Higher Potassium Intake Associated with Lower Risk of Cardiovascular Disease

by | Oct 12, 2022 | Cardiovascular Health, Minerals, Potassium

Written by Taylor Woosley, Staff Writer. Both men and women within the highest tertile of potassium intake had a lower risk of CVD events compared with those within the lowest tertile of potassium intake, but the HR associated with high potassium intake was lower in women than in men (fully adjusted model: men: HR 0.93, 95% CI 0.87–1.00; women: HR 0.89, 95% CI 0.83–0.95). 

Cardiovascular disease (CVD) consists of a group of heart and blood vessel disorders that include coronary heart disease, cerebrovascular disease, and diseases of the arteries, including hypertension1. CVD continues to be the leading cause of mortality across both sexes and all races and ethnicities in the United States2. Multiple factors contribute to the disease development and progression, such as age, gender, genetics, smoking, physical inactivity, elevated blood pressure, and poor eating habits3.

Over the years, increasing evidence suggests that sodium and potassium intake influence long-term blood pressure and cardiovascular health4. Sodium is an essential nutrient responsible for the regulation of the extracellular fluid compartment5. Potassium may influence the development and progression of CVD outcomes, including stroke, through inflammation pathways and blood pressure6. The World Health Organization recommends that the daily sodium intake does not exceed 85 mmol/d, and that the daily potassium intake is at least 90 mmol/d7. A high intake of sodium and a high ratio of sodium to potassium has been associated with elevated blood pressure and clinical hypertension8.

Wouda et al. conducted a study to analyze the sex-specific associations between daily potassium consumption and blood pressure (BP), as well as CVD, and whether these associations depend on daily sodium consumption. The study featured subjects from the Norfolk cohort of the European Prospective Investigation into Cancer (EPIC-Norfolk) study. Subjects (n=25639), aged 40-79 years, were included in the prospective population-based cohort study. General health and lifestyle information was performed at the first health check, along with a physical examination, and collecting blood and urine samples. The Kawasaki formula was used to estimate 24-h potassium and sodium excretion from urine samples.

Main outcomes of the study were SBP at baseline and the composite of hospitalization or mortality from CVD. Secondary outcomes of interest were diastolic BP, mean arterial pressure (MAP), and the composite of hospitalization or mortality from stroke. Unpaired t-tests for continuous variables were used to compare differences in baseline characteristics between men and women separately, while X2 tests were used for categorical variables. A multivariable linear regression analysis stratified by sex was performed to determine the association between potassium intake (g/day) and SBP. A Cox proportional hazards model stratified by sex was utilized to explore the association between potassium intake and cardiovascular events. Significant findings of the study are as follows:

  • After adjusting for sex, age and sodium intake, potassium intake was significantly associated with SBP (β= -0.8, P < 0.001), and significant interaction by sex was found (P < 0.001).
  • In men, neither an inverse association between potassium intake and SBP was present (β= -0.3, P = 0.336), nor interaction by sodium intake (P=0.481).
  • In women, a highly significant interaction by sodium intake for the association between potassium intake and SBP was present (P < 0.001).
  • Sodium-stratified analyses indicated that an inverse association between potassium intake and SBP was only present in the highest tertile of sodium intake (β=2.4, P < 0.0001).
  • In the fully adjusted model, people within the highest tertile of potassium intake had a lower risk of CVD events (HR 0.87, 95% CI 0.82–0.93) compared with those within the lowest tertile of potassium intake.

Results of this study using data from the population-based EPIC-Norfolk cohort show that the association between potassium consumption and both SBP and CVD risk is sex specific. Specifically, among women, the association between potassium intake and SBP was modified by sodium intake. Women with a high sodium intake benefit from a higher potassium intake with regards to SBP. Study limitations include the use of only one random spot urine collection for estimation of 24-h sodium and potassium secretion.

Source: Wouda, Rosa D., S. Matthijs Boekholdt, Kay Tee Khaw, Nicholas J. Wareham, Martin H. de Borst, Ewout J. Hoorn, Joris I. Rotmans, and Liffert Vogt. “Sex-specific associations between potassium intake, blood pressure, and cardiovascular outcomes: the EPIC-Norfolk study.” European heart journal 43, no. 30 (2022): 2867-2875.

© The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

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Posted October 12, 2022.

Taylor Woosley studied biology at Purdue University before becoming a 2016 graduate of Columbia College Chicago with a major in Writing. She currently resides in Glen Ellyn, IL.

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