• Posted August 10, 2022

A Switch to Salt Substitute Could Slash Your Heart Risks

Swapping salt out for the salt substitute potassium chloride lowers blood pressure, and thereby the risk of heart attack, stroke and cardiovascular disease, a new analysis finds.

"It's in processed and prepared foods where most people in developed countries get their salt," explained senior researcher Dr. Bruce Neal, executive director of the George Institute for Global Health in Newtown, Australia.

"What you have to do is go to the people who provide ingredients, and what you do is you say to the suppliers, instead of selling regular salt, use potassium-rich salt, and that way the population will get the benefit," he added.

By substituting potassium chloride in varying amounts for sodium chloride (regular table salt), you can dramatically reduce people's blood pressure and their risk for stroke, heart attack and other consequences of high blood pressure, Neal said.

The latest findings build on a large study the same researchers conducted in rural China that demonstrated an impressive reduction in heart attacks and strokes by using a potassium-enriched salt substitute.

But the team wondered if the same results would be seen in other countries and populations, so Neal and his colleagues combined the results of 21 published studies involving nearly 30,000 people. The studies were carried out in Europe, the Western Pacific region, the Americas and Southeast Asia.

The amount of sodium chloride in the salt substitutes varied from 33% to 75% and the amount of potassium chloride ranged from 25% to 65%. Analysis showed that salt substitutes lowered blood pressure in all the participants.

The reduction in systolic blood pressure was nearly 5 mm Hg and the reduction in diastolic blood pressure was almost 2 mm Hg.

These reductions in blood pressure were consistent, regardless of geography, age, gender, history of high blood pressure, weight and baseline blood pressure, the researchers found.

Each 10% reduction in sodium chloride in the salt substitute was linked with a 1.5 mm Hg reduction in systolic blood pressure and about a 1 mm Hg fall in diastolic blood pressure.

A further analysis of five trials involving more than 24,000 participants also found that salt substitutes lowered the risks of early death by 11%, cardiovascular disease by 13% and the risks of heart attack or stroke by 11%.

Neal's team also found that for most people, using potassium was safe.

However, salt substitutes can be dangerous when you have conditions such as kidney disease, heart disease, high blood pressure, liver disease or diabetes, according to the Cleveland Clinic.

Those chronic conditions can sometimes raise potassium levels in your blood, and the potassium in salt substitutes can tip that balance dangerously.

And using salt substitutes while on certain medications -- notably ACE inhibitors and potassium-sparing diuretics -- can push your blood potassium levels too high.

The report was published online Aug. 9 in the journal Heart.

One U.S. cardiologist noted the positives in this study.

"The fact that dietary change in the form of a salt substitute can reduce cardiovascular events and death is truly a thought-provoking finding," said Dr. Guy Mintz, director of cardiovascular health and lipidology at Sandra Atlas Bass Heart Hospital in Manhasset, N.Y.

"The effectiveness of salt substitutes across various populations, as an adjunct to medical therapy and lifestyle changes including exercise, is a welcome finding," he said. "Salt substitution to reduce blood pressure and cardiovascular events is something that should interest all clinicians."

More information

For more on salt and blood pressure, see the U.S. Centers for Disease Control and Prevention.

SOURCES: Bruce Neal, MB, ChB, PhD, executive director, George Institute for Global Health, Newtown, Australia; Guy Mintz, MD, director, cardiovascular health and lipidology, Sandra Atlas Bass Heart Hospital, Manhasset, N.Y.; Heart, Aug. 9, 2022, online