Ambulatory cardiac arrhythmias in relation to mild hypokalaemia and prognosis in community dwelling middle-aged and elderly subjects

Mattsson, Nick; Sadjadieh, Golnaz; Kumarathurai, Preman; Nielsen, Olav Wendelboe; Køber, Lars; Sajadieh, Ahmad

doi:10.1093/europace/euv204

Cited by 11 publications

(11 citation statements)

References 21 publications

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“…Thus, event rates in subjects with ESVEA and accompanying hypokalemia were almost 14× greater compared with the event rates seen when no ESVEA or hypokalemia were present. According to this study and previous studies, hypokalemia seems to be independently associated with a worse prognostic outcome in terms of cardiovascular-related events, 6,[17][18][19] and data from the present study suggest that mild hypokalemia interacts with excessive supraventricular ectopy to increase the risk of stroke significantly. Earlier studies has shown ESVEA as a predictor of atrial fibrillation and stroke.…”

Section: Discussionsupporting

confidence: 83%

“…In a recent study, mild hypokalemia was found to be associated to increased risk of mortality in a hypertensive population, 24 and these data are consistent with our previous findings in the Copenhagen Holter Study cohort. 19 Even though our study population had hypertensive blood pressure values at baseline, adjustments for systolic blood pressure did not change significance in terms of end points in neither the previous nor the present study. Therefore, it seems likely that the effect of the possible RAAS activation exceeds an increased blood pressure level.…”

Section: Discussioncontrasting

confidence: 70%

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Mild Hypokalemia and Supraventricular Ectopy Increases the Risk of Stroke in Community-Dwelling Subjects

Mattsson

Kumarathurai

Larsen

et al. 2017

Stroke

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Background and Purpose-Stroke is independently associated with the common conditions of hypokalemia and supraventricular ectopy, and we hypothesize that the combination of excessive supraventricular ectopic activity and hypokalemia has a synergistic impact on the prognosis in terms of stroke in the general population. Methods-Subjects (55-75 years old) from the Copenhagen Holter Study cohort (N=671) with no history of atrial fibrillation or stroke were studied-including baseline values of potassium and ambulatory 48-hour Holter monitoring. Excessive supraventricular ectopic activity is defined as ≥30 premature atrial complexes per hour or any episodes of runs of ≥20. Hypokalemia was defined as plasma-potassium ≤3.6 mmol/L. The primary end point was ischemic stroke. Cox models were used. Results-Hypokalemia was mild (mean, 3.4 mmol/L; range, 2.7-3.6). Hypokalemic subjects were older (67.0±6.94 versus 64.0±6.66 years; P<0.0001) and more hypertensive (165.1±26.1 versus 154.6±23.5 mm Hg; P<0.0001). Median followup time was 14.4 years (Q1-Q3, 9.4-14.7 years). The incidence of stroke was significantly higher in the hypokalemic group (hazard ratio, 1.84; 95% confidence interval, 1.04-3.28) after covariate adjustments, as well as in a competing risk analysis with death (hazard ratio, 1.51; 95% confidence interval, 1.12-2.04). Excessive supraventricular ectopic activity was also associated with stroke (hazard ratio, 2.23; 95% confidence interval, 1.33-3.76). The combination of hypokalemia and excessive supraventricular ectopic activity increased the risk of events synergistically. Stroke rate was 93 per 1000 patient-year (P<0.0001) in this group (n=17) compared with 6.9 (n=480); 11 (n=81), and 13 (n=93) per 1000 patient-year in the groups without the combination. Conclusions-The combination of hypokalemia and excessive supraventricular ectopy carries a poor prognosis in terms of stroke.

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Section: Discussionsupporting

confidence: 83%

Section: Discussioncontrasting

confidence: 70%

Mild Hypokalemia and Supraventricular Ectopy Increases the Risk of Stroke in Community-Dwelling Subjects

Mattsson

Kumarathurai

Larsen

et al. 2017

Stroke

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“…The association between abnormal values of potassium and adverse outcomes may be explained by underlying disruption in kidney function, or by downstream effects of potassium itself. Both hypo- and hyperkalemia have been associated with arrhythmias, [39][40][41][42][43] which can cause sudden cardiac death. Potassium levels affect the resting membrane potential of cardiomyocytes and the activity of potassium channels important for the cardiac electrical cycle, with hypokalemia inducing hyperpolarization, faster electrical conduction, and delays in ventricular repolarization, and hyperkalemia resulting in slower electrical conduction.…”

Section: Discussionmentioning

confidence: 99%

Serum Potassium, Mortality, and Kidney Outcomes in the Atherosclerosis Risk in Communities Study

