Dietary Sodium Intake and Risk of Cardiovascular Disease: A Systematic Review and Dose-Response Meta-Analysis

Yi-Jie Wang, Tzu-Lin Yeh, Ming-Chieh Shih, Yu-Kang Tu, Kuo-Liong Chien, Yi-Jie Wang, Tzu-Lin Yeh, Ming-Chieh Shih, Yu-Kang Tu, Kuo-Liong Chien

Abstract

Dietary sodium intake has received considerable attention as a potential risk factor of cardiovascular disease. However, evidence on the dose-response association between dietary sodium intake and cardiovascular disease risk is unclear. Embase and PubMed were searched from their inception to 17 August 2020 and studies that examined the association between sodium intake and cardiovascular disease in adolescents were not included in this review. We conducted a meta-analysis to estimate the effect of high sodium intake using a random effects model. The Newcastle-Ottawa Scale assessment was performed. A random-effects dose-response model was used to estimate the linear and nonlinear dose-response relationships. Subgroup analyses and meta-regression were conducted to explain the observed heterogeneity. We identified 36 reports, which included a total of 616,905 participants, and 20 of these reports were also used for a dose-response meta-analysis. Compared with individuals with low sodium intake, individuals with high sodium intake had a higher adjusted risk of cardiovascular disease (Rate ratio: 1.19, 95% confidence intervals = 1.08-1.30). Our findings suggest that there is a significant linear relationship between dietary sodium intake and cardiovascular disease risk. The risk of cardiovascular disease increased up to 6% for every 1 g increase in dietary sodium intake. A low-sodium diet should be encouraged and education regarding reduced sodium intake should be provided.

Keywords: 24 h urinary sodium excretion; cardiovascular disease; cardiovascular mortality; dose-response meta-analysis; sodium intake.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of the literature search for studies investigating association between dietary sodium intake and the risk of cardiovascular disease. Abbreviation: CVD, cardiovascular disease; RRs:Rate ratios.
Figure 2
Figure 2
Forest plot of total cardiovascular disease1 for highest versus lowest categories of dietary sodium intake in 24 studies. 1: Total cardiovascular disease. This included total cardiovascular disease, cardiovascular disease mortality, stroke, coronary heart disease, myocardial infarction and heart failure. Abbreviation: RR: Rate ratios;CI: confidence interval.
Figure 3
Figure 3
The linear (A) and non-linear (B) association of dietary sodium intake and cardiovascular disease. A, Heterogeneity: I2 = 72%; p ≤ 0.0001; B, Heterogeneity: I2 = 58%; p ≤ 0.0001.

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