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Author Manuscript
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Published in final edited form as:
N Engl J Med. 2010 February 18; 362(7): 590–599. doi:10.1056/NEJMoa0907355.

Reductions in Cardiovascular Disease Projected from Modest
Reductions in Dietary Salt
Kirsten Bibbins-Domingo, PhD, MD1,2,3,4, Glenn M. Chertow, MD, MPH5, Pamela G.
Coxson, PhD1,3,4, Andrew E. Moran, MD, MAS6, James M. Lightwood, PhD7, Mark J.
Pletcher, MD, MPH1,2, and Lee Goldman, MD, MPH6
1Department of Medicine, University of California, San Francisco (UCSF), San Francisco,California
2Department of Epidemiology and Biostatistics, UCSF
3Division of General Internal Medicine, San Francisco General Hospital, UCSF

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4UCSF Center for Vulnerable Populations at San Francisco General Hospital
5Department of Medicine, Stanford University, Palo Alto, California
6Department of Medicine, College of Physicians and Surgeons, Columbia University, New York
7Department of Clinical Pharmacy, School of Pharmacy, UCSF

Abstract
Background—The US diet is high in salt, with the majority coming from processed foods.
Reducing dietary salt is an important potential public health target.
Methods—We used the Coronary Heart Disease (CHD) Policy Model to quantify the benefits ofpotentially achievable population-wide reductions in dietary salt of up to 3 gm/day (1200 mg/day
of sodium). We estimated cardiovascular disease rates and costs in age, sex, and race subgroups,
compared salt reduction with other interventions to reduce cardiovascular risk, and determined thecost-effectiveness of salt reduction compared with drug treatment of hypertension.

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Results—Reducing salt by 3 gm/day is projected to result in 60,000–120,000 fewer new CHD
cases, 32,000–66,000 fewer new strokes, 54,000–99,000 fewer myocardial infarctions, and44,000–92,000 fewer deaths from any cause annually. All segments of the population would
benefit, with blacks benefiting proportionately more, women benefiting particularly from stroke
reduction, older adults from reductions in CHD events, and younger adults from lower mortality
rates. The cardiovascular benefits from lower salt are on par with benefits from reducing tobacco,
obesity, or cholesterol. A regulatory intervention designed to achieve 3 gm/day salt reduction
would save 194,000–392,000 quality-adjusted life-years and $10–24 billion in healthcare costs
annually. Such an intervention would be cost-saving even if only a modest 1 gm/day reduction
were achieved gradually over the decade from 2010–2019 and would be more cost-effective thantreating all hypertensive individuals with medications.
Conclusions—Modest reduction in dietary salt could substantially reduce cardiovascular eventsand medical costs and should be a public health target.

Corresponding Author: Kirsten Bibbins-Domingo, PhD, MD, Associate Professor of Medicine and of Epidemiology and Biostatistics,
University of California, San Francisco, Box 1364 UCSF-SFGH, San Francisco, CA 94143-1364, Phone: 415-206-4464, Fax:
415-206-5586, Kirsten.Bibbins-Domingo@ucsf.edu, kdomingo@medsfgh.ucsf.edu.

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Page 2Introduction
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The US diet is high in salt. The Departments of Agriculture and Health and Human Services
recommend daily intake of less than 6 grams of salt (2300 mg of sodium), with a lower
target of 3.7 gm/day of salt for most adults (persons over age 40, blacks, and persons withhypertension.1 Despite these guidelines, in 2005-6 the average adult man in the US isestimated to have consumed 10.4 gm/day and the average woman 7.3 gm/day, amounts
higher than preceding years.2

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Reducing dietary salt lowers blood pressure and cardiovascular risk.3, 4 Lowering salt intake
is challenging, in part because 75–80% of the salt in the US diet comes from processed
foods, not from salt added during food preparation or consumption.5, 6 Many countries,
including Japan, the United Kingdom, Finland, and Portugal, have reduced population-widesalt intake through a combination of regulations on the salt content in processed foods,
labeling of processed and prepared foods, public education, and engagement with the foodindustry.7 To explore the potential impact of a modest reduction in dietary salt on population
health, we used the Coronary Heart Disease (CHD) Policy Model, a computer simulation ofheart disease in US adults ages 35–84, and an extension that assesses stroke. We estimatedthe effects in different segments of the US population, compared these projections to thehealth benefits expected from a range of other public health and clinical interventions aimed
at reducing cardiovascular disease, and analyzed the relative cost-effectiveness of salt
reduction compared with treatment of hypertensive individuals with medications.

