Daily sodium consumption and CVD mortality in the general population: systematic review and meta-analysis of prospective studies

Abstract

Objective: The purpose of the present study was to determine whether elevated dietary Na intake could be associated with CVD mortality. Design: We performed a systematic review and meta-analysis of prospective studies representing the general population. The adjusted relative risks and their 95 % confidence intervals were pooled by the inverse variance method using random-effects models. Heterogeneity, publication bias, subgroup and meta-regression analyses were performed. Settings: MEDLINE (since 1973), Embase (since 1975), the Cochrane Library (since 1976), ISI Web of Science, Google Scholar (until September 2013) and secondary referencing were searched for inclusion in the study. Subject: Eleven prospective studies with 229 785 participants and average followup period of 13·37 years (range 5·5-19 years). Results: Higher Na intake was significantly associated with higher CVD mortality (relative risk = 1·12; 95 % CI 1·06, 1·19). In the sensitivity analysis, the exclusion of studies with important relative weights did not significantly affect the results (relative risk = 1·08; 95 % CI 1·01, 1·15). The meta-regression analysis showed that for every increase of 10 mmol/d in Na intake, CVD mortality increased significantly by 1 % (P = 0·016). Age, hypertensive status and length of follow-up were also associated with increased CVD mortality. Conclusions: Higher Na intake was associated with higher CVD mortality in the general population; this result suggests a reduction in Na intake to prevent CVD mortality from any cause.

Dietary Sodium and Cardiovascular Disease Risk — Measurement Matters

“…In keeping with the linear dose–response effect of sodium intake on blood pressure and of blood pressure on the risk of cardiovascular disease or death, 3–9 analyses of general population cohort studies 6,38–40 or of specific groups, such as patients with chronic kidney disease, 41 support a positive linear association from low to high levels of sodium intake and an increased risk of cardiovascular disease. One analysis indicated that the rate of death from cardiovascular disease increased linearly by 1% with every 230-mg increase in daily sodium intake (4% for every 1000 mg).…”

“…One analysis indicated that the rate of death from cardiovascular disease increased linearly by 1% with every 230-mg increase in daily sodium intake (4% for every 1000 mg). 38 This association, however, is probably attenuated by reporting and coding errors in dietary measures of sodium intake and, for urinary biomarkers, the use of one or two consecutive 24-hour urine collections. 24,25,29,38,42 Because the foods we eat vary from day to day, a person’s variability in sodium intake can be as great or greater than interpersonal variability.…”

“…38 This association, however, is probably attenuated by reporting and coding errors in dietary measures of sodium intake and, for urinary biomarkers, the use of one or two consecutive 24-hour urine collections. 24,25,29,38,42 Because the foods we eat vary from day to day, a person’s variability in sodium intake can be as great or greater than interpersonal variability. 24,25 Even on a fixed sodium intake, the day-to-day variance in 24-hour urine sodium excretion may be up to 40% of a person’s average long-term sodium excretion.…”

Estimating change in cardiovascular disease and diabetes burdens due to dietary and metabolic factors in Korea 1998–2011: a comparative risk assessment analysis

“…For example, although high blood pressure has remained the leading risk factor in Korea, it is closely related to the consumption of sodium 22. The sodium intake in Korea is more than double the WHO dietary recommendation and increases the risk of hypertensive disease 37…”

Which foods are displaced in the diets of adults with type 2 diabetes with the inclusion of eggs in their diets? A randomized, controlled, crossover trial

“…Increased dietary consumption of total vegetables; greens and beans; total fruit; whole fruit; whole grains; seafood and plant proteins; and healthful fatty acids, and the reduced consumption of sodium and empty calories has been shown to improve cardiometabolic risk in type 2 diabetes. [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] Limitations This study has several limitations. First, the sample size of the study was small, limiting the ability to detect significant findings in some variables.…”