ÈÛÙÔÓ ¶›Ó·Î· 1, ÂÓÒ ÛÙÔÓ ¶›Ó·Î· 2·Ó·Ê¤ÚÔÓÙ·È ÔÈ ·ÓÙ›ÛÙÔÈ¯Â˜ ‰fi-ÛÂÈ˜ ÙÈÙÏÔÔ›ËÛË˜.

Δ· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· È‰È·›ÙÂ-ÚË ÚÔÛÔ¯‹ ¤¯ÂÈ ‰ÔıÂ› ÛÙÔ˘˜·ÛıÂÓÂ›˜ ÌÂ Î·Ú‰È·Î‹ ·ÓÂ¿Ú-ÎÂÈ· Î·È ‰È·ÙËÚËÌ¤ÓÔ ÎÏ¿ÛÌ·ÂÍÒıËÛË˜. ∞ÔÙÂÏ¤ÛÌ·Ù· ÌÂÏÂ-ÙÒÓ Î·Ù·ÁÚ·Ê‹˜ ¤‰ÂÈÍ·Ó fiÙÈ ÔÈÌÈÛÔ› ÂÚ›Ô˘ ·fi ÙÔ˘˜ ·ÛıÂ-ÓÂ›˜ ÌÂ Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ· Â›-ÙÂ ÛÙË ÎÔÈÓfiÙËÙ· (8), Â›ÙÂ ÛÙÔÓÔÛÔÎÔÌÂ›Ô (9) ¤¯Ô˘Ó ‰È·ÙËÚË-Ì¤ÓÔ ÎÏ¿ÛÌ· ÂÍÒıËÛË˜ Î·È ·-ÚfiÌÔÈ· ÓÔÛËÚfiÙËÙ· Î·È ıÓËÙfiÙË-Ù· ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙÔ˘˜ ·ÓÙ›-ÛÙÔÈ¯Ô˘˜ ·ÛıÂÓÂ›˜ ÌÂ ÌÂÈˆÌ¤ÓÔÎÏ¿ÛÌ· ÂÍÒıËÛË˜. (8-10) ¢Â‰Ô-Ì¤Ó· Ù˘¯·ÈÔÔÈËÌ¤ÓˆÓ ÌÂÏÂÙÒÓÁÈ· ÙË ¯ÔÚ‹ÁËÛË ‚-·ÔÎÏÂÈÛÙÒÓÛÂ ·ÛıÂÓÂ›˜ ÌÂ Î·Ú‰È·Î‹ ·ÓÂ-¿ÚÎÂÈ· Î·È ‰È·ÙËÚËÌ¤ÓÔ ÎÏ¿-ÛÌ· ÂÍÒıËÛË˜ Â›Ó·È Û¿ÓÈ·. £Â-ÙÈÎ¿ Â›Ó·È Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ·fi

ÙË ¯ÔÚ‹ÁËÛË ‚-·ÔÎÏÂÈÛÙÒÓ ÛÂËÏÈÎÈˆÌ¤ÓÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ Î·Ú-‰È·Î‹ ·ÓÂ¿ÚÎÂÈ· Î·È ‰È·ÙËÚË-Ì¤ÓÔ ÎÏ¿ÛÌ· ÂÍÒıËÛË˜ fiˆ˜·Ó¤‰ÂÈÍÂ Ë ÌÂÏ¤ÙË SENIORS. (5)√È Û˘ÛÙ¿ÛÂÈ˜ ÁÈ· ÙË ¯ÔÚ‹ÁËÛË‚-·ÔÎÏÂÈÛÙÒÓ ÛÂ ·ÛıÂÓÂ›˜ ÌÂÎ·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ· Î·È ‰È·ÙË-ÚËÌ¤ÓÔ ÎÏ¿ÛÌ· ÂÍÒıËÛË˜ Â›Ó·ÈÂÌÂÈÚÈÎ¤˜ Î·È ‚·Û›˙ÔÓÙ·È ÛÙ·ıÂˆÚËÙÈÎ¿ ÔÊ¤ÏË Ô˘ ËÁ¿˙Ô˘Ó·fi ÙËÓ ÌÂ›ˆÛË ÙË˜ Î·Ú‰È·Î‹˜Û˘¯ÓfiÙËÙ·˜, ÙËÓ ·‡ÍËÛË ÙË˜‰È·ÛÙÔÏÈÎ‹˜ ÂÚÈfi‰Ô˘ Î·È ÙËÓ‚ÂÏÙ›ˆÛË ÙË˜ ÈÛ¯·ÈÌ›·˜ Ô˘ Ù·Ê¿ÚÌ·Î· ·˘Ù¿ ÚÔÎ·ÏÔ‡Ó.

¶·ÚÔÌÔ›ˆ˜ ‰Â‰ÔÌ¤Ó· Ù˘¯·È-ÔÔÈËÌ¤ÓˆÓ ÌÂÏÂÙÒÓ ‰ÂÓ ˘¿Ú-¯Ô˘Ó Ô‡ÙÂ fiÛÔÓ ·ÊÔÚ¿ ÙË ¯ÔÚ‹-ÁËÛË ‚-·ÔÎÏÂÈÛÙÒÓ ÛÂ ÔÍÂ›·Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ·. º·›ÓÂÙ·ÈfiÙÈ Ë ¯ÔÚ‹ÁËÛË ÙˆÓ Ê·ÚÌ¿ÎˆÓ·˘ÙÒÓ ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÌÂÔÏ‡ ÚÔÛÔ¯‹ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ˘ÁÚÔ‡˜ ÚfiÁ¯Ô˘˜ Î·È ˘fiÙ·ÛË,ÂÓÒ ›Ûˆ˜ Ó· ˆÊÂÏÔ‡Ó ·ÛıÂÓÂ›˜ÌÂ ÔÍÂ›· Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ·,Ù·¯˘Î·Ú‰›· Î·È Ì˘ÔÎ·Ú‰È·Î‹ÈÛ¯·ÈÌ›·. (11). ¶¿ÓÙˆ˜ ‚-·ÔÎÏÂÈ-ÛÙ¤˜ ı· Ú¤ÂÈ Ó· ¯ÔÚËÁÔ‡ÓÙ·È¿ÌÂÛ· ÌÂÙ¿ ÙË ÛÙ·ıÂÚÔÔ›ËÛËÙˆÓ ·ÛıÂÓÒÓ ·˘ÙÒÓ.(11) ™ÙËÓ ÌÂ-Ï¤ÙË COMMIT (ClOpidogrel andMetoprolol in Myocardial Infarc-

π √ À ¡ π √ ™ 2 0 0 8

18

¶›Ó·Î·˜ 1. ∂Ó‰Â›ÍÂÈ˜ ¯ÔÚ‹ÁËÛË˜ ‚-·ÔÎÏÂÈÛÙÒÓ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ·[ÙÚÔÔÔÈËÌ¤ÓÔ ·fi (2)]

Δ¿ÍË ∂›Â‰ÔÙÂÎÌËÚ›ˆÛË˜

ŸÏÔÈ ÔÈ ÛÙ·ıÂÚÔÔÈËÌ¤ÓÔÈ ·ÛıÂÓÂ›˜ ÌÂ NYHA II-IV π ∞

∞Û˘ÌÙˆÌ·ÙÈÎ‹ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ·ÚÈÛÙÂÚ¿˜ ÎÔÈÏ›·˜ ÌÂÙ¿ ·fi √∂ª π ∞

∞Û˘ÌÙˆÌ·ÙÈÎ‹ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ·ÚÈÛÙÂÚ¿˜ ÎÔÈÏ›·˜ ¯ˆÚ›˜ √∂ª π μ

ÃÚfiÓÈ· ∫∞ ÌÂ ‰È·ÙËÚËÌ¤ÓÔ ÎÏ¿ÛÌ· ÂÍÒıËÛË˜ (ÌÂ›ˆÛË Û˘¯ÓfiÙËÙ·˜) ππa C

√ÍÂ›· ·ÓÙÈÚÚÔÔ‡ÌÂÓË Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ· ÌÂÙ¿ ·fi √∂ª IIa B

∞ÛıÂÓÂ›˜ ÌÂ ÔÍÂ›· ∫∞ ÌÂÙ¿ ÙË ÛÙ·ıÂÚÔÔ›ËÛË π ∞

∫∞: Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ·, √∂ª: ÔÍ‡ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘

¶›Ó·Î·˜ 2. ¢fiÛÂÈ˜ ÙÈÙÏÔÔ›ËÛË˜ ‚-·ÔÎÏÂÈÛÙÒÓ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ· ·Ó¿ ÛÎÂ‡·ÛÌ·[ÙÚÔÔÔÈËÌ¤ÓÔ ·fi (7)]

™ÎÂ‡·ÛÌ· ∞Ú¯ÈÎ‹ ‰fiÛË ∞˘Í‹ÛÂÈ˜ ¢fiÛË ÛÙfi¯Ô˜(mg) (mg/Ì¤Ú·) (mg/Ì¤Ú·)

μÈÛÔÚÔÏfiÏË 1,25 2,5 - 3,75 - 5 - 7,5 - 10 10

ªÂÙÔÚÔÏfiÏË CR/XL 12,5/25 25 - 50 - 100 -200 200

∫·Ú‚Â‰ÈÏfiÏË 3,125 6,25 - 12,5 -25 - 50 50

¡ÂÌÈ‚ÔÏfiÏË 1,25 2,5 - 5 - 10 10

tion) Ë ¿ÌÂÛË ¯ÔÚ‹ÁËÛË ÌÂÙÔ-ÚÔÏfiÏË˜ Û¯ÂÙ›ÛÙËÎÂ ÌÂ ÌÂÈˆÌ¤-ÓÔ Î›Ó‰˘ÓÔ ÁÈ· Â·Ó¤ÌÊÚ·ÁÌ· Î·ÈÂÌÊ¿ÓÈÛË ÎÔÈÏÈ·Î‹˜ Ù·¯˘Î·Ú‰›·˜,·ÏÏ¿ ÌÂ ·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ÂÎ-‰‹ÏˆÛË Î·Ú‰ÈÔÁÂÓÔ‡˜ Î·Ù·ÏË-Í›·˜ Î·Ù¿ 30%, Î˘Ú›ˆ˜ Î·Ù¿ ÙÔÚÒÙÔ 24ˆÚÔ ·fi ÙËÓ ¤Ó·ÚÍËÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ. (12) √ Î›Ó‰˘-ÓÔ˜ ·˘Ùfi˜ ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚÔ˜ ÛÂ·ÛıÂÓÂ›˜ ËÏÈÎ›·˜ >70 ÂÙÒÓ, ÛÂ·˘ÙÔ‡˜ ÌÂ Û˘ÛÙÔÏÈÎ‹ ›ÂÛË <120mmHg, Î·Ú‰È·Î‹ Û˘¯ÓfiÙËÙ· >110ÛÊ‡ÍÂÈ˜/ÏÂÙfi, Î·È ÛÂ ·˘ÙÔ‡˜Ô˘ ÌÂ Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ· Ù¿-ÍË˜ III Î·Ù¿ Killip Î·Ù¿ ÙËÓ ÂÈÛ·-ÁˆÁ‹. (12) °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi Ë¯ÔÚ‹ÁËÛË ‚-·ÔÎÏÂÈÛÙÒÓ ÛÂ·ÛıÂÓÂ›˜ ÌÂ Î·Ú‰È·Î‹ ·ÓÂ¿Ú-ÎÂÈ· Î·È ÔÍ‡ ÛÙÂÊ·ÓÈ·›Ô Û‡Ó‰ÚÔ-ÌÔ Î·Ù¿ ÙËÓ ÔÍÂ›· Ê¿ÛË ı· Ú¤-ÂÈ Ó· ·ÔÊÂ‡ÁÂÙ·È ÙÔ˘Ï¿¯ÈÛÙÔÓÌ¤¯ÚÈ Ó· ÂÈÙÂ˘¯ıÂ› Ë ·ÈÌÔ‰˘Ó·ÌÈ-Î‹ ÛÙ·ıÂÚfiÙËÙ· Î·È Ó· ˘Ô¯ˆÚ‹-ÛÔ˘Ó Ù· Û˘ÌÙÒÌ·Ù· ÙË˜ ÔÍÂ›·˜Î·Ú‰È·Î‹˜ ·ÓÂ¿ÚÎÂÈ·˜ ÛÙÔ˘˜

·ÛıÂÓÂ›˜ ·˘ÙÔ‡˜. (12) √È ‚-·ÔÎÏÂÈÛÙ¤˜ Â›Ó·È Ë 4Ë

Î·Ù¿ ÛÂÈÚ¿ ÈÔ Û˘¯Ó¿ Û˘ÓÙ·ÁÔ-ÁÚ·ÊÔ‡ÌÂÓË Î·ÙËÁÔÚ›· Ê·ÚÌ¿-ÎˆÓ (Î˘Ú›ˆ˜ Ë ·ÙÂÓÔÏfiÏË) ÛÙÈ˜H¶∞ ·ÏÏ¿ Ë ¯Ú‹ÛË ÙÔ˘˜ ÛÙË ıÂ-Ú·Â›· ÙË˜ ·ÓÂ›ÏÂÎÙË˜ ˘¤Ú-Ù·ÛË˜ ˘Ê›ÛÙ·Ù·È ÌÂÁ¿ÏË ÎÚÈÙÈÎ‹(3). ΔÔÓ›˙ÂÙ·È fiÙÈ ıÂÚ·Â›· 1000·ÛıÂÓÒÓ ÌÂ ‚-·ÔÎÏÂÈÛÙ¤˜ ÁÈ·4.4 ¯ÚfiÓÈ· ı· Î·Ù·Ï‹ÍÂÈ ÛÂ 14Ó¤Â˜ ÂÚÈÙÒÛÂÈ˜ ‰È·‚‹ÙË, 3 ÂÈ-Ï¤ÔÓ ı·Ó¿ÙÔ˘˜ Î·È 5 ÂÈÏ¤ÔÓÂÁÎÂÊ·ÏÈÎ¿. ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÚˆÙÔÁÂÓ‹ ÚfiÏË„Ë ÙË˜ Î·Ú-‰È·Î‹˜ ·ÓÂ¿ÚÎÂÈ·˜ ÌÂ ‚-·Ô-ÎÏÂÈÛÙ¤˜ ÚfiÛÊ·ÙË ÌÂÙ·-·Ó¿Ï˘-ÛË (12 Ù˘¯·ÈÔÔÈËÌ¤ÓÂ˜ ÌÂÏ¤ÙÂ˜,112,177 ˘ÂÚÙ·ÛÈÎÔ›) ¤‰ÂÈÍÂ fiÙÈÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜ ‰ÂÓ ˘ÂÚ¤¯Ô˘ÓÙˆÓ ¿ÏÏˆÓ ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ Î·ÈÌfiÓÔ ÛÙÈ˜ ËÏÈÎ›Â˜ <60 ÂÙÒÓ. ™ÙÈ˜ÌÂÁ·Ï‡ÙÂÚÂ˜ ËÏÈÎ›Â˜ Ë ·˘ÍËÌ¤ÓËÛ˘¯ÓfiÙËÙ· ÙˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ ‰ÂÓÙ· ‰ÈÎ·ÈÔÏÔÁÂ› Û·Ó Ê¿ÚÌ·Î·ÚÒÙË˜ ÂÎÏÔÁ‹˜ ÛÙË ÚˆÙÔÁÂÓ‹

ÚfiÏË„Ë ÙË˜ Î·Ú‰È·Î‹˜ ·ÓÂ-¿ÚÎÂÈ·˜ (13)

™Â ·ÓÙ›ıÂÛË fiÌˆ˜ ÌÂ ÙËÓ˘¤ÚÙ·ÛË ÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜ ıÂˆ-ÚÔ‡ÓÙ·È ÙÔ ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÊ¿ÚÌ·ÎÔ ÛÙË ıÂÚ·Â›· ÙË˜ Î·Ú-‰È·Î‹˜ ·ÓÂ¿ÚÎÂÈ·˜. ∞Ù˘¯Ò˜ ÛÂÈÎ·Ófi ÔÛÔÛÙfi ·˘ÙÒÓ ÙˆÓ ·ÛıÂ-ÓÒÓ ‰ÂÓ ¯ÔÚËÁÔ‡ÓÙ·È ‚-·ÔÎÏÂÈ-ÛÙ¤˜ ·ÏÏ¿ Î·È Ë Û˘ÌÌfiÚÊˆÛËÙˆÓ ·ÛıÂÓÒÓ (fiˆ˜ ÌÂ fiÏÂ˜ ÙÈ˜¯ÚfiÓÈÂ˜ ıÂÚ·Â›Â˜) ‰ÂÓ Â›Ó·È Ë·Ó·ÌÂÓfiÌÂÓË. •ÂÎ›ÓËÌ· ÌÂ ÌÈÎÚ¤˜‰fiÛÂÈ˜ Î·È ·ÚÁ¤˜ ÚÔ˜ Ù· ¿ÓˆÙÈÙÏÔÔÈ‹ÛÂÈ˜ (Î¿ıÂ 2 -4 Â‚‰ÔÌ¿-‰Â˜), ·Ú·ÎÔÏÔ‡ıËÛË ÛÊ‡ÍÂˆÓ,›ÂÛË˜ Î·È ¿ÏÏˆÓ ·ÚÂÓÂÚÁÂÈÒÓı· ‚ÂÏÙÈÒÛÔ˘Ó ÙËÓ Û˘ÌÌfiÚÊˆ-ÛË. ∞ÎfiÌË Ú¤ÂÈ Ó· ‰È‰¿ÍÔ˘ÌÂÙÔ˘˜ ·ÛıÂÓÂ›˜ ÁÈ· ·Ú·ÎÔÏÔ‡-ıËÛË ÙÔ˘ ‚¿ÚÔ˘˜ ÙˆÓ Î·È ÂÓ‰Â-¯fiÌÂÓË ÂÈ‰Â›ÓˆÛË ÙˆÓ Û˘ÌÙˆ-Ì¿ÙˆÓ Î·Ù¿ ÙËÓ ¤Ó·ÚÍË Î·È ÙÈÙ-ÏÔÔ›ËÛË ÙË˜ ‰fiÛË˜.


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

2. Lopez-Sendon, J, Swedberg, K, McMurray, J, et al. Expert consensusdocument on beta-adrenergic rece-ptor blockers. Eur Heart J 2004,25:1341-62.

3. Bangalore, S, Messerli, FH, Kostis, JBPepine, CJ. Cardiovascular protectionusing beta-blockers: a critical reviewof the evidence. J Am Coll Cardiol2007, 50:563-72.

4. Dulin, BR, Haas, SJ, Abraham, WTKrum, H. Do elderly systolic heartfailure patients benefit from betablockers to the same extent as thenon-elderly? Meta-analysis of >12,000patients in large-scale clinical trials.Am J Cardiol 2005, 95:896-8.

5. Flather, MD, Shibata, MC, Coats, AJ,et al. Randomized trial to determinethe effect of nebivolol on mortality andcardiovascular hospital admission inelderly patients with heart failure(SENIORS). Eur Heart J 2005, 26:215-25.

6. Poole-Wilson, PA, Swedberg, K,Cleland, JG, et al. Comparison ofcarvedilol and metoprolol on clinicaloutcomes in patients with chronicheart failure in the Carvedilol OrMetoprolol European Trial (COMET):randomised controlled trial. Lancet2003, 362:7-13.

7. Swedberg, K, Cleland, J, Dargie, H, etal. Guidelines for the diagnosis andtreatment of chronic heart failure:executive summary (update 2005):The Task Force for the Diagnosis andTreatment of Chronic Heart Failure ofthe European Society of Cardiology.Eur Heart J 2005, 26:1115-40.

8. Bursi, F, Weston, SA, Redfield, MM, etal. Systolic and diastolic heart failurein the community. Jama 2006, 296:2209-16.

9. Gheorghiade, M, Abraham, WT, Albe-rt, NM, et al. Systolic blood pressureat admission, clinical characteristics,and outcomes in patients hospitalizedwith acute heart failure. Jama 2006,296:2217-26.

10. Hildebrandt, P. Systolic and nonsy-stolic heart failure: equally seriousthreats. Jama 2006, 296:2259-60.

11. Nieminen, MS, Bohm, M, Cowie, MR,et al. Executive summary of theguidelines on the diagnosis andtreatment of acute heart failure: theTask Force on Acute Heart Failure ofthe European Society of Cardiology.Eur Heart J 2005, 26:384-416.

12. Chen, ZM, Pan, HC, Chen, YP, et al.Early intravenous then oral metoprololin 45,852 patients with acutemyocardial infarction: randomisedplacebo-controlled trial. Lancet 2005,366:1622-32.

13. μangalore S, Wild D, Sanobar P, KukinM, Messerli FH. Beta-blockers forprimary prevention of heart failure inpatients with hypertension: A Meta-analysis of randomized controlledtrials. Circulation 2007, II -457 2110(abstract)


π √ À ¡ π √ ™ 2 0 0 8

20

∏ ™˘ÌÌfiÚÊˆÛË ÙˆÓ ∞ÛıÂÓÒÓ ÛÙËÓ ÀÔÏÈÈ‰·ÈÌÈÎ‹ ∞ÁˆÁ‹ Î·È ÔÈ ∂ÈÙÒÛÂÈ˜

ÙË˜ ÛÙËÓ ∫·Ú‰È·ÁÁÂÈ·Î‹ ¡ÔÛËÚfiÙËÙ· Î·È £ÓËÙfiÙËÙ·.

ª. ºÏˆÚÂÓÙ›Ó, ∂ÈÛÙËÌÔÓÈÎfi˜ ™˘ÓÂÚÁ¿ÙË˜∂. §˘ÌÂÚfiÔ˘ÏÔ˜, §¤ÎÙÔÚ·˜ ¶·ıÔÏÔÁ›·˜, π·ÙÚÈÎ‹˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ

ªˆ˘Û‹˜ ∂ÏÈÛ¿Ê, ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜, π·ÙÚÈÎ‹˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ

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

∂ÈÛ·ÁˆÁ‹Δ· Î·Ú‰È·ÁÁÂÈ·Î¿ ÓÔÛ‹Ì·Ù· ·Ô--ÙÂÏÔ‡Ó ÙËÓ Î˘ÚÈfiÙÂÚË ·ÈÙ›· ı·-Ó¿ÙÔ˘ ÛÂ ·ÁÎfiÛÌÈ· ÎÏ›Ì·Î·.[1]

√È ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓÂÌÊ¿ÓÈÛË Î·Ú‰È·ÁÁÂÈ·Î‹˜ ÓfiÛÔ˘ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙË ‰˘ÛÏÈÈ‰·ÈÌ›·,ÙËÓ ·ÚÙËÚÈ·Î‹ ˘¤ÚÙ·ÛË, ÙÔ Î¿-ÓÈÛÌ·, ÙËÓ ·‡ÍËÛË ÙË˜ ËÏÈÎ›·˜,ÙÔ ·Ó‰ÚÈÎfi Ê‡ÏÔ, ÙÔ Û·Î¯·ÚÒ‰Ë‰È·‚‹ÙË, ÙËÓ ·¯˘Û·ÚÎ›· Î·È ÙÔÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÚÒÈÌË˜Î·Ú‰È·ÁÁÂÈ·Î‹˜ ÓfiÛÔ˘. ªÂÁ¿ÏÔ˜·ÚÈıÌfi˜ ÎÏÈÓÈÎÒÓ ÌÂÏÂÙÒÓ Î·ÈÌÂÙ·-·Ó·Ï‡ÛÂˆÓ ¤‰ÂÈÍ·Ó fiÙÈ Ë·ÓÙÈ˘ÂÚÙ·ÛÈÎ‹ Î·È Ë ˘ÔÏÈÈ‰·È-ÌÈÎ‹ ·ÁˆÁ‹ ÂÏ·ÙÙÒÓÔ˘Ó ÙÔÓ Î›Ó-‰˘ÓÔ ÂÌÊ¿ÓÈÛË˜ ÛÙÂÊ·ÓÈ·›·˜ Ófi-ÛÔ˘ (™¡), ·ÁÁÂÈ·ÎÔ‡ ÂÁÎÂÊ·ÏÈ-ÎÔ‡ ÂÂÈÛÔ‰›Ô˘ (∞∂∂) Î·È ı·Ó¿-ÙÔ˘ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ·Ú¿ÁÔÓÙÂ˜ÎÈÓ‰‡ÓÔ˘ ÁÈ· Î·Ú‰È·ÁÁÂÈ·Î‹ Ófi-ÛÔ, Î·ıÒ˜ Î·È ÛÂ ·ÛıÂÓÂ›˜ ÌÂÁÓˆÛÙ‹ Î·Ú‰È·ÁÁÂÈ·Î‹ ÓfiÛÔ.[2-4]

øÛÙfiÛÔ, Ë Û˘ÌÌfiÚÊˆÛË ÙˆÓ ·Û-ıÂÓÒÓ ÛÙË Ê·ÚÌ·ÎÂ˘ÙÈÎ‹ ·ÁˆÁ‹ÛÙËÓ ÎÏÈÓÈÎ‹ Ú¿ÍË ‰ÂÓ Â›Ó·È ÈÎ·-ÓÔÔÈËÙÈÎ‹.

™ÎÔfi˜ ·˘Ù‹˜ ÙË˜ Û‡ÓÙÔÌË˜·Ó·ÛÎfiËÛË˜ Â›Ó·È Ó· ÂÈÛËÌ¿ÓÂÈÙÔ Úfi‚ÏËÌ· ÙË˜ ¤ÏÏÂÈ„Ë˜ Û˘Ì-ÌfiÚÊˆÛË˜ ÙˆÓ ·ÛıÂÓÒÓ ÛÙËÓÚÔÙÂÈÓfiÌÂÓË ·fi ÙÔ˘˜ ÁÈ·ÙÚÔ‡˜ÙÔ˘˜ Ê·ÚÌ·ÎÂ˘ÙÈÎ‹ ·ÁˆÁ‹ Î·ÈÙÈ˜ ÂÈÙÒÛÂÈ˜ Ô˘ ·˘Ù‹ Ë ¤ÏÏÂÈ-„Ë Û˘ÌÌfiÚÊˆÛË˜ ¤¯ÂÈ ÛÙËÓ Î·Ú-‰È·ÁÁÂÈ·Î‹ ÓÔÛËÚfiÙËÙ· Î·È ıÓË-ÙfiÙËÙ·.

