Reducing Sodium Intake to Prevent Stroke
Time for Action, Not Hesitation
The burden of stroke is enormous and increasing. According to the Global Burden of Disease Study, stroke is the second leading cause of mortality and the third leading cause of disability-adjusted life-years worldwide.1 In the United States, stroke is the second leading cause of mortality and the seventh leading cause of disability-adjusted life-years.2 Although standardized rates of stroke seem to be decreasing somewhat, the absolute number of strokes, both ischemic and hemorrhagic, have increased during the past 2 decades.3 Importantly, most strokes occur in low- and middle-income countries, which are poorly equipped to deal with the vast medical, economic, and societal consequences of strokes.
The relationship of blood pressure (BP) with stroke is direct and progressive throughout the range of usual BP, starting at a level of ≈115/75 mm Hg.4 It has been estimated that elevated BP accounts for 54% of stroke and 47% of coronary heart disease events.5 It is noteworthy that about half of these events occur in persons without hypertension. Prevention of stroke in this setting will require nonpharmacological approaches, given that such persons are not candidates for antihypertensive drug therapy.
Excess salt (sodium chloride) intake has a major role in the pathogenesis of elevated BP.6 Supportive evidence comes from animal studies, observational studies, trials, and meta-analyses. To date, >50 clinical trials have evaluated the effects of sodium reduction on BP in adults. A recent systematic review and meta-analysis of trials testing the effects of sodium intake on BP concluded that lowering sodium intake reduces BP in adults and children and that most people will likely benefit from reducing sodium intake.7
Although most studies on the health effects of sodium have been done in Western countries, several key studies have been done in Africa and Asia, where the burden of …