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 "We still do not have a clear understanding of the mechanisms that
may link salt intake with heart failure," said lead study author Dr.
Kamal Mahtani of the University of Oxford in the UK.
But the results still don't mean doctors and patients should abandon
recommendations to cut back on salt, said Dr. Clyde Yancy of the
Northwestern University, Feinberg School of Medicine in Chicago.
"I am certain that there will be those who declare, `Hallelujah! I
can have a big bag of potato chips tonight!' but don't do it," Yancy,
author of an accompanying editorial, said by email. "The
consequences will be the same as before, you will become ill."
Restricting salt or sodium in the diet has been a cornerstone of
lifestyle recommendations for heart failure patients, and that
shouldn't change because too much salt causes fluid retention that a
heart weakened by heart failure can't handle, Yancy said.
"The injudicious consumption of pizza, pickles, French fries and
other very salted foods will lead to worsening heart failure,
occasionally sufficient to require hospitalization," Yancy said. "So
yes, sodium restriction in heart failure remains necessary."
But the study also highlights that scientists don't know with
certainty exactly what level of salt restriction is ideal or whether
this might vary for different types of patients, Yancy added. More
research is needed to answer this question and give patients better
guidance in the future.
For the new study, Mahtani and colleagues examined data from nine
previously published studies involving a total of 479 patients. None
of these studies provided sufficient data to determine if a low-salt
diet might be associated with a lower risk of death from
cardiovascular causes like heart attacks or strokes.
"A lot of the guidelines appear to vary in the exact advice they
give heart failure patients when it comes to reducing salt intake,"
Mahtani said by email. "Our research highlights a paucity of robust
high-quality evidence available to support or refute current
guidance."
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High salt intake is a leading risk factor for high blood pressure,
which can lead to heart disease, heart attacks and strokes.
Heart failure happens when the heart muscle is too weak to
effectively pump enough blood through the body. Symptoms can include
fatigue, weight gain from fluid retention, shortness of breath and
coughing or wheezing. Medications can help strengthen the heart and
minimize fluid buildup in the body.
Coronary artery disease, which develops when fatty deposits
accumulate in the arteries and reduce blood flow, is a common cause
of heart failure. Patients are often advised to cut back on salt to
help lower their blood pressure and reduce the strain on clogged
arteries.
In the study, researchers examined several potential impacts of a
low-salt diet on heart failure patients and didn't find a decisive
connection.
For example, the number of repeat hospitalizations for acute illness
was similar regardless of how much salt patients with heart failure
consumed, the analysis found.
Salt intake also didn't appear to influence the frequency or
severity of heart failure symptoms.
One drawback of the analysis is that the smaller studies varied in
how they measured salt intake and assessed heart failure symptoms
and outcomes, making it hard to pool results across all of these
studies to get a clearer picture of the impact of a low-salt diet,
the authors note.
SOURCE: http://bit.ly/2F8Mzvq and http://bit.ly/2FjRHgD JAMA
Internal Medicine, online November 5, 2018.
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