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Дефицит калия и магния, их роль в развитии сердечно-сосудистых заболеваний и возможность коррекции
Дефицит калия и магния, их роль в развитии сердечно-сосудистых заболеваний и возможность коррекции
Барышникова Г.А., Чорбинская С.А., Степанова И.И., Блохина О.Е. Дефицит калия и магния, их роль в развитии сердечно-сосудистых заболеваний и возможность коррекции. Consilium Medicum. 2019; 21 (1): 67–73. DOI: 10.26442/20751753.2019.1.190240
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Аннотация
Цель. Оценить важность роли калия и магния в формировании здоровья человека, а также их роль в возникновении функциональных расстройств сердечно-сосудистой и нервной системы, в развитии и прогрессировании сердечно-сосудистых заболеваний.
Материалы и методы. Рассмотрены данные 55 научных источников, опубликованных в российской и зарубежной печати в 1972–2018 гг.
Результаты. Калий играет важную роль в осуществлении биоэлектрической активности клеток, формировании клеточных потенциалов действия и поддержании нервно-мышечной возбудимости и проводимости. Проявления гипокалиемии весьма разнообразны. Одни из частых – расстройство нейромышечной передачи, те или иные изменения со стороны сердечно-сосудистой системы (снижение сократительной функции миокарда, артериального давления – АД, дилатация полостей сердца). Повышение потребления калия сопровождается более низкой частотой сердечно-сосудистых и цереброваскулярных событий, новых случаев сахарного диабета (СД) 2-го типа, гипертрофии левого желудочка, сердечной недостаточности и аритмий. Магний является универсальным регулятором биохимических и физиологических процессов в организме, кофактором более 300 ферментов, участвующих в биохимических реакциях, а также естественным физиологическим антагонистом кальция. Он уменьшает высвобождение кальция из саркоплазматического ретикулума и защищает клетки от перегрузки кальцием в условиях ишемии. Вследствие этого магний уменьшает системное и легочное сосудистое сопротивление с последующим снижением системного АД и небольшим увеличением сердечного индекса. Получены также достоверные данные об умеренном, но вместе с тем клинически значимом антигипертензивном эффекте препаратов магния. Дефицит магния ассоциируется с повышением уровня общего холестерина, липопротеидов низкой плотности, триглицеридов. Уровень плазменного магния обратно пропорционален степени риска развития кардиоваскулярной патологии, в частности нарушений ритма сердца и осложнений ишемической болезни сердца (ИБС). Европейское ведомство по безопасности пищевых продуктов (EAFSA) подтвердило факт улучшения состояния здоровья пациентов на фоне адекватного потребления магния. Даже выраженные гипокалиемия и гипомагниемия в клинической практике часто остаются нераспознанными. Врачу любой специальности следует помнить о клинических проявлениях дефицита калия и магния в организме, чтобы своевременно их устранить либо предупредить их развитие в группах риска, назначив адекватную терапию. Описанные взаимоотношения магния и калия, а также достаточно высокая частота и выраженность сочетанного дефицита данных макроэлементов у пациентов обосновывают целесообразность применения комбинированных препаратов калия и магния в терапии целого ряда состояний. При одновременной коррекции уровня этих электролитов наблюдается аддитивный эффект.
Заключение. Неотъемлемой составляющей современной клинической практики должен быть контроль электролитного, в первую очередь калиево-магниевого баланса. У пациентов с высоким риском развития гипокалиемии и гипомагниемии следует осуществлять как коррекцию (в случае выявления), так и профилактику дефицита калия и магния. Поддержание калиево-магниевого баланса обеспечивает дополнительный терапевтический эффект у пациентов с АГ, СД, застойной сердечной недостаточностью, ИБС (в том числе при остром инфаркте миокарда), а также у больных с высоким риском развития мозгового инсульта и тяжелой желудочковой аритмии.
Ключевые слова: артериальная гипертензия, калий, магний, дефицит калия, дефицит магния, электролитный баланс, калия и магния аспарагинат, Панангин.
Материалы и методы. Рассмотрены данные 55 научных источников, опубликованных в российской и зарубежной печати в 1972–2018 гг.
Результаты. Калий играет важную роль в осуществлении биоэлектрической активности клеток, формировании клеточных потенциалов действия и поддержании нервно-мышечной возбудимости и проводимости. Проявления гипокалиемии весьма разнообразны. Одни из частых – расстройство нейромышечной передачи, те или иные изменения со стороны сердечно-сосудистой системы (снижение сократительной функции миокарда, артериального давления – АД, дилатация полостей сердца). Повышение потребления калия сопровождается более низкой частотой сердечно-сосудистых и цереброваскулярных событий, новых случаев сахарного диабета (СД) 2-го типа, гипертрофии левого желудочка, сердечной недостаточности и аритмий. Магний является универсальным регулятором биохимических и физиологических процессов в организме, кофактором более 300 ферментов, участвующих в биохимических реакциях, а также естественным физиологическим антагонистом кальция. Он уменьшает высвобождение кальция из саркоплазматического ретикулума и защищает клетки от перегрузки кальцием в условиях ишемии. Вследствие этого магний уменьшает системное и легочное сосудистое сопротивление с последующим снижением системного АД и небольшим увеличением сердечного индекса. Получены также достоверные данные об умеренном, но вместе с тем клинически значимом антигипертензивном эффекте препаратов магния. Дефицит магния ассоциируется с повышением уровня общего холестерина, липопротеидов низкой плотности, триглицеридов. Уровень плазменного магния обратно пропорционален степени риска развития кардиоваскулярной патологии, в частности нарушений ритма сердца и осложнений ишемической болезни сердца (ИБС). Европейское ведомство по безопасности пищевых продуктов (EAFSA) подтвердило факт улучшения состояния здоровья пациентов на фоне адекватного потребления магния. Даже выраженные гипокалиемия и гипомагниемия в клинической практике часто остаются нераспознанными. Врачу любой специальности следует помнить о клинических проявлениях дефицита калия и магния в организме, чтобы своевременно их устранить либо предупредить их развитие в группах риска, назначив адекватную терапию. Описанные взаимоотношения магния и калия, а также достаточно высокая частота и выраженность сочетанного дефицита данных макроэлементов у пациентов обосновывают целесообразность применения комбинированных препаратов калия и магния в терапии целого ряда состояний. При одновременной коррекции уровня этих электролитов наблюдается аддитивный эффект.
