盐替代品对心血管健康影响的研究进展
Research Progress on the Impact of Salt Substitutes on Cardiovascular Health
DOI: 10.12677/acm.2024.144986, PDF,   
作者: 罗 艺, 佘 强*:重庆医科大学附属第二医院心血管内科/重庆医科大学临床医学系,重庆
关键词: 高血压盐替代品心血管疾病盐摄入Hypertension Salt Substitutes Cardiovascular Disease Salt Intake
摘要: 心血管疾病(CVD)在21世纪初期已成为全球过早死亡和发病的主要原因,而预防和控制高血压是阻止心血管疾病发生、发展的核心措施之一。既往大量研究已表明减少食盐摄入可以降低并控制血压,食用盐替代品——即富含钾或其他类似成分(如MgCl2,MgSO4和CaCl2等)可以作为一种低成本、非药物性降压措施,但其对心血管疾病的发生、发展及与预后仍有待进一步研究。现就盐替代品对心血管健康影响的研究进行综述,以期为预防和控制心血管事件提供更具参考价值的信息。
Abstract: Cardiovascular disease (CVD) has become the leading cause of premature death and morbidity in the world at the beginning of the 21st century, the prevention and control of hypertension is one of the core measures to prevent the occurrence and progression of cardiovascular disease. Previous studies have shown that reducing salt intake can lower and control blood pressure. Salt substitutes, which are rich in potassium or other similar ingredients (such as MgCl2, MgSO4, and CaCl2, etc.) can be used as a low-cost, non-pharmacological antihypertensive measure, but their impact on the occurrence, progression, and prognosis of cardiovascular disease still need further studies. This article reviews the effects of salt substitutes on cardiovascular health to provide more valuable information for the prevention and control of cardiovascular events.
文章引用:罗艺, 佘强. 盐替代品对心血管健康影响的研究进展[J]. 临床医学进展, 2024, 14(4): 47-52. https://doi.org/10.12677/acm.2024.144986

参考文献

[1] NCD Risk Factor Collaboration (NCD-RisC) (2021) Worldwide Trends in Hypertension Prevalence and Progress in Treatment and Control from 1990 to 2019: A Pooled Analysis of 1201 Population-Representative Studies with 104 Million Participants. The Lancet, 398, 957-980.
[2] Mills, K.T., Bundy, J.D., Kelly, T.N., Reed, J.E., Kearney, P.M., Reynolds, K., Chen, J. and He, J. (2016) Global Disparities of Hypertension Prevalence and Control: A Systematic Analysis of Population-Based Studies from 90 Countries. Circulation, 134, 441-450. [Google Scholar] [CrossRef
[3] Wang, D.D., Li, Y., Nguyen, X.T., Song, R.J., et al. (2022) Dietary Sodium and Potassium Intake and Risk of Non-Fatal Cardiovascular Diseases: The Million Veteran Program. Nutrients, 14, Article 1121. [Google Scholar] [CrossRef] [PubMed]
[4] Mirmiran, P., Bahadoran, Z., Nazeri, P. and Azizi, F. (2018) Dietary Sodium to Potassium Ratio and the Incidence of Hypertension and Cardiovascular Disease: A Population-Based Longitudinal Study. Clinical and Experimental Hypertension, 40, 772-779. [Google Scholar] [CrossRef] [PubMed]
[5] Mosallanezhad, Z., Jalali, M., Bahadoran, Z., Mirmiran, P. and Azizi, F. (2023) Dietary Sodium to Potassium Ratio Is an Independent Predictor of Cardiovascular Events: A Longitudinal Follow-Up Study. BMC Public Health, 23, Article No. 705. [Google Scholar] [CrossRef] [PubMed]
[6] Kurtz, T.W., Pravenec, M. and DiCarlo, S.E. (2022) Mechanism-Based Strategies to Prevent Salt Sensitivity and Salt-Induced Hypertension. Clinical Science, 136, 599-620. [Google Scholar] [CrossRef
[7] Neal, B., Wu, Y., Feng, X., Zhang, R., et al. (2021) Effect of Salt Substitution on Cardiovascular Events and Death. The New England Journal of Medicine, 385, 1067-1077. [Google Scholar] [CrossRef
[8] Li, N., Yan, L.L., Niu, W., Yao, C., et al. (2016) The Effects of A Community-Based Sodium Reduction Program in Rural China—A Cluster-Randomized Trial. PLOS ONE, 11, e0166620. [Google Scholar] [CrossRef] [PubMed]
[9] Mente, A., O’Donnell, M.J., Rangarajan, S., et al. (2014) PURE Investigators. Association of Urinary Sodium and Potassium Excretion with Blood Pressure. The New England Journal of Medicine, 371, 601-611. [Google Scholar] [CrossRef
