A review of calcium supplements and cardiovascular disease risk

Robert P. Heaney, Stephen Kopecky, Kevin C. Maki, John Hathcock, Douglas MacKay, Taylor C. Wallace

Research output: Contribution to journalReview article

49 Citations (Scopus)

Abstract

A group of academic and industry experts in the fields of nutrition, cardiology, epidemiology, food science, bone health, and integrative medicine examined the data on the relationship between calcium supplement use and risk of cardiovascular events, with an emphasis on 4 of the Bradford Hill criteria for causal inference: strength, consistency, dose-response, and biological plausibility. Results from 2 epidemiological studies and a meta-analysis of randomized, controlled clinical trials, including a subgroup analysis from the Women's Health Initiative, have prompted concern about a potential association between calcium supplement use and a small increase in the risk of adverse cardiovascular events. However, a number of issues with the studies, such as inadequate compliance with the intervention, use of nontrial calcium supplements, potential bias in event ascertainment, and lack of information on and adjustment for known cardiovascular risk determinants, suggest that bias and confounding cannot be excluded as explanations for the reported associations. Findings from other cohort studies also suggest no detrimental effect of calcium from diet or supplements, with or without vitamin D, on cardiovascular disease risk. In addition, little evidence exists for plausible biological mechanisms to link calcium supplement use with adverse cardiovascular outcomes. The authors do not believe that the evidence presented to date regarding the hypothesized relationship between calcium supplement use and increased cardiovascular disease risk is sufficient to warrant a change in the Institute of Medicine recommendations, which advocate use of supplements to promote optimal bone health in individuals who do not obtain recommended intakes of calcium through dietary sources.

Original languageEnglish
Pages (from-to)763-771
Number of pages9
JournalAdvances in nutrition (Bethesda, Md.)
Volume3
Issue number6
DOIs
StatePublished - Nov 2012

Fingerprint

cardiovascular diseases
Cardiovascular Diseases
Calcium
calcium
Integrative Medicine
medicine
Bone and Bones
Dietary Calcium
bones
National Academies of Science, Engineering, and Medicine (U.S.) Health and Medicine Division
Food Technology
women's health
Health
Women's Health
randomized clinical trials
Cardiology
Vitamin D
vitamin D
Meta-Analysis
Epidemiologic Studies

All Science Journal Classification (ASJC) codes

  • Food Science
  • Medicine (miscellaneous)
  • Nutrition and Dietetics
  • Medicine(all)

Cite this

Heaney, R. P., Kopecky, S., Maki, K. C., Hathcock, J., MacKay, D., & Wallace, T. C. (2012). A review of calcium supplements and cardiovascular disease risk. Advances in nutrition (Bethesda, Md.), 3(6), 763-771. https://doi.org/10.3945/an.112.002899

A review of calcium supplements and cardiovascular disease risk. / Heaney, Robert P.; Kopecky, Stephen; Maki, Kevin C.; Hathcock, John; MacKay, Douglas; Wallace, Taylor C.

In: Advances in nutrition (Bethesda, Md.), Vol. 3, No. 6, 11.2012, p. 763-771.

Research output: Contribution to journalReview article

Heaney, RP, Kopecky, S, Maki, KC, Hathcock, J, MacKay, D & Wallace, TC 2012, 'A review of calcium supplements and cardiovascular disease risk', Advances in nutrition (Bethesda, Md.), vol. 3, no. 6, pp. 763-771. https://doi.org/10.3945/an.112.002899
Heaney RP, Kopecky S, Maki KC, Hathcock J, MacKay D, Wallace TC. A review of calcium supplements and cardiovascular disease risk. Advances in nutrition (Bethesda, Md.). 2012 Nov;3(6):763-771. https://doi.org/10.3945/an.112.002899
Heaney, Robert P. ; Kopecky, Stephen ; Maki, Kevin C. ; Hathcock, John ; MacKay, Douglas ; Wallace, Taylor C. / A review of calcium supplements and cardiovascular disease risk. In: Advances in nutrition (Bethesda, Md.). 2012 ; Vol. 3, No. 6. pp. 763-771.
@article{bb958a873b434f608288f897c276dbd6,
title = "A review of calcium supplements and cardiovascular disease risk",
abstract = "A group of academic and industry experts in the fields of nutrition, cardiology, epidemiology, food science, bone health, and integrative medicine examined the data on the relationship between calcium supplement use and risk of cardiovascular events, with an emphasis on 4 of the Bradford Hill criteria for causal inference: strength, consistency, dose-response, and biological plausibility. Results from 2 epidemiological studies and a meta-analysis of randomized, controlled clinical trials, including a subgroup analysis from the Women's Health Initiative, have prompted concern about a potential association between calcium supplement use and a small increase in the risk of adverse cardiovascular events. However, a number of issues with the studies, such as inadequate compliance with the intervention, use of nontrial calcium supplements, potential bias in event ascertainment, and lack of information on and adjustment for known cardiovascular risk determinants, suggest that bias and confounding cannot be excluded as explanations for the reported associations. Findings from other cohort studies also suggest no detrimental effect of calcium from diet or supplements, with or without vitamin D, on cardiovascular disease risk. In addition, little evidence exists for plausible biological mechanisms to link calcium supplement use with adverse cardiovascular outcomes. The authors do not believe that the evidence presented to date regarding the hypothesized relationship between calcium supplement use and increased cardiovascular disease risk is sufficient to warrant a change in the Institute of Medicine recommendations, which advocate use of supplements to promote optimal bone health in individuals who do not obtain recommended intakes of calcium through dietary sources.",
author = "Heaney, {Robert P.} and Stephen Kopecky and Maki, {Kevin C.} and John Hathcock and Douglas MacKay and Wallace, {Taylor C.}",
year = "2012",
month = "11",
doi = "10.3945/an.112.002899",
language = "English",
volume = "3",
pages = "763--771",
journal = "Advances in Nutrition",
issn = "2161-8313",
publisher = "American Society for Nutrition",
number = "6",