Methods
Structure of the Model

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The CHD Policy Model (see Appendix) is a computer-simulation, state-transition (Markov
cohort) model of CHD incidence, prevalence, mortality, and costs in the US population overage 35 that has been used to describe CHD trends, and the effects of interventions to treat
CHD risk factors.8, 9The Model has three sub-models: the demographic-epidemiologic submodel predicts CHD incidence and non-CHD mortality among the population without CHD,
stratified in these simulations by age, sex, and six risk factors; systolic blood pressure (SBP),
use of anti-hypertensive medications, smoking, high density lipoprotein (HDL) cholesterol,low-density lipoprotein (LDL) cholesterol, and diabetes mellitus. After CHD develops, thebridge sub-model characterizes the initial CHD event and its sequelae for 30 days. Then, thedisease-history sub-model predicts subsequent CHD events and CHD and non-CHD
mortality among simulated subjects with CHD, stratified by age, sex, and history of events.
Model inputs are derived from national datasets and calibrated to national event rateestimates.
In addition to the standard Model of the entire US population, we also created race-specificversions of the Model for the black and non-black population in the US. We derived racespecific distribution of risk factors for CHD from NHANES. The same Framingham-derived
beta coefficients were used for all three versions of the Model, but the average incidence
rate (alpha or intercept) was specific for each population.10 The average incidence rates forthe black and non-black sub-populations from the Model were validated with national data.
11 In sensitivity analyses we also examined black-specific beta coefficients. We did not
assign a coefficient to use of anti-hypertensive medications; rather we used the SBP value or
use of anti-hypertensive medications to define the hypertensive population that might bemore responsive to a salt reduction. Finally, we extended the Model to estimate incident
stroke using beta coefficients derived from Framingham and published rates of incident
stroke.12, 13

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Page 3Modeling approach and underlying assumptions

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We modeled the linear effect of reducing daily salt intake by 0–3 grams/day14 using a lower
estimate for the effect of salt reduction on SBP based on a large meta analysis3, 15 and ahigher estimate based on clinical trial data.16, 17 We modeled an accentuated response to salt
reduction among blacks, persons with hypertension, and persons 65 years or older (Table 1).
16, 18–21 We compared reductions in events for salt restriction with other interventions
aimed at reducing cardiovascular risk by modeling a 50% reduction in smoking andenvironmental tobacco exposure,22 a 5% reduction in body mass index among obese adults,8treatment of low and intermediate risk individuals with statins in accordance with theguidelines outlined in the Adult Treatment Panel III,9 and treatment of hypertension as
described in the ALLHAT trial.23, 24

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We conducted simulations in the entire US population and among black and non-black
subgroups and estimated annual reductions in incident CHD, total MI, incident stroke, anddeath from any cause as a result of reductions in dietary salt for the entire population andseparately by age, sex and race. We projected healthcare costs saved and quality-adjusted
life years (QALY) gained annually, overall and in the Medicare population, from a
population-wide intervention to reduce salt, using the World Health Organization estimates
for the cost of such a national effort of $1 per person annually,25 and from treatment ofhypertension with antihypertensive medications.24 We also reported cumulative costs andeffectiveness over the decade from 2010–2019 if the effects of an intervention were phasedin gradually over time.
Sensitivity Analyses
We used Monte Carlo simulations to estimate the uncertainty of our projections for both thehigh and low estimates for the effects of salt reduction on SBP. Beta coefficients for the
association of SBP, LDL and HDL cholesterol, and diabetes with both CHD events anddeaths not associated with CHD were assumed to have a normal probability distribution,with standard errors derived from the fitted regression. We generated covariance matrices
for each of these beta coefficients. On the basis of evidence for minimal correlation between
factors, we assumed effects to be independent. For each simulation, we report the mean(±SE) for 1000 simulations. We conducted sensitivity analyses varying the impact of salt
reduction on changes in cardiovascular risk based on estimates suggesting that treating
blood pressure through salt reduction or medication use does not lower cardiovascular risk
to the same level as native blood pressure.26

