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Back to Cardiovascular Disease

Calcium Supplements in Cardiovascular Health

Several meta-analyses have investigated the effect of calcium supplements on the risk of cardiovascular disease, but the evidence is inconclusive. While some studies have found that calcium supplements may increase the risk of cardiovascular disease, this has not been observed in several more recent studies.

While calcium supplements may lead to small reductions in fracture risk, they may also increase cardiovascular risk. However, calcium from food sources has not been associated with adverse cardiovascular effects and may be preferable.1 As well, the evidence related to milk products indicates that they may reduce the risk of cardiovascular disease.2

Osteoporosis Canada recommends that people get their calcium from food sources.3 If this is not possible, people are encouraged to talk to their physicians about calcium supplements.

A closer look at the evidence

Evidence suggesting calcium supplements do not increase cardiovascular disease risk

  • A 2015 meta-analysis of 18 randomized controlled trials concluded that “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.”4
  • As well, the lack of association was supported by a systematic review of five trials.5
  • Another meta-analysis, published in 2012, showed that the use of calcium supplements was not significantly associated with an increase in cardiovascular disease risk.6
  • A prospective cohort study of 74,245 women from the Nurses’ Health Study observed that a greater intake of calcium supplements (>1,000 mg/day) was associated with an 18% reduced risk of cardiovascular disease.7 In fact, a decreased risk was observed for coronary heart disease, especially non-fatal coronary heart disease with a risk reduction of 23%.

Evidence suggesting that calcium supplements are associated with an increased risk of cardiovascular disease

  • A previous meta-analysis by Bolland et al. showed an association between calcium supplements and an increased risk of myocardial infarction.8 In a subsequent 2011 meta-analysis, which included the Women’s Health Initiative Calcium/Vitamin D Supplementation Study, it was found that calcium supplements with or without vitamin D modestly increased the risk of cardiovascular events.9
  • Three prospective studies suggest an association between calcium supplements and increased risk of cardiovascular disease.
    • Among the 388,229 participants of the NIH-AARP Diet and Health Study, it was found that for men (but not women) calcium intake from supplements was associated with an increased risk of cardiovascular mortality.10 Conversely, dietary calcium intake was not associated with mortality from cardiovascular disease for both men and women.
    • Another study of 81,433 women in the Swedish mammography cohort observed that total calcium intakes of ≥1,400 mg/day (including dietary calcium and calcium supplements) were associated with a 40% increase in all-cause mortality rates, as well as a 51% increase in cardiovascular mortality. The study included a 19-year follow-up. Dietary calcium was not associated with all-cause mortality.11
    • The Heidelberg cohort of the EPIC study also found that users of calcium supplements had an increased risk of myocardial infarction.12  

Why calcium supplements may increase cardiovascular disease risk

Ingesting of calcium supplements may acutely increase serum calcium. Elevated serum calcium levels have been associated with increased carotid plaque thickness, increased likelihood of abdominal aortic calcification, increased cardiovascular risk and increased mortality.13

Nonetheless, several other studies have also shown calcium supplementation to have a beneficial effect on cardiovascular health.14

This research overview suggests more research is needed:

  • on the effect of calcium supplements on vascular health;
  • on different population groups to adequately evaluate any possible risks that calcium supplements may have on cardiovascular events; and
  • to clarify the mechanisms by which calcium supplements impact cardiovascular health.

Conclusion

The evidence that calcium supplements may increase cardiovascular disease risk is inconclusive. There do not appear to be any adverse effects with the recommended amounts of dietary calcium or milk products. 

References

  1. Reid IR et al. Cardiovascular effects of calcium supplementation. Osteoporos Int 2011;22:1649-1658.
  2. Rice BH. Dairy and cardiovascular disease: a review of recent observational research. Curr Nutr Rep 2014;3:130-138.
  3. Osteoporosis Canada. 2015. How Do I Know if I Need a Calcium Supplement. www.osteoporosis.ca. Accessed October 28, 2015.
  4. Lewis JR et al. The effects of calcium supplementation on verified coronary heart disease hospitalization and death in postmenopausal women: a collaborative meta-analysis of randomized controlled trials. J Bone Miner Res 2015;30:165-175.
  5. Fortmann SP et al. Vitamin and mineral supplements in the primary prevention of cardiovascular disease and cancer: an updated systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med 2013;159:824-834.
  6. Wang L et al. Calcium intake and risk of cardiovascular disease: a review of prospective studies and randomized clinical trials. Am J Cardiovasc Drugs 2012;12:105-116.
  7. Paik JM et al. Calcium supplement intake and risk of cardiovascular disease in women. Osteoporos Int 2014;25:2047-2056.
  8. Bolland MJ et al. Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ 2010;341:c3691.
  9. Bolland MJ et al. Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the Women's Health Initiative limited access dataset and meta-analysis. BMJ 2011;342:d2040.
  10. Xiao Q et al. Dietary and supplemental calcium intake and cardiovascular disease mortality: the National Institutes of Health-AARP diet and health study. JAMA Intern Med 2013;173:639-646.
  11. Michaëlsson K et al. Long term calcium intake and rates of all cause and cardiovascular mortality: community based prospective longitudinal cohort study. BMJ 2013;346:f228.
  12. Li K et al. Associations of dietary calcium intake and calcium supplementation with myocardial infarction and stroke risk and overall cardiovascular mortality in the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition study (EPIC-Heidelberg). Heart 2012;98:920-925.
  13. Reid IR et al. Calcium supplementation: balancing the cardiovascular risks. Maturitas 2011;69:289-295.
  14. Guessous I et al. Calcium, vitamin D and cardiovascular disease. Kidney Blood Press Res 2011;34:404-417.

Keywords: calcium supplements , cardiovascular disease , calcium


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