Calcium/Vitamin D Supplementation and Cardiovascular Events

TLDR

Individuals with vascular or valvular calcification face higher coronary event risk, yet the impact of calcium intake on cardiovascular outcomes remains unclear. The study assessed whether calcium plus vitamin D supplementation affects coronary and cerebrovascular event risk in postmenopausal women. In a double‑blind RCT, 36,282 postmenopausal women were assigned to calcium carbonate 500 mg with vitamin D 200 IU twice daily or placebo, with cardiovascular disease as a prespecified secondary outcome. Over seven years, calcium/vitamin D supplementation neither raised nor lowered myocardial infarction, coronary heart disease death, or stroke risk (HRs 1.04 and 0.95, 95 % CI 0.92–1.18 and 0.82–1.10), and higher baseline calcium intake did not modify these outcomes.

Abstract

Background— Individuals with vascular or valvular calcification are at increased risk for coronary events, but the relationship between calcium consumption and cardiovascular events is uncertain. We evaluated the risk of coronary and cerebrovascular events in the Women’s Health Initiative randomized trial of calcium plus vitamin D supplementation. Methods and Results— We randomized 36 282 postmenopausal women 50 to 79 years of age at 40 clinical sites to calcium carbonate 500 mg with vitamin D 200 IU twice daily or to placebo. Cardiovascular disease was a prespecified secondary efficacy outcome. During 7 years of follow-up, myocardial infarction or coronary heart disease death was confirmed for 499 women assigned to calcium/vitamin D and 475 women assigned to placebo (hazard ratio, 1.04; 95% confidence interval, 0.92 to 1.18). Stroke was confirmed among 362 women assigned to calcium/vitamin D and 377 assigned to placebo (hazard ratio, 0.95; 95% confidence interval, 0.82 to 1.10). In subgroup analyses, women with higher total calcium intake (diet plus supplements) at baseline were not at higher risk for coronary events ( P =0.91 for interaction) or stroke ( P =0.14 for interaction) if assigned to active calcium/vitamin D. Conclusions— Calcium/vitamin D supplementation neither increased nor decreased coronary or cerebrovascular risk in generally healthy postmenopausal women over a 7-year use period.