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(Circulation. 1998;98:1198-1204.)
© 1998 American Heart Association, Inc.

Clinical Investigation and Reports

Intake of Potassium, Magnesium, Calcium, and Fiber and Risk of Stroke Among US Men

A. Ascherio, MD, DrPH; E. B. Rimm, ScD; M. A. Hernán, MD, MPH; E. L. Giovannucci, MD, ScD; I. Kawachi, MD, DrPH; M. J. Stampfer, MD, DrPH; ; W. C. Willett, MD, DrPH

From the Departments of Nutrition (A.A., E.B.R., E.L.G., M.J.S., W.C.W.), Epidemiology (A.A., E.B.R., M.A.H., M.J.S., W.C.W.), and Health and Social Behavior (I.K.), Harvard School of Public Health, and the Channing Laboratory, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital (E.B.R., E.L.G., M.J.S., W.C.W., I.K.), Boston, Mass.

Background—Animal experiments and epidemiological studies have suggested that high potassium intake may reduce the risk of stroke, but the evidence is inconclusive, and the role of other nutrients in potassium-rich foods remains unknown.

Methods and Results—We examined the association of potassium and related nutrients with risk of stroke among 43 738 US men, 40 to 75 years old, without diagnosed cardiovascular diseases or diabetes, who completed a semiquantitative food frequency questionnaire in 1986. During 8 years of follow-up, 328 strokes (210 ischemic, 70 hemorrhagic, 48 unspecified) were documented. The multivariate relative risk of stroke of any type for men in the top fifth of potassium intake (median intake, 4.3 g/d) versus those in the bottom (median, 2.4 g/d) was 0.62 (95% CI, 0.43, 0.88; P for trend=0.007). Results for ischemic stroke alone were similar. Intakes of cereal fiber and magnesium, but not of calcium, were also inversely associated with risk of total stroke. These inverse associations were all stronger in hypertensive than normotensive men and were not materially altered by adjustment for blood pressure levels. Use of potassium supplements was also inversely related to risk of stroke, particularly among men taking diuretics (relative risk, 0.36; 95% CI, 0.18, 0.72).

Conclusions—Although these data do not prove a causal relationship, they are consistent with the hypothesis that diets rich in potassium, magnesium, and cereal fiber reduce the risk of stroke, particularly among hypertensive men. Potassium supplements may also be beneficial, but because of potential risks, use should be carefully monitored and restricted to men taking potassium-losing diuretics.

Key Words: stroke • potassium • magnesium • epidemiology • diet

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