Key result
Meeting sodium reduction targets could prevent ~384,000 cardiovascular events and save billions in healthcare costs.
Why the study?
High dietary sodium is the main dietary risk factor for cardiovascular diseases, and the potential avoidable ischemic heart disease and stroke cases, QALY gains, and healthcare cost savings from different sodium reduction strategies and recommendations in Canada needed to be estimated.
Do population-level dietary sodium reduction strategies (including meeting intake recommendations, food reformulation targets, and front-of-package labeling regulations) prevent incident ischemic heart disease and stroke, increase QALYs, and reduce healthcare costs in the Canadian adult population?
Do population-level dietary sodium reduction strategies (including meeting intake recommendations, food reformulation targets, and front-of-package labeling regulations) prevent incident ischemic heart disease and stroke, increase QALYs, and reduce healthcare costs in the Canadian adult population?
Effect estimate: 219,490 prevented IHD cases; 164,435 prevented strokes; 276,185 QALYs gained; CAD 4,212 million saved (95% CI 73,409-408,630)
Population-level sodium reduction strategies in Canada, particularly making Health Canada's voluntary sodium targets mandatory and implementing front-of-package labeling, are projected to be cost-saving and prevent hundreds of thousands of cardiovascular events over the population's lifetime.
BACKGROUND: High dietary sodium is the main dietary risk factor for non-communicable diseases due to its impact on cardiovascular diseases, the leading cause of death globally. The objective of the study was to estimate the number of avoidable ischemic heart disease (IHD) and stroke incidence cases, and their associated healthcare cost and Quality-Adjusted Life Year (QALY) savings resulting from different sodium reduction strategies and recommendations in Canada. METHODS: We used the PRIMEtime model, a proportional multi-state lifetable model. Outcomes were modeled over the lifetime of the population alive in 2019, at a 1.5% discount rate, and from the public healthcare system perspective. Nationally representative data were used as inputs for the model. RESULTS: Fully meeting Health Canada's sodium reduction targets was estimated to prevent 219,490 (95% UI (Uncertainty Interval), 73,409-408,630) cases of IHD, and 164,435 (95% UI, 56,121-305,770) strokes. This led to a gain of 276,185 (95% UI, 85,414-552,616) QALYs, and healthcare costs savings of CAD 4,212 (95% UI, 1,303-8,206) million over the lifetime of the 2019 cohort. Sodium reduction intake through front-of-package labeling (FOPL) regulations has the potential to prevent between 35,930 (95% UI, 8,058-80,528) and 124,744 (95% UI, 40,125-235,643) cases of IHD, and between 26,869 (95% UI, 5,235-61,621) and 93,129 (95% UI, 30,296-176,014) strokes. This results in QALY gains ranging from 45,492 (95% UI, 10,281-106,579) to 157,628 (95% UI, 46,701-320,622), and healthcare costs savings ranging from CAD 695 (95% UI, 160-1,580) to CAD 2,415 (95% UI, 722-4,746) million over the lifetime of the 2019 Canadian cohort. All sodium reduction strategies tested were cost saving. CONCLUSIONS: Reducing population-level sodium intakes is feasible and has the potential to improve health outcomes and save healthcare costs in Canada. From interventions tested, most health and healthcare costs gains were attributed to fully meeting sodium reduction targets, which highlights the importance of changing the voluntary nature of these targets to mandatory. A combination of strategies, mandatory sodium reduction targets and implementation of the 'high in' FOPL symbol would provide the most benefit from a public health standpoint.
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Flexner et al. (2025) studied Ischemic heart disease and stroke related to high dietary sodium intake. Population-level dietary sodium reduction strategies (meeting Health Canada's sodium reduction targets and front-of-package labeling regulations) vs. Business as usual (baseline sodium intake of 2,758 mg/day) was evaluated on Avoidable ischemic heart disease (IHD) incident cases, stroke incident cases, QALY gains, and healthcare cost savings (under Scenario 3: fully meeting Health Canada's sodium reduction targets) (219,490 prevented IHD cases; 164,435 prevented strokes; 276,185 QALYs gained; CAD 4,212 million saved, 95% CI 73,409-408,630). Fully meeting Health Canada's sodium reduction targets was estimated to prevent 219,490 ischemic heart disease cases and 164,435 strokes, saving CAD 4,212 million over the 2019 cohort's lifetime.
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