Generating Health Benefits and Cost Savings Through Sodium Reduction

By Jonathan Springston, Editor, Relias-AHC Media

In 2016, the FDA called for the voluntary reduction of sodium levels in commercially processed, packaged, and prepared foods. Recently, investigators modeled and compared the potential health and economic effects of three scenarios of differing implementation of the agency’s proposed voluntary policy over a 20-year period. Even under modest scenarios, these researchers found the potential for billions of dollars in economic gains and significant health benefits.

Noting that sodium consumption is a leading modifiable risk factor for high blood pressure and cardiovascular disease (CVD), a team of researchers from the United States and the United Kingdom created three scenarios: optimal (100% compliance with 10-year targets), modest (50% compliance with 10-year targets), and pessimistic (100% compliance with two-year targets, but no further progress). Investigators considered costs such as administration and monitoring, industry costs, and CVD-related healthcare, productivity, and other informal care costs.

“Between 2017 and 2036, the optimal reformulation scenario achieving the FDA sodium reduction targets could prevent approximately 450,000 CVD cases (95% uncertainty interval: 240,000 to 740,000), gain approximately 2.1 million discounted QALYs [quality-adjusted life years] (1.7 million to 2.4 million), and produce discounted cost savings (health savings minus policy costs) of approximately $41 billion ($14 billion to $81 billion),” the authors wrote. “In the modest and pessimistic scenarios, health gains would be 1.1 million and 0.7 million QALYS, with savings of $19 billion and $12 billion, respectively. All the scenarios were estimated with more than 80% probability to be cost-effective (incremental cost/QALY < $100,000) by 2021 and to become cost-saving by 2031.”

The authors noted limitations to their approach, including evaluating only diseases mediated through blood pressure and the fact that the effect estimates in their model were based on interventional and prospective observational studies, which could lead to biases and confounding. Still, these investigators were pleased with the results and noted that the potential “would be of great interest to policymakers.”

“Implementing and achieving the FDA sodium reformulation targets could generate substantial health gains and net cost savings,” the authors added. The American Heart Association received this study warmly, concurring with these authors about the benefits of sodium reduction.

“The American Heart Association strongly believes voluntary sodium targets for food manufacturers, restaurants, and food service operators can reduce our nation’s excessive sodium intake. This study reaffirms that the FDA strategy with industry implementation will positively impact millions of lives, produce societal cost savings, and should move forward without delay,” American Heart Association CEO Nancy Brown said in a statement. “This change is something consumers say they want, and several major food companies have already been working to reduce sodium in many of their products. We commend those industry leaders and urge them to continue their efforts to give consumers more choice over the amount of sodium they eat.” Brown called on the FDA to “level the playing field for food companies and advance the voluntary sodium targets.”

(Editor’s Note: In March, FDA Commissioner Scott Gottlieb, MD, delivered a lengthy speech on chronic disease burden and announced a comprehensive, multiyear plan intended to tackle the problem, which includes a continued call for sodium reduction in food. You can read the full speech here.)

Although medical professionals agree that reducing sodium intake produces many positive health gains, including lower blood pressure, the debate continues regarding safe blood pressure targets. In an upcoming issue of Internal Medicine Alert, Joseph Scherger, MD, MPH, takes a closer look at a study of how lower blood pressure targets might negatively affect type 2 diabetes patients. In that study, researchers followed 28,014 primary care adult patients with type 2 diabetes with no prior diagnosis of CVD who achieved systolic blood pressure targets of less than 120 mmHg, less than 130 mmHg, and less than 140 mmHg.

“Over a follow-up period of about five years, the highest cardiovascular events occurred in patients with systolic blood pressures less than 120 mmHg,” Scherger explains. “These findings held for patients under and over age 65. Patients with systolic blood pressures up to 140 mmHg had no increased risk compared with patients with systolic blood pressures of less than 130 mmHg. This study supports the use of a systolic blood pressure of up to 140 mmHg as a target for control in type 2 diabetic patients.”

Scherger goes on to warn of the potential hazards of overtreating blood pressure, which he argues could be just as dangerous as not treating high blood pressure. He notes that patients often may register higher blood pressure readings in a physician’s office than they would at home because of anxiety about visiting the doctor.

“We need to be diligent in getting accurate resting blood pressures in the office, and not overreact to readings when the patient is likely to be normal or controlled,” Scherger adds.

For much more on blood pressure targets and other cardiology-related research, be sure to check out the latest issues of Clinical Cardiology Alert. And don’t forget to read our special book STEMI Watch 2018: Advances in Diagnosis, Treatment, and Management for more information about improving the consistency of cardiac care for STEMI patients.