Salt or Sodium Chloride has been shown to negatively affect cardiovascular health. The Sodium in the salt has been deemed as the main culprit for the bad effects. Although, the effect is varied, as such it might not have much influence on individuals with normal blood pressure; in those with high blood pressure, intake of sodium chloride or salt has been associated with a further increase of blood pressure by 4-10 mm of Hg. This high blood pressure often translates into devastating cardiovascular health issues like stroke and myocardial infarctions if stays untreated for long. But, can a substitute for salt or sodium chloride turn the table?
It has been found that increased sodium consumption along with low potassium consumption is associated with elevated blood pressure and hence risks of heart attacks, stroke, and premature death. To address this question a study called "Salt Substitute and Stroke Study (SSaSS)" was conducted in China to find out if Salt Substitute can decrease blood pressure and its complications, the results of which were recently published in the NEJM journal. A similar study was conducted previously in India but was of doubtful credibility due to the short duration of the study and a low number of participants. However, the results of SSaSS had diluted and negated such doubts.
In SSaSS, the study involved 20995 individuals from 600 villages in rural China who are above 60 years of age, had high blood pressure, or had a prior history of stroke. They were randomly divided into two groups. One group consumed regular salt (which contained 100% Sodium Chloride by Mass) and the other one consumed salt substitute (which was made up of 75% Sodium Chloride and 25% Potassium Chloride by mass). The individuals were followed up for a mean duration of 5 years and the following has been concluded:
- The rate of stroke was lower in the salt substitute group compared to the regular group
- The rate of other major cardiovascular events (like a heart attack or myocardial infarction) was lower in the salt substitute group than the group that consumed regular salt.
- Death due to any cause in the salt substitute group was lower compared to the normal salt group.
The above results thus prove that salt substitutes can positively have major public health implications if adopted widely. Apart from the above results, the blood pressure-lowering effect of low sodium and high potassium diet has already been established in other studies. However, there is a matter of concern. As the salt substitute contains potassium, there might be chances of hyperkalemia (or increased potassium level in blood) and its ill effects. Also, this substitute may not be suitable for Chronic Renal Failure patients who have more propensity to develop hyperkalemia. As in this study, serial measurement of potassium level was not done, the question thus remains, whether individuals consuming salt substitute can develop hyperkalemia and succumb to its effects? A further study that involves measurement of potassium levels is needed to settle this concern.
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