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

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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, Mony, Prem, Devanath, Anitha, Rosengren, Annika, Lopez-Jaramillo, Patricio, Diaz, Rafael, Avezum, Alvaro, Lanas, Fernando, Yusoff, Khalid, Iqbal, Romaina, Ilow, Rafal, Mohammadifard, Noushin, Gulec, Sadi, Yusufali, Afzal Hussein, Kruger, Lanthe, Yusuf, Rita, Chifamba, Jephat, Kabali, Conrad, Dagenais, Gilles, Lear, Scott A., Teo, Koon, Yusuf, Salim·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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Capítulo 5 - Decisão e Metas Terapêuticas
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BackgroundMethodResultInfluential
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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: O'Donnell, Martin
Mente, Andrew
Rangarajan, Sumathy
Wang, Xingyu
Liu, Lisheng
Lee, Shun Fu
Mony, Prem
Devanath, Anitha
Rosengren, Annika
Lanas, Fernando
Yusoff, Khalid
Iqbal, Romaina
Mohammadifard, Noushin
Yusuf, Rita
Chifamba, Jephat
Kabali, Conrad
Dagenais, Gilles
Lear, Scott A.
Teo, Koon
Yusuf, Salim
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: bronze
doi.org
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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Urinary Sodium and Potassium Excretion, Mortality, and Cardiovascular Events

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