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Published on: July 3, 2013
Sodium excretion and risk of developing coronary heart disease
Michel M Joosten1, Ron T Gansevoort, Kenneth J Mukamal
1Top Institute Food and Nutrition, Wageningen, The Netherlands (M.M.J., J.M.G., E.J.M.F., S.J.L.B.); University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, The Netherlands (M.M.J., R.T.G., G.N., S.J.L.B.); Beth Israel Deaconess Medical Center, Department of Medicine, Boston, MA (M.M.J.,K.J.M.); University of Groningen, University Medical Center Groningen, Department of Clinical Pharmacology, Groningen, The Netherlands (H.J.L.H.); and Wageningen University, Division of Human Nutrition, Wageningen, The Netherlands (J.M.G., E.J.M.F.).
Insights
High sodium intake is not linked to coronary heart disease (CHD) risk in the general population. However, increased sodium excretion is associated with higher CHD risk in individuals with hypertension or elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels.
Area of Science:
- Cardiovascular epidemiology
- Renal and vascular disease research
- Dietary salt and health studies
Background:
- Sodium intake's established link to elevated blood pressure.
- Uncertainty regarding sodium's role as a coronary heart disease (CHD) risk factor in the general population.
- Need to investigate susceptible subgroups for differential sodium-CHD risk.
Purpose of the Study:
- To examine the association between sodium excretion and incident coronary heart disease (CHD) risk.
- To investigate potential effect modification by blood pressure and N-terminal pro-B-type natriuretic peptide (NT-proBNP) on the sodium-CHD relationship.
Main Methods:
- Prospective cohort study (PREVEND) of 7543 adults initially free of cardiovascular and kidney disease.
- Measurement of sodium excretion via two 24-hour urine collections at baseline.
- Assessment of potential susceptibility factors including blood pressure and plasma NT-proBNP levels.
- Follow-up for a median of 10.5 years to ascertain CHD events.
Main Results:
- No overall association was found between sodium excretion and CHD risk in the entire cohort.
- The association between sodium excretion and CHD risk was significantly modified by NT-proBNP levels (Pinteraction=0.002).
- A trend for modification was observed with mean arterial pressure (Pinteraction=0.08).
- Higher sodium excretion was linked to increased CHD risk in hypertensive individuals (aHR=1.14) and those with NT-proBNP above the median (aHR=1.16).
Conclusions:
- Sodium excretion was not associated with CHD risk in the general population.
- NT-proBNP levels modify the relationship between sodium excretion and CHD risk.
- Individuals with hypertension or elevated NT-proBNP concentrations face a higher CHD risk with increased sodium excretion.
Background:
Despite compelling evidence for sodium's adverse effects on blood pressure, it remains uncertain whether excess sodium intake is a risk factor for coronary heart disease (CHD) in the overall population and in potentially more susceptible subgroups.
Methods And Results:
We prospectively followed 7543 adults aged 28 to 75 years and free of cardiovascular and kidney disease in 1997/1998 of the Prevention of Renal and Vascular End-stage Disease (PREVEND) study. Sodium excretion was measured in two 24-hour urine collections at baseline. Potential susceptibility factors were blood pressure and plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP). Median 24-hour sodium excretion was 137 mmol (Q1-Q3, 106-171 mmol). During a median follow-up of 10.5 (Q1-Q3: 9.9-10.8) years, 452 CHD events occurred. In the entire cohort, there was no association between each 1-g/d (43 mmol/24 h) increment in sodium excretion and CHD risk (adjusted hazard ratio, 1.07; 95% confidence interval, 0.98-1.18; P=0.15). However, the association of sodium excretion with CHD risk tended to be modified by mean arterial pressure (Pinteraction=0.08) and was modified by NT-proBNP (Pinteraction=0.002). When stratified, each 1-g/d increment in sodium excretion was associated with an increased risk for CHD in subjects with hypertension (adjusted hazard ratio, 1.14; 95% confidence interval, 1.01-1.28; n=2363) and in subjects with NT-proBNP concentrations above the sex-specific median (adjusted hazard ratio, 1.16; 95% confidence interval, 1.03-1.30; n=3771).
Conclusions:
Overall, there was no association between sodium excretion and risk of CHD. The association between sodium excretion and CHD risk was modified by NT-proBNP. Higher sodium excretion was associated with an increased CHD risk among subjects with increased NT-proBNP concentrations or with hypertension.
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