Mortality Benefits From US Population-Wide Reduction in Sodium Consumption: Projections From 3 Modeling Approaches

Abstract

To the Editor: The intent of Coxson et al1 in using computer simulations to estimate mortality benefits from population-wide reductions in dietary sodium (Na) is admirable. However, we have several methodologic concerns. First, the authors used the observational follow-up of Trials of Hypertension Prevention (TOHP) to estimate the direct effect of Na on cardiovascular disease (CVD) risk. This trial was designed to assess the effect of Na reduction on blood pressure (BP), which it clearly did. In the extended follow-up (which probably was initially unplanned), 23% of participants were lost to follow-up, and of the remainder who were followed up, medical records were obtained to adjudicate CVD events in 66% of events, and so a substantial number of CVD events …