Sodium Excretion and Risk of Developing Coronary Heart Disease

Study Questions:

What is the association between sodium intake and risk of coronary heart disease (CHD) in the general population and in subgroups potentially more sensitive to the effects of sodium intake (i.e., subjects with higher blood pressure or with increased circulating N-terminal pro-B-type natriuretic peptide [NT-proBNP] concentrations)?


The investigators prospectively followed 7,543 adults ages 28-75 years and free of cardiovascular and kidney disease in 1997-1998 from the PREVEND (Prevention of Renal and Vascular End-stage Disease) trial. Sodium excretion was measured in two 24-hour urine collections at baseline. Potential susceptibility factors were blood pressure and plasma NT-proBNP.


Median 24-hour sodium excretion was 137 mmol (Q1-Q3: 106-171 mmol). During a median follow-up of 10.5 (Q1-Q3: 9.9-10.8) years, 452 CHD events occurred. In the entire cohort, there was no association between each 1-g/d (43 mmol/24 hours) increment in sodium excretion and CHD risk (adjusted hazard ratio [HR], 1.07; 95% confidence interval [CI], 0.98-1.18; p = 0.15). However, the association of sodium excretion with CHD risk tended to be modified by mean arterial pressure (Pinteraction = 0.08) and was modified by NT-proBNP (Pinteraction = 0.002). When stratified, each 1-g/d increment in sodium excretion was associated with an increased risk for CHD in subjects with hypertension (HR, 1.14; 95% CI, 1.01-1.28; n = 2,363) and in subjects with NT-proBNP concentrations above the sex-specific median (HR, 1.16; 95% CI, 1.03-1.30; n = 3,771).


The authors concluded that there was no overall association between sodium excretion and risk of CHD.


This study reports that there was no association between urinary sodium excretion and risk of CHD in the overall cohort. The association between sodium excretion and risk of CHD was modified by NT-proBNP, with positive associations between sodium excretion and risk of CHD among individuals with higher concentrations of NT-proBNP and among individuals with hypertension. These results are in line with the notion that excess sodium intake is associated with an increased risk of CHD, particularly among vulnerable groups who comprise a large portion of the population. Furthermore, there is evidence that a modest 4% per year decrease in sodium intake might prevent more than half a million deaths and add almost 2 million person-years of life in the United States over a period of 10 years, and a gradual decrease in the addition of sodium to food products represents the easiest change for the general population and the intervention option with the greatest potential for success.

Clinical Topics: Prevention, Hypertension

Keywords: Risk, Follow-Up Studies, Kidney Diseases, Sodium, Coronary Disease, Blood Pressure, Urine Specimen Collection, Hypertension, United States, Natriuretic Peptide, Brain

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