TY - JOUR
T1 - Association of Abnormal Serum Potassium Levels with Arrhythmias and Cardiovascular Mortality
T2 - a Systematic Review and Meta-Analysis of Observational Studies
AU - Hoppe, Liesa K.
AU - Muhlack, Dana C.
AU - Koenig, Wolfgang
AU - Carr, Prudence R.
AU - Brenner, Hermann
AU - Schöttker, Ben
PY - 2018/4/20
Y1 - 2018/4/20
N2 - Purpose: To provide the first systematic review and meta-analysis of observational studies on the association of abnormal serum potassium and cardiovascular outcomes. Methods: Medline and ISI Web of Knowledge were systematically searched from inception until November 24, 2017. Data synthesis of relevant studies was performed using random effects model meta-analyses. Results: Meta-analyses included 310,825 participants from 24 studies. In the older general population, low serum potassium was associated with a 1.6-fold increased risk of supraventricular arrhythmias (risk ratio [95% confidence interval] 1.62 [1.02–2.55]). Contrarily, high serum potassium was associated with increased cardiovascular mortality (CVM) (1.38 [1.14–1.66]). In patients with acute myocardial infarction, the risk of ventricular arrhythmias was increased for high serum potassium (2.33 [1.60–3.38]). A U-shaped association was observed with a composite cardiovascular outcome in hypertensive patients (2.6-fold increased risk with hypokalemia and 1.7-fold increased risk with hyperkalemia), with CVM in dialysis patients (1.1-fold increased risk with hypokalemia and 1.4-fold increased risk with hyperkalemia) and with CVM in heart failure patients (albeit not statistically significant). Further, only hyperkalemia was associated with an increased risk of a composite cardiovascular outcome in both dialysis (1.12 [1.03–1.23]) and chronic kidney disease (1.34 [1.06–1.71]) patients. Conclusions: Controlled clinical trials are needed to determine which populations may profit from more frequent potassium-monitoring and subsequent interventions, e.g., change or withdrawal of potassium-influencing drugs, in order to restore normal values and prevent cardiovascular outcomes. Registration Details: Registration in PROSPERO (Centre for Reviews and Dissemination University of York, York, UK): CRD42016048897 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=48897).
AB - Purpose: To provide the first systematic review and meta-analysis of observational studies on the association of abnormal serum potassium and cardiovascular outcomes. Methods: Medline and ISI Web of Knowledge were systematically searched from inception until November 24, 2017. Data synthesis of relevant studies was performed using random effects model meta-analyses. Results: Meta-analyses included 310,825 participants from 24 studies. In the older general population, low serum potassium was associated with a 1.6-fold increased risk of supraventricular arrhythmias (risk ratio [95% confidence interval] 1.62 [1.02–2.55]). Contrarily, high serum potassium was associated with increased cardiovascular mortality (CVM) (1.38 [1.14–1.66]). In patients with acute myocardial infarction, the risk of ventricular arrhythmias was increased for high serum potassium (2.33 [1.60–3.38]). A U-shaped association was observed with a composite cardiovascular outcome in hypertensive patients (2.6-fold increased risk with hypokalemia and 1.7-fold increased risk with hyperkalemia), with CVM in dialysis patients (1.1-fold increased risk with hypokalemia and 1.4-fold increased risk with hyperkalemia) and with CVM in heart failure patients (albeit not statistically significant). Further, only hyperkalemia was associated with an increased risk of a composite cardiovascular outcome in both dialysis (1.12 [1.03–1.23]) and chronic kidney disease (1.34 [1.06–1.71]) patients. Conclusions: Controlled clinical trials are needed to determine which populations may profit from more frequent potassium-monitoring and subsequent interventions, e.g., change or withdrawal of potassium-influencing drugs, in order to restore normal values and prevent cardiovascular outcomes. Registration Details: Registration in PROSPERO (Centre for Reviews and Dissemination University of York, York, UK): CRD42016048897 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=48897).
KW - Arrhythmia
KW - Cardiovascular mortality
KW - Meta-analysis
KW - Observational studies
KW - Serum potassium
KW - Systematic review
UR - http://www.scopus.com/inward/record.url?scp=85045745011&partnerID=8YFLogxK
U2 - 10.1007/s10557-018-6783-0
DO - 10.1007/s10557-018-6783-0
M3 - Review Article
C2 - 29679302
AN - SCOPUS:85045745011
SN - 0920-3206
VL - 32
SP - 197
EP - 212
JO - Cardiovascular Drugs and Therapy
JF - Cardiovascular Drugs and Therapy
IS - 2
ER -