Salt substitutes cut back coronary heart assault, stroke, and demise dangers

Cardiovascular illnesses are the main reason behind demise globally, with hypertension being a significant threat issue for untimely deaths. Inadequate dietary potassium and extra dietary sodium are widespread causes of hypertension.

Study: Effects of salt substitutes on clinical outcomes: a systematic review and meta-analysis. Image Credit: Andrey_Popov /

Examine: Effects of salt substitutes on clinical outcomes: a systematic review and meta-analysis. Picture Credit score: Andrey_Popov /


A number of earlier randomized trials have reported that potassium supplementation and lowered sodium consumption can decrease blood strain. These blood strain reducing results might be present in sodium-reduced and potassium-enriched salt substitutes, the place the sodium chloride (NaCl) content material of standard salt is changed with potassium chloride (KCl).

Just lately, the Salt Substitute and Stroke Examine (SSaSS), which is a five-year cluster randomized trial involving 600 villages in China, supplied proof that salt substitutes can shield towards demise, cardiovascular occasions, and stroke. SSaSS additionally addressed considerations relating to the hostile influence of dietary potassium supplementation and the danger of hyperkalemia. The advance in scientific outcomes noticed in SSaSS is usually mediated by reducing blood strain.

A brand new Heart journal examine gives a scientific evaluate of the influence of salt substitutes on scientific outcomes and blood strain for all accessible trials. The researchers additionally sought to find out the fidelity of the findings throughout numerous geographies and populations.

Concerning the examine

The examine concerned searches on Embase, Cochrane, and MEDLINE databases for key phrases corresponding to low-sodium salt, salt substitute, potassium salt, and reduced-sodium salt via August 31, 2021.

All research the place clusters or adults had been randomly assigned to a daily salt or salt substitute had been included. Mortality, blood strain, cardiovascular occasions, and cardiovascular mortality had been the commonest outcomes.

The titles and abstracts of the research had been screened by one creator to evaluate eligibility, whereas the full-text variations had been independently reviewed by the authors. Variations between reviewers had been solved via a reference with a 3rd creator.

The participant and examine traits, in addition to all outcomes, had been extracted from the data. The chance of bias for all research was additionally decided independently.

Examine findings

Three cluster-randomized trials, 17 individually-randomized trials, and one step-wedged randomized trial had been included within the present evaluation. Of the included research, 11 had been within the World Well being Group (WHO) Western Pacific Area, 5 within the WHO European Area, one within the WHO South-East Asian Area, and 4 within the WHO Area of the Americas.

The length of intervention ranged from one to 60 months. The NaCl proportion within the salt substitutes different from 33% to 75%, whereas the KCl proportion different from 25% to 65%.

The imply baseline systolic blood strain (SBP) was between 113 mm Hg and 177 mm Hg, whereas the imply baseline diastolic blood strain (DBP) was inside the vary of 71 mm Hg and 105 mm Hg.

The imply baseline 24-hour sodium excretion in urine was between 2.9 g and 5.5 g, whereas the imply day by day 24-hour potassium excretion in urine was between 0.8 g and three.6 g. The general threat of bias was excessive for 2 research, of some concern for eight research, and low for 11 research.

An general −4.61 mm Hg discount in SBP, together with a −1.61 mm Hg in DBP, was noticed with salt substitutes as in comparison with controls. Trial durations for lower than 12 months had been related to higher reductions in DBP and SBP.

A decrease proportion of NaCl within the salt substitute and the next consumption of potassium at baseline had been noticed to be related to higher reductions in DBP. Furthermore, these outcomes had been discovered to be constant throughout varied geographical areas and populations.

Moreover, 5 research reported results on mortality, two on main cardiovascular occasions, and three on cardiovascular mortality. Nevertheless, six research reported no critical hostile occasions related to hyperkalemia, whereas two reported no impact of salt substitute on the serum potassium ranges.

Salt substitutes additionally lowered urinary sodium excretion by −0.48 g/day and elevated urinary potassium excretion by 0.45 g/day. The influence on potassium excretion was highest within the European areas and least within the Southeast Asian area. Furthermore, the rise in urinary potassium secretion was greater in males.


The present examine demonstrated that salt substitutes can result in constant blood pressure-lowering results throughout numerous populations and geographies with out inflicting any extreme hostile occasions.

Salt substitutes might be adopted in public well being insurance policies and scientific observe for the discount of dietary sodium consumption. Moreover, these substitutes can improve dietary potassium consumption to in the end cut back blood strain and forestall critical cardiovascular illnesses.


Full information was not accessible for a lot of research, and the gray literature was not searched. An extra limitation was that the variety of accessible trials is comparatively small.

Restricted information on non- hypertensive people makes drawing particular conclusions troublesome. Lastly, the info on scientific outcomes had been primarily obtained from one trial.

Journal reference:
  • Yin, X., Rodgers, A., Perkovic, A., et al. (2022). Results of salt substitutes on scientific outcomes: a scientific evaluate and meta-analysis. Coronary heart. doi:10.1136/heartjnl-2022-321332.



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