Salt (Sodium) Intake, Stroke & Cardiovascular Disease

Table salt consists of the elements sodium and chloride, both of which are essential for life.
There is a great deal of clinical research suggesting that more than 5 to 6 grams of salt intake per
day (which is equal to 2 to 2.4 grams of sodium) is associated with a significant increase in the
risk of developing high blood pressure which, in turn, is associated with a significantly increased
risk of stroke and cardiovascular disease. Unfortunately, in most countries, the average daily salt
intake for adults is considerably greater than 6 grams per day. Moreover, in many countries of
the world, the average daily adult intake of salt is a whopping 12 grams per day, or almost 5
grams of sodium per day.
In the United States, the American Heart Association (AHA) currently recommends no more
than 2.3 grams of sodium intake per day (equivalent to 5 grams, or about one teaspoon, of salt
per day). At the same time, the AHA also states that the ideal daily intake of sodium should
actually be about 1.5 grams per day but, in an acknowledgment regarding the high intake of salt-
rich processed foods in the United States, the AHA considers the 2.3 gram per day dietary
sodium target to be more "realistic" for Americans.
There is considerable public health research data suggesting that the reduction of average daily
adult salt intake, to 6 grams per day, or less, would result in a significant lowering of blood
pressure in both people with and without high blood pressure. Based upon these research
findings, some public health experts have predicted that lowering the average daily salt intake
below 6 grams per day could reduce the incidence of stroke by almost 25 percent, and the
incidence of cardiovascular disease by almost 20 percent. Unfortunately, there have not been any
large-scale prospective, randomized, placebo-controlled clinical research trials performed to
validate these estimates. On the other hand, there have been multiple short-term prospective
public health trials that have followed groups (cohorts) of patients in terms of their dietary intake
of salt and the incidence of stroke and cardiovascular disease events.
Now, a newly published research study, in the British Medical Journal, has performed a meta-
analysis of 13 of these "prospective cohort" studies, encompassing a total of 177,025 patient
volunteers, with average durations of patient follow-up ranging from 4 to 19 years. (Meta-
analysis is a method of combining the data from multiple different clinical studies into a single
"super-study," in an effort to improve the validity of the resulting data, as well as the conclusions
that are reached from such data.)
Among these more than 177,000 patient volunteers, there were 11,000 "vascular events"
observed, including stroke and heart attacks (myocardial infarctions). When the incidence of
these vascular events was analyzed, along with dietary salt intake, the patients with the highest
daily salt intake were observed to experience a 23 percent greater risk of stroke, and a 17 percent
greater risk of cardiovascular disease, when compared to the adults who consumed less salt on a
daily basis.
The increasing consumption of salt-rich processed foods throughout both the developed and
underdeveloped countries of the world has been pushing daily salt intake to ever higher levels,
with many Western countries reporting average daily adult salt intake of nearly 10 grams per
day.
In other countries, and most notably in Asia and Eastern Europe, dietary practices that include a
high concentration
of heavily salted foods have pushed daily salt intake into the 10 to 12 gram per day range for the
average adult.
The World Heart Federation estimates that there are 5.5 million annual deaths from stroke across
the globe, and an additional 17.5 million annual deaths from cardiovascular disease. Based upon
the increased incidence of stroke and cardiovascular disease predicted by this meta-analysis
study, even a rather modest decrease in the average adult daily salt intake, to the World Health
Organization's target of 5 grams per day, should result in 1.25 million fewer deaths per year from
stroke and nearly 3 million fewer annual deaths from cardiovascular disease around the world.
Needless to say, this is a tremendous potential public health dividend from a rather simple
alteration in our dietary habits. (On the surface, reducing our daily salt intake would appear to be
a rather simple goal. However, the more complicated reality is that to achieve even the World
Health Organization's rather liberal target of 5 grams of salt per day, our entire food chain would
have to be comprehensively reexamined and overhauled.)
The world's increasing consumption of highly-processed foods, which often contain high levels
of salt as a preservative, are largely responsible for the high levels of salt intake in the developed
world (in addition to a preference for salt-cured foods in much of Asia and Eastern Europe). In
the United States, the sodium content of most processed foods is readily available on food
packages. Unfortunately, most restaurants in the United States have not been as forthcoming
about the sodium content of the food on their menus (as well as other important nutritional
information), and so it continues to be very difficult to determine the actual salt content of much
of what we eat here in the United States and, indeed, throughout much of the world.