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Dietary Sodium Intake and Atherosclerosis

Published: 11 Apr 2023

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Investigator, Dr Jonas Wuopio (Karolinska Institute, SE) outlines the findings from a study aimed to investigate the link between salt intake and carotid and coronary atherosclerosis in 10 778 participants from the Swedish SCAPIS cohort.

A recent study published in the European Heart Journal Open is the first to report the association between sodium excretion and sub-clinical coronary atherosclerosis measured with computed tomography in a general population.

The study found that increased sodium excretion was significantly associated with carotid atherosclerosis, coronary artery stenosis, and overall coronary artery calcification. However, when adjusting for blood pressure, the association disappeared, suggesting that elevated blood pressure from sodium intake, even below the threshold for defining arterial hypertension, plays a crucial role in the development of atherosclerosis.

Questions:

  1. What was the rationale behind this study?
  2. What was the patient population and study design?
  3. What were the main findings?
  4. How should these findings impact practice and clinical decision-making?
  5. What further study is needed?

Recorded remotely from Solna, 2023. 

Sources: 

Wuopio, J, Ling, Y, Orho-Melander, M, et al. The association between sodium intake and coronary and carotid atherosclerosis in the general Swedish population. European Heart Journal Open. 2023;3:2:oead024. 

Transcript

"- My name is Jonas Wuopio. I'm a specialist in internal medicine and I am also a doctoral student at Karolinska Institute and Clinical Research Centre, Falun, Sweden, Uppsala University.

Study Rationale

Several studies in the past, looked at salt intake and cardiovascular risk and mortality but none have studied the actual changes in the arteries from salt intake. And we had this explicit data so we wanted to close this knowledge gap.

Patient Population and Study Design

This is a cross-sectional study and we used a cohort called SCAPIS, the Swedish CArdioPulmonary bioImage Study, where participants had been recruited from the general population in the age 50 to 64 years old. We had almost 11,000 participants, 10,778, and we used spot urine samples for measuring sodium intake or estimating sodium intake. Then we had three measurements for atherosclerosis. The first were the overall calcifications in the arteries in the heart that is measured with the coronary artery calcium score or CACS. Then we had also data for how many and how severe the stenosis in the coronary arteries, and we also had the data for the atherosclerosis in the carotids in the neck. So we studied the association between salt intake and these measurements.

Main Findings

The main finding is that for every increase in sodium intake, there is a higher risk of finding atherosclerosis in the coronary arteries and in the carotids. And this is also the case among individuals without hypertension or known cardiovascular disease.

Impact on Practice and Clinical Descision Making

I believe doctors should emphasise the advices given by World Health Organisation or other medical societies to limit the salt intake to about a teaspoon a day, and that this not just include those patients with hypertension or known cardiovascular disease.

Next Steps

I think there is a consensus in the research society that a high amount of salt intake causes hypertension and atherosclerosis. There is a little controversy around a very low intake, if it's beneficial or in fact harmful. My research will focus more on the pathological mechanism behind the association between salt intake and atherosclerosis because this is not known in its details.

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