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ÃÚ‹ÛÙÔ˜ ¶›ÙÛ·‚Ô˜ª¤ÏÔ˜

∞ϤͷӉÚÔ˜ ΔÛÂϤ˘ª¤ÏÔ˜

¶∞ƒ∞°√¡Δ∂™ ∫π¡¢À¡√À∏ ¢È·¯Â›ÚÈÛË Ù˘ ¢˘ÛÏÈȉ·ÈÌ›·˜ ÛÙË ÃÚfiÓÈ· ¡ÂÊÚÈ΋ ¡fiÛÔManaging Dyslipidemia in Chronic Kidney Disease ( C.K.D)Charles R. Harper, Terry A. JacobsonJournal of the American College of Cardiology 2008(June 24);51:2375-84∂È̤ÏÂÈ·: ª·Ú›· ¶·ÓÙÂÚ‹, ∂ÌÌ·ÓÔ˘‹Ï °·ÓˆÙ¿Î˘

∫§π¡π∫∂™ ª∂§∂Δ∂™°Ï˘Î·ÈÌÈÎfi˜ ŒÏÂÁ¯Ô˜ Î·È ∫·Ú‰È·ÁÁÂȷ΋ ¡fiÛÔ˜: ∞ÔÙÂϤÛÌ·Ù· ªÂÏÂÙÒÓ ACCORD Î·È ADVANCEÕÚ˘-¢ËÌ‹ÙÚÈÔ˜ ∞ÁÁÔ˘Ú›‰Ë˜, ∂ÈÛÙËÌÔÓÈÎfi˜ ™˘ÓÂÚÁ¿Ù˘ ÙÔ˘ ∂Í. π·ÙÚ›Ԣ ÙˆÓ ¢È·Ù·Ú·¯ÒÓ ÙÔ˘ ªÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ §Èȉ›ˆÓ ÙÔ˘ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ °ÂÓÈÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ πˆ·ÓÓ›ÓˆÓ

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

ªÂϤÙË GISSI-HF(Gruppo Italiano per lo Studio della Sopravvivenza nell'Insufficienza cardiaca)GISSI-HF InvestigatorsLancet 2008;372:1223-1239∂È̤ÏÂÈ·: ∏Ï›·˜ ÃÂÈÌÒÓ·˜

ªÂϤÙË BEAUTIFUL(morBidity-mortality EvAlUaTion of the If inhibitor ivabradine in patients with coronary disease and left-ventricULar dysfunction)Fox K, Ford I, Steg PG, Tendera M, Ferrari R, on behalf of the BEAUTIFUL investigators.Lancet 2008;372:807-821.∂È̤ÏÂÈ·: ∏Ï›·˜ ÃÂÈÌÒÓ·˜

ªÂϤÙË SEAS(Simvastatin and Ezetimibe in Aortic Stenosis)Rossebo AB, Pedersen TR, Boman K, Brudi P, Chambers JB, Egstrup K, Gerdts E, Gohlke-Borwolf C, Holme I, Kesaniemi YA, Malbecq K, Nienaber CA, Ray S, Skjaerpe T, Wachtell K, Willenheimer R, for the SEAS InvestigatorsN Engl J Med 2008;359:1-14∂È̤ÏÂÈ·: ∏Ï›·˜ ÃÂÈÌÒÓ·˜

£∂ƒ∞¶∂π∞ - º∞ƒª∞∫∞∂›‰Ú·ÛË ÙˆÓ ∞ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ º·ÚÌ¿ÎˆÓ ÛÙÔ ªÂÙ·‚ÔÏÈÛÌfi Ù˘ °Ï˘Îfi˙˘ÕÚ˘-¢ËÌ‹ÙÚÈÔ˜ ∞ÁÁÔ˘Ú›‰Ë˜, ∂ÈÛÙËÌÔÓÈÎfi˜ ™˘ÓÂÚÁ¿Ù˘ ÙÔ˘ ∂Í. π·ÙÚ›Ԣ ÙˆÓ ¢È·Ù·Ú·¯ÒÓ ÙÔ˘ ªÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ §Èȉ›ˆÓ ÙÔ˘ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ °ÂÓÈÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ πˆ·ÓÓ›ÓˆÓªˆ˘Û‹˜ ∂ÏÈÛ¿Ê, ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓΔÔ̤·˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ

∂›Ó·È ∂ÊÈÎÙ‹ Ë Δ·˘Ùfi¯ÚÔÓË ∞ÓÙÈÌÂÙÒÈÛË Ù˘ ∞ıËÚÔÛÎÏ‹ÚˆÛ˘ Î·È Ù˘ √ÛÙÂÔfiÚˆÛ˘;¶·Ó·ÁÈÒÙ˘ ∞Ó·ÁÓˆÛÙ‹˜, ∂˘ÛÙ¿ıÈÔ˜ ¶·ÁÎÔ˘Ú¤ÏÈ·˜, ÷ڿϷÌÔ˜ ∫Ô˘Ì·Ú¿˜, £ˆÌ¿˜ °ÎfiÛÈÔ˜, μ·Û›ÏÂÈÔ˜ Õı˘ÚÔ˜, ∞ÛÙ¤ÚÈÔ˜ ∫·Ú·ÁÈ¿ÓÓË˜μ’ ¶ÚÔ·È‰Â˘ÙÈ΋ ¶·ıÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ∞¶£, πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌ›Ô, £ÂÛÛ·ÏÔÓ›ÎË.

O ƒfiÏÔ˜ Ù˘ ™ÂÈÚÔÓÔÏ·ÎÙfiÓ˘ ÛÙËÓ ∞ÓıÂÎÙÈ΋ ∞ÚÙËÚȷ΋ À¤ÚÙ·Û˪·Ú›· Δ˙‹ÌÔ˘, ÷ڿϷÌÔ˜ ∫Ô˘Ì·Ú¿˜, £ÂÔ‰ÒÚ· °Ú›‚·, ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ∫·ÚÁÈÒÙ˘,μ·Û›ÏÂÈÔ˜ Õı˘ÚÔ˜, ∞ÛÙ¤ÚÈÔ˜ ∫·Ú·ÁÈ¿ÓÓË˜μ’ ¶ÚÔ·È‰Â˘ÙÈ΋ ¶·ıÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ∞¶£, πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌ›Ô, £ÂÛÛ·ÏÔÓ›ÎË.

¶POTEINOMENH BIB§IO°PAºIA

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T˘ ™‡ÓÙ·Í˘

√È ·ÛıÂÓ›˜ Ì ÃÚÔÓ›· ¡ÂÊÚÈ΋ ¡fiÛÔ ¤¯Ô

˘Ó Ôχ ˘„ËÏfi ΛӉ˘ÓÔ Î·Ú‰

È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚¿-

ÓÙˆÓ Î·È ı·Ó¿ÙÔ˘. Δ· ÏÈ›‰È· Ê·›ÓÂÙ·È fiÙÈ ·

›˙Ô˘Ó ÚˆÙ‡ÔÓÙ· ÚfiÏÔ ÛÙÔÓ ·˘ÍË̤ÓÔ

·˘-

Ùfi ΛӉ˘ÓÔ. √È ÛÙ·Ù›Ó˜ ·ÔÙ

ÂÏÔ‡Ó ÙÔÓ ·ÎÚÔÁˆÓÈ·›Ô Ï›ıÔ ÛÙË

ıÂڷ›· ÙˆÓ ·ÛıÂÓÒÓ ·˘-

ÙÒÓ, ÂÎÙfi˜ ·fi ÙȘ ÂÚÈÙÒÛÂȘ Ì ˘„ËÏ¿

ÙÚÈÁÏ˘ÎÂÚ›‰È· (500 mg/dl) fiÔ˘ Ë

ıÂڷ›·

Â›Ó·È gemfibrozil ‹ ˆ-3 §È·Ú¿ √ͤ·. √È ÌÂϤÙ˜

ACCORD Î·È ADVANCE Âͤٷ۷

Ó ·Ó Ë

ÂÈıÂÙÈ΋ ıÂڷ›· ÁÈ· ÙËÓ Â

›Ù¢ÍË ÙˆÓ ÁÏ˘Î·ÈÌÈÎÒÓ ÛÙfi¯ˆÓ Û ·ÛıÂÓ›˜ Ì ™¢2 ÚÔ-

Ï·Ì‚¿ÓÂÈ Î·Ï‡ÙÂÚ· Ù· ηډ

È·ÁÁÂȷο ÂÂÈÛfi‰È·, ·¤Ù˘¯

·Ó fï˜ Ó· ·Ô‰Â›ÍÔ˘Ó fiÙÈ Ë

ÂÓÙ·ÙÈ΋ ˘ÔÁÏ˘Î·ÈÌÈ΋ ·Áˆ

Á‹ Â›Ó·È Î·Ï‡ÙÂÚË Ù˘ Û˘Ó‹ı

Ô˘˜. √È ÛÙ·Ù›Ó˜ ‰ÂÓ ÚÔÛʤ-

ÚÔ˘Ó fiÊÂÏÔ˜ Û ·ÛıÂÓ›˜ Ì ÂÁηÙÂÛ

ÙË̤ÓË Î·Ú‰È·Î‹ ·Ó¿ÚÎÂÈ·

, ·ÓÙ›ıÂÙ· Ù· ˆ-3 ÏÈ-

·Ú¿ Ôͤ· ÌÂÈÒÓÔ˘Ó ÙËÓ ıÓËÛÈ

ÌfiÙËÙ·. ∏ ηډȷ΋ Û˘¯ÓfiÙË

Ù· Â›Ó·È ·ÓÂÍ¿ÚÙËÙÔ˜ ·Ú¿-

ÁˆÓ ÎÈÓ‰‡ÓÔ˘ Û ·ÛıÂÓ›˜ Ì ÛÙ

ÂÊ·ÓÈ·›· ÓfiÛÔ Î·È ÂËÚ·Ṳ̂Ó

Ë ÏÂÈÙÔ˘ÚÁ›· Ù˘ ·ÚÈÛÙÂ-

Ú¿˜ ÎÔÈÏ›·˜. ∏ È‚·ÌÚ·‰›ÓË

ÌÂÈÒÓÂÈ Ù· ÛÙÂÊ·ÓÈ·›· ÂÂÈÛfi‰È·, fi¯È fï˜ ÙËÓ ÂΉ‹ÏˆÛË

ηډȷ΋˜ ·Ó¿ÚÎÂÈ·˜ ÛÙÔ˘

˜ ·ÛıÂÓ›˜ ·˘ÙÔ‡˜. ™ÙË ÌÂϤÙ

Ë SEAS Ë ¯ÔÚ‹ÁËÛË ÛÈÌ‚·ÛÙ·

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Ù›Ó˘ Î·È Â˙ÂÙÈÌ›Ì˘ Û ·Ûı

ÂÓ›˜ Ì ÛÎÏËÚ˘ÓÙÈ΋ ÛÙ¤ÓˆÛË ·ÔÚÙÈ΋˜ ‚

·Ï‚›‰·˜ ‰ÂÓ ÂË-

Ú¤·Û ÙËÓ ÂͤÏÈÍË Ù˘ ‚·Ï‚ȉ

Ô¿ıÂÈ·˜ Ì›ˆÛ fï˜ Ù· ·ıËÚÔÛÎÏ

ËÚˆÙÈο ÂÂÈÛfi‰È·. ¢˘-

ÛÌÂÓ¤˜ ‡ÚËÌ· ·ÔÙ¤ÏÂÛ Ë

·‡ÍËÛË ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ Î·ÚΛÓÔ˘ ÛÙËÓ ÔÌ¿‰· ıÂÚ·

›·˜.

√È ‚-·ÔÎÏÂÈÛÙ¤˜ Î·È Ù· ıÂÈ·

˙ȉÈο ‰ÈÔ˘ÚËÙÈο, ·ÔÙÂÏÂÛÌ

·ÙÈο Ê¿Ú̷η ÁÈ· ÙËÓ ·ÓÙÈ-

ÌÂÙÒÈÛË Ù˘ ˘¤ÚÙ·Û˘ Ì ¯·ÌË

Ïfi ÎfiÛÙÔ˜, ·˘Í¿ÓÔ˘Ó ÙËÓ Èı

·ÓfiÙËÙ· ‰È·Ù·Ú·¯‹˜ ÙÔ˘

ÌÂÙ·‚ÔÏÈÛÌÔ‡ Ù˘ ÁÏ˘Îfi˙˘ ‹

·ÎfiÌ· Î·È Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË. √È

·ÁÁÂÈԉȷÛÙ·ÏÙÈÎÔ› ‚-

·ÔÎÏÂÈÛÙ¤˜, ÔÈ ·-ª∂∞ Î·È Ô

È ·ÓÙ·ÁˆÓÈÛÙ¤˜ ÙˆÓ ˘Ô‰Ô¯¤ˆÓ Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘ ‚ÂÏÙÈÒ-

ÓÔ˘Ó ÙËÓ ÈÓÛÔ˘ÏÈÓÔ¢·ÈÛıËÛ›·

Î·È ÙÔ ÌÂÙ·‚ÔÏÈÛÌfi Ù˘ ÁÏ˘Î

fi˙˘ ∏ ‡·ÚÍË ÎÔÈÓÒÓ ·ıÔ-

Ê˘ÛÈÔÏÔÁÈÎÒÓ Ì˯·ÓÈÛÌÒÓ ÛÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË Î·È ÛÙË ÔÛ

ÙÂÔfiÚˆÛË, ‰ËÌÈÔ˘ÚÁ› ÙËÓ

ÂÏ›‰· ıÂÚ·ÂÈÒÓ Ô˘ ı· ÛÙÔ¯Â

‡Ô˘Ó ÛÙËÓ Ù·˘Ùfi¯ÚÔÓË ·ÓÙÈÌÂ

ÙÒÈÛ‹ ÙÔ˘˜. Δ· ̤¯ÚÈ ÛÙÈÁ-

Ì‹˜ ‰Â‰Ô̤ӷ Ô˘ ·ÊÔÚÔ‡Ó ÛÙË ¯ÔÚ

‹ÁËÛË ÙˆÓ ÛÙ·ÙÈÓÒÓ, ÙˆÓ ‰ÈʈÛÊÔÓÈÎÒÓ Î·È ÔÚÈṲ̂-

ÓˆÓ ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ Â›Ó·È ÂÓı·ÚÚ

˘ÓÙÈο. ∏ ÛÂÈÚÔÓÔÏ·ÎÙfiÓË

η٤¯ÂÈ ÛËÌ·ÓÙÈ΋ ı¤ÛË

ÛÙË Ú‡ıÌÈÛË Ù˘ ·ÓıÂÎÙÈ΋˜

∞À. ∞ӷ̤ÓÔÓÙ·È Î·È ÌÂϤÙÂ

˜ Ì ÙÔ ÓÂfiÙÂÚÔ ·ÓÙ·ÁˆÓÈÛÙ‹

ÙˆÓ ˘Ô‰Ô¯¤ˆÓ Ù˘ ·Ï‰ÔÛÙÂÚfiÓ˘, ÙËÓ ÂÏÂ

ÚÂÓfiÓË. ∏∏ÏÏ››··˜̃ ÃÃÂÂÈÈÌÌÒÒÓÓ··˜̃

YY‡‡ıı˘̆ÓÓÔÔ˜̃ ™™‡‡ÓÓÙÙ··ÍÍˢ̃

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∏ ¢È·¯Â›ÚÈÛË Ù˘ ¢˘ÛÏÈȉ·ÈÌ›·˜ ÛÙË ÃÚfiÓÈ· ¡ÂÊÚÈ΋ ¡fiÛÔManaging Dyslipidemia in Chronic Kidney Disease ( C.K.D)

Charles R. Harper, Terry A. Jacobson

Journal of the American College of Cardiology 2008(June 24);51:2375-84

∏ ›وÛË Ù˘ ¯ÚfiÓÈ·˜ ÓÂÊÚÈ΋˜ÓfiÛÔ˘ (á¡) ·˘Í¿ÓÂÈ ‰È·ÚÎÒ˜(>10% ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘ÛÌÔ‡ÛÙȘ ∏¶∞ ¤¯ÂÈ Î¿ÔÈÔ˘ ÛÙ·‰›Ô˘Ã¡¡) (1,2). ∞Ó Î·È ÌÂÚÈÎÔ› ·ÛıÂ-Ó›˜ Ì á¡ ı· ·Ó·Ù‡ÍÔ˘Ó ÙÂÏÈ-ο ÓfiÛÔ ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘, ÔÈ Â-ÚÈÛÛfiÙÂÚÔÈ ı· Âı¿ÓÔ˘Ó ·fiηډȷÁÁÂȷ΋ ÓfiÛÔ Ôχ ÚÈÓÊı¿ÛÔ˘Ó Û ·ÈÌԉȇÏÈÛË (3). √È·ÛıÂÓ›˜ Ì á¡ ¤¯Ô˘Ó Ì›˙ÔÓ˜ÚÔ·ıËÚÔÁfiÓ˜ ‰È·Ù·Ú·¯¤˜ ÙˆÓÏÈȉ›ˆÓ Ô˘ Â›Ó·È ‰˘Ó·ÙfiÓ Ó··ÓÙÈÌÂÙˆÈÛıÔ‡Ó Ì ηٿÏÏËÏË·ÁˆÁ‹, ˆÛÙfiÛÔ ÔÏÏÔ› ÎÏÈÓÈÎÔ› ›-Ó·È ·ÓÙ›ıÂÙÔÈ ÛÙËÓ ÂÈıÂÙÈ΋ ˘Ô-ÏÈȉ·ÈÌÈ΋ ıÂڷ›·, ÚÔ‚¿ÏÏÔ-ÓÙ·˜ ı¤Ì·Ù· Ô˘ ·ÊÔÚÔ‡Ó ÙËÓ·ÛÊ¿ÏÂÈ· ‹ ÙËÓ ¤ÏÏÂÈ„Ë ‰Â‰Ô̤-ÓˆÓ ÁÈ· ÙÔ Â·ÎfiÏÔ˘ıÔ ÎÏÈÓÈÎfifiÊÂÏÔ˜ ÙˆÓ ˘ÔÏÈȉ·ÈÌÈÎÒÓ Ê·Ú-Ì¿ÎˆÓ Û ·ÛıÂÓ›˜ Ì á¡ (4).

™ÙËÓ ·Ó·ÛÎfiËÛË ·˘Ù‹ ı· Á›-ÓÂÈ ·Ó·ÊÔÚ¿ ÛÙË ÛÙ·‰ÈÔÔ›ËÛËÙ˘ á¡, ÛÙËÓ Â›ÙˆÛË Ù˘ ηÚ-‰È·ÁÁÂȷ΋˜ ÓfiÛÔ˘ Î·È ÛÙ· ¯·Ú·-ÎÙËÚÈÛÙÈο Ù˘ ‰˘ÛÏÈȉ·ÈÌ›·˜ Û·˘Ù‹ ÙËÓ ÔÌ¿‰· ·ÛıÂÓÒÓ. ∞ÎfiÌËı· Á›ÓÂÈ ·Ó·ÊÔÚ¿ ÛÙ· ‰Â‰Ô̤ӷ·Ó·ÊÔÚÈο Ì ÙËÓ ˘ÔÏÈȉ·ÈÌÈ΋ıÂڷ›·, Î·È Û˘˙‹ÙËÛË ÁÈ· ÙËÓ·ÛÊ¿ÏÂÈ· Î·È ÙȘ ıÂڷ¢ÙÈΤ˜ÛÙÚ·ÙËÁÈΤ˜.

Δ·ÍÈÓfiÌËÛË Ù˘ ÛÔ‚·ÚfiÙËÙ·˜ Ù˘ á¡

™‡Ìʈӷ Ì ÙÔ National KidneyFoundation (NKF), ÁÈ· ÙË ‰È¿ÁÓˆ-ÛË Ù˘ á¡ ··ÈÙÔ‡ÓÙ·È ¤Ó· ·fiÙ· ·Ú·Î¿Ùˆ 2 ¯·Ú·ÎÙËÚÈÛÙÈο:1) ¡ÂÊÚÈ΋ ‚Ï¿‚Ë ÁÈ· >3 Ì‹ÓÂ˜Ô˘ ÂȂ‚·ÈÒÓÂÙ·È Ì ‚ÈÔ„›· ‹‰Â›ÎÙ˜ ηٷÛÙÚÔÊ‹˜ fiˆ˜ ÌÈ-ÎÚÔ·Ï‚Ô˘ÌÈÓÔ˘Ú›· Ì ‹ ¯ˆÚ›˜Ì›ˆÛË ÙÔ˘ Ú˘ıÌÔ‡ Ù˘ ÛÂÈÚ·-Ì·ÙÈ΋˜ ‰È‹ıËÛ˘ (glomerularfiltration rate [GFR]) ‹ 2) GFR<60ml/min/1.73 m2 ÁÈ· >3 Ì‹Ó˜(¶›Ó·Î·˜ 1).

∞ÛıÂÓ›˜ Ì ÛÙ¿‰ÈÔ 1 ᡤ¯Ô˘Ó Ê˘ÛÈÔÏÔÁÈ΋ GFR, Û˘ÓÔ-‰Â˘fiÌÂÓË ·fi ÚˆÙÂ˚ÓÔ˘Ú›· ‹

·fi ¿ÏÏÔ˘˜ ‰Â›ÎÙ˜ ÓÂÊÚÈ΋˜‚Ï¿‚˘. ™Ù¿‰ÈÔ 2 á¡ (‹È·) ‰È·-ÁÈÁÓÒÛÙÂÙ·È fiÙ·Ó Ë GFR Â›Ó·È 60-89 ml/min/1.73 m2. ∞ÛıÂÓ›˜ ÌÂÛÙ¿‰ÈÔ 3 á¡ (̤ÙÚÈ·), ¤¯Ô˘ÓGFR 30 - 59 ml/min/1.73 m2. ∏‰È¿ÁÓˆÛË ÛÔ‚·Ú‹˜ ÓfiÛÔ˘ (ÛÙ¿-‰ÈÔ 4) Ù›ıÂÙ·È Ì GFR 15 - 29ml/min/1.73 m2. ÃÚfiÓÈ· ÓÂÊÚÈ΋·Ó¿ÚÎÂÈ· ‹ ÛÙ·‰›Ô˘ 5 á¡, ÔÚ›-˙ÂÙ·È Û·Ó GFR <15 ml/min/1.73m2. ∏ ›وÛË ÙÔ˘ ÛÙ·‰›Ô˘ 5á¡ (ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ· ‹ ·ÈÌÔ-οı·ÚÛË) Â›Ó·È 0.1% Î·È ÙˆÓ ÛÙ·-‰›ˆÓ 1 - 4 Â›Ó·È 11% ÛÙÔ ÏËı˘-ÛÌfi ÙˆÓ ∏¶∞ (5).

∂ȉËÌÈÔÏÔÁ›· Ù˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘ ÛÂ

·ÛıÂÓ›˜ Ì á¡

∞ÈÌÔηı·ÚfiÌÂÓÔÈ ·ÛıÂÓ›˜ (ÛÙ·-‰›Ô˘ 5 á¡) ¤¯Ô˘Ó ȉȷÈÙ¤Úˆ˜˘„ËÏ‹ ÓÔÛËÚfiÙËÙ· Î·È ıÓËÙfiÙËÙ·ÏfiÁˆ ηډȷÁÁÂÈ·ÎÒÓ Û˘Ì‚¿ÓÙˆÓ.μ·ÛÈ˙fiÌÂÓÔÈ Û ÛÙÔȯ›· ·fi ÙËÓU.S. Renal Data System Coordina-ting Center Case-Mix AdequacyStudy, Ë Â›ÙˆÛË Ù˘ ÛÙÂÊ·ÓÈ·›-·˜ ÓfiÛÔ˘ (™¡) Â›Ó·È 40% Î·È ËηډȷÁÁÂȷ΋ ıÓËÙfiÙËÙ· ›ӷÈηٿ 10 - 30 ÊÔÚ¤˜ ˘„ËÏfiÙÂÚË·' fiÙÈ ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi ·ÓÂ-Í¿ÚÙËÙ· ʇÏÔ˘, ËÏÈΛ·˜, ÂıÓÈÎfiÙË-

Ù·˜ Î·È ·ÚÔ˘Û›·˜ ۷ί·Ú҉ˉȷ‚‹ÙË (™¢) (6).

∏ ·‡ÍËÛË ÙÔ˘ ̤ÛÔ˘ fiÚÔ˘ËÏÈΛ·˜ ÛÙÔÓ ÏËı˘ÛÌfi Î·È Ë ÂÈ-‰ËÌ›· ÙÔ˘ ™¢ ¤¯Ô˘Ó ·˘Í‹ÛÂÈ ÛË-Ì·ÓÙÈο ÙËÓ Â›ÙˆÛË Ù˘ ‹È·˜Î·È ̤ÙÚÈ·˜ á¡ ÛÙȘ ∏¶∞. ™ÂÚÔÔÙÈ΋ ÏËı˘ÛÌȷ΋ ÌÂϤÙË·ÙfiÌˆÓ ËÏÈΛ·˜ > 65 ÂÙÒÓ Ô˘·Ú·ÎÔÏÔ˘ı‹ıËÎ·Ó ÁÈ· 7 ¯ÚfiÓÈ·,á¡ Ô˘ ÔÚ›ÛÙËÎÂ Û·Ó ÎÚ·ÙÈÓ›ÓË>1,5 mg/dl ÛÙÔ˘˜ ¿Ó‰Ú˜ ηÈ>1,3 mg/dl ÛÙȘ Á˘Ó·›Î˜, ‚Ú¤ıË-Π۠ÔÛÔÛÙfi 11% (7). √È ·ÛıÂ-Ó›˜ Ì á¡ Â›Ó·È ÂÚÈÛÛfiÙÂÚÔÂÈÚÚ›˜ ÛÙËÓ ·Ó¿Ù˘ÍË Û˘Ì-ÊÔÚËÙÈ΋˜ ηډȷ΋˜ ·Ó¿ÚÎÂÈ-·˜, ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘, ÂÚÈ-ÊÂÚÈ΋˜ ·ÁÁÂȷ΋˜ ÓfiÛÔ˘ (¶›Ó·-η˜ 2) (8). ∏ Û˘Û¯¤ÙÈÛË ·˘Ù‹ ·-ڷ̤ÓÂÈ Î·È ÌÂÙ¿ ·fi ‰ÈfiÚıˆÛËÁÈ· ÙÔ˘˜ ÎÏ·ÛÛÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ÎÈÓ‰‡ÓÔ˘, Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤Ó˘Ù˘ ËÏÈΛ·˜. ¶·ÚfiÌÔÈ· Â˘Ú‹Ì·Ù··Ó·Ê¤ÚıËÎ·Ó Î·È ÛÙËÓ ÌÂϤÙËARIC (Atherosclerosis Risk in Com-munities Study), Ë ÔÔ›· ¤‰ÂÈÍ fiÙÈË ÌÂȈ̤ÓË GFR Û¯ÂÙÈ˙fiÙ·Ó ·ÓÂ-Í¿ÚÙËÙ· Ì ÙËÓ ·Ó¿Ù˘ÍË ·ıËÚÔ-ÛÎÏËÚˆÙÈ΋˜ ηډȷÁÁÂȷ΋˜ Ófi-ÛÔ˘ (9).

√ Û‡Ó‰ÂÛÌÔ˜ ÌÂٷ͇ ‰˘ÛÏÈÈ-‰·ÈÌ›·˜ Î·È ·‡ÍËÛ˘ ÙÔ˘ ηډȷÁ-ÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ Û ·ÛıÂÓ›˜ ÌÂá¡ Â›Ó·È ‰‡ÛÎÔÏÔ Ó· ÂÎÙÈÌËı›

¡ÂÊÚÈ΋ ‚Ï¿‚Ë ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ ‹

·˘ÍË̤ÓË GFR3.3

¡ÂÊÚÈ΋ ‚Ï¿‚Ë Ì‹ȷ Ì›ˆÛË GFR 3.0

ª¤ÙÚÈ· Ì›ˆÛËGFR

4.3

™Ô‚·Ú‹ Ì›ˆÛËGFR

0.2

¡ÂÊÚÈ΋ ·Ó¿ÚÎÂÈ·

0.1

GFR: Ú˘ıÌfi˜ ÛÂÈÚ·Ì·ÙÈ΋˜ ‰È‹ıËÛ˘

¶›Ó·Î·˜ 1: ™Ù¿‰È· ÃÚfiÓÈ·˜ ¡ÂÊÚÈ΋˜ ¡fiÛÔ˘. (5)

™Ù¿‰ÈÔ ¶ÂÚÈÁÚ·Ê‹ GFR ∂ÈÔÏ·ÛÌfi˜ (∏¶∞) ml/min/1.73 m2 ÃÈÏÈ¿‰Â˜ %

1

2

3

4

5 <15 ‹ ·ÈÌÔοı·ÚÛË

15-29

30-59

60-89

≥90 5.900

5.300

7.600

400

300

Û ÌÂÁ¿ÏÔ ‚·ıÌfi, ÂÍ ·ÈÙ›·˜ ÙˆÓÔÏÏ·ÏÒÓ ¿ÏÏˆÓ ·Ú·ÁfiÓÙˆÓÎÈÓ‰‡ÓÔ˘, Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤ӈÓÙÔ˘ ·˘ÍË̤ÓÔ˘ ÔÍÂȉˆÙÈÎÔ‡ stress,Ù˘ ÊÏÂÁÌÔÓ‹˜, Ù˘ Ê˘ÛÈ΋˜·‰Ú¿ÓÂÈ·˜, Ù˘ ·Ó·ÈÌ›·˜, Ù˘·Û‚¤ÛÙˆÛ˘ ÙˆÓ ·ÁÁ›ˆÓ, Ù˘‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ÂÓ‰ÔıËÏ›Ô˘Î·È Ù˘ Ì›ˆÛ˘ Ù˘ ‰È·ıÂÛÈÌfiÙË-Ù·˜ ÙÔ˘ ¡√.

∂ȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ¤¯Ô˘Ó‰Â›ÍÂÈ fiÙÈ ·ÛıÂÓ›˜ Û ·ÈÌԉȇÏÈ-ÛË ¤¯Ô˘Ó ηχÙÂÚË ÂÈ‚›ˆÛË ·ÓÙ· ›‰· ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏË˜Â›Ó·È ˘„ËÏ¿. øÛÙfiÛÔ Ù· Â˘Ú‹Ì·-Ù· ·˘Ù¿ ‰ÂÓ Â›Ó·È ÛËÌ·ÓÙÈο ÌÂÙ¿ÙË ‰ÈfiÚıˆÛË ÁÈ· ÙË ÊÏÂÁÌÔÓ‹ ηÈÙË ‰È·ÙÚÔÊ‹ (10,11).

Δ· ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ‰˘ÛÏÈȉ·ÈÌ›·˜

ÛÙË Ã¡¡

∏ á¡ ÚÔηÏ› Ï‹ÚË ·ÔÚÚ‡ı-ÌÈÛË ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ ÏÈÔ-ÚˆÙÂ˚ÓÒÓ Ì ·ÔÙ¤ÏÂÛÌ· ÙȘÔÏϷϤ˜ ·ÓˆÌ·Ï›Â˜ ·˘ÙÒÓ ÙˆÓÌÔÚ›ˆÓ (¶›Ó·Î·˜ 3) (12). ∏ ‰˘ÛÏÈ-ȉ·ÈÌ›· ·Ó·Ù‡ÛÛÂÙ·È Î·Ù¿ ÙˉȿÚÎÂÈ· ÙˆÓ ÚÒÈÌˆÓ ÛÙ·‰›ˆÓá¡ Î·È ÔÈ ÛËÌ·ÓÙÈΤ˜ ·ÏÏ·Á¤˜ÛÙ· ÌfiÚÈ· ÙˆÓ ·ÔÏÈÔÚˆÙÂ˚ÓÒÓÚÔËÁÔ‡ÓÙ·È Û˘Ó‹ıˆ˜ ÙˆÓ ·ÏÏ·-ÁÒÓ ÙˆÓ ÂȤ‰ˆÓ ÙˆÓ ÏÈȉ›ˆÓÛÙÔ ·›Ì· (13,14).

∏ ÂÏ¿ÙÙˆÛË Ù˘ ¯ÔÏËÛÙÂÚfi-Ï˘ ÙˆÓ ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈ-ÔÚˆÙÂ˚ÓÒÓ (HDL) Î·È Ë ·‡ÍËÛËÙˆÓ ÏÔ‡ÛÈˆÓ Û ÙÚÈÁÏ˘ÎÂÚ›‰È· ÏÈ-ÔÚˆÙÂ˚ÓÒÓ ·ÔÙÂÏÔ‡Ó Ì›˙ÔÓ˜‰È·Ù·Ú·¯¤˜ ÙˆÓ ÏÈȉ›ˆÓ ÛÙËá¡. ™ËÌ·ÓÙÈÎfi ÚfiÏÔ ÁÈ· Ù· ¯·-ÌËÏ¿ ›‰· HDL-¯ÔÏËÛÙÂÚfiÏ˘ʷ›ÓÂÙ·È Ó· ·›˙ÂÈ Ë ÂÏ¿ÙÙˆÛËÙ˘ Û˘ÁΤÓÙÚˆÛ˘ ÙˆÓ ·ÔÏÈÔ-ÚˆÙÂ˚ÓÒÓ (apo) A-I Î·È apoA-II, ÔÈÔԛ˜ ·ÔÙÂÏÔ‡Ó Î‡ÚÈ· Û˘ÛÙ·ÙÈ-ο ÙˆÓ HDL ۈ̷Ùȉ›ˆÓ. Œ¯ÂÈ ‰ÂÈ-¯ı› fiÙÈ ·ÛıÂÓ›˜ Ì á¡, ¤¯Ô˘ÓÌÂȈ̤ÓË ÁÔÓȉȷ΋ ¤ÎÊÚ·ÛË ÙˆÓ

·ÔÏÈÔÚˆÙÂ˚ÓÒÓ ·˘ÙÒÓ ÛÙȘ ı¤-ÛÂȘ ·Ú·ÁˆÁ‹˜ Ù˘ HDL-¯ÔÏË-ÛÙÂÚfiÏ˘ ÛÙÔ ‹·Ú (15).

ŒÓ·˜ ¿ÏÏÔ˜ ·Ú¿ÁˆÓ Ô˘ Û˘-ÓÂÈÛʤÚÂÈ ÛÙ· ¯·ÌËÏ¿ ›‰·HDL-¯ÔÏËÛÙÂÚfiÏ˘ ÛÙÔ˘˜ ·ÛıÂ-Ó›˜ ·˘ÙÔ‡˜ Â›Ó·È Ë ·ÚÔ˘Û›·ÊÏÂÁÌÔÓ‹˜. ∏ ¯ÚfiÓÈ· ÊÏÂÁÌÔÓ‹¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙË Ì›ˆÛËÙ˘ ÏÂ˘ÎˆÌ·Ù›Ó˘, ÊÔÚ¤· ÂχıÂ-Ú˘ ¯ÔÏËÛÙÂÚfiÏ˘ ·fi ÙÔ˘˜ÈÛÙÔ‡˜ ÛÙËÓ HDL-¯ÔÏËÛÙÂÚfiÏË,Ì ·ÔÙ¤ÏÂÛÌ· ¯·ÌËÏ‹ HDL-¯Ô-ÏËÛÙÂÚfiÏË ÛÙÔ Ï¿ÛÌ· (12).

Δ· ·˘ÍË̤ӷ ›‰· ÙÚÈÁÏ˘-ÎÂÚȉ›ˆÓ ÛÙÔ Ï¿ÛÌ· ÂÍËÁÔ‡ÓÙ·È·fi ÙË ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË Ù˘apoC-III. ∏ apoC-III Â›Ó·È ¤Ó·˜·ÔÙÂÏÂÛÌ·ÙÈÎfi˜ ·Ó·ÛÙÔϤ·˜Ù˘ ÏÈÔÚˆÙÂ˚ÓÈ΋˜ ÏÈ¿Û˘, ÂÓ-˙‡ÌÔ˘ Ô˘ Â›Ó·È ˘Â‡ı˘ÓÔ ÁÈ· ÙÔÓηٷ‚ÔÏÈÛÌfi ÙˆÓ ÏÔ‡ÛÈˆÓ ÛÂ

ÙÚÈÁÏ˘ÎÂÚ›‰È· ÌÔÚ›ˆÓ (16). À¿Ú¯ÂÈ ·ÚÈıÌfi˜ Î·È ¿ÏψÓ

·Ú·ÁfiÓÙˆÓ Ô˘ Û˘ÌÌÂÙ¤¯Ô˘ÓÛÙËÓ ·‡ÍËÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓÛ ·ÛıÂÓ›˜ Ì á¡, Ë ÂÚÈÁÚ·-Ê‹ ÙˆÓ ÔÔ›ˆÓ ÍÂʇÁÂÈ ·fi ÙÔÛÎÔfi ·˘Ù‹˜ Ù˘ ·Ó·ÛÎfiËÛ˘.

∞ԉ›ÍÂȘ Ù˘ ıÂڷ›·˜ ·ÈÌÔηı·ÚfiÌÂÓˆÓ ·ÛıÂÓÒÓ

(á¡ ÛÙ·‰›Ô˘ 5)

∞Ó Î·È ÔÈ ·ÈÌÔηı·ÚfiÌÂÓÔÈ ·ÛıÂ-Ó›˜ ¤¯Ô˘Ó ˘„ËÏ‹ ÓÔÛËÚfiÙËÙ· ηÈıÓËÙfiÙËÙ· ·fi ηډȷÁÁÂÈ·Î¿Û˘Ì‚¿ÓÙ·, ÔÈ ·fi„ÂȘ ÁÈ· ÙËÓ˘ÔÏÈȉ·ÈÌÈ΋ ıÂڷ›· ‰È›ÛÙ·-ÓÙ·È. À¿Ú¯Ô˘Ó ‰Â‰Ô̤ӷ Ô˘˘ÔÛÙËÚ›˙Ô˘Ó ÔʤÏË ·fi ÙË ıÂ-ڷ›· Ù˘ ‰˘ÛÏÈȉ·ÈÌ›·˜ Û·ÛıÂÓ›˜ Ì á¡ ÛÙ·‰›Ô˘ 5. ™ÙËÓU.S Renal Data System DialysisMorbidity and Mortality Study,3700 ·ÛıÂÓ›˜ Û ·ÈÌԉȇÏÈÛË ·-Ú·ÎÔÏÔ˘ı‹ıËÎ·Ó ÁÈ· 2 ¯ÚfiÓÈ·. ∏ÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ¤Ï·‚ÂÛÙ·Ù›ÓË, ›¯Â ÂÏ¿ÙÙˆÛË ÙÔ˘ Û¯ÂÙÈ-ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ÛÙË Û˘ÓÔÏÈ΋ ıÓË-ÙfiÙËÙ· ηٿ 32%, ÂÓÒ Ë ÔÌ¿‰·Ô˘ ¤Ï·‚ ÊÈÌÚ¿ÙË ‰ÂÓ ·ÚÔ˘-Û›·Û Ì›ˆÛË ÛÙËÓ Î·Ú‰È·ÁÁÂȷ΋‹ ÛÙË Û˘ÓÔÏÈ΋ ıÓËÛÈÌfiÙËÙ· (17).™ÙË Dialysis Outcomes PracticePatterns Study, 9.800 ·ÛıÂÓ›˜ Û·ÈÌԉȇÏÈÛË ·Ú·ÎÔÏÔ˘ı‹ıËηÓ

¶∞ƒ∞°√¡Δ∂™ ∫π¡¢À¡√À

3

*ƒ˘ıÌfi˜ ·Ó·Ê¤ÚÂÙ·È ·Ó¿ 100 ·ÓıÚˆÔ¤ÙË √∂ª: Ô͇ ¤ÌÊÚ·ÁÌ· Ì˘Ôηډ›Ô˘, ∞∂∂/Δπ∞: ·ÁÁÂÈ·Îfi ÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔ/·-ÚÔ‰ÈÎfi ÈÛ¯·ÈÌÈÎfi ÂÂÈÛfi‰ÈÔ, ¶∞¡: ÂÚÈÊÂÚÈ΋ ·ÁÁÂȷ΋ ÓfiÛÔ˜, ∞ıËÚ/η ∞™: ·ıË-ÚˆÛÎÏËÚˆÙÈο ·ÁÁÂȷο Û˘Ì‚¿ÓÙ· á¡: ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ÓfiÛÔ˜.

¶›Ó·Î·˜ 2: ƒ˘ıÌfi˜ ∫·Ú‰È·ÁÁÂÈ·ÎÒÓ ™˘Ì‚¿ÓÙˆÓ* ÙÔ 2000 Î·È 2001. (8)

√Ì¿‰· √∂ª ∞∂∂/Δπ∞ ¶∞¡ ∞ıËÚ/ο ∞™ £¿Ó·ÙÔÈ

ªË ‰È·‚‹Ù˘/ÌË Ã¡¡ 1.6 7.6 6.9 14.1 5.5

¢È·‚‹Ù˘/ÌË Ã¡¡ 3.2 13.1 12.8 25.3 8.1

ªË-‰È·‚‹Ù˘/á¡ 3.9 16.6 19.9 35.7 17.7

¢È·‚‹Ù˘/á¡ 6.9 22.0 26.6 49.1 19.9

↓ = Ì›ˆÛË, ↑ = ·‡ÍËÛË, ACAT = acyl-CoA (cholesterol acyl) transferase; Apo =apoprotein, CETP = cholesterol ester transferase protein, CM = ¯˘ÏÔÌÈÎÚ¿,DGAT = acyl-CoA diglycerol acyl transferase; HDL = ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔ-ÚˆÙ½ÓË, HDL-C = ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙ½ÓË ¯ÔÏËÛÙÂÚfiÏË, HDL-TG =˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙ½ÓË ÙÚÈÁÏ˘ÎÂÚ›‰È·, IDL = ÂӉȿÌÂÛ˘ ˘ÎÓfiÙËÙ·˜ÏÈÔÚˆÙ½ÓË, LCAT = lecithin cholesterol acyl transferase, LDL-TG = ¯·ÌËÏ‹˜˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙ½ÓË ÙÚÈÁÏ˘ÎÂÚ›‰È·; LP = ÏÈÔÚˆÙ½Ó˜ LPL = lipoproteinlipase; LRP = ÚˆÙ½ÓË Û¯ÂÙÈ˙fiÌÂÓË Ì ÙÔÓ ˘Ô‰Ô¯¤· ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔ-ÚˆÙ½Ó˘, Trig = ÙÚÈÁÏ˘ÎÂÚ›‰È·, VLDL = Ôχ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆ-Ù½ÓË, VLDL-C = Ôχ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙ½ÓË ¯ÔÏËÛÙÂÚfiÏË, VLDL-TG = Ôχ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙ½ÓË ÙÚÈÁÏ˘ÎÂÚ›‰È·.

¶›Ó·Î·˜ 3: ªË¯·ÓÈÛÌÔ› ‰˘ÛÏÈȉ·ÈÌ›·˜ ÛÙËÓ ÃÚfiÓÈ· ¡ÂÊÚÈ΋ ¡fiÛÔ

¶ÚˆÙ½ÓË ∞ÏÏ·Á‹ ¢Ú¿ÛË ÛÙ· ÏÈ›‰È· ‹ ÏÈÔÚˆÙ½Ó˜ Ï¿ÛÌ·ÙÔ˜

ApoA-1 ↓ ↓ HDLLCAT ↓ ↓ HDL-C, HDL-2/HDL-3CETP ↑ ↓ HDL-CACAT ↑ ↑ VLDL-C, HDL-CLPL ↓ Trig (↑ ·fiÛ·Û˘ TG

·fi VLDL Î·È CM)VLDL receptor ↓ 1VLDL, TrigHepatic lipase ↓ ↑ IDL, CM ˘ÔÏ›ÌÌ·Ù·,

HDL-TG, Trig, LDL-TGLRP ↓ ↑ IDL, CM ˘ÔÏ›ÌÌ·Ù· ApoCII/CIII ratio ↓ ↑ Trig (↑ LPL ‰Ú·ÛÙÈÎfiÙËÙ·)Pre-‚ HDL ↑ ↑ Trig (↑ LPL ‰Ú·ÛÙÈÎfiÙËÙ·)

ÁÈ· 5 ¯ÚfiÓÈ·. √ Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜Ù˘ Û˘ÓÔÏÈ΋˜ ıÓËÙfiÙËÙ·˜ ÌÂÈÒ-ıËΠηٿ 31% (p = 0.0001)ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ¤Ï·‚·Ó ÛÙ·-Ù›ÓË Û ۯ¤ÛË Ì ÂΛÓÔ˘˜ Ô˘‰ÂÓ ¤Ï·‚·Ó (18).

∏ ÌÂϤÙË 4D (Die DeutscheDiabetes Dialyse Study) Â›Ó·È ËÌfiÓË ÚÔÔÙÈ΋ Ù˘¯·ÈÔÔÈË̤ÓËÂÏÂÁ¯fiÌÂÓË ÎÏÈÓÈ΋ ÌÂϤÙË ÌÂÛÙ·Ù›ÓË Û ·ÈÌÔηı·ÚfiÌÂÓÔ ÏË-ı˘ÛÌfi (¶›Ó·Î·˜ 4) (19). ™ÙË ÌÂϤ-ÙË Û˘ÌÌÂÙ›¯·Ó Û˘ÓÔÏÈο 1.200·ÛıÂÓ›˜ ÌÂ Ù‡Ô 2 ™¢ Û ·ÈÌÔ-‰È‡ÏÈÛË. Δ˘¯·ÈÔÔÈ‹ıËÎ·Ó Û·˘ÙÔ‡˜ Ô˘ ¤Ï·‚·Ó atorvastatin20 mg/ËÌÂÚËÛ›ˆ˜ ‹ ÂÈÎÔÓÈÎfi Ê¿Ú-Ì·ÎÔ ÁÈ· 4 ¯ÚfiÓÈ·. ™Â ·ÓÙ›ıÂÛË ÌÂÙȘ ÌÂϤÙ˜ ·Ú·Ù‹ÚËÛ˘, Ëatorvastatin Ì›ˆÛ ÌË ÛËÌ·ÓÙÈοÙÔ Û¯ÂÙÈÎfi ΛӉ˘ÓÔ Î·Ù¿ 8% (95%CI 0.77 - 1.10; p = 0.37) ÙÔ˘ Û˘Ó-‰˘·Ṳ̂ÓÔ˘ ÚˆÙ·Ú¯ÈÎÔ‡ ηٷÏË-ÎÙÈÎÔ‡ ÛËÌ›Ԣ (ηډȷÎfi˜ ı¿Ó·-ÙÔ˜, ÌË ı·Ó·ÙËÊfiÚÔ ¤ÌÊÚ·ÁÌ·Ì˘Ôηډ›Ô˘ [∂ª], ·ÁÁÂÈ·Îfi ÂÁÎÂ-Ê·ÏÈÎfi ÂÂÈÛfi‰ÈÔ [∞∂∂]). ∂ÈϤ-ÔÓ, Ë atorvastatin ·‡ÍËÛ ÙÔÓ Û¯Â-ÙÈÎfi ΛӉ˘ÓÔ ı·Ó·ÙËÊfiÚˆÓ ∞∂∂(RR 2.03; 95% CI 1.05 - 3.93; p =0.04). ∫·È ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ ÙÔ21% ÙˆÓ ı·Ó¿ÙˆÓ ‹Ù·Ó ÂÍ·ÈÙ›·˜∂ª, ·Ó Î·È ÙÔ 60% ·Ô‰fiıËΠ۷ÈÊÓ›‰ÈÔ Î·Ú‰È·Îfi ı¿Ó·ÙÔ (19).∞˘Ùfi ˘Ô‰ËÏÒÓÂÈ fiÙÈ Î‡ÚÈ· ·ÈÙ›·Î·Ú‰È·ÁÁÂÈ·ÎÔ‡ ı·Ó¿ÙÔ˘ ÛÙÔ˘˜·ÈÌÔηı·ÚfiÌÂÓÔ˘˜ ·ÛıÂÓ›˜ ›Ûˆ˜Â›Ó·È Ë ·ÚÚ˘ıÌ›· Î·È fiÙÈ ·˘Ù‹ Ë·ÈÙ›· ı·Ó¿ÙÔ˘ ‰ÂÓ Â›Ó·È ·Ó·ÛÙÚ¤-„ÈÌË Ì ÛÙ·Ù›Ó˜. ªÈ· ¿ÏÏË ÂÍ‹-ÁËÛË ÙˆÓ ·ÚÓËÙÈÎÒÓ ·ÔÙÂÏÂÛÌ¿-ÙˆÓ Â›Ó·È fiÙÈ Ô ÏËı˘ÛÌfi˜ Ù˘ÌÂϤÙ˘ 4D ›¯Â Ôχ ÚÔ¯ˆÚË-̤ÓË ·ıËÚÔÛÎÏËÚˆÙÈ΋ ÓfiÛÔ ÁÈ·Ó· ˆÊÂÏËı› ·fi ÙËÓ ıÂڷ›·. √È·ÛıÂÓ›˜ ¢ڛÛÎÔÓÙÔ Û ÚfiÁÚ·Ì-Ì· ·ÈÌÔοı·ÚÛ˘ ÙÔ˘Ï¿¯ÈÛÙÔÓÁÈ· 2 ¯ÚfiÓÈ·, 50% ‹Ù·Ó ηÓÈÛÙ¤˜Î·È 50% ›¯·Ó ÈÛÙÔÚÈÎfi ∂ª.

