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The association of arterial stiffness with estimated excretion levels of urinary sodium and potassium and their ratio in Chinese adults

Abstract

Arterial stiffness is an independent cardiovascular risk factor. However, the association between sodium/potassium intake and arterial stiffness in the Chinese population is unclear. Therefore, we performed a large, community-based cross-sectional study to reach a more definitive conclusion. The study was conducted at the Third Xiangya Hospital in Changsha between August 2017 and September 2019. Urinary sodium, potassium, and creatinine levels were tested from spot urine samples during physical examinations of each recruited participant. The 24-hour estimated urinary sodium excretion (eUNaE) and estimated urinary potassium excretion (eUKE) levels were calculated using the Kawasaki formula (used as a surrogate for intake). The brachial-ankle pulse wave velocity (baPWV) and ankle brachial index (ABI) were measured using an automatic waveform analyzer. In 22,557 subjects with an average age of 49.3 ± 10.3 years, the relationships of the ABI and baPWV with the levels of eUNaE, eUKE and the ratio of sodium to potassium (Na/K ratio) were analyzed. A significant negative relationship was found between the eUKE and baPWV levels (β = 2.41, p < 0.01), whereas the Na/K ratio was positively associated with baPWV (β = 2.46, p < 0.01), especially in the overweight and hypertensive populations (both pinteraction = 0.04). The association of eUNaE quartiles with baPWV presented a J-shaped curve after adjusting for confounders. In addition, a positive association was observed between the Na/K ratio and the ABI (β = 0.002, p < 0.01). In this study, high potassium and/or low sodium intake was further confirmed to be related to vascular stiffness in Chinese individuals.

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Fig. 1: Flow chart of participant selection.
Fig. 2: The association of baPWV and ABI with eUNaE, eUKE levels and the Na/K ratio in quartile subgroups.
Fig. 3: Forest plots of changes in the baPWV and ABI per unit increase in the Na/K ratio.

Data availability

The dataset and code supporting the conclusions of this article are available upon reasonable request from the authors.

References

  1. Laurent S, Boutouyrie P, Asmar R, Gautier I, Laloux B, Guize L, et al. Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension. 2001;37:1236–41.

    CAS  PubMed  Google Scholar 

  2. Mitchell GF, Powell JT. Arteriosclerosis: a primer for “in focus” reviews on arterial stiffness. ATVB. 2020;40:1025–7.

    CAS  Google Scholar 

  3. Chirinos JA, Segers P, Hughes T, Townsend R. Large-artery stiffness in health and disease: JACC state-of-the-art review. J Am Coll Cardiol. 2019;74:1237–63.

    PubMed  PubMed Central  Google Scholar 

  4. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M, et al. ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34:2159–219. 2013

    PubMed  Google Scholar 

  5. Laurent S, Cockcroft J, Van Bortel L, Boutouyrie P, Giannattasio C, Hayoz D, et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J. 2006;27:2588–605.

    PubMed  Google Scholar 

  6. Laurent S, Cockcroft J, Van Bortel L, Boutouyrie P, Giannattasio C, Hayoz D, et al. Abridged version of the expert consensus document on arterial stiffness. ARTRES. 2007;1:2.

    Google Scholar 

  7. Schellinger IN, Mattern K, Raaz U. The Hardest Part. Arterioscler Thromb Vasc Biol. 2019;39:1301–6.

    CAS  PubMed  Google Scholar 

  8. Munakata M. Brachial-Ankle pulse wave velocity: background, method, and clinical evidence. Pulse (Basel). 2016;3:195–204.

    Google Scholar 

  9. Baier D, Teren A, Wirkner K, Loeffler M, Scholz M. Parameters of pulse wave velocity: determinants and reference values assessed in the population-based study LIFE-Adult. Clin Res Cardiol. 2018;107:1050–61.

    PubMed  PubMed Central  Google Scholar 

  10. Tomiyama H, Shiina K. State of the art review: Brachial-Ankle PWV. J Atheroscler Thromb. 2020;27:621–36.

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Ohkuma T, Ninomiya T, Tomiyama H, Kario K, Hoshide S, Kita Y, et al. Brachial-Ankle Pulse Wave Velocity and the Risk Prediction of Cardiovascular Disease: An Individual Participant Data Meta-Analysis. Hypertension. 2017;69:1045–52.

    CAS  PubMed  Google Scholar 

  12. Hu B-C, Li Y, Liu M, Sheng C-S, Wang J-G. Ankle-brachial index in relation to the natriuretic peptide system polymorphisms and urinary sodium excretion in Chinese. Atherosclerosis. 2013;230:86–91.

    CAS  PubMed  Google Scholar 

  13. Giugliano G, Sannino A, Brevetti L, Perrino C, Schiattarella GG, Franzone A, et al. Ankle/brachial index to everyone. BMC Surg. 2012;12:S18. Suppl 1

    PubMed  PubMed Central  Google Scholar 

  14. Golledge J, Moxon JV, Rowbotham S, Pinchbeck J, Quigley F, Jenkins J. High ankle brachial index predicts high risk of cardiovascular events amongst people with peripheral artery disease. PLoS One. 2020;15:e0242228.

