Commentary by Gregory S. Pokrywka, MD, FACP, FNLA, NCMP
Stroke has devastating consequences for menopausal women, and treating modifiable risk factors should have a large payoff in reduction of morbidity and mortality. Dietary potassium intake has been associated with stroke risk in most but not all previous studies. In the largest study of menopausal women to date, using Women’s Health Initiative observational study data, the association between stroke and dietary potassium intake is confirmed. Interestingly, the association is strongest in nonhypertensive women. Hypertensive women with increasing potassium intake had lowered mortality but no lower incidence of stroke itself. The authors speculate that this may be because of a greater effect on arterial stiffness in the prehypertensive endothelial wall. Higher potassium intake was also associated with lowered all-cause mortality in all women, suggesting effects above and beyond the vascular system. The heterogeneity of “stroke” as a diagnosis was illustrated by the association with reduction in ischemic but not hemorrhagic stroke.
Of course, two major weaknesses of all such studies are our inability to infer causation from association in an observational study and reliance on the human brain to fill out food frequency forms. If potassium’s ability to reduce stoke in menopausal women was confirmed by a randomized clinical trial, public health efforts could be undertaken to increase the US population’s already lower-than-recommended potassium intake (only about 1/6 of these women met US Department of Agriculture potassium intake recommendations.) Such efforts would best take a simple macronutrient/whole foods approach, because counting dietary potassium intake itself would be difficult for patients. However, before considering increasing dietary potassium intake, special attention would have to be given to the potential for hyperkalemia in a population full of risk factors, such as chronic renal failure, and angiotensin-converting enzyme inhibitor use. Forget “an apple a day”—maybe “half a cantaloupe a day (with twice the potassium of a banana) makes the stroke go away” will be the new mantra for menopausal women.
From the NAMS First to Know e-newsletter released October 30, 2014
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