Efforts during the last decade to reduce Americans’ salt intake by encouraging consumption of low-sodium food products have been largely unsuccessful, according to an American Heart Association report, prompting the organization to urge for a stronger public health approach.
Lowering population-wide BP to 120/80 mm Hg, and reducing daily salt intake to 1,500 mg per day are key components in achieving the agency’s goal of reducing CVD and stroke deaths and improving cardiovascular health by 20% each.
But individuals cannot do this alone, mostly because the sodium content in Western diets is not readily apparent. Excess salt often occurs from the cumulative intake of foods that are only moderately high in sodium, the AHA stated.
“Successful sodium reduction requires action and partnership at all levels — individuals, healthcare providers, professional organizations, public health agencies, governments and industry,” AHA member Lawrence J. Appel, MD, of Johns Hopkins Bloomberg School of Public Health, and colleagues wrote in Circulation.
Lowering sodium intake by 1,200 mg per day has “substantial” benefits, according to the association, and could result in:
- As many as 120,000 fewer coronary heart disease events
- Up to 66,000 fewer strokes
- Between 54,000 to 99,000 fewer myocardial infarctions
- As many as 92,000 fewer deaths.
The AHA report cited more than 50 trials documenting the effects of salt intake on BP and major adverse outcomes including heart disease, stroke and kidney disease.
One cited meta-analysis indicated that reducing sodium by 1,800 mg per day lowered systolic BP by 5 mm Hg and diastolic BP by 2.7 mm Hg. Results from other studies indicate that salt reduction can prevent BP increases that come with age — a health issue that 90% of adults ultimately experience.
High sodium levels also result in other negative health effects, including left ventricular hypertrophy and renal damage; mineral metabolism abnormalities; organ fibrosis; and endothelial and arterial dysfunction.
In 2005, U.S. Dietary Guidelines for Americans recommended that the general adult population consume <2,300 mg per day and that high risk populations including those with hypertension, blacks and middle-aged and older adults would benefit from reducing sodium intake to 1,500 mg per day.
But because such a wide range of adults fall into these risk groups — as many as 70% of the population — the 2010 Dietary Guidelines Committee set sodium intake goals at 1,500 mg per day for the entire population.
“The health benefits apply to Americans in all groups, and there is no compelling evidence to exempt special populations from this public health recommendation,” the researchers wrote.
The AHA called for efforts to reduce the overall level of sodium in the food supply, supporting regulatory actions that the Institute of Medicine proposed in 2010.