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Li L, Lutsey PL, Chen LY, Soliman EZ, Rooney MR, Alonso A. Circulating Magnesium and Risk of Major Adverse Cardiac Events among Patients with Atrial Fibrillation in the ARIC Cohort. Nutrients 2023; 15:1211. [PMID: 36904210 PMCID: PMC10005106 DOI: 10.3390/nu15051211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/20/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
Background: Serum magnesium (Mg) has been reported to be inversely associated with the risk of atrial fibrillation (AF), coronary artery disease (CAD), and major adverse cardiovascular events (MACE). The association between serum Mg and the risk of MACE, heart failure (HF), stroke, and all-cause mortality among patients with AF has not been evaluated. Objective: We aim to examine whether higher serum Mg is associated with a lower risk of MACE, heart failure (HF), stroke, and all-cause mortality among patients with AF. Methods: We evaluated prospectively 413 participants of the Atherosclerosis Risk in Communities (ARIC) Study with a diagnosis of AF at the time of Mg measurement participating in visit 5 (2011-2013). Serum Mg was modeled in tertiles and as a continuous variable in standard deviation units. Endpoints (HF, MI, stroke, cardiovascular (CV) death, all-cause mortality, and MACE) were identified and modeled separately using Cox proportional hazard regression adjusting for potential confounders. Results: During a mean follow-up of 5.8 years, there were 79 HFs, 34 MIs, 24 strokes, 80 CV deaths, 110 MACEs, and 198 total deaths. After adjustment for demographic and clinical variables, participants in the second and third tertiles of serum Mg had lower rates of most endpoints, with the strongest inverse association for the incidence of MI (HR 0.20, 95% CI 0.07, 0.61) comparing top to bottom tertile. Serum Mg modeled linearly as a continuous variable did not show clear associations with endpoints except MI (HR 0.50, 95% CI 0.31, 0.80). Due to the limited number of events, the precision of most estimates of association was relatively low. Conclusions: Among patients with AF, higher serum Mg was associated with a lower risk of developing incident MI and, to a lesser extent, other CV endpoints. Further studies in larger patients with AF cohorts are needed to evaluate the role of serum Mg in preventing adverse CV outcomes in these patients.
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Affiliation(s)
- Linzi Li
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota Twin City, Minneapolis, MN 55455, USA
| | - Lin Yee Chen
- Lillehei Heart Institute and Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Elsayed Z. Soliman
- Epidemiological Cardiology Research Center, Section on Cardiovascular Medicine, Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
| | - Mary R. Rooney
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
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2
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Magnesium Administration in Chronic Kidney Disease. Nutrients 2023; 15:nu15030547. [PMID: 36771254 PMCID: PMC9920010 DOI: 10.3390/nu15030547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/11/2023] [Accepted: 01/16/2023] [Indexed: 01/24/2023] Open
Abstract
Awareness of the clinical relevance of magnesium in medicine has increased over the last years, especially for people with chronic kidney disease (CKD), due to magnesium's role in vascular calcification and mineral metabolism. The inverse association between serum magnesium and clinically relevant, adverse outcomes is well-established in people with CKD. Subsequent intervention studies have focused on the effect of magnesium administration, mainly in relation to cardiovascular diseases, mineral bone metabolism, and other metabolic parameters. The most commonly used routes of magnesium administration are orally and by increasing dialysate magnesium. Several oral magnesium formulations are available and the daily dosage of elemental magnesium varies highly between studies, causing considerable heterogeneity. Although data are still limited, several clinical studies demonstrated that magnesium administration could improve parameters of vascular function and calcification and mineral metabolism in people with CKD. Current clinical research has shown that magnesium administration in people with CKD is safe, without concerns for severe hypermagnesemia or negative interference with bone metabolism. It should be noted that there are several ongoing magnesium intervention studies that will contribute to the increasing knowledge on the potential of magnesium administration in people with CKD.
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3
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Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia despite substantial efforts to understand the pathophysiology of the condition and develop improved treatments. Identifying the underlying causative mechanisms of AF in individual patients is difficult and the efficacy of current therapies is suboptimal. Consequently, the incidence of AF is steadily rising and there is a pressing need for novel therapies. Research has revealed that defects in specific molecular pathways underlie AF pathogenesis, resulting in electrical conduction disorders that drive AF. The severity of this so-called electropathology correlates with the stage of AF disease progression and determines the response to AF treatment. Therefore, unravelling the molecular mechanisms underlying electropathology is expected to fuel the development of innovative personalized diagnostic tools and mechanism-based therapies. Moreover, the co-creation of AF studies with patients to implement novel diagnostic tools and therapies is a prerequisite for successful personalized AF management. Currently, various treatment modalities targeting AF-related electropathology, including lifestyle changes, pharmaceutical and nutraceutical therapy, substrate-based ablative therapy, and neuromodulation, are available to maintain sinus rhythm and might offer a novel holistic strategy to treat AF.
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Affiliation(s)
- Bianca J J M Brundel
- Department of Physiology, Amsterdam University Medical Centers, VU Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands.
| | - Xun Ai
- Department of Physiology and Cell Biology, College of Medicine/Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | | | - Myrthe F Kuipers
- AFIPonline.org, Atrial Fibrillation Innovation Platform, Amsterdam, Netherlands
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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4
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Induruwa I, Hennebry E, Hennebry J, Thakur M, Warburton EA, Khadjooi K. Sepsis-driven atrial fibrillation and ischaemic stroke. Is there enough evidence to recommend anticoagulation? Eur J Intern Med 2022; 98:32-36. [PMID: 34763982 PMCID: PMC8948090 DOI: 10.1016/j.ejim.2021.10.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/16/2021] [Accepted: 10/18/2021] [Indexed: 02/06/2023]
Abstract
Sepsis can lead to cardiac arrhythmias, of which the most common is atrial fibrillation (AF). Sepsis is associated with up to a six-fold higher risk of developing AF, where it occurs most commonly in the first 3 days of hospital admission. In many patients, AF detected during sepsis is the first documented episode of AF, either as an unmasking of sub-clinical AF or as a newly developed arrhythmia. In the short term, sepsis that is complicated by AF leads to longer hospital stays and an increased risk of inpatient mortality. Sepsis-driven AF can also increase an individual's risk of inpatient stroke by nearly 3-fold, compared to sepsis patients without AF. In the long-term, it is estimated that up to 50% of patients have recurrent episodes of AF within 1-year of their episode of sepsis. The common perception that once the precipitating illness is treated or sinus rhythm is restored the risk of stroke is removed is incorrect. For clinicians, there is a paucity of evidence on how to reduce an individual's risk of stroke after developing AF during sepsis, including whether to start anticoagulation. This is pertinent when considering that more patients are surviving episodes of sepsis and are left with post-sepsis sequalae such as AF. This review provides a summary on the literature available surrounding sepsis-driven AF, focusing on AF recurrence and ischaemic stroke risk. Using this, pragmatic advice to clinicians on how to better detect and reduce an individual's stroke risk after developing AF during sepsis is discussed.
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Affiliation(s)
- Isuru Induruwa
- Department of Stroke, Cambridge University Hospitals, Cambridge CB2 0QQ, United Kingdom; Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, United Kingdom.
| | - Eleanor Hennebry
- Department of Medicine, Royal Sussex County Hospital, Brighton BN2 5BE, United Kingdom
| | - James Hennebry
- Department of Medicine, Royal Sussex County Hospital, Brighton BN2 5BE, United Kingdom
| | - Mrinal Thakur
- Department of Stroke, Cambridge University Hospitals, Cambridge CB2 0QQ, United Kingdom
| | - Elizabeth A Warburton
- Department of Stroke, Cambridge University Hospitals, Cambridge CB2 0QQ, United Kingdom; Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
| | - Kayvan Khadjooi
- Department of Stroke, Cambridge University Hospitals, Cambridge CB2 0QQ, United Kingdom
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5
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Wodschow K, Villanueva CM, Larsen ML, Gislason G, Schullehner J, Hansen B, Ersbøll AK. Association between magnesium in drinking water and atrial fibrillation incidence: a nationwide population-based cohort study, 2002-2015. Environ Health 2021; 20:126. [PMID: 34906160 PMCID: PMC8672465 DOI: 10.1186/s12940-021-00813-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 11/30/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is a common heart rhythm disorder and a risk factor of adverse cardiovascular diseases. Established causes do not fully explain the risk of AF and unexplained risk factors might be related to the environment, e.g. magnesium in drinking water. Low magnesium levels in drinking water might be associated with higher risk of cardiovascular diseases including AF. With detailed individual data from nationwide registries and long-term magnesium exposure time series, we had a unique opportunity to investigate the association between magnesium in drinking water and AF. OBJECTIVE We evaluated the association between magnesium concentration in drinking water and AF risk. METHODS A nationwide register-based cohort study (2002-2015) was used including individuals aged ≥30 years. Addresses were linked with water supply areas (n = 2418) to obtain time-varying drinking water magnesium exposure at each address. Five exposure groups were defined based on a 5-year rolling time-weighted average magnesium concentration. AF incidence rate ratios (IRRs) between exposure groups were calculated using a Poisson regression of incidence rates, adjusted for sex, age, and socioeconomic position. Robustness of results was investigated with different exposure definitions. RESULTS The study included 4,264,809 individuals (44,731,694 person-years) whereof 222,998 experienced an incident AF. Magnesium exposure ranged from 0.5 to 62.0 mg/L (mean = 13.9 mg/L). Estimated IRR (95% CI) compared to the referent exposure group (< 5 mg/L) was 0.98 (0.97-1.00) for the second lowest exposure group (5-10 mg/L), and 1.07 (1.05-1.08) for the two highest exposure groups (15-62 mg/L). Strongest positive associations were observed among those aged ≥80 years and with lowest education group. An inverse association was found among individuals with highest education group. CONCLUSION There might be a small beneficial effect on AF of an increase in magnesium level in drinking water up to 10 mg/L, though an overall positive association was observed. The unexpected positive association and different associations observed for subgroups suggest a potential influence of unaccounted factors, particularly in vulnerable populations. Future research on magnesium in drinking water and cardiovascular diseases needs to focus on contextual risk factors, especially those potentially correlating with magnesium in drinking water.
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Affiliation(s)
- Kirstine Wodschow
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen C, Denmark
| | - Cristina M. Villanueva
- ISGlobal, Campus Mar, Dr. Aiguader, 88, 08003 Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Av. Monforte de Lemos 3-5. Pabellón 11. Planta 0, 28029 Madrid, Spain
- Universitat Pompeu Fabra (UPF), Plaça de la Mercè, 10-12, 08002 Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Dr. Aiguader, 88, 08003 Barcelona, Spain
| | - Mogens Lytken Larsen
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej15, 9000 Aalborg, Denmark
| | - Gunnar Gislason
- Department of Cardiology, The Cardiovascular Research Centre, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
- The Danish Heart Foundation, Vognmagergade 7, 3. sal, 1120 Copenhagen C, Denmark
| | - Jörg Schullehner
- Geological Survey of Denmark and Greenland, GEUS Department of Groundwater and Quaternary Geology Mapping, C.F. Moellers Allé 8, Bygning 1110, 8000 Aarhus C, Denmark
- Department of Public Health –Research Unit for Environment, Work and Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark
| | - Birgitte Hansen
- Geological Survey of Denmark and Greenland, GEUS Department of Groundwater and Quaternary Geology Mapping, C.F. Moellers Allé 8, Bygning 1110, 8000 Aarhus C, Denmark
| | - Annette Kjær Ersbøll
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen C, Denmark
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6
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Wang KM, Li J, Bhalla V, Jardine MJ, Neal B, de Zeeuw D, Fulcher G, Perkovic V, Mahaffey KW, Chang TI. Canagliflozin, serum magnesium and cardiovascular outcomes-Analysis from the CANVAS Program. Endocrinol Diabetes Metab 2021; 4:e00247. [PMID: 34277971 PMCID: PMC8279612 DOI: 10.1002/edm2.247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 02/09/2021] [Accepted: 02/13/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Patients with type 2 diabetes (T2D) are predisposed to derangements in serum Magnesium (Mg), which may have implications for cardiometabolic events and outcomes. In clinical trials, participants with T2D randomized to sodium-glucose co-transporter 2 (SGLT2) inhibitors have shown mild to moderate increases in serum Mg from baseline levels. This post hoc analysis assesses the relation between serum Mg with cardiovascular outcomes in 10,140 participants of the Canagliflozin Cardiovascular Assessment Study (CANVAS) Program. METHODS We evaluated the association of baseline serum Mg with the primary composite end point of death from cardiovascular causes, non-fatal myocardial infarction, and non-fatal stroke, and tested whether this association is modified by baseline serum Mg. Using mediation analysis, we determined whether change in serum Mg post-randomization mediates the beneficial effect of canagliflozin on cardiovascular outcomes. RESULTS Mean serum Mg levels at baseline were 0.77 ± 0.09 mmol/L in both canagliflozin group and placebo groups. The canagliflozin group experienced an average increase in serum Mg by 0.07 mmol/L (95% CI, 0.065-0.072 mmol/L; p < .001) for the duration of the trial. We found no association between baseline serum Mg levels and the primary composite end point, and no evidence of effect modification by baseline Mg levels. Change in serum Mg post-randomization was not a mediator of the effects of canagliflozin on cardiovascular outcomes. CONCLUSIONS In participants of the CANVAS Program, baseline and post-randomization serum Mg levels are not associated with cardiovascular outcomes.