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Resnick HE, Lindsay RS, McDermott MM, Devereux RB, Jones KL, Fabsitz RR, et al. Relationship of high and low ankle brachial index to all-cause and cardiovascular disease mortality: the Strong Heart Study. Circulation 2004;109:733–9.

    PubMed  Google Scholar 

  16. Blanch N, Clifton PM, Keogh JB. Postprandial effects of potassium supplementation on vascular function and blood pressure: a randomised cross-over study. Nutr Metab Cardiovasc Dis. 2014;24:148–54.

    CAS  PubMed  Google Scholar 

  17. D’Elia L, Galletti F, La Fata E, Sabino P, Strazzullo P. Effect of dietary sodium restriction on arterial stiffness: systematic review and meta-analysis of the randomized controlled trials. J Hypertens. 2018;36:734–43.

    PubMed  Google Scholar 

  18. Jennings A, Berendsen AM, de Groot LCPGM, Feskens EJM, Brzozowska A, Sicinska E, et al. Mediterranean-style diet improves systolic blood pressure and arterial stiffness in older adults. Hypertension. 2019;73:578–86.

    CAS  PubMed  Google Scholar 

  19. Jung S, Kim MK, Shin J, Choi BY, Lee Y-H, Shin DH, et al. High sodium intake and sodium to potassium ratio may be linked to subsequent increase in vascular damage in adults aged 40 years and older: the Korean multi-rural communities cohort (MRCohort). Eur J Nutr. 2019;58:1659–71.

    CAS  PubMed  Google Scholar 

  20. Zhang Z, Liao H, Zhang X, Meng Q, Shi R, Feng J, et al. Associations of urinary sodium excretion with central hemodynamics and changes in vascular structure and function at high altitude. J Clin Hypertens (Greenwich). 2021;23:1907–14.

    CAS  Google Scholar 

  21. García-Ortiz L, Recio-Rodríguez JI, Rodríguez-Sánchez E, Patino-Alonso MC, Agudo-Conde C, Rodríguez-Martín C, et al. Sodium and potassium intake present a J-shaped relationship with arterial stiffness and carotid intima-media thickness. Atherosclerosis. 2012;225:497–503.

    PubMed  Google Scholar 

  22. Tan M, He FJ, Wang C, MacGregor GA. TwEnty-four-hour Urinary Sodium And Potassium Excretion In China: A Systematic Review And Meta-analysis. J Am Heart Assoc. 2019;8:e012923.

    CAS  PubMed  PubMed Central  Google Scholar 

  23. Sun N, Mu J, Li Y. Working Committee of Salt evaluation, Blood Pressure Management, Chinese Medical Association Hypertension Professional Committee, Hypertension Group, Chinese Society of Cardiology. An expert recommendation on salt intake and blood pressure management in Chinese patients with hypertension: A statement of the Chinese Medical Association Hypertension Professional Committee. J Clin Hypertens (Greenwich). 2019;21:446–50.

    Google Scholar 

  24. Yang P, Chen Z, Yin L, Peng Y, Li X, Cao X, et al. Salt intake assessed by spot urine on physical examination in Hunan, China. Asia Pac J Clin Nutr. 2019;28:845–56.

    CAS  PubMed  Google Scholar 

  25. Li Y, Yin L, Peng Y, Liu X, Cao X, Wang Y, et al. The association of blood pressure with estimated urinary sodium, potassium excretion and their ratio in hypertensive, normotensive, and hypotensive Chinese adults. Asia Pac J Clin Nutr. 2020;29:101–9.

    PubMed  Google Scholar 

  26. Lu Y, Pechlaner R, Cai J, Yuan H, Huang Z, Yang G, et al. Trajectories of Age-Related Arterial Stiffness in Chinese Men and Women. J Am Coll Cardiol. 2020;75:870–80.

    PubMed  Google Scholar 

  27. Diehm C, Allenberg JR, Pittrow D, Mahn M, Tepohl G, Haberl RL, et al. German Epidemiological Trial on Ankle Brachial Index Study Group. Mortality and vascular morbidity in older adults with asymptomatic versus symptomatic peripheral artery disease. Circulation. 2009;120:2053–61.

    PubMed  Google Scholar 

  28. Natsuaki C, Inoguchi T, Maeda Y, Yamada T, Sasaki S, Sonoda N, et al. Association of borderline ankle-brachial index with mortality and the incidence of peripheral artery disease in diabetic patients. Atherosclerosis 2014;234:360–5.

    CAS  PubMed  Google Scholar 

  29. Peng S, Wang J, Xiao Y, Yin L, Peng Y, Yang L, et al. The association of carotid artery atherosclerosis with the estimated excretion levels of urinary sodium and potassium and their ratio in Chinese adults. Nutr J. 2021;20:50.

