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

Abstract

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.

Correlation of Vitamin 25(OH)D, Liver Enzymes, Potassium, and Oxidative Stress Markers with Lipid Profile and Atheromatic Index: A Pilot Study

“…In addition, this result could be useful to investigate the effect of potassium supplements on the lipid profile, also including the atheromatic index TC/HDL. Our finding about the inverse correlation of potassium and TC/HDL ratio is broadly in line with other studies, reporting the positive effect of increased potassium supplement intake resulting in reducing cardiovascular risk factors, such as hypertension and dyslipidemia [ 38 , 39 , 40 ]. On the other hand, serum sodium (Na) levels show no significant correlation with the lipid profile.…”

Sodium, potassium intake, and all-cause mortality: confusion and new findings

“…Current studies [ 43 – 45 ] concerning the sodium–potassium ratio primarily revolve around its connection with hypertension, with limited literature on its relation to all-cause mortality. Some research findings [ 46 , 47 ] point towards a correlation between a high sodium–potassium ratio and the onset of cardiovascular diseases. In our study, in our study's restricted cubic spline model, we observed that as the sodium-to-potassium ratio exceeded 1.203 mg/mg/day, the overall mortality rate showed an increasing trend (see Fig.…”

Data Resource Profile: Nutrition Data in the VA Million Veteran Program

“…MVP nutrient data have been used to examine different health conditions affecting Veterans. Based on MVP nutrition data, a study entitled “Dietary Sodium and Potassium Intake and Risk of Non-Fatal Cardiovascular Diseases” has been published [ 8 ], which demonstrated a linear dose-response association between dietary sodium intake and Na:K ratio with risk of cardiovascular disease (CVD) and a nonlinear inverse association between dietary potassium intake and risk of CVD. The observed associations were consistent across racial groups and participants with or without baseline cardiometabolic conditions, but appeared to be slightly stronger among Veterans with low dietary quality [ 8 ].…”

“…Based on MVP nutrition data, a study entitled “Dietary Sodium and Potassium Intake and Risk of Non-Fatal Cardiovascular Diseases” has been published [ 8 ], which demonstrated a linear dose-response association between dietary sodium intake and Na:K ratio with risk of cardiovascular disease (CVD) and a nonlinear inverse association between dietary potassium intake and risk of CVD. The observed associations were consistent across racial groups and participants with or without baseline cardiometabolic conditions, but appeared to be slightly stronger among Veterans with low dietary quality [ 8 ]. Additional studies have examined the association of dietary fatty acids with risk of atherosclerotic CVD [ 11 ] and dietary omega-3 fatty acid consumption and the incidence of atrial fibrillation [ 12 ].…”