Article Impact Level: HIGH Data Quality: STRONG Summary of JAMA Cardiology. https://doi.org/10.1001/jamacardio.2024.5417 Dr. Xiong Ding et al.
Points
- The Salt Substitute and Stroke Study (SSaSS) investigated the impact of a low-sodium, high-potassium salt alternative on stroke recurrence and mortality among 15,249 participants from northern China who had a history of stroke.
- The use of the salt substitute resulted in a 14% decrease in recurrent strokes (RR 0.86, P = .005), with a notable 30% decrease in hemorrhagic strokes (P = .002).
- Those utilizing the salt substitute showed a 12% decrease in overall mortality (RR 0.88, P = .003) and a 21% reduction in deaths related to stroke (P = .01).
- The use of the salt substitute led to a modest yet significant decrease in systolic blood pressure, measuring −2.05 mm Hg (95% CI, −3.03 to −1.08 mm Hg).
- The intervention demonstrated safety, showing no significant rise in hyperkalemia risk (RR 1.01, P = .96), underscoring its promise as a cost-effective approach for global stroke prevention.
Summary
This research investigates the impact of a low-sodium, high-potassium salt alternative on the recurrence of stroke and mortality rates among individuals with a prior stroke history. The trial, part of the Salt Substitute and Stroke Study (SSaSS), included 15,249 participants who self-reported a history of stroke, drawn from 600 villages in northern China. Participants were randomly assigned to utilize either a salt substitute, consisting of 75% sodium chloride and 25% potassium chloride, or standard salt. The main outcome assessed was the incidence of recurrent stroke, with additional outcomes focusing on mortality rates.
During a median follow-up of 61.2 months, the implementation of the salt substitute resulted in a notable 14% decrease in the risk of recurrent stroke (rate ratio [RR], 0.86; 95% CI, 0.77-0.95; P = .005), with a more significant impact seen in hemorrhagic stroke (relative reduction of 30%; P = .002). The salt substitute led to a notable 12% decrease in mortality, with a death rate ratio of 0.88 (95% CI, 0.82-0.96; P = .003), and a 21% relative reduction in deaths associated with stroke (P = .01). The average difference in systolic blood pressure between the groups was −2.05 mm Hg (95% CI, −3.03 to −1.08 mm Hg), indicating a modest yet significant reduction in blood pressure due to the salt substitute.
The findings of this study suggest that the implementation of a salt substitute may notably decrease the risks associated with recurrent stroke and mortality in stroke patients, presenting a cost-effective and feasible therapeutic alternative. The intervention demonstrated safety, showing no significant differences in hyperkalemia incidence (RR, 1.01; 95% CI, 0.74-1.38; P = .96). The findings indicate the promising advantages of increasing the use of salt substitutes in the global management of stroke.
Link to the article: https://jamanetwork.com/journals/jamacardiology/article-abstract/2829790
References Ding, X., Zhang, X., Huang, L., Xiong, S., Li, Z., Zhao, Y., Zhou, B., Yin, X., Xu, B., Wu, Y., Neal, B., Tian, M., & Yan, L. L. (2025). Salt substitution and recurrent stroke and death: A randomized clinical trial. JAMA Cardiology. https://doi.org/10.1001/jamacardio.2024.5417
