Long-Term Effects of Dietary Sodium Intake on Cytokines and Neurohormonal Activation in Patients With Recently Compensated Congestive Heart Failure |
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| Authors: | Gaspare Parrinello Pietro Di Pasquale Giuseppe Licata Daniele Torres Marco Giammanco Sergio Fasullo Manuela Mezzero Salvatore Paterna |
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| Affiliation: | 1. Department of Internal Medicine, University of Palermo, Italy;2. Department of Pharmacology, University of Palermo, Italy;3. Department of Emergency Care, University of Palermo, Italy;4. Department of Cardiology, “Paolo Borsellino” GF Ingrassia Hospital, Palermo, Italy;1. Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA;2. Georgia State University, Byrdine F. Lewis School of Nursing, Atlanta, GA, USA;3. Boston College, School of Nursing, Chestnut Hill, MA 02467, USA;4. School of Medicine, Emory University, Atlanta, GA, USA;1. Emergency Department, Hospital Clínic, IDIBAPS, Barcelona, Spain;2. School of Medicine, University of Barcelona, Barcelona, Spain;3. Department of Internal Medicine, Hospital Clínic, IDIBAPS, Barcelona, Spain;4. CIBER OBN, Physiopathology of Obesity and Nutrition, Instituto de Salud Carlos III, Madrid, Spain;5. Emergency Department, Hospital Clínico San Carlos, Madrid, Universidad Complutense de Madrid, Madrid, Spain;6. Emergency Department, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain;7. Emergency Department, Hospital Universitario Central de Asturias, Oviedo, Spain;8. Emergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain;9. Emergency Department, Hospital del Mar, Barcelona, Spain;10. Emergency Department, Hospital Universitario Gregorio Marañón, Madrid, Spain;11. Emergency Department, Home Hospitalization and Short Stay Unit, Hospital General de Alicante, ISABIAL-FISABIO, Alicante, Spain;1. National Council of Science and Technology (CONACYT), National Institute of Cardiology “Ignacio Chavez”, Mexico City, Mexico;2. Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada;3. Division of Cardiology, Department of Medicine, Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada;1. Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada;2. Division of Cardiology, Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada;3. Division of Gastroenterology, Department of Medicine, University Health Network, Toronto, Ontario, Canada;1. OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, Ohio;2. Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio;3. Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio;4. Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio;5. Department of Psychology, Kent State University, Kent, Ohio;6. Summa Health System, Akron City Hospital, Akron, Ohio;7. Division of Cardiology, Department of Internal Medicine, University Hospital, Salt Lake City, Utah |
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| Abstract: | BackgroundA growing body of evidence suggests that the fluid accumulation plays a key role in the pathophysiology of heart failure (HF) and that the inflammatory and neurohormonal activation contribute strongly to the progression of this disorder.Methods and ResultsThe study evaluated the long-term effects of 2 different sodium diets on cytokines neurohormones, body hydration and clinical outcome in compensated HF outpatients (New York Heart Association Class II). A total of 173 patients (105 males, mean age 72.5 ± 7) recently hospitalized for worsening advanced HF and discharged in normal hydration and in clinical compensation were randomized in 2 groups (double blind). In Group 1, 86 patients received a moderate restriction in sodium (120 mmol to 2.8 g/day) plus oral furosemide (125 to 250 mg bid); in Group 2, 87 patients: received a low-sodium diet (80 mmol to 1.8 g/day) plus oral furosemide (125 to 250 mg bid). Both groups were followed for 12 months and the treatment was associated with a drink intake of 1000 mL daily. Neurohormonal (brain natriuretic peptide, aldosterone, plasma rennin activity) and cytokines values (tumor necrosis factor-α, interleukin-6) were significantly reduced with a significant increase of the anti-inflammatory cytokine interleukin-10 at 12 months in normal, P < .0001) than low-sodium group. The low-sodium diet showed a significant activation of neurohormones and cytokines and worsening the body hydration, whereas moderate sodium restriction maintained dry weigh and improved outcome in the long term.ConclusionsOur results appear to suggest a surprising efficacy of a new strategy to improve the chronic diuretic response by increasing Na intake and limiting fluid intake. This counterintuitive approach underlines the need for a better understanding of factors that regulate sodium and water handling in chronic congestive HF. A larger sample of patients and further studies are required to evaluate whether this is due to the high dose of diuretic used or the low-sodium diet. |
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