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Title: Is complying with the recommendations of sodium intake beneficial for health in individuals at high cardiovascular risk? Findings from the PREDIMED study
Authors: Merino, Jordi
Guasch-Ferré, Marta
Martínez-González, Miguel A.
Corella, Dolores
Estruch, Ramon
Fitó, Montserrat
Ros, Emilio
Arós, Fernando
Bulló, Mònica
Gómez-Gracia, Enrique
Moñino, Manuel
Lapetra, José
Serra-Majem, Lluís 
Razquin, Cristina
Buil-Cosiales, Pilar
Sorlí, José V.
Muñoz, Miguel A.
Pintó, Xavier
Masana, Luis
Salas-Salvadó, Jordi
Keywords: Blood-Pressure
Urinary Sodium
Potassium Excretion
Mediterranean Diet
Primary Prevention, et al
Issue Date: 2015
Publisher: 0002-9165
Journal: The American journal of clinical nutrition 
Abstract: Background: Excess sodium intake is associated with high blood pressure, a major risk factor for cardiovascular disease (CVD). It is unknown whether decreasing sodium intake to <2300 mg/d has an effect on CVD or all-cause mortality.Objective: The objective was to assess whether reductions in sodium intake to <2300 mg/d were associated with either an increased or a decreased risk of fatal and nonfatal CVD and all-cause mortality.Design: This observational prospective study of the PREvencion con DIeta MEDiterranea (PREDIMED) trial included 3982 participants at high CVD risk. Sodium intake was evaluated with a validated food-frequency questionnaire and categorized as low (<1500 mg/d), intermediate (>= 1500 to <= 2300 mg/d), high (>2300 to <= 3400 mg/d), or very high (>3400 mg/d). Subsequently, 1-y and 3-y changes in sodium intake were calculated. Multivariate relative risks were assessed by using Cox proportional hazards ratios. Marginal structural models with inverse probability weighting were used to test the effect of changes in sodium intake and the Mediterranean diet (MedDiet).Results: We documented 125 CVD events and 131 deaths after a 4.8-y median follow-up. Sodium intake <2300 mg/d was associated with a lower risk of all-cause mortality: 48% (HR: 0.52; 95% CI: 0.30, 0.91; P = 0.02) and 49% (HR: 0.51; 95% CI: 0.26, 0.98; P = 0.04) after 1 and 3 y, respectively. Increasing sodium intake after 1 y was associated with a 72% (HR: 1.72; 95% CI: 1.01, 2.91; P = 0.04) higher risk of CVD events. The incidence rate of CVD was reduced for those who reduced their sodium intake and were randomly assigned to MedDiet interventions [4.1/10,000 (95% CI: 3.1, 8.0) compared with 4.4/10,000 (95% CI: 2.7, 12.4) person-years; P = 0.0021.Conclusions: Decreasing sodium intake to <2300 mg/d was associated with a reduced risk of all-cause mortality, whereas increasing the intake to >2300 mg/d was associated with a higher risk of CVD. Our observational data suggest that sodium intake <2300 mg/d was associated with an enhanced beneficial effect of the MedDiet on CVD. These results should be interpreted with caution, and other confirmatory studies are necessary.
ISSN: 0002-9165
DOI: 10.3945/ajcn.114.096750
Source: American Journal of Clinical Nutrition[ISSN 0002-9165],v. 101, p. 440-448
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