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Affiliation(s)
- Katherine M. Wang
- Division of NephrologyStanford University School of MedicineStanfordCAUSA
| | - JingWei Li
- The George Institute for Global HealthUniversity of New South WalesSydneyNSWAustralia
- Department of CardiologyXinqiao HospitalArmy Military Medical UniversityChongqingChina
| | - Vivek Bhalla
- Division of NephrologyStanford University School of MedicineStanfordCAUSA
| | - Meg J. Jardine
- The George Institute for Global HealthUniversity of New South WalesSydneyNSWAustralia
- Department of Renal MedicineConcord Repatriation General HospitalSydneyNSWAustralia
- Kidney Health ResearchNHMRC Clinical Trials CentreUniversity of SydneySydneyNSWAustralia
| | - Bruce Neal
- The George Institute for Global HealthUniversity of New South WalesSydneyNSWAustralia
- Charles Perkins CentreUniversity of SydneySydneyNSWAustralia
- Epidemiology and BiostatisticsSchool of Public HealthImperial College LondonLondonUK
| | - Dick de Zeeuw
- Department of Clinical Pharmacy and PharmacologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Greg Fulcher
- Kolling InstituteRoyal North Shore Hospital and University of SydneySydneyNSWAustralia
| | - Vlado Perkovic
- The George Institute for Global HealthUniversity of New South WalesSydneyNSWAustralia
- Department of Renal MedicineRoyal North Shore HospitalSydneyNSWAustralia
| | - Kenneth W. Mahaffey
- Stanford Center for Clinical ResearchStanford University School of MedicineStanfordCAUSA
- Division of Cardiovascular MedicineStanford University School of MedicineStanford CAUSA
| | - Tara I. Chang
- Division of NephrologyStanford University School of MedicineStanfordCAUSA
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7
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Zhu HL, Liu Y, Zhang J, Wang MX, Jiang H, Guo F, Li M, Qi FF, Liu XH, Ma L. Dietary calcium, magnesium, and phosphorus intakes and risk of stroke in Chinese adults. Sci Rep 2021; 11:11270. [PMID: 34050206 PMCID: PMC8163833 DOI: 10.1038/s41598-021-90388-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 05/04/2021] [Indexed: 02/04/2023] Open
Abstract
Controversial results have been reported about the association of calcium, magnesium, and phosphorus and stroke risk, but none in China. To investigate the association between dietary calcium, magnesium, phosphorus, and stroke incidence in Chinese adults, we collected data from the China Health and Nutrition Survey (CHNS) from 2004 to 2011, including 6411 participants aged 45-79 years and free of stroke at baseline. Diet was assessed by interviews combining 3-d 24-h food recalls and household food inventory weighing at each survey round. The stroke incident was identified based on the validated self-report. Multivariate Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). For 32,024 person-years of follow-up, 179 stroke cases were documented. After adjustment for major lifestyle and dietary risk factors, calcium intake was positively associated with reduced stroke risk, and the HR of stroke comparing extreme quartiles was 0.53 (95% CI 0.29-0.96, Ptrend = 0.03). In further stratified analyses, significant heterogeneity across sex strata was found (Pinteraction = 0.03). Dietary calcium intake among men was more inversely related to stroke, with HRs being 0.33 (95% CI 0.15-0.76, P trend = 0.02), compared to 1.24 (95% CI 0.46-3.35, Ptrend = 0.89) among women. However, no significant association between stroke and magnesium or phosphorus was revealed. Our findings suggest that higher dietary calcium intake was associated with a lower risk of stroke in Chinese adults, particularly in men.
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Affiliation(s)
- Hai-Lu Zhu
- grid.43169.390000 0001 0599 1243The First Affiliated Hospital, Xi’an Jiaotong University Health Science Center, Xi’an 710061, People’s Republic of China ,grid.43169.390000 0001 0599 1243Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi’an Jiaotong University, Xi’an, China ,grid.43169.390000 0001 0599 1243School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, People’s Republic of China
| | - Yan Liu
- grid.43169.390000 0001 0599 1243The First Affiliated Hospital, Xi’an Jiaotong University Health Science Center, Xi’an 710061, People’s Republic of China ,grid.43169.390000 0001 0599 1243Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi’an Jiaotong University, Xi’an, China
| | - Jian Zhang
- grid.43169.390000 0001 0599 1243School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, People’s Republic of China
| | - Ming-Xu Wang
- grid.43169.390000 0001 0599 1243School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, People’s Republic of China
| | - Hong Jiang
- grid.43169.390000 0001 0599 1243School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, People’s Republic of China
| | - Fang Guo
- grid.43169.390000 0001 0599 1243School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, People’s Republic of China ,grid.194645.b0000000121742757School of Public Health, University of Hong Kong, Hong Kong Special Administrative Region 999077, Pok Fu Lam, People’s Republic of China
| | - Ming Li
- grid.1026.50000 0000 8994 5086Center for Population Health Research, Division of Health Sciences, University of South Australia, Adelaide, South Australia 5000 Australia
| | - Fei-Fei Qi
- grid.43169.390000 0001 0599 1243School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, People’s Republic of China
| | - Xiao-Hong Liu
- grid.43169.390000 0001 0599 1243The First Affiliated Hospital, Xi’an Jiaotong University Health Science Center, Xi’an 710061, People’s Republic of China
| | - Le Ma
- grid.43169.390000 0001 0599 1243School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, People’s Republic of China
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Negrea L, DeLozier SJ, Janes JL, Rahman M, Dobre M. Serum Magnesium and Cardiovascular Outcomes and Mortality in CKD: The Chronic Renal Insufficiency Cohort (CRIC). Kidney Med 2021; 3:183-192.e1. [PMID: 33851114 PMCID: PMC8039411 DOI: 10.1016/j.xkme.2020.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
RATIONALE & OBJECTIVE Low serum magnesium level has been shown to be associated with increased mortality, but its role as a predictor of cardiovascular disease is unclear. This study evaluates the association between serum magnesium level and cardiovascular events and all-cause mortality in a large cohort of individuals with chronic kidney disease (CKD). STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS 3,867 participants with CKD, enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study. EXPOSURES Serum magnesium measured at study baseline. OUTCOMES Composite cardiovascular events (myocardial infarction, cerebrovascular accident, heart failure, and peripheral arterial disease) and all-cause mortality. ANALYTICAL APPROACH Cox proportional hazards models adjusted for demographic, clinical, and laboratory characteristics. RESULTS During the 14.6 (4.4) years (standard deviation) of follow-up, 1,384 participants died (36/1,000 person-years), and 1,227 (40/1,000 person-years) had a composite cardiovascular event. There was a nonlinear association between serum magnesium level and all-cause mortality. Low and high magnesium levels were associated with greater rates of all-cause mortality after adjusting for demographics, comorbid conditions, medications including diuretics, estimated glomerular filtration rate, and proteinuria (P < 0.001). No significant associations were observed between serum magnesium levels and the composite cardiovascular events. Low serum magnesium level was associated with incident atrial fibrillation (HR, 1.36; 95% CI, 1.01-1.82; P = 0.04). LIMITATIONS Single measurement of serum magnesium. CONCLUSIONS In this large CKD cohort, serum magnesium level < 1.9 mg/dL and >2.1 mg/dL was associated with increased risk for all-cause mortality. Low magnesium level was associated with incident atrial fibrillation but not with composite cardiovascular disease events. Further studies are needed to determine the optimal range of serum magnesium in CKD to prevent adverse clinical outcomes.
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Affiliation(s)
- Lavinia Negrea
- Division of Nephrology and Hypertension, University Hospital Case Medical Center, Case Western Reserve University, Cleveland, OH
| | | | | | - Mahboob Rahman
- Division of Nephrology and Hypertension, University Hospital Case Medical Center, Case Western Reserve University, Cleveland, OH
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH
| | - Mirela Dobre
- Division of Nephrology and Hypertension, University Hospital Case Medical Center, Case Western Reserve University, Cleveland, OH
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9
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Rodelo-Haad C, Pendón-Ruiz de Mier MV, Díaz-Tocados JM, Martin-Malo A, Santamaria R, Muñoz-Castañeda JR, Rodríguez M. The Role of Disturbed Mg Homeostasis in Chronic Kidney Disease Comorbidities. Front Cell Dev Biol 2020; 8:543099. [PMID: 33282857 PMCID: PMC7688914 DOI: 10.3389/fcell.2020.543099] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 10/09/2020] [Indexed: 12/19/2022] Open
Abstract
Some of the critical mechanisms that mediate chronic kidney disease (CKD) progression are associated with vascular calcifications, disbalance of mineral metabolism, increased oxidative and metabolic stress, inflammation, coagulation abnormalities, endothelial dysfunction, or accumulation of uremic toxins. Also, it is widely accepted that pathologies with a strong influence in CKD progression are diabetes, hypertension, and cardiovascular disease (CVD). A disbalance in magnesium (Mg) homeostasis, more specifically hypomagnesemia, is associated with the development and progression of the comorbidities mentioned above, and some mechanisms might explain why low serum Mg is associated with negative clinical outcomes such as major adverse cardiovascular and renal events. Furthermore, it is likely that hypomagnesemia causes the release of inflammatory cytokines and C-reactive protein and promotes insulin resistance. Animal models have shown that Mg supplementation reverses vascular calcifications; thus, clinicians have focused on the potential benefits that Mg supplementation may have in humans. Recent evidence suggests that Mg reduces coronary artery calcifications and facilitates peripheral vasodilation. Mg may reduce vascular calcification by direct inhibition of the Wnt/β-catenin signaling pathway. Furthermore, Mg deficiency worsens kidney injury induced by an increased tubular load of phosphate. One important consequence of excessive tubular load of phosphate is the reduction of renal tubule expression of α-Klotho in moderate CKD. Low Mg levels worsen the reduction of Klotho induced by the tubular load of phosphate. Evidence to support clinical translation is yet insufficient, and more clinical studies are required to claim enough evidence for decision-making in daily practice. Meanwhile, it seems reasonable to prevent and treat Mg deficiency. This review aims to summarize the current understanding of Mg homeostasis, the potential mechanisms that may mediate the effect of Mg deficiency on CKD progression, CVD, and mortality.
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Affiliation(s)
- Cristian Rodelo-Haad
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.,University of Córdoba, Córdoba, Spain.,Nephrology Service, Reina Sofia University Hospital, Córdoba, Spain.,Spanish Renal Research Network (REDinREN), Institute of Health Carlos III, Madrid, Spain
| | - M Victoria Pendón-Ruiz de Mier
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.,University of Córdoba, Córdoba, Spain.,Nephrology Service, Reina Sofia University Hospital, Córdoba, Spain.,Spanish Renal Research Network (REDinREN), Institute of Health Carlos III, Madrid, Spain
| | - Juan Miguel Díaz-Tocados
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.,University of Córdoba, Córdoba, Spain
| | - Alejandro Martin-Malo
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.,University of Córdoba, Córdoba, Spain.,Nephrology Service, Reina Sofia University Hospital, Córdoba, Spain.,Spanish Renal Research Network (REDinREN), Institute of Health Carlos III, Madrid, Spain
| | - Rafael Santamaria
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.,University of Córdoba, Córdoba, Spain.,Nephrology Service, Reina Sofia University Hospital, Córdoba, Spain.,Spanish Renal Research Network (REDinREN), Institute of Health Carlos III, Madrid, Spain
| | - Juan Rafael Muñoz-Castañeda
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.,University of Córdoba, Córdoba, Spain.,Nephrology Service, Reina Sofia University Hospital, Córdoba, Spain.,Spanish Renal Research Network (REDinREN), Institute of Health Carlos III, Madrid, Spain
| | - Mariano Rodríguez
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.,University of Córdoba, Córdoba, Spain.,Nephrology Service, Reina Sofia University Hospital, Córdoba, Spain.,Spanish Renal Research Network (REDinREN), Institute of Health Carlos III, Madrid, Spain
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10
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Low Serum Magnesium is Associated with Incident Dementia in the ARIC-NCS Cohort. Nutrients 2020; 12:nu12103074. [PMID: 33050118 PMCID: PMC7600951 DOI: 10.3390/nu12103074] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/01/2020] [Accepted: 10/01/2020] [Indexed: 01/02/2023] Open
Abstract
Higher serum magnesium is associated with lower risk of multiple morbidities, including diabetes, stroke, and atrial fibrillation, but its potential neuroprotective properties have also been gaining traction in cognitive function and decline research. We studied 12,040 participants presumed free of dementia in the Atherosclerosis Risk in Communities (ARIC) study. Serum magnesium was measured in fasting blood samples collected in 1990–1992. Dementia status was ascertained through cognitive examinations in 2011–2013, 2016–2017, and 2018–2019, along with informant interviews and indicators of dementia-related hospitalization events and death. Participants’ cognitive functioning capabilities were assessed up to five times between 1990–1992 and 2018–2019. The cognitive function of participants who did not attend follow-up study visits was imputed to account for attrition. We identified 2519 cases of dementia over a median follow-up period of 24.2 years. The lowest quintile of serum magnesium was associated with a 24% higher rate of incident dementia compared to those in the highest quintile of magnesium (HR, 1.24; 95% CI, 1.07, 1.44). No relationship was found between serum magnesium and cognitive decline in any cognitive domain. Low midlife serum magnesium is associated with increased risk of incident dementia, but does not appear to impact rates of cognitive decline.
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Rooney MR, Lutsey PL, Alonso A, Selvin E, Pankow JS, Rudser KD, Dudley SC, Chen LY. Serum magnesium and burden of atrial and ventricular arrhythmias: The Atherosclerosis Risk in Communities (ARIC) Study. J Electrocardiol 2020; 62:20-25. [PMID: 32745731 PMCID: PMC7665977 DOI: 10.1016/j.jelectrocard.2020.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/22/2020] [Accepted: 07/17/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Low serum magnesium (Mg) is associated with an increased incidence of atrial and ventricular arrhythmias. A richer phenotyping of arrhythmia indices, such as burden or frequency, may provide etiologic insights. OBJECTIVES To evaluate cross-sectional associations of serum Mg with burden of atrial arrhythmias [atrial fibrillation (AF), premature atrial contractions (PAC), supraventricular tachycardia (SVT)], and ventricular arrhythmias [premature ventricular contractions (PVC), non-sustained ventricular tachycardia (NSVT)] over 2-weeks of ECG monitoring. METHODS We included 2513 ARIC Study visit 6 (2016-2017) participants who wore the Zio XT Patch-a leadless, ambulatory ECG-monitor-for up to 2-weeks. Serum Mg was modeled categorically and continuously. AF burden was categorized as intermittent or continuous based on the percent of analyzable time spent in AF. Other arrhythmia burdens were defined by the average number of abnormal beats per day. Linear regression was used for continuous outcomes; logistic and multinomial regression were used for categorical outcomes. RESULTS Participants were mean ± SD age 79 ± 5 years, 58% were women and 25% black. Mean serum Mg was 0.82 ± 0.08 mmol/L and 19% had hypomagnesemia (<0.75 mmol/L). Serum Mg was inversely associated with PVC burden and continuous AF. The AF association was no longer statistically significant with further adjustment for traditional lifestyle risk factors, only the association with PVC burden remained significant. There were no associations between serum Mg and other arrhythmias examined. CONCLUSIONS In this community-based cohort of older adults, we found little evidence of independent cross-sectional associations between serum Mg and arrhythmia burden.
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Affiliation(s)
- Mary R Rooney
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA; Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA.
| | - Pamela L Lutsey
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Elizabeth Selvin
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - James S Pankow
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Kyle D Rudser
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Samuel C Dudley
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Lin Yee Chen
- Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
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Alonso A, Rooney MR, Chen LY, Norby FL, Saenger AK, Soliman EZ, O'Neal WT, Hootman KC, Selvin E, Lutsey PL. Circulating electrolytes and the prevalence of atrial fibrillation and supraventricular ectopy: The Atherosclerosis Risk in Communities (ARIC) study. Nutr Metab Cardiovasc Dis 2020; 30:1121-1129. [PMID: 32451276 PMCID: PMC7302995 DOI: 10.1016/j.numecd.2020.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 01/01/2020] [Accepted: 03/14/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND AIMS Evaluating associations of circulating electrolytes with atrial fibrillation (AF) and burden of supraventricular arrhythmias can give insights into arrhythmia pathogenesis. METHODS AND RESULTS We conducted a cross-sectional analysis of 6398 participants of the Atherosclerosis Risk in Communities (ARIC) study, ages 71-90, with data on serum electrolytes (magnesium, calcium, potassium, phosphorus, chloride, sodium). Prevalence of AF was determined from electrocardiograms and history of AF hospitalizations. A subset of 317 participants also underwent electrocardiographic recordings for up to 14 days using the Zio® patch. Burden of other supraventricular arrhythmias [premature atrial contractions (PACs), supraventricular tachycardia] was determined with the Zio® patch. We used logistic and linear regression adjusting for potential confounders to determine associations of electrolytes with arrhythmia prevalence and burden. Among 6394 eligible participants, 614 (10%) had AF. Participants in the top quintiles of magnesium [odds ratio (OR) 0.82, 95% confidence interval (CI) 0.62, 1.08], potassium (OR 0.82, 95%CI 0.68, 1.00), and phosphorus (OR 0.73, 95%CI 0.59, 0.89) had lower AF prevalence compared to those in the bottom quintiles. No clear association was found for circulating chloride, calcium or sodium. Higher concentrations of circulating calcium were associated with lower prevalence of PACs in the 12-lead electrocardiogram, while higher concentrations of potassium, chloride and sodium were associated with higher PAC prevalence. Circulating electrolytes were not significantly associated with burden of PACs or supraventricular tachycardia among 317 participants with extended electrocardiographic monitoring. CONCLUSION Concentrations of circulating electrolytes present complex associations with selected supraventricular arrhythmias. Future studies should evaluate underlying mechanisms.
