« Back to Exclusive Articles

Sodium & Cardiovascular Disease: When Good Science Meets Bad Thinking

This content is restricted to members.

To view our premium content, sign up for a membership:


Register New Account

Choose your membership level

Choose Your Payment Method

‹ Back to Exclusive Articles


1.  Donnell MO, Mente A, Alderman MH, Brady AJB, Diaz R, Gupta R, et al. Salt and cardiovascular disease : insufficient evidence to recommend low sodium intake. 2020;1–11.
2.  MacMahon S, Peto R, Collins R, Godwin J, MacMahon S, Cutler J, et al. Blood pressure, stroke, and coronary heart disease. Part 1, prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet. 1990;335(8692):765–74.
3.  Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360(9349):1903–13.
4.  Vasan RS, Larson MG, Leip EP, Evans JC, O’Donnell CJ, Kannel WB, et al. Impact of High-Normal Blood Pressure on the Risk of Cardiovascular Disease. N Engl J Med. 2001;345(18):1291–7.
5. Page LB. Epidemiologic evidence on the etiology of human hypertension and its possible prevention. Am Heart J. 1976;91(4):804–7.
6.  Carvalho JJM, Baruzzi RG, Howard PF, Poulter N, Alpers MP, Franco LJ, et al. Blood pressure in four remote populations in the INTERSALT study. Hypertension. 1989;14(3):238–46.
7. Oliver WJ, Cohen EI, Neel J V. Blood pressure, sodium intake, and sodium related hormones in the Yanomamo indians, a “no salt” culture. Circulation. 1975;52(1):146–51.
8. Batuman V. Salt and hypertension: Why is there still a debate. Kidney Int Suppl. 2013;3(4):316–20.
9.  Prior I, Evans J, Harvey H, Davidson F, Lindsay M. Sodium Intake and Blood Pressure in Two Polynesian Populations. N Engl J Med. 1968;279(10):515–20.
10. Poulter NR, Khaw KT, Hopwood BEC, Mugambi M, Peart WS, Rose G, et al. The Kenyan Luo migration study: observations on the initiation of a rise in blood pressure. Br Med J. 1990;300(6730):967–72.
11. Klag MJ, He J, Coresh J, Whelton PK, Chen JY, Mo JP, et al. The contribution of urinary cations to the blood pressure differences associated with migration. Am J Epidemiol. 1995;142(3):295–303.
12. Hollenberg NK, Martinez G, McCullough M, Meinking T, Passan D, Preston M, et al. Aging, Acculturation, Salt Intake, and Hypertension in the Kuna of Panama. Hypertension. 1997;29(1):171–6.
13. Page LB. Epidemiologic evidence on the etiology of human hypertension and its possible prevention. Am Heart J. 1976;91(4):804–7.
14. Eds Margetts BM, Nelson M. Design Concepts in Nutritional Epidemiology. Oxford: Oxford University Press, 1991.
15. Liu K, Cooper R, Mckeever J, Makeever P, Byington R, Soltero I, et al. Assessment of the association between habitual salt intake and high blood pressure: Methodological problems. Am J Epidemiol. 1979;110(2):219–26.
16. Willett W. Nutritional epidemiology. New York: Oxford University Press; 2013.
17. Campbell NRC, He FJ, Tan M, Cappuccio FP, Neal B, Woodward M, Cogswell ME, McLean R, Arcand J, MacGregor G, Whelton P, Jula A, L’Abbe MR, Cobb LK, Lackland DT. The International Consortium for Quality Research on Dietary Sodium/Salt (TRUE) position statement on the use of 24-hour, spot, and short duration (<24 hours) timed urine collections to assess dietary sodium intake. J Clin Hypertens (Greenwich). 2019 Jun;21(6):700-709.
18. Mente A, O’Donnell M, Rangarajan S, Dagenais G, Lear S, McQueen M, et al. Associations of urinary sodium excretion with cardiovascular events in individuals with and without hypertension: a pooled analysis of data from four studies. Lancet. 2016;388(10043):465–75.
19. Graudal N, Jürgens G, Baslund B, Alderman MH. Compared with usual sodium intake, low- and excessive-sodium diets are associated with increased mortality: A meta-analysis. Am J Hypertens. 2014;27(9):1129–37.
20. Barnard N, Willett W, Ding E. The Misuse of Meta-analysis in Nutrition Research. JAMA. 2017;318(15):1435.
21. Rose G, Stamler J, Stamler R, Elliott P, Marmot M, Pyorala K, et al. Intersalt: An international study of electrolyte excretion and blood pressure. Results for 24 hour urinary sodium and potassium excretion. BMJ. 1988;297(6644):319–28.
22. Perry IJ, Beevers DG. Salt intake and stroke: a possible direct effect. J Hum Hypertens. 1992 Feb;6(1):23-5.
