Log in to MyACC
Urinary Sodium and Potassium Excretion and Cardiovascular Risk
Quick Takes
- Higher sodium intake, measured by multiple 24-hour urine samples, was significantly associated with higher cardiovascular risk in a dose–response manner with a daily sodium intake of approximately 2000–6000 mg.
- Lower potassium intake and higher sodium-to-potassium ratio were also associated with higher cardiovascular risks.
- These data support reducing sodium intake and increasing potassium intake from current levels for reducing cardiovascular risk.
Study Questions:
What is the relation between sodium and potassium intakes and cardiovascular risk by combining individual-level data from studies in healthy populations in which multiple 24-hour urine samples, the most accurate method for assessing sodium intake, were obtained for each participant?
Methods:
The investigators included individual-participant data from six prospective cohorts of generally healthy adults; sodium and potassium excretion was 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). The authors 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 (± standard deviation) age of 51.5 ± 12.6 years and of whom 54.2% were women, 571 cardiovascular events were ascertained during a median study follow-up of 8.8 years (incidence rate, 5.9 per 1,000 person-years). The median 24-hour urinary sodium excretion was 3270 mg (10th–90th percentile, 2099–4899). Higher sodium excretion, lower potassium excretion, and a higher sodium-to-potassium ratio were all associated with a higher cardiovascular risk in analyses that were controlled for confounding factors (p ≤ 0.005 for all comparisons). In analyses that compared quartile 4 of the urinary biomarker (highest) with quartile 1 (lowest), the hazard ratios were 1.60 (95% confidence interval [CI], 1.19-2.14) for sodium excretion, 0.69 (95% CI, 0.51-0.91) for potassium excretion, and 1.62 (95% CI, 1.25-2.10) for the sodium-to-potassium ratio. Each daily increment of 1000 mg in sodium excretion was associated with an 18% increase in cardiovascular risk (hazard ratio, 1.18; 95% CI, 1.08-1.29), and each daily increment of 1000 mg in potassium excretion was associated with an 18% decrease in risk (hazard ratio, 0.82; 95% CI, 0.72-0.94).
Conclusions:
The authors concluded that higher sodium and lower potassium intakes, as measured in multiple 24-hour urine samples, were associated in a dose–response manner with a higher cardiovascular risk.
Perspective:
This study involving 10,709 adults whose data were pooled from six prospective cohort studies across the United States and Europe, with a median follow-up of 8.8 years, reports that higher sodium intake, measured by multiple 24-hour urine samples, was significantly associated with higher cardiovascular risk in a dose–response manner with a daily sodium intake of approximately 2000–6000 mg. Furthermore, lower potassium intake and higher sodium-to-potassium ratio were also associated with higher cardiovascular risks. These data support reducing sodium intake and increasing potassium intake from current levels for reducing cardiovascular risk.
Clinical Topics: Cardiac Surgery, Diabetes and Cardiometabolic Disease, Invasive Cardiovascular Angiography and Intervention, Prevention, Cardiac Surgery and Arrhythmias
Keywords: AHA21, AHA Annual Scientific Sessions, Biomarkers, Cardiometabolic Risk Factors, Heart Disease Risk Factors, Metabolic Syndrome, Myocardial Infarction, Myocardial Ischemia, Myocardial Revascularization, Potassium, Primary Prevention, Risk Factors, Sodium, Stroke, Vascular Diseases
< Back to Listings
