Background: Excessive salt consumption is an important risk factor for cardiovascular diseases (CVD), especially through increased blood pressure. In Brazil, the average salt intake is almost twice the international recommendations, and the current population-level salt reduction policies include only voluntary maximum salt targets for packaged foods and communication strategies. This study aims to quantify the potential health and economic impact of additional salt reduction strategies in Brazil from 2019 to 2038.Methods: We used a previously validated microsimulation of a close-to-reality synthetic population (IMPACTNCD-BR) to estimate CVD events (cases and deaths) prevented or postponed and the corresponding cost savings from 2019 to 2038, stratified by age and sex. The policy scenarios that were modelled include 1) regulatory front-of-pack labelling warnings for excessive salt in foods, 2) universal use of 10% potassium table salt, and 3) voluntary and regulatory limits (targets) for maximum salt content in packaged foods. Model inputs were informed by nationally representative health and food consumption surveys and high-quality meta-analyses. Cost analysis incorporated the costs of CVD treatment to the National Health System and informal care costs.Findings: The study found that from 2019 to 2038, the continuation of the current voluntary targets could prevent or postpone some 268,000 CVD case-years (95% UI: 90,000 to 584,000) and 5,000 CVD deaths (95% UI: 1,000 to 12,000). Mandatory front-of-pack labelling warnings could prevent or postpone approximately 406,000 CVD case-years (95% UI: 130,000 to 872,000) and some 7,000 CVD deaths (1,000 to 18,000). During the same period, the replacement of regular table salt with 10% potassium salt could prevent or postpone approximately 794,000 CVD case-years (293,000 to 1,663,000) and 57,000 CVD deaths (34,000 to 92,000), and regulatory limits to the salt content in foods could prevent or postpone some 843,000 CVD case-years (95% UI: 278,000 to 1,809,000) and 16,000 CVD deaths (95% UI: 4,000 to 33,000). The estimated cost savings related to CVD treatment by implementing mandatory front-of-pack warnings, 10% potassium table salt, and regulatory salt limits could respectively save approximately Int$ 2.5 billion (Int$ 0.8b to 5.4b), Int$ 3.9 billion (Int$ 1.7b to 9.9b) and Int$ 5.2 billion (Int$ 1.7b to 10.7b).Interpretation: The current Brazilian voluntary salt targets for packaged foods may generate modest health and economic impacts compared to other strategies. Our analysis suggests that stricter regulatory salt targets for food industries, mandatory front of pack warning labels for excessive salt in foods and universal use of low sodium table salt could maximise the health and economic benefits of salt reduction for the Brazilian people and contribute to go further and faster to achieving the World Health Organization goals for salt intake.Funding: This article was possible due to technical cooperation between the researchers.Declaration of Interest: The authors declare that they have no competing interests
