EÏÏËÓÈο ¢È·‚ËÙÔÏÔÁÈο XÚÔÓÈο 25, 2: 106-113, 2012

∞Ó·ÛÎfiËÛË

§ÈÔÚˆÙ½ÓË (·) Î·È Î·Ú‰È·ÁÁÂȷ΋ ÓfiÛÔ˜

A.∫. ¶··˙·ÊÂÈÚÔÔ‡ÏÔ˘ ¶ÂÚ›ÏË„Ë

π. ¶··ÁˆÚÁ›Ô˘ H ÏÈÔÚˆÙ½ÓË (·) [Lp(a)] ·Ó·Î·Ï‡ÊıËΠ·fi ÙÔÓ Kare Berg ÙÔ
™.π. ¶·¿˜ 1963. ΔÔ ÂӉȷʤÚÔÓ ÁÈ· ÙȘ ‰Ú¿ÛÂȘ Ù˘ Lp(a) ¤¯ÂÈ ·˘ÍËı› Ù· ÙÂ-
ÏÂ˘Ù·›· ¯ÚfiÓÈ·, ηıÒ˜ ¤¯ÂÈ ‚ÚÂı› Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ˘„ËÏÒÓ ÂÈ¤-
‰ˆÓ Ï¿ÛÌ·ÙÔ˜ Ù˘ Lp(a) ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ Î·È ÂÁÎÂÊ·ÏÈÎÒÓ ·Á-
ÁÂÈ·ÎÒÓ ÂÂÈÛÔ‰›ˆÓ. ¶ÔÏ˘¿ÚÈı̘ ÌÂϤÙ˜ ·ÛıÂÓÒÓ-Ì·ÚÙ‡ÚˆÓ ¤-
¯Ô˘Ó ÂȂ‚·ÈÒÛÂÈ fiÙÈ Ë Lp(a) ·ÔÙÂÏ› ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÁÈ· Úfi-
ˆÚË Î·Ú‰È·ÁÁÂȷ΋ ÓfiÛÔ. ¢È¿ÊÔÚ˜ ÚÔÛÂÁÁ›ÛÂȘ ¤¯Ô˘Ó ÚÔÙ·ı›
ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ˘„ËÏÒÓ ÂÈ¤‰ˆÓ Lp(a) Ï¿ÛÌ·ÙÔ˜ Ì ΢-
ÚÈfiÙÂÚ˜ ÙË ¯Ú‹ÛË ÊÈÌÚ·ÙÒÓ, ÓÈ·Û›Ó˘ Î·È ¿ÛÎËÛ˘ ¯ˆÚ›˜, ˆÛÙfiÛÔ,
Ó· ·ÔÙÂÏÔ‡Ó ıÂÚ·¢ÙÈ΋ ÂÈÏÔÁ‹ ̤¯ÚÈ Û‹ÌÂÚ·. ™ÎÔfi˜ Ù˘ ·-
ÚÔ‡Û·˜ ·Ó·ÛÎfiËÛ˘ Â›Ó·È Ó· Û˘ÓÔ„›ÛÂÈ Ù· ˘¿Ú¯ÔÓÙ· ‚È‚ÏÈÔÁÚ·-
ÊÈο ‰Â‰Ô̤ӷ Û¯ÂÙÈο Ì ÙËÓ ‡·ÚÍË Û˘Û¯¤ÙÈÛ˘ ÌÂٷ͇ ÙˆÓ ˘„Ë-
ÏÒÓ ÂÈ¤‰ˆÓ Ù˘ Lp(a) Î·È Ù˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘ ηıÒ˜ ηÈ
ÙˆÓ ÎÏÈÓÈÎÒÓ ÂÈÙÒÛÂÒÓ Ù˘.

°′ ¶·ıÔÏÔÁÈÎfi ΔÌ‹Ì· &
¢È·‚ËÙÔÏÔÁÈÎfi ∫¤ÓÙÚÔ
°.¡. ¡›Î·È·˜ «ÕÁÈÔ˜ ¶·ÓÙÂÏ‹̈ӻ ÊÚfi˜2. ∏ Lp(a), fiˆ˜ Î·È Ë LDL-¯ÔÏËÛÙÂÚfiÏË, ·ÔÙÂÏÂ›Ù·È ·fi
¶ÂÈÚ·È¿˜
∂ÈÛ·ÁˆÁ‹
∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ë Î·Ú‰È·ÁÁÂȷ΋ ÓfiÛÔ˜ ·ÔÙÂÏ› Ì›· ·fi
ÙȘ ΢ÚÈfiÙÂÚ˜ ·Èٛ˜ ıÓËÛÈÌfiÙËÙ·˜ ·ÁÎÔÛÌ›ˆ˜ ·Ú¿ ÙȘ Û˘Ó¯È-
˙fiÌÂÓ˜ ÚÔÛ¿ıÂȘ ·ÓÙÈÌÂÙÒÈÛ‹˜ Ù˘ Ô˘ ·ÊÔÚÔ‡Ó ÙfiÛÔ ·ÏÏ·-
Á¤˜ ÛÙÔÓ ÙÚfiÔ ˙ˆ‹˜ fiÛÔ Î·È Ê·Ú̷΢ÙÈΤ˜ ·ÚÂÌ‚¿ÛÂȘ Ô˘
ÛÙÔ¯Â‡Ô˘Ó ÛÙÔ˘˜ ÎÏ·ÛÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡-
ÓÔ˘ fiˆ˜ Â›Ó·È Ë ·ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË Î·È Ù· ·˘ÍË̤ӷ Â›‰·
Ù˘ LDL (low density lipoprotein) -¯ÔÏËÛÙÂÚfiÏ˘ Ï¿ÛÌ·ÙÔ˜. ¶·-
Ú¿ ÙËÓ ÂÈıÂÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÎÏ·ÛÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Î·Ú-
‰È·ÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ Î·È ÙËÓ Â›Ù¢ÍË ÙˆÓ ıÂÚ·¢ÙÈÎÒÓ ÛÙfi¯ˆÓ
Û ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ·ÛıÂÓÒÓ, Ë Â›ÙˆÛË Ù˘ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘
‰ÂÓ ¤¯ÂÈ ÌÂȈı› ·Ó·ÏfiÁˆ˜, ÁÂÁÔÓfi˜ Ô˘ Ô‰ËÁ› ÛÙÔ Û˘Ì¤Ú·ÛÌ·
fiÙÈ ˘¿Ú¯Ô˘Ó Î·È ¿ÏÏÔÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ¤Ú·Ó ÙˆÓ ÎÏ·ÛÈ-
ÎÒÓ. OÈ ·Ú¿ÁÔÓÙ˜ ·˘ÙÔ› ·ÔÙÂÏÔ‡Ó ·ıÚÔÈÛÙÈο ÙÔÓ ÔÓÔÌ·˙fiÌÂ-
ÓÔ «˘ÔÏÂÈfiÌÂÓÔ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ». ™ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜
·˘ÙÔ‡˜ ·Ó‹ÎÔ˘Ó Î·È Ù· ˘„ËÏ¿ Â›‰· Ù˘ ÏÈÔÚˆÙ½Ó˘ (·)
[Lipoprotein (a), Lp(a)]1.
∏ Lp(a) ·ÔÙÂÏÂ›Ù·È ·fi ¤Ó· ÌfiÚÈÔ LDL-¯ÔÏËÛÙÂÚfiÏ˘ Ô˘
Â›Ó·È Âӈ̤ÓÔ Ì ÔÌÔÈÔÔÏÈÎfi ‰ÂÛÌfi Ì ̛· ÁÏ˘ÎÔÚˆÙ½ÓË, ÙËÓ
·ÔÏÈÔÚˆÙ½ÓË ·1. ∏ Lp(a) ·Ú¿ÁÂÙ·È ·ÔÎÏÂÈÛÙÈο ·fi ÙÔ
‹·Ú Î·È ÛÙÔÓ Î·Ù·‚ÔÏÈÛÌfi Ù˘ Ê·›ÓÂÙ·È Ó· Û˘ÌÌÂÙ¤¯ÂÈ Ô ÓÂ-
ÂÛÙ¤Ú˜ ¯ÔÏËÛÙÂÚfiÏ˘, ʈÛÊÔÏÈ›‰È· Î·È ÙÚÈÁÏ˘ÎÂÚ›‰È· ηıÒ˜
 EÏÏËÓÈο ¢È·‚ËÙÔÏÔÁÈο XÚÔÓÈο 25, 2
Î·È ·fi Â·Ó·Ï·Ì‚·ÓfiÌÂÓ˜ ·ÏÏËÏÔ˘¯›Â˜ 80-90
·ÌÈÓÔͤˆÓ ‰È·Ù·ÁÌ¤ÓˆÓ Û ÙÚÈÙÔÙ·Á‹ ‰ÔÌ‹1,3. Δ·
Â›‰· Ï¿ÛÌ·ÙÔ˜ Ù˘ Lp(a) ÔÈΛÏÏÔ˘Ó ÌÂٷ͇
ÙˆÓ ·ÙfiÌˆÓ Î·È Î·ıÔÚ›˙ÔÓÙ·È Î˘Ú›ˆ˜ ·fi ÔÏ˘-
ÌÔÚÊÈÛÌÔ‡˜ ÛÙÔ ÁÔÓ›‰ÈÔ LPA Ô˘ ‰ڿ˙ÂÙ·È ÛÙÔ
¯ÚˆÌfiۈ̷ 6 Î·È Îˆ‰ÈÎÔÔÈ› ÙËÓ ·ÔÏÈÔÚˆ-
Ù½ÓË ∞ (∞ƒO-∞)4. Δ· Â›‰· Ù˘ Lp(a) ÛÙÔ ·›Ì·
Û¯ÂÙ›˙ÔÓÙ·È ·ÓÙ›ÛÙÚÔÊ· Ì ÙÔÓ ·ÚÈıÌfi ÙˆÓ ·ÏÏË-
ÏÔ˘¯ÈÒÓ ·ÌÈÓÔͤˆÓ (kringle πV repeats) ÛÙÔ ÌfiÚÈÔ
Ù˘ ∞ (∞ƒO-∞). O ·ÚÈıÌfi˜ ·˘Ùfi˜ ÌÔÚ› Ó· ÔÈ-
ΛÏÏÂÈ ·fi 10 ¤ˆ˜ Î·È ¿Óˆ ÙˆÓ 50. Δ· ÂÏ·ÊÚfiÙÂÚ·
ÌfiÚÈ· Â›Ó·È Î·È Ù· ϤÔÓ ·ıËÚÔÁfiÓ·4,5.
