136ｾ408 縺0106 ﾌ036ﾑ86ｾ4 ﾌ04 ﾇ 罔ﾐ6ﾑ86ｾ4 ｨB080ｸ ｧ90ｷ ｧ8 apple080ｸ7046ｧ ｦ001000ｷ ｹ ｧ9000ｹ ｧ9000ｹ0, 02

ªÂ ÙÔÓ fiÚÔ ÂÚÈÊÂÚÈ΋ ·ÚÙËÚÈÔ-¿ıÂÈ· ‹ ÂÚÈÊÂÚÈ΋ ·ÚÙËÚȷ΋ ÓfiÛÔ˜ (¶∞¡) ·Ó·ÊÂÚfiÌ·ÛÙ ÛÙËÓ ·ıËÚÔÛÎÏËÚˆÙÈ΋˜ ·ÈÙÈÔ-ÏÔÁ›·˜ ‘·ÔÊÚ·ÎÙÈ΋’ ÓfiÛÔ ÙˆÓ ·ÚÙËÚÈÒÓ ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ Î·È Ù˘ ÎÔÈÏȷ΋˜ ·ÔÚÙ‹˜. √ ÂÎÙÈÌÒ-ÌÂÓÔ˜ ÂÈÔÏ·ÛÌfi˜ Ù˘ ÓfiÛÔ˘ ÂÍ·ÚÙ¿Ù·È ·fi ‰ËÌÔÁÚ·ÊÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÙˆÓ ˘fi ÌÂϤÙË ÏËı˘ÛÌÒÓ, ηıÒ˜ Î·È ·fi ÙȘ ÌÂıfi‰Ô˘˜ Ù˘ ‰È¿ÁÓˆÛ˘. °È· ·Ú¿‰ÂÈÁÌ·, Ô ÂÈÔÏ·ÛÌfi˜ Ù˘ ¶∞¡ Â›Ó·È ‰ÈÏ¿ÛÈÔ˜ ÛÙÔ˘˜ ∞ÊÚÈηÓÈ΋˜ ηٷÁˆÁ‹˜ ∞ÌÂÚÈ-ηÓÔ‡˜ Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ ÌË ÈÛ·ÓfiʈÓÔ˘˜ Ï¢ÎÔ‡˜, ÁÂÁÔ-Ófi˜ Ô˘ ÌÔÚ› Ó· ÂÍËÁËı› ÌÂ-ÚÈÎÒ˜ ·fi ÙËÓ ÌÂÁ·Ï‡ÙÂÚË Â›-ÙˆÛË ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘ (∫∞¡), fiˆ˜ Ô Û·Î¯·Ú҉˘ ‰È·‚‹Ù˘, Ë ˘¤ÚÙ·ÛË Î·È Ë ·¯˘Û·ÚΛ·.[1] °ÂÓÈο, Ë Û˘¯ÓfiÙËÙ· Ù˘ ÓfiÛÔ˘ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË ÛÙÔ˘˜ ¿Ó‰Ú˜ Î·È ·˘Í¿ÓÂÙ·È Ì ÙËÓ ËÏÈΛ·.[1] ∏ ¶∞¡ ıˆÚÂ›Ù·È ˆ˜ ÂΉ‹ÏˆÛË Ù˘ Û˘ÛÙËÌ·ÙÈ΋˜ ·ıËÚÔÛÎÏË-Ú˘ÓÙÈ΋˜ ÓfiÛÔ˘ Ô˘ ¤¯ÂÈ ÂÍÂÏÈ-¯ı› ÛÙË ‰È¿ÚÎÂÈ· ·ÚÎÂÙÒÓ ¯Úfi-ÓˆÓ. √ ÛÊ˘ÚÔ‚Ú·¯ÈfiÓÈÔ˜ ‰Â›-ÎÙ˘ (∞µπ, ankle-brachial index) ¤¯ÂÈ ·ÍÈÔÏÔÁËı› ˆ˜ ȉȷ›ÙÂÚ· ¢·›ÛıËÙË Î·È ÂȉÈ΋ ̤ıÔ‰Ô˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ ¶∞¡ Î·È ıÂ-ˆÚÂ›Ù·È ‰Â›ÎÙ˘ ÁÂÓÈÎÂ˘Ì¤Ó˘ ·ıËڈ̿وÛ˘.[2] ¶ÚfiÛÊ·Ù· ‰Â-‰Ô̤ӷ ·fi ÙËÓ ÂȉËÌÈÔÏÔÁÈ΋ ηٷÁÚ·Ê‹ REACH ÂÈÛËÌ·›-ÓÔ˘Ó fiÙÈ ÂÚÈÛÛfiÙÂÚÔÈ ·fi ÙÔ 60% ÙˆÓ ·ÛıÂÓÒÓ Ì ¶∞¡ ›¯·Ó ÎÏÈÓÈΤ˜ ÂӉ›ÍÂȘ ÛÙÂÊ·ÓÈ·›·˜ ‹ ÂÁÎÂÊ·ÏÔ·ÁÁÂȷ΋˜ ÓfiÛÔ˘[3] (™¯‹-Ì· 1). ™Ë(™¯‹-Ì·ÓÙÈÎfi˜ ·ÚÈıÌfi˜ ÙˆÓ ·ÛıÂÓÒÓ Ì ¶∞¡ ·Ú·Ì¤ÓÔ˘Ó ·‰È¿ÁÓˆÛÙÔÈ[4]_{, ÂÓÒ ÛËÌ·ÓÙÈÎfi} ÔÛÔÛÙfi ·ÛıÂÓÒÓ Ì ÙÂÎÌËÚȈ-̤ÓË ¶∞¡ ‰ÂÓ Ï·Ì‚¿ÓÂÈ Î·Ù¿Ï-ÏËÏË ıÂÚ·¢ÙÈ΋ ·ÁˆÁ‹ Ì ·-Ú¿ÁÔÓÙ˜ Ô˘ ÌÂÈÒÓÔ˘Ó ÙÔÓ Î›Ó-‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ηډȷÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ[5, 6]_.

1. º˘ÛÈ΋ ÈÛÙÔÚ›·

·ÛıÂÓÒÓ Ì ¶∞¡ (™¯‹Ì· 2)

™ÙËÓ ÏÂÈÔÓfiÙËÙ¿ ÙÔ˘˜ ÔÈ ·ÛıÂ-Ó›˜ Ì ¶∞¡ Â›Ó·È ·Û˘Ìو̷ÙÈ-ÎÔ›. ªÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ·ÛıÂÓÒÓ Ì ‰È·Ï›Ô˘Û· ¯ˆÏfiÙËÙ· Ë Ô-Ú›· Â›Ó·È ÛÙ·-ıÂÚ‹ Î·È ÌfiÓÔ ¤Ó· ÌÈÎÚfi Ô-ÛÔÛÙfi ÂÌÊ·Ó›-˙ÂÈ Âȉ›ӈÛË Ù˘ Û˘Ìو̷-ÙÔÏÔÁ›·˜ ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ[5, 6]_. ¶ÚfiÎÂÈÙ·È ÁÈ· ÌÈ· ÂÍÂÏÈÎÙÈ΋ ‰È·‰Èηۛ· Ô˘ ÂÈ‚¿ÏÏÂÈ Ù Ë Ó  · ڤ̂·ÛË ÚÈÓ ·fi ÙËÓ ÂÌÊ¿ÓÈÛË Û˘-ÌÙˆÌ¿ÙˆÓ Î·È ÛËÌ›ˆÓ ÎÚ›ÛÈ-Ì˘ ÈÛ¯·ÈÌ›·˜ ÙÔ˘ ÛΤÏÔ˘˜.

