Sugar vs. Salt: Which is Worse for the Heart?

the MPR take:

Research on the potential benefits of sodium reduction for treatment of hypertension has yielded conflicting results, with some evidence suggesting that reducing sodium intake could actually increase cardiovascular and all-cause mortality in patients with diabetes. A review in the journal Open Heart examines the role of sugar, not salt, in cardiometabolic health, as up to 80% of individuals with “essential” hypertension also exhibit insulin resistance and about 50% of hypertensive patients also have hyperinsulinemia. Numerous studies have linked sugar intake with blood pressure, especially with sugar-sweetened beverages and hypertension. However, naturally occurring sugars appear to not have this same association. One study found that a diet with increased servings of whole fruit significantly lowered systolic blood pressure, even with a fructose intake of about 200g. The American Heart Association currently recommends no more than six teaspoons of sugar per day for women and no more than nine for men, but does not make specific recommendations regarding added sugars and hypertension. Because added sugars may increase cardiovascular risk by inciting metabolic dysfunction and increasing blood pressure variability, myocardial oxygen demand, heart rate, and inflammation, the authors recommend a greater emphasis on added sugar reduction in hypertension and cardiovascular disease guidelines.

Cardiovascular disease is the leading cause of premature mortality in the developed world, and hypertension is its most important risk factor. Controlling hypertension is a major focus of public health initiatives, and dietary approaches have historically focused on sodium.