Заключение. Неотъемлемой составляющей современной клинической практики должен быть контроль электролитного, в первую очередь калиево-магниевого баланса. У пациентов с высоким риском развития гипокалиемии и гипомагниемии следует осуществлять как коррекцию (в случае выявления), так и профилактику дефицита калия и магния. Поддержание калиево-магниевого баланса обеспечивает дополнительный терапевтический эффект у пациентов с АГ, СД, застойной сердечной недостаточностью, ИБС (в том числе при остром инфаркте миокарда), а также у больных с высоким риском развития мозгового инсульта и тяжелой желудочковой аритмии.
Ключевые слова: артериальная гипертензия, калий, магний, дефицит калия, дефицит магния, электролитный баланс, калия и магния аспарагинат, Панангин.
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Aim. To evaluate the significance of potassium and magnesium in human health formation and their role in development of functional disorders of cardiovascular and nervous system and in development and progression of cardiovascular diseases.
Materials and methods. Data from 55 literature sources published in Russia and abroad in the period of 1972–2018 years are reviewed.
Results. Potassium has an important role in cells bioelectrical activity organization, cell action potentials formation and neuromuscular excitability and conductibility sustentation. Hypokalemia symptoms can be quite various. Frequent ones include neuromuscular conductibility disorders, various changes in cardiovascular system (myocardial contractile function decrease, blood pressure (BP) decrease, cardiac cavities dilatation). Potassium intake increase is followed by lower incidence of cardiovascular and cerebrovascular events, new cases of diabetes mellitus (DM) type 2, left ventricular hypertrophy, cardiac insufficiency, and arrhythmias. Magnesium is a universal regulator of biochemical and physiological processes in the body, a cofactor of more than 300 enzymes participating in biochemical reactions, and a natural physiologic potassium antagonist. It reduces potassium release from sarcoplasmic reticulum and protects cells from potassium overload in conditions of ischemia. Therefore magnesium reduces systemic and pulmonary vascular resistance that results in systemic BP reduction and moderate cardiac index increase. Also reliable evidence indicating moderate but clinically significant antihypertensive effect of magnesium medications was received. Magnesium deficiency is associated with increase of total cholesterol level, low-density lipoprotein, and triglycerides. Serum magnesium level is inversely proportional to the degree of cardiovascular disorders development risk, particularly of cardiac rhythm disorders and IHD complications. European Food Safety Authority (EFSA) confirmed that patients’ health status improved after a period of magnesium adequate intake. Even severe hypokalemia and hypomagnesemia often remain non-diagnosed in clinical practice. Medical practitioner of any kind should remember of potassium and magnesium deficiency clinical manifestations in order to manage it or prevent its development in patients with risk factors by adequate treatment assignment. Described potassium and magnesium interrelations as well as relatively high frequency and severity of combined deficit of these macronutrients justify advisability of the use of combined medications containing К+ and Mg2+in treatment of many disorders. An additional effect is observed when these electrolytes levels are corrected together.
Conclusion. Control of electrolyte balance, first of all, of potassium and magnesium balance, should be an intrinsic part of present day clinical practice. In patients with high risk of hypokalemia and hypomagnesemia development either its correction in case of detection or prevention of potassium and magnesium deficiency development should be performed. Potassium and magnesium balance maintenance provides additional therapeutic effect in patients with AH, DM, congestive heart failure, IHD (including myocardial infarction), as well as in patients with high risk of stroke or severe ventricular arrhythmia development.
Key words: arterial hypertension, potassium, magnesium, potassium deficiency, magnesium deficiency, electrolyte balance, potassium and magnesium asparaginate, Panangin.
Materials and methods. Data from 55 literature sources published in Russia and abroad in the period of 1972–2018 years are reviewed.
