Prognostic Impact of Mild Hypokalemia in Terms of Death and Stroke in the General Population - a Prospective Population Study
(2018) In American Journal of Medicine 131(3). p.9-318- 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 (48-76 year old) 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 in potassium<3.4 and... (More)
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 (48-76 year old) 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 in potassium<3.4 and 3.4-3.6 mmol/L. The primary endpoints were all-cause mortality and non-fatal validated ischemic stroke. Secondary endpoint was AMI. We adjusted for conventional risk factors, diuretics and atrial fibrillation (AF) at baseline.
RESULTS: Mean potassium in the hypokalemic group was 3.5 mmol/L (range 2.6-3.6) 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 AF 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 (HR:1.40;95%CI:1.00-1.98). The subgroup with potassium<3.4 mmol/L had higher stroke- (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.
CONCLUSIONS: In a general population mild hypokalemia is associated with increased stroke-risk and to a lesser degree increased mortality-risk.
(Less)
- author
- Mattsson, Nick ; Nielsen, Olav Wendelboe ; Johnson, Linda LU ; Prescott, Eva ; Schnohr, Peter ; Jensen, Gorm Boje ; Køber, Lars and Sajadieh, Ahmad
- organization
- publishing date
- 2018-03
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Journal Article
- in
- American Journal of Medicine
- volume
- 131
- issue
- 3
- pages
- 9 - 318
- publisher
- Elsevier
- external identifiers
-
- scopus:85035026883
- pmid:29024624
- ISSN
- 0002-9343
- DOI
- 10.1016/j.amjmed.2017.09.026
- language
- English
- LU publication?
- yes
- id
- d8bbd1c0-7fb5-4b2c-bb39-c4a315dba222
- date added to LUP
- 2017-10-21 17:28:11
- date last changed
- 2024-06-10 02:02:40
@article{d8bbd1c0-7fb5-4b2c-bb39-c4a315dba222,
abstract = {{<p>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.</p><p>METHODS: participants (48-76 year old) 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 in potassium<3.4 and 3.4-3.6 mmol/L. The primary endpoints were all-cause mortality and non-fatal validated ischemic stroke. Secondary endpoint was AMI. We adjusted for conventional risk factors, diuretics and atrial fibrillation (AF) at baseline.</p><p>RESULTS: Mean potassium in the hypokalemic group was 3.5 mmol/L (range 2.6-3.6) 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 AF 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 (HR:1.40;95%CI:1.00-1.98). The subgroup with potassium<3.4 mmol/L had higher stroke- (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.</p><p>CONCLUSIONS: In a general population mild hypokalemia is associated with increased stroke-risk and to a lesser degree increased mortality-risk.</p>}},
author = {{Mattsson, Nick and Nielsen, Olav Wendelboe and Johnson, Linda and Prescott, Eva and Schnohr, Peter and Jensen, Gorm Boje and Køber, Lars and Sajadieh, Ahmad}},
issn = {{0002-9343}},
keywords = {{Journal Article}},
language = {{eng}},
number = {{3}},
pages = {{9--318}},
publisher = {{Elsevier}},
series = {{American Journal of Medicine}},
title = {{Prognostic Impact of Mild Hypokalemia in Terms of Death and Stroke in the General Population - a Prospective Population Study}},
url = {{http://dx.doi.org/10.1016/j.amjmed.2017.09.026}},
doi = {{10.1016/j.amjmed.2017.09.026}},
volume = {{131}},
year = {{2018}},
}