Heart failure & cardiomyopathiesSecondary analysis
Serum Magnesium, Outcomes, and the Effect of Empagliflozin in Heart Failure With Mildly Reduced and Preserved Ejection Fraction
- Secondary analysis of the EMPEROR-Preserved randomised trial
Authors' conclusion
In EMPEROR-Preserved, higher serum magnesium levels were associated with a higher risk of primary outcome events among patients treated with placebo but not among patients treated with empagliflozin who experienced pronounced benefit.
Study context
- Population
- Patients with HF with mildly reduced or preserved EF (EMPEROR-Preserved)
- Participants
- 5,988 patients
- Comparison
- Empagliflozin vs placebo by baseline serum magnesium quintile
- Primary endpoint
- CV death or HF hospitalization
- Follow-up
- Median 26.2 months
Primary result
As reported in the abstract
CV death or HF hospitalization, by baseline magnesium quintile
Empagliflozin vs PlaceboHazard ratio (95% CI)
Q1 (0.67 ± 0.07 mmol/L, n = 1,291)
1.05(0.77–1.39)
Q2 (0.78 ± 0.02, n = 1,189)
0.85(0.63–1.14)
Q3 (0.83 ± 0.01, n = 1,378)
0.88(0.66–1.17)
Q4 (0.88 ± 0.01, n = 1,078)
0.62(0.45–0.86)
Q5 (0.96 ± 0.05, n = 1,052)
0.60(0.45–0.79)
Further findings
Baseline serum magnesium
- Mean serum magnesium
- 0.82 ± 0.11 mmol/L
Change in serum magnesium with empagliflozin · week 4
- Empagliflozin increased magnesium, steady state thereafter
- 0.05 mmol/L
Original publication
Serum Magnesium, Outcomes, and the Effect of Empagliflozin in Heart Failure With Mildly Reduced and Preserved Ejection Fraction. JACC Heart Fail. Published 5 January 2026. doi:10.1016/j.jchf.2025.102889
Summarised from the published abstract; every number is checked against it