Cutting, Taxing Salt Would Trim CVD Deaths by 3% in Half the World

Shelley Wood

April 24, 2012

April 23, 2012 (Dubai, United Arab Emirates) — A combined approach of reducing salt content by just 10% in processed foods and taxing foods with high salt content could reduce cardiovascular deaths in developing countries by as much as 3%, a new modeling study suggests. This two-pronged approach would also be cheap, Dr Thomas Gaziano (Harvard School of Medicine, Boston, MA) told journalists this past Saturday at the World Congress of Cardiology 2012 .

Dr Thomas Gaziano

"A 3% reduction is considerable," Gaziano told heartwire . "It would translate to 500 000 fewer deaths per year if there were global adoption or 250 000 in the 19 countries we [modeled]. Also several million nonfatal heart attacks and strokes would be prevented."

Hypertension is the number-one risk factor for death worldwide, accounting for 12.8% of deaths every year, Gaziano noted. It also accounts for 10% of all healthcare spending worldwide--$450 billion per year in the US alone.

Gaziano and colleagues modeled the impact of applying the approach to sodium reduction used in the UK to 19 developing countries, making up half the world's population. That approach includes voluntary collaboration on the part of food manufacturers to reduce sodium content by 10% and adding a 40% tax to salty foods--similar to the taxes applied to tobacco in many countries.

According to Gaziano, both strategies proved cost saving in all countries and would lead to a drop of roughly 3% in the rate of cardiovascular deaths. Stroke rates would drop even more sharply, he added, by as much as 5%.

Collaboration with industry to reduce sodium content in foods was the more effective strategy of the two and produced the most cost savings, he noted. Both, however, were cheap--in the range of $43 to $49 per capita over the lifetime of the individual.

Screening Would Cut Another 3%

Gaziano and his coinvestigators also modeled a strategy of increased screening and treatment for high-risk hypertensives. Here, too, they found that population screening would also reduce cardiovascular deaths in low- and middle-income countries by roughly 3% and at a cost per disability-adjusted life-year falling well below accepted cost-efficacy cut points used in the US and UK and by the World Health Organization.

In interviews, Gaziano stressed the model wasn't ambitious in its salt targets--rather than set a specific level that industry would be asked to conform with, the model looked only at whether a 10% reduction would have any impact, even though, for many countries, a 10% reduction would still leave daily sodium-intake levels far higher than those recommended by groups such as the AHA and other professional organizations. Daily guidelines for maximum sodium consumption are 2300 mg among the general population and 1500 mg for specific, high-risk populations, such as African Americans and those with hypertension, diabetes, and chronic kidney disease--a broad group that likely covers more than half of the US population alone.

The countries modeled in Gaziano's study were primarily in South and Central America, South and Central Africa, and the Middle East, as well as India, Russia, and China.

Getting to Global Targets

Johanna Ralston

Also speaking with the press, World Heart Federation CEO Johanna Ralston pointed out that a 25% reduction in blood pressure, globally, is one of the targets set during last year's UN Summit on Noncommunicable Disease in New York, which also set a 25% reduction in premature deaths due to cardiovascular causes overall. Global leaders are to sign on to the WHO's cardiovascular mortality goals before May 2012.

"Timing of release of this study is extremely important," she said. "This study provides critical evidence to make the case to ministries of finance and other decision-makers of the importance of simple yet critical interventions in improving the health of their populations," she said.

Gaziano did the math for heartwire : "Each 3% is about 12.5% of that [WHO] target, meaning that you need about eight such interventions to achieve the goal [of 25%]. If, say, one salt intervention and the screening intervention were adopted, this would get the world 6%, or one-quarter, of the 25% goal.  Smoking interventions, improvements in acute treatments, and other dietary interventions to reduce saturated or trans-fat, etc, will need to fill the gap."

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