Sodium: You can’t live with it and you might not be able to live without it

December 15, 2011 By

By: Rupika Malhotra, MSc
Scientific and Regulatory Affairs Associate, dicentra Inc.

A new study published in the Journal of the American Medical Association demonstrates findings which indicate that along with high daily sodium consumption reduced daily sodium consumption can also lead to increased risk of heart disease and stroke.

The double cohort, ONTARGET and TRANSCEND trials were conducted in a total of 28 880 patients with cardiovascular disease or diabetes mellitus assessed from urinary sodium and potassium excretion from a morning fasting urine sample. Outcomes measured throughout the duration of the study (November 2001- March 2008) were the following: Cardiovascular (CV) death, myocardial infarction (MI), stroke and hospitalization for congestive heart failure (CHF). Baseline measurements of 24-hour excretion for sodium had a mean of 4.77 g of sodium and 2.19 g for potassium. In a 56 month follow-up, 2057 CV related deaths, 1412 cases of myocardial infarctions, 1282 stoke incidences and 1213 cases of hospitalization for CHF were observed. Higher baseline sodium excretion was associated with an increased risk of CV deaths, myocardial infarctions, incidences of stroke and hospitalization when the reference group was measured to the other cohort. Upon a multivariable analysis lower sodium excretion was also shown to be associated with increased risk of CV death and hospitalization for CHF. However, compared with an estimated excretion of potassium of less than 1.5 g per day, high potassium excretion demonstrated significant reduction of risk of stroke/day on a multivariable analysis. The authors concluded that in comparison to baseline values, sodium excretion higher than 7 g/day and sodium excretion less than 3 g/day were both associated with increased risk of CV deaths and hospitalization of CHF.

Such a finding is important not only to the general public but rather to the industry on a national and international level. Various authoritative bodies have taken what some may consider “drastic” and “harsh” measures to ensure that overall sodium consumption is reduced in the general population, affecting the food industry on various levels. Conversely, some health experts would argue that consumption levels of sodium are already too high and it is more than unlikely that drastically low levels of sodium consumption are to pose an issue. While more studies will be needed to additionally contribute and substantiate these findings, this study may give the industry and the general public a breath of fresh air from the constant reminders to reduce sodium intake.


O’Donnell MJ, Yusuf S, Mente A, Gao P, Mann JF, Teo K, McQueen M, Sleight P, Sharma AM, Dans A, Probstfield J, Schmieder RE. Urinary sodium and potassium excretion and risk of cardiovascular events. JAMA. 2011 Nov 23;306(20):2229-38.

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