Potassium intake: the Cinderella electrolyte

Graphical Abstract Potassium and sodium intake and pathophysiological mechanisms mediating cardiovascular risk. The Graphical Abstract illustrates that diets low in potassium and high in sodium intake increase the risk of hypertension and cardiovascular disease. Increased potassium intake is associated with reduced cardiovascular risk, mediated through diverse renal and vascular mechanisms. Increased potassium intake may be achieved through increasing dietary intake of foods that are rich in potassium, or through salt substitution (i.e. replacing some NaCl with KCl in salt) which is relevant in countries where sodium intake is high and most sodium intake is derived from discretionary sources, such as China. ROS, reactive oxygen species; SSaSS, Salt Substitution and Stroke Study; TGF-beta, transforming growth factor-beta. Dietary guidelines recommend intake targets for some essential minerals, based on observational and experimental evidence relating mineral intake levels to health outcomes. For prevention of cardiovascular disease, reducing sodium intake and increasing potassium intake are the principal tools. While reducing sodium intake has received greatest public health priority, emerging evidence suggests that increasing potassium intake may be a more important target for cardiovascular prevention. Increased potassium intake reduces blood pressure and mitigates the hypertensive effects of excess sodium intake, and the recent large Phase III SSaSS trial reported that increasing potassium intake (and reducing sodium intake) in populations with low potassium intake and high sodium intake, through salt substitution (25% KCl, 75%NaCl), reduces the risk of stroke in patients at increased cardiovascular risk. As key sources of potassium intake include fruit, vegetables, nuts, and legumes, higher potassium intake may be associated with healthy dietary patterns. The current review makes the case that increasing potassium intake might represent a more advantageous dietary strategy for prevention of cardiovascular disease. Future research should focus on addressing the independent effect of potassium supplementation in populations with low or moderate potassium intake, and determine effective strategies to increase potassium intake from diet.