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Affiliation(s)
- Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Mary R Rooney
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Lin Y Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Faye L Norby
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Amy K Saenger
- Chemistry Laboratory, Hennepin Healthcare, Minneapolis, MN, USA
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Wesley T O'Neal
- Division of Cardiology, Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Katie C Hootman
- Metabolic Research Unit, Clinical and Translational Science Center, Weill Cornell Medicine, New York, NY, USA
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Alonso A, Chen LY, Rudser KD, Norby FL, Rooney MR, Lutsey PL. Effect of Magnesium Supplementation on Circulating Biomarkers of Cardiovascular Disease. Nutrients 2020; 12:nu12061697. [PMID: 32517192 PMCID: PMC7352673 DOI: 10.3390/nu12061697] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 12/31/2022] Open
Abstract
(1) Background: Magnesium supplementation may be effective for the prevention of cardiometabolic diseases, but the mechanisms are unclear. Proteomic approaches can assist in identifying the underlying mechanisms. (2) Methods: We collected repeated blood samples from 52 individuals enrolled in a double-blind trial which randomized participants 1:1 to oral magnesium supplementation (400 mg magnesium/day in the form of magnesium oxide) or a matching placebo for 10 weeks. Plasma levels of 91 proteins were measured at baseline with follow-up samples using the Olink Cardiovascular Disease III proximity extension assay panel and were modeled as arbitrary units in a log2 scale. We evaluated the effect of oral magnesium supplementation for changes in protein levels and the baseline association between serum magnesium and protein levels. The Holm procedure was used to adjust for multiple comparisons. (3) Results: Participants were 73% women, 94% white, and had a mean age of 62. Changes in proteins did not significantly differ between the two intervention groups after correction for multiple comparisons. The most statistically significant effects were on myoglobin [difference −0.319 log2 units, 95% confidence interval (CI) (−0.550, −0.088), p = 0.008], tartrate-resistant acid phosphatase type 5 (−0.187, (−0.328, −0.045), p = 0.011), tumor necrosis factor ligand superfamily member 13B (−0.181, (−0.332, −0.031), p = 0.019), ST2 protein (−0.198, (−0.363, −0.032), p = 0.020), and interleukin-1 receptor type 1 (−0.144, (−0.273, −0.015), p = 0.029). Similarly, none of the associations of baseline serum magnesium with protein levels were significant after correction for multiple comparisons. (4) Conclusions: Although we did not identify statistically significant effects of oral magnesium supplementation in this relatively small study, this study demonstrates the value of proteomic approaches for the investigation of mechanisms underlying the beneficial effects of magnesium supplementation. Clinical Trials Registration: ClinicalTrials.gov NCT02837328.
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Affiliation(s)
- Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
- Correspondence: ; Tel.: +1-404-727-8714
| | - Lin Y. Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Kyle D. Rudser
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Faye L. Norby
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55454, USA; (F.L.N.); (P.L.L.)
| | - Mary R. Rooney
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21287, USA;
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55454, USA; (F.L.N.); (P.L.L.)
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Wu WC, Huang M, Taveira TH, Roberts MB, Martin LW, Wellenius GA, Johnson KC, Manson JE, Liu S, Eaton CB. Relationship Between Dietary Magnesium Intake and Incident Heart Failure Among Older Women: The WHI. J Am Heart Assoc 2020; 9:e013570. [PMID: 32192409 PMCID: PMC7428611 DOI: 10.1161/jaha.119.013570] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Women represent a large proportion of the growing heart failure (HF) epidemic, yet data are lacking regarding optimal dietary and lifestyle prevention strategies for them. Specifically, the association between magnesium intake and HF in a multiracial cohort of women is uncertain. Methods and Results We included 97 725 postmenopausal women from the WHI (Women's Health Initiative) observational studies and placebo arms of the hormone trial. Magnesium intake was measured at baseline by a 122‐item validated food‐frequency questionnaire and stratified into quartiles based on diet only, total intake (diet with supplements), and residual intake (calibration by total energy). Incident hospitalized HF (2153 events, median follow‐up 8.1 years) was adjudicated by medical record abstraction. In Cox proportional hazards models, we evaluated the association between magnesium intake and HF adjusting for potential confounders. Analyses were repeated on a subcohort (n=18 745; median‐follow‐up, 13.2 years) for whom HF cases were subclassified into preserved ejection fraction (526 events), reduced ejection fraction (291 events) or unknown (168 events). Most women were white (85%) with a mean age of 63. Compared with the highest quartile of magnesium intake, women in the lowest quartile had an increased risk of incident HF, with adjusted hazard ratios of 1.32 (95% CI, 1.02–1.71) for diet only (P trend=0.03), 1.26 (95% CI, 1.03–1.56) for total intake, and 1.31 (95% CI, 1.02–1.67) for residual intake. Results did not significantly vary by race. Subcohort analyses showed low residual magnesium intake was associated with HF with reduced ejection fraction (hazard ratio, 1.81, lowest versus highest quartile; 95% CI, 1.08–3.05) but not HF with preserved ejection fraction. Conclusions Low magnesium intake in a multiracial cohort of postmenopausal women was associated with a higher risk of incident HF, especially HF with reduced ejection fraction.
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Affiliation(s)
- Wen-Chih Wu
- Division of Cardiology Veterans Affairs Medical Center & The Miriam Hospital Alpert Medical School Brown University Providence RI.,Department of Epidemiology Brown University School of Public Health Providence RI
| | - Mengna Huang
- Channing Division of Network Medicine Brigham and Women's Hospital Boston MA
| | - Tracey H Taveira
- Division of Cardiology Veterans Affairs Medical Center & The Miriam Hospital Alpert Medical School Brown University Providence RI.,University of Rhode Island, College of Pharmacy Kingston RI
| | - Mary B Roberts
- Center for Primary Care and Prevention and the Department of Family Medicine Memorial Hospital of Rhode Island Pawtucket RI
| | - Lisa W Martin
- Division of Cardiology George Washington University School of Medicine and Health Sciences Washington DC
| | - Gregory A Wellenius
- Department of Epidemiology Brown University School of Public Health Providence RI
| | - Karen C Johnson
- Department of Preventive Medicine University of Tennessee Health Science Center Memphis TN
| | - JoAnn E Manson
- Brigham and Women's Hospital Harvard Medical School Boston MA
| | - Simin Liu
- Department of Epidemiology Brown University School of Public Health Providence RI
| | - Charles B Eaton
- Center for Primary Care and Prevention and the Department of Family Medicine Memorial Hospital of Rhode Island Pawtucket RI.,Department of Epidemiology Brown University School of Public Health Providence RI
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Nutraceutical support in heart failure: a position paper of the International Lipid Expert Panel (ILEP). Nutr Res Rev 2020; 33:155-179. [PMID: 32172721 DOI: 10.1017/s0954422420000049] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Heart failure (HF) is a complex clinical syndrome that represents a major cause of morbidity and mortality in Western countries. Several nutraceuticals have shown interesting clinical results in HF prevention as well as in the treatment of the early stages of the disease, alone or in combination with pharmacological therapy. The aim of the present expert opinion position paper is to summarise the available clinical evidence on the role of phytochemicals in HF prevention and/or treatment that might be considered in those patients not treated optimally as well as in those with low therapy adherence. The level of evidence and the strength of recommendation of particular HF treatment options were weighed up and graded according to predefined scales. A systematic search strategy was developed to identify trials in PubMed (January 1970 to June 2019). The terms 'nutraceuticals', 'dietary supplements', 'herbal drug' and 'heart failure' or 'left verntricular dysfunction' were used in the literature search. The experts discussed and agreed on the recommendation levels. Available clinical trials reported that the intake of some nutraceuticals (hawthorn, coenzyme Q10, l-carnitine, d-ribose, carnosine, vitamin D, probiotics, n-3 PUFA and beet nitrates) might be associated with improvements in self-perceived quality of life and/or functional parameters such as left ventricular ejection fraction, stroke volume and cardiac output in HF patients, with minimal or no side effects. Those benefits tended to be greater in earlier HF stages. Available clinical evidence supports the usefulness of supplementation with some nutraceuticals to improve HF management in addition to evidence-based pharmacological therapy.
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Arkhipov M, Bozhko Y, Beloconova N, Kochmasheva V, Chromtsova O. Optimization of hypomagnesemia diagnostics as an integral element in paroxysmal atrial fibrillation management strategy. BIO WEB OF CONFERENCES 2020. [DOI: 10.1051/bioconf/20202202023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Purpose. To study magnesium status of patients having paroxysmal atrial fibrillation (AF) based on the use of an integrated clinical and laboratory approach. Methods. A prospective cohort study included 58 patients of the cardiology department of New Hospital Medical Association. The main group consisted of 32 patients having frequently recurring paroxysmal AF, the control group consisted of 26 patients without paroxysmal rhythm disturbance. The clinical status, Holter ECG monitoring data, the test results for magnesium deficiency (MD) clinical evidence, laboratory evidence of calcium, magnesium in blood plasma and formed elements, magnesium in whole blood, free fatty acids (FFA) and osmolality in blood plasma were assessed. Results. The score obtained when assessing MD clinical evidence was significantly higher in the main group patients compared with the control group (16.5 (11÷21) vs. 13 (8÷15), p<0.001). A statistically significant magnesium decrease in whole blood was revealed in patients having paroxysmal AF (0.54 (0.46÷0.60) vs. 0.61 (0.59÷0.64), p<0.001) and inside formed elements (0.68 (0.53÷1.07) vs. 1.31 (1.07÷1.44), p<0.001), which reflected changes in their magnesium status to a greater extent than the measured plasma cation concentrations. A close correlation between magnesium content in formed elements (intracellularly) and AF paroxysms frequency (Spearman’s rank correlation -0.51, p<0.001) was established. A violation of calcium to magnesium ratio in blood plasma (2.6 (2.5÷2.9) vs. 3.0 (2.8÷3.1), p=0.004) and intracellularly (4.85 (2.62÷9.3) vs. 1.85 (1.57÷2.07), p<0.001) was revealed in patients having AF. It has been shown that complex forming interactions with free fatty acids may affect intracellular calcium and magnesium content.
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Rooney MR, Alonso A, Folsom AR, Michos ED, Rebholz CM, Misialek JR, Chen LY, Dudley S, Lutsey PL. Serum magnesium and the incidence of coronary artery disease over a median 27 years of follow-up in the Atherosclerosis Risk in Communities (ARIC) Study and a meta-analysis. Am J Clin Nutr 2020; 111:52-60. [PMID: 31622458 PMCID: PMC7307183 DOI: 10.1093/ajcn/nqz256] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 09/19/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Low serum magnesium (Mg) concentrations have been associated with higher coronary artery disease (CAD) risk. A previous Atherosclerosis Risk in Communities (ARIC) Study article that evaluated the Mg-CAD association, based on 319 events occurring over 4-7 y, identified a sex-interaction whereby the inverse Mg-CAD association was much stronger among women than men. More than 1700 additional ARIC CAD events have since accrued. OBJECTIVE We aimed to test our hypothesis that serum Mg is inversely and independently associated with long-term CAD risk in ARIC and in a meta-analysis with other prospective studies. METHODS A total of 14,446 ARIC study participants (baseline mean ± SD age: 54 ± 6 y, 57% women, 27% African American) were followed for incident CAD through 2017. CAD events were defined by myocardial infarction or CAD mortality. Serum Mg was modeled as quintiles based on mean visit 1 (1987-1989) and visit 2 (1990-1992) concentrations. Cox regression models were used. We also conducted a random-effects meta-analysis incorporating these contemporary ARIC findings. RESULTS Over a median follow-up of 27 y, 2131 incident CAD cases accrued. Overall, low serum Mg was associated with higher CAD risk after adjustment for demographics, lifestyle factors, and other CAD risk factors than was higher serum Mg (HR Q1 compared with Q5: 1.28; 95% CI: 1.11, 1.47; P-linear trend <0.001). The association was stronger among women (HR Q1 compared with Q5: 1.53; 95% CI: 1.22, 1.92) than men (HR: 1.11; 95% CI: 0.92, 1.34) (P-interaction = 0.05). In the meta-analysis including 5 studies, the pooled RR (95% CI) for CAD in the lowest compared with the highest circulating Mg category was 1.18 (1.06, 1.31) (I2 = 22%, P-heterogeneity = 0.27). CONCLUSIONS In this large community-based cohort and updated meta-analysis, low circulating Mg was associated with higher CAD risk than was higher Mg. Whether increasing Mg concentrations within healthy limits is a useful strategy for CAD prevention remains to be seen.
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Affiliation(s)
- Mary R Rooney
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Alvaro Alonso
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Aaron R Folsom
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Erin D Michos
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | - Casey M Rebholz
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Jeffrey R Misialek
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Lin Yee Chen
- Division of Cardiology, University of Minnesota, Minneapolis, MN, USA
| | - Samuel Dudley
- Division of Cardiology, University of Minnesota, Minneapolis, MN, USA
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
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Storz MA, Helle P. Atrial fibrillation risk factor management with a plant-based diet: A review. J Arrhythm 2019; 35:781-788. [PMID: 31844466 PMCID: PMC6898539 DOI: 10.1002/joa3.12254] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/19/2019] [Accepted: 10/13/2019] [Indexed: 12/13/2022] Open
Abstract
Atrial fibrillation is the most prevalent cardiac arrhythmia in the clinical setting affecting approximately 34 million individuals worldwide. The disease is associated with a significant burden of morbidity and mortality resulting from stroke, heart failure, and acute coronary syndrome. Atrial fibrillation is now a major public health problem with tremendous implications on the economy and the world's healthcare systems. Numerous risk factors and clinical conditions that are associated with the development and progression of atrial fibrillation have been identified in the past. Within the last decades, a shift in awareness toward modifiable conditions has been observed and risk factor management has gained significant momentum. In light of this, dietary approaches are of paramount importance. Whole-food plant-based diets emphasizing grains, legumes, vegetables, fruits and nuts and excluding most (or all) animal products have recently experienced a significantly increased interest. The purpose of this review is to present evidence suggestive of a plant-based diet being a valuable tool in atrial fibrillation risk factor management. The effects of a plant-based diet on both established and emerging risk factors, such as inflammation and subclinical atherosclerosis, are reviewed in this article. A special focus is put on cardiovascular and metabolic risk factors including hypertension, coronary artery disease, diabetes, and obesity.
