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Associations between sodium and potassium intake and risk of cardiovascular disease.

The association between 24-hour urinary excretion of sodium and potassium and the composite end point of death and major cardiovascular events was examined in a prospective cohort study of 101,945 individuals (aged 35-70 years) in 17 countries. During a mean follow-up period of 3.7 years, compared with sodium excretion of 4.00-5.99 g per day (reference range), higher sodium excretion (7 g per day or more) was associated with a significant 15% increase in the risk of the composite end point. The association between high sodium excretion and the composite end point was strongest among participants with hypertension. Compared with the reference range, sodium excretion below 3 g per day was associated with a 27% increase in the risk of the composite end point. Compared with potassium excretion of less than 1.5 g per day, higher potassium excretion was associated with a reduced risk of the composite endpoint.

Comment: Urinary excretion of sodium and potassium are fairly reliable indicators of dietary intake of these electrolytes. Observational studies cannot prove causation; however, the results suggest that both high and low sodium intake may increase the risk of death or cardiovascular disease. Excessive sodium intake is known to increase blood pressure in susceptible individuals (about one-third of the population), and may also lead to cardiac hypertrophy, independently of any effect on blood pressure. In addition, very low sodium intake may have a deleterious effect on the cardiovascular system, possibly by causing insulin resistance. The present study also suggests that high potassium intake is beneficial for the cardiovascular system. Potassium is known to have an antihypertensive effect, to inhibit platelet aggregation, and to stabilize cardiac electrical activity.

O'Donnell M et al. Urinary sodium and potassium excretion, mortality, and cardiovascular events. N Engl J Med. 2014;371:612-623.

by Alan R. Gaby, MD

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Title Annotation:Literature Review & Commentary
Author:Gaby, Alan R.
Publication:Townsend Letter
Article Type:Brief article
Date:May 1, 2015
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