Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP)
Identifieur interne : 004C34 ( Main/Exploration ); précédent : 004C33; suivant : 004C35Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP)
Auteurs : Nancy R. Cook [États-Unis] ; Jeffrey A. Cutler [États-Unis] ; Eva Obarzanek [États-Unis] ; Julie E. Buring [États-Unis] ; Kathryn M. Rexrode [États-Unis] ; Shiriki K. Kumanyika [États-Unis] ; Lawrence J. Appel [États-Unis] ; Paul K. Whelton [États-Unis]Source :
- BMJ [ 0959-8138 ] ; 2007-04-28.
English descriptors
- Teeft :
- Additional adjustment, Antihypertensive medication, Arch intern, Baseline, Baseline characteristics, Baseline sodium excretion, Baseline weight, Blood institute, Blood pressure, Blood pressure levels, Cardiovascular, Cardiovascular cause, Cardiovascular disease, Cardiovascular event, Cardiovascular events, Cardiovascular outcomes, Clinic sites, Collaborative research group, Comparison groups, Composite outcome, Confidence interval, Control group, Coronary heart disease, Coronary revascularisation, Cumulative incidence, Daily intake, Dietary, Dietary approaches, Dietary salt reduction, Dietary sodium, Dietary sodium intake, Dietary sodium reduction, Direct association, Direct relation, Essential hypertension, Excretion, Final data, Final questionnaire, Food labels, Full intention, Further adjustment, Hazard ratio, High blood pressure, High sodium intake, Higher response, Hypertension, Hypertension incidence, Hypertension prevention, Intake, Intervention group, Intervention groups, Logistic regression, Long term, Long term effects, Lower blood pressure, Mass index, Medical records, Myocardial infarction, National health, National heart, Nonpharmacologic interventions, Nutrition examination survey, Observation data, Observational studies, Odds ratio, Online, Overweight adults, Participant, Primary outcome, Public health, Randomised, Randomised trials, Relative risk, Research group, Risk reduction, Sodium, Sodium excretion, Sodium intake, Sodium intervention, Sodium intervention control, Sodium intervention group, Sodium products, Sodium reduction, Sodium reduction intervention, Sodium reduction interventions, Stroke alderman, Study outcomes, Tohp, Total mortality, Urinary sodium excretion, Usual care, Ventricular hypertrophy, Weekly group counselling sessions, Weight loss, Weight loss intervention, Year study.
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. Design Long term follow-up assessed 10-15 years after the original trial. 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. Participants Adults aged 30-54 years with prehypertension. Intervention Dietary sodium reduction, including comprehensive education and counselling on reducing intake, for 18 months (TOHP I) or 36-48 months (TOHP II). Main outcome measure Cardiovascular disease (myocardial infarction, stroke, coronary revascularisation, or cardiovascular death). 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). Conclusion Sodium reduction, previously shown to lower blood pressure, may also reduce long term risk of cardiovascular events.
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DOI: 10.1136/bmj.39147.604896.55
Affiliations:
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Kumanyika</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><placeName><region type="state">Pennsylvanie</region></placeName><wicri:cityArea>University of Pennsylvania School of Medicine, Philadelphia</wicri:cityArea></affiliation></author><author><name sortKey="Appel, Lawrence J" sort="Appel, Lawrence J" uniqKey="Appel L" first="Lawrence J" last="Appel">Lawrence J. Appel</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><placeName><region type="state">Maryland</region></placeName><wicri:cityArea>Johns Hopkins University, Baltimore</wicri:cityArea></affiliation></author><author><name sortKey="Whelton, Paul K" sort="Whelton, Paul K" uniqKey="Whelton P" first="Paul K" last="Whelton">Paul K. Whelton</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><placeName><region type="state">Illinois</region></placeName><wicri:cityArea>Loyola University Health System, Maywood</wicri:cityArea></affiliation></author></analytic><monogr></monogr><series><title level="j">BMJ</title><title level="j" type="abbrev">BMJ</title><idno type="ISSN">0959-8138</idno><idno type="eISSN">1468-5833</idno><imprint><publisher>British Medical Journal Publishing Group</publisher><date type="published" when="2007-04-28">2007-04-28</date><biblScope unit="volume">334</biblScope><biblScope unit="issue">7599</biblScope><biblScope unit="page" from="885">885</biblScope></imprint><idno type="ISSN">0959-8138</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0959-8138</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="Teeft" xml:lang="en"><term>Additional adjustment</term><term>Antihypertensive medication</term><term>Arch intern</term><term>Baseline</term><term>Baseline characteristics</term><term>Baseline sodium excretion</term><term>Baseline