Salt Substitutes Offer Cheap Ways To Reduce Large-Scale Stroke Risk, Studies Find

Results at the same time New England Journal of Medicine..¹

The idea that reducing salt intake improves health is not new. Studies have shown that reducing salt lowers blood pressure.But tracking how population-level interventions can reduce cardiovascular events is another thing, Julie R. Ingelfinger, MD writes in an editorial. NEJM..²

“If the strategy is feasible in the long run, the salt alternative approach could have significant public health consequences in China, and perhaps elsewhere,” she wrote, but the findings are from other groups. Warned that this may not be the case.

In this study, villages were assigned to receive either table salt or an alternative that was 75% salt and 25% potassium. In each village, one of the products was given to about 35 people over the age of 60 or at high cardiovascular risk. This is enough for the whole family to use for cooking, seasonings and food preservation. In the countryside of China, families cannot cook themselves and get processed foods.

People in the salt replacement group were advised to reduce salt, as low-income groups are known to use more salt than necessary to prepare their meals. The table salt group prepared meals as usual.

The primary outcome was stroke, and the secondary outcome was major cardiovascular adverse events and death from any cause. The researchers also measured clinical hyperkalemia as a result of safety. After a follow-up of 4.74 years, the results showed that:

• The average age of participants was 65.4 years, 49.5% were female, 72.6% had a history of stroke, and 88.4% had a history of hypertension.
• The incidence of stroke was lower with salt substitutes, with 29.14 vs. 33.65 events per 1000 man-years. The rate ratio (RR) is 0.86 (95% CI, 0.77-0.96; NS = .006)
• The incidence of major cardiovascular events was also lower in the salt replacement group: 49.09 vs. 56.29 events per 1000 person-years, RR 0.87 (95% CI, 0.80-0.94; NS <.001)
• The salt replacement group had a low cardiovascular mortality rate, with an RR of 0.88 (95% CI, 0.82-0.95), 39.28 vs. 44.61 events per 1000 man-years. NS <.001)
• Hyperkalemia was not significantly higher in the salt replacement group. If the RR is 1.04 (95% CI, 0.80-1.37), 3.35 vs. 3.30 events per 1000 man-years. NS = 0.76)

The lead investigators in this study found that the ability to use salt substitutes to reduce the risk of stroke along with other cardiovascular events is another developing diet with a high incidence of chronic disease and a high salt content. He said it would affect the country.

Bruce Neil, MB ChB, PhD, FRCP and FAHA of the George Global Health Institute in Sydney said: Australia, in a statement. “Other salt-reducing interventions struggled to achieve large and lasting effects.”

Neil and his co-authors cited some important limitations of their study, including the use of only one salt alternative, which prevented the opportunity to assess reduced salt consumption. They also noted the lack of measured serum potassium levels. However, the method of conducting this study, similar to the way public or non-governmental salt substitution programs are implemented on a large scale, proved what health promotion is possible.

The study proves that simple interventions can be “performed very quickly at a very low cost,” he said.

In China, the price of salt is $ 1.08 (US $) per kilogram. The price of an easy-to-manufacture salt substitute is $ 1.62 per kilogram. Countries that have adopted policies to implement salt substitutes can quickly change the health of their population, Neil said.

In a press presentation prior to the official presentation at ESC Congress 2021, Neil provided a world map of salt-intensive countries. Developing countries were disproportionately represented. He said China provides a good example of what the interests are.

“A recent modeling study in China predicted that if salt substitutes proved effective, China could avoid 365,000 strokes and 461,000 premature deaths each year.” Neil said. “We have now shown that it is effective, and these are benefits only for China. Salt alternatives are used by billions more people with even greater benefits. May be done. “

References

1. Neal B, Wu Y, Feng X, etc. Effects of salt substitution on cardiovascular events and death. N Engl J Med.. Published August 29, 2021. doi: 10.1056 / NEJMoa2105675

2. Can Ingelfinger J. Salt Substitution Save People at Risk from Stroke? N Engl J Med.. Published August 29, 2021. doi: 10.1056 / NEJMe2112857