Estimated urinary sodium excretion and risk of heart failure in men and women in the EPIC-Norfolk study
Open accessAbstract
AIMS: Interventional trials provide evidence for a beneficial effect of reduced dietary sodium intake on blood pressure. The association of sodium intake with heart failure which is a long-term complication of hypertension has not been examined. METHODS AND RESULTS: Hazard ratios [HRs, 95% confidence interval (CI)] of heart failure comparing quintiles of estimated 24 h urinary sodium excretion (USE) were calculated in apparently healthy men (9017) and women (10,840) aged 39–79 participating in the EPIC study in Norfolk. During a mean follow-up of 12.9 years, 1210 incident cases of heart failure occurred. Compared with the reference category (128 mmol/day≤USE≤148 mmol/day), the top quintile (USE≥191 mmol/day) was associated with a significantly increased hazard of heart failure (1.32, 1.07–1.62) in multivariable analysis adjusting for age, sex, body mass index, diabetes, cholesterol, social class, educational level, smoking, physical activity, and alcohol consumption, with a marked attenuation (1.21, 0.98–1.49) when further adjusting for blood pressure. The bottom quintile (USE≤127 mmol/day) was also associated with an increased hazard of heart failure (1.29, 1.04–1.60) in multivariable analysis without relevant attenuation by blood pressure adjustment (1.26, 1.02–1.56), but with substantial attenuation when adjusting for interim ischaemic heart disease and baseline C-reactive protein levels and exclusion of events during the first 2 years (1.18, 0.96–1.47). CONCLUSION: We demonstrate a U-shaped association between USE and heart failure risk in an apparently healthy middle-aged population. The risk associated with the high range of USE was attenuated after adjustment for blood pressure, whereas the risk associated with the low range of USE was attenuated after adjustment for pre-existing disease processes.
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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 [264]
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- Authors
- Pfister, R., Michels, G., Sharp, S. J., Luben, R., Wareham, N. J., & Khaw, K.-T.
- Affiliations
- University of Cologne (DE)
- University of Cambridge (GB)
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge , Cambridge ,
- Corresponding author
- Pfister, Roman
- Venue
- European Journal of Heart Failure
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-01-20
- Volume
- 16
- Issue
- 4
- Pages
- 394-402
- ISSN
- 1388-9842 (ISSN-L)
- 1879-0844
- OpenAlex
- W1486561568
- Cited by
- 100
- References
- 45
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 5 · 2023: 4 · 2022: 10 · 2021: 9 · 2020: 11 · 2019: 7 · 2018: 7 · 2017: 9 · 2016: 11 · 2015: 14 · 2014: 5
- FWCI
- 12.11
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Journal of Heart Failure (publishedVersion)
- PubMed (publishedVersion)
- Kölner Universitäts PublikationsServer (Universität zu Köln) (publishedVersion)
- Funders
- Cancer Research UK
- National Institute for Health and Care Research (NF-SI-0512-10114, NF-SI-0512-10135)
- University of Cambridge
- Medical Research Council (MC_UU_12015/1)
- 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, heart failure, sodium intake, hypertension, blood pressure, U-shaped relationship, C-reactive protein, ischemic heart disease, EPIC-Norfolk cohort, middle-aged adults
- MeSH terms
- Adult, Aged, Blood Pressure, C-Reactive Protein, Female, United Kingdom, Heart Failure, Humans, Male, Middle Aged, Prospective Studies, Risk Factors, Sodium, Sodium, Dietary, Body Mass Index
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