™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ·Ó·ÛÎfiËÛ˘ Â›Ó·È Ó·
Û˘ÓÔ„›ÛÂÈ Ù· ÚfiÛÊ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ
Û¯ÂÙÈο Ì ÙËÓ ‡·ÚÍË ·ÈÙÈÔÏÔÁÈ΋˜ Û¯¤Û˘ ÌÂÙ·-
͇ ÙˆÓ ·˘ÍËÌ¤ÓˆÓ ÂÈ¤‰ˆÓ Lp(a) Î·È ÙÔ˘ ÎÈÓ‰‡-
ÓÔ˘ ÈÛ¯·ÈÌÈ΋˜ ηډÈÔ¿ıÂÈ·˜ ÂÛÙÈ¿˙ÔÓÙ·˜ ÛÙ·
·ÔÙÂϤÛÌ·Ù· ÙfiÛÔ ÂȉËÌÈÔÏÔÁÈÎÒÓ fiÛÔ Î·È ÂÈ-
Ú·Ì·ÙÈÎÒÓ ÌÂÏÂÙÒÓ.
™‡ÓıÂÛË Î·È ÌÂÙ·‚ÔÏÈÛÌfi˜ Ù˘ Lp(·)
ΔÔ ‹·Ú Â›Ó·È ÙÔ Î‡ÚÈÔ Ì¤ÚÔ˜ Ù˘ Û‡ÓıÂÛ˘
Ù˘ Lp(a)6,7. ∏ Û‡ÓıÂÛË Ù˘ Lp(a) Á›ÓÂÙ·È Û 2 ‚‹-
Ì·Ù·8: ÙÔ ÚÒÙÔ ÂÚÈÏ·Ì‚¿ÓÂÈ ÌË ÔÌÔÈÔÔÏÈΤ˜
·ÏÏËÏÂȉڿÛÂȘ ·Ó¿ÌÂÛ· ÛÙËÓ ∞ƒO-∞ Î·È ÛÙËÓ
·ÔÏÈÔÚˆÙ½ÓË μ (∞ƒO-μ) – Î·È ÙÔ ‰Â‡ÙÂÚÔÓ ÙÔ
Û¯ËÌ·ÙÈÛÌfi ‰ÈÛÔ˘ÏÊȉÈÎÔ‡ ‰ÂÛÌÔ‡ ̤ۈ Û˘ÁÎÂ-
ÎÚÈÌ¤ÓˆÓ ·ÏÏËÏÔ˘¯ÈÒÓ ·ÌÈÓÔͤˆÓ9-15. ∏ Û˘ÁΤ-
ÓÙÚˆÛË Ù˘ Lp(a) ÛÙÔ Ï¿ÛÌ· ÔÈΛÏÏÂÈ ÌÂٷ͇
ÙˆÓ ·ÙfiÌˆÓ Î·ıÒ˜ Â›Ó·È ÙÔ ·ÔÙ¤ÏÂÛÌ· Ù˘ ¤Î-
ÊÚ·Û˘ ÙÔ˘ ∞ƒO-∞ ÁÔÓȉ›Ô˘ ÁÈ· ÙÔ ÔÔ›Ô ¤¯Ô˘Ó
ÂÓÙÔÈÛÙ› ÂÚÈÛÛfiÙÂÚ· ·fi 100 ·ÏÏ‹ÏÈ·16,17.
O Ú˘ıÌfi˜ Û¯ËÌ·ÙÈÛÌÔ‡ Ù˘ Lp(a) Âȉڿ ÛÙ·
Â›‰¿ Ù˘ ÛÙÔ Ï¿ÛÌ· ÂÚÈÛÛfiÙÂÚÔ ·fi fi,ÙÈ Ô Î·-
Ù·‚ÔÏÈÛÌfi˜ Ù˘18. OÈ White Î·È Û˘Ó., ¯ÚËÛÈÌÔÔÈÒ-
ÓÙ·˜ Ë·ÙÔ·ÙÙ·Ú· Ì·ÌÔ˘›ÓÔ˘, ¤‰ÂÈÍ·Ó fiÙÈ Ô Ú˘ı-
Ìfi˜ ·Ú·ÁˆÁ‹˜ Ù˘ Lp(a) ηıÔÚ›˙ÂÙ·È ·fi ÙËÓ Èη-
ÓfiÙËÙ· ÙˆÓ ÌÔÚ›ˆÓ Ù˘ Ó· ·Ô‰ÂÛ̇ÔÓÙ·È ·fi ÙÔ ÂÓ-
‰ÔÏ·ÛÌ·ÙÈÎfi ‰›ÎÙ˘Ô17. O ηٷ‚ÔÏÈÛÌfi˜ Ù˘ Lp(a)
Á›ÓÂÙ·È ÚˆÙ›ÛÙˆ˜ ÛÙÔ ‹·Ú, ·ÏÏ¿ ÔÈ Ì˯·ÓÈÛÌÔ› Ô˘
ÂÌϤÎÔÓÙ·È Û ·˘ÙfiÓ ‰ÂÓ Â›Ó·È Ï‹Úˆ˜ ÁÓˆÛÙÔ›19,20.
Δ¤ÏÔ˜, Ù· Ì·ÎÚÔÊ¿Á· ¤¯Ô˘Ó ÙËÓ ÈηÓfiÙËÙ· Ó· Ê·ÁÔ-
΢ÙÙ·ÚÒÓÔ˘Ó ÙËÓ Lp(a), ̤ۈ ÂȉÈÎÒÓ ˘Ô‰Ô¯¤ˆÓ,
ÁÂÁÔÓfi˜ Ô˘ ı· ÌÔÚÔ‡Û ӷ ÂÍËÁ‹ÛÂÈ ÙÔÓ ·ıÔÁÂ-
ÓÂÙÈÎfi ÚfiÏÔ Ù˘ Lp(a) ÛÙËÓ ·ıËÚÔÁ¤ÓÂÛË21.
Lp(·): ÌÈ· ·ıËÚÔÁfiÓÔ˜ Î·È ıÚÔÌ‚ÔÁfiÓÔ˜
ÏÈÔÚˆÙ½ÓË
∞ÚÎÂÙ¤˜ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ù·
·˘ÍË̤ӷ Â›‰· Ù˘ Lp(a) ÛÙÔ Ï¿ÛÌ· (>30
mg/dl) ·ÔÙÂÏÔ‡Ó ¤Ó·Ó ·ÓÂÍ¿ÚÙËÙÔ ·Ú¿ÁÔÓÙ· ÎÈÓ-
‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛ˘ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘, ÚfiˆÚ˘ ηÚ-
‰È·ÁÁÂȷ΋˜ ÓfiÛÔ˘, ·ÁÁÂÈ·ÎÔ‡ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÂÈÛÔ-
‰›Ô˘ Î·È Â·Ó·ÛÙ¤ÓˆÛ˘ ÌÂÙ¿ ·fi ·ÁÁÂÈÔÏ·ÛÙÈ΋,
Ì ·ÚfiÌÔÈ· Â›ÙˆÛË Û ¿ÓÙÚ˜ Î·È Á˘Ó·›Î˜22-28.
Œ¯ÂÈ ‚ÚÂı› fiÙÈ Ë Lp(a) ·ÛΛ Â›‰Ú·ÛË ÛÂ
·ÓÙÈÊÏÂÁÌÔÓÒ‰ÂȘ ·Ú¿ÁÔÓÙ˜, ÛÙËÓ ÂÍ·ÚÙÒÌÂÓË
·fi ÙÔ ÌÔÓÔÍ›‰ÈÔ ÙÔ˘ ·˙ÒÙÔ˘ ·ÁÁÂÈԉȷÛÙÔÏ‹ ηÈ
ÛÙËÓ ÈÛÔÚÚÔ›· ÌÂٷ͇ ËÎÙÈÎÒÓ Î·È ·ÓÙÈËÎÙÈ-
ÎÒÓ ·Ú·ÁfiÓÙˆÓ ÙˆÓ ÙÔȯˆÌ¿ÙˆÓ ÙˆÓ ·ÈÌÔÊfiÚˆÓ
·ÁÁ›ˆÓ29, ÂËÚ¿˙ÔÓÙ·˜ ÙȘ ÏÂÈÙÔ˘ÚÁ›Â˜ ÙÔ˘ ÂÓ‰Ô-
ıËÏ›Ô˘ ÙˆÓ ·ÁÁ›ˆÓ30.
