Can Salt Substitution Save At-Risk Persons from Stroke?

This editorial reviews the Salt Substitute and Stroke Study (SSaSS), a cluster-randomized trial involving over 20,000 adults in rural China most with a history of stroke or hypertension. Participants in intervention villages received a salt substitute (75% sodium chloride, 25% potassium chloride), while controls used regular salt. Over time, stroke rates, cardiovascular events, and mortality were significantly lower in the salt-substitute group, without an observed increase in clinical hyperkalemia. The study underscores that salt substitutes could yield major public health benefits, especially where processed food intake is low and household cooking predominates. Nonetheless, limitations include lack of potassium monitoring, absence of household-level data, and evaluation of only one salt substitute composition. Broader generalizability remains uncertain.

This editorial reviews the Salt Substitute and Stroke Study (SSaSS), a cluster-randomized trial involving over 20,000 adults in rural China most with a history of stroke or hypertension. Participants in intervention villages received a salt substitute (75% sodium chloride, 25% potassium chloride), while controls used regular salt. Over time, stroke rates, cardiovascular events, and mortality were significantly lower in the salt-substitute group, without an observed increase in clinical hyperkalemia. The study underscores that salt substitutes could yield major public health benefits, especially where processed food intake is low and household cooking predominates. Nonetheless, limitations include lack of potassium monitoring, absence of household-level data, and evaluation of only one salt substitute composition. Broader generalizability remains uncertain.