∏ Û˘ÌÌfiÚÊˆÛË ÙˆÓ ·ÛıÂÓÒÓÛÙË ıÂÚ·Â›· ÛÙ· Ï·›ÛÈ· ÙË˜ÚˆÙÔÁÂÓÔ‡˜ ÚfiÏË„Ë˜

¶·Ú¿ Ù· ÂÈ‚Â‚·ÈˆÌ¤Ó· ÔÊ¤ÏËÙË˜ ˘ÔÏÈÈ‰·ÈÌÈÎ‹˜ ·ÁˆÁ‹˜ ÛÙËÓÎ·Ú‰È·ÁÁÂÈ·Î‹ ÓÔÛËÚfiÙËÙ· Î·ÈıÓËÙfiÙËÙ·, ÛÙËÓ ÎÏÈÓÈÎ‹ Ú¿ÍË ËÛ˘ÌÌfiÚÊˆÛË ÙˆÓ ·ÛıÂÓÒÓ ÛÙËÊ·ÚÌ·ÎÂ˘ÙÈÎ‹ ·ÁˆÁ‹ ‰ÂÓ Â›Ó·È

ÈÎ·ÓÔÔÈËÙÈÎ‹, È‰È·›ÙÂÚ· ÛÙËÓÚˆÙÔÁÂÓ‹ ÚfiÏË„Ë.[5,6] √È ·ÛıÂ-ÓÂ›˜, ÂÊfiÛÔÓ ‰ÂÓ ÂÌÊ·Ó›˙Ô˘Ó ¤Î-‰ËÏ· Û˘ÌÙÒÌ·Ù· ÙË˜ ÓfiÛÔ˘ ÁÈ·ÙËÓ ÔÔ›· ıÂÚ·Â‡ÔÓÙ·È, Û˘¯Ó¿‰ÂÓ Â›Ó·È Úfiı˘ÌÔÈ Ó· ‰Â¯ıÔ‡ÓÌÈ· Ì·ÎÚÔ¯ÚfiÓÈ· Ê·ÚÌ·ÎÂ˘ÙÈÎ‹·ÁˆÁ‹. ∂ÈÚfiÛıÂÙ·, ‰‡ÛÎÔÏ··Ô‰¤¯ÔÓÙ·È ·ÎfiÌ· Î·È ÙÈ˜ ‹ÈÂ˜·ÚÂÓ¤ÚÁÂÈÂ˜ ÙˆÓ Ê·ÚÌ¿ÎˆÓ Ù·ÔÔ›· ÙÔ˘˜ ¯ÔÚËÁÔ‡ÓÙ·È. ∞Í›˙ÂÈÓ· ÛËÌÂÈˆıÂ› fiÙÈ Ù· ÔÛÔÛÙ¿‰È·ÎÔ‹˜ ÙˆÓ ÛÙ·ÙÈÓÒÓ ÌÂÙ¿ ·fi¤Ó· ¯ÚfiÓÔ ıÂÚ·Â›·˜ Î˘Ì·›ÓÔ-ÓÙ·È ·fi 15% ˆ˜ 60%.[5, 7, 8]

ªÈ· ˘Ô·Ó¿Ï˘ÛË ÙË˜ ÌÂÏ¤ÙË˜WOSCOPS (West of ScotlandPrevention Study) ¤‰ÂÈÍÂ fiÙÈ Ì›·Û˘ÌÌfiÚÊˆÛË ≥75% ÛÙË ıÂÚ·-Â›· ÌÂ Ú·‚·ÛÙ·Ù›ÓË Ô‰‹ÁËÛÂÛÂ 38% ÌÂ›ˆÛË ÙË˜ ıÓËÙfiÙËÙ·˜·fi ™¡, ÙˆÓ ÌË ı·Ó·ÙËÊfiÚˆÓÂÌÊÚ·ÁÌ¿ÙˆÓ ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘Î·È ÙË˜ Î·Ú‰È·ÁÁÂÈ·Î‹˜ ıÓËÙfiÙË-Ù·˜ (p=0,0001), ÛÂ Ì›· Î·Ù¿ 46%ÌÂ›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÛÙÂÊ·ÓÈ·›-·˜ Â·Ó·ÈÌ¿ÙˆÛË˜ (p=0,003),Î·ıÒ˜ Î·È ÛÂ Ì›· Î·Ù¿ 32% ÌÂ›ˆ-ÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ıÓËÙfiÙËÙ·˜ ·fiÔÔÈÔ‰‹ÔÙÂ ·›ÙÈÔ (p=0,015),ÂÓÒ Ù· ·ÓÙ›ÛÙÔÈ¯· ÔÛÔÛÙ¿ ÛÙÔÛ˘ÓÔÏÈÎfi ÏËı˘ÛÌfi ÙË˜ ÌÂÏ¤ÙË˜[intention-to-treat (ITT)] ‹Ù·Ó 31%(p=0,0001), 37% (p=0,009) Î·È22% (p=0,05).[9]

√È ‰È·ÊÔÚ¤˜ ÌÂÙ·Í‡ ÙˆÓ ·ÛıÂ-ÓÒÓ ÛÙÔ ı¤Ì· ÙË˜ Û˘ÌÌfiÚÊˆÛË˜ÌÔÚÂ› Ó· Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÙË˜›‰È·˜ ÙË˜ Ê·ÚÌ·ÎÂ˘ÙÈÎ‹˜ ·Áˆ-Á‹˜, Î·ıÒ˜ Î·È ÎÔÈÓˆÓÈÎÒÓ ‹ ¿Ï-ÏˆÓ ·Ú·ÁfiÓÙˆÓ. °È· ·Ú¿‰ÂÈÁ-Ì·, ÔÈ ·ÓÂÈı‡ÌËÙÂ˜ ÂÓ¤ÚÁÂÈÂ˜ÙˆÓ Ê·ÚÌ¿ÎˆÓ Èı·Ó¿ ÂÏ·ÙÙÒ-ÓÔ˘Ó ÙË Û˘ÌÌfiÚÊˆÛË, ÂÓÒ Ù·ÚÔÛ‰ÔÎÒÌÂÓ· ÔÊ¤ÏË ÙË˜ ıÂÚ·-Â›·˜ ÙËÓ ·˘Í¿ÓÔ˘Ó. ∂ÈÚfiÛıÂ-Ù·, ÔÈ ·ÛıÂÓÂ›˜ ÔÈ ÔÔ›ÔÈ ·›Ú-ÓÔ˘Ó Ê¿ÚÌ·Î· ÁÈ· ¿ÏÏ· ·›ÙÈ· Û˘-¯Ó¿ ÂÌÊ·Ó›˙Ô˘Ó Î·Ï‡ÙÂÚË Û˘Ì-

ÌfiÚÊˆÛË, ÂÂÈ‰‹ ¤¯Ô˘Ó ‹‰Ë ·Ô-‰Â¯ıÂ› ÙËÓ È‰¤· ÙË˜ Ì·ÎÚÔ¯Úfi-ÓÈ·˜ Ê·ÚÌ·ÎÂ˘ÙÈÎ‹˜ ·ÁˆÁ‹˜.

ªÈ· ÚfiÛÊ·ÙË ÌÂÏ¤ÙË ÂÍ¤Ù·ÛÂÙËÓ Â›‰Ú·ÛË ÙË˜ Û˘ÌÌfiÚÊˆÛË˜ÛÙËÓ ·ÁˆÁ‹ ÌÂ ÛÙ·Ù›ÓÂ˜ ÛÙËÓ ÂÌ-Ê¿ÓÈÛË Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·-Ì¿ÙˆÓ ÛÙ· Ï·›ÛÈ· ÙË˜ ÚˆÙÔÁÂ-ÓÔ‡˜ ÚfiÏË„Ë˜. ∞˘Ù‹ Ë ÌÂÏ¤ÙË¤‰ÂÈÍÂ fiÙÈ Ì›· Û˘ÌÌfiÚÊˆÛË ≥90%Û˘Û¯ÂÙ›ÛıËÎÂ ÌÂ 19% ÏÈÁfiÙÂÚ·ÌË ı·Ó·ÙËÊfiÚ· Î·Ú‰È·ÁÁÂÈ·Î¿Û˘Ì‚¿Ì·Ù· [Û¯ÂÙÈÎfi˜ Î›Ó‰˘ÓÔ˜=0,81; 95% ‰È¿ÛÙËÌ· ÂÌÈÛÙÔ-Û‡ÓË˜ (¢∂) 0,67-0,97] ÛÂ Û‡ÁÎÚÈ-ÛË ÌÂ Û˘ÌÌfiÚÊˆÛË <90%.[10]

∞Í›˙ÂÈ Ó· ÛËÌÂÈˆıÂ› fiÙÈ ÌfiÓÔ ¤Ó·ÌÈÎÚfi Û¯ÂÙÈÎ¿ ÔÛÔÛÙfi ·ÛıÂÓÒÓÂÈÙ˘Á¯¿ÓÂÈ Ù· ÂÈı˘ÌËÙ¿ Â›Â-‰· ¯ÔÏËÛÙÂÚfiÏË˜ ÛÙËÓ ÎÏÈÓÈÎ‹Ú¿ÍË,[11-13] ÁÂÁÔÓfi˜ Ô˘ ¤¯ÂÈ Û˘-Û¯ÂÙÈÛıÂ› ÌÂ ·˘ÍËÌ¤ÓË Î·Ú‰È·Á-ÁÂÈ·Î‹ ÓÔÛËÚfiÙËÙ· Î·È ıÓËÙfiÙË-Ù·.[14,15] ªÈ· ÂÓ‰È·Ê¤ÚÔ˘Û· ÌÂÏ¤-ÙË ¤‰ÂÈÍÂ fiÙÈ ÌfiÓÔ ÙÔ 25% ÙˆÓ·ÛıÂÓÒÓ Ô˘ ¤·ÈÚÓÂ ˘ÔÏÈÈ-‰·ÈÌÈÎ‹ ·ÁˆÁ‹ ¤Ù˘¯Â Ù· ÂÈı˘-ÌËÙ¿ Â›Â‰· ¯ÔÏËÛÙÂÚfiÏË˜ ÌÂ-Ù¿ ·fi 3 ¤ÙË ·Ú·ÎÔÏÔ‡ıË-ÛË˜.[16] √ Î›Ó‰˘ÓÔ˜ Î·Ú‰È·ÁÁÂÈ·-ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ ‹Ù·Ó ÛËÌ·ÓÙÈ-Î¿ ·˘ÍËÌ¤ÓÔ˜ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜Ô˘ ¤Ù˘¯·Ó Ù· Â›Â‰·-ÛÙfi¯ÔÙË˜ ¯ÔÏËÛÙÂÚfiÏË˜ ÛÂ ÔÚÈÛÌ¤Ó·ÌfiÓÔ ¯ÚÔÓÈÎ¿ ‰È·ÛÙ‹Ì·Ù· Î·Ù¿ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÌÂÏ¤ÙË˜ (Û¯ÂÙÈÎfi˜Î›Ó‰˘ÓÔ˜=2,34, 95% ¢∂=1,01-5,39), Î·ıÒ˜ Î·È ÛÂ fiÛÔ˘˜ ‰ÂÓ¤Ù˘¯·Ó ÔÙ¤ ·˘Ù¿ Ù· Â›Â‰·(Û¯ÂÙÈÎfi˜ Î›Ó‰˘ÓÔ˜=2,99; 95%¢∂=1,26-7,08) ÛÂ Û‡ÁÎÚÈÛË ÌÂfiÛÔ˘˜ ¤Ù˘¯·Ó Ù· ÂÈı˘ÌËÙ¿Â›Â‰· ¯ÔÏËÛÙÂÚfiÏË˜ ÛÂ fiÏËÙË ‰È¿ÚÎÂÈ· ÙË˜ ÌÂÏ¤ÙË˜.[16] ∞ÓÎ·È Ë ·Ú·¿Óˆ ÌÂÏ¤ÙË ‰ÂÓ Û¯Â-‰È¿ÛıËÎÂ ÁÈ· Ó· ÂÎÙÈÌ‹ÛÂÈ ÙËÛ˘ÌÌfiÚÊˆÛË ÙˆÓ ·ÛıÂÓÒÓ ÛÙËÊ·ÚÌ·ÎÂ˘ÙÈÎ‹ ·ÁˆÁ‹, Èı·Ó¿ Ë¤ÏÏÂÈ„Ë Û˘ÌÌfiÚÊˆÛË˜ Ó· ·Ô-


21

ÙÂÏÂ› ¤Ó·Ó ·fi ÙÔ˘˜ ÏfiÁÔ˘˜ ÁÈ·ÙÔ˘˜ ÔÔ›Ô˘˜ Ù· ÂÈı˘ÌËÙ¿ Â›-Â‰· ¯ÔÏËÛÙÂÚfiÏË˜ ÂÈÙ˘Á¯¿ÓÔ-ÓÙ·È ÛÂ ÙfiÛÔ ÌÈÎÚfi ÔÛÔÛÙfi·ÛıÂÓÒÓ.

Ÿˆ˜ ‹‰Ë ·Ó·Ê¤ÚıËÎÂ, Ë Û˘Ì-ÌfiÚÊˆÛË ÙˆÓ ·ÛıÂÓÒÓ ÛÙËÓ˘ÔÏÈÈ‰·ÈÌÈÎ‹ ·ÁˆÁ‹ Â›Ó·È ÌÈ-ÎÚfiÙÂÚË ÛÙËÓ ÚˆÙÔÁÂÓ‹ ÛÂ Û‡-ÁÎÚÈÛË ÌÂ ÙË ‰Â˘ÙÂÚÔÁÂÓ‹ Úfi-ÏË„Ë. ªÈ· ÌÂÏ¤ÙË ¤‰ÂÈÍÂ fiÙÈ ËÛ˘ÌÌfiÚÊˆÛË ÛÙËÓ ·ÁˆÁ‹ ÌÂÛÙ·Ù›ÓÂ˜ ‹Ù·Ó 71% ÌÂÙ¿ ·fi 6Ì‹ÓÂ˜ Î·È 45% ÌÂÙ¿ ·fi 3 ¯Úfi-ÓÈ· ıÂÚ·Â›·˜ ÛÂ ·ÛıÂÓÂ›˜ ‰Â˘-ÙÂÚÔÁÂÓÔ‡˜ ÚfiÏË„Ë˜, ÂÓÒ Ù··ÓÙ›ÛÙÔÈ¯· ÔÛÔÛÙ¿ ÛÂ ¿ÙÔÌ·ÚˆÙÔÁÂÓÔ‡˜ ÚfiÏË„Ë˜ ‹Ù·Ó65% Î·È 35%.[17]

ªÈ· ¿ÏÏË ÌÂÏ¤ÙË ÂÍ¤Ù·ÛÂ ÙËÛ˘ÌÌfiÚÊˆÛË ·ÛıÂÓÒÓ ÌÂ Úˆ-ÙÔ‰È·ÁÓˆÛÌ¤ÓË ·ÚÙËÚÈ·Î‹ ˘¤Ú-Ù·ÛË Î·È ‰˘ÛÏÈÈ‰·ÈÌ›· ÛÙË ¯Ô-ÚËÁÔ‡ÌÂÓË ·ÓÙÈ˘ÂÚÙ·ÛÈÎ‹ Î·È˘ÔÏÈÈ‰·ÈÌÈÎ‹ ·ÁˆÁ‹.[18] ΔÔ Ô-ÛÔÛÙfi ÙˆÓ ·ÛıÂÓÒÓ Ô˘ Û˘Ì-ÌÔÚÊÒıËÎÂ ÙfiÛÔ ÛÙËÓ ·ÓÙÈ˘ÂÚ-Ù·ÛÈÎ‹, fiÛÔ Î·È ÛÙËÓ ˘ÔÏÈÈ‰·È-ÌÈÎ‹ ·ÁˆÁ‹ ÂÏ·ÙÙÒıËÎÂ ÛËÌ·-ÓÙÈÎ¿ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ·Áˆ-Á‹˜. ™˘ÁÎÂÎÚÈÌ¤Ó·, Û˘ÌÌfiÚÊˆ-ÛË ≥80% ÂÌÊ¿ÓÈ˙Â ÙÔ 44,7%,35,9% Î·È 35,8% ÙˆÓ ·ÛıÂÓÒÓ ÛÂ3, 6 Î·È 12 Ì‹ÓÂ˜, ·ÓÙ›ÛÙÔÈ¯·.[18]

∏ Û˘ÌÌfiÚÊˆÛË ÙˆÓ ·ÛıÂÓÒÓÛÙËÓ ˘ÔÏÈÈ‰·ÈÌÈÎ‹ ·ÁˆÁ‹ ÛÙ·Ï·›ÛÈ· ÙË˜ ‰Â˘ÙÂÚÔÁÂÓÔ‡˜ Úfi-ÏË„Ë˜

∏ Ì·ÎÚÔ¯ÚfiÓÈ· ·ÁˆÁ‹ ÌÂ ÛÙ·Ù›-ÓÂ˜ ¤¯ÂÈ È‰È·›ÙÂÚË ÛËÌ·Û›· ÛÂ·ÛıÂÓÂ›˜ Ô˘ ¤¯Ô˘Ó ‹‰Ë ÂÌÊ·Ó›-ÛÂÈ ¤Ó· Î·Ú‰È·ÁÁÂÈ·Îfi ÓfiÛË-Ì·.[19,20] ªÈ· ÌÂÏ¤ÙË Ë ÔÔ›· ÂÎÙ›-ÌËÛÂ ÙË Û˘ÌÌfiÚÊˆÛË ·ÛıÂÓÒÓÌÂ ÈÛÙÔÚÈÎfi ∞∂∂ ÛÙËÓ ·ÁˆÁ‹ ÌÂÛÙ·Ù›ÓÂ˜ ¤‰ÂÈÍÂ ÌÈ· ÛÙ·‰È·Î‹·‡ÍËÛË ÙË˜ ‰È·ÎÔ‹˜ ÙˆÓ ÛÙ·ÙÈ-ÓÒÓ ÛÂ ÔÛÔÛÙfi Ô˘ ¤Êı·ÛÂ ÙÔ39% ¤Ó· ¯ÚfiÓÔ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍËÙË˜ ıÂÚ·Â›·˜.[21] ∏ ‰È·ÎÔ‹ ÙË˜Ê·ÚÌ·ÎÂ˘ÙÈÎ‹˜ ·ÁˆÁ‹˜ ‹Ù·Ó·ÓÂÍ¿ÚÙËÙÔ˜ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡-ÓÔ˘ ÁÈ· ı¿Ó·ÙÔ ·fi ÔÔÈ·‰‹Ô-ÙÂ ·ÈÙÈÔÏÔÁ›· ÌÂÙ¿ ·fi ¤Ó· ¯Úfi-ÓÔ ·Ú·ÎÔÏÔ‡ıËÛË˜ (Û¯ÂÙÈÎfi˜Î›Ó‰˘ÓÔ˜=2,78; 95% ¢∂ 1,96-3,72, p=0,03).[21] ∂›ÛË˜, Ë ‰È·-ÎÔ‹ ÙË˜ ·ÓÙÈ·ÈÌÔÂÙ·ÏÈ·Î‹˜·ÁˆÁ‹˜ Û˘Û¯ÂÙ›ÛıËÎÂ ÌÂ ·‡ÍË-ÛË ıÓËÙfiÙËÙ·˜ ·fi fiÏ· Ù· ·›ÙÈ·Î·Ù¿ 81% (Û¯ÂÙÈÎfi˜ Î›Ó‰˘-ÓÔ˜=1,81; 95% ¢∂ 1,23-4,27,p=0,008).[21] øÛÙfiÛÔ, Ô Î›Ó‰˘ÓÔ˜

·˘Ùfi˜ ‹Ù·Ó ÛËÌ·ÓÙÈÎ¿ ÌÈÎÚfiÙÂ-ÚÔ˜ ·fi ÙÔÓ Î›Ó‰˘ÓÔ Ô˘ ·Ú·-ÙËÚ‹ıËÎÂ ÌÂÙ¿ ÙË ‰È·ÎÔ‹ ÙˆÓÛÙ·ÙÈÓÒÓ.

π‰È·›ÙÂÚÔ ÚfiÏÔ Ê·›ÓÂÙ·È fiÙÈ ‰È·-‰Ú·Ì·Ù›˙ÂÈ Ë Î·Ù·ÓfiËÛË ·fi ÙÔÓ·ÛıÂÓ‹ ÙË˜ ÛËÌ·Û›·˜ ÙË˜ Î·ıË-ÌÂÚÈÓ‹˜ Ï‹„Ë˜ ÙË˜ ˘ÔÏÈÈ‰·ÈÌÈ-Î‹˜ ·ÁˆÁ‹˜ ÌÂÙ¿ ·fi ¤Ó· Î·Ú-‰È·ÁÁÂÈ·Îfi Û‡Ì‚·Ì·. ªÈ· ÔÏ‡ÚfiÛÊ·ÙË ÌÂÏ¤ÙË ¤‰ÂÈÍÂ fiÙÈ Ìfi-ÓÔ ÙÔ 74% ÙˆÓ ·ÛıÂÓÒÓ ¤·ÈÚÓÂfiÏ· Ù· Û˘ÓÙ·ÁÔÁÚ·ÊÔ‡ÌÂÓ· Ê¿Ú-Ì·Î· ÌfiÏÈ˜ 120 ËÌ¤ÚÂ˜ ÌÂÙ¿·fi ¤Ó· ÔÍ‡ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ô-Î·Ú‰›Ô˘ (√∂ª).[22] ™ÙËÓ ›‰È· ÌÂ-Ï¤ÙË Ë ıÓËÙfiÙËÙ· ÌÂÙ¿ ·fi ¤Ó·¯ÚfiÓÔ ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚË ÛÙÔ˘˜·ÛıÂÓÂ›˜ Ô˘ ¤·ÈÚÓ·Ó ÌfiÓÔÔÚÈÛÌ¤Ó· Ê¿ÚÌ·Î· (Û¯ÂÙÈÎfi˜Î›Ó‰˘ÓÔ˜ =1,44; 95% ¢∂ 1,15-1,79, p=0,001) ‹ Î·Ó¤Ó· Ê¿ÚÌ·-ÎÔ (Û¯ÂÙÈÎfi˜ Î›Ó‰˘ÓÔ˜ =1,80;95% ¢∂ 1,35-2,42, p<0,0001) ÛÂÛ‡ÁÎÚÈÛË ÌÂ Ù· ¿ÙÔÌ· Ô˘¤·ÈÚÓ·Ó fiÏ· Ù· Û˘ÓÙ·ÁÔÁÚ·-ÊÔ‡ÌÂÓ· Ê¿ÚÌ·Î·.[22]

™Â ÌÈ· ¿ÏÏË ÌÂÏ¤ÙË ÂÎÙÈÌ‹ıËÎ·ÓÔÈ Û˘Ó¤ÂÈÂ˜ ÙË˜ ÚfiˆÚË˜ ‰È·-ÎÔ‹˜ ÙˆÓ ‚-·ÔÎÏÂÈÛÙÒÓ, ÙË˜·ÛÈÚ›ÓË˜ Î·È ÙˆÓ ÛÙ·ÙÈÓÒÓ ÛÙËıÓËÙfiÙËÙ· ·ÛıÂÓÒÓ ¤Ó· ¯ÚfiÓÔÌÂÙ¿ ·fi ¤Ó· √∂ª.[23] ∞fi ÙÔ˘˜1521 ·ÛıÂÓÂ›˜ ÙË˜ ÌÂÏ¤ÙË˜ 184·ÛıÂÓÂ›˜ (12,1%) ‰È¤ÎÔ„·Ó Î·ÈÙ· 3 Ê¿ÚÌ·Î·, 56 ·ÛıÂÓÂ›˜(3,7%) Ù· ‰‡Ô Ê¿ÚÌ·Î· Î·È 272·ÛıÂÓÂ›˜ (17,9%) ÙÔ ¤Ó· Ê¿ÚÌ·-ÎÔ, ÂÓÒ 1009 ·ÛıÂÓÂ›˜ (66,3%)Û˘Ó¤¯ÈÛ·Ó ÙË Ï‹„Ë Î·È ÙˆÓ 3Ê·ÚÌ¿ÎˆÓ ¤Ó· Ì‹Ó· ÌÂÙ¿ ÙËÓ¤Ó·ÚÍË ÙË˜ ·ÁˆÁ‹˜. √È ·ÛıÂÓÂ›˜Ô˘ ‰È¤ÎÔ„·Ó fiÏ· Ù· Ê¿ÚÌ·Î·Â›¯·Ó ¯ÂÈÚfiÙÂÚË ÂÈ‚›ˆÛË ÌÂÙ¿·fi ¤Ó· ¯ÚfiÓÔ ÛÂ Û‡ÁÎÚÈÛË ÌÂÙÔ˘˜ ·ÛıÂÓÂ›˜ Ô˘ Û˘Ó¤¯ÈÛ·Ó Ó··›ÚÓÔ˘Ó ¤Ó· ‹ ÂÚÈÛÛfiÙÂÚ·Ê¿ÚÌ·Î· (97,7% ¤Ó·ÓÙÈ 88,5%,·ÓÙ›ÛÙÔÈ¯·, p<0,001). Δ· ·ÔÙÂ-Ï¤ÛÌ·Ù· ‹Ù·Ó ·ÚfiÌÔÈ· fiÙ·ÓÂÎÙÈÌ‹ıËÎÂ Ë ‰È·ÎÔ‹ Î·ıÂÓfi˜·fi Ù· 3 Ê¿ÚÌ·Î· ¯ˆÚÈÛÙ¿.[23]

Œ¯ÂÈ ÏÔÈfiÓ È‰È·›ÙÂÚË ÛËÌ·Û›· ËÙ·ÎÙÈÎ‹ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ·ÛıÂÓÒÓ ÌÂÙ¿ ·fi ¤Ó· √∂ª,ÒÛÙÂ Ó· ÂÈ‚Â‚·ÈÒÓÂÙ·È Ë ÛˆÛÙ‹Ï‹„Ë ÙË˜ Ê·ÚÌ·ÎÂ˘ÙÈÎ‹˜ ÙÔ˘˜·ÁˆÁ‹˜. º·›ÓÂÙ·È Â›ÛË˜ fiÙÈ ÔÈ·ÛıÂÓÂ›˜ Ô˘ Û˘ÌÌÔÚÊÒÓÔÓÙ·ÈÌÂ ÙË Ï‹„Ë ÙˆÓ Ê·ÚÌ¿ÎˆÓ Ô˘ÙÔ˘˜ Û˘ÓÙ·ÁÔÁÚ·ÊÔ‡ÓÙ·È ˘ÈÔıÂ-ÙÔ‡Ó Î·È ÙÈ˜ ˘ÁÈÂÈÓÔ‰È·ÈÙËÙÈÎ¤˜Ô‰ËÁ›Â˜ Ô˘ Û˘ÓÈÛÙÒÓÙ·È.

∏ ÛËÌ·Û›· ÙË˜ ·ÁˆÁ‹˜ ÌÂ ‚-·Ô-

ÎÏÂÈÛÙ¤˜ Î·È ÛÙ·Ù›ÓÂ˜ ÌÂÙ¿ ·fi¤Ó· √∂ª ¤¯ÂÈ ÂÈ‚Â‚·ÈˆıÂ› ·fiÌÂÁ¿ÏÔ ·ÚÈıÌfi ÎÏÈÓÈÎÒÓ ÌÂÏÂ-ÙÒÓ.[24,25] ∂ÈÚfiÛıÂÙ·, Ë ıÓËÙfi-ÙËÙ· ·˘Í¿ÓÂÙ·È fiÛÔ ÌÂÈÒÓÂÙ·È ËÛ˘ÌÌfiÚÊˆÛË ÛÙË Ï‹„Ë ÛÙ·ÙÈÓÒÓ‹ ‚-·ÔÎÏÂÈÛÙÒÓ. ŒÙÛÈ, ÌÈ· ÌÂÏ¤-ÙË ÛÂ ÌÂÙÂÌÊÚ·ÁÌ·ÙÈÎÔ‡˜ ·ÛıÂ-ÓÂ›˜ ¤‰ÂÈÍÂ Ì›· Î·Ù¿ 25% ·‡ÍËÛËÙË˜ ıÓËÙfiÙËÙ·˜ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ¯·ÌËÏ‹ Û˘ÌÌfiÚÊˆÛË (<40%)ÛÙË Ï‹„Ë ÛÙ·ÙÈÓÒÓ ÛÂ Û‡ÁÎÚÈÛËÌÂ ÙÔ˘˜ ·ÛıÂÓÂ›˜ Ô˘ ÂÌÊ¿ÓÈ˙·ÓÛ˘ÌÌfiÚÊˆÛË ≥80%.[26] ¶·Úfi-ÌÔÈ· Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÙË˜ Û˘Ì-ÌfiÚÊˆÛË˜ Î·È ÙË˜ ÔÏÈÎ‹˜ ıÓËÙfi-ÙËÙ·˜ ‰È·ÈÛÙÒıËÎÂ Î·È ÁÈ· ÙÔ˘˜‚-·ÔÎÏÂÈÛÙ¤˜.[26]

ªÈ· ¿ÏÏË ÌÂÏ¤ÙË ‰ÈÂÚÂ‡ÓËÛÂ ÙËÛ¯¤ÛË ÙË˜ Û˘ÌÌfiÚÊˆÛË˜ ÛÙËÓ·ÁˆÁ‹ ÌÂ ÛÙ·Ù›ÓÂ˜ ÌÂÙ¿ ·fi ¤Ó·√∂ª ÌÂ ÙËÓ ÂÌÊ¿ÓÈÛË Ó¤Ô˘ √∂ªÎ·È ı·Ó¿ÙÔ˘ ÔÔÈ·Û‰‹ÔÙÂ ·È-ÙÈÔÏÔÁ›·˜ ÌÂÙ¿ ·fi Î·Ù¿ Ì¤ÛÔfiÚÔ 2,4 ¤ÙË ·Ú·ÎÔÏÔ‡ıËÛË˜.[27]

∞fi ÙÔ˘˜ 5,590 ·ÛıÂÓÂ›˜ ÌÂ√∂ª ÌfiÓÔ ÙÔ 7,7% ¤·ÈÚÓÂ ÛÙ·-Ù›ÓË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÌÂÏ¤-ÙË˜ Î·È ÙÔ 12,8% ÂÌÊ¿ÓÈÛÂ ÙÔ˘-Ï¿¯ÈÛÙÔÓ ¤Ó· Ó¤Ô √∂ª. ∏ ≥80%Û˘ÌÌfiÚÊˆÛË ÛÙËÓ ·ÁˆÁ‹ ÌÂÛÙ·Ù›ÓÂ˜ Û˘Û¯ÂÙ›ÛıËÎÂ ÌÂ ¤Ó·Î·Ù¿ 81% ÌÈÎÚfiÙÂÚÔ Î›Ó‰˘ÓÔ ÁÈ·ÙËÓ ÂÌÊ¿ÓÈÛË Ó¤Ô˘ √∂ª (Û¯ÂÙÈ-Îfi˜ Î›Ó‰˘ÓÔ˜=0,19; 95% ¢∂0,08-0,47) Î·È Ì›· Î·Ù¿ 53% ÌÂ›-ˆÛË ÙË˜ ıÓËÙfiÙËÙ·˜ ÔÔÈ·Û‰‹-ÔÙÂ ·ÈÙÈÔÏÔÁ›·˜ (Û¯ÂÙÈÎfi˜ Î›Ó-‰˘ÓÔ˜=0,47; 95% ¢∂ 0,22-0,99)ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙË ÌË Û˘ÌÌfiÚ-ÊˆÛË ÛÙË ıÂÚ·Â›·.[27]

™ÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ ·fi ÙÈ˜ ÌÂÁ¿-ÏÂ˜ ÎÏÈÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ‰ÂÓ Û˘ÌÌÂ-ÙÂ›¯Â ÛËÌ·ÓÙÈÎfi˜ ·ÚÈıÌfi˜ ËÏÈ-ÎÈˆÌ¤ÓˆÓ ·ÛıÂÓÒÓ, ÌÂ ·ÔÙ¤ÏÂ-ÛÌ· Ó· ÌËÓ ˘¿Ú¯Ô˘Ó ÔÏÏ¿ ‰È·-ı¤ÛÈÌ· ÛÙÔÈ¯Â›· ÁÈ· ÙË Û˘ÌÌfiÚ-ÊˆÛË ·˘ÙÒÓ ÙˆÓ ·ÙfiÌˆÓ ÛÙËÊ·ÚÌ·ÎÂ˘ÙÈÎ‹ ·ÁˆÁ‹. ™Â ÌÈ· ÌÂ-Ï¤ÙË ÂÎÙÈÌ‹ıËÎÂ Ë Ì·ÎÚÔ¯ÚfiÓÈ·Û˘ÌÌfiÚÊˆÛË ·ÛıÂÓÒÓ ËÏÈÎ›·˜≥65 ÂÙÒÓ ÛÙËÓ ·ÁˆÁ‹ ÌÂ ÛÙ·Ù›-ÓÂ˜ Î·È ‚Ú¤ıËÎÂ fiÙÈ ÌfiÓÔ ÙÔ 26%ÂÌÊ¿ÓÈÛÂ Û˘ÌÌfiÚÊˆÛË ≥80% 5¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂ-Ú·Â›·˜.[28] ∏ Û˘ÌÌfiÚÊˆÛË ÙˆÓ·ÛıÂÓÒÓ ÌÂÈÒÓÔÓÙ·Ó ÛÙ·‰È·Î¿ÌÂ ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘, ÁÂ-ÁÔÓfi˜ Ô˘ ‹Ù·Ó È‰È·›ÙÂÚ· ÂÌÊ·-Ó¤˜ ÙÔ˘˜ ÚÒÙÔ˘˜ 6 Ì‹ÓÂ˜ ·fiÙËÓ ¤Ó·ÚÍË ÙË˜ Ê·ÚÌ·ÎÂ˘ÙÈÎ‹˜·ÁˆÁ‹˜.

