Salt substitution reduces cardiovascular mortality in the high-risk population

A recent comprehensive review highlights the potential health benefits of salt substitution for cardiovascular outcomes. This research found that replacing regular salt with substitutes could lead to a reduction in mortality and major cardiovascular events among the high-risk populations. The crucial findings were published in the Annals of Internal Medicine.

The study synthesized data from 16 randomized controlled trials (RCTs) and focused on the effects of salt substitutes on adults for durations of six months or longer. The study data were primarily sourced from databases such as PubMed, EMBASE, Cochrane CENTRAL and CINAHL to compile the most relevant information up to the date of search completion.

Also, the meta-analysis showed that salt substitutes might reduce the risk of all-cause mortality by 12% and cardiovascular mortality by 17% according to the data from trials that involved a total of 27,710 and 25,050 participants, respectively. Most of the studies reviewed were conducted in China or Taiwan, focusing primarily on older populations with an average age of 62 years and higher-than-average cardiovascular risks. The potential reduction in major cardiovascular events (MACE) was observed with very low certainty.

The evidence highlighted an increase in the risk of serious adverse events associated with salt substitutes which was not statistically significant. This aspect underlines the need for careful consideration in balancing the benefits and potential risks of salt substitution among different global populations.

The study employed the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system to assess the certainty of the evidence, which generally ranged from low to very low across different outcomes. This necessitates the need for further high-quality studies to confirm these potential benefits and establish clearer guidelines for their application.

The dominance of the data by a single, large RCT and the concentration of studies in Asian countries with high cardiovascular risk profiles pose significant limitations to the generalizability of this study. It indicates that while the initial results are encouraging for the populations in China or Taiwan which were studied.

While salt substitution appears to be a promising strategy for improving cardiovascular health outcomes (reducing mortality rates among high-risk groups), further research is mandatory to fully understand its benefits and risks across different populations and this will encourage to consider the context of broader dietary and health management strategies.

Source:

Greenwood, H., Barnes, K., Clark, J., Ball, L., & Albarqouni, L. (2024). Long-Term Effect of Salt Substitution for Cardiovascular Outcomes. In Annals of Internal Medicine. American College of Physicians. https://doi.org/10.7326/m23-2626