title: Global sodium consumption and death from cardiovascular causes.
abstract: BACKGROUND
  High sodium intake increases blood pressure, a risk factor for cardiovascular disease, but the effects of sodium intake on global cardiovascular mortality are uncertain.
  
  
  METHODS
  We collected data from surveys on sodium intake as determined by urinary excretion and diet in persons from 66 countries (accounting for 74.1% of adults throughout the world), and we used these data to quantify the global consumption of sodium according to age, sex, and country. The effects of sodium on blood pressure, according to age, race, and the presence or absence of hypertension, were calculated from data in a new meta-analysis of 107 randomized interventions, and the effects of blood pressure on cardiovascular mortality, according to age, were calculated from a meta-analysis of cohorts. Cause-specific mortality was derived from the Global Burden of Disease Study 2010. Using comparative risk assessment, we estimated the cardiovascular effects of current sodium intake, as compared with a reference intake of 2.0 g of sodium per day, according to age, sex, and country.
  
  
  RESULTS
  In 2010, the estimated mean level of global sodium consumption was 3.95 g per day, and regional mean levels ranged from 2.18 to 5.51 g per day. Globally, 1.65 million annual deaths from cardiovascular causes (95% uncertainty interval [confidence interval], 1.10 million to 2.22 million) were attributed to sodium intake above the reference level; 61.9% of these deaths occurred in men and 38.1% occurred in women. These deaths accounted for nearly 1 of every 10 deaths from cardiovascular causes (9.5%). Four of every 5 deaths (84.3%) occurred in low- and middle-income countries, and 2 of every 5 deaths (40.4%) were premature (before 70 years of age). The rate of death from cardiovascular causes associated with sodium intake above the reference level was highest in the country of Georgia and lowest in Kenya.
  
  
  CONCLUSIONS
  In this modeling study, 1.65 million deaths from cardiovascular causes that occurred in 2010 were attributed to sodium consumption above a reference level of 2.0 g per day. (Funded by the Bill and Melinda Gates Foundation.).
authors.affiliation: From the Friedman School of Nutrition Science and Policy, Tufts University (D.M.), the Departments of Epidemiology (D.M., S.F., G.M.S., R.M., S.K., G.D.), Nutrition (D.M.), and Global Health and Population (G.D.), Harvard School of Public Health, and the Division of Cardiovascular Medicine and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School (D.M.) - all in Boston; the Department of Public Health and Primary Care, Cambridge Institute of Public Health, Cambridge (S.F., J.P.), and the MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London (M.E.) - both in the United Kingdom; and the Institute for Health Metrics and Evaluation, University of Washington, Seattle (R.E.E., S.L.).
authors.forename: Dariush
authors.initials: D
authors.lastname: Mozaffarian
authors.forename: Saman
authors.initials: S
authors.lastname: Fahimi
authors.forename: Gitanjali M
authors.initials: GM
authors.lastname: Singh
authors.forename: Renata
authors.initials: R
authors.lastname: Micha
authors.forename: Shahab
authors.initials: S
authors.lastname: Khatibzadeh
authors.forename: Rebecca E
authors.initials: RE
authors.lastname: Engell
authors.forename: Stephen
authors.initials: S
authors.lastname: Lim
authors.forename: Goodarz
authors.initials: G
authors.lastname: Danaei
authors.forename: Majid
authors.initials: M
authors.lastname: Ezzati
authors.forename: John
authors.initials: J
authors.lastname: Powles
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality*; D004032:Diet; D005260:Female; D014943:Global Health; D006801:Humans; D008297:Male; D008875:Middle Aged; D017678:Sex Distribution; D012964:Sodium / Q000652:urine; D012982:Sodium, Dietary / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D012982:Sodium, Dietary; D012964:Sodium