TY - JOUR
T1 - Calcium Intake, Calcium Supplementation and Cardiovascular Disease and Mortality in the British Population
T2 - EPIC-Norfolk Prospective Cohort study and Meta-Analysis
AU - Pana, Tiberiu
AU - Dehghani, Mohsen
AU - Baradaran, Hamid
AU - Neal, Samuel R.
AU - Wood, Adrian
AU - Kwok, Chun Shing
AU - Loke, Yoon Kong
AU - Luben, Robert N
AU - Mamas, Mamas A
AU - Khaw, Kay-Tee
AU - Myint, Phyo K
N1 - Open Access via the Springer Compact Agreement
Acknowledgements: We are grateful to all the participants who have been part of the project and to the many members of the study teams at the University of Cambridge who have enabled this research. We would also like to acknowledge the principal investigators and staff of the EPIC-Norfolk study. The EPIC-Norfolk study (DOI 10.22025/2019.10.105.00004) has received funding from the Medical Research Council (MR/N003284/1 and MC-UU_12015/1) and Cancer Research UK (C864/A14136).
PY - 2021/7/31
Y1 - 2021/7/31
N2 - Background: The role of dietary calcium in cardiovascular disease prevention is unclear.Objective: To determine the association between calcium intake and incident cardiovascular disease and mortality.Methods: Data were extracted from the European Prospective Investigation of Cancer, Norfolk (EPIC-Norfolk). Multivariable Cox regressions analysed associations between calcium intake (dietary and supplemental) and cardiovascular disease (myocardial infarction, stroke, heart failure, aortic stenosis, peripheral vascular disease) and mortality (cardiovascular and all-cause). The results of this study were pooled with those from published prospective cohort studies in a meta-analsyis, stratifying by average calcium intake using a 700 mg/day threshold.Results: A total of 17,968 participants aged 40-79 years were followed up for a median of 20.36 years (20.32-20.38). Compared to the first quintile of calcium intake (<770 mg/day), intakes between 771-926 mg/day (second quintile) and 1074-1254 mg/day (fourth quintile) were associated with reduced all-cause mortality (HR 0.91 (0.83-0.99) and 0.85 (0.77-0.93), respectively) and cardiovascular mortality (HR 0.95 (0.87-1.04) and 0.93 (0.83-1.04)).17 Compared to the first quintile of calcium intake, second, third, fourth, but not fifth quintiles were associated with fewer incident strokes: respective HR 0.84 (0.72-0.97), 0.83 (0.71- 0.97), 0.78 (0.66-0.92) and 0.95 (0.78-1.15). The meta-analysis results suggest that high levels of calcium intake were associated with decreased all-cause mortality, but not cardiovascular mortality regardless of average calcium intake. Calcium supplementation wasassociated with cardiovascular and all-cause mortality amongst women, but not men. Conclusions: Moderate dietary calcium intake may protect against cardiovascular and all cause mortality and incident stroke. Calcium supplementation may reduce mortality in women.
AB - Background: The role of dietary calcium in cardiovascular disease prevention is unclear.Objective: To determine the association between calcium intake and incident cardiovascular disease and mortality.Methods: Data were extracted from the European Prospective Investigation of Cancer, Norfolk (EPIC-Norfolk). Multivariable Cox regressions analysed associations between calcium intake (dietary and supplemental) and cardiovascular disease (myocardial infarction, stroke, heart failure, aortic stenosis, peripheral vascular disease) and mortality (cardiovascular and all-cause). The results of this study were pooled with those from published prospective cohort studies in a meta-analsyis, stratifying by average calcium intake using a 700 mg/day threshold.Results: A total of 17,968 participants aged 40-79 years were followed up for a median of 20.36 years (20.32-20.38). Compared to the first quintile of calcium intake (<770 mg/day), intakes between 771-926 mg/day (second quintile) and 1074-1254 mg/day (fourth quintile) were associated with reduced all-cause mortality (HR 0.91 (0.83-0.99) and 0.85 (0.77-0.93), respectively) and cardiovascular mortality (HR 0.95 (0.87-1.04) and 0.93 (0.83-1.04)).17 Compared to the first quintile of calcium intake, second, third, fourth, but not fifth quintiles were associated with fewer incident strokes: respective HR 0.84 (0.72-0.97), 0.83 (0.71- 0.97), 0.78 (0.66-0.92) and 0.95 (0.78-1.15). The meta-analysis results suggest that high levels of calcium intake were associated with decreased all-cause mortality, but not cardiovascular mortality regardless of average calcium intake. Calcium supplementation wasassociated with cardiovascular and all-cause mortality amongst women, but not men. Conclusions: Moderate dietary calcium intake may protect against cardiovascular and all cause mortality and incident stroke. Calcium supplementation may reduce mortality in women.
KW - Dietary calcium
KW - calcium supplements
KW - Cardiovascular Disease
KW - Systematic Review
KW - meta-analysis
KW - mortality
UR - http://www.scopus.com/inward/record.url?scp=85098499706&partnerID=8YFLogxK
U2 - 10.1007/s10654-020-00710-8
DO - 10.1007/s10654-020-00710-8
M3 - Article
VL - 36
SP - 669
EP - 683
JO - European Journal of Epidemiology
JF - European Journal of Epidemiology
SN - 0393-2990
IS - 7
ER -
