Long Term Calcium Intake and Rates of All Cause and Cardiovascular Mortality: Community Based Prospective Longitudinal Cohort Study

Overview

Journal BMJ

Specialty General Medicine

Date 2013 Feb 14

PMID 23403980

Citations 84

Authors

Karl Michaelsson

Hakan Melhus

Eva Warensjo Lemming

Alicja Wolk

Liisa Byberg

Affiliations

Soon will be listed here.

Abstract

Objective: To investigate the association between long term intake of dietary and supplemental calcium and death from all causes and cardiovascular disease.

Design: Prospective longitudinal cohort study.

Setting: Swedish mammography cohort, a population based cohort established in 1987-90.

Participants: 61 433 women (born between 1914 and 1948) followed-up for a median of 19 years.

Main Outcome Measures: Primary outcome measures, identified from registry data, were time to death from all causes (n=11 944) and cause specific cardiovascular disease (n=3862), ischaemic heart disease (n=1932), and stroke (n=1100). Diet was assessed by food frequency questionnaires at baseline and in 1997 for 38 984 women, and intakes of calcium were estimated. Total calcium intake was the sum of dietary and supplemental calcium.

Results: The risk patterns with dietary calcium intake were non-linear, with higher rates concentrated around the highest intakes (≥1400 mg/day). Compared with intakes between 600 and 1000 mg/day, intakes above 1400 mg/day were associated with higher death rates from all causes (hazard ratio 1.40, 95% confidence interval 1.17 to 1.67), cardiovascular disease (1 49, 1.09 to 2.02), and ischaemic heart disease (2.14, 1.48 to 3.09) but not from stroke (0.73, 0.33 to 1.65). After sensitivity analysis including marginal structural models, the higher death rate with low dietary calcium intake (<600 mg/day) or with low and high total calcium intake was no longer apparent. Use of calcium tablets (6% users; 500 mg calcium per tablet) was not on average associated with all cause or cause specific mortality but among calcium tablet users with a dietary calcium intake above 1400 mg/day the hazard ratio for all cause mortality was 2.57 (95% confidence interval 1.19 to 5.55).

Conclusion: High intakes of calcium in women are associated with higher death rates from all causes and cardiovascular disease but not from stroke.

Citing Articles

Association between serum calcium level and the risk of acute kidney injury in ICU patients with subarachnoid hemorrhage: a retrospective cohort study.

Zhao Z, Xiao K, Zhao S, Liu K, Huang F, Xiao H Front Neurol. 2024; 15:1433653.

PMID: 39726758 PMC: 11670206. DOI: 10.3389/fneur.2024.1433653.

Calcium deficiency and its implications for cardiovascular disease and cancer: Strategies for resolution via agronomic fortification.

Cheng L, Lian J, Ding Y, Wang X, Munir M, Ullah S Food Sci Nutr. 2024; 12(11):8594-8607.

PMID: 39619946 PMC: 11606831. DOI: 10.1002/fsn3.4464.

Total, dietary, and supplemental calcium intake and risk of all-cause, cardiovascular, and cancer mortality among U.S. adults: a prospective cohort study from the National Health and Nutrition Examination Survey.

Chen R, Tang Y, Fang S, Gong K, Liu D, Xie Y Arch Osteoporos. 2024; 19(1):114.

PMID: 39528775 DOI: 10.1007/s11657-024-01457-5.

Gastrointestinal surgery, malabsorptive conditions, and postoperative hypocalcemia after neck surgery.

Passman J, Ginzberg S, Gasior J, Krumeich L, Brensinger C, Bader A Surgery. 2024; 177:108905.

PMID: 39472261 PMC: 11649444. DOI: 10.1016/j.surg.2024.08.057.

The essential role of combined calcium and vitamin D supplementation in the osteoporosis scenario in italy: Expert opinion paper.

Carugo S, Vescini F, Giusti A, Letizia Mauro G, Tafaro L, Festuccia F Arch Osteoporos. 2024; 19(1):99.

PMID: 39438361 PMC: 11496317. DOI: 10.1007/s11657-024-01451-x.

