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Epidemiologic Reviews Vol. 19, No. 2
Copyright © 1997 by The Johns Hopkins University School of Hygiene and Public Health Printed in U.S.A.
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Magnesium in Drinking Water and Ischemic Heart Disease

Arthur Marx and Raymond R. Neutra

Table 1, Table 2, Table 3, and Table 4


 

TABLE 1. Results from autopsy studies of myocardial magnesium concentrations

Authors and year (ref.)

Location of study

Mean myocardial magnesium content (µg/g)*

p value

Controls†

No. of patients

Sudden deaths

No. of patients

Chipperfield and Chipperfield, 1973 (59)

England

205

14

172

19

<0.001

Anderson et al., 1975 (60)‡

Canada

 

 

 

 

 

    Soft water

 

918

54

697

27

<0.01

    Hard water

 

982

29

744

12

 

Chipperfield et al, 1976 (61)

England

219

12

174

12

<0.001

Chipperfield and Chipperfield, 1978 (62)

England

186

158

154

59

<0.001

Johnson et al., 1979 (63)

United States

221

7

194

14

<0.05

Chipperfield and Chipperfield, 1979 (64)§

England

186

158

179

7

NS¶

Elwood et al., 1980 (65)

England/Wales

181

305

159

489

<0.05

* Wet weight of myocardial tissue.
† Persons who died of trauma, accident, or suicide.
‡ Magnesium content reported for dry weight of myocardial tissue.
§ Sudden infant deaths vs. adult controls.
¶ NS, not significant.


 

TABLE 2. Correlation coefficients for water hardness and cardiovascular
mortality in various studies

Author(s) and year (ref.) r*
  Calcium Magnesium
Biersteker, 1967 (71) -0.15  
  -0.46  
Björck et al., 1965 (72) -0.03 -0.03
  -0.40 0.15
Blachly, 1969 (73) -0.40  
Crawford and Crawford, 1967 (74) -0.56  
Dudley et al., 1969 (75) -0.39  
Elwood et al., 1974 (76) -0.56 -0.35
Hart, 1970 (77) -0.46  
Lindemann and Assenzo, 1964 (78) 0.18 0.16
  0.05 0.03
Morris et al., 1961 (79) -0.54 -0.04
  -0.48 0.08
  -0.54 -0.09
  -0.43 0.05
Nerbrand et al., 1992 (80) --† --‡
Neri et al., 1974 (69) -0.08 -0.10
Roberts and Lloyd, 1972 (81) -0.46  
  -0.43  
Sauer et al., 1971 (82) -0.32  
Scassellati-Sforzolini and Pascasio, 1971 (83) -0.11  
Schroeder, 1966 (84) -0.51  
Schroeder and Kraemer, 1974 (85) -0.32 -0.30
  -0.35 -0.28
Shaper et al., 1980 (86) --§ --‡
Voors, 1971 (87) -0.35 -0.32
Winton and McCabe, 1970 (88) -0.32  
  -0.55  
* Pearson's product-moment correlation coefficient. Coefficients listed pertain
to different study methods, age/sex groups, and ICD-9-CM codes.
† Significant at the 0.05 level.
‡ Not significant.
§ Standardized regression effect: -3.9%/100 mg of calcium carbonate.

 

Table 3. Rate-based studies of magnesium in the drinking water and diet and ischemic heart disease
Author(s) and year (ref.) Location of study Study population Outcome Magnesium Calcium Observa- tion period (years) Parameters RR* p value of 95% CI* Attrib- utable risk†
        Level (mg/liter) Level (mg/liter of CaCO3*)   Rate (per 100,000)      
               
Ecologic studies              
Luoma et al., 1973 (98) Finland 300 men aged 24-70 years Prevalence of IHD* morbidity 5.8 N/A* "Several" 8,600 7.82 —‡ 0.87
11.0     1,100      
Allwright et al., (1974 (99) Los Angeles, California n=244,524, all ages§ IHD mortality 5.0 82 2 99 1.03 NS* 0.03
18.0 327   96      
Leary et al., 1983 (100) South Africa White males, age N/A IHD mortality 1.0 N/A 1 500 5.00 p<0.02 0.80
45.0 N/A   100      
Teitge, 1990 (102) East Germany n=105,000; males and females aged > 40 yrs Incidence of MI* 2.9 N/A 10 332 1.61 p<0.05 0.38
5.8 N/A   206      
Rylander et al., 1991 (103) Sweden n=800,655; males and females, all ages IHD mortality 1.0 N/A 10 N/A 1.41¶ p<0.02 0.29
15.0 N/A   N/A      
              No. of cases No. of controls      
                   
