Looking at the Link Between Salt and Heart Failure

Study shows possible connection, but other factors may be important

A recent study suggests that eating a lot of salt every day doubles your risk of heart failure. But you may want to take the results with a grain of salt.

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In the study of more than 4,500 Finnish adults, researchers found that those who ate more than 13.7 grams of salt daily nearly doubled their risk of heart failure over a 12-year follow-up period. An increase risk of developing heart failure was observed in subjects who ate 6.8 grams or salt or greater.

But the study did not examine other known risk factors — heart disease, high blood pressure, smoking, diabetes and obesity — nor what role they might play in such high rates of heart failure, says heart failure specialist and transplant cardiologist Antonio Perez, MD, MBA.

“The study is thought-provoking, but I do not believe  that it sheds any great light on the causes of heart failure, independent of things we already know,” Dr. Perez says. “It may be that patients who consumed greater amounts of salt also had higher rates of hypertension and other co-morbidities such as coronary disease, which we know increase risk for heart failure.”

“To better evaluate possible direct links between salt consumption and heart failure risk, the study authors would have to account for the presence or absence of these other risk factors in their analysis,” Dr. Perez says.

How much salt

The average American eats more salt than the recommended dietary guidelines of 2.3 grams daily, but less than the higher risk levels found in the Finnish study. The Centers for Disease Control and Prevention (CDC) reports that the average American consumes 3.4 grams of salt daily.

“The 13.7 grams of sodium consumed by the highest risk group in the Finnish study is a very large amount; however, there are Americans who do regularly consume greater than 6 grams of sodium a day,” Dr. Perez says.

“This study suggests that they also may be at increased risk of developing heart failure over the long-term. The increased risk may be due to high blood pressure, coronary disease, diabetes and obesity, which are often associated with poor dietary choices, including processed foods that can be high in salt.”

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The role excessive salt consumption plays in heart disease has been well-documented.

It can contribute to high blood pressure. Elevated blood pressure, chronic and untreated, can weaken the heart and damage arteries, leading to heart failure and other heart diseases. In patients with heart failure, high salt consumption contributes to fluid retention, which can result in shortness of breath, fatigue and swelling. For patients with severe heart failure, a high-salt diet can make it difficult for their hearts to supply adequate blood flow to their organs.

Whether to follow a low-salt diet

Doctors routinely discuss how important a low-sodium diet is with people who have heart failure, high blood pressure or are at risk for heart disease.

“Salt matters. The degree to which it matters varies from person to person, depending on their medical history and dietary habits. However, no one should be eating the amount of salt reported in the Finnish study,” Dr. Perez says.

For people with high blood pressure, research has shown that salt reduction plus a diet rich in fruits and vegetables can lower blood pressure. For people without high blood pressure or heart disease, the science on the ideal amount of salt intake is less certain.

If your blood pressure is normal and you do not have heart disease, avoid overdoing salt and heed the CDC recommendations.  If you do have hypertension, heart disease or cardiac risk factors, talk about your salt consumption with your doctor, who can provide recommendations tailored to you.

How to lower the salt in your diet

Hiding the salt shaker is not the answer when it comes to eating a low-sodium diet. “The sodium driver is processed foods,” Dr. Perez says.

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Soups and other canned foods, salad dressings, chips and other snacks, and some breakfast cereals are high in sodium. And, you may not realize that processors infuse many frozen meats and poultry with salt water for preservation.

The key is reading nutritional labels when grocery shopping and eating at a restaurant.

Foods that contain 35 mg or less per serving are very low in sodium. Foods that contain 140 mg or less per serving are low in sodium, according to the CDC.

If you and your doctor decide that you should lower your sodium intake, it’s a good idea to give yourself time to adjust to the change.

“People will comment when they start decreasing salt in their diet that the food tastes bland. But your taste buds regenerate every few weeks. After about a month, the food will taste better. Many who stick with salt reduction later say that they find their old recipes way too salty,” Dr. Perez says.

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