improvement in quality of life and in the severity of their heart failure.
Ezekowitz thinks that these results might have been different if the study had gone on longer or if the levels of salt consumption had been even lower.
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Uncertainty about the benefits of reducing salt
The findings are not a license to eat as much salt as you like, he adds.
“People should continue to be concerned about the amount of salt in their diet and continue to reduce the sodium in their diet overall,” Ezekowitz notes. “There may be benefits that we didn’t measure in our clinical trial that they might get from reducing salt in the diet. A low-salt diet may actually improve their overall quality of life. The real take-home is that a low-sodium diet remains an important part for most patients.”
Dr. Gregg Fonarow, interim chief of the division of cardiology at University of California, Los Angeles, says for decades patients with heart failure have been advised to restrict their salt intake.
“This longstanding, widely accepted recommendation was based on a physiologic rationale, clinical observation and expert opinion rather than having been demonstrated in prospective, randomized clinical trials,” he notes.
While more recent guidelines for heart failure have acknowledged the uncertainty about the benefits of reducing salt, many patients have still been told to reduce their salt to very low levels, Fonarow says.
“The evidence from this very important randomized clinical trial suggests that dietary sodium restriction to a target of less than 1,500 mg per day in patients with heart failure did not reduce mortality, cardiovascular-related hospitalization or cardiovascular-related emergency room visits,” he adds.
For patients with heart failure, it remains unclear whether any level of salt restriction offers clinical benefits, Fonarow notes.
“Yet it is important to keep in mind the usual care comparison group was consuming a little over 2,000 mg of sodium daily, which is still lower than the 3,400 mg of sodium that is the average amount consumed in the U.S. by the general population,” he shares.
Living with heart failure
The key to living with heart failure is to follow the proven treatment advice, he adds.
“Importantly, use and adherence to disease-modifying guidelines and medical therapy have been shown to be the best and safest way to improve clinical outcomes for patients with heart failure,” Fonarow concludes.
If you have heart failure, you should discuss how these new findings might apply to you with your doctor.