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：一项美国退伍军人全国队列研究

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

机构信息

Department of Clinical Research and Leadership, George Washington University, Washington, DC 20052, USA.

Department of Medicine, Veterans Affairs Medical Center, Washington, DC 20420, USA.

出版信息

Nutrients. 2025 Jun 21;17(13):2067. doi: 10.3390/nu17132067.

DOI:10.3390/nu17132067

PMID:40647173

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12251466/

Abstract

OBJECTIVES

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

RESEARCH DESIGN AND METHODS

This nationwide 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, ischemic stroke, or all-cause mortality) was determined using multivariable-adjusted Cox-regression models. Using a new-user-design and propensity-score-matching approach, 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 (serum magnesium >2.3 mg/dL). Compared to patients with normomagnesemia (serum magnesium 1.8-2.3 mg/dL), those with either hypomagnesemia or hypermagnesemia had elevated hazards for MACE. The risk increased with the severity of serum magnesium abnormalities in both directions-low (hazard ratios [HRs] 1.11-1.20) and high (HRs 1.04-1.39)-in a parabolic pattern. 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% confidence interval [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年期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T2D退伍军人。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、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方法，我们进一步分析了低镁血症（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之间的关系。

结果

在1284940名T2D患者中，229210名（17.8%）患者患有低镁血症，117674名（9.2%）患者患有高镁血症（血清镁>2.3mg/dL）。与正常镁血症（血清镁1.8 - 2.3mg/dL）患者相比，低镁血症或高镁血症患者发生MACE的风险更高。血清镁异常的风险在两个方向上均随异常严重程度增加呈抛物线型增加——低水平（风险比[HRs] 1.11 - 1.20）和高水平（HRs 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%的患者使用了口服镁。在64个基线特征平衡后的倾向评分匹配后，在40766名匹配的低镁血症患者中，口服镁与较低的MACE风险相关（HR 0.89；95%置信区间[CI]，0.84 - 0.93），尤其是那些使用质子泵抑制剂或噻嗪类药物的患者。在11838名匹配的正常镁血症患者中，口服镁与MACE无关（HR 1.07；95% CI，0.97 - 1.17）。