预计减少饮食盐摄入量对未来心血管疾病的影响。
Projected effect of dietary salt reductions on future cardiovascular disease.
机构信息
Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA.
出版信息
N Engl J Med. 2010 Feb 18;362(7):590-9. doi: 10.1056/NEJMoa0907355. Epub 2010 Jan 20.
BACKGROUND
The U.S. diet is high in salt, with the majority coming from processed foods. Reducing dietary salt is a potentially important target for the improvement of public health.
METHODS
We used the Coronary Heart Disease (CHD) Policy Model to quantify the benefits of potentially achievable, population-wide reductions in dietary salt of up to 3 g per day (1200 mg of sodium per day). We estimated the rates and costs of cardiovascular disease in subgroups defined by age, sex, and race; compared the effects of salt reduction with those of other interventions intended to reduce the risk of cardiovascular disease; and determined the cost-effectiveness of salt reduction as compared with the treatment of hypertension with medications.
RESULTS
Reducing dietary salt by 3 g per day is projected to reduce the annual number of new cases of CHD by 60,000 to 120,000, stroke by 32,000 to 66,000, and myocardial infarction by 54,000 to 99,000 and to reduce the annual number of deaths from any cause by 44,000 to 92,000. All segments of the population would benefit, with blacks benefiting proportionately more, women benefiting particularly from stroke reduction, older adults from reductions in CHD events, and younger adults from lower mortality rates. The cardiovascular benefits of reduced salt intake are on par with the benefits of population-wide reductions in tobacco use, obesity, and cholesterol levels. A regulatory intervention designed to achieve a reduction in salt intake of 3 g per day would save 194,000 to 392,000 quality-adjusted life-years and $10 billion to $24 billion in health care costs annually. Such an intervention would be cost-saving even if only a modest reduction of 1 g per day were achieved gradually between 2010 and 2019 and would be more cost-effective than using medications to lower blood pressure in all persons with hypertension.
CONCLUSIONS
Modest reductions in dietary salt could substantially reduce cardiovascular events and medical costs and should be a public health target.
背景
美国的饮食中盐含量很高，其中大部分来自加工食品。减少饮食中的盐摄入量是改善公众健康的一个潜在重要目标。
方法
我们使用冠心病（CHD）政策模型来量化全人群每日减少高达 3 克（每天 1200 毫克钠）饮食盐摄入量的潜在获益。我们按年龄、性别和种族对心血管疾病的亚组进行了发病率和成本的估计；比较了盐摄入量减少与其他旨在降低心血管疾病风险的干预措施的效果；并确定了与药物治疗高血压相比，减少盐摄入量的成本效益。
结果
每天减少 3 克饮食盐预计将使每年新发冠心病病例减少 6 万至 12 万例，中风减少 3.2 万至 6.6 万例，心肌梗死减少 5.4 万至 9.9 万例，并使任何原因导致的死亡人数减少 4.4 万至 9.2 万例。所有人群都会受益，黑人受益比例更大，女性特别受益于中风减少，老年人受益于冠心病事件减少，年轻人受益于死亡率降低。减少盐摄入量的心血管益处与降低全人群吸烟、肥胖和胆固醇水平的益处相当。旨在实现每日减少 3 克盐摄入量的监管干预措施每年将节省 19.4 万至 39.2 万个质量调整生命年，并节省 100 亿至 240 亿美元的医疗保健费用。即使在 2010 年至 2019 年期间逐步实现每天 1 克的适度减少，这种干预措施也将具有成本效益，并且比在所有高血压患者中使用药物降低血压更具成本效益。
结论
适度减少饮食中的盐可以显著降低心血管事件和医疗成本，应成为公共卫生的目标。
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