An estimated sodium intake between 3 g per day and 6 g per day was associated with a lower risk of death and cardiovascular events than either a higher or lower estimated level of sodium intake. As compared with an estimated potassium excretion of less than 1.50 g per day, higher potassium excretion was associated with a reduction in the risk of the composite outcome. Both higher and lower levels of estimated sodium excretion were associated with increased risk, resulting in a J-shaped association curve. The association between a high estimated sodium excretion and increased risk, which was significant only among patients with hypertension, suggesting that the adverse effects of high sodium intake may be mediated to some degree by the effects of sodium intake on blood pressure. By contrast, the association between a low estimated sodium excretion and increased risk, which was seen among both patients with hypertension and those without hypertension, suggesting that mechanisms other than blood-pressure effects may play a role. Current guidelines recommend a maximum sodium intake of 1.5 to 2.4 g per day, are based on evidence from largely short-term clinical trials showing that reducing sodium intake from a moderate to a low level results in modest reductions in blood pressure. The benefits of low sodium intake with respect to cardiovascular disease are derived from blood-pressure trials that assume a linear relationship between sodium intake and blood pressure and between blood pressure and cardiovascular events. Sodium is known to play a critical role in normal human physiology, and activation of the renin–angiotensin–aldosterone system occurs when sodium intake falls below approximately 3.0 g per day. Higher estimated potassium excretion was associated with a lower risk of death and major cardiovascular events. Increased potassium consumption and reduced high sodium consumption through the use of potassium-enriched salt, showed a reduction in cardiovascular mortality. An increased potassium intake may reduce the risk of death and cardiovascular disease through its effects on blood pressure, or it may simply be a marker of healthy dietary patterns that are rich in potassium (e.g., high consumption of fruit and vegetables). Dr Martin ODonnell (McMaster University, Hamilton, ON, and National University of Ireland, Galway, published in the August 14, 2013 issue of the New England Journal of Medicine.
Posted on: Fri, 15 Aug 2014 03:48:59 +0000
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