2. ∏ ¶∞¡ ˆ˜ ÈÛÔ‰‡Ó·ÌÔ

ÛÙÂÊ·ÓÈ·›Ô˘ ÎÈÓ‰‡ÓÔ˘

∏ Èı·ÓfiÙËÙ· ÂΉ‹ÏˆÛ˘ ·ıË-ÚÔÛÎÏËÚˆÙÈÎÒÓ ÂÈÏÔÎÒÓ Â›Ó·È ·˘ÍË̤ÓË ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ¶∞¡. √ ΛӉ˘ÓÔ˜ ÂÌÊ¿ÓÈÛ˘ ÂÌ-ÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ôηډ›Ô˘ ›-Ó·È ÙÂÙÚ·Ï¿ÛÈÔ˜, ÂÓÒ Ô Î›Ó‰˘-ÓÔ˜ ·ÁÁÂÈ·ÎÔ‡ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÂÈ-ÛÔ‰›Ô˘ 2-3 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔ˜ Û ۇÁÎÚÈÛË Ì ¿ÙÔÌ· Ô˘ ‰ÂÓ ¤¯Ô˘Ó ÂÚÈÊÂÚÈ΋ ·ÚÙËÚÈÔ¿-ıÂÈ·. √È ·ÛıÂÓ›˜ Ì ¶∞¡ ‰È·-ÙÚ¤¯Ô˘Ó 2-4 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ Û˘ÓÔÏÈ΋˜ ıÓËÛÈÌfiÙËÙ·˜ Î·È 3-6 ÊÔÚ¤˜ ÈÔ ·˘ÍË̤ÓÔ Î›Ó-‰˘ÓÔ ıÓËÙfiÙËÙ·˜ ÂÍ·ÈÙ›·˜ ηÚ-‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ Û ۇ-ÁÎÚÈÛË Ì ·ÛıÂÓ›˜ Ô˘ ‰ÂÓ ¤¯Ô˘Ó ¶∞¡[1, 2, 9]_. √ ΛӉ˘ÓÔ˜ Ì›˙ÔÓÔ˜ ηډȷÁÁÂÈ-·ÎÔ‡ Û˘Ì‚¿Ì·ÙÔ˜ Â›Ó·È ·ÓÂÍ¿Ú-ÙËÙÔ˜ ·fi ÙËÓ ·ÚÔ˘Û›· ‹ fi¯È Û˘ÌÙˆÌ¿ÙˆÓ ‰È·Ï›Ô˘Û·˜ ¯ˆ-ÏfiÙËÙ·˜ Î·È Â›Ó·È ·˘ÍË̤ÓÔ˜ ·ÎfiÌË Î·È ÛÙȘ ÂÚÈÙÒÛÂȘ ·ÛıÂÓÒÓ ¯ˆÚ›˜ Û˘ÌÙÒÌ·Ù· Ô˘ ‰È·ÁÈÁÓÒÛÎÔÓÙ·È Ì ‚¿ÛË ÙË Ì¤-ÙÚËÛË ÙÔ˘ ∞µπ. ∫·Ù¿ Û˘Ó¤ÂÈ·, ÔÈ ·ÛıÂÓ›˜ Ì ¶∞¡ Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È ˆ˜ ·ÛıÂÓ›˜ Ù˘ ‰Â˘ÙÂÚÔÁÂÓÔ‡˜ ÚfiÏ˄˘, fiˆ˜ Î·È ÔÈ ·ÛıÂÓ›˜ Ì ÙÂÎÌË-ÚȈ̤ÓË ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ[10]_.

3. £ÂÚ·¢ÙÈ΋ ÚÔÛ¤ÁÁÈÛË

·ÛıÂÓÒÓ Ì ¶∞¡

∂ÎÙfi˜ ·fi ÙȘ ÂÚÈÙÒÛÂȘ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ Ú¤ÂÈ Ó· ·ÓÙÈÌÂ-ÙˆÈÛıÔ‡Ó ÂÂÈÁfiÓÙˆ˜ ·fi ÙÔÓ ·ÁÁÂÈÔ¯ÂÈÚÔ˘ÚÁfi, Ô È·ÙÚfi˜ Ù˘ ÚˆÙÔÁÂÓÔ‡˜ ÊÚÔÓÙ›‰·˜ ÔÊ›ÏÂÈ Ó· ·Ú·¤ÌÂÈ ÛÙÔÓ ÂȉÈÎfi ·Á-ÁÂÈÔ¯ÂÈÚÔ˘ÚÁfi οı ÂÚ›ÙˆÛË ·ÛıÂÓÔ‡˜ Ì ÂÌÌÔÓ‹ ÙˆÓ Û˘-ÌÙˆÌ¿ÙˆÓ ·Ú¿ ÙËÓ Î·Ù¿ÏÏËÏË ıÂÚ·›·, ·ÛıÂÓÒÓ Ô˘

ÂÌÊ·Ó›-∆ÚÔÔÔ›ËÛË ÙˆÓ ¶·Ú·ÁfiÓÙˆÓ

∫ÈÓ‰‡ÓÔ˘ Û ∞ÛıÂÓ›˜ ÌÂ

¶ÂÚÈÊÂÚÈ΋ ∞ÚÙËÚÈÔ¿ıÂÈ·

÷ڿϷÌÔ˜ ªËÏÈÒÓ˘*,

∂›ÎÔ˘ÚÔ˜ ∫·ıËÁËÙ‹˜ ¶·ıÔÏÔÁ›·˜,

π·ÙÚÈ΋ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ

ªÈÏÙÈ¿‰Ë˜ ª·ÙÛ¿Áη˜,

∂›ÎÔ˘ÚÔ˜ ∫·ıËÁËÙ‹˜ ∞ÁÁÂÈÔ¯ÂÈÚÔ˘ÚÁÈ΋˜,

π·ÙÚÈ΋ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ

™ÙÂÊ·ÓÈ·›· ÓfiÛÔ˜ ∂ÁÎÂÊ·ÏÔ·ÁÁÂȷ΋ ÓfiÛÔ˜ ¶ÂÚÈÊÂÚÈ΋ ·ÚÙËÚÈÔ¿ıÂÈ· ™¯‹Ì· 1. ™˘Ó‡·ÚÍË ÙˆÓ ÂΉËÏÒÛÂˆÓ Ù˘ ·ıËÚÔ-ÎÏËÚˆÙÈ΋˜ ·ÈÙÈÔÏÔÁ›·˜ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘[3] .

