Calcium supplementation and risk of dementia in women with cerebrovascular disease

Kern, Jürgen; Kern, Silke; Blennow, Kaj; Zetterberg, Henrik; Wærn, Margda; Guo, Xinxin; Börjesson‐Hanson, Anne; Skoog, Ingmar; Östling, Svante

doi:10.1212/wnl.0000000000003111

Cited by 41 publications

(28 citation statements)

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“…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.…”

Section: Discussionsupporting

confidence: 84%

Association of Multivitamin and Mineral Supplementation and Risk of Cardiovascular Disease

Kim

Choi

Kwon

et al. 2018

Circ: Cardiovascular Quality and Outcomes

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BACKGROUND:Multiple studies have attempted to identify the association between multivitamin/mineral (MVM) supplementation and cardiovascular disease (CVD) outcomes, but the benefits remain controversial. We performed a systematic review and meta-analysis of the associations between MVM supplementation and various CVD outcomes, including coronary heart disease (CHD) and stroke. METHODS AND RESULTS:We conducted a comprehensive search of Medline, Embase, and the Cochrane Library for studies published between January 1970 and August 2016. We included clinical trials and prospective cohort studies in the general population evaluating associations between MVM supplementation and CVD outcomes. Data extraction and quality assessment were independently conducted by 2 authors, and a third author resolved discrepancies. Eighteen studies with 2 019 862 participants and 18 363 326 person-years of follow-up were included in the analysis. Five studies specified the dose/type of MVM supplement and the rest did not. Overall, there was no association between MVM supplementation and CVD mortality (relative risk [RR], 1.00; 95% confidence interval [CI], 0.97-1.04), CHD mortality (RR, 1.02; 95% CI, 0.92-1.13), stroke mortality (RR, 0.95; 95% CI, 0.82-1.09), or stroke incidence (RR, 0.98; 95% CI, 0.91-1.05). There was no association between MVM supplements and CVD or CHD mortality in prespecified subgroups categorized by mean follow-up period, mean age, period of MVM use, sex, type of population, exclusion of patients with history of CHD, and adjustment for diet, adjustment for smoking, adjustment for physical activity, and study site. In contrast, MVM use did seem to be associated with a lower risk of CHD incidence (RR, 0.88; 95% CI, 0.79-0.97). However, this association did not remain significant in the pooled subgroup analysis of randomized controlled trials (RR, 0.97; 95% CI, 0.80-1.19). CONCLUSIONS:Our meta-analysis of clinical trials and prospective cohort studies demonstrates that MVM supplementation does not improve cardiovascular outcomes in the general population.

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Section: Discussionsupporting

confidence: 84%

Association of Multivitamin and Mineral Supplementation and Risk of Cardiovascular Disease

Kim

Choi

Kwon

et al. 2018

Circ: Cardiovascular Quality and Outcomes

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“…Experienced psychiatric research nurses performed the neuropsychiatric examinations, which comprised ratings of psychiatric symptoms and signs, and tests of mental functioning, including assessments of episodic memory (short-term, long-term memory), aphasia, apraxia, agnosia, executive functioning, and personality changes. 21 – 23 Key informant interviews were performed by psychiatric research nurses as described previously. 21 …”

Section: Methodsmentioning

confidence: 99%

Prevalence of preclinical Alzheimer disease

et al. 2018

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ObjectiveTo determine the prevalence of preclinical Alzheimer disease (AD) according to current classification systems by examining CSF from a representative general population sample of 70-year-olds from Gothenburg, Sweden.MethodThe sample was derived from the population-based H70 Gothenburg Birth Cohort Studies in Gothenburg, Sweden. The participants (n = 322, age 70 years) underwent comprehensive neuropsychiatric, cognitive, and somatic examinations. CSF levels of β-amyloid (Aβ)42, Aβ40, total tau, and phosphorylated tau were measured. Preclinical AD was classified according to criteria of the A/T/N system, Dubois 2016, National Institute on Aging–Alzheimer's Association (NIA-AA) criteria, and International Working Group-2 (IWG-2) criteria. Individuals with Clinical Dementia Rating score >0 were excluded, leaving 259 cognitively unimpaired individuals.ResultsThe prevalence of amyloid pathology was 22.8%, of total tau pathology was 33.2%, and of phosphorylated tau pathology was 6.9%. With the A/T/N system, the prevalence of A+/T−/N− was 13.1%, A+/T−/N+ was 7.3%, A+/T+/N+ was 2.3%, A−/T−/N+ was 18.9%, and A−/T+/N+ was 4.6%. When the Dubois criteria were applied, the prevalence of asymptomatic at risk for AD was 36.7% and of preclinical AD was 9.7%. With the NIA-AA criteria, the prevalence of stage 1 was 13.1% and stage 2 was 9.7%. With the IWG-2 criteria, the prevalence of asymptomatic at risk for AD was 9.7%. The APOE ε4 allele was associated with several of the categories. Men more often had total tau pathology, A+/T−/N+, preclinical AD according to Dubois 2016, asymptomatic at risk for AD according to the IWG-2 criteria, and NIA-AA stage 2.ConclusionThe prevalence of pathologic AD markers was very common (46%) in a representative population sample of 70-year-olds. The clinical implications of these findings need to be scrutinized further in longitudinal studies.

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“…In Finland, the Kuopio Osteoporosis Risk Factor and Prevention Study found that the use of calcium or calcium plus vitamin D supplementation increased the risk for coronary heart disease [multivariate adjusted HR 1.26 (95% CI 1.01-1.57)] in 10,555 women aged 52-62 years [47]. Another 5-year follow-up study in Gothenburg, Sweden, found that elderly women taking calcium supplements doubled their dementia risk [48].…”

Section: Cardiovascular Diseasementioning

confidence: 99%

Calcium in the prevention of postmenopausal osteoporosis: EMAS clinical guide

et al. 2018

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The recommended daily intake of calcium varies between 700 and 1200mg of elemental calcium, depending on the endorsing source. Although calcium can be derived either from the diet or supplements, the former source is preferred. Intake below the recommended amount may increase fragility fracture risk; however, there is no consistent evidence that calcium supplementation at, or above, recommended levels reduces risk. The addition of vitamin D may minimally reduce fractures, mainly among institutionalised people. Excessive intake of calcium, defined as higher than 2000mg/day, can be potentially harmful. Some studies demonstrated harm even at lower dosages. An increased risk for cardiovascular events, urolithiasis and even fractures has been found in association with excessive calcium intake, but this issue remains unresolved. In conclusion, an adequate intake of calcium is recommended for general bone health. Excessive calcium intake seems of no benefit, and could possibly be harmful.

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Calcium supplementation and risk of dementia in women with cerebrovascular disease

Cited by 41 publications

References 40 publications

Association of Multivitamin and Mineral Supplementation and Risk of Cardiovascular Disease

Association of Multivitamin and Mineral Supplementation and Risk of Cardiovascular Disease

Prevalence of preclinical Alzheimer disease

Calcium in the prevention of postmenopausal osteoporosis: EMAS clinical guide

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