The Impact of Sodium Reduction on Cardiovascular Disease (CVD) Primary and Secondary Prevention: An Umbrella Review

Abstract

University of Washington Abstract The Impact of Sodium Reduction on Cardiovascular Disease (CVD) Primary and Secondary Prevention: An Umbrella Review Kokou Tbah Tighankpa Chair of the Supervisor Committee: Yanfang Su Global Health Background: The impact of dietary interventions in primary and secondary prevention of cardiovascular diseases is not well synthesized. Specific aim: To determine the health benefits of sodium reduction interventions by comparing primary prevention versus secondary prevention. Data source: PubMed from January 1, 2010, to January 21, 2025. Study selection: Systematic reviews and meta-analyses (SRMAs) of randomized controlled trials (RCTs) and cohort studies that explored the impact of sodium reduction interventions on our targeted outcomes: systolic blood pressure (SBP), diastolic blood pressure (DBP), heart failure (HF), cardiovascular diseases (CVD) incidence, and CVD mortality. Data Management: COVIDENCE. Data Synthesis: We screened 425 titles and abstracts and included 10 SRMAs in our umbrella review. In primary prevention, we found that the dietary approaches to stop hypertension (DASH), Sodium-reduced Diet, Sodium Substitution by potassium, and Mediterranean Diet reduce SBP and DBP among normotensive and hypertensive populations. Similarly, the Japanese Diet and DASH were found to be effective in reducing the risk of CVD in general and stroke. In secondary prevention, despite the low quality of the SRMAs assessed by the Modified AMSTAR-2 tool, our review reported a significant impact of the Mediterranean Diet on risk reduction among populations with existing cardiovascular disease conditions and CVD mortality. Conclusion: Sodium reduction interventions could contribute to reducing the global burden of cardiovascular diseases. Besides the Sodium-reduced Diet and Sodium Substitution interventions, food-related interventions can contribute to preventing cardiovascular diseases through both primary and secondary strategies.