Even partial salt substitution conferred reduced stroke risk
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Partial replacement of dietary salt with a potassium-enriched substitute conferred reduced risk for stroke, major CV events and death among Chinese adults, researchers reported.
The post hoc analysis of the Salt Substitute and Stroke Study (SSaSS) was published in Hypertension.
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“Worldwide estimates indicate an average sodium intake of 4 g/day, twice the maximum intake recommended by the World Health Organization (2 g/day). Average daily potassium intake is also lower than the World Health Organization-recommended level of 3.5 g/day (90 mmol/day) in many countries around the world,” Xuejun Yin, PhD candidate at The George Institute for Global Health, and colleagues wrote. “Interventions that reduce dietary sodium, increase dietary potassium, or both have significant potential for blood pressure lowering and cardiovascular protection.”
The SSaSS trial
SSaSS was an open-label, cluster-randomized trial in which researchers enrolled 20,995 adults with a history of stroke or aged 60 years and older with high BP living in rural China (mean age, 65 years; 49.5% women; 72.6% with history of stroke; 59.3% with uncontrolled high BP). Participants were randomly assigned to regular salt or a salt substitute containing 70% sodium chloride and 25% potassium chloride.
The main results of the SSaSS were presented at the 2021 European Society of Cardiology Congress.
As Healio previously reported, switching to a salt substitute from regular salt reduced risk for stroke, major CV events and death among Chinese adults.
Proportion of salt substitution
For the present analysis of the SSaSS trial, Yin and colleagues assessed how the amount of salt substitute intake affected the risk reduction observed in the main findings.
During 5 years of follow-up, researchers collected baseline and annual 24-hour urinary samples from SSaSS participants and used the mean difference in 24-hour urine potassium between the regular and salt substitute groups to estimate the quantity of salt substitute intake in the intervention group.
Mean increase in 24-hour urinary potassium in the salt substitute group was 0.8 g more per day more compared with the regular salt group (95% CI, 0.71-0.9), correlating to an mean intake of 8.8 g per day of the salt substitute (95% CI, 7.8-9.9), according to the study.
At mean 8.8 g per day of salt substitute intake, the estimated expected difference in 24-hour urinary sodium was 0.79 g less per day compared with regular salt.
With an observed difference of –0.35 g per day (95% CI, –0.55 to –0.15), the researchers estimated that 72% of baseline salt intake was replaced by the salt substitute, according to the study.
The researchers posited that the 0.44 g per day difference between the observed and expected 24-hour urinary sodium may be explained in part by salt substitute use on top of regular salt intake rather than 100% substitution.
“This level of replacement of regular salt with potassium-enriched salt could be achieved in many other settings inside and outside of China,” the researchers wrote. “It is not necessary to replace all dietary salt with potassium-enriched salt to achieve significant clinical benefits, although it is likely that health gains will be greatest when most regular salt is replaced by potassium-enriched salt.”
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