Impact of Dietary Sodium Restriction on Heart Failure Outcomes

详细信息    查看全文

• 作者：Rami Doukky ; MD ; MSc^&lowast ; ; ^&dagger ; ; ^&Dagger ; ; ^§ ; ; ^{rami_doukky@rush.edu" class="auth_mail" title="E-mail the corresponding author} ; Elizabeth Avery ; MS^&lowast ; ; ^§ ; ; Ashvarya Mangla ; MD^&lowast ; ; ^&Dagger ; ; ^§ ; ; Fareed M. Collado ; MD^&Dagger ; ; Zeina Ibrahim ; MD^&dagger ; ; Marie-France Poulin ; MD^&Dagger ; ; DeJuran Richardson ; PhD^&lowast ; ; ^§ ; ; ^‖ ; Lynda H. Powell ; PhD^&lowast ; ; ^§ ;
• 关键词：heart failure ; Heart Failure Adherence and Retention Trial ; outcome ; salt restriction ; sodium restriction
• 刊名：JACC: Heart Failure
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：4
• 期：1
• 页码：24-35
• 全文大小：1342 K

文摘

This study sought to evaluate the impact of sodium restriction on heart failure (HF) outcomes.

<h4 id="absSec_2">Backgroundh4>

Although sodium restriction is advised for patients with HF, data on sodium restriction and HF outcomes are inconsistent.

<h4 id="absSec_3">Methodsh4>

We analyzed data from the multihospital HF Adherence and Retention Trial, which enrolled 902 New York Heart Association functional class II/III HF patients and followed them up for a median of 36 months. Sodium intake was serially assessed by a food frequency questionnaire. Based on the mean daily sodium intake prior to the first event of death or HF hospitalization, patients were classified into sodium restricted (<2,500 mg/d) and unrestricted (≥2,500 mg/d) groups. Study groups were propensity score matched according to plausible baseline confounders. The primary outcome was a composite of death or HF hospitalization. The secondary outcomes were cardiac death and HF hospitalization.

<h4 id="absSec_4">Resultsh4>

Sodium intake data were available for 833 subjects (145 sodium restricted, 688 sodium unrestricted), of whom 260 were propensity matched into sodium restricted (n = 130) and sodium unrestricted (n = 130) groups. Sodium restriction was associated with significantly higher risk of death or HF hospitalization (42.3% vs. 26.2%; hazard ratio [HR]: 1.85; 95% confidence interval [CI]: 1.21 to 2.84; p = 0.004), derived from an increase in the rate of HF hospitalization (32.3% vs. 20.0%; HR: 1.82; 95% CI: 1.11 to 2.96; p = 0.015) and a nonsignificant increase in the rate of cardiac death (HR: 1.62; 95% CI: 0.70 to 3.73; p = 0.257) and all-cause mortality (p = 0.074). Exploratory subgroup analyses suggested that sodium restriction was associated with increased risk of death or HF hospitalization in patients not receiving angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (HR: 5.78; 95% CI: 1.93 to 17.27; p = 0.002).

<h4 id="absSec_5">Conclusionsh4>

In symptomatic patients with chronic HF, sodium restriction may have a detrimental impact on outcome. A randomized clinical trial is needed to definitively address the role of sodium restriction in HF management. (A Self-management Intervention for Mild to Moderate Heart Failure [HART]; https" data-locatorKey="//clinicaltrials.gov/ct2/show/NCT00018005">NCT00018005)