ΤΕΥΧΟΣ 19 ΣΕΠΤΕΜΒΡΙΟΣ 2008 - ΑΘΗΡΟΣΚΛΗΡΩΣΗ

¶·Ú¿ÁÔÓÙÂ˜ ∫ÈÓ‰‡ÓÔ˘

∫ÏÈÓÈÎ¤˜ ªÂÏ¤ÙÂ˜

¶·ıÔÊ˘ÛÈÔÏÔÁ›·

¶ÚÔÎÏÈÓÈÎ‹ ŒÚÂ˘Ó·

¶ÚÔÙÂÈÓfiÌÂÓË µÈ‚ÏÈÔÁÚ·Ê›·

∆ƒπª∏¡π∞π√ ¶∂ƒπ√¢π∫√ §π¶π¢πø¡ ∆∂ÀÃ√™ 19 ñ ™∂¶∆∂ªµƒπ√™ 2008

172

1823

32

ÀÂ‡ı˘ÓÔ˜ ™‡ÓÙ·ÍË˜

HÏ›·˜ XÂÈÌÒÓ·˜

K·Ú‰ÈÔÏfiÁÔ˜

YÔÙ¤Ú·Ú¯Ô˜ Â.·.

¢ÈÔÈÎËÙÈÎfi ™˘Ì‚Ô‡ÏÈÔ ∂ÏÏËÓÈÎ‹˜ ∂Ù·ÈÚÂ›·˜

∞ıËÚÔÛÎÏ‹ÚˆÛË˜

°ÂÓÔ‚¤Ê· KÔÏÔ‚Ô‡ ¶ÚfiÂ‰ÚÔ˜

ªˆ˘Û‹˜ ∂ÏÈÛ¿Ê ∞ÓÙÈÚfiÂ‰ÚÔ˜

HÏ›·˜ XÂÈÌÒÓ·˜ °ÂÓÈÎfi˜ °Ú·ÌÌ·Ù¤·˜

¢ËÌÔÛı¤ÓË˜ ¶·Ó·ÁÈˆÙ¿ÎÔ˜∂È‰ÈÎfi˜ °Ú·ÌÌ·Ù¤·˜

∂Ï¤ÓË ªÈÏÈ·ÓÔ‡∆·Ì›·˜

µ·Û›ÏË˜ Õı˘ÚÔ˜ª¤ÏÔ˜

ª·ÓÒÏË˜ °·ÓˆÙ¿ÎË˜ª¤ÏÔ˜

∞ÛÙ¤ÚÈÔ˜ ∫·Ú·ÁÈ¿ÓÓË˜ª¤ÏÔ˜

µ·Û›ÏË˜ ¡ÈÎÔÏ¿Ô˘ª¤ÏÔ˜

ÃÚ‹ÛÙÔ˜ ¶›ÙÛ·‚Ô˜ª¤ÏÔ˜

∞Ï¤Í·Ó‰ÚÔ˜ ∆ÛÂÏ¤Ë˜ª¤ÏÔ˜

¶∞ƒ∞°√¡∆∂™ ∫π¡¢À¡√ÀÃ·ÌËÏ‹ HDL ÃÔÏËÛÙÂÚfiÏË Î·È Ë ∞ÓÙÈÌÂÙÒÈÛ‹ ÙË˜

ƒ›˙Ô˜ ÃÚ‹ÛÙÔ˜, ∂ÈÛÙËÌÔÓÈÎfi˜ ™˘ÓÂÚÁ¿ÙË˜ ÙÔ˘ ∂Í. π·ÙÚÂ›Ô˘ ¢È·Ù·Ú·¯ÒÓ ÙÔ˘ ªÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ §ÈÈ‰›ˆÓ

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

¢È·ÁÓˆÛÙÈÎ‹ ¶ÚÔÛ¤Ï·ÛË Î·È ∞ÓÙÈÌÂÙÒÈÛË ∞ÛıÂÓÒÓ ÌÂ ÀÂÚÙÚÈÁÏ˘ÎÂÚÈ‰·ÈÌ›·∞ÁÁÔ˘Ú›‰Ë˜ ÕÚË˜-¢ËÌ‹ÙÚÈÔ˜, ∂ÈÛÙËÌÔÓÈÎfi˜ ™˘ÓÂÚÁ¿ÙË˜ ÙÔ˘ ∂Í. π·ÙÚÂ›Ô˘ ÙˆÓ ¢È·Ù·Ú·¯ÒÓ ÙÔ˘ ªÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ §ÈÈ‰›ˆÓ ÙÔ˘ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ °ÂÓÈÎÔ‡ ¡ÔÛÔÎÔÌÂ›Ô˘ πˆ·ÓÓ›ÓˆÓ

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

ªË ™ÙÂÚÔÂÈ‰‹ ∞ÓÙÈÊÏÂÁÌÔÓÒ‰Ë º¿ÚÌ·Î·Î·È ∫·Ú‰È·ÁÁÂÈ·Îfi˜ ∫›Ó‰˘ÓÔ˜º. ∞ÔÛÙfiÏÔ˘ ∂ÈÌÂÏ‹ÙÚÈ· µ' ÙË˜ µ' ¶·ıÔÏÔÁÈÎ‹˜ ∫ÏÈÓÈÎ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ °ÂÓÈÎÔ‡ ¡ÔÛÔÎÔÌÂ›Ô˘ πˆ·ÓÓ›ÓˆÓ∂. §˘ÌÂÚfiÔ˘ÏÔ˜ §¤ÎÙÔÚ·˜ ¶·ıÔÏÔÁ›·˜, π·ÙÚÈÎ‹˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓª. ∂ÏÈÛ¿Ê ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜ π·ÙÚÈÎ‹˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ

∫§π¡π∫∂™ ª∂§∂∆∂™ªÂÏ¤ÙË CORONA (COntrolled ROsuvastatin in MultinatioNAl Trial in Heart Failure)ƒÔÛÔ˘‚·ÛÙ·Ù›ÓË ÛÂ ËÏÈÎÈˆÌ¤ÓÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ Û˘ÛÙÔÏÈÎ‹ Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ·

Kjekshus J, Apetrei E, Barrios V, Böhm M, Cleland JG, Cornel JH, Dunselman P, Fonseca C, Goudev A, Grande P, Gullestad L, Hjalmarson A, Hradec J, Jànosi A,Kamensky G, Komajda M, Korewicki J, Kuusi T, Mach F, Mareev V, McMurray JJ, Ranjith N, Schaufelberger M, Vanhaecke J, van Veldhuisen DJ, Waagstein F, Wedel H, Wikstrand J; CORONA Group.

N Engl J Med. 2007 Nov 29;357(22):2248-61.

¶∞£√ºÀ™π√§√°π∞¢ÔÌ‹ Î·È §ÂÈÙÔ˘ÚÁ›· ÙˆÓ À„ËÏ‹˜ ¶˘ÎÓfiÙËÙ·˜ §ÈÔÚˆÙÂ˚ÓÒÓ ÛÙÔ ªÂÙ·‚ÔÏÈÎfi ™‡Ó‰ÚÔÌÔ ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ §·Áfi˜, ∂ÈÛÙËÌÔÓÈÎfi˜ Û˘ÓÂÚÁ¿ÙË˜ ÙÔ˘ π·ÙÚÂ›Ô˘ ¢È·Ù·Ú·¯ÒÓ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ §ÈÈ‰›ˆÓ, ¶·ÓÂÈÛÙËÌÈ·Îfi ¡ÔÛÔÎÔÌÂ›Ô πˆ·ÓÓ›ÓˆÓ

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

¶ƒ√∫§π¡π∫∏ ∂ƒ∂À¡∞∆›ÙÏÔÈ ∞˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ŒÓ·ÓÙÈ ¢È·ÊfiÚˆÓ ªÔÚÊÒÓ√ÍÂÈ‰ˆÌ¤ÓË˜ LDL ÛÂ ∞ÛıÂÓÂ›˜ ÌÂ √Í‡ ™ÙÂÊ·ÓÈ·›Ô ™‡Ó‰ÚÔÌÔ.∏ ∂›‰Ú·ÛË ÙË˜ ∞ÙÔÚ‚·ÛÙ·Ù›ÓË˜∞. ¶··ı·Ó·Û›Ô˘, π. °Ô˘‰¤‚ÂÓÔ˜, ∞. ∆ÛÂÏ¤Ë˜1∫·Ú‰ÈÔÏÔÁÈÎ‹ ∫ÏÈÓÈÎ‹, π·ÙÚÈÎ‹ ™¯ÔÏ‹, ¶·ÓÂÈÛÙËÌÈ·Îfi ¡ÔÛÔÎÔÌÂ›Ô πˆ·ÓÓ›ÓˆÓ1∂ÚÁ·ÛÙ‹ÚÈÔ µÈÔ¯ËÌÂ›·˜, ∆Ì‹Ì· ÃËÌÂ›·˜, ¶·ÓÂÈÛÙ‹ÌÈÔ πˆ·ÓÓ›ÓˆÓ

¶POTEINOMENH BIB§IO°PAºIA

2

5

13

17

18

23

32

TË˜ ™‡ÓÙ·ÍË˜

∏ ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚ

ˆÙÂ˝ÓË (HDL) ·ÔÙÂÏÂ› ÙËÓ Î‡Ú

È· ·ÓÙÈ·ıËÚˆÁfiÓÔ ÏÈÔÚˆ-

ÙÂ˝ÓË. °È· Î¿ıÂ 1% ÌÂ›ˆÛË ÙË˜ HDL ¯ÔÏËÛÙÂÚfiÏË˜ (HDL-C) ·Ú·ÙËÚÂ›Ù·È

·‡ÍËÛË ÙË˜

Î·Ú‰È·ÁÁÂÈ·Î‹˜ ıÓËÙfiÙËÙ·˜

Î·Ù¿ 2-3%. ªÂ›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ HDL-C

ÚÔÎ·ÏÔ‡Ó ÙÔ

Î¿ÓÈÛÌ·, Ë ·¯˘Û·ÚÎ›·, Ë

ÌÂÈˆÌ¤ÓË ÛˆÌ·ÙÈÎ‹ ‰Ú·ÛÙËÚÈfiÙËÙ·, Ë ¯Ô

Ú‹ÁËÛË ÔÚÈÛÌ¤ÓˆÓ

Ê·ÚÌ¿ÎˆÓ, Ô Û·Î¯·ÚÒ‰Ë˜ ‰È·‚‹ÙË˜ Î·È ‰È¿ÊÔÚÂ˜ ÁÔÓÈ‰È·Î

¤˜ ‰È·Ù·Ú·¯¤˜. Δ· ·˘ÍËÌ¤Ó·

ÙÚÈÁÏ˘ÎÂÚ›‰È· Â›ÛË˜ Û¯ÂÙ›˙Ô

ÓÙ·È ÌÂ ÂÏ·ÙÙˆÌ¤ÓË HDL-C. ¶

·ÚÂÌ‚¿ÛÂÈ˜ ÁÈ· ·‡ÍËÛË ÙË˜

HDL-C ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙËÓ Ù·

ÎÙÈÎ‹ ÛˆÌ·ÙÈÎ‹ ¿ÛÎËÛË, ÙËÓ ˘ÁÈÂÈÓ‹ ‰

È·ÙÚÔÊ‹, ÙËÓ ·ÒÏÂÈ·

‚¿ÚÔ˘˜, ÙË ‰È·ÎÔ‹ ÙÔ˘ Î·Ó

›ÛÌ·ÙÔ˜, Î·ıÒ˜ Î·È Èı·ÓÒ˜ ÙË ÌÂÙÚ›Ô˘ ‚

·ıÌÔ‡ Î·ıËÌÂÚÈÓ‹

Î·Ù·Ó¿ÏˆÛË ·ÏÎÔfiÏ. ∞Ó Ù· Ì¤ÙÚ· ·˘Ù

¿ ‰ÂÓ Â›Ó·È ·ÚÎÂÙ¿, ÌÔÚÔ‡Ó

Ó· ¯ÔÚËÁËıÔ‡Ó Ê¿Ú-

Ì·Î·, fiˆ˜ ÙÔ ÓÈÎÔÙÈÓÈÎfi ÔÍ‡, ÔÈ ÊÈÌÚ¿ÙÂ˜ Î·È

ÔÈ ÛÙ·Ù›ÓÂ˜. ∏ ˘ÂÚÙÚÈÁÏ˘ÎÂÚ

È‰·ÈÌ›·

Â›Ó·È Ì›· Û˘¯Ó‹ ‰È·Ù·Ú·¯‹

Ô˘ ÔÏÏ¤˜ ÊÔÚ¤˜ Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂ ÚÒÈÌË ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ.

∂›ÛË˜ Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙËÓ

·ÚÔ˘Û›· ÌÈÎÚÒÓ ˘ÎÓÒÓ LDL ÛˆÌ·ÙÈ‰›ˆÓ Î·È ÙË ÌÂ›ˆÛË ÙˆÓ

HDL2 ˘ÔÎÏ·ÛÌ¿ÙˆÓ. ∞˘Ù¤˜ ÔÈ ‰‡Ô ÌÂÙ·‚ÔÏÈÎ¤˜ ‰

È·Ù·Ú·¯¤˜ Ô˘ Û˘¯Ó¿ ·Ú·ÙË

ÚÔ‡ÓÙ·È ÛÂ

·ÛıÂÓÂ›˜ ÌÂ ˘ÂÚÙÚÈÁÏ˘ÎÂÚÈ‰·

ÈÌ›· ·ÔÙÂÏÔ‡Ó ·ÓÂÍ¿ÚÙËÙÔ˘˜

·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙË

Ó

ÂÌÊ¿ÓÈÛË ÚÒÈÌË˜ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘. ∞Ó Î·È ‰ÂÓ ˘

¿Ú¯Ô˘Ó Û·ÊÂ›˜ Ô‰ËÁ›Â˜ ÁÈ· ÙËÓ Â›-

ÙÂ˘ÍË Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÛÙfi¯ˆÓ ÁÈ· Ù· Â›Â

‰· ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ, Û˘ÓÈÛÙ¿Ù·È

¯ÔÚ‹ÁËÛË

ÊÈÌÚ·ÙÒÓ ÛÂ ¿ÙÔÌ· ÌÂ Â›Â‰· ÙÚÈÁÏ˘

ÎÂÚÈ‰›ˆÓ ¿Óˆ ·fi 1000 mg/dl ÁÈ· ÙË ÌÂ›ˆÛË ÙÔ˘

ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛË˜ ·ÁÎÚÂ·Ù›ÙÈ‰·˜. ™Â ·

ÛıÂÓÂ›˜ ÌÂ ÌÈÎÚfiÙÂÚ· Â›Â‰

· ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ

(200 mg/dl), fiÙ·Ó ÂÈÙÂ˘¯ıÂ› Ô ÛÙfi

¯Ô˜ fiÛÔÓ ·ÊÔÚ¿ ÙËÓ LDL ¯ÔÏËÛÙÂÚfiÏË, Û

˘ÓÈÛÙ¿Ù·È Ë

ÌÂ›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ. Δ· NSAIDs

ÚÔÎ·ÏÔ‡Ó ·ÁÁÂÈ·Î¿ ÂÂÈÛfi‰È

· ÌÂ

¿ÌÂÛÔ˘˜ Î·È ¤ÌÌÂÛÔ˘˜ ÌË¯·Ó

ÈÛÌÔ‡˜. ∫·Ù·ÎÚ·ÙÔ‡Ó ¡·

+, ÌÂ ·ÔÙ¤ÏÂÛÌ· ·‡ÍËÛË ÙË˜

·Ú-

ÙËÚÈ·Î‹˜ ›ÂÛË˜ Î·È Û˘ÌÊÔÚËÙÈÎ‹ Î·Ú‰È

·Î‹ ·ÓÂ¿ÚÎÂÈ·. ∂ÈÏ¤ÔÓ Ú

ÔÎ·ÏÔ‡Ó ‚Ï¿‚Ë ÙÔ˘

ÂÓ‰ÔıËÏ›Ô˘ Î·È ÂÓ‰ÔıËÏÈ·Î‹

‰˘ÛÏÂÈÙÔ˘ÚÁ›·, ÂÓÒ ÚÔ‰È·ı¤ÙÔ˘Ó

ÛÙÔ Û¯ËÌ·ÙÈÛÌfi ıÚfiÌ‚Ô˘

Î·È ÛÂ ·ÁÁÂÈ·Îfi ÂÂÈÛfi‰ÈÔ (È

Û¯·ÈÌÈÎfi Î·Ú‰È·Îfi ÂÂÈÛfi‰ÈÔ

Î·È ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘ÔÎ·Ú‰›-

Ô˘, ·ÁÁÂÈ·Îfi ÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰È

Ô Î·È ·ÈÊÓ›‰ÈÔ ı¿Ó·ÙÔ). ∏ CORONA Â›Ó·

È Ë ÚÒÙË ÚÔ-

ÔÙÈÎ‹ ÔÏ˘ÎÂÓÙÚÈÎ‹, Ù˘¯·ÈÔ

ÔÈËÌ¤ÓË, ÂÏÂÁ¯fiÌÂÓË ÌÂ ÂÈÎÔ

ÓÈÎfi Ê¿ÚÌ·ÎÔ ÎÏÈÓÈÎ‹ ÌÂÏ¤ÙË

ÙË˜ ‰Ú¿ÛË˜ ÙˆÓ ÛÙ·ÙÈÓÒÓ ÛÙËÓ Î·Ú‰È·Î

‹ ·ÓÂ¿ÚÎÂÈ·. ∫·Ù¿ ÙË ‰È¿ÚÎ

ÂÈ· ÙË˜ ·Ú·ÎÔÏÔ‡-

ıËÛË˜ (‰È¿ÌÂÛË ‰È¿ÚÎÂÈ· 32,8

Ì‹ÓÂ˜) ‰ÂÓ ·Ú·ÙËÚ‹ıËÎÂ ‰

È·ÊÔÚ¿ ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ Î·Ú-

‰È·ÁÁÂÈ·ÎÒÓ ı·Ó¿ÙˆÓ, ÙˆÓ ÌË ı·Ó·ÙËÊfiÚˆÓ ÂÌÊÚ·ÁÌ¿ÙˆÓ Î·È ·ÁÁÂÈ·ÎÒÓ ÂÁÎÂÊ·ÏÈÎÒÓ.

ΔÔ ªÂÙ·‚ÔÏÈÎfi ™‡Ó‰ÚÔÌÔ ¯·Ú

·ÎÙËÚ›˙ÂÙ·È ·fi ÙËÓ ·ıËÚÔÁfi

ÓÔ ‰˘ÛÏÈÈ‰·ÈÌ›·, ÌÂ ÙËÓ ·‡-

ÍËÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ Î·È ÙË ÌÂ›ˆÛË ÙË˜ HDL ¯Ô

ÏËÛÙÂÚfiÏË˜. ∏ HDL ¯ÔÏËÛÙÂÚfi

ÏË˜ ÂÌ-

Ê·Ó›˙ÂÈ ·ıÔÏÔÁÈÎ‹ ÏÂÈÙÔ˘ÚÁÈ

ÎfiÙËÙ· Î·È Â¿ÁÂÈ ÙËÓ ÊÏÂÁÌÔÓ‹ Î·È Ù

ËÓ ÂÎ‰‹ÏˆÛË ÙÔ˘

ÔÍÂÈ‰ˆÙÈÎÔ‡ ÛÙÚÂ˜. ∏ ÔÍÂÈ‰ˆÌ¤ÓË ÌÔÚÊ‹ ÙË˜ ¯·ÌËÏ‹˜

˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˝ÓË˜ (oxLDL)

‰È·‰Ú·Ì·Ù›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ·ıÔÁ¤ÓÂÈ· ÙË˜ ·ıËÚÔÛÎÏ‹ÚˆÛË˜. ªÂÙ¿ ·fi ÔÍ‡

ÛÙÂÊ·ÓÈ·›Ô Û‡Ó‰ÚÔÌÔ, ·Ú·ÙËÚÂ›

Ù·È ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ

fiÏˆÓ ÙˆÓ ÌÔÚÊÒÓ ÔÍÂÈ‰ˆÌ¤ÓË˜ LDL, Èı·ÓÒ˜ ˆ˜ ·¿ÓÙËÛË ÙÔ

˘ ÔÚÁ·ÓÈÛÌÔ‡ ÛÙË Ú‹ÍË ÙË˜

·ıËÚˆÌ·ÙÈÎ‹˜ Ï¿Î·˜ Î·È ÙË˜ ·Â

ÏÂ˘ı¤ÚˆÛË˜ ÛÙËÓ Î˘ÎÏÔÊÔÚ›· ‚ÈÔ‰Ú·ÛÙ

ÈÎÒÓ Û˘ÛÙ·ÙÈ-

ÎÒÓ ÙË˜. ∏ ¿ÌÂÛË ¯ÔÚ‹ÁËÛË ·ÙÔ

Ú‚·ÛÙ·Ù›ÓË˜ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜

·˘ÙÔ‡˜ ·Ó·ÛÙ¤ÏÏÂÈ ÙËÓ ·-

Ú·¿Óˆ ·ÓÔÛÔÏÔÁÈÎ‹ ·fiÎÚÈÛË, ÌÈ·

‰Ú¿ÛË ÙË˜ ÔÔ›·˜ Ë ÎÏÈÓÈÎ‹

ÛËÌ·Û›· ı· Ú¤ÂÈ Ó·

·Ô‰ÂÈ¯ıÂ› ÛÂ ÌÂÁ¿ÏË˜ ¤ÎÙ·Û

Ë˜ ÎÏÈÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜. ∏∏ÏÏ››··˜̃ ÃÃÂÂÈÈÌÌÒÒÓÓ··˜̃

YYÂÂ‡‡ıı˘̆ÓÓÔÔ˜̃ ™™‡‡ÓÓÙÙ··ÍÍËË˜̃

∂ÈÛ·ÁˆÁ‹∏ ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔ-ÚˆÙÂ˝ÓË (HDL) ·ÔÙÂÏÂ› ÙËÓÎ‡ÚÈ· ·ÓÙÈ·ıËÚˆÁfiÓÔ ÏÈÔÚˆ-ÙÂ˝ÓË. ¶Ú¿ÁÌ·ÙÈ, Ë HDL ‰È·‰Ú·-Ì·Ù›˙ÂÈ Î·ıÔÚÈÛÙÈÎfi ÚfiÏÔ ÛÙÔÌË¯·ÓÈÛÌfi ÙË˜ ·Ó¿ÛÙÚÔÊË˜ ÌÂ-Ù·ÊÔÚ¿˜ ¯ÔÏËÛÙÂÚfiÏË˜, ‰ËÏ·-‰‹ ÛÙË ÌÂÙ·ÊÔÚ¿ ÙË˜ ÂÚ›ÛÛÂÈ-·˜ ¯ÔÏËÛÙÂÚfiÏË˜ ·fi Ù· ÂÚÈ-ÊÂÚÈÎ¿ Î‡ÙÙ·Ú· ÛÙÔ ‹·Ú. ∂È-ÚfiÛıÂÙ·, Ë HDL ¤¯ÂÈ ·ÓÙÈÔÍÂÈ-‰ˆÙÈÎ¤˜ Î·È ·ÓÙÈıÚÔÌ‚ˆÙÈÎ¤˜‰Ú¿ÛÂÈ˜, ÂÓÒ ·ÛÎÂ› Â˘ÓÔ˚Î‹Â›‰Ú·ÛË ÛÙË ÏÂÈÙÔ˘ÚÁ›· ÙˆÓÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ [1].ªÂÏ¤ÙÂ˜ ¤‰ÂÈÍ·Ó fiÙÈ ÁÈ· Î¿ıÂÎ·Ù¿ 1% ·‡ÍËÛË ÙË˜ HDL ¯ÔÏË-ÛÙÂÚfiÏË˜ (HDL-C) ·Ú·ÙËÚÂ›-Ù·È ÌÂ›ˆÛË ÙË˜ Î·Ú‰È·ÁÁÂÈ·Î‹˜ıÓËÙfiÙËÙ·˜ Î·Ù¿ 2-3% [2].

Δ· ¯·ÌËÏ¿ Â›Â‰· ÙË˜ HDL-C(Î¿Ùˆ ·fi 40 mg/dl) ·ÔÙÂÏÔ‡Ó·ÓÂÍ¿ÚÙËÙÔ ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË Î·Ú‰È·ÁÁÂÈ·-Î‹˜ ÓfiÛÔ˘ [3]. ¶ÔÏÏ¤˜ Î·Ù·ÛÙ¿-ÛÂÈ˜ ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛıÂ› ÌÂ ÌÂ›-ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ HDL-C,fiˆ˜ ÙÔ Î¿ÓÈÛÌ·, Ë ·¯˘Û·Ú-Î›·, Ë ÌÂÈˆÌ¤ÓË ÛˆÌ·ÙÈÎ‹ ‰Ú·-ÛÙËÚÈfiÙËÙ·, Ë ¯ÔÚ‹ÁËÛË Ê·Ú-Ì¿ÎˆÓ (.¯. ‚-·ÔÎÏÂÈÛÙÒÓ,ıÂÈ·˙È‰ÈÎÒÓ ‰ÈÔ˘ÚËÙÈÎÒÓ), Î·-ıÒ˜ Î·È Ô Û·Î¯·ÚÒ‰Ë˜ ‰È·‚‹-ÙË˜. Δ· ·˘ÍËÌ¤Ó· ÙÚÈÁÏ˘ÎÂÚ›‰È·Â›ÛË˜ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÂÏ·ÙÙˆ-Ì¤ÓË HDL-C. ∏ ÚˆÙÂ˝ÓË Ô˘ÌÂÙ·Ê¤ÚÂÈ ÂÛÙ¤ÚÂ˜ ¯ÔÏËÛÙÂÚfi-ÏË˜ (CETP) ·ÓÙ·ÏÏ¿ÛÂÈ Ù· ÙÚÈ-ÁÏ˘ÎÂÚ›‰È· ÙˆÓ ÔÏ‡ ¯·ÌËÏ‹˜ ˘Î-ÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ (VLDL)ÌÂ ÂÛÙ¤ÚÂ˜ ¯ÔÏËÛÙÂÚfiÏË˜ ÙˆÓHDL. ™Â ÂÚÈÙÒÛÂÈ˜ ˘ÂÚÙÚÈ-ÁÏ˘ÎÂÚÈ‰·ÈÌ›·˜ ·˘Ù‹ Ë ·ÓÙ·ÏÏ·-Á‹ ÏÈÈ‰›ˆÓ ÂÈÙ·¯‡ÓÂÙ·È ÌÂ ·Ô-Ù¤ÏÂÛÌ· ÙËÓ ·Ú·ÁˆÁ‹ ÏÔ‡-ÛÈˆÓ ÛÂ ÙÚÈÁÏ˘ÎÂÚ›‰È· HDL Ûˆ-Ì·ÙÈ‰›ˆÓ. ∏ Ë·ÙÈÎ‹ ÏÈ¿ÛË˘‰ÚÔÏ‡ÂÈ Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È· ÙˆÓHDL ÛˆÌ·ÙÈ‰›ˆÓ ÌÂ ·ÔÙ¤ÏÂÛÌ·ÙÔ Û¯ËÌ·ÙÈÛÌfi ÌÈÎÚÒÓ Î·È˘ÎÓÒÓ HDL ÛˆÌ·ÙÈ‰›ˆÓ. ∞˘Ù¿Ù· ÛˆÌ·Ù›‰È· ·Ô‰ÂÛÌÂ‡Ô˘Ó Â‡-

ÎÔÏ· ÙËÓ ·ÔÏÈÔÚˆÙÂ˝ÓË ∞-π(Apo A-I), Ë ÔÔ›· ÛÂ ÂÏÂ‡ıÂÚËÌÔÚÊ‹ ·ÔÌ·ÎÚ‡ÓÂÙ·È ·fi ÙËÓÎ˘ÎÏÔÊÔÚ›· ‰È·Ì¤ÛÔ˘ ÙˆÓ ÓÂ-ÊÚÒÓ, ÌÂ ÙÂÏÈÎfi ·ÔÙ¤ÏÂÛÌ· ÙËÌÂ›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ HDL-C. ∂ÈÏ¤ÔÓ, Ë CETP ·ÓÙ·ÏÏ¿ÛÂÈÙÚÈÁÏ˘ÎÂÚ›‰È· ÙˆÓ VLDL ÌÂ ÂÛÙ¤-ÚÂ˜ ¯ÔÏËÛÙÂÚfiÏË˜ ÙˆÓ ¯·ÌËÏ‹˜˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ (LDL)ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·Ú·ÁˆÁ‹·ıËÚÔÁfiÓˆÓ ÌÈÎÚÒÓ ˘ÎÓÒÓ LDLÛˆÌ·ÙÈ‰›ˆÓ.

¶·ÚÂÌ‚¿ÛÂÈ˜ ÁÈ· ÙËÓ·‡ÍËÛË ÙË˜ HDL-C

A) ÀÁÈÂÈÓÔ‰È·ÈÙËÙÈÎ¤˜·ÚÂÌ‚¿ÛÂÈ˜

i) ÕÛÎËÛË∏ Ù·ÎÙÈÎ‹ ·ÂÚfi‚È· ¿ÛÎËÛËÌÔÚÂ› Ó· ‚ÔËı‹ÛÂÈ ÛÙËÓ ·‡ÍË-ÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ HDL-CÎ·Ù¿ 3-9% [4]. ∏ Û˘¯ÓfiÙËÙ· ÙË˜¿ÛÎËÛË˜ Ê·›ÓÂÙ·È fiÙÈ ‰È·‰Ú·Ì·-Ù›˙ÂÈ ÛËÌ·ÓÙÈÎfiÙÂÚÔ ÚfiÏÔ ·fifiÙÈ Ë ¤ÓÙ·Û‹ ÙË˜. ŒÙÛÈ Ë Û˘ÛÙË-Ì·ÙÈÎ‹ Ì¤ÙÚÈ·˜ ¤ÓÙ·ÛË˜ ·ÂÚfi‚È·¿ÛÎËÛË 5 ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰·ÁÈ· 30 ÏÂÙ¿ ÙËÓ ËÌ¤Ú· Â›Ó·È ÈÔ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ·fi ÙËÓ ¤ÓÙÔÓË¿ÛÎËÛË 3 ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰·ÁÈ· 60 ÏÂÙ¿ [4]. ™ÙËÓ ÂÚ›Ùˆ-ÛË ÙË˜ ÛˆÌ·ÙÈÎ‹˜ ¿ÛÎËÛË˜ Ù·Â›Â‰· ÙË˜ HDL-C ·˘Í¿ÓÔÓÙ·ÈÛÙ·‰È·Î¿.

ii) ¢È·ÙÚÔÊ‹ Î·È ·ÒÏÂÈ· ‚¿ÚÔ˘˜

∏ Ùˆ¯‹ ÛÂ ÏÈ·Ú¿ ‰›·ÈÙ· Û˘ÓÔ-‰Â‡ÂÙ·È ·fi ÌÂ›ˆÛË ÙˆÓ ÂÈ¤-‰ˆÓ ÙË˜ HDL-C [5]. øÛÙfiÛÔ, Ù·ÔÊ¤ÏË ÌÈ·˜ Ù¤ÙÔÈ·˜ ‰›·ÈÙ·˜ ·fiÙË ÌÂ›ˆÛË ÙË˜ LDL-C ·ÓÙÈÛÙ·ıÌ›-˙Ô˘Ó ÙË ‰˘ÛÌÂÓ‹ Â›‰Ú·ÛË ÙË˜·fi ÙËÓ ÂÏ¿ÙÙˆÛË ÙË˜ HDL-C.¶Ú¤ÂÈ Ó· ·Ó·ÊÂÚıÂ› fiÙÈ ÏË-ı˘ÛÌÔ› ÛÙÔ˘˜ ÔÔ›Ô˘˜ Ù· ˆ-3ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ ÔÍ¤· Î·-Ù¤¯Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙË‰È·ÙÚÔÊ‹ ¤¯Ô˘Ó ·˘ÍËÌ¤Ó· Â›-Â‰· HDL-C [6]. ∂ÈÚfiÛıÂÙ·,ÙÚÔÊ¤˜ ÏÔ‡ÛÈÂ˜ ÛÂ ˘‰·Ù¿ÓıÚ·-

ÎÂ˜ Ô˘ ÚÔÎ·ÏÔ‡Ó ·‡ÍËÛË ÙÔ˘ÁÏ˘Î·ÈÌÈÎÔ‡ ÊÔÚÙ›Ô˘ (.¯. ·Ù¿-ÙÂ˜, ÏÂ˘Îfi „ˆÌ›) ÌÂÈÒÓÔ˘Ó Ù·Â›Â‰· ÙË˜ HDL-C [7].

™Ù· Ï·›ÛÈ· ÌÈ·˜ ÈÛÔÚÚÔËÌ¤ÓË˜‰È·ÙÚÔÊ‹˜, Ë ·ÒÏÂÈ· ‚¿ÚÔ˘˜¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·ÎfiÌËÌÂÁ·Ï‡ÙÂÚË ·‡ÍËÛË ÙË˜ HDL-C.Δ· Â˘Ú‹Ì·Ù· ÌÈ·˜ ÌÂÙ¿-·Ó¿Ï˘-ÛË˜ ¤‰ÂÈÍ·Ó fiÙÈ Î·Ù¿ ÙËÓ ÚÔ-Û¿ıÂÈ· ·ÒÏÂÈ·˜ ‚¿ÚÔ˘˜ Ù·Â›Â‰· ÙË˜ HDL-C ÌÂÈÒÓÔÓÙ·ÈÎ·Ù¿ 0.27 mg/dl ÁÈ· Î¿ıÂ ÎÈÏfiÌÂ›ˆÛË˜ ÙÔ˘ ÛˆÌ·ÙÈÎÔ‡ ‚¿ÚÔ˘˜[8]. øÛÙfiÛÔ, ÌÂÙ¿ ÙË ÛÙ·ıÂÚÔ-Ô›ËÛË ÙÔ˘ ÛˆÌ·ÙÈÎÔ‡ ‚¿ÚÔ˘˜·Ú·ÙËÚÂ›Ù·È ·‡ÍËÛË ÙË˜ HDL-CÎ·Ù¿ 0.35 mg/dl ÁÈ· Î¿ıÂ ÎÈÏfiÌÂ›ˆÛË˜ ÙÔ˘ ÛˆÌ·ÙÈÎÔ‡ ‚¿ÚÔ˘˜.∂ÔÌ¤Óˆ˜ Ë Ú‡ıÌÈÛË ÙÔ˘ Ûˆ-Ì·ÙÈÎÔ‡ ‚¿ÚÔ˘˜ Â›Ó·È ¤Ó·˜·ÔÙÂÏÂÛÌ·ÙÈÎfi˜ ÙÚfiÔ˜ ÁÈ·ÙËÓ ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜HDL-C ÛÂ ˘¤Ú‚·Ú· ¿ÙÔÌ·.

iii) ¢È·ÎÔ‹ ÙÔ˘ Î·Ó›ÛÌ·ÙÔ˜ªÈ· ·fi ÙÈ˜ ÔÏÏ¤˜ ‚Ï·ÙÈÎ¤˜Û˘Ó¤ÂÈÂ˜ ÙÔ˘ Î·Ó›ÛÌ·ÙÔ˜ Â›Ó·ÈÎ·È Ë ÌÂ›ˆÛË ÙË˜ HDL-C. ¶Ú¿Á-Ì·ÙÈ, Ë ‰È·ÎÔ‹ ÙÔ˘ Î·Ó›ÛÌ·-ÙÔ˜ ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ HDL-C Î·Ù¿ 7-12% [9]. ∞˘Ù‹ Ë ÌÂÙ·-‚ÔÏ‹ Â›Ó·È ÈÔ ÂÌÊ·Ó‹˜ ÛÙÈ˜ Á˘-Ó·›ÎÂ˜, Î·ıÒ˜ Î·È ÛÂ ¿ÙÔÌ· ÌÂ·˘ÍËÌ¤Ó· Â›Â‰· HDL-C (>47mg/dl) [9].

iv) ∞ÏÎÔfiÏ∏ Î·Ù·Ó¿ÏˆÛË ÌÈÎÚ‹˜ ÔÛfiÙË-Ù·˜ ·ÏÎÔfiÏ Î·ıËÌÂÚÈÓ¿ ¤¯ÂÈ ˆ˜·ÔÙ¤ÏÂÛÌ· ÙËÓ ·‡ÍËÛË ÙˆÓÂÈ¤‰ˆÓ ÙË˜ HDL-C. Δ· ·Ô-ÙÂÏ¤ÛÌ·Ù· ÌÈ·˜ ÌÂÙ¿-·Ó¿Ï˘ÛË˜¤‰ÂÈÍ·Ó fiÙÈ Ë Î·Ù·Ó¿ÏˆÛË 30 gr·ÏÎÔfiÏ ÙËÓ ËÌ¤Ú· Ô‰ËÁÂ› ÛÂ·‡ÍËÛË ÙË˜ HDL-C Î·Ù¿ 8.3%·ÓÂÍ¿ÚÙËÙ· ·fi ÙÔ Â›‰Ô˜ ÙÔ˘ÔÙÔ‡ [10]. øÛÙfiÛÔ, Ú¤ÂÈ Ó·Ï·Ì‚¿ÓÔÓÙ·È ˘fi„Ë ÔÈ È‰È·ÈÙÂÚfi-ÙËÙÂ˜ ÙÔ˘ Î¿ıÂ ·ÙfiÌÔ˘ ÚÈÓ ÙËÓ˘ÈÔı¤ÙËÛË ÙË˜ Î·ıËÌÂÚÈÓ‹˜ Î·-Ù·Ó¿ÏˆÛË˜ ÌÈÎÚÒÓ ÔÛÔÙ‹ÙˆÓ

™ ∂ ¶ Δ ∂ ª μ ƒ π √ ™ 2 0 0 8

2

Ã·ÌËÏ‹ HDL ÃÔÏËÛÙÂÚfiÏË Î·È Ë ∞ÓÙÈÌÂÙÒÈÛ‹ ÙË˜

ÃÚ‹ÛÙÔ˜ ƒ›˙Ô˜, ∂ÈÛÙËÌÔÓÈÎfi˜ ™˘ÓÂÚÁ¿ÙË˜ ÙÔ˘ ∂Í. π·ÙÚÂ›Ô˘ ¢È·Ù·Ú·¯ÒÓ ÙÔ˘ ªÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ §ÈÈ‰›ˆÓ

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

·ÏÎÔfiÏ. ŒÙÛÈ ÛÂ ¿ÙÔÌ· ÌÂ ‰È·Ù·-Ú·¯¤˜ ÙË˜ Ë·ÙÈÎ‹˜ ‚ÈÔÏÔÁ›·˜,˘„ËÏ¿ Â›Â‰· ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ,Î·ıÒ˜ Î·È ÛÂ ¿ÙÔÌ· ÂÈÚÚÂ‹ ÛÂÂıÈÛÌfi Ù· ÔÊ¤ÏË ·fi ÙËÓ ·‡ÍË-ÛË ÙË˜ HDL-C Ú¤ÂÈ Ó· ÛÙ·ıÌ›-˙ÔÓÙ·È ÌÂ ÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜ Ô˘Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙË Û˘ÓÂ¯È˙fiÌÂÓËÎ·Ù·Ó¿ÏˆÛË ·ÏÎÔÔÏÔ‡¯ˆÓ Ô-ÙÒÓ.

B) º·ÚÌ·ÎÂ˘ÙÈÎ¤˜ ·ÚÂÌ‚¿ÛÂÈ˜

i) ¡ÈÎÔÙÈÓÈÎfi ÔÍ‡ΔÔ ÓÈÎÔÙÈÓÈÎfi ÔÍ‡ ·ÔÙÂÏÂ› ÙËÓÈÔ ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ Ê·ÚÌ·ÎÂ˘-ÙÈÎ‹ ·Ú¤Ì‚·ÛË ÁÈ· ÙËÓ ·‡ÍË-ÛË ÙË˜ HDL-C. ŒÓ·˜ ·fi ÙÔ˘˜ÌË¯·ÓÈÛÌÔ‡˜ ‰Ú¿ÛË˜ ÙÔ˘ Ê·Ú-Ì¿ÎÔ˘ Â›Ó·È Ë ·Ó·ÛÙÔÏ‹ ÙË˜ Ë·-ÙÈÎ‹˜ ÚfiÛÏË„Ë˜ ÙË˜ Apo A-I,Ô˘ ·ÔÙÂÏÂ› ‚·ÛÈÎfi Û˘ÛÙ·ÙÈÎfiÙË˜ HDL [11], ÌÂ ·ÔÙ¤ÏÂÛÌ·ÙËÓ ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜HDL-C ÛÙÔ Ï¿ÛÌ· Î·Ù¿ 20-35%[12]. ∂ÈÚfiÛıÂÙ·, ÌÈÎÚ¤˜ ÌÂÏ¤-ÙÂ˜ ¤‰ÂÈÍ·Ó fiÙÈ Ë ¯ÔÚ‹ÁËÛË ÓÈÎÔ-ÙÈÓÈÎÔ‡ ÔÍ¤Ô˜ Û¯ÂÙ›˙ÂÙ·È ÌÂ ÂÈ-‚Ú¿‰˘ÓÛË ÙË˜ ÂÍ¤ÏÈÍË˜ ÙË˜ ·ıË-ÚÔÛÎÏ‹ÚˆÛË˜ Î·È ÌÂ›ˆÛË ÙˆÓÎ·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ [13].øÛÙfiÛÔ, Ë Â˘ÂÚÁÂÙÈÎ‹ Â›‰Ú·ÛËÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÂÚÈÔÚ›˙ÂÙ·È ·fiÙÈ˜ ·ÚÂÓ¤ÚÁÂÈ¤˜ ÙÔ˘ Ô˘ ÂÚÈ-Ï·Ì‚¿ÓÔ˘Ó ¤Í·„Ë, ‰˘ÛÂ„›·,Î·ıÒ˜ Î·È ÌÈÎÚ‹ ·‡ÍËÛË ÙˆÓ ÂÈ-¤‰ˆÓ ÙË˜ ÁÏ˘Îfi˙Ë˜ Î·È ÙÔ˘ Ô˘-ÚÈÎÔ‡ ÔÍ¤Ô˜.

ii) ºÈÌÚ¿ÙÂ˜√È ÊÈÌÚ¿ÙÂ˜ Â›Ó·È Ê¿ÚÌ·Î·Ô˘ ÂÏ·ÙÙÒÓÔ˘Ó Ù· ÙÚÈÁÏ˘ÎÂÚ›-‰È· [14] Î·È ÂÈÏ¤ÔÓ ·˘Í¿ÓÔ˘ÓÙËÓ HDL-C ÛÂ ÔÛÔÛÙfi 10-25%[15, 16]. √È ÊÈÌÚ¿ÙÂ˜ ÂÓÂÚÁÔ-ÔÈÔ‡Ó ÙÔ˘˜ PPAR· ˘ÚËÓÈÎÔ‡˜˘Ô‰Ô¯Â›˜ ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙËÓ·‡ÍËÛË ÙË˜ HDL-C Î·È ÙˆÓ 2 Î‡-ÚÈˆÓ Û˘ÛÙ·ÙÈÎÒÓ ÙË˜, ‰ËÏ·‰‹ÙË˜ Apo ∞-π Î·È ÙË˜ Apo ∞-ππ [17].ŒÙÛÈ, ÛÂ ÌÈ· ÌÂÏ¤ÙË ·ÙfiÌˆÓ ÌÂÛÙÂÊ·ÓÈ·›· ÓfiÛÔ, LDL-C≤140mg/dl Î·È ¯·ÌËÏ‹ HDL-C Ë ¯ÔÚ‹-ÁËÛË ÁÂÌÊÈ‚ÚÔ˙›ÏË˜ Â›¯Â ˆ˜·ÔÙ¤ÏÂÛÌ· ÙËÓ ·‡ÍËÛË ÙË˜HDL-C Î·Ù¿ 6% (p<0.001 ¤Ó·ÓÙÈÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘) [18] Î·È ÙËÌÂ›ˆÛË Î·Ù¿ 22% (p<0.001) ÙˆÓÎ·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ.™ÙË Û˘Ó¤¯ÂÈ·, ‰ÈÂÚÂ˘Ó‹ıËÎÂ ËÛ˘Û¯¤ÙÈÛË ÙÔ˘ ÔÊ¤ÏÔ˘˜ fiÛÔÓ·ÊÔÚ¿ ÙË ÌÂ›ˆÛË ÙˆÓ Û˘Ì‚·Ì¿-ÙˆÓ ÌÂ ÙÈ˜ ÌÂÙ·‚ÔÏ¤˜ ÙˆÓ ÏÈÈ-‰·ÈÌÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ. ªfiÓÔ Ë

·‡ÍËÛË ÙË˜ HDL-C Û˘Û¯ÂÙ›˙Ô-ÓÙ·Ó ÌÂ ÙË ÌÂ›ˆÛË ÙˆÓ Û˘Ì‚·Ì¿-ÙˆÓ ·Ú¿ ÙË Û˘Ó˘¿Ú¯Ô˘Û· ÛË-Ì·ÓÙÈÎ‹ ÌÂ›ˆÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ-‰›ˆÓ (-31%; p<0.001) [19].

iii) ™Ù·Ù›ÓÂ˜√È ÛÙ·Ù›ÓÂ˜ ¤Ú·Ó ÙË˜ ÌÂÁ¿ÏË˜·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿˜ ÙÔ˘˜ fiÛÔÓ·ÊÔÚ¿ ÙË ÌÂ›ˆÛË ÙË˜ LDL-C¤¯Ô˘Ó ÙËÓ ÈÎ·ÓfiÙËÙ· Ó· ·˘Í¿-ÓÔ˘Ó ÛÂ ÌÈÎÚfiÙÂÚÔ ‚·ıÌfi ÙËÓHDL-C Î·Ù¿ 2-15% [20, 21]. ∞˘-Ù‹ Ë È‰ÈfiÙËÙ¿ ÙÔ˘˜ ÔÊÂ›ÏÂÙ·È ÛÂ·‡ÍËÛË ÙË˜ ·Ú·ÁˆÁ‹˜ ÙË˜ Apo∞-π. ŒÙÛÈ, Ô Û˘Ó‰˘·ÛÌfi˜ ÛÙ·ÙÈ-ÓÒÓ ÌÂ ÓÈÎÔÙÈÓÈÎfi ÔÍ‡ ÌÔÚÂ› Ó··ÔÙÂÏ¤ÛÂÈ ÌÈ· ÂÏÎ˘ÛÙÈÎ‹ ÂÈÏÔ-Á‹ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÌÈ-ÎÙÒÓ ‰˘ÛÏÈÈ‰·ÈÌÈÒÓ ÌÂ Ù·˘Ùfi-¯ÚÔÓË ÌÂ›ˆÛË ÙË˜ LDL-C Î·È ÛË-Ì·ÓÙÈÎ‹ ·‡ÍËÛË ÙË˜ HDL-C. ™ÂÌÈ· ÌÂÏ¤ÙË ÛÙËÓ ÔÔ›· ¯ÔÚËÁ‹-ıËÎÂ ÛÈÌ‚·ÛÙ·Ù›ÓË (20-40 mg/ËÌ¤Ú·) ÌÂ ÓÈÎÔÙÈÓÈÎfi ÔÍ‡ (2-4gr/ËÌ¤Ú·) ÛÂ ¿ÙÔÌ· ÌÂ Î·Ú‰È·Á-ÁÂÈ·Î‹ ÓfiÛÔ, ¯·ÌËÏ‹ HDL-C Î·ÈÊ˘ÛÈÔÏÔÁÈÎ‹ LDL-C ·Ú·ÙËÚ‹-ıËÎÂ ·‡ÍËÛË ÙË˜ HDL-C Î·Ù¿26% [22]. ™ÙË ÌÂÏ¤ÙË ·˘Ù‹, ÔÈÛÙÂÓÒÛÂÈ˜ ÛÙ· ÛÙÂÊ·ÓÈ·›· ·Á-ÁÂ›· ·Ú¤ÌÂÈÓ·Ó ÛÙ¿ÛÈÌÂ˜ ÛÙËÓÔÌ¿‰· ÙÔ˘ Û˘Ó‰˘·ÛÌÔ‡ (+0.4%),ÂÓÒ ·˘Í‹ıËÎ·Ó ÛÙËÓ ÔÌ¿‰· ÙÔ˘ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ (+3.9%;p<0.001 ¤Ó·ÓÙÈ ÙË˜ ÔÌ¿‰·˜ ÙÔ˘Û˘Ó‰˘·ÛÌÔ‡).

iv) ÕÏÏ· Ê¿ÚÌ·Î·∏ ¯ÔÚ‹ÁËÛË ·Ó·Û˘Ó‰˘·ÛÌ¤ÓËÃpo ∞-π ªÈÏ¿ÓÔ ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂ-ÛÌ· ÙËÓ ÂÈÙ¿¯˘ÓÛË ÙÔ˘ ÌË¯·ÓÈ-ÛÌÔ‡ ÙË˜ ·Ó¿ÛÙÚÔÊË˜ ÌÂÙ·ÊÔ-Ú¿˜ ¯ÔÏËÛÙÂÚfiÏË˜. ™Â ÌÈ· ÌÂ-Ï¤ÙË 47 ·ÛıÂÓÒÓ Ô˘ ÂÏ¿Ì‚·Ó·Ó5 Â‚‰ÔÌ·‰È·›Â˜ ÂÁ¯‡ÛÂÈ˜ ÙËÃpo ∞-π ªÈÏ¿ÓÔ (15-45 mg/kg)·Ú·ÙËÚ‹ıËÎÂ ‹È· ˘ÔÛÙÚÔÊ‹(0.81%; p=0.02 ¤Ó·ÓÙÈ ÙË˜ ·Ú¯È-Î‹˜ ÙÈÌ‹˜) ÙË˜ ÛÙÂÊ·ÓÈ·›·˜ ·ıË-ÚÔÛÎÏ‹ÚˆÛË˜, fiˆ˜ ·˘Ù‹ ÂÎÙÈ-Ì‹ıËÎÂ ÌÂ ÂÓ‰ÔÛÙÂÊ·ÓÈ·›Ô ˘¤-ÚË¯Ô [23].

√È ÁÏÈÙ·˙fiÓÂ˜ Î·È È‰È·›ÙÂÚ· ËÈÔÁÏÈÙ·˙fiÓË ·˘Í¿ÓÔ˘Ó Ù· Â›Â-‰· ÙË˜ HDL-C Î·Ù¿ 14-19% [24].∏ ·‡ÍËÛË ·˘Ù‹ Ê·›ÓÂÙ·È fiÙÈ Û¯Â-Ù›˙ÂÙ·È ÌÂ ÙËÓ È‰ÈfiÙËÙ· ÙˆÓ Ê·Ú-Ì¿ÎˆÓ Ó· ÂÓÂÚÁÔÔÈÔ‡Ó ÛÂ Î¿-ÔÈÔ ‚·ıÌfi Î·È ÙÔ˘˜ PPAR·˘Ô‰Ô¯Â›˜.

ΔÔ rimonabant, ¤Ó·˜ ·Ó·ÛÙÔÏ¤-·˜ ÙˆÓ ÂÓ‰ÔÎ·ÓÓ·‚ÈÓÔÂÈ‰ÒÓ ˘Ô-‰Ô¯¤ˆÓ, ÚÔÎ·ÏÂ› ÂÏ¿ÙÙˆÛË ÙÔ˘

ÛˆÌ·ÙÈÎÔ‡ ‚¿ÚÔ˘˜ Î·È ·˘Í¿ÓÂÈÛËÌ·ÓÙÈÎ¿ Ù· Â›Â‰· ÙË˜ HDL-C Î·Ù¿ 10% ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙÔÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ [25]. ∞˘Ù‹ Ë·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ HDL-CÂ›Ó·È ÌÂÁ·Ï‡ÙÂÚË ·fi ÙËÓ ·Ó·-ÌÂÓfiÌÂÓË ·fi ÙËÓ ·ÒÏÂÈ· ÙÔ˘ÛˆÌ·ÙÈÎÔ‡ ‚¿ÚÔ˘˜ [26]. ∂ÈÚfi-ÛıÂÙ·, ÙÔ rimonabant ÌÂÈÒÓÂÈÛËÌ·ÓÙÈÎ¿ Ù· Â›Â‰· ÙˆÓ ÙÚÈ-ÁÏ˘ÎÂÚÈ‰›ˆÓ [25].

ŒÓ· ¿ÏÏÔ Ê¿ÚÌ·ÎÔ ÌÂ ÛËÌ·ÓÙÈ-Î‹ ÈÎ·ÓfiÙËÙ· ·‡ÍËÛË˜ ÙË˜ HDL-C (+72%) Â›Ó·È ÙÔ torcetrapibÔ˘ ·Ó·ÛÙ¤ÏÏÂÈ ÙËÓ CETP.ŸÌˆ˜, ·Ú¿ ÙË ÛËÌ·ÓÙÈÎ‹ ·‡ÍË-ÛË ÙË˜ HDL-C, Ë ¯ÔÚ‹ÁËÛË ÙÔ˘Ê·ÚÌ¿ÎÔ˘ ‰ÂÓ Û˘ÓÔ‰Â‡ÂÙ·È ·fiÙËÓ ·Ó·ÌÂÓfiÌÂÓË Â˘ÂÚÁÂÙÈÎ‹ Â›-‰Ú·ÛË ÛÂ ÎÏÈÓÈÎfi Â›Â‰Ô. ∞ÓÙ›-ıÂÙ·, ÙÔ torcetrapib Û˘Û¯ÂÙ›ÛÙË-ÎÂ ÌÂ ·‡ÍËÛË ÙË˜ ·ÚÙËÚÈ·Î‹˜›ÂÛË˜ Î·È ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓÛ˘Ì‚·Ì¿ÙˆÓ, Î·ıÒ˜ Î·È ÙˆÓ ı·-Ó¿ÙˆÓ ·fi ÔÔÈ·‰‹ÔÙÂ ·ÈÙ›·[27]. øÛÙfiÛÔ, ‰ÂÓ Â›Ó·È ÍÂÎ·ı·-ÚÈÛÌ¤ÓÔ Â¿Ó Ë ‰˘ÛÌÂÓ‹˜ Â›‰Ú·-ÛË ÙÔ˘ torcetrapib ÔÊÂ›ÏÂÙ·È ÛÙÔÌË¯·ÓÈÛÌfi ‰Ú¿ÛË˜ ÙÔ˘ ‹ Â›Ó·È·ÔÎÏÂÈÛÙÈÎfi ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙÔ˘Û˘ÁÎÂÎÚÈÌ¤ÓÔ˘ Ê·ÚÌ¿ÎÔ˘ [28].