˙Ô˘Ó Ì›ˆÛË ‹ ·Ô˘Û›· ÛʇÍÂˆÓ ÛÙȘ ÌËÚÈ·›Â˜ ·ÚÙËڛ˜, ηıÒ˜ Î·È fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ۷Î-¯·ÚÒ‰Ë ‰È·‚‹ÙË[11]_{(¶›Ó·Î·˜ 1).} ∏ ÂÈıÂÙÈ΋ ·Ú¤Ì‚·ÛË Ì ÙÚÔ-ÔÔ›ËÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ Î·Ú-‰È·ÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ Ô˘ ÙÂÎ-ÌËÚȈ̤ӷ ·˘Í¿ÓÔ˘Ó ÙÔÓ Î›Ó‰˘-ÓÔ ¶∞¡ Â›Ó·È ÂȂ‚ÏË̤ÓË Î·È ‰ÂÓ Âȉ¤¯ÂÙ·È ¯ÚÔÓÔÙÚÈ‚‹˜[2, 9] (™¯‹Ì· 3).

3.1. ¢È·ÎÔ‹ ÙÔ˘ ηÓ›ÛÌ·ÙÔ˜

∆Ô Î¿ÓÈÛÌ· ‰ÈÏ·ÛÈ¿˙ÂÈ ÙÔÓ Î›Ó-‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ¶∞¡, ÂÓÒ Ë ÂÈ-ÌÔÓ‹ ÙˆÓ ·ÛıÂÓÒÓ Û ·˘Ù‹ ÙËÓ ÂÈ˙‹ÌÈ· Û˘Ó‹ıÂÈ· ˘ÂÚÙÚÈÏ·-ÛÈ¿˙ÂÈ ÙÔ Î›Ó‰˘ÓÔ Âȉ›ӈÛ˘ Ù˘ ‹‰Ë ˘¿Ú¯Ô˘Û·˜ ·ÚÙËÚÈÔ-¿ıÂÈ·˜[13] _{·˘Í¿ÓÔÓÙ·˜ ÙÔÓ} ΛÓ-‰˘ÓÔ ÂΉ‹ÏˆÛ˘ ÎÚÈÙÈ΋˜ ÈÛ¯·È-Ì›·˜ ÙÔ˘ ÛΤÏÔ˘˜ ‹/Î·È ·ÎÚˆÙË-ÚÈ·ÛÌÔ‡. ™Â ÌÈ· ÌÂϤÙË ·Ú·Ù‹-ÚËÛ˘ ‚Ú¤ıËΠÌÈ· ‰ÔÛÔ-ÂÍ·Ú-ÙÒÌÂÓË Û˘Û¯¤ÙÈÛË ÙÔ˘ ηÓ›-ÛÌ·ÙÔ˜ Î·È ÙˆÓ ·ÎÚˆÙËÚÈ·ÛÌÒÓ Û ·ÛıÂÓ›˜ Ì ¶∞¡[14] . ∞ÓÙ›ıÂÙ·, Ë ‰È·ÎÔ‹ ÙÔ˘ ηÓ›ÛÌ·ÙÔ˜ ·˘-Í¿ÓÂÈ ÙËÓ ÂÈ‚›ˆÛË[15] . °È· ÙË ‰È·ÎÔ‹ ÙÔ˘ ηÓ›ÛÌ·-ÙÔ˜ Û˘ÓÈÛÙ¿Ù·È Ë Û˘ÌÌÂÙÔ¯‹ ÙˆÓ ·ÛıÂÓÒÓ ÛÂ Û˘Ì‚Ô˘Ï¢ÙÈο ÚÔÁÚ¿ÌÌ·Ù· ‚Ô‹ıÂÈ·˜ ‹/Î·È ¯Ú‹ÛË Ê·Ú̷΢ÙÈÎÒÓ ·Ú·Áfi-ÓÙˆÓ, fiˆ˜ ÙÔ ‚Ô˘ÚfiÈÔ, Ù· ˘ÔηٿÛٷٷ ÓÈÎÔÙ›Ó˘, ηıÒ˜ Î·È ÓÂfiÙÂÚ· Ê¿Ú̷η fiˆ˜ Ë ‚·ÚÂÓÈÎÏ›ÓË[16] .

3.2. ÕÛÎËÛË

∞fi Ù· ÌË Ê·Ú̷΢ÙÈο ̤ÙÚ·, Ë ·‡ÍËÛË Ù˘ ۈ̷ÙÈ΋˜ ‰Ú·-ÛÙËÚÈfiÙËÙ·˜ ¤¯ÂÈ ·Ô‰Âȯı› fiÙÈ ‚ÂÏÙÈÒÓÂÈ ÙË Û˘Ìو̷ÙÔÏÔÁ›· ÙˆÓ ·ÛıÂÓÒÓ, Èı·ÓfiÓ ‰È·Ì¤ÛÔ˘ Ù˘ ‚ÂÏÙ›ˆÛ˘ Ù˘ ÏÂÈÙÔ˘ÚÁÈÎfi-ÙËÙ·˜ ÙÔ˘ ÂÓ‰ÔıËÏ›Ô˘, Ù˘ Ì›ˆ-Û˘ Ù˘ ÊÏÂÁÌÔÓÒ‰Ô˘˜ ‰ÈÂÚÁ·-Û›·˜, Ù˘ ¢ÓÔ˚΋˜ Â›‰Ú·Û˘ ÛÙÔ ÌÂÙ·‚ÔÏÈÛÌfi ÙˆÓ Ì˘ÒÓ Î·È ÛÙÔ˘˜ ·ÈÌÔÚÚÂÔÏÔÁÈÎÔ‡˜ ·Ú¿-ÁÔÓÙ˜[17] . ™ÙȘ Û‡Á¯ÚÔÓ˜ Û˘ÛÙ¿-ÛÂȘ ·ÓÙÈÌÂÙÒÈÛ˘ ÙˆÓ ·ÛıÂÓÒÓ Ì ¶∞¡ Ë ¿ÛÎËÛË ·ÔÙÂÏ› Úˆ-Ù·Ú¯ÈÎfi ̤ÙÚÔ ·Ú¤Ì‚·Û˘[2, 9]_. ™ÙȘ ηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ Û˘-ÛÙ‹ÓÂÙ·È Â›Ù ¤Ó· ÚfiÁÚ·ÌÌ· ¿ÛÎËÛ˘ ˘fi Â›‚ÏÂ„Ë ÂÏ¿¯È-ÛÙ˘ ‰È¿ÚÎÂÈ·˜ 30-45 min, ÙÔ˘-Ï¿¯ÈÛÙÔÓ 3 ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰· ÁÈ· ÂÚÈÛÛfiÙÂÚ˜ ·fi 12 ‚‰Ô-Ì¿‰Â˜ ›Ù ·ÙÔÌÈÎfi ÚfiÁÚ·ÌÌ· ¿ÛÎËÛ˘ (‚¿‰ÈÛÌ·) ¯ˆÚ›˜ Â›-‚ÏÂ„Ë ÙÔ˘Ï¿¯ÈÛÙÔÓ 3 ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰·. ™Â ÌÈ· Ù˘¯·ÈÔÔÈË̤ÓË ÌÂϤÙË ÛÙËÓ ÔÔ›· Û˘ÌÌÂÙ›¯·Ó 882 ¿Ó-‰Ú˜ ·ÛıÂÓ›˜ Ì ·Û˘Ìو̷ÙÈ-΋ ¶∞¡, ̤Û˘ ËÏÈΛ·˜ 73 ÂÙÒÓ, ÂÊ·ÚÌfiÛÙËΠ›Ù ¤Ó· ‰ÔÌË̤ÓÔ ÚfiÁÚ·ÌÌ· ‰È·ÎÔ‹˜ ÙÔ˘ ηÓ›-ÛÌ·ÙÔ˜ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ·‡ÍËÛË ÛˆÌ·ÙÈ΋˜ ‰Ú·ÛÙËÚÈfi-ÙËÙ·˜ (ÔÌ¿‰· ·Ú¤Ì‚·Û˘, n=441) ›Ù ÔÈ ·ÛıÂÓ›˜ ·Ê¤ıË-Î·Ó ÛÙËÓ Î·ıÈÂڈ̤ÓË ÊÚÔÓÙ›‰· ÙÔ˘ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÁÈ·ÙÚÔ‡ (ÔÌ¿-‰· ÂϤÁ¯Ô˘, n=441). ™‡Ìʈӷ Ì ٷ ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤ-Ù˘, ÛÙËÓ ÔÌ¿‰· Ù˘ ·Ú¤Ì‚·-Û˘ ·Ú·ÙËÚ‹ıËÎ·Ó ÌÂÁ·Ï‡ÙÂ-Ú· ÔÛÔÛÙ¿ ‚ÂÏÙ›ˆÛ˘ Ù˘ ̤ÁÈ-ÛÙ˘ ‰È·Ó˘fiÌÂÓ˘ ·fiÛÙ·Û˘ (maximum walking distance, Ô-ÛÔÛÙfi ‚ÂÏÙ›ˆÛ˘ Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ (23% vs 15%;