∏ Lp(a) ¤¯ÂÈ ·ÚfiÌÔÈ· ‰ÔÌ‹ Ì ÙÔ ÌfiÚÈÔ ÙÔ˘
Ï·ÛÌÈÓÔÁfiÓÔ˘ (ÔÌÔÏÔÁ›·, homology) Ì ·ÔÙ¤ÏÂ-
ÛÌ· ÙÔÓ Û˘Ó·ÁˆÓÈÛÌfi ÙˆÓ ‰‡Ô ÌÔÚ›ˆÓ ÁÈ· ÙË ı¤ÛË
Û‡Ó‰ÂÛ˘ ÛÙÔ ·ÁÁÂÈ·Îfi ÙÔ›¯ˆÌ·. ΔÔ ÁÔÓ›‰ÈÔ Ù˘
Lp(a) ÚÔ¤Ú¯ÂÙ·È ·fi ‰ÈÏ·ÛÈ·ÛÌfi ÙÔ˘ ÁÔÓȉ›Ô˘
ÙÔ˘ Ï·ÛÌÈÓÔÁfiÓÔ˘. ∏ ·˘ÍË̤ÓË Û‡Ó‰ÂÛË ÙÔ˘ ÌÔÚ›-
Ô˘ Ù˘ Lp(a) ÛÙË ı¤ÛË ·˘Ù‹, fiÙ·Ó Ù· Â›‰¿ Ù˘ ›-
Ó·È ·˘ÍË̤ӷ, ÂÏ·ÙÙÒÓÂÈ ÙËÓ ·Ú·ÁˆÁ‹ Ï·ÛÌ›Ó˘
Î·È Î·Ù¿ Û˘Ó¤ÂÈ· ÙËÓ ÈÓˆ‰fiÏ˘ÛË. ∂›Û˘ Ë Lp(a)
‰ÈÂÁ›ÚÂÈ ÙËÓ ·Ú·ÁˆÁ‹ ÙÔ˘ ·Ó·ÛÙÔϤ· ÙÔ˘ ÂÓÂÚÁÔ-
ÔÈËÙ‹ ÙÔ˘ Ï·ÛÌÈÓÔÁfiÓÔ˘ (plasmigen activator
inhibitor-1, PAI-1) Ô˘ Û˘ÓÙ›ıÂÙ·È ÛÙ· ÂÓ‰Ô-ıËÏÈ·-
ο ·ÙÙ·Ú·, Ù· Ï›· Ì˘˚ο ·ÙÙ·Ú· ÙˆÓ ·ÁÁ›ˆÓ ηÈ
Ù· Ì·ÎÚÔÊ¿Á·31,32. O PAI-1 Â›Ó·È ÁÓˆÛÙfi fiÙÈ ÌÂÈÒ-
ÓÂÈ ÙË ‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘ ÂÓÂÚÁÔÔÈËÙ‹ ÙÔ˘ ÈÛÙÈÎÔ‡
Ï·ÛÌÈÓÔÁfiÓÔ˘, ÌÏÔοÚÔÓÙ·˜ ÙËÓ ÂÓÂÚÁÔÔ›ËÛË
ÙÔ˘ Ï·ÛÌÈÓÔÁfiÓÔ˘ Î·È ÙË ‰È¿Û·ÛË ÙÔ˘ ÈÓÒ‰Ô˘˜.
∞˘Ù¿ ηıÈÛÙÔ‡Ó ÙËÓ Lp(a) ıÚÔÌ‚ÔÁfiÓÔ ·Ú¿ÁÔÓÙ·.
ªÂ ·˘Ùfi ÙÔÓ ÙÚfiÔ, Ë Lp(a) ·Ó·ÛÙ¤ÏÏÂÈ ÙËÓ ÈÓˆ‰fi-
Ï˘ÛË, ÂÌÔ‰›˙ÔÓÙ·˜ ÙË ‰È·‰Èηۛ· Ù˘ ÂÓÂÚÁÔÔ›Ë-
Û˘ ÙÔ˘ Ï·ÛÌÈÓÔÁfiÓÔ˘ ηÈ, ̤ۈ Ù˘ ‰È¤ÁÂÚÛ˘ ÙÔ˘
PAI-1, ÂÈÙÚ¤ÔÓÙ·˜ ÙËÓ ·Ú·ÌÔÓ‹ ÙÔ˘ ıÚfiÌ‚Ô˘,
¢ԉÒÓÔÓÙ·˜ ÙË ıÚÔÌ‚ÔÙÈ΋ ‰È·‰Èηۛ·32.
∞ÚÎÂÙ¤˜ ÌÂϤÙ˜33,34 ¤‰ÂÈÍ·Ó fiÙÈ Ù· ÌfiÚÈ· Ù˘
Lp(a) Ô˘ Û˘ÛÛˆÚ‡ÔÓÙ·È ÛÙÔ ÂÓ‰Ôı‹ÏÈÔ, ÚÔη-
ÏÔ‡Ó ÙËÓ ¤ÎÎÚÈÛË ¯ËÌÂÈÔÙ·ÎÙÈÎÒÓ Ô˘ÛÈÒÓ Î·È ÙË
Û˘ÛÛÒÚ¢ÛË ÙˆÓ ÌÔÓÔ΢ÙÙ¿ÚˆÓ Â˘Ô‰ÒÓÔÓÙ·˜ ÙËÓ
·ıËÚÔÛÎÏËÚˆÙÈ΋ ‰È·‰Èηۛ·26. ∞˘Ù¿ Ù· ÌfiÚÈ· Ù˘
Lp(a) ÔÍÂȉÒÓÔÓÙ·È Î·È Ê·ÁÔ΢ÙÙ·ÚÒÓÔÓÙ·È Ù·¯¤-
ˆ˜ ·fi Ù· Ì·ÎÚÔÊ¿Á· Û ۇÁÎÚÈÛË Ì ÙȘ ¿ÏϘ ÏÈ-
ÔÚˆÙ½Ó˜, Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Ù˘ LDL-¯Ô-
ÏËÛÙÂÚfiÏ˘35-37. ∂ÈϤÔÓ, Ë ·ıËڈ̷ÙÈ΋ ‰È·‰Èη-
Û›· ÚÔ¿ÁÂÙ·È ·fi ÙËÓ Lp(a) ÏfiÁˆ ÙÔ˘ fiÙÈ ÛÙÔ Ìfi-
ÚÈfi Ù˘ ÂÚȤ¯ÂÙ·È LDL-¯ÔÏËÛÙÂÚfiÏË. ™Â ˘„ËÏ¿
Â›‰· LDL-¯ÔÏËÛÙÂÚfiÏ˘ Ë ‚Ï·ÙÈ΋ Â›‰Ú·ÛË
Ù˘ Lp(a) ‰ÈÂÓÂÚÁÂ›Ù·È Ì¤Ûˆ Ù˘ ıÚÔÌ‚ÔÁfiÓÔ˘ ‰Ú¿-
Û˘ Ù˘ (ıÚfiÌ‚ˆÛË ·ıËڈ̷ÙÈ΋˜ Ͽη˜) Î·È ˆ˜
ÂÎ ÙÔ‡ÙÔ˘ Â›Ó·È ·ÓÂÍ¿ÚÙËÙÔ˜ ·Ú¿ÁˆÓ ÎÈÓ‰‡ÓÔ˘ ÌË
ÂÍ·ÚÙÒÌÂÓÔ˜ ·fi ÙËÓ LDL-¯ÔÏËÛÙÂÚfiÏË33-37.
107
 EÏÏËÓÈο ¢È·‚ËÙÔÏÔÁÈο XÚÔÓÈο 25, 2
∏ Lp(a) ‰ÈÂÁ›ÚÂÈ ÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ Ï›ˆÓ Ì˘-
˚ÎÒÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ ÙˆÓ ·ÁÁ›ˆÓ ̤ۈ
Ù˘ ·ÂÓÂÚÁÔÔ›ËÛ˘ ÙÔ˘ ·˘ÍËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ·
ÙˆÓ fiÁÎˆÓ (Δumor growth factor-‚, TGF-‚). ∂›Ó·È
ÁÓˆÛÙfi fiÙÈ Ë ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘ TGF-‚ ·Ó·ÛÙ¤ÏÏÂÈ
ÙË ÌÂÙ·Ó¿ÛÙ¢ÛË Î·È ÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙˆÓ Ï›-
ˆÓ Ì˘˚ÎÒÓ Î˘ÙÙ¿ÚˆÓ. ŒÙÛÈ Ë ·Ó·ÛÙÔÏ‹ ÙÔ˘ Â¿ÁÂÈ
ÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ÙÔȯˆÌ·ÙÈÎÒÓ Ï›ˆÓ Ì˘˚ÎÒÓ Î˘Ù-
Ù¿ÚˆÓ Ì ·ÔÙ¤ÏÂÛÌ· ÙË ÛÙ¤ÓˆÛË ÙˆÓ ·ÁÁ›ˆÓ ηÈ
ÙËÓ ÂÈÙ¿¯˘ÓÛË Ù˘ ·ıËÚÔÛÎÏËÚˆÙÈ΋˜ ‰È·‰Èη-
Û›·˜32. ∂ÈϤÔÓ Ë ÔÍÂȉˆÌ¤ÓË ÌÔÚÊ‹ Ù˘ Lp(a)
·Ó·ÛÙ¤ÏÏÂÈ ÙËÓ ÂÍ·ÚÙË̤ÓË ·fi ÙÔ ÌÔÓÔÍ›‰ÈÔ ÙÔ˘
·˙ÒÙÔ˘ ·ÁÁÂÈԉȷÛÙÔÏ‹ ÙˆÓ ·ÁÁ›ˆÓ ÂȉÂÈÓÒÓÔ-
ÓÙ·˜ Ù˘¯fiÓ ÚÔ¸¿Ú¯Ô˘Û· ·ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË35.