™˘ÌÂÚ¿ÛÌ·Ù·

∏ HDL-C ‰È·‰Ú·Ì·Ù›˙ÂÈ ÛËÌ·-ÓÙÈÎfi ÚfiÏÔ ÛÙË ÌÂÙ·ÊÔÚ¿ ¯ÔÏË-ÛÙÂÚfiÏË˜ ·fi Ù· Î‡ÙÙ·Ú· ÛÙÔ‹·Ú Î·È Ë ÌÂ›ˆÛ‹ ÙË˜ ·ÔÙÂ-ÏÂ› ·ÓÂÍ¿ÚÙËÙÔ ·Ú¿ÁÔÓÙ· ÎÈÓ-‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË Î·Ú-‰È·ÁÁÂÈ·Î‹˜ ÓfiÛÔ˘. øÛÙfiÛÔ, Ë∂ıÓÈÎ‹ (ÙˆÓ ∏.¶.∞.) ∂ÈÙÚÔ‹ÁÈ· ÙË ÃÔÏËÛÙÂÚfiÏË (NCEP)‰ÂÓ ÚÔÙÂ›ÓÂÈ Û˘ÁÎÂÎÚÈÌ¤ÓÔ˘˜ÛÙfi¯Ô˘˜ ÁÈ· ÙËÓ HDL-C [3]. HLDL-C ·ÔÙÂÏÂ› ÙÔÓ Î‡ÚÈÔ ÛÙfi-¯Ô ÙË˜ ˘ÔÏÈÈ‰·ÈÌÈÎ‹˜ ·Áˆ-Á‹˜. ∞ÊÔ‡ ÂÈÙÂ˘¯ıÂ› Ô ÛÙfi¯Ô˜fiÛÔÓ ·Ó·ÊÔÚ¿ ÙËÓ LDL-C Î·ÈÂÊfiÛÔÓ Û˘Ó˘¿Ú¯Ô˘Ó ¯·ÌËÏ¿Â›Â‰· HDL-C Û˘ÓÈÛÙ¿Ù·È Ë˘ÈÔı¤ÙËÛË ·ÚÂÌ‚¿ÛÂˆÓ ÌÂÛÙfi¯Ô ÙËÓ ·‡ÍËÛË ÙË˜ HDL-C.∞˘Ù¤˜ ÔÈ ·ÚÂÌ‚¿ÛÂÈ˜ ÂÚÈÏ·Ì-‚¿ÓÔ˘Ó ÙËÓ Ù·ÎÙÈÎ‹ ÛˆÌ·ÙÈÎ‹¿ÛÎËÛË, ÙËÓ ˘ÁÈÂÈÓ‹ ‰È·ÙÚÔÊ‹Î·È ÙËÓ ·ÒÏÂÈ· ‚¿ÚÔ˘˜. ∂È-ÚfiÛıÂÙ·, Ë ‰È·ÎÔ‹ ÙÔ˘ Î·-Ó›ÛÌ·ÙÔ˜, Î·ıÒ˜ Î·È Ë ÌÂÙÚ›-Ô˘ ‚·ıÌÔ‡ Î·ıËÌÂÚÈÓ‹ Î·Ù·Ó¿-ÏˆÛË ·ÏÎÔfiÏ Û˘Ì‚¿ÏÔ˘Ó Â›-ÛË˜ ÛÙËÓ ·‡ÍËÛË ÙË˜ HDL-C.∞Ó Ù· Ì¤ÙÚ· ·˘Ù¿ ‰ÂÓ Â›Ó·È ·Ú-ÎÂÙ¿ ÁÈ· ÙË ÛËÌ·ÓÙÈÎ‹ ·‡ÍËÛËÙË˜ HDL-C ÌÔÚÔ‡Ó Ó· ¯ÔÚË-

¶∞ƒ∞°√¡Δ∂™ ∫π¡¢À¡√À

3

ÁËıÔ‡Ó Ê¿ÚÌ·Î·, fiˆ˜ ÙÔ ÓÈ-ÎÔÙÈÓÈÎfi ÔÍ‡, ÔÈ ÊÈÌÚ¿ÙÂ˜ Î·ÈÔÈ ÛÙ·Ù›ÓÂ˜, È‰È·›ÙÂÚ· ÛÂ ¿ÙÔÌ·ÌÂ ·˘ÍËÌ¤ÓÔ Î·Ú‰È·ÁÁÂÈ·ÎfiÎ›Ó‰˘ÓÔ, fiˆ˜ ÛÂ ·ÛıÂÓÂ›˜ ÌÂÛÙÂÊ·ÓÈ·›· ÓfiÛÔ ‹ Û·Î¯·ÚÒ‰Ë‰È·‚‹ÙË. øÛÙfiÛÔ, Ú¤ÂÈ Ó··Ó·ÊÂÚıÂ› fiÙÈ ÌÂÁ·Ï‡ÙÂÚË ÛË-Ì·Û›· ¤¯ÂÈ Ë ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·ÙˆÓ HDL ÛˆÌ·ÙÈ‰›ˆÓ Î·È ÏÈÁfiÙÂ-ÚÔ Ë Û˘ÁÎ¤ÓÙÚˆÛË ÙË˜ HDL-CÛÙÔÓ ÔÚfi. ¶Ú¿ÁÌ·ÙÈ, Ù· ·˘ÍËÌ¤-

Ó· Â›Â‰· ÙË˜ HDL-C ÛÂ ¿ÙÔÌ·ÌÂ ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÙË˜ CETP ‰ÂÓÛ˘Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÌÂÈˆÌ¤ÓÔ Î·Ú-‰È·ÁÁÂÈ·Îfi Î›Ó‰˘ÓÔ [29]. ∂ÈÏ¤-ÔÓ, ÌÂÈˆÌ¤Ó· Â›Â‰· HDL-C ÛÂ¿ÙÔÌ· ÌÂ ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÙÔ˘ ÁÔÓÈ-‰›Ô˘ ÙË˜ Apo A-I ‰ÂÓ ·˘Í¿ÓÔ˘ÓÙÔÓ Î›Ó‰˘ÓÔ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛËÎ·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ [30].∂›ÛË˜, ¿ÙÔÌ· ÌÂ ÙË ÌÂÙ¿ÏÏ·ÍËApo A-I ªÈÏ¿ÓÔ ‰ÂÓ ¤¯Ô˘Ó ·˘ÍË-Ì¤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË

·ıËÚˆÌ¿ÙˆÛË˜ ·Ú¿ Ù· ¯·ÌËÏ¿Â›Â‰· ÙË˜ HDL-C [31]. ∂ÔÌ¤-Óˆ˜, Ô ‚·ÛÈÎfi˜ ÛÙfi¯Ô˜ ÁÈ· ÙËÓ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ‰˘ÛÏÈÈ‰·È-Ì›·˜ Â›Ó·È Ë ÌÂ›ˆÛË ÙË˜ LDL-CÎ·È ÂÊfiÛÔÓ ·˘Ùfi˜ Ô ÛÙfi¯Ô˜ ÂÈ-ÙÂ˘¯ıÂ› Ú¤ÂÈ Ó· ÂÈ¯ÂÈÚÂ›Ù·È Ë·‡ÍËÛË ÙË˜ HDL-C Î˘Ú›ˆ˜ ÌÂ˘ÁÈÂÈÓÔ‰È·ÈÙËÙÈÎ¿ Ì¤ÙÚ·.

™ ∂ ¶ Δ ∂ ª μ ƒ π √ ™ 2 0 0 8

4

1. Florentin M, Liberopoulos EN, Wierz-bicki AS, et al. Multiple actions of high-density lipoprotein. Curr Opin Cardiol2008; 23: 370-8.

2. Gordon DJ, Probstfield JL, GarrisonRJ, et al. High-density lipoproteincholesterol and cardiovascular disea-se. Four prospective American studies.Circulation 1989; 79: 8-15.

3. Third Report of the National Choleste-rol Education Program (NCEP) ExpertPanel on Detection, Evaluation, andTreatment of High Blood Cholesterol inAdults (Adult Treatment Panel III) finalreport. Circulation 2002; 106: 3143-421.

4. King AC, Haskell WL, Young DR, et al.Long-term effects of varying intensitiesand formats of physical activity onparticipation rates, fitness, and lipopro-teins in men and women aged 50 to 65years. Circulation 1995; 91: 2596-604.

5. Meksawan K, Pendergast DR, LeddyJJ, et al. Effect of low and high fat dietson nutrient intakes and selectedcardiovascular risk factors in sedentarymen and women. J Am Coll Nutr 2004;23: 131-40.

6. Gerasimova E, Perova N, Ozerova I, etal. The effect of dietary n-3 polyun-saturated fatty acids on HDL choleste-rol in Chukot residents vs muscovites.Lipids 1991; 26: 261-5.

7. Slyper A, Jurva J, Pleuss J, et al.Influence of glycemic load on HDLcholesterol in youth. Am J Clin Nutr2005; 81: 376-9.

8. Dattilo AM and Kris-Etherton PM.Effects of weight reduction on bloodlipids and lipoproteins: a meta-ana-lysis. Am J Clin Nutr 1992; 56: 320-8.

9. Maeda K, Noguchi Y, and Fukui T. Theeffects of cessation from cigarettesmoking on the lipid and lipoproteinprofiles: a meta-analysis. Prev Med2003; 37: 283-90.

10. Rimm EB, Williams P, Fosher K, et al.Moderate alcohol intake and lower riskof coronary heart disease: meta-analysis of effects on lipids andhaemostatic factors. BMJ 1999; 319:1523-8.

11. Piepho RW. The pharmacokinetics andpharmacodynamics of agents provento raise high-density lipoprotein chole-sterol. Am J Cardiol 2000; 86: 35L-40L.

12. Alderman JD, Pasternak RC, SacksFM, et al. Effect of a modified, well-tolerated niacin regimen on serumtotal cholesterol, high density lipo-protein cholesterol and the cholesterolto high density lipoprotein ratio. Am JCardiol 1989; 64: 725-9.

13. Canner PL, Berge KG, Wenger NK, etal. Fifteen year mortality in CoronaryDrug Project patients: long-termbenefit with niacin. J Am Coll Cardiol1986; 8: 1245-55.

14. Elisaf M. Effects of fibrates on serummetabolic parameters. Curr Med ResOpin 2002; 18: 269-76.

15. Mellies MJ, Stein EA, Khoury P, et al.Effects of fenofibrate on lipids, lipopro-teins, and apolipoproteins in 33 sub-jects with primary hypercholesterole-mia. Atherosclerosis 1987; 63: 57-64.

16. Malmendier CL and Delcroix C. Effectsof fenofibrate on high and low densitylipoprotein metabolism in hetero-zygous familial hypercholesterolemia.Atherosclerosis 1985; 55: 161-9.

17. Staels B, Dallongeville J, Auwerx J, etal. Mechanism of action of fibrates onlipid and lipoprotein metabolism.Circulation 1998; 98: 2088-93.

18. Rubins HB, Robins SJ, Collins D, et al.Gemfibrozil for the secondary preve-ntion of coronary heart disease in menwith low levels of high-density lipo-protein cholesterol. Veterans AffairsHigh-Density Lipoprotein CholesterolIntervention Trial Study Group. N EnglJ Med 1999; 341: 410-8.

19. Robins SJ, Collins D, Wittes JT, et al.Relation of gemfibrozil treatment andlipid levels with major coronary events:VA-HIT: a randomized controlled trial.JAMA 2001; 285: 1585-91.

20. Schaefer JR, Schweer H, Ikewaki K, etal. Metabolic basis of high densitylipoproteins and apolipoprotein A-I in-crease by HMG-CoA reductase inhi-bition in healthy subjects and a patientwith coronary artery disease. Athero-sclerosis 1999; 144: 177-84.

21. Asztalos BF, Horvath KV, McNamaraJR, et al. Comparing the effects of fivedifferent statins on the HDL subpo-pulation profiles of coronary heart di-sease patients. Atherosclerosis 2002;164: 361-9.

22. Brown BG, Zhao XQ, Chait A, et al.Simvastatin and niacin, antioxidantvitamins, or the combination for theprevention of coronary disease. N EnglJ Med 2001; 345: 1583-92.

23. Nissen SE, Tsunoda T, Tuzcu EM, etal. Effect of recombinant ApoA-I Milanoon coronary atherosclerosis in patientswith acute coronary syndromes: arandomized controlled trial. JAMA2003; 290: 2292-300.

24. Rizos CV, Liberopoulos EN, MikhailidisDP, et al. Pleiotropic effects of thiazoli-dinediones. Expert Opin Pharmacother2008; 9: 1087-108.

25. Despres JP, Golay A, and Sjostrom L.Effects of rimonabant on metabolic riskfactors in overweight patients withdyslipidemia. N Engl J Med 2005; 353:2121-34.

26. Van Gaal LF, Rissanen AM, Scheen AJ,et al. Effects of the cannabinoid-1receptor blocker rimonabant on weightreduction and cardiovascular riskfactors in overweight patients: 1-yearexperience from the RIO-Europe study.Lancet 2005; 365: 1389-97.

27. Barter PJ, Caulfield M, Eriksson M, etal. Effects of torcetrapib in patients athigh risk for coronary events. N Engl JMed 2007; 357: 2109-22.

28. Tall AR, Yvan-Charvet L, and Wang N.The failure of torcetrapib: was it themolecule or the mechanism? Arte-rioscler Thromb Vasc Biol 2007; 27:257-60.

29. Zhong S, Sharp DS, Grove JS, et al.Increased coronary heart disease inJapanese-American men with mutationin the cholesteryl ester transfer proteingene despite increased HDL levels. JClin Invest 1996; 97: 2917-23.

30. Frikke-Schmidt R, Nordestgaard BG,Stene MC, et al. Association of loss-of-function mutations in the ABCA1 genewith high-density lipoprotein choleste-rol levels and risk of ischemic heartdisease. JAMA 2008; 299: 2524-32.

31. Chiesa G and Sirtori CR. Apolipopro-tein A-I(Milano): current perspectives.Curr Opin Lipidol 2003; 14: 159-63.

μμÈÈ‚‚ÏÏÈÈÔÔÁÁÚÚ··ÊÊ››··

¶·ÚÔ˘Û›·ÛË ÂÚÈÛÙ·ÙÈÎÔ‡

ÕÓ‰Ú·˜ 45 ÂÙÒÓ ÛÂ ¤ÏÂÁ¯Ô ÚÔ˘-Ù›Ó·˜ ÂÌÊ¿ÓÈÛÂ ˘ÂÚÙÚÈÁÏ˘ÎÂÚÈ-‰·ÈÌ›·. √ ·ÛıÂÓ‹˜ ‰ÂÓ Î¿ÓÈ˙Â,·ÎÔÏÔ˘ıÔ‡ÛÂ ÛˆÛÙ‹ ‰È·ÙÚÔÊ‹,Î·Ù·Ó¿ÏˆÓÂ ¤Ó· ÔÙfi ·ÏÎÔfiÏÙËÓ Â‚‰ÔÌ¿‰· Î·È ·ÛÎÔ‡ÓÙ·Ó Ù·-ÎÙÈÎ¿. ¢ÂÓ ¤·ÈÚÓÂ Ê¿ÚÌ·Î·, Ô·Ù¤Ú·˜ ÙÔ˘ ¤ı·ÓÂ ÛÂ ËÏÈÎ›·55 ÂÙÒÓ ÛÂ ÙÚÔ¯·›Ô ·Ù‡¯ËÌ·,ÂÓÒ Ë ÌËÙ¤Ú· ÙÔ˘ ‹Ù·Ó 67 ÂÙÒÓ¯ˆÚ›˜ ÚÔ‚Ï‹Ì·Ù· ˘ÁÂ›·˜, fiˆ˜Î·È ÔÈ ‰‡Ô ÌÂÁ·Ï‡ÙÂÚÔÈ ·‰ÂÏÊÔ›ÙÔ˘. ∏ ·ÚÙËÚÈ·Î‹ ÙÔ˘ ›ÂÛË‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ‹, Ô ‰Â›ÎÙË˜ Ì¿-˙·˜ ÛÒÌ·ÙÔ˜ 28 kg/mg2 Î·È Ë Â-Ú›ÌÂÙÚÔ˜ Ì¤ÛË˜ 96 cm. ∞fi Ù·ÂÚÁ·ÛÙËÚÈ·Î¿ Â˘Ú‹Ì·Ù·, Ù· Â›-Â‰· ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ ÓËÛÙÂ›-·˜ ‹Ù·Ó 400 mg/dl, ÙË˜ ÔÏÈÎ‹˜¯ÔÏËÛÙÂÚfiÏË˜ 230 mg/dl, ÙË˜LDL ¯ÔÏËÛÙÂÚfiÏË˜ 120 mg/dlÎ·È ÙË˜ HDL ¯ÔÏËÛÙÂÚfiÏË˜ 30mg/dl, ÂÓÒ Ù· Â›Â‰· ÙË˜ ÁÏ˘-Îfi˙Ë˜ ÓËÛÙÂ›·˜ 90 mg/dl. ¢ÂÓ˘‹Ú¯·Ó ‰È·Ù·Ú·¯¤˜ ÙË˜ ı˘ÚÂÔ-ÂÈ‰ÈÎ‹˜ Î·È ÙË˜ ÓÂÊÚÈÎ‹˜ ÏÂÈ-ÙÔ˘ÚÁ›·˜.

¢È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË·ÛıÂÓÒÓ ÌÂ

˘ÂÚÙÚÈÁÏ˘ÎÂÚÈ‰·ÈÌ›·

∏ ˘ÂÚÙÚÈÁÏ˘ÎÂÚÈ‰·ÈÌ›· Â›Ó·È Ì›·Û˘¯Ó‹ ‰È·Ù·Ú·¯‹ Ô˘ ÔÏÏ¤˜ÊÔÚ¤˜ Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂ ÚÒÈÌËÛÙÂÊ·ÓÈ·›· ÓfiÛÔ.1-4 ∂›ÛË˜ Û˘-Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙËÓ ·ÚÔ˘Û›· ÌÈ-ÎÚÒÓ ˘ÎÓÒÓ LDL ÛˆÌ·ÙÈ‰›ˆÓÎ·È ÙË ÌÂ›ˆÛË ÙˆÓ HDL2 ˘ÔÎÏ·-ÛÌ¿ÙˆÓ. ∞˘Ù¤˜ ÔÈ ‰‡Ô ÌÂÙ·‚ÔÏÈ-Î¤˜ ‰È·Ù·Ú·¯¤˜ Ô˘ Û˘¯Ó¿ ·-Ú·ÙËÚÔ‡ÓÙ·È ÛÂ ·ÛıÂÓÂ›˜ ÌÂ˘ÂÚÙÚÈÁÏ˘ÎÂÚÈ‰·ÈÌ›· ·ÔÙÂ-ÏÔ‡Ó ·ÓÂÍ¿ÚÙËÙÔ˘˜ ·Ú¿ÁÔ-ÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛËÚÒÈÌË˜ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘.5

∞ÛıÂÓÂ›˜ ÌÂ ˘„ËÏ¿ Â›Â‰·ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ Â›Ó·È Èı·Ófi Ó·ÂÌÊ·Ó›˙Ô˘Ó ÁÂÓÂÙÈÎ¤˜ ‰È·Ù·Ú·-

¯¤˜ Ô˘ Û˘Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÚÒÈ-ÌË ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ. ∞˘Ù¤˜ ÔÈ‰È·Ù·Ú·¯¤˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙËÓÔÈÎÔÁÂÓ‹ ÌÂÈÎÙ‹ ˘ÂÚÏÈÈ‰·È-Ì›·, ÙËÓ ˘ÔÏÂÈÌÌ·ÙÈÎ‹ (resi-dual) ‰˘ÛÏÈÈ‰·ÈÌ›· ·ÛıÂÓÒÓÌÂ Ú˘ıÌÈÛÌ¤ÓÔ Û·Î¯·ÚÒ‰Ë ‰È·-‚‹ÙË Ù‡Ô˘ 2 (™¢2) Î·È ÙËÓ ÔÈ-ÎÔÁÂÓ‹ ˘Ô·ÏÊ·ÏÈÔÚˆÙÂ˚Ó·È-Ì›·. ∞˘Ù¤˜ ÔÈ ‰È·Ù·Ú·¯¤˜ ·Ú·-ÙËÚÔ‡ÓÙ·È Û˘¯Ó¿ ÛÂ ·ÛıÂÓÂ›˜Ô˘ ÏËÚÔ‡Ó Ù· ÎÚÈÙ‹ÚÈ· ÁÈ· ÙË‰È¿ÁÓˆÛË ÙÔ˘ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó-‰ÚfiÌÔ˘.6 ∏ Â›ÙˆÛË ÙË˜ ÔÈÎÔ-ÁÂÓÔ‡˜ ÌÂÈÎÙ‹˜ ˘ÂÚÏÈÈ‰·ÈÌ›·˜1

3 4 Î·È ÙË˜ ÔÈÎÔÁÂÓÔ‡˜ ˘Ô·ÏÊ·-ÏÈÔÚˆÙÂ˚Ó·ÈÌ›·˜3 7 Â›Ó·È ÂÚ›-Ô˘ 1% ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi,ÂÓÒ Ô ™¢2 ·ÓÈ¯ÓÂ‡ÂÙ·È ÙÔ˘Ï¿¯È-ÛÙÔÓ ÛÙÔ 5% ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘-ÛÌÔ‡. ÀÔÏÔÁ›˙ÂÙ·È fiÙÈ ¿Óˆ

·fi ÙÔ 50% ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓÛ˘Ì‚·Ì¿ÙˆÓ Û¯ÂÙ›˙ÂÙ·È ÌÂ ·˘Ù¤˜ÙÈ˜ ÙÚÂÈ˜ ÌÂÙ·‚ÔÏÈÎ¤˜ ‰È·Ù·Ú·-¯¤˜.8 ∏ ‰È¿ÁÓˆÛË ÙˆÓ ·Ú·¿-Óˆ ‰È·Ù·Ú·¯ÒÓ ··ÈÙÂ› ÂÈıÂÙÈ-Î‹ ·Ú¤Ì‚·ÛË ÌÂ ÛÎÔfi ÙËÌÂ›ˆÛË ÙÔ˘ Î·Ú‰È·ÁÁÂÈ·ÎÔ‡ÎÈÓ‰‡ÓÔ˘. ∞ÓÙ›ıÂÙ· ÌÈ· ¿ÏÏËÎÏËÚÔÓÔÌÈÎ‹ ÌÔÚÊ‹ ˘ÂÚÙÚÈ-ÁÏ˘ÎÂÚÈ‰·ÈÌ›·˜, Ë ÌÔÓÔÁÂÓ‹˜ÔÈÎÔÁÂÓ‹˜ ˘ÂÚÙÚÈÁÏ˘ÎÂÚÈ‰·È-Ì›·, Ô˘ ·Ú·ÙËÚÂ›Ù·È Â›ÛË˜ÛÙÔ 1% ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘-ÛÌÔ‡, ‰ÂÓ Ê·›ÓÂÙ·È Ó· Û¯ÂÙ›˙Â-Ù·È ÌÂ ÚÒÈÌË ÛÙÂÊ·ÓÈ·›· Ófi-ÛÔ.2 8 9 ¶Ú¤ÂÈ ÏÔÈfiÓ ÛÂ Î¿ıÂÂÚ›ÙˆÛË Ó· Á›ÓÂÙ·È ÛˆÛÙ‹‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ÙˆÓ ·Ú·-¿Óˆ ‰È·Ù·Ú·¯ÒÓ ¤ÙÛÈ ÒÛÙÂ Ó·ÂÈÏ¤ÁÂÙ·È Ë Î·Ù¿ÏÏËÏË ıÂÚ·-Â˘ÙÈÎ‹ ·ÁˆÁ‹.

¶∞ƒ∞°√¡Δ∂™ ∫π¡¢À¡√À

5

¢È·ÁÓˆÛÙÈÎ‹ ¶ÚÔÛ¤Ï·ÛË Î·È ∞ÓÙÈÌÂÙÒÈÛË∞ÛıÂÓÒÓ ÌÂ ÀÂÚÙÚÈÁÏ˘ÎÂÚÈ‰·ÈÌ›·

ÕÚË˜-¢ËÌ‹ÙÚÈÔ˜ ∞ÁÁÔ˘Ú›‰Ë˜, ∂ÈÛÙËÌÔÓÈÎfi˜ ™˘ÓÂÚÁ¿ÙË˜ ÙÔ˘ ∂Í. π·ÙÚÂ›Ô˘ ÙˆÓ ¢È·Ù·Ú·¯ÒÓ ÙÔ˘ ªÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ §ÈÈ‰›ˆÓ

ÙÔ˘ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ °ÂÓÈÎÔ‡ ¡ÔÛÔÎÔÌÂ›Ô˘ πˆ·ÓÓ›ÓˆÓ

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

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

ΔÔ ·ÏÎÔfiÏ, Ù· ÔÈÛÙÚÔÁfiÓ·, Ë ÔÈÛÙÚ·‰ÈfiÏË, Ù· ÁÏ˘ÎÔÎÔÚÙÈÎÔÂÈ‰‹, Ù· ıÂÈ·˙È‰È-Î¿ ‰ÈÔ˘ÚËÙÈÎ¿, ÔÈ ‚-·ÔÎÏÂÈÛÙ¤˜, Ë ÛÂÚÙÚ·Ï›ÓË, ÔÈ ·Ó·ÛÙÔÏÂ›˜ ÙˆÓ ÚˆÙÂ·-ÛÒÓ, ÙÔ ‚·ÏÚÔ˚Îfi ÔÍ‡ Î·È Ë ÈÛÔÙÚÂÙÈÓÔ˝ÓË ÌÔÚÂ› Ó· ÚÔÎ·Ï¤ÛÔ˘Ó ‚·ÚÈ¿˘ÂÚÙÚÈÁÏ˘ÎÂÚÈ‰·ÈÌ›· Î·È ÙÔ Û‡Ó‰ÚÔÌÔ ÙË˜ ¯˘ÏÔÌÈÎÚÔÓ·ÈÌ›·˜ ÛÂ ·ÛıÂÓÂ›˜ ÌÂÔÈÎÔÁÂÓ‹ ˘ÂÚÙÚÈÁÏ˘ÎÂÚÈ‰·ÈÌ›·.

¶›Ó·Î·˜ 1: ∂›‰Ú·ÛË Ê·ÚÌ¿ÎˆÓ ÛÙ· Â›Â‰· ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓÎ·È ÙË˜ ¯ÔÏËÛÙÂÚfiÏË˜

º¿ÚÌ·Î· ΔÚÈÁÏ˘ÎÂÚ›‰È· LDL ¯ÔÏËÛÙÂÚfiÏË HDL ¯ÔÏËÛÙÂÚfiÏË

∞ÏÎÔfiÏ ∞‡ÍËÛË ∫·Ì›· Â›‰Ú·ÛË ∞‡ÍËÛË

√ÈÛÙÚÔÁfiÓ·, ∞‡ÍËÛË ªÂ›ˆÛË ∞‡ÍËÛËÔÈÛÙÚ·‰ÈfiÏË∞Ó‰ÚÔÁfiÓ·, ∞‡ÍËÛË ∞‡ÍËÛË ªÂ›ˆÛË

ÙÂÛÙÔÛÙÂÚfiÓË

¶ÚÔÁÂÛÙ›ÓÂ˜ ªÂ›ˆÛË ∞‡ÍËÛË ªÂ›ˆÛË

°Ï˘ÎÔÎÔÚÙÈÎÔÂÈ‰‹ ∞‡ÍËÛË ∫·Ì›· Â›‰Ú·ÛË ∞‡ÍËÛË

∫˘ÎÏÔÛÔÚ›ÓË ∞‡ÍËÛË ∞‡ÍËÛË ∞‡ÍËÛË

Tacrolimus ∞‡ÍËÛË ∞‡ÍËÛË ∞‡ÍËÛË

£ÂÈ·˙È‰ÈÎ¿ ∞‡ÍËÛË ∞‡ÍËÛË ªÂ›ˆÛË‰ÈÔ˘ÚËÙÈÎ¿

‚-·ÔÎÏÂÈÛÙ¤˜ ∞‡ÍËÛË ∫·Ì›· Â›‰Ú·ÛË ªÂ›ˆÛË

™ÂÚÙÚ·Ï›ÓË ¶Èı·Ó‹ ·‡ÍËÛË ∞‡ÍËÛË ∫·Ì›· Â›‰Ú·ÛË

∞Ó·ÛÙÔÏÂ›˜ ∞‡ÍËÛË ∫·Ì›· Â›‰Ú·ÛË ∫·Ì›· Â›‰Ú·ÛËÙˆÓ ÚˆÙÂ·ÛÒÓ

μ·ÏÚÔ˚Îfi ÔÍ‡ ∞‡ÍËÛË ∫·Ì›· Â›‰Ú·ÛË ªÂ›ˆÛË

πÛÔÙÚÂÙÈÓÔ˝ÓË ∞‡ÍËÛË ∫·Ì›· Â›‰Ú·ÛË ªÂ›ˆÛË

∏ ·¯˘Û·ÚÎ›·, Î·È ÈÔ Û˘ÁÎÂÎÚÈ-Ì¤Ó· Ë ÛÏ·¯ÓÈÎ‹ ·¯˘Û·ÚÎ›·,Û¯ÂÙ›˙ÂÙ·È ÌÂ ·‡ÍËÛË ÙˆÓ ÂÈ¤-‰ˆÓ ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ Î·È ÌÂÌÂ›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ HDL¯ÔÏËÛÙÂÚfiÏË˜. √ Û˘Ó‰˘·ÛÌfi˜ ÙË˜ÛÏ·¯ÓÈÎ‹˜ ·¯˘Û·ÚÎ›·˜ ÌÂ ÙËÓ·ÓÙ›ÛÙ·ÛË ÛÙË ‰Ú¿ÛË ÙË˜ ÈÓÛÔ˘-Ï›ÓË˜ Èı·Ó¿ ÌÔÚÂ› Ó· ÂÍËÁ‹ÛÂÈÙÈ˜ ÔÛÔÙÈÎ¤˜ Î·È ÔÈÔÙÈÎ¤˜ ‰È·-Ù·Ú·¯¤˜ ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ Ô˘·Ú·ÙËÚÔ‡ÓÙ·È ÛÙË ‰˘ÛÏÈÈ‰·È-Ì›· Ô˘ Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙÔÓ ™¢2,10

ÛÙËÓ ÔÈÎÔÁÂÓ‹ ÌÂÈÎÙ‹ ˘ÂÚÏÈÈ-‰·ÈÌ›· Î·È ÛÙËÓ ÔÈÎÔÁÂÓ‹ ˘Ô·Ï-Ê·ÏÈÔÚˆÙÂ˚Ó·ÈÌ›·. ¡ÔÛ‹Ì·Ù· Ô˘ ÚÔÎ·ÏÔ‡Ó ‰Â˘-ÙÂÚÔ·ı‹ ˘ÂÚÙÚÈÁÏ˘ÎÂÚÈ‰·È-Ì›· Â›Ó·È Ô ¯ˆÚ›˜ ıÂÚ·Â›· ‹ ÔÌË Ú˘ıÌÈÛÌ¤ÓÔ˜ ™¢2, Ë ıÂÚ·-Â›· ÌÂ Û˘ÁÎÂÎÚÈÌ¤Ó· Ê¿ÚÌ·Î·(¶›Ó·Î·˜ 1) Î·È Ë Î·Ù·Ó¿ÏˆÛË·ÏÎÔfiÏ. ÕÏÏ· Û¿ÓÈ· ·›ÙÈ· ‰Â˘-ÙÂÚÔ·ıÔ‡˜ ˘ÂÚÙÚÈÁÏ˘ÎÂÚÈ‰·È-Ì›·˜ ·ÔÙÂÏÔ‡Ó Ô ˘Ôı˘ÚÂÔÂÈ-‰ÈÛÌfi˜, Ë ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ ÓÂ-ÊÚÈÎ‹ ·ÓÂ¿ÚÎÂÈ·, ÙÔ ÓÂÊÚˆÛÈ-Îfi Û‡Ó‰ÚÔÌÔ Î·È Ë ÏÔ›ÌˆÍË·fi ÙÔÓ Èfi ÙË˜ Â›ÎÙËÙË˜ ·ÓÔ-ÛÔ·ÓÂ¿ÚÎÂÈ·˜. ∞ÛıÂÓÂ›˜ ÌÂÂ›Â‰· ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ ¿Óˆ·fi 2000 mg/dl Î·Ù¿ Î·ÓfiÓ·ÂÌÊ·Ó›˙Ô˘Ó Û˘Ó‰˘·ÛÌfi ‰Â˘ÙÂ-ÚÔ·ıÔ‡˜ Î·È ÔÈÎÔÁÂÓÔ‡˜ ˘ÂÚ-ÙÚÈÁÏ˘ÎÂÚÈ‰·ÈÌ›·˜.

∂ÎÙ›ÌËÛË ·ÛıÂÓÒÓÌÂ ˘ÂÚÙÚÈÁÏ˘ÎÂÚÈ‰·ÈÌ›·

™Â ·ÛıÂÓÂ›˜ ÌÂ ˘ÂÚÙÚÈÁÏ˘ÎÂÚÈ-‰·ÈÌ›· Ú¤ÂÈ ·Ú¯ÈÎ¿ Ó· ÂÈÎÂ-ÓÙÚˆıÔ‡ÌÂ ÛÙËÓ ‡·ÚÍË ÔÈÎÔÁÂ-ÓÂÈ·ÎÔ‡ ÈÛÙÔÚÈÎÔ‡ ˘ÂÚÙÚÈÁÏ˘-ÎÂÚÈ‰·ÈÌ›·˜ ‹ ÛÙËÓ ‡·ÚÍË ·ÙÔ-ÌÈÎÔ‡ ‹ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÈÛÙÔÚÈÎÔ‡ÚÒÈÌË˜ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘.∂ÈÚfiÛıÂÙ·, Ú¤ÂÈ Ó· ·Ó·-ÁÓˆÚÈÛıÔ‡Ó ÂÓ‰Â¯fiÌÂÓ· ÓÔÛ‹-Ì·Ù· Ô˘ Ô‰ËÁÔ‡Ó ÛÂ ·‡ÍËÛËÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ-‰›ˆÓ. ∏ ·ÚÔ˘Û›· ÚÒÈÌË˜ ÛÙÂ-Ê·ÓÈ·›·˜ ÓfiÛÔ˘ ÛÂ ÚÒÙÔ˘‚·ıÌÔ‡ Û˘ÁÁÂÓÂ›˜ (ÁÔÓÂ›˜, ·È-‰È¿ ‹ ·‰¤ÚÊÈ·) ‹ Î·È ÛÂ ·‰ÂÚ-ÊÔ‡˜ ÙˆÓ ÁÔÓ¤ˆÓ ‰ËÌÈÔ˘ÚÁÂ›ÙËÓ ˘Ô„›· Â›ÙÂ ÔÈÎÔÁÂÓÔ‡˜ÌÂÈÎÙ‹˜ ˘ÂÚÏÈÈ‰·ÈÌ›·˜ Â›ÙÂÛ˘ÁÁÂÓÔ‡˜ ˘Ô·ÏÊ·ÏÈÔÚˆ-ÙÂ˚Ó·ÈÌ›·˜ Î·È ·ÔÙÂÏÂ› ¤Ó‰ÂÈÍËÁÈ· ÙË ¯ÔÚ‹ÁËÛË ıÂÚ·Â›·˜.∏ ÂÌÊ¿ÓÈÛË Í·ÓıˆÌ¿ÙˆÓ ÛÂ·ÛıÂÓÂ›˜ ÌÂ ‹È· ‹ Ì¤ÙÚÈÔ˘ ‚·ı-ÌÔ‡ ˘ÂÚÙÚÈÁÏ˘ÎÂÚÈ‰·ÈÌ›· ‰ÂÓÂ›Ó·È Û˘ÓËıÈÛÌ¤ÓË. ™Â ·ÛıÂÓÂ›˜

™ ∂ ¶ Δ ∂ ª μ ƒ π √ ™ 2 0 0 8

6

¶›Ó·Î·˜ 2: ™¯ÂÙÈÎfi˜ Î›Ó‰˘ÓÔ˜ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘Ì˘ÔÎ·Ú‰›Ô˘, ÈÛ¯·ÈÌÈÎ‹˜ Î·Ú‰È·Î‹˜ ÓfiÛÔ˘ Î·È ı·Ó¿ÙÔ˘ ÛÂ Û¯¤ÛË ÌÂÙ· Â›Â‰· ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ ÛÂ Á˘Ó·›ÎÂ˜

∂›Â‰· ∞ÚÈıÌfi˜ ∞ÚÈıÌfi˜ ™¯ÂÙÈÎfi˜ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ ·ÛıÂÓÒÓ Û˘Ì‚·Ì¿ÙˆÓ Î›Ó‰˘ÓÔ˜ P

(mg/dl)

ŒÌÊÚ·ÁÌ· ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘

<88.5 2194 109 1

88.5-176.1 3948 382 1.7

177.0-264.6 969 141 2.5

265.5-353.0 237 30 2.1

354.0-441.6 96 14 2.4

≥442.5 60 15 5.4

πÛ¯·ÈÌÈÎ‹ Î·Ú‰È·Î‹ ÓfiÛÔ˜

<88.5 2193 290 1

88.5-176.1 3947 878 1.4

177.0-264.6 967 289 1.8

265.5-353.0 237 66 1.8

354.0-441.6 96 23 1.2

≥442.5 60 21 2.6

£¿Ó·ÙÔ˜

<88.5 2210 754 1

88.5-176.1 3992 2076 1.3

177.0-264.6 986 623 1.6

265.5-353.0 241 164 2.2

354.0-441.6 96 64 1.9

≥442.5 62 50 3.3

<0.001

<0.001

<0.001

¶›Ó·Î·˜ 3: ™¯ÂÙÈÎfi˜ Î›Ó‰˘ÓÔ˜ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ÂÌÊÚ¿ÁÌ·ÙÔ˜ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘, ÈÛ¯·ÈÌÈÎ‹˜ Î·Ú‰È·Î‹˜ ÓfiÛÔ˘ Î·È ı·Ó¿ÙÔ˘ ÛÂÛ¯¤ÛË ÌÂ Ù· Â›Â‰· ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ ÛÂ ¿Ó‰ÚÂ˜

∂›Â‰· ∞ÚÈıÌfi˜ ∞ÚÈıÌfi˜ ™¯ÂÙÈÎfi˜ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ ·ÛıÂÓÒÓ Û˘Ì‚·Ì¿ÙˆÓ Î›Ó‰˘ÓÔ˜ P

(mg/dl)

ŒÌÊÚ·ÁÌ· ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘

<88.5 882 104 1

88.5-176.1 2938 477 1.4

177.0-264.6 1366 270 1.6

265.5-353.0 530 133 2.3

354.0-441.6 229 54 1.9

≥442.5 250 64 2.4πÛ¯·ÈÌÈÎ‹ Î·Ú‰È·Î‹ ÓfiÛÔ˜

<88.5 882 214 1

88.5-176.1 2935 853 1.1

177.0-264.6 1364 469 1.3

265.5-353.0 530 198 1.3354.0-441.6 229 80 1.2

≥442.5 250 98 1.5

£¿Ó·ÙÔ˜

<88.5 906 470 1

88.5-176.1 3026 1920 1.2

177.0-264.6 1415 959 1.4

265.5-353.0 549 386 1.5

354.0-441.6 239 176 1.6

≥442.5 259 176 1.8

<0.001

<0.001

<0.001

ÌÂ ·˘ÍËÌ¤Ó· Â›Â‰· ÙÚÈÁÏ˘ÎÂ-ÚÈ‰›ˆÓ Ú¤ÂÈ Ó· ÌÂÙÚ¿Ù·È Ë Â-Ú›ÌÂÙÚÔ˜ Ì¤ÛË˜ Î·È Ó· ˘ÔÏÔÁ›-˙ÂÙ·È Ô ‰Â›ÎÙË˜ Ì¿˙·˜ ÛÒÌ·ÙÔ˜.√ Û˘Ó‰˘·ÛÌfi˜ ÙË˜ ˘ÂÚÙÚÈÁÏ˘-ÎÂÚÈ‰·ÈÌ›·˜ ÌÂ ·˘ÍËÌ¤ÓË ÂÚ›-ÌÂÙÚÔ Ì¤ÛË˜11 Ê·›ÓÂÙ·È fiÙÈ ·Ô-ÙÂÏÂ› Î·Ï‡ÙÂÚÔ ‰Â›ÎÙË ÙË˜ ·ÓÙ›-ÛÙ·ÛË˜ ÛÙË ‰Ú¿ÛË ÙË˜ ÈÓÛÔ˘Ï›-ÓË˜ Î·È ÈÛ¯˘ÚfiÙÂÚÔ ·Ú¿ÁÔ-ÓÙ· ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛËÚÒÈÌË˜ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ ÛÂÛ‡ÁÎÚÈÛË ÌÂ ÙËÓ ·ÚÔ˘Û›· ÌÂ-ÌÔÓˆÌ¤ÓË˜ ˘ÂÚÙÚÈÁÏ˘ÎÂÚÈ‰·È-Ì›·˜. ∏ ·ÚÔ˘Û›· ·˘ÍËÌ¤ÓË˜ Â-ÚÈÌ¤ÙÚÔ˘ Ì¤ÛË˜ (¿Óˆ ·fi 102cm ÁÈ· ÙÔ˘˜ ¿Ó‰ÚÂ˜ Î·È ¿Óˆ·fi 88 cm ÁÈ· ÙÈ˜ Á˘Ó·›ÎÂ˜) ÌÔ-ÚÂ› Ó· ‚ÔËı‹ÛÂÈ ÛÙË ‰È¿ÎÚÈÛËÌÂÙ·Í‡ ÙË˜ ÔÈÎÔÁÂÓÔ‡˜ ÌÂÈÎÙ‹˜˘ÂÚÏÈÈ‰·ÈÌ›·˜ ‹ ÙË˜ ÔÈÎÔÁÂ-ÓÔ‡˜ ˘Ô·ÏÊ·ÏÈÔÚˆÙÂ˚Ó·ÈÌ›·˜Î·È ÙË˜ ÔÈÎÔÁÂÓÔ‡˜ ˘ÂÚÙÚÈÁÏ˘-ÎÂÚÈ‰·ÈÌ›·˜, Ë ÔÔ›· ‰ÂÓ Û˘Û¯Â-Ù›˙ÂÙ·È ÌÂ ÎÔÈÏÈ·Î‹ ·¯˘Û·ÚÎ›·Î·È Èı·Ó¿ ÌÂ ·˘ÍËÌ¤ÓÔ Î·Ú-‰È·ÁÁÂÈ·Îfi Î›Ó‰˘ÓÔ.

™˘Ó‹ıˆ˜, Â›Ó·È ·ÚÎÂÙfi ¤Ó· Ï‹-ÚÂ˜ ÏÈÈ‰·ÈÌÈÎfi ÚÔÊ›Ï ÓËÛÙÂ›·˜ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË ·ÛıÂÓÒÓ ÌÂ ·˘-ÍËÌ¤Ó· Â›Â‰· ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ

Î·È ÚÒÈÌË ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ.¶Ú¤ÂÈ ˆÛÙfiÛÔ Ó· ·Ó·ÊÂÚıÂ›fiÙÈ ÛÂ ÌÈ· ÚfiÛÊ·ÙË ÌÂÏ¤ÙË ·-Ú·ÙËÚ‹ıËÎÂ ıÂÙÈÎ‹ Û˘Û¯¤ÙÈÛËÌÂÙ·Í‡ ÙˆÓ ÌÂÙ·ÁÂ˘Ì·ÙÈÎÒÓ ÂÈ-¤‰ˆÓ ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ Î·ÈÙË˜ ÂÌÊ¿ÓÈÛË˜ ÛÙÂÊ·ÓÈ·›·˜ Ófi-ÛÔ˘. ™ÙË Û˘ÁÎÂÎÚÈÌ¤ÓË ÌÂÏ¤ÙË,ÛÙËÓ ÔÔ›· Û˘ÌÌÂÙÂ›¯·Ó 7587Á˘Ó·›ÎÂ˜ Î·È 6394 ¿Ó‰ÚÂ˜, ÂÎÙÈ-Ì‹ıËÎÂ Ô Û¯ÂÙÈÎfi˜ Î›Ó‰˘ÓÔ˜ ÂÌ-Ê¿ÓÈÛË˜ ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ô-Î·Ú‰›Ô˘, ÈÛ¯·ÈÌÈÎ‹˜ Î·Ú‰È·Î‹˜ÓfiÛÔ˘ Î·È ı·Ó¿ÙÔ˘ ÛÂ Û¯¤ÛË ÌÂÙ· Â›Â‰· ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ(¶›Ó·ÎÂ˜ 2 Î·È 3).12

øÛÙfiÛÔ, ‰ÂÓ Û˘ÓÈÛÙ¿Ù·È ÛÙËÓ ÎÏÈ-ÓÈÎ‹ Ú¿ÍË Ë Ì¤ÙÚËÛË Î·È ÂÎÙ›ÌË-ÛË ÙˆÓ ÌÂÙ·ÁÂ˘Ì·ÙÈÎÒÓ ÂÈ¤‰ˆÓÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ, Î·ıÒ˜ ‰ÂÓ˘¿Ú¯Ô˘Ó ·ÎfiÌË Â·ÚÎ‹ ‰Â‰Ô-Ì¤Ó· fiÛÔÓ ·ÊÔÚ¿ ÙÈ˜ Ê˘ÛÈÔÏÔÁÈ-Î¤˜ ÙÈÌ¤˜ ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ ÌÂ-Ù¿ Ù· ÁÂ‡Ì·Ù·, ·ÏÏ¿ Î·È ÂÍ·ÈÙ›·˜ÙË˜ ÔÈÎÈÏ›·˜ ÙˆÓ ÌÂÙ·ÁÂ˘Ì·ÙÈ-ÎÒÓ ÙÈÌÒÓ ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ,Ô˘ Î·Ù¿ Î·ÓfiÓ· Û˘Û¯ÂÙ›˙ÔÓÙ·ÈÌÂ ÙÈ˜ ÙÈÌ¤˜ ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓÓËÛÙÂ›·˜.

√È ·ÛıÂÓÂ›˜ ÌÂ ÔÈÎÔÁÂÓ‹ ÌÂÈÎÙ‹

˘ÂÚÏÈÈ‰·ÈÌ›· ÌÔÚÂ› Ó· ¤¯Ô˘Ó·˘ÍËÌ¤Ó· ‹ Ê˘ÛÈÔÏÔÁÈÎ¿ Â›Â-‰· LDL ¯ÔÏËÛÙÂÚfiÏË˜. Δ· Â›Â-‰· ÙË˜ HDL ¯ÔÏËÛÙÂÚfiÏË˜ Â›Ó·ÈÌÂÈˆÌ¤Ó· ÙfiÛÔ ÛÙËÓ ÔÈÎÔÁÂÓ‹Û˘Ó‰˘·ÛÌ¤ÓË ˘ÂÚÏÈÈ‰·ÈÌ›· fiÛÔÎ·È ÛÙË Û˘ÁÁÂÓ‹ ˘Ô·ÏÊ·ÏÈÔ-ÚˆÙÂ˚Ó·ÈÌ›·.

∂ÈÚfiÛıÂÙ· Ë ·ÚÔ˘Û›· ·˘ÍË-Ì¤ÓˆÓ Û˘ÁÎÂÓÙÚÒÛÂˆÓ ÌÈÎÚÒÓ,˘ÎÓÒÓ LDL ÛˆÌ·ÙÈ‰›ˆÓ ÙfiÛÔ ÛÂ·ÛıÂÓÂ›˜ ÌÂ ÔÈÎÔÁÂÓ‹ ÌÂÈÎÙ‹˘ÂÚÏÈÈ‰·ÈÌ›· fiÛÔ Î·È ÛÂ ·ÛıÂ-ÓÂ›˜ ÌÂ ÔÈÎÔÁÂÓ‹ ˘Ô·ÏÊ·ÏÈÔ-ÚˆÙÂ˚Ó·ÈÌ›· ¤¯ÂÈ Û˘Û¯ÂÙÈÛıÂ›ÌÂ ÙËÓ ÂÌÊ¿ÓÈÛË ÚÒÈÌË˜ ÛÙÂ-Ê·ÓÈ·›·˜ ÓfiÛÔ˘.13 ™Â ·ÛıÂÓÂ›˜ÌÂ ·˘ÍËÌ¤Ó· Â›Â‰· ÙÚÈÁÏ˘ÎÂ-ÚÈ‰›ˆÓ Î·È ÂÏÂ‡ıÂÚÔ ·ÙÔÌÈÎfiÎ·È ÎÏËÚÔÓÔÌÈÎfi ÈÛÙÔÚÈÎfi, ËÌ¤ÙÚËÛË ÙË˜ ·ÔÏÈÔÚˆÙÂ˝-ÓË˜ μ (ApoB) ÌÔÚÂ› Ó· ‚ÔËı‹-ÛÂÈ ÛÙË ‰È¿ÎÚÈÛË ÌÂÙ·Í‡ ÙË˜ ÔÈ-ÎÔÁÂÓÔ‡˜ ÌÂÈÎÙ‹˜ ˘ÂÚÏÈÈ‰·È-Ì›·˜ Î·È ÙË˜ ÔÈÎÔÁÂÓÔ‡˜ ˘ÂÚ-ÙÚÈÁÏ˘ÎÂÚÈ‰·ÈÌ›·˜. ¶Ú¿ÁÌ·ÙÈ, Ù·Â›Â‰· ÙË˜ ApoB Â›Ó·È ·˘ÍË-Ì¤Ó· (> 90Ë ı¤ÛË ÁÈ· ÙËÓ ËÏÈ-Î›· Î·È ÙÔ Ê‡ÏÔ) ÛÂ ·ÛıÂÓÂ›˜ ÌÂÔÈÎÔÁÂÓ‹ ÌÂÈÎÙ‹ ˘ÂÚÏÈÈ‰·ÈÌ›·Î·È fi¯È ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ÔÈÎÔÁÂ-

¶∞ƒ∞°√¡Δ∂™ ∫π¡¢À¡√À

7

¶›Ó·Î·˜ 4: ∞ÏÁfiÚÈıÌÔ˜ ÁÈ· ÙË ‰È·ÁÓˆÛÙÈÎ‹ ÚÔÛ¤ÁÁÈÛË Î·È ·ÓÙÈÌÂÙÒÈÛË ·ÛıÂÓÒÓ ÌÂ ˘ÂÚÙÚÈÁÏ˘ÎÂ-ÚÈ‰·ÈÌ›· (Â›Â‰· ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ 250-1000 mg/dl)

∂›Â‰· ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ 250-1000 mg/dl¯ˆÚ›˜ ·˘ÍËÌ¤Ó· Â›Â‰· LDL ¯ÔÏËÛÙÂÚfiÏË˜

∞ÔÎÏÂÈÛÌfi˜ ‰Â˘ÙÂÚÔ·ıÔ‡˜˘ÂÚÙÚÈÁÏ˘ÎÂÚÈ‰·ÈÌ›·˜

¶Èı·Ó¿ ÔÈÎÔÁÂÓ‹˜ ÌÂÈÎÙ‹˘ÂÚÏÈÈ‰·ÈÌ›· ‹

ÔÈÎÔÁÂÓ‹˜˘Ô·ÏÊ·ÏÈÔÚˆÙÂ˚Ó·ÈÌ›·

∫ÏËÚÔÓÔÌÈÎfi ÈÛÙÔÚÈÎfiÚÒÈÌË˜ ™¡;

ªÂÈˆÌ¤ÓËApoAI;

√ÈÎÔÁÂÓ‹˜ÀÔ·ÏÊ·ÏÈÔÚˆÙÂ˚Ó·ÈÌ›·;

√ÈÎÔÁÂÓ‹˜ ÌÂÈÎÙ‹˘ÂÚÏÈÈ‰·ÈÌ›·;

ªfiÓÔ ·ÏÏ·Á‹ÙÚfiÔ˘ ˙ˆ‹˜

∞ÏÏ·Á‹ ÙÚfiÔ˘ ˙ˆ‹˜Èı·Ó¿ Ê·ÚÌ·ÎÂ˘ÙÈÎ‹

·ÁˆÁ‹∞ÏÏ·Á‹ ÙÚfiÔ˘ ˙ˆ‹˜Èı·Ó¿ Ê·ÚÌ·ÎÂ˘ÙÈÎ‹

·ÁˆÁ‹

∞ÏÏ·Á‹ ÙÚfiÔ˘ ˙ˆ‹˜Î·È Û˘Ó‰˘·ÛÌ¤ÓË

˘ÔÏÈÈ‰·ÈÌÈÎ‹ ·ÁˆÁ‹

∞˘ÍËÌ¤ÓËApoμ;

√ÈÎÔÁÂÓ‹˜˘ÂÚÙÚÈÁÏ˘ÎÂÚÈ‰·ÈÌ›·

ªÂ ÚÒÈÌË ™¡;

Ÿ¯È

Ÿ¯ÈŸ¯È

¡·È

¡·È

¡·È ¡·È

¡·È

¡·È¡·È

£ÂÙÈÎfi∞ÚÓËÙÈÎfi ÕÁÓˆÛÙÔ

Ó‹ ˘ÂÚÙÚÈÁÏ˘ÎÂÚÈ‰·ÈÌ›·.14 ∫·ÈÛÙÈ˜ ‰‡Ô ‰È·Ù·Ú·¯¤˜ Ù· Â›Â-‰· ÙË˜ ApoB ÌÔÚÔ‡Ó Ó· ¯ÚË-ÛÈÌÔÔÈËıÔ‡Ó ÁÈ· ÙÔÓ ˘ÔÏÔÁÈ-ÛÌfi ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ ·ÚÈıÌÔ‡ ÙˆÓLDL ÛˆÌ·ÙÈ‰›ˆÓ. ™‡ÌÊˆÓ· ÌÂÙÈ˜ Ô‰ËÁ›Â˜ ÙÔ˘ NCEP (NationalCholesterol Education Program)Û˘ÓÈÛÙ¿Ù·È Ë Ì¤ÙÚËÛË ÙË˜ non-HDL ¯ÔÏËÛÙÂÚfiÏË˜ (non-HDL¯ÔÏËÛÙÂÚfiÏË = TCHOL HDL¯ÔÏËÛÙÂÚfiÏË) ·ÓÙ› ÁÈ· ÙË Ì¤-ÙÚËÛË ÙË˜ ApoB. ¶·ÚfiÙÈ Ë non-HDL ¯ÔÏËÛÙÂÚfiÏË ·ÔÙÂÏÂ› Î·-Ï‡ÙÂÚÔ ÚÔÁÓˆÛÙÈÎfi ·Ú¿ÁÔ-ÓÙ· Î·Ú‰È·ÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙËÓ LDL ¯ÔÏË-ÛÙÂÚfiÏË,15 ·ÚÎÂÙ¤˜ ÌÂÏ¤ÙÂ˜ ¤-‰ÂÈÍ·Ó fiÙÈ Ë ApoB Â›Ó·È Î·Ï‡ÙÂ-ÚÔ˜ ÚÔÁÓˆÛÙÈÎfi˜ ‰Â›ÎÙË˜ ÛÂÛ‡ÁÎÚÈÛË ÌÂ ÙËÓ non-HDL ¯Ô-ÏËÛÙÂÚfiÏË.8 16 ¶Ú¤ÂÈ Ó· ·Ó·-ÊÂÚıÂ›, fiÙÈ ÙfiÛÔ Ë Ì¤ÙÚËÛË ÙË˜Û˘ÁÎ¤ÓÙÚˆÛË˜ ÙË˜ ApoAI fiÛÔÎ·È Ë Ì¤ÙÚËÛË ÙË˜ Û˘ÁÎ¤ÓÙÚˆ-ÛË˜ ÙˆÓ ÌÈÎÚÒÓ ˘ÎÓÒÓ LDL Ûˆ-Ì·ÙÈ‰›ˆÓ ‰ÂÓ ·ÔÙÂÏÔ‡Ó ÂÍÂÙ¿-ÛÂÈ˜ ÚÔ˘Ù›Ó·˜ ÛÙËÓ ÎÏÈÓÈÎ‹ Ú¿-ÍË, ·Ó Î·È ˘¿Ú¯Ô˘Ó ‰Â‰ÔÌ¤Ó·fiÙÈ Ô ÏfiÁÔ˜ ApoB/ ApoAI Â›Ó·È¤Ó·˜ ÔÏ‡ Î·Ïfi˜ ÚÔÁÓˆÛÙÈÎfi˜‰Â›ÎÙË˜ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ÚÒÈ-ÌË˜ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘.17 ∞Ó Î·ÈË Ì¤ÙÚËÛË ÙË˜ Lp(a) ‰ÂÓ ÌÔÚÂ›Ó· ‚ÔËı‹ÛÂÈ ÛÙË ‰È·ÊÔÚÈÎ‹ ‰È¿-ÁÓˆÛË ÙˆÓ ‰È¿ÊÔÚˆÓ ÌÔÚÊÒÓ˘ÂÚÙÚÈÁÏ˘ÎÂÚÈ‰·ÈÌ›·˜, ÌÔÚÂ›ˆÛÙfiÛÔ, ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ÙÔ˘˜¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙÂ˜ Î·Ú‰È·ÁÁÂÈ·-ÎÔ‡ ÎÈÓ‰‡ÓÔ˘, Ó· Â›Ó·È ¯Ú‹ÛÈÌË ÁÈ·ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛË˜ ·ıËÚˆÌ·ÙÈ-Î‹˜ ÓfiÛÔ˘.18 øÛÙfiÛÔ, Ë Ì¤ÙÚËÛËÙË˜ Lp(a) ‰ÂÓ ·ÔÙÂÏÂ› ÂÍ¤Ù·ÛËÚÔ˘Ù›Ó·˜ ÛÙËÓ ÎÏÈÓÈÎ‹ Ú¿ÍË.