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Affiliation(s)
| | - Paul Helle
- Department of Intensive Care MedicineDie FilderklinikFilderstadt‐BonlandenGermany
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Safaryan AS, Sargsyan VS, Kamyshova TV, Akhmedzhanov NM, Nebieridze DV, Poddubskaya EA. The Role of Magnesium in the Development of Cardiovascular Diseases and the Possibility of their Prevention and Correction with Magnesium Preparations (Part 1). RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2019. [DOI: 10.20996/1819-6446-2019-15-5-725-735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The article is devoted to the influence of magnesium on the homeostasis of the body and, in particular, on the cardiovascular system. It describes the importance of the presence and effects of magnesium on various key processes and functions occurring in the body. The reasons for the lack of magnesium and ways to replenish it both in the natural way (eating, certain foods) and magnesium preparations are considered. The article provides examples of large randomized studies that prove the importance of the influence of normal magnesium levels on human health in general and on the state of the cardiovascular system. These studies show how magnesium deficiency increases the risk of cardiovascular diseases and how it can be reduced. It is also shown which trace elements and vitamins are closely related to magnesium metabolism, and how they (in particular, potassium and vitamin B6) improve and facilitate the normalization of magnesium levels. It is noted how comorbidity decreases with the normalization of magnesium level – the higher the magnesium level in the blood plasma (closer to the upper limit and more), the less comorbidity and longer life expectancy. Magnesium is an absolutely essential ion and a good medicine. Magnesium deficiency and hypomagnesemia are quite common, difficult to diagnose (due to underestimation and rare level control) and accompany many diseases of the cardiovascular system and beyond. The widespread use of organic magnesium salts would improve the situation as a whole, due to their universal multiple effect on many processes in the body. This is an integral part of therapeutic and preventive measures in patients with already existing diseases and in people who do not have diseases, but who are at risk due to existing hypomagnesemia.
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Affiliation(s)
- A. S. Safaryan
- National Medical Research Center for Preventive Medicine
| | - V. S. Sargsyan
- National Medical Research Center for Preventive Medicine
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Sun X, Zhuang X, Huo M, Feng P, Zhang S, Zhong X, Zhou H, Guo Y, Hu X, Du Z, Zhang M, Liao X. Serum magnesium and the prevalence of peripheral artery disease: The Atherosclerosis Risk in Communities (ARIC) study. Atherosclerosis 2019; 282:196-201. [DOI: 10.1016/j.atherosclerosis.2018.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/01/2018] [Accepted: 12/13/2018] [Indexed: 01/22/2023]
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Magnesium: A Magic Bullet for Cardiovascular Disease in Chronic Kidney Disease? Nutrients 2019; 11:nu11020455. [PMID: 30813254 PMCID: PMC6412491 DOI: 10.3390/nu11020455] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/17/2019] [Accepted: 02/19/2019] [Indexed: 12/19/2022] Open
Abstract
Magnesium is essential for many physiological functions in the human body. Its homeostasis involves dietary intake, absorption, uptake and release from bone, swifts between the intra- and extracellular compartment, and renal excretion. Renal excretion is mainly responsible for regulation of magnesium balance. In chronic kidney disease (CKD), for a long time the general policy has been limiting magnesium intake. However, this may not be appropriate for many patients. The reference ranges for magnesium are not necessarily optimal concentrations, and risks for insufficient magnesium intake exist in patients with CKD. In recent years, many observational studies have shown that higher (in the high range of “normal” or slightly above) magnesium concentrations are associated with better survival in CKD cohorts. This review gives an overview of epidemiological associations between magnesium and overall and cardiovascular survival in patients with CKD. In addition, potential mechanisms explaining the protective role of magnesium in clinical cardiovascular outcomes are described by reviewing evidence from in vitro studies, animal studies, and human intervention studies with non-clinical endpoints. This includes the role of magnesium in cardiac arrhythmia, heart failure, arterial calcification, and endothelial dysfunction. Possible future implications will be addressed, which will need prospective clinical trials with relevant clinical endpoints before these can be adopted in clinical practice.
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Fowke JH, Koyama T, Dai Q, Zheng SL, Xu J, Howard LE, Freedland SJ. Blood and dietary magnesium levels are not linked with lower prostate cancer risk in black or white men. Cancer Lett 2019; 449:99-105. [PMID: 30776477 DOI: 10.1016/j.canlet.2019.02.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 01/18/2019] [Accepted: 02/11/2019] [Indexed: 12/15/2022]
Abstract
Recent studies suggest a diet low in dietary magnesium intake or lower blood magnesium levels is linked with increased prostate cancer risk. This study investigates the race-specific link between blood magnesium and calcium levels, or dietary magnesium intake, and the diagnosis of low-grade and high-grade prostate cancer. The study included 637 prostate cancer cases and 715 biopsy-negative controls (50% black) recruited from Nashville, TN or Durham, NC. Blood was collected at the time of recruitment, and dietary intake was assessed by food frequency questionnaire. Percent genetic African ancestry was determined as a compliment to self-reported race. Blood magnesium levels and dietary magnesium intake were significantly lower in black compared to white men. However, magnesium levels or intake were not associated with risk of total prostate cancer or aggressive prostate cancer. Indeed, a higher calcium-to-magnesium diet intake was significantly protective for high-grade prostate cancer in black (OR = 0.66 (0.45, 0.96), p = 0.03) but not white (OR = 1.00 (0.79, 1.26), p = 0.99) men. In summary, there was a statistically significant difference in magnesium intake between black and white men, but the biological impact was unclear, and we did not confirm a lower prostate cancer risk associated with magnesium levels.
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Affiliation(s)
- Jay H Fowke
- Department of Preventive Medicine, University of Tennessee Health Science Center, TN, USA.
| | - Tatsuki Koyama
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Qi Dai
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - S Lilly Zheng
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA.
| | - Jianfeng Xu
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA.
| | - Lauren E Howard
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA; Surgery Section, Durham VA Medical Center, Durham, NC, USA.
| | - Stephen J Freedland
- Surgery Section, Durham VA Medical Center, Durham, NC, USA; Department of Surgery, Division of Urology, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Larsson SC, Traylor M, Burgess S, Boncoraglio GB, Jern C, Michaëlsson K, Markus HS. Serum magnesium and calcium levels in relation to ischemic stroke: Mendelian randomization study. Neurology 2019; 92:e944-e950. [PMID: 30804065 PMCID: PMC6404465 DOI: 10.1212/wnl.0000000000007001] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 10/24/2018] [Indexed: 12/15/2022] Open
Abstract
Objective To determine whether serum magnesium and calcium concentrations are causally associated with ischemic stroke or any of its subtypes using the mendelian randomization approach. Methods Analyses were conducted using summary statistics data for 13 single-nucleotide polymorphisms robustly associated with serum magnesium (n = 6) or serum calcium (n = 7) concentrations. The corresponding data for ischemic stroke were obtained from the MEGASTROKE consortium (34,217 cases and 404,630 noncases). Results In standard mendelian randomization analysis, the odds ratios for each 0.1 mmol/L (about 1 SD) increase in genetically predicted serum magnesium concentrations were 0.78 (95% confidence interval [CI] 0.69–0.89; p = 1.3 × 10−4) for all ischemic stroke, 0.63 (95% CI 0.50–0.80; p = 1.6 × 10−4) for cardioembolic stroke, and 0.60 (95% CI 0.44–0.82; p = 0.001) for large artery stroke; there was no association with small vessel stroke (odds ratio 0.90, 95% CI 0.67–1.20; p = 0.46). Only the association with cardioembolic stroke was robust in sensitivity analyses. There was no association of genetically predicted serum calcium concentrations with all ischemic stroke (per 0.5 mg/dL [about 1 SD] increase in serum calcium: odds ratio 1.03, 95% CI 0.88–1.21) or with any subtype. Conclusions This study found that genetically higher serum magnesium concentrations are associated with a reduced risk of cardioembolic stroke but found no significant association of genetically higher serum calcium concentrations with any ischemic stroke subtype.
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Affiliation(s)
- Susanna C Larsson
- From the Unit of Cardiovascular and Nutritional Epidemiology (S.C.L.), Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Stroke Research Group, Department of Clinical Neurosciences (M.T., H.S.M.), MRC Biostatistics Unit (S.B.), and Department of Public Health and Primary Care (S.B.), University of Cambridge, UK; Department of Cerebrovascular Diseases (G.B.B.), Fondazione IRCCS-Istituto Neurologico Carlo Besta, Milano, Italy; Department of Clinical Pathology and Genetics (C.J.), Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg; and Department of Surgical Sciences (K.M.), Uppsala University, Sweden.
| | - Matthew Traylor
- From the Unit of Cardiovascular and Nutritional Epidemiology (S.C.L.), Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Stroke Research Group, Department of Clinical Neurosciences (M.T., H.S.M.), MRC Biostatistics Unit (S.B.), and Department of Public Health and Primary Care (S.B.), University of Cambridge, UK; Department of Cerebrovascular Diseases (G.B.B.), Fondazione IRCCS-Istituto Neurologico Carlo Besta, Milano, Italy; Department of Clinical Pathology and Genetics (C.J.), Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg; and Department of Surgical Sciences (K.M.), Uppsala University, Sweden
| | - Stephen Burgess
- From the Unit of Cardiovascular and Nutritional Epidemiology (S.C.L.), Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Stroke Research Group, Department of Clinical Neurosciences (M.T., H.S.M.), MRC Biostatistics Unit (S.B.), and Department of Public Health and Primary Care (S.B.), University of Cambridge, UK; Department of Cerebrovascular Diseases (G.B.B.), Fondazione IRCCS-Istituto Neurologico Carlo Besta, Milano, Italy; Department of Clinical Pathology and Genetics (C.J.), Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg; and Department of Surgical Sciences (K.M.), Uppsala University, Sweden
| | - Giorgio B Boncoraglio
- From the Unit of Cardiovascular and Nutritional Epidemiology (S.C.L.), Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Stroke Research Group, Department of Clinical Neurosciences (M.T., H.S.M.), MRC Biostatistics Unit (S.B.), and Department of Public Health and Primary Care (S.B.), University of Cambridge, UK; Department of Cerebrovascular Diseases (G.B.B.), Fondazione IRCCS-Istituto Neurologico Carlo Besta, Milano, Italy; Department of Clinical Pathology and Genetics (C.J.), Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg; and Department of Surgical Sciences (K.M.), Uppsala University, Sweden
| | - Christina Jern
- From the Unit of Cardiovascular and Nutritional Epidemiology (S.C.L.), Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Stroke Research Group, Department of Clinical Neurosciences (M.T., H.S.M.), MRC Biostatistics Unit (S.B.), and Department of Public Health and Primary Care (S.B.), University of Cambridge, UK; Department of Cerebrovascular Diseases (G.B.B.), Fondazione IRCCS-Istituto Neurologico Carlo Besta, Milano, Italy; Department of Clinical Pathology and Genetics (C.J.), Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg; and Department of Surgical Sciences (K.M.), Uppsala University, Sweden
| | - Karl Michaëlsson
- From the Unit of Cardiovascular and Nutritional Epidemiology (S.C.L.), Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Stroke Research Group, Department of Clinical Neurosciences (M.T., H.S.M.), MRC Biostatistics Unit (S.B.), and Department of Public Health and Primary Care (S.B.), University of Cambridge, UK; Department of Cerebrovascular Diseases (G.B.B.), Fondazione IRCCS-Istituto Neurologico Carlo Besta, Milano, Italy; Department of Clinical Pathology and Genetics (C.J.), Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg; and Department of Surgical Sciences (K.M.), Uppsala University, Sweden
| | - Hugh S Markus
- From the Unit of Cardiovascular and Nutritional Epidemiology (S.C.L.), Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Stroke Research Group, Department of Clinical Neurosciences (M.T., H.S.M.), MRC Biostatistics Unit (S.B.), and Department of Public Health and Primary Care (S.B.), University of Cambridge, UK; Department of Cerebrovascular Diseases (G.B.B.), Fondazione IRCCS-Istituto Neurologico Carlo Besta, Milano, Italy; Department of Clinical Pathology and Genetics (C.J.), Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg; and Department of Surgical Sciences (K.M.), Uppsala University, Sweden
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van Orten-Luiten ACB, Janse A, Verspoor E, Brouwer-Brolsma EM, Witkamp RF. Drug use is associated with lower plasma magnesium levels in geriatric outpatients; possible clinical relevance. Clin Nutr 2018; 38:2668-2676. [PMID: 30581015 DOI: 10.1016/j.clnu.2018.11.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 11/04/2018] [Accepted: 11/26/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Hypomagnesemia has been associated with diabetes, cardiovascular disease, and other disorders. Drug use has been suggested as one of the risk factors for low magnesium (Mg) levels. In the elderly population, prone to polypharmacy and inadequate Mg intake, hypomagnesemia might be relevant. Therefore, we aimed to investigate associations between drug use and plasma Mg. METHODS Cross-sectional data of 343 Dutch geriatric outpatients were analysed by Cox and linear regression, while adjusting for covariates. Drug groups were coded according to the Anatomical Therapeutic Chemical classification system; use was compared to non-use. Hypomagnesemia was defined as plasma Mg < 0.75 mmol/l and <0.70 mmol/l. RESULTS Prevalence of hypomagnesemia was 22.2% (Mg < 0.75 mmol/l) or 12.2% (Mg < 0.70 mmol/l); 67.6% of the patients used ≥5 medications (polypharmacy). The number of different drugs used was inversely linearly associated with Mg level (beta -0.01; p < 0.01). Fully adjusted Cox regression showed significant associations of polypharmacy with hypomagnesemia (Mg < 0.75 mmol/l) (prevalence ratio (PR) 1.81; 95%CI 1.08-3.14), proton pump inhibitors (PR 1.80; 95%CI 1.20-2.72), and metformin (PR 2.34; 95%CI 1.56-3.50). Moreover, stratified analyses pointed towards associations with calcium supplements (PR 2.26; 95%CI 1.20-4.26), insulins (PR 3.88; 95%CI 2.19-6.86), vitamin K antagonists (PR 2.01; 95%CI 1.05-3.85), statins (PR 2.44; 95%CI 1.31-4.56), and bisphosphonates (PR 2.97; 95%CI 1.65-5.36) in patients <80 years; selective beta blockers (PR 2.01; 95%CI 1.19-3.40) if BMI <27.0 kg/m2; and adrenergic inhalants in male users (PR 3.62; 95%CI 1.73-7.56). Linear regression supported these associations. CONCLUSION As polypharmacy and several medications are associated with hypomagnesemia, Mg merits more attention, particularly in diabetes, cardiovascular disease, and in side-effects of proton pump inhibitors and calcium supplements.
