Urinary sodium and potassium, and risk of ischemic and hemorrhagic stroke (INTERSTROKE): A case–control study
O'Donnell, Martin J.
Hankey, Graeme J.
Chin, Siu Lim
Dans, Antonio L.
Ogah, Okechukwu S.
Iversen, Helle K.
Hussain, Fawaz Al
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Judge, Conor, O’Donnell, Martin J, Hankey, Graeme J, Rangarajan, Sumathy, Chin, Siu Lim, Rao-Melacini, Purnima, Ferguson, John, Smyth, Andrew, Xavier, Denis, Lisheng, Liu, Zhang, Hongye, Lopez-Jaramillo, Patricio, Damasceno, Albertino, Langhorne, Peter, Rosengren, Annika, Dans, Antonio L., Elsayed, Ahmed, Avezum, Alvaro, Mondo, Charles, Ryglewicz, Danuta, Czlonkowska, Anna, Pogosova, Nana, Weimar, Christian, Diaz, Rafael, Yusoff, Khalid, Yusufali, Afzalhussein, Oguz, Aytekin, Wang, Xingyu, Lanas, Fernando, Ogah, Okechukwu S., Ogunniyi, Adesola,,, Iversen, Helle K., Malaga, German, Rumboldt, Zvonko, Oveisgharan, Shahram, Al Hussain, Fawaz, Yusuf, Salim. (2020). Urinary Sodium and Potassium, and Risk of Ischemic and Hemorrhagic Stroke (INTERSTROKE): A Case–Control Study. American Journal of Hypertension. doi:10.1093/ajh/hpaa176
Although low sodium intake (3·5g/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 and its subtypes. We obtained random urine samples from 9,275 cases of acute first stroke and 9,726 matched controls (8,761 matched pairs for conditional analysis) 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. The mean estimated 24-hour sodium and potassium urinary excretion was 3·29g/day and 1·57g/day, with 0·01% of participants having both low sodium (3·5g/day). There was a moderate positive correlation between sodium and potassium excretion (r=0·4435, P4·26g/day) (OR 1.81;95%CI,1.65-2.00) and lower (4·26g/day) was significantly greater (P1·58g/day) and moderate sodium intake (2.8-3.5 g/day) was associated with the lowest risk of stroke. The association of sodium intake and stroke is J-shaped, with high sodium intake a stronger risk factor for intracerebral haemorrhage 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.