∞ÓÙÈÌÂÙÒÈÛË ·ÛıÂÓ‹ ÌÂ ˘ÂÚÙÚÈÁÏ˘ÎÂÚÈ‰·ÈÌ›·

ªÂÙ¿ ÙÔÓ ·ÔÎÏÂÈÛÌfi ÙË˜ ‰Â˘ÙÂ-ÚÔ·ıÔ‡˜ ˘ÂÚÙÚÈÁÏ˘ÎÂÚÈ‰·ÈÌ›·˜,·ÏÏ¿ Î·È ÙË ‰È·ÎÔ‹ ÙˆÓ Ê·ÚÌ¿-ÎˆÓ Ô˘ ÂÓ‰Â¯fiÌÂÓ· ·˘Í¿ÓÔ˘ÓÙ· Â›Â‰· ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ,Ë ·ÏÏ·Á‹ ÙÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜ Î·ÈÂÓ‰Â¯fiÌÂÓ· Ë ÚÔÛı‹ÎË Ê·ÚÌ·-ÎÂ˘ÙÈÎ‹˜ ·ÁˆÁ‹˜ ·ÔÙÂÏÔ‡Ó ÙÈ˜Î·Ù¿ÏÏËÏÂ˜ ıÂÚ·Â˘ÙÈÎ¤˜ ÂÈÏÔ-Á¤˜ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ˘ÂÚÙÚÈÁÏ˘-ÎÂÚÈ‰·ÈÌ›· Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ·˘-ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈ-ÛË ÚÒÈÌË˜ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘(¶›Ó·Î·˜ 4). ΔÔ ÂÚÒÙËÌ· Ô˘ÚÔÎ‡ÙÂÈ Â›Ó·È ·Ó Ë ıÂÚ·Â›·

Ú¤ÂÈ Ó· ·ÊÔÚ¿ ÌfiÓÔ ÛÙË ÌÂ›ˆ-ÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ÙÚÈÁÏ˘ÎÂ-ÚÈ‰›ˆÓ ‹ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓÏÈÈ‰·ÈÌÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ Ô˘Û˘Ó˘¿Ú¯Ô˘Ó (·˘ÍËÌ¤ÓË LDL Î·ÈIDL ¯ÔÏËÛÙÂÚfiÏË Î·È ÌÂÈˆÌ¤ÓËHDL ¯ÔÏËÛÙÂÚfiÏË).6 11 19 ¶Ú¤ÂÈÓ· ·Ó·ÊÂÚıÂ› fiÙÈ Â›Â‰· ÙÚÈ-ÁÏ˘ÎÂÚÈ‰›ˆÓ ÌÂÁ·Ï‡ÙÂÚ· ·fi1000 mg/dl ··ÈÙÔ‡Ó ¿ÌÂÛË ıÂ-Ú·Â›· ÌÂ ÊÈÌÚ¿ÙÂ˜, ÌÂ ÛÎÔ-fi ÙË ÌÂ›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ·ÙËÓ ÂÌÊ¿ÓÈÛË ·ÁÎÚÂ·Ù›ÙÈ‰·˜.20

∞ÏÏ·Á‹ ÙÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜

∏ ·ÒÏÂÈ· ‚¿ÚÔ˘˜ Ô‰ËÁÂ› ÛÂ Ì›·‹È· ¤ˆ˜ Ì¤ÙÚÈ· ÌÂ›ˆÛË ÙˆÓ ÂÈ-¤‰ˆÓ ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ (ÂÚ›-Ô˘ Î·Ù¿ 22%) Î·È ÛÂ Ì›· ·‡ÍË-ÛË ÙË˜ HDL ¯ÔÏËÛÙÂÚfiÏË˜ Î·Ù¿9% (Î˘Ú›ˆ˜ ÂÍ·ÈÙ›·˜ ÙË˜ ·‡ÍË-ÛË˜ ÙË˜ HDL2 Î·Ù¿ 43%). Δ·Â›Â‰· ÙˆÓ ÌÈÎÚÒÓ, ˘ÎÓÒÓ LDLÛˆÌ·ÙÈ‰›ˆÓ ÌÔÚÂ› Â›ÛË˜ Ó·ÌÂÈˆıÔ‡Ó ¤ˆ˜ Î·È 40% (¶›Ó·Î·˜5).21 ¶Ú¤ÂÈ Ó· ÂÈÛËÌ·ÓıÂ› fiÙÈ·ÎfiÌ· Î·È Ë ÌÂÙÚ›Ô˘ ‚·ıÌÔ‡·ÒÏÂÈ· ‚¿ÚÔ˘˜ Ô‰ËÁÂ› ÛÂ ÌÂ›ˆ-ÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ÙÚÈÁÏ˘ÎÂ-ÚÈ‰›ˆÓ. ∏ ‰È·Ù‹ÚËÛË ·˘Ù‹˜ ÙË˜·ÒÏÂÈ·˜ ‚¿ÚÔ˘˜ ÌÔÚÂ› Ó· ÂÈ-ÙÂ˘¯ıÂ› ÌÂ ·ÂÚÔ‚ÈÎ‹ ¿ÛÎËÛË.22-24

∏ ·ÂÚÔ‚ÈÎ‹ ¿ÛÎËÛË Ì¤ÙÚÈ·˜¤ÓÙ·ÛË˜ Î·È ·˘ÍËÌ¤ÓË˜ Û˘¯ÓfiÙË-Ù·˜ (ÂÚ›Ô˘ 4 ÒÚÂ˜ ÙËÓ Â‚‰Ô-Ì¿‰·) ¤¯ÂÈ Û˘Û¯ÂÙÈÛıÂ› ÌÂ ÙË‚ÂÏÙ›ˆÛË ÙË˜ Î·Ú‰ÈÔ·Ó·ÓÂ˘ÛÙÈ-Î‹˜ ÈÎ·ÓfiÙËÙ·˜.25 26 ∏ ÛˆÌ·ÙÈÎ‹¿ÛÎËÛË ¤¯ÂÈ Â›ÛË˜ Û˘Û¯ÂÙÈÛıÂ›ÌÂ ÙË ÌÂ›ˆÛË ÙÔ˘ ÂÓ‰ÔÎÔÈÏÈ·ÎÔ‡Ï›Ô˘˜, ÌÂ ÙËÓ ·‡ÍËÛË ÙˆÓ ÂÈ-¤‰ˆÓ ÙË˜ HDL ¯ÔÏËÛÙÂÚfiÏË˜Î·È ÌÂ Ì›· ÌÈÎÚ‹ ÌÂ›ˆÛË ÙˆÓ ÂÈ-¤‰ˆÓ ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ.27 28

∂ÓÒ Ë ÌÂ›ˆÛË ÙÔ˘ ‰È·ÈÙËÙÈÎÔ‡ Ï›-Ô˘˜ Ô‰ËÁÂ› ÛÂ ·ÒÏÂÈ· ‚¿ÚÔ˘˜(ÌÂ Â·ÎfiÏÔ˘ıÔ ÙË ÌÂ›ˆÛË ÙˆÓÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ), Ë Ùˆ¯‹ ÛÂ Ï›-Ô˜ ‰›·ÈÙ· Ô˘ Â›Ó·È ÏÔ‡ÛÈ· ÛÂ˘‰·Ù¿ÓıÚ·ÎÂ˜ ÌÔÚÂ› Ó· Ô‰ËÁ‹-ÛÂÈ ÛÂ ·Ú¿ÏÏËÏË ÌÂ›ˆÛË ÙfiÛÔÙË˜ LDL fiÛÔ Î·È ÙË˜ HDL ¯ÔÏË-ÛÙÂÚfiÏË˜.23 ŸÙ·Ó Ù· ÎÔÚÂÛÌ¤Ó·Ï›Ë ·ÓÙÈÎ·ı›ÛÙ·ÓÙ·È ·fi ÌÔÓÔ·-ÎfiÚÂÛÙ· Ï›Ë (ÂÏ·ÈfiÏ·‰Ô), Ë ÌÂ›-ˆÛË ÙË˜ HDL ¯ÔÏËÛÙÂÚfiÏË˜ Â›-Ó·È ÌÈÎÚfiÙÂÚË ·fi ÙË ÌÂ›ˆÛËÔ˘ ·Ú·ÙËÚÂ›Ù·È ÌÂ ÙËÓ ·ÓÙÈÎ·-Ù¿ÛÙ·ÛË ÙˆÓ ˙ˆÈÎÒÓ ÏÈÒÓ ·fi˘‰·Ù¿ÓıÚ·ÎÂ˜. ŒÙÛÈ, Û˘ÓÈÛÙ¿Ù·ÈË ÌÂ›ˆÛË ÙˆÓ ÏÔ‡ÛÈˆÓ ÛÂ ˙ˆÈÎ¿Ï›Ë ÙÚÔÊÒÓ Î·È Ë ·ÓÙÈÎ·Ù¿ÛÙ·-Û‹ ÙÔ˘˜ ÌÂ Û˘Ó‰˘·ÛÌfi ÙÚÔÊÒÓÔ˘ Â›Ó·È ÏÔ‡ÛÈÂ˜ ÛÂ ˘‰·Ù¿Ó-ıÚ·ÎÂ˜, ÌÔÓÔ·ÎfiÚÂÛÙ· Ï›Ë Î·ÈÔÏ˘·ÎfiÚÂÛÙ· Ï›Ë.23 ∂ÈÚfi-ÛıÂÙ·, ÂÓ‰Â›ÎÓ˘Ù·È Ë ·ÔÊ˘Á‹ÙË˜ ˙¿¯·ÚË˜ Î·È Î˘Ú›ˆ˜ ÙË˜ÊÚÔ˘ÎÙfi˙Ë˜, Ë ÔÔ›· ¤¯ÂÈ Û˘Û¯Â-ÙÈÛıÂ› ÌÂ ÛËÌ·ÓÙÈÎ‹ ÌÂÙ·ÁÂ˘Ì·ÙÈ-Î‹ ·‡ÍËÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ.29

∏ ÊÚÔ˘ÎÙfi˙Ë ˘¿Ú¯ÂÈ ÛÂ ÔÏÏ¿·ÓıÚ·ÎÔ‡¯· ÔÙ¿, Î·ıÒ˜ Î·È ÛÂÊÚÔ˘ÙÔ¯˘ÌÔ‡˜ Î·È ÔÏÏ¤˜ ÊÔ-Ú¤˜ ÚÔÛÙ›ıÂÙ·È ÛÙÈ˜ ÙÚÔÊ¤˜ ˆ˜Û˘ÓÙËÚËÙÈÎfi Î·È ÁÏ˘Î·ÓÙÈÎfi.

∏ ÚÔÛı‹ÎË ÛÙË ‰›·ÈÙ· ˆ-3 ÏÈ·-ÚÒÓ ÔÍ¤ˆÓ ÌÔÚÂ› Ó· ÌÂÈÒÛÂÈ Ù·Â›Â‰· ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ Î·ÈÛ‡ÌÊˆÓ· ÌÂ ÔÚÈÛÌ¤ÓÂ˜ ÌÂÏ¤ÙÂ˜Ó· ÌÂÈÒÛÂÈ Î·È Ù· Î·Ú‰È·ÁÁÂÈ·Î¿Û˘Ì‚¿Ì·Ù·. ™˘ÁÎÂÎÚÈÌ¤Ó·, ÛÂÌ›· ÌÂÏ¤ÙË, ÛÙËÓ ÔÔ›· Û˘ÁÎÚ›ıË-ÎÂ Ë ¯ÔÚ‹ÁËÛË ˆ-3 ÏÈ·ÚÒÓ ÔÍ¤-ˆÓ (1 gr ÙËÓ ËÌ¤Ú· ÛÂ 2836 ·ÛıÂ-ÓÂ›˜), Ë ¯ÔÚ‹ÁËÛË ‚ÈÙ·Ì›ÓË˜ ∂(300 mg ÙËÓ ËÌ¤Ú· ÛÂ 2830·ÛıÂÓÂ›˜), Ë Ù·˘Ùfi¯ÚÔÓË ¯ÔÚ‹ÁË-Û‹ ÙÔ˘˜ (ÛÂ 2830 ·ÛıÂÓÂ›˜) Î·È Ë

™ ∂ ¶ Δ ∂ ª μ ƒ π √ ™ 2 0 0 8

8

¶›Ó·Î·˜ 5: μ¿ÚÔ˜ ÛÒÌ·ÙÔ˜ Î·È ÏÈÈ‰·ÈÌÈÎfi ÚÔÊ›Ï ÚÈÓ Î·È ÌÂÙ¿ÙËÓ ·ÒÏÂÈ· ‚¿ÚÔ˘˜

¶ÚÈÓ ÙËÓ ·ÒÏÂÈ· ªÂÙ¿ ÙËÓ ·ÒÏÂÈ·p‚¿ÚÔ˘˜ (±SD) ‚¿ÚÔ˘˜ (±SD)

μ¿ÚÔ˜ ÛÒÌ·ÙÔ˜ (kg) 96 (11) 86 (11) <0.001

√ÏÈÎ‹ ¯ÔÏËÛÙÂÚfiÏË (mg/dl) 194 (25) 189 (21) 0.18

ΔÚÈÁÏ˘ÎÂÚ›‰È· (mg/dl) 138 (51) 107 (37) <0.001

VLDL-C (mg/dl) 27.6 (10.3) 21.3 (7.2) <0.001

LDL-C (mg/dl) 130 (24) 128 (22) 0.49

HDL-C (mg/dl) 35.9 (7.2) 39.1 (8.9) 0.006

HDL2-C (mg/dl) 6.8 (4.2) 9.7 (5.3) <0.001

ApoAI (mg/dl) 111 (15) 114 (16) 0.18

ApoB (mg/dl) 108 (18) 100 (18) 0.004

SD:ÛÙ·ıÂÚ‹ ·fiÎÏÈÛËΔÚÔÔÔ›ËÛË ·fi: J Clin Endocrinol Metab 2000;346:393-403

ÌË ¯ÔÚ‹ÁËÛË ˆ-3 ÏÈ·ÚÒÓ ÔÍ¤ˆÓ‹ ‚ÈÙ·Ì›ÓË˜ ∂ (ÔÌ¿‰· ÂÏ¤Á¯Ô˘:2828 ·ÛıÂÓÂ›˜) ÛÂ 11324 ÌÂÙÂÌ-ÊÚ·ÁÌ·ÙÈÎÔ‡˜ ·ÛıÂÓÂ›˜ ·Ú·ÙË-Ú‹ıËÎÂ ÌÂ›ˆÛË ÙÔ˘ Û¯ÂÙÈÎÔ‡ ÎÈÓ-‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË Ó¤Ô˘ ÂÌ-ÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘, ·Á-ÁÂÈ·ÎÔ‡ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘Î·È ı·Ó¿ÙÔ˘ Î·Ù¿ 15% (95 % ‰È¿-ÛÙËÌ· ÂÌÈÛÙÔÛ‡ÓË˜ 2-26%) ÛÙÔ˘˜·ÛıÂÓÂ›˜ Ô˘ ¤·ÈÚÓ·Ó ˆ-3 ÏÈ·-Ú¿ ÔÍ¤·.30 ∞ÓÙ›ıÂÙ· ÛÂ ÌÈ· ÌÂÙ·-·Ó¿Ï˘ÛË 48 Ù˘¯·ÈÔÔÈËÌ¤ÓˆÓ ÎÏÈ-ÓÈÎÒÓ ÌÂÏÂÙÒÓ ‰ÂÓ ˘‹Ú¯Â ÛÙ·ÙÈ-ÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ÌÂ›ˆÛË ÙˆÓ Î·Ú-‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ [Û¯ÂÙÈ-Îfi˜ Î›Ó‰˘ÓÔ˜: 0.87 (95% ‰È¿ÛÙË-Ì· ÂÌÈÛÙÔÛ‡ÓË˜: 0.73-1.03)] ‹ÙË˜ ıÓËÙfiÙËÙ·˜ [Û¯ÂÙÈÎfi˜ Î›Ó‰˘-ÓÔ˜: 0.95 (95% ‰È¿ÛÙËÌ· ÂÌÈ-ÛÙÔÛ‡ÓË˜: 0.82-1.12)] ÛÂ ·ÛıÂ-ÓÂ›˜ Ô˘ ¤·ÈÚÓ·Ó ˆ-3 ÏÈ·Ú¿ÔÍ¤· Â›ÙÂ ÛÙË ‰›·ÈÙ¿ ÙÔ˘˜ Â›ÙÂ ˆ˜ÛÎÂ˘¿ÛÌ·Ù·.31

ΔÔ Î¿ÓÈÛÌ· Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂ Ì›·Î·Ù¿ 10 ¯ÚfiÓÈ· ÁÚËÁÔÚfiÙÂÚË ÂÌ-Ê¿ÓÈÛË ÚÒÈÌË˜ ÛÙÂÊ·ÓÈ·›·˜ Ófi-ÛÔ˘. ∏ ‰È·ÎÔ‹ ÙÔ˘ Î·Ó›ÛÌ·ÙÔ˜¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙË ‚ÂÏÙ›ˆÛËÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ÏÈÈ‰›ˆÓ, ·Ú¿ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÛÂ ¿ÙÔÌ· Ô˘ ‰È·-ÎfiÙÔ˘Ó ÙÔ Î¿ÓÈÛÌ· ·Ú·ÙËÚÂ›Ù·È·‡ÍËÛË ÙÔ˘ ÛˆÌ·ÙÈÎÔ‡ ‚¿ÚÔ˘˜.

∏ Î·Ù·Ó¿ÏˆÛË ·ÏÎÔÔÏÔ‡¯ˆÓ Ô-ÙÒÓ ÌÔÏÔÓfiÙÈ Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂÌÂÈˆÌ¤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ÙËÓ ÂÌÊ¿-ÓÈÛË ·ıËÚÔÛÎÏËÚˆÙÈÎ‹˜ Î·Ú-‰È·ÁÁÂÈ·Î‹˜ ÓfiÛÔ˘ ÌÔÚÂ› Ó·Ô‰ËÁ‹ÛÂÈ ÛÂ ·‡ÍËÛË ÙË˜ ·ÚÙË-ÚÈ·Î‹˜ ›ÂÛË˜ ÌÂ Î›Ó‰˘ÓÔ ÙËÓ ÂÌ-Ê¿ÓÈÛË ÂÓfi˜ ·ÈÌÔÚÚ·ÁÈÎÔ‡ ÂÁÎÂ-Ê·ÏÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘. ∏ Ì¤ÙÚÈ·

Ï‹„Ë ·ÏÎÔfiÏ (2 ÔÙ¿ ÙËÓ ËÌ¤Ú·ÁÈ· ÙÔ˘˜ ¿ÓÙÚÂ˜ Î·È 1 ÔÙfi ÙËÓËÌ¤Ú· ÁÈ· ÙÈ˜ Á˘Ó·›ÎÂ˜) ıÂˆÚÂ›-Ù·È ·Ô‰ÂÎÙ‹ ÛÂ ¿ÙÔÌ· Ô˘ ‰ÂÓ¤¯Ô˘Ó ÚÔ‰È¿ıÂÛË ÛÙËÓ Î·Ù¿-¯ÚËÛË ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ.∞·ÈÙÂ›Ù·È Ë ¿ÌÂÛË ‰È·ÎÔ‹ÙË˜ Î·Ù·Ó¿ÏˆÛË˜ ·ÏÎÔÔÏÔ‡¯ˆÓÔÙÒÓ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ˘„ËÏ¿Â›Â‰· ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ.32 33 øÛ-ÙfiÛÔ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ Â›Â‰·ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ < 500 mg/dl ‰ÂÓÚ¤ÂÈ Ó· ·ÔÎÏÂÈÛıÂ› Ë Ì¤-ÙÚÈ· Î·Ù·Ó¿ÏˆÛË ·ÏÎÔÔÏÔ‡¯ˆÓÔÙÒÓ.34

º·ÚÌ·ÎÂ˘ÙÈÎ‹ ·ÁˆÁ‹

™Â ·ÛıÂÓÂ›˜ ÌÂ ˘ÂÚÙÚÈÁÏ˘ÎÂÚÈ-‰·ÈÌ›· Ô˘ ¤¯Ô˘Ó ·ÙÔÌÈÎfi ‹ ÎÏË-ÚÔÓÔÌÈÎfi ÈÛÙÔÚÈÎfi ÚÒÈÌË˜ ÛÙÂ-Ê·ÓÈ·›·˜ ÓfiÛÔ˘ Èı·Ó¿ ··ÈÙÂ›-Ù·È Ë ¯ÔÚ‹ÁËÛË Ê·ÚÌ·ÎÂ˘ÙÈÎ‹˜·ÁˆÁ‹˜. ¶Ú¤ÂÈ ÛÂ ·˘Ù¤˜ ÙÈ˜ Â-ÚÈÙÒÛÂÈ˜ Ó· ÚÔÙÈÌÒÓÙ·È Ê¿Ú-Ì·Î· Ô˘ ÌÂÈÒÓÔ˘Ó Ù· Â›Â‰·ÙˆÓ ÌÈÎÚÒÓ ˘ÎÓÒÓ LDL ÛˆÌ·ÙÈ-‰›ˆÓ Î·È ·˘Í¿ÓÔ˘Ó Ù· Â›Â‰·ÙË˜ HDL2 ¯ÔÏËÛÙÂÚfiÏË˜ (¶›Ó·-Î·˜ 6).

™ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ÚÒÈÌË ÛÙÂ-Ê·ÓÈ·›· ÓfiÛÔ ‹ ÛÙ· ¿ÙÔÌ· ˘„Ë-ÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛËÚÒÈÌË˜ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘, ÔÈÛÙ·Ù›ÓÂ˜ ·ÔÙÂÏÔ‡Ó ÙÔ Ê¿ÚÌ·-ÎÔ ÚÒÙË˜ ÂÈÏÔÁ‹˜ ÁÈ· ÙË ÌÂ›-ˆÛË ÙË˜ LDL ¯ÔÏËÛÙÂÚfiÏË˜.35

∂Ó·ÏÏ·ÎÙÈÎ¿, ÚÔÙÂ›ÓÂÙ·È ÔÛ˘Ó‰˘·ÛÌfi˜ ÛÙ·Ù›ÓË˜ ÌÂ ÓÈÎÔ-ÙÈÓÈÎfi ÔÍ‡. ΔÔ ÓÈÎÔÙÈÓÈÎfi ÔÍ‡ÌÂÈÒÓÂÈ Ù· Â›Â‰· ÙˆÓ ÌÈÎÚÒÓ˘ÎÓÒÓ LDL ÛˆÌ·ÙÈ‰›ˆÓ Î·È

·˘Í¿ÓÂÈ Ù· Â›Â‰· ÙË˜ HDL2¯ÔÏËÛÙÂÚfiÏË˜. ™Â Ì›· ÌÂÏ¤ÙË(Coronary Drug Project), Ë ıÂÚ·-Â›· ÌÂ ÓÈÎÔÙÈÓÈÎfi ÔÍ‡ ÛÂ ¿Ó‰ÚÂ˜·ÛıÂÓÂ›˜ ÌÂ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·È-Ì›· Î·È ÂÁÎ·ÙÂÛÙËÌ¤ÓË ·ıËÚˆ-Ì·ÙÈÎ‹ ÓfiÛÔ Ô‰‹ÁËÛÂ ÛÂ Ì›· Î·-Ù¿ 15% ÌÂ›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌ-Ê¿ÓÈÛË˜ ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ô-Î·Ú‰›Ô˘36 Î·È ÌÂ›ˆÛÂ Î·Ù¿ 10%ÙËÓ ÔÏÈÎ‹ ıÓËÙfiÙËÙ· ÛÂ 15 ¯Úfi-ÓÈ·.37 ™ÙË ÌÂÏ¤ÙË ARBITER 2(Arterial Biology for the Investi-gation of the Treatment Effects ofReducing Cholesterol) Ë ÚÔ-Ûı‹ÎË ÓÈÎÔÙÈÓÈÎÔ‡ ÔÍ¤Ô˜ ÛÂ·ÛıÂÓÂ›˜ ÌÂ ÂÁÎ·ÙÂÛÙËÌ¤ÓË ·ıË-ÚÔÛÎÏ‹ÚˆÛË Ô˘ ¤·ÈÚÓ·Ó ‹‰ËÛÙ·Ù›ÓË Â›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓÚfiÏË„Ë ÙË˜ ÂÍ¤ÏÈÍË˜ ÙË˜ ·ıË-ÚˆÌ·ÙÈÎ‹˜ ÓfiÛÔ˘ ÙˆÓ Î·ÚˆÙ›-‰ˆÓ (¶›Ó·Î·˜ 7).38

√ Û˘Ó‰˘·ÛÌfi˜ ÓÈÎÔÙÈÓÈÎÔ‡ ÔÍ¤Ô˜ÌÂ ¿ÏÏÔ Ê¿ÚÌ·ÎÔ Ê·›ÓÂÙ·È fiÙÈÂ›Ó·È È‰È·›ÙÂÚ· ·ÔÙÂÏÂÛÌ·ÙÈÎfi˜fiÛÔÓ ·ÊÔÚ¿ ÙË ÌÂ›ˆÛË ÙË˜ ÂÍ¤-ÏÈÍË˜ ÙË˜ ·ıËÚÔÛÎÏ‹ÚˆÛË˜ ÛÂ·ÛıÂÓÂ›˜ ÌÂ ˘ÂÚÙÚÈÁÏ˘ÎÂÚÈ‰·È-Ì›·, ÔÈ ÔÔ›ÔÈ ¤¯Ô˘Ó ·˘ÍËÌ¤ÓÔÎ›Ó‰˘ÓÔ ÚÒÈÌË˜ ÛÙÂÊ·ÓÈ·›·˜ÓfiÛÔ˘. ™Â Ì›· Ù˘¯·ÈÔÔÈËÌ¤ÓËÌÂÏ¤ÙË, ÛÙËÓ ÔÔ›· Û˘ÌÌÂÙÂ›¯·Ó·ÛıÂÓÂ›˜ ÌÂ ·ıËÚÔÛÎÏ‹ÚˆÛË,¯·ÌËÏ¿ Â›Â‰· HDL ¯ÔÏËÛÙÂ-ÚfiÏË˜ Î·È ÔÚÈ·Î¿ ·˘ÍËÌ¤Ó· Â›-Â‰· ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ, Ô Û˘Ó‰˘·-ÛÌfi˜ ÓÈÎÔÙÈÓÈÎÔ‡ ÔÍ¤Ô˜ ÌÂ ÛÈÌ-‚·ÛÙ·Ù›ÓË Â›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ·ÙËÓ ˘ÔÛÙÚÔÊ‹ ÙˆÓ ·ıËÚˆÌ·ÙÈ-ÎÒÓ ‚Ï·‚ÒÓ ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ·ÚÙËÚÈÒÓ, ÂÓÒ Ë ıÂÚ·Â›· ÌÂ ÂÈ-ÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ ‹ ÌÂ ·ÓÙÈÔÍÂÈ-

¶∞ƒ∞°√¡Δ∂™ ∫π¡¢À¡√À

9

¶›Ó·Î·˜ 6: º·ÚÌ·ÎÂ˘ÙÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË ˘ÂÚÙÚÈÁÏ˘ÎÂÚÈ‰·ÈÌ›·˜

∫·ÙËÁÔÚ›· ªÂ›ˆÛË ∞ÓÙÂÓ‰Â›ÍÂÈ˜ ¶·ÚÂÓ¤ÚÁÂÈÂ˜ ªÂ›ˆÛË ÙˆÓ ÌÈÎÚÒÓ, ∞‡ÍËÛË ÙË˜ HDL2Ê·ÚÌ¿ÎÔ˘ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ ˘ÎÓÒÓ LDL ÛˆÌ·ÙÈ‰›ˆÓ ¯ÔÏËÛÙÂÚfiÏË˜

(%)

¡ÈÎÔÙÈÓÈÎfi ÔÍ‡ 17-26% ÀÂÚÂ˘·ÈÛıËÛ›·, ŒÍ·„Ë, ÎÓËÛÌfi˜, ¡·È ¡·È(1500-2000 mg/ËÌÂÚ.) Ë·ÙÈÎ‹ Ó·˘Ù›·, Ë·Ù›ÙÈ‰·,

‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÂÓÂÚÁÔÔ›ËÛË ËÌÈÎÚ·Ó›·˜

ºÈÌÚ¿ÙÂ˜ 18-45% ÀÂÚÂ˘·ÈÛıËÛ›·, ª˘ÔÛ›ÙÈ‰·, ¡·È Ÿ¯È(ÁÂÌÊÈÌÚÔ˙›ÏË Ë·ÙÈÎ‹ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·, ¯ÔÏÔÏÈı›·ÛË

600 mgÃ 2 /ËÌÂÚ., ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘Ê·ÈÓÔÊÈÌÚ¿ÙË ÓÂÊÚÈÎ‹ ·ÓÂ¿ÚÎÂÈ·145 mg/ËÌÂÚ.)

™Ù·Ù›ÓÂ˜ 5% ÀÂÚÂ˘·ÈÛıËÛ›·, ª˘·ÏÁ›·, Ÿ¯È Ÿ¯ÈÂÁÎ˘ÌÔÛ‡ÓË, Ú·‚‰ÔÌ˘fiÏ˘ÛË,

ıËÏ·ÛÌfi˜ ·‰˘Ó·Ì›·

¡ÈÎÔÙÈÓÈÎfi ÔÍ‡ 36% ÿ‰ÈÂ˜ ÌÂ Ù· ÿ‰ÈÂ˜ ÌÂ Ù· ¡·È ¡·È+ ÛÙ·Ù›ÓË ·ÓÙ›ÛÙÔÈ¯· Ê¿ÚÌ·Î· ·ÓÙ›ÛÙÔÈ¯· Ê¿ÚÌ·Î·

‰ˆÙÈÎ¤˜ ‚ÈÙ·Ì›ÓÂ˜ Ô‰‹ÁËÛÂ ÛÂÂÈÙ¿¯˘ÓÛË ÙË˜ ÂÍ¤ÏÈÍË˜ ÙˆÓ·ıËÚˆÌ·ÙÈÎÒÓ ‚Ï·‚ÒÓ (ÌÂÏ¤ÙËHATS).39 ™Â Ì›· ¿ÏÏË ÌÂÏ¤ÙË,ÛÙËÓ ÔÔ›· Û˘ÌÌÂÙÂ›¯·Ó ·ÛıÂ-ÓÂ›˜ ÌÂ ·˘ÍËÌ¤Ó· Â›Â‰· apoB,Ô Û˘Ó‰˘·ÛÌfi˜ ÓÈÎÔÙÈÓÈÎÔ‡ ÔÍ¤Ô˜ÌÂ ÎÔÏÂÛÙÈfiÏË ÌÂ›ˆÛÂ ÙËÓ ÂÍ¤-ÏÈÍË ÙˆÓ ·ıËÚˆÌ·ÙÈÎÒÓ ‚Ï·‚ÒÓÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙË ıÂÚ·Â›· ÌÂÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ.40

√È ÊÈÌÚ¿ÙÂ˜ Â›ÛË˜ ÌÂÈÒÓÔ˘ÓÙ· Â›Â‰· ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ.™Â Ì›· ÌÂÏ¤ÙË (Veterans AffairsHigh-Density Lipoprotein Chole-sterol Intervention Trial) Ë ¯ÔÚ‹-ÁËÛË ÁÂÌÊÈÌÚÔ˙›ÏË˜ ÛÂ ·ÛıÂ-ÓÂ›˜ ÌÂ ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ Â›¯Â ˆ˜·ÔÙ¤ÏÂÛÌ· ÛËÌ·ÓÙÈÎ‹ ÌÂ›ˆÛËÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ Û˘Ì‚·Ì¿ÙˆÓ Î·ÈÙˆÓ ÌË ı·Ó·ÙËÊfiÚˆÓ ÂÌÊÚ·ÁÌ¿-ÙˆÓ ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘. øÛÙfiÛÔ‰ÂÓ ·Ú·ÙËÚ‹ıËÎÂ ÌÂ›ˆÛË ÙˆÓı·Ó·ÙËÊfiÚˆÓ ÂÌÊÚ·ÁÌ¿ÙˆÓ ÙÔ˘Ì˘ÔÎ·Ú‰›Ô˘ ‹ ÙˆÓ ı·Ó¿ÙˆÓ ·fiÔÔÈ·‰‹ÔÙÂ ·ÈÙ›· ÛÂ Û‡ÁÎÚÈÛËÌÂ ÙË ¯ÔÚ‹ÁËÛË ÂÈÎÔÓÈÎÔ‡ Ê·Ú-Ì¿ÎÔ˘ (¶›Ó·Î·˜ 8).41 ¶·ÚfiÌÔÈ··ÔÙÂÏ¤ÛÌ·Ù· ¤‰ÂÈÍÂ Î·È Ì›· ÌÂ-Ï¤ÙË (World Health OrganizationTrial) ÛÙËÓ ÔÔ›· ¯ÔÚËÁ‹ıËÎÂÎÏÔÊÈÌÚ¿ÙË.42

∞ÓÙÈÌÂÙÒÈÛË ·ÛıÂÓÒÓ ÌÂ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË 2

™‡ÌÊˆÓ· ÌÂ ÙËÓ ∞ÌÂÚÈÎ·ÓÈÎ‹¢È·‚ËÙÔÏÔÁÈÎ‹ ∂Ù·ÈÚ›·43 Î·È ÙÈ˜Ô‰ËÁ›Â˜ ÙË˜ NCEP35 Û˘ÓÈÛÙ¿Ù·ÈË ¯ÔÚ‹ÁËÛË ÛÙ·Ù›ÓË˜ ÌÂ ÛÎÔfiÙË ÌÂ›ˆÛË ÙË˜ LDL ¯ÔÏËÛÙÂÚfi-ÏË˜ ÛÂ fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ™¢2 ÌÂ ·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ ÁÈ·ÙËÓ ÂÌÊ¿ÓÈÛË ÛÙÂÊ·ÓÈ·›·˜ Ófi-ÛÔ˘. ™Â ·ÛıÂÓÂ›˜ ÌÂ ™¢2, Ô Û˘Ó-‰˘·ÛÌfi˜ ÛÙ·Ù›ÓË˜ ÌÂ ÊÈÌÚ¿ÙË¯ÚËÛÈÌÔÔÈÂ›Ù·È Û˘¯Ó¿ ÁÈ· ÙËÓ

·ÓÙÈÌÂÙÒÈÛË ÙË˜ Û˘Ó˘¿Ú¯Ô˘-

Û·˜ ˘ÂÚÙÚÈÁÏ˘ÎÂÚÈ‰·ÈÌ›·˜. ŸÌˆ˜

ÛÙË ÌÂÏ¤ÙË FIELD (Fenofibrate

Intervention and Event Lowering

in Diabetes Trial) Ë ¯ÔÚ‹ÁËÛË

Ê·ÈÓÔÊÈÌÚ¿ÙË˜ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ

™¢2 Â›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÌÈ· ÌÈ-

ÎÚ‹ Î·È fi¯È ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹

ÌÂ›ˆÛË ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì-

‚·Ì¿ÙˆÓ ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙË ¯Ú‹-

ÛË ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ (ÌÂ›ˆÛË

Î·Ù¿ 11%, Û¯ÂÙÈÎfi˜ Î›Ó‰˘ÓÔ˜:

0.89, 95% ‰È¿ÛÙËÌ· ÂÌÈÛÙÔÛ‡-

ÓË˜: 0.75-1.05, p=0.16).44

Œ¯ÂÈ ‰È·Ù˘ˆıÂ› Ë ¿Ô„Ë fiÙÈ ÙÔ

ÓÈÎÔÙÈÓÈÎfi ÔÍ‡ ‰ÂÓ Ú¤ÂÈ Ó·

·ÔÙÂÏÂ› Ê¿ÚÌ·ÎÔ ÂÎÏÔÁ‹˜ ÁÈ·

ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ˘ÂÚÙÚÈ-

ÁÏ˘ÎÂÚÈ‰·ÈÌ›·˜ ÛÙÔ˘˜ ‰È·‚ËÙÈ-

ÎÔ‡˜ ·ÛıÂÓÂ›˜ ÁÈ·Ù› ¤¯ÂÈ ‰˘ÛÌÂ-

Ó‹ Â›‰Ú·ÛË ÛÙÔ ÁÏ˘Î·ÈÌÈÎfi

¤ÏÂÁ¯Ô. øÛÙfiÛÔ ÛÙË ÌÂÏ¤ÙË

ADMIT,45 ÛÙËÓ ÔÔ›· Û˘ÌÌÂÙÂ›-

¯·Ó 468 ¿ÙÔÌ·, ·Ú·ÙËÚ‹ıËÎÂ

fiÙÈ Ë ¯ÔÚ‹ÁËÛË ÓÈ·Û›ÓË˜ ÛÂ

·ÛıÂÓÂ›˜ ÌÂ ™¢2 Â›Ó·È ·ÛÊ·Ï‹˜.

¶Ú¿ÁÌ·ÙÈ Ë ıÂÚ·Â›· ÌÂ ÓÈ·Û›ÓË

ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ‹ ¯ˆÚ›˜ ™¢2

Ô‰‹ÁËÛÂ ÛÂ ÛËÌ·ÓÙÈÎ‹ ·‡ÍËÛË

ÙË˜ HDL ¯ÔÏËÛÙÂÚfiÏË˜ Î·Ù¿

28.9% Î·È 29.3% ·ÓÙ›ÛÙÔÈ¯·, ÛÂ

ÌÂ›ˆÛË ÙË˜ LDL ¯ÔÏËÛÙÂÚfiÏË˜

Î·Ù¿ 8.3% Î·È 9% ·ÓÙ›ÛÙÔÈ¯· Î·È

ÛÂ ÌÂ›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ÙÚÈ-

ÁÏ˘ÎÂÚÈ‰›ˆÓ Î·Ù¿ 22.7% Î·È

28.4% ·ÓÙ›ÛÙÔÈ¯· (p< 0.001, ÓÈ·-

Û›ÓË ¤Ó·ÓÙÈ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿-

ÎÔ˘). ¶·Ú·ÙËÚ‹ıËÎÂ Â›ÛË˜ Ì›·

Ì¤ÙÚÈ· ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ

ÙË˜ ÁÏ˘Îfi˙Ë˜ Î·Ù¿ 5% Î·È 6.6%

(p= 0.04 Î·È p< 0.001, ÓÈ·Û›ÓË

¤Ó·ÓÙÈ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘)

·ÓÙ›ÛÙÔÈ¯·, ÂÓÒ ‰ÂÓ ·Ú·ÙËÚ‹-

ıËÎÂ Î·Ì›· ÌÂÙ·‚ÔÏ‹ ÛÙ· Â›Â-

‰· ÙË˜ ÁÏ˘ÎÔ˙˘ÏÈˆÌ¤ÓË˜ ·ÈÌÔ-

ÛÊ·ÈÚ›ÓË˜.39 45 46

™ ∂ ¶ Δ ∂ ª μ ƒ π √ ™ 2 0 0 8

10

¶›Ó·Î·˜ 7: ¶ÚÔÛı‹ÎË ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ ‹ ÓÈÎÔÙÈÓÈÎÔ‡ ÔÍ¤Ô˜ ÛÂ ·ÛıÂÓÂ›˜ Ô˘ ¤·ÈÚÓ·Ó‹‰Ë ıÂÚ·Â›· ÌÂ ÛÙ·Ù›ÓË (ÌÂÏ¤ÙË ARBITER 2)

∞Ú¯ÈÎ¿ Â›Â‰· 12 Ì‹ÓÂ˜ p

∂ÈÎÔÓÈÎfi ¡ÈÎÔÙÈÓÈÎfi ∂ÈÎÔÓÈÎfi ¡ÈÎÔÙÈÓÈÎfi ∂ÈÎÔÓÈÎfi ¡ÈÎÔÙÈÓÈÎfiÊ¿ÚÌ·ÎÔ ÔÍ‡ Ê¿ÚÌ·ÎÔ ÔÍ‡ Ê¿ÚÌ·ÎÔ ÔÍ‡(¡= 71) (¡= 78) (¡= 71) (¡= 78)

TCHOL 161±29 154±27 156±24 155±38 0.06 0.92

LDL-C 91±22 87±17 86±20 85±25 0.37 0.42

HDL-C 40±7 39±7 40±9 47±16 0.61 <0.001

ΔÚÈÁÏ˘ÎÂÚÈ‰›· 172±104 154±82 164±83 134±87 0.07 0.009

Non-HDL-C 121±27 115±26 115±21 107±34 0.03 0.02

CIMT (mm) 0.868±0.207 0.893±0.259 0.912±0.202 0.907±0.234 <0.001 0.23

TCHOL: ÔÏÈÎ‹ ¯ÔÏËÛÙÂÚfiÏË, CIMT: carotid intima-media thickness (¿¯˘ÓÛË ÙÔ˘ ÙÔÈ¯ÒÌ·ÙÔ˜ ÙˆÓ Î·ÚˆÙ›‰ˆÓ)ΔÚÔÔÔ›ËÛË ·fi: Circulation 2004;110;3512-3517

¶›Ó·Î·˜ 8: °ÂÌÊÈÌÚÔ˙›ÏË ¤Ó·ÓÙÈ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘(ÌÂÏ¤ÙË VA-HIT)

™‡Ì‚·Ì· ∂ÈÎÔÓÈÎfi °ÂÌÊÈÌÚÔ˙›ÏË ªÂ›ˆÛË PÊ¿ÚÌ·ÎÔ ¡(%) Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ %

¡(%) (95% ‰È¿ÛÙËÌ· ÂÌÈÛÙÔÛ‡ÓË˜)

275 (21.7) 219 (17.3) 22 (7-35) 0.006

184 (14.5) 146 (11.6) 23 (4-38) 0.02

220 (17.4) 198 (15.7) 11 (2-38) 0.23

™¡: ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ˜ ΔÚÔÔÔ›ËÛË ·fi: New England Journal of Medicine 1999;341:410-8

ªË ı·Ó·ÙËÊfiÚÔ¤ÌÊÚ·ÁÌ· ‹ ı¿Ó·ÙÔ˜

ÂÍ·ÈÙ›·˜ ™¡

ªË ı·Ó·ÙËÊfiÚÔ¤ÌÊÚ·ÁÌ· ÙÔ˘Ì˘ÔÎ·Ú‰›Ô˘

£¿Ó·ÙÔ˜ ·fiÔÔÈ·‰‹ÔÙÂ

·ÈÙ›·

¶Ú·ÎÙÈÎ¤˜ Ô‰ËÁ›Â˜

¢ÂÓ ˘¿Ú¯Ô˘Ó Û·ÊÂ›˜ Ô‰ËÁ›Â˜ÁÈ· ÙËÓ Â›ÙÂ˘ÍË Û˘ÁÎÂÎÚÈÌ¤-ÓˆÓ ÛÙfi¯ˆÓ fiÛÔÓ ·ÊÔÚ¿ Ù·Â›Â‰· ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ.™˘ÓÈÛÙ¿Ù·È ˆÛÙfiÛÔ Ë ¯ÔÚ‹ÁËÛËÊÈÌÚ·ÙÒÓ ÛÂ ¿ÙÔÌ· ÌÂ Â›Â-‰· ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ ¿Óˆ ·fi1000 mg/dl ÁÈ· ÙË ÌÂ›ˆÛË ÙÔ˘ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛË˜ ·ÁÎÚÂ·-Ù›ÙÈ‰·˜.20 ™Â ·ÛıÂÓÂ›˜ ÌÂ ÌÈÎÚfi-ÙÂÚ· Â›Â‰· ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ(>200 mg/dl) fiÙ·Ó ÂÈÙÂ˘¯ıÂ› ÔÛÙfi¯Ô˜ fiÛÔÓ ·ÊÔÚ¿ ÙËÓ LDL¯ÔÏËÛÙÂÚfiÏË, Û˘ÓÈÛÙ¿Ù·È Ë ÌÂ›-ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ÙÚÈÁÏ˘-ÎÂÚÈ‰›ˆÓ, ·Ó Î·È ‰ÂÓ ˘¿Ú¯Ô˘Ó·ÎfiÌ· Û·Ê‹ ‰Â‰ÔÌ¤Ó· Ô˘ Ó·˘ÔÛÙËÚ›˙Ô˘Ó ·˘Ù‹ ÙË Û‡ÛÙ·-ÛË.

™˘ÌÂÚ¿ÛÌ·Ù· Î·È Û˘ÛÙ¿ÛÂÈ˜

√ ·ÛıÂÓ‹˜ Ô˘ ÂÚÈÁÚ¿„·ÌÂÛÙËÓ ·Ú¯‹ ¤¯ÂÈ ·˘ÍËÌ¤Ó· Â›Â-‰· ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ Î·È ¯·ÌËÏ¿Â›Â‰· HDL ¯ÔÏËÛÙÂÚfiÏË˜.ŸÌˆ˜ Ù· Â›Â‰· ÙË˜ LDL ¯ÔÏË-ÛÙÂÚfiÏË˜ ÁÈ· ÙÔ Û˘ÁÎÂÎÚÈÌ¤ÓÔ·ÛıÂÓ‹ ‚Ú›ÛÎÔÓÙ·È ÂÓÙfi˜ ÙˆÓ ıÂ-Ú·Â˘ÙÈÎÒÓ ÛÙfi¯ˆÓ. ΔfiÛÔ Ù· ·˘-ÍËÌ¤Ó· Â›Â‰· ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ-

‰›ˆÓ, fiÛÔ Î·È Ù· ¯·ÌËÏ¿ Â›Â‰·ÙË˜ HDL ‰ÂÓ Â·ÚÎÔ‡Ó ÛÙÔ Ó·Î·ıÔÚ›ÛÔ˘Ó Â¿Ó Ô ·ÛıÂÓ‹˜ ¤¯ÂÈÛ˘ÁÁÂÓ‹ ˘ÂÚÙÚÈÁÏ˘ÎÂÚÈ‰·ÈÌ›·,ÔÈÎÔÁÂÓ‹ ÌÂÈÎÙ‹ ˘ÂÚÏÈÈ‰·ÈÌ›·‹ ÔÈÎÔÁÂÓ‹ ˘Ô·ÏÊ·ÏÈÔÚˆÙÂ˚-Ó·ÈÌ›·. ¢ÂÓ Ê·›ÓÂÙ·È Ó· ˘¿Ú¯ÂÈÎ¿ÔÈÔ ˘ÔÎÂ›ÌÂÓÔ ÓfiÛËÌ· Ô˘Ó· ÌÔÚÂ› Ó· ÂÍËÁ‹ÛÂÈ ÙËÓ ˘ÂÚ-ÙÚÈÁÏ˘ÎÂÚÈ‰·ÈÌ›·, ÂÓÒ ‰ÂÓ ˘¿Ú-¯Ô˘Ó Â›ÛË˜ Î·È ¿ÏÏÔÈ ·Ú¿ÁÔ-ÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛËÚÒÈÌË˜ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘. ΔÔÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÌÔÚÂ› Ó·Ì·˜ ‚ÔËı‹ÛÂÈ ÛÙËÓ ÂÎÙ›ÌËÛË·ÛıÂÓÒÓ ÌÂ ˘ÂÚÙÚÈÁÏ˘ÎÂÚÈ‰·È-Ì›·. ¶Ú¤ÂÈ Ó· ·Ó·˙ËÙËıÔ‡ÓÛ˘ÁÁÂÓÂ›˜ ÌÂ ÂÁÎ·ÙÂÛÙËÌ¤ÓË·ıËÚÔÛÎÏ‹ÚˆÛË, Ë ËÏÈÎ›· ÙË˜ÂÌÊ¿ÓÈÛË˜ ÙË˜ ·ıËÚÔÛÎÏ‹Úˆ-ÛË˜, Î·ıÒ˜ Â›ÛË˜ Î·È ÛÂ ÂÚ›-ÙˆÛË Ô˘ Î¿ÔÈÔ˜ Û˘ÁÁÂÓ‹˜¤¯ÂÈ Âı¿ÓÂÈ, Ú¤ÂÈ Ó· ·Ó·˙Ë-ÙÂ›Ù·È Ë ËÏÈÎ›· Î·È Ë ·ÈÙ›· ÙÔ˘ ı·-Ó¿ÙÔ˘. ∂›ÛË˜, ÙÔ ÔÈÎÔÁÂÓÂÈ·ÎfiÈÛÙÔÚÈÎfi Â›Ó·È ¯Ú‹ÛÈÌÔ ÁÈ·Ù› ÌÔ-ÚÂ› Ó· ·ÔÎ·Ï‡„ÂÈ Î·È ¿ÏÏ· ¿ÙÔ-Ì· Ô˘ ¯ÚÂÈ¿˙ÔÓÙ·È ˘ÔÏÈÈ‰·È-ÌÈÎ‹ ·ÁˆÁ‹. ŒÓ· ÔÈÎÔÁÂÓÂÈ·ÎfiÈÛÙÔÚÈÎfi ÚÒÈÌË˜ ÛÙÂÊ·ÓÈ·›·˜ÓfiÛÔ˘ ‚ÔËı¿ÂÈ ÛÙË ‰È¿ÁÓˆÛËÙË˜ ÔÈÎÔÁÂÓÔ‡˜ ÌÂÈÎÙ‹˜ ˘ÂÚÏÈ-È‰·ÈÌ›·˜ ‹ ÙË˜ ÔÈÎÔÁÂÓÔ‡˜ ˘Ô-

·ÏÊ·ÏÈÔÚˆÙÂ˚Ó·ÈÌ›·˜.

ŸÙ·Ó ¤Ó·˜ ·ÛıÂÓ‹˜ ¤¯ÂÈ ·ÚÎÂ-ÙÔ‡˜ Û˘ÁÁÂÓÂ›˜ ÌÂ ˘ÂÚÙÚÈÁÏ˘-ÎÂÚÈ‰·ÈÌ›·, ·ÏÏ¿ ¯ˆÚ›˜ ÎÏÈÓÈÎ‹¤Ó‰ÂÈÍË ·ıËÚÔÛÎÏ‹ÚˆÛË˜, Ë·ÓÙÈÌÂÙÒÈÛË ÙË˜ ˘ÂÚÙÚÈÁÏ˘ÎÂ-ÚÈ‰·ÈÌ›·˜ ·ÏÏ¿ Î·È ÙˆÓ ¯·ÌËÏÒÓÂÈ¤‰ˆÓ HDL ¯ÔÏËÛÙÂÚfiÏË˜ÌÔÚÂ› Ó· ÂÈÙÂ˘¯ıÂ› ÌÂ ·ÏÏ·Á‹ÙÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜, Ë ÔÔ›· ÂÚÈ-Ï·Ì‚¿ÓÂÈ ‰›·ÈÙ· ¯·ÌËÏ‹ ÛÂ ıÂÚ-Ì›‰Â˜ Î·È ˙ˆÈÎ¿ Ï›Ë ÛÂ Û˘Ó‰˘·-ÛÌfi ÌÂ ÛˆÌ·ÙÈÎ‹ ¿ÛÎËÛË Î·È·ÒÏÂÈ· ‚¿ÚÔ˘˜.

∞ÛıÂÓÂ›˜ ÌÂ ˘ÂÚÙÚÈÁÏ˘ÎÂÚÈ‰·È-Ì›· Î·È ÚÒÈÌË ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ‹ ·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ÙËÓ ÂÌ-Ê¿ÓÈÛ‹ ÙË˜ ÌÂ ‚¿ÛË ÙÔ ÔÈÎÔÁÂ-ÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Ê·›ÓÂÙ·È fiÙÈ ÂÌ-Ê·Ó›˙Ô˘Ó ÔÈÎÔÁÂÓ‹ ÌÂÈÎÙ‹ ˘ÂÚ-ÏÈÈ‰·ÈÌ›· ‹ ÔÈÎÔÁÂÓ‹ ˘Ô·ÏÊ·-ÏÈÔÚˆÙÂ˚Ó·ÈÌ›·. ™Â ·˘Ù¤˜ ÙÈ˜ÂÚÈÙÒÛÂÈ˜ ¤Ú·Ó ÙË˜ ·ÏÏ·Á‹˜ÙÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜ Ú¤ÂÈ Ó· Û˘-˙ËÙËıÂ› Ë ¯ÔÚ‹ÁËÛË Ê·ÚÌ·ÎÂ˘-ÙÈÎ‹˜ ·ÁˆÁ‹˜. ∞Ó Î·È ‰ÂÓ ˘¿Ú-¯Ô˘Ó Û·Ê‹ ‰Â‰ÔÌ¤Ó· ÁÈ· ÙËÓ Î·-Ù¿ÏÏËÏË ıÂÚ·Â›· ÛÂ ·˘Ù¤˜ ÙÈ˜ÂÚÈÙÒÛÂÈ˜, ÚÔÙÂ›ÓÂÙ·È Ë ¯Ô-Ú‹ÁËÛË Û˘Ó‰˘·ÛÌÔ‡ ÛÙ·Ù›ÓË˜ÌÂ ÓÈÎÔÙÈÓÈÎfi ÔÍ‡ (‹ ÊÈÌÚ¿ÙË).

¶∞ƒ∞°√¡Δ∂™ ∫π¡¢À¡√À

11


1. Goldstein JL, Schrott HG, Hazzard WR,Bierman EL, Motulsky AG. Hyperlipi-demia in coronary heart disease. II.Genetic analysis of lipid levels in 176families and delineation of a newinherited disorder, combined hyperlipi-demia. J Clin Invest 1973;52:1544-68.

2. Brunzell JD, Schrott HG, Motulsky AG,Bierman EL. Myocardial infarction inthe familial forms of hypertriglyceri-demia. Metabolism 1976;25:313-20.

3. Genest JJ, Jr., Martin-Munley SS, McNamara JR, Ordovas JM, Jenner J,Myers RH, et al. Familial lipoproteindisorders in patients with prematurecoronary artery disease. Circulation1992;85:2025-33.

4. Hopkins PN, Heiss G, Ellison RC,Province MA, Pankow JS, Eckfeldt JH,et al. Coronary artery disease risk infamilial combined hyperlipidemia andfamilial hypertriglyceridemia: a case-control comparison from the NationalHeart, Lung, and Blood InstituteFamily Heart Study. Circulation 2003;108: 519-23.

5. Hokanson JE, Austin MA. Plasma trigly-ceride level is a risk factor forcardiovascular disease independent ofhigh-density lipoprotein cholesterollevel: a meta-analysis of population-based prospective studies. J Cardio-vasc Risk 1996;3:213-9.

6. Carr MC, Brunzell JD. Abdominal obe-sity and dyslipidemia in the metabolicsyndrome: importance of type 2 diabe-tes and familial combined hyperlipide-mia in coronary artery disease risk. JClin Endocrinol Metab 2004;89:2601-7.

7. Watanabe H, Soderlund S, Soro-Paa-vonen A, Hiukka A, Leinonen E, Alago-na C, et al. Decreased high-density li-poprotein (HDL) particle size, prebeta,and large HDL subspecies concentra-tion in Finnish low-HDL families: rela-tionship with intima-media thickness.Arterioscler Thromb Vasc Biol 2006;26:897-902.

8. Zambon A, Brown BG, Deeb SS, Bru-nzell JD. Genetics of apolipoprotein Band apolipoprotein AI and prematurecoronary artery disease. J Intern Med2006;259:473-80.

9. Austin MA, McKnight B, Edwards KL,Bradley CM, McNeely MJ, Psaty BM,et al. Cardiovascular disease mortalityin familial forms of hypertriglyceride-mia: A 20-year prospective study.Circulation 2000;101:2777-82.

10. Despres JP, Lemieux I. Abdominal obe-sity and metabolic syndrome. Nature2006;444:881-7.

11. Lemieux I, Pascot A, Couillard C, Lama-rche B, Tchernof A, Almeras N, et al.Hypertriglyceridemic waist: A marker ofthe atherogenic metabolic triad (hype-rinsulinemia; hyperapolipoprotein B;

small, dense LDL) in men? Circulation2000;102:179-84.

12. Nordestgaard BG, Benn M, Schnohr P,Tybjaerg-Hansen A. Nonfasting trigly-cerides and risk of myocardial infar-ction, ischemic heart disease, and de-ath in men and women. JAMA 2007;298:299-308.

13. Lamarche B, Tchernof A, Moorjani S,Cantin B, Dagenais GR, Lupien PJ, etal. Small, dense low-density lipopro-tein particles as a predictor of the riskof ischemic heart disease in men.Prospective results from the QuebecCardiovascular Study. Circulation1997;95:69-75.

14. Brunzell JD, Albers JJ, Chait A, GrundySM, Groszek E, McDonald GB. Plasmalipoproteins in familial combinedhyperlipidemia and monogenic familialhypertriglyceridemia. J Lipid Res1983;24:147-55.

15. Cui Y, Blumenthal RS, Flaws JA, White-man MK, Langenberg P, Bachorik PS,et al. Non-high-density lipoproteincholesterol level as a predictor ofcardiovascular disease mortality. ArchIntern Med 2001;161:1413-9.

16. Pischon T, Girman CJ, Sacks FM, RifaiN, Stampfer MJ, Rimm EB. Non-high-density lipoprotein cholesterol andapolipoprotein B in the prediction ofcoronary heart disease in men.Circulation 2005;112:3375-83.

17. Yusuf S, Hawken S, Ounpuu S, DansT, Avezum A, Lanas F, et al. Effect ofpotentially modifiable risk factorsassociated with myocardial infarctionin 52 countries (the INTERHEARTstudy): case-control study. Lancet2004;364:937-52.

18. Maher VM, Brown BG, Marcovina SM,Hillger LA, Zhao XQ, Albers JJ. Effectsof lowering elevated LDL cholesterolon the cardiovascular risk of lipo-protein(a). JAMA 1995;274:1771-4.

19. Berneis KK, Krauss RM. Metabolicorigins and clinical significance of LDLheterogeneity. J Lipid Res 2002;43:1363-79.

20. Brunzell JD, Schrott HG. Theinteraction of familial and secondarycauses of hypertriglyceridemia: role inpancreatitis. Trans Assoc AmPhysicians 1973;86:245-54.

21. Purnell JQ, Kahn SE, Albers JJ, NevinDN, Brunzell JD, Schwartz RS. Effectof weight loss with reduction of intra-abdominal fat on lipid metabolism inolder men. J Clin Endocrinol Metab2000;85:977-82.

22. Knowler WC, Barrett-Connor E, FowlerSE, Hamman RF, Lachin JM, WalkerEA, et al. Reduction in the incidenceof type 2 diabetes with lifestyle inter-vention or metformin. N Engl J Med2002;346:393-403.

23. Lichtenstein AH, Appel LJ, Brands M,Carnethon M, Daniels S, Franch HA,et al. Summary of American HeartAssociation Diet and LifestyleRecommendations revision 2006.Arterioscler Thromb Vasc Biol2006;26:2186-91.

24. Tuomilehto J, Lindstrom J, ErikssonJG, Valle TT, Hamalainen H, Ilanne-Parikka P, et al. Prevention of type 2diabetes mellitus by changes inlifestyle among subjects with impairedglucose tolerance. N Engl J Med2001;344:1343-50.

