journal · Public research summary
Effect of Salt Substitution on Cardiovascular Events and Death
A reduced-sodium, potassium-enriched salt substitute lowered stroke rates compared with regular salt in this higher-risk population.
Educational only. Associations do not establish individual risk or diagnosis. Read the original sources and limitations. Editorial review: 2026-10-06.
Citation
Neal et al. · New England Journal of Medicine · 2021 · DOI: 10.1056/NEJMoa2105675
Study design
Randomised trial
Population
20,995 people in 600 villages; prior stroke or age ≥60 with high blood pressure.
Geography
Rural China
Finding
A reduced-sodium, potassium-enriched salt substitute lowered stroke rates compared with regular salt in this higher-risk population.
Estimate
Stroke: 29.14 vs 33.65 events per 1,000 person-years; rate ratio 0.86 (95% CI 0.77–0.96). Mean follow-up: 4.74 years.
Measured relationship
Salt substitute → stroke and cardiovascular events. The intervention changed both sodium and potassium, not sodium alone.
Limitations
An open-label cluster trial in a selected population. Potassium-containing substitutes are not appropriate for everyone, especially with impaired potassium excretion; this is not personal treatment advice.