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Canagliflozin, serum magnesium and cardiovascular outcomes-Analysis from the CANVAS Program

Katherine M Wang1, JingWei Li2,3, Vivek Bhalla1

  • 1Division of Nephrology Stanford University School of Medicine Stanford CA USA.

Endocrinology, Diabetes & Metabolism
|July 19, 2021
PubMed
Abstract

Insights

Serum magnesium levels in type 2 diabetes patients are not linked to cardiovascular outcomes, even with SGLT2 inhibitor use. Changes in magnesium did not mediate the drug

Area of Science:

  • Cardiology
  • Endocrinology
  • Metabolic Diseases

Background:

  • Patients with type 2 diabetes (T2D) often have altered serum magnesium (Mg) levels, potentially impacting cardiometabolic health.
  • Sodium-glucose co-transporter 2 (SGLT2) inhibitors have been observed to increase serum Mg in T2D patients.
  • The Canagliflozin Cardiovascular Assessment Study (CANVAS) Program provides data to investigate these relationships.

Purpose of the Study:

  • To assess the association between baseline serum Mg and cardiovascular outcomes in T2D patients.
  • To determine if baseline serum Mg modifies the effect of canagliflozin on cardiovascular events.
  • To investigate whether changes in serum Mg mediate canagliflozin's cardiovascular benefits.

Main Methods:

  • Post hoc analysis of 10,140 participants from the CANVAS Program.
  • Evaluation of the association between baseline serum Mg and a composite endpoint (cardiovascular death, myocardial infarction, stroke).
  • Mediation analysis to assess the role of serum Mg changes in canagliflozin's effects.

Main Results:

  • Mean baseline serum Mg was 0.77 ± 0.09 mmol/L in both canagliflozin and placebo groups.
  • Canagliflozin use led to a mean serum Mg increase of 0.07 mmol/L (p < .001).
  • No association was found between baseline serum Mg and cardiovascular outcomes, nor was effect modification observed. Changes in serum Mg did not mediate canagliflozin's effects.

Conclusions:

  • In the CANVAS Program cohort, neither baseline nor post-randomization serum Mg levels were associated with cardiovascular outcomes.
  • Serum Mg levels do not appear to be a significant factor in the cardiovascular risk or canagliflozin's efficacy in T2D patients.
Keywords:
canagliflozincardiovascular outcomesmagnesiumtype 2 diabetes

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