title: Urinary sodium and potassium excretion, mortality, and cardiovascular events.
abstract: The optimal range of sodium intake for cardiovascular health is controversial.
  
  
  
  We obtained morning fasting urine samples from 101,945 persons in 17 countries and estimated 24-hour sodium and potassium excretion (used as a surrogate for intake). We examined the association between estimated urinary sodium and potassium excretion and the composite outcome of death and major cardiovascular events.
  
  
  
  The mean estimated sodium and potassium excretion was 4.93 g per day and 2.12 g per day, respectively. With a mean follow-up of 3.7 years, the composite outcome occurred in 3317 participants (3.3%). As compared with an estimated sodium excretion of 4.00 to 5.99 g per day (reference range), a higher estimated sodium excretion (≥ 7.00 g per day) was associated with an increased risk of the composite outcome (odds ratio, 1.15; 95% confidence interval [CI], 1.02 to 1.30), as well as increased risks of death and major cardiovascular events considered separately. The association between a high estimated sodium excretion and the composite outcome was strongest among participants with hypertension (P=0.02 for interaction), with an increased risk at an estimated sodium excretion of 6.00 g or more per day. As compared with the reference range, an estimated sodium excretion that was below 3.00 g per day was also associated with an increased risk of the composite outcome (odds ratio, 1.27; 95% CI, 1.12 to 1.44). As compared with an estimated potassium excretion that was less than 1.50 g per day, higher potassium excretion was associated with a reduced risk of the composite outcome.
  
  
  
  In this study in which sodium intake was estimated on the basis of measured urinary excretion, an estimated sodium intake between 3 g per day and 6 g per day was associated with a lower risk of death and cardiovascular events than was either a higher or lower estimated level of intake. As compared with an estimated potassium excretion that was less than 1.50 g per day, higher potassium excretion was associated with a lower risk of death and cardiovascular events. (Funded by the Population Health Research Institute and others.).
authors.affiliation: The authors' affiliations are listed in the Appendix.
authors.forename: Martin
authors.initials: M
authors.lastname: O'Donnell
authors.forename: Andrew
authors.initials: A
authors.lastname: Mente
authors.forename: Sumathy
authors.initials: S
authors.lastname: Rangarajan
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: McQueen
authors.forename: Xingyu
authors.initials: X
authors.lastname: Wang
authors.forename: Lisheng
authors.initials: L
authors.lastname: Liu
authors.forename: Hou
authors.initials: H
authors.lastname: Yan
authors.forename: Shun Fu
authors.initials: SF
authors.lastname: Lee
authors.forename: Prem
authors.initials: P
authors.lastname: Mony
authors.forename: Anitha
authors.initials: A
authors.lastname: Devanath
authors.forename: Annika
authors.initials: A
authors.lastname: Rosengren
authors.forename: Patricio
authors.initials: P
authors.lastname: Lopez-Jaramillo
authors.forename: Rafael
authors.initials: R
authors.lastname: Diaz
authors.forename: Alvaro
authors.initials: A
authors.lastname: Avezum
authors.forename: Fernando
authors.initials: F
authors.lastname: Lanas
authors.forename: Khalid
authors.initials: K
authors.lastname: Yusoff
authors.forename: Romaina
authors.initials: R
authors.lastname: Iqbal
authors.forename: Rafal
authors.initials: R
authors.lastname: Ilow
authors.forename: Noushin
authors.initials: N
authors.lastname: Mohammadifard
authors.forename: Sadi
authors.initials: S
authors.lastname: Gulec
authors.forename: Afzal Hussein
authors.initials: AH
authors.lastname: Yusufali
authors.forename: Lanthe
authors.initials: L
authors.lastname: Kruger
authors.forename: Rita
authors.initials: R
authors.lastname: Yusuf
authors.forename: Jephat
authors.initials: J
authors.lastname: Chifamba
authors.forename: Conrad
authors.initials: C
authors.lastname: Kabali
authors.forename: Gilles
authors.initials: G
authors.lastname: Dagenais
authors.forename: Scott A
authors.initials: SA
authors.lastname: Lear
authors.forename: Koon
authors.initials: K
authors.lastname: Teo
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology; D004032:Diet; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011188:Potassium / Q000008:administration & dosage / Q000652:urine*; D012964:Sodium / Q000652:urine*; D012982:Sodium, Dietary / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D012982:Sodium, Dietary; D012964:Sodium; D011188:Potassium