Restricting salt intake too much may backfire for some heart patients
![Salt substitutes are associated with a reduced risk of high blood pressure without increasing the risk of low blood pressure, according to new findings published in the Journal of the American College of Cardiology.[1]](/sites/default/files/styles/top_stories/public/2018-04/salt-3285024_1920.jpg.webp?itok=cA0aeCky)
Limiting salt is a common recommendation for patients hoping to improve their heart health or lose weight. Restricting salt too much, however, may actually be bad for certain heart failure patients, according to a new study published in Heart.
Patients with heart failure with preserved ejection fraction (HFpEF) are often excluded from clinical studies focused on sodium intake, the study’s authors wrote. They hoped to gain a better understanding of the relationship between sodium and HFpEF outcomes, exploring data from more than 1,700 patients who participated in the previously completed TOPCAT trial.
Participants in the TOPCAT trial answered questions about how much salt they add to the food they eat at home. They earned a “cooking salt score” from zero to 12 based on their answers, with 12 being the highest possible score.
The study’s primary endpoint was a composite of cardiovascular death, heart failure hospitalization and aborted cardiac arrest. Patients with a cooking salt score of zero had a higher risk of that primary endpoint than patients with a cooking salt score higher than zero. Also, this relationship between “overstrict” salt limitations and poor cardiovascular outcomes was more common among patients younger than 70 years old and patients who were not white.
“In the setting of heart failure, the effect of sodium intake restriction is complicated,” wrote first author Jiayong Li, with the First Affiliated Hospital, Sun Yat-sen University in China, and colleagues. “Low sodium intake may lead to intravascular volume contraction, which could in turn reduce congestion and diuretic requirement, leading to heart failure compensation. However, the results in our study showed that plasma volume status had no significant relationship with cooking salt score, suggesting that low sodium intake did not have an intravascular volume contraction effect on patients with HFpEF.”
The authors also noted that physicians should reconsider advising patients with HFpEF to limit their salt intake in such a severe way.
“High-quality trials are needed to determine the optimal salt intake range for patients with HFpEF,” they concluded.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.