Population Health Research Institute, DBCVS Research Institute, McMaster University, 3rd Floor, 237 Barton St East, Hamilton, Ont, Canada L8L 2X2.
Eur Heart J. 2013 Apr;34(14):1034-40. doi: 10.1093/eurheartj/ehs409. Epub 2012 Dec 17.
Effective population-based interventions are required to reduce the global burden of cardiovascular disease (CVD). Reducing salt intake has emerged as a leading target, with many guidelines recommending sodium intakes of 2.3 g/day or lower. These guideline thresholds are based largely on clinical trials reporting a reduction in blood pressure with low, compared with moderate, intake. However, no large-scale randomized trials have been conducted to determine the effect of low sodium intake on CV events. Prospective cohort studies evaluating the association between sodium intake and CV outcomes have been inconsistent and a number of recent studies have reported an association between low sodium intake (in the range recommended by current guidelines) and an increased risk of CV death. In the largest of these studies, a J-shaped association between sodium intake and CV death and heart failure was found. Despite a large body of research in this area, there are divergent interpretations of these data, with some advocating a re-evaluation of the current guideline recommendations. In this article, we explore potential reasons for the differing interpretations of existing evidence on the association between sodium intake and CVD. Similar to other areas in prevention, the controversy is likely to remain unresolved until large-scale definitive randomized controlled trials are conducted to determine the effect of low sodium intake (compared to moderate intake) on CVD incidence.
需要采取有效的基于人群的干预措施来降低全球心血管疾病（CVD）负担。减少盐摄入量已成为主要目标，许多指南建议钠摄入量为每天 2.3 克或更低。这些指南阈值主要基于报告低钠摄入与中钠摄入相比可降低血压的临床试验。然而，尚未进行大规模随机试验来确定低钠摄入对心血管事件的影响。评估钠摄入量与心血管结局之间关联的前瞻性队列研究结果不一致，最近的一些研究报告了低钠摄入（在当前指南推荐的范围内）与心血管死亡风险增加之间的关联。在这些研究中最大的一项研究中，发现钠摄入量与心血管死亡和心力衰竭之间呈 J 形关联。尽管在这一领域进行了大量研究，但对这些数据存在不同的解释，一些人主张重新评估当前的指南建议。在本文中，我们探讨了对钠摄入量与 CVD 之间关联的现有证据存在不同解释的潜在原因。与预防的其他领域类似，在进行大规模的确定性随机对照试验以确定低钠摄入（与中钠摄入相比）对 CVD 发病率的影响之前，争议可能仍无法解决。