ªÈ· ¿ÏÏË ÌÂÏ¤ÙË ÛÂ ¿ÙÔÌ· ≥66ÂÙÒÓ ¤‰ÂÈÍÂ fiÙÈ Ë ‰ÈÂÙ‹˜ Û˘ÌÌfiÚ-

π √ À ¡ π √ ™ 2 0 0 8

22

ÊˆÛË ÛÙËÓ ·ÁˆÁ‹ ÌÂ ÛÙ·Ù›ÓÂ˜‹Ù·Ó 40,1% ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂÚfiÛÊ·ÙÔ ÔÍ‡ ÛÙÂÊ·ÓÈ·›Ô Û‡Ì-‚·Ì·, 36,1% ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ¯Úfi-ÓÈ· ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ Î·È 25,4%ÛÂ ·ÛıÂÓÂ›˜ ÚˆÙÔÁÂÓÔ‡˜ Úfi-ÏË„Ë˜.[29] ∂È‚Â‚·ÈÒÓÔÓÙ·È ‰ËÏ·-‰‹ Ù· ¯·ÌËÏ¿ ÔÛÔÛÙ¿ Û˘ÌÌfiÚ-ÊˆÛË˜ ÛÙËÓ ÚˆÙÔÁÂÓ‹ ÚfiÏË-„Ë Î·È ÛÙÈ˜ ÌÂÁ·Ï‡ÙÂÚÂ˜ ËÏÈÎ›Â˜.

¶Èı·Ó¿ ÔÈ ·ÛıÂÓÂ›˜ ÌÂ ÁÓˆÛÙ‹Î·Ú‰È·ÁÁÂÈ·Î‹ ÓfiÛÔ Ó· Û˘ÌÌÔÚ-ÊÒÓÔÓÙ·È Î·Ï‡ÙÂÚ· ÛÙËÓ ·ÁˆÁ‹ÌÂ ÛÙ·Ù›ÓÂ˜ ÂÂÈ‰‹ ·ÓÙÈÏ·Ì‚¿ÓÔ-ÓÙ·È ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ Î·Ú‰È·ÁÁÂÈ-·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘. ∞ÓÙ›ıÂÙ·, ¿ÙÔÌ·Ô˘ ˘Ê›ÛÙ·ÓÙ·È Î¿ÔÈÔ Û‡Ì‚·Ì·ÂÓÒ ‹‰Ë ¤·ÈÚÓ·Ó ÛÙ·Ù›ÓÂ˜ Â›Ó·ÈÈÔ ÂÈÚÚÂ‹ ÛÙÔ Ó· ‰È·Îfi„Ô˘ÓÙËÓ ·ÁˆÁ‹ ıÂˆÚÒÓÙ·˜ ÙË Ê·Ú-Ì·ÎÂ˘ÙÈÎ‹ ıÂÚ·Â›· ·Ó·ÔÙÂÏÂ-ÛÌ·ÙÈÎ‹.

∞Í›˙ÂÈ Ó· ·Ó·ÊÂÚıÂ› fiÙÈ Ë ‰È·ÎÔ-‹ ÙË˜ Ê·ÚÌ·ÎÂ˘ÙÈÎ‹˜ ·ÁˆÁ‹˜ÛÂ ÌÈÎÚfi ÌfiÓÔ ‚·ıÌfi ·Ô‰›‰ÂÙ·ÈÛÙÈ˜ ·ÓÂÈı‡ÌËÙÂ˜ ÂÓ¤ÚÁÂÈÂ˜ ÙˆÓÊ·ÚÌ¿ÎˆÓ. °È· ·Ú¿‰ÂÈÁÌ·, ÛÙËÌÂÏ¤ÙË 4S (Scandinavian Simva-statin Survival Study) ÙÔ ÔÛÔ-ÛÙfi ‰È·ÎÔ‹˜ ÙË˜ ÛÈÌ‚·ÛÙ·Ù›ÓË˜ÂÍ·ÈÙ›·˜ ·ÚÂÓÂÚÁÂÈÒÓ ‹Ù·Ó 6%[30]

Î·È ÛÙË ÌÂÏ¤ÙË WOSCOPS ÙÔ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi ‰È·ÎÔ‹˜ÙË˜ Ú·‚·ÛÙ·Ù›ÓË˜ ‹Ù·Ó 2%,ÂÓÒ Û˘ÓÔÏÈÎ¿ ÙÔ 30% ÙˆÓ ·ÛıÂ-ÓÒÓ ‰È¤ÎÔ„Â ÙË Ê·ÚÌ·ÎÂ˘ÙÈÎ‹·ÁˆÁ‹ ÛÙ· 5 ¤ÙË.[9] ¶ÔÏÏÔ› ·ÛıÂ-ÓÂ›˜ ‰È·ÎfiÙÔ˘Ó ÙË Ê·ÚÌ·ÎÂ˘ÙÈ-Î‹ ·ÁˆÁ‹ ÂÂÈ‰‹ ÈÛÙÂ‡Ô˘Ó fiÙÈ‰ÂÓ ÙË ¯ÚÂÈ¿˙ÔÓÙ·È ‹ Â›Ó·È ·Ó·-ÔÙÂÏÂÛÌ·ÙÈÎ‹, ÂÍ·ÈÙ›·˜ ÙË˜ Ô-Ï˘ÏÔÎfiÙËÙ·˜ ÙÔ˘ ıÂÚ·Â˘ÙÈÎÔ‡Û¯‹Ì·ÙÔ˜ ‹ ÙÔ˘ ˘„ËÏÔ‡ Îfi-ÛÙÔ˘˜ ÙˆÓ Ê·ÚÌ¿ÎˆÓ.[31, 32]

¶Ú¤ÂÈ ÛÂ ·˘Ùfi ÙÔ ÛËÌÂ›Ô Ó· ÂÈ-ÛËÌ·ÓıÂ› fiÙÈ Ë ÚÒÈÌË ‰È·ÎÔ‹ÙË˜ Ï‹„Ë˜ ÛÙ·ÙÈÓÒÓ ÌÂÙ¿ ·fi ¤Ó·ÔÍ‡ ÛÙÂÊ·ÓÈ·›Ô Û‡Ì‚·Ì· ¤¯ÂÈ Â-ÚÈÛÛfiÙÂÚÂ˜ ‰˘ÛÌÂÓÂ›˜ ÂÈÙÒÛÂÈ˜ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙË ÌË Ï‹„Ë ÛÙ·Ù›-ÓË˜ ÚÈÓ ·fi ·˘Ùfi ÙÔ Û‡Ì‚·Ì·.™˘ÁÎÂÎÚÈÌ¤Ó·, ‰Â‰ÔÌ¤Ó· ·fi ÙËÌÂÏ¤ÙË PRISM (Platelet ReceptorInhibition in Ischemic SyndromeManagement) ¤‰ÂÈÍ·Ó fiÙÈ Ë ·‡ÍË-ÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· Ó¤Ô ÔÍ‡ ÛÙÂ-Ê·ÓÈ·›Ô Û‡Ì‚·Ì· ‹Ù·Ó ÙÚÈÏ¿ÛÈ·ÌÂÙ¿ ÙË ‰È·ÎÔ‹ Ï‹„Ë˜ ÛÙ·Ù›ÓË˜,

ÂÓÒ Ô Î›Ó‰˘ÓÔ˜ ·˘Ùfi˜ ‹Ù·Ó 1,6ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔ˜ ÛÙÔ˘˜ ·ÛıÂ-ÓÂ›˜ Ô˘ ‰ÂÓ ¤·ÈÚÓ·Ó Î·ıfiÏÔ˘·ÁˆÁ‹ ÌÂ ÛÙ·Ù›ÓË.[33]

∂›ÛË˜, Ë ‰È·ÎÔ‹ ÙË˜ Ì·ÎÚÔ-¯ÚfiÓÈ·˜ ·ÁˆÁ‹˜ ÌÂ ÛÙ·Ù›ÓÂ˜ ÌÂÙ¿·fi ¤Ó· ∞∂∂ Ê·›ÓÂÙ·È fiÙÈ ÂÈ‰ÂÈ-ÓÒÓÂÈ ÙËÓ ÚfiÁÓˆÛË ÙˆÓ ·ÛıÂ-ÓÒÓ. ™˘ÁÎÂÎÚÈÌ¤Ó·, ·ÛıÂÓÂ›˜ Ô˘‰È¤ÎÔ„·Ó ÙË Ï‹„Ë ÛÙ·Ù›ÓË˜ ·Ì¤-Ûˆ˜ ÌÂÙ¿ ·fi ¤Ó· ∞∂∂ ÂÌÊ¿ÓÈ-Û·Ó ·˘ÍËÌ¤ÓË ıÓËÙfiÙËÙ· Î·È ·˘-ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ ÚÒÈÌË˜ ÓÂ˘ÚÔ-ÏÔÁÈÎ‹˜ ÂÈ‰Â›ÓˆÛË˜, Î·ıÒ˜ Î·È·‡ÍËÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙÔ˘ ÈÛ¯·È-ÌÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘ ÛÂ Û‡ÁÎÚÈÛË ÌÂÙÔ˘˜ ·ÛıÂÓÂ›˜ Ô˘ Û˘Ó¤¯ÈÛ·Ó Ó··›ÚÓÔ˘Ó ÛÙ·Ù›ÓË.[34]

ª¤ÙÚ· ÁÈ· ÙË ‚ÂÏÙ›ˆÛË ÙË˜Û˘ÌÌfiÚÊˆÛË˜ ÙˆÓ ·ÛıÂÓÒÓÛÙËÓ ˘ÔÏÈÈ‰·ÈÌÈÎ‹ ıÂÚ·Â›·

™ÙËÓ ÚÔÛ¿ıÂÈ· ‚ÂÏÙ›ˆÛË˜ ÙË˜Û˘ÌÌfiÚÊˆÛË˜ ÙˆÓ ·ÛıÂÓÒÓ ÛÙËÊ·ÚÌ·ÎÂ˘ÙÈÎ‹ ·ÁˆÁ‹ ¤¯ÂÈ ÌÂÏÂ-ÙËıÂ› Ë Â›‰Ú·ÛË ‰È¿ÊÔÚˆÓ·ÏÒÓ Ì¤ÙÚˆÓ. °È· ·Ú¿‰ÂÈÁÌ·,Ë ¤ÁÎ·ÈÚË ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ·ÛıÂÓÒÓ (Ì¤Û· ÛÂ ¤Ó· Ì‹Ó·) ÌÂ-Ù¿ ·fi ¤Ó· √∂ª Û˘Û¯ÂÙ›ÛıËÎÂÌÂ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi Ï‹„Ë˜‚-·ÔÎÏÂÈÛÙÒÓ, ·ÛÈÚ›ÓË˜ Î·ÈÛÙ·ÙÈÓÒÓ ÛÙÔ˘˜ 6 Ì‹ÓÂ˜ ÛÂ Û‡-ÁÎÚÈÛË ÌÂ ÙË ÌË ·Ú·ÎÔÏÔ‡ıËÛ‹ÙÔ˘˜ [(80,1% ¤Ó·ÓÙÈ 71,3%;p=0,001), (82,9% ¤Ó·ÓÙÈ 77,1%;p=0,01) Î·È (75,9% ¤Ó·ÓÙÈ68,6%; p=0,005), ·ÓÙ›ÛÙÔÈ¯·].[35]

∂ÈÚfiÛıÂÙ·, Ë ÂÈÎÔÈÓˆÓ›· ÙˆÓıÂÚ·fiÓÙˆÓ È·ÙÚÒÓ ÌÂ ÙÔ˘˜·ÛıÂÓÂ›˜, ·ÎfiÌ· Î·È ‰È·Ì¤ÛÔ˘ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘, Ê·›ÓÂÙ·È fiÙÈ ‚ÂÏ-ÙÈÒÓÂÈ ÙË Û˘ÌÌfiÚÊˆÛË ÙˆÓ ·Û-ıÂÓÒÓ ÛÙË Ê·ÚÌ·ÎÂ˘ÙÈÎ‹ ·ÁˆÁ‹.™˘ÁÎÂÎÚÈÌ¤Ó·, Ë ÂÈÎÔÈÓˆÓ›· ÙÔ˘ÁÈ·ÙÚÔ‡ ÌÂ ·ÛıÂÓÂ›˜ Ô˘ Â›¯·Ó˘ÔÛÙÂ› √∂ª ÌÂ ‰‡Ô ÌËÓ‡Ì·Ù·‰È·Ì¤ÛÔ˘ ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘ Û˘Û¯Â-Ù›ÛıËÎÂ ÌÂ ÌÈ· Î·Ù¿ 17% ·‡ÍËÛËÙË˜ Ï‹„Ë˜ ‚-·ÔÎÏÂÈÛÙÒÓ 9 Ì‹-ÓÂ˜ ÌÂÙ¿ ÙÔ √∂ª.[36]

∏ ÌË Û˘ÌÌfiÚÊˆÛË ÙˆÓ ·ÛıÂÓÒÓÛÙËÓ ÂÓ‰ÂÈÎÓ˘fiÌÂÓË Ê·ÚÌ·ÎÂ˘ÙÈ-Î‹ ·ÁˆÁ‹ ÂÈ‚·Ú‡ÓÂÈ ÛËÌ·ÓÙÈÎ¿Ù· Û˘ÛÙ‹Ì·Ù· ˘ÁÂ›·˜ Î·È fiÛÔÓ·ÊÔÚ¿ ÙÔÓ ÔÈÎÔÓÔÌÈÎfi ÙÔÌ¤·ÂÍ·ÈÙ›·˜ ·‡ÍËÛË˜ ÙË˜ ¯Ú‹ÛË˜ÙˆÓ ˘ËÚÂÛÈÒÓ ˘ÁÂ›·˜ (.¯. ÓÔ-

ÛËÏÂ›Â˜, È·ÙÚÈÎ¤˜ ÂÈÛÎ¤„ÂÈ˜,¯Ú‹ÛË ÙˆÓ ÌÔÓ¿‰ˆÓ ÂÓÙ·ÙÈÎ‹˜ıÂÚ·Â›·˜).[37, 38]

∞ÓÙ›ıÂÙ·, Ë Î·Ï‹ Û˘ÌÌfiÚÊˆÛËÛÙËÓ ˘ÔÏÈÈ‰·ÈÌÈÎ‹ ·ÁˆÁ‹ ¤¯ÂÈÛ˘Û¯ÂÙÈÛıÂ› ÌÂ ÌÈÎÚfiÙÂÚÔ Îfi-ÛÙÔ˜ ˘ËÚÂÛÈÒÓ ˘ÁÂ›·˜.[39] ΔÔ˘„ËÏfiÙÂÚÔ ÎfiÛÙÔ˜ ·fi ÙË ¯ÔÚ‹-ÁËÛË ÙˆÓ Ê·ÚÌ¿ÎˆÓ ˘ÂÚÎÂÚ¿-˙ÂÙ·È ·fi ÙË ÌÂ›ˆÛË ÙÔ˘ Îfi-ÛÙÔ˘˜ Ô˘ ¤¯ÂÈ Û¯¤ÛË ÌÂ ÙÈ˜˘ËÚÂÛ›Â˜ ˘ÁÂ›·˜.

∂ÈÚfiÛıÂÙ·, Ë ‰ˆÚÂ¿Ó ·ÚÔ¯‹˘ÔÏÈÈ‰·ÈÌÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ÛÂ·ÛıÂÓÂ›˜ ˘„ËÏÔ‡ Î·Ú‰È·ÁÁÂÈ·-ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ Î·È Ë Ù·˘Ùfi¯ÚÔÓË·‡ÍËÛË ÙÔ˘ ÎfiÛÙÔ˘˜ ÙÔ˘˜ ÁÈ·ÙÔ˘˜ ·ÛıÂÓÂ›˜ ¯·ÌËÏÔ‡ Î·Ú‰È·Á-ÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ Ê·›ÓÂÙ·È fiÙÈÂÏ·ÙÙÒÓÂÈ ÙÈ˜ ÓÔÛËÏÂ›Â˜ Î·È ÙË¯Ú‹ÛË ÙˆÓ ÌÔÓ¿‰ˆÓ ÂÓÙ·ÙÈÎ‹˜ıÂÚ·Â›·˜.[40]

Δ¤ÙÔÈÔ˘ Â›‰Ô˘˜ Ú˘ıÌ›ÛÂÈ˜ ‚¤‚·È·‰ÂÓ ·ÊÔÚÔ‡Ó ÙÔÓ ÎÏÈÓÈÎfi ÁÈ·ÙÚfi,·ÏÏ¿ ÙÔ Û‡ÛÙËÌ· ˘ÁÂ›·˜ Î¿ıÂ¯ÒÚ·˜. ∞˘Ùfi ˆÛÙfiÛÔ Ô˘ ÔÊÂ›-ÏÔ˘ÌÂ Ó· ÁÓˆÚ›˙Ô˘ÌÂ Â›Ó·È fiÙÈÛ˘¯Ó¿ ÙÔ ˘„ËÏfi ÎfiÛÙÔ˜ ÙˆÓÊ·ÚÌ¿ÎˆÓ Ô‰ËÁÂ› ÛÂ ¯·ÌËÏ‹Û˘ÌÌfiÚÊˆÛË ÙˆÓ ·ÛıÂÓÒÓ ÛÙËÊ·ÚÌ·ÎÂ˘ÙÈÎ‹ ÙÔ˘˜ ·ÁˆÁ‹.[41-44]

™˘Ì¤Ú·ÛÌ·¶·Ú¿ Ù· ·Ô‰Â‰ÂÈÁÌ¤Ó· ÔÊ¤ÏËÙË˜ ˘ÔÏÈÈ‰·ÈÌÈÎ‹˜ ·ÁˆÁ‹˜ÛÙËÓ ÚˆÙÔÁÂÓ‹ Î·È ‰Â˘ÙÂÚÔÁÂ-Ó‹ ÚfiÏË„Ë ÙˆÓ Î·Ú‰È·ÁÁÂÈ·-ÎÒÓ ÓÔÛËÌ¿ÙˆÓ Ë Û˘ÌÌfiÚÊˆÛËÙˆÓ ·ÛıÂÓÒÓ Â›Ó·È Û˘¯Ó¿ ·Ô-ÁÔËÙÂ˘ÙÈÎ‹. ∂›Ó·È ÂÓ‰ÂÈÎÙÈÎfi fiÙÈÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ·ÛıÂÓÂ›˜ ÛÙ·-Ì·ÙÔ‡Ó ÙË ıÂÚ·Â›· ÌÂ ÛÙ·Ù›ÓÂ˜6 Ì‹ÓÂ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍ‹ ÙË˜. ∏‰È·ÎÔ‹ ÙË˜ ·ÁˆÁ‹˜ Ô‰ËÁÂ›ÛÙËÓ ÂÏ¿ÙÙˆÛË ÙË˜ Â˘ÂÚÁÂÙÈÎ‹˜Â›‰Ú·ÛË˜ ÙˆÓ Ê·ÚÌ¿ÎˆÓ, ÛÙËÓÂÈ‰Â›ÓˆÛË ÙË˜ ÚfiÁÓˆÛË˜ ÙˆÓ·ÛıÂÓÒÓ, Î·ıÒ˜ Î·È ÛÙËÓ ÔÈÎÔ-ÓÔÌÈÎ‹ ÂÈ‚¿Ú˘ÓÛË ÙˆÓ Û˘ÛÙË-Ì¿ÙˆÓ ˘ÁÂ›·˜. √È ÁÈ·ÙÚÔ› ÔÊÂ›-ÏÔ˘Ó Ó· ·ÊÈÂÚÒÓÔ˘Ó ÂÚÈÛÛfiÙÂ-ÚÔ ¯ÚfiÓÔ ÁÈ· Ó· ÂÍËÁÔ‡Ó ÙËÓ·Ó·ÁÎ·ÈfiÙËÙ· ÙË˜ Î·ıËÌÂÚÈÓ‹˜Ï‹„Ë˜ ÙË˜ Ê·ÚÌ·ÎÂ˘ÙÈÎ‹˜ ·Áˆ-Á‹˜, Î·ıÒ˜ Î·È ÁÈ· ÙËÓ ·Ú·ÎÔ-ÏÔ‡ıËÛË ÙˆÓ ·ÛıÂÓÒÓ ÛÂ Ù·ÎÙ¿¯ÚÔÓÈÎ¿ ‰È·ÛÙ‹Ì·Ù· ÌÂÙ¿ ÙËÓ·Ú¯ÈÎ‹ Û˘ÓÙ·ÁÔÁÚ¿ÊËÛË.


23


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40. Goldman DP, Joyce GF, Karaca-Mandic P. Varying pharmacy benefitswith clinical status: the case ofcholesterol-lowering therapy. Am JManag Care 2006; 12:21-8.

41. Osterberg L, Blaschke T. Adherence tomedication. N Engl J Med 2005; 353:487-97.

42. Federman AD, Adams AS, Ross-Degnan D et al. Supplemental insu-rance and use of effective cardiova-scular drugs among elderly medicarebeneficiaries with coronary heartdisease. JAMA 2001; 286:1732-9.

43. Tamblyn R, Laprise R, Hanley JA et al.Adverse events associated withprescription drug cost-sharing amongpoor and elderly persons. JAMA 2001;285:421-9.

44. Roblin DW, Platt R, Goodman MJ et al.Effect of increased cost-sharing on oralhypoglycemic use in five managedcare organizations: how much is toomuch? Med Care 2005; 43:951-9.

π √ À ¡ π √ ™ 2 0 0 8

24

√ ÚfiÏÔ˜ ÙË˜ ‰È·ÙÚÔÊ‹˜ ÛÙËÓÚfiÏË„Ë ÙË˜ Î·Ú‰ÈÔ·ÁÁÂÈ·Î‹˜ÓfiÛÔ˘ (∫∞¡) Â›Ó·È È‰È·›ÙÂÚ· ÛË-Ì·ÓÙÈÎfi˜. ¢È¿ÊÔÚ· ıÚÂÙÈÎ¿ Û˘-ÛÙ·ÙÈÎ¿, fiˆ˜ Ë ÚˆÙÂ˝ÓË Ûfi-ÁÈ·˜, ¤¯Ô˘Ó ÌÂÏÂÙËıÂ› fiÛÔÓ ·ÊÔ-Ú¿ ÙÔ ÚfiÏÔ ÙÔ˘˜ ÛÙËÓ ÂÌÊ¿ÓÈÛË∫∞¡. ΔÔ 1999 Ô ∞ÌÂÚÈÎ·ÓÈÎfi˜√ÚÁ·ÓÈÛÌfi˜ ΔÚÔÊ›ÌˆÓ Î·È º·Ú-Ì¿ÎˆÓ ¤‰ˆÛÂ ¤ÁÎÚÈÛË ÁÈ· ÂÈÛ‹-Ì·ÓÛË ÛÂ ÂÙÈÎ¤ÙÂ˜ ÙÚÔÊ›ÌˆÓÏÔ‡ÛÈˆÓ ÛÂ ÚˆÙÂ˝ÓË ÛfiÁÈ·˜fiÙÈ ·˘Ù¤˜ ÔÈ ÙÚÔÊ¤˜ ÌÔÚÔ‡Ó Ó·ÚÔÛÙ·ÙÂ‡ÛÔ˘Ó ·fi Î·Ú‰È·ÁÁÂÈ-·Î¿ ÓÔÛ‹Ì·Ù·. ∏ ·fiÊ·ÛË ·˘Ù‹‚·Û›ÛÙËÎÂ ÛÂ ÎÏÈÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜Ô˘ ¤‰ÂÈÍ·Ó fiÙÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ 25ÁÚ·ÌÌ¿ÚÈ· ÚˆÙÂ˝ÓË˜ ÛfiÁÈ·˜ÙËÓ ËÌ¤Ú· ÌÂ›ˆÛ·Ó ÙËÓ ÔÏÈÎ‹ ¯Ô-ÏËÛÙÂÚfiÏË Î·È ÙË ¯ÔÏËÛÙÂÚfiÏËÙˆÓ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔ-ÚˆÙÂ˚ÓÒÓ (LDL-¯ÔÏËÛÙÂÚfiÏË).ΔËÓ ÂfiÌÂÓË ¯ÚÔÓÈ¿ Ë ∞ÌÂÚÈÎ·ÓÈ-Î‹ ∫·Ú‰ÈÔÏÔÁÈÎ‹ ∂Ù·ÈÚÂ›· (∞∫∂)ÂÍ¤‰ˆÛÂ ·Ó·ÎÔ›ÓˆÛË Ô˘ ˘Ô-ÛÙ‹ÚÈ˙Â ÙËÓ ÚÔÛı‹ÎË Úˆ-ÙÂ˝ÓË˜ ÛfiÁÈ·˜ ÛÂ Ì›· ‰›·ÈÙ· ¯·-ÌËÏÒÓ ÏÈ·ÚÒÓ Î·È ¯ÔÏËÛÙÂÚfi-ÏË˜. ŒÎÙÔÙÂ, ·ÚÎÂÙ¤˜ ÌÂÏ¤ÙÂ˜ÚÔÛÙ¤ıËÎ·Ó ÛÙÈ˜ ˘¿Ú¯Ô˘ÛÂ˜Î·È Ì›· Ó¤· ·Ó·ÎÔ›ÓˆÛË Ô˘ Û˘-Ófi„È˙Â Ù· ÓÂfiÙÂÚ· ‰Â‰ÔÌ¤Ó· ÂÎ-‰fiıËÎÂ ·fi ÙËÓ ∞∫∂ ÙÔ 2006.

√È ÚˆÙÂ˝ÓÂ˜ ˙ˆÈÎ‹˜ ÚÔ¤ÏÂ˘-ÛË˜ ·˘Í¿ÓÔ˘Ó ÙËÓ ¯ÔÏËÛÙÂÚfiÏËfiÙ·Ó ¯ÔÚËÁÔ‡ÓÙ·È Ì·˙› ÌÂ ÙÚÔÊ‹Ô˘ ‰ÂÓ ÂÚÈ¤¯ÂÈ ¯ÔÏËÛÙÂÚfiÏËÛÂ ‰È¿ÊÔÚ· Â›‰Ë ˙ÒˆÓ. ™ÙÈ˜ ·Ú-¯¤˜ ÙË˜ ‰ÂÎ·ÂÙ›·˜ ÙÔ˘ 1980 ¤ÁÈ-ÓÂ Ë ·Ú·Ù‹ÚËÛË ÛÂ ÂÈÚ·Ì·Ùfi-˙ˆ· fiÙÈ Ë ·ÓÙÈÎ·Ù¿ÛÙ·ÛË ÙË˜Î·˙Â˝ÓË˜ ÙÔ˘ Á¿Ï·ÎÙÔ˜ ·fi Úˆ-ÙÂ˝ÓË ÛfiÁÈ·˜ ‰ÂÓ Û˘ÓÔ‰Â‡ÂÙ·È·fi ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·. ∞˘Ù¿Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ‰ÂÓ Â·ÏËıÂ‡-ıËÎ·Ó ÛÂ ˘ÁÈÂ›˜ ÂıÂÏÔÓÙ¤˜, Î·-ıÒ˜ Ë ÚÔ¤ÏÂ˘ÛË ÙË˜ ÚˆÙÂ˝ÓË˜ÙË˜ ÙÚÔÊ‹˜ ‰ÂÓ ÂËÚ¤·ÛÂ Ù·Â›Â‰· ÙË˜ ¯ÔÏËÛÙÂÚfiÏË˜ ÙÔ˘ÔÚÔ‡. ŸÌˆ˜ ÔÈ Sirtori Î·È Û˘ÓÂÚ-Á¿ÙÂ˜ ¤‰ÂÈÍ·Ó ÛÂ ¿ÙÔÌ· ÌÂ ˘ÂÚ-

ÏÈÈ‰·ÈÌ›· Ù‡Ô˘ ππ ∞ Î·È ππ μ fiÙÈ‰›·ÈÙÂ˜ ÛÙÈ˜ ÔÔ›Â˜ ÔÈ ˙ˆÈÎ¤˜ÚˆÙÂ˝ÓÂ˜ Â›¯·Ó ·ÓÙÈÎ·Ù·ÛÙ·ıÂ›ÛÂ ÌÂÁ¿ÏÔ ‚·ıÌfi ·fi ÚˆÙÂ˝ÓËÛfiÁÈ·˜ ÌÂ›ˆÛ·Ó ÙËÓ ÔÏÈÎ‹ ¯ÔÏË-ÛÙÂÚfiÏË ÙÔ˘ ÔÚÔ‡ Î·Ù¿ 20% -30%. ŸÌˆ˜, Ë ÌÂ›ˆÛË ÙË˜ ¯ÔÏË-ÛÙÂÚfiÏË˜ ÙÔ˘ ÔÚÔ‡ Èı·Ó¿ ÔÊÂÈ-ÏfiÙ·Ó ¤ˆ˜ ¤Ó· ‚·ıÌfi ÛÙËÓ Ù·˘-Ùfi¯ÚÔÓË ·ÒÏÂÈ· ‚¿ÚÔ˘˜, ÙËÌÂ›ˆÛË ÙË˜ ÚfiÛÏË„Ë˜ ÎÔÚÂ-ÛÌ¤ÓˆÓ ÏÈ·ÚÒÓ ÔÍ¤ˆÓ Î·È ¯ÔÏË-ÛÙÂÚfiÏË˜, Î·ıÒ˜ Î·È ÙËÓ ·‡ÍËÛËÙˆÓ ÔÏ˘·ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓÔÍ¤ˆÓ ÙË˜ ‰È·ÙÚÔÊ‹˜. ª›· ÌÂÙ·-·Ó¿Ï˘ÛË Ô˘ ‰ËÌÔÛÈÂ‡ıËÎÂ ÙÔ1995, ¤‰ÂÈÍÂ fiÙÈ Ë ÌÂ›ˆÛË ÙË˜ ¯Ô-ÏËÛÙÂÚfiÏË˜ ·fi ÚˆÙÂ˝ÓË Ûfi-ÁÈ·˜ Â›Ó·È ·Ó¿ÏÔÁË ÙÔ˘ ‚·ıÌÔ‡ÙË˜ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜: ¶Ú¿-ÁÌ·ÙÈ ¿ÙÔÌ· ÌÂ Â›Â‰· ¯ÔÏË-ÛÙÂÚfiÏË˜ ÔÚÔ‡ >335 mg/dL ÂÌ-Ê¿ÓÈÛ·Ó ÌÂ›ˆÛË ÙË˜ ¯ÔÏËÛÙÂÚfi-ÏË˜ ÙÔ˘ ÔÚÔ‡ Î·Ù¿ 20%, ÂÓÒ ÛÂ¿ÙÔÌ· ÌÂ Â›Â‰· ¯ÔÏËÛÙÂÚfiÏË˜ÔÚÔ‡ <255 mg/dL, Ë Â›‰Ú·Û‹ÙË˜ ‰ÂÓ ‹Ù·Ó ÛËÌ·ÓÙÈÎ‹.

√È ÌË¯·ÓÈÛÌÔ› ‰Ú¿ÛÂÈ˜ ÙË˜ Úˆ-ÙÂ˝ÓË˜ ÛfiÁÈ·˜ ¤¯Ô˘Ó ‰ÈÂÚÂ˘ÓËıÂ›ÛÂ ÔÏÏ¤˜ ÌÂÏ¤ÙÂ˜ Î·È Ê·›ÓÂÙ·ÈfiÙÈ ÔÚÈÛÌ¤Ó· ıÚÂÙÈÎ¿ Û˘ÛÙ·ÙÈ-Î¿ ÙË˜ ÚˆÙÂ˝ÓË˜ ÛfiÁÈ·˜, fiˆ˜ÔÈ ÈÛÔÊÏ·‚fiÓÂ˜, ÌÔÚÂ› Ó· Â›Ó·È˘Â‡ı˘Ó· ÁÈ· ÙËÓ Èı·Ó‹ Â˘ÂÚ-ÁÂÙÈÎ‹ ‰Ú¿ÛË ÙË˜. √È ÈÛÔÊÏ·‚fi-ÓÂ˜ Â›Ó·È ÔÏ˘Ê·ÈÓÔÏÈÎ¤˜ ÂÓÒ-ÛÂÈ˜ Ô˘ ‚Ú›ÛÎÔÓÙ·È ÛÙ· fiÛÚÈ·,Î˘Ú›ˆ˜ ÛÙ· Ê·ÛfiÏÈ· ÛfiÁÈ·˜.Œ¯ÂÈ ·Ó·ÊÂÚıÂ› fiÙÈ ·˘Ù¤˜ ÔÈ Ô˘-Û›Â˜ ¤¯Ô˘Ó ÙfiÛÔ ÔÈÛÙÚÔÁÔÓÈÎ¤˜,fiÛÔ Î·È ·ÓÙÈÔÈÛÙÚÔÁÔÓÈÎ¤˜ ‰Ú¿-ÛÂÈ˜. √È ÈÛÔÊÏ·‚fiÓÂ˜ Ô˘ ··-ÓÙÒÓÙ·È Û˘¯ÓfiÙÂÚ· ÛÙË Ê‡ÛË Â›-Ó·È Ë ÁÂÓÈÛÙÂ˝ÓË, Ë ÓÙ·˚Ù˙Â˝ÓË Î·ÈË ÁÏ˘ÛÈÙ›ÓË. ∏ ÂÚÈÂÎÙÈÎfiÙËÙ·ÙË˜ ÚˆÙÂ˝ÓË˜ ÛfiÁÈ·˜ ÛÂ ÈÛÔ-ÊÏ·‚fiÓÂ˜ ÔÈÎ›ÏÏÂÈ Î·È ÂÍ·ÚÙ¿-Ù·È ·fi ÙÈ˜ ÌÂıfi‰Ô˘˜ ÂÂÍÂÚÁ·-Û›·˜ Î·Ù¿ ÙËÓ ·Ú·ÁˆÁ‹. ΔÔ ÁÂ-ÁÔÓfi˜ ·˘Ùfi ÂÈ‚¿ÏÏÂÈ ÙÔ ‰È·¯ˆ-ÚÈÛÌfi ÙˆÓ ÌÂÏÂÙÒÓ ÌÂ ‚¿ÛË ÙËÓ

ÂÚÈÂÎÙÈÎfiÙËÙ· ÙË˜ ÚˆÙÂ˝ÓË˜ÛfiÁÈ·˜ ÛÂ ÈÛÔÊÏ·‚fiÓÂ˜.

∂›‰Ú·ÛË ÙË˜ ÚˆÙÂ˝ÓË˜ÛfiÁÈ·˜ ÌÂ ÈÛÔÊÏ·‚fiÓÂ˜

™Â 22 Ù˘¯·ÈÔÔÈËÌ¤ÓÂ˜ ÌÂÏ¤ÙÂ˜,Ë ÚˆÙÂ˝ÓË ÛfiÁÈ·˜ ÌÂ ÈÛÔÊÏ·‚fi-ÓÂ˜ Û˘ÁÎÚ›ıËÎÂ ÌÂ ÙËÓ Î·˙Â˝ÓË ‹ÙËÓ ÚˆÙÂ˝ÓË ÙÔ˘ ÛÈÙ¿ÏÂ˘ÚÔ˘ ‹ÌÂ ˙ˆÈÎ‹ ÚˆÙÂ˝ÓË. ∏ ËÌÂÚ‹ÛÈ·ÚfiÛÏË„Ë ÚˆÙÂ˝ÓË˜ ÛfiÁÈ·˜ Î˘-Ì·ÈÓfiÙ·Ó ·fi 25-135 ÁÚ·ÌÌ¿ÚÈ·Î·È ÙˆÓ ÈÛÔÊÏ·‚ÔÓÒÓ ·fi 40-318 mg. ¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ·Ú·ÙËÚ‹ıËÎÂ ÌÂ›ˆÛË ÂÚ›Ô˘Î·Ù¿ 3% ÙË˜ LDL ¯ÔÏËÛÙÂÚfiÏË˜ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ÌÂÏÂÙÒÓ, ÌfiÓÔÛÂ 6 ÌÂÏ¤ÙÂ˜ ·˘Ù‹ Ë ÌÂ›ˆÛË ‹Ù·ÓÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹. ª›· Úfi-ÛÊ·ÙË ÌÂÙ·-·Ó¿Ï˘ÛË 10 Ù˘¯·ÈÔ-ÔÈËÌ¤ÓˆÓ ÌÂÏÂÙÒÓ Ô˘ ‰ËÌÔÛÈ-Â‡ıËÎ·Ó ·fi ÙÔ 1995 ¤ˆ˜ ÙÔ2002, ¤‰ÂÈÍÂ ·ÚfiÌÔÈ· ÌÂ›ˆÛËÙË˜ LDL ¯ÔÏËÛÙÂÚfiÏË˜, Ë ÔÔ›·‰ÂÓ ‹Ù·Ó ‰ÔÛÔÂÍ·ÚÙÒÌÂÓË.

∂›‰Ú·ÛË ÙË˜ ÚˆÙÂ˝ÓË˜ÛfiÁÈ·˜ ¯ˆÚ›˜ ÈÛÔÊÏ·‚fiÓÂ˜

™Â 7 ÌÂÏ¤ÙÂ˜ ÛÙÈ˜ ÔÔ›Â˜ ·Ê·È-Ú¤ıËÎ·Ó ÔÈ ÈÛÔÊÏ·‚fiÓÂ˜ ·fi ÙËÓÚˆÙÂ˝ÓË ÛfiÁÈ·˜, Ë ÙÂÏÂ˘Ù·›·Û˘ÁÎÚ›ıËÎÂ ÌÂ ÙËÓ Î·˙Â˝ÓË ‹ ÌÂ˙ˆÈÎ‹ ÚˆÙÂ˝ÓË. ™Â 2 ·fi ·˘Ù¤˜ÙÈ˜ ÌÂÏ¤ÙÂ˜, ‚Ú¤ıËÎÂ Ì›· ÌÈÎÚ‹·ÏÏ¿ ÛËÌ·ÓÙÈÎ‹ ÌÂ›ˆÛË ÙË˜ LDL¯ÔÏËÛÙÂÚfiÏË˜. ∞˘Ù¤˜ ÔÈ ÌÂÏ¤ÙÂ˜‹Ù·Ó ÔÏ‡ Î·Ï¿ Û¯Â‰È·ÛÌ¤ÓÂ˜fiÛÔÓ ·ÊÔÚ¿ ÙË ¯ÔÚ‹ÁËÛË ÙË˜ÙÚÔÊ‹˜, Î·ıÒ˜ fiÏ· Ù· ÁÂ‡Ì·Ù·Ô˘ ¯ÔÚËÁÔ‡ÓÙ·Ó ÛÙÔ˘˜ Û˘ÌÌÂ-Ù¤¯ÔÓÙÂ˜ ‹Ù·Ó Ï‹Úˆ˜ ˘ÔÏÔÁÈ-ÛÌ¤Ó· ÁÈ· fiÏ· Ù· ıÚÂÙÈÎ¿ Û˘-ÛÙ·ÙÈÎ¿. ¶·Ú·ÙËÚ‹ıËÎÂ ÌÂ›ˆÛËÙË˜ LDL ¯ÔÏËÛÙÂÚfiÏË˜ Î·Ù¿ 2%- 7%, Ë ÔÔ›· fiÌˆ˜ ÎÚ›ÓÂÙ·È Û¯Â-ÙÈÎ¿ ÌÈÎÚ‹ ÛÂ Û¯¤ÛË ÌÂ ÙËÓ Ô-ÛfiÙËÙ· ÙˆÓ 50 ÁÚ·ÌÌ·Ú›ˆÓ Úˆ-ÙÂ˝ÓË˜ ÛfiÁÈ·˜ Ô˘ Û˘ÓÈÛÙ¿Ù·ÈÎ·ıËÌÂÚÈÓ¿ Î·È Ë ÔÔ›· ·Ó¤Ú¯Â-Ù·È ÛÙÔ ÌÈÛfi ‹ Î·È ÂÚÈÛÛfiÙÂÚÔÙË˜ Ì¤ÛË˜ ËÌÂÚ‹ÛÈ·˜ ÚfiÛÏË-

¶ÚˆÙÂ˝ÓË ™fiÁÈ·˜, πÛÔÊÏ·‚fiÓÂ˜ Î·È ∫·Ú‰È·ÁÁÂÈ·Î‹ ¡fiÛÔ˜

ÃÚ‹ÛÙÔ˜ ¢ÂÚ‰ÂÌ¤˙Ë˜, ∫ÏÈÓÈÎfi˜ ¢È·ÈÙÔÏfiÁÔ˜ - ¢È·ÙÚÔÊÔÏfiÁÔ˜, ∂ÈÛÙËÌÔÓÈÎfi˜ ™˘ÓÂÚÁ¿ÙË˜ ÙÔ˘ ∂ÍˆÙÂÚÈÎÔ‡ π·ÙÚÂ›Ô˘ ¢È·Ù·Ú·¯ÒÓ ÙÔ˘ ªÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ §ÈÈ‰›ˆÓ

Î·È ¶·¯˘Û·ÚÎ›·˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ ¡ÔÛÔÎÔÌÂ›Ô˘ πˆ·ÓÓ›ÓˆÓªˆ˘Û‹˜ ∂ÏÈÛ¿Ê, ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈÎ‹˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ

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

¢IATPOºH

25

„Ë˜ ÚˆÙÂ˝ÓË˜ ÛÂ Ì›· ¢˘ÙÈÎÔ‡Ù‡Ô˘ ‰È·ÙÚÔÊ‹. ∂ÈÚfiÛıÂÙ·,ÛÂ ¿ÏÏÂ˜ ÌÂÏ¤ÙÂ˜ ‰ÂÓ ‚Ú¤ıËÎÂÛËÌ·ÓÙÈÎ‹ Â›‰Ú·ÛË ÙË˜ Úˆ-ÙÂ˝ÓË˜ ÛfiÁÈ·˜, Ô˘ ‰ÂÓ ÂÚÈÂ›¯ÂÈÛÔÊÏ·‚fiÓÂ˜, ÛÙ· Â›Â‰· ÙË˜LDL ¯ÔÏËÛÙÂÚfiÏË˜.

∂›‰Ú·ÛË ÙˆÓ ÈÛÔÊÏ·‚ÔÓÒÓ

√ÚÈÛÌ¤ÓÂ˜ ÌÂÏ¤ÙÂ˜ Û˘Ó¤ÎÚÈÓ·ÓÙËÓ ÚˆÙÂ˝ÓË ÛfiÁÈ·˜ Ô˘ ÂÚÈ¤-¯ÂÈ ‹ fi¯È ÈÛÔÊÏ·‚fiÓÂ˜, ÂÓÒ ¿Ï-ÏÂ˜ ÌÂÏ¤ÙÂ˜ ‰ÈÂÚÂ‡ÓËÛ·Ó ÙËÓÂ›‰Ú·ÛË ÙË˜ ¯ÔÚ‹ÁËÛË˜ ÙˆÓÈÛÔÊÏ·‚ÔÓÒÓ ÛÂ ÌÔÚÊ‹ ¯·ÈÔ‡¤Ó·ÓÙÈ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘. ∞fiÙÈ˜ 19 Û˘ÓÔÏÈÎ¿ ÌÂÏ¤ÙÂ˜, ÌfiÓÔÛÂ 3 ÌÂÏ¤ÙÂ˜ Ë ¯ÔÚ‹ÁËÛË ÈÛÔ-ÊÏ·‚ÔÓÒÓ Ô‰‹ÁËÛÂ ÛÂ ÛÙ·ÙÈÛÙÈ-Î¿ ÛËÌ·ÓÙÈÎ‹ ÌÂ›ˆÛË ÙË˜ LDL¯ÔÏËÛÙÂÚfiÏË˜. ™ÙÈ˜ ÌÂÏ¤ÙÂ˜¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ‰È·ÊÔÚÂÙÈÎ¤˜ÔÛfiÙËÙÂ˜ ÈÛÔÊÏ·‚ÔÓÒÓ ¯ˆÚ›˜Ó· ˘¿Ú¯ÂÈ ‰ÔÛÔÂÍ·ÚÙÒÌÂÓÔ·ÔÙ¤ÏÂÛÌ·. ∂ÈÚfiÛıÂÙ·, Ì›·ÌÂÙ·-·Ó¿Ï˘ÛË ‰ÂÓ ¤‰ÂÈÍÂ Â›-‰Ú·ÛË ÙˆÓ ÈÛÔÊÏ·‚ÔÓÒÓ ÛÙ·Â›Â‰· ÙˆÓ ÏÈÈ‰›ˆÓ.

∂›‰Ú·ÛË ÛÙ· Â›Â‰· ÙË˜HDL ¯ÔÏËÛÙÂÚfiÏË˜ Î·È ÙˆÓ

ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ

™Â Î·Ì›· ÌÂÏ¤ÙË Ô˘ ¯ÔÚËÁ‹ıË-ÎÂ ÚˆÙÂ˝ÓË ÛfiÁÈ·˜, ÌÂ ‹ ¯ˆÚ›˜ÈÛÔÊÏ·‚fiÓÂ˜, ‹ Û˘ÌÏËÚÒÌ·Ù·ÈÛÔÊÏ·‚ÔÓÒÓ ‰ÂÓ ·Ú·ÙËÚ‹ıË-ÎÂ ÛËÌ·ÓÙÈÎ‹ Â›‰Ú·ÛË ÛÙ· Â›-Â‰· ÙË˜ HDL ¯ÔÏËÛÙÂÚfiÏË˜ Î·ÈÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ.

∂›‰Ú·ÛË ÙˆÓ ·Ú¯ÈÎÒÓÂÈ¤‰ˆÓ LDL ¯ÔÏËÛÙÂÚfiÏË˜

√È Lichtenstein Î·È Û˘ÓÂÚÁ¿ÙÂ˜Î·È ÔÈ Crouse Î·È Û˘ÓÂÚÁ¿ÙÂ˜¤‰ÂÈÍ·Ó ÌÂÁ·Ï‡ÙÂÚË ÔÛÔÛÙÈ·›·ÌÂ›ˆÛË ÙË˜ LDL ¯ÔÏËÛÙÂÚfiÏË˜ÛÂ ¿ÙÔÌ· ÌÂ Â›Â‰· LDL ¯ÔÏË-ÛÙÂÚfiÏË˜ > 160 mg/dL ÛÂ Û‡-ÁÎÚÈÛË ÌÂ ¿ÙÔÌ· ÌÂ ¯·ÌËÏfiÙÂÚ·Â›Â‰· LDL ¯ÔÏËÛÙÂÚfiÏË˜.øÛÙfiÛÔ, ÔÈ Dent Î·È Û˘ÓÂÚÁ¿ÙÂ˜‰ÂÓ ·Ú·Ù‹ÚËÛ·Ó ·Ó¿ÏÔÁÔ ·Ô-Ù¤ÏÂÛÌ· ÛÂ Á˘Ó·›ÎÂ˜ ÌÂ ˘ÂÚ¯Ô-ÏËÛÙÂÚÔÏ·ÈÌ›·, ÔÈ ÔÔ›Â˜ Û˘ÁÎÚ›-ıËÎ·Ó ÌÂ ÓÔÚÌÔÏÈÈ‰·ÈÌÈÎ¤˜ Á˘-Ó·›ÎÂ˜. °ÂÓÈÎ¿ ÛÙÈ˜ ÂÚÈÛÛfiÙÂ-ÚÂ˜ ÌÂÏ¤ÙÂ˜ ‰ÂÓ ·Ú·ÙËÚ‹ıËÎÂÌÂÁ·Ï‡ÙÂÚË ÌÂ›ˆÛË ÙË˜ LDL ¯Ô-

ÏËÛÙÂÚfiÏË˜ ÛÂ ¿ÙÔÌ· ÌÂ ˘„ËÏ¿·Ú¯ÈÎ¿ Â›Â‰· ¯ÔÏËÛÙÂÚfiÏË˜.

∂›‰Ú·ÛË ÙË˜ ‰È·ÙÚÔÊ‹˜

™Â 11 ÌÂÏ¤ÙÂ˜, ÛÙÈ˜ ÔÔ›Â˜ ÌÂÏÂ-Ù‹ıËÎÂ Ô Û˘Ó‰˘·ÛÌfi˜ ÙË˜ Úˆ-ÙÂ˝ÓË˜ ÛfiÁÈ·˜ ‹ ÙˆÓ ÈÛÔÊÏ·‚Ô-ÓÒÓ ÌÂ ‰È·ÙÚÔÊ‹ Ô˘ ÌÂÈÒÓÂÈ Ù·Â›Â‰· ÙË˜ ¯ÔÏËÛÙÂÚfiÏË˜, ·-Ú·ÙËÚ‹ıËÎÂ ÌÂ›ˆÛË ÙË˜ LDL ¯Ô-ÏËÛÙÂÚfiÏË˜ Î·Ù¿ ÂÚ›Ô˘ 2%.∂ÔÌ¤Óˆ˜, Ë Â›‰Ú·ÛË ÙË˜ Úˆ-ÙÂ˝ÓË˜ ÛfiÁÈ·˜ ‹ ÙˆÓ ÈÛÔÊÏ·‚Ô-ÓÒÓ ÛÙ· Â›Â‰· ÙË˜ LDL ¯ÔÏË-ÛÙÂÚfiÏË˜, Èı·Ó¿ ‰ÂÓ ÂËÚÂ¿˙Â-Ù·È ·fi ÙËÓ ÂÚÈÂÎÙÈÎfiÙËÙ· ÙË˜‰È·ÙÚÔÊ‹˜ ÛÂ ÎÂÎÔÚÂÛÌ¤Ó· ÏÈ-·Ú¿ ‹ ¯ÔÏËÛÙÂÚfiÏË.

∂›‰Ú·ÛË ÛÙËÏÈÔÚˆÙÂ˝ÓË Lp(a).

∏ ÏÈÔÚˆÙÂ˝ÓË Lp(a) Â›Ó·È ·ÓÂ-Í¿ÚÙËÙÔ˜ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË Î·Ú‰È·ÁÁÂÈ·-ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ. ∞fi ÙÈ˜ 11 ÌÂ-Ï¤ÙÂ˜ Ô˘ ‰ÈÂÚÂ‡ÓËÛ·Ó ÙËÓ È-ı·Ó‹ Â›‰Ú·ÛË ÙË˜ ÚˆÙÂ˝ÓË˜ÛfiÁÈ·˜ ‹ ÙˆÓ ÈÛÔÊÏ·‚ÔÓÒÓ ÛÙËÓÏÈÔÚˆÙÂ˝ÓË Lp(a), ÌfiÓÔ 2 ÌÂ-Ï¤ÙÂ˜ ¤‰ÂÈÍ·Ó fiÙÈ ·˘Ù¿ Ù· ıÚÂ-ÙÈÎ¿ Û˘ÛÙ·ÙÈÎ¿ ÌÔÚÂ› Ó· ÚÔ-Î·ÏÔ‡Ó ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓÙË˜.

∂›‰Ú·ÛË ÛÙËÓ·ÚÙËÚÈ·Î‹ ›ÂÛË

™Â ÔÏÏ¤˜ ÌÂÏ¤ÙÂ˜ ‰ÈÂÚÂ˘Ó‹ıË-ÎÂ Ë Â›‰Ú·ÛË ÛÙËÓ ·ÚÙËÚÈ·Î‹›ÂÛË ÙË˜ ÚˆÙÂ˝ÓË˜ ÛfiÁÈ·˜ ÌÂÈÛÔÊÏ·‚fiÓÂ˜ ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙË¯ÔÚ‹ÁËÛË Î·˙Â˝ÓË˜. ™Â 1 ÌfiÓÔÌÂÏ¤ÙË ·Ú·ÙËÚ‹ıËÎÂ ÌÈÎÚ‹ ÌÂ›-ˆÛË ÙË˜ Û˘ÛÙÔÏÈÎ‹˜ ·ÚÙËÚÈ·Î‹˜›ÂÛË˜ Î·Ù¿ 1 mmHg. √È ÈÛÔ-ÊÏ·‚fiÓÂ˜ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ¤¯Ô˘ÓÎ·Ì›· Â›‰Ú·ÛË ÛÙËÓ ·ÚÙËÚÈ·Î‹›ÂÛË.

™˘ÌÂÚ¿ÛÌ·Ù·

Δ· ÚÒÈÌ· ·ÔÙÂÏ¤ÛÌ·Ù· ÙˆÓÌÂÏÂÙÒÓ ÁÈ· ÙË ıÂÙÈÎ‹ Â›‰Ú·ÛËÙË˜ ÚˆÙÂ˝ÓË˜ ÛfiÁÈ·˜ ÛÙ· Â›Â-‰· ÙË˜ LDL ¯ÔÏËÛÙÂÚfiÏË˜ Î·ÈÛÂ ¿ÏÏÔ˘˜ Î·Ú‰È·ÁÁÂÈ·ÎÔ‡˜ ·-Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ‰ÂÓ ÂÈ‚Â‚·È-ÒıËÎ·Ó ·fi ÌÂÙ·ÁÂÓ¤ÛÙÂÚÂ˜ ÌÂ-Ï¤ÙÂ˜ ÙˆÓ 10 ÙÂÏÂ˘Ù·›ˆÓ ¯Úfi-ÓˆÓ. ∏ ÚˆÙÂ˝ÓË ÛfiÁÈ·˜ ÛÂ Ô-

ÛfiÙËÙ· ›ÛË ‹ ÌÂÁ·Ï‡ÙÂÚË ·fi ÙËÌÈÛ‹ ËÌÂÚ‹ÛÈ· ÚfiÛÏË„Ë ÔÏÈÎ‹˜ÚˆÙÂ˝ÓË˜ ÌÔÚÂ› Ó· ÌÂÈÒÛÂÈ Ù·Â›Â‰· LDL ¯ÔÏËÛÙÂÚfiÏË˜ ÛÂÌÈÎÚfi fiÌˆ˜ ÔÛÔÛÙfi, fiÙ·Ó ·ÓÙÈ-Î·ıÈÛÙ¿ ÙËÓ ÚˆÙÂ˝ÓË ÙˆÓ Á·Ï·-ÎÙÔÎÔÌÈÎÒÓ ÚÔ˚fiÓÙˆÓ ‹ ÙËÓÚˆÙÂ˝ÓË ˙ˆÈÎ‹˜ ÚÔ¤ÏÂ˘ÛË˜. ∏Â›‰Ú·ÛË ÛÙ· Â›Â‰· ÙË˜ LDL¯ÔÏËÛÙÂÚfiÏË˜ ÔÊÂ›ÏÂÙ·È ÛÙËÓÚˆÙÂ˝ÓË ÛfiÁÈ·˜ ·˘Ù‹ Î·ı·˘Ù‹Î·È fi¯È ÛÙÈ˜ ÈÛÔÊÏ·‚fiÓÂ˜, ¯ˆÚ›˜fiÌˆ˜ Ó· ÌÔÚÂ› Ó· ·ÔÎÏÂÈÛıÂ›Ë Â›‰Ú·ÛË Î¿ÔÈÔ˘ ¿ÏÏÔ˘ ıÚÂ-ÙÈÎÔ‡ Û˘ÛÙ·ÙÈÎÔ‡ ÙË˜ Úˆ-ÙÂ˝ÓË˜ ÛfiÁÈ·˜. ¢ÂÓ ˘¿Ú¯ÂÈ ıÂÙÈ-Î‹ Â›‰Ú·ÛË ÛÙ· Â›Â‰· ÙË˜HDL ¯ÔÏËÛÙÂÚfiÏË˜, ÙˆÓ ÙÚÈÁÏ˘-ÎÂÚÈ‰›ˆÓ, ÙË˜ Lp(a) Î·È ÙË˜ ·Ú-ÙËÚÈ·Î‹˜ ›ÂÛË˜. ∏ ÚˆÙÂ˝ÓËÛfiÁÈ·˜ Î·È ÔÈ ÈÛÔÊÏ·‚fiÓÂ˜ ‰ÂÓ‚ÂÏÙÈÒÓÔ˘Ó Ù· ·ÁÁÂÈÔÎÈÓËÙÈÎ¿Û˘ÌÙÒÌ·Ù· ÙË˜ ÂÌÌËÓfi·˘ÛË˜Î·È Ù· ‰Â‰ÔÌ¤Ó· ÁÈ· ÙË ÌÂÙÂÌÌË-ÓÔ·˘ÛÈ·Î‹ ·ÒÏÂÈ· ÔÛÙÈÎ‹˜Ì¿˙·˜ Â›Ó·È ·ÓÙÈÊ·ÙÈÎ¿. ∂ÈÚfi-ÛıÂÙ·, ‰ÂÓ ¤¯ÂÈ ·Ô‰ÂÈ¯ıÂ› Ë Â›-‰Ú·ÛË Î·È Ë ·ÛÊ¿ÏÂÈ· ÙˆÓ ÈÛÔ-ÊÏ·‚ÔÓÒÓ ÛÙËÓ ÚfiÏË„Ë ‹ ıÂ-Ú·Â›· ÙÔ˘ Î·ÚÎ›ÓÔ˘ ÙÔ˘ Ì·-ÛÙÔ‡, ÙÔ˘ ÂÓ‰ÔÌËÙÚ›Ô˘ Î·È ÙÔ˘ÚÔÛÙ¿ÙË. °È· ·˘Ùfi ÙÔ ÏfiÁÔ ‰ÂÓÛ˘ÓÈÛÙ¿Ù·È Ë ¯Ú‹ÛË Û˘ÌÏËÚˆ-Ì¿ÙˆÓ ÈÛÔÊÏ·‚ÔÓÒÓ.