Δ· ÔÍÂȉˆÌ¤Ó· ÌfiÚÈ· Ù˘ Lp(a), Â›Û˘, ‰ÈÂÁ›-
ÚÔ˘Ó ÙËÓ ·Ú·ÁˆÁ‹ ÙÔ˘ PAI-1 ·˘Í¿ÓÔÓÙ·˜ Ì ÙÔÓ
ÙÚfiÔ ·˘Ùfi ÙËÓ ÚÔÛÎfiÏÏËÛË ÙˆÓ ÌÔÓÔ΢ÙÙ¿ÚˆÓ
ÛÙ· ·ÁÁÂȷο ÙÔȯÒÌ·Ù·36,37. ∏ Lp(a) Âȉڿ Â›-
Û˘ ÛÙËÓ ·ÏÏËÏÂ›‰Ú·ÛË ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ Ì ÙÔ
·ÁÁÂÈ·Îfi ÙÔ›¯ˆÌ·, ÂÓÈÛ¯‡ÔÓÙ·˜ ÙË Û˘ÛÛÒÚ¢ÛË
ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ Î·È Û˘Ì‚¿ÏÏÔÓÙ·˜ ÛÙËÓ ÂÌÊ¿ÓÈ-
ÛË ıÚÔÌ‚ÔÂÌ‚ÔÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ31.
∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ë ·ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË, Ë ˘-
ÂÚ¯ÔÏÂÛÙÂÚÔÏ·ÈÌ›· Î·È ÙÔ Î¿ÓÈÛÌ· ¤¯Ô˘Ó ÈÛ¯˘-
Ú‹ Û˘Û¯¤ÙÈÛË Ì ÙËÓ ÂÌÊ¿ÓÈÛË ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘.
∂›Û˘, ¤¯ÂÈ ‰Âȯı› fiÙÈ Ù· ·˘ÍË̤ӷ Â›‰·
Lp(a) Ï¿ÛÌ·ÙÔ˜ ¢ԉÒÓÔ˘Ó ÙËÓ ÚÔηÏÔ‡ÌÂÓË
·fi ÙȘ ·Ú·¿Óˆ ηٷÛÙ¿ÛÂȘ ·ıËÚÔÛÎÏËÚˆÙÈ΋
‰È·‰Èηۛ·29. ∞ÁÁÂÈÔÁÚ·ÊÈΤ˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó
ÙËÓ ‡·ÚÍË Û˘Û¯¤ÙÈÛ˘ ÌÂٷ͇ ÙˆÓ ÂÈ¤‰ˆÓ Ù˘
Lp(a) ÛÙÔÓ ÔÚfi Î·È ÙÔ˘ ‚·ıÌÔ‡ ÛÙ¤ÓˆÛ˘ ÙˆÓ ÛÙÂ-
Ê·ÓÈ·›ˆÓ ·ÁÁ›ˆÓ29. Œ¯ÂÈ ·Ó·ÊÂÚı› fiÙÈ Ù· ˘„Ë-
Ï¿ Â›‰· Ù˘ Lp(a) ÌÔÚ› Ó· ÚÔ¿ÁÔ˘Ó ÙËÓ ÂÎ-
‰‹ÏˆÛË Î·Ú‰È·ÁÁÂȷ΋˜ ÓfiÛÔ˘ ηٿ 10 Ì 20 ¯Úfi-
ÓÈ· ÓˆÚ›ÙÂÚ· Û ۇÁÎÚÈÛË Ì ¿ÙÔÌ· Ì ¿ÏÏÔ˘˜ ·-
Ú¿ÁÔÓÙ˜ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘29.
Lp(a) Î·È Î›Ó‰˘ÓÔ˜ ÈÛ¯·ÈÌÈ΋˜ ηډÈÔ¿ıÂÈ·˜
ΔÔ ÌfiÚÈÔ Ù˘ Lp(a) ·Ó·Î·Ï‡ÊıËΠÙÔ 1963 ·-
fi ÙÔ˘˜ Berg Î·È Û˘Ó., Î·È ¤ÎÙÔÙ ·ÚÎÂÙ¤˜ ÌÂϤÙ˜
¤‰ÂÈÍ·Ó ÙËÓ ‡·ÚÍË Ì›·˜ Û˘Û¯¤ÙÈÛ˘ ÌÂٷ͇ ÙˆÓ
·˘ÍËÌ¤ÓˆÓ ÂÈ¤‰ˆÓ Lp(a) Ï¿ÛÌ·ÙÔ˜ Î·È ÙÔ˘
ÎÈÓ‰‡ÓÔ˘ ÈÛ¯·ÈÌÈ΋˜ ηډÈÔ¿ıÂÈ·˜1,38. øÛÙfiÛÔ,
˘¿Ú¯Ô˘Ó ÌÂϤÙ˜ Ô˘ ·¤Ù˘¯·Ó Ó· ‰Â›ÍÔ˘Ó ÙËÓ
‡·ÚÍË Û¯¤Û˘ ÌÂٷ͇ Ù˘ Lp(a) Î·È ÙÔ˘ ÎÈÓ‰‡ÓÔ˘
ÈÛ¯·ÈÌÈ΋˜ ηډÈÔ¿ıÂÈ·˜39-44. ™˘ÁÎÂÎÚÈ̤ӷ, Ì›·
ÌÂϤÙË ·ÛıÂÓÒÓ-Ì·ÚÙ‡ÚˆÓ, ÛÙËÓ ÔÔ›· Û˘ÌÌÂÙ›-
¯·Ó 296 ¿ÙÔÌ· Ì ÈÛÙÔÚÈÎfi ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ô-
ηډ›Ô˘, ‰ÂÓ Î·Ù¿ÊÂÚ ӷ ‰Â›ÍÂÈ ÙËÓ ‡·ÚÍË Û˘-
Û¯¤ÙÈÛ˘ ÌÂٷ͇ ÙˆÓ ·˘ÍËÌ¤ÓˆÓ ÂÈ¤‰ˆÓ Lp(a)
Î·È ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ôηډ›Ô˘45.
108
ŸÌÔÈ·, Û ̛· ÊÈÓÏ·Ó‰È΋ ÌÂϤÙË ·ÛıÂÓÒÓ-Ì·ÚÙ‡-
ÚˆÓ, ÛÙËÓ ÔÔ›· Û˘ÌÌÂÙ›¯·Ó 191 ¿ÙÔÌ· Ì ¤Ì-
ÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘ ‰ÂÓ ‚Ú¤ıËΠۯ¤ÛË ÌÂÙ·-
͇ ÙˆÓ ·˘ÍËÌ¤ÓˆÓ ÂÈ¤‰ˆÓ Lp(a) Î·È ÙÔ˘ ÎÈÓ‰‡-
ÓÔ˘ ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ôηډ›Ô˘39. ª›· Èı·Ó‹
ÂÍ‹ÁËÛË ÁÈ· Ù· ·Ú·¿Óˆ ·ÚÓËÙÈο Â˘Ú‹Ì·Ù· ›-
Ó·È fiÙÈ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ‰Â›ÁÌ·Ù· Ï¿ÛÌ·ÙÔ˜
Ô˘ ›¯·Ó „˘¯ı› ÁÈ· Ôχ ηÈÚfi Ì ·ÔÙ¤ÏÂÛÌ·
ÙË ÌÂȈ̤ÓË ·ÍÈÔÈÛÙ›· ÙÔ˘˜ ÏfiÁˆ Ù˘ ÌÂÁ¿Ï˘
·ÛÙ¿ıÂÈ·˜ ÙÔ˘ ÌÔÚ›Ô˘ Ù˘ Lp(a)42-45.
