"Substituting the World’s Salt Supply"
Excess dietary sodium consumption and inadequate dietary potassium consumption are both associated with higher blood pressure levels. Corresponding data from multiple trials show that reducing sodium intake and supplementing potassium intake both lower blood pressure. ‘Salt substitutes’ are alternates to regular salt that combine these effects by substituting part of the sodium chloride in regular salt with potassium chloride.
Recently we completed a large-scale trial examining the effects of salt substitution on health outcomes. The Salt Substitute and Stroke Study included 20995 individuals followed for an average of 4.7 years with randomisation to continued use of regular salt or a switch to salt substitute. The study showed that use of salt substitute reduced the risks of stroke (-14%, p=0.006), major cardiovascular events (-13%, p<0.001) and premature death (-12%, p<0.001) with no evidence of any harms.
The Salt Substitute and Stroke Study was done in a selected population in rural China to enable robust testing of the hypothesis. We now need to define the likely broader generalizability of the findings and understand how to achieve uptake of salt substitute in communities likely to benefit. Social, political and cost factors will be key to translation of the research findings into appropriate policies, clinical practice and community behavior
Bruce Neal is Professor of Medicine at UNSW Sydney and Executive Director of The George Institute Australia. Bruce trained in medicine in the United Kingdom where he practiced for 5 years before switching to a full-time career in research. His research has focused on clinical and public health interventions targeting cardiovascular disease.