Calcium Intake, Calcium Supplementation and Cardiovascular Disease and Mortality in the British Population: EPIC-Norfolk Prospective Cohort study and Meta-Analysis

Tiberiu Pana, Mohsen Dehghani, Hamid Baradaran, Samuel R. Neal, Adrian Wood, Chun Shing Kwok, Yoon Kong Loke, Robert N Luben, Mamas A Mamas, Kay-Tee Khaw, Phyo K Myint* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

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.
Original languageEnglish
Pages (from-to)669-683
Number of pages15
JournalEuropean Journal of Epidemiology
Volume36
Issue number7
Early online date31 Dec 2020
DOIs
Publication statusPublished - 31 Jul 2021

Keywords

  • Dietary calcium
  • calcium supplements
  • Cardiovascular Disease
  • Systematic Review
  • meta-analysis
  • mortality

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