Cost-Effectiveness of a Household Salt Substitution Intervention: Findings From 20 995 Participants of the Salt Substitute and Stroke Study

Chen

et al. 2023

Stroke

BACKGROUND: It is unclear whether sodium intake had similar effects on mortality of stroke subtypes. The purpose of this study is to compare the long-term trends in mortality of stroke subtypes attributable to high sodium intake in China during 1990 to 2019. METHODS: Data for China in the GBD (Global Burden of Disease) 2019 study were obtained mainly from the Chinese surveillance systems and the KaiLuan Study. The trends in stroke mortality due to high sodium intake (>5 g/d) were evaluated using join-point regression and age-period-cohort methods adjusting for age, period, and cohort. RESULTS: The age-standardized mortality rates of stroke attributable to high sodium intake showed downward trends during 1990 to 2019 in China, with an average annual percentage change of −0.6 (95% CI, −0.8 to −0.4) for ischemic stroke, −2.5 (95% CI, −2.8 to −2.2) for intracerebral hemorrhage, and −6.1 (95% CI, −6.6 to −5.7) for subarachnoid hemorrhage. The curves of local drifts, which reflected the average annual percentage change of stroke mortality due to high sodium intake across age groups, showed a slow upward trend with age for ischemic stroke, a slow downward trend for intracerebral hemorrhage, and a sharp downward trend for subarachnoid hemorrhage. The high sodium–related mortality increased dramatically with age for ischemic stroke and intracerebral hemorrhage, while it reached a peak at 50 to 70 years old for subarachnoid hemorrhage. The period and cohort rate ratios of stroke mortality due to high sodium intake decreased in the past 3 decades, with the greatest decline for subarachnoid hemorrhage and the weakest decrease for ischemic stroke. Notably, men had higher high sodium–related mortality and risk but slighter declines for all stroke subtypes than women. CONCLUSIONS: Our results provided powerful evidence that high sodium–related age-standardized mortality rates and risk of stroke in China decreased in the past 3 decades, with diverse changing patterns for different stroke subtypes, highlighting that salt reduction had distinct impact on stroke subtypes.

mentioning

confidence: 99%

Different Changing Patterns for Stroke Subtype Mortality Attributable to High Sodium Intake in China During 1990 to 2019

Chen

et al. 2023

Stroke

“…10 In these scenarios, the potential for subsidizing the price of potassium-enriched salt to that of regular salt may be a cost-effective option for enhancing delivery. 20 SSaSS participants in intervention villages were advised to replace all regular salt with potassium-enriched salt but also to use it more sparingly than they previously used salt. The data suggest that participants were strongly adherent to the advice to switch household use of regular salt for potassium-enriched salt, reflecting the ease with which the switch can be made.…”

Section: Discussionmentioning

confidence: 99%

The Proportion of Dietary Salt Replaced With Potassium-Enriched Salt in the SSaSS: Implications for Scale-Up

et al. 2023

Self Cite

BACKGROUND: The SSaSS (Salt Substitute and Stroke Study) recently reported definitive effects of a potassium-enriched salt on cardiovascular outcomes and death. Quantifying the amount of potassium-enriched salt used by trial participants is important for understanding the magnitude of the effect of potassium-enriched salt on risk reduction and how population-wide scale-up might be achieved. METHODS: Baseline and annual 24-hour urine samples were collected from subgroups of participants in SSaSS throughout the 5-year follow-up. The mean difference in 24-hour potassium excretion between the 2 groups was used to estimate the quantity of potassium-enriched salt consumed in the intervention group. The corresponding projected difference in sodium intake between groups was calculated and compared with the observed difference. RESULTS: The potassium-enriched salt group, compared to the regular salt group, had a mean increase in 24-hour urinary potassium excretion of 0.80 g/d (95% CI, 0.71–0.90), which equates to consumption of 8.8 g/d (95% CI, 7.8–9.9) of potassium-enriched salt. Based on 8.8 g/d potassium-enriched salt consumption, the projected difference in 24-hour urinary sodium excretion was −0.79 g/d. This compares to an observed difference of −0.35 g/d (95% CI, −0.55 to −0.15) and suggests that 72% of baseline regular salt intake was replaced by potassium-enriched salt. CONCLUSIONS: The smaller than anticipated between-group difference in sodium excretion likely results from the joint use of regular salt and potassium-enriched salt in the intervention group. Our findings suggest that even an incomplete replacement of regular salt with potassium-enriched salt can deliver significant health gains. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02092090.

“…It's di cult to reduce salt intake in these countries due to the di culty of changing dietary patterns. Evidence has shown salt substitutes lower blood pressure and major adverse cardiovascular events e ciently [20]. The main challenge in both countries now is how to make the necessary adaptations to ensure the strategy of salt substitutes effectively reduces salt intake, like overcoming the extra costs of salt substitutes, which are nearly double the price of standard salt.…”

Section: Discussionmentioning

confidence: 99%

Estimates of Cardiovascular Diseases Burden Attributable to High Sodium Intake from 1990 to 2019: A Systematic Analysis of Data from the Global Burden of Disease Study

Jin

et al. 2022

Preprint

Background Sodium intake shows a positive correlation with blood pressure, resulting in an increased risk for cardiovascular diseases (CVD). Salt reduction is a key step toward the WHO's goal of 25% reduction in mortality from noncommunicable diseases (NCDs) by 2025. This study aims to assess the current condition and temporal changes of the global CVD burden due to high sodium intake. Methods We extracted data from the Global Burden of Disease (GBD) study 2019. The numbers and age-standardized rates of mortality and disability-adjusted life-years (DALYs), stratified by location, sex, and socio-demographic Index (SDI), were used to assess the high sodium intake attributable CVD burden from 1990 to 2019. Stepwise multiple linear regression analysis was performed to evaluate the relationship between the DALYs rates and related factors. Results Globally, in 2019, the deaths and DALYs of high sodium-related CVD were 1.72 million and 40.54 million, respectively, increasing by 41.08% and 33.06% from 1990. Meanwhile, the corresponding mortality and DALYs rates dropped by 35.1% and 35.2% respectively. The high-middle and middle SDI quintiles bore almost two-thirds of the CVD burden caused by high sodium, while the high SDI quintile had the lowest DALYs rate with the greatest annual decline. Males and the elderly had a higher risk suffering CVD from high dietary sodium. And the leading causes of high sodium intake attributable CVD burden were ischemic heart disease, stroke, and hypertensive heart disease. Universal health coverage (UHC) was significantly associated with the DALYs rates after adjustment. Conclusions From 1990 to 2019, the global CVD burden attributable to high sodium intake has declined with spatiotemporal and sexual heterogeneity. However, it remains a major public health challenge because of the increasing absolute numbers in DALYs and mortality. Improving universal health coverage may serve as an effective strategy to reduce the high sodium-related CVD burden.