Dietary Salt Reduction and Cardiovascular Disease Rates in India: A Mathematical Model

Basu S, Stuckler D, Vellakkal S, Ebrahim S (2012). Dietary Salt Reduction and Cardiovascular Disease Rates in India: A Mathematical Model. PLoS ONE 7(9): e44037. doi:10.1371/journal.pone.0044037

7 Pages Posted: 30 Jan 2013 Last revised: 3 Feb 2013

See all articles by Sanjay Basu

Sanjay Basu

Stanford University - Center for Primary Care and Outcomes Research and Center for Population Health Sciences; Harvard University - Center for Primary Care

David Stuckler

University of Cambridge - Faculty of Human, Social, and Political Science

Sukumar Vellakkal

Public Health foundation of India (PHFI)

Shah Ebrahim

Public Health Foundation of India

Date Written: January 29, 2013

Abstract

Background: Reducing salt intake has been proposed to prevent cardiovascular disease in India. We sought to determine whether salt reductions would be beneficial or feasible, given the worry that unrealistically large reductions would be required, worsening iodine deficiency and benefiting only urban subpopulations.

Methods and Results: Future myocardial infarctions (MI) and strokes in India were predicted with a Markov model simulating men and women aged 40 to 69 in both urban and rural locations, incorporating the risk reduction from lower salt intake. If salt intake does not change, we expect ~8.3 million MIs (95% CI: 6.9-9.6 million), 830,000 strokes (690,000–960,000) and 2.0 million associated deaths (1.5–2.4 million) per year among Indian adults aged 40 to 69 over the next three decades. Reducing intake by 3 g/day over 30 years (−0.1 g/year, 25% reduction) would reduce annual MIs by 350,000 (a 4.6% reduction; 95% CI: 320,000-380,000), strokes by 48,000 (−6.5%; 13,000–83,000) and deaths by 81,000 (−4.9%; 59,000-100,000) among this group. The largest decline in MIs would be among younger urban men, but the greatest number of averted strokes would be among rural men, and nearly one-third of averted strokes and one-fifth of averted MIs would be among rural women. Only under a highly pessimistic scenario would iodine deficiency increase (by <0.0001%, ~1600 persons), since inadequate iodized salt access — not low intake of iodized salt — is the major cause of deficiency and would be unaffected by dietary salt reduction.

Conclusions: Modest reductions in salt intake could substantially reduce cardiovascular disease throughout India.

Keywords: salt, hypertension

JEL Classification: I18

Suggested Citation

Basu, Sanjay and Stuckler, David and Vellakkal, Sukumar and Ebrahim, Shah, Dietary Salt Reduction and Cardiovascular Disease Rates in India: A Mathematical Model (January 29, 2013). Basu S, Stuckler D, Vellakkal S, Ebrahim S (2012). Dietary Salt Reduction and Cardiovascular Disease Rates in India: A Mathematical Model. PLoS ONE 7(9): e44037. doi:10.1371/journal.pone.0044037. Available at SSRN: https://ssrn.com/abstract=2208318

Sanjay Basu (Contact Author)

Stanford University - Center for Primary Care and Outcomes Research and Center for Population Health Sciences ( email )

1070 Arastradero Road Office 282
Palo Alto, CA 94304
United States

Harvard University - Center for Primary Care ( email )

Cambridge, MA
United States

David Stuckler

University of Cambridge - Faculty of Human, Social, and Political Science ( email )

Cambridge, CB3 9DD
United Kingdom

Sukumar Vellakkal

Public Health foundation of India (PHFI) ( email )

4 Institutional Area
Vasant Kunj
New Delhi, Delhi 110070
India

HOME PAGE: http://www.phfi.org

Shah Ebrahim

Public Health Foundation of India ( email )

4 Institutional Area
Vasant Kunj
New Delhi, Delhi 110070
India

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