Abstract
Aims The objective was to evaluate whether sodium intake, assessed with the gold standard 24-h urinary collections, was related to long-term incidence of death, cardiovascular disease (CVD) and diabetes mellitus (DM). Methods A cohort of 4630 individuals aged 25–64 years collected 24-h urine samples in 1979–2002 and were followed up to 14 years for the incidence of any CVD, coronary heart disease (CHD), stroke, heart failure (HF) and DM event, and death. Cox proportional hazards models were used to estimate the association between the baseline salt intake and incident events and adjusted for baseline age, body mass index, serum cholesterol, prevalent DM, and stratified by sex and cohort baseline year. Results During the follow-up, we observed 423 deaths, 424 CVD events (288 CHD events, 142 strokes, 139 HF events) and 161 DM events. Compared with the highest quartile of salt intake, persons in the lowest quartile had a lower incidence of CVD (hazard ratio [HR] 0.70; 95% confidence interval [CI], 0.51–0.95, p = .02), CHD (HR 0.63 [95% CI 0.42–0.94], p = .02) and DM (HR 0.52 [95% CI 0.31–0.87], p = .01). The results were non-significant for mortality, HF, and stroke. Conclusion High sodium intake is associated with an increased incidence of CVD and DM.
Highlights
The association between high sodium intake and elevated blood pressure (BP) has been established in numerous studies [1]
The proportion of individuals experiencing adverse health events increased across the increasing sodium excretion quartiles, except for stroke where the nadir was seen in the second lowest quartile (Table 2)
We found a direct association between the 24-hour urinary sodium excretion and the incidence of cardiovascular disease (CVD), coronary heart disease (CHD), stroke and diabetes mellitus (DM), but not with all-cause mortality and heart failure (HF)
Summary
The association between high sodium intake and elevated blood pressure (BP) has been established in numerous studies [1]. The role of excess sodium as a risk factor for cardiometabolic disease, and what may be the optimal amount of sodium intake, remain debated. The association between sodium intake and risk of certain health outcomes such as heart failure (HF) and diabetes mellitus (DM) have been scarcely studied. Several prior adequately sized studies [2,3,4] on the association between salt intake and incident cardiometabolic disease have relied on sodium intake estimates derived from spot urine samples. Many studies have demonstrated a direct association between 24-h urine sodium excretion and adverse health outcomes [6,7,8,9]. Studies using inaccurate methods such as spot or overnight urine collections have, presented no significant associations, an inverse association between sodium excretion and mortality, or a direct
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