Estimated Dietary Na⁺/K⁺-Ratio and Cardiovascular Disease: A Systematic Review and Meta-Analysis

High sodium and low potassium intake are associated with cardiovascular disease. This meta-analysis investigates the combined effect of dietary sodium and potassium intake (Na+/K+-ratio), on cardiovascular outcome.

We systematically searched MEDLINE and Embase databases (1946-2024) for randomized controlled trials and cohort studies reporting the association between estimated diet Na+/K+-ratio and cardiovascular events or mortality in adults. Two authors screened articles, extracted data, and assessed risk of bias (ROBINS-E tool). We pooled results using random-effects models and compared outcomes across the general population, patients with chronic kidney disease, and those with a history of cardiovascular disease. The study was registered in PROSPERO (ID: CRD42024450279).

Twenty-four studies were included. Participants were 59 ± 11 years old, 49 ± 22% were men and the estimated dietary Na+/K+-ratio was 2.0 ± 0.6 mmol/mmol. The risk of bias was low in 9% of the studies, high in 39% of the studies and 52% of the studies were appraised as some concerns. Higher estimated diet Na+/K+-ratio was associated with a higher risk for cardiovascular events and mortality (hazard ratio 1.10 [95% confidence interval: 1.06-1.16]), which was apparent in the general population and subjects with a history of cardiovascular disease. In patients with chronic kidney disease, only limited data were available.

Higher estimated diet Na+/K+-ratio is associated with a higher incidence of cardiovascular events and mortality in both the general population and patients with a cardiovascular disease history.