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

The DOI matches its Crossref record; 43 of the 43 references it cites were found in a registry or an index.

Urinary Sodium and Potassium Excretion, Mortality, and Cardiovascular Events

Open access
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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  1. Graudal NA, 2011, Cochrane Database Syst Rev, 11, CD004022

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Metadata

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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