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Title: The association of serum magnesium and mortality outcomes in heart failure patients: A systematic review and meta-analysis
Authors: Angkananard T.
Anothaisintawee T.
Eursiriwan S.
Gorelik O.
McEvoy M.
Attia J.
Thakkinstian A.
Keywords: magnesium
biological marker
diuretic agent
cardiovascular mortality
cerebrovascular accident
heart ejection fraction
heart failure
heart infarction
ischemic heart disease
magnesium blood level
meta analysis
outcome assessment
priority journal
randomized controlled trial (topic)
sudden death
systematic review
cause of death
disease course
heart failure
middle aged
prospective study
severity of illness index
sex difference
survival analysis
very elderly
all cause mortality
cardiovascular risk
cause of death
disease association
dose response
heart left ventricle ejection fraction
high risk patient
mortality rate
risk assessment
risk factor
Age Factors
Aged, 80 and over
Cause of Death
Disease Progression
Heart Failure
Middle Aged
Prospective Studies
Severity of Illness Index
Sex Factors
Survival Analysis
Issue Date: 2016
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=1.05mmol/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. © 2016 the Author(s). Published by Wolters Kluwer Health, Inc. All rights reserved.
ISSN: 257974
Appears in Collections:Scopus 1983-2021

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