Cutting 1 Gram of Sodium Per Day Could Prevent Millions of Cardiovascular, Stroke Events in China

A new study is adding to the growing evidence base supporting reduction of dietary sodium for the prevention of cardiovascular and cerebrovascular events on a population level.

A modeling study using a meta-regression of randomized trials and a population study, results of the study demonstrate reducing sodium intake by 1 gram daily could reduce blood pressure and was associated with reductions in ischemic cardiovascular disease by about 4% and for stroke risk by about 6%.

“The Chinese government’s action plan ‘Healthy China 2030’ includes nutritional recommendations to reduce the intake of salt, sugar and oil. This modelling study shows that salt reduction alone could bring enormous health benefits to the entire population of China,” investigators wrote.

With the salt intake in China considered to be among the highest in the world at approximately 11 grams per person per day, a mountain of data has outlined the prevalence of cardiovascular disease risk in the overall population. At ESC 2021, the Salt Substitute and Stroke Study found use of a salt substitute that was 75% sodium chloride and 25% potassium chloride by mass across whole villages in rural China was associated with a 14% reduction in stroke incidence. Since the release of the study, additional research, including the present study, has been performed to further explore the impact of sodium reduction on risk of events at a population level.

With this in mind, a team from Queen Mary University of London and St. George’s University of London designed the current study to develop a model that used meta-regression of randomized trials and a population study to determine the effect of salt reduction on systolic blood pressure and the effect of systolic blood pressure on cardiovascular risk from pooled cohort studies with the aim estimating the effect of salt reduction on risk of ischemic heart disease and stroke in China.

Upon analysis, investigators found reducing population salt intake by 1 gram per day should lower mean systolic blood pressure levels by 1.2 mmHg (95% UI, 0.5-2.2). This reduction in blood pressure correlated to a 4% (95% UI, 1.8-7.7) reduction in risk of ischemic heart disease and a 6% (95% UI, 2.4-9.3) reduction in risk of stroke. Investigators pointed out that if this reduction was achieved within 1 year and sustained beyond that point, it would result in the prevention of 9 million (95% UI, 7 million–10.8 million) cardiovascular events by 2030, including 4 million (95% CI, 3.1 million-4.9 million) that could have been fatal. Further analysis demonstrated greater and gradual reductions, which were aimed at achieving the World Health Organization’s target of 30% reduction by 2025 or the Chinese government’s target of less than 5 grams per day by 2030, could prevent 1.5 or 2 times more cardiovascular events and deaths, respectively.

“Modelling studies like this one provide an indicator of how specific dietary changes have the potential to alter the course of diet-related disease,” comments Shane McAuliffe, Science and Digital Communications Lead at the NNEdPro Global Centre for Nutrition and Health, which co-owns the journal, in a statement. “Given the established dose-response relationship between salt intake, systolic blood pressure and cardiovascular disease, reducing the intake of one of the highest global consumers would have a significant impact on population health—something that has already been achieved in other countries worldwide.”

This study, “Reducing daily salt intake in China by 1 g could prevent almost 9 million cardiovascular events by 2030: a modelling study,” was published in BMJ Nutrition, Prevention, and Health.