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Meta-Analysis
. 2015 Mar;18(4):695-704.
doi: 10.1017/S1368980014000949. Epub 2014 May 22.

Daily sodium consumption and CVD mortality in the general population: systematic review and meta-analysis of prospective studies

Rosana Poggio  1 , Laura Gutierrez  1 , María G Matta  1 , Natalia Elorriaga  1 , Vilma Irazola  1 , Adolfo Rubinstein  1
Affiliations
Meta-Analysis

Daily sodium consumption and CVD mortality in the general population: systematic review and meta-analysis of prospective studies

Rosana Poggio et al. Public Health Nutr. 2015 Mar.

Abstract

Objective: The purpose of the present study was to determine whether elevated dietary Na intake could be associated with CVD mortality.

Design: We performed a systematic review and meta-analysis of prospective studies representing the general population. The adjusted relative risks and their 95 % confidence intervals were pooled by the inverse variance method using random-effects models. Heterogeneity, publication bias, subgroup and meta-regression analyses were performed. Settings MEDLINE (since 1973), Embase (since 1975), the Cochrane Library (since 1976), ISI Web of Science, Google Scholar (until September 2013) and secondary referencing were searched for inclusion in the study. Subject Eleven prospective studies with 229 785 participants and average follow-up period of 13.37 years (range 5.5-19 years).

Results: Higher Na intake was significantly associated with higher CVD mortality (relative risk=1.12; 95 % CI 1.06, 1.19). In the sensitivity analysis, the exclusion of studies with important relative weights did not significantly affect the results (relative risk=1.08; 95 % CI 1.01, 1.15). The meta-regression analysis showed that for every increase of 10 mmol/d in Na intake, CVD mortality increased significantly by 1 % (P=0.016). Age, hypertensive status and length of follow-up were also associated with increased CVD mortality.

Conclusions: Higher Na intake was associated with higher CVD mortality in the general population; this result suggests a reduction in Na intake to prevent CVD mortality from any cause.

Keywords: Meta-analysis.

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Figures

Fig. 1
Fig. 1
Search strategy
Fig. 2
Fig. 2
Flowchart showing selection of studies for the present review and meta-analysis
Fig. 3
Fig. 3
Risk of CVD mortality associated with higher compared with lower sodium intake in eleven published prospective studies. Shown are authors, year and reference, relative risk (RR) and 95 % confidence interval, and the weight to the overall meta-analysis. The study-specific RR and 95 % CI are represented by the black diamond and horizontal line, respectively; the area of the grey square is proportional to the specific-study weight to the overall meta-analysis. The centre of the open diamond presents the pooled RR risk and its width represents the pooled 95 % CI. The percentage of heterogeneity due to between-study variation is shown by the I 2 statistic
Fig. 4
Fig. 4
Begg’s funnel plot for prospective studies of sodium intake and CVD mortality. Studies are plotted with their relative risk (RR; logarithmic scale) on the y-axis and the corresponding standard error on the x-axis; pseudo 95 % confidence limits are represented by dashed lines
Fig. 5
Fig. 5
Forest plot for risk of CVD mortality associated with sodium intake in eleven published prospective studies: (a) sensitivity analysis and (b) subgroup analysis. The relative risk (RR) and 95 % CI are represented by the black square and horizontal line, respectively
See this image and copyright information in PMC

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