Physicians' Academy for Cardiovascular Education

High sodium intake may benefit women, not men, with high potassium diet

Sex-specific associations between potassium intake, blood pressure, and cardiovascular outcomes: the EPIC-Norfolk study

Literature - Wouda RD, Boekholdt DM, Khaw KT, et al. - Eur Heart J. 2022 Jul 21;ehac313 [Online ahead of print]. doi: 10.1093/eurheartj/ehac313

Introduction and methods


Several cohort studies have shown that a potassium replete diet is associated with lower blood pressure (BP) and lower CVD risk [1,2-5]. However, it is unknown whether these associations are sex specific and whether they depend on daily sodium consumption, given that women are more sodium sensitive [6-8].

Aim of the study

The goal was to analyze whether the association between daily potassium intake and either systolic BP (SBP) or CV events differs between men and women and whether these associations depend on daily sodium intake.


Data of 11,267 men and 13,696 women from the Norfolk cohort of the European Prospective Investigation into Cancer (EPIC-Norfolk) study, a prospective population-based cohort study, were analyzed. Spot urine samples were used to estimate 24-hour excretion of sodium and potassium—which was considered to reflect daily intake—using the Kawasaki formula. Due to differences in potassium and sodium intake between men and women, sex-specific tertiles of potassium and sodium intake were defined.


Main outcomes were SBP at baseline and the composite outcome of hospitalization or death due to CVD during follow-up. Other outcomes of interest were diastolic BP, mean arterial pressure (MAP), the composite outcome of hospitalization or mortality from ischemic heart disease, and the composite of hospitalization or mortality from ischemic or hemorrhagic stroke.

Main results

Systolic blood pressure

Cardiovascular outcomes


In this analysis of the EPIC-Norfolk cohort, the association between potassium intake and both SBP and CV events was sex specific. Moreover, the inverse relation between potassium intake and SBP was only present in women in the highest tertile of sodium intake. The association between potassium consumption and CV events was not influenced by sodium intake. The authors add that “[c]onsidering the natriuretic effects of potassium, these findings seem consistent with increased sodium sensitivity of BP in women.”


Show references

Find this article online at Eur Heart J.

Share this page with your colleagues and friends: