Tag: cardiovascular disease

Categories : Cardiovascular Disease Environmental EffectsTags :

Extreme Heat Threatens Cardiovascular Health

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Photo from Olivier Collett on Unsplash
Photo from Olivier Collett on Unsplash


With South Africa’s summer being expected to be both wetter and hotter this year, there is a greater risk of adverse cardiovascular incidents, especially for adults with pre-existing cardiovascular diseases. Experts writing in the Canadian Journal of Cardiology discuss how extreme heat affects cardiovascular health, why health professionals should care and what recommendations they can make to minimise consequences.

Extreme heat events are predicted to become longer, more common and more severe. Some 70 000 heat-related deaths occurred during the 2003 European heatwave. Risk factors for heat-related hospitalisation include age, chronic illnesses, social isolation, some medications, and lack of access to air conditioning. Among chronic illnesses, cardiovascular diseases are often identified as a risk factor for heat-related hospitalisation and death.

The Intergovernmental Panel on Climate Change (IPCC) recently reported that global temperatures are rising at a greater rate than previously projected, and that the number of extreme heat days will significantly increase across most land regions,” said senior author Daniel Gagnon, PhD, University of Montreal. “Although we don’t yet fully understand the reasons, people with cardiovascular disease are at greater risk of hospitalisations and death during extreme heat events.”

The researchers reviewed studies and noted a consistent association between extreme heat and increased risk of adverse cardiovascular outcomes. An examination of reviews and meta-analyses on the effect of extreme heat on adverse cardiovascular outcomes showed that heatwaves significantly increase mortality risk from ischaemic heart disease, stroke, and heart failure.

“Although the effects of extreme heat on adverse cardiovascular events have been explained in the context of heatstroke, many events occur without heatstroke, and the mechanisms of these events in the absence of heatstroke remain unclear,” observed Dr Gagnon. “It is likely that heat exposure increases myocardial oxygen needs.”

One possibility is that heat exposure puts excessive strain on the heart for individuals with heart disease and that heat exposure increases the risk of blood clots forming within cardiac blood vessels.

The authors propose that preventive strategies should aim to reduce the extent of hyperthermia and dehydration. In Canada, heat-health warnings systems act as a first line of defence by raising awareness of upcoming heat events and recommending strategies to minimise possible heat complications. For example, heat warnings are issued 18-24 hours before a heat event in Ontario and Québec, when ambient temperature will remain above 30°C for a minimum of two days. Public advisories include identifying the signs of heat stress, ensuring people drink adequate amounts of cold fluid or seeking an air-conditioned environment – though for many people, this is not an option.

Recent research supports electric fan use, skin wetting and immersing the feet in tap water as simple methods to stay cool during extreme heat events. “Air conditioning is the most effective strategy that can be recommended since it effectively removes the heat stimulus and minimises the risk of adverse cardiovascular outcomes,” commented Dr Gagnon. “However, less than one third of global households own air conditioning.”

More studies are needed to explain why extreme heat is linked to increased risk of adverse cardiovascular outcomes; the effect of cardiovascular medication on the human body’s physiological responses during heat exposure; the best cooling strategies in heat waves for individuals with CVD; and safe environmental limits for outdoor exercise in individuals with heart disease.

“Cardiovascular health professionals need to be aware of the negative consequences of extreme heat on cardiovascular health. A better awareness and understanding of the cardiovascular consequences of extreme heat, and of the measures to take to prevent and mitigate adverse events, will help us all assess the risk and optimize the care of patients exposed to an increasingly warm climate,” concluded Dr Gagnon.

Source: Elsevier

Categories : Cardiovascular DiseaseTags :

Firefighters’ Blood Pressure Soars in an Emergency

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When the emergency alarm sounds, blood pressure (BP) among firefighters often soars, according to preliminary research presented at the American Heart Association’s Scientific Sessions 2021.

“All emergency and first responders should be aware of their health. They should know what their typical blood pressure level is and be aware of how it fluctuates. Most important, if they have high blood pressure, they should make sure it is well-controlled,” said senio author Deborah Feairheller, PhD.