øÛÙfiÛÔ, ÌÂÙ¤ÂÈÙ· ÚÔÔÙÈΤ˜ ÌÂϤÙ˜ ηÈ
ÌÂÙ·-·Ó·Ï‡ÛÂȘ ÙÂÎÌËÚ›ˆÛ·Ó ÙË Û¯¤ÛË ÙˆÓ ·˘ÍË-
Ì¤ÓˆÓ ÂÈ¤‰ˆÓ Lp(a) Ï¿ÛÌ·ÙÔ˜ Î·È ÙÔ˘ ÎÈÓ‰‡-
ÓÔ˘ ÈÛ¯·ÈÌÈ΋˜ ηډÈÔ¿ıÂÈ·˜22,46,47. ™Â Ì›· ÌÂÙ·-
·Ó¿Ï˘ÛË Ô˘ ‰ËÌÔÛȇÙËΠÙÔ 2000, ÔÈ Danesh ηÈ
Û˘Ó., ¤‰ÂÈÍ·Ó fiÙÈ Ô Î›Ó‰˘ÓÔ˜ ÈÛ¯·ÈÌÈ΋˜ ηډÈÔ¿-
ıÂÈ·˜ ‹Ù·Ó 1,7 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔ˜ ÁÈ· Ù· ¿ÙÔÌ· ÌÂ
˘„ËÏ¿ Â›‰· Lp(a) Û ۇÁÎÚÈÛË Ì ÂΛӷ ÌÂ
¯·ÌËÏ¿ Â›‰· Lp(a) Ï¿ÛÌ·ÙÔ˜46.
∂ÈϤÔÓ, ÚÔÔÙÈΤ˜ ÌÂϤÙ˜ ÂȂ‚·›ˆÛ·Ó
Ù· ·Ú·¿Óˆ Â˘Ú‹Ì·Ù· ηÈ, Ì¿ÏÈÛÙ·, Û ÌÂÚÈΤ˜
ÂÎÙÈÌ‹ıËÎ·Ó Û˘ÁÎÂÎÚÈ̤ӷ Â›‰· Lp(a) Ô˘
Û˘Ó‰¤ÔÓÙ·È Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÈÛ¯·ÈÌÈ΋˜ ηÚ-
‰ÈÔ¿ıÂÈ·˜48-50. ™Â Ì›· ÌÂϤÙË ·ÛıÂÓÒÓ-Ì·ÚÙ‡ÚˆÓ,
Ë ÔÔ›· ÂÚÈÂÏ¿Ì‚·Ó 195 ¿Ó‰Ú˜, ÔÈ Rifai ηÈ
Û˘Ó. ‚Ú‹Î·Ó 4Ï¿ÛÈÔ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ÛÔ‚·Ú‹˜
ÛÙËı¿Á¯Ë˜ ÛÙÔ˘˜ ¿Ó‰Ú˜ Ì ˘„ËÏ¿ Â›‰· ¤Ó·ÓÙÈ
ÂÎÂ›ÓˆÓ Ì ¯·ÌËÏ¿ Â›‰· Lp(a)48. ™Â Ì›· ¿ÏÏË
ÌÂϤÙË, ÛÙËÓ ÔÔ›· Û˘ÌÌÂÙ›¯·Ó ÂÚÈÛÛfiÙÂÚ˜ ·fi
27.000 Á˘Ó·›Î˜, Ì ‰È¿ÚÎÂÈ· ·Ú·ÎÔÏÔ‡ıËÛ˘ Ù·
10 ¯ÚfiÓÈ·, ÔÈ Danik Î·È Û˘Ó., ¤‰ÂÈÍ·Ó ‰ÈÏ¿ÛÈÔ Î›Ó-
‰˘ÓÔ ÈÛ¯·ÈÌÈ΋˜ ηډÈÔ¿ıÂÈ·˜ Û ÂΛӘ ÌÂ
˘„ËÏ¿ Â›‰· ¤Ó·ÓÙÈ ÂÎÂ›ÓˆÓ Ì ¯·ÌËÏ¿ Â›‰·
Lp(a) Ï¿ÛÌ·ÙÔ˜49. ™Â Ì›· ¿ÏÏË ÌÂϤÙË Ô˘ Ú·Á-
Ì·ÙÔÔÈ‹ıËΠÛÙËÓ ∫ÔÂÁ¯¿ÁË, Û 9.330 ¿ÙÔÌ·
ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘ÛÌÔ‡ Ô˘ ·Ú·ÎÔÏÔ˘ı‹ıËηÓ
ÁÈ· 10 ¯ÚfiÓÈ·, ‚Ú¤ıËΠÛÙ·‰È·Î‹ ·‡ÍËÛË ÙÔ˘ ÎÈÓ-
‰‡ÓÔ˘ ÈÛ¯·ÈÌÈ΋˜ ηډÈÔ¿ıÂÈ·˜ Î·È ÂÌÊÚ¿ÁÌ·-
ÙÔ˜ ÙÔ˘ Ì˘Ôηډ›Ô˘ ÛÙ· ¿ÙÔÌ· Ì ·˘ÍË̤ӷ Â›Â-
‰· Lp(a) Ï¿ÛÌ·ÙÔ˜50.
À¿Ú¯Ô˘Ó ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ Ô˘ ·Û¯Ô-
Ï‹ıËÎ·Ó Ì ÙËÓ ·ÏÏËÏÂ›‰Ú·ÛË ÌÂٷ͇ Lp(a) ηÈ
ÂÈ¤‰ˆÓ LDL-¯ÔÏËÛÙÂÚfiÏ˘ Ï¿ÛÌ·ÙÔ˜ ˆ˜ ÚÔ˜
ÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ÈÛ¯·ÈÌÈ΋˜ ηډÈÔ¿ıÂÈ-
·˜48,49. Δ· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ÌÂÏÂÙÒÓ ·˘ÙÒÓ ¤‰ÂÈ-
Í·Ó fiÙÈ Ù· ·˘ÍË̤ӷ Â›‰· Lp(a) ÚÔηÏÔ‡Ó ·‡-
ÍËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÈÛ¯·ÈÌÈ΋˜ ηډÈÔ¿ıÂÈ·˜ Û ¿-
ÙÔÌ· Ì ˘„ËÏ¿ Â›‰· LDL-¯ÔÏËÛÙÂÚfiÏ˘ Ï¿-
ÛÌ·ÙÔ˜50. ¶·ÚfiÌÔÈ· ‹Ù·Ó Ù· ·ÔÙÂϤÛÌ·Ù· Ì›·˜
ÚfiÛÊ·Ù˘ ÚÔÔÙÈ΋˜ ÌÂϤÙ˘, ÛÙËÓ ÔÔ›· ÂÎÙÈÌ‹-
ıËÎÂ Ô Î›Ó‰˘ÓÔ˜ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘ ˆ˜ Û˘Ó¿Ú-
 EÏÏËÓÈο ¢È·‚ËÙÔÏÔÁÈο XÚÔÓÈο 25, 2
ÙËÛË ÙˆÓ ·˘ÍËÌ¤ÓˆÓ ÂÈ¤‰ˆÓ Ù˘ ∞ƒO-μ Î·È Ù˘
Lp(a)51. Δ¤ÏÔ˜, Ù· ·ÔÙÂϤÛÌ·Ù· ·fi ÂȉËÌÈÔÏÔÁÈ-
Τ˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ Ë Lp(a) Â›Ó·È ¤Ó·˜ ·ÓÂÍ¿Ú-
ÙËÙÔ˜ ÚÔÁÓˆÛÙÈÎfi˜ ‰Â›ÎÙ˘ ÈÛ¯·ÈÌÈ΋˜ ηډÈÔ¿-
ıÂÈ·˜, ·ÓÂÍ¿ÚÙËÙÔ˜ ·fi ÙËÓ ·ÚÔ˘Û›· ÙˆÓ ÎÏ·ÛÈ-
ÎÒÓ ·Ú·ÁfiÓÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘48,49.
Lp(a) Î·È Î›Ó‰˘ÓÔ˜ ·ÁÁÂÈ·ÎÔ‡ ÂÁÎÂÊ·ÏÈÎÔ‡
ÂÂÈÛÔ‰›Ô˘
™Â Ì›· ÌÂϤÙË Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËΠÛÙËÓ
∞Û›· ‚Ú¤ıËΠfiÙÈ Ù· Â›‰· ÙˆÓ Lp(a) Î·È Apo B
Û¯ÂÙ›˙ÔÓÙ·Ó Ì ÙËÓ ÂÌÊ¿ÓÈÛË ÈÛ¯·ÈÌÈÎÔ‡ ·ÁÁÂÈ·-
ÎÔ‡ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ (∞∂∂)52. ŸÌÔÈ·, ηÈ
Û ¿ÏÏË ÌÂϤÙË ÂȂ‚·ÈÒıËÎÂ Ë Û¯¤ÛË ÙˆÓ ˘„Ë-
ÏÒÓ ÂÈ¤‰ˆÓ Lp(a), ηıÒ˜ Î·È ÔÌÔ΢ÛÙ½Ó˘, ÌÂ
ÙËÓ ÂÌÊ¿ÓÈÛË ÈÛ¯·ÈÌÈÎÔ‡ ∞∂∂53. ™Â ÚfiÛÊ·ÙË Ô-
Ï˘ÎÂÓÙÚÈ΋ ÌÂϤÙË Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËΠÛÙȘ
∏¶∞ ‚Ú¤ıËΠfiÙÈ Ë Lp(a) ·ÔÙÂÏ› ·ÓÂÍ¿ÚÙËÙÔ ·-
Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛ˘ ∞∂∂54. Δ· ·Ú·¿Óˆ
Â˘Ú‹Ì·Ù· ÂȂ‚·ÈÒıËÎ·Ó ·fi ÌÂÁ¿ÏË ÂȉËÌÈÔÏÔ-
ÁÈ΋ ÌÂϤÙË Û 126.634 ¿ÙÔÌ· Ô˘ ¤‰ÂÈÍ fiÙÈ Ë Lp(a)
·ÔÙÂÏ› ·ÓÂÍ¿ÚÙËÙÔ ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ Ì·ÎÚÔ-
·ÁÁÂÈÔ¿ıÂÈ·˜ (ÈÛ¯·ÈÌÈ΋˜ ηډÈÔ¿ıÂÈ·˜ ηÈ
∞∂∂)55. Δ¤ÏÔ˜, Û ¿ÏÏË ÌÂϤÙË ‚Ú¤ıËΠfiÙÈ Ù· Â›-
‰· Ù˘ Lp(a) Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔ ¿¯Ô˜ ÙÔ˘ ¤Ûˆ-̤-
ÛÔ˘ ¯ÈÙÒÓ· ÙˆÓ Î·ÚˆÙ›‰ˆÓ ·ÚÙËÚÈÒÓ ÛÙ· ¿ÙÔÌ· ÌÂ
۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ 256.
