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Cutting Salt Could Prevent Almost 500,000 Heart Attacks
Date:3/1/2010

Government-industry collaboration would work better than a "salt tax," study finds

MONDAY, March 1 (HealthDay News) -- A combined government-industry initiative to reduce U.S. sodium consumption by as little as 10 percent would save thousands of lives and billions of dollars, according to new research.

Cutting salt reduces blood pressure, a key factor contributing to heart attacks and stroke.

"Per person on average it is a very small decrease in blood pressure, but over large populations, we saw a significant reduction in cardiovascular disease and in cost savings," said Dr. Crystal Smith-Spangler, lead author of a study in the March 2 issue of Annals of Internal Medicine.

"This new report strongly supports the conclusion that a concerted national effort to reduce sodium in processed foods would save hundreds of thousands of lives at minimal cost," added Dr. Walter Willett, chairman of nutrition and epidemiology at the Harvard School of Public Health in Boston. "We should not delay taking on this challenge."

Like several other recent reports and recommendations, the study advocates a population-based strategy to reduce salt intake and, thereby, blood pressure.

Willett was a co-author of an Institute of Medicine (IOM) report released a week ago urging public-health initiatives to combat salt consumption.

And the New York City Health Department, under Mayor Michael Bloomberg, has announced that it is spearheading the National Salt Reduction Initiative, which aims for a 20 percent reduction in salt consumption over five years.

The initiative is targeted primarily at restaurants and food manufacturers, which supply the majority of sodium in American diets.

According to a commentary in the same issue of the journal, co-authored by Dr. Thomas R. Frieden, director of the U.S. Centers for Disease Control and Prevention, too much salt is responsible for 100,000 deaths each year in the United States.

To estimate the potential lives saved from a reduction in salt intake, the researchers devised computer models assessing the cost-effectiveness of two scenarios.

The first scenario was a government collaboration with the food industry to reduce the amount of sodium in processed foods, similar to an effort undertaken in the United Kingdom that has led to an estimated 9.5 percent decline in overall sodium consumption among its residents.

A similar reduction of 9.5 percent in the United States would prevent 531,885 strokes and 480,358 heart attacks over the lifetime of adults ages 40 to 85, would increase quality-adjusted life years by 2.1 million and would save $32.1 billion in medical costs, the authors stated.

The second scenario involved a tax on salt that would increase the price by 40 percent and lower intake by 6 percent. This would prevent an estimated 327,892 strokes and 306,137 heart attacks, save about $22.4 billion and would increase quality-adjusted life years by 1.3 million.

The first option -- a government/industry united effort -- makes more sense and yielded better results, according to both the study authors and Frieden.

If done slowly, American taste buds might even adjust to the change, according to Dr. David Fleming, chairman of the IOM committee and director of public health for Seattle and King County, Washington. He spoke during a Feb. 22 teleconference on the issue.

"If you look at the experience in other countries, for example, the U.K., which has been a leader in reducing salt, we find that if you drop the amount of salt precipitously, people notice," Fleming said. "But if you drop it slowly over time, months or a year, then nobody notices."

Dr. John Bisognano, a professor of medicine and director of outpatient cardiology at the University of Rochester Medical Center and president of the New York Chapter of the American College of Cardiology, said that "there's a recognition that we're getting salt from processed and restaurant food."

"Even if you're trying your best at home to restrict salt intake, one can of really good soup or one trip to the buffet at a restaurant and you've exceeded the recommendation," Bisognano said.

For people with chronic kidney disease or heart failure, such an unintended spree could also mean a trip to the emergency room, he said.

"Our idea is to create a healthier environment so people, by default, make healthier choices," said Smith-Spangler, who is a health services researcher at the Stanford University Center for Health Policy and a physician with the Veterans Administration Palo Alto Healthcare System. "If manufacturers were able to work with us and decrease sodium in processed food, it would be easier to decrease sodium intake."

More information

The American Heart Association has more on shaking the salt habit.



SOURCES: Crystal Smith-Spangler, M.D., health services researcher, Stanford University Center for Health Policy, and physician, Veterans Administration Palo Alto Healthcare System, Palo Alto, Calif.; Walter Willett, M.D., Dr.P.H., Fredrick John Stare professor, epidemiology and nutrition, and chairman, department of nutrition and epidemiology, Harvard School of Public Health, Boston; John Bisognano, M.D., Ph.D., professor, medicine, and director, outpatient cardiology, University of Rochester Medical Center, Rochester, N.Y., and president, New York chapter, American College of Cardiology; Feb. 22, 2010, teleconference with David W. Fleming, M.D., director, public health, Seattle and King County, Washington; March 2, 2010, Annals of Internal Medicine


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