What does this research mean for the field?

High dietary salt intake increases cardiovascular disease, hypertension, and stroke risks in a dose-dependent manner, whereas sodium reduction decreases blood pressure and reduces cardiovascular, stroke, and all-cause mortality without adverse lipid effects. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

November 16, 2025Annals of MedicineOpen Access

Dietary salt intake and cardiovascular outcomes: an umbrella review of meta-analyses and dose-response evidence

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Why the study?

Excessive salt intake is a known CVD risk factor, but the health impacts of both high and low sodium intake remain debated.

Does low sodium intake reduce cardiovascular mortality and events compared to high sodium intake?

Structured PICO

Does low sodium intake reduce cardiovascular mortality and events compared to high sodium intake?

Population

21 meta-analyses comprising 91 outcomes of randomized controlled trials and observational studies evaluating dietary salt intake

Intervention

Low sodium intake / dietary salt reduction

Comparator

High sodium intake / usual diet

Outcome

Cardiovascular outcomes including CVD mortality, stroke mortality, all-cause mortality, incident CVD, hypertension, and strokehard clinical

This umbrella review confirms that high salt intake increases cardiovascular risk, while moderate reduction provides protective benefits for mortality and blood pressure without adverse lipid effects.

Implication

Salt recommendations should stay evidence-based and cautious; leaves open optimal intake thresholds for CVD.

Abstract

BACKGROUND: Excessive salt intake is a known cardiovascular disease (CVD) risk factor, but the health impacts of both high and low sodium intake remain debated. This study synthesize meta-analytic evidence on dietary salt intake and cardiovascular outcomes, including subgroup and dose-response analyses. METHODS: PubMed, Embase, Web of Science, and Cochrane Library were searched through August 28, 2024, for meta-analyses of randomized controlled trials and observational studies. RESULTS: 21 meta-analyses comprising 91 outcomes were included. Low sodium intake was associated with reduced risks of CVD mortality (RR = 0.83, 95% CI: 0.73-0.95), stroke mortality (RR = 0.74, 95% CI: 0.57-0.95), and all-cause mortality (RR = 0.88, 95% CI: 0.82-0.93), as well as systolic blood pressure (MD = -3.39 mmHg) and diastolic blood pressure (MD = -1.54 mmHg), improved vascular elasticity, and increased heart rate. Urinary sodium excretion and Na/K ratio decreased, while urinary potassium, calcium, and serum potassium increased. No adverse effects on lipid profiles were observed. High salt intake was associated with increased risks of CVD (RR = 1.13, 95% CI: 1.06-1.20), hypertension (OR = 1.33, 95% CI: 1.24-1.42), stroke (OR = 1.34, 95% CI: 1.19-1.51), and stroke mortality (OR = 1.40, 95% CI: 1.21-1.63). Each 1 g/day sodium increase raised systolic blood pressure by 0.60 mmHg and CVD and stroke risks by 4% and 6%, respectively. CONCLUSION: High salt intake increases cardiovascular risk, while moderate reduction provides protective benefits without adverse lipid effects. Tailored strategies are needed based on regional, sex-specific, and methodological differences.