Magnesium Disorders and Prognosis in Heart Failure: A Systematic Review

Abstract

Magnesium is an essential mineral for the human body and plays an important role in cardiovascular health. Hypomagnesaemia has been linked with increased cardiovascular mortality in heart failure; however, previous studies have yielded conflicting results. Even fewer studies have addressed the association between hypermagnesemia and prognosis in heart failure. The aim of the present systematic review was to investigate the association of serum magnesium levels with cardiovascular and all-cause mortality in patients with heart failure and reduced ejection fraction (HFrEF). Cardiovascular morbidity, referring to heart failure rehospitalizations and ventricular arrhythmias, was also investigated. Eligible studies were identified by searching PubMed and Scopus. The Quality in Prognosis (QUIPS) tool was used to assess the quality of included studies. Eight studies (total of 13,539 patients with HFrEF) that assessed the effects of serum magnesium levels on cardiovascular mortality, all-cause mortality, and cardiovascular morbidity met inclusion criteria. In half of the studies, hypomagnesemia was found to be an independent risk factor for cardiovascular mortality, including sudden cardiac death. Only 1 study reported that hypermagnesemia (serum magnesium levels above 2.4 mg/dL) is a prognostic factor for noncardiac mortality suggesting that hypermagnesemia is more likely an indicator of comorbidities rather than a true independent prognostic marker. Finally, low serum magnesium levels were not associated with readmissions for heart failure or ventricular arrhythmias in patients with HFrEF.

Magnesium Is a Vital Ion in the Body—It Is Time to Consider Its Supplementation on a Routine Basis

“…However, hypomagnesemia causes mitochondrial dysfunction, oxidative stress, and inflammation [ 27 ], as discussed in the next section. Several studies have confirmed that hypomagnesemia is an independent risk factor for cardiovascular mortality, including sudden cardiac death [ 28 ]. Recent evidence suggests that magnesium plays a clinically significant role in vascular calcification and mortality in individuals with chronic kidney disease (CKD) [ 29 ].…”

The role of magnesium in cardiac arrest

“…Hypermagnesemia usually occurs when creatinine clearance decreases in renal dysfunction and in instances of excessive magnesium intake from dietary supplements or magnesium containing medication. Common causes of hypomagnesaemia include a magnesium-insufficient diet, reduced intestinal absorption of magnesium, and the use of diuretics which increases the urinary excretion of magnesium ( 12 ).…”

“…According to the results, higher dietary magnesium intake and plasma concentrations corresponded to reduced risks of sudden cardiac death ( 19 ). A systematic review that included eight studies encompassing 13,539 individuals with heart failure, examined the relationship between levels of serum magnesium with cardiovascular and all-cause mortality ( 12 ). An independent risk factor for sudden cardiac death is hypomagnesemia.…”

“…An independent risk factor for sudden cardiac death is hypomagnesemia. Hypermagnesemia (serum magnesium > 2.4 mg/dl), however, was revealed an indicator for comorbidities but was not an independent marker of cardiovascular mortality ( 12 ).…”

Association of magnesium depletion score with cardiovascular disease and its association with longitudinal mortality in cardiovascular disease patients

“…Magnesium has also been crucial in regulating blood pressure, myocardial metabolism, cardiac contractility and excitability, and vascular tone 4,5 . Hypomagnesemia has been associated with elevated risk and adverse prognosis in individuals with diabetes, heart failure, coronary artery disease, and stroke [6][7][8][9][10] . Increased dietary magnesium intake reduced the risk of diabetes, stroke, metabolic syndrome, and hypertension [11][12][13][14] .…”