Association of serum potassium time in target range with cardiovascular outcomes in patients with HFpEF
Background Serum potassium (sK) disorders are associated with worse outcomes in patients with heart failure with preserved ejection fraction (HFpEF). This study introduced a novel metric, time in target range (TTR), for long-term monitoring of sK levels and determined its prognostic value in patient...
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| Format: | Article |
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BMJ Publishing Group
2025-08-01
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| Series: | Open Heart |
| Online Access: | https://openheart.bmj.com/content/12/2/e003439.full |
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| author | Yu Liu Jianping Bin Yating Tang Yanmei Chen Wenlong Xu Yuegang Wang Zhiwen Xiao Yingxuan Li Xingqiao Chen Fengling He Haoxiang Huang Chuling Li Jiajun Zhou |
| author_facet | Yu Liu Jianping Bin Yating Tang Yanmei Chen Wenlong Xu Yuegang Wang Zhiwen Xiao Yingxuan Li Xingqiao Chen Fengling He Haoxiang Huang Chuling Li Jiajun Zhou |
| author_sort | Yu Liu |
| collection | DOAJ |
| description | Background Serum potassium (sK) disorders are associated with worse outcomes in patients with heart failure with preserved ejection fraction (HFpEF). This study introduced a novel metric, time in target range (TTR), for long-term monitoring of sK levels and determined its prognostic value in patients with HFpEF from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial.Methods The TTR for sK levels was defined as the percentage of time during which the sK was within the target range of 4.3–4.9 mmol/L, and was estimated using linear interpolation based on at least five valid measurements of sK. The association between sK TTR and cardiovascular (CV) events was estimated using adjusted Cox proportional hazards regression models.Results A total of 3141 TOPCAT participants with HFpEF were evaluated over a median follow-up period of 3.9 years. A greater time within the range of 4.3–4.9 mmol/L for sK was associated with a lower risk of CV events in patients with HFpEF (HR: 0.712; 95% CI: 0.571 to 0.889). The benefits remained when the range of sK was set at 4.3–4.6, or 4.6–4.9, while no benefits or even negative effects were observed at 4.0–4.3, or 4.9–5.2 mmol/L. The association between a higher TTR and lower risk of CV outcomes was consistent across subgroups. The sK TTR predicted a lower risk of CV events, even after adjusting for traditional CV risk factors, mean sK and sK variability.Conclusion Maintaining sK levels within the range of 4.3–4.9 mmol/L most of the time in patients with HFpEF is associated with a lower risk of CV events or all-cause mortality.Trial registration number NCT00094302. |
| format | Article |
| id | doaj-art-c91a7e6f9be64ed49cfd2e3bf8861ea5 |
| institution | Kabale University |
| issn | 2053-3624 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Open Heart |
| spelling | doaj-art-c91a7e6f9be64ed49cfd2e3bf8861ea52025-08-21T11:00:13ZengBMJ Publishing GroupOpen Heart2053-36242025-08-0112210.1136/openhrt-2025-003439Association of serum potassium time in target range with cardiovascular outcomes in patients with HFpEFYu Liu0Jianping Bin1Yating Tang2Yanmei Chen3Wenlong Xu4Yuegang Wang5Zhiwen Xiao6Yingxuan Li7Xingqiao Chen8Fengling He9Haoxiang Huang10Chuling Li11Jiajun Zhou12Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Jiangsu, Nanjing, ChinaDepartment of Cardiology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, ChinaShanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China2 Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Guangzhou, Guangdong, China1 Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, ChinaDepartment of Cardioloqy, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China3 Department of Cardiology, The Sixth Affiliated Hospital of South China University of Technology, Foshan, Guangdong, China2 Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Guangzhou, Guangdong, China1 Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China1 Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China1 Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China1 Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China1 Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, ChinaBackground Serum potassium (sK) disorders are associated with worse outcomes in patients with heart failure with preserved ejection fraction (HFpEF). This study introduced a novel metric, time in target range (TTR), for long-term monitoring of sK levels and determined its prognostic value in patients with HFpEF from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial.Methods The TTR for sK levels was defined as the percentage of time during which the sK was within the target range of 4.3–4.9 mmol/L, and was estimated using linear interpolation based on at least five valid measurements of sK. The association between sK TTR and cardiovascular (CV) events was estimated using adjusted Cox proportional hazards regression models.Results A total of 3141 TOPCAT participants with HFpEF were evaluated over a median follow-up period of 3.9 years. A greater time within the range of 4.3–4.9 mmol/L for sK was associated with a lower risk of CV events in patients with HFpEF (HR: 0.712; 95% CI: 0.571 to 0.889). The benefits remained when the range of sK was set at 4.3–4.6, or 4.6–4.9, while no benefits or even negative effects were observed at 4.0–4.3, or 4.9–5.2 mmol/L. The association between a higher TTR and lower risk of CV outcomes was consistent across subgroups. The sK TTR predicted a lower risk of CV events, even after adjusting for traditional CV risk factors, mean sK and sK variability.Conclusion Maintaining sK levels within the range of 4.3–4.9 mmol/L most of the time in patients with HFpEF is associated with a lower risk of CV events or all-cause mortality.Trial registration number NCT00094302.https://openheart.bmj.com/content/12/2/e003439.full |
| spellingShingle | Yu Liu Jianping Bin Yating Tang Yanmei Chen Wenlong Xu Yuegang Wang Zhiwen Xiao Yingxuan Li Xingqiao Chen Fengling He Haoxiang Huang Chuling Li Jiajun Zhou Association of serum potassium time in target range with cardiovascular outcomes in patients with HFpEF Open Heart |
| title | Association of serum potassium time in target range with cardiovascular outcomes in patients with HFpEF |
| title_full | Association of serum potassium time in target range with cardiovascular outcomes in patients with HFpEF |
| title_fullStr | Association of serum potassium time in target range with cardiovascular outcomes in patients with HFpEF |
| title_full_unstemmed | Association of serum potassium time in target range with cardiovascular outcomes in patients with HFpEF |
| title_short | Association of serum potassium time in target range with cardiovascular outcomes in patients with HFpEF |
| title_sort | association of serum potassium time in target range with cardiovascular outcomes in patients with hfpef |
| url | https://openheart.bmj.com/content/12/2/e003439.full |
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