Evidence map›Paper›PMID 27216139›Full record

ReviewLancet (London, England)2016

Associations of urinary sodium excretion with cardiovascular events in individuals with and without hypertension: a pooled analysis of data from four studies.

Andrew Mente, Martin O'Donnell, Sumathy Rangarajan, Gilles Dagenais, Scott Lear, Matthew McQueen, Rafael Diaz, Alvaro Avezum, Patricio Lopez-Jaramillo, Fernando Lanas and 20 more

Erratum issued Registry-linked trialAbstract readReview
PubMed Publisher
In one paragraph

Review in Lancet (London, England), 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT03225586 (Prospective Urban Rural Epidemiology Study), which is not on this map. Cited by 229 papers, 18 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
229citing papers in PubMed, 18 pooled it
–field-weighted citation impact
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.

NCT03225586 recruitingnot on this map

Prospective Urban Rural Epidemiology Study

TypeobservationalSponsorPopulation Health Research InstituteRan2002 to 2030Enrolled200,000ConditionsCardiovascular Diseases, Risk Factor, Cardiovascular, Health Behavior, Environmental Exposure
3 · Its place in the literature

Who cites it

229 citing papers in PubMed, 18 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Effects of Sodium Intake on Health and Performance in Endurance and Ultra-Endurance Sports.International journal of environmental research and public health · 2022
    Pooled it
  5. Pooled it
  6. Pooled it
  7. Pooled it
  8. Pooled it
  9. Pooled it
  10. The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019).Hypertension research : official journal of the Japanese Society of Hypertension · 2019
    Guideline
  11. Pooled it
  12. Pooled it
  13. Pooled it
  14. Dietary Sources of Salt in Low- and Middle-Income Countries: A Systematic Literature Review.International journal of environmental research and public health · 2019
    Pooled it
  15. Pooled it
  16. Pooled it
  17. Pooled it
  18. Guideline
  19. Trial
  20. Trial

169 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

30 authors.

Andrew MentePopulation Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada; Department of Clinical Epidemiology and Biostatistics, Hamilton, ON, Canada. Electronic address: andrew.mente@phri.ca.
Martin O'DonnellPopulation Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada; Department of Medicine, Hamilton, ON, Canada; HRB-Clinical Research Facility, NUI Galway, Ireland.
Sumathy RangarajanPopulation Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada.
Gilles DagenaisLaval University Heart and Lungs Institute, Quebec City, QC, Canada.
Scott LearFaculty of Health Sciences, Simon Fraser University, BC, Canada; Division of Cardiology, Providence Health Care, BC, Canada.
Matthew McQueenDepartment of Laboratory Medicine, McMaster University, Hamilton, ON, Canada.
Rafael DiazEstudios Clínicos Latinoamérica, Rosario, Argentina.
Alvaro AvezumDante Pazzanese Institute of Cardiology, Sao Paulo, SP, Brazil.
Patricio Lopez-JaramilloFundacion Oftalmologica de Santander-FOSCAL, Medical School, Universidad de Santander Floridablanca-Santander, Colombia.
Fernando LanasUniversidad de La Frontera, Temuco, Chile.
Wei LiNational Centre for Cardiovascular Diseases, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Yin LuMedical Research & Biometrics Center, National Center for Cardiovascular Diseases, FuWai Hospital, Beijing, China.
Sun YiMedical Research & Biometrics Center, National Center for Cardiovascular Diseases, FuWai Hospital, Beijing, China.
Lei RenshengCenter for Disease Control & Prevention Nanchang County, Nanchang City, Jiangxi Province, China.
Romaina IqbalDepartments of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan.
Prem MonyCommunity Health & Epidemiology, St John's Research Institute, Bangalore, India.
Rita YusufThe School of Life Sciences and The Centre for Health, Population, and Development, Independent University, Bangladesh.
Khalid YusoffFaculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia.
Andrzej SzubaDivision of Angiology, Wroclaw Medical University, Wrocław, Poland; Department of Internal Medicine, 4th Military Hospital in Wroclaw, Poland.
Aytekin OguzIstanbul Medeniyet University, Faculty of Medicine, Department of Internal Medicine, Istanbul, Turkey.
Annika RosengrenSahlgrenska Academy University of Gothenburg, Gothenburg, Sweden.
Ahmad BahonarHypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Afzalhussein YusufaliHatta Hospital, Dubai Health Authority, Dubai, UAE.
Aletta Elisabeth SchutteMRC Unit for Hypertension and CVD/Hypertension in Africa Research Team, North-West University, Potchefstroom, North West Province, South Africa.
Jephat ChifambaUniversity of Zimbabwe, College of Health Sciences, Physiology Department, Harare, Zimbabwe.
Johannes F E MannPopulation Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada; Department of Nephrology, University of Erlangen-Nurnberg and Munich General Hospitals, Munich, Germany.
Sonia S AnandPopulation Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada; Department of Clinical Epidemiology and Biostatistics, Hamilton, ON, Canada; Department of Medicine, Hamilton, ON, Canada.
Koon TeoPopulation Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada.
S YusufPopulation Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada; Department of Clinical Epidemiology and Biostatistics, Hamilton, ON, Canada; Department of Medicine, Hamilton, ON, Canada.
PURE, EPIDREAM and ONTARGET/TRANSCEND Investigators

