Lowering Sodium Intake: Reduction and Substitution for Cardiovascular Health

Abstract

Clinical and epidemiological evidence supports sodium reduction as an effective strategy to lower blood pressure and reduce the risk of stroke, cardiovascular disease, and overall mortality. High sodium (salt) intake is a well-established contributor to elevated blood pressure and adverse cardiovascular outcomes. The World Health Organization (WHO) recommends that adults should consume less than 5 g of table salt per day; however, the global average intake is estimated at around 10.78 g/day. The primary sources of dietary sodium vary by region: in high-income countries, the majority of salt intake comes from processed foods and meals prepared outside the home, while in many low-and middle-income countries, sodium is mainly added during home cooking or comes from condiments such as soy sauce and fish sauce. This review discusses the effects of high dietary sodium on blood pressure and vascular health, along with global consumption trends, regional disparities, and key nutritional sources. In addition to reducing sodium, adopting a salt-sensitive, whole-diet approach, such as increasing fruit and vegetable intake to boost potassium, can further protect cardiovascular health. Potassium-enriched, low-sodium salt substitutes are increasingly used in food production. Emerging strategies, including flavor enhancers, bitter blockers, spatial salt distribution, and microencapsulation, also help enhance saltiness perception while lowering sodium content. The review also summarizes national guidelines and those by the WHO, highlights selected country strategies, and calls for coordinated global and national efforts to reduce sodium intake and improve cardiovascular health worldwide.