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Sodium confers CV risks only with large consumption



  Franz Messerli

Franz H. Messerli

Sodium consumption was associated with CHD and risk of stroke only when it exceeded 5 g per day, according to the new data from the PURE study.

Of the 18 countries in the study, only one, China, had an average sodium consumption of more than 5 g per day in at least 80% of the participating communities.

"The World Health Organization recommends consumption of less than 2 g sodium – is a teaspoon of salt – one day as a preventive measure against cardiovascular disease, but there is little evidence in terms of better results of health that individuals never reach such a low level " Andrew Mente, PhD, principal investigator for the epidemiology program in the Population Health Research Institute at McMaster University and Hamilton Health Sciences in Ontario, Canada , stated in a press release. "Only in the communities with the highest intake of sodium ̵

1; those with more than 5 g of sodium per day – which is mainly in China, we have found a direct link between sodium intake and major cardiovascular events such as heart attack and stroke In the communities that consumed less than 5 g of sodium a day, it was the other way around: sodium consumption was inversely associated with myocardial infarction or heart attack and total mortality and no increase in stroke. "

Associations vary

Mind and colleagues assessed community-level associations between sodium and potassium intake and BP in 369 communities (n = 95.767) and between sodium and potassium intake and CVD and mortality in 255 communities (n = 82.544). The median follow-up was 8.1 years

In countries other than China, 84% of the communities had a mean sodium intake between 3 g and 5 g per day,

The average systolic pressure increased of 2.86 mm Hg 1-g increase in mean sodium consumption, but the association was significant only in communities in the highest tertiary sodium tertile ( P <0.0001 for heterogeneity) according to the researchers.

There were significant deviations from linearity in associations between mean sodium intake and major CV events ( P = .043) due to an inverse association in the lowest tertile of sodium intake (mean intake, 4.04 g per day, range, 3.42 -4.43, variation, -1 events per 1,000 years, 95% CI, -2 to -0.01), no association in average tertile sodium intake (mean intake, 4.7 g per day, range, 4.44-5.05, change 0.24 events per 1,000 years, 95% CI, -2.12 to 2.61) and a positive but insignificant association in the highest tertile s sodium intake (mean intake, 5.5 g per day; interval, 5.08-7.49; change, 0.37 events per 1,000 years; 95% CI, – 0.03 to 0.78), the researchers wrote.

In China, there was a strong association between sodium intake and stroke risk (mean sodium intake, 5.58 g per day, exchange rate, 0.42 events per 1,000 years,% CI, 0, 16-.67); this was significant but weaker in other countries ( P due to heterogeneity = 0.0001).

In all participating countries, the increase in potassium intake was associated with a decreased risk for all major CV events.

found all the major cardiovascular problems, including death, decreased in communities and in countries where there is an increase in potassium consumption, which is found in foods such as fruits, vegetables, dairy products, potatoes and nuts and beans " , Mente said in the statement

Randomized study opportunity

"Before changing the recommendations, we recall that the results of Mind and colleagues are observational data in a predominantly Asian population and that 39; 24-hour sodium excretion was estimated from one day to another fasting urine measurements. This does not necessarily mean that active intervention, such as reducing the intake of salt in patients at risk of stroke or increasing salt intake in patients at risk for myocardial infarction, will result beneficial, " Cardiology Today Editorial Board Member Franz H. Messerli, MD, of the School of Medicine at Icahn on Mount Sinai, and colleagues wrote in a related editorial." However, results are extremely provocative and should be tested in a randomized controlled trial. Indeed, this process has been proposed in a tightly controlled environment, the federal prison population in the United States. " – by Erik Swain

Disclosures: The authors do not report disclosures Messerli reports that he received grants, honorary advisor and honorariums from Medscape, Medtronic, Menarini, Novartis and Pfizer. Please consult the editorial for relevant financial information of other authors.


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