尿鈉排出量與心血管疾病風險的關係：台灣社區型世代研究

Urinary Sodium Excretion and The Risk of Cardiovascular Diseases: A Community-based Cohort Study in Taiwan

王依婕(Yi-Jie Wang)

指導教授 ： 簡國龍

國立臺灣大學/公共衛生學院/流行病學與預防醫學研究所/碩士(2021年)

https://doi.org/10.6342/NTU202100930

摘要

背景介紹：
本研究為探討不同尿鈉排出量和發生心血管疾病的風險，以及高血壓、代謝症候群與過重狀態對尿鈉排出量和心血管疾病的風險相關性的影響，並找出生物學因子可作為中介因子之中介比例。
方法：
本研究是一個長期追蹤之世代研究，利用在臺灣金山地區的世代研究資料，排除在進入研究時有心血管疾病事件的受試者，挑選出2112名符合納入條件的受試者，透過結構式問卷、血液樣本及尿液樣本收集，利用Cox比例風險模型探討尿鈉排出量及不同的心血管疾病危險因子對於尿鈉排出量與心血管疾病的效果。利用傳統中介分析方法計算可能的中介因子之比例。
結果：
本研究在中位數19.1年的長期追蹤下，在調整可能干擾因子後，尿鈉排出量在第四百分位具有顯著較高的心血管疾病風險。（調整後的HR：1.43, 95% CI：1.02-1.99）。當以鈉排出量每天2.0公克作為切點，與低鈉排出量且無高血壓或無代謝症候群組相比，研究顯示無論低鈉或高鈉排出量並同時有高血壓或同時具有代謝症候群組別具有顯著較高的心血管疾病、冠狀動脈心臟病及中風的風險。此外，傳統中介方法顯示頸動脈厚度具有最高中介比例。
結論：
研究顯示經長期追蹤觀察後，較高的尿鈉排出量會增加心血管疾病風險，尤其中風的風險更高。

關鍵字

心血管疾病 ； 尿鈉排出量 ； 冠狀動脈心臟病 ； 中介分析 ； 鈉攝取量 ； 中風

並列摘要

Introduction:
This study aims to explore the relationships between urinary sodium excretion and the risk of cardiovascular diseases, the effects of hypertension, overweight, and metabolic syndrome status on sodium-cardiovascular disease risk relationship, and to find out the mediation contribution of some biological factors on the association between urinary sodium excretion and risk of cardiovascular diseases.
Methods:
Followed up for a median of 19.1years, a total of 2112 participants were selected. Structured questionnaires, blood, and overnight urine samples were collected. Cox proportional hazard model was used to investigate the effects of hypertension, overweight, and metabolic syndrome status on urinary sodium excretion and the risk of cardiovascular disease. The traditional mediation approach was conducted to calculate the mediation proportion.
Results:
During a median of 19.1 years of follow-up, after adjusting for potential confounding, the highest baseline urinary sodium excretion (>4.2g/24hr) was associated with as much as a 43% higher cardiovascular disease risk (95% CI: 1.02-1.99). Whether high or low urinary sodium excretion with hypertension or with metabolic syndrome have significantly higher risks of cardiovascular disease, coronary heart disease, and stroke. The traditional mediation approach showed that carotid intima-media thickness has the largest mediating effects.
Conclusions:
Higher urinary sodium excretion increases the risk of cardiovascular disease, especially the risk of stroke.

並列關鍵字

Cardiovascular disease ； mediation analysis ； stroke ； coronary heart disease ； urinary sodium excretion ； dietary sodium intake

參考文獻

1. Collaborators G, Roth G, Abate D, et al. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. 2018;392(10159):1736-1788.

2. James SL, Abate D, Abate KH, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. 2018;392(10159):1789-1858.

3. Jagannathan R, Patel SA, Ali MK, et al. Global updates on cardiovascular disease mortality trends and attribution of traditional risk factors. Current diabetes reports. 2019;19(7):44.

4. Wang Y-J, Yeh T-L, Shih M-C, Tu Y-K, et al. Dietary Sodium Intake and Risk of Cardiovascular Disease: A Systematic Review and Dose-Response Meta-Analysis. Nutrients. 2020;12(10):2934.

5. World Health Organization. Guideline: Sodium intake for adults and children. World Health Organization; 2012.