[10] The Trials of Hypertension Prevention, Phase II. the Trials of Hypertension Prevention Collaborative Research Group (1997) Effects of Weight Loss and Sodium Reduction Intervention on Blood Pressure and Hypertension Incidence in Overweight People with High-Normal Blood Pressure. The Archives of Internal Medicine, 157, 657-667. [Google Scholar] [CrossRef
[11] Whelton, P.K., Appel, L.J., Espeland, M.A., Applegate, W.B., Ettinger Jr., W.H., Kostis, J.B., Kumanyika, S., Lacy, C.R., Johnson, K.C., Folmar, S. and Cutler, J.A. (1998) Sodium Reduction and Weight Loss in the Treatment of Hypertension in Older Persons: A Randomized Controlled Trial of Nonpharmacologic Interventions in the Elderly (TONE). JAMA, 279, 839-846. [Google Scholar] [CrossRef] [PubMed]
[12] Newberry, S.J., Chung, M., Anderson, C.A.M., Chen, C., Fu, Z., Tang, A., Zhao, N., Booth, M., Marks, J., Hollands, S., Motala, A., Larkin, J., Shanman, R. and Hempel, S. (2018) Sodium and Potassium Intake: Effects on Chronic Disease Outcomes and Risks. Agency for Healthcare Research and Quality, Rockville. [Google Scholar] [CrossRef
[13] Jin, A., Xie, W. and Wu, Y. (2020) Effect of Salt Reduction Interventions in Lowering Blood Pressure in Chinese Populations: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. BMJ Open, 10, e032941. [Google Scholar] [CrossRef] [PubMed]
[14] Bernabe-Ortiz, A., Sal, Y., Rosas, V.G., Ponce-Lucero, V., Cárdenas, M.K., Carrillo-Larco, R.M., Diez-Canseco, F., Pesantes, M.A., Sacksteder, K.A., Gilman, R.H. and Miranda, J.J. (2020) Effect of Salt Substitution on Community-Wide Blood Pressure and Hypertension Incidence. Nature Medicine, 26, 374-378. [Google Scholar] [CrossRef] [PubMed]
[15] Zhou, B., Webster, J., Fu, L.Y., Wang, H.L., Wu, X.M., Wang, W.L. and Shi, J.P. (2016) Intake of Low Sodium Salt Substitute for 3 Years Attenuates the Increase in Blood Pressure in a Rural Population of North China—A Randomized Controlled Trial. International Journal of Cardiology, 215, 377-382. [Google Scholar] [CrossRef] [PubMed]
[16] Hu, J., Zhao, L., Thompson, B., Zhang, Y. and Wu, Y. (2018) Effects of Salt Substitute on Home Blood Pressure Differs According to Age and Degree of Blood Pressure in Hypertensive Patients and Their Families. Clinical and Experimental Hypertension, 40, 664-672. [Google Scholar] [CrossRef] [PubMed]
[17] Chang, H.Y., Hu, Y.W., Yue, C.S., Wen, Y.W., Yeh, W.T., Hsu, L.S., Tsai, S.Y. and Pan, W.H. (2006) Effect of Potassium-Enriched Salt on Cardiovascular Mortality and Medical Expenses of Elderly Men. The American Journal of Clinical Nutrition, 83, 1289-1296. [Google Scholar] [CrossRef] [PubMed]
[18] Khan, S.U., Khan, M.U., Riaz, H., Valavoor, S., Zhao, D., Vaughan, L., Okunrintemi, V., Riaz, I.B., Khan, M.S., Kaluski, E., Murad, M.H., Blaha, M.J., Guallar, E. and Michos, E.D. (2019) Effects of Nutritional Supplements and Dietary Interventions on Cardiovascular Outcomes: An Umbrella Review and Evidence Map. Annals of Internal Medicine, 171, 190-198. [Google Scholar] [CrossRef
[19] Adler, A.J., Taylor, F., Martin, N., Gottlieb, S., Taylor, R.S. and Ebrahim, S. (2014) Reduced Dietary Salt for the Prevention of Cardiovascular Disease. Cochrane Database of Systematic Reviews, 12, CD009217. [Google Scholar] [CrossRef
[20] Cook, N.R., Cutler, J.A., Obarzanek, E., Buring, J.E., Rexrode, K.M., Kumanyika, S.K., Appel, L.J. and Whelton, P.K. (2007) Long Term Effects of Dietary Sodium Reduction on Cardiovascular Disease Outcomes: Observational Follow-Up of the Trials of Hypertension Prevention (TOHP). BMJ, 334, 885-888. [Google Scholar] [CrossRef] [PubMed]
