Calcium Intake From Diet and Supplements and the Risk of Coronary Artery Calcification and its Progression Among Older Adults: 10‐Year Follow‐up of the Multi‐Ethnic Study of Atherosclerosis (MESA)

Abstract

BackgroundRecent randomized data suggest that calcium supplements may be associated with increased risk of cardiovascular disease (CVD) events. Using a longitudinal cohort study, we assessed the association between calcium intake, from both foods and supplements, and atherosclerosis, as measured by coronary artery calcification (CAC).Methods and ResultsWe studied 5448 adults free of clinically diagnosed CVD (52% female; aged 45–84 years) from the Multi‐Ethnic Study of Atherosclerosis. Baseline total calcium intake was assessed from diet (using a food frequency questionnaire) and calcium supplements (by a medication inventory) and categorized into quintiles. Baseline CAC was measured by computed tomography, and CAC measurements were repeated in 2742 participants ≈10 years later. At baseline, mean calcium intakes across quintiles were 313.3, 540.3, 783.0, 1168.9, and 2157.4 mg/day. Women had higher calcium intakes than men. After adjustment for potential confounders, among 1567 participants without baseline CAC, the relative risk (RR) of developing incident CAC over 10 years, by quintile 1 to 5 of calcium intake, were 1 (reference), 0.95 (0.79–1.14), 1.02 (0.85–1.23), 0.86 (0.69–1.05), and 0.73 (0.57–0.93). After accounting for total calcium intake, calcium supplement use was associated with increased risk for incident CAC (RR=1.22 [1.07–1.39]). No relation was found between baseline calcium intake and 10‐year changes in log‐transformed CAC among those participants with baseline CAC >0.ConclusionsHigh total calcium intake was associated with a decreased risk of incident atherosclerosis over long‐term follow‐up, particularly if achieved without supplement use. However, calcium supplement use may increase the risk for incident CAC.

Association of Multivitamin and Mineral Supplementation and Risk of Cardiovascular Disease

“…47,48 Furthermore, several studies demonstrated that routine vitamin and mineral supplementation in certain populations, for instance in elderly patients, could lead to a worse outcome. [49][50][51] Our finding supports the hypothesis that the net effect of MVM supplementation in the general population for CVD prevention is neutral.…”

Vitamin D and calcium intake and risk of early menopause ,

“…Importantly, because the mean age at the beginning of follow-up for these women was 51.5 y, the relation of vitamin D and calcium intakes and risk of early menopause (,45 y old) remains unclear. In addition, this study did not distinguish calcium and vitamin D from dietary compared with supplemental sources, which has proven to be an important distinction in previous studies of reproductive-related conditions and other outcomes (18,24,25).…”

Dietary Phosphorus Intake and the Kidney

“…However, concerns have been raised owing to associations between calcium supplements and an increased risk of vascular calcification and cardiovascular events (3, 15, 71). Phosphorus balance has not been studied as rigorously as calcium balance, although older metabolic studies suggest that high intakes of inorganic phosphorus additives could lead to positive phosphorus balance (46, 153).…”