Projected Impact of a Sodium Consumption Reduction Initiative in Argentina: An Analysis from the CVD Policy Model – Argentina

Abstract

BackgroundCardiovascular disease (CVD) is the leading cause of death in adults in Argentina. Sodium reduction policies targeting processed foods were implemented in 2011 in Argentina, but the impact has not been evaluated. The aims of this study are to use Argentina-specific data on sodium excretion and project the impact of Argentina’s sodium reduction policies under two scenarios - the 2-year intervention currently being undertaken or a more persistent 10 year sodium reduction strategy.MethodsWe used Argentina-specific data on sodium excretion by sex and projected the impact of the current strategy on sodium consumption and blood pressure decrease. We assessed the projected impact of sodium reduction policies on CVD using the Cardiovascular Disease (CVD) Policy Model, adapted to Argentina, modeling two alternative policy scenarios over the next decade.ResultsOur study finds that the initiative to reduce sodium consumption currently in place in Argentina will have substantial impact on CVD over the next 10 years. Under the current proposed policy of 2-year sodium reduction, the mean sodium consumption is projected to decrease by 319–387 mg/day. This decrease is expected to translate into an absolute reduction of systolic blood pressure from 0.93 mmHg to 1.81 mmHg. This would avert about 19,000 all-cause mortality, 13,000 total myocardial infarctions, and 10,000 total strokes over the next decade. A more persistent sodium reduction strategy would yield even greater CVD benefits.ConclusionThe impact of the Argentinean initiative would be effective in substantially reducing mortality and morbidity from CVD. This paper provides evidence-based support to continue implementing strategies to reduce sodium consumption at a population level.

Analysis of a voluntary initiative to reduce sodium in processed and ultra-processed food products in Argentina: the views of public and private sector representatives

“…First, the interviews showed that companies selected the products for inclusion in the program and established the reduction targets without a clear statement from the public health authorities on how much reduction was needed in each food category in order to produce the estimated benefits 43 .…”

Comparing Strategies for Lipid Lowering in Argentina: An Analysis from the CVD Policy Model–Argentina

“…Argentina has used evidence-based strategies in the past to inform national policy. For example, other modeling studies using the CVD Policy Model-Argentina on tobacco control 13 and salt consumption 14,15 suggested policies that were subsequently implemented. Other Latin American countries including Chile and Brazil also have national CVD prevention guidelines 56, 57 that focus on lipids; modeling exercises like this one, which are commonly used, for example, in countries of the United Kingdom, 58 can be instrumental in the development of evidence-based guidelines that incorporate resource impact.…”

“…Previously published papers have used the CVD Policy Model to accurately predict outcomes in the Argentine population, which increases our confidence in the model's accuracy. [13][14][15]62 Despite these limitations, we believe that this study contributes to the ongoing debate in Argentina by projecting the health benefits of three possible strategies for lipid control in cardiovascular disease prevention. To our knowledge, this study is the first to analyze the impact of current national guidelines for cardiovascular disease prevention in Latin America or to model alternatives to current guidelines based on lowering the primary prevention threshold or treating highrisk patients with high-potency statins, as is currently recommended in many other international guidelines.…”

“…11,12 The model was adapted for the population of Argentina using Argentina-specific demographic and epidemiologic inputs wherever possible, and calibrating to reproduce CVD events and deaths observed in the Argentine population. The CVD Policy Model-Argentina has been used previously to evaluate population-wide policies aimed at tobacco control 13 and dietary salt restriction 14,15 (see Supplementary Online Appendix 1 for details).…”

“…The demographic-epidemiological sub-model predicts coronary heart disease (CHD) and stroke incidence and non-CVD mortality in the population without CVD stratified by age, sex, and six modifiable risk factors: smoking status (active smoker or secondhand smokeexposed or no exposure), systolic blood pressure (SBP), highdensity lipoprotein cholesterol (HDL-C), LDL-C, use of medication to lower cholesterol (statins, other drugs, or no use), and presence or absence of diabetes mellitus. The incidence of CHD, stroke, and non-CVD death is determined by beta coefficients estimated from Framingham Heart Study Original Cohort (exams [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] and Offspring Cohort (exams 1-7) data using the counting process extension of the Cox proportional hazards model, which allows for time-dependent covariates. [16][17][18][19][20] For the fraction of the population developing CVD, the bridge sub-model characterizes the initial CVD event and related events over the next 30 days.…”