The study recruited 37 male and 4 female volunteer and municipal firefighters who wore ambulatory BP monitors during an on-call work shift lasting at least 12 consecutive hours. In addition to the automatic BP readings from the monitor, study participants were instructed to prompt the monitor to take a BP reading whenever a pager or emergency call sounded and whenever they felt they entered a stressful situation. Participants also logged activities and call types for each measurement. The firefighters’ average age was 41.2 years. Average body mass index (BMI) of all participants was 30.3, with BMI ≥ 25 defined as overweight, while BMI ≥ 30 is defined as obesity. The firefighters all had high blood pressure, defined as systolic BP as 130 mm Hg or higher, or a diastolic BP of 80 mm Hg or higher, as defined by the American Heart Association’s most recent guideline.

The findings were that:

  • Average BP and heart rate (HR) were 131/79.3 mmHg and 75.7 beats per minute (bpm) respectively.
  • Compared with the reading immediately preceding the call, systolic BPsurged an average of 19.2 mm Hg with fire calls and 18.7 mm Hg with medical calls.
  • Meanwhile, diastolic BP surged 10.5 mm Hg with fire calls and 16.5 mm Hg with medical calls.
  • Compared with the average BP during the entire 12-hour shift, systolic BP was 9% higher during fire calls, and diastolic BP was 9% higher during medical calls.
  • Average HR also increased during both types of calls: 10bpm with fire calls, and 15bpm for medical calls.
  • There were no significant differences in BP, HR or BP surge levels when comparing responses among fire calls, medical calls, riding an emergency vehicle or false alarms.

Surprising findings
“The public knows the value that emergency responders provide to communities. We hope to increase awareness that many firefighters have hypertension and that their blood pressure can increase to very dangerous levels when responding to emergency calls,” said Dr Feairheller.

“The current data show that almost 75% of firefighters have hypertension, and less than 25% have their blood pressure under control. I hope that our research can help identify occupational factors that affect blood pressure and increase awareness among this population,” Dr Feairheller added.

They were also surprised at the findings on diastolic BP increases. “We anticipated systolic blood pressure surges because that reading is usually more responsive to stimuli; however, the extent of the diastolic blood pressure surge was unexpected,” said Dr Feairheller.

The investigators are currently exploring whether diet and exercise regimens could help to lower the BP surge that firefighters experience during emergency calls.

Source: EurekAlert!

Categories : Cardiovascular DiseaseTags :

New Guidance Pivot on Daily Aspirin Advice

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In a distinct on previous advice, new draft recommendations posted by the U.S. Preventive Services Task Force (USPSTF) advise against adults 60 and older to begin taking aspirin to lower their risk of a first heart attack or stroke. 

They further advise that people aged 40 to 59 at higher risk for cardiovascular disease, but without a history of it, should talk to a health care provider before starting an aspirin regimen.

The proposed guidance is based on new evidence that suggests the potential harms of taking aspirin can outweigh the benefits. While daily aspirin use reduces the odds of a first heart attack or stroke, it increases the risks of gastrointestinal and intracerebral bleeding, which progressively increase with age.

“The latest evidence is clear: starting a daily aspirin regimen in people who are 60 or older to prevent a first heart attack or stroke is not recommended,” UPTSTF member Chien-Wen Tseng, MD, a professor at the University of Hawaii John A. Burns School of Medicine, said in a statement. “However, this Task Force recommendation is not for people already taking aspirin for a previous heart attack or stroke; they should continue to do so unless told otherwise by their clinician.”

