Salt substitute is a cost-effective intervention for stroke prevention and improving quality of life
A salt substitute with less sodium was a cost-effective intervention for preventing strokes and improving quality of life, according to an analysis published in the journal Traffic.
A previous study found the surrogate to be effective in preventing strokes and heart attacks, so these findings reinforce the utility of this intervention, according to Darwin Labarthe, MD, PhD, MPH, professor of preventive medicine at the Division of Epidemiology and study co-author.
Because hypertension is so widespread and the costs of its morbidity and mortality outcomes are so high, economic intervention has enormous implications for national health expenditures.
Darwin Labarthe, MD, PhD, MPH, Professor of Preventive Medicine, Division of Epidemiology
Reducing salt intake lowers blood pressure, which is a major contributor to disease and death from heart attack or stroke. As many as one billion people worldwide suffer from uncontrolled high blood pressure, Labarthe said, and that number is only growing.
Salt substitutes — in this study, a salt made from a mixture of sodium chloride and potassium chloride — have been shown to reduce blood pressure. A previous study of more than 20,000 people in 600 villages in northwest China found that rates of stroke, major cardiovascular events and death were all lower among participants using salt substitutes. compared to participants using regular salt.
In the current study, the researchers performed a cost-effectiveness analysis of the previous study, measuring health outcomes in quality-adjusted life years (QALYs). Health care costs were identified from participants’ health insurance records and estimated using figures from previous studies.
Over the nearly five-year follow-up period, replacing regular salt with a salt substitute reduced the risk of stroke by 14%. The salt substitute group had an average of 0.054 more QALYs per person. Average annual costs were lower in the salt substitute group: 1,538 Chinese yuan (about $241) for the intervention group and 1,649 Chinese yuan (about $259) for the control group.
This means that the intervention was dominant – a term used in cost-effectiveness for better outcomes at lower cost – for stroke prevention. Sensitivity analyzes performed by the authors showed that these conclusions held even when the price of salt substitutes increased, only losing their profitability when the price increased to the highest market prices identified in China.
“This presents powerful evidence for ‘hard results’ long clamored for by sodium reduction skeptics who have failed to see the value of interventions that would lower blood pressure itself, despite the fact that these are a huge health and public health problem,” Labarthe said.
This intervention holds promise, especially in countries like China where large segments of the population eat home-prepared foods rather than commercially processed foods, unlike in Western countries like the United States, according to Labarthe.
“Governments and health systems would benefit and serve their beneficiaries by implementing salt substitution as an important way to reduce blood pressure and stroke risk,” Labarthe said. “This will have an impact to the extent that individual behavior determines the amount of salt consumed; it will be less so where processed or manufactured foods predominate, until the food industry adopts the use of salt substitutes in his products.”
Li, KC., et al. (2022) Cost-effectiveness of a household salt substitution intervention: results from 20,995 participants in the Salt Substitute and Stroke (SSaSS) Study. Traffic. doi.org/10.1161/CIRCULATIONAHA.122.059573.