Editor's Choice
RCT | Endovascular ultrasound renal denervation is modestly effective in the treatment of hypertension
1 Mar, 2023 | 14:11h | UTCSummary: The RADIANCE II randomized clinical trial investigated the efficacy and safety of endovascular ultrasound renal denervation in patients with hypertension without the influence of antihypertensive medications. The trial enrolled 224 patients who were withdrawn from such medications and randomly assigned to receive either ultrasound renal denervation or a sham procedure. Results showed that ultrasound renal denervation reduced ambulatory systolic blood pressure by 6.3 mmHg on average at 2 months, compared to the sham procedure, without any reported adverse events. While these findings suggest that ultrasound renal denervation may be modestly effective in the treatment of hypertension, the short-term follow-up period limits the generalizability of these results to daily practice. Additionally, the clinical relevance of a procedure that reduces blood pressure only after withdrawing blood pressure medications should be considered.
Article: Endovascular Ultrasound Renal Denervation to Treat Hypertension: The RADIANCE II Randomized Clinical Trial – JAMA (free for a limited period)
Editorial: Is There a Role for Renal Denervation in the Treatment of Hypertension? – JAMA Cardiology (free for a limited period)
RCT | Long-term effects of early antiretroviral therapy initiation in HIV infection highlight the importance of early treatment
1 Mar, 2023 | 14:12h | UTCSummary: The article discusses the long-term results of the Strategic Timing of AntiRetroviral Treatment (START) trial, which aimed to determine the effects of early initiation of antiretroviral therapy (ART) for individuals with HIV and CD4+ counts above 500 cells/mm3 compared to those who deferred treatment until their CD4+ count was below 350 cells/mm3. The trial found that immediate ART initiation reduced the risk of AIDS and serious non-AIDS (SNA) conditions compared to deferred treatment. The study’s long-term results also found that a persistent excess risk of AIDS and SNA conditions remained even after ART was initiated in those who initially deferred treatment. The study highlights the importance of early diagnosis and prompt initiation of ART for individuals with HIV.
Article: Long-Term Benefits from Early Antiretroviral Therapy Initiation in HIV Infection – NEJM Evidence
Original Study: Initiation of Antiretroviral Therapy in Early Asymptomatic HIV Infection – New England Journal of Medicine
Pooled analysis of 3 sham-controlled trials on ultrasound renal denervation for patients with hypertension
1 Mar, 2023 | 14:10h | UTCSummary: The article reports a patient-level pooled analysis of 3 randomized clinical trials that aimed to determine the effectiveness and safety of ultrasound renal denervation (uRDN) in reducing blood pressure (BP) compared to a sham procedure. The analysis included 506 patients with varying severities of hypertension and found that uRDN was modestly effective in reducing daytime ambulatory systolic BP at 2 months compared to the sham procedure, with a mean difference of 5.9 mmHg. One of the limitations of this analysis is that its findings are restricted to a 2-month follow-up. Additional follow-up from the included trials will be required to examine the durability of the effect and safety data.
Editorial: Is There a Role for Renal Denervation in the Treatment of Hypertension? – JAMA Cardiology (free for a limited period)
Artificial sweetener erythritol possibly implicated in increased cardiovascular risk
1 Mar, 2023 | 14:08h | UTCSummary: A recent study published in Nature Medicine found that erythritol, a popular artificial sweetener, is possibly implicated with an increased risk of major adverse cardiovascular events (MACE) such as heart attack and stroke. Analyzing data from over 4,000 people in the US and Europe, the researchers found that those with higher blood erythritol levels were at a greater risk of MACE. The researchers also examined the effects of adding erythritol to whole blood or isolated platelets and found that it made platelets easier to activate and form clots. In addition, a pilot intervention study with healthy volunteers showed that erythritol ingestion led to a marked and sustained increase in plasma erythritol levels above those associated with heightened platelet reactivity and thrombosis potential. The authors note that further studies are needed to confirm their findings and assess the long-term safety of erythritol.
