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The association between sodium intake and cardiovascular risk remains controversial, due in part to an inaccurate estimation of sodium intake. Assessing 24-hour urinary output over several days is considered an accurate method.

Individual participant data from six prospective cohorts of generally healthy adults; Sodium and potassium excretion were determined using at least two 24-hour urine samples per participant. The primary endpoint was a cardiovascular event (coronary revascularization or fatal or non-fatal myocardial infarction or stroke). We analyzed each cohort using consistent methods and pooled the results using a random-effects meta-analysis. Higher sodium excretion, decrease potassium excretion, and a better sodium-to-potassium ratio was related to extended cardiovascular threat in analyzes managed for confounders.

The average sodium intake of all ages is about twice the recommended upper limit, and the potassium intake is less than half of the recommended one.

A high-sodium, low-potassium diet leads to high blood pressure and ultimately cardiovascular disease, which is the leading cause of death and disability and the rest of the world. The World Health Organization recommends that all adults limit their sodium intake to 87 mmol ( and 5 g salt) per day and increase their potassium intake to ≥ 90 mmol (≥ 3.5 g) per day. Given the large share of the global burden of cardiovascular disease, particularly hypertension and stroke, more robust estimates of sodium and potassium intake are needed.

All studies reporting sodium or potassium in 24-hour urine were included; Hospitalized patients were excluded. Data were pooled using random-effects meta-analysis and heterogeneity was examined using meta-regression.

High sodium and low potassium intakes lead to high blood pressure, a major cause of cardiovascular risk, but estimates of intake are imprecise and dietary strategies remain limited. These findings may support a reduction in sodium intake and an increase in potassium intake from current levels.