Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
PLoS One. 2022 Mar 17;17(3):e0265429. doi: 10.1371/journal.pone.0265429. eCollection 2022.
Most evidence on the relationship between sodium and potassium intake and cardiovascular disease originated from general population studies. This study aimed to evaluate the relation between estimated 24-hour sodium and potassium urinary excretion and the risk of recurrent vascular events and mortality in patients with vascular disease.
7561 patients with vascular disease enrolled in the UCC-SMART cohort (1996-2015) were included. Twenty-four hour sodium and potassium urinary excretion were estimated (Kawasaki formulae) from morning urine samples. Cox proportional hazard models with restricted cubic splines were used to evaluate the relation between estimated urinary salt excretion and major adverse cardiovascular events (MACE; including myocardial infarction, stroke, cardiovascular mortality) and all-cause mortality.
After a median follow-up of 7.4 years (interquartile range: 4.1-11.0), the relations between estimated 24-hour sodium urinary excretion and outcomes were J-shaped with nadirs of 4.59 gram/day for recurrent MACE and 4.97 gram/day for all-cause mortality. The relation between sodium-to-potassium excretion ratio and outcomes were also J-shaped with nadirs of 2.71 for recurrent MACE and 2.60 for all-cause mortality. Higher potassium urinary excretion was related to an increased risk of both recurrent MACE (HR 1.25 per gram potassium excretion per day; 95%CI 1.13-1.39) and all cause-mortality (HR 1.13 per gram potassium excretion per day; 95%CI 1.03-1.25).
In patients with established vascular disease, lower and higher sodium intake were associated with higher risk of recurrent MACE and all-cause mortality. Higher estimated 24-hour potassium urinary excretion was associated with a higher risk of recurrent MACE and all-cause mortality.
大多数关于钠和钾摄入量与心血管疾病之间关系的证据来自于一般人群研究。本研究旨在评估 24 小时尿钠和钾排泄与血管疾病患者复发性血管事件和死亡率之间的关系。
纳入了 UCC-SMART 队列（1996-2015 年）中的 7561 例血管疾病患者。使用 Kawasaki 公式从晨尿样本中估算 24 小时尿钠和钾排泄量。使用 Cox 比例风险模型和限制性三次样条评估估计的尿盐排泄与主要不良心血管事件（MACE；包括心肌梗死、中风、心血管死亡率）和全因死亡率之间的关系。
在中位数为 7.4 年（四分位距：4.1-11.0）的随访期间，估计 24 小时尿钠排泄与结局之间的关系呈 J 形，复发性 MACE 的最低点为 4.59 克/天，全因死亡率的最低点为 4.97 克/天。钠钾排泄比值与结局之间的关系也呈 J 形，复发性 MACE 的最低点为 2.71，全因死亡率的最低点为 2.60。较高的尿钾排泄与复发性 MACE（每克钾排泄/天的 HR 为 1.25；95%CI 为 1.13-1.39）和全因死亡率（每克钾排泄/天的 HR 为 1.13；95%CI 为 1.03-1.25）的风险增加相关。
在已确诊血管疾病的患者中，较低和较高的钠摄入量与复发性 MACE 和全因死亡率的风险增加相关。较高的估计 24 小时尿钾排泄与复发性 MACE 和全因死亡率的风险增加相关。
