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Sodium Intake as a Risk Factor for Cardiovascular Disease—Reply

Jiang He, MD, PhD; Lorraine G. Ogden, MS; Paul K. Whelton, MD, MSc
JAMA. 2000;283(15):1957-1958. doi:10.1001/jama.283.15.1957.
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In Reply: We agree with Dr Alderman and colleagues that there were meaningful differences in the methods used in our study and theirs.1 However, in contrast to their claims, we believe that our findings are more generalizable. We excluded participants consuming low-salt diets because they had restricted their salt intake due to health concerns. As such, estimates derived from a 24-hour recall at baseline would not have represented their habitual dietary intake of sodium. Similarly, patients with CVD might have reduced their dietary sodium intake because of their diagnosis. This assumption was well supported by our finding of an inverse association between dietary sodium intake and CVD prevalence at baseline. In addition, incident cases provide the best estimate of disease risk associated with an exposure.2 We included coronary heart disease, stroke, hypertensive heart disease, and heart failure as the study outcomes, because they were the most common and biologically appropriate blood pressure–related CVD outcomes.


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