The effects of calcium supplementation on verified coronary heart disease hospitalization and death in postmenopausal women

A collaborative meta-Analysis of randomized controlled trials

Joshua R. Lewis, Simone Radavelli-Bagatini, Lars Rejnmark, Jian Sheng Chen, Judy M. Simpson, Joan M. Lappe, Leif Mosekilde, Ross L. Prentice, Richard L. Prince

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Abstract

Calcium supplementation, particularly with vitamin D, has been an approved public health intervention to reduce fracture risk. Enthusiasm for this intervention has been mitigated by meta-Analyses suggesting that calcium supplementation with or without vitamin D increases myocardial infarction (MI) risk; however, concern has been raised over the design of these meta-Analyses. We, therefore, undertook a meta-Analysis of randomized controlled trials with placebo or no-treatment control groups to determine if these supplements increase all-cause mortality and coronary heart disease (CHD) risk including MI, angina pectoris and acute coronary syndrome, and chronic CHD verified by clinical review, hospital record, or death certificate in elderly women. The Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE databases were searched from January 1, 1966, to May 24, 2013, for potentially eligible studies, reference lists were checked, and trial investigators were contacted where additional unpublished data were required. The search yielded 661 potentially eligible reports of which 18 met the inclusion criteria and contributed information on 63,563 participants with 3390 CHD events and 4157 deaths. Two authors extracted the data independently with trial data combined using random-effects meta-Analysis to calculate the relative risk (RR). Five trials contributed CHD events with pooled relative RR of 1.02 (95% confidence interval [CI], 0.96-1.09; p=0.51). Seventeen trials contributed all-cause mortality data with pooled RR of 0.96 (95% CI, 0.91-1.02; p=0.18). Heterogeneity among the trials was low for both primary outcomes (I2=0%). For secondary outcomes, the RR for MI was 1.08 (95% CI, 0.92-1.26; p=0.32), angina pectoris and acute coronary syndrome 1.09 (95% CI, 0.95-1.24; p=0.22) and chronic CHD 0.92 (95% CI, 0.73-1.15; p=0.46). In conclusion, current evidence does not support the hypothesis that calcium supplementation with or without vitamin D increases coronary heart disease or all-cause mortality risk in elderly women.

Original languageEnglish
Pages (from-to)165-175
Number of pages11
JournalJournal of Bone and Mineral Research
Volume30
Issue number1
DOIs
StatePublished - Jan 1 2015

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Coronary Disease
Meta-Analysis
Hospitalization
Randomized Controlled Trials
Calcium
Confidence Intervals
Vitamin D
Myocardial Infarction
Angina Pectoris
Acute Coronary Syndrome
Mortality
Death Certificates
Hospital Records
MEDLINE
Public Health
Placebos
Research Personnel
Databases
Control Groups

All Science Journal Classification (ASJC) codes

  • Orthopedics and Sports Medicine
  • Endocrinology, Diabetes and Metabolism
  • Medicine(all)

Cite this

The effects of calcium supplementation on verified coronary heart disease hospitalization and death in postmenopausal women : A collaborative meta-Analysis of randomized controlled trials. / Lewis, Joshua R.; Radavelli-Bagatini, Simone; Rejnmark, Lars; Chen, Jian Sheng; Simpson, Judy M.; Lappe, Joan M.; Mosekilde, Leif; Prentice, Ross L.; Prince, Richard L.

In: Journal of Bone and Mineral Research, Vol. 30, No. 1, 01.01.2015, p. 165-175.

Research output: Contribution to journalArticle

Lewis, Joshua R. ; Radavelli-Bagatini, Simone ; Rejnmark, Lars ; Chen, Jian Sheng ; Simpson, Judy M. ; Lappe, Joan M. ; Mosekilde, Leif ; Prentice, Ross L. ; Prince, Richard L. / The effects of calcium supplementation on verified coronary heart disease hospitalization and death in postmenopausal women : A collaborative meta-Analysis of randomized controlled trials. In: Journal of Bone and Mineral Research. 2015 ; Vol. 30, No. 1. pp. 165-175.
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abstract = "Calcium supplementation, particularly with vitamin D, has been an approved public health intervention to reduce fracture risk. Enthusiasm for this intervention has been mitigated by meta-Analyses suggesting that calcium supplementation with or without vitamin D increases myocardial infarction (MI) risk; however, concern has been raised over the design of these meta-Analyses. We, therefore, undertook a meta-Analysis of randomized controlled trials with placebo or no-treatment control groups to determine if these supplements increase all-cause mortality and coronary heart disease (CHD) risk including MI, angina pectoris and acute coronary syndrome, and chronic CHD verified by clinical review, hospital record, or death certificate in elderly women. The Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE databases were searched from January 1, 1966, to May 24, 2013, for potentially eligible studies, reference lists were checked, and trial investigators were contacted where additional unpublished data were required. The search yielded 661 potentially eligible reports of which 18 met the inclusion criteria and contributed information on 63,563 participants with 3390 CHD events and 4157 deaths. Two authors extracted the data independently with trial data combined using random-effects meta-Analysis to calculate the relative risk (RR). Five trials contributed CHD events with pooled relative RR of 1.02 (95{\%} confidence interval [CI], 0.96-1.09; p=0.51). Seventeen trials contributed all-cause mortality data with pooled RR of 0.96 (95{\%} CI, 0.91-1.02; p=0.18). Heterogeneity among the trials was low for both primary outcomes (I2=0{\%}). For secondary outcomes, the RR for MI was 1.08 (95{\%} CI, 0.92-1.26; p=0.32), angina pectoris and acute coronary syndrome 1.09 (95{\%} CI, 0.95-1.24; p=0.22) and chronic CHD 0.92 (95{\%} CI, 0.73-1.15; p=0.46). In conclusion, current evidence does not support the hypothesis that calcium supplementation with or without vitamin D increases coronary heart disease or all-cause mortality risk in elderly women.",
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