}

TY - JOUR

T1 - A review of calcium supplements and cardiovascular disease risk

AU - Heaney, Robert P.

AU - Kopecky, Stephen

AU - Maki, Kevin C.

AU - Hathcock, John

AU - MacKay, Douglas

AU - Wallace, Taylor C.

PY - 2012/11

Y1 - 2012/11

N2 - A group of academic and industry experts in the fields of nutrition, cardiology, epidemiology, food science, bone health, and integrative medicine examined the data on the relationship between calcium supplement use and risk of cardiovascular events, with an emphasis on 4 of the Bradford Hill criteria for causal inference: strength, consistency, dose-response, and biological plausibility. Results from 2 epidemiological studies and a meta-analysis of randomized, controlled clinical trials, including a subgroup analysis from the Women's Health Initiative, have prompted concern about a potential association between calcium supplement use and a small increase in the risk of adverse cardiovascular events. However, a number of issues with the studies, such as inadequate compliance with the intervention, use of nontrial calcium supplements, potential bias in event ascertainment, and lack of information on and adjustment for known cardiovascular risk determinants, suggest that bias and confounding cannot be excluded as explanations for the reported associations. Findings from other cohort studies also suggest no detrimental effect of calcium from diet or supplements, with or without vitamin D, on cardiovascular disease risk. In addition, little evidence exists for plausible biological mechanisms to link calcium supplement use with adverse cardiovascular outcomes. The authors do not believe that the evidence presented to date regarding the hypothesized relationship between calcium supplement use and increased cardiovascular disease risk is sufficient to warrant a change in the Institute of Medicine recommendations, which advocate use of supplements to promote optimal bone health in individuals who do not obtain recommended intakes of calcium through dietary sources.

AB - A group of academic and industry experts in the fields of nutrition, cardiology, epidemiology, food science, bone health, and integrative medicine examined the data on the relationship between calcium supplement use and risk of cardiovascular events, with an emphasis on 4 of the Bradford Hill criteria for causal inference: strength, consistency, dose-response, and biological plausibility. Results from 2 epidemiological studies and a meta-analysis of randomized, controlled clinical trials, including a subgroup analysis from the Women's Health Initiative, have prompted concern about a potential association between calcium supplement use and a small increase in the risk of adverse cardiovascular events. However, a number of issues with the studies, such as inadequate compliance with the intervention, use of nontrial calcium supplements, potential bias in event ascertainment, and lack of information on and adjustment for known cardiovascular risk determinants, suggest that bias and confounding cannot be excluded as explanations for the reported associations. Findings from other cohort studies also suggest no detrimental effect of calcium from diet or supplements, with or without vitamin D, on cardiovascular disease risk. In addition, little evidence exists for plausible biological mechanisms to link calcium supplement use with adverse cardiovascular outcomes. The authors do not believe that the evidence presented to date regarding the hypothesized relationship between calcium supplement use and increased cardiovascular disease risk is sufficient to warrant a change in the Institute of Medicine recommendations, which advocate use of supplements to promote optimal bone health in individuals who do not obtain recommended intakes of calcium through dietary sources.

UR - http://www.scopus.com/inward/record.url?scp=84871896391&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84871896391&partnerID=8YFLogxK

U2 - 10.3945/an.112.002899

DO - 10.3945/an.112.002899

M3 - Review article

VL - 3

SP - 763

EP - 771

JO - Advances in Nutrition

JF - Advances in Nutrition

SN - 2161-8313

IS - 6

ER -