WASHINGTON, DC — What is the effect of nonprescription magnesium supplements on the risk of HF or major adverse cardiac events in patients with diabetes?
That was the question addressed in a recent target trial-emulation approach. It was especially significant since both diabetes and low magnesium-containing food intake may increase the risk of heart failure (HF)?
Researchers from George Washington University and the Washington, DC, VAMC put together a national cohort of 94,239 U.S. military veterans. All were 40 and older and had diabetes but not prior HF. The participants had received ambulatory care in the U.S. Veterans Affairs healthcare system between Jan. 1, 2006, and Dec. 31, 2020.
Results were published in the Journal of the American Heart Association.1
The study team used a natural language processing approach to detect self-reported magnesium-supplement use from clinical notes, finding that 17,619 were users compared to 76,620 who were not.
Using inverse probability treatment weighting, the researchers constructed a cohort balanced in 88 baseline characteristics between users and nonusers.
Incident HF was defined as the primary outcome, while major adverse cardiac events (myocardial infarction, stroke, HF hospitalization or death made up the secondary outcomes.
The cohort studies had a mean age of 67.4, 18.4% were Black, and 5.1% were women. The mean duration of magnesium-supplement use was 3.5±3.1. Incident HF was found to occur in 8.0% of users and 9.7% of nonusers of magnesium supplements (HR, 0.94 [95% CI, 0.89-0.99]). Magnesium-supplement use was also associated with a reduced risk of major adverse cardiac events (HR, 0.94 [95% CI, 0.90-0.97]), the researchers advised.
Background information in the article points out, “A low magnesium state may lead to myocardial fibrosis, left ventricular hypertrophy, and dysfunction, eventually leading to incident HF in patients with diabetes. Therefore, it is mechanistically plausible that magnesium supplement use may delay HF onset in patients with diabetes by reducing left ventricular fibrosis and hypertrophy, thereby improving left ventricular systolic and diastolic function. In addition, given the magnesium effects on hypertension, endothelial function, and inflammation, it is likely that these are also potential pathways involved in the association of magnesium supplement use and the reduced risk of myocardial infarction and stroke in our findings,” they wrote.
The authors concluded, “Long-term nonprescription magnesium supplement use was associated with a lower risk of incident HF and major adverse cardiac events in patients with diabetes. These findings should be replicated in randomized controlled trials.”
- Cheng Y, Zullo AR, Yin Y, Shao Y, Liu S, Zeng-Treitler Q, Wu WC. Nonprescription Magnesium Supplement Use and Risk of Heart Failure in Patients With Diabetes: A Target Trial Emulation. J Am Heart Assoc. 2025 Apr;14(7):e038870. doi: 10.1161/JAHA.124.038870. Epub 2025 Mar 26. PMID: 40135571.