The new guidance will be finalised after public comments close in November. It pivots from previous recommendations issued in 2016, which suggest that people ages 50 to 59 with a risk of cardiovascular disease ≥ 10% in the next decade and a low risk for bleeding take a daily low-dose aspirin (≤ 100mg/day) to reduce the likelihood of suffering a heart attack or stroke. According to the 2016 recommendations, the decision to start taking aspirin for preventive reasons should be “an individual one” for adults ages 60 to 69 who are at risk for cardiovascular disease

At present, neither the American Heart Association nor the American College of Cardiology recommend aspirin use for the prevention of heart attack and stroke in the general population; this only applies for some people between the ages of 40 and 70 who have never had a heart attack or stroke but have an increased risk for cardiovascular disease and a low risk for bleeding. The groups recommend that adults 70 and up should not take aspirin for first stroke or heart attack prevention.

Still, aspirin use for cardiovascular risk prevention is widespread in the US, “and is often self-initiated rather than recommended by a physician,” the latest USPSTF report states. A 2017 National Health Interview Survey (NHIS) found that 23.4 percent of adults age 40 or older and without cardiovascular disease took aspirin for primary prevention; among adults 60-69 years, 34.7 percent reported aspirin use.
Tomas Ayala, MD, a cardiologist at Mercy Personal Physicians, said that this pivot had been anticipated by doctors.

“It is not that aspirin is less effective at reducing heart attacks or strokes than it once was,” he told Health. “Rather, it is that we have other therapies at our disposal that have reduced the overall population risk of these conditions, so the relative benefit of aspirin is less, and in many cases, is outweighed by the risks.” 

Source: AARP

Categories : Cardiovascular Disease COVIDTags :

Impact of Pandemic Delay to Cardiac Procedures

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A Canadian study found that after the onset of the COVID pandemic, there was a significant decline in referrals and procedures for common cardiac interventions. 

Patients awaiting coronary bypass surgery or stenting were at higher risk of dying while waiting for their procedure compared to before the pandemic, despite wait times not being longer. The study was published in the Canadian Journal of Cardiology.

“In the first wave of the COVID pandemic, we kept hearing stories from patients and other doctors that there were delays in care for patients with heart disease,” explained lead investigator Harindra C. Wijeysundera, MD, PhD, University of Toronto. “We decided to look into these claims using the Ontario database that keeps track of wait lists and wait times for individuals with heart disease who require a procedure or surgery.”

The researchers were able to link multiple population-based administrative data sources and clinical registries. The study looked at adult patients who were referred for four commonly performed cardiac procedures: percutaneous coronary intervention; isolated coronary bypass grafting; valve surgery; or transcatheter aortic valve implantation from January 1, 2014 to September 30, 2020, and the start of the pandemic was put at March 31 2020. Outcomes were defined as death while awaiting procedure and hospitalisation while waiting for procedure.

Of 584 341 patients identified, 37 718 were referred during the pandemic. As expected, a decline in referrals was observed at the outset of the pandemic, although those numbers steadily increased throughout the pandemic period, along with an initial decline in the number of procedures performed. Individuals waiting for coronary bypass surgery or stenting were at higher risk of dying while waiting for their procedure compared to before the pandemic. Mortality rates increased even though wait times did not during the pandemic, suggesting patients may have delayed in presenting to their doctors with symptoms.

“We found that the increase in wait list mortality was consistent across patients with stable coronary artery disease, acute coronary syndrome, or emergency referral,” said Dr Wijeysundera. “Coupled with reduced referrals, this raises concerns of a care deficit due to delays in diagnosis and wait list referral.”

A number of potential explanations were suggested by the researchers for the decline in referrals during the pandemic, from patient factors such as fear of contracting COVID in the hospital or concerns about missing work, to system factors including testing delays and pressures on hospital beds and staffing.

Source: EurekAlert!

Categories : Cardiovascular DiseaseTags :

High Fat Dairy Intake not Tied to CVD Risk

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In a study of countries with high dairy consumption, higher intakes of dairy fat, as measured by bloodstream levels of fatty acids, had a lower risk of cardiovascular disease (CVD) compared to those with low intakes. Higher intakes of dairy fat were not linked to an increased mortality risk.

In a study published in PLoS Medicine, researchers combined results from 4000 Swedish adults with those from 17 similar studies in other countries, creating the most comprehensive evidence to date on the relationship between this more objective measure of dairy fat consumption, risk of  and death.

