Adding Salt to Food and Risk of Cardiovascular Disease

Quick Takes

  • In an analysis of 176,570 adults in the UK Biobank, reduced frequency of adding salt to food with high adherence to the DASH diet correlated with reduced risk for cardiovascular events.
  • Reduced frequency of adding salt correlated with lower risk for heart failure and ischemic heart disease, but not stroke.

Study Questions:

What is the association between cardiovascular risk and the frequency of adding salt to foods and the DASH (Dietary Approaches to Stop Hypertension) diet?


This was an analysis of the prospective UK Biobank registry between 2006 and 2010. All participants with at least one web-based 24-hour dietary assessment and completion of data on frequency of adding salt to diet were included. Adding salt to diet was categorized as never/rarely, sometimes, usually, or always. Twenty-four–hour dietary assessment was used to assess adherence to the DASH diet. Twenty-four–hour sodium excretion was estimated from random urinary spot sodium in stored urine samples. Endpoints included a composite of cardiovascular (CVD) events including incident ischemic heart disease, stroke, and heart failure assessed using International Classification of Diseases, Tenth Edition (ICD-10) codes.


Overall, 176,570 adults were included with a median follow-up of 11.8 years, during which 9,963 CVD events occurred. Compared with adults reporting higher frequency of adding salts to food, those adding lower frequency were more likely women, white, had a lower body mass index (BMI), and more physically active but with higher prevalence of chronic kidney disease. Twenty-four–hour sodium excretion showed a graded response with self-reported frequency of adding salt to foods. After multivariable adjustment for factors such as age, sex, race, BMI, chronic kidney disease, and diabetes, among others, lower frequency of adding salt was associated with a lower risk of CVD events. This association was strongest for heart failure, followed by ischemic heart disease, but was not significant for stroke alone. The association between adding salt and CVD risk was strongest for participants from a lower socioeconomic level. Higher adherence to the DASH diet with a lower frequency of adding salt to the diet had the lowest CVD risk.


In a large, population-based registry, adults reporting lower frequency of adding salt with higher adherence to the DASH diet had the lowest risk for CVD.


Dietary salt restriction has been recommended universally for decades for patients with risk factors for adverse cardiovascular risk such as hypertension. However, studies evaluating the relation between dietary salt and CVD events have not shown a consistent association. In this large, population-based registry, the authors demonstrate an association between increased frequency of adding salt and increased risk for CVD events, particularly heart failure and ischemic heart disease. In addition to the large cohort size, the authors also demonstrated reliability of dietary salt intake by correlating it with urinary sodium levels. These findings support a simple behavior change of reducing the addition of salt to table food.

Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure, Diet, Hypertension

Keywords: Body Mass Index, Cardiovascular Diseases, Diabetes Mellitus, Dietary Approaches To Stop Hypertension, Heart Disease Risk Factors, Heart Failure, Hypertension, Myocardial Ischemia, Nutrition Assessment, Primary Prevention, Renal Insufficiency, Chronic, Risk Factors, Salts, Socioeconomic Factors, Sodium, Sodium, Dietary, Stroke

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