∞ÓÙ›ıÂÙ·, Ù· ÚÔ˚fiÓÙ· Úˆ-ÙÂ˝ÓË˜ ÛfiÁÈ·˜, fiˆ˜ ÙÔ Á¿Ï· Ûfi-ÁÈ·˜ ‹ Ô ÎÈÌ¿˜ ÛfiÁÈ·˜, ÌÔÚÂ› Ó·Â›Ó·È Â˘ÂÚÁÂÙÈÎ¿ ÛÙËÓ Î·Ú‰È·Á-ÁÂÈ·Î‹ Î·È Û˘ÓÔÏÈÎ‹ ˘ÁÂ›· ÂÍ·È-Ù›·˜ ÙË˜ ˘„ËÏ‹˜ ÂÚÈÂÎÙÈÎfiÙË-Ù·˜ ÙÔ˘˜ ÛÂ ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ-·Ú¿ ÔÍ¤·, Ê˘ÙÈÎ¤˜ ›ÓÂ˜, ‚ÈÙ·Ì›-ÓÂ˜ Î·È Ì¤Ù·ÏÏ· Î·È ÙË˜ ¯·ÌËÏ‹˜ÂÚÈÂÎÙÈÎfiÙËÙ·˜ ÙÔ˘˜ ÛÂ ÎÂÎÔ-ÚÂÛÌ¤Ó· ÏÈ·Ú¿ ÔÍ¤·. ∏ Î·Ù·Ó¿-ÏˆÛË ÚÔ˚fiÓÙˆÓ ÚˆÙÂ˝ÓË˜ Ûfi-ÁÈ·˜ ÛÂ ·ÓÙÈÎ·Ù¿ÛÙ·ÛË ÙÚÔÊ›-ÌˆÓ ˘„ËÏ‹˜ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ ÛÂ˙ˆÈÎ‹ ÚˆÙÂ˝ÓË Ô˘ ÂÚÈ¤¯Ô˘Ó·Ú¿ÏÏËÏ· ÎÂÎÔÚÂÛÌ¤Ó· ÏÈ·Ú¿Î·È ¯ÔÏËÛÙÂÚfiÏË ÌÔÚÂ› Ó· ‚ÂÏ-ÙÈÒÛÂÈ ÙËÓ Î·Ú‰È·ÁÁÂÈ·Î‹ ˘ÁÂ›·.™˘ÓÔ„›˙ÔÓÙ·˜, Û‡ÌÊˆÓ· ÌÂ ÙËÓ∞∫∂, Ë ÚˆÙÂ˝ÓË ÛfiÁÈ·˜ ÌÔÚÂ›Ó· ·ÔÙÂÏ¤ÛÂÈ ¤Ó· ·Ó·fiÛ·ÛÙÔÙÌ‹Ì· Ì›·˜ ‰È·ÙÚÔÊ‹˜ ¯·ÌËÏ‹˜ÛÂ ÎÔÚÂÛÌ¤Ó· ÏÈ·Ú¿ Î·È ¯ÔÏË-ÛÙÂÚfiÏË.

π √ À ¡ π √ ™ 2 0 0 8

26

∂π™∞°ø°∏Δ· ‰È·ÈÙËÙÈÎ¿ ÏÈ›‰È· ÂÌÏ¤ÎÔ-ÓÙ·È fiÏÔ Î·È ÂÚÈÛÛfiÙÂÚÔ ÛÙËÓ·ÈÙÈÔÏÔÁ›· ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ·ı‹ÛÂˆÓ Î·ıÒ˜ ·ÔÎÙÔ‡ÌÂ Â-ÚÈÛÛfiÙÂÚË ÁÓÒÛË ÁÈ· ÙËÓ ÌÂÙ·-‚ÔÏÈÎ‹ Â›‰Ú·ÛË ÙÔ˘ Î¿ıÂ ÏÈ·-ÚÔ‡ ÔÍ¤Ô˜ ÍÂ¯ˆÚÈÛÙ¿ ÛÙÔ˘˜ ·-Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ·˘ÙÒÓ ÙˆÓ·ı‹ÛÂˆÓ. .¯., Ù· ÎÔÚÂÛÌ¤Ó·ÏÈ·Ú¿ ÔÍ¤· ¤¯Ô˘Ó Û¯ÂÙÈÛıÂ› ÌÂ˘„ËÏfiÙÂÚÔ Î›Ó‰˘ÓÔ ÁÈ· Î·Ú‰È·-Î¿ ÓÔÛ‹Ì·Ù· ÂÓÒ Ù· ÌÔÓÔ·ÎfiÚÂ-ÛÙ· ÏÈ·Ú¿ ÔÍ¤· Î·È Ù· ˆ-3 Ô-Ï˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ ÔÍ¤· Ê·›ÓÔ-ÓÙ·È Ó· ¤¯Ô˘Ó ÚÔÛÙ·ÙÂ˘ÙÈÎ‹‰Ú¿ÛË[1]. ŒÓ· ·fi Ù· ÛËÌ·ÓÙÈÎfi-ÙÂÚ· ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙË˜ ÌÂÛÔ-ÁÂÈ·Î‹˜ ‰È·ÙÚÔÊ‹˜ Â›Ó·È Ë ¯Ú‹-ÛË ·Úı¤ÓÔ˘ ÂÏ·ÈfiÏ·‰Ô˘ ˆ˜ ‚·-ÛÈÎ‹˜ ËÁ‹˜ ÂÓ¤ÚÁÂÈ·˜ ÚÔÂÚ-¯fiÌÂÓË˜ ·fi Ï›Ô˜, ÙÔ ÔÔ›Ô Â›-Ó·È Î·Ï‹ ËÁ‹ ÌÔÓÔ·ÎfiÚÂÛÙˆÓÏÈ·ÚÒÓ ÔÍ¤ˆÓ Î·ıÒ˜ Î·È ÂÎ·-ÙÔÓÙ¿‰ˆÓ ÌÈÎÚÔıÚÂÙÈÎÒÓ Û˘-

ÛÙ·ÙÈÎÒÓ[2-8]. ∏ ¤ÚÂ˘Ó· ÙˆÓ ∂Ù¿ÃˆÚÒÓ ¤‰ÂÈÍÂ Ù· ÚÒÙ· ÂÈ‰Ë-ÌÈÔÏÔÁÈÎ¿ ÛÙÔÈ¯Â›· ÁÈ· ·ÚÓËÙÈÎ‹Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÙË˜ ‰È·ÈÙËÙÈ-Î‹˜ ÚfiÛÏË„Ë˜ ÌÔÓÔ·ÎfiÚÂÛÙˆÓÏÈ·ÚÒÓ ÔÍ¤ˆÓ Î·È ÙË˜ ıÓËÛÈÌfi-ÙËÙ·˜ ·fi Î·Ú‰È·Î¿ ÓÔÛ‹Ì·Ù·[3].∂›ÛË˜, ÌÈ· ¿ÏÏË ÂÈ‰ËÌÈÔÏÔÁÈÎ‹¤ÚÂ˘Ó· ÌÂ ÓÔÛËÏÂ‡ÙÚÈÂ˜ (Nurse'sHealth study) ÂÈ‚Â‚·›ˆÛÂ ÙËÓÚÔÛÙ·ÙÂ˘ÙÈÎ‹ ‰Ú¿ÛË ÙˆÓ ÌÔÓÔ-·ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓ ÔÍ¤ˆÓ ÂÓ¿-ÓÙÈ· ÛÙÈ˜ Î·Ú‰È·Î¤˜ ·ı‹ÛÂÈ˜[4].√ ÚÔÛÙ·ÙÂ˘ÙÈÎfi˜ ÚfiÏÔ˜ ÙÔ˘ÂÏ·ÈÔÏ¿‰Ô˘ fiÛÔÓ ·ÊÔÚ¿ ÙËÓıÓËÛÈÌfiÙËÙ· ·ÛıÂÓÒÓ ÌÂ ÚÔË-ÁÔ‡ÌÂÓÔ ÂÂÈÛfi‰ÈÔ ÔÍ¤Ô˜ ÂÌ-ÊÚ¿ÁÌ·ÙÔ˜ Ì˘ÔÎ·Ú‰›Ô˘ ÂÈ‚Â-‚·ÈÒıËÎÂ Î·È ÛÙËÓ ÎÏÈÓÈÎ‹ ÌÂÏ¤-ÙË GISSI[5]. ¶·ÚfiÏ· ·˘Ù¿ Ú¤ÂÈÓ· ÂÈÛËÌ·ÓıÂ› fiÙÈ ¤ÚÂ˘ÓÂ˜·ÛıÂÓÒÓ-Ì·ÚÙ‡ÚˆÓ ÂÌÊ¿ÓÈÛ·Ó·ÓÙÈÎÚÔ˘fiÌÂÓ· ·ÔÙÂÏ¤ÛÌ·Ù·,‰Â›¯ÓÔÓÙ·˜ Ó· ÌËÓ ˘¿Ú¯ÂÈ Û˘-Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÂÏ·ÈÔÏ¿‰Ô˘ Î·ÈÎ›Ó‰˘ÓÔ˘ ÁÈ· Î·Ú‰È·ÁÁÂÈ·Î¿ ÓÔ-

Û‹Ì·Ù·[6,7]. ™Â ÌÈ· ÂÏÏËÓÈÎ‹ ¤ÚÂ˘-Ó· ·ÛıÂÓÒÓ-Ì·ÚÙ‡ÚˆÓ[9] Ë ÔÔ›·ÂÈÎÂÓÙÚÒıËÎÂ ÛÙÔÓ Ù‡Ô ÙÔ˘Ï·‰ÈÔ‡ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·ÓÛÙÔ Ì·ÁÂ›ÚÂÌ·, ‰ÂÓ ‚Ú¤ıËÎÂ Î¿-ÔÈ· ÛËÌ·ÓÙÈÎ‹ Û¯¤ÛË ÌÂÙ·Í‡Î·Ù·Ó¿ÏˆÛË˜ ÌÔÓÔ·ÎfiÚÂÛÙˆÓÏÈ·ÚÒÓ ÔÍ¤ˆÓ Î·È Î·Ú‰È·ÁÁÂÈ-·ÎÒÓ ·ı‹ÛÂˆÓ, ÂÓÒ ·ÓÙ›ıÂÙ·ÂÚÂ˘ÓËÙ¤˜ ·fi ÙËÓ ÌÂÏ¤ÙË EPIC¤‰ÂÈÍ·Ó fiÙÈ Ë Î·Ù¿ ÎÂÊ·Ï‹ Úfi-ÛÏË„Ë ÂÏ·ÈfiÏ·‰Ô˘ Û¯ÂÙÈ˙fiÙ·Ó·ÓÙ›ÛÙÚÔÊ· ÌÂ ÙËÓ Û˘ÛÙÔÏÈÎ‹Î·È ÙËÓ ‰È·ÛÙÔÏÈÎ‹ ›ÂÛË, Ô˘Â›Ó·È ‰˘Ó·ÙÔ› ‰Â›ÎÙÂ˜ ·˘ÙÒÓ ÙˆÓ·ı‹ÛÂˆÓ[10].

√ ÛÎÔfi˜ ÙË˜ ·ÚÔ‡Û·˜ ÂÚÁ·-Û›·˜ ‹Ù·Ó Ó· ·ÍÈÔÏÔÁ‹ÛÂÈ ÙËÛ¯¤ÛË ÌÂÙ·Í‡ ÙË˜ Û˘Ó‹ıÂÈ·˜ Î·-Ù·Ó¿ÏˆÛË˜ ÂÏ·ÈÔÏ¿‰Ô˘ Î·È ¿Ï-ÏˆÓ ÏÈÒÓ Î·È ÂÏ·›ˆÓ ÛÙÔ Î·ıË-ÌÂÚÈÓfi Ì·ÁÂ›ÚÂÌ·, ÌÂ ÙËÓ Èı·-ÓfiÙËÙ· ÚˆÙÔÂÌÊ·ÓÈ˙fiÌÂÓÔ˘ ÌËı·Ó·ÙËÊfiÚÔ˘ ÔÍ¤Ô˜ ÛÙÂÊ·ÓÈ·›-Ô˘ Û˘Ó‰ÚfiÌÔ˘ (¤ÌÊÚ·ÁÌ· Ì˘Ô-

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3. Sirtori CR, Gatti E, Mantero O, Conti F,Agradi E, Tremoli E, et al. Clinicalexperience with the soybean protein dietin the treatment of hypercholesterolemia.Am J Clin Nutr 1979;32:1645-58.

4. Anderson JW, Johnstone BM, Cook-Newell ME. Meta-analysis of theeffects of soy protein intake on serumlipids. N Engl J Med 1995;333:276-82.

5. Crouse JR, 3rd, Morgan T, Terry JG,Ellis J, Vitolins M, Burke GL. Arandomized trial comparing the effectof casein with that of soy proteincontaining varying amounts ofisoflavones on plasma concentrationsof lipids and lipoproteins. Arch InternMed 1999;159:2070-6.

6. Teixeira SR, Potter SM, Weigel R,Hannum S, Erdman JW, Jr., HaslerCM. Effects of feeding 4 levels of soyprotein for 3 and 6 wk on blood lipidsand apolipoproteins in moderatelyhypercholesterolemic men. Am J ClinNutr 2000;71:1077-84.

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

8. Kreijkamp-Kaspers S, Kok L, GrobbeeDE, de Haan EH, Aleman A, Lampe

JW, et al. Effect of soy protein contai-ning isoflavones on cognitive function,bone mineral density, and plasma li-pids in postmenopausal women: arandomized controlled trial. JAMA2004;292:65-74.

9. Lichtenstein AH, Jalbert SM,Adlercreutz H, Goldin BR, RasmussenH, Schaefer EJ, et al. Lipoproteinresponse to diets high in soy oranimal protein with and withoutisoflavones in moderately hyperchole-sterolemic subjects. Arterioscler Thro-mb Vasc Biol 2002;22:1852-8.

10. Weggemans RM, Trautwein EA. Re-lation between soy-associated isofla-vones and LDL and HDL cholesterolconcentrations in humans: a meta-analysis. Eur J Clin Nutr 2003;57:940-6.


∏ ∂›‰Ú·ÛË ÙË˜ ∫·Ù·Ó¿ÏˆÛË˜ ∂Ï·ÈÔÏ¿‰Ô˘ ÛÙËÓ ¶Èı·ÓfiÙËÙ· √Í¤Ô˜

™ÙÂÊ·ÓÈ·›Ô˘ ™˘Ó‰ÚfiÌÔ˘. ªÂÏ¤ÙË ∞ÛıÂÓÒÓ-ª·ÚÙ‡ÚˆÓ CARDIO2000.

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

1 ΔÌ‹Ì· ∂ÈÛÙ‹ÌË˜ ¢È·ÙÚÔÊ‹˜ - ¢È·ÈÙÔÏÔÁ›·˜, Ã·ÚÔÎfiÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ2 ∞’ ∫·Ú‰ÈÔÏÔÁÈÎ‹ ∫ÏÈÓÈÎ‹, π·ÙÚÈÎ‹ ™¯ÔÏ‹ ∞ıËÓÒÓ.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÂÏ·ÈfiÏ·‰Ô, ÔÍ¤· ÛÙÂÊ·ÓÈ·›· Û‡Ó‰ÚÔÌ·, ¤ÌÊÚ·ÁÌ· Ì˘ÔÎ·Ú‰›Ô˘

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27

Î·Ú‰›Ô˘ ‹ ·ÛÙ·ı‹˜ ÛÙËı¿Á¯Ë)ÛÂ ÂÏÏËÓÈÎfi ‰Â›ÁÌ· ÙÔ˘ ÏËı˘-ÛÌÔ‡.

À§π∫√-ª∂£√¢√™∞ÛıÂÓÂ›˜ Î·È Ì¿ÚÙ˘ÚÂ˜

ÙË˜ ÌÂÏ¤ÙË˜∏ CARDIO2000 Â›Ó·È ÌÈ· ÂÈ‰Ë-ÌÈÔÏÔÁÈÎ‹ ¤ÚÂ˘Ó· ·ÛıÂÓÒÓ-Ì·Ú-Ù‡ÚˆÓ Ô˘ ¤Ï·‚Â ¯ÒÚ· ÛÂ ÔÏÏ¿Î¤ÓÙÚ· Î·È Ë ÔÔ›· ÌÂÏ¤ÙËÛÂ ÙËÛ¯¤ÛË ÌÂÙ·Í‡ ‰È·ÊfiÚˆÓ ·Ú·Áfi-ÓÙˆÓ fiˆ˜ Â›Ó·È Ë ‰È·ÙÚÔÊ‹, ÔÙÚfiÔ˜ ˙ˆ‹˜, ‰È¿ÊÔÚÔÈ ÎÔÈÓˆÓÈ-ÎÔ-‰ËÌÔÁÚ·ÊÈÎÔ› Î·È ÎÏÈÓÈÎÔ› ·-Ú¿ÁÔÓÙÂ˜, ÌÂ ÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿-ÓÈÛË˜ ÌË ı·Ó·ÙËÊfiÚÔ˘ ÛÙÂÊ·ÓÈ-·›Ô˘ Û˘Ó‰ÚfiÌÔ˘. ™ÙËÓ ¤ÚÂ˘Ó·Û˘ÌÌÂÙÂ›¯·Ó 848 ·fi ÙÔ˘˜ 956·ÛıÂÓÂ›˜, Ù˘¯·›· ÂÈÏÂÁÌ¤ÓÔÈ ·fiÓÔÛÔÎÔÌÂ›·, ÔÈ ÔÔ›ÔÈ ÂÌÊ¿ÓÈÛ·ÓÛ‡ÌÙˆÌ· Î·Ú‰È·Î‹˜ ÓfiÛÔ˘ ÁÈ·ÚÒÙË ÊÔÚ¿ ÛÙËÓ ˙ˆ‹ ÙÔ˘˜.

Δ· ÎÚÈÙ‹ÚÈ· ÂÈÛ·ÁˆÁ‹˜ ÙˆÓ·ÛıÂÓÒÓ ÛÙËÓ ¤ÚÂ˘Ó· ‹Ù·Ó:

1. ‰È¿ÁÓˆÛË ÚÒÙÔ˘ ÂÂÈÛÔ‰›Ô˘ÔÍ¤Ô˜ ÂÌÊÚ¿ÁÌ·ÙÔ˜ Ì˘ÔÎ·Ú-‰›Ô˘ ÌÂ ‰‡Ô ÔÈ ÂÚÈÛÛfiÙÂÚ··fi ÙÔ˘˜ ÂfiÌÂÓ· ÎÚÈÙ‹ÚÈ·:·ÏÏ·Á¤˜ ÛÙÔ ËÏÂÎÙÚÔÎ·Ú‰ÈÔ-ÁÚ¿ÊËÌ·, Â›ÌÔÓ· ÎÏÈÓÈÎ¿ Û˘-ÌÙÒÌ·Ù·, ·‡ÍËÛË ÛÂ ÂÈ‰ÈÎ¿‰È·ÁÓˆÛÙÈÎ¿ ¤Ó˙˘Ì·,

2. ÚÒÙË ‰È¿ÁÓˆÛË ·ÛÙ·ıÔ‡˜ÛÙËı¿Á¯Ë˜ (Ù¿ÍË πππ ÙË˜ Î·Ù¿-Ù·ÍË˜ Î·Ù¿ Braunwald).

™ÙË Û˘Ó¤¯ÂÈ· ÂÈÏ¤¯ıËÎ·Ó Ù˘-¯·›· 1078 ÂıÂÏÔÓÙ¤˜ (830 ¿Ó-‰ÚÂ˜ Î·È 248 Á˘Ó·›ÎÂ˜) ÂÍÔÌÔÈˆ-Ì¤ÓÔÈ ÌÂ ÙÔ˘˜ ·ÛıÂÓÂ›˜ ˆ˜ ÚÔ˜ÙËÓ ËÏÈÎ›· (± 3 ¤ÙË), ÙÔ Ê‡ÏÔ Î·ÈÙÔÓ ÙfiÔ Î·ÙÔÈÎ›·˜, Î·È ¯ˆÚ›˜Î·Ó¤Ó· Û‡ÌÙˆÌ· ‹ ˘Ô„›· Î·Ú-‰È·ÁÁÂÈ·Î‹˜ ÓfiÛÔ˘ ÛÙÔ È·ÙÚÈÎfiÈÛÙÔÚÈÎfi ÙÔ˘˜.

ªÂÙÚ‹ÛÂÈ˜ŸÛÔÓ ·ÊÔÚ¿ ÙÈ˜ ÏËÚÔÊÔÚ›Â˜ÁÈ· ÎÏÈÓÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜, ·˘Ù¤˜‚Ú¤ıËÎ·Ó ·fi ÙÔ˘˜ È·ÙÚÈÎÔ‡˜Ê·Î¤ÏÔ˘˜ ÙˆÓ Û˘ÌÌÂÙÂ¯fiÓÙˆÓ,ÂÓÒ ÏËÚÔÊÔÚ›Â˜ ÁÈ· ÙÔÓ ÙÚfiÔ˙ˆ‹˜ Û˘ÏÏ¤¯ıËÎ·Ó Ì¤Û· ·fi ÏÂ-ÙÔÌÂÚ¤˜ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ. √È‰È·ÙÚÔÊÈÎ¤˜ Û˘Ó‹ıÂÈÂ˜ ·ÍÈÔÏÔ-Á‹ıËÎ·Ó ÌÂ ËÌÈÔÛÔÙÈÎÔÔÈËÌ¤-ÓÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Û˘¯ÓfiÙËÙ·˜Î·Ù·Ó¿ÏˆÛË˜ ÙÚÔÊ›ÌˆÓ. ∂È‰ÈÎfi-ÙÂÚ· Ë Î·Ù·Ó¿ÏˆÛË ÂÏ·ÈÔÏ¿‰Ô˘,ÂÏ·›ˆÓ ·fi Î·ÚÔ‡˜, ‚Ô˘Ù‡ÚÔ˘Î·È Ì·ÚÁ·Ú›ÓË˜ ·ÍÈÔÏÔÁ‹ıËÎÂÚˆÙÒÓÙ·˜ fiÏÔ˘˜ ÙÔ˘˜ Û˘ÌÌÂÙ¤-¯ÔÓÙÂ˜ Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ ¯Ú‹ÛË ·˘-ÙÒÓ ÛÙÔ Î·ıËÌÂÚÈÓfi Ì·ÁÂ›ÚÂÌ·Î·È ÙËÓ ÚÔÂÙÔÈÌ·Û›· Ê·ÁËÙÔ‡

(¯ ÚÔÛı‹ÎË ÛÂ Û·Ï¿ÙÂ˜ ÎÏ).∂›ÛË˜ Î·Ù·ÁÚ¿ÊËÎ·Ó ÙÔ ‡„Ô˜,ÙÔ ‚¿ÚÔ˜ Î·ıÒ˜ Î·È ÛÙÔÈ¯Â›·Ô˘ ·ÊÔÚÔ‡Û·Ó ÙËÓ Î·Ù·Ó¿Ïˆ-ÛË ·ÏÎÔfiÏ, ÙÔ Î¿ÓÈÛÌ·, ÙË Ê˘-ÛÈÎ‹ ‰Ú·ÛÙËÚÈfiÙËÙ·, ÙÔ ÌÔÚÊˆ-ÙÈÎfi Â›Â‰Ô Î·È ÙËÓ ‡·ÚÍËÚÒÈÌË˜ Î·Ú‰È·Î‹˜ ÓfiÛÔ˘ ÌÂÙ·-Í‡ ÙˆÓ Û˘ÁÁÂÓÒÓ ÚÒÙÔ˘ ‚·ı-ÌÔ‡. ø˜ ˘¤ÚÙ·ÛË ÔÚ›ÛÙËÎÂ Ë ÂÌ-Ê¿ÓÈÛË ÙÈÌÒÓ Û˘ÛÙÔÏÈÎ‹˜ /‰È·ÛÙÔ-ÏÈÎ‹˜ ›ÂÛË˜ ·›Ì·ÙÔ˜ >140/90mmHg ‹ Ë Ï‹„Ë ·ÓÙÈ˘ÂÚÙ·ÛÈ-Î‹˜ ·ÁˆÁ‹˜, ˆ˜ ˘ÂÚ¯ÔÏËÛÙÂ-ÚÔÏ·ÈÌ›·, Ë ÂÌÊ¿ÓÈÛË ÙÈÌÒÓ ÔÏÈ-Î‹˜ ¯ÔÏËÛÙÂÚfiÏË˜ >200 mg/dl ‹Ë ¯Ú‹ÛË ˘ÔÏÈÈ‰·ÈÌÈÎÒÓ Ê·Ú-Ì¿ÎˆÓ Î·È ˆ˜ ‰È·‚‹ÙË˜, Ë ÂÌÊ¿-ÓÈÛË ÙÈÌÒÓ ÁÏ˘Îfi˙Ë˜ ÓËÛÙÂ›-·˜>125 mg/dl ‹ Ë ¯Ú‹ÛË ·ÓÙÈ-‰È·‚ËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ.∏ ÌÂÏ¤ÙË CARDIO2000 ÂÁÎÚ›ıË-ÎÂ ·fi ÙËÓ ÂÈÙÚÔ‹ ËıÈÎ‹˜ Î·È‰ÂÔÓÙÔÏÔÁ›·˜ ÙÔ˘ ΔÌ‹Ì·ÙÔ˜. ¶Â-ÚÈÛÛfiÙÂÚÂ˜ ÏÂÙÔÌ¤ÚÂÈÂ˜ fiÛÔÓ·ÊÔÚ¿ ÙËÓ ¤ÚÂ˘Ó· ¤¯Ô˘Ó ·ÚÔ˘-ÛÈ·ÛÙÂ› Î·È ÛÙÔ ·ÚÂÏıfiÓ[13].

