Urinary Sodium and Potassium Excretion, Mortality, and Cardiovascular Events

Mente, Andrew; Rangarajan, Sumathy; McQueen, Matthew; Wang, Xingyu; Liu, Lisheng; Hou, Yan; Lee, Shun Fu; Mony, Prem; Devanath, Anitha; Rosengren, Annika; López‐Jaramillo, Patricio; Dı́az, Rafael; Avezum, Álvaro; Lanas, Fernando; Yusoff, Khalid; Ilow, Rafał; Mohammadifard, Noushin; Güleç, Sadi; Yusufali, Afzalhussein; Kruger, Iolanthé M.; Yusuf, Rita; Chifamba, Jephat; Kabali, Conrad; Dagenais, Gilles R.; Lear, Scott A.; Teo, Koon; Yusuf, Salim; Act, Abstr

doi:10.1056/nejmoa1311889

Cited by 735 publications

(670 citation statements)

References 40 publications

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“…Other potential lifestyle interventions to reduce blood pressure include increasing physical activity,45, 46 reducing weight,47 and improving overall diet quality 46. Further studies are needed to inform safety48, 49 and selection of the most cost‐effective population‐wide interventions in the United States to decrease SBP.…”

Section: Discussionmentioning

confidence: 99%

Reducing the Blood Pressure–Related Burden of Cardiovascular Disease: Impact of Achievable Improvements in Blood Pressure Prevention and Control

Hardy

Loehr

Butler

et al. 2015

JAHA

154

119

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Background US blood pressure reduction policies are largely restricted to hypertensive populations and associated benefits are often estimated based on unrealistic interventions.Methods and ResultsWe used multivariable linear regression to estimate incidence rate differences contrasting the impact of 2 pragmatic hypothetical interventions to reduce coronary heart disease, stroke, and heart failure (HF) incidence: (1) a population‐wide intervention that reduced systolic blood pressure by 1 mm Hg and (2) targeted interventions that reduced the prevalence of unaware, untreated, or uncontrolled blood pressure above goal (per Eighth Joint National Committee treatment thresholds) by 10%. In the Atherosclerosis Risk in Communities Study (n=15 744; 45 to 64 years at baseline, 1987–1989), incident coronary heart disease and stroke were adjudicated by physician panels. Incident HF was defined as the first hospitalization with discharge diagnosis code of “428.” A 10% proportional reduction in unaware, untreated, or uncontrolled blood pressure above goal resulted in ≈4.61, 3.55, and 11.01 fewer HF events per 100 000 person‐years in African Americans, and 3.77, 1.63, and 4.44 fewer HF events per 100 000 person‐years, respectively, in whites. In contrast, a 1 mm Hg population‐wide systolic blood pressure reduction was associated with 20.3 and 13.3 fewer HF events per 100 000 person‐years in African Americans and whites, respectively. Estimated event reductions for coronary heart disease and stroke were smaller than for HF, but followed a similar pattern for both population‐wide and targeted interventions.ConclusionsModest population‐wide shifts in systolic blood pressure could have a substantial impact on cardiovascular disease incidence and should be developed in parallel with interventions targeting populations with blood pressure above goal.

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Section: Discussionmentioning

confidence: 99%

Reducing the Blood Pressure–Related Burden of Cardiovascular Disease: Impact of Achievable Improvements in Blood Pressure Prevention and Control

Hardy

Loehr

Butler

et al. 2015

JAHA

154

119

View full text Add to dashboard Cite

show abstract

“…More recently, a large, international, prospective cohort study including .100,000 participants, only 9.1% of whom were diabetes, reported an estimated high potassium intake was associated with a lower risk of death and cardiovascular outcomes (19). Smyth et al also reported urinary potassium excretion, but not urinary sodium excretion, predicted the progression to CKD stage 4 or chronic dialysis in a post hoc analysis of the ongoing telmisartan alone and in combination with ramipril global endpoint trial and telmistartan randomized assessment study in ACE intolerant subjects with cardiovascular disease studies (20).…”

Section: Discussionmentioning

confidence: 99%

Urinary Potassium Excretion and Renal and Cardiovascular Complications in Patients with Type 2 Diabetes and Normal Renal Function

