Source:,

Bibbins-Domingo
K
,
Chertow
GM
,
Coxson
PG
, et al
.
Projected effect of dietary salt reductions on future cardiovascular disease
.
N Engl J Med
.
2010
;
362
(
7
):
590
599
; doi:
https://doi.org/10.1056/NEJMoa0907355

Investigators from the University of California, Stanford, and Columbia Universities used the Coronary Heart Disease (CHD) Policy Model to quantify the benefits of achievable, population-wide reductions in dietary salt of up to 3 g per day (1200 mg of sodium per day). They estimated the rates and costs of cardiovascular disease in subgroups defined by age, sex, and race; they compared the effects of salt reduction with those of other interventions intended to reduce the risk of cardiovascular disease; and they determined the cost-effectiveness of salt reduction as compared with the treatment of hypertension with medication.

Reducing dietary salt by 3 g per day could reduce the annual number of new cases of CHD in the US by 60,000 to 120,000, stroke by 32,000 to 66,000, and myocardial infarction by 54,000 to 99,000. This change could reduce the annual number of deaths from any cause by 44,000 to 92,000. All segments of the population would benefit, with African Americans benefiting proportionately more, women benefiting particularly from stroke reduction, older adults from reductions in CHD events, and younger adults from lower mortality rates. Cardiovascular benefits of reduced salt intake are on par with the benefits of population-wide reductions in tobacco use, obesity, and cholesterol levels. Salt reduction would be more cost-effective than using medications to lower blood pressure. A regulatory intervention designed to achieve a reduction in salt intake of 3 g per day could save $10 billion to $24 billion in health care costs annually.

The authors conclude that reductions in dietary salt could sub-stantially reduce cardiovascular events and costs. They argue that salt reduction should be a public health priority.

The FDA currently designates salt as a food additive that is “generally regarded as safe.” However, mounting evidence suggests that the current quantity of salt in a typical American diet can lead to significant health problems.1,2 The health risks of current levels of salt intake are similar to those of tobacco use, obesity, and hypercholesterolemia. The potential health benefits of changing salt intake are staggering, as is the economic impact projected from even modest adjustments in dietary consumption.

Approximately 75% of the salt in American diets comes from processed foods. As a consequence, individuals have limited ability to reduce dietary sodium unless they eliminate consumption of processed foods. For individual families this is a desirable but often elusive goal. Therefore, the authors appropriately focus on the role of public health policy to reduce salt in food products consumed regularly by all Americans.

While some food manufacturers are actively reducing the salt in their products, others are doing the opposite. In the UK a population-wide reduction in dietary salt of 10% was achieved over four years without a reduction in sales of the...

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