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High sodium intake and sodium to potassium ratio may be linked to subsequent increase in vascular damage in adults aged 40 years and older: the Korean multi-rural communities cohort (MRCohort)

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Abstract

Purpose

Subclinical vascular damage is a chronic intermediate process in cardiovascular disease (CVD) and high sodium (Na) has been regarded as an adverse factor in subclinical vascular health; however, the longitudinal relationship between Na intake and subclinical vascular damage has not been studied. We aimed to evaluate the longitudinal relationship of dietary Na intake and sodium to potassium ratio (Na:K) with brachial-ankle pulse wave velocity (baPWV) and carotid intima media thickness (cIMT) in healthy adults aged 40 years and older in Korea.

Methods

The present study was based on participants (n = 2145 for baPWV analysis and n = 2494 for cIMT analysis) who visited three times during 2005–2013 (median 5.3 years of follow-up). We used both dietary Na intake and Na:K at baseline and its average (baseline, 2nd, 3rd), which was obtained from food frequency questionnaire (FFQ) as exposure at every visit. baPWV and cIMT levels at the third visit and change from baseline to the third visit were used to represent the level of subclinical vascular damage.

Results

After adjustment for potential confounders, significant positive relationships between dietary Na intake and both baPWV3rd and cIMT3rd were observed (baPWV: p for trend ≤ 0.0001 for Naaverage; cIMT: p for trend = 0.013 for Naaverage). Compared with Na:Ks less than 1.0, the levels of both baPWV and cIMT were higher for participants with Na:Ks over 1.0 (baPWV: p for trend = 0.0002 for Na:Kaverage; cIMT: p for trend = 0.005 for Na:Kaverage). Similar significant trends were shown in relationships between dietary Na intake and Na:K and changes in baPWV and cIMT levels.

Conclusions

In conclusion, dietary Na intake and Na:K may be positively linked to subsequent baPWV and cIMT levels in adults aged 40 years and older in Korea. Our findings may provide informative evidence on subclinical vascular damage, particularly for populations with relatively high dietary Na intake and low dietary K intake.

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References

  1. Palombo C, Kozakova M (2016) Arterial stiffness, atherosclerosis and cardiovascular risk: pathophysiologic mechanisms and emerging clinical indications. Vascul Pharmacol 77:1–7. https://doi.org/10.1016/j.vph.2015.11.083

    Article  CAS  PubMed  Google Scholar 

  2. Wang TJ (2011) Assessing the role of circulating, genetic, and imaging biomarkers in cardiovascular risk prediction. Circulation 123(5):551–565

    Article  PubMed  PubMed Central  Google Scholar 

  3. MacLellan WR, Wang Y, Lusis AJ (2012) Systems-based approaches to cardiovascular disease. Nat Rev Cardiol 9(3):172–184. https://doi.org/10.1038/nrcardio.2011.208

    Article  CAS  PubMed  Google Scholar 

  4. Taivainen SH, Yli-Ollila H, Juonala M, Kahonen M, Raitakari OT, Laitinen TM, Laitinen TP (2017) Interrelationships between indices of longitudinal movement of the common carotid artery wall and the conventional measures of subclinical arteriosclerosis. Clin Physiol Funct Imaging 37(3):305–313. https://doi.org/10.1111/cpf.12305

    Article  PubMed  Google Scholar 

  5. Degrell P, Sorbets E, Feldman LJ, Steg PG, Ducrocq G (2015) Screening for coronary artery disease in asymptomatic individuals: why and how? Arch Cardiovasc Dis 108(12):675–682. https://doi.org/10.1016/j.acvd.2015.10.001

    Article  PubMed  Google Scholar 

  6. Ohkuma T, Ninomiya T, Tomiyama H, Kario K, Hoshide S, Kita Y, Inoguchi T, Maeda Y, Kohara K, Tabara Y, Nakamura M, Ohkubo T, Watada H, Munakata M, Ohishi M, Ito N, Nakamura M, Shoji T, Vlachopoulos C, Yamashina A (2017) Brachial-ankle pulse wave velocity and the risk prediction of cardiovascular disease: an individual participant data meta-analysis. Hypertension 69(6):1045–1052. https://doi.org/10.1161/hypertensionaha.117.09097

