Sex-specific associations between potassium intake, blood pressure, and cardiovascular outcomes: the EPIC-Norfolk study. (22nd June 2022)

• Record Type: Journal Article
• Authors: Wouda, Rosa D; Boekholdt, S Matthijs; Khaw, Kay Tee; Wareham, Nicholas J; de Borst, Martin H; Hoorn, Ewout J; Rotmans, Joris I; Vogt, Liffert
• Is Part Of: European heart journal. Volume 43:Number 30(2022)
• Page Start: 2867
• Page End: 2875
• Publication Date: 2022-06-22
• Subjects: Sex differences -- Potassium intake -- Sodium intake -- Blood pressure -- Cardiovascular disease; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehac313
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Aims: A potassium replete diet is associated with lower blood pressure (BP) and lower risk of cardiovascular disease (CVD). Whether these associations differ between men and women and whether they depend on daily sodium intake is unknown. Methods and results: An analysis was performed in 11 267 men and 13 696 women from the EPIC-Norfolk cohort. Twenty-four hour excretion of sodium and potassium, reflecting intake, was estimated from sodium and potassium concentration in spot urine samples using the Kawasaki formula. Linear and Cox regression were used to explore the association between potassium intake, systolic BP (SBP), and CVD events (defined as hospitalization or death due to CVD). After adjustment for confounders, interaction by sex was found for the association between potassium intake and SBP ( P < 0.001). In women, but not in men, the inverse slope between potassium intake and SBP was steeper in those within the highest tertile of sodium intake compared with those within the lowest tertile of sodium intake ( P < 0.001 for interaction by sodium intake). Both in men and women, higher potassium intake was associated with a lower risk of CVD events, but the hazard ratio (HR) associated with higher potassium intake was lower in women than in men [highest vs. lowest potassium intake tertile: men: HR 0.93, 95% confidence interval (CI) 0.87–1.00; women: HR 0.89, 95% CI 0.83–0.95, P = 0.033 for interaction by sex]. Conclusion: The association between potassium intake, SBP, and CVD events is sex specific. The data suggest that women with a high sodium intake in particular benefit most from a higher potassium intake with regard to SBP. Structured Graphical Abstract: Structured Graphical Abstract An analysis was performed in 11 267 men and 13 696 women from the EPIC-Norfolk cohort. Twenty-four hour excretion of sodium and potassium, reflecting intake, was estimated from sodium and potassium concentration in spot urine samples using the Kawasaki formula. Linear and Cox regression analyses showed that the association between potassium intake and both SBP and CVD risk is sex specific. Moreover, among women, the association between potassium intake and SBP was modified by sodium intake. EPIC-Norfolk, Norfolk cohort of the European Prospective Investigation into Cancer; CVD, cardiovascular disease; SBP, systolic blood pressure.