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Affiliation(s)
- A C B van Orten-Luiten
- Division of Human Nutrition and Health, Wageningen University and Research Centre, P.O. Box 17, 6700 AA Wageningen, the Netherlands; Nutrition & Healthcare Alliance, Willy Brandtlaan 10, 6716 RP Ede, the Netherlands.
| | - A Janse
- Nutrition & Healthcare Alliance, Willy Brandtlaan 10, 6716 RP Ede, the Netherlands; Department of Geriatric Medicine, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP Ede, the Netherlands.
| | - E Verspoor
- Division of Human Nutrition and Health, Wageningen University and Research Centre, P.O. Box 17, 6700 AA Wageningen, the Netherlands.
| | - E M Brouwer-Brolsma
- Division of Human Nutrition and Health, Wageningen University and Research Centre, P.O. Box 17, 6700 AA Wageningen, the Netherlands.
| | - R F Witkamp
- Division of Human Nutrition and Health, Wageningen University and Research Centre, P.O. Box 17, 6700 AA Wageningen, the Netherlands; Nutrition & Healthcare Alliance, Willy Brandtlaan 10, 6716 RP Ede, the Netherlands.
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25
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Ismail AAA, Ismail Y, Ismail AA. Chronic magnesium deficiency and human disease; time for reappraisal? QJM 2018; 111:759-763. [PMID: 29036357 DOI: 10.1093/qjmed/hcx186] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Indexed: 02/05/2023] Open
Abstract
Numerous epidemiological, experimental and clinical studies over the last 30 years have consistently shown that chronic magnesium deficiency is associated with and/or exacerbates a number of major disorders (Table 1). Yet chronic magnesium deficiency is not widely recognized and a major reason for this failure is that serum magnesium levels do not accurately reflect body magnesium stores. Specifically, in chronic magnesium deficiency, serum magnesium levels are often within the normal reference range (usually lowest quartile) and may not progress to overt hypomagnesaemia. This raises serious questions namely (i) should chronic magnesium deficiency be considered in high-risk patients irrespective of serum magnesium, even when 'normal'? and (ii) if recognized, should oral magnesium supplement be given to restore body stores? Appreciating the vital role of magnesium for normal cellular function and bone health may help in formulating a well-considered and justifiable approach to these questions. Pragmatic tests for assessing magnesium status in the adult are suggested and discussed.
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Affiliation(s)
- A A A Ismail
- Retired Consultant Clinical Biochemist, Chevet Lane, Wakefield, West Yorkshire, UK
| | - Y Ismail
- Department of Cardiology, Bristol Heart Institute, Bristol, Avon, UK
| | - A A Ismail
- Rheumatology Department, Stockport NHS Foundation Trust, Stockport, UK
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26
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Voskoboinik A, Prabhu S, Sugumar H, Kistler PM. Effect of Dietary Factors on Cardiac Rhythm. Am J Cardiol 2018; 122:1265-1271. [PMID: 30075892 DOI: 10.1016/j.amjcard.2018.06.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/15/2018] [Accepted: 06/25/2018] [Indexed: 11/19/2022]
Abstract
The interaction between arrhythmias and certain lifestyle factors such as obesity and alcohol consumption is well-established. There is significant public and professional interest in the role of various diets, vitamins, and minerals in cardiovascular health. However, many widely held beliefs are not supported by the literature. There is limited evidence for routine magnesium and omega-3 poly-unsaturated fatty acids supplementation, while coffee, tea, nuts, antioxidant vitamins, and even chocolate may have some antiarrhythmic properties. Saturated fat, added salt, and excessive energy drink consumption appear to be harmful for patients with rhythm disorders. However most recommendations are based on observation studies, and this remains a fertile area for further research.
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Affiliation(s)
- Aleksandr Voskoboinik
- Alfred Heart Centre, Alfred Hospital, Melbourne, Victoria, Australia; Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia
| | - Sandeep Prabhu
- Alfred Heart Centre, Alfred Hospital, Melbourne, Victoria, Australia; Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia
| | - Hariharan Sugumar
- Alfred Heart Centre, Alfred Hospital, Melbourne, Victoria, Australia; Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia
| | - Peter M Kistler
- Alfred Heart Centre, Alfred Hospital, Melbourne, Victoria, Australia; Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; University of Melbourne, Parkville, Victoria, Australia.
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27
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Affiliation(s)
- Dipak Kotecha
- From the Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom & Monash Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Australia.
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Lutsey PL, Chen LY, Eaton A, Jaeb M, Rudser KD, Neaton JD, Alonso A. A Pilot Randomized Trial of Oral Magnesium Supplementation on Supraventricular Arrhythmias. Nutrients 2018; 10:nu10070884. [PMID: 29996476 PMCID: PMC6073799 DOI: 10.3390/nu10070884] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/05/2018] [Accepted: 07/06/2018] [Indexed: 02/07/2023] Open
Abstract
Low magnesium may increase the risk of atrial fibrillation. We conducted a double-blind pilot randomized trial to assess adherence to oral magnesium supplementation (400 mg of magnesium oxide daily) and a matching placebo, estimate the effect on circulating magnesium concentrations, and evaluate the feasibility of using an ambulatory heart rhythm monitoring device (ZioPatch) for assessing premature atrial contractions. A total of 59 participants were randomized; 73% were women, and the mean age was 62 years. A total of 98% of the participants completed the follow-up. In the magnesium supplement group, 75% of pills were taken, and in the placebo group, 83% were taken. The change in magnesium concentrations was significantly greater for those given the magnesium supplements than for those given the placebo (0.07; 95% confidence interval: 0.03, 0.12 mEq/L; p = 0.002). The ZioPatch wear time was approximately 13 of the requested 14 days at baseline and follow-up. There was no difference by intervention assignment in the change in log premature atrial contractions burden, glucose, or blood pressure. Gastrointestinal changes were more common among the participants assigned magnesium (50%) than among those assigned the placebo (7%), but only one person discontinued participation. In sum, compliance with the oral magnesium supplementation was very good, and acceptance of the ZioPatch monitoring was excellent. These findings support the feasibility of a larger trial for atrial fibrillation (AF) prevention with oral magnesium supplementation.
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Affiliation(s)
- Pamela L Lutsey
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, 1300 South 2nd Street, Suite 300, Minneapolis, MN 55454, USA.
| | - Lin Y Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Anne Eaton
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Melanie Jaeb
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, 1300 South 2nd Street, Suite 300, Minneapolis, MN 55454, USA.
| | - Kyle D Rudser
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA.
| | - James D Neaton
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
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Tangvoraphonkchai K, Davenport A. Magnesium and Cardiovascular Disease. Adv Chronic Kidney Dis 2018; 25:251-260. [PMID: 29793664 DOI: 10.1053/j.ackd.2018.02.010] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 02/12/2018] [Accepted: 02/13/2018] [Indexed: 12/21/2022]
Abstract
Magnesium is the most abundant intracellular divalent cation and essential for maintaining normal cellular physiology and metabolism, acting as a cofactor of numerous enzymes, regulating ion channels and energy generation. In the heart, magnesium plays a key role in modulating neuronal excitation, intracardiac conduction, and myocardial contraction by regulating a number of ion transporters, including potassium and calcium channels. Magnesium also has a role in regulating vascular tone, atherogenesis and thrombosis, vascular calcification, and proliferation and migration of endothelial and vascular smooth muscle cells. As such, magnesium potentially has a major influence on the pathogenesis of cardiovascular disease. As the kidney is a major regulator of magnesium homeostasis, kidney disorders can potentially lead to both magnesium depletion and overload, and as such increase the risk of cardiovascular disease. Observational data have shown an association between low serum magnesium concentrations or magnesium intake and increased atherosclerosis, coronary artery disease, arrhythmias, and heart failure. However, major trials of supplementation with magnesium have reported inconsistent benefits and also raised potential adverse effects of magnesium overload. As such, there is currently no firm recommendation for routine magnesium supplementation except when hypomagnesemia has been proven or suspected as a cause for cardiac arrhythmias.
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Serum magnesium and risk of incident heart failure in older men: The British Regional Heart Study. Eur J Epidemiol 2018; 33:873-882. [PMID: 29663176 PMCID: PMC6133024 DOI: 10.1007/s10654-018-0388-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 03/25/2018] [Indexed: 12/21/2022]
Abstract
To examine the association between serum magnesium and incident heart failure (HF) in older men and investigate potential pathways including cardiac function, inflammation and lung function. Prospective study of 3523 men aged 60–79 years with no prevalent HF or myocardial infarction followed up for a mean period of 15 years, during which 268 incident HF cases were ascertained. Serum magnesium was inversely associated with many CVD risk factors including prevalent atrial fibrillation, lung function (FEV1) and markers of inflammation (IL-6), endothelial dysfunction (vWF) and cardiac dysfunction [NT-proBNP and cardiac troponin T (cTnT)]. Serum magnesium was inversely related to risk of incident HF after adjustment for conventional CVD risk factors and incident MI. The adjusted hazard ratios (HRs) for HF in the 5 quintiles of magnesium groups were 1.00, 0.72 (0.50, 1.05), 0.85 (0.59, 1.26), 0.76 (0.52, 1.11) and 0.56 (0.36, 0.86) respectively [p (trend) = 0.04]. Further adjustment for atrial fibrillation, IL-6, vWF and FEV1 attenuated the association but risk remained significantly reduced in the top quintile (≥ 0.87 mmol/l) compared with the lowest quintile [HR 0.62 (0.40, 0.97)]. Adjustment for NT-proBNP and cTnT attenuated the association further [HR 0.70 (0.44, 1.10)]. The benefit of high serum magnesium on HF risk was most evident in men with ECG evidence of ischaemia [HR 0.29 (0.13, 0.68)]. The potential beneficial effect of high serum magnesium was partially explained by its favourable association with CVD risk factors. Further studies are needed to investigate whether serum magnesium supplementation in older adults may protect from the development of HF.
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Rosique-Esteban N, Guasch-Ferré M, Hernández-Alonso P, Salas-Salvadó J. Dietary Magnesium and Cardiovascular Disease: A Review with Emphasis in Epidemiological Studies. Nutrients 2018; 10:nu10020168. [PMID: 29389872 PMCID: PMC5852744 DOI: 10.3390/nu10020168] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 01/24/2018] [Accepted: 01/24/2018] [Indexed: 12/15/2022] Open
Abstract
Magnesium (Mg) is an essential dietary element for humans involved in key biological processes. A growing body of evidence from epidemiological studies, randomized controlled trials (RCTs) and meta-analyses have indicated inverse associations between Mg intake and cardiovascular diseases (CVD). The present review aims to summarize recent scientific evidence on the topic, with a focus on data from epidemiological studies assessing the associations between Mg intake and major cardiovascular (CV) risk factors and CVD. We also aimed to review current literature on circulating Mg and CVD, as well as potential biological processes underlying these observations. We concluded that high Mg intake is associated with lower risk of major CV risk factors (mainly metabolic syndrome, diabetes and hypertension), stroke and total CVD. Higher levels of circulating Mg are associated with lower risk of CVD, mainly ischemic heart disease and coronary heart disease. Further, RCTs and prospective studies would help to clarify whether Mg intake and Mg circulating levels may also protect against other CVDs and CVD death.
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Affiliation(s)
- Nuria Rosique-Esteban
- Human Nutrition Unit, Department of Biochemistry and Biotechnology, Faculty of Medicine and Health Sciences, University Hospital of Sant Joan de Reus, Pere Virgili Institute for Health Research, Rovira i Virgili University, St/Sant Llorenç 21, 43201 Reus, Spain.
- CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III (ISCIII), 28029 Madrid, Spain.
| | - Marta Guasch-Ferré
- Human Nutrition Unit, Department of Biochemistry and Biotechnology, Faculty of Medicine and Health Sciences, University Hospital of Sant Joan de Reus, Pere Virgili Institute for Health Research, Rovira i Virgili University, St/Sant Llorenç 21, 43201 Reus, Spain.
- CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III (ISCIII), 28029 Madrid, Spain.
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
| | - Pablo Hernández-Alonso
- Human Nutrition Unit, Department of Biochemistry and Biotechnology, Faculty of Medicine and Health Sciences, University Hospital of Sant Joan de Reus, Pere Virgili Institute for Health Research, Rovira i Virgili University, St/Sant Llorenç 21, 43201 Reus, Spain.
- CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III (ISCIII), 28029 Madrid, Spain.
| | - Jordi Salas-Salvadó
- Human Nutrition Unit, Department of Biochemistry and Biotechnology, Faculty of Medicine and Health Sciences, University Hospital of Sant Joan de Reus, Pere Virgili Institute for Health Research, Rovira i Virgili University, St/Sant Llorenç 21, 43201 Reus, Spain.
- CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III (ISCIII), 28029 Madrid, Spain.
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Ter Braake AD, Shanahan CM, de Baaij JHF. Magnesium Counteracts Vascular Calcification: Passive Interference or Active Modulation? Arterioscler Thromb Vasc Biol 2017; 37:1431-1445. [PMID: 28663256 DOI: 10.1161/atvbaha.117.309182] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 06/15/2017] [Indexed: 12/24/2022]
Abstract
Over the last decade, an increasing number of studies report a close relationship between serum magnesium concentration and cardiovascular disease risk in the general population. In end-stage renal disease, an association was found between serum magnesium and survival. Hypomagnesemia was identified as a strong predictor for cardiovascular disease in these patients. A substantial body of in vitro and in vivo studies has identified a protective role for magnesium in vascular calcification. However, the precise mechanisms and its contribution to cardiovascular protection remain unclear. There are currently 2 leading hypotheses: first, magnesium may bind phosphate and delay calcium phosphate crystal growth in the circulation, thereby passively interfering with calcium phosphate deposition in the vessel wall. Second, magnesium may regulate vascular smooth muscle cell transdifferentiation toward an osteogenic phenotype by active cellular modulation of factors associated with calcification. Here, the data supporting these major hypotheses are reviewed. The literature supports both a passive inorganic phosphate-buffering role reducing hydroxyapatite formation and an active cell-mediated role, directly targeting vascular smooth muscle transdifferentiation. However, current evidence relies on basic experimental designs that are often insufficient to delineate the underlying mechanisms. The field requires more advanced experimental design, including determination of intracellular magnesium concentrations and the identification of the molecular players that regulate magnesium concentrations in vascular smooth muscle cells.
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Affiliation(s)
- Anique D Ter Braake
- From the Department of Physiology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands (A.D.t.B., J.H.F.d.B.); Cardiovascular Division, BHF Centre of Research Excellence, James Black Centre, King's College, London, United Kingdom (C.M.S.); and Department of Physiology, Anatomy and Genetics, University of Oxford, United Kingdom (J.H.F.d.B.)
| | - Catherine M Shanahan
- From the Department of Physiology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands (A.D.t.B., J.H.F.d.B.); Cardiovascular Division, BHF Centre of Research Excellence, James Black Centre, King's College, London, United Kingdom (C.M.S.); and Department of Physiology, Anatomy and Genetics, University of Oxford, United Kingdom (J.H.F.d.B.)
| | - Jeroen H F de Baaij
- From the Department of Physiology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands (A.D.t.B., J.H.F.d.B.); Cardiovascular Division, BHF Centre of Research Excellence, James Black Centre, King's College, London, United Kingdom (C.M.S.); and Department of Physiology, Anatomy and Genetics, University of Oxford, United Kingdom (J.H.F.d.B.).
