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Cardiovascular diseases are the major cause of morbidity, disability and death in the world. Furthermore, approximately 62% of all strokes and 49% of coronary heart disease events are attributable to high blood pressure. High salt intake is one of the major potentially modifiable causes of the global burden of stroke and other cardiovascular events,1 2 mainly through its effect on population blood pressure. A 5 g/day difference in habitual salt intake is associated with a 23% difference in the rate of stroke (representing approximately 1.25 million deaths world wide each year) and a 17% difference in the rate of total cardiovascular disease (approximately 3 million deaths world wide).2 Citizens in most countries eat salt far in excess of healthy physiological requirements. Substantially reducing dietary salt intake is therefore an important priority for public health. In recent years, the debate has shifted from ‘whether reducing salt intake is of public health benefit’ to ‘how best to reduce population salt intake to save the most lives’. Several countries and health organisations have therefore developed recommendations for the reduction of salt intake in populations to reduce the increasing burden of cardiovascular disease. They have also provided evidence-based appraisals on how this might be achieved in specific settings.3–6 The current population salt targets set by the World Health Organization are 5 g/day,3 with some countries aiming for even less in the longer term.4 5 In most developed economies, however, the majority of salt in our diets is added during food production, long before it is sold. That excess is therefore not a matter of personal choice. Moreover, before acting, all countries will need to satisfy increasingly stringent cost-effectiveness criteria within a general climate of ageing populations, escalating healthcare demands and recently reduced financial resources.
The study by Cobiac et al7 …