Hypertensive heart disease burden attributable to high salt intake in the United States compared to the European Union and the global status: trends from 1990 to 2019
Authors: Aryan Z , Saeedi Moghaddam S , Ebrahimi H , Farzadfar F 
Published: October 2021

Abstract

Background
Hypertensive heart disease (HHD) is a major cause of heart failure, cardiovascular related hospitalizations, and mortality. Diet high in salt is one of modifiable risk factors of HHD that can be controlled by appropriate policies.

Purpose
This study aims to provide the HHD burden attributable to diet high in sodium in the United States compared to European and the global trends from 1990 to 2019.

Methods
Using the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 methodology, we calculated the HHD, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs). Diet high in sodium was defined as a diet with more than 1,000 milligrams of sodium per day. HHD deaths attributable to the diet high in sodium was estimated based on risk exposure, relative risks, and the theoretical minimum risk exposure level Trends of HHD attributable to diet high in sodium was estimated from 1990 to 2019.

Results
Globally, there were 170·3 thousand (95% uncertainty interval [UI] 31.2 to 459.5) deaths, YLLs, YLDs, DALYs due to HHD attributable to diet high in sodium, in 2019. In the United States, 4525 deaths happened because of HHD caused by the diet high in sodium, with 208.4% rise from 1990. In the European Union, 18,143 deaths happened because of HHD caused by the diet high in sodium, with 78.0% rise from 1990. To address the impact of population aging and population growth, we estimated the age standardized values for burden of HHD attributable to the diet high in sodium. From 1990 to 2019, worldwide age standardized YLL, YLD, and DALY rates per 100,000 for HHD attributable to the diet high in sodium changed by −44.0% (−63.6 to −30.6), +3.7% (−14.3 to +13.6), and −41.8% (−61.3 to −28.8), respectively (Figure 1). In the European Union, age standardized YLL, YLD, and DALY rates per 100,000 for HHD attributable to the diet high in sodium changed by −14.8% (−44.6 to −0.2), −13.5% (−45.8 to −14.0), and −14.8% (−43.5 to −0.9), respectively. Compared to the European Union and the worldwide trends, United Sates had the opposite increasing trend of HHD caused by the diet high in sodium. In the United States, age standardized YLL, YLD, and DALY rates per 100,000 for HHD attributable to the diet high in sodium changed by +110.4% (+42.0 to +631.0), +44.2% (+106.4 to +300.5), and −14.8% (−43.5 to −0.9), respectively. As shown in figure 2, the United States' increasing trend of HHD attributable to the diet high in sodium was caused mainly by the increasing trend observed in men.

Conclusions
Despite worldwide success in the restriction of the diet high in sodium, HHD burden attributable to high consumption of sodium is rising in the United States. This warning results requires public health attention to taking actions such as advocating for healthy diet, restricting foods high in sodium such as fast foods, and increasing the access to low salt foods for working groups.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Bill & Melinda Gates Foundation Annual % DALY change of HHD due to saltTrend of HHD DALY in men vs women