Dr Matti Marklund from The George Institute for Global Health, Johns Hopkins Bloomberg School of Public Health, and Uppsala University said that with rising dairy consumption around the world, a better understanding of the health impact was needed.

“Many studies have relied on people being able to remember and record the amounts and types of dairy foods they’ve eaten, which is especially difficult given that dairy is commonly used in a variety of foods.

“Instead, we measured blood levels of certain fatty acids, or fat ‘building blocks’ that are found in dairy foods, which gives a more objective measure of dairy fat intake that doesn’t rely on memory or the quality of food databases,” he added.

“We found those with the highest levels actually had the lowest risk of CVD. These relationships are highly interesting, but we need further studies to better understand the full health impact of dairy fats and dairy foods.”

Sweden has one of the world’s highest consumption of dairy. An international team of researchers assessed dairy fat consumption in 4150 Swedish 60-year-olds by measuring blood levels of a particular fatty acid that is mainly found in dairy foods and therefore can be used to reflect intake of dairy fat.

The participants were then followed up for an average of 16 years, recording heart attacks, strokes and other serious circulatory events, and all cause mortality.

After adjustment for other known CVD risk factors including things like age, income, lifestyle, dietary habits, and other diseases, the CVD risk was lowest for those with high levels of the fatty acid (which reflects a high intake of dairy fats). Those with the highest levels had no increased all-cause mortality risk.

These findings highlight the uncertainty of evidence in this area, which is reflected in dietary guidelines, noted  Dr Marklund.

“While some dietary guidelines continue to suggest consumers choose low-fat dairy products, others have moved away from that advice, instead suggesting dairy can be part of a healthy diet with an  emphasis on selecting certain dairy foods — for example, yoghurt rather than butter — or avoiding sweetened dairy products that are loaded with added sugar,” he said.

Combining these results with 17 other studies with a total of almost 43 000 participants from the US, Denmark, and the UK confirmed these findings in other populations.

“While the findings may be partly influenced by factors other than dairy fat, our study does not suggest any harm of dairy fat per se,” Dr. Marklund said.

Lead author Dr Kathy Trieu from The George Institute for Global Health pointed out that consumption of some dairy products, especially fermented products, have been shown to be linked to cardiovascular benefits.

“Increasing evidence suggests that the health impact of dairy foods may be more dependent on the type — such as cheese, yoghurt, milk, and butter — rather than the fat content, which has raised doubts if avoidance of dairy fats overall is beneficial for cardiovascular health,” she said.

“Our study suggests that cutting down on dairy fat or avoiding dairy altogether might not be the best choice for heart health.”

“It is important to remember that although dairy foods can be rich in saturated fat, they are also rich in many other nutrients and can be a part of a healthy diet. However, other fats like those found in seafood, nuts, and non-tropical vegetable oils can have greater health benefits than dairy fats,” Dr Trieu added.

Source: The George Institute for Global Health

Categories : Cardiovascular DiseaseTags :

A Year of Exercise Reverses Heart Failure Signs

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In a small study, a year of exercise training helped to maintain or increase the youthful elasticity of the heart muscle among people in late middle age showing early signs of heart failure.

Published in Circulation, the research reinforces the notion that “exercise is medicine,” an important shift in approach, according to the researchers.

The study focused on heart failure with preserved ejection fraction, which is characterised by stiffening of the heart muscle and high pressures inside the heart during exercise. Once established, the condition is largely untreatable and causes fatigue, excess fluid in the lungs and legs, and shortness of breath.

“It is considered by some to be one of the most important virtually untreatable diseases in cardiovascular medicine,” said senior author Dr Benjamin Levine,  professor of internal medicine at UT Southwestern and director of the Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Dallas. “So, of course, if there are no therapies, then the most important thing to do is to figure out how to prevent it from happening in the first place.”

In previous studies, prolonged exercise training was shown to improve heart elasticity in younger people, but was ineffective for heart stiffness in people 65 and older. The researchers decided to see if committed exercise could improve heart stiffness in healthy, sedentary men and women ages 45 to 64.

