Nick Mattsson1, Olav Wendelboe Nielsen2, Linda Johnson3, Eva Prescott4, Peter Schnohr5, Gorm Boje Jensen5, Lars Køber6, Ahmad Sajadieh2. 1. Department of Cardiology, Copenhagen University Hospital of Bispebjerg, Denmark. Electronic address: nickm@dadlnet.dk. 2. Department of Cardiology, Copenhagen University Hospital of Bispebjerg, Denmark. 3. Department of Clinical Sciences, Skåne University Hospital, Lund University, Malmö, Sweden. 4. Department of Cardiology, Copenhagen University Hospital of Bispebjerg, Denmark; Copenhagen City Heart Study, Copenhagen University Hospital of Frederiksberg, Denmark. 5. Copenhagen City Heart Study, Copenhagen University Hospital of Frederiksberg, Denmark. 6. Department of Cardiology, Copenhagen University Hospital of Rigshospitalet, Denmark.
Abstract
BACKGROUND: Potassium supplementation reduces the risk of cardiovascular mortality and stroke in population studies; however, the prognostic impact of mild hypokalemia in the general population has not been thoroughly investigated. We aimed to investigate associations between mild hypokalemia and endpoints in the general population. METHODS: Participants (aged 48-76 years) from the general population study "Copenhagen City Heart Study" (n = 5916) were studied. Participants were divided into groups according to baseline values of plasma potassium (potassium): hypokalemia (<3.7 mmol/L, n = 758), normokalemia (3.7-4.5 mmol/L, n = 4973), and high potassium (>4.5 mmol/L, n = 185). Hypokalemia was further divided as potassium <3.4 mmol/L and 3.4-3.6 mmol/L. The primary endpoints were all-cause mortality and nonfatal validated ischemic stroke. The secondary endpoint was acute myocardial infarction (AMI). We adjusted for conventional risk factors, diuretics, and atrial fibrillation at baseline. RESULTS: Mean potassium in the hypokalemic group was 3.5 mmol/L (range, 2.6-3.6 mmol/L) and was associated (P < 0.05) with increased systolic blood pressure, higher CHA2DS2-VASc score, and increased use of diuretics as compared with normokalemia. Baseline atrial fibrillation was equally frequent across groups. Median follow-up-time was 11.9 years (Q1-Q3: 11.4-12.5 years). Hypokalemia was borderline associated with increased stroke risk in a multivariable Cox model (including adjustment for competing risk) as compared with normokalemia (hazard ratio [HR] 1.40; 95% confidence interval [CI], 1.00-1.98). The subgroup with potassium <3.4 mmol/L had higher stroke risk (HR 2.10; 95% CI, 1.19-3.73) and mortality risk (HR 1.32; 95% CI, 1.01-1.74) as compared with normokalemia. Hypokalemia was not associated with AMI, and no increased risk of mortality was seen with concomitant AMI and hypokalemia. No associations were seen with high potassium. CONCLUSION: In a general population mild hypokalemia is associated with increased stroke risk and, to a lesser degree, increased mortality risk.
BACKGROUND:Potassium supplementation reduces the risk of cardiovascular mortality and stroke in population studies; however, the prognostic impact of mild hypokalemia in the general population has not been thoroughly investigated. We aimed to investigate associations between mild hypokalemia and endpoints in the general population. METHODS:Participants (aged 48-76 years) from the general population study "Copenhagen City Heart Study" (n = 5916) were studied. Participants were divided into groups according to baseline values of plasma potassium (potassium): hypokalemia (<3.7 mmol/L, n = 758), normokalemia (3.7-4.5 mmol/L, n = 4973), and high potassium (>4.5 mmol/L, n = 185). Hypokalemia was further divided as potassium <3.4 mmol/L and 3.4-3.6 mmol/L. The primary endpoints were all-cause mortality and nonfatal validated ischemic stroke. The secondary endpoint was acute myocardial infarction (AMI). We adjusted for conventional risk factors, diuretics, and atrial fibrillation at baseline. RESULTS: Mean potassium in the hypokalemic group was 3.5 mmol/L (range, 2.6-3.6 mmol/L) and was associated (P < 0.05) with increased systolic blood pressure, higher CHA2DS2-VASc score, and increased use of diuretics as compared with normokalemia. Baseline atrial fibrillation was equally frequent across groups. Median follow-up-time was 11.9 years (Q1-Q3: 11.4-12.5 years). Hypokalemia was borderline associated with increased stroke risk in a multivariable Cox model (including adjustment for competing risk) as compared with normokalemia (hazard ratio [HR] 1.40; 95% confidence interval [CI], 1.00-1.98). The subgroup with potassium <3.4 mmol/L had higher stroke risk (HR 2.10; 95% CI, 1.19-3.73) and mortality risk (HR 1.32; 95% CI, 1.01-1.74) as compared with normokalemia. Hypokalemia was not associated with AMI, and no increased risk of mortality was seen with concomitant AMI and hypokalemia. No associations were seen with high potassium. CONCLUSION: In a general population mild hypokalemia is associated with increased stroke risk and, to a lesser degree, increased mortality risk.
Authors: Maria Lukács Krogager; Peter Søgaard; Christian Torp-Pedersen; Henrik Bøggild; Christina Ji-Young Lee; Anders Bonde; Jesper Q Thomassen; Gunnar Gislason; Manan Pareek; Kristian Kragholm Journal: BMC Cardiovasc Disord Date: 2020-08-24 Impact factor: 2.298
Authors: Marcin Adamczak; Jerzy Chudek; Jan Zejda; Magdalena Bartmańska; Tomasz Grodzicki; Tomasz Zdrojewski; Andrzej Wiecek Journal: Eur Geriatr Med Date: 2021-04-08 Impact factor: 1.710