Protective role of magnesium in cardiovascular diseases: A review

A considerable number of experimental, epidemiological and clinical studies are now available which point to an important role of Mg²⁺ in the etiology of cardiovascular pathology. In human subjects, hypomagnesemia is often associated with an imbalance of electrolytes such as Na⁺, K⁺ and Ca²⁺. Abnormal dietary deficiency of Mg²⁺ as well as abnormalities in Mg²⁺ metabolism play important roles in different types of heart diseases such as ischemic heart disease, congestive heart failure, sudden cardiac death, atheroscelerosis, a number of cardiac arrhythmias and ventricular complications in diabetes mellitus. Mg²⁺ deficiency results in progressive vasoconstriction of the coronary vessels leading to a marked reduction in oxygen and nutrient delivery to the cardiac myocytes.Numerous experimental and clinical data have suggested that Mg²⁺ deficiency can induce elevation of intracellular Ca²⁺ concentrations, formation of oxygen radicals, proinflammatory agents and growth factors and changes in membrane permeability and transport processes in cardiac cells. The opposing effects of Mg²⁺ and Ca²⁺ on myocardial contractility may be due to the competition between Mg²⁺ and Ca²⁺ for the same binding sites on key myocardial contractile proteins such as troponin C, myosin and actin.Stimulants, for example, catecholamines can evoke marked Mg²⁺ efflux which appears to be associated with a concomitant increase in the force of contraction of the heart. It has been suggested that Mg²⁺ efflux may be linked to the Ca²⁺ signalling pathway. Depletion of Mg²⁺ by alcohol in cardiac cells causes an increase in intracellular Ca²⁺, leading to coronary artery vasospasm, arrhythmias, ischemic damage and cardiac failure. Hypomagnesemia is commonly associated with hypokalemia and occurs in patients with hypertension or myocardial infarction as well as in chronic alcoholism.The inability of the senescent myocardium to respond to ischemic stress could be due to several reasons. Mg²⁺ supplemented K⁺ cardioplegia modulates Ca²⁺ accumulation and is directly involved in the mechanisms leading to enhanced post ischemic functional recovery in the aged myocardium following ischemia. While many of these mechanisms remain controversial and in some cases speculative, the beneficial effects related to consequences of Mg²⁺ supplementation are apparent. Further research are needed for the incorporation of these findings toward the development of novel myocardial protective role of Mg²⁺ to reduce morbidity and mortality of patients suffering from a variety of cardiac diseases.