Lower Levels of Sodium Intake and Reduced Cardiovascular Risk
Open accessAbstract
Background—: Recent studies have raised the possibility of adverse effects of low sodium, particularly <2300 mg/d, on cardiovascular disease; however, these paradoxical findings might have resulted from suboptimal measurement of sodium and potential biases related to indication or reverse causation. Methods and Results—: Phases 1 and 2 of the Trials of Hypertension Prevention (TOHP) collected multiple 24-hour urine specimens among prehypertensive individuals. During extended posttrial surveillance, 193 cardiovascular events or cardiovascular disease deaths occurred among 2275 participants not in a sodium reduction intervention with 10 (TOHP II) or 15 (TOHP I) years of posttrial follow-up. Median sodium excretion was 3630 mg/d, with 1.4% of the participants having intake <1500 mg/d and 10% <2300 mg/d, consistent with national levels. Compared with those with sodium excretion of 3600 to <4800 mg/d, risk for those with sodium <2300 mg/d was 32% lower after multivariable adjustment (hazard ratio, 0.68; 95% confidence interval, 0.34–1.37; P for trend=0.13). There was a linear 17% increase in risk per 1000 mg/d increase in sodium ( P =0.05). Spline curves supported a linear association of sodium with cardiovascular events, which continued to decrease from 3600 to 2300 and 1500 mg/d, although the data were sparse at the lowest levels. Controlling for creatinine levels had little effect on these results. Conclusions—: Results from the TOHP studies, which overcome the major methodological challenges of prior studies, are consistent with overall health benefits of reducing sodium intake to the 1500 to 2300 mg/d range in the majority of the population, in agreement with current dietary guidelines.
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In a large sodium study which excluded sick individuals at baseline and collected multiple 24-hour urine per subject, participants with lowest intakes (<2300 mg/d) experienced 32% lower CVD risk than those consuming high intakes, with evidence for linearly decreasing risk.
“In comparison, during extended surveillance in a large sodium study which excluded sick individuals at baseline and collected multiple 24-hour urine per subject, minimizing the potential influence of these biases, participants with lowest intakes (<2300 mg/d) experienced 32% lower CVD risk than those consuming high intakes, with evidence for linearly decreasing risk.317”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [317]
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- Authors
- Cook, N. R., Appel, L. J., & Whelton, P. K.
- Affiliations
- Tulane University (US)
- Venue
- Circulation
- Published
- 2014-03-04
- Volume
- 129
- Issue
- 9
- Pages
- 981-989
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- PMC
- PMC4181831
- OpenAlex
- W2070187546
- Cited by
- 256
- References
- 39
- Citations by year
- 2026: 8 · 2025: 13 · 2024: 17 · 2023: 13 · 2022: 13 · 2021: 30 · 2020: 22 · 2019: 20 · 2018: 27 · 2017: 14 · 2016: 26 · 2015: 27 · 2014: 25
- FWCI
- 28.57
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (2u01hl037884-05, 5u01hl037924-09, 2u01hl037904-05, 5u01hl037906-09, 5u01hl037849-07, 5u01hl037854-09, 5u01hl037852-11, 5u01hl037907-08, UL1TR001079, 1u01hl037872-01, 5u01hl037899-08, 5u01hl037853-09)
- National Heart, Lung, and Blood Institute (HL-37924, HL 37849, HL 37899, HL37852, HL 37904, HL-37854, HL-37872, HL37906, HL37853, HL 37884, R01HL057915, HL37915, HL-37907)
- National Center for Advancing Translational Sciences
- 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 intake, sodium restriction, cardiovascular risk, cardiovascular events, sodium reduction, dietary guidelines, creatinine adjustment
- MeSH terms
- Adult, Cardiovascular Diseases, Creatinine, Female, Follow-Up Studies, Humans, Male, Middle Aged, Risk Factors, Sodium, Sodium, Dietary, Linear Models
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