P

=0.008). ∞˘Ùfi ·Ô‰fiıË-Π΢ڛˆ˜ ÛÙËÓ ·‡ÍËÛË Ù˘ Ûˆ-Ì·ÙÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ [34% ÙˆÓ ·ÛıÂÓÒÓ ÛÙËÓ ÔÌ¿‰· Ù˘ ·Ú¤Ì‚·Û˘ ÂÚ·ÙÔ‡Û·Ó Â-ÚÈÛÛfiÙÂÚ˜ ·fi 3 ÊÔÚ¤˜ ÙËÓ Â‚-‰ÔÌ¿‰· vs 25% ÛÙËÓ ÔÌ¿‰· ÂϤ-Á¯Ô˘ (

P

=0.01)]. ∞Í›˙ÂÈ Ó· ÛËÌÂȈ-ı› fiÙÈ ÛÙËÓ ÔÌ¿-‰· Ù˘ ·Ú¤Ì‚·-Û˘ 12% ÙˆÓ Î·-ÓÈÛÙÒÓ Î·ÙfiÚ-ıˆÛ ӷ ‰È·Îfi-„ÂÈ ÙÔ Î¿ÓÈÛÌ· ¤Ó·ÓÙÈ 8% ÛÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ (

P

=0.43)

3.3. ∞ÓÙÈ·ÈÌÔÂÙ·Ïȷ΋

·ÁˆÁ‹

ªÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ÌÂÏÂÙÒÓ ¤‰ÂÈ-Í fiÙÈ Ë ¯ÔÚ‹ÁËÛË ·ÓÙÈ·ÈÌÔÂÙ·-Ïȷ΋˜ ·ÁˆÁ‹˜ (Ù˘Èο Ì ·ÛÈ-Ú›ÓË) ÌÂÈÒÓÂÈ ÙË ıÓËÛÈÌfiÙËÙ· Î·È Ù· ηډȷÁÁÂȷο Û˘Ì‚¿Ì·Ù· Û ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ·ÛıÂÓ›˜ Ì ¶∞¡. ™Â ÌÈ· ÌÂÙ·-·Ó¿Ï˘ÛË 42 Ù˘¯·ÈÔÔÈËÌ¤ÓˆÓ ÌÂÏÂÙÒÓ, Ô˘ Û˘ÌÂÚȤϷ‚·Ó Û˘ÓÔÏÈο 9700 ·ÛıÂÓ›˜ ÌÂ Û˘Ìو̷ÙÈ΋ ¶∞¡, Ë ¯ÔÚ‹ÁËÛË ·ÓÙÈ·ÈÌÔÂÙ·Ïȷ΋˜ ·ÁˆÁ‹˜ Û˘Û¯ÂÙ›˙ÔÓÙ·Ó Ì Ì›ˆ-ÛË Î·Ù¿ 23% ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌ-ÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ôηډ›Ô˘, ·Á-ÁÂÈ·ÎÔ‡ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ ‹ ηډȷÁÁÂȷ΋˜ ıÓËÛÈÌfiÙËÙ·˜ Û ۇÁÎÚÈÛË Ì ÙË Ï‹„Ë ÂÈÎÔÓÈ-ÎÔ‡ Ê·ÚÌ¿ÎÔ˘[19] . ™ÙË ÌÂϤÙË CAPRIE (Clopidogrel versus Aspirin in Patients at Risk of Ischemic Events), ÌÂٷ͇ ÙˆÓ 19185 ·ÛıÂÓÒÓ Û˘ÌÂÚÈÏ‹ÊıË-Î·Ó Î·È 6400 ·ÛıÂÓ›˜ Ì ¶∞¡, ÔÈ ÔÔ›ÔÈ Ù˘¯·ÈÔÔÈ‹ıËÎ·Ó Â›Ù Û ·ÛÈÚ›ÓË (325 mg/Ë̤ڷ) ›Ù Û ÎÏÔȉÔÁÚ¤ÏË (·ÓÙ·ÁˆÓÈÛÙ‹ ÙˆÓ ˘Ô‰Ô¯¤ˆÓ Ù˘ ‰ÈÊÔÛʈÚÈ΋˜ ·‰ÂÓÔÛ›Ó˘, 75 mg/Ë̤ڷ) . ∏ post-hoc ·Ó¿Ï˘ÛË ÙˆÓ ·ÛıÂÓÒÓ Ì ¶∞¡ ¤‰ÂÈÍ fiÙÈ Û ۇÁÎÚÈÛË Ì ÙËÓ ·ÛÈÚ›ÓË ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ‹Ú·Ó ÎÏÔȉÔÁÚ¤ÏË ·Ú·-ÙËÚ‹ıËΠ̛ˆÛË Î·Ù¿ 23.8% ÙÔ˘ Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈ-Û˘ ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ôηډ›-Ô˘, ÈÛ¯·ÈÌÈÎÔ‡ ·ÁÁÂÈ·ÎÔ‡ ÂÁÎÂ-Ê·ÏÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ ‹ ı·Ó·ÙËÊfi-ÚˆÓ Û˘Ì‚·Ì¿ÙˆÓ ·ÁÁÂȷ΋˜ ·È-ÙÈÔÏÔÁ›·˜ (

