Cochrane Salt/Blood-Pressure Message Blasted in the Lancet

The battle rages on.

Two preventive-medicine experts in the UK are crying foul over a recent and controversial meta-analysis that concluded cutting salt consumption would have no clear health benefits. In a Comment published in the July 30, 2011 issue of the Lancet, Dr Feng J He (Queen Mary University, London, UK) and Dr Graham A MacGregor (Wolfson Institute of Preventive Medicine, Barts, London, UK) say that the meta-analysis published simultaneously by Taylor and colleagues in the Cochrane Review and the American Journal of Hypertension and press release that accompanied it "reflect poorly on the reputation of the Cochrane Library and the authors."

As previously reported by heartwire , Taylor et al's meta-analysis included seven randomized controlled trials of dietary salt reduction in normotensives (three studies), hypertensives (two studies), a mixed population (one study), and one trial of patients with heart failure.

At follow-up, relative risks for all-cause mortality and cardiovascular mortality for both normotensives and hypertensives were only mildly to moderately reduced, and not to a statistically significant degree. In congestive heart failure patients, salt restriction actually significantly increased all-cause death.

He and MacGregor, in their Comment, reanalyze the same data but combined the normotensives and hypertensives. They also omitted the heart-failure trial--a group of "very ill" patients taking large doses of diuretics in whom salt restrictions would seldom be recommended, MacGregor observed. In the combined patient analysis, they find a now statistically significant 20% reduction in cardiovascular events and a nonsignificant reduction in all-cause mortality.

Who will win?

To be determined.

Still, do you really believe they know what they are talking about?

Caveat (salt) shaker.