Oral magnesium and outcomes in US veterans with heart failure

Authors

Ying Yin, Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, 50 Irving St NW, Washington, DC 20422, USA.
Rebecca B. Costello, Office of Dietary Supplements, National Institutes of Health, Bethesda, MD, USA.
Gregg C. Fonarow, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
Paul A. Heidenreich, Department of Medicine, Stanford University, CA, USA.
Charity J. Morgan, Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, 50 Irving St NW, Washington, DC 20422, USA.
Charles Faselis, Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, 50 Irving St NW, Washington, DC 20422, USA.
Yan Cheng, Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, 50 Irving St NW, Washington, DC 20422, USA.
Andrew R. Zullo, Department of Epidemiology, Brown University, Providence, RI, USA.
Simin Liu, Department of Epidemiology and Biostatistics, University of California, Irvine, Irvine, CA, USA.
Phillip H. Lam, Department of Medicine, Georgetown University, Washington, DC, USA.
Andrea Rosanoff, CMER Center for Magnesium Education & Research, Pahoa, HI, USA.
Jose D. Vargas, Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, 50 Irving St NW, Washington, DC 20422, USA.
Stephen S. Gottlieb, Department of Medicine, University of Maryland, Baltimore, MD, USA.
Prakash Deedwania, Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, 50 Irving St NW, Washington, DC 20422, USA.
Hans J. Moore, Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, 50 Irving St NW, Washington, DC 20422, USA.
Yijun Shao, Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, 50 Irving St NW, Washington, DC 20422, USA.
Helen M. Sheriff, Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, 50 Irving St NW, Washington, DC 20422, USA.
Wen-Chih Wu, Department of Epidemiology, Brown University, Providence, RI, USA.
Qing Zeng-Treitler, Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, 50 Irving St NW, Washington, DC 20422, USA.
Ali Ahmed, Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, 50 Irving St NW, Washington, DC 20422, USA.

Document Type

Journal Article

Publication Date

1-5-2026

Journal

European heart journal

Volume

47

Issue

1

DOI

10.1093/eurheartj/ehaf881

Keywords

Heart failure; Magnesium deficiency; Oral magnesium therapy

Abstract

BACKGROUND AND AIMS: Magnesium deficiency is associated with poor outcomes in patients with heart failure (HF), but less is known about the impact of oral magnesium therapy. This study aimed to examine the association of oral magnesium with outcomes in patients with HF and whether it depends on baseline serum magnesium. METHODS: Of 54 696 Veterans with HF (2001-2023) and hypomagnesemia (serum magnesium <1.7 mg/dL), 10 695 were initiated on oral magnesium (median dose, 420 mg/day). A propensity score-matched cohort of 21 098 patients (treated, n = 10 549) balanced on 71 baseline characteristics was assembled while remaining outcome-blinded. This process was repeated to assemble a matched cohort of 11 634 patients (treated, n = 5817) with normomagnesemia (serum magnesium, 1.7-2.3 mg/dL). Hazard ratios (HR) (95% confidence intervals [CIs]) for one-year outcomes associated with oral magnesium were estimated. RESULTS: In the hypomagnesemia cohort, HF hospitalization or death occurred in 21.7% of patients not receiving and 20.1% receiving oral magnesium (HR: 0.91; 95% CI: 0.86-0.97). Respective HRs (95% CIs) in subgroups with serum magnesium 1.6 (n = 5929), 1.3-1.5 (n = 11 293) and <1.3 (n = 3876) mg/dL were 0.99 (0.88-1.12), 0.91 (0.84-0.98; interaction P = .20), and 0.81 (0.71-0.93; interaction P = .03). Respective rates in the normomagnesemia cohort were 17.8% and 19.5% (HR: 1.11; 95% CI: 1.02-1.21). Spline regression analysis revealed that HRs were lower at serum magnesium <1.5 mg/dL, higher at >1.8 mg/dL, and not significant at 1.5-1.8 mg/dL. CONCLUSIONS: Oral magnesium therapy was associated with a lower risk of HF hospitalization or death in patients with HF and hypomagnesemia. Future clinical trials need to confirm these findings.

APA Citation

Yin, Ying; Costello, Rebecca B.; Fonarow, Gregg C.; Heidenreich, Paul A.; Morgan, Charity J.; Faselis, Charles; Cheng, Yan; Zullo, Andrew R.; Liu, Simin; Lam, Phillip H.; Rosanoff, Andrea; Vargas, Jose D.; Gottlieb, Stephen S.; Deedwania, Prakash; Moore, Hans J.; Shao, Yijun; Sheriff, Helen M.; Wu, Wen-Chih; Zeng-Treitler, Qing; and Ahmed, Ali, "Oral magnesium and outcomes in US veterans with heart failure" (2026). GW Authored Works. Paper 8618.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/8618

Department

Clinical Research and Leadership