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The association between serum sodium concentration, hypertension and primary cardiovascular events: a retrospective
Nicholas I Cole1, Rebecca J Suckling2, Pauline A Swift2
1Renal Department, Epsom and St Helier University Hospitals NHS Trust, London, UK. nicholascole@nhs.net.
Insights
Serum sodium levels impact cardiovascular disease (CVD) risk, with the lowest risk observed between 141-143 mmol/l. Both high and low sodium levels increase CVD events, particularly in hypertensive individuals.
Area of Science:
- Cardiology
- Nephrology
- Endocrinology
Background:
- Increased salt intake is linked to cardiovascular disease (CVD), but the precise mechanisms involving serum sodium are unclear.
- Serum sodium concentration may play a crucial role in the development of hypertension and subsequent cardiovascular events.
- Understanding the relationship between serum sodium and CVD is essential for risk stratification and prevention strategies.
Purpose of the Study:
- To investigate the association between serum sodium concentration and incident cardiovascular disease (CVD).
- To examine the relationship between serum sodium, hypertension, and the risk of developing CVD.
- To identify optimal serum sodium levels for minimizing cardiovascular risk.
Main Methods:
- Retrospective cohort study utilizing primary care data from the Royal College of General Practitioners Research and Surveillance Centre.
- Analysis of baseline serum sodium concentration in 231,545 individuals, excluding those with specific pre-existing conditions or abnormal sodium levels.
- Primary outcome was incident CVD, defined as myocardial infarction, stroke, heart failure, and other major cardiovascular events over a 5-year period.
Main Results:
- A 'J-shaped' relationship was observed between serum sodium concentration and incident cardiovascular events, independent of other risk factors.
- The lowest cardiovascular risk was associated with serum sodium levels between 141 and 143 mmol/l.
- Elevated serum sodium increased CVD risk in hypertensive individuals, while low serum sodium increased risk in all participants.
Conclusions:
- Serum sodium concentration serves as a potential indicator for cardiovascular disease risk.
- Higher serum sodium may directly impact vasculature, especially in hypertensive patients.
- Lower serum sodium might reflect complex physiological changes, including volume and neuroendocrine alterations.
Abstract:
The mechanisms underlying the adverse cardiovascular effects of increased salt intake are incompletely understood, but parallel increases in serum sodium concentration may be of importance. The aim of this retrospective cohort study was to investigate the relationship between serum sodium, hypertension and incident cardiovascular disease (CVD). Routinely collected primary care data from the Royal College of General Practitioners Research and Surveillance Centre were analysed. A total of 231,545 individuals with a measurement of serum sodium concentration at baseline were included. Exclusion criteria were: age < 40 years; abnormal serum sodium; diabetes mellitus; prior CVD event; stage 5 chronic kidney disease; and liver cirrhosis. The primary outcome was incident CVD (myocardial infarction, acute coronary syndrome, coronary revascularisation, stroke, transient ischaemic attack or new heart failure diagnosis) over 5 years. There was a 'J-shaped' relationship between serum sodium concentration and primary cardiovascular events that was independent of established risk factors, medications and other serum electrolytes. The lowest cardiovascular risk was found with a serum sodium between 141 and 143 mmol/l. Higher serum sodium was associated with increased risk in hypertensive individuals, whereas lower concentrations were associated with increased risk in all individuals. Therefore, alterations in serum sodium concentration may be a useful indicator of CVD risk. Higher serum sodium could have a direct effect on the vasculature, particularly in hypertensive individuals. Lower serum sodium may be a reflection of complex volume and neuroendocrine changes.
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