[21] Kwok, T.C.Y., Lam, L.C.W., Sea, M.M.M., Goggins, W. and Woo, J. (2012) A Randomized Controlled Trial of Dietetic Interventions to Prevent Cognitive Decline in Old Age Hostel Residents. European Journal of Clinical Nutrition, 66, 1135-1140. [Google Scholar] [CrossRef] [PubMed]
[22] Campbell, N.R., Lackland, D.T., Niebylski, M.L., et al. (2016) 2016 Dietary Salt Fact Sheet and Call to Action: The World Hypertension League, International Society of Hypertension, and the International Council of Cardiovascular Prevention and Rehabilitation. The Journal of Clinical Hypertension, 18, 1082-1085. [Google Scholar] [CrossRef] [PubMed]
[23] Mancia, G., Oparil, S., Whelton, P.K., et al. (2017) The Technical Report on Sodium Intake and Cardiovascular Disease in Low-and Middle-Income Countries by the Joint Working Group of the World Heart Federation, the European Society of Hypertension and the European Public Health Association. European Heart Journal, 38, 712-719. [Google Scholar] [CrossRef] [PubMed]
[24] Ekinci, E.I., Clarke, S., Thomas, M.C., Moran, J.L., Cheong, K., MacIsaac, R.J. and Jerums, G. (2011) Dietary Salt Intake and Mortality in Patients with Type 2 Diabetes. Diabetes Care, 34, 703-709. [Google Scholar] [CrossRef] [PubMed]
[25] Sacks, F.M., Svetkey, L.P., Vollmer, W.M., et al. (2001) Effects on Blood Pressure of Reduced Dietary Sodium and the Dietary Approaches to Stop Hypertension (DASH) Diet. DASH-Sodium Collaborative Research Group. The New England Journal of Medicine, 344, 3-10. [Google Scholar] [CrossRef
[26] Thomas, M.C., Moran, J., Forsblom, C., et al. (2011) The Association between Dietary Sodium Intake, ESRD, and All-Cause Mortality in Patients with Type 1 Diabetes. Diabetes Care, 34, 861-866. [Google Scholar] [CrossRef] [PubMed]
[27] Campbell, N.R.C., Whelton, P.K., Orias, M., et al. (2023) 2022 World Hypertension League, Resolve to Save Lives and International Society of Hypertension Dietary Sodium (Salt) Global Call to Action. Journal of Human Hypertension, 37, 428-437.
[28] Powell, L., Calvin Jr., J., Richardson, D., Janssen, I., Mendes De Leon, C. and Flynn, K. (2010) Self-Management Counseling in Patients with Heart Failure: The Heart Failure Adherence and Retention Randomized Behavioral Trial. JAMA, 304, 1331-1338. [Google Scholar] [CrossRef] [PubMed]
[29] Colin-Ramirez, E., Castillo, M.L., Orea, T.A., Monta-No, H.P. and Dorantes, G.J. (2010) Impact of a Sodium and Fluid Restricted Diet on Clinical Status in Heart Failure Patients. Revista chilena de nutrición, 37, 427-437. [Google Scholar] [CrossRef
[30] Bistola, V., Arfaras-Melainis, A., Trogkanis, E., et al. (2020) Safety and Efficacy of Salt Substitution with a Low Sodium-Potassium Enriched Dietary Salt in Patients with Heart Failure with Reduced Ejection Fraction: A Pilot Study. Clinical Nutrition ESPEN, 35, 90-94. [Google Scholar] [CrossRef] [PubMed]
[31] Little, R. and Ellison, D.H. (2023) Modifying Dietary Sodium and Potassium Intake: An End to the “Salt Wars”? Hypertension, 81, 415-425.
[32] Hunter, R.W. and Bailey, M.A. (2019) Hyperkalemia: Pathophysiology, Risk Factors and Consequences. Nephrology Dialysis Transplantation, 34, iii2-iii11. [Google Scholar] [CrossRef] [PubMed]
[33] Yuan, Y., Jin, A., Neal, B., Feng, X., et al. (2023) Salt Substitution and Salt-Supply Restriction for Lowering Blood Pressure in Elderly Care Facilities: A Cluster-Randomized Trial. Nature Medicine, 29, 973-981. [Google Scholar] [CrossRef] [PubMed]
[34] Kovesdy, C.P., Matsushita, K., Sang, Y., et al. (2018) CKD Prognosis Consortium. Serum Potassium and Adverse Outcomes across the Range of Kidney Function: A CKD Prognosis Consortium Meta-Analysis. European Heart Journal, 39, 1535-1542.
[35] 胡继宏, 赵连成, 李贤, 武阳丰. 代用盐影响原发性高血压患者家庭自测血压的双盲随机对照试验[J]. 中华高血压杂志, 2014, 22(1): 42-46.