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The association of serum magnesium and mortality outcomes in heart failure patients: A systematic review and meta-analysis.

Abstract

BACKGROUND

Low serum magnesium (Mg) has been independently shown to increase risk of heart failure (HF), but data on the association between serum Mg concentration and the outcome of patients with HF are conflicting. The purpose of this systematic review and meta-analysis was to estimate the prognostic effects of hypermagnesemia and hypomagnesemia on cardiovascular (CV) mortality and all-cause mortality (ACM) of patients with HF.

METHODS

Relevant studies were identified from Medline and Scopus databases. Included and excluded criteria were defined. Effects (i.e., log [risk ratio [RR]]) of hypomagnesemia and hypermagnesemia versus normomagnesemia were estimated using Poisson regression, and then a multivariate meta-analysis was applied for pooling RRs across studies. Heterogeneity was explored using a meta-regression and subgroup analysis.

RESULTS

On analysis, 7 eligible prospective studies yielded a total of 5172 chronic HF patients with 913 and 1438 deaths from CV and ACM, respectively. Most participants were elderly men with left ventricular (LV) ejection fraction ≤40%. Those patients with baseline hypermagnesemia had a significantly higher risk of CV mortality (RR, 1.38; 95% confidence interval [CI], 1.07-1.78) or ACM (RR, 1.35; 95% CI, 1.18-1.54) than those with baseline normomagnesemia. However, baseline hypomagnesemia was not associated with the risk of CV mortality (RR, 1.11; 95% CI, 0.79-1.57) and ACM (RR, 1.11; 95% CI, 0.87-1.41). A subgroup analysis by Mg cutoff suggested a dose-response trend for hypermagnesemia effects, that is, the pooled RRs for CV mortality were 1.28 (95% CI, 1.05-1.55) and 1.92 (95% CI, 1.00-3.68) for the cutoff of 0.89 to 1.00 and 1.05 to 1.70 mmol/L, respectively.

CONCLUSION

The present systematic review and meta-analysis suggested that, in HF patients, hypermagnesemia with serum Mg ≥ 1.05 mmol/L was associated with an increased risk of CV mortality and ACM but this was not observed for hypomagnesemia. This finding was limited to the elderly patients with chronic HF who had reduced LV systolic function.

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  • Authors+Show Affiliations

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    aSection for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok bDivision of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, HRH Princess Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University, Ongkharak, Nakhon Nayok cDepartment of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University dCardiology Unit, Department of Pediatrics, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand eDepartment of Internal Medicine "F", Assaf Harofeh Medical Center (Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel), Zerifin, Israel fCenter for Clinical Epidemiology and Biostatistics, The School of Medicine and Public Health, the University of Newcastle, Newcastle, NSW, Australia.

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    Source

    Medicine 95:50 2016 Dec pg e5406

    MeSH

    Age Factors
    Aged
    Aged, 80 and over
    Biomarkers
    Cause of Death
    Disease Progression
    Female
    Heart Failure
    Humans
    Magnesium
    Male
    Middle Aged
    Prospective Studies
    Severity of Illness Index
    Sex Factors
    Survival Analysis

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    27977579

    Citation

    Angkananard, Teeranan, et al. "The Association of Serum Magnesium and Mortality Outcomes in Heart Failure Patients: a Systematic Review and Meta-analysis." Medicine, vol. 95, no. 50, 2016, pp. e5406.
    Angkananard T, Anothaisintawee T, Eursiriwan S, et al. The association of serum magnesium and mortality outcomes in heart failure patients: A systematic review and meta-analysis. Medicine (Baltimore). 2016;95(50):e5406.
    Angkananard, T., Anothaisintawee, T., Eursiriwan, S., Gorelik, O., McEvoy, M., Attia, J., & Thakkinstian, A. (2016). The association of serum magnesium and mortality outcomes in heart failure patients: A systematic review and meta-analysis. Medicine, 95(50), pp. e5406.
    Angkananard T, et al. The Association of Serum Magnesium and Mortality Outcomes in Heart Failure Patients: a Systematic Review and Meta-analysis. Medicine (Baltimore). 2016;95(50):e5406. PubMed PMID: 27977579.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - The association of serum magnesium and mortality outcomes in heart failure patients: A systematic review and meta-analysis. AU - Angkananard,Teeranan, AU - Anothaisintawee,Thunyarat, AU - Eursiriwan,Sudarat, AU - Gorelik,Oleg, AU - McEvoy,Mark, AU - Attia,John, AU - Thakkinstian,Ammarin, PY - 2016/12/16/entrez PY - 2016/12/16/pubmed PY - 2017/2/15/medline SP - e5406 EP - e5406 JF - Medicine JO - Medicine (Baltimore) VL - 95 IS - 50 N2 - BACKGROUND: Low serum magnesium (Mg) has been independently shown to increase risk of heart failure (HF), but data on the association between serum Mg concentration and the outcome of patients with HF are conflicting. The purpose of this systematic review and meta-analysis was to estimate the prognostic effects of hypermagnesemia and hypomagnesemia on cardiovascular (CV) mortality and all-cause mortality (ACM) of patients with HF. METHODS: Relevant studies were identified from Medline and Scopus databases. Included and excluded criteria were defined. Effects (i.e., log [risk ratio [RR]]) of hypomagnesemia and hypermagnesemia versus normomagnesemia were estimated using Poisson regression, and then a multivariate meta-analysis was applied for pooling RRs across studies. Heterogeneity was explored using a meta-regression and subgroup analysis. RESULTS: On analysis, 7 eligible prospective studies yielded a total of 5172 chronic HF patients with 913 and 1438 deaths from CV and ACM, respectively. Most participants were elderly men with left ventricular (LV) ejection fraction ≤40%. Those patients with baseline hypermagnesemia had a significantly higher risk of CV mortality (RR, 1.38; 95% confidence interval [CI], 1.07-1.78) or ACM (RR, 1.35; 95% CI, 1.18-1.54) than those with baseline normomagnesemia. However, baseline hypomagnesemia was not associated with the risk of CV mortality (RR, 1.11; 95% CI, 0.79-1.57) and ACM (RR, 1.11; 95% CI, 0.87-1.41). A subgroup analysis by Mg cutoff suggested a dose-response trend for hypermagnesemia effects, that is, the pooled RRs for CV mortality were 1.28 (95% CI, 1.05-1.55) and 1.92 (95% CI, 1.00-3.68) for the cutoff of 0.89 to 1.00 and 1.05 to 1.70 mmol/L, respectively. CONCLUSION: The present systematic review and meta-analysis suggested that, in HF patients, hypermagnesemia with serum Mg ≥ 1.05 mmol/L was associated with an increased risk of CV mortality and ACM but this was not observed for hypomagnesemia. This finding was limited to the elderly patients with chronic HF who had reduced LV systolic function. SN - 1536-5964 UR - https://www.unboundmedicine.com/medline/citation/27977579/full_citation L2 - http://Insights.ovid.com/pubmed?pmid=27977579 DB - PRIME DP - Unbound Medicine ER -