Results
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A population-wide reduction in dietary salt of 3 gm/day (1200 mg/day of sodium) is
projected to result in 60,000–120,000 fewer new cases of CHD, 54,000–99,000 fewer new
and recurrent MIs, 32,000–66,000 fewer new strokes, and 44,000–92,000 fewer deaths fromany cause annually compared with current levels of salt consumption. Since the relationshipbetween reductions in salt and the projected reductions in event rates is linear over the range
examined, even a more modest 1 gm/day reduction is projected to result in large reductionsin annual cardiovascular events and deaths (20,000–40,000 fewer new cases of CHD,
18,000–35,000 fewer new and recurrent MIs, 11,000–23,000 fewer new strokes, and
15,000–32,000 fewer deaths from any cause).
All adult age groups, both sexes, and blacks and non-blacks would all be expected to benefit
from reductions in salt intake (Figure). The anticipated relative benefits in blacks weregreater than those for non-blacks across all age and sex groups. Women were projected tohave greater reductions in stroke than men, with rates decreasing by 9–15% among black

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women and by 5–9% among non-black women. All age groups would be expected tobenefit, with middle-aged and older populations expected to experience large relative
reductions in incident CHD and new and recurrent MI and stroke. Young and middle aged
adults were projected to experience a large relative reduction in morality, with 7–11% lower
mortality rates for blacks between 35–64 years and 3–6% lower mortality rates for nonblacks in this age range.
Sensitivity analyses
If a lower blood pressure level reached as a result of reduced salt intake is not as
advantageous as the same native blood pressure level, the health benefit of salt reduction
would be smaller (Table 2). If individuals 65 years of age or older have the same degree ofsalt sensitivity as those under 65 years of age, the estimated benefits of salt reductions areminimally changed. If blacks have no greater salt sensitivity than non-black populations, themagnitude of the anticipated effects on blacks would be reduced, but blacks would still havegreater reductions in cardiovascular events and deaths because of their higher prevalence ofhypertension.
Comparison with other interventions to prevent cardiovascular disease

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Even modest population reductions in dietary salt would be expected to provide comparable
reductions in cardiovascular events as are projected from public health interventions
targeting tobacco, obesity, primary prevention with statins, and drug treatment ofhypertension based on simulations for the same time frame and underlying population(Table 3). For example, achieving a 3 gm/day reduction in dietary salt would haveapproximately the same impact on CHD events as a 50% reduction in tobacco use, a 5%
reduction in body mass index among obese adults, or treatment of low and intermediate risk
individuals with statins. Salt reduction would have a far greater benefit on stroke prevention
than these comparison interventions. The 3 gm/day salt reduction has about the same
projected mortality benefit compared with the medical treatment of all hypertensive
individuals.
Cost-Effectiveness

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A national effort to decrease salt consumption by 3 gm/day would result in an estimatedannual gain of 194,000–392,000 quality-adjusted life-years (QALYs) and $10–24 billion insaved healthcare costs. Even if salt targets were achieved gradually over the decade (Table4), decreases in salt consumption to the target reduction of only a more modest 1 gm/day
were projected to be cost-savings. Salt reduction strategies are projected to compare
favorably to the treatment of all hypertensive individuals with antihypertensive medications-- a strategy that would result in more QALYs gained, but at a cost of $6,000–26,000 per
QALY gained. Even if the federal government bore the entire cost of a regulatory program
to reduce salt consumption, the federal government would also be expected to realize
reduced healthcare costs within Medicare, saving $6–12 in healthcare expenditures for eachdollar spent on the regulation of salt. Of note is that antihypertensive medications retain acost-effective benefit when added to a successful population-wide reduction of salt intake,but the number of individuals requiring treatment with medications would be markedly
reduced; a 3 gm/day reduction in salt would result in 16–24% fewer women and 22–34%
fewer men with hypertension and an additional savings of $3–6 billion annually in
hypertension treatment avoided.

