Replace household salt with a lower-sodium, potassium-containing substitute when suitable
Among people with a previous stroke or hypertension after 60, replacing ordinary salt reduced deaths by about 12% and strokes by 14% over roughly five years.
What it takes
A bag costs a few renminbi more than ordinary salt in China. Change what you buy; no extra time and little change in taste.
What you may gain
A randomized trial in rural China enrolled 20,995 people with previous stroke or hypertension at age 60 or older, followed for 4.74 years. The substitute reduced death by about 12% (RR 0.88), stroke by 14% (RR 0.86), and major cardiovascular events by 13% (RR 0.87) versus ordinary salt. Hyperkalemia events did not differ significantly.
Context & considerations
PURE was observational, not randomized. It found 27% higher combined death and cardiovascular-event risk with sodium excretion below 3 g/day, and 15% higher risk above 7 g/day, suggesting a middle range was best. But the Chinese trial replaced only part of the sodium and did not lower it that far. Its participants were high-risk older adults; healthy younger people can expect much smaller absolute benefits. Ask a clinician before changing salt if you have impaired kidney function or take potassium-sparing medication.
Research & references
Neal B et al. (2021). Effect of Salt Substitution on Cardiovascular Events and Death. NEJM. https://doi.org/10.1056/NEJMoa2105675 ; O'Donnell M et al. (2014). Urinary sodium and potassium excretion, mortality, and cardiovascular events. NEJM. https://doi.org/10.1056/NEJMoa1311889 (the contrasting PURE findings).