    Article  CAS  PubMed  Google Scholar 

  7. Bauer M, Caviezel S, Teynor A, Erbel R, Mahabadi AA, Schmidt-Trucksass A (2012) Carotid intima-media thickness as a biomarker of subclinical atherosclerosis. Swiss Med Wkly 142:w13705. https://doi.org/10.4414/smw.2012.13705

    Article  PubMed  Google Scholar 

  8. Tomiyama H, Yamashina A (2010) Non-invasive vascular function tests. Circ J 74(1):24–33

    Article  PubMed  Google Scholar 

  9. Simon A, Megnien J-L, Chironi G (2010) The value of carotid intima-media thickness for predicting cardiovascular risk. Arterioscler Thromb Vasc Biol 30(2):182–185

    Article  CAS  PubMed  Google Scholar 

  10. Edwards DG, Farquhar WB (2015) Vascular effects of dietary salt. Curr Opin Nephrol Hypertens 24(1):8–13. https://doi.org/10.1097/mnh.0000000000000089

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Sanders PW (2009) Vascular consequences of dietary salt intake. Am J Physiol Renal Physiol 297(2):F237-243. https://doi.org/10.1152/ajprenal.00027.2009

    Article  CAS  Google Scholar 

  12. Zieman SJ, Melenovsky V, Kass DA (2005) Mechanisms, pathophysiology, and therapy of arterial stiffness. Arterioscler Thromb Vasc Biol 25(5):932–943. https://doi.org/10.1161/01.atv.0000160548.78317.29

    Article  CAS  PubMed  Google Scholar 

  13. Powles J, Fahimi S, Micha R, Khatibzadeh S, Shi P, Ezzati M, Engell RE, Lim SS, Danaei G, Mozaffarian D (2013) Global, regional and national sodium intakes in 1990 and 2010: a systematic analysis of 24 h urinary sodium excretion and dietary surveys worldwide. BMJ Open 3(12):e003733. https://doi.org/10.1136/bmjopen-2013-003733

    Article  PubMed  PubMed Central  Google Scholar 

  14. Prevention KCfDCa (2017) Korea health statistics 2015: Korea National Health and Nutritional Examination Survey (KNHANES VI-3). Korea Centers for Disease Control and Prevention, Cheongju, Korea

    Google Scholar 

  15. Kim HJ, Oh K (2014) Methodological issues in estimating sodium intake in the Korea National Health and Nutrition Examination Survey. Epidemiol Health 36

  16. Garcia-Ortiz L, Recio-Rodriguez JI, Rodriguez-Sanchez E, Patino-Alonso MC, Agudo-Conde C, Rodriguez-Martin C, Castano-Sanchez C, Runkle I, Gomez-Marcos MA (2012) Sodium and potassium intake present a J-shaped relationship with arterial stiffness and carotid intima-media thickness. Atherosclerosis 225(2):497–503. https://doi.org/10.1016/j.atherosclerosis.2012.09.038

    Article  CAS  PubMed  Google Scholar 

  17. Dai XW, Wang C, Xu Y, Guan K, Su YX, Chen YM (2016) Urinary sodium and potassium excretion and carotid atherosclerosis in Chinese men and women. Nutrients. https://doi.org/10.3390/nu8100612

    Article  PubMed  PubMed Central  Google Scholar 

  18. Ferreira-Sae MC, Cipolli JA, Cornelio ME, Matos-Souza JR, Fernandes MN, Schreiber R, Costa FO, Franchini KG, Rodrigues RC, Gallani MC, Nadruz W Jr (2011) Sodium intake is associated with carotid artery structure alterations and plasma matrix metalloproteinase-9 upregulation in hypertensive adults. J Nutr 141(5):877–882. https://doi.org/10.3945/jn.110.135921

    Article  CAS  PubMed  Google Scholar 

  19. Gijsbers L, Dower JI, Mensink M, Siebelink E, Bakker SJ, Geleijnse JM (2015) Effects of sodium and potassium supplementation on blood pressure and arterial stiffness: a fully controlled dietary intervention study. J Hum Hypertens 29(10):592–598. https://doi.org/10.1038/jhh.2015.3

