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).
Investigation Participants and you will Consequences
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.
Committee A says a restricted-cubic-spline area of one’s association between projected 24-hr urinary sodium removal while the element outcome of death regarding any trigger and significant aerobic situations. New spline bend was truncated during the g a-day (feel speed certainly one of professionals having sodium removal > grams every day, 8 situations in 305 users). Panel B reveals a limited-cubic-spline spot of relationship anywhere between estimated sodium removal and you may death. Case price among participants having sodium excretion greater than g on a daily basis is actually 5 occurrences inside the 305 people. Panel C reveals a finite-cubic-spline patch of the relationship ranging from projected salt removal and you may big cardio events (recognized as dying from cardiovascular factors, myocardial infarction, stroke, otherwise center inability). The big event rate certainly players having salt excretion greater than grams a day try 6 occurrences into the 305 participants. All plots was adjusted to own decades, intercourse, geographic region, academic peak, origins (Far eastern versus. non-Asian), alcoholic beverages consumption, body-bulk list, and you will standing in terms of all forms of diabetes mellitus, reputation of aerobic situations, and most recent smoking. Dashed outlines indicate 95% depend on periods. This new average sodium removal (4.72 g everyday) are the fresh new site standard, conveyed from the red-colored line. To alter the prices to have estimated sodium removal so you can sodium consumption into the g just about every day, multiply because of the 2.5.
As compared with an estimated salt excretion of cuatro.00 in order to 5.99 g every day (new site class), projected excretion from seven.00 g just about every day or maybe more was associated with the improved threats of your primary substance consequences (chances proportion, step one.15; 95% trust interval [CI], 1.02 to a single.30), dying regarding one lead to (odds ratio, step one.25; 95% CI, step 1.07 to at least one.48), a major cardiovascular skills (opportunity proportion, step one.16; 95% CI, step 1.01 to a single.34), passing off aerobic grounds (opportunity proportion, step 1.54; 95% CI, 1.21 to 1.95), and you will coronary arrest causing death otherwise hospitalization (opportunity proportion, step one.29; 95% CI, 1.02 to at least one.63) to the multivariable data ( Table dos and you will Profile step one , and you will Dining table S2 on Secondary Appendix). The new organization between a premier projected sodium excretion (?seven.00 g a day) and the first ingredient result, biggest cardio occurrences, and you can coronary arrest causing demise or hospitalization is attenuated and you can was not any longer tall just after modifications to own blood pressure levels or earlier diagnosis away from blood pressure levels but remained significant to own dying of any trigger ( Dining table 2 , and Table S2 regarding Second Appendix).