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Monday, 16 December 2013

Magnesium and heart failure

Magnesium is the eleventh most abundant element by mass in the human body. The adult body content is 25 g distributed in the skeleton and soft tissues. The chemical is essential in manipulating important biological polyphosphate such as ATP, DNA, and RNA and in functionming enzymes(a).
1. Significance of magnesium in congestive heart failure
Electrolyte balance has been regarded as a factor important to cardiovascular stability, particularly in congestive heart failure. According to the study by the Irvine Medical Center,, magnesium is important as a cofactor in several enzymatic reactions contributing to stable cardiovascular hemodynamics and electrophysiologic functioning. Its deficiency is common and can be associated with risk factors and complications of heart failure. Typical therapy for heart failure (digoxin, diuretic agents, and ACE inhibitors) are influenced by or associated with significant alteration in magnesium balance. Magnesium therapy, both for deficiency replacement and in higher pharmacologic doses, has been beneficial in improving hemodynamics and in treating arrhythmias. Magnesium toxicity rarely occurs except in patients with renal dysfunction(1).

2. Magnesium in congestive heart failure, acute myocardial infarction and dysrhythmias
Magnesium plays an important role in the functioning of the cardiovascular system. According to the study by the Hackettstown Community Hospital, a decrease in magnesium has been linked with tachydysrhythmias, increased mortality in patients with congestive heart failure, and increased mortality after an acute myocardial infarction. The research shows that the use of magnesium supplements in these situations may be beneficial for treating and preventing life-threatening conditions. Magnesium supplements can be administered safely either orally or parenterally depending on the situation(2).

3. Potassium and magnesium depletions in congestive heart failure--pathophysiology, consequences and replenishment
Congestive heart failure (CHF) is becoming more frequent worldwide. According to the study by the Volgograd State Medical University, both potassium (K) and magnesium (Mg) deficiencies are common and can be associated with risk factors and complications of heart failure (HF). The major causes of K and Mg depletions are the effects of compensatory neuroendocrine mechanisms (activation of the renin-angiotensin-aldosterone and sympathoadrenergic systems), digoxin therapy, and administration of thiazide or loop diuretic therapy in CHF. Particular attention should be paid to K and Mg restoration in CHF, because of the consequences of both deficiencies (increased arrhythmic risk, vasoconstriction), and the co-supplementation of both ions is necessary in order to achieve K repletion. Mg and K should be employed as first-line therapy in digitalis intoxication and drug-related arrhythmias, and should be considered an important adjuvant therapy in diuretic treated patients with CHF. Another possibility to restore normal K and Mg status is usage of a K, Mg sparing diuretics(3).

4.  Calcium, magnesium and potassium intake and mortality in women with heart failure
In the study of the 161 808 participants in the Women's Health Initiative (WHI), we studied 3340 who experienced a HF hospitalisation to hypothesised that Ca, Mg and K would be inversely associated with mortality in people with HF, showed that intake was assessed using questionnaires on food and supplement intake. Hazard ratios (HR) and 95 % CI were calculated using Cox proportional hazards models adjusted for demographics, physical function, co-morbidities and dietary covariates. Over a median of 4·6 years of follow-up, 1433 (42·9 %) of the women died. HR across quartiles of dietary Ca intake were 1·00 (referent), 0·86 (95 % CI 0·73, 1·00), 0·88 (95 % CI 0·75, 1·04) and 0·92 (95 % CI 0·76, 1·11) (P for trend = 0·63). Corresponding HR were 1·00 (referent), 0·86 (95 % CI 0·71, 1·04), 0·88 (95 % CI 0·69, 1·11) and 0·84 (95 % CI 0·63, 1·12) (P for trend = 0·29), across quartiles of dietary Mg intake, and 1·00 (referent), 1·20 (95 % CI 1·01, 1·43), 1·06 (95 % CI 0·86, 1·32) and 1·16 (95 % CI 0·90, 1·51) (P for trend = 0·35), across quartiles of dietary K intake(4).

5. Functional reserves of the heart under conditions of alimentary magnesium deficit
In the study to assess functional reserves of myocardium in animals with deficit of magnesium during stress tests with magnesium deficit was modeled by 10 week long magnesium deficient diet, showed that
in animals with magnesium deficit we noted smaller increases of left ventricular pressure, myocardial contraction and relaxation rates under conditions of all functional tests, and of systolic arterial pressure during loading with volume and adrenaline. Lowering of myocardial reactivity under conditions of volume and adrenaline loading as well as isometric work load could constitute a basis of genesis of heart failure in magnesium deficit(5).

6. Complications of association magnesium sulfate with nicardipine during preeclampsia
There is a report of a heart failure and a collapse following concurrently administration of nicardipine and magnesium sulfate. These two drugs have potential negative inotropic effect and decrease systemic vascular resistance. Magnesium sulfate is the first-line treatment for the prevention of primary and recurrent eclamptic seizures. Combination with calcium channel blockers should be used cautiously, according to Service de gynécologie-obstétrique, centre hospitalier Franck-Joly(6).

