Impact of salt intake reduction on CVD mortality in Costa Rica: A scenario modelling study

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Abstract

Cardiovascular diseases (CVD) represent the leading cause of death in Costa Rica and high blood pressure was associated with a mortality rate of 29% in 2018. The average household sodium intake in the country is also two times higher than the World Health Organization recommendation. The objective of this study was to estimate the impact of reducing salt intake on CVD mortality in Costa Rica using a scenario simulation model. The Preventable Risk Integrated ModEl (PRIME) was used to estimate the number of deaths that would be averted or delayed in the Costa Rican population by following the national and the international guidelines to reduce salt consumption, according to two scenarios: A) 46% reduction and B) 15% reduction, both at an energy intake of 2171 kcal. The scenarios estimated that between 4% and 13%, respectively, of deaths due to CVD would be prevented or postponed. The highest percentages of deaths prevented or postponed by type of CVD would be related to Coronary heart disease (39% and 38%, respectively), Hypertensive disease (32% and 33%, respectively), and Stroke (22% in both). The results demonstrate that reducing salt consumption could prevent or postpone an important number of deaths in Costa Rica. More support for existing policies and programs urges.

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Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Ashkan Afshin, Patrick Sur, Kairsten A. Fay … (2019)

Summary Background Suboptimal diet is an important preventable risk factor for non-communicable diseases (NCDs); however, its impact on the burden of NCDs has not been systematically evaluated. This study aimed to evaluate the consumption of major foods and nutrients across 195 countries and to quantify the impact of their suboptimal intake on NCD mortality and morbidity. Methods By use of a comparative risk assessment approach, we estimated the proportion of disease-specific burden attributable to each dietary risk factor (also referred to as population attributable fraction) among adults aged 25 years or older. The main inputs to this analysis included the intake of each dietary factor, the effect size of the dietary factor on disease endpoint, and the level of intake associated with the lowest risk of mortality. Then, by use of disease-specific population attributable fractions, mortality, and disability-adjusted life-years (DALYs), we calculated the number of deaths and DALYs attributable to diet for each disease outcome. Findings In 2017, 11 million (95% uncertainty interval [UI] 10–12) deaths and 255 million (234–274) DALYs were attributable to dietary risk factors. High intake of sodium (3 million [1–5] deaths and 70 million [34–118] DALYs), low intake of whole grains (3 million [2–4] deaths and 82 million [59–109] DALYs), and low intake of fruits (2 million [1–4] deaths and 65 million [41–92] DALYs) were the leading dietary risk factors for deaths and DALYs globally and in many countries. Dietary data were from mixed sources and were not available for all countries, increasing the statistical uncertainty of our estimates. Interpretation This study provides a comprehensive picture of the potential impact of suboptimal diet on NCD mortality and morbidity, highlighting the need for improving diet across nations. Our findings will inform implementation of evidence-based dietary interventions and provide a platform for evaluation of their impact on human health annually. Funding Bill & Melinda Gates Foundation.

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A comprehensive review on salt and health and current experience of worldwide salt reduction programmes.

W. MacGregor, F He (2009)

Cardiovascular disease (CVD) is the leading cause of death and disability worldwide. Raised blood pressure (BP), cholesterol and smoking, are the major risk factors. Among these, raised BP is the most important cause, accounting for 62% of strokes and 49% of coronary heart disease. Importantly, the risk is throughout the range of BP, starting at systolic 115 mm Hg. There is strong evidence that our current consumption of salt is the major factor increasing BP and thereby CVD. Furthermore, a high salt diet may have direct harmful effects independent of its effect on BP, for example, increasing the risk of stroke, left ventricular hypertrophy and renal disease. Increasing evidence also suggests that salt intake is related to obesity through soft drink consumption, associated with renal stones and osteoporosis and is probably a major cause of stomach cancer. In most developed countries, a reduction in salt intake can be achieved by a gradual and sustained reduction in the amount of salt added to food by the food industry. In other countries where most of the salt consumed comes from salt added during cooking or from sauces, a public health campaign is needed to encourage consumers to use less salt. Several countries have already reduced salt intake, for example, Japan (1960-1970), Finland (1975 onwards) and now the United Kingdom. The challenge is to spread this out to all other countries. A modest reduction in population salt intake worldwide will result in a major improvement in public health.

