JOURNAL ARTICLE

Dietary sodium content, mortality, and risk for cardiovascular events in older adults: the Health, Aging, and Body Composition (Health ABC) Study

Andreas P Kalogeropoulos, Vasiliki V Georgiopoulou, Rachel A Murphy, Anne B Newman, Douglas C Bauer, Tamara B Harris, Zhou Yang, William B Applegate, Stephen B Kritchevsky
JAMA Internal Medicine 2015, 175 (3): 410-9
25599120

IMPORTANCE: Additional information is needed about the role of dietary sodium on health outcomes in older adults.

OBJECTIVE: To examine the association between dietary sodium intake and mortality, incident cardiovascular disease (CVD), and incident heart failure (HF) in older adults.

DESIGN, SETTING, AND PARTICIPANTS: We analyzed 10-year follow-up data from 2642 older adults (age range, 71-80 years) participating in a community-based, prospective cohort study (inception between April 1, 1997, and July 31, 1998).

EXPOSURES: Dietary sodium intake at baseline was assessed by a food frequency questionnaire. We examined sodium intake as a continuous variable and as a categorical variable at the following levels: less than 1500 mg/d (291 participants [11.0%]), 1500 to 2300 mg/d (779 participants [29.5%]), and greater than 2300 mg/d (1572 participants [59.5%]).

MAIN OUTCOMES AND MEASURES: Adjudicated death, incident CVD, and incident HF during 10 follow-up years. Analysis of incident CVD was restricted to 1981 participants without prevalent CVD at baseline.

RESULTS: The mean (SD) age of participants was 73.6 (2.9) years, 51.2% were female, 61.7% were of white race, and 38.3% were black. After 10 years, 881 participants had died, 572 had developed CVD, and 398 had developed HF. In adjusted Cox proportional hazards regression models, sodium intake was not associated with mortality (hazard ratio [HR] per 1 g, 1.03; 95% CI, 0.98-1.09; P = .27). Ten-year mortality was nonsignificantly lower in the group receiving 1500 to 2300 mg/d (30.7%) than in the group receiving less than 1500 mg/d (33.8%) and the group receiving greater than 2300 mg/d (35.2%) (P = .07). Sodium intake of greater than 2300 mg/d was associated with nonsignificantly higher mortality in adjusted models (HR vs 1500-2300 mg/d, 1.15; 95% CI, 0.99-1.35; P = .07). Indexing sodium intake for caloric intake and body mass index did not materially affect the results. Adjusted HRs for mortality were 1.20 (95% CI, 0.93-1.54; P = .16) per milligram per kilocalorie and 1.11 (95% CI, 0.96-1.28; P = .17) per 100 mg/kg/m2 of daily sodium intake. In adjusted models accounting for the competing risk for death, sodium intake was not associated with risk for CVD (subHR per 1 g, 1.03; 95% CI, 0.95-1.11; P = .47) or HF (subHR per 1 g, 1.00; 95% CI, 0.92-1.08; P = .92). No consistent interactions with sex, race, or hypertensive status were observed for any outcome.

CONCLUSIONS AND RELEVANCE: In older adults, food frequency questionnaire-assessed sodium intake was not associated with 10-year mortality, incident CVD, or incident HF, and consuming greater than 2300 mg/d of sodium was associated with nonsignificantly higher mortality in adjusted models.

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Elliott Antman

As president of the AHA, I have posted an extensive post on the limitations of this study at http://blog.heart.org/aha-president-points-problems-new-study-urges-sodium-limits

Let me emphasize the most important point of the post: Everyone, except those with specific and rare medical conditions or circumstances, should take in less than 1,500 milligrams of sodium a day.

10

Emily Ann Miller

As an American Heart Association staff person, I would like to add to Dr. Antman's comment. The same methodological concerns with this study on sodium and older adults also exist in other observational studies that suggests higher-than-recommended sodium intakes are better for cardiovascular health. In each of these cases, the AHA’s scientists have reiterated their concerns about the research’s limitations. The AHA also published a science advisory that explains these limitations and why they should warrant caution in using this research to set population sodium intake guidelines: http://circ.ahajournals.org/content/129/10/1173

2

jk punjabi

Low salt diet definitely helps controlling HBP in elderly.

2

Alexander Aviram

My very extensive clinical experience allows me to speculate that, at least as hypertension is concerned, there are two populations of patients: the sodium sensitive and the sodium non-sensitive.

1

Julie Jimenez

Thank you for this great info:)

-1

Ahmed Fadel

Thanks for these valuable date
I think the results will be changed if we consider factors like the climate. In our practice low serum sodium sometimes associate with disturbance of consciousness like semi coma. That improved by replacement. And sometimes we advice increase salt salads for some periods to normalized symptoms. I think better moderate balance in diet and no restriction for those using diuretics including antihypertensive drugs combine with HCT.

-4

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