Urinary Sodium and Potassium, and Risk of Ischemic and Hemorrhagic Stroke (INTERSTROKE): A Case-Control Study.

Iversen, Helle K.; Lanas, Fernando; Hankey, Graeme J.; Oguz, Aytekin; Mondo, Charles; Ferguson, John; O'Donnell, Martin J.; Rosengren, Annika; Oveisgharan, Shahram; Pogosova, Nana; Judge, Conor; Chin, Siu Lim; Al Hussain, Fawaz; Ryglewicz, Danuta; Rumboldt, Zvonko; Rangarajan, Sumathy; Málaga Rodríguez, Germán Javier; Zhang, Hongye; Dans, Antonio L.; Elsayed, Ahmed; Lisheng, Liu; Avezum, Alvaro; Czlonkowska, Anna; Wang, Xingyu; Langhorne, Peter; Ogah, Okechukwu S.; Smyth, Andrew; Yusufali, Afzalhussein; Ogunniyi, Adesola; Lopez-Jaramillo, Patricio; Xavier, Denis; Diaz, Rafael; Rao-Melacini, Purnima; Damasceno, Albertino; Weimar, Christian; Yusoff, Khalid; Yusuf, Salim

dc.contributor.author	Judge, Conor
dc.contributor.author	O'Donnell, Martin J.
dc.contributor.author	Hankey, Graeme J.
dc.contributor.author	Rangarajan, Sumathy
dc.contributor.author	Chin, Siu Lim
dc.contributor.author	Rao-Melacini, Purnima
dc.contributor.author	Ferguson, John
dc.contributor.author	Smyth, Andrew
dc.contributor.author	Xavier, Denis
dc.contributor.author	Lisheng, Liu
dc.contributor.author	Zhang, Hongye
dc.contributor.author	Lopez-Jaramillo, Patricio
dc.contributor.author	Damasceno, Albertino
dc.contributor.author	Langhorne, Peter
dc.contributor.author	Rosengren, Annika
dc.contributor.author	Dans, Antonio L.
dc.contributor.author	Elsayed, Ahmed
dc.contributor.author	Avezum, Alvaro
dc.contributor.author	Mondo, Charles
dc.contributor.author	Ryglewicz, Danuta
dc.contributor.author	Czlonkowska, Anna
dc.contributor.author	Pogosova, Nana
dc.contributor.author	Weimar, Christian
dc.contributor.author	Diaz, Rafael
dc.contributor.author	Yusoff, Khalid
dc.contributor.author	Yusufali, Afzalhussein
dc.contributor.author	Oguz, Aytekin
dc.contributor.author	Wang, Xingyu
dc.contributor.author	Lanas, Fernando
dc.contributor.author	Ogah, Okechukwu S.
dc.contributor.author	Ogunniyi, Adesola
dc.contributor.author	Iversen, Helle K.
dc.contributor.author	Málaga Rodríguez, Germán Javier
dc.contributor.author	Rumboldt, Zvonko
dc.contributor.author	Oveisgharan, Shahram
dc.contributor.author	Al Hussain, Fawaz
dc.contributor.author	Yusuf, Salim
dc.date.accessioned	2021-05-18T21:44:17Z
dc.date.available	2021-05-18T21:44:17Z
dc.date.issued	2021
dc.identifier.uri	https://hdl.handle.net/20.500.12866/9410
dc.description.abstract	BACKGROUND: Although low sodium intake (<2 g/day) and high potassium intake (>3.5 g/day) are proposed as public health interventions to reduce stroke risk, there is uncertainty about the benefit and feasibility of this combined recommendation on prevention of stroke. METHODS: We obtained random urine samples from 9,275 cases of acute first stroke and 9,726 matched controls from 27 countries and estimated the 24-hour sodium and potassium excretion, a surrogate for intake, using the Tanaka formula. Using multivariable conditional logistic regression, we determined the associations of estimated 24-hour urinary sodium and potassium excretion with stroke and its subtypes. RESULTS: Compared with an estimated urinary sodium excretion of 2.8-3.5 g/day (reference), higher (>4.26 g/day) (odds ratio [OR] 1.81; 95% confidence interval [CI], 1.65-2.00) and lower (<2.8 g/day) sodium excretion (OR 1.39; 95% CI, 1.26-1.53) were significantly associated with increased risk of stroke. The stroke risk associated with the highest quartile of sodium intake (sodium excretion >4.26 g/day) was significantly greater (P < 0.001) for intracerebral hemorrhage (ICH) (OR 2.38; 95% CI, 1.93-2.92) than for ischemic stroke (OR 1.67; 95% CI, 1.50-1.87). Urinary potassium was inversely and linearly associated with risk of stroke, and stronger for ischemic stroke than ICH (P = 0.026). In an analysis of combined sodium and potassium excretion, the combination of high potassium intake (>1.58 g/day) and moderate sodium intake (2.8-3.5 g/day) was associated with the lowest risk of stroke. CONCLUSIONS: The association of sodium intake and stroke is J-shaped, with high sodium intake a stronger risk factor for ICH than ischemic stroke. Our data suggest that moderate sodium intake-rather than low sodium intake-combined with high potassium intake may be associated with the lowest risk of stroke and expected to be a more feasible combined dietary target	en_US
dc.language.iso	eng
dc.publisher	Oxford University Press
dc.relation.ispartofseries	American Journal of Hypertension
dc.rights	info:eu-repo/semantics/restrictedAccess
dc.subject	blood pressure	en_US
dc.subject	hypertension	en_US
dc.subject	intracerebral hemorrhage	en_US
dc.subject	ischemic stroke	en_US
dc.subject	potassium	en_US
dc.subject	sodium	en_US
dc.subject	stroke	en_US
dc.title	Urinary Sodium and Potassium, and Risk of Ischemic and Hemorrhagic Stroke (INTERSTROKE): A Case-Control Study.	en_US
dc.type	info:eu-repo/semantics/article
dc.identifier.doi	https://doi.org/10.1093/ajh/hpaa176
dc.subject.ocde	https://purl.org/pe-repo/ocde/ford#3.02.27
dc.relation.issn	1941-7225