25. Duncan GE, Anton SD, Sydeman SJ,Newton RL, Jr., Corsica JA, DurningPE, et al. Prescribing exercise atvaried levels of intensity and freque-ncy: a randomized trial. Arch InternMed 2005;165:2362-9.

26. Blair SN, LaMonte MJ. How much andwhat type of physical activity isenough? What physicians should telltheir patients. Arch Intern Med2005;165:2324-5.

27. Leon AS, Sanchez OA. Response ofblood lipids to exercise training aloneor combined with dietary intervention.Med Sci Sports Exerc 2001;33:S502-15; discussion S528-9.

28. Ross R, Dagnone D, Jones PJ, SmithH, Paddags A, Hudson R, et al.

Reduction in obesity and relatedcomorbid conditions after diet-indu-ced weight loss or exercise-inducedweight loss in men. A randomized,controlled trial. Ann Intern Med2000;133:92-103.

29. Havel PJ. Dietary fructose: implicationsfor dysregulation of energy homeo-stasis and lipid/carbohydrate metabo-lism. Nutr Rev 2005;63:133-57.

30. GISSI-Prevenzione, Investigators. Die-tary supplementation with n-3 polyun-saturated fatty acids and vitamin Eafter myocardial infarction: results ofthe GISSI-Prevenzione trial. GruppoItaliano per lo Studio della Sopravvi-venza nell'Infarto miocardico. Lancet1999;354:447-55.

31. Hooper L, Thompson RL, Harrison RA,Summerbell CD, Ness AR, Moore HJ,et al. Risks and benefits of omega 3fats for mortality, cardiovascular di-sease, and cancer: systematic review.BMJ 2006;332:752-60.

32. Taskinen MR, Nikkila EA. Nocturnalhypertriglyceridemia andhyperinsulinemia following moderateevening intake of alcohol. Acta MedScand 1977;202:173-7.

33. Erkelens DW, Brunzell JD. Effect ofcontrolled alcohol feeding on trigly-cerides in patients with outpatient'alcohol hypertriglyceridemia'. J HumNutr 1980;34:370-5.

34. Phillips NR, Havel RJ, Kane JP. Levelsand interrelationships of serum andlipoprotein cholesterol and triglyceri-des. Association with adiposity andthe consumption of ethanol, tobacco,and beverages containing caffeine.Arteriosclerosis 1981;1:13-24.

35. Grundy SM, Cleeman JI, Merz CN,Brewer HB, Jr., Clark LT,Hunninghake DB, et al. Implications ofrecent clinical trials for the NationalCholesterol Education Program AdultTreatment Panel III guidelines.Circulation 2004;110:227-39.

36. Clofibrate and niacin in coronary heartdisease. JAMA 1975;231:360-81.

37. Canner PL, Berge KG, Wenger NK,Stamler J, Friedman L, Prineas RJ, etal. Fifteen year mortality in CoronaryDrug Project patients: long-termbenefit with niacin. J Am Coll Cardiol1986;8:1245-55.

38. Taylor AJ, Sullenberger LE, Lee HJ,Lee JK, Grace KA. Arterial Biology forthe Investigation of the TreatmentEffects of Reducing Cholesterol(ARBITER) 2: a double-blind, placebo-controlled study of extended-releaseniacin on atherosclerosis progressionin secondary prevention patients trea-ted with statins. Circulation 2004;

110:3512-7.39. Brown BG, Zhao XQ, Chait A, Fisher

LD, Cheung MC, Morse JS, et al.Simvastatin and niacin, antioxidantvitamins, or the combination for theprevention of coronary disease. NEngl J Med 2001;345:1583-92.

40. Brown G, Albers JJ, Fisher LD,Schaefer SM, Lin JT, Kaplan C, et al.Regression of coronary artery diseaseas a result of intensive lipid-loweringtherapy in men with high levels ofapolipoprotein B. N Engl J Med1990;323:1289-98.

41. Rubins HB, Robins SJ, Collins D, FyeCL, Anderson JW, Elam MB, et al.Gemfibrozil for the secondaryprevention of coronary heart diseasein men with low levels of high-densitylipoprotein cholesterol. VeteransAffairs High-Density Lipoprotein Cho-lesterol Intervention Trial StudyGroup. N Engl J Med 1999;341:410-8.

42. The coronary drug project. JAMA1972;221:918.

43. Haffner SM. Management ofdyslipidemia in adults with diabetes.Diabetes Care 1998;21:160-78.

44. Keech A, Simes RJ, Barter P, Best J,Scott R, Taskinen MR, et al. Effects oflong-term fenofibrate therapy oncardiovascular events in 9795 peoplewith type 2 diabetes mellitus (theFIELD study): randomised controlledtrial. Lancet 2005;366:1849-61.

45. Elam MB, Hunninghake DB, Davis KB,Garg R, Johnson C, Egan D, et al.Effect of niacin on lipid and lipoproteinlevels and glycemic control in patientswith diabetes and peripheral arterialdisease: the ADMIT study: Arandomized trial. Arterial DiseaseMultiple Intervention Trial. JAMA2000;284:1263-70.

46. Grundy SM, Vega GL, McGovern ME,Tulloch BR, Kendall DM, Fitz-PatrickD, et al. Efficacy, safety, andtolerability of once-daily niacin for thetreatment of dyslipidemia associatedwith type 2 diabetes: results of theassessment of diabetes control andevaluation of the efficacy of niaspantrial. Arch Intern Med 2002;162:1568-76.

™ ∂ ¶ Δ ∂ ª μ ƒ π √ ™ 2 0 0 8

12

¶∞ƒ∞°√¡Δ∂™ ∫π¡¢À¡√À

13

ªË ™ÙÂÚÔÂÈ‰‹ ∞ÓÙÈÊÏÂÁÌÔÓÒ‰Ë º¿ÚÌ·Î·Î·È ∫·Ú‰È·ÁÁÂÈ·Îfi˜ ∫›Ó‰˘ÓÔ˜º. ∞ÔÛÙfiÏÔ˘ ∂ÈÌÂÏ‹ÙÚÈ· μ' ÙË˜ μ' ¶·ıÔÏÔÁÈÎ‹˜ ∫ÏÈÓÈÎ‹˜

ÙÔ˘ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ °ÂÓÈÎÔ‡ ¡ÔÛÔÎÔÌÂ›Ô˘ πˆ·ÓÓ›ÓˆÓ

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

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

Δ· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÔÏÏ¤˜ ÌÂ-Ï¤ÙÂ˜ ¤‰ÂÈÍ·Ó ·‡ÍËÛË ÙˆÓ ·ÁÁÂÈ-·ÎÒÓ ÂÂÈÛÔ‰›ˆÓ ÛÂ ·ÛıÂÓÂ›˜Ô˘ ¤·ÈÚÓ·Ó ·Ó·ÛÙÔÏÂ›˜ ÙË˜ Î˘-ÎÏÔÍ˘ÁÂÓ¿ÛË˜-2 (coxibs). √È ÏË-ÚÔÊÔÚ›Â˜ ÚÔ‹Úı·Ó ·fi ÙÔÓ Ù‡-Ô, fiÔ˘ Â›ÛË˜ ‰ËÌÔÛÈÂ‡ÙËÎ·ÓÚÔÛÊ˘Á¤˜ ÛÙË ‰ÈÎ·ÈÔÛ‡ÓË Î·Ù¿Ê·ÚÌ·ÎÂ˘ÙÈÎÒÓ ÂÙ·ÈÚÈÒÓ. ™ÙËÓ·ÌÊÈ‚ÔÏ›· ÙˆÓ ÎÏÈÓÈÎÒÓ ÁÈ·ÙÚÒÓ·Ó Ú¤ÂÈ Ó· ¯ÔÚËÁ‹ÛÔ˘Ó ¤Ó·ÌË ÛÙÂÚÔÂÈ‰¤˜ ·ÓÙÈÊÏÂÁÌÔÓÒ‰Â˜Ê¿ÚÌ·ÎÔ (NSAID) ÛÂ ¤Ó· ·ÛıÂÓ‹˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ·ÁÁÂÈ·ÎfiÂÂÈÛfi‰ÈÔ ÚÔÛÙ¤ıËÎÂ Ë ‰˘ÛÈ-ÛÙ›· ÙˆÓ ·ÛıÂÓÒÓ ·¤Ó·ÓÙÈ ÛÙ·ÌË ÛÙÂÚÔÂÈ‰‹ ·ÓÙÈÊÏÂÁÌÔÓÒ‰ËÊ¿ÚÌ·Î·, Ù· ÔÔ›· ¯ÔÚËÁÔ‡ÓÙ·ÈÛ˘¯Ó¿ ÛÙËÓ ÎÏÈÓÈÎ‹ Ú¿ÍË.

√È ÌÂÏ¤ÙÂ˜ Û¯Â‰È¿ÛıËÎ·Ó ÁÈ· Ó··Ó·‰Â›ÍÔ˘Ó ÙÈ˜ È‰ÈfiÙËÙÂ˜ ÙˆÓNSAIDs (·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·,ÂÈÙÒÛÂÈ˜ ÛÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi,¤Ó‰ÂÈÍË ÁÈ· ÙË ÓfiÛÔ Altzheimer).™ÙËÓ ÔÚÂ›· ÙˆÓ ÂÚÂ˘ÓÒÓ ÚÔ¤-Î˘„Â fiÙÈ ·˘Ù¿ Ù· Ê¿ÚÌ·Î· Û¯Â-Ù›˙ÔÓÙ·È ÌÂ ·‡ÍËÛË ÙˆÓ ·ÁÁÂÈ·-ÎÒÓ ÂÂÈÛÔ‰›ˆÓ, ÌÂ ·ÔÙ¤ÏÂÛÌ·ÔÏÏ¤˜ ¤ÚÂ˘ÓÂ˜ Ó· ‰È·ÎÔÔ‡ÓÎ·È ÔÚÈÛÌ¤Ó· Ê¿ÚÌ·Î· Ó· ·Ô-Û˘ÚıÔ‡Ó. ™ÙË ÌÂÏ¤ÙË APC1 ¤ÁÈÓÂÛ‡ÁÎÚÈÛË ÙË˜ celecoxib ÌÂ ÂÈÎÔ-ÓÈÎfi Ê¿ÚÌ·ÎÔ ÁÈ· ÙËÓ ÚfiÏË„ËÙÔ˘ Î·ÚÎ›ÓÔ˘ ÙÔ˘ ·¯¤ˆ˜ ÂÓÙ¤-ÚÔ˘ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ·‰ÂÓˆÌ·ÙÒ-‰ÂÈ˜ ÔÏ‡Ô‰Â˜. ∏ ÌÂÏ¤ÙË Û¯Â-‰È¿ÛıËÎÂ ÁÈ· 5 ¯ÚfiÓÈ·, ·ÏÏ¿ ‰È·-ÎfiËÎÂ ÛÙ· 3 ¯ÚfiÓÈ· fiÙ·Ó ‰È·È-ÛÙÒıËÎÂ fiÙÈ ·˘Í‹ıËÎ·Ó Ù· ·Á-ÁÂÈ·Î¿ ÂÂÈÛfi‰È· ÛÙÔ˘˜ ·ÛıÂ-ÓÂ›˜ Ô˘ ¤·ÈÚÓ·Ó celecoxib. ∞‡-ÍËÛË ÙˆÓ ·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿-ÙˆÓ ·Ú·ÙËÚ‹ıËÎÂ ÛÙË ÌÂÏ¤ÙËVIGOR2, ÛÙËÓ ÔÔ›· Û˘ÁÎÚ›ıËÎÂË rofecoxib ÌÂ ÙË naproxen fiÛÔÓ·ÊÔÚ¿ ÙÈ˜ ÂÈÏÔÎ¤˜ ·fi ÙÔ Á·-ÛÙÚÂÓÙÂÚÈÎfi ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ÈÛÙÔ-ÚÈÎfi ÚÂ˘Ì·ÙÔÂÈ‰Ô‡˜ ·ÚıÚ›ÙÈ‰·˜.∂›ÛË˜ ·‡ÍËÛË ÙˆÓ ·ÁÁÂÈ·ÎÒÓÂÂÈÛÔ‰›ˆÓ ·Ú·ÙËÚ‹ıËÎÂ ÛÙËÌÂÏ¤ÙË APPROVe3 ÛÙËÓ ÔÔ›·Û˘ÁÎÚ›ıËÎÂ Ë rofecocib ÌÂ ÂÈÎÔ-

ÓÈÎfi Ê¿ÚÌ·ÎÔ ÁÈ· ÙËÓ ÚfiÏË„ËÙÔ˘ Î·ÚÎ›ÓÔ˘ ÙÔ˘ ·¯¤ˆ˜ ÂÓÙ¤-ÚÔ˘ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ·‰ÂÓˆÌ·ÙÒ-‰ÂÈ˜ ÔÏ‡Ô‰Â˜. ∏ ¤ÚÂ˘Ó· ‰È·-ÎfiËÎÂ Î·È Ë ÂÙ·ÈÚÂ›· Merk ·¤-Û˘ÚÂ ÙË rofecocib (Vioxx). §›ÁÂ˜Â‚‰ÔÌ¿‰Â˜ ·ÚÁfiÙÂÚ· Ë Pfizer·¤Û˘ÚÂ ÙË valdecoxib (Valtrex).∞ÓÙ›ıÂÙ· ·ÔÙÂÏ¤ÛÌ·Ù· ·Ú·ÙË-Ú‹ıËÎ·Ó ÛÙË ÌÂÏ¤ÙË ADAPT4 (ÌÂ-Ï¤ÙË ÁÈ· ÙËÓ ÚfiÏË„Ë ÙË˜ ÓfiÛÔ˘ÙÔ˘ Altzheimer), Ë ÔÔ›· ¤‰ÂÈÍÂfiÙÈ Ë naproxen ·‡ÍËÛÂ ÙÔÓ Î·Ú-‰È·ÁÁÂÈ·Îfi Î›Ó‰˘ÓÔ ÛÂ Û‡ÁÎÚÈÛËÌÂ ÙË celecoxib. ™ÙÈ˜ ÌÂÏ¤ÙÂ˜TARGET5 Î·È MEDAL6 ÔÈ coxibsÎ·È Ù· ·Ú·‰ÔÛÈ·Î¿ ÌË ÂÎÏÂÎÙÈ-Î¿ NSAIDs Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıË-Î·Ó ·‡ÍËÛ·Ó ÙÔÓ Î·Ú‰È·ÁÁÂÈ·ÎfiÎ›Ó‰˘ÓÔ.

ªË¯·ÓÈÛÌfi˜ ‰Ú¿ÛË˜ ÙˆÓ NSAIDs

∞fi ÙÔ ·Ú·¯È‰ÔÓÈÎfi ÔÍ‡ ÌÂ ÙË‚Ô‹ıÂÈ· ‰È·ÊÔÚÂÙÈÎÒÓ ÂÓ˙‡ÌˆÓ·Ú¿ÁÔÓÙ·È Ù· ÂÈÎÔÛ·ÓÔÂÈ‰‹. ™Ë-Ì·ÓÙÈÎfi˜ Â›Ó·È Ô ÚfiÏÔ˜ ÙË˜ Î˘-ÎÏÔÍ˘ÁÂÓ¿ÛË˜ (COX), Ë ÔÔ›·ÂÌÊ·Ó›˙ÂÈ ‰‡Ô ÈÛÔ¤Ó˙˘Ì· (COX-1Î·È COX-2). ∞fi ÙÔ ·Ú·¯È‰ÔÓÈÎfiÔÍ‡ ÌÂ ÙË ‚Ô‹ıÂÈ· ÙË˜ COX ·-Ú¿ÁÔÓÙ·È ÔÈ ÚÔÛÙ·ÁÏ·Ó‰›ÓÂ˜(PGD2, PGF2a, PGE2, PGI2) Î·È ËıÚÔÌ‚ÔÍ¿ÓË (TxA2)7. Δ· ÈÛÔ¤Ó˙˘-Ì· ÙË˜ COX ¤¯Ô˘Ó ‰È·ÊÔÚÂÙÈÎ‹Î·Ù·ÓÔÌ‹ ·Ó¿ÏÔÁ· ÌÂ ÙÔÓ Ù‡ÔÙˆÓ Î˘ÙÙ¿ÚˆÓ. ∏ COX-1 ÂÎÊÚ¿-˙ÂÙ·È ÛÂ ÔÏÏÔ‡˜ Ù‡Ô˘˜ Î˘ÙÙ¿-ÚˆÓ Î·È Â›Ó·È Ë ÌfiÓË COX Ô˘‰È·ı¤ÙÔ˘Ó Ù· PLT. ∂ÈÏ¤ÔÓ Ù·Î‡ÙÙ·Ú· ‰È·ı¤ÙÔ˘Ó ‰È·ÊÔÚÂÙÈÎ¤˜ÈÛÔÌÂÚ¿ÛÂ˜ Î·È ·Ó¿ÏÔÁ· ÌÂ ÙÔÓÙ‡Ô ÙË˜ ÈÛÔÌÂÚ¿ÛË˜ ·Ú¿ÁÔ˘Ó‰È·ÊÔÚÂÙÈÎ¤˜ ÚÔÛÙ·ÁÏ·Ó‰›ÓÂ˜‹ TxA2

8. ªÂ ÙË ‚Ô‹ıÂÈ· ÙË˜ COX-1·Ú¿ÁÔÓÙ·È ÚÔÛÙ·ÁÏ·Ó‰›ÓÂ˜ Ô˘Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÂ Ê˘ÛÈÔÏÔÁÈÎ¤˜ÏÂÈÙÔ˘ÚÁ›Â˜. ¶Ú¿ÁÌ·ÙÈ ·˘Ù¤˜ ÔÈÚÔÛÙ·ÁÏ·Ó‰›ÓÂ˜ ÚÔÛÙ·ÙÂ‡Ô˘ÓÙÔ Á·ÛÙÚÈÎfi ‚ÏÂÓÓÔÁfiÓÔ Î·È Û˘Ì-ÌÂÙ¤¯Ô˘Ó ÛÙË Ê˘ÛÈÔÏÔÁÈÎ‹ ÓÂ-ÊÚÈÎ‹ ÏÂÈÙÔ˘ÚÁ›·. ªÂ ÙËÓ COX-2,

Ë ÔÔ›· Â¿ÁÂÙ·È ·fi ÙÈ˜ Î˘ÙÔÎ›-ÓÂ˜, ·Ú¿ÁÔÓÙ·È ÚÔÛÙ·ÁÏ·Ó‰›-ÓÂ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙË ÊÏÂÁ-ÌÔÓ‹, ÙÔÓ ˘ÚÂÙfi, ÙÔÓ fiÓÔ Î·ÈÙËÓ Î·ÚÎÈÓÔÁ¤ÓÂÛË9. £ÂˆÚËÙÈ-Î¿ ÙÔ È‰·ÓÈÎfi ·ÓÙÈÊÏÂÁÌÔÓÒ‰Â˜Ê¿ÚÌ·ÎÔ ·Ó·ÛÙ¤ÏÏÂÈ ÂÎÏÂÎÙÈÎ¿ÙËÓ COX-2.

øÛÙfiÛÔ ·fi ÙÔ ·Ú·¯È‰ÔÓÈÎfi ÔÍ‡ÌÂ ÙË ‚Ô‹ıÂÈ· ÙË˜ COX-1 ·Ú¿-ÁÂÙ·È Ë TxA2, Ë ÔÔ›· ÚÔ¿ÁÂÈÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ PLT. ∏·ÛÈÚ›ÓË ÛÂ ¯·ÌËÏ¤˜ ‰fiÛÂÈ˜·Ó·ÛÙ¤ÏÏÂÈ ÙË COX-1, ÙË ‰Ú¿ÛËÙË˜ TxA2 Î·È ÙËÓ ÂÓÂÚÁÔÔ›ËÛËÙˆÓ PLT Î·È ·ÔÙÂÏÂ› ıÂÌÂÏÈÒ-‰Â˜ Ê¿ÚÌ·ÎÔ ÁÈ· ÙËÓ ÚˆÙÔÁÂÓ‹Î·È ÙË ‰Â˘ÙÂÚÔÁÂÓ‹ ÚfiÏË„ËÙˆÓ ·ÁÁÂÈ·ÎÒÓ ÂÂÈÛÔ‰›ˆÓ10.

Δ· NSAIDs ·ÔÙÂÏÔ‡Ó ÌÈ· ÂÙÂ-ÚÔÁÂÓ‹ ÔÌ¿‰· Ê·ÚÌ¿ÎˆÓ ÌÂ ‰È·-ÊÔÚÂÙÈÎ‹ ÚÔ¤ÏÂ˘ÛË Î·È ‰È·ÊÔ-ÚÂÙÈÎ‹ ¯ËÌÈÎ‹ ‰ÔÌ‹. ∞Ó·ÛÙ¤Ï-ÏÔ˘Ó ÙË ‰Ú¿ÛË ÙË˜ COX Î·È ÙËÓ·Ú·ÁˆÁ‹ ÙˆÓ ÚÔÛÙ·ÁÏ·Ó‰È-ÓÒÓ. Δ· NSAIDs ‰È·ÎÚ›ÓÔÓÙ·È ÌÂ‚¿ÛË ÙË Û¯ÂÙÈÎ‹ ·Ó·ÛÙÔÏ‹ ÙË˜COX ÛÙ· NSAIDs Ô˘ ·Ó·ÛÙ¤Ï-ÏÔ˘Ó ÂÚÈÛÛfiÙÂÚÔ ÙËÓ COX-1 Î·ÈÛÂ ÂÎÂ›Ó· Ô˘ ·Ó·ÛÙ¤ÏÏÔ˘Ó ÂÚÈÛ-ÛfiÙÂÚÔ ÙËÓ COX-2 (EÈÎfiÓ· 1)11. Δ·ÌË ÂÎÏÂÎÙÈÎ¿ NSAIDs ·Ó·ÛÙ¤Ï-ÏÔ˘Ó ÙfiÛÔ ÙËÓ COX-1 fiÛÔ Î·ÈÙËÓ COX-211. ∏ ·ÛÈÚ›ÓË ·Ó·-ÛÙ¤ÏÏÂÈ ÙË COX-1 Î·Ù¿ 170 ÊÔ-Ú¤˜ ÂÚÈÛÛfiÙÂÚÔ ·fi ÙËÓ COX-2ÌÂ ·ÔÙ¤ÏÂÛÌ· in vivo Ó· ·ÔÙÂ-ÏÂ› ¤Ó·Ó ÂÎÏÂÎÙÈÎfi ·Ó·ÛÙÔÏ¤·ÙË˜ COX-1 ÌÂ ÛËÌ·ÓÙÈÎ‹ ·ÓÙÈ·È-ÌÔÂÙ·ÏÈ·Î‹ ‰Ú¿ÛË10,12. OÈ coxibsÙ· ÓÂfiÙÂÚ· NSAIDs ·Ó·ÛÙ¤Ï-ÏÔ˘Ó ÂÎÏÂÎÙÈÎ¿ ÙËÓ COX-2 Î·ÈÚÔÎ·ÏÔ‡Ó ÏÈÁfiÙÂÚÂ˜ ·ÈÌÔÚÚ·-Á›Â˜ ·fi ÙÔÓ ÂÙÈÎfi ÛˆÏ‹Ó·11.

ªË¯·ÓÈÛÌÔ› ÌÂ ÙÔ˘˜ÔÔ›Ô˘˜ Ù· NSAIDs

ÚÔÎ·ÏÔ‡Ó·ÁÁÂÈ·Î¿ ÂÂÈÛfi‰È·

Δ· NSAIDs ÚÔÎ·ÏÔ‡Ó ·ÁÁÂÈ·Î¿ÂÂÈÛfi‰È· ÌÂ ¿ÌÂÛÔ˘˜ Î·È ¤ÌÌÂ-

ÛÔ˘˜ ÌË¯·ÓÈÛÌÔ‡˜. ¶Ú¿ÁÌ·ÙÈ·˘Ù¿ Ù· Ê¿ÚÌ·Î· ÚÔÎ·ÏÔ‡ÓÎ·Ù·ÎÚ¿ÙËÛË ¡·+, ÌÂ ·ÔÙ¤ÏÂ-ÛÌ· ·‡ÍËÛË ÙË˜ ·ÚÙËÚÈ·Î‹˜ ›Â-ÛË˜ Î·È Û˘ÌÊÔÚËÙÈÎ‹ Î·Ú‰È·Î‹·ÓÂ¿ÚÎÂÈ·13,14. ∂ÈÏ¤ÔÓ Ù·NSAIDs ÚÔÎ·ÏÔ‡Ó ‚Ï¿‚Ë ÙÔ˘ ÂÓ-‰ÔıËÏ›Ô˘ Î·È ÂÓ‰ÔıËÏÈ·Î‹ ‰˘-ÛÏÂÈÙÔ˘ÚÁ›·, ÂÓÒ ÚÔ‰È·ı¤ÙÔ˘ÓÛÙÔ Û¯ËÌ·ÙÈÛÌfi ıÚfiÌ‚Ô˘ Î·È ÛÂ·ÁÁÂÈ·Îfi ÂÂÈÛfi‰ÈÔ (ÈÛ¯·ÈÌÈÎfiÎ·Ú‰È·Îfi ÂÂÈÛfi‰ÈÔ Î·È ¤ÌÊÚ·Á-Ì· ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘, ·ÁÁÂÈ·ÎfiÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔ Î·È ·ÈÊÓ›-‰ÈÔ ı¿Ó·ÙÔ)11.

ΔÔ ÂÓ‰Ôı‹ÏÈÔ ‰È·ı¤ÙÂÈ COX-1 Î·ÈCOX-2 Î·È ·Ú¿ÁÂÈ ÚÔÛÙ·Î˘ÎÏ›-ÓË (PGI2). øÛÙfiÛÔ Ù· PLT ¤¯Ô˘ÓÌfiÓÔ COX-1 Î·È ·Ú¿ÁÔ˘Ó TxA2.∏ PGI2 ·Ó·ÛÙ¤ÏÏÂÈ ÙËÓ ÂÓÂÚÁÔ-Ô›ËÛË ÙˆÓ PLT Î·È ÚÔÎ·ÏÂ› ·Á-ÁÂÈÔ‰È·ÛÙÔÏ‹, ÂÓÒ ·ÓÙ›ıÂÙ· ËTxA2 ÚÔÎ·ÏÂ› ·ÁÁÂÈÔÛ‡Û·ÛË

Î·È ÚÔ¿ÁÂÈ ÙËÓ ÂÓÂÚÁÔÔ›ËÛËÙˆÓ PLT. ™Â ÂÚ›ÙˆÛË Ê˘ÛÈÔÏÔ-ÁÈÎÔ‡ ÂÓ‰ÔıËÏ›Ô˘ Ë ÈÛÔÚÚÔ›·ÌÂÙ·Í‡ TxA2 Î·È PGI2 Â›Ó·È ˘¤ÚÙË˜ PGI2 ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙË ÌÂ›-ˆÛË ÙË˜ ÂÓÂÚÁÔÔ›ËÛË˜ ÙˆÓPLT. ™Â ÂÚ›ÙˆÛË ·ıÔÏÔÁÈÎÔ‡ÂÓ‰ÔıËÏ›Ô˘ ·˘Í¿ÓÂÙ·È Ë ·Ú·-ÁˆÁ‹ TxA2, ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙËÓ·‡ÍËÛË ÙË˜ ÂÓÂÚÁÔÔ›ËÛË˜ ÙˆÓPLT. ∏ ·‡ÍËÛË ÙË˜ PGI2 Â›Ó·È·ÓÙÈÛÙ·ıÌÈÛÙÈÎ‹ Î·È ‰ÂÓ Â›Ó·ÈÈÎ·Ó‹ Ó· ·Ó·ÙÚ¤„ÂÈ ÙËÓ ·ÚÓËÙÈÎ‹ÈÛÔÚÚÔ›· ˘¤Ú ÙË˜ TxA2

11.

∏ PGI2 ÛÂ Ê˘ÛÈÔÏÔÁÈÎfi ÂÓ‰Ôı‹-ÏÈÔ ·Ú¿ÁÂÙ·È Î˘Ú›ˆ˜ ‰È·Ì¤ÛÔ˘ÙË˜ COX-1, ÂÓÒ ÛÂ ·ıÔÏÔÁÈÎfiÂÓ‰Ôı‹ÏÈÔ ‰È·Ì¤ÛÔ˘ ÙË˜ COX-2.√È coxibs ÛÂ Ê˘ÛÈÔÏÔÁÈÎfi ÂÓ‰Ô-ı‹ÏÈÔ ‰ÂÓ ÂËÚÂ¿˙Ô˘Ó ÛËÌ·ÓÙÈ-Î¿ ÙËÓ ÈÛÔÚÚÔ›· ÌÂÙ·Í‡ ÙË˜PGI2 Î·È ÙË˜ TxA2. ∞ÓÙ›ıÂÙ· ÛÂ·ıÔÏÔÁÈÎfi ÂÓ‰Ôı‹ÏÈÔ Ë ·Ó·-

ÛÙÔÏ‹ ÙË˜ COX-2 ·Ó·ÛÙ¤ÏÏÂÈ ÛË-Ì·ÓÙÈÎ¿ ÙËÓ ·Ú·ÁˆÁ‹ ÙË˜ PGI2

Î·È Â˘ÓÔÂ› ÙÔ Û¯ËÌ·ÙÈÛÌfi ıÚfiÌ-‚Ô˘ (∂ÈÎfiÓ· 2)11.

∞Ó·Ï‡ÛÂÈ˜ ÌÂÏÂÙÒÓ

∂Ó‰È·Ê¤ÚÔÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ù··ÔÙÂÏ¤ÛÌ·Ù· ÌÈ·˜ ÌÂÙ·-·Ó¿Ï˘-ÛË˜ Ù˘¯·ÈÔÔÈËÌ¤ÓˆÓ ÌÂÏÂÙÒÓÔ˘ ‰ËÌÔÛÈÂ‡ıËÎÂ ÙÔ 200615.™ÙËÓ ·Ó¿Ï˘ÛË Û˘ÌÂÚÈÂÏ‹ÊıË-Î·Ó 138 Ù˘¯·ÈÔÔÈËÌ¤ÓÂ˜ ÌÂÏ¤-ÙÂ˜ ÛÙÈ˜ ÔÔ›Â˜ Û˘ÌÌÂÙÂ›¯·Ó145.373 ·ÛıÂÓÂ›˜. ™ÙÈ˜ ÌÂÏ¤ÙÂ˜·˘Ù¤˜ Û˘ÁÎÚ›ıËÎ·Ó coxibs ÌÂ ÂÈ-ÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ, ÌË ÂÎÏÂÎÙÈÎ¿NSAIDs ‹ naproxen. ∂ÎÙÈÌ‹ıËÎ·ÓÙ· ÛÔ‚·Ú¿ ·ÁÁÂÈ·Î¿ ÂÂÈÛfi‰È·(ı·Ó·ÙËÊfiÚ· Û˘Ì‚¿Ì·Ù· ‹ Û˘Ì-‚¿Ì·Ù· Ô˘ ÂÈ‚Â‚·ÈÒıËÎ·Ó ÛÂÓÔÛÔÎÔÌÂ›Ô). ∂ÂÈ‰‹ Ë ·‡ÍËÛËÙˆÓ ·ÁÁÂÈ·ÎÒÓ ÂÂÈÛÔ‰›ˆÓ ‹Ù·ÓÛËÌ·ÓÙÈÎ‹ ÌÂÙ¿ ÙÔÓ ÚÒÙÔ Ì‹Ó·ıÂÚ·Â›·˜ ÂÈÏ¤¯ıËÎ·Ó ÌÂÏ¤ÙÂ˜ÌÂ ‰È¿ÚÎÂÈ· ıÂÚ·Â›·˜ ÙÔ˘Ï¿¯È-ÛÙÔÓ 4 Â‚‰ÔÌ¿‰ˆÓ. ™Â ¿ÏÏË ÌÂÙ·-·Ó¿Ï˘ÛË Ô˘ ‰ËÌÔÛÈÂ‡ıËÎÂ ÙÔÓ›‰ÈÔ ¯ÚfiÓÔ Ë ‰È¿ÚÎÂÈ· ıÂÚ·Â›·˜Î·ıÔÚ›ÛÙËÎÂ ÛÂ 6 Â‚‰ÔÌ¿‰Â˜16.

∏ naproxen ÌÂÏÂÙ‹ıËÎÂ ¯ˆÚÈÛÙ¿ÁÈ·Ù› ÂÎÙÈÌ‹ıËÎÂ fiÙÈ ¤¯ÂÈ ÍÂ¯ˆÚÈ-ÛÙfi ÚfiÏÔ15. ∏ naproxen ·Ó‹ÎÂÈÛÙ· NSAIDs Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ÌÂ-Á·Ï‡ÙÂÚË Û¯ÂÙÈÎ‹ ·Ó·ÛÙÔÏ‹ ÙË˜COX-1. ¶ÚÔÎ‡ÙÂÈ ÙÔ ÂÚÒÙËÌ··Ó Ë naproxen Î·È Ù· NSAIDs ÌÂÌÂÁ·Ï‡ÙÂÚË ·Ó·ÛÙÔÏ‹ ÙË˜ COX-1 ¤¯Ô˘Ó ·ÓÙÈ·ÈÌÔÂÙ·ÏÈ·Î‹ ‰Ú¿-ÛË, fiˆ˜ Ë ·ÛÈÚ›ÓË2,4,5,17,18. °È·Ó· ÂÏ·ÙÙˆıÂ› ·ÔÙÂÏÂÛÌ·ÙÈÎ¿ Ë·Ú·ÁˆÁ‹ ÙË˜ TxA2 Â›Ó·È ··-Ú·›ÙËÙË Ë ·Ó·ÛÙÔÏ‹ ÙË˜ COX-1Î·Ù¿ 95%. ∏ ·ÛÈÚ›ÓË ·Ó·ÛÙ¤Ï-ÏÂÈ ÌË ·ÓÙÈÛÙÚÂÙ¿ ÙËÓ COX-1Î·Ù¿ 95% Î·È ÂÏ·ÙÙÒÓÂÈ ÙËÓ ·-Ú·ÁˆÁ‹ ÙË˜ TxA2

19. Δ· NSAIDsÔ˘ ·Ó·ÛÙ¤ÏÏÔ˘Ó Î˘Ú›ˆ˜ ÙËÓCOX-1 ·Ó·ÛÙ¤ÏÏÔ˘Ó ·ÓÙÈÛÙÚÂ-Ù¿ Î·Ù¿ 59-95% ÙËÓ COX-120.

™ÙÔ ÚÒÙÔ Ì¤ÚÔ˜ ÙË˜ ·Ó¿Ï˘ÛË˜¤ÁÈÓÂ Û‡ÁÎÚÈÛË ÙˆÓ coxibs (rofe-coxib, celecoxib, etoricoxib, lumi-racoxib, valdecoxib, subtotal) ÌÂÙÔ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ ÁÈ· ÙÔÓ Î›Ó-‰˘ÓÔ ÂÌÊ¿ÓÈÛË˜ ·ÁÁÂÈ·ÎÔ‡ ÂÂÈ-ÛÔ‰›Ô˘, ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ô-Î·Ú‰›Ô˘ (√∂ª), ·ÁÁÂÈ·ÎÔ‡ ÂÁÎÂ-Ê·ÏÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ (∞∂∂) Î·È·ÁÁÂÈ·ÎÔ‡ ı·Ó¿ÙÔ˘. ¶·Ú·ÙËÚ‹-ıËÎÂ ÛËÌ·ÓÙÈÎ‹ ·‡ÍËÛË ÙÔ˘ ÎÈÓ-‰‡ÓÔ˘ Û˘ÓÔÏÈÎ¿ ÁÈ· ·ÁÁÂÈ·Î¿ÂÂÈÛfi‰È· Î·È √∂ª ÛÙÔ˘˜ ·ÛıÂ-ÓÂ›˜ Ô˘ ¤·ÈÚÓ·Ó coxibs.

™ ∂ ¶ Δ ∂ ª μ ƒ π √ ™ 2 0 0 8

14

∂ÈÎfiÓ· 1 ™Â ·ıÔÏÔÁÈÎfi ÂÓ‰Ôı‹ÏÈÔ Ë PGI2 ·Ú¿ÁÂÙ·È Î˘Ú›ˆ˜ ·fi ÙËÓ COX-2.√È ·Ó·ÛÙÔÏÂ›˜ COX-2 ÂÏ·ÙÙÒÓÔ˘Ó ÙËÓ ·Ú·ÁˆÁ‹ PGI2, ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙË ‰È·-Ù·Ú·¯‹ ÙË˜ ÈÛÔÚÚÔ›·˜ ÌÂÙ·Í‡ PGI2 Î·È TxA2, ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ PLT Î·ÈÙÔ Û¯ËÌ·ÙÈÛÌfi ıÚfiÌ‚Ô˘.

ºÀ™π√§√°π∫∞ ∞£∏ƒ√£ƒ√ªμø™∏

ÃˆÚ›˜£ÂÚ·Â›·

∞ÛÈÚ›ÓË ÛÂÌÈÎÚ‹ ‰fiÛË

∫ÔÍ›ÌÂ˜

¶∞ƒ∞°√¡Δ∂™ ∫π¡¢À¡√À

15

™ÙÔ ‰Â‡ÙÂÚÔ Ì¤ÚÔ˜ ÙË˜ ·Ó¿Ï˘-ÛË˜ Û˘ÁÎÚ›ıËÎ·Ó ÔÈ coxibs ÌÂ Ù·ÌË ÂÎÏÂÎÙÈÎ¿ NSAIDs ‹ ÙËnaproxen. ™ÙË Û‡ÁÎÚÈÛË ÙˆÓ ÌËÂÎÏÂÎÙÈÎÒÓ NSAIDs ÌÂ ÙÈ˜ coxibs‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ÛËÌ·ÓÙÈÎ¤˜‰È·ÊÔÚ¤˜ fiÛÔÓ ·ÊÔÚ¿ ÙËÓ Â›-ÙˆÛË ÙˆÓ ·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿-ÙˆÓ. ™ÙË Û‡ÁÎÚÈÛË ÙˆÓ coxibs ÌÂÙË naproxen ·Ú·ÙËÚ‹ıËÎÂ ÛË-Ì·ÓÙÈÎ‹ ·‡ÍËÛË Û˘ÓÔÏÈÎ¿ ÙˆÓ·ÁÁÂÈ·ÎÒÓ ÂÂÈÛÔ‰›ˆÓ Î·È ÙˆÓ√∂ª. ∂ÈÏ¤ÔÓ ‰ÂÓ ·Ú·ÙËÚ‹ıË-Î·Ó ÛËÌ·ÓÙÈÎ¤˜ ‰È·ÊÔÚ¤˜ fiÛÔÓ·ÊÔÚ¿ ÙËÓ Â›ÙˆÛË ÙˆÓ ∞∂∂Î·È ÙÔ˘ ·ÁÁÂÈ·ÎÔ‡ ı·Ó¿ÙÔ˘.

∞ÎfiÌË ¤ÁÈÓÂ ¤ÌÌÂÛË Û‡ÁÎÚÈÛËÙˆÓ ÌË ÂÎÏÂÎÙÈÎÒÓ NSAIDs ÌÂ ÙÔÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ ÁÈ· ÙËÓ ÂÎÙ›ÌË-ÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ·ÁÁÂÈ·ÎfiÂÂÈÛfi‰ÈÔ. ™˘ÁÎÂÎÚÈÌ¤Ó· ÂÎÙÈÌ‹-ıËÎ·Ó Ù· ÛÙÔÈ¯Â›· Ô˘ ÚÔ¤Î˘-„·Ó ·fi ÙË Û‡ÁÎÚÈÛË ÙˆÓ ÌËÂÎÏÂÎÙÈÎÒÓ NSAIDs ÌÂ ÙÈ˜ coxibsÎ·È ÙÈ˜ coxibs ÌÂ ÙÔ ÂÈÎÔÓÈÎfi Ê¿Ú-Ì·ÎÔ. ∏ ÌÂÏ¤ÙË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ¤‰ÂÈÍÂ fiÙÈ Ë diclofenac Î·È Ëibuprofen ·˘Í¿ÓÔ˘Ó Ù· ·ÁÁÂÈ·Î¿ÂÂÈÛfi‰È·11.

™Â 121 ÌÂÏ¤ÙÂ˜ ÔÈ ·ÛıÂÓÂ›˜ ¤·ÈÚ-

Ó·Ó coxibs ÁÈ· 1 ¤ÙÔ˜ ‹ ÂÚÈÛÛfi-

ÙÂÚÔ Î·È ÛËÌÂÈÒıËÎ·Ó ÂÚÈÛÛfi-

ÙÂÚ· ·fi Ù· 2/3 ÙˆÓ ·ÁÁÂÈ·ÎÒÓ

ÂÂÈÛÔ‰›ˆÓ. ™Â 112 ÌÂÏ¤ÙÂ˜ Ë Ì¤-

ÛË ‰È¿ÚÎÂÈ· ıÂÚ·Â›·˜ ‹Ù·Ó 11

Â‚‰ÔÌ¿‰Â˜. ∞ÎfiÌË ÂÎÙfi˜ ·fi ÙË

celecoxib ‰ÂÓ ˘‹Ú¯·Ó ·ÚÎÂÙ¿

‰Â‰ÔÌ¤Ó· Ô˘ Ó· Û˘Û¯ÂÙ›˙Ô˘Ó ÙË

‰fiÛË ÙˆÓ Ê·ÚÌ¿ÎˆÓ ÌÂ ÙËÓ ·‡-

ÍËÛË ÙˆÓ ·ÁÁÂÈ·ÎÒÓ ÂÂÈÛÔ‰›ˆÓ

ÁÈ· ÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ coxibs11.

Δ· NSAIDs ·˘Í¿ÓÔ˘Ó ÙËÓ ·ÚÙË-

ÚÈ·Î‹ ›ÂÛË. ¶ÔÏÏ¤˜ ÌÂÏ¤ÙÂ˜

¤‰ÂÈÍ·Ó fiÙÈ ‰ÂÓ ˘¿Ú¯ÂÈ ÛËÌ·ÓÙÈ-

Î‹ ‰È·ÊÔÚ¿ ÌÂÙ·Í‡ ÙˆÓ ÌË ÂÎÏÂ-

ÎÙÈÎÒÓ NSAIDs Î·È ÙˆÓ coxibs

fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ·‡ÍËÛË ÙË˜ ·Ú-

ÙËÚÈ·Î‹˜ ›ÂÛË˜21.

™‡Á¯ÚÔÓÂ˜ Ô‰ËÁ›Â˜

¶ÚfiÛÊ·Ù· ‰ËÌÔÛÈÂ‡ÙËÎ·Ó Ô‰Ë-

Á›Â˜ ÁÈ· ÙË ¯ÔÚ‹ÁËÛË ·Ó·ÏÁËÙÈ-

ÎÒÓ Ê·ÚÌ¿ÎˆÓ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ

ÈÛÙÔÚÈÎfi ·ÁÁÂÈ·ÎÔ‡ ÂÂÈÛÔ‰›Ô˘ ‹

ÌÂ ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ·

ÈÛ¯·ÈÌÈÎ‹ Î·Ú‰È·Î‹ ÓfiÛÔ22. ∞Ú¯È-

Î¿ Ú¤ÂÈ Ó· ‰›ÓÔÓÙ·È ·ÛÊ·Ï‹

Ê¿ÚÌ·Î· ÛÙË ¯·ÌËÏfiÙÂÚË ‰˘Ó·-Ù‹ ‰fiÛË ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ Û˘-ÌÙˆÌ¿ÙˆÓ. ∞ÛÊ·Ï‹ Ê¿ÚÌ·Î·ıÂˆÚÔ‡ÓÙ·È Ë ·Ú·ÎÂÙ·ÌfiÏË, Ë·ÛÈÚ›ÓË, Ë tramadol, Î·È Ù· Ó·Ú-ÎˆÙÈÎ¿ ·Ó·ÏÁËÙÈÎ¿ (ÁÈ· ‚Ú·¯‡¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·). ∂ÓÙÔ‡ÙÔÈ˜ Ë·ÛÈÚ›ÓË ÚÔÎ·ÏÂ› ·ÈÌÔÚÚ·Á›··fi ÙÔÓ ÂÙÈÎfi ÛˆÏ‹Ó· Î·È Ë·Ú·ÎÂÙ·ÌfiÏË Ë·ÙÔÙÔÍÈÎfiÙËÙ·ÛÂ ˘„ËÏ¤˜ ‰fiÛÂÈ˜.

ΔÔ ÂfiÌÂÓÔ ‚‹Ì· fiÙ·Ó ·˘Ù¿ Ù·Û¯ÂÙÈÎ¿ ·ÛÊ·Ï‹ Ê¿ÚÌ·Î· ‰ÂÓ Â›-Ó·È ·ÔÙÂÏÂÛÌ·ÙÈÎ¿ Â›Ó·È Ë ¯ÔÚ‹-ÁËÛË NSAIDs, Ù· ÔÔ›· Â›Ó·È ÈÔÈÛ¯˘Ú¿ ·Ó·ÏÁËÙÈÎ¿ Ê¿ÚÌ·Î·, ·Ï-Ï¿ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ·˘ÍËÌ¤ÓÔ Î·Ú-‰È·ÁÁÂÈ·Îfi Î›Ó‰˘ÓÔ. ŸÛÔ ÌÂÁ·-Ï‡ÙÂÚË Â›Ó·È Ë ·Ó·ÛÙÔÏ‹ ÙË˜COX-2, ÙfiÛÔ ÌÂÁ·Ï‡ÙÂÚÔ Â›Ó·È ÙÔ·Ó·ÏÁËÙÈÎfi ·ÔÙ¤ÏÂÛÌ·, Ô Î›Ó‰˘-ÓÔ˜ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ·ÈÌÔÚÚ·-ÁÈÒÓ ·fi ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi ÌÂÈÒ-ÓÂÙ·È Î·È Ô Î›Ó‰˘ÓÔ˜ ÁÈ· ·ÁÁÂÈ·Î¿ÂÂÈÛfi‰È· ·˘Í¿ÓÂÙ·È. º¿ÚÌ·Î·ÚÒÙË˜ ÂÈÏÔÁ‹˜ Â›Ó·È Ù· ÌËÂÎÏÂÎÙÈÎ¿ NSAIDs ÌÂ Û¯ÂÙÈÎ¿ ÈÔÈÛ¯˘Ú‹ COX-1 ‰Ú¿ÛË. √È Û˘Á-ÁÚ·ÊÂ›˜ ÚÔÙÂ›ÓÔ˘Ó ÙË napro-

∂ÈÎ.2 Δ· NSAIDs ·ÔÙÂÏÔ‡ÓÌÈ· ÂÙÂÚÔÁÂÓ‹ ÔÌ¿‰· Ê·ÚÌ¿-ÎˆÓ ÌÂ ‰È·ÊÔÚÂÙÈÎ‹ ÚÔ¤ÏÂ˘-ÛË Î·È ¯ËÌÈÎ‹ ‰ÔÌ‹. ¢È·ÎÚ›ÓÔ-ÓÙ·È ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ÈÎ·ÓfiÙË-Ù¿ ÙÔ˘˜ Ó· ·Ó·ÛÙ¤ÏÏÔ˘Ó Û¯Â-ÙÈÎ¿ ÂÚÈÛÛfiÙÂÚÔ ÙËÓ COX-1‹ ÙËÓ COX-2.

xen. ∞Ó ÙÔ ·Ó·ÏÁËÙÈÎfi ·ÔÙ¤ÏÂ-ÛÌ· ‰ÂÓ Â›Ó·È ÈÎ·ÓÔÔÈËÙÈÎfi,Ê¿ÚÌ·Î· ‰Â‡ÙÂÚË˜ ÂÈÏÔÁ‹˜ Â›-Ó·È Ù· ÌË ÂÎÏÂÎÙÈÎ¿ NSAIDs ÌÂÛ¯ÂÙÈÎ¿ ÈÔ ÈÛ¯˘Ú‹ COX-2 ‰Ú¿-ÛË. ΔÚ›ÙË˜ ÂÈÏÔÁ‹˜ Ê¿ÚÌ·Î· Â›-Ó·È ÔÈ ÂÎÏÂÎÙÈÎÔ› ·Ó·ÛÙÔÏÂ›˜ ÙË˜COX-2 (coxibs). Δ· NSAIDs Ú¤-ÂÈ Ó· ‰›ÓÔÓÙ·È ÌÂÙ¿ ·fi ÚÔÛÂ-ÎÙÈÎ‹ ÂÎÙ›ÌËÛË ÙÔ˘ ·Ó·ÏÁËÙÈÎÔ‡·ÔÙÂÏ¤ÛÌ·ÙÔ˜ Î·È ÙÔ˘ ·ÁÁÂÈ·-ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ÛÂ ·ÛıÂÓÂ›˜ ˘„Ë-ÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ·ÁÁÂÈ·Îfi ÂÂÈ-Ûfi‰ÈÔ. ∂ÈÏ¤ÔÓ Ú¤ÂÈ Ó· ¯ÔÚË-ÁÔ‡ÓÙ·È ÛÙË ÌÈÎÚfiÙÂÚË ‰˘Ó·Ù‹‰fiÛË Î·È ÁÈ· ÙÔ ÌÈÎÚfiÙÂÚÔ ¯ÚÔÓÈ-Îfi ‰È¿ÛÙËÌ·. Œ¯ÂÈ È‰È·›ÙÂÚË ÛË-Ì·Û›· Ë Ù·ÎÙÈÎ‹ ·Ú·ÎÔÏÔ‡ıËÛËÙˆÓ ·ÛıÂÓÒÓ (Ì¤ÙÚËÛË ÙË˜ ·ÚÙË-ÚÈ·Î‹˜ ›ÂÛË˜, ÂÎÙ›ÌËÛË ÙÔ˘ Â-ÚÈÊÂÚÈÎÔ‡ ÔÈ‰‹Ì·ÙÔ˜, ÙË˜ ÓÂÊÚÈ-

Î‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ Î·È ·ÔÎÏÂÈÛÌfi˜ÙË˜ ·ÈÌÔÚÚ·Á›·˜ ·fi ÙÔ Á·ÛÙÚÂ-ÓÙÂÚÈÎfi). -

∂ÈÏ¤ÔÓ ÚÔÙÂ›ÓÂÙ·È Ë ÚÔÛı‹-ÎË ·ÛÈÚ›ÓË˜ ÛÂ ·ÛıÂÓÂ›˜ ˘„Ë-ÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ·ÁÁÂÈ·Îfi ÂÂÈ-Ûfi‰ÈÔ Ô˘ ·›ÚÓÔ˘Ó NSAIDs.∂ÓÙÔ‡ÙÔÈ˜ ÛËÌÂÈÒÓÂÙ·È fiÙÈ Ë·ÛÈÚ›ÓË ‰ÂÓ ·ÔÎÏÂ›ÂÈ ÙËÓ ÂÌÊ¿-ÓÈÛË ÂÓfi˜ ·ÁÁÂÈ·ÎÔ‡ Û˘Ì‚¿Ì·ÙÔ˜Î·È ·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ·ÈÌÔÚÚ·-Á›·˜ ·fi ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi22.

¶ÚfiÛÊ·Ù· ‰ËÌÔÛÈÂ‡ıËÎÂ ÌÈ· ÌÂ-Ï¤ÙË Ô˘ Û¯Â‰È¿ÛÙËÎÂ ÁÈ· Ó···ÓÙ‹ÛÂÈ ÛÙÔ ÂÚÒÙËÌ· ÔÈ·NSAIDs Â›Ó·È ÈÔ ·ÛÊ·Ï‹ ÁÈ·ÙÔ˘˜ ·ÛıÂÓÂ›˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ÁÈ· ·ÁÁÂÈ·Îfi ÂÂÈÛfi‰ÈÔ Ô˘·›ÚÓÔ˘Ó ‹‰Ë ·ÛÈÚ›ÓË. √È Û˘Á-ÁÚ·ÊÂ›˜ ÂÎÙ›ÌËÛ·Ó ÙÔÓ Î·Ú‰È·Á-

ÁÂÈ·Îfi Î›Ó‰˘ÓÔ Î·È ÙÔÓ Î›Ó‰˘ÓÔÁÈ· ·ÈÌÔÚÚ·Á›· ·fi ÙÔ Á·ÛÙÚÂ-ÓÙÂÚÈÎfi Î·È ÚfiÙÂÈÓ·Ó ˆ˜ Î·Ù·Ï-ÏËÏfiÙÂÚÔ Ê¿ÚÌ·ÎÔ ÙÈ˜ coxibs ÛÂÛ‡ÁÎÚÈÛË ÌÂ Ù· ÌË ÂÎÏÂÎÙÈÎ¿NSAIDs23. ∂›Ó·È ·ÍÈÔÛËÌÂ›ˆÙÔ fiÙÈÙ· ÌË ÂÎÏÂÎÙÈÎ¿ NSAIDs ÂÎÙfi˜·fi ÙËÓ ·‡ÍËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ÁÈ· ·ÈÌÔÚÚ·Á›· ·fi ÙÔ Á·ÛÙÚÂ-ÓÙÂÚÈÎfi, ·ÏÏËÏÂÈ‰ÚÔ‡Ó ÌÂ ÙËÓ·ÛÈÚ›ÓË. ∏ ibuprofen ·ÓÙ·ÁˆÓ›-˙ÂÙ·È ÙËÓ ·ÛÈÚ›ÓË Î·È ÌÂÈÒÓÂÈÙËÓ ·ÓÙÈ·ÈÌÔÂÙ·ÏÈ·Î‹ ÙË˜ ‰Ú¿-ÛË Î·È Ú¤ÂÈ Ó· ‰›ÓÂÙ·È 30 ÏÂ-Ù¿ ÌÂÙ¿ ‹ 8 ÒÚÂ˜ ÚÈÓ ÙËÓ ·ÛÈ-Ú›ÓË. ∏ ·Ú·ÎÂÙ·ÌfiÏË Î·È Ë di-clofenac ‰ÂÓ ÂËÚÂ¿˙Ô˘Ó ÙËÓ·ÓÙÈ·ÈÌÔÂÙ·ÏÈ·Î‹ ‰Ú¿ÛË ÙË˜·ÛÈÚ›ÓË˜. øÛÙfiÛÔ ÁÈ· Ù· ˘fi-ÏÔÈ· NSAIDs ‰ÂÓ ˘¿Ú¯Ô˘Ó ·Ú-ÎÂÙ¿ ÛÙÔÈ¯Â›·24.

™ ∂ ¶ Δ ∂ ª μ ƒ π √ ™ 2 0 0 8

16

1. Solomon SD, McMurray JJ, Pfeffer MA,et al. Cardiovascular risk associatedwith celecoxib in a clinical trial forcolorectal adenoma prevention. NEngl J Med. 2005; 352: 1071-1080.

2. Bombardier C, Laine L, Reicin A, et al.Comparison of upper gastrointestinaltoxicity of rofecoxib and naproxen inpatients with rheumatoid arthritis:VIGOR Study Group. N Engl J Med.2000; 343: 1520 -1528.

3. Bresalier RS, Sandler RS, Quan H, et al.Cardiovascular events associated withrofecoxib in a colorectal adenomachemoprevention trial. N Engl J Med.2005; 352: 1092-102.

4. Cardiovascular and cerebrovascularevents in the randomized, controlledAlzheimer's Disease Anti-InflammatoryPrevention Trial (ADAPT). PLoS ClinTrials. 2006; 1: e33.

5. Farkouh ME, Kirshner H, Harrington RA,et al. Comparison of lumiracoxib withnaproxen and ibuprofen in theTherapeutic Arthritis Research andGastrointestinal Event Trial (TARGET),cardiovascular outcomes: randomisedcontrolled trial. Lancet. 2004; 364:675- 684.

6. Cannon CP, Curtis SP, Bolognese JA,Laine L; MEDAL Steering Commit-tee.Clinical trial design and patientdemographics of the MultinationalEtoricoxib and Diclofenac ArthritisLong-term (MEDAL) study program:cardiovascular outcomes with etorico-xib versus diclofenac in patients withosteoarthritis and rheumatoid arthritis.Am Heart J. 2006; 152: 237-245.

7. Antman EM, DeMets D, Loscalzo J.Cyclooxygenase inhibition andcardiovascular risk. Circulation. 2005;112: 759-70.

8. Foegh ML, Hartmann DP, Rowles JR,Khirabadi BS, Alijani MR, Helfrich GB,Ramwell PW. Leukotrienes, thromboxa-ne, and platelet activating factor in organ

transplantation. Adv Prostaglandin Thro-mboxane Leukot Res. 1987; 17: 140-6.

9. Marcus AJ. Transcellular metabolism ofeicosanoids. Prog Hemost Thromb.1986; 8: 127-42.

10. Hern·ndez-Diaz S, GarcÓa RodriguezLA: Association between nonsteroidalanti-inflammatory drugs and uppergastrointestinal tract bleeding andperforation: An overview of epidemio-logical studies published in the 1990s.Arch Intern Med 2000; 160: 2093-9.

11. Campbell CL, Smyth S, Montalescot G,Steinhubl SR. Aspirin dose for theprevention of cardiovascular disease:a systematic review. JAMA. 2007; 297:2018-24.