Araki¹,

Haneda

Koya

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives We investigated the association of urinary potassium and sodium excretion with the incidence of renal failure and cardiovascular disease in patients with type 2 diabetes.Design, setting, participants, & measurements A total of 623 Japanese type 2 diabetic patients with eGFR$60 ml/min per 1.73 m 2 were enrolled in this observational follow-up study between 1996 and 2003 and followed-up until 2013. At baseline, a 24-hour urine sample was collected to estimate urinary potassium and sodium excretion. The primary end point was renal and cardiovascular events (RRT, myocardial infarction, angina pectoris, stroke, and peripheral vascular disease). The secondary renal end points were the incidence of a 50% decline in eGFR, progression to CKD stage 4 (eGFR,30 ml/min per 1.73 m 2 ), and the annual decline rate in eGFR.Results During the 11-year median follow-up period, 134 primary end points occurred. Higher urinary potassium excretion was associated with lower risk of the primary end point, whereas urinary sodium excretion was not. The adjusted hazard ratios for the primary end point in Cox proportional hazards analysis were 0.56 (95% confidence interval [95% CI], 0.33 to 0.95) in the third quartile of urinary potassium excretion (2.33-2.90 g/d) and 0.33 (95% CI, 0.18 to 0.62) in the fourth quartile (.2.90 g/d) compared with the lowest quartile (,1.72 g/d). Similar associations were observed for the secondary renal end points. The annual decline rate in eGFR in the fourth quartile of urinary potassium excretion (-1.3 ml/min per 1.73 m 2 /y; 95% CI, -1.5 to -1.0) was significantly slower than those in the first quartile (-2.2; 95% CI, -2.4 to -1.8).Conclusions Higher urinary potassium excretion was associated with the slower decline of renal function and the lower incidence of cardiovascular complications in type 2 diabetic patients with normal renal function. Interventional trials are necessary to determine whether increasing dietary potassium is beneficial.

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“…Decreasing salt intake reduces the incidence of noncommunicable diseases, such as coronary artery disease and stroke, and remains an important global priority in the public health field (1)(2)(3)(4) . Recently, He et al reported a successful nationwide salt reduction programme in the UK that reduced population salt intake by 15 % from 2003 to 2011 (5,6) .…”

mentioning

confidence: 99%

Sodium sources in the Japanese diet: difference between generations and sexes

Asakura

Uechi

Masayasu³

et al. 2015

Public Health Nutr.

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Objective: Globally, the Na consumption of most people exceeds the WHO recommendation. To be effective, salt reduction programmes require assessment of the dietary sources of Na. Due to methodological difficulties however, comprehensive assessments are rare. Here, we identified Na sources in the Japanese diet using a 4 d diet record that was specifically designed for Na source description. Design: A cross-sectional study. Subjects: Apparently healthy men (n 196) and women (n 196) aged 20-69 years. Setting: The subjects were recruited from twenty-three of forty-seven prefectures in Japan.Results: The proportion of discretionary Na intake in total Na intake was 52·3 % in men and 57·1 % in women, and was significantly lower in younger subjects. The two major food groups contributing to Na intake were seasonings such as salt or soya sauce (61·7 % of total Na intake in men, 62·9 % in women) and fish and shellfish (6·7 % in men, 6·6 % in women). The third major contributor differed between men and women (noodles in men, 4·9 %; bread in women, 5·0 %). Further, the contribution of each food group to total Na intake differed among age groups. Conclusions: While individual efforts to decrease Na intake remain important, population approaches to reducing Na content in processed foods are already equally important and will assume greater importance in the future even in Japan, an Asian country facing a rapid Westernization in dietary habits.

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Urinary Sodium and Potassium Excretion, Mortality, and Cardiovascular Events

Cited by 735 publications

References 40 publications

Reducing the Blood Pressure–Related Burden of Cardiovascular Disease: Impact of Achievable Improvements in Blood Pressure Prevention and Control

Reducing the Blood Pressure–Related Burden of Cardiovascular Disease: Impact of Achievable Improvements in Blood Pressure Prevention and Control

Urinary Potassium Excretion and Renal and Cardiovascular Complications in Patients with Type 2 Diabetes and Normal Renal Function

Sodium sources in the Japanese diet: difference between generations and sexes

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