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Salt in the diet in patients with heart failure

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Colin-Ramirez, Eloisa; Ezekowitz, Justin A.

Current Opinion in Cardiology: March 2016 - Volume 31 - Issue 2 - p 196–203
doi: 10.1097/HCO.0000000000000253
HEART FAILURE: Edited by Haissam Haddad

Purpose of review Recognizing the relevance of sodium balance in heart failure, it has been presumed that patients with heart failure benefit from a low-sodium diet, though its efficacy and safety are unclear. The purpose of this review is to provide insight into the currently available evidence base for the effects of dietary sodium restriction in patients with chronic heart failure.

Recent findings There has been an increasing body of evidence on the effects of sodium restriction in heart failure; however, both observational and experimental studies have shown mixed results. Recent randomized controlled trial data has even suggested that sodium restriction may have detrimental effects in patients with heart failure. Only a few randomized controlled trials have included clinical outcomes as a primary endpoint. These have been either unpowered to test the association between reduced sodium intake and outcomes, or conducted in the context of an aggressive diuretic treatment and fluid restriction.

Summary The effects of a low-sodium diet on clinical outcomes in patients with heart failure remain unclear. Ongoing research into the effects of lowering sodium for patients with chronic or acute heart failure will shed light on the importance of holistic self-care and dietary strategies in heart failure.

aResearcher, National Council of Science and Technology (CONACYT), and National Institute of Cardiology ‘Ignacio Chavez’, Mexico City, Mexico

bDivision of Cardiology, Department of Medicine

cCanadian VIGOUR Centre, University of Alberta, Edmonton, Canada

Correspondence to Justin A. Ezekowitz, MBBCh MSc, 2-132 Li Ka Shing Centre for Health Research Innovation, Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada. Tel: +1 780 407 8719; fax: +1 780 407 6452; e-mail:

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