SODIUM-HF is the largest and longest RCT done looking at sodium restriction heart failure. The top line results show no effect but the more you look at the study the more problematic it is. The Filtrate take it to task.

The Filtrate:

Joel Topf

Swapnil Hiremath

Josh Waitzman

Sophia Ambruso

Special Guests:

Boback Ziaeian @boback Assistant Professor of Medicine David Geffen School of Medicine at UCLA. His Google Schoolar page is better than yours.

And returning for her third time (why do we keep inviting her back?)
Sadiya Khan @heartDocSadiya Assistant Professor of Medicine (Cardiology) and Preventative Medicine at Northwestern Feinberg School of Medicine. Link

Editor:

Sophia Ambruso

Show Notes:

2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure says:

Restricting dietary sodium is a common nonpharmacological treatment for patients with HF symptomatic with congestion, but specific recommendations have been based on low-quality evidence. Concerns about the quality of data regarding clinical benefits or harm of sodium restriction in patients with HF include the lack of current pharmacological therapy, small samples without sufficient racial and ethnic diversity, questions about the correct threshold for clinical benefit, uncertainty about which subgroups benefit most from sodium restriction, and serious questions about the validity of several RCTs in this area. However, there are promising pilot trials of sodium restriction in patients with HF. The AHA currently recommends a reduction of sodium intake to <2300 mg/d for general cardiovascular health promotion; however, there are no trials to support this level of restriction in patients with HF. Sodium restriction can result in poor dietary quality with inadequate macronutrient and micronutrient intake. Nutritional inadequacies have been associated with clinical instability, but routine supplementation of oral iron, thiamine, zinc, vitamin D, or multivitamins has not proven beneficial. The DASH diet is rich in antioxidants and potassium, can achieve sodium restriction without compromising nutritional adequacy when accompanied by dietary counseling, and may be associated with reduced hospitalizations for HF.

This is 2a Class of Recommendation (moderate strength) with a C-LoD level of evidence (Limited data).

Study acronym: the Study Of Dietary Intervention Under 100 Milimoles in Heart Failure.

100 mmol of sodium is 2300 mg

Meta analysis of high versus low sodium diet pulled from Heart due to duplicated and missing data. Retraction Watch.

65 mmol of sodium is 1500 mg

The trial design papers: Design and Region-Specific Adaptation of the Dietary Intervention Used in the SODIUM-HF Trial: A Multicentre Study and Rationale and design of the Study of Dietary Intervention Under 100 MMOL in Heart Failure (SODIUM-HF)

3-day food diaries underestimate sodium intake vs 24 hour urine - and this is worse for patients on loop diuretics: Evaluation of 2 methods for sodium intake assessment in cardiac patients with and without heart failure: the confounding effect of loop diuretics

PREDIMED trial of Mediterranean diet: retracted, republished, still trusted?

DASH Diet trial where they gave food to the participants Effects on Blood Pressure of Reduced Dietary Sodium and the Dietary Approaches to Stop Hypertension (DASH) Diet

Medical Therapy for Heart Failure With Reduced Ejection Fraction: The CHAMP-HF Registry

Interpreting the Kansas City Cardiomyopathy Questionnaire in Clinical Trials and Clinical Care: JACC State-of-the-Art Review

Development and evaluation of the Seattle Angina questionnaire: A new functional status measure for coronary artery disease