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September 14, 2011

Urinary Sodium Excretion and Cardiovascular Disease Mortality

Author Affiliations

Author Affiliations: Division of Interventional Cardiology, Universidade Federal de São Paulo, Sao Paulo, Brazil (Dr Oliveira de Abreu-Silva); and Division of Cardiology, Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil (Dr Marcadenti) (

JAMA. 2011;306(10):1083-1087. doi:10.1001/jama.2011.1296

To the Editor: The study by Dr Stolarz-Skrzypek and colleagues1 showed that systolic blood pressure changes over time were associated with changes in sodium excretion but not with a higher risk of hypertension or CVD complications. Lower sodium excretion was associated with higher CVD mortality. In our view, the study has some limitations.

First, patients with established CVD at baseline were excluded. However, the authors did not report whether patients with other risk factors, such as family history of CVD,2 high levels of low-density lipoprotein cholesterol, abdominal obesity, or inflammatory markers,3 were also excluded.

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