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DiNicolantonio JJ, McCarty MF, O'Keefe JH. Decreased magnesium status may mediate the increased cardiovascular risk associated with calcium supplementation. Open Heart 2017; 4:e000617. [PMID: 29225900 PMCID: PMC5708314 DOI: 10.1136/openhrt-2017-000617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2017] [Indexed: 02/05/2023] Open
Affiliation(s)
| | | | - James H O'Keefe
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
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Nielsen FH, Johnson LAK. Data from Controlled Metabolic Ward Studies Provide Guidance for the Determination of Status Indicators and Dietary Requirements for Magnesium. Biol Trace Elem Res 2017; 177:43-52. [PMID: 27778151 DOI: 10.1007/s12011-016-0873-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 10/11/2016] [Indexed: 02/03/2023]
Abstract
Determination of whether magnesium (Mg) is a nutrient of public health concern has been hindered by questionable Dietary Recommended Intakes (DRIs) and problematic status indicators that make Mg deficiency assessment formidable. Balance data obtained since 1997 indicate that the EAR and RDA for 70-kg healthy individuals are about 175 and 250 mg/day, respectively, and these DRIs decrease or increase based on body weight. These DRIs are less than those established for the USA and Canada. Urinary excretion data from tightly controlled metabolic unit balance studies indicate that urinary Mg excretion is 40 to 80 mg (1.65 to 3.29 mmol)/day when Mg intakes are <250 mg (10.28 mmol)/day, and 80 to 160 mg (3.29 to 6.58 mmol)/day when intakes are >250 mg (10.28 mmol)/day. However, changing from low to high urinary excretion with an increase in dietary intake occurs within a few days and vice versa. Thus, urinary Mg as a stand-alone status indicator would be most useful for population studies and not useful for individual status assessment. Tightly controlled metabolic unit depletion/repletion experiments indicate that serum Mg concentrations decrease only after a prolonged depletion if an individual has good Mg reserves. These experiments also found that, although individuals had serum Mg concentrations approaching 0.85 mmol/L (2.06 mg/dL), they had physiological changes that respond to Mg supplementation. Thus, metabolic unit findings suggest that individuals with serum Mg concentrations >0.75 mmol/L (1.82 mg/L), or as high as 0.85 mmol/L (2.06 mg/dL), could have a deficit in Mg such that they respond to Mg supplementation, especially if they have a dietary intake history showing <250 mg (10.28 mmol)/day and a urinary excretion of <80 mg (3.29 mmol)/day.
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Affiliation(s)
- Forrest H Nielsen
- USDA, ARS, Grand Forks Human Nutrition Research Center, 2420 2nd Ave N, PO Box 9034, Grand Forks, ND, 58202-9034, USA.
| | - Lu Ann K Johnson
- USDA, ARS, Grand Forks Human Nutrition Research Center, 2420 2nd Ave N, PO Box 9034, Grand Forks, ND, 58202-9034, USA
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35
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Bertinato J, Wang KC, Hayward S. Serum Magnesium Concentrations in the Canadian Population and Associations with Diabetes, Glycemic Regulation, and Insulin Resistance. Nutrients 2017; 9:nu9030296. [PMID: 28304338 PMCID: PMC5372959 DOI: 10.3390/nu9030296] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 02/24/2017] [Accepted: 03/14/2017] [Indexed: 01/10/2023] Open
Abstract
Total serum magnesium (Mg) concentration (SMC) is commonly used to assess Mg status. This study reports current SMCs of Canadians and their associations with demographic factors, diabetes, and measures of glycemic control and insulin resistance using results from the Canadian Health Measures Survey cycle 3 (2012-2013). Associations were examined in adults aged 20-79 years using linear mixed models. Mean SMCs and percentile distributions for 11 sex-age groups between 3 and 79 years (n = 5561) are reported. SMCs were normally distributed and differences (p < 0.05) among sex and age groups were small. Between 9.5% and 16.6% of adult sex-age groups had a SMC below the lower cut-off of a population-based reference interval (0.75-0.955 mmol·L-1) established in the United States population as part of the NHANES I conducted in 1971-1974. Having diabetes was associated with 0.04 to 0.07 mmol·L-1 lower SMC compared to not having diabetes in the various models. Body mass index, glycated hemoglobin, serum glucose and insulin concentrations, and homeostatic model assessment of insulin resistance were negatively associated with SMC. This is the first study to report SMCs in a nationally representative sample of the Canadian population. A substantial proportion of Canadians are hypomagnesaemic in relation to a population-based reference interval, and SMC was negatively associated with diabetes and indices of glycemic control and insulin resistance.
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Affiliation(s)
- Jesse Bertinato
- Nutrition Research Division, Food Directorate, Health Products and Food Branch, Health Canada, Sir Frederick G. Banting Research Centre, 251 Sir Frederick Banting Driveway, Ottawa, ON K1A 0K9, Canada.
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON K1H 8M5, Canada.
| | - Kuan Chiao Wang
- Bureau of Food Surveillance and Science Integration, Food Directorate, Health Products and Food Branch, Health Canada, Ottawa, ON K1A 0K9, Canada.
| | - Stephen Hayward
- Bureau of Food Surveillance and Science Integration, Food Directorate, Health Products and Food Branch, Health Canada, Ottawa, ON K1A 0K9, Canada.
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Costello RB, Elin RJ, Rosanoff A, Wallace TC, Guerrero-Romero F, Hruby A, Lutsey PL, Nielsen FH, Rodriguez-Moran M, Song Y, Van Horn LV. Perspective: The Case for an Evidence-Based Reference Interval for Serum Magnesium: The Time Has Come. Adv Nutr 2016; 7:977-993. [PMID: 28140318 PMCID: PMC5105038 DOI: 10.3945/an.116.012765] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The 2015 Dietary Guidelines Advisory Committee indicated that magnesium was a shortfall nutrient that was underconsumed relative to the Estimated Average Requirement (EAR) for many Americans. Approximately 50% of Americans consume less than the EAR for magnesium, and some age groups consume substantially less. A growing body of literature from animal, epidemiologic, and clinical studies has demonstrated a varied pathologic role for magnesium deficiency that includes electrolyte, neurologic, musculoskeletal, and inflammatory disorders; osteoporosis; hypertension; cardiovascular diseases; metabolic syndrome; and diabetes. Studies have also demonstrated that magnesium deficiency is associated with several chronic diseases and that a reduced risk of these diseases is observed with higher magnesium intake or supplementation. Subclinical magnesium deficiency can exist despite the presentation of a normal status as defined within the current serum magnesium reference interval of 0.75-0.95 mmol/L. This reference interval was derived from data from NHANES I (1974), which was based on the distribution of serum magnesium in a normal population rather than clinical outcomes. What is needed is an evidenced-based serum magnesium reference interval that reflects optimal health and the current food environment and population. We present herein data from an array of scientific studies to support the perspective that subclinical deficiencies in magnesium exist, that they contribute to several chronic diseases, and that adopting a revised serum magnesium reference interval would improve clinical care and public health.
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Affiliation(s)
| | - Ronald J Elin
- Department of Pathology and Laboratory Medicine, University of Louisville, KY
| | | | - Taylor C Wallace
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA
| | | | - Adela Hruby
- Nutritional Epidemiology Program, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA
| | - Pamela L Lutsey
- School of Public Health, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| | | | | | - Yiqing Song
- Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN; and
| | - Linda V Van Horn
- Division of Nutrition, Department of Preventive Medicine, Northwestern University, Chicago, IL
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Baker WL. Treating arrhythmias with adjunctive magnesium: identifying future research directions. EUROPEAN HEART JOURNAL - CARDIOVASCULAR PHARMACOTHERAPY 2016:pvw028. [DOI: 10.1093/ehjcvp/pvw028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Potassium and Magnesium Supplementation Do Not Protect Against Atrial Fibrillation After Cardiac Operation: A Time-Matched Analysis. Ann Thorac Surg 2016; 102:1181-8. [PMID: 27596917 DOI: 10.1016/j.athoracsur.2016.06.066] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 04/30/2016] [Accepted: 06/14/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Despite a lack of demonstrated efficacy, potassium and magnesium supplementation are commonly thought to prevent postoperative atrial fibrillation (POAF) after cardiac operation. Our aim was to evaluate the natural time course of electrolyte level changes after cardiac operation and their relation to POAF occurrence. METHODS Data were reviewed from 2,041 adult patients without preoperative AF who underwent coronary artery bypass grafting, valve operation, or both between 2009 and 2013. In patients with POAF, the plasma potassium and magnesium levels nearest to the first AF onset time were compared with time-matched electrolyte levels in patients without AF. RESULTS POAF occurred in 752 patients (36.8%). At the time of AF onset or the matched time point, patients with POAF had higher potassium (4.30 versus 4.21 mmol/L, p < 0.001) and magnesium (2.33 versus 2.16 mg/dL, p < 0.001) levels than controls. A stepwise increase in AF risk occurred with increasing potassium or magnesium quintile (p < 0.001). On multivariate logistic regression analysis, magnesium level was an independent predictor of POAF (odds ratio 4.26, p < 0.001), in addition to age, Caucasian race, preoperative β-blocker use, valve operation, and postoperative pneumonia. Prophylactic potassium supplementation did not reduce the POAF rate (37% versus 37%, p = 0.813), whereas magnesium supplementation was associated with increased POAF (47% versus 36%, p = 0.005). CONCLUSIONS Higher serum potassium and magnesium levels were associated with increased risk of POAF after cardiac operation. Potassium supplementation was not protective against POAF, and magnesium supplementation was even associated with increased POAF risk. These findings help explain the poor efficacy of electrolyte supplementation in POAF prophylaxis.
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Rajagopalan B, Shah Z, Narasimha D, Bhatia A, Kim CH, Switzer DF, Gudleski GH, Curtis AB. Efficacy of Intravenous Magnesium in Facilitating Cardioversion of Atrial Fibrillation. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.116.003968. [DOI: 10.1161/circep.116.003968] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 07/11/2016] [Indexed: 11/16/2022]
Abstract
Background—
Low serum magnesium (Mg) levels are associated with an increased risk of atrial fibrillation. Some studies have shown a benefit of Mg in facilitating pharmacological cardioversion. The role of an intravenous infusion of Mg alone in facilitating electric cardioversion is not clear.
Methods and Results—
In a prospective, randomized, double-blind, placebo-controlled trial, we enrolled patients with atrial fibrillation who were scheduled for electric cardioversion. Patients were randomized to receive Mg or placebo before cardioversion using a step-up protocol with 75, 100, 150, and 200 J biphasic shocks. Patients with hypokalemia, hypermagnesemia, or postcardiac surgery atrial fibrillation were excluded. Patients on antiarrhythmic drugs were included as long as they were at steady state. All patients were monitored for 1 hour post procedure for the maintenance of sinus rhythm. A total of 261 patients (69% male, mean age 65.5±11.1 years) were randomized (132 and 129 patients receiving Mg and placebo, respectively). Baseline characteristics were similar between both the groups. There was no statistically significant difference in the success rate of cardioversion between the 2 groups (86.4% versus 86.0%;
P
=0.94), cumulative amount of energy required for successful cardioversion (123.3±55.5 versus 129.5±52.6 J;
P
=0.40), or the number of shocks required to convert to sinus rhythm (2.25±1.24 versus 2.41±1.22,
P
=0.31). No adverse events were noted in either group.
Conclusions—
In patients undergoing electric cardioversion for persistent atrial fibrillation, Mg infusion does not increase the rate of successful cardioversion.
Clinical Trial Information—
URL:
https://clinicaltrials.gov
. Unique identifier: NCT01597557.
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Affiliation(s)
- Bharath Rajagopalan
- From the Department of Medicine, University at Buffalo, NY (B.R., G.H.G., A.B.C.); Department of Medicine, University of Kansas, Kansas City (Z.S.); Department of Medicine, Loma Linda University, CA (D.N.); and Division of Cardiac Electrophysiology, Great Lakes Cardiology P.C., Buffalo, NY (A.B., C.H.K., D.F.S.)
| | - Zubair Shah
- From the Department of Medicine, University at Buffalo, NY (B.R., G.H.G., A.B.C.); Department of Medicine, University of Kansas, Kansas City (Z.S.); Department of Medicine, Loma Linda University, CA (D.N.); and Division of Cardiac Electrophysiology, Great Lakes Cardiology P.C., Buffalo, NY (A.B., C.H.K., D.F.S.)
| | - Deepika Narasimha
- From the Department of Medicine, University at Buffalo, NY (B.R., G.H.G., A.B.C.); Department of Medicine, University of Kansas, Kansas City (Z.S.); Department of Medicine, Loma Linda University, CA (D.N.); and Division of Cardiac Electrophysiology, Great Lakes Cardiology P.C., Buffalo, NY (A.B., C.H.K., D.F.S.)
| | - Ashish Bhatia
- From the Department of Medicine, University at Buffalo, NY (B.R., G.H.G., A.B.C.); Department of Medicine, University of Kansas, Kansas City (Z.S.); Department of Medicine, Loma Linda University, CA (D.N.); and Division of Cardiac Electrophysiology, Great Lakes Cardiology P.C., Buffalo, NY (A.B., C.H.K., D.F.S.)
| | - Chee H. Kim
- From the Department of Medicine, University at Buffalo, NY (B.R., G.H.G., A.B.C.); Department of Medicine, University of Kansas, Kansas City (Z.S.); Department of Medicine, Loma Linda University, CA (D.N.); and Division of Cardiac Electrophysiology, Great Lakes Cardiology P.C., Buffalo, NY (A.B., C.H.K., D.F.S.)
| | - Donald F. Switzer
- From the Department of Medicine, University at Buffalo, NY (B.R., G.H.G., A.B.C.); Department of Medicine, University of Kansas, Kansas City (Z.S.); Department of Medicine, Loma Linda University, CA (D.N.); and Division of Cardiac Electrophysiology, Great Lakes Cardiology P.C., Buffalo, NY (A.B., C.H.K., D.F.S.)
| | - Gregory H. Gudleski
- From the Department of Medicine, University at Buffalo, NY (B.R., G.H.G., A.B.C.); Department of Medicine, University of Kansas, Kansas City (Z.S.); Department of Medicine, Loma Linda University, CA (D.N.); and Division of Cardiac Electrophysiology, Great Lakes Cardiology P.C., Buffalo, NY (A.B., C.H.K., D.F.S.)
| | - Anne B. Curtis
- From the Department of Medicine, University at Buffalo, NY (B.R., G.H.G., A.B.C.); Department of Medicine, University of Kansas, Kansas City (Z.S.); Department of Medicine, Loma Linda University, CA (D.N.); and Division of Cardiac Electrophysiology, Great Lakes Cardiology P.C., Buffalo, NY (A.B., C.H.K., D.F.S.)