Funding

Canadian Institutes of Health Research
6 · The paper itself

Abstract

backgroundSeveral studies reported a U-shaped association between urinary sodium excretion and cardiovascular disease events and mortality. Whether these associations vary between those individuals with and without hypertension is uncertain. We aimed to explore whether the association between sodium intake and cardiovascular disease events and all-cause mortality is modified by hypertension status.

methodsIn this pooled analysis, we studied 133,118 individuals (63,559 with hypertension and 69,559 without hypertension), median age of 55 years (IQR 45-63), from 49 countries in four large prospective studies and estimated 24-h urinary sodium excretion (as group-level measure of intake). We related this to the composite outcome of death and major cardiovascular disease events over a median of 4.2 years (IQR 3.0-5.0) and blood pressure.

findingsIncreased sodium intake was associated with greater increases in systolic blood pressure in individuals with hypertension (2.08 mm Hg change per g sodium increase) compared with individuals without hypertension (1.22 mm Hg change per g; pinteraction<0.0001). In those individuals with hypertension (6835 events), sodium excretion of 7 g/day or more (7060 [11%] of population with hypertension: hazard ratio [HR] 1.23 [95% CI 1.11-1.37]; p<0.0001) and less than 3 g/day (7006 [11%] of population with hypertension: 1.34 [1.23-1.47]; p<0.0001) were both associated with increased risk compared with sodium excretion of 4-5 g/day (reference 25% of the population with hypertension). In those individuals without hypertension (3021 events), compared with 4-5 g/day (18,508 [27%] of the population without hypertension), higher sodium excretion was not associated with risk of the primary composite outcome (≥ 7 g/day in 6271 [9%] of the population without hypertension; HR 0.90 [95% CI 0.76-1.08]; p=0.2547), whereas an excretion of less than 3 g/day was associated with a significantly increased risk (7547 [11%] of the population without hypertension; HR 1.26 [95% CI 1.10-1.45]; p=0.0009).

interpretationCompared with moderate sodium intake, high sodium intake is associated with an increased risk of cardiovascular events and death in hypertensive populations (no association in normotensive population), while the association of low sodium intake with increased risk of cardiovascular events and death is observed in those with or without hypertension. These data suggest that lowering sodium intake is best targeted at populations with hypertension who consume high sodium diets.

fundingFull funding sources listed at end of paper (see Acknowledgments).

Indexed as

Blood PressureDiet, Sodium-RestrictedAdultAgedAged, 80 and overCardiovascular DiseasesFemaleGlobal HealthHumansHypertensionMaleMiddle AgedProspective StudiesRisk AssessmentRisk FactorsSodiumSodiumSodium, Dietary

Identifiers

PMID27216139

What OpenQuestion holds

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Registered trials

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.