Cardiovascular Diseases Deaths Attributable to High Sodium Intake in Shandong Province, China.

Background-High sodium intake elevates blood pressure and thereby raises cardiovascular diseases (CVDs). Sodium intake is high in northern China, including Shandong province where the SMASH (Shandong-Ministry of Health Action on Sodium and Hypertension) is currently underway. Methods and Results-Blood pressure values and sodium intake measurements using 24-hour urinary excretion were collected from the 2011 SMASH baseline survey, which was conducted in 20 counties/districts using a multistage stratified cluster random sampling method. We derived cause-specific mortality from the Shandong Death Registration System (SDRS) during the same year and used population-attributable fraction to estimate annual CVDs deaths attributable to high sodium intake (mediated through elevated systolic blood pressure) and CVD deaths averted by achieving different sodium-reduction targets. Overall, 16 100 (95% uncertainty intervals, 11 000-22 600) CVD deaths among adults aged 25 to 69 years, including 5600 (4000-6500) for ischemic heart disease and 9000 (6700-11 600) for stroke, were attributable to higher sodium intake (2000 mg/day or 5.0 g/day of salt as a reference) in Shandong in 2011, accounting for 19.9% (13.7-25.0%) of total CVD deaths. The benefit of CVD deaths from sodium reduction is considerable with 8800 (6400-13 600), 6700 (4900-11 600), and 8500 (6000-10 800) averted, respectively, if sodium intake was reduced from the 2011 baseline to 3500 mg/day, 4000 mg/day, or reduced by 30%. Conclusions-Nearly 20% of CVD deaths among adults aged 25 to 69 years could be attributable to the systolic blood pressure- raising effect of high sodium intake in Shandong in 2011. Potential benefits from population reduction of sodium intake are considerable.