Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the Women's Health Initiative limited access dataset and meta-analysis
Bolland MJ, Grey A, Avenell A, Gamble GD, Reid IR
BMJ (Clinical research ed.) · 555 citas
Cómo se estudió
- Diseño
- Metaanálisis (indexado por PubMed)
- Estudiado en
- Personas
- Resultado principal
- Eventos clínicos como enfermedad o muerte
Quién lo pagó
- Financiación
- Financiación independiente
- Gobierno
- Chief Scientist Office, Scottish Government Health and Social Care Directorate
- Gobierno
- Health Research Council of New Zealand
- Gobierno
- Chief Scientist Office
Según 3 financiadores declarados.
Publicación
- Publicado
- 2011-04-19 · BMJ · vol. 342 · número apr19 1 · pág. d2040
- Citado
- 848 citas · más que el 100% de estudios similares · 68.8× el promedio de su campo
- Impacto
- Entre el 10 % más citado de su campo
- Referencias
- 44 trabajos
- Acceso
- Acceso abierto (revista híbrida) · CC-BY-NC
- Áreas de investigación
- Vitamin D Research Studies · Bone health and osteoporosis research · Nutrition and Health Studies
- Palabras clave
- calcium supplements, vitamin D supplementation, cardiovascular events, myocardial infarction, stroke, coronary revascularization, coronary heart disease mortality, postmenopausal women, Women's Health Initiative, meta-analysis reanalysis, cardiovascular risk reduction, calcium intake
- MeSH
- humans, osteoporosis, postmenopausal, cardiovascular diseases, coronary disease, myocardial infarction, calcium, dietary, vitamin d, drug therapy, combination, myocardial revascularization, risk factors, dietary supplements, aged, middle aged, female, bone density conservation agents, randomized controlled trials as topic, stroke
5 autores
- Mark J Bolland🇳🇿University of Auckland
- Andrew B. Grey🇳🇿University of Auckland
- Alison Avenell🇬🇧University of Aberdeen
- Greg D. Gamble🇳🇿University of Auckland
- Ian R. Reid🇳🇿 · autor de correspondenciaUniversity of Auckland
Resumen
El texto original del estudio, en el idioma en que se publicó.
Objectives
To investigate the effects of personal calcium supplement use on cardiovascular risk in the Women's Health Initiative Calcium/Vitamin D Supplementation Study (WHI CaD Study), using the WHI dataset, and to update the recent meta-analysis of calcium supplements and cardiovascular risk.
Design
Reanalysis of WHI CaD Study limited access dataset and incorporation in meta-analysis with eight other studies. Data source WHI CaD Study, a seven year, randomised, placebo controlled trial of calcium and vitamin D (1g calcium and 400 IU vitamin D daily) in 36,282 community dwelling postmenopausal women. Main outcome measures Incidence of four cardiovascular events and their combinations (myocardial infarction, coronary revascularisation, death from coronary heart disease, and stroke) assessed with patient-level data and trial-level data.
Results
In the WHI CaD Study there was an interaction between personal use of calcium supplements and allocated calcium and vitamin D for cardiovascular events. In the 16,718 women (46%) who were not taking personal calcium supplements at randomisation the hazard ratios for cardiovascular events with calcium and vitamin D ranged from 1.13 to 1.22 (P = 0.05 for clinical myocardial infarction or stroke, P = 0.04 for clinical myocardial infarction or revascularisation), whereas in the women taking personal calcium supplements cardiovascular risk did not alter with allocation to calcium and vitamin D. In meta-analyses of three placebo controlled trials, calcium and vitamin D increased the risk of myocardial infarction (relative risk 1.21 (95% confidence interval 1.01 to 1.44), P = 0.04), stroke (1.20 (1.00 to 1.43), P = 0.05), and the composite of myocardial infarction or stroke (1.16 (1.02 to 1.32), P = 0.02). In meta-analyses of placebo controlled trials of calcium or calcium and vitamin D, complete trial-level data were available for 28,072 participants from eight trials of calcium supplements and the WHI CaD participants not taking personal calcium supplements. In total 1384 individuals had an incident myocardial infarction or stroke. Calcium or calcium and vitamin D increased the risk of myocardial infarction (relative risk 1.24 (1.07 to 1.45), P = 0.004) and the composite of myocardial infarction or stroke (1.15 (1.03 to 1.27), P = 0.009).
Conclusions
Calcium supplements with or without vitamin D modestly increase the risk of cardiovascular events, especially myocardial infarction, a finding obscured in the WHI CaD Study by the widespread use of personal calcium supplements. A reassessment of the role of calcium supplements in osteoporosis management is warranted.
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