title: Sodium and potassium intake and mortality among US adults: prospective data from the Third National Health and Nutrition Examination Survey.
abstract: BACKGROUND
  Several epidemiologic studies suggested that higher sodium and lower potassium intakes were associated with increased risk of cardiovascular diseases (CVD). Few studies have examined joint effects of dietary sodium and potassium intake on risk of mortality.
  
  
  METHODS
  To investigate estimated usual intakes of sodium and potassium as well as their ratio in relation to risk of all-cause and CVD mortality, the Third National Health and Nutrition Examination Survey Linked Mortality File (1988-2006), a prospective cohort study of a nationally representative sample of 12,267 US adults, studied all-cause, cardiovascular, and ischemic heart (IHD) diseases mortality.
  
  
  RESULTS
  During a mean follow-up period of 14.8 years, we documented a total of 2270 deaths, including 825 CVD deaths and 443 IHD deaths. After multivariable adjustment, higher sodium intake was associated with increased all-cause mortality (hazard ratio [HR], 1.20; 95% confidence interval [CI], 1.03-1.41 per 1000 mg/d), whereas higher potassium intake was associated with lower mortality risk (HR, 0.80; 95% CI, 0.67-0.94 per 1000 mg/d). For sodium-potassium ratio, the adjusted HRs comparing the highest quartile with the lowest quartile were HR, 1.46 (95% CI, 1.27-1.67) for all-cause mortality; HR, 1.46 (95% CI, 1.11-1.92) for CVD mortality; and HR, 2.15 (95% CI, 1.48-3.12) for IHD mortality. These findings did not differ significantly by sex, race/ethnicity, body mass index, hypertension status, education levels, or physical activity.
  
  
  CONCLUSIONS
  Our findings suggest that a higher sodium-potassium ratio is associated with significantly increased risk of CVD and all-cause mortality, and higher sodium intake is associated with increased total mortality in the general US population.
authors: Division for Heart Diseases and Stroke Prevention, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mail Stop K-47, Atlanta, GA 30341, USA. qay0@cdc.gov
authors: Quanhe
authors: Q
authors: Yang
authors: Tiebin
authors: T
authors: Liu
authors: Elena V
authors: EV
authors: Kuklina
authors: W Dana
authors: WD
authors: Flanders
authors: Yuling
authors: Y
authors: Hong
authors: Cathleen
authors: C
authors: Gillespie
authors: Man-Huei
authors: MH
authors: Chang
authors: Marta
authors: M
authors: Gwinn
authors: Nicole
authors: N
authors: Dowling
authors: Muin J
authors: MJ
authors: Khoury
authors: Frank B
authors: FB
authors: Hu
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000139:chemically induced* / Q000401:mortality / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000139:chemically induced / Q000401:mortality; D018673:Nutrition Policy; D009749:Nutrition Surveys; D016017:Odds Ratio; D017419:Potassium, Dietary / Q000008:administration & dosage*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012982:Sodium, Dietary / Q000008:administration & dosage* / Q000009:adverse effects*; D014481:United States / Q000453:epidemiology
chemical_list: D017419:Potassium, Dietary; D012982:Sodium, Dietary