Kristine E. Ensrud, MD, MPH
Do calcium supplements increase risk for cardiovascular (CV) events?
Included studies evaluated elemental calcium supplements ≥ 500 mg/d, randomized ≥ 100 participants with a mean age > 40 years, and lasted > 1 year. Exclusion criteria were calcium given as a complex nutritional supplement or in the form of a modified diet, combinations of calcium plus vitamin D unless vitamin D was also given in the control group, and trials in which most participants had major systemic disease other than osteoporosis. Outcomes were myocardial infarction (MI), stroke, a composite endpoint (MI, stroke, or sudden death), and all-cause mortality.
MEDLINE, EMBASE/Excerpta Medica, and Cochrane Central Register of Controlled Trials (all to Mar 2010); reference lists; and 2 clinical trial registries were searched for randomized, double-blind, placebo-controlled trials (RCTs). Investigators were contacted for additional data. 15 RCTs (n = 12 843) met the selection criteria, and 11 (n = 11 921, mean age 72 y, 83% women) provided data on CV outcomes. Complete trial-level CV data were available and pooled from 8 RCTs (n = 10 908), and individual patient data for CV events were obtained for 5 of those RCTs (n = 8151).
Individual patient data analyses showed that calcium supplements increased risk for MI but not stroke or all-cause mortality (Table); calcium increased risk for the composite endpoint with borderline significance (Table). Results were consistent in the trial-level analyses.
In adults, calcium supplements increase risk for myocardial infarction but not mortality or stroke.
Individual patient data analyses of calcium supplements vs placebo*
*MI = myocardial infarction; other abbreviations defined in Glossary.
†Information provided by author.
Ensrud KE. Review: Calcium supplements increase risk for myocardial infarction but not mortality or stroke in adults. Ann Intern Med. ;153:JC5–7. doi: 10.7326/0003-4819-153-10-201011160-02007
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Published: Ann Intern Med. 2010;153(10):JC5-7.
Acute Coronary Syndromes, Cardiology, Coronary Heart Disease, Emergency Medicine, Neurology.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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