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- Title
Sodium Intake and Incident Atrial Fibrillation in Individuals With Vascular Disease.
- Authors
Johnson, Linda S.; Mente, Andrew; Joseph, Philip; Conen, David; Benz, Alexander P.; McIntyre, William F.; Drake, Isabel; Engström, Gunnar; Connolly, Stuart J.; Yusuf, Salim; Healey, Jeffrey S.
- Abstract
Key Points: Question: Is estimated sodium intake associated with atrial fibrillation (AF) risk in individuals with vascular disease? Findings: In this cohort study among 27 391 participants with vascular disease or high-risk diabetes enrolled in the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial and Telmisartan Randomised Assessment Study in ACE Intolerant Subjects With Cardiovascular Disease trials, there was an independent J-shaped association between estimated sodium intake and atrial fibrillation incidence. Sodium intakes greater than 6 g/d were associated with 10% increase in risk for each additional 1 g of sodium consumed. Meaning: These findings suggest that lowering sodium intake for AF prevention is best targeted at individuals who consume high sodium diets exceeding 6 g per day. This cohort study assesses the association of daily sodium intake with risk of incident atrial fibrillation among individuals with vascular disease. Importance: Numerous prospective cohort studies have reported a J-shaped association of urinary sodium excretion with cardiovascular events and mortality. Objective: To study the association between sodium intake and incident atrial fibrillation (AF). Design, Setting, and Participants: This cohort study included participants in the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial (ONTARGET) and Telmisartan Randomised Assessment Study in ACE Intolerant Subjects With Cardiovascular Disease (TRANSCEND) multicenter, randomized clinical trials comparing the effect of ramipril 10 mg daily with telmisartan 80 mg daily, or their combination (ONTARGET) or 80 mg telmisartan daily with placebo (TRANSCEND) for the outcome of death from cardiovascular causes, myocardial infarction, stroke, or hospitalization for heart failure. ONTARGET and TRANSCEND included 31 546 participants with vascular disease or high-risk diabetes, and this study excluded participants without a urine sample for sodium measurement, missing data for key covariates, a history of AF, or AF detected in the first year after enrollment. Analyses were performed in July 2023 to May 2024. Exposure: Estimated sodium intake from a morning fasting urine sample (Kawasaki formula). Main Outcomes and Measures: The main outcome was incident AF. The association between estimated sodium intake and incident AF was modeled using multivariable adjusted Cox regression and cubic splines. Results: A total of 27 391 participants (mean [SD] age, 66.3 [7.2] years; 19 310 [70.5%] male) were included. Mean (SD) estimated sodium intake was 4.8 (1.6) g/d. During a mean (SD) follow-up of 4.6 (1.0) years, 1562 participants (5.7%) had incident AF. After multivariable adjustment, a J-shaped association between sodium intake and AF risk was observed (P for nonlinearity =.03). Sodium intake of 8 g/d or greater (3% of participants) was associated with incident AF (hazard ratio, 1.32; 95% CI, 1.01-1.74) compared with sodium intake of 4 to 5.99 g/d. Cubic splines showed that sodium intake greater than 6 g/d (19% of participants) was associated with a 10% increased AF risk per additional 1-g/d sodium intake (hazard ratio, 1.10; 95% CI, 1.03-1.18), but with no further lowering of AF risk at lower levels of sodium intake. Conclusions and Relevance: In this cohort study of sodium intake and AF risk, there was a J-shaped association between sodium intakes and AF risk in patients with cardiovascular disease or diabetes. Lowering sodium intake for AF prevention is best targeted at individuals who consume high sodium diets.
- Subjects
ATRIAL fibrillation risk factors; RISK assessment; PREPROCEDURAL fasting; RESEARCH funding; HYPERTENSION; SALT-free diet; DESCRIPTIVE statistics; MULTIVARIATE analysis; DIURETICS; CARDIOVASCULAR diseases risk factors; DIETARY sodium; LONGITUDINAL method; FOOD habits; SODIUM; DATA analysis software; VASCULAR diseases; DIET; COMORBIDITY
- Publication
JAMA Network Open, 2024, Vol 7, Issue 7, pe2421589
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.21589