Cardiovascular disease deaths and high sodium consumption in Shandong province and China: a modelling analysis

• Published in: The Lancet (British edition) Vol. 386; p. S80
• Main Authors: Liu, Shiwei, PhD, Cai, Xiaoning, MMS, Hong, Yuling, Prof, Yang, Quanhe, PhD, Engelgau, Michael, MD, Ge, Zeng, PhD, Cai, Ying, MA, Li, Yichong, PhD, Wang, Limin, Prof, Ma, Jixiang, Prof, Zhou, Maigeng, Prof
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 01.10.2015; Elsevier Limited
• Subjects: Blood pressure; Cardiovascular diseases; Family planning; Hypertension; Internal Medicine; Monte Carlo simulation; Mortality; Prevention; Risk assessment; Risk factors; Sodium
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(15)00661-3

Abstract Background Sodium intake and the prevalence of increased blood pressure are high in China, especially in northern China, including Shandong province where the Shandong-Ministry of Health Action on Sodium and Hypertension (SMASH) is currently underway. The aim of this study is to estimate the benefit of mortality from sodium reduction for both Shandong province and China. Methods We obtained blood pressure values from the Chinese 2010 National Chronic Diseases and Risk Factors Surveillance. Sodium intake as measured by 24 h urinary excretion was obtained from the 2011 SMASH baseline survey for Shandong and extracted from the 2010 Global Burden of Disease (GBD) project for China. We derived cause-specific mortality from the GBD project and used the GBD comparative risk assessment framework and Monte Carlo simulation techniques to estimate annual deaths from cardiovascular disease attributable to high sodium consumption (mediated through elevated systolic blood pressure), and cardiovascular mortality averted by achieving sodium-reduction targets. The baseline survey in SMASH received ethical approval from the ethics committee of Shandong Center for Disease Control and Prevention. The survey of National Chronic Diseases and Risk Factors Surveillance received ethical approval from National Health and Family Planning Commission of China and the ethics committee of the Chinese Center for Disease Control and Prevention. All enrolled participants gave written informed consent. Findings 441 200 (95% uncertainty interval 356 100–571 000) deaths from cardiovascular disease were attributable to high sodium consumption (2 g/day as a reference) in China, accounting for 12·8% (8·8–15.4%) of total deaths from cardiovascular disease in adults aged 25 years and more. In Shandong province, 34 500 (25 600–48 400) deaths from cardiovascular disease were attributable to high sodium consumption, the equivalent of 11·6% (8·0–14.6%) of all deaths from cardiovascular disease. We estimated that 248 800 (170 400–290 600) deaths or 208 100 deaths (124 700–260 900) from cardiovascular disease could be prevented each year if sodium consumption was reduced from the 2010 baseline to 3·5 g/day or 4·0 g/d, respectively. If sodium consumption was reduced from the 2010 baseline by 30%, we estimate that 231 300 (168 300–294 500) deaths from cardiovascular disease could be prevented each year. In Shandong province alone, 19 800 (13 800–24 900), 14 400 (10 100–19 500), and 18 300 (13 400–25 500) deaths from cardiovascular disease are estimated to be prevented under these three scenarios each year. Interpretation In 2010, more than 10% of deaths from cardiovascular disease were attributable to high sodium consumption in Shandong province and China. Potential benefits from a population-wide reduction of sodium intake are considerable. The successful outcomes of the SMASH project in Shandong suggests that implementation of SMASH-like interventions elsewhere in China would help reduce the number of deaths from cardiovascular disease. Funding US Centers for Disease Control and Prevention through the Cooperative Agreement between the US Centers for Disease Control and Prevention and China Center for Disease Control and Prevention.