Journal
BMJ-BRITISH MEDICAL JOURNAL
Volume 364, Issue -, Pages -Publisher
BMJ PUBLISHING GROUP
DOI: 10.1136/bmj.l772
Keywords
-
Categories
Funding
- European Research Council (COSIP grant) [640580]
- Heart and Stroke Foundation of Ontario
- Mary W Burke endowed chair of the Heart and Stroke Foundation of Ontario
- Population Health Research Institute
- Canadian Institutes of Health Research
- CIHR's Strategy for Patient Oriented Research, through the Ontario SPOR Support Unit
- Ontario Ministry of Health and Long-Term Care
- Astra Zeneca (Canada)
- Sanofi-Aventis (France)
- Sanofi-Aventis (Canada)
- Boehringer Ingelheim (Germany)
- Boehringer Ingelheim (Canada)
- Servier
- GSK
- Novartis
- King Pharma
- Fundacion ECLA
- Independent University, Bangladesh
- Mitra and Associates
- Unilever Health Institute, Brazil
- Public Health Agency of Canada
- Champlain Cardiovascular Disease Prevention Network, Canadian Institutes of Health Research [126524]
- Universidad de La Frontera [DI13-PE11]
- National Center for Cardiovascular Diseases
- Colciencias [6566-04-18062]
- Indian Council of Medical Research
- Ministry of Science, Technology and Innovation of Malaysia [100-IRDC/BIOTEK 16/6/21 (13/2007), 07-05-IFN-BPH 010]
- Ministry of Higher Education of Malaysia [600-RMI/LRGS/5/3 (2/2011)]
- Universiti Teknologi MARA
- Faculty of Medicine, Universiti Kebangsaan Malaysia
- Kuala Lumpur Malaysia
- CRIM, University Kebangsaan Malaysia
- Occupied Palestinian Territory: The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), occupied Palestinian territory
- International Development Research Centre (IDRC), Canada
- National Heart, Lung and Blood Institute [HHSN268200900033C]
- National Cancer Institute [1P20CA217231]
- Wellcome [103994/Z/14/Z]
- Philippine Council for Health Research & Development (PCHRD)
- Polish Ministry of Science and Higher Education [290/W-PURE/2008/0]
- Wroclaw Medical University
- Saudi Heart Association
- Deanship of Scientific Research at King Saud University, Riyadh, Saudi Arabia [RG -1436-013]
- North-West University
- SANPAD (SA and Netherlands Programme for Alternative Development)
- National Research Foundation
- Medical Research Council of SA
- SA Sugar Association (SASA)
- Faculty of Community and Health Sciences (UWC)
- Swedish state under the Agreement concerning research and education of doctors
- Swedish Heart and Lung Foundation
- Swedish Research Council
- Swedish Council for Health, Working Life and Welfare
- King Gustaf V:s and Queen Victoria Freemason's Foundation
- AFA Insurance
- Pamoja Tunaweza Health Research Centre (Tanzania)
- Queen's University, Department of Medicine
- Metabolic Syndrome Society
- Astra Zeneca, Turkey
- Sheikh Hamdan Bin Rashid Al Maktoum Award for Medical Sciences
- Dubai Health Authority, Dubai UAE
- Wellcome Trust [103994/Z/14/Z] Funding Source: Wellcome Trust
- European Research Council (ERC) [640580] Funding Source: European Research Council (ERC)
Ask authors/readers for more resources
OBJECTIVE To evaluate the joint association of sodium and potassium urinary excretion (as surrogate measures of intake) with cardiovascular events and mortality, in the context of current World Health Organization recommendations for daily intake (< 2.0 g sodium, > 3.5 g potassium) in adults. DESIGN International prospective cohort study. SETTING 18 high, middle, and low income countries, sampled from urban and rural communities. PARTICIPANTS 103 570 people who provided morning fasting urine samples. MAIN OUTCOME MEASURES Association of estimated 24 hour urinary sodium and potassium excretion (surrogates for intake) with all cause mortality and major cardiovascular events, using multivariable Cox regression. A six category variable for joint sodium and potassium was generated: sodium excretion (low (< 3 g/day), moderate (3-5 g/day), and high (> 5 g/day) sodium intakes) by potassium excretion (greater/equal or less than median 2.1 g/day). RESULTS Mean estimated sodium and potassium urinary excretion were 4.93 g/day and 2.12 g/day, respectively. After a median follow-up of 8.2 years, 7884 (6.1%) participants had died or experienced a major cardiovascular event. Increasing urinary sodium excretion was positively associated with increasing potassium excretion (unadjusted r=0.34), and only 0.002% had a concomitant urinary excretion of < 2.0 g/day of sodium and > 3.5 g/day of potassium. A J-shaped association was observed of sodium excretion and inverse association of potassium excretion with death and cardiovascular events. For joint sodium and potassium excretion categories, the lowest risk of death and cardiovascular events occurred in the group with moderate sodium excretion (3-5 g/day) and higher potassium excretion (21.9% of cohort). Compared with this reference group, the combinations of low potassium with low sodium excretion (hazard ratio 1.23, 1.11 to 1.37; 7.4% of cohort) and low potassium with high sodium excretion (1.21, 1.11 to 1.32; 13.8% of cohort) were associated with the highest risk, followed by low sodium excretion (1.19, 1.02 to 1.38; 3.3% of cohort) and high sodium excretion (1.10, 1.02 to 1.18; 29.6% of cohort) among those with potassium excretion greater than the median. Higher potassium excretion attenuated the increased cardiovascular risk associated with high sodium excretion (P for interaction=0.007). CONCLUSIONS These findings suggest that the simultaneous target of low sodium intake (< 2 g/day) with high potassium intake (> 3.5 g/day) is extremely uncommon. Combined moderate sodium intake (3-5 g/day) with high potassium intake is associated with the lowest risk of mortality and cardiovascular events.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available