    Article  CAS  PubMed  Google Scholar 

  20. Wang Y, Mu JJ, Geng LK, Wang D, Ren KY, Guo TS, Chu C, Xie BQ, Liu FQ, Yuan ZY (2015) Effect of salt intake and potassium supplementation on brachial-ankle pulse wave velocity in Chinese subjects: an interventional study. Braz J Med Biol Res 48(1):83–90

    Article  PubMed  Google Scholar 

  21. Ahn Y, Kwon E, Shim JE, Park MK, Joo Y, Kimm K, Park C, Kim DH (2007) Validation and reproducibility of food frequency questionnaire for Korean genome epidemiologic study. Eur J Clin Nutr 61(12):1435–1441. https://doi.org/10.1038/sj.ejcn.1602657

    Article  CAS  PubMed  Google Scholar 

  22. The Korean Nutrition Society (2009) Food Values. The Korean Nutrition Society, Seoul, Korea

    Google Scholar 

  23. Yang Q, Liu T, Kuklina EV, Flanders WD, Hong Y, Gillespie C, Chang MH, Gwinn M, Dowling N, Khoury MJ, Hu FB (2011) Sodium and potassium intake and mortality among US adults: prospective data from the Third National Health and Nutrition Examination Survey. Arch Intern Med 171(13):1183–1191. https://doi.org/10.1001/archinternmed.2011.257

    Article  PubMed  Google Scholar 

  24. Perez V, Chang ET (2014) Sodium-to-potassium ratio and blood pressure, hypertension, and related factors. Adv Nutr 5(6):712–741. https://doi.org/10.3945/an.114.006783

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Yamashina A, Tomiyama H, Arai T, Hirose K, Koji Y, Hirayama Y, Yamamoto Y, Hori S (2003) Brachial-ankle pulse wave velocity as a marker of atherosclerotic vascular damage and cardiovascular risk. Hypertens Res 26(8):615–622

    Article  PubMed  Google Scholar 

  26. Shin J, Lee J, Lim HK, Lee BH, Kim MK, Choi BY (2005) The relationship between the pulse wave velocity (PWV) and the left ventricular geometry: a community-based cross-sectional study. Korean Circ J 35(9):683–689

    Article  Google Scholar 

  27. Friedewald WT, Levy RI, Fredrickson DS (1972) Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 18(6):499

    CAS  PubMed  Google Scholar 

  28. Willett W (2013) Nutritional epidemiology, vol 40, 3rd edn. Oxford University Press, NY

    Google Scholar 

  29. Hu FB, Stampfer MJ, Rimm E, Ascherio A, Rosner BA, Spiegelman D, Willett WC (1999) Dietary fat and coronary heart disease: a comparison of approaches for adjusting for total energy intake and modeling repeated dietary measurements. Am J Epidemiol 149(6):531–540

    Article  CAS  PubMed  Google Scholar 

  30. Organization WH (2012) WHO guidelines approved by the guidelines review committee. In: Guideline: sodium intake for adults and children. World Health Organization World Health Organization., Geneva

    Google Scholar 

  31. Munakata M (2016) Brachial-ankle pulse wave velocity: background, method, and clinical evidence. Pulse (Basel) 3(3–4):195–204. https://doi.org/10.1159/000443740

    Article  Google Scholar 

  32. Barnett AG, van der Pols JC, Dobson AJ (2005) Regression to the mean: what it is and how to deal with it. Int J Epidemiol 34(1):215–220. https://doi.org/10.1093/ije/dyh299

    Article  PubMed  Google Scholar 

  33. Yu R, Chen L (2014) The need to control for regression to the mean in social psychology studies. Front Psychol 5:1574. https://doi.org/10.3389/fpsyg.2014.01574

    Article  PubMed  Google Scholar 

  34. Prevention KCfDCa (2011) Korea health statistics 2011: Korea National Health and Nutritional Examination Survey (KNHANES 2010). Korea Centers for Disease Control and Prevention, Cheongju, Korea