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Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia despite substantial efforts to understand the pathophysiology of the condition and develop improved treatments. Identifying the underlying causative mechanisms of AF in individual patients is difficult and the efficacy of current therapies is suboptimal. Consequently, the incidence of AF is steadily rising and there is a pressing need for novel therapies. Research has revealed that defects in specific molecular pathways underlie AF pathogenesis, resulting in electrical conduction disorders that drive AF. The severity of this so-called electropathology correlates with the stage of AF disease progression and determines the response to AF treatment. Therefore, unravelling the molecular mechanisms underlying electropathology is expected to fuel the development of innovative personalized diagnostic tools and mechanism-based therapies. Moreover, the co-creation of AF studies with patients to implement novel diagnostic tools and therapies is a prerequisite for successful personalized AF management. Currently, various treatment modalities targeting AF-related electropathology, including lifestyle changes, pharmaceutical and nutraceutical therapy, substrate-based ablative therapy, and neuromodulation, are available to maintain sinus rhythm and might offer a novel holistic strategy to treat AF.
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Affiliation(s)
- Bianca J. J. M. Brundel
- Department of Physiology, Amsterdam University Medical Centers, VU Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands.,
| | - Xun Ai
- Department of Physiology and Cell Biology, College of Medicine/Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | | | - Myrthe F. Kuipers
- AFIPonline.org, Atrial Fibrillation Innovation Platform, Amsterdam, Netherlands
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Rosanoff A, Dai Q, Shapses SA. Essential Nutrient Interactions: Does Low or Suboptimal Magnesium Status Interact with Vitamin D and/or Calcium Status? Adv Nutr 2016; 7:25-43. [PMID: 26773013 PMCID: PMC4717874 DOI: 10.3945/an.115.008631] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Although much is known about magnesium, its interactions with calcium and vitamin D are less well studied. Magnesium intake is low in populations who consume modern processed-food diets. Low magnesium intake is associated with chronic diseases of global concern [e.g., cardiovascular disease (CVD), type 2 diabetes, metabolic syndrome, and skeletal disorders], as is low vitamin D status. No simple, reliable biomarker for whole-body magnesium status is currently available, which makes clinical assessment and interpretation of human magnesium research difficult. Between 1977 and 2012, US calcium intakes increased at a rate 2-2.5 times that of magnesium intakes, resulting in a dietary calcium to magnesium intake ratio of >3.0. Calcium to magnesium ratios <1.7 and >2.8 can be detrimental, and optimal ratios may be ∼2.0. Background calcium to magnesium ratios can affect studies of either mineral alone. For example, US studies (background Ca:Mg >3.0) showed benefits of high dietary or supplemental magnesium for CVD, whereas similar Chinese studies (background Ca:Mg <1.7) showed increased risks of CVD. Oral vitamin D is widely recommended in US age-sex groups with low dietary magnesium. Magnesium is a cofactor for vitamin D biosynthesis, transport, and activation; and vitamin D and magnesium studies both showed associations with several of the same chronic diseases. Research on possible magnesium and vitamin D interactions in these human diseases is currently rare. Increasing calcium to magnesium intake ratios, coupled with calcium and vitamin D supplementation coincident with suboptimal magnesium intakes, may have unknown health implications. Interactions of low magnesium status with calcium and vitamin D, especially during supplementation, require further study.
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Affiliation(s)
| | - Qi Dai
- Vanderbilt Epidemiology Center, Department of Medicine, School of Medicine, Vanderbilt University, Nashville, TN; and
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Markovits N, Kurnik D, Halkin H, Margalit R, Bialik M, Lomnicky Y, Loebstein R. Database evaluation of the association between serum magnesium levels and the risk of atrial fibrillation in the community. Int J Cardiol 2015; 205:142-146. [PMID: 26736089 DOI: 10.1016/j.ijcard.2015.12.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 12/03/2015] [Accepted: 12/12/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND In population studies, mild hypomagnesemia, determined by a single measurement, was associated with incident atrial fibrillation, over ~20 years of follow-up. We sought to determine whether mild (≤ 1.7 mg/dL) and moderate (≤ 1.5mg/dL) hypomagnesemia are temporally associated with increased incidence of atrial fibrillation (AF) in the community. METHODS Health Maintenance Organization (HMO) database cohort study including beneficiaries with ≥ 1 serum magnesium measurement between 2004 and 2013. The follow-up period was defined from the first magnesium measurement to first listing in an AF registry (for cases) and December 2013 or date of death or loss to follow-up (for controls). We analyzed the association between serum magnesium quintiles, as well as the above clinically relevant hypomagnesemia thresholds, and incident AF using Cox proportional hazard regression analysis, adjusting for confounders. The association between serum magnesium and AF occurring within 3 months was also examined. RESULTS Among 162,162 subjects, 2228 (1.4%) developed AF over a median follow-up of 25.3 months. Compared to the middle quintile the lowest magnesium quintile (≤ 1.9 mg/dL) had a significantly higher risk of AF (HR, 1.21; 95% CI: 1.07-1.37). Increased AF risk was also associated with mild (HR, 1.44; 95% CI: 1.20-1.73) and moderate hypomagnesemia (HR, 1.57; 95% CI: 1.14-2.15). No association was found when limiting the follow-up period to 3 months. CONCLUSIONS In our study, hypomagnesemia was associated with incident AF over prolonged but not short-term follow-up periods, suggesting that this association may not be causal.
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Affiliation(s)
- Noa Markovits
- Institute of Clinical Pharmacology, Sheba Medical Center, Tel Hashomer, Israel
| | - Daniel Kurnik
- Division of Clinical Pharmacology and Toxicology, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Hillel Halkin
- Department of Pharmacy and Clinical Pharmacology, Maccabi Healthcare Services, Israel; Institute of Clinical Pharmacology, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Reuma Margalit
- Institute of Clinical Pharmacology, Sheba Medical Center, Tel Hashomer, Israel
| | - Martin Bialik
- Department of Pharmacy and Clinical Pharmacology, Maccabi Healthcare Services, Israel
| | - Yossi Lomnicky
- Department of Pharmacy and Clinical Pharmacology, Maccabi Healthcare Services, Israel
| | - Ronen Loebstein
- Department of Pharmacy and Clinical Pharmacology, Maccabi Healthcare Services, Israel; Institute of Clinical Pharmacology, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Klinger RY, Thunberg CA, White WD, Fontes M, Waldron NH, Piccini JP, Hughes GC, Podgoreanu MV, Stafford-Smith M, Newman MF, Mathew JP. Intraoperative Magnesium Administration Does Not Reduce Postoperative Atrial Fibrillation After Cardiac Surgery. Anesth Analg 2015; 121:861-867. [PMID: 26237622 DOI: 10.1213/ane.0000000000000873] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Hypomagnesemia has been associated with an increased risk of postoperative atrial fibrillation (POAF). Although previous studies have suggested a beneficial effect of magnesium (Mg) therapy, almost all of these are limited by small sample size and relatively low Mg dose. We hypothesized that high-dose Mg decreases the occurrence of new-onset POAF, and we tested this hypothesis by using data from a prospective trial that assessed the effect of Mg on cognitive outcomes in patients undergoing cardiac surgery. METHODS A total of 389 patients undergoing cardiac surgery were enrolled in this double-blind, placebo-controlled trial. Subjects were randomized to receive Mg as a 50-mg/kg bolus immediately after induction of anesthesia followed by another 50 mg/kg as an infusion given over 3 hours (total dose, 100 mg/kg) or placebo. We tested the effect of Mg therapy on POAF with logistic regression, adjusting for the risk of atrial fibrillation (AF) by using the Multicenter Study of Perioperative Ischemia risk index for Atrial Fibrillation after Cardiac Surgery. RESULTS Among the 363 patients analyzed, after we excluded patients with chronic or acute preoperative AF (placebo: n = 177; Mg: n = 186), the incidence of new-onset POAF was 42.5% (95% confidence interval [CI], 35%-50%) in the Mg group compared with 37.9% (95% CI, 31%-45%) in the placebo group (P = 0.40). The 95% CI for this absolute risk difference of 4.6% is -5.5% to 14.7%. The time to onset of POAF also was identical between the groups, and no significant effect of Mg was found in logistic regression analysis after we adjusted for AF risk (odds ratio, 1.09; 95% CI, 0.69-1.72; P = 0.73). CONCLUSIONS High-dose intraoperative Mg therapy did not decrease the incidence of new-onset POAF after cardiac surgery.
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Affiliation(s)
- Rebecca Y Klinger
- From the Departments of Anesthesiology, Medicine-Cardiology, and Surgery, Duke University Medical Center, Durham, North Carolina
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45
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Zeng C, Wei J, Li H, Yang T, Zhang FJ, Pan D, Xiao YB, Yang TB, Lei GH. Relationship between Serum Magnesium Concentration and Radiographic Knee Osteoarthritis. J Rheumatol 2015; 42:1231-6. [PMID: 26034158 DOI: 10.3899/jrheum.141414] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To establish whether there is a relationship between serum magnesium (Mg) concentration and radiographic knee osteoarthritis (OA). METHODS There were 2855 subjects in this cross-sectional study. Serum Mg concentration was measured using the chemiluminescence method. Radiographic OA of the knee was defined as changes consistent with Kellgren-Lawrence (K-L) grade 2 on at least 1 side. Mg concentration was classified into 1 of 4 quartiles: ≤ 0.87, 0.88-0.91, 0.92-0.96, or ≥ 0.97 mmol/l. Multivariable logistic analysis was used to test the association between serum Mg and radiographic knee OA after adjustment for potentially confounding factors. The OR with 95% CI for the association between radiographic knee OA and serum Mg concentration were calculated for each quartile. The quartile with the lowest value was regarded as the reference category. RESULTS Significant association between serum Mg concentration and radiographic knee OA was observed in the model after adjustment for age, sex, and body mass index, as well as in the multivariable model. The multivariable-adjusted OR (95% CI) for radiographic knee OA in the second, third, and fourth serum Mg concentration quartiles were 0.90 (95% CI 0.71-1.13), 0.92 (95% CI 0.73-1.16), and 0.72 (95% CI 0.57-0.92), respectively, compared with the lowest (first) quartile. A clear trend (p for trend was 0.01) was observed. The relative odds of radiographic knee OA was decreased by 0.72 times in the fourth serum Mg quartile compared with the lowest quartile. CONCLUSION Serum Mg concentration may have an inverse relationship with radiographic OA of the knee.
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Affiliation(s)
- Chao Zeng
- From the Department of Orthopedics, Xiangya Hospital, and Department of Epidemiology and Health Statistics, School of Public Health Central South University, Central South University, Changsha, Hunan Province, China.C. Zeng, MD, Department of Orthopedics, Xiangya Hospital, Central South University; J. Wei, MD, Department of Epidemiology and Health Statistics, School of Public Health, Central South University; H. Li, MD; T. Yang, MD; F.J. Zhang, PhD; D. Pan, PhD; Y.B. Xiao, PhD, Department of Orthopedics, Xiangya Hospital, Central South University; T.B. Yang, PhD, Department of Epidemiology and Health Statistics, School of Public Health, Central South University; G.H. Lei, MD, PhD, Department of Orthopedics, Xiangya Hospital, Central South University
| | - Jie Wei
- From the Department of Orthopedics, Xiangya Hospital, and Department of Epidemiology and Health Statistics, School of Public Health Central South University, Central South University, Changsha, Hunan Province, China.C. Zeng, MD, Department of Orthopedics, Xiangya Hospital, Central South University; J. Wei, MD, Department of Epidemiology and Health Statistics, School of Public Health, Central South University; H. Li, MD; T. Yang, MD; F.J. Zhang, PhD; D. Pan, PhD; Y.B. Xiao, PhD, Department of Orthopedics, Xiangya Hospital, Central South University; T.B. Yang, PhD, Department of Epidemiology and Health Statistics, School of Public Health, Central South University; G.H. Lei, MD, PhD, Department of Orthopedics, Xiangya Hospital, Central South University
| | - Hui Li
- From the Department of Orthopedics, Xiangya Hospital, and Department of Epidemiology and Health Statistics, School of Public Health Central South University, Central South University, Changsha, Hunan Province, China.C. Zeng, MD, Department of Orthopedics, Xiangya Hospital, Central South University; J. Wei, MD, Department of Epidemiology and Health Statistics, School of Public Health, Central South University; H. Li, MD; T. Yang, MD; F.J. Zhang, PhD; D. Pan, PhD; Y.B. Xiao, PhD, Department of Orthopedics, Xiangya Hospital, Central South University; T.B. Yang, PhD, Department of Epidemiology and Health Statistics, School of Public Health, Central South University; G.H. Lei, MD, PhD, Department of Orthopedics, Xiangya Hospital, Central South University
| | - Tuo Yang
- From the Department of Orthopedics, Xiangya Hospital, and Department of Epidemiology and Health Statistics, School of Public Health Central South University, Central South University, Changsha, Hunan Province, China.C. Zeng, MD, Department of Orthopedics, Xiangya Hospital, Central South University; J. Wei, MD, Department of Epidemiology and Health Statistics, School of Public Health, Central South University; H. Li, MD; T. Yang, MD; F.J. Zhang, PhD; D. Pan, PhD; Y.B. Xiao, PhD, Department of Orthopedics, Xiangya Hospital, Central South University; T.B. Yang, PhD, Department of Epidemiology and Health Statistics, School of Public Health, Central South University; G.H. Lei, MD, PhD, Department of Orthopedics, Xiangya Hospital, Central South University
| | - Fang-Jie Zhang
- From the Department of Orthopedics, Xiangya Hospital, and Department of Epidemiology and Health Statistics, School of Public Health Central South University, Central South University, Changsha, Hunan Province, China.C. Zeng, MD, Department of Orthopedics, Xiangya Hospital, Central South University; J. Wei, MD, Department of Epidemiology and Health Statistics, School of Public Health, Central South University; H. Li, MD; T. Yang, MD; F.J. Zhang, PhD; D. Pan, PhD; Y.B. Xiao, PhD, Department of Orthopedics, Xiangya Hospital, Central South University; T.B. Yang, PhD, Department of Epidemiology and Health Statistics, School of Public Health, Central South University; G.H. Lei, MD, PhD, Department of Orthopedics, Xiangya Hospital, Central South University
| | - Ding Pan
- From the Department of Orthopedics, Xiangya Hospital, and Department of Epidemiology and Health Statistics, School of Public Health Central South University, Central South University, Changsha, Hunan Province, China.C. Zeng, MD, Department of Orthopedics, Xiangya Hospital, Central South University; J. Wei, MD, Department of Epidemiology and Health Statistics, School of Public Health, Central South University; H. Li, MD; T. Yang, MD; F.J. Zhang, PhD; D. Pan, PhD; Y.B. Xiao, PhD, Department of Orthopedics, Xiangya Hospital, Central South University; T.B. Yang, PhD, Department of Epidemiology and Health Statistics, School of Public Health, Central South University; G.H. Lei, MD, PhD, Department of Orthopedics, Xiangya Hospital, Central South University
| | - Yong-Bing Xiao
- From the Department of Orthopedics, Xiangya Hospital, and Department of Epidemiology and Health Statistics, School of Public Health Central South University, Central South University, Changsha, Hunan Province, China.C. Zeng, MD, Department of Orthopedics, Xiangya Hospital, Central South University; J. Wei, MD, Department of Epidemiology and Health Statistics, School of Public Health, Central South University; H. Li, MD; T. Yang, MD; F.J. Zhang, PhD; D. Pan, PhD; Y.B. Xiao, PhD, Department of Orthopedics, Xiangya Hospital, Central South University; T.B. Yang, PhD, Department of Epidemiology and Health Statistics, School of Public Health, Central South University; G.H. Lei, MD, PhD, Department of Orthopedics, Xiangya Hospital, Central South University
| | - Tu-Bao Yang
- From the Department of Orthopedics, Xiangya Hospital, and Department of Epidemiology and Health Statistics, School of Public Health Central South University, Central South University, Changsha, Hunan Province, China.C. Zeng, MD, Department of Orthopedics, Xiangya Hospital, Central South University; J. Wei, MD, Department of Epidemiology and Health Statistics, School of Public Health, Central South University; H. Li, MD; T. Yang, MD; F.J. Zhang, PhD; D. Pan, PhD; Y.B. Xiao, PhD, Department of Orthopedics, Xiangya Hospital, Central South University; T.B. Yang, PhD, Department of Epidemiology and Health Statistics, School of Public Health, Central South University; G.H. Lei, MD, PhD, Department of Orthopedics, Xiangya Hospital, Central South University
| | - Guang-Hua Lei
- From the Department of Orthopedics, Xiangya Hospital, and Department of Epidemiology and Health Statistics, School of Public Health Central South University, Central South University, Changsha, Hunan Province, China.C. Zeng, MD, Department of Orthopedics, Xiangya Hospital, Central South University; J. Wei, MD, Department of Epidemiology and Health Statistics, School of Public Health, Central South University; H. Li, MD; T. Yang, MD; F.J. Zhang, PhD; D. Pan, PhD; Y.B. Xiao, PhD, Department of Orthopedics, Xiangya Hospital, Central South University; T.B. Yang, PhD, Department of Epidemiology and Health Statistics, School of Public Health, Central South University; G.H. Lei, MD, PhD, Department of Orthopedics, Xiangya Hospital, Central South University.
