Journal
JOURNAL OF THE RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM
Volume 19, Issue 4, Pages -Publisher
SAGE PUBLICATIONS LTD
DOI: 10.1177/1470320318810015
Keywords
Salt; cardiovascular disease; mortality; salt reduction programmes; prevention
Categories
Funding
- National Institute for Health Research (NIHR) Global Health Research Unit Action on Salt China (ASC) at Queen Mary University of London [16/136/77]
- NIHR grant
- MRC [MR/P012590/1, MR/J015903/1] Funding Source: UKRI
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The latest Prospective Urban Rural Epidemiology (PURE) study claims that salt reduction should be confined to settings where its intake exceeds 12.7 g/day and that eating less than 11.1 g/day of salt could increase cardiovascular risk. More specifically, Mente et al. suggested that (a) salt intake was positively associated with stroke only when it exceeded 12.7 g/day, (b) salt intake was inversely associated with myocardial infarction and total mortality, and (c) these associations were largely independent of blood pressure. These provocative findings challenge the robust evidence on the role of salt reduction in the prevention of cardiovascular disease and call into question the World Health Organization's global recommendation to reduce salt intake to less than 5 g/day. However, Mente et al.'s re-analysis of the PURE data has several severe methodological problems, including erroneous estimations of salt intake from a single spot urine using the problematic Kawasaki formula. As such, these implausible results cannot be used to refute the strong evidence supporting the benefits of salt reduction for the general population worldwide.
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