∞¶√Δ∂§∂™ª∞Δ∞ΔÔ 65,2% ÙˆÓ ·ÙfiÌˆÓ ÛÙËÓ ÔÌ¿-‰· ÂÏ¤Á¯Ô˘ Î·È ÙÔ 58,6% ·fiÙÔ˘˜ ·ÛıÂÓÂ›˜ ·Ó¤ÊÂÚ·Ó ·Ô-ÎÏÂÈÛÙÈÎ‹ ¯Ú‹ÛË ÂÏ·ÈÔÏ¿‰Ô˘ (p=0.002), ÂÓÒ ÙÔ 16,3% ÙË˜ ÔÌ¿-‰·˜ ÂÏ¤Á¯Ô˘ Î·È ÙÔ 22,4% ÙˆÓ·ÛıÂÓÒÓ ‰ÂÓ ¯ÚËÛÈÌÔÔÈÔ‡Û·ÓÎ·ıfiÏÔ˘ ÂÏ·ÈfiÏ¿‰Ô (p= 0.002).∂Ï·ÈfiÏ·‰Ô ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ¿Ï-Ï· Ï›Ë Î·Ù·Ó¿ÏˆÓ·Ó ÙÔ 18,5%·fi ÙËÓ ÔÌ¿‰· ÂÏ¤Á¯Ô˘ Î·È ÙÔ19% ÙˆÓ ·ÛıÂÓÒÓ (p= 0.002). ¶ÂÚÈÁÚ·ÊÈÎ‹ ·Ó¿Ï˘ÛË ¤‰ÂÈÍÂ fiÙÈÛÙËÓ ÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ ‰ÂÓ·Ú·ÙËÚ‹ıËÎÂ Î¿ÔÈ· ÛËÌ·ÓÙÈ-Î‹ Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÙË˜ Û˘Ó‹-ıÂÈ·˜ Î·Ù·Ó¿ÏˆÛË˜ ÂÏ·›ˆÓ ÌÂÙÔ˘˜ ‰È¿ÊÔÚÔ˘˜ ‰ËÌÔÁÚ·ÊÈÎÔ‡˜·Ú¿ÁÔÓÙÂ˜ ·ÏÏ¿ Ô‡ÙÂ Î·È ÌÂÙÔ˘˜ ÎÏÈÓÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜.øÛÙfiÛÔ ÛÙËÓ ÔÌ¿‰· ÂÏ¤Á¯Ô˘ ËÛ˘Ó‹ıÂÈ· Î·Ù·Ó¿ÏˆÛË˜ ÂÏ·›ˆÓÛ˘Û¯ÂÙ›ÛıËÎÂ ÌÂ ÙËÓ ËÏÈÎ›·, ÙÔÊ‡ÏÔ, ÙÔÓ ¢ª™, ÙÔ Î¿ÓÈÛÌ·, ÙËÓÂ›ÙˆÛË ÙË˜ ˘¤ÚÙ·ÛË˜ Î·È ÙË˜˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜. ŸÏÔÈ ·˘-ÙÔ› ÔÈ ·Ú¿ÁÔÓÙÂ˜ Ï‹ÊıËÎ·Ó ˘fifi„ÈÓ Î·Ù¿ ÙËÓ ÛÙ·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘-ÛË. ∂ÈÏ¤ÔÓ, ÙfiÛÔ ÛÙÔ˘˜ ·ÛıÂ-ÓÂ›˜ fiÛÔ Î·È ÛÙËÓ ÔÌ¿‰· ÂÏ¤Á-¯Ô˘, ·Ú·ÙËÚ‹Û·ÌÂ fiÙÈ Ù· ¿ÙÔ-Ì· Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡Û·Ó ÂÏ·Èfi-Ï·‰Ô Â›¯·Ó ¯·ÌËÏfiÙÂÚË ÚfiÛÏË„ËÏÂ˘ÎÔ‡ ÎÚ¤·ÙÔ˜ (p < 0.001) Î·ÈÌÂÁ·Ï‡ÙÂÚË Î·Ù·Ó¿ÏˆÛË „·ÚÈÒÓ(p<0.001), ÔÛÚ›ˆÓ (p=0.002),ÊÚÔ‡ÙˆÓ Î·È Ï·¯·ÓÈÎÒÓ (p < 0.001),

ÛÂ Û¯¤ÛË ÌÂ Ù· ¿ÙÔÌ· Ô˘ ‰ÂÓ Î·-Ù·Ó¿ÏˆÓ·Ó Î·ıfiÏÔ˘ ÂÏ·ÈfiÏ·‰Ô.√È Èı·ÓfiÙËÙÂ˜ ÂÌÊ¿ÓÈÛË˜ ÔÍ¤Ô˜ÛÙÂÊ·ÓÈ·›Ô˘ Û˘Ó‰ÚfiÌÔ˘ ‹Ù·Ó0.66 ÊÔÚ¤˜ ÏÈÁfiÙÂÚÂ˜ (95% ¢∂0.52 ˆ˜ 0.84) ÁÈ· ·˘ÙÔ‡˜ Ô˘ Î·-Ù·Ó¿ÏˆÓ·Ó ·ÔÎÏÂÈÛÙÈÎ¿ ÂÏ·Èfi-Ï·‰Ô, Û˘ÁÎÚÈÓfiÌÂÓÔÈ ÌÂ ·˘ÙÔ‡˜Ô˘ ‰ÂÓ ¯ÚËÛÈÌÔÔÈÔ‡Û·Ó Î·ıfi-ÏÔ˘ ÂÏ·ÈfiÏ·‰Ô. ∏ Û˘Ó‰˘·ÛÌ¤ÓËÎ·Ù·Ó¿ÏˆÛË ÂÏ·ÈÔÏ¿‰Ô˘ Ì·˙› ÌÂ¿ÏÏ· Ï›Ë Î·È ¤Ï·È· ‰ÂÓ ¤‰ÂÈÍÂÎ·Ì›· ÛËÌ·ÓÙÈÎ‹ Û¯¤ÛË. ∂ÈÏ¤-ÔÓ Ë ·Ó¿Ï˘ÛË ¤‰ÂÈÍÂ fiÙÈ Ë ·Ô-ÎÏÂÈÛÙÈÎ‹ ¯Ú‹ÛË ÂÏ·ÈÔÏ¿‰Ô˘Û¯ÂÙÈ˙fiÙ·Ó ÌÂ 47% ¯·ÌËÏfiÙÂÚËÈı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛË˜ ÔÍ¤Ô˜ÛÙÂÊ·ÓÈ·›Ô˘ Û˘Ó‰ÚfiÌÔ˘ (95%¢∂ 0.4 ˆ˜ 0.71), Ï·Ì‚¿ÓÔÓÙ·˜˘fi„Ë ‰È¿ÊÔÚ· ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ÙˆÓ ·ÙfiÌˆÓ (.¯. ¢ª™, Î¿ÓÈ-ÛÌ·, Â›Â‰Ô Ê˘ÛÈÎ‹˜ ‰Ú·ÛÙË-ÚÈfiÙËÙ·˜, ÌÔÚÊˆÙÈÎfi Â›Â‰Ô,‡·ÚÍË ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÈÛÙÔÚÈ-ÎÔ‡, Î·Ú‰È·ÎÒÓ ·ı‹ÛÂˆÓ Î·-ıÒ˜ Î·È ÁÈ· ˘¤ÚÙ·ÛË, ˘ÂÚ¯Ô-ÏËÛÙÂÚÔÏ·ÈÌ›· Î·È ‰È·‚‹ÙË). ∏ Û¯¤ÛË ÌÂÙ·Í‡ Î·Ù·Ó¿ÏˆÛË˜ÂÏ·ÈÔÏ¿‰Ô˘ Î·È Èı·ÓfiÙËÙ·˜ ÂÌ-Ê¿ÓÈÛË˜ ÔÍ¤Ô˜ ÛÙÂÊ·ÓÈ·›Ô˘ Û˘Ó-‰ÚfiÌÔ˘ ‰ÂÓ ¿ÏÏ·ÍÂ Ô‡ÙÂ ÌÂÙ¿·fi ÛÙ¿ıÌÈÛË ÁÈ· ÙËÓ Î·Ù·Ó¿Ïˆ-ÛË ‰È·ÊfiÚˆÓ ÔÌ¿‰ˆÓ ÙÚÔÊ›ÌˆÓÎ·È ·ÏÎÔfiÏ (¶›Ó·Î·˜ 1). Δ¤ÏÔ˜, Î·Ì›· ¿ÏÏË ÛËÌ·ÓÙÈÎ‹ Û˘-Û¯¤ÙÈÛË ‰ÂÓ ·Ú·ÙËÚ‹ıËÎÂ ÌÂ-Ù·Í‡ ÙË˜ Û˘Ó‹ıÂÈ·˜ Î·Ù·Ó¿Ïˆ-ÛË˜ ÂÏ·ÈÔÏ¿‰Ô˘ Î·È ÙˆÓ ‰È¿ÊÔ-ÚˆÓ ÎÔÈÓˆÓÈÎfi-‰ËÌÔÁÚ·ÊÈÎÒÓ, ÎÏÈ-ÓÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ‹ ÙÔ˘ ÙÚfi-Ô˘ ˙ˆ‹˜, fiÛÔÓ ·ÊÔÚ¿ ÙËÓ È-ı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛË˜ ÔÍ¤Ô˜ ÛÙÂ-Ê·ÓÈ·›Ô˘ Û˘Ó‰ÚfiÌÔ˘.

™À∑∏Δ∏™∏∏ ·ÚÔ‡Û· ¤ÚÂ˘Ó· ‰Â›¯ÓÂÈ fiÙÈ Ë·ÔÎÏÂÈÛÙÈÎ‹ ¯Ú‹ÛË ÂÏ·ÈÔÏ¿‰Ô˘Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ Ì·ÁÂÈÚ¤Ì·-ÙÔ˜ ‹ ˆ˜ ÚÔÛÙÈı¤ÌÂÓÔ˘ ÂÏ·›Ô˘Û˘Û¯ÂÙ›˙ÂÙ·È ÛËÌ·ÓÙÈÎ¿ ÌÂ ¯·ÌË-ÏfiÙÂÚÂ˜ Èı·ÓfiÙËÙÂ˜ ÂÌÊ¿ÓÈÛË˜ÔÍ¤Ô˜ ÛÙÂÊ·ÓÈ·›Ô˘ Û˘Ó‰ÚfiÌÔ˘,·ÎfiÌ· Î·È ÌÂÙ¿ ·fi ¤ÏÂÁ¯Ô ·Ú-ÎÂÙÒÓ Û˘Á¯˘ÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓÎÈÓ‰‡ÓÔ˘. ∏ ∂ÏÏ¿‰· Â›Ó·È ÌÈ· ¯Ò-Ú· ÛÙËÓ ÔÔ›· ·Ú·‰ÔÛÈ·Î¿¯ÚËÛÈÌÔÔÈÂ›Ù·È ÂÏ·ÈfiÏ·‰Ô Î·Ù¿ÙËÓ ÚÔÂÙÔÈÌ·Û›· ÙÔ˘ Ê·ÁËÙÔ‡.™ÙËÓ ¤ÚÂ˘Ó· EPIC Ë ÌÂÁ·Ï‡ÙÂÚËÎ·Ù·Ó¿ÏˆÛË ÂÏ·ÈÔÏ¿‰Ô˘ Î·Ù·-ÁÚ¿ÊËÎÂ ÛÙËÓ ∂ÏÏ¿‰·[14] Î·ÈÛ‡ÌÊˆÓ· ÌÂ ÙËÓ ÌÂÏ¤ÙË DAFNE,ÙÔ ÂÏ·ÈfiÏ·‰Ô ‹Ù·Ó ÙÔ ÚˆÙ·Ú¯È-Îfi ¤Ï·ÈÔ Ô˘ ‹Ù·Ó ‰È·ı¤ÛÈÌÔ ÛÂ∂ÏÏ¿‰· Î·È πÛ·Ó›·[15]. °ÂÓÈÎ¿ ÔÈÌÂÛÔÁÂÈ·Î¤˜ ¯ÒÚÂ˜ Â›¯·Ó ÙË ÌÈ-

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ÎÚfiÙÂÚË ‰È·ıÂÛÈÌfiÙËÙ· ÛÂ ÚÔ-ÛÙÈı¤ÌÂÓÔ ˙ˆÈÎfi Î·È Ê˘ÙÈÎfi Ï›-Ô˜. ™ÙËÓ ·ÚÔ‡Û· ¤ÚÂ˘Ó· ÙÔ65% ÙË˜ ÔÌ¿‰· ÂÏ¤Á¯Ô˘ Î·È ÙÔ59% ÙˆÓ ·ÛıÂÓÒÓ ·Ó¤ÊÂÚ·Ó·ÔÎÏÂÈÛÙÈÎ‹ ¯Ú‹ÛË ÂÏ·ÈÔÏ¿‰Ô˘ÂÓÒ ÙÔ 16% ÙË˜ ÔÌ¿‰·˜ ÂÏ¤Á-¯Ô˘ Î·È ÙÔ 22% ÙˆÓ ·ÛıÂÓÒÓ ‰ÂÓ¯ÚËÛÈÌÔÔÈÔ‡Û·Ó Î·ıfiÏÔ˘ ÂÏ·È-fiÏ·‰Ô. ∞ÎfiÌ·, ·˘ÙÔ› Ô˘ ·Ó¤ÊÂ-Ú·Ó ·ÔÎÏÂÈÛÙÈÎ‹ ¯Ú‹ÛË ÂÏ·ÈÔ-Ï¿‰Ô˘, ·Ó¤ÊÂÚ·Ó Î·È ÌÂÁ·Ï‡ÙÂ-ÚË Î·Ù·Ó¿ÏˆÛË „·ÚÈÒÓ, ÔÛ-Ú›ˆÓ ÊÚÔ‡ÙˆÓ Î·È Ï·¯·ÓÈÎÒÓ·ÓÙÈÎ·ÙÔÙÚ›˙ÔÓÙ·˜ ‰È·ÙÚÔÊÈÎ¤˜Û˘Ó‹ıÂÈÂ˜ ÎÔÓÙ¿ ÛÙË ÌÂÛÔÁÂÈ·Î‹‰È·ÙÚÔÊ‹. øÛÙfiÛÔ Ë Â›‰Ú·ÛËÙÔ˘ ÂÏ·ÈÔÏ¿‰Ô˘ ÛÙË ÌÂ›ˆÛË ÙÔ˘ÎÈÓ‰‡ÓÔ˘ Î·Ú‰È·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ‹Ù·Ó ·ÓÂÍ¿ÚÙËÙË ·fi ·˘Ù¤˜ ÙÈ˜ÔÌ¿‰Â˜ ÙÚÔÊ›ÌˆÓ.∞ÓÙ›ÛÙÚÔÊË Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡Î·Ù·Ó¿ÏˆÛË˜ ÂÏ·ÈÔÏ¿‰Ô˘ Î·ÈÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛË˜ ÔÍ¤Ô˜ÂÌÊÚ¿ÁÌ·ÙÔ˜ Ì˘ÔÎ·Ú‰›Ô˘ ‚Ú¤-ıËÎÂ Î·È ÛÂ Ì›· ¤ÚÂ˘Ó· ·ÛıÂÓÒÓ-Ì·ÚÙ‡ÚˆÓ ·fi ÙËÓ πÛ·Ó›·[8],fiÔ˘ ÛÙÔ ·ÓÒÙÂÚÔ ÙÂÙ·ÚÙËÌfiÚÈÔÎ·Ù·Ó¿ÏˆÛË˜ ÙÔ ÂÏ·ÈfiÏ·‰Ô Û˘-Û¯ÂÙ›ÛıËÎÂ ÛËÌ·ÓÙÈÎ¿ ÌÂ 82%Û¯ÂÙÈÎ‹ ÌÂ›ˆÛË ÛÙÔÓ Î›Ó‰˘ÓÔ ÁÈ·ÂÌÊ¿ÓÈÛË ÔÍ¤Ô˜ ÂÌÊÚ¿ÁÌ·ÙÔ˜Ì˘ÔÎ·Ú‰›Ô˘, ÌÂÙ¿ ·fi Ú‡ıÌÈÛËÁÈ· ·ÚÎÂÙÔ‡˜ Û˘Á¯˘ÙÈÎÔ‡˜ ·Ú¿-ÁÔÓÙÂ˜. ¢˘ÛÙ˘¯Ò˜ Ù· ÛÙÔÈ¯Â›·Ô˘ ¤¯Ô˘ÌÂ ‰ÂÓ ÂÈÙÚ¤Ô˘Ó Ô‡ÙÂÓ· ÔÛÔÙÈÎÔÔÈ‹ÛÔ˘ÌÂ ÙËÓ Î·Ù·-Ó¿ÏˆÛË ÂÏ·›ˆÓ Î·È ÏÈÒÓ Ô‡ÙÂÓ· ˘ÔÏÔÁ›ÛÔ˘ÌÂ ÙËÓ ÔÛfiÙËÙ·ÌÔÓÔ·ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓ ÔÍ¤ˆÓÔ˘ Î·Ù·Ó·ÏÒÓÔÓÙ·Ó. øÛÙfiÛÔ ËÎ·Ù·ÁÚ·Ê‹ ÙÔ˘ Ù‡Ô˘ ÙÔ˘ ÂÏ·ÈÔ-Ï¿‰Ô˘ Î·Ù¿ ÙËÓ ·Ú·ÛÎÂ˘‹ ÙÔ˘

Ê·ÁËÙÔ‡ (¯ Ì·ÁÂ›ÚÂÌ·, ÙËÁ¿ÓÈ-ÛÌ· ÚÔÛı‹ÎË ÛÂ Û·Ï¿ÙÂ˜) ı·ÌÔÚÔ‡ÛÂ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÏÈÁfi-ÙÂÚ¿ ÛÊ¿ÏÌ·Ù· ·Ó¿ÎÏËÛË˜ ·fifiÙÈ ÌÈ· ÔÛÔÙÈÎÔÔÈËÌ¤ÓË ÚÔ-Û¤ÁÁÈÛË Î·È Ì·˜ ¤‰ˆÛÂ ÛËÌ·ÓÙÈ-Î¤˜ ÏËÚÔÊÔÚ›Â˜ Ô˘ ÂÈÙÚ¤-Ô˘Ó ÙËÓ ÂÍ·ÁˆÁ‹ ÌËÓ˘Ì¿ÙˆÓÁÈ· ÙË ‰ËÌfiÛÈ· ˘ÁÂ›·.∏ Â›‰Ú·ÛË ÙÔ˘ ÂÏ·ÈÔÏ¿‰Ô˘ÛÙÔÓ Î›Ó‰˘ÓÔ ÁÈ· Î·Ú‰È·Î¿ ÓÔÛ‹-Ì·Ù· ÌÔÚÂ› Ó· ·Ô‰ÔıÂ› ÛÙÈ˜‰È¿ÊÔÚÂ˜ ÂÈ‰Ú¿ÛÂÈ˜ ÙÔ˘ ÂÏ·Èfi-Ï·‰Ô˘ ÛÂ ·Ú¿ÁÔÓÙÂ˜ Î·Ú‰È·Á-ÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘, .¯. ÛÙË ÌÂ›ˆ-ÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ ÔÏÈÎ‹˜ Î·ÈLDL ¯ÔÏËÛÙÂÚfiÏË˜ Î·ıÒ˜ Î·ÈÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ[16-18]. ∂ÈÚÔ-Ûı¤Ùˆ˜ ÌÈ· ‰›·ÈÙ· ÏÔ‡ÛÈ· ÛÂÂÏ·ÈfiÏ·‰Ô ÌÂÈÒÓÂÈ ÙËÓ Ù¿ÛË ÁÈ·ıÚÔÌ‚ˆÙÈÎ¿ ÂÂÈÛfi‰È·[19] Î·È›Ûˆ˜ ÂÈ‚Ú·‰‡ÓÂÈ ÙËÓ ÂÌÊ¿ÓÈÛË·ıËÚÔÛÎÏ‹ÚˆÛË˜[20]. Δ· ÌÔÓÔ·-ÎfiÚÂÛÙ· ÏÈ·Ú¿ ÔÍ¤· Â›ÛË˜·ÛÎÔ‡Ó ÚÔÛÙ·ÙÂ˘ÙÈÎ‹ ‰Ú¿ÛËÂÓ¿ÓÙÈ· ÛÙË ÔÍÂ›‰ˆÛË ÙË˜ LDL[20],ÂÓÒ ÙÔ ÂÏ·˚Îfi ÔÍ‡ ÂÌÊ·Ó›˙ÂÙ·ÈÓ· ·ÏÏËÏÂÈ‰Ú¿ Î·ÙÂ˘ıÂ›·Ó ÛÙËÓÊÏÂÁÌÔÓÒ‰Ë ·ÓÙ›‰Ú·ÛË Ô˘ ¯·-Ú·ÎÙËÚ›˙ÂÈ ÙË ·ıËÚÔÁ¤ÓÂÛË [21].Ã·Ú·ÎÙËÚÈÛÙÈÎ¿, ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ Ì·˜ ÌÂ ˘ÂÚ¯ÔÏË-ÛÙÂÚÔÏ·ÈÌ›·, Ë ·ÔÎÏÂÈÛÙÈÎ‹ Î·-Ù·Ó¿ÏˆÛË ÂÏ·ÈÔÏ¿‰Ô˘ Û¯ÂÙ›ÛÙË-ÎÂ ÌÂ 0.55 ÊÔÚ¤˜ Èı·ÓfiÙËÙ· ÂÌ-Ê¿ÓÈÛË˜ ÔÍ¤Ô˜ ÛÙÂÊ·ÓÈ·›Ô˘ Û˘Ó-‰ÚfiÌÔ˘ Î·È ·˘Ùfi ÙÔ ·ÔÙ¤ÏÂÛÌ·Â›Ó·È Û‡ÌÊˆÓÔ Î·È ÌÂ ÔÏÏ¤˜ ÌÂ-Ù·‚ÔÏÈÎ¤˜ ¤ÚÂ˘ÓÂ˜[16,17]. ∂ÈÚfi-ÛıÂÙ· ÔÈ Ô‰ËÁ›Â˜ ÙË˜ EıÓÈÎ‹˜∂ÈÙÚÔ‹˜ ÁÈ· ÙË ¯ÔÏËÛÙÂÚfiÏËÙˆÓ ∏.¶.∞. (Third Report of theNCEP Adult Treatment Panel)

Û˘ÛÙ‹ÓÔ˘Ó ¤Ó· ÚfiÁÚ·ÌÌ· ·fi·ÏÏ·Á¤˜ ÛÙÔ ÙÚfiÔ ˙ˆ‹˜, ÔÔÔ›Ô˜ ‰›ÓÂÈ ÂÚÈÛÛfiÙÂÚÔ ¤ÌÊ·-ÛË ÛÙËÓ ÔÈfiÙËÙ· ÙÔ˘ Ï›Ô˘˜,ÚÔˆıÒÓÙ·˜ ÙËÓ Î·Ù·Ó¿ÏˆÛËÌÔÓÔ·ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓ ÔÍ¤ˆÓ,·Ú¿ ÛÙËÓ ÔÛfiÙËÙ¿ ÙÔ˘[22]. ∞Ó Î·È ÌÂÙ·‚ÔÏÈÎ¤˜ ¤ÚÂ˘ÓÂ˜¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ÙÔ ÂÏ·ÈfiÏ·‰Ô‚ÂÏÙÈÒÓÂÈ ÙÔ ÏÈÈ‰·ÈÌÈÎfi ÚÔÊ›ÏÎ·È ÙÔ ÁÏ˘Î·ÈÌÈÎfi ¤ÏÂÁ¯Ô ÛÂ ‰È·-‚ËÙÈÎÔ‡˜ ·ÛıÂÓÂ›˜[23] ÛÙËÓ ‰ÈÎ‹Ì·˜ ¤ÚÂ˘Ó· ‰ÂÓ ‚Ú¤ıËÎÂ Î¿ÔÈ·ÛËÌ·ÓÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÛÂ ·˘Ù‹ ÙËÓÔÌ¿‰· ·ÛıÂÓÒÓ, Èı·ÓÒ˜ ÏfiÁˆÙÔ˘ ÌÈÎÚÔ‡ ·ÚÈıÌÔ‡ ‰È·‚ËÙÈÎÒÓ·ÛıÂÓÒÓ Ô˘ Û˘ÌÂÚÈÏ‹ÊıËÎ·ÓÛÙÔ ‰Â›ÁÌ· Ì·˜. ∞ÓÙ›ıÂÙ· ·Ú·-ÙËÚ‹Û·ÌÂ fiÙÈ Ë ·ÔÎÏÂÈÛÙÈÎ‹¯Ú‹ÛË ÂÏ·ÈÔÏ¿‰Ô˘ Û˘Û¯ÂÙ›ÛıËÎÂÌÂ 48% ¯·ÌËÏfiÙÂÚË Èı·ÓfiÙËÙ·ÂÌÊ¿ÓÈÛË˜ ÔÍ¤Ô˜ ÛÙÂÊ·ÓÈ·›Ô˘Û˘Ó‰ÚfiÌÔ˘ ÌÂÙ·Í‡ ÙˆÓ ˘ÂÚÙ·-ÛÈÎÒÓ ·ÛıÂÓÒÓ. ∂ÈÚfiÛıÂÙ·, ÛÂ¿ÏÏÂ˜ ÂÈ‰ËÌÈÔÏÔÁÈÎ¤˜ ÌÂÏ¤ÙÂ˜,ÙÔ ÂÏ·ÈfiÏ·‰Ô ¤¯ÂÈ ·ÓÙ›ÛÙÚÔÊ·Û˘Û¯ÂÙÈÛıÂ› ÌÂ ÙËÓ ›ÂÛË ÙÔ˘ ·›-Ì·ÙÔ˜[10] Î·È ÂÌÊ·Ó›˙ÂÙ·È Ó· ÌÂÈÒ-ÓÂÈ ÙËÓ Î·ıËÌÂÚÈÓ‹ ‰fiÛË ÙˆÓ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ Ê·ÚÌ¿ÎˆÓ [24].

¶∂ƒπ√ƒπ™ª√π™ÙÈ˜ ¤ÚÂ˘ÓÂ˜ ·ÛıÂÓÒÓ-Ì·ÚÙ‡ÚˆÓ‰‡Ô ‚·ÛÈÎ¤˜ ËÁ¤˜ Û˘ÛÙËÌ·ÙÈ-ÎÒÓ ÛÊ·ÏÌ¿ÙˆÓ ÌÔÚÔ‡Ó Ó·˘¿ÚÍÔ˘Ó: Ù· ÛÊ¿ÏÌ·Ù· ÂÈÏÔ-Á‹˜ Î·È Ù· ÛÊ¿ÏÌ·Ù· ·Ó¿ÎÏË-ÛË˜. ¶ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ÌÂÈˆıÔ‡ÓÙ· ÛÊ¿ÏÌ·Ù· ÂÈÏÔÁ‹˜ ÚÔÛ·-ı‹Û·ÌÂ Ó· ı¤ÛÔ˘ÌÂ ·ÓÙÈÎÂÈÌÂÓÈ-Î¿ ÎÚÈÙ‹ÚÈ· ÙfiÛÔ ÁÈ· ÙÔ˘˜ ·ÛıÂ-ÓÂ›˜ fiÛÔ Î·È ÁÈ· ÙËÓ ÔÌ¿‰· ÂÏ¤Á-¯Ô˘. ŒÓ·˜ ·ÎfiÌ· ÂÚÈÔÚÈÛÌfi˜

™¯ÂÙÈÎfi˜ 95% ‰È¿ÛÙËÌ· PÏfiÁÔ˜ ÂÌÈÛÙÔÛ‡ÓË˜

∫·ÙËÁÔÚ›· ÂÏ·›Ô˘ªË ¯Ú‹ÛË ÂÏ·ÈÔÏ¿‰Ô˘ (Î·ÙËÁÔÚ›· ·Ó·ÊÔÚ¿˜) 1.00 - -∞ÔÎÏÂÈÛÙÈÎ‹ ¯Ú‹ÛË ÂÏ·ÈÔÏ¿‰Ô˘ 0.53 0.34 0.71 <0.001∂Ï·ÈfiÏ·‰Ô ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ¿ÏÏ· ¤Ï·È· 0.77 0.54 1. 09 0.14

∏ÏÈÎ›· (·Ó¿ 1 ¤ÙÔ˜) 1.03 1.01 1.04 <0.001ÕÓ‰ÚÂ˜ / °˘Ó·›ÎÂ˜ 2.73 2.10 3.63 <0.001√ÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ·ı‹ÛÂˆÓ (¡·È / Ÿ¯È) 4.07 3.20 5.19 <0.001¶·ÚÔ‡Û· Û˘Ó‹ıÂÈ· Î·Ó›ÛÌ·ÙÔ˜ (¡·È / Ÿ¯È) 1.79 1.41 2.27 <0.001À¤ÚÙ·ÛË (¡·È / Ÿ¯È) 1.94 1.54 2.45 <0.001ÀÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· (¡·È / Ÿ¯È) 3.76 3.01 4.69 <0.001¢È·‚‹ÙË˜ (¡·È / Ÿ¯È) 2.39 1.76 3.25 <0.001¢Â›ÎÙË˜ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (·Ó¿ 1 kg/m2) 0.97 0.94 1.00 0.07∫·ıÈÛÙÈÎ‹ ˙ˆ‹ (¡·È / Ÿ¯È) 0.81 0.65 1.00 0.05∞ÓÒÙÂÚË / Ì¤ÙÚÈ· ‹ ¯·ÌËÏfiÙÂÚË ÌfiÚÊˆÛË 0.94 0.70 1.20 0.68¶ÚfiÛÏË„Ë ÎfiÎÎÈÓÔ˘ ÎÚ¤·ÙÔ˜ (ÌÂÚ›‰Â˜ / Â‚‰ÔÌ¿‰·) 1.68 1.40 2.03 <0.001¶ÚfiÛÏË„Ë ÊÚÔ‡ÙˆÓ Î·È Ï·¯·ÓÈÎÒÓ (ÌÂÚ›‰Â˜ / Â‚‰ÔÌ¿‰·) 0.66 0.57 0.76 0.001¶ÚfiÛÏË„Ë ‰ËÌËÙÚÈ·ÎÒÓ (ÌÂÚ›‰Â˜ / Â‚‰ÔÌ¿‰·) 1.15 0.98 1.33 0.06¶ÚfiÛÏË„Ë ·ÏÎÔfiÏ (ÔÙ‹ÚÈ· ÎÚ·Û›/ ËÌ¤Ú·) 1.09 0.97 1.22 0.14

¶›Ó·Î·˜ 1. ∫·Ù·Ó¿ÏˆÛË ÂÏ·ÈÔÏ¿‰Ô˘ Î·È ÔÍ‡ ÛÙÂÊ·ÓÈ·›Ô Û‡Ó‰ÚÔÌÔ.

