Lower levels of sodium intake and reduced cardiovascular risk

iStock_000020735338XSmallIn the Circulation Cook and colleagues in their an observational follow-up study of phases 1 and 2 of TOHP (Trials of Hypertension Prevention) reported a lower risk of cardiovascular disease (CVD) and CVD mortality among study participants with lower urinary sodium (<2300mg/24h).

There is evidence for a relationship between salt intake and BP and excessive salt consumption may contribute to resistant hypertension. Mechanisms linking salt intake and BP elevation include an increase in extracellular volume, peripheral vascular resistance, due in part to sympathetic activation.

The usual salt intake is between 9 and 12 g/day in many European countries and it has been shown that reduction to about 5 g/day has a modest (1 – 2 mmHg) SBP-lowering effect in normotensive individuals and a somewhat more pronounced effect (4 – 5 mmHg) in hypertensive individuals.

A recent simulation study estimated that for the USA, a reduction in salt intake of 3 g/day would result in a reduction of 5.9 – 9.6% in the incidence of CHD, a reduction of 5.0 – 7.8% in the incidence of stroke, and a reduction of 2.6– 4.1% in death from any cause.(3)

Cook NR at al presented results of an observational follow-up study of TOHP (Trials of Hypertension Prevention), phases 1 and 2. Phases 1 and 2 of the TOHP collected multiple 24-hour urine specimens over periods of either 18 – 48 months among prehypertensive individuals. During extended posttrial surveillance, 193 cardiovascular events or cardiovascular disease deaths occurred among 2275 participants not in a sodium reduction intervention with 10 (TOHP II) or 15 (TOHP I) years of posttrial follow-up. First events included 68 myocardial infarctions, 77 coronary revascularizations, 22 strokes (1 participant
reported both myocardial infarction and stroke), and 27 CVD deaths. Median sodium excretion was 3630 mg/d (levels were higher in men, with medians of 3934 mg/d in men and 3078 mg/d in women). Only 10% of participants were at <2300 mg/d. Compared with those with sodium excretion of 3600 to <4800 mg/d, risk for those with sodium <2300 mg/d was 32% lower after multivariable adjustment (HR, 0.68; P for trend=0.13). There was a linear 17% increase in risk per 1000 mg/d increase in sodium (P=0.05).

On the basis of the study findings by Cook et al, the ideal level of sodium intake to achieve lower CVD risk was <2.3g of sodium per day (< 5,75g of salt, the equivalent of <1 teaspoon of salt per day; 1g of sodium corresponds to 2.5g of salt).

European Society of Hypertension (ESH) and European Society of Cardiology (ESC) guidelines recommend 5-6g maximum daily intake of salt in general population and lower than 5g/day in patients with coronary artery disease. Do not forget about it at your clinical practice and your everyday life.

Written by: Anna Oleksiak

1. Cook NR; Appel LJ, et al. Lower Levels of Sodium Intake and Reduced Cardiovascular Risk. Circulation 2014; 129:981-989.
2. Lyn M. Steffen; Lower Levels of Sodium Intake and Reduced Cardiovascular Risk: The Challenge to Achieve Lower Sodium Recommendations. Circulation. 2014;129:956-957.
3. Bibbins-Domingo K, Chertow GM, Coxson PG et al. Projected effect of dietary salt reductions on future cardiovascular disease. N Engl J Med, 2010; 362: 590–599.
4. Wytyczne ESC dotyczące postępowania w stabilnej chorobie wieńcowej w 2013 roku.
5. Wytyczne ESH/ESC dotyczące postępowania w nadciśnieniu tętniczym w 2013 roku.

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