P

=0.0028). ∏ Û˘Á¯Ô-Ú‹ÁËÛË ·ÛÈÚ›Ó˘ Ì ÎÏÔȉÔ-ÁÚ¤ÏË Û ·ÁÁÂÈ·ÎÔ‡˜ ·ÛıÂÓ›˜ Ì ÔÏÏ·ÏÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ-‰‡ÓÔ˘ ‰ÂÓ ‚Ú¤ıËΠfiÙÈ ˘ÂÚ¤¯ÂÈ ÛÙË Ì›ˆÛË ÙˆÓ Û˘Ì‚·Ì¿ÙˆÓ, ÂÓÒ ·˘Í¿ÓÂÈ ÙÔ ÔÛÔÛÙfi ÙˆÓ ·È-ÌÔÚÚ·ÁÈÎÒÓ ÂÈÏÔÎÒÓ[21]_{. ∏} ¯Ô-Ú‹ÁËÛË ·ÓÙÈ·ÈÌÔÂÙ·ÏÈ·ÎÒÓ Û ·ÛıÂÓ›˜ Ì ¶∞¡ ¤¯ÂÈ Â˘ÓÔ˚΋ Â›‰Ú·ÛË ÛÙË ‚·ÙfiÙËÙ· ÙˆÓ ·Á-ÁÂÈ·ÎÒÓ ÌÔÛ¯Â˘Ì¿ÙˆÓ, ÙˆÓ ÂÓ-‰·ÁÁÂÈ·ÎÒÓ ÚÔı¤ÛÂˆÓ Î·È Ù˘ ·ÁÁÂÈÔÏ·ÛÙÈ΋˜[22]_. ™ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ¶∞¡ ÚÔÙ›-ÓÂÙ·È Ë ¯ÔÚ‹ÁËÛË ·ÛÈÚ›Ó˘ 75 mg-325 mg/Ë̤ڷ ‹ ÂÓ·ÏÏ·ÎÙÈ-ο ÎÏÔȉÔÁÚ¤Ï˘ 75 mg/Ë̤ڷ. ∏ ÂÈÏÔÁ‹ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÂÍ·ÙÔÌÈÎÂ˘Ì¤Ó· Ì ‚¿ÛË Û˘Ì·ÚÔÌ·ÚÙÔ‡Û˜ ηٷ-¶ÚˆÙÔÁÂÓ‹˜ ÊÚÔÓÙ›‰· - ‘∞‰˘Ó·Ì›·’ ‰È¿ÁÓˆÛ˘ - ¢˘Û¯¤ÚÂÈ· ÛÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË - ∂ÌÌÔÓ‹ Û˘ÌÙˆÌ¿ÙˆÓ ·Ú¿ ÙË ıÂÚ·›· - ªÂ›ˆÛË ‹ ·Ô˘Û›· ÛʇÍÂˆÓ ÛÙȘ ÌËÚÈ·›Â˜ ·ÚÙËڛ˜ - ™·Î¯·Ú҉˘ ‰È·‚‹Ù˘ ∂›ÁÔ˘Û·: - ∫Ú›ÛÈÌË ÈÛ¯·ÈÌ›· / ¶fiÓÔ˜ ÛÙËÓ ·Ó¿·˘ÛË - ŒÏÎÔ˜ ‹ °¿ÁÁÚ·ÈÓ· - ÀÔ„›· ∞∫∞ / ∆π∞ / Amaurosis Fugax ¶›Ó·Î·˜ 1. ∞Ó¿ÁÎË ∞ÁÁÂÈÔ¯ÂÈÚÔ˘ÚÁÈ΋˜ ∂ÎÙ›ÌËÛ˘ ∞ÛıÂÓÒÓ Ì ¶ÂÚÈÊÂÚÈ΋ ∞ÚÙËÚÈÔ¿ıÂÈ·[2,9]_.

ÛÙ¿ÛÂȘ, ÙËÓ ·ÓÔ¯‹ ÙÔ˘ ·ÛıÂ-ÓÔ‡˜ Î·È ÙÔ ÎfiÛÙÔ˜[2, 9]_.

3.4. ÀÔÏÈȉ·ÈÌÈ΋ ·ÁˆÁ‹

∂ȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ ˘¿Ú¯ÂÈ ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂ-ٷ͇ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ¶∞¡ Î·È ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ÔÏÈ΋˜, Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘, Î·È ÙˆÓ ÙÚÈÁÏ˘ÎÂ-Úȉ›ˆÓ Î·È ·ÚÓËÙÈ΋ ÌÂٷ͇ ¶∞¡ Î·È ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ HDL-¯ÔÏË-ÛÙÂÚfiÏ˘. ¶Ú¿ÁÌ·ÙÈ ÁÈ· οı ·‡-ÍËÛË Ù˘ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ ηٿ 10 mg/dL Ô Î›Ó‰˘ÓÔ˜ ÂÌÊ¿ÓÈÛ˘ ¶∞¡ ·˘Í¿ÓÂÙ·È Î·Ù¿ 5% -10%[23]_{, ÂÓÒ ÁÈ· οı ÌÔÓ¿‰·} ·‡-ÍËÛ˘ ÙÔ˘ ËÏ›ÎÔ˘ ÔÏÈ΋/ HDL-¯ÔÏËÛÙÂÚfiÏË Ô Û¯ÂÙÈÎfi˜ ΛӉ˘-ÓÔ˜ ¶∞¡ ·˘Í¿ÓÂÙ·È Î·Ù¿ 35%[13] . ◊‰Ë ÚÈÓ ·fi ÙËÓ ÂÌÊ¿ÓÈÛË ÙˆÓ ÛÙ·ÙÈÓÒÓ, Ë Ì›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ Ì ˘ÔÏÈȉ·È-ÌÈο Ê¿Ú̷η ‹ Ì ÙË ¯ÂÈÚÔ˘ÚÁÈ-΋ ÌÂÚȯÂÈÚÔ˘ÚÁÈ-΋ ·Ú¿Î·Ì„Ë ÙÔ˘ ÂÈÏÂÔ‡ ›¯Â ·Ô‰Âȯı› fiÙÈ ÌÂÈÒÓÂÈ ‹ ÂÈ-‚Ú·‰‡ÓÂÈ ÙËÓ ÂͤÏÈÍË ÙˆÓ ·ıËÚÔ-ÛÎÏËÚˆÙÈÎÒÓ ‚Ï·‚ÒÓ ÛÙȘ ÌËÚÈ-·›Â˜ ·ÚÙËڛ˜[24]_{. ªÈ· post-hoc} ·Ó¿Ï˘ÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Ù˘ ÌÂϤÙ˘ 4S (Simvastatin Scandi-navian Survival Study) ¤‰ÂÈÍ fiÙÈ Ë ¯ÔÚ‹ÁËÛË ÛÈÌ‚·ÛÙ·Ù›Ó˘ Û ÛÙÂÊ·ÓÈ·›Ô˘˜ ·ÛıÂÓ›˜ Ì ˘ÂÚ-¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· Ì›ˆÛ ηٿ 38% ÙËÓ ÂÌÊ¿ÓÈÛË Ó¤·˜ ‹ ÙËÓ Âȉ›ӈÛË ÚÔ¸¿Ú¯Ô˘Û·˜ ‰È·-Ï›Ô˘Û·˜ ¯ˆÏfiÙËÙ·˜[25] . ¢Â‰Ô-̤ӷ ·fi ÙË ÌÂϤÙË Heart Protection Study ¤‰ÂÈÍ·Ó fiÙÈ ÔÈ ·ÛıÂÓ›˜ Ì ¶∞N ˆÊÂÏÔ‡ÓÙ·È ÛÙÔÓ ›‰ÈÔ ‚·ıÌfi Ì ÙÔ˘˜ ·ÛıÂ-Ó›˜ Ô˘ ¤¯Ô˘Ó ¿ÏÏÔ˘ ›‰Ô˘˜ ·Á-ÁÂȷ΋ ÓfiÛÔ (Ì›ˆÛË Î·Ù¿ 24% ÙˆÓ ÌÂÈ˙fiÓˆÓ ·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·-Ì¿ÙˆÓ), ·ÓÂÍ¿ÚÙËÙ· ·fi Ù· Â›-‰· ÙˆÓ ÏÈȉ›ˆÓ Î·È ·ÓÂÍ¿ÚÙË-Ù· ·fi ÙËÓ ·ÚÔ˘Û›· ۷ί·ÚÒ-‰Ë ‰È·‚‹ÙË[26]_. ™¯ÂÙÈο ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ÂȂ‚·ÈÒÛÂÈ ÙË ÛËÌ·ÓÙÈ΋ ı¤ÛË Ù˘ ıÂÚ·›·˜ Ì ÛÙ·Ù›Ó˜ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ·ÛıÂÓÒÓ Ì ¶∞¡ Î·È ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· ÙfiÛÔ ÁÈ· ÙË ‚ÂÏÙ›ˆÛË ÙˆÓ Û˘Ìو̿-ÙˆÓ[27] fiÛÔ Î·È ÁÈ· ÙËÓ ·‡ÍËÛË Ù˘ Û˘ÓÔÏÈ΋˜ ÂÈ‚›ˆÛ˘[28]_. ∞Í›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈ Ë ıÂÚ·-›· Ì ÙË ¯ÔÚ‹ÁËÛË ÛÙ·ÙÈÓÒÓ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ¶∞¡ ¤¯ÂÈ Â˘-ÓÔ˚΋ Â›‰Ú·ÛË ÛÙÔ˘˜ ‰Â›ÎÙ˜ Ù˘ ÊÏÂÁÌÔÓ‹˜, Î·È È‰È·›ÙÂÚ· ÛÙȘ Û˘ÁÎÂÓÙÚÒÛÂȘ Ù˘ C-·ÓÙȉÚÒ-Û·˜ ÚˆÙ½Ó˘ (CRP). ∞˘Ù‹ Ë ·ÓÙÈÊÏÂÁÌÔÓ҉˘ ‰Ú¿ÛË ÙˆÓ ÛÙ·ÙÈÓÒÓ ¤¯ÂÈ ‚ÚÂı› fiÙÈ Û˘Û¯ÂÙ›-˙ÂÙ·È Ì Ì›ˆÛË Ù˘ Û˘ÓÔÏÈ΋˜ ıÓËÛÈÌfiÙËÙ·˜ Î·È ÙËÓ ·‡ÍËÛË Ù˘ ÂχıÂÚ˘ Û˘ÌÙˆÌ¿ÙˆÓ ÂÈ‚›ˆ-Û˘ ·˘ÙÒÓ ÙˆÓ ·ÛıÂÓÒÓ[28]_. Ÿˆ˜ Î·È ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÛÙÂ-Ê·ÓÈ·›· ÓfiÛÔ, ·ÚÈÔ˜ ÛÙfi¯Ô˜ Ù˘ ˘ÔÏÈȉ·ÈÌÈ΋˜ ·ÁˆÁ‹˜ Â›Ó·È Ë Ì›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ LDL-¯Ô-ÏËÛÙÂÚfiÏ˘ οو ·fi 100 mg/dL ‹ Î·È Î¿Ùˆ ·fi 70 mg/dL Û ·ÛıÂÓ›˜ Ì Ôχ ·˘ÍË̤ÓÔ Î·Ú-‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ[29]_.

