NEJM:24小时尿钠和钾排泄与心血管风险相关

2022-01-22 MedSci原创 MedSci原创

在多次24小时尿液样本中测量的较高钠和钾摄入量与较高的心血管风险呈剂量反应关系。这些结果可能支持从当前水平的基础上减少钠摄入量和增加钾摄入量。

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够准确。评估一段时间的24小时尿排泄被认为是一种较为准确的方法。

近日,顶级医学期刊NEJM上发表了一篇研究文章,研究人员纳入了来自六个健康成年人的前瞻性队列个体参与者数据;每位参与者至少使用两个24小时尿样来评估钠和钾的排泄量。该研究的主要结局是心血管事件(冠状动脉血运重建或致死性或非致死性心肌梗死卒中)。研究人员使用一致的方法分析了每个队列,并使用随机效应荟萃分析综合了结局。

在10709名参与者中,受试者平均(±SD)年龄为51.5±12.6岁,其中54.2%为女性,在8.8年的中位随访期间,研究人员共确定了571起心血管事件(发生率为5.9/1000人-年)。24小时尿钠排泄中位数为3270mg(第10至90个百分位为2099至4899)。在控制混杂因素的分析中,较高的钠排泄、较低的钾排泄和较高的钠钾比均与较高的心血管风险相关(所有P≤0.005)。

在比较尿液生物标志物最高四分位数与最低四分位数的分析中,钠排泄的风险比为1.60(95%置信区间[CI]为1.19至2.14),钾排泄的风险比为0.69(95%CI为0.51至0.91),钠钾比的风险比为1.62(95%CI为1.25至2.10)。钠排泄量每天增加1000mg与心血管风险增加18%相关(风险比为1.18;95%CI为1.08至1.29),钾排泄量每天增加1000mg与心血管风险降低18%相关(风险比为0.82;95%CI为0.72至0.94)。

由此可见,在多次24小时尿液样本中测量的较高钠和钾摄入量与较高的心血管风险呈剂量反应关系。这些结果可能支持从当前水平的基础上减少钠摄入量和增加钾摄入量。

原始出处:
 
Yuan Ma,et al.24-Hour Urinary Sodium and Potassium Excretion and Cardiovascular Risk.NEJM.2022.https://www.nejm.org/doi/full/10.1056/NEJMoa2109794

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    2022-01-27 chengjn
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    2022-07-21 维他命
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    2022-01-26 ms5000001649854049

    这篇文章对我工作及临床经验积累有很多帮助

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