Overview of recent observational study on vascular event and sodium 2016. Overview of recent observational study on vascular event and sodium 박정배 (단국의대 제일병원 내과)

Contents: Observational study on Sodium intake 와 혈압과의 위험 Large international Cohort studies Sodium intake 측정 방법의 장단점 Future Research 기존 Data 활용: KMetS

Observational study on Sodium intake 와 혈압과의 위험 Forest plot for changes in blood pressure per 1 g/d increase in sodium excretion .. Ref Martin O’Donnell et al. Circ Res 2016;116:1046~1057

Association between sodium intake and blood pressure by potassium intake groups (PURE study). Ref Martin O’Donnell et al. Circ Res 2016;116:1046~1057

Large international Cohort studies Estimated 24-hour urinary excretion of sodium and composite of cardiovascular (CV) death, stroke, myocardial infarction and hospitalization for congestive heart failure

Relationship of risk and sodium intake, showing the location of the 3 principal dietary reference intakes.

Relationship of risk and sodium intake Relationship of risk and sodium intake. Estimated 24-hour urinary excretion of sodium and composite of CV death, stroke, myocardial infarction and hospitalization for congestive heart failure (primary prevention cohort, Population Urban Rural Epidemiology [PURE] study).

Sodium intake 측정 방법의 장단점 Advantages Disadvantages Dietary survey methods Low to moderate burden Difficult to accurately assess the amount of sodium added or lost during cooking and eating Simultaneous measurement of other nutrients and energy Inaccurate or incomplete food consumption tables and use of different tables between countries Available in a large population survey Reporting and coding errors Variable content in manufactured or processed foods High intra-observer and inter-observer variability Variable food culture 24-hour urine collection method Enables comparison with other countries High burden Independent of cooking and eating habits, and food culture Dependency on the season and weather Low intra-observer and inter-observer variability Incomplete collection Low inter-survey variability Dependency on the physical condition or renal function Spot urine method Easy Dependency on the time of collection Convenient Inaccuracy of the calculation formula Can be used easily in daily clinical practice and mass survey

K– MetS STUDY [summary] 2013.12.30. 1 yr F/U ended Hypertensive patients 2014.3Q Final report enroll 3month 1-year 3-year Visit 1 Visit 2 Visit 3 Spot urine Na/K/Cr Degree of BP Metabolic syndrome Risk elements - obesity - age - Dyslipidemia - Prediabetes - comorbidity Incidence of diabetes Incidence of cardiovascular disease Early blood pressure control Controlling metabolic syndrome Home BP  clinic BP Insulin resistance/DM CV events

KMetS: Indication Male n=5384 Female n=5029 Total n=10413 Naïve 45.7 44.8 45.3 Change 34.3 37.2 35.7 Add-on 20.0 18.1 19.1

Figure 1. Study Population – BP arm K-1 3/1/2017 Figure 1. Study Population – BP arm Enrollment : N = 10,732 593 hospitals, Oct 2011 ~ Dec 2012 Screening failure : 131 (Consent withdrawn)  Baseline : N = 10,601 HBP (n=6,171) Patients excluded : 2,876 3 Month: N = 7,725 HBP (n=2,991) Patients excluded : 1,326 HBP, home BP 1 Year: N = 6,399 HBP (n= 1,892)

Study population II : N = 5,315 K-1 3/1/2017 Fig 2. Study Population – MetS arm Enrollment : N = 10,732 593 hospitals, Oct 2011 ~ Dec 2012 Screening failure : 131 (Consent withdrawn)  Inclusion I Data for Metabolic Syndrome at baseline and 3 M F/U Data set I : N = 10,601 Inclusion II Data for ACR at baseline, 3 M and 1Y F/U Data set II : N = 5,748 Study population I : N = 5,481 Exclusion: 166 Patients with SBP<130 and DBP<85 Study population II : N = 5,315

Future Research 우리나라에서 소디움 섭취와 위험인자, 심혈관 위험 발생과의 관계 정립 다양한 군에서 소디움에 대한 영향을 조사해서 어떤 군에서 소디움에 취약할 것인지 규명 소디움에 취약한 군 대상으로 소량 및 중간 정도의 소디움 섭취 감소에 따른 심 혈관 위험인자에 대한 무작위 임상연구가 필요하고 또 그 중간 단계의 생리적 지표에 대한 변화를 찾는 것도 필요 소디움 섭취에 따른 고혈압 약물에 대한 반응