title: Urinary potassium excretion and risk of cardiovascular events.
abstract: BACKGROUND
  Observational studies on dietary potassium and risk of cardiovascular disease (CVD) have reported weak-to-modest inverse associations. Long-term prospective studies with multiple 24-h urinary samples for accurate estimation of habitual potassium intake, however, are scarce.
  
  
  OBJECTIVE
  We examined the association between urinary potassium excretion and risk of blood pressure-related cardiovascular outcomes.
  
  
  METHODS
  We studied 7795 subjects free of cardiovascular events at baseline in the Prevention of Renal and Vascular End-stage Disease study, a prospective, observational cohort with oversampling of subjects with albuminuria at baseline. Main cardiovascular outcomes were CVD [including ischemic heart disease (IHD), stroke, and vascular interventions], IHD, stroke, and new-onset heart failure (HF). Potassium excretion was measured in two 24-h urine specimens at the start of the study (1997-1998) and midway through follow-up (2001-2003).
  
  
  RESULTS
  Baseline median urinary potassium excretion was 70 mmol/24 h (IQR: 56-84 mmol/24 h). During a median follow-up of 10.5 y (IQR: 9.9-10.8 y), a total of 641 CVD, 465 IHD, 172 stroke, and 265 HF events occurred. After adjustment for age and sex, inverse associations were observed between potassium excretion and risk [HR per each 26-mmol/24-h (1-g/d) increase; 95% CI] of CVD (0.87; 0.78, 0.97) and IHD (0.86; 0.75, 0.97), as well as nonsignificant inverse associations for risk of stroke (0.85; 0.68, 1.06) and HF (0.94; 0.80, 1.10). After further adjustment for body mass index, smoking, alcohol consumption, education, and urinary sodium and magnesium excretion, urinary potassium excretion was not statistically significantly associated with risk (multivariable-adjusted HR per 1-g/d increment; 95% CI) of CVD (0.96; 0.85, 1.09), IHD (0.90; 0.81, 1.04), stroke (1.09; 0.86, 1.39), or HF (0.99; 0.83, 1.18). No associations were observed between the sodium-to-potassium excretion ratio and risk of CVD, IHD, stroke, or HF.
  
  
  CONCLUSIONS
  In this cohort with oversampling of subjects with albuminuria at baseline, urinary potassium excretion was not independently associated with a lower risk of cardiovascular events.
authors.affiliation: Top Institute Food and Nutrition, Wageningen, Netherlands; Department of Internal Medicine and.
authors.forename: Lyanne M
authors.initials: LM
authors.lastname: Kieneker
authors.affiliation: Department of Internal Medicine and.
authors.forename: Ron T
authors.initials: RT
authors.lastname: Gansevoort
authors.affiliation: Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands; and.
authors.forename: Rudolf A
authors.initials: RA
authors.lastname: de Boer
authors.affiliation: Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands; and.
authors.forename: Frank P
authors.initials: FP
authors.lastname: Brouwers
authors.affiliation: Top Institute Food and Nutrition, Wageningen, Netherlands; Wageningen University, Division of Human Nutrition, Wageningen, Netherlands.
authors.forename: Edith Jm
authors.initials: EJ
authors.lastname: Feskens
authors.affiliation: Top Institute Food and Nutrition, Wageningen, Netherlands; Wageningen University, Division of Human Nutrition, Wageningen, Netherlands.
authors.forename: Johanna M
authors.initials: JM
authors.lastname: Geleijnse
authors.affiliation: Department of Internal Medicine and.
authors.forename: Gerjan
authors.initials: G
authors.lastname: Navis
authors.affiliation: Top Institute Food and Nutrition, Wageningen, Netherlands; Department of Internal Medicine and.
authors.forename: Stephan Jl
authors.initials: SJ
authors.lastname: Bakker
authors.affiliation: Top Institute Food and Nutrition, Wageningen, Netherlands; Department of Internal Medicine and mmjoosten@gmail.com.
authors.forename: Michel M
authors.identifier: http://orcid.org/0000-0002-0039-6629
authors.initials: MM
authors.lastname: Joosten
mesh_terms: D000328:Adult; D000419:Albuminuria / Q000175:diagnosis / Q000652:urine; D001794:Blood Pressure / Q000187:drug effects; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000652:urine*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008274:Magnesium / Q000652:urine; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000652:urine*; D017419:Potassium, Dietary / Q000008:administration & dosage; D011446:Prospective Studies; D012307:Risk Factors; D012964:Sodium / Q000652:urine
chemical_list: D017419:Potassium, Dietary; D012964:Sodium; D008274:Magnesium; D011188:Potassium
keywords: cardiovascular disease; epidemiology; potassium; risk factors; sodium