Article: The artificial sweetener erythritol and cardiovascular event risk – Nature Medicine (free for a limited period)
News Release: Cleveland Clinic study finds common artificial sweetener linked to higher rates of heart attack and stroke
Commentaries:
Zero-calorie sweetener linked to heart attack and stroke, study finds – CNN
Could a Common Sweetener Raise Heart Risks? – HealthDay
Commentary on Twitter
A study in @NatureMedicine suggests that a commonly used artificial sweetener—erythritol—may be linked to cardiovascular disease events. https://t.co/QrbtvCFDJ4 pic.twitter.com/WpM9cLnXh7
— Nature Portfolio (@NaturePortfolio) February 27, 2023
M-A | Combination of multiple low-risk lifestyle behaviors and incident type 2 diabetes
1 Mar, 2023 | 14:06h | UTCSummary: This systematic review and meta-analysis assessed the association between multiple low-risk lifestyle behaviors (LRLBs) and the incidence of type 2 diabetes. The study examined 30 cohort comparisons involving 1,693,753 participants and 75,669 cases of type 2 diabetes. The LRLBs evaluated in the study were maintaining a healthy body weight, healthy diet, regular exercise, smoking abstinence or cessation, and light alcohol consumption. Results showed that the highest adherence to these LRLBs was associated with an 80% lower risk of type 2 diabetes compared to the lowest adherence group. Thus, targeting these LRLBs could be an effective strategy for the primary prevention of type 2 diabetes. However, the authors recommend promoting only four LRLBs, excluding alcohol intake, due to its association with increased harm. The potential benefits of small alcohol intake remain a controversial issue since most studies on the subject are observational and subject to residual confounding.
Article: Combination of Multiple Low-Risk Lifestyle Behaviors and Incident Type 2 Diabetes: A Systematic Review and Dose-Response Meta-analysis of Prospective Cohort Studies – Diabetes Care (free for a limited period)
Commentary from the author on Twitter (thread – click for more)
https://twitter.com/tauseefkhan/status/1628510003853131776
Review | Borderline personality disorder
1 Mar, 2023 | 14:04h | UTCBorderline Personality Disorder: A Review – JAMA (free for a limited period)
JAMA Patient Page: Borderline Personality Disorder
Review | Platelet aggregation inhibitors and anticoagulants in gastroenterological and visceral surgical procedures
1 Mar, 2023 | 14:03h | UTC
WHO Report | A woman dies every two minutes due to pregnancy or childbirth
28 Feb, 2023 | 14:04h | UTCSummary: This new report by United Nations agencies shows that a woman dies every two minutes due to pregnancy or childbirth. The report covers maternal deaths from 2000 to 2020 and reveals that maternal deaths either increased or stagnated in nearly all regions of the world, with some regions experiencing major setbacks. The poorest parts of the world and countries affected by conflict continue to have the highest rates of maternal deaths. Severe bleeding, high blood pressure, pregnancy-related infections, complications from unsafe abortion, and underlying conditions aggravated by pregnancy are the leading causes of maternal deaths, which are largely preventable and treatable with access to high-quality healthcare. The COVID-19 pandemic may have further held back progress on maternal health. The report calls for urgent action to ensure every woman and girl has access to critical health services before, during, and after childbirth, so they can fully exercise their reproductive rights.
News Release: A woman dies every two minutes due to pregnancy or childbirth: UN agencies – World Health Organization
Commentaries:
Ambitious goal to slash maternal deaths in jeopardy – Nature
U.N.: Progress on reducing global maternal mortality has stalled since 2015 – STAT
Eight Hundred Women Die Every Day During Pregnancy or Childbirth – Health Policy Watch
Choosing Wisely in Cardiology | New ACC list of five things physicians and patients should question
28 Feb, 2023 | 14:03h | UTCSummary: The American College of Cardiology (ACC) has released a list of “Five Things Physicians and Patients Should Question” in cardiology as part of the Choosing Wisely campaign, which encourages conversations between clinicians and patients about potentially unnecessary tests, treatments, and procedures. The list includes recommendations to:
- Avoid the routine use of invasive hemodynamic monitoring with pulmonary artery catheters in patients with uncomplicated acute decompensated heart failure.
- Avoid performing atrial fibrillation ablation for the sole purpose of discontinuing chronic anticoagulation.
- Avoid routine imaging stress tests or coronary CT angiography for the workup of palpitations or presyncope.
- Avoid obtaining a coronary artery calcium score in patients with known clinical atherosclerotic cardiovascular disease.
- Avoid obtaining routine serial echocardiograms for chronic heart failure if there has been no change in signs, symptoms, or management.
