New study shows “win-win” salt substitutes can save lives in China

People throughout China can dramatically reduce their risk of stroke, heart attack and death by simply switching regular salt in their kitchen at mealtimes with salt substitutes, a landmark new study conducted throughout China has found.  Salt substitutes are a reduced sodium/added potassium product.

Presented at a ‘hotline session’ at the European Society of Cardiology Congress in Paris on August 29, and simultaneously published in the New England Journal of Medicine, the results also showed that there were no harmful effects from the salt substitute.

By simultaneously tackling two widespread problems, salt substitutes are a win-win: they reduce high and unwanted levels of sodium intake and boost otherwise low levels of potassium intake, both of which are associated with high blood pressure and greater risks of stroke, heart disease and premature death. Salt substitutes are known to lower blood pressure but their effects on heart disease, stroke, and death were unclear, until now.

“For many years, China has focused on how to improve the lives of the Chinese people.  But the Chinese people eat far too much salt, which contributes to strokes, heart attacks and premature death,” said Yangfeng Wu, Co-Principal Investigator, Professor of Peking University School of Public Health and Executive Associate Director of the Peking University Clinical Research Institute. “People like salt, and it’s hard to stop the salt habit. This important new salt substitute study in China offers a win-win. By switching from regular salt to a salt substitute, we can save millions of lives in China and around the world while eating well and living longer.”

“This is a very definitive and important study for China. The benefits for China and the Chinese people are clear. Switching from regular table salt to salt substitutes can save 460,000 lives a year from cardiovascular disease,” said Dr Maoyi Tian, senior research fellow at The George Institute for Global Health, China, and Professor, School of Public Health, Harbin Medical University.  

The Salt Substitute and Stroke Study involved 21,000 adults with either a history of stroke or poorly controlled blood pressure from 600 villages in rural areas of five provinces in China - Hebei, Liaoning, Ningxia, Shanxi and Shaanxi between April 2014 and January 2015.

Participants in intervention villages were provided enough salt substitute to cover all household cooking and food preservation requirements - free-of-charge. Those in the other villages continued using regular salt.  

During an average follow up of almost five years, about 3,000 people had a stroke. For those using the salt substitute, researchers found that stroke risk was reduced by 14 percent, total cardiovascular events (strokes and heart attacks combined) by 13 percent and premature death by 12 percent.  

Dr Tian noted that since salt substitutes are relatively cheap (about 1.5 times higher than regular salt) they are likely to be very cost effective too.

Researchers recommended the following be considered along with further research in China:

• Salt manufacturers and retailers can consider producing and marketing salt substitutes
• Stakeholders and policymakers can review policies on how to promote salt substitutes and reduce regular salt use
• Chinese consumers can cook, season and preserve foods with salt substitute instead of regular salt

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About salt and health*

• Globally, excess salt consumption (more than five grams per day) is responsible for three million deaths from heart disease, stroke, and related causes each year. 
• Four out of five of these deaths occur in low- and middle-income countries, and nearly half are among people younger than 70.
• Average salt intake is nearly twice the recommended level globally. 
• In 181 of 187 countries, covering 99 percent of the world’s population, estimated average levels of salt intake exceed the World Health Organization’s recommendation of five grams, or just under one teaspoon per day.

*Data from Resolve to Save Lives https://resolvetosavelives.org/