Salt reduction and cardiovascular risk: the anatomy of a myth

Wardener, HE de

doi:10.1038/sj.jhh.1000759

Cited by 36 publications

(20 citation statements)

References 8 publications

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“…However, these two analyses are deeply flawed and have been severely criticised elsewhere. [48][49][50][51][52] A further analysis of the same NHANES 1 data showed that a high salt intake was significantly associated with an increased risk of cardiovascular disease and all cause mortality in overweight persons. 53 A recent study from Finland using a random sample of the Finnish adult population showed that salt intake was directly related to increased cardiovascular mortality and total mortality.…”

Section: Mortality Studiesmentioning

confidence: 99%

Effect of modest salt reduction on blood pressure: a meta-analysis of randomized trials. Implications for public health

2002

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Two recent meta-analyses of randomised salt reduction trials have concluded that there is little purpose in reducing salt intake in the general population. However, the authors, as with other previous meta-analyses, included trials of very short duration (eg 1 week or less) and trials of acute salt loading followed by abrupt reductions to very low salt intake (eg from 20 to less than 1 g of salt/day). These acute salt loading and salt depletion experiments are known to increase sympathetic tone, and with salt depletion cause a rise in renin release and, thereby, plasma angiotensin II. These trials are not appropriate, therefore, for helping to inform public health policy, which is for a more modest reduction in salt intake, ie, from a usual intake of E10 to E5 g of salt per day over a more prolonged period of time. We carried out a meta-analysis to assess the effect of a modest salt reduction on blood pressure. Our data sources were MEDLINE, EMBASE, Cochrane library, CINAHL, and the reference lists of original and review articles. We included randomised trials with a modest reduction in salt intake and a duration of 4 or more weeks. Meta-analysis, meta-regression, and funnel plots were performed. A total of 17 trials in hypertensives (n ¼ 734) and 11 trials in normotensives (n ¼ 2220) were included in our study. The median reduction in 24-h urinary sodium excretion was 78 mmol (equivalent to 4.6 g of salt/day) in hypertensives and 74 mmol in normotensives. The pooled estimates of blood pressure fall were 4.96/2.73 7 0.40/0.24 mmHg in hypertensives (Po0.001 for both systolic and diastolic) and 2.03/ 0.97 7 0.27/0.21 mmHg in normotensives (Po0.001 for both systolic and diastolic). Weighted linear regression analyses showed a dose response between the change in urinary sodium and blood pressure. A reduction of 100 mmol/day (6 g of salt) in salt intake predicted a fall in blood pressure of 7.11/3.88 mmHg (Po0.001 for both systolic and diastolic) in hypertensives and 3.57/ 1.66 mmHg in normotensive individuals (systolic: Po0.001; diastolic: Po0.05). Our results demonstrate that a modest reduction in salt intake for a duration of 4 or more weeks does have a significant and, from a population viewpoint, important effect on blood pressure in both hypertensive and normotensive individuals. This meta-analysis strongly supports other evidence for a modest and long-term reduction in population salt intake, and would be predicted to reduce stroke deaths immediately by E14% and coronary deaths by E9% in hypertensives, and reduce stroke and coronary deaths by E6 and E4%, in normotensives, respectively.

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Section: Mortality Studiesmentioning

confidence: 99%

Effect of modest salt reduction on blood pressure: a meta-analysis of randomized trials. Implications for public health

2002

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“…Subsequent microscale derivatization of OLC (400 ng, gift from Upjohn Laboratories) also gave the same RP-HPLC and CD (''zero-CD'') profiles as those of HIF pentanaphthoate (14). This led to the conclusion that the ouabain-like sodium pump inhibitor is an ouabain isomer, often referred to as endogenous ouabain (2,4,5), even though the physiological discrepancies between HIF and other compounds still remained to be clarified (2): the term endogenous ouabain has been used to distinguish this compound from plant ouabain (2,4,5), although its true origin has not yet been clarified.…”

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confidence: 91%

“…Search for the endogenous ligands of Na ϩ ,K ϩ -ATPase has been an enticing yet puzzling research subject for the last several decades (1)(2)(3)(4). Putative endogenous sodium pump inhibitors have been detected many times in various mammalian tissues and plasma.…”

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confidence: 99%

Structure of 'endogenous ouabain'

Kawamura¹,

Guo²,

Maggiali³

et al. 1999

Pure and Applied Chemistry

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The ouabain-like sodium pump inhibitor in mammals (so-called ''endogenous ouabain'') has been considered a subtle structural isomer of ouabain. Its structural investigation, however, has long been hindered by the paucity of sample material. Our recent purification of endogenous ouabain (3 g) from bovine hypothalamus allowed the measurement of its 1 H-NMR. The obtained spectrum as well as reexamination of past microscale structural studies on endogenous ouabain led us to identify the purified material as ouabain in an unusual manner. It turned out that the structural analysis had been complicated by a facile ouabainborate complexation in borosilicate glassware. In retrospect, it is not surprising that the polyhydroxylated ouabain molecule serves as a polydentate ligand to inorganic species. In its physiological environment, ouabain may exist as some unknown complex. The chemical species giving rise to the reported biological activities of hypothalamic inhibitory factor preparations remain to be clarified.

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“…He quotes the data derived from acute and large reductions in salt intake and ignores the correspondence 10 and contrary evidence, including an article published in the Journal of Human Hypertension, which refutes his claims. 11 Indeed, longer-term modest salt reduction trials have shown no effect on the sympathetic nervous system 12 or insulin sensitivity 13 and only a small but physiological increase in plasma renin activity (PRA). Indeed, this rise in PRA is less than that seen with thiazide diuretics, which lower BP by mechanisms similar to salt reduction.…”

mentioning

confidence: 99%

Salt and blood pressure in children: reply to commentary by Alderman

MacGregor

2007

J Hum Hypertens

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Salt reduction and cardiovascular risk: the anatomy of a myth

Cited by 36 publications

References 8 publications

Effect of modest salt reduction on blood pressure: a meta-analysis of randomized trials. Implications for public health

Effect of modest salt reduction on blood pressure: a meta-analysis of randomized trials. Implications for public health

Structure of 'endogenous ouabain'

Salt and blood pressure in children: reply to commentary by Alderman

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