Restricting dietary sodium is a common recommendation given by clinicians to patients with heart failure and is one supported by current guidelines. However, the quality of evidence for this recommendation is suboptimal, and there is no consensus on the optimal level of sodium intake. Though excessive sodium intake is associated with left ventricular hypertrophy and hypertension, recent data have suggested that very low sodium intake is paradoxically associated with worse outcomes for patients with heart failure. This is possibly explained by the association between low sodium intake and activation of the sympathetic and renin-angiotensin-aldosterone systems. Nevertheless, sodium restriction is routinely recommended and remains a cornerstone of heart failure and blood pressure therapy. In this review we discuss the pros and cons of sodium restriction for patients with heart failure from the current literature.
The prevalence of heart failure is increasing and now affects more than 25 million people globally.1, 2 Restricting dietary sodium is a common recommendation given by physicians to patients with heart failure. On average, Americans consume 3500-4000 mg of dietary sodium every day.3 All current international heart failure guidelines recommend restriction in sodium intake.4, 5, 6, 7, 8, 9, 10, 11, 12 However, the level of evidence in these guidelines is either not provided or is derived from expert opinion and lacks of high-quality data (Grade C; Table 1). Guidelines recommend sodium restriction ranging from 1500 to 3000 mg/d and reflect a lack of consensus on the maximum sodium intake.
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-Muhammad Shahzeb Khan, MDa, Daniel W. Jones, MD, MACP, FAHAb, Javed Butler, MD, MPH, MBAb
