Is Sodium Restriction Associated With Decreased HF Outcomes?

Sodium restriction was not associated with lower risk of death or heart failure (HF) hospitalization, according to the results of a study published Dec. 28 in JACC: Heart Failure.

Led by Rami Doukky, MD, MSc, FACC, et al., researchers evaluated sodium intake data from 833 subjects in the Heart Failure Adherence Retention trial who had New York Heart Association class II/II HF. Patients were classified into two groups based on feedback from food frequency questionnaires: sodium restricted (<2,500 mg/day) and unrestricted (≥2,500 mg/day).

The results of the analysis showed that patients who restricted their sodium intake had a higher risk of death or HF. Further, sodium restriction did not have an evident impact on factors like six-minute walk distance, quality of life, physical function, energy and vitality or cardio-pulmonary symptoms.

According to the authors of the study, “our findings support further downgrade of the ACC/American Heart Association sodium restriction recommendation in patients with chronic HF to class IIb.”

In an accompanying editorial comment, Scott L. Hummel, MD, MS, and Matthew C. Konerman, MD, note that “considering the challenge [of sodium restriction] poses for patients, it is even more important to clarify whether sodium restriction is beneficial at all.” They add that “[future] studies need to determine if variables such as HF subtype … should affect a patient’s recommended daily sodium intake.”

“Given the burden of HF and the billions of dollars expended each year to provide care, we cannot allow such a fundamental question as dietary recommendations to remain unanswered,” adds Clyde W. Yancy, MD, MSc, MACC, in a second accompanying editorial comment. “If any component of the burden of hospitalization is driven by errant dietary directives, then we have done a disservice to the community and are now compelled to pursue this question and provide answers as soon as possible.” 

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: American Heart Association, Heart Failure, Hospitalization, Quality of Life, Recommended Dietary Allowances, Sodium, Sodium, Dietary

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