Methodological Issues in Cohort Studies That Relate Sodium Intake to Cardiovascular Disease Outcomes A Science Advisory From the American Heart Association
Methodological Issues in Cohort Studies That Relate Sodium Intake to Cardiovascular Disease Outcomes A Science Advisory From the American Heart Association
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DOI：
10.1161/cir.0000000000000015
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发表时间：
2014-03-11
期刊：
影响因子：
37.8
通讯作者：
Appel, Lawrence J.
中科院分区：
文献类型：
--
作者：
Cobb, Laura K.;Anderson, Cheryl A. M.;Appel, Lawrence J.
背景——关于钠摄入量与血压相关心血管疾病（CVD）的队列研究结果并不一致。为了解方法学问题是否是造成这种不一致的原因，我们对这些研究的质量进行了评估。
方法与结果——我们回顾了研究钠与CVD之间关联的队列研究。然后，我们确定了最有可能改变关联方向的方法学问题（反向因果关系、钠评估中的系统误差）、有一定可能改变关联方向的问题（残余混杂、随访不充分）以及可能产生假阴性结果的问题（钠评估中的随机误差、检验效能不足）。我们纳入了26项研究，包含31项独立分析。其中，13项研究发现钠与CVD之间存在直接关联，8项发现呈反向关联，2项发现呈J形关联，8项仅发现无关联。平均每项研究存在3到4个方法学问题。在26项研究中，除1项外，其余所有研究都存在更有可能改变关联方向的问题（系统误差，22项；反向因果关系，16项）。18项研究存在改变关联方向可能性较小的问题，23项研究存在可能产生假阴性结果的问题。
结论——方法学问题可能是目前有关钠与CVD的观察性研究结果不一致的原因。在针对普通人群设计良好的队列研究出现之前，基于将钠与血压升高相关联的有力证据以及少数现有的关于钠减少对CVD影响的普通人群试验来制定钠的相关指南仍然是合适的。
Background-The results of cohort studies relating sodium (Na) intake to blood pressure-related cardiovascular disease (CVD) are inconsistent. To understand whether methodological issues account for the inconsistency, we reviewed the quality of these studies.Methods and Results-We reviewed cohort studies that examined the association between Na and CVD. We then identified methodological issues with greatest potential to alter the direction of association (reverse causality, systematic error in Na assessment), some potential to alter the direction of association (residual confounding, inadequate follow-up), and the potential to yield false null results (random error in Na assessment, insufficient power). We included 26 studies with 31 independent analyses. Of these, 13 found direct associations between Na and CVD, 8 found inverse associations, 2 found J-shaped associations, and 8 found null associations only. On average there were 3 to 4 methodological issues per study. Issues with greater potential to alter the direction of association were present in all but 1 of the 26 studies (systematic error, 22; reverse causality, 16). Issues with lesser potential to alter the direction of association were present in 18 studies, whereas those with potential to yield false null results were present in 23.Conclusions-Methodological issues may account for the inconsistent findings in currently available observational studies relating Na to CVD. Until well-designed cohort studies in the general population are available, it remains appropriate to base Na guidelines on the robust body of evidence linking Na with elevated blood pressure and the few existing general population trials of the effects of Na reduction on CVD.