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. 2024 Sep 19;25(9):332.
doi: 10.31083/j.rcm2509332. eCollection 2024 Sep.

Association of Adding Salt to Foods and Potassium Intake with Incident Atrial Fibrillation in the UK Biobank Study

Yoon Jung Park  1   2 , Pil-Sung Yang  3 , Bo Eun Park  2   4 , Jong Sung Park  2   4 , Eunsun Jang  5 , Daehoon Kim  5 , Hong Nyun Kim  1   2 , Namkyun Kim  2   4 , Jang Hoon Lee  2   4 , Yongkeun Cho  2   4 , Jung-Hoon Sung  3 , Boyoung Joung  5
Affiliations

Association of Adding Salt to Foods and Potassium Intake with Incident Atrial Fibrillation in the UK Biobank Study

Yoon Jung Park et al. Rev Cardiovasc Med. .

Abstract

Background: High sodium and low potassium consumption are related to hypertension and cardiovascular disease. We aimed to determine the relationship between the frequency of salt addition and potassium consumption with the risk of new-onset atrial fibrillation (AF).

Methods: Our study used the UK Biobank cohort, which included over 500,000 individuals enrolled from the United Kingdom between 2006 and 2010. This study involved 416,868 participants who filled out the dietary recall regarding the frequency of salt addition.

Results: During follow-up, 19,164 (4.6%) developed AF. The incidence of new-onset AF was increased based on the frequency of salt addition (never/rarely 3.83; always 4.72 per 1000 person-years). Compared with the group that never/rarely added salt, those adding salt always were at significantly higher risk of incident AF after adjusting for multiple variables (hazard ratio (HR) 1.15; 95% confidence interval (CI) 1.06-1.24), and additional adjustment of dietary and total energy consumption (HR 1.37; 95% CI 1.08-1.73). In the subgroup analysis, the risk of AF incident according to the frequency of salt addition significantly increased in low urine potassium levels compared to high (p for interaction = 0.046). In the subgroup analysis for AF patients, higher salt addition frequency was related to increased all-cause mortality.

Conclusions: Our study demonstrated that adding salt to foods more frequently increases the risk of incident AF, even after adjusting for dietary and total energy consumption. In the high urine potassium group, the impact of high sodium consumption on incident AF was attenuated.

Keywords: atrial fibrillation; mortality; potassium; sodium.

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Conflict of interest statement

The authors declare no conflict of interest. Boyoung Joung is serving as one of the Editorial Board members of this journal. We declare that Boyoung Joung had no involvement in the peer review of this article and has no access to information regarding its peer review. Full responsibility for the editorial process for this article was delegated to Buddhadeb Dawn.

Figures

Fig. 1.
Fig. 1.
Inclusion and exclusion processes from the UK biobank study. Among 502,421 participants, 501,296 participants answered the questionnaire about the frequency of salt addition to foods. After excluding participants with previous AF, CAD, HF, ischemic stroke or TIA, MI, and malignancy and those without data of spot urine sodium and potassium, 416,868 participants were enrolled. Abbreviations: AF, atrial fibrillation; CAD, coronary artery disease; HF, heart failure; TIA, transient ischemic attack; MI, myocardial infarction.
Fig. 2.
Fig. 2.
Stratified analysis for AF incident risk based on the frequency of salt addition. Fig. 2 displays the association between the risk of AF incident and frequency of salt addition in subgroup analysis. It demonstrates that participants who added salt to foods more frequently had an increased risk of AF incidents regardless of age, BMI, economic status, comorbidities, and lifestyle, except for sex. Abbreviations: AF, atrial fibrillation; HR, hazard ratio; CI, confidence interval; Ref, reference; BMI, body mass index.
Fig. 3.
Fig. 3.
Association between the frequency of salt addition and urinary potassium in relation to risk of AF incident. In Fig. 3, we divided the estimated 24-hour potassium excretion into tertiles and analyzed the association between the frequency of salt addition and the risk of incident AF in each group. It illustrates that the risk of AF incidents increased in participants who always added salt to foods, especially in low and intermediate-potassium level groups. Abbreviations: AF, atrial fibrillation; HR, hazard ratio; CI, confidence interval; Ref, reference.
Fig. 4.
Fig. 4.
The incidence of stroke or systemic embolism, HF, and mortality based on the frequency of salt addition in AF patients. (A) Mortality. (B) Stroke or systemic embolism. (C) HF. Fig. 4 shows the association between the frequency of salt addition and the incidence of mortality, stroke or systemic embolism, and HF in patients with AF. (A) shows that the incidence of mortality increased in patients with a higher frequency of salt addition. (B) shows that the incidence of stroke or systemic embolism was highest in patients who always added salt to foods. (C) shows that the incidence of HF was highest in patients who always added salt to foods. Abbreviations: AF, atrial fibrillation; HF, heart failure.
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