Patient Education Understanding the effects of Salt on Heart Health

#HaveHeart: What does this mean?

#HaveHeart for yourself: We can all #HaveHeart by getting screened to identify what puts us at risk for heart disease and strokes. Next, we can show that we care by starting to take charge of our own health and ensuring that we are living a healthy lifestyle.

#HaveHeart for your family: We can #HaveHeart for our family by encouraging a healthy home environment. Aim to make it easy for your family to be healthy and take care of their hearts for the future. #HaveHeart for South Africa: We can also #HaveHeart by helping to create awareness around heart disease, thus making South Africa a healthier country.

What is the story about heart disease in South Africa?

Cardiovascular disease (CVD), commonly known as heart disease, is the second leading cause of death in South Africa after HIV/AIDS. The latest statistics show that 210 people die of heart disease and strokes every day. Once thought to be a disease of the elderly, heart disease now affects people of working age with more than half of all deaths occurring in people under the age of 65. The good news, however, is that 80% of heart disease and strokes can be prevented by maintaining a healthy, balanced diet, regular exercise and avoiding smoking.

What role does salt play?

It has long been established that a high salt (sodium) intake is linked to hypertension. It is also well-known that a diet that is high in salt can worsen existing hypertension. Along with this, decreasing salt intake relative to the usual or increased intake leads to reduced blood pressure in adults, with or without hypertension. Hypertension is the leading risk factor for strokes, responsible for 1 in 2 (50%) strokes and 2 in 5 (42%) heart attacks.

How will the salt regulations affect people of South Africa?

We are the first country globally to regulate the salt content across a wide spectrum of foods, with the first reduction due in 2016. A recent study calculated the potential impact of these salt reduction targets in a cohort of South African adults. Achieving the salt reduction targets, set by the National Department of Health, of less than 5 g of salt per day per person would translate to an average of 2.9 to 3.3g/day lower salt intake per person.

These targets are estimated to:

  • Reduce CVD deaths by 11%, averting 3 363 deaths and 6 563 new cases of CVD per year in the general population;
  • Amount to an annual household saving of R42 million in healthcare costs, mostly in middle-class families; and
  • Save the government approximately R536 million a year in health care subsidies alone.


One has to consider though whether legislation alone will be enough?

40% of salt consumed in South Africa is discretionary salt, which is added during cooking and at the table. Furthermore, according to a study presented at the Salt Summit on 13 March 2014, researchers found that nearly a fifth of consumers compensated for a reduced salt meal (prepared by a reduced salt stock cube) by adding salt back to the meal, even to the point of overcompensation, despite not being aware of the reduced salt levels. We are, therefore, in need of a public education campaign regarding salt reduction. The first phase of such a campaign is an education and awareness campaign led by Salt Watch, a mutli-sectoral coalition lead by the Heart and Stroke Foundation SA and supported by the National Department of Health.

Do health care professionals and nurses play a role?

Most definitely! Research has shown that people view the medical community as a trusted source of information. We, therefore, call on all nurses to partner with us and help us to win this fight by spreading the same consistent messages about the dangers of too much salt, as well as encourage the public to know their numbers and get screened. In support of public awareness campaigns, like Heart Awareness Month and Salt Watch, we need the help of nurses to get the following key messages to the public:

  • Get your blood pressure screened to know whether you are at risk.
  • Too much salt increases blood pressure, which causes heart attacks and strokes.
  • Many South Africans consume too much salt, up to twice the recommended amount.
  • The foods that we buy already contain a lot of salt, so it is important for us to use less salt at home while cooking and at the table.


What is your practical advice for making flavourful foods without adding excessive salt?

I would recommend taking it one step at a time. Firstly, taste your food before adding salt, how many of us actually do that? If you have already added salty spices or a stock cube to your cooking, you don’t need to add salt too. If you used salt during cooking then there’s no need to add more salt at the table – hide that salt shaker! To make your food really flavourful, try these herbs and unsalted spices instead of salt:

  • Vegetables: Herbs like Italian herbs mix, parsley or rosemary.
  • Lamb: Rosemary and mint.
  • Fish or chicken: Garlic, parsley and lemon juice.
  • Beef: Black pepper, garlic or balsamic vinegar.
  • Potatoes: Paprika, parsley, basil or nutmeg.


We would like to call on all healthcare professionals to encourage their patients to get tested at their local pharmacy and then to take action by adopting healthy diets and lifestyles and passing those on to their children, families and communities.

For more practical tips on how your patients can look after their hearts and improve their heart health, please dial *120*7532# for salt information and *120*7536# for cholesterol information.

For more information on the Heart and Stroke Foundation please get in touch on 0860 1 HEART (43278), visit www.heartfoundation.co.za or heart@heartfoundation.co.za

Written by the Heart and Stroke Foundation