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Cochrane review mines the evidence on salt reduction and cardiovascular disease
DOI: 10.1038/ajh.2011.115
A large-scale analysis of the effect of dietary salt reduction on mortality and morbidity from cardiovascular disease (CVD) in adults has been inconclusive, reports a review by the Cochrane Collaboration published in the American Journal of Hypertension. The authors found no strong evidence that salt reduction reduced all-cause mortality or morbidity from CVD in people with normal or high blood pressure, or heart failure. Although the sodium reduction did produce a small blood pressure decline, there was insufficient evidence to determine whether this reduction of salt intake increased or decreased cardiovascular mortality.
Dietary salt intake has been identified as a potential risk factor for CVD. Many public health agencies and government guidelines advise people to cut their salt intake by half. In the face of scientific uncertainty surrounding these recommendations, Rod Taylor and colleagues undertook a systematic review of the effect of dietary salt reduction on mortality and CVD morbidity in adults with normal and high blood pressure, and those with heart failure. Through a rigorous search process, they were able to identify only seven randomized controlled trials (RCTs), comprising ~6,520 participants, for meta-analysis. The single heart failure study found a significantly increased mortality in those allocated to the lower sodium diet. Nevertheless, sodium intake did not significantly influence mortality in the studies taken together.
Based upon their findings, the Cochrane authors support the recent call for further rigorous, large, long-term RCTs, capable of definitively demonstrating the CVD benefit of dietary salt reduction. They also recommend evaluation of the effects of reducing the sodium content of processed food.
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Rod Taylor (University of Exeter, UK)
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Michael Alderman (Editor-in-Chief, American Journal of Hypertension, New York, NY, USA)
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