• Yuan Ma, Feng J He, Qi Sun, Changzheng Yuan, Lyanne M Kieneker, Gary C Curhan, Graham A MacGregor, BakkerStephan J LSJLFrom the Departments of Epidemiology (Y.M., Q.S., G.C.C., M.W., E.B.R., J.E.M., W.C.W., A.H., N.R.C., F.B.H.) and Nutrition (Q.S., C.Y., E.B.R., W.C.W., F.B.H.), Harvard T.H. Chan School of Public Health, and the Channing Division of N, CampbellNorm R CNRCFrom the Departments of Epidemiology (Y.M., Q.S., G.C.C., M.W., E.B.R., J.E.M., W.C.W., A.H., N.R.C., F.B.H.) and Nutrition (Q.S., C.Y., E.B.R., W.C.W., F.B.H.), Harvard T.H. Chan School of Public Health, and the Channing Division of Ne, Molin Wang, Eric B Rimm, JoAnn E Manson, Walter C Willett, Albert Hofman, Ron T Gansevoort, Nancy R Cook, and Frank B Hu.
• From the Departments of Epidemiology (Y.M., Q.S., G.C.C., M.W., E.B.R., J.E.M., W.C.W., A.H., N.R.C., F.B.H.) and Nutrition (Q.S., C.Y., E.B.R., W.C.W., F.B.H.), Harvard T.H. Chan School of Public Health, and the Channing Division of Network Medicine, the Department of Medicine (Q.S., G.C.C., E.B.R., J.E.M., W.C.W., F.B.H.), Renal Division, the Department of Medicine (G.C.C.), and the Division of Preventive Medicine (J.E.M., N.R.C.), Brigham and Women's Hospital and Harvard Medical School - all in Boston; the Wolfson Institute of Population Health, St. Bartholomew's Hospital and the London School of Medicine and Dentistry, Queen Mary University of London, London (F.J.H., G.A.M.); the Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands (L.M.K., S.J.L.B., R.T.G.); and the Departments of Medicine, Community Health Sciences, and Physiology and Pharmacology, O'Brien Institute of Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada (N.R.C.C.).
• N. Engl. J. Med. 2022 Jan 20; 386 (3): 252263252-263.

BackgroundThe relation between sodium intake and cardiovascular disease remains controversial, owing in part to inaccurate assessment of sodium intake. Assessing 24-hour urinary excretion over a period of multiple days is considered to be an accurate method.MethodsWe included individual-participant data from six prospective cohorts of generally healthy adults; sodium and potassium excretion was assessed with the use of at least two 24-hour urine samples per participant. The primary outcome was a cardiovascular event (coronary revascularization or fatal or nonfatal myocardial infarction or stroke). We analyzed each cohort using consistent methods and combined the results using a random-effects meta-analysis.ResultsAmong 10,709 participants, who had a mean (±SD) age of 51.5±12.6 years and of whom 54.2% were women, 571 cardiovascular events were ascertained during a median study follow-up of 8.8 years (incidence rate, 5.9 per 1000 person-years). The median 24-hour urinary sodium excretion was 3270 mg (10th to 90th percentile, 2099 to 4899). Higher sodium excretion, lower potassium excretion, and a higher sodium-to-potassium ratio were all associated with a higher cardiovascular risk in analyses that were controlled for confounding factors (P≤0.005 for all comparisons). In analyses that compared quartile 4 of the urinary biomarker (highest) with quartile 1 (lowest), the hazard ratios were 1.60 (95% confidence interval [CI], 1.19 to 2.14) for sodium excretion, 0.69 (95% CI, 0.51 to 0.91) for potassium excretion, and 1.62 (95% CI, 1.25 to 2.10) for the sodium-to-potassium ratio. Each daily increment of 1000 mg in sodium excretion was associated with an 18% increase in cardiovascular risk (hazard ratio, 1.18; 95% CI, 1.08 to 1.29), and each daily increment of 1000 mg in potassium excretion was associated with an 18% decrease in risk (hazard ratio, 0.82; 95% CI, 0.72 to 0.94).ConclusionsHigher sodium and lower potassium intakes, as measured in multiple 24-hour urine samples, were associated in a dose-response manner with a higher cardiovascular risk. These findings may support reducing sodium intake and increasing potassium intake from current levels. (Funded by the American Heart Association and the National Institutes of Health.).Copyright © 2021 Massachusetts Medical Society.

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