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Comment & Response
July 2019

Postholiday Heart Failure Triggered by Dietary Salt Excess

Author Affiliations
  • 1Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
JAMA Intern Med. 2019;179(7):1006-1007. doi:10.1001/jamainternmed.2019.1374

To the Editor We read with interest the recently published article by Mahtani and colleagues1 that showed limited evidence of clinical improvement among patients with heart failure who reduced dietary salt intake, most likely owing to paucity of robust high-quality evidence. This may hold true for habitual salt intake; however, clinical data documenting detrimental effects of acute salt excess in patients with heart failure are more convincing. Ever since our original case report,2 a variety of studies3-5 have reported increased heart failure admissions immediately following holidays such as Independence Day, Thanksgiving, Christmas, and New Year’s Day. In contrast, the holidays themselves often note lower admission rates. Admittedly, an excessive salt consumption may only be one pathogenic factor for triggering acute postholiday heart failure, the others being overeating, excessive alcohol consumption, emotional stressors, omission of exercise, and postponing medical visits. However, traditional holiday menus with smoked meat, preceded by lox or sturgeon, are notorious for their high salt content. In a susceptible patient, the resulting salt overload may well facilitate the transition from latent to overt heart failure.

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