weight</term><term>Blood institute</term><term>Blood pressure</term><term>Blood pressure levels</term><term>Cardiovascular</term><term>Cardiovascular cause</term><term>Cardiovascular disease</term><term>Cardiovascular event</term><term>Cardiovascular events</term><term>Cardiovascular outcomes</term><term>Clinic sites</term><term>Collaborative research group</term><term>Comparison groups</term><term>Composite outcome</term><term>Confidence interval</term><term>Control group</term><term>Coronary heart disease</term><term>Coronary revascularisation</term><term>Cumulative incidence</term><term>Daily intake</term><term>Dietary</term><term>Dietary approaches</term><term>Dietary salt reduction</term><term>Dietary sodium</term><term>Dietary sodium intake</term><term>Dietary sodium reduction</term><term>Direct association</term><term>Direct relation</term><term>Essential hypertension</term><term>Excretion</term><term>Final data</term><term>Final questionnaire</term><term>Food labels</term><term>Full intention</term><term>Further adjustment</term><term>Hazard ratio</term><term>High blood pressure</term><term>High sodium intake</term><term>Higher response</term><term>Hypertension</term><term>Hypertension incidence</term><term>Hypertension prevention</term><term>Intake</term><term>Intervention group</term><term>Intervention groups</term><term>Logistic regression</term><term>Long term</term><term>Long term effects</term><term>Lower blood pressure</term><term>Mass index</term><term>Medical records</term><term>Myocardial infarction</term><term>National health</term><term>National heart</term><term>Nonpharmacologic interventions</term><term>Nutrition examination survey</term><term>Observation data</term><term>Observational studies</term><term>Odds ratio</term><term>Online</term><term>Overweight adults</term><term>Participant</term><term>Primary outcome</term><term>Public health</term><term>Randomised</term><term>Randomised trials</term><term>Relative risk</term><term>Research group</term><term>Risk reduction</term><term>Sodium</term><term>Sodium excretion</term><term>Sodium intake</term><term>Sodium intervention</term><term>Sodium intervention control</term><term>Sodium intervention group</term><term>Sodium products</term><term>Sodium reduction</term><term>Sodium reduction intervention</term><term>Sodium reduction interventions</term><term>Stroke alderman</term><term>Study outcomes</term><term>Tohp</term><term>Total mortality</term><term>Urinary sodium excretion</term><term>Usual care</term><term>Ventricular hypertrophy</term><term>Weekly group counselling sessions</term><term>Weight loss</term><term>Weight loss intervention</term><term>Year study</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">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. Design Long term follow-up assessed 10-15 years after the original trial. 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. Participants Adults aged 30-54 years with prehypertension. Intervention Dietary sodium reduction, including comprehensive education and counselling on reducing intake, for 18 months (TOHP I) or 36-48 months (TOHP II). Main outcome measure Cardiovascular disease (myocardial infarction, stroke, coronary revascularisation, or cardiovascular death). 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). Conclusion Sodium reduction, previously shown to lower blood pressure, may also reduce long term risk of cardiovascular events.</div></front></TEI><affiliations><list><country><li>États-Unis</li></country><region><li>Illinois</li><li>Maryland</li><li>Massachusetts</li><li>Pennsylvanie</li></region></list><tree><country name="États-Unis"><region name="Massachusetts"><name sortKey="Cook, Nancy R" sort="Cook, Nancy R" uniqKey="Cook N" first="Nancy R" last="Cook">Nancy R. Cook</name></region><name sortKey="Appel, Lawrence J" sort="Appel, Lawrence J" uniqKey="Appel L" first="Lawrence J" last="Appel">Lawrence J. Appel</name><name sortKey="Buring, Julie E" sort="Buring, Julie E" uniqKey="Buring J" first="Julie E" last="Buring">Julie E. Buring</name><name sortKey="Cook, Nancy R" sort="Cook, Nancy R" uniqKey="Cook N" first="Nancy R" last="Cook">Nancy R. Cook</name><name sortKey="Cutler, Jeffrey A" sort="Cutler, Jeffrey A" uniqKey="Cutler J" first="Jeffrey A" last="Cutler">Jeffrey A. Cutler</name><name sortKey="Kumanyika, Shiriki K" sort="Kumanyika, Shiriki K" uniqKey="Kumanyika S" first="Shiriki K" last="Kumanyika">Shiriki K. Kumanyika</name><name sortKey="Obarzanek, Eva" sort="Obarzanek, Eva" uniqKey="Obarzanek E" first="Eva" last="Obarzanek">Eva Obarzanek</name><name sortKey="Rexrode, Kathryn M" sort="Rexrode, Kathryn M" uniqKey="Rexrode K" first="Kathryn M" last="Rexrode">Kathryn M. Rexrode</name><name sortKey="Whelton, Paul K" sort="Whelton, Paul K" uniqKey="Whelton P" first="Paul K" last="Whelton">Paul K. Whelton</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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