Research
Print page Print page
Switch language
The Capital Region of Denmark - a part of Copenhagen University Hospital
Published

Urinary Sodium and Potassium, and Risk of Ischemic and Hemorrhagic Stroke (INTERSTROKE): a case-control study

Research output: Contribution to journalJournal articleResearchpeer-review

DOI

  1. Relative and Absolute Risk to Guide the Management of Pulse Pressure, an Age-Related Cardiovascular Risk Factor

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Role of Inflammatory Biomarkers in the Prevalence and Incidence of Hypertension Among HIV-Positive Participants in the START Trial

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. Cardiovascular Outcome in Relation to Progression to Hypertension in the Copenhagen MONICA Cohort

    Research output: Contribution to journalJournal articleResearchpeer-review

  4. Smoking related to 24-h ambulatory blood pressure and heart rate: a study in 352 normotensive Danish subjects

    Research output: Contribution to journalJournal articleResearchpeer-review

  1. Workforce Attachment after Ischemic Stroke – The Importance of Time to Thrombolytic Therapy

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Assessment of patients with a suspected cardioembolic ischemic stroke. A national consensus statement

    Research output: Contribution to journalReviewResearchpeer-review

  3. Global Impact of COVID-19 on Stroke Care and IV Thrombolysis

    Research output: Contribution to journalJournal articleResearchpeer-review

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

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.

Original languageEnglish
JournalAmerican Journal of Hypertension
Volume34
Issue number4
Pages (from-to)414-425
Number of pages12
ISSN0895-7061
DOIs
Publication statusPublished - 20 Apr 2021

    Research areas

  • blood pressure, hypertension, intracerebral hemorrhage, ischemic stroke, potassium, sodium, stroke

ID: 61829762