Evidence map›Paper›PMID 24415713›Full record

Trial reportCirculation2014

Lower levels of sodium intake and reduced cardiovascular risk.

Nancy R Cook, Lawrence J Appel, Paul K Whelton

Open access · bronzeAbstract readClinical Trial, Phase IClinical Trial, Phase II
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Circulation, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 136 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
136citing papers in PubMed, 8 pooled it
21.5field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

136 citing papers in PubMed, 8 syntheses or guidelines pooled it, 251 citations in OpenAlex.

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  7. The science of salt: a systematic review of clinical salt studies 2013 to 2014.Journal of clinical hypertension (Greenwich, Conn.) · 2015
    Pooled it
  8. Reduced dietary salt for the prevention of cardiovascular disease.The Cochrane database of systematic reviews · 2014
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76 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

3 authors at 3 institutions in 1 country.

Nancy R CookDivision of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (N.R.C.); Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins School of Medicine, Baltimore, MD (L.J.A.); and Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.).
Lawrence J Appel
Paul K Whelton
Brigham and Women's Hospital · USHarvard University · USJohns Hopkins University · US

Funding

Institute for Clinical and Translational ResearchUL1TR001079 · NCATS · JOHNS HOPKINS UNIVERSITY · PI FORD, DANIEL ERNEST · 2013 to 2017
$60.1M
OBSERVATIONAL COHORT STUDY OF SODIUM, WEIGHT AND CVDR01HL057915 · NHLBI · BRIGHAM AND WOMEN'S HOSPITAL · PI COOK, NANCY R · 1999 to 2003
$1.2M
COORDINATIONG CENTER--TRIALS OF HYPERTENSION PREVENTIONU01HL037852 · NHLBI · BRIGHAM AND WOMEN'S HOSPITAL · PI HENNEKENS, CHARLES H · 1986 to 1996
–
TRIALS OF HYPERTENSION PREVENTION (TOHP) PHASE IIU01HL037853 · NHLBI · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI KULLER, LEWIS H · 1986 to 1994
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TRIALS OF HYPERTENSION PREVENTION-PHASE IIU01HL037854 · NHLBI · UNIVERSITY OF MISSISSIPPI MEDICAL CENTER · PI JONES, DANIEL W · 1986 to 1994
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CLINICAL CENTERS FOR TRIALS OF HYPERTENSION PREVENTIONU01HL037872 · NHLBI · BRIGHAM AND WOMEN'S HOSPITAL · PI TAYLOR, JAMES · 1986 to 1989
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PREVENTION OF HYPERTENSIONU01HL037884 · NHLBI · UNIV OF MED/DENT OF NJ-NJ MEDICAL SCHOOL · PI LASSER, NORMAN L. · 1986 to 1994
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TRIALS OF HYPERTENSION PREVENTION (THOP) - PHASE IIU01HL037899 · NHLBI · KAISER FOUNDATION RESEARCH INSTITUTE · PI HOLLIS, JACK F · 1986 to 1994
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CLINICAL CENTERS FOR TRIALS OF HYPERTENSION PREVENTIONU01HL037904 · NHLBI · UNIVERSITY OF CALIFORNIA DAVIS · PI BOLT, ROBERT J · 1986 to 1994
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TRIALS OF HYPERTENSION PREVENTION-PHASE IIU01HL037906 · NHLBI · SAINT LOUIS UNIVERSITY · PI COHEN, JEROME D · 1986 to 1994
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TRIALS OF HYPERTENSION PREVENTION (TOHP)--PHASE IIU01HL037907 · NHLBI · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI OBERMAN, ALBERT J · 1986 to 1994
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TRIALS OF HYPERTENSION PREVENTION: PHASE IIU01HL037924 · NHLBI · JOHNS HOPKINS UNIVERSITY · PI WHELTON, PAUL K · 1986 to 1994
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NCATS NIH HHS UL1 TR001079NHLBI NIH HHS HL37849NHLBI NIH HHS HL37852NHLBI NIH HHS HL37853NHLBI NIH HHS HL37854NHLBI NIH HHS HL37872NHLBI NIH HHS HL37884NHLBI NIH HHS HL37899NHLBI NIH HHS HL37904NHLBI NIH HHS HL37906NHLBI NIH HHS HL37907NHLBI NIH HHS HL37915NHLBI NIH HHS HL37924NHLBI NIH HHS R01 HL057915
6 · The paper itself

Abstract

backgroundRecent studies have raised the possibility of adverse effects of low sodium, particularly <2300 mg/d, on cardiovascular disease; however, these paradoxical findings might have resulted from suboptimal measurement of sodium and potential biases related to indication or reverse causation. METHODS AND

resultsPhases 1 and 2 of the Trials of Hypertension Prevention (TOHP) collected multiple 24-hour urine specimens among prehypertensive individuals. During extended post-trial 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 post-trial follow-up. Median sodium excretion was 3630 mg/d, with 1.4% of the participants having intake <1500 mg/d and 10% <2300 mg/d, consistent with national levels. 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 (hazard ratio, 0.68; 95% confidence interval, 0.34-1.37; P for trend=0.13). There was a linear 17% increase in risk per 1000 mg/d increase in sodium (P=0.05). Spline curves supported a linear association of sodium with cardiovascular events, which continued to decrease from 3600 to 2300 and 1500 mg/d, although the data were sparse at the lowest levels. Controlling for creatinine levels had little effect on these results.

conclusionsResults from the TOHP studies, which overcome the major methodological challenges of prior studies, are consistent with overall health benefits of reducing sodium intake to the 1500 to 2300 mg/d range in the majority of the population, in agreement with current dietary guidelines.

Indexed as

AdultCardiovascular DiseasesCreatinineFemaleFollow-Up StudiesHumansLinear ModelsMaleMiddle AgedRisk FactorsSodiumSodium, DietaryCreatinineSodiumSodium, Dietarycardiovascular diseasesdietnutritionprimary preventionsodium chloride, dietary

Identifiers

PMID24415713
PMCPMC4181831
OpenAlexW2070187546

What OpenQuestion holds

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Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.