Low sodium diet significantly increases morbidity and mortality in systolic HF

Discussed on 9th November 2012

Heart. 2012 Aug 21. [Epub ahead of print]

Low sodium versus normal sodium diets in systolic heart failure: systematic review and meta-analysis.

Dinicolantonio JJ, Pasquale PD, Taylor RS, Hackam DG.

Source

Ithaca, New York, USA.

Abstract

CONTEXT:

A low sodium diet has been proposed to reduce the risk of heart failure (HF) hospitalisations and is currently advocated in consensus guidelines, yet some evidence suggests adverse neurohumoral activation for sodium restriction in the HF setting.

OBJECTIVES:

To evaluate the effects of a restricted sodium diet in patients with systolic HF.

DATA SOURCES:

A systematic review and meta-analysis of randomised trials OVID MEDLINE, PubMed, Excerpta Medica (Embase), the Cochrane Controlled Trials Register, Scopus, Web of Science and Google Scholar were searched up to April 2012.

STUDY SELECTION:

Two independent reviewers selected studies for inclusion on the basis of a randomised controlled trial design that included adults with systolic HF receiving a restricted salt diet or control diet and reporting mortality (all-cause, sudden death or HF-related) and HF-related hospitalisations.

DATA EXTRACTION AND ANALYSIS:

Descriptive and quantitative information was extracted from included studies. A random-effects model was used to compute pooled risk ratios (RR) for mortality and morbidity outcomes.

RESULTS:

Six randomised trials comparing low sodium diets (1.8 g/day) with normal sodium diets (2.8 g/d) in 2747 patients with systolic HF were identified. Compared with a normal sodium diet, a low sodium diet significantly increased all cause mortality (RR 1.95, 95% CI 1.66 to 2.29), sudden death (RR 1.72, 95% CI 1.21 to 2.44), death due to HF (RR 2.23, 95% CI 1.77 to 2.81) and HF readmissions (RR 2.10, 95% CI 1.67 to 2.64).

CONCLUSION:

Compared with a normal sodium diet, a low sodium diet significantly increases morbidity and mortality in systolic HF.