Spot Urine Sodium-to-Potassium Ratio Is a Predictor of Stroke: The MESA

Michelle M. Averill, Rebekah L. Young, Alexis C. Wood, Emily O. Kurlak, Holly Kramer, Lyn Steffen, Robyn L. McClelland, Joseph A. Delaney, Adam Drewnowski

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Background and Purpose - Dietary sodium reduction with concurrent increase in potassium intake is a current public health priority to reduce risk of cardiovascular events. This study explored associations between the spot urine sodium-to-potassium ratio and cardiovascular events in the MESA (Multi-Ethnic Study of Atherosclerosis) longitudinal cohort. Methods - The MESA is a prospective cohort study of 6814 adults from 4 ethnic groups (European-, Asian-, African- and Hispanic-American) with a mean age of 62 (±10.2) years and an average of 11.7 (±2.2) years of follow-up. Participants were free of clinical cardiovascular disease at baseline. Spot urine sodium and potassium excretion, as a marker of dietary intake, was collected at baseline. The impact of urinary sodium-to-potassium ratio on adjudicated cardiovascular events was assessed using Cox proportional hazards models. Results - Only 39% of MESA participants had a urinary sodium-to-potassium ratio ≤1, and these participants experienced only 74 of the 236 strokes. A sodium-to-potassium ratio >1 was associated with a hazard ratio of 1.47 (95% CI,1.07-2.00) for risk of stroke, adjusting for age, sex, race, cardiovascular risk factors, socio-demographic characteristics, body size, and kidney function. Conclusions - The spot urine sodium-to-potassium ratio (measurable in routine care) is associated with stroke. A urine sodium-to-potassium ratio of ≤1, may be related to a clinically relevant reduction in stroke risk and is a feasible target for health interventions.

Original languageEnglish (US)
Pages (from-to)321-327
Number of pages7
Issue number2
StatePublished - 2019

Bibliographical note

Funding Information:
This research was supported by R01 DK 076608 and contracts HHSN268201500003I, N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, and N01-HC-95169 from the National Heart, Lung, and Blood Institute and by grants UL1-TR-000040, UL1-TR-001079, and UL1-TR-001420 from National Center for Advancing Translational Sciences. This work is also a publication of the US Department of Agriculture, Agricultural Research Service (USDA/ARS) Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine (Houston, TX) funded in part by the USDA/ARS (Cooperative Agreement 58-3092-5-001). The contents of this publication do not necessarily reflect the views or policies of the USDA nor does mention of trade names, commercial products, or organizations imply endorsement from the US government.

Publisher Copyright:
© 2019 Lippincott Williams and Wilkins. All rights reserved.


  • atherosclerosis
  • diet
  • ethnic groups
  • potassium
  • sodium


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