Effect of Salt Substitution on Cardiovascular Events and Death
Effect of Salt Substitution on Cardiovascular Events and Death
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DOI：
10.1056/nejmoa2105675
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发表时间：
2021-08-29
影响因子：
158.5
通讯作者：
Elliott, P.
中科院分区：
文献类型：
--
作者：
Neal, B.;Wu, Y.;Elliott, P.
盐的替代品，减少钠水平和增加钾水平已被证明可以降低血压，但其对心血管和安全outcome. METHODS的影响，我们进行了一项开放标签，整群随机试验，涉及600个村庄的人在中国农村。参与者有中风史或60岁或以上，并有高血压。那些村庄被以1：1的比例随机分配到干预组，参与者使用盐替代品（75%氯化钠和25%氯化钾），或对照组，参与者继续使用普通盐（100%氯化钠）。主要结局为卒中，次要结局为主要不良心血管事件和全因死亡，安全性结局为临床高钾血症。参与者的平均年龄为65.4岁，49.5%为女性，72.6%有中风史，88.4%有高血压史。平均随访时间为4.74年。使用盐替代品的中风发生率低于使用普通盐的中风发生率（每1000人-年29.14例事件vs. 33.65例事件;率比，0.86; 95%置信区间[CI]，0.77 - 0.96; P=0.006），以及主要心血管事件的发生率（49.09例事件vs. 56.29例事件/1000人-年;率比，0.87; 95%CI，0.80 - 0.94; P
BACKGROUNDSalt substitutes with reduced sodium levels and increased potassium levels have been shown to lower blood pressure, but their effects on cardiovascular and safety outcomes are uncertain.METHODSWe conducted an open-label, cluster-randomized trial involving persons from 600 villages in rural China. The participants had a history of stroke or were 60 years of age or older and had high blood pressure. The villages were randomly assigned in a 1:1 ratio to the intervention group, in which the participants used a salt substitute (75% sodium chloride and 25% potassium chloride by mass), or to the control group, in which the participants continued to use regular salt (100% sodium chloride). The primary outcome was stroke, the secondary outcomes were major adverse cardiovascular events and death from any cause, and the safety outcome was clinical hyperkalemia.RESULTSA total of 20,995 persons were enrolled in the trial. The mean age of the participants was 65.4 years, and 49.5% were female, 72.6% had a history of stroke, and 88.4% a history of hypertension. The mean duration of follow-up was 4.74 years. The rate of stroke was lower with the salt substitute than with regular salt (29.14 events vs. 33.65 events per 1000 person-years; rate ratio, 0.86; 95% confidence interval [CI], 0.77 to 0.96; P=0.006), as were the rates of major cardiovascular events (49.09 events vs. 56.29 events per 1000 person-years; rate ratio, 0.87; 95% CI, 0.80 to 0.94; P