24-Hour Urinary Sodium and Potassium Excretion and Cardiovascular Risk

Ma, Yuan; He, Feng J; Sun, Qi; Yuan, Changzheng; Kieneker, Lyanne M.; Curhan, Gary C.; MacGregor, Graham A.; Bakker, Stephan J. L.; Campbell, Norm R.C.; Wang, Molin; Rimm, Eric B.; Manson, JoAnn E.; Willett, Walter C.; Hofman, Albert; Gansevoort, Ron T.; Cook, Nancy R.; Hu, Frank B.

doi:10.1056/nejmoa2109794

Cited by 159 publications

(138 citation statements)

References 34 publications

(40 reference statements)

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“…Collectively these articles express opinions based on flawed evidence without due discussion of the scientific criticisms of the methods and evidence that supports reduction in dietary sodium intake globally [1-3, 4•, 6, 7, 8••, 9, 10•, 11, 12•, 13•, 14]. The articles perpetuate old myths about sodium intake, BP, and CVD (Table 1) and create a controversy based on denial of the merits of the existing scientific consensus, with the lack of acknowledgement of the evidence and the unwillingness to directly address the scientific criticisms of their methods [43,49,50,52,53,55,60,62,67,68,69,[73][74][75][79][80][81][82][83][84].…”

Section: Case Study: the European Heart Journalmentioning

confidence: 99%

“…Nevertheless, a small group of scientists continues to publish research based on use of the same flawed methods and without an acknowledgement of the criticisms of their work. This practice of publishing controversial results that are decisively discredited by reputable scientists [68] and scientific authorities [8 ••] is contrary to the norms of science and the expected behavior of scientists. Moreover, continuing to insist upon the validity of the J-curve representation of data, without recognizing and addressing criticisms and making appropriate amendments [69,70] reinforces misperceptions about the benefits and risks of reducing sodium consumption (Table 1) [17].…”

Section: Introductionmentioning

confidence: 99%

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Sodium and Health: Old Myths and a Controversy Based on Denial

Cappuccio

Campbell

et al. 2022

Curr Nutr Rep

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Purpose of Review The scientific consensus on which global health organizations base public health policies is that high sodium intake increases blood pressure (BP) in a linear fashion contributing to cardiovascular disease (CVD). A moderate reduction in sodium intake to 2000 mg per day helps ensure that BP remains at a healthy level to reduce the burden of CVD. Recent Findings Yet, since as long ago as 1988, and more recently in eight articles published in the European Heart Journal in 2020 and 2021, some researchers have propagated a myth that reducing sodium does not consistently reduce CVD but rather that lower sodium might increase the risk of CVD. These claims are not well-founded and support some food and beverage industry’s vested interests in the use of excessive amounts of salt to preserve food, enhance taste, and increase thirst. Nevertheless, some researchers, often with funding from the food industry, continue to publish such claims without addressing the numerous objections. This article analyzes the eight articles as a case study, summarizes misleading claims, their objections, and it offers possible reasons for such claims. Summary Our study calls upon journal editors to ensure that unfounded claims about sodium intake be rigorously challenged by independent reviewers before publication; to avoid editorial writers who have been co-authors with the subject paper’s authors; to require statements of conflict of interest; and to ensure that their pages are used only by those who seek to advance knowledge by engaging in the scientific method and its collegial pursuit. The public interest in the prevention and treatment of disease requires no less.

