本文由小咖机器人翻译整理

期刊来源：Ann Intern Med

原文链接：https://doi.org/10.7326/M23-2626

摘要内容如下：

背景

盐替代是一种简单但越来越有前途的改善心血管结局的策略。

目的

评估盐替代对心血管结局的长期影响。

数据源

PubMed、EMBASE、Cochrane Central和CINAHL从开始到2023年8月23日进行搜索。还进行了试验登记、引文分析和手工搜索。

研究选择

随机对照试验（RCT）比较了在整个研究期间6个月或更长时间内，在成人中提供或建议使用盐替代品而不进行干预或使用常规盐。

数据提取

两位作者独立筛选文章、提取数据并评估偏倚风险。主要转归包括6个月或更长时间的死亡率、主要心血管事件（MACE）和不良事件。次要和事后结果包括血压、病因特异性死亡率和6个月或更长时间的尿液排泄量。进行了随机效应荟萃分析，并使用GRADE（建议评估、开发和评价的分级）评估了效应估计的确定性。

数据综合

在纳入的16项随机对照试验中，有8项报告了主要结果。大多数（n=7/8）是在中国大陆或台湾进行的，3例是在住宅设施中进行的，7例包括年龄较大（平均62岁）和/或心血管风险高于平均水平的人群。在这一人群中，食盐替代品可降低全因死亡率的风险（6项RCT；27710人参与；比率比[RR]，0.88[95%CI，0.82至0.93]；低确定性）和心血管死亡率（4项RCT；参与人数25050人；RR为0.83[CI为0.73~0.95]；低确定性）。盐替代品可能导致MACE轻微减少（3个RCT；参加人数23215人；RR，0.85[CI，0.71~1.00]；极低确定性），具有极低确定性的严重不良事件证据（6个RCT；27995人参与；风险比，1.04[CI，0.87至1.25]）。

局限性

证据库由单一的大型随机对照试验主导。大多数随机对照试验来自中国大陆或台湾，涉及心血管风险高于平均水平的参与者；因此，对其他人群的可推广性非常有限。

结论

盐替代可能降低全因或心血管死亡率，但减少心血管事件和不增加严重不良事件的证据尚不确定，特别是在西方人群中。在心血管风险较高和/或遵循中国饮食的人群中，证据的确定性更高。

主要资金来源

国家卫生和医学研究委员会。（普洛斯彼罗：CRD42022327566）。

英文原文如下：

Abstracts

BACKGROUND  Salt substitution is a simple yet increasingly promising strategy to improve cardiovascular outcomes.

PURPOSE  To evaluate the long-term effects of salt substitution on cardiovascular outcomes.

DATA SOURCES  PubMed, EMBASE, Cochrane CENTRAL, and CINAHL searched from inception to 23 August 2023. Trial registries, citation analysis, and hand-search were also done.

STUDY SELECTION  Randomized controlled trials (RCTs) comparing provision of or advice to use a salt substitute with no intervention or use of regular salt among adults for 6 months or longer in total study duration.

DATA EXTRACTION  Two authors independently screened articles, extracted data, and assessed risk of bias. Primary outcomes include mortality, major cardiovascular events (MACE), and adverse events at 6 months or greater. Secondary and post hoc outcomes include blood pressure, cause-specific mortality, and urinary excretion at 6 months or greater. Random-effects meta-analyses were done and certainty of effect estimates were assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation).

DATA SYNTHESIS  Of the 16 included RCTs, 8 reported on primary outcomes. Most (n = 7 of 8) were done in China or Taiwan, 3 were done in residential facilities, and 7 included populations of older age (average 62 years) and/or with higher-than-average cardiovascular risk. In this population, salt substitute may reduce risk for all-cause mortality (6 RCTs; 27 710 participants; rate ratio [RR], 0.88 [95% CI, 0.82 to 0.93]; low certainty) and cardiovascular mortality (4 RCTs; 25 050 participants; RR, 0.83 [CI, 0.73 to 0.95]; low certainty). Salt substitute may result in a slight reduction in MACE (3 RCTs; 23 215 participants; RR, 0.85 [CI, 0.71 to 1.00]; very low certainty), with very low-certainty evidence of serious adverse events (6 RCTs; 27 995 participants; risk ratio, 1.04 [CI, 0.87 to 1.25]).

LIMITATIONS  The evidence base is dominated by a single, large RCT. Most RCTs were from China or Taiwan and involved participants with higher-than-average cardiovascular risk; therefore, generalizability to other populations is very limited.

CONCLUSION  Salt substitution may reduce all-cause or cardiovascular mortality, but the evidence for reducing cardiovascular events and for not increasing serious adverse events is uncertain, particularly for a Western population. The certainty of evidence is higher among populations at higher cardiovascular risk and/or following a Chinese diet.

PRIMARY FUNDING SOURCE  National Health and Medical Research Council. (PROSPERO: CRD42022327566).

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