∏ OPACH (Omega-3 FattyAcids as Secondary PreventionAgainst Cardiovascular Events inPatients Who Undergo ChronicHemodialysis) ‹Ù·Ó ÌÈ· ÚfiÛÊ·-ÙË Ù˘¯·ÈÔÔÈË̤ÓË, ‰ÈÏ¿ Ù˘ÊÏ‹,ÂÏÂÁ¯fiÌÂÓË Ì ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔÌÂϤÙË, Û 206 ¯ÚÔÓ›ˆ˜ ·ÈÌÔη-ı·ÚfiÌÂÓÔ˘˜ ·ÛıÂÓ›˜ (20). √ÈÛ˘ÌÌÂÙ¤¯ÔÓÙ˜ ¤Ï·‚·Ó ˆÌ¤Á·-3ÏÈ·Ú¿ Ôͤ· (ˆ-3 §√) Û ‰fiÛË1.7g/ËÌÂÚËÛ›ˆ˜ ‹ ÂÏ·ÈfiÏ·‰Ô ÂÈ-ÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ. ∞Ó Î·È ‰ÂÓ ˘‹Ú-¯Â ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÛÙÔ Û˘Ó‰˘·-Ṳ̂ÓÔ ÚˆÙ·Ú¯ÈÎfi ÙÂÏÈÎfi ÛËÌ›ÔÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ Û˘Ì‚¿ÓÙÔ˜ ‹

ı·Ó¿ÙÔ˘ (62 Û˘Ì‚¿ÓÙ· ÛÙËÓ ÔÌ¿-‰· ÙˆÓ ˆ-3 §√ Î·È 59 ÛÙËÓ ÔÌ¿‰·ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘), ·Ú·ÙËÚ‹-ıËΠ̛ˆÛË Î·Ù¿ 70% (95% CI0.10 - 0.92; p = 0.036) ÙÔ˘ Û¯ÂÙÈ-ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ∂ª. ∂ÈϤÔÓ ËÛ˘¯ÓfiÙËÙ· ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚ-ÁÂÈÒÓ ‰ÂÓ ‹Ù·Ó ÛËÌ·ÓÙÈο ˘„ËÏfi-ÙÂÚË Ù˘ ÔÌ¿‰·˜ ÂÈÎÔÓÈÎÔ‡ Ê·Ú-Ì¿ÎÔ˘. √ ÌÈÎÚfi˜ ·ÚÈıÌfi˜ Û˘ÌÌÂ-Ù¯fiÓÙˆÓ Î·È ÔÈ ÌÈÎÚ¤˜ ·ÏÏ·Á¤˜ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ Ô˘ ·Ú·ÙË-Ú‹ıËÎ·Ó Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂ-ϤÙ˘, ·ÔÙÂÏÔ‡Ó ·ÛıÂÓ‹ ÛËÌ›·Ù˘ ÌÂϤÙ˘.

¢‡Ô ÌÂÁ¿Ï˜ ÌÂϤÙ˜ Û¯ÂÙÈοÌ ÙË ¯Ú‹ÛË ÛÙ·ÙÈÓÒÓ Û ·ÈÌÔη-ı·ÚfiÌÂÓÔ˘˜ ·ÛıÂÓ›˜ ‚Ú›ÛÎÔ-ÓÙ·È Û ÂͤÏÈÍË. ∏ ÚÒÙË, AURO-RA (A Study to Evaluate the Useof Rosuvastatin in Subjects on Re-gular Hemodialysis: an Assess-ment of Survival and Cardiovascu-lar Events), fiÔ˘ Ï·Ì‚¿ÓÔ˘Ó Ì¤-ÚÔ˜ 2.700 ·ÈÌÔηı·ÚfiÌÂÓÔÈ Ì ÙËÏ‹„Ë ‹ fi¯È rosuvastatin 10 mg/ËÌÂÚËÛ›ˆ˜ (21) Î·È Ë ‰Â‡ÙÂÚË,SHARP (Study of Heart and RenalProtection), ÛÙËÓ ÔÔ›· ı· ˘¿Ú-¯ÂÈ ÌÈ· ÔÌ¿‰· Ì 3.000 ·ÛıÂÓ›˜Û ·ÈÌÔοı·ÚÛË Ô˘ Ù˘¯·ÈÔÔÈ‹-ıËÎ·Ó Ó· Ï¿‚Ô˘Ó simvastatin20 mg/ ËÌÂÚËÛ›ˆ˜ ‹ simvastatin20 mg/ ËÌÂÚËÛ›ˆ˜ Î·È ezetimibe(22).

∞ԉ›ÍÂȘ Ù˘ ıÂڷ›·˜·ÛıÂÓÒÓ Ì ‹È· ¤ˆ˜ Î·È Ì¤ÙÚÈ· á¡ (ÛÙ·‰›Ô˘ 1-4)

™Â ·ÛıÂÓ›˜ ÚÒÈÌÔ˘ ÛÙ·‰›Ô˘Ã¡¡ ˘¿Ú¯Ô˘Ó ÛÙÔȯ›· Ô˘·ÓÙÏÔ‡ÓÙ·È ·fi ˘ÔÔÌ¿‰Â˜ ·Ó·-χÛÂˆÓ ÌÂÏÂÙÒÓ ‰Â˘ÙÂÚÔÁÂÓÔ‡˜ÚfiÏ˄˘ (¶›Ó·Î·˜ 4). ∏ HeartProtection Study Û˘ÌÂÚȤϷ‚Â20.000 μÚÂÙ·ÓÔ‡˜ ¿Ó‰Ú˜ Î·È Á˘-Ó·›Î˜ 40-80 ÂÙÒÓ Ô˘ ‹Ù·Ó Û·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ı·Ó¿ÙÔ˘ ·fiηډȷÁÁÂȷ΋ ÓfiÛÔ, Û˘Ó›·™¢, ™¡, ‹ ¿ÏÏ˘ ·ıËÚÔÛÎÏËÚˆÙÈ-΋˜ ÓfiÛÔ˘ (23). ∏ 5ÂÙ‹˜ ·˘Ù‹ ÌÂ-ϤÙË, ÂÎÙ›ÌËÛ ÙÔ fiÊÂÏÔ˜ Ù˘ Ì›-ˆÛ˘ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ÌÂsimvastatin 40 mg/ËÌÂÚËÛ›ˆ˜. ΔÔÚˆÙ‡ÔÓ Î·Ù·ÏËÎÙÈÎfi ÛËÌÂ›Ô‹Ù·Ó Ë Û˘ÓÔÏÈ΋ ıÓËÙfiÙËÙ·, Ù·ı·Ó·ÙËÊfiÚ· Î·È ÌË ·ÁÁÂÈ·Î¿Û˘Ì‚¿ÓÙ·. ∞˘Ù‹ Ë ÌÂÁ¿ÏË ÏËı˘-ÛÌȷ΋ ÌÂϤÙË ÂÚÈ›¯Â ˘ÔÔÌ¿-‰· 1.329 ·ÛıÂÓÒÓ Ì á¡ Ì ÎÚÂ-·ÙÈÓ›ÓË 1,3 - 2,3 mg/dl. ¶·Ú·ÙËÚ‹-ıËΠ̛ˆÛË ÙÔ˘ Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡-ÓÔ˘ ηٿ 28% (95% CI 0.72 - 0.85;

p = 0.05). ∏ Û˘¯ÓfiÙËÙ· ÙˆÓ Û˘Ì-‚¿ÓÙˆÓ ‹Ù·Ó 39,2% ÛÙËÓ ÔÌ¿‰·ÂϤÁ¯Ô˘ Î·È 28% ÛÙËÓ ÔÌ¿‰· ÌÂsimvastatin, Ì Ì›ˆÛË ÙÔ˘ ·fi-Ï˘ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ (∞∫) Ô˘ ¤Êı·ÛÂÙÔ 11% Î·È ÙÔÓ ·ÚÈıÌfi ÙˆÓ ·ÛıÂ-ÓÒÓ Ô˘ Ú¤ÂÈ Ó· ıÂڷ¢ıÔ‡ÓÛÙÔ 9. ∏ Ì›ˆÛË ÙÔ˘ ∞∫ ·˘Ù‹, ›-Ó·È ·ÍÈÔÛËÌ›ˆÙË Û˘ÁÎÚÈÙÈο ÌÂÙËÓ Ì›ˆÛË ÙÔ˘ ∞∫ (5.4%) Ù˘ Û˘-ÓÔÏÈ΋˜ ÌÂϤÙ˘.

™ÙË ÌÂϤÙË CARE (Cholesteroland Recurrent Events), ¿Óˆ ·fi4.000 ·ÛıÂÓ›˜ Ì ÚÔËÁËı¤Ó ∂ªÎ·È ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË <240 mg/dlÙ˘¯·ÈÔÔÈ‹ıËÎ·Ó Û pravastatin40 mg/ËÌÂÚËÛ›ˆ˜ ‹ ÂÈÎÔÓÈÎfi Ê¿Ú-Ì·ÎÔ Î·È ·Ú·ÎÔÏÔ˘ı‹ıËÎ·Ó ÁÈ·5 ¯ÚfiÓÈ· (¶›Ó·Î·˜ 4). ªÈ· ˘ÔÔ-Ì¿‰· 1.700 ·ÛıÂÓÒÓ Ì οı·ÚÛËÎÚ·ÙÈÓ›Ó˘ <75 ml/min ÂÎÙÈÌ‹ıË-ÎÂ. ™ÙÔ˘˜ ·ÛıÂÓ›˜ ·˘ÙÔ‡˜ Ì‹ȷ á¡, Ë ıÂڷ›· Ì prava-statin 40 mg/ËÌÂÚËÛ›ˆ˜ Ì›ˆÛÂÙÔ Û¯ÂÙÈÎfi ΛӉ˘ÓÔ Î·Ù¿ 28%(95% CI 0.55 - 0.95; p = 0.02) ηÈÙÔÓ ∞∫ ηٿ 4%, ÛÙÔ ÚˆÙ‡ÔÓÙÂÏÈÎfi ÛËÌÂ›Ô (ı¿Ó·ÙÔ˜ ·fi ™¡ ‹Û˘Ìو̷ÙÈÎfi ÌË ı·Ó·ÙËÊfiÚÔ∂ª) (24).

H ÌfiÓË ‰ËÌÔÛÈÂ˘Ì¤ÓË ÚÔÔ-ÙÈ΋ Ù˘¯·ÈÔÔÈË̤ÓË ÎÏÈÓÈ΋ ÌÂ-ϤÙË Ô˘ ÂÎÙ›ÌËÛ ÙË ıÂڷ›·Ì ÛÙ·Ù›Ó˜ Û ·ÛıÂÓ›˜ Ì ‹È·Ã¡¡ Â›Ó·È Ë PREVEND IT (Preven-tion of Renal and Vascular EndStage Disease Intervention Trial)(¶›Ó·Î·˜ 4) (25). ™ÙË ÌÂϤÙË ·˘Ù‹ÚˆÙÔÁÂÓÔ‡˜ ÚfiÏ˄˘, 2Ã2 ·-Ú·ÁÔÓÙÈ΋, 864 ·ÛıÂÓ›˜ Ì ÌÈ-ÎÚÔÏÂ˘ÎˆÌ·ÙÈÓÔ˘Ú›· Ù˘¯·ÈÔÔÈ‹-ıËÎ·Ó Û fosinopril 20 mg/d ‹ ÂÈ-ÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ Î·È Û pravasta-tin 40 mg/ËÌÂÚËÛ›ˆ˜ ‹ ÂÈÎÔÓÈÎfiÊ¿ÚÌ·ÎÔ. √È ·ÛıÂÓ›˜ ·Ú·ÎÔ-ÏÔ˘ı‹ıËÎ·Ó ÁÈ· 4 ¯ÚfiÓÈ·. ∏ ¯Ô-Ú‹ÁËÛË pravastatin 40 mg/ËÌÂÚË-Û›ˆ˜ ›¯Â Û·Ó ·ÔÙ¤ÏÂÛÌ· ÌË ÛË-Ì·ÓÙÈ΋ Ì›ˆÛË Î·Ù¿ 13% (0.87[95% CI 0.49 to 1.57]; p = 0.649)ÙÔ˘ ÚˆÙ‡ÔÓÙÔ˜ ÙÂÏÈÎÔ‡ ÛËÌ›-Ô˘ Ù˘ ηډȷÁÁÂȷ΋˜ ıÓËÙfiÙË-Ù·˜ Î·È ÓÔÛËÏ›·˜ ηډȷÁÁÂÈ·-΋˜ ÓÔÛËÚfiÙËÙ·˜. ΔÔ ÌË ÛËÌ·ÓÙÈ-Îfi ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ, ÏfiÁˆ ÙÔ˘ÌÈÎÚÔ‡ ·ÚÈıÌÔ‡ ÙˆÓ Î·Ú‰È·ÁÁÂÈ·-ÎÒÓ Û˘Ì‚¿ÓÙˆÓ, ÂÚÈÔÚ›˙ÂÈ ÙËÓÌÂϤÙË.

∏ ÌÂϤÙË ALERT (Assessmentof Lescol in Renal TransplantTrial) ‹Ù·Ó ÌÈ· Ù˘¯·ÈÔÔÈË̤ÓË ‰È-Ï¿ Ù˘ÊÏ‹ ÌÂϤÙË, Ì 2.102 ÌÂÙ·-ÌÔÛ¯Â˘Ì¤ÓÔ˘˜ ·ÛıÂÓ›˜. √È Û˘Ì-ÌÂÙ¤¯ÔÓÙ˜, ›¯·Ó ̤ÛË ÙÈÌ‹ ¯·-ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙ½ÓË

¢ ∂ ∫ ∂ ª μ ƒ π √ ™ 2 0 0 8

4

¶∞ƒ∞°√¡Δ∂™ ∫π¡¢À¡√À

5

(LDL) ¯ÔÏËÛÙÂÚfiÏË 160 mg/dl ηÈ̤ÛË ÎÚ·ÙÈÓ›ÓË 1,6 mg/dl (26). ™ÙË5-ÂÙ‹ ·˘Ù‹ ÌÂϤÙË, Ë Ù˘¯·ÈÔÔ›ËÛËÛ fluvastatin 40 Î·È 80 mg/ËÌÂÚË-Û›ˆ˜ ›¯Â Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙË ÌËÛËÌ·ÓÙÈ΋ Ì›ˆÛË Î·Ù¿ 17% (p =0.139) ÙÔ˘ Û˘Ó‰˘·Ṳ̂ÓÔ˘ ÚˆÙ·Ú-¯ÈÎÔ‡ ÙÂÏÈÎÔ‡ ÛËÌ›Ԣ (ηډȷÎfi˜ı¿Ó·ÙÔ˜, ÌË ı·Ó·ÙËÊfiÚÔ ∂ª ‹ÂÂÌ‚¿ÛÂȘ ÛÙ· ÛÙÂÊ·ÓÈ·›·). ªÈ·˘Ô·Ó¿Ï˘ÛË Ù˘ ALERT Ô˘ ¯ÚË-ÛÈÌÔÔ›ËÛÂ Û·Ó ÚˆÙ‡ÔÓ ÙÂÏÈÎfiÛËÌÂ›Ô ÙÔÓ Î·Ú‰È·Îfi ı¿Ó·ÙÔ Î·È ÙÔÌË ı·Ó·ÙËÊfiÚÔ ∂ª, ¤‰ÂÈÍ ÛËÌ·-ÓÙÈ΋ Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ηٿ35% (p = 0.005) (27).

™ÙË ÌÂϤÙË VA-HIT (Veterans'Affairs High-Density LipoproteinIntervention Trial) ¿Óˆ ·fi 2.500¿Ó‰Ú˜ Ù˘¯·ÈÔÔÈ‹ıËÎ·Ó Û gemfi-mbrozil 1200 mg/ËÌÂÚËÛ›ˆ˜ ‹ ÂÈ-

ÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ. ∏ post hoc ·Ó¿-Ï˘ÛË Û ÌÈ· ˘ÔÔÌ¿‰· 1.000 ·Ó-‰ÚÒÓ Ì οı·ÚÛË ÎÚ·ÙÈÓ›Ó˘<75 ml/min ¤‰ÂÈÍÂ, fiÙÈ ÛÙÔ˘˜·ÛıÂÓ›˜ Ì ‹È· ¤ˆ˜ ̤ÙÚȷá¡, ÌÂÈÒıËÎÂ Ô Û¯ÂÙÈÎfi˜ ΛӉ˘-ÓÔ˜ ηٿ 27% (0.73 [95% CI 0.56to 0.96]; p = 0.02) Î·È Ô ∞∫ ı·Ó·-ÙËÊfiÚÔ˘ Î·È ÌË ∂ª ηٿ 6.3%(¶›Ó·Î·˜ 4) (28).

∏ SHARP Â›Ó·È ÎÏÈÓÈ΋ ÌÂϤÙËÛ ÂͤÏÈÍË, ÛÙËÓ ÔÔ›· ÌÈ· ˘ÔÔ-Ì¿‰· Ì ‹È· ‹ ̤ÙÚÈ· á¡ (ÎÚÂ-·ÙÈÓ›ÓË >1,5 mg/dl) ¤¯ÂÈ Ù˘¯·ÈÔ-ÔÈËı› Û simvastatin 20 mg/ËÌÂ-ÚËÛ›ˆ˜ ‹ simvastatin 20 mg/ËÌÂ-ÚËÛ›ˆ˜ Î·È ezetimibe 10 mg/ËÌÂ-ÚËÛ›ˆ˜. ™ÙËÓ ›‰È· ÌÂϤÙË ı· ˘¿Ú-ÍÂÈ ÌÈ· ÂÈÚfiÛıÂÙË ÔÌ¿‰· ÌÂ3.000 ·ÛıÂÓ›˜ Û ·ÈÌÔοı·ÚÛË(22).

¢Â‰Ô̤ӷ ·ÛÊ¿ÏÂÈ·˜ Û·ÛıÂÓ›˜ Ì á¡

∞ÛÊ¿ÏÂÈ· ÛÙË ıÂڷ›· Ì ÛÙ·Ù›-ÓË. ŸÏ˜ ÔÈ ÛÙ·Ù›Ó˜ ¤¯Ô˘Ó ¯ÚËÛÈ-ÌÔÔÈËı› Ì ·ÛÊ¿ÏÂÈ· Û ·ÛıÂ-Ó›˜ Ì ÛÙ·‰›Ô˘ 1 Î·È 2. ¶ÚÔÎÂÈ̤-ÓÔ˘ ÁÈ· ·ÛıÂÓ›˜ ÛÙ·‰›Ô˘ 3 - 5,ÏfiÁˆ ÙˆÓ ‰È·ÊÔÚÒÓ ÛÙȘ Ê·ÚÌ·-ÎÔÎÈÓËÙÈΤ˜ ÙÔ˘˜ ȉÈfiÙËÙ˜, ›Ûˆ˜··ÈÙÂ›Ù·È ÚÔÛ·ÚÌÔÁ‹ ÛÙȘ ‰fi-ÛÂȘ ÙÔ˘˜.

√È ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂÈÂ˜ÙˆÓ ÛÙ·ÙÈÓÒÓ Â›Ó·È ‰ÔÛÔÂÍ·ÚÙÒ-ÌÂÓ˜ Î·È Û¯ÂÙ›˙ÔÓÙ·È Ì ٷ ·˘ÍË-̤ӷ ›‰· ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÛÙÔÏ¿ÛÌ·. √È ÛÙ·Ù›Ó˜ Ô˘ ¤¯Ô˘Ó΢ڛˆ˜ ÓÂÊÚÈ΋ ·¤ÎÎÚÈÛË Â›Ó·ÈÏÔÁÈÎfi Ó· ¯ÚÂÈ¿˙ÔÓÙ·È Ú‡ıÌÈÛË(¶›Ó·Î·˜ 5). ∏ atorvastatin ¤¯ÂÈ<2% ÓÂÊÚÈ΋ ·¤ÎÎÚÈÛË Î·È ‰ÂÓ

¶›Ó·Î·˜ 4: ∫ÏÈÓÈΤ˜ ÌÂϤÙ˜ ÌÂÙ·‚ÔÏ‹˜ ÙˆÓ ÏÈȉ›ˆÓ Û ·ÛıÂÓ›˜ Ì ÃÚfiÓÈ· ¡ÂÊÚÈ΋ ¡fiÛÔ

ªÂϤÙË ¶ÏËı˘ÛÌfi˜ ™¯Â‰È·ÛÌfi˜ ¶ÚˆÙ·Ú¯ÈÎfi ¢È¿ÚÎÂÈ· £Âڷ›· RRR ARRηٷÏËÎÙÈÎfi (Ì‹Ó˜) 95% CI

ÛËÌ›Ô

Δ∂ª = Ù˘¯·ÈÔÔÈË̤ÓË ÂÏÂÁ¯fiÌÂÓË ÌÂϤÙË, RRR = Ì›ˆÛË Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘, ARR = Ì›ˆÛË ·fiÏ˘ÙÔ˘ ÎÈÓ‰‡ÓÔ˘, ™¡ =ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ˜, Cr = ÎÚ·ÙÈÓ›ÓË ÔÚÔ‡, CrCl = οı·ÚÛË ÎÚ·ÙÈÓ›Ó˘, GFR = Ú˘ıÌfi˜ ÛÂÈÚ·Ì·ÙÈ΋˜ ‰È‹ıËÛ˘, n-3PUFA = ˆÌ¤Á·-3 ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ·, NA = ÌË ‰È·ı¤ÛÈÌ·; ª£∂ª = ÌË ı·Ó·ÙËÊfiÚÔ ¤ÌÊÚ·ÁÌ· Ì˘Ôηډ›Ô˘.

ªÂϤÙ˜ ÛÙ·ÙÈÓÒÓ

ÕÏϘ ÌÂϤÙ˜

4D (19) n = 1.255 ‰È·‚ËÙÈÎÔ› Û·ÈÌÔοı·ÚÛË

Δ∂ª ∫·Ú‰È·ÎÔ› ı¿Ó·ÙÔÈ,

ı·Ó·ÙËÊfiÚÔ∞∂∂, ª£∂ª

‹ ∞∂∂

48 Atorvastatin20 mg/d

8%0.77-1.10(p = 0.37)

NA

PREVENDIT(25)

n = 1.439, ÌÈÎÚÔÏÂ˘ÎˆÌ·ÙÈ-

ÓÔ˘Ú›·,GFR ≥60

Δ∂ª, 2 x 2 ·Ú·ÁÔÓÙÈ΋

∫·Ú‰È·ÁÁÂȷ΋ıÓËÙfiÙËÙ· ηÈ

ÓÔÛËÏ›·

46 Pravastatin40 mg/d

13%0.49-1.57

(p = 0.649)

NA

HPS (23) n= 1.329, Cr1.3-2.3, ™¡, ‰È·‚‹Ù˘,

‹ ¿ÏÏË ·ÔÊÚ·ÎÙÈ΋

·ÁÁÂȷ΋ ÓfiÛÔ˜

Δ∂ª ˘ÔÔÌ¿‰·,

2 x 2·Ú·ÁÔÓÙÈ΋

√ÏÈ΋ ıÓËÛÈÌfiÙËÙ·,

Ì›˙ÔÓ· ·ÁÁÂÈ·Î¿Û˘Ì‚¿ÓÙ·

60 Simvastatin40 mg/d

28%(p = 0.05)

11%

CARE (24) n = 1.711, ™¡,GFR ≤75 ml/min

Post-hoc ·Ó¿Ï˘ÛË

˘ÔÔÌ¿‰·˜Δ∂ª

™ÙÂÊ·ÓÈ·›ÔÈ ı¿Ó·ÙÔÈ ‹

Û˘Ìو̷ÙÈÎfiª£∂ª

58.9 Pravastatin40 mg/d

28% 0.55-0.95(p = 0.02)

4%

ALERT (26) n = 2.102, ·ÛıÂÓ›˜ ÌÂ

ÓÂÊÚÈ΋ ÌÂÙ·ÌfiÛ¯Â˘ÛË

Δ∂ª ∫·Ú‰È·Îfi˜ ı¿Ó·ÙÔ˜, ª£∂ª,

ηډȷΤ˜ ÂÂÌ‚¿ÛÂȘ

60 Fluvastatin40-80 mg/d

17% 0.64-1.06

(p = 0.139)

NA

VA-HIT(28)

n = 1.046, ¿Ó‰Ú˜ Ì ™¡,

CrCl <75 ml/min

Post-hoc ·Ó¿Ï˘ÛË

˘ÔÔÌ¿‰·˜Δ∂ª

™ÙÂÊ·ÓÈ·›ÔÈı¿Ó·ÙÔÈ, ª£∂ª

60 Gemfibrozil1,200 mg/d

27% 0.56-0.96(p = 0.02)

6.3%

OPACH(20)

n = 206, ÛÙÂÊ·ÓÈ·›ÔÈ·ÛıÂÓ›˜ ÛÂ

·ÈÌÔοı·ÚÛË

Δ∂ª √ÏÈο ηډȷÁÁÂÈ·Î¿Û˘Ì‚¿ÓÙ· ηÈ

ı¿Ó·ÙÔ˜

24 n-3 PUFA 1.7 g/d

-3%0.72-1.48(p = 0.85)

NA

··ÈÙÂ›Ù·È Ú‡ıÌÈÛË Û GFR <30ml/min/1,73m2 (29). ∂›Û˘ ÔÈÛÙ·Ù›Ó˜ Ô˘ ÌÂÙ·‚ÔÏ›˙ÔÓÙ·È ·fiÙÔ Î˘Ùfi¯ÚˆÌ· P450-3A4 (cyto-chrome p450-3A4 [CYP-3A4])ÌÔÚ› ÈÔ Û˘¯Ó¿ Ó· ·ÚÔ˘ÛÈ¿-ÛÔ˘Ó ·ÚÂÓ¤ÚÁÂȘ ÂÍ·ÈÙ›·˜ Ù˘·ÏÏËÏ›‰Ú·Û˘ ÙÔ˘˜ Ì ʿÚÌ·-η Ô˘ ÌÂÙ·‚ÔÏ›˙ÔÓÙ·È ÛÙËÓ ›‰È·Ô‰fi. ∏ fluvastatin, fiˆ˜ Î·È Ëatorvastatin, ¤¯ÂÈ ÂÏ¿¯ÈÛÙË ·¤Î-ÎÚÈÛË ·fi ÙÔ˘˜ ÓÂÊÚÔ‡˜, ›Û˘‰ÂÓ ¯ÚËÛÈÌÔÔÈ› ÙÔ CYP-3A4 ÁÈ·Ó· ÌÂÙ·‚ÔÏÈÛı› (¶›Ó·Î·˜ 5) ηȉÂÓ ¤¯ÂÈ ÂÓÂÚÁÔ‡˜ ÌÂÙ·‚Ôϛ٘ÛÙËÓ Î˘ÎÏÔÊÔÚ›· (30,31). ∂ÈϤ-ÔÓ Ë ‰fiÛË Ù˘ ‰ÂÓ ·ÏÏ¿˙ÂÈ Û ·È-ÌÔηı·ÚfiÌÂÓÔ˘˜ ·ÛıÂÓ›˜ ‹ Û·ÛıÂÓ›˜ Ì ÂÚÈÙÔÓ·˚΋ οı·ÚÛË(30,31).

∂ÚˆÙ‹Ì·Ù· Û¯ÂÙÈο Ì ÙË ‰Ú¿-ÛË ÙˆÓ ÛÙ·ÙÈÓÒÓ ÛÙË Ê˘ÛÈ΋ ÈÛÙÔ-Ú›· Ù˘ á¡ ÚÔοÏÂÛÂ Ë ‰È·›-ÛÙˆÛË fiÙÈ ÚÔηÏÔ‡Ó ‹È· ·ÚÔ-‰È΋ ÛˆÏËÓ·Úȷ΋ ÚˆÙÂ˚ÓÔ˘Ú›·Û ÌÂÚÈÎÔ‡˜ ·ÛıÂÓ›˜ (32). Δ·ÂÚˆÙ‹Ì·Ù· ·˘Ù¿ ÈÛÙ‡ÂÙ·È fiÙÈ ı···ÓÙËıÔ‡Ó Ì ÙË Û˘ÌÏ‹ÚˆÛËÔÚÈÛÌ¤ÓˆÓ ÌÂÁ¿ÏˆÓ ÎÏÈÓÈÎÒÓ ÌÂÏÂ-ÙÒÓ (.¯. Ë ÌÂϤÙË SHARP). ¢Â‰Ô-̤ӷ fï˜ ·fi ÙȘ post hoc ·Ó·-χÛÂȘ ÌÂÁ¿ÏˆÓ ÎÏÈÓÈÎÒÓ ÌÂÏÂÙÒÓÌ ηډȷÁÁÂȷο ÙÂÏÈο ÛËÌ›·,ÚÔÙ›ÓÔ˘Ó fiÙÈ ÔÈ ÛÙ·Ù›Ó˜ ÚÔÊ˘-Ï¿ÛÛÔ˘Ó ÙË ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›·Î·È ÌÂÈÒÓÔ˘Ó ÙËÓ ÚˆÙÂ˚ÓÔ˘Ú›· ÌÂÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘. ∏Pravastatin Pooling Project ‹Ù·Ópost hoc ·Ó¿Ï˘ÛË ‰Â‰ÔÌ¤ÓˆÓ ·fi3 Ù˘¯·ÈÔÔÈË̤Ó˜ ÂÏÂÁ¯fiÌÂÓ˜ÌÂϤÙ˜ Û‡ÁÎÚÈÛ˘ pravastatin40 mg/ËÌÂÚËÛ›ˆ˜ Ì ÂÈÎÔÓÈÎfiÊ¿ÚÌ·ÎÔ, Û 18.000 ·ÛıÂÓ›˜ ÌÂÚÔËÁËı¤Ó ∂ª (33). H pravastatinÌ›ˆÛ ÙÔ Ú˘ıÌfi Ù˘ ·ÒÏÂÈ·˜Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ηٿ 8%(0.08 ml/min/1.73 m2/¤ÙÔ˜, 95% CI0.01 - 0.15) Î·È ÙÔ Û¯ÂÙÈÎfi ΛӉ˘ÓÔ

ÁÈ· ÔÍ›· ÓÂÊÚÈ΋ ‚Ï¿‚Ë Î·Ù¿ 60%(95% CI 0.41 - 0.86; p = 0.005). ™ÂÚfiÛÊ·ÙË ÌÂÙ·-·Ó¿Ï˘ÛË, ·Ó·ÁÓˆ-Ú›ÛÙËÎ·Ó 22 ÌÂϤÙ˜ ÂÏÂÁ¯fiÌÂӘ̠ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ Ô˘ ÌÂϤÙË-Û·Ó ÙÔ ÓÂÊÚÈÎfi fiÊÂÏÔ˜ ÙˆÓ ÛÙ·ÙÈ-ÓÒÓ. √È ÛÙ·Ù›Ó˜ ÂÏ¿ÙÙˆÛ·Ó ÙÔÚ˘ıÌfi Ì›ˆÛ˘ Ù˘ GRF ηٿ 1.23ml/min/1.73 m2/ÂÙËÛ›ˆ˜ Û˘ÁÎÚÈÙÈ-ο Ì ÙÔ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ. ∏ ÛË-Ì·ÓÙÈ΋ fï˜ ÂÙÂÚÔÁ¤ÓÂÈ· ÌÂÙ·Í‡ÙˆÓ ÌÂÏÂÙÒÓ ÂÚÈÔÚ›˙Ô˘Ó ÙËÓ ÈÛ¯‡·˘Ù‹˜ Ù˘ ·Ó·ÛÎfiËÛ˘ (34).

√È ÚÔÙÂÈÓfiÌÂÓÔÈ ÓÂÊÚÈÎÔ›ÚÔÛٷ٢ÙÈÎÔ› Ì˯·ÓÈÛÌÔ› ‚·Û›-ÛÙËÎ·Ó Û in vitro ·Ú·ÙËÚ‹ÛÂȘfiÙÈ ÔÈ ÛÙ·Ù›Ó˜ ÂÌÔ‰›˙Ô˘Ó ÙË Ê˘-ÛÈÔÏÔÁÈ΋ ·ӷÚÚfiÊËÛË Ù˘ÏÂ˘ÎˆÌ·Ù›Ó˘ ÛÙÔ ÂÁÁ‡˜ ÛˆÏËÓ¿-ÚÈÔ. ΔÔ Ì‚·ÏÔÓÈÎfi, ÂӉȿÌÂÛÔ˜ÌÂÙ·‚ÔÏ›Ù˘ ÛÙË ‚ÈÔÛ‡ÓıÂÛË Ù˘¯ÔÏËÛÙÂÚfiÏ˘, Â›Ó·È ··Ú·›ÙËÙÔÛÙË Ê˘ÛÈÔÏÔÁÈ΋ ·ӷÚÚfiÊËÛËÙ˘ ÏÂ˘ÎˆÌ·Ù›Ó˘ ÛÙÔ ÂÁÁ‡˜ Ûˆ-ÏËÓ¿ÚÈÔ Î·È Â›Ó·È ÌÂȈ̤ÓÔ Û·ÛıÂÓ›˜ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ÛÙ·Ù›ÓË(35). ™Â in vitro ÌÂϤÙ˜ Ê¿ÓËÎÂfiÙÈ Ë Â·Ó·ÚÚfiÊËÛ˘ ÙˆÓ ÚˆÙÂ-˚ÓÒÓ ÛÙ· ÂÁÁ‡˜ ÛˆÏËÓ¿ÚÈ· ›ӷÈÚÔÊÏÂÁÌÔÓ҉˘ ηٿÛÙ·ÛË, ÂÔ-̤ӈ˜ Ë ·Ó·ÛÙÔÏ‹ Ù˘ ·ӷÚÚfi-ÊËÛ˘ Ù˘ ÚˆÙ½Ó˘ ÛÙ· ÛˆÏË-Ó¿ÚÈ· ›Ûˆ˜ ‰Ú· ÓÂÊÚÔÚÔÛÙ·-Ù¢ÙÈο Ì·ÎÚÔ¯ÚfiÓÈ·.

™˘ÌÂÚ·ÛÌ·ÙÈο, ·Ó Î·È ÔÈ ÛÙ·-Ù›Ó˜ ·Ú¯Èο ·˘Í¿ÓÔ˘Ó ÙË ÛˆÏËÓ·-Úȷ΋ ÚˆÙÂ˚ÓÔ˘Ú›·, Û ‚¿ıÔ˜¯ÚfiÓÔ˘ ÌÔÚ› Ó· ÌÂÈÒÓÔ˘Ó ÙËÊÏÂÁÌÔÓ‹, ÙËÓ ÂÚ·ÈÙ¤Úˆ ›ÓˆÛËÎ·È Ó· ¤¯Ô˘Ó Û·Ó Â·ÎfiÏÔ˘ıÔ ÙËÌ›ˆÛË Ù˘ ÚˆÙÂ˚ÓÔ˘Ú›·˜ (36).

∏ ·ÛÊ¿ÏÂÈ· ÙˆÓ ·Ú·ÁÒÁˆÓÙÔ˘ ÊÈÌÚÈÎÔ‡ ÔͤԘ.

Δ· ·Ú¿ÁˆÁ· ÙÔ˘ ÊÈÌÚÈÎÔ‡ Ôͤ-Ô˜, ÁÓˆÛÙ¿ Û·Ó ÊÈÌÚ¿Ù˜, ÂÓÂÚ-

ÁÔÔÈÔ‡Ó ÂȉÈÎÔ‡˜ ÌÂÙ·ÁÚ·ÊÈ-ÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ·Ó‹ÎÔ˘ÓÛÙËÓ ÔÌ¿‰· ÙˆÓ ˘ÚËÓÈÎÒÓ ˘Ô-‰Ô¯¤ˆÓ, ÙÔ˘˜ peroxisome prolife-rators activated receptor-· (PPAR-·), ÌÂÙ·‚ÔÏ›˙ÔÓÙ·È Î·È ·Ô‚¿ÏÏÔ-ÓÙ·È ·fi ÙÔ˘˜ ÓÂÊÚÔ‡˜ (37,38).÷ڷÎÙËÚÈÛÙÈÎfi Ù˘ ηÙËÁÔÚ›·˜·˘Ù‹˜ Â›Ó·È Ë Ù¿ÛË Ó· ÚÔηÏÔ‡ÓÌÈ· ÌÈÎÚ‹, ·ÓÙÈÛÙÚÂÙ‹ ·‡ÍËÛËÙ˘ ÎÚ·ÙÈÓ›Ó˘ ÙÔ˘ ÔÚÔ‡. ™ÙȘ∏¶∞, Â›Ó·È ‰È·ı¤ÛÈ̘ Ë feno-fibrate Î·È Ë gemfibrozil. H gemfi-brozil Û ۯ¤ÛË Ì ÙËÓ fenofibrate‰ÂÓ ÚÔηÏ› ·‡ÍËÛË Ù˘ ÎÚ·ÙÈ-Ó›Ó˘, fï˜ ÚÔηÏ› Ú·‚‰ÔÌ˘fi-Ï˘ÛË fiÙ·Ó Û˘Ó‰˘·ÛÙ› Ì ÛÙ·Ù›-ÓË, ÂÍ·ÈÙ›·˜ Ù˘ Ê·ÚÌ·ÎÔÎÈÓËÙÈ-΋˜ ·ÏÏËÏ›‰Ú·Û˘ (¶›Ó·Î·˜ 6)(39). ∂ȉÈÎfiÙÂÚ·, Ë gemfibrozil ·˘-Í¿ÓÂÈ ÙË Û˘ÁΤÓÙÚˆÛË Ù˘ ÛÙ·Ù›-Ó˘ ÛÙÔ Ï¿ÛÌ·, ÂÓÒ Ë ‰Ú¿ÛËÙ˘ fenofibrate ÛÙË Û‡˙¢ÍË ÌÂÁÏ˘ÎÔ˘ÚÔÓÈÎfi Ô͇ ÙˆÓ ÛÙ·ÙÈÓÒÓÂ›Ó·È ÂÏ¿¯ÈÛÙË (¶›Ó·Î·˜ 6) (40).™ÙË ÌÂϤÙË FIELD (FenofibrateIntervention and Event Loweringin Diabetes) Ô˘ ÔÏÔÎÏËÚÒıËÎÂÛ 5 ¯ÚfiÓÈ·, 9.700 ·ÛıÂÓ›˜ ÌÂÙ‡Ô˘ 2 ™¢ Ô˘ ‰ÂÓ ÂÏ¿Ì‚·Ó·ÓÛÙ·Ù›ÓË Î·Ù¿ ÙËÓ ¤Ó·ÚÍË, Ù˘¯·ÈÔ-ÔÈ‹ıËÎ·Ó Ó· Ï¿‚Ô˘Ó micronizedfenofibrate 200 mg/ËÌÂÚËÛ›ˆ˜ ‹ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ (41). Δ· ›Â-‰· ÎÚ·ÙÈÓ›Ó˘ Ï¿ÛÌ·ÙÔ˜ ·Ú·-ÎÔÏÔ˘ıÔ‡ÓÙ·Ó ÛÙÂÓ¿ ηٿ ÙˉȿÚÎÂÈ· Ù˘ ÌÂϤÙ˘. ΔÂÏÈο ËÎÚ·ÙÈÓ›ÓË ·Ú¤ÌÂÈÓ ηٿ ̤ÛÔfiÚÔ 0,11- 0,14 mg/dl ˘„ËÏfiÙÂÚËÛÙËÓ ÔÌ¿‰· Ù˘ fenofibrate (1,03vs 0,90 mg/dl, p <0.001) ·fi ÙËÓÔÌ¿‰· ÂϤÁ¯Ô˘. Δ¤ÏÔ˜, Û ˘ÔÔ-Ì¿‰· 661 ·ÛıÂÓÒÓ Ô˘ ÌÂÏÂÙ‹ıË-Î·Ó ÁÈ· 8 ‚‰ÔÌ¿‰Â˜ ÌÂÙ¿ ·fi ÙˉȷÎÔ‹ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Ù˘ ÌÂϤ-Ù˘, Ë ÎÚ·ÙÈÓ›ÓË Ï¿ÛÌ·ÙÔ˜ ·-Ó‹Ïı ·fi ÙÔ 1,03 ÛÙÔ 0,89 mg/dl,ÁÂÁÔÓfi˜ Ô˘ ˘Ô‰ËÏÒÓÂÈ fiÙÈ ÙÔÊ¿ÚÌ·ÎÔ ‰ÂÓ ÚÔηÏ› Ì·ÎÚÔ-¯ÚfiÓÈ· ÓÂÊÚÈ΋ ‚Ï¿‚Ë. ªÂÚÈÎÔ›ÂÚ¢ÓËÙ¤˜ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ë·‡ÍËÛË Ù˘ ÎÚ·ÙÈÓ›Ó˘ Ô˘ ÚÔ-ηÏÂ›Ù·È ·fi ÙȘ ÊÈÌÚ¿Ù˜, ÔÊ›-ÏÂÙ·È ÛÙË ÌÂȈ̤ÓË ·Ú·ÁˆÁ‹·ÁÁÂÈԉȷÛÙ·ÏÙÈÎÒÓ ÚÔÛÙ·ÁÏ·Ó-‰ÈÓÒÓ. ∂ÓÒ ¿ÏÏÔÈ, fiÙÈ ÔÈ ·ÁˆÓÈ-ÛÙ¤˜ ÙˆÓ PPAR-· ˘Ô‰Ô¯¤ˆÓ ·˘-Í¿ÓÔ˘Ó ÙËÓ ·Ú·ÁˆÁ‹ Ù˘ ÎÚ·ÙÈ-Ó›Ó˘ ¯ˆÚ›˜ Ó· ÌÂÈÒÓÔ˘Ó ÙËÓ GFR(42). ªÈÎÚ‹ ·Ó·‰ÚÔÌÈ΋ ÌÂϤÙˤ‰ÂÈÍ fiÙÈ Ë gemfibrozil ÏÈÁfiÙÂÚÔÈı·Ó¿ ·˘Í¿ÓÂÈ ÙËÓ ÎÚ·ÙÈÓ›ÓË Û˘-ÁÎÚÈÙÈο Ì ÙËÓ fenofibrate, ÂÓÙÔ‡ÙÔȘ ÓÂfiÙÂÚ˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·ÓfiÙÈ ÙËÓ ·˘Í¿ÓÂÈ ·ÏÏ¿ Û ÌÈÎÚfiÙÂ-

¢ ∂ ∫ ∂ ª μ ƒ π √ ™ 2 0 0 8

6

¶›Ó·Î·˜ 5: º·ÚÌ·ÎÔÎÈÓËÙÈ΋ ÛÙ·ÙÈÓÒÓ. (31)

Atorva = atorvastatin, CYP = ΢Ùfi¯ÚˆÌ· P450; CYP-3A4 = ΢Ùfi¯ÚˆÌ· p450-3A4; Fluva = Fluvastatin, Lova = lovastatin, Prava = pravastatin, Rosuva =rosuvastatin, Simva = simvastatin, T 1/2 = ¯ÚfiÓÔ˜ ËÌ›ÛÂÈ·˜ ˙ˆ‹˜.

Rosuva Atorva Simva Lova Prava Fluva

T 1/2, h 20.8 15-30 2-3 2.9 1.3-2.8 0.5-2.3

¡ÂÊÚÈ΋ 10 <2 13 10 20 6·Ô‚ÔÏ‹, %

CYP-3A4 Ÿ¯È ¡·È ¡·È ¡·È Ÿ¯È Ÿ¯ÈÌÂÙ·‚ÔÏÈÛÌfi˜

CYP 2CY9 3A4 3A4 3A4 ı›ˆÛË 2CY9ÌÂÙ·‚ÔÏÈÛÌfi˜

ÚÔ ‚·ıÌfi (43). ™ËÌ·ÓÙÈÎfiÙÂÚ· ›-Ó·È Ù· ·ÔÙÂϤÛÌ·Ù· Ê·ÚÌ·ÎÔÎÈ-ÓËÙÈÎÒÓ ÌÂÏÂÙÒÓ Ì gemfibrozilÛ ·ÛıÂÓ›˜ Ì á¡, Ô˘ ¤‰ÂÈÍ·ÓfiÙÈ Ë ·¤ÎÎÚÈÛË Ù˘ gemfibrozilÂ›Ó·È ÌÂȈ̤ÓË Û ÌÈÎÚfiÙÂÚÔ ‚·ı-Ìfi ·fi ÙËÓ ·¤ÎÎÚÈÛË Ù˘fenofibrate (43). ªÂϤÙ˜ Û·ÛıÂÓ›˜ Ì GFR <50 ml/min/1.73m2 (̤ÙÚÈ· á¡) ¤‰ÂÈÍ·Ó ÌÂȈ̤-ÓÔ ‚·ıÌfi ·¤ÎÎÚÈÛ˘ Ù˘fenofibrate Î·È Û˘ÛÛÒÚÂ˘Û‹ Ù˘ÛÂ Û˘Ó¯‹ ¯Ú‹ÛË (38).

§fiÁˆ ÙˆÓ Ê·ÚÌ·ÎÔÎÈÓËÙÈÎÒÓ·˘ÙÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ, ÙÔ NKFÎ·È Ë ¡LA (National Lipid Asso-ciation) Âͤ‰ˆÛ·Ó Ô‰ËÁ›Â˜ ÁÈ· ÙËÓÚÔÛÂÎÙÈ΋ ¯Ú‹ÛË ÊÈÌÚ·ÙÒÓ Û·ÛıÂÓ›˜ Ì á¡ (29) Î·È ¤¯Ô˘Óˆ˜ ÂÍ‹˜: Û ·ÛıÂÓ›˜ Ì GFR 60 -90 ml/min/1.73 m2, Ì›ˆÛË Ù˘ ‰fi-Û˘ Ù˘ fenofibrate ηٿ 50%, ÁÈ·GFR 15 - 59 ml/min/1.73 m2, Ì›ˆ-ÛË Ù˘ ‰fiÛ˘ ηٿ 75% Î·È ÁÈ·GFR <15 ml/min/1.73 m2, Ó· ·Ô-ʇÁÂÙ·È. ™‡Ìʈӷ Ì ÙȘ Û˘ÛÙ¿-ÛÂȘ ÙÔ˘ NKF, Ë ÊÈÌÚ¿ÙË ÂÎÏÔ-Á‹˜ Û ·ÛıÂÓ›˜ Ì á¡ Â›Ó·È Ëgemfibrozil, ¯ˆÚ›˜ Ó· ··ÈÙ›ٷÈÚÔÛ·ÚÌÔÁ‹ Ù˘ ‰fiÛ˘ ·Ó¿ÏÔÁ·Ì ÙËÓ GFR (29).

√È ÚfiÛÊ·Ù˜ Û˘ÛÙ¿ÛÂȘ Ù˘NLA Ô˘ ·ÊÔÚÔ‡Ó ÙËÓ fenÔfibrateÂ›Ó·È ·ÚfiÌÔȘ Ì ÙȘ Ô‰ËÁ›Â˜ÙÔ˘ NKF, ‰È·Ê¤ÚÔ˘Ó ›Ûˆ˜ Û fiÙÈ·ÊÔÚ¿ ÙË ¯Ú‹ÛË Ù˘ gemfibrozil.™˘ÓÈÛÙÒÌÂÓË ‰fiÛË Ù˘ gemfibro-zile Û ·ÛıÂÓ›˜ Ì GFR <60ml/min/1.73 m2 Â›Ó·È 600 mg/ËÌÂ-ÚËÛ›ˆ˜ (50% Ì›ˆÛË) Î·È ·ÔÊ˘-Á‹ fiÏˆÓ ÙˆÓ ÊÈÌÚ·ÙÒÓ Û GFR<15 ml/min/1.73 m2. ∂ÈϤÔÓ ı·Ú¤ÂÈ Ó· ˘ÔÏÔÁ›˙ÂÙ·È Ë ÎÚ·ÙÈ-Ó›ÓË ÚÈÓ ÙËÓ ¤Ó·ÚÍË Ù˘ ÊÈÌÚ¿-Ù˘ (39).

Δ¤ÏÔ˜, ˘¿Ú¯ÂÈ ÂӉȷʤÚÔÓÁÈ· ÙËÓ Ù¿ÛË Ô˘ ¤¯ÂÈ Ë feno-fibrate Ó· ·˘Í¿ÓÂÈ ÂÚ·ÈÙ¤Úˆ Ù·‹‰Ë ·˘ÍË̤ӷ ›‰· Ù˘ ÔÌÔ-΢ÛÙ½Ó˘ (44). Δ· ·˘ÍË̤ӷ ›-‰· ÔÌÔ΢ÛÙ½Ó˘ ıˆÚÔ‡ÓÙ·È·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ηډȷÁ-

ÁÂȷ΋˜ ÓfiÛÔ˘ Î·È ˘ÂÚËÎÙÈÎfi-ÙËÙ·˜. ™ÙË ÌÂϤÙË FIELD, Ë ÔÌÔ-΢ÛÙ½ÓË Ï¿ÛÌ·ÙÔ˜ ÛÙËÓ ÔÌ¿‰·Ù˘ fenofibrate, ‹Ù·Ó ηٿ ̤ÛÔfiÚÔ 3.7 Ìmol ˘„ËÏfiÙÂÚË, ˆÛÙfiÛÔ8 ‚‰ÔÌ¿‰Â˜ ÌÂÙ¿ ÙËÓ ‰È·ÎÔ‹ÙÔ˘ Ê·ÚÌ¿ÎÔ˘, Ù· ›‰¿ Ù˘¤ÂÛ·Ó ÛÙ· ÚÈÓ ·fi ÙËÓ ¤Ó·ÚÍË›‰· (41). ΔÔ ›‰ÈÔ ¤‰ÂÈÍ·Ó Î·È¿ÏϘ ÌÂϤÙ˜ Ì fenofibrate, ÂÓÒÌÂϤÙ˜ Ì ¿ÏϘ ÊÈÌÚ¿Ù˜ ‰ÂÓ¤‰ÂÈÍ·Ó ÛÙ·ıÂÚ‹ ·‡ÍËÛË ÙˆÓ ÂÈ-¤‰ˆÓ Ù˘ ÔÌÔ΢ÛÙ½Ó˘ (45). ∏ÎÏÈÓÈ΋ ÛËÌ·Û›· ·˘Ù‹˜ Ù˘ ·‡ÍË-Û˘ Ù˘ ÔÌÔ΢ÛÙ½Ó˘ Ì feno-fÈbrate Â›Ó·È ·Û·Ê‹˜, ·ÏÏ¿ ÙfiÛÔÛÙËÓ FIELD fiÛÔ Î·È ÛÙËÓ Coro-nary Drug Project (46) Ì clofi-brate, ·Ú·ÙËÚ‹ıËΠÌÈÎÚ‹ ·ÏÏ¿ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË Ù˘ ıÚÔÌ‚ÔÂÌ-‚ÔÏÈ΋˜ ÓfiÛÔ˘ ÛÙÔ˘˜ ·ÛıÂÓ›˜Ô˘ Ï¿Ì‚·Ó·Ó ÊÈÌÚ¿ÙË.

