Higher sodium and lower potassium intakes, as measured in multiple 24-hour urine samples, were associated in a dose–response manner with a higher cardiovascular risk in a pooled random-effects meta-analysis of individual-participant data from six prospective cohorts of generally healthy adults in the US. The analysis included 10,709 participants, mean age 51.5 years, 54.2% women. There were 571 cardiovascular events (coronary revascularization or fatal or nonfatal myocardial infarction or stroke) during a median follow-up of 8.8 years (5.9 per 1000 person-years). Sodium and potassium excretion were measured in at least two 24-hour urine samples per participant. The median 24-hour urinary sodium excretion was 3270 mg (10th to 90th percentile, 2099 to 4899). Higher sodium excretion, lower potassium excretion, and a higher sodium-to-potassium ratio were all associated with a higher cardiovascular risk in analyses controlled for confounding factors. Each daily increment of 1000 mg in sodium excretion was associated with an 18% increase in cardiovascular risk (hazard ratio, 1.18), and each daily increment of 1000 mg in potassium excretion was associated with an 18% decrease in risk (hazard ratio, 0.82). In analyses that compared the highest with the lowest quartile of the urinary biomarkers, the hazard ratios were 1.60, 0.69, and 1.62, respectively, for sodium, potassium excretion, and for the sodium-to-potassium ratio. The findings are in line with several studies and support reducing sodium intake and increasing potassium intake from current levels. Source: https://www.nejm.org/
