Using a simple and low-cost salt substitute could slash the risk of cardiovascular disease, stroke, and all-cause mortality in older adults with a history of stroke or high blood pressure. A new study from China found that this strategy could prevent up to one million major cardiovascular disease events annually in that country. The salt substitute employed in the study included the mineral potassium which researchers said contributed to the heart-saving benefit, along with the decrease in sodium.

Experts have long cautioned that eating too much salt and too little potassium can cause high blood pressure, leading to cardiovascular disease and death, notes Dr. Julie R. Ingelfinger, in an editorial published in The New England Journal of Medicine.

We also know low-salt diets and potassium supplements can lower blood pressure. Until this recent study, there was no gold-standard evidence for trying a salt substitute that replaces part of the sodium chloride with potassium chloride to reduce the risk of cardiovascular events.

A large, clinical trial studied the effect of using a salt substitute in about 21,000 people in rural China with poorly controlled blood pressure who had a history of stroke or were age 60 or older. After five years, people who took the salt substitute had significantly lower rates of cardiovascular disease or death compared to people who used regular salt, with no apparent serious side effects.

According to TCTMD, the Salt Substitute and Stroke Study (SSaSS) found that the salt stand-in spiked with potassium lowered the risk of stroke by 14% and reduced the risk of major adverse cardiovascular events by 13% when compared to regular salt intake.

“There’s about 10 million major adverse cardiovascular events each year in China,” said Dr. Bruce Neal, an Australian researcher and the lead investigator of the study. “Last year, a study was done modelling the effects of salt substitution and estimated that 10%, or 1 million, of these events could be avoided each year. Our study now confirms that benefit and suggests the benefit might be slightly greater.”

Neal adds that these results show that swapping salt for a safer spice could benefit everyone.

“Almost everyone, except the few people with kidney disease who should be avoiding salt anyway, could switch to using a salt substitute and expect to see some sort of benefit,” he told reporters during a press conference announcing the results of his study, says TCTMD.

The salt substitute used in Neal’s study was composed of 70% sodium chloride (NaCl) and 30% potassium chloride (KCl) which differs from regular table salt that is pure NaCl. Neal noted that potassium-rich salt substitutes help reduce blood pressure because there is less sodium and more potassium

The researcher acknowledged that the increase of potassium in the salt substitute he used in his study may have contributed to the beneficial cardiovascular effect noted in the results.

“While it’s not easy to dissect out whether the lower sodium or the higher potassium was responsible for benefits, the likelihood is that both contributed but the major contribution came from the increased potassium,” he said, according to TCTMD.

Healthcare experts at the conference praised the findings of the study, saying now we have unequivocal evidence that reducing dietary salt not only lowers blood pressure, but also has far-reaching cardiovascular benefits.

“Those who doubted the potential benefits of salt restriction in terms of cardiovascular disease prevention must now conclude they are wrong,” said Dr. Bryan Williams, of University College London in England. “Really, the debate stops here. The data is in. Now, global public health interventions are needed to implement these incredibly important findings.”

Other experts caution that the Chinese study included only high-risk individuals over the age of 60 and the data might not be as relevant for younger, healthier populations. They also noted that the mean intake of sodium for the study participants was 4.3 grams daily while in North America the average daily intake of sodium is 3.5 grams.

“So, it’s unclear that the results can be applied to North America, Western Europe, or to many regions of the world where sodium intake is lower,” Dr. Salim Yusuf, a leading cardiologist at McMaster University in Hamilton, Canada, told TCTMD.

According to the American Heart Association, we should be limiting our salt intake to no more than 2.3 grams daily while moving to an ideal limit of 1.5 grams.