∏ ·ÛÊ¿ÏÂÈ· ÙÔ˘ Û˘Ó‰˘·ÛÌÔ‡ÛÙ·Ù›Ó˘ Ì ÊÈÌÚ¿ÙË

∞ÛıÂÓ›˜ Ì á¡ ¤¯Ô˘Ó Û˘¯Ó¿ ÌÈ-ÎÙ‹ ‰˘ÛÏÈȉ·ÈÌ›· Î·È Û ·ÛıÂÓ›˜˘„ËÏÔ‡ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘›Ûˆ˜ ··ÈÙÂ›Ù·È Û˘Á¯ÔÚ‹ÁËÛËÛÙ·Ù›Ó˘ Ì ÊÈÌÚ¿ÙË, Ì ·ÔÙ¤-ÏÂÛÌ· Ó· Â›Ó·È ÛËÌ·ÓÙÈÎfi Ó· ÁÓˆ-Ú›˙Ô˘Ì ÙËÓ ·ÛÊ¿ÏÂÈ· Ù˘ Û˘Á¯Ô-Ú‹ÁËÛ˘ ·˘Ù‹˜. Ÿˆ˜ ·Ó·Ê¤Ú-ıËΠÈÔ ¿Óˆ, ˘¿Ú¯Ô˘Ó ¢‰È¿-ÎÚÈÙ˜ Ê·ÚÌ·ÎÔÎÈÓËÙÈΤ˜ ‰È·ÊÔ-Ú¤˜ ÌÂٷ͇ ÙˆÓ ÊÈÌÚ·ÙÒÓ fiÙ·ÓÛ˘Ó‰˘¿˙ÔÓÙ·È Ì ÛÙ·Ù›Ó˜ (¶›Ó·-η˜ 6). ∏ gemfibrozil ·˘Í¿ÓÂÈ Ù·Â›Â‰· fiÏˆÓ ÙˆÓ ÛÙ·ÙÈÓÒÓ ÛÙÔÏ¿ÛÌ·, Ì ÂÍ·›ÚÂÛË Ù˘ fluva-statin Ì ·ÔÙ¤ÏÂÛÌ· Ó· ·˘Í¿ÓÂÈÙÔÓ Î›Ó‰˘ÓÔ Ú·‚‰ÔÌ˘fiÏ˘Û˘ (47).ΔÔ ·ÔÙ¤ÏÂÛÌ· ·˘Ùfi ‰ÂÓ ·Ú·ÙË-ÚÂ›Ù·È Ì ÙË fenofibrate Î·È ‰ÂÛ¯ÂÙ›˙ÂÙ·È Ì ÙÔ CYP-3A4, ·ÏÏ¿ÔÊ›ÏÂÙ·È ÛÙËÓ ·Ó·ÛÙÔÏ‹ Ù˘ԉԇ Û‡˙¢Í˘ Ì ÙÔ ÁÏ˘ÎÔ˘ÚÔÓÈ-Îfi Ô͇ Ô˘ ÂÌϤÎÂÙ·È ÛÙÔ ÌÂÙ·-‚ÔÏÈÛÌfi ÙˆÓ ÛÙ·ÙÈÓÒÓ (47). ™‡Ì-ʈӷ Ì ÙÔ NKF, ÊÈÌÚ¿ÙË ÂÎÏÔ-Á‹˜ Â›Ó·È Ë gemfibrozil, fiÙ·Ó fï˜

ı· Ú¤ÂÈ Ó· Á›ÓÂÈ Û˘Ó‰˘·ÛÌfi˜Ì ÛÙ·Ù›ÓË, ÚÔÙÈÌ¿Ù·È Ë fenofibra-te. ∂Ó ÙÔ‡ÙÔȘ ·ÌÊfiÙÂÚ˜ (ÛÙ·-Ù›Ó˜ Î·È ÊÈÌÚ¿Ù˜) Û¯ÂÙ›˙ÔÓÙ·È·ÓÂÍ¿ÚÙËÙ· Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔÌ˘Ô¿ıÂÈ·˜ Î·È Ú·‚‰ÔÌ˘fiÏ˘Û˘fiÙ·Ó Û˘Ó‰˘¿˙ÔÓÙ·È. °È· ÙÔ Ì¤ÁÈ-ÛÙÔ Ù˘ ·ÛÊ¿ÏÂÈ·˜ ÛÙË Û˘Ó‰˘·-Ṳ̂ÓË ıÂڷ›·, Ë NLA Û˘ÛÙ‹ÓÂÈÓ· ÌË ¯ÔÚËÁÂ›Ù·È Ë Ì¤ÁÈÛÙË ‰fiÛËÙ˘ ÛÙ·Ù›Ó˘ ÛÙÔ Û˘Ó‰˘·ÛÌfi ÌÂÊÈÌÚ¿ÙË (39).

∏ ·ÛÊ¿ÏÂÈ· ÙˆÓ ¿ÏÏˆÓ ˘ÔÏÈȉ·ÈÌÈÎÒÓ Ê·Ú̿ΈÓ

√È ÈÔÓÙÔ·ÓÙ·ÏÏ·ÎÙÈΤ˜ ÚËÙ›Ó˜(colesevelam Î·È cholestyramine)Â›Ó·È ÁÂÓÈο ·ÛÊ·Ï›˜ Û ·ÛıÂ-Ó›˜ Ì á¡, ÂÂȉ‹ ‰ÂÓ ·ÔÚÚÔ-ÊÔ‡ÓÙ·È Û˘ÛÙËÌ·ÙÈο. ∂ÓÙÔ‡ÙÔȘ,ÌÔÚ› Ó· ·˘Í‹ÛÔ˘Ó Ù· ›‰·ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ Î·È ·ÓÙ‰›ÎÓ˘ÓÙ·ÈÛ ·ÛıÂÓ›˜ Ì ˘„ËÏ¿ ›‰·ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ (48). ™Â ÚfiÛÊ·-ÙË ÌÂϤÙË, 36 ·ÈÌÔηı·ÚfiÌÂÓÔÈ·ÛıÂÓ›˜ ÂÏ¿Ì‚·Ó·Ó 1.5 g colese-velam ËÌÂÚËÛ›ˆ˜ ÚÔÁÂ˘Ì·ÙÈοÁÈ· 6 Ì‹Ó˜. √È ÂÚ¢ÓËÙ¤˜ ‰È·›-ÛÙˆÛ·Ó Ì›ˆÛË Ù˘ non-HDL η-Ù¿ 20% (p <0.0001) Î·È Ù˘ ‰È¿-ÌÂÛ˘ ÙÈÌ‹˜ Ù˘ CRP ηٿ 63% (p= 0.0259) (49).

À¿Ú¯Ô˘Ó ÂÚÈÔÚÈṲ̂ӷ ‰Â‰Ô-̤ӷ fiÛÔÓ ·ÊÔÚ¿ ÙË ‰Ú¿ÛË Î·ÈÙËÓ ·ÛÊ¿ÏÂÈ· ÙÔ˘ ÓÈÎÔÙÈÓÈÎÔ‡ Ôͤ-Ô˜ ÛÙË Ã¡¡. º·ÚÌ·ÎÔÎÈÓËÙÈΤ˜ÌÂϤÙ˜ ‰ÂÈÎÓ‡Ô˘Ó fiÙÈ 34% ÙÔ˘Ê·ÚÌ¿ÎÔ˘ ÂÎÎÚ›ÓÂÙ·È ·fi ÙÔ˘˜ÓÂÊÚÔ‡˜. ™‡Ìʈӷ Ì ÙȘ Ô‰Ë-Á›Â˜ ÙÔ˘ NKF, ÁÈ· ÙÔ˘˜ ·ÛıÂÓ›˜Ì GFR <15 ml/min/1.73 m2, ˉfiÛË ı· Ú¤ÂÈ Ó· ÌÂÈÒÓÂÙ·È Î·-Ù¿ 50%, ¿Ïψ˜ ‰ÂÓ ··ÈÙÂ›Ù·È ·Ï-Ï·Á‹ Ù˘ ‰fiÛ˘ (29). À¿Ú¯Ô˘ÓÌÈÎÚ¤˜ ÌÂϤÙ˜ Ì ezetimibe Ô˘‰Â›¯ÓÔ˘Ó fiÙÈ Â›Ó·È ·ÛÊ·Ï‹˜ ηÈηϿ ·ÓÂÎÙ‹ ÛÙË Ì¤ÙÚÈ· ¤ˆ˜ ηÈÛÔ‚·Ú‹ á¡ Î·È fiÙÈ ‰ÂÓ ··ÈÙ›-Ù·È ÚÔÛ·ÚÌÔÁ‹ Ù˘ ‰fiÛ˘ ÛÂÌÂȈ̤ÓË GFR. ™ÙË ÌÂϤÙË UK-HARP II (United Kingdom Heartand Renal Protection II), ÌÂÏÂÙ‹-ıËÎ·Ó ÁÈ· 6 Ì‹Ó˜ 203 ·ÛıÂÓ›˜Ì ‰È·ÊfiÚÔ˘ ‚·ıÌÔ‡ ÓÂÊÚÈ΋·Ó¿ÚÎÂÈ· (50). ™ÙË ÌÂϤÙË Û˘-ÌÂÚÈÏ‹ÊıËÎ·Ó 152 ·ÛıÂÓ›˜ Ì›‰· ÎÚ·ÙÈÓ›Ó˘ >1,7 mg/dl,18 Û ÂÚÈÙÔÓ·˚΋ οı·ÚÛË Î·È33 Û ·ÈÌԉȇÏÈÛË. ∏ ÔÌ¿‰· ÂϤÁ-¯Ô˘ Ù¤ıËΠ۠simvastatin 20 mg/ËÌÂÚËÛ›ˆ˜ Î·È Ë ˘fi ÌÂϤÙË ÔÌ¿‰·ÛÂ Û˘Ó‰˘·ÛÌfi simvastatin 20 mgÎ·È ezetimibe 10 mg/ËÌÂÚËÛ›ˆ˜.

¶∞ƒ∞°√¡Δ∂™ ∫π¡¢À¡√À

7

Gemfibrozil FenofibrateAtorvastatin ↑ Cmax ηٿ 1.8 ∫·Ì›· ‰Ú¿ÛËSimvastatin ↑ Cmax ηٿ 2 ∫·Ì›· ‰Ú¿ÛËPravastatin ↑ Cmax ηٿ 2 ∫·Ì›· ‰Ú¿ÛËRosuvastatin ↑ Cmax ηٿ 2 ∫·Ì›· ‰Ú¿ÛËFluvastatin ∫·Ì›· ‰Ú¿ÛË ∫·Ì›· ‰Ú¿ÛËLovastatin ↑ Cmax ηٿ 2.8 ªË ‰È·ı¤ÛÈÌËCerivastatin ↑ Cmax ηٿ 2-3 ∫·Ì›· ‰Ú¿ÛË

↓ = Ì›ˆÛË, ↑ = ·‡ÍËÛË, Cmax = ̤ÁÈÛÙË Û˘ÁΤÓÙÚˆÛË.

¶›Ó·Î·˜ 6: º·ÚÌ·ÎÔÎÈÓËÙÈ΋ ·ÏÏËÏ›‰Ú·ÛË ÛÙ·ÙÈÓÒÓ/ÊÈÌÚ·ÙÒÓ. (47)

™ÙËÓ ÔÌ¿‰· Ô˘ ‹Ú ÙÔ Û˘Ó‰˘·-ÛÌfi, Ë LDL-¯ÔÏËÛÙÂÚfiÏË ÌÂÈÒıË-Πηٿ 21% ÂÚÈÛÛfiÙÂÚÔ (p =0.0001) ·fi ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘¯ˆÚ›˜ Ó· ·Ú·ÙËÚËıÔ‡Ó ÂÈϤÔÓ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ.

¢È·¯Â›ÚÈÛË ÙˆÓ ÏÈȉ›ˆÓ Û ·ÛıÂÓ›˜ Ì á¡

ÛÙ·‰›Ô˘ 3 - 4 (GFR:15-50 ml/min/1,73m2)

Δ· NKF Î·È National CholesterolEducation Program Adult Treat-ment Panel (ATP) III, ¤¯Ô˘Ó ÂΉÒ-ÛÂÈ ·ÚfiÌÔȘ Ô‰ËÁ›Â˜ ÁÈ· ÙËÓ·ÓÙÈÌÂÙÒÈÛË Ù˘ ‰˘ÛÏÈȉ·ÈÌ›·˜ÛÙË Ì¤ÙÚÈ· á¡, ˆÛÙfiÛÔ (ÔÈ Ô‰Ë-Á›Â˜) ÂÌÊ·Ó›˙Ô˘Ó ÛËÌ·ÓÙÈΤ˜ ‰È·-ÊÔÚ¤˜. (29,51). ™‡Ìʈӷ Ì ÙÈ˜Û˘ÛÙ¿ÛÂȘ ÙÔ˘ NKF, Ë Ã¡¡ ıˆ-ÚÂ›Ù·È ÈÛÔ‰‡Ó·ÌÔ ™¡ Î·È ··ÈÙ›-Ù·È ÂÙ‹ÛÈÔ˜ ÏÈȉ·ÈÌÈÎfi˜ ¤ÏÂÁ¯Ô˜.Ÿˆ˜ Â›Ó·È ÁÓˆÛÙfi, Û οı·ÛıÂÓ‹ Ì ‰˘ÛÏÈȉ·ÈÌ›· ··ÈÙ›-Ù·È ¤ÏÂÁ¯Ô˜ ÁÈ· ‰Â˘ÙÂÚÔ·ı›˜·Èٛ˜ ‰˘ÛÏÈȉ·ÈÌ›·˜ (˘Ôı˘ÚÂÔ-ÂȉÈÛÌfi˜, ‰È·‚‹Ù˘, ıÂڷ›· ÌÂÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹, protease inhi-bitors, beta-blockers, ‰ÈÔ˘ÚËÙÈο,ÔÈÛÙÚÔÁfiÓ· ).À„ËÏ‹ LDL-C. ∞Ó Î·È ÔÈ ·ÛıÂÓ›˜Ì á¡ ¤¯Ô˘Ó Û˘¯Ó¿ ÔÏϷϤ˜‰È·Ù·Ú·¯¤˜ ÙˆÓ ÏÈȉ›ˆÓ, Úˆ-Ù·Ú¯ÈÎfi˜ ÛÙfi¯Ô˜ Â›Ó·È Ë Ì›ˆÛËÙ˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘. ™‡ÌʈӷÌ ÙÔ NKF Ë LDL-¯ÔÏËÛÙÂÚfiÏË ı·Ú¤ÂÈ Ó· ÌÂÈÒÓÂÙ·È Û ›‰·<100 mg/dl Î·È Â› ÙÔ˘ ·ÚfiÓÙÔ˜,‰ÂÓ Û˘ÛÙ‹ÓÂÙ·È ÂÈıÂÙÈÎfiÙÂÚÔ˜ÛÙfi¯Ô˜ Û ·ÛıÂÓ›˜ Ì á¡ ηÈÛ˘Ìو̷ÙÈ΋ ·ıËÚÔÛÎÏËÚˆÙÈ΋ÓfiÛÔ (30). μ¿ÛÂÈ ÙˆÓ ÙÚÔÔÔÈË-Ì¤ÓˆÓ Ô‰ËÁÈÒÓ ATP III, ›Ûˆ˜ ›ӷÈÛ˘ÓÂÙfi, ÔÈ ·ÛıÂÓ›˜ Ì á¡ ηȷıËÚÔÛÎÏËÚˆÙÈ΋ ÓfiÛÔ Ó· ıÂÚ·-‡ÔÓÙ·È Ì ÛÙfi¯Ô LDL-¯ÔÏËÛÙÂ-ÚfiÏ˘ <70 mg/dl.

√È ÛÙ·Ù›Ó˜, fiˆ˜ Î·È ÛÙÔ ÁÂ-ÓÈÎfi ÏËı˘ÛÌfi, Â›Ó·È Ô ·ÎÚÔÁˆÓÈ-·›Ô˜ Ï›ıÔ˜ ÛÙË ıÂڷ›· Ù˘ ‰˘-ÛÏÈȉ·ÈÌ›·˜. ™˘Ó‹ıˆ˜ ÁÈ· Ó· ÂÈ-Ù¢¯ı› Ô ÛÙfi¯Ô˜ ··ÈÙÂ›Ù·È ÔÛ˘Ó‰˘·ÛÌfi˜ Ì ÙËÓ ·ÏÏ·Á‹ ÙÔ˘ÙÚfiÔ˘ ˙ˆ‹˜. ™Â ·ÛıÂÓ›˜ ÌÂá¡ ÌÔÚÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈË-ıÔ‡Ó Ì ·ÛÊ¿ÏÂÈ· fiϘ ÔÈ ÛÙ·Ù›-Ó˜. ∂Ó ÙÔ‡ÙÔȘ Û ÚÔ¯ˆÚË̤ÓËá¡ (GFR <30 ml/min/1,73m2)ÏÂÔÓÂÎÙÔ‡Ó ÔÚÈṲ̂Ó˜ ÛÙ·Ù›Ó˜,ÏfiÁˆ ‰È·ÊÔÚÒÓ ÛÙȘ Ê·ÚÌ·ÎÔÎÈ-ÓËÙÈΤ˜ ÙÔ˘˜ ȉÈfiÙËÙ˜. ¶ÚÔÎÂÈ̤-ÓÔ˘ ÁÈ· ÙËÓ atorvastatin, ÂÂȉ‹ Ë·¤ÎÎÚÈÛ‹ Ù˘ ·fi ÙÔ˘˜ ÓÂÊÚÔ‡˜

Â›Ó·È Ìˉ·ÌÈÓ‹, ‰ÂÓ ··ÈÙ›ٷÈÚÔÛ·ÚÌÔÁ‹ Ù˘ ‰fiÛ˘ Û ·ÛıÂ-Ó›˜ Ì ÌÂȈ̤ÓË GFR ‹ ·ÈÌԉȇ-ÏÈÛË (¶›Ó·Î·˜ 7). ∞Ó ··ÈÙ›ٷÈÛ˘Ó‰˘·ÛÌfi˜ Ì gemfibrozil, Ëfluvastatin ·ÔÙÂÏ› ÙËÓ Ï¤ÔÓ·ÛÊ·Ï‹ ÂÈÏÔÁ‹. ÕÏϘ ÛÙ·Ù›Ó˜··ÈÙÔ‡Ó ÚÔÛ·ÚÌÔÁ‹ Ù˘ ‰fiÛ˘Ì ÙËÓ ÂͤÏÈÍË Ù˘ á¡ (30) (¶›-ӷη˜ 7). ™Â ·ÛıÂÓ›˜ Ô˘ ‰ÂÓ¤¯ÂÈ ÂÈÙ¢¯ı› Ô ÛÙfi¯Ô˜ Ì ator-vastatin ‹ fluvastatin, ÌÔÚ› Ó·ÚÔÛÙÂı› Ì ·ÛÊ¿ÏÂÈ· ezetimibe‹ ÚËÙ›ÓË (¶›Ó·Î·˜ 8). ∏ ¯Ú‹ÛËÙˆÓ ÚËÙÈÓÒÓ ÌÔÚ› Ó· Â›Ó·È Â-ÚÈÔÚÈṲ̂ÓË ÏfiÁˆ ÙÔ˘ fiÙÈ ÌÔÚ›ӷ ·˘Í‹ÛÔ˘Ó Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È· ‹Ó· ÌÂÈÒÛÔ˘Ó ÙËÓ ·ÔÚÚfiÊËÛË¿ÏÏˆÓ Ê·ÚÌ¿ÎˆÓ (48).

ªÈÎÙ‹ ‰˘ÛÏÈȉ·ÈÌ›·. √È ÂÚÈÛ-ÛfiÙÂÚÔÈ ·ÛıÂÓ›˜ Ì á¡ ¤¯Ô˘Ó‰È·Ù·Ú·¯¤˜ ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ,Ù˘ HDL-¯ÔÏËÛÙÂÚfiÏ˘ ηıÒ˜Î·È ˘„ËÏ¿ ›‰· LDL-¯ÔÏËÛÙÂ-ÚfiÏ˘ (ÌÈÎÙ‹ ‰˘ÛÏÈȉ·ÈÌ›·). ªÂ-Ù¿ ÙËÓ Â›Ù¢ÍË ÙÔ˘ ÛÙfi¯Ô˘ ÁÈ·ÙËÓ LDL-¯ÔÏËÛÙÂÚfiÏË, Ô ÂfiÌÂ-ÓÔ˜ ÛÙfi¯Ô˜ Â›Ó·È Ë non-HDL, ËÔÔ›· Â›Ó·È Ë ÌfiÓË ÏÈȉ·ÈÌÈ΋ ·-Ú¿ÌÂÙÚÔ˜ Ô˘ Û˘Û¯ÂÙ›˙ÂÙ·È ıÂÙÈ-ο Ì ÙËÓ Î·Ú‰È·ÁÁÂȷ΋ ıÓËÙfi-ÙËÙ· Û ·ÈÌÔηı·ÚfiÌÂÓÔ˘˜ ·ÛıÂ-Ó›˜ (52). ∂›Ó·È ÁÓˆÛÙfi fiÙÈ ÔÈ Ôχ¯·ÌËÏ‹˜ (VLDL) Î·È ÂӉȿÌÂÛ˘(IDL) ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙ½Ó˜,Â›Ó·È ·˘ÍË̤Ó˜ Û ·ÛıÂÓ›˜ ÌÂá¡ Ì ÌÈÎÙ‹ ‰˘ÛÏÈȉ·ÈÌ›· ηÈÂÔ̤ӈ˜ Ë non-HDL ›Ûˆ˜ ›ӷÈηχÙÂÚÔ˜ ‰Â›ÎÙ˘ ÙˆÓ ÂȤ‰ˆÓÙˆÓ ·ıËÚÔÁÒÓˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ.μ¿ÛÂÈ ÙˆÓ Û˘ÛÙ¿ÛÂˆÓ ÙÔ˘ NKF,ıÂڷ¢ÙÈÎfi˜ ÛÙfi¯Ô˜ ÁÈ· ÙËÓLDL-¯ÔÏËÛÙÂÚfiÏË Î·È ÙËÓ non-HDL Û ·ÛıÂÓ›˜ Ì á¡ ›ӷÈ<100 mg/dl Î·È <130 mg/dl ·ÓÙ›-ÛÙÔȯ· (30).

∞ÛıÂÓ›˜ Ì ÌÈÎÙ‹ ‰˘ÛÏÈȉ·È-Ì›· Û˘¯Ó¿ ¯ÚÂÈ¿˙ÔÓÙ·È Û˘Ó‰˘·-Ṳ̂ÓË ıÂڷ›· Ì ÛÙ·Ù›ÓË Î·È Î¿-ÔÈÔ ¿ÏÏÔ ˘ÔÏÈȉ·ÈÌÈÎfi Ê¿ÚÌ·-ÎÔ Ô˘ ı· ÌÔÚÔ‡Û ӷ ›ӷÈezetimibe, ÊÈÌÚ¿ÙË, ÓÈÎÔÙÈÓÈÎfiÔ͇, ‹ ˆ-3 §√. ∞Ó Î·È Ë ezetimibe¤¯ÂÈ Ìˉ·ÌÈÓ‹ ›‰Ú·ÛË ÛÙËÓHDL-¯ÔÏËÛÙÂÚfiÏË Î·È Ù· ÙÚÈÁÏ˘-ÎÂÚ›‰È·, Ë ÚÔÛı‹ÎË Ù˘ Û ÛÙ·Ù›-ÓË ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· ÛËÌ·ÓÙÈ-΋ Ì›ˆÛË Ù˘ non-HDL, ‰Â˘ÙÂ-Ú‡ÔÓÙ· ÛÙfi¯Ô ÛÙË ÌÈÎÙ‹ ‰˘ÛÏÈÈ-‰·ÈÌ›· (¶›Ó·Î·˜ 8). √ Û˘Ó‰˘·-ÛÌfi˜ ÛÙ·Ù›Ó˘ Î·È ezetimibe ›ӷÈÛ¯ÂÙÈο ·ÛÊ·Ï‹˜ Î·È Î·Ï¿ ·ÓÂ-ÎÙfi˜ Û á¡ (50). Δ· ˆ-3 §√ ›-Û˘ ÌÔÚÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó

ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÛÙ·Ù›ÓË. ∞Ó Î·ÈÙ· ‰ËÌÔÛÈÂ˘Ì¤Ó· ÛÙÔȯ›· Â›Ó·È Ï›-Á·, ‰ÂÓ ˘¿Ú¯ÂÈ ÂÚÈÔÚÈÛÌfi˜ ÁÈ·Ù›‰ÂÓ ÂÌÊ·Ó›˙Ô˘Ó ÛËÌ·ÓÙÈΤ˜ ·ÏÏË-ÏÂȉڿÛÂȘ Ì ÙȘ ÛÙ·Ù›Ó˜ ηȉÂÓ ··ÈÙÂ›Ù·È ÚÔÛ·ÚÌÔÁ‹ Ù˘‰fiÛ˘ ÙÔ˘˜ Û ¤ÎÙˆÛË Ù˘ ÓÂ-ÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ (53).

√È ÊÈÌÚ¿Ù˜ ÌÔÚÔ‡Ó Ó· ‰Ô-ıÔ‡Ó ÛÙË ÌÈÎÙ‹ ‰˘ÛÏÈȉ·ÈÌ›· ÌÂÚÔÛÔ¯‹ ÂÂȉ‹ ÌÂÙ·‚ÔÏ›˙ÔÓÙ·È΢ڛˆ˜ ÛÙÔ˘˜ ÓÂÊÚÔ‡˜. ™‡ÌʈӷÌ ÙȘ Ô‰ËÁ›Â˜ ÙÔ˘ NKF, ÊÈÌÚ¿ÙËÂÎÏÔÁ‹˜ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì á¡Â›Ó·È Ë gemfibrozil (29). À¿Ú¯Ô˘Ó·ÌÊÈÛ‚ËÙ‹ÛÂȘ Û¯ÂÙÈο Ì ÙËÓ·ÛÊ¿ÏÂÈ· Ù˘ fenofibrate, ÏfiÁˆÙ˘ Ù¿Û˘ Ù˘ Ó· ·˘Í¿ÓÂÈ ÙËÓÎÚ·ÙÈÓ›ÓË Î·È ÙËÓ ÔÌÔ΢ÛÙ½ÓËÛ ÌÂÁ·Ï‡ÙÂÚÔ ‚·ıÌfi ·fi fiÙÈ Ëgemfibrozil. √ ·˘ÍË̤ÓÔ˜ ΛӉ˘-ÓÔ˜ Ú·‚‰ÔÌ˘fiÏ˘Û˘ ÛÙË Û˘Ó‰˘·-Ṳ̂ÓË ıÂڷ›· (ÛÙ·Ù›ÓË Ì ÊÈ-ÌÚ¿ÙË) ··ÈÙ› ÛÙÂÓ‹ ·Ú·ÎÔ-ÏÔ‡ıËÛË ÙˆÓ ·ÛıÂÓÒÓ Î·È ¿ÌÂÛË·Ó·ÊÔÚ¿ ÙˆÓ Ì˘˚ÎÒÓ Û˘Ìو̿-ÙˆÓ. ¶ÏÂÔÓ¤ÎÙËÌ· Ê·›ÓÂÙ·È Ó·¤¯ÂÈ Ë fenofibrate ÛÙÔ Û˘Ó‰˘·ÛÌfi,ÏfiÁˆ ÌË ·ÏÏËÏ›‰Ú·Û‹˜ Ù˘ ÌÂÙȘ ÛÙ·Ù›Ó˜ (47). ŸÙ·Ó ¯ÔÚËÁ›-Ù·È Ë gemfibrozil, ÚÔÙÈÌ¿Ù·È Ëfluvastatin Û·Ó ÛÙ·Ù›ÓË Û˘Á¯ÔÚ‹-ÁËÛ˘, ÂÂȉ‹ ‰ÂÓ ˘¿Ú¯ÂÈ ·ÏÏË-Ï›‰Ú·ÛË Î·È ¤¯Ô˘Ó ·Ó·ÊÂÚı›ÏÈÁfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ Ú·‚‰Ô-Ì˘fiÏ˘Û˘ Û˘ÁÎÚÈÙÈο Ì ¿ÏϘÛÙ·Ù›Ó˜. ∂Í·ÈÙ›·˜ Ù˘ ¯·ÌËÏ‹˜·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ Ù˘ fluva-statin ÛÙË Ì›ˆÛË Ù˘ LDL-¯ÔÏË-ÛÙÂÚfiÏ˘, Û˘¯Ó¿ ··ÈÙÂ›Ù·È ÙÚ›ÙÔÊ¿ÚÌ·ÎÔ Ô˘ ÌÔÚ› Ó· Â›Ó·È Ëezetimibe (¶›Ó·Î·˜ 8). ∂Âȉ‹ Ëá¡ ·ÔÙÂÏ› ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡-ÓÔ˘ ÁÈ· Ú·‚‰ÔÌ˘fiÏ˘ÛË, Ô Û˘Ó‰˘·-ÛÌfi˜ ÌÈ·˜ ÛÙ·Ù›Ó˘ Ì ÊÈÌÚ¿ÙË··ÈÙ› ȉȷ›ÙÂÚË ÚÔÛÔ¯‹.

∏ ÓÈ·Û›ÓË ıˆÚÂ›Ù·È ÌÈ· ÂÈÏÔ-Á‹ ÛÙË ıÂڷ›· Ù˘ ÌÈÎÙ‹˜ ‰˘-ÛÏÈȉ·ÈÌ›·˜. Œ¯ÂÈ Ê·Ó› fiÙÈ ·˘-Í¿ÓÂÈ ÙËÓ HDL-¯ÔÏËÛÙÂÚfiÏË Î·ÈÌÂÈÒÓÂÈ Î·È ÙË lipoprotein(a) Î·È Ù·ÙÚÈÁÏ˘ÎÂÚ›‰È·, Ô˘ Â›Ó·È ·˘ÍË̤-Ó· ÛÙË Ã¡¡, ·ÏÏ¿ Ë ¯Ú‹ÛË Ù˘ ›-Ó·È ÂÚÈÔÚÈṲ̂ÓË ÏfiÁˆ Ù˘ η΋˜·ÓÔ¯‹˜. √‰ËÁ›Â˜ ÙÔ˘ NKF ˘Ô-ÛÙËÚ›˙Ô˘Ó Ì›ˆÛË Ù˘ ‰fiÛ˘ η-Ù¿ 50% ÁÈ· GFR <15 mg/ml/1.73m2. √È ÚËÙ›Ó˜ ‰ÂÓ ¯ÚËÛÈÌÔÔÈÔ‡-ÓÙ·È Û˘Ó‹ıˆ˜ ÛÙË ÌÈÎÙ‹ ‰˘ÛÏÈÈ-‰·ÈÌ›· ÂÍ·ÈÙ›·˜ Ù˘ Ù¿Û˘ Ó· ·˘-Í¿ÓÔ˘Ó Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È· (29).

¶Ôχ ˘„ËÏ¿ ÙÚÈÁÏ˘ÎÂÚ›‰È·. √ Úˆ-Ù·Ú¯ÈÎfi˜ ÛÙfi¯Ô˜ Û ·ÛıÂÓ›˜ ÌÂΔG >500 mg/dl Â›Ó·È Ë ÚfiÏË„Ë

¢ ∂ ∫ ∂ ª μ ƒ π √ ™ 2 0 0 8

8

Ù˘ ·ÁÎÚ·ٛÙȉ·˜ (51). £ÂÚ·-›· ÂÎÏÔÁ‹˜ Â›Ó·È ÔÈ ÊÈÌÚ¿Ù˜ÂÂȉ‹ Â›Ó·È Î·ÏÏ›ÙÂÚ· ·ÓÂÎÙ¤˜·fi ÙË ÓÈ·Û›ÓË Î·È ·ÔÙÂÏÂÛÌ·ÙÈ-ÎfiÙÂÚ˜ ·fi ÙȘ ÛÙ·Ù›Ó˜. ™˘Á-¯ÚfiÓˆ˜ ÏfiÁˆ ·ÛÊ¿ÏÂÈ·˜ ÚÔÙ›-ÓÂÙ·È Ë gemfibrozil ·ÓÙ› Ù˘fenofibrate (¶›Ó·Î·˜ 8). ∞Ó Î·È ÌÂ-ÚÈΤ˜ ÌÂϤÙ˜ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ë‰fiÛË Ù˘ gemfibrozil ‰Â ¯ÚÂÈ¿˙Â-Ù·È Ó· ÌÂȈı› Û ÛÔ‚·Ú‹ á¡, ËNLA Safety Task Force on Lipid-Lowering Drugs, ˘ÔÛÙËÚ›˙ÂÈ fiÙÈË gemfibrozil Ú¤ÂÈ Ó· ÌÂÈÒÓÂÙ·ÈÛ 600 mg/ËÌÂÚËÛ›ˆ˜ ÛÙÔ˘˜·ÛıÂÓ›˜ Ì GFR <60 ml/min/1.73m2 Î·È Ó· ·ÔʇÁÂÙ·È fiÙ·Ó ËGFR Â›Ó·È <15 ml/min/1.73 m2(30). Δ¤ÏÔ˜, ·Ó Ú¤ÂÈ Ó· ‰Ôı› Ëfenofibrate, Ë ‰fiÛË ‰ÂÓ ı· Ú¤ÂÈÓ· ÍÂÂÚÓ¿ÂÈ Ù· 48 mg/ËÌÂÚË-Û›ˆ˜ Ì ÚÔÛÂÎÙÈ΋ ·Ú·ÎÔÏÔ‡-ıËÛË Ù˘ ÎÚ·ÙÈÓ›Ó˘ (39). ªÈ·¿ÏÏË ÂÈÏÔÁ‹ Û Ôχ ˘„ËÏ¿ ›-‰· ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ Â›Ó·È Ë ıÂÚ·-›· Ì ˆ-3 §√. Δ· ·ÚÈ· Û˘ÛÙ·-ÙÈο ÙˆÓ È¯ı˘¤Ï·ÈˆÓ Â›Ó·È ÙÔ ÂÈÎÔ-

Û·-ÂÓÙ·-ÂÓ-Ô˚Îfi Ô͇ (EPA) Î·È ÙÔÂÈÎÔÛȉ˘·-ÂÍ·-ÂÓ-Ô˚Îfi Ô͇ (DHA).ø-3 §√ Û ‰fiÛË 4 g ËÌÂÚËÛ›ˆ˜,Ì ÙË ÌÔÚÊ‹ η„Ô˘ÏÒÓ È¯ı˘ÂÏ·›-ˆÓ ÌÂÈÒÓÔ˘Ó Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È·Î·Ù¿ 35 - 45% (54), Â›Ó·È ·ÛÊ·Ï‹Û ·ÛıÂÓ›˜ Ì á¡ Î·È ¤¯Ô˘ÓÂÏ¿¯ÈÛÙË ·ÏÏËÏ›‰Ú·ÛË Ì ¿Ï-Ï· Ê¿Ú̷η. ª¤¯ÚÈ ÚfiÛÊ·Ù·,Ì›˙ˆÓ ÂÚÈÔÚÈÛÌfi˜ ·ÔÙÂÏÔ‡ÛÂË ÌÔÚÊ‹ ÙÔ˘˜, ÂÚÈ›¯·Ó ÌfiÓÔ200 - 300 mg ˆ-3 §√ ·Ó¿ ο„Ô˘-Ï· Ì ·ÔÙ¤ÏÂÛÌ· Ó· ··ÈÙÔ‡-ÓÙ·È 12 - 16 ο„Ô˘Ï˜ ËÌÂÚË-Û›ˆ˜. ™‹ÌÂÚ· ˘¿Ú¯ÂÈ ‰È·ı¤ÛÈÌËÌÔÚÊ‹ Ô˘ ÂÚȤ¯ÂÈ 900 mg, ηȷ·ÈÙÔ‡ÓÙ·È ÌfiÓÔ 4 ο„Ô˘Ï˜ËÌÂÚËÛ›ˆ˜ (54).

¢È·¯Â›ÚËÛË ÙˆÓ ÏÈȉ›ˆÓ Û·ÛıÂÓ›˜ Ì ·ÈÌÔ‰È¿Ï˘ÛË (™Ù·-‰›Ô 5, GFR <15 ml/min/1.73 m2)™Â ·ÛıÂÓ›˜ ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ á¡˘¿Ú¯Ô˘Ó ÂÚÈÛÛfiÙÂÚÔÈ ÂÚÈÔÚÈ-ÛÌÔ›. ™Â ·ÛıÂÓ›˜ Ì ˘„ËÏ‹ LDL-¯ÔÏËÛÙÂÚfiÏË, ÂÈϤÁÂÙ·È ÛÙ·Ù›ÓËÌ ÂÚÈÔÚÈṲ̂ÓË ÓÂÊÚÈ΋ ·¤Î-

ÎÚÈÛË, fiˆ˜ Ë atorvastatin ‹ Ëfluvastatin (¶›Ó·Î·˜ 8). μ·ÛÈÎfiÚfiÏÔ ÛÙË ÌÈÎÙ‹ ‰˘ÛÏÈȉ·ÈÌ›·¤¯Ô˘Ó Ù· ˆ-3 §√, ÁÈ·Ù› Û‡ÌʈӷÌ ÙȘ Ô‰ËÁ›Â˜ Ù˘ NLA, ÔÈ ÊÈ-ÌÚ¿Ù˜ Ú¤ÂÈ Ó· ·ÔʇÁÔÓÙ·ÈÛ GFR <15 ml/min/1.73 m2 (39).™Â ·ÛıÂÓ›˜ Ì Ôχ ˘„ËÏ¿ ›-‰· ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ, ¯ÔÚËÁÔ‡-ÓÙ·È 3-4 g ˆ-3 §√ ËÌÂÚËÛ›ˆ˜ ηÈÂÊfiÛÔÓ Ú¤ÂÈ Ó· ‰Ôı› ÌÈ· ÊÈ-ÌÚ¿ÙË, ÚÔÙÈÌ¿Ù·È Ë gemfimpro-zil Û ÌÂȈ̤ÓË ‰fiÛË 600 mg ËÌÂ-ÚËÛ›ˆ˜.

™˘ÌÂÚ¿ÛÌ·Ù·∏ Û˘¯ÓfiÙËÙ· Ù˘ á¡ ‰È·ÚÎÒ˜·˘Í¿ÓÂÈ ÛÙȘ ∏¶∞, Ì ÔÛÔÛÙfiÏËı˘ÛÌÔ‡ ¿Óˆ ÙÔ˘ 10% Ó· ¿-Û¯ÂÈ ·fi οÔÈÔ ÛÙ¿‰ÈÔ ÓÂÊÚÈ΋˜ÓfiÛÔ˘. √È ·ÛıÂÓ›˜ Ì á¡ ¤¯Ô˘ÓÔχ ˘„ËÏfi ΛӉ˘ÓÔ Î·Ú‰È·ÁÁÂÈ·-ÎÒÓ Û˘Ì‚¿ÓÙˆÓ Î·È ı·Ó¿ÙÔ˘.∂Í·ÈÙ›·˜ ÙÔ˘ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘Ô˘ ‰È·ÙÚ¤¯Ô˘Ó, ÙÔ NKF ¤¯ÂÈ Î·-ıÔÚ›ÛÂÈ ÙËÓ Ã¡¡ Û·Ó ÈÛÔ‰‡Ó·ÌÔηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘ Î·È ÌÂϤ-

¶∞ƒ∞°√¡Δ∂™ ∫π¡¢À¡√À

9

º¿ÚÌ·ÎÔ GFR 60-90 GFR 15-59 GFR <15ml/min/1.73 m2 ml/min/1.73 m2 ml/min/1.73 m2

™Ù·Ù›Ó˜

Atorvastatin Ÿ¯È Ÿ¯È Ÿ¯È

Fluvastatin Ÿ¯È ¢ÂÓ Î·ıÔÚ›˙ÂÙ·È ¢ÂÓ Î·ıÔÚ›˙ÂÙ·È ↓ ‰fiÛ˘ ÛÙÔ ó Û GFR <30ml/min/1.73 m2

Lovastatin Ÿ¯È ↓ ¤ˆ˜ 50% ↓ ¤ˆ˜ 50% ↓ ‰fiÛ˘ ÛÙÔ ó Û GFR <30ml/min/1.73 m2

Pravastatin Ÿ¯È Ÿ¯È Ÿ¯È ŒÓ·ÚÍË Ì 10 mg/ËÌ. ÛÂGFR <60 ml/min/1.73 m2

Rosuvastatin Ÿ¯È 5-10 mg 5-10 mg ŒÓ·ÚÍË Ì 5 mg/ËÌ. Û GFR<30 ml/min/1.73 m2, ̤ÁÈÛÙˉfiÛË 10 mg/ËÌ.

Simvastatin Ÿ¯È Ÿ¯È 5 mg ŒÓ·ÚÍË Ì 5 mg ·Ó Ë GFR<10 ml/min/1.73 m2

ÕÏÏ·Nicotinic acid Ÿ¯È Ÿ¯È ↓ ¤ˆ˜ 50% 34% ÓÂÊÚÈ΋ ·¤ÎÎÚÈÛË

Cholestyramine Ÿ¯È Ÿ¯È Ÿ¯È ¢ÂÓ ·ÔÚÚÔÊ¿Ù·È

Colesevelam Ÿ¯È Ÿ¯È Ÿ¯È ¢ÂÓ ·ÔÚÚÔÊ¿Ù·È

Ezetimibe Ÿ¯È Ÿ¯È Ÿ¯È

Fenofibrate ↓ ¤ˆ˜ 50% ↓ ¤ˆ˜ 25% ∞ÔÊ˘Á‹ ªÔÚ› Ó· ↑ ÙËÓ ÎÚ·ÙÈÓ›ÓË

Gemfibrozil Ÿ¯È Ÿ¯È Ÿ¯È NLA Û˘ÛÙ‹ÓÂÈ ‰fiÛË 600mg/ËÌ Û GFR 15-59ml/min/1.73 m2 Î·È Ó· ·Ô-ʇÁÂÙ·È Û GFR <15ml/min/1.73 m2

ø̤Á·-3 §√ Ÿ¯È Ÿ¯È Ÿ¯È

¶›Ó·Î·˜ 7: ΔÚÔÔÔ›ËÛË ‰fiÛ˘ ˘ÔÏÈȉ·ÈÌÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ÛÙËÓ Ã¡¡. (29)

↓ = Ì›ˆÛË, ↑ = ·‡ÍËÛË, á¡ = ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ÓfiÛÔ˜, §√ = ÏÈ·Ú¿ Ôͤ·, GFR = Ú˘ıÌfi˜ ÛÂÈÚ·Ì·ÙÈ΋˜ ‰È‹ıËÛ˘,NLA = National Lipid Association.

Ù˜ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ë Ã¡¡ Û˘-ÁηٷϤÁÂÙ·È ÛÙȘ ÓfiÛÔ˘˜ ˘„Ë-ÏÔ‡ ÎÈÓ‰‡ÓÔ˘ fiˆ˜ Ô Û·Î¯·ÚÒ-‰Ë˜ ‰È·‚‹Ù˘ (8). ∞Ó Î·È ÔÏÏÔ›¿ÏÏÔÈ ·Ú¿ÁÔÓÙ˜ ÂÎÙfi˜ ÙˆÓ ÏÈÈ-‰›ˆÓ Û˘Ì‚¿ÏÏÔ˘Ó ÛÙÔÓ ·˘ÍË̤ÓÔηډȷÁÁÂÈ·Îfi ΛӉ˘ÓÔ ÛÙÔ˘˜·ÛıÂÓ›˜ Ì á¡, Ù· ÏÈ›‰È· Ê·›-ÓÂÙ·È fiÙÈ ·›˙Ô˘Ó ÚˆÙ‡ÔÓÙ· Úfi-ÏÔ. Δ· ·ÔÙÂϤÛÌ·Ù· ÚÒÈ̈ÓÂȉËÌÈÔÏÔÁÈÎÒÓ ÌÂÏÂÙÒÓ Ô˘¤‰ÂÈÍ·Ó fiÙÈ Ù· ˘„ËÏ¿ ›‰· ¯Ô-ÏËÛÙÂÚfiÏ˘ ·ÔÙÂÏ› ÏÂÔÓ¤ÎÙË-Ì· Û ·ÛıÂÓ›˜ Û ·ÈÌÔοı·ÚÛË,Ì¿ÏÏÔÓ Û‡Á¯˘ÛË ÚÔοÏÂÛ·Ó. √ÈÛÔ‚·Ú¤˜ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ÌÂÙ·‚Ô-ÏÈÛÌÔ‡ ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ Ô˘·Ú·ÙËÚÔ‡ÓÙ·È Û ·ÛıÂÓ›˜ ÌÂá¡, ¤¯Ô˘Ó Û·Ó ·ÔÙ¤ÏÂÛÌ· Ù·

˘„ËÏ¿ ÙÚÈÁÏ˘ÎÂÚ›‰È· Î·È ¯·ÌËÏ‹HDL-¯ÔÏËÛÙÂÚfiÏË.√È ÛÙ·Ù›Ó˜ ·ÔÙÂÏÔ‡Ó ÙÔÓ ·ÎÚÔ-ÁˆÓÈ·›Ô Ï›ıÔ ÛÙË ıÂڷ›· ÙˆÓ·ÛıÂÓÒÓ Ì á¡ , ÂÎÙfi˜ ·fi ÙȘÂÚÈÙÒÛÂȘ ·ÛıÂÓÒÓ Ì ˘„ËÏ¿ÙÚÈÁÏ˘ÎÂÚ›‰È· (>500 mg/dl) fiÔ˘Ë ıÂڷ›· Â›Ó·È gemfibrozil ‹ ˆ-3§√. §fiÁˆ Ù˘ ·˘ÍË̤Ó˘ ›و-Û˘ ÙˆÓ ˘„ËÏÒÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓÛÙÔ˘˜ ·ÛıÂÓ›˜ ·˘ÙÔ‡˜, Â›Ó·È ÛË-Ì·ÓÙÈÎfi Ó· ˘ÔÏÔÁ›˙ÂÙ·È Ë non-HDL Î·È Ó· ·ÔÙÂÏ› ‰Â˘ÙÂÚ‡Ô-ÓÙ· ÛÙfi¯Ô ıÂڷ›·˜.∂Ӊ›ÍÂȘ ·fi ·Ó·Ï‡ÛÂȘ ˘ÔÔÌ¿-‰ˆÓ ·ÚÎÂÙÒÓ ÛËÌ·ÓÙÈÎÒÓ ÌÂÏÂ-ÙÒÓ ˘ÔÛÙËÚ›˙Ô˘Ó ÙË ıÂڷ›·Ù˘ ‰˘ÛÏÈȉ·ÈÌ›·˜ Û ‹È· Î·È ÛÂ̤ÙÚÈ· á¡. ∏ ÔÌ¿‰· ·˘Ù‹ ·ÓÙÈ-

ÚÔۈ‡ÂÈ ¿ÏψÛÙ ÙËÓ ÏÂÈÔ-ÓfiÙËÙ· ÙˆÓ ·ÛıÂÓÒÓ Ì á¡.ŸÛÔÓ ·ÊÔÚ¿ ÙÔ˘˜ ·ÛıÂÓ›˜ Û·ÈÌÔοı·ÚÛË, › ÙÔ˘ ·ÚfiÓÙÔ˜,‰ÂÓ ˘¿Ú¯Ô˘Ó ·Ô‰Â›ÍÂȘ ÁÈ· ÙÔfiÊÂÏÔ˜ Ù˘ ıÂڷ›·˜, ‰‡Ô fï˜ÌÂÁ¿Ï˜ ÌÂϤÙ˜ Ì ·ÛıÂÓ›˜ Û·ÈÌԉȇÏÈÛË Â›Ó·È Û ÂͤÏÈÍË. ª¤-¯ÚȘ fiÙÔ˘ ÔÏÔÎÏËÚˆıÔ‡Ó Î·È Ïfi-Áˆ ÙÔ˘ fiÙÈ ÔÈ ÛÙ·Ù›Ó˜ Â›Ó·È ÁÂÓÈο·ÛÊ·Ï›˜ Î·È ÌÂÈÒÓÔ˘Ó ÙÔÓ Î·Ú-‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ Û ÌË ·ÈÌÔη-ı·ÚfiÌÂÓÔ˘˜ ·ÛıÂÓ›˜, Â›Ó·È ÏÔÁÈ-Îfi Ó· ÂÍ·ÎÔÏÔ˘ı‹ÛÔ˘Ó Ó· ¯ÔÚË-ÁÔ‡ÓÙ·È ÛÙÔ˘˜ ·ÈÌÔηı·ÚfiÌÂ-ÓÔ˘˜.

∂È̤ÏÂÈ·: ª·Ú›· ¶·ÓÙÂÚ‹,

∂ÌÌ·ÓÔ˘‹Ï °·ÓˆÙ¿Î˘

¢ ∂ ∫ ∂ ª μ ƒ π √ ™ 2 0 0 8

10

μμÈÈ‚‚ÏÏÈÈÔÔÁÁÚÚ··ÊÊ››··

1. National Institute of Diabetes andDigestive and Kidney Disease, NationalInstitutes of Health. U.S. Renal DataSystem: USRDS 2000 annual report,Bethesda, Maryland. Available at:http://www.usrds.org/atlas_2000.htm.Accessed July 6, 2007.

2. U.S. Renal Data System. USRDS 2000annual data report: atlas of endstagerenal diseases in the United States (12thannual report). Bethesda, MD: Division ofKidney, Urologic, and HematologicalDisease, National Institute of Diabetes

and Digestive Disease, NationalInstitutes of Health, 2000.

3. Shulman NB, Ford CE, Hall WD, et al.Hypertension Detection and Follow-UpProgram Cooperative Group. Prognosticvalue of serum creatinine and effect oftreatment of hypertension on renalfunction. Results from the hypertensiondetection and follow-up program.Hypertension 1989;13:I80 -93.

4. Vaziri ND. Dyslipidemia of chronic renalfailure: the nature, mechanisms, andpotential consequences. Am J PhysiolRen Physiol 2005;290:F262-72.

5. Sarnak MJ, Levey AS, Schoolwerth AC,et al. Kidney disease as a risk factor fordevelopment of cardiovascular disease:a statement from the American HeartAssociation Councils on Kidney inCardiovascular Disease, High BloodPressure Research, Clinical Cardiology,and Epidemiology and Prevention.Hypertension 2003;42:1050-65.

