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LETTER TO THE EDITOR |
Graduate Center for Nutritional Sciences
University of Kentucky
Lexington, KY 40506-0054
E-mail: ckchow{at}uky.edu
Dear Sir:
The article entitled "Effect of potassium-enriched salt on cardiovascular mortality and medical expenses of elderly men" by Chang et al (1), published in a recent issue of the Journal, reports the beneficial effects of potassium-enriched salt on cardiovascular mortality and medical expenses. With the rapid and persistent increase of health care costs in the United States and elsewhere (2, 3), the article is timely and useful. The results obtained from the relatively large scale (768 experimental subjects and 1213 age-matched control subjects), long-term (for 31 mo) follow-up study, conducted in a veteran’s retired home in northern Taiwan, showed that a simple and inexpensive change of dietary habit (salt used in the kitchen) cannot only significantly improve health conditions (cardiovascular disease survivorship) but also provide economic benefits (a 40% reduction per patient in inpatient care) to patients with cardiovascular disease–related conditions.
Although the article is interesting, whether the beneficial effects observed on the cardiovascular disease survivorship can be attributed solely to the potassium-enrichment, as the article implies, is questionable. As described in the Methods section, the potassium-enriched salt used by the experimental subjects was composed of 49% sodium chloride, 49% potassium chloride, and 2% other additive, whereas control subjects used regular salt, which was composed of 99.6% sodium chloride and 0.4% other additives, and the calculated daily intakes of sodium were 3.8 g and 5.2 g for the experimental and control groups, respectively. This represents a higher sodium intake in the control subjects by 37% compared with that of the experimental subjects. As also described in the article, both observational and experimental studies have shown that high sodium intake is an important contributing factor toward the development of hypertension and cardiovascular diseases (4-6). Thus, it is logical to argue that a decreased sodium intake of the experimental subjects is at least partially responsible for the observed improvement in cardiovascular disease survivorship.
To provide the readers with an unambiguous message, a simple reappraisal of the study plan and findings would be helpful. On the basis of the available information, the lowering of the sodium-to-potassium ratio in the diet of the patients with cardiovascular diseases may be as responsible, if not more, as the use of enriched potassium for the beneficial effects observed. Although this view may not sound as attractive as the original one, it does not diminish the significance or the contribution of the findings reported. Due to the importance of the subject area and the implications this article may have, a clarification of this matter is needed.
ACKNOWLEDGMENTS
There is no financial or other contractual agreement that may cause conflicts of interest or be perceived as causing conflicts of interest.
REFERENCES
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