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CardioBrief: Salt Restriction Harmful in HF?

Sodium limitation is a cornerstone of heart disaster management, though many people would be astounded to learn that there is no good ancillary justification for a practice. Now a new observational investigate raises serve questions about sodium limitation in heart failure.

In a paper published in a Jan. 1 emanate of JACC: Heart Failure, researchers from Rush University Medical Center sought to consider a impact of sodium restriction, that was tracked by sequence food magnitude questionnaires, on outcomes in 833 heart disaster patients who participated in a HF Adherence and Retention Trial (HART).

No justification to support sodium limitation was found. In fact, sodium limitation was compared with poignant boost in a risk of genocide or heart disaster hospitalization, nonetheless any organisation interpretation is unfit due to a retrospective and observational inlet of a study.

The authors wrote that their “findings support serve hillside of a American College of Cardiology Foundation/American Heart Association sodium limitation recommendation in patients with ongoing HF to category IIb (efficacy reduction good established, conflictive evidence), and press a need for multicenter randomized hearing to definitively residence a purpose of sodium limitation in HF management.”

In a 2009 heart disaster guidelines, sodium limitation in heart disaster perceived a Class we recommendation (recommended), though this was formed usually on consultant accord (a C turn of evidence). More recently, a 2013 discipline downgraded a recommendation to Class IIa (reasonable) formed on a same turn of evidence.

Heart Failure Experts Decry Absence of Evidence

In an concomitant editorial comment, Scott Hummel, MD, and Matthew Konerman, MD, both of a University of Michigan in Ann Arbor, concurred a study’s stipulations though endorsed that a stream discipline “should be taken with a pellet of salt.”

“Considering a plea this limitation poses for patients, it is even some-more critical to explain either sodium limitation is profitable during all,” they wrote.

In a second editorial comment, Clyde Yancy, MD, of Northwestern University and past boss of a AHA, forked out that a “traditional logic” ancillary sodium limitation “has been so transparent that to call for explanation seemed heretical. Yet, an downright hunt of accessible novel does not yield evidence.”

“The stream study,” he continued, “adds to a movement to call a doubt though does not yield answers.”

Asked to criticism on a paper, Milton Packer, MD, of Baylor University in Dallas, sent a following statement:

“I am not certain what we are ostensible to do with these data. A retrospective research of a organisation of reported (not confirmed) sodium intake and several outcomes is not a quite useful square of evidence. Should we boot a commentary entirely? Should a commentary lead us to doubt a core recommendations per sodium restriction? How is one ostensible to know? These information do not assistance explain a conditions during all.

“We have had no basement for any of a recommendations per sodium limitation during a past 50 years, nonetheless these recommendations have altered a good understanding (for no good reason). After this report, we still have no basement for any of a recommendations per sodium restriction. We were ignorant before; we are not any smarter now. Did we unequivocally need this news to tell us that we miss justification for a recommendations per dietary sodium in patients with heart failure?”

Salim Yusuf, MD, DPhil, of McMaster University in Hamilton, Ontario, told CardioBrief that he entirely concurred with a authors and commenters that “we need decisive randomized trials of either impassioned obscure of sodium is helpful, protected or useless.” He continued:

“The flourishing physique of justification from epidemiologic studies is unchanging in not display any clinical advantage with reduce sodium intakes next 4 g per day in several opposite populations: healthy giveaway living, e.g., the PURE study; those with vascular disease, e.g., in ONTARGET; in diabetics; and now in heart failure.

“Surely discipline can't keep on ignoring a common weight of justification that really low sodium expenditure is compared with worse outcomes. Of course, epidemiologic studies can't indispensably prove either a additional events with low sodium is causal. The usually approach brazen is to control a array of randomized tranquil trials to inspect a impact of impassioned obscure of sodium in several opposite populations where obscure sodium is being recommended.

“While such trials are underway, it would be advantageous to stop recommending impassioned obscure of sodium (say next 3 g of sodium per day) as one can't bar mistreat and there is no justification of benefit.

“The emanate is no longer who is right, though what is right.”

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