Projected Impact of Salt Restriction on Prevention of Cardiovascular Disease in China: A Modeling Study

Miao Wang,Pamela G Coxson,Joanne Penko,Andrew E Moran,Kirsten Bibbins-Domingo,Lee Goldman,Dong Zhao,Jing Liu,An Pan

doi:10.1371/journal.pone.0146820

Abstract

ObjectivesTo estimate the effects of achieving China’s national goals for dietary salt (NaCl) reduction or implementing culturally-tailored dietary salt restriction strategies on cardiovascular disease (CVD) prevention.MethodsThe CVD Policy Model was used to project blood pressure lowering and subsequent downstream prevented CVD that could be achieved by population-wide salt restriction in China. Outcomes were annual CVD events prevented, relative reductions in rates of CVD incidence and mortality, quality-adjusted life-years (QALYs) gained, and CVD treatment costs saved.ResultsReducing mean dietary salt intake to 9.0 g/day gradually over 10 years could prevent approximately 197 000 incident annual CVD events [95% uncertainty interval (UI): 173 000–219 000], reduce annual CVD mortality by approximately 2.5% (2.2–2.8%), gain 303 000 annual QALYs (278 000–329 000), and save approximately 1.4 billion international dollars (Int$) in annual CVD costs (Int$; 1.2–1.6 billion). Reducing mean salt intake to 6.0 g/day could approximately double these benefits. Implementing cooking salt-restriction spoons could prevent 183 000 fewer incident CVD cases (153 000–215 000) and avoid Int$1.4 billion in CVD treatment costs annually (1.2–1.7 billion). Implementing a cooking salt substitute strategy could lead to approximately three times the health benefits of the salt-restriction spoon program. More than three-quarters of benefits from any dietary salt reduction strategy would be realized in hypertensive adults.ConclusionChina could derive substantial health gains from implementation of population-wide dietary salt reduction policies. Most health benefits from any dietary salt reduction program would be realized in adults with hypertension.

Highlights

Hypertension is a leading contributor to the epidemic of cardiovascular disease (CVD) in China [1], and high salt intake is an important behavioral cause of raised blood pressure (BP) and hypertension [2, 3]
Projected Impact of Salt Restriction in China researchers in order to assess the feasibility of collaboration and clarify any questions about the research question, whether the CVD Policy Model is designed to address the question
Most health benefits from any dietary salt reduction program would be realized in adults with hypertension

Summary

Introduction

Hypertension is a leading contributor to the epidemic of cardiovascular disease (CVD) in China [1], and high salt intake is an important behavioral cause of raised blood pressure (BP) and hypertension [2, 3]. China’s mean daily salt (NaCl) consumption is more than 12 g/day, higher than in most other countries [4, 5]. Reducing daily salt consumption has been proposed as part of China’s national strategy for non-communicable disease (NCD) prevention [6, 7]. The objective of the national government’s Work Plan of Chronic Non-Communicable Disease Prevention was to decrease daily mean salt intake level below 9.0g during China's 12th Five-Year Plan. Potential downstream CVD health benefits of reaching national dietary salt reduction goals have not been estimated. This study integrated data from Chinese data sources into a population-scale simulation model and projected potential health benefits and health care cost savings from prevented CVD if national salt reduction goals are achieved among 35–94 years old adults in China as planned

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Conclusion