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Switching Salt for Health: The Heart-Healthy Promise of Salt Substitution

Written by Andrew Le, MD

UpdatedMay 29, 2024

The simple act of swapping table salt with a substitute could have significant benefits for heart health, suggests a comprehensive review and meta-analysis published in the Annals of Internal Medicine. According to a team of researchers who analyzed data from randomized controlled trials, using reduced-sodium, potassium-enriched salt alternatives may potentially decrease the risk of all-cause and cardiovascular mortality.

The team, led by Hannah Greenwood, with contributions from Katelyn Barnes, Justin Clark, Lauren Ball, and Loai Albarqouni, scoured databases like PubMed and EMBASE up until late August 2023 to find relevant trials. They focused on adult participants who used salt substitutes instead of regular salt for at least six months.

Their analysis included 16 trials, with most conducted in China or Taiwan, targeting older individuals or those with a higher risk of cardiovascular diseases (CVD). The results suggested that salt substitutes might reduce the risk of death due to any cause by 12% and specifically reduce cardiovascular deaths by 17%. The evidence also hinted at a possible slight reduction in major cardiovascular events.

Despite these promising findings, the evidence has its limitations. The majority of the data comes from one large randomized controlled trial and predominantly involves participants from East Asian countries, which limits the generalizability of the results to other populations.

This thorough investigation consolidates the idea that salt substitution could be a viable strategy to tackle heart-related mortality and diseases, but there remains a degree of uncertainty, especially in applying these outcomes to Western populations. Further research is needed to conclusively determine the effect of salt substitutes on populations with diverse dietary habits.

The study, funded by the National Health and Medical Research Council, is a step towards understanding the potential of dietary interventions in cardiovascular prevention and treatment.

For more on this heart-healthy salt switch, the full article can be accessed via, published on April 9, 2024, with the article identifier doi:10.7326/M23-2626. This news article was built with the help of Buoy Health.


Greenwood, H., Barnes, K., Clark, J., Ball, L., & Albarqouni, L. (2024). Long-Term Effect of Salt Substitution for Cardiovascular Outcomes: A Systematic Review and Meta-Analysis. Annals of Internal Medicine. doi:10.7326/M23-2626