COMMENTARY

Low Sodium and High Risk? Maybe It's Not the Salt

Lynda A. Szczech, MD, MSCE

Disclosures

June 10, 2011

Fatal and Nonfatal Outcomes, Incidence of Hypertension, and Blood Pressures Changes in Relation to Urinary Sodium Excretion

Stolarz-Skrzypek K, Kuznetsova T, Thijs L
JAMA. 2011;305:1777-1785

The initiative to reduce salt as public policy has been the focus of significant attention due to consistent results from multiple studies, including a recent meta-analysis of multiple trials.[1] The current study by Stolarz-Skrzypek and colleagues examines the question of sodium reduction on a different and perhaps more granular level..It examines risk among individuals using exact urine sodium assessments and asks whether risk varies based on baseline intake prior to intervention. This analysis represents the summary of several prospective observational cohorts of people without prior cardiovascular disease and correlates urine sodium excretion with risk for future cardiovascular event during the subsequent period of observation.

Approximately 3600 people provided urine specimens and contributed a median follow-up of almost 8 years each. When stratified into 3 groups based on urine sodium excretion, surprisingly, people in the lowest tertile had the highest risk for mortality. Participants with the lowest tertile had a death rate of 4.1%, while the middle and highest tertiles experienced mortality rates of 1.9% and 0.8%, respectively. Similar results were seen when cardiac events and strokes were considered separately. However, no association between urine sodium excretion and new onset of hypertension was demonstrated.

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