美国哈佛大学公共卫生学院Yuan Ma和Frank B. Hu团队研究了24小时尿钠钾排泄与心血管风险的相关性。该项研究成果发表在2021年11月13日出版的《新英格兰医学杂志》上。
钠摄入量与心血管疾病之间的关系仍然存在争议,部分原因是对钠摄入量的评估不准确。评估多次24小时尿液排泄量被认为是一种准确的方法。
研究组纳入了来自6个一般健康成年人的前瞻性队列的个体参与者数据;通过对每名参与者至少使用两个24小时尿样来评估钠和钾的排泄。主要结局是心血管事件(冠状动脉血运重建或致命非致命性心肌梗死或中风)。研究组使用一致的方法分析每个队列,并结合结果使用随机效应荟萃分析。
10709名参与者的平均年龄为51.5岁,其中54.2%为女性,中位研究随访8.8年,共确定了571例心血管事件(发病率为5.9例/1000人-年)。24小时尿钠排泄中位数为3270mg。在控制混杂因素的分析中,高钠排泄、低钾排泄和高钠钾比均与较高的心血管风险相关。
在比较尿生物标志物最高四分位和最低四分位的分析中,钠排泄的危险比为1.60,钾排泄的危险比为0.69,钠钾比的危险比为1.62。钠排泄量每天增加1000毫克与心血管风险增加18%相关(危险比为1.18),钾排泄量每天增加1000毫克与风险降低18%相关(危险比为0.82)。
研究结果表明,在多个24小时尿样中测得的高钠和低钾摄入,以剂量-反应方式与更高的心血管风险相关。这些发现可能支持从目前水平上减少钠摄入量和增加钾摄入量。
附:英文原文
Title: 24-Hour Urinary Sodium and Potassium Excretion and Cardiovascular Risk | NEJM
Author: Yuan Ma, Ph.D.,, Feng J. He, Ph.D.,, Qi Sun, M.D., Sc.D.,, Changzheng Yuan, Sc.D.,, Lyanne M. Kieneker, Ph.D.,, Gary C. Curhan, M.D., Sc.D.,, Graham A. MacGregor, M.D.,, Stephan J.L. Bakker, M.D., Ph.D.,, Norm R.C. Campbell, M.D.,, Molin Wang, Ph.D.,, Eric B. Rimm, Sc.D.,, JoAnn E. Manson, M.D., Dr.P.H.,, Walter C. Willett, M.D., Dr.P.H.,, Albert Hofman, M.D., Ph.D.,, Ron T. Gansevoort, M.D., Ph.D.,, Nancy R. Cook, Sc.D.,, and Frank B. Hu, M.D., Ph.D.
Issue&Volume: 2021-11-13
Abstract:
Background
The relation between sodium intake and cardiovascular disease remains controversial, owing in part to inaccurate assessment of sodium intake. Assessing 24-hour urinary excretion over a period of multiple days is considered to be an accurate method.
Methods
We included individual-participant data from six prospective cohorts of generally healthy adults; sodium and potassium excretion was assessed with the use of at least two 24-hour urine samples per participant. The primary outcome was a cardiovascular event (coronary revascularization or fatal or nonfatal myocardial infarction or stroke). We analyzed each cohort using consistent methods and combined the results using a random-effects meta-analysis.
Results
Among 10,709 participants, who had a mean (±SD) age of 51.5±12.6 years and of whom 54.2% were women, 571 cardiovascular events were ascertained during a median study follow-up of 8.8 years (incidence rate, 5.9 per 1000 person-years). The median 24-hour urinary sodium excretion was 3270 mg (10th to 90th percentile, 2099 to 4899). Higher sodium excretion, lower potassium excretion, and a higher sodium-to-potassium ratio were all associated with a higher cardiovascular risk in analyses that were controlled for confounding factors (P≤0.005 for all comparisons). In analyses that compared quartile 4 of the urinary biomarker (highest) with quartile 1 (lowest), the hazard ratios were 1.60 (95% confidence interval [CI], 1.19 to 2.14) for sodium excretion, 0.69 (95% CI, 0.51 to 0.91) for potassium excretion, and 1.62 (95% CI, 1.25 to 2.10) for the sodium-to-potassium ratio. Each daily increment of 1000 mg in sodium excretion was associated with an 18% increase in cardiovascular risk (hazard ratio, 1.18; 95% CI, 1.08 to 1.29), and each daily increment of 1000 mg in potassium excretion was associated with an 18% decrease in risk (hazard ratio, 0.82; 95% CI, 0.72 to 0.94).
Conclusions
Higher sodium and lower potassium intakes, as measured in multiple 24-hour urine samples, were associated in a dose–response manner with a higher cardiovascular risk. These findings may support reducing sodium intake and increasing potassium intake from current levels.
DOI: 10.1056/NEJMoa2109794
Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2109794
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
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