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Title: Joint association of urinary sodium and potassium excretion with cardiovascular events and mortality : Prospective cohort study
Authors: O’Donnell, Martin J.
Mente, Andrew
Rangarajan, Sumathy
McQueen, Matthew J.
O’Leary, Neil
Yin, Lu
Liu, Xiaoyun
Swaminathan, Sumathi
Khatib, Rasha
Rosengren, Annika
Ferguson, John
Smyth, Andrew
López Jaramillo, Patricio
Diaz, Rafael
Avezum, Alvaro
Lanas, Fernando
Ismail, Noorhassim
Yusoff, Khalid
Dans, Antonio
Iqbal, Romaina
Szuba, Andrzej
Mohammadifard, Noushin
Oguz, Atyekin
Hussein Yusufali, Afzal
AlHabib, Khalid F.
Kruger, Iolanthe Marike
Yusuf, Rita
Chifamba, Jephat
Yeates, Karen
Dagenais, Gilles
Wielgosz, Andreas
Lear, Scott A.
Teo, Koon
Yusuf, Salim
Keywords: Potassium urinary excretion
Cardiovascular events and mortality
Issue Date: 13-Mar-2019
Publisher: BMJ (Online), 2019
Abstract: Objective To evaluate the joint association of sodium and potassium urinary excretion (as surrogate measures of intake) with cardiovascular events and mortality, in the context of current World Health Organization recommendations for daily intake (<2.0 g sodium, >3.5 g potassium) in adults. Design International prospective cohort study. Setting 18 high, middle, and low income countries, sampled from urban and rural communities. Participants 103 570 people who provided morning fasting urine samples. Main outcome measures Association of estimated 24 hour urinary sodium and potassium excretion (surrogates for intake) with all cause mortality and major cardiovascular events, using multivariable Cox regression. A six category variable for joint sodium and potassium was generated: sodium excretion (low (<3 g/day), moderate (3-5 g/day), and high (>5 g/day) sodium intakes) by potassium excretion (greater/equal or less than median 2.1 g/day). Results Mean estimated sodium and potassium urinary excretion were 4.93 g/day and 2.12 g/day, respectively. After a median follow-up of 8.2 years, 7884 (6.1%) participants had died or experienced a major cardiovascular event. Increasing urinary sodium excretion was positively associated with increasing potassium excretion (unadjusted r=0.34), and only 0.002% had a concomitant urinary excretion of <2.0 g/day of sodium and >3.5 g/day of potassium. A J-shaped association was observed of sodium excretion and inverse association of potassium excretion with death and cardiovascular events. For joint sodium and potassium excretion categories, the lowest risk of death and cardiovascular events occurred in the group with moderate sodium excretion (3-5 g/day) and higher potassium excretion (21.9% of cohort). Compared with this reference group, the combinations of low potassium with low sodium excretion (hazard ratio 1.23, 1.11 to 1.37; 7.4% of cohort) and low potassium with high sodium excretion (1.21, 1.11 to 1.32; 13.8% of cohort) were associated with the highest risk, followed by low sodium excretion (1.19, 1.02 to 1.38; 3.3% of cohort) and high sodium excretion (1.10, 1.02 to 1.18; 29.6% of cohort) among those with potassium excretion greater than the median. Higher potassium excretion attenuated the increased cardiovascular risk associated with high sodium excretion (P for interaction=0.007). Conclusions These findings suggest that the simultaneous target of low sodium intake (<2 g/day) with high potassium intake (>3.5 g/day) is extremely uncommon. Combined moderate sodium intake (3-5 g/day) with high potassium intake is associated with the lowest risk of mortality and cardiovascular events.
ISSN: 2044-6055
Appears in Collections:DCABA. Artículos de Investigación

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