血清钠和氯与普通人群心血管死亡率的关联风险。
Risk of Cardiovascular Mortality Associated With Serum Sodium and Chloride in the General Population.
机构信息
Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China.
Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China.
出版信息
Can J Cardiol. 2018 Aug;34(8):999-1003. doi: 10.1016/j.cjca.2018.03.013. Epub 2018 Mar 29.
BACKGROUND
The prognostic value of serum chloride among patients with heart failure was demonstrated by previous studies. However, the association of serum chloride and risk of cardiovascular mortality among the general population remains unclear.
METHODS
We included 16,483 participants in National Health and Nutrition Examination Survey III. Cox proportional hazards models were used to assess the association of serum sodium and chloride and cardiovascular mortality. Potential confounders were included in the models. Levels of serum sodium and chloride were also modeled with restrictive cubic splines for potential nonlinear associations. Subgroup analyses were based on baseline diseases and use of diuretics.
RESULTS
The mean age was 43.5 years, and 47.8% of the participants were men. During 277,059 person-years of follow-up, there were 1714 cardiovascular deaths. In the multivariate model, low-level serum sodium was associated with an increased risk of cardiovascular mortality (hazard ratio [HR], 1.10; 95% confidence interval [CI], 1.02-1.18 per standard deviation [SD]; P = 0.009), whereas a lower level of serum chloride was not (HR, 1.04; 95% CI, 0.97-1.12 per standard deviation; P = 0.278). Analyses with restrictive cubic splines yielded similar results.
CONCLUSIONS
Low serum sodium, rather than chloride, was independently associated with an increased risk of cardiovascular mortality.
背景
先前的研究表明，血清氯水平对心力衰竭患者的预后具有预测价值。然而，血清氯与普通人群心血管死亡率风险之间的关系尚不清楚。
方法
我们纳入了美国第三次国家健康与营养调查（National Health and Nutrition Examination Survey III）中的 16483 名参与者。采用 Cox 比例风险模型评估血清钠和氯水平与心血管死亡率之间的相关性。模型中纳入了潜在的混杂因素。同时，采用限制性立方样条模型来评估血清钠和氯水平与心血管死亡率之间潜在的非线性关系。亚组分析基于基线疾病和利尿剂的使用情况。
结果
参与者的平均年龄为 43.5 岁，其中 47.8%为男性。在 277059 人年的随访期间，共有 1714 例心血管死亡事件。在多变量模型中，低水平的血清钠与心血管死亡率风险增加相关（风险比 [HR]，1.10；95%置信区间 [CI]，每标准差 [SD]增加 1.02-1.18；P=0.009），而低水平的血清氯与心血管死亡率风险增加无关（HR，1.04；95%CI，每 SD 增加 0.97-1.12；P=0.278）。限制性立方样条分析也得到了相似的结果。
结论
低血清钠而非低血清氯与心血管死亡率风险增加独立相关。
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