TY - JOUR
T1 - Associations of 24-Hour Urinary Sodium and Potassium Excretion with Cardiac Biomarkers
T2 - The Maastricht Study
AU - Martens, Remy J. H.
AU - Henry, Ronald M. A.
AU - Bekers, Otto
AU - Dagnelie, Pieter C.
AU - van Dongen, Martien C. J. M.
AU - Eussen, Simone J. P. M.
AU - van Greevenbroek, Marleen
AU - Kroon, Abraham A.
AU - Stehouwer, Coen D. A.
AU - Wesselius, Anke
AU - Meex, Steven J. R.
AU - Kooman, Jeroen P.
N1 - Funding Information:
The Maastricht Study was supported by the European Regional Development Fund via OP-Zuid, the Province of Limburg, and Dutch Ministry of Economic Affairs grant 31O.041; Stichting De Weijerhorst (Maastricht, Netherlands); the Pearl String Initiative Diabetes (Amsterdam, Netherlands); the Cardiovascular Center (Maastricht, Netherlands); CARIM School for Cardiovascular Diseases (Maastricht, Netherlands); CAPHRI School for Public Health and Primary Care (Maastricht, Netherlands); NUTRIM School for Nutrition and Translational Research in Metabolism (Maastricht, Netherlands); Stichting Annadal (Maastricht, Netherlands); Health Foundation Limburg (Maastricht, Netherlands); and by unrestricted grants from Janssen-Cilag BV (Tilburg, Netherlands), Novo Nordisk Farma BV (Alphen aan den Rijn, Netherlands), and Sanofi-Aventis Netherlands BV (Gouda, Netherlands). The high-sensitivity cardiac troponin I kits were provided by Abbott Diagnostics (Hoofddorp, Netherlands). Author disclosures: The authors report no conflicts of interest. Supplemental Methods, Supplemental Tables 1–7, and Supplemental Figures 1– 5 are available from the “Supplementary data” link in the online posting of the article and from the same link in the online table of contents at https://academ ic.oup.com/jn/. Data are available from the Maastricht Study for any interested researcher who meets the criteria for access to confidential data. The Maastricht Study management team ([email protected]) may be contacted to request data. Address correspondence to JPK (e-mail: [email protected]). Abbreviations used: BNP, B-type natriuretic peptide; CVD, cardiovascular disease; eGFR, estimated glomerular filtration rate; HbA1c, glycated hemoglobin; hs-cTnI, high-sensitivity cardiac troponin I; hs-cTnT, high-sensitivity cardiac troponin T; NT-proBNP, N-terminal pro-B-type natriuretic peptide; UAE, urinary albumin excretion; UKE, urinary potassium excretion; UNaE, urinary sodium excretion.
Publisher Copyright:
© The Author(s) on behalf of the American Society for Nutrition 2020.
PY - 2020/6
Y1 - 2020/6
N2 - Background: It is a matter of debate whether sodium and potassium intake are associated with heart disease. Further, the mechanisms underlying associations of sodium and potassium intake with cardiac events, if any, are not fully understood.Objectives: We examined cross-sectional associations of 24-h urinary sodium excretion (UNaE) and potassium excretion (UKE), as estimates of their intakes, with high-sensitivity cardiac troponins T (hs-cTnT) and I (hs-cTnI), and N-terminal pro-B-type natriuretic peptide (NT-proBNP), which are markers of cardiomyocyte injury and cardiac dysfunction.Methods: We included 2961 participants from the population-based Maastricht Study (mean +/- SD age 59.8 +/- 8.2 y, 51.9% men), who completed the baseline survey between November 2010 and September 2013. Associations were examined with restricted cubic spline linear regression analyses and ordinary linear regression analyses, adjusted for demographics, lifestyle, and cardiovascular disease (CVD) risk factors.Results: Median [QR] 24-h UNaE and UKE were 3.7 (2.8-4.71 g/24 h and 3.0 12.4-3.61 g/24 h, respectively. After adjustment for potential confounders, 24-h UNaE was not associated with hs-cTnT, hs-cTnI, and NT-proBNP concentrations. In contrast, after adjustment for potential confounders, lower 24-h UKE was nonlinearly associated with higher hs-cTnT and NT-proBNP. For example, as compared with the third/median quintile of 24-h UKE (range: 2.8-3.2 g/24 h), participants in the first quintile (range: 0.5-2.3 g/24 h) had 1.05 (95% CI: 0.99, 1.11) times higher hs-cTnT and 1.14 (95% CI: 1.03, 1.26) times higher NT-proBNP. Associations were similar after further adjustment for estimated glomerular filtration rate, albuminuria, blood pressure, and serum potassium.Conclusions: Twenty-four-hour UNaE was not associated with the studied cardiac biomarkers. In contrast, lower 24-h UKE was nonlinearly associated with higher hs-cTnT and NT-proBNP. This finding supports recommendations to increase potassium intake in the general population. In addition, it suggests that cardiac dysfunction and/or cardiomyocyte injury may underlie previously reported associations of lower potassium intake with CVD mortality.
