Abstract
Abstract only Background: Diets high in sodium and low in potassium are associated with increased blood pressure level but associations with cardiovascular disease (CVD) remain controversial. Few studies have evaluated this relationship among Hispanic/Latino adults. Objective: To assess whether dietary sodium and potassium are associated with incident CVD among diverse US Hispanics/Latino adults. Methods: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) is a cohort of 16,415 self-identifying Hispanic/Latino adults aged 18-74 four US urban communities in 2008-2011 (visit 1; V1). V1 included a comprehensive examination with in-person measurement of health information and interviewer administered questionnaires. Dietary sodium (mg/day) and potassium (mg/day) intakes were assessed from the average of two 24-hour dietary recall surveys administered by bilingual registered dietitians. CVD events occurring from V1 through 2019 were adjudicated by an expert panel of clinicians. We used Poisson regression to determine the association (incidence rate ratio, IRR) between sodium, potassium, and the sodium-to-potassium ratio, with CVD, using time to CVD as an offset. Models accounted for HCHS/SOL complex survey design and were adjusted for demographic, including Hispanic/Latino background, socioeconomic, and behavioral factors along with energy consumption, body mass index, cholesterol, and family history of CVD. Results: Among 15,291 participants without self-reported CVD at V1, mean age was 40 years, with 53% female. Mean daily intakes of sodium and potassium were 3,040 mg/day and 2,422 mg/day, respectively. Molar ratio of sodium to potassium was 1.33. Over 9.7 years of follow-up, there were 311 CVD events (2.0 events per 1,000 person years, 95% CI: 1.6, 2.5). In adjusted models, nutrients were associated with increased risk of CVD: by 17% for each 1g/day increment of sodium (IRR: 1.17, 95% CI: 1.03, 1.33); by 29% for each 1g/day decrement of potassium (IRR: 1.29, 95% CI: 1.01, 1.64); and by 112% for each 0.5 molar increment of sodium to potassium ratio (IRR: 2.12, 95% CI: 1.13, 4.11). Conclusions: In a large diverse sample of Hispanic/Latino adults, high dietary sodium and low dietary potassium were independently associated with an increased risk of CVD. Results underscore the importance of intensifying public health interventions to improve nutrient quality, by reducing dietary sodium and increasing dietary potassium consumption as a means of preventing CVD.