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Mild Hyponatremia Carries a Poor Prognosis in Community Subjects
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| 07.08.2009, 23:07 |
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OBJECTIVE: Hyponatremia has been shown to predict adverse outcome in congestive heart failure and
pneumonia among other common clinical entities, but its significance in the general population is elusive.
METHODS: The population-based Copenhagen Holter Study included 671 men and women aged 55 to 75
years with no history of cardiovascular disease, stroke, or cancer. Baseline evaluation included 48-hour
ambulatory electrocardiogram monitoring, blood tests, and a questionnaire. Hyponatremia was defined as
s-Na 134 mEq/L or s-Na 137 mEq/L according to previously accepted definitions. An adverse
outcome was defined as deaths or myocardial infarction. Median follow-up was 6.3 years.
RESULTS: Fourteen subjects (2.1%, group A) had s-Na 134 mEq/L, and 62 subjects (9.2%, group B) had
s-Na 137 mEq/L. No subject had s-Na 129 mEq/L. An adverse outcome occurred in 43% of group
A, 27% of group B, and 14% of subjects with s-Na 137mEq/L (controls) ( P .002). Adjusted hazard
ratio for adverse outcome was 3.56 (95% confidence interval [CI], 1.53-8.28, P .005) in group A
compared with controls and 2.21 (95% CI, 1.29-3.80, P .005) in group B after controlling for age, gender,
smoking, diabetes, low-density lipoprotein cholesterol, and blood pressure. The hazard ratios were robust
for additional adjusting for variables showing univariate association to hyponatremia (ie, beta-blocker and
diuretic use, heart rate variability, creatinine, C-reactive protein, and NT-pro brain natriuretic peptide). By
excluding diuretic users (18% of subjects), the adjusted hazard ratio for adverse outcome was 8.00 (95%
CI, 3.04-21.0, P .0001) in group A and 3.17 (95% CI, 1.76-5.72, P .0001) in group B compared with
controls.
CONCLUSION: Hyponatremia is an independent predictor of deaths and myocardial infarction in middleaged
and elderly community subjects.
© 2009 Published by Elsevier Inc. • The American Journal of Medicine (2009) 122, 679-686
KEYWORDS: Diuretic; Heart rate variability; Inflammation; Mortality; Myocardial infarction; Sodium
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| Категория: Статьи | Добавил: nbylova
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