24-Hour Urinary Sodium Excretion Association with Cardiovascular Events: A Systematic Review and Dose-Response Meta-Analysis

Abstract

Objective: The relationship between sodium intake and cardiovascular (CV) events remains unconfirmed. Therefore, we carried out a systematic review and dose-response meta-analysis for evaluating the potential impact of 24-hour sodium excretion on CV risk. Besides, 24-hour sodium excretion was used to replace daily sodium diet intake.

Methods: We searched ISI Web of Science, Embase, PubMed, and the Cochrane Library. Our study included cohort studies reporting hazard ratio ( HR). The random-effects model was used for summarizing the total relative risks ( RRs) between the included studies. In addition, the generalized least-squares regression was employed to fit the study model.

Results: A total of 9 studies involving 645,006 participants were included in this study. A significant non-linear relationship was observed between sodium excretion and CV events ( P _{non-linearity} < 0.001). In studies collecting 24-h urine samples, the sodium excretion and CV events risk were associated linearly ( RR: 1.04; 95% CI: 1.01, 1.07).

Conclusion: In a linear dose-response manner, every 1 g increase in sodium intake was associated with an increased risk of CV events up to 4%. Further studies are required to validate our conclusions further.

Keywords: 24-h urinary sodium excretion; Cardiovascular events; Dose-response; Meta-analysis; Sodium intake.