The study recruited 31 participants who showed some thickening of the heart muscle and an increase in blood biomarkers associated with heart failure, even though they had no other symptoms such as shortness of breath.

Eleven were randomly assigned to a control group and prescribed a program of yoga, balance and strength training three times a week. The rest were assigned to an individually tailored exercise regimen that gradually ramped up until the participants were doing intensive aerobic interval training for at least 30 minutes at least twice a week, plus two to three moderate-intensity training sessions and one to two strength training sessions each week. 

After one year, the group assigned vigorous exercise training showed a physiologically and statistically significant improvement in measures of cardiac stiffness and cardiorespiratory fitness, compared to no change in the control group.

The results suggest late middle age may be a “sweet spot” for using exercise to prevent heart failure with preserved ejection fraction, before the heart gets too stiff, Prof Levine said. He compared the heart muscle to an elastic band: a new one stretches easily and snaps right back.

“That’s a youthful cardiovascular system,” he said. “Now, stick it in a drawer and come back 30 years later—it doesn’t stretch, and it doesn’t snap back. And that’s one of the things that happens to the circulation, both the heart and the blood vessels as we age, particularly with sedentary aging.”

However, the study cannot determine if the participants will still go on to develop heart failure. This question will have to be addressed by larger studies. Furthermore, it is difficult for people to adhere to an exercise program, and the intensive intervention studied may be difficult and expensive to replicate on a large scale.

Source: American Heart Association

Categories : Cardiovascular Disease Medical Research & TechnologyTags :

Is Heart Pump Development Dead in the Water?

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At an annual meeting of the Heart Failure Society of America (HFSA), heart failure specialists agreed that recalling the HeartWare heart pump was good but debated whether its departure leaves the field of mechanical circulatory support (MCS) dead in the water.

In June, Medtronic stopped sales of its HeartWare Ventricular Assist Device (HVAD), citing excess neurological events and mortality with the device. As a result, Abbott’s HeartMate 3 became the only FDA-approved, durable left ventricular assist device (LVAD) on the market.

“Competition breeds innovation. When competition is absent or minimal, there is little incentive for corporations to innovate,” said Jennifer Cowger, MD, MS, of Henry Ford Hospital in Detroit, during the annual scientific meeting.

“While I believe the removal of the HVAD from the market was the ethical thing to do, unless we as a field start embracing MCS technology and change our messaging to the general cardiology community, our field is going to be viewed as niche to referring cardiologists and we’re going to face irrelevance and we’re going to have bad times ahead,” she added.

However Nancy Sweitzer MD, PhD, of the University of Arizona in Tucson, disagreed, pointing out that there are plenty of advances on the horizon.

Nine companies worldwide are developing heart pumps for this $3-4 billion market, Dr Sweitzer noted. Several devices under investigation — implantable ones with no external component — will probably proceed to first-in-man trials in the next year, she said. “There’s a lot of money if you do this well,” she added

Internal competition alone may be enough to advance the field, Sweitzer argued, citing Thoratec’s HeartMate II superseding their old HeartMate XVE.

“They put their own device up against their own device. So I would argue that corporate competition isn’t necessary when the stakeholders realize that we need to get better at this. I think the companies in this space realize there’s a huge unmet need here if we develop a really good MCS that was truly portable, gave people excellent quality of life, and had lower complications,” she said.

Yet given the pace of LVAD research, “in the next decade, we have cause for concern in the MCS field,” Dr Cowger countered.

Both debaters suggested that MCS technology shouldn’t stop at HeartMate 3, even with its relatively impressive performance.

“Outcomes on HeartMate 3 are not the outcomes we really want for these patients. There are still innumerable complications. Hospitalization rates are extraordinarily high in these patients post-implant even if they’re successful implants. They bleed, they get infected, they get strokes. That still happens,” noted Dr Sweitzer.

