NEJM Study Finds Salt Substitute Linked to Reduced Risk of Stroke and Heart Attack

Maoyi TIAN PhD Program Head, Digital Health and Head, Injury & Trauma Senior Research Fellow The George Institute

Dr. Tian Interview with:
Maoyi TIAN PhD
Program Head, Digital Health and Head, Injury & Trauma
Senior Research Fellow
The George Institute What is the background for this study?

Response: There is clear evidence from the literature that sodium reduction or potassium supplementation can reduce blood pressure. Reduced blood pressure can also lead to a risk reduction for cardiovascular diseases.

Salt substitute is a reduced sodium added potassium product combined those effects. Previous research of salt substitute focus on the blood pressure outcome. There is no evidence if salt substitute can reduce the risk of cardiovascular diseases or pre-mature death. This study provided a definitive evidence for this unaddressed question. What are the main findings?

The main findings of the research were:

  • The salt substitute reduced the risk of stroke by 14%
  • The salt substitute reduced the risk of major adverse cardiovascular events by 13%
  • The salt substitute reduced the risk of pre-mature death by 12% What should readers take away from your report?

Response: Salt substitute effectively reduced the risk of stroke, heart attacks and pre-mature death, and there is no harm of using salt substitute. What recommendations do you have for future research as a result of this work?

Response: We recommend:

  • Salt manufacturers and retailers worldwide could switch to producing and marketing salt substitute at scale.
  • Food processing industry worldwide could reformulate products to lower sodium and higher potassium compositions.
  • Governments worldwide could design polices to promote salt substitute and discourage regular salt use.
  • Consumers worldwide could cook, season and preserve foods with salt substitute not regular salt. Is there anything else you would like to add?

Response: Despite the trial was conducted in China, there might be large benefits for other countries in Asia, Africa and Latin America in which the salt intake level is above the recommended level.


This study was presented as “SSaSS: Salt Substitute and Stroke Study into the effect of salt substitutes on cardiovascular events and death,“ at ESC Congress 2021 and simultaneously published as “Effect of Salt Substitution on Cardiovascular Events and Death,” in the New England Journal of Medicine.

Bruce Neal, Yangfeng Wu, Xiangxian Feng, Ruijuan Zhang, Yuhong Zhang, Jingpu Shi, Jianxin Zhang, Maoyi Tian, Liping Huang, Zhifang Li, Yan Yu, Yi Zhao, Bo Zhou, Jixin Sun, Yishu Liu, Xuejun Yin, Zhixin Hao, Jie Yu, Ka-Chun Li, Xinyi Zhang, Peifen Duan, Faxuan Wang, Bing Ma, Weiwei Shi, Gian Luca Di Tanna, Sandrine Stepien, Sana Shan, Sallie-Anne Pearson, Nicole Li, Lijing L. Yan, Darwin Labarthe, Paul Elliott. Effect of Salt Substitution on Cardiovascular Events and DeathNew England Journal of Medicine, 2021; DOI: 10.1056/NEJMoa2105675

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Last Updated on September 3, 2021 by Marie Benz MD FAAD