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Does reducing your salt intake make you live longer?

Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK

*Corresponding author. Tel./fax: +44-780-1548122.

E-mail address: joeldunning{at}doctors.org.uk (J. Dunning).

A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether restricting dietary salt intake would provide protection from adverse cardiovascular events or mortality. Using the reported search, 462 papers were identified of which 14 papers represented the best evidence on the subject. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and weaknesses were tabulated. We conclude that restricting sodium intake to levels below 6 g per day as most international guidelines such as those of the AHA, the US Dietary Guideline Committee and the Scientific Advisory Committee on Nutrition recommend, clearly reduces blood pressure and in turn may reduce the need for antihypertensives by as much as 30%. However, the ability of dietary sodium restriction to reduce the incidence of cardiovascular events is more controversial due to the lack of adequately powered randomised trials or observational studies conducted with sufficient rigour. Some of the largest studies such as NHANES and TOHP, which do demonstrate a significant benefit, report a 20–30% relative reduction in adverse events which, due to the low rate of these events in the studies equates to an absolute risk reduction over 10–20 years in the region of 2–3% for protection from adverse cardiovascular events from sodium dietary restriction.

Key Words: Salt; Diet; Hypertension; Blood pressure