Microvascular dysfunction and magnesium - impact in COVID times and further on

ABSTRACT

For decades, the macrovascular system was in the focus of diagnostic and therapeutic medicine. The relevance of microvascular pathology was widely underestimated but is revealed in a new break-through cardiological study. Increasing knowledge reveals the microvascular system as the essential target structure of chronic magnesium-depletion, mediating smoldering chronic disease processes. Microvascular dysfunction could be the common basis for the association of chronic magnesium deficiency and polytopic diseases of high-energy dependent organs diabetic retinopathy, renal failure - diabetic and other -, microvascular = non-Alzheimer dementia, diastolic cardiac dysfunction (HFpEF - heart failure with preserved ejection fraction) - analog arterial hypertension - microvascular angina, atrial fibrillation but also diabetic foot and diabetic neuropathy. In early studies the actual COVID-19 pandemic is related to microvascular pathomechanisms. Following earlier results reporting better survival of intensive care patients with highly normal magnesium as well as epidemiological associations we recommended for all patients from the beginning of the COVID 19 epidemic high-dose magnesium supplementation 15 - 25 mmol (and zinc 20 mg, vitamin D 2,000 IE each/day). In the context of COVID-19, we can assume four constellations of possibly positive effects of this magnesium strategy 1. Due to our own limited cohorts the most evident Tolerance of immunization with Biontech/Pfizer COVID-19 vaccine was distinctly better in our cohort of over 412 vaccinations compared with published data. 2. Rare, but a few patients with more intense adverse reactions had low magnesium and/or abnormal microvascular results in pulse wave analysis. 3. COVID patients (also elderly) with documented high serum magnesium - and pre-supplemented - recovered well from the disease. 4. Two post-Corona, long-COVID patients with symptoms of fatigue, reduced mental concentration, and dizziness reacted well after repeated parenteral magnesium infusion. Whether SARS-Cov-2-antibody formation correlates with magnesium or zinc values is topic of running investigations. Systematic prospective investigations are warranted. But due to the circumstances - considering that there are no evidence-based alternatives - for healthy individuals, for persons at risk, for patients at risk of magnesium depletion as well as for COVID-19 vaccination candidates, optimizing of magnesium is justified (Global Mg COVID-19 project) - and in terms of other health concerns, the prevention of chronic microvascular disease entities also justifies supplementation. Personalized magnesium dosage in medical office should be oriented by practical serum Mg/Ca (mmol/mmol) target 0.4 - including calcium. This approach seems to us to be expedient and more successful didactically. (outpatient medicine Mg/Ca in serum;intensive care ionized magnesium).