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 Table of Contents  
EVIDENCE-BASED MEDICINE: SUMMARY OF STUDY
Year : 2016  |  Volume : 14  |  Issue : 4  |  Page : 126-127

Is low sodium intake beneficial?


Assistant Professor, Department of Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India

Date of Web Publication22-Nov-2016

Correspondence Address:
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Source of Support: Associations of urinary sodium excretion with cardiovascular events in individuals with or without hypertension: A pooled analysis of data from four studies. Mente A et al. Lancet. 2016 Jul 30;388(10043):465.75., Conflict of Interest: None


DOI: 10.4103/0973-4651.194508

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How to cite this article:
Anand R. Is low sodium intake beneficial?. Curr Med Issues 2016;14:126-7

How to cite this URL:
Anand R. Is low sodium intake beneficial?. Curr Med Issues [serial online] 2016 [cited 2019 Jul 20];14:126-7. Available from: http://www.cmijournal.org/text.asp?2016/14/4/126/194508

Clinical Question: Is the association between sodium intake and incidence of cardiovascular events different between individuals with and without hypertension?
Authors′ conclusions

  • High dietary sodium intake increases risk of cardiovascular disease in hypertensive subjects
  • Low dietary sodium can increase risk of cardiovascular events in subjects irrespective of their hypertensive status
  • Dietary recommendation for reducing sodium intake is best targeted at populations with hypertension who consume high sodium diets.



  Background Top


Several studies in the past have observed an association between dietary sodium (Na) intake and risk of cardiovascular disease (CVD) events and mortality. [1],[2],[3],[4] Interestingly, an increased risk of CVD is noted with both low and high Na intake states depicting a U-shaped profile. However, whether these observed associations are different between those with hypertension or without hypertension are not known.


  Methods Top


Investigators of the present study recruited individuals who were part of four different cohorts, namely, PURE, DREAM, ONTARGET, and TRANSCEND. [5],[6],[7],[8] This included 133,118 individuals from 49 different countries. Among the study participants, 63,559 were hypertensives (HT Group) and 69,559 were without hypertension (non-HT Group). The study aimed at correlating dietary Na intake with the risk of cardiovascular events as their primary objective.

Since, an accurate, direct quantification of dietary Na intake is difficult, the researchers used an indirect approach. A morning fasting urine specimen was collected from all participants for estimation of spot Na. From the obtained value, a 24 h urine Na excretion was calculated using Kawasaki et al. formula. [9] This was used a surrogate marker for dietary Na intake. The 24 h urine excretion was correlated with the incidence of CVD events over 4 years.


  Results Top


The findings could be summarized in [Table 1]:
Table 1: Summary of the findings of the study


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  • For each g change in intake of Na, the rise in systolic blood pressure was 2.08 mmHg in the HT group, while the rise was 1.22 mmHg in non-HT Group (P < 0.0001)
  • In the HT Group, it was noted that high Na intake (>7 g/day) was associated with an increased risk of CVD in HT Group with a hazard ratio (HR) of 1·23 (95% confidence interval [CI] 1·11-1.37). On the other hand, low Na intake (<3 g/day) was also associated with an increased risk of CVD (HR 1·34 (95% CI 1·23-1·47)
  • In the non-HT group, high Na intake was not associated with increased risk of CVD while low Na intake significantly increased the risk (HR 1·26 (95% CI 1·10-1·45)
  • In both groups, moderate Na intake had no association with risk of CVD.
Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Stolarz-Skrzypek K, Kuznetsova T, Thijs L, Tikhonoff V, Seidlerová J, Richart T, et al. Fatal and nonfatal outcomes, incidence of hypertension, and blood pressure changes in relation to urinary sodium excretion. JAMA 2011;305:1777-85.  Back to cited text no. 1
    
2.
O'Donnell M, Mente A, Rangarajan S, McQueen MJ, Wang X, Liu L, et al. Urinary sodium and potassium excretion, mortality, and cardiovascular events. N Engl J Med 2014;371:612-23.  Back to cited text no. 2
    
3.
O'Donnell MJ, Yusuf S, Mente A, Gao P, Mann JF, Teo K, et al. Urinary sodium and potassium excretion and risk of cardiovascular events. JAMA 2011;306:2229-38.  Back to cited text no. 3
    
4.
Graudal N, Jürgens G, Baslund B, Alderman MH. Compared with usual sodium intake, low- and excessive-sodium diets are associated with increased mortality: A meta-analysis. Am J Hypertens 2014;27:1129-37.  Back to cited text no. 4
    
5.
Yusuf S, Islam S, Chow CK, Rangarajan S, Dagenais G, Diaz R, et al. Use of secondary prevention drugs for cardiovascular disease in the community in high-income, middle-income, and low-income countries (the PURE Study): A prospective epidemiological survey. Lancet 2011;378:1231-43.  Back to cited text no. 5
    
6.
DREAM (Diabetes REduction Assessment with ramipril and rosiglitazone Medication) Trial Investigators, Gerstein HC, Yusuf S, Bosch J, Pogue J, Sheridan P, et al. Effect of rosiglitazone on the frequency of diabetes in patients with impaired glucose tolerance or impaired fasting glucose: A randomised controlled trial. Lancet 2006;368:1096-105.  Back to cited text no. 6
    
7.
ONTARGET Investigators, Yusuf S, Teo KK, Pogue J, Dyal L, Copland I, et al. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med 2008;358:1547-59.  Back to cited text no. 7
    
8.
Telmisartan Randomised AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease (TRANSCEND) Investigators, Yusuf S, Teo K, Anderson C, Pogue J, Dyal L, et al. Effects of the angiotensin-receptor blocker telmisartan on cardiovascular events in high-risk patients intolerant to angiotensin-converting enzyme inhibitors: A randomised controlled trial. Lancet 2008;372:1174-83.  Back to cited text no. 8
    
9.
Kawasaki T, Itoh K, Uezono K, Sasaki H. A simple method for estimating 24 h urinary sodium and potassium excretion from second morning voiding urine specimen in adults. Clin Exp Pharmacol Physiol 1993;20:7-14.  Back to cited text no. 9
    



 
 
    Tables

  [Table 1]



 

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