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Note: thesis: Thesis (Sc. M.)--Brown University, 2018
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Abstract: Abstract of "Associations of Calibrated Dietary Sodium and Potassium Intakes with the Risk of Heart Failure and its Subtypes in Postmenopausal Women: the Women’s Health Initiative", by Xiao Gu, ScM., Brown University, May 2018. Importance: The associations of dietary sodium and potassium with CVD remained controversial mainly due to measurement error. Relatively few studies have been conducted on calibrated dietary sodium and potassium with the incidence of heart failure (HF) and its major subtypes; HF with preserved ejection function (HFpEF) and HF with reduced ejection function (HFrEF). Objective: To investigate whether dietary sodium and potassium were associated with the risk of HF and its major subtypes. Design, setting, and participants: Our observational cohort study included 118,060 postmenopausal women recruited during 1993-1998 and followed up until 2015 in the Women’s Health Initiative. Women who reported a history of HF, were underweight, or had implausible/missing food frequency questionnaire (FFQ) data were excluded at baseline. Exposures: FFQ-measured dietary sodium and potassium calibrated by recovery biomarkers estimated from 24-hour urine excretion collections. Main outcomes and measures: Hospitalized heart failure, HFpEF and HFrEF self-reported through questionnaire and adjudicated by trained physicians. Results: During up to 22 years of follow-up, 3,347, 738 and 432 participants developed HF, HFpEF and HFrEF, respectively. The mean age of the study population was 63.4 years. In the Cox proportional hazard model adjusted for suspected confounding factors and major risk factors, calibrated sodium intake was positively associated with the incidence of total HF (HR Q5 vs. Q1 =2.36, 95% CI: 2.05-2.72, P-trend <0.001). Comparing extreme quintiles of sodium intake, the HR was 2.72 for HFpEF (95% CI: 2.01-3.68, P-trend<0.001) and 1.78 for HFrEF (95% CI: 1.19-2.69, P-trend=0.005). Calibrated potassium intake was inversely associated with the risk of HF in the multivariate model (HR Q5 vs. Q1 =0.66, 95% CI: 0.56-0.78, P-trend <0.001). Moreover, positive associations were observed for the analyses on calibrated sodium/potassium ratio. The dose-response relationship between sodium intake and the risks of HF, HFpEF and HFrEF appeared to be monotonically increasing. Conclusions: Higher sodium and sodium/potassium intakes are associated with increased risk of HF, HFpEF and HFrEF in postmenopausal women. The observed positive association appears to be stronger for HFpEF than for HFrEF. For dietary potassium, higher intake is association with lower risk of HF. Our findings are consistent with population-level recommendations of lower sodium diets for primary prevention of cardiovascular disease, particularly heart failure.
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Identifier: DOI: 10.26300/aj6m-ky48
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