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盐替代品可有效降低高危人群心脑血管事件和死亡的风险
作者:小柯机器人 发布时间:2021/8/31 15:24:45

北京大学Yangfeng Wu、Maoyi Tian团队研究了盐替代品对心血管事件和死亡率的影响。相关论文发表在2021年8月29日出版的《新英格兰医学杂志》上。

降低钠水平和增加钾水平的盐替代品已被证明能降低血压,但它们对心血管和安全结局的影响尚不确定。

研究组进行了一项开放标签、整群随机试验,涉及中国农村600个村庄的人。参与者有中风史或年龄在60岁及以上并有高血压。将这些村庄按照1:1的比例随机分配,其中干预组参与者使用盐的替代品(质量为75%氯化钠和25%氯化钾),对照组参与者继续使用普通盐(100%氯化钠)。主要结局为脑卒中,次要结局为重大不良心血管事件和全因死亡,安全性结局为临床高钾血症。

该试验共纳入20995人。参与者的平均年龄为65.4岁,其中49.5%为女性,72.6%有卒中史,88.4%有高血压史。平均随访时间为4.74年。盐替代品组的卒中发生率为29.14次/1000人-年,显著低于普通盐组(33.65次/1000人-年);重大心血管事件的发生率为49.09次/1000人-年,显著低于普通盐组(56.29次/1000人-年);死亡发生率为39.28例/1000人-年,显著低于普通盐组(44.61例/1000人-年)。盐替代品引起高钾血症的严重不良事件发生率为3.35次/1000人-年,普通盐组为3.30次/1000人-年,差异并不显著。

研究结果表明,对于有中风史或60岁及以上且患有高血压的人群,盐替代品的中风、重大心血管事件和全因死亡率均低于普通盐。

附:英文原文

Title: Effect of Salt Substitution on Cardiovascular Events and Death | NEJM

Author: Bruce Neal, M.B., Ch.B., Ph.D.,, Yangfeng Wu, M.D., Ph.D.,, Xiangxian Feng, Ph.D.,, Ruijuan Zhang, M.Sc.,, Yuhong Zhang, M.Med.,, Jingpu Shi, Ph.D.,, Jianxin Zhang, Ph.D.,, Maoyi Tian, Ph.D.,, Liping Huang, Ph.D.,, Zhifang Li, M.Sc.,, Yan Yu, Ph.D.,, Yi Zhao, Ph.D.,, Bo Zhou, Ph.D.,, Jixin Sun, M.Sc.,, Yishu Liu, M.Sc.,, Xuejun Yin, M.P.H.,, Zhixin Hao, M.D.,, Jie Yu, M.D., Ph.D.,, Ka-Chun Li, M.Sc.,, Xinyi Zhang, M.P.H.,, Peifen Duan, M.Sc.,, Faxuan Wang, Ph.D.,, Bing Ma, M.Sc.,, Weiwei Shi, Ph.D.,, Gian Luca Di Tanna, Ph.D.,, Sandrine Stepien, M.Sc.,, Sana Shan, M.Sc.,, Sallie-Anne Pearson, Ph.D.,, Nicole Li, M.D., Ph.D.,, Lijing L. Yan, Ph.D.,, Darwin Labarthe, Ph.D.,, and Paul Elliott, M.B., B.S., Ph.D.

Issue&Volume: 2021-08-29

Abstract:

Background

Salt 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.

Methods

We 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.

Results

A 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<0.001) and death (39.28 events vs. 44.61 events per 1000 person-years; rate ratio, 0.88; 95% CI, 0.82 to 0.95; P<0.001). The rate of serious adverse events attributed to hyperkalemia was not significantly higher with the salt substitute than with regular salt (3.35 events vs. 3.30 events per 1000 person-years; rate ratio, 1.04; 95% CI, 0.80 to 1.37; P=0.76).

Conclusions

Among persons who had a history of stroke or were 60 years of age or older and had high blood pressure, the rates of stroke, major cardiovascular events, and death from any cause were lower with the salt substitute than with regular salt.

DOI: 10.1056/NEJMoa2105675

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2105675

 

期刊信息

The New England Journal of Medicine:《新英格兰医学杂志》,创刊于1812年。隶属于美国麻省医学协会,最新IF:70.67
官方网址:http://www.nejm.org/
投稿链接:http://www.nejm.org/page/author-center/home