Sex-Specific Associations and Potassium Intake, Blood Pressure, and CVD

Aug 15, 2022
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Authors:
Wouda RD, Boekholdt SM, Khaw KT, et al.
Citation:
Sex-Specific Associations Between Potassium Intake, Blood Pressure, and Cardiovascular Outcomes: The EPIC-Norfolk Study. Eur Heart J 2022;43:2867-2875.
Summary By:
Debabrata Mukherjee, MD, FACC

Quick Takes

  • The association between potassium consumption and both systolic blood pressure (SBP) and CVD risk is sex specific, and among women, the association between potassium intake and SBP was modified by sodium intake.
  • An inverse relation between potassium intake and SBP was only present in women in the highest tertile of sodium intake, suggesting that particularly high sodium-consuming women would benefit from a high potassium diet.
  • These observations underscore the overall beneficial effects of a high potassium diet.

Study Questions:

Do the associations between daily potassium consumption and blood pressure (BP) as well as cardiovascular disease (CVD) differ between men and women, and do these associations depend on daily sodium consumption?

Methods:

The investigators analyzed 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 blood pressure (SBP), and CVD events (defined as hospitalization or death due to CVD).

Results:

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).

Conclusions:

The authors reported that the association between potassium intake, SBP, and CVD events is sex specific.

Perspective:

This study reported that the association between potassium consumption and both SBP and CVD risk is sex specific, and among women, the association between potassium intake and SBP was modified by sodium intake. Specifically, an inverse relation between potassium intake and SBP was only present in women in the highest tertile of sodium intake, suggesting that particularly high sodium-consuming women would benefit from a high potassium diet. The stronger association between potassium intake and SBP in women seems also relevant for long-term CV outcomes, as the inverse association between potassium intake and CVD events was stronger in women than in men. These observations underscore the overall beneficial effects of a potassium-replete diet.

Clinical Topics: Prevention, Diet

Keywords: Blood Pressure, Cardiovascular Diseases, Diet, Potassium, Potassium, Dietary, Primary Prevention, Risk, Sodium, Sodium, Dietary, Vascular Diseases, Women


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