Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden.
Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
JAMA Netw Open. 2024 Jul 1;7(7):e2421589. doi: 10.1001/jamanetworkopen.2024.21589.
Numerous prospective cohort studies have reported a J-shaped association of urinary sodium excretion with cardiovascular events and mortality.
To study the association between sodium intake and incident atrial fibrillation (AF).
DESIGN, SETTING, AND PARTICIPANTS: This cohort study included participants in the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial (ONTARGET) and Telmisartan Randomised Assessment Study in ACE Intolerant Subjects With Cardiovascular Disease (TRANSCEND) multicenter, randomized clinical trials comparing the effect of ramipril 10 mg daily with telmisartan 80 mg daily, or their combination (ONTARGET) or 80 mg telmisartan daily with placebo (TRANSCEND) for the outcome of death from cardiovascular causes, myocardial infarction, stroke, or hospitalization for heart failure. ONTARGET and TRANSCEND included 31 546 participants with vascular disease or high-risk diabetes, and this study excluded participants without a urine sample for sodium measurement, missing data for key covariates, a history of AF, or AF detected in the first year after enrollment. Analyses were performed in July 2023 to May 2024.
Estimated sodium intake from a morning fasting urine sample (Kawasaki formula).
The main outcome was incident AF. The association between estimated sodium intake and incident AF was modeled using multivariable adjusted Cox regression and cubic splines.
A total of 27 391 participants (mean [SD] age, 66.3 [7.2] years; 19 310 [70.5%] male) were included. Mean (SD) estimated sodium intake was 4.8 (1.6) g/d. During a mean (SD) follow-up of 4.6 (1.0) years, 1562 participants (5.7%) had incident AF. After multivariable adjustment, a J-shaped association between sodium intake and AF risk was observed (P for nonlinearity = .03). Sodium intake of 8 g/d or greater (3% of participants) was associated with incident AF (hazard ratio, 1.32; 95% CI, 1.01-1.74) compared with sodium intake of 4 to 5.99 g/d. Cubic splines showed that sodium intake greater than 6 g/d (19% of participants) was associated with a 10% increased AF risk per additional 1-g/d sodium intake (hazard ratio, 1.10; 95% CI, 1.03-1.18), but with no further lowering of AF risk at lower levels of sodium intake.
In this cohort study of sodium intake and AF risk, there was a J-shaped association between sodium intakes and AF risk in patients with cardiovascular disease or diabetes. Lowering sodium intake for AF prevention is best targeted at individuals who consume high sodium diets.
许多前瞻性队列研究报告了尿钠排泄与心血管事件和死亡率之间呈 J 型关联。
研究钠摄入量与心房颤动（AF）事件之间的关系。
设计、地点和参与者：这项队列研究纳入了 Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial（ONTARGET）和 Telmisartan Randomised Assessment Study in ACE Intolerant Subjects With Cardiovascular Disease（TRANSCEND）多中心、随机临床试验的参与者，这些试验比较了每日雷米普利 10mg 与替米沙坦 80mg 的效果、或其组合（ONTARGET）或每日替米沙坦 80mg 与安慰剂（TRANSCEND）用于心血管原因导致的死亡、心肌梗死、中风或心力衰竭住院的结局。ONTARGET 和 TRANSCEND 纳入了 31546 名有血管疾病或高危糖尿病的患者，本研究排除了未进行尿液钠测量、关键协变量数据缺失、有 AF 病史或入组后第一年发现 AF 的患者。分析于 2023 年 7 月至 2024 年 5 月进行。
清晨空腹尿样中估计的钠摄入量（川崎公式）。
主要结果是新发 AF。使用多变量调整 Cox 回归和三次样条模型来模拟估计的钠摄入量与新发 AF 之间的关系。
共纳入 27391 名参与者（平均[标准差]年龄 66.3[7.2]岁；19310[70.5%]名男性）。平均（标准差）估计的钠摄入量为 4.8（1.6）g/d。在平均（标准差）4.6（1.0）年的随访期间，有 1562 名参与者（5.7%）发生了新发 AF。经过多变量调整后，观察到钠摄入量与 AF 风险之间呈 J 型关联（非线性 P 值=0.03）。与 4 至 5.99 g/d 的钠摄入量相比，每日 8 g/d 或更高（3%的参与者）的钠摄入量与新发 AF 相关（风险比，1.32；95%CI，1.01-1.74）。三次样条显示，每日钠摄入量大于 6 g/d（19%的参与者）时，每额外摄入 1 g/d 钠，AF 风险增加 10%（风险比，1.10；95%CI，1.03-1.18），但在较低钠摄入量水平下，AF 风险进一步降低。
在这项关于钠摄入量和 AF 风险的队列研究中，心血管疾病或糖尿病患者的钠摄入量与 AF 风险之间呈 J 型关联。为了预防 AF，降低钠摄入量的最佳目标是摄入高钠饮食的个体。
