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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 5, September/October 2016
294
AFRICA
The relationship between elevated magnesium levels
and coronary artery ectasia
Mustafa Yolcu, Emrah Ipek, Serdar Turkmen, Yücel Ozen, Erkan Yıldırım, Alper Sertcelik, Fatih Rıfat
Ulusoy
Abstract
Background:
Coronary artery ectasia (CAE) without specific
symptoms is the localised or diffuse swelling of the epicar-
dial coronary arteries. Magnessium (Mg) plays an important
role in cardiac excitability, vascular tonus, contractibility,
reactivity and vasodilatation. In our research, we aimed to
study the vasodilatory effect of Mg in the aetiopathogenesis
of ectasia.
Methods:
Patients identified during routine coronary angio-
grams in our clinic between January 2010 and 2013 were
included in the study. Sixty-two patients with isolated CAE,
57 with normal coronary angiograms (NCA), 73 with severe
coronary artery disease (CAD), and 95 with stenosis of at
least one coronary artery and CAE (CAD
+
CAE) were
included in the study. Serum Mg levels were measured in mg/
dl after 12 hours of fasting.
Results:
There were no statistically significant differences
between the groups in terms of age, hypertension, smoking,
hyperlipidaemia, diabetes mellitus, family history of coronary
artery disease and medications used. Serum glucose, thyroid
stimulating hormone (TSH), urea, total cholesterol, triglycer-
ide, low-density lipoprotein (LDL) cholesterol, sodium and
potassium levels were similar in all groups. Serum Mg levels
were 1.90
±
0.19 mg/dl in patients with isolated CAE, 1.75
±
0.19 mg/dl in those with CAD, 1.83
±
0.20 mg/dl in those with
CAD
+
CAE, and 1.80
±
0.16 mg/dl in the NCA group. These
results show that Mg levels were higher in ectasia patients
with or without CAD.
Conclusions:
The histopathological characteristics of patients
with CAE were similar to those with CAD. The specific
mechanism of abnormal luminal dilatation seen in CAE
however remains to be elucidated. Mg is a divalent cation with
powerful vasodilatory effects. In our study, serum Mg levels
were found to be statistically higher in ectasia patients with
or without CAD.
Keywords:
coronary artery ectasia, magnessium, pathophysiol-
ogy
Submitted 28/1/14, accepted 8/3/16
Published online 21/4/16
Cardiovasc J Afr
2016;
27
: 294–298
www.cvja.co.zaDOI: 10.5830/CVJA-2016-023
Coronary artery ectasia (CAE) without specific symptoms is the
localised or diffuse swelling of the epicardial coronary arteries
to at least 1.5 times the adjacent normal coronary segment.
1,2
It
is congenital or acquired and several studies have reported its
incidence at 0.3–5%.
1,3
Atherosclerosis, congenital factors, and inflammatory or
connective tissue disorders may play a role in the aetiology,
however, the aetiopathogenesis remains unclear despite some
molecular, cellular and vascular mechanisms being defined in
previous studies.
4,5
In several studies, other vascular structures
were shown to be involved in CAE patients, which indicates CAE
is a vascular disease and not localised to the coronary arteries.
Therefore factors other than atheroscleosis may play a role in its
aetiopathogenesis.
Magnesium, the second most abundant intracellular cation,
is an essential element that plays a crucial role in cardiac and
vascular functions. Magnesium regulates contractile proteins,
modulates transmembrane transport of calcium (Ca
2
+
), sodium
(Na
+
) and potassium (K
+
), acts as a co-factor in the activation of
ATPase, controls regulation of energy-dependent cytoplasmic
and mitochondrial metabolism, and influences DNA and protein
synthesis at the subcellular level.
6,7
Small changes in concentration of extracellular and/or
intracellular freeMg have important effects in cardiac excitability,
vascular tonus, contractibility, reactivity and growth.
8,9
Low
levels of intracellular Mg lead to abnormal vascular cell growth,
inflammation, fibrosis and contraction, resulting in positive
vascular remodelling. Dosing with Mg was found to cause
vasodilatation and to have anti-inflammatory effects.
8,9
In our study, we aimed to study the vasodilatory effect of Mg
in the aetiopathogenesis of ectasia, and the long-term effects of
elevated Mg levels on the vascular structure, leading to abnormal
coronary dilatation.
Department of Cardiology, Arel Universty, Private Medicana
Camlica Hospital, Istanbul, Turkey
Mustafa Yolcu, MD,
yolcudoctor@gmail.comDepartment of Cardiology, Erzurum Region Training and
Research Hospital, Erzurum, Turkey
Emrah Ipek, MD
Erkan Yıldırım, MD
Fatih Rıfat Ulusoy, MD
Department of Cardiology, Sani Konuko
ğ
lu Medical Centre,
Gaziantep, Turkey
Serdar Turkmen, MD
Alper Sertcelik, MD
Department of Cardiovascular Surgery, Kartal Kosuyolu High
Specialty Education and Research Hospital, Erzurum, Turkey
Yücel Ozen, MD