3.5. ŒÏÂÁ¯Ô˜ Ù˘ ˘¤ÚÙ·Û˘

∏ Û˘Û¯¤ÙÈÛË ˘¤ÚÙ·Û˘ Î·È ¶∞¡ ıˆÚÂ›Ù·È ÏÈÁfiÙÂÚÔ ÈÛ¯˘Ú‹ Û ۇÁÎÚÈÛË Ì ÙË Û˘Û¯¤ÙÈÛË ¶∞¡ Î·È Î·Ú‰È·ÁÁÂȷ΋˜ ‹ ÛÙÂÊ·ÓÈ·›-·˜ ÓfiÛÔ˘. ™ÙË ÌÂϤÙË ÙÔ˘ Framingham, Ë ˘¤ÚÙ·ÛË ·Ô-‰Â›¯ıËΠfiÙÈ ·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ‰˘fiÌÈÛÈ ÊÔÚ¤˜ ÂÚÈÛÛfiÙÂÚÔ ÛÙÔ˘˜ ¿Ó‰Ú˜ Î·È Î·Ù¿ 4 ÊÔÚ¤˜ ÂÚÈÛÛfiÙÂÚÔ ÛÙȘ Á˘Ó·›Î˜ Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ ÓÔÚÌÔÙ·ÛÈ-ÎÔ‡˜ ·ÛıÂÓ›˜[30]_{. ¡ÂfiÙÂÚ·} ÂÈ-‰ËÌÈÔÏÔÁÈο ‰Â‰Ô̤ӷ ÂȂ‚·È-ÒÓÔ˘Ó fiÙÈ ÔÈ ˘ÂÚÙ·ÛÈÎÔ› ¤¯Ô˘Ó ‰ÈÏ¿ÛÈ· Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ¶∞¡[12]_. ŸÏÔÈ ÔÈ ·ÓÙÈ˘ÂÚÙ·ÛÈÎÔ› ·Ú¿-ÁÔÓÙ˜ ÌÔÚÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈ-ËıÔ‡Ó ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ¶∞¡. ¶·Ú¿ ÙËÓ ·ÓËÛ˘¯›· Û¯ÂÙÈο Ì ÙË ‰˘ÛÌÂÓ‹ Â›‰Ú·ÛË ÙˆÓ ‚-·Ô-ÎÏÂÈÛÙÒÓ, ÛËÌ·ÓÙÈÎfi˜ ·ÚÈıÌfi˜ ÌÂÏÂÙÒÓ Î·È ÌÂÙ·-·Ó·Ï‡ÛÂˆÓ ¤¯ÂÈ ·ÔηٷÛÙ‹ÛÂÈ ÙË ı¤ÛË ÙÔ˘˜ Î·È ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ˘ÂÚÙ·ÛÈÎÒÓ ·ÛıÂÓÒÓ Ì ¶∞¡[31]_. ™ÙË ÌÂϤÙË ∏√ƒ∂ (Heart Out-comes Prevention Evaluation), ÙÔ ÂÈÚfiÛıÂÙÔ fiÊÂÏÔ˜ ÛÙË Ì›ˆÛË ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿-ÙˆÓ ·fi ÙË ¯ÔÚ‹ÁËÛË ÂÓfi˜ ·ÓÙ·-ÁˆÓÈÛÙ‹ ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡-ÌÔ˘ Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘ (·-ª∂∞), Ù˘ Ú·ÌÈÚ›Ï˘, ‹Ù·Ó ÙÔ ›‰ÈÔ ÛË-Ì·ÓÙÈÎfi ÙfiÛÔ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ¶∞¡ fiÛÔ Î·È ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ¿ÏϘ ÂΉËÏÒÛÂȘ ·ÁÁÂȷ΋˜ Ófi-ÛÔ˘[32] . ™ÙË ÌÂϤÙË ·˘Ù‹ Ù˘¯·ÈÔ-ÔÈ‹ıËÎ·Ó 4051 ·ÛıÂÓ›˜ Ì ¶∞¡, ÛÙÔ˘˜ ÔÔ›Ô˘˜ Ë ¯ÔÚ‹ÁËÛË Ú·ÌÈÚ›Ï˘ Ì›ˆÛ ηٿ 22% ÙÔ Û¯ÂÙÈÎfi ΛӉ˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ÂÌ-ÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ôηډ›Ô˘, ·Á-ÁÂÈ·ÎÔ‡ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ ‹ Ù˘ ıÓËÙfiÙËÙ·˜ ·fi ηډȷÁ-ÁÂȷ΋ ÓfiÛÔ[32] . √È ÛÙfi¯ÔÈ Ù˘ ·ÓÙÈ˘ÂÚÙ·ÛÈ΋˜ ·ÁˆÁ‹˜ ηıÔÚ›˙ÔÓÙ·È ÛÙËÓ Â›-Ù¢ÍË ÂÈ¤‰ˆÓ ¯·ÌËÏfiÙÂÚˆÓ ·fi 140/90 mmHg ‹ ¯·ÌËÏfiÙÂ-ÚˆÓ ·fi 130/80 mmHg Û ·ÛıÂ-Ó›˜ Ì ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Î·È ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ÓfiÛÔ[2, 9]_{. ∏}