12. Vane JR, Bakhle YS, Botting RM.Cyclooxygenases 1 and 2. Annu RevPharmacol Toxicol. 1998; 38: 97-120

13. Lewington S, Clarke R, Qizilbash N,Peto R, Collins R; Prospective StudiesCollaboration. Age-specific relevanceof usual blood pressure to vascularmortality: a meta-analysis of individualdata for one million adults in 61prospective studies. Lancet. 2002;360: 1903-13.

14. Solomon SD, Pfeffer MA, McMurray JJ,Fowler R, Finn P, Levin B, Eagle C,Hawk E, Lechuga M, Zauber AG,Bertagnolli MM, Arber N, Wittes J; APCand PreSAP Investigators. Effect ofcelecoxib on cardiovascular eventsand blood pressure in two trials for theprevention of colorectal adenomas.Circulation. 2006; 114: 1028 -35.

15. Kearney PM, Baigent C, Godwin J,Halls H, Emberson JR, Patrono C. Doselective cyclo-oxygenase-2 inhibitorsand traditional non-steroidal anti-inflammatory drugs increase the riskof atherothrombosis? Meta-analysis ofrandomised trials. BMJ. 2006; 332:1302-8.

16. Salpeter SR, Gregor P, Ormiston TM,Whitlock R, Raina P, Thabane L, TopolEJ. Meta-analysis: cardiovascularevents associated with nonsteroidalanti-inflammatory drugs. Am J Med.2006; 119: 552-9.

17. Mukherjee D, Nissen SE, Topol EJ.Lack of cardioprotective effect of na-proxen. Arch Intern Med. 2002;162:2637-9.

18. Rahme E, Pilote L, LeLorier J. Asso-ciation between naproxen use and pro-tection against acute myocardial in-farction. Arch Intern Med. 2002; 162:1111-5.

19. Reilly IA, FitzGerald GA. Inhibition ofthromboxane formation in vivo and exvivo: implications for therapy with pla-telet inhibitory drugs. Blood. 1987; 69:180-6.

20. Patrono C, Ciabattoni G, Patrignani P,et al. Clinical pharmacology of plateletcyclooxygenase inhibition. Circulation.1985; 72: 1177-84.

21. Aw TJ, Haas SJ, Liew D, Krum H. Meta-analysis of cyclooxygenase-2 inhibi-tors and their effects on blood pres-sure. Arch Intern Med. 2005; 165: 490-6.

22. Antman EM, Bennett JS, Daugherty A,Furberg C, Roberts H, Taubert KA;American Heart Association. Use ofnonsteroidal antiinflammatory drugs:an update for clinicians: a scientificstatement from the American HeartAssociation. Circulation. 2007; 115:1634-42.

23. Strand V. Are COX-2 inhibitors prefera-ble to non-selective non-steroidal anti-inflammatory drugs in patients with riskof cardiovascular events taking low-doseaspirin? Lancet. 2007; 370: 2138-51.

24. Catella-Lawson F, Reilly MP, KapoorSC, Cucchiara AJ, DeMarco S,Tournier B, Vyas SN, FitzGerald GA.Cyclooxygenase inhibitors and theantiplatelet effects of aspirin. N Engl JMed. 2001; 345: 1809-17.


∫§π¡π∫∂™ ª∂§∂Δ∂™

17

∏ ‰Ú¿ÛË ÙˆÓ ÛÙ·ÙÈÓÒÓ ÛÙËÓ Î·Ú-‰È·Î‹ ·ÓÂ¿ÚÎÂÈ· ‰ÂÓ Â›Ó·È ÁÓˆÛÙ‹,ÂÂÈ‰‹ Ë Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ· ‹Ù·ÓÎÚÈÙ‹ÚÈÔ ·ÔÎÏÂÈÛÌÔ‡ ·fi ÙÈ˜ÌÂÁ¿ÏÂ˜ ÎÏÈÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ‰Â˘ÙÂÚÔÁÂ-ÓÔ‡˜ ÚfiÏË„Ë˜. ∏ ·Ó·‰ÚÔÌÈÎ‹ ·Ó¿-Ï˘ÛË ÌÂÚÈÎÒÓ ÌÂÏÂÙÒÓ ¤‰ˆÛÂ ·Û·-Ê‹ Î·È ·ÓÙÈÊ·ÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù·. ∏ÚÒÙË ÚÔÔÙÈÎ‹ ÎÏÈÓÈÎ‹ ÌÂÏ¤ÙË ÙË˜‰Ú¿ÛË˜ ÙˆÓ ÛÙ·ÙÈÓÒÓ ÛÙËÓ Î·Ú‰È·Î‹·ÓÂ¿ÚÎÂÈ· Â›Ó·È Ë CORONA.

¶ÚfiÎÂÈÙ·È ÁÈ· ÌÈ· ÔÏ˘ÎÂÓÙÚÈÎ‹,Ù˘¯·ÈÔÔÈËÌ¤ÓË, ÂÏÂÁ¯fiÌÂÓË ÌÂ ÂÈ-ÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ ÌÂÏ¤ÙË Ô˘ ‰ÈÂÍ‹-¯ıË ÛÙËÓ ∂˘ÚÒË, ÙË ƒˆÛ›· Î·È ÙË¡fiÙÈÔ ∞ÊÚÈÎ‹. ¶ÂÚÈ¤Ï·‚Â 5.011·ÛıÂÓÂ›˜, ËÏÈÎ›·˜ ¿Óˆ ÙˆÓ 60 ÂÙÒÓ,ÌÂ Û˘ÛÙÔÏÈÎ‹ Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ·ÈÛ¯·ÈÌÈÎ‹˜ ·ÈÙÈÔÏÔÁ›·˜, (ÎÏ¿ÛÌ·ÂÍÒıËÛË˜ <40%), ÏÂÈÙÔ˘ÚÁÈÎÔ‡ÛÙ·‰›Ô˘ Î·Ù¿ ¡À∏∞ ππ (37%), πππ(62%), ‹ IV, Ô˘ ‰ÂÓ Â›¯·Ó ¤Ó‰ÂÈÍËÛÙ·Ù›ÓË˜. ∞ÔÎÏÂ›ÛıËÎ·Ó ·ÛıÂÓÂ›˜ÌÂ ·ÛÙ·ı‹ ÛÙËı¿Á¯Ë ‹ ÚfiÛÊ·ÙÔ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘, ÌË·ÓÙÈÚÚÔÔ‡ÌÂÓË Î·Ú‰È·Î‹ ·ÓÂ¿Ú-ÎÂÈ·, ÚˆÙÔ·ıÂ›˜ ‚·Ï‚È‰Ô¿ıÂÈÂ˜ÌÂ ‰ÈÔÚıˆÌ¤ÓÂ˜, ˘ÂÚÙÚÔÊÈÎ‹ Ì˘Ô-Î·Ú‰ÈÔ¿ıÂÈ· Î·È ·ÛıÂÓÂ›˜ ÌÂ Ë·-ÙÈÎ‹ ‹ ÓÂÊÚÈÎ‹ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·.

√È ·ÛıÂÓÂ›˜ Î·Ù·ÓÂÌ‹ıËÎ·Ó Ù˘-¯·›· Ó· Ï¿‚Ô˘Ó 10 mg ÚÔÛÔ˘‚·-ÛÙ·Ù›ÓË˜ ÙËÓ ËÌ¤Ú· ‹ ÂÈÎÔÓÈÎfi Ê¿Ú-Ì·ÎÔ. ¶ÚˆÙÂ‡ÔÓ Î·Ù·ÏËÎÙÈÎfi ÛË-ÌÂ›Ô ÔÚ›ÛıËÎÂ ÙÔ ¿ıÚÔÈÛÌ· ÙˆÓÎ·Ú‰È·ÁÁÂÈ·ÎÒÓ ı·Ó¿ÙˆÓ Î·È ÙˆÓÌË ı·Ó·ÙËÊfiÚˆÓ ÂÌÊÚ·ÁÌ¿ÙˆÓÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘ Î·È ·ÁÁÂÈ·ÎÒÓÂÁÎÂÊ·ÏÈÎÒÓ. ¢Â˘ÙÂÚÂ‡ÔÓÙ· Î·Ù·-ÏËÎÙÈÎ¿ ÛËÌÂ›· ‹Ù·Ó: Ô ı¿Ó·ÙÔ˜·fi ÔÔÈ·‰‹ÔÙÂ ·ÈÙ›·, Î¿ıÂ ÛÙÂ-Ê·ÓÈ·›Ô ÂÂÈÛfi‰ÈÔ, Ô ı¿Ó·ÙÔ˜ ·fiÎ·Ú‰È·ÁÁÂÈ·Î¿ ·›ÙÈ· Î·È ÔÈ ÂÈÛ·Áˆ-Á¤˜ ÛÙ· ÓÔÛÔÎÔÌÂ›·.

∞ÔÙÂÏ¤ÛÌ·Ù·: ∏ ÔÌ¿‰· ÙˆÓ·ÛıÂÓÒÓ Ô˘ ¤Ï·‚Â ÚÔÛÔ˘‚·ÛÙ·Ù›-ÓË ÂÌÊ¿ÓÈÛÂ ÂÏ¿ÙÙˆÛË ÙË˜ LDL-¯Ô-ÏËÛÙÂÚfiÏË˜ (‰È·ÊÔÚ¿ ÌÂÙ·Í‡ ÙˆÓÔÌ¿‰ˆÓ 45%, ƒ<0,001) Î·È ÙË˜CRP (‰È·ÊÔÚ¿ ÌÂÙ·Í‡ ÙˆÓ ÔÌ¿‰ˆÓ

37,1%, ƒ<0,001). ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ·ÙË˜ ·Ú·ÎÔÏÔ‡ıËÛË˜ (‰È¿ÌÂÛË‰È¿ÚÎÂÈ· 32,8 Ì‹ÓÂ˜) ·Ú·ÙËÚ‹ıË-Î·Ó 692 ÂÚÈÙÒÛÂÈ˜ ÚˆÙÂ‡ÔÓÙÔ˜Î·Ù·ÏËÎÙÈÎÔ‡ ÛËÌÂ›Ô˘ ÛÙËÓ ÔÌ¿‰·ÙË˜ ÚÔÛÔ˘‚·ÛÙ·Ù›ÓË˜ Î·È 732 ÛÙËÓÔÌ¿‰· ÂÏ¤Á¯Ô˘ (HR 0,92: 95% CI0,83 - 1,02: P = 0,12). ¢ÂÓ ˘‹ÚÍÂÂ›ÛË˜ ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈÎ‹ ‰È·-ÊÔÚ¿ ÛÙÔÓ ·ÚÈıÌfi ÙˆÓ ı·Ó¿ÙˆÓ, Â›-ÙÂ ·fi ÔÔÈÔ‰‹ÔÙÂ ·›ÙÈÔ Â›ÙÂ ·fiÎ·Ú‰È·ÁÁÂÈ·Î¿ ÓÔÛ‹Ì·Ù· Ô‡ÙÂ ÛÙÔÓ·ÚÈıÌfi ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ÂÂÈÛÔ-‰›ˆÓ. ™ÙÔ ÌfiÓÔ ‰Â˘ÙÂÚÂ‡ÔÓ Î·Ù·ÏË-ÎÙÈÎfi ÛËÌÂ›Ô ÛÙÔ ÔÔ›Ô ·Ú·ÙËÚ‹-ıËÎÂ ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔ-Ú¿ ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ‹Ù·Ó Ô·ÚÈıÌfi˜ ÙˆÓ ÂÈÛ·ÁˆÁÒÓ ÛÂ ÓÔÛÔ-ÎÔÌÂ›· (¶›Ó·Î·˜ 1)

√È ·ÓÂÈı‡ÌËÙÂ˜ ÂÓ¤ÚÁÂÈÂ˜, Û˘-ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ ÚÔ‚ÏË-Ì¿ÙˆÓ ·fi ÙÔ˘˜ Ì‡Â˜, ·Ú·ÙËÚ‹-ıËÎ·Ó ÛÂ ›ÛÔ ÔÛÔÛÙfi Î·È ÛÙÈ˜ ‰‡ÔÔÌ¿‰Â˜.

∂› ÙÔ˘ ÈÂÛÙËÚ›Ô˘: ∂ÓÒ Â›¯Â‰ÔıÂ› Ë ‡ÏË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ ÛÙÔ Ù˘-ÔÁÚ·ÊÂ›Ô Î·È Ï›ÁÔ ÚÈÓ ÙËÓ ÂÎÙ‡-ˆÛË, ÛÙÈ˜ 30 ∞˘ÁÔ‡ÛÙÔ˘ 2008,·Ó·ÎÔÈÓÒıËÎ·Ó ÛÙÔ ∂˘Úˆ·˚Îfi∫·Ú‰ÈÔÏÔÁÈÎfi ™˘Ó¤‰ÚÈÔ, ÛÙÔ ªfi-Ó·¯Ô, Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ÌÂÏ¤-ÙË˜ GISSI-HF, Ù· ÔÔ›· ÂÈ‚Â‚·ÈÒ-ÓÔ˘Ó Ù· Â˘Ú‹Ì·Ù· ÙË˜ CORONA. ∏GISSI-HF ‰ÈÂÍ‹¯ıË ÛÙËÓ πÙ·Ï›·,Â›Ó·È ÔÏ˘ÎÂÓÙÚÈÎ‹ ÌÂÏ¤ÙË, Ù˘¯·È-ÔÔÈËÌ¤ÓË Î·È ÂÚÈ¤Ï·‚Â 4.574·ÛıÂÓÂ›˜ ¿Óˆ ÙˆÓ 18 ÂÙÒÓ, ÌÂ ¯Úfi-ÓÈ· Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ· ÏÂÈÙÔ˘ÚÁÈ-ÎÔ‡ ÛÙ·‰›Ô˘ ππ ¤ˆ˜ IV Î·Ù¿ NYHA,·ÓÂÍ¿ÚÙËÙ· ·ÈÙÈÔÏÔÁ›·˜ Î·È ÎÏ¿-

ÛÌ·ÙÔ˜ ÂÍˆı‹ÛÂˆ˜. √È ÌÈÛÔ› ·ÛıÂ-ÓÂ›˜ ¤Ï·‚·Ó 10 mg ÚÔÛÔ˘‚·ÛÙ·Ù›-ÓË˜ ËÌÂÚËÛ›ˆ˜ Î·È ÔÈ ¿ÏÏÔÈ ÌÈÛÔ› ÂÈ-ÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ. ∏ Ì¤ÛË ‰È¿ÚÎÂÈ··Ú·ÎÔÏÔ‡ıËÛË˜ ‹Ù·Ó 3,9 ¤ÙË Î·Èˆ˜ ÚˆÙÂ‡ÔÓÙ· Î·Ù·ÏËÎÙÈÎ¿ ÛË-ÌÂ›· Â›¯·Ó ÔÚÈÛıÂ› Ô ·ÚÈıÌfi˜ ÙˆÓı·Ó¿ÙˆÓ Î·È ÙÔ ¿ıÚÔÈÛÌ· ÙˆÓ ı·-Ó¿ÙˆÓ Î·È ÙˆÓ ÂÈÛ·ÁˆÁÒÓ ÛÂ ÓÔÛÔ-ÎÔÌÂ›· ÁÈ· Î·Ú‰È·ÁÁÂÈ·Î¿ ·›ÙÈ·.¢ÂÓ ·Ú·ÙËÚ‹ıËÎÂ Î·Ì›· ‰È·ÊÔÚ¿ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ÛÙ· Úˆ-ÙÂ‡ÔÓÙ· Î·Ù·ÏËÎÙÈÎ¿ ÛËÌÂ›·. √ ·-ÚÔ˘ÛÈ·ÛÙ‹˜ Î·ıËÁËÙ‹˜ Gianni To-gnoni ¯·Ú·ÎÙ‹ÚÈÛÂ Ù· Â˘Ú‹Ì·Ù·ÙË˜ ÌÂÏ¤ÙË˜ Ô˘‰¤ÙÂÚ· Î·È fi¯È ·Ú-ÓËÙÈÎ¿, ‰Â‰ÔÌ¤ÓÔ˘ fiÙÈ ÔÈ ·ÛıÂÓÂ›˜Ô˘ ‹Ú·Ó ÚÔÛÔ˘‚·ÛÙ·Ù›ÓË ‰ÂÓ˘¤ÛÙËÛ·Ó Î·ÌÈ¿ ‚Ï¿‚Ë, Ô Û¯ÔÏÈ·-ÛÙ‹˜ fiÌˆ˜ Î·ıËÁËÙ‹˜ Phillip Pool-Wilson Â›Â fiÙÈ ÔÈ ·ÛıÂÓÂ›˜ Ô˘ ‚Ú›-ÛÎÔÓÙ·È ‹‰Ë ˘fi ·˘Ù‹ ÙËÓ ·ÁˆÁ‹ı· Ú¤ÂÈ «Èı·ÓfiÙ·Ù·» Ó· ÙËÓ ‰È·-Îfi„Ô˘Ó. ™Â ¤Ó· ¿ÏÏÔ ÛÎ¤ÏÔ˜ ÙË˜›‰È·˜ ÌÂÏ¤ÙË˜ ‰È·ÈÛÙÒıËÎÂ fiÙÈ 1ÁÚ·ÌÌ¿ÚÈÔ ˆ-3 ÏÈ·ÚÒÓ ÔÍ¤ˆÓ ÙËÓËÌ¤Ú· ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ·˘ÙÔ‡˜ ÌÂ›-ˆÛÂ ÙÔ˘˜ ı·Ó¿ÙÔ˘˜ Î·Ù¿ 9%(p=0.041) Î·È ÙÔ ¿ıÚÔÈÛÌ· ı·Ó¿-ÙˆÓ Î·È ÂÈÛ·ÁˆÁÒÓ ÛÂ ÓÔÛÔÎÔÌÂ›·Î·Ù¿ 8% (p=0.009). ¶ÂÚÈÛÛfiÙÂÚ·ÁÈ· ÙË ÛËÌ·ÓÙÈÎ‹ ·˘Ù‹ ÌÂÏ¤ÙË ı··Ó·Ê¤ÚÔ˘ÌÂ ÛÙÔ ÂfiÌÂÓÔ ÙÂ‡¯Ô˜. ™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Ë ÚÔÛÔ˘‚·ÛÙ·Ù›-ÓË ‰ÂÓ ÚÔÛÊ¤ÚÂÈ Î·Ó¤Ó· fiÊÂÏÔ˜ÛÂ ·ÛıÂÓÂ›˜ ÌÂ Î·Ú‰È·Î‹ ·ÓÂ¿Ú-ÎÂÈ· ÔÔÈ·Û‰‹ÔÙÂ ·ÈÙÈÔÏÔÁ›·˜ ‹‚·Ú‡ÙËÙ·˜.

∂ÈÌ¤ÏÂÈ·:∏Ï›·˜ ÃÂÈÌÒÓ·˜

ªÂÏ¤ÙË CORONA (COntrolled ROsuvastatin in MultinatioNAl Trial in Heart Failure)

ƒÔÛÔ˘‚·ÛÙ·Ù›ÓË ÛÂ ËÏÈÎÈˆÌ¤ÓÔ˘˜ ·ÛıÂÓÂ›˜

ÌÂ Û˘ÛÙÔÏÈÎ‹ Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ·

Kjekshus J, Apetrei E, Barrios V, Böhm M, Cleland JG, Cornel JH, Dunselman P, Fonseca C,Goudev A, Grande P, Gullestad L, Hjalmarson A, Hradec J, Jànosi A, Kamensky G,

Komajda M, Korewicki J, Kuusi T, Mach F, Mareev V, McMurray JJ, Ranjith N, SchaufelbergerM, Vanhaecke J, van Veldhuisen DJ, Waagstein F, Wedel H, Wikstrand J; CORONA Group.

N Engl J Med. 2007 Nov 29;357(22):2248-61.

¶›Ó·Î·˜ 1. ∞ÚÈıÌfi˜ ÂÈÛ·ÁˆÁÒÓ ÛÂ ÓÔÛÔÎÔÌÂ›·, Î·Ù¿ ·ÈÙ›· ÂÈÛ·ÁˆÁ‹˜

∞ÈÙ›· ÂÈÛ·ÁˆÁ‹˜ Placebo, Rosuvastatin, pn=2497 (n) n=2514 (n)

∞fi Î¿ıÂ ·ÈÙ›· 4074 3694 0.007

∫·Ú‰È·ÁÁÂÈ·Î‹ 2564 2193 <0.001

∫·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ· 1299 1109 0.01

∞ÛÙ·ı‹˜ ÛÙËı¿Á¯Ë 90 74 0.30

™ ∂ ¶ Δ ∂ ª μ ƒ π √ ™ 2 0 0 8

18

∂ÈÛ·ÁˆÁ‹¶ÚfiÛÊ·ÙÂ˜, ÌÂÁ¿ÏÂ˜, ÚÔÔÙÈ-Î¤˜, ÂÈ‰ËÌÈÔÏÔÁÈÎ¤˜ ÌÂÏ¤ÙÂ˜¤‰ÂÈÍ·Ó fiÙÈ Ë ÌÂ›ˆÛË ÙË˜ ¯ÔÏË-ÛÙÂÚfiÏË˜ ÙˆÓ ˘„ËÏ‹˜ ˘ÎÓfiÙË-Ù·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ (high dencitylipoproteins, HDL) Î·Ù¿ 1 mg/dl·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛË˜Î·Ú‰È·ÁÁÂÈ·Î‹˜ ÓfiÛÔ˘ Î·Ù¿ 3%ÛÙÈ˜ Á˘Ó·›ÎÂ˜ Î·È 2% ÛÙÔ˘˜¿ÓÙÚÂ˜ (1). ªÂ›ˆÛË ÙË˜ ¯ÔÏËÛÙÂ-ÚfiÏË˜ ÙˆÓ HDL (HDL ¯ÔÏËÛÙÂ-ÚfiÏË˜) Î·È ·‡ÍËÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂ-ÚÈ‰›ˆÓ ·Ú·ÙËÚÂ›Ù·È Û˘¯Ó¿ ÛÙ·Ï·›ÛÈ· ÙË˜ ·ıËÚˆÁfiÓÔ˘ ‰˘ÛÏÈ-È‰·ÈÌ›·˜ ÙÔ˘ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó-‰ÚfiÌÔ˘ (ªÂÙ™) (2). ¡ÂfiÙÂÚ· ‰Â-‰ÔÌ¤Ó· ¤‰ÂÈÍ·Ó fiÙÈ Ô ÚfiÏÔ˜ ÙˆÓHDL Â›Ó·È ÔÏ‡ÏÔÎÔ˜, ·ÊÔ‡ ·˘-Ù¿ Ù· ÛˆÌ·Ù›‰È· ÂÌÊ·Ó›˙Ô˘Ó‰Ú¿ÛÂÈ˜ ¤Ú· ·fi ÙËÓ ·Ó¿ÛÙÚÔ-ÊË ÌÂÙ·ÊÔÚ¿ ÙË˜ ¯ÔÏËÛÙÂÚfiÏË˜Î·È Û˘ÁÎÂÎÚÈÌ¤Ó· ·ÓÙÈÔÍÂÈ‰ˆÙÈ-Î¤˜ Î·È ·ÓÙÈÊÏÂÁÌÔÓÒ‰ÂÈ˜ ‰Ú¿-ÛÂÈ˜ (3). ™‡ÌÊˆÓ· ÌÂ ÚfiÛÊ·ÙÂ˜ÌÂÏ¤ÙÂ˜ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ªÂÙ™·Ú·ÙËÚÂ›Ù·È ÌÂ›ˆÛË ÙË˜ HDL¯ÔÏËÛÙÂÚfiÏË˜ Î·È ÂÍ·Ûı¤ÓËÛËÙˆÓ ·ÓÙÈÔÍÂÈ‰ˆÙÈÎÒÓ Î·È ·ÓÙÈ-ÊÏÂÁÌÔÓˆ‰ÒÓ È‰ÈÔÙ‹ÙˆÓ ÙˆÓHDL ÛˆÌ·ÙÈ‰›ˆÓ (4,5). ™ÙË Û˘Ó¤-¯ÂÈ· ı· Û˘˙ËÙËıÔ‡Ó Ù· ÓÂfiÙÂÚ·‰Â‰ÔÌ¤Ó· fiÛÔÓ ·ÊÔÚ¿ ÙË ‰ÔÌ‹Î·È ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ HDL ˘fi Ê˘-ÛÈÔÏÔÁÈÎ¤˜ Û˘Óı‹ÎÂ˜ Î·È Î˘Ú›ˆ˜ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ªÂÙ™.

ªÂÙ·‚ÔÏÈÛÌfi˜ HDL

√ Û¯ËÌ·ÙÈÛÌfi˜ ÙˆÓ HDL ÛˆÌ·ÙÈ-‰›ˆÓ ÍÂÎÈÓ¿ ÌÂ ÙË Û‡ÓıÂÛË ÙË˜·ÔÏÈÔÚˆÙÂ˝ÓË˜ ∞1 (apoA1)Î·È ÙËÓ ·ÂÏÂ˘ı¤ÚˆÛ‹ ÙË˜ ÛÙÔÏ¿ÛÌ·. ∏ apoA1 Â›Ó·È ÌÈ· Úˆ-ÙÂ˝ÓË ÌÂ 243 ·ÌÈÓÔÍ¤· Ô˘ Û˘ÓÙ›-ıÂÙ·È Î‡ÚÈ· ÛÙÔ ‹·Ú, ·ÏÏ¿ Î·ÈÛÙ· Î‡ÙÙ·Ú· ÙÔ˘ ÂÓÙ¤ÚÔ˘. ∂›-ÛË˜ Ë apoA1 ·ÂÏÂ˘ıÂÚÒÓÂÙ·È

ÛÙÔ ·›Ì· Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘Î·Ù·‚ÔÏÈÛÌÔ‡ ÙˆÓ ¯˘ÏÔÌÈÎÚÒÓ(6). ∏ apoA1 Û˘Ó‰¤ÂÙ·È ÌÂ Êˆ-ÛÊÔÏÈ›‰È· Î·È ¯ÔÏËÛÙÂÚfiÏË ÌÂ·ÔÙ¤ÏÂÛÌ· ÙÔ Û¯ËÌ·ÙÈÛÌfi ÙˆÓ·Ú¯¤ÁÔÓˆÓ, ‰ÈÛÎÔÂÈ‰ÒÓ ÌÔÚÊÒÓÙˆÓ HDL (pre-‚ HDL). √È ·Ú¯¤ÁÔ-ÓÂ˜ ÌÔÚÊ¤˜ ÙˆÓ HDL ·ÔÙÂÏÔ‡-ÓÙ·È ·fi apoA1, ÊˆÛÊÔÏÈ›‰È·Î·È ÌÈÎÚ¤˜ ÔÛfiÙËÙÂ˜ ÂÏÂ‡ıÂÚË˜¯ÔÏËÛÙÂÚfiÏË˜ (7). Δ· ÛˆÌ·Ù›‰È··˘Ù¿ ÚÔÛÏ·Ì‚¿ÓÔ˘Ó ÂÈÚfi-ÛıÂÙË ¯ÔÏËÛÙÂÚfiÏË Î·È ÊˆÛÊÔ-ÏÈ›‰È· ·fi ÙÈ˜ Î˘ÙÙ·ÚÈÎ¤˜ ÌÂÌ-‚Ú¿ÓÂ˜, ‰È·Ì¤ÛÔ˘ ÙˆÓ ÌÂÙ·ÊÔ-Ú¤ˆÓ ABCA1 (ATP-bindingcassette A1) Ô˘ Û˘Ó‰¤ÔÓÙ·È ÌÂÙËÓ apoA1 Î·È ·˘Í¿ÓÔ˘Ó ÛÂ Ì¤-ÁÂıÔ˜ (8). ™ÙË Û˘Ó¤¯ÂÈ· ÌÂ ÙË‰Ú¿ÛË ÙÔ˘ ¤Ó˙˘ÌÔ˘ ÏÂÎ›ıÈÓÔ-¯Ô-ÏÂÛÙ¤Ú˘Ï-·Î˘ÏÔÙÚ·ÓÛÊÂÚ¿ÛË(lecithin:cholesterol acyl-transferase, LCAT) Ë ¯ÔÏËÛÙÂÚfi-ÏË ÙˆÓ HDL ÛˆÌ·ÙÈ‰›ˆÓ ÂÛÙÂÚÔ-ÔÈÂ›Ù·È Î·È ÔÈ ÂÛÙ¤ÚÂ˜ ¯ÔÏËÛÙÂ-ÚfiÏË˜ Ô˘ Û¯ËÌ·Ù›˙ÔÓÙ·È ÌÂÙ·ÎÈ-ÓÔ‡ÓÙ·È ÛÙÔ ÂÛˆÙÂÚÈÎfi ÙˆÓ Ûˆ-Ì·ÙÈ‰›ˆÓ. ∏ ÌÂÙ·Î›ÓËÛË ·˘Ù‹¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙÔ Û¯ËÌ·ÙÈ-ÛÌfi ÙˆÓ ÒÚÈÌˆÓ, ÌÈÎÚÒÓ, ÛÊ·ÈÚÈ-ÎÒÓ HDL ÛˆÌ·ÙÈ‰›ˆÓ, Ù· ÔÔ›··ÓÙÈÛÙÔÈ¯Ô‡Ó ÛÙÔ ˘ÔÎÏ¿ÛÌ·HDL3 Ô˘ Ï·Ì‚¿ÓÂÙ·È Î·Ù¿ ÙËÓÈÛÔ˘ÎÓÈÎ‹ ˘ÂÚÊ˘ÁÔÎ¤ÓÙÚËÛË‚·ıÌ›‰ˆÛË˜ ˘ÎÓÔÙ‹ÙˆÓ (isopy-cnic dencity gradient ultracentri-fugation) ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ (8).Δ· HDL3 ÛˆÌ·Ù›‰È· Û˘ÓÂ¯›˙Ô˘ÓÓ· ÚÔÛÏ·Ì‚¿ÓÔ˘Ó ¯ÔÏËÛÙÂÚfi-ÏË ‰È·Ì¤ÛÔ˘ ÙˆÓ ˘Ô‰Ô¯¤ˆÓABCG1/G4 (ATP-binding casset-te G1/G4), ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙË‰ËÌÈÔ˘ÚÁ›· ÙˆÓ ÒÚÈÌˆÓ, ÌÂÁ¿-ÏˆÓ, ÛÊ·ÈÚÈÎÒÓ HDL ÛˆÌ·ÙÈ-‰›ˆÓ, Ô˘ ·ÓÙÈÛÙÔÈ¯Ô‡Ó ÛÙÔ ˘Ô-ÎÏ¿ÛÌ· HDL2 ÙË˜ ˘ÂÚÊ˘ÁÔÎ¤-ÓÙÚËÛË˜ (9).

Δ· ÌÂÁ¿Ï·, ÛÊ·ÈÚÈÎ¿ HDL2ÛˆÌ·Ù›‰È· ·ÏÏËÏÂÈ‰ÚÔ‡Ó ÌÂ ÙÈ˜

ÏÔ‡ÛÈÂ˜ ÛÂ ÙÚÈÁÏ˘ÎÂÚ›‰È· ÏÈÔ-ÚˆÙÂ˝ÓÂ˜ (low density lipopro-teins, LDL Î·È very low densitylipoproteins, VLDL) ·ÓÙ·ÏÏ¿˙Ô-ÓÙ·˜ ÂÛÙ¤ÚÂ˜ ¯ÔÏËÛÙÂÚfiÏË˜ ÌÂÙÚÈÁÏ˘ÎÂÚ›‰È·, ‰È·Ì¤ÛÔ˘ ÙÔ˘ ¤Ó-˙˘ÌÔ˘ ÌÂÙ·ÊÔÚ¿˜ ÂÛÙ¤ÚˆÓ ¯Ô-ÏËÛÙÂÚfiÏË˜ (cholesteryl estertransfer protein, CETP) (10). ΔÂ-ÏÈÎ¿ Ù· HDL2 ÛˆÌ·Ù›‰È· ·ÏÏËÏÂ-È‰ÚÔ‡Ó ÌÂ Ù· Ë·ÙÈÎ¿ Î‡ÙÙ·Ú·ÌÂ ÂÈ‰ÈÎÔ‡˜ ˘Ô‰Ô¯Â›˜ (scave-nger receptors type B1, SRB1),‰È·Ì¤ÛÔ˘ ÙˆÓ ÔÔ›ˆÓ ·Ô‰›‰Ô˘ÓÂÛÙ¤ÚÂ˜ ¯ÔÏËÛÙÂÚfiÏË˜ ÛÙ· Ë·-ÙÔÎ‡ÙÙ·Ú· Î·È ÌÂÙ·ÙÚ¤ÔÓÙ·È¿ÏÈ ÛÙ· HDL3 ÛˆÌ·Ù›‰È· (11).Δ· ÊˆÛÊÔÏÈ›‰È· Î·È Ù· ÙÚÈÁÏ˘-ÎÂÚ›‰È· Ô˘ ·ÔÌ¤ÓÔ˘Ó ÛÙ·HDL3 ÛˆÌ·Ù›‰È· ˘‰ÚÔÏ‡ÔÓÙ·È ÌÂÙË ‰Ú¿ÛË ÙË˜ Ë·ÙÈÎ‹˜ ÏÈ¿ÛË˜(hepatic lipase, HL) Î·È ÙË˜ Úˆ-ÙÂ˝ÓË˜ ÌÂÙ·ÊÔÚ¿˜ ÊˆÛÊÔÏÈÈ-‰›ˆÓ (phospholipid transfer pro-tein, PLTP) Î·È ÙÂÏÈÎ¿ ·Ô‰Â-ÛÌÂ‡ÂÙ·È Ë apoA1 (8), ÁÈ· Ó· ÍÂ-ÎÈÓ‹ÛÂÈ Ë ·Ú·ÁˆÁ‹ ·Ú¯¤ÁÔÓˆÓHDL, ÂÓÒ ¤Ó· ÔÛÔÛÙfi ·˘Ù‹˜ÙË˜ ·ÔÏÈÔÚˆÙÂ˝ÓË˜ ·Ô‚¿Ï-ÏÂÙ·È ·fi ÙÔ˘˜ ÓÂÊÚÔ‡˜ ÌÂ Ûˆ-ÏËÓ·ÚÈ·Î‹ ·¤ÎÎÚÈÛË ‹ ÛÂÈÚ·-Ì·ÙÈÎ‹ ‰È‹ıËÛË (3).

∞ÓÙÈ·ıËÚÔÁfiÓÂ˜ ‰Ú¿ÛÂÈ˜ÙˆÓ HDL

Δ· HDL ÛˆÌ·Ù›‰È· ÂÈÙÂÏÔ‡ÓÙÔÓ ÌË¯·ÓÈÛÌfi ÙË˜ ·Ó¿ÛÙÚÔÊË˜ÌÂÙ·ÊÔÚ¿˜ ÙË˜ ¯ÔÏËÛÙÂÚfiÏË˜·fi ÙÔ˘˜ ÂÚÈÊÂÚÈÎÔ‡˜ ÈÛÙÔ‡˜ÚÔ˜ Ù· Ë·ÙÔÎ‡ÙÙ·Ú·. √È Úfi-‰ÚÔÌÂ˜ ÌÔÚÊ¤˜ ÙˆÓ HDL ÛˆÌ·-ÙÈ‰›ˆÓ ÚÔÛÏ·Ì‚¿ÓÔ˘Ó ¯ÔÏËÛÙÂ-ÚfiÏË Î·È ÊˆÛÊÔÏÈ›‰È· ·fi Ù·Î‡ÙÙ·Ú· ÙˆÓ ÂÚÈÊÂÚÈÎÒÓ ÈÛÙÒÓ‰È·Ì¤ÛÔ˘ ÙˆÓ ABCA1 ÌÂÙ·ÊÔÚ¤-ˆÓ (8), ÂÓÒ ÔÈ ÈÔ ÒÚÈÌÂ˜ ÌÔÚ-Ê¤˜ ÚÔÛÏ·Ì‚¿ÓÔ˘Ó Ù· ÂÓ‰ÔÎ˘Ù-Ù¿ÚÈ· ÏÈ›‰È· ‰È·Ì¤ÛÔ˘ ÙˆÓ ˘Ô-

¢ÔÌ‹ Î·È §ÂÈÙÔ˘ÚÁ›· ÙˆÓ À„ËÏ‹˜ ¶˘ÎÓfiÙËÙ·˜ §ÈÔÚˆÙÂ˚ÓÒÓ

ÛÙÔ ªÂÙ·‚ÔÏÈÎfi ™‡Ó‰ÚÔÌÔ

∫ˆÓÛÙ·ÓÙ›ÓÔ˜ §·Áfi˜, ∂ÈÛÙËÌÔÓÈÎfi˜ ™˘ÓÂÚÁ¿ÙË˜ ÙÔ˘ π·ÙÚÂ›Ô˘ ¢È·Ù·Ú·¯ÒÓ ÙÔ˘ ªÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ §ÈÈ‰›ˆÓ,

¶·ÓÂÈÛÙËÌÈ·Îfi ¡ÔÛÔÎÔÌÂ›Ô πˆ·ÓÓ›ÓˆÓ

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

¶∞£√ºÀ™π√§√°π∞

19

‰Ô¯¤ˆÓ ABCG1/G4 (9). Δ· ÒÚÈÌ·

HDL ÛˆÌ·Ù›‰È· ¤¯Ô˘Ó ÙËÓ ÈÎ·Ófi-

ÙËÙ· Ó· ·Ô‰›‰Ô˘Ó Ù· ÏÈ›‰È·

Ô˘ ÌÂÙ·Ê¤ÚÔ˘Ó ÛÙ· Ë·ÙÔÎ‡Ù-

Ù·Ú· ‰È·Ì¤ÛÔ˘ ÙˆÓ ˘Ô‰Ô¯¤ˆÓ

SRB1. ∏ ÈÎ·ÓfiÙËÙ· ÙˆÓ HDLÛˆÌ·ÙÈ‰›ˆÓ Ó· ÚÔÛÏ·Ì‚¿ÓÔ˘Ó‹ Ó· ·Ô‰›‰Ô˘Ó ÏÈ›‰È· Â›Ó·È·ÓÙÈÛÙÚfiÊˆ˜ ·Ó¿ÏÔÁË ÌÂ ÙËÓÔÛfiÙËÙ· ÏÈÈ‰›ˆÓ Ô˘ ÂÚÈ¤-¯Ô˘Ó (12). Δ· ÌÈÎÚ¿-˘ÎÓ¿ Î·È

Ùˆ¯¿ ÛÂ ÏÈ›‰È· HDL3 ÛˆÌ·Ù›-

‰È· ÚÔÛÏ·Ì‚¿ÓÔ˘Ó ¯ÔÏËÛÙÂÚfi-

ÏË Î·È ÊˆÛÊÔÏÈ›‰È· ·fi Ù· Î‡Ù-

Ù·Ú· ÙˆÓ ÈÛÙÒÓ Î·È ÌÂÙ·ÙÚ¤Ô-

ÓÙ·È ÛÙ· ÌÂÁ¿Ï·, ÏÔ‡ÛÈ· ÛÂ ÏÈ-

›‰È· HDL2 ÛˆÌ·Ù›‰È·, Ù· ÔÔ›·

ÛÙÔ ‹·Ú ·Ô‰›‰Ô˘Ó Ù· ÏÈ›‰È·

ÛÙ· Ë·ÙÔÎ‡ÙÙ·Ú· (11).

∂ÈÏ¤ÔÓ Ù· HDL ÛˆÌ·Ù›‰È·

ÂÌÊ·Ó›˙Ô˘Ó ·ÓÙÈÔÍÂÈ‰ˆÙÈÎ‹ ‰Ú¿-ÛË, ·ÊÔ‡ ·Ó·ÛÙ¤ÏÏÔ˘Ó ÙËÓ ÔÍÂ›-

‰ˆÛË ÙˆÓ LDL (13). Δ· Û˘ÛÙ·ÙÈ-

Î¿ ÙˆÓ HDL Ô˘ ¤¯Ô˘Ó ·ÓÙÈÔÍÂÈ-

‰ˆÙÈÎ¤˜ È‰ÈfiÙËÙÂ˜ Â›Ó·È Ë apoA1

Î·ıÒ˜ Î·È ÔÚÈÛÌ¤Ó· ¤Ó˙˘Ì· Ô˘

‚Ú›ÛÎÔÓÙ·È ÛÙ· HDL ÛˆÌ·Ù›‰È·.

™˘ÁÎÂÎÚÈÌ¤Ó· Ë apoA1 ‰Ú· ÚÔ-

ÛÏ·Ì‚¿ÓÔÓÙ·˜ Ù· ÔÍÂÈ‰ˆÌ¤Ó·

ÊˆÛÊÔÏÈ›‰È· ·fi ÙÈ˜ LDL ‹ Ù·

Î‡ÙÙ·Ú· ÙÔ˘ ·ÚÙËÚÈ·ÎÔ‡ ÙÔÈ¯Ò-

Ì·ÙÔ˜ Î·È Ù· ÌÂÙ·Ê¤ÚÂÈ ÛÙÔ

‹·Ú (13). Δ· ¤Ó˙˘Ì· ÙˆÓ HDL

Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ·ÓÙÈÔÍÂÈ‰ˆÙÈÎ¤˜

È‰ÈfiÙËÙÂ˜ Â›Ó·È Ë ·Î¤Ù˘ÏÔ-˘‰ÚÔ-

Ï¿ÛË ÙÔ˘ ·Ú¿ÁÔÓÙ· ÂÓÂÚÁÔÔ›-

ËÛË˜ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ ( platelet

-activating factor acetyl-hydrola-

se, PAF-AH), Ë ·Ú·ÔÍÔÓ¿ÛË-1

(paraoxonase-1, PON1) Î·È Ë

LCAT. ∏ ·ÓÙÈÔÍÂÈ‰ˆÙÈÎ‹ ÙÔ˘˜ ‰Ú¿-

ÛË ·ÊÔÚ¿ Î˘Ú›ˆ˜ ÙËÓ ˘‰ÚfiÏ˘ÛË

ÙˆÓ ÔÍÂÈ‰ˆÌ¤ÓˆÓ ÊˆÛÊÔÏÈÈ‰›ˆÓ

(13). Δ· ¤Ó˙˘Ì· ·˘Ù¿ ‰ÂÓ ÂÌÊ·Ó›-

˙Ô˘Ó ÔÌÔÈfiÌÔÚÊË Î·Ù·ÓÔÌ‹ ÛÙÈ˜

HDL, ·ÊÔ‡ ÛÂ ÌÂÁ·Ï‡ÙÂÚË ·Ó·-

ÏÔÁ›· ‚Ú›ÛÎÔÓÙ·È ÛÙ· ÌÈÎÚ¿

HDL3 ÛˆÌ·Ù›‰È·. ΔÔ Â‡ÚËÌ· ·˘-

Ùfi ˘Ô‰ËÏÒÓÂÈ fiÙÈ Ë ·ÓÙÈÔÍÂÈ‰ˆ-ÙÈÎ‹ ÈÎ·ÓfiÙËÙ· ÙˆÓ HDL ÔÊÂ›ÏÂ-Ù·È Î˘Ú›ˆ˜ ÛÙ· HDL3 ÛˆÌ·Ù›‰È·(14). ΔÔ Û˘Ì¤Ú·ÛÌ· ·˘Ùfi ÂÓÈ-

Û¯‡ÂÙ·È ·Ó Ï¿‚Ô˘ÌÂ ˘fi„Ë fiÙÈ

Ù· ÛˆÌ·Ù›‰È· ·˘Ù¿, Ô˘ Â›Ó·È

Ùˆ¯¿ ÛÂ ÏÈ›‰È·, ·ÚÔ˘ÛÈ¿˙Ô˘Ó

·˘ÍËÌ¤ÓË ÈÎ·ÓfiÙËÙ· ÚfiÛÏË„Ë˜


·fi Ù· Î‡ÙÙ·Ú· ÙˆÓ ÂÚÈÊÂÚÈÎÒÓ

ÈÛÙÒÓ (12).

Δ· HDL ÛˆÌ·Ù›‰È· ÂÌÊ·Ó›-

˙Ô˘Ó, Â›ÛË˜, ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë‰Ú¿ÛË. ∏ ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë˜ ‰Ú¿-

ÛË ÙÔ˘˜ Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙËÓ ÈÎ·Ófi-

ÙËÙ· ÙÔ˘˜ Ó· ·Ó·ÛÙ¤ÏÏÔ˘Ó ÙËÓ

¤ÎÊÚ·ÛË ÙˆÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏ-

ÏËÛË˜, ÌÂ ·ÔÙ¤ÏÂÛÌ· Ó· ÌÂÈÒ-

ÓÂÙ·È Ë ‰ÈÂ›Û‰˘ÛË ÙˆÓ Ì·ÎÚÔÊ¿-

ÁˆÓ ÛÙÔ ÙÔ›¯ˆÌ· ÙˆÓ ·ÁÁÂ›ˆÓ

Î·È Ë ·Ú·ÁˆÁ‹ ÂÏÂ‡ıÂÚˆÓ ÚÈ-

˙ÒÓ ÔÍ˘ÁfiÓÔ˘ (15). ∏ ÌÂ›ˆÛË ÙË˜

¤ÎÊÚ·ÛË˜ ÙˆÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏ-

ÏËÛË˜ ÔÊÂ›ÏÂÙ·È ÛÙËÓ ·ÚÔ˘Û›·

ÙË˜ apoA1, ·ÏÏ¿ Î·È ÊˆÛÊÔÏÈÈ-

‰›ˆÓ, fiˆ˜ Ë 1-ÊˆÛÊÔÚÈÎ‹ ÛÊÈÁ-

ÁÔÛ›ÓË (sphingosine-1-phosphate)

Î·È Ë ÛÊÈÁÁfiÛ˘ÏÔ-ÊˆÛÊfiÚ˘ÏÔ-

¯ÔÏ›ÓË (sphingosyl-phosphory-

lcholine) (16). ∂ÈÚfiÛıÂÙ· Ë

·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë˜ ‰Ú¿ÛË Ê·›ÓÂ-

Ù·È fiÙÈ ÂÓÈÛ¯‡ÂÙ·È Î·È ·fi ¿Ï-

ÏÔ˘˜ ÌË¯·ÓÈÛÌÔ‡˜ (˘‰ÚfiÏ˘ÛË


·fi Ù· ¤Ó˙˘Ì· PAF-AH, PON1

Î·È LCAT, ÌÂ›ˆÛË ÙË˜ ¤ÎÎÚÈÛË˜

ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ ÌÂ Â·ÁˆÁ‹

ÙÔ˘ ·Ú¿ÁÔÓÙ·-‚ ·Ó¿Ù˘ÍË˜ ÙˆÓ

fiÁÎˆÓ (tumor growth factor-‚,

TGF-‚), ÌÂ›ˆÛË ÙË˜ ÈÓÙÂÚÏÂ˘Î›-

ÓË˜-6, ·Ó·ÛÙÔÏ‹ ÙË˜ Û‡ÓıÂÛË˜

ÙÔ˘ ·Ú¿ÁÔÓÙ· ÂÓÂÚÁÔÔ›ËÛË˜

ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ Î·È ÌÂ›ˆÛË ÙË˜

¤ÎÎÚÈÛË˜ ÙË˜ ÚˆÙÂ˝ÓË˜ MCP-1)

(12). Δ· ‰Â‰ÔÌ¤Ó· Ô˘ ˘¿Ú¯Ô˘Ó

∂ÈÎfiÓ· 1. ™¯ËÌ·ÙÈÎ‹ ·ÂÈÎfiÓÈÛË ÙË˜ ÂÙÂÚÔÁ¤ÓÂÈ·˜, ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ Î·È ÙˆÓ ‚ÈÔÏÔÁÈÎÒÓ ‰Ú¿ÛÂˆÓ ÙˆÓ ˘ÔÎÏ·ÛÌ¿ÙˆÓ ÙˆÓ ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ÏÈÔÚˆÙÂ˝ÓÒÓ (HDL). √È ·ÏÏËÏÔÌÂÙ·ÙÚÔ¤˜ ÌÂÙ·Í‡ ÙË˜ ÂÏÂ‡ıÂÚË˜ ·ÔÏÈÔÚˆÙÂ›ÓË˜ ∞1, ÙˆÓ ·Ú¯¤ÁÔÓˆÓ, ‰ÈÛÎÔÂÈ‰ÒÓ, Ùˆ¯ÒÓ ÛÂ ÏÈ›‰È·pre-‚ HDL, ÙˆÓ ÌÈÎÚÒÓ, ˘ÎÓÒÓ HDL3 Î·È ÙˆÓ ÌÂÁ¿ÏˆÓ HDL2 Á›ÓÔÓÙ·È ‰È·Ì¤ÛÔ˘ ÙˆÓ ÂÓ˙‡ÌˆÓ ÏÂÎ›ıÈÓÔ-¯ÔÏÂÛÙ¤Ú˘Ï-·Î˘ÏÔÙÚ·ÓÛÊÂÚ¿ÛË (LCAT),ÙÔ˘ ÂÓ˙‡ÌÔ˘ ÌÂÙ·ÊÔÚ¿˜ ÂÛÙ¤ÚˆÓ ¯ÔÏËÛÙÂÚfiÏË˜ (CETP), ÙË˜ ÚˆÙÂ›ÓË˜ ÌÂÙ·ÊÔÚ¿˜ ÊˆÛÊÔÏÈÈ‰›ˆÓ (PLTP), ÙË˜ Ë·ÙÈÎ‹˜ Î·È ÙË˜ ÂÓ‰ÔıËÏÈ·Î‹˜ÏÈ¿ÛË˜ (HL Î·È EL ·ÓÙ›ÛÙÔÈ¯·), ÙˆÓ ÌÂÙ·ÊÔÚ¤ˆÓ ABCA1 Î·È ÙˆÓ ˘Ô‰Ô¯¤ˆÓ SRB1 Î·È Ê·›ÓÔÓÙ·È ÛÙÔ Û¯‹Ì· ÌÂ Û˘ÓÂ¯Â›˜ ÁÚ·ÌÌ¤˜. ™ÙÔ Û¯‹Ì· ·ÂÈÎÔÓ›˙ÔÓÙ·È ÔÈ ‚ÈÔÏÔÁÈÎ¤˜ ‰Ú¿ÛÂÈ˜ ÙˆÓ HDL ÛˆÌ·ÙÈ‰›ˆÓ.AI: ·ÔÏÈÔÚˆÙÂ›ÓË AI, CE: ÂÛÙ¤ÚÂ˜ ¯ÔÏËÛÙÂÚfiÏË˜, FC: ÂÏÂ‡ıÂÚË ¯ÔÏËÛÙÂÚfiÏË, PL: ÊˆÛÊÔÏÈ›‰È·, PON1: ·Ú·ÔÍÔÓ¿ÛË 1.(¶ÚÔÛ·ÚÌÔÁ‹ ·fi Kontush et al, 2005, Nat Clin Pract Cardiovasc Med 2006; 3: 144-153)

™ ∂ ¶ Δ ∂ ª μ ƒ π √ ™ 2 0 0 8

20

˘ÔÛËÌ·›ÓÔ˘Ó fiÙÈ Ë ·ÓÙÈÊÏÂÁÌÔ-ÓÒ‰Ë˜ ‰Ú¿ÛË ¯·Ú·ÎÙËÚ›˙ÂÈ Î˘-Ú›ˆ˜ Ù· HDL3 ÛˆÌ·Ù›‰È· (12).

¢˘ÛÏÂÈÙÔ˘ÚÁÈÎ¤˜ HDL

™ÙÔ ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ (ªÂÙ™)Ù· ÛˆÌ·Ù›‰È· ÙˆÓ HDL ÂÌÊ·Ó›-˙Ô˘Ó ‰ÔÌÈÎ¤˜ Î·È ÏÂÈÙÔ˘ÚÁÈÎ¤˜ÌÂÙ·‚ÔÏ¤˜ ·fi ÙË ÊÏÂÁÌÔÓ‹ Î·ÈÙËÓ ·ÓÙ›‰Ú·ÛË ÔÍÂ›·˜ Ê¿ÛË˜, ÔÈÔÔ›Â˜ ·ÊÔÚÔ‡Ó fiÏ· Ù· Û˘ÛÙ·ÙÈ-Î¿ ÙÔ˘˜ (17,18). ¶Ú¿ÁÌ·ÙÈ, Ù·HDL ÛˆÌ·Ù›‰È· ÂÌÏÔ˘Ù›˙ÔÓÙ·ÈÌÂ ÙÚÈÁÏ˘ÎÂÚ›‰È·. ∞˘Ùfi˜ Ô ÂÌ-ÏÔ˘ÙÈÛÌfi˜ ÔÊÂ›ÏÂÙ·È ÛÙ· ·˘ÍË-Ì¤Ó· Â›Â‰· ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓÛÙÔ ·›Ì·, ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ÙËÌÂÙ·‚ÔÏ‹ ÙË˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓÂÓ˙‡ÌˆÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙÔÌÂÙ·‚ÔÏÈÛÌfi ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ.ªÂÏ¤ÙÂ˜ ¤‰ÂÈÍ·Ó fiÙÈ ÛÂ ¿ÙÔÌ· ÌÂªÂÙ™ ·ÏÏ¿ Î·È ÛÂ ÂÚÈÙÒÛÂÈ˜ÔÍ¤Ô˜ stress ÛÙ· Ï·›ÛÈ· ÙË˜·ÓÙ›‰Ú·ÛË˜ ÔÍÂ›·˜ Ê¿ÛË˜ ·˘Í¿-ÓÂÙ·È Ë ‰Ú·ÛÙÈÎfiÙËÙ· ÙË˜ CETP.∫·Ù¿ Û˘Ó¤ÂÈ· ·˘Í¿ÓÂÙ·È Ë Â-ÚÈÂÎÙÈÎfiÙËÙ· ÙˆÓ HDL ÛÂ ÙÚÈÁÏ˘-ÎÂÚ›‰È·, ÂÓÒ ÌÂÈÒÓÂÙ·È Ë ÂÚÈÂ-ÎÙÈÎfiÙËÙ· ÙÔ˘˜ ÛÂ ÂÛÙ¤ÚÂ˜ ¯ÔÏË-ÛÙÂÚfiÏË˜ (19). ™ÙËÓ ·‡ÍËÛË ÙË˜

ÂÚÈÂÎÙÈÎfiÙËÙ·˜ ÙˆÓ HDL ÛÂ ÙÚÈ-ÁÏ˘ÎÂÚ›‰È· Û˘Ì‚¿ÏÏÂÈ Â›ÛË˜ Î·ÈË ÂÏ·ÙÙˆÌ¤ÓË ‰Ú·ÛÙÈÎfiÙËÙ· ÙË˜ÏÈÔÚˆÙÂ˚ÓÈÎ‹˜ Î·È ÙË˜ Ë·ÙÈ-Î‹˜ ÏÈ¿ÛË˜, Î·ıÒ˜ Î·È ÙË˜LCAT Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÂ Â-ÚÈÙÒÛÂÈ˜ ÊÏÂÁÌÔÓ‹˜ (17,18).