∞˘ÍË̤ÓË LDL-C 1) Atorvastatin, ÚÔÛı‹ÎË ezetimibe ·Ó ‰ÂÓ ÂÈÙ¢¯ı› Ô ÛÙfi¯Ô˜ Ù˘ LDL-C

2) Fluvastatin, ÚÔÛı‹ÎË ezetimibe ·Ó ‰ÂÓ ÂÈÙ¢¯ı› Ô ÛÙfi¯Ô˜ Ù˘ LDL-C

ªÈÎÙ‹ ‰˘ÛÏÈȉ·ÈÌ›·* 1) Atorvastatin ‹ fluvastatin + ezetimibe(·Ó ‰ÂÓ ÂÈÙ¢¯ı› Ô 2) Fluvastatin + gemfibrozil 600 mg/day + ezetimibeÛÙfi¯Ô˜ Ù˘ non-HDL†) ·Ó ‰ÂÓ ÂÈÙ¢¯ı› Ô ÛÙfi¯Ô˜ Ù˘ non-HDL

3) Statin + ˆÌ¤Á·-3 ÏÈ·Ú¿ Ôͤ·, ÚÔÛı‹ÎË ezetimibe ·Ó ‰ÂÓ ÂÈÙ¢¯ı› Ô ÛÙfi¯Ô˜ Ù˘ non-HDL

4) Statin + fenofibrate 48 mg/day, ÚÔÛı‹ÎË ezetimibe ·Ó ‰ÂÓ ÂÈÙ¢¯ı› Ô ÛÙfi¯Ô˜ Ù˘ non-HDL

¶Ôχ ˘„ËÏ¿ ÙÚÈÁÏ˘ÎÂÚ›‰È· 1) Gemfibrozil 600 mg/ËÌ(>500 mg/dl) 2) ø̤Á·-3 ÏÈ·Ú¿ Ôͤ· 3-4 g/ËÌ

3) Fenofibrate 48 mg/ËÌ

á¡ ÛÙ·‰›Ô˘ 5 (·ÈÌÔοı·ÚÛË ‹ GFR <15 ml/min/1.73 m2)

∞˘ÍË̤ÓË LDL-C Atorvastatin (10-80 mg/day) ‹ fluvastatin 40 mg/day, ÚÔÛı‹ÎË ezetimibe ·Ó ‰ÂÓ ÂÈÙ¢¯ı› Ô ÛÙfi¯Ô˜ Ù˘ LDL-C

ªÈÎÙ‹ ‰˘ÛÏÈȉ·ÈÌ›· Atorvastatin ‹ fluvastatin 40 mg/ËÌ, ÚÔÛı‹ÎË ezetimibe 10 mg/ËÌ. ‹ ˆÌ¤Á·-3 ÏÈ·Ú¿ Ôͤ· 3-4 g/ËÌ. ·Ó ‰ÂÓ ¤¯ÂÈ ÂÈÙ¢¯ı› Ô ÛÙfi¯Ô˜ Ù˘ non-HDL

¶Ôχ ˘„ËÏ¿ ÙÚÈÁÏ˘ÎÂÚ›‰È· ø̤Á·-3 ÏÈ·Ú¿ Ôͤ· 3-4 g/ËÌÂÚËÛ›ˆ˜ ‹ gemfibrozil 600 mg/ËÌÂÚËÛ›ˆ˜

¶›Ó·Î·˜ 8: ¶ÚÔÙÂÈÓfiÌÂÓÔ˜ ıÂڷ¢ÙÈÎfi˜ ·ÏÁfiÚÈıÌÔ˜ ‰È·¯Â›ÚÈÛ˘ ÙˆÓ ÏÈȉ›ˆÓ Û ·ÛıÂÓ›˜ Ì á¡(ÛÙ¿‰ÈÔ 3-5)

*ªÈÎÙ‹ ‰˘ÛÏÈȉ·ÈÌ›· = elevated triglycerides and low HDL with or without elevated LDL. †Non-HDL = ÔÏÈ΋¯ÔÏËÛÙÂÚfiÏË - HDL-¯ÔÏËÛÙÂÚfiÏË, á¡ = ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ÓfiÛÔ˜, GFR = Ú˘ıÌfi˜ ÛÂÈÚ·Ì·ÙÈ΋˜ ‰È‹ıËÛ˘;HDL = ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙ½ÓË, LDL-C = ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙ½ÓË ¯ÔÏËÛÙÂÚfiÏË.

¢È·Ù·Ú·¯‹ ÏÈȉ›ˆÓ £Âڷ¢ÙÈ΋ ÂÈÏÔÁ‹ (ÛÙÔ ¶›Ó·Î· 7 Ë ÚÔÛ·ÚÌÔÁ‹ ÙˆÓ ‰fiÛˆÓ)

ª¤ÙÚÈ· ¤ˆ˜ ™Ô‚·Ú‹ á¡, ÛÙ¿‰ÈÔ 3-4 (GFR 15-59 ml/min/1.73 m2)

¶∞ƒ∞°√¡Δ∂™ ∫π¡¢À¡√À

11

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¢ ∂ ∫ ∂ ª μ ƒ π √ ™ 2 0 0 8

12

∏ ›وÛË Ù˘ ηډȷÁÁÂȷ΋˜ÓfiÛÔ˘ Û ·ÛıÂÓ›˜ Ì ۷ί·ÚÒ-‰Ë ‰È·‚‹ÙË Ù‡Ô˘ 2 (™¢2) Û˘-Û¯ÂÙ›˙ÂÙ·È Ì ÙÔ ÁÏ˘Î·ÈÌÈÎfi ¤ÏÂÁ-¯Ô, Ô ÔÔ›Ô˜ ÂÎÙÈÌ¿Ù·È ÎÏÈÓÈο ÌÂÙË Ì¤ÙÚËÛË Ù˘ ÁÏ˘ÎÔ˙˘ÏȈ̤-Ó˘ ·ÈÌÔÛÊ·ÈÚ›Ó˘ (HbA1C).1-3

∂ÓÒ Ô ™¢2 ·˘Í¿ÓÂÈ ÛËÌ·ÓÙÈοÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ηډȷÁ-ÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ, ÙÔ ÂÚÒÙË-Ì· Ô˘ ·Ú·Ì¤ÓÂÈ Â›Ó·È Â¿Ó ËÌ›ˆÛË Ù˘ ÁÏ˘ÎÔ˙˘ÏȈ̤Ó˘ ·È-ÌÔÛÊ·ÈÚ›Ó˘, ÌÂÈÒÓÂÈ Î·È Û ÔÈÔ‚·ıÌfi ÙËÓ Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈ-Û˘ ηډȷÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿-ÙˆÓ.

™ÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ Î›ÌÂÓÔ ı··Ó·Ï˘ıÔ‡Ó Ù· ·ÔÙÂϤÛÌ·Ù·‰‡Ô ÚfiÛÊ·ÙˆÓ ÔÏ˘ÎÂÓÙÚÈÎÒÓÎÏÈÓÈÎÒÓ ÌÂÏÂÙÒÓ, Ù˘ ÌÂϤÙ˘ACCORD (Action to ControlCardiovascular Risk in Diabetes)4

Î·È Ù˘ ÌÂϤÙ˘ ADVANCE(Action in Diabetes and VascularDisease: Preterax and DiamicronModified Release ControlledEvaluation).5 ∫·È ÔÈ ‰‡Ô ÌÂϤÙÂ˜Û˘Ó¤ÎÚÈÓ·Ó ÔÌ¿‰Â˜ Ô˘ ‹Ú·ÓÂÈıÂÙÈ΋ ‹ Û˘Ó‹ıË ıÂڷ›· ÁÈ·ÙËÓ Â›Ù¢ÍË ÙˆÓ ÁÏ˘Î·ÈÌÈÎÒÓÛÙfi¯ˆÓ Û ·ÛıÂÓ›˜ Ì ™¢2.øÛÙfiÛÔ, ˘‹Ú¯·Ó ÛËÌ·ÓÙÈΤ˜‰È·ÊÔÚ¤˜ ÛÙ· ·ÔÙÂϤÛÌ·Ù·ÙÔ˘˜ fiÛÔÓ ·ÊÔÚ¿ Î·È ÙÔ ÁÏ˘Î·È-ÌÈÎfi ¤ÏÂÁ¯Ô Î·È Ù· ηډȷÁÁÂÈ·-ο Û˘Ì‚¿Ì·Ù·. ∫·È ÔÈ ‰‡Ô ÌÂϤ-Ù˜ ·ÎÔÏÔ‡ıËÛ·Ó ÂÈıÂÙÈ΋ ıÂ-ڷ¢ÙÈ΋ ÛÙÚ·ÙËÁÈ΋ fiÛÔÓ ·ÊÔ-Ú¿ ÙÔ˘˜ ıÂڷ¢ÙÈÎÔ‡˜ ÛÙfi-¯Ô˘˜, Ì ÛÎÔfi ÙË Ì›ˆÛ‹ Ù˘HbA1C (%) οو ·fi 7% (¶›Ó·-η˜ 1).6 7

√È ÂÚÈÛÛfiÙÂÚÔÈ ·ÛıÂÓ›˜ ηÈÛÙȘ ‰‡Ô ÌÂϤÙ˜ ‹Ú·Ó Ê¿ÚÌ·-η ÔÏÏÒÓ ‰È·ÊÔÚÂÙÈÎÒÓ Î·ÙË-ÁÔÚÈÒÓ, Ì ‹ ¯ˆÚ›˜ ÙË Û˘Á¯ÔÚ‹-ÁËÛË ÈÓÛÔ˘Ï›Ó˘. ∂ÓÒ ÛÙË ÌÂϤ-ÙË ACCORD ‰ÂÓ ˘‹Ú¯·Ó ÂÚÈÔ-ÚÈÛÌÔ› fiÛÔÓ ·ÊÔÚ¿ ÙË ¯ÔÚ‹ÁËÛË

°Ï˘Î·ÈÌÈÎfi˜ ŒÏÂÁ¯Ô˜ Î·È ∫·Ú‰È·ÁÁÂȷ΋ ¡fiÛÔ˜:

∞ÔÙÂϤÛÌ·Ù· ªÂÏÂÙÒÓ ACCORD Î·È ADVANCE

ÕÚ˘-¢ËÌ‹ÙÚÈÔ˜ ∞ÁÁÔ˘Ú›‰Ë˜, ∂ÈÛÙËÌÔÓÈÎfi˜ ™˘ÓÂÚÁ¿Ù˘ ÙÔ˘ ∂Í. π·ÙÚ›Ԣ ÙˆÓ ¢È·Ù·Ú·¯ÒÓ ÙÔ˘ ªÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ §Èȉ›ˆÓ

ÙÔ˘ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ °ÂÓÈÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ πˆ·ÓÓ›ÓˆÓ

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

ΔÔ̤·˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ

÷ڷÎÙËÚÈÛÙÈο ACCORD ADVANCEÙˆÓ ·ÛıÂÓÒÓ

∫·Ù¿ ÙËÓ ¤Ó·ÚÍË

∞ÚÈıÌfi˜ ·ÛıÂÓÒÓ 10251 11140

ª¤ÛË ËÏÈΛ· (¤ÙË) 62 66

¢È¿ÚÎÂÈ· ™¢2 (¤ÙË) 10 8

ª¤ÛË HbA1C (%) 8.1 7.2

πÛÙÔÚÈÎfi 35 32Ì·ÎÚÔ·ÁÁÂȷ΋˜

ÓfiÛÔ˘ (%)

¶·Ú¤Ì‚·ÛË

™Ùfi¯Ô˜ HbA1C (%) < 6.0 < 6.5

ª¤ÛË ‰È¿ÚÎÂÈ· (¤ÙË) 3.4 5.0

º·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ ηٿ ÙËÓ ÔÏÔÎÏ‹ÚˆÛË Ù˘ ÌÂϤÙ˘ (ÂÈıÂÙÈ΋¤Ó·ÓÙÈ Û˘Ó‹ıÔ˘˜ ·ÁˆÁ‹˜) (%)

πÓÛÔ˘Ï›ÓË 77 vs 55 41 vs 24

ªÂÙÊÔÚÌ›ÓË 95 vs 87 74 vs 67

º¿Ú̷η Ô˘ ¿ÁÔ˘Ó ÙËÓ ¤ÎÎÚÈÛË ÈÓÛÔ˘Ï›Ó˘ 87 vs 74 94 vs 62(ÛÔ˘ÏÊÔÓ˘ÏÔ˘Ú›Â˜ ‹ ÁÏÈÓ›‰Â˜)

£ÂÈ·˙ÔÏȉÈÓ‰ÈfiÓ˜ 92 vs 58 17 vs 11

πÓÎÚÂÙ›ÓË 18 vs 5 ( -)

™Ù·Ù›Ó˜ 88 vs 88 46 vs 48

∞ÓÙÈ˘ÂÚÙ·ÛÈο Ê¿Ú̷η 91 vs 92 89 vs 88

·-ª∂∞ 70 vs 72 (-)

∞ÛÈÚ›ÓË 76 vs 76 57 vs 55

ŒÎ‚·ÛË (ÂÈıÂÙÈ΋ ¤Ó·ÓÙÈ Û˘Ó‹ıÔ˘˜ ·ÁˆÁ‹˜)

ª¤ÛË HbA1C ÛÙÔ Ù¤ÏÔ˜Ù˘ ÌÂϤÙ˘ (%) 6.4 vs 7.5 6.4 vs 7.0

£¿Ó·ÙÔÈ ·fi 5.0 vs 4.0 8.9 vs 9.6ÔÔÈÔ‰‹ÔÙ ·›ÙÈÔ (%)

£¿Ó·ÙÔÈ Î·Ú‰È·ÁÁÂȷ΋˜ 2.6 vs 1.8 4.5 vs 5.2·ÈÙÈÔÏÔÁ›·˜ (%)

ªË ı·Ó·ÙËÊfiÚ· ÂÌÊÚ¿ÁÌ·Ù· ÙÔ˘ 3.6 vs 4.6 2.7 vs 2.8Ì˘Ôηډ›Ô˘ (%)

ªË ı·Ó·ÙËÊfiÚ· 1.3 vs 1.2 3.8 vs 3.8ÂÁÎÂÊ·ÏÈο ÂÂÈÛfi‰È· (%)

™ËÌ·ÓÙÈÎÔ‡ ‚·ıÌÔ‡ ˘ÔÁÏ˘Î·ÈÌ›·Ô˘ ¯ÚÂÈ¿ÛÙËΠȷÙÚÈ΋ ‚Ô‹ıÂÈ· 3.1 vs 1.0 0.7 vs 0.4

(ACCORD), ‹ ÛÔ‚·Ú‹ ˘ÔÁÏ˘Î·ÈÌ›· (ADVANCE) (%/¤ÙÔ˜)

∞‡ÍËÛË ‚¿ÚÔ˘˜ (kg) 3.5 vs 0.4 0.0 vs -1.0

∂ÓÂÚÁÔ› ηÓÈÛÙ¤˜ (%) 10 vs 10 8 vs 8

¶›Ó·Î·˜ 1: ¢È·ÊÔÚ¤˜ ·Ó¿ÌÂÛ· ÛÙË ÌÂϤÙË ACCORD Î·È ÛÙË ÌÂϤÙËADVANCE

ΔÚÔÔÔ›ËÛË ·fi N Engl J Med 2008;358:2630-3.8

∫§π¡π∫∂™ ª∂§∂Δ∂™

13

Û˘ÁÎÂÎÚÈ̤ÓÔ˘ Ê·ÚÌ¿ÎÔ˘ ÁÈ·ÙËÓ Â›Ù¢ÍË ÙˆÓ ÛÙfi¯ˆÓ, ÛÙËÌÂϤÙË ADVANCE fiÏÔÈ ÔÈ ·ÛıÂ-Ó›˜ Ô˘ ·Ó‹Î·Ó ÛÙËÓ ÔÌ¿‰·ÂÓÙ·ÙÈ΋˜ ıÂڷ›·˜ ¤Ú ӷ¿ÚÔ˘Ó ÛÔ˘ÏÊÔÓ˘ÏÔ˘Ú›· (ÁÏÈ-ÎÏ·˙›‰Ë) ηٿ ÙËÓ ¤ÓÙ·ÍË ÙÔ˘˜ÛÙË ÌÂϤÙË. ™ÙË ÌÂϤÙË ADVA-NCE Ë ıÂڷ›· Ì ıÂÈ·˙ÔÏȉÈÓÂ-‰ÈfiÓË ‹Ù·Ó ÂÚÈÔÚÈṲ̂ÓË (<20%ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ¤Ï·‚·Ó ̤ÚÔ˜ÛÙË ÌÂϤÙË), ÂÓÒ ÛÙË ÌÂϤÙËACCORD ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ÚÔ-ÛÈÁÏÈÙ·˙fiÓË ÛÙÔ 92% ÙˆÓ ·ÛıÂ-ÓÒÓ Ô˘ ·Ó‹Î·Ó ÛÙËÓ ÔÌ¿‰· ÂÈ-ıÂÙÈ΋˜ ıÂڷ›·˜ Î·È ÛÙÔ 58%ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ·Ó‹Î·Ó ÛÙËÓÔÌ¿‰· Ù˘ Û˘Ó‹ıÔ˘˜ ·ÁˆÁ‹˜.™ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ Û˘ÌÌÂÙ›¯·ÓÛÙË ÌÂϤÙË ACCORD ¤ÁÈÓ ›-Û˘ Ù˘¯·ÈÔÔ›ËÛË fiÛÔÓ ·ÊÔÚ¿ÙË ¯ÔÚ‹ÁËÛË ÂÈıÂÙÈ΋˜ ‹ Û˘Ó‹-ıÔ˘˜ ıÂڷ›·˜ ÁÈ· ÙË Ì›ˆÛËÙ˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘, ηıÒ˜Î·È fiÛÔÓ ·ÊÔÚ¿ ÙË ¯ÔÚ‹ÁËÛËÊ·ÈÓÔÊÈÌÚ¿Ù˘ ‹ ÂÈÎÔÓÈÎԇʷÚÌ¿ÎÔ˘. ∞ÓÙ›ÛÙÔȯ·, ÛÙÔ˘˜·ÛıÂÓ›˜ Ô˘ Û˘ÌÌÂÙ›¯·Ó ÛÙËÌÂϤÙË ADVANCE ¤ÁÈÓÂ Ù˘¯·ÈÔ-Ô›ËÛË fiÛÔÓ ·ÊÔÚ¿ ÙË ¯ÔÚ‹ÁË-ÛË Û˘Ó‰˘·ÛÌÔ‡ ÂÚÈÓÙÔÚ›ÏË˜Î·È ÈÓ‰··Ì›‰Ë˜ ‹ ÂÈÎÔÓÈÎԇʷÚÌ¿ÎÔ˘.9

ΔÔ Î‡ÚÈÔ Î·Ù·ÏËÎÙÈÎfi ÛË-ÌÂ›Ô ÛÙË ÌÂϤÙË ADVANCE ‹Ù·ÓÔ Û˘Ó‰˘·ÛÌfi˜ Ì·ÎÚÔ·ÁÁÂÈ·ÎÒÓÎ·È ÌÈÎÚÔ·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿-ÙˆÓ. ™ÙËÓ ÔÌ¿‰· Ù˘ ÂÈıÂÙÈ΋˜ıÂڷ›·˜ ·Ú·ÙËÚ‹ıËΠ̛·Î·Ù¿ 10% Ì›ˆÛË ÙÔ˘ ·ÚÈÔ˘Î·Ù·ÏËÎÙÈÎÔ‡ ÛËÌ›Ԣ (Û¯ÂÙÈ-Îfi˜ ΛӉ˘ÓÔ˜: 0.90, 95% ‰È¿-ÛÙËÌ· ÂÌÈÛÙÔÛ‡Ó˘: 0.82-0.98,p=0.01) Û ۇÁÎÚÈÛË Ì ÙËÓÔÌ¿‰· Ù˘ Û˘Ó‹ıÔ˘˜ ·ÁˆÁ‹˜.øÛÙfiÛÔ, ·˘Ùfi ÙÔ ·ÔÙ¤ÏÂÛÌ·ÔÊ›ÏÂÙ·È ÛÙË ÌÂÁ¿ÏË Ì›ˆÛËÌÈ·˜ ÌÈÎÚÔ·ÁÁÂȷ΋˜ ÂÈÏÔ-΋˜, Ù˘ ÓÂÊÚÔ¿ıÂÈ·˜ (Û¯ÂÙÈ-Îfi˜ ΛӉ˘ÓÔ˜: 0.86, 95% ‰È¿-ÛÙËÌ· ÂÌÈÛÙÔÛ‡Ó˘: 0.77-0.97,p=0.01). ŸÛÔÓ ·ÊÔÚ¿, ‰ËÏ·‰‹,Ù· ηډȷÁÁÂȷο Û˘Ì‚¿Ì·Ù·ÛÙË ÌÂϤÙË ADVANCE ‰ÂÓ ·-Ú·ÙËÚ‹ıËΠÛËÌ·ÓÙÈ΋ Ì›ˆÛË(Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜: 0.94, 95%‰È¿ÛÙËÌ· ÂÌÈÛÙÔÛ‡Ó˘: 0.84-1.06, p=0.32). øÛÙfiÛÔ, Ë ÌÂϤ-ÙË ADVANCE ¤‰ÂÈÍ ÙÔÓ È‰È·›ÙÂ-ÚÔ ÚfiÏÔ Ô˘ ‰È·‰Ú·Ì·Ù›˙ÂÈ ÔηÏfi˜ ÁÏ˘Î·ÈÌÈÎfi˜ ¤ÏÂÁ¯Ô˜fiÛÔÓ ·ÊÔÚ¿ ÙË Ì›ˆÛË ÙˆÓ ÌÈ-ÎÚÔ·ÁÁÂÈ·ÎÒÓ ÂÈÏÔÎÒÓ Û·ÛıÂÓ›˜ Ì ™¢2.

∞ÓÙ›ıÂÙ·, ÛÙË ÌÂϤÙË ACCORD,

¶›Ó·Î·˜ 2: ∫‡ÚÈ· Î·È ‰Â˘ÙÂÚ‡ÔÓÙ· ηٷÏËÎÙÈο ÛËÌ›· ÛÙË ÌÂϤÙËACCORD

∫‡ÚÈÔ Î·Ù·ÏËÎÙÈÎfi 352 (6.9) 371 (7.2) 0.90 (0.78-1.04) 0.16

ÛËÌ›Ô

¢Â˘ÙÂÚ‡ÔÓÙ· ηٷÏËÎÙÈο ÛËÌ›·

£¿Ó·ÙÔÈ ·fi ÔÔÈÔ‰‹ÔÙ 257 (5.0) 203 (4.0) 1.22 (1.01-1.46) 0.04

·›ÙÈÔ

£¿Ó·ÙÔÈ Î·Ú‰È·ÁÁÂȷ΋˜ 135 (2.6) 94 (1.8) 1.35 (1.04-1.76) 0.02

·ÈÙÈÔÏÔÁ›·˜

ªË ı·Ó·ÙËÊfiÚ· ÂÌÊÚ¿ÁÌ·Ù· 186 (3.6) 235 (4.6) 0.76 (0.62-0.92) 0.004

ÙÔ˘ Ì˘Ôηډ›Ô˘

ªË ı·Ó·ÙËÊfiÚ· ·ÁÁÂȷο 67 (1.3) 61 (1.2) 1.06 (0.75-1.50) 0.74

ÂÁÎÂÊ·ÏÈο ÂÂÈÛfi‰È·

£·Ó·ÙËÊfiÚ· ‹ÌË ı·Ó·ÙËÊfiÚ·

ÂÂÈÛfi‰È· Û˘ÌÊÔÚËÙÈ΋˜ 152 (3.0) 124 (2.4) 1.18 (0.93-1.49) 0.17

ηډȷ΋˜ ·Ó¿ÚÎÂÈ·˜

ŒÎ‚·ÛË

∂ÈıÂÙÈ΋ ıÂڷ›·,¡=5128 ·ÚÈıÌfi˜

·ÛıÂÓÒÓ (%)

™˘Ó‹ı˘ ·ÁˆÁ‹,¡=5123 ·ÚÈıÌfi˜

·ÛıÂÓÒÓ (%)

™¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜

(95% ‰È¿ÛÙËÌ·

ÂÌÈÛÙÔÛ‡Ó˘)

P

ΔÚÔÔÔ›ËÛË ·fi N ∂ngl J Med 2008;358:2545-59

·Ú·ÙËÚ‹ıËΠ·‡ÍËÛË Ù˘ ÔÏÈ-΋˜ ıÓËÙfiÙËÙ·˜ ÛÙËÓ ÔÌ¿‰· Ù˘ÂÈıÂÙÈ΋˜ ıÂڷ›·˜. §fiÁˆ Ù˘·˘ÍË̤Ó˘ ıÓËÙfiÙËÙ·˜ Ë ÌÂϤÙˉȷÎfiËΠ17 Ì‹Ó˜ ÚÈÓ ÙËÓÔÏÔÎÏ‹ÚˆÛ‹ Ù˘ Î·È ÔÈ ·ÛıÂÓ›˜Û˘Ó¤¯ÈÛ·Ó Ì ÙË Û˘Ó‹ıË ·ÁˆÁ‹.À¿Ú¯ÂÈ fï˜ Ì›· ·ÓٛʷÛË fiÛÔÓ·ÊÔÚ¿ Ù· ‰Â˘ÙÂÚ‡ÔÓÙ· ηٷÏË-ÎÙÈο ÛËÌ›·. °È· ·Ú¿‰ÂÈÁÌ·, Ë›وÛË ı·Ó¿ÙˆÓ ·fi ÔÔÈÔ‰‹-ÔÙ ·›ÙÈÔ, ηıÒ˜ Î·È ÙˆÓ ı·Ó¿-ÙˆÓ Î·Ú‰È·ÁÁÂȷ΋˜ ·ÈÙÈÔÏÔÁ›·˜‹Ù·Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚË ÛÙËÓÔÌ¿‰· Ù˘ ÂÈıÂÙÈ΋˜ ıÂڷ›·˜Û ۇÁÎÚÈÛË Ì ÙËÓ ·ÓÙ›ÛÙÔȯËÙ˘ ÔÌ¿‰·˜ Û˘Ó‹ıÔ˘˜ ·ÁˆÁ‹˜(p=0.04 Î·È p=0.02 ·ÓÙ›ÛÙÔȯ·),ÂÓÒ Ë Â›ÙˆÛË ÙˆÓ ÌË ı·Ó·ÙË-ÊfiÚˆÓ ÂÌÊÚ·ÁÌ¿ÙˆÓ ÙÔ˘ Ì˘Ô-ηډ›Ô˘ ‹Ù·Ó ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂ-ÚË (p=0.004) ÛÙËÓ ÔÌ¿‰· ÂÈıÂ-ÙÈ΋˜ ıÂڷ›·˜ Û ۇÁÎÚÈÛË ÌÂÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë Ù˘ ÔÌ¿‰·˜ Û˘Ó‹-ıÔ˘˜ ·ÁˆÁ‹˜ (¶›Ó·Î·˜ 2).

¢È·Ù˘ÒıËÎÂ Ë ¿Ô„Ë fiÙÈ Ë˘ÔÁÏ˘Î·ÈÌ›· Â›Ó·È Èı·Ó¿ Ë Î‡-ÚÈ· ·ÈÙ›· Ù˘ ·˘ÍË̤Ó˘ ıÓËÙfi-ÙËÙ·˜ Ô˘ ·Ú·ÙËÚ‹ıËΠÛÙËÌÂϤÙË ACCORD, ηıÒ˜ Ô Û˘Ó-‰˘·ÛÌfi˜ ÛÔ˘ÏÊÔÓ˘ÏÔ˘Ú›·˜ ÌÂÈÓÛÔ˘Ï›ÓË, Ô ÔÔ›Ô˜ ·ÔÙÂÏÔ‡-

Û ÙÔ ‚·ÛÈÎfi ıÂڷ¢ÙÈÎfi Û¯‹-Ì· Ù˘ ÂÈıÂÙÈ΋˜ ıÂڷ›·˜,Û˘Û¯ÂÙ›˙ÂÙ·È Ì ·˘ÍË̤ÓÔ Î›Ó-‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ˘ÔÁÏ˘Î·ÈÌ›·˜.ÕÏϘ ÌÂϤÙ˜ ÛÙÔ Ì¤ÏÏÔÓ ı·‰Â›ÍÔ˘Ó Â¿Ó Ú¿ÁÌ·ÙÈ Ë ˘ÔÁÏ˘-ηÈÌ›· ·ÔÙÂÏ› ¤Ó· ·fi ÙÔ˘˜Î‡ÚÈÔ˘˜ ·Ú¿ÁÔÓÙ˜ ·˘ÍË̤Ó˘ıÓËÙfiÙËÙ·˜ Û ÂÚÈÙÒÛÂȘ ÂÈ-ıÂÙÈ΋˜ ÁÏ˘Î·ÈÌÈ΋˜ ·ÁˆÁ‹˜ .

™ÙË ÌÂϤÙË ADVANCE Ô ÛÙfi-¯Ô˜ fiÛÔÓ ·ÊÔÚ¿ ÙË ÁÏ˘ÎÔ˙˘ÏȈ-̤ÓË ·ÈÌÔÛÊ·ÈÚ›ÓË ÛÙËÓ ÔÌ¿‰·Ù˘ ÂÈıÂÙÈ΋˜ ıÂڷ›·˜ ‹Ù·Ó<6.5%, ÂÓÒ ÛÙË ÌÂϤÙË ACCORDÔ ›‰ÈÔ˜ ÛÙfi¯Ô˜ ‹Ù·Ó <6.0%. ΔÔÔÛÔÛÙfi Ì›ˆÛ˘ Ù˘ ÁÏ˘ÎÔ˙˘-ÏȈ̤Ó˘ ·ÈÌÔÛÊ·ÈÚ›Ó˘ ›Û˘‰È¤ÊÂÚ ÛËÌ·ÓÙÈο ÛÙȘ ‰‡Ô ÌÂ-ϤÙ˜. ™ÙË ÌÂϤÙË ACCORD ÔÈ·ÛıÂÓ›˜ Ô˘ ·Ó‹Î·Ó ÛÙËÓ ÔÌ¿-‰· Ù˘ ÂÈıÂÙÈ΋˜ ıÂڷ›·˜ ÂÌ-Ê¿ÓÈÛ·Ó Ì›ˆÛË Ù˘ ÁÏ˘ÎÔ˙˘ÏȈ-̤Ó˘ ·ÈÌÔÛÊ·ÈÚ›Ó˘ ηٿ 1.4 %Û 4 Ì‹Ó˜, ÂÓÒ ÛÙË ÌÂϤÙËADVANCE Ë ·ÓÙ›ÛÙÔÈ¯Ë Ì›ˆÛË‹Ù·Ó ÌfiÏȘ 0.5 % ÙÔ˘˜ ÚÒÙÔ˘˜6 Ì‹Ó˜ Î·È 0.6% ÛÙÔ˘˜ 12 Ì‹Ó˜·ÁˆÁ‹˜. ∞Í›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈÔÈ ·ÛıÂÓ›˜ Ù˘ ÔÌ¿‰·˜ Ù˘ ÂÈ-ıÂÙÈ΋˜ ıÂڷ›·˜ ÛÙË ÌÂϤÙËADVANCE ¤Ù˘¯·Ó ÙÔ˘˜ ıÂÚ·-

¢ ∂ ∫ ∂ ª μ ƒ π √ ™ 2 0 0 8

14

¢ÙÈÎÔ‡˜ ÛÙfi¯Ô˘˜ fiÛÔÓ ·ÊÔÚ¿ÙË Ì›ˆÛË Ù˘ ÁÏ˘ÎÔ˙˘ÏȈ̤Ó˘·ÈÌÔÛÊ·ÈÚ›Ó˘ Û ۇÁÎÚÈÛË ÌÂÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ÔÌ¿‰·˜ Û˘Ó‹-ıÔ˘˜ ·ÁˆÁ‹˜, ÂÓÒ ÛÙË ÌÂϤÙËACCORD ÌfiÓÔ ¤Ó·˜ ÌÈÎÚfi˜·ÚÈıÌfi˜ ·ÛıÂÓÒÓ Ù˘ ÔÌ¿‰·˜Ù˘ ÂÈıÂÙÈ΋˜ ıÂڷ›·˜ ¤Ù˘¯ÂÙÔ˘˜ ›‰ÈÔ˘˜ ÛÙfi¯Ô˘˜. ŒÓ· ÂÚÒ-ÙËÌ· Ô˘ ÚÔ·ÙÂÈ ·fi ÙËÓ·Ó¿Ï˘ÛË ·˘ÙÒÓ ÙˆÓ ‰Â‰Ô̤ӈÓÂ›Ó·È Â¿Ó Ô ‚·ıÌfi˜ Ì›ˆÛ˘ Ù˘ÁÏ˘ÎÔ˙˘ÏȈ̤Ó˘ ·ÈÌÔÛÊ·ÈÚ›Ó˘ÌÔÚ› Ó· ÂÍËÁ‹ÛÂÈ ÙȘ ‰È·ÊÔÚ¤˜ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÛÙȘ ‰‡Ô ÌÂ-ϤÙ˜ fiÛÔÓ ·ÊÔÚ¿ Ù· ηډȷÁ-ÁÂȷο ηٷÏËÎÙÈο ÛËÌ›·.

Δ¤ÏÔ˜, ·Í›˙ÂÈ Ó· ·Ó·ÊÂÚıÔ‡ÓÔÈ ÌÂÙ·‚ÔϤ˜ ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿-ÚÔ˘˜ ÛÙȘ ‰‡Ô ÌÂϤÙ˜. ™ÙË ÌÂ-ϤÙË ACCORD, Ë Ì¤ÛË ·‡ÍËÛËÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜ (kg) ÛÙËÓÔÌ¿‰· Ù˘ ÂÈıÂÙÈ΋˜ ıÂڷ›·˜Î·È ÛÙËÓ ÔÌ¿‰· Û˘Ó‹ıÔ˘˜ ·Áˆ-Á‹˜ ‹Ù·Ó 3.5 kg Î·È 0.4 kg ·ÓÙ›-

ÛÙÔȯ·. ∞Í›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈÙÔ 27.8% ÙˆÓ ·ÛıÂÓÒÓ Ù˘ ÔÌ¿-‰·˜ Ù˘ ÂÈıÂÙÈ΋˜ ıÂڷ›·˜ÂÌÊ¿ÓÈÛ ·‡ÍËÛË ‚¿ÚÔ˘˜ ¿Óˆ·fi 10 kg, ÂÓÒ ÙËÓ ›‰È· ·‡ÍËÛËۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜ ÂÌÊ¿ÓÈÛ Ìfi-ÓÔ ÙÔ 14.1 % ÙˆÓ ·ÛıÂÓÒÓ Ù˘ ÔÌ¿-‰·˜ Û˘Ó‹ıÔ˘˜ ·ÁˆÁ‹˜ (p<0.001).¶Èı·Ó¿, Ë Ì¤ÛË ·‡ÍËÛË ÙÔ˘ ‚¿-ÚÔ˘˜ ηٿ 3.5 kg ÛÙËÓ ÔÌ¿‰·Ù˘ ÂÈıÂÙÈ΋˜ ıÂڷ›·˜ ÔÊ›-ÏÂÙ·È ÛÙË ¯ÔÚ‹ÁËÛË ÁÏÈÙ·˙fiÓË˜Î·È ÈÓÛÔ˘Ï›Ó˘. ™ÙË ÌÂϤÙË AD-VANCE, ·Ú·ÙËÚ‹ıËΠ̛· ‰È·-ÊÔÚ¿ ÌfiÓÔ Î·Ù¿ 0.7 kg ÛÙÔ Ûˆ-Ì·ÙÈÎfi ‚¿ÚÔ˜ ÛÙËÓ ÔÌ¿‰· Ù˘ÂÈıÂÙÈ΋˜ ıÂڷ›·˜ Û ۇÁÎÚÈ-ÛË Ì ÙËÓ ÔÌ¿‰· Û˘Ó‹ıÔ˘˜ ·Áˆ-Á‹˜ (p<0.001). ŸÌˆ˜ Ë ÌÂÙ·‚Ô-Ï‹ ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜ ‹Ù·Ó·ÌÂÏËÙ¤· Î·È ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜. ∫·È ÔÈ ‰‡Ô ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ ËÌ›ˆÛË Ù˘ ÁÏ˘ÎÔ˙˘ÏȈ̤Ó˘ ·È-ÌÔÛÊ·ÈÚ›Ó˘ οو ·fi 7% Û·ÛıÂÓ›˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÌÂ

™¢2 ‰ÂÓ ÌÂÈÒÓÂÈ Ù· ηډȷÁÁÂÈ·-ο Û˘Ì‚¿Ì·Ù·. ∂›Û˘, ·˘Ù¤˜ Ôȉ‡Ô ÌÂϤÙ˜ ‰ÂÓ Î·Ù¤ÏËÍ·Ó ÛÂıÂڷ¢ÙÈÎÔ‡˜ ÛÙfi¯Ô˘˜ fiÛÔÓ·ÊÔÚ¿ ÙÔ ÁÏ˘Î·ÈÌÈÎfi ¤ÏÂÁ¯Ô Û·ÛıÂÓ›˜ ¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘. Δ¤-ÏÔ˜, Ô ÎÏÈÓÈÎfi˜ ÁÈ·ÙÚfi˜ Ô˘·ÓÙÈÌÂÙˆ›˙ÂÈ ·ÛıÂÓ›˜ Ì ™¢2Ú¤ÂÈ Ó· ÂÈÎÂÓÙÚÒÓÂÙ·È ÛÙˉȷÎÔ‹ ÙÔ˘ ηӛÛÌ·ÙÔ˜, ÛÙȘ‰È·ÈÙËÙÈΤ˜ Ô‰ËÁ›Â˜, ÛÙÔÓ ¤ÏÂÁ-¯Ô Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ηÈÛÙË ¯ÔÚ‹ÁËÛË ·ÛÈÚ›Ó˘ ηÈÛÙ·Ù›Ó˘. Δ· ÔʤÏË Û ¤Ó··ÛıÂÓ‹ Ì ™¢2 Ô ÔÔ›Ô˜ ·›ÚÓÂÈ·ÛÈÚ›ÓË, Ì›· ÛÙ·Ù›ÓË Î·È ¤¯ÂÈ Î·-Ï¿ Ú˘ıÌÈṲ̂ÓË ·ÚÙËÚȷ΋ ˘¤Ú-Ù·ÛË Â›Ó·È Ôχ ÌÂÁ·Ï‡ÙÂÚ·fiÛÔÓ ·ÊÔÚ¿ ÙË Ì›ˆÛË ÙˆÓ Î·Ú-‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ, ·ÊÔ‡fiϘ ·˘Ù¤˜ ÔÈ ıÂڷ¢ÙÈΤ˜ ÚÔ-ÛÂÁÁ›ÛÂȘ ͯˆÚÈÛÙ¿ ÌÂÈÒÓÔ˘ÓÙÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ.10 11

μμÈÈ‚‚ÏÏÈÈÔÔÁÁÚÚ··ÊÊ››··

1. Selvin E, Marinopoulos S, Berkenblit G,Rami T, Brancati FL, Powe NR, et al.Meta-analysis: glycosylatedhemoglobin and cardiovasculardisease in diabetes mellitus. AnnIntern Med 2004;141:421-31.

2. Gerstein HC, Pogue J, Mann JF, LonnE, Dagenais GR, McQueen M, et al.The relationship betweendysglycaemia and cardiovascular andrenal risk in diabetic and non-diabeticparticipants in the HOPE study: aprospective epidemiological analysis.Diabetologia 2005;48:1749-55.

3. Stratton IM, Adler AI, Neil HA, MatthewsDR, Manley SE, Cull CA, et al.Association of glycaemia with macro-vascular and microvascular compli-cations of type 2 diabetes (UKPDS35): prospective observational study.Bmj 2000;321:405-12.

4. Gerstein HC, Miller ME, Byington RP,Goff DC, Jr., Bigger JT, Buse JB, et al.Effects of intensive glucose lowering

in type 2 diabetes. N Engl J Med2008;358:2545-59.

5. Patel A, MacMahon S, Chalmers J, NealB, Billot L, Woodward M, et al.Intensive blood glucose control andvascular outcomes in patients withtype 2 diabetes. N Engl J Med2008;358:2560-72.

6. Standards of medical care in diabetes--2008. Diabetes Care 2008;31 Suppl1:S12-54.

7. Ryden L, Standl E, Bartnik M, Van denBerghe G, Betteridge J, de Boer MJ,et al. Guidelines on diabetes, pre-diabetes, and cardiovasculardiseases: executive summary. TheTask Force on Diabetes andCardiovascular Diseases of theEuropean Society of Cardiology(ESC) and of the EuropeanAssociation for the Study of Diabetes(EASD). Eur Heart J 2007;28:88-136.

8. Dluhy RG, McMahon GT. Intensiveglycemic control in the ACCORD andADVANCE trials. N Engl J Med2008;358:2630-3.

9. Patel A, MacMahon S, Chalmers J, NealB, Woodward M, Billot L, et al. Effectsof a fixed combination of perindopriland indapamide on macrovascularand microvascular outcomes inpatients with type 2 diabetes mellitus(the ADVANCE trial): a randomisedcontrolled trial. Lancet 2007;370:829-40.

10. Gaede P, Lund-Andersen H, ParvingHH, Pedersen O. Effect of amultifactorial intervention on mortalityin type 2 diabetes. N Engl J Med2008;358:580-91.

11. Gaede P, Vedel P, Larsen N, JensenGV, Parving HH, Pedersen O.Multifactorial intervention andcardiovascular disease in patientswith type 2 diabetes. N Engl J Med2003;348:383-93.

35Ô ¶·ÓÂÏÏ‹ÓÈÔ π·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ

∏ π·ÙÚÈ΋ ∂Ù·ÈÚ›· ∞ıËÓÒÓ ÔÚÁ·ÓÒÓÂÈ ÙÔ 35Ô ∂Ù‹ÛÈÔ ¶·ÓÂÏÏ‹ÓÈÔ π·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ ÛÙÔ •ÂÓÔ‰Ô¯Â›Ô Hilton, 5-9 ª·˝Ô˘ 2009.

ΔÔ ™˘Ó¤‰ÚÈÔ ÂÚÈÏ·Ì‚¿ÓÂÈ ¢È·Ï¤ÍÂȘ, ¢ÈÂÙ·ÈÚÈΤ˜ ™˘˙ËÙ‹ÛÂȘ, ™ÙÚÔÁÁ˘Ï¿ ΔÚ·¤˙È·, ™˘ÌfiÛÈ·,

∫ÏÈÓÈο ºÚÔÓÙÈÛÙ‹ÚÈ·, ™ÂÌÈÓ¿ÚÈ· Î·È ∂χıÂÚ˜ ∞Ó·ÎÔÈÓÒÛÂȘ.

∏ÌÂÚÔÌËÓ›· ÀÔ‚ÔÏ‹˜ ¶ÂÚÈÏ‹„ˆÓ: 16 π·ÓÔ˘·Ú›Ô˘ 2009.

∫§π¡π∫∂™ ª∂§∂Δ∂™

15

ªÂϤÙË GISSI-HF(Gruppo Italiano per lo Studio della Sopravvivenza ¡ell'Insufficienza Cardiaca)

GISSI-HF Investigators

Lancet 2008;372:1223-1239

¶ÚfiÎÂÈÙ·È ÁÈ· ÌÈ· ÔÏ˘ÎÂÓÙÚÈ΋,Ù˘¯·ÈÔÔÈË̤ÓË, ‰ÈÏ¿ Ù˘ÊÏ‹, ÂÏÂÁ-¯fiÌÂÓË Ì ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ ÎÏÈÓÈ-΋ ÌÂϤÙË Ô˘ ‰ÈÂÍ‹¯ıË ÛÙËÓ πÙ·-Ï›· Î·È ÂÚȤϷ‚ ·ÛıÂÓ›˜ ÌÂηډȷ΋ ·Ó¿ÚÎÂÈ· ÏÂÈÙÔ˘ÚÁÈ-ÎÔ‡ ÛÙ·‰›Ô˘ ηٿ ¡À∏∞ II ¤ˆ˜ IV.™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ó· ÂÚ¢-Ó‹ÛÂÈ Â¿Ó Ë ÚÔÛı‹ÎË ÛÙ·Ù›Ó˘ ‹ˆ-3 ÏÈ·ÚÒÓ ÔͤˆÓ ÛÙËÓ Î·ıÈÂÚˆ-̤ÓË Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ Ù˘ηډȷ΋˜ ·Ó¿ÚÎÂÈ·˜ ÌÔÚ› Ó·‚ÂÏÙÈÒÛÂÈ ·ÎfiÌË ÂÚÈÛÛfiÙÂÚÔ ÙËÓÚfiÁÓˆÛË ÙˆÓ ·ÛıÂÓÒÓ Î·È Ó·ÌÂÈÒÛÂÈ ÙË ıÓËÛÈÌfiÙËÙ· ‹/Î·È ÙËÓÔÛËÚfiÙËÙ·. ™ÙË ÌÂϤÙË ÂÓÙ¿¯ıË-Î·Ó 7.046 ·ÛıÂÓ›˜ Î·È ÙˆÓ ‰‡ÔʇψÓ, ËÏÈΛ·˜ 18 ÂÙÒÓ Î·È ¿Óˆ ÌÂÎÏÈÓÈΤ˜ ÂӉ›ÍÂȘ ‹ ÈÛÙÔÚÈÎfi ηÚ-‰È·Î‹˜ ·Ó¿ÚÎÂÈ·˜ ÔÈ·Û‰‹ÔÙ·ÈÙÈÔÏÔÁ›·˜ Î·È Â˘Ú›ÛÎÔÓÙ·Ó ˘fiÏ‹ÚË Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹, Û‡Ì-ʈӷ Ì Ù˘ Ô‰ËÁ›Â˜ Ù˘ ESC.ªÂÙ¿ ÙÔÓ ·ÔÎÏÂÈÛÌfi ÙˆÓ ·ÛıÂ-ÓÒÓ Ô˘ ‹Ù·Ó ‹‰Ë ˘fi ıÂڷ›·Ì ÛÙ·Ù›ÓË, fiÛˆÓ Â›¯·Ó ·ÓÙ¤Ó‰ÂÈÍËÓ· Ï¿‚Ô˘Ó ÛÙ·Ù›ÓË Î·È fiÛˆÓ ‰ÂÓ˘¤ÁÚ·„·Ó ÙËÓ ÂÓËÌÂڈ̤ÓË Û˘-ÁηٿıÂÛË, ÔÈ ˘fiÏÔÈÔÈ Î·Ù·ÓÂ-Ì‹ıËÎ·Ó Ù˘¯·›· Û ‰‡Ô ÔÌ¿‰Â˜Î·È ÔÈ ÌÈÛÔ› (n=2.285) ¤Ï·‚·Ó ÚÔ-ÛÔ˘‚·ÛÙ·Ù›ÓË 10 mg ÙËÓ ËÌ¤Ú·Î·È ÔÈ ¿ÏÏÔÈ (n=2.289) ÂÈÎÔÓÈÎfiÊ¿ÚÌ·ÎÔ. ªÂ ‰Â‡ÙÂÚË Ù˘¯·›· η-Ù·ÓÔÌ‹ ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ·ÛıÂ-ÓÒÓ, ·ÊÔ‡ ·ÔÎÏ›ÛıËÎ·Ó fiÛÔÈ·ÚÓ‹ıËÎ·Ó Ó· Û˘ÌÌÂÙ¿Û¯Ô˘Ó, ÔÈÌÈÛÔ› (n=3.494) ¤Ï·‚·Ó 1 g ˆ-3ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ· Ì·-ÎÚ¿˜ ·Ï‡ÛÔ˘ (ÂÈÎÔÛÈÂÓÙ·ÓÔ˚ÎfiÎ·È ÂÈÎÔÛȉ˘ÔÂÍ·ÓÔ˚Îfi Û ·Ó·ÏÔ-Á›· 1:1,2) Î·È ÔÈ ¿ÏÏÔ ÌÈÛÔ› (n=3.481)fiÌÔÈ·˜ ÂÌÊ¿ÓÈÛ˘ ÂÈÎÔÓÈÎfi Ê¿Ú-Ì·ÎÔ.

¶ÚˆÙ‡ÔÓÙ· ηٷÏËÎÙÈο ÛË-Ì›· ÔÚ›ÛıËÎ·Ó ‰‡Ô: Ô ·ÚÈıÌfi˜ÙˆÓ ı·Ó¿ÙˆÓ ÔÔÈ·Û‰‹ÔÙ ·ÈÙÈÔ-ÏÔÁ›·˜ Î·È ÙÔ ¿ıÚÔÈÛÌ· ÙˆÓ ı·Ó¿-ÙˆÓ ÔÔÈ·Û‰‹ÔÙ ·ÈÙÈÔÏÔÁ›·˜ ηÈÙˆÓ ÂÈÛ·ÁˆÁÒÓ Û ÓÔÛÔÎÔÌ›·ÏfiÁˆ ηډȷÁÁÂȷ΋˜ ¿ıËÛ˘.¢Â˘ÙÂÚ‡ÔÓÙ· ηٷÏËÎÙÈο ÛË-Ì›· ηıÔÚ›ÛıËÎ·Ó ÔÏÏ¿ Î·È Â-ÚÈÏ¿Ì‚·Ó·Ó ÙËÓ Î·Ú‰È·ÁÁÂȷ΋ıÓËÛÈÌfiÙËÙ·, ÙÔ ¿ıÚÔÈÛÌ· ηÚ-‰È·ÁÁÂÈ·ÎÒÓ ı·Ó¿ÙˆÓ Î·È ÂÈÛ·Áˆ-

ÁÒÓ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÁÈ· ÔÔÈ·‰‹-ÔÙ ·ÈÙ›·, ÙÔÓ ·ÈÊÓ›‰ÈÔ Î·Ú‰È·Îfiı¿Ó·ÙÔ, ÙÔ Ô͇ ¤ÌÊÚ·ÁÌ· ÙÔ˘Ì˘Ôηډ›Ô˘, ÙÔ ·ÁÁÂÈ·Îfi ÂÁÎÂÊ·-ÏÈÎfi, ÙË ÓÔÛËÏ›· ÁÈ· ηډȷ΋·Ó¿ÚÎÂÈ·, ÙË ÓÔÛËÏ›· ÁÈ· ηÚ-‰È·ÁÁÂÈ·Îfi ÓfiÛËÌ· Î·È ÙË ÓÔÛË-Ï›· ÁÈ· ÔÔÈ·‰‹ÔÙ ·ÈÙ›·. ∏ ·-Ú·ÎÔÏÔ‡ıËÛË ‹Ù·Ó ·fi 3 ̤¯ÚÈ4,5 ¤ÙË (‰È¿ÌÂÛË ÙÈÌ‹ 3,9 ¤ÙË).