References

Ross A, Manson J, Abrams S, Aloia J, Brannon P, Clinton S . The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab. 2010; 96(1):53-8. PMC: 3046611. DOI: 10.1210/jc.2010-2704. View

Rautiainen S, Akesson A, Levitan E, Morgenstern R, Mittleman M, Wolk A . Multivitamin use and the risk of myocardial infarction: a population-based cohort of Swedish women. Am J Clin Nutr. 2010; 92(5):1251-6. DOI: 10.3945/ajcn.2010.29371. View

Iso H, Stampfer M, Manson J, Rexrode K, Hennekens C, Colditz G . Prospective study of calcium, potassium, and magnesium intake and risk of stroke in women. Stroke. 1999; 30(9):1772-9. DOI: 10.1161/01.str.30.9.1772. View

Mirza M, Larsson A, Melhus H, Lind L, Larsson T . Serum intact FGF23 associate with left ventricular mass, hypertrophy and geometry in an elderly population. Atherosclerosis. 2009; 207(2):546-51. DOI: 10.1016/j.atherosclerosis.2009.05.013. View

Hu F, Stampfer M, Rimm E, Ascherio A, Rosner B, Spiegelman D . Dietary fat and coronary heart disease: a comparison of approaches for adjusting for total energy intake and modeling repeated dietary measurements. Am J Epidemiol. 1999; 149(6):531-40. DOI: 10.1093/oxfordjournals.aje.a009849. View

Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi J . Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005; 43(11):1130-9. DOI: 10.1097/01.mlr.0000182534.19832.83. View

Bolland M, Avenell A, Baron J, Grey A, MacLennan G, Gamble G . Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ. 2010; 341:c3691. PMC: 2912459. DOI: 10.1136/bmj.c3691. View

Mangano K, Walsh S, Insogna K, Kenny A, Kerstetter J . Calcium intake in the United States from dietary and supplemental sources across adult age groups: new estimates from the National Health and Nutrition Examination Survey 2003-2006. J Am Diet Assoc. 2011; 111(5):687-95. PMC: 3896234. DOI: 10.1016/j.jada.2011.02.014. View

Messerer M, Johansson S, Wolk A . The validity of questionnaire-based micronutrient intake estimates is increased by including dietary supplement use in Swedish men. J Nutr. 2004; 134(7):1800-5. DOI: 10.1093/jn/134.7.1800. View

10.

Bostick R, Kushi L, Wu Y, Meyer K, Sellers T, Folsom A . Relation of calcium, vitamin D, and dairy food intake to ischemic heart disease mortality among postmenopausal women. Am J Epidemiol. 1999; 149(2):151-61. DOI: 10.1093/oxfordjournals.aje.a009781. View

11.

Gahche J, Bailey R, Burt V, Hughes J, Yetley E, Dwyer J . Dietary supplement use among U.S. adults has increased since NHANES III (1988-1994). NCHS Data Brief. 2011; (61):1-8. View

12.

Warensjo E, Byberg L, Melhus H, Gedeborg R, Mallmin H, Wolk A . Dietary calcium intake and risk of fracture and osteoporosis: prospective longitudinal cohort study. BMJ. 2011; 342:d1473. PMC: 3101331. DOI: 10.1136/bmj.d1473. View

13.

Larsson S, Virtamo J, Wolk A . Potassium, calcium, and magnesium intakes and risk of stroke in women. Am J Epidemiol. 2011; 174(1):35-43. DOI: 10.1093/aje/kwr051. View

14.

Snellman G, Melhus H, Gedeborg R, Olofsson S, Wolk A, Pedersen N . Seasonal genetic influence on serum 25-hydroxyvitamin D levels: a twin study. PLoS One. 2009; 4(11):e7747. PMC: 2774516. DOI: 10.1371/journal.pone.0007747. View

15.

Peiris A, Youssef D, Grant W . Secondary hyperparathyroidism: benign bystander or culpable contributor to adverse health outcomes?. South Med J. 2011; 105(1):36-42. DOI: 10.1097/SMJ.0b013e31823c4155. View

16.

Larsson S, Bergkvist L, Wolk A . Long-term meat intake and risk of breast cancer by oestrogen and progesterone receptor status in a cohort of Swedish women. Eur J Cancer. 2009; 45(17):3042-6. DOI: 10.1016/j.ejca.2009.04.035. View

17.

Cashman K . Diet, nutrition, and bone health. J Nutr. 2007; 137(11 Suppl):2507S-2512S. DOI: 10.1093/jn/137.11.2507S. View

18.

Kaaks R, Ferrari P, Ciampi A, Plummer M, Riboli E . Uses and limitations of statistical accounting for random error correlations, in the validation of dietary questionnaire assessments. Public Health Nutr. 2003; 5(6A):969-76. DOI: 10.1079/phn2002380. View

19.

Lin D . Non-parametric inference for cumulative incidence functions in competing risks studies. Stat Med. 1997; 16(8):901-10. DOI: 10.1002/(sici)1097-0258(19970430)16:8<901::aid-sim543>3.0.co;2-m. View

20.

Mursu J, Robien K, Harnack L, Park K, Jacobs Jr D . Dietary supplements and mortality rate in older women: the Iowa Women's Health Study. Arch Intern Med. 2011; 171(18):1625-33. PMC: 4114071. DOI: 10.1001/archinternmed.2011.445. View