∂ÈÚfiÛıÂÙ· ÛÙÔ ªÂÙ™ ·Ú·-ÙËÚÂ›Ù·È ÌÂ›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓÙË˜ apoA1 ÙˆÓ HDL ÛˆÌ·ÙÈ‰›ˆÓ(4,5). ∏ ÌÂ›ˆÛË ·˘Ù‹ ÔÊÂ›ÏÂÙ·ÈÛÂ ÂÏ·ÙÙˆÌ¤ÓË Û‡ÓıÂÛË Î·È ÛÂ·˘ÍËÌ¤ÓÔ Î·Ù·‚ÔÏÈÛÌfi ÙËãpoA1, ÛÙ· Ï·›ÛÈ· ÙË˜ ‰È·Ù·Ú·-¯‹˜ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ HDL(12), ·ÏÏ¿ Î·È ÛÙËÓ ·ÓÙÈÎ·Ù¿ÛÙ·-ÛË ÙË˜ ·fi ÙÔ ·Ì˘ÏÔÂÈ‰¤˜-·(17,18). ΔÔ ·Ì˘ÏÔÂÈ‰¤˜-· Â›Ó·ÈÌÈ· ÚˆÙÂ˝ÓË ÔÍÂ›·˜ Ê¿ÛË˜ Ô˘·Ú¿ÁÂÙ·È ÛÙÔ ‹·Ú Î·È ÛÂ Û˘Ó-ı‹ÎÂ˜ ÊÏÂÁÌÔÓ‹˜ Ù· Â›Â‰· ÙË˜ÛÙÔÓ ÔÚfi ÙÔ˘ ·›Ì·ÙÔ˜ ·˘Í¿ÓÔ-ÓÙ·È ¤ˆ˜ 1000 ÊÔÚ¤˜. ΔÔ ·Ì˘ÏÔ-ÂÈ‰¤˜-· ÌÔÚÂ› Ó· ·ÓÙÈÎ·Ù·ÛÙ‹-ÛÂÈ ÙËÓ apoA1 Î·È ¿ÏÏÂ˜ ÏÈÔ-ÚˆÙÂ˝ÓÂ˜ ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙˆÓHDL ÛˆÌ·ÙÈ‰›ˆÓ (20). ŒÙÛÈ ÚÔ-Î·ÏÂ›Ù·È ÌÈ· ÛÂÈÚ¿ ·ÏÏ·ÁÒÓ ÛÙËÏÂÈÙÔ˘ÚÁ›· ÙˆÓ HDL Ô˘ ı· Û˘-˙ËÙËıÔ‡Ó ÛÙË Û˘Ó¤¯ÂÈ· Î·È ÔÈÔÔ›Â˜ ÌÂÈÒÓÔ˘Ó ÙËÓ ÚÔÛÙ·ÙÂ˘-

ÙÈÎ‹ ÙÔ˘˜ ‰Ú¿ÛË ÛÙ· ·ÁÁÂ›·.√È ‰ÔÌÈÎ¤˜ ÌÂÙ·‚ÔÏ¤˜ ·ÊÔ-

ÚÔ‡Ó Â›ÛË˜ Î·È Ù· ¤Ó˙˘Ì· ÙˆÓHDL. ∏ PAF-AH, Ë PON-1, ËLCAT ÂÌÊ·Ó›˙Ô˘Ó ‰ÔÌÈÎ¤˜ ÌÂÙ·-‚ÔÏ¤˜ Î·È Û˘ÁÎÂÎÚÈÌ¤Ó· ÔÍÂ›‰ˆ-ÛË ·fi Ù· Î‡ÙÙ·Ú· ÙÔ˘ ·ÁÁÂÈ·-ÎÔ‡ ÙÔÈ¯ÒÌ·ÙÔ˜ ‹ ÁÏ˘ÎÔ˙˘Ï›ˆÛË,ÂÍ·ÈÙ›·˜ ÙË˜ ˘ÂÚÁÏ˘Î·ÈÌ›·˜ Ô˘Û˘¯Ó¿ Û˘ÓÔ‰Â‡ÂÈ ÙÔ ªÂÙ™ (12).∞ÎfiÌË, Ù· Â›Â‰· ÙˆÓ ÂÓ˙‡ÌˆÓÔ˘ ‚Ú›ÛÎÔÓÙ·È ÛÙ· HDL ÛˆÌ·Ù›-‰È· ÌÂÈÒÓÔÓÙ·È ÛÂ Û˘Óı‹ÎÂ˜ÊÏÂÁÌÔÓ‹˜ ‹ ÌÂÙ·‚ÔÏÈÎ‹˜ ‰˘-ÛÏÂÈÙÔ˘ÚÁ›·˜ (17,18).

ΔÔ Û‡ÓÔÏÔ ÙˆÓ ‰ÔÌÈÎÒÓ ·Ï-ÏÔÈÒÛÂˆÓ ÙˆÓ HDL ÛˆÌ·ÙÈ‰›ˆÓÔ‰ËÁÂ› ÛÂ ÌÈ· ÛÂÈÚ¿ ·ÏÏ·ÁÒÓÛÙÔ ÌÂÙ·‚ÔÏÈÛÌfi ÙÔ˘˜, ÛÙÈ˜ ÏÂÈ-ÙÔ˘ÚÁ›Â˜ ÙÔ˘˜ Î·È ÛÙËÓ ÔÛfiÙË-Ù· Î·È Î·Ù·ÓÔÌ‹ ÙË˜ HDL ¯ÔÏË-ÛÙÂÚfiÏË˜. ∏ ·‡ÍËÛË ÙˆÓ ÙÚÈÁÏ˘-ÎÂÚÈ‰›ˆÓ ÙˆÓ HDL ¤¯ÂÈ ˆ˜ ·Ô-Ù¤ÏÂÛÌ· ÙË ÌÂ›ˆÛË ÙˆÓ ÂÈ¤-‰ˆÓ ÙˆÓ HDL ÛÙÔ ·›Ì·, Î·ıÒ˜ÌÂÈÒÓÂÙ·È Ë ‰ÔÌÈÎ‹ ÛÙ·ıÂÚfiÙËÙ·ÙˆÓ ÛˆÌ·ÙÈ‰›ˆÓ Î·È Ô ¯ÚfiÓÔ˜ ·-Ú·ÌÔÓ‹˜ ÙÔ˘˜ ÛÙËÓ Î˘ÎÏÔÊÔÚ›·(21). ∏ ÌÂ›ˆÛË ÙË˜ HDL ¯ÔÏËÛÙÂ-ÚfiÏË˜ Û˘ÓÔ‰Â‡ÂÙ·È ·fi ·Ó¿ÏÔÁËÌÂ›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ HDL2

∂ÈÎfiÓ· 2. ™¯ËÌ·ÙÈÎ‹ ·ÂÈÎfiÓÈÛË ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂÈÓÒÓ (HDL) ÛÙÔ ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ (ªÂÙ™).™ÙÔ Û¯‹Ì··ÂÈÎÔÓ›˙ÂÙ·È ÌÂ ÛÙÈÎÙ¤˜ ÁÚ·ÌÌ¤˜ Ô Ê˘ÛÈÔÏÔÁÈÎfi˜ Î‡ÎÏÔ˜ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ HDL ÛˆÌ·ÙÈ‰›ˆÓ. ªÂ Û˘ÓÂ¯Â›˜ ÁÚ·ÌÌ¤˜ ·ÂÈÎÔÓ›˙ÂÙ·È Ë Â›-‰Ú·ÛË ÙË˜ ÊÏÂÁÌÔÓ‹˜, ÙÔ˘ ·Ì˘ÏÔÂÈ‰Ô‡˜ ∞, ÙÔ˘ ÔÍÂÈ‰ˆÙÈÎÔ‡ stress, ÙË˜ ˘ÂÚÙÚÈÁÏ˘ÎÂÚÈ‰·ÈÌ›·˜ Î·È ÙË˜ ˘ÂÚÁÏ˘Î·ÈÌ›·˜ ÌÂ ÙÂÏÈÎfi ·ÔÙ¤ÏÂÛÌ·ÙÔ Û¯ËÌ·ÙÈÛÌfi ÙˆÓ ‰˘ÛÏÂÈÙÔ˘ÚÁÈÎÒÓ HDL3.ABCA1: ˘Ô‰Ô¯¤·˜ ATP-binding cassette transporter A1, AI: ·ÔÏÈÔÚˆÙÂ›ÓË AI, CE: ÂÛÙ¤ÚÂ˜ ¯ÔÏËÛÙÂÚfiÏË˜, CETP: ¤Ó˙˘ÌÔ ÌÂÙ·ÊÔÚ¿˜ ÂÛÙ¤-ÚˆÓ ¯ÔÏËÛÙÂÚfiÏË˜, EL: ÂÓ‰ÔıËÏÈ·Î‹ ÏÈ¿ÛË, FC: ÂÏÂ‡ıÂÚË ¯ÔÏËÛÙÂÚfiÏË, HL: Ë·ÙÈÎ‹ ÏÈ¿ÛË, LCAT: ÏÂÎ›ıÈÓ-¯ÔÏÂÛÙ¤Ú˘Ï-·Î˘ÏÔÙÚ·ÓÛÊÂÚ¿ÛË,PL: ÊˆÛÊÔÏÈ›‰È·, PLTP:¶ÚˆÙÂ›ÓË ÌÂÙ·ÊÔÚ¿˜ ÊˆÛÊÔÏÈÈ‰›ˆÓ, PON1: ·Ú·ÔÍÔÓ¿ÛË 1, SAA: ·Ì˘ÏÔÂÈ‰¤˜ ∞, SR-BI: ˘Ô‰Ô¯¤·˜ scavenger receptor type BI.(¶ÚÔÛ·ÚÌÔÁ‹ ·fi Kontush et al, 2005, Nat Clin Pract Cardiovasc Med 2006; 3: 144-153)

21

¶∞£√ºÀ™π√§√°π∞

ÛˆÌ·ÙÈ‰›ˆÓ, ÂÓÒ Ù· Â›Â‰· ÙˆÓHDL3 ÛˆÌ·ÙÈ‰›ˆÓ ÌÂÈÒÓÔÓÙ·È ÛÂÌÈÎÚfiÙÂÚÔ ‚·ıÌfi. ΔÔ Â‡ÚËÌ··˘Ùfi ÔÊÂ›ÏÂÙ·È ÛÂ ·˘ÍËÌ¤ÓË ÏÈ-fiÏ˘ÛË ÙˆÓ ÏÔ‡ÛÈˆÓ ÛÂ ÙÚÈÁÏ˘-ÎÂÚ›‰È· HDL2 ÛˆÌ·ÙÈ‰›ˆÓ, Ô˘Ô‰ËÁÂ› ÛÙÔ ·˘ÍËÌ¤ÓÔ Û¯ËÌ·ÙÈ-ÛÌfi ÌÈÎÚÒÓ HDL3 ÛˆÌ·ÙÈ‰›ˆÓ.√È HDL, ·ÎfiÌË, ÂÌÊ·Ó›˙Ô˘Ó ·˘-ÍËÌ¤ÓÔ Ú˘ıÌfi ·Ô‚ÔÏ‹˜ ·fiÙËÓ Î˘ÎÏÔÊÔÚ›·, ·ÊÔ‡ Ë ‰ÔÌÈÎ‹·ÛÙ¿ıÂÈ· ÙˆÓ ÏÔ‡ÛÈˆÓ ÛÂ ÙÚÈ-ÁÏ˘ÎÂÚ›‰È· HDL ‰ÈÂ˘ÎÔÏ‡ÓÂÈ ÙËÓ·Ô‰¤ÛÌÂ˘ÛË ÙË˜ apoA1 Î·Ù¿ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÏÈfiÏ˘ÛË˜ ÙˆÓÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ ÛÙ· Ë·ÙÈÎ¿ ÙÚÈ-¯ÔÂÈ‰‹ (4,5,21).

À¿Ú¯Ô˘Ó Â›ÛË˜ ÂÓ‰Â›ÍÂÈ˜fiÙÈ Ù· ÏÔ‡ÛÈ· ÛÂ ÙÚÈÁÏ˘ÎÂÚ›‰È·HDL ÛˆÌ·Ù›‰È· ¤¯Ô˘Ó ÌÂÈˆÌ¤ÓËÈÎ·ÓfiÙËÙ· Ó· ·Ô‰›‰Ô˘Ó ÂÛÙ¤ÚÂ˜¯ÔÏËÛÙÂÚfiÏË˜ ÛÙ· Î‡ÙÙ·Ú· ‰È·-Ì¤ÛÔ˘ ÙˆÓ SRB1 ˘Ô‰Ô¯¤ˆÓ(22). ªÂ ÙÔÓ ›‰ÈÔ ÙÚfiÔ Ê·›ÓÂÙ·ÈfiÙÈ ÂÈ‰Ú¿ Î·È Ë ·ÓÙÈÎ·Ù¿ÛÙ·ÛËÙË˜ apoA1 ·fi ÙÔ ·Ì˘ÏÔÂÈ‰¤˜-·(23), ÂÓÒ ·Ú¿ÏÏËÏ· ·˘Í¿ÓÂÙ·ÈË ÈÎ·ÓfiÙËÙ· ÙˆÓ HDL ÛˆÌ·ÙÈ-‰›ˆÓ Ó· ·ÏÏËÏÂÈ‰ÚÔ‡Ó ÌÂ Ù·Ì·ÎÚÔÊ¿Á· ·Ô‰›‰ÔÓÙ·˜ ÛÂ ·˘-Ù¿ ÂÛÙ¤ÚÂ˜ ¯ÔÏËÛÙÂÚfiÏË˜ (24).∞˘Ù¤˜ ÔÈ ‰‡Ô ·Ú·ÙËÚ‹ÛÂÈ˜ Â›Ó·ÈÈı·Ófi Ó· ·ÓÙÈÎ·ÙÔÙÚ›˙Ô˘Ó ÌÈ·ıÂÌÂÏÈÒ‰Ë ·ÏÏ·Á‹ ÛÙÔ ÌÂÙ·‚Ô-ÏÈÛÌfi Î·È ÙË ‰Ú¿ÛË ÙˆÓ HDL Ûˆ-Ì·ÙÈ‰›ˆÓ. º·›ÓÂÙ·È ‰ËÏ·‰‹ fiÙÈÛÂ Û˘Óı‹ÎÂ˜ ÊÏÂÁÌÔÓ‹˜ ¤ˆ˜ ¤Ó·‚·ıÌfi ·Ó·ÛÙ¤ÏÏÂÙ·È Ë ·Ó¿ÛÙÚÔ-ÊË ÌÂÙ·ÊÔÚ¿ ¯ÔÏËÛÙÂÚfiÏË˜ Î·ÈÙ· HDL ÛˆÌ·Ù›‰È· ·ÓÙ› Ó· ÌÂÙ·-Ê¤ÚÔ˘Ó ÙË ¯ÔÏËÛÙÂÚfiÏË ÛÙ·Ë·ÙÔÎ‡ÙÙ·Ú· ÙËÓ Î·ÙÂ˘ı‡ÓÔ˘ÓÛÙ· Î‡ÙÙ·Ú· ÙÔ˘ ·ÓÔÛÔÔÈËÙÈ-ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (13,24). ∏ ·Ï-Ï·Á‹ ·˘Ù‹ ·Ó·ÛÙ¤ÏÏÂÈ ÙËÓ ·ÓÙÈ·-ıËÚˆÁfiÓÔ ‰Ú¿ÛË ÙˆÓ HDL Ûˆ-Ì·ÙÈ‰›ˆÓ Î·È Ô‰‹ÁËÛÂ ÛÙË ‰È·Ù‡-ˆÛË ÙÔ˘ fiÚÔ˘ «‰˘ÛÏÂÈÙÔ˘ÚÁÈ-Î¤˜» (dysfunctional) HDL (13).

Δ· HDL ÛˆÌ·Ù›‰È· Ô˘ ‰˘-ÛÏÂÈÙÔ˘ÚÁÔ‡Ó ÂÌÊ·Ó›˙Ô˘Ó Â›-ÛË˜ ÌÂÈˆÌ¤ÓË ·ÓÙÈÔÍÂÈ‰ˆÙÈÎ‹Î·È ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë ‰Ú¿ÛË ˆ˜·ÔÙ¤ÏÂÛÌ· ÙˆÓ ÌÂÙ·‚ÔÏÒÓÛÙËÓ ÔÛfiÙËÙ·, ‰ÔÌ‹ Î·È ÏÂÈ-ÙÔ˘ÚÁ›· ÙË˜ apoA1 Î·È ÙˆÓ ÂÓ˙‡-ÌˆÓ ÙÔ˘˜ (12). √È Èı·ÓÔ› ÌË¯·-ÓÈÛÌÔ› Ô˘ ÂÍËÁÔ‡Ó ÙË ÌÂ›ˆÛËÙË˜ ·ÓÙÈÔÍÂÈ‰ˆÙÈÎ‹˜ ÈÎ·ÓfiÙËÙ·˜ÙˆÓ HDL ÛˆÌ·ÙÈ‰›ˆÓ Â›Ó·È ËÂÏ·ÙÙˆÌ¤ÓË ‰ÔÌÈÎ‹ ÛÙ·ıÂÚfiÙË-Ù· ÙË˜ apoA1 Î·È Ë ÌÂÙ·‚ÔÏ‹ÙË˜ ÛÙÂÚÂÔ‰ÔÌ‹˜ ÙË˜, Ô˘ Û¯Â-Ù›˙ÂÙ·È ÌÂ ÙËÓ ·ÏÏ·Á‹ ÙË˜ ÏÈÈ-‰È·Î‹˜ Û‡ÛÙ·ÛË˜ ÙˆÓ HDL, Ë

·ÓÙÈÎ·Ù¿ÛÙ·Û‹ ÙË˜ ·fi ÙÔ ·Ì˘-ÏÔÂÈ‰¤˜-·, ÔÈ ‰ÔÌÈÎ¤˜ ÌÂÙ·‚ÔÏ¤˜ÙˆÓ ÂÓ˙‡ÌˆÓ ÙˆÓ HDL Î·È Ë Â·-ÎfiÏÔ˘ıË ÌÂ›ˆÛË ÙË˜ ˘‰ÚÔÏ˘ÙÈ-Î‹˜-·ÓÙÈÔÍÂÈ‰ˆÙÈÎ‹˜ ÙÔ˘˜ ÈÎ·Ófi-ÙËÙ·˜ (12). ªÂ ·Ó¿ÏÔÁÔ ÙÚfiÔÊ·›ÓÂÙ·È fiÙÈ ÌÂÈÒÓÂÙ·È Î·È Ë ·ÓÙÈ-ÊÏÂÁÌÔÓÒ‰Ë˜ ‰Ú¿ÛË ÙˆÓ HDL(12). ∏ ÌÂ›ˆÛË ·˘Ù‹ ‰ÂÓ Ê·›ÓÂ-Ù·È Ó· Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙË ‰Ú¿ÛËÙË˜ PON-1. ΔÔ Â‡ÚËÌ· ·˘Ùfi·ÔÙÂÏÂ› ¤Ó‰ÂÈÍË fiÙÈ Ë ‰Ú¿ÛËÙË˜ PON-1 ‰ÂÓ Â›Ó·È Î·ıÔÚÈÛÙÈÎ‹ÁÈ· ÙËÓ ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë ÈÎ·Ófi-ÙËÙ· ÙˆÓ HDL ÛˆÌ·ÙÈ‰›ˆÓ (25).

™˘ÌÂÚ¿ÛÌ·Ù·

√È ‰È¿ÊÔÚÂ˜ ÌÔÚÊ¤˜ ÙˆÓ HDLÔ˘ Î˘ÎÏÔÊÔÚÔ‡Ó Î·ıÒ˜ ˆÚÈÌ¿-˙Ô˘Ó Î·È Î·ıÒ˜ ÌÂÙ·‚¿ÏÏÂÙ·È ÙÔÂÚÈÂ¯fiÌÂÓÔ ÙÔ˘˜ ÛÂ ¯ÔÏËÛÙÂ-ÚfiÏË, ¿Ú· Î·È ÙÔ Ì¤ÁÂıfi˜ ÙÔ˘˜,Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÂ ‰È·ÊÔÚÂÙÈÎfi‚·ıÌfi ÛÙÔÓ ÚÔÛÙ·ÙÂ˘ÙÈÎfi ÚfiÏÔÙˆÓ HDL (12). Δ· ÙÂÏÂ˘Ù·›· ¯Úfi-ÓÈ· ˘¿Ú¯Ô˘Ó Ó¤· ‰Â‰ÔÌ¤Ó· Ô˘˘Ô‰ÂÈÎÓ‡Ô˘Ó fiÙÈ Ù· ÌÈÎÚ¿ HDL3ÛˆÌ·Ù›‰È· Â›Ó·È ÙÔ ÎÏ¿ÛÌ· Ô˘Â›Ó·È ˘Â‡ı˘ÓÔ ÁÈ· ÙËÓ ·ÓÙÈÔÍÂÈ-‰ˆÙÈÎ‹ Î·È ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë ‰Ú¿-ÛË ÙˆÓ HDL (4,5,12). øÛÙfiÛÔ·˘Ù¿ Ù· ÛˆÌ·Ù›‰È· ÂËÚÂ¿˙ÔÓÙ·È·fi ÙÔ ÔÍÂÈ‰ˆÙÈÎfi stress Î·ÈÙË ÊÏÂÁÌÔÓ‹, ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙËÌÂ›ˆÛË ÙÔ˘ ÚÔÛÙ·ÙÂ˘ÙÈÎÔ‡ Úfi-ÏÔ˘ ÙˆÓ HDL ÛÂ ·˘Ù¤˜ ÙÈ˜ Û˘Ó-ı‹ÎÂ˜ (4,5,12). Àfi Ê˘ÛÈÔÏÔÁÈ-Î¤˜ Û˘Óı‹ÎÂ˜ Ù· ÌÈÎÚ¿ HDL Ûˆ-Ì·Ù›‰È· ¤¯Ô˘Ó ÙËÓ Ù¿ÛË Ó· ÚÔ-ÛÏ·Ì‚¿ÓÔ˘Ó ¯ÔÏËÛÙÂÚfiÏË ·fiÙ· ÂÚÈÊÂÚÈÎ¿ Î‡ÙÙ·Ú· Î·È Ó··˘Í¿ÓÔ˘Ó ÛÂ Ì¤ÁÂıÔ˜. ∏ ‰ËÌÈ-Ô˘ÚÁ›· ÙˆÓ ÌÂÁ¿ÏˆÓ HDL ÛˆÌ·-ÙÈ‰›ˆÓ ÛËÌ·ÙÔ‰ÔÙÂ› Î·È ÙË ÌÂÙ·-ÙÚÔ‹ ÙÔ˘˜ ·fi ·ÓÙÈÔÍÂÈ‰ˆÙÈ-ÎÔ‡˜-·ÓÙÈÊÏÂÁÌÔÓÒ‰ÂÈ˜ ·Ú¿ÁÔ-ÓÙÂ˜ ÛÂ ÌÂÙ·ÊÔÚÂ›˜ ÙˆÓ ÂÛÙ¤-ÚˆÓ ÙË˜ ¯ÔÏËÛÙÂÚfiÏË˜ ÚÔ˜ ÙÔ‹·Ú Î·È ¤ÙÛÈ ÔÏÔÎÏËÚÒÓÂÙ·È Ë·Ó¿ÛÙÚÔÊË ÌÂÙ·ÊÔÚ¿ ÙË˜ ¯ÔÏË-ÛÙÂÚfiÏË˜ (12).

™ÙÔ ªÂÙ™ Ô Ê˘ÛÈÔÏÔÁÈÎfi˜ ·ıË-ÚÔÚÔÛÙ·ÙÂ˘ÙÈÎfi˜ ÚfiÏÔ˜ ÙˆÓHDL ‰È·Ù·Ú¿ÛÛÂÙ·È Î·È ÛÙË ı¤-ÛË ÙÔ˘ ÂÌÊ·Ó›˙ÔÓÙ·È Ó¤Â˜ È‰ÈfiÙË-ÙÂ˜ Ô˘ Â¿ÁÔ˘Ó ÙËÓ ·ıËÚˆÌ¿-ÙˆÛË (12). Œ¯ÂÈ ‰È·Ù˘ˆıÂ› ÌÈ·˘fiıÂÛË Ô˘ ÂÈ¯ÂÈÚÂ› Ó· ÂÍËÁ‹-ÛÂÈ ·˘Ù¿ Ù· Â˘Ú‹Ì·Ù·. ™‡ÌÊˆÓ·ÌÂ ·˘Ù‹Ó ÙËÓ ˘fiıÂÛË, Ë ·ÏÏ·Á‹ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ ÏÈÔÚˆ-ÙÂ˚ÓÒÓ ·Ú·ÙËÚÂ›Ù·È ÛÙ· Ï·›ÛÈ·ÂÓfi˜ ÂÍÂÏÈÎÙÈÎÔ‡ ÌË¯·ÓÈÛÌÔ‡ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜

ÌÂ ÛÎÔfi ÙËÓ ÚÔÛÙ·Û›· ÂÓ¿ÓÙÈ·ÛÙÔ ‚Ï·ÙÈÎfi ·Ú¿ÁÔÓÙ· Î·È ÙËÓÂÈ‰ÈfiÚıˆÛË ÙˆÓ ÈÛÙÈÎÒÓ ‚Ï·-‚ÒÓ Ô˘ ÚÔÎ·ÏÂ›. ∏ ·Ó¿ÛÙÚÔÊËÌÂÙ·ÊÔÚ¿ ¯ÔÏËÛÙÂÚfiÏË˜ ·Ó·-ÚÔÛ·ÚÌfi˙ÂÙ·È ÚÔ˜ Ù· Ì·ÎÚÔ-Ê¿Á·, ·ÓÙ› ÁÈ· Ù· Ë·ÙÈÎ¿ Î‡ÙÙ·-Ú·, ‰È·Ì¤ÛÔ˘ ÙË˜ ÌÂ›ˆÛË˜ ÙˆÓÂÈ¤‰ˆÓ ÙˆÓ HDL2 ÛˆÌ·ÙÈ‰›ˆÓÎ·È ÁÂÓÈÎfiÙÂÚ· ÙË˜ ÌÂ›ˆÛË˜ ÙË˜ÈÎ·ÓfiÙËÙ·˜ ÙˆÓ HDL ÁÈ· ·fi‰Ô-ÛË ÂÛÙ¤ÚˆÓ ¯ÔÏËÛÙÂÚfiÏË˜ ÛÙ·Ë·ÙÈÎ¿ Î‡ÙÙ·Ú·. ∞˘Ùfi˜ Ô ÌË¯·-ÓÈÛÌfi˜ Û˘Ì‚¿ÏÏÂÈ ÛÙË ‰È·Ù‹ÚË-ÛË ÙË˜ ÔÌÔÈÔÛÙ·Û›·˜ ÙˆÓ ÈÛÙÒÓÎ·Ù¿ ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÔÍ¤ˆÓ‚Ï·ÙÈÎÒÓ Î·Ù·ÛÙ¿ÛÂˆÓ. ŸÌˆ˜ÛÂ Ì·ÎÚÔ¯ÚfiÓÈÂ˜ Î·Ù·ÛÙ¿ÛÂÈ˜(fiˆ˜ Ë ÂÍÂÏÈÛÛfiÌÂÓË ·ıËÚˆÌ·-ÙÈÎ‹ Ï¿Î·) Ë ·Ó·ÚÔÛ·ÚÌÔÁ‹ÙË˜ ·Ó¿ÛÙÚÔÊË˜ ÌÂÙ·ÊÔÚ¿˜ ÙË˜¯ÔÏËÛÙÂÚfiÏË˜ ÚÔ˜ Ù· Ì·ÎÚÔÊ¿-Á· ÌÔÚÂ› Ó· Ô‰ËÁ‹ÛÂÈ ÛÂ ¯Úfi-ÓÈÂ˜ ÌÂÙ·‚ÔÏ¤˜ ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÈ-ÎÒÓ ÛˆÌ·ÙÈ‰›ˆÓ Î·È ÙˆÓ ÂÈ¤‰ˆÓÙˆÓ ÏÈÈ‰›ˆÓ ÛÙÔ Ï¿ÛÌ·, fiˆ˜·Ú·ÙËÚÂ›Ù·È ÛÙÔ ªÂÙ™. ¢ËÏ·‰‹Ë ¯ÚfiÓÈ· ·ÓÙ›‰Ú·ÛË Á›ÓÂÙ·È ‚Ï·-ÙÈÎ‹ Î·È ÂÈÙ·¯‡ÓÂÈ ÙËÓ ·ıËÚˆ-Ì·ÙÈÎ‹ ÓfiÛÔ (17,18).

™ÙË ‰˘ÛÏÈÈ‰·ÈÌ›· ÌÂ ¯·ÌËÏ‹HDL, Ë ÔÛÔÙÈÎ‹ ÌÂ›ˆÛË ÙË˜HDL ¯ÔÏËÛÙÂÚfiÏË˜ ·ÓÙÈÎ·ÙÔ-ÙÚ›˙ÂÈ ÙË ÌÂ›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓÙˆÓ ÌÂÁ¿ÏˆÓ, ÏÔ‡ÛÈˆÓ ÛÂ ¯ÔÏË-ÛÙÂÚfiÏË ÛˆÌ·ÙÈ‰›ˆÓ(4,5). Δ·˘-Ùfi¯ÚÔÓ·, Ê·›ÓÂÙ·È fiÙÈ ˘Ô‰ËÏÒ-ÓÂÈ Î·È ÙËÓ ÔÈÔÙÈÎ‹ ‰˘ÛÏÂÈÙÔ˘Ú-Á›· ÙˆÓ ÌÈÎÚÒÓ ÛˆÌ·ÙÈ‰›ˆÓ Î·ÈÙË ÌÂ›ˆÛË ÙË˜ ·ÓÙÈ-·ıËÚˆÁfiÓÔ˘ÈÎ·ÓfiÙËÙ·˜ ÙÔ˘˜ (4,12). ŒÙÛÈ, ·ÓÎ·È ÔÈ ÌÂÙÚ‹ÛÂÈ˜ ÙË˜ HDL ¯ÔÏË-ÛÙÂÚfiÏË˜ Ô˘ Ú·ÁÌ·ÙÔÔÈÔ‡-ÓÙ·È ÛÂ Î·ıËÌÂÚÈÓ‹ ‚¿ÛË ÛÙ· È·-ÙÚÈÎ¿ ÂÚÁ·ÛÙ‹ÚÈ· ÌÂÙÚÔ‡Ó ÌfiÓÔÙËÓ ÔÛfiÙËÙ¿ ÙË˜, ›Ûˆ˜ ÌÔÚÔ‡-ÌÂ Ó· ıÂˆÚ‹ÛÔ˘ÌÂ fiÙÈ Ù· ¯·ÌË-Ï¿ Â›Â‰· ÙË˜ HDL ¯ÔÏËÛÙÂÚfi-ÏË˜ ÛÙÔ ªÂÙ™ ÂÎÊÚ¿˙Ô˘Ó Î·È ÙËÓÔÈÔÙÈÎ‹ ‰È·Ù·Ú·¯‹ ÙˆÓ HDL,‰È·Ì¤ÛÔ˘ ÙÔ˘ ÎÔÈÓÔ‡ ·ıÔÊ˘-ÛÈÔÏÔÁÈÎÔ‡ ÌË¯·ÓÈÛÌÔ‡ Ô˘ ÂË-ÚÂ¿˙ÂÈ ÙËÓ ÔÛfiÙËÙ· Î·È ÙË ÏÂÈ-ÙÔ˘ÚÁ›· ÙˆÓ HDL ÛˆÌ·ÙÈ‰›ˆÓ.

∂›ÏÔÁÔ˜

ΔÔ ªÂÙ™ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÙËÓ·ıËÚÔÁfiÓÔ ‰˘ÛÏÈÈ‰·ÈÌ›·, ÌÂÙËÓ ·‡ÍËÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓÎ·È ÙË ÌÂ›ˆÛË ÙË˜ HDL ¯ÔÏËÛÙÂ-ÚfiÏË˜, Ë ÔÔ›· Â¿ÁÂÈ ÙËÓ ÊÏÂÁ-ÌÔÓ‹ Î·È ÙËÓ ÂÎ‰‹ÏˆÛË ÙÔ˘ ÔÍÂÈ-‰ˆÙÈÎÔ‡ ÛÙÚÂ˜. ™ÙÈ˜ Û˘Óı‹ÎÂ˜·˘Ù¤˜ ·Ú·ÙËÚÂ›Ù·È ÔÛÔÙÈÎ‹

ÌÂ›ˆÛË ÙË˜ HDL ¯ÔÏËÛÙÂÚfiÏË˜,ÌÂ ·Ó¿ÏÔÁË ÌÂ›ˆÛË ÙˆÓ HDL2ÛˆÌ·ÙÈ‰›ˆÓ. Δ· Â›Â‰· ÙˆÓHDL3 ÂËÚÂ¿˙ÔÓÙ·È ÛÂ ÌÈÎÚfi-ÙÂÚÔ ‚·ıÌfi, ·ÏÏ¿ Ë ÏÂÈÙÔ˘ÚÁ›·ÙÔ˘˜ ‰È·Ù·Ú¿ÛÛÂÙ·È ÌÂ ·Ô-Ù¤ÏÂÛÌ· ·˘Ù¿ Ù· ÛˆÌ·Ù›‰È·Ó· ¯¿ÓÔ˘Ó ÙÈ˜ ·ÓÙÈÔÍÂÈ‰ˆÙÈÎ¤˜Î·È ·ÓÙÈÊÏÂÁÌÔÓÒ‰ÂÈ˜ È‰ÈfiÙË-ÙÂ˜. ∂›ÛË˜ Ë ·Ó¿ÛÙÚÔÊË ÌÂÙ·-ÊÔÚ¿ ÙË˜ ¯ÔÏËÛÙÂÚfiÏË˜ ÚÔ˜ÙÔ ‹·Ú ÌÂÈÒÓÂÙ·È Î·È Ë ¯ÔÏË-ÛÙÂÚfiÏË Î·ÙÂ˘ı‡ÓÂÙ·È ÚÔ˜ Ù·Î‡ÙÙ·Ú· ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘-

ÛÙ‹Ì·ÙÔ˜. √È ÌË¯·ÓÈÛÌÔ› ÌÂÙÔ˘˜ ÔÔ›Ô˘˜ ÂÍËÁÔ‡ÓÙ·È ÔÈ ·-Ú·¿Óˆ ·ÏÏ·Á¤˜ ÂÚÈÏ·Ì‚¿ÓÔ˘ÓÙËÓ ˘ÂÚÙÚÈÁÏ˘ÎÂÚÈ‰·ÈÌ›· ÙÔ˘ªÂÙ™ Î·È ÙËÓ ·ÓÙ›‰Ú·ÛË ÙË˜ÔÍÂ›·˜ Ê¿ÛË˜ Î·È ÙË˜ ÊÏÂÁÌÔ-Ó‹˜, Ô˘ ÚÔÎ·ÏÔ‡Ó ‰ÔÌÈÎ¤˜ Î·ÈÏÂÈÙÔ˘ÚÁÈÎ¤˜ ÌÂÙ·‚ÔÏ¤˜ ÛÙ·HDL ÛˆÌ·Ù›‰È·. º·›ÓÂÙ·È fiÙÈÚfiÎÂÈÙ·È ÁÈ· ÌË¯·ÓÈÛÌÔ‡˜ Ô˘·ÔÛÎÔÔ‡Ó ÛÙË ‰È·Ù‹ÚËÛË ÙË˜ÔÌÔÈÔÛÙ·Û›·˜ ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡,·ÏÏ¿ Ë ¯ÚfiÓÈ· Â›‰Ú·ÛË ÙÔ˘˜ÛÙÔ ÌÂÙ·‚ÔÏÈÛÌfi ÙˆÓ ÏÈÔÚˆ-

ÙÂ˚ÓÒÓ Ô‰ËÁÂ› ÛÙËÓ ÌÂÙ¿ÙˆÛ‹ÙÔ˘˜ ÛÂ ÌË¯·ÓÈÛÌÔ‡˜ Ô˘ Â˘Ô-‰ÒÓÔ˘Ó ÙËÓ ÂÍ¤ÏÈÍË ÙË˜ ·ıËÚˆ-Ì·ÙÈÎ‹˜ Ï¿Î·˜. ∏ Î·Ù·ÓfiËÛËÙˆÓ ·Ú·¿Óˆ ÌË¯·ÓÈÛÌÒÓ ÛÂ‚¿ıÔ˜ ı· ‰ËÌÈÔ˘ÚÁ‹ÛÂÈ Î·Ï‡ÙÂ-ÚÂ˜ ÚÔ¸Ôı¤ÛÂÈ˜ ÁÈ· ÙËÓ ·ÓÙÈ-ÌÂÙÒÈÛË ÙË˜ ·ıËÚˆÁfiÓÔ˘ ‰˘-ÛÏÈÈ‰·ÈÌ›·˜ Î·È ÙËÓ ÂÚ·ÈÙ¤ÚˆÌÂ›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÌ-Ê¿ÓÈÛË ÙË˜ Î·Ú‰È·ÁÁÂÈ·Î‹˜ Ófi-ÛÔ˘.

™ ∂ ¶ Δ ∂ ª μ ƒ π √ ™ 2 0 0 8

22


1. Chapman MJ et al. Raising high-densitylipoprotein cholesterol with reductionof cardiovascular risk: the role ofnicotinic acid--a position paper deve-loped by the European ConsensusPanel on HDL-C. Curr Med Res Opin2004; 20: 1253-1268.

2. Gazi I et al. Concentration and relativedistribution of low-density lipoproteinsubfractions in patients with meta-bolic syndrome defined according tothe National Cholesterol EducationProgram criteria. Metabolism 2006;55: 885-891.

3. Link JJ et al. HDL cholesterol: physio-logy, pathophysiology, and manage-ment. Curr Probl Cardiol 2007; 32:268-314.

4. Hansel B et al. Metabolic syndrome isassociated with elevated oxidativestress and dysfunctional dense high-density lipoprotein particles display-ing impaired antioxidative activity. JClin Endocrinol Metab 2004; 89:4963-4971.

5. de Souza JA et al. Metabolic syndromefeatures small, apolipoprotein A-I-poor, triglyceride-rich HDL3 particleswith defective anti-apoptotic activity.Atherosclerosis 2007; (article inpress).

6. Segrest JP et al. The amphipathic helixin the exchangeable apolipoproteins: areview of secondary structure andfunction. J Lipid Res 1992; 33: 141-166.

7. Segrest JP et al. Structure and functionof apolipoprotein A-I and high-densitylipoprotein. Curr Opin Lipidol 2000;11: 105-115.

8. von Eckardstein A et al. High densitylipoproteins and arteriosclerosis. Roleof cholesterol efflux and reversecholesterol transport. ArteriosclerThromb Vasc Biol 2001; 21: 13-27.

9. Wang N et al. ATP-binding cassettetransporters G1 and G4 mediatecellular cholesterol efflux to high-density lipoproteins. Proc Natl AcadSci U S A 2004; 101: 9774-9779.

10. Barter PJ et al. Targeting cholesterylester transfer protein for the preven-tion and management of cardio-vascular disease. J Am Coll Cardiol2006; 47: 492-499.

11. Williams DL et al. Scavenger receptorBI and cholesterol trafficking. CurrOpin Lipidol 1999; 10: 329-339.

12. Kontush A et al. Antiatherogenic small,dense HDL--guardian angel of thearterial wall? Nat Clin Pract Cardio-vasc Med 2006; 3: 144-153.

13. Navab M et al. The oxidation hypothe-sis of atherogenesis: the role ofoxidized phospholipids and HDL. JLipid Res 2004; 45: 993-1007.

14. Kontush A et al. Small, dense HDL parti-cles exert potent protection of athe-rogenic LDL against oxidative stress.Arterioscler Thromb Vasc Biol 2003;23: 1881-1888.

15. Barter PJ et al. Antiinflammatory prope-rties of HDL. Circ Res 2004; 95: 764-772.

16. Nofer JR et al. Atheroprotective effectsof high-density lipoprotein-associatedlysosphingolipids. Trends CardiovascMed 2005; 15: 265-271.

17. Khovidhunkit W et al. Effects of infe-ction and inflammation on lipid andlipoprotein metabolism: mechanismsand consequences to the host. J LipidRes 2004; 45: 1169-1196.

18. Esteve E et al. Dyslipidemia and inflam-mation: an evolutionary conservedmechanism. Clin Nutr 2005; 24: 16-31.

19. Le Goff W et al. Pharmacologicalmodulation of cholesteryl ester tran-sfer protein, a new therapeutic targetin atherogenic dyslipidemia. Pharma-col Ther 2004; 101: 17-38.

20. Malle E et al. Serum amyloid A (SAA): anacute phase protein and apolipopro-tein. Atherosclerosis 1993; 102: 131-146.

21. Lamarche B et al. HDL metabolism in hy-pertriglyceridemic states: an over-view. Clin Chim Acta 1999; 286: 145-161.

22. Greene DJ et al. Elevated triglyceridecontent diminishes the capacity ofhigh density lipoprotein to delivercholesteryl esters via the scavengerreceptor class B type I (SR-BI). J BiolChem 2001; 276: 4804-4811.

23. Cai L et al. Serum amyloid A is a ligandfor scavenger receptor class B type Iand inhibits high density lipoproteinbinding and selective lipid uptake. JBiol Chem 2005; 280: 2954-2961.

24. Artl A et al. Role of serum amyloid Aduring metabolism of acute-phaseHDL by macrophages. ArteriosclerThromb Vasc Biol 2000; 20: 763-772.

25. Ansell BJ et al. Inflammatory/ antiin-flammatory properties of high-densitylipoprotein distinguish patients fromcontrol subjects better than high-density lipoprotein cholesterol levelsand are favorably affected by simva-statin treatment. Circulation 2003;108: 2751-2756.

23

¶ƒ√∫§π¡π∫∏ ∂ƒ∂À¡∞

Δ›ÙÏÔÈ ∞˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ŒÓ·ÓÙÈ ¢È·ÊfiÚˆÓ ªÔÚÊÒÓ √ÍÂÈ‰ˆÌ¤ÓË˜ LDL ÛÂ ∞ÛıÂÓÂ›˜ ÌÂ √Í‡ ™ÙÂÊ·ÓÈ·›Ô ™‡Ó‰ÚÔÌÔ.

∏ ∂›‰Ú·ÛË ÙË˜ ∞ÙÔÚ‚·ÛÙ·Ù›ÓË˜∞. ¶··ı·Ó·Û›Ô˘, π. °Ô˘‰¤‚ÂÓÔ˜, ∞. ΔÛÂÏ¤Ë˜1

∫·Ú‰ÈÔÏÔÁÈÎ‹ ∫ÏÈÓÈÎ‹, π·ÙÚÈÎ‹ ™¯ÔÏ‹, ¶·ÓÂÈÛÙËÌÈ·Îfi ¡ÔÛÔÎÔÌÂ›Ô πˆ·ÓÓ›ÓˆÓ

1∂ÚÁ·ÛÙ‹ÚÈÔ μÈÔ¯ËÌÂ›·˜, ΔÌ‹Ì· ÃËÌÂ›·˜, ¶·ÓÂÈÛÙ‹ÌÈÔ πˆ·ÓÓ›ÓˆÓ

∂ÈÛ·ÁˆÁ‹

∏ ÔÍÂÈ‰ˆÌ¤ÓË ÌÔÚÊ‹ ÙË˜ ¯·ÌË-Ï‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˝ÓË˜(oxLDL) ‰È·‰Ú·Ì·Ù›˙ÂÈ ÛËÌ·ÓÙÈ-Îfi ÚfiÏÔ ÛÙËÓ ·ıÔÁ¤ÓÂÈ· ÙË˜·ıËÚÔÛÎÏ‹ÚˆÛË˜ (1,2). ∫·Ù¿ ÙË‰È¿ÚÎÂÈ· ÙË˜ ÔÍÂ›‰ˆÛË˜ ÙfiÛÔ ÙÔÏÈÈ‰È·Îfi ÂÚÈÂ¯fiÌÂÓÔ, fiÛÔ Î·È Ë·ÔÏÈÔÚˆÙÂ˝ÓË B-100 (∞poB-100) ÙË˜ LDL ˘Ê›ÛÙ·ÓÙ·È ¯ËÌÈÎ¤˜ÙÚÔÔÔÈ‹ÛÂÈ˜ ‰È·Ì¤ÛÔ˘ ·ÓÙÈ-‰Ú¿ÛÂˆÓ ÛÙÈ˜ ÔÔ›Â˜ Û˘ÌÌÂÙ¤-¯Ô˘Ó ÔÈ ÂÏÂ‡ıÂÚÂ˜ Ú›˙Â˜. ªÈ··fi ·˘Ù¤˜ ÙÈ˜ ÙÚÔÔÔÈ‹ÛÂÈ˜ Â›-Ó·È Ë ˘ÂÚÔÍÂ›‰ˆÛË ÙˆÓ ÔÏ˘·-ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓ ÔÍ¤ˆÓ Ù·ÔÔ›· Â›Ó·È ÂÛÙÂÚÔÔÈËÌ¤Ó· ÛÙËÓsn-2 ı¤ÛË ÌÔÚ›ˆÓ ÊˆÛÊ·ÙÈ‰˘ÏÔ-¯ÔÏ›ÓË˜ (PC) ÚÔ˜ Ù· ·ÓÙ›ÛÙÔÈ¯·˘‰ÚÔ¸ÂÚÔÍÂ›‰È·. Δ· ˘‰ÚÔ¸Â-ÚÔÍÂ›‰È· ÛÙË Û˘Ó¤¯ÂÈ· ‰È·ÛÒ-ÓÙ·È, ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙÔÓ Û¯Ë-Ì·ÙÈÛÌfi ‚ÈÔÏÔÁÈÎ¿ ÂÓÂÚÁÒÓ ÔÍÂÈ-‰ˆÌ¤ÓˆÓ ÊˆÛÊÔÏÈÈ‰›ˆÓ (oxPL)Î·È ·Ï‰Â¸‰ÒÓ, fiˆ˜ Ë ÌËÏÔÓÈÎ‹‰È·Ï‰Â˛‰Ë (MDA) Î·È Ë 4-˘‰ÚÔ-Í˘ÓÔÓÂÓ¿ÏË (4-∏¡∂) (2). ªÈ··fi ÙÈ˜ ÛËÌ·ÓÙÈÎfiÙÂÚÂ˜ ‰ÈÂÚÁ·-Û›Â˜ Ô˘ Ï·Ì‚¿ÓÂÈ ¯ÒÚ· Î·Ù¿ ÙË‰È¿ÚÎÂÈ· ÙË˜ ÔÍÂ›‰ˆÛË˜ ÙË˜LDL, Â›Ó·È Ë ˘‰ÚfiÏ˘ÛË ÙˆÓ Û¯Ë-Ì·ÙÈ˙fiÌÂÓˆÓ oxPL Î·È Ë ·Ú·-ÁˆÁ‹ Ï˘ÛÔÊˆÛÊ·ÙÈ‰˘ÏÔ¯ÔÏ›ÓË˜(lyso-PC), ÌÈ· ·ÓÙ›‰Ú·ÛË Ô˘ Î·-Ù·Ï‡ÂÙ·È ·fi ÙË ÊˆÛÊÔÏÈ¿ÛË∞2 Ô˘ Â›Ó·È Û˘Ó‰Â‰ÂÌ¤ÓË ÛÙËÓLDL (ÏÈÔÚˆÙÂ˚ÓÈÎ‹ ÊˆÛÊÔÏÈ¿-ÛË ∞2, Lp-PLA2) (3). ∫·Ù¿ ÙË‰È¿ÚÎÂÈ· ÙË˜ ÔÍÂ›‰ˆÛË˜ ÙË˜ LDL,Ë ÂÓÂÚÁfiÙËÙ· ÙÔ˘ ÂÓ˙‡ÌÔ˘ ÌÂÈÒ-ÓÂÙ·È, Û˘ÓÂÒ˜ Ô ‚·ıÌfi˜ ÙË˜ÔÍÂ›‰ˆÛË˜ ÙË˜ LDL ÂËÚÂ¿˙ÂÈÛËÌ·ÓÙÈÎ¿ ÙËÓ ÂÓÂÚÁfiÙËÙ· ÙÔ˘ÂÓ˙‡ÌÔ˘ Î·È ÂÔÌ¤Óˆ˜ Ù· Â›Â-‰· ÙˆÓ Û¯ËÌ·ÙÈ˙fiÌÂÓˆÓ oxPL Î·Èlyso-PC ÛÙËÓ oxLDL (4).

ªÈ· ÛËÌ·ÓÙÈÎ‹ È‰ÈfiÙËÙ· ÙËõxLDL Â›Ó·È Ë ÂÌÊ¿ÓÈÛË ·ÓÙÈÁÔÓÈ-

ÎfiÙËÙ·˜ Ë ÔÔ›· ¤¯ÂÈ ˆ˜ Û˘Ó¤-ÂÈ· ÙÔ Û¯ËÌ·ÙÈÛÌfi ·˘ÙÔ·ÓÙÈÛˆ-Ì¿ÙˆÓ ¤Ó·ÓÙÈ ÙË˜ oxLDL (5) ™Ë-Ì·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ·ÓÙÈÁÔÓÈÎfiÙË-Ù· ÙË˜ oxLDL ‰È·‰Ú·Ì·Ù›˙Ô˘Ó Ùfi-ÛÔ Ù· oxPL fiÛÔ Î·È Ë lyso-PCÛ˘ÌÌÂÙ¤¯ÔÓÙ·˜ ÛÙÔ Û¯ËÌ·ÙÈÛÌfi‰È·ÊfiÚˆÓ ·ÓÙÈÁÔÓÈÎÒÓ ÂÈÙfiˆÓÛÙ· ÛˆÌ·Ù›‰È· ÙË˜ oxLDL (6, 7).ªÂ ‰Â‰ÔÌ¤ÓÔ fiÙÈ Ë Lp-PLA2 Ô˘Û˘Ó‰¤ÂÙ·È ÛÙËÓ LDL Â›Ó·È Ô Î‡-ÚÈÔ˜ ·Ú¿ÁÔÓÙ·˜ Ô˘ Î·ıÔÚ›˙ÂÈÙ· Â›Â‰· ÙˆÓ oxPL Î·È lyso-PCÛÙËÓ oxLDL, ÙÔ ¤Ó˙˘ÌÔ ·˘Ùfi ÌÔ-ÚÂ› Ó· ÂËÚÂ¿˙ÂÈ ÙÔ Â›‰Ô˜ ÙˆÓ·ÓÙÈÁÔÓÈÎÒÓ ÂÈÙfiˆÓ, Î·ıÒ˜ Î·ÈÙÔ˘˜ Ù›ÙÏÔ˘˜ ÙˆÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿-ÙˆÓ ¤Ó·ÓÙÈ ÙË˜ oxLDL (8).

¶ÔÏÏ¤˜ ÌÂÏ¤ÙÂ˜ ¤¯Ô˘Ó ·Ó·-ÊÂÚıÂ› ÛÙËÓ ·ÚÔ˘Û›· ·˘ÙÔ·ÓÙÈ-ÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙË˜ ¤ÓÙÔÓ· ÔÍÂÈ-‰ˆÌ¤ÓË˜ LDL ÛÙÔÓ ÔÚfi ·ÛıÂÓÒÓÌÂ ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ ·ÏÏ¿ Î·ÈÛÙÔÓ ÔÚfi ˘ÁÈÒÓ ÂıÂÏÔÓÙÒÓ (1, 2,9, 10). π‰È·›ÙÂÚ· ÛÂ ·ÛıÂÓÂ›˜ ÌÂ-Ù¿ ·fi ÔÍ‡ ÛÙÂÊ·ÓÈ·›Ô Û‡Ó‰ÚÔÌÔ(√™™) ·Ú·ÙËÚÂ›Ù·È ‚Ú·¯˘Úfi-ıÂÛÌË ·‡ÍËÛË ÙÔ˘ Ù›ÙÏÔ˘ ÙˆÓ ·˘-ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ Ï‹ÚˆõxLDL Î·ıÒ˜ Î·È ÙˆÓ ÂÈ¤‰ˆÓÙˆÓ oxPL ÛÙÔ Ï¿ÛÌ· (5).

∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ë ¿ÌÂÛË ¯Ô-Ú‹ÁËÛË ÛÙ·ÙÈÓÒÓ ‚ÂÏÙÈÒÓÂÈ ÙËÓÚfiÁÓˆÛË ·ÛıÂÓÒÓ ÌÂÙ¿ ·fi√™™. √È ˘ÔÎÂ›ÌÂÓÔÈ ÌË¯·ÓÈÛÌÔ›‰ÂÓ Â›Ó·È ·fiÏ˘Ù· ÁÓˆÛÙÔ› ·ÏÏ¿Ê·›ÓÂÙ·È fiÙÈ ‰ÂÓ Û¯ÂÙ›˙ÔÓÙ·È ÌfiÓÔÌÂ ÙËÓ ˘ÔÏÈÈ‰·ÈÌÈÎ‹ ‰Ú¿ÛË ÙˆÓÛÙ·ÙÈÓÒÓ ·ÏÏ¿ Î·È ÌÂ ‰È¿ÊÔÚÂ˜·ÓÙÈÊÏÂÁÌÔÓÒ‰ÂÈ˜ (11), ·ÓÔÛÔ-ÙÚÔÔÔÈËÙÈÎ¤˜ Î·È ·ÓÙÈÔÍÂÈ‰ˆÙÈ-Î¤˜ ‰Ú¿ÛÂÈ˜ Ô˘ Ù· Ê¿ÚÌ·Î· ·˘-Ù¿ ÂÌÊ·Ó›˙Ô˘Ó (12, 13). ™Â ˘ÔÔ-Ì¿‰· ·ÛıÂÓÒÓ ÙË˜ ÌÂÏ¤ÙË˜MIRACL, Ë ¯ÔÚ‹ÁËÛË ·ÙÔÚ‚·-ÛÙ·Ù›ÓË˜ ÛÂ ·ÛıÂÓÂ›˜ ÌÂÙ¿ ·fi√™™, ¤¯ÂÈ Û˘Ó‰˘·ÛÙÂ› ÌÂ ÌÂ›ˆÛËÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ oxPL ÙÔ˘ ÔÚÔ‡(14). ™ÙÈ˜ ÌÂÏ¤ÙÂ˜ ·˘Ù¤˜ ÁÈ· ÙÔÓ

ÚÔÛ‰ÈÔÚÈÛÌfi ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ·˘ÙÔÓ·ÓÙÈÛˆÌ¿ÙˆÓ ¯ÚËÛÈÌÔÔÈ‹-ıËÎÂ Ï‹Úˆ˜ ÔÍÂÈ‰ˆÌ¤ÓË LDL,‰ËÏ·‰‹ oxLDL ÏÔ‡ÛÈ· ÛÂ ·Ï-‰Â˛‰Â˜. ¢ÂÓ Â›Ó·È fiÌˆ˜ Ì¤¯ÚÈ Û‹-ÌÂÚ· ÁÓˆÛÙ‹ Ë Â›‰Ú·ÛË ÙË˜ ¯Ô-Ú‹ÁËÛË˜ ÛÙ·ÙÈÓÒÓ ÛÙÔ˘˜ Ù›ÙÏÔ˘˜ÙˆÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ‹È· ÔÍÂÈ‰ˆÌ¤ÓˆÓ ÌÔÚÊÒÓ LDLÛÂ ·ÛıÂÓÂ›˜ ÌÂÙ¿ ·fi ÔÍ‡ ÛÙÂ-Ê·ÓÈ·›Ô ÂÂÈÛfi‰ÈÔ.

™ÎÔfi˜ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤-ÙË˜ ‹Ù·Ó Ó· ÌÂÏÂÙËıÔ‡Ó ÔÈ Ù›ÙÏÔÈ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ‹È·ÔÍÂÈ‰ˆÌ¤ÓˆÓ ÌÔÚÊÒÓ LDL, ‰ËÏ·-‰‹ ÌÔÚÊÒÓ ÙË˜ oxLDL ÏÔ‡ÛÈˆÓÛÂ ÔxPL ‹/Î·È lyso-PC ÛÂ ·ÛıÂ-ÓÂ›˜ ÌÂ ÔÍ‡ ÛÙÂÊ·ÓÈ·›Ô ÂÂÈÛfi-‰ÈÔ. ∂›ÛË˜ ÌÂÏÂÙ‹ıËÎÂ Ë Û˘ÌÂ-ÚÈÊÔÚ¿ ÙÔ˘ Ù›ÙÏÔ˘ ÙˆÓ ·˘ÙÔ·ÓÙÈ-ÛˆÌ¿ÙˆÓ ·˘ÙÒÓ ÛÙË ‰È¿ÚÎÂÈ·ÙÔ˘ ¯ÚfiÓÔ˘ ÌÂÙ¿ ·fi ÙÔ ÛÙÂÊ·ÓÈ-·›Ô ÂÂÈÛfi‰ÈÔ Î·ıÒ˜ Î·È Ë Â›-‰Ú·ÛË ÙË˜ ¯ÔÚ‹ÁËÛË˜ ·ÙÔÚ‚·-ÛÙ·Ù›ÓË˜ ÛÙÈ˜ ·Ú·¿Óˆ Èı·Ó¤˜ÌÂÙ·‚ÔÏ¤˜.

ÀÏÈÎfi Î·È Ì¤ıÔ‰Ô˜

¶ÏËı˘ÛÌfi˜ ÙË˜ ÌÂÏ¤ÙË˜

ÀÏÈÎfi ÙË˜ ÌÂÏ¤ÙË˜ ·ÔÙ¤ÏÂÛ·ÓÂÓ‹ÓÙ·-¤ÓÙÂ (55) ·ÛıÂÓÂ›˜ (Ì¤-ÛË ËÏÈÎ›· 58,9±9 ¤ÙË, 42-78ÂÙÒÓ, 49 ¿Ó‰ÚÂ˜, 6 Á˘Ó·›ÎÂ˜) ÌÂ√™™. √È ·ÛıÂÓÂ›˜ ·˘ÙÔ› Â›¯·ÓÂÏÂ‡ıÂÚÔ ·ÙÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfiÎ·Ú‰È·ÁÁÂÈ·Î‹˜ ‹ ¿ÏÏË˜ ÓfiÛÔ˘ ‹Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË, ‰ÂÓ ‹Ù·Ó ÛÂÔÔÈ·‰‹ÔÙÂ ·ÁˆÁ‹ ÚÈÓ ÙÔ ÂÂÈ-Ûfi‰ÈÔ Î·È ÂÈÛ‹¯ıËÛ·Ó ÛÙËÓ ÌÔÓ¿-‰· ·Ú·ÎÔÏÔ‡ıËÛË˜ Î·Ú‰ÈÔ·-ıÒÓ ÙÔ˘ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ ¡ÔÛÔ-ÎÔÌÂ›Ô˘ πˆ·ÓÓ›ÓˆÓ ÌÂ ÙÂÎÌËÚÈˆ-Ì¤ÓË ‰È¿ÁÓˆÛË ÔÍ¤Ô˜ ÛÙÂÊ·ÓÈ·›-Ô˘ Û˘Ó‰ÚfiÌÔ˘ ¯ˆÚ›˜ ÂÌÌ¤ÓÔ˘Û··Ó¿Û·ÛË ÙÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜ ST ÛÙÔËÏÂÎÙÚÔÎ·Ú‰ÈÔÁÚ¿ÊËÌ· (NSTEMI)ÛÂ ‰È¿ÛÙËÌ· ÏÈÁfiÙÂÚÔ ÙˆÓ 2

™ ∂ ¶ Δ ∂ ª μ ƒ π √ ™ 2 0 0 8

24

ˆÚÒÓ ·fi ÙËÓ ¤Ó·ÚÍË ÙˆÓ Û˘-ÌÙˆÌ¿ÙˆÓ. ∞ÛıÂÓÂ›˜, ÔÈ ÔÔ›ÔÈÌÂÙ¿ ÙËÓ ·Ú¯ÈÎ‹ ÂÎÙ›ÌËÛË ‰ÂÓÛ˘ÌÏ‹ÚˆÓ·Ó Ù· ÎÚÈÙ‹ÚÈ· ‰È¿-ÁÓˆÛË˜ NSTEMI, ·ÔÎÏÂ›ÛÙËÎ·Ó·fi ÙËÓ ÌÂÏ¤ÙË.

