Abstract 16886: Less Than 2g of Daily Sodium Intake Independently Predicts Shorter Cardiac Event-Free Survival Through Increased Tumor Necrosis Factor Alpha in Patients With Heart Failure
Background: There is a growing awareness that a very low sodium diet may be associated with adverse health outcome in patients with heart failure (HF). However, there is limited evidence to explain how a very low sodium diet is associated with adverse health outcomes. Increased tumor necrosis factor-alpha (TNF-α) is known to predict adverse health outcome.
Purposes: 1) To compare differences in serum levels of TNF-α among 4 groups divided by daily sodium intake and 2) To determine whether < 2g/day of sodium intake independently predicts higher levels of TNF-α and shorter cardiac event-free survival compared to > 4g/day of sodium intake.
Method: A total of 154 patients with HF (age 65±9 years, 36% female) provided blood to measure serum TNF-α levels that were split at median value of 8.60 pg/mL. Patients collected a 24-hour urine sodium to indicate daily sodium intake and were divided into 4 groups; < 2g, 2-3g, 3-4g, > 4g. Patients were followed for 1 year to determine time to first event of hospitalization due to cardiac problems or cardiac death. One-way ANOVA, hierarchical logistic, and Cox hazard regression were used to address our purposes.
Results: Seventeen patients (11%) had < 2g of daily sodium intake. Patients with < 2g of daily sodium intake had the highest level of TNF-α (F = 5.43, p = .001). Less than 2g of daily sodium intake was associated with higher level of TNF-α (OR = 13.4, 95% CI = 2.85-62.62) in hierarchical logistic regression. During 1-year follow-up period, 56 patients (36%) had cardiac events. Less than 2g of daily sodium intake (HR = 4.13, 95% CI = 1.45-11.76) and TNF-α > 8.60 pg/ml (HR = 2.07, 95% CI = 1.10-3.88) predicted shorter cardiac event-free survival after controlling for age, gender, body mass index, NYHA class, ejection fraction, comorbidities, and prescribed medications.
Conclusion: This finding shows that higher levels of TNF- α is one possible bio-behavioral mechanism by which a very low sodium diet contributed to adverse health outcomes for patients with HF.
- © 2013 by American Heart Association, Inc.