¢IATPOºH

29

Â›Ó·È fiÙÈ Ù· ÛÙÔÈ¯Â›·, ‰ÂÓ Ì·˜ÂÈÙÚ¤Ô˘Ó Ó· ÔÛÔÙÈÎÔÔÈ‹ÛÔ˘-ÌÂ Ù· Ï›Ë Î·È Ù· ¤Ï·È· Î·È Ô‡ÙÂÓ· ˘ÔÏÔÁ›ÛÔ˘ÌÂ ÙÔ ÔÛfi ÙˆÓÌÔÓÔ·ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓ ÔÍ¤ˆÓÔ˘ Î·Ù·Ó·ÏÒÓÔÓÙ·Ó, ˆÛÙfiÛÔ ËÎ·Ù·ÁÚ·Ê‹ ÙÔ˘ Ù‡Ô˘ ÙÔ˘ ÚÔ-ÛÙÈı¤ÌÂÓÔ˘ ÂÏ·›Ô˘ Î·È Ï›Ô˘˜ Î·-Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÚÔÂÙÔÈÌ·-Û›·˜ ÙÔ˘ Ê·ÁËÙÔ‡ (¯ Ì·ÁÂ›ÚÂ-Ì·, ÙËÁ¿ÓÈÛÌ·, ÚÔÛı‹ÎË ÛÙÈ˜Û·Ï¿ÙÂ˜) ı· ÌÔÚÔ‡ÛÂ Ó· ÂÚÈ-Ï·Ì‚¿ÓÂÈ ÏÈÁfiÙÂÚ¿ ÛÊ¿ÏÌ·Ù··Ó¿ÎÏËÛË˜ ·fi fiÙÈ ÌÈ· ÔÛÔÙÈ-ÎÔÔÈËÌ¤ÓË ÚÔÛ¤ÁÁÈÛË Î·È Ì·˜¤‰ˆÛÂ ÛËÌ·ÓÙÈÎ¤˜ ÏËÚÔÊÔÚ›Â˜Ô˘ ÂÈÙÚ¤Ô˘Ó ÙËÓ ÂÍ·ÁˆÁ‹ ÌË-Ó˘Ì¿ÙˆÓ ÁÈ· ÙË ‰ËÌfiÛÈ· ˘ÁÂ›·.ŸÛÔÓ ·ÊÔÚ¿ Ù· ÛÊ¿ÏÌ·Ù· ÛÙËÛ˘ÏÏÔÁ‹ ÙˆÓ ÏËÚÔÊÔÚÈÒÓ, ÚÔ-Û·ı‹Û·ÌÂ Ó· Ù· ·ÔÊ‡ÁÔ˘ÌÂ

Ì¤Ûˆ ÏÂÙÔÌÂÚÔ‡˜ Î·Ù·ÁÚ·Ê‹˜ÙˆÓ ÛÙÔÈ¯Â›ˆÓ ·fi ÙÔ˘˜ È·ÙÚÈ-ÎÔ‡˜ Ê·Î¤ÏÔ˘˜ ÙˆÓ ·ÛıÂÓÒÓ.Δ¤ÏÔ˜, ÔÈ ·ÛıÂÓÂ›˜ ÌÂ ÛÙÂÊ·ÓÈ-·›· ÓfiÛÔ Ô˘ Î·Ù¤ÏËÍ·Ó Î·Ù¿ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘˜ ‹ ÙËÓ ÂfiÌÂ-ÓË Ì¤Ú· ‰ÂÓ Û˘ÌÂÚÈÏ‹ÊıËÎ·ÓÛÙËÓ ¤ÚÂ˘Ó·. ∞˘Ù¿ Ù· ÛÊ¿ÏÌ·Ù·ı· ÌÔÚÔ‡Û·Ó Ó· ÂËÚÂ¿ÛÔ˘ÓÙËÓ ¤ÚÂ˘Ó· Ì·˜.

™Àª¶∂ƒ∞™ª∞™‡ÌÊˆÓ· ÌÂ Ù· Â˘Ú‹Ì·Ù¿ Ì·˜, Ë·ÔÎÏÂÈÛÙÈÎ‹ ¯Ú‹ÛË ÂÏ·ÈÔÏ¿‰Ô˘Î·Ù¿ ÙÔ Ì·ÁÂ›ÚÂÌ· Î·È ÙËÓ ÚÔÂ-ÙÔÈÌ·Û›· ÙÔ˘ Ê·ÁËÙÔ‡ Û¯ÂÙ›˙ÂÙ·ÈÛËÌ·ÓÙÈÎ¿ ÌÂ ÌÈÎÚfiÙÂÚË Èı·Ófi-ÙËÙ· ÂÌÊ¿ÓÈÛË˜ ÔÍ¤Ô˜ ÛÙÂÊ·ÓÈ-·›Ô˘ Û˘Ó‰ÚfiÌÔ˘ Î·È ı· Ú¤ÂÈÓ· ÚÔˆıÂ›Ù·È Ì¤Ûˆ ÚÔÁÚ·ÌÌ¿-ÙˆÓ ÚfiÏË„Ë˜ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ·ÛıÂÓÂÈÒÓ.

∂ÀÃ∞ƒπ™Δπ∂™√È Û˘ÁÁÚ·ÊÂ›˜ ı· ‹ıÂÏ·Ó Ó· Â˘-¯·ÚÈÛÙ‹ÛÔ˘Ó ÙÔ˘˜ È·ÙÚÔ‡˜ Ô˘Û˘ÓÙfiÓÈÛ·Ó ÙË Û˘ÏÏÔÁ‹ ‰Â‰ÔÌ¤-ÓˆÓ: ∫. Δ˙ÈÔ‡ÌË˜ (∞ı‹Ó·, ∫Ú‹ÙË,¶ÂÏÔfiÓÓËÛÔ˜), π. ™ÎÔ‡Ì·˜ (∞ı‹-Ó·), ¡. ¶··Èˆ¿ÓÓÔ˘ (∞ı‹Ó·, £ÂÛ-Û·Ï›·), ¶. ™ÙÚ·‚Ôfi‰Ë˜ (¡ËÛÈ¿πÔÓ›Ô˘), §. ∫·ÚÚ¿ (¡ËÛÈ¿ ∞ÈÁ·›-Ô˘), ¢. ∞ÓÙˆÓÈ¿‰Ë˜ (ª·ÎÂ‰ÔÓ›·),°. ƒ¤ÌÂÏÔ˜ (¡ËÛÈ¿ ∞ÈÁ·›Ô˘), ¢.ª¿ÚÎÔ˘ (∞ı‹Ó·), ∞. ªÔÚ·˝ÙË(∞ı‹Ó·), ¢. ∂˘·ÁÁ¤ÏÔ˘ (∫Ú‹ÙË),™. μ¤ÏÏ·˜ (∞ÙÙÈÎ‹, ◊ÂÈÚÔ˜), °.™ÎÔ˘ÌÔ˘Ú‰‹˜ (™ÙÂÚ·È¿ ∂ÏÏ¿-‰·), μ. ªÂ˚‰¿ÓË˜ (ª·ÎÂ‰ÔÓ›·,™ÙÂÚÂ¿ ∂ÏÏ¿‰·, £ÂÛÛ·Ï›·), ™.§fiÁÁÔ˜ (∞ÙÙÈÎ‹), π. ∂ÏÂ˘ÛÈÓÈÒÙË˜(∞ı‹Ó·), ¡. ª·ÚÈÓ¿ÎË˜ (¡ËÛÈ¿ ∞È-Á·›Ô˘), °. ∫Ô˘ÙÛÈÌ¿ÓË˜ (£Ú¿ÎË),™. ∑fiÌÔÏÔ˜ (¶ÂÏÔfiÓÓËÛÔ˜).

1. Wahrburg U. What are the health effects offat? Eur J Nutr 2004;43 Suppl 1:I/6-11.

2. Owen RW, Mier W, Giacosa A, Hule WE,Spiegelhalder B, Bartsch H. Phenoliccompounds and squalene in olive oils:the concentration and antioxidantpotential of total phenols, simplephenols, secoroids, lignans and squa-lene. Food Chem Toxicol 2000; 38:647-659.

3. Keys A, Menotti A, Karvonen MJ, et al.The diet and 15-year death rate in theSeven Countries Study. Am J Epi-demiol 1986;124:903-915.

4. Hu FB, Stampfer MJ, Manson JE, RimmE, Colditz GA, Rosner BA, HennekensCH, Willett WC. Dietary fat intake andthe risk of coronary heart disease inwomen. New Engl J Med1997;337:1491-1499.

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

6. Gramenzi A, Gentile A, Fasoli M, NegriE, Parazzini F, La Vecchia C. Asso-ciation between certain foods and riskof acute myocardial infarction inwomen. BMJ 1990;300:771-773.

7. Bertuzzi M, Tavani A, Negri E, La VecchiaC. Olive oil consumption and risk of non-fatal myocardial infarction in Italy. Int JEpidemiol 2002;31:1274-1275.

8. Fernandez-Jarne E, Martinez-Losa E,Prado-Santamaria M, Brugarolas-Bru-fau C, Serrano-Martinez M, Martinez-Gonzalez MA. Risk of first non-fatalmyocardial infarction negatively asso-ciated with olive oil consumption: Acase-control study in Spain. Int JEpidemiol 2002;31:474-480.

9. Tzonou A, Kalandidi A, Trichopoulou AHsieh CC, Toupadaki N, Willett W,Trichopoulos D. Diet and coronaryheart disease: a case-control study inAthens, Greece. Epidemiology 1993;4:511-516.

10. Psaltopoulou T, Naska A, Orfanos P,Trichopoulos D, Mountokalakis T,Trichopoulou A. Olive oil, theMediterranean diet, and arterial bloodpressure: the Greek EuropeanProspective Investigation into Cancerand Nutrition (EPIC) study. Am J ClinNutr 2004;80:1012-1018.

11. Myocardial infarction redefined-a conse-nsus document of The Joint EuropeanSociety of Cardiology/ AmericanCollege of Cardiology Committee forthe redefinition of myocardial infarction.Eur Heart J 2000;21:1502-1513.

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

13. Panagiotakos DB, Pitsavos C, Chryso-hoou C, Stefanadis C, Toutouzas PK.Risk stratification of coronary heartdisease, in Greece: Final results fromCARDIO2000 epidemiological study.Prev Med 2002;35:548-556.

14. Linseisen J, Bergstrom E, Gafa L, et al.Consumption of added fats and oils in theEuropean Prospective Investigation intoCancer and Nutrition (EPIC) centresacross 10 European countries asassessed by 24-hour dietary recalls.Public Health Nutr 2002;5(6B) :1227-1242.

15. Byrd-Bredbenner C, Lagiou P, Tricho-poulou A. A comparison of householdfood availability in 11 countries. J HumNutr Diet 2000;13:197-204.

16. Gardner CD, Kraemer HC. Monounsa-turated versus polyunsaturated dietaryfat and serum lipids: a metaanalysis.Arterioscler Throm Vasc Biol 1995;15:1918-1927.

17. Mata P, Alvarezsala LA, Ubio MJ, NunoJ, Oya M de. Effects of long-term mo-nounsaturated-enriched vs polyunsa-turated- enriched diets on lipoproteins inhealthy men and women. Am J Clin Nutr1992; 55:846-850.

18. Pieke B, Eckardstein A von, GulbahceE, Chirazi A, Schulte H, Assmann G,Wahrburg U. Treatment of hypertri-glyceridemia by two diets rich either inunsaturated fatty acids or in carbo-hydrates: effects on lipoprotein subclas-ses, lipolytic enzymes, lipid transferproteins, insulin and leptin. Int J ObesRel Metab Dis 2000;24:1286-1296.

19. Frost Larsen L, Jespersen J,Marckmann P. Are olive oil diets anti-thrombotic? Diets enriched with olive,rapeseed, or sunflower oil affectpostprandial factor VII differently1-3.Am J Clin Nutr 1999;70:976-982.

20. Mata P, Varela O, Alonso R, Lahoz C,de Oya M, Badimon L. Monounsatu-rated and polyunsaturated n-6 fattyacid-enriched diets modify LDL oxi-dation and decrease human coronarysmooth muscle cell DNA synthesis.Arterioscler Thromb Vasc Biol1997;17:2088-2095.

21. Massaro M, Carluccio MA, De CaterinaR. Direct vascular antiatherogenic effe-cts of oleic acid: a clue to the cardio-protective effects of the Mediterraneandiet. Cardiologia 1999; 44:507-513.

22. Expert Panel on Detection, Evaluation,and Treatment of High Blood Chole-sterol in Adults. Executive Summary ofthe Third Report of the NationalCholesterol Education Program(NCEP) Expert Panel on Detection,Evaluation, and Treatment of HighBlood Cholesterol in Adults. JAMA2001;285:2486-2497.

23. Garg A. High-monounsaturatedfatdiets for patients with diabetesmellitus: a meta-analysis. Am J ClinNutr 1998;67(Suppl 3):577S-582S.

24. Ferrara LA, Raimondi AS, d'EpiscopoL, Guida L, Dello Russo A, Marotta T.Olive oil and reduced need forantihypertensive medications. ArchIntern Med 2000;160:837-842.


π √ À ¡ π √ ™ 2 0 0 8

30

ª¤Û· ÛÙÔ Î·ÏÔÎ·›ÚÈ ÙÔ˘ 2007‰ËÌÔÛÈÂ‡ÙËÎ·Ó ·Ó·ÓÂˆÌ¤ÓÂ˜ ÔÈÎ·ÙÂ˘ı˘ÓÙ‹ÚÈÂ˜ Ô‰ËÁ›Â˜ ÙË˜ ∂˘-Úˆ·ÈÎ‹˜ ∫·Ú‰ÈÔÏÔÁÈÎ‹˜ ∂Ù·È-Ú›·˜(1) Î·ıÒ˜ Î·È ÔÈ ÎÔÈÓ¤˜ Ô‰Ë-Á›Â˜ ÙË˜ ∞ÌÂÚÈÎ·ÓÈÎ‹˜ ∫·Ú‰ÈÔ-ÏÔÁÈÎ‹˜ ∂Ù·ÈÚ›·˜ Î·È ÙÔ˘ ∞ÌÂÚÈ-Î·ÓÈÎÔ‡ ∫ÔÏÂÁ›Ô˘ ∫·Ú‰ÈÔÏÔÁ›·˜ÁÈ· ÙËÓ ∞ÛÙ·ı‹ ™ÙËı¿Á¯Ë Î·È ÙÔŒÌÊÚ·ÁÌ· ÙÔ˘ ª˘ÔÎ·Ú‰›Ô˘ ¯ˆ-Ú›˜ ·Ó¿Û·ÛË ÙÔ˘ ST (NSTEMI)(2).√È Ô‰ËÁ›Â˜ Û˘ÌÊˆÓÔ‡Ó ÛÙÔ ÌÂ-Á·Ï‡ÙÂÚÔ Ì¤ÚÔ˜ ÙÔ˘˜, ·Ó·ÓÂÒ-ÓÔ˘Ó ÙÈ˜ ÚÔÁÂÓ¤ÛÙÂÚÂ˜ Î·È ÂÓ-ÛˆÌ·ÙÒÓÔ˘Ó Ù· Â˘Ú‹Ì·Ù· ÙˆÓÓÂˆÙ¤ÚˆÓ ÌÂÏÂÙÒÓ.Δ· ÛËÌ·ÓÙÈÎfiÙÂÚ· ÛËÌÂ›· ÙˆÓÓÂÒÙÂÚˆÓ Ô‰ËÁÈÒÓ Û˘ÓÔ„›˙ÔÓÙ·È·Ú·Î¿Ùˆ:

∞Ú¯ÈÎ‹ ∂ÎÙ›ÌËÛË

1. ™ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ÛÙËı¿Á¯ËÔ˘ ‰ÂÓ ÂÌÊ·Ó›˙ÂÈ ‡ÊÂÛË ÙÔ˘fiÓÔ˘ ÌÂÙ¿ 5 ÏÂÙ¿ ·fi ÙË Ï‹-„Ë ÓÈÙÚˆ‰ÒÓ Û˘ÓÈÛÙ¿Ù·È ÎÏ‹ÛËÕÌÂÛË˜ μÔ‹ıÂÈ·˜ ÚÈÓ ÙË Ï‹„ËÂÈÏ¤ÔÓ ÓÈÙÚˆ‰ÒÓ. √È ·ÛıÂÓÂ›˜ÌÂ ¯ÚfiÓÈ· ÛÙ·ıÂÚ‹ ÛÙËı¿Á¯ËÌÔÚÔ‡Ó Ó· Ï¿‚Ô˘Ó ¤ˆ˜ 3 ‰fi-ÛÂÈ˜ ÓÈÙÚˆ‰ÒÓ, ÌÂ ‰È¿ÛÙËÌ· 5ÏÂÙÒÓ ÌÂÙ·Í‡ ÙÔ˘˜ ÂÊfiÛÔÓ Ù·Û˘ÌÙÒÌ·Ù· ÂÌÊ·Ó›˙Ô˘Ó ÚÔÔ-‰Â˘ÙÈÎ‹ ‡ÊÂÛË. ™Â ·ÓÙ›ıÂÙË Â-Ú›ÙˆÛË Û˘ÓÈÛÙ¿Ù·È ÎÏ‹ÛË ‚Ô‹-ıÂÈ·˜.

2. ™Â Î¿ıÂ ·ÛıÂÓ‹ ÌÂ ÛÙËı¿Á¯Ëı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ∏∫° Ì¤Û·ÛÂ 10 ÏÂÙ¿ ·fi ÙËÓ ¿ÊÈÍË ÛÙÔÙÌ‹Ì· ÂÂÈÁfiÓÙˆÓ. √È ·ÛıÂÓÂ›˜ÌÂ ÛÙËı¿Á¯Ë Ú¤ÂÈ Ó· Î·Ù·Ó¤-ÌÔÓÙ·È ÛÂ 4 Î·ÙËÁÔÚ›Â˜: ÂÍˆ-Î·Ú‰È·Î¿ ·›ÙÈ·, ‚¤‚·ÈÔ ÔÍ‡ ÛÙÂ-Ê·ÓÈ·›Ô Û‡Ó‰ÚÔÌÔ (√™™), Èı·Ófi√™™ Î·È ¯ÚfiÓÈ· ÛÙ·ıÂÚ‹ ÛÙË-ı¿Á¯Ë.

3. ∏ ÙÚÔÔÓ›ÓË Â›Ó·È Ô ‚ÈÔ¯ËÌÈ-Îfi˜ ‰Â›ÎÙË˜ Ô˘ ÚÔÙÈÌ¿Ù·È ÛÂ·ÛıÂÓÂ›˜ Ô˘ ÚÔÛ¤Ú¯ÔÓÙ·È ÌÂÛ˘ÌˆÌ·ÙÔÏÔÁ›· Û˘Ì‚·Ù‹ ÌÂ√™™.

4. √È ·ÛıÂÓÂ›˜ ÌÂ Èı·Ófi √™™,ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ∏∫° Î·È ·ÚÓËÙÈ-Î‹ ÙÚÔÔÓ›ÓË ÁÈ· ÂÚÈÛÛfiÙÂÚÔ·fi 12 ¤ˆ˜ 16 ÒÚÂ˜ Ú¤ÂÈ Ó·˘Ô‚¿ÏÏÔÓÙ·È ÛÂ ‰ÔÎÈÌ·Û›· Îfi-ˆÛË˜ ÚÈÓ ÙËÓ ¤ÍÔ‰fi ÙÔ˘˜ ·fiÙÔ ÙÌ‹Ì·, Â›ÙÂ Ì¤Û· ÛÂ 72 ÒÚÂ˜·fi ÙÔ ÂÍÈÙ‹ÚÈfi ÙÔ˘˜. √È ·ÛıÂ-ÓÂ›˜ ·˘ÙÔ› ı· Ú¤ÂÈ Ó· Î·Ï‡-ÙÔÓÙ·È ·fi Ê·ÚÌ·ÎÂ˘ÙÈÎ‹ ·Áˆ-Á‹ Ì¤¯ÚÈ ÙË ‰ÔÎÈÌ·Û›· ÎfiˆÛË˜.

5. √È ·ÛıÂÓÂ›˜ ÌÂ ¯·ÌËÏ‹ Èı·-ÓfiÙËÙ· ÁÈ· ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ Î·ÈÈı·Ófi √™™ ÌÔÚÔ‡Ó Ó· ÂÎÙÈÌË-ıÔ‡Ó ÌÂ ÔÏ˘ÙÔÌÈÎ‹ ˘ÔÏÔÁÈÛÙÈ-Î‹ ÙÔÌÔÁÚ·Ê›· (MSCT) ·ÓÙ› ÙË˜‰ÔÎÈÌ·Û›·˜ ÎÔÒÛÂˆ˜.

6. ¶ÚÔÛÔ¯‹ ÛÙÈ˜ ˘ÔÔÌ¿‰Â˜ÏËı˘ÛÌÔ‡: ∏ÏÈÎÈˆÌ¤ÓÔ˘˜, °˘-Ó·›ÎÂ˜, ¢È·‚ËÙÈÎÔ‡˜, ·ÛıÂÓÂ›˜ÌÂ ÓÂÊÚÈÎ‹ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·

¶ÚÒÈÌË ∞ÓÙÈÌÂÙÒÈÛË

1. √È ·ÛıÂÓÂ›˜ ÌÂ ·ÈÌÔ‰˘Ó·ÌÈÎ‹·ÛÙ¿ıÂÈ· ‹ ÌÂ Û˘ÌÙÒÌ·Ù· Ô˘ÂÈÌ¤ÓÔ˘Ó ı· Ú¤ÂÈ Ó· ÓÔÛË-ÏÂ‡ÔÓÙ·È ÛÂ Î·Ú‰ÈÔÏÔÁÈÎ‹ ÌÔÓ¿-‰·, ÂÓÒ ÔÈ ˘fiÏÔÈÔÈ Ú¤ÂÈ Ó·ÂÈÛ¿ÁÔÓÙ·È ÛÂ ÌÔÓ¿‰Â˜ ·˘ÍËÌ¤-ÓË˜ ÊÚÔÓÙ›‰·˜.

2. √È ‚-·ÔÎÏÂÈÛÙ¤˜ Ú¤ÂÈ Ó·¯ÔÚËÁÔ‡ÓÙ·È ·fi ÙÔ ÛÙfiÌ· Ì¤Û·ÛÙÈ˜ ÚÒÙÂ˜ 24 ÒÚÂ˜ ÛÂ ·Ô˘-Û›· ·ÓÙÂÓ‰Â›ÍÂˆÓ. ∂Ó‰ÔÊÏ¤‚È·¯ÔÚ‹ÁËÛË Û˘ÓÈÛÙ¿Ù·È ÌfiÓÔ Â›Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÂÓ‰Â›ÍÂˆÓ Î·Èfi¯È Û·Ó ıÂÚ·Â›· ÚÔ˘Ù›Ó·˜.

3. Δ· ÌË ÛÙÂÚÔÂÈ‰‹ ·ÓÙÈÊÏÂÁÌÔ-ÓÒ‰Ë Ê¿ÚÌ·Î· (·Ó·ÛÙÔÏÂ›˜COX-1 Î·È COX-2) ÂÎÙfi˜ ·fiÙËÓ ·ÛÈÚ›ÓË ı· Ú¤ÂÈ Ó· ‰È·-ÎfiÙÔÓÙ·È Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ÙˆÓ ·ÛıÂÓÒÓ ÌÂ √™™.

4. ∏ ¯Ú‹ÛË ÌÔÚÊ›ÓË˜ Û·Ó ·Ó·Ï-ÁËÙÈÎfi ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙÂ› ÌÂ ¯ÂÈ-ÚfiÙÂÚ· ·ÔÙÂÏ¤ÛÌ·Ù· ÛÂ ÌÂÏ¤-ÙÂ˜ ·Ú·Ù‹ÚËÛË˜. ™ÙÈ˜ Ô‰ËÁ›Â˜Ë ¯ÚËÛÈÌÔÔ›ËÛ‹ ÙË˜ ˘Ô‚È‚¿-ÛÙËÎÂ ·fi Class I ÛÂ Class IIaÛ‡ÛÙ·ÛË.

5. ∞ÓÙÈ·ÈÌÔÂÙ·ÏÈ·Î‹ ıÂÚ·Â›·

·) ∏ ·ÛÈÚ›ÓË ı· Ú¤ÂÈ Ó· ¯Ô-ÚËÁÂ›Ù·È ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ√™™ ÙÔ Û˘ÓÙÔÌfiÙÂÚÔ ‰˘Ó·ÙfiÎ·È ı· Ú¤ÂÈ Ó· ‰È·ÙËÚÂ›Ù·È‰È¿ ‚›Ô˘. √È ·ÛıÂÓÂ›˜ ÌÂ ·ÏÏÂÚ-Á›· ‹ ‰˘Û·ÓÂÍ›· ÛÙËÓ ·ÛÈÚ›ÓËı· Ú¤ÂÈ Ó· ıÂÚ·Â‡ÔÓÙ·È ÌÂÎÏÔÈ‰ÔÁÚ¤ÏË.

‚) ∏ ÎÏÔÈ‰ÔÁÚ¤ÏË ı· Ú¤ÂÈÓ· ÚÔÛÙ›ıÂÙ·È ÛÙËÓ ·ÛÈÚ›ÓË,ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ Ô˘ ÂÓ‰‡ÎÓ˘-Ù·È Â›ÙÂ Û˘ÓÙËÚËÙÈÎ‹ ·ÓÙÈÌÂÙÒ-ÈÛË Â›ÙÂ ÎÚ›ÓÔÓÙ·È ˘Ô„‹ÊÈÔÈÁÈ· ÚÒÈÌË ÂÂÌ‚·ÙÈÎ‹ ·ÓÙÈÌÂ-ÙÒÈÛË, ·ÏÏ¿ ÂÊfiÛÔÓ Ë Èı·Ófi-ÙËÙ· ÁÈ· ¯ÂÈÚÔ˘ÚÁÈÎ‹ ·ÓÙÈÌÂÙÒ-ÈÛË ÌÂ ·ÔÚÙÔÛÙÂÊ·ÓÈ·›· ·-Ú¿Î·Ì„Ë Â›Ó·È ¯·ÌËÏ‹.

Á) ∏ ¯ÔÚ‹ÁËÛË ·Ó·ÛÙÔÏ¤ˆÓ GPIIb/IIIa (ÂÙ·ÊÈÌ·Ù›‰Ë˜ ‹ ÙÈÚÔ-ÊÈÌ¿ÓË˜) ı· Ú¤ÂÈ Ó· ÂÍÂÙ¿-˙ÂÙ·È ÛÙÔ˘˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘·ÛıÂÓÂ›˜ Î·È ÛÂ ÂÎÂ›ÓÔ˘˜ Ô˘ÂÌÊ·Ó›˙Ô˘Ó ¿ÓÔ‰Ô ÙÚÔÔÓ›ÓË˜,È‰È·›ÙÂÚ· ÛÙÈ˜ ÂÚÈÙÒÛÂÈ˜ Ô˘Û¯Â‰È¿˙ÂÙ·È ·ÁÁÂÈÔÏ·ÛÙÈÎ‹.∞ÌÛÈÍÈÌ¿ÌË ‰ÂÓ ı· Ú¤ÂÈ Ó·¯ÔÚËÁÂ›Ù·È, ·Ú¿ ÌfiÓÔÓ Â¿Ó ‰ÂÓ˘¿Ú¯ÂÈ ·Ó·ÌÂÓfiÌÂÓË Î·ı˘ÛÙ¤-ÚËÛË ÁÈ· ·ÁÁÂÈÔÏ·ÛÙÈÎ‹. ∏·ÌÛÈÍÈÌ¿ÌË ÌÔÚÂ› Ó· ¯ÔÚË-ÁËıÂ› ÌÂ ·ÛÊ¿ÏÂÈ· ÛÂ ·ÁÁÂÈÔ-Ï·ÛÙÈÎ‹ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ Ô˘‰ÂÓ ¤¯Ô˘Ó Ï¿‚ÂÈ ÂÓ‰ÔÊÏ¤‚È··Ó·ÛÙÔÏÂ›˜ GP IIb/IIIa Î·È ÌÔ-ÚÂ› Ó· Â›Ó·È Î·Ï‡ÙÂÚË ÙË˜ ÙÈÚÔ-ÊÈÌ¿ÓË˜. √È ·Ó·ÛÙÔÏÂ›˜ GPIIb/IIIa ·Ú¤¯Ô˘Ó ÂÈÏ¤ÔÓ fiÊÂ-ÏÔ˜ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ·˘ÍËÌ¤-ÓË ÙÚÔÔÓ›ÓË Ô˘ ˘Ô‚¿ÏÏÔÓÙ·ÈÛÂ ·ÁÁÂÈÔÏ·ÛÙÈÎ‹, ·ÎfiÌ· Î·È·Ó¿ÌÂÛ· ÛÂ ÂÎÂ›ÓÔ˘˜ Ô˘ Ï·Ì-‚¿ÓÔ˘Ó ÎÏÔÈ‰ÔÁÚ¤ÏË.

6. ∞ÓÙÈËÎÙÈÎ‹ £ÂÚ·Â›·

·) ™ÙÔ˘˜ ·ÛıÂÓÂ›˜ Ô˘ ·ÓÙÈÌÂ-Ùˆ›˙ÔÓÙ·È Û˘ÓÙËÚËÙÈÎ¿, Ë·ÓÙÈËÎÙÈÎ‹ ·ÁˆÁ‹ Ô˘ ÚÔÙÈ-Ì¿Ù·È Â›Ó·È ÌÂ ÛÂÈÚ¿ ÚÔÙÂÚ·È-fiÙËÙ·˜: fondaparinux, ÂÓÔÍ·-

∫·ÙÂ˘ı˘ÓÙ‹ÚÈÂ˜ √‰ËÁ›Â˜ ÁÈ· ÙËÓ ∞ÛÙ·ı‹™ÙËı¿Á¯Ë Î·È ÙÔ ∂ÌÊÚ·ÁÌ· ª˘ÔÎ·Ú‰›Ô˘ÃˆÚ›˜ ∞Ó¿Û·ÛË ÙÔ˘ ¢È·ÛÙ‹Ì·ÙÔ˜ ST

¶·ÓÙÂÏ‹˜ °Ô˘ÓfiÔ˘ÏÔ˜, ∫·Ú‰ÈÔÏfiÁÔ˜°È¿ÓÓË˜ °Ô˘‰¤‚ÂÓÔ˜, ∫·ıËÁËÙ‹˜ ∫·Ú‰ÈÔÏÔÁ›·˜ π·ÙÚÈÎ‹˜ ™¯ÔÏ‹˜ πˆ·ÓÓ›ÓˆÓ

∫·Ú‰ÈÔÏÔÁÈÎ‹ ∫ÏÈÓÈÎ‹ π·ÙÚÈÎ‹ ™¯ÔÏ‹ πˆ·ÓÓ›ÓˆÓ

∫∞Δ∂À£À¡Δ∏ƒπ∂™ √¢∏°π∂™

31

·Ú›ÓË (ÁÈ· 5 ËÌ¤ÚÂ˜ ‹ ÁÈ· ÙË‰È¿ÚÎÂÈ· ÙË˜ ÓÔÛËÏÂ›·˜) ‹ ÎÏ·Û-ÛÈÎ‹ Ë·Ú›ÓË (ÁÈ· 48 ÒÚÂ˜).

