Joint effects of sodium and potassium intake on subsequent cardiovascular disease: the Trials of Hypertension Prevention follow-up study.
Joint effects of sodium and potassium intake on subsequent cardiovascular disease: the Trials of Hypertension Prevention follow-up study.
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DOI：
10.1001/archinternmed.2008.523
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发表时间：
2009-01-12
影响因子：
--
通讯作者：
Whelton, Paul K.
中科院分区：
文献类型：
--
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.
之前关于常规钠和钾摄入量对后期心血管疾病（CVD）的剂量反应影响的研究在很大程度上依赖于次优的摄入量测量。在1987-1990年的18个月（TOHP I）和1990-1995年的36个月（TOHP II）中，两项关于钠减少和其他干预措施的试验间歇性收集了30-54岁的高血压前期成人的24小时尿排泄。在那些没有被分配到主动减钠干预的患者中，我们通过10-15年的试验后随访，评估了平均3 - 7项钠和钾排泄指标及其比值与随后CVD（心肌梗死、卒中、冠状动脉血运重建或CVD死亡率）的关系。在2，974名参与者中，获得了2，275名（76.5%）的随访信息，其中193起心血管事件。校正基线变量和生活方式改变后，CVD风险与性别特异性钠四分位数相比无显著性趋势（从最低到最高的率比（RR）= 1.00、0.99、1.16、1.20，p趋势=0.38）和钾（RR=1.00、0.94、0.91、0.64，p趋势=0.08）排泄，但钠钾比四分位数上存在显著趋势（RR=1.00、0.84、1.18和1.50，p趋势=0.04）。在同时包含两种测量的模型中，线性效应为每100 mmol/d钠排泄的RR=1.42（95%置信区间（CI）=0.99-2.04）（p=0.05）和每50 mmol/d钾排泄的RR=0.67（95%CI=0.41-1.10）（p=0.12）。包含钠钾比的模型（RR=1.24/单位，95%CI=1.05-1.46，p=0.01）具有最低的贝叶斯信息标准（最佳拟合）。较高的钠/钾比例与后期CVD的风险增加有关，并且比单独的钠或钾更强。
Previous studies of dose-response effects of usual sodium and potassium intake on later cardiovascular disease (CVD) have largely relied on sub-optimal measures of intake. Two trials of sodium reduction and other interventions collected 24-hour urinary excretions intermittently over 18 months in 1987-1990 (TOHP I) and 36 months in 1990-1995 (TOHP II) among pre-hypertensive adults aged 30-54. Among those not assigned to an active sodium reduction intervention, we assessed the relation of an average of 3 to 7 measures of sodium and potassium excretion and their ratio with subsequent CVD (myocardial infarction, stroke, coronary revascularization, or CVD mortality) through 10-15 years of post-trial follow-up. Among 2,974 participants, follow-up information was obtained on 2,275 (76.5%), with 193 CVD events. After adjustment for baseline variables and lifestyle changes, there was a non-significant trend in CVD risk over gender-specific quartiles of sodium (rate ratio (RR) from lowest to highest = 1.00, 0.99, 1.16, 1.20, p-trend=0.38), and potassium (RR=1.00, 0.94, 0.91, 0.64, p-trend=0.08) excretion, but a significant trend over quartiles of the sodium-potassium ratio (RR=1.00, 0.84, 1.18, and 1.50, p-trend=0.04). In models containing both measures simultaneously, linear effects were RR=1.42 (95% confidence interval (CI) =0.99-2.04) per 100 mmol/d of sodium excretion (p=0.05) and RR=0.67 (95%CI=0.41-1.10) per 50 mmol/d of potassium excretion (p=0.12). A model containing the sodium-potassium ratio (RR=1.24 per unit, 95%CI=1.05-1.46, p=0.01) had the lowest Bayes information criterion (best fit). A higher sodium/potassium ratio is associated with increased risk of later CVD, and is stronger than sodium or potassium alone.
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