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Meta-analytic research of the dose-response relationship between salt intake and risk of heart failure

Hypertension Research volume 44, pages 885–887 (2021)Cite this article

A Correction to this article was published on 25 March 2021

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There is a growing epidemic of heart failure (HF) worldwide. Hypertension and coronary heart disease (CHD) are major contributors to HF [1]. Increased salt intake is associated with a rise in blood pressure [2], and the risk of CHD-related mortality is well known [3]. The risk of HF is believed to be reduced with restricted salt intake. However, some data contradict this belief. We explored the dose-response relationship between salt intake and HF risk using a meta-analytic approach.

The study protocol was registered in the international prospective register of systematic reviews (PROSPERO) (ID: CRD42020163680). Using MEDLINE and EMBASE (from 1950 Jan. 1 to 2019 Sep. 30), we searched for cohort studies of HF risk related to salt intake. Studies had to assess salt intake using 24-h urine Na excretion (UNa) by collection of 24-h urine specimens or validated estimation from spot urine samples and show data on the number of participants at baseline and HF events for participants classified by UNa. A 1 g/day UNa corresponds to 2.5 g/day of salt intake [4]. Studies evaluating salt intake using dietary assessments (e.g., food frequency questionnaire or 24-h dietary recall) were excluded because self-reported salt intake has been critically underestimated compared with actual intake [5]. Since this research focuses on primary prevention of HF, we also excluded studies targeting patients with existing HF. Search keywords consisted of the following elements: UNa, HF, incidence, and cohort study (Supplementary Table 1). Of 351 studies retrieved, 6 were eligible (Supplementary Fig. 1). Supplementary Table 2 shows the characteristics of these 6 studies. One cohort study [6] combined participants with and without a past history of HF. We contacted the author and obtained data on the number of HF events in each UNa category after excluding participants with HF history. The numbers of participants and HF events were 477469 and 3562, respectively (Supplementary Fig. 1, Supplementary Table 2).

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Acknowledgements

We thank Ms. Haga and Ms. Chino at Niigata University for their excellent secretarial work.

Funding

SK was financially supported by a Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (JSPS) (ID:19K12840) and the Taiju Life Social Welfare Foundation. These sponsors had no influence on the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript.

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  1. Department of Prevention of Noncommunicable Diseases and Promotion of Health Checkup, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan

    Satoru Kodama, Kiminori Kato & Kenichi Watanabe

  2. Department of Hematology, Endocrinology and Metabolism, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan

    Chika Horikawa, Kazuya Fujihara, Mariko Hatta, Yasunaga Takeda, Rena Nedachi & Hirohito Sone

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  1. Satoru Kodama
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Correspondence to Satoru Kodama.

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Kodama, S., Horikawa, C., Fujihara, K. et al. Meta-analytic research of the dose-response relationship between salt intake and risk of heart failure. Hypertens Res 44, 885–887 (2021). https://doi.org/10.1038/s41440-021-00632-2

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