ÌÂϤ-ÙË ABCD (Appropriate Blood Pressure Control in Diabetics) ¤‰ÂÈÍ fiÙÈ Ë ¯ÔÚ‹ÁËÛË ÂÈıÂÙÈ-΋˜ ıÂÚ·›·˜ (Ì ¤Ó·Ó ·-ª∂∞, ÙËÓ ÂÓ·Ï·Ú›ÏË, ‹ Ì ¤Ó·Ó ·ÓÙ·-ÁˆÓÈÛÙ‹ ÙˆÓ ‰È·‡ÏˆÓ ·Û‚ÂÛÙ›Ô˘, ÙËÓ ÓÈÛÔωÈ›ÓË) ÁÈ· ÙËÓ Â›Ù¢ÍË ÙˆÓ ÛÙfi¯ˆÓ Ù˘ ·ÓÙÈ˘ÂÚÙ·ÛÈ-΋˜ ·ÁˆÁ‹˜ ηٷÚÁ› ÙËÓ ·ÚÓË-ÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙÔ˘ ∞µπ Î·È ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛ˘ ÂÌ-ÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ôηډ›Ô˘, ·Á-ÁÂÈ·ÎÔ‡ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ ‹ Ù˘ ıÓËÙfiÙËÙ·˜ ·fi ηډȷÁ-™¯‹Ì· 2. º˘ÛÈ΋ ÈÛÙÔÚ›· Ù˘ ÂÚÈÊÂÚÈ΋˜ ·ÚÙËÚȷ΋˜ ÓfiÛÔ˘[2,9]_.

ÁÂȷ΋ ÓfiÛÔ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ¶∞¡[33]_.

3.6. ŒÏÂÁ¯Ô˜ Ù˘ ÁÏ˘¯·ÈÌ›·˜

¢Â‰Ô̤ӷ ÌÂÏÂÙÒÓ ·Ú·Ù‹ÚË-Û˘ ¤‰ÂÈÍ·Ó fiÙÈ Ë ·ÚÔ˘Û›· Û·Î-¯·ÚÒ‰Ë ‰È·‚‹ÙË ·˘Í¿ÓÂÈ ÛËÌ·-ÓÙÈο ÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ¶∞¡ ȉȷ›ÙÂÚ· Û ËÏÈÎȈ̤ÓÔ˘˜ (¿Óˆ ÙˆÓ 60 ¯ÚfiÓˆÓ) ηÓÈÛÙ¤˜ Ì ˘¤ÚÙ·ÛË Î·È ˘ÂÚ¯ÔÏËÛÙÂ-ÚÔÏ·ÈÌ›·[12, 23]_. ¢ÂÓ ¤¯ÂÈ ·Ô‰Âȯı› Ì ۷ʋ-ÓÂÈ· fiÙÈ Ë ÂÈıÂÙÈ΋ ·ÓÙÈÌÂÙÒÈ-ÛË ÙÔ˘ ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡-Ô˘ 1 Î·È Ù‡Ù‡-Ô˘ 2 ÌÂÈÒÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·-Ì¿ÙˆÓ Û ·ÛıÂÓ›˜ ¶∞¡[34, 35]_. øÛÙfiÛÔ, Û fiÏÔ˘˜ ÙÔ˘˜ ‰È·‚ËÙÈ-ÎÔ‡˜ ·ÛıÂÓ›˜ Û˘ÓÈÛÙ¿Ù·È Ë ‰È·-Ù‹ÚËÛË Ù˘ ÁÏ˘ÎÔ˙˘ÏȈ̤Ó˘ ·ÈÌÔÛÊ·ÈÚ›Ó˘ (HbA1C) Û Â›-‰· ÌÈÎÚfiÙÂÚ· ·fi 7%, ηıÒ˜ Î·È Ë Û¯ÔÏ·ÛÙÈ΋ ÊÚÔÓÙ›‰· ÙˆÓ ¿ÎÚˆÓ Ô‰ÈÒÓ ÁÈ· ÙË Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛ˘ ÂÏÎÒÓ, Á¿ÁÁÚ·ÈÓ·˜ Î·È Ù˘ ·Ó·ÁηÈfiÙËÙ·˜ ·ÎÚˆ-ÙËÚÈ·ÛÌÔ‡[2, 9] .

