Fatal and Nonfatal Outcomes, Incidence of Hypertension, and Blood Pressure Changes in Relation to Urinary Sodium Excretion
Open accessAbstract
CONTEXT: Extrapolations from observational studies and short-term intervention trials suggest that population-wide moderation of salt intake might reduce cardiovascular events. OBJECTIVE: To assess whether 24-hour urinary sodium excretion predicts blood pressure (BP) and health outcomes. DESIGN, SETTING, AND PARTICIPANTS: Prospective population study, involving 3681 participants without cardiovascular disease (CVD) who are members of families that were randomly enrolled in the Flemish Study on Genes, Environment, and Health Outcomes (1985-2004) or in the European Project on Genes in Hypertension (1999-2001). Of 3681 participants without CVD, 2096 were normotensive at baseline and 1499 had BP and sodium excretion measured at baseline and last follow-up (2005-2008). MAIN OUTCOME MEASURES: Incidence of mortality and morbidity and association between changes in BP and sodium excretion. Multivariable-adjusted hazard ratios (HRs) express the risk in tertiles of sodium excretion relative to average risk in the whole study population. RESULTS: Among 3681 participants followed up for a median 7.9 years, CVD deaths decreased across increasing tertiles of 24-hour sodium excretion, from 50 deaths in the low (mean, 107 mmol), 24 in the medium (mean, 168 mmol), and 10 in the high excretion group (mean, 260 mmol; P < .001), resulting in respective death rates of 4.1% (95% confidence interval [CI], 3.5%-4.7%), 1.9% (95% CI, 1.5%-2.3%), and 0.8% (95% CI, 0.5%-1.1%). In multivariable-adjusted analyses, this inverse association retained significance (P = .02): the HR in the low tertile was 1.56 (95% CI, 1.02-2.36; P = .04). Baseline sodium excretion predicted neither total mortality (P = .10) nor fatal combined with nonfatal CVD events (P = .55). Among 2096 participants followed up for 6.5 years, the risk of hypertension did not increase across increasing tertiles (P = .93). Incident hypertension was 187 (27.0%; HR, 1.00; 95% CI, 0.87-1.16) in the low, 190 (26.6%; HR, 1.02; 95% CI, 0.89-1.16) in the medium, and 175 (25.4%; HR, 0.98; 95% CI, 0.86-1.12) in the high sodium excretion group. In 1499 participants followed up for 6.1 years, systolic blood pressure increased by 0.37 mm Hg per year (P < .001), whereas sodium excretion did not change (-0.45 mmol per year, P = .15). However, in multivariable-adjusted analyses, a 100-mmol increase in sodium excretion was associated with 1.71 mm Hg increase in systolic blood pressure (P.<001) but no change in diastolic BP. CONCLUSIONS: In this population-based cohort, systolic blood pressure, but not diastolic pressure, changes over time aligned with change in sodium excretion, but this association did not translate into a higher risk of hypertension or CVD complications. Lower sodium excretion was associated with higher CVD mortality.
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Prospective cohort studies suggest a J-shaped association between sodium intake and CVD events, consistent across methods of sodium estimation.
“Prospective cohort studies suggest a J-shaped association between sodium intake and CVD events, consistent across methods of sodium estimation (259–265).”
From Food Consumption and its Impact on Cardiovascular Disease: Importance of Solutions Focused on the Globalized Food System (2015) · cites this paper as [261]
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- Authors
- Stolarz-Skrzypek, K.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2011-05-04
- Volume
- 305
- Issue
- 17
- Pages
- 1777
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2150639294
- Semantic Scholar
- 84e0ae286140da2dedb378747cffa269ad57d3f7
- Cited by
- 569
- References
- 49
- Citations by year
- 2026: 11 · 2025: 16 · 2024: 14 · 2023: 24 · 2022: 21 · 2021: 28 · 2020: 43 · 2019: 25 · 2018: 35 · 2017: 28 · 2016: 42 · 2015: 58 · 2014: 61 · 2013: 60 · 2012: 71
- FWCI
- 66.25
- Type
- journal article
- Language
- en
- Open access
- green
- lirias.kuleuven.be
- Licence
- other-oa
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Lirias (submittedVersion, other-oa)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Padua Research Archive (University of Padova) (submittedVersion)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Keywords
- sodium excretion, salt intake, blood pressure, hypertension incidence, cardiovascular mortality, cardiovascular morbidity, salt reduction, normotensive subjects, salt sensitivity, cardiovascular risk prediction
- MeSH terms
- Adult, Aged, Belgium, Blood Pressure, Cardiovascular Diseases, Diet, Sodium-Restricted, Female, Humans, Hypertension, Male, Middle Aged, Mortality, Predictive Value of Tests, Prospective Studies, Sodium, Sodium, Dietary, Incidence, Young Adult
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