2型糖尿病成人患者的血清镁、规定的镁补充与心血管事件：美国退伍军人的一项全国队列研究

Serum Magnesium, Prescribed Magnesium Replacement and Cardiovascular Events in Adults with Type 2 Diabetes: A National Cohort Study in U.S. Veterans.

作者信息

Yin Ying, Cheng Yan, Zullo Andrew R, Shao Yijun, Sheriff Helen M, Faselis Charles, Liu Simin, Ahmed Ali, Zeng-Treitler Qing, Wu Wen-Chih

出版信息

medRxiv. 2025 May 21:2025.05.19.25327928. doi: 10.1101/2025.05.19.25327928.

DOI:10.1101/2025.05.19.25327928

PMID:40475157

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12140534/

Abstract

OBJECTIVE

To investigate the relationship between serum magnesium levels, prescribed oral magnesium replacement, and major adverse cardiovascular events (MACE) in type-2 diabetes (T2D).

RESEARCH DESIGN AND METHODS

This national-wide retrospective study analyzed 1,284,940 US Veterans (≥18 years) with T2D who had outpatient serum magnesium testing between 1999-2021 in the Veterans Health Administration. The relationship between serum magnesium levels and MACE (hospitalizations for acute myocardial infarction, heart failure, or ischemic stroke, or all-cause mortality) was determined using multivariable-adjusted Cox-regression models. Using a new-user-design and propensity-score-matching analysis, we further related the use of prescribed oral magnesium and MACE among patients with hypomagnesemia (serum magnesium <1.8 mg/dL) and normomagnesemia (serum magnesium 1.8-2.3 mg/dl).

RESULTS

Of 1,284,940 patients with T2D, 229,210 (17.8%) patients had hypomagnesemia, and 117,674 (9.2%) patients had hypermagnesemia. Both hypomagnesemia and hypermagnesemia (serum magnesium >2.3 mg/dL) were linked to higher MACE risks (HRs 1.11-1.20 for hypo-and 1.04-1.39 for hypermagnesemia, respectively) compared to normomagnesemia. Oral magnesium was prescribed to 9.7% and 0.7% of patients with hypomagnesemia and normomagnesemia, respectively. After propensity-score-matching balanced across 64 baseline characteristics, oral magnesium was associated with a lower MACE risk in 40,766 matched patients with hypomagnesemia (HR 0.89; 95%CI, 0.84-0.93), especially those on proton-pump-inhibitors or thiazides. Oral magnesium was not related to MACE in 11,838 matched patients with normomagnesemia (HR 1.07; 95%CI, 0.97-1.17).

CONCLUSIONS

In patients with T2D, both hypomagnesemia and hypermagnesemia were associated with higher one-year MACE risks compared to normomagnesemia. Prescribed oral magnesium was associated with a reduced MACE risk in hypomagnesemia but not in normomagnesemia.

摘要

目的

探讨2型糖尿病（T2D）患者血清镁水平、口服镁补充剂的使用与主要不良心血管事件（MACE）之间的关系。

研究设计与方法

这项全国性回顾性研究分析了1999年至2021年间在美国退伍军人健康管理局进行门诊血清镁检测的1284940名≥18岁的退伍军人T2D患者。使用多变量调整的Cox回归模型确定血清镁水平与MACE（急性心肌梗死、心力衰竭或缺血性中风住院或全因死亡率）之间的关系。采用新用户设计和倾向评分匹配分析，我们进一步探讨了低镁血症（血清镁<1.8mg/dL）和正常镁血症（血清镁1.8 - 2.3mg/dL）患者中口服镁的使用与MACE的关系。

结果

在1284940例T2D患者中，229210例（17.8%）患者存在低镁血症，117674例（9.2%）患者存在高镁血症。与正常镁血症相比，低镁血症和高镁血症（血清镁>2.3mg/dL）均与较高的MACE风险相关（低镁血症的风险比为1.11 - 1.20，高镁血症为1.04 - 1.39）。低镁血症和正常镁血症患者中分别有9.7%和0.7%接受了口服镁治疗。在64个基线特征平衡后的倾向评分匹配后，在40766例匹配的低镁血症患者中，口服镁与较低的MACE风险相关（风险比0.89；95%置信区间，0.84 - 0.93），尤其是那些服用质子泵抑制剂或噻嗪类药物的患者。在11838例匹配的正常镁血症患者中，口服镁与MACE无关（风险比1.07；95%置信区间，0.97 - 1.17）。