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A new systematic review from researchers at the University of Oxford has found limited evidence of any benefit for heart failure patients who follow a low-salt diet, despite many international guidelines recommending this.

Eat less salt Kamal R Mahtani
When considering a lower salt diet, patients with heart failure should discuss the evidence with their healthcare professional, and come to a shared decision based on both the evidence and the individual circumstances of the patient.
- Dr Kamal R Mahtani, Associate Professor, University of Oxford.

The review included just nine small trials, involving a total of 479 participants. None of these studies provided clinically relevant data to determine whether a low-salt diet is associated with a reduced risk of death from heart attack or stroke, hospitalisation or length of hospital stay. However, for patients not in hospital, the authors found no significant evidence of harms from a reduction of dietary salt intake and a trend for some clinical improvements.

Lead author, Dr Kamal Mahtani, an Oxfordshire GP and Associate Professor in the Nuffield Department of Primary Care Health Sciences, said: “ A lot of the guidelines appear to vary in the exact advice they give heart failure patients when it comes to reducing salt intake. Our research highlights a lack of robust, high-quality evidence available to support or refute current guidance.

"When considering a lower salt diet, patients with heart failure should discuss the evidence with their healthcare professional, and come to a shared decision based on both the evidence and the individual circumstances of the patient." 

Writing in JAMA Internal Medicine, the research team suggest larger, well-designed studies are needed and recommend that clinicians and policymakers should acknowledge the weak evidence base for heart failure patients when considering a salt-restricted diet.

A linked editorial by Professor Clyde Yancy, Chief of Cardiology at Northwestern University Feinberg School of Medicine, Chicago, Illinois, highlighted the importance of their work: “the core issue here that resonates loudest is the absence of high-quality evidence.” 

The study was funded by the National Institute for Health Research School for Primary Care Research and the Royal College of General Practitioners Scientific Funding Board.

Read more

Reduced Salt Intake for Heart Failure. A Systematic Review.
Kamal R Mahtani, Carl Heneghan, Igho Onakpoya, Stephanie Tierney, Jeffrey K Aronson, Nia Roberts, F.D Richard Hobbs, David Nunan
JAMA Internal Medicine 2018 doi: 10.1001/jamainternmed.2018.4673

Sodium Restriction in Heart Failure: Too Much Uncertainty—Do the Trials.
Yancy CW. 
JAMA Internal Medicine. 2018. doi:10.1001/jamainternmed.2018.4653

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