Discussion
Despite evidence linking salt intake to hypertension and cardiovascular disease, salt intake
in the US diet is actually on the rise. These worsening trends have led to calls for
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population-wide interventions to reduce salt in the US diet,27 as have already been adopted
in other countries.7 Our findings provide evidence to support these calls. Our postulated 3
gm/day reduction in dietary – a reduction in the range targeted by other developed countries-is projected to benefit the entire US population and yield substantial reductions inmorbidity, mortality, and costs. The population-wide benefits from salt reduction are similar
in magnitude to the health benefits that would accrue from other public health and clinicalinterventions and would be cost-savings, even if only a more modest 1 gm/day reduction is
gradually achieved over time. Changes in behavior are notoriously difficult to achieve, andindividual approaches to achieving lower dietary salt have largely proven ineffective.
Nevertheless, cholesterol levels fell in the US prior to the widespread use of medications,and smoking rates have fallen substantially through a combination of regulatory, publichealth, and individual approaches to smoking cessation. The large and growing burden of
hypertension despite improved medical therapies28 and the potential for lower dietary salt to
aid in the prevention and treatment of hypertension reinforce the urgent need for thisapproach.

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Considerable literature links higher salt intake with higher blood pressure and increased
cardiovascular risk,15, 29 and randomized trials have demonstrated that a lower salt dietlowers blood pressure16, 30 and cardiovascular risk.31 Despite concerns about the accurate
assessment of salt intake, adherence with low-salt interventions, and theoretical increased
risks of very low salt diets, several large meta-analyses and reports from the Institute ofMedicine3, 5, 15, 26, 32 concluded that reducing dietary salt would lower blood pressure andcardiovascular risk. Professional societies including the American Medical Association, theAmerican Heart Association, the American Society of Hypertension, and the World HealthOrganization have all endorsed population-wide efforts to reduce salt intake.
Our results are similar to other analyses33, 34 and extend them in important ways. We
incorporated updated prevalence distributions of cardiovascular risk factors, particularly
hypertension, in the entire US population and in black and non-black subpopulations. We
considered current levels of hypertension treatment, treatment and control of othercardiovascular risk factors, and competing and ongoing risks among persons in whom deaths
were averted. Our comparisons of the cardiovascular benefits of salt reduction were similar
to those anticipated for established public-health targets such as tobacco, obesity, and LDLcholesterol. Targeted interventions have very large per-person effects, but their benefits are
restricted to the smaller numbers of higher-risk, affected individuals. Lowering salt in the
US diet would result in small but measurable blood pressure reductions across the entire US
population, thereby reducing cardiovascular disease in all adults at risk.

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A national regulatory effort to lower dietary salt intake would be cost saving even if only
modest salt reduction were achieved after a decade-long period. If the population-wide
approach to lowering salt were a federal effort, the healthcare savings to the current major
federally sponsored healthcare program – Medicare- would be greater than the cost of theregulatory intervention itself, even without incremental benefits afforded to younger, nonMedicare-covered persons. Some costs, such as those borne by the food industry inreformulating processed foods, are not considered in these analyses. However, as salt intake
is reduced, individuals appear to prefer food with less salt,15 likely related toaccommodation of taste receptors - a process that occurs over weeks to months.35 In the UK
a 10% population-reduction in salt was achieved over 4 years36 without reduction in sales ofthe products included in the initial voluntary effort and without consumer complaints about
taste. The magnitude of the health benefit suggests that salt should be a regulatory target of
the Food and Drug Administration, which currently designates salt as a food additive that is“generally regarded as safe.”27

