Abstract
Abstract Background Diagnostic markers associated with atrial cardiomyopathy, a precursor state to atrial fibrillation (AF), include premature atrial complex (PACs) frequency, left atrial volume index (LAVi) and p-wave indices. Life-style factors associated with atrial myopathy markers are insufficiently studied. Sodium intake is a modifiable risk factor for hypertension, cardiovascular disease and AF. Purpose We aimed to study the association between sodium intake and atrial myopathy markers in the population-based multicenter Swedish CArdioPulmonary bioImage Study. Methods We included 5,309 randomly invited 50–65-year-olds at the Malmö (n=1,125,) and Uppsala sites (n=4,184) without AF who had contributed a 24hECG and a fasting morning urine sample, from which daily sodium intake was estimated using the Kawasaki formula. At the Malmö site resting ECGs from which P-wave indices could be measured were available in 1,066 individuals, and LAVi was available in a random subsample (n=357). The association between sodium intake and atrial myopathy markers was modeled adjusted for age, sex, body mass index, smoking, systolic blood pressure, antihypertensive treatment, coronary artery disease, and heart failure using negative binomial regression for PAC frequency, linear regression for P-wave duration and LAVi and logistic regression for P-wave terminal force in V1, all using sodium intake as a continuous variable and strata at <2, 2.0-2.99g, 3.0-3.99g, 4.0-4.99g and ≥5 g/day, with 3.0-3.99 as the reference category. We also modeled the association between sodium intake and PACs using restricted cubic splines. Results The mean age was 58.1 (±4.1) years, and 52.7% were female. The mean estimated sodium intake was 3.3 (±1.4) g/day. Mean 24h PAC count was 27, 4.7% had ≥500 PACs. High sodium intakes were associated with increased PAC frequency, of 14% (95% confidence interval (CI 1-29% p=0.03)) for 4.0-4.99g/day and 25% (95%CI 8-45%, p=0.002) for intakes ≥5.0g/day, compared to sodium intakes of 3.0-3.99 g/day. There was no significant association between low sodium intakes (<3.0 g/day) and PACs, Figure 1. Sodium intakes of 4.0-4.99 g/day were associated with increased P-wave duration, ß-coefficient 2.4 (95%CI 0.3-4.1, p=0.03), compared to 3.0-3.99g/day, but there was no association between sodium intakes and LAVi, or P-wave terminal force in V1, either as a continuous variable or in strata. Conclusion High dietary sodium intake is associated with PAC frequency, a known prediction of AF and stroke. Whether reduced sodium diets could reduce PAC frequency, and whether that would impact AF and stroke risk needs further study.Sodium intake and PAC frequency
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