Magnesium is an essential mineral not only involved in regulating cardiac and vascular smooth muscle function,¹ but also required as a cofactor for energy metabolism² and insulin-mediated glucose uptake.³ Inadequate magnesium intake has been associated with hyperglycaemia, dyslipidaemia, hypertension, and markers of endothelial inflammation, underscoring its importance in cardiometabolic health. The following table has been summarised from a review exploring the relationship between dietary magnesium and cardiometabolic disease, with a particular focus on epidemiological studies.⁴

Disease	Epidemiological evidence
Type 2 diabetes mellitus (T2DM)	Meta-analysis (n=637,922) conducted on 25 cohort studies. A linear dose-response relationship was observed between dietary magnesium intake and T2DM incidence. Risk was 8 to 13% lower per 100 mg/day increment in intake.5
T2DM	Prospective study including >200,000 participants followed up for over 28 years. Pooled analysis of the three cohorts showed that those with the highest intake of magnesium (median 390 mg/day) had a 15% lower risk of T2DM compared to those with the lowest intake (median 229 mg/day).6
Metabolic syndrome (MetS)	Meta-analysis (n=31,876) on nine observational studies. Higher magnesium consumption was associated with a lower risk of MetS compared to participants in the lowest categories of consumption (odds ratio [OR] 0.73).7
MetS	Cross-sectional study (n=535). Magnesium intake was inversely associated with MetS (OR 0.36), body mass index (BMI) [OR 0.47] and fasting glucose (OR 0.41).8 Two other meta-analyses drew similar conclusions.9,10
Hypertension	Meta-analysis (n=180,566) of nine articles of ten cohort studies. A statistically significant inverse association between dietary magnesium intake and hypertension risk (pooled relative risk [RR] 0.92) was reported. Range of magnesium intake was 96 to 425 mg/day. A 100 mg/day increment in intake correlated with a 5% reduction in risk of hypertension.11
Hypertension	Cross-sectional study (n=657 women). Magnesium intake was inversely associated with plasma concentrations of C-reactive protein (CRP), E-selectin and soluble intercellular adhesion molecule-1 (sICAM-1), i.e., inflammatory and endothelial biomarkers. Furthermore, CRP and E-selectin means were 24% and 14% lower for women in the highest quintile of intake compared to women in the lowest quintile, respectively.12 Similar findings were reported for postmenopausal women included in the Women's Health Initiative (WHI) long-term national study (n=3713).13
Hypertension and dyslipidaemia	Cross-sectional study (n=576). Low serum magnesium (hypomagnesemia) was identified in 65.6% and 4.9% of individuals with and without MetS, respectively (p<0.00001); and strongly associated with dyslipidaemia (OR 2.8) and hypertension (OR 1.9).14
Fasting blood glucose and triglycerides	Cross-sectional study (n=2504). An inverse correlation between dietary magnesium intake (mean 349 mg/day) and fasting blood glucose, triglycerides and waist circumference (WC) was observed.15
Cholesterol, hypertension and stroke	Cross-sectional analysis in a case-cohort study (n=4443). Higher magnesium intake was inversely associated with total cholesterol in men and women. Differences of -7 mmHg systolic blood pressure (BP) and -3.8 mmHg BP were observed between men in the highest (mean intake 456 mg) versus lowest (mean 206 mg) quintiles of magnesium intake. Additionally, men in the top 30% of magnesium intake had a relative risk reduction of 41% for stroke compared to the bottom 10%.16
Stroke	A dose-dependent protective effect of magnesium intake and stroke risk, particularly ischaemic stroke, has been observed by several meta-analyses of prospective data.17-19 Likewise, correlations between lower magnesium levels and ischaemic stroke incidence have been reported in a nested case-control analysis in women (plasma magnesium)20 and a separate cohort study in men and women (serum magnesium).21
