Associations of Biomarker-Calibrated Sodium and Potassium Intakes with Cardiovascular Disease Risk among Postmenopausal Women

Ross L. Prentice, Ying Huang, Marian L. Neuhouser, Joann E. Manson, Yasmin Mossavar-Rahmani, Fridtjof Thomas, Lesley F. Tinker, Matthew Allison, Karen C. Johnson, Sylvia Wassertheil-Smoller, Arjun Seth, Jacques E. Rossouw, James Shikany, Laura D. Carbone, Lisa W. Martin, Marcia L. Stefanick, Bernhard Haring, Linda Van Horn

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26 Scopus citations


Studies of the associations of sodium and potassium intakes with cardiovascular disease incidence often rely on self-reported dietary data. In the present study, self-reported intakes from postmenopausal women at 40 participating US clinical centers are calibrated using 24-hour urinary excretion measures in cohorts from the Women's Health Initiative, with follow-up from 1993 to 2010. The incidence of hypertension was positively related to (calibrated) sodium intake and to the ratio of sodium to potassium. The sodium-to-potassium ratio was associated with cardiovascular disease incidence during an average follow-up period of 12 years. The estimated hazard ratio for a 20% increase in the sodium-to-potassium ratio was 1.13 (95% confidence interval (CI): 1.04, 1.22) for coronary heart disease, 1.20 (95% CI: 1.01, 1.42) for heart failure, and 1.11 (95% CI: 1.04, 1.19) for a composite cardiovascular disease outcome. The association with total stroke was not significant, but it was positive for ischemic stroke and inverse for hemorrhagic stroke. Aside from hemorrhagic stroke, corresponding associations of cardiovascular disease with sodium and potassium jointly were positive for sodium and inverse for potassium, although some were not statistically significant. Specifically, for coronary heart disease, the hazard ratios for 20% increases were 1.11 (95% CI: 0.95, 1.30) for sodium and 0.85 (95% CI: 0.73, 0.99) for potassium; and corresponding values for heart failure were 1.36 (95% CI: 1.02, 1.82) for sodium and 0.90 (95% CI: 0.69, 1.18) for potassium.

Original languageEnglish (US)
Pages (from-to)1035-1043
Number of pages9
JournalAmerican Journal of Epidemiology
Issue number9
StatePublished - Nov 1 2017


  • cardiovascular disease
  • energy consumption
  • hazard ratio
  • measurement error
  • odds ratio
  • potassium
  • regression calibration
  • sodium

ASJC Scopus subject areas

  • General Medicine


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