Article Text

Original research
Salt restriction and risk of adverse outcomes in heart failure with preserved ejection fraction
  1. Jiayong Li1,2,
  2. Zhe Zhen1,2,
  3. Peisen Huang1,2,
  4. Yu-Gang Dong1,2,3,
  5. Chen Liu1,2,3,
  6. Weihao Liang1,2
  1. 1 Department of Cardiology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
  2. 2 NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, Guangdong, China
  3. 3 National‐Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, Guangdong, China
  1. Correspondence to Dr Weihao Liang, Department of Cardiology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China; liangwh26{at}mail.sysu.edu.cn; Professor Chen Liu, Department of Cardiology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China; liuch75{at}mail.sysu.edu.cn

Abstract

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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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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Footnotes

  • 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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.