    CAS  PubMed  PubMed Central  Google Scholar 

  30. Tabara Y, Takahashi Y, Kumagai K, Setoh K, Kawaguchi T, Takahashi M, et al. Descriptive epidemiology of spot urine sodium-to-potassium ratio clarified close relationship with blood pressure level: the Nagahama study. J Hypertens. 2015;33:2407–13.

    CAS  PubMed  Google Scholar 

  31. Andrus EC, Allen EV, Merritt HH, Duff GL, Moore RA, Kendall FE, et al. The pathogenesis of arteriosclerosis. Int J Epidemiol. 2015;44:1791–3.

    PubMed  Google Scholar 

  32. O’Donnell MJ, Yusuf S, Mente A, Gao P, Mann JF, Teo K, et al. Urinary sodium and potassium excretion and risk of cardiovascular events. JAMA. 2011;306:2229–38.

    PubMed  Google Scholar 

  33. O’Donnell M, Mente A, Rangarajan S, McQueen MJ, Wang X, Liu L, et al. Urinary sodium and potassium excretion, mortality, and cardiovascular events. N Engl J Med. 2014;371:612–23.

    PubMed  Google Scholar 

  34. Todd AS, Macginley RJ, Schollum JBW, Williams SM, Sutherland WHF, Mann JI, et al. Dietary sodium loading in normotensive healthy volunteers does not increase arterial vascular reactivity or blood pressure. Nephrol (Carlton). 2012;17:249–56.

    CAS  Google Scholar 

  35. Lennon-Edwards S, Ramick MG, Matthews EL, Brian MS, Farquhar WB, Edwards DG. Salt loading has a more deleterious effect on flow-mediated dilation in salt-resistant men than women. Nutr Metab Cardiovasc Dis. 2014;24:990–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  36. Polónia J, Maldonado J, Ramos R, Bertoquini S, Duro M, Almeida C, et al. Estimation of salt intake by urinary sodium excretion in a Portuguese adult population and its relationship to arterial stiffness. Rev Port Cardiol. 2006;25:801–17.

    PubMed  Google Scholar 

  37. Lennon-Edwards S, Allman BR, Schellhardt TA, Ferreira CR, Farquhar WB, Edwards DG. Lower potassium intake is associated with increased wave reflection in young healthy adults. Nutr J. 2014;13:39.

    PubMed  PubMed Central  Google Scholar 

  38. Sun Y, Byon CH, Yang Y, Bradley WE, Dell’Italia LJ, Sanders PW, et al. Dietary potassium regulates vascular calcification and arterial stiffness. JCI Insight. 2017;2:e94920.

    PubMed Central  Google Scholar 

  39. Cunha MR, Cunha AR, Marques BCAA, Mattos SS, D’El-Rei J, França NM, et al. Association of urinary sodium/potassium ratio with structural and functional vascular changes in non-diabetic hypertensive patients. J Clin Hypertens (Greenwich). 2019;21:1360–9.

    CAS  Google Scholar 

  40. Dai XW, Wang C, Xu Y, Guan K, Su YX, Chen YM. Urinary Sodium and Potassium Excretion and Carotid Atherosclerosis in Chinese Men and Women. Nutrients. 2016;8:612.

    PubMed Central  Google Scholar 

  41. Yang Q, Liu T, Kuklina EV, Flanders WD, Hong Y, Gillespie C, et al. Sodium and potassium intake and mortality among US adults: prospective data from the Third National Health and Nutrition Examination Survey. Arch Intern Med. 2011;171:1183–91.

    PubMed  Google Scholar 

  42. Castro H, Raij L. Potassium in hypertension and cardiovascular disease. Semin Nephrol. 2013;33:277–89.

    CAS  PubMed  Google Scholar 

  43. He FJ, Campbell NRC, Ma Y, MacGregor GA, Cogswell ME, Cook NR. Errors in estimating usual sodium intake by the Kawasaki formula alter its relationship with mortality: implications for public health. Int J Epidemiol. 2018;47:1784–95.

    PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We gratefully acknowledge the voluntary participation of all the study subjects. This work was supported by funding from the National Science Foundation of China (81973324, 81872685, and 82003537), the Hunan Young Talent grant (2020RC3063), the Hunan Science Foundation (2020JJ5858, 2020JJ4439) and the Wisdom Accumulation and Talent Cultivation Project of the Third XiangYa Hospital of Central South University (YX202002).

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QY, WH, Lu Yin, YM, and Xin Huang produced data for analysis. QY, WH, Lin Yang and YL wrote the manuscript. YL designed the study. CK, LJ, PT, and Xiao Hui included patients for the study. All authors reviewed and edited the manuscript. YL and Xin Huang handled funding and supervision. All authors read and approved the final manuscript.

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Correspondence to Ying Li.

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Yang, Q., Jiang, W., He, Y. et al. The association of arterial stiffness with estimated excretion levels of urinary sodium and potassium and their ratio in Chinese adults. J Hum Hypertens (2022). https://doi.org/10.1038/s41371-022-00671-3

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  • DOI: https://doi.org/10.1038/s41371-022-00671-3

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