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We projected that certain sub-populations may experience a proportionately greater benefit
from similar levels of salt reduction. Blacks have high rates of hypertension andcardiovascular diseases that contribute to racial disparities in mortality;37 their benefits fromsalt reduction could potentially narrow these disparities. Women would also experience a
proportionately greater benefit because of their higher risk for stroke.11 Young and middleaged adults could benefit because of the relative importance of blood pressure elevations inyounger adults without major risk factors. Blood pressure elevations in young adulthood
accelerate atherosclerosis9 and morbidity by middle age,38 yet younger adults withhypertension are less likely to be on treatment or have their blood pressure controlled.39 The
benefits of salt reduction could be even greater than we projected because hypertension may
be completely prevented or its onset delayed by lowering salt intake even earlier duringchildhood and adolescence.40

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Projections such as ours are limited by uncertainty in the modeling inputs. We modeled theeffects of salt reduction on blood pressure based on published data and assumed that thehealth benefits of salt reduction were mediated through these blood pressure reductions. We
did not account fully for possible effects of salt reductions unrelated to blood pressure, suchas potential improvements in outcomes of the increasing numbers of patients with heart
failure or prevention of other highly morbid conditions such as end-stage renal disease. Ourestimates of differential effects of salt reduction by age and race were extrapolated fromclinical trial data, and there is more uncertainty about these effects on the total population;
however, sensitivity analyses suggest that our primary findings are not very dependent onvariations in these assumptions. We modeled only linear effects of salt reduction on
reductions in blood pressure. Others have suggested that these effects may be non-linear,16
with greater reductions in blood pressure at lower salt intake; such an assumption would
result in larger reductions in cardiovascular disease than we present here.
Even with these limitations, our simulations suggest that modest reductions in dietary salt
would yield substantial health benefits across the adult US population by lowering
cardiovascular event rates, deaths, and medical costs. Our findings support the urgent needfor action to achieve these readily attainable benefits to the cardiovascular health of thenation.

Supplementary Material
Refer to Web version on PubMed Central for supplementary material.

Acknowledgments
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The Framingham Heart Study (FHS) and Framingham Offspring Study (FOS) are conducted and supported by the
National Heart, Lung, and Blood Institute (NHLBI) in collaboration with the FHS and FOS Investigators. This
manuscript was prepared using a limited access dataset obtained by the NHLBI and does not necessarily reflect theopinions or views of the FHS, the FOS or the NHLBI.
We gratefully acknowledge the work of Ms. Tekeshe Mekonnen, MS, who was invaluable in the preparation of thetext and figures for this manuscript, and David Fairley, PhD, who developed the Monte Carlo simulation routine
used in this work. This work was supported in part by a Grant-in-Aid from the American Heart Association
Western States Affiliate (09GRNT2060096).

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Figure.

Percent change in cardiovascular events with 3 gm/day reduction in dietary salt by US subpopulations. a) incident coronary heart disease, b) new and recurrent myocardial infarctions,c) incident stroke, d) death from any cause.

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1.80
1.20
1.20

Age ≥65 years
All others

0.60

All others

Hypertensive individuals*

1.20

Age ≥65 years

1.87

1.87

3.03

1.17

1.87

1.87

3.60

3.60

5.40

1.80

3.60

3.60

5.61

5.61

9.10

3.51

5.61

5.61

based on systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg or use of antihypertensive medications*

Black population sub-group

1.20

Hypertensive individuals*

Entire US population and non-black population sub-group

High SBP
estimate

Low SBPestimate

Low SBPestimate

High SBP
estimate

3 gm/day salt reduction

1 gm/day salt reduction

Degree of reduction in dietary salt and corresponding
change in systolic blood pressure (SBP in mmHg)

3, 14Reference

16, 18, 19, 21

16, 18, 19

3, 16, 18, 19, 21

3, 14

16, 18, 19 20, 21

Change in systolic blood pressure associated with reductions in dietary salt, by sub-population.

