TY - JOUR
T1 - Urinary sodium and potassium excretion, mortality, and cardiovascular events
AU - O'Donnell, Martin
AU - Mente, Andrew
AU - Rangarajan, Sumathy
AU - McQueen, Matthew J.
AU - Wang, Xingyu
AU - Liu, Lisheng
AU - Yan, Hou
AU - Lee, Shun Fu
AU - Mony, Prem
AU - Devanath, Anitha
AU - Rosengren, Annika
AU - Lopez-Jaramillo, Patricio
AU - Diaz, Rafael
AU - Avezum, Alvaro
AU - Lanas, Fernando
AU - Yusoff, Khalid
AU - Iqbal, Romaina
AU - Ilow, Rafal
AU - Mohammadifard, Noushin
AU - Gulec, Sadi
AU - Yusufali, Afzal Hussein
AU - Kruger, Lanthe
AU - Yusuf, Rita
AU - Chifamba, Jephat
AU - Kabali, Conrad
AU - Dagenais, Gilles
AU - Lear, Scott A.
AU - Teo, Koon
AU - Yusuf, Salim
PY - 2014/8/14
Y1 - 2014/8/14
N2 - BACKGROUND: The optimal range of sodium intake for cardiovascular health is controversial. METHODS: We obtained morning fasting urine samples from 101,945 persons in 17 countries and estimated 24-hour sodium and potassium excretion (used as a surrogate for intake). We examined the association between estimated urinary sodium and potassium excretion and the composite outcome of death and major cardiovascular events. RESULTS: The mean estimated sodium and potassium excretion was 4.93 g per day and 2.12 g per day, respectively. With a mean follow-up of 3.7 years, the composite outcome occurred in 3317 participants (3.3%). As compared with an estimated sodium excretion of 4.00 to 5.99 g per day (reference range), a higher estimated sodium excretion (≥7.00 g per day) was associated with an increased risk of the composite outcome (odds ratio, 1.15; 95% confidence interval [CI], 1.02 to 1.30), as well as increased risks of death and major cardiovascular events considered separately. The association between a high estimated sodium excretion and the composite outcome was strongest among participants with hypertension (P=0.02 for interaction), with an increased risk at an estimated sodium excretion of 6.00 g or more per day. As compared with the reference range, an estimated sodium excretion that was below 3.00 g per day was also associated with an increased risk of the composite outcome (odds ratio, 1.27; 95% CI, 1.12 to 1.44). As compared with an estimated potassium excretion that was less than 1.50 g per day, higher potassium excretion was associated with a reduced risk of the composite outcome. CONCLUSIONS: In this study in which sodium intake was estimated on the basis of measured urinary excretion, an estimated sodium intake between 3 g per day and 6 g per day was associated with a lower risk of death and cardiovascular events than was either a higher or lower estimated level of intake. As compared with an estimated potassium excretion that was less than 1.50 g per day, higher potassium excretion was associated with a lower risk of death and cardiovascular events.
AB - BACKGROUND: The optimal range of sodium intake for cardiovascular health is controversial. METHODS: We obtained morning fasting urine samples from 101,945 persons in 17 countries and estimated 24-hour sodium and potassium excretion (used as a surrogate for intake). We examined the association between estimated urinary sodium and potassium excretion and the composite outcome of death and major cardiovascular events. RESULTS: The mean estimated sodium and potassium excretion was 4.93 g per day and 2.12 g per day, respectively. With a mean follow-up of 3.7 years, the composite outcome occurred in 3317 participants (3.3%). As compared with an estimated sodium excretion of 4.00 to 5.99 g per day (reference range), a higher estimated sodium excretion (≥7.00 g per day) was associated with an increased risk of the composite outcome (odds ratio, 1.15; 95% confidence interval [CI], 1.02 to 1.30), as well as increased risks of death and major cardiovascular events considered separately. The association between a high estimated sodium excretion and the composite outcome was strongest among participants with hypertension (P=0.02 for interaction), with an increased risk at an estimated sodium excretion of 6.00 g or more per day. As compared with the reference range, an estimated sodium excretion that was below 3.00 g per day was also associated with an increased risk of the composite outcome (odds ratio, 1.27; 95% CI, 1.12 to 1.44). As compared with an estimated potassium excretion that was less than 1.50 g per day, higher potassium excretion was associated with a reduced risk of the composite outcome. CONCLUSIONS: In this study in which sodium intake was estimated on the basis of measured urinary excretion, an estimated sodium intake between 3 g per day and 6 g per day was associated with a lower risk of death and cardiovascular events than was either a higher or lower estimated level of intake. As compared with an estimated potassium excretion that was less than 1.50 g per day, higher potassium excretion was associated with a lower risk of death and cardiovascular events.
UR - http://www.scopus.com/inward/record.url?scp=84906080079&partnerID=8YFLogxK
U2 - 10.1056/NEJMoa1311889
DO - 10.1056/NEJMoa1311889
M3 - Article
C2 - 25119607
AN - SCOPUS:84906080079
SN - 0028-4793
VL - 371
SP - 612
EP - 623
JO - New England Journal of Medicine
JF - New England Journal of Medicine
IS - 7
ER -