title: Desalinated seawater supply and all-cause mortality in hospitalized acute myocardial infarction patients from the Acute Coronary Syndrome Israeli Survey 2002-2013.
abstract: 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±0.24mg/dL compared with 2.08±0.27mg/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.
authors.affiliation: Bar Ilan University, Israel; Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Meital
authors.initials: M
authors.lastname: Shlezinger
authors.affiliation: Bar Ilan University, Israel.
authors.forename: Yona
authors.initials: Y
authors.lastname: Amitai
authors.affiliation: Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel.
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
authors.affiliation: Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel. Electronic address: shechtes@netvision.net.il.
authors.forename: Michael
authors.initials: M
authors.lastname: Shechter
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000175:diagnosis / Q000401:mortality*; D000368:Aged; D002423:Cause of Death / Q000639:trends; D015331:Cohort Studies; D060766:Drinking Water / Q000008:administration & dosage / Q000592:standards*; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000639:trends; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008274:Magnesium / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality*; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D012623:Seawater; D011795:Surveys and Questionnaires
chemical_list: D060766:Drinking Water; D008274:Magnesium
keywords: Acute myocardial infarction; Cardiovascular; Desalinated sea water; Drinking water; Magnesium; Major adverse cardiovascular events