Salt and Cardiovascular Disease: Insufficient Evidence to Recommend Low Sodium intake

Martin O'Donnell; Andrew Mente; Michael H. Alderman; Adrian J.B. Brady; Rafael Diaz; Rajeev Gupta; Patricio López-Jaramillo; Friedrich C. Luft; Thomas F. Lüscher; Giuseppe Mancia; Johannes F.E. Mann; David McCarron; Martin McKee; Franz H. Messerli; Lynn L. Moore; Jagat Narula; Suzanne Oparil; Milton Packer; Dorairaj Prabhakaran; Alta Schutte; Karen Sliwa; Jan A. Staessen; Clyde Yancy; Salim Yusuf


Eur Heart J. 2020;41(35):3363-3373. 

In This Article

Do we Need Large Randomized Controlled Trials of Sodium Reduction?

There remain major gaps in our knowledge of the relationship of sodium intake with human physiology and health. A frequently cited deficit is the absence of large randomized controlled trials to establish the effectiveness and safety of lowering sodium intake on cardiovascular events and mortality, particularly in patients with heart failure.[67,122] While such trials are expected to provide clarity on the effectiveness of reducing mean sodium intake by 0.5–1 g/day, they will not answer the question of whether low sodium intake (<2.3 g/day) is effective and safe. We now know that larger differences in sodium intake between groups are difficult to achieve, even with intensive dietary counselling, and there is no available intervention that results in sustained low sodium intake. Ongoing randomized controlled trials can address whether specialist dietary counselling to reduce sodium intake reduces cardiovascular events, and whether it improves outcomes in patients with heart failure, but are unlikely specifically to evaluate low sodium intake, as sustained low sodium intake (<2.3 g/day) levels are unlikely to be achieved in the intervention group.