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Excreción urinaria de sodio y potasio y riesgo de eventos cardiovasculares
Martin J O'Donnell1, Salim Yusuf, Andrew Mente
1Population Health Research Institute, Hamilton General Hospital, McMaster University, 237 Barton St E, Third Floor, Hamilton, ON, L8L 2X2, Canada. odonnm@mcmaster.ca
JAMA
|November 24, 2011
Resumen
La alta ingesta de sodio aumenta el riesgo cardiovascular, mientras que una ingesta muy baja también aumenta los riesgos de mortalidad e insuficiencia cardíaca. Una mayor ingesta de potasio está relacionada con una reducción del riesgo de accidente cerebrovascular en pacientes con enfermedades cardiovasculares.
Área de la Ciencia:
- Medicina Cardiovascular La medicina cardiovascular es una especialidad de la salud.
- Nefrología Nefrología.
- Epidemiología La epidemiología.
Sus antecedentes:
- La relación entre la ingesta de sodio y potasio y el riesgo de enfermedad cardiovascular (ECV) no se comprende completamente, especialmente en personas con ECV existentes.
- La excreción urinaria sirve como un sustituto confiable para la ingesta dietética de sodio y potasio.
Objetivo del estudio:
- Investigar la asociación entre la excreción urinaria estimada de sodio y potasio y la aparición de eventos cardiovasculares en pacientes con enfermedad cardiovascular establecida o diabetes mellitus.
Principales métodos:
- Análisis de observación de dos grandes cohortes (ensayos ONTARGET y TRANSCEND, N=28,880). análisis de observación de dos grandes cohortes (ensayos ONTARGET y TRANSCEND, N=28,880). análisis de observación de dos grandes cohortes (ensayos ONTARGET y TRANSCEND, N=28,880). análisis de observación de dos grandes cohortes (ensayos ONTARGET y TRANSCEND, N=28,880). análisis de observación de dos grandes cohortes (ensayos ONTARGET y TRANSCEND, N=28,880).
- Estimada excreción urinaria de sodio y potasio en 24 horas utilizando la fórmula de Kawasaki de muestras de orina en ayunas por la mañana.
- Se utilizaron tramas de spline cúbico restringido y modelos multivariables de riesgos proporcionales de Cox para analizar las asociaciones con eventos cardiovasculares y mortalidad.
Principales resultados:
- Una mayor excreción de sodio (>7 g / día) se asoció con un mayor riesgo de muerte cardiovascular, infarto de miocardio, accidente cerebrovascular y hospitalización por insuficiencia cardíaca.
- La menor excreción de sodio (<3 g/día) se relacionó con mayores riesgos de muerte cardiovascular y hospitalización por insuficiencia cardíaca.
- El aumento de la excreción de potasio se asoció con un menor riesgo de accidente cerebrovascular.
Conclusiones:
- La asociación entre la excreción de sodio y los eventos cardiovasculares sigue una curva en forma de J, con una ingesta alta y muy baja que plantea riesgos.
- La ingesta óptima de sodio parece estar entre 4-6 g/día para pacientes con enfermedad cardiovascular establecida.
- Una mayor ingesta de potasio demuestra un efecto protector contra el ictus en esta población de pacientes.
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