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Table 1
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−12.6 (1.0)−15.8%−7.9 (0.7)−9.8%Black population sub-group−5.2 (0.5)−6.5%−4.5 (0.4)−5.9%−2.8 (0.3)−4.1%Black population sub-group (alternate betas)−6.4 (2.8)−8.0%Black-specific beta coefficients based on the ARIC Study§

Black population sub-group (no increase by race)

No increased salt sensitivity due to race

US Population

No increased salt sensitivity due to age

US Population−4.6 (2.0)−9.0%−4.0 (0.3)−8.0%−3.5 (0.3)−7.2%−2.5 (0.2)−5.2%−5.8 (0.5)−11.8%−3.4 (0.3)−7.7%−3.7 (0.3)
−7.7%

Low

−7.0 (2.9)−13.9%−6.1 (0.5)−12.4%−5.6 (0.5)−11.5%−4.0 (0.3)−8.3%−9.3 (0.7)−18.7%−5.3 (0.4)−12.0%−6.2 (0.6)−12.8%

High

Total MI

−4.2 (0.6)−7.7%−2.8 (0.4)−5.2%−2.2 (0.3)−4.7%−1.6 (0.2)−3.5%−4.2 (0.5)−7.7%−2.2 (0.3)−5.1%−2.4 (0.3)
−5.2%

Low

−6.8 (0.9)−12.5%−4.4 (0.6)−8.1%−3.6 (0.5)−7.6%−2.6 (0.3)−5.5%−6.7 (0.9)−12.4%−3.4 (0.5)−8.0%−3.9 (0.5)
−8.2%

High

Incident Stroke−4.7 (1.2)−3.8%−3.5 (0.5)−2.9%−3.2 (0.4)−2.5%−2.3 (0.3)−1.8%−5.3 (0.7)−4.4%−3.1 (0.4)−2.7%−3.3 (0.5)
−2.7%

Low

−7.4 (1.8)−6.1%−5.5 (0.8)−4.6%−5.2 (0.7)−4.1%−3.6 (0.5)−2.9%−8.5 (1.2)−7.0%−4.9 (0.7)−4.3%−5.4 (0.8)
−4.4%

High

All-Cause Mortality

Uses black-specific beta coefficients for all of the CHD risk factors based on a published analysis from the Atherosclerosis Risk In Communities (ARIC) study42.

§

Assumes cardiovascular benefit of 2/3 of the native blood pressure26, 41‡

Rates are age-adjusted to the US population†−10.0 (4.2)−12.5%−8.2 (0.7)−10.3%−7.3 (0.6)−9.6%−4.6 (0.4)−6.6%

Diminished cardiovascular risk reversal with blood pressure lowering‡

Results for the 1 gm/day reduction are in the online appendix*−7.0 (0.6)−9.8%−4.3 (0.4)−6.1%

Non-black population sub-group

Sensitivity analysis−8.3 (0.8)−10.7%−4.7 (0.4)−6.1 %High

US Population

Main Simulation

Low

Incident CHD

Change in rate per 10,000 (SD)†(percent change)

Annual rate differences in cardiovascular rate reductions for 3 gm/day reduction in dietary salt by assumptions of differential salt sensitivity by age andrace*

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Table 2
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Table 3Comparative impact of various population interventions on annual reductions in cardiovascular events

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Change in absolute number of events (SD) and percent change from expected

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Incident CHD

Total myocardial
infarction

Incident Stroke

All-cause mortality

1 gm/day - Low−22,000 (2,000)−2.0%−20,000 (1,800)−2.6%−13,000 (1,800)−1.7%−17,000 (2,400)
−0.9%

High

−37,000 (3,300)−3.3%−32,000 (2,900)−4.2%−20,000 (2,900)−2.7%−28,000 (3,800)−1.4%

2 gm/day – Low−44,000 (4,000)−4.0%−39,000 (3,500)−5.1%−25,000 (3,500)−3.4%−34,000 (4,600)
−1.7%

High

−71,500 (6,300)−6.4 %−62,500 (5,400)−8.1%−40,000 (5,400)−5.3%−55,000 (7,500)−2.8%

3 gm/day - Low−66,000 (5,800)−5.9%−58,000 (5,100)−7.6%−37,000 (5,100)−5.0%−51,000 (7,100)
−2.6%

High

−110,000 (9,200)−9.6%−92,000 (7,800)−12.0%−59,000 (8,100)−7.8%−81,000 (11,000)−4.1%

Smoking cessation*−41,000 (10,000)−3.7%−92,000 (14,000)−11.9%−32,000 (13,000)−4.4%−84,000 (9,300)−4.3%

