Low-sodium salt substitutes (LSSS) for cardiovascular health: do they work?

Cochrane Review: Brand A, Visser ME, Schoonees A, Naude CE. Replacing salt with low-sodium salt substitutes (LSSS) for cardiovascular health in adults, children and pregnant women. Cochrane Database of Systematic Reviews 2022, Issue 8, Art. No. CD015207. doi: 10.1002/14651858.CD015207.¹

Hypertension is a known public health problem that affects both the economic developed and developing world and effects somewhere between 25 and 33% of the adult population.² It is one of the leading factors attributing to global mortality and is the third highest risk factor for the global burden of disease.³ The World Health Organisation (WHO) states that a population level reduction in sodium intake is strongly recommended in order to reduce blood pressure and cardiovascular disease.⁴ The question here is, does LSSS help to reduce sodium intake?

Using LSSS will reduce both diastolic and systolic blood pressure which in turn results in a reduction of cardiovascular mortality and the number of cardiovascular non-fatal events.¹ The reduction shown here was clinically relatively small (systolic blood pressure reduction of 4.76 mmHg) at an individual level but at a population level a reduction of even 1 mmHg in SBP can prevent substantial numbers of cardiac events (Table 1).⁵

Table 1.  Summary of effects of LSSS compared to regular salt in the general adult population.