Clinical Nutrition Perspectives: The Influence of Diet on Metabolic Health, Inflammation, and Cardiovascular Risk (Oral Session 18)

(OR18-05-25) Increased Risk of Coronary Artery Disease in Participants With Hypertension and Higher Dietary Sodium-to-Potassium Ratio: Analysis of NHANES 2017–2020

Tuesday, June 3, 2025

9:18 AM – 9:30 AM ET

Location: S220 B-D

Presenting Author(s)

NW

Nicha Wareesawetsuwan, MD

American Heart Association Comprehensive Hypertension Center at the University of California Medical Center, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, United States
Nonthaburi, Nonthaburi, Thailand

Disclosure information not submitted.

Co-Author(s)

KM

Kanita Mankan, MD

Chiang Mai University, Department of Biochemistry, Thailand
NM

Nopavit Mohpichai

Excellent Center for Organ Transplantation, Ramathibodi Hospital, Mahidol University, Thailand
WP

Weerinth Puyati, MD

Siriraj Hospital, Mahidol University, Thailand
NC

Natanon Chamnarnphol, MD

Siriraj Hospital, Mahidol University, Thailand
UC

Urairat Chuenchaem, MD

Bumrungrad International Hospital, United States
WN

Wanprapit Noree, MD

American Heart Association Comprehensive Hypertension Center at the University of California Medical Center, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, United States, United States
RB

Rabhas Boonyawairote, MD

American Heart Association Comprehensive Hypertension Center at the University of California Medical Center, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, United States, United States
VS

Varissara Sinkajarern, MD

American Heart Association Comprehensive Hypertension Center at the University of California Medical Center, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, United States, United States
TP

Thutpharritchn Phoonakh, MD

American Heart Association Comprehensive Hypertension Center at the University of California Medical Center, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, United States, United States
VR

Voramol Rochanaroon, MD

American Heart Association Comprehensive Hypertension Center at the University of California Medical Center, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, United States, United States
PV

Possawat Vutthikraivit, MD

Phramongkutklao College of Medicine, Mahidol University
Bangkok, Krung Thep, Thailand
SK

Seonghyeon Kim, BS

American Heart Association Comprehensive Hypertension Center at the University of California Medical Center, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, United States, United States
YH

Young Ha, BS

American Heart Association Comprehensive Hypertension Center at the University of California Medical Center, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, United States, United States
NW

Napat Wongmat, MD

American Heart Association Comprehensive Hypertension Center at the University of California Medical Center, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, United States, United States
CK

Chutawat Kookanok, MD

American Heart Association Comprehensive Hypertension Center at the University of California Medical Center, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, United States, United States
NK

Narathorn Kulthamrongsri, MD

University of Hawaii Internal Medicine Residency Program, Department of Medicine, University of Hawaii John A. Burns School of Medicine, United States
PW

Phuuwadith Wattanachayakul, MD

Albert Einstein Medical Center, United States
ET

Ekamol Tantisattamo, MD, MPH

Assistant Clinical Professor of Medicine
Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine
Irvine, California, United States

Objectives: High dietary sodium intake (DSI) is associated with an increased risk for cardiovascular disease; while increased dietary potassium intake (DPI) appears protective. The WHO recommends a dietary molar sodium-to-potassium ratio (Na/K) ≤1. However, the relationship between Na/K and coronary artery disease (CAD) remains unclear. This study aimed to investigate the association between Na/K and CAD.

Methods: This retrospective cross-sectional study analyzed data from adult participants in the National Health and Nutrition Examination Survey 2017–2020. DSI and DPI were estimated based on daily total nutrient consumption, and participants were categorized into two groups: Na/K ≤1 and >1. Logistic regression was used to assess the association between the Na/K and CAD.

Results: A total of 7,524 participants were included, with 48.8% male and a mean age of 49.3±18.2 years. Participants with a Na/K ratio ≤1 accounted for 4.3%, while those with a Na/K ratio >1 accounted for 95.7%. The mean Na/K ratios were 0.79 ± 0.2 and 2.6 ± 1.3 for the two groups, respectively, with a mean difference (MD) of 1.8 (95% CI 1.7–2.0, P < 0.001). A history of hypertension (HTN) accounted for 37% of participants. Among patients with HTN, the mean systolic BP and diastolic BP were 132 ± 19 mmHg and 78 ± 14 mmHg, respectively, compared to 124 ± 14 mmHg (MD 7.8, 95% CI 4.9–10.7, P < 0.001) and 76 ± 10 mmHg (MD 1.4, 95% CI 0.9–3.6, P 0.228) in patients without HTN. A Na/K >1 was significantly associated with CAD (OR 1.8, 95% CI 1.2–2.7, P 0.009), angina (OR 2.1, 95% CI 1.3–3.6, P 0.005), and obesity (OR 1.4, 95% CI 1.1–1.8, P 0.002) in univariate analysis. After adjustment for age, sex, race, smoking status, serum creatinine, HTN, diabetes, stroke, and heart failure, a Na/K >1 remained significantly associated with CAD, but not angina and obesity (aOR 2.2, 95% CI 1.2–4.2, P 0.018). In sensitivity analysis, a Na/K >1 was significantly associated with CAD in patients with HTN (aOR 2.48, 95% CI 1.20–5.13, P 0.014), whereas no association was found in patients without HTN.

Conclusions: This study shows that disproportionately high DSI or low DPI is independently associated with CAD, highlighting the importance of improving dietary sodium and potassium balance to reduce CAD risk, particularly for patients with HTN. Further prospective longitudinal studies are needed to validate these findings.

Funding Sources: None