A salt substitute that includes less sodium reduces stroke and heart attack rates in rural China, according to an essay published in the New England Journal of Medicine.

According to Darwin Labarthe, MD, PhD, MPH, professor of preventive medicine in the Division of Epidemiology and co-author of the study, these salt substitutes are a promising intervention in areas where most salt intakes come from the home cooking.

In northeast China or other parts of the world where manufactured foods are still only a small part of the food supply, this is a practical intervention. Hundreds of millions of people could benefit from it. “

Darwin Labarthe, MD, PhD, MPH, Professor of Preventive Medicine, Division of Epidemiology, Northwestern University

Reducing salt intake lowers blood pressure, which is a major contributor to illness and death from heart attacks or strokes. Up to a billion people worldwide have uncontrolled high blood pressure, Labarthe said, and that number is only growing.

Salt substitutes – in this study, a salt made from a mixture of sodium chloride and potassium chloride – were shown to reduce blood pressure, but their impact on downstream cardiac events had not been determined previously.

In the current study, conducted in 600 villages in northeast China, investigators recruited more than 20,000 people with a history of hypertension or stroke. Study villages were randomized to either receive the salt substitute or continue to use common salt in home cooking.

Investigators followed participants for almost five years on average, and found that the rates of stroke, major cardiovascular events, and death were all lower in participants using salt substitutes compared to participants using regular salt.

The results strongly suggest that salt substitutes – especially those that replace sodium with potassium – are an effective, convenient, and inexpensive intervention for cardiovascular disease in areas of the world where home cooking is prevalent, according to Labarthe.

“Salt goes down and potassium goes up, which is also good for lowering blood pressure – so it’s doubly effective,” Labarthe said.

However, for more developed countries – especially in the West – public health must look to food manufacturers, according to Labarthe.

“Evidence suggests that if food manufacturers used salt substitutes in processed foods, it could have a substantial health benefit,” Labarthe said. “Cardiovascular disease itself is a major pandemic, which has been around for a century, and salt substitutes could have a huge impact. “

The study was led by researchers at the George Institute for Global Health in Sydney, Australia.


Journal reference:

Neal, B., et al. (2021) Effect of salt substitution on cardiovascular events and death. New England Journal of Medicine. doi.org/10.1056/NEJMoa2105675.

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