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Dietary Sodium Intake and Incidence of Congestive Heart Failure in Overweight US Men and Women
First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study
Jiang He, MD, PhD;
Lorraine G. Ogden, MS;
Lydia A. Bazzano, PhD;
Suma Vupputuri, MPH, PhD;
Catherine Loria, PhD, MS;
Paul K. Whelton, MD, MSc
Arch Intern Med. 2002;162:1619-1624.
Background Cross-sectional epidemiologic studies suggest that a higher intake of
dietary sodium is associated with an increased risk of left ventricular hypertrophy.
We studied the relationship between dietary sodium intake and incidence of
congestive heart failure (CHF) in the first National Health and Nutrition
Examination Survey Epidemiologic Follow-up Study participants.
Participants and Methods The study sample consisted of 5233 nonoverweight and 5129 overweight
men and women without a history of CHF at their baseline examination. Dietary
sodium and other nutrient intake estimates were obtained by a 24-hour dietary
recall method at the baseline examination, conducted from 1971 to 1975. The
incidence of CHF was assessed using medical records and death certificates
obtained in 1982 to 1984, 1986, 1987, and 1992.
Results During an average of 19 years of follow-up, we documented 413 cases
of CHF in nonoverweight and 679 cases of CHF in overweight participants. After
adjustment for known CHF risk factors, the relative risk of CHF among overweight
participants was 1.43 (95% confidence interval, 1.07-1.91) for those whose
sodium intake was greater than 113.6 mmol/d compared with those whose intake
was less than 50.2 mmol/d. The relative risks of CHF for a 100-mmol/d higher
intake of sodium or per 1743 kcal (average energy intake in the study population)
were 1.26 (95% confidence interval, 1.03-1.53) and 1.21 (95% confidence interval,
1.04-1.40), respectively.
Conclusions A higher intake of dietary sodium is a strong independent risk factor
for CHF in overweight persons. A reduction in sodium intake may play an important
role in the prevention of CHF in overweight individuals and populations.
From the Departments of Epidemiology (Drs He, Bazzano, Vupputuri, and
Whelton) and Biostatistics (Ms Ogden), Tulane University School of Public
Health and Tropical Medicine, New Orleans, La; the Department of Medicine,
Tulane University School of Medicine, New Orleans (Drs He and Whelton); and
the National Heart, Lung, and Blood Institute, Bethesda, Md (Dr Loria).
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