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A high-salt diet promotes atherosclerosis by altering haematopoiesis

Nature Reviews Cardiology volume 20, pages 435–436 (2023)Cite this article

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Excessive salt intake is a known risk factor for cardiovascular disease commonly associated with hypertension. However, we propose that a high-salt diet can promote cardiovascular and other diseases independently of high blood pressure through inflammatory pathways that increase the production of myeloid cells.

Modern diets typically contain high levels of salt (NaCl), which are linked to an increase in all-cause mortality, primarily due to cardiovascular disease (CVD)1. Although the relationship between a high-salt diet (HSD) and CVD has generally been attributed to hypertension, this association is not ubiquitous, with many individuals showing no sensitivity of blood pressure to salt intake. Therefore, a clear need exists to understand alternative mechanisms by which a HSD drives CVD. From a clinical standpoint, this understanding could have major implications for global morbidity and mortality related to CVD because these hypertension-independent mechanisms are currently not assessed in patient screening. This situation underscores the need to broaden the advice and awareness surrounding dietary salt, which is not adequately delivered to patients. Additionally, hypertension driven by a HSD could be a secondary outcome, with tissue and vessel damage occurring silently for years or decades before rises in blood pressure occur. Indeed, evidence is available to support this hypothesis2, which might indicate that much of the silent organ damage occurs before hypertension develops and is treated. Therefore, it might be beneficial to investigate when and how HSDs initially promote inflammation. Moreover, dietary patterns are well documented to be habitual. Indeed, if parents consume a HSD, their children have been shown to do so as well, suggesting that the deleterious effects of a HSD might start early in life. Therefore, we suggest that a major knowledge gap is understanding the effect of a HSD on CVD, independent of hypertension.

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Fig. 1: A high-salt diet drives cardiovascular disease through inflammatory haematopoiesis.

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Acknowledgements

M.K.S.L. (2018214) and A.J.M. (1194329) are supported by investigator grants from the National Health and Medical Research Council of Australia.

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  1. Division of Immunometabolism, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia

    Man K. S. Lee & Andrew J. Murphy

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  1. Man K. S. Lee
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Correspondence to Andrew J. Murphy.

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The authors declare no competing interests.

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World Action on Salt, Sugar and Health: https://www.worldactiononsalt.com/

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Lee, M.K.S., Murphy, A.J. A high-salt diet promotes atherosclerosis by altering haematopoiesis. Nat Rev Cardiol 20, 435–436 (2023). https://doi.org/10.1038/s41569-023-00879-x

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