Innovation issues aside, Dr Cowger pointed out that HeartMate 3 is also much larger than the HVAD, and the smaller device’s loss leaves a gap for patients. She said negative media views had not helped the recent “sense of apathy and loss of enthusiasm for MCS”.

“Physicians don’t want to use technology that will harm or be perceived to harm patients,” she said, noting that sentiment has shifted from “VADs are sexy, cool” to “we would not choose LVADs over [heart] transplant.”

Source: MedPage Today

Categories : Cardiovascular Disease Neurodegenerative DiseasesTags :

Unexpected Cognitive Effect of ARNI Therapy in Heart Failure

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Despite fears about cognitive decline in heart failure patients taking angiotensin receptor-neprilysin inhibition (ARNI), an observational study found that the drug instead had a protective effect.

Adults with systolic heart failure taking sacubitril/valsartan (Entresto) starting from 2015–2019 had fewer neurocognitive diagnoses up to 5 years later compared with a those staying on angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) alone.

  • Alzheimer’s disease: 1.11% on ARNI vs 1.24% on ACE inhibitors/ARBs
  • Dementia: 4.18% vs 6.49%
  • Cognitive decline: 11.82% vs 14.53%

On the basis of the PARAGON-HF trial,  sacubitril/valsartan won a broad heart failure indication, reaching into the normal ejection fraction range, for prevention of cardiovascular death and hospitalisation.

“Experimental studies with sacubitril/valsartan have fueled theoretical concerns about neurocognitive side effects, but long-term clinical data are scarce,” noted Prabhjot Grewal, MD, of Stony Brook University Hospital in New York, who reported the findings for the Heart Failure Society of America annual virtual meeting.

She explained that neprilysin inhibition by sacubitril could theoretically inadvertently interfere with the degradation of beta amyloid in the central nervous system, where neprilysin is expressed, in addition to the kidneys where it is most abundant.

However there are many factors in cognitive decline in heart failure, such as the circulatory deficit itself; vascular dementia resulting from comorbidities such as hypertension and vascular disease; and Alzheimer’s disease or Lewy body dementia. By ameliorating heart failure and improving blood pressure, drugs such as ACE inhibitors and sacubitril/valsartan could protect cognition, according to Mandeep Mehra, MBBS, MSc, of Brigham and Women’s Hospital and Harvard Medical School in Boston.

“Thus, even if a drug like sacubitril may cause worsening of one type of cognitive decline, it may be counterbalanced by positive effects on other domains since the reasons for cognitive decline in such patients are almost always multi-factorial and the signals may therefore be obfuscated in general analyses,” explained Mehra, who was not involved in the study.

The authors acknowledged that the observational study lacked systematic characterisation, and also leaves room for residual confounding despite propensity matching.

“This is why we require a prospective study that includes mechanistic end points (degree of beta amyloid protein deposition) in concert with functional outcomes (sensitive measures of cognitive decline) while ensuring that sufficient time is allowed to be evaluated since these are slow and subtle effects,” Mehra said, adding that the PERSPECTIVE trial will likely publish findings in 2022.

Source: MedPage Today

Categories : Cardiovascular DiseaseTags :

Worse Lung Function Linked to Sudden Cardiac Death

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A new study found that people with modest but measurably worse lung function are more likely to suffer sudden cardiac death (SCD).

SCD is death due to a cardiovascular cause that occurs within one hour of the onset of symptoms. A sudden cardiac arrest occurs when the heart stops beating or is not beating sufficiently to maintain perfusion and life. There are often no previous warning signs, and is thought to be responsible for around 20% of all deaths in Europe.

The study was presented at the ERS International Congress by Dr Suneela Zaigham of Lund University. She said: “Although sudden cardiac deaths are common, we don’t know enough about who is at risk in the general population. There are links between lung and heart health, so we wanted to investigate whether measurable differences in lung function could offer clues about the risk of sudden cardiac death.”

