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Replacing common salt with a lower sodium alternative in home cooking and seasoning can be a simple and inexpensive way to reduce risk of stroke, heart attack and death from any cause in people with a history of stroke or high blood pressure, new research shows.
The innovative study explored the benefits of a potassium-containing a salt substitute instead of traditional table salt in a key demographic, says Wesley Milks, MD, a cardiologist and an assistant professor of internal medicine at the Wexner Medical Center at Ohio State University in Columbus, who was not involved in the new research. “There is a very strong association between uncontrolled high blood pressure and stroke. It has long been recognized that high potassium and lower sodium intake are linked to reduced blood pressure, so this study appears to provide relatively strong confirmatory evidence for the association, ”says Dr Milks .
‘Clear evidence’ that a salt substitute can improve heart disease outcomes
Although salt substitutes containing less sodium and increased potassium levels have been shown to lower blood pressure, there is little evidence linking them to fewer heart attacks and blows. To find out whether the substitution actually resulted in fewer cardiovascular events and deaths, the researchers recruited 20,995 participants from 600 villages in rural China, all of whom had previously had a stroke or were aged 60 or older with poorly controlled blood pressure. The results were presented during a Hot Line session at the 2021 Congress of the European Society of Cardiology (ESC) and published in the New England Journal of Medicine August 29.
Participants were randomized into clusters based on their village, with half of the subjects using the supplied salt substitute and the other half continuing to use regular salt. Those in the intervention group were asked to use the substitution, consisting of 75 percent sodium chloride and 25 percent potassium chloride, as a replacement for common salt (100% sodium chloride) for cooking, seasoning and preserving food; they were also encouraged to reduce their use of the salt substitute compared to the amount of salt they usually consumed.
During an average follow-up of 4.74 years, more than 3,000 people have had a stroke, more than 4,000 have died and more than 5,000 have had a major cardiovascular event. The risk of fatal and non-fatal stroke was reduced with salt substitute compared to common salt, 29.14 versus 33.65 per 1,000 patient-years, a 14% risk reduction compared to normal use of salt.
Major cardiovascular events were reduced with the salt substitute compared to the group using normal salt, 49.09 vs. 56.29 per 1,000 patient-years, a 13% risk reduction, as was the number of people who died from any cause, 39.27 versus 44.61 per 1,000 patient-years, a risk reduction of 12 percent.
This study provides clear positive evidence for this intervention, which could be undertaken very quickly at very low cost, said the study’s lead author, Bruce Neal, Ph.D., the executive director of the George Institute for Global Health in Sydney, in a CES press release. “The result of the trial is particularly exciting because salt substitution is one of the few practical ways to achieve changes in people’s salt intake,” said Dr Neal.
These results confirm the findings of a recent modeling study that predicted that 365,000 strokes and 461,000 premature deaths could be prevented each year if a salt substitute was used in China, he said, referring to research published in April 2020 in the BMJ. “Salt substitution could be used by billions more with even greater benefits,” he said.
Lowering blood pressure by reducing salt can have a significant impact on health
Why is sodium so important? It really comes down to blood pressure, says Jim Liu, MD, cardiologist and assistant professor in the division of cardiovascular medicine at the Wexner Medical Center at Ohio State University in Columbus. Dr Liu did not participate in the study.
Hypertension is one of the main risk factors for stroke and heart disease. If blood pressure is not controlled and remains high, the risk of stroke and heart disease will be high; a low sodium diet can help lower blood pressure.
Americans Consume Too Much Sodium, Mostly From Processed Foods and Fast Foods
Everyone needs sodium to stay healthy, but too much sodium is linked to high blood pressure. The average American consumes about 3,400 milligrams (mg) of sodium per day, almost 50% more than the recommended amount of 2,300 mg per day, according to the United States Food and Drug Administration (FDA).
In the United States, most of that extra sodium doesn’t just hit the salt shaker too hard. Over 70 percent of our dietary sodium comes from packaged and prepared foods such as cold cuts, pizza, tacos and fries.
“I encourage patients to cook fresh to control the ingredients in their diet as much as possible, as many canned, frozen or packaged foods contain much more sodium than is ideal for health,” says Milks.
Reducing sodium intake may reduce the need for blood pressure medication
It can be difficult to reduce your intake to recommended levels if you’ve consumed a lot of sodium, he says. “If I have patients who cannot meet these daily goals, I would like them to at least reduce their current sodium intake by 1000 mg per day. If using a salt substitute helps them achieve this, that’s definitely something I would encourage, ”Liu says.
Patients who are able to reduce their sodium intake can significantly lower their blood pressure, he says. “This can sometimes lead to deprescribing hypotensive drugs,” says Liu.
In addition to reducing sodium intake, it’s important to keep in mind other lifestyle factors that can help lower blood pressure, such as weight loss and exercise, he adds. -he.
More Potassium In Your Diet May Have Heart Health Benefits
Potassium helps relieve tension in the walls of blood vessels, which can also lower blood pressure, according to the American Heart Association (AHA).
The most natural way for people to get more potassium and less sodium is to eat more naturally sources of potassium – fruits and vegetables such as citrus fruits, bananas, tomatoes, spinach and broccoli, says Milks.
Widespread use of a salt substitute could help tackle health inequalities
The study authors pointed out that salt substitutes similar to the one used in their research have the potential to reduce health inequalities linked to cardiovascular disease.
Black adults are up to twice as likely to develop high blood pressure by age 55 as white adults, according to results of the CARDIA study, published in the Journal of the American Heart Association in July 2018.
Liu agrees, saying, “I think it can help reduce health disparities, since using a salt substitute is a relatively easy and inexpensive procedure. As the authors mentioned, the cost of salt substitutes is not very high, and it can be a practical intervention in low-income populations.
A salt substitute also appears to be a change people can stick to – the study population was able to continue using the salt substitute for five years, Liu adds.
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