Key result
Lower sodium intake reduces SBP, while salt substitutes cut all-cause mortality by ~1% absolute.
Why the study?
The quality of systematic reviews with meta-analyses reporting absolute effect estimates of sodium intake on major cardiovascular events and the certainty of evidence had not been explicitly summarized.
Does lower sodium intake or salt substitution reduce blood pressure, mortality, and major cardiovascular events in various cardiovascular risk populations?
Systematic Review (n=56)
Does lower sodium intake or salt substitution reduce blood pressure, mortality, and major cardiovascular events in various cardiovascular risk populations?
Moderate to high certainty evidence supports that lower sodium intake and salt substitutes reduce blood pressure and mortality, particularly benefiting low cardiovascular risk populations.
Supports sodium reduction and salt substitutes for BP lowering and mortality reduction; reinforces guidelines with moderate-high certainty evidence.
A plethora of systematic reviews with meta-analyses (SRMAs) evaluating sodium intake on cardiovascular health have been published. However, the quality of the SRMAs, that report absolute estimates of effect for major cardiovascular events and the corresponding certainty of the evidence has not been explicitly summarized. We conducted an umbrella review to assess the strength and validity of associations between lower sodium intake and cardiovascular outcomes. We used a modified, more stringent, version of the AMSTAR 2 instrument and the GRADE approach to assess SRMA methodological quality and evidence certainty, respectively. Across three cardiovascular risk strata, we computed the absolute risk reduction (ARR) for binary outcomes. We included 56 SRMAs. In various cardiovascular risk populations, moderate to high certainty evidence suggested that lower sodium intake reduced systolic blood pressure (BP) by -8.69 to -2.00 mmHg, and had concordant but smaller effects on diastolic BP. Salt substitutes conferred a small but important reduction in all-cause and cardiovascular mortality [ARR 12 fewer per 1000; 9 fewer per 1000; respectively], and had little to no effect on the risk of stroke [ARR 1 fewer per 1000]. Moderate to high certainty evidence suggested that lower sodium intake is probably beneficial for the prevention of major cardiovascular events, especially in low cardiovascular risk populations.
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Yang et al. (2024) conducted a systematic review in Cardiovascular risk (n=56). Lower sodium intake and salt substitutes vs. Higher sodium intake / regular salt was evaluated on All-cause mortality (ARR 12 fewer per 1000). Lower sodium intake reduced systolic blood pressure by 2.00 to 8.69 mmHg, and salt substitutes reduced all-cause mortality (ARR 1.2%) and cardiovascular mortality (ARR 0.9%).
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