The recommendations are based on published national guidelines and aim to broadly represent the field of cardiology.
Commentary: ACC Releases New List of Choosing Wisely Recommendations – American College of Cardiology
See complete lists of low-value practices: Choosing Wisely U.S. / Choosing Wisely UK / Choosing Wisely Australia AND Choosing Wisely Canada
Review | Antiphospholipid syndrome: advances in diagnosis, pathogenesis, and management
28 Feb, 2023 | 14:00h | UTCAntiphospholipid syndrome: advances in diagnosis, pathogenesis, and management – The BMJ
Physicians are more burned out than ever — here’s what can be done about it
28 Feb, 2023 | 13:57h | UTCPhysicians Are More Burned Out Than Ever—Here’s What Can Be Done About It – JAMA (free for a limited period)
Related Report: Addressing Health Worker Burnout – The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
Related:
AAP Clinical Report | Physician health and wellness.
M-A | Physicians suffering burnout are twice as likely to be involved in patient safety incidents.
Systematic Review | Predictors of burnout among healthcare providers.
Physician Well-being 2.0: Where Are We and Where Are We Going? – Mayo Clinic Proceedings
Assessment of Risk Factors for Suicide Among US Health Care Professionals
Beyond Burnout: Docs Decry ‘Moral Injury’ From Financial Pressures of Health Care
Hospital administration response to physician stress and burnout – Journal of Hospital Practice
Opinion: It’s Time to Talk About Physician Burnout and Moral Injury
Systematic Review: Effect of Organization-Directed Workplace Interventions on Physician Burnout
The 3 Causes Of Physician Burnout (And Why There’s No Simple Solution) – Forbes
Physician Burnout: A Global Crisis
The Burnout Crisis in American Medicine – The Atlantic
Physician burnout costs up to $17B a year, task force says – HealthcareDive
Systematic Review: Prevalence of Burnout Among Physicians
Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction
M-A | Which adverse events and which drugs are implicated in drug-related hospital admissions
28 Feb, 2023 | 13:59h | UTCSummary: This systematic review and meta-analysis aimed to provide an updated estimation of drug-related hospital admissions, the types and frequency of drug-induced harm, and the drugs involved. The review included 17 studies that examined acute admissions to emergency departments or inpatient wards resulting from drug-induced harm in the general population. These studies were published between January 2012 and December 2021. The estimated rates of admissions resulting from adverse drug reactions* (ADRs) and adverse drug events* (ADEs) were 8.3% and 13.9%, respectively. Almost half of the admissions related to ADRs and over two-thirds of those related to ADEs were possibly preventable. Gastrointestinal disorders, electrolyte disturbances, bleeding events, and renal and urinary disorders were the most frequently involved categories of drug-induced harm. The most frequently involved drug groups were nervous system drugs, followed by cardiovascular and antithrombotic agents.
*Adverse drug events (ADEs) and adverse drug reactions (ADRs) are two terms that are often used interchangeably, but they actually have different meanings. Adverse drug events (ADEs) refer to any negative effect that results from medication exposure and can be caused by a variety of factors, including medication errors, overdose, drug interactions, or allergic reactions. In contrast, adverse drug reactions (ADRs) are a specific type of ADE that occur as unintended effects of medication at normal therapeutic doses.
Perspective | Gender dysphoria in young people is rising — and so is professional disagreement
28 Feb, 2023 | 13:55h | UTCGender dysphoria in young people is rising—and so is professional disagreement – The BMJ
News Release: Gender dysphoria is rising—and so is professional disagreement – BMJ Newsroom
Commentary on Twitter
More children and adolescents are identifying as transgender and are being offered medical treatment, especially in the US—but some providers and European authorities are urging caution because of a lack of strong evidence. @writingblock reports https://t.co/24aDMo7rb0
— The BMJ (@bmj_latest) February 26, 2023
RCT | 2-y outcomes confirm the harms caused by high prophylactic platelet transfusion thresholds in preterm infants
28 Feb, 2023 | 13:53h | UTCSummary: The study investigated the long-term outcomes of preterm infants who participated in a randomized trial of platelet transfusions at different threshold levels. Infants with platelet counts below 50×109/L were enrolled and randomized to either a higher threshold of 50×109/L or a lower threshold of 25×109/L. The study found that infants randomized to the higher threshold had a higher rate of death or significant neurodevelopmental impairment at a corrected age of 2 years compared to the lower threshold group. The study further supports evidence of harm caused by high prophylactic platelet transfusion thresholds in preterm infants. The mechanisms by which platelet transfusions could mediate harmful effects remain unknown, but the study identified increased rates of intraventricular hemorrhage and bronchopulmonary dysplasia in the higher threshold group, which may contribute to the adverse outcomes observed.
