Deans' stroke musings: Cochrane salt/blood-pressure message blasted in the Lancet

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

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My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Monday, August 1, 2011

Cochrane salt/blood-pressure message blasted in the Lancet

I also posted that the low-salt diet was ineffective here;
http://oc1dean.blogspot.com/2011/06/low-salt-diet-ineffective-study-finds.html
This may have been wrong, read these researchers writing in the lancet.
http://www.theheart.org/article/1258599.do?utm_campaign=newsletter&utm_medium=email&utm_source=20110801_EN_Heartwire

London, UK - 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 [1]. 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 [2] and the American Journal of Hypertension [3] 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.

"The results of our reanalysis, contrary to the claims by Taylor and colleagues, support current public-health recommendations to reduce salt intake in the whole population," He and MacGregor conclude.

Misleading public messages?

In an interview with heartwire, MacGregor, who is also chair of both the Consensus Action on Salt and Health and the World Action on Salt and Health, said he and his coauthor felt Taylor et al's conclusions in the paper itself were measured. But they take issue with both the "Plain Language Summary" printed within the main article and with a press release sent out by the publisher.

"The press release and the paper have seriously misled the press and thereby the public," they write. "For example, in the UK the Daily Express front-page headline read, 'Now salt is safe to eat—Health fascists proved wrong after lecturing us all for years,' and there were similar headlines throughout the world."

"In actual fact, the findings we have when we reanalyze the data are the exact opposite of what the others conclude in their attention-grabbing headlines," MacGregor told heartwire.

An urgent retort

Asked why their comment was sent to the Lancet rather than one of the two publications in which the Taylor et al paper was published, MacGregor cited the need for a swift, high-profile response.

"Obviously this is somewhat urgent—this caused headline news around the world, and the [salt-industry trade association] SALT Institute has a huge amount on its website about this," he said. "We wanted to get this correction in [print] very quickly and get it some publicity, because it's obviously totally wrong to claim salt reduction is not beneficial." In fact, he points out, Taylor et al's review "doesn't say that; it says we need more evidence. We say it is [beneficial]; we've done this reanalysis, and we've got the evidence. In fact, all the evidence about salt is overwhelming. . . . It all shows that salt is a major factor bringing up our blood pressure."

Asked to respond to He and MacGregor's Comment, Dr Rod Taylor (University of Exeter, UK) told heartwire that he and his coauthors are preparing a "formal letter in response" that they plan to submit to the Lancet, and "We'd rather make use of our letter as our communication vehicle in this case."