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Explaining the decline in coronary heart disease mortality in Finland between 1982 and 1997.

Tiina Laatikainen, Simon Capewell, Erkki Vartiainen … (2005)

In Finland since the 1980s, coronary heart disease mortality has declined more than might be predicted by risk factor reductions alone. The aim of this study was to assess how much of the decline could be attributed to improved treatments and risk factor reductions. The authors used the cell-based IMPACT mortality model to synthesize effectiveness of treatments and risk factor reductions with data on treatments administered to patients and trends in cardiovascular risk factors in the population. Cardiovascular risk factors were measured in random samples of patients in 1982 (n=8,501) and 1997 (n=4,500). Mortality and treatment data were obtained from the National Causes of Death Register, Hospital Discharge Register, social insurance data, and medical records. Estimated and observed changes in coronary heart disease mortality were used as main outcome measures. Between 1982 and 1997, coronary heart disease mortality rates declined by 63%, with 373 fewer deaths in 1997 than expected from baseline mortality rates in 1982. Improved treatments explained approximately 23% of the mortality reduction, and risk factors explained some 53-72% of the reduction. These findings highlight the value of a comprehensive strategy that promotes primary prevention programs and actively supports secondary prevention. It also emphasizes the importance of maximizing population coverage of effective treatments.

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Author and article information

Contributors

Jaritza Vega-Solano:

ORCID: https://orcid.org/0000-0001-5942-7090

Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Writing – original draft

Adriana Blanco-Metzler: Role: ConceptualizationRole: Funding acquisitionRole: InvestigationRole: Project administrationRole: SupervisionRole: Writing – review & editing

Karol Madriz-Morales: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Writing – review & editing

Eduardo-Augusto Fernandes-Nilson:

ORCID: https://orcid.org/0000-0002-2650-4878

Role: Formal analysisRole: ValidationRole: Writing – review & editing

Marie Eve Labonté: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – review & editing

Venkata Naga Srikanth Garikipati: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS One

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 12 January 2021

Publication date Collection: 2021

Volume: 16

Issue: 1

Electronic Location Identifier: e0245388

Affiliations

[1 ] Costa Rican Institute of Research and Teaching in Nutrition and Health (INCIENSA), Tres Ríos, Cartago, Costa Rica

[2 ] Center for Epidemiological Research on Health and Nutrition, University of São Paulo, São Paulo, São Paulo, Brazil

[3 ] Centre Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Université Laval, Québec, Canada

The Ohio State University College of Medicine, UNITED STATES

Author notes

Competing Interests: The authors declare no conflict of interest. The founding sponsor had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, and in the decision to publish the results. Marie-Eve Labonté has received funding from the Fundación de la Universidad de Costa Rica para la Investigación through the IDRC project #108167 for providing training to the INCIENSA team about the use of PRIME. This does not alter our adherence to PLOS ONE policies on sharing data and material.

* E-mail: ablanco@ 123456inciensa.sa.cr

Author information

Jaritza Vega-Solano https://orcid.org/0000-0001-5942-7090

Eduardo-Augusto Fernandes-Nilson https://orcid.org/0000-0002-2650-4878

Article

Publisher ID: PONE-D-20-29491

DOI: 10.1371/journal.pone.0245388

PMC ID: 7802917

PubMed ID: 33434241

SO-VID: 4028a524-9615-4af2-9a89-dad367984536

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 18 September 2020

Date accepted : 29 December 2020

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Figures: 0, Tables: 4, Pages: 11

Funding

Funded by: The International Development Research Center of Canada

Award ID: IDRC 108167

Award Recipient : Adriana Blanco-Metzler

A.B.M. awarded IDRC PROJECT 108167, from "The International Development Reserch Center of Canada". Website: https://www.idrc.ca/en The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Data Availability All relevant data are within the manuscript and its Supporting Information files.

Impact of salt intake reduction on CVD mortality in Costa Rica: A scenario modelling study

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Most cited references 28

Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

A comprehensive review on salt and health and current experience of worldwide salt reduction programmes.

Explaining the decline in coronary heart disease mortality in Finland between 1982 and 1997.

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