™ÙËÓ ÔÌ¿‰· Ù˘ ÚÔÛÔ˘‚·ÛÙ·-Ù›Ó˘ Ë LDL-¯ÔÏËÛÙÂÚfiÏË ‹Ù·Ó η-Ù¿ 32% ¯·ÌËÏfiÙÂÚË ÙÔÓ ÚÒÙÔ

¯ÚfiÓÔ Î·È Î·Ù¿ 27% ÙÔÓ ÙÚ›ÙÔ¯ÚfiÓÔ. ™Â ÌÈ· ÔÌ¿‰· 626 ·ÛıÂÓÒÓÛÙÔ˘˜ ÔÔ›Ô˘˜ ÌÂÙÚ‹ıËΠËhsCRP ‚Ú¤ıËΠηٿ 0,45 mg/L¯·ÌËÏfiÙÂÚË ÛÙËÓ ÔÌ¿‰· Ù˘ ÚÔ-ÛÔ˘‚·ÛÙ·Ù›ÓË Û˘ÁÎÚÈÙÈο Ì ·˘-ÙÔ‡˜ Ô˘ ‹Ú·Ó ÂÈÎÔÓÈÎfi Ê¿ÚÌ·-ÎÔ. ™ÙËÓ ¤Î‚·ÛË ÙˆÓ ·ÛıÂÓÒÓfï˜ Ë ÚÔÛÔ˘‚·ÛÙ·Ù›ÓË ‰ÂÓ Â›¯Âη̛· ›‰Ú·ÛË. ¢Â ‰È·ÈÛÙÒıËΉȷÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓÛ ηӤӷ ·fi Ù· ÚˆÙ‡ÔÓÙ· ‹‰Â˘ÙÂÚ‡ÔÓÙ· ηٷÏËÎÙÈο ÛËÌ›·

∂ÈÎfiÓ· 1. ∫·Ì‡Ï˜ Kaplan-Meier ÁÈ· ÙÔÓ ¯ÚfiÓÔ Ì¤¯ÚÈ ÙÔÓ ı¿Ó·ÙÔ ·fi ÔÔÈ·‰‹-ÔÙ ·ÈÙ›· (∞) Î·È ÁÈ· ÙÔÓ ¯ÚfiÓÔ Ì¤¯ÚÈ ÙÔÓ ı¿Ó·ÙÔ ·fi ÔÔÈ·‰‹ÔÙ ·ÈÙ›· Û˘Ó ÂÈÛ·ÁˆÁ¤˜ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÁÈ· ηډȷÁÁÂȷο ÓÔÛ‹Ì·Ù· (μ) Û ·ÛıÂÓ›˜ Ô˘ ¤Ï·‚·Ó ÚÔÛÔ˘‚·ÛÙ·Ù›ÓË ‹ placebo.

(∂ÈÎfiÓ· 1). ∏ ÌÂϤÙË CORONA, ËÔÔ›· ›¯Â ·ÚfiÌÔÈÔ Û¯Â‰È·ÛÌfiÎ·È ‰ËÌÔÛȇıËΠÌÂÚÈÎÔ‡˜ Ì‹Ó˜ÚÈÓ, ‰ÂÓ ¤‰ÂÈÍ ›Û˘ ηӤӷfiÊÂÏÔ˜ ·fi ÙËÓ ÚÔÛÔ˘‚·ÛÙ·Ù›ÓËÛÙÔ˘˜ ηډȷÁÁÂÈ·ÎÔ‡˜ ı·Ó¿-ÙÔ˘˜, ›¯Â fï˜ ‰Â›ÍÂÈ Î¿ÔÈ· Ì›-ˆÛË ÛÙȘ ÂÈÛ·ÁˆÁ¤˜ ÛÙÔ ÓÔÛÔ-ÛÎÔÌ›Ô.

¶ÚÈÓ ÙËÓ ‰ËÌÔÛ›Â˘ÛË ÙˆÓ ÌÂ-ÏÂÙÒÓ ·˘ÙÒÓ ˘‹Ú¯·Ó ·ÚÎÂÙ¤˜ÂӉ›ÍÂȘ ·fi ÂÈÚ·Ì·ÙÈΤ˜ ÌÂϤ-Ù˜, ÌÂϤÙ˜ ·Ú·Ù‹ÚËÛ˘, ‰Â˘-ÙÂÚ‡ԢÛ˜ (post hoc) ·Ó·Ï‡ÛÂȘÎÏÈÓÈÎÒÓ ÌÂÏÂÙÒÓ Î·Ú‰È·Î‹˜ ·ÓÂ-¿ÚÎÂÈ·˜ Î·È ÌÈÎÚ¤˜ ÚÔÔÙÈΤ˜Ù˘¯·ÈÔÔÈË̤Ó˜ ÌÂϤÙ˜ fiÙÈ ÔÈÛÙ·Ù›Ó˜ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ˆÊÂ-ÏÔ‡Ó ÛÙËÓ Î·Ú‰È·Î‹ ·Ó¿ÚÎÂÈ·.√È ÂӉ›ÍÂȘ ·˘Ù¤˜ ÂÓÈÛ¯‡ÔÓÙ·Ó·fi ÙËÓ ıˆÚËÙÈ΋ ¿Ô„Ë Ô˘˘ÔÛÙ‹ÚÈ˙ fiÙÈ ÔÈ ÏÂÈÔÙÚÔÈΤ˜‰Ú¿ÛÂȘ ÙˆÓ ÛÙ·ÙÈÓÒÓ (·ÓÙÈÊÏÂÁ-ÌÔÓ҉˘ ‰Ú¿ÛË, ‚ÂÏÙ›ˆÛË Ù˘ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜ ÙÔ˘ ÂÓ‰ÔıËÏ›-Ô˘, ·Ó·ÛÙÔÏ‹ Ù˘ Ó¢ÚÔÔÚÌÔÓÈ-΋˜ ‰Ú·ÛÙËÚÈÔÔ›ËÛ˘, ·ÓÙÈÔÍÂÈ-‰ˆÙÈ΋ Î·È ·ÓÙÈ·ıËÚÔÛÎÏËÚˆÙÈ΋‰Ú¿ÛË), ÂÓ‰¤¯ÂÙ·È Ó· ‚ÂÏÙÈÒÓÔ˘ÓÙËÓ ¤Î‚·ÛË ·ÛıÂÓÒÓ Ì ηډȷ΋·Ó¿ÚÎÂÈ·. Δ· Â˘Ú‹Ì·Ù· Û˘ÓÂ-Ò˜ ‰ÂÓ Â›Ó·È Ù· ·Ó·ÌÂÓfiÌÂÓ· ηȉÂÓ ÌÔÚÔ‡Ó Â‡ÎÔÏ· Ó· ÂÍËÁË-ıÔ‡Ó. √È ÛÙ·Ù›Ó˜ Û·ÊÒ˜ ˆÊÂ-ÏÔ‡Ó ÛÙËÓ ÚfiÏË„Ë Ù˘ ηډȷÁ-ÁÂȷ΋˜ ·Ó¿ÚÎÂÈ·˜, ÌÂÈÒÓÔÓÙ·˜Ù· ÂÌÊÚ¿ÁÌ·Ù·, Ê·›ÓÂÙ·È fï˜fiÙÈ fiÙ·Ó Ë Î·Ú‰È·Î‹ ·Ó¿ÚÎÂÈ·ÂÁηٷÛÙ·ı› ‰ÂÓ Â›Ó·È ÈηӤ˜ Ó··Ó·Îfi„Ô˘Ó ÙËÓ ÔÚ›· Ù˘ Ófi-ÛÔ˘. √È ÏÂÁfiÌÂÓ˜ ÏÂÈÔÙÚÔÈΤ˜‰Ú¿ÛÂȘ ¤¯Ô˘Ó ·Ô‰Âȯı› Û¢ÔηٿÛٷٷ (surrogate) ÙÂÏÈοÛËÌ›·, fi¯È fï˜ Û ÎÏÈÓÈο Û˘Ì-‚¿Ì·Ù·. ∞fi ÙËÓ ¿ÏÏË ÏÂ˘Ú¿ÛÙȘ ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ¤¯ÂÈÊ·Ó› fiÙÈ ÔÈ ·ÛıÂÓ›˜ Ì ٷ ¯·ÌË-ÏfiÙÂÚ· ›‰· ¯ÔÏËÛÙÂÚfiÏ˘¤¯Ô˘Ó ÙË ¯ÂÈÚfiÙÂÚË ÚfiÁÓˆÛË.ÿÛˆ˜ ÔÈ ÏÈÔÚˆÙ½Ó˜ ÂÍÔ˘‰ÂÙÂ-ÚÒÓÔ˘Ó ÂÓ‰ÔÙÔ͛Ә Ô˘ ÂÈÛ¤Ú¯Ô-ÓÙ·È ÛÙËÓ Î˘ÎÏÔÊÔÚ›· ·fi ÙÔ ÔÈ-‰ËÌ·Ù҉˜ ¤ÓÙÂÚÔ ÛÙËÓ Î·Ú‰È·-΋ ·Ó¿ÚÎÂÈ·. ¶¿ÓÙˆ˜ Î·È ÛÙȘ‰‡Ô ÌÂϤÙ˜ ‰ÂÓ ·Ú·ÙËÚ‹ıËηӷÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ·fi ÙËÚÔÛÔ˘‚·ÛÙ·Ù›ÓË ÂÚÈÛÛfiÙÂÚ˜·fi ÙÔ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ, Ú¿Á-Ì· Ô˘ ·Ô‰ÂÈÎÓ‡ÂÈ fiÙÈ ÔÈ ÛÙ·Ù›-Ó˜ Â›Ó·È ÙÔ˘Ï¿¯ÈÛÙÔÓ ·ÛÊ·Ï›˜ÛÙËÓ Î·Ú‰È·Î‹ ·Ó¿ÚÎÂÈ·.

Δ· ˆ-3 ÏÈ·Ú¿ Ôͤ·, Û ·ÓÙ›-ıÂÛË Ì ÙËÓ ÚÔÛÔ˘‚·ÛÙ·Ù›ÓË, ‰ÂÓÌ›ˆÛ·Ó ÙËÓ LDL-¯ÔÏËÛÙÂÚfiÏË,·Ô‰Â›¯ıËÎ·Ó fï˜ ·ÔÙÂÏÂÛÌ·-

ÙÈο Î·È Ì›ˆÛ·Ó ηٿ 9% ÙÔ˘˜ı·Ó¿ÙÔ˘˜ (p=0,04) Î·È Î·Ù¿ 8%ÙÔ ¿ıÚÔÈÛÌ· ı·Ó¿ÙˆÓ Î·È ÓÔÛË-ÏÂÈÒÓ (p=0,009) (∂ÈÎfiÓ· 2). ™Â·fiÏ˘ÙÔ˘˜ ·ÚÈıÌÔ‡˜, ÁÈ· Ó· ·Ô-Ê¢¯ı› ¤Ó·˜ ı¿Ó·ÙÔ˜ ¯ÚÂÈ¿˙ÂÙ·ÈÓ· Ï·Ì‚¿ÓÔ˘Ó ˆ-3 ÏÈ·Ú¿ Ôͤ·56 ¿ÙÔÌ· (¡¡Δ) › 3,9 ¯ÚfiÓÈ· ηÈÁÈ· Ó· ·ÔÊ¢¯ı› ¤Ó·˜ ı¿Ó·ÙÔ˜‹ ÌÈ· ÂÈÛ·ÁˆÁ‹ Û ÓÔÛÔÎÔÌ›ԯÚÂÈ¿˙ÂÙ·È Ó· ıÂڷ‡ÔÓÙ·È 44¿ÙÔÌ·. ∂˘ÓÔ˚ο ·ÔÙÂϤÛÌ·Ù·ÙˆÓ ˆ-3 ÏÈ·ÚÒÓ ÔͤˆÓ ¤¯Ô˘Ó‰È·ÈÛÙˆı› Î·È ÛÙȘ ÌÂϤÙ˜GISSI-P Î·È DART Û ·ÛıÂÓ›˜ ÌÂ-Ù¿ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘ ηÈÛÙË ÌÂϤÙË JELIS Û ·ÛıÂÓ›˜ Ì¢ÂÚÏÈȉ·ÈÌ›· Î·È Ì ‹ ¯ˆÚ›˜ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ (ÚˆÙÔÁÂÓ‹˜ Î·È‰Â˘ÙÂÚÔÁÂÓ‹˜ ÚfiÏË„Ë). ™˘ÌÂÚ·ÛÌ·ÙÈο, ÛÙËÓ Î·Ú‰È·Î‹

·Ó¿ÚÎÂÈ· Â›Ó·È ˆÊ¤ÏÈÌ· Ù· ˆ-3ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ· Û‰fiÛË 1 g ÙËÓ Ë̤ڷ, ·ÏÏ¿ ÔÈ ÛÙ·-Ù›Ó˜ ‰ÂÓ ÚÔÛʤÚÔ˘Ó fiÊÂÏÔ˜. √ÈıÂÚ¿ÔÓÙ˜ È·ÙÚÔ› ‰ÂÓ ‰ÈηÈÔÏÔ-ÁÔ‡ÓÙ·È Ó· ·Ú¯›ÛÔ˘Ó ÛÙ·Ù›ÓË ÛÂ¤Ó·Ó ·ÛıÂÓ‹ Ì ÂÁηÙÂÛÙË̤ÓËηډȷ΋ ·Ó¿ÚÎÂÈ· ÔÔÈ·Û‰‹-ÔÙ ·ÈÙÈÔÏÔÁ›·˜ ‹ ÏÂÈÙÔ˘ÚÁÈÎÔ‡ÛÙ·‰›Ô˘, ‰ÂÓ Â›Ó·È fï˜ ۷ʤ˜ ·ÓÚ¤ÂÈ Ó· ‰È·ÎfiÙÔ˘Ó ÙȘ ÛÙ·Ù›-Ó˜ Û ·ÛıÂÓ›˜ Ô˘ ‹‰Ë ‚Ú›ÛÎÔ-ÓÙ·È Û ıÂڷ›· Ì ٷ Ê¿Ú̷η·˘Ù¿ Î·È ÂΉËÏÒÓÔ˘Ó Î·Ú‰È·Î‹·Ó¿ÚÎÂÈ·. ™ÙȘ ÂÚÈÙÒÛÂȘ ·˘-Ù¤˜ ·ʛÂÙ·È ÛÙËÓ ÎÏÈÓÈ΋ ÎÚ›ÛËÙÔ˘˜ Ó· ÂÎÙÈÌ‹ÛÔ˘Ó ÙÔÓ Î›Ó‰˘ÓÔ·ıËÚÔıÚÔÌ‚ˆÙÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘Û οıÂ Û˘ÁÎÂÎÚÈ̤ÓÔ ·ÛıÂÓ‹.

∂È̤ÏÂÈ·: ∏Ï›·˜ ÃÂÈÌÒÓ·˜

¢ ∂ ∫ ∂ ª μ ƒ π √ ™ 2 0 0 8

16

∂ÈÎfiÓ· 2. ∫·Ì‡Ï˜ Kaplan-Meier ÁÈ· ÙÔÓ ¯ÚfiÓÔ Ì¤¯ÚÈ ÙÔÓ ı¿Ó·ÙÔ ·fi ÔÔÈ·‰‹-ÔÙ ·ÈÙ›· (∞) Î·È ÁÈ· ÙÔÓ ¯ÚfiÓÔ Ì¤¯ÚÈ ÙÔÓ ı¿Ó·ÙÔ ·fi ÔÔÈ·‰‹ÔÙ ·ÈÙ›· Û˘Ó ÂÈ-Û·ÁˆÁ¤˜ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÁÈ· ηډȷÁÁÂȷο ÓÔÛ‹Ì·Ù· (μ) Û ·ÛıÂÓ›˜ Ô˘ ¤Ï·-‚·Ó ˆ-3 ÏÈ·Ú¿ Ôͤ· ‹ placebo.

∫§π¡π∫∂™ ª∂§∂Δ∂™

17

ªÂϤÙË BEAUTIFUL

(morBidity-mortality EvAlUaTion of the If inhibitor ivabradine in patients withcoronary disease and left-ventricULar dysfunction)

Fox K, Ford I, Steg PG, Tendera M, Ferrari R, on behalf of the BEAUTIFUL investigators.

Lancet 2008;372:807-821.

™ÎÔfi˜ ·˘Ù‹˜ Ù˘ ÔÏ˘ÎÂÓÙÚÈ΋˜Ù˘¯·ÈÔÔÈË̤Ó˘, ‰ÈÏ¿ Ù˘ÊÏ‹˜,ÂÏÂÁ¯fiÌÂÓ˘ Ì placebo ÎÏÈÓÈ΋˜ÌÂϤÙ˘ ‹Ù·Ó Ó· ÂÚ¢ӋÛÂÈ Â¿Ó ËÈ‚·ÌÚ·‰›ÓË ÌÔÚ› Ó· ÌÂÈÒÛÂÈÙËÓ Î·Ú‰È·ÁÁÂȷ΋ ÓÔÛËÚfiÙËÙ·Î·È ıÓËÛÈÌfiÙËÙ· Û ·ÛıÂÓ›˜ ÌÂÛÙ·ıÂÚ‹ ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ Î·È Û˘-ÛÙÔÏÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ù˘ ·ÚÈ-ÛÙÂÚ¿˜ ÎÔÈÏ›·˜. ∏ È‚·ÌÚ·‰›ÓË(ivabradine) Â›Ó·È ¤Ó· Ê¿ÚÌ·ÎÔÔ˘ ·Ó·ÛÙ¤ÏÏÂÈ ÙÔ Ú‡̷ If ÛÙÔÓÊÏ‚fiÎÔÌ‚Ô Î·È Ì ÙÔÓ Ì˯·ÓÈÛÌfi·˘Ùfi ÌÂÈÒÓÂÈ ÙËÓ Î·Ú‰È·Î‹ Û˘¯Ófi-ÙËÙ· (∫™), ¯ˆÚ›˜ Ó· ÂËÚ¿˙ÂÈ ÙËÛ˘ÛÙ·ÏÙÈÎfiÙËÙ· ÙÔ˘ Ì˘Ôηډ›Ô˘‹ ÙȘ ÂÚÈÊÂÚÈΤ˜ ·ÁÁÂȷΤ˜ ·ÓÙÈ-ÛÙ¿ÛÂȘ. ∏ ÌÂϤÙË ÂÚȤϷ‚Â10.917 ·ÛıÂÓ›˜ Î·È ÙˆÓ ‰‡Ô ʇ-ψÓ, ¿Óˆ ÙˆÓ 55 ÂÙÒÓ (‹ ¿Óˆ ÙˆÓ18 ÂÙÒÓ ·Ó ›¯·Ó ۷ί·ÚÒ‰Ë ‰È·-‚‹ÙË) Ì ÛÙ·ıÂÚ‹ ÛÙÂÊ·ÓÈ·›· Ófi-ÛÔ (ÛÙ·ıÂÚ‹ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÙÔ˘˜ÙÂÏÂ˘Ù·›Ô˘˜ ÙÔ˘Ï¿¯ÈÛÙÔÓ 3 Ì‹ÓÂ˜Î·È ˘fi ÛÙ·ıÂÚ‹ ·ÁˆÁ‹ › ¤Ó·Ì‹Ó·), Ô˘ ÂÌÊ¿ÓÈ˙·Ó ÎÏ¿ÛÌ·ÂÍÒıËÛ˘ <40% Î·È ÙÂÏԉȷÛÙÔ-ÏÈ΋ ‰È¿ÌÂÙÚÔ ·ÚÈÛÙÂÚ¿˜ >56mm. √È ·ÛıÂÓ›˜ ¤Ú ӷ ›ӷÈÛ ÊÏ‚ÔÎÔÌ‚ÈÎfi Ú˘ıÌfi Î·È Ó·¤¯Ô˘Ó ηډȷ΋ Û˘¯ÓfiÙËÙ· > 60/1’.√È 5.479 ·ÛıÂÓ›˜ ¤Ï·‚·Ó 5 mgÈ‚·ÌÚ·‰›Ó˘ ‰‡Ô ÊÔÚ¤˜ ÙËÓ Ë̤-Ú· Ì ÚÔÔÙÈ΋ Ó· ·˘ÍËı› Ë ‰fi-ÛË Û 7,5 mg fiÔ˘ ‹Ù·Ó ·ÓÂÎÙ‹ ‹fiÌÔÈ·˜ ÌÔÚÊ‹˜ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·-ÎÔ. ŸÏÔÈ ÔÈ ·ÛıÂÓ›˜ ¤Ï·‚·Ó ÙËÓ

ηıÈÂڈ̤ÓË Ê·Ú̷΢ÙÈ΋ ·Áˆ-Á‹. ΔÔ 87% ÙˆÓ ·ÛıÂÓÒÓ Ï¿Ì‚·Ó‚-·Ó·ÛÙÔÏ›˜.

¶ÚˆÙ‡ÔÓ Î·Ù·ÏËÎÙÈÎfi ÛËÌ›ÔÔÚ›ÛıËΠÙÔ ¿ıÚÔÈÛÌ· ÙˆÓ Î·Ú-‰È·ÁÁÂÈ·ÎÒÓ ı·Ó¿ÙˆÓ Î·È ÙˆÓ ÂÈ-Û·ÁˆÁÒÓ Û ÓÔÛÔÎÔÌÂ›Ô ÁÈ· Ô͇¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘ ‹ ηÚ-‰È·Î‹ ·Ó¿ÚÎÂÈ· (ÓÂÔÂÌÊ·ÓÈ˙fi-ÌÂÓË ‹ ÂȉÂÈÓˆı›۷). ¢Â˘ÙÂÚ‡-ÔÓÙ· ηٷÏËÎÙÈο ÛËÌ›· ÔÚ›ÛıË-Î·Ó ÔÏÏ¿, fiˆ˜ ı¿Ó·ÙÔÈ ·fi fiÏ·Ù· ·›ÙÈ·, ηډȷÁÁÂÈ·ÎÔ› ı¿Ó·ÙÔÈ,ηډȷÎÔ› ı¿Ó·ÙÔÈ, ÛÙÂÊ·ÓÈ·›·Â·Ó·ÁÁ›ˆÛË Î·È ‰È¿ÊÔÚ· Û‡Ó-ıÂÙ· ÙÂÏÈο ÛËÌ›·. ∏ ̤ÛË ·Ú·-ÎÔÏÔ‡ıËÛË ‹Ù·Ó 19 Ì‹Ó˜.

∏ È‚·ÌÚ·‰›ÓË Ì›ˆÛ ÙËÓηډȷ΋ Û˘¯ÓfiÙËÙ· ηٿ 6 ÛÊ/1’ÛÙÔ˘˜ 12 Ì‹Ó˜, ‰ÂÓ ÂËÚ¤·ÛÂfï˜ ÙÔ ÚˆÙ‡ÔÓ Î·Ù·ÏËÎÙÈÎfiÛËÌÂ›Ô (ÏfiÁÔ˜ ÎÈÓ‰‡ÓÔ˘ 1,00).™˘Ì‚¿Ì·Ù· ÂÌÊ¿ÓÈÛ·Ó 1233 ·Û-ıÂÓ›˜ ÛÙËÓ ÔÌ¿‰· Ù˘ È‚·ÌÚ·‰›-Ó˘ (22,5%) Î·È 1239 ·ÛıÂÓ›˜ÛÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ (22,8%),p=0,70. ¢ÂÓ ÂËÚ¤·Û ›Û˘ ËÈ‚·ÌÚ·‰›ÓË Î·Ó¤Ó· ‰Â˘ÙÂÚ‡ÔÓηٷÏËÎÙÈÎfi Û˘Ì‚¿Ó ÛÙÔ Û‡ÓÔÏÔÙˆÓ ·ÛıÂÓÒÓ ˆ˜ ÔÌ¿‰·, ›¯Âfï˜ οÔÈ· ¢ÓÔ˚΋ ‰Ú¿ÛË ÛÙËÓÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ›¯Â ∫™ÌÂÁ·Ï‡ÙÂÚË ÙˆÓ 70 ÛÊ/1’. ™ÙÔ˘˜·ÛıÂÓ›˜ ·˘ÙÔ‡˜ ·Ú·ÙËÚ‹ıËÎÂÌ›ˆÛË ÙˆÓ ÂÈÛ·ÁˆÁÒÓ Û ÓÔÛÔ-ÎÔÌÂ›Ô ÁÈ· ı·Ó·ÙËÊfiÚÔ ‹ ÌË ı·-Ó·ÙËÊfiÚÔ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘ÔηÚ-

‰›Ô˘ ηٿ 36% (p=0,001) Î·È ÙˆÓÛÙÂÊ·ÓÈ·›ˆÓ ·ӷÁÁÂÈÒÛÂˆÓ 30%(p=0,016), ‰ÂÓ ·Ú·ÙËÚ‹ıËÎÂfï˜ fiÊÂÏÔ˜ Ô‡ÙÂ Î·È Û ·˘ÙÔ‡˜ÙÔ˘˜ ·ÛıÂÓ›˜ ÛÙË ÓÔÛËÚfiÙËÙ·Î·È ıÓËÛÈÌfiÙËÙ· ·fi ηډȷ΋·Ó¿ÚÎÂÈ·.

™ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ (5.438¿ÙÔÌ·) ¤ÁÈÓ ·Ó¿Ï˘ÛË Ù˘ ¤Î‚·-Û˘ ·Ó¿ÏÔÁ· Ì ÙËÓ Î·Ú‰È·Î‹ Û˘-¯ÓfiÙËÙ·. ¢È·ÈÛÙÒıËΠfiÙÈ ÔÈ·ÛıÂÓ›˜ Ì 70 ÛʇÍÂȘ ·Ó¿ ÏÂ-Ùfi Î·È ¿Óˆ ›¯·Ó ·˘ÍË̤ÓÔ Î·Ù¿34% ΛӉ˘ÓÔ Î·Ú‰È·ÁÁÂÈ·ÎÔ‡ ı·-Ó¿ÙÔ˘, ηٿ 53% Èı·ÓfiÙËÙ· ÂÈ-Û·ÁˆÁ‹˜ Û ÓÔÛÔÎÔÌÂ›Ô ÁÈ· ηÚ-‰È·Î‹ ·Ó¿ÚÎÂÈ·, ηٿ 46% ΛÓ-‰˘ÓÔ ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ôηډ›-Ô˘ Î·È Î·Ù¿ 38% Èı·ÓfiÙËÙ· Ó·˘Ô‚ÏËıÔ‡Ó Û ÛÙÂÊ·ÓÈ·›· ·-Ó·ÁÁ›ˆÛË, fiÏ· ÛÙ·ÙÈÛÙÈο ÛËÌ·-ÓÙÈο. °È· οı 5 ÛÊ/1’ ·‡ÍËÛËÙ˘ ∫™ ·Ú·ÙËÚ‹ıËΠ·‡ÍËÛËÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ ı·Ó¿ÙÔ˘ η-Ù¿ 8% (p=0,0005), ÙˆÓ ÓÔÛËÏÂÈÒÓÁÈ· ηډȷ΋ ·Ó¿ÚÎÂÈ· ηٿ16%, ÙˆÓ ÂÌÊÚ·ÁÌ¿ÙˆÓ Î·Ù¿ 7%Î·È ÙˆÓ Â·Ó·ÁÁÂÈÒÛÂˆÓ Î·Ù¿8%. ™˘ÌÂÚ·›ÓÂÙ·È fiÙÈ ÛÙÔ˘˜·ÛıÂÓ›˜ Ì ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ Î·ÈÛ˘ÛÙÔÏÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ù˘ ·ÚÈ-ÛÙÂÚ¿˜ ÎÔÈÏ›·˜, Ë ·˘ÍË̤ÓË ∫™ ›-Ó·È ·ÓÂÍ¿ÚÙËÙÔ˜ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ-‰‡ÓÔ˘ ‰˘ÛÌÂÓÔ‡˜ ¤Î‚·Û˘.

∂È̤ÏÂÈ·: ∏Ï›·˜ ÃÂÈÌÒÓ·˜

∏ ÌÂϤÙË SEAS ۯ‰ȿÛÙËΠÁÈ·Ó· ÌÂÏÂÙ‹ÛÂÈ ÙÔ ·ÔÙ¤ÏÂÛÌ· Ù˘̷ÎÚÔ¯ÚfiÓÈ·˜ ÂÓÙ·ÙÈ΋˜ ˘ÔÏÈÈ-‰·ÈÌÈ΋˜ ·ÁˆÁ‹˜ Ì ÛÈÌ‚·ÛÙ·Ù›ÓËÎ·È Â˙ÂÙÈÌ›ÌË ÛÙËÓ ¤Î‚·ÛË ·ÛıÂ-ÓÒÓ Ì ·Û˘Ìو̷ÙÈ΋ ‹È· ÚԘ̤ÙÚÈ· ÛÙ¤ÓˆÛË Ù˘ ·ÔÚÙÈ΋˜‚·Ï‚›‰·˜. ∂›Ó·È ÌÈ· ÔÏ˘ÎÂÓÙÚÈ΋,‰ÈÏ¿ Ù˘ÊÏ‹, Ù˘¯·ÈÔÔÈË̤ÓË ÌÂ-ϤÙË, ÛÙËÓ ÔÔ›· ÂÓÙ¿¯ıËηÓ1873 ·ÛıÂÓ›˜, ¿Ó‰Ú˜ Î·È Á˘Ó·›-Θ ËÏÈΛ·˜ 45-85 ÂÙÒÓ. ∞ÔÎÏ›-ÛıËÎ·Ó ·ÛıÂÓ›˜ Ì ÛÙÂÊ·ÓÈ·›·ÓfiÛÔ, ÂÚÈÊÂÚÈ΋ ·ÚÙËÚÈÔ¿ıÂÈ·,·ÁÁÂÈ·Îfi ÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔ ‹Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË Î·È (ÁÈ· ËıÈ-ÎÔ‡˜ ÏfiÁÔ˘˜) fiÛÔÈ Â›¯·Ó Û·Ê‹ ¤Ó-‰ÂÈÍË ˘ÔÏÈȉ·ÈÌÈ΋˜ ·ÁˆÁ‹˜. √È·ÛıÂÓ›˜ ηٷÓÂÌ‹ıËÎ·Ó Ù˘¯·›·Û ·Ó·ÏÔÁ›· 1:1 Ó· Ï¿‚Ô˘Ó 40 mgÛÈÌ‚·ÛÙ·Ù›Ó˘ Î·È 10 mg Â˙ÂÙÈÌ›-Ì˘ ËÌÂÚËÛ›ˆ˜ ›Ù ÂÈÎÔÓÈÎfiÊ¿ÚÌ·ÎÔ. ∏ ̤ÛË ‰È¿ÚÎÂÈ· ·Ú·-ÎÔÏÔ‡ıËÛ˘ ‹Ù·Ó 52,2 Ì‹Ó˜ ηÈË ÂÏ¿¯ÈÛÙË 4 ¯ÚfiÓÈ·. ΔÔ ÚˆÙ‡ÔÓηٷÏËÎÙÈÎfi ÛËÌÂ›Ô ‹Ù·Ó ÙÔ¿ıÚÔÈÛÌ· ÙˆÓ «ÌÂÈ˙fiÓˆÓ Î·Ú‰È·Á-ÁÂÈ·ÎÒÓ Û˘Ì‚¿ÓÙˆÓ», Ù· ÔÔ›·ÌÔÚÔ‡Ó Ó· ‰È·ÎÚÈıÔ‡Ó Û ·˘Ù¿Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ÛÙ¤ÓˆÛËÙ˘ ·ÔÚÙÈ΋˜ ‚·Ï‚›‰·˜ (¯ÂÈÚÔ˘Ú-ÁÈ΋ ·ÓÙÈηٿÛÙ·ÛË Ù˘ ‚·Ï‚›-‰·˜, ÓÔÛËÏ›· ÁÈ· ηډȷ΋ ·ÓÂ-¿ÚÎÂÈ· Î·È Î·Ú‰È·ÁÁÂÈ·ÎÔ› ı¿Ó·-ÙÔÈ) Î·È Û ·ıËÚÔÛÎÏËÚˆÙÈο Û˘Ì-‚¿Ì·Ù· (·ÔÚÙÔÛÙÂÊ·ÓÈ·›· ·Ú¿-η̄Ë, ‰È·‰ÂÚÌÈ΋ ÛÙÂÊ·ÓÈ·›· ·Á-ÁÂÈÔÏ·ÛÙÈ΋ Î·È ÌË ·ÈÌÔÚÚ·ÁÈÎfi·ÁÁÂÈ·Îfi ÂÁÎÂÊ·ÏÈÎfi). ¢Â˘ÙÂÚ‡-ÔÓÙ· ηٷÏËÎÙÈο ÛËÌ›· ÔÚ›ÛıË-Î·Ó ÙÔ ¿ıÚÔÈÛÌ· ÙˆÓ Û¯ÂÙÈ˙fiÌÂ-ÓˆÓ Ì ÙË ÛÙ¤ÓˆÛË Ù˘ ‚·Ï‚›‰·˜Û˘Ì‚·Ì¿ÙˆÓ Î·È ¯ˆÚÈÛÙ¿ Ù· ·ıË-ÚÔÛÎÏËÚˆÙÈο Û˘Ì‚¿Ì·Ù·.

™ÙËÓ ÔÌ¿‰· Ô˘ ¤Ï·‚ ÙË ÛÈÌ-‚·ÛÙ·Ù›ÓË Î·È Â˙ÂÙÈÌ›ÌË ÌÂÈÒıË-ÎÂ Ë LDL-¯ÔÏËÛÙÂÚfiÏË Î·Ù¿ 61%.∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂϤÙ˘ ÙÔÚˆÙ‡ÔÓ Î·Ù·ÏËÎÙÈÎfi ÛËÌÂ›Ô ·-Ú·ÙËÚ‹ıËΠ۠333 ·ÛıÂÓ›˜ Ù˘ÔÌ¿‰·˜ ÂÓÂÚÁÔ‡ ıÂڷ›·˜(35,3%) Î·È Û 355 ÛÙËÓ ÔÌ¿‰·ÂϤÁ¯Ô˘ (38,2%, p=0,59). ¢ÂÓ ·-Ú·ÙËÚ‹ıËΠ‰È·ÊÔÚ¿ Ô‡Ù ÛÙ·ÂÂÈÛfi‰È· Ù· Û¯ÂÙÈ˙fiÌÂÓ· Ì ÙË‚·Ï‚ȉԿıÂÈ· Ù˘ ·ÔÚÙ‹˜, ·-

Ú·ÙËÚ‹ıËΠfï˜ ÛÙ·ÙÈÛÙÈÎÒ˜ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙ· ·ıËÚÔ-ÛÎÏËÚˆÙÈο ÂÂÈÛfi‰È· (148 ÛÙËÓÔÌ¿‰· Ù˘ ÂÓÂÚÁÔ‡ ıÂڷ›·˜ ηÈ187 ÛÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘, p=0,02)(EÈÎfiÓ· 1).

ŒÓ· ÌË ·Ó·ÌÂÓfiÌÂÓÔ Î·È ·ÓË-Û˘¯ËÙÈÎfi ‡ÚËÌ· ‹Ù·Ó Ë ÂÌÊ¿ÓÈ-ÛË ÂÚÈÛÛfiÙÂÚˆÓ ÂÚÈÛÙ·ÙÈÎÒÓηÚΛÓÔ˘ ÛÙËÓ ÔÌ¿‰· Ù˘ ˘ÔÏÈÈ-‰·ÈÌÈ΋˜ ıÂڷ›·˜ Û˘ÁÎÚÈÙÈο ÌÂÙËÓ ÔÌ¿‰· ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿-ÎÔ˘ (105 ¤Ó·ÓÙÈ 70, p=0,01). ∏‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ‰ÂÓ ÔÊ›ÏÂÙ·È Û οÔÈÔÓ È‰È·›ÙÂ-ÚÔ Ù‡Ô Î·ÚΛÓÔ˘ Î·È ‰ÂÓ ‰È¢-Ú‡ÓıËΠ̠ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯Úfi-ÓÔ˘. √È ·Ú·ÙËÚ‹ÛÂȘ ·˘Ù¤˜ Î·È ÔÌÈÎÚfi˜ Û˘ÓÔÏÈÎfi˜ ·ÚÈıÌfi˜ ÙˆÓηÚÎ›ÓˆÓ Î¿ÓÔ˘Ó ·ÚÎÂÙ¿ ÌÂÁ¿ÏËÙËÓ Èı·ÓfiÙËÙ· Ó· Â›Ó·È ÙÔ Â‡ÚË-Ì· Ù˘¯·›Ô. ¶·Ú' fiÏ· ·˘Ù¿, ÙÔ Â‡-ÚËÌ· ·ÓËÛ‡¯ËÛ ÙËÓ ÂÈÛÙËÌÔÓÈ-΋ ÎÔÈÓfiÙËÙ· Î·È ÙȘ ÂÔÙ‡Ԣ-Û˜ ·Ú¯¤˜ Î·È ÁÈ' ·˘Ùfi ¤ÁÈÓ ·Ô-Ù‡ÊψÛË ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ Î·ÚΛ-

ÓÔ˘ Ô˘ ¤¯Ô˘Ó ηٷÁÚ·Ê› ̤¯ÚÈÙÒÚ· Û ‰‡Ô ÌÂÁ¿Ï˜ ÎÏÈÓÈΤ˜ ÌÂ-ϤÙ˜, Ù˘ SHARP (Study of HeartAnd Renal Protection) Î·È Ù˘IMPROVE-IT (IMProved Reductionof Outcomes: Vitorin EfficacyInternational Trial) Ô˘ ‚Ú›ÛÎÔÓÙ·ÈÛ ÂͤÏÈÍË Î·È ÛÙȘ Ôԛ˜ ‰ÔÎÈÌ¿-˙ÂÙ·È Ô Û˘Ó‰˘·ÛÌfi˜ ÛÈÌ‚·ÛÙ·Ù›-Ó˘ Î·È Â˙ÂÙÈÌ›Ì˘. Δ· ÂÚÈÛÙ·ÙÈ-ο ·fi ÙȘ ÌÂϤÙ˜ ·˘Ù¤˜, ÏfiÁˆÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙˆÓ ÌÂÏÂÙÒÓ, ›ӷÈÙÂÙÚ·Ï¿ÛÈ· Û ·ÚÈıÌfi ·fi ·˘Ù¿Ù˘ SEAS Î·È ·Ó·Ï‡ıËÎ·Ó ·fiÌÈ· ·ÓÂÍ¿ÚÙËÙË ·Î·‰ËÌ·˚΋ ÂÈ-ÛÙËÌÔÓÈ΋ ÔÌ¿‰· (ÙËÓ ClinicalTrial Service Unit ÙÔ˘ ¶·ÓÂÈÛÙË-Ì›Ô˘ Ù˘ √ÍÊfiډ˘) fiÏ· Ì·˙›.∞fi ÙËÓ ·Ó¿Ï˘ÛË ·˘Ù‹ ‰ÂÓ ÚÔ¤-΢„ ηÌÈ¿ ¤Ó‰ÂÈÍË fiÙÈ Ë ıÂÚ·-›· ÌÂ Û˘Ó‰˘·ÛÌfi ÛÈÌ‚·ÛÙ·Ù›-Ó˘ Î·È Â˙ÂÙÈÌ›Ì˘ ·˘Í¿ÓÂÈ ÙÔ˘˜Î·ÚΛÓÔ˘˜, Ú¿ÁÌ· Ô˘ ÂȂ‚·È-ÒÓÂÈ fiÙÈ ÙÔ Â‡ÚËÌ· Ù˘ SEAS‹Ù·Ó Ù˘¯·›Ô.

∂È̤ÏÂÈ·: ∏Ï›·˜ ÃÂÈÌÒÓ·˜

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Rossebo AB, Pedersen TR, Boman K, Brudi P, Chambers JB, Egstrup K, Gerdts E, Gohlke-Borwolf C, Holme I, Kesaniemi YA, Malbecq K, Nienaber CA, Ray S, Skjaerpe T,

Wachtell K, Willenheimer R, for the SEAS Investigators

N Engl J Med 2008;359:1-14

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∏ ›وÛË Ù˘ ·¯˘Û·ÚΛ·˜ ¤¯ÂȉÈÏ·ÛÈ·Ûı› Ù· ÙÂÏÂ˘Ù·›· 20 ¯Úfi-ÓÈ·. √È ·¯‡Û·ÚÎÔÈ Û ۇÁÎÚÈÛËÌ ٷ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ‚¿ÚÔ˘˜ ¿ÙÔÌ·¤¯Ô˘Ó 3.5 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚË È-ı·ÓfiÙËÙ· Ó· ÂÌÊ·Ó›ÛÔ˘Ó ˘¤ÚÙ·-ÛË , ÂÓÒ Ù·˘Ùfi¯ÚÔÓ· ¿Óˆ ·fi ÙÔ60% ÙˆÓ ·¯‡Û·ÚÎˆÓ ·ÙfiÌˆÓ ¤¯ÂÈ·˘ÍË̤ӷ ›‰· ·ÚÙËÚȷ΋˜›ÂÛ˘.1 2 ∂ÈÚfiÛıÂÙ· ÔÈ ·ÛıÂÓ›˜Ì ˘¤ÚÙ·ÛË ¤¯Ô˘Ó ·˘ÍË̤ÓË Â›-ÙˆÛË ‰È·Ù·Ú·¯‹˜ ·ÓÔ¯‹˜ ÛÙËÁÏ˘Îfi˙Ë Î·È Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙËÙ‡Ô˘ 2 (™¢2).3 4 ∏ ˘¤ÚÙ·ÛË, ËÎÔÈÏȷ΋ ·¯˘Û·ÚΛ· Î·È Ë ‰È·Ù·-Ú·¯‹ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ ˘‰·-Ù·ÓıÚ¿ÎˆÓ Â›Ó·È ¯·Ú·ÎÙËÚÈÛÙÈοÙÔ˘ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘.

¶·Ï·ÈfiÙÂÚ˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·ÓfiÙÈ Ë ıÂڷ›· Ì ‰È·ÊÔÚÂÙÈΤ˜Î·ÙËÁÔڛ˜ ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ Ê·Ú-Ì¿ÎˆÓ ¤¯ÂÈ ·ÔÙ¤ÏÂÛÌ· ÔÈΛϘÂȉڿÛÂȘ ÛÙÔ ÌÂÙ·‚ÔÏÈÛÌfi Ù˘ÁÏ˘Îfi˙˘.5 ∞˘Ù¤˜ ÔÈ ÂȉڿÛÂÈ˜Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ÌÂÙ·‚ÔϤ˜ Ù˘ÈÓÛÔ˘ÏÈÓÔ¢·ÈÛıËÛ›·˜. ∏ ·‡ÍËÛËÙ˘ ÁÏ˘Îfi˙˘ ÙÔ˘ ÔÚÔ‡ ηٿ ÙˉȿÚÎÂÈ· Ù˘ ·ÓÙÈ˘ÂÚÙ·ÛÈ΋˜ ıÂ-ڷ›·˜ Èı·Ó¿ ·ÔÙÂÏ› ÚÔÁÓˆ-ÛÙÈÎfi ‰Â›ÎÙË ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ÂÌ-ÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ôηډ›Ô˘.6 ∏·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË ¤¯ÂÈ Â›-Û˘ Û˘Û¯ÂÙÈÛı› Ì ÂÓ‰ÔıËÏȷ΋‰˘ÛÏÂÈÙÔ˘ÚÁ›·, Ë ÔÔ›· ıˆÚ›ٷÈÚÔÁÓˆÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡-ÓÔ˘ ÁÈ· ÌÂÏÏÔÓÙÈο ηډȷÁÁÂÈ·Î¿Û˘Ì‚¿Ì·Ù·.7 ªÂ ‚¿ÛË Ù· ·Ú·¿-Óˆ ‰Â‰Ô̤ӷ Â›Ó·È ÛËÌ·ÓÙÈÎfi Ó··Ó·ÁÓˆÚ›˙ÂÈ Ô ÎÏÈÓÈÎfi˜ ÁÈ·ÙÚfi˜ ÙȘÂӉ¯fiÌÂÓ˜ ‰˘ÛÌÂÓ›˜ ÌÂÙ·‚ÔÏÈ-Τ˜ ÂȉڿÛÂȘ ·˘ÙÒÓ ÙˆÓ Ê·ÚÌ¿-ΈÓ. ™ÙÔ ¿ÚıÚÔ ·˘Ùfi ı· ·ÚÔ˘-ÛÈ·ÛıÔ‡Ó Í¯ˆÚÈÛÙ¿ ÔÈ Âȉڿ-ÛÂȘ Ô˘ ¤¯Ô˘Ó ÔÈ Î·ÙËÁÔڛ˜ ÙˆÓ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ÛÙÔÌÂÙ·‚ÔÏÈÛÌfi Ù˘ ÁÏ˘Îfi˙˘.

