Urinary Sodium and Potassium Excretion and Risk of Cardiovascular Events
Urinary Sodium and Potassium Excretion and Risk of Cardiovascular Events
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DOI：
10.1001/jama.2011.1729
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发表时间：
2011-11-23
影响因子：
120.7
通讯作者：
Schmieder, Roland E.
中科院分区：
文献类型：
--
作者：
O'Donnell, Martin J.;Yusuf, Salim;Schmieder, Roland E.
钠和钾摄入量与心血管（CV）风险之间的确切关系仍不确定，特别是在患有CV疾病的患者中。目的探讨已确诊的心血管疾病或糖尿病患者尿钠和钾排泄量（替代摄入量）与心血管事件的关系。ONTARGET和TRANSCEND试验（2001年11月至2008年3月，从初始招募到最终随访）中纳入的2个队列（N= 28880）的观察分析。我们从空腹尿样（川崎公式）中估计24小时尿钠和尿钾排泄。我们使用限制三次样条图来描述钠和钾排泄与CV事件和死亡率之间的关系，并确定钠和钾排泄的参考类别。我们使用Cox比例风险多变量模型来确定尿钠和尿钾与心血管事件和死亡率的关系。主要结局指标CV死亡、心肌梗死（MI）、中风和因充血性心力衰竭（CHF）住院。结果基线时，钠的平均（SD）估计24小时排泄量为4.77 g (1.61)；钾为2.19 g（0.57）。中位随访56个月后，4729名（16.4%）参与者出现了复合结局，包括2057例CV死亡、1412例MI、1282例卒中和1213例因CHF住院。相比之下,估计基线钠排泄的参照组每天4到5.99 g (n = 14 156; 6.3%参与者与简历死亡,与心肌梗死4.6%,4.2%,中风,和3.8%住院与瑞士法郎),高基线的钠排泄会简历死亡的风险增加(9.7% 7 - 8 g /天;风险比[HR], 1.53; 95%可信区间,1.26 - -1.86;11.2%,> 8 g /天;人力资源,1.66;95%可信区间,1.31 - -2.10),心肌梗死(6.8%;人力资源,1.48;95%置信区间,1.11 - -1.98 > 8 g /天),中风(6.6%;人力资源,1.48;95% CI为1.09-2.01,>8 g/天)，住院治疗为瑞士法郎（6.5%；HR为1.51;1.12-2.05,>8 g/天）。在多变量分析中，较低的钠排泄与CV死亡风险增加相关（8.6%；HR, 1.19; 95% CI, 2-2.99 g/天1.02-1.39;10.6%；HR, 1.37; 95% CI， 3g /天1.09-1.73）。结论钠排泄量与CV事件呈j型关系。与基线钠排泄量4 ~ 5.99 g /天相比，钠排泄量大于7 g /天与所有CV事件的风险增加相关，钠排泄量小于3 g /天与CV死亡和CHF住院风险增加相关。较高的钾排泄量与中风风险降低有关。《美国医学协会杂志》上。2011年;306 (20): 2229 - 2238
Context The precise relationship between sodium and potassium intake and cardiovascular (CV) risk remains uncertain, especially in patients with CV disease.Objective To determine the association between estimated urinary sodium and potassium excretion (surrogates for intake) and CV events in patients with established CV disease or diabetes mellitus.Design, Setting, and Patients Observational analyses of 2 cohorts (N=28 880) included in the ONTARGET and TRANSCEND trials (November 2001-March 2008 from initial recruitment to final follow-up). We estimated 24-hour urinary sodium and potassium excretion from a morning fasting urine sample (Kawasaki formula). We used restricted cubic spline plots to describe the association between sodium and potassium excretion and CV events and mortality, and to identify reference categories for sodium and potassium excretion. We used Cox proportional hazards multivariable models to determine the association of urinary sodium and potassium with CV events and mortality.Main Outcome Measures CV death, myocardial infarction (MI), stroke, and hospitalization for congestive heart failure (CHF).Results At baseline, the mean (SD) estimated 24-hour excretion for sodium was 4.77 g (1.61); and for potassium was 2.19 g (0.57). After a median follow-up of 56 months, the composite outcome occurred in 4729 (16.4%) participants, including 2057 CV deaths, 1412 with MI, 1282 with stroke, and 1213 with hospitalization for CHF. Compared with the reference group with estimated baseline sodium excretion of 4 to 5.99 g per day (n=14 156; 6.3% participants with CV death, 4.6% with MI, 4.2% with stroke, and 3.8% admitted to hospital with CHF), higher baseline sodium excretion was associated with an increased risk of CV death (9.7% for 7-8 g/day; hazard ratio [HR], 1.53; 95% CI, 1.26-1.86; and 11.2% for >8 g/day; HR, 1.66; 95% CI, 1.31-2.10), MI (6.8%; HR, 1.48; 95% CI, 1.11-1.98 for >8 g/day), stroke (6.6%; HR, 1.48; 95% CI, 1.09-2.01 for >8 g/day), and hospitalization for CHF (6.5%; HR, 1.51; 1.12-2.05 for >8 g/day). Lower sodium excretion was associated with an increased risk of CV death (8.6%; HR, 1.19; 95% CI, 1.02-1.39 for 2-2.99 g/day; 10.6%; HR, 1.37; 95% CI, 1.09-1.73 for 3 g/day) on multivariable analysis.Conclusions The association between estimated sodium excretion and CV events was J-shaped. Compared with baseline sodium excretion of 4 to 5.99 g per day, sodium excretion of greater than 7 g per day was associated with an increased risk of all CV events, and a sodium excretion of less than 3 g per day was associated with increased risk of CV mortality and hospitalization for CHF. Higher estimated potassium excretion was associated with a reduced risk of stroke. JAMA. 2011;306(20):2229-2238