Salt substitutes and premature cardiovascular deaths in Africa: a modelling study

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Abstract Background/Introduction Hypertension is a leading cause of death worldwide, with many African countries experiencing significantly low rates of treatment and control. Lower sodium potassium-enriched salt substitutes (LSSS) are considered a cost-effective strategy for managing hypertension. However, the potential impact of widely adopting LSSS in Africa remains unclear. Purpose This study aimed to predict the long-term impact of a government-led strategy to gradually replace regular salt (100% sodium chloride) with LSSS (75% sodium chloride + 25% potassium chloride) over a ten-year period, focusing on hypertension and premature cardiovascular deaths across all African countries. Methods We developed a multicohort proportional multistate lifetable model in R Studio to simulate the impact of the LSSS strategy. Blood pressure distributions and epidemiological data were sourced from the Global Burden of Disease 2021 study. Meta-analyses of randomized controlled trials and cohort studies were used to estimate the effects of LSSS on blood pressure and related cardiovascular risk. To account for uncertainty in the model’s results, probabilistic sensitivity analysis was performed using Monte Carlo simulations. Results Our model projects that LSSS could reduce the age-standardized prevalence of hypertension in Africa by an average of 36%, with relative reductions ranging from 22% in South Africa to 61% in Ethiopia. By 2050, widespread adoption of these LSSS could decrease the probability of premature cardiovascular deaths in women by between 9.8% (95% uncertainty interval [UI]: 8.1% to 10.9%) in Ethiopia to 14.0% (95% UI: 10.3% to 17.8%) in Cameroon. For men, the predicted reductions in the probability of premature cardiovascular deaths range from 9.6% (95% UI: 8.4% to 11.7%) in Libya to 13.9% (95% UI: 10.2% to 17.7%) in Cameroon. Conclusions A continent-wide shift from current regular salt to LSSS could greatly lessen the impact of hypertension and cardiovascular disease in Africa.

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