Cardiovascular disease (CVD), T2DM and all-cause mortality	Meta-analysis of four cohort studies including >1 million participants. Per 100 mg/day increment, magnesium intake was associated with reduced risk of heart failure (-22%), stroke (-7%), T2DM (-19%), and all-cause mortality (-10%). Significant associations with total CVD and coronary heart disease (CHD) were not observed.22 Other studies assessing the correlation between dietary magnesium intake and CHD incidence have reached mixed conclusions.23-28 However, a prospective population-based study comprised of 9820 participants found that a 0.1 mmol/L increase in serum magnesium level was associated with a lower risk for CHD mortality (hazard ratio [HR] 0.82). Links between low serum magnesium (≤0.8 mmol/L) and CHD mortality (HR 1.36), sudden cardiac death (HR 1.54) and accelerated subclinical atherosclerosis were also reported.29
Atrial fibrillation	Low serum magnesium has been associated with an increased risk of atrial fibrillation after cardiac surgery. However, it is unknown whether hypomagnesemia predisposes to atrial fibrillation in the general population.4 Two prospective community studies investigated this relationship, both of which found an association between low serum magnesium and the development of atrial fibrillation.30,31
Left ventricular hypertrophy and heart failure	Some population-based evidence suggests that low serum magnesium can predict left ventricular hypertrophy32 and heart failure.33,34
Atherosclerosis and coronary artery calcification (CAC)	Low serum magnesium has been inversely associated with atherosclerosis and CAC. In the Atherosclerosis Risk in Communities (ARIC) Study (n=15,248), decreased serum were associated with increased mean carotid wall thickness in women.35 Similarly, the Ohasama study (n=728) found that lower serum magnesium was significantly associated with mean common carotid intima-media thickness and risk of carotid plaques in Japanese participants.36 Another two cross-sectional studies, conducted in Korean37 and Mexican38 populations free from CVD, reported associations between low serum magnesium and CAC.
CVD	Meta-analysis of prospective data (n=313,041) from 16 studies. Circulating magnesium (per 0.2 mmol/L increment) was associated with a 30% lower risk of CVD, with trends towards reduced risk of ischemic heart disease (IHD) [RR 0.83] and fatal IHD (RR 0.61). Dietary magnesium (per 200 mg/day increment) was not significantly associated with CVD (RR 0.89) but did lower risk of IHD by 22%.39 Since this review was published, three additional large-scale, prospective studies examining similar relationships have been completed. In the first, higher magnesium intake was not associated with lower risk of total CHD or nonfatal CHD. However, magnesium intake was inversely associated with risk of fatal CHD, partly mediated by hypertension.24 The second concluded that an increased magnesium intake, particularly in those with the lowest urinary magnesium, could reduce risk of IHD.40 The third showed that very low serum magnesium concentrations (<0.7 mmol/L) were associated with greater all-cause mortality (HR 1.34) and stroke mortality (HR 2.55); and a trend towards greater CVD mortality (HR 1.28).41
Cardiovascular death	Several epidemiological studies evaluating the association between dietary magnesium and risk of cardiovascular death have yielded inconclusive results.42-46 A more recent meta-analysis including close to 450,000 adults from different cohorts provides a comprehensive overview. Higher dietary magnesium reduced risk of cardiovascular mortality by 14%, compared to lower categories of intake. Subgroup analysis indicated that the protective effect was stronger in women than in men (-16% versus -8%, respectively). Further investigation revealed that dietary magnesium intake was inversely and significantly associated with risk of CHD (HR 0.69), heart failure (0.90) and sudden cardiac death (0.68). Dose-response analysis found a 25% protection in women for the increment of 100 mg/day.47

The review also provides an illustrated summary of the interconnected mechanisms by which inadequate magnesium is thought to induce detrimental effects in CVD.

Figure 1. Mechanisms Linking Impaired Magnesium Levels With Cardiometabolic Risk Factors and Subsequent Cardiovascular Disease (CVD)⁴

Magnesium-Rich Foods^48-54

Overall, this evidence emphasises the importance of adequate dietary magnesium intake for reducing CVD risk factors and preventing the development of cardiometabolic disease. Regularly consuming a variety of foods high in magnesium, such as those listed above, may contribute to better cardiometabolic function combined with healthy diet and lifestyle changes, and appropriate supplementation.

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