- Reducing sodium and increasing potassium intake can be a crucial strategy for minimizing the risk of stroke.
- Recent research indicates that using potassium-enriched salt substitutes instead of regular salt may lead to a 14% reduction in recurrent stroke rates and a 21% decrease in deaths related to strokes.
- Experts suggest that salt substitutes may help reduce stroke risk as a simple, low-cost intervention but should be part of a healthy diet and lifestyle.
Stroke remains a major health challenge in the United States, ranking as one of the leading causes of
According to the Centers of Disease Control and Prevention (CDC), over
Preventing strokes and mitigating their impact on individuals and families is crucial.
A new study offers hope, highlighting the potential of salt substitutes as a promising strategy to reduce stroke recurrence and mortality.
The research, published in
Results showed a significant 14% reduction in recurrent stroke rates and a 21% decrease in stroke-related deaths for those using a salt substitute compared to regular table salt.
These findings follow new guidelines from the World Health Organization (WHO) regarding lower sodium salt substitutes and build on previous studies supporting the role of salt substitutes in promoting vascular health.
This study was a subgroup analysis of participants from the Salt Substitute and Stroke Study (SSaSS), a large randomized clinical trial conducted across 600 villages in northern China. It followed participants for an average of around 5 years.
The SSaSS investigated how a potassium-enriched salt substitute could affect the risk of stroke, major cardiovascular events, and mortality compared to regular salt.
The substitute was composed of 75% sodium chloride and 25% potassium chloride.
This particular subgroup analysis included 15,249 individuals with a prior history of stroke. The average age of participants was 64 years, with 54.1% being male. Researchers evaluated their data between November 2023 and August 2024.
Among these participants, there were 2,735 cases of recurrent strokes, which included 691 fatal strokes and 2,044 nonfatal ones, as well as 3,242 recorded deaths.
The researchers found that those using the salt substitute instead of regular salt had a 14% reduction in the risk of recurrent strokes and a 12% decrease in overall mortality rates.
The results were even more pronounced for hemorrhagic strokes, showing a 30% reduction, and for stroke-related deaths, which decreased by 21%.
Importantly, the use of the potassium-enriched salt substitute did not significantly increase the risk of high potassium levels (hyperkalemia).
Diet, including salt intake, plays an important role in the risk of stroke. Regular table salt contains high levels of sodium, which can raise blood pressure when consumed in excess.
“Over time [high blood pressure] causes increased stress on the blood vessel walls, causing them to develop plaques and narrowing,” Rebecca DiBiase, MD, MPH, assistant professor of vascular neurology at the Yale New Haven Stroke Center, not involved in the study, told Medical News Today.
She explained that “narrowed blood vessels in the heart can make people more likely to have heart attacks, and narrowed blood vessels leading to and inside the brain can make people more likely to experience stroke.”
Thomas M. Holland, MD, MS, a physician-scientist and assistant professor at the RUSH Institute for Healthy Aging, RUSH University, College of Health Sciences, who was also not involved in the study, noted that “reduced-sodium replaced by added-potassium salt as substitutes help lower blood pressure by reducing sodium intake, which directly reduces vascular strain.”
He also pointed out that “the potassium component has a vasodilatory [vessel widening] effect, further enhancing and helping with blood pressure control.”
Holland explained that the combination of decreased sodium and increased potassium “reduces the risk of stroke recurrence and stroke-related deaths by mitigating a major stroke risk factor — the blood pressure.”
Previous research suggests that “even a small reduction in blood pressure (as little as 1 mm Hg) can lower stroke risk by 5%,” noted Kiran Campbell, RDN, a registered dietitian specializing in cardiovascular health.
Therefore, she added, “swapping regular salt for a potassium-enriched salt substitute offers a low-effort, high-impact solution for stroke survivors.”
Campbell, who also had no involvement in the recent study, highlighted that the body’s
Therefore, while potassium-enriched salt substitutes may be a helpful option, Campbell recommends also focusing on increasing potassium-rich foods and minimizing high-sodium sources to promote heart health and reduce stroke risk.
She recommends incorporating the following high-potassium foods:
- potatoes (with the skin on)
- tomatoes
- bananas
- avocados
- canned or dried beans and lentils
- yogurt
- leafy greens
- unsweetened dried fruits.
“In addition to improving the sodium-to-potassium ratio, these foods provide essential fiber and phytonutrients that further promote cardiovascular health,” she explained.
She cautioned that those taking certain medications and “people with kidney disease or reduced kidney function should be careful with potassium intake and should not use potassium-enriched salt substitutes.”
Campbell also recommended practical ways to lower sodium intake, such as:
- seasoning meals with herbs and spices instead of salt
- choosing fresh, whole foods over highly processed and convenience items
- opting for “no salt added” or low-sodium options when grocery shopping
- preparing meals at home instead of eating at restaurants to better control sodium content.
While salt substitutes show promise, experts agree they should be part of a healthy diet and lifestyle for maximum benefit.
“As you can imagine, beyond salt substitution, adopting a broader approach to dietary change—such as increasing fresh fruit and vegetable intake and reducing intake of processed foods, fried fast foods, baked goods—can further enhance neurovascular and cardiovascular health.”
— Thomas Holland, MD, MS
DiBiase suggested an evidence-based approach, the DASH diet (Dietary Approaches to Stop Hypertension). It focuses on nutrient-dense foods like fruits, vegetables, and whole grains while minimizing sodium.
“This diet is not very restrictive and can be adopted with some relatively simple modifications,” she noted.
“[Simply] adopting a healthier diet and exercise habits can go a long way in decreasing people’s risk of stroke and heart disease,” said DiBiase.
She concluded by exclaiming, “the earlier we can teach this and have people implement these changes every day, the healthier our world will be!”
