A new study by researchers from Duke Kunshan University, Wuhan University, and Harbin Medical University shows that replacing regular salt with a salt substitute can significantly reduce the risk of recurrent stroke and death from any cause.
The study, published in JAMA Cardiology, one of the world’s leading medical journals specializing in heart and vascular health, provides strong evidence that a simple dietary change could help millions of people live longer and healthier lives.
The study analyzed data from the Salt Substitute and Stroke Study, which followed more than 15,000 stroke patients across 600 villages in rural northern China. Researchers found that switching to a salt substitute lowered the risk of recurrent stroke by 14% and the risk of dying from any cause by 12%.
“Given that the mean systolic blood pressure in the salt substitute group decreased by 2.05 mm Hg, this observational finding further supports the conclusion that salt substitutes help lower blood pressure and improve cardiovascular outcomes,” said Lijing Yan, corresponding author, professor of global health and head of non-communicable chronic diseases research at Duke Kunshan. “Stroke is the leading disease burden in rural areas, and this study provides direct evidence that using a salt substitute can help reduce stroke recurrence and mortality.”
Significantly, the study found no increased risk of hyperkalemia, a common concern with potassium-enriched salt substitutes.
The research highlighted that salt substitutes are especially effective in areas where home-cooked meals are the main source of dietary sodium, as these diets are often high in sodium and low in potassium.
Participants were randomly assigned to either use a salt substitute (containing less sodium and more potassium) or continue using regular salt. Researchers tracked their health and monitored sodium and potassium levels to measure the effects of salt substitution on blood pressure and heart health.
Notably, the greatest reduction was seen in hemorrhagic stroke, where recurrence rates dropped by 30%. Since this type of stroke is closely linked to high blood pressure, the findings suggest that salt substitutes could be especially helpful for people at risk of bleeding strokes.
While salt substitutes benefit most people, researchers advise caution for those with chronic kidney disease, heart failure, or certain medications due to potential potassium risks. Further research is needed for these groups.
The first author of the paper, Xiong Ding, a researcher at Duke Kunshan’s Global Health Research Center and Ph.D. student at Wuhan University, played a key role in analyzing the data.
“Making salt substitutes the ‘mainstay’ in household kitchens aligns with the ‘Healthy China’ strategic goals. It represents a simple, safe, and cost-effective dietary intervention and strategy that deserves promotion and widespread adoption,” Lijing Yan and Maoyi Tian, another corresponding author from Harbin Medical University, further emphasized.
An editorial accompanying the study highlighted that salt substitutes are especially beneficial in regions where home cooking heavily relies on added salt. Therefore, it is recommended that the general adult population consider using salt substitutes.
