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Bruce Charles Neal, Yangfeng Wu, Xiangxian Feng, Ruijuan Zhang, Yuhong Zhang, Jingpu Shi, Jianxin Zhang, Maoyi Tian, Liping Huang, Zhifang Li and 22 more
BACKGROUND: Salt substitutes with reduced sodium levels and increased potassium levels have been shown to lower blood pressure, but their effects on cardiovascular and safety outcomes are uncertain. METHODS: We conducted an open-label, cluster-randomized trial involving persons from 600 villages in rural China. The participants had a history of stroke or were 60 years of age or older and had high blood pressure. The villages were randomly assigned in a 1:1 ratio to the intervention group, in which the participants used a salt substitute (75% sodium chloride and 25% potassium chloride by mass), or to the control group, in which the participants continued to use regular salt (100% sodium chloride). The primary outcome was stroke, the secondary outcomes were major adverse cardiovascular events and death from any cause, and the safety outcome was clinical hyperkalemia. RESULTS: A total of 20,995 persons were enrolled in the trial. The mean age of the participants was 65.4 years, and 49.5% were female, 72.6% had a history of stroke, and 88.4% a history of hypertension. The mean duration of follow-up was 4.74 years. The rate of stroke was lower with the salt substitute than with regular salt (29.14 events vs. 33.65 events per 1000 person-years; rate ratio, 0.86; 95% confidence interval [CI], 0.77 to 0.96; P = 0.006), as were the rates of major cardiovascular events (49.09 events vs. 56.29 events per 1000 person-years; rate ratio, 0.87; 95% CI, 0.80 to 0.94; P<0.001) and death (39.28 events vs. 44.61 events per 1000 person-years; rate ratio, 0.88; 95% CI, 0.82 to 0.95; P<0.001). The rate of serious adverse events attributed to hyperkalemia was not significantly higher with the salt substitute than with regular salt (3.35 events vs. 3.30 events per 1000 person-years; rate ratio, 1.04; 95% CI, 0.80 to 1.37; P = 0.76). CONCLUSIONS: Among persons who had a history of stroke or were 60 years of age or older and had high blood pressure, the rates of stroke, major cardiovascular events, and death from any cause were lower with the salt substitute than with regular salt. (Funded by the National Health and Medical Research Council of Australia; SSaSS ClinicalTrials.gov number, NCT02092090.).
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Neal, B. C., Wu, Y., Feng, X., Zhang, R., Zhang, Y., Shi, J., Zhang, J., Tian, M., Huang, L., Li, Z., Yu, Y., Zhao, Y., Zhou, B., Sun, J., Liu, Y., Yin, X., Hao, Z., Yu, J., Li, K., … Elliott, P. (2021). Effect of Salt Substitution on Cardiovascular Events and Death. New England Journal of Medicine, 385(12), 1067–1077. https://doi.org/10.1056/nejmoa2105675
Neal, Bruce Charles, et al. "Effect of Salt Substitution on Cardiovascular Events and Death." New England Journal of Medicine, vol. 385, no. 12, 2021, pp. 1067–1077, https://doi.org/10.1056/nejmoa2105675.
Neal, Bruce Charles, Yangfeng Wu, Xiangxian Feng, Ruijuan Zhang, Yuhong Zhang, Jingpu Shi, Jianxin Zhang, et al. "Effect of Salt Substitution on Cardiovascular Events and Death." New England Journal of Medicine 385, no. 12 (2021): 1067–1077. https://doi.org/10.1056/nejmoa2105675.
Neal B. C., Wu Y., Feng X. [и др.] Effect of Salt Substitution on Cardiovascular Events and Death // New England Journal of Medicine. — 2021. — Vol. 385, № 12. — P. 1067–1077. — URL: https://doi.org/10.1056/nejmoa2105675
@article{neal2021effect,
title = {{Effect of Salt Substitution on Cardiovascular Events and Death}},
author = {Bruce Charles Neal and Yangfeng Wu and Xiangxian Feng and Ruijuan Zhang and Yuhong Zhang and Jingpu Shi and Jianxin Zhang and Maoyi Tian and Liping Huang and Zhifang Li and Yan Yu and Yi Zhao and Bo Zhou and Jixin Sun and Yishu Liu and Xuejun Yin and Zhixin Hao and Jie Yu and Ka‐Chun Li and Xinyi Zhang and Peifen Duan and Faxuan Wang and Bing Ma and Weiwei Shi and Gian Luca Di Tanna and Sandrine Stepien and Sana Shan and Sallie‐Anne Pearson and Nicole Li and Lijing L. Yan and Darwin R. Labarthe and Paul Elliott},
journal = {New England Journal of Medicine},
year = {2021},
volume = {385},
number = {12},
pages = {1067--1077},
doi = {10.1056/nejmoa2105675},
url = {https://doi.org/10.1056/nejmoa2105675}
}TY - JOUR AU - Neal, Bruce Charles AU - Wu, Yangfeng AU - Feng, Xiangxian AU - Zhang, Ruijuan AU - Zhang, Yuhong AU - Shi, Jingpu AU - Zhang, Jianxin AU - Tian, Maoyi AU - Huang, Liping AU - Li, Zhifang AU - Yu, Yan AU - Zhao, Yi AU - Zhou, Bo AU - Sun, Jixin AU - Liu, Yishu AU - Yin, Xuejun AU - Hao, Zhixin AU - Yu, Jie AU - Li, Ka‐Chun AU - Zhang, Xinyi AU - Duan, Peifen AU - Wang, Faxuan AU - Ma, Bing AU - Shi, Weiwei AU - Tanna, Gian Luca Di AU - Stepien, Sandrine AU - Shan, Sana AU - Pearson, Sallie‐Anne AU - Li, Nicole AU - Yan, Lijing L. AU - Labarthe, Darwin R. AU - Elliott, Paul TI - Effect of Salt Substitution on Cardiovascular Events and Death JO - New England Journal of Medicine VL - 385 IS - 12 SP - 1067 EP - 1077 PY - 2021 DA - 2021/08/29 DO - 10.1056/nejmoa2105675 UR - https://doi.org/10.1056/nejmoa2105675 ER -
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