7. Magnesium deficiency in heart failure patients with diabetes mellitus
In the study to assess the serum magnesium level in heart failure patients with diabetes mellitus conducted at Basic Medical Sciences Institute (BMSI), Jinnah Postgraduate Medical Centre (JPMC), Karachi, in collaboration with National Institute of Cardiovascular Diseases (NICVD), Karachi, from April 2003 to December 2003, showed that out of 45 cases of heart failure, 15 were diabetic. Of these, eleven (73.3%) had low serum magnesium (<1.8 mg/dl), one (6.7%) was within normal range (1.8-2.0 mg/dl) and three (20%) were in the high level range(>2.0 mg/dl). Low serum magnesium level in heart failure patients with diabetes mellitus(7).

8. Associations of dietary magnesium intake with mortality from cardiovascular disease
In the study to to investigate the relationship between dietary magnesium intake and mortality from cardiovascular disease in a population-based sample of Asian adults, based on dietary magnesium intake in 58,615 healthy Japanese aged 40-79 years, in the Japan Collaborative Cohort (JACC) Study, found that
dietary magnesium intake was inversely associated with mortality from hemorrhagic stroke in men and with mortality from total and ischemic strokes, coronary heart disease, heart failure and total cardiovascular disease in women. The multivariable hazard ratio (95% CI) for the highest vs. the lowest quintiles of magnesium intake after adjustment for cardiovascular risk factor and sodium intake was 0.49 (0.26-0.95), P for trend = 0.074 for hemorrhagic stroke in men, 0.68 (0.48-0.96), P for trend = 0.010 for total stroke, 0.47 (0.29-0.77), P for trend < 0.001 for ischemic stroke, 0.50 (0.30-0.84), P for trend = 0.005 for coronary heart disease, 0.50 (0.28-0.87), P for trend = 0.002 for heart failure and 0.64 (0.51-0.80), P for trend < 0.001 for total cardiovascular disease in women. The adjustment for calcium and potassium intakes attenuated these associations(8).

9. Parameters of mineral metabolism predict midterm clinical outcome in end-stage heart failure patients
In the study to investigate to which extent disturbances in mineral metabolism predict 90-day clinical outcome in end-stage heart failure patients, found that of the study cohort, 33.4% reached the primary endpoint. In detail, 19% were transplanted (the vast majority was listed "high urgent"), 8.8% died and 5.6% received MCS implants. As determined by logistic regression analysis, all aforementioned biochemical parameters were independently related to the primary endpoint. Results did not change substantially when transplanted patients were censored. A risk score (0-5 points) was developed. Of the patients who scored 5 points 89.5% reached the primary endpoint whereas of the patients with a zero score only 3.8% reached the primary endpoint. The data demonstrate that in addition to the well-known predictive value of disturbed sodium metabolism, derangements in calcium, phosphate, and magnesium metabolism also predict midterm clinical outcome in end-stage heart failure patients(9).

10. Magnesium and anabolic hormones in older men
Optimal nutritional and hormonal statuses are determinants of successful ageing. The age associated decline in anabolic hormones such as testosterone and insulin-like growth factor 1 (IGF-1) is a strong predictor of metabolic syndrome, diabetes and mortality in older men. Studies have shown that magnesium intake affects the secretion of total IGF-1 and increase testosterone bioactivity. In the study to  evaluate of 399 ≥65-year-old men of CHIANTI, a study population representative of two municipalities of Tuscany (Italy) with complete data on testosterone, total IGF-1, sex hormone binding globulin (SHBG), dehydroepiandrosterone sulphate (DHEAS) and serum magnesium levels, showed that
after adjusting for age, magnesium was positively associated with total testosterone (β ± SE, 34.9 ± 10.3; p = 0.001) and with total IGF-1 (β ± SE, 15.9 ± 4.8; p = 0.001). After further adjustment for body mass index (BMI), log (IL-6), log (DHEAS), log (SHBG), log (insulin), total IGF-1, grip strength, Parkinson's disease and chronic heart failure, the relationship between magnesium and total testosterone remained strong and highly significant (β ± SE, 48.72 ± 12.61; p = 0.001). In the multivariate analysis adjusted for age, BMI, log (IL-6), liver function, energy intake, log (insulin), log (DHEAS), selenium, magnesium levels were also still significantly associated with IGF-1 (β ± SE, 16.43 ± 4.90; p = 0.001) and remained significant after adjusting for total testosterone (β ± SE, 14.4 ± 4.9; p = 0.01). In a cohort of older men, magnesium levels are strongly and independently associated with the anabolic hormones testosterone and IGF-1.© 2011 The Authors. International Journal of Andrology © 2011 European Academy of Androlo(10).

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