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Keep sodium intake low for heart failure patients ...

Sodium intake was estimated from 3-day food records in 123 patients (mean age, 60 years) with stable systolic heart failure, and the patients were then followed for a median of 3 years. Mean sodium intakes in the lower, middle, and upper tertiles were 1.4, 2.4, and 3.8 g per day, respectively. The cumulative number of episodes of acute decompensated heart failure (ADHF) after 3 years were 12%, 15%, and 46% in the lower, middle, and upper tertiles of sodium intake, respectively (p = 0.001), and the upper tertile was associated with an adjusted hazard ratio of 2.55 (p < 0.001). In addition, the upper tertile was associated with an adjusted hazard ratio of 1.39 (p < 0.02) for all-cause hospitalization and 3.54 (p - 0.005) for mortality.

Comment: Most experts recommend that patients with symptomatic heart failure limit sodium intake to 2 to 3 g per day. However, current guidelines of the American College of Cardiology/American Heart Association suggest that as much as 4 g per day may be appropriate for a similar patient group. The results of the present study support more stringent guidelines for sodium intake than those currently recommended for heart failure patients. However, because this was an observational study, it does not prove causality. The better outcomes in patients who consumed less sodium may have been due in part to compliance bias. It is well known that patients who comply with doctors' recommendation tend to have better outcomes than patients who do not comply, regardless of what the recommendations are.

Arcand J et al. A high-sodium diot is associated with acute decompensated heart failure in ambulatory heart failure patients: a prospective follow-up study. Am / Clin Nutr. 2011;93;332-337.

by Alan R. Gaby, MD

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Title Annotation:Literature Review & Commentary
Author:Gaby, Alan R.
Publication:Townsend Letter
Article Type:Brief article
Geographic Code:1USA
Date:Apr 1, 2012
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