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¶ÔÏϤ˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ·Ó·ÊÂÚı›

ÛÙË Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ ¯ÔÚ‹-ÁËÛ˘ ıÂÈ·˙ȉÈÎÒÓ ‰ÈÔ˘ÚËÙÈÎÒÓÎ·È ÛÙËÓ ÂÌÊ¿ÓÈÛË ‰È·Ù·Ú·¯‹˜·ÓÔ¯‹˜ ÛÙË ÁÏ˘Îfi˙Ë ‹ ۷ί·ÚÒ-‰Ë ‰È·‚‹ÙË. ¶Ú¿ÁÌ·ÙÈ, ÛÙË ÌÂϤÙËALLHAT (Antihypertensive andLipid-Lowering Treatment to Pre-vent Heart Attack Trial) Ë Â›ÙˆÛËÙÔ˘ ™¢2 ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚË ÛÙÔ˘˜·ÛıÂÓ›˜ Ô˘ ‹Ú·Ó ¯ÏˆÚÔı·ÏÈ-‰fiÓË Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ ·ÛıÂ-Ó›˜ Ô˘ ¤Ï·‚·Ó ›Ù ·ÌÏԉțÓ˛٠ÏÈÛÈÓÔÚ›ÏË (¶›Ó·Î·˜ 1).8

™ÙË ÌÂϤÙË SHEP (SystolicHypertension in the Elderly Pro-gram), ÌÂÙ¿ ·fi Ì·ÎÚÔ¯ÚfiÓÈ· ıÂ-ڷ›· (14 ¯ÚfiÓÈ·), ÙÔ 13% ÙˆÓ·ÛıÂÓÒÓ Ô˘ ‹Ú ¯ÏˆÚÔı·Ïȉfi-ÓË ÂÌÊ¿ÓÈÛ ‰È·‚‹ÙË Û ۇÁÎÚÈÛËÌ ÙÔ 8.7% ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ‹-Ú ıÂڷ›· Ì ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ(p<0.0001).9 10 ™Â ÌÈ· ÌÂÁ¿ÏˤÚ¢ӷ (NHS I: Á˘Ó·›Î˜ ËÏÈΛ·˜30-55 ÂÙÒÓ, NHS II: Á˘Ó·›Î˜ ËÏÈ-Λ·˜ 25-42 ÂÙÒÓ, HPFS: ¿ÓÙÚ˜ËÏÈΛ·˜ 40-75 ÂÙÒÓ) ÛÙËÓ ÔÔ›·Û˘ÌÌÂÙ›¯·Ó 19.472 ¿Ó‰Ú˜ ηÈ55.344 Á˘Ó·›Î˜ Î·È ÛÙËÓ ÔÔ›·¤ÁÈÓ ‰ÈfiÚıˆÛË ÁÈ· ÙÔ ‰Â›ÎÙË Ì¿-˙·˜ ÛÒÌ·ÙÔ˜, ÔÈ ·ÛıÂÓ›˜ Ô˘¤·ÈÚÓ·Ó ıÂÈ·˙ȉÈο ‰ÈÔ˘ÚËÙÈο ›-¯·Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ÙËÓ ÂÌ-

Ê¿ÓÈÛË Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË ÛÂÛ‡ÁÎÚÈÛË Ì ٷ ¿ÙÔÌ· Ô˘ ‰ÂÓ¤·ÈÚÓ·Ó ·˘Ù¿ Ù· Ê¿Ú̷η [NHSI: Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜: 1.20 (95%‰È¿ÛÙËÌ· ÂÌÈÛÙÔÛ‡Ó˘ 1.08-1.33), NHS II: Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜:1.45 (95% ‰È¿ÛÙËÌ· ÂÌÈÛÙÔÛ‡-Ó˘ 1.17-1.79), HPFS: Û¯ÂÙÈÎfi˜Î›Ó‰˘ÓÔ˜: 1.36 (95% ‰È¿ÛÙËÌ·ÂÌÈÛÙÔÛ‡Ó˘ 1.17-1.58)].11

∂ÈϤÔÓ, Û ̛· ÚfiÛÊ·ÙˤÚ¢ӷ 2.624 ·ÛıÂÓÒÓ Ô˘ ‹Ú·ÓıÂÈ·˙ȉÈο ‰ÈÔ˘ÚËÙÈο, Ô ÏËı˘-ÛÌfi˜ Ù˘ ÌÂϤÙ˘ ¯ˆÚ›ÛıËΠÛÂÙÂÙ·ÚÙËÌfiÚÈ· Ì ‚¿ÛË ÙÔ ‰Â›ÎÙËÌ¿˙·˜ ÛÒÌ·ÙÔ˜ (·fi 25.9kg/m2

ÛÙÔ ÚÒÙÔ ÙÂÙ·ÚÙËÌfiÚÈÔ ¤ˆ˜ ηȿӈ ·fi 32.3kg/m2 ÛÙÔ ÙÂÏ¢-Ù·›Ô ÙÂÙ·ÚÙËÌfiÚÈÔ). √È ÙÈ̤˜ ÁÏ˘-Îfi˙˘ ÓËÛÙ›·˜ ·˘Í¿ÓÔÓÙ·Ó ÌÂÙËÓ ·‡ÍËÛË ÙÔ˘ ‰Â›ÎÙË Ì¿˙·˜ ÛÒ-Ì·ÙÔ˜, ÂÓÒ Ù·˘Ùfi¯ÚÔÓ· ˘‹Ú¯ÂÛÙ·‰È·Î‹ ·‡ÍËÛË ÛÙÔ Ì¤ÁÂıÔ˜Ù˘ ÌÂÙ·‚ÔÏ‹˜ Ù˘ ÁÏ˘Îfi˙˘ ÓË-ÛÙ›·˜ ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ıÂÈ·˙ȉÈ-ÎÒÓ ‰ÈÔ˘ÚËÙÈÎÒÓ ·Ú¿ÏÏËÏ· ÌÂÙËÓ ·‡ÍËÛË ÙÔ˘ ‰Â›ÎÙË Ì¿˙·˜ ÛÒ-Ì·ÙÔ˜.12

™ÙËÓ ·Ú·¿Óˆ ÌÂϤÙË ‰ÂÓ·Ú·ÙËÚ‹ıËÎÂ Û˘Û¯¤ÙÈÛË ÌÂٷ͇Ù˘ ·‡ÍËÛ˘ Ù˘ ÁÏ˘Îfi˙˘ ÓËÛÙ›-·˜ ÌÂÙ¿ ·fi ÙË ¯ÔÚ‹ÁËÛË ıÂÈ·˙È-

∂›‰Ú·ÛË ÙˆÓ ∞ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ º·ÚÌ¿ÎˆÓ ÛÙÔ ªÂÙ·‚ÔÏÈÛÌfi Ù˘ °Ï˘Îfi˙˘

ÕÚ˘-¢ËÌ‹ÙÚÈÔ˜ ∞ÁÁÔ˘Ú›‰Ë˜, ∂ÈÛÙËÌÔÓÈÎfi˜ ™˘ÓÂÚÁ¿Ù˘ ÙÔ˘ ∂Í. π·ÙÚ›Ԣ ÙˆÓ ¢È·Ù·Ú·¯ÒÓÙÔ˘ ªÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ §Èȉ›ˆÓ ÙÔ˘ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ °ÂÓÈÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ πˆ·ÓÓ›ÓˆÓ

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

ΔÔ̤·˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ

¶›Ó·Î·˜ 1: °Ï˘Îfi˙Ë ÓËÛÙ›·˜ Û ÌË ‰È·‚ËÙÈÎÔ‡˜ ·ÛıÂÓ›˜ Ì ·Ú¯Èο ›‰· ÁÏ˘Îfi˙˘ ÓËÛÙ›·˜ <126 mg/dl (ÌÂϤÙË ALLHAT)

ÃψÚÔı·ÏȉfiÓË ∞ÌÏԉțÓË §ÈÛÈÓÔÚ›ÏË

∞ÚÈıÌfi˜ ·ÛıÂÓÒÓ(%)

™ÙËÓ ¤Ó·ÚÍË 6766 (100) 3954 (100) 4096 (100)Ù˘ ÌÂϤÙ˘

ªÂÙ¿ 2 ¤ÙË 3074 (45.4) 1787 (45.2) 1737 (42.4)ªÂÙ¿ 4 ¤ÙË 2606 (40.3) 1567 (39.6) 1464 (35.7)

ª¤ÛË ÙÈÌ‹ mg/dl (±ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË)

∞Ú¯Èο ›‰· 93.1 (11.7) 93.0 (11.4) 93.3 (11.8)

2 ¤ÙË 102.2 (27.1) 99.0 (22.5) 97.4 (20.0)

4 ¤ÙË 104.4 (28.5) 103.1 (27.7) 100.5 (19.5)

∞ÚÈıÌfi˜ ·ÛıÂÓÒÓ (%) Ì ÁÏ˘Îfi˙Ë ÓËÛÙ›·˜ ≥126 mg/dl

2 ¤ÙË 295 (9.6) 132 (7.4) 101 (5.8)

4 ¤ÙË 302 (11.6) 154 (9.8) 119 (8.1)

¢ ∂ ∫ ∂ ª μ ƒ π √ ™ 2 0 0 8

20

‰ÈÎÒÓ ‰ÈÔ˘ÚËÙÈÎÒÓ Ì ÙË ‰ÔÛÔÏÔ-Á›· ÙˆÓ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ Ê·ÚÌ¿-ΈÓ. øÛÙfiÛÔ ¿ÏÏÔÈ ÂÚ¢ÓËÙ¤˜·Ó¤ÊÂÚ·Ó Ì›· ‰ÔÛÔÂÍ·ÚÙÒÌÂÓË·‡ÍËÛË Ù˘ ÁÏ˘Îfi˙˘ ÙÔ˘ ÔÚÔ‡ Û·ÛıÂÓ›˜ Ô˘ ‹Ú·Ó ¯ÏˆÚÔı·ÏÈ-‰fiÓË.13 ™Â Ì›· ¿ÏÏË ÌÂϤÙË, Ë ¯Ô-Ú‹ÁËÛË ‚ÂÓ‰ÚÔÊıÔÚÈÔÌÂıÂÈ·˙›-‰Ë˜ (10 mg/Ë̤ڷ) ÁÈ· 10 ‚‰ÔÌ¿-‰Â˜ ›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· ·‡ÍËÛËÙ˘ ÁÏ˘Îfi˙˘ ÙÔ˘ ÔÚÔ‡ ηٿ 7%,ÂÓÒ Ë ¯ÔÚ‹ÁËÛË 1.25 mg/Ë̤ڷ‰ÂÓ Â›¯Â η̛· ›‰Ú·ÛË ÛÙ· ›-‰· Ù˘ ÁÏ˘Îfi˙˘ ÙÔ˘ ÔÚÔ‡.14

¶Ú¤ÂÈ Ó· ÂÈÛËÌ·Óı› fiÙÈ ÔNeutel Û ̛· ÌÂÙ·-·Ó¿Ï˘ÛË 9 Ù˘-¯·ÈÔÔÈËÌ¤ÓˆÓ ÎÏÈÓÈÎÒÓ ÌÂÏÂÙÒÓ

‰È·›ÛÙˆÛ fiÙÈ ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛˢ‰ÚԯψÚÔıÂÈ·˙›‰Ë˜ (12.5 mg/Ë̤-Ú·) ˆ˜ ÌÔÓÔıÂڷ›·, ÔÈ ÌÂÙ·‚Ô-Ϥ˜ Ù˘ ÁÏ˘Îfi˙˘ Û ۇÁÎÚÈÛË ÌÂÙ· ·Ú¯Èο ›‰· ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈ-ÛÙÈο ÛËÌ·ÓÙÈΤ˜.15

™Â Ì›· ÔÏ˘·Ú·ÁÔÓÙÈ΋ ·Ó¿-Ï˘ÛË ‚Ú¤ıËΠfiÙÈ Ù· ¯·ÌËÏ¿ ›-‰· ÙÔ˘ Î·Ï›Ô˘ ·ÔÙÂÏÔ‡Ó ÛË-Ì·ÓÙÈÎfi ÚÔÁÓˆÛÙÈÎfi ·Ú¿ÁÔÓÙ·ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ™¢2ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ·›ÚÓÔ˘Ó ıÂÈ-·˙ȉÈο ‰ÈÔ˘ÚËÙÈο.12 ™ÙÔ˘˜ ·ÛıÂ-Ó›˜ ·˘ÙÔ‡˜ Ë ·‡ÍËÛË ÙˆÓ ÂȤ-‰ˆÓ Ù˘ ÁÏ˘Îfi˙˘ ÓËÛÙ›·˜ Û˘-Û¯ÂÙ›ÛıËΠ̠ÙËÓ ÂÌÊ¿ÓÈÛË ˘Ô-ηÏÈ·ÈÌ›·˜, ÂÓÒ ·ÔηٷÛÙ¿ıËÎÂ

ÓÔÚÌÔÁÏ˘Î·ÈÌ›· ÌÂÙ¿ ÙË ¯ÔÚ‹ÁË-ÛË Î·Ï›Ô˘.3 16

∏ Ì›ˆÛË ÙˆÓ ÂȤ‰ˆÓ ÙÔ˘Î·Ï›Ô˘ Â›Ó·È Û˘¯Ó‹ ·ÚÂÓ¤ÚÁÂÈ·ÙˆÓ ıÂÈ·˙ȉÈÎÒÓ ‰ÈÔ˘ÚËÙÈÎÒÓ. ÀÔ-ÏÔÁ›˙ÂÙ·È fiÙÈ ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi·ÛıÂÓÒÓ Ô˘ ·›ÚÓÂÈ ıÂÈ·˙ȉÈο‰ÈÔ˘ÚËÙÈο ·Ó·Ù‡ÛÛÂÈ ˘ÔηÏÈ·È-Ì›· (∫+ <3.5mmol/L).17 √ ˘ÔΛ-ÌÂÓÔ˜ Ì˯·ÓÈÛÌfi˜ Ù˘ ˘ÔηÏÈ·È-Ì›·˜ Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ·˘ÍË̤ÓËÓÂÊÚÈ΋ ·¤ÎÎÚÈÛË ÙÔ˘ Î·Ï›Ô˘. ∏‰Ú¿ÛË ÙˆÓ ıÂÈ·˙ȉÈÎÒÓ ‰ÈÔ˘ÚËÙÈ-ÎÒÓ ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·‡ÍË-ÛË Ù˘ Û˘ÁΤÓÙÚˆÛ˘ ÙÔ˘ Ó·ÙÚ›Ô˘ÛÙ· ¿ˆ ÂÛÂÈڷ̤ӷ ÛˆÏËÓ¿ÚÈ·,Ë ÔÔ›· Ô‰ËÁ› Û ·‡ÍËÛË Ù˘ ÓÂ-ÊÚÈ΋˜ ·¤ÎÎÚÈÛ˘ ÙÔ˘ Î·Ï›Ô˘.∂ÈÚfiÛıÂÙ·, Û ·¿ÓÙËÛË ÛÙËÛ˘ÛÙÔÏ‹ ÙÔ˘ fiÁÎÔ˘ ÙÔ˘ ·›Ì·ÙÔ˜,·˘Í¿ÓÂÙ·È Ë ¤ÎÎÚÈÛË Ù˘ ·Ï‰ÔÛÙÂ-ÚfiÓ˘, Ë ÔÔ›· Ì ÙË ÛÂÈÚ¿ Ù˘ÚÔηÏ› ÂÚ·ÈÙ¤Úˆ ·‡ÍËÛË Ù˘·¤ÎÎÚÈÛ˘ ÙÔ˘ Î·Ï›Ô˘.∏ ·‡ÍËÛË Ù˘ ÓÂÊÚÈ΋˜ ·¤ÎÎÚÈ-Û˘ ÙÔ˘ Î·Ï›Ô˘ Ô˘ ÔÊ›ÏÂÙ·È ÛÙ·ıÂÈ·˙ȉÈο ‰ÈÔ˘ÚËÙÈο Èı·Ó¿ ÂÈ-‰Ú¿ ‰˘ÛÌÂÓÒ˜ ÛÙÔ ÌÂÙ·‚ÔÏÈÛÌfiÙ˘ ÁÏ˘Îfi˙˘, ηıÒ˜ ÂÏ·ÙÙÒÓÂÙ·ÈÙfiÛÔ Ë ¤ÎÎÚÈÛË Ù˘ ÈÓÛÔ˘Ï›Ó˘ÂÍ·ÈÙ›·˜ Ù˘ Ì›ˆÛ˘ ÙÔ˘ Î·Ï›Ô˘fiÛÔ Î·È Ë ÈÓÛÔ˘ÏÈÓÔ¢·ÈÛıËÛ›·ÛÙÔ˘˜ ÂÚÈÊÂÚÈÎÔ‡˜ ÈÛÙÔ‡˜. ™ÙËÌÂϤÙË ALLHAT Û˘ÁÎÚ›ıËÎ·Ó Ù·Â›Â‰· ÙÔ˘ Î·Ï›Ô˘ Û ·ÛıÂÓ›˜Ô˘ ¤·ÈÚÓ·Ó Â›Ù ¯ÏˆÚÔı·ÏȉfiÓ˛٠·ÌÏԉțÓË Â›Ù ÏÈÛÈÓÔÚ›ÏË(¶›Ó·Î·˜ 2).8

∞Ó·ÛÙÔÏ›˜ ÙˆÓ ‚-·‰ÚÂÓÂÚÁÈÎÒÓ˘Ô‰Ô¯¤ˆÓ (‚-·ÔÎÏÂÈÛÙ¤˜)

™Â ·ÚÎÂÙ¤˜ ÌÂϤÙ˜ Û ˘ÂÚÙ·ÛÈ-ÎÔ‡˜ ·ÛıÂÓ›˜ ·Ú·ÙËÚ‹ıËÎÂÌ›ˆÛË ÛÙËÓ ÈÓÛÔ˘ÏÈÓÔ¢·ÈÛıË-Û›· ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ÙfiÛÔ ÙˆÓÌË ÂÎÏÂÎÙÈÎÒÓ ‚-·ÔÎÏÂÈÛÙÒÓ18

fiÛÔ Î·È ÙˆÓ ‚1 ÂÎÏÂÎÙÈÎÒÓ ·Ô-ÎÏÂÈÛÙÒÓ.19-21 Δ· ‰Â‰Ô̤ӷ ·˘Ù¿‰Â›¯ÓÔ˘Ó fiÙÈ ÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜¤¯Ô˘Ó ‰˘ÛÌÂÓ›˜ ÂȉڿÛÂȘ ÛÙÔÌÂÙ·‚ÔÏÈÛÌfi Ù˘ ÁÏ˘Îfi˙˘ ˘ÂÚ-Ù·ÛÈÎÒÓ ·ÛıÂÓÒÓ, ·ÏÏ¿ Î·È ·ÛıÂ-ÓÒÓ Ì ™¢2.

™Â Ì›· ÌÂÁ¿ÏË ÌÂϤÙË (NHS I,NHS II, HPFS), ÛÙËÓ ÔÔ›· Û˘ÌÌÂ-Ù›¯·Ó 19.472 ¿Ó‰Ú˜ Î·È 55.344Á˘Ó·›Î˜, ÔÈ ˘ÂÚÙ·ÛÈÎÔ› ·ÛıÂÓ›˜Ô˘ ¤·ÈÚÓ·Ó ‚-·ÔÎÏÂÈÛÙ¤˜ ›¯·Ó·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈ-ÛË ™¢2 Û ۇÁÎÚÈÛË Ì ÙÔ˘˜·ÛıÂÓ›˜ Ô˘ ‰ÂÓ ¤·ÈÚÓ·Ó ·˘Ù¿Ù· Ê¿Ú̷η.11 ¶·ÚfiÌÔÈ·, ÛÙË ÌÂ-ϤÙË ARIC (Atherosclerosis Risk inCommunities study) Ë ¯ÔÚ‹ÁËÛË

¶›Ó·Î·˜ 2: ∫¿ÏÈÔ, mEq/L (ÌÂϤÙË ALLHAT)

ÃψÚÔı·ÏȉfiÓË ∞ÌÏԉțÓË §ÈÛÈÓÔÚ›ÏË

∞ÚÈıÌfi˜ ·ÛıÂÓÒÓ(%)

™ÙËÓ ¤Ó·ÚÍË 14487 (95.0) 8586 (94.9) 8573 (94.7)Ù˘ ÌÂϤÙ˘

ªÂÙ¿ 2 ¤ÙË 9877 (64.7) 5794 (64.0) 5516 (60.9)

ªÂÙ¿ 4 ¤ÙË 8315 (54.5) 4919 (54.4) 4616 (51.0)

ª¤ÛË ÙÈÌ‹ (±ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË)

∞Ú¯Èο ›‰· 4.3 (0.7) 4.3 (0.7) 4.4 (0.7)

2 ¤ÙË 4 (0.7) 4.3 (0.7) 4.5 (0.7)

4 ¤ÙË 4.1 (0,7) 4.4 (0.7) 4.5 (0.7)

∞ÚÈıÌfi˜ ·ÛıÂÓÒÓ (%) Ì οÏÈÔ<3.5mEq/L

™ÙËÓ ¤Ó·ÚÍË 493 (3.4) 292 (3.4) 223 (2.6)Ù˘ ÌÂϤÙ˘

2 ¤ÙË 1254 (12.7) 151 (2.6) 83 (1.5)

4 ¤ÙË 707 (8.5) 93 (1.9) 37 (0.8)

¶›Ó·Î·˜ 3: ∫›Ó‰˘ÓÔ˜ ÂÌÊ¿ÓÈÛ˘ ™¢2 Û 3804 ˘ÂÚÙ·ÛÈÎÔ‡˜ ·ÛıÂ-Ó›˜ ·Ó¿ÏÔÁ· Ì ÙË Ê·Ú̷΢ÙÈ΋ ·ÓÙÈ˘ÂÚÙ·ÛÈ΋ ıÂڷ›· (ÌÂϤ-ÙË ARIC)

∫·Ì›· 1.0 1.0 1.0

·-ª∂∞ 0.99 (0.73-1.35) 0.96 (0.71-1.31) 0.98 (0.72-1.34)

‚-·ÔÎÏÂÈÛÙ¤˜ 1.26 (1.03-1.52) † 1.25 (1.03-1.52) † 1.28 (1.04-1.57) †

∞ÓÙ·ÁˆÓÈÛÙ¤˜ 1.17 (0.85-1.62) 1.16 (0.84-1.60) 1.17 (0.83-1.66)‰È·‡ÏˆÓ Ca++

£ÂÈ·˙ȉÈο 0.95 (0.77-1.17) 0.93 (0.76-1.15) 0.91 (0.73-1.13)‰ÈÔ˘ÚËÙÈο

*ªÔÓÙ¤ÏÔ1: ‰ÈÔÚıˆÌ¤ÓÔ ˆ˜ ÚÔ˜ ÙËÓ ËÏÈΛ·, ÙÔ Ê‡ÏÔ, ÙË Ê˘Ï‹ Î·È ÙË ¯Ú‹ÛË ¿Ï-ÏˆÓ ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ Ê·Ú̿ΈÓ. ªÔÓÙ¤ÏÔ 2: ‰ÈÔÚıˆÌ¤ÓÔ ˆ˜ ÚÔ˜ ÙȘ ·Ú·Ì¤-ÙÚÔ˘˜ ÙÔ˘ ÌÔÓÙ¤ÏÔ˘ 1, ÙÔ ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜, ÙÔ ÏfiÁÔ ÂÚÈ̤ÙÚÔ˘ ̤Û˘ ÚÔ˜ÂÚ›ÌÂÙÚÔ ÈÛ¯›Ô˘, ÙÔ ÌÔÚʈÙÈÎfi ›‰Ô, ÙÔ Î¿ÓÈÛÌ·, ÙË ¯Ú‹ÛË ·ÏÎÔfiÏ Î·È ÙËÊ˘ÛÈ΋ ηٿÛÙ·ÛË. ªÔÓÙ¤ÏÔ 3: ‰ÈÔÚıˆÌ¤ÓÔ ˆ˜ ÚÔ˜ ÙÔ ÌÔÓÙ¤ÏÔ 2, ÙË Û˘ÛÙÔÏÈ΋·ÚÙËÚȷ΋ ›ÂÛË, ÙË ‰È·ÛÙÔÏÈ΋ ·ÚÙËÚȷ΋ ›ÂÛË, ÙË Û˘ÁΤÓÙÚˆÛË ÈÓÛÔ˘Ï›Ó˘ ÓË-ÛÙ›·˜ ÛÙÔÓ ÔÚfi Î·È ÛÙËÓ ·ÚÔ˘Û›· ‹ ·Ô˘Û›· ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜, ηډȷÁ-ÁÂȷ΋˜ ÓfiÛÔ˘, Ó¢ÌÔÓÈ΋˜ ÓfiÛÔ˘, ÓÂÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜ Î·È ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ÈÛÙÔÚÈÎÔ‡ ‰È·‚‹ÙË.**·-ª∂∞: ·Ó·ÛÙÔÏ›˜ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘.†P<0.05 Û ۇÁÎÚÈÛË Ì ·ÛıÂÓ›˜ Ô˘ ‰ÂÓ Ï¿Ì‚·Ó·Ó η̛· ·ÓÙÈ˘ÂÚÙ·ÛÈ΋ ·ÁˆÁ‹

™¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ (95% ‰È¿ÛÙËÌ· ÂÌÈÛÙÔÛ‡Ó˘)

ªÔÓÙ¤ÏÔ 1 ªÔÓÙ¤ÏÔ 2 ªÔÓÙ¤ÏÔ 3

∞ÓÙÈ˘ÂÚÙ·ÛÈ΋

ıÂڷ›·

‚-·ÔÎÏÂÈÛÙÒÓ Û˘Óԉ‡ÔÓÙ·Ó ·fiÌ›· ηٿ 28% ·‡ÍËÛË ÙÔ˘ ÎÈÓ‰‡-ÓÔ˘ ÂÌÊ¿ÓÈÛ˘ ™¢2 Û ۇÁÎÚÈÛËÌ ٷ ¿ÙÔÌ· Ô˘ ‰ÂÓ ¤·ÈÚÓ·Ó ·˘-Ù‹ ÙË ıÂڷ›· (¶›Ó·Î·˜ 3).22

™ÙË ÌÂϤÙË INVEST (Inter-national VErapamil SR-Trandona-pril Study) Ë ¯ÔÚ‹ÁËÛË ‚ÂÚ··Ì›-Ï˘ ›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ì›· ηٿ15% Ì›ˆÛË Ù˘ ›وÛ˘ ÓÂÔ-ÂÌÊ·ÓÈ˙fiÌÂÓÔ˘ ‰È·‚‹ÙË Û ۇ-ÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· Ô˘ ‹Ú·ÁˆÁ‹ Ì ·ÙÂÓÔÏfiÏË.23

¶Ú¤ÂÈ Ó· ·Ó·ÊÂÚı›, fiÙÈ ÔÈ ÓÂ-fiÙÂÚÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜, fiˆ˜ Ë Î·Ú-‚ÂÓÙÈÏfiÏË, Ê·›ÓÂÙ·È Ó· ‚ÂÏÙÈÒÓÔ˘ÓÙËÓ ÈÓÛÔ˘ÏÈÓÔ¢·ÈÛıËÛ›·. ¶Ú¿ÁÌ·-ÙÈ, Û 72 ˘ÂÚÙ·ÛÈÎÔ‡˜ ·ÛıÂÓ›˜¯ˆÚ›˜ ‰È·‚‹ÙË, Ë ¯ÔÚ‹ÁËÛË Î·Ú‚Â-ÓÙÈÏfiÏ˘ ·‡ÍËÛ ηٿ 14% ÙËÓ Â˘-·ÈÛıËÛ›· ÛÙËÓ ÈÓÛÔ˘Ï›ÓË, ÂÓÒ Ë ¯Ô-Ú‹ÁËÛË ÌÂÙÔÚÔÏfiÏ˘ Ô‰‹ÁËÛÂÛ Ì›ˆÛ‹ Ù˘.24 ¶·ÚfiÌÔÈ· ·ÔÙÂ-ϤÛÌ·Ù· ·Ú·ÙËÚ‹ıËÎ·Ó fiÙ·Ó Û˘-ÁÎÚ›ıËÎÂ Ë Î·Ú‚ÂÓÙÈÏfiÏË Ì ÙËÓ·ÙÂÓÔÏfiÏË.25 ™ÙË ÌÂϤÙË GEMINI(Glycemic Effects in Diabetes Me-litus: Carvedilol-metoprolol Compa-rison in Hypertensives) 1235 ˘ÂÚ-Ù·ÛÈÎÔ› ·ÛıÂÓ›˜ Ì ™¢2, Ô˘ ‹‰Ë¤·ÈÚÓ·Ó ·-ª∂∞ ‹ ·ÓÙ·ÁˆÓÈÛÙ¤˜ÙˆÓ ˘Ô‰Ô¯¤ˆÓ Ù˘ ·ÁÁÂÈÔÙÂÓÛ›-Ó˘ Ù˘¯·ÈÔÔÈ‹ıËÎ·Ó Û ηڂÂÓÙÈ-ÏfiÏË (‰fiÛË ÙÈÙÏÔÔ›ËÛ˘ 6.25 mg¤ˆ˜ 25 mg) ‹ ÌÂÙÔÚÔÏfiÏË (‰fiÛËÙÈÙÏÔÔ›ËÛ˘ 50 mg ¤ˆ˜ 200 mg) 2ÊÔÚ¤˜ ÙË Ì¤Ú·. ªÂÙ¿ ·fi 5 Ì‹Ó˜ıÂڷ›· ÔÈ ·ÛıÂÓ›˜ Ô˘ ¤·ÈÚ-Ó·Ó Î·Ú‚ÂÓÙÈÏfiÏË ·ÚÔ˘Û›·Û·ÓÌ›ˆÛË Ù˘ ·ÓÙ›ÛÙ·Û˘ ÛÙËÓ ÈÓ-ÛÔ˘Ï›ÓË, ·ÏÏ¿ Î·È ÂÏ¿ÙÙˆÛË ÙˆÓÂȤ‰ˆÓ Ù˘ ÁÏ˘ÎÔ˙˘ÏȈ̤Ó˘ ·È-ÌÔÛÊ·ÈÚ›Ó˘ (HbA1c), ÂÓÒ ÔÈ·ÛıÂÓ›˜ Ô˘ ‹Ú·Ó ÌÂÙÔÚÔÏfiÏˉÂÓ ÂÌÊ¿ÓÈÛ·Ó ÌÂÙ·‚ÔÏ‹ Ù˘ ÈÓ-ÛÔ˘ÏÈÓÔ·ÓÙ›ÛÙ·Û˘ Ì ·Ú¿ÏÏËÏË·‡ÍËÛË Ù˘ ÁÏ˘ÎÔ˙˘ÏȈ̤Ó˘ ·È-ÌÔÛÊ·ÈÚ›Ó˘ (HbA1c).26

∂ÈÚfiÛıÂÙ·, ·Ó·Ê¤ÚÂÙ·È fiÙÈÔÚÈṲ̂ÓÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜, fiˆ˜ ËÈÓ‰ÔÏfiÏË, Ô˘ ¤¯Ô˘Ó ÂÓ‰ÔÁÂÓ‹Û˘Ì·ıËÙÈÎÔÌÈÌËÙÈ΋ ‰Ú¿ÛË, ÂÌ-Ê·Ó›˙Ô˘Ó ÏÈÁfiÙÂÚ˜ ‰˘ÛÌÂÓ›˜ÂȉڿÛÂȘ ÛÙËÓ ÈÓÛÔ˘ÏÈÓÔ¢·È-ÛıËÛ›· Î·È Û ¿ÏϘ ÌÂÙ·‚ÔÏÈΤ˜·Ú·Ì¤ÙÚÔ˘˜ Û ۇÁÎÚÈÛË Ì ¿Ï-ÏÔ˘˜ ‚-·ÔÎÏÂÈÛÙ¤˜.18

∞Ó·ÛÙÔÏ›˜ ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ-˙‡ÌÔ˘ Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘ (·-ª∂∞)Î·È ·ÓÙ·ÁˆÓÈÛÙ¤˜ ÙˆÓ ˘Ô‰Ô¯¤-ˆÓ Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘ ππ√È ·-ª∂∞ Î·È ÔÈ ·ÓÙ·ÁˆÓÈÛÙ¤˜ ÙˆÓ˘Ô‰Ô¯¤ˆÓ Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘ ππ‰ÚÔ˘Ó Â˘ÓÔ˚ο ÛÙÔ ÌÂÙ·‚ÔÏÈÛÌfi

Ù˘ ÁÏ˘Îfi˙˘ ̤۷ ·fi ÌÈ· ÔÈÎÈ-Ï›· Ì˯·ÓÈÛÌÒÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·ÈÌ ÙËÓ ·Ó·ÛÙÔÏ‹ Ù˘ ·ÁÁÂÈÔÙÂÓÛ›-Ó˘ ππ.27 √È ·-ª∂∞ ‚ÂÏÙÈÒÓÔ˘Ó ÙËÓÈÓÛÔ˘ÏÈÓÔ¢·ÈÛıËÛ›· ΢ڛˆ˜ ÛÙÔ˘˜ÛÎÂÏÂÙÈÎÔ‡˜ Ì˘˜. ∞˘Ù‹ Ë ‰Ú¿ÛËÙˆÓ ·-ª∂∞ ‰È·ÈÛÙÒıËΠÛÙË ÌÂ-ϤÙË HOPE (Heart Outcomes Pre-vention Evaluation), ÛÙËÓ ÔÔ›··Ú·ÙËÚ‹ıËΠ̛· Ì›ˆÛË Ù˘ ÂÌ-Ê¿ÓÈÛ˘ ™¢2 Û ·ÛıÂÓ›˜ Ô˘ ‹-Ú·Ó Ú·ÌÈÚ›ÏË Û ۇÁÎÚÈÛË ÌÂÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ‹Ú·Ó ÂÈÎÔÓÈÎfiÊ¿ÚÌ·ÎÔ [102 ·ÛıÂÓ›˜ (3.6%)ÛÙËÓ ÔÌ¿‰· Ù˘ Ú·ÌÈÚ›Ï˘ ¤Ó·ÓÙÈ155 ·ÛıÂÓÒÓ (5,4%) ÛÙËÓ ÔÌ¿‰·ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘, Û¯ÂÙÈ-Îfi˜ ΛӉ˘ÓÔ˜: 0.66, p<0.001].28

™ÙË ÌÂϤÙË DREAM (DiabetesReduction Assessment with Rami-pril and Rosiglitazone Medication),ˆÛÙfiÛÔ, ‰È·ÈÛÙÒıËΠfiÙÈ Ë ¯Ô-Ú‹ÁËÛË 15 mg Ú·ÌÈÚ›Ï˘ ÙËÓË̤ڷ ÁÈ· 3 ¯ÚfiÓÈ· ‰ÂÓ Ì›ˆÛÂÙËÓ Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ™¢2ÛÙÔ˘˜ ·ÛıÂÓ›˜ ¯ˆÚ›˜ ηډȷÁÁÂÈ-·Î‹ ÓfiÛÔ. ∞Í›˙ÂÈ Ó· ÛËÌÂȈı›,fï˜, fiÙÈ Ë Â›Ù¢ÍË ÓÔÚÌÔÁÏ˘-ηÈÌ›·˜ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ‹-Ú·Ó Ú·ÌÈÚ›ÏË Î·È Â›¯·Ó Ê˘ÛÈÔÏÔ-ÁÈο ›‰· ÁÏ˘Îfi˙˘ ÓËÛÙ›·˜‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚË Û ۇÁÎÚÈÛË ÌÂÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ‹Ú·Ó ÂÈÎÔÓÈÎfiÊ¿ÚÌ·ÎÔ (¶›Ó·Î·˜ 4).29

∂ӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÔÚÈ-Ṳ̂Ó˜ ÌÂϤÙ˜, ÛÙȘ Ôԛ˜ ·Ó·-ʤÚÔÓÙ·È ‰È·ÊÔÚÂÙÈÎÔ› Ì˯·ÓÈÛÌÔ›‰Ú¿Û˘ ·˘ÙÒÓ ÙˆÓ Î·ÙËÁÔÚÈÒÓ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ÛÙÔÌÂÙ·‚ÔÏÈÛÌfi Ù˘ ÁÏ˘Îfi˙˘. √È

Kurtz Î·È Pravenec, ÁÈ· ·Ú¿‰ÂÈÁ-Ì·, ·Ú·Ù‹ÚËÛ·Ó fiÙÈ ÔÈ ·-ª∂∞ÌÔÚÔ‡Ó Ó· ÂËÚ¿ÛÔ˘Ó ıÂÙÈοÙÔ ÌÂÙ·‚ÔÏÈÛÌfi Ù˘ ÁÏ˘Îfi˙˘ ‰È·-̤ÛÔ˘ Ù˘ Ô‰Ô‡ Ù˘ ‚Ú·‰˘ÎÈÓ›Ó˘‚ÂÏÙÈÒÓÔÓÙ·˜ ÙËÓ ·ÈÌ·ÙÈ΋ ÚÔ‹ÛÙÔ˘˜ ÛÎÂÏÂÙÈÎÔ‡˜ Ì˘˜.30 ∞ÓÙ›ıÂ-Ù·, Ë ÙÂÏÌÈÛ·ÚÙ¿ÓË Ê·›ÓÂÙ·È Ó·‰Ú· ‰È·Ì¤ÛÔ˘ Ù˘ ÂÓÂÚÁÔÔ›ËÛË˜ÙˆÓ PPAR-Á ˘Ô‰Ô¯¤ˆÓ30 Ì ¢ÂÚ-ÁÂÙÈο ·ÔÙÂϤÛÌ·Ù· Û ÔÚÈṲ̂-Ó˜ ÎÏÈÓÈΤ˜ Î·È ÚÔÎÏÈÓÈΤ˜ ÌÂϤ-Ù˜.31 ¶Ú¿ÁÌ·ÙÈ, Û ÔÚÈṲ̂Ó˜ ÌÂ-ϤÙ˜ ÛÙȘ Ôԛ˜ ¯ÔÚËÁ‹ıËÎÂÙÂÏÌÈÛ·ÚÙ¿ÓË ˆ˜ ÌÔÓÔıÂڷ›·Û ÌË ‰È·‚ËÙÈÎÔ‡˜ ˘ÂÚÙ·ÛÈÎÔ‡˜·ÛıÂÓ›˜ ·Ú·ÙËÚ‹ıËΠ‚ÂÏÙ›ˆÛËÙ˘ ÈÓÛÔ˘ÏÈÓÔ¢·ÈÛıËÛ›·˜.32

∞Ó·ÛÙÔÏ›˜ ÙˆÓ ‰È·‡ÏˆÓ·Û‚ÂÛÙ›Ô˘

√È ·Ó·ÛÙÔÏ›˜ ÙˆÓ ‰È·‡ÏˆÓ ·Û‚Â-ÛÙ›Ô˘ Ê·›ÓÂÙ·È fiÙÈ ÌÂÈÒÓÔ˘Ó ÙËÓ·ÂÏ¢ı¤ÚˆÛË Ù˘ ÈÓÛÔ˘Ï›Ó˘,ÁÂÁÔÓfi˜ ÙÔ ÔÔ›Ô ÂÍÈÛÔÚÚÔ›ٷȷfi ÙËÓ ÈηÓfiÙËÙ· ÙÔ˘˜ Ó· ·˘Í¿-ÓÔ˘Ó ÙËÓ ÚfiÛÏË„Ë Ù˘ ÁÏ˘Îfi˙˘ÛÙÔ˘˜ ÂÚÈÊÂÚÈÎÔ‡˜ ÈÛÙÔ‡˜.33 34

ŒÙÛÈ ÔÈ ·Ó·ÛÙÔÏ›˜ ÙˆÓ ‰È·‡ÏˆÓ·Û‚ÂÛÙ›Ô˘ ‰ÂÓ ÂËÚ¿˙Ô˘Ó ‰˘-ÛÌÂÓÒ˜ ÙÔ ÌÂÙ·‚ÔÏÈÛÌfi Ù˘ ÁÏ˘-Îfi˙˘.35-37

™Â Ì›· ÌÂϤÙË 16.176 ÛÙÂÊ·ÓÈ-·›ˆÓ ·ÛıÂÓÒÓ Ì ˘¤ÚÙ·ÛË Ë ¯Ô-Ú‹ÁËÛË ‚ÂÚ··Ì›Ï˘ ›¯Â ÌÈÎÚfi-ÙÂÚË Èı·ÓfiÙËÙ· Ó· Ô‰ËÁ‹ÛÂÈÛÙËÓ ÂÌÊ¿ÓÈÛË ™¢2 ·fi ÙË ıÂÚ·-›· Ì ·ÙÂÓÔÏfiÏË (¶›Ó·Î·˜ 5).23

™ÙËÓ ›‰È· ÌÂϤÙË Ë ÚÔÛı‹ÎË

£∂ƒ∞¶∂π∞ - º∞ƒª∞∫∞

21

¶›Ó·Î·˜ 4: ™¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ‰È·‚‹ÙË, ÁÈ· ı¿Ó·ÙÔÎ·È ÁÈ· ÙËÓ Â›Ù¢ÍË ÓÔÚÌÔÁÏ˘Î·ÈÌ›·˜ (ÌÂϤÙË DREAM)

ŒÎ‚·ÛË ƒ·ÌÈÚ›ÏË ∂ÈÎÔÓÈÎfi ™¯ÂÙÈÎfi˜ PÊ¿ÚÌ·ÎÔ Î›‰˘ÓÔ˜

¡=2623 ¡=2646 (95% ‰È¿ÛÙËÌ· ÂÌÈÛÙÔÛ‡Ó˘)

¢È·‚‹Ù˘, 449 (17.1) 489 (18.5) 0.91 (0.80-1.03) NSn(%)

£¿Ó·ÙÔ˜, 31 (1.2) 32 (1.2) 0.98 (0.60-1.60) NSn(%)

∂›Ù¢ÍË 1116 (42.5) 1012 (38.2) 1.16 (1.07-1.27) 0.001ÓÔÚÌÔÁÏ˘Î·ÈÌ›·˜,

n(%)

†¶ÚÈÓ ÙË ‰È¿ÁÓˆÛË ÙÔ˘ ™¢2, 26 ı¿Ó·ÙÔÈ ·Ú·ÙËÚ‹ıËÎ·Ó ÛÙËÓ ÔÌ¿‰· Ù˘ Ú·ÌÈÚ›-Ï˘ Î·È 28 ı¿Ó·ÙÔÈ ·Ú·ÙËÚ‹ıËÎ·Ó ÛÙËÓ ÔÌ¿‰· ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘

¶›Ó·Î·˜ 5: μÂÚ··Ì›ÏË ¤Ó·ÓÙÈ ·ÙÂÓÔÏfiÏ˘ (ÌÂϤÙË INVEST)

μÂÚ··Ì›ÏË ∞ÙÂÓÔÏfiÏË

∞ÚÈıÌfi˜ ·ÛıÂÓÒÓ 8098 8078

∂ÌÊ¿ÓÈÛË ™¢2 569 (7%) 665(8.2%)

·-ª∂∞ (ÙÚ·ÓÙÔÏ·Ú›ÏË) ÛÙË ıÂÚ·-›· Ì ‚ÂÚ··Ì›ÏË Ì›ˆÛ ÙÔÓΛӉ˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ™¢2 (ηٿ 44%Ì ÚÔÛı‹ÎË 2 mg ÙÚ·ÓÙÔÏ·Ú›-Ï˘ Û 180 mg ‚ÂÚ··Ì›Ï˘ ÙËÓË̤ڷ Î·È Î·Ù¿ 42% Ì ÚÔÛı‹ÎË4 mg ÙÚ·ÓÙÔÏ·Ú›Ï˘ Û 240 mg‚ÂÚ··Ì›Ï˘ ÙËÓ Ë̤ڷ), ÂÓÒ ËÚÔÛı‹ÎË ˘‰ÚԯψÚÔıÂÈ·˙›‰Ë˜ÛÙËÓ ·ÙÂÓÔÏfiÏË ·‡ÍËÛ ÙÔÓ Î›Ó‰˘-ÓÔ (ηٿ 7% Ì ÚÔÛı‹ÎË 12.5 mg˘‰ÚԯψÚÔıÂÈ·˙›‰Ë˜ Û 50mg·ÙÂÓÔÏfiÏ˘ ÙËÓ Ë̤ڷ Î·È Î·Ù¿38% Ì ÚÔÛı‹ÎË 25 mg ˘‰ÚÔ-¯ÏˆÚÔıÂÈ·˙›‰Ë˜ Û 100 mg ·ÙÂÓÔ-ÏfiÏ˘ ÙËÓ Ë̤ڷ).23

™Â Ì›· ¿ÏÏË ÌÂϤÙË (VALUE), ËıÂڷ›· Ì ·ÓÙ·ÁˆÓÈÛÙ‹ ÙˆÓ˘Ô‰Ô¯¤ˆÓ Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘(‚·ÏÛ·ÚÙ¿ÓË) Û˘Û¯ÂÙ›ÛıËΠÌÂÌ›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛ˘™¢2 Û ۇÁÎÚÈÛË Ì ÙË ıÂڷ›·Ì ·ÌÏԉțÓË (¶›Ó·Î·˜ 6).38

∞ÓÙ·ÁˆÓÈÛÙ¤˜ ÙˆÓ ·-·‰ÚÂÓÂÚÁÈÎÒÓ ˘Ô‰Ô¯¤ˆÓ

∏ ÌÂϤÙË ALS ¤‰ÂÈÍ fiÙÈ Ë Ú·˙Ô-Û›ÓË ‚ÂÏÙÈÒÓÂÈ ÙËÓ Â˘·ÈÛıËÛ›·ÛÙËÓ ÈÓÛÔ˘Ï›ÓË Û ·ÛıÂÓ›˜ ÌÂȉÈÔ·ı‹ ˘¤ÚÙ·ÛË.39 ∏ ÙÂÚ·˙ÔÛ›-ÓË Ê·›ÓÂÙ·È Ó· ÌËÓ ¤¯ÂÈ Î¿Ôȷ›‰Ú·ÛË ÛÙËÓ ÈÓÛÔ˘ÏÈÓÔ¢·ÈÛıË-Û›·,40 ÂÓÒ ‰ÂÓ ˘¿Ú¯Ô˘Ó ‰Â‰Ô̤ӷfiÛÔÓ ·ÊÔÚ¿ ÙËÓ Ù·ÌÛÔ˘ÏÔÛ›ÓË.Δ¤ÏÔ˜ Ë Ô˘Ú·È‰›ÏË ·ÚfiÙÈ ‰ÂÓ¤¯ÂÈ ÂȉڿÛÂȘ ÛÙÔ ÌÂÙ·‚ÔÏÈÛÌfiÙ˘ ÁÏ˘Îfi˙˘, ÂËÚ¿˙ÂÈ ¤Ó· ¿ÏÏÔηډȷÁÁÂÈÎfi ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡-ÓÔ˘, ÙÔ ÈÓˆ‰ÔÁfiÓÔ.41

¢ÈÂÁ¤ÚÙ˜ ÙˆÓ ÎÂÓÙÚÈÎÒÓ ·-·‰ÚÂÓÂÚÁÈÎÒÓ ˘Ô‰Ô¯¤ˆÓ

∏ ÎÏÔÓȉ›ÓË Ê·›ÓÂÙ·È Ó· ¤¯ÂÈ Ô˘‰¤-ÙÂÚ˜ ÂȉڿÛÂȘ ÛÙÔ ÌÂÙ·‚ÔÏÈ-ÛÌfi Ù˘ ÁÏ˘Îfi˙˘.42 ™Â Ì›· Úfi-ÛÊ·ÙË ÌÂϤÙË, ÛÙËÓ ÔÔ›· Û˘ÌÌÂ-Ù›¯·Ó 108 Á˘Ó·›Î˜ (55 ÌË ‰È·‚Ë-ÙÈΤ˜ ˘ÂÚÙ·ÛÈΤ˜ Á˘Ó·›Î˜ Î·È 53ÓÔÚÌÔÙ·ÛÈΤ˜ Á˘Ó·›Î˜), ‰ÈÂÚ¢-Ó‹ıËÎÂ Ë ‰Ú¿ÛË Ù˘ ÌÔÍÔÓȉ›Ó˘ÛÙ· ›‰· Ù˘ ·‰ÈÔÓÂÎÙ›Ó˘ÙÔ˘ ÔÚÔ‡. ∏ ¯ÔÚ‹ÁËÛË 0.4 mg ÙËÓË̤ڷ ÌÔÍÔÓȉ›Ó˘ ÁÈ· 12 ‚‰ÔÌ¿-‰Â˜ ÛÙȘ ˘ÂÚÙ·ÛÈΤ˜ Á˘Ó·›Î˜ ›-¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ì›· Ì›ˆÛË Ù˘ÁÏ˘Îfi˙˘ ÓËÛÙ›·˜ ηٿ 2.1%(±16.7%, p<0.05),( ¶›Ó·Î·˜ 7).43

¡ÂÔÂÌÊ·ÓÈ˙fiÌÂÓÔ˜ ۷ί·Ú҉˘‰È·‚‹Ù˘ Î·È Î·Ú‰È·ÁÁÂȷο Û˘Ì‚¿Ì·Ù·

∂›Ó·È ÛËÌ·ÓÙÈÎfi Ó· ·Ó·Ï˘ı› Ë Â›-‰Ú·ÛË ÙÔ˘ ÓÂÔÂÌÊ·ÓÈ˙fiÌÂÓÔ˘Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË Û ˘fi ıÂÚ·-›· ˘ÂÚÙ·ÛÈÎÔ‡˜ ·ÛıÂÓ›˜ fiÛÔÓ·ÊÔÚ¿ ÙËÓ ÂÌÊ¿ÓÈÛË Î·Ú‰È·ÁÁÂÈ·-ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ. ¢È¿ÊÔÚ˜ ÌÂϤ-Ù˜ ·Ó·Ê¤ÚÔ˘Ó ·‡ÍËÛË ÙÔ˘ ηÚ-‰È·ÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ÛÙÔ˘˜ ·-Ú·¿Óˆ ·ÛıÂÓ›˜. ¶ÚfiÛÊ·Ù·, ÛÂÌ›· ÌÂϤÙË ‰È¿ÚÎÂÈ·˜ 28 ÂÙÒÓ ‰ÈÂ-Ú¢ӋıËÎÂ Ë Â›‰Ú·ÛË ÙÔ˘ ÓÂÔÂÌ-Ê·ÓÈ˙fiÌÂÓÔ˘ ™¢2 ÛÙ· ηډȷÁÁÂÈ-·Î¿ Û˘Ì‚¿Ì·Ù·. ™ÙË ÌÂϤÙË ·˘Ù‹Û˘ÌÌÂÙ›¯·Ó 754 ·ÛıÂÓ›˜ Ô˘¤·ÈÚÓ·Ó ·ÓÙÈ˘ÂÚÙ·ÛÈ΋ ·ÁˆÁ‹.Δ· ·ÓÙÈ˘ÂÚÙ·ÛÈο Ê¿Ú̷η Ô˘¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ‹Ù·Ó Ù· ıÂÈ·˙È-‰Èο ‰ÈÔ˘ÚËÙÈο, ÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜,

ÔÈ ·Ó·ÛÙÔÏ›˜ ÙˆÓ ‰È·‡ÏˆÓ ·Û‚Â-ÛÙ›Ô˘ Î·È ÔÈ ·Ó·ÛÙÔÏ›˜ ÙÔ˘ ÌÂÙ·-ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ Ù˘ ·ÁÁÂÈÔÙÂÓ-Û›Ó˘. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂϤ-Ù˘ 148 ·ÛıÂÓ›˜ (20.4%) ÂÌÊ¿ÓÈ-Û·Ó ™¢2, Ô ÔÔ›Ô˜ Û˘Û¯ÂÙ›ÛıËÎÂıÂÙÈο Ì ÙÔ ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·-ÙÔ˜, Ù· ›‰· ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓÎ·È ÙË ¯ÔÚ‹ÁËÛË ‚-·Ó·ÛÙÔϤˆÓ. √ÓÂÔÂÌÊ·ÓÈ˙fiÌÂÓÔ˜ ™¢2 ÛÙÔ˘˜·ÛıÂÓ›˜ ·˘ÙÔ‡˜ Û˘Û¯ÂÙ›ÛıËÎÂıÂÙÈο Ì ÙËÓ ÂÌÊ¿ÓÈÛË ·ÁÁÂÈ·ÎÔ‡ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ (Û¯ÂÙÈÎfi˜Î›Ó‰˘ÓÔ˜: 1.67, 95% ‰È¿ÛÙËÌ·ÂÌÈÛÙÔÛ‡Ó˘: 1.1-2.6, p<0.05), ÂÌ-ÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ôηډ›Ô˘ (Û¯Â-ÙÈÎfi˜ ΛӉ˘ÓÔ˜: 1.66, 95% ‰È¿ÛÙË-Ì· ÂÌÈÛÙÔÛ‡Ó˘: 1.1-2.5, p<0.05)Î·È ÙËÓ ÔÏÈ΋ ıÓËÙfiÙËÙ· (Û¯ÂÙÈÎfi˜Î›Ó‰˘ÓÔ˜: 1.42, 95% ‰È¿ÛÙËÌ·ÂÌÈÛÙÔÛ‡Ó˘: 1.1-1.9, p<0.05).44

∂ÈÚfiÛıÂÙ· ÌÈ· ¿ÏÏË ÌÂϤÙË,ÛÙËÓ ÔÔ›· Û˘ÌÌÂÙ›¯·Ó 795·ÛıÂÓ›˜ Ì ˘¤ÚÙ·ÛË ¤‰ÂÈÍ fiÙÈ ËÂÌÊ¿ÓÈÛË ™¢2 ηٿ ÙË ‰È¿ÚÎÂÈ·Ù˘ ıÂڷ›·˜ ·ÔÙÂÏ› ÛËÌ·ÓÙÈ-Îfi ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓÂÌÊ¿ÓÈÛË Î·Ú‰È·ÁÁÂȷ΋˜ ÓfiÛÔ˘.™˘ÁÎÂÎÚÈ̤ӷ, Ô Û¯ÂÙÈÎfi˜ ΛӉ˘-ÓÔ˜ ÁÈ· ηډȷÁÁÂȷο Û˘Ì‚¿Ì·Ù·ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ÂÌÊ¿ÓÈ۷Ӊȷ‚‹ÙË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ıÂ-ڷ›·˜ ‹Ù·Ó 2.92 (95% ‰È¿ÛÙËÌ·ÂÌÈÛÙÔÛ‡Ó˘: 1.33-6.41, p=0.007)Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ ·ÛıÂÓ›˜Ô˘ ‰ÂÓ ÂÌÊ¿ÓÈÛ·Ó ‰È·‚‹ÙË. Δ·˘-Ùfi¯ÚÔÓ·, ·ÚfiÌÔÈÔ˜ ‹Ù·Ó Î·È ÔÛ¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ ÁÈ· ηډȷÁÁÂÈ-·Î¿ Û˘Ì‚¿Ì·Ù· ÛÙÔ˘˜ ·ÛıÂÓ›˜Ô˘ ›¯·Ó ‰È·‚‹ÙË Î·Ù¿ ÙËÓ ¤Ó·Ú-ÍË Ù˘ ıÂڷ›·˜: 3.57 (95% ‰È¿-ÛÙËÌ· ÂÌÈÛÙÔÛ‡Ó˘: 1.65-7.73,p=0.001) Û ۇÁÎÚÈÛË Ì ÙÔ˘˜·ÛıÂÓ›˜ Ô˘ ‰ÂÓ ÂÌÊ¿ÓÈÛ·Ó ‰È·-‚‹ÙË.45

™˘ÁÎÂÓÙÚˆÙÈο ‰Â‰Ô̤ӷ ÁÈ· ÙËÓ›‰Ú·ÛË ÙˆÓ ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓÊ·ÚÌ¿ÎˆÓ ÛÙËÓ ÂÌÊ¿ÓÈÛË۷ί·ÚÒ‰Ë ‰È·‚‹ÙË

™Â Ì›· ÚfiÛÊ·ÙË ÌÂÙ·-·Ó¿Ï˘ÛË,22 ÎÏÈÓÈÎÒÓ ÌÂÏÂÙÒÓ, ‰ÈÂÚ¢ӋıË-ÎÂ Ë ÂÌÊ¿ÓÈÛË ™¢2 Û 143.153 Ìˉȷ‚ËÙÈÎÔ‡˜ ˘ÂÚÙ·ÛÈÎÔ‡˜ ·ÛıÂ-Ó›˜ (¶›Ó·Î·˜ 8).46

∏ ÌÂÙ·-·Ó¿Ï˘ÛË ¤‰ÂÈÍ fiÙÈ ÔÈ·ÓÙ·ÁˆÓÈÛÙ¤˜ ÙˆÓ ˘Ô‰Ô¯¤ˆÓ Ù˘·ÁÁÂÈÔÙÂÓÛ›Ó˘ Î·È ÔÈ ·Ó·ÛÙÔÏ›˜ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ Ù˘·ÁÁÂÈÔÙÂÓÛ›Ó˘ Â›Ó·È Ù· ·ÓÙÈ˘ÂÚ-Ù·ÛÈο Ê¿Ú̷η Ô˘ Û¯ÂÙ›˙ÔÓÙ·ÈÏÈÁfiÙÂÚÔ Ì ÙËÓ ÂÌÊ¿ÓÈÛË ™¢2ÛÙÔ˘˜ ˘ÂÚÙ·ÛÈÎÔ‡˜ ·ÛıÂÓ›˜ (ηÈÌ¿ÏÈÛÙ· Ê·›ÓÂÙ·È fiÙÈ ·ÛÎÔ‡Ó ÚÔ-

¢ ∂ ∫ ∂ ª μ ƒ π √ ™ 2 0 0 8

22

n= 51 ¶ÚÈÓ ÙË ªÂÙ¿ ÙË ªÂÙ·‚ÔÏ‹ (%) P¯ÔÚ‹ÁËÛË ¯ÔÚ‹ÁËÛË

ÌÔÍÔÓȉ›Ó˘ ÌÔÍÔÓȉ›Ó˘

°Ï˘Îfi˙Ë ÓËÛÙ›·˜ 98.5±12.6 95.2±12.6 2.1±16.7 <0.05(mg/dl)

∞‰ÈÔÓÂÎÙ›ÓË 6.21±0.85 6.63±0.60 8.5±16.3 0.01(Ìg/dl)

¶›Ó·Î·˜ 7: ∂›Â‰· ÁÏ˘Îfi˙˘ ÚÈÓ Î·È ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË 0.4 mg ÌÔÍÔÓȉ›Ó˘

¶›Ó·Î·˜ 6: μ·ÏÛ·ÚÙ¿ÓË ¤Ó·ÓÙÈ ·ÌÏԉțÓ˘ (ÌÂϤÙË VALUE)

μ·ÏÛ·ÚÙ¿ÓË (n=7622) ∞ÌÏԉțÓË (n=7576)

∞Ú¯È΋ ÙÈÌ‹ Δ¤ÏÔ˜ ÌÂϤÙ˘ ∞Ú¯È΋ ÙÈÌ‹ Δ¤ÏÔ˜ ÌÂϤÙ˘

124,2 (±52.2) 120.6 (±46.8) 124.2 (±50.4) 124,2 (±48.6)°Ï˘Îfi˙Ë(mg/dl)

Ûٷ٢ÙÈ΋ ‰Ú¿ÛË). ∞ÎÔÏÔ˘ıÔ‡ÓÔÈ ·Ó·ÛÙÔÏ›˜ ÙˆÓ ‰È·‡ÏˆÓ ·Û‚Â-ÛÙ›Ô˘ Î·È Ë ıÂڷ›· Ì ÂÈÎÔÓÈÎfiÊ¿ÚÌ·ÎÔ (Ô˘‰¤ÙÂÚË Â›‰Ú·ÛË).Δ¤ÏÔ˜ Ù· ·ÓÙÈ˘ÂÚÙ·ÛÈο Ê¿ÚÌ·-η Ô˘ ¤¯Ô˘Ó ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ·‡ÍËÛË Ù˘ ›وÛ˘ ÓÂÔÂÌÊ·ÓÈ-˙fiÌÂÓÔ˘ ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Â›Ó·ÈÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜ Î·È Ù· ıÂÈ·˙ȉÈο‰ÈÔ˘ÚËÙÈο (¶›Ó·Î·˜ 9).

