Hypermagnesemia Predicts Mortality in Elderly with Congestive Heart Disease: Relationship with Laxative and Antacid Use

Abstract

The aim of this study was to evaluate the role of magnesium levels on 3-year survival in the elderly with congestive heart failure (CHF) admitted to the Rehabilitative Cardiology Unit of S. Maugeri Foundation Scientific Institute of Telese/Campoli. All elderly patients > or = 65 years old with a diagnosis of CHF underwent clinical and instrumental examination, and their demographics, co-morbidity, and in-hospital and 3-year mortality rates were recorded. Hypomagnesemia was found in 4.8%, normomagnesemia in 67.5%, and hypermagnesemia in 27.8% of subjects. The hypomagnesemic group was excluded for numerical exiguity; the analysis was performed on a total of 199 elderly patients. Hypermagnesemia was found in 29.1% and normomagnesemia in 70.9%. At the univariate analysis no differences were found in hypermagnesemia in respect to normomagnesemia group, except for slightly higher levels of creatininemia (1.35 +/- 0.61 vs. 1.13 +/- 0.55 mg/dL, respectively; p < 0.02), greater disability (lost ADL, 2.69 +/- 1.57 vs. 2.15 +/- 1.56, respectively; p < 0.05), more mortality for CHF (32.6 vs. 48.3%; p < 0.05), and higher antacid and laxative use (82.7 vs. 24.8%, respectively; p < 0.0001). Patients with higher magnesium showed less probability to survive at a 3-year follow-up than did patients with lower levels (17.32 +/- 15.93 vs. 22.46 +/- 16.16 months; p < 0.05), and this finding remained significant in the multivariate analysis after adjusting for some confounders. Finally hypermagnesemia should also be considered in the absence of pre-existing renal failure clinical evidence because of its negative prognostic value, especially in elderly patients with CHF. The shown relationship between hypermagnesemia and laxative/antacid use should induce physicians to pay more attention to abuse of these drugs.

Relation of Serum Magnesium Levels and Postdischarge Outcomes in Patients Hospitalized for Heart Failure (from the EVEREST Trial)

“…5 In another study of patients admitted to an Italian rehabilitation unit, hypermagnesemia was associated with increased risk of mortality at 3-year follow-up. 6 These studies have been small single-center experiences with limited covariate adjustment, likely explaining the observed discrepancies in findings from the present investigation.…”

“…5 An Italian study with follow-up up to 3 years showed that hypermagnesemia was associated with increased mortality in elderly patients with HF. 6 These incongruent data highlight the need for more robust and complete characterization of the clinical profiles and prognostic impact of serum magnesium levels during hospitalization for HF. The Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) 7,8,9 dataset provides insight into the longitudinal electrolyte profiles in a large cohort of hospitalized patients with HF.…”

Elevated serum magnesium associated with SGLT2 inhibitor use in type 2 diabetes patients: a meta-analysis of randomised controlled trials

“…The significant elevations in serum magnesium levels, and the possibility of increased phosphate levels, might be the result of osmotic diuresis caused by SGLT2 inhibitors, but the precise mechanisms involved are unknown. Abnormally high magnesium levels are predictive of total mortality in individuals with heart failure [22], those who are critically ill [23] and those receiving haemodialysis [24]. Therefore, caution must be exercised in patients with impaired renal function, such as in severe CKD.…”

Magnesium Content in Daily Food Portions and the Influence of Supplementation

“…Magnesium is one of several nutrients that may cause detrimental effects when present in excess, such as neuromuscular effects (confusion, lethargy, respiratory depression, muscle weakness/paralysis), cardio vascular effects (hypotension, bradycardia, cardiac arrest) and nausea and vomiting (3,5).…”