Skip to main content
Advertisement
  • Neurology.org
  • Journals
    • Neurology
    • Clinical Practice
    • Genetics
    • Neuroimmunology & Neuroinflammation
    • Education
  • Online Sections
    • COVID-19
    • Inclusion, Diversity, Equity, Anti-racism, & Social Justice (IDEAS)
    • Innovations in Care Delivery
    • Practice Buzz
    • Practice Current
    • Residents & Fellows
    • Without Borders
  • Collections
    • Topics A-Z
    • Disputes & Debates
    • Health Disparities
    • Infographics
    • Patient Pages
    • Null Hypothesis
    • Translations
  • Podcast
  • CME
  • About
    • About the Journals
    • Contact Us
    • Editorial Board
  • Authors
    • Submit a Manuscript
    • Author Center

Advanced Search

Main menu

  • Neurology.org
  • Journals
    • Neurology
    • Clinical Practice
    • Genetics
    • Neuroimmunology & Neuroinflammation
    • Education
  • Online Sections
    • COVID-19
    • Inclusion, Diversity, Equity, Anti-racism, & Social Justice (IDEAS)
    • Innovations in Care Delivery
    • Practice Buzz
    • Practice Current
    • Residents & Fellows
    • Without Borders
  • Collections
    • Topics A-Z
    • Disputes & Debates
    • Health Disparities
    • Infographics
    • Patient Pages
    • Null Hypothesis
    • Translations
  • Podcast
  • CME
  • About
    • About the Journals
    • Contact Us
    • Editorial Board
  • Authors
    • Submit a Manuscript
    • Author Center
  • Home
  • Latest Articles
  • Current Issue
  • Past Issues
  • Residents & Fellows

User menu

  • Subscribe
  • My Alerts
  • Log in

Search

  • Advanced search
Neurology
Home
The most widely read and highly cited peer-reviewed neurology journal
  • Subscribe
  • My Alerts
  • Log in
Site Logo
  • Home
  • Latest Articles
  • Current Issue
  • Past Issues
  • Residents & Fellows

Reply to Letter to the Editor

  • Deborah M Green, University of Hawaii Honolulu Hawaiidgreen@queens.org
  • Allen H Ropper, Richard A Krommal, Bruce M Psaty and Gregory L Burke for The Cardiovascular Health Study
Submitted November 26, 2002

We appreciate Hart et al. from the SPAF study examining their cohort data in order to compare it with our results. One of our findings was that the small number of diuretic users with lower serum potassium and atrial fibrillation had a 10-fold greater risk of stroke compared with those with higher serum potassium without atrial fibrillation. [1] The SPAF findings do not contradict our findings. They calculate the risk of stroke for those diuretic users with serum potassium levels less than 4.1 meq/L compared with greater than 4.0 meq/L among participants with atrial fibrillation. However, in our study the comparison group was those diuretic users without atrial fibrillation and a serum potassium level greater than 4.0 meq/L. If we restrict our analysis to those with atrial fibrillation, there is a relative risk of 4.7 (p=0.026, 95% confidence interval of 1.2 to 18.2) for a potassium level less than 4.1 compared with greater than 4.0 after adjustments for covariates. These confidence intervals overlap with theirs (RR 1.5, p=0.12, 95% confidence interval 0.9 to 2.4), therefore their results are within sampling error of ours. SPAF study participants were treated with either aspirin or placebo and were more closely monitored than those in CHS, thereby potentially decreasing the relative risk by preventing some strokes in those with low serum potassium.

In the CHS only 21% of those with lower potassium and 20% with higher potassium levels were using potassium supplements, compared with 43% and 42% in SPAF. The greater use of potassium supplementation in the SPAF trial may have made it more difficult to detect an effect of low serum potassium on stroke risk.

Their results also cannot challenge our overall finding of higher stroke risk associated with lower serum potassium level that we found for all diuretic users with or without atrial fibrillation. Nor do they address our finding of higher stroke risk with low dietary potassium intake among older individuals not taking diuretics. We agree with Hart et al. that no recommendations can be made with regard to diuretic use based on these studies however, we question whether diuretics would be more effective with closer potassium level monitoring and supplementation. We again encourage further prospective studies or reexamination of prior cohort studies to corroborate our findings.

References:

1) Green DM, Ropper AH, Kroumal RA, Psaty BM, Burke GL, for The Cardiovascular Health Study. Serum potassium level and dietary potassium intake as risk factors for stroke. Neurology 2002;59:314-320.

Navigate back to article

Neurology: 98 (24)

Articles

  • Ahead of Print
  • Current Issue
  • Past Issues
  • Popular Articles
  • Translations

About

  • About the Journals
  • Ethics Policies
  • Editors & Editorial Board
  • Contact Us
  • Advertise

Submit

  • Author Center
  • Submit a Manuscript
  • Information for Reviewers
  • AAN Guidelines
  • Permissions

Subscribers

  • Subscribe
  • Activate a Subscription
  • Sign up for eAlerts
  • RSS Feed
Site Logo
  • Visit neurology Template on Facebook
  • Follow neurology Template on Twitter
  • Visit Neurology on YouTube
  • Neurology
  • Neurology: Clinical Practice
  • Neurology: Genetics
  • Neurology: Neuroimmunology & Neuroinflammation
  • Neurology: Education
  • AAN.com
  • AANnews
  • Continuum
  • Brain & Life
  • Neurology Today

Wolters Kluwer Logo

Neurology | Print ISSN:0028-3878
Online ISSN:1526-632X

© 2022 American Academy of Neurology

  • Privacy Policy
  • Feedback
  • Advertise