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Calcium intake, calcium supplementation and cardiovascular disease and mortality in the British population: EPIC-norfolk prospective cohort study and meta-analysis.

European journal of epidemiology
July 1, 2021
Tiberiu A Pana et al. (11 authors)
Journal ArticleMeta-AnalysisHuman Study
Study Details

Study Goal

The researchers aimed to determine the association between calcium intake (dietary and supplemental) and cardiovascular disease incidence and mortality.

Results Summary

Moderate dietary calcium intake was associated with reduced all-cause and cardiovascular mortality, as well as fewer incident strokes. Calcium supplementation was linked to reduced mortality in women but not men.

Population

17,968 participants aged 40-79 years from the EPIC-Norfolk study.

Effective Dosage

Quintiles of calcium intake: <770 mg/day, 771-926 mg/day, 1074-1254 mg/day.

Duration

Median follow-up of 20.36 years.

Interactions

None mentioned

Extracted Claims (15)
InterventionDirectionEndpointPopulationDosageImpactClaim #
calcium intake (dietary and supplemental)
decrease
all-cause mortality
participants aged 40-79 years
HR 0.91 (0.83-0.99)
were associated with reduced
#1
calcium intake (dietary and supplemental)
decrease
all-cause mortality
participants aged 40-79 years
HR 0.85 (0.77-0.93)
were associated with reduced
#2
calcium intake (dietary and supplemental)
decrease
cardiovascular mortality
participants aged 40-79 years
HR 0.95 (0.87-1.04)
were associated with reduced
#3
calcium intake (dietary and supplemental)
decrease
cardiovascular mortality
participants aged 40-79 years
HR 0.93 (0.83-1.04)
were associated with reduced
#4
calcium intake (dietary and supplemental)
decrease
strokes
participants aged 40-79 years
HR 0.84 (0.72-0.97)
were associated with fewer incident
#5
calcium intake (dietary and supplemental)
decrease
strokes
participants aged 40-79 years
HR 0.83 (0.71-0.97)
were associated with fewer incident
#6
calcium intake (dietary and supplemental)
decrease
strokes
participants aged 40-79 years
HR 0.78 (0.66-0.92)
were associated with fewer incident
#7
calcium intake (dietary and supplemental)
no change
strokes
participants aged 40-79 years
HR 0.95 (0.78-1.15)
were associated with
#8
high levels of calcium intake
decrease
all-cause mortality
-
-
were associated with decreased
#9
high levels of calcium intake
no change
cardiovascular mortality
-
-
were associated with
#10
Calcium supplementation
increase
cardiovascular and all-cause mortality
women
-
was associated with
#11
Calcium supplementation
no change
cardiovascular and all-cause mortality
men
-
was associated with
#12
Moderate dietary calcium intake
decrease
cardiovascular and all-cause mortality
-
-
may protect against
#13
Moderate dietary calcium intake
decrease
incident stroke
-
-
may protect against
#14
Calcium supplementation
decrease
mortality
women
-
may reduce
#15
Abstract

The role of dietary calcium in cardiovascular disease prevention is unclear. We aimed to determine the association between calcium intake and incident cardiovascular disease and mortality. Data were extracted from the European Prospective Investigation of Cancer, Norfolk (EPIC-Norfolk). Multivariable Cox regressions analysed associations between calcium intake (dietary and supplemental) and cardiovascular disease (myocardial infarction, stroke, heart failure, aortic stenosis, peripheral vascular disease) and mortality (cardiovascular and all-cause). The results of this study were pooled with those from published prospective cohort studies in a meta-analsyis, stratifying by average calcium intake using a 700 mg/day threshold. A total of 17,968 participants aged 40-79 years were followed up for a median of 20.36 years (20.32-20.38). Compared to the first quintile of calcium intake (< 770 mg/day), intakes between 771 and 926 mg/day (second quintile) and 1074-1254 mg/day (fourth quintile) were associated with reduced all-cause mortality (HR 0.91 (0.83-0.99) and 0.85 (0.77-0.93), respectively) and cardiovascular mortality [HR 0.95 (0.87-1.04) and 0.93 (0.83-1.04)]. Compared to the first quintile of calcium intake, second, third, fourth, but not fifth quintiles were associated with fewer incident strokes: respective HR 0.84 (0.72-0.97), 0.83 (0.71-0.97), 0.78 (0.66-0.92) and 0.95 (0.78-1.15). The meta-analysis results suggest that high levels of calcium intake were associated with decreased all-cause mortality, but not cardiovascular mortality, regardless of average calcium intake. Calcium supplementation was associated with cardiovascular and all-cause mortality amongst women, but not men. Moderate dietary calcium intake may protect against cardiovascular and all-cause mortality and incident stroke. Calcium supplementation may reduce mortality in women.

Medical Subject Headings (MeSH)
AdultAgedAged, 80 and overCalciumCalcium, DietaryCardiovascular DiseasesCause of DeathDiet SurveysDietary SupplementsFemaleFollow-Up StudiesHumansMaleMiddle AgedProportional Hazards ModelsProspective StudiesProtective FactorsUnited Kingdom
Study Links
Quality Scores
Safety85
Efficacy75/10
Quality90/10
Citation Metrics
Total Citations29
Citations/Year7.3
Relative Citation Ratio2.90
NIH Percentile84.3%
Research Impact Scores
APT Score0.95
Weight Score2.87
Normalized Score0.82
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