Title | Urinary sodium and potassium excretion, mortality, and cardiovascular events. |
Publication Type | Journal Article |
Year of Publication | 2014 |
Authors | O'Donnell, M, Mente, A, Rangarajan, S, McQueen, MJ, Wang, X, Liu, L, Yan, H, Lee, SFu, Mony, P, Devanath, A, Rosengren, A, Lopez-Jaramillo, P, Diaz, R, Avezum, A, Lanas, F, Yusoff, K, Iqbal, R, Ilow, R, Mohammadifard, N, Gulec, S, Yusufali, AHussein, Kruger, L, Yusuf, R, Chifamba, J, Kabali, C, Dagenais, G, Lear, SA, Teo, K, Yusuf, S |
Corporate Authors | PURE Investigators |
Journal | N Engl J Med |
Volume | 371 |
Issue | 7 |
Pagination | 612-23 |
Date Published | 2014 Aug 14 |
ISSN | 1533-4406 |
Keywords | Adult, Cardiovascular Diseases, Diet, Female, Follow-Up Studies, Humans, Linear Models, Male, Middle Aged, Mortality, Potassium, Sodium, Sodium, Dietary |
Abstract | 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. (Funded by the Population Health Research Institute and others.). |
DOI | 10.1056/NEJMoa1311889 |
Alternate Journal | N. Engl. J. Med. |
PubMed ID | 25119607 |
Grant List | / / Canadian Institutes of Health Research / Canada |