Original Study: Randomized Trial: Platelet-Transfusion Thresholds in Neonates
Commentary from the author on Twitter (thread – click for more)
We already knew from the @PlaNeT2_trial that a higher prophylactic platelet transfusion threshold (<50) in preterm babies is associated with significantly increased mortality or major bleeding compared with a lower one (<25)… https://t.co/pJrE44BIIx
— Carmel Moore (@carmelmoore) February 22, 2023
Perspective | The inertia of clinical trials and unethical control arms in oncology
28 Feb, 2023 | 13:51h | UTCThe inertia of clinical trials and unethical control arms – Sensible Medicine
Choosing Wisely internationally – 213 helpful recommendations for antimicrobial stewardship!
27 Feb, 2023 | 13:19h | UTCSummary: The article discusses the importance of antimicrobial stewardship (AMS) in the face of increasing antimicrobial resistance and the role of the Choosing Wisely campaign in promoting the rational use of antibiotics. The study evaluated 213 Choosing Wisely recommendations related to AMS practices in six countries (Australia/New Zealand, Canada, Italy, Switzerland, the USA, and Germany) and categorized them according to six categories: diagnostics, indication, choice of anti-infective drugs, dosing, application, and duration of therapy. Topics related to indication and diagnostics were most frequently addressed, and avoiding antibiotic treatment of asymptomatic bacteriuria and upper respiratory tract infections were central topics across all countries.
Article: Choosing Wisely internationally – helpful recommendations for antimicrobial stewardship! – Infection
See complete lists of low-value practices: Choosing Wisely U.S. / Choosing Wisely UK / Choosing Wisely Australia AND Choosing Wisely Canada
Perspective | Beware of overdiagnosis harms from screening, lower diagnostic thresholds, and incidentalomas
27 Feb, 2023 | 13:18h | UTCSummary: This article discusses the concept of overdiagnosis and its relevance to clinical practice guidelines. Overdiagnosis is the diagnosis of a condition that, if unrecognized, would not result in symptoms or cause a patient harm during their lifetime, such as discovering a low-grade cancer that will never lead to symptoms at the end of life. But, unlike false positives, overdiagnosed individuals truly have the condition; they just don’t benefit from the diagnosis. Overdiagnosis can also result from lowering diagnostic thresholds for diagnosing a disease, which inflates diagnosis rates among patients and leads to recommendations for subsequent interventions without clear benefits. The article highlights the importance of providing accurate information to patients about the possibility and burden of overdiagnosis to inform shared decision-making and minimize the harms of screening interventions.
Related:
Overdiagnosis: it’s official – The BMJ
Overdiagnosis: what it is and what it isn’t – BMJ Evidence Based Medicine
Overdiagnosis across medical disciplines: a scoping review – The BMJ Open
Too much medical care: bad for you, bad for health care systems – STAT News
Overdiagnosis: causes and consequences in primary health care – Canadian Family Physician
Five warning signs of overdiagnosis – The Conversation
What is overdiagnosed cancer? And why does it matter? – Croakey
Blame rising cancer overdiagnosis on ‘irrational exuberance’ for early detection – STAT
A food allergy epidemic… or just another case of overdiagnosis?
An epidemic of overdiagnosis: Melanoma diagnoses sky rocket
RCT | Tight glycemic control did not preserve pancreatic beta cell function in newly diagnosed pediatric type 1 diabetes
27 Feb, 2023 | 13:16h | UTCSummary: The study aimed to determine if intensive diabetes management with an automated insulin delivery system could help preserve pancreatic beta cell function in youth with newly diagnosed type 1 diabetes. The randomized clinical trial included 113 youths aged 7 to 17 years and found that although the mean time in the target range of 70 to 180 mg/dL was 78% in the intensive management group vs. 64% in the standard care group, intensive diabetes management did not affect the decline in pancreatic C-peptide secretion at 52 weeks. The study concluded that near normalization of glucose levels instituted immediately after diagnosis of type 1 diabetes did not preserve pancreatic beta cell function in youth.