‚) ™ÙÔ˘˜ ·ÛıÂÓÂ›˜ Ô˘ ı· ˘Ô-‚ÏËıÔ‡Ó ÛÂ ·ÁÁÂÈÔÏ·ÛÙÈÎ‹Û˘ÓÈÛÙÒÓÙ·È ÂÓÔÍ··Ú›ÓË ‹ÎÏ·ÛÛÈÎ‹ Ë·Ú›ÓË Ô˘ ¤¯Ô˘ÓÙÈ˜ ÈÔ ÙÂÎÌËÚÈˆÌ¤ÓÂ˜ ÂÓ‰Â›-ÍÂÈ˜.

Á) ™ÙÔ˘˜ ·ÛıÂÓÂ›˜ Ô˘ ı· ˘Ô-‚ÏËıÔ‡Ó ÛÂ ·ÔÚÙÔÛÙÂÊ·ÓÈ·›··Ú¿Î·Ì„Ë Ë ·ÛÈÚ›ÓË ı· Ú¤-ÂÈ Ó· ÂÍ·ÎÔÏÔ˘ıÂ› Ó· ¯ÔÚËÁÂ›-Ù·È, Ë ÎÏÔÈ‰ÔÁÚ¤ÏË ·ÓÙ›ıÂÙ·ı· Ú¤ÂÈ Ó· ‰È·ÎfiÙÂÙ·È 5-7ËÌ¤ÚÂ˜ ÚÈÓ, ÂÓÒ ÔÈ ·Ó·ÛÙÔÏÂ›˜GP IIb/IIIa 4 ÒÚÂ˜ ÚÈÓ ÙÔ ¯ÂÈ-ÚÔ˘ÚÁÂ›Ô. ∏ ÂÓÔÍ··Ú›ÓË ‰È·-ÎfiÙÂÙ·È 12-24 ÒÚÂ˜ ÚÈÓ, Î·ÈÙÔ fondaparinux 24 ÒÚÂ˜ ÚÈÓÙÔ ¯ÂÈÚÔ˘ÚÁÂ›Ô Î·È ·Ú¿ÏÏËÏ·ÍÂÎÈÓ¿ Ë ¯ÔÚ‹ÁËÛË ÎÏ·ÛÛÈÎ‹˜Ë·Ú›ÓË˜.

‰) ™Â fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜ Ô˘¯ÔÚËÁÔ‡ÓÙ·È ·Ó·ÛÙÔÏÂ›˜ GPIIb/IIIa Ú¤ÂÈ Ó· Û˘Á¯ÔÚËÁÂ›-Ù·È ÎÏ·ÛÛÈÎ‹ Ë·Ú›ÓË ‹ ¿ÏÏ··ÓÙÈËÎÙÈÎ¿.

7. √È ·ÛıÂÓÂ›˜ ÌÂ NSTEMI, Ô˘ÛÙË ÛÙÂÊ·ÓÈÔÁÚ·Ê›· ‚Ú¤ıËÎÂ Ó··ÚÔ˘ÛÈ¿˙Ô˘Ó ÔÏÈÎ¿ ·fiÊÚ·Á-Ì¤Ó· ·ÁÁÂ›·, ‰ÂÓ ˆÊÂÏ‹ıËÎ·Ó·fi ·ÁÁÂÈÔÏ·ÛÙÈÎ‹ ÛÙË ÌÂÏ¤ÙËOAT (fiˆ˜ Î·È ÂÎÂ›ÓÔÈ ÌÂ STEMI)Î·È ‰ÂÓ ı· Ú¤ÂÈ Ó· ˘Ô‚¿ÏÏÔ-ÓÙ·È ÛÂ ÂÚ·ÈÙ¤Úˆ ·Ú¤Ì‚·ÛË.

8. ∏ ÚÒÈÌË ÂÂÌ‚·ÙÈÎ‹ ·ÓÙÈÌÂ-ÙÒÈÛË ÚÔÙÈÌ¿Ù·È ÛÙÔ˘˜ ˘„Ë-ÏÔ‡ ÎÓ‰‡ÓÔ˘ ·ÛıÂÓÂ›˜ ÌÂ ÂÌÌ¤-ÓÔÓÙ· Û˘ÌÙÒÌ·Ù· ‹ Ô˘ ÂÌÊ·-Ó›˙Ô˘Ó ·ÈÌÔ‰˘Ó·ÌÈÎ‹ ·ÛÙ¿ıÂÈ·,ÂÓÒ ÁÈ· ÙÔ˘˜ ˘fiÏÔÈÔ˘˜ ·ÛıÂ-ÓÂ›˜ ÂÈÏ¤ÁÂÙ·È Â›ÙÂ Ë Û˘ÓÙËÚËÙÈ-Î‹ Â›ÙÂ Ë ÚÒÈÌË ÂÂÌ‚·ÙÈÎ‹·ÓÙÈÌÂÙÒÈÛË ·Ó¿ÏÔÁ· ÌÂ ÙÈ˜ÚÔÙÈÌ‹ÛÂÈ˜ ÙÔ˘ ÁÈ·ÙÚÔ‡ Î·È ÙÔ˘·ÛıÂÓ‹. √È ·ÛıÂÓÂ›˜ Ô˘ ·ÓÙÈÌÂ-Ùˆ›ÛÙËÎ·Ó Û˘ÓÙËÚËÙÈÎ¿ Î·È ·-Ú¤ÌÂÈÓ·Ó ÛÙ·ıÂÚÔ› ÁÈ· 12-24ÒÚÂ˜ ı· Ú¤ÂÈ Ó· ˘Ô‚¿ÏÏÔ-

ÓÙ·È ÛÂ ÌË ÂÂÌ‚·ÙÈÎ‹ ‰ÔÎÈÌ·Û›·ÎÔÒÛÂˆ˜ ÚÈÓ ÙËÓ ¤ÍÔ‰fi ÙÔ˘˜·fi ÙÔ ÓÔÛÔÎÔÌÂ›Ô.

9. ∏ ÂÈÏÔÁ‹ ÙË˜ ¯ÂÈÚÔ˘ÚÁÈÎ‹˜Â·Ó·ÁÁÂ›ˆÛË˜ ¤Ó·ÓÙÈ ÙË˜ ‰È·-‰ÂÚÌÈÎ‹˜ Â·Ó·ÁÁÂ›ˆÛË˜ (fiˆ˜Î·È ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ÛÙ·ıÂÚ‹ÛÙËı¿Á¯Ë), ı· ·ÔÊ·Û›˙ÂÙ·È ÌÂÎÚÈÙ‹ÚÈ· ÙËÓ ·Ó·ÙÔÌ›· ÙÔ˘ ·ÛıÂ-Ó‹, ÙË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· ÙË˜ ·ÚÈ-ÛÙÂÚ‹˜ ÎÔÈÏ›·˜ Î·È ÙËÓ ·ÚÔ˘Û›·‹ ·Ô˘Û›· Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙËÎ·È ¿ÏÏˆÓ ÓÔÛËÌ¿ÙˆÓ.

10. √ Î›Ó‰˘ÓÔ˜ ÁÈ· ı¿Ó·ÙÔ ‹ ÁÈ·Ó¤Ô ¤ÌÊÚ·ÁÌ· Ì˘ÔÎ·Ú‰›Ô˘ ÛÙÔ˘˜·ÛıÂÓÂ›˜ ÌÂ NSTEMI Â›Ó·È ˘„Ë-ÏfiÙÂÚÔ˜ ÙÔ˘˜ ÚÒÙÔ˘˜ 2 Ì‹ÓÂ˜Î·È Â·Ó¤Ú¯ÂÙ·È ÛÙÔ ‚·ÛÈÎfi Î›Ó-‰˘ÓÔ ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ÛÙ·ıÂÚ‹ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ ÛÂ 3 Ì‹ÓÂ˜. √È¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ·ÛıÂÓÂ›˜ (Î·ÈÔÈ ·ÛıÂÓÂ›˜ Ô˘ Â·Ó·ÈÌ·ÙÒÓÔ-ÓÙ·È Ï‹Úˆ˜) Ú¤ÂÈ Ó· ·Ú·ÎÔ-ÏÔ˘ıÔ‡ÓÙ·È ÁÈ· ‰È¿ÛÙËÌ· 2-6Â‚‰ÔÌ¿‰ˆÓ, ÂÓÒ ÔÈ ˘„ËÏÔ‡ ÎÈÓ-‰‡ÓÔ˘ ·ÛıÂÓÂ›˜ ı· Ú¤ÂÈ Ó·Â·ÓÂÎÙÈÌËıÔ‡Ó Ì¤Û· ÛÂ 2 Â‚‰Ô-Ì¿‰Â˜.

11. ŸÏÔÈ ÔÈ ·ÛıÂÓÂ›˜ ÌÂ √™™ ı·Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÔ˘Ó ·ÛÈÚ›ÓË,ÛÙ·Ù›ÓÂ˜, ‚-·ÔÎÏÂÈÛÙ¤˜ Î·È ÎÏÔ-È‰ÔÁÚ¤ÏË. ∞Ó·ÛÙÔÏÂ›˜ ÙÔ˘ ÌÂ-Ù·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ ‹ ·ÓÙ·Áˆ-ÓÈÛÙ¤˜ ÙˆÓ ˘Ô‰Ô¯¤ˆÓ ·ÁÁÂÈÔ-ÙÂÓÛ›ÓË˜ II ı· Ú¤ÂÈ Ó· ¯ÔÚËÁË-ıÔ‡Ó ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ÂËÚÂ·-ÛÌ¤ÓÔ ÎÏ¿ÛÌ· ÂÍÒıËÛË˜ ÙË˜·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜, ˘¤ÚÙ·ÛË,Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË Î·È Î·Ú‰È·-Î‹ ·ÓÂ¿ÚÎÂÈ·. ∏ Ê·ÚÌ·ÎÂ˘ÙÈÎ‹·ÁˆÁ‹ ı· Ú¤ÂÈ Ó· ÍÂÎÈÓ¿ ÛÙÔÓÔÛÔÎÔÌÂ›Ô Î·ıÒ˜ Ë Èı·ÓfiÙËÙ·Ó· ‰È·ÙËÚËıÂ› ‰È· ‚›Ô˘ Â›Ó·È ÌÂ-Á·Ï‡ÙÂÚË. √ ÛÙfi¯Ô˜ ÙË˜ ·ÚÙËÚÈ·-Î‹˜ ›ÂÛË˜ Â›Ó·È Ó· ‰È·ÙËÚÂ›Ù·È¯·ÌËÏfiÙÂÚË ·fi 140/90 mmHgÁÈ· fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜ Î·È ¯·-ÌËÏfiÙÂÚË ·fi 130/80 mmHg ÁÈ·ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ Û·Î¯·ÚÒ‰Ë‰È·‚‹ÙË Î·È ¯ÚfiÓÈ· ÓÂÊÚÔ¿-ıÂÈ·.

12. £ÂÚ·Â›· ÔÚÌÔÓÈÎ‹˜ ˘ÔÎ·-Ù¿ÛÙ·ÛË˜ ‰ÂÓ ı· Ú¤ÂÈ Ó· ÍÂÎÈ-Ó¿ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ √™™, ÂÓÒ ÔÈ·ÛıÂÓÂ›˜ Ô˘ Â›Ó·È ‹‰Ë ÛÂ ıÂÚ·-Â›· ˘ÔÎ·Ù¿ÛÙ·ÛË˜ ı· Ú¤ÂÈÓ· ÙËÓ ‰È·ÎfiÙÔ˘Ó.

13. √È ·ÛıÂÓÂ›˜ ÌÂ Û·Î¯·ÚÒ‰Ë‰È·‚‹ÙË ı· Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ-›˙ÔÓÙ·È ÂÈıÂÙÈÎ¿ ÁÈ· ÙË Ú‡ıÌÈ-ÛË ÙÔ˘ Û·Î¯¿ÚÔ˘ Î·Ù¿ ÙË ‰È¿Ú-ÎÂÈ· ÙË˜ ÓÔÛËÏÂ›·˜. √È ˘fiÏÔÈ-Â˜ ‰È·ÁÓˆÛÙÈÎ¤˜ Î·È ıÂÚ·Â˘ÙÈ-Î¤˜ ·ÚÂÌ‚¿ÛÂÈ˜ Â›Ó·È ›‰ÈÂ˜ ÌÂÂÎÂ›ÓÂ˜ ÙˆÓ ÌË ‰È·‚ËÙÈÎÒÓ.

14. ∂È‰ÈÎ‹ ÚÔÛÔ¯‹ ··ÈÙÂ›Ù·ÈÛÙË ‰ÔÛÔÏÔÁ›· (È‰È·›ÙÂÚ· ÙË˜ÂÓÔÍÔ·Ú›ÓË˜) Î·È ÛÙËÓ ÙÚÔÔ-ÔÈËÌ¤ÓË Ê·ÚÌ·ÎÔ‰˘Ó·ÌÈÎ‹, ÛÙËıÂÚ·Â›· ËÏÈÎÈˆÌ¤ÓˆÓ Î·È ·ÛıÂ-ÓÒÓ ÌÂ ÂËÚÂ·ÛÌ¤ÓË ÓÂÊÚÈÎ‹ÏÂÈÙÔ˘ÚÁ›· (GFR < 50 ml/min)ÁÈ· ÙÔÓ Î›Ó‰˘ÓÔ ·ÈÌÔÚÚ·ÁÈÒÓ.∞fi ·ÈÌÔÚÚ·Á›· ÎÈÓ‰˘ÓÂ‡Ô˘Ó ÔÈËÏÈÎÈˆÌ¤ÓÔÈ ÌÂ ÂËÚÂ·ÛÌ¤ÓË ÓÂ-ÊÚÈÎ‹ ÏÂÈÙÔ˘ÚÁ›· Î·È ·˘ÙÔ› Ô˘ı· ˘Ô‚ÏËıÔ‡Ó ÛÂ ·ÁÁÂÈÔÏ·-ÛÙÈÎ‹ ÌÂ ¯Ú‹ÛË˜ ·Ó·ÛÙÔÏ¤ˆÓ GPIIb/IIIa

15. ∏ ÂÈÛÙÚÔÊ‹ ÛÙË ‰Ô˘ÏÂÈ¿ ı·Ú¤ÂÈ Ó· Î·ıÔ‰ËÁÂ›Ù·È ·fi ÙË‰ÔÎÈÌ·Û›· ·ÓÔ¯‹˜ ÛÙËÓ ¿ÛÎËÛË.∏ ÚÔÁ‡ÌÓ·ÛË ÛÙËÓ ¿ÛÎËÛËÌÔÚÂ› Ó· ÍÂÎÈÓ‹ÛÂÈ Ì¤Û· ÛÂ 1-2Â‚‰ÔÌ¿‰Â˜ ÌÂÙ¿ ·fi ÙË ÛÙÂÊ·-ÓÈ·›· Â·Ó·ÁÁÂ›ˆÛË. √È ·ÛıÂÓÂ›˜ı· Ú¤ÂÈ Ó· ÂÓı·ÚÚ‡ÓÔÓÙ·È Ó·‚·‰›˙Ô˘Ó (‹ Ó· ÂÈ‰›‰ÔÓÙ·È ÛÂ¿ÏÏË Ê˘ÛÈÎ‹ ‰Ú·ÛÙËÚÈfiÙËÙ·) ÁÈ·30-60 ÏÂÙ¿ Î·ıËÌÂÚÈÓ¿. √È·ÛıÂÓÂ›˜ ÌÂ ÌË ÂÈÏÂÁÌ¤ÓÔNSTEMI ÌÔÚÔ‡Ó Ó· ÂÈÛÙÚ¤-„Ô˘Ó ÛÙËÓ Ô‰‹ÁËÛË Ì¤Û· ÛÂ 1Â‚‰ÔÌ¿‰· ·fi ÙËÓ ¤ÍÔ‰fi ÙÔ˘˜·fi ÙÔ ÓÔÛÔÎÔÌÂ›Ô.√È ·ÛıÂÓÂ›˜ÌÂ ÂÈÏÂÁÌ¤ÓÔ ¤ÌÊÚ·ÁÌ· Ì˘Ô-Î·Ú‰›Ô˘ ı· Ú¤ÂÈ Ó· Î·ı˘ÛÙÂ-ÚÔ‡Ó ÙËÓ Ô‰‹ÁËÛË ÁÈ· 2-3 Â‚‰Ô-Ì¿‰Â˜.


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Ó· Á›ÓÂÈ ÁÈ·ÙÚfi˜, ·ÏÏ¿ Ô Êfi‚Ô˜ ÙÔ˘ ·›Ì·ÙÔ˜ ÙÔÓ Ô‰‹ÁËÛÂ, ÌÂÙ¿ ·fi ¤Ó· ¯ÚfiÓÔ ÊÔ›ÙËÛË˜, ÛÙÈ˜ ÙÂ¯ÓÈÎ¤˜ ÂÈÛÙ‹ÌÂ˜ ÙÔ˘ ∂ª¶ Î·ÈÛÙË ˙ˆÁÚ·ÊÈÎ‹. ∂ÚÁ¿ÛÙËÎÂ ÁÈ· ¤Ó· ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ˆ˜ ‰¿ÛÎ·ÏÔ˜ ÛÂ ÙÂ¯ÓÈÎ¤˜ Û¯ÔÏ¤˜ Î·È Ï›ÁÔ ·ÚÁfiÙÂÚ· ·Ó·ÁÎ¿ÛÙËÎÂ, ·fi ÙÈ˜‰È¿ÊÔÚÂ˜ ·Ó·Ô‰È¤˜ Ô˘ Û˘Ó·ÓÙÔ‡ÛÂ ÂÎÂ›Ó· Ù· ¯ÚfiÓÈ·, Ó· ÚÔÛÁÂÈˆıÂ› ÛÙÔ˘˜ ¯ÒÚÔ˘˜ ÂÚÁ·Û›·˜ ÙÔ˘ ¢ËÌfiÛÈÔ˘ ΔÔÌ¤·. ¶·Ú¿Ï-ÏËÏ· ·Û¯ÔÏ‹ıËÎÂ ÌÂ ÙË §ÔÁÔÙÂ¯Ó›·, ÙÔ £¤·ÙÚÔ (™ÎËÓÔıÂÛ›·, ™ÎËÓÔÁÚ·Ê›·) ÙË Û˘ÁÁÚ·Ê‹ ΔËÏÂÔÙÈÎÒÓ Î·È £Â·ÙÚÈÎÒÓ ¤ÚÁˆÓ,ÙËÓ Ô›ËÛË, ÙË ∑ˆÁÚ·ÊÈÎ‹ Î·È Ù¤ÏÔ˜ ÌÂ ÙÔ ŒÓÙÂ¯ÓÔ-§·˚Îfi ΔÚ·ÁÔ‡‰È ÌÂ ÙËÓ È‰ÈfiÙËÙ· ÙÔ˘ ÛÙÈ¯Ô˘ÚÁÔ‡.

¶·Ú·ÎÔÏÔ‡ıËÛÂ Ì·ı‹Ì·Ù· ˙ˆÁÚ·ÊÈÎ‹˜, ÁÈ· ¤Ó· ÌÂÁ¿ÏÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·, ÛÙËÓ ∞™∫Δ Î·È ÙËÓ ÂÚ›Ô‰Ô 1995 - 1998 ÛÙÔ ∂ÏÏË-ÓÔ·ÌÂÚÈÎ·ÓÈÎfi ∫ÔÏ¤ÁÈÔ ∞ıËÓÒÓ, ÌÂ ‰¿ÛÎ·ÏÔ ÙÔÓ ¶·Ó·ÁÈÒÙË ªÂÏÓÙ¤ÎÔ. Δ¤ÏÔ˜ Û˘Ó¤¯ÈÛÂ Ó· ÌÂÏÂÙ¿ ÙÔ «ÛÒÌ·» ÛÙÔ ÂÚÁ·ÛÙ‹ÚÈ ÙÔ˘˙ˆÁÚ¿ÊÔ˘ ΔÈÌfiıÂÔ˘ ª·ÙÈÓ¿ÎË ÙË ¯ÚÔÓÈÎ‹ ÂÚ›Ô‰Ô 1999 - 2005. Œ¯ÂÈ Ï¿‚ÂÈ ÛÂ ÙÚÂÈ˜ ÔÌ·‰ÈÎ¤˜ ÂÎı¤ÛÂÈ˜ ÛÙÔÓ ÂÎıÂÛÈ·Îfi ¯ÒÚÔ ÙÔ˘∫ÔÏÂÁ›Ô˘ ∞ıËÓÒÓ. ŒÚÁ· ÙÔ˘ ˘¿Ú¯Ô˘Ó ÛÂ ÔÏÏ¤˜ È‰ÈˆÙÈÎ¤˜ Û˘ÏÏÔÁ¤˜ ÛÙËÓ ∂ÏÏ¿‰· Î·È ÛÙÔ ÂÍˆÙÂÚÈÎfi.

Δ· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, Ì·˙› ÌÂ Ì›· ÔÌ¿‰· Ê›ÏˆÓ, Î·È ÌÚÔÛÙ¿ ÛÙË ıÏÈ‚ÂÚ‹ ‰È·›ÛÙˆÛË fiÙÈ Ë ÈÛÙÔÚ›· Î·È Ô ¶ÔÏÈÙÈÛÌfi˜ Ì·˜ Û˘ÓÂ-¯Ò˜ Êı›ÓÔ˘Ó Î·È Ì·˙› Ë ÊıÔÚ¿ ÙÔ˘ ¶ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ·fi ÙËÓ ·ÏfiÁÈÛÙË ·ÓıÚÒÈÓË ¯Ú‹ÛË ÌÂ fiÏÂ˜ ÙÈ˜ ÁÓˆÛÙ¤˜ ¿ÌÂÛÂ˜ Û˘Ó¤ÂÈÂ˜ ·ÏÏ¿Î·È ÌÂ fiÏÂ˜ ÙÈ˜ ·ÚÔÛ‰ÈfiÚÈÛÙÂ˜ Î·È Ô‰˘ÓËÚ¤˜ Û˘Ó¤ÂÈÂ˜ Ô˘ ÙÔ Ì¤ÏÏÔÓ Ì·˜ ÂÈÊ˘ÏÏ¿ÛÂÈ, ·ÈÛı¿ÓÔÓÙ·È fiÙÈ Ù·ÍÈ‰Â‡Ô˘Ó ¿Óˆ ÛÂ ¯¿Ú-ÙÈÓ· Î·Ú¿‚È·. ∞˘Ù‹ Ë ·›ÛıËÛË ÙÔ˘˜ ‰Ú·ÛÙËÚÈÔÔÈÂ› Î·È ·ÔÊ·Û›˙Ô˘Ó, ·fi ÙË ‰ÈÎ‹ ÙÔ˘˜ ÌÂÚÈ¿ Î·È ÌÂ ÙÈ˜ ‰ÈÎ¤˜ ÙÔ˘˜ ÌÈÎÚ¤˜ ‰˘Ó·Ùfi-ÙËÙÂ˜, ·Ó ·Ê˘Ó›ÛÔ˘Ó Î·È Ó· Â˘·ÈÛıËÙÔÔÈ‹ÛÔ˘Ó fiÛÔ ÙÔ ‰˘Ó·ÙfiÓ ÂÚÈÛÛfiÙÂÚÔ˘˜ Û˘ÌÔÏ›ÙÂ˜ ÙÔ˘˜, ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ‰È·ÛˆıÂ› ÔÓÂ˘Ì·ÙÈÎfi˜ ¶ÔÏÈÙÈÛÌfi˜ ÙË˜ ¯ÒÚ·˜ Ì·˜, ·ÏÏ¿ Î·È ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ‰È·Ê˘Ï·¯ıÂ› ÌÂ ÙÔÓ Î·ÏÏ‡ÙÂÚÔ ‰˘Ó·Ùfi ÙÚfiÔ ÙÔ ¶ÂÚÈ‚¿ÏÏÔÓfiÔ˘ ˙Ô‡ÌÂ ‚ÂÏÙÈÒÓÔÓÙ·˜ ¤ÙÛÈ ÙÔ Â›Â‰Ô ‰È·‚›ˆÛ‹˜ Ì·˜ ÛÂ ·˘Ùfi, ·ÏÏ¿ Î·È ·Ê‹ÓÔÓÙ·˜ Ì›· ÛËÌ·ÓÙÈÎ‹ ·Ú·Î·Ù·ı‹ÎË ÛÙÈ˜ ÂfiÌÂ-ÓÂ˜ ÁÂÓ¤˜, ÛÙ· ·È‰È¿ Ì·˜...

∏ ÚÒÙË ÂÓ¤ÚÁÂÈ· ÚÔ˜ ·˘Ù‹Ó ÙËÓ Î·ÙÂ‡ı˘ÓÛË ‹Ù·Ó Ó· È‰Ú‡ÛÔ˘Ó ¤Ó· £Â·ÙÚÈÎfi ∂ÚÁ·ÛÙ‹ÚÈ ÛÙÔÓ ¶ÂÈÚ·È¿, Ô˘ Û˘ÓÙÚÔÊÂ‡Â-Ù·È ·fi ·È‰È¿ Î·È È‰È·›ÙÂÚ· ·fi ·È‰È¿ Ô˘ ¤¯Ô˘Ó ¯¿ÛÂÈ ‹ ¤¯Ô˘Ó ÛÙÂÚËıÂ› ÙË ª¿Ó· Î·È ÙÔÓ ¶·Ù¤Ú·. ∏ ‰Â‡ÙÂÚË ÚÔÛ¿ıÂÈ· ‹Ù·ÓË ¤Î‰ÔÛË ·fi ÙÔÓ πˆ¿ÓÓË ∫ÔÎÎ¿ÚË, ÙÚÈÒÓ ª˘ıÈÛÙÔÚËÌ¿ÙˆÓ (“¢πÃø™ ΔÀæ∂π™”, “¶∂Δƒπ¡√™ ∏§π√™” Î·È “∂À¢øƒ∞™ ∫∞π º√πμ∏”)ÌÂ ÔÈËÙÈÎ‹ Î·È Ê·ÓÙ·ÛÙÈÎ‹ ÁÚ·Ê‹ Ô˘ ·ÓÙÏÔ‡Ó ÙË ıÂÌ·ÙÔÏÔÁ›· ÙÔ˘˜ ·fi Ù· È‰·ÓÈÎ¿, ÙÈ˜ ·Ú¯¤˜ Î·È ÙÈ˜ ËıÈÎ¤˜ ·Í›Â˜ ÙÔ˘ ¶ÔÏÈÙÈ-ÛÌÔ‡ Ì·˜. ∏ ÙÚ›ÙË ÚÔÛ¿ıÂÈ· Â›Ó·È Ë ¤Î‰ÔÛË ÂÓfi˜ CD ÌÂ ‰¤Î· ÙÚ›· ¤ÓÙÂ¯Ó· ÙÚ·ÁÔ‡‰È·, Ô˘ Û˘ÓÔ‰Â‡ÔÓÙ·È ·fi ·Ó¤ÌÔÚÊÂ˜ÌÂÏˆ‰›Â˜ Î·È ·fi ¤Ó· ¤ÓıÂÙÔ ÌÂ Â›ÎÔÛÈ ÂÓÓ¤· ˙ˆÁÚ·ÊÈÎÔ‡˜ ›Ó·ÎÂ˜ (∂Ï·ÈÔÁÚ·Ê›Â˜ ÛÂ Î·Ì‚¿), ÌÂ ÊÈÁÔ‡ÚÂ˜ —ÚfiÛˆ· Ô˘ Û˘ÓÔ-‰Â‡Ô˘Ó, ÌÂ fiÏË ÙËÓ ÂÈÎ·ÛÙÈÎ‹ ÔÌÔÚÊÈ¿ ÙÔ˘˜, Ù· ÙÚ·ÁÔ‡‰È· Î·È ÛÎÔÚÔ‡Ó Ì›· Â˘ˆ‰È¿ ÓÔÛÙ·ÏÁ›·˜...ª¤ÓÂÈ ÛÙËÓ ∞Á›· ¶·Ú·ÛÎÂ˘‹ - ∞ı‹Ó·, ΔËÏ¤ÊˆÓÔ Î·È Fax 210 60.16.760 ‹ 6936526778, ∏ÏÂÎÙ. ¢ÈÂ‡ı. e-mail:[email protected]

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

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

ΤΕΥΧΟΣ 18 ΙΟΥΝΙΟΣ 2008 - ΑΘΗΡΟΣΚΛΗΡΩΣΗ

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