Results. Potassium has an important role in cells bioelectrical activity organization, cell action potentials formation and neuromuscular excitability and conductibility sustentation. Hypokalemia symptoms can be quite various. Frequent ones include neuromuscular conductibility disorders, various changes in cardiovascular system (myocardial contractile function decrease, blood pressure (BP) decrease, cardiac cavities dilatation). Potassium intake increase is followed by lower incidence of cardiovascular and cerebrovascular events, new cases of diabetes mellitus (DM) type 2, left ventricular hypertrophy, cardiac insufficiency, and arrhythmias. Magnesium is a universal regulator of biochemical and physiological processes in the body, a cofactor of more than 300 enzymes participating in biochemical reactions, and a natural physiologic potassium antagonist. It reduces potassium release from sarcoplasmic reticulum and protects cells from potassium overload in conditions of ischemia. Therefore magnesium reduces systemic and pulmonary vascular resistance that results in systemic BP reduction and moderate cardiac index increase. Also reliable evidence indicating moderate but clinically significant antihypertensive effect of magnesium medications was received. Magnesium deficiency is associated with increase of total cholesterol level, low-density lipoprotein, and triglycerides. Serum magnesium level is inversely proportional to the degree of cardiovascular disorders development risk, particularly of cardiac rhythm disorders and IHD complications. European Food Safety Authority (EFSA) confirmed that patients’ health status improved after a period of magnesium adequate intake. Even severe hypokalemia and hypomagnesemia often remain non-diagnosed in clinical practice. Medical practitioner of any kind should remember of potassium and magnesium deficiency clinical manifestations in order to manage it or prevent its development in patients with risk factors by adequate treatment assignment. Described potassium and magnesium interrelations as well as relatively high frequency and severity of combined deficit of these macronutrients justify advisability of the use of combined medications containing К+ and Mg2+in treatment of many disorders. An additional effect is observed when these electrolytes levels are corrected together.
Conclusion. Control of electrolyte balance, first of all, of potassium and magnesium balance, should be an intrinsic part of present day clinical practice. In patients with high risk of hypokalemia and hypomagnesemia development either its correction in case of detection or prevention of potassium and magnesium deficiency development should be performed. Potassium and magnesium balance maintenance provides additional therapeutic effect in patients with AH, DM, congestive heart failure, IHD (including myocardial infarction), as well as in patients with high risk of stroke or severe ventricular arrhythmia development.
Key words: arterial hypertension, potassium, magnesium, potassium deficiency, magnesium deficiency, electrolyte balance, potassium and magnesium asparaginate, Panangin.
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Список литературы
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43. Zola-Sleczek E, Mochalski W. Potassium magnesium aspartate (K-Mg-aspartate) in the treatment of digitalis glycoside poisoning. Folia Med Cracov 1979; 21 (2): 323–31.
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45. Биологическая химия с упражнениями и задачами. Под ред. С.Е.Северина. 3-е изд. М.: ГЭОТАР-Медиа, 2016.
[Biologicheskaia khimiia s uprazhneniiami i zadachami. Pod red. S.E.Severina. 3-е izd. Moscow: GEOTAR-Media, 2016 (in Russian).]
46. Xu Fengmei Jia Jizhen Yang Suhong. Effect of Panangin on left ventricular function in patients with coronary heart disease. J Kaifeng Med College 2000; 19 (3).
47. Zhi YF et al. Clinical investigation of the protective effects of potassium magnesium aspartate against arrhythmia and its possible anti-oxidative mechanism. Chin Crit Care Med 2007; 19 (11): 662–6.
48. Zhang Xing-Ping. Clinical observation of potassium magnesium aspartate in the treatment of angina pectoris of coronary heart disease. Chongqing Med J 2003; 32.
49. Wang Huiqing, Wei Qida. Panangin's Effect on Unstable Angina Pectoris. J Tianjin Med University 1999; 5 (3).
50. Tian Guoping, Yan Xibin. Therapeutic effect of potassium magnesium aspartate on heart failure. J Hengyang Med College 2000; 28 (4).
51. Ляшенко Е.А. Роль калия и магния в профилактике инсульта. РМЖ. 2012; 19: 60–5.
[Liashenko E.A. Rol' kaliia i magniia v profilaktike insul'ta. RMZh. 2012; 19: 60–5 (in Russian).]
52. Агеев Ф.Т., Смирнова М.Д., Галанинский П.В. и др. Применение препарата Панангин в амбулаторной практике у больных артериальной гипертонией в период летней жары. Врач. 2012; 5: 64–9.
[Ageev F.T., Smirnova M.D., Galaninskii P.V. i dr. Primenenie preparata Panangin v ambulatornoi praktike u bol'nykh arterial'noi gipertoniei v period letnei zhary. Vrach. 2012; 5: 64–9 (in Russian).]
53. Hak AE, Pols HA, Visser TJ et al. Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: The Rotterdam Study. Ann Intern Med 2000; 132 (4): 270–8.
54. Cappuccio FP, Buchanan LA, Ji C et al. Systematic review and meta-analysis of randomized controlled trials on the effects of potassium supplements on serum potassium and creatinine. BMJ Open 2016; 6: e011716. DOI: 10.1136
55. Weir MR, Rolfe M. Potassium homeostasis and renin-angiotensin-aldosterone system inhibitors. Clin J Am Soc Nephrol 2010; 5 (3): 531–48.
2. Weglicki WB, Mak IT, Chmielinska JJ et al. The role of magnesium deficiency in cardiovascular and intestinal inflammation. Magnes Res 2010.
3. Fox CH, Mahoney MC, Ramsoomair D, Carter CA. Magnesium deficiency in African-Americans: does it contribute to increased cardiovascular risk factors? J Natl Med Assoc 2003; 95 (4): 257–62.
4. Lücker PW, Witzmann HK. Influence of magnesium and potassium deficiency on renal elimination and cardiovascular function demonstrated by impedance cardiography. Magnesium 1984; 3 (4–6): 265–73.