Article: Effect of Tight Glycemic Control on Pancreatic Beta Cell Function in Newly Diagnosed Pediatric Type 1 Diabetes: A Randomized Clinical Trial – JAMA (free for a limited period)
Editorial: Preserving Pancreatic Beta Cell Function in Recent-Onset Type 1 Diabetes – JAMA (free for a limited period)
Commentary on Twitter
Intensive diabetes management with automated insulin delivery did not affect the decline in pancreatic C-peptide secretion at 52 weeks in youths with newly diagnosed type 1 diabetes. https://t.co/e1n5xagrtv #ATTD2023 pic.twitter.com/C6743BmqyH
— JAMA (@JAMA_current) February 24, 2023
Study links proton pump inhibitor use to increased risk of acquiring drug-resistant bacteria in hospitalized patients
27 Feb, 2023 | 13:13h | UTCSummary: This case-control study investigated whether proton pump inhibitors (PPIs) are associated with an increased risk of acquiring extended-spectrum β-lactamase (ESBL) or carbapenemase-producing Enterobacterales among hospitalized patients. The study involved 2239 adult hospitalized patients. After controlling for confounding factors, patients who received PPIs within the previous 30 days had a nearly 50% increased risk (aIRR, 1.48) of acquiring ESBL- or carbapenemase-producing Enterobacterales compared with those who did not receive PPIs. The study has the limitations of an observational study but points to the need for judicious use of PPIs to mitigate the risk of acquiring drug-resistant Enterobacterales among hospitalized patients.
Commentaries:
Study links acid suppressants to colonization with multidrug-resistant bacteria – CIDRAP
Proton Pump Inhibitors Associated With Increased Risk of Drug-Resistant Infections – HCP Live
RCT | Verapamil partially preserved pancreatic beta cell function in newly diagnosed pediatric type 1 diabetes
27 Feb, 2023 | 13:14h | UTCSummary: The study aimed to determine whether verapamil could preserve pancreatic beta cell function in children and adolescents with newly diagnosed type 1 diabetes. The randomized clinical trial involved 88 participants who were given either verapamil or placebo once daily for 52 weeks. The study found that C-peptide levels were 30% higher in the verapamil group compared to the placebo group at 52 weeks, and the percentage of participants with a 52-week peak C-peptide level of 0.2 pmol/mL or greater was 95% in the verapamil group compared to 71% in the placebo group. The study also found that verapamil was well tolerated with few adverse events. The results suggest that verapamil may partially preserve stimulated C-peptide secretion in children and adolescents with newly diagnosed type 1 diabetes. However, further studies with patient-relevant outcomes are needed to determine the long-term effectiveness and the optimal length of therapy.
Article: Effect of Verapamil on Pancreatic Beta Cell Function in Newly Diagnosed Pediatric Type 1 Diabetes: A Randomized Clinical Trial – JAMA (free for a limited period)
Editorial: Preserving Pancreatic Beta Cell Function in Recent-Onset Type 1 Diabetes – JAMA (free for a limited period)
News Release: Verapamil shows beneficial effect on the pancreas in children with newly-diagnosed type 1 diabetes – University of Minnesota
Commentary on Twitter
In youth with newly diagnosed type 1 diabetes, verapamil partially preserved stimulated C-peptide secretion at 52 weeks from diagnosis compared with placebo. https://t.co/m4xbczf93C #ATTD2023 pic.twitter.com/teM0jjh1tT
— JAMA (@JAMA_current) February 24, 2023
Perspective | Can artificial intelligence help for scientific writing?
27 Feb, 2023 | 13:09h | UTCCan artificial intelligence help for scientific writing? – Critical Care
Related:
Perspective | ChatGPT-assisted diagnosis: is the future suddenly here?
