Background The optimal salt restriction in patients with heart failure (HF), especially patients with heart failure with preserved ejection fraction (HFpEF), remains controversial.
Objective To investigate the associations of cooking salt restriction with risks of clinical outcomes in patients with HFpEF.
Methods Cox proportional hazards model and subdistribution hazards model were used in this secondary analysis in 1713 participants with HFpEF from the Americas in the TOPCAT trial. Cooking salt score was the sum of self-reported salt added during homemade food preparation. The primary endpoint was a composite of cardiovascular death, HF hospitalisation and aborted cardiac arrest, and secondary outcomes were all-cause death, cardiovascular death and HF hospitalisation.
Results Compared with patients with cooking salt score 0, patients with cooking salt score >0 had significantly lower risks of the primary endpoint (HR=0.760, 95% CI 0.638 to 0.906, p=0.002) and HF hospitalisation (HR=0.737, 95% CI 0.603 to 0.900, p=0.003), but not all-cause (HR=0.838, 95% CI 0.684 to 1.027, p=0.088) or cardiovascular death (HR=0.782, 95% CI 0.598 to 1.020, p=0.071). Sensitivity analyses using propensity score matching baseline characteristics and in patients who prepared meals mostly at home yielded similar results. Subgroup analysis suggested that the association between overstrict salt restriction and poor outcomes was more predominant in patients aged ≤70 years and of non-white race.
Conclusion Overstrict cooking salt intake restriction was associated with worse prognosis in patients with HFpEF, and the association seemed to be more predominant in younger and non-white patients. Clinicians should be prudent when giving salt restriction advice to patients with HFpEF.
- Heart failure
Data availability statement
Data are available upon reasonable request. Data of the TOPCAT trial can be acquired via reasonable request to BioLINCC (https://biolincc.nhlbi.nih.gov/)
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JL and ZZ are joint first authors.
Contributors Conception and study design: WL and PH, analysis and manuscript drafting: JL and ZZ manuscript revision and supervision: YD, CL and WL. WL is responsible for the overall content as guarantor.
Funding This study was funded by the National Natural Science Foundation of China (No. 81770392, 81770394, 81970340, 82000260), Guangdong Natural Science Foundation (No. 2021A1515010755) and China Postdoctoral Science Foundation (No. 2019TQ0380, 2019 M660229, 2021 M693615).
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
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