Serum Magnesium and the Effect of Empagliflozin in Heart Failure With Reduced Ejection Fraction: Findings From EMPEROR-Reduced
Abstract
BACKGROUND: Magnesium plays a central role in maintaining cellular homeostasis. Limited data exist on the clinical implications of magnesium derangements in heart failure with reduced ejection fraction (HFrEF) and on the influence of sodium-glucose cotransporter 2 (SGLT2) inhibitors on serum magnesium levels.
OBJECTIVES: Using the EMPEROR-Reduced (Empagliflozin Outcome Trial in Patients With Chronic Heart Failure With Reduced Ejection Fraction; NCT03057977) population, the authors studied the association of serum magnesium with outcomes, assessed the impact of empagliflozin on serum magnesium levels, and explored the influence of serum magnesium on the effect of empagliflozin on cardiovascular and renal outcomes.
METHODS: Patients with HFrEF were randomized to receive placebo or 10 mg/day of empagliflozin. Laboratory results were available at baseline, week 4, weeks 12, 32, and 52, and every 24 weeks thereafter. The median follow-up time was 16 months. The primary outcome was a composite of cardiovascular death or heart failure (HF) hospitalization.
RESULTS: A total of 3,730 patients were included. The mean serum magnesium levels at baseline were 0.83 ± 0.11 mmol/L. The corresponding magnesium quintiles were Q1 = 0.68 ± 0.07 mmol/L (n = 878); Q2 = 0.79 ± 0.02 (n = 724); Q3 = 0.84 ± 0.01 (n = 668); Q4 = 0.88 ± 0.02 (n = 733); and Q5 = 0.97 ± 0.05 (n = 727). The patients with higher magnesium levels were older and had a lower estimated glomerular filtration rate. Conversely,…
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: 3,730 participants or records.
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