Key result
Higher sodium excretion is linked to ~17% higher odds of coronary stenosis, mediated by blood pressure.
Why the study?
Is higher estimated 24-h sodium excretion associated with increased coronary and carotid atherosclerosis in the general population?
Cross-Sectional (n=10,764)
Yes
Is higher estimated 24-h sodium excretion associated with increased coronary and carotid atherosclerosis in the general population?
Odds Ratio: 1.17 (95% CI 1.13–1.2)
p-value: p=<0.001
Higher sodium intake is associated with coronary and carotid atherosclerosis, but this relationship appears to be primarily mediated by blood pressure.
Association between estimated sodium excretion and coronary stenosis attenuated after BP adjustment; hypothesis-generating for mediation by hypertension in observational data.
Aims A high intake of salt raises blood pressure and the risk of cardiovascular disease. Previous studies have reported on the association between salt intake and carotid stenosis, but the association with coronary atherosclerosis has not been reported. Therefore, this project aimed at studying the association between salt intake and both carotid and coronary atherosclerosis in a contemporary community-based cohort. Methods and results Estimated 24-h sodium excretion (est24hNa) was calculated by the Kawasaki formula for participants of two sites (Uppsala and Malmö) of the Swedish Cardiopulmonary bioImage Study, who underwent a coronary computed tomography (n = 9623) and measurement of coronary artery calcium score (CACS, n = 10 289). Carotid ultrasound was used to detect carotid plaques (n = 10 700). Ordered logistic regression was used to calculate odds ratios (OR) per 1000 mg increase in est24hNa. We also investigated potential J-formed associations using quintiles of est24hNa. Increased est24hNa was associated with increased occurrence of carotid plaques [OR: 1.09, P < 0.001, confidence interval (CI): 1.06–1.12], higher CACS (OR: 1.16, P < 0.001, CI: 1.12–1.19), and coronary artery stenosis (OR: 1.17, P < 0.001, CI: 1.13–1.20) in minimal adjusted models. Associations were abolished when adjusting for blood pressure. When adjusting for established cardiovascular risk factors (not including blood pressure), associations remained for carotid plaques but not for coronary atherosclerosis. There was no evidence of J-formed associations. Conclusion Higher est24hNa was associated with both coronary and carotid atherosclerosis in minimal adjusted models. The association seemed mainly mediated by blood pressure but to some degree also influenced by other established cardiovascular risk factors.
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Wuopio et al. (2023) conducted a cross-sectional in Atherosclerosis (n=10,764). Higher estimated 24-hour sodium excretion (est24hNa) vs. Lower estimated 24-hour sodium excretion (evaluated per 1000 mg/day increase) was evaluated on Coronary artery stenosis per 1000 mg increase in estimated 24-hour sodium excretion (minimally adjusted model) (OR 1.17, 95% CI 1.13-1.20, p=<0.001). Higher estimated 24-hour sodium excretion was significantly associated with an increased odds of coronary artery stenosis (OR 1.17) in minimally adjusted models, though the association was abolished after adjusting for blood pressure.
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