MedicalResearch.com Interview with:
Jiang He, M.D., Ph.D.
Joseph S. Copes Chair and Professor
Department of Epidemiology
School of Public Health and Tropical Medicine
Tulane University, New Orleans
MedicalResearch: What is the background for this study?
Dr. Jiang He: Chronic kidney disease is associated with increased risk of end-stage renal disease, cardiovascular disease, and all-cause mortality. A positive association between sodium intake and blood pressure is well established in observational studies and clinical trials. However, the association between sodium intake and clinical cardiovascular disease remains less clear. Positive monotonic, J-shaped, and U-shaped associations have been reported. Methodologic limitations, including inconsistencies in dietary sodium measurement methods, could be contributing to these conflicting findings. Furthermore, no previous studies have examined the association between sodium intake and incident cardiovascular disease among patients with chronic kidney disease.
MedicalResearch: What are the main findings?
Dr. Jiang He: We studied the prospective relationship between urinary sodium excretion, estimated from the mean of three repeated 24-hour urine samples, and risk of clinical cardiovascular disease among 3,757 patients with chronic kidney disease enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study. We found a positive and significant association between urinary sodium excretion (a good measure of dietary sodium intake) and risk of composite cardiovascular disease (myocardial infarction, heart failure, and stroke). From the lowest to the highest quartile of sodium excretion, the cumulative incidence of composite cardiovascular disease at median follow-up of 6.8 years was 18.4%, 16.5%, 20.6%, and 29.8%, respectively, p for difference
MedicalResearch: What should readers take away from your report?
Dr. Jiang He: Our study documented a significantly increased risk of cardiovascular disease in those with high urinary sodium excretion independent of several important cardiovascular risk factors including use of antihypertensive medications, baseline kidney function, and history of cardiovascular disease. These findings, if confirmed by clinical trials, suggest that moderate sodium reduction among patients with chronic kidney disease and high sodium intake may lower cardiovascular disease risk.
MedicalResearch: What recommendations do you have for future research as a result of this study?
Dr. Jiang He: Future randomized controlled trials should recommend testing the effect of sodium reduction on risk of cardiovascular disease.
Katherine T. Mills, Jing Chen, Wei Yang, Lawrence J. Appel, John W. Kusek, Arnold Alper, Patrice Delafontaine, Martin G. Keane, Emile Mohler, Akinlolu Ojo, Mahboob Rahman, Ana C. Ricardo, Elsayed Z. Soliman, Susan Steigerwalt, Raymond Townsend, Jiang He. Sodium Excretion and the Risk of Cardiovascular Disease in Patients With Chronic Kidney Disease. JAMA, 2016; 315 (20): 2200 DOI:10.1001/jama.2016.4447
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