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Dietary salt substitutes reduce the risk of heart attack, stroke and death from all causes and cardiovascular disease, finds a pooled data analysis of the available evidence, published online in the journal chorus.
The beneficial effects of these substitutes are likely to apply to people around the world, the researchers say.
Cardiovascular disease is the leading cause of death worldwide, and high blood pressure is a major risk factor for premature death. A diet high in sodium and low in potassium is known to increase blood pressure.
About 1.28 billion people worldwide have high blood pressure, although more than half of them are undiagnosed, researchers say.
Salt substitutes, in which a proportion of sodium chloride (NaCl) is replaced by potassium chloride (KCl), are known to help lower blood pressure.
A recently published large study from China (Salt Substitutes and Stroke Study; SSaSS) found that salt substitutes reduce the risk of heart attack, stroke and premature death, but it was unclear whether these benefits would hold in other parts of the world.
To find out, the researchers searched research databases for randomized clinical trials published up to the end of August 2021 that reported on the effects of a salt substitute on the blood pressure, cardiovascular health and premature death.
Blood pressure, which is measured in mmHg, is made up of two numbers: systolic: the higher number that indicates how hard the heart pumps blood around the body; and diastolic: the lowest number indicating blood pressure when the heart is filling with blood.
They brought together the results of 21 relevant international clinical trials involving nearly 30,000 people, conducted in Europe, the Western Pacific region, the Americas and Southeast Asia.
Study periods ranged from 1 month to 5 years. The proportion of sodium chloride in the salt substitutes varied from 33% to 75%; the proportion of potassium ranged from 25% to 65%.
Pooled data analysis showed that salt substitutes reduced blood pressure in all participants. The overall reduction in systolic blood pressure was 4.61 mm Hg and the overall reduction in diastolic blood pressure was 1.61 mmHg.
Reductions in blood pressure appeared to be consistent regardless of geography, age, sex, history of high blood pressure, weight (BMI), baseline blood pressure, and baseline urinary sodium and potassium levels.
And each 10% lower proportion of sodium chloride in the salt substitute was associated with a 1.53 mmHg greater drop in systolic blood pressure and a 0.95 mmHg greater drop in diastolic blood pressure. There was no evidence that higher potassium in the diet was associated with any harm to health.
A pooled data analysis of the results of five such trials with more than 24,000 participants showed that salt substitutes reduced the risks of premature death from any cause by 11%, cardiovascular disease by 13% and risks of heart attack or stroke by 11%.
The researchers acknowledge certain limitations of their findings, including that the studies in the pooled data analysis varied in design and that there were relatively few data for people who did not have high blood pressure.
But they nevertheless point out that their findings echo those of SSaSS, the largest trial of a potassium-enriched salt substitute to date.
“Since blood pressure lowering is the mechanism by which salt substitutes confer their cardiovascular protection, the consistent reductions in blood pressure observed make a strong case for the generalizability of the cardiovascular protective effect observed in the SSaSS both outside of China and beyond,” they write.
“These findings are unlikely to reflect chance and support the adoption of salt substitutes in clinical practice and public health policy as a strategy to reduce dietary sodium intake, increase dietary potassium intake, lower blood pressure and prevent major cardiovascular events,” they said. to conclude.
The women were urged to eat potassium-rich foods to improve their heart health. More information: Effects of salt substitutes on clinical outcomes: a systematic review and meta-analysis, chorus (2022). DOI: 10.1136/heartjnl-2022-321332 Journal information: Heart provided by the British Medical Journal
Citation: Dietary salt substitutes reduce risk of heart attack, stroke and death (2022, August 9) Retrieved August 9, 2022, from
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