Case-control studies                  
Luoma et al., 1983 (104) Finland Men aged 30-64 years First MI <1.2 N/A 2 50 50 4.67¶ 1.3-25.32 0.65
>3.0 N/A       1.63¶ 0.62-4.52  
Rubenowitz et al., 1996 (12) Sweden Men aged 50-69 years (median age, 64 years) Mortality from acute MI <3.5   8 854 989 1.51¶ p<0.05 0.34
>9.8         1.00¶    
              No. of cases Sample size      
                   
Cohort studies                  
Punsar and Karvonen, 1979 (106) Finland Men aged 40-59 years                  
               
    Eastern Finland IHD mortality 3.1 (0.3)# Lower 15 121 823 1.57 p<0.001 0.36
    Western Finland 13.1 (2.0) Higher   77 888      
                       
    Eastern Finland Sudden cardiac death 3.1 (0.3)     45 823 1.50 NS 0.33
    Western Finland 13.1 (2.0)     30 888      
                       
        Intake (mg/day) Intake (mg/day)            
Dietary Intervention Studies                  
Singh, 1990 (56) India 400 men aged 25-63 yrs                  
               
    Intervention group IHD complications 1.142 (233) 880 (212) 10 59 206 2.11 p<0.001 0.53
    Control group 418 (105) 512 (150)   117 194      
                       
    Intervention group Sudden cardiac death 1.142 (233) 880 (212)   19 206 1.58 p<0.02 0.37
    Control group 418 (105) 512 (150)   30 194      
* RR, relative risk; CI, confidence Interval; CaCO3, calcium carbonate; IHD, ischemic heart disease; N/A, not available; NS, not significant; MI, myocardial infarction.
† Attributable risk=(incidence in exposed—Incidence in unexposed)/Incidence in exposed=(relative risk-1)/relative risk.
‡ The trend of ischemic heart disease prevalence with increasing levels of waterborne magnesium was not uniform.
§ Communities matched according to age, sex, race, income, socioeconomic status, and stability of mineral concentrations.
¶ Risk estimate provided in original published article.
# Numbers in parentheses, standard deviation.

 

TABLE 4. Range of absolute rates and relative risk gradients for the relation of magnesium intake with cardiovascular morbidity and mortality in various studies
Author(s) and year (ref.) Outcome Daily magnesium
intake (mg)*
Estimated rate per
100,000 population
Absolute risk
gradient†
(mg x 100,000-1)
Rate
ratio
RR‡
gradient§
(1/mg)
    Lowest Highest Range Low intake High intake      
Allwright et al., 1974 (99) IHD‡ mortality 10 36 26 99.0 96.0 0.1 1.03 0.001
Leary et al., 1983 (100) IHD mortality 2 90 88 500.0 100.0 4.5 5.00 0.045
Punsar and Karvonen, 1979 (106) IHD mortality 6.2 26.2 20 980.0 580.0 20.0 1.69 0.034
Rylander et al., 1991 (103) MI‡ incidence 2 30 28 (RR=1.1) (RR=0.78) N/A‡ 1.41 0.015
Singh, 1990 (56)¶ IHD morbidity 418 1142 724 1800.0 1070.0 1.0 2.11 0.002
Teitge, 1990 (102) MI incidence 5.8 11.6 5.8 332.0 206.0 21.7 1.61 0.105
* Consumption of 2 liters of water per day was assumed in order to obtain an estimate of the range of differences in magnesium intake from drinking water or dietary intervention
† Absolute slope = (rate for low magnesium intake - rate for high magnesium intake)/range (in mg), which has units of [mg x 100,000]-1.
‡ RR, relative risk; IHD, ischemic heart disease; MI, myocardial infarction; N/A, not available.
§ Relative risk slope = (rr - 1)/range (in mg), which has units of 1/mg.
¶ Dietary intervention study.

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