The article by Andrew Mente and colleagues1 on the association between urinary sodium and cardiovascular events is heavily questionable on scientific grounds and imposes a rebuttal in the interest of public health and primary prevention, a milestone of any efficient public health system. Our criticisms are based on critically faulted methodology about: study design, which was unfit for nutritional investigation; characteristics of the populations, as participants were recruited in different countries and had different dietary habits and lifestyles, and included individuals using heavy pharmacological treatments, including high-dose diuretics (“reverse causality and high residual confounding”);1 using an unreliable method for the assessment of habitual sodium intake; the extremely low number of cardiovascular events among participants with a salt intake of 5 g or less per day; and lack of plausible explanations for the study findings. The striking paradox of the authors' position is that they do recognise that higher sodium intake translates into higher blood pressure levels; yet, they argue that a salt intake as high as 17 g per day (appendix p 19)1 is preferable to one of 5 g or less, implying that the levels currently observed in European countries should be left untouched. As everyone realises, by doing so, one could only expect a further increase in the prevalence of hypertension, and in turn, a greater financial burden on the national health systems for pharmacological expenses. We reject these messages, we believe in primary prevention, and we rely on the positive outcome of a lower sodium environment for the future generations. We will stick to this commitment.
Sodium and cardiovascular disease
VEGLIO, Franco;
2016-01-01
Abstract
The article by Andrew Mente and colleagues1 on the association between urinary sodium and cardiovascular events is heavily questionable on scientific grounds and imposes a rebuttal in the interest of public health and primary prevention, a milestone of any efficient public health system. Our criticisms are based on critically faulted methodology about: study design, which was unfit for nutritional investigation; characteristics of the populations, as participants were recruited in different countries and had different dietary habits and lifestyles, and included individuals using heavy pharmacological treatments, including high-dose diuretics (“reverse causality and high residual confounding”);1 using an unreliable method for the assessment of habitual sodium intake; the extremely low number of cardiovascular events among participants with a salt intake of 5 g or less per day; and lack of plausible explanations for the study findings. The striking paradox of the authors' position is that they do recognise that higher sodium intake translates into higher blood pressure levels; yet, they argue that a salt intake as high as 17 g per day (appendix p 19)1 is preferable to one of 5 g or less, implying that the levels currently observed in European countries should be left untouched. As everyone realises, by doing so, one could only expect a further increase in the prevalence of hypertension, and in turn, a greater financial burden on the national health systems for pharmacological expenses. We reject these messages, we believe in primary prevention, and we rely on the positive outcome of a lower sodium environment for the future generations. We will stick to this commitment.
I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
