Abstract 4145926: The Importance of Dietary Salt in the Process of Atherosclerosis The Results of the International Survey

Introduction: Excessive dietary salt intake is a recognized ASCVD risk factor, and causes approximately 1.89 million deaths annually. There is also an ongoing discussion whether dietary salt might be associated with the direct ASCVD risk. Thus, we aimed to check the knowledge, perception, diagnosis, and management of indirect and direct salt-related ASCVD risk among healthcare professionals. Methods: The survey, consisting of 17 questions, was developed by the Polish Lipid Association (PoLA). It was launched in March 2024 and promoted through multiple online channels. Many questions allowed for multiple responses. The questionnaire is ongoing and available at the PoLA webpage. Results: By the end of May 313 respondents (48.6% females) from 40 countries participated in the survey, 70% of whom were physicians. They mostly came from cities with over 500 thousand inhabitants (53.4%). The largest percentage of responses were from Poland (28.7%), Lithuania (19.4%), and Romania (14.8%). More than 1/3 of the respondents correctly indicated the permissible amount of salt in the diet recommended by WHO; even larger percentage (86.3%) correctly indicated that limiting salt intake in the diet applies to both healthy and sick people. Excess salt in the diet was indicated as a recognized risk factor in the case of hypertension 82.4%, atrial fibrillation 28.8%, obesity 36.4%, type 2 diabetes 20.4%, lipid disorders 18.5%, heart failure 59.1%, stroke 56.9%, and atherosclerosis 42.2%. It is worth emphasizing that a significant percentage did not have or had incorrect knowledge about excessive salt consumption and the risk of the above diseases – from 6.4 to even 53%. In the context of data indicating a large number of deaths related to excessive salt intake, only 57.5% of respondents clearly correctly answered the question on the excess salt association with a higher risk of mortality. The respondents' knowledge about the mechanisms linking excessive dietary salt intake with the progression of atherosclerosis varied greatly, with the majority (38%) indicating that it was only a result of increased BP. Conclusion: A significant percentage of respondents have incomplete knowledge about the role of excessive dietary salt intake on ASCVD risk. It is worth emphasizing that excessive salt intake in the diet directly damages the vascular endothelium and thus contributes to ASCVD development. This extremely important mechanism was indicated by only 24% of respondents.