Small Vessel Disease and Dietary Salt Intake: Cross-Sectional Study and Systematic Review

J Stroke Cerebrovasc Dis. 2017 Dec;26(12):3020-3028. doi: 10.1016/j.jstrokecerebrovasdis.2017.08.004. Epub 2017 Sep 8.


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.

Keywords: Dietary salt; acute stroke; urinary sodium/creatinine ratio; white matter lesions.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Aged
  • Biomarkers / urine
  • Cerebral Small Vessel Diseases / diagnostic imaging
  • Cerebral Small Vessel Diseases / epidemiology*
  • Cerebral Small Vessel Diseases / urine
  • Creatinine / urine
  • Cross-Sectional Studies
  • Diet, Sodium-Restricted
  • Diffusion Magnetic Resonance Imaging
  • Feeding Behavior
  • Female
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Risk Factors
  • Scotland / epidemiology
  • Sodium / urine
  • Sodium Chloride, Dietary / adverse effects*
  • Stroke, Lacunar / diagnostic imaging
  • Stroke, Lacunar / epidemiology*
  • Stroke, Lacunar / urine
  • Surveys and Questionnaires
  • Time Factors


  • Biomarkers
  • Sodium Chloride, Dietary
  • Sodium
  • Creatinine