Changing salt with a low-sodium alternative reduces the threat of stroke in individuals with hypertension or previous stroke, according to late-breaking research study provided in a Hot Line session at ESC Congress 2021 [1] and released in the New England Journal of Medicine. [2]
Both raised salt consumption and low potassium intake are related to hypertension and an increased danger of cardiovascular illness and sudden death. [3,4] Salt replaces, which replace part of the salt chloride in routine salt with potassium chloride, have actually been revealed to lower blood pressure [5] however their results on heart disease, stroke, and death had actually been unpredictable. In addition, there had been issues about causing hyperkalemia in people with chronic kidney illness resulting in heart arrhythmias and sudden death.
Funding: The study was supported by the National Health and Medical Research Council (APP1164206 and APP1049417) with the study salt substitute acquired from local manufacturers in each province for years 1, 2 and 5 but provided complimentary of charge by Jiangsu Sinokone Technology Company Limited for several years 3 to 4.
SSaSS: Salt Substitute and Stroke Study into the impact of salt replaces on cardiovascular events and death.
Tian M, et al. The impact of salt alternative on cardiovascular events and death (SSaSS). N Engl J Med. 10.1056/ NEJMoa2105675.
Dietary salt and cardiovascular illness risk– measurement matters. N Engl J Med.
Aburto NJ, Hanson S, Gutierrez H, et al. Result of increased potassium intake on cardiovascular threat aspects and disease: systematic review and meta-analyses. BMJ. 2013; 346: f1378.
Greer RC, Marklund M, Anderson CAM, et al. Potassium-enriched salt substitutes as a means to lower blood pressure. Hypertension. 2020; 75:266– 274.
Neal B, Tian M, Li N, et al. Rationale, style, and standard attributes of the Salt Substitute and Stroke Study (SSaSS)- A massive cluster randomized regulated trial. Am Heart J. 2017; 188:109– 117.
Inadequately controlled blood pressure was defined as: systolic blood pressure =140 mmHg if on high blood pressure lowering medication or systolic blood pressure =160 mmHg if not on blood pressure decreasing medication.
Marklund M, Singh G, Greer R, et al. Estimated population broad advantages and threats in China of lowering salt through potassium enriched salt substitution: modelling study.
Bhat S, Marklund M, Henry ME, et al. An organized evaluation of the sources of dietary salt around the world.
The Salt Substitute and Stroke Study (SSaSS) compared the effect of reduced-sodium salt substitute versus regular salt on stroke, cardiovascular occasions, death and medical hyperkalaemia. [6] SSaSS was an open, cluster-randomized, trial that registered participants in between April 2014 and January 2015. Participants were grownups with either previous stroke or age 60 years and above with badly controlled blood pressure. [7]
The trial was conducted in 600 villages in rural locations of five provinces in China. 2 counties within each province were selected that represented the socioeconomic advancement level of rural counties because province. Around 35 individuals were recruited from each town– for an overall of 20,995 participants. Individuals were cluster-randomized by village in a 1:1 ratio to provision of salt alternative or continued use of regular salt.
Individuals in intervention villages were offered free salt replacement (about 75% salt chloride and 25% potassium chloride) as a replacement for regular salt and advised to utilize it for all food, cooking, and flavoring conservation. They were likewise encouraged to utilize the salt replacement more sparingly than they formerly utilized salt to optimize their sodium reduction.
The average age of individuals was 65.4 years and 49.5% were female. Some 72.6% had a history of stroke and 88.4% had a history of high blood pressure.
During an average follow up of 4.74 years, more than 3,000 people had a stroke, more than 4,000 passed away and more than 5,000 had a major cardiovascular event. 0.77– 0.96; p= 0.006).
Concerning secondary results, major cardiovascular events (non-fatal stroke, non-fatal severe coronary syndrome, vascular death) were minimized with salt alternative (49.09 versus 56.29 per 1,000 patient-years; RR 0.87; 95% CI 0.80– 0.94; p<< 0.001) as was overall mortality (39.27 versus 44.61 per 1,000 patient-years; RR 0.88; 95% CI 0.82-- 0.95; p<< 0.001).
Relating to security, there was no increased risk of major adverse events attributed to clinical hyperkalaemia with salt substitute compared to regular salt (3.35 versus 3.30 per 1,000 client years; RR 1.04; 95% CI 0.80-- 1.37; p= 0.76). Neither were any other dangers identified.
Principal detective Professor Bruce Neal of the George Institute for Global Health, Sydney, Australia stated: "This research study offers clear proof about an intervention that might be taken up extremely rapidly at very low cost. If salt alternative was shown to be efficient, a current modeling study done for China projected that 365,000 strokes and 461,000 early deaths might be avoided each year in China. [8] We have actually now revealed that it works, and these are the advantages for China alone. Salt substitution could be used by billions more with even higher advantages."
He included: "The trial outcome is especially amazing because salt substitution is one of the few useful ways of accomplishing modifications in the salt individuals consume. Other salt decrease interventions have actually struggled to accomplish continual and large effect.".
" Importantly, salt replacement is extremely easy to manufacture and it is not expensive. A kilo of regular salt, which lasts for months, expenses about US$ 1.08 in China. The rate for a kilo of salt substitute is $1.62/ kg, "he said." It is primarily lower-income and more disadvantaged populations that add large quantities of salt throughout food preparation and cooking. [9] This means that salt replacement has the prospective to minimize health inequities related to cardiovascular illness.".
References and notes.
The Salt Substitute and Stroke Study (SSaSS) compared the effect of reduced-sodium salt substitute versus regular salt on stroke, cardiovascular events, death and medical hyperkalaemia. Individuals were cluster-randomized by village in a 1:1 ratio to provision of salt substitute or continued use of routine salt.
Individuals in intervention towns were offered totally free salt substitute (about 75% sodium chloride and 25% potassium chloride) as a replacement for regular salt and encouraged to use it for all flavoring, cooking, and food conservation. They were likewise motivated to use the salt replacement more moderately than they formerly utilized salt to maximize their salt decrease. He added: "The trial outcome is especially amazing due to the fact that salt alternative is one of the couple of practical methods of achieving changes in the salt people consume.
