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

What can we Recommend/Suggest Based on Current Evidence?

Individual level

In the absence of large clinical outcome trials, and of feasible methods to accurately measure sodium intake in individuals, we should avoid recommending a specific g/day sodium intake target. It is reasonable to provide practical advice on avoidance of key sources of high sodium intake (especially those food items independently associated with cardiovascular risk, such as processed foods with high sodium content). This guidance should be embedded within recommendations on overall dietary quality, and best targeted at specific groups of individuals, particularly those with hypertension.

Population level

While current evidence has limitations, and there are differences of opinion in interpretation of existing evidence, it is reasonable, based upon observational studies, to suggest a population-level mean target of <5 g/day in populations with mean sodium intake of >5 g/day, while awaiting the results of large randomized controlled trials of sodium reduction on incidence of cardiovascular events and mortality.