Vitamin D, calcium, and cardiovascular mortality: a perspective from a plenary lecture given at the annual meeting of the American Association of Clinical Endocrinologists.
Study Goal
The researchers aimed to examine associations between serum 25-hydroxyvitamin D levels, calcium intake, and cardiovascular mortality, as well as their implications for clinical management.
Results Summary
The study found that excessive calcium intake may be linked to increased cardiovascular disease risk, particularly in patients with chronic kidney disease, but no solid evidence supports causality. Safe upper limits for calcium intake were noted as 2000-3000 mg daily.
Population
Patients with varying creatinine clearance levels, including those with chronic kidney disease.
Effective Dosage
Safe upper limit: 2000-3000 mg daily; suggested intake: 1200 mg daily.
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
vitamin D | neutral | proper skeletal growth (modeling) and repair (remodeling) | - | - | are needed to ensure | #1 |
calcium | neutral | proper skeletal growth (modeling) and repair (remodeling) | - | - | are needed to ensure | #2 |
Excessive consumption of either nutrient | increase | a variety of medical disorders, such as hypercalcemia or renal stones | - | - | has been linked to | #3 |
vitamin D or calcium intake | neutral | cardiovascular disease | - | - | associations between | #4 |
vitamin D or calcium intake | no change | cardiovascular risk or all-cause mortality | patients with creatinine clearances greater than 60 mL/min | - | neither of these associations have established evidence nor known causality for increasing | #5 |
excess calcium (or phosphorus) intake | increase | increase in vascular calcification | patients with more severe chronic kidney disease | - | stronger data link | #6 |
excess calcium (or phosphorus) intake | no change | mortality | patients with more severe chronic kidney disease | - | stronger data link | #7 |
serum vitamin D levels between 15 and 70 ng/mL | no change | increased cardiovascular disease risk | - | - | no solid scientific evidence validates that | #8 |
calcium supplementation greater than 500 mg daily | increase | increase in cardiovascular disease risk | - | - | stronger but inconsistent evidence shows an association between | #9 |
OBJECTIVE: To examine data showing associations between serum 25-hydroxyvitamin D levels and calcium intake and cardiovascular mortality. METHODS: The articles reviewed include those published from 1992-2011 derived from search engines (PubMed, Scopus, Medscape) using the following search terms: vitamin D, calcium, cardiovascular events, cardiovascular mortality, all-cause mortality, vascular calcification, chronic kidney disease, renal stones, and hypercalciuria. Because these articles were not weighted (graded) on the level of evidence, this review reflects my own perspective on the data and how they should be applied to clinical management. RESULTS: For skeletal health, vitamin D and calcium are both needed to ensure proper skeletal growth (modeling) and repair (remodeling). Nutritional deficiencies of either vitamin D or calcium may lead to a spectrum of metabolic bone disorders. Excessive consumption of either nutrient has been linked to a variety of medical disorders, such as hypercalcemia or renal stones. There have also been associations between vitamin D or calcium intake and cardiovascular disease. However, neither of these associations have established evidence nor known causality for increasing cardiovascular risk or all-cause mortality in patients with creatinine clearances greater than 60 mL/min. In patients with more severe chronic kidney disease, stronger data link excess calcium (or phosphorus) intake and increase in vascular calcification, but not mortality. The safe upper limit for vitamin D intake is at least 4000 IU daily and probably 10 000 IU daily; for calcium, the safe upper limit is between 2000 and 3000 mg daily. CONCLUSIONS: While no solid scientific evidence validates that serum vitamin D levels between 15 and 70 ng/mL are associated with increased cardiovascular disease risk, stronger but inconsistent evidence shows an association between calcium supplementation greater than 500 mg daily and an increase in cardiovascular disease risk. Most professional societies suggest that replacement levels of these nutrients be personalized with the goal of reaching a 25-hydroxyvitamin D concentration between 30 and 50 ng/mL and a calcium intake of 1200 mg daily.