The Study
The relation between urinary sodium and potassium excretion and risk of cardiovascular events and mortality in patients with cardiovascular disease
This study looked at people who already had heart or blood vessel problems and saw that those with very low or very high salt in their urine tended to have more heart problems later. But it didn’t change anyone’s diet — so we can’t say salt caused it. It just shows a pattern, not proof.
Analysis score
Maximum 72 for a cohort study.
Where the score came from
This study looked at people who already had heart or blood vessel problems and found that eating just the right amount of salt is safest — too little or too much raises the risk of heart attacks or death. Surprisingly, eating more potassium (like from bananas) was linked to higher risk, not lower. The best balance was a specific ratio of salt to potassium.
Where does this study sit?
Reviews of RCTs (Meta-analyses)
Max 100Randomized Trials
Max 90Reviews of Cohort Studies
Max 85Cohort Studies
Max 72Reviews of Case-Control Studies
Max 63Case-Control Studies
Max 58Cross-Sectional & Case Series
Max 50Expert Opinion
Max 559 / 100
Quality score
Groups of people are followed over time to see who develops an outcome. Strong for identifying risk factors and associations, but cannot prove causation as firmly as RCTs.
Key takeaways
Summary
Based on the study abstract and findings.
- 1Yes — for someone with heart disease, going outside the 4.5–5 g salt range or eating very high potassium may increase their risk of another heart event or death.
- 2Best salt intake: 4.59–4.97 grams/day.
- 3Best salt-to-potassium ratio: 2.60–2.71.
- 4Every extra gram of salt raised blood pressure by 1.28 mmHg (systolic) and 0.46 mmHg (diastolic).
- 5Every extra gram of potassium raised blood pressure by 1.04 mmHg (systolic) and 0.61 mmHg (diastolic).
Score breakdown, methodology, conflicts of interest, evidence analysis & raw study data
Publication
Journal
PLoS ONE
Year
2022
Authors
Eline H Groenland, Jean-Paul A C Vendeville, M. Bots, G. D. de Borst, H. Nathoe, Y. Ruigrok, P. Blankestijn, F. Visseren, W. Spiering
Related Content
Claims (6)
For people who already have heart disease, having just the right balance of salt and potassium in their urine — not too much, not too little — seems to be linked to the lowest chance of heart problems or dying from any cause. Too little or too much of this balance is linked to higher risks.
For people who already have heart disease, eating just the right amount of salt — not too little and not too much — seems to be linked to the lowest chance of heart problems or dying from any cause. Too little or too much salt might actually be riskier.
For people who already have heart disease, the more potassium their body gets rid of in urine, the more likely they are to have a heart attack, stroke, or die — which is the opposite of what most people think potassium does.
Eating too little or too much salt might both be bad for your heart — people who eat way less than 3,000 mg or way more than 6,000 mg of salt a day seem to have a higher chance of heart problems or dying from them.
For people with heart disease, the more potassium their body gets rid of in urine, the higher their blood pressure tends to be — every extra gram of potassium excreted per day raises systolic pressure by about 1 point and diastolic by about 0.6 points, which is the opposite of what doctors usually expect.
If you have heart disease and eat more salt, your blood pressure tends to go up — for every extra gram of salt you excrete in urine, your top blood pressure number goes up by about 1.3 points and your bottom number by about 0.5 points.
Not medical advice. For informational purposes only. Always consult a qualified healthcare professional before making health decisions.