£ÂÚ·¢ÙÈΤ˜ ÚÔÛÂÁÁ›ÛÂȘ ÙˆÓ ·ÙfïÓ
Ì ˘„ËÏ¿ Â›‰· Lp(a)
Δ· Â›‰· Ù˘ Lp(a) ‰ÂÓ ÂËÚ¿˙ÔÓÙ·È ·fi
ÙȘ ˘¿Ú¯Ô˘Û˜ Ê·ÚÌ·ÎÔÏÔÁÈΤ˜ Î·È ÌË ·ÚÂÌ‚¿-
ÛÂȘ, ·ÓÙ›ıÂÙ· Ì ÙȘ ¿ÏϘ ÏÈÔÚˆÙ½Ó˜ ÙÔ˘ Ï¿-
ÛÌ·ÙÔ˜. ¶·ÚfiÏ· ·˘Ù¿, ·ÚÎÂÙ¤˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó
fiÙÈ Ù· Â›‰· Ù˘ Lp(a) ÌÔÚÔ‡Ó Ó· ÙÚÔÔÔÈË-
ıÔ‡Ó ·fi ·Ú¿ÁÔÓÙ˜ fiˆ˜ Â›Ó·È Ë ÓÈ·Û›ÓË, Ë ·˘-
ÍËÙÈ΋ ÔÚÌfiÓË Î·È Ô ·˘ÍËÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ Ù˘ ÈÓ-
ÛÔ˘Ï›Ó˘ Ù‡Ô˘ π (Insulin growth factor-1, IGF-
1)57, Ô˘Û›Â˜ Ô˘ ÂÚȤ¯ÔÓÙ·È ÛÙË ÛfiÁÈ·58, Ë Î·˙½-
ÓË59, ÔÈ ÛÙÂÚÔÂȉ›˜ ÔÚÌfiÓ˜ (·Ó‰ÚÔÁfiÓ·, ÙÂÛÙÔ-
ÛÙÂÚfiÓË Î·È ÔÈÛÙÚÔÁfiÓ·), Ë ·ÛÈÚ›ÓË, Ë Ï‹„Ë Ô-
Ï˘·ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ Î·È Ë ¿ÛÎËÛË. ∏
Ï·ÛÌ·Ê·›ÚÂÛË, Ô˘ ·ÔÙÂÏ› ·ÎÚÈ‚‹ ‰È·‰Èηۛ·
Î·È ¯ÚËÛÈÌÔÔÈÂ›Ù·È Û ÂÚÈÙÒÛÂȘ ÔÈÎÔÁÂÓÔ‡˜
˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜, Â›Ó·È Ë ÌfiÓË ÈηӋ ̤ıÔ-
‰Ô˜ Ó· ÌÂÈÒÛÂÈ Ù· Â›‰· Ù˘ Lp(a) ηٿ 50%44.
¢›·ÈÙ·
∂ȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó ÙȘ ˆÊ¤ÏÈ-
̘ ÂȉڿÛÂȘ Ù˘ ηٷӿψÛ˘ „·ÚÈÒÓ, ΢ڛˆ˜
ÙˆÓ ÏÈ·ÚÒÓ, ÛÙË Ì›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ Lp(a).
™˘ÁÎÂÎÚÈ̤ӷ, ÌÂϤÙË Û ÏËı˘ÛÌfi ·fi ÙËÓ Δ·Ó-
˙·Ó›· ¤‰ÂÈÍ fiÙÈ Ù· ¿ÙÔÌ· ÙˆÓ ÔÔ›ˆÓ Ë ‰È·ÙÚÔÊ‹
‚·ÛÈ˙fiÙ·Ó ÛÙÔ „¿ÚÈ, ›¯·Ó Â›‰· Lp(a) ÛÙÔ Ï¿-
ÛÌ· 48% ¯·ÌËÏfiÙÂÚ· Û ۇÁÎÚÈÛË Ì ¯ÔÚÙÔÊ¿Á·
¿ÙÔÌ· ÙÔ˘ ›‰ÈÔ˘ ÏËı˘ÛÌÔ‡. OÈ ÂÚ¢ÓËÙ¤˜ Û˘Ì¤-
Ú·Ó·Ó fiÙÈ Ë Ì·ÎÚ¿˜ ‰È¿ÚÎÂÈ·˜ ‰È·ÙÚÔÊ‹ ÏÔ‡ÛÈ·
Û ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ· Ì›ˆÛ ٷ Â›‰·
Ù˘ Lp(a) ÛÙÔ Ï¿ÛÌ· Î·È fiÙÈ Ì›· ‰›·ÈÙ· ‚·ÛÈṲ̂-
ÓË ÛÙËÓ Î·Ù·Ó¿ÏˆÛË „·ÚÈÒÓ Â›Ó·È ÈηӋ Ó· ÌÂÈÒ-
ÛÂÈ Ù· Â›‰· Ù˘ Lp(a) ÛÙÔÓ ÔÚfi60.
OÈ Ê˘ÙÈΤ˜ Î·È ˙ˆÈΤ˜ ÚˆÙ½Ó˜ ‚Ú¤ıËΠfiÙÈ
ÂËÚ¿˙Ô˘Ó ÙË Û˘ÁΤÓÙÚˆÛË Ù˘ Lp(a) ÛÙÔ Ï¿ÛÌ·,
Ì ÙËÓ ÚˆÙ½ÓË Ù˘ ÛfiÁÈ·˜ Ó· ÚÔηÏ› ·‡ÍËÛË Ù˘
Lp(a) Î·È ÙËÓ Î·˙½ÓË Ó· ÚÔηÏ› Ì›ˆÛË ÛÙ· Â›-
‰· Ù˘ Lp(a).58 øÛÙfiÛÔ, Û ¿ÏÏË ÌÂϤÙË ÙˆÓ Mei-
nertz Î·È Û˘Ó., ‚Ú¤ıËΠfiÙÈ Ë ÚˆÙ½ÓË ÛfiÁÈ·˜ ÌÔ-
Ú› Ó· ÂÏ·ÙÙÒÛÂÈ Ù· Â›‰· Ù˘ Lp(a)59.
¡È·Û›ÓË
∏ ÓÈ·Û›ÓË Â›Ó·È ¤Ó·˜ ·fi ÙÔ˘˜ Ï›ÁÔ˘˜ ıÂÚ·-
¢ÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ‰È·ı¤ÙÂÈ ÙËÓ ÈηÓfiÙËÙ·
Ó· ÌÂÈÒÓÂÈ ·ÔÙÂÏÂÛÌ·ÙÈο ÙȘ Û˘ÁÎÂÓÙÚÒÛÂȘ Ù˘
Lp(a) Ï¿ÛÌ·ÙÔ˜ ηٿ ÙÚfiÔ ‰ÔÛÔÂÍ·ÚÙÒÌÂÓÔ29.
OÈ Carlson Î·È Û˘Ó. ‚Ú‹Î·Ó fiÙÈ ÔÈ ·ÛıÂÓ›˜ ÔÈ Ô-
Ô›ÔÈ ¤Ï·‚·Ó ÓÈ·Û›ÓË Û ‰fiÛÂȘ ÙˆÓ 2 Î·È 4 g/Ë̤ڷ
·ÚÔ˘Û›·Û·Ó Ì›ˆÛË ÛÙ· Â›‰· Ù˘ Lp(a) ηٿ
25% Î·È 38%, ·ÓÙ›ÛÙÔȯ·61. OÈ Pan Î·È Û˘Ó. Û ÌÂ-
ϤÙË ÙÔ˘˜ ¤‰ÂÈÍ·Ó ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ÓÈ·-
Û›Ó˘ ÛÙË Ì›ˆÛË ÙfiÛÔ Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ fiÛÔ
Î·È ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ Lp(a) Û ·ÛıÂÓ›˜ Ì ۷ί·-
ÚÒ‰Ë ‰È·‚‹ÙË, Ì Ì›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ Lp(a)
·fi 37±10 ÛÂ 23±10 mg/dL (p<0,001)62.