5. Altura BM, Shah NC, Jiang XC et al. Short-term magnesium deficiency results in decreased levels of serum sphingomyelin, lipid peroxidation, and apoptosis in cardiovascular tissues. Am J Physiol Heart Circ Physiol 2009; 297 (1): H86–92.
6. Shivakumar K. Pro-fibrogenic effects of magnesium deficiency in the cardiovascular system. Magnes Res 2002; 15 (3–4): 307–15.
7. Abbrecht PH. Cardiovascular effects of chronic potassium deficiency in the dog. Am J Physiol 1972; 223 (3): 555–60.
8. Agadzhanian N.A., Tel' L.Z., Tsirkin V.I., Chesnokova S.A. Fiziologiia cheloveka. Saint Petersburg, 1998 (in Russian).
9. Hoshino K, Ogawa K, Hishitani T et al. Successful uses of magnesium sulfate for torsades de pointes in children with long QT syndrome. Pediatr Int 2006; 48 (2): 112–7.
10. He F, MacGregor G. Potassium intake and blood pressure. Am J Hypertens 1999; 12: 849–51.
11. Shilov A.M., Mel'nik M.V., Osiia A.O. et al. Lechenie serdechno-sosudistykh zabolevanii v praktike vracha pervichnogo zvena zdravookhraneniia: mesto preparatov kaliia i magniia (Panangin). RMZh. 2012; 3: 102–7 (in Russian).
12. Buldakova N.G. Defitsit kaliia i magniia pri serdechno-sosudistykh zabolevaniiakh i metody ego korrektsii. RMZh. 2008; 29: 1956–8 (in Russian).
13. Ukholkina G.B. Rol' magniia v zabolevaniiakh serdechno-sosudistoi sistemy. RMZh. 2011; 7: 476–80 (in Russian).
14. Gu D, He J, Xigui W et al. Effect of potassium supplementation on blood pressure in Chinese: a randomized, placebo controlled trial. J Hypertens 2001; 19: 1325–31.
15. D’Elia L, Barba G, Cappuccio FP, Strazzullo P. Potassium intake,stroke, and cardiovascular disease a meta-analysis of prospective studies. J Am Coll Cardiol 2011; 57: 1210–9.
16. Cohen HW, Madhavan S, Alderman MH. High and low serum potassium associated with cardiovascular events in diuretic–treated patients. J Hypertens 2001; 19 (7): 1315–23.
17. Sica DA, Struthers AD, Cushman WC. Importance of potassium in cardiovascular disease. J Clin Hypertens (Greenwich) 2002; 4 (3): 198–206.
18. Yang Q, Liu T, Kuklina EV et al. Sodium and potassium intake and mortality among US adults: prospective data from the third national health and nutrition examination survey. Arch Intern Med 2011; 171: 1183–91.
19. Cappucio F, McGregor G. Does potassium supplementation lower blood pressure? A meta-analysis of published trials. J Hypertens 1991; 9: 456–73.
20. Canadian Hypertension Education Program Guidelines for pressure Measurement, Diagnosis, Assessment of Risk, prevention and Treatment of Hypertension. Canadian J Cardiol 2016; 32: 569–88.
21. Houston MC. The importance of potassium in managing hypertension. Curr Hypertens Rep 2011; 13: 309–17.
22. Gromova O.A., Torshin I.Iu., Iudina N.V. et al. Defitsit magniia i narusheniia reguliatsii tonusa sosudov. Kardiologiia. 2014; 7: 66–72 (in Russian).
23. Kircelli F, Peter ME, Ok ES et al. Magnesium reduces calcification in bovine vascular smooth muscle cells in a dose-dependent manner. Nephrol Dial Transplant 2012; 27 (2): 514–21.
24. Jee SH, Miller ER, Guallar E et al. The effect of magnesium supplementation on blood pressure: a meta-analysis of randomized clinical trials. Am J Hypertens 2002; 15: 691–6.
25. Povoroznyuk VV, Snezhitskiy VA, Yankouskaya LV et al. Extraskeletal effects of vitamin D: role in the pathogenesis of cardiovascular diseases. J Grodno State Med University 2015; 2 (50): 6–15.
26. Gröber U, Schmidt J, Kisters K. Magnesium in Prevention and Therapy. Nutrients 2015; 7 (9): 8199–226.
27. Corretti MC, Anderson TJ, Benjamin EJ et al. International Brachial Artery Reactivity Task Force. Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilatation of the brachial artery. J Am Coll Cardiol 2002; 39: 257–65.
28. Shechter M. Magnesium and cardiovascular system. Magnes Res 2010; 23: 60–72.
29. Del Gobbo LC, Imamura F, Wu JH et al. Circulating and dietary magnesium and risk of cardiovascular disease: a systematic review and meta-analysis of prospective studies. Am J Clin Nutr 2013; 98: 160–73.
30. Gromova O.A., Torshin I.Iu., Iudina N.V. i dr. Defitsit magniia i narusheniia reguliatsii tonusa sosudov. Kardiologiia. 2014; 7: 66–72 (in Russian).
31. Quantative Factors Regarding Magnesium Status in the Modern-Day World. Magnesium 1982; 1: 3–15.
32. Gromova O.A., Nikonov A.A. Rol' i znachenie magniia v patogeneze zabolevanii nervnoi sistemy. Zhurn. nevrologii i psikhiatrii im. S.S.Korsakova. 2002; 2: 45–9 (in Russian).