    Google Scholar 

  35. Welfare MoHa (2015) Dietary Reference intakes for Koreans 2015. Sejong

  36. Cobb LK, Anderson CA, Elliott P, Hu FB, Liu K, Neaton JD, Whelton PK, Woodward M, Appel LJ (2014) Methodological issues in cohort studies that relate sodium intake to cardiovascular disease outcomes: a science advisory from the American Heart Association. Circulation 129(10):1173–1186. https://doi.org/10.1161/cir.0000000000000015

    Article  CAS  PubMed  Google Scholar 

  37. Maddock J, Ziauddeen N, Ambrosini GL, Wong A, Hardy R, Ray S (2018) Adherence to a dietary approaches to stop hypertension (DASH)-type diet over the life course and associated vascular function: a study based on the MRC 1946 British birth cohort. Br J Nutr 119(5):581–589. https://doi.org/10.1017/s0007114517003877

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Blumenthal JA, Babyak MA, Hinderliter A, Watkins LL, Craighead L, Lin PH, Caccia C, Johnson J, Waugh R, Sherwood A (2010) Effects of the DASH diet alone and in combination with exercise and weight loss on blood pressure and cardiovascular biomarkers in men and women with high blood pressure: the ENCORE study. Arch Intern Med 170(2):126–135. https://doi.org/10.1001/archinternmed.2009.470

    Article  PubMed  PubMed Central  Google Scholar 

  39. Al-Solaiman Y, Jesri A, Zhao Y, Morrow JD, Egan BM (2009) Low-sodium DASH reduces oxidative stress and improves vascular function in salt-sensitive humans. J Hum Hypertens 23(12):826–835. https://doi.org/10.1038/jhh.2009.32

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM, Bray GA, Vogt TM, Cutler JA, Windhauser MM, Lin PH, Karanja N (1997) A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med 336(16):1117–1124. https://doi.org/10.1056/nejm199704173361601

    Article  CAS  PubMed  Google Scholar 

  41. K. MRVLS-T (2008) Atherosclerosis, Large Arteries and Cardiovascular Risk, vol 44. Calcifications, Arterial Stiffness and Atherosclerosis. Karger

  42. Vlachopoulos C, Aznaouridis K, Terentes-Printzios D, Ioakeimidis N, Stefanadis C (2012) Prediction of cardiovascular events and all-cause mortality with brachial-ankle elasticity index: a systematic review and meta-analysis. Hypertension 60(2):556–562. https://doi.org/10.1161/hypertensionaha.112.194779

    Article  CAS  PubMed  Google Scholar 

  43. van den Oord SC, Sijbrands EJ, ten Kate GL, van Klaveren D, van Domburg RT, van der Steen AF, Schinkel AF (2013) Carotid intima-media thickness for cardiovascular risk assessment: systematic review and meta-analysis. Atherosclerosis 228(1):1–11. https://doi.org/10.1016/j.atherosclerosis.2013.01.025

    Article  CAS  PubMed  Google Scholar 

  44. Robertson CM, Gerry F, Fowkes R, Price JF (2012) Carotid intima-media thickness and the prediction of vascular events. Vasc Med 17(4):239–248. https://doi.org/10.1177/1358863x12445103

    Article  PubMed  Google Scholar 

  45. Appel LJ, Frohlich ED, Hall JE, Pearson TA, Sacco RL, Seals DR, Sacks FM, Smith SC Jr, Vafiadis DK, Van Horn LV (2011) The importance of population-wide sodium reduction as a means to prevent cardiovascular disease and stroke: a call to action from the American Heart Association. Circulation 123(10):1138–1143. https://doi.org/10.1161/CIR.0b013e31820d0793

    Article  PubMed  Google Scholar 

  46. Aburto NJ, Ziolkovska A, Hooper L, Elliott P, Cappuccio FP, Meerpohl JJ (2013) Effect of lower sodium intake on health: systematic review and meta-analyses. BMJ 346:f1326. https://doi.org/10.1136/bmj.f1326

    Article  PubMed  PubMed Central  Google Scholar 

  47. Libby P, Ridker PM, Hansson GK (2011) Progress and challenges in translating the biology of atherosclerosis. Nature 473(7347):317–325. https://doi.org/10.1038/nature10146

