Sodium Intake and All-Cause Mortality Over 20 Years in the Trials of Hypertension Prevention.
Sodium Intake and All-Cause Mortality Over 20 Years in the Trials of Hypertension Prevention.
复制标题
DOI：
10.1016/j.jacc.2016.07.745
复制
发表时间：
2016-10-11
影响因子：
24
通讯作者：
Whelton, Paul K.
中科院分区：
文献类型：
--
作者：
Cook, Nancy R.;Appel, Lawrence J.;Whelton, Paul K.
虽然一些研究表明低钠对心血管疾病有益，但与总死亡率的关系仍然存在争议。有些人报告了 J 形曲线，但这可能是由于钠测量质量差或混杂偏差造成的。旨在检查根据尿钠排泄估算的钠摄入量的明确特征指标与长期死亡率之间的关系。两项试验[高血压预防试验中为期 18 个月的第一阶段 (1987-90) 和为期 36 个月的第二阶段 (1990-5)] 实施了减钠干预措施。在这些试验期间，我们收集了 30-54 岁的高血压前期成年人的多次 24 小时尿液。使用国家死亡指数确定了截至 2013 年 12 月 31 日的平均 24 年的试验后死亡情况。研究了死亡率与随机干预和平均钠摄入量的关联。在 744 名 I 期参与者和 2382 名 II 期参与者中，随机接受钠减少或控制，发生了 251 例死亡，积极干预后风险降低了 15%（风险比 (HR)=0.85，95% CI=0.66-1.09，p=0.19）。在 2,974 名未接受主动钠干预的参与者中，有 272 人死亡。平均钠摄入量与死亡率存在直接线性相关性，<2300、2300-<3600、3600-<4800 和 >=4800 mg/24 小时的 HR 分别为 0.75、0.95、1.00（参考）和 1.07（p 趋势 = 0.30），HR=1.12/1000 mg/24hr (95% CI = 1.00-1.26, p=0.05)，没有证据表明存在 J 形或非线性关系。钠/钾比率每增加一个单位的 HR 为 1.13（95% CI = 1.01-1.27，p=0.04）。这项研究通过仔细测量钠摄入量，发现高钠摄入量会增加风险，并且即使在最低钠摄入量时也与总死亡率直接相关。总体而言，这些结果与 20 多年来减少钠和钠/钾对总死亡率的益处是一致的。
While several studies suggest beneficial effects of lower sodium on cardiovascular disease, the relationship with total mortality remains controversial. Some have reported a J-shaped curve, but this may be due to poor quality measurement of sodium or confounding bias. To examine the relationship of well-characterized measures of sodium intake, estimated from urinary sodium excretion, with long-term mortality. Two trials [Phase I (1987-90) over 18 month and Phase II (1990-5) over 36 months in the Trials of Hypertension Prevention] implemented sodium reduction interventions. Multiple 24-hour urines were collected from pre-hypertensive adults aged 30-54 during these trial periods. Post-trial deaths were ascertained over a median 24 years through December 31, 2013 using the National Death Index. The association of mortality with both the randomized intervention and average sodium intake was examined. Among 744 Phase I and 2382 Phase II participants randomized to sodium reduction or control, 251 deaths occurred, with a nonsignificant 15% lower risk in the active intervention (hazard ratio (HR)=0.85, 95% CI=0.66-1.09, p=0.19). Among 2,974 participants not assigned to an active sodium intervention, 272 deaths occurred. There was a direct linear association of average sodium intake with mortality, with HR=0.75, 0.95, 1.00 (reference), and 1.07 (p-trend = 0.30) for <2300, 2300-<3600, 3600-<4800, and >=4800 mg/24hr, respectively, with HR=1.12 per 1000 mg/24hr (95% CI = 1.00-1.26, p=0.05) and no evidence of a J-shape or nonlinear relation. The HR per unit increase in sodium/potassium ratio was 1.13 (95% CI = 1.01-1.27, p=0.04). This study, with carefully characterized measures of sodium intake, found an increased risk at high sodium intake and a direct relation with total mortality even at the lowest levels of sodium intake. Overall, these results are consistent with a benefit of reduced sodium and sodium/potassium on total mortality over a period of over 20 years.
登录
查看更多内容
影响因子：
--
作者：
Cook, Nancy R.;Obarzanek, Eva;Cutler, Jeffrey A.;Buring, Julie E.;Rexrode, Kathryn M.;Kumanyika, Shiriki K.;Appel, Lawrence J.;Whelton, Paul K.
通讯作者：
Whelton, Paul K.
影响因子：
37.8
作者：
Cobb, Laura K.;Anderson, Cheryl A. M.;Appel, Lawrence J.
通讯作者：
Appel, Lawrence J.
影响因子：
120.7
作者：
Whelton, PK;Appel, LJ;Cutler, JA
通讯作者：
Cutler, JA
影响因子：
120.7
作者：
O'Donnell, Martin J.;Yusuf, Salim;Schmieder, Roland E.
通讯作者：
Schmieder, Roland E.
影响因子：
7.1
作者：
Cogswell, Mary E.;Zhang, Zefeng;Moshfegh, Alanna J.
通讯作者：
Moshfegh, Alanna J.