Cardiovascular Drugs and Therapy

, Volume 32, Issue 2, pp 197–212 | Cite as

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
REVIEW ARTICLE
  • 165 Downloads

Abstract

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).

Keywords

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

Notes

Acknowledgements

We thank Maurizio Grilli for his advice and support concerning the development of the search strategy.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Compliance with Ethical Standards

Conflicts of Interest

The authors declare that they have no conflict of interest.

Supplementary material

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Liesa K. Hoppe
    • 1
    • 2
  • Dana C. Muhlack
    • 1
    • 2
  • Wolfgang Koenig
    • 3
    • 4
    • 5
  • Prudence R. Carr
    • 2
  • Hermann Brenner
    • 1
    • 2
  • Ben Schöttker
    • 1
    • 2
    • 6
  1. 1.Network Aging ResearchUniversity of HeidelbergHeidelbergGermany
  2. 2.Division of Clinical Epidemiology and Aging ResearchGerman Cancer Research CenterHeidelbergGermany
  3. 3.Deutsches Herzzentrum MünchenTechnische Universität MünchenMunichGermany
  4. 4.DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart AllianceTechnische Universität MünchenMunichGermany
  5. 5.Department of Internal Medicine II – CardiologyUniversity of Ulm Medical CentreUlmGermany
  6. 6.Institute of Health Care and Social SciencesFOM UniversityEssenGermany

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