Cheng Yan, Zullo Andrew R, Yin Ying, Shao Yijun, Liu Simin, Zeng-Treitler Qing, Wu Wen-Chih
Department of Clinical Research and Leadership George Washington University Washington DC USA.
Washington DC VA Medical Center Washington DC USA.
J Am Heart Assoc. 2025 Apr;14(7):e038870. doi: 10.1161/JAHA.124.038870. Epub 2025 Mar 26.
Both diabetes and low magnesium-containing food intake may increase the risk of heart failure (HF). However, the effect of nonprescription magnesium supplements on the risk of HF or major adverse cardiac events in patients with diabetes is unknown.
Using a target-trial-emulation approach, we assembled a national cohort of 94 239 veterans ≥40 years with diabetes, without prior HF or magnesium use, who received ambulatory care in the US veterans-health care system documented by electronic clinic notes between January 1, 2006 and December 31, 2020. A natural language processing approach was used to detect self-reported magnesium-supplement use from clinic notes, n=17 619 were identified as users versus n=76 620 as nonusers. Using inverse probability treatment weighting, we constructed a cohort balanced in 88 baseline characteristics between users and nonusers. The primary outcome was incident HF. Secondary outcomes were major adverse cardiac events (myocardial infarction, stroke, HF hospitalization, or death). Hazard ratios (HRs) associated with magnesium-supplement use and outcomes were estimated in the inverse probability treatment weighting weighted cohort using Cox regression. The inverse probability treatment weighting weighted cohort had a mean age of 67.4±10.3 years; 18.4% were Black, and 5.1% were women. The mean duration of magnesium-supplement use was 3.5±3.1 (interquartile range, 1.1-5.1) years. Incident HF occurred 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]).
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.
糖尿病和低镁饮食摄入均可能增加心力衰竭（HF）风险。然而，非处方镁补充剂对糖尿病患者发生HF或主要不良心脏事件风险的影响尚不清楚。
采用目标试验模拟方法，我们纳入了一个全国性队列，共94239名年龄≥40岁的糖尿病退伍军人，这些患者既往无HF病史且未使用过镁剂，他们于2006年1月1日至2020年12月31日期间在美国退伍军人医疗保健系统接受门诊治疗，相关信息记录于电子病历中。采用自然语言处理方法从病历中检测自我报告的镁补充剂使用情况，确定17619人为使用者，76620人为非使用者。使用逆概率处理加权法，我们构建了一个在使用者和非使用者的88项基线特征上达到平衡的队列。主要结局为新发HF。次要结局为主要不良心脏事件（心肌梗死、中风、HF住院或死亡）。在逆概率处理加权队列中，使用Cox回归估计与镁补充剂使用及结局相关的风险比（HR）。逆概率处理加权队列的平均年龄为67.4±10.3岁；18.4%为黑人，5.1%为女性。镁补充剂的平均使用时长为3.5±3.1（四分位间距，1.1 - 5.1）年。镁补充剂使用者中8.0%发生新发HF，非使用者中为9.7%（HR，0.94 [95%CI，0.89 - 0.99]）。镁补充剂使用还与主要不良心脏事件风险降低相关（HR，0.94 [95%CI，0.90 - 0.97]）。
长期使用非处方镁补充剂与糖尿病患者新发HF和主要不良心脏事件风险降低相关。这些发现应在随机对照试验中进行重复验证。
