Association of Abnormal Serum Potassium Levels with Arrhythmias and Cardiovascular Mortality: a Systematic Review and Meta-Analysis of Observational Studies

Liesa K. Hoppe, Dana C. Muhlack, Wolfgang Koenig, Prudence R. Carr, Hermann Brenner, Ben Schöttker

Research output: Contribution to journalReview ArticleResearchpeer-review

54 Citations (Scopus)


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 (

Original languageEnglish
Pages (from-to)197-212
Number of pages16
JournalCardiovascular Drugs and Therapy
Issue number2
Publication statusPublished - 20 Apr 2018
Externally publishedYes


  • Arrhythmia
  • Cardiovascular mortality
  • Meta-analysis
  • Observational studies
  • Serum potassium
  • Systematic review

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