33. Ma B, Lawson AB, Liese AD et al. Dairy, magnesium, and calcium intake in relation to insulin sensitivity: approaches to modeling a dose-dependent association. Am J Epidemiol 2006; 164 (5): 449–58.
34. Xuexian Fang, Kai Wang, Dan Han et al. Dietary magnesium intake and the risk of cardiovascular disease, type 2 diabetes, and all-cause mortality: a dose-response meta-analysis of prospective cohort studies. BMC Medicine 2016; 14.1: 210.
35. Whang R, Ryder KW. Frequency of hypomagnesemia and hypermagnesemia: Requested vs routine. JAMA 1990; 263: 3063–4.
36. Ascherio A, Rimm E, Hernan M. Intake of potassium, magnesium, calcium and fiber and risk of stroke among US men. Circulation 1998; 98: 1198–204.
37. Kostiuchenko L.N. Narusheniia kalii-magnievogo gomeostaza i ego korrektsiia v khode nutritsionnoi podderzhki bol'nykh gastroenterologicheskogo profilia. Trudnyi patsient. 2010; 10: 14–8 (in Russian).
38. Gröber U. Magnesium. In Micronutrients: Metabolic Tuning-Prevention-Therapy, 1st ed. Stuttgart, Germany: MedPharm Scientific Publishers, 2009; p. 159–66.
39. Elin RJ. Assessment of magnesium status for diagnosis and therapy. Magnes Res 2010; 23: 194–8.
40. Cohn JN, Kowey PR, Whelton PK, Prisant LM. New guidelines for potassium replacement in clinical practice: a contemporary review by the National Council on Potassium in Clinical Practice. Arch Intern Med 2000; 160 (16): 2429–36.
41. Nizovtseva O.A. Kompleksnaia terapiia serdechno-sosudistykh zabolevanii i defitsit magniia. Trudnyi patsient. 2014; 7: 37–41 (in Russian).
42. Hatsional'nye rekomendatsii po opredeleniiu riska i profilaktike vnezapnoi serdechnoi smerti. Pod red. E.V.Shliakhto, Iu.N.Belenkovoi. 2-e izd. Moscow, 2018 (in Russian).
43. Zola-Sleczek E, Mochalski W. Potassium magnesium aspartate (K-Mg-aspartate) in the treatment of digitalis glycoside poisoning. Folia Med Cracov 1979; 21 (2): 323–31.
44. Whang R, Whang D, Ryan M. Arch Intern Med 1992; 152: 40–5.
45. Biologicheskaia khimiia s uprazhneniiami i zadachami. Pod red. S.E.Severina. 3-е izd. Moscow: GEOTAR-Media, 2016 (in Russian).
46. Xu Fengmei Jia Jizhen Yang Suhong. Effect of Panangin on left ventricular function in patients with coronary heart disease. J Kaifeng Med College 2000; 19 (3).
47. Zhi YF et al. Clinical investigation of the protective effects of potassium magnesium aspartate against arrhythmia and its possible anti-oxidative mechanism. Chin Crit Care Med 2007; 19 (11): 662–6.
48. Zhang Xing-Ping. Clinical observation of potassium magnesium aspartate in the treatment of angina pectoris of coronary heart disease. Chongqing Med J 2003; 32.
49. Wang Huiqing, Wei Qida. Panangin's Effect on Unstable Angina Pectoris. J Tianjin Med University 1999; 5 (3).
50. Tian Guoping, Yan Xibin. Therapeutic effect of potassium magnesium aspartate on heart failure. J Hengyang Med College 2000; 28 (4).
51. Liashenko E.A. Rol' kaliia i magniia v profilaktike insul'ta. RMZh. 2012; 19: 60–5 (in Russian).
52. Ageev F.T., Smirnova M.D., Galaninskii P.V. i dr. Primenenie preparata Panangin v ambulatornoi praktike u bol'nykh arterial'noi gipertoniei v period letnei zhary. Vrach. 2012; 5: 64–9 (in Russian).
53. Hak AE, Pols HA, Visser TJ et al. Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: The Rotterdam Study. Ann Intern Med 2000; 132 (4): 270–8.
54. Cappuccio FP, Buchanan LA, Ji C et al. Systematic review and meta-analysis of randomized controlled trials on the effects of potassium supplements on serum potassium and creatinine. BMJ Open 2016; 6: e011716. DOI: 10.1136
55. Weir MR, Rolfe M. Potassium homeostasis and renin-angiotensin-aldosterone system inhibitors. Clin J Am Soc Nephrol 2010; 5 (3): 531–48.
2. Weglicki WB, Mak IT, Chmielinska JJ et al. The role of magnesium deficiency in cardiovascular and intestinal inflammation. Magnes Res 2010.
3. Fox CH, Mahoney MC, Ramsoomair D, Carter CA. Magnesium deficiency in African-Americans: does it contribute to increased cardiovascular risk factors? J Natl Med Assoc 2003; 95 (4): 257–62.
4. Lücker PW, Witzmann HK. Influence of magnesium and potassium deficiency on renal elimination and cardiovascular function demonstrated by impedance cardiography. Magnesium 1984; 3 (4–6): 265–73.
