Salt substitute acts better in stroke prevention: Circulation

Australia: Replacing conventional salt with salt substitute was a cost-effective strategy for stroke prevention and quality of life improvement among The Salt Substitute and Stroke Study (SSaSS) participants, says an article published in Circulation Journal.

The SSaSS, a five-year cluster randomized controlled trial, found that replacing regular salt with a reduced-sodium added-potassium salt substitute reduced the risks of stroke, major adverse cardiovascular events, and premature death in people with a history of stroke or uncontrolled high blood pressure in rural China. Ka-Chun Li and colleagues conducted this study to analyze the cost-effectiveness profile of the intervention.

This was a within-trial economic evaluation of SSaSS, carried out from the standpoint of the healthcare system and customers. The major health outcome studied was a stroke, and the impacts on quality-adjusted life years were measured (QALYs). The expenses of healthcare were derived from participant health insurance information and the literature. All expenses (Chinese Yuan - CNY) and QALYs were discounted at a rate of 5% each year. Bivariate multilevel models were used to estimate incremental expenditures, stroke events avoided, and QALYs gained.

The results of this study stated as follow:

1. The average length of follow-up for the 20,995 individuals was 4.7 years.

2. During this time, substituting conventional salt with salt replacement lowered the risk of stroke by 14%, and the salt substitute group had 0.054 more QALYs per person on average.

3. The salt replacement group had reduced average expenses (CNY 1,538 for the intervention group and CNY 1,649 for the control group) (CNY 110 less).

4. The intervention was dominating in terms of stroke prevention as well as QALYs gained.

5. Sensitivity tests revealed that these results were robust, with the exception of when the price of salt replacement was raised to the median and maximum market values observed in China.

6. The salt replacement intervention had a 95.0% chance of being cost-effective and a greater than 99.9% chance of being cost-saving.

In conclusion, the findings of this study showed the efficiency of the salt-based substitution for regular salt in stroke prevention and improving the quality of life.

Reference:

Li, K.-C., Huang, L., Tian, M., Di Tanna, G. L., Yu, J., Zhang, X., Yin, X., Liu, Y., Hao, Z., Zhou, B., Feng, X., Li, Z., Zhang, J., Sun, J., Zhang, Y., Zhao. Cost-effectiveness of a Household Salt Substitution Intervention: Findings From 20,995 Participants of the Salt Substitute and Stroke Study (SSaSS). In Circulation. Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1161/circulationaha.122.059573

Keywords: Circulation, salt, stroke, salt substitute, cardiovascular events, quality of life, rock salt, blood pressure, sodium, potassium, American Heart Association, AHA