Long-term salt preferences may influence CVD risk
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Less use of added dietary salt is associated with lower risk for CVD, particularly HF and ischemic heart disease, whether or not individuals follow the Dietary Approaches to Stop Hypertension diet, data from a prospective study show.
“Previous epidemiologic studies investigating the relation between dietary sodium intake and CVD have generated conflicting results, with either a J-shaped or null relationship reported,” Lu Qi, MD, PhD, FAHA, HCA Regents Distinguished Chair and professor in the department of epidemiology at Tulane University School of Public Health and Tropical Medicine, and colleagues wrote in the Journal of the American College of Cardiology. “An important reason for such conflicting results is the lack of valid and feasible methods for assessing long-term dietary sodium intake.”
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As Healio previously reported, data from the Salt Substitute and Stroke Study (SSaSS) demonstrated that switching from regular salt to a salt substitute reduced the risk for stroke, major CV events and death in a large trial of adults in rural China with a history of stroke or high risk for stroke. The data suggest that discretionary sodium intake may lower risk for CVD, the researchers wrote.
“Therefore, the frequency of adding salt to foods may be considered as a surrogate marker for evaluating individual long-term sodium intake in the Western diet,” the researchers wrote. “To date, no study has assessed whether the frequency of adding salt to foods is associated with CVD risk in prospective cohorts.”
Assessing long-term salt use
Qi and colleagues analyzed data from 176,570 adults participating in the UK Biobank who were free of CVD at baseline. Participants completed at least one web-based 24-hour dietary assessment (Oxford WebQ) between 2009 and 2012. At baseline, participants were also asked, “Do you add salt to your foods? (Do not include salt used in cooking).” Responses included never/rarely; sometimes; usually; and always. Researchers estimated the association between the frequency of adding salt to foods and incident CVD events. Additionally, researchers also analyzed the joint association between the frequency of adding salt to foods and the Dietary Approaches to Stop Hypertension (DASH) diet, using a modified DASH score without considering sodium intake, in relation to CVD risk.
During a median of 11.8 years of follow-up, there were 9,963 total CVD events, 6,993 cases of ischemic heart disease, 2,007 cases of stroke and 2,269 cases of HF.
Lower frequency of adding salt to foods was significantly associated with lower risk for total CVD events after adjustment for covariates and the DASH diet.
Compared with adults who reported always adding salt to foods, adjusted HRs were 0.81 (95% CI, 0.73-0.9), 0.79 (95% CI, 0.71-0.87), and 0.77 (95% CI, 0.7-0.84) across the groups of usually, sometimes, and never/rarely adding salt to foods, respectively (P for trend < .001). Among the subtypes of CVD, adding salt had the strongest association with HF (P for trend < .001) and a significant association with ischemic heart disease (P for trend < .001), but was not associated with stroke.
“The lack of statistically significant association with stroke risk should be interpreted with caution,” the researchers wrote. “The benefits of sodium reduction on stroke risk have been demonstrated in the SSaSS. The null association in the present study might be partly caused by the limited number of stroke cases.”
Study findings ‘promising’
In a related editorial, Sara Ghoneim, MD, of the division of gastroenterology and hepatology at the University of Nebraska Medical Center, noted that participants who combined the lowest frequency of salt addition and the highest level of DASH diet adherence had the lowest risk for CVD, suggesting the additive role that lower salt preferences and a healthier diet may have on CVD prevention.
“In a previous study, Ma and colleagues reported higher frequency of adding salt to foods was associated with higher risk of all-cause premature mortality and lower life expectancy,” Ghoneim wrote. “The present study builds on what was previously reported and alludes to the possible role that long-term salt preferences may have on the risks of total CVD events and major subtypes of CVD.”
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