5. Altura BM, Shah NC, Jiang XC et al. Short-term magnesium deficiency results in decreased levels of serum sphingomyelin, lipid peroxidation, and apoptosis in cardiovascular tissues. Am J Physiol Heart Circ Physiol 2009; 297 (1): H86–92.
6. Shivakumar K. Pro-fibrogenic effects of magnesium deficiency in the cardiovascular system. Magnes Res 2002; 15 (3–4): 307–15.
7. Abbrecht PH. Cardiovascular effects of chronic potassium deficiency in the dog. Am J Physiol 1972; 223 (3): 555–60.
8. Агаджанян Н.А., Тель Л.З., Циркин В.И., Чеснокова С.А. Физиология человека. СПб., 1998.
[Agadzhanian N.A., Tel' L.Z., Tsirkin V.I., Chesnokova S.A. Fiziologiia cheloveka. Saint Petersburg, 1998 (in Russian).]
9. Hoshino K, Ogawa K, Hishitani T et al. Successful uses of magnesium sulfate for torsades de pointes in children with long QT syndrome. Pediatr Int 2006; 48 (2): 112–7.
10. He F, MacGregor G. Potassium intake and blood pressure. Am J Hypertens 1999; 12: 849–51.
11. Шилов А.М., Мельник М.В., Осия А.О. и др. Лечение сердечно-сосудистых заболеваний в практике врача первичного звена здравоохранения: место препаратов калия и магния (Панангин). РМЖ. 2012; 3: 102–7.
[Shilov A.M., Mel'nik M.V., Osiia A.O. et al. Lechenie serdechno-sosudistykh zabolevanii v praktike vracha pervichnogo zvena zdravookhraneniia: mesto preparatov kaliia i magniia (Panangin). RMZh. 2012; 3: 102–7 (in Russian).]
12. Булдакова Н.Г. Дефицит калия и магния при сердечно-сосудистых заболеваниях и методы его коррекции. РМЖ. 2008; 29: 1956–8.
[Buldakova N.G. Defitsit kaliia i magniia pri serdechno-sosudistykh zabolevaniiakh i metody ego korrektsii. RMZh. 2008; 29: 1956–8 (in Russian).]
13. Ухолкина Г.Б. Роль магния в заболеваниях сердечно-сосудистой системы. РМЖ. 2011; 7: 476–80.
[Ukholkina G.B. Rol' magniia v zabolevaniiakh serdechno-sosudistoi sistemy. RMZh. 2011; 7: 476–80 (in Russian).]
14. Gu D, He J, Xigui W et al. Effect of potassium supplementation on blood pressure in Chinese: a randomized, placebo controlled trial. J Hypertens 2001; 19: 1325–31.
15. D’Elia L, Barba G, Cappuccio FP, Strazzullo P. Potassium intake,stroke, and cardiovascular disease a meta-analysis of prospective studies. J Am Coll Cardiol 2011; 57: 1210–9.
16. Cohen HW, Madhavan S, Alderman MH. High and low serum potassium associated with cardiovascular events in diuretic–treated patients. J Hypertens 2001; 19 (7): 1315–23.
17. Sica DA, Struthers AD, Cushman WC. Importance of potassium in cardiovascular disease. J Clin Hypertens (Greenwich) 2002; 4 (3): 198–206.
18. Yang Q, Liu T, Kuklina EV et al. Sodium and potassium intake and mortality among US adults: prospective data from the third national health and nutrition examination survey. Arch Intern Med 2011; 171: 1183–91.
19. Cappucio F, McGregor G. Does potassium supplementation lower blood pressure? A meta-analysis of published trials. J Hypertens 1991; 9: 456–73.
20. Canadian Hypertension Education Program Guidelines for pressure Measurement, Diagnosis, Assessment of Risk, prevention and Treatment of Hypertension. Canadian J Cardiol 2016; 32: 569–88.
21. Houston MC. The importance of potassium in managing hypertension. Curr Hypertens Rep 2011; 13: 309–17.
22. Громова О.А., Торшин И.Ю., Юдина Н.В. и др. Дефицит магния и нарушения регуляции тонуса сосудов. Кардиология. 2014; 7: 66–72.
[Gromova O.A., Torshin I.Iu., Iudina N.V. et al. Defitsit magniia i narusheniia reguliatsii tonusa sosudov. Kardiologiia. 2014; 7: 66–72 (in Russian).]
23. Kircelli F, Peter ME, Ok ES et al. Magnesium reduces calcification in bovine vascular smooth muscle cells in a dose-dependent manner. Nephrol Dial Transplant 2012; 27 (2): 514–21.
24. Jee SH, Miller ER, Guallar E et al. The effect of magnesium supplementation on blood pressure: a meta-analysis of randomized clinical trials. Am J Hypertens 2002; 15: 691–6.
25. Povoroznyuk VV, Snezhitskiy VA, Yankouskaya LV et al. Extraskeletal effects of vitamin D: role in the pathogenesis of cardiovascular diseases. J Grodno State Med University 2015; 2 (50): 6–15.
26. Gröber U, Schmidt J, Kisters K. Magnesium in Prevention and Therapy. Nutrients 2015; 7 (9): 8199–226.
27. Corretti MC, Anderson TJ, Benjamin EJ et al. International Brachial Artery Reactivity Task Force. Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilatation of the brachial artery. J Am Coll Cardiol 2002; 39: 257–65.
