Mutengo Katongo Hope, Ngalamika Owen, Kirabo Annet, Masenga Sepiso K
Department of Internal Medicine, Ministry of Health, Monze Mission Hospital, Monze, Zambia.
Department of Internal Medicine, School of Medicine, University of Zambia, Lusaka, Zambia.
Front Pharmacol. 2025 Jun 13;16:1626492. doi: 10.3389/fphar.2025.1626492. eCollection 2025.
Salt sensitivity is a well-recognized contributor to cardiovascular risk, traditionally linked to elevated blood pressure. However, emerging evidence suggests that high dietary sodium may also promote myocardial fibrosis through non-hemodynamic mechanisms, including the activation of redox-sensitive and profibrotic pathways. Despite growing mechanistic insights, the connection between salt sensitivity and myocardial fibrosis remains underexplored, particularly in human studies. This review synthesizes current experimental and translational evidence linking dietary salt intake to myocardial fibrosis, with a focus on molecular signaling cascades, tissue sodium compartmentalization, and the clinical implications of salt-sensitive physiology. We discuss the relevance of these mechanisms to the development of diastolic dysfunction and their potential contribution to heart failure with preserved ejection fraction (HFpEF). In addition, we highlight findings from animal models and the emerging application of sodium magnetic resonance imaging (Na-MRI) as a novel imaging tool for visualizing myocardial sodium overload and its association with fibrotic remodeling. Finally, we explore future therapeutic strategies that extend beyond traditional antihypertensives, including mineralocorticoid receptor antagonists (MRAs), angiotensin receptor blockers (ARBs), sodium-glucose cotransport 2 (SGLT2) inhibitors, and sodium-modulating interventions. Together, these insights offer new opportunities for early detection and targeted treatment in salt-sensitive cardiovascular disease.
盐敏感性是心血管风险的一个公认因素,传统上与血压升高有关。然而,新出现的证据表明,高膳食钠摄入也可能通过非血流动力学机制促进心肌纤维化,包括氧化还原敏感和促纤维化途径的激活。尽管对其机制的认识不断增加,但盐敏感性与心肌纤维化之间的联系仍未得到充分探索,尤其是在人体研究中。本综述综合了目前将膳食盐摄入与心肌纤维化联系起来的实验和转化证据,重点关注分子信号级联、组织钠分隔以及盐敏感生理学的临床意义。我们讨论了这些机制与舒张功能障碍发展的相关性及其对射血分数保留的心力衰竭(HFpEF)的潜在贡献。此外,我们强调了动物模型的研究结果以及钠磁共振成像(Na-MRI)作为一种新型成像工具在可视化心肌钠过载及其与纤维化重塑关联方面的新兴应用。最后,我们探索了超越传统抗高血压药物的未来治疗策略,包括盐皮质激素受体拮抗剂(MRAs)、血管紧张素受体阻滞剂(ARBs)、钠-葡萄糖协同转运蛋白2(SGLT2)抑制剂和钠调节干预措施。这些见解共同为盐敏感性心血管疾病的早期检测和靶向治疗提供了新机会。
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