Perspective | Generating scholarly content with ChatGPT: ethical challenges for medical publishing
ChatGPT: Will It Transform the World of Health Care? – UCSF Department of Medicine
ChatGPT and the future of medical writing (ChatGPT itself wrote this paper)
ChatGPT: five priorities for research – Nature
The path forward for ChatGPT in academia – Lumo’s Newsletter
ChatGPT is fun, but not an author – Science
Tools such as ChatGPT threaten transparent science; here are our ground rules for their use – Nature
ChatGPT listed as author on research papers: many scientists disapprove – Nature
Abstracts written by ChatGPT fool scientists
Cohort Study | Aggressive end-of-life care is still common among older adults with metastatic cancer in the US
27 Feb, 2023 | 13:11h | UTCSummary: The study aimed to compare the markers of aggressive end-of-life (EOL) care between older adults with metastatic cancer who are nursing home (NH) residents and those who live in community settings. The study analyzed data from 146,329 patients who died from metastatic breast, colorectal, lung, pancreas, or prostate cancer between 2013 and 2017, and found that aggressive EOL care was more common among NH residents than community-dwelling residents (63.6% vs. 58.3%). More than one hospital admission in the last 30 days of life and death in the hospital were the key markers associated with a higher prevalence of aggressive EOL care. The authors suggest that interventions targeting these factors could improve the quality of end-of-life care.
Artificial intelligence in academic writing: a paradigm-shifting technological advance
27 Feb, 2023 | 13:07h | UTCArtificial intelligence in academic writing: a paradigm-shifting technological advance – Nature Reviews Urology (free for a limited period)
Commentary on Twitter
Artificial Intelligence will not replace academics, but academics who use AI will replace those who do not.
-We should discuss boundaries/ethical issues!@NatRevUrol @OncoAlert @Roei_Golan7 @AkhilMuthigi @ranjithramamd @VincentRK @VPrasadMDMPH #ChatGPT https://t.co/neAtxrRXI8 pic.twitter.com/gOpzbdg1mO— Yüksel Ürün (@DrYukselUrun) February 26, 2023
Related:
Perspective | ChatGPT-assisted diagnosis: is the future suddenly here?
Perspective | Generating scholarly content with ChatGPT: ethical challenges for medical publishing
ChatGPT: Will It Transform the World of Health Care? – UCSF Department of Medicine
ChatGPT and the future of medical writing (ChatGPT itself wrote this paper)
ChatGPT: five priorities for research – Nature
The path forward for ChatGPT in academia – Lumo’s Newsletter
ChatGPT is fun, but not an author – Science
Tools such as ChatGPT threaten transparent science; here are our ground rules for their use – Nature
ChatGPT listed as author on research papers: many scientists disapprove – Nature
Abstracts written by ChatGPT fool scientists
Cluster RCT | Effect of an antibiotic stewardship intervention to improve antibiotic prescribing for suspected UTI in older adults
24 Feb, 2023 | 13:58h | UTCSummary: The study evaluated the effectiveness of a multifaceted antibiotic stewardship intervention to improve antibiotic prescribing for suspected urinary tract infections (UTI) in frail older adults. The study was a pragmatic, parallel, cluster-randomized controlled trial conducted in four European countries and included 1041 frail older adults aged 70 or older. The intervention involved a decision tool for appropriate antibiotic use, supported by a toolbox with educational materials. The control group provided care as usual. The primary outcome was the number of antibiotic prescriptions for suspected UTI per person year, and secondary outcomes included incidence of complications, hospital referrals, admissions, and mortality. The results showed that the intervention group had a lower rate of receiving an antibiotic prescription for a suspected UTI (0.27 per person year) compared to the control group (0.58 per person year), with no increase in complications or adverse events.
Commentary: Trial: Stewardship intervention cuts antibiotic prescribing for suspected urinary infections – CIDRAP
Related:
Case-Control Study | Current pyuria cut-offs may promote inappropriate UTI diagnosis in older women
USPSTF Recommendation Statement: Screening for Asymptomatic Bacteriuria in Adults
[Not published yet] M-A | Too little sodium can be harmful to heart failure patients
24 Feb, 2023 | 13:59h | UTCSummary: New research presented at the American College of Cardiology’s annual scientific session suggests that heart failure patients restricting their dietary sodium intake to levels below the standard recommended maximum of 2.3 grams per day do not have additional benefits and may be at increased risk of death. The study analyzed nine randomized controlled trials that assessed different levels of sodium restriction and found that patients following a diet with a sodium intake target below 2.5 grams per day were 80% more likely to die than those following a diet with a target of 2.5 grams per day or more. The researchers recommend establishing a safe level of sodium consumption instead of overly restricting sodium.
News release: Too Little Sodium Can be Harmful to Heart Failure Patients – American College of Cardiology