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Salt substitutes can help to lower the risk of heart attack, stroke, and death from all causes and cardiovascular disease, according to a large, pooled data analysis of more than 30,000 participants, published in the journal Heart.
The researchers carried out the analysis after a large study from China (SSaSS) found that salt substitutes cut the risk of heart attacks, stroke, and early death, but it was unclear whether these benefits would apply to people in other parts of the world.
Salt substitutes were found to lower blood pressure in all participants
To confirm these findings, the researchers pooled the results of 21 relevant international clinical trials published up to the end of August 2021. The studies were carried out in Europe, the Western Pacific Region, the Americas, and South-East Asia and follow up periods lasted from one month to five years.
Salt substitutes replace a proportion of sodium chloride with potassium chloride. Across the studies, the proportion of sodium chloride in the salt substitutes varied from 33% to 75%, while the proportion of potassium ranged from 25% to 65%.
Salt substitutes were found to lower blood pressure in all the participants. The overall reduction in systolic blood pressure (the higher number that indicates the force at which the heart pumps blood around the body) was 4.61 mmHg and the overall reduction in diastolic blood pressure (the lower number that indicates arterial pressure when the heart is filling with blood) was 1.61 mmHg.
Reductions in blood pressure seemed to be consistent, irrespective of geography, age, sex, history of high blood pressure, weight (BMI), baseline blood pressure, and baseline levels of urinary sodium and potassium. There was no evidence that higher dietary potassium was associated with any health harms.
A pooled data analysis of the results of five of these trials involving more than 24,000 participants showed that salt substitutes lowered the risks of early death from any cause by 11%, from cardiovascular disease by 13%, and the risks of heart attack or stroke by 11%.
The findings support the adoption of salt substitutes in clinical practice and public health policy
The researchers highlight that while their findings echo those of the SSaSS, it is important to be aware that the studies in the pooled data varied in design and there were relatively few data for people who didn’t have high blood pressure.
Nevertheless, they say: “The observed consistent blood pressure reductions make a strong case for generalisability of the cardiovascular protective effect observed in the SSaSS both outside of China and beyond.”
For this reason, the authors conclude that the findings 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.