Weight loss†−59,000 (3,500)−5.3%−61,000 (3,200)−8.0%−5,600 (600)−0.7%−36,000 (2,000)−2.0%

Cholesterol treatment for primary prevention‡−52,000 (5,600)−5.3%−17,000 (1,800)−2.9%−6,600 (200)−0.9%−5.400 (540)−0.3%

Blood pressure treatment with medications
among hypertensive individuals§−100,000 (11,000)−9.3%−100,000 (9,700)−13.1%−69,000 (11,000)−9.3%−80,000 (10,000)−4.1%

Salt reduction*

Elimination of 50% tobacco use/exposure†

5 percent reduction in BMI among obese adults‡

Full adherence to ATPIII guidelines in people with 10 Yr CHD risk <20%§

Systolic blood pressure reduction in hypertensive individuals based on ALLHAT

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$0.32

High

$0.32

High

220 (26)350 (42)−$20.4 (4.1)

120 (14.6)−$7.0 (1.4)−$12.1 (2.4)

74.9 (8.8)−$4.1 (0.8)

cost savings

cost savings

cost savings

cost savings

Cost per
QALY−$14.2(2.7)
360 (42)$15,800(9,900)

$2.72

High

$2.72

$2.72

Low

High

3gms/day

$2.72

Low

1gm/day650 (78)
1,000 (127)−$95.6(19.6)

350 (43)−$31.6 (6.5)−$56.9(11.5)

220 (27)−$18.9 (3.8)

cost savings

cost savings

cost savings

cost savings$35.6 (7.3)$21.2 (4.3)$11.8 (2.4)$7.0 (1.4)

$2.7

$2.7

$2.7

$2.7

−$18.
(1.9)

−$12.1(1.2)−$6.1 (0.6)−$4.3 (0.4)

−$3.4
(0.3)

−$3.0 (0.3)−$2.0 (0.2)−$1.0 (0.1)−$0.7 (0.06)

665 (58)420 (37)240 (21)220 (20)260(24)208.3 (18.6)

135.0 (12.2)

72 (6.4)

46 (4.1)

Change in
QALYs(thousands)

cost savings

cost savings

cost savings

cost savings$23,300(3,600)cost savings

cost savings

cost savings

cost savings

Cost per
QALY$6.9 (0.7)$4.5 (0.5)$2.3 (0.2)$1.6 (0.2)$0.4 (0.04)$11.1 (1.1)$7.3 (0.7)$3.8 (0.4)$2.5 (0.2)

Healthcare
cost saved
per dollar
spent onintervention$1 per person estimate per year for the cost of a population-wide regulatory approach to salt reduction based on the World Health Organization estimate, US population of 306,913,687 as of July 2009.
http://www.census/gov, discounted at 3% over the decade2$9.3(0.03)

$0.3

$0.3

$0.3

$0.3

Change inhealthcare
cost(billions)

Costs and QALYs for the MediCare population(SD)Cost ofintervention(billions)

Cumulative cost and effectiveness of gradually reducing dietary salt over the decade from 2010–20194$19.5(0.07)$0.7 (0.1)$76.0 (15.4)$45.2 (9.1)$26.1 (5.2)$15.4 (3.0)

Healthcare
cost saved per
dollar spenton intervention

Blood pressure treatment with medications among hypertensive individuals 3

$0.32

Low

3gms/day

$0.32

Low

1gm/day

Change in
QALYs(thousands)

Healthcare costs for the US adults population age 35 years and older, discounted at 3% over the decade1

Change inhealthcare
cost(billions)1

Population reduction in dietary salt

Cost ofintervention(billions)

Costs and QALYs for the US population (SD)Cost and effectiveness of salt reduction and hypertension treatment annually and cumulatively from 2010–2019

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Table 4
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Gradual reduction from 2010–2019, with one third of the total reduction achieved in 2012, a second 1/3 in 2015, and a third 1/3 in 20194

Treatment of all hypertensive individuals to the degree observed in clinical trials25.and cost effectiveness analysis24

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