Not All Patients with Heart Failure Benefit from Salt Restriction Interview with
Weihao Liang
on behalf of Professor Chen Liu
Department of Cardiology, Sun Yat-sen University First Affiliated Hospital
Guangzhou, Guangdong, China  What is the background for this study?   

Response: Salt intake restriction is frequently recommended in heart failure guidelines, but is restricting salt intake to “as least as possible” appropriate? Evidence is lacking. Besides, the effect of salt restriction on patients with heart failure with preserved ejection fraction isn’t clear as they have often been excluded from relevant studies.  What are the main findings?

Response: In this secondary analysis of the TOPCAT trial with patients with heart failure with preserved ejection fraction enrolled, participants with a cooking salt score above zero were at significantly lower risk of the composite primary endpoint than those whose score was zero, which was mainly driven by that they were less likely to be admitted to hospital for heart failure. Moreover, those of black and Asian ethnicities seemed to benefit more from adding salt to their cooking compared with those of white ethnicity, although the numbers were small. What should readers take away from your report?

Response: -As the result suggests, an overstrict salt restriction might harm the prognosis of patients with heart failure with preserved ejection fraction. Salt restriction recommendation should be given carefully by physicians to patients with heart failure with preserved ejection fraction, not just “as least as possible”. What recommendations do you have for future research as a result of this work?

Response: -The effect of salt restriction to different ranges, e.g. 1-2 g/day, 2-3 g/day or 3-4 g/day, is supposed to be investigated in the future researches. Besides, effects of salt restriction on patients with heart failure with different ejection fraction categories and of different ethnicities should also be taken into consideration. Is there anything else you would like to add?

Response: It should be stressed that, though we found that overstrict salt restriction might do harm to patients with heart failure with preserved ejection fraction, salt restriction is still an important component of heart failure management, only that the optimal range of salt restriction needs new evidence to determine.

Citation:Li J, Zhen Z, Huang P, et al. Salt restriction and risk of adverse outcomes in heart failure with preserved ejection fraction. Heart 2022. Epub ahead of print. doi: 10.1136/ heartjnl-2022-321167.[wysija_form id=”3″]


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Last Updated on July 20, 2022 by Marie Benz MD FAAD