How to have a heart-healthy Valentine’s Day: Study shows salt substitutes reduce risk of CVDs in aging populations

14 Feb 2024 --- On the occasion of Valentine’s Day, we look at the results of a recent study showing that the use of salt substitutes can increase heart health by reducing the risk of incidence of cardiovascular disease (CVD) and hypertension in older adults.

A team of China-based researchers are highlighting findings, as hypertension — commonly referred to as high blood pressure — is a leading risk factor for CVDs, heart health and mortality worldwide, making effective management crucial for public health.

The study, published in the Journal of the American College of Cardiology, looks at the effects of the health strategy known as the DECIDE (diet, exercise and cardiovascular health) Salt diet. The researchers focus on evaluating the impact of sodium reduction strategies on blood pressure among elderly adults residing in care facilities in China.

With hypertension affecting over 1.4 billion adults globally and contributing to millions of deaths each year, the team stresses that finding effective interventions is of paramount importance.

“Adults frequently fall into the trap of consuming excess salt through easily accessible and budget-friendly processed foods,” says Dr. Yangfeng Wu, lead author of the study and the executive director of the Peking University Clinical Research Institute in Beijing, China. “It’s crucial to recognize the impact of our dietary choices on heart health and increase the public’s awareness of lower-sodium options.”

“Our results showcase an exciting breakthrough in maintaining blood pressure that offers a way for people to safeguard their health and minimize the potential for cardiovascular risks, all while being able to enjoy the perks of adding delicious flavor to their favorite meals.”

Significant heart-health results
Researchers divided 611 participants aged 55 and older from 48 care facilities into two groups. One group replaced regular salt with a salt substitute, while the other continued using regular salt. Participants were monitored for incident hypertension, initiation of antihypertensive medications and for major cardiovascular adverse events over a two-year period. According to the team, the results were striking.

Participants using the salt substitute demonstrated a 40% lower incidence and likelihood of developing hypertension compared to those using regular salt. These findings illustrate the potential of salt substitutes as a viable strategy for controlling and maintaining healthy blood pressure levels in older adults without increasing the risk of low blood pressure episodes, or hypotension, which can be particularly concerning within this demographic.

“Considering its blood pressure lowering effect, proven in previous studies, the salt substitute shows beneficial to all people, either hypertensive or normotensive, and thus a desirable population strategy for prevention and control of hypertension and cardiovascular disease,” Wu underscores.The results show that the use of salt substitutes dramatically decreased the risk of developing CVDs like hypertension.

More research needed
While the study presents promising findings, it is not without limitations. The researchers stress that the analysis was conducted post-hoc and study outcomes were not pre-specified. Additionally, there was a loss of follow-up visits in some patients.

However, multiple sensitivity analyses support the robustness of the results, indicating the potential efficacy of salt substitutes in hypertension management.

Dr. Rik Olde Engberink, a researcher and clinical pharmacologist at Amsterdam University Medical Center, acknowledges the study’s significance but also emphasizes the need for further investigation and efforts to address remaining questions and challenges.

“In the DECIDE-Salt trial, the salt substitute was given to the kitchen staff and the facilities were not allowed to provide externally sourced food more than once per week,” Engberink stresses. “This approach potentially has a greater impact on blood pressure outcomes, and for this reason, salt substitutes should be adopted early in the food chain by the food industry so that the sodium-potassium ratio of processed foods will improve.”

Edited by William Bradford Nichols