Cardiovascular disease (CVD) currently ranks as the number one killer in the United States. In fact, one out of every four deaths can be attributed to CVD. In New York City, more than one in three adults lives with cardiovascular disease. Many factors contribute to CVD, but most research suggests that one of the major risks can be attributed to something we eat every day: salt.

Our bodies need sodium to function as it helps regulate fluid balance, transmit nerve impulses, and control muscle function. Yet, when consumed in excess, sodium can cause severe damage to our heart and blood vessels. With 75 percent of the population eating nearly two times the amount of daily recommended sodium, and almost 1.65 million CVD-related deaths in the world associated with high sodium consumption, there’s a critical need to find an effective way to lower the amount of salt in our national and international diet.

Multiple government and community-based initiatives have attempted to help people reduce excessive sodium intake. This includes the American Heart Association’s #BreakUpWithSalt Campaign, New York City’s sodium warning label requirement for chain restaurants, and recommendations encouraging health professionals to advise patients on reducing their sodium intake. New research suggests, however, that a one-size-fits-all approach may not be effective.

A 2017 study conducted at The New York Academy of Medicine by Yan Li, PhD, José Pagán, PhD, and Julia Berenson, MS, along with Andrew Moran, MD, from Columbia University Medical Center, investigates this question. The research team identified key characteristics (i.e., age, geographic location, income, ethnicity, race, body mass index, and self-reported hypertension status) that they used to categorize people into subgroups based on how likely they might be to heed professional recommendations to reduce sodium consumption. The study was based on survey data on 125,764 respondents to the 2013 Behavioral Risk Factor Surveillance System.

Li and colleagues found that age was the most significant predictor for whether a person would follow recommendations from their health professional on sodium intake. The study results also revealed that within each age group, predictors of sodium intake were quite different. For instance, for people ages 18 through 64, the predictors of sodium intake behavior were linked to geographic location, income, and self-reported hypertension status. For the younger group, under age 45, BMI was also a factor. Yet, for people 65 and older, diabetes, hypertension, race, ethnicity, and geographic location shaped their sodium-intake choices.

Findings like these suggest that a one-size-fits-all approach to reducing sodium intake at the population level, such as simply informing people about the sodium content of popular foods,  may not be enough to get people to act. When it comes to reducing sodium consumption, a more productive approach may be to segment populations into different groups based on demographic, clinical, and geographic characteristics, and tailor interventions to the needs and interests of each subgroup.

Earlier work by Pagán and Li found that among New York City residents, cutting salt intake could actually add years to life. With this new research, the Center for Health Innovation team may be a few steps closer to figuring out the best ways to convince people to shake off the salt for better health.