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He J, Ogden LG, Vupputuri S, Bazzano LA, Loria C, Whelton PK. Dietary Sodium Intake and Subsequent Risk of Cardiovascular Disease in Overweight Adults. JAMA. 1999;282(21):2027–2034. doi:10.1001/jama.282.21.2027
Author Affiliations: Departments of Epidemiology (Drs He and Whelton and Mss Vupputuri and Bazzano), and Biostatistics (Ms Ogden), Tulane University School of Public Health and Tropical Medicine, New Orleans, La; and the National Center for Health Statistics, Hyattsville, Md (Dr Loria).
Context Dietary sodium is positively associated with blood pressure, and ecological
and animal studies both have suggested that high dietary sodium intake increases
Objective To examine the risk of cardiovascular disease associated with dietary
sodium intake in overweight and nonoverweight persons.
Design Prospective cohort study.
Setting The first National Health and Nutrition Examination Survey Epidemiologic
Follow-up Study, conducted in 1982-1984, 1986, 1987, and 1992.
Participants Of those aged 25 to 74 years when the survey was conducted in 1971-1975
(14,407 participants), a total of 2688 overweight and 6797 nonoverweight persons
were included in the analysis.
Main Outcome Measures Dietary sodium and energy intake were estimated at baseline using a
single 24-hour dietary recall method. Incidence and mortality data for cardiovascular
disease were obtained from medical records and death certificates.
Results For overweight and nonoverweight persons, over an average of 19 years
of follow-up, the total number of documented cases were as follows: 680 stroke
events (210 fatal), 1727 coronary heart disease events (614 fatal), 895 cardiovascular
disease deaths, and 2486 deaths from all causes. Among overweight persons
with an average energy intake of 7452 kJ, a 100 mmol higher sodium intake
was associated with a 32% increase (relative risk [RR], 1.32; 95% confidence
interval [CI], 1.07-1.64; P = .01) in stroke incidence,
89% increase (RR, 1.89; 95% CI, 1.31-2.74; P<.001)
in stroke mortality, 44% increase (RR, 1.44; 95% CI, 1.14-1.81; P = .002) in coronary heart disease mortality, 61% increase (RR, 1.61;
95% CI, 1.32-1.96; P<.001) in cardiovascular disease
mortality, and 39% increase (RR, 1.39; 95% CI, 1.23-1.58; P<.001) in mortality from all causes. Dietary sodium intake was
not significantly associated with cardiovascular disease risk in nonoverweight
Conclusions Our analysis indicates that high sodium intake is strongly and independently
associated with an increased risk of cardiovascular disease and all-cause
mortality in overweight persons.
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