Scott Kahan, MD, MPH; Yoni Freedhoff, MD
Do interventions aimed at reducing dietary salt reduce mortality and cardiovascular (CV) morbidity in the long-term?
Included studies compared interventions aimed at reducing dietary salt (restricted salt intake or advice to reduce salt intake) with usual, control, or placebo diets, or no intervention in adults, and had ≥ 6 months of follow-up. Outcomes included mortality, CV mortality, and CV morbidity (fatal and nonfatal myocardial infarction, stroke, angina, heart failure, peripheral vascular events, sudden death, revascularization, and CV hospitalization).
MEDLINE, EMBASE/Excerpta Medica, CINAHL, PsycINFO (all to Oct 2008); Cochrane Central Register of Controlled Trials, Health Technology Assessment database, Database of Abstracts of Reviews of Effects (Issue 4, 2008); and reference lists of identified studies and reviews were searched for randomized controlled trials (RCTs). 7 RCTs (n = 6489) met inclusion criteria; populations included persons with normotension (3 RCTs, n = 3518), hypertension (2 RCTs, n = 758), normotension or hypertension (1 RCT, n = 1981), and heart failure (1 RCT, n = 232). 6 trials met ≥ 5 of 9 quality criteria (higher score = lower risk for bias).
Meta-analysis showed that interventions to reduce dietary salt did not reduce mortality or CV morbidity overall or in persons with normotension or hypertension, or CV mortality in persons with hypertension (Table). In 1 RCT of patients with heart failure, interventions to reduce dietary salt increased all-cause mortality (Table).
Interventions to reduce dietary salt do not reduce mortality or cardiovascular morbidity in persons with normotension or hypertension.
*CV = cardiovascular; NS = not significant; other abbreviations defined in Glossary. RRR, RRI, NNT, NNH, and CI calculated from control event rates and risk ratios in article using a fixed-effect model.
†Fatal and nonfatal myocardial infarction, stroke, angina, heart failure, peripheral vascular events, sudden death, revascularization, and CV hospitalization.
Kahan S, Freedhoff Y. Review: Interventions to reduce dietary salt do not reduce mortality or morbidity. Ann Intern Med. ;156:JC1–4. doi: 10.7326/0003-4819-156-2-201201170-02004
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Published: Ann Intern Med. 2012;156(2):JC1-4.
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