Small vessel disease and dietary salt intake: cross-sectional study and systematic review

Makin, S. D.J., Mubki, G. F., Doubal, F. N., Shuler, K., Staals, J., Dennis, M. S. and Wardlaw, J. M. (2017) Small vessel disease and dietary salt intake: cross-sectional study and systematic review. Journal of Stroke and Cerebrovascular Diseases, 26(12), pp. 3020-3028. (doi: 10.1016/j.jstrokecerebrovasdis.2017.08.004) (PMID:28889932) (PMCID:PMC5711036)

Abstract

Background: Higher dietary salt intake increases the risk of stroke and may increase white matter hyperintensity (WMH) volume. We hypothesized that a long-term higher salt intake may be associated with other features of small vessel disease (SVD). Methods: We recruited consecutive patients with mild stroke presenting to the Lothian regional stroke service. We performed brain magnetic resonance imaging, obtained a basic dietary salt history, and measured the urinary sodium/creatinine ratio. We also carried out a systematic review to put the study in the context of other studies in the field. Results: We recruited 250 patients, 112 with lacunar stroke and 138 with cortical stroke, with a median age of 67.5 years. After adjustment for risk factors, including age and hypertension, patients who had not reduced their salt intake in the long term were more likely to have lacunar stroke (odds ratio [OR], 1.90; 95% confidence interval [CI], 1.10-3.29), lacune(s) (OR, 2.06; 95% CI, 1.09-3.99), microbleed(s) (OR, 3.4; 95% CI, 1.54, 8.21), severe WMHs (OR, 2.45; 95% CI 1.34-4.57), and worse SVD scores (OR, 2.17; 95% CI, 1.22-3.9). There was limited association between SVD and current salt intake or urinary sodium/creatinine ratio. Our systematic review found no previously published studies of dietary salt and SVD. Conclusion: The association between dietary salt and background SVD is a promising indication of a potential neglected contributory factor for SVD. These results should be replicated in larger, long-term studies using the recognized gold-standard measures of dietary sodium.

• Item Type: Articles
• Additional Information: Grant support: Wellcome Trust (grant 088134/Z/09/A); Scottish Funding Council and the Chief Scientist Office of Scotland for funding the Scottish Imaging Network: A Platform for Scientific Excellence. F.D. holds an NHS Research Scotland and Stroke Association-Garfield Weston Foundation Senior Lectureship (grant TSA Lect 2015/04). J.S. was supported by the MUMC Academic Fund. J.M.W. receives support from the European Union Horizon 2020, PHC-03-15, project number 666881; “SVDs@Target,” the Fondation Leducq Network for the Study of Perivascular Spaces in Small Vessel Disease, reference number 16 CVD 05; and the Row Fogo Charitable Trust, reference number AD.ROW4.35. BRO-D.FID3668413.
• Keywords: Dietary salt, acute stroke, urinary sodium/creatinine ratio, white matter lesions.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Makin, Dr Stephen
• Authors: Makin, S. D.J., Mubki, G. F., Doubal, F. N., Shuler, K., Staals, J., Dennis, M. S., and Wardlaw, J. M.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Journal of Stroke and Cerebrovascular Diseases
• Publisher: Elsevier
• ISSN: 1052-3057
• ISSN (Online): 1532-8511
• Published Online: 08 September 2017
• Copyright Holders: Copyright © 2017 The Authors
• First Published: First published in Journal of Stroke and Cerebrovascular Diseases 26(12): 3020-3028
• Publisher Policy: Reproduced under a Creative Commons license