Too little sodium can be fatal for patients with heart failure

Pouring Table Salt From Shaker

According to a new meta-analysis presented at the American College of Cardiology’s Annual Scientific Session Together With the World Congress of Cardiology, individuals suffering from heart failure may not gain additional benefit from limiting their dietary sodium intake below the recommended maximum level of about 2.3. grams per day. In fact, the analysis of nine randomized controlled trials suggests that such restriction may even increase the risk of death.

Cutting sodium below current recommendations may be counterproductive, research shows.

For people with heart failure, limiting dietary sodium intake to levels below the standard recommended maximum of about 2.3 grams per day provides no additional benefits and may increase the risk of death, according to findings from nine randomized controlled trials in a new study. meta-analysis presented at the American College of Cardiology’s Annual Scientific Session Together With the World Congress of Cardiology.

Heart failure, in which the heart muscle becomes too weak or stiff to pump blood effectively, is a chronic condition that affects more than 6 million adults in the US. Doctors recommend a low-sodium diet to lower blood pressure and common symptoms such as fluid retention and swelling. However, previous studies have reported mixed results regarding the optimal maximum daily sodium intake for people with heart failure.

“Our findings showed that limiting dietary sodium to less than the usual recommendation was counterproductive in the treatment of heart failure,” says Anirudh Palicherla, MD, an internal medicine resident at Creighton University School of Medicine in Omaha, Nebraska. , and the lead author of the study. . “This was in line with a recent randomized controlled trial that suggested that limiting sodium beyond what we’re doing now doesn’t necessarily lead to better outcomes.”

The U.S. Dietary Guidelines for Americans recommends that most adults limit dietary sodium intake to 2.3 grams per day or less, which is equivalent to about one teaspoon of table salt. The average American consumes more than 3.4 grams of sodium per day.

In the study, researchers analyzed nine randomized controlled trials that assessed different levels of sodium restriction for people with heart failure and included data on death rates and hospitalizations. Most of the studies were conducted between 2008 and 2022, with the exception of one previous study published in 1991. Altogether, the studies enrolled a total of nearly 3,500 patients with heart failure.

By analyzing the results of all studies, the researchers found that patients who followed a diet with a target sodium intake of less than 2.5 grams per day were 80% more likely to die than those who followed a diet with a target of less than 2.5 grams per day. 2.5 grams per day or more. Sodium limits ranged from approximately 1.2-1.8 grams per day in the more restrictive study arms. The analysis showed no trend towards more hospital admissions in patients following a more restrictive diet.

“Restricting sodium is still the way to help manage heart failure, but the amount of restriction is up for debate,” Palicherla said. “This study shows that the focus should be on establishing a safe level of sodium consumption rather than overly restricting sodium.”

The researchers said there was considerable variability in the study designs used in the clinical trials, including different baseline characteristics of participants, different health care settings, and different methods of tracking sodium intake and health outcomes. Some studies required participants to limit their fluid intake in addition to their sodium intake, while others did not. However, Palicherla said the number of studies and total number of participants gives the researchers a high level of confidence in the overall findings.

Future studies could help clarify the optimal targets for dietary sodium or identify subgroups of heart failure patients who could benefit from more or less restriction, researchers said. To limit sodium intake, experts recommend eating more fresh fruits and vegetables and cooking with basic ingredients rather than processed, packaged, and canned foods and sauces that often contain high amounts of sodium. When dining out or buying ready-to-eat foods, ask for nutritional information or read food labels and choose items with the lowest amounts of sodium.

Palicherla will present the study “Sodium Restriction in Heart Failure: A Meta-Analysis of Randomized Trials” on Sunday, March 5 at 11:15 AM CT / 5:15 PM[{” attribute=””>UTC in Heart Failure and Cardiomyopathies Moderated Poster Theater 11, Hall F.

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