Background
The relationship between sodium intake and cardiovascular disease remains controversial, due in part to inaccurate assessment of sodium intake. Assessment of 24-hour urinary excretion over a period of several days is considered an accurate method.
Methods
We included individual participant data from six prospective cohorts of generally healthy adults; Sodium and potassium excretion were assessed with the use of at least two 24-hour urine samples per participant.
The primary outcome was a cardiovascular event (coronary revascularization or fatal or nonfatal myocardial infarction or stroke).
We analyzed each cohort using consistent methods and combined the results using a random effects meta-analysis.
Results
Among 10,709 participants, who had a mean (± SD) age of 51.5 ± 12.6 years and of whom 54.2% were women, 571 cardiovascular events were determined during a median study follow-up of 8. 8 years (incidence rate, 5.9 per 1000 people). years).
Median 24-hour urinary sodium excretion was 3270 mg (10th to 90th percentile, 2099 to 4899). Higher sodium excretion, lower potassium excretion, and higher sodium-to-potassium ratio were associated with increased cardiovascular risk in analyzes controlled for confounders (P≤0.005 for all comparisons).
In analyzes comparing urinary biomarker quartile 4 (highest) with quartile 1 (lowest), hazard ratios were 1.60 (95% confidence interval [CI], 1.19 to 2.14) for sodium excretion, 0.69 (95% CI, 0.51 to 0.91) for potassium excretion, and 1.62 (95% CI, 1.25 to 2.10) for potassium excretion. the sodium-potassium ratio.
Each daily increase of 1,000 mg in sodium excretion was associated with an 18% increase in cardiovascular risk ( hazard ratio , 1.18; 95% CI, 1.08 to 1.29), and each daily increase of 1000 mg in potassium excretion was associated with an 18% decreased risk (hazard ratio, 0.82; 95% CI, 0.72 to 0.94).
Conclusions
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(Funded by the American Heart Association and the National Institutes of Health).
