Younger people and people of black and other ethnicities appear to be at higher risk
Restricting salt intake is considered a key component of heart failure treatment, but restricting it too much may actually worsen outcomes for people with a common form of the condition, research published in the journal Heart suggests.
Younger people and those of black and other ethnicities appear to be at higher risk, the findings indicate.
Salt restriction is frequently recommended in heart failure guidelines, but the optimal range of restriction (from less than 1.5 g to less than 3 g daily) and its effect in heart failure patients with preserved ejection fraction is not clear. clear, since they have often been excluded. of relevant studies.
Heart failure with preserved ejection fraction, which accounts for half of all heart failure cases, occurs when the lower left chamber of the heart (left ventricle) is unable to fill adequately with blood (diastolic phase), reducing the amount of blood pumped to the body.
In an attempt to further explore the association with salt intake, the researchers relied on a secondary analysis of data from 1,713 people aged 50 years and older with heart failure with preserved ejection fraction who were part of the TOPCAT trial.
This trial was designed to find out if the drug spironolactone could effectively treat symptomatic heart failure with preserved ejection fraction.
Salt restriction is frequently recommended in heart failure guidelines
Participants were asked how much salt they typically added to cooking staples such as rice, pasta, and potatoes; Soup; meat; and vegetables, and this was scored as: 0 points (none); 1 (⅛ teaspoon); 2 (¼ teaspoon); and 3 (½+teaspoon).
Their health was then monitored for an average of 3 years for primary endpoint, a composite of death from cardiovascular disease or admission to hospital for heart failure plus aborted cardiac arrest. Secondary outcomes of interest were death from any cause and death from cardiovascular disease plus hospital admission for heart failure.
About half of the participants (816) had a cooking salt score of zero: more than half were male (56%) and the majority were white (81%). They weighed significantly more and had lower diastolic blood pressure (70 mm Hg) than those with a cooking salt score greater than zero (897).
They had also been admitted to hospital more often for heart failure, were more likely to have type 2 diabetesa poorer kidney functionare taking medications to control your heart failure, and have a reduced left ventricular ejection fraction (lower cardiac output).
Participants with a cooking salt score greater than zero had a significantly lower risk of the endpoint than those whose score was zero, mainly due to the fact that they were less likely to be hospitalized for heart failure. But they were no less likely to die from any cause or from cardiovascular disease than those whose cooking salt score was zero.
People aged 70 years or younger had significantly more likely to benefit from adding salt to your cooking than people older than 70 years in terms of the primary endpoint and hospital admission for heart failure.
Similarly, black and other ethnic people seemed to benefit more from adding salt to their cooking compared to white people, although the numbers were small.
Gender, previous hospital admission for heart failure, and use of heart failure medications were not associated with increased risks for any of the measured outcomes and cooking salt score.
Lower sodium intake is generally associated with lower blood pressure
This is an observational study and as such cannot establish cause. Not all relevant trial data TOPCAT were available, while the cooking salt score was self-reported, the researchers acknowledge. And reverse causality cannot be ruled out, whereby people in poorer health might have been advised to further restrict their salt intake.
Lower sodium intake is generally associated with lower blood pressure and reduced risk of cardiovascular disease in the general public and those with high blood pressure. It is believed to reduce fluid retention and the activation of hormones involved in blood pressure regulation.
But restricting salt intake to control heart failure is less straightforward, the researchers say. May cause intravascular volume contraction, which in turn may reduce congestion and the need for diuretics to relieve fluid retention.
But their study findings show that blood plasma volume, an indicator of congestion, was not significantly associated with cooking salt score, suggesting that low sodium intake did not alleviate fluid retention in people with preserved heart failure, ejection fraction, the researchers note.
“Excessive restriction of dietary salt intake could harm patients with [insuficiencia cardíaca con fracción de eyección preservada] and is associated with a worse prognosis. Physicians should reconsider giving this advice to patients.”
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