Stephen L. Kopecky, MD; Douglas C. Bauer, MD; Martha Gulati, MD; Jeri W. Nieves, PhD; Andrea J. Singer, MD; Peter P. Toth, MD, PhD; James A. Underberg, MD; Taylor C. Wallace, PhD; Connie M. Weaver, PhD
Disclosures: Dr. Kopecky reports personal fees from Applied Clinical Intelligence, Prime Therapeutics, and Pfizer; nonfinancial support from True Health and Amgen; and other from American Society for Men's Health, American Society for Preventive Cardiology, and Mayo Clinic Support Services, Texas, outside the submitted work. Dr. Toth reports personal fees from Amarin, Amgen, AstraZeneca, Gemphire, Kowa, Merck, and Regeneron Pharmaceuticals/Sanofi outside the submitted work. Dr. Underberg reports personal fees from Amgen, Aegerion, Merck, Regeneron Pharmaceuticals/Sanofi, Kastle Therapeutics, True Health Diagnostics, Akcea Therapeutics, Alexion Pharmaceuticals, Pfizer, Recombine, and Invitae outside the submitted work. Dr. Wallace reports grants from the National Osteoporosis Foundation during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1743.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Requests for Single Reprints: Taylor C. Wallace, PhD, George Mason University, 10340 Democracy Lane, Suite 306, Fairfax, VA 22030; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Kopecky: Mayo Clinic, 1216 Second Street Southwest, Rochester, MN 55902.
Dr. Bauer: University of California, San Francisco, 550 16th Street, Second Floor, San Francisco, CA 94143.
Dr. Gulati: The Heart Institute, University of Arizona College of Medicine–Phoenix, 1111 East McDowell, Suite 200, Phoenix, AZ 85006.
Dr. Nieves: Institute of Human Nutrition, Columbia University Medical Center, 630 West 168th Street, PH 1512, New York, NY 10032.
Dr. Singer: MedStar Georgetown University Hospital, 3800 Reservoir Road Northwest, Washington, DC 20007.
Dr. Toth: CGH Medical Center, 100 E Le Fevre Road, Sterling, IL 61081.
Dr. Underberg: Murray Hill Medical Group, 317 East 34th Street, 7th Floor, New York, NY 10016.
Dr. Wallace: National Osteoporosis Foundation, 251 18th Street South, Suite 630, Arlington, VA 22202.
Dr. Weaver: Department of Nutrition Science, Purdue University, 700 West State Street, West Lafayette, IN 47907.
Author Contributions: Conception and design: D.C. Bauer, J.A. Underberg, T.C. Wallace, C.M. Weaver.
Analysis and interpretation of the data: M. Gulati, A.J. Singer, P.P. Toth, J.A. Underberg, T.C. Wallace.
Drafting of the article: M. Gulati, J.W. Nieves, J.A. Underberg, T.C. Wallace, C.M. Weaver.
Critical revision of the article for important intellectual content: S.L. Kopecky, D.C. Bauer, M. Gulati, J.W. Nieves, A.J. Singer, P.P. Toth, T.C. Wallace.
Final approval of the article: S.L. Kopecky, D.C. Bauer, M. Gulati, J.W. Nieves, A.J. Singer, P.P. Toth, J.A. Underberg, T.C. Wallace, C.M. Weaver.
Provision of study materials or patients: T.C. Wallace.
Statistical expertise: T.C. Wallace.
Obtaining of funding: T.C. Wallace.
Administrative, technical, or logistic support: T.C. Wallace.
Collection and assembly of data: T.C. Wallace.
Kopecky SL, Bauer DC, Gulati M, Nieves JW, Singer AJ, Toth PP, et al. Lack of Evidence Linking Calcium With or Without Vitamin D Supplementation to Cardiovascular Disease in Generally Healthy Adults: A Clinical Guideline From the National Osteoporosis Foundation and the American Society for Preventive Cardiology. Ann Intern Med. 2016;165:867-868. doi: 10.7326/M16-1743
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Published: Ann Intern Med. 2016;165(12):867-868.
Published at www.annals.org on 25 October 2016
Calcium is the dominant mineral present in bone and a shortfall nutrient in the American diet. Supplements have been recommended for persons who do not consume adequate calcium from their diet as a standard strategy for the prevention of osteoporosis and related fractures. Whether calcium with or without vitamin D supplementation is beneficial or detrimental to vascular health is not known.
The National Osteoporosis Foundation and American Society for Preventive Cardiology convened an expert panel to evaluate the effects of dietary and supplemental calcium on cardiovascular disease based on the existing peer-reviewed scientific literature. The panel considered the findings of the accompanying updated evidence report provided by an independent evidence review team at Tufts University.
The National Osteoporosis Foundation and American Society for Preventive Cardiology adopt the position that there is moderate-quality evidence (B level) that calcium with or without vitamin D intake from food or supplements has no relationship (beneficial or harmful) to the risk for cardiovascular and cerebrovascular disease, mortality, or all-cause mortality in generally healthy adults at this time. In light of the evidence available to date, calcium intake from food and supplements that does not exceed the tolerable upper level of intake (defined by the National Academy of Medicine as 2000 to 2500 mg/d) should be considered safe from a cardiovascular standpoint.
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