Thread by @hmkyale

Should we put patients w/chronic heart failure on low sodium diets. This international trial indicates it doesn’t decrease risk of CV events or all-cause death. Little reason to promote the approach.
Nice study @JustinEzekowitz and colleagues. #ACC22 thelancet.com/journals/lance…

@JustinEzekowitz The #SODIUMHF study had an interesting finding…secondary endpoints of health status modestly improved w/low salt diet. People can try it if they want & see if they feel better. If not, they can stop w/o fear they're increasing their risk. We docs should not push it on them.

@JustinEzekowitz Another interesting feature of the study is that while people reported modest improvement in health status w/low salt diet, they did not walk farther in 6 minute walk test. So a split in what you might expect.

@JustinEzekowitz I did see a low salt enthusiastic tweet this trial as if it were positive, extolling the health status finding… but the for the experiment they ran, it did not show the benefit they expected. We can explore the data though, but it should be done w/caution.

@JustinEzekowitz Another issue is salt was self-reported…makes sense, as expensive to measure it in everyone, but adds uncertainty as to what people actually did. Also, at baseline people did not have a high salt diet (groups started ~2100 mg/d). Might be different for someone on high salt diet.

@JustinEzekowitz And then it took 6 years at 26 sites in 6 countries to enroll people with chronic heart failure into a simple diet study… maybe people didn’t want to try a low salt diet. That is a very selected sample.

@JustinEzekowitz Digging into data… what to make of separation of curves at 6 mos. And the 11% lower risk would be meaningful for benign intervention, but the study was powered for 30% reduction. But 11% is not nothing for these people…need a bigger study though. And late separation… not sure.

@JustinEzekowitz Anyway, kudos to those who do trials and to these investigators… 6 years in the trenches to provide evidence from the largest trial of a low salt diet for chronic heart failure. Easy to raise the unanswered questions, hard to do the trials. Thanks to them for this evidence.