To further explore the potential effect of imbalanced confounders, we performed propensity-score–matched sensitivity analyses 30 that compared a high estimated sodium excretion (?6.00 g per day) with a moderate level (3.00 to 5.99 g per day) and that compared a low estimated sodium excretion (<3.00 g per day) with the moderate level. In a secondary analysis, we examined the association between an estimated “usual” level of sodium or potassium excretion and death and cardiovascular disease, with correction for regression dilution bias (with the use of repeated measurements in 448 participants). 31 All analyses were conducted with the use of SAS software, version 9.2, for the UNIX operating system (SAS Institute).
Study Participants and you will Outcomes
The study included 101,945 participants, 42% of whom were from China. The mean estimated 24-hour sodium excretion was 4.93 g, and the mean estimated 24-hour potassium excretion was 2.12 g ( Table 1 , and Table S1 in the Supplementary Appendix). The mean systolic and diastolic blood pressures were higher among participants with a higher estimated sodium excretion (P<0.001). The mean duration of follow-up was 3.7 years, with follow-up completed for 95% of the participants. The primary composite outcome of death or a major cardiovascular event occurred in 3317 participants (3.3%): 1976 participants died (650 from cardiovascular causes), 857 had myocardial infarction, 872 had stroke, and 261 had heart failure. Participants may have had more than one cardiovascular event.
Panel A claims a restricted-cubic-spline plot of one’s relationship anywhere between estimated 24-hours urinary sodium removal while the substance result of dying from any trigger and you will major cardiovascular situations. The fresh new spline curve is actually truncated on grams daily (experience speed one of professionals which have salt excretion > grams on a daily basis, 8 incidents into the 305 people). Panel B reveals a small-cubic-spline area of your connection between projected salt excretion and death. The function price certainly one of players that have salt excretion of more than g every single day is actually 5 situations during the 305 professionals. Committee C reveals a finite-cubic-spline plot of your own organization ranging from estimated sodium removal and you can significant cardiovascular situations (recognized as passing out-of aerobic reasons, myocardial infarction, coronary arrest, or cardio incapacity). The event price one of players with salt removal in excess of grams daily was six Denver hookup occurrences inside the 305 members. Most of the plots was adjusted for age, intercourse, geographical region, informative top, ancestry (Western vs. non-Asian), liquor consumption, body-size index, and you can updates with respect to diabetic issues mellitus, history of cardiovascular situations, and you may latest smoking. Dashed outlines mean 95% confidence times. This new median salt removal (4.72 g each and every day) was the new source practical, shown by the purple line. To alter the prices having estimated salt excretion to sodium intake inside g every day, proliferate by 2.5.
As compared with a projected sodium removal of 4.00 so you can 5.99 grams everyday (this new reference group), projected removal away from seven.00 g on a daily basis or even more is actually associated with improved dangers of the number 1 ingredient consequences (chance ratio, 1.15; 95% trust interval [CI], step one.02 to a single.30), demise off any produce (chances ratio, step 1.25; 95% CI, 1.07 to one.48), a major cardiovascular enjoy (chances proportion, 1.16; 95% CI, step 1.01 to 1.34), death from cardio grounds (potential ratio, step 1.54; 95% CI, step one.21 to one.95), and you may coronary arrest causing death otherwise hospitalization (chance ratio, step 1.29; 95% CI, 1.02 to just one.63) into multivariable investigation ( Dining table dos and you can Figure step 1 , and you will Desk S2 about Second Appendix). The newest association anywhere between a high projected salt excretion (?seven.00 grams every day) as well as the first element benefit, big cardio incidents, and heart attack leading to demise otherwise hospitalization is attenuated and you may is no more extreme just after changes having blood pressure level otherwise past prognosis away from blood pressure level however, stayed tall getting death from one cause ( Desk 2 , and you can Desk S2 throughout the Secondary Appendix).