Impact of a hospital-based educational intervention on dietary salt-related knowledge and behaviour in a cardiac care unit population in Lebanon

Cardiovascular disease is the most common cause of morbidity and mortality globally, the majority of which is preventable (1,2). Numerous strategies are effective in reducing cardiovascular disease risk. Pharmacological approaches include the use of drugs to reduce blood pressure (3), serum cholesterol (4) and more recently inhibit pro-inflammatory pathways (5). Aspects of lifestyle modification have also been well demonstrated to reduce cardiovascular disease risk, including optimising physical activity, smoking cessation and dietary modification, including dietary sodium reduction (2,6). Reduction in dietary sodium reduces cardiovascular risk by reducing high blood pressure, perhaps the most important cardiovascular risk factor (7,8) In Lebanon 47% of deaths are attributed to cardiovascular disease and dietary salt consumption is high, estimated between 7–14 g per day (9,10). High dietary salt intake increases blood pressure and a reduction in dietary salt consumption reduces both blood pressure and the risk of hypertension-mediated disease. A meta-analysis has demonstrated that higher dietary sodium intake was consistently associated with a greater risk of fatal coronary artery disease and stroke. The same meta-analysis demonstrated that dietary salt reduction reduces systolic and diastolic blood pressure, with a greater mean reduction in systolic blood pressure in patients with hypertension (11). A subsequent meta-analysis comparing the effects of salt consumption on hypertensive and normotensive individuals confirmed that individuals with established hypertension benefit most from a reduction in dietary salt intake (12)