Replacing salt reduces mortality and stroke recurrence

Original paper reference

  • Original title: Salt Substitution and Recurrent Stroke and Death: A Randomized Clinical Trial
  • Published in: JAMA Cardiology, 2025
  • DOI: 10.1001/jamacardio.2024.5417

Paper abstract

This large randomized clinical trial in 600 villages in northern China evaluated the effects of a salt substitute (75% sodium chloride and 25% potassium chloride) in patients with a history of stroke. With a sample of 15,249 patients followed for over 5 years, it was shown that the use of salt substitutes significantly reduced stroke recurrence and overall mortality.

The results showed a 14% reduction in recurrent stroke, a 12% reduction in all-cause mortality, and a 30% reduction in hemorrhagic stroke. No increased risk of hyperkalemia was found, confirming the safety of this intervention.

Key points

  • Study with 15,249 patients with a history of stroke, followed for more than 5 years.
  • Use of modified salt: 75% NaCl and 25% KCl.
  • 14% reduction in the risk of recurrent stroke.
  • 12% reduction in total mortality and 21% reduction in stroke-related deaths.
  • Particularly significant reduction in hemorrhagic stroke (−30%).
  • No increased risk of hyperkalemia (RR = 1.01; not significant).
  • Mean reduction in systolic blood pressure of −2.05 mm Hg.
  • Consistent results across all subgroups (age, sex, hypertension, diabetes).
  • Low-cost, safe, effective, and scalable intervention.
  • Especially relevant for settings where cooking with salt is done at home.
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