Salt substitution associated with lower risk for all-cause, cardiovascular mortality

A systematic review of 16 randomized controlled trials found that the use of a salt substitute in food preparation was associated with a lower risk for both all-cause and cardiovascular mortality. The analysis is published in Annals of Internal Medicine.

Cardiovascular disease is the leading cause of death globally, and its onset is associated with high dietary sodium intake. Despite calls from organizations like the World Health Organization for people worldwide to reduce sodium intake, global sodium consumption still exceeds the recommended daily limit. Substituting table salt with a substitute containing reduced sodium and increased potassium may be a minimally invasive, achievable strategy to reduce sodium intake.

Researchers from Bond University, Queensland, Australia, conducted a systematic review and meta-analysis of 16 randomized controlled trials (RCTs) of persons using regular table salt or salt substitutions for at least six months. They found that salt substitution may reduce all-cause or cardiovascular mortality, but the evidence for reducing cardiovascular events and for not increasing serious adverse events is uncertain. The authors found that 8 of the 16 included RCTs studied primary outcomes. Of these, 7 studies occurred in China or Taiwan. Additionally, 7 of the 16 studies included older persons, who are at higher risk for cardiovascular disease. Because of these factors, generalizability to a population with an average cardiovascular disease risk or eating a Western diet is limited.

An accompanying editorial by authors from the University of Sydney, University of California San Diego, and University of New South Wales highlights the lack of changes made by governments and the global food production history to tackle the World Health Organization’s recommendations to reduce worldwide sodium consumption by 30 percent by 2025. The authors suggest that the widespread use of salt substitutions provide an achievable, accessible means to reaching that goal for the global food production industry.  

Media contacts: For an embargoed PDF, please contact Angela Collom at [email protected]. To speak with the corresponding author,  Loai Albarqouni, MD, MSc, PhD, please contact [email protected].