™˘ÌÂÚ¿ÛÌ·Ù·

∏ ÂÈÏÔÁ‹ Ù˘ ·ÓÙÈ˘ÂÚÙ·ÛÈ΋˜ıÂڷ›·˜ ¤¯ÂÈ ÌÂÁ¿ÏË ÛËÌ·Û›·ÂÂȉ‹ ÂËÚ¿˙ÂÈ ÙË ÓÔÛËÚfiÙËÙ·,ÙË ıÓËÛÈÌfiÙËÙ·, ·ÏÏ¿ Î·È ÙÔ Îfi-ÛÙÔ˜ Ù˘ È·ÙÚÈ΋˜ ÊÚÔÓÙ›‰·˜. ¶·-ÚfiÙÈ ÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜ Î·È Ù· ıÂÈ·-

˙ȉÈο ‰ÈÔ˘ÚËÙÈο, Ù· ÔÔ›· ›ӷȷÔÙÂÏÂÛÌ·ÙÈο Ê¿Ú̷η ÁÈ· ÙËÓ·ÓÙÈÌÂÙÒÈÛË Ù˘ ˘¤ÚÙ·Û˘,¤¯Ô˘Ó ¯·ÌËÏfi ÎfiÛÙÔ˜, Ë ·‡ÍËÛËÙ˘ Èı·ÓfiÙËÙ·˜ ÚfiÎÏËÛ˘ ‰È·-Ù·Ú·¯‹˜ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ Ù˘

ÁÏ˘Îfi˙˘ ‹ ·ÎfiÌ· Î·È Û·Î¯·Ú҉ˉȷ‚‹ÙË, Ì ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘˜ÛÙËÓ Ô˘Û›· ·˘Í¿ÓÂÈ ÙÔ ÎfiÛÙÔ˜ Ù˘ȷÙÚÈ΋˜ ÊÚÔÓÙ›‰·˜.

∏ Û˘Ó‡·ÚÍË ˘¤ÚÙ·Û˘ ηș¢2 ·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈ-

£∂ƒ∞¶∂π∞ - º∞ƒª∞∫∞

23

ªÂϤÙ˜ ŒÙÔ˜ ¢È¿ÚÎÂÈ· º¿ÚÌ·ÎÔ 1 ∂ÌÊ¿ÓÈÛË º¿ÚÌ·ÎÔ 2 ∂ÌÊ¿ÓÈÛË º¿ÚÌ·ÎÔ 3 ∂ÌÊ¿ÓÈÛË ‰ËÌÔÛ›Â˘Û˘ (¤ÙË) ™¢2, Ó (%) ™¢2,Ó (%) ™¢2, Ó (%)

AASK 2006 3.8 ACE in h. 45 (11) ‚-blocker 70 (7.2) CCB 32 (15.8)

ALLHAT 2002 4.0 ACE inh. 119 (3) CCB 154 (3.8) diuretic 302 (4.4)

ALPINE 2003 1.0 ARB 1 (0.5) Diuretic 8 (4)

ANBP-2 2005 4.1 ACE inh. 138 (4.9) Diuretic 200 (7.1)

ASCOT 2005 5.5 ‚-blocker 799(11.3) CCB 567 (8)

CAPPP 1999 6.1 ACE inh. 337 (6.5) ‚-blocker 380 (7.2)

CHARM 2003 3.1 ARB 163(6) Placebo 202 (7.4)

DREAM 2006 3.0 ACE inh. 449 (17.1) Placebo 489 (18.4)

EWPHE 1991 4.7 Diuretic 29 (6.9) Placebo 20 (4.8)

FEVER 2005 3.3 CCB 177 (3.6) Placebo 154 (3.1)

HAPPHY 1987 3.8 ‚-blocker 86 (2.6) Diuretic 75 (2.3)

HOPE 2001 4.5 ACE inh. 102 (3.6) Placebo 155 (5.3)

INSIGHT 2000 3.0 CCB 136 (5.4) Diuretic 176 (7)

INVEST 2003 4.0 ‚-blocker 665 (8.2) CCB 569 (7)

LIFE 2002 4.8 ARB 242 (6) ‚-blocker 320 (8)

MRC-E 1992 5.8 ‚-blocker 37 (3) Diuretic 43 (4) placebo 34 (1.5)

NORDIL 2000 4.5 ‚-blocker 251 (5) CCB 216 (4.2)

or diuretic

PEACE 2004 4.8 ACE inh. 335 (9.7) Placebo 399 (11.5)

SCOPE 2003 3.7 ARB 93 (4.3) Placebo 115 (5.3)

SHEP 1998 3.0 Diuretic 140 (8.6) Placebo 118 (7.4)

STOP-2 1999 4.0 ACE inh. 93 (4.7) ‚-blocker 97 (4.9) CCB 95 (4.8)

or diuretic

VALUE 2004 4.2 ARB 690 (13.6) CCB 845 (16.7)

¶›Ó·Î·˜ 8:

ARB: ·ÓÙ·ÁˆÓÈÛÙ¤˜ ÙˆÓ ˘Ô‰Ô¯¤ˆÓ Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘ ππ, CCB: ·ÓÙ·ÁˆÓÈÛÙ¤˜ ÙˆÓ ‰È·‡ÏˆÓ ·Û‚ÂÛÙ›Ô˘, ACE inhibitor: ·Ó·ÛÙÔ-Ï›˜ ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘, diuretic: ‰ÈÔ˘ÚËÙÈο, placebo: ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ, ‚-blocker: ‚-·ÔÎÏÂÈÛÙ¤˜Lancet 2007;369:201-7

™¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ 95% ‰È¿ÛÙËÌ· PÂÌÈÛÙÔÛ‡Ó˘

Diuretic 1μ-blocker 0.90 (0.75-1.09) 0.30Placebo 0.77 (0.63-0.94) 0.009

CCB 0.75 (0.62-0.90) 0.002ACE inhibitor 0.67 (0.56-0.80) <0.0001

ARB 0.57 (0.46-0.72) <0.0001

¶›Ó·Î·˜ 9: ™¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ™¢2 Ì ‚¿ÛË ÙËÓ›‰Ú·ÛË ÙˆÓ ‰ÈÔ˘ÚËÙÈÎÒÓ (ÚÔÛ·ÚÌÔṲ̂ÓÔ ·fi Elliott et all,Lancet 2007;369:201-7)

¢ ∂ ∫ ∂ ª μ ƒ π √ ™ 2 0 0 8

24

μμÈÈ‚‚ÏÏÈÈÔÔÁÁÚÚ··ÊÊ››··

Û˘ ÌÈÎÚÔ·ÁÁÂÈ·ÎÒÓ Î·È Ì·ÎÚÔ·Á-ÁÂÈ·ÎÒÓ ÂÈÏÔÎÒÓ.47-49 ∂ÈÚfi-ÛıÂÙ·, ÙÔ ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔÛ˘Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ÂÌÊ¿ÓÈÛËηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘ Î·È ÙËÓ ÂÌ-Ê¿ÓÈÛË Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË.50-52 ™Â˘ÂÚÙ·ÛÈÎÔ‡˜ ·ÛıÂÓ›˜ Ô˘ Ï·Ì-‚¿ÓÔ˘Ó ıÂڷ›· Ú¤ÂÈ ¿ÓÙ· Ó·

Ï·Ì‚¿ÓÂÙ·È ˘fi„Ë Ë ÔÌÔÈÔÛÙ·Û›·ÙˆÓ ˘‰·Ù·ÓıڿΈÓ. √È ·ÁÁÂÈԉȷ-ÛÙ·ÏÙÈÎÔ› ‚-·ÔÎÏÂÈÛÙ¤˜, ÔÈ ·-ª∂∞ Î·È ÔÈ ·ÓÙ·ÁˆÓÈÛÙ¤˜ ÙˆÓ ˘Ô-‰Ô¯¤ˆÓ Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘ ‚ÂÏ-ÙÈÒÓÔ˘Ó ÙËÓ ÈÓÛÔ˘ÏÈÓÔ¢·ÈÛıËÛ›·Î·È ÙÔ ÌÂÙ·‚ÔÏÈÛÌfi Ù˘ ÁÏ˘Îfi˙˘.™˘ÌÂÚ·ÛÌ·ÙÈο, Â›Ó·È ÛËÌ·ÓÙÈÎfi

Ó· ·Ó·ÁÓˆÚ›˙Ô˘Ì ÔÈÔÈ ˘ÂÚÙ·ÛÈ-ÎÔ› ·ÛıÂÓ›˜ ¤¯Ô˘Ó ·˘ÍË̤ÓÔ Î›Ó-‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ™¢2 Î·È Û ·˘-ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Ú¤ÂÈ Ó··ÔʇÁÂÙ·È Ë ¯ÔÚ‹ÁËÛË ÙˆÓ ‰È-Ô˘ÚËÙÈÎÒÓ Î·È ÙˆÓ ÎÏ·ÛÈÎÒÓ ‚-·ÔÎÏÂÈÛÙÒÓ.

1. Must A, Spadano J, Coakley EH, Field AE,Colditz G, Dietz WH. The diseaseburden associated with overweight andobesity. JAMA 1999;282:1523-9.

2. Mokdad AH, Ford ES, Bowman BA, DietzWH, Vinicor F, Bales VS, et al.Prevalence of obesity, diabetes, andobesity-related health risk factors. JAMA2003;289:76-9.

3. Siegel D, Saliba P, Haffner S. Glucose andinsulin levels during diuretic therapy inhypertensive men. Hypertension1994;23:688-94.

4. Sowers JR, Bakris GL. Antihypertensivetherapy and the risk of type 2 diabetesmellitus. N Engl J Med 2000;342:969-70.

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∏ ·ıËÚÔÛÎÏ‹ÚˆÛË Î·È Ë ÔÛÙÂÔ-fiÚˆÛË, ‰‡Ô ÔÏ˘·Ú·ÁÔÓÙÈΤ˜Î·È ÂÎÊ˘ÏÈÛÙÈΤ˜ ηٷÛÙ¿ÛÂȘ,·ÔÙÂÏÔ‡Ó Ì›˙ÔÓ· ÚÔ‚Ï‹Ì·Ù·˘Á›·˜ ÛÙÔ Û‡Á¯ÚÔÓÔ ÎfiÛÌÔ. ∏Ù·˘Ùfi¯ÚÔÓË ·ÚÔ˘Û›· ÙÔ˘˜ ÛÙÔ›‰ÈÔ ¿ÙÔÌÔ ‰ÂÓ ÂÍËÁÂ›Ù·È ÌfiÓÔˆ˜ ·ÔÙ¤ÏÂÛÌ· Ù˘ ‰È·‰Èηۛ·˜Ù˘ Á‹Ú·ÓÛ˘ ‹ Ù˘ ‰Ú¿Û˘ ÎÔÈ-ÓÒÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘. √ÈÔÓÙfiÙËÙ˜ ·˘Ù¤˜ ‰È¤ÔÓÙ·È ·fiÎÔÈÓÔ‡˜ ·ıÔÁÂÓÂÙÈÎÔ‡˜ Ì˯·ÓÈ-ÛÌÔ‡˜, fiˆ˜ Ë ·Ú¿ÏÏËÏË ‰È·-‰Èηۛ· Ù˘ ·ۂ¤ÛÙˆÛ˘ ÙˆÓÔÛÙÒÓ Î·È ÙˆÓ ·ÁÁ›ˆÓ (‰Ú¿ÛËÔ˘ÛÈÒÓ, fiˆ˜ Gla ÚˆÙ½Ó˜,ÔÛÙÂÔÔÓÙ›ÓË, ÔÛÙÂÔÚÔÙÂÁÂÚ›-ÓË), Ë ÂÏ¿ÙÙˆÛË ÙˆÓ ÂȤ‰ˆÓÙˆÓ ÔÈÛÙÚÔÁfiÓˆÓ, Ë Â›‰Ú·ÛËÙˆÓ ÚÔ˚fiÓÙˆÓ ÔÍ›‰ˆÛ˘ ÙˆÓÏÈȉ›ˆÓ (ÌÂÚÈÎÒ˜ ÔÍÂȉˆÌ¤ÓËLDL, ÈÛÔÚÔÛÙ¿Ó˜), Ë ÊÏÂÁÌÔ-Ó‹, Ë ·‡ÍËÛË Ù˘ ÔÌÔ΢ÛÙ½Ó˘,ÔÈ ÔÏ˘ÌÔÚÊÈÛÌÔ› Ù˘ ‚ÈÙ·Ì›Ó˘D Î·È Ë ÂÏ¿ÙÙˆÛË Ù˘ ‚ÈÙ·Ì›Ó˘∫1. ∂ÈϤÔÓ ¤¯ÂÈ Û˘˙ËÙËı› Ë¢ÂÚÁÂÙÈ΋ ›‰Ú·ÛË ÔÚÈṲ̂ӈÓηÙËÁÔÚÈÒÓ Ê·ÚÌ¿ÎˆÓ ÛÙË Ì›ˆ-ÛË Ù˘ ÔÛÙÈ΋˜ Ì¿˙·˜ (√ª) ηÈÛÙËÓ ·ÁÁÂȷ΋ ÓfiÛÔ. ™ÙËÓ ·-ÚÔ‡Û· ·Ó·ÛÎfiËÛË ·Ó·Ï‡ÔÓÙ·ÈÔÈ Èı·Ó¤˜ ÎÔÈÓ¤˜ ıÂڷ¢ÙÈΤ˜ÚÔÛÂÁÁ›ÛÂȘ ÙˆÓ ‰‡Ô ·˘ÙÒÓ ·-ıÔÏÔÁÈÎÒÓ Î·Ù·ÛÙ¿ÛˆÓ.

√ ÚfiÏÔ˜ ÙˆÓ ÛÙ·ÙÈÓÒÓ ÛÙËÓÂÏ¿ÙÙˆÛË Ù˘ ηډȷÁÁÂȷ΋˜ıÓËÛÈÌfiÙËÙ·˜ Â›Ó·È ÁÓˆÛÙfi˜2. Δ·Ê¿Ú̷η ·˘Ù¿ fï˜ ÂÌÊ·Ó›˙Ô˘ÓÛËÌ·ÓÙÈ΋ ¢ÂÚÁÂÙÈ΋ ‰Ú¿ÛË Î·ÈÛÙÔÓ ÔÛÙÈÎfi ÌÂÙ·‚ÔÏÈÛÌfi3,4. §·Ì-‚¿ÓÔÓÙ·˜ ˘fi„Ë ÙÔÓ ·ıÔÁÂÓÂ-ÙÈÎfi ÚfiÏÔ Ù˘ ˘ÂÚÏÈȉ·ÈÌ›·˜ÛÙË Ì›ˆÛË Ù˘ √ª1, Ë È‰ÈfiÙËÙ·ÙˆÓ Ê·ÚÌ¿ÎˆÓ ·˘ÙÒÓ ı· ÌÔ-ÚÔ‡Û ӷ ·Ô‰Ôı› ÛÙËÓ ˘ÔÏÈ-ȉ·ÈÌÈ΋ ÙÔ˘˜ ‰Ú¿ÛË. º·›ÓÂÙ·Èfï˜ fiÙÈ Â›Ó·È ·ÓÂÍ¿ÚÙËÙË. ™˘-ÁÎÂÎÚÈ̤ӷ, fiˆ˜ Â›Ó·È ÁÓˆÛÙfi, ÔÌ˯·ÓÈÛÌfi˜ ‰Ú¿Û˘ ÙˆÓ ÛÙ·ÙÈÓÒÓ¤ÁÎÂÈÙ·È ÛÙË ·Ó·ÛÙÔÏ‹ Ù˘ ·Ó·-ÁˆÁ¿Û˘ ÙÔ˘ 3-hydroxy-3-methy-lglutaryl coenzyme A (HMG-CÔ∞), ÙÔ˘ ÂÓ˙‡ÌÔ˘ Ô˘ ÂÌϤÎÂ-Ù·È ÛÙË ‚ÈÔÛ‡ÓıÂÛË Ù˘ ¯ÔÏË-

ÛÙÂÚfiÏ˘ Î·È Î·Ù·Ï‡ÂÈ ÙË ÌÂÙ·-ÙÚÔ‹ ÙÔ˘ HMG-CÔ∞ Û Ì‚·ÏÔ-ÓÈÎfi Ô͇. ∂ÎÙfi˜ ·fi ÙËÓ ÂÏ¿ÙÙˆ-ÛË Ù˘ ·Ú·ÁˆÁ‹˜ ¯ÔÏËÛÙÂÚfi-Ï˘, Ë ·Ó·ÛÙÔÏ‹ ÙÔ˘ Ì‚·ÏÔÓÈ-ÎÔ‡ Ô‰ËÁ› ÛÙË Ì›ˆÛË Ù˘ Û‡Ó-ıÂÛ˘ ÛËÌ·ÓÙÈÎÒÓ ‰È¿ÌÂÛˆÓÚÔ˚fiÓÙˆÓ, fiˆ˜ ÙˆÓ ÈÛÔÚÂÓÔ˚-‰ÒÓ farnesyl pyrophosphate ηÈgeranylgeranyl pyrophosphate.5

∞˘Ù¿ Ì ÙË ÛÂÈÚ¿ ÙÔ˘˜ ÂÌϤÎÔ-ÓÙ·È ÛÙË ‰È·ÌfiÚʈÛË (prenyla-tion) ·ÚÎÂÙÒÓ ÚˆÙÂ˚ÓÒÓ, fiˆ˜ÔÈ Ras, Rho Î·È Rac, ÔÈ ÔÔ›Â˜Ú˘ıÌ›˙Ô˘Ó Ì›· ÔÈÎÈÏ›· ΢ÙÙ·ÚÈ-ÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ, fiˆ˜ ÙËÓ Î˘Ù-Ù·ÚÈ΋ ÛËÌ·ÙÔ‰fiÙËÛË, ÙË ‰È·ÊÔ-ÚÔÔ›ËÛË Î·È ÙÔÓ ÔÏÏ·Ï·ÛÈ·-ÛÌfi6. √È ÚˆÙ½Ó˜ ·˘Ù¤˜ ›ӷȷ·Ú·›ÙËÙ˜ Î·È ÁÈ· ÙË ÏÂÈÙÔ˘Ú-Á›· ÙˆÓ ÔÛÙÂÔÎÏ·ÛÙÒÓ. ΔÔ ÁÂÁÔ-Ófi˜ ·˘Ùfi Â›Ó·È ÛÂ Û˘Ìʈӛ· ÌÂοÔȘ ·Ú·ÙËÚ‹ÛÂȘ fiÙÈ ÔÈÛÙ·Ù›Ó˜ ·Ó·ÛÙ¤ÏÏÔ˘Ó ÙËÓ ÔÛÙÂ-ÔÎÏ·ÛÙÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· invitro7. ∂›Û˘, ÔÈ ÛÙ·Ù›Ó˜ ÚÔ¿-ÁÔ˘Ó Î·È ÙÔÓ ÔÛÙÈÎfi ·Ó·‚ÔÏÈÛÌfi,Èı·ÓÒ˜ ̤ۈ Ù˘ ·‡ÍËÛ˘ Ù˘BMP-2, ÌÈ·˜ ÚˆÙ½Ó˘ Ô˘ÂÌϤÎÂÙ·È ÛÙÔ Û¯ËÌ·ÙÈÛÌfi ÙÔ˘ÔÛÙÔ‡ Î·È ÙÔ˘ ¯fiÓ‰ÚÔ˘8.

™Â Ì›· ÚÔÔÙÈ΋ ÌÂϤÙË, ˯ÔÚ‹ÁËÛË ÛÈÌ‚·ÛÙ·Ù›Ó˘ Û˘Û¯Â-Ù›ÛÙËΠ̠ÙËÓ ·‡ÍËÛË Ù˘ ÔÛÙÂ-ÔηÏÛ›Ó˘ (ÂÓfi˜ ‰Â›ÎÙË ÙÔ˘ ÔÛÙÈ-ÎÔ‡ ·Ó·‚ÔÏÈÛÌÔ‡ Î·È Ù˘ ÔÛÙÂÔ-‚Ï·ÛÙÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜) 9,ÁÂÁÔÓfi˜ ÙÔ ÔÔ›Ô ¤Ú¯ÂÙ·È ÛÂÛ˘Ìʈӛ· Ì ̛· ¿ÏÏË ÌÂϤÙË ÛÂıËÏ˘ÎÔ‡˜ Â›Ì˘Â˜ ÛÙÔ˘˜ ÔÔ›-Ô˘˜ ·Ú·ÙËÚ‹ıËΠ·‡ÍËÛË Ù˘̿˙·˜ ÛÙ· ÛÔÁÁÒ‰Ë ÔÛÙ¿10.∂ÈϤÔÓ, Ë ¯ÔÚ‹ÁËÛË ·ÙÔÚ‚·-ÛÙ·Ù›Ó˘ ·fi ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜Û˘Óԉ‡ÙËΠ·fi ·‡ÍËÛË ÙË˜Û˘ÁΤÓÙÚˆÛ˘ Ù˘ ‚ÈÙ·Ì›Ó˘ D11.ª›· ·Ó¿Ï˘ÛË 4 ÌÂÁ¿ÏˆÓ ÚÔÔ-ÙÈÎÒÓ ÌÂÏÂÙÒÓ, ÂÍ¿ÏÏÔ˘, ηٷ-‰ÂÈÎÓ‡ÂÈ fiÙÈ ÔÈ ÛÙ·Ù›Ó˜ Èı·ÓfiÓÓ· ÚÔÏ·Ì‚¿ÓÔ˘Ó ÙËÓ ÂÌÊ¿ÓÈÛËÔÛÙÂÔÔÚˆÙÈÎÒÓ Î·Ù·ÁÌ¿ÙˆÓ.™Â ηıÂÌÈ¿ ÌÂϤÙË Í¯ˆÚÈÛÙ¿˘‹ÚÍ ̛· ‰˘Ó·ÌÈ΋ Ù¿ÛË ÚÔ˜ÙËÓ Î·Ù‡ı˘ÓÛË Ù˘ ÂÏ¿ÙÙˆÛ˘

ÙˆÓ Î·Ù·ÁÌ¿ÙˆÓ ÈÛ¯›Ô˘ ÛÙȘ Á˘-Ó·›Î˜ Ô˘ ·Ó¤ÊÂÚ·Ó ¯Ú‹ÛËÛÙ·Ù›Ó˘, ·ÎfiÌ· Î·È ÌÂÙ¿ ·fiÚÔÛ·ÚÌÔÁ‹ ÁÈ· ÁÓˆÛÙÔ‡˜ ·-Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘12.

∂ÈÚfiÛıÂÙ·, Û ̛· ÌÂÁ¿ÏË·Ó·‰ÚÔÌÈ΋ ·Ó¿Ï˘ÛË Ê¿ÓËΠfiÙÈË ¤ÎıÂÛË ÛÙË ‰Ú¿ÛË ÙˆÓ ÛÙ·ÙÈ-ÓÒÓ ·ÎfiÌ· Î·È ÁÈ· ÌÈÎÚfi ¯ÚÔÓÈÎfi‰È¿ÛÙËÌ· (·fi Ï›Á˜ ‚‰ÔÌ¿‰Â˜¤ˆ˜ Ï›ÁÔ˘˜ Ì‹Ó˜) Û˘Û¯ÂÙ›ÛÙËÎÂÌ Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ο-Ù·ÁÌ·, ÁÂÁÔÓfi˜ ÙÔ ÔÔ›Ô ‰Â ‰È·-ÈÛÙÒıËΠÌÂÙ¿ ·fi Ï‹„Ë ÊÈ-ÌÚ·ÙÒÓ ‹ ¿ÏÏˆÓ ˘ÔÏÈȉ·ÈÌÈ-ÎÒÓ Ê·Ú̿ΈÓ3. ∞Í›˙ÂÈ Ó· ÛËÌÂÈ-ˆı› ¿ÓÙˆ˜ fiÙÈ Ù· ‰Â‰Ô̤ӷ·˘Ù¿ ‰ÂÓ ÂȂ‚·ÈÒıËÎ·Ó ·fiÌ›· ÌÂÁ¿ÏË Ù˘¯·ÈÔÔË̤ÓË ÌÂϤ-ÙË Ô˘ ·ÊÔÚÔ‡Û ÛÙË ¯Ú‹ÛËÚ·‚·ÛÙ·Ù›Ó˘, ·Ó Î·È ÂÚÈÏ¿Ì-‚·Ó ÌË ÔÛÙÂÔÔÚˆÙÈÎÔ‡˜ ·ÛıÂ-Ó›˜13. ∏ Û˘ÁÎÂÎÚÈ̤ÓË ÛÙ·Ù›ÓËÊ·›ÓÂÙ·È fiÙÈ ‰ÂÓ Â›Ó·È ·ÔÙÂÏÂ-ÛÌ·ÙÈ΋ ÛÙËÓ ·‡ÍËÛË Ù˘ BMP-2, ‰ÈfiÙÈ Û˘Ó‰¤ÂÙ·È ÏÈÁfiÙÂÚÔ ÌÂÙȘ ÚˆÙ½Ó˜ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜Û˘ÁÎÚÈÙÈο Ì ¿ÏϘ ÛÙ·Ù›Ó˜,fiˆ˜ ÏÔ‚·ÛÙ·Ù›ÓË, ÛÈÌ‚·ÛÙ·Ù›-ÓË Î·È ÊÏÔ˘‚·ÛÙ·Ù›ÓË14.

ª›· ÌÂÙ·Ó¿Ï˘ÛË 19 ÌÂÏÂÙÒÓÂͤٷÛ ÙËÓ Â›‰Ú·ÛË ÙˆÓ ÛÙ·ÙÈ-ÓÒÓ ÛÙËÓ √ª Î·È ÛÙÔÓ Î›Ó‰˘ÓÔηٿÁÌ·ÙÔ˜, ·fi ÙȘ Ôԛ˜ ÔÈ12 η٤‰ÂÈÍ·Ó ÙËÓ Â˘ÂÚÁÂÙÈ΋ÙÔ˘˜ ‰Ú¿ÛË Û ·ÓÙ›ıÂÛË Ì 1Ô˘ ¤‰ÂÈÍ ÂÈΛӉ˘ÓË ‰Ú¿ÛË,ÂÓÒ Û 6 ÌÂϤÙ˜ ÔÈ ÛÙ·Ù›Ó˜ ‰ÂÓ›¯·Ó η̛· ›‰Ú·ÛË ÛÙËÓ √ª.∂ÈϤÔÓ, ‰È·ÈÛÙÒıËÎ·Ó ‰È·ÊÔ-Ú¤˜ ÛÙË ‰Ú¿ÛË ÙÔ˘˜ ·Ó¿ÏÔÁ· ÌÂÙȘ ÏÈÔÊÈÏÈΤ˜ ‹ ˘‰ÚÔÊÈÏÈΤ˜ÙÔ˘˜ ȉÈfiÙËÙ˜. ™˘ÁÎÂÎÚÈ̤ӷ, ÔÈÏÈfiÊÈϘ ÛÙ·Ù›Ó˜ (ÛÈÌ‚·ÛÙ·Ù›-ÓË, ÏÔ‚·ÛÙ·Ù›ÓË) Û˘Û¯ÂÙ›ÛÙËηÓÌ ·‡ÍËÛË Ù˘ √ª ÛÙÔÓ ·˘¯¤Ó·ÙÔ˘ ÌËÚÈ·›Ô˘ (ÂÚ›Ô˘ 0,2 SD ÛÂÛ¯¤ÛË Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘),Û ·ÓÙ›ıÂÛË Ì ÙȘ ˘‰ÚfiÊÈϘ(·ÙÔÚ‚·ÛÙ·Ù›ÓË, ÊÏÔ˘‚·ÛÙ·Ù›-ÓË, Ú·‚·ÛÙ·Ù›ÓË). ∏ √ª, fï˜,ÛÙËÓ ÔÛÊ˘˚΋ ÌÔ›Ú· ·˘Í‹ıËÎÂÔÚȷο, ÁÂÁÔÓfi˜ Ô˘ ‰Â›¯ÓÂÈ fiÙÈÈı·ÓfiÓ ÔÈ ÛÙ·Ù›Ó˜ ‰ÚÔ˘Ó Î˘-

£∂ƒ∞¶∂π∞ - º∞ƒª∞∫∞

27

Ú›ˆ˜ ÛÙ· ÊÏÔÈÒ‰Ë ÔÛÙ¿. ¶¿-ÓÙˆ˜, Ë ·Û˘Ìʈӛ· Ô˘ ·Ú·ÙË-Ú‹ıËΠÛÙȘ ÌÂϤÙ˜ ·˘Ù¤˜ ·Ô-‰›‰ÂÙ·È Û ·ÚÎÂÙÔ‡˜ ¿ÏÏÔ˘˜ ·-Ú¿ÁÔÓÙ˜, fiˆ˜ Â›Ó·È Ë ‰È·ÊÔ-ÚÂÙÈ΋ ÚfiÛÏË„Ë ÙˆÓ ÛÙ·ÙÈÓÒÓ·fi Ù· ÔÛÙ¿, Ë ‰È·ÊÔÚÂÙÈ΋ ‚ÈÔ-‰È·ıÂÛÈÌfiÙËÙ¿ ÙÔ˘˜ Î·È ‰Ú¿ÛËÛÙÔ˘˜ ÔÛÙÂÔ‚Ï¿ÛÙ˜ Î·È ÔÛÙÂÔ-ÎÏ¿ÛÙ˜, ηıÒ˜ ›Û˘ Î·È ÛÂÔÈΛÏÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘,‰ÔÛÔÏÔÁ›· Î·È ‰È¿ÚÎÂÈ· ¯ÔÚ‹ÁË-Û˘ Û οı ¿ÙÔÌÔ15.

∏ ÂÏ¿ÙÙˆÛË ÙÔ˘ Ì‚·ÏÔÓÈ-ÎÔ‡ ÔͤԘ, Ô˘ Ô‰ËÁ› ÛÙËÓ·Ó·ÛÙÔÏ‹ Ù˘ ÔÛÙÂÔÎÏ·ÛÙÈ΋˜‰Ú·ÛÙËÚÈfiÙËÙ·˜, ·ÔÙÂÏ› ›-Û˘ ¤Ó· ÛËÌ·ÓÙÈÎfi ‚ÈÔÏÔÁÈÎfi«ÌÔÓÔ¿ÙÈ» Î·È ÁÈ· ÙË ‰Ú¿ÛËÙˆÓ ‰ÈʈÛÊÔÓÈÎÒÓ, Ô˘ ¯ÚËÛÈ-ÌÔÔÈÔ‡ÓÙ·È Â˘Ú¤ˆ˜ ÁÈ· ÙË ıÂ-ڷ›· Ù˘ ÔÛÙÂÔfiÚˆÛ˘. Δ·‰ÈʈÛÊÔÓÈο Ê·›ÓÂÙ·È fiÙÈ ·Ó·-ÛÙ¤ÏÏÔ˘Ó ÙËÓ ÚfiÔ‰Ô Ù˘ ·ıË-ÚÔÛÎÏ‹ÚˆÛ˘ ÛÙ· ÂÈÚ·Ì·Ùfi-˙ˆ· Î·È Ë Â›‰Ú·ÛË ·˘Ù‹ ÛÙÔ·ÚÙËÚÈ·Îfi ÙÔ›¯ˆÌ· Â›Ó·È ·ÓÂ-Í¿ÚÙËÙË Ù˘ ˘·Û‚ÂÛÙÈ·ÈÌÈ΋˜ÙÔ˘˜ ‰Ú¿Û˘16. √ ÚÔÛٷ٢ÙÈ-Îfi˜ ÙÔ˘˜ ÚfiÏÔ˜ ÛÙ· ·ÁÁ›· Û˘-Ó›ÛÙ·Ù·È ÛÙËÓ Â›Ù·ÛË Ù˘ ·fi-ÙˆÛ˘ ÙˆÓ Ì·ÎÚÔÊ¿ÁˆÓ ΢ÙÙ¿-ÚˆÓ Î·È Ù˘ ÚfiÏ˄˘ Û¯ËÌ·ÙÈ-ÛÌÔ‡ ÙˆÓ ·ÊÚˆ‰ÒÓ Î˘ÙÙ¿ÚˆÓ,̤ۈ ·Ó·ÛÙÔÏ‹˜ Ù˘ ÚfiÛÏË-„˘ Ù˘ LDL17. ™Â Ì›· ÌÂϤÙË, ËÂÙÈÓ‰ÚÔÓ¿ÙË, ¤Ó· ·fi Ù· Ê¿ÚÌ·-η Ù˘ ηÙËÁÔÚ›·˜ ·˘Ù‹˜, Û˘-Û¯ÂÙ›ÛÙËΠ̠ÙËÓ ·Ó·ÛÙÔÏ‹ Ù˘·ıËÚÔÛÎÏ‹ÚˆÛ˘ fiÙ·Ó ¯ÔÚËÁ‹-ıËΠ۠·ÛıÂÓ›˜ Ì ¯·ÌËÏ‹√ª18. ¢ÂÓ Â›Ó·È ·ÎÚÈ‚Ò˜ ÁÓˆ-ÛÙfi ÁÈ·Ù› Ù· ‰ÈʈÛÊÔÓÈο ¤¯Ô˘ÓÌfiÓÔ ·ÓÙÈÔÛÙÂÔÎÏ·ÛÙÈ΋ ‰Ú¿ÛË,Û ۇÁÎÚÈÛË Ì ÙȘ ÛÙ·Ù›Ó˜ Ô˘¤¯Ô˘Ó Î·È ·Ó·‚ÔÏÈ΋, ·Ú¿ ÙÔÓÎÔÈÓfi ÌÔÚÈ·Îfi Ì˯·ÓÈÛÌfi ‰Ú¿-Û˘. ¶Èı·ÓÔÏÔÁÂ›Ù·È fiÙÈ ˘¿Ú¯ÂȉȷÊÔÚÂÙÈ΋ ¢·ÈÛıËÛ›· ÙˆÓ

ÔÛÙÂÔÎÏ·ÛÙÒÓ Î·È ÙˆÓ ÔÛÙÂÔ-‚Ï·ÛÙÒÓ ÛÙË ‰Ú¿ÛË ÙˆÓ ÛÙ·ÙÈ-ÓÒÓ Î·È ÙˆÓ ‰ÈʈÛÊÔÓÈÎÒÓ15. Δ··ÈÛÈfi‰ÔÍ· ·˘Ù¿ ÌËӇ̷ٷ ̤ÓÂÈÓ· ÂȂ‚·ÈˆıÔ‡Ó ·fi ÌÂÁ¿ÏÂ˜Ù˘¯·ÈÔÔÈË̤Ó˜ ÚÔÔÙÈΤ˜ ÌÂ-ϤÙ˜.

™ËÌ·ÓÙÈο ÛÙÔȯ›· ¤¯Ô˘ÓÚÔ·„ÂÈ Û¯ÂÙÈο Ì ÙÔ ÚfiÏÔÔÚÈÛÌ¤ÓˆÓ Î·ÙËÁÔÚÈÒÓ ·ÓÙÈ˘-ÂÚÙ·ÛÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ÛÙËÓ ·‡-ÍËÛË Ù˘ √ª, ·Ó Î·È ‰ÂÓ ¤¯ÂÈ·Ô‰Âȯı› fiÙÈ Ë ˘¤ÚÙ·ÛË ·Ô-ÙÂÏ› ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÁÈ·ÙËÓ ·Ó¿Ù˘ÍË Ù˘ ÔÛÙÂÔfiÚˆ-Û˘. ™˘ÁÎÂÎÚÈ̤ӷ, ÔÈ ‚-·Ô-ÎÏÂÈÛÙ¤˜ ¤¯ÂÈ ‚ÚÂı› fiÙÈ ÚÔ¿-ÁÔ˘Ó ÙÔÓ ÔÛÙÈÎfi ·Ó·‚ÔÏÈÛÌfi ηÈÂÈ‚Ú·‰‡ÓÔ˘Ó ÙÔÓ ÔÛÙÈÎfi ηٷ-‚ÔÏÈÛÌfi ÛÙ· ÂÈÚ·Ì·Ùfi˙ˆ·, η-ıÒ˜ ›Û˘ Û˘Ó‰¤ÔÓÙ·È Ì ÙËÌ›ˆÛË Î·Ù·ÁÌ¿ÙˆÓ ÛÙÔ˘˜ ·Ó-ıÚÒÔ˘˜19. ∏ ‰Ú¿ÛË ÙÔ˘˜ ·˘Ù‹·Ô‰›‰ÂÙ·È Èı·ÓfiÓ ÛÙË Ú‡ıÌÈÛËÙ˘ ÔÛÙÈ΋˜ ·Ó·Î·Ù·Û΢‹˜ ̤-Ûˆ ÙÔ˘ Û˘Ì·ıËÙÈÎÔ‡ Ó¢ÚÈÎÔ‡Û˘ÛÙ‹Ì·ÙÔ˜, ÂÊfiÛÔÓ Û˘Ì·ıË-ÙÈΤ˜ Ó¢ÚÈΤ˜ ›Ó˜ ˘¿Ú¯Ô˘ÓÛÙ· ÔÛÙ¿ Î·È Ë ‚-·‰ÚÂÓÂÚÁÈ΋‰È¤ÁÂÚÛË Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ÔÛÙÂÔÎÏ·-ÛÙÒÓ20.

™ËÌ·ÓÙÈο ‰Â‰Ô̤ӷ ÚÔ·-ÙÔ˘Ó Â›Û˘ ·fi ÙË Â›‰Ú·ÛËÙˆÓ ıÂÈ·˙ȉÈÎÒÓ ‰ÈÔ˘ÚËÙÈÎÒÓÛÙËÓ ÚfiÏË„Ë Ù˘ ÔÛÙÂÔfiÚˆ-Û˘ ÛÙȘ ÌÂÙÂÌÌËÓÔ·˘ÛȷΤ˜Á˘Ó·›Î˜21, ȉÈfiÙËÙ· Ô˘ ‰ÂÓ·Ô‰›‰ÂÙ·È ÌfiÓÔ ÛÙËÓ ·‡ÍËÛËÙ˘ ·ӷÚÚfiÊËÛ˘ ÙÔ˘ ·Û‚Â-ÛÙ›Ô˘ ÛÙÔ ¿ˆ ÂÛÂÈڷ̤ÓÔ Ûˆ-ÏËÓ¿ÚÈÔ, ̤ۈ Ù˘ ·Ó·ÛÙÔÏ‹˜Ù˘ ·ÓÙÏ›·˜ Û˘ÓÌÂÙ·ÊÔÚ¿˜Na+-Cl- (Na+-Cl- cotransporter,NCC), ·ÏÏ¿ Î·È ÛÙËÓ ÂÓÂÚÁÔÔ›-ËÛË ÙˆÓ ÔÛÙÂÔ‚Ï·ÛÙÒÓ (ÔÈ ÔÔ›-ÔÈ Â›Û˘ Ê·›ÓÂÙ·È fiÙÈ ÂÎÊÚ¿-˙Ô˘Ó ÙËÓ NCC)22. √ÛÔÓ ·ÊÔÚ¿ÛÙÔ˘˜ ·ÓÙ·ÁˆÓÈÛÙ¤˜ ÙˆÓ ˘Ô‰Ô-

¯¤ˆÓ Ù‡Ô˘ ∞Δ1 Ù˘ ·ÁÁÂÈÔÙÂÓ-Û›Ó˘ ππ (∞ππ), Ê·›ÓÂÙ·È fiÙÈ ÂÏ·Ù-ÙÒÓÔ˘Ó ÙËÓ ÔÛÙÈ΋ ·ÒÏÂÈ·,·ÊÔ‡ Î·È Ë ∞ππ ÂÈÙ›ÓÂÈ ÙËÓÔÛÙÂÔÎÏ·ÛÙÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ·23.°È· ÙÔ˘˜ ·Ó·ÛÙÔÏ›˜ ÙÔ˘ ÌÂÙ·-ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ Ù˘ ·ÁÁÂÈÔ-ÙÂÓÛ›Ó˘ π (∞-ª∂∞) ˘¿Ú¯Ô˘Ó·ÌÊÈÏÂÁfiÌÂÓ· ÛÙÔȯ›·24.

Δ¤ÏÔ˜, Ó¤ÔÈ ıÂڷ¢ÙÈÎÔ›ÔÚ›˙ÔÓÙ˜ ·ÓÔ›ÁÔÓÙ·È Ì ÙËÓ·Ó·Î¿Ï˘„Ë Ê·ÚÌ¿ÎˆÓ Ô˘ ı··Ó·ÛÙ¤ÏÏÔ˘Ó ÙËÓ ÂͤÏÈÍË ÙˆÓ·ıËڈ̷ÙÈÎÒÓ Ï·ÎÒÓ Î·È Ù·˘-Ùfi¯ÚÔÓ· ı· ÂÓÈÛ¯‡Ô˘Ó ÙËÓ √ª.™˘ÓÔÙÈο ·Ó·Ê¤ÚÔÓÙ·È Ë ÙÂÚÈ-·Ú·Ù›‰Ë (Û˘ÓıÂÙÈÎfi ·Ó¿ÏÔÁÔÙ˘ ·Ú·ıÔÚÌfiÓ˘), Ë ·Ó·Û˘Ó-‰˘·Ṳ̂ÓË ÔÛÙÂÔÚÔÙÂÁÂÚ›ÓË Î·ÈÔÈ ·Ó·ÛÙÔÏ›˜ Ù˘ 12/15 ÏÈÔ͢-ÁÂÓ¿Û˘ Î·È ÙˆÓ ·ÓÙ·ÁˆÓÈÛÙÒÓÙ˘ ÔÌ¿‰·˜ ÙˆÓ Wnt ÌÔÚ›ˆÓ,Ô˘ ÂÌϤÎÔÓÙ·È ÛÙË ‰È·‰Èηۛ·Ù˘ ÔÛÙÈ΋˜ ·Ó·Î·Ù·Û΢‹˜8.

™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ·Ú·‰Ô-¯‹ Ù˘ ‡·Ú͢ ÎÔÈÓÒÓ ·ıÔÊ˘-ÛÈÔÏÔÁÈÎÒÓ Ì˯·ÓÈÛÌÒÓ Ô˘ ‰È¤-Ô˘Ó ÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË Î·ÈÙËÓ ÔÛÙÂÔfiÚˆÛË, ¤Ú·Ó ÙÔ˘¯·Ú·ÎÙËÚÈÛÌÔ‡ ÙÔ˘˜ ˆ˜ «ÓÔÛË-Ì¿ÙˆÓ ÊıÔÚ¿˜», ‰ËÌÈÔ˘ÚÁ› ÊÈ-Ïfi‰ÔÍÔ˘˜ ۯ‰ȷÛÌÔ‡˜ ÁÈ· ˘ÈÔ-ı¤ÙËÛË ıÂÚ·ÂÈÒÓ Ô˘ ı· ÛÙÔ-¯Â‡Ô˘Ó ÛÙËÓ Ù·˘Ùfi¯ÚÔÓË ·ÓÙÈÌÂ-ÙÒÈÛ‹ ÙÔ˘˜. Δ· ̤¯ÚÈ ÛÙÈÁÌ‹˜‰Â‰Ô̤ӷ Ô˘ ·ÊÔÚÔ‡Ó ÛÙË ¯Ô-Ú‹ÁËÛË ÙˆÓ ÛÙ·ÙÈÓÒÓ, ÙˆÓ ‰Èʈ-ÛÊÔÓÈÎÒÓ Î·È ÔÚÈÛÌ¤ÓˆÓ ·ÓÙÈ˘-ÂÚÙ·ÛÈÎÒÓ Â›Ó·È ÂÓı·ÚÚ˘ÓÙÈο.∞·ÈÙÔ‡ÓÙ·È fï˜ ÌÂÁ¿Ï˜ Ù˘-¯·ÈÔÔÈË̤Ó˜ ÚÔÔÙÈΤ˜ ÌÂϤ-Ù˜ ÁÈ· ÙËÓ ÙÂÏÈ΋ ÂÊ·ÚÌÔÁ‹ÙÔ˘˜ ÛÙËÓ ·Ú¿ÏÏËÏË ÚfiÏË„ËÙˆÓ ÂÈÏÔÎÒÓ Ô˘ Û˘Óԉ‡ԢÓÙȘ ‰‡Ô ·˘Ù¤˜ ·ıÔÏÔÁÈΤ˜ÔÓÙfiÙËÙ˜.

μμÈÈ‚‚ÏÏÈÈÔÔÁÁÚÚ··ÊÊ››··

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¶ƒ√∂π¢√¶√π∏™∏(FDA ALERT [08/08/2008])

√ ∞ÌÂÚÈηÓÈÎfi˜ √ÚÁ·ÓÈÛÌfi˜ º·ÚÌ¿ÎˆÓ Î·È ΔÚÔÊ›ÌˆÓ (FDA) Âͤ‰ˆÛ ÙËÓ 08/08/2008 ·Ó·ÎÔ›Óˆ-ÛË-ÚÔÂȉÔÔ›ËÛË ÚÔ˜ ÙÔ˘˜ ·ÁÁÂÏ̷ٛ˜ ˘Á›·˜ Î·È ÚÔ˜ ÙÔ ÎÔÈÓfi ÁÈ· ÙÔÓ Î›Ó‰˘ÓÔ Ú·‚‰ÔÌ˘fi-Ï˘Û˘ ·fi ÙËÓ Û˘Á¯ÔÚ‹ÁËÛË ·ÌȈ‰·ÚfiÓ˘ Î·È ÛÈÌ‚·ÛÙ·Ù›Ó˘, ȉ›ˆ˜ fiÙ·Ó Ë ‰fiÛË Ù˘ ÛÈÌ‚·ÛÙ·Ù›-Ó˘ Â›Ó·È > 20 mg ËÌÂÚËÛ›ˆ˜. ¢ÂÓ Â›Ó·È ÁÓˆÛÙfi ·Ó ÔÈ ‰È¿ÊÔÚ˜ ‰fiÛÂȘ Ù˘ ·ÌȈ‰·ÚfiÓ˘ ÙÚÔÔ-ÔÈÔ‡Ó ÙÔÓ Î›Ó‰˘ÓÔ. ∏ Ú·‚‰ÔÌ˘fiÏ˘ÛË ÌÔÚ› Ó· ÚÔηϤÛÂÈ ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ· Î·È Ó· Ô‰ËÁ‹ÛÂÈÛ ı¿Ó·ÙÔ. ∏ ·ÓÂÈı‡ÌËÙË ÂÓ¤ÚÁÂÈ· ÔÊ›ÏÂÙ·È ÛÙËÓ ·Ó·ÛÙÔÏ‹ ÙÔ˘ ΢ÙÙÔ¯ÚÒÌ·ÙÔ˜ P450 3A4(CYP3A4) Ô˘ ÚÔηÏ› Ë ·ÌȈ‰·ÚfiÓË. √È È·ÙÚÔ› Ô˘ Û˘ÓÙ·ÁÔÁÚ·ÊÔ‡Ó ÛÈÌ‚·ÛÙ·Ù›ÓË Ú¤ÂÈ Ó·ÚˆÙÔ‡Ó ·Ó Ô ·ÛıÂÓ‹˜ ¢ڛÛÎÂÙ·È Û ·ÁˆÁ‹ Ì ·ÌȈ‰·ÚfiÓË Î·È ÛÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜ Ó· ÌË ¯Ô-ÚËÁÔ‡Ó ‰fiÛË ÛÈÌ‚·ÛÙ·Ù›Ó˘ ÌÂÁ·Ï‡ÙÂÚË ·fi 20 mg ËÌÂÚËÛ›ˆ˜, Ó· ÂÓËÌÂÚÒÓÔ˘Ó ÙÔÓ ·ÛıÂÓ‹ fiÙÈÚ¤ÂÈ Ó· ·Ó·Ê¤ÚÂÈ ·Ì¤Ûˆ˜ ·Ó ÂÌÊ·Ó›ÛÂÈ ·ÓÂÍ‹ÁËÙË Ì˘·ÏÁ›·, Ì˘˚΋ ¢·ÈÛıËÛ›· ‹ Ì˘˚΋ ÎfiˆÛËÎ·È Ó· ÙÔÓ ¤¯Ô˘Ó ˘fi Ù·ÎÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË.

