Use of calcium supplements and the risk of coronary heart disease in 52–62-year-old women: The Kuopio Osteoporosis Risk Factor and Prevention Study
Introduction
So far evidence has suggested that vascular disease might be protected by high calcium intakes. In observational studies, calcium has been associated with lower blood pressure [1], [2] and weight loss [3] which might be expected to lower the risk for coronary heart disease and stroke. In the prospective studies, The Nurses’ Health Study [4] and the Health Professionals’ Follow-up Study [5], the risks for developing hypertension were reduced to about 20–25% with calcium supplements. On the other hand, in 2006 Cochrane Database of Systematic Review published a 13-trial meta-analysis which could not find robust evidence of high blood pressure reducing the effects of calcium supplements [6].
Recently, a research group from New Zealand reported a harmful effect of calcium supplementation on vascular event rates in healthy postmenopausal women [7]. Despite previous interventional studies [8], [9], [10] and epidemiological studies suggesting that calcium intake may decrease vascular events, this randomised controlled trial has for the first time questioned the benefits of calcium supplementation on bone due to its possible harmful cardiovascular effects.
Today the use of calcium or calcium + D supplements is very common especially among postmenopausal women who are trying to prevent osteoporosis. Evidence of the trials concerning other effects of calcium is still lacking. The aim of this prospective cohort study is to determine the effect of calcium or calcium + D supplements on the incidence of CHD in women before old age in a population-based design.
Section snippets
Study population
This study is a part of the Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) population-based prospective cohort study. The target population primarily consisted of the 14,220 women resident in Kuopio Province and born in 1932–1941 (aged 47–56 years in 1989). The names, addresses and social security numbers of these women were obtained from the National Population Register of Finland. A postal inquiry was sent to 14,121 women, whose postal address could be retrieved in May 1989. In all,
Results
Use of calcium supplements was reported by 2723 (25.8%) of the 10,555 CHD free women at baseline in 1994. The average time of follow-up was 6.55 years (range 0.01–6.75). There were some marked differences between calcium supplement users and non-users (Table 1). Calcium supplements users had a lower BMI (mean 26.3 kg/m2) than non-users, and they also were more often non-smokers or former smokers than calcium supplement non-users. Calcium supplements users had given fewer childbirths and less
Discussion
In the present prospective cohort study, use of calcium or calcium + D supplements tended to increase the risk of CHD during the 6.75 years follow-up among 52–62-year-old women free of CHD at the beginning of the follow-up. The same result was seen in the subgroup of postmenopausal women. Our findings confirm the results of the trial by Bolland et al. [7].
The Finnish Social Insurance Institution carries out the reimbursements for medicines used for severe and chronic illnesses. The National
Conflict of interest
None declared.
Acknowledgments
The authors would like to thank Kuopio University Hospital (EVO-grant), Finnish Menopause Society (grant), National Statistics Finland, Finnish Academy and The Finnish Social Insurance Institution for the support of this work.
References (43)
- et al.
The influence of dietary and nondietary calcium supplementation on blood pressure: an updated metaanalysis of randomized controlled trials
Am J Hypertens
(1999) Ischaemic-heart-disease mortality and dietary intake of calcium
Lancet
(1973)- et al.
The validity of death certificates: routine validation of death certification and its effects on mortality statistics
Forensic Sci Int
(2001) - et al.
Cardiovascular and cancer morbidity and mortality and sudden cardiac death in postmenopausal women on oestrogen replacement therapy (ERT)
Lancet
(1998) - et al.
Does vitamin D3 have negative effects on serum levels of lipids? A follow-up study with a sequential combination of estradiol valerate and cyproterone acetate and/or vitamin D3
Maturitas
(1995) - et al.
Protective effects of dietary calcium and magnesium on platelet function and atherosclerosis in rabbits fed saturated fat
Atherosclerosis
(1983) - et al.
Effects of dietary calcium on blood and tissue lipids, tissue phospholipids, calcium and magnesium levels in rabbits fed diets containing beef tallow
J Nutr
(1979) - et al.
Dietary calcium and vitamin D: risk factors in the development of atherosclerosis in young goats
J Nutr
(1985) - et al.
Long-term studies on the hypolipemic effect of dietary calcium in mature male rats fed cocoa butter
J Nutr
(1967) - et al.
Relationship of metal metabolism to vascular disease mortality rates in texas
Am J Clin Nutr
(1978)
A survey of 246 suggested coronary risk factors
Atherosclerosis
Effects of sevelamer and calcium on coronary artery calcification in patients new to hemodialysis
Kidney Int
Treat to Goal Working Group. Sevelamer attenuates the progression of coronary and aortic calcification in hemodialysis patients
Kidney Int
Mortality effect of coronary calcification and phosphate binder choice in incident hemodialysis patients
Kidney Int
Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis
Lancet
Effects of dietary calcium supplementation on blood pressure. A meta-analysis of randomized controlled trials
JAMA
Effects of calcium supplementation on body weight and blood pressure in normal older women: a randomized controlled trial
J Clin Endocrinol Metab
A prospective study of nutritional factors and hypertension among US women
Circulation
A prospective study of nutritional factors and hypertension among US men
Circulation
Calcium supplementation for the management of primary hypertension in adults
Cochrane Database Syst Rev
Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial
BMJ
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