尿中のナトリウムとカリウムの排泄と心血管疾患のリスク
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
まとめ
高濃度のナトリウム摂取は心血管疾患のリスクを高め,非常に低濃度のナトリウム摂取は死亡率や心不全のリスクを高めます. 高度のカリウム摂取は,心血管疾患の患者の脳卒中リスクの低下と関連しています.
科学分野:
- 心血管医学 心血管医学
- ネフロロジーはネフロロジーを用います.
- エピデミオロジー エピデミオロジー
背景:
- ナトリウムとカリウム摂取量と心血管疾患 (CVD) のリスクの関係については,特に既存のCVDを有する個体では,完全に理解されていません.
- 尿による排泄は,食によるナトリウムとカリウムの摂取の信頼できる代用物として機能する.
研究 の 目的:
- 推定される尿中のナトリウムとカリウムの排泄と,確立されたCVDまたは糖尿病の患者における心血管疾患の発生との関連を調査する.
主な方法:
- 2つの大きなコホート (ONTARGETとTRANSCEND試験,N=28,880) の観察分析.
- 朝の空腹の尿サンプルから,川崎式を用いた24時間の尿中のナトリウムとカリウム排出量の推定値.
- 制限された立方スラインプロットとコックス比例リスクの多変数モデルを使用して,心血管疾患と死亡率との関連性を分析しました.
主要な成果:
- 高いナトリウム分泌量 (>7g/日) は,心血管疾患による死亡,心筋梗塞,脳卒中,心不全の入院のリスクの増加と関連していました.
- 低ナトリウム分泌量 (<3g/日) は,心血管疾患による死亡と心不全による入院のリスクの高さに関連していた.
- カリウムの分泌量の増加は,脳卒中のリスクの低下と関連していました.
結論:
- ナトリウム排泄と心血管疾患との関連はJ型曲線に沿っており,高摂取量と非常に低摂取量の両方がリスクをもたらす.
- 最適なナトリウム摂取量は,既定の心血管疾患を有する患者にとって,一日4~6gの範囲にあるようです.
- より高いカリウム摂取量は,この患者集団における脳卒中に対する保護効果を示しています.
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