£∂ƒ∞¶∂π∞ - º∞ƒª∞∫∞

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ø˜ ·ÓıÂÎÙÈ΋ ·ÚÙËÚȷ΋˘¤ÚÙ·ÛË (∞À) ÔÚ›˙ÂÙ·È Ë ‡·Ú-ÍË ·ÚÙËÚȷ΋˜ ›ÂÛ˘ (∞¶) ≥140/90 mmHg ‹ ∞¶ ≥ 130/80mmHg Û ·ÛıÂÓ›˜ Ì ۷ί·ÚÒ-‰Ë ‰È·‚‹ÙË (™¢) ‹ ÓÂÊÚÈ΋ ÓfiÛÔ,·Ú¿ ÙË ıÂڷ›· Ì ÙÚ›· ÙÔ˘Ï¿-¯ÈÛÙÔÓ ·ÓÙÈ˘ÂÚÙ·ÛÈο Ê¿Ú̷η,ÛÙȘ ̤ÁÈÛÙ˜ ‰fiÛÂȘ, ·fi Ù·ÔÔ›· ÙÔ ¤Ó· Ú¤ÂÈ Ó· ›ӷÈÔˆÛ‰‹ÔÙ ‰ÈÔ˘ÚËÙÈÎfi1.

√ ·ÎÚÈ‚‹˜ ÂÈÔÏ·ÛÌfi˜ Ù˘·ÓıÂÎÙÈ΋˜ ∞À ÛÙÔ ÁÂÓÈÎfi ˘ÂÚ-Ù·ÛÈÎfi ÏËı˘ÛÌfi ‰ÂÓ Â›Ó·È ÙÂÎÌË-ÚȈ̤ÓÔ˜, ˆÛÙfiÛÔ Î·Ù·ÁÚ¿ÊÂÙ·ÈÛ ÔÛÔÛÙfi 15% ÙˆÓ ˘ÂÚÙ·ÛÈ-ÎÒÓ ·ÛıÂÓÒÓ Ô˘ Û˘ÌÌÂÙ¤¯Ô˘ÓÛ ÌÂϤÙ˜ ·Ú·Ù‹ÚËÛ˘2. ™Â ÌÂ-Á¿Ï˜ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ Ô˘ ·ÊÔ-ÚÔ‡Ó ·ÛıÂÓ›˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘,‰È·ÈÛÙÒÓÂÙ·È ·ÔÙ˘¯›· ›Ù¢-͢ ÙˆÓ ıÂڷ¢ÙÈÎÒÓ ÛÙfi¯ˆÓÙ˘ ∞¶ Û ÔÛÔÛÙfi 40%3,4 ηȤˆ˜ 60% Û ·ÛıÂÓ›˜ ¿Óˆ ÙˆÓ 60ÂÙÒÓ5. Δ· ÛÙÔȯ›· ·˘Ù¿ ‰Â›¯ÓÔ˘ÓfiÙÈ Ë ·ÓıÂÎÙÈ΋ ∞À ·ÔÙÂÏ› Û˘-¯Ófi ÎÏÈÓÈÎfi Úfi‚ÏËÌ·, ÂÓÒ ·Ó·-̤ÓÂÙ·È ¿ÓÔ‰Ô˜ ÛÙÔÓ ÂÈÔÏ·ÛÌfi·Ú¿ÏÏËÏ· Ì ÙË Á‹Ú·ÓÛË ÙÔ˘ÏËı˘ÛÌÔ‡ Î·È ÙËÓ ·‡ÍËÛË ÙÔ˘ÛˆÌ·ÙÈÎÔ‡ ‚¿ÚÔ˘˜ (™μ), ‰Â‰Ô̤-ÓÔ˘ fiÙÈ Ë ÌÂÁ¿ÏË ËÏÈΛ· Î·È Ë ·-¯˘Û·ÚΛ· Â›Ó·È ÔÈ Î˘ÚÈfiÙÂÚÔÈ ·-Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Ô˘ Û˘Ì‚¿Ï-ÏÔ˘Ó ÛÙËÓ ÂÌÊ¿ÓÈÛË Î·È ÂÁηٿ-ÛÙ·Û‹ Ù˘5.

∏ ‡·ÚÍË ÁÚ·ÌÌÈ΋˜ Û˘Û¯¤ÙÈ-Û˘ ÌÂٷ͇ ÙÔ˘ ‡„Ô˘˜ Ù˘ ∞¶Î·È ÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘Â›Ó·È Ï¤ÔÓ ÙÂÎÌËÚȈ̤ÓË1, ÁÂÁÔ-Ófi˜ Ô˘ ÂÍËÁ› ÙËÓ ·Ó·ÁηÈfiÙËÙ·¯ÔÚ‹ÁËÛ˘ Û˘Ó‰˘·ÛÌÔ‡ ÙÚÈÒÓ ‹ÂÚÈÛÛÔÙ¤ÚˆÓ ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓÊ·ÚÌ¿ÎˆÓ ÁÈ· ÙËÓ Â›Ù¢ÍË ÙˆÓÚÔÙÂÈÓfiÌÂÓˆÓ ÛÙfi¯ˆÓ Û ·ÛıÂ-Ó›˜ Ì ·ÓıÂÎÙÈ΋ ∞À6.

¶ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·ÓfiÙÈ Ë ÛÂÈÚÔÓÔÏ·ÎÙfiÓË, Ô ÚÒ-ÙÔ˜ ·ÓÙ·ÁˆÓÈÛÙ‹˜ ÙˆÓ ˘Ô‰Ô¯¤-ˆÓ Ù˘ ·Ï‰ÔÛÙÂÚfiÓ˘, Û ËÌÂÚ‹-ÛÈ· ‰fiÛË 25-50 mg, Û˘Ì‚¿ÏÏÂÈÛÙËÓ ÂÈÚfiÛıÂÙË ÂÏ¿ÙÙˆÛË Ù˘∞¶ Û ·ÛıÂÓ›˜ Ô˘ Ï·Ì‚¿ÓÔ˘Óηٿ ̤ÛÔ fiÚÔ ÙÚ›· ·ÓÙÈ˘ÂÚÙ·-

ÛÈο Ê¿Ú̷η6-9. ™Ù· ·Ú·¿Óˆ‰Â‰Ô̤ӷ ‚·Û›˙ÔÓÙ·È ÔÈ ÙÂÏÂ˘Ù·›-˜ ηÙ¢ı˘ÓÙ‹ÚȘ ÁÚ·Ì̤˜ Ù˘∂˘Úˆ·˚΋˜ ∞ÓÙÈ˘ÂÚÙ·ÛÈ΋˜∂Ù·ÈÚ›·˜ Î·È Ù˘ ∂˘Úˆ·˚΋˜∫·Ú‰ÈÔÏÔÁÈ΋˜ ∂Ù·ÈÚ›·˜, Ô˘Û˘ÛÙ‹ÓÔ˘Ó ÙË ÛÂÈÚÔÓÔÏ·ÎÙfiÓˈ˜ ·ÓÙÈ˘ÂÚÙ·ÛÈÎfi Ê¿ÚÌ·ÎÔ Ù¤-Ù·ÚÙ˘ ÁÚ·ÌÌ‹˜10.

∏ ÌÂÁ·Ï‡ÙÂÚË Î·È ÈÔ Úfi-ÛÊ·ÙË ·Ó¿Ï˘ÛË11 fiÏˆÓ ÙˆÓ ‰ËÌÔ-ÛÈ¢ı¤ÓÙˆÓ Ì¤¯ÚÈ ÙÒÚ· ÁÈ· Ù˯ڋÛË Ù˘ ÛÂÈÚÔÓÔÏ·ÎÙfiÓ˘ÛÙËÓ ·ÓıÂÎÙÈ΋ ∞À ÚÔ¤Ú¯ÂÙ·È·fi ˘ÔÔÌ¿‰· ·ÛıÂÓÒÓ Ù˘ ÌÂ-ϤÙ˘ ASCOT-BPLA (Anglo-Scan-dinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm)12.™ÙË ÌÂϤÙË ·˘Ù‹ Û˘ÁÎÚ›ıËΠ˷ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ·ÙÂÓÔ-ÏfiÏ˘ Ì ‹ ¯ˆÚ›˜ ıÂÈ·˙ȉÈÎfi ‰È-Ô˘ÚËÙÈÎfi ¤Ó·ÓÙÈ Ù˘ ·ÌÏԉțÓ˘Ì ‹ ¯ˆÚ›˜ ÂÚÈÓ‰ÔÚ›ÏË ÛÙËÓÚfiÏË„Ë ÙˆÓ ÌÂÈ˙fiÓˆÓ Î·Ú‰È·Á-ÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ Û 19.257˘ÂÚÙ·ÛÈÎÔ‡˜ ·ÛıÂÓ›˜, Ì ÙÚÂȘ‹ ÂÚÈÛÛfiÙÂÚÔ˘˜ ·Ú¿ÁÔÓÙ˜ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ Î·È ¯ˆ-Ú›˜ ÈÛÙÔÚÈÎfi ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘.ø˜ ·ÓÙÈ˘ÂÚÙ·ÛÈÎfi Ê¿ÚÌ·ÎÔ ÙÚ›-Ù˘ ÁÚ·ÌÌ‹˜ ¯ÚËÛÈÌÔÔÈ‹ıËΠˉÔÍ·˙ÔÛ›ÓË ÁÈ· Ó· ÂÈÙ¢¯ıÔ‡ÓÙ· ÂÈı˘ÌËÙ¿ ›‰· Ù˘ ∞¶Û ÂÚ›ÙˆÛË ·ÔÙ˘¯›·˜ ÌÂÙÔ˘˜ ·Ú¯ÈÎÔ‡˜ Ê·Ú̷΢ÙÈÎÔ‡˜Û˘Ó‰˘·ÛÌÔ‡˜. ™Â 1.141 ·ÛıÂÓ›˜Ù˘ ÌÂϤÙ˘ ASCOT-BPLA (̤ÛËËÏÈΛ· 63 ¤ÙË, 77% ¿Ó‰Ú˜, 40%Ì ™¢), Ô˘ ‰ÂÓ ÂÈÙ‡¯ıËÎ·Ó ÔÈÛÙfi¯ÔÈ Ù˘ ·ÓÙÈ˘ÂÚÙ·ÛÈ΋˜ ·Áˆ-Á‹˜ Ì ÙÔ Û˘Ó‰˘·ÛÌfi ÙˆÓ ·Ú·-¿Óˆ ·ÓÙÈ˘ÂÚÙ·ÛÈÎÒÓ Ê·ÚÌ¿-ÎˆÓ ÛÙȘ ̤ÁÈÛÙ˜ ‰fiÛÂȘ, ¯ÔÚË-Á‹ıËΠÛÂÈÚÔÓÔÏ·ÎÙfiÓË (25mg/ËÌ.), Ì ̤ÛË ‰È¿ÚÎÂÈ· ıÂÚ·-›·˜ Ù· 1,3 ¤ÙË11. ¢È·ÈÛÙÒıËÎÂÂÏ¿ÙÙˆÛË Ù˘ Û˘ÛÙÔÏÈ΋˜ ·ÚÙË-Úȷ΋˜ ›ÂÛ˘ (™∞¶) ηٿ 21,9mmHg Î·È Ù˘ ‰È·ÛÙÔÏÈ΋˜ ·ÚÙË-Úȷ΋˜ ›ÂÛ˘ (¢∞¶) ηٿ 9,5mmHg. ∞Ó¿ÏÔÁË ÂÏ¿ÙÙˆÛË Ù˘∞¶ ηٷÁÚ¿ÊËÎÂ Î·È Û ˘ÔÔÌ¿-‰Â˜ ·ÛıÂÓÒÓ Ô˘ ÂÈϤ¯ıËÎ·Ó Ì‚¿ÛË ÙËÓ ËÏÈΛ·, ÙÔ Ê‡ÏÔ, ÙÔ Î¿-

ÓÈÛÌ·, ÙËÓ ·ÚÔ˘Û›· ‹ ·Ô˘Û›·™¢ Î·È ÛÂ Ù˘¯·ÈÔÔÈË̤Ó˜ ÔÌ¿-‰Â˜ ·ÛıÂÓÒÓ ·Ó¿ÏÔÁ· Ì ÙË ¯Ô-Ú‹ÁËÛË ·ÙÂÓÔÏfiÏ˘ ‹ ·ÌÏԉț-Ó˘.

Δ· ·ÔÙÂϤÛÌ·Ù· ·˘Ù¿ Ù˘ÌÂϤÙ˘ ASCOT-BPLA Û˘Ìʈ-ÓÔ‡Ó Ì ·Ú·ÙËÚ‹ÛÂȘ ÌÈÎÚfiÙÂ-ÚˆÓ ÌÂÏÂÙÒÓ ÁÈ· ÙÔ ÚfiÏÔ Ù˘ÛÂÈÚÔÓÔÏ·ÎÙfiÓ˘ ÛÙËÓ ·ÓıÂÎÙÈ-΋ ∞À6-9. ™Â Ì›· Ù¤ÙÔÈ· ÌÂϤÙË6, ËËÌÂÚ‹ÛÈ· ¯ÔÚ‹ÁËÛË ÛÂÈÚÔÓÔÏ·-ÎÙfiÓ˘ Û ‰fiÛË 25 mg/ËÌ. ¤-ÊÂÚ Ì›ˆÛË Ù˘ ™∞¶ Î·È Ù˘¢∞¶ ηٿ 21,7 mmHg Î·È 8,5mmHg, ·ÓÙ›ÛÙÔȯ·, Û ÔÌ¿‰·114 ˘ÂÚÙ·ÛÈÎÒÓ ·ÛıÂÓÒÓ Ô˘‹Ù·Ó ‹‰Ë Û ·ÁˆÁ‹ Ì ·Ó·ÛÙÔ-Ï›˜ ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘ I (·-ª∂∞) ÛÂÛ˘Ó‰˘·ÛÌfi Ì ¿ÏÏ· ·ÓÙÈ˘ÂÚÙ·-ÛÈο Ê¿Ú̷η.

øÛÙfiÛÔ, Ë ·ÍÈÔÏfiÁËÛË ÙˆÓ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÙˆÓ ·Ú·¿ÓˆÌÂÏÂÙÒÓ ı· Ú¤ÂÈ Ó· Á›ÓÂÈ ÌÂȉȷ›ÙÂÚË ÚÔÛÔ¯‹2. ∂Í·ÈÙ›·˜ Ù˘·Ô˘Û›·˜ ÔÌ¿‰·˜ ÂϤÁ¯Ô˘ Ì ÂÈ-ÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ, Ë ÂÏ¿ÙÙˆÛË Ù˘∞¶ ı· ÌÔÚÔ‡Û ıˆÚËÙÈο Ó·ÔÊ›ÏÂÙ·È Û ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙ˜ÂÎÙfi˜ Ù˘ ıÂڷ›·˜ Ì ÛÂÈÚÔ-ÓÔÏ·ÎÙfiÓË, fiˆ˜ ÛÙËÓ Èı·ÓfiÙË-Ù· ‡·Ú͢ ÌÂıÔ‰ÔÏÔÁÈÎÒÓ ·ÙÂ-ÏÂÈÒÓ (bias). ∂›Û˘, ÛÙȘ ÌÂϤ-Ù˜ ·˘Ù¤˜ ‰ÂÓ ‰È¢ÎÚÈÓ›˙ÂÙ·È ·Ó›¯·Ó ·ÔÎÏÂÈÛı› Ï‹Úˆ˜ Ù·‰Â˘ÙÂÚÔ·ı‹ ·›ÙÈ· Ù˘ ∞À, ÂÓÒÛ ÔÚÈṲ̂Ó˜ ‰ÂÓ ˘¿Ú¯Ô˘Ó ÛÙÔÈ-¯Â›· ÁÈ· ÙËÓ ‹‰Ë ˘¿Ú¯Ô˘Û··ÓÙÈ˘ÂÚÙ·ÛÈ΋ ·ÁˆÁ‹ ÙˆÓ ·ÛıÂ-ÓÒÓ ÚÈÓ ·fi ÙËÓ ÚÔÛı‹ÎË Ù˘ÛÂÈÚÔÓÔÏ·ÎÙfiÓ˘6,11.

™Â Ì›· Ù˘¯·ÈÔÔÈË̤ÓË Î·ÈÂÏÂÁ¯fiÌÂÓË Ì ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔÌÂϤÙË13 ÂÍÂÙ¿ÛÙËÎ·Ó ÔÈ Âȉڿ-ÛÂȘ Ù˘ ÛÂÈÚÔÓÔÏ·ÎÙfiÓ˘ ηÈÙ˘ ·ÌÈÏÔÚ›‰Ë˜ ͯˆÚÈÛÙ¿ ηÈÙÔ˘ Û˘Ó‰˘·ÛÌÔ‡ ÙÔ˘˜ ÛÙËÓ ÂÏ¿Ù-ÙˆÛË Ù˘ ∞¶. ¢È·ÈÛÙÒıËÎÂÂÏ¿ÙÙˆÛË Ù˘ ™∞¶ Î·È Ù˘ ¢∞¶Î·Ù¿ 9,8 mmHg Î·È 3,4 mmHgÁÈ· ÙËÓ ·ÌÈÏÔÚ›‰Ë, ·ÓÙ›ÛÙÔȯ·,Î·È Î·Ù¿ 4,6 mmHg Î·È 1,8mmHg ÁÈ· ÙË ÛÂÈÚÔÓÔÏ·ÎÙfiÓË,

O ƒfiÏÔ˜ Ù˘ ™ÂÈÚÔÓÔÏ·ÎÙfiÓ˘ ÛÙËÓ ∞ÓıÂÎÙÈ΋ ∞ÚÙËÚȷ΋ À¤ÚÙ·ÛË

ª·Ú›· Δ˙‹ÌÔ˘, ÷ڿϷÌÔ˜ ∫Ô˘Ì·Ú¿˜, £ÂÔ‰ÒÚ· °Ú›‚·, ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ∫·ÚÁÈÒÙ˘,μ·Û›ÏÂÈÔ˜ Õı˘ÚÔ˜, ∞ÛÙ¤ÚÈÔ˜ ∫·Ú·ÁÈ¿ÓÓ˘

μ’ ¶ÚÔ·È‰Â˘ÙÈ΋ ¶·ıÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ∞¶£, πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌ›Ô, £ÂÛÛ·ÏÔÓ›ÎË.

¢ ∂ ∫ ∂ ª μ ƒ π √ ™ 2 0 0 8

30

·ÓÙ›ÛÙÔȯ·. ∏ ÂÏ¿ÙÙˆÛË Ù˘ ∞¶Ì ÙË ÛÂÈÚÔÓÔÏ·ÎÙfiÓË ‹Ù·Ó ÏÈ-ÁfiÙÂÚÔ ÂÓÙ˘ˆÛȷ΋ Û ۇÁÎÚÈ-ÛË Ì ÂΛӘ Ô˘ ηٷÁÚ¿ÊË-Î·Ó ÛÙȘ ·ÓÔȯ٤˜, ÌË ÂÏÂÁ¯fiÌÂ-Ó˜ ÌÂϤÙ˜.

Δ· ¢ÓÔ˚ÎfiÙÂÚ· ·ÔÙÂϤÛÌ·-Ù· Ù˘ ‰Ú¿Û˘ Ù˘ ÛÂÈÚÔÓÔÏ·-ÎÙfiÓ˘ ÛÙËÓ ÂÏ¿ÙÙˆÛË Ù˘ ∞¶Ô˘ ·Ú·ÙËÚ‹ıËΠÛÙȘ ÌË ÂÏÂÁ-¯fiÌÂÓ˜ ÌÂϤÙ˜ Ê·›ÓÂÙ·È Ó· ÂË-Ú¿˙ÔÓÙ·È ·fi: ·) ÙËÓ Èı·Ó‹‡·ÚÍË ‰Â˘ÙÂÚÔ·ıÒÓ ÌÔÚÊÒÓ∞À, ‚) ÙËÓ ˘¿Ú¯Ô˘Û· ·ÓÙÈ˘ÂÚ-Ù·ÛÈ΋ ·ÁˆÁ‹, Á) ÙËÓ ÂÈÏÔÁ‹ ÙÔ˘ÏËı˘ÛÌÔ‡ ÌÂϤÙ˘ Î·È ‰) ÙË Û˘-Ó‡·ÚÍË ÌÂÙ·‚ÔÏÈÎÒÓ ‰È·Ù·Ú·-¯ÒÓ fiˆ˜ ·¯˘Û·ÚΛ·, ™¢ Ù‡Ô˘2 ‹ ¿ÏÏˆÓ ·ıÔÏÔÁÈÎÒÓ Î·Ù·ÛÙ¿-ÛÂˆÓ fiˆ˜ ÙÔ Û‡Ó‰ÚÔÌÔ ¿ÓÔÈ·˜Î·Ù¿ ÙÔÓ ‡ÓÔ (™∞À) Î.¿2.

∂ÎÙÈÌ¿Ù·È fiÙÈ ÙÔ 5-10% ÙˆÓÂÚÈÙÒÛÂˆÓ Ù˘ ·ÓıÂÎÙÈ΋˜ ∞ÀÔÊ›ÏÂÙ·È Û ‰Â˘ÙÂÚÔ·ı‹ ·›ÙÈ·1.ªÂٷ͇ ·˘ÙÒÓ Ô ÚˆÙÔ·ı‹˜˘ÂڷωÔÛÙÂÚÔÓÈÛÌfi˜ Ê·›ÓÂÙ·ÈÓ· Â›Ó·È Û˘¯ÓfiÙÂÚÔ˜ ·fi fi,ÙÈ ·Ú-¯Èο ıˆڋıËÎÂ14-15. ™‡Ìʈӷ ÌÂÚfiÛÊ·Ù˜ ¤Ú¢Ó˜, Ô ÂÈÔÏ·-ÛÌfi˜ ÙÔ˘ ·ÁÁ›˙ÂÈ ÙÔ 10-15% ÙˆÓ˘ÂÚÙ·ÛÈÎÒÓ ·ÛıÂÓÒÓ5, ÂÓÒ·Ó¤Ú¯ÂÙ·È ÛÙÔ 40% ÙˆÓ ·ÛıÂÓÒÓÌ ·ÓıÂÎÙÈ΋ ∞À16. ™˘ÓÂÒ˜ ‰ÂÓ·ÔÎÏ›ÂÙ·È Ë Èı·Ó‹ Û˘ÌÌÂÙÔ¯‹·ÛıÂÓÒÓ Ì ·‰È¿ÁÓˆÛÙÔ ˘ÂÚ·Ï-‰ÔÛÙÂÚÔÓÈÛÌfi Ó· Ô‰‹ÁËÛ Û ÌÂ-Á·Ï‡ÙÂÚË ·ÓÙ·fiÎÚÈÛË ÛÙË ‰Ú¿-ÛË Ù˘ ÛÂÈÚÔÓÔÏ·ÎÙfiÓ˘. ™ÂÚfiÛÊ·ÙË ÌÂϤÙË ‚Ú¤ıËΠfiÙÈ Ë¯ÔÚ‹ÁËÛË Ù˘ ÛÂÈÚÔÓÔÏ·ÎÙfiÓ˘Û ‰fiÛË 25-50 mg/ËÌ., › 6 Ì‹-Ó˜, ÚÔοÏÂÛ ÂÏ¿ÙÙˆÛË Ù˘™∞¶ Î·È Ù˘ ¢∞¶ ηٿ 25±20mmHg Î·È 12±12 mmHg, ·ÓÙ›-ÛÙÔȯ·, Û ¿ÙÔÌ· Ì ·ÓıÂÎÙÈ΋∞À Ì ‹ ¯ˆÚ›˜ ÚˆÙÔ·ı‹ ˘Â-ڷωÔÛÙÂÚÔÓÈÛÌfi, Ô˘ ‹Ù·Ó ‹‰ËÛ ·ÁˆÁ‹ Ì ‰ÈÔ˘ÚËÙÈο ÛÂ Û˘Ó-‰˘·ÛÌfi Ì ·-ª∂∞ ‹ Ì ·ÓÙ·ÁˆÓÈ-ÛÙ¤˜ ÙˆÓ ˘Ô‰Ô¯¤ˆÓ ∞Δ1 Ù˘ ·Á-ÁÂÈÔÙÂÓÛ›Ó˘ ππ17 .

ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÂÈÏÔÁ‹ÙÔ˘ ÏËı˘ÛÌÔ‡ ÌÂϤÙ˘ ÁÈ· ÙˉȷÌfiÚʈÛË ÙˆÓ ·Ú·¿Óˆ·ÔÙÂÏÂÛÌ¿ÙˆÓ, ·Í›˙ÂÈ Ó· ÛËÌÂÈ-ˆı› fiÙÈ Û ̛· ·fi ÙȘ ÚÔ·Ó·-ÊÂÚfiÌÂÓ˜ ÌÂϤÙ˜, Ë ·fiÊ·ÛËÓ· ¯ÔÚËÁËı› ÛÂÈÚÔÓÔÏ·ÎÙfiÓË‚·Û›ÛÙËΠÛÙËÓ ËÏÈΛ· ÙˆÓ ·ÛıÂ-ÓÒÓ, ÂÍ·ÈÙ›·˜ ÙÔ˘ ‰ÈÛÙ·ÁÌÔ‡ Ó·¯ÔÚËÁËı› Û ӤԢ˜ ¿Ó‰Ú˜·ÛıÂÓ›˜, ÏfiÁˆ ÙˆÓ ·ÓÂÈı‡ÌË-ÙˆÓ ÂÓÂÚÁÂÈÒÓ ÛÙË ÛÂÍÔ˘·ÏÈ΋ÏÂÈÙÔ˘ÚÁ›·6. °È· ÙÔ ÏfiÁÔ ·˘Ùfi, Ë̤ÛË ËÏÈΛ· ÙˆÓ Û˘ÌÌÂÙ¯fiÓÙˆÓ

‹Ù·Ó 62,5 ¤ÙË. ¶·ÚfiÌÔÈ·, ÛÙÔÓ˘ÔÏËı˘ÛÌfi Ù˘ ÌÂϤÙ˘ASCOT-BPLA, Ë Ì¤ÛË ËÏÈΛ· ÙˆÓ·ÛıÂÓÒÓ ‹Ù·Ó Ù· 63 ¤ÙË11. Δ·ÛÙÔȯ›· ·˘Ù¿, ÂӉ¯Ô̤ӈ˜,Ô‰‹ÁËÛ·Ó Û ˘ÂÚÂÎÙ›ÌËÛË ÙˆÓÏÂÔÓÂÎÙËÌ¿ÙˆÓ Ù˘ ÛÂÈÚÔÓÔ-Ï·ÎÙfiÓ˘, ÂÂȉ‹ Ë ÌÂÁ¿ÏË ËÏÈ-Λ· (> 60 ÂÙÒÓ) Â›Ó·È ÈÛ¯˘Úfi˜ÚÔÁÓˆÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ Ù˘·ÓıÂÎÙÈ΋˜ ∞À2.

™‡Ìʈӷ Ì ÂȉËÌÈÔÏÔÁÈο‰Â‰Ô̤ӷ, Ë Â›ÙˆÛË Ù˘ ·ÓıÂ-ÎÙÈ΋˜ ∞À Â›Ó·È È‰È·›ÙÂÚ· ˘„ËÏ‹Û 2 ‚·ÛÈΤ˜ ÏËı˘ÛÌȷΤ˜ ÔÌ¿-‰Â˜: ·) Û ¿ÙÔÌ· > 60 ÂÙÒÓ Î·ÈÛ ¿ÙÔÌ· Ì ™¢ Ù‡Ô˘ 2. ™˘¯Ó‹ÌÂÙ·‚ÔÏÈ΋ ‰È·Ù·Ú·¯‹ ÌÂÙ·Í‡ÙˆÓ 2 ÔÌ¿‰ˆÓ Â›Ó·È Ë ·¯˘Û·Ú-Λ·, ΢ڛˆ˜ Ë ÎÂÓÙÚÈÎÔ‡ Ù‡Ô˘18.™ÙÔÓ ˘ÔÏËı˘ÛÌfi Ù˘ ÌÂϤÙ˘ASCOT-BPLA, ÙÔ 40% ÙˆÓ ·ÛıÂ-ÓÒÓ ¤·Û¯Â ·fi ™¢ Ù‡Ô˘ 211.∞Ó¿ÏÔÁ· ‹Ù·Ó Ù· ÔÛÔÛÙ¿ ÙˆÓ·ÛıÂÓÒÓ Ì ™¢ Ù‡Ô˘ 2 ÛÙȘ ÌÈ-ÎÚfiÙÂÚ˜ ÌÂϤÙ˜6-9, ÂÓÒ ÂÚÈÛ-ÛfiÙÂÚÔÈ ·fi ÙÔ 50% ‹Ù·Ó ·¯‡-Û·ÚÎÔÈ. Δ· ¯·Ú·ÎÙËÚÈÛÙÈο ·˘Ù¿,ÂÍ·ÈÙ›·˜ Ù˘ Èı·Ó‹˜ Û˘Û¯¤ÙÈÛ˘Ì ·˘ÍË̤Ó˜ Û˘ÁÎÂÓÙÚÒÛÂȘ ·Ï-‰ÔÛÙÂÚfiÓ˘ Ï¿ÛÌ·ÙÔ˜, ÂӉ¯Ô-̤ӈ˜ Ô‰‹ÁËÛ·Ó Û ÌÂÁ·Ï‡ÙÂÚË·ÓÙ·fiÎÚÈÛË ÛÙË ‰Ú¿ÛË Ù˘ ÛÂÈ-ÚÔÓÔÏ·ÎÙfiÓ˘2. ¶Ú¿ÁÌ·ÙÈ, ÔÏ-Ϥ˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó Û·Ê‹ Û˘Û¯¤-ÙÈÛË ÌÂٷ͇ ÙˆÓ ·ÓıÚˆÔÌÂÙÚÈ-ÎÒÓ ·Ú·Ì¤ÙÚˆÓ Ù˘ ÎÂÓÙÚÈ΋˜·¯˘Û·ÚΛ·˜ Î·È ÙˆÓ ·˘ÍË̤ӈÓÛ˘ÁÎÂÓÙÚÒÛÂˆÓ Ù˘ ·Ï‰ÔÛÙÂÚfi-Ó˘ Ï¿ÛÌ·ÙÔ˜ Û ¿ÙÔÌ· Ì ∞À,Ô˘ ‰ÂÓ ÂÚÈÔÚ›˙ÂÙ·È ÛÙȘ Ù˘ÈΤ˜ÂÚÈÙÒÛÂȘ ÙÔ˘ ÚˆÙÔ·ıÔ‡˜˘ÂڷωÔÛÙÂÚÔÓÈÛÌÔ‡.

™Â ÚfiÛÊ·ÙË ÌÂϤÙË Ô˘·ÊÔÚÔ‡Û 397 ·ÊÚÈηÓÈ΋˜ η-Ù·ÁˆÁ‹˜ ∞ÌÂÚÈηÓÔ‡˜ (47% ÌÂ∞À, 50% Á˘Ó·›Î˜ Î·È 17% Ì ÌÂ-Ù·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ) ‰È·ÈÛÙÒıË-ΠfiÙÈ ÔÈ ·ÛıÂÓ›˜ Ì ∞À ÂÌÊ¿ÓÈ-Û·Ó ÌÂÁ·Ï‡ÙÂÚË ÂÚ›ÌÂÙÚÔ Ì¤-Û˘ Î·È ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜(body mass index, μªπ), ‰˘ÛÏÈÈ-‰·ÈÌ›· Î·È ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘-Ï›ÓË ÛÂ Û˘Ó‰˘·ÛÌfi Ì ˘„ËÏfiÙÂ-Ú· ›‰· ·Ï‰ÔÛÙÂÚfiÓ˘ Ï¿-ÛÌ·ÙÔ˜ Û ۇÁÎÚÈÛË Ì ٷ ÓÔÚ-ÌÔÙ·ÛÈο ¿ÙÔÌ·19. ∞ÓÙÈÊ·ÙÈο ‰Â-‰Ô̤ӷ ÚԤ΢„·Ó ÁÈ· ÙȘ ÙÈ̤˜Ù˘ ‰Ú·ÛÙÈÎfiÙËÙ·˜ ÚÂÓ›Ó˘ Ï¿-ÛÌ·ÙÔ˜ (plasma renin activity,PRA). Δ¤ÏÔ˜, Ù· ¿ÙÔÌ· Ì ÌÂÙ·-‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ ÂÌÊ¿ÓÈÛ·Ó˘„ËÏfiÙÂÚË ·Ï‰ÔÛÙÂÚfiÓË Ï¿-ÛÌ·ÙÔ˜ Î·È ˘„ËÏfiÙÂÚÔ ÏfiÁÔ ·Ï-‰ÔÛÙÂÚfiÓ˘/PRA Û ۇÁÎÚÈÛË ÌÂ

Ù· ¿ÙÔÌ· ¯ˆÚ›˜ ÙÔ Û‡Ó‰ÚÔÌÔ.∏ ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË Ù˘ ·Ï‰Ô-

ÛÙÂÚfiÓ˘ Ï¿ÛÌ·ÙÔ˜ Ì ÙȘ ·-Ú·¿Óˆ ·ÓıÚˆÔÌÂÙÚÈΤ˜ ·Ú·-̤ÙÚÔ˘˜ Î·È ÌÂÙ·‚ÔÏÈΤ˜ ‰È·Ù·-Ú·¯¤˜ ÛÙÔ˘˜ ˘ÂÚÙ·ÛÈÎÔ‡˜ ·Û-ıÂÓ›˜, ˘Ô‰ËÏÒÓÂÈ fiÙÈ Ë ·Ï‰Ô-ÛÙÂÚfiÓË Èı·ÓfiÓ Ó· ÂÌϤÎÂÙ·ÈÛÙÔ˘˜ Ì˯·ÓÈÛÌÔ‡˜ Ì ÙÔ˘˜ÔÔ›Ô˘˜ Ë ·¯˘Û·ÚΛ· ÚÔηÏ›∞À2. ¶ÚÔ·ÙÂÈ Â›Û˘ ÙÔ ÂÚÒ-ÙËÌ· ÁÈ· ÙÔ ÂÚ¤ıÈÛÌ· Ô˘ ÚÔ-ηÏ› ·‡ÍËÛË Ù˘ ·Ï‰ÔÛÙÂÚfiÓ˘ϿÛÌ·ÙÔ˜ ÛÙÔ˘˜ ˘ÂÚÙ·ÛÈÎÔ‡˜·ÛıÂÓ›˜ ¯ˆÚ›˜ ÙËÓ ·Ú¿ÏÏËÏË·‡ÍËÛË Ù˘ PRA, ‰ËÏ·‰‹ ¯ˆÚ›˜ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘ Û˘ÛÙ‹Ì·-ÙÔ˜ ÚÂÓ›Ó˘-·ÁÁÂÈÔÙÂÓÛ›Ó˘-·Ï-‰ÔÛÙÂÚfiÓ˘ (™ƒ∞∞).

√ÚÈṲ̂ÓÔÈ ÂÚ¢ÓËÙ¤˜ ıˆ-ÚÔ‡Ó fiÙÈ Ë ˘„ËÏ‹ ·Ï‰ÔÛÙÂÚfiÓËÎ·È Ë Û¯ÂÙÈο ¯·ÌËÏ‹ PRA ·ÓÙ·-Ó·ÎÏÔ‡Ó ÌÈ· ‹È· ·Ú·ÏÏ·Á‹ ÙÔ˘ÚˆÙÔ·ıÔ‡˜ ˘ÂڷωÔÛÙÂÚÔÓÈ-ÛÌÔ‡, Ô˘ ÂӉ¯Ô̤ӈ˜ Û˘Ó‰¤Â-Ù·È Â›Ù Ì ÙË ÌÔÚȷ΋ ÔÈÎÈÏfiÙË-Ù· Ù˘ ÊÏÔÈÔÙÚfiÔ˘ ÔÚÌfiÓ˘(ACTH) ›Ù Ì ÙË ÁÂÓÂÙÈ΋ ÔÈÎÈ-ÏÔÌÔÚÊ›· ÙˆÓ ÁÔÓȉ›ˆÓ Ô˘ Έ-‰ÈÎÔÔÈÔ‡Ó ÙË Û˘ÓıÂÙ¿ÛË Ù˘ ·Ï-‰ÔÛÙÂÚfiÓ˘. ∞˘Ù¤˜ ÔÈ ‰‡Ô ÌÔ-Ú› Ó· ÂÈʤÚÔ˘Ó ·‡ÍËÛË Ù˘ ·Ï-‰ÔÛÙÂÚfiÓ˘, ¯ˆÚ›˜ ÙË ÌÂÛÔÏ¿‚Ë-ÛË Â͈ÁÂÓÒÓ Ú˘ıÌÈÛÙÒÓ, fiˆ˜Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘ ππ (∞ππ), ÙÔ˘Î·Ï›Ô˘ Î·È Ù˘ ACTH20.

∂Ӊ›ÍÂȘ ÁÈ· ÙËÓ Èı·Ó‹‡·ÚÍË Ì˯·ÓÈÛÌÒÓ ·ÓÂÍ¿ÚÙË-ÙˆÓ ÙÔ˘ ™ƒ∞∞ Ô˘ ÚÔηÏÔ‡Ó·‡ÍËÛË Ù˘ ¤ÎÎÚÈÛ˘ Ù˘ ·Ï‰Ô-ÛÙÂÚfiÓ˘ Û ·¯‡Û·Úη ¿ÙÔÌ·ÚԤ΢„·Ó ·fi ÚfiÛÊ·ÙË ÌÂϤ-ÙË ÛÙËÓ ÔÔ›· Û˘ÁÎÚ›ıËÎ·Ó Ù·Â›Â‰· Ù˘ ·Ï‰ÔÛÙÂÚfiÓ˘ Ï¿-ÛÌ·ÙÔ˜, Ù˘ PRA, Ù˘ ¯ÔÏËÛÙÂ-ÚfiÏ˘, ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ ¯·ÌË-Ï‹˜ ˘ÎÓfiÙËÙ·˜ (LDL) Û ·¯‡-Û·ÚΘ ˘ÂÚÙ·ÛÈΤ˜ Î·È ·¯‡-Û·ÚΘ ÓÔÚÌÔÙ·ÛÈΤ˜ Á˘Ó·›Î˜21.™ÙȘ ·¯‡Û·ÚΘ ˘ÂÚÙ·ÛÈΤ˜Á˘Ó·›Î˜ ‰È·ÈÛÙÒıËÎ·Ó ¯·ÌËÏ‹PRA, ·˘ÍË̤ÓÔ˜ ÏfiÁÔ˜ ·ÏÔ‰Ô-ÛÙÂÚfiÓ˘/PRA Î·È ˘„ËϤ˜ ÙÈ̤˜LDL Û ۯ¤ÛË Ì ÙȘ ·¯‡Û·ÚΘÓÔÚÌÔÙ·ÛÈΤ˜ Á˘Ó·›Î˜. ™ÙËÓ ›‰È·ÌÂϤÙË, ·Ó·Ê¤ÚÂÙ·È Û ÂÈÚ·Ì·-ÙÈÎfi Â›Â‰Ô fiÙÈ ÔÈ LDL ÏÈÔÚˆ-Ù½Ó˜ ·˘Í¿ÓÔ˘Ó ÙËÓ Â˘·ÈÛıËÛ›·ÙˆÓ ÊÏÔÈÔÂÈÓÂÊÚȉȷÎÒÓ Î‡ÙÙ·-ÚˆÓ ÛÙË ‰Ú¿ÛË Ù˘ ∞ππ Î·È ÙËÓÂÍ·ÚÙÒÌÂÓË ·fi ÙËÓ ∞ππ ¤ÎÎÚÈÛËÙ˘ ·Ï‰ÔÛÙÂÚfiÓ˘. Δ· ÛÙÔȯ›··˘Ù¿ Ô‰‹ÁËÛ·Ó ÛÙËÓ ˘fiıÂÛË fiÙÈË ·‡ÍËÛË ÙÔ˘ ÏfiÁÔ˘ ·Ï‰ÔÛÙÂÚfi-Ó˘/PRA ÔÊ›ÏÂÙ·È Â›Ù ÛÙȘ ˘„Ë-

∫§π¡π∫∂™ ª∂§∂Δ∂™

31

Ϥ˜ ÙÈ̤˜ ÙˆÓ LDL ›Ù ÛÙËÓ ·-ÚÔ˘Û›· ¿ÏÏˆÓ ‰Ú·ÛÙÈÎÒÓ ·Ú·-ÁfiÓÙˆÓ Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙÔÛÏ·¯ÓÈÎfi ÏÈÒ‰Ë ÈÛÙfi. ∞Ó·ÊÔÚÈ-ο Ì ÙÔ ÙÂÏÂ˘Ù·›Ô, ¤¯ÂÈ ·Ô‰ÂÈ-¯Ù› in vitro fiÙÈ Ë ÔÍ›‰ˆÛË ÙˆÓÂχıÂÚˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ ÙÔ˘ÛÏ·¯ÓÈÎÔ‡ Ï›Ô˘˜ ·fi Ù· Ë·-ÙÔ·ÙÙ·Ú· Ô‰ËÁ› ÛÙËÓ ·Ú·Áˆ-Á‹ ÂÓÂÚÁÒÓ Ú˘ıÌÈÛÙÒÓ ÁÈ· ÙËÓ¤ÎÎÚÈÛË Ù˘ ·Ï‰ÔÛÙÂÚfiÓ˘ ¯ˆÚ›˜ÙË ÌÂÛÔÏ¿‚ËÛË ÙÔ˘ ™ƒ∞∞22.

∏ ÂÓ‰ÔÎÚÈÓÈ΋ ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ÛÏ·¯ÓÈÎÔ‡ ÏÈÒ‰Ô˘˜ ÈÛÙÔ‡ ›ӷȷԉ‰ÂÈÁ̤ÓË ‹‰Ë ·fi ÙËÓÚÔËÁÔ‡ÌÂÓË ‰ÂηÂÙ›·23. ªÂϤ-Ù˜ Û ÂÈÚ·Ì·Ùfi˙ˆ·24 Î·È Û ·Ó-ıÚÒÔ˘˜23 ¤‰ÂÈÍ·Ó fiÙÈ Ô ÛÏ·¯ÓÈ-Îfi˜ ÏÈ҉˘ ÈÛÙfi˜ ·ÔÙÂÏ› ÛË-Ì·ÓÙÈ΋ Â͈˷ÙÈ΋ ËÁ‹ ·Ú·-ÁˆÁ‹˜ ·ÁÁÂÈÔÙÂÓÛÈÓÔÁfiÓÔ˘ (AGT),Ë ·Ú·ÁˆÁ‹ ÙÔ˘ ÔÔ›Ô˘ ·˘Í¿ÓÂÈÛËÌ·ÓÙÈο ÛÙËÓ ·¯˘Û·ÚΛ·.∂Ӊ¯Ô̤ӈ˜ Ó· ¢ı‡ÓÂÙ·È ÁÈ·Ù· ·˘ÍË̤ӷ ΢ÎÏÔÊÔÚÔ‡Óٷ›‰· ÙÔ˘ AGT Î·È Î·Ù' ¤-ÎÙ·ÛË Ù˘ ∞ππ Î·È Ù˘ ·Ï‰ÔÛÙÂÚfi-Ó˘ Ï¿ÛÌ·ÙÔ˜ ÛÙ· ·¯‡Û·ÚηÛ ۇÁÎÚÈÛË Ì ٷ ÏÂÙfiۈ̷

¿ÙÔÌ· Î·È ÛÙËÓ ¿ÓÔ‰Ô Ù˘ ∞¶ ̤-Ûˆ Ù˘ ÂÓÂÚÁÔÔ›ËÛ˘ ÙÔ˘™ƒ∞∞24.

™‡Ìʈӷ Ì ÚfiÛÊ·Ù· ÛÙÔÈ-¯Â›·, Ô ÛÏ·¯ÓÈÎfi˜ ÏÈ҉˘ÈÛÙfi˜ Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ∞À¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi: 1) ‰È·Ù·Ú·-¯‹ Ù˘ ·Ú·ÁˆÁ‹˜ ‚ÈÔ‰Ú·ÛÙÈÎÒÓÌÔÚ›ˆÓ ÁÈ· ·Ú¿‰ÂÈÁÌ· ÙÔ˘ AGTÔ˘ fiˆ˜ ·Ó·Ê¤ÚıËΠÂÌϤÎÂ-Ù·È ÛÙÔ Ì˯·ÓÈÛÌfi ·‡ÍËÛ˘ Ù˘∞¶ Ì ÙË ÌÂÛÔÏ¿‚ËÛË ÙÔ˘ ™ƒ∞∞Î·È ÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ ˘ÂڷωÔ-ÛÙÂÚÔÓÈÛÌÔ‡, 2) ¤ÎÙÔË ÂÓ·fi-ıÂÛË Ï›Ô˘˜ ÛÙÔ˘˜ ÛÎÂÏÂÙÈÎÔ‡˜Ì‡Â˜ Î·È ÙÔ ‹·Ú Ô˘ Ô‰ËÁ› Û¢ÂÚÈÓÛÔ˘ÏÈÓ·ÈÌ›· Î·È ·‡ÍËÛËÙ˘ ∞¶ Ì ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘Û˘Ì·ıËÙÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹-Ì·ÙÔ˜ Î·È 3) ‰È‹ıËÛË ·fi Ì·ÎÚÔ-Ê¿Á· ·ÙÙ·Ú·, Ë ÔÔ›· ÚÔηÏ›·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË, ˘Â-ÚÈÓÛÔ˘ÏÈÓ·ÈÌ›· Î·È ·‡ÍËÛË ÙÔ˘ÔÍÂȉˆÙÈÎÔ‡ stress Ô˘ Ô‰ËÁÔ‡ÓÛ ·‡ÍËÛË Ù˘ ∞¶24.

ΔÔÓ›˙ÂÙ·È fiÙÈ Ù· ·Ú·¿Óˆ¯·Ú·ÎÙËÚÈÛÙÈο Û¯ÂÙ›˙ÔÓÙ·È ÌÂÛ˘ÁÎÂÎÚÈ̤ÓË ÌÔÚÊÔÏÔÁ›· ÙÔ˘ÏÈÒ‰Ô˘˜ ÈÛÙÔ‡, Ô˘ ·ÔÙÂÏ›ٷÈ

·fi ¢ÌÂÁ¤ıË ÏÈÔ·ÙÙ·Ú·. μÚ¤-ıËΠfiÙÈ ÙÔ Ì¤ÁÂıÔ˜ ÙˆÓ ÏÈÔ΢Ù-Ù¿ÚˆÓ Û¯ÂÙ›˙ÂÙ·È ÁÚ·ÌÌÈο ÌÂÙËÓ ·Ú·ÁˆÁ‹ ÙÔ˘ AGT, ÙËÓ¤ÎÙÔË ÂÓ·fiıÂÛË Ï›Ô˘˜ Î·È ÙÔ‚·ıÌfi Ù˘ ÏÈȉÈ΋˜ ‰È‹ıËÛ˘,ÂÓÒ Ë Î·Ù·ÛÙÔÏ‹ ÙÔ˘ ™ƒ∞∞ Ì ·-ª∂∞ ‹ Ô ·ÔÎÏÂÈÛÌfi˜ ÙˆÓ ˘Ô-‰Ô¯¤ˆÓ ∞Δ1 Ù˘ ∞ππ Ô‰ËÁÔ‡Ó ÛÂÂÏ¿ÙÙˆÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙˆÓ Î˘Ù-Ù¿ÚˆÓ, ÔÌ·ÏÔÔ›ËÛË Ù˘ ∞¶ ηȷ‡ÍËÛË Ù˘ ¢·ÈÛıËÛ›·˜ ÛÙËÓ ÈÓ-ÛÔ˘Ï›ÓË23.

™˘ÌÂÚ·ÛÌ·ÙÈο, Ê·›ÓÂÙ·ÈfiÙÈ Ë ÛÂÈÚÔÓÔÏ·ÎÙfiÓË Î·Ù¤¯ÂÈÛËÌ·ÓÙÈ΋ ı¤ÛË ÛÙË Ú‡ıÌÈÛË Ù˘·ÓıÂÎÙÈ΋˜ ∞À Î·È ÂȉÈο Û ÂÚÈ-ÙÒÛÂȘ Ì ¯·Ú·ÎÙËÚÈÛÙÈο ·˘-ÍË̤Ó˘ ¤ÎÎÚÈÛ˘ ·Ï‰ÔÛÙÂÚfi-Ó˘, fiˆ˜ Û ·ÛıÂÓ›˜ Ì ڈ-ÙÔ·ı‹ ˘ÂڷωÔÛÙÂÚÔÓÈÛÌfi, ·-¯˘Û·ÚΛ·, ™¢ Ù‡Ô˘ 2, Î.¿. ∞Ó·-̤ÓÔÓÙ·È Î·È ÓÂfiÙÂÚ˜ ÌÂϤ̠٘ÙÔ ÓÂfiÙÂÚÔ ·ÓÙ·ÁˆÓÈÛÙ‹ ÙˆÓ˘Ô‰Ô¯¤ˆÓ Ù˘ ·Ï‰ÔÛÙÂÚfiÓ˘,ÙËÓ ÂÏÂÚÂÓfiÓË, Û ·ÛıÂÓ›˜ Ì·ÓıÂÎÙÈ΋ ∞À.

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