Serum magnesium and the incidence of coronary artery disease over a median 27 years of follow-up in the Atherosclerosis Risk in Communities (ARIC) Study and a meta-analysis

Author:

Rooney Mary R12ORCID,Alonso Alvaro3,Folsom Aaron R1,Michos Erin D24,Rebholz Casey M2,Misialek Jeffrey R1,Chen Lin Yee5,Dudley Samuel5,Lutsey Pamela L1

Affiliation:

1. Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA

2. Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA

3. Department of Epidemiology, Emory University, Atlanta, GA, USA

4. Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA

5. Division of Cardiology, University of Minnesota, Minneapolis, MN, USA

Abstract

ABSTRACT Background Low serum magnesium (Mg) concentrations have been associated with higher coronary artery disease (CAD) risk. A previous Atherosclerosis Risk in Communities (ARIC) Study article that evaluated the Mg–CAD association, based on 319 events occurring over 4–7 y, identified a sex-interaction whereby the inverse Mg–CAD association was much stronger among women than men. More than 1700 additional ARIC CAD events have since accrued. Objective We aimed to test our hypothesis that serum Mg is inversely and independently associated with long-term CAD risk in ARIC and in a meta-analysis with other prospective studies. Methods A total of 14,446 ARIC study participants (baseline mean ± SD age: 54 ± 6 y, 57% women, 27% African American) were followed for incident CAD through 2017. CAD events were defined by myocardial infarction or CAD mortality. Serum Mg was modeled as quintiles based on mean visit 1 (1987–1989) and visit 2 (1990–1992) concentrations. Cox regression models were used. We also conducted a random-effects meta-analysis incorporating these contemporary ARIC findings. Results Over a median follow-up of 27 y, 2131 incident CAD cases accrued. Overall, low serum Mg was associated with higher CAD risk after adjustment for demographics, lifestyle factors, and other CAD risk factors than was higher serum Mg (HR Q1 compared with Q5: 1.28; 95% CI: 1.11, 1.47; P-linear trend <0.001). The association was stronger among women (HR Q1 compared with Q5: 1.53; 95% CI: 1.22, 1.92) than men (HR: 1.11; 95% CI: 0.92, 1.34) (P-interaction = 0.05). In the meta-analysis including 5 studies, the pooled RR (95% CI) for CAD in the lowest compared with the highest circulating Mg category was 1.18 (1.06, 1.31) (I2 = 22%, P-heterogeneity = 0.27). Conclusions In this large community-based cohort and updated meta-analysis, low circulating Mg was associated with higher CAD risk than was higher Mg. Whether increasing Mg concentrations within healthy limits is a useful strategy for CAD prevention remains to be seen.

Funder

National Heart, Lung, and Blood Institute

NIH

Department of Health and Human Services

National Institute of Diabetes and Digestive and Kidney Diseases

Publisher

Oxford University Press (OUP)

Subject

Nutrition and Dietetics,Medicine (miscellaneous)

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