Low Sodium Versus Normal Sodium Diets in Systolic Heart Failure: Systematic Review and Meta-Analysis


There is an abundance of scientific evidence to suggest that high dietary salt intake is an important risk factor for cardiovascular and renal morbidity and mortality including stroke, hypertension, myocardial infarction, and renal insufficiency.2-5

Meta-analysis was performed in six clinical studies that were identified using a literature search of several clinical databases in order to assess the outcome of different levels of sodium intake in patients with systolic heart failure. In order to be included in this study, human trials had to be randomized, controlled trials that included adults (18 years or older) with systolic heart failure (left ventricular ejection fraction <40%) receiving a restricted salt diet or control diet. The primary outcomes considered were mortality (overall, sudden death and heart failure-related hospital admissions).

All patients received the same amount of sodium in their diet, low-sodium (1.8 g/day) or normal-sodium (2.8 g/day) during the course of each trial. All diets were the same with the only difference being the level of sodium consumed between groups.

The results of this meta-analysis showed that heart failure patients receiving a low-sodium diet exhibited significantly increased all-cause mortality, sudden death, and death due to heart failure as well as increased heart failure-related hospital readmissions as compared to heart failure patients receiving a normal-sodium diet.

While the finding of the present study cannot be extrapolated to the population as a whole, they do suggest that a low-sodium diet might not be the best treatment for this patient population and that further investigation is warranted.

Reference List

  1. DiNicolantonio JJ, Pasquale PD, Taylor RS, Hackam DG. Low sodium versus normal sodium diets in systolic heart failure: systematic review and meta-analysis. Heart 2012
  2. He FJ, Burnier M, MacGregor GA. Nutrition in cardiovascular disease: salt in hypertension and heart failure. Eur Heart J 2011;32:3073-3080.
  3. Taylor RS, Ashton KE, Moxham T, Hooper L, Ebrahim S. Reduced Dietary Salt for the Prevention of Cardiovascular Disease: A Meta-Analysis of Randomized Controlled Trials (Cochrane Review). Am J Hypertens 2011;24:843-853.
  4. He FJ, MacGregor GA. Salt intake, plasma sodium, and worldwide salt reduction. Ann Med 2012;44:S127-S137.
  5. Gardener H, Rundek T, Wright CB, Elkind MSV, Sacco RL. Dietary Sodium and Risk of Stroke in the Northern Manhattan Study. Stroke 2012;43:1200-1205.

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