Effect of Salt Substitution on Cardiovascular Events and Death

This large cluster-randomized trial (SSaSS) enrolled 20,995 adults from 600 rural Chinese villages primarily individuals aged ≥60 years with hypertension or prior stroke to assess health outcomes from switching regular salt (100% sodium chloride) to a salt substitute (75% sodium chloride, 25% potassium chloride). Over a mean follow-up of 4.74 years, stroke incidence was significantly reduced in the salt-substitute group (rate ratio, 0.86; P=0.006), as were major cardiovascular events (rate ratio, 0.87; P<0.001) and mortality (rate ratio, 0.88; P<0.001). The risk of serious hyperkalemia did not differ significantly between groups (rate ratio, 1.04; P=0.76). Reductions in urinary sodium and blood pressure confirmed adherence. The findings support salt substitution as a low-cost, effective public health strategy for reducing cardiovascular risk, especially in low-resource settings.

This large cluster-randomized trial (SSaSS) enrolled 20,995 adults from 600 rural Chinese villages primarily individuals aged ≥60 years with hypertension or prior stroke to assess health outcomes from switching regular salt (100% sodium chloride) to a salt substitute (75% sodium chloride, 25% potassium chloride). Over a mean follow-up of 4.74 years, stroke incidence was significantly reduced in the salt-substitute group (rate ratio, 0.86; P=0.006), as were major cardiovascular events (rate ratio, 0.87; P<0.001) and mortality (rate ratio, 0.88; P<0.001). The risk of serious hyperkalemia did not differ significantly between groups (rate ratio, 1.04; P=0.76). Reductions in urinary sodium and blood pressure confirmed adherence. The findings support salt substitution as a low-cost, effective public health strategy for reducing cardiovascular risk, especially in low-resource settings.