3.7. ÕÏÏ·

ıÂÚ·¢-ÙÈο ̤ÙÚ·

™Â fiÏÔ˘˜ ÙÔ˘˜ ˘¤Ú-‚·ÚÔ˘˜ ‹ ·¯‡Û·Ú-ÎÔ˘˜ ·ÛıÂÓ›˜ Ì ¶∞¡ ‰›ÓÔÓÙ·È Û˘Ì‚Ô˘Ï¤˜ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜. ∞ÓÙÈËÎÙÈ΋ ·ÁˆÁ‹ ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ Û˘-ÓÈÛÙ¿Ù·È ÌfiÓÔ ÛÙȘ Â-ÚÈÙÒÛÂȘ ·ÛıÂÓÒÓ Ì ÎÔÏÈ΋ Ì·ÚÌ·Ú˘Á‹, ‚·Ï‚ȉÔ¿ıÂÈ·, ÂÓ Ùˆ ‚¿ıÂÈ ÊÏ‚ÔıÚfiÌ‚ˆÛË, η-ıÒ˜ Î·È Û ·ÛıÂÓ›˜ ˘„ËÏÔ‡ ÎÈÓ-‰‡ÓÔ˘ ·fiÊڷ͢ ÙˆÓ ·ÚÙËÚÈ·-ÎÒÓ ÌÔÛ¯Â˘Ì¿ÙˆÓ. ¢ÂÓ ˘¿Ú¯Ô˘Ó ÚÔÔÙÈΤ˜, Ù˘-¯·ÈÔÔÈË̤Ó˜ ÌÂϤÙ˘ ÂÎÙ›ÌË-Û˘ ÙÔ˘ ÔʤÏÔ˘˜ ¯ÔÚ‹ÁËÂÎÙ›ÌË-Û˘ ‚È-Ù·ÌÈÓÒÓ, fiˆ˜ ÙÔ Ê˘ÏÏÈÎfi Ô͇ Î·È Ë ‚ÈÙ·Ì›ÓË µ12 Ô˘ ÌÂÈÒÓÔ˘Ó Ù· Â›‰· Ù˘ ÔÌÔ΢ÛÙ½Ó˘ ÛÙÔÓ ÔÚfi, Û ·ÛıÂÓ›˜ Ì ¶∞¡. ™Â ÌÈ· ÂӉȷʤÚÔ˘Û· ÌÂϤÙË Ì ÙËÓ ÔÓÔÌ·Û›· Health Professio-nals Follow-up Study, Û˘ÌÌÂÙ›-¯·Ó 46036 ¿Ó‰Ú˜ ¯ˆÚ›˜ ¶∞¡, ηډȷÁÁÂȷ΋ ÓfiÛÔ ‹ ۷ί·ÚÒ-‰Ë ‰È·‚‹ÙË Î·È ·Ú·ÎÔÏÔ˘ı‹ıË-Î·Ó ÁÈ· 12 ¯ÚfiÓÈ· ÛÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÔÔ›ˆÓ ηٷÁÚ¿ÊËÎ·Ó 308 ÂÚÈÙÒÛÂȘ ¶∞¡. ™ÙË ÌÂϤÙË ·˘Ù‹ ‰È·ÈÛÙÒıËΠÌÈ· ·ÓÙ›-ÛÙÚÔÊË Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ ηıËÌÂÚÈÓ‹˜ ÚfiÛÏ˄˘ Ê˘ÏÏÈ-ÎÔ‡ ÔͤԘ (400 mg/Ë̤ڷ) Î·È ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛ˘ ¶∞¡ (Ì›ˆÛË Î·Ù¿ 21%)[36] .

4. ªÂ›ˆÛË ÙÔ˘

ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘

Û ·ÛıÂÓ›˜ Ì ¶∞¡:

ÂÎÙ›ÌËÛË ÙÔ˘

Û˘ÓÔÏÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘

Î·È ÂÈıÂÙÈ΋ ÂÊ·ÚÌÔÁ‹

ıÂÚ·¢ÙÈÎÒÓ Ì¤ÙÚˆÓ

ªÈ· ·ÔÙÂÏÂÛÌ·ÙÈ΋ ÛÙÚ·ÙËÁÈ΋ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ·ÛıÂÓÒÓ Ì ¶∞¡ ÂÈ‚¿ÏÏÂÈ ÙËÓ ¤ÁηÈÚË ‰È¿-ÁÓˆÛË, ÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ Û˘ÓÔÏÈ-ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ Î·È ÙËÓ ÂÈıÂÙÈ΋ ·Ú¤Ì‚·ÛË ÁÈ· ÙËÓ ÙÚÔÔÔ›Ë-ÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘[2, 9] . À¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ fiÙÈ Ë ÂÈıÂ-ÙÈ΋ ÙÚÔÔÔ›ËÛË ÙˆÓ ·Ú·Áfi-ÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ Û ·ÛıÂÓ›˜ Ì ¶∞¡ ÚÔÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÌÊ¿ÓÈÛË ÂÌÊÚ¿ÁÌ·ÙÔ˜, ·ÁÁÂÈ·ÎÔ‡ ÂÁÎÂ-Ê·ÏÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ Î·È ÌÂÈÒÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ı·Ó·ÙËÊfiÚˆÓ Û˘Ì-‚·Ì¿ÙˆÓ. ™Â ÌÈ· ÚfiÛÊ·ÙË ÌÂ-ϤÙË 2420 ·ÛıÂÓÒÓ Ì ¶∞¡, ‰È¿ÚÎÂÈ·˜ 8 ÂÙÒÓ, ‚Ú¤ıËΠfiÙÈ Ë ıÂÚ·›· Ì ·ÛÈÚ›ÓË, ÛÙ·Ù›Ó˜, ‚-·ÔÎÏÂÈÛÙ¤˜ Î·È ·-ª∂∞ Û˘Û¯Â-Ù›˙ÔÓÙ·Ó ·ÓÂÍ¿ÚÙËÙ· Ì ·‡ÍËÛË Ù˘ ÂÈ‚›ˆÛ˘[37] . ∆· Â˘Ú‹Ì·Ù· ·˘Ù¿ Û˘ÓËÁÔÚÔ‡Ó ÛÙÔ fiÙÈ ÌÈ· ÔÏ˘‰È¿ÛÙ·ÙË ıÂÚ·›· ÛÂ Û˘Ó-‰˘·ÛÌfi Ì ÙËÓ ÂÊ·ÚÌÔÁ‹ ˘ÁÈÂÈ-ÓԉȷÈÙËÙÈÎÒÓ ÌË Ê·Ú̷΢ÙÈ-ÎÒÓ Ì¤ÙÚˆÓ (¿ÛÎËÛË, ‰È·ÎÔ‹ ÙÔ˘ ηÓ›ÛÌ·ÙÔ˜, Ì›ˆÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜) ¤¯ÂÈ ·ıÚÔÈ-ÛÙÈÎfi fiÊÂÏÔ˜ ÛÙË Ì›ˆÛË ÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ Î·È ÛÙË ıÓËÛÈÌfiÙËÙ· ÙˆÓ ·ÛıÂÓÒÓ Ì ¶∞¡.

™¯ÂÙÈÎfi˜ ∫›Ó‰˘ÓÔ˜ (RR)

™¯‹Ì· 3. ¶·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ¶ÂÚÈÊÂÚÈ΋˜ ∞ÚÙËÚÈÔ¿ıÂÈ·˜ – ¢Â‰Ô̤ӷ ∂ȉËÌÈÔÏÔÁÈ-ÎÒÓ ªÂÏÂÙÒÓ[5] . µ µÈÈ‚‚ÏÏÈÈÔÔÁÁÚÚ··ÊÊ››··

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Elhendy A, Boersma E, Schouten O, et al. Cardioprotective medication is associated with improved survival in patients with peripheral arterial disease. Journal of the American College of Cardiology 2006;47: 1182-7. ∆· ÏÂÔÓÂÎÙ‹Ì·Ù· Î·È ÌÂÈÔÓÂ-ÎÙ‹Ì·Ù· Ù˘ ÚÔÏËÙÈ΋˜ Âͤٷ-Û˘ ÁÈ· ·Ó‡ÚÂÛË ‰È·Ù·Ú·¯ÒÓ ÙˆÓ ÏÈȉ›ˆÓ Û ·È‰È¿, ¤ÊË‚Ô˘˜ Î·È Ó·ÚÔ‡˜ ÂÓ‹ÏÈΘ ̤¯ÚÈ 20 ÂÙÒÓ ‰ÂÓ Â›Ó·È ·ÎfiÌË ·fiÏ˘Ù· Û·Ê‹. ¶ÚfiÛÊ·Ù· Ë ∂ÈÙÚÔ‹ ÂÈ-‰ÈÎÒÓ ÁÈ· ÙËÓ ÚfiÏË„Ë (US Preventive Services Task Force

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