Salt substitution reduces stroke recurrence, saves lives

Use of a salt substitute is not only safe but reduces recurrent stroke and saves lives, researchers reported on Feb. 5, 2025 in JAMA Cardiology.

“The results suggest that salt substitution significantly reduced the risks of stroke recurrence and death and is a novel and practical therapeutic option for patients with stroke,” the authors said.

The SSaSS trial was conducted in 600 villages across 5 provinces in northern China.

Researchers in the open-label trial assessed benefits and risks associated with the use of a salt substitute (75% sodium chloride, 25% potassium chloride) vs regular salt (100% sodium chloride).

Data were analyzed from November 2023 to August 2024.

The primary outcome was the incidence of recurrent stroke.

For this sub-analysis, the investigators excluded 5,746 potential subjects without a history of stroke.

They included 15,249 subjects with a history of stroke (mean age, 64.1 years)

Of the included subjects 6,999 (45.9%) were female and 8,250 were male (54.1%).

Over a mean period of 61.2 months, the investigators reported 2,735 recurrent stroke events (691 fatal and 2,044 nonfatal). They also reported 3,242 deaths.

Recurrent stroke was significantly lower in the salt substitute  group vs regular salt group (P = .005), with a larger effect on hemorrhagic stroke (comparative reduction of 30%; P = .002).

Death rates were also significantly lower for the salt substitute group compared to the salt-using group (P=.003), with larger effect on stroke-related deaths (comparative reduction 21%; P = .01).

“No significant difference was observed for hyperkalemia,” the researchers noted.

The authors concluded, “In this prespecified subgroup analysis of the Salt Substitute and Stroke Study (SSaSS) trial involving 15,249 patients with stroke, the use of a salt substitute led to a 14% reduction in the risk of recurrent stroke and a 12% reduction in mortality.  Results suggest that salt substitution significantly reduced the risks of stroke recurrence and death and is a novel and practical therapeutic option for patients with.”