Global cardiovascular mortality attributable to sodium intake

1. Approximately 1.65 million deaths from cardiovascular causes in 2010 resulted from sodium consumption greater than 2.0 g per day. 

2. Of these deaths, 84.3% occurred in low- and middle-income countries. 

Study Rundown: Hypertension is one of the strongest modifiable risk factors for cardiovascular disease and death globally. With the increasing burden of disease, national efforts in education and prevention have become a public health priority in many countries. A key recommendation in the management of hypertension is reducing sodium consumption. In this study, the Global Burden of Diseases Nutrition and Chronic Diseases Expert Group (NUTRICODE) estimated the effects of excess sodium consumption on global cardiovascular mortality. The investigators found that the mean level of sodium consumption worldwide in 2010 was close to 4 g per day. The World Health Organization (WHO) recommends that daily sodium intake should not exceed 2 g per day – a standard which was exceeded in 181 of 187 countries evaluated in this study. Using a model that considers current global sodium intake, the relationship between reduced sodium intake and blood pressure, and the relationship between blood pressure and cardiovascular mortality, it was estimated that 1.65 million deaths from cardiovascular causes in 2010 were attributable to sodium consumption that exceeded a reference level of 2 g per day. Limitations of this study include that sodium intake was estimated mainly by 24-hour urine collection and the study includes incomplete data from some countries. Overall, these findings provide perspective on current levels of sodium consumption and its implications for global cardiovascular disease.

Click to read the study, published today in NEJM

Click to read an accompanying editorial in NEJM

In-Depth: This study assessed the effect of sodium consumption on global cardiovascular mortality. Global sodium consumption was estimated using data from surveys conducted in 66 countries. These surveys estimated sodium consumption based on 24-hour urine collections, estimates of dietary intake, or both. The effects of reduced sodium intake on blood pressure were evaluated in a meta-analysis of randomized trials. The effects of systolic blood pressure on death from cardiovascular disease were calculated using data from two large international studies. The reference level of sodium intake was determined using levels associated with the lowest blood pressure levels and lowest risk of disease in past studies and trials. Dietary guidelines were also considered in setting the reference level. Data on current blood pressure levels and cardiovascular mortality were obtained from multiple sources including the Global Burden of Disease Study 2010. Finally, cardiovascular mortality attributable to sodium intake above the reference level was estimated by multiplying a calculated population-attributable fraction by the number of deaths in each country.

Globally, the mean level of sodium consumption in 2010 was 3.95 g per day. The mean level of sodium intake exceeded the WHO-recommended level (2.0 g per day) in 181 of 187 countries. There was a linear dose-response relationship between reduced sodium intake and blood pressure (P<0.001 for linearity and P=0.58 for nonlinearity). There was a log-linear dose-response relationship between blood pressure and cardiovascular mortality. In 2010, 1.65 million deaths from cardiovascular causes were attributable to sodium consumption above a reference level of 2.0±0.2 g per day. Of these deaths, 4 out of 5 occurred in low- and middle-income countries.

Image: PD 

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