The Association of Desalinated Drinking Water and All-cause Mortality in Hospitalized Patients with Acute Myocardial Infarction from the Acute Coronary Syndrome Israeli Survey 2002-2013

Background/Objectives: Extensive sea water desalination in Israel may decrease magnesium (Mg) in drinking water (DW) causing hypomagnesemia and adverse health effects. We hypothesized that low levels of Mg in DW is associated with increased acute myocardial infarction (AMI).The aim of the present study was to assess 1-year all-cause mortality in AMI patients in regions with compared to without desalinated drinking water (DSW) between the years 2002-2013.

Methods: We evaluated time-dependent changes in the clinical characteristics, management strategies, and 1 year all-cause mortality of AMI patients enrolled in the biannual Acute Coronary Syndrome Israeli Survey (ACSIS) between 2002-2013. Patients (n=4,678) were divided into 2 groups: those who live in DSW regions not (n=1,600, 34.2%) and those who did (n=3,078, 65.8%). Data were compared between an early period (2002, 2004 and 2006 surveys - before desalination was started) and a later period (2008, 2010 and 2013 surveys - during desalination).

Results: Both groups in the two periods were comparable regarding gender, age, prior congestive heart failure, diabetes, percutaneous coronary interventions, coronary artery bypass grafting operations, smoking, creatinine ≥3 mg/dL and discharge medications. Compared with DSW regions, patients in the non-DSW regions displayed a significantly lower rate of 30-day and 1-yaer all-cause mortality.

There was a significant reduction in the risk of 1-year all-cause mortality only among patients in the non-DSW regions in the late period (HR=0.49 CI 95% 0.34-0.71, p<0.0001) (Figure 1-B), whereas patients in the non-DSW regions who were enrolled in earlier survey periods did not display a significant risk reduction (HR=0.79 CI 95% 0.61-1.01, p=0.06) (Figure 1-A).

Conclusion: Reduction of Mg concentration in DSW is associated with higher 1-year all cause mortality in AMI patients.