Yang Qiuyu, Vernooij Robin W M, Zhu Hongfei, Nesrallah Gihad, Bai Chunyang, Wang Qi, Li Ying, Xia Danni, Bała Małgorzata M, Warzecha Sylwia, Sun Mingyao, Jayedi Ahmad, Shab-Bidar Sakineh, Pan Bei, Tian Jinhui, Yang Kehu, Ge Long, Johnston Bradley C
Department of Health Policy and Health Management, School of Public Health, Lanzhou University, Lanzhou, China.
Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China.
Crit Rev Food Sci Nutr. 2024 Dec 3:1-11. doi: 10.1080/10408398.2024.2434166.
A plethora of systematic reviews with meta-analyses (SRMAs) evaluating sodium intake on cardiovascular health have been published. However, the quality of the SRMAs, that report absolute estimates of effect for major cardiovascular events and the corresponding certainty of the evidence has not been explicitly summarized. We conducted an umbrella review to assess the strength and validity of associations between lower sodium intake and cardiovascular outcomes. We used a modified, more stringent, version of the AMSTAR 2 instrument and the GRADE approach to assess SRMA methodological quality and evidence certainty, respectively. Across three cardiovascular risk strata, we computed the absolute risk reduction (ARR) for binary outcomes. We included 56 SRMAs. In various cardiovascular risk populations, moderate to high certainty evidence suggested that lower sodium intake reduced systolic blood pressure (BP) by -8.69 to -2.00 mmHg, and had concordant but smaller effects on diastolic BP. Salt substitutes conferred a small but important reduction in all-cause and cardiovascular mortality [ARR 12 fewer per 1000; 9 fewer per 1000; respectively], and had little to no effect on the risk of stroke [ARR 1 fewer per 1000]. Moderate to high certainty evidence suggested that lower sodium intake is probably beneficial for the prevention of major cardiovascular events, especially in low cardiovascular risk populations.
已经发表了大量评估钠摄入对心血管健康影响的系统评价和荟萃分析（SRMA）。然而，这些报告主要心血管事件绝对效应估计值及相应证据确定性的SRMA的质量尚未得到明确总结。我们进行了一项综合评价，以评估较低钠摄入与心血管结局之间关联的强度和有效性。我们分别使用改良的、更严格版本的AMSTAR 2工具和GRADE方法来评估SRMA的方法学质量和证据确定性。在三个心血管风险分层中，我们计算了二元结局的绝对风险降低率（ARR）。我们纳入了56项SRMA。在各种心血管风险人群中，中等至高度确定性的证据表明，较低的钠摄入可使收缩压（BP）降低8.69至2.00 mmHg，对舒张压也有一致但较小的影响。盐替代品可使全因死亡率和心血管死亡率小幅但显著降低[每1000人分别减少12例；每1000人减少9例]，对中风风险几乎没有影响[每1000人减少1例]。中等至高度确定性的证据表明，较低的钠摄入可能有利于预防主要心血管事件，尤其是在心血管风险较低的人群中。