28. Shechter M. Magnesium and cardiovascular system. Magnes Res 2010; 23: 60–72.
29. Del Gobbo LC, Imamura F, Wu JH et al. Circulating and dietary magnesium and risk of cardiovascular disease: a systematic review and meta-analysis of prospective studies. Am J Clin Nutr 2013; 98: 160–73.
30. Скальный А.В. Химические элементы в физиологии и экологии человека. М., 2004.
[Gromova O.A., Torshin I.Iu., Iudina N.V. i dr. Defitsit magniia i narusheniia reguliatsii tonusa sosudov. Kardiologiia. 2014; 7: 66–72 (in Russian).]
31. Quantative Factors Regarding Magnesium Status in the Modern-Day World. Magnesium 1982; 1: 3–15.
32. Громова O.A., Никонов A.A. Роль и значение магния в патогенезе заболеваний нервной системы. Журн. неврологии и психиатрии им. С.С.Корсакова. 2002; 2: 45–9.
[Gromova O.A., Nikonov A.A. Rol' i znachenie magniia v patogeneze zabolevanii nervnoi sistemy. Zhurn. nevrologii i psikhiatrii im. S.S.Korsakova. 2002; 2: 45–9 (in Russian).]
33. Ma B, Lawson AB, Liese AD et al. Dairy, magnesium, and calcium intake in relation to insulin sensitivity: approaches to modeling a dose-dependent association. Am J Epidemiol 2006; 164 (5): 449–58.
34. Xuexian Fang, Kai Wang, Dan Han et al. Dietary magnesium intake and the risk of cardiovascular disease, type 2 diabetes, and all-cause mortality: a dose-response meta-analysis of prospective cohort studies. BMC Medicine 2016; 14.1: 210.
35. Whang R, Ryder KW. Frequency of hypomagnesemia and hypermagnesemia: Requested vs routine. JAMA 1990; 263: 3063–4.
36. Ascherio A, Rimm E, Hernan M. Intake of potassium, magnesium, calcium and fiber and risk of stroke among US men. Circulation 1998; 98: 1198–204.
37. Костюченко Л.Н. Нарушения калий-магниевого гомеостаза и его коррекция в ходе нутриционной поддержки больных гастроэнтерологического профиля. Трудный пациент. 2010; 10: 14–8.
[Kostiuchenko L.N. Narusheniia kalii-magnievogo gomeostaza i ego korrektsiia v khode nutritsionnoi podderzhki bol'nykh gastroenterologicheskogo profilia. Trudnyi patsient. 2010; 10: 14–8 (in Russian).]
38. Gröber U. Magnesium. In Micronutrients: Metabolic Tuning-Prevention-Therapy, 1st ed. Stuttgart, Germany: MedPharm Scientific Publishers, 2009; p. 159–66.
39. Elin RJ. Assessment of magnesium status for diagnosis and therapy. Magnes Res 2010; 23: 194–8.
40. Cohn JN, Kowey PR, Whelton PK, Prisant LM. New guidelines for potassium replacement in clinical practice: a contemporary review by the National Council on Potassium in Clinical Practice. Arch Intern Med 2000; 160 (16): 2429–36.
41. Низовцева О.А. Комплексная терапия сердечно-сосудистых заболеваний и дефицит магния. Трудный пациент. 2014; 7: 37–41.
[Nizovtseva O.A. Kompleksnaia terapiia serdechno-sosudistykh zabolevanii i defitsit magniia. Trudnyi patsient. 2014; 7: 37–41 (in Russian).]
42. Hациональные рекомендации по определению риска и профилактике внезапной сердечной смерти. Под ред. Е.В.Шляхто, Ю.Н.Беленковой. 2-е изд. М., 2018.
[Hatsional'nye rekomendatsii po opredeleniiu riska i profilaktike vnezapnoi serdechnoi smerti. Pod red. E.V.Shliakhto, Iu.N.Belenkovoi. 2-e izd. Moscow, 2018 (in Russian).]
43. Zola-Sleczek E, Mochalski W. Potassium magnesium aspartate (K-Mg-aspartate) in the treatment of digitalis glycoside poisoning. Folia Med Cracov 1979; 21 (2): 323–31.
44. Whang R, Whang D, Ryan M. Arch Intern Med 1992; 152: 40–5.
45. Биологическая химия с упражнениями и задачами. Под ред. С.Е.Северина. 3-е изд. М.: ГЭОТАР-Медиа, 2016.
[Biologicheskaia khimiia s uprazhneniiami i zadachami. Pod red. S.E.Severina. 3-е izd. Moscow: GEOTAR-Media, 2016 (in Russian).]
46. Xu Fengmei Jia Jizhen Yang Suhong. Effect of Panangin on left ventricular function in patients with coronary heart disease. J Kaifeng Med College 2000; 19 (3).
47. Zhi YF et al. Clinical investigation of the protective effects of potassium magnesium aspartate against arrhythmia and its possible anti-oxidative mechanism. Chin Crit Care Med 2007; 19 (11): 662–6.
48. Zhang Xing-Ping. Clinical observation of potassium magnesium aspartate in the treatment of angina pectoris of coronary heart disease. Chongqing Med J 2003; 32.
