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According to a new study in JAMA Cardiology, a dietary change as simple as swapping salt could soon be a cornerstone in preventing recurrent strokes. Researchers in northern China found that potassium-enriched salt substitutes may drastically reduce the risk of stroke-related deaths.
The findings point to the potential of this cost-effective measure to reshape how stroke survivors manage their long-term health.
A Growing Stroke Crisis
The toll of strokes is heavy in the UK, with over 795,000 people affected annually, and nearly one in four of them enduring another stroke.
The Centres for Disease Control and Prevention (CDC) reports a sobering statistic: stroke-related deaths occur every three minutes.
For survivors, the danger of recurrence looms large, often resulting in further disability or even death. The new research on potassium-enriched salt substitutes offers hope, with the potential to reduce the risk of future strokes amid this crisis.
What the Study Found
The findings are based on a subgroup analysis of the Salt Substitute and Stroke Study (SSaSS), a large-scale randomised clinical trial conducted across 600 villages in northern China.
The study followed 15,249 participants, all of whom had a prior history of stroke, over an average period of five years. Researchers compared the effects of using a salt substitute—composed of 75% sodium chloride and 25% potassium chloride—against regular table salt.
The results were striking:
- A 14% reduction in recurrent stroke risk
- A 21% decrease in stroke-related deaths
- A 12% reduction in overall mortality
- A 30% lower risk of haemorrhagic stroke (bleeding in the brain)
- No significant increase in hyperkalaemia (high potassium levels), a common concern with increased potassium intake
These findings reinforce the World Health Organisation’s (WHO) recent recommendations promoting lower sodium and higher potassium intake to improve cardiovascular health.
How Potassium-Enriched Salt Substitutes Work
The key to the effectiveness of potassium-enriched salt lies in its ability to counteract the harmful effects of excess sodium. High sodium intake is a major risk factor for high blood pressure, which significantly increases the likelihood of stroke.
According to Dr. Rebecca DiBiase, MD, MPH, a vascular neurology expert at Yale New Haven Stroke Centre, “High blood pressure causes increased stress on the blood vessel walls, causing them to develop plaques and narrowing.” This narrowing restricts blood flow, making stroke more likely.
Dr. Thomas M. Holland, MD, MS, a physician-scientist at the RUSH Institute for Healthy Ageing, explains that potassium helps by acting as a vasodilator, meaning it widens blood vessels, reducing vascular strain. He states, “Reduced-sodium replaced by added-potassium salt as substitutes help lower blood pressure by reducing sodium intake, which directly reduces vascular strain.”
Even a small reduction of 1 mmHg in blood pressure can lower stroke risk by 5%, according to previous research.
Balancing Sodium and Potassium for Vascular Health
Stroke prevention is closely tied to diet, and a growing body of research points to the sodium-to-potassium ratio as a critical factor. Kiran Campbell, RDN, a registered dietitian specialising in cardiovascular health, suggests that balancing these two minerals could be more impactful than focusing on one over the other.
Campbell recommends including potassium-rich foods in the diet, offering a practical solution for improving cardiovascular health to help achieve this balance.
- Potatoes (with skin), tomatoes, bananas, avocados
- Beans, lentils, yoghurt, leafy greens, dried fruits
However, individuals with kidney disease or those taking certain medications should consult a doctor before using potassium-enriched salt substitutes, as their bodies may struggle to regulate potassium levels.
Practical Ways to Reduce Sodium Intake
While potassium-enriched salt substitutes are a helpful tool, they should be part of a broader strategy to reduce sodium intake and improve heart health. Experts recommend:
- Using herbs and spices instead of salt for seasoning
- Choosing fresh foods over processed or packaged items
- Opting for “no salt added” or low-sodium products
- Cooking meals at home to control sodium content
A Holistic Approach to Stroke Prevention
Experts agree that a well-rounded dietary and lifestyle strategy is essential to preventing strokes. Dr. Thomas Holland advocates for cutting out processed foods, fried fast foods, and baked goods while emphasising the need for more fresh fruits and vegetables.
Dr. Rebecca DiBiase supports this approach with her endorsement of the DASH diet (Dietary Approaches to Stop Hypertension), which encourages a diet rich in low-sodium, nutrient-dense foods.
“Simply adopting a healthier diet and exercise habits can go a long way in decreasing people’s risk of stroke and heart disease.” She adds, “The earlier we can teach this and have people implement these changes every day, the healthier our world will be!”