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Circulation. 2014 Mar 4;129(9):981-9. doi: 10.1161/CIRCULATIONAHA.113.006032. Epub 2014 Jan 10.

Lower levels of sodium intake and reduced cardiovascular risk.

Author information

  • 1Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (N.R.C.); Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins School of Medicine, Baltimore, MD (L.J.A.); and Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.).

Abstract

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 post-trial 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 post-trial 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.

KEYWORDS:

cardiovascular diseases; diet; nutrition; primary prevention; sodium chloride, dietary

PMID:
24415713
[PubMed - indexed for MEDLINE]
PMCID:
PMC4181831
Free PMC Article
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