Research Suggests Hydration Could Prevent Heart Failure


When the body attempts to conserve water, it activates processes that contribute to the development of heart failure.

Maintaining good hydration throughout life could reduce the risk of developing heart failure, according to researchers at the National Heart, Lung, and Blood Institute (NHLBI).

Recommendations for adequate hydration range from 1.6 to 2.1 liters for women and from 2 to 3 liters for men. However, surveys from around the globe have found that many people do not meet even the lower end of these recommendations, as measured by serum sodium. According to the NHLBI, when individuals drink less water, the concentration of serum sodium in the body increases. The body then attempts to conserve water, which activates processes that contribute to the development of heart failure.

“Our study suggests that maintaining good hydration can prevent or at least slow down the changes within the heart that lead to heart failure,” said study author Natalia Dmitrieva, PhD, in the press release. “The findings indicate that we need to pay attention to the amount of fluid we consume every day and take action if we find that we drink too little.”

In the study, researchers examined whether serum sodium concentration in middle age can predict the development of heart failure 25 years later. They also investigated links between hydration and thickening of the walls in the left ventricle—called left ventricular hypertrophy—which is a precursor to heart failure diagnosis, according to the NHLBI.

These analyses were performed in 15,792 adults who were included in the Atherosclerosis Risk in Communities study. Participants were between 44 and 66 years of age at the time of recruitment and were evaluated over 5 visits until 70 to 90 years of age.

Participants were then divided into 4 groups based on their average serum sodium concentration at study visits 1 and 2. Group 1 had concentrations between 135 and 139.5 mmol/l; group 2 had concentrations between 140 and 141.5 mmol/l; group 3 had concentrations between 142 and 143.5 mmol/l; and group 4 had concentrations between 144 and 146 mmol/l. For each group, the investigators then analyzed the proportion of individuals who developed heart failure and left ventricular hypertrophy at visit 5, which occurred 25 years later.

According to the study, higher serum sodium concentration in midlife was associated with both heart failure and left ventricular hypertrophy at visit 5, even after adjusting for other factors related to the development of heart failure, such as age, blood pressure, kidney function, blood cholesterol, blood glucose, body mass index, sex, and smoking status.

“It is natural to think that hydration and serum sodium should change day to day depending on how much we drink on each day,” Dmitrieva said in the press release. “However, serum sodium concentration remains within a narrow range over long periods, which is likely related to habitual fluid consumption.”

Specifically, every 1 mmol/l increase in serum sodium concentration during midlife was associated with 1.2 increased odds of developing left ventricular hypertrophy and 1.11 increased odds of developing heart failure. The risks for both left ventricular hypertrophy and heart failure between 70 and 90 years of age began to increase when serum sodium concentration exceeded 142 mmol/l in midlife.

“The results suggest that good hydration throughout life may decrease the risk of developing left ventricular hypertrophy and heart failure,” Dmitrieva said in the press release. “In addition, our finding that serum sodium exceeding 142 mmol/l increases the risk of adverse effects in the heart may help to identify people who could benefit from an evaluation of their hydration level. This sodium level is within the normal range and would not be labelled as abnormal in lab test results but could be used by physicians during regular physical exams to identify people whose usual fluid intake should be assessed.”


Drinking sufficient water could prevent heart failure. News release. European Society of Cardiology; August 24, 2021. Accessed September 9, 2021.

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