Do Salt "Substitutes" Save Lives?

The 2 minute update looks at a meta-analysis asking if salt “substitutes” save lives

This 2024 meta-analysis evaluated 16 randomized trials. Researchers evaluated multiple outcomes, and there were at least 23,000 patients represented for each outcome. All of the trials replaced at least 25% of sodium chloride with potassium chloride, and some also included up to 10% magnesium sulfate. That’s really all that they did – replace some sodium chloride with potassium chloride. Follow-up was most commonly for 5 years, but ranged from 1-10 years.

Participants were high risk for cardiovascular events, often based on age or the presence of hypertension. Typically people were excluded if they were high risk for hyperkalemia, based on supplements, medications or severe renal disease, or if this intervention would place a household member at risk.

The results are impressive. All cause mortality fell 12% with the salt substitutes, and deaths from cardiovascular causes fell 17%. MACE – major adverse cardiovascular events, which typically included stroke, myocardial infarction and cardiovascular-related deaths – appears to be 15% lower, although the difference did not quite reach statistical significance. Of course, there’s a concern for hyperkalemia, but there was no difference in the rates of serious adverse events.

This is a very simple intervention, just replace 25% of someone’s table salt with potassium chloride

Most participants were in China, some were in Peru and Taiwan. Will this be consistent in other populations?

I did try this myself – I bought some potassium chloride and mixed it about 1:3 with sodium chloride. I cannot taste a difference, and one little container of potassium chloride will probably last years, and cost just a few dollars.

Reference: Greenwood et al. Long-Term Effect of Salt Substitution for Cardiovascular Outcomes. Ann Intern Med 2024:177:643