∞ÛÈÚ›ÓË
To 2002 ÔÈ Kagawa Î·È Û˘Ó. ÌÂϤÙËÛ·Ó 70 π¿-
ˆÓ˜ ·ÛıÂÓ›˜ Ì ηډȷÁÁÂȷ΋ ÓfiÛÔ, ÔÈ ÔÔ›ÔÈ
·ÎÔÏÔ˘ıÔ‡Û·Ó Ê·ÚÌ·ÎÔÏÔÁÈ΋ ıÂÚ·›· Ì ·ÛÈ-
Ú›ÓË63. μÚ‹Î·Ó fiÙÈ Ë ·ÛÈÚ›ÓË Ì›ˆÛ ٷ Â›‰· Ù˘
Lp(a) ÛÙÔ 80% ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó Î·È ÔÈ
ÔÔ›ÔÈ Â›¯·Ó ˘„ËÏ‹ Û˘ÁΤÓÙÚˆÛË Lp(a) Ï¿ÛÌ·ÙÔ˜
(>300 mg/L). øÛÙfiÛÔ, ÛÙËÓ ›‰È· ÌÂϤÙË ‰ÂÓ ˘‹Ú-
¯·Ó ÛËÌ·ÓÙÈΤ˜ ·ÏÏ·Á¤˜ ÛÙË Û˘ÁΤÓÙÚˆÛË Ù˘ Lp(a)
ÛÙ· ¿ÙÔÌ· ÌÂ Û˘ÁÎÂÓÙÚÒÛÂȘ <300 mg/L63.
™Ù·Ù›Ó˜ Î·È ÊÈÌÚ¿Ù˜
OÈ Goudevenos Î·È Û˘Ó. ¤‰ÂÈÍ·Ó fiÙÈ Ë ıÂÚ·-
›· Ì 20 mg/Ë̤ڷ ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ ÁÈ· 24 ‚‰Ô-
Ì¿‰Â˜ Û 90 ‰˘ÛÏÈȉ·ÈÌÈÎÔ‡˜, ÌË Î·ÓÈÛÙ¤˜ ·-
ÛıÂÓ›˜, ÂÓÒ ‚ÂÏÙ›ˆÛ ÙÔ ÏÈȉ·ÈÌÈÎfi ÙÔ˘˜ ÚÔÊ›Ï,
109
 EÏÏËÓÈο ¢È·‚ËÙÔÏÔÁÈο XÚÔÓÈο 25, 2
‰ÂÓ Â›¯Â η̛· Â›‰Ú·ÛË ÛÙ· Â›‰· Ù˘ Lp(a)64.
ŸÌÔÈ·, ÔÈ Kaur Î·È Û˘Ó. ¤‰ÂÈÍ·Ó fiÙÈ Ë ıÂÚ·›· ÌÂ
ÛÈÌ‚·ÛÙ·Ù›ÓË ‚ÂÏÙ›ˆÛ ÙȘ ·Ú·Ì¤ÙÚÔ˘˜ ÙÔ˘ ÏÈÈ-
‰·ÈÌÈÎÔ‡ ÚÔÊ›Ï ·ÏÏ¿ ‰ÂÓ ÂËÚ¤·Û ÛËÌ·ÓÙÈο Ù·
Â›‰· Ù˘ Lp(a) Ï¿ÛÌ·ÙÔ˜65.
™˘ÁÎÚ›ÓÔÓÙ·˜ ÙË ÏÔ‚·ÛÙ·Ù›ÓË Ì ÙË ÁÂÌÊÈÌ-
ÚÔ˙›ÏË, Û¯ÂÙÈο Ì ÙȘ ÂȉڿÛÂȘ ÙÔ˘˜ ÛÙËÓ Lp(a)
Û ·ÛıÂÓ›˜ Ì ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·, ÔÈ Ramirez
Î·È Û˘Ó. ‚Ú‹Î·Ó fiÙÈ Ë ÁÂÌÊÈÌÚÔ˙›ÏË Ì›ˆÛ ÛË-
Ì·ÓÙÈο Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È·, ÙËÓ ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË,
ÙËÓ LDL-¯ÔÏËÛÙÂÚfiÏË, ÙËÓ Ôχ ¯·ÌËÏ‹˜ ˘ÎÓfiÙË-
Ù·˜ ÏÈÔÚˆÙ½ÓË, Î·È Ù· Â›‰· Ù˘ Lp(a) Ï¿-
ÛÌ·ÙÔ˜ Î·È ·‡ÍËÛ ÙËÓ HDL (high density lipopro-
tein) – ¯ÔÏËÛÙÂÚfiÏË Û ۇÁÎÚÈÛË Ì ÙË ÏÔ‚·ÛÙ·Ù›-
ÓË66. ¶·ÚfiÌÔÈ· ·ÔÙÂϤÛÌ·Ù· ¤‰ÂÈÍ·Ó ÌÂϤÙ˜
Ô˘ ¤Î·Ó·Ó Û‡ÁÎÚÈÛË Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜
ÛÙ· Â›‰· Ù˘ Lp(a) Ï¿ÛÌ·ÙÔ˜ ÌÂٷ͇ Ù˘ ÁÂÌ-
ÊÈÌÚÔ˙›Ï˘ Î·È Ù˘ ÛÈÌ‚·ÛÙ·Ù›Ó˘67.
™Â ˘„ËϤ˜ ‰fiÛÂȘ ‚Ú¤ıËΠfiÙÈ Ë ÓÈ·Û›ÓË ÌÔ-
Ú› Ó· ÌÂÈÒÛÂÈ Ù· Â›‰· Ù˘ Lp(a) Ï¿ÛÌ·ÙÔ˜68.
™Â ÚfiÛÊ·ÙË ÌÂϤÙË ‚Ú¤ıËΠfiÙÈ Ô Û˘Ó‰˘·ÛÌfi˜
ÓÈ·Û›Ó˘ Î·È ˆ-3 ÏÈ·ÚÒÓ ÔͤˆÓ Ì›ˆÛ ٷ Â›Â-
‰· Ù˘ Lp(a) Ï¿ÛÌ·ÙÔ˜ ÂȉÈο ÛÙÔ˘˜ ·ÛıÂÓ›˜ ÌÂ
˘„ËÏ¿ Â›‰· Ù˘ Lp(a) ÛÙËÓ ·Ú¯‹ Ù˘ ÌÂϤÙ˘69.
OÚÌÔÓÈ΋ ıÂÚ·›·
∏ ıÂÚ·¢ÙÈ΋ ¯Ú‹ÛË Ù˘ ·ÓıÚÒÈÓ˘ ·˘ÍËÙÈ-
΋˜ ÔÚÌfiÓ˘ Û ·ÛıÂÓ›˜ Ì ·ÓÂ¿ÚÎÂÈ¿ Ù˘ ›¯Â ˆ˜
·ÔÙ¤ÏÂÛÌ· ÙËÓ ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ Lp(a),
ÁÂÁÔÓfi˜ Ô˘ ı· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È ˘fi„Ë Î·-
Ù¿ ÙË ¯ÔÚ‹ÁËÛ‹ Ù˘ Û ¿ÙÔÌ· ÌÂ Û˘Ó˘¿Ú¯Ô˘Û·
ηډȷÁÁÂȷ΋ ÓfiÛÔ70,71.
∞fi ÙËÓ ¿ÏÏË ÏÂ˘Ú¿, Ù· ·ÔÙÂϤÛÌ·Ù· Ì›·˜
Û¯ÂÙÈο ÚfiÛÊ·Ù˘ ÌÂϤÙ˘ ¤‰ÂÈÍ·Ó fiÙÈ Ë ıÂÚ·-
›· ÔÚÌÔÓÈ΋˜ ˘ÔηٿÛÙ·Û˘ Ô‰ËÁ› ÛÙË Ì›ˆÛË
ÙˆÓ Û˘ÁÎÂÓÙÚÒÛÂˆÓ Ù˘ Lp(a)72. ΔÔ ÁÂÁÔÓfi˜ ·˘Ùfi
ÂȂ‚·ÈÒÓÂÙ·È ·fi ÙËÓ ·Ú·Ù‹ÚËÛË fiÙÈ Î·Ù¿ ÙË
‰È¿ÚÎÂÈ· Ù˘ ÂÌÌËÓfi·˘Û˘ ·Ú·ÙËÚÂ›Ù·È ÌÈ· ·-
ÚÔ‰È΋ ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ Lp(a) Ô˘ ·Ô-
‰fiıËΠÛÙËÓ ¤ÏÏÂÈ„Ë ÔÈÛÙÚÔÁfiÓˆÓ73.
ÕÏϘ ıÂÚ·¢ÙÈΤ˜ ÂÈÏÔÁ¤˜ fiˆ˜ ÔÈ Ê˘ÙÈΤ˜
ÛÙÂÚfiϘ74, Ë ‰È·Î˘ÏÔÁÏ˘ÎÂÚfiÏË,75 Î·È Ù· ·Ó·‚Ô-
ÏÈο ÛÙÂÚÔÂȉ‹76 ¤¯Ô˘Ó ÂÌÊ·Ó›ÛÂÈ ıÂÙÈ΋ Â›‰Ú·-
ÛË ÛÙ· Â›‰· Ù˘ Lp(a). øÛÙfiÛÔ, ÂÍ·ÈÙ›·˜ ÙÔ˘
ÂÚÈÔÚÈṲ̂ÓÔ˘ ÌÂÁ¤ıÔ˘˜ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜, ··ÈÙÔ‡-
ÓÙ·È ÂÚ·ÈÙ¤Úˆ ÌÂϤÙ˜ ÁÈ· Ó· ÂȂ‚·Èˆı› Ë ·-
ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ·˘ÙÒÓ ÙˆÓ ·Ú·ÁfiÓÙˆÓ.
