Does limiting salt intake prevent heart failure? A critical appraisal

Reducing the incidence of heart failure (HF) and its associated morbidity is a major goal for public health authorities. In this review, we evaluate the evidence supporting sodium restriction as a means to prevent HF. High dietary sodium intake is associated with several factors that promote the development of HF including systemic hypertension, ventricular hypertrophy, diastolic dysfunction, vascular stiffness, and endothelial dysfunction. Some argue that sodium restriction actually may contribute to the development of HF through increased neurohormonal activation. The effect of sodium intake on HF risk may depend on an individual’s “salt-sensitivity.” Due in part to methodological limitations, currently available cohort studies have not fully clarified the links between sodium intake and incident HF. Future research is needed to determine accurate and reproducible methods of measuring sodium intake and to identify factors which may make specific individuals more vulnerable to developing HF in the setting of high sodium intake. © Springer Science+Business Media New York (outside the USA) 2016.