title: The technical report on sodium intake and cardiovascular disease in low- and middle-income countries by the joint working group of the World Heart Federation, the European Society of Hypertension and the European Public Health Association.
abstract: Ingestion of sodium is essential to health, but excess sodium intake is a risk factor for hypertension and cardiovascular disease. Defining an optimal range of sodium intake in populations has been challenging and controversial. Clinical trials evaluating the effect of sodium reduction on blood pressure have shown blood pressure lowering effects down to sodium intake of less than 1.5 g/day. Findings from these blood pressure trials form the basis for current guideline recommendations to reduce sodium intake to less than 2.3 g/day. However, these clinical trials employed interventions that are not feasible for population-wide implementation (i.e. feeding studies or intensive behavioural interventions), particularly in low and middle-income countries. Prospective cohort studies have identified the optimal range of sodium intake to reside in the moderate range (3-5 g/day), where the risk of cardiovascular disease and death is lowest. Therefore, there is consistent evidence from clinical trials and observational studies to support reducing sodium intake to less than 5 g/day in populations, but inconsistent evidence for further reductions below a moderate intake range (3-5 g/day). Unfortunately, there are no large randomized controlled trials comparing low sodium intake (< 3 g/day) to moderate sodium intake (3-5 g/day) in general populations to determine the net clinical effects of low sodium intake. Until such trials are completed, it is likely that controversy about optimal sodium intake range will continue. This working group calls for the completion of large definitive clinical trials to clarify the range of sodium intake for optimal cardiovascular health within the moderate to low intake range. We support interventions to reduce sodium intake in populations who consume high sodium intake (> 5 g/day), which should be embedded within an overall healthy dietary pattern.
authors.affiliation: University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126 Milano, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mancia
authors.affiliation: University of Alabama at Birmingham, 703 19th St. South, ZRB 1034, Birmingham, Alabama 35294-0007.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Oparil
authors.affiliation: Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, Louisiana 70112, USA.
authors.forename: Paul K
authors.initials: PK
authors.lastname: Whelton
authors.affiliation: ECOHOST, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: McKee
authors.affiliation: College of Medical, Veterinary and Life Sciences, University of Glasgow, Wolfson Medical School Building, University Avenue, Glasgow G12 8QQ, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: Dominiczak
authors.affiliation: Experimental and Clinical Research Center LindenbergerWeg 80, 131225 Berlin, Germany.
authors.forename: Friedrich C
authors.initials: FC
authors.lastname: Luft
authors.affiliation: Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, PO Box 7805, Riyadh 11472, Saudi Arabia.
authors.forename: Khalid
authors.initials: K
authors.lastname: AlHabib
authors.affiliation: Medcina Interna, Universidad de la Frontera, M Montt 112, Temuco 4780000, Chile.
authors.forename: Fernando
authors.initials: F
authors.lastname: Lanas
authors.affiliation: Department of Medicine, Faculty of Medicine, Eduardo Mondlane University, Agostinho Neto Ave. 679, Maputo, 1111 Mozambique.
authors.forename: Albertino
authors.initials: A
authors.lastname: Damasceno
authors.affiliation: Research & Policy, Plot No. 47, Sector 44, Near HUDA City Metro Station, Gurgaon, Haryana 122002, India.
authors.forename: Dorairaj
authors.initials: D
authors.lastname: Prabhakaran
authors.affiliation: Department of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: La Torre
authors.affiliation: Division of Cardiovascular Medicine, The State University of New York, Downstate College of Medicine, 450 Clarkson Avenue, Brooklyn, New York 11203, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Weber
authors.affiliation: HRB-Clinical Research Facility Galway, NUI Galway, Newcastle Rd., Galway, Ireland.
authors.forename: Martin
authors.initials: M
authors.lastname: O'Donnell
authors.affiliation: Department of Medicine, The University of North Carolina in Chapel Hill, 125 MacNider Hall, Campus Box #7005, Chapel Hill NC 27599-7005, USA.
authors.forename: Sidney C
authors.initials: SC
authors.lastname: Smith
authors.affiliation: St. Luke's/Roosevelt Hospital of Mount Sinai, 1111 Amsterdam Avenue, New York, NY 10025, USA.
authors.forename: Jagat
authors.initials: J
authors.lastname: Narula
mesh_terms: D015415:Biomarkers / Q000378:metabolism; D001794:Blood Pressure / Q000502:physiology; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002986:Clinical Trials as Topic; D015331:Cohort Studies; D048909:Diabetes Complications / Q000453:epidemiology; D004039:Diet, Sodium-Restricted / Q000706:statistics & numerical data; D014943:Global Health; D006293:Health Promotion / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007182:Income; D009765:Obesity / Q000453:epidemiology; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D012982:Sodium, Dietary / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D015415:Biomarkers; D012982:Sodium, Dietary
keywords: Hypertension ; LMIC; Sodium 