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

Abstract

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.

Association of Dyskalemias with Ischemic Stroke in Advanced Chronic Kidney Disease Patients Transitioning to Dialysis

“…Our results align with existing research that suggests that hypokalemia (chronic exposure) is associated with a higher risk of ischemic stroke. Among diuretic users [12], general population [14], and a treated hypertensive population [15], hypokalemia was associated with a 2.5-, 2.1-, and 2-fold higher risk of ischemic stroke, respectively. On the other hand, in a general population [13], both K levels between 4.3-8.4 mmol/L and a per mmol/L increase in K levels were associated with 1.3-fold higher risk of ischemic stroke.…”

“…To determine the short-term risk associated with dyskalemias, we also assessed the association of time-updated dyskalemias (acute exposure) with ischemic stroke where we observed that hyperkalemia (and higher levels of K) was associated with a lower risk of ischemic stroke. Previous studies have hypothesized that hypokalemia might be a marker of increased RAAS activity [28], and an increased activity in systemic and cerebral RAAS system could potentiate the effect of a stroke, by resulting in more extensive neurologic damage and neurologic deficits [14]. This may explain the association of hypokalemia (chronic exposure) with a higher risk of ischemic stroke.…”

“…Previous studies suggested that dyskalemias (especially hypokalemia) are associated with a higher risk of ischemic stroke [12-15]. Among the general population [14], diuretics users [12] and treated hypertensive patients [15], hypokalemia was associated with a higher risk of ischemic stroke. Conversely, a study in the general population [13] showed that higher levels of K were associated with a higher risk of ischemic stroke.…”

Lower Serum Potassium Levels at Admission are Associated with the Risk of Recurrent Stroke in Patients with Acute Ischemic Stroke or Transient Ischemic Attack

“…Previous studies reported that both high and low serum potassium levels were associated with mortality in patients with cardiovascular disease [9], even mild or moderate abnormality increased the risks of morbidity and mortality in cardiovascular disease patients as well [10]. The association of abnormal levels of serum potassium with morbidity and mortality of stroke in the general population has also been reported by several recent studies [11, 12]. However, few studies have focused on the connection between serum potassium and stroke outcome in patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA) after treatment.…”

Incidence and Determinants of Piperacillin/Tazobactam-Associated Hypokalemia: A Retrospective Study

“…Mild hypokalemia is generally asymptomatic; however, severe hypokalemia might cause respiratory depression, paralytic ileus, and life-threatening cardiac arrhythmias [ 1 , 2 , 3 , 4 ]. Additionally, it has been reported that a low serum potassium level is associated with mortality and morbidity [ 5 , 6 , 7 , 8 , 9 , 10 , 11 ] in patients with cardiovascular disease, renal conditions, and others. Thus, it is important to identify or review the causes of hypokalemia to prevent or promptly and appropriately manage the disorder.…”