23. Olde Engberink RHG, van den Hoek TC, van Noordenne ND, van den Born BH, Peters-Sengers H, Vogt L. Use of a Single Baseline Versus Multiyear 24-Hour Urine Collection for Estimation of Long-Term Sodium Intake and Associated Cardiovascular and Renal Risk. Circulation. 2017 Sep 5;136(10):917-926.
24. Cook NR, Appel LJ, Whelton PK. Lower Levels of Sodium Intake and Reduced Cardiovascular Risk. Circulation. 2014;129(9):981–9.
25. Cook NR, He FJ, MacGregor GA, Graudal N. Sodium and health-concordance and controversy. BMJ. 2020;369:m2440.
26. Cook NR, Obarzanek E, Cutler JA, Buring JE, Rexrode KM, Kumanyika SK, et al. Joint effects of sodium and potassium intake on subsequent cardiovascular disease: The trials of hypertension prevention follow-up study. Arch Intern Med. 2009;169(1):32–40.
27. Stamler J, The INTERMAP Research Group. Relation of Dietary Sodium (Salt) to Blood Pressure and Its Possible Modulation by Other Dietary Factors: The INTERMAP Study. Hypertension. 2018;71(4):631–7.
28. Tanaka H, Ueda Y, Hayashi M, Date C, Baba T, Yamashita H, et al. Risk factors for cerebral hemorrhage and cerebral infarction in a japanese rural community. Stroke. 1982;13(1):62–73.
29. Nakagawa H, Miura K. Salt reduction in a population for the prevention of hypertension. Environ Health Prev Med. 2004;9(4):123–9.
30. Pietinen P, Vartiainen E, Seppänen R, Aro A, Puska P. Changes in diet in Finland from 1972 to 1992: impact on coronary heart disease risk. Prev Med. 1996 May-Jun;25(3):243-50. doi: 10.1006/pmed.1996.0053.
31. Tuomilehto J, Jousilahti P, Rastenyte D, Moltchanov V, Tanskanen A, Pietinen P, Nissinen A. Urinary sodium excretion and cardiovascular mortality in Finland: a prospective study. Lancet. 2001 Mar 17;357(9259):848-51.
32. He FJ, Pombo-Rodrigues S, MacGregor GA. Salt reduction in England from 2003 to 2011: Its relationship to blood pressure, stroke and ischaemic heart disease mortality. BMJ Open. 2014;4(4).
33. Mozaffarian D, Fahimi S, Singh GM, et al. Global sodium consumption and death from cardiovascular causes. N Engl J Med 2014;371:624-34.
34. Cutler A, Scott P. Randomized trials of sodium reduction: an overview. Am J Clin Nutr. 1997;65(Suppl):643S-51S.
35. He FJ, MacGregor GA. Effect of Longer-Term Modest Salt Reduction on Blood Pressure. a Meta-Analysis. Implications for Public Health. J Hypertens. 2000;18(4):S91–2.
36. Huang L, Trieu K, Yoshimura S, Neal B, Woodward M, Campbell NRC, et al. Effect of dose and duration of reduction in dietary sodium on blood pressure levels: Systematic review and meta-analysis of randomised trials. BMJ. 2020;368:8–10.
37. Meneton P, Jeunemaitre X, De Wardener HE, Macgregor GA. Links between dietary salt intake, renal salt handling, blood pressure, and cardiovascular diseases. Physiol Rev. 2005;85(2):679–715.
38. Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure lowering on outcome incidence in hypertension: 4. effects of various classes of antihypertensive drugs – Overview and meta-analyses. J Hypertens. 2015;33(2):195–211.
39. Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J, et al. Blood pressure lowering for prevention of cardiovascular disease and death: A systematic review and meta-analysis. Lancet. 2016;387(10022):957–67.
40. He FJ, MacGregor GA. Salt reduction lowers cardiovascular risk: Meta-analysis of outcome trials. Lancet. 2011;378(9789):380–2.
41. Chang HY, Hu YW, Yue CSJ, Wen YW, Yeh WT, Hsu LS, et al. Effect of potassium-enriched salt on cardiovascular mortality and medical expenses of elderly men. Am J Clin Nutr. 2006;83(6):1289–96.
42. Kupari M, Koskinen P, Virolainen J. Correlates of left ventricular mass in a population sample aged 36 to 37 years. Focus on lifestyle and salt intake. Circulation. 1994 Mar;89(3):1041-50.
43. Tzemos N, Lim PO, Wong S, Struthers AD, MacDonald TM. Adverse cardiovascular effects of acute salt loading in young normotensive individuals. Hypertension. 2008 Jun;51(6):1525-30.
44. Asaria P, Chisholm D, Mathers C, Ezzati M, Beaglehole R. Chronic disease prevention: health effects and financial costs of strategies to reduce salt intake and control tobacco use. Lancet. 2007 Dec 15;370(9604):2044-53.