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Cited by 886Sodium Intake and HealthBlood Pressure and Hypertension StudiesNutritional Studies and Diet

Urinary Sodium and Potassium Excretion, Mortality, and Cardiovascular Events

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O'Donnell, Martin, Mente, Andrew, Rangarajan, Sumathy, McQueen, Matthew J., Wang, Xingyu, Liu, Lisheng, Yan, Hou, Lee, Shun Fu +21 more·2014·New England Journal of Medicine
DOI 10.1056/nejmoa1311889
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Abstract

BACKGROUND: The optimal range of sodium intake for cardiovascular health is controversial. METHODS: We obtained morning fasting urine samples from 101,945 persons in 17 countries and estimated 24-hour sodium and potassium excretion (used as a surrogate for intake). We examined the association between estimated urinary sodium and potassium excretion and the composite outcome of death and major cardiovascular events. RESULTS: The mean estimated sodium and potassium excretion was 4.93 g per day and 2.12 g per day, respectively. With a mean follow-up of 3.7 years, the composite outcome occurred in 3317 participants (3.3%). As compared with an estimated sodium excretion of 4.00 to 5.99 g per day (reference range), a higher estimated sodium excretion (≥ 7.00 g per day) was associated with an increased risk of the composite outcome (odds ratio, 1.15; 95% confidence interval [CI], 1.02 to 1.30), as well as increased risks of death and major cardiovascular events considered separately. The association between a high estimated sodium excretion and the composite outcome was strongest among participants with hypertension (P=0.02 for interaction), with an increased risk at an estimated sodium excretion of 6.00 g or more per day. As compared with the reference range, an estimated sodium excretion that was below 3.00 g per day was also associated with an increased risk of the composite outcome (odds ratio, 1.27; 95% CI, 1.12 to 1.44). As compared with an estimated potassium excretion that was less than 1.50 g per day, higher potassium excretion was associated with a reduced risk of the composite outcome. CONCLUSIONS: In this study in which sodium intake was estimated on the basis of measured urinary excretion, an estimated sodium intake between 3 g per day and 6 g per day was associated with a lower risk of death and cardiovascular events than was either a higher or lower estimated level of intake. As compared with an estimated potassium excretion that was less than 1.50 g per day, higher potassium excretion was associated with a lower risk of death and cardiovascular events. (Funded by the Population Health Research Institute and others.).

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Authors
O'Donnell, M., Mente, A., Rangarajan, S., McQueen, M. J., Wang, X., Liu, L., Yan, H., Lee, S. F., Mony, P., Devanath, A., Rosengren, A., Lopez-Jaramillo, P., Diaz, R., Avezum, A., Lanas, F., Yusoff, K., Iqbal, R., Ilow, R., Mohammadifard, N., Gulec, S., Yusufali, A. H., Kruger, L., Yusuf, R., Chifamba, J., Kabali, C., Dagenais, G., Lear, S. A., Teo, K., & Yusuf, S.
Affiliations
  • Ollscoil na Gaillimhe – University of Galway (IE)
  • Population Health Research Institute (CA)
  • Chinese Academy of Medical Sciences & Peking Union Medical College (CN)
  • St. John's Research Institute (IN)
  • University of Gothenburg (SE)
  • Universidad de La Frontera (CL)
  • UCSI University (MY)
  • Aga Khan University (PK)
  • Isfahan University of Medical Sciences (IR)
  • Independent University, Bangladesh (BD)
  • University of Zimbabwe (ZW)
  • Institut universitaire de cardiologie et de pneumologie de Québec (CA)
  • Providence Health Care (CA)
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
2014-08-14
Volume
371
Issue
7
Pages
612-623
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejmoa1311889
OpenAlex
W2106445408
Cited by
886
References
43
Citations by year
2026: 29 · 2025: 37 · 2024: 55 · 2023: 60 · 2022: 73 · 2021: 84 · 2020: 82 · 2019: 68 · 2018: 81 · 2017: 76 · 2016: 100 · 2015: 98 · 2014: 41
FWCI
95.89
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, cc-by-nc-nd)
  • Omeka S (Universidad de La Frontera) (submittedVersion, cc-by-nc-nd)
  • Boloka Institutional Repository (North-west University) (submittedVersion)
Funders
Canadian Institutes of Health Research
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, potassium excretion, sodium intake, potassium intake, mortality, cardiovascular events, hypertension
MeSH terms
Adult, Cardiovascular Diseases, Diet, Female, Follow-Up Studies, Humans, Male, Middle Aged, Mortality, Potassium, Sodium, Sodium, Dietary, Linear Models

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