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Miyamura M, Fujita SI, Morita H, Sakane K, Okamoto Y, Sohmiya K, Hoshiga M, Ishizaka N. Circulating Fibroblast Growth Factor 23 Has a U-Shaped Association With Atrial Fibrillation Prevalence. Circ J 2015; 79:1742-8. [PMID: 26016926 DOI: 10.1253/circj.cj-15-0413] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) occurs more frequently among patients with renal dysfunction. We investigated the possible association between prevalence of AF and serum fibroblast growth factor 23 (FGF23), which has been shown to be increased in subjects with renal dysfunction. METHODS AND RESULTS Among the total enrollment of 851 cardiac patients, 188 patients had AF (paroxysmal AF, 95; non-paroxysmal AF, 93). Prevalence of AF for FGF23 octile had a U-shaped relationship with the lowest prevalence at the fifth octile. On logistic regression analysis, when the third FGF23 quartile was used as the reference, the first and fourth FGF23 quartiles were associated with prevalence of AF with an odds ratio (OR) of 3.34 (95% confidence interval [CI]: 1.89-5.88) and 2.58 (95% CI: 1.45-4.58), respectively, after adjusting for confounding factors including estimated glomerular filtration rate (eGFR). Among the subgroup of 416 patients for whom serum parathyroid hormone and 25-hydroxy vitamin D data were available, OR of the first and the fourth FGF23 quartile were calculated to be 3.52 and 2.97, respectively, when further adjusted for these two variables in the statistical model. CONCLUSIONS Serum FGF23 had a U-shaped relationship with prevalence of AF among Japanese cardiac patients, which was independent of other calcium/phosphate metabolism-related parameters and eGFR. Pathophysiology underlying the observed link, if at all, awaits further investigation.
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Lutsey PL, Alonso A, Michos ED, Loehr LR, Astor BC, Coresh J, Folsom AR. Serum magnesium, phosphorus, and calcium are associated with risk of incident heart failure: the Atherosclerosis Risk in Communities (ARIC) Study. Am J Clin Nutr 2014; 100:756-64. [PMID: 25030784 PMCID: PMC4135486 DOI: 10.3945/ajcn.114.085167] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Heart failure (HF) is a major source of morbidity and mortality, particularly among the elderly. Magnesium, phosphorus, and calcium are micronutrients traditionally viewed in relation to bone health or chronic kidney disease. However, they also may be associated with risk of cardiovascular disease through a broad range of physiologic roles. OBJECTIVE With the use of data from the Atherosclerosis Risk in Communities (ARIC) cohort, we tested the hypotheses that the incidence of HF is greater among individuals with low serum magnesium and those with high serum phosphorus and calcium. DESIGN A total of 14,709 African Americans (27%) and whites from the ARIC cohort [aged 45-64 y at baseline (1987-1989)] were observed through 2009. Proportional hazards regression was used to explore associations between biomarkers and incident HF. Serum calcium was corrected for serum albumin. Models were adjusted for demographics, behaviors, and physiologic characteristics. RESULTS A total of 2250 incident HF events accrued over a median follow-up of 20.6 y. Participants in the lowest (≤1.4 mEq/L) compared with the highest (≥1.8 mEq/L) category of magnesium were at greater HF risk (HR: 1.71; 95% CI: 1.46, 1.99). For phosphorus, there appeared to be a threshold whereby only those in the highest quintile were at greater HF risk [HR(Q5 vs Q1): 1.34; 95% CI: 1.16, 1.54]. Higher concentrations of calcium were also associated with greater risk of HF [HR(Q5 vs Q1): 1.24; 95% CI: 1.07, 1.43]. Results were not modified by race, sex, or kidney function and were similar when incident coronary heart disease was included as a time-varying covariate. CONCLUSIONS Low serum magnesium and high serum phosphorus and calcium were independently associated with greater risk of incident HF in this population-based cohort. Whether these biomarkers will be useful candidates for HF risk prediction or targets for prevention remains to be seen.
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Affiliation(s)
- Pamela L Lutsey
- From the Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN (PLL, AA, and ARF); the Division of Cardiology, Johns Hopkins University, Baltimore, MD (EDM); the Department of Epidemiology, University of North Carolina, Chapel Hill, NC (LRL); the Departments of Medicine and Population Health Sciences, University of Wisconsin, Madison, WI (BCA); and the Department of Epidemiology, Johns Hopkins University, Baltimore, MD (JC)
| | - Alvaro Alonso
- From the Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN (PLL, AA, and ARF); the Division of Cardiology, Johns Hopkins University, Baltimore, MD (EDM); the Department of Epidemiology, University of North Carolina, Chapel Hill, NC (LRL); the Departments of Medicine and Population Health Sciences, University of Wisconsin, Madison, WI (BCA); and the Department of Epidemiology, Johns Hopkins University, Baltimore, MD (JC)
| | - Erin D Michos
- From the Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN (PLL, AA, and ARF); the Division of Cardiology, Johns Hopkins University, Baltimore, MD (EDM); the Department of Epidemiology, University of North Carolina, Chapel Hill, NC (LRL); the Departments of Medicine and Population Health Sciences, University of Wisconsin, Madison, WI (BCA); and the Department of Epidemiology, Johns Hopkins University, Baltimore, MD (JC)
| | - Laura R Loehr
- From the Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN (PLL, AA, and ARF); the Division of Cardiology, Johns Hopkins University, Baltimore, MD (EDM); the Department of Epidemiology, University of North Carolina, Chapel Hill, NC (LRL); the Departments of Medicine and Population Health Sciences, University of Wisconsin, Madison, WI (BCA); and the Department of Epidemiology, Johns Hopkins University, Baltimore, MD (JC)
| | - Brad C Astor
- From the Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN (PLL, AA, and ARF); the Division of Cardiology, Johns Hopkins University, Baltimore, MD (EDM); the Department of Epidemiology, University of North Carolina, Chapel Hill, NC (LRL); the Departments of Medicine and Population Health Sciences, University of Wisconsin, Madison, WI (BCA); and the Department of Epidemiology, Johns Hopkins University, Baltimore, MD (JC)
| | - Josef Coresh
- From the Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN (PLL, AA, and ARF); the Division of Cardiology, Johns Hopkins University, Baltimore, MD (EDM); the Department of Epidemiology, University of North Carolina, Chapel Hill, NC (LRL); the Departments of Medicine and Population Health Sciences, University of Wisconsin, Madison, WI (BCA); and the Department of Epidemiology, Johns Hopkins University, Baltimore, MD (JC)
| | - Aaron R Folsom
- From the Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN (PLL, AA, and ARF); the Division of Cardiology, Johns Hopkins University, Baltimore, MD (EDM); the Department of Epidemiology, University of North Carolina, Chapel Hill, NC (LRL); the Departments of Medicine and Population Health Sciences, University of Wisconsin, Madison, WI (BCA); and the Department of Epidemiology, Johns Hopkins University, Baltimore, MD (JC)
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Adebamowo SN, Jiménez MC, Chiuve SE, Spiegelman D, Willett WC, Rexrode KM. Plasma magnesium and risk of ischemic stroke among women. Stroke 2014; 45:2881-6. [PMID: 25116874 DOI: 10.1161/strokeaha.114.005917] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE Lower plasma magnesium levels may be associated with higher blood pressure and endothelial dysfunction, but sparse prospective data are available for stroke. METHODS Among 32,826 participants in the Nurses' Health Study who provided blood samples in 1989 to 1990, incident ischemic strokes were identified and confirmed by medical records through 2006. We conducted a nested case-control analysis of 459 cases, matched 1:1 to controls on age, race/ethnicity, smoking status, date of blood draw, fasting status, menopausal status, and hormone use. We used conditional logistic regression models to estimate the multivariable adjusted association of plasma magnesium and the risk of ischemic stroke and ischemic stroke subtypes. RESULTS Median magnesium levels did not differ between ischemic stroke cases and controls (median, 0.86 mmol/L for both; P=0.14). Conditional on matching factors, women in the lowest magnesium quintile had a relative risk of 1.34 (95% confidence interval, 0.86-2.10; P trend=0.13) for total ischemic stroke compared with women in the highest quintile. Additional adjustment for risk factors and confounders did not substantially alter the risk estimates for total ischemic stroke. Women with magnesium levels<0.82 mmol/L had significantly greater risk of total ischemic stroke (multivariable relative risk, 1.57; 95% confidence interval, 1.09-2.27; P=0.01) and thrombotic stroke (multivariable relative risk, 1.66; 95% confidence interval, 1.03-2.65; P=0.03) compared with women with magnesium levels≥0.82 mmol/L. No significant effect modification was observed by age, body mass index, hypertension, or diabetes mellitus. CONCLUSIONS Lower plasma magnesium levels may contribute to higher risk of ischemic stroke among women.
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Affiliation(s)
- Sally N Adebamowo
- From the Departments of Nutrition (S.N.A.-A., S.E.C., W.C.W.), Epidemiology (D.S., W.C.W.), and Biostatistics (D.S.), Harvard School of Public Health, Boston, MA; and Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA (S.N.A.-A., M.C.J., S.E.C., K.M.R.).
| | - Monik C Jiménez
- From the Departments of Nutrition (S.N.A.-A., S.E.C., W.C.W.), Epidemiology (D.S., W.C.W.), and Biostatistics (D.S.), Harvard School of Public Health, Boston, MA; and Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA (S.N.A.-A., M.C.J., S.E.C., K.M.R.)
| | - Stephanie E Chiuve
- From the Departments of Nutrition (S.N.A.-A., S.E.C., W.C.W.), Epidemiology (D.S., W.C.W.), and Biostatistics (D.S.), Harvard School of Public Health, Boston, MA; and Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA (S.N.A.-A., M.C.J., S.E.C., K.M.R.)
| | - Donna Spiegelman
- From the Departments of Nutrition (S.N.A.-A., S.E.C., W.C.W.), Epidemiology (D.S., W.C.W.), and Biostatistics (D.S.), Harvard School of Public Health, Boston, MA; and Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA (S.N.A.-A., M.C.J., S.E.C., K.M.R.)
| | - Walter C Willett
- From the Departments of Nutrition (S.N.A.-A., S.E.C., W.C.W.), Epidemiology (D.S., W.C.W.), and Biostatistics (D.S.), Harvard School of Public Health, Boston, MA; and Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA (S.N.A.-A., M.C.J., S.E.C., K.M.R.)
| | - Kathryn M Rexrode
- From the Departments of Nutrition (S.N.A.-A., S.E.C., W.C.W.), Epidemiology (D.S., W.C.W.), and Biostatistics (D.S.), Harvard School of Public Health, Boston, MA; and Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA (S.N.A.-A., M.C.J., S.E.C., K.M.R.)
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Dousdampanis P, Trigka K, Fourtounas C. Hypomagnesemia, chronic kidney disease and cardiovascular mortality: Pronounced association but unproven causation. Hemodial Int 2014; 18:730-9. [PMID: 24641780 DOI: 10.1111/hdi.12159] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
| | - Konstantina Trigka
- Hemodialysis Unit; Hemodialysis Unit Kyanos Stavros Patras; Patras Greece
| | - Costas Fourtounas
- Department of Internal Medicine-Nephrology; Patras University Hospital; Patras Greece
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50
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Ochi A, Ishimura E, Tsujimoto Y, Kakiya R, Tabata T, Mori K, Fukumoto S, Tahara H, Shoji T, Yasuda H, Nishizawa Y, Inaba M. Hair magnesium, but not serum magnesium, is associated with left ventricular wall thickness in hemodialysis patients. Circ J 2013; 77:3029-36. [PMID: 23979658 DOI: 10.1253/circj.cj-13-0347] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Extracellular magnesium (Mg) accounts for approximately 1% of the total body Mg. Clinically, serum Mg concentration is measured, but it does not necessarily reflect total body Mg status. Although relationships have been reported between reduced Mg and cardiovascular disease in non-dialysis patients, there have been few such studies in hemodialysis patients. It was hypothesized that reduced Mg, as represented by lower Mg concentration in the hair, would be associated with echocardiographic parameters in chronic hemodialysis patients. METHODS AND RESULTS Hair Mg concentration was measured in 79 male hemodialysis patients using inductively coupled plasma mass spectrometry, and the relationships between hair Mg concentration and echocardiographic parameters were investigated. There was no significant correlation between Mg concentration in the hair and in serum. Hair Mg concentration in the patients with high-left ventricular mass index (LVMI) was significantly lower than that in the low-LVMI patients. Hair Mg concentration correlated significantly and negatively with posterior left ventricular wall thickness, interventricular septum thickness, left ventricular wall thickness (LVWT), and relative wall thickness. Serum Mg concentration, however, did not correlate with any of these echocardiographic parameters. CONCLUSIONS In hemodialysis patients, hair Mg concentration is a biomarker, independent of serum Mg concentration. Hair Mg, but not serum Mg, was significantly and negatively associated with LVWT. Reduced tissue Mg concentration, as measured in the hair, may be associated with left ventricular hypertrophy in hemodialysis patients.
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Affiliation(s)
- Akinobu Ochi
- Metabolism, Endocrinology, Molecular Medicine and Nephrology, Osaka City University Graduate School of Medicine
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