Heavy Burden of HEART Diseases in India
The noncommunicable diseases commonly include cardiovascular disease (CVD), various cancers, chronic respiratory illnesses, diabetes, and so on which are estimated to account for around 60% of all deaths.
CVDs such as ischemic heart disease and cerebrovascular such as stroke account for 17.7 million deaths and are the leading cause.
In accordance with the World Health Organization, India accounts for one-fifth of these deaths worldwide especially in younger population.
The results of Global Burden of Disease study state age-standardized CVD death rate of 272 per 100000 population in India which is much higher than that of global average of 235.
CVDs strike Indians a decade earlier than the western population. For us Indians, particular causes of concern in CVD are early age of onset, rapid progression and high mortality rate.
Indians are known to have the highest coronary artery disease (CAD) rates, and the conventional risk factors fail to explain this increased risk.
In India in 2016, CVDs contributed to 28·1% of total deaths and 14·1% of total disability-adjusted life years (DALYs) compared with 15·2% and 6·9%, respectively in 1990.
Within India, the rates of CVD vary markedly with highest in states of Kerala, Punjab and Tamil Nadu. Moreover, these states also have the highest prevalence of raised cholesterol levels and blood pressure.
At present, India has the highest burden of acute coronary syndrome and ST-elevation myocardial infarction (MI).
Another significant problem in India, among other CVD’s, is that of hypertensive heart disease, with 261,694 deaths in 2013 (an increase of 138% in comparison with 1990).
Rheumatic heart disease remains in epidemic proportions in India with an estimated prevalence of 1.5-2 per 1000 individuals. Migrant Asian Indians have a 3-time higher prevalence of CAD than the native population.
Indians are liable to get hospitalized 2–4 times more frequently for complications of CAD, in comparison with other ethnic groups, and admission rates are 5–10 times higher for populations younger than 40 years.
The prevalence of CAD in Indians living in India is 21.4% for diabetics and 11% for nondiabetics. The prevalence of CAD in rural parts of country is nearly half than that in urban population.
Magnesium – How Magnesium Supplementation May SIGNIFICANTLY Help in CVDs
Magnesium is a plentiful micronutrient and cation, and it activates enzymes, aids in the synthesis of energy, and controls the levels of calcium and associated biomarkers, among other vital functions in the body.
Low magnesium levels have been linked to CVD through a variety of physiological processes, including high blood sugar levels, chronic inflammation, hypertension, abnormal tone of the vessels, and circulation to the peripheral tissues.
In various settings, total magnesium in the serum has long been used to evaluate magnesium levels. In multiple studies, low levels of magnesium have been linked to a higher risk of various health problems, such as a greater risk of diabetes, hypertension, and CVD.
Given the high prevalence of CVDs and their significant public health impact, investigating the link between magnesium deficiency and cardiovascular risk becomes imperative.
Role of Magnesium in cardiovascular health
Magnesium improves the function of the cardiovascular system by acting on membrane ion flow pumps, encouraging endothelium-dependent blood vessel dilatation, reducing blood pressure, reducing inflammation, and boosting insulin and glucose breakdown.
In addition, magnesium contains antiplatelet and anticoagulant characteristics, is a natural inhibitor of calcium, and is a necessary cofactor in cellular oxidation reactions.
Magnesium’s Role in Modulating Ionic Channels
Certain ionic channels, including calcium, potassium, and sodium, are controlled in part by magnesium.
Magnesium regulates cardiac responsiveness and the length of action potentials by decreasing the fast influx element of the delayed rectifier potassium channel. Magnesium influx influences the elongation of QRS and PR duration on ECG and also slows atrioventricular node conductivity.
Magnesium inhibits coronary vessel spasm, plays a critical function in regulating vascular muscle tone and, consequently, systemic arterial blood pressure, and provides protection against stimulated activity through its antagonistic impact on two calcium channels, transient type (T-type) and long-lasting type (L-type).
Magnesium is also essential for the exchange of potassium for protons as well as for preventing potassium loss.
In addition to competing for the same binding sites as calcium, magnesium might restrict the extent of the infarct by minimizing coronary vessel contractions, lowering damage from oxidation after myocardial infarction, and enhancing endothelial-dependent dilatation of vessels through the production of nitrous oxide during myocardial ischemia.
Magnesium’s Role in Metabolic Regulation
By lowering the likelihood of metabolic syndrome and type 2 diabetes mellitus, magnesium supplementation appears to have positive benefits on cardiovascular health.
The glucose transporter protein 4 is regulated by this ion, which improves insulin responsiveness and increases both insulin and glucose breakdown. Magnesium has been shown to control post=receptor signaling via insulin, mediate insulin release from the pancreas, and function as a second responder for transmitting insulin-mediated signals.
Magnesium’s Role in Regulating Inflammatory Reactions
Magnesium exhibits antioxidant properties by neutralizing free radicals of oxygen and reduces inflammation by regulating the expression of nuclear factor kappa B.
In hypomagnesemia, the inflammation that occurs also affects the balance of lipids by lipid peroxidation, which leads to dyslipidemia by raising lipids rich in triglycerides, boosting plasma levels of a protein called apolipoprotein B, and lowering the concentrations of high-density lipoprotein cholesterol (HDL-C).
Magnesium’s Role in Hemostasis and Coagulation
Magnesium can prevent the accumulation of platelets by competing with the ions of calcium for particular places in the glycoprotein (Gp) IIb subunit, changing the receptor’s configuration, and preventing interactions between Gp IIb-IIIa and fibrinogen.