AB - Background: It is a matter of debate whether sodium and potassium intake are associated with heart disease. Further, the mechanisms underlying associations of sodium and potassium intake with cardiac events, if any, are not fully understood.Objectives: We examined cross-sectional associations of 24-h urinary sodium excretion (UNaE) and potassium excretion (UKE), as estimates of their intakes, with high-sensitivity cardiac troponins T (hs-cTnT) and I (hs-cTnI), and N-terminal pro-B-type natriuretic peptide (NT-proBNP), which are markers of cardiomyocyte injury and cardiac dysfunction.Methods: We included 2961 participants from the population-based Maastricht Study (mean +/- SD age 59.8 +/- 8.2 y, 51.9% men), who completed the baseline survey between November 2010 and September 2013. Associations were examined with restricted cubic spline linear regression analyses and ordinary linear regression analyses, adjusted for demographics, lifestyle, and cardiovascular disease (CVD) risk factors.Results: Median [QR] 24-h UNaE and UKE were 3.7 (2.8-4.71 g/24 h and 3.0 12.4-3.61 g/24 h, respectively. After adjustment for potential confounders, 24-h UNaE was not associated with hs-cTnT, hs-cTnI, and NT-proBNP concentrations. In contrast, after adjustment for potential confounders, lower 24-h UKE was nonlinearly associated with higher hs-cTnT and NT-proBNP. For example, as compared with the third/median quintile of 24-h UKE (range: 2.8-3.2 g/24 h), participants in the first quintile (range: 0.5-2.3 g/24 h) had 1.05 (95% CI: 0.99, 1.11) times higher hs-cTnT and 1.14 (95% CI: 1.03, 1.26) times higher NT-proBNP. Associations were similar after further adjustment for estimated glomerular filtration rate, albuminuria, blood pressure, and serum potassium.Conclusions: Twenty-four-hour UNaE was not associated with the studied cardiac biomarkers. In contrast, lower 24-h UKE was nonlinearly associated with higher hs-cTnT and NT-proBNP. This finding supports recommendations to increase potassium intake in the general population. In addition, it suggests that cardiac dysfunction and/or cardiomyocyte injury may underlie previously reported associations of lower potassium intake with CVD mortality.
KW - sodium intake
KW - potassium intake
KW - sodium excretion
KW - potassium excretion
KW - cardiac biomarkers
KW - troponin
KW - natriuretic peptides
KW - cardiovascular disease
KW - FOOD FREQUENCY QUESTIONNAIRE
KW - REDUCING SALT INTAKE
KW - CARDIOVASCULAR-DISEASE
KW - POPULATION-LEVEL
KW - BLOOD-PRESSURE
KW - RISK
KW - MORTALITY
KW - DIET
KW - HYPERTENSION
KW - INDIVIDUALS
U2 - 10.1093/jn/nxaa080
DO - 10.1093/jn/nxaa080
M3 - Article
C2 - 32386231
SN - 0022-3166
VL - 150
SP - 1413
EP - 1424
JO - Journal of Nutrition
JF - Journal of Nutrition
IS - 6
ER -