Abstract
Guidelines have recommended significant reductions in dietary sodium intake to improve cardiovascular health. However, these dietary sodium intake recommendations have been questioned as emerging evidence has shown that there is a higher risk of cardiovascular disease with a low sodium diet, including in individuals with type 2 diabetes. This may be related to the other pleotropic effects of dietary sodium intake. Therefore, despite recent review of dietary sodium intake guidelines by multiple organizations, including the dietary guidelines for Americans, American Diabetes Association, and American Heart Association, concerns about the impact of the degree of sodium restriction on cardiovascular health continue to be raised. This literature review examines the effects of dietary sodium intake on factors contributing to cardiovascular health, including left ventricular hypertrophy, heart rate, albuminuria, rennin–angiotensin–aldosterone system activation, serum lipids, insulin sensitivity, sympathetic nervous system activation, endothelial function, and immune function. In the last part of this review, the association between dietary sodium intake and cardiovascular outcomes, especially in individuals with diabetes, is explored. Given the increased risk of cardiovascular disease in individuals with diabetes and the increasing incidence of diabetes worldwide, this review is important in summarizing the recent evidence regarding the effects of dietary sodium intake on cardiovascular health, especially in this population.
Highlights
High dietary sodium intake has been related to high blood pressure for more than 4,000 years [1]
Dietary sodium intake recommendations support sodium restriction based on previous evidence suggesting a reduction in blood pressure
Current dietary sodium intake guidelines have been revised since the Institute of Medicine (IOM) reported that there was no clear benefit or harm of sodium restriction to less than 100 mmol/24 h in 2013
Summary
High dietary sodium intake has been related to high blood pressure for more than 4,000 years [1]. The concept that fluid volume influenced arterial pressure was deduced by Stephan Hales in the early 18th century. He provided the scientific rationale that sodium intake might be related to blood pressure since blood volume is largely determined by its sodium and water content [2]. In communities with low sodium intake, blood pressure tended to be lower and did not rise with age. This led to the hypothesis that, at a population level, blood pressure may be correlated with sodium intake [3, 4].
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