New research published today in the Journal of the American College of Cardiology found that adding salt to meals less often is associated with a decreased risk of heart disease, heart failure, and ischemic heart disease.

Even among those who consume a diet similar to the DASH, behavioral treatments to cut down on salt intake might enhance heart health.

There is a lot of evidence that shows a link between a high sodium intake and high blood pressure, which is a major risk factor for heart disease. However, epidemiological studies that looked into this link came up with mixed results because there were no good ways to measure long-term sodium intake. Recent studies show that the number of times a person adds salt to their food could be used to estimate how much sodium they will take in over time.

“Overall, we found that people who don’t shake on a little additional salt to their foods very often had a much lower risk of heart disease events, regardless of lifestyle factors and pre-existing disease,” adds researcher Lu Qi. 

They “also found that when patients combine a DASH diet with a low frequency of adding salt, they had the lowest heart disease risk. This is meaningful as reducing additional salt to food, not removing salt entirely, is an incredibly modifiable risk factor that we can hopefully encourage our patients to make without much sacrifice.”

In this study, the authors looked at 176,570 people from the UK Biobank to see if the amount of salt they put on their food was linked to their risk of getting heart disease. The research also looked at how often salting meals connects to the DASH diet and how it affects the risk of cardiovascular disease.

At the start of the study, a questionnaire was used to find out how often people add salt to their food, excluding salt used in cooking. Participants were also asked if they had made any big changes to their diet in the last five years, and they had to fill out 1–5 rounds of 24-hour dietary recalls over a three-year period.

By minimizing intake of red and processed meats and putting an emphasis on vegetables, fruit, whole grains, low-fat dairy, nuts, and legumes, the DASH-style diet was created to avoid hypertension. Even though the DASH diet has helped reduce the risk of heart disease, a recent clinical trial found that combining the DASH diet with a lower sodium intake was even better for certain biomarkers of heart damage, strain, and inflammation. Based on seven foods and nutrients that are highlighted or downplayed in the DASH-style diet, researchers created a modified DASH score that does not incorporate salt consumption.

Medical history, hospital admissions, questionnaires, and death registration data were used to obtain data on heart disease events.

Overall, research participants who added less salt to their diets were more likely to be women, Caucasian, have a lower BMI, drink moderately, are less likely to be current smokers, and are more physically active. They were also more likely to have high blood pressure and chronic renal disease, but less likely to have cancer. Additionally, compared to those who added salt to their meal more often, these individuals were more likely to follow a DASH-style diet and consume more fruits, vegetables, nuts, and legumes, whole grains, low-fat foods, but less sugar-sweetened beverages, or red/processed meats.

The researchers discovered that the relationship between adding salt to meals and the risk of heart disease was greater among people with a lower socioeconomic position and current smokers. A higher score on the modified DASH diet was related to a decreased risk of cardiovascular events.

Sara Ghoneim, MD, a gastrointestinal fellow at the University of Nebraska Medical Center, stated in a related editorial comment that the research is promising, builds on earlier findings, and points to the possible influence of long-term salt preferences on overall cardiovascular risk.

“A major limitation of the study is the self-reported frequency of adding salt to foods and the enrollment of participants only from the UK, limiting generalizability to other populations with different eating behaviors,” Ghoneim added. “The findings of the present study are encouraging and are poised to expand our understanding of salt-related behavioral interventions on cardiovascular health.”

Source: 10.1016/j.jacc.2022.09.039

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