The Importance of Population-Wide Sodium Reduction as a Means to Prevent Cardiovascular Disease and Stroke: A Call to Action from the American Heart Association

Perspective:

The following are 10 points to remember about sodium reduction:

1. The relation between blood pressure (BP) and adverse health outcomes is direct and progressive with no evidence of a threshold; that is, the risk of cardiovascular disease (CVD), stroke, and end-stage kidney disease increases progressively throughout the range of usual BP starting at a level of >115/75 mm Hg.

2. Overall, elevated BP is the second leading modifiable cause of death, accounting for an estimated 395,000 preventable deaths in the United States in 2005. Worldwide, elevated BP accounts for 54% of stroke and 47% of coronary heart disease events.

3. The 2020 goal of the American Heart Association is to improve the cardiovascular health of all Americans by 20%, while continuing to reduce deaths from CVD and stroke by 20%.

4. Two of the key metrics for ideal cardiovascular health are a BP of <120/80 mm Hg and sodium consumption of <1500 mg/d.

5. Excess intake of salt has a major role in the pathogenesis of elevated BP, and BP-independent effects including promoting left ventricular hypertrophy and fibrosis in the heart, kidneys, and arteries.

6. Salt-restricted diets lower the BP in both normotensive and hypertensive persons, with the greatest impact when salt is reduced by 4600 mg/d (22.7/9.1 mm Hg). The benefit of reduction in salt intake by 900 mg/d has a greater impact on BP when the baseline intake is ~2300 mg/d than ~3500 mg/d.

7. An acute increase in sodium intake impairs vascular endothelial function in young adults with normal BP, and among middle-aged and older adults with elevated systolic BP, lower sodium intake is associated with enhanced vascular endothelial function, independent of BP or other risk factors.

8. US Dietary Guidelines for Americans in 2005 recommend a sodium intake of ~2300 mg/d for the general adult population and state that hypertensive individuals, blacks, and middle-aged and older adults would benefit from reducing their sodium intake even further to 1500 mg/d. Because these latter groups comprise up to 70% of adults, and because about 90% of US adults will develop hypertension over their lifetime, the 2010 goal is 1500 mg/d.

9. A national effort that reduces sodium intake by 1200 mg/d should result in 60,000 to 120,000 fewer CHD events, 32,000 to 66,000 fewer strokes, 54,000 to 99,000 fewer myocardial infarctions, and 44,000 to 92,000 fewer deaths, and should save $10-$24 billion in health care costs annually.

10. Any meaningful strategy to reduce sodium intake population-wide must involve the efforts of food manufacturers, food processors, and restaurant industries, a strategy that is being successfully implemented in other countries.

Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Diet, Hypertension

Keywords: Hypertrophy, Left Ventricular, Myocardial Infarction, Stroke, Kidney Failure, Chronic, Nutrition Policy, Coronary Disease, Blood Pressure, Risk Factors, Sodium Chloride, Dietary, Diet, Sodium-Restricted, Sodium, Dietary, Hypertension, United States


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