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Meta ‐ Analysis of Potassium Intake and the Risk of Stroke

View Article: PubMed Central - PubMed

ABSTRACT

Background: The possibility that lifestyle factors such as diet, specifically potassium intake, may modify the risk of stroke has been suggested by several observational cohort studies, including some recent reports. We performed a systematic review and meta‐analysis of existing studies and assessed the dose–response relation between potassium intake and stroke risk.

Methods and results: We reviewed the observational cohort studies addressing the relation between potassium intake, and incidence or mortality of total stroke or stroke subtypes published through August 6, 2016. We carried out a meta‐analysis of 16 cohort studies based on the relative risk (RR) of stroke comparing the highest versus lowest intake categories. We also plotted a pooled dose–response curve of RR of stroke according to potassium intake. Analyses were performed with and without adjustment for blood pressure. Relative to the lowest category of potassium intake, the highest category of potassium intake was associated with a 13% reduced risk of stroke (RR=0.87, 95% CI 0.80–0.94) in the blood pressure–adjusted analysis. Summary RRs tended to decrease when original estimates were unadjusted for blood pressure. Analysis for stroke subtypes yielded comparable results. In the spline analysis, the pooled RR was lowest at 90 mmol of potassium daily intake (RRs=0.78, 95% CI 0.70–0.86) in blood pressure–adjusted analysis, and 0.67 (95% CI 0.57–0.78) in unadjusted analysis.

Conclusions: Overall, this dose–response meta‐analysis confirms the inverse association between potassium intake and stroke risk, with potassium intake of 90 mmol (≈3500 mg)/day associated with the lowest risk of stroke.

No MeSH data available.


Flow chart summarizing study identification and selection. Box 1 shows details of research strategy.
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jah31793-fig-0001: Flow chart summarizing study identification and selection. Box 1 shows details of research strategy.

Mentions: We followed the “Preferred reporting items for systematic reviews and meta‐analyses” (PRISMA) statement for reporting of this systematic review.12 We performed a systematic literature search on potassium intake and stroke into the PubMed/Medline database on August 6, 2016. The search strategy is reported in Box 1 of Figure 1. “Stroke” and “potassium” were used both as MeSH terms and title/abstract keywords. Only cohort studies were selected, provided that they investigated stroke incidence or stroke mortality, and that they assessed dietary potassium intake through dietary questionnaires or determination of urinary potassium excretion. We did not apply any restriction based on the length of follow‐up. The extracted data (made in duplicates by M.V. and T.F.) included the population characteristics (sex, total study sample, location of the study), the length of follow‐up and the percentage loss at follow‐up, the baseline median/mean potassium intake for each exposure category, the type of stroke and number of cases for total stroke and stroke subtypes (including person‐years within each exposure category), the covariates adjusted for in the multivariable analysis and eventually the relative risk (RR) estimates with their 95% CI for all exposure categories. We assessed the overall quality of studies using the Newcastle‐Ottawa quality assessment scale13 in duplicate (T.F. and A.S.), and publication bias through Egger's test.14


Meta ‐ Analysis of Potassium Intake and the Risk of Stroke
Flow chart summarizing study identification and selection. Box 1 shows details of research strategy.
© Copyright Policy - creativeCommonsBy-nc-nd
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5121516&req=5

jah31793-fig-0001: Flow chart summarizing study identification and selection. Box 1 shows details of research strategy.
Mentions: We followed the “Preferred reporting items for systematic reviews and meta‐analyses” (PRISMA) statement for reporting of this systematic review.12 We performed a systematic literature search on potassium intake and stroke into the PubMed/Medline database on August 6, 2016. The search strategy is reported in Box 1 of Figure 1. “Stroke” and “potassium” were used both as MeSH terms and title/abstract keywords. Only cohort studies were selected, provided that they investigated stroke incidence or stroke mortality, and that they assessed dietary potassium intake through dietary questionnaires or determination of urinary potassium excretion. We did not apply any restriction based on the length of follow‐up. The extracted data (made in duplicates by M.V. and T.F.) included the population characteristics (sex, total study sample, location of the study), the length of follow‐up and the percentage loss at follow‐up, the baseline median/mean potassium intake for each exposure category, the type of stroke and number of cases for total stroke and stroke subtypes (including person‐years within each exposure category), the covariates adjusted for in the multivariable analysis and eventually the relative risk (RR) estimates with their 95% CI for all exposure categories. We assessed the overall quality of studies using the Newcastle‐Ottawa quality assessment scale13 in duplicate (T.F. and A.S.), and publication bias through Egger's test.14

View Article: PubMed Central - PubMed

ABSTRACT

Background: The possibility that lifestyle factors such as diet, specifically potassium intake, may modify the risk of stroke has been suggested by several observational cohort studies, including some recent reports. We performed a systematic review and meta‐analysis of existing studies and assessed the dose–response relation between potassium intake and stroke risk.

Methods and results: We reviewed the observational cohort studies addressing the relation between potassium intake, and incidence or mortality of total stroke or stroke subtypes published through August 6, 2016. We carried out a meta‐analysis of 16 cohort studies based on the relative risk (RR) of stroke comparing the highest versus lowest intake categories. We also plotted a pooled dose–response curve of RR of stroke according to potassium intake. Analyses were performed with and without adjustment for blood pressure. Relative to the lowest category of potassium intake, the highest category of potassium intake was associated with a 13% reduced risk of stroke (RR=0.87, 95% CI 0.80–0.94) in the blood pressure–adjusted analysis. Summary RRs tended to decrease when original estimates were unadjusted for blood pressure. Analysis for stroke subtypes yielded comparable results. In the spline analysis, the pooled RR was lowest at 90 mmol of potassium daily intake (RRs=0.78, 95% CI 0.70–0.86) in blood pressure–adjusted analysis, and 0.67 (95% CI 0.57–0.78) in unadjusted analysis.

Conclusions: Overall, this dose–response meta‐analysis confirms the inverse association between potassium intake and stroke risk, with potassium intake of 90 mmol (≈3500 mg)/day associated with the lowest risk of stroke.

No MeSH data available.