    Article  CAS  PubMed  Google Scholar 

  48. D’Elia L, Barba G, Cappuccio FP, Strazzullo P (2011) Potassium intake, stroke, and cardiovascular disease a meta-analysis of prospective studies. J Am Coll Cardiol 57(10):1210–1219. https://doi.org/10.1016/j.jacc.2010.09.070

    Article  CAS  PubMed  Google Scholar 

  49. Bailey RL, Parker EA, Rhodes DG, Goldman JD, Clemens JC, Moshfegh AJ, Thuppal SV, Weaver CM (2016) Estimating sodium and potassium intakes and their ratio in the American diet: data from the 2011–2012 NHANES. J Nutr. https://doi.org/10.3945/jn.115.221184

    Article  PubMed Central  Google Scholar 

  50. Castro H, Raij L (2013) Potassium in hypertension and cardiovascular disease. Semin Nephrol 33(3):277–289. https://doi.org/10.1016/j.semnephrol.2013.04.008

    Article  CAS  PubMed  Google Scholar 

  51. O’Donnell M, Mente A, Yusuf S (2015) Sodium intake and cardiovascular health. Circ Res 116(6):1046–1057. https://doi.org/10.1161/circresaha.116.303771

    Article  PubMed  Google Scholar 

  52. Wood AD, Strachan AA, Thies F, Aucott LS, Reid DM, Hardcastle AC, Mavroeidi A, Simpson WG, Duthie GG, Macdonald HM (2014) Patterns of dietary intake and serum carotenoid and tocopherol status are associated with biomarkers of chronic low-grade systemic inflammation and cardiovascular risk. Br J Nutr 112(8):1341–1352. https://doi.org/10.1017/s0007114514001962

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

This work was supported by a National Research Foundation of Korea (NRF) Grant funded by the Korean government (Ministry of Science, ICT and Future Planning; no. 2016R1A2B2011352) and by the Research Program funded by the Korea Centers for Disease Control and Prevention (2004-E71004-00, 2005-E71011-00, 2006-E71009-00, 2007-E71002-00, 2008-E71004-00, 2009-E71006-00, 2010-E71003-00, 2011-E71002-00, 2012-E71007-00, and 2013-E71008-00). The funders played no role in study design, data collection and analysis, the decision to publish, or the preparation of the manuscript.

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Authors and Affiliations

  1. Department of Health Care Policy Research, Korea Institute for Health and Social Affairs, Sejong, South Korea

    Sukyoung Jung

  2. Institute for Health and Society, Hanyang University, Seoul, South Korea

    Sukyoung Jung, Mi Kyung Kim & Bo Youl Choi

  3. Department of Preventive Medicine, College of Medicine, Hanyang University, Seoul, South Korea

    Mi Kyung Kim & Bo Youl Choi

  4. Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, South Korea

    Jinho Shin

  5. Department of Preventive Medicine and Institute of Wonkwang Medical Science, Wonkwang University College of Medicine, Iksan, South Korea

    Young-Hoon Lee

  6. Department of Occupational and Environmental Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea

    Dong Hoon Shin

  7. Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, South Korea

    Min-Ho Shin

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  1. Sukyoung Jung
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Contributions

Conceived and designed the experiments: MKK, BYC, JS, YHL, DHS, MHS. Formal analysis: SJ. Investigation: SJ, MKK. Methodology: MKK. Project administration: BYC. Supervision: MKK. Validation: MKK, BYC, JS, YHL, DHS, MHS. Writing—original draft: SJ, MKK. Writing—review and editing: SJ, MKK.

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Correspondence to Mi Kyung Kim.

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Ethical standards

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (Institutional Review Board of Hanyang University) and with the Helsinki Declaration of 1964, as revised in 2000. Informed consent was obtained from all participants for being included in the study.

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Jung, S., Kim, M.K., Shin, J. et al. High sodium intake and sodium to potassium ratio may be linked to subsequent increase in vascular damage in adults aged 40 years and older: the Korean multi-rural communities cohort (MRCohort). Eur J Nutr 58, 1659–1671 (2019). https://doi.org/10.1007/s00394-018-1712-3

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