ŸÏÔÈ ÔÈ ·ÛıÂÓÂ›˜ ˘Ô‚Ï‹ıË-Î·Ó ÛÂ ‰È·ÁÓˆÛÙÈÎ‹ ·ÁÁÂÈÔÁÚ·-Ê›· ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÁÁÂ›ˆÓÎ·È ‰È·‰ÂÚÌÈÎ‹ ·ÁÁÂÈÔÏ·ÛÙÈÎ‹ÌÂ ¯Ú‹ÛË ÂÓ‰ÔÚfiÛıÂÛË˜ (ste-nt) ÂÓÙfi˜ 24 ˆÚÒÓ ·fi ÙËÓ ÂÈÛ·-ÁˆÁ‹ ÙÔ˘˜ ÛÙË ÌÔÓ¿‰·. ∞ÛıÂ-ÓÂ›˜ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó ÛÂ ·ÔÚ-ÙÔÛÙÂÊ·ÓÈ·›· ·Ú¿Î·Ì„Ë Â›ÙÂÛÙË ‰È¿ÚÎÂÈ· ÙË˜ ÓÔÛËÏÂ›·˜ÙÔ˘˜, Â›ÙÂ ÛÙË ‰È¿ÚÎÂÈ· ÙË˜ Â-ÚÈfi‰Ô˘ ·Ú·ÎÔÏÔ‡ıËÛË˜, Î·-ıÒ˜ Î·È ·ÛıÂÓÂ›˜ ÌÂ «Ê˘ÛÈÔÏÔÁÈ-Î¿» ÛÙÂÊ·ÓÈ·›· ·ÁÁÂ›· (ÏÂ›· ÛÙÂ-Ê·ÓÈ·›· ·ÁÁÂ›· ÌÂ Ê˘ÛÈÔÏÔÁÈÎ‹‰È¿ÌÂÙÚÔ ·˘ÏÔ‡ ÛÙË ÛÙÂÊ·ÓÈÔ-ÁÚ·Ê›·) ·ÔÎÏÂ›ÛÙËÎ·Ó Â›ÛË˜·fi ÙË ÌÂÏ¤ÙË.

√È ·ÛıÂÓÂ›˜ Î·Ù¿ ÙËÓ ÂÚ›Ô-‰Ô ·Ú·ÎÔÏÔ‡ıËÛË˜ ‹Ù·Ó ÛÂ·ÁˆÁ‹ ÌÂ ·ÛÈÚ›ÓË (100 mg/Ì¤-Ú·), ÎÏÔÈ‰ÔÁÚ¤ÏË (75 mg/Ì¤-Ú·), Î·È ‚-·ÔÎÏÂÈÛÙ‹. ∞ÙÔÚ‚·-ÛÙ·Ù›ÓË ¯ÔÚËÁ‹ıËÎÂ ÛÂ fiÏÔ˘˜ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÛÙË ‰È¿ÚÎÂÈ· ÙË˜ÓÔÛËÏÂ›·˜ ÙÔ˘˜ (3-5 Ì¤ÚÂ˜). ªÂ-Ù¿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙÔ ÓÔÛÔÎÔÌÂ›Ô

Ë Û˘Ó¤¯ÈÛË ÙË˜ ˘ÔÏÈÈ‰·ÈÌÈÎ‹˜·ÁˆÁ‹˜ ‹Ù·Ó ÛÙËÓ Â˘ı‡ÓË ÙˆÓıÂÚ·fiÓÙˆÓ È·ÙÚÒÓ ÙÔ˘˜.

√È ·ÛıÂÓÂ›˜ Ù¤ıËÎ·Ó ÛÂ ·-Ú·ÎÔÏÔ‡ıËÛË ÁÈ· ‰È¿ÛÙËÌ· 6ÌËÓÒÓ. ¢Â›ÁÌ·Ù· ÔÚÔ‡ Û˘ÏÏ¤-¯ıËÎ·Ó Î·Ù¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ·-Ú·ÎÔÏÔ‡ıËÛË˜ (ÂÓÙfi˜ 30 ÏÂÙÒÓ·fi ÙËÓ ÂÌÊ¿ÓÈÛ‹ ÙÔ˘˜ ÛÙ· ÂÂ›-ÁÔÓÙ· È·ÙÚÂ›· ÙÔ˘ ÓÔÛÔÎÔÌÂ›Ô˘)Î·È ÛÙÔÓ 1Ô , 3Ô Î·È 6Ô Ì‹Ó· ÌÂ-Ù¿. ™ÙÔ˘˜ ·ÛıÂÓÂ›˜ ¤ÁÈÓÂ Î·Ù·-ÁÚ·Ê‹ fiÏˆÓ ÙˆÓ ÎÏ·ÛÈÎÒÓ ·-Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÛÙÂÊ·ÓÈ-·›· ÓfiÛÔ (·ÚÙËÚÈ·Î‹ ˘¤ÚÙ·ÛË,Î¿ÓÈÛÌ·, ÎÏËÚÔÓÔÌÈÎfi ÈÛÙÔÚÈÎfiÚÒÈÌË˜ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ Î·ÈÔ ‰Â›ÎÙË˜ Ì¿˙·˜ ÛÒÌ·ÙÔ˜), ÂÓÒÚÔÛ‰ÈÔÚ›ÛÙËÎÂ ÙÔ ÏÈÈ‰·ÈÌÈÎfiÚÔÊ›Ï ÙÔ˘˜, ÛÂ Î¿ıÂ ¯ÚÔÓÈÎ‹ÛÙÈÁÌ‹.

√È ·ÛıÂÓÂ›˜ ¯ˆÚ›ÛÙËÎ·Ó ÛÂ‰‡Ô ÔÌ¿‰Â˜ ÌÂ ‚¿ÛË ÙË ˘ÔÏÈÈ-‰·ÈÌÈÎ‹ ·ÁˆÁ‹ ÛÙËÓ ÔÔ›· Â›¯·Ó˘Ô‚ÏËıÂ› Î·Ù¿ ÙËÓ ÂÚ›Ô‰Ô·Ú·ÎÔÏÔ‡ıËÛË˜. ™ÙËÓ ÚÒÙËÔÌ¿‰· ÂÓÙ¿¯ıËÎ·Ó 34 ·ÛıÂÓÂ›˜,ÔÈ ÔÔ›ÔÈ ‹Ù·Ó ÛÂ ·ÁˆÁ‹ ÌÂ·ÙÔÚ‚·ÛÙ·Ù›ÓË Î·ı' fiÏË ÙË ‰È¿Ú-ÎÂÈ· ÙË˜ ÂÚÈfi‰Ô˘ ·Ú·ÎÔÏÔ‡-ıËÛË˜ ¯ˆÚ›˜ ‰È·ÎÔ¤˜ (fiÏÔÈ ÔÈ·ÛıÂÓÂ›˜ ¤Ï·‚·Ó 20-40 mg/Ì¤-Ú·). ™ÙË ‰Â‡ÙÂÚË ÔÌ¿‰· Û˘ÌÂ-

ÚÈÂÏ‹ÊıËÎ·Ó ÔÈ 21 ·ÛıÂÓÂ›˜, ÔÈÔÔ›ÔÈ Â›¯·Ó ‰È·Îfi„ÂÈ ÙËÓ ·ÁˆÁ‹ÌÂ ·ÙÔÚ‚·ÛÙ·Ù›ÓË ÂÓÙfi˜ ‰‡Ô¤ˆ˜ ÙÂÛÛ¿ÚˆÓ ËÌÂÚÒÓ ÌÂÙ¿ ÙËÓ¤ÍÔ‰fi ÙÔ˘˜ ·fi ÙÔ ÓÔÛÔÎÔÌÂ›ÔÎ·È ‰ÂÓ ¤Ï·‚·Ó Î·ıfiÏÔ˘ ˘ÔÏÈ-È‰·ÈÌÈÎ‹ ·ÁˆÁ‹ Î·ı' fiÏË ÙË‰È¿ÚÎÂÈ· ÙË˜ ÂÍ¿ÌËÓË˜ ÂÚÈfi-‰Ô˘ ·Ú·ÎÔÏÔ‡ıËÛË˜. ∞ÛıÂ-ÓÂ›˜ ÔÈ ÔÔ›ÔÈ Ï¿Ì‚·Ó·Ó ÛÙ·Ù›ÓÂ˜ÂÚÈÛÙ·ÛÈ·Î¿, ‹ ˘Ô‚Ï‹ıËÎ·ÓÛÂ ¿ÏÏË ˘ÔÏÈÈ‰·ÈÌÈÎ‹ ·ÁˆÁ‹Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÂÚÈfi‰Ô˘·Ú·ÎÔÏÔ‡ıËÛË˜ ·ÔÎÏÂ›ÛÙË-Î·Ó ·fi ÙË ÌÂÏ¤ÙË.

¶ÂÈÚ·Ì·ÙÈÎ‹ ‰È·‰ÈÎ·Û›·

∏ ÂÈÚ·Ì·ÙÈÎ‹ ‰È·‰ÈÎ·Û›· Ô˘·ÎÔÏÔ˘ı‹ıËÎÂ ¤¯ÂÈ ·Ó·Ï˘ÙÈÎ¿ÂÚÈÁÚ·ÊÂ› ÛÂ ÚÔËÁÔ‡ÌÂÓÂ˜ÌÂÏ¤ÙÂ˜ Ì·˜ (8, 15, 16). ™˘ÓÔÙÈ-Î¿ Ë ÔÍÂ›‰ˆÛË ÙË˜ LDL Ú·ÁÌ·-ÙÔÔÈ‹ıËÎÂ ÌÂ ‹ ¯ˆÚ›˜ ·ÂÓÂÚ-ÁÔÔÈËÌ¤ÓË ÙËÓ ÂÓ‰ÔÁÂÓ‹ Lp-PLA2 (4). ¶·Ú·ÛÎÂ˘¿ÛıËÎ·Ó ÙÚÂÈ˜ÌÔÚÊ¤˜ oxLDL ÌÂ ÂÓÂÚÁfi ÙËÓ ÂÓ-‰ÔÁÂÓ‹ Lp-PLA2, Ë oxLDLL (ÛÙÔÙ¤ÏÔ˜ ÙË˜ Ï·Óı¿ÓÔ˘Û·˜ Ê¿ÛË˜),Ë oxLDLP (ÛÙÔ Ù¤ÏÔ˜ ÙË˜ ÂÎıÂÙÈ-Î‹˜ Ê¿ÛË˜) Î·È Ë oxLDLD (ÛÙÔÙ¤ÏÔ˜ ÙË˜ Ê¿ÛË˜ ·ÔÈÎÔ‰fiÌË-ÛË˜). √È ›‰ÈÂ˜ ÌÔÚÊ¤˜ ·Ú·-

∂ÈÎfiÓ· 1. ™ÈÁÌÔÂÈ‰Â›˜ Î·Ì‡ÏÂ˜ ÔÍÂ›‰ˆÛË˜ ÙË˜ LDL ÌÂ ‹ ¯ˆÚ›˜ ·ÂÓÂÚÁÔÔÈËÌ¤ÓË ÙËÓ PAF-AH Î·È ÛËÌÂ›· ·ÔÌfiÓˆÛË˜ ÙˆÓ·ÓÙÈÁfiÓˆÓ oxLDL Î·È oxLDL(-) (‰Â˜ ÎÂ›ÌÂÓÔ)

∞ÔÚ

ÚfiÊ

ËÛË,

234

nm

XÚfiÓÔ˜ (ÏÂÙ¿)

25

¶ƒ√∫§π¡π∫∏ ∂ƒ∂À¡∞

ÛÎÂ˘¿ÛıËÎ·Ó ÌÂÙ¿ ·fi ÚÔË-ÁÔ‡ÌÂÓË ·ÂÓÂÚÁÔÔ›ËÛË ÙË˜Lp-PLA2 [oxLDL(-)], Ë oxLDL(-)L(ÛÙÔ Ù¤ÏÔ˜ ÙË˜ Ï·Óı¿ÓÔ˘Û·˜Ê¿ÛË˜), Ë oxLDL(-)P (ÛÙÔ Ù¤ÏÔ˜ÙË˜ ÂÎıÂÙÈÎ‹˜ Ê¿ÛË˜) Î·È ËoxLDL(-)D (ÛÙÔ Ù¤ÏÔ˜ ÙË˜ Ê¿-ÛË˜ ·ÔÈÎÔ‰fiÌËÛË˜), (∂ÈÎfiÓ·1). ∂›ÛË˜ ·Ú·ÛÎÂ˘¿ÛÙËÎÂ ËLDL ÙÚÔÔÔÈËÌ¤ÓË ÌÂ MDA(MDA-LDL). Δ· ·˘ÙÔ·ÓÙÈÛÒÌ·Ù·¤Ó·ÓÙÈ Ê˘ÛÈÎ‹˜ LDL (natLDL),fiÏˆÓ ÙˆÓ ÌÔÚÊÒÓ oxLDL Î·ÈMDA-LDL ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó ÌÂÌ¤ıÔ‰Ô ELISA. Δ· ·ÔÙÂÏ¤ÛÌ·-Ù· ÂÎÊÚ¿ÛÙËÎ·Ó ˆ˜ Ô ÏfiÁÔ˜ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ oxLDL/natLDL (17-19).

Δ· Â›Â‰· ÔxLDL ÛÙÔÓ ÔÚfiÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó ÌÂ ELISA ÌÂ ÙË¯Ú‹ÛË ÂÌÔÚÈÎÔ‡ kit (Merco-dia® Oxidized LDL ELISA, Me-rcodia AB). Δ· ·ÔÙÂÏ¤ÛÌ·Ù·ÂÎÊÚ¿ÛÙËÎ·Ó ÛÂ U/l.

∏ ÂÓÂÚÁfiÙËÙ· ÙË˜ Lp-PLA2

ÙÔ˘ ÔÚÔ‡ ÚÔÛ‰ÈÔÚ›ÛÙËÎÂ ÌÂ ÙËÌ¤ıÔ‰Ô È˙ËÌ·ÙÔÔ›ËÛË˜ ÌÂ ÙÚÈ-¯ÏˆÚÔÍÂÈÎfi ÔÍ‡ (TCA), fiˆ˜¤¯ÂÈ ÚÔËÁÔ‡ÌÂÓ· ÂÚÈÁÚ·ÊÂ›(4).

√È ÏÈÈ‰·ÈÌÈÎ¤˜ ·Ú¿ÌÂÙÚÔÈ,Ù· Â›Â‰· ÙˆÓ ·ÔÏÈÔÚˆÙÂ˚-ÓˆÓ Î·È Ù· Â›Â‰· ÙË˜ ˘„ËÏ‹˜Â˘·ÈÛıËÛ›·˜ CRP ÚÔÛ‰ÈÔÚ›ÛÙË-

Î·Ó fiˆ˜ ¤¯Ô˘ÌÂ ÂÚÈÁÚ¿„ÂÈ ÛÂÚÔËÁÔ‡ÌÂÓË ÌÂÏ¤ÙË (16).

™Ù·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË

√È Û˘ÓÂ¯Â›˜ ÌÂÙ·‚ÏËÙ¤˜ ÂÎÊÚ¿-ÛÙËÎ·Ó ˆ˜ Ì¤ÛÔÈ fiÚÔÈ ± Ù˘ÈÎ‹·fiÎÏÈÛË (mean ± standard de-viation), ÂÓÒ ÔÈ ‰È·ÎÚÈÙ¤˜ ÌÂÙ·-‚ÏËÙ¤˜ ÂÎÊÚ¿ÛÙËÎ·Ó ˆ˜ ·fiÏ˘-ÙÔÈ ·ÚÈıÌÔ›. √È Ù›ÙÏÔÈ ·˘ÙÔ·ÓÙÈ-ÛˆÌ¿ÙˆÓ ÂÎÊÚ¿ÛÙËÎ·Ó ˆ˜ Ì¤-ÛÔÈ fiÚÔÈ ± Ù˘ÈÎ‹ ·fiÎÏÈÛË.

°È· ÙË Û‡ÁÎÚÈÛË ÙˆÓ ‰È·Êfi-ÚˆÓ ÌÂÙ·‚ÏËÙÒÓ ÌÂÙ·Í‡ ÙˆÓ‰‡Ô ÔÌ¿‰ˆÓ Î·Ù¿ ÙË ÛÙÈÁÌ‹ ÚÈÓÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜ Ú·Á-Ì·ÙÔÔÈ‹ıËÎÂ Student's t-test(ÁÈ· ÙÈ˜ Û˘ÓÂ¯Â›˜ ÌÂÙ·‚ÏËÙ¤˜)Î·È x2-test (ÁÈ· ÙÈ˜ ‰È·ÎÚÈÙ¤˜ ÌÂ-Ù·‚ÏËÙ¤˜).

∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÂÚÈfi-‰Ô˘ ·Ú·ÎÔÏÔ‡ıËÛË˜ ÁÈ· Î¿ıÂÔÌ¿‰· ·ÛıÂÓÒÓ ¯ˆÚÈÛÙ¿, ‰È·ÊÔ-Ú¤˜ ÛÙÈ˜ ÙÈÌ¤˜ ÙˆÓ ÌÂÙ·‚ÏËÙÒÓÛÂ Î¿ıÂ ¯ÚÔÓÈÎ‹ ÛÙÈÁÌ‹ ÂÎÙÈÌ‹-ıËÎ·Ó ÌÂ ÙË ‚Ô‹ıÂÈ· ÙË˜ ·Ó¿Ï˘-ÛË˜ ÙË˜ ‰È·Î‡Ì·ÓÛË˜ ÁÈ· Â·Ó·-Ï·Ì‚·ÓfiÌÂÓÂ˜ ÌÂÙÚ‹ÛÂÈ˜ (repe-ated measures analysis of varia-nces - ANOVA). °È· ÙËÓ ÂÎÙ›ÌËÛËÙ˘¯fiÓ ‰È·ÊÔÚÒÓ ÛÙÈ˜ ÌÂÙ·‚ÔÏ¤˜ÙˆÓ ‰È·ÊfiÚˆÓ ·Ú·Ì¤ÙÚˆÓ ÛÂÎ¿ıÂ ¯ÚÔÓÈÎ‹ ÛÙÈÁÌ‹ ÌÂÙ·Í‡ ÙˆÓ

‰‡Ô ÔÌ¿‰ˆÓ ·ÛıÂÓÒÓ ÙË˜ ÌÂÏ¤-ÙË˜ Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ ·Ó¿Ï˘ÛËÛ˘ÌÌÂÙ·‚ÏËÙ‹˜ (analysis of co-variance, ANCOVA), Ï·Ì‚¿ÓÔ-ÓÙ·˜ ˆ˜ Û˘ÌÌÂÙ·‚ÏËÙ‹ ÙÈ˜ ÙÈÌ¤˜Î¿ıÂ ÌÂÙ·‚ÏËÙ‹˜ ÚÈÓ ÙËÓ ¤Ó·Ú-ÍË ÙË˜ ıÂÚ·Â›·˜, ÒÛÙÂ Ó· Á›ÓÂÈ‰ÈfiÚıˆÛË ˆ˜ ÚÔ˜ ·˘Ù¤˜.

∏ ÛÙ·ÙÈÛÙÈÎ‹ ÂÂÍÂÚÁ·Û›· ¤ÁÈ-ÓÂ ÌÂ ÙËÓ ‚Ô‹ıÂÈ· ÙÔ˘ ÛÙ·ÙÈÛÙÈ-ÎÔ‡ ÏÔÁÈÛÌÈÎÔ‡ ®SPSS 11.0 sof-tware (SPSS INC., Chicago, III).™Â Î¿ıÂ ÂÚ›ÙˆÛË p-value <0,05ıÂˆÚ‹ıËÎÂ ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈ-Îfi.

∞ÔÙÂÏ¤ÛÌ·Ù·

∫ÏÈÓÈÎ¿ Î·È ‚ÈÔ¯ËÌÈÎ¿¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙÔ˘ÏËı˘ÛÌÔ‡ ÙË˜ ÌÂÏ¤ÙË˜

Δ· ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙÔ˘ ÏËı˘-ÛÌÔ‡ ÙË˜ ÌÂÏ¤ÙË˜ Ê·›ÓÔÓÙ·ÈÛÙÔÓ ¶›Ó·Î· 1. ¢ÂÓ ·Ú·ÙËÚ‹-ıËÎ·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¤˜‰È·ÊÔÚ¤˜ ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô ÔÌ¿-‰ˆÓ ·ÛıÂÓÒÓ ÙË˜ ÌÂÏ¤ÙË˜, fiÛÔÓ·ÊÔÚ¿ ÙËÓ ËÏÈÎ›·, ÙÔ Ê‡ÏÔ, ÙÔÓ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜ Î·È ÙËÓÂ›ÙˆÛË ÙË˜ ·ÚÙËÚÈ·Î‹˜ ˘¤Ú-Ù·ÛË˜, ÙÔ˘ Î·Ó›ÛÌ·ÙÔ˜ Î·È ÙÔ˘ÎÏËÚÔÓÔÌÈÎÔ‡ ÈÛÙÔÚÈÎÔ‡ ÚÒÈ-

√Ì¿‰· ·ÛıÂÓÒÓ √Ì¿‰· ·ÛıÂÓÒÓ Ô˘Ô˘ Ï¿Ì‚·Ó·Ó ‰ÂÓ Ï¿Ì‚·Ó·Ó p-value

·ÙÔÚ‚·ÛÙ·Ù›ÓË (n=34) ·ÙÔÚ‚·ÛÙ·Ù›ÓË (n=21)

∏ÏÈÎ›· (¤ÙË) 58,2±8,97 60,1±9,22 0,453ÕÓ‰ÚÂ˜/°˘Ó·›ÎÂ˜ 30/4 19/2 0,285

¶·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÛÙÂÊ·ÓÈ·›· ÓfiÛÔÀ¤ÚÙ·ÛË (n,%) 11 (32,3%) 7 (33,3%) 0,584∂ÓÂÚÁÔ› Î·ÓÈÛÙ¤˜ (n,%) 26 (76,4%) 14 (66,7%) 0,252∫ÏËÚÔÓÔÌÈÎfi ÈÛÙÔÚÈÎfi (n,%) 6 (17,6%) 6 (28,5%) 0,266BMI (kg/m2) 26,9±2,37 27,8±2,24 0,218

§ÈÈ‰·ÈÌÈÎfi ÚÔÊ›Ï √ÏÈÎ‹ ¯ÔÏËÛÙÂÚfiÏË(mg/dl) 248,5±52,7 212,2±42,2 0,007LDL ¯ÔÏËÛÙÂÚfiÏË (mg/dl) 165,5±49,4 134,9±28,8 0,013HDL ¯ÔÏËÛÙÂÚfiÏË (mg/dl) 49,2±8,7 45,8±11,0 0,240ΔÚÈÁÏ˘ÎÂÚ›‰È·(mg/dl) 193,1±122,9 158,8±97,9 0,259∞po A-I (mg/dl) 133,6±23,7 128,6±22,7 0,474∞po B (mg/dl) 119,5±28,1 101,4±31,2 0,005∞ÔÏÈÔÚˆÙÂ˝ÓË E (mg/dl) 44,3±21,9 37,4±28,6 0,387LDL / ApoB 1,36±0,27 1,4±0,37 0,534Lp(a) (mg/dl) 9,9±8,5 8,6±4,5 0,462

CRP (mg/l) 2,11±1,48 2,73±1,18 0,274

¶›Ó·Î·˜ 1 Ã·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙÔ˘ ÏËı˘ÛÌÔ‡ ÙË˜ ÌÂÏ¤ÙË˜

ÌË˜ Î·Ú‰È·ÁÁÂÈ·Î‹˜ ÓfiÛÔ˘.ŸÏÔÈ ÔÈ ·ÛıÂÓÂ›˜ ÙË˜ ÌÂÏ¤ÙË˜‹Ù·Ó ÂÏÂ‡ıÂÚÔÈ ÌÂÈ˙fiÓˆÓ Î·Ú-‰È·ÁÁÂÈ·ÎÒÓ ÂÂÈÛÔ‰›ˆÓ Î·ı'fiÏË ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÂÍ¿ÌËÓË˜ÂÚÈfi‰Ô˘ ·Ú·ÎÔÏÔ‡ıËÛË˜.

√È ·ÛıÂÓÂ›˜ Ô˘ Ï¿Ì‚·Ó·Ó·ÙÔÚ‚·ÛÙ·Ù›ÓË ÛÂ Û‡ÁÎÚÈÛË ÌÂ·˘ÙÔ‡˜ Ô˘ ‰ÂÓ Ï¿Ì‚·Ó·Ó, ÂÌ-Ê¿ÓÈ˙·Ó Î·Ù¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ·-Ú·ÎÔÏÔ‡ıËÛË˜, ˘„ËÏfiÙÂÚ· Â›-Â‰· ÔÏÈÎ‹˜ ¯ÔÏËÛÙÂÚfiÏË˜, LDL¯ÔÏËÛÙÂÚfiÏË˜ Î·È apo μ (¶›Ó·-Î·˜ 1). ∞ÓÙ›ıÂÙ·, ‰ÂÓ ·Ú·ÙËÚ‹-ıËÎ·Ó ÛËÌ·ÓÙÈÎ¤˜ ‰È·ÊÔÚ¤˜ ÌÂ-Ù·Í‡ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ·ÛıÂÓÒÓÙË˜ ÌÂÏ¤ÙË˜ fiÛÔÓ ·ÊÔÚ¿ ÙÈ˜˘fiÏÔÈÂ˜ ÏÈÈ‰·ÈÌÈÎ¤˜ ·Ú·Ì¤-ÙÚÔ˘˜ Î·È Ù· Â›Â‰· CRP ÔÚÔ‡(¶›Ó·Î·˜ 1).

∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÂÚÈfi-‰Ô˘ ·Ú·ÎÔÏÔ‡ıËÛË˜ ·Ú·ÙË-Ú‹ıËÎÂ, fiˆ˜ ·Ó·ÌÂÓfiÙ·Ó, ÛÙ·-ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ÌÂ›ˆÛË ÙˆÓ ÏÈ-È‰·ÈÌÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ ÛÙËÓÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ Ô˘ Ï¿Ì‚·-Ó·Ó ·ÙÔÚ‚·ÛÙ·Ù›ÓË (¶›Ó·Î·˜ 2).∏ ÛËÌ·ÓÙÈÎ‹ ·˘Ù‹ ÌÂ›ˆÛË ·ÊÔ-ÚÔ‡ÛÂ Ù· Â›Â‰· ÔÚÔ‡ ÙË˜ ÔÏÈ-Î‹˜, LDL Î·È HDL ¯ÔÏËÛÙÂÚfiÏË˜,Î·ıÒ˜ Â›ÛË˜ Î·È ·˘Ù¿ ÙˆÓ ∞poA-I, ∞po B Î·È ∞po E. √È ‰È·ÊÔ-Ú¤˜ ·˘Ù¤˜ ·Ú·ÙËÚ‹ıËÎ·Ó ·fiÙÔÓ ÚÒÙÔ Ì‹Ó· Î·È ‰È·ÙËÚ‹ıË-Î·Ó Î·ı' fiÏË ÙË ‰È¿ÚÎÂÈ· ÙË˜ Â-

ÚÈfi‰Ô˘ ·Ú·ÎÔÏÔ‡ıËÛË˜ ¶›Ó·-Î·˜ 2). ∞ÓÙ›ıÂÙ· ‰ÂÓ ·Ú·ÙËÚ‹-ıËÎ·Ó ÛËÌ·ÓÙÈÎ¤˜ ÌÂÙ·‚ÔÏ¤˜ÛÙ· Â›Â‰· ÙˆÓ ÏÈÈ‰·ÈÌÈÎÒÓ·Ú·Ì¤ÙÚˆÓ ÛÙËÓ ÔÌ¿‰· ÙˆÓ·ÛıÂÓÒÓ Ô˘ ‰ÂÓ Ï¿Ì‚·Ó·Ó·ÙÔÚ‚·ÛÙ·Ù›ÓË. (¶›Ó·Î·˜ 2).

∂›Â‰· ÔÍÂÈ‰ˆÌ¤ÓË˜LDL ÔÚÔ‡

™ÙË Ì¤ÙÚËÛË Î·Ù¿ ÙËÓ ¤Ó·ÚÍËÙË˜ ·Ú·ÎÔÏÔ‡ıËÛË˜, ÔÈ ·ÛıÂ-ÓÂ›˜ Ô˘ Ï¿Ì‚·Ó·Ó ·ÙÔÚ‚·ÛÙ·Ù›-ÓË ÛÂ Û‡ÁÎÚÈÛË ÌÂ ·˘ÙÔ‡˜ Ô˘‰ÂÓ Ï¿Ì‚·Ó·Ó, ÂÌÊ¿ÓÈ˙·Ó ˘„ËÏfi-ÙÂÚ· Â›Â‰· oxLDL ÔÚÔ‡(41,7±10,1 U/l ¤Ó·ÓÙÈ 32,8±7,3U/l ·ÓÙ›ÛÙÔÈ¯·, p=0,02), ÁÂÁÔÓfi˜Ô˘ Ê·›ÓÂÙ·È Ó· ÔÊÂ›ÏÂÙ·È ÛÙ·˘„ËÏfiÙÂÚ· Â›Â‰· ÔÏÈÎ‹˜ ¯Ô-ÏËÛÙÂÚfiÏË˜ Ô˘ ÔÈ ·ÛıÂÓÂ›˜ ·˘-ÙÔ› ·ÚÔ˘Û›·˙·Ó, Î·ıÒ˜ ‚Ú¤ıË-ÎÂ ÈÛ¯˘Ú‹ Û˘Û¯¤ÙÈÛË ÙˆÓ ÂÈ¤-‰ˆÓ ÙË˜ oxLDL ÌfiÓÔ ÌÂ Ù· Â›Â-‰· ÙË˜ ÔÏÈÎ‹˜ ¯ÔÏËÛÙÂÚfiÏË˜ÔÚÔ‡ ÙfiÛÔ Î·Ù¿ ÙË ¯ÚÔÓÈÎ‹ ÛÙÈÁ-Ì‹ ÙË˜ ¤Ó·ÚÍË˜ (r=0,584,p=0,002) fiÛÔ Î·È ÛÙÔÓ ÚÒÙÔ,ÙÚ›ÙÔ Î·È ¤ÎÙÔ Ì‹Ó· ·Ú·ÎÔÏÔ‡-ıËÛË˜ (r=0,430, p=0,036 -r=0,505, p=0,012 Î·È r=0,512,p=0,021 ·ÓÙ›ÛÙÔÈ¯·).

∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÂÚÈfi-‰Ô˘ ·Ú·ÎÔÏÔ‡ıËÛË˜ ÛÙÔ˘˜

·ÛıÂÓÂ›˜ Ô˘ ‰ÂÓ Ï¿Ì‚·Ó·Ó·ÙÔÚ‚·ÛÙ·Ù›ÓË, ·Ú·ÙËÚ‹ıËÎÂÛÙ·‰È·Î‹ ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓÙË˜ oxLDL ÔÚÔ‡ ÛÂ Û‡ÁÎÚÈÛË ÌÂÙËÓ ÙÈÌ‹ Î·Ù¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ·-Ú·ÎÔÏÔ‡ıËÛË˜, ÙfiÛÔ ÛÙÔÓ 1ÔÌ‹Ó· (35,4±12 U/l ·‡ÍËÛË+8,2%±4,1%, p=0,03), fiÛÔ Î·ÈÛÙÔÓ 3Ô Ì‹Ó· (41,4±16,8 U/l, ·‡-ÍËÛË +27,4%±6,8%, p=0,01) ‹ÙÔÓ 6Ô Ì‹Ó· ·Ú·ÎÔÏÔ‡ıËÛË˜(44,2±17,2 U/l, ·‡ÍËÛË +34,7%±8,3% p=0,01) (∂ÈÎfiÓ· 2). ∞ÓÙ›-ıÂÙ·, ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ Ô˘ Ï¿Ì-‚·Ó·Ó ·ÙÔÚ‚·ÛÙ·Ù›ÓË ·Ú·ÙË-Ú‹ıËÎÂ ÚÔÔ‰Â˘ÙÈÎ‹ ÌÂ›ˆÛË ÙˆÓÂÈ¤‰ˆÓ ·˘ÙÒÓ, ·fi ÙËÓ ¤Ó·ÚÍËÙË˜ ·Ú·ÎÔÏÔ‡ıËÛË˜, ÛÙÔÓ 1ÔÌ‹Ó· (35,2±12,7 U/l, ÌÂ›ˆÛË -15,3%±7,2%, p=0,04), ÛÙÔÓ 3ÔÌ‹Ó· (31±12 U/l, ÌÂ›ˆÛË -25,6%±8,7%, p=0,04) ¤ˆ˜ Î·ÈÛÙÔÓ 6Ô Ì‹Ó· ·Ú·ÎÔÏÔ‡ıËÛË˜(29,2±11,7 U/l, ÌÂ›ˆÛË -30%±6,7%, p=0,03) (∂ÈÎfiÓ· 2).

Ÿˆ˜ ÚÔ¤Î˘„Â ·fi ÙËÓ·Ó¿Ï˘ÛË ANCOVA, ÌÂÙ·Í‡ ÙˆÓ‰‡Ô ÔÌ¿‰ˆÓ ÙË˜ ÌÂÏ¤ÙË˜, ÔÈ ÌÂ-Ù·‚ÔÏ¤˜ ÛÙ· Â›Â‰· ÙË˜ oxLDLÙÔ˘ ÔÚÔ‡ ‰È¤ÊÂÚ·Ó ÛÙ·ÙÈÛÙÈÎ¿ÛËÌ·ÓÙÈÎ¿ ÛÂ Î¿ıÂ ¯ÚÔÓÈÎ‹ ÛÙÈÁ-Ì‹, ‹ÙÔÈ ÛÙÔÓ 1Ô Ì‹Ó· (-15,3%±7,2%, ¤Ó·ÓÙÈ +8,2%±4,1%, ÁÈ·ÙÔ˘˜ ·ÛıÂÓÂ›˜ Ô˘ Ï¿Ì‚·Ó·Ó Î·È·˘ÙÔ‡˜ Ô˘ ‰ÂÓ Ï¿Ì‚·Ó·Ó ·ÙÔÚ-

™ ∂ ¶ Δ ∂ ª μ ƒ π √ ™ 2 0 0 8

26

√Ì¿‰· ·ÛıÂÓÒÓ Ô˘ Ï¿Ì‚·Ó·Ó ·ÙÔÚ‚·ÛÙ·Ù›ÓË √Ì¿‰· ·ÛıÂÓÒÓ Ô˘ ‰ÂÓ Ï¿Ì‚·Ó·Ó ·ÙÔÚ‚·ÛÙ·Ù›ÓË

∫·Ù¿ ÙËÓ ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ∫·Ù¿ ÙËÓ ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ·¤Ó·ÚÍË ÙË˜ ÙË˜ ÂÚÈfi‰Ô˘ ¤Ó·ÚÍË ÙË˜ ÙË˜ ÂÚÈfi‰Ô˘

·Ú·ÎÔÏÔ‡ıËÛË˜ ·Ú·ÎÔÏÔ‡ıËÛË˜ ·Ú·ÎÔÏÔ‡ıËÛË˜ ·Ú·ÎÔÏÔ‡ıËÛË˜

1 Ì‹Ó·˜ 3 Ì‹ÓÂ˜ 6 Ì‹ÓÂ˜ 1 Ì‹Ó·˜ 3 Ì‹ÓÂ˜ 6 Ì‹ÓÂ˜

TCHL (mg/dl) 248,5±52,7 169,5±55 * 158,4±32,4 * 188,5±42,3 * 212,2±42,2 201,3±29,3 227,0±31,1 220,9±52,3

LDL-C (mg/dl) 165,5±49,4 100,0±40 * 90,4±27,4 * 110,1±30,9 * 134,9±28,8 121,6±32,7 138,7±22,5 134,6±43,3

HDL-C (mg/dl) 49,2±8,7 38,6±8,6 * 39,8±7,6 * 42,3±7,7 * 45,8±11,0 42,6±7,8 38,7±8,7 53,7±16,5

TRG (mg/dl) 193,1±122,9 154,8±73,8 129,0±39,3 130,4±49 158,8±97,9 185,2±90,4 221,1±131 162,5±106,9

Apo A (mg/dl) 133,6±23,7 127,5±21,1 ^ 128,9±21,7 ^ 130,1±23,7 ^ 128,6±22,7 135,5±18,3 140,1±23,1 141,2±23,2

Apo B (mg/dl) 119,5±28,1 90,4±43,2 * 76,48±24,15 * 92,5±28,3 * 101,4±31,2 93,6±24,7 97,9±35,2 98,4±33,2

Apo E (mg/dl) 44,3±21,9 29,8±13 * 26,6±10,6 * 32,7±14,1 * 37,4±28,6 33,4±12,2 46,0±39,0 44,1±38,4

LDL / ∞poB 1,36±0,27 1,14±0,29 1,25±0,27 1,19±0,29 1,40±0,37 1,39±0,82 1,75±1,58 1,36±1,2

Lp(a) (mg/dl) 9,9±8,5 9,4±9,1 9,5±8,7 9,5±9,2 8,6±4,5 8,5±4,8 8,1±4,4 8,4±4,3

CRP (mg/L) 2,11±1,48 0,90±0,58 $ 0,91±0,60 $ 0,93±0,64 $ 2,73±1,18 1,49±0,79 ∧ 1,62±0,77 ∧ 1,64±0,85 ∧

¶›Ó·Î·˜ 2 ªÂÙ·‚ÔÏ¤˜ ÙˆÓ ÏÈÈ‰·ÈÌÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ Î·È ÙË˜ CRP Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÂÚÈfi‰Ô˘·Ú·ÎÔÏÔ‡ıËÛË˜.

TCHL: ÔÏÈÎ‹ ¯ÔÏËÛÙÂÚfiÏË, LDL-C: LDL ¯ÔÏËÛÙÂÚfiÏË, HDL-C: HDL ¯ÔÏËÛÙÂÚfiÏË Î·È TRG: ÙÚÈÁÏ˘ÎÂÚ›‰È·.*p=0,0001, #p=0,01,$p=0,02, ∧p=0,04, ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÙÈÌ‹ Î·Ù¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ·Ú·ÎÔÏÔ‡ıËÛË˜

¶ƒ√∫§π¡π∫∏ ∂ƒ∂À¡∞

27

‚·ÛÙ·Ù›ÓË ·ÓÙ›ÛÙÔÈ¯·, p=0,01),ÛÙÔÓ 3Ô Ì‹Ó· (-25,6±8,7% ¤Ó·ÓÙÈ+27,4±6,8%, ÁÈ· ÙÔ˘ ̃·ÛıÂÓÂ›̃ Ô˘Ï¿Ì‚·Ó·Ó Î·È ·˘ÙÔ‡˜ Ô˘ ‰ÂÓÏ¿Ì‚·Ó·Ó ·ÙÔÚ‚·ÛÙ·Ù›ÓË ·ÓÙ›-ÛÙÔÈ¯· p=0,003) Î·È ÛÙÔÓ 6Ô Ì‹Ó··Ú·ÎÔÏÔ‡ıËÛË˜ (-30%±6,7%¤Ó·ÓÙÈ +34,7%±8,3%, ÁÈ· ÙÔ˘˜·ÛıÂÓÂ›˜ Ô˘ Ï¿Ì‚·Ó·Ó Î·È ·˘-ÙÔ‡˜ Ô˘ ‰ÂÓ Ï¿Ì‚·Ó·Ó ·ÙÔÚ‚·-ÛÙ·Ù›ÓË ·ÓÙ›ÛÙÔÈ¯·, p=0,003 -∂ÈÎfiÓ· 2),

Δ›ÙÏÔÈ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ¤Ó·ÓÙÈ ‰È·ÊfiÚˆÓ ÌÔÚÊÒÓoxLDL

™ÙËÓ ÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ Ô˘‰ÂÓ Ï¿Ì‚·Ó·Ó ·ÙÔÚ‚·ÛÙ·Ù›ÓË,·Ú·ÙËÚ‹ıËÎ·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛË-Ì·ÓÙÈÎ¤˜ ·˘Í‹ÛÂÈ˜ ÙÔÓ 1Ô Ì‹Ó··Ú·ÎÔÏÔ‡ıËÛË˜ ÛÂ Û‡ÁÎÚÈÛËÌÂ ÙÈ˜ ·ÓÙ›ÛÙÔÈ¯Â˜ ÙÈÌ¤˜ Î·Ù¿ ÙËÓ¤Ó·ÚÍË ÙË˜ ·Ú·ÎÔÏÔ‡ıËÛË˜,ÛÙ· Â›Â‰· anti-oxLDLL, anti-oxLDLP, anti-oxLDLD, anti-oxLDL(-)P Î·È anti-oxLDL(-)D (¶›-Ó·Î·˜ 3). ™ÙËÓ ›‰È· ÔÌ¿‰· ·ÛıÂ-ÓÒÓ, ÔÈ Ù›ÙÏÔÈ ÙˆÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿-ÙˆÓ ¤Ó·ÓÙÈ ÙˆÓ oxLDLL, oxLDLPÎ·È oxLDLD, ÂÌÊ¿ÓÈÛ·Ó Êı›ÓÔ˘-Û· ÔÚÂ›· ÙfiÛÔ ÛÙÔ˘˜ 3 fiÛÔ Î·ÈÛÙÔ˘˜ 6 Ì‹ÓÂ˜ ·Ú·ÎÔÏÔ‡ıË-ÛË˜, ÌÂ ·ÔÙ¤ÏÂÛÌ· Ó· ÌËÓ ·-Ú·ÙËÚÔ‡ÓÙ·È ÛÙÔ˘˜ Û˘ÁÎÂÎÚÈÌ¤-ÓÔ˘˜ Ì‹ÓÂ˜ ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈ-Î¤˜ ‰È·ÊÔÚ¤˜ ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙÈ˜·ÓÙ›ÛÙÔÈ¯Â˜ ÙÈÌ¤˜ Î·Ù¿ ÙËÓ ¤Ó·Ú-ÍË ÙË˜ ·Ú·ÎÔÏÔ‡ıËÛË˜ (¶›Ó·-

Î·˜ 3, ∂ÈÎfiÓ· 3) ∞ÓÙ›ıÂÙ·, ÔÈ Ù›Ù-ÏÔÈ ÙˆÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈÙˆÓ oxLDL(-)P Î·È oxLDL(-)D ‰ÂÌÂÈÒıËÎ·Ó ÌÂÙ¿ ÙÔÓ ÚÒÙÔ Ì‹Ó··Ú·ÎÔÏÔ‡ıËÛË˜, ·ÏÏ¿ ·Ú¤-ÌÂÈÓ·Ó ÛÙ·ÙÈÛÙÈÎ¿ ˘„ËÏfiÙÂÚÔÈ ÛÂÛ‡ÁÎÚÈÛË ÌÂ ÙÈ˜ ·Ú¯ÈÎ¤˜ ÙÔ˘˜ ÙÈ-Ì¤˜ ÙfiÛÔ ÛÙÔ˘˜ 3 Ì‹ÓÂ˜ fiÛÔ Î·ÈÛÙÔ˘˜ 6 Ì‹ÓÂ˜ ·Ú·ÎÔÏÔ‡ıËÛË˜(¶›Ó·Î·˜ 3).

™Â ·ÓÙ›ıÂÛË ÌÂ Ù· ·Ú·¿Óˆ,ÔÈ Ù›ÙÏÔÈ ÙˆÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ¤Ó·ÓÙÈ oxLDL(-)L ‹Ù·Ó Û˘ÓÂ¯Ò˜·˘Í·ÓfiÌÂÓÔÈ Î·ı' fiÏË ÙË ‰È¿Ú-ÎÂÈ· ÙË˜ ·Ú·ÎÔÏÔ‡ıËÛË˜ (¶›-Ó·Î·˜ 3). ∏ Û˘ÓÂ¯‹˜ ·˘Ù‹ ·‡ÍË-ÛË ‹Ù·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ÛÙÔ˘˜ 3 Î·È ÙÔ˘˜ 6 Ì‹ÓÂ˜, ·ÏÏ¿fi¯È ÛÙÔÓ ÚÒÙÔ Ì‹Ó· ÙË˜ ÂÚÈfi‰Ô˘·Ú·ÎÔÏÔ‡ıËÛË˜ (¶›Ó·Î·˜ 3).

¶Ú¤ÂÈ Ó· ÛËÌÂÈˆıÂ› fiÙÈ ÛÙÔ˘˜·ÛıÂÓÂ›˜ ÔÈ ÔÔ›ÔÈ Ï¿Ì‚·Ó·Ó·ÙÔÚ‚·ÛÙ·Ù›ÓË, ÔÈ Ù›ÙÏÔÈ ÙˆÓ ·˘-ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ fiÏˆÓ ÙˆÓÌÔÚÊÒÓ ÔÍÂÈ‰ˆÌ¤ÓË˜ LDL ·Ú¤-ÌÂÈÓ·Ó ÛÂ Â›Â‰· ·ÚfiÌÔÈ· ÌÂÙ· ·Ú¯ÈÎ¿, Î·ı' fiÏË ÙË ‰È¿ÚÎÂÈ·ÙË˜ ÌÂÏ¤ÙË˜ (¶›Ó·Î·˜ 3).

¢ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ‰È·ÊÔÚ¤˜ÛÙÔ˘˜ Ù›ÙÏÔ˘˜ ÙˆÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿-ÙˆÓ ¤Ó·ÓÙÈ ÙË˜ MDA-LDL ÛÙË‰È¿ÚÎÂÈ· ÙË˜ ÂÚÈfi‰Ô˘ ·Ú·ÎÔ-ÏÔ‡ıËÛË˜ ÛÂ Î·ÌÈ¿ ·fi ÙÈ˜ ÔÌ¿-‰Â˜ ÙË˜ ÌÂÏ¤ÙË˜ (¶›Ó·Î·˜ 3).

√È ·ÛıÂÓÂ›˜ Ô˘ ‰ÂÓ Ï¿Ì‚·-Ó·Ó ·ÙÔÚ‚·ÛÙ·Ù›ÓË, Û˘ÁÎÚÈÓfiÌÂ-ÓÔÈ ÌÂ ·˘ÙÔ‡˜ Ô˘ Ï¿Ì‚·Ó·Ó, ÂÌ-Ê¿ÓÈÛ·Ó ÛÙÔÓ 1Ô Ì‹Ó· ·Ú·ÎÔ-ÏÔ‡ıËÛË˜ ÛÙ·ÙÈÛÙÈÎ¿ ÌÂÁ·Ï‡ÙÂ-ÚÂ˜ % ÌÂÙ·‚ÔÏ¤˜ ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ

·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ oxLDLL(24,8±30,6% ¤Ó·ÓÙÈ 3±25% ·ÓÙ›-ÛÙÔÈ¯·, p=0,012), oxLDLP (21,2±17% ¤Ó·ÓÙÈ 8,8±30% ·ÓÙ›ÛÙÔÈ-¯·, p=0,012), Î·È oxLDLD (34,9±47,5% ¤Ó·ÓÙÈ 4,5±28,2% ·ÓÙ›-ÛÙÔÈ¯·, p=0,035). √È ·Ú·¿ÓˆÌÂÙ·‚ÔÏ¤˜ ‰ÂÓ ‹Ù·Ó Ï¤ÔÓ ÛÙ·-ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¤˜ ÛÙÔÓ 3Ô Î·È6Ô Ì‹Ó· ·Ú·ÎÔÏÔ‡ıËÛË˜ fiˆ˜ÚÔ¤Î˘„Â ·fi ÙËÓ ·Ó¿Ï˘ÛËANCOVA Î·È ÌÂÙ¿ ÙË Î·Ù¿ÏÏËÏË‰ÈfiÚıˆÛË ˆ˜ ÚÔ˜ ÙÈ˜ ÙÈÌ¤˜ Î·-Ù¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ·Ú·ÎÔÏÔ‡-ıËÛË˜ (∂ÈÎfiÓ· 3).

ŸÛÔÓ ·ÊÔÚ¿ ÙÔ˘˜ Ù›ÙÏÔ˘˜ÙˆÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈÙˆÓ ‰È·ÊfiÚˆÓ ÌÔÚÊÒÓ oxLDL(-),ÔÈ ·ÛıÂÓÂ›˜ Ô˘ ‰ÂÓ Ï¿Ì‚·Ó·Ó·ÙÔÚ‚·ÛÙ·Ù›ÓË, Û˘ÁÎÚÈÓfiÌÂÓÔÈ,ÌÂ ·˘ÙÔ‡˜ Ô˘ Ï¿Ì‚·Ó·Ó, ÂÌÊ¿-ÓÈÛ·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÌÂÁ·Ï‡ÙÂÚÂ˜ %ÌÂÙ·‚ÔÏ¤˜ ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ ·˘ÙÔ-·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙË˜ oxLDL(-)P (26,8±55.2% ¤Ó·ÓÙÈ 2±28,6%·ÓÙ›ÛÙÔÈ¯·, p=0,012) Î·È oxLDL(-)D(31,1±41,5% ¤Ó·ÓÙÈ 2,72± 23,4%·ÓÙ›ÛÙÔÈ¯·, p=0,022) ÛÙÔÓ 1ÔÌ‹Ó· ·Ú·ÎÔÏÔ‡ıËÛË˜. √È ‰È·-ÊÔÚ¤˜ ·˘Ù¤˜ ·Ú¤ÌÂÈÓ·Ó ÛÙ·ÙÈ-ÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¤˜ ÁÈ· ÙÔ˘˜ ·ÛıÂ-ÓÂ›˜ Ô˘ ‰ÂÓ Ï¿Ì‚·Ó·Ó ·ÙÔÚ‚·-ÛÙ·Ù›ÓË ÙfiÛÔ ÛÙÔÓ 3Ô Ì‹Ó·(oxLDL(-)P: 21,8 ±26,9% ¤Ó·ÓÙÈ0,9± 25,4% ·ÓÙ›ÛÙÔÈ¯·, p=0,031,oxLDL(-)D: 24,5±34,1% ¤Ó·ÓÙÈ7,8±27,4% ·ÓÙ›ÛÙÔÈ¯·, p=0,02)fiÛÔ Î·È ÛÙÔÓ 6Ô Ì‹Ó· ·Ú·ÎÔÏÔ‡-ıËÛË˜ (oxLDL(-)P: 24,6±27,9%¤Ó·ÓÙÈ 8,1±32,1% ·ÓÙ›ÛÙÔÈ¯·,

√Ì¿‰· ·ÛıÂÓÒÓ Ô˘ Ï¿Ì‚·Ó·Ó ·ÙÔÚ‚·ÛÙ·Ù›ÓË √Ì¿‰· ·ÛıÂÓÒÓ Ô˘ ‰ÂÓ Ï¿Ì‚·Ó·Ó ·ÙÔÚ‚·ÛÙ·Ù›ÓË

∫·Ù¿ ÙËÓ ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ∫·Ù¿ ÙËÓ ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ·¤Ó·ÚÍË ÙË˜ ÙË˜ ÂÚÈfi‰Ô˘ ¤Ó·ÚÍË ÙË˜ ÙË˜ ÂÚÈfi‰Ô˘

·Ú·ÎÔÏÔ‡ıËÛË˜ ·Ú·ÎÔÏÔ‡ıËÛË˜ ·Ú·ÎÔÏÔ‡ıËÛË˜ ·Ú·ÎÔÏÔ‡ıËÛË˜

1 Ì‹Ó·˜ 3 Ì‹ÓÂ˜ 6 Ì‹ÓÂ˜ 1 Ì‹Ó·˜ 3 Ì‹ÓÂ˜ 6 Ì‹ÓÂ˜

Anti- oxLDLL 0,986±0,179 0,982±0,194 1,041±0,216 1,019±0,110 0,893±0,163 1,066±0,276* 0,968±0,223 0,925±0,278

Anti- oxLDLP 1,089±0,226 1,137±0,247 1,073±0,181 1,110±0,158 0,962±0,186 1,127±0,274* 1,032±0,218 1,001±0,316

Anti- oxLDLD 1,222±0,380 1,232±0,351 1,187±0,261 1,169±0,298 0,994±0,284 1,224±0,481** 1,103±0,293 1,068±0,455

Anti- oxLDL(-)L 1,047±0,154 1,023±0,179 1,066±0,185 1,026±0,168 0,953±0,208 1,055±0,213 1,122±0,210# 1,178±0,175*

Anti- oxLDL(-)P 1,205±0,278 1,213±0,289 1,210±0,276 1,202±0,287 1,033±0,250 1,246±0,440* 1,236±0,268* 1,158±0,413$

Anti- oxLDL(-)D 1,307±0,319 1,376±0,372 1,243±0,309 1,312±0,398 1,220±0,382 1,434±0,431# 1,452±0,309# 1,379±0,244$

Anti-MDA-LDL 1,274±0,211 1,214±0,189 1,292±0,206 1,299±0,201 1,208±0,155 1,197±0,158 1,197±0,139 1,182±0,121

¶›Ó·Î·˜ 3 Δ›ÙÏÔÈ ÙˆÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ‰È·ÊfiÚˆÓ ÌÔÚÊÒÓ LDL Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÂÚÈfi‰Ô˘ ·Ú·ÎÔÏÔ‡ıËÛË˜ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÙË˜ ÌÂÏ¤ÙË˜

*p=0,01, #p=0,02, **p=0,03, $p=0,04 ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÙÈÌ‹ Î·Ù¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ·Ú·ÎÔÏÔ‡ıËÛË˜

™ ∂ ¶ Δ ∂ ª μ ƒ π √ ™ 2 0 0 8

28

p=0,04, oxLDL(-)D: 25,7± 40,3%¤Ó·ÓÙÈ 8,5± 27,3% ·ÓÙ›ÛÙÔÈ¯·,p=0,04 - ∂ÈÎfiÓ· 3). ∂ÈÚfiÛıÂ-Ù·, ÔÈ ·ÛıÂÓÂ›˜ Ô˘ ‰ÂÓ Ï¿Ì‚·-Ó·Ó ·ÙÔÚ‚·ÛÙ·Ù›ÓË, ÛÂ Û‡ÁÎÚÈÛËÌÂ ·˘ÙÔ‡˜ Ô˘ Ï¿Ì‚·Ó·Ó, ÂÌÊ¿-ÓÈÛ·Ó ÛÙ·ÙÈÛÙÈÎ¿ ˘„ËÏfiÙÂÚÂ˜ %ÌÂÙ·‚ÔÏ¤˜ ÙÔ˘ Ù›ÙÏÔ˘ ÙˆÓ ·˘ÙÔ·-ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙË˜ oxLDL(-)L,ÛÙÔÓ 3Ô Ì‹Ó· (15,5±21,4% ¤Ó·-ÓÙÈ 1,65±18% ·ÓÙ›ÛÙÔÈ¯·, p=0,05)Î·È ÛÙÔÓ 6Ô Ì‹Ó· (28±43,2%¤Ó·ÓÙÈ 1,7±23,9% ·ÓÙ›ÛÙÔÈ¯·,p=0,01), ·ÏÏ¿ fi¯È ÛÙÔÓ 1Ô Ì‹Ó··Ú·ÎÔÏÔ‡ıËÛË˜ (8±45,6% ¤Ó·-ÓÙÈ 0,13±23,7% ·ÓÙ›ÛÙÔÈ̄ ·, p=0,152- ∂ÈÎfiÓ· 3).

√ ÚfiÏÔ˜ ÙË˜ Lp-PLA2

√È ÌÔÚÊ¤˜ oxLDL(-) ÔÈ ÔÔ›Â˜¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ˆ˜ ·ÓÙÈÁfiÓ·,·Ú·ÛÎÂ˘¿ÛÙËÎ·Ó ·ÊÔ‡ ÚÒÙ·Â›¯Â ·ÂÓÂÚÁÔÔÈËıÂ› Ë ÂÓ‰ÔÁÂ-Ó‹˜ Lp-PLA2. √È ÌÔÚÊ¤˜ ·˘Ù¤˜Â›Ó·È ÏÔ‡ÛÈÂ˜ ÛÂ oxPL ·ÏÏ¿ fi¯ÈÛÂ lyso-PC (8). ∞ÓÙ›ıÂÙ· ÔÈ ÌÔÚ-Ê¤˜ ÙË˜ oxLDL ÌÂ ÂÓÂÚÁfi ÙËÓLp-PLA2 Â›Ó·È ÏÔ‡ÛÈÂ˜ ÛÂ lyso-PC, Ë ÔÔ›· ·ÔÙÂÏÂ› Î·È ÙÔÚÔ˚fiÓ ÙË˜ Â›‰Ú·ÛË˜ ÙË˜ Lp-PLA2 ÛÙ· oxPL.

