Dietary sodium-to-potassium ratio as a risk factor for stroke, cardiovascular disease and all-cause mortality in Japan: the NIPPON DATA80 cohort study

NIPPON DATA80 Research Group

Research output: Contribution to journalArticle

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Abstract

OBJECTIVES: To evaluate the impact of dietary sodium and potassium (Na-K) ratio on mortality from total and subtypes of stroke, cardiovascular disease (CVD) and all causes, using 24-year follow-up data of a representative sample of the Japanese population.

SETTING: Prospective cohort study.

PARTICIPANTS: In the 1980 National Cardiovascular Survey, participants were followed for 24 years (NIPPON DATA80, National Integrated Project for Prospective Observation of Non-communicable Disease And its Trends in the Aged). Men and women aged 30-79 years without hypertensive treatment, history of stroke or acute myocardial infarction (n=8283) were divided into quintiles according to dietary Na-K ratio assessed by a 3-day weighing dietary record at baseline. Age-adjusted and multivariable-adjusted HRs were calculated using the Mantel-Haenszel method and Cox proportional hazards model.

PRIMARY OUTCOME MEASURES: Mortality from total and subtypes of stroke, CVD and all causes.

RESULTS: A total of 1938 deaths from all causes were observed over 176 926 person-years. Na-K ratio was significantly and non-linearly related to mortality from all stroke (p=0.002), CVD (p=0.005) and total mortality (p=0.001). For stroke subtypes, mortality from haemorrhagic stroke was positively related to Na-K ratio (p=0.024). Similar relationships were observed for men and women. The observed relationships remained significant after adjustment for other risk factors. Quadratic non-linear multivariable-adjusted HRs (95% CI) in the highest quintile versus the lowest quintile of Na-K ratio were 1.42 (1.07 to 1.90) for ischaemic stroke, 1.57 (1.05 to 2.34) for haemorrhagic stroke, 1.43 (1.17 to 1.76) for all stroke, 1.39 (1.20 to 1.61) for CVD and 1.16 (1.06 to 1.27) for all-cause mortality.

CONCLUSIONS: Dietary Na-K ratio assessed by a 3-day weighing dietary record was a significant risk factor for mortality from haemorrhagic stroke, all stroke, CVD and all causes among a Japanese population.

Original languageEnglish
Pages (from-to)e011632
JournalBMJ Open
Volume6
Issue number7
DOIs
Publication statusPublished - 2016 Jul 13
Externally publishedYes

Fingerprint

Dietary Sodium
Potassium
Japan
Cohort Studies
Cardiovascular Diseases
Stroke
Mortality
Diet Records
Dietary Potassium
Proportional Hazards Models
Population
Cause of Death
Myocardial Infarction

Keywords

  • cardiovascular disease
  • NUTRITION & DIETETICS
  • potassium
  • prospective cohort
  • sodium

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Dietary sodium-to-potassium ratio as a risk factor for stroke, cardiovascular disease and all-cause mortality in Japan : the NIPPON DATA80 cohort study. / NIPPON DATA80 Research Group.

In: BMJ Open, Vol. 6, No. 7, 13.07.2016, p. e011632.

Research output: Contribution to journalArticle

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title = "Dietary sodium-to-potassium ratio as a risk factor for stroke, cardiovascular disease and all-cause mortality in Japan: the NIPPON DATA80 cohort study",
abstract = "OBJECTIVES: To evaluate the impact of dietary sodium and potassium (Na-K) ratio on mortality from total and subtypes of stroke, cardiovascular disease (CVD) and all causes, using 24-year follow-up data of a representative sample of the Japanese population.SETTING: Prospective cohort study.PARTICIPANTS: In the 1980 National Cardiovascular Survey, participants were followed for 24 years (NIPPON DATA80, National Integrated Project for Prospective Observation of Non-communicable Disease And its Trends in the Aged). Men and women aged 30-79 years without hypertensive treatment, history of stroke or acute myocardial infarction (n=8283) were divided into quintiles according to dietary Na-K ratio assessed by a 3-day weighing dietary record at baseline. Age-adjusted and multivariable-adjusted HRs were calculated using the Mantel-Haenszel method and Cox proportional hazards model.PRIMARY OUTCOME MEASURES: Mortality from total and subtypes of stroke, CVD and all causes.RESULTS: A total of 1938 deaths from all causes were observed over 176 926 person-years. Na-K ratio was significantly and non-linearly related to mortality from all stroke (p=0.002), CVD (p=0.005) and total mortality (p=0.001). For stroke subtypes, mortality from haemorrhagic stroke was positively related to Na-K ratio (p=0.024). Similar relationships were observed for men and women. The observed relationships remained significant after adjustment for other risk factors. Quadratic non-linear multivariable-adjusted HRs (95{\%} CI) in the highest quintile versus the lowest quintile of Na-K ratio were 1.42 (1.07 to 1.90) for ischaemic stroke, 1.57 (1.05 to 2.34) for haemorrhagic stroke, 1.43 (1.17 to 1.76) for all stroke, 1.39 (1.20 to 1.61) for CVD and 1.16 (1.06 to 1.27) for all-cause mortality.CONCLUSIONS: Dietary Na-K ratio assessed by a 3-day weighing dietary record was a significant risk factor for mortality from haemorrhagic stroke, all stroke, CVD and all causes among a Japanese population.",
keywords = "cardiovascular disease, NUTRITION & DIETETICS, potassium, prospective cohort, sodium",
author = "{NIPPON DATA80 Research Group} and Akira Okayama and Nagako Okuda and Katsuyuki Miura and Tomonori Okamura and Takehito Hayakawa and Hiroshi Akasaka and Hirofumi Ohnishi and Shigeyuki Saitoh and Yusuke Arai and Yutaka Kiyohara and Naoyuki Takashima and Katsushi Yoshita and Akira Fujiyoshi and Maryam Zaid and Takayoshi Ohkubo and Hirotsugu Ueshima",
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month = "7",
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doi = "10.1136/bmjopen-2016-011632",
language = "English",
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TY - JOUR