The study involved 28 584 middle-aged participants with no known heart problems. All took part in spirometry tests where they were asked to blow into a machine to measure how well their lungs were working. Over the following approximately 40 years, researchers recorded any SCDs (death on the day of a coronary event) or any non-fatal coronary events (coronary events where people survived the first 24 hours)

They found that measurably lower lung function in middle-aged people (one standard deviation lower in the amount of air they could blow out in one second, which equates to around 0.8 litres) was more strongly associated with suffering a SCD (a 23% increase in risk) than a non-fatal coronary event (an 8% increase in risk) later on in life. The pattern of risk remained even in people who had never smoked.

Dr Zaigham said: “We believe this is the first study to directly compare the risk of sudden cardiac death and non-fatal coronary events and their links with lung function in the general population.

“Our findings suggest that testing people’s lungs when they are middle-aged and healthy could help spot those who have a higher risk of sudden cardiac death. This could enable people to take steps to potentially reduce the risk of this devastating event.”

A limitation of the study is that risk questionnaires were administered at the start of the study and these factors could have changed. The researchers next seek to see whether SCD could be prevented by testing lung function as part of current cardiovascular risk assessment. They plan to explore the link between lung function and SCD further to see if heart abnormalities, variable blood pressure or genetic causes are involved.

Source: European Respiratory Society

Categories : Cardiovascular Disease Diet and NutritionTags :

Added Potassium Salt Substitute Greatly Cuts CVD Risk

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Replacing table salt with a low-sodium, added potassium ‘salt substitute’ significantly reduces rates of stroke, heart attack and death, one of the largest dietary intervention studies ever conducted.

Presented at the European Society of Cardiology Congress in Paris, and simultaneously published in the New England Journal of Medicine, the results also showed that there were no harmful effects from the salt substitute, such as hyperkalaemia.

High sodium intake and low potassium intake are widespread. Both are linked to hypertension and increased risks of stroke, heart disease and premature death. Using a salt substitute – where part of the sodium chloride is replaced with potassium chloride – addresses both problems at once. Salt substitutes are known to lower blood pressure but their effects on heart disease, stroke, and death were unclear, until now.

Lead researcher, Professor Bruce Neal of The George Institute for Global Health, said that the benefit could prevent millions of early deaths with the widespread adoption of salt substitutes.

“Almost everyone in the world eats more salt than they should.  Switching to a salt substitute is something that everyone could do if salt substitutes were on the supermarket shelves,’’ he said.

“Better still, while salt substitutes are a bit more expensive than regular salt, they’re still very low-cost – just a few dollars a year to make the switch.”

“As well as showing clear benefits for important health outcomes, our study also allays concerns about possible risks.  We saw no indication of any harm from the added potassium in the salt substitute.  Certainly, patients with serious kidney disease should not use salt substitutes, but they need to keep away from regular salt as well,” added Professor Neal.

The Salt Substitute and Stroke Study enrolled 21 000 adults with either a history of stroke or poorly controlled blood pressure from 600 villages in rural areas of China from 2014 to 2015.

Participants in intervention villages were provided enough salt substitute to cover all household cooking and food preservation requirements – a daily amount of 20g per person. Those in the other villages continued using regular salt.

Over five years’ average follow up, more than 3000 participants had a stroke. Use of salt substitute reduced stroke risk by 14 percent, total cardiovascular events (strokes and heart attacks combined) by 13 percent and premature death by 12 percent.

Professor Neal said that as salt substitutes are relatively cheap (US$1.62 per kg vs US$1.08 per kg for regular salt in China), they are likely very cost effective.

“Last year, a modelling study done for China suggested that about 400 000 premature deaths might be prevented each year by national uptake of salt substitute. Our results now confirm this. If salt was switched for salt substitute worldwide, there would be several million premature deaths prevented every year,” he said.    

“This is quite simply the single most worthwhile piece of research I’ve ever been involved with. Switching table salt to salt substitute is a highly feasible and low-cost opportunity to have a massive global health benefit.”

As a result of the study, George Institute researchers are calling for salt manufacturers to embrace salt substitution, the promotion of salt substitutes by governments, and the use of substitute salt by consumers.

Source: George Institute for Global Health