February 3, 2016Open Access
Projected Impact of Salt Restriction on Prevention of Cardiovascular Disease in China: A Modeling Study
Structured PICO
Does population-wide dietary salt reduction prevent cardiovascular disease events and mortality in Chinese adults?
P
Population
Chinese adults aged 35 to 94 years (simulated population of approximately 387.8 million to 577.2 million eligible adults).
I
Intervention
Population-wide dietary salt reduction policies, including gradual reduction of mean dietary salt intake to 9.0 g/day, 7.5 g/day, or 6.0 g/day over 10 years, or implementation of culturally-tailored strategies such as cooking salt-restriction spoons or salt substitutes.
C
Comparator
Baseline dietary salt consumption remaining at 2010 levels (no change in salt intake).
O
Outcome
Annual CVD events prevented, relative reductions in rates of CVD incidence and mortality, quality-adjusted life-years (QALYs) gained, and CVD treatment costs saved.hard clinical
Population-wide dietary salt reduction policies in China, particularly through the use of salt substitutes, could prevent hundreds of thousands of cardiovascular events annually and yield substantial cost savings.
Abstract
OBJECTIVES: To estimate the effects of achieving China's national goals for dietary salt (NaCl) reduction or implementing culturally-tailored dietary salt restriction strategies on cardiovascular disease (CVD) prevention. METHODS: The CVD Policy Model was used to project blood pressure lowering and subsequent downstream prevented CVD that could be achieved by population-wide salt restriction in China. Outcomes were annual CVD events prevented, relative reductions in rates of CVD incidence and mortality, quality-adjusted life-years (QALYs) gained, and CVD treatment costs saved. RESULTS: Reducing mean dietary salt intake to 9. 0 g/day gradually over 10 years could prevent approximately 197 000 incident annual CVD events 95% uncertainty interval (UI): 173 000-219 000, reduce annual CVD mortality by approximately 2. 5% (2. 2-2. 8%), gain 303 000 annual QALYs (278 000-329 000), and save approximately 1. 4 billion international dollars (Int) in annual CVD costs (Int; 1. 2-1. 6 billion). Reducing mean salt intake to 6. 0 g/day could approximately double these benefits. Implementing cooking salt-restriction spoons could prevent 183 000 fewer incident CVD cases (153 000-215 000) and avoid Int1. 4 billion in CVD treatment costs annually (1. 2-1. 7 billion). Implementing a cooking salt substitute strategy could lead to approximately three times the health benefits of the salt-restriction spoon program. More than three-quarters of benefits from any dietary salt reduction strategy would be realized in hypertensive adults. CONCLUSION: China could derive substantial health gains from implementation of population-wide dietary salt reduction policies. Most health benefits from any dietary salt reduction program would be realized in adults with hypertension.