高血压预防试验随访观察结果：低盐饮食对心血管疾病预后的长期影响

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TITLE: Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP)
标题：高血压预防试验随访观察结果：低盐饮食对心血管疾病预后的长期影响\"
AUTHOR: Nancy R Cook 1*, Jeffrey A Cutler 2, Eva Obarzanek 2, Julie E Buring 1, Kathryn M Rexrode 1, Shiriki K Kumanyika 3, Lawrence J Appel 4, Paul K Whelton 5
作者：Nancy R Cook 1*, Jeffrey A Cutler 2, Eva Obarzanek 2, Julie E Buring 1, Kathryn M Rexrode 1, Shiriki K Kumanyika 3, Lawrence J Appel 4, Paul K Whelton 5
1 Brigham and Women's Hospital, Harvard Medical School, Boston, MA
2 National Heart, Lung, and Blood Institute, Bethesda, MD
3 University of Pennsylvania School of Medicine, Philadelphia, PA
4 Johns Hopkins University, Baltimore, MD
5 Loyola University Health System, Maywood, IL

ABSTRACT:
Objective To examine the effects of reduction in dietary sodium intake on cardiovascular events using data from two completed randomised trials, TOHP I and TOHP II.
摘要：
目的：为了调查饮食中低钠摄入对于心血管事件的影响，采用TOHP I和 TOHP II两项已完成的随机试验数据。
Design Long term follow-up assessed 10-15 years after the original trial.
计划在最初试验后进行10-15年的长期随访评估。
Setting 10 clinic sites in 1987-90 (TOHP I) and nine sites in 1990-5 (TOHP II). Central follow-up conducted by post and phone.
环境；
1987-90年设置10个临床地点(TOHP I)，1990-5年设置9个地点(TOHP II)。主要随访通过邮件和电话进行。
Participants Adults aged 30-54 years with prehypertension.
参与者：
年龄为30-54岁有前期高血压的成年人。
Intervention Dietary sodium reduction, including comprehensive education and counselling on reducing intake, for 18 months (TOHP I) or 36-48 months (TOHP II).
干预措施：
减少饮食中的盐量，对低盐摄入进行18个月(TOHP I)或36-48个月(TOHP II)的综合教育和劝告。
Main outcome measure Cardiovascular disease (myocardial infarction, stroke, coronary revascularisation, or cardiovascular death).
主要观察指标：
心血管疾病（心肌梗塞，中风，冠状动脉血运重建术，或心血管性死亡）
Results 744 participants in TOHP I and 2382 in TOHP II were randomised to a sodium reduction intervention or control. Net sodium reductions in the intervention groups were 44 mmol/24 h and 33 mmol/24 h, respectively. Vital status was obtained for all participants and follow-up information on morbidity was obtained from 2415 (77%), with 200 reporting a cardiovascular event. Risk of a cardiovascular event was 25% lower among those in the intervention group (relative risk 0.75, 95% confidence interval 0.57 to 0.99, P=0.04), adjusted for trial, clinic, age, race, and sex, and 30% lower after further adjustment for baseline sodium excretion and weight (0.70, 0.53 to 0.94), with similar results in each trial. In secondary analyses, 67 participants died (0.80, 0.51 to 1.26, P=0.34).
结果：
TOHP I 中的744名参与者和TOHP II中的2382名参与者，被随机分成低盐摄入组或对照组。干预组中纯钠盐摄入分别减少到44 mmol/24 h和33 mmol/24 h。研究获得了所有参与者的重要数据，及2415 (77%)名患者发病率的随访信息，其中200名报告有心血管发病。在对试验，临床，年龄，种族，和性别进行校正后，干预组的心血管疾病风险降低25%（相对危险度为0.75，95%置信区间为0.57 - 0.99 P=0.04），在对基线钠排泄和体重进行进一步校正后下降30%(0.70, 0.53 - 0.94)，两个试验结果类似。在后继分析中，67名参与者死亡(0.80, 0.51 - 1.26, P=0.34)。
Conclusion Sodium reduction, previously shown to lower blood pressure, may also reduce long term risk of cardiovascular events.
结论：
以前研究显示减少钠盐摄入能降低血压，现在发现也可能减少心血管发病的长期风险。