The Spring Festival is approaching, the taste of the New Year is getting stronger, and what I look forward to most is the taste of home, dumplings, eight treasure rice, salted duck, slaughtered pig vegetables, braised shrimp in oil, Buddha jumping off the wall, sausages, smoked fish, sauce elbows... The little taste is the warmth of home.
Chinese cuisine pays attention to color and flavor, but behind the thick oil red sauce, there is a hidden health risk - too much salt intake will lead to increased blood pressure, increasing the risk of cardiovascular disease and stroke.
According to statistics, the average salt intake of Chinese reached 10.5 g/ day, far exceeding the WHO's recommended 5 g / day, ranking among the top in the world. At the same time, salt intake in various regions also shows the characteristics of "rural areas are higher than cities, and the north is higher than south".
Even if you know that eating less salt can reduce blood pressure, but because people's taste is difficult to change in the short term, accustomed to heavy bites and then eat light, they feel tasteless, salt reduction measures are difficult to adhere to and promote for a long time, so low sodium and high potassium alternative salt came into being.
The alternative salts, which are made up of 75% sodium chloride and 25% potassium chloride, taste similar to regular salts, but with a significantly reduced sodium content.
Meta-analyses have shown that consumption of substitute salts can reduce systolic blood pressure by 5.58 mm Hg (95% CI -7.08 to -4.09) and diastolic blood pressure by 2.88 (95% CI -3.93 to -1.83).
However, whether the consumption of substitute salt can reduce the risk of stroke, cardiovascular disease and death in the population is still lacking in strong randomized controlled trials to prove, on the other hand, whether the consumption of potassium salt will cause hyperkalemia and its adverse consequences, including arrhythmias and sudden cardiac death, also needs to be explored.
Recently, a team led by Peking University and the George Institute for Global Health published the results of the Chinese Group of "Salt Substitute and Stroke Study" (SSaSS) completed in 2021 at NEJM, which proved that the consumption of alternative salts in patients with hypertension can effectively reduce the incidence of stroke and cardiovascular disease and all-cause mortality, and the safety is good.
Experimental design
"Study on the Relationship between Alternative Salt and Stroke" is a five-year large-scale, cluster-randomized controlled trial (Cluster-RCT) jointly conducted by Peking University and the George Institute for Global Health, together with well-known local medical schools or government agencies in the five northern provinces of the mainland (Liaoning, Hebei, Shanxi, Ningxia, shaanxi).
It is one of the largest health research projects in China to date, involving 20,995 villagers from 600 villages, who were selected for patients with a history of stroke or ≥60 years of age, poor blood pressure control (systolic blood pressure ≥ 140 mmHg or systolic blood pressure ≥160 mmHg for those who are taking antihypertensive drugs). Exclusion criteria include potassium-sparing diuretics, potassium supplements, severe renal insufficiency, etc.
The entrants were randomly divided into intervention groups (edible substitute salt) and control groups (edible common salt) on a 1:1 basis by village.
The main results of the study were stroke, and the secondary outcomes were major cardiovascular events and all-cause deaths, including non-fatal stroke, non-fatal acute coronary syndrome, cardiovascular death, and safety outcomes were clinical hyperkalemia and sudden death.
Research results
The final participants had an average age of 65.4 years, a similar proportion of men and women (49.5% of women), 72.6% had had a stroke, 88.4% had hypertension, the average blood pressure was 154.0/89.2mmHg, 79.3% took at least one antihypertensive drug, the average 24-hour urinary sodium excretion was 187 mmol, the urinary potassium excretion was 36 mmol, and the average follow-up period was 4.74 years.
At the end of the follow-up, participants in the intervention group decreased their mean urine sodium excretion by 15.2 mmol (15.2 mmol) compared with the control group at 24 hours. 95% CI, 23.7 to 6.7), urine potassium excretion increased by 20.6 mmol (20.6 mmol; 95% CI, 18.3 to 23.0), a 24-hour decrease in urinary sodium was significantly associated with a decrease in blood pressure, and in this study, participants in the intervention group decreased mean systolic blood pressure by 3.34 mmHg (-3.34, 95% CI, 4.51 to 2.18).
Note: Changes in systolic and diastolic blood pressure in the intervention and control groups during follow-up
In terms of primary and secondary outcomes, participants in the intervention group were associated with a 14% reduction in stroke incidence compared with the control group (29.14 times/1000 person-years vs. 33.65 times/1000 person-years; RR 0.86; 95% [CI] 0.77-0.96; P=0.006), the incidence of major cardiovascular events decreased by 13% (49.1 times/1000 person-years vs. 56.3 times/1000 person-years; RR 0.87; 95% CI, 0.80 - 0.94; P
In terms of safety outcomes, the incidence of hyperkalemia did not differ significantly between intervention and control groups (3.35 sessions/1000 person-years vs. 3.30 beats/1000 person-years; RR, 1.04; 95% CI, 0.80-1.37; P = 0.76)。
Figure Note: Primary, secondary, and safety outcomes of the study
In summary, this study demonstrates that salt replacement reduces the risk of stroke, important cardiovascular events, and all-cause death in patients with hypertension who have a history of previous stroke or who are over 60 years of age with poorly controlled blood pressure, and are safe.
However, for patients with hypertension and renal insufficiency or who are using potassium supplements, it is best to consult a doctor before consuming alternative salts and use them with caution.
A small salt brings health to the elders in the family, people in a foreign land, the stomach is in the hometown, and the taste of home will never change.
bibliography:
Neal B, Wu Y, Feng X, et al. Effect of Salt Substitution on Cardiovascular Events and Death. N Engl J Med. 2021;385(12):1067-1077. doi:10.1056/NEJMoa2105675
Source: Metz Medical
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