{"doi":"10.1056/nejmoa2109794","title":"24-Hour Urinary Sodium and Potassium Excretion and Cardiovascular Risk","abstract":"BACKGROUND: The relation between sodium intake and cardiovascular disease remains controversial, owing in part to inaccurate assessment of sodium intake. Assessing 24-hour urinary excretion over a period of multiple days is considered to be an accurate method. METHODS: We included individual-participant data from six prospective cohorts of generally healthy adults; sodium and potassium excretion was assessed with the use of at least two 24-hour urine samples per participant. The primary outcome was a cardiovascular event (coronary revascularization or fatal or nonfatal myocardial infarction or stroke). We analyzed each cohort using consistent methods and combined the results using a random-effects meta-analysis. RESULTS: Among 10,709 participants, who had a mean (±SD) age of 51.5±12.6 years and of whom 54.2% were women, 571 cardiovascular events were ascertained during a median study follow-up of 8.8 years (incidence rate, 5.9 per 1000 person-years). The median 24-hour urinary sodium excretion was 3270 mg (10th to 90th percentile, 2099 to 4899). Higher sodium excretion, lower potassium excretion, and a higher sodium-to-potassium ratio were all associated with a higher cardiovascular risk in analyses that were controlled for confounding factors (P≤0.005 for all comparisons). In analyses that compared quartile 4 of the urinary biomarker (highest) with quartile 1 (lowest), the hazard ratios were 1.60 (95% confidence interval [CI], 1.19 to 2.14) for sodium excretion, 0.69 (95% CI, 0.51 to 0.91) for potassium excretion, and 1.62 (95% CI, 1.25 to 2.10) for the sodium-to-potassium ratio. Each daily increment of 1000 mg in sodium excretion was associated with an 18% increase in cardiovascular risk (hazard ratio, 1.18; 95% CI, 1.08 to 1.29), and each daily increment of 1000 mg in potassium excretion was associated with an 18% decrease in risk (hazard ratio, 0.82; 95% CI, 0.72 to 0.94). CONCLUSIONS: Higher sodium and lower potassium intakes, as measured in multiple 24-hour urine samples, were associated in a dose-response manner with a higher cardiovascular risk. These findings may support reducing sodium intake and increasing potassium intake from current levels. (Funded by the American Heart Association and the National Institutes of Health.).","journal":"New England Journal of Medicine","year":2021,"id":145907,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":290,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9026,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":103406,"name":"Feng J. He","orcid":"0000-0003-2807-4119","position":1,"is_corresponding":false},{"id":594965,"name":"Qi Sun","orcid":"0009-0003-5107-1909","position":2,"is_corresponding":false},{"id":267715,"name":"Changzheng Yuan","orcid":"0000-0002-2389-8752","position":3,"is_corresponding":false},{"id":620013,"name":"Lyanne M. Kieneker","orcid":null,"position":4,"is_corresponding":false},{"id":268733,"name":"Gary C. Curhan","orcid":"0000-0001-7386-6305","position":5,"is_corresponding":false},{"id":620014,"name":"Graham A. MacGregor","orcid":null,"position":6,"is_corresponding":false},{"id":620015,"name":"Stephan J.L. Bakker","orcid":null,"position":7,"is_corresponding":false},{"id":385982,"name":"Norm R.C. Campbell","orcid":"0000-0002-1093-4742","position":8,"is_corresponding":false},{"id":131778,"name":"Molin Wang","orcid":"0000-0003-1951-8961","position":9,"is_corresponding":false},{"id":14733,"name":"Eric B. Rimm","orcid":"0000-0002-1402-7250","position":10,"is_corresponding":false},{"id":11268,"name":"JoAnn E. Manson","orcid":"0000-0002-9426-7595","position":11,"is_corresponding":false},{"id":104570,"name":"Walter C. Willett","orcid":"0000-0003-1458-7597","position":12,"is_corresponding":false},{"id":361118,"name":"Albert Hofman","orcid":"0009-0007-3564-3267","position":13,"is_corresponding":false},{"id":21877,"name":"Ron T. Gansevoort","orcid":"0000-0002-3223-0906","position":14,"is_corresponding":false},{"id":232625,"name":"Nancy R. Cook","orcid":"0000-0002-9705-0842","position":15,"is_corresponding":false},{"id":240837,"name":"Frank B. Hu","orcid":"0000-0002-8412-2261","position":16,"is_corresponding":false},{"id":619256,"name":"Yuan Ma","orcid":"0000-0002-0207-3620","position":0,"is_corresponding":true}],"reference_count":34,"raw_metadata":null,"created_at":"2026-07-18T23:42:12.871665Z","pmid":"34767706","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}