The ongoing prospective urban rural epidemiology study in 21 countries suggested that sodium intake was associated with cardiovascular disease (CVD) and strokes in communities where mean intake was greater than 5 g/day, and CVD decreased with increasing potassium intake in all countries. The study included 95 767 participants in 369 communities assessed for blood pressure (BP) and 82 544 in 255 communities for CVD with follow-up for a median of 8·1 years. Morning fasting urine was used to estimate 24 h sodium and potassium excretion as a surrogate for intake. 82 (80%) of 103 communities in China had a mean sodium intake greater than 5 g/day, whereas in other countries 224 (84%) of 266 communities had a mean intake of 3–5 g/day. Overall, mean systolic BP increased by 2·86 mm Hg per 1 g increase in mean sodium intake, but positive associations were only seen among the communities in the highest tertile of sodium intake. The association between mean sodium intake and major cardiovascular events showed significant deviations from linearity due to a significant inverse association in the lowest tertile of sodium intake (<4·43 g/day, mean intake 4·04 g/day; change –1·00 events per 1000 years), no association in the middle tertile (4·43–5·08 g/day, mean intake 4·70 g/day; change 0·24 events per 1000 years), and a positive but non-significant association in the highest tertile (>5·08 g/day, mean intake 5·75 g/day; change 0·37 events per 1000 years). A strong association was seen with stroke in China (mean sodium intake 5·58 g/day, 0·42 events per 1000 years) compared with in other countries (4·49 g/day, –0·26 events). All major cardiovascular outcomes decreased with increasing potassium intake in all countries. Analyses also suggested that the effects of sodium intake on cardiovascular events are largely unrelated to the effects of sodium intake on BP. The World Health Organization currently recommends a target of 2 g/day sodium (equivalent to approximately 5 g/day salt). The findings suggest that a population-specific strategy for sodium reduction may be appropriate. Source: https://www.thelancet.com/
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