Excessive Salt Consumption Linked to Atherosclerosis Even With Regular BP

A big examine from Sweden concludes {that a} excessive salt consumption is a crucial danger issue for atherosclerosis, even within the absence of hypertension.

The examine, together with greater than 10,000 people between the ages of fifty and 64 years from the Swedish Cardiopulmonary bioImage Research, confirmed a big hyperlink between dietary salt consumption and the danger for atherosclerotic lesions within the coronary and carotid arteries, even in members with regular blood strain and with out recognized heart problems.

The discovering means that salt could possibly be a harmful think about its personal proper earlier than the event of hypertension, the authors write. The outcomes have been published online March 30 in European Coronary heart Journal Open.

It has been recognized for a very long time that salt is linked to hypertension, however the position that salt performs in atherosclerosis has not been examined, first writer, Jonas Wuopio, MD, Karolinska Institutet, Huddinge, and Scientific Analysis Middle, Falun, Uppsala College, each in Sweden, instructed theheart.org | Medscape Cardiology.

“Hardly anybody appears at adjustments within the arteries’ calcification, the atherosclerotic plaques and the affiliation with salt consumption,” Wuopio stated. “We had this unique knowledge from our cohort, so we needed to make use of it to shut this information hole.”

The evaluation included 10,788 adults ages 50 to 64 years, (common age, 58 years; 52% girls) who underwent a coronary computed tomography angiography (CCTA) scan. The estimated 24-hour sodium excretion was used to measure sodium consumption.

CCTA was used to acquire 3D pictures of the coronary arteries to measure the diploma of coronary artery calcium in addition to detect stenosis within the coronary arteries. Contributors additionally had an ultrasound of the carotid arteries.

After adjusting for age, intercourse, and examine web site (the examine was finished at Uppsala and Malmö), the researchers discovered that rising salt consumption was linked with rising atherosclerosis in a linear trend in each the coronary and carotid arteries.

Every 1000 mg rise in sodium excretion was related to a 9% elevated incidence of carotid plaque (odds ratio [OR], 1.09; P < .001; confidence interval [CI], 1.06 – 1.12), a better coronary artery calcium rating (OR, 1.16; P < .001; CI, 1.12 – 1.19), and a 17% elevated incidence of coronary artery stenosis (OR, 1.17; P < .001; CI, 1.13 – 1.20).

The affiliation was abolished, although, after adjusting for blood strain, they be aware. Their “interpretation is that the rise in blood strain from sodium consumption, even beneath the extent that presently defines arterial hypertension, is a crucial issue that mediates the interaction between salt consumption and the atherosclerotic course of,” they write. “As we noticed an affiliation in people with regular blood strain, one attainable clarification for these findings is that the detrimental pathological processes start already previous to the event of hypertension,” they be aware, though they warning that no causal relationships will be gleaned from this cross-sectional examine. 

In addition they reported no signal of a “J-curve”; members with the bottom ranges of sodium excretion had the bottom incidence of each coronary and carotid atherosclerosis, which contradicts findings in some research that discovered very low sodium linked to elevated heart problems–associated occasions.

“There have been some controversies amongst researchers relating to very low consumption, the place some say very low salt consumption can improve the danger of heart problems, however we couldn’t discover this on this examine,” Wuopio stated.

“Our examine is confirming that extra salt shouldn’t be an excellent factor, however the truth that it’s linked to atherosclerosis, even within the absence of hypertension, was a little bit of a shock,” he stated.

“I will probably be telling my sufferers to observe the recommendation given by the World Well being Group and different medical societies, to restrict your consumption of salt to roughly 1 teaspoon, even when your blood strain is regular.”

Time to Scrutinize Salt’s Position in Atherosclerosis

In an accompanying editorial, Maciej Banach, MD, Medical College of Lodz, and Stanislaw Surma, MD, College of Medical Sciences in Katowice, each in Poland, write that extreme dietary salt consumption is a well-documented cardiovascular danger issue, and that the affiliation is defined in most research by elevated blood strain.

“We should always look extra extensively on the position of dietary salt, because it impacts many pathological mechanisms, by which, particularly with the coexistence of different danger elements, atherosclerosis might progress very quick,” they write.

“The outcomes of the examine shed new gentle on the direct relationship between extreme dietary salt consumption and the danger of ASCVD [atherosclerotic cardiovascular disease], indicating that salt consumption is perhaps a danger issue for atherosclerosis even previous to the event of hypertension,” they conclude.

Confirmatory and Novel

“No one questions the truth that hypertension is a robust danger issue for atherosclerotic illness, however not all research have urged that, not less than at considerably larger ranges of sodium consumption, that prime salt consumption tracks with danger for atherosclerotic illness,” Alon Gitig, MD, assistant professor and director of cardiology, Mount Sinai Docs-Westchester, Yonkers, New York, instructed theheart.org | Medscape Cardiology.

Many of the research of salt consumption within the food regimen are primarily based on affected person self-reports by way of meals frequency questionnaires, which can provide a normal concept of salt consumption, however are sometimes not completely correct, Gitig stated.

“Right here, they measured sodium within the urine and estimated the 24-hour salt consumption from that, which is barely novel,” he stated.

Everyone is aware of that hypertension is related to future heart problems danger, however what many do not understand is that that danger begins to extend barely however considerably above a blood strain that’s already within the vary of 115 mm Hg/75 mm Hg, he stated.

“The decrease you may get your blood strain down, to round 115 – 120, the decrease your danger for heart problems,” Gitig stated.

It’s attainable for most individuals to decrease blood strain by consideration to food regimen, limiting sodium, performing cardio and weight coaching workouts, and sustaining a wholesome weight, he stated.

An instance of a cardiovascular well being food regimen is the Dietary Approaches to Cease Hypertension (DASH) food regimen.

“The DASH food regimen, consisting of 9 servings of vegetables and fruit a day with few refined carbs, flour and sugar, has been proven in a randomized trial to dramatically scale back blood strain. There are 2 causes for that. One is that the vegetables and fruit have many phytonutrients which are good for arteries. The opposite is that a big proportion of US adults have insulin resistance, which ends up in hypertension.  

“The extra vegetables and fruit and wholesome animal merchandise, and fewer sugar and flour, the extra you’ll enhance your insulin resistance, so you’ll be able to deliver your blood strain down that method,” Gitig stated.

The examine was funded by the Swedish Coronary heart-Lung Basis, the Knut and Alice Wallenberg Basis, the Swedish Analysis Council and Vinnova (Sweden’s Innovation company), the College of Gothenburg and Sahlgrenska College Hospital, the Karolinska Institutet and Stockholm County Council, the Linköping College and College Hospital, the Lund College and Skane College Hospital, the Umea College and College Hospital, and the Uppsala College and College Hospital. Wuopio and Gitig report no related monetary relationships. Banach experiences monetary relationships with Adamed, Amgen, Daichii Sankyo, Esperion, KrKa, NewAmsterdam, Polpharma, Novartis, Pfizer, Sanofi, Teva, Viatris, and CMDO at Longevity Group (LU). Surma experiences a monetary relationship with Sanofi and Novartis.

Eur Coronary heart J Open. Printed on-line March 30. Abstract, Editorial

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