L-ηÚÓÈÙ›ÓË
OÈ Sirtori Î·È Û˘Ó.77, Û ̛· ‰ÈÏ¿-Ù˘ÊÏ‹ ÌÂϤ-
ÙË, ‰È·›ÛÙˆÛ·Ó fiÙÈ Ë ¯ÔÚ‹ÁËÛË 2 g/Ë̤ڷ L-ηÚ-
110
ÓÈÙ›Ó˘ Ì›ˆÛ ٷ Â›‰· Ù˘ Lp(a) Û 77,8% ÙˆÓ
·ÛıÂÓÒÓ (-7,7% ÛÙÔ Ù¤ÏÔ˜ Ù˘ ÌÂϤÙ˘ ¤Ó·ÓÙÈ Ù˘
·Ú¯È΋˜ ÙÈÌ‹˜ Û˘ÁÎÚÈÙÈο Ì -11,7% ÛÙËÓ ÔÌ¿‰·
Ô˘ ¤Ï·‚ placebo). ∂›Û˘, ÔÈ Derosa Î·È Û˘Ó. ¤-
‰ÂÈÍ·Ó fiÙÈ Û 94 ·ÛıÂÓ›˜ Ì ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·È-
Ì›· Î·È ÚfiÛÊ·ÙË ‰È¿ÁÓˆÛË Û·Î¯·ÚÒ‰Ô˘˜ ‰È·‚‹-
ÙË Ù‡Ô˘ 2 Ë ¯ÔÚ‹ÁËÛË L-ηÚÓÈÙ›Ó˘ Ì›ˆÛ ÛËÌ·-
ÓÙÈο Ù· Â›‰· Ù˘ Lp(a) ÛÙÔ Ï¿ÛÌ· Û ۯ¤ÛË
Ì ÙËÓ ÔÌ¿‰· Ô˘ ¤Ï·‚ placebo78.
ÕÛÎËÛË
¶ÔÏϤ˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ë Û˘ÛÙËÌ·ÙÈ-
΋ ¿ÛÎËÛË ¤¯ÂÈ ˆÊ¤ÏÈ̘ ÂȉڿÛÂȘ ÛÙÔ ÏÈȉ·È-
ÌÈÎfi ÚÔÊ›Ï Î·È ÌÂÈÒÓÂÈ ÙËÓ Î·Ú‰È·ÁÁÂȷ΋ ıÓËÛÈ-
ÌfiÙËÙ·79. øÛÙfiÛÔ, fiÛÔÓ ·ÊÔÚ¿ Ù· Â›‰· Ï¿-
ÛÌ·ÙÔ˜ Ù˘ Lp(a) Ù· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ÌÂÏÂÙÒÓ
Â›Ó·È ·ÓÙÈÊ·ÙÈο80. OÈ Ruiz Î·È Û˘Ó., Û ̛· ÌÂϤÙË
Ô˘ ÂÚÈÏ¿Ì‚·Ó ·ıÏËÙ¤˜ Ù˘ ÂÙÔÛÊ·›ÚÈÛ˘, Ù˘
ÎÔχ̂ËÛ˘ Î·È ÙÔ˘ Ô‰ÔÛÊ·›ÚÔ˘ Î·È ÔÌ¿‰· ˘ÁÈÒÓ
Ì·ÚÙ‡ÚˆÓ, Ì ·ÚfiÌÔÈ· ·ÓıÚˆÔÌÂÙÚÈο Î·È ÎÔÈ-
ÓˆÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο, ‰È·›ÛÙˆÛ·Ó fiÙÈ ÔÈ ·›-
ÎÙ˜ ÙÔ˘ Ô‰ÔÛÊ·›ÚÔ˘ ›¯·Ó Ù· ˘„ËÏfiÙÂÚ· Â›‰·
Lp(a) ÛÙÔ Ï¿ÛÌ·, ÂÓÒ ÔÈ ÎÔÏ˘Ì‚ËÙ¤˜ Ù· ¯·ÌËÏfi-
ÙÂÚ· Â›‰· Lp(a) ÛÙÔ Ï¿ÛÌ·79. ∂›Û˘, Úfi-
ÛÊ·Ù˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ ÌÂÙ¿ ·fi ÂÓÙ·ÙÈ΋ ¿-
ÛÎËÛË (‰È¿ÚÎÂÈ·˜ ÂÚ›Ô˘ 9-12 ÌËÓÒÓ) ·Ú·ÙËÚ‹-
ıËΠ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ Lp(a) ÛÙÔ Ï¿ÛÌ·
ηٿ 10%-15%79. ¶ÚfiÛÊ·ÙË ÌÂϤÙË Ô˘ Ú·ÁÌ·-
ÙÔÔÈ‹ıËΠÛÙË ¡. ∞ÌÂÚÈ΋ ¤‰ÂÈÍ fiÙÈ Ë ¤ÓÙÔÓË
ۈ̷ÙÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· Û¯ÂÙ›˙ÂÙ·È ÌÂ Ê˘ÛÈÔÏÔÁÈ-
ο Â›‰· Ù˘ Lp(a) ÛÙÔ Ï¿ÛÌ·81.
™˘ÌÂÚ·ÛÌ·ÙÈο, Ë Lp(a) ·ÔÙÂÏ› ¤Ó·Ó ·Ó·-
‰˘fiÌÂÓÔ ·Ú¿ÁÔÓÙ· ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ η-
ıÒ˜ ˘¿Ú¯Ô˘Ó ·ÚÎÂÙ¤˜ ÌÂϤÙ˜ Ô˘ ÙÂÎÌËÚÈÒÓÔ˘Ó
ÙË Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ˘„ËÏÒÓ ÂÈ¤‰ˆÓ Ï¿ÛÌ·ÙÔ˜
Ù˘ Lp(a) ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ Î·È ÂÁÎÂÊ·ÏÈÎÒÓ ·Á-
ÁÂÈ·ÎÒÓ ÂÂÈÛÔ‰›ˆÓ82. OÈ ˘¿Ú¯Ô˘Û˜ ıÂÚ·¢ÙÈ-
Τ˜ ÚÔÛÂÁÁ›ÛÂȘ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ˘„ËÏÒÓ
ÂÈ¤‰ˆÓ Lp(a) Ï¿ÛÌ·ÙÔ˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙË ¯Ú‹-
ÛË ÊÈÌÚ·ÙÒÓ, ÓÈ·Û›Ó˘ Î·È ¿ÛÎËÛ˘ ¯ˆÚ›˜, ˆÛÙfiÛÔ,
Ó· ·ÔÙÂÏÔ‡Ó ıÂÚ·¢ÙÈ΋ ÂÈÏÔÁ‹ ̤¯ÚÈ Û‹ÌÂÚ·.
∞·ÈÙÔ‡ÓÙ·È ÂÈϤÔÓ ÌÂÁ¿Ï˜ ÂȉËÌÈÔÏÔÁÈΤ˜ η-
ıÒ˜ Î·È ÌÂϤÙ˜ ·Ú¤Ì‚·Û˘ ÚÔÎÂÈ̤ÓÔ˘ Ó· ÙÂÎ-
ÌËÚȈı› Ô ÚfiÏÔ˜ ÙˆÓ ·Ú·¿Óˆ ·Ú·ÁfiÓÙˆÓ ÛÙË
ıÂÚ·›· ÙˆÓ ˘„ËÏÒÓ ÂÈ¤‰ˆÓ Ï¿ÛÌ·ÙÔ˜ Lp(a).
Abstract
Papazafiropoulou AK, Papageorgiou I, Pappas SI. Li-
poprotein (a) and cardiovascular disease. Hellen
Diabetol Chron 2012; 2: 106-113.
 EÏÏËÓÈο ¢È·‚ËÙÔÏÔÁÈο XÚÔÓÈο 25, 2
Lipoprotein (a) [Lp(a)] was discovered by Kare
Berg in 1963. Interest in Lp(a) has increased because
an important association between high plasma levels
of Lp(a) and coronary artery disease and cerebral
vascular disorders has been demonstrated. Numerous
case control studies have confirmed that hyper-Lp(a)
is a risk factor for premature cardiovascular disease.
Various approaches to drug treatment using fibric a-
cid derivatives, growth hormone, insulin-like growth
factor-1, niacin, and exercise have been proven to de-
crease Lp(a) in high risk patients, but none has really
been an effective therapeutic option for successfully
reducing Lp(a) plasma levels. The aim of this review
is to summarize present evidence of a causal associa-
tion of Lp(a) with risk of ischemic heart disease and
its clinical implications.
μÈ‚ÏÈÔÁÚ·Ê›·
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§ÈÔÚˆÙ½ÓË (·)
∞ıËÚÔÁ¤ÓÂÛË
£ÂÚ·›·
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Key-words:
Cardiovascular disease
Lipoprotein (a)
Atherogenesis
Therapeutics
113