Department of Cardiology, The First Hospital of Hebei Medical University, Shijiazhuang, 050031, Hebei, China.
Hebei Key Laboratory of Heart and Metabolism, Shijiazhuang, 050031, Hebei, China.
Sci Rep. 2024 Aug 6;14(1):18154. doi: 10.1038/s41598-024-69342-2.
Sodium is crucial for maintaining cardiovascular health, especially in relation to heart failure. The impact of baseline serum sodium concentrations on the outcomes of newly diagnosed coronary heart disease (CHD) without heart failure remains unclear. This prospective cohort study included 681 patients who were newly diagnosed with CHD. Cox proportional hazards models and restricted cubic spline (RCS) analysis were used to assess the relationship between serum sodium concentrations and major adverse cardiovascular events. The improvement in traditional prediction models by the addition of serum sodium concentrations was assessed using changes in the C-statistic, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). During a median follow-up of 51.04 months (IQR: 40.88-53.80 months), 131 events were recorded. Multivariate Cox proportional hazards models showed that the L2 group (136-138.9 mmol/L) had the highest MACE risk. Compared to L2, the hazard ratios (HRs) and 95% confidence intervals (CIs) for the L1 (130-135.9 mmol/L), L3 (139-140.9 mmol/L), L4 (141-142.9 mmol/L), and L5 (143-147.0 mmol/L) groups were 0.31 (0.14-0.70, P = 0.005), 0.48 (030-0.78, P = 0.003), 0.56 (0.34-0.92, P = 0.022), and 0.37 (0.22-0.64, P < 0.001), respectively. Including serum sodium concentrations in the prediction model significantly improved the C-statistic from 0.647 to 0.679 (P = 0.022), with an NRI of 0.338 (P < 0.001) and an IDI of 0.026 (P < 0.001). RCS analysis showed a nonlinear relationship: within the 130-138 mmol/L sodium range, MACE risk gradually increased with higher sodium levels (HR 1.39, 95% CI 1.09-1.76, P = 0.008); whereas within the 138-147 mmol/L range, the risk gradually decreased (HR 0.88, 95% CI 0.80-0.98, P = 0.014). Baseline serum sodium concentrations are significantly associated with long-term cardiovascular risk in newly diagnosed CHD patients, showing an inverted U-shaped relationship, whereas low serum sodium may be specifically linked to higher risks of death and nonfatal myocardial infarction. Further research is needed to explore the impact of long-term changes in serum sodium concentrations on disease prognosis.
钠对于维持心血管健康至关重要，尤其是与心力衰竭相关。基线血清钠浓度对无心力衰竭的新发冠心病（CHD）结局的影响仍不清楚。这项前瞻性队列研究纳入了 681 名新诊断为 CHD 的患者。Cox 比例风险模型和限制性立方样条（RCS）分析用于评估血清钠浓度与主要不良心血管事件之间的关系。通过改变 C 统计量、净重新分类改善（NRI）和综合判别改善（IDI），评估了添加血清钠浓度对传统预测模型的改善情况。在中位随访 51.04 个月（IQR：40.88-53.80 个月）期间，记录到 131 例事件。多变量 Cox 比例风险模型显示，L2 组（136-138.9mmol/L）的 MACE 风险最高。与 L2 相比，L1（130-135.9mmol/L）、L3（139-140.9mmol/L）、L4（141-142.9mmol/L）和 L5（143-147.0mmol/L）组的危险比（HR）和 95%置信区间（CI）分别为 0.31（0.14-0.70，P=0.005）、0.48（0.30-0.78，P=0.003）、0.56（0.34-0.92，P=0.022）和 0.37（0.22-0.64，P<0.001）。将血清钠浓度纳入预测模型可显著提高 C 统计量，从 0.647 提高至 0.679（P=0.022），NRI 为 0.338（P<0.001），IDI 为 0.026（P<0.001）。RCS 分析显示出一种非线性关系：在 130-138mmol/L 钠范围内，随着钠水平的升高，MACE 风险逐渐增加（HR 1.39，95%CI 1.09-1.76，P=0.008）；而在 138-147mmol/L 范围内，风险逐渐降低（HR 0.88，95%CI 0.80-0.98，P=0.014）。基线血清钠浓度与新发 CHD 患者的长期心血管风险显著相关，呈倒 U 型关系，而低血清钠可能与死亡和非致死性心肌梗死的风险增加有关。需要进一步研究探讨长期血清钠浓度变化对疾病预后的影响。
