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

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.

Association of dietary calcium with mortality from all causes, cardiovascular disease and cancer in people with hypertension

“…In contrast, the findings from the British population, 6 the older Chinese community‐dwelling population 7 or the US population, 9 discovered that higher calcium intake was associated with decreased mortality rate. We at first attributed the contradictory results to different forms of calcium intake, but in studies taken forms of calcium intake into consideration, some found higher dietary calcium intake was not associated with premature death, 8,9,12 while others found a statistically significant relationship with lower mortality risk 6,7,10,11 . Thus we assumed that certain characteristics of the different populations may confound the association, so herein we carried out analyses in people with hypertension from NHANES based on previous physiological evidence 13–17 .…”

“…8,12 These controversial findings may in part due to different forms of calcium intake (dietary calcium or calcium supplements) 8,12 and different populations the researchers based on. [6][7][8][9] The role of calcium in the development of hypertension and CVD like arteriosclerosis has been recognized [13][14][15][16][17] ; meanwhile, individuals with hypertension have lower calcium intake than the general population. 18 We therefore assume that calcium in the hypertensive population may have a unique effect on health compared with those without hypertension, and heterogeneity of previous studies on the association between calcium intake and mortality may be attributed to hypertension morbidity.…”

Association between Dietary Calcium and Potassium and Diabetic Retinopathy: A Cross-Sectional Retrospective Study

“…In addition, high calcium intake is suggested to be correlated with a decreased risk of incident atherosclerosis [ 31 ]. There is evidence suggesting that higher calcium intake is associated with better lipid profiles and lower blood pressure [ 32 , 33 ], which may be beneficial for cardiovascular health [ 34 ]. According to the above findings, we speculated that high dietary calcium might have an important role in improving microvascular change in patients with diabetic retinopathy.…”

Higher Lead and Lower Calcium Levels Are Associated with Increased Risk of Mortality in Malaysian Older Population: Findings from the LRGS-TUA Longitudinal Study

“…Our current findings demonstrated that lower calcium levels were associated with higher risk of mortality among community-dwelling older adults. Previously, several cohort studies and meta-analyses have demonstrated that dietary calcium intake was inversely associated with the risk of all-cause mortality [ 30 , 31 , 32 ]. Meanwhile, lower serum calcium levels (<7.9 mg/dL) during admission were associated with higher risk of in-hospital mortality among the hospitalized patients [ 33 ].…”