Impact of Dietary Sodium Restriction on Heart Failure Outcomes.
Impact of Dietary Sodium Restriction on Heart Failure Outcomes.
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DOI：
10.1016/j.jchf.2015.08.007
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发表时间：
2016-01
期刊：
影响因子：
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通讯作者：
Powell LH
中科院分区：
文献类型：
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作者：
Doukky R;Avery E;Mangla A;Collado FM;Ibrahim Z;Poulin MF;Richardson D;Powell LH
虽然心力衰竭（HF）患者被建议限制钠摄入，但关于钠限制与HF预后的数据并不一致。
我们试图评估钠限制对HF预后的影响。
我们分析了来自多医院的心力衰竭依从性和保留试验的数据，该试验招募了902名纽约心脏协会（NYHA）II/III级HF患者，并对他们进行了中位36个月的随访。通过食物频率问卷对钠摄入量进行了连续评估。根据在首次死亡或因HF住院之前的平均每日钠摄入量，将患者分为钠限制组（<2500毫克/天）和非限制组（≥2500毫克/天）。根据可能的基线混杂因素对研究组进行倾向评分匹配。主要结局是死亡或因HF住院的复合结局。次要结局是心脏性死亡和因HF住院。
833名受试者有钠摄入数据（145名钠限制，688名钠非限制），其中260名经倾向评分匹配进入钠限制组（n = 130）和钠非限制组（n = 130）。钠限制与死亡或因HF住院的风险显著升高相关（42.3%对26.2%；风险比[HR]，1.83；95%置信区间[CI]，1.21 - 2.84；P = 0.004），这是由于因HF住院率增加（32.3%对20.0%；HR，1.82；CI，1.11 - 2.96；P = 0.015）以及心脏性死亡率（HR，1.62；CI，0.70 - 3.73；P = 0.257）和全因死亡率（P = 0.074）的非显著增加所致。探索性亚组分析表明，在未接受血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂的患者中，钠限制与死亡或因HF住院的风险增加相关（HR，5.78；CI，1.93 - 17.27；P = 0.002）。
在有症状的慢性HF患者中，钠限制可能对预后有不利影响。需要一项随机临床试验来明确解决钠限制在HF管理中的作用。
Although sodium restriction is advised for patients with heart failure (HF), data on sodium restriction and HF outcomes are inconsistent. We sought to evaluate the impact of sodium restriction on HF outcomes. We analyzed data from the multi-hospital, Heart Failure Adherence and Retention Trial which enrolled 902 NYHA class II/III HF patients and followed them for a median of 36 months. Sodium intake was serially assessed by a food frequency questionnaire. Based on the mean daily sodium intake prior to the first event of death or HF hospitalization, patients were classified into sodium restricted (<2,500 mg/day) and unrestricted (≥2,500 mg/day) groups. Study groups were propensity score-matched according to plausible baseline confounders. The primary outcome was a composite of death or HF hospitalization. The secondary outcomes were cardiac death and HF hospitalization. Sodium intake data were available for 833 subjects (145 sodium restricted, 688 sodium unrestricted), of whom 260 were propensity-matched into sodium restricted (n=130) and sodium unrestricted (n=130) groups. Sodium restriction was associated with significantly higher risk of death or HF hospitalization (42.3% vs. 26.2%; hazard ratio [HR], 1.83; 95% confidence interval [CI], 1.21–2.84; P=0.004), derived from an increase in the rate of HF hospitalization (32.3% vs. 20.0%; HR, 1.82; CI, 1.11–2.96; P=0.015) and a non-significant increase in the rate of cardiac death (HR, 1.62; CI, 0.70–3.73; P=0.257) and all-cause mortality (P=0.074). Exploratory subgroup analyses suggested that sodium restriction was associated with increased risk of death or HF hospitalization in patients not receiving angiotensin converting-enzyme inhibitor or angiotensin receptor blocker (HR, 5.78; CI, 1.93–17.27; P=0.002). In symptomatic patients with chronic HF, sodium restriction may have a detrimental impact on outcome. A randomized clinical trial is needed to definitively address the role of sodium restriction in HF management.