Johnson Linda S, Mattsson Nick, Sajadieh Ahmad, Wollmer Per, Söderholm Martin
From the Department of Clinical Sciences Malmö, Lund University, and Skåne University Hospital, Sweden (L.S.J., M.S.); Department of Cardiology, Copenhagen University Hospital of Bispebjerg, Denmark (N.M., A.S.); and Department of Translational Medicine, Lund University, and Skåne University Hospital, Malmö, Sweden (P.W.).
Stroke. 2017 Nov;48(11):2973-2978. doi: 10.1161/STROKEAHA.117.018148. Epub 2017 Oct 3.
Low serum potassium is associated with stroke in populations with cardiovascular disease, hypertension, and diabetes mellitus but has not been studied in a mainly healthy population. We aimed to study the relation between serum potassium and incident stroke and mortality in the Malmö Preventive Project, a large cohort with screening in early mid-life and follow-up >25 years.
Serum potassium measurements and covariates were available in 21 353 individuals (79% men, mean age 44 years). Mean follow-up time was 26.9 years for stroke analyses and 29.3 years for mortality analyses. There were 2061 incident stroke events and 8709 deaths. Cox regression analyses adjusted for multiple stroke risk factors (age, sex, height, weight, systolic blood pressure, fasting blood glucose, serum sodium, current smoking, prevalent diabetes mellitus, prevalent coronary artery disease, and treatment for hypertension) were fitted.
There was an independent, linear association between serum potassium, per mmol/L increase, and both stroke (hazard ratio, 1.33; 95% confidence interval, 1.17-1.52; <0.0001) and mortality (hazard ratio, 1.20; 95% confidence interval, 1.13-1.28; <0.0001). This was significant in subjects both older and younger than the median age (46.5 years), and there was evidence of an interaction with serum sodium. The association was positive and significant for both ischemic stroke and intracerebral hemorrhage and in both hypertensive and normotensive subjects.
Serum potassium, measured in early mid-life, was linearly associated with both incidence of ischemic stroke and intracerebral hemorrhage and all-cause mortality. An interaction with serum sodium implies that factors related to electrolyte balance and incident hypertension may be mediating factors.
低血钾与心血管疾病、高血压和糖尿病患者的中风有关，但尚未在主要为健康人群中进行研究。我们旨在研究马尔默预防项目中血清钾与中风发生率和死亡率之间的关系，该项目是一个大型队列，在中年早期进行筛查，随访时间超过25年。
对21353名个体（79%为男性，平均年龄44岁）进行了血清钾测量和协变量分析。中风分析的平均随访时间为26.9年，死亡率分析的平均随访时间为29.3年。共有2061例中风事件和8709例死亡。采用Cox回归分析，对多个中风危险因素（年龄、性别、身高、体重、收缩压、空腹血糖、血清钠、当前吸烟、糖尿病患病率、冠状动脉疾病患病率和高血压治疗情况）进行校正。
血清钾每升高1 mmol/L，与中风（风险比，1.33；95%置信区间，1.17 - 1.52；<0.0001）和死亡率（风险比，1.20；95%置信区间，1.13 - 1.28；<0.0001）均存在独立的线性关联。在年龄大于和小于年龄中位数（46.5岁）的受试者中均有显著意义，并且有证据表明与血清钠存在相互作用。这种关联在缺血性中风和脑出血以及高血压和血压正常的受试者中均为正向且显著。
中年早期测量的血清钾与缺血性中风和脑出血的发生率以及全因死亡率均呈线性关联。与血清钠的相互作用表明，与电解质平衡和高血压发生相关的因素可能是中介因素。
