Lower Levels of Sodium Intake and Reduced Cardiovascular Risk
The Challenge to Achieve Lower Sodium Recommendations
This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
It is well known that sodium intake is directly related to the development of high blood pressure. In 2 recent meta-analyses, higher sodium intake was also related to greater risk of incident stroke and cardiovascular disease (CVD)2; however, whether lower sodium intake reduces risk of CVD is not clear.3 One meta-analysis of 7 clinical trials originally designed to test the effectiveness of sodium reduction on blood pressure found nonsignificant associations of sodium reduction with lower CVD risk and total mortality over ≥6 months of follow-up.4 In observational studies of diverse populations, a J-shaped relation between sodium intake (or urinary sodium excretion) and risk of CVD has been reported.5,6 In contrast, study participants assigned to a sodium reduction intervention had a lower risk of CVD over several years of follow-up.6 In this issue of Circulation, Cook and colleagues7 reported a lower risk of CVD or CVD mortality among study participants with lower urinary sodium (<2300 mg/24 h) than among those with higher levels (3600 to <4800 mg/24 h). Although the current study was not originally designed to test the effectiveness of lower sodium intake on CVD risk, multiple 24-hour urine samples, the “gold standard” measure of sodium intake, were used to characterize usual sodium intake.8 In most observational studies, sodium intake has been represented by a “spot urine” or overnight urine collection, which is not an accurate estimate of …