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Observational Study
. 2020 Dec;52(8):488-496.
doi: 10.1080/07853890.2020.1780469. Epub 2020 Jun 30.

24-h urinary sodium excretion and the risk of adverse outcomes

Matti A Vuori  1   2 , Kennet Harald  2 , Antti Jula  2 , Liisa Valsta  2 , Tiina Laatikainen  2   3   4 , Veikko Salomaa  2 , Jaakko Tuomilehto  2   5   6 , Pekka Jousilahti  2 , Teemu J Niiranen  1   2
Affiliations
Observational Study

24-h urinary sodium excretion and the risk of adverse outcomes

Matti A Vuori et al. Ann Med. 2020 Dec.

Abstract

Aims: The objective was to evaluate whether sodium intake, assessed with the gold standard 24-h urinary collections, was related to long-term incidence of death, cardiovascular disease (CVD) and diabetes mellitus (DM).

Methods: A cohort of 4630 individuals aged 25-64 years collected 24-h urine samples in 1979-2002 and were followed up to 14 years for the incidence of any CVD, coronary heart disease (CHD), stroke, heart failure (HF) and DM event, and death. Cox proportional hazards models were used to estimate the association between the baseline salt intake and incident events and adjusted for baseline age, body mass index, serum cholesterol, prevalent DM, and stratified by sex and cohort baseline year.

Results: During the follow-up, we observed 423 deaths, 424 CVD events (288 CHD events, 142 strokes, 139 HF events) and 161 DM events. Compared with the highest quartile of salt intake, persons in the lowest quartile had a lower incidence of CVD (hazard ratio [HR] 0.70; 95% confidence interval [CI], 0.51-0.95, p = .02), CHD (HR 0.63 [95% CI 0.42-0.94], p = .02) and DM (HR 0.52 [95% CI 0.31-0.87], p = .01). The results were non-significant for mortality, HF, and stroke.

Conclusion: High sodium intake is associated with an increased incidence of CVD and DM.

Keywords: Cardiovascular disease; coronary heart disease; diabetes; heart failure; sodium; stroke.

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Conflict of interest statement

Dr. Vuori reports grants from Aarne Koskelo Foundation, Juho Vainio Foundation, and The state research funding of Finland used on this work and doctoral thesis in general. Drs. Harald, Jousilahti, Valsta, Jula, and Laatikainen have nothing to disclose. Dr. Tuomilehto reports grants from Bayer AG, grants from Boehringer Ingelheim, personal fees from Eli Lilly, personal fees and non-financial support from Merck, personal fees from MSD, personal fees from Novo Nordisk, grants from Sanofi, during the conduct of the study; other from Orion pharma, outside the submitted work. Dr. Salomaa reports personal fees and other from Novo Nordisk, personal fees from Sanofi, grants from Bayer AG, outside the submitted work. Dr. Niiranen reports grants from Academy of Finland, grants from Emil Aaltonen Foundation, grants from Finnish Medical Foundation, grants from Paavo Nurmi Foundation, outside the submitted work.

Figures

Figure 1.
Figure 1.
Outcome-free survival after baseline by quartiles of 24-h sodium excretion. Log rank P value for all outcomes < .001. Numbers of censored events and individuals at risk at each time point are provided in Supplementary Table S1.
Figure 2.
Figure 2.
Multivariable-adjusted risk of adverse health outcomes by quartiles of 24-h urinary sodium excretion. Models are adjusted for baseline age, body mass index, cholesterol, prevalent diabetes and stratified by sex and cohort. Individuals with a prevalent disease in question at baseline have been removed from the corresponding analyses. CI: confidence interval; HR: hazard ratio.
Figure 3.
Figure 3.
Multivariable-adjusted risk of adverse health outcomes by 24-h sodium excretion. Hazard ratios (black line) were estimated using Cox proportional hazards regression and plotted by restricted cubic splines. The models are centered at the median (dashed line, 170.6 mmol/day; hazard ratio = 1.0) with 4 knots at the 5th, 35th, 65th and 95th percentiles and the plot truncated at the 2.5th and 97.5th percentiles. The grey lines represent the 95% confidence interval. The models are adjusted for baseline age, body mass index, cholesterol, prevalent diabetes and stratified by sex and cohort. The density of the observations along the spline variable is marked by the mountain plot, marking the median and the 1st and 3rd quartile with vertical lines.
See this image and copyright information in PMC

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