Journal
LANCET
Volume 388, Issue 10043, Pages 465-475Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/S0140-6736(16)30467-6
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Funding
- Population Health Research Institute
- Canadian Institutes of Health Research
- Heart and Stroke Foundation of Ontario, Canada
- AstraZeneca (Sweden, Canada, Turkey)
- Sanofi-Aventis (France, Canada, Turkey)
- Boehringer Ingelheim (Germany)
- Boehringer Ingelheim (Canada)
- Servier
- GlaxoSmithKline
- Novartis
- King Pharma
- Bangladesh Independent University and Mitra and Associates, Bangladesh
- Unilever Health Institute, Brazil
- Public Health Agency of Canada
- Champlain Cardiovascular Disease Prevention Network, Canada
- Universidad de la Frontera, Chile
- National Center for Cardiovascular Diseases, China
- Colciencias, Colombia [6566-04-18062]
- Indian Council of Medical Research, India
- Ministry of Science, Technology and Innovation, Malaysia [07-05-IFN-MEB010]
- Ministry of Higher Education, Malaysia [600-RMI/LRGS/5/3]
- Universiti Kebangsaan Malaysia, Malaysia [UKM-Hejim-Komuniti-15-2010]
- Ministry of Science and Higher Education, Poland [290/W-PURE/2008/0]
- Wroclaw Medical University, Poland
- North-West University, South Africa
- South Africa Netherlands Research Programme on Alternatives in Development (SANPAD)
- National Research Foundation
- Medical Research Council of South Africa
- South Africa Sugar Association (SASA), South Africa
- Faculty of Community and Health Sciences (UWC), South Africa
- Council for Working Life and Social Research, Sweden
- Swedish Research Council for Environment, Agricultural Sciences and Spatial Planning, Sweden
- Swedish Heart and Lung Foundation, Sweden
- Swedish Research Council
- Swedish State under LUA (LakarUtbildningsAvtalet)
- Vastra Gotaland Region (FOUU), Sweden
- Metabolic Syndrome Society
- Sheikh Hamdan Bin Rashid Al Maktoum Award For Medical Sciences
- Dubai Health Authority, Dubai, the United Arab Emirates
- Sanofi-Aventis Global
- Sanofi Aventis Canada
- Genome Quebec Innovation Centre
- Heart and Stroke Foundation of Canada
- Boehringer Ingelheim
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Background Several studies reported a U-shaped association between urinary sodium excretion and cardiovascular disease events and mortality. Whether these associations vary between those individuals with and without hypertension is uncertain. We aimed to explore whether the association between sodium intake and cardiovascular disease events and all-cause mortality is modified by hypertension status. Methods In this pooled analysis, we studied 133 118 individuals (63 559 with hypertension and 69 559 without hypertension), median age of 55 years (IQR 45-63), from 49 countries in four large prospective studies and estimated 24-h urinary sodium excretion (as group-level measure of intake). We related this to the composite outcome of death and major cardiovascular disease events over a median of 4.2 years (IQR 3.0-5.0) and blood pressure. Findings Increased sodium intake was associated with greater increases in systolic blood pressure in individuals with hypertension (2.08 mm Hg change per g sodium increase) compared with individuals without hypertension (1.22 mm Hg change per g; p(interaction) < 0.0001). In those individuals with hypertension (6835 events), sodium excretion of 7 g/day or more (7060 [11%] of population with hypertension: hazard ratio [HR] 1.23 [95% CI 1.11-1.37]; p < 0.0001) and less than 3 g/day (7006 [11%] of population with hypertension: 1.34 [1.23-1.47]; p < 0.0001) were both associated with increased risk compared with sodium excretion of 4-5 g/day (reference 25% of the population with hypertension). In those individuals without hypertension (3021 events), compared with 4-5 g/day (18 508 [27%] of the population without hypertension), higher sodium excretion was not associated with risk of the primary composite outcome (>= 7 g/day in 6271 [9%] of the population without hypertension; HR 0.90 [95% CI 0.76-1.08]; p = 0.2547), whereas an excretion of less than 3 g/day was associated with a significantly increased risk (7547 [11%] of the population without hypertension; HR 1.26 [95% CI 1.10-1.45]; p = 0.0009). Interpretation Compared with moderate sodium intake, high sodium intake is associated with an increased risk of cardiovascular events and death in hypertensive populations (no association in normotensive population), while the association of low sodium intake with increased risk of cardiovascular events and death is observed in those with or without hypertension. These data suggest that lowering sodium intake is best targeted at populations with hypertension who consume high sodium diets.
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