Additionally, magnesium can decrease the activation of platelets by preventing the synthesis of factors that stimulate platelets, like thromboxane A2, and by promoting the breakdown of factors that inhibit platelets, like prostacyclin.
Clinical Evidence – Magnesium Supplementation and Cardiac Arrhythmias
A study was conducted by Raghu et al. on 55 participants with a cardiac response rate of more than 120 beats/minute and atrial fibrillation. Of them, 75% received treatment with magnesium sulfate (MgSO4) and 25% received a placebo.
In addition to conventional therapy, 2.5 grams of intravenous MgSO4 was given, and it led to a conversion to sinus rhythm and a reduction in pulse rate.
Davey and Teubner observed similar outcomes in a prospective, randomized, double-blind, placebo-controlled experiment on 199 adults with fast atrial fibrillation who were admitted to the emergency room. MgSO4 was given to 102 participants, while a placebo was given to 97.
It was shown that the MgSO4 group had a higher chance of achieving a heart rate of less than 100 beats/minute and changing to sinus rhythm.
Two hundred patients undergoing their first coronary artery bypass grafting procedure were examined by Toraman et al. and randomly assigned to two separate groups.
In the group that was administered magnesium, atrial fibrillation after surgery affected two patients (2%), whereas in the control group, it affected 21 patients (21%).
Thus, it was determined that magnesium supplementation during the period before surgery, as well as during the early phase after surgery, significantly lowers the risk of atrial fibrillation following coronary artery bypass grafting.
Clinical Evidence – Dietary Magnesium and Coronary Heart Disease and Stroke
Kokubo et al. assessed the dietary magnesium intake of 85,293 Japanese participants aged 45-74 years, free of cancer or CVD, using 138-item food-frequency questionnaires from the Japan Public Health Center-Based Prospective Study.
In a study conducted by Abbott et al., a cohort of 7,172 men aged 45-68 participated in the Honolulu Heart Program, where 24-hour food recall techniques were employed to assess magnesium intake. Both studies discovered a link between a lower incidence of coronary heart disease and a higher dietary magnesium consumption.
Zhang et al. reported results from the Japan Collaborative Cohort Study, which involved 58,615 Japanese adults in the age group 40-79, whose dietary magnesium consumption was measured by food frequency questionnaires. Food magnesium intake was found to be inversely linked with death from coronary heart disease and ischemic strokes.
In another study by Larsson et al., 34,670 women in the Swedish mammography cohort, aged 49-83, who answered a questionnaire about their food habits in 1997 were investigated for their consumption of potassium, magnesium, and calcium in relation to their risk of stroke.
It was demonstrated that the risk of ischemic stroke was negatively associated with magnesium consumption in women with a diagnosis of hypertension.
Clinical Evidence – Magnesium Supplementation and Hypertension
In 2014, Rodríguez-Moran and Guerrero-Romero recruited 47 metabolically obese, normal-weight (MONW) participants for a randomized, double-blind, placebo-controlled study.
For four months, the treatment group was given 30 mL of magnesium chloride (MgCl2) 5% solution, while the untreated group was given 30 mL of placebo solution.
A comparable study was conducted by Guerrero-Romero and Rodríguez-Morán in 2009 on persons with diabetes who were hypertensive and had low levels of serum magnesium, were not taking diuretics, and were taking captopril at the same time.
At the end of the follow-up, both studies found that the average diastolic and systolic blood pressure changes were considerably lower in the treatment group of patients than in the control group.
To assess the effects of oral magnesium supplementation, Borrello et al. and Purvis et al. conducted randomized, double-blind, placebo-controlled trials on patients with moderate hypertension and patients with non-insulin-dependent diabetic mellitus (NIDDM), respectively.
They concluded that people with NIDDM and mild hypertension can lower their systolic blood pressure by taking an oral magnesium supplement.
Clinical Evidence – Magnesium Supplementation and Changes in Lipid Profile
According to a 12-week double-blind, placebo-controlled, randomized clinical trial in Iran involving 86 individuals with prediabetes, those who took magnesium supplements had noticeably increased HDL-C levels.
Guerrero-Romero et al. observed reduced triglycerides and higher HDL-C in a comparable trial where participants were given 30 mL of a 5% MgCl2 or a placebo solution once daily for four months.
Solati et al. and Rodriguez-Moran et al. have shown that oral magnesium supplementation enhances the lipid profile in patients with type 2 diabetes and MONW adults, respectively. In the former study, magnesium supplementation was associated with lower levels of low-density lipoprotein cholesterol and non-HDL-C in the patients; in the latter, the magnesium treatment group was associated with lower levels of triglycerides.
Conclusions
Because MAGNESIUM affects vital physiological processes such as ionic channel modulation, enzymatic reactions, metabolic regulation, inflammation, and hemostasis, magnesium is essential for cardiovascular health.
The benefits of it are currently supported by evidence, but more research is necessary because of the limitations of the studies that have already been done, including differences in dosage, study designs, and measurement techniques.
A greater understanding of Role of and benefits of MAGNESIUM Supplementation, could result in more effective public health initiatives, individualized treatment plans, and dietary recommendations, all of which would improve the prevention and management of CVD.
Sources;
- Cardiovascular disease in India: A 360 degree overview; PMCID: PMC6994761 PMID: 32020960
- The Connection Between Magnesium and Heart Health: Understanding Its Impact on Cardiovascular Wellness; Cureus 2024 Oct 24;16(10):e72302. doi: 10.7759/cureus.72302 and PMCID: PMC11585403 PMID: 39583450
