Desalinated seawater supply and all-cause mortality in hospitalized acute myocardial infarction patients from the Acute Coronary Syndrome Israeli Survey 2002-2013

Background: Consuming desalinated seawater (DSW) as drinking water (DW) may reduce magnesium in water intake causing hypomagnesemia and adverse cardiovascular effects. Methods: We evaluated 30-day and 1-year all-cause mortality of acute myocardial infarction (AMI) patients enrolled in the biannual Acute Coronary Syndrome Israeli Survey (ACSIS) during 2002-2013. Patients (n = 4678) were divided into 2 groups: those living in regions supplied by DSW(n = 1600, 34.2%) and non-DSW(n = 3078, 65.8%). Data were compared between an early period [2002-2006 surveys (n = 2531) - before desalination] and a late period [2008-2013 surveys (n= 2147) - during desalination]. Results: Thirty-day all-cause-mortality was significantly higher in the late period in patients from the DSW regions compared with those from the non-DSW regions (HR = 2.35 CI 95% 1.33-4.15, P < 0.001) while in the early period there was no significant difference (HR = 1.37 CI 95% 0.9-2, P = 0.14). Likewise, there was a significantly higher 1-year all-cause mortality in the late period in patients from DSW regions compared with those from the non-DSW regions (HR = 1.87 CI 95% 1.32-2.63, P < 0.0001), while in the early period there was no significant difference (HR = 1.17 CI 95% 0.9-1.5, P = 0.22). Admission serum magnesium level (M +/- SD) in the DSW regions (n = 130) was 1.94 +/- 0.24 mg/dL compared with 2.08 +/- 0.27 mg/dL in 81 patients in the non-DSW(P < 0.0001). Conclusions: Higher 30-day and 1-year all-cause mortality in AMI patients, found in the DSW regions may be attributed to reduced magnesium intake secondary to DSW consumption. (C) 2016 Elsevier Ireland Ltd. All rights reserved.