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代盐对心血管事件和死亡的影响
Effect of Salt Substitution on Cardiovascular Events and Death


Bruce Neal ... 心脑血管疾病 • 2021.09.16
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• 代盐可否降低卒中发病率 • 强化降压与标准降压比较的随机试验 • 强化降压与标准降压比较试验的最终报告

代盐显著降低高危人群卒中和死亡率

 

高润霖

中国医学科学院阜外医院心内科

 

2021年8月30日,《新英格兰医学杂志》(NEJM)发表了由北京大学临床研究所武阳丰教授团队联合国内多家研究机构并与澳大利亚、美国、英国等国际学者合作的SSaSS研究1。这项在我国北方5省10县600个村庄开展的超大型整群随机对照试验评估了长期食用含钾代用盐(俗称“低钠盐”)减少卒中、主要心血管病事件和降低全因死亡的效果和安全性。

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摘要


背景

减少钠含量而增加钾含量的代盐已被证明可降低血压,但其对心血管和安全性结局的影响尚未明确。

 

方法

我们开展了一项从中国600个村庄纳入参与者的开放标签的整群随机试验。参与者有卒中病史,或者年龄≥60岁且患高血压。我们以1∶1的比例将这些村庄随机分配到干预组和对照组,干预组参与者食用代盐(按质量计,约含70%氯化钠和30%氯化钾),而对照组参与者继续食用普通盐(100%氯化钠)。主要结局是卒中,次要结局是主要心血管不良事件和全因死亡,安全性结局是临床高钾血症。

 

结果

共计20,995人被纳入本试验。参与者的平均年龄为65.4岁,其中49.5%为女性,72.6%有卒中病史,88.4%有高血压病史。平均随访时间为4.74年。在食用代盐的参与者中,卒中发生率低于食用普通盐的参与者(每1,000人-年29.14起事件 vs. 33.65起事件;率比,0.86;95%置信区间[CI],0.77~0.96;P=0.006),前者的心血管主要事件发生率(每1,000人-年49.09起事件vs. 56.29起事件;率比,0.87;95% CI,0.80~0.94;P<0.001)和死亡率(每1,000人-年39.28起事件 vs. 44.61起事件;率比,0.88;95% CI,0.82~0.95;P<0.001)也低于后者。在食用代盐的参与者中,高钾血症引起的严重不良事件的发生率并未显著高于食用普通盐的参与者(每1,000人-年3.35起事件 vs. 3.30起事件;率比,1.04;95% CI,0.80~1.37;P=0.76)。

 

结论

在有卒中病史,或者年龄≥60岁且患高血压的人群中,食用代盐的卒中、心血管主要不良事件和全因死亡发生率低于食用普通盐(由澳大利亚国家健康与医学研究委员会[National Health and Medical Research Council of Australia]资助,SSaSS在ClinicalTrials.gov注册号为NCT02092090)。





作者信息

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.
From the George Institute for Global Health (B.N., M.T., L.H., Y.L., X.Y., J.Y., K.-C.L., G.L.D.T., S. Stepien, S. Shan) and the Centre for Big Data Research in Health (S.-A.P.), University of New South Wales, and George Clinical (N.L.) — all in Sydney; the School of Public Health (B.N., K.-C.L., P.E.), the U.K. Dementia Research Institute (P.E.), the British Heart Foundation Centre for Research Excellence (P.E.), and the NIHR Imperial Biomedical Research Centre (P.E.), Imperial College London, Health Data Research (P.E.), the NIHR Health Protection Research Unit in Chemical and Radiation Threats and Hazards (P.E.), and the Medical Research Council Centre for Environment and Health (P.E.) — all in London; Peking University Clinical Research Center, Peking University (Y.W.), the George Institute for Global Health at Peking University Health Science Center (Y.W., M.T., Z.H., X.Z., L.L.Y.), and the Department of Cardiology, Peking University Third Hospital (J.Y.), Beijing, the School of Public Health, Changzhi Medical College, Changzhi (X.F., Z.L., P.D.), the School of Public Health, Xi’an Jiaotong University, Xi’an (R.Z., Y.Y.), the School of Public Health and Management, Ningxia Medical University, Yinchuan (Y. Zhang, Y. Zhao, F.W.), the Department of Evidence-Based Medicine, First Hospital of China Medical University, Shenyang (J. Shi, B.Z., B.M.), the Department of Noncommunicable Disease Prevention and Control, Center for Disease Control of Hebei Province, Shijiazhuang (J.Z., J. Sun, W.S.), the School of Public Health, Harbin Medical University, Harbin (M.T.), the Global Health Research Center, Duke Kunshan University, Kunshan (L.L.Y.), and the School of Health Sciences, Wuhan University, Wuhan (L.L.Y.) — all in China; and the Feinberg School of Medicine, Northwestern University, Chicago (D.L.). Address reprint requests to Dr. Wu at Peking University Clinical Research Center, Peking University, 38 Xueyuan Rd., Haidian District, Beijing, China, or at wuyf@bjmu.edu.cn, or to Dr. Tian at the George Institute for Global Health at Peking University Health Science Center, Rm. 052A, Unit 1, Tayuan Diplomatic Office Bldg., No. 14 Liangmahe Nan Lu, Chaoyang District, Beijing, China, or at mtian@georgeinstitute.org.cn. Jingpu Shi, Ph.D., is deceased.

