A recent clinical trial in northern China has unveiled promising findings regarding the use of salt substitutes in reducing the risk of recurrent stroke and stroke-related mortality. The Salt Substitute and Stroke Study (SSaSS) conducted a comprehensive analysis across 600 villages in five provinces, following the World Health Organization's (WHO) guidelines on sodium reduction. The study demonstrated that replacing regular salt with lower-sodium substitutes could significantly lower the incidence of recurrent stroke by 14% and reduce stroke-related deaths by 12%.
The SSaSS, a cluster-randomized clinical trial, spanned an average follow-up period of 4.74 years. Researchers analyzed data from a subset of participants, providing substantial evidence supporting the positive health impact of substituting regular salt with potassium-containing alternatives. George, an associate professor of neurology and neurological sciences at Stanford, shared his insights on the study’s importance, although he was not directly involved.
“To some degree, it has been shown prior to this study the impact salt has on blood pressure, which is a main stroke risk factor, so I wouldn’t say totally surprising.” – Paul George, MD, PhD
The trial's findings are in alignment with WHO's recommendation to replace regular table salt with lower-sodium salt substitutes containing potassium. Potassium plays a vital role in regulating the body's sodium-water balance by encouraging water retention within cells. This balance is critical for managing blood pressure, a key factor in stroke prevention.
“In this context, using less regular table salt is an important part of an overall sodium reduction strategy. If choosing to use table salt, WHO suggests replacing regular table salt with lower-sodium salt substitutes that contain potassium.” – WHO guidelines
May Kim-Tenser, MD, emphasized the significance of managing blood pressure in stroke prevention.
“High blood pressure, out of all the risk factors for stroke, is the number one modifiable risk factor for stroke.” – May Kim-Tenser, MD
Christopher Yi, a board-certified vascular surgeon, advocates for the use of salt substitutes, highlighting their cost-effectiveness and health benefits.
“Given the clear benefits and low cost, salt substitutes should be widely promoted — especially in populations with high stroke prevalence. However, patients with kidney disease should consult their doctors before using potassium-containing substitutes.” – Christopher Yi, MD
Jason Tarpley, a board-certified vascular neurologist, shed light on the physiological mechanism underlying the efficacy of salt substitutes.
“Water follows salt, and you have more actual water volume in your body when you’re ingesting more sodium.”
“More volume of water in the same amount of blood vessels means higher pressure. So that’s really the link between high sodium intake and blood pressure. It’s related to the fact that sodium draws in water. Potassium doesn’t seem to have the same effect. And that’s the basis of the salt substitutes.” – Jason Tarpley, MD, PhD
The study authors reiterated the profound implications of their findings.
“This finding shows that salt substitution is a cost-effective option for survivors of stroke by providing considerable health benefits through a simple dietary intervention strategy. It provides direct evidence to shape public health strategies worldwide, especially among populations who rely on home cooking with salt.” – Study authors
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