TY - JOUR
T1 - Urinary Sodium and Potassium, and Risk of Ischemic and Hemorrhagic Stroke (INTERSTROKE)
T2 - A Case-Control Study
AU - Judge, Conor
AU - O'Donnell, Martin J.
AU - Hankey, Graeme J.
AU - Rangarajan, Sumathy
AU - Chin, Siu Lim
AU - Rao-Melacini, Purnima
AU - Ferguson, John
AU - Smyth, Andrew
AU - Xavier, Denis
AU - Lisheng, Liu
AU - Zhang, Hongye
AU - Lopez-Jaramillo, Patricio
AU - Damasceno, Albertino
AU - Langhorne, Peter
AU - Rosengren, Annika
AU - Dans, Antonio L.
AU - Elsayed, Ahmed
AU - Avezum, Alvaro
AU - Mondo, Charles
AU - Ryglewicz, Danuta
AU - Czlonkowska, Anna
AU - Pogosova, Nana
AU - Weimar, Christian
AU - Diaz, Rafael
AU - Yusoff, Khalid
AU - Yusufali, Afzalhussein
AU - Oguz, Aytekin
AU - Wang, Xingyu
AU - Lanas, Fernando
AU - Ogah, Okechukwu S.
AU - Ogunniyi, Adesola
AU - Iversen, Helle K.
AU - Malaga, German
AU - Rumboldt, Zvonko
AU - Oveisgharan, Shahram
AU - Al Hussain, Fawaz
AU - Yusuf, Salim
N1 - Publisher Copyright:
© 2020 The Author(s) 2020. Published by Oxford University Press on behalf of American Journal of Hypertension, Ltd.
PY - 2021/4/1
Y1 - 2021/4/1
N2 - Although low sodium intake (<2 g/day) and high potassium intake (>3.5 g/day) are proposed as public health interventions to reduce stroke risk, there is uncertainty about the benefit and feasibility of this combined recommendation on prevention of stroke. METHODS: We obtained random urine samples from 9,275 cases of acute first stroke and 9,726 matched controls from 27 countries and estimated the 24-hour sodium and potassium excretion, a surrogate for intake, using the Tanaka formula. Using multivariable conditional logistic regression, we determined the associations of estimated 24-hour urinary sodium and potassium excretion with stroke and its subtypes. RESULTS: Compared with an estimated urinary sodium excretion of 2.8-3.5 g/day (reference), higher (>4.26 g/day) (odds ratio [OR] 1.81; 95% confidence interval [CI], 1.65-2.00) and lower (<2.8 g/day) sodium excretion (OR 1.39; 95% CI, 1.26-1.53) were significantly associated with increased risk of stroke. The stroke risk associated with the highest quartile of sodium intake (sodium excretion >4.26 g/day) was significantly greater (P < 0.001) for intracerebral hemorrhage (ICH) (OR 2.38; 95% CI, 1.93-2.92) than for ischemic stroke (OR 1.67; 95% CI, 1.50-1.87). Urinary potassium was inversely and linearly associated with risk of stroke, and stronger for ischemic stroke than ICH (P = 0.026). In an analysis of combined sodium and potassium excretion, the combination of high potassium intake (>1.58 g/day) and moderate sodium intake (2.8-3.5 g/day) was associated with the lowest risk of stroke. CONCLUSIONS: The association of sodium intake and stroke is J-shaped, with high sodium intake a stronger risk factor for ICH than ischemic stroke. Our data suggest that moderate sodium intake - rather than low sodium intake - combined with high potassium intake may be associated with the lowest risk of stroke and expected to be a more feasible combined dietary target.
AB - Although low sodium intake (<2 g/day) and high potassium intake (>3.5 g/day) are proposed as public health interventions to reduce stroke risk, there is uncertainty about the benefit and feasibility of this combined recommendation on prevention of stroke. METHODS: We obtained random urine samples from 9,275 cases of acute first stroke and 9,726 matched controls from 27 countries and estimated the 24-hour sodium and potassium excretion, a surrogate for intake, using the Tanaka formula. Using multivariable conditional logistic regression, we determined the associations of estimated 24-hour urinary sodium and potassium excretion with stroke and its subtypes. RESULTS: Compared with an estimated urinary sodium excretion of 2.8-3.5 g/day (reference), higher (>4.26 g/day) (odds ratio [OR] 1.81; 95% confidence interval [CI], 1.65-2.00) and lower (<2.8 g/day) sodium excretion (OR 1.39; 95% CI, 1.26-1.53) were significantly associated with increased risk of stroke. The stroke risk associated with the highest quartile of sodium intake (sodium excretion >4.26 g/day) was significantly greater (P < 0.001) for intracerebral hemorrhage (ICH) (OR 2.38; 95% CI, 1.93-2.92) than for ischemic stroke (OR 1.67; 95% CI, 1.50-1.87). Urinary potassium was inversely and linearly associated with risk of stroke, and stronger for ischemic stroke than ICH (P = 0.026). In an analysis of combined sodium and potassium excretion, the combination of high potassium intake (>1.58 g/day) and moderate sodium intake (2.8-3.5 g/day) was associated with the lowest risk of stroke. CONCLUSIONS: The association of sodium intake and stroke is J-shaped, with high sodium intake a stronger risk factor for ICH than ischemic stroke. Our data suggest that moderate sodium intake - rather than low sodium intake - combined with high potassium intake may be associated with the lowest risk of stroke and expected to be a more feasible combined dietary target.
KW - blood pressure
KW - hypertension
KW - intracerebral hemorrhage
KW - ischemic stroke
KW - potassium
KW - sodium
KW - stroke
UR - https://www.scopus.com/pages/publications/85105696305
U2 - 10.1093/ajh/hpaa176
DO - 10.1093/ajh/hpaa176
M3 - Article
C2 - 33197265
AN - SCOPUS:85105696305
SN - 0895-7061
VL - 34
SP - 414
EP - 425
JO - American Journal of Hypertension
JF - American Journal of Hypertension
IS - 4
ER -
SDG 3 Good Health and Well-being