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Sodium Restriction in Heart Failure: Too Much Uncertainty—Do the Trials December 2018 - Dr. Clyde W. Yancy - Invited Commentary - [ jamanetwork.com ]

We have long treated the dictum to restrict sodium intake in heart failure as a pillar of best practices and a sacrosanct edict that populates the core database for all physicians treating cardiovascular disease. Guidelines have mandated empirical thresholds that are to be respected, and consensus statements from leading organizations further make the case for sodium restriction as a basic tenet of good cardiovascular care.1 However, like many other dogmatic statements that were fully embedded in cardiovascular medicine—for example, suppression of premature ventricular contractions, avoidance of β-blockers in left ventricular dysfunction, and use of hormone replacement therapy in women at risk for cardiovascular disease—the time has now come for sodium restriction in heart failure to be critically reevaluated. There is simply too much uncertainty for a conviction we hold as truth. At a minimum, rigorous testing in well-performed randomized clinical trials is needed. There should be only 1 goal: valid evidence leading to a much more informed position, actionable guidelines, and personalized implementation.