Serum Magnesium, Outcomes, and the Effect of Empagliflozin in Heart Failure With Mildly Reduced and Preserved Ejection Fraction: Findings From EMPEROR-Preserved
Abstract
BACKGROUND: Magnesium plays a central role in maintaining cellular homeostasis. Limited data exist on the clinical implications of magnesium derangements and the influence of sodium-glucose cotransporter 2 inhibitors on magnesium levels in heart failure with mildly reduced or preserved ejection fraction.
OBJECTIVES: Using the EMPEROR-Preserved (Empagliflozin Outcome Trial in Patients with Chronic Heart Failure with Preserved Ejection Fraction) population, the authors aimed to study the association of serum magnesium with outcomes, assess the impact of empagliflozin on serum magnesium levels, and explore the influence of serum magnesium on the effect of empagliflozin on the study outcomes.
METHODS: Patients with heart failure with mildly reduced or preserved ejection fraction were randomized to receive placebo or empagliflozin 10 mg daily. Laboratory results were available at baseline; week 4; weeks 12, 32, and 52; and every 24 weeks thereafter. The median follow-up time was 26.2 months. The primary outcome was a composite of cardiovascular death or heart failure hospitalization.
RESULTS: A total of 5,988 patients were included. The mean serum magnesium levels at baseline were 0.82 ± 0.11 mmol/L. The corresponding magnesium quintiles were as follows: Q1 = 0.67 ± 0.07 mmol/L (n = 1,291), Q2 = 0.78 ± 0.02 (n = 1,189), Q3 = 0.83 ± 0.01 (n = 1,378), Q4 = 0.88 ± 0.01 (n = 1,078), and Q5 = 0.96 ± 0.05 (n = 1,052). Patients with higher magnesium levels were older, had lower…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 5,988 participants or records.
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