49. Wang Huiqing, Wei Qida. Panangin's Effect on Unstable Angina Pectoris. J Tianjin Med University 1999; 5 (3).
50. Tian Guoping, Yan Xibin. Therapeutic effect of potassium magnesium aspartate on heart failure. J Hengyang Med College 2000; 28 (4).
51. Ляшенко Е.А. Роль калия и магния в профилактике инсульта. РМЖ. 2012; 19: 60–5.
[Liashenko E.A. Rol' kaliia i magniia v profilaktike insul'ta. RMZh. 2012; 19: 60–5 (in Russian).]
52. Агеев Ф.Т., Смирнова М.Д., Галанинский П.В. и др. Применение препарата Панангин в амбулаторной практике у больных артериальной гипертонией в период летней жары. Врач. 2012; 5: 64–9.
[Ageev F.T., Smirnova M.D., Galaninskii P.V. i dr. Primenenie preparata Panangin v ambulatornoi praktike u bol'nykh arterial'noi gipertoniei v period letnei zhary. Vrach. 2012; 5: 64–9 (in Russian).]
53. Hak AE, Pols HA, Visser TJ et al. Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: The Rotterdam Study. Ann Intern Med 2000; 132 (4): 270–8.
54. Cappuccio FP, Buchanan LA, Ji C et al. Systematic review and meta-analysis of randomized controlled trials on the effects of potassium supplements on serum potassium and creatinine. BMJ Open 2016; 6: e011716. DOI: 10.1136
55. Weir MR, Rolfe M. Potassium homeostasis and renin-angiotensin-aldosterone system inhibitors. Clin J Am Soc Nephrol 2010; 5 (3): 531–48.
________________________________________________
2. Weglicki WB, Mak IT, Chmielinska JJ et al. The role of magnesium deficiency in cardiovascular and intestinal inflammation. Magnes Res 2010.
3. Fox CH, Mahoney MC, Ramsoomair D, Carter CA. Magnesium deficiency in African-Americans: does it contribute to increased cardiovascular risk factors? J Natl Med Assoc 2003; 95 (4): 257–62.
4. Lücker PW, Witzmann HK. Influence of magnesium and potassium deficiency on renal elimination and cardiovascular function demonstrated by impedance cardiography. Magnesium 1984; 3 (4–6): 265–73.
5. Altura BM, Shah NC, Jiang XC et al. Short-term magnesium deficiency results in decreased levels of serum sphingomyelin, lipid peroxidation, and apoptosis in cardiovascular tissues. Am J Physiol Heart Circ Physiol 2009; 297 (1): H86–92.
6. Shivakumar K. Pro-fibrogenic effects of magnesium deficiency in the cardiovascular system. Magnes Res 2002; 15 (3–4): 307–15.
7. Abbrecht PH. Cardiovascular effects of chronic potassium deficiency in the dog. Am J Physiol 1972; 223 (3): 555–60.
8. Agadzhanian N.A., Tel' L.Z., Tsirkin V.I., Chesnokova S.A. Fiziologiia cheloveka. Saint Petersburg, 1998 (in Russian).
9. Hoshino K, Ogawa K, Hishitani T et al. Successful uses of magnesium sulfate for torsades de pointes in children with long QT syndrome. Pediatr Int 2006; 48 (2): 112–7.
10. He F, MacGregor G. Potassium intake and blood pressure. Am J Hypertens 1999; 12: 849–51.
11. Shilov A.M., Mel'nik M.V., Osiia A.O. et al. Lechenie serdechno-sosudistykh zabolevanii v praktike vracha pervichnogo zvena zdravookhraneniia: mesto preparatov kaliia i magniia (Panangin). RMZh. 2012; 3: 102–7 (in Russian).
12. Buldakova N.G. Defitsit kaliia i magniia pri serdechno-sosudistykh zabolevaniiakh i metody ego korrektsii. RMZh. 2008; 29: 1956–8 (in Russian).
13. Ukholkina G.B. Rol' magniia v zabolevaniiakh serdechno-sosudistoi sistemy. RMZh. 2011; 7: 476–80 (in Russian).
14. Gu D, He J, Xigui W et al. Effect of potassium supplementation on blood pressure in Chinese: a randomized, placebo controlled trial. J Hypertens 2001; 19: 1325–31.
15. D’Elia L, Barba G, Cappuccio FP, Strazzullo P. Potassium intake,stroke, and cardiovascular disease a meta-analysis of prospective studies. J Am Coll Cardiol 2011; 57: 1210–9.
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Авторы
Г.А.Барышникова*, С.А.Чорбинская, И.И.Степанова, О.Е.Блохина
ФГБУ ДПО «Центральная государственная медицинская академия» Управления делами Президента РФ. 121359, Россия, Москва, ул. Маршала Тимошенко, д. 19, стр. 1а
*bargalan@mail.ru
ФГБУ ДПО «Центральная государственная медицинская академия» Управления делами Президента РФ. 121359, Россия, Москва, ул. Маршала Тимошенко, д. 19, стр. 1а
*bargalan@mail.ru
________________________________________________
Galina A. Baryshnikova*, Svetlana A. Chorbinskaya, Irina I. Stepanova, Olga E. Blokhina
Central State Medical Academy of the President of the Russian Federation. 19, Timoshenko st., Moscow, 121359, Russian Federation
*bargalan@mail.ru
Central State Medical Academy of the President of the Russian Federation. 19, Timoshenko st., Moscow, 121359, Russian Federation
*bargalan@mail.ru
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