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Serum potassium level and dietary potassium intake as risk factors for stroke

From the Neuroscience Institute (Dr. Green), The Queen’s Medical Center, Honolulu, HI; Department of Neurology (Dr. Ropper), Saint Elizabeth’s Medical Center, Boston, MA; Department of Biostatistics (Dr. Kronmal), and Cardiovascular Health Research Unit (Dr. Psaty), University of Washington, Seattle, WA; and Department of Public Health Sciences (Dr. Burke), Bowman Gray School of Medicine, Winston-Salem, NC.

Address correspondence and reprint requests to Deborah M. Green, MD, Neuroscience Institute, The Queen’s Medical Center, 1301 Punchbowl Street, Honolulu, HI 96813; e-mail: dgreen{at}queens.org

Background: Numerous studies have found that low potassium intake and low serum potassium are associated with increased stroke mortality, but data regarding stroke incidence have been limited. Serum potassium levels, dietary potassium intake, and diuretic use in relation to risk for stroke in a prospectively studied cohort were investigated.

Methods: The study comprised 5,600 men and women older than 65 years who were free of stroke at enrollment. Baseline data included serum potassium level, dietary potassium intake, and diuretic use. Participants were followed for 4 to 8 years, and the incidence and types of strokes were recorded. Low serum potassium was defined as less than 4.1 mEq/L, and low potassium intake as less than 2.4 g/d.

Results: Among diuretic users, there was an increased risk for stroke associated with lower serum potassium (relative risk [RR]: 2.5, p < 0.0001). Among individuals not taking diuretics, there was an increased risk for stroke associated with low dietary potassium intake (RR: 1.5, p < 0.005). The small number of diuretic users with lower serum potassium and atrial fibrillation had a 10-fold greater risk for stroke compared with those with higher serum potassium and normal sinus rhythm.

Conclusions: A lower serum potassium level in diuretic users, and low potassium intake in those not taking diuretics were associated with increased stroke incidence among older individuals. Lower serum potassium was associated with a particularly high risk for stroke in the small number of diuretic users with atrial fibrillation. Further study is required to determine if modification of these factors would prevent strokes.

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