Advertisement

The Reply

      We read with great interest Dalan et al's letter in response to our article, “Salt, No Salt, or Less Salt for Patients With Heart Failure?”
      • Khan MS
      • Jones DW
      • Butler J
      Salt, no salt, or less salt for patients with heart failure?.
      We agree with the authors’ argument that low intake of sodium may not be needed in select heart failure patients, such as those who are elderly with low caloric intake and have hypovolemic hyponatremia with natriuresis, as increased solute load may improve intravascular volume and blood pressure. However, it is important to note that while, theoretically, this approach may seem reasonable, there are no data to support this claim. Previously, multiple other approaches in heart failure that theoretically seemed justified, such as avoidance of beta-blockers, have been proven wrong.
      • Yancy CW.
      Sodium restriction in heart failure: too much uncertainty–do the trials.
      There is a need for more data generation in the context of salt and heart failure before we can make evidence-substantiated claims. As Dalan et al have alluded to, a “one size fits all” approach may not be appropriate, and thresholds of salt intake may need to be personalized in the context of various factors such as heart failure phenotype and severity, caloric intake, baseline sodium levels, volume status, and race.

      References

        • Khan MS
        • Jones DW
        • Butler J
        Salt, no salt, or less salt for patients with heart failure?.
        Am J Med. 2020; 133: 32-38
        • Yancy CW.
        Sodium restriction in heart failure: too much uncertainty–do the trials.
        JAMA Intern Med. 2018; 178: 1700-1701