Chen

Chang

McAdams‐DeMarco

et al. 2016

Mayo Clinic Proceedings

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Objectives To investigate the association between serum potassium, mortality, and kidney outcomes in the general population and whether potassium-altering medications modify these associations. Patients and Methods We studied 15,539 adults in the Atherosclerosis Risk in Communities (ARIC) study. Cox proportional hazard regression was used to investigate the association of serum potassium at baseline (1987–1989), evaluated categorically (hypokalemia, <3.5 mmol/L; normokalemia, ≥3.5 and < 5.5 mmol/L; hyperkalemia, ≥5.5 mmol/L) and continuously using linear spline terms (knots at 3.5 and 5.5 mmol/L), with mortality, sudden cardiac death (SCD), incident chronic kidney disease (CKD), and end-stage renal disease (ESRD). The end date of follow up for all outcomes was December 31, 2012. We also evaluated whether classes of potassium-altering medications modified the association between serum potassium and adverse outcomes. Results Overall, 2.7% of the participants had hypokalemia and 2.1% had hyperkalemia. In a fully adjusted model, hyperkalemia was significantly associated with mortality (HR: 1.24; 95% CI: 1.04–1.49) but not SCD, CKD, or ESRD. Hypokalemia as a categorical variable was not associated with any outcome; however, associations of hypokalemia with all-cause mortality and kidney outcomes were observed among those who were not taking potassium-wasting diuretics (all P for interaction <.001). Conclusions Higher values of serum potassium were associated with higher risk of mortality in the general population. Lower levels of potassium were associated with adverse kidney outcomes and mortality among participants not taking potassium-wasting diuretics.

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“…Hypokalemia is a common electrolyte disorder and complication of hospitalized patients. Serum K + has been confirmed to be a predictor of adverse cardiovascular and renal outcomes [12–15], but there has been only 1 previous report of hypokalemia being associated with high short-term mortality in acute stroke patients [16]. …”

Section: Introductionmentioning

confidence: 99%

Effect of Hypokalemia on Functional Outcome at 3 Months Post-Stroke Among First-Ever Acute Ischemic Stroke Patients

et al. 2017

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BackgroundHypokalemia has been confirmed to be a predictor of adverse cardiovascular and renal outcomes. There is a paucity of studies focusing on the potential connection between the serum K+ level and the outcome after acute ischemic stroke (AIS). This study investigated whether hypokalemia in the acute stroke stage contributes to worse functional outcome in AIS patients.Material/MethodsThis retrospective cohort study included consecutive patients with first-ever AIS admitted between June 2015 and March 2016. Patients were divided into 2 groups: hypokalemia (K+ <3.5 mmol/L) and normokalemia (3.5 mmol/L ≤K+ ≤5.5 mmol/L). Primary outcome measure was poor outcome at 3 months (modified Rankin scale >2). Univariate and multivariate logistic regression analyses were used to assess the association between hypokalemia and poor outcome. Receiver operating curve (ROC) analysis was performed to determine the optimal cutoff point of serum K+ level for predicting poor outcome.ResultsThe percent of patients with poor outcome at 3 months was higher in the hypokalemic group (62.9%) than in the normokalemic group (45.5%). Hypokalemic patients tended to have lower fasting glucose at admission, lower Glasgow coma scale score, and longer time from symptom onset to treatment compared with normokalemic patients. Hypokalemia was associated with poor outcome at 3 months after adjusting for potential confounders (odds ratio=2.42, 95% confidence interval=1.21–4.86, P=0.013). ROC analysis showed that the optimal threshold for serum K+ level was 3.7 mmol/L.ConclusionsHypokalemia at the initial admission is associated with poor prognosis at 3 months in first-ever AIS patients.

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Ambulatory cardiac arrhythmias in relation to mild hypokalaemia and prognosis in community dwelling middle-aged and elderly subjects

Abstract: In middle-aged and elderly subjects with no manifest heart disease, mild hypokalaemia is associated with increased rate of ventricular but not supraventricular arrhythmias. Hypokalaemia interacts synergistically with increased ventricular ectopy to increase the risk of adverse events.

Cited by 11 publications

References 21 publications

Mild Hypokalemia and Supraventricular Ectopy Increases the Risk of Stroke in Community-Dwelling Subjects

Mild Hypokalemia and Supraventricular Ectopy Increases the Risk of Stroke in Community-Dwelling Subjects

Serum Potassium, Mortality, and Kidney Outcomes in the Atherosclerosis Risk in Communities Study

Effect of Hypokalemia on Functional Outcome at 3 Months Post-Stroke Among First-Ever Acute Ischemic Stroke Patients

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