Scientists from Sun Yat-sen University found that restricting salt intake is considered a key component of heart failure treatment, but restricting it too much may actually worsen the outcomes for people with a common form of the condition.
Younger people and those of Black and other ethnicities seem to be most at risk.
The research is published in the journal Heart and was conducted by Jiayong Li et al.
Salt restriction is frequently recommended in heart failure guidelines, but the optimal restriction range (from less than 1.5 g to less than 3 g daily) and its effect on patients with heart failure with preserved ejection fraction isn’t clear, as they have often been excluded from 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) isn’t able to fill properly with blood (diastolic phase), reducing the amount of blood pumped out into the body.
In the study, researchers drew on analysis of data from 1713 people aged 50 and above with heart failure with preserved ejection fraction.
Participants were asked how much salt they routinely added to the cooking of staples, such as rice, pasta, and potatoes; soup; meat; and vegetables, and this was scored as: 0 points (none); 1 (⅛ tsp); 2 (¼ tsp); and 3 (½+tsp).
Participants with a cooking salt score above zero were at significantly lower risk of the primary endpoint than those whose score was zero, mainly driven by the fact that they were less likely to be admitted to the hospital 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.
Those aged 70 or younger were much more likely to benefit from adding salt to their cooking than were those older than 70 in terms of the primary endpoint and admission to the hospital for heart failure.
Similarly, those of Black and other ethnicities seemed to benefit more from adding salt to their cooking compared with those of white ethnicity, although the numbers were small.
The team says lower sodium intake is usually linked to lower blood pressure and a reduced risk of heart disease in the general public and in those with high blood pressure.
It is thought that it reduces fluid retention and the triggering of the hormones involved in blood pressure regulation.
But restricting salt intake to control heart failure is less straightforward. It may prompt intravascular volume contraction, which could, in turn, reduce congestion and the requirement for water tablets to ease fluid retention.
The new study findings show that the volume of plasma in the blood—an indicator of congestion—wasn’t strongly linked to the cooking salt score.
This means that low sodium intake didn’t ease fluid retention in people with heart failure with preserved ejection fraction.
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