T1 - Dietary sodium-to-potassium ratio as a risk factor for stroke, cardiovascular disease and all-cause mortality in Japan

T2 - the NIPPON DATA80 cohort study

AU - NIPPON DATA80 Research Group

AU - Okayama, Akira

AU - Okuda, Nagako

AU - Miura, Katsuyuki

AU - Okamura, Tomonori

AU - Hayakawa, Takehito

AU - Akasaka, Hiroshi

AU - Ohnishi, Hirofumi

AU - Saitoh, Shigeyuki

AU - Arai, Yusuke

AU - Kiyohara, Yutaka

AU - Takashima, Naoyuki

AU - Yoshita, Katsushi

AU - Fujiyoshi, Akira

AU - Zaid, Maryam

AU - Ohkubo, Takayoshi

AU - Ueshima, Hirotsugu

PY - 2016/7/13

Y1 - 2016/7/13

N2 - OBJECTIVES: To evaluate the impact of dietary sodium and potassium (Na-K) ratio on mortality from total and subtypes of stroke, cardiovascular disease (CVD) and all causes, using 24-year follow-up data of a representative sample of the Japanese population.SETTING: Prospective cohort study.PARTICIPANTS: In the 1980 National Cardiovascular Survey, participants were followed for 24 years (NIPPON DATA80, National Integrated Project for Prospective Observation of Non-communicable Disease And its Trends in the Aged). Men and women aged 30-79 years without hypertensive treatment, history of stroke or acute myocardial infarction (n=8283) were divided into quintiles according to dietary Na-K ratio assessed by a 3-day weighing dietary record at baseline. Age-adjusted and multivariable-adjusted HRs were calculated using the Mantel-Haenszel method and Cox proportional hazards model.PRIMARY OUTCOME MEASURES: Mortality from total and subtypes of stroke, CVD and all causes.RESULTS: A total of 1938 deaths from all causes were observed over 176 926 person-years. Na-K ratio was significantly and non-linearly related to mortality from all stroke (p=0.002), CVD (p=0.005) and total mortality (p=0.001). For stroke subtypes, mortality from haemorrhagic stroke was positively related to Na-K ratio (p=0.024). Similar relationships were observed for men and women. The observed relationships remained significant after adjustment for other risk factors. Quadratic non-linear multivariable-adjusted HRs (95% CI) in the highest quintile versus the lowest quintile of Na-K ratio were 1.42 (1.07 to 1.90) for ischaemic stroke, 1.57 (1.05 to 2.34) for haemorrhagic stroke, 1.43 (1.17 to 1.76) for all stroke, 1.39 (1.20 to 1.61) for CVD and 1.16 (1.06 to 1.27) for all-cause mortality.CONCLUSIONS: Dietary Na-K ratio assessed by a 3-day weighing dietary record was a significant risk factor for mortality from haemorrhagic stroke, all stroke, CVD and all causes among a Japanese population.

AB - OBJECTIVES: To evaluate the impact of dietary sodium and potassium (Na-K) ratio on mortality from total and subtypes of stroke, cardiovascular disease (CVD) and all causes, using 24-year follow-up data of a representative sample of the Japanese population.SETTING: Prospective cohort study.PARTICIPANTS: In the 1980 National Cardiovascular Survey, participants were followed for 24 years (NIPPON DATA80, National Integrated Project for Prospective Observation of Non-communicable Disease And its Trends in the Aged). Men and women aged 30-79 years without hypertensive treatment, history of stroke or acute myocardial infarction (n=8283) were divided into quintiles according to dietary Na-K ratio assessed by a 3-day weighing dietary record at baseline. Age-adjusted and multivariable-adjusted HRs were calculated using the Mantel-Haenszel method and Cox proportional hazards model.PRIMARY OUTCOME MEASURES: Mortality from total and subtypes of stroke, CVD and all causes.RESULTS: A total of 1938 deaths from all causes were observed over 176 926 person-years. Na-K ratio was significantly and non-linearly related to mortality from all stroke (p=0.002), CVD (p=0.005) and total mortality (p=0.001). For stroke subtypes, mortality from haemorrhagic stroke was positively related to Na-K ratio (p=0.024). Similar relationships were observed for men and women. The observed relationships remained significant after adjustment for other risk factors. Quadratic non-linear multivariable-adjusted HRs (95% CI) in the highest quintile versus the lowest quintile of Na-K ratio were 1.42 (1.07 to 1.90) for ischaemic stroke, 1.57 (1.05 to 2.34) for haemorrhagic stroke, 1.43 (1.17 to 1.76) for all stroke, 1.39 (1.20 to 1.61) for CVD and 1.16 (1.06 to 1.27) for all-cause mortality.CONCLUSIONS: Dietary Na-K ratio assessed by a 3-day weighing dietary record was a significant risk factor for mortality from haemorrhagic stroke, all stroke, CVD and all causes among a Japanese population.

KW - cardiovascular disease

KW - NUTRITION & DIETETICS

KW - potassium

KW - prospective cohort

KW - sodium

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U2 - 10.1136/bmjopen-2016-011632

DO - 10.1136/bmjopen-2016-011632

M3 - Article

C2 - 27412107

AN - SCOPUS:85020746020

VL - 6

SP - e011632

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

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