 

参考文献

1. Cogswell ME, Mugavero K, Bowman BA, Frieden TR. Dietary sodium and cardiovascular disease risk — measurement matters. N Engl J Med 2016;375:580-586.

2. Aburto NJ, Hanson S, Gutierrez H, Hooper L, Elliott P, Cappuccio FP. Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses. BMJ 2013;346:f1378-f1378.

3. Aburto NJ, Ziolkovska A, Hooper L, Elliott P, Cappuccio FP, Meerpohl JJ. Effect of lower sodium intake on health: systematic review and meta-analyses. BMJ 2013;346:f1326-f1326.

4. Huang L, Trieu K, Yoshimura S, et al. Effect of dose and duration of reduction in dietary sodium on blood pressure levels: systematic review and meta-analysis of randomised trials. BMJ 2020;368:m315-m315.

5. Filippini T, Naska A, Kasdagli M-I, et al. Potassium intake and blood pressure: a dose-response meta-analysis of randomized controlled trials. J Am Heart Assoc 2020;9(12):e015719-e015719.

6. Greer RC, Marklund M, Anderson CAM, et al. Potassium-enriched salt substitutes as a means to lower blood pressure: benefits and risks. Hypertension 2020;75:266-274.

7. Yin X, Liu H, Webster J, et al. Availability, formulation, labeling, and price of low-sodium salt worldwide: environmental scan. JMIR Public Health Surveill 2021;7(7):e27423-e27423.

8. Neal B, Tian M, Li N, et al. Rationale, design, and baseline characteristics of the Salt Substitute and Stroke Study (SSaSS) — a large-scale cluster randomized controlled trial. Am Heart J 2017;188:109-117.

9. Meng Q, Xu K. Progress and challenges of the rural cooperative medical scheme in China. Bull World Health Organ 2014;92:447-451.

10. Huang L, Yu J, Neal B, et al. Feasibility and validity of using death surveillance data and SmartVA for fact and cause of death in clinical trials in rural China: a substudy of the China Salt Substitute and Stroke Study (SSaSS). J Epidemiol Community Health 2020 December 7 (Epub ahead of print).

11. Huang L, Tian M, Yu J, et al. Interim effects of salt substitution on urinary electrolytes and blood pressure in the China Salt Substitute and Stroke Study (SSaSS). Am Heart J 2020;221:136-145.

12. Sacco RL, Kasner SE, Broderick JP, et al. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013;44:2064-2089.

13. Dyer AR, Elliott P, Shipley M. Urinary electrolyte excretion in 24 hours and blood pressure in the INTERSALT Study. II. Estimates of electrolyte-blood pressure associations corrected for regression dilution bias. Am J Epidemiol 1994;139:940-951.

14. Adrogué HJ, Madias NE. Sodium and potassium in the pathogenesis of hypertension. N Engl J Med 2007;356:1966-1978.

15. Jafarnejad S, Mirzaei H, Clark CCT, Taghizadeh M, Ebrahimzadeh A. The hypotensive effect of salt substitutes in stage 2 hypertension: a systematic review and meta-analysis. BMC Cardiovasc Disord 2020;20:98-98.

16. Brown IJ, Tzoulaki I, Candeias V, Elliott P. Salt intakes around the world: implications for public health. Int J Epidemiol 2009;38:791-813.

17. He FJ, Campbell NRC, Ma Y, MacGregor GA, Cogswell ME, Cook NR. Errors in estimating usual sodium intake by the Kawasaki formula alter its relationship with mortality: implications for public health. Int J Epidemiol 2018;47:1784-1795.

18. Cobb LK, Anderson CAM, Elliott P, et al. Methodological issues in cohort studies that relate sodium intake to cardiovascular disease outcomes: a science advisory from the American Heart Association. Circulation 2014;129:1173-1186.

19. Marklund M, Singh G, Greer R, et al. Estimated population wide benefits and risks in China of lowering sodium through potassium enriched salt substitution: modelling study. BMJ 2020;369:m824-m824.

20. GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020;396:1223-1249.

21. Bhat S, Marklund M, Henry ME, et al. A systematic review of the sources of dietary salt around the world. Adv Nutr 2020;11:677-686.

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