Potassium levels and the risk of all-cause and cardiovascular mortality among patients with cardiovascular diseases: a meta-analysis of cohort studies.
Potassium levels and the risk of all-cause and cardiovascular mortality among patients with cardiovascular diseases: a meta-analysis of cohort studies.
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DOI：
10.1186/s12937-023-00888-z
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发表时间：
2024-01-10
影响因子：
5.4
通讯作者：
Ma, Le
中科院分区：
文献类型：
--
作者：
Fan, Yahui;Wu, Min;Li, Xiaohui;Zhao, Jinping;Shi, Jia;Ding, Lu;Jiang, Hong;Li, Zhaofang;Zhang, Wei;Ma, Tianyou;Wang, Duolao;Ma, Le
在一般人群中，血钾水平异常与心脏代谢疾病和死亡率风险增加相关;然而，关于心血管疾病（CVD）患者中血钙异常与死亡率之间相关性的证据仍不确定。本研究旨在评估心血管疾病患者钾水平与全因死亡率和心血管死亡率的关系。检索了截至2023年8月的PubMed、Embase、Web of Science和科克伦图书馆数据库，以识别心血管疾病（如心肌梗死、卒中和心力衰竭）患者的相关队列研究。钾水平异常被认为是低钾血症或高钾血症。主要结局是基于随访时间的全因死亡率（包括住院、短期和长期死亡率）和心血管死亡率。纳入研究的方法学质量采用Newcastle-Ottawa量表进行评估。使用随机效应模型计算合并相对风险（RR）和95%置信区间（CI）。应用约束三次样条函数探讨剂量-反应关系。荟萃分析纳入了31项队列研究，涉及227，645名参与者，平均年龄为68.3岁，所有研究均达到中等至高质量。高钾血症与全因住院死亡风险增加约3.0倍（RR：2.78，95 CI %：1.92，4.03）、全因短期死亡风险增加1.8倍（RR：1.80，95 CI %：1.44，2.27）、全因长期死亡风险增加1.3倍（RR：1.33，95 CI %：1.19，1.48）和心血管死亡风险增加1.2倍（RR：1.19，95 CI %：1.04，1.36）显著相关。在低钾血症与全因死亡率和心血管死亡率之间也观察到类似的正相关。以低钾血症合并正常钾血症为对照组，高钾血症患者的院内全因死亡率、近期死亡率、远期死亡率和心血管死亡率的RR分别为2.21（95 CI %：1.60，3.06）、1.46（95 CI %：1.25，1.71）、1.23（95 CI %：1.09，1.39）和1.13（95 CI %：1.00，1.27）。钾水平与死亡率之间呈U形关系，最低风险约为4.2 mmol/L。低钾血症和高钾血症均与CVD患者的死亡风险呈正相关。我们的研究结果支持钾稳态对改善CVD管理的重要性。PROSPERO，CRD 42022324337。在线版本包含补充材料，可通过10.1186/s12937-023-00888-z获得。
Abnormal blood potassium levels are associated with an increased risk of cardiometabolic diseases and mortality in the general population; however, evidence regarding the association between dyskalemia and mortality among patients with cardiovascular disease (CVD) remains inconclusive. This study aimed to evaluate the association of potassium levels with all-cause and cardiovascular mortality among patients with CVD. PubMed, Embase, Web of Science, and Cochrane Library databases were searched up to August 2023 to identify relevant cohort studies among patients with CVD, such as myocardial infarction, stroke, and heart failure. Abnormal potassium levels were considered as hypokalemia or hyperkalemia. The primary outcomes were all-cause mortality based on follow-up length (including in-hospital, short-term and long-term mortality) and cardiovascular mortality. The methodological quality of included studies was assessed by using the Newcastle-Ottawa Scale. The pooled relative risks (RRs) and 95% confidence intervals (CIs) were calculated using random-effects models. Restricted cubic splines were applied to explore the dose-response relationship. Thirty-one cohort studies involving 227,645 participants with an average age of 68.3 years were included in the meta-analysis, all of which achieved moderate to high quality. Hyperkalemia was significantly associated with an approximately 3.0-fold increased risk of all-cause in-hospital mortality (RR:2.78,95CI%:1.92,4.03), 1.8-fold of all-cause short-term mortality (RR:1.80, 95CI%:1.44,2.27), 1.3-fold of all-cause long-term mortality (RR:1.33, 95CI%:1.19,1.48) and 1.2-fold of cardiovascular mortality (RR:1.19, 95CI%:1.04,1.36). Similar positive associations were also observed between hypokalemia and risk of all-cause mortality and cardiovascular mortality. The RRs of all-cause in-hospital, short-term, long-term mortality and cardiovascular mortality with hyperkalemia were attenuated to 2.21 (95CI%:1.60,3.06), 1.46(95CI%:1.25,1.71), 1.23 (95CI%:1.09,1.39) and 1.13 (95CI%:1.00,1.27) when treating hypokalemia together with normokalemia as the reference group. A U-shaped association was observed between potassium levels and mortality, with the lowest risk at around 4.2 mmol/L. Both hypokalemia and hyperkalemia were positively associated with the risk of mortality in patients with CVD. Our results support the importance of potassium homeostasis for improving the CVD management. PROSPERO, CRD42022324337. The online version contains supplementary material available at 10.1186/s12937-023-00888-z.
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