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Urinary sodium excretion, blood pressure, cardiovascular disease, and mortality: a community-level prospective epidemiological cohort study

The Lancet (British edition), 2018-08, Vol.392 (10146), p.496-506 [Peer Reviewed Journal]

2018 Elsevier Ltd ;Copyright © 2018 Elsevier Ltd. All rights reserved. ;Copyright Elsevier Limited Aug 11, 2018 ;ISSN: 0140-6736 ;EISSN: 1474-547X ;DOI: 10.1016/S0140-6736(18)31376-X ;PMID: 30129465

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Title:
Urinary sodium excretion, blood pressure, cardiovascular disease, and mortality: a community-level prospective epidemiological cohort study
Author: Mente, Andrew ; O'Donnell, Martin ; Rangarajan, Sumathy ; McQueen, Matthew ; Dagenais, Gilles ; Wielgosz, Andreas ; Lear, Scott ; Ah, Shelly Tse Lap ; Wei, Li ; Diaz, Rafael ; Avezum, Alvaro ; Lopez-Jaramillo, Patricio ; Lanas, Fernando ; Mony, Prem ; Szuba, Andrzej ; Iqbal, Romaina ; Yusuf, Rita ; Mohammadifard, Noushin ; Khatib, Rasha ; Yusoff, Khalid ; Ismail, Noorhassim ; Gulec, Sadi ; Rosengren, Annika ; Yusufali, Afzalhussein ; Kruger, Lanthe ; Tsolekile, Lungiswa Primrose ; Chifamba, Jephat ; Dans, Antonio ; Alhabib, Khalid F ; Yeates, Karen ; Teo, Koon ; Yusuf, Salim
Subjects: Adult ; Adults ; Aged ; American-Heart-Association ; Blood ; Blood pressure ; Blood Pressure - drug effects ; Cardiac and Cardiovascular Systems ; Cardiovascular disease ; Cardiovascular diseases ; Cardiovascular Diseases - epidemiology ; Cardiovascular Diseases - etiology ; Cardiovascular Diseases - mortality ; Clinical trials ; Communities ; Councils ; Epidemiology ; events ; Excretion ; Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi ; Fruits ; Health ; Heart ; Heterogeneity ; Higher education ; Humans ; hypertension ; Kardiologi ; Linearity ; Long-term care ; low-income countries ; Male ; Medical research ; middle ; Middle Aged ; Mortality ; national-health ; Population ; Potassium ; potassium excretion ; Potassium, Dietary - administration & dosage ; Potassium, Dietary - adverse effects ; Prospective Studies ; Public Health, Global Health, Social Medicine and Epidemiology ; reduction ; risk ; Rural areas ; salt ; Sodium ; Sodium - urine ; Sodium, Dietary - administration & dosage ; Sodium, Dietary - adverse effects ; Stroke ; Urine
Is Part Of: The Lancet (British edition), 2018-08, Vol.392 (10146), p.496-506
Description: WHO recommends that populations consume less than 2 g/day sodium as a preventive measure against cardiovascular disease, but this target has not been achieved in any country. This recommendation is primarily based on individual-level data from short-term trials of blood pressure (BP) without data relating low sodium intake to reduced cardiovascular events from randomised trials or observational studies. We investigated the associations between community-level mean sodium and potassium intake, cardiovascular disease, and mortality. The Prospective Urban Rural Epidemiology study is ongoing in 21 countries. Here we report an analysis done in 18 countries with data on clinical outcomes. Eligible participants were adults aged 35–70 years without cardiovascular disease, sampled from the general population. We used morning fasting urine to estimate 24 h sodium and potassium excretion as a surrogate for intake. We assessed community-level associations between sodium and potassium intake and BP in 369 communities (all >50 participants) and cardiovascular disease and mortality in 255 communities (all >100 participants), and used individual-level data to adjust for known confounders. 95 767 participants in 369 communities were assessed for BP and 82 544 in 255 communities for cardiovascular outcomes with follow-up for a median of 8·1 years. 82 (80%) of 103 communities in China had a mean sodium intake greater than 5 g/day, whereas in other countries 224 (84%) of 266 communities had a mean intake of 3–5 g/day. Overall, mean systolic BP increased by 2·86 mm Hg per 1 g increase in mean sodium intake, but positive associations were only seen among the communities in the highest tertile of sodium intake (p<0·0001 for heterogeneity). The association between mean sodium intake and major cardiovascular events showed significant deviations from linearity (p=0·043) due to a significant inverse association in the lowest tertile of sodium intake (lowest tertile <4·43 g/day, mean intake 4·04 g/day, range 3·42–4·43; change –1·00 events per 1000 years, 95% CI –2·00 to –0·01, p=0·0497), no association in the middle tertile (middle tertile 4·43–5·08 g/day, mean intake 4·70 g/day, 4·44–5.05; change 0·24 events per 1000 years, –2·12 to 2·61, p=0·8391), and a positive but non-significant association in the highest tertile (highest tertile >5·08 g/day, mean intake 5·75 g/day, >5·08–7·49; change 0·37 events per 1000 years, –0·03 to 0·78, p=0·0712). A strong association was seen with stroke in China (mean sodium intake 5·58 g/day, 0·42 events per 1000 years, 95% CI 0·16 to 0·67, p=0·0020) compared with in other countries (4·49 g/day, –0·26 events, –0·46 to –0·06, p=0·0124; p<0·0001 for heterogeneity). All major cardiovascular outcomes decreased with increasing potassium intake in all countries. Sodium intake was associated with cardiovascular disease and strokes only in communities where mean intake was greater than 5 g/day. A strategy of sodium reduction in these communities and countries but not in others might be appropriate. Population Health Research Institute, Canadian Institutes of Health Research, Canadian Institutes of Health Canada Strategy for Patient-Oriented Research, Ontario Ministry of Health and Long-Term Care, Heart and Stroke Foundation of Ontario, and European Research Council.
Publisher: England: Elsevier Ltd
Language: English
Identifier: ISSN: 0140-6736
EISSN: 1474-547X
DOI: 10.1016/S0140-6736(18)31376-X
PMID: 30129465
Source: ProQuest One Psychology
AUTh Library subscriptions: ProQuest Central
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Urinary sodium excretion, blood pressure, cardiovascular disease, and mortality: a community-level prospective epidemiological cohort study

2018 Elsevier Ltd ;Copyright © 2018 Elsevier Ltd. All rights reserved. ;Copyright Elsevier Limited Aug 11, 2018 ;ISSN: 0140-6736 ;EISSN: 1474-547X ;DOI: 10.1016/S0140-6736(18)31376-X ;PMID: 30129465

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