Salt intake, stroke, and cardiovascular disease: meta-analysis of prospective studies.
Salt intake, stroke, and cardiovascular disease: meta-analysis of prospective studies.
复制标题
DOI：
10.1136/bmj.b4567
复制
发表时间：
2009-11-24
期刊：
影响因子：
--
通讯作者：
Cappuccio FP
中科院分区：
文献类型：
--
作者：
Strazzullo P;D'Elia L;Kandala NB;Cappuccio FP
目的探讨习惯盐摄入水平与脑卒中或心血管疾病转归的关系。设计对1966-2008年发表的前瞻性研究进行系统回顾和荟萃分析。数据来源Medline（1966-2008）、Embase（1988年）、AMED（1985年）、CINAHL（1982年）、Psychinfo（1985年）和Cochrane图书馆。对于每项研究，提取相对风险和95%置信区间，并与随机效应模型合并，加权为方差的倒数。进行异质性、发表偏倚、亚组和元回归分析。纳入标准是前瞻性成人人群研究，评估盐摄入量作为基线暴露，评估中风或心血管疾病作为结果，至少随访三年，表明暴露的参与者人数和不同盐摄入类别的事件数量。结果来自13项研究的19个独立队列样本，177025名参与者（随访3.5-19年），超过11000例血管事件。较高的盐摄入量与卒中（总相对危险度1.23,95%可信区间1.06 ~ 1.43，P=0.007）和心血管疾病（总相对危险度1.14,0.99 ~ 1.32，P=0.07）的较高风险相关，无显著证据表明存在发表偏倚。对于心血管疾病，敏感性分析显示，排除一项研究导致合并估计为1.17（1.02至1.34；P=0.02）。观察到的关联越大，钠摄入量差异越大，随访时间越长。结论高盐摄入与卒中和心血管疾病风险显著增加相关。由于测量盐摄入量的不精确，这些效应值可能被低估了。这些结果支持大量减少人口盐摄入量对预防心血管疾病的作用。
Objective To assess the relation between the level of habitual salt intake and stroke or total cardiovascular disease outcome. Design Systematic review and meta-analysis of prospective studies published 1966-2008. Data sources Medline (1966-2008), Embase (from 1988), AMED (from 1985), CINAHL (from 1982), Psychinfo (from 1985), and the Cochrane Library. Review methods For each study, relative risks and 95% confidence intervals were extracted and pooled with a random effect model, weighting for the inverse of the variance. Heterogeneity, publication bias, subgroup, and meta-regression analyses were performed. Criteria for inclusion were prospective adult population study, assessment of salt intake as baseline exposure, assessment of either stroke or total cardiovascular disease as outcome, follow-up of at least three years, indication of number of participants exposed and number of events across different salt intake categories. Results There were 19 independent cohort samples from 13 studies, with 177 025 participants (follow-up 3.5-19 years) and over 11 000 vascular events. Higher salt intake was associated with greater risk of stroke (pooled relative risk 1.23, 95% confidence interval 1.06 to 1.43; P=0.007) and cardiovascular disease (1.14, 0.99 to 1.32; P=0.07), with no significant evidence of publication bias. For cardiovascular disease, sensitivity analysis showed that the exclusion of a single study led to a pooled estimate of 1.17 (1.02 to 1.34; P=0.02). The associations observed were greater the larger the difference in sodium intake and the longer the follow-up. Conclusions High salt intake is associated with significantly increased risk of stroke and total cardiovascular disease. Because of imprecision in measurement of salt intake, these effect sizes are likely to be underestimated. These results support the role of a substantial population reduction in salt intake for the prevention of cardiovascular disease.