Rami Doukky1, Elizabeth Avery2, Ashvarya Mangla3, Fareed M Collado4, Zeina Ibrahim5, Marie-France Poulin4, DeJuran Richardson6, Lynda H Powell2. 1. Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois; Division of Cardiology, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois; Division of Cardiology, Rush University Medical Center, Chicago, Illinois; Rush Center for Urban Health Equity, Rush University Medical Center, Chicago, Illinois. Electronic address: rami_doukky@rush.edu. 2. Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois; Rush Center for Urban Health Equity, Rush University Medical Center, Chicago, Illinois. 3. Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois; Division of Cardiology, Rush University Medical Center, Chicago, Illinois; Rush Center for Urban Health Equity, Rush University Medical Center, Chicago, Illinois. 4. Division of Cardiology, Rush University Medical Center, Chicago, Illinois. 5. Division of Cardiology, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois. 6. Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois; Rush Center for Urban Health Equity, Rush University Medical Center, Chicago, Illinois; Department of Mathematics and Computer Science, Lake Forest College, Lake Forest, Illinois.
Abstract
OBJECTIVES: This study sought to evaluate the impact of sodium restriction on heart failure (HF) outcomes. BACKGROUND: Although sodium restriction is advised for patients with HF, data on sodium restriction and HF outcomes are inconsistent. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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]; NCT00018005).
OBJECTIVES: This study sought to evaluate the impact of sodium restriction on heart failure (HF) outcomes. BACKGROUND: Although sodium restriction is advised for patients with HF, data on sodium restriction and HF outcomes are inconsistent. METHODS: 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. RESULTS: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). CONCLUSIONS: 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]; NCT00018005).
Authors: J A West; N H Miller; K M Parker; D Senneca; G Ghandour; M Clark; G Greenwald; R S Heller; M B Fowler; R F DeBusk Journal: Am J Cardiol Date: 1997-01-01 Impact factor: 2.778
Authors: Kathleen L Grady; Peter M Meyer; Diane Dressler; Annette Mattea; Suzanne Chillcott; Alice Loo; Connie White-Williams; Barbara Todd; Sophia Ormaza; Annemarie Kaan; Maria Rosa Costanzo; William Piccione Journal: Ann Thorac Surg Date: 2004-04 Impact factor: 4.330
Authors: Ashvarya Mangla; Rami Doukky; Lynda H Powell; Elizabeth Avery; DeJuran Richardson; James E Calvin Journal: BMJ Open Date: 2014-12-04 Impact factor: 2.692
Authors: Katherine J Overwyk; Zerleen S Quader; Joyce Maalouf; Marlana Bates; Jacqui Webster; Mary G George; Robert K Merritt; Mary E Cogswell Journal: Adv Nutr Date: 2020-09-01 Impact factor: 8.701
Authors: Matthew Griffin; Aaron Soufer; Erden Goljo; Matthew Colna; Veena S Rao; Sangchoon Jeon; Parinita Raghavendra; Julie D'Ambrosi; Ralph Riello; Steven G Coca; Devin Mahoney; Daniel Jacoby; Tariq Ahmad; Michael Chen; W H Wilson Tang; Jeffrey Turner; Wilfried Mullens; Francis P Wilson; Jeffrey M Testani Journal: JACC Heart Fail Date: 2020-02-05 Impact factor: 12.035
Authors: Ashvarya Mangla; Rami Doukky; DeJuran Richardson; Elizabeth F Avery; Rebecca Dawar; James E Calvin; Lynda H Powell Journal: Am Heart J Date: 2017-09-29 Impact factor: 4.749
Authors: Stephan von Haehling; Nicole Ebner; Marcelo R Dos Santos; Jochen Springer; Stefan D Anker Journal: Nat Rev Cardiol Date: 2017-04-24 Impact factor: 32.419
Authors: Scott L Hummel; Wahida Karmally; Brenda W Gillespie; Stephen Helmke; Sergio Teruya; Joanna Wells; Erika Trumble; Omar Jimenez; Cara Marolt; Jeffrey D Wessler; Maria L Cornellier; Mathew S Maurer Journal: Circ Heart Fail Date: 2018-08 Impact factor: 8.790
Authors: Jennifer S Hanberg; Veena Rao; Jozine M Ter Maaten; Olga Laur; Meredith A Brisco; F Perry Wilson; Justin L Grodin; Mahlet Assefa; J Samuel Broughton; Noah J Planavsky; Tariq Ahmad; Lavanya Bellumkonda; W H Wilson Tang; Chirag R Parikh; Jeffrey M Testani Journal: Circ Heart Fail Date: 2016-08 Impact factor: 8.790