Secondary Analysis of the Salt Substitute and Stroke Study (SSaSS): Effects of Potassium-Enriched Salt on Cardiac Outcomes,Hypertension

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Secondary Analysis of the Salt Substitute and Stroke Study (SSaSS): Effects of Potassium-Enriched Salt on Cardiac Outcomes
Hypertension ( IF 6.9 ) Pub Date : 2024-03-11 , DOI: 10.1161/hypertensionaha.123.22410
Jie Yu _{1,

2,

3} , Clare Arnott _{1,

2,

4,

5} , Qiang Li ₁ , Gian Luca Di Tanna ₁ , Maoyi Tian ₆ , Liping Huang ₁ , Xuejun Yin _{1,

7} , Xinyi Zhang ₆ , Sallie-Anne Pearson ₈ , Darwin R. Labarthe ₉ , Paul Elliott ₁₀ , Lijing L. Yan _{11,

12} , Bo Zhou ₁₃ , Yangfeng Wu _{11,

14} , Bruce Neal _{1,

15,

16}

Affiliation

The George Institute for Global Health, University of New South Wales, Sydney, Australia. (J.Y., C.A., Q.L., G.L.D.T., L.H., X.Y., B.N.)
Faculty of Medicine, University of New South Wales, Sydney, Australia. (J.Y., C.A.)
Sydney Medical School, Department of Cardiology, Peking University Third Hospital, Beijing, China. (J.Y.)
University of Sydney, Australia (C.A.).
Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia (C.A.).
School of Public Health, Harbin Medical University, Harbin, China (M.T., X.Z.).
School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Y.).
School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia. (S.-A.P.)
Northwestern University Feinberg School of Medicine, Chicago, United States (D.R.L.).
School of Public Health, Imperial College London, United Kingdom. (P.E.)
The George Institute for Global Health at Peking University Health Science Centre, Beijing, China (L.L.Y., Y.W.).
Global Health Research Centre, Duke Kunshan University, Kunshan, China (L.L.Y.).
First Hospital of China Medical University, Shenyang, China (B.Z.).
Peking University Clinical Research Institute, Beijing, China (Y.W.).
The Charles Perkins Centre, Department of Cardiology, Peking University Third Hospital, Beijing, China. (B.N.)
Department of Epidemiology and Biostatistics, Imperial College London, United Kingdom. (B.N.)

BACKGROUND:The SSaSS (Salt Substitute and Stroke Study) has shown that use of a potassium-enriched salt lowers the risk of stroke, total cardiovascular events, and premature death. The effects on cause-specific cardiac outcomes are reported here.METHODS:SSaSS was an unblinded, cluster-randomised trial assessing the effects of potassium-enriched salt compared with regular salt among 20 995 Chinese adults with established stroke and older age and uncontrolled hypertension. Post hoc efficacy analyses were performed using an intention-to-treat method and a hierarchical Poisson regression model adjusting for clustering to obtain rate ratios and 95% CIs. We assessed acute coronary syndrome, heart failure, arrhythmia, and sudden death.RESULTS:Over a mean 4.74 years follow-up, there were 695 acute coronary syndrome events, 454 heart failure events, 230 arrhythmia events, and 1133 sudden deaths recorded. The rates of events were lower in potassium-enriched salt group for all outcomes but CIs were wide for most: acute coronary syndrome (6.32 versus 7.65 events per 1000 person-years; rate ratio, 0.80 [95% CI, 0.65–0.99]); heart failure (9.14 versus 11.32 events per 1000 person-years; rate ratio, 0.88 [95% CI, 0.60–1.28]); arrhythmia (4.43 versus 6.20 events per 1000 person-years; rate ratio, 0.59 [95% CI, 0.35–0.98]); and sudden death (11.01 versus 11.76 events per 1000 person-years; rate ratio, 0.94 [95% CI, 0.82–1.07]; all P>0.05 with adjustment for multiple comparisons).CONCLUSIONS:These results suggest that use of potassium-enriched salt is more likely to prevent than cause cardiac disease but the post hoc nature of these analyses precludes definitive conclusions.REGISTRATION:URL: https://www.clinicaltrials.gov; Unique identifier: NCT02092090.

更新日期：2024-03-11

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