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Section: Case Study: the European Heart Journalmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Sodium and Health: Old Myths and a Controversy Based on Denial

Cappuccio

Campbell

et al. 2022

Curr Nutr Rep

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“…High sodium intake has been shown to be associated with a higher risk of hypertension and cardiovascular morbidity and mortality in an approximately linear dose-response manner [ 1 , 2 , 3 ]. For example, a recent meta-analysis of 261,732 participants with 10,150 cases of stroke reported that dietary sodium intake and sodium-to-potassium ratio were positively associated with risk of stroke without evidence of nonlinearity [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Dietary Sodium and Potassium Intake and Risk of Non-Fatal Cardiovascular Diseases: The Million Veteran Program

Wang

Nguyen

et al. 2022

Nutrients

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Objective: To examine the association between intakes of sodium and potassium and the ratio of sodium to potassium and incident myocardial infarction and stroke. Design, Setting and Participants: Prospective cohort study of 180,156 Veterans aged 19 to 107 years with plausible dietary intake measured by food frequency questionnaire (FFQ) who were free of cardiovascular disease (CVD) and cancer at baseline in the VA Million Veteran Program (MVP). Main outcome measures: CVD defined as non-fatal myocardial infarction (MI) or acute ischemic stroke (AIS) ascertained using high-throughput phenotyping algorithms applied to electronic health records. Results: During up to 8 years of follow-up, we documented 4090 CVD cases (2499 MI and 1712 AIS). After adjustment for confounding factors, a higher sodium intake was associated with a higher risk of CVD, whereas potassium intake was inversely associated with the risk of CVD [hazard ratio (HR) comparing extreme quintiles, 95% confidence interval (CI): 1.09 (95% CI: 0.99–1.21, p trend = 0.01) for sodium and 0.87 (95% CI: 0.79–0.96, p trend = 0.005) for potassium]. In addition, the ratio of sodium to potassium (Na/K ratio) was positively associated with the risk of CVD (HR comparing extreme quintiles = 1.26, 95% CI: 1.14–1.39, p trend < 0.0001). The associations of Na/K ratio were consistent for two subtypes of CVD; one standard deviation increment in the ratio was associated with HRs (95% CI) of 1.12 (1.06–1.19) for MI and 1.11 (1.03–1.19) for AIS. In secondary analyses, the observed associations were consistent across race and status for diabetes, hypertension, and high cholesterol at baseline. Associations appeared to be more pronounced among participants with poor dietary quality. Conclusions: A high sodium intake and a low potassium intake were associated with a higher risk of CVD in this large population of US veterans.

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“…It is known that dietary K + modulates blood pressure. The higher the K + ingestion, the lower the blood pressure and vice versa (Mente et al, 2014) (Sacks et al, 2001;Ma et al, 2021). This has been observed in open population and in several potassium supplementation trials.…”

Section: Renal Salt and Potassium Transport In The Distal Nephronmentioning

confidence: 67%

Molecular mechanisms for the modulation of blood pressure and potassium homeostasis by the distal convoluted tubule

2021

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Epidemiological and clinical observations have shown that potassium ingestion is inversely correlated with arterial hypertension prevalence and cardiovascular mortality. The higher the dietary potassium, the lower the blood pressure and mortality. This phenomenon is explained, at least in part, by the interaction between salt reabsorption in the distal convoluted tubule (DCT) and potassium secretion in the connecting tubule/collecting duct of the mammalian nephron: In order to achieve adequate K+ secretion levels under certain conditions, salt reabsorption in the DCT must be reduced. Because salt handling by the kidney constitutes the basis for the long‐term regulation of blood pressure, losing salt prevents hypertension. Here, we discuss how the study of inherited diseases in which salt reabsorption in the DCT is affected has revealed the molecular players, including membrane transporters and channels, kinases, and ubiquitin ligases that form the potassium sensing mechanism of the DCT and the processes through which the consequent adjustments in salt reabsorption are achieved.

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24-Hour Urinary Sodium and Potassium Excretion and Cardiovascular Risk

Cited by 159 publications

References 34 publications

Sodium and Health: Old Myths and a Controversy Based on Denial

Sodium and Health: Old Myths and a Controversy Based on Denial

Dietary Sodium and Potassium Intake and Risk of Non-Fatal Cardiovascular Diseases: The Million Veteran Program

Molecular mechanisms for the modulation of blood pressure and potassium homeostasis by the distal convoluted tubule

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