Δ· Â›Â‰· ÙË˜ ÂÓÂÚÁfiÙËÙ·˜ÙË˜ Lp-PLA2 ÙÔ˘ ÔÚÔ‡, Î·Ù¿ ÙËÓ¤Ó·ÚÍË ÙË˜ ·Ú·ÎÔÏÔ‡ıËÛË˜,

‰Â ‰È¤ÊÂÚ·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈ-Î¿ ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ÙË˜ÌÂÏ¤ÙË˜. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ÂÚÈfi‰Ô˘ ·Ú·ÎÔÏÔ‡ıËÛË˜, ËÂÓÂÚÁfiÙËÙ· ÙÔ˘ ÂÓ˙‡ÌÔ˘ ‰Â ÌÂ-Ù·‚Ï‹ıËÎÂ ÛËÌ·ÓÙÈÎ¿ ÛÙÔ˘˜ ·ÛıÂ-ÓÂ›˜ Ô˘ ‰ÂÓ Ï¿Ì‚·Ó·Ó ·ÙÔÚ‚·-ÛÙ·Ù›ÓË, (∂ÈÎfiÓ· 4). ∞ÓÙ›ıÂÙ·,ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ Ô˘ Ï¿Ì‚·Ó·Ó·ÙÔÚ‚·ÛÙ·Ù›ÓË, ·Ú·ÙËÚ‹ıËÎÂÛËÌ·ÓÙÈÎ‹ ÌÂ›ˆÛË ÙË˜ ÂÓÂÚÁfiÙË-Ù·˜ ÙÔ˘ ÂÓ˙‡ÌÔ˘ ÙÔÓ ÚÒÙÔ Ì‹-Ó· ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙËÓ ÙÈÌ‹ Î·Ù¿ÙËÓ ¤Ó·ÚÍË ÙË˜ ·Ú·ÎÔÏÔ‡ıË-ÛË˜, (ÌÂ›ˆÛË Î·Ù¿ 23±11,1%,p=0,004). ∏ ÌÂ›ˆÛË ·˘Ù‹ ‰È·ÙË-Ú‹ıËÎÂ ÙÔÓ 3Ô Ì‹Ó· (ÌÂ›ˆÛË Î·-Ù¿ 16±7,4%, p=0,02) Î·È ÙÔÓ 6ÔÌ‹Ó· ·Ú·ÎÔÏÔ‡ıËÛË˜ (ÌÂ›ˆÛËÎ·Ù¿ 18±6,2%, p=0,005), ÌÂ·ÔÙ¤ÏÂÛÌ· ÔÈ % ÌÂÙ·‚ÔÏ¤˜ ÙË˜ÂÓÂÚÁfiÙËÙ·˜ ÙÔ˘ ÂÓ˙‡ÌÔ˘ ÛÙÔ˘˜·ÛıÂÓÂ›˜ Ô˘ Ï¿Ì‚·Ó·Ó ·ÙÔÚ‚·-ÛÙ·Ù›ÓË, ÛÂ Û‡ÁÎÚÈÛË ÌÂ ·˘ÙÔ‡˜Ô˘ ‰ÂÓ Ï¿Ì‚·Ó·Ó, ‰È¤ÊÂÚ·ÓÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¿ ÛÂ Î¿ıÂ¯ÚÔÓÈÎ‹ ÛÙÈÁÌ‹ ÙË˜ ÂÚÈfi‰Ô˘·Ú·ÎÔÏÔ‡ıËÛË˜ (∂ÈÎfiÓ· 4).

™˘˙‹ÙËÛË

™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ‰ÈÂÚÂ˘Ó‹-ıËÎ·Ó ÁÈ· ÚÒÙË ÊÔÚ¿ ÔÈ Ù›ÙÏÔÈ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ‹È·ÔÍÂÈ‰ˆÌ¤ÓˆÓ ÌÔÚÊÒÓ LDL, ÛÂ

·ÛıÂÓÂ›˜ ÌÂ √™™. Δ· ·ÔÙÂÏ¤-ÛÌ·Ù· ‰Â›¯ÓÔ˘Ó fiÙÈ ÔÈ Ù›ÙÏÔÈ ·˘-ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ fiÏˆÓ ÙˆÓÌÔÚÊÒÓ oxLDL ·˘Í¿ÓÔÓÙ·È ÙÔÓÚÒÙÔ Ì‹Ó· ÌÂÙ¿ ·fi √™™.∞ÍÈÔÛËÌÂ›ˆÙÔ Â›Ó·È fiÙÈ ÔÈ Ù›ÙÏÔÈÙˆÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈÙˆÓ ÌÔÚÊÒÓ oxLDL ÏÔ‡ÛÈˆÓ ÛÂlyso-PC Ê·›ÓÂÙ·È fiÙÈ ÌÂÈÒÓÔÓÙ·ÈÛÙË Û˘Ó¤¯ÂÈ·, ÂÓÒ ÔÈ ·ÓÙ›ÛÙÔÈ¯ÔÈÙ›ÙÏÔÈ ¤Ó·ÓÙÈ ÙˆÓ ÌÔÚÊÒÓ oxLDLÏÔ‡ÛÈˆÓ ÛÂ oxPL [oxLDL(-)]‰È·ÙËÚÔ‡ÓÙ·È ÛÂ ˘„ËÏ¿ Â›Â‰·ÁÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 6 Ì‹ÓÂ˜ ÌÂÙ¿ ÙÔ√™™. ∂ÈÚfiÛıÂÙ·, Ë Û˘ÁÎÂÎÚÈ-Ì¤ÓË ÌÂÏ¤ÙË ˘Ô‰ÂÈÎÓ‡ÂÈ ÁÈ·ÚÒÙË ÊÔÚ¿ fiÙÈ Ë ¯ÔÚ‹ÁËÛË·ÙÔÚ‚·ÛÙ·Ù›ÓË˜ ÙÚÔÔÔÈÂ› ÙËÛ˘ÁÎÂÎÚÈÌ¤ÓË ·ÓÔÛÔÏÔÁÈÎ‹ ·fi-ÎÚÈÛË ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡, ·ÊÔ‡·Ó·ÛÙ¤ÏÏÂÈ Î¿ıÂ ·‡ÍËÛË ÙÔ˘ Ù›Ù-ÏÔ˘ ÙˆÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·-ÓÙÈ fiÏˆÓ ÙˆÓ ÌÔÚÊÒÓ oxLDL ÛÂ·ÛıÂÓÂ›˜ ÌÂÙ¿ ·fi √™™.

√È ΔÛÈÌ›Î·˜ Î·È Û˘Ó. (5)¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ-Ù¿ ·fi √™™ ·Ú·ÙËÚÂ›Ù·È ‚Ú·-¯˘ÚfiıÂÛÌË ·‡ÍËÛË ÙˆÓ ÂÈ¤-‰ˆÓ ÙˆÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·-ÓÙÈ Ï‹Úˆ˜ ÔÍÂÈ‰ˆÌ¤ÓË˜ LDL(ÔÍÂ›‰ˆÛË ÙÔ˘Ï¿¯ÈÛÙÔÓ ÁÈ· 12ÒÚÂ˜). ™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ÔÈ·ÛıÂÓÂ›˜ Ô˘ ‰ÂÓ Ï¿Ì‚·Ó·Ó·ÙÔÚ‚·ÛÙ·Ù›ÓË ÂÌÊ¿ÓÈÛ·Ó ÌÈ·ÛËÌ·ÓÙÈÎ‹ ·‡ÍËÛË ÙˆÓ Ù›ÙÏˆÓ

∂ÈÎfiÓ· 2. ªÂÙ·‚ÔÏ¤˜ (%) ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ oxLDL ÔÚÔ‡ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÂÚÈfi‰Ô˘ ·Ú·ÎÔÏÔ‡ıËÛË˜ ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙÈ˜·ÓÙ›ÛÙÔÈ¯Â˜ ÙÈÌ¤˜ Î·Ù¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ·Ú·ÎÔÏÔ‡ıËÛË˜ (*p=0,01, **p=0,03, #p=0,04 ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÙÈÌ‹Î·Ù¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ·Ú·ÎÔÏÔ‡ıËÛË˜, _p=0,003, $p=0,01 ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÙÈÌ‹ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ Ï¿Ì‚·Ó·Ó·ÙÔÚ‚·ÛÙ·Ù›ÓË).

∞ÛıÂÓÂ›˜ Ô˘ ¤·ÈÚÓ·Ó ·ÙÔÚ‚·ÛÙ·Ù›ÓË∞ÛıÂÓÂ›˜ ¯ˆÚ›˜ ˘ÔÏÈÈ‰·ÈÌÈÎ‹ ·ÁˆÁ‹

¶ÂÚ›Ô‰Ô˜ ·Ú·ÎÔÏÔ‡ıËÛË˜

% Ì

ÂÙ·‚

ÔÏ‹

·fi

Ù· Â

›Â

‰· Î

·Ù¿

ÙËÓ

¤Ó·Ú

ÍË Ù

Ë˜ Ì

ÂÏ¤Ù

Ë˜

1 Ì‹Ó·˜ 3 Ì‹ÓÂ˜

$

6 Ì‹ÓÂ˜

¶ƒ√∫§π¡π∫∏ ∂ƒ∂À¡∞

29

∂ÈÎfiÓ· 3 ªÂÙ·‚ÔÏ¤˜ (%), ÙˆÓ Ù›ÙÏˆÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ‰È·ÊfiÚˆÓ ÌÔÚÊÒÓ oxLDL Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÂÚÈfi‰Ô˘ ·Ú·ÎÔ-ÏÔ‡ıËÛË˜ ÛÂ Û‡ÁÎÚÈÛË ÌÂ ·˘Ù¤˜ ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ Î·Ù¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ·Ú·ÎÔÏÔ‡ıËÛË˜ ÛÙÈ˜ ‰‡Ô ÔÌ¿‰Â˜ ÙË˜ÌÂÏ¤ÙË˜ (*p=0,01, **p=0,02, #p=0,03 $p=0,04 &p=0,05 ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÙÈÌ‹ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ÂÏ¿Ì‚·Ó·Ó·ÙÔÚ‚·ÛÙ·Ù›ÓË ÁÈ· ÙË ‰Â‰ÔÌ¤ÓË ¯ÚÔÓÈÎ‹ ÛÙÈÁÌ‹

ÙˆÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈfiÏˆÓ ÙˆÓ ÌÔÚÊÒÓ ÙfiÛÔ ÙËõxLDL fiÛÔ Î·È ÙË˜ oxLDL(-),ÛÙÔÓ ÚÒÙÔ Ì‹Ó· ·Ú·ÎÔÏÔ‡ıË-ÛË˜. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ù· ÔÍ¤·ÛÙÂÊ·ÓÈ·›· ÂÂÈÛfi‰È· ÔÊÂ›ÏÔ-ÓÙ·È ÛÂ Ú‹ÍË ÌÈ·˜ ·ıËÚˆÌ·ÙÈÎ‹˜Ï¿Î·˜, ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·Â-ÏÂ˘ı¤ÚˆÛË ÛÙËÓ Î˘ÎÏÔÊÔÚ›·‰È·ÊfiÚˆÓ ÛÙÔÈ¯Â›ˆÓ ÙË˜, fiˆ˜ÛˆÌ·ÙÈ‰›ˆÓ oxLDL ÌÂ ¤ÓÙÔÓË·ÓÙÈÁÔÓÈÎfiÙËÙ· (5, 20, 21), Ù·ÔÔ›· Ê˘ÛÈÔÏÔÁÈÎ¿ ˘¿Ú¯Ô˘ÓÛÙÔ Ï¿ÛÌ· ÛÂ ÔÏ‡ ÌÈÎÚ¤˜ Ô-ÛfiÙËÙÂ˜ (14). ¶·ÚfiÌÔÈ· ·‡ÍËÛË·Ú·ÙËÚ‹ıËÎÂ Â›ÛË˜ Î·È ÛÂ·ÛıÂÓÂ›˜ ÌÂÙ¿ ·fi ‰È·‰ÂÚÌÈÎ‹·ÁÁÂÈÔÏ·ÛÙÈÎ‹ ÙˆÓ ÛÙÂÊ·ÓÈ·›-ˆÓ ·ÁÁÂ›ˆÓ, ÌÈ· ‰È·‰ÈÎ·Û›· Ô˘Â›Ó·È ÁÓˆÛÙfi fiÙÈ Û¯ÂÙ›˙ÂÙ·È ÌÂÛ‡ÓıÏÈ„Ë ÙË˜ ·ıËÚˆÌ·ÙÈÎ‹˜Ï¿Î·˜ (22). ∏ ¤ÓÙÔÓË ·ÓÙÈÁÔÓÈ-ÎfiÙËÙ· ÙË˜ ÔxLDL, fiˆ˜ ‹‰Ë¤¯ÂÈ ·Ó·ÊÂÚıÂ›, ÔÊÂ›ÏÂÙ·È ÛÙ·oxPL, ÛÙË lyso-PC Î·È ÛÙÈ˜ ‰Ú·-ÛÙÈÎ¤˜ ·Ï‰Â˛‰Â˜ Ô˘ ·˘Ù¿ Ù·ÛˆÌ·Ù›‰È· ÂÚÈ¤¯Ô˘Ó (23). ∏ ·Ú-¯ÈÎ‹ ·˘Ù‹ ·‡ÍËÛË ÏÔÈfiÓ ÛÙÔ˘˜Ù›ÙÏÔ˘˜ ÙˆÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ¤Ó·ÓÙÈ ÙˆÓ ·Ú·¿Óˆ ·ÓÙÈÁfi-ÓˆÓ, Ô˘ ·Ú·ÙËÚÂ›Ù·È ÙfiÛÔÛÙËÓ ‰ÈÎ‹ Ì·˜ ÌÂÏ¤ÙË fiÛÔ Î·È ÛÂ¿ÏÏÂ˜ (5, 7, 22), Ê·›ÓÂÙ·È fiÙÈÛ¯ÂÙ›˙ÂÙ·È ÌÂ ÙËÓ ·ÓÔÛÔÏÔÁÈÎ‹·ÓÙ›‰Ú·ÛË ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ ¤Ó·-ÓÙÈ ¤ÓÙÔÓ· ‚ÈÔ‰Ú·ÛÙÈÎÒÓ Û˘ÛÙ·-

ÙÈÎÒÓ ÙË˜ oxLDL Ù· ÔÔ›· ÂÈÛ¤Ú-¯ÔÓÙ·È ÛÙËÓ Î˘ÎÏÔÊÔÚ›· ·fi ÙÔ·ÚÙËÚÈ·Îfi ÙÔ›¯ˆÌ·. ¢ÂÓ Â›Ó·ÈÁÓˆÛÙfi fiÌˆ˜ Ì¤¯ÚÈ ÛÙÈÁÌ‹˜ ·Ó·˘Ù‹ Ë ·ÓÔÛÔÏÔÁÈÎ‹ ·ÓÙ›‰Ú·ÛËÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡, ‰Ú· Â˘ÓÔ˚Î¿·ÔÌ·ÎÚ‡ÓÔÓÙ·˜ ·fi ÙËÓ Î˘ÎÏÔ-ÊÔÚ›· ÙËÓ oxLDL ‹ ·Ï¿ ·ÔÙÂ-ÏÂ› ¤Ó· ÂÈÏ¤ÔÓ ¯·Ú·ÎÙËÚÈÛÙÈÎfiÙË˜ ÊÏÂÁÌÔÓÒ‰Ô˘˜ ‰ÈÂÚÁ·Û›·˜Î·È ÙÔ˘ ¤ÓÙÔÓÔ˘ ÔÍÂÈ‰ˆÙÈÎÔ‡ÛÙÚÂ˜ Ô˘ ·Ú·ÙËÚÂ›Ù·È ÌÂÙ¿·fi √™™. ™ÙË ÌÂÏ¤ÙË Ì·˜ ‰Â›ÎÙË·˘ÍËÌ¤ÓË˜ ÊÏÂÁÌÔÓÒ‰Ô˘˜ ‰ÈÂÚ-Á·Û›·˜ ÌÂÙ¿ ÙÔ ÂÂÈÛfi‰ÈÔ ·ÔÙÂ-ÏÔ‡Ó Ù· ·˘ÍËÌ¤Ó· Â›Â‰· CRPÔ˘ ÂÌÊ·Ó›˙Ô˘Ó fiÏÔÈ ÔÈ ·ÛıÂÓÂ›˜Î·È Ù· ÔÔ›· ÌÂÈÒÓÔÓÙ·È ÛÙË‰È¿ÚÎÂÈ· ÙË˜ ÂÚÈfi‰Ô˘ ·Ú·ÎÔ-ÏÔ‡ıËÛË˜ Î·È ÛÙÈ˜ ‰‡Ô ÔÌ¿‰Â˜ÙË˜ ÌÂÏ¤ÙË˜.

¶Ú¤ÂÈ Ó· ÛËÌÂÈˆıÂ› fiÌˆ˜fiÙÈ Ù· ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÙˆÓ‰È·ÊfiÚˆÓ ÌÔÚÊÒÓ oxLDL Û˘-ÌÂÚÈÊ¤ÚÔÓÙ·È ‰È·ÊÔÚÂÙÈÎ¿ ÛÂÛ¯¤ÛË ÌÂ ·˘Ù¿ ¤Ó·ÓÙÈ ÙˆÓ ‰È·-ÊfiÚˆÓ ÌÔÚÊÒÓ oxLDL(-) Î·Ù¿ ÙË‰È¿ÚÎÂÈ· ÙË˜ ÂÚÈfi‰Ô˘ ·Ú·ÎÔ-ÏÔ‡ıËÛË˜ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ Ô˘‰ÂÓ Ï¿Ì‚·Ó·Ó ·ÙÔÚ‚·ÛÙ·Ù›ÓË.¶Ú¿ÁÌ·ÙÈ Ù· Â›Â‰· ÙˆÓ ·˘ÙÔ·-ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙˆÓ ÌÔÚÊÒÓoxLDL ÂÌÊ·Ó›˙Ô˘Ó ÌÂÙ¿ ÙËÓ ·Ú-¯ÈÎ‹ (ÛÙÔÓ 1Ô Ì‹Ó·) ·‡ÍËÛË, ÛË-Ì·ÓÙÈÎ‹ ÌÂ›ˆÛË ÛÙÔ˘˜ 3 Î·È 6Ì‹ÓÂ˜, ÂÈÛÙÚ¤ÊÔÓÙ·˜ ÛÙÈ˜ ·Ú¯È-

Î¤˜ ÙÔ˘ ÙÈÌ¤˜. ∞ÓÙ›ıÂÙ·, ÔÈ Ù›ÙÏÔÈÙˆÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈÙˆÓ ‰È·ÊfiÚˆÓ ÌÔÚÊÒÓ oxLDL(-)·Ú·Ì¤ÓÔ˘Ó ÛÂ ·˘ÍËÌ¤Ó· Â›Â-‰· Î·ı' fiÏË ÙË ‰È¿ÚÎÂÈ· ÙË˜ ·-Ú·ÎÔÏÔ‡ıËÛË˜,. ∫·ıÒ˜ ÔÈ ÌÔÚ-Ê¤˜ ÙË˜ oxLDL Â›Ó·È ÏÔ‡ÛÈÂ˜ ÛÂlyso-PC (·ÊÔ‡ Ë Lp-PLA2 ‰ÂÓ¤¯ÂÈ ·ÂÓÂÚÁÔÔÈËıÂ›), ÂÓÒ ÔÈÌÔÚÊ¤˜ ÙË˜ oxLDL(-) Â›Ó·È ÏÔ‡-ÛÈÂ˜ ÛÂ ÔxPL, Ê·›ÓÂÙ·È fiÙÈ ˘¿Ú-¯ÂÈ ‰È·ÊÔÚÂÙÈÎ‹ ·ÓÔÛÔÏÔÁÈÎ‹·¿ÓÙËÛË ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ ÛÙ·‰È·ÊÔÚÂÙÈÎ¿ ·˘Ù¿ ·ÓÙÈÁfiÓ· ÛÙË‰È¿ÚÎÂÈ· ÙÔ˘ ¯ÚfiÓÔ˘ ÌÂÙ¿ ·fi√™™. ŒÙÛÈ, Ë ·ÓÙ›‰Ú·ÛË ÙÔ˘ ÔÚ-Á·ÓÈÛÌÔ‡ ÛÙËÓ lyso-PC Ê·›ÓÂÙ·ÈÓ· Â›Ó·È ÔÍÂ›· Î·È Ó· ÂÍ·ÏÂ›ÊÂÙ·ÈÌÂ ÙÔÓ ¯ÚfiÓÔ, ÂÓÒ Ë ‰È·Ù‹ÚËÛË·˘ÍËÌ¤ÓˆÓ ÂÈ¤‰ˆÓ ¤Ó·ÓÙÈ ÙˆÓoxPL Î·ı' fiÏË ÙË ‰È¿ÚÎÂÈ· ÙË˜ÂÚÈfi‰Ô˘ ·Ú·ÎÔÏÔ‡ıËÛË˜, ˘Ô-‰ËÏÒÓÂÈ ÌÈ· ¯ÚfiÓÈ· ·ÓÔÛÔÏÔÁÈÎ‹·fiÎÚÈÛË ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ ÛÙÔÔÍ‡ ÛÙÂÊ·ÓÈ·›Ô ÂÂÈÛfi‰ÈÔ.

∏ ¯ÔÚ‹ÁËÛË ·ÙÔÚ‚·ÛÙ·Ù›ÓË˜Ê·›ÓÂÙ·È fiÙÈ ÙÚÔÔÔÈÂ› ÛËÌ·ÓÙÈ-Î¿ ÙËÓ ·Ú·¿Óˆ ·ÓÔÛÔÏÔÁÈÎ‹·¿ÓÙËÛË ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ ÌÂÙ¿·fi √™™. ¶Ú¿ÁÌ·ÙÈ, ÛÙÔ˘˜·ÛıÂÓÂ›˜ ÔÈ ÔÔ›ÔÈ Ï¿Ì‚·Ó·Ó·ÙÔÚ‚·ÛÙ·Ù›ÓË ‰ÂÓ ·Ú·ÙËÚ‹-ıËÎÂ Î·ÌÈ¿ ÌÂÙ·‚ÔÏ‹ ÙˆÓ Ù›ÙÏˆÓ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ fiÏˆÓÙˆÓ ÌÔÚÊÒÓ ÙfiÛÔ ÙË˜ oxLDL,fiÛÔ Î·È ÙË˜ oxLDL(-) Î·ı' fiÏË ÙË

6 Ì‹ÓÂ˜ 6 Ì‹ÓÂ˜ 6 Ì‹ÓÂ˜

6 Ì‹ÓÂ˜ 6 Ì‹ÓÂ˜ 6 Ì‹ÓÂ˜3 Ì‹ÓÂ˜ 3 Ì‹ÓÂ˜ 3 Ì‹ÓÂ˜

3 Ì‹ÓÂ˜ 3 Ì‹ÓÂ˜ 3 Ì‹ÓÂ˜1 Ì‹Ó·˜ŒÓ·ÚÍË

·Ú·ÎÔÏÔ‡ıËÛË˜

ŒÓ·ÚÍË

·Ú·ÎÔÏÔ‡ıËÛË˜ ÂÚ›Ô‰Ô˜ ·Ú·ÎÔÏÔ‡ıËÛË˜ ÂÚ›Ô‰Ô˜ ·Ú·ÎÔÏÔ‡ıËÛË˜ ÂÚ›Ô‰Ô˜ ·Ú·ÎÔÏÔ‡ıËÛË˜

ÂÚ›Ô‰Ô˜ ·Ú·ÎÔÏÔ‡ıËÛË˜ÂÚ›Ô‰Ô˜ ·Ú·ÎÔÏÔ‡ıËÛË˜ÂÚ›Ô‰Ô˜ ·Ú·ÎÔÏÔ‡ıËÛË˜

∞ÛıÂÓÂ›˜ Ô˘ ‰ÂÓ ÂÏ¿Ì‚·Ó·Ó ·ÙÔÚ‚·ÛÙ·Ù›ÓË

∞ÛıÂÓÂ›˜ Ô˘ ÂÏ¿Ì‚·Ó·Ó ·ÙÔÚ‚·ÛÙ·Ù›ÓË

ŒÓ·ÚÍË


ŒÓ·ÚÍË


ŒÓ·ÚÍË


ŒÓ·ÚÍË


1 Ì‹Ó·˜ 1 Ì‹Ó·˜

1 Ì‹Ó·˜% Ì

ÂÙ·‚

ÔÏ‹

·fi

ÙÈ˜ Ù

ÈÌ¤˜

Î·Ù

¿ ÙË

Ó¤Ó

·ÚÍË

ÙË˜

·Ú

·ÎÔÏ

Ô‡ıË

ÛË˜

% Ì

ÂÙ·‚

ÔÏ‹

·fi

ÙÈ˜ Ù

ÈÌ¤˜

Î·Ù

¿ ÙË

Ó¤Ó

·ÚÍË

ÙË˜

·Ú

·ÎÔÏ

Ô‡ıË

ÛË˜

¤Ó·ÓÙÈ LDLL ¤Ó·ÓÙÈ LDLP ¤Ó·ÓÙÈ LDLD

¤Ó·ÓÙÈ LDL(-)L ¤Ó·ÓÙÈ LDL(-)P ¤Ó·ÓÙÈ LDL(-)D

1 Ì‹Ó·˜ 1 Ì‹Ó·˜

‰È¿ÚÎÂÈ· ÙË˜ ·Ú·ÎÔÏÔ‡ıËÛË˜.√È ÌË¯·ÓÈÛÌÔ› ÌÂ ÙÔ˘˜ ÔÔ›Ô˘˜ÌÔÚÂ› Ë ·ÙÔÚ‚·ÛÙ·Ù›ÓË Î·È ÁÂ-ÓÈÎfiÙÂÚ· ÔÈ ÛÙ·Ù›ÓÂ˜ Ó· ÂÌÔ‰›-ÛÔ˘Ó ÌÈ· Ù¤ÙÔÈ· ·‡ÍËÛË Â›Ó·ÈÔÈÎ›ÏÔÈ (13). ¶Ú¿ÁÌ·ÙÈ, Ë ÌÂ›ˆ-ÛË ÙˆÓ ÂÈ¤‰ˆÓ LDL ¯ÔÏËÛÙÂ-ÚfiÏË˜ ÔÚÔ‡ Ô˘ Ù· Ê¿ÚÌ·Î· ·˘-Ù¿ ÂÈÙ˘Á¯¿ÓÔ˘Ó, Ô‰ËÁÂ› ÛÂ ÌÂ›-ˆÛË ÙË˜ ‰È·ı¤ÛÈÌË˜ ÔÛfiÙËÙ·˜LDL ÁÈ· ÔÍÂ›‰ˆÛË Î·È Î·Ù¿ Û˘Ó¤-ÂÈ· ÛÂ ÌÂ›ˆÛË ÙË˜ oxLDL. ™Â˘ÔÔÌ¿‰· ·ÛıÂÓÒÓ ÙË˜ ÌÂÏ¤ÙË˜MIRACL, Ë ¯ÔÚ‹ÁËÛË ·ÙÔÚ‚·-ÛÙ·Ù›ÓË˜ ÌÂÙ¿ ·fi ÔÍ‡ ÛÙÂÊ·ÓÈ-·›Ô ÂÂÈÛfi‰ÈÔ, ¤¯ÂÈ Û˘Ó‰˘·ÛÙÂ›ÌÂ ÌÂ›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓoxPL ÙÔ˘ ÔÚÔ‡ (14). ∂ÈÚfiÛıÂ-Ù· Â›Ó·È ÁÓˆÛÙfi fiÙÈ ÔÈ ÛÙ·Ù›ÓÂ˜ÂÌÊ·Ó›˙Ô˘Ó ·ÓÙÈÊÏÂÁÌÔÓÒ‰ÂÈ˜Î·È ·ÓÔÛÔÙÚÔÔÔÈËÙÈÎ¤˜ ‰Ú¿-ÛÂÈ˜ (12, 24, 25). ∏ ¯ÔÚ‹ÁËÛËÙÔ˘˜ Ô‰ËÁÂ› ÛÂ ÙÚÔÔÔ›ËÛË ÙË˜ÂÓÂÚÁÔÔ›ËÛË˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·-ÙÔ˜, ‰Ú¿ÛË Ô˘ ·ÊÔÚ¿ ÙfiÛÔ Ù·B fiÛÔ Î·È T ÏÂÌÊÔÎ‡ÙÙ·Ú· (13).∏ ¯ÔÚ‹ÁËÛË ·ÙÔÚ‚·ÛÙ·Ù›ÓË˜ÛÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË Û˘Ó‰˘¿-ÛÙËÎÂ ÌÂ ÌÈ· ÛËÌ·ÓÙÈÎ‹ ÌÂ›ˆÛËÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ ÔxLDL ÔÚÔ‡Î·È ÙË˜ CRP, Ê·ÈÓfiÌÂÓÔ ÙÔ ÔÔ›Ô¤¯ÂÈ ·Ú·ÙËÚËıÂ› Î·È ÛÂ ¿ÏÏÂ˜

ÌÂÏ¤ÙÂ˜ (12), Î·È Û¯ÂÙ›˙ÂÙ·È ÌÂÙË ÌÂ›ˆÛË Ô˘ ÚÔÎ·ÏÔ‡Ó ÔÈÛÙ·Ù›ÓÂ˜ ÙfiÛÔ ÙÔ˘ ÔÍÂÈ‰ˆÙÈÎÔ‡ÛÙÚÂ˜ fiÛÔ Î·È ÙË˜ ÊÏÂÁÌÔÓ‹˜ÌÂÙ¿ ·fi √™™ (26). ∂ÈÚfiÛıÂÙ·Ë ÌË ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙˆÓ‰È·ÊfiÚˆÓ ÌÔÚÊÒÓ oxLDL, ‰ËÏ·-‰‹ ÌÔÚÊÒÓ ÏÔ‡ÛÈˆÓ ÛÂ lyso-PC, ÌÔÚÂ› Ó· ÔÊÂ›ÏÂÙ·È Î·È ÛÙËÌÂ›ˆÛË ÙË˜ ÂÓÂÚÁfiÙËÙ·˜ ÙË˜ Lp-PLA2, Ë ÔÔ›· ·Ú·ÙËÚ‹ıËÎÂÌfiÓÔ ÛÙËÓ ÔÌ¿‰· ·ÛıÂÓÒÓ Ô˘Ï¿Ì‚·Ó·Ó ·ÙÔÚ‚·ÛÙ·Ù›ÓË Î·È ËÔÔ›· Â›Ó·È ÁÓˆÛÙfi fiÙÈ ÚÔÎ·ÏÂ›-Ù·È ·fi ÙÈ˜ ÛÙ·Ù›ÓÂ˜ (27-29). Δ·Â›Â‰· ÙË˜ Lp-PLA2 ·ÔÙÂÏÔ‡Ó·ÓÂÍ¿ÚÙËÙÔ ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ÁÈ· ÙË ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ (30), ·Ï-Ï¿ Ë ÌÂ›ˆÛË ÙÔ˘˜ ÌÂ ÙË ¯ÔÚ‹ÁË-ÛË ÛÙ·ÙÈÓÒÓ ‰ÂÓ ¤¯ÂÈ ·ÎfiÌË Û˘Ó-‰ÂıÂ› ÌÂ Â˘ÓÔ˚Î¿ ÎÏÈÓÈÎ¿ ‹ ·ıÔ-Ê˘ÛÈÔÏÔÁÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù· (27).∏ ·ÚÔ‡Û· ÌÂÏ¤ÙË ˘Ô‰ÂÈÎÓ‡ÂÈÁÈ· ÚÒÙË ÊÔÚ¿ fiÙÈ Ë ÌÂ›ˆÛËÙË˜ ÂÓÂÚÁfiÙËÙ·˜ ÙË˜ Lp-PLA2·fi ÙÈ˜ ÛÙ·Ù›ÓÂ˜ ÌÔÚÂ› Ó· Û˘Ó-‰¤ÂÙ·È ÌÂ ÙËÓ ÌÂ›ˆÛË ÙË˜ ·ÓÙÈÁÔ-ÓÈÎfiÙËÙ·˜ ÙË˜ oxLDL Ë ÔÔ›·ÔÊÂ›ÏÂÙ·È ÛÙËÓ lyso-PC.

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, ÛÙÔ˘˜ ·ÛıÂ-ÓÂ›˜ ÌÂÙ¿ ·fi ÔÍ‡ ÛÙÂÊ·ÓÈ·›ÔÛ‡Ó‰ÚÔÌÔ, ·Ú·ÙËÚÂ›Ù·È ·‡ÍËÛË

ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ·˘ÙÔ·ÓÙÈÛˆ-Ì¿ÙˆÓ ¤Ó·ÓÙÈ fiÏˆÓ ÙˆÓ ÌÔÚÊÒÓÔÍÂÈ‰ˆÌ¤ÓË˜ LDL, Èı·ÓÒ˜ ˆ˜·¿ÓÙËÛË ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ ÛÙËÚ‹ÍË ÙË˜ ·ıËÚˆÌ·ÙÈÎ‹˜ Ï¿Î·˜Î·È ÙË˜ ·ÂÏÂ˘ı¤ÚˆÛË˜ ÛÙËÓ Î˘-ÎÏÔÊÔÚ›· ‚ÈÔ‰Ú·ÛÙÈÎÒÓ Û˘ÛÙ·ÙÈ-ÎÒÓ ÙË˜, fiˆ˜ Ù· oxPL Î·È Ëlyso-PC. °È· Ù· ·˘ÙÔ·ÓÙÈÛÒÌ·Ù·¤Ó·ÓÙÈ ÙˆÓ oxPL, Ë ·‡ÍËÛË ·˘Ù‹‰È·ÙËÚÂ›Ù·È ¤ˆ˜ Î·È 6 Ì‹ÓÂ˜ ÌÂÙ¿·fi ÙÔ ÔÍ‡ ÛÙÂÊ·ÓÈ·›Ô Û‡Ó‰ÚÔ-ÌÔ, ÂÓÒ Â›Ó·È ·ÚÔ‰ÈÎ‹ ÁÈ· Ù··˘ÙÔ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÙË˜ lyso-PC, ÁÂÁÔÓfi˜ Ô˘ ˘Ô‰ËÏÒÓÂÈ fiÙÈË Lp-PLA2 Ô˘ Û˘Ó‰¤ÂÙ·È ÛÙËÓLDL ‰È·‰Ú·Ì·Ù›˙ÂÈ ÛËÌ·ÓÙÈÎfiÚfiÏÔ ÛÙËÓ ·ÓÔÛÔÏÔÁÈÎ‹ ·¿ÓÙË-ÛË ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ ¤Ó·ÓÙÈ ÙËõxLDL, ÌÂÙ¿ ·fi ÔÍ‡ ÛÙÂÊ·ÓÈ·›ÔÂÂÈÛfi‰ÈÔ. ∏ ¿ÌÂÛË ¯ÔÚ‹ÁËÛË·ÙÔÚ‚·ÛÙ·Ù›ÓË˜ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜·˘ÙÔ‡˜ ·Ó·ÛÙ¤ÏÏÂÈ ÙËÓ ·Ú·¿-Óˆ ·ÓÔÛÔÏÔÁÈÎ‹ ·fiÎÚÈÛË, ÌÈ·‰Ú¿ÛË ÙË˜ ÔÔ›·˜ Ë ÎÏÈÓÈÎ‹ ÛË-Ì·Û›· ı· Ú¤ÂÈ Ó· ·Ô‰ÂÈ¯ıÂ›ÛÂ ÌÂÁ¿ÏË˜ ¤ÎÙ·ÛË˜ ÎÏÈÓÈÎ¤˜ ÌÂ-Ï¤ÙÂ˜.

™ ∂ ¶ Δ ∂ ª μ ƒ π √ ™ 2 0 0 8

30

∂ÈÎfiÓ· 4. ªÂÙ·‚ÔÏ¤˜ (%) ÙË˜ ÂÓÂÚÁfiÙËÙ·˜ ÙË˜ Lp-PLA2 ÛÙÈ˜ ‰‡Ô ÔÌ¿‰Â˜ ÙË˜ ÌÂÏ¤ÙË˜ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÂÚÈfi‰Ô˘ ·Ú·ÎÔ-ÏÔ‡ıËÛË˜ (*p=0,002, **p=0,03, #p=0,04 ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÙÈÌ‹ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ‰ÂÓ Ï¿Ì‚·Ó·Ó ÛÙ·Ù›ÓÂ˜ ÛÙËÓÎ¿ıÂ ‰Â‰ÔÌ¤ÓË ÛÙÈÁÌ‹)

∞ÛıÂÓÂ›˜ Ô˘ ¤·ÈÚÓ·Ó ·ÙÔÚ‚·ÛÙ·Ù›ÓË∞ÛıÂÓÂ›˜ ¯ˆÚ›˜ ˘ÔÏÈÈ‰·ÈÌÈÎ‹ ·ÁˆÁ‹

¶ÂÚ›Ô‰Ô˜ ·Ú·ÎÔÏÔ‡ıËÛË˜

% Ì

ÂÙ·‚

ÔÏ‹

·fi

ÙÈ˜

ÙÈÌ¤

˜ Î·

Ù¿ Ù

ËÓ ¤

Ó·ÚÍ

Ë ÙË

˜ ÌÂ

Ï¤ÙË

˜

1 Ì‹Ó·˜ 3 Ì‹ÓÂ˜ 6 Ì‹ÓÂ˜

¶ƒ√∫§π¡π∫∏ ∂ƒ∂À¡∞

31

1. Choy P, Siow Y, Mymin D, Karmin O.Lipids and atherosclerosis. BiochemCell Biol 2004; 82: 212-24.

2. Navab M, Ananthramaiah GM, ReddyST, Van Lenten BJ, Ansell BJ,Fonarow GC, Vahabzadeh K, Hama S,Hough G, Kamranpour N, Berliner JA,Lusis AJ, Fogelman AM. The oxidationhypothesis of atherogenesis: the roleof oxidized phospholipids and HDL. JLipid Res 2004; 45: 993-1007.

3. Tselepis AD, John Chapman M.Inflammation, bioactive lipids andatherosclerosis: potential roles of alipoprotein-associated phospholipaseA2, platelet activating factor-acetylhy-drolase. Atheroscler Suppl 2002; 3:57-68.

4. Karabina S, Liapikos T, Grekas G,Goudevenos J, Tselepis A. Distri-bution of PAF-acetylhydrolase activityin human plasma low-density lipopro-tein. Biochim Biophys Acta. 1994;1213: 34-8.

5. Tsimikas S, Bergmark C, Beyer R, PatelR, Pattison J, Miller E, Juliano J,Witztum J. Temporal increases in pla-sma markers of oxidized low-densitylipoprotein strongly reflect the presenceof acute coronary syndromes. J Am CollCardiol 2003; 41: 360-70.

6. Itabe H, Takano T. Oxidized low densitylipoprotein: the occurrence and meta-bolism in circulation and in foam cells.J Atheroscler Thromb 2000; 7: 123-31.

7. Tsimikas S, Brilakis ES, Miller ER,McConnell JP, Lennon RJ, KornmanKS, Witztum JL, Berger PB. Oxidizedphospholipids, Lp(a) lipoprotein, andcoronary artery disease. N Engl J Med2005; 353: 46-57.

8. Lourida ES, Papathanasiou AI,Goudevenos JA, Tselepis AD. Thelow-density lipoprotein (LDL)-asso-ciated PAF-acetylhydrolase activityand the extent of LDL oxidation areimportant determinants of theautoantibody titers against oxidizedLDL in patients with coronary arterydisease. Prostaglandins LeukotEssent Fatty Acids 2006; 75: 117-26.

9. Fukumoto M, Shoji T, Emoto M,Kawagishi T, Okuno Y, Nishizawa Y.Antibodies against oxidized LDL andcarotid artery intima-media thicknessin a healthy population. ArteriosclerThromb Vasc Biol 2000; 20: 703-7.

10. Itabe H. Oxidized low-dnsity lipoproteins:what is understood and what remainsto be clarified. Biol Pharm Bull 2003;26: 1-9.

11. Riesen W, Engler H, Risch M, Korte W,Noseda G. Short-term effects ofatorvastatin on C-reactive protein. EurHeart J 2002; 23: 794-9.

12. Ndrepepa G, Braun S, vonBeckerathN, Mehilli J, Gorchakova O, Vogt W,Schomig A, Kastrati A. Oxidized lowdensity lipoproteins, statin therapy andseverity of coronary artery disease.Clinica Chimica Acta 2005; in press.

13. Palinski W, Tsimikas S. Immunomodu-latory effects of statins: Mechanismsand potential impact on arterioscle-rosis. J Am Soc Nephrol 2002; 13:1673-81.

14. Tsimikas S, Witztum JL, Miller ER,Sasiela WJ, Szarek M, Olsson AG,Schwartz GG. High-dose atorvastatinreduces total plasma levels ofoxidized phospholipids and immunecomplexes present on apolipoproteinB-100 in patients with acute coronarysyndromes in the MIRACL trial.Circulation 2004; 110: 1406-12.

15. Lourida ES, Georgiadis AN, Papavasili-ou EC, Papathanasiou AI, Drosos AA,Tselepis AD. Patients with earlyrheumatoid arthritis exhibit elevatedautoantibody titers against mildlyoxidized low-density lipoprotein andexhibit decreased activity of thelipoprotein-associated phospholipaseA2. Arthritis Res Ther 2007; 9: R19.

16. Papathanasiou AI, Lourida ES, TsironisLD, Goudevenos JA, Tselepis AD.Short- and long-term elevation ofautoantibody titers against oxidizedLDL in patients with acute coronarysyndromes. Role of the lipoprotein-associated phospholipase A2 and theeffect of atorvastatin treatment. Athe-rosclerosis 2008; 196: 289-97.

17. Craig WY, Davis AE, Poulin SE. Effectsof incubation conditions on ELISA forautoantibodies against oxidised low-density lipoprotein. Clin Chem 1996;42: 1709-11.

18. Craig WY, Rawstron MW, Rundell CA,Robinson E, Poulin SE, Neveux LM,Nishina PM, Keilson LM. Relationshipbetween lipoprotein- and oxidation-relatedvariables and atheroma lipid compositionin subjects undergoing coronary arterybypass graft surgery. Arterioscler ThrombVasc Biol 1999; 19: 1512-7.

19. Craig WY, Raytcheva SE, Poulin SE,Ritchie RF. Effect of low-densitylipoprotein (LDL) antigen source onan enzyme-linked immunosorbent as-say for autoantibodies against oxidi-zed LDL. Ann Clin Biochem 1999; 36:333-9.

20. Horkko S, Bird DA, Miller E, Itabe H,Leitinger N, Subbanagounder G,Berliner JA, Friedman P, Dennis EA,Curtiss LK, Palinski W, Witztum JL.Monoclonal autoantibodies specificfor oxidized phospholipids or oxidizedphospholipid-protein adducts inhibitmacrophage uptake of oxidized low-

density lipoproteins. J Clin Invest1999; 103: 117-28.

21. Tsimikas S, Witztum JL. Measuringcirculating oxidized low-density lipo-protein to evaluate coronary risk. Cir-culation 2001; 103: 1930-2.

22. Tsimikas S, Lau H, Han S, Shortal B,Miller E, Segev A, Curtiss LK, WitztumJ, Strauss B. Percutaneous coronaryintervention results in acute increasesin oxidized phospholipids and lipopro-tein(a). Circulation 2004; 109: 3164-70.

23. Holvoet P, Vanhaecke J, Janssens S,Van-de-Werf F, Collen D. OxidizedLDL and malodialdehyde-modified LDLin patients with acute coronary syn-dromes and stable angina. Circulation1998; 98: 1487-94.

24. Balk EM, Lau J, Goudas LC, JordanHS, Kupelnick B, Kim LU, Karas RH.Effects of statins on nonlipid serummarkers associated with cardio-vascular disease: a systematic review.Ann Intern Med 2003; 139: 670-82.

25. Bellosta S, Ferri N, Bernini F, PaolettiR, Corsini A. Non-lipid related effectsof statins. Ann Med 2000; 32: 164-76.

26. Kausik R, Cannon C. Pathologicalchanges in acute coronary syndro-mes: the role of statin therapy in themodulation of inflammation, endothe-lial functionand coagulation. J ThrombThrombolysis 2004; 18: 89-101.

27. Macphee C, Nelson J, Zalewski A.Lipoprotein-associatedphospholipase A2 as a target oftherapy. Curr Opin Lipidol 2005; 16:442-6.

28. Tambaki A, Rizos E, Tsimihodimos V,Tselepis A, Elisaf M. Effects of anti-hypertensive and hypolipidemic drugson plasma and high-density lipopro-tein-associated platelet activating fac-tor-acetylhydrolase activity. J Cardio-vasc Pharmacol Ther. 2004; 9: 91-5.

29. Tsimihodimos V, Karabina S-A,Tambaki A, Bairaktari E, GoudevenosJ, Chapman J, Elisaf M, Tselepis A.Atorvastatin Preferentially ReducesLDL-Associated Platelet-ActivatingFactor Acetylhydrolase Activity inDyslipidemias of Type IIA and TypeIIB. Arterioscler Thromb Vasc Biol2002; 22: 306-11.

30. Packard CJ, O'Reilly DS, Caslake MJ,McMahon AD, Ford I, Cooney J,Macphee CH, Suckling KE, Krishna M,Wilkinson FE, Rumley A, Lowe GD.Lipoprotein-associatedphospholipase A2 as an independentpredictor of coronary heart disease.West of Scotland Coronary PreventionStudy Group. N Engl J Med 2000;343: 1148-55.


1: Goldstein LB, Amarenco P, Szarek M,Callahan A 3rd, Hennerici M, Sillesen H,Zivin JA, Welch KM; SPARCL Investi-gators. Hemorrhagic stroke in the Stro-ke Prevention by Aggressive Reductionin Cholesterol Levels study. Neurology.2008 Jun 10;70(24 Pt 2):2364-70.

2: Song YB, On YK, Kim JH, Shin DH, KimJS, Sung J, Lee SH, Kim WS, Lee YT.The effects of atorvastatin on the occur-rence of postoperative atrial fibrillationafter off-pump coronary artery bypassgrafting surgery. Am Heart J. 2008Aug;156(2):373.e9-16.

3: Athyros VG, Kakafika AI, Karagiannis A,Mikhailidis DP. Do we need to considerinflammatory markers when we treatatherosclerotic disease? Atherosclero-sis. 2008 Sep 10;200 (1):1-12.

4: Targher G, Arcaro G. Non-alcoholic fattyliver disease and increased risk ofcardiovascular disease. Atherosclerosis2007 Apr;191(2):235-40.

5: Targher G. Non-alcoholic fatty liverdisease, the metabolic syndrome andthe risk of cardiovascular disease: theplot thickens. Diabet Med. 2007 Jan;24(1):1-6.

6: Zebrack JS, Anderson JL. Role ofinflammation in cardiovascular disease:how to use C-reactive protein in clinicalpractice. Prog Cardiovasc Nurs. 2002Fall;17(4):174-85.

7: Choi SH, Chae A, Miller E, Messig M,Ntanios F, DeMaria AN, Nissen SE,Witztum JL, Tsimikas S. Relationshipbetween biomarkers of oxidized low-density lipoprotein, statin therapy,quantitative coronary angiography, andatheroma: volume observations fromthe REVERSAL (Reversal of Atheroscle-rosis with Aggressive Lipid Lowering)study. J Am Coll Cardiol. 2008 Jul1;52(1):24-32.

8: Graham KL, Lee LY, Higgins JP,Steinman L, Utz PJ, Ho PP. Failure oforal atorvastatin to modulate a murinemodel of systemic lupus erythemato-sus. Arthritis Rheum. 2008 Jul;58(7):2098-104.

9: Molokhia M, McKeigue P, Curcin V,Majeed A. Statin induced myopathyand myalgia: time trend analysis andcomparison of risk associated withstatin class from 1991-2006. PLoS ONE.2008 Jun 25;3(6):e2522.

10: Gfimez-Hernàndez A, Sànchez-Galàn E,Ortego M, Martin-Ventura JL, Blanco-Colio LM, Tarin-Vicente N, Jiménez-Nacher JJ, Lfipez-Bescos L, Egido J,

Tun~fin J. Effect of intensive atorvastatintherapy on prostaglandin E2 levels andmetalloproteinase-9 activity in theplasma of patients with non-ST-eleva-tion acute coronary syndrome. Am JCardiol. 2008 Jul 1;102(1):12-8.

11: Bachmann JM, Majmudar M, TompkinsC, Blumenthal RS, Marine JE. Lipid-al-tering therapy and atrial fibrillation. Car-diol Rev. 2008 Jul-Aug;16(4):197-204.

12: Read WL, Baggstrom MQ, Fracasso PM,Govindan R. A phase I study ofbexarotene and rosiglitazone in patientswith refractory cancers. Chemotherapy.2008;54(3):236-41.

13: Foody JM, Joyce AT, Rudolph AE, LiuLZ, Benner JS. Persistence of atorva-statin and simvastatin among patientswith and without prior cardiovasculardiseases: a US managed care study.Curr Med Res Opin. 2008 Jul;24(7):1987-2000.

14: Mayne J, Dewpura T, Raymond A, Cou-sins M, Chaplin A, Lahey KA, LahayeSA, Mbikay M, Ooi TC, Chrétien M. Pla-sma PCSK9 levels are significantly mo-dified by statins and fibrates in humans.Lipids Health Dis. 2008 Jun 11;7:22.

15: Kapoor S. Atorvastatin and celecoxib: afuture role in cancer chemoprevention.Int J Cancer. 2008 Aug 1;123(3):737.

16: Peura P, Martikainen J, Soini E, HallinenT, Niskanen L. Cost-effectiveness of sta-tins in the prevention of coronary heartdisease events in middle-aged Finnishmen. Curr Med Res Opin. 2008 Jun;24(6):1823-32.

17: Kruger PS; STATInS Investigators. Re:Statins and sepsis. Br J Anaesth. 2008Jun;100(6):862.

18: Athyros VG, Kakafika AI, PapageorgiouAA, Paraskevas KI, Tziomalos K, Ana-gnostis P, Pagourelias E, Koumaras C,Karagiannis A, Mikhailidis DP. Effectsof statin treatment in men and womenwith stable coronary heart disease: asubgroup analysis of the GREACEStudy. Curr Med Res Opin. 2008Jun;24(6):1593-9.

19: Qunibi W, Moustafa M, Muenz LR, HeDY, Kessler PD, Diaz-Buxo JA, BudoffM; CARE-2 Investigators. A 1-yearrandomized trial of calcium acetateversus sevelamer on progression of co-ronary artery calcification in hemo-dialysis patients with comparable lipidcontrol: the Calcium Acetate RenagelEvaluation-2 (CARE-2) study. Am JKidney Dis. 2008 Jun;51(6):952-65.

20: Kadoglou NP, Gerasimidis T, Moum-tzouoglou A, Kapelouzou A, Sailer N,Fotiadis G, Vitta I, Katinios A, KougiasP, Bandios S, Voliotis K, KarayannacosPE, Liapis CD. Intensive lipid-loweringtherapy ameliorates novel calcificationmarkers and GSM score in patients withcarotid stenosis. Eur J Vasc EndovascSurg. 2008 Jun;35(6):661-8.

21: Stanca CM, Bach N, Allina J, Bodian C,Bodenheimer H Jr, Odin JA. Atorvasta-tin does not improve liver biochemi-stries or Mayo Risk Score in primarybiliary cirrhosis. Dig Dis Sci. 2008Jul;53(7):1988-93.

22: Müller K, Skepper JN, Tang TY, GravesMJ, Patterson AJ, Corot C, Lancelot E,Thompson PW, Brown AP, Gillard JH.Atorvastatin and uptake of ultrasmallsuperparamagnetic iron oxide nano-particles (Ferumoxtran-10) in humanmonocyte-macrophages: implicationsfor magnetic resonance imaging. Bio-materials. 2008 Jun;29(17):2656-62.

23: Parini P, Gustafsson U, Davis MA, Lars-son L, Einarsson C, Wilson M, RudlingM, Tomoda H, Omura S, Sahlin S,Angelin B, Rudel LL, Eriksson M. Cho-lesterol synthesis inhibition elicits anintegrated molecular response in hu-man livers including decreased ACAT2.Arterioscler Thromb Vasc Biol. 2008Jun;28(6):1200-6.

24: Goulas A, Kosmidou M, Hatzitolios AI,Molyva D, Fidani L, Giannopoulos S,Mirtsou V. Glutathione S-transferasenull and cholesteryl ester transfer pro-tein TaqI B polymorphisms and lipidresponse to atorvastatin in Greek dysli-pidaemic patients. Basic Clin Pharma-col Toxicol. 2008 Jun;102(6):559-62.

25: Hashimoto T, Toya Y, Kihara M, YabanaM, Inayama Y, Tanaka K, Iwatsubo K,Yanagi M, Oshikawa J, Kokuho T, Kuji T,Yoshida S, Tamura K, Umemura S.Behçet's disease complicated by IgAnephropathy with nephrotic syndrome.Clin Exp Nephrol. 2008 Jun;12(3):224-7.

26: Ford JS, Tayek JA. Lipophilicity andcardiovascular outcome in patients withCHF. Am Heart J. 2008 Aug;156(2):e7;author reply e9.

27: Sànchez CA, Rodriguez E, Varela E,

Zapata E, Pàez A, Massfi FA, Montan~oLF, Lfiopez-Marure R. Statin-inducedinhibition of MCF-7 breast cancer cellproliferation is related to cell cyclearrest and apoptotic and necrotic celldeath mediated by an enhanced oxida-tive stress. Cancer Invest. 2008 Aug;26(7): 698-707.

28: Nozue T, Michishita I, Ito Y, Hirano T. Ef-fects of statin on small dense low-density lipoprotein cholesterol and rem-nant-like particle cholesterol in hetero-zygous familial hypercholesterolemia. JAtheroscler Thromb. 2008 Jun;15(3):146-53.

29: Montero J, Morales A, Llacuna L, Lluis

JM, Terrones O, Basan~ez G, AntonssonB, Prieto J, Garcia-Ruiz C, Colell A,Fernàndez-Checa JC. Mitochondrialcholesterol contributes to chemothera-py resistance in hepatocellular carcino-ma. Cancer Res. 2008 Jul 1;68(13):5246-56.

30: Tsai CT, Lai LP, Hwang JJ, Wang YC,Chiang FT, Lin JL. Atorvastatin preventsatrial fibrillation in patients with bradyar-rhythmias and implantation of an atrial-based or dual-chamber pacemaker: aprospective randomized trial. Am HeartJ. 2008 Jul;156(1):65-70.

™ ∂ ¶ Δ ∂ ª μ ƒ π √ ™ 2 0 0 8

32

¶ƒ√Δ∂π¡√ª∂¡∏ μπμ§π√°ƒ∞ºπ∞

∂ÈÌ¤ÏÂÈ·: μ·Û›ÏÂÈÔ˜ Õı˘ÚÔ˜

IATPOI KA§§ITEXNE™ IATPOI KA§§ITEXNE™ IATPOI KA§§ITEXNE™

∂πƒ∏¡∏ º∞¡√Àƒ∞∫∏∏ ∂ÈÚ‹ÓË º·ÓÔ˘Ú¿ÎË ÁÂÓÓ‹ıËÎÂ ÛÙÔ ∏Ú¿ÎÏÂÈÔ ∫Ú‹ÙË˜ ÙÔ 1978, fiÔ˘ Î·È ÙÂÏÂ›ˆÛÂ ÙÔ §‡ÎÂÈÔ. ™Ô‡‰·-ÛÂ π·ÙÚÈÎ‹ ÛÙÔ ¶·ÓÂÈÛÙ‹ÌÈÔ ¶¿ÙÚ·˜ Î·È ˘ËÚ¤ÙËÛÂ ˆ˜ ·ÁÚÔÙÈÎfi˜ È·ÙÚfi˜ ÛÙÔ ∫¤ÓÙÚÔ ÀÁÂ›·˜ ¶ÂÚ¿Ì·-ÙÔ˜ ÙÔ˘ ¡ÔÌÔ‡ ƒÂı‡ÌÓË˜. ªÂ ÙË ˙ˆÁÚ·ÊÈÎ‹ ·Û¯ÔÏÂ›Ù·È ÂÚ·ÛÈÙÂ¯ÓÈÎ¿ ·fi ÙË ·È‰ÈÎ‹ ÙË˜ ËÏÈÎ›·

Documents

ΤΕΥΧΟΣ 19 ΣΕΠΤΕΜΒΡΙΟΣ 2008 - ΑΘΗΡΟΣΚΛΗΡΩΣΗ