Wannamethee G, Whincup P H, Shaper A G, Lever A F
Department of Public Health, Royal Free Hospital, School of Medicine, London, UK.
J Hypertens. 1994 Aug;12(8):971-9.
Clinical disturbances of the circulating sodium concentration are both a cause and a consequence of cerebrovascular disease. We examined the relationship between serum sodium level and risk of stroke and major ischaemic heart disease in a prospective study of 7690 middle-aged males drawn from general practices in 24 British towns followed over a 9.5-year period.
The mean serum sodium level was 141.5 mmol/l and 375 males on antihypertensive treatment were excluded from the analyses. A significant inverse trend was seen between serum sodium and risk of stroke up to 144 mmol/l; above this the risk of stroke was increased. Those with levels of 143-144 mmol/l showed over a 70% reduction in risk of stroke compared with those with levels of < or = 140 mmol/l. The inverse relationship between sodium and stroke up to 144 mmol/l was seen in males with and without pre-existing ischaemic heart disease or stroke, in normotensives and untreated hypertensives, and in non-smokers and current smokers. A weak but significant inverse association was seen between serum sodium and diastolic but not systolic blood pressure. The association between serum sodium level and stroke remained significant after adjustment for diastolic blood pressure and other factors associated with stroke: age, smoking, social class, body mass index, physical activity, heavy drinking, presence of diabetes, blood glucose and pre-existing ischaemic heart disease. No association was seen between serum sodium level and risk of ischaemic heart disease after adjustment for other risk factors. All-cause and non-cardiovascular mortality were significantly increased at serum sodium levels of < or = 138 mmol/l, probably due to an association between lung cancer and hyponatraemia.
These findings suggest that sodium concentration may be related to risk of stroke even at levels of sodium usually regarded as normal.
循环钠浓度的临床紊乱既是脑血管疾病的一个原因，也是其一个后果。我们在一项对7690名中年男性进行的前瞻性研究中，考察了血清钠水平与中风及主要缺血性心脏病风险之间的关系。这些男性来自英国24个城镇的普通诊所，随访时间长达9.5年。
血清钠平均水平为141.5 mmol/L，375名接受抗高血压治疗的男性被排除在分析之外。在血清钠水平达到144 mmol/L之前，血清钠与中风风险之间呈现出显著的负相关趋势；高于此水平，中风风险增加。血清钠水平为143 - 144 mmol/L的人群与血清钠水平≤140 mmol/L的人群相比，中风风险降低了70%以上。在有或没有既往缺血性心脏病或中风病史的男性中、在血压正常者和未经治疗的高血压患者中、以及在不吸烟者和当前吸烟者中，均观察到血清钠水平在144 mmol/L之前与中风之间存在负相关关系。血清钠与舒张压之间存在微弱但显著的负相关，与收缩压之间则无此关系。在对舒张压以及与中风相关的其他因素（年龄、吸烟、社会阶层、体重指数、身体活动、大量饮酒、糖尿病、血糖及既往缺血性心脏病）进行调整后，血清钠水平与中风之间的关联仍然显著。在对其他风险因素进行调整后，未观察到血清钠水平与缺血性心脏病风险之间存在关联。血清钠水平≤13
