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Global Sodium Consumption and Death From Cardiovascular Causes
Study Questions:
What are the effects of sodium intake on global cardiovascular mortality?
Methods:
The investigators collected data from surveys on sodium intake, as determined by urinary excretion and diet in persons from 66 countries (accounting for 74.1% of adults throughout the world), and used these data to quantify the global consumption of sodium according to age, sex, and country. The effects of sodium on blood pressure, according to age, race, and the presence or absence of hypertension, were calculated from data in a new meta-analysis of 107 randomized interventions, and the effects of blood pressure on cardiovascular mortality, according to age, were calculated from a meta-analysis of cohorts. Cause-specific mortality was derived from the Global Burden of Disease Study 2010. Using comparative risk assessment, the authors estimated the cardiovascular effects of current sodium intake, as compared with a reference intake of 2.0 g of sodium per day, according to age, sex, and country.
Results:
In 2010, the estimated mean level of global sodium consumption was 3.95 g per day, and regional mean levels ranged from 2.18 to 5.51 g per day. Globally, 1.65 million annual deaths from cardiovascular causes (95% uncertainty interval [confidence interval], 1.10 million to 2.22 million) were attributed to sodium intake above the reference level; 61.9% of these deaths occurred in men and 38.1% occurred in women. These deaths accounted for nearly one of every ten deaths from cardiovascular causes (9.5%). Four of every five deaths (84.3%) occurred in low- and middle-income countries, and two of every five deaths (40.4%) were premature (before 70 years of age). The rate of death from cardiovascular causes associated with sodium intake above the reference level was highest in the country of Georgia and lowest in Kenya.
Conclusions:
The authors concluded that 1.65 million deaths from cardiovascular causes that occurred in 2010 were attributed to sodium consumption above a reference level of 2.0 g per day.
Perspective:
This study reports that globally, 1.65 million deaths from cardiovascular causes in 2010 (i.e., approximately one of ten deaths) were attributed to sodium consumption of >2.0 g per day. Notably, four of five of these deaths occurred in low- and middle-income countries, and two of five of these deaths occurred prematurely (i.e., before the age of 70 years). Although precise targets for sodium reduction remain controversial, various organizations have arrived at target levels ranging from 1200 to 2400 mg per day. Although this analysis suggests that the lower range may be better, prospective validation is indicated since some studies have reported worse cardiovascular outcomes with lower sodium intake.
Keywords: Cause of Death, Sodium, Cardiovascular Diseases, Blood Pressure, Diet, Georgia, Risk Assessment, Cost of Illness, Hypertension
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