The effects of calcium supplementation on verified coronary heart disease hospitalization and death in postmenopausal women: a collaborative meta-analysis of randomized controlled trials.
Study Goal
The researchers aimed to determine whether calcium supplementation, with or without vitamin D, increases coronary heart disease risk or all-cause mortality in elderly women.
Results Summary
The meta-analysis found no significant increase in coronary heart disease events (RR 1.02) or all-cause mortality (RR 0.96) associated with calcium supplementation. Secondary outcomes, including myocardial infarction and chronic CHD, also showed no statistically significant risks.
Population
Elderly women (63,563 participants across 18 trials).
Effective Dosage
Not specified in the abstract.
Duration
Not specified in the abstract.
Interactions
None mentioned.
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
calcium supplementation, particularly with vitamin D | decrease | fracture risk | - | - | has been an approved public health intervention to reduce | #1 |
calcium supplementation with or without vitamin D | increase | myocardial infarction (MI) risk | - | - | increases | #2 |
calcium supplementation with or without vitamin D | increase | all-cause mortality | elderly women | - | increase | #3 |
calcium supplementation with or without vitamin D | increase | coronary heart disease (CHD) risk including MI, angina pectoris and acute coronary syndrome, and chronic CHD | elderly women | - | increase | #4 |
calcium supplementation with or without vitamin D | no change | CHD events | - | 1.02 (95% confidence interval [CI], 0.96-1.09; p = 0.51) | pooled relative RR of 1.02 | #5 |
calcium supplementation with or without vitamin D | no change | all-cause mortality | - | 0.96 (95% CI, 0.91-1.02; p = 0.18) | pooled RR of 0.96 | #6 |
calcium supplementation with or without vitamin D | no change | MI | - | 1.08 (95% CI, 0.92-1.26; p = 0.32) | RR of 1.08 | #7 |
calcium supplementation with or without vitamin D | no change | angina pectoris and acute coronary syndrome | - | 1.09 (95% CI, 0.95-1.24; p = 0.22) | RR of 1.09 | #8 |
calcium supplementation with or without vitamin D | no change | chronic CHD | - | 0.92 (95% CI, 0.73-1.15; p = 0.46) | RR of 0.92 | #9 |
calcium supplementation with or without vitamin D | no change | coronary heart disease | elderly women | - | does not support the hypothesis that it increases | #10 |
